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https://www.readbyqxmd.com/read/28484930/heart-shaped-bilateral-medullary-pyramidal-infarction-as-a-pathognomonic-finding-of-anterior-spinal-artery-occlusion
#1
Sammy Searcy, Oluwaseun O Akinduro, Andrew Spector, Jang W Yoon, Benjamin L Brown, William D Freeman
BACKGROUND: Unilateral anterior spinal artery (ASA) occlusion resulting in bilateral medullary pyramidal (BMP) infarction is a rare and devastating stroke subtype. We present two cases highlighting the diagnostic and clinical challenges of BMP infarction. METHODS: Case reports and literature review. RESULTS: A 57-year-old man rapidly had severe vomiting and diarrhea 2 h after a meal. Examination revealed bulbar weakness and areflexic tetraplegia...
May 8, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28209218/the-changing-landscape-for-stroke%C3%A2-prevention-in-af-findings-from-the-gloria-af-registry-phase-2
#2
Menno V Huisman, Kenneth J Rothman, Miney Paquette, Christine Teutsch, Hans-Christoph Diener, Sergio J Dubner, Jonathan L Halperin, Chang Sheng Ma, Kristina Zint, Amelie Elsaesser, Dorothee B Bartels, Gregory Y H Lip
BACKGROUND: GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non-vitamin K antagonist oral anticoagulant (NOAC), became available. OBJECTIVES: This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1...
February 21, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28106498/performing-concurrent-operations-in-academic-vascular-neurosurgery-does-not-affect-patient-outcomes
#3
Corinna C Zygourakis, Janelle Lee, Julio Barba, Errol Lobo, Michael T Lawton
OBJECTIVE Concurrent surgeries, also known as "running two rooms" or simultaneous/overlapping operations, have recently come under intense scrutiny. The goal of this study was to evaluate the operative time and outcomes of concurrent versus nonconcurrent vascular neurosurgical procedures. METHODS The authors retrospectively reviewed 1219 procedures performed by 1 vascular neurosurgeon from 2012 to 2015 at the University of California, San Francisco. Data were collected on patient age, sex, severity of illness, risk of mortality, American Society of Anesthesiologists (ASA) status, procedure type, admission type, insurance, transfer source, procedure time, presence of resident or fellow in operating room (OR), number of co-surgeons, estimated blood loss (EBL), concurrent vs nonconcurrent case, severe sepsis, acute respiratory failure, postoperative stroke causing neurological deficit, unplanned return to OR, 30-day mortality, and 30-day unplanned readmission...
January 20, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/27903339/-effect-of-goal-directed-haemodynamic-management-on-the-postoperative-outcome-in-elderly-patients-with-fragile-cardiac-function-undergoing-abdominal-surgery
#4
L S Zheng, E W Gu, X H Peng, L Zhang, Y Y Cao
Objective: To investigate the effect of goal-directed haemodynamic management based on stroke volume variation (SVV), cardiac index (CI) and mean arterial blood pressure (MAP) on the postoperative outcome in elderly patients with fragile cardiac function undergoing gastrointestinal surgery. Methods: Ninety patients with fragile cardiac function, aged 65-90 years old, ASAⅡ or Ⅲ, NYHA Ⅱor Ⅲ, scheduled for abdominal surgery were enrolled in this study.The patients were randomly assigned to two groups: Experience anesthesia group (group E, n=45) and goal-directed hemodynamic management group (G group, n=45)...
