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Good surgical outcome in discordant ictal EEG-MRI unilateral mesial temporal sclerosis patients

CASTRO, Luiz H.; SERPA, Mauricio H.; VALERIO, Rosa M.; JORGE, Carmen L.; ONO, Carla R.; ARANTES, Paula R.; ROSEMBERG, Sergio; WEN, Hung Tzu
Fonte: BLACKWELL PUBLISHING Publicador: BLACKWELL PUBLISHING
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
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Purpose:Video electroencephalography (vEEG) monitoring of patients with unilateral mesial temporal sclerosis (uMTS) may show concordant or discordant seizure onset in relation to magnetic resonance imaging (MRI) evidence of MTS. Contralateral seizure usually leads to an indication of invasive monitoring. Contralateral seizure onset on invasive monitoring may contraindicate surgery. We evaluated long-term outcome after anteromesial temporal lobectomy (AMTL) in a consecutive series of uMTS patients with concordant and discordant vEEG findings, uniformly submitted to AMTL on the MRI evidence of MTS side without invasive monitoring. Methods:We compared surgical outcome of all uMTS patients undergoing vEEG monitoring between January 1999 and April 2005 in our service. Discordant cases were defined by at least one seizure onset contralateral to the MRI evidence of MTS. Good surgical outcome was considered as Engel`s class I. We also evaluated ictal SPECT concordance to ictal EEG and surgical outcome. Results:Fifty-four patients had concordant (C) and 22 had discordant (D) scalp EEG and MRI. Surgical outcome was similar in both groups (C = 74% versus D = 86%). Duration of follow-up was comparable in both groups: C = 56.1 +/- 20.7 months versus D = 59.8 +/- 21.2 months (p = 0.83...

Towards global consensus on outcome measures for atopic eczema research: results of the HOME II meeting

Schmitt, Jochen; Spuls, Phyllis; Boers, Maarten; Thomas, Kim; Chalmers, Joanne; Roekevisch, Evelien; Schram, Mandy; Allsopp, Richard; Aoki, Valeria; Apfelbacher, Christian; Bruijnzeel-Koomen, Carla; Bruin-Weller, Marjolein; Charman, Carolyn; Cohen, Arnon;
Fonte: WILEY-BLACKWELL; HOBOKEN Publicador: WILEY-BLACKWELL; HOBOKEN
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
36.3%
The use of nonstandardized and inadequately validated outcome measures in atopic eczema trials is a major obstacle to practising evidence-based dermatology. The Harmonising Outcome Measures for Eczema (HOME) initiative is an international multiprofessional group dedicated to atopic eczema outcomes research. In June 2011, the HOME initiative conducted a consensus study involving 43 individuals from 10 countries, representing different stakeholders (patients, clinicians, methodologists, pharmaceutical industry) to determine core outcome domains for atopic eczema trials, to define quality criteria for atopic eczema outcome measures and to prioritize topics for atopic eczema outcomes research. Delegates were given evidence-based information, followed by structured group discussion and anonymous consensus voting. Consensus was achieved to include clinical signs, symptoms, long-term control of flares and quality of life into the core set of outcome domains for atopic eczema trials. The HOME initiative strongly recommends including and reporting these core outcome domains as primary or secondary endpoints in all future atopic eczema trials. Measures of these core outcome domains need to be valid, sensitive to change and feasible. Prioritized topics of the HOME initiative are the identification/development of the most appropriate instruments for the four core outcome domains. HOME is open to anyone with an interest in atopic eczema outcomes research.; National Institute for Health Research (NIHR); National Institute for Health Research (NIHR) [RP-PG-0407-10177]

Independent predictors and a prognostic model for surgical outcome in refractory frontal lobe epilepsy

