Objectives: Concomitant injuries play an important role when it comes to clinical management of traumatic brain injury (TBI). We examined the incidence of concomitant injuries and their relevance with respect to hospi...Objectives: Concomitant injuries play an important role when it comes to clinical management of traumatic brain injury (TBI). We examined the incidence of concomitant injuries and their relevance with respect to hospitalization. Methods: Children aged between 0 - 18 years hospitalized for treatment of TBI (ICD 10;S06.0 - 9) during 2010-2011 were included. The data relating to concomitant injuries and the course of treatment were evaluated. Statistical analysis included multivariate regressions at a level of significance of p ≤ 0.05. Results: 794 children were treated for head injury in our hospital. Head injury with other associated injuries had been sustained by 158 (19.9%) children. The face and the extremities were the areas of the body most often affected (p = 0.001). Boys represent the majority within the cohort of multiple injured children (p = 0.0001). The older the child, the higher the percentage of children with concomitant injuries (r = 0.27;p = 0.034). There was a significant correlation between the severity of the head injury and the occurrence of concomitant injuries (r = 0.19;p = 0.046). Children with concomitant injuries were found to suffer significantly more falls (N = 82;51.9%) than road traffic accidents (N = 68;43%) (p = 0.0001). A comparison of different variables revealed that age (7 to 10 years), severity of head injury (mild TBI), and trauma mechanism (fall) were most influential (KB = ?1.55;p = 0.023) for concomitant injuries. Children with concomitant injuries have a significant longer stay in hospital than those without: mean stay 2.5 to 4.5 days (p = 0.0001). Conclusion: Concomitant injuries are hints for more severe head injuries and children should be examined with special care.展开更多
Objective: To present long- term results after interstitial iodine125 irradiation of adult patients with de- novo World Health Organization (WHO) Grade II astrocytomas and oligoastrocytomas of the insula of Reil with ...Objective: To present long- term results after interstitial iodine125 irradiation of adult patients with de- novo World Health Organization (WHO) Grade II astrocytomas and oligoastrocytomas of the insula of Reil with special respect to the treatment- related risk. Methods: 55 consecutively treated patients (from 1979 to 1992) with circumscribed tumors with a diameter < 5 cm (astrocytomas: 46 patients, oligoastrocytomas: 9 patients) were included. The reference dose - calculated to the outer boundary of the tumor - was in the range of 60- 100 Gy and the dose rate was low ( < 10 cGy/h). Progression- free survival, risk of malignant transformation, survival, and the incidence of radiogenic complications were estimated by the Kaplan- Meier method. Prognostic factors were obtained from the Cox- model. Results: Median follow up for the survivors was > 10 years. 5- year (10- year) progression- free survival was 40.7% (20.2% ), and 5- year (10- year) survival 54.6% (28.4% ). Malignant transformation occurred in 42.4 % after 5 years. Neither of the Kaplan- Meier curves showed a leveling off over time. Transient (progressive) radiogenic complications were observed in 13 [4] patients (one- year overall complication rate: 18% ), and were significantly associated with a tumor diameter > 3.5 cm (p < 0.001). No long term side- effects were detected and delayed external beam irradiation (in case of tumor progression) did not enhance the risk. Tumor enhancement on CT was the only unfavorable predictor for survival. Conclusion: A limited overall prognosis for adult patients with insular WHO grade II astrocytomas and oligoastrocytomas was detected. Interstitial 1- 125 irradiation offers a minimal- invasive and low- risk treatment option for circumscribed tumors with a diameter < 3.5 cm. Larger tumors require further evaluation for optimal treatment.展开更多
Background In recent years,a growing number of stents and stent-like devices have become available to facilitate the treatment of challenging aneurysms.However,the need for dual antiplatelet therapy can limit their us...Background In recent years,a growing number of stents and stent-like devices have become available to facilitate the treatment of challenging aneurysms.However,the need for dual antiplatelet therapy can limit their use,especially in ruptured aneurysms.The hydrophilic polymer coating(pHPC,phenox)is a novel glycan-based multilayer polymer that reduces platelet adhesion.This study aims to report our initial experience using the pCONUS HPC device for the treatment of unruptured wide-necked bifurcation aneurysms(WNBA)using acetylsalicylic acid(ASA)as single antiplatelet therapy(SAPT).Methods We retrospectively identified all patients who were treated with the pCONUS HPC for unruptured WNBA in a multi-staged procedure using ASA as SAPT.Records were made of periprocedural complications,clinical outcome and angiographic and clinical follow-up.Results We identified 15 patients with 15 WNBA.The average age was 69 years old(range,41-76).Seven aneurysms were located in the middle cerebral artery,five in the anterior communicating artery,two at the basilar tip and one in the posterior communicating artery.Immediate post-treatment angiography showed five aneurysms with modified Raymond-Roy classification(mRRC)grade Ⅰ and four aneurysms with mRRC grade Ⅱ.There were no haemorrhagic complications.Four patients developed thrombus formation during the second treatment session,all of them completely resolving after administration of glycoprotein Ⅱb/Ⅲa antagonists.Angiographic follow-up data were available for 10 patients and showed adequate occlusion(mRRC Ⅰ or Ⅱ)in eight aneurysms(80%).In-stent stenosis was observed in one patient whereas two patients showed de novo stenosis in one of the efferent branches.Conclusions This early experience on the use of the pCONUS HPC device suggests that it can be useful for treating unruptured WNBA under ASA as SAPT.Further investigation with a randomised treatment registry and larger cohort is needed.展开更多