November 22, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/27892890/trial-design-rivaroxaban-for-the-prevention-of-major-cardiovascular-events-after-transcatheter-aortic-valve-replacement-rationale-and-design-of-the-galileo-study
#5
RANDOMIZED CONTROLLED TRIAL
Stephan Windecker, Jan Tijssen, Gennaro Giustino, Ana H C Guimarães, Roxana Mehran, Marco Valgimigli, Pascal Vranckx, Robert C Welsh, Usman Baber, Gerrit-Anne van Es, Peter Wildgoose, Albert A Volkl, Ana Zazula, Karen Thomitzek, Melanie Hemmrich, George D Dangas
BACKGROUND: Optimal antithrombotic treatment after transcatheter aortic valve replacement (TAVR) is unknown and determined empirically. The direct factor Xa inhibitor rivaroxaban may potentially reduce TAVR-related thrombotic complications and premature valve failure. DESIGN: GALILEO is an international, randomized, open-label, event-driven, phase III trial in more than 1,520 patients without an indication for oral anticoagulation who underwent a successful TAVR (ClinicalTrials...
February 2017: American Heart Journal
https://www.readbyqxmd.com/read/27807846/borderline-operability-in-hepatectomy-patients-is-associated-with-higher-rates-of-failure-to-rescue-after-severe-complications
#6
Bradford J Kim, Ching-Wei D Tzeng, Amanda B Cooper, Jean-Nicolas Vauthey, Thomas A Aloia
BACKGROUND/OBJECTIVE: To understand the influence of age and comorbidities, this study analyzed the incidence and risk factors for post-hepatectomy morbidity/mortality in patients with "borderline" (BL) operability, defined by the preoperative factors: age ≥75 years, dependent function, lung disease, ascites/varices, myocardial infarction, stroke, steroids, weight loss >10%, and/or sepsis. METHODS: All elective hepatectomies were identified in the 2005-2013 ACS-NSQIP database...
March 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/27757229/risk-of-cardiovascular-events-after-initiation-of-long-acting-bronchodilators-in-patients-with-chronic-obstructive-lung-disease-a-population-based-study
#7
Almotasembellah Aljaafareh, Jose Ruben Valle, Yu-Li Lin, Yong-Fang Kuo, Gulshan Sharma
OBJECTIVES: Long-acting bronchodilators are mainstay treatment for moderate to severe chronic obstructive pulmonary disease. A growing body of evidence indicates an increased risk of cardiovascular events upon initiation of these medications. We hypothesize that this risk is higher in patients with chronic obstructive pulmonary disease who had a preexisting cardiovascular disease regardless of receipt of any cardiovascular medication. METHODS: A retrospective cohort of patients with a diagnosis of chronic obstructive pulmonary disease based on two outpatient visits or one inpatient visit for chronic obstructive pulmonary disease (International Classification of Diseases, 9th Edition, Clinical Modification codes 491...
2016: SAGE Open Medicine
https://www.readbyqxmd.com/read/27621487/anticoagulant-and-antiplatelet-prescribing-patterns-for-patients-with-atrial-fibrillation-after-percutaneous-coronary-intervention
#8
Erin A Woods, Margaret L Ackman, Michelle M Graham, Sheri L Koshman, Rosaleen M Boswell, Arden R Barry
BACKGROUND: Current guidelines recommend triple antithrombotic therapy (TAT), defined as acetylsalicylic acid (ASA), clopidogrel, and warfarin, for patients with nonvalvular atrial fibrillation who have undergone percutaneous coronary intervention with stent implantation. The choice of anticoagulant/antiplatelet therapy in this population is ambiguous and complex, and prescribing patterns are not well documented. OBJECTIVE: To characterize local prescribing patterns for anticoagulant/antiplatelet therapy after percutaneous coronary intervention in patients with nonvalvular atrial fibrillation...