Pinheiro-Martins, Ana P.; Bianchin, Marino M.; Velasco, Tonicarlo R.; Terra, Vera C.; Araujo, David, Jr.; Wichert-Ana, Lauro; Assirati, Joao A., Jr.; Machado, Hello R.; Carlotti, Carlos G., Jr.; Sakamoto, Americo C.
Fonte: ELSEVIER SCIENCE BV; AMSTERDAM Publicador: ELSEVIER SCIENCE BV; AMSTERDAM
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
36.3%
Purpose: Refractory frontal lobe epilepsy (FLE) remains one of the most challenging surgically remediable epilepsy syndromes. Nevertheless, definition of independent predictors and predictive models of postsurgical seizure outcome remains poorly explored in FLE. Methods: We retrospectively analyzed data from 70 consecutive patients with refractory FLE submitted to surgical treatment at our center from July 1994 to December 2006. Univariate results were submitted to logistic regression models and Cox proportional hazards regression to identify isolated risk factors for poor surgical results and to construct predictive models for surgical outcome in FLE. Results: From 70 patients submitted to surgery, 45 patients (64%) had favorable outcome and 37 (47%) became seizure free. Isolated risk factors for poor surgical outcome are expressed in hazard ratio (H.R.) and were time of epilepsy (H.R.=4.2; 95% C.I.=.1.5-11.7; p=0.006), ictal EEG recruiting rhythm (H.R. = 2.9; 95% C.I. = 1.1-7.7; p=0.033); normal MRI (H.R. = 4.8; 95% C.I. = 1.4-16.6; p = 0.012), and MRI with lesion involving eloquent cortex (H.R. = 3.8; 95% C.I. = 1.2-12.0; p = 0.021). Based on these variables and using a logistic regression model we constructed a model that correctly predicted long-term surgical outcome in up to 80% of patients. Conclusion: Among independent risk factors for postsurgical seizure outcome...

What comprises a good outcome in spinal surgery? a preliminary survey among spine surgeons of the SSE and European spine patients

Haefeli, M.; Elfering, A.; Aebi, M.; Freeman, B.; Fritzell, P.; Consciencia, J.; Lamartina, C.; Mayer, M.; Lund, T.; Boos, N.
Fonte: Springer Publicador: Springer
Tipo: Artigo de Revista Científica
Publicado em //2008 EN
Relevância na Pesquisa
36.32%
Standardized and validated self-administered outcome-instruments are broadly used in spinal surgery. Despite a plethora of articles on outcome research, no systematic evaluation is available on what actually comprises a good outcome in spinal surgery from the patients’ and surgeons’ perspective, respectively. However, this is a prerequisite for improving outcome instruments. In performing a cross-sectional survey among spine patients from different European regions and spine surgeons of the SSE, the study attempted (1) to identify the most important domains determining a good outcome from a patients’ as well as a surgeon’s perspective, and (2) to explore regional differences in the identified domains. For this purpose, a structured interview was performed among 30 spine surgeons of the SSE and 353 spine surgery patients (representing Northern, Central and Southern Europe) to investigate their criteria for a good outcome. A qualitative and descriptive approach was used to evaluate the data. Results revealed a high agreement on what comprises a good outcome among surgeons and patients, respectively. The main parameters determining good outcome were achieving the patients’ expectations/satisfaction, pain relief, improvement of disability and social reintegration. Younger patients more often expected a complete pain relief...

Cilial entropion: Surgical outcome with a new modification of the Hotz procedure

Kakizaki, H.; Selva-Nayagam, D.; Leibovitch, I.
Fonte: Elsevier Science Inc Publicador: Elsevier Science Inc
Tipo: Artigo de Revista Científica
Publicado em //2009 EN
Relevância na Pesquisa
36.3%
PURPOSE: To report the surgical outcome with a new modification of the Hotz procedure for cilial entropion repair. DESIGN: Retrospective case series. PARTICIPANTS: Forty-nine lower eyelids of 29 patients (22 female, 7 male; average age 8.4 years, range 2-27 years). METHODS: The study included all patients diagnosed with cilial entropion and significant ocular irritation causing epiphora, photophobia, and ocular discharge, with or without keratitis. Surgery is based on dividing the anterior layer of the lower eyelid retractors from the anterior tarsal plate surface, definite identification of the inferior tarsal plate border, and reinforcement of the skin to the tarsal plate and lower eyelid retractors. Surgical outcome was defined as "good" or "fair" when there was no contact between the eyelashes and the globe or when less than 5 asymptomatic eyelashes had direct contact with the globe, respectively. A "poor" outcome was defined as either the majority of eyelashes remained in contact with the globe or persistence of irritation/keratitis in the presence of residual in-turned eyelashes. A successful outcome ("good" or "fair") required no additional surgical intervention. MAIN OUTCOME MEASURES: Surgical outcome ("good," "fair," or "poor")...