文摘Objectives: Concomitant injuries play an important role when it comes to clinical management of traumatic brain injury (TBI). We examined the incidence of concomitant injuries and their relevance with respect to hospitalization. Methods: Children aged between 0 - 18 years hospitalized for treatment of TBI (ICD 10;S06.0 - 9) during 2010-2011 were included. The data relating to concomitant injuries and the course of treatment were evaluated. Statistical analysis included multivariate regressions at a level of significance of p ≤ 0.05. Results: 794 children were treated for head injury in our hospital. Head injury with other associated injuries had been sustained by 158 (19.9%) children. The face and the extremities were the areas of the body most often affected (p = 0.001). Boys represent the majority within the cohort of multiple injured children (p = 0.0001). The older the child, the higher the percentage of children with concomitant injuries (r = 0.27;p = 0.034). There was a significant correlation between the severity of the head injury and the occurrence of concomitant injuries (r = 0.19;p = 0.046). Children with concomitant injuries were found to suffer significantly more falls (N = 82;51.9%) than road traffic accidents (N = 68;43%) (p = 0.0001). A comparison of different variables revealed that age (7 to 10 years), severity of head injury (mild TBI), and trauma mechanism (fall) were most influential (KB = ?1.55;p = 0.023) for concomitant injuries. Children with concomitant injuries have a significant longer stay in hospital than those without: mean stay 2.5 to 4.5 days (p = 0.0001). Conclusion: Concomitant injuries are hints for more severe head injuries and children should be examined with special care.
文摘Objective: To present long- term results after interstitial iodine125 irradiation of adult patients with de- novo World Health Organization (WHO) Grade II astrocytomas and oligoastrocytomas of the insula of Reil with special respect to the treatment- related risk. Methods: 55 consecutively treated patients (from 1979 to 1992) with circumscribed tumors with a diameter < 5 cm (astrocytomas: 46 patients, oligoastrocytomas: 9 patients) were included. The reference dose - calculated to the outer boundary of the tumor - was in the range of 60- 100 Gy and the dose rate was low ( < 10 cGy/h). Progression- free survival, risk of malignant transformation, survival, and the incidence of radiogenic complications were estimated by the Kaplan- Meier method. Prognostic factors were obtained from the Cox- model. Results: Median follow up for the survivors was > 10 years. 5- year (10- year) progression- free survival was 40.7% (20.2% ), and 5- year (10- year) survival 54.6% (28.4% ). Malignant transformation occurred in 42.4 % after 5 years. Neither of the Kaplan- Meier curves showed a leveling off over time. Transient (progressive) radiogenic complications were observed in 13 [4] patients (one- year overall complication rate: 18% ), and were significantly associated with a tumor diameter > 3.5 cm (p < 0.001). No long term side- effects were detected and delayed external beam irradiation (in case of tumor progression) did not enhance the risk. Tumor enhancement on CT was the only unfavorable predictor for survival. Conclusion: A limited overall prognosis for adult patients with insular WHO grade II astrocytomas and oligoastrocytomas was detected. Interstitial 1- 125 irradiation offers a minimal- invasive and low- risk treatment option for circumscribed tumors with a diameter < 3.5 cm. Larger tumors require further evaluation for optimal treatment.
文摘Background In recent years,a growing number of stents and stent-like devices have become available to facilitate the treatment of challenging aneurysms.However,the need for dual antiplatelet therapy can limit their use,especially in ruptured aneurysms.The hydrophilic polymer coating(pHPC,phenox)is a novel glycan-based multilayer polymer that reduces platelet adhesion.This study aims to report our initial experience using the pCONUS HPC device for the treatment of unruptured wide-necked bifurcation aneurysms(WNBA)using acetylsalicylic acid(ASA)as single antiplatelet therapy(SAPT).Methods We retrospectively identified all patients who were treated with the pCONUS HPC for unruptured WNBA in a multi-staged procedure using ASA as SAPT.Records were made of periprocedural complications,clinical outcome and angiographic and clinical follow-up.Results We identified 15 patients with 15 WNBA.The average age was 69 years old(range,41-76).Seven aneurysms were located in the middle cerebral artery,five in the anterior communicating artery,two at the basilar tip and one in the posterior communicating artery.Immediate post-treatment angiography showed five aneurysms with modified Raymond-Roy classification(mRRC)grade Ⅰ and four aneurysms with mRRC grade Ⅱ.There were no haemorrhagic complications.Four patients developed thrombus formation during the second treatment session,all of them completely resolving after administration of glycoprotein Ⅱb/Ⅲa antagonists.Angiographic follow-up data were available for 10 patients and showed adequate occlusion(mRRC Ⅰ or Ⅱ)in eight aneurysms(80%).In-stent stenosis was observed in one patient whereas two patients showed de novo stenosis in one of the efferent branches.Conclusions This early experience on the use of the pCONUS HPC device suggests that it can be useful for treating unruptured WNBA under ASA as SAPT.Further investigation with a randomised treatment registry and larger cohort is needed.