July 2016: Canadian Journal of Hospital Pharmacy
https://www.readbyqxmd.com/read/27595681/a-randomized-parallel-group-double-blind-study-of-ticagrelor-compared-with-aspirin-for-prevention-of-vascular-events-in-patients-undergoing-coronary-artery-bypass-graft-operation-rationale-and-design-of-the-ticagrelor-in-cabg-ticab-trial-an-investigator-initiated
#9
RANDOMIZED CONTROLLED TRIAL
Antoinette de Waha, Sigrid Sandner, Moritz von Scheidt, Andreas Boening, Katharina Koch-Buettner, Dieter Hammel, Rainer Hambrecht, Bernhard C Danner, Friedrich A Schöndube, Gerold Goerlach, Theodor Fischlein, Michael Schmoeckel, Martin Oberhoffer, Rainer Schulz, Thomas Walther, Tibor Ziegelhöffer, Christoph Knosalla, Felix Schönrath, Friedhelm Beyersdorf, Matthias Siepe, Tim Attmann, Martin Misfeld, Friedrich-Wilhelm Mohr, Hans-Hinrich Sievers, Alexander Joost, Leon M Putman, Günther Laufer, Christian Hamm, Uwe Zeymer, Adnan Kastrati, Peter W Radke, Rüdiger Lange, Jochen Cremer, Heribert Schunkert
BACKGROUND: For patients with coronary artery disease undergoing coronary bypass surgery, acetylsalicylic acid (ASA) currently represents the gold standard of antiplatelet treatment. However, adverse cardiovascular event rates in the first year after coronary artery bypass grafting (CABG) still exceed 10%. Graft failure, which is predominantly mediated by platelet aggregation, has been identified as a major contributing factor in this context. Therefore, intensified platelet inhibition is likely to be beneficial...
September 2016: American Heart Journal
https://www.readbyqxmd.com/read/27528853/incidence-and-risk-factors-for-30-day-readmissions-after-hip-fracture-surgery
#10
Christopher T Martin, Yubo Gao, Andrew J Pugely
BACKGROUND: Unplanned hospital readmission following orthopedic procedures results in significant expenditures for the Medicare population. In order to reduce expenditures, hospital readmission has become an important quality metric for Medicare patients. The purpose of the present study is to determine the incidence and risk factors for 30-day readmissions after hip fracture surgery. METHODS: Patients over the age of 18 years who underwent hip fracture surgery, including open reduction internal fixation (ORIF), intramedullary nailing, hemi-arthroplasty, or total hip arthroplasty, between the years 2012 and 2013 were identified from the American College of Surgeons National Surgical Quality improvement Program (NSQIP) database...
2016: Iowa Orthopaedic Journal
https://www.readbyqxmd.com/read/27496661/predictors-of-30-day-mortality-following-hip-pelvis-fractures
#11
A C Dodd, C Bulka, A Jahangir, H R Mir, W T Obremskey, M K Sethi
INTRODUCTION: With the cost of healthcare in the United States reaching $2.9 trillion in 2013 and expected to increase with a growing geriatric population, the Center for Medicare and Medicaid Services (CMS) and Hospital Quality Alliance (HQA) began publicly reporting 30-day mortality rates so that hospitals and physicians may begin to confront clinical problems and promote high-quality and patient-centered care. Though the 30-day mortality is considered a highly effective tool in measuring hospital performance, little data actually exists that explores the rate and risk factors for trauma-related hip and pelvis fractures...
October 2016: Orthopaedics & Traumatology, Surgery & Research: OTSR
https://www.readbyqxmd.com/read/27438114/hospital-volume-outcomes-after-septal-myectomy-and-alcohol-septal-ablation-for-treatment-of-obstructive-hypertrophic-cardiomyopathy-us-nationwide-inpatient-database-2003-2011
#12
Luke K Kim, Rajesh V Swaminathan, Patrick Looser, Robert M Minutello, S Chiu Wong, Geoffrey Bergman, Srihari S Naidu, Christopher L F Gade, Konstantinos Charitakis, Harsimran S Singh, Dmitriy N Feldman
IMPORTANCE: Previous data on septal myectomy (SM) and alcohol septal ablation (ASA) in obstructive hypertrophic cardiomyopathy have been limited to small, nonrandomized, single-center studies. Use of septal reduction therapy and the effect of institutional experience on procedural outcomes nationally are unknown. OBJECTIVE: To examine in-hospital outcomes after SM and ASA stratified by hospital volume within a large, national inpatient database. DESIGN, SETTING, AND PARTICIPANTS: This study analyzed all patients who were hospitalized for SM or ASA in a nationwide inpatient database from January 1, 2003, through December 31, 2011...