Impact of gender and age on the long-term outcome of laparoscopic fundoplication

Beck, P.; Watson, D.; Devitt, P.; Game, P.; Jamieson, G.
Fonte: Springer Publicador: Springer
Tipo: Artigo de Revista Científica
Publicado em //2009 EN
Relevância na Pesquisa
36.29%
Background: It has been suggested that gender and age could be factors that influence the likelihood of success following antireflux surgery, and our anecdotal impression has been that the outcome following Nissen fundoplication in older women is often disappointing. If correct, characterization of the extent of any differences in outcome might help patient selection and, hence, surgical outcomes. Therefore, in this study we investigated the impact of gender and age on longer-term clinical outcomes following laparoscopic fundoplication. Methods: Perioperative and follow-up data from patients undergoing laparoscopic fundoplication in our departments have been collected prospectively and stored in a database. From the database, patients who had undergone either an anterior 180° partial or 360° total laparoscopic fundoplication for gastroesophageal reflux and completed 5 years clinical follow-up were identified. Patients were classified according to gender and age, and outcome data were analyzed to determine differences. Analog scales of 0–10 were used to determine symptoms of heartburn and dysphagia and overall satisfaction. Results: Seven hundred three patients were studied (58% males). Females were less satisfied with the outcome (score = 7.8 ± 2.8 vs. 8.4 ± 2.5...

The impact of pharmacological treatments on outcome after adult traumatic brain injury: what does the research show?

Wheaton, Patricia
Fonte: Universidade de Adelaide Publicador: Universidade de Adelaide
Tipo: Tese de Doutorado
Publicado em //2011
Relevância na Pesquisa
36.3%
A traumatic brain injury (TBI) can cause immediate and delayed damage to the brain producing long-term cognitive and behavioural problems. Young people in the early stages of a productive life are at most risk of sustaining a TBI making these persistent problems of major personal and social importance. Post-TBI rehabilitation provides one possible strategy for improving outcome following injury. Pharmacological treatments, on the other hand, have the potential to either minimise the amount of damage that the brain sustains following TBI, thereby improving outcome, or reduce persistent biochemical disruptions that are associated with poorer outcome. However, research in this area has shown mixed results hampering advances in the treatment of this condition. This thesis will, therefore, synthesise the findings from pre-clinical and clinical research that has examined the effects of pharmacological treatments on cognitive and behavioural outcome following adult TBI. A large number of the pharmacological agents have been investigated in pre-clinical experimental research with rodents making it difficult to consolidate the findings. Therefore, the first study meta-analysed the data from 223 pre-clinical studies that examined 91 pharmacological treatments in adult male rodents (rats...

Ethnic disparities in the risk of adverse neonatal outcome after spontaneous preterm birth

Schaaf, J.; Mol, B.; Abu-Hanna, A.; Ravelli, A.
Fonte: John Wiley Publicador: John Wiley
Tipo: Artigo de Revista Científica
Publicado em //2012 EN
Relevância na Pesquisa
36.3%
Objective. To describe ethnic disparities in the risk of spontaneous preterm birth and related adverse neonatal outcome. Design. Nationwide prospective cohort study. Setting. The Netherlands, 1999–2007. Population. Nine hundred and sixty-nine thousand, four hundred and ninety-one singleton pregnancies with a spontaneous onset of labor. Methods. We investigated ethnic disparities in perinatal outcome for European white, African, South-Asian, Mediterranean and East-Asian women. We performed multivariate logistic regression analyses to calculate the adjusted odds ratio (aOR) and confidence intervals (CIs) of spontaneous preterm birth and the risk of subsequent neonatal morbidity and mortality. Main outcome measures. The primary outcome measure was spontaneous preterm birth before 37 completed weeks of gestation. Secondarily, we investigated subsequent adverse neonatal outcome, which was a composite outcome of intraventricular hemorrhage, bronchopulmonary dysplasia, infant respiratory distress syndrome, neonatal sepsis or neonatal mortality within 28 days after birth. Results. Compared with European whites, the aOR of delivering preterm was 1.33 (95% CI 1.26–1.41) for African women, 1.58 (95% CI 1.47–1.69) for South-Asians, 0.88 (95% CI 0.84–0.91) for Mediterraneans and 1.04 (95% CI 0.98–1.11) for East-Asians. Subsequent odds of adverse neonatal outcome were significantly lower for African (aOR 0.51; 95% CI 0.41–0.64) and Mediterranean women (aOR 0.86; 95% CI 0.75–0.99) when compared with European whites. Conclusions. African and South-Asian women are at higher risk for preterm birth than European white women. However...