June 1, 2016: JAMA Cardiology
https://www.readbyqxmd.com/read/27395809/increased-duration-of-operating-time-for-carotid-endarterectomy-is-associated-with-increased-mortality
#13
Faisal Aziz, Erik B Lehman, Amy B Reed
BACKGROUND: Carotid endarterectomy is the gold standard operation to prevent stroke in patients with symptomatic carotid artery stenosis and asymptomatic high-grade carotid artery stenosis. Longer operative times for different operations have been shown to affect the outcomes adversely. The purpose of this study was to determine the incidence of postoperative complications after carotid endarterectomy, and their relation to the operative times. METHODS: The American College of Surgeons database was queried for all patients who underwent carotid endarterectomies from 2005 to 2007...
October 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27105460/medical-complications-after-adult-spinal-deformity-surgery-incidence-risk-factors-and-clinical-impact
#14
Alex Soroceanu, Douglas C Burton, Jonathan Haim Oren, Justin S Smith, Richard Hostin, Christopher I Shaffrey, Behrooz A Akbarnia, Christopher P Ames, Thomas J Errico, Shay Bess, Munish C Gupta, Vedat Deviren, Frank J Schwab, Virginie Lafage
STUDY DESIGN: Retrospective review of a prospective multicenter database evaluating surgical adult spinal deformity (ASD) patients. OBJECTIVE: This study aims to identify risk factors for medical complications in ASD patients undergoing surgery. SUMMARY OF BACKGROUND DATA: ASD surgery is known for its high complication rate. This study examines baseline patient characteristics for predictors of medical complications in surgical ASD patients...
November 15, 2016: Spine
https://www.readbyqxmd.com/read/26884272/trainee-participation-and-perioperative-complications-in-benign-hysterectomy-the-effect-of-route-of-surgery
#15
Emma L Barber, Benjamin Harris, Paola A Gehrig
BACKGROUND: Intraoperative trainee involvement in hysterectomy is common. However, the effect of intraoperative trainee involvement on perioperative complications depending on surgical approach is unknown. OBJECTIVE: To estimate the effect of intraoperative trainee involvement on perioperative complication after vaginal, laparoscopic, and abdominal hysterectomy for benign disease. METHODS: Patients undergoing laparoscopic, vaginal, or abdominal hysterectomy for benign disease from 2010 to 2012 were identified from the American College of Surgeons National Surgical Quality Improvement Program database...
August 2016: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/26652126/resident-physicians-choices-of-anticoagulation-for-stroke-prevention-in-patients-with-nonvalvular-atrial-fibrillation
#16
Zardasht Oqab, William F McIntyre, Kieran L Quinn, Tyler Lamb, Kenneth Quadros, Payam Yazdan-Ashoori, Erik van Oosten, Karen Chu, Jasmine Lamba, Walid Barake, Kiarash Mohajer, Jeffrey N Marr, Adrian Baranchuk
Atrial fibrillation (AF) is a common cardiac arrhythmia and is associated with an increased risk of ischemic stroke. The aim of this study was to identify practice patterns of Canadian resident physicians pertaining to stroke prevention in nonvalvular AF according to the Canadian Cardiovascular Society guidelines. A Web-based survey consisting of 16 multiple-choice questions was distributed to 11 academic centres. Questions involved identification of risks of stroke, bleeding, and selection of appropriate therapy in clinical scenarios that involve a patient with AF with a Congestive Heart Failure, Hypertension, Age, Diabetes, Stroke/Transient Ischemic Attack (CHADS2) score of 3 and no absolute contraindications to anticoagulation...