Association of TGFβ1 and clinical factors with scar outcome following melanoma excision; Association of TGFbeta1 and clinical factors with scar outcome following melanoma excision

Ward, S.; Cadby, G.; Heyworth, J.; Fear, M.; Wallace, H.; Cole, J.; Wood, F.; Palmer, L.
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
Publicado em //2012 EN
Relevância na Pesquisa
36.32%
All patients with primary cutaneous malignant melanoma undergo surgical excision to remove the tumour, resulting in scar formation. There is marked variation in the aesthetic appearance of scars following surgery but limited knowledge about the genetic factors affecting non-keloid, surgical scar outcomes. This study aimed to investigate the role of known clinical factors and genetic polymorphisms in pigmentation and wound repair genes in non-keloid scar outcome, following melanoma excision. Participants were 202 cases who underwent a standardized scar assessment following surgical melanoma excision and provided a DNA sample. Genetic association analyses between single nucleotide polymorphisms (SNPs) from 24 candidate genes and scar outcome data were performed, controlling for relevant clinical factors. Following adjustment for multiple testing, SNP rs8110090 in TGFβ1 was significantly associated with both the primary scar outcome (a combination score reflecting vascularity, height and pliability, p = 0.0002, q = 0.01) and the secondary scar outcome (a combination score reflecting vascularity, height, pliability and pigmentation, p = 0.0002, q = 0.006). The minor allele G was associated with a poorer scar outcome. Younger age, time elapsed since excision...

Indices affecting outcome of neglected femoral neck fractures after valgus intertrochanteric osteotomy

Varghese, V.; Ramasamy, B.; Titus, V.; Oommen, A.; Jepegnanam, T.
Fonte: Lippincott Williams & Wilkins Publicador: Lippincott Williams & Wilkins
Tipo: Artigo de Revista Científica
Publicado em //2014 EN
Relevância na Pesquisa
36.29%
Objectives: To evaluate preoperative neck resorption and postoperative valgus orientation as predictors of union and functional outcome after valgus intertrochanteric osteotomy for treatment of neglected femoral neck fractures and nonunions. Design: Retrospective cohort study. Setting: Tertiary care center. Patients/Participants: Forty consecutive patients with neglected femoral neck fracture and nonunions were treated with valgus intertrochanteric osteotomy, and follow-up was available in 32 patients (average age, 43 years; range, 14–60 years; average nonunion duration, 6 6 7 months; range, 1–36 months). Intervention: Valgus intertrochanteric osteotomy. Main Outcome Measurements: Clinical outcome was assessed with Harris hip score. Plain radiographs were evaluated for union, avascular necrosis, preoperative bone deficiency (neck resorption ratio), and postoperative femoral head fragment alignment (head-shaft angle). Results: Follow-up at 5 6 3 years (range, 2–12 years) after surgery showed union in 29 patients (91%), and Harris hip score was 82 6 13 points (range, 63–100 points). The 3 patients with persistent nonunion at the neck of femur had neck resorption ratio ,0.52. Increased postoperative head-shaft angle was associated with lower follow-up Harris hip score; postoperative valgus alignment .15 degrees compared with the contralateral side was associated with poor functional outcome. The presence of avascular necrosis did not affect the outcome. Conclusions: Valgus intertrochanteric osteotomy resulted in union and satisfactory functional outcome in most patients who had neglected femoral neck fractures and nonunions. Preoperative neck resorption ratio ...

Reintonaudiometrie in klinischen Studien zur Hörsturztherapie:Die Bedeutung der Auswahl des Zielkriteriums; Comparison of pure tone audiometry analysis in sudden hearing loss studies:Lack of agreement for different outcome measures

Bauer, Michael
Fonte: Universidade de Tubinga Publicador: Universidade de Tubinga
Tipo: Dissertação
DE_DE
Relevância na Pesquisa
36.34%
Zurzeit gibt es eine Vielzahl von Auswertungsverfahren, die in den publizierten Studien zur akuten idiopathischen Hörminderung Verwendung finden. Nach den hier vorgestellten Ergebnissen stimmen die Auswertungsverfahren jedoch meist nicht überein. Die Auswahl einer Methode beeinflusst aber nicht nur das Ergebnis der Studie, sondern auch die für die Durchführung einer kontrollierten klinischen Studie notwendige Zahl an Patienten. Um eine systematische Vergleichbarkeit der vielen unterschiedlichen Behandlungsschemata und -techniken im Rahmen von Metaanalysen zu ermöglichen, ist es dringend erforderlich, einheitliche Standards für die Zielparameter zu etablieren. Aufgrund des hier vorliegenden Vergleichs vieler Auswerteverfahren anhand einer großen Beispielpopulation lassen sich einige Vorschläge für die Planung weiterer Studien zum Hörsturz formulieren: 1) In Übereinstimmung mit den Beobachtungen von Berliner und Mitarbeitern (bei Schallleitungsschwerhörigkeit) hat die Definition von Erfolgskriterien einen größeren Einfluss auf das Therapieergebnis als die Auswahl der zu untersuchenden Frequenzen. 2) Eine sinnvolle Vergleichbarkeit von Studien, die unterschiedliche Auswerteverfahren benutzen, ist dennoch meist nicht gegeben. 3) Daher ist es nötig...

Nachuntersuchung nach Beckenring- und Acetabulumfrakturen - gesundheitsbezogene Lebensqualität (SF-36) im Vergleich zu radiologischem und klinischem Outcome nach zwei Jahren.; Follow-up study on pelvic ring and acetabulum fractures - health-related quality of life (SF-36) compared to the radiological and clinical outcome after two years.

Baacke, Manuel
Fonte: Universidade de Tubinga Publicador: Universidade de Tubinga
Tipo: Dissertação
DE_DE
Relevância na Pesquisa
36.32%
Im Rahmen neuer Gesichtspunkte der Outcomebeurteilung sollen bei Patienten mit Beckenverletzungen, traditionelle objektive Parameter der klinisch- radiologischen Nachuntersuchung mit der subjektiven Lebensqualität, erfasst durch den SF-36, verglichen werden. Nachuntersucht werden 143 von insgesamt 324 Patienten (44,1%), die im Zeitraum Januar 1998 bis Dezember 2001 unfallbedingt eine Verletzung des Beckens (45 Beckenringfrakturen, 33 Acetabulumfrakturen, 30 kombinierte Beckenring- / Acetabulumfrakturen, 35 Komplexverletzungen) erlitten haben und in der Berufsgenossenschaftlichen Unfallklinik Tübingen operativ oder konservativ behandelt wurden. Die Verletzungseinteilung erfolgt gemäß der AO-Klassifikation. Der Anteil der isolierten Beckenverletzungen beträgt lediglich 26,6%, ansonsten liegen zusätzliche Verletzungen anderer Organsysteme vor. Die Nachuntersuchung erfolgt durchschnittlich 28,6 Monate nach dem Unfallereignis. Die Gesamtverletzungsschwere beträgt im arithmetischen Mittel für den ISS (Injury Severity Score) 16,8 und den PTS (Hannoveraner Polytraumaschlüssel) 18,3. Die Outcome - Bewertung erfolgt anhand des Outcomescores Beckenring nach Pohlemann, des Merle d’Aubigné-Scores sowie des vom Patienten auszufüllenden SF-36-Fragebogens. Mit steigendem ISS und zunehmender Komplexität der Verletzung nimmt der Anteil der schmerzfreien Patienten stetig ab. Bei Typ-A-Verletzungen (52...

Prädiktoren des postinterventionellen Outcomes bei Patienten mit kritischer Beinischämie und arteriell-ischämischen Ulcerationen; Factors predicting postinterventional outcome in patients with CLI

Langhof, Isabell
Fonte: Universidade de Tubinga Publicador: Universidade de Tubinga
Tipo: Dissertação
DE_DE
Relevância na Pesquisa
36.32%
Hintergrund Die pAVK ist eine sehr häufige Erkrankung. Dennoch ist sie vielfach unterdiagnostiziert, obwohl bei dieser Erkrankung eine Früherkennung mit einfachen Methoden möglich ist. Aufgrund der hohen Komorbidität und zahlreichen Risikofaktoren wird der Erkrankungsverlauf häufig akzeleriert, was für die Prognose und das postinterventionelle Outcome nachteilig ist. Studiendesign Es handelt sich um eine retrospektive Studie an 148 per Randomverfahren ermittelten pAVK-Patienten (88 Männer, 60 Frauen) mit chronischen arteriell-ischämisch bedingten Ulcerationen, die im Universitätsklinikum Tübingen im Wundzentrum der beteiligten Abteilungen für Gefäßchrurgie, Allgemeinchirurgie, Angiologie sowie Diagnostische und Interventionelle Radiologie behandelt wurden und eine Angiographie erhalten hatten. Untersucht wurde der Einfluß des atherogenen Risikoprofils, der Komorbidität und der endovaskulären Therapie auf den Krankheitsverlauf und die weitere Prognose nach Auswertung der Angiographien und Patientenakten unter Einschluß von Verfahren der deskriptiven und analytischen Statistik. Zielsetzung Ziel dieser Arbeit war es einerseits, wichtige Risiko- und Einflußfaktoren für diese Erkrankung zu ermitteln und andererseits...