June 2016: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/26316345/clinical-and-economic-implications-of-apixaban-versus-aspirin-in-the-low-risk-nonvalvular-atrial-fibrillation-patients
#17
RANDOMIZED CONTROLLED TRIAL
Gregory Y H Lip, Tereza Lanitis, Jack Mardekian, Thitima Kongnakorn, Hemant Phatak, Paul Dorian
BACKGROUND AND PURPOSE: Although recommended by guidelines, the benefits of treating patients with atrial fibrillation with a low-stroke risk score, with aspirin or anticoagulants, have not been clearly established. With advent of safer non-vitamin K antagonist oral anticoagulant, we assessed the clinical and economic implications of 5 mg BID of apixaban versus aspirin among patients with a relative low risk of stroke as assessed using the CHADS2 (congestive heart failure, hypertension, age>75, diabetes mellitus, stroke/transient ischemic attack) and CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes mellitus, stroke/transient ischemic attack, vascular disease) stroke risk classification...
October 2015: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/25438725/reviewing-a-clinical-decision-aid-for-the-selection-of-anticoagulation-treatment-in-patients-with-nonvalvular-atrial-fibrillation-applications-in-a-us-managed-care-health-plan-database
#18
Steven B Deitelzweig, Yonghua Jing, Jason P Swindle, Dinara Makenbaeva
PURPOSE: The Clinical Decision Aid was created to assist in selecting anticoagulant therapies for patients with nonvalvular atrial fibrillation. The aid incorporates a patient's absolute risk for stroke and bleeding, relative stroke risk reduction, and increase in relative bleeding risk to identify the agent with the lowest net risk. We describe theoretical implications of utilizing the aid at a US managed care population level. METHODS: This retrospective study used claims data from a large US managed care database including enrollees in commercial and Medicare Advantage plans...
November 1, 2014: Clinical Therapeutics
https://www.readbyqxmd.com/read/25063717/antithrombotic-therapy-for-secondary-stroke-prevention-in-bacterial-meningitis-in-children
#19
Cyrus Boelman, Manohar Shroff, Ivanna Yau, Bruce Bjornson, Susan Richrdson, Gabrielle deVeber, Daune MacGregor, Mahendranathn Moharir, Rand Askalan
OBJECTIVE: To assess the safety and efficacy of antithrombotic therapy (ATT) for secondary stroke prevention of childhood bacterial meningitis. STUDY DESIGN: A retrospective study of cases of stroke associated with bacterial meningitis in 2 pediatric hospitals during a period of 15 years. Patients were included in the study if they were between 28 days and 18 years of age and had at least 2 serial neuroimaging studies during the acute phase of their illness. The safety of ATT was assessed by the presence or absence of intracranial hemorrhage...
October 2014: Journal of Pediatrics
https://www.readbyqxmd.com/read/24916911/modification-of-outcomes-with-aspirin-or-apixaban-in-relation-to-female-and-male-sex-in-patients-with-atrial-fibrillation-a-secondary-analysis-of-the-averroes-study
#20
RANDOMIZED CONTROLLED TRIAL
Gregory Y H Lip, John Eikelboom, Salim Yusuf, Olga Shestakovska, Robert G Hart, Stuart Connolly
BACKGROUND AND PURPOSE: The main objective of the present analysis was to assess the effect of treatment with aspirin compared with apixaban on ischemic stroke and major bleeding in women compared with men. Female patients with atrial fibrillation are at increased stroke risk compared with male patients, and the underlying reasons for higher risk are uncertain. METHODS: Ancillary analysis of the Apixaban Versus Acetylsalicylic Acid [ASA] to Prevent Stroke in Atrial Fibrillation Patients Who Have Failed or Are Unsuitable for Vitamin K Antagonist Treatment (AVERROES) trial, comparing aspirin and apixaban, focused on sex differences...
July 2014: Stroke; a Journal of Cerebral Circulation
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