Funktionelle Langzeitergebnisse von Beckenringfrakturen unter besonderer Berücksichtigung der Instabilität des hinteren Beckenrings; Behandlungsmethoden und Ergebnisse der Jahrgänge 1990-2002; Functional long-term outcome of pelvic ring fractures with special consideration of instability of the posterior pelvic ring; Methods of treatment and outcome from 1990 to 2002

Landaverde Mendizabal, Elena
Fonte: Universidade de Tubinga Publicador: Universidade de Tubinga
Tipo: Dissertação
DE_DE
Relevância na Pesquisa
36.32%
In der vorliegenden Studie wurden mittel- bis langfristige klinische sowie radiologische Ergebnisse nach instabilen Beckenringfrakturen erfasst. Hierzu wurden umfassende Daten von 123 Patienten erhoben, die sich im Zeitraum zwischen 1990 und 2002 mit Beckenringfrakturen vom Typ B oder C in der BG-Unfallklinik in Tübingen in Behandlung befunden hatten. Der klinisch-radiologische Langzeitverlauf konnte bei einem repräsentativen Kollektiv von insgesamt 71 (58%) dieser Patienten analysiert werden. Die Mindestnachbeobachtungszeit betrug dabei 5 Jahre. Das Durchschnittsalter unseres Patientenkollektivs zum Unfallzeitpunkt lag bei 37 Jahren, wobei 66% der Patienten männlich waren. Unfallursache war meist der Verkehrsunfall. Daher traten die betrachteten Beckenringfrakturen in der Mehrzahl der Fälle (87%) im Rahmen von Mehrfach- oder Polytraumata auf. Die Gesamtletalität lag bei 5%. Mit 77% am häufigsten lagen Typ C Frakturen vor, während Typ B Frakturen nur 23% ausmachten. Die Therapie war meist (56%) operativ. Am häufigsten kam in der später nachuntersuchten Patientengruppe hierbei am vorderen wie auch am hinteren Beckenring die Plattenosteosynthese zum Einsatz. Postoperativ wurden dann bei 71% unserer Patienten exzellente bzw. gute Repositionsergebnisse nach Matta und Tornetta verzeichnet. Dieser Anteil stieg im Langzeitverlauf auf 87% an. Die Beurteilung des Gesundheitszustands sowie der Lebensqualität unserer Patienten im Langzeitverlauf erfolgte mit Hilfe diverser Fragebögen und der klinischen Nachuntersuchung. Verbleibende Schmerzen im Bereich des Beckens gaben hierbei 55% unserer Patienten an. Dieser wurde von 30% als stark...

Parameter des intraoperativen elektrophysiologischen Monitorings bei intramedullären Tumoren als Prädiktoren des postoperativen Outcomes; Parameter of the intraoperative electrophysiological monitoring of intramedullary tumors as predictors of the postoperative outcome

Hermann, Sabine
Fonte: Universidade de Tubinga Publicador: Universidade de Tubinga
Tipo: Dissertação
DE_DE
Relevância na Pesquisa
36.3%
Die Operation an intramedullären Tumoren bleibt trotz operationstechnischen Verbesserungen eine Herausforderung. Die Gründe für den Einsatz des intraoperativen Monitorings liegen darin, zu versuchen, die Tumorresektion zu maximieren und die neurologische Morbidität zu minimieren. In dieser Arbeit wurde versucht, einen elektrophysiologischen Prädiktor für das klinische Outcome von Patienten nach einer Operation eines intramedullären Tumors zu finden. Unter den Werten des intraoperativen Monitorings fand sich kein Potential, welches alleine als verlässlicher Prädiktor für das neurologische Outcoome dienen könnte. Somit sollte die multimodale Ableittechnik während der Operation eines intramedullären Tumors Goldstandart bleiben. Die durchgeführten Berechnungen mit den elektrophysiologischen Daten ließen folgende Schlussfolgerungen zu: Die Durchführung des IOM scheint einen positiven Effekt bezüglich klinischer Defizite zu haben. Die D-Welle hingegen scheint nur einen positiven Effekt auf das klinische Outcome zu haben, wenn diese im intraoperativen Monitoring zusammen mit MEPs und SEPs abgeleitet wird. Weiterhin zeigte eine genauere Untersuchung der Ergebnisse in der McCormick-Skala, dass sich Veränderungen zwischen den einzelnen Untersuchungszeitpunkten meist um plus/ minus einen Grad abspielen und dass aufgetretene Ausfälle zum Zeitpunkt der Entlassung meist eine Tendenz haben...

Genetic factors involved in stroke susceptibility and in outcome at three months

Gomes Pires Manso, Helena Isabel
Fonte: Instituto Nacional de Saúde Doutor Ricardo Jorge Publicador: Instituto Nacional de Saúde Doutor Ricardo Jorge
Tipo: Tese de Doutorado
Publicado em 23/11/2011 ENG
Relevância na Pesquisa
36.39%
Tese de Doutoramento em Biologia (Genética) apresentada à Faculdade de Ciências da Universidade de Lisboa em 2011. Tese defendida e aprovada em 23 de Novembro de 2011.; Astrid M. Vicente: Departamento de Promoção da Saúde e Doenças Crónicas do INSA,IP.; Trabalho de investigação realizado no Departamento de Promoção da Saúde e Doenças Crónicas do INSA, Grupo de Neurogenética e Saúde Mental (Janeiro 2007 – Novembro 2011).; Stroke is a significant cause of death and disability in developed countries. It is a multifactorial disease, resulting from the interplay between genes and well-known lifestyle/environmental risk factors. Numerous studies have attempted to identify the genetic risk factors predisposing to stroke, but few have investigated the genetic factors involved in stroke outcome. This work aimed at the identification of genes contributing to stroke and influencing patient’s outcome after three months. Four inflammatory genes (IL1B, IL6, MPO and TNF) and two genes involved in the nitric oxide metabolism (NOS1 and NOS3) were tested for association with stroke. The results suggest that the IL6 and MPO influence stroke susceptibility through independent effects and non-additive interactions. Furthermore, they provided novel evidence for the involvement of the NOS1 gene in stroke susceptibility. Several studies have shown the important impact of inflammation...

Early clinical prediction of neurological outcome following out of hospital cardiac arrest managed with therapeutic hypothermia

Ruknuddeen, M.I.; Ramadoss, R.; Rajajee, V.; Grzeskowiak, L.E.; Rajagopalan, R.E.
Fonte: Wolters Kluwer Publicador: Wolters Kluwer
Tipo: Artigo de Revista Científica
Publicado em //2015 EN
Relevância na Pesquisa
36.32%
BACKGROUND: Therapeutic hypothermia (TH) may improve neurological outcome in comatose patients following out of hospital cardiac arrest (OHCA). The reliability of clinical prediction of neurological outcome following TH remains unclear. In particular, there is very limited data on survival and predictors of neurological outcome following TH for OHCA from resource-constrained settings in general and South Asia in specific. OBJECTIVE: The objective was to identify factors predicting unfavorable neurological outcome at hospital discharge in comatose survivors of OHCA treated with hypothermia. DESIGN: Retrospective chart review. SETTING: Urban 200-bed hospital in Chennai, India. METHODS: Predictors of unfavorable neurological outcome (cerebral performance category score [3-5]) at hospital discharge were evaluated among patients admitted between January 2006 and December 2012 following OHCA treated with TH. Hypothermia was induced with cold intravenous saline bolus, ice packs and cold-water spray with bedside fan. Predictors of unfavorable neurological outcome were examined through multivariate exact logistic regression analysis. RESULTS: A total of 121 patients were included with 106/121 (87%) experiencing the unfavorable neurological outcome. Independent predictors of unfavorable neurological outcome included: Status myoclonus <24 h (odds ratio [OR] 21.79...

Interaction between anesthesia, gender, and functional outcome task following diffuse traumatic brain injury in rats

O'Connor, C.; Cernak, I.; Vink, R.
Fonte: Mary Ann Liebert Inc Publ Publicador: Mary Ann Liebert Inc Publ
Tipo: Artigo de Revista Científica
Publicado em //2003 EN
Relevância na Pesquisa
36.3%
A number of experimental and clinical studies have demonstrated that functional outcome following traumatic brain injury differs between males and females. Some studies report that females have a better outcome than males following trauma while others report the opposite. In experimental studies, some of the contradictory results may be due to the different experimental conditions, including type of anesthesia and the outcome measures employed. In the present study we have used three different anesthetic protocols and four different outcome measures to determine how these parameters interact and affect functional outcome following traumatic brain injury in male and female rats. Diffuse traumatic brain injury was induced in adult male and female animals using the impact-acceleration brain injury model. Mortality in female animals was no different than males when using halothane anesthesia, slightly better than males when using isoflurane anesthesia, but significantly worse than males under pentobarbital anesthesia. Female animals always performed better than males on rotarod tests of motor outcome, with this effect being unrelated to anesthetic effects. Conversely, in cognitive tests using the Barnes Maze, only isoflurane-anesthetized females performed better than their male counterparts. Similarly...

Preoperative prediction of long-term outcome following laparoscopic fundoplication

O'Boyle, C.; Watson, D.; deBeaux, A.; Jamieson, G.
Fonte: Blackwell Science Asia Publicador: Blackwell Science Asia
Tipo: Artigo de Revista Científica
Publicado em //2002 EN
Relevância na Pesquisa
36.32%
Background: Although long-term outcomes following laparoscopic fundoplication for gastro-oesophageal disease have now been reported as very satisfactory, a small, but important, minority of patients are unhappy with the outcome, often due to recurrent reflux symptoms or new-onset dysphagia. In this study, we sought to establish whether various parameters that can be determined before surgery, can predict the long-term outcome of surgery. Methods: Data collected prospectively were evaluated to determine factors that were associated with outcome at 5 years following laparoscopic fundoplication. Inclusion criteria were complete preoperative assessment data and 5-year follow-up data. Data examined included information on preoperative age, sex, weight, home address, health insurance status, duration of reflux symptoms, previous surgery, operating surgeon, endoscopy and 24-h pH monitoring. In addition, lower oesophageal sphincter resting and residual relaxation pressures were evaluated before and after surgery. The postoperative symptoms of heartburn and dysphagia, as well as overall satisfaction 5 years following surgery was determined using a 0−10 visual analogue scale. The association of the pre- and perioperative factors and outcome at 5 years was determined by univariate and linear regression analysis. Results: Two hundred and sixty-two patients from an overall experience of over 1000 laparoscopic anti-reflux procedures met the entry criteria. There was no association between patient address...

Outcome da reparação slap e da tenodesis do bíceps; revisão sistemática

Marafona, Diogo de Vasconcelos Castelo
Fonte: [s.n.] Publicador: [s.n.]
Tipo: Trabalho de Conclusão de Curso
Publicado em //2015 POR
Relevância na Pesquisa
36.3%
Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciado em Fisioterapia; Objetivo: Observar o outcome da reparação SLAP e da tenodesis do bíceps e os fatores que poderão interferir no sucesso deste. Metodologia: Pesquisa computorizada na base de dados da Science direct de forma a identificar artigos relativos ao outcome da reparação SLAP e da tenodesis do bíceps avaliados metodologicamente através da Oxford Centre for Evidence-Based Medicine (CEBM) e da escala Newcastle-Otawa. Resultados: Foram selecionados 5 artigos onde participaram 252 indivíduos com uma idade média de 40,56 anos, obtendo um score total entre 8 e 9 estrelas na escala de Newcastle-Otawa. O outcome foi satisfatório em todos os estudos, evidenciando-se, no entanto, a presença de um fator, worker’s compensation status, que afeta de certo modo o seu sucesso. Estes indivíduos obtiveram piores resultados nos questionários efetuados nos diferentes estudos. Conclusão: A reparação SLAP e a tenodesis do bíceps são as estratégias de tratamento mais eficazes, apresentando outcomes positivos. Sugere-se, de futuro, a realização de mais estudos experimentais para comprovar esta tendência. Objective: To observe the outcome of the SLAP repair and the biceps tenodesis and what factors could interfere with the success of these two surgical procedures. Methodology: Research computerized on the database Science Direct in order to identify articles referring to the outcome of the SLAP repair and the biceps tenodesis...