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Filioglo A, Simaan N, Honig A, Heldner MR, von Rennenberg R, Pezzini A, Padjen V, Rentzos A, Altersberger VL, Baumgartner P, Zini A, Grisendi I, Aladdin S, Gomori JM, Pilgram-Pastor SM, Scheitz JF, Magoni M, Berisavac I, Nordanstig A, Psychogios M, Luft A, Gentile M, Assenza F, Arnold M, Nolte CH, Gamba M, Ercegovac M, Jood K, Engelter ST, Wegener S, Forlivesi S, Zedde M, Gensicke H, Tatlisumak T, Cohen JE, Leker RR. Outcomes after reperfusion therapies in patients with ACA stroke: A multicenter cohort study from the EVATRISP collaboration. J Neurol Sci 2022; 432:120081. [PMID: 34920158 DOI: 10.1016/j.jns.2021.120081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with stroke secondary to occlusions of the anterior cerebral artery (ACA) often have poor outcomes. The optimal acute therapeutic intervention for these patients remains unknown. METHODS Patients with isolated ACA-stroke were identified from 10 centers participating in the EndoVascular treatment And ThRombolysis in Ischemic Stroke Patients (EVATRISP) prospective registry. Patients treated with endovascular thrombectomy (EVT) were compared to those treated with intravenous thrombolysis (IVT). Odds ratios with 95% confidence intervals (OR; 95%CI) were calculated using multivariate regression analysis. RESULTS Included were 92 patients with ACA-stroke. Of the 92 ACA patients, 55 (60%) were treated with IVT only and 37 (40%) with EVT (±bridging IVT). ACA patients treated with EVT had more often wake-up stroke (24% vs. 6%, p = 0.044) and proximal ACA occlusions (43% vs. 24%, p = 0.047) and tended to have higher stroke severity on admission [NIHSS: 10.0 vs 7.0, p = 0.054). However, odds for favorable outcome, mortality or symptomatic intracranial hemorrhage did not differ significantly between both groups. Exploration of the effect of clot location inside the ACA showed that in patients with A1 or A2/A3 ACA occlusions the chances of favorable outcome were not influenced by treatment allocation to IVT or EVT. DISCUSSION Treatment with either IVT or EVT could be safe with similar effect in patients with ACA-strokes and these effects may be independent of clot location within the occluded ACA.
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Affiliation(s)
- A Filioglo
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - N Simaan
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - A Honig
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - M R Heldner
- Department of Neurology, University Hospital Bern, Switzerland
| | - R von Rennenberg
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin Institute of Health, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - A Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Italy
| | - V Padjen
- Neurology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - A Rentzos
- Department of Diagnostic and Interventional Neuroradiology, Sahlgrenska University Hospital and Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden
| | - V L Altersberger
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland
| | - P Baumgartner
- University Hospital Zurich and University of Zurich, Switzerland
| | - A Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy
| | - I Grisendi
- Neurology Unit, Stroke Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - S Aladdin
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - J M Gomori
- Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - S M Pilgram-Pastor
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - J F Scheitz
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin Institute of Health, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - M Magoni
- U.O Vascular Neurology, Stroke Unit, ASST Spedali Civili, Brescia, Italy
| | - I Berisavac
- Neurology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - A Nordanstig
- Department of Clinical Neurosciences, Institute of Neurosciences and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M Psychogios
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland
| | - A Luft
- University Hospital Zurich and University of Zurich, Switzerland
| | - M Gentile
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy
| | - F Assenza
- Neurology Unit, Stroke Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Arnold
- Department of Neurology, University Hospital Bern, Switzerland
| | - C H Nolte
- Department of Neurology, Charité-Universitätsmedizin Berlin, Center for Stroke Research, Berlin, Berlin Institute of Health, Berlin, Germany
| | - M Gamba
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - M Ercegovac
- Neurology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - K Jood
- Department of Clinical Neurosciences, Institute of Neurosciences and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - S T Engelter
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland; Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Switzerland
| | - S Wegener
- University Hospital Zurich and University of Zurich, Switzerland
| | - S Forlivesi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy
| | - M Zedde
- Neurology Unit, Stroke Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - H Gensicke
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland; Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Switzerland
| | - T Tatlisumak
- Department of Clinical Neurosciences, Institute of Neurosciences and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - J E Cohen
- Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - R R Leker
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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Abstract
Primary tracheal tumors are rare and trachea is an exceedingly rare site of extramedullary plasmacytoma (EMP). We report a case of solitary tracheal plasmacytoma causing symptoms of airway obstruction in a 59-year-old man. Flow/volume loop indicated the fixed central airway obstruction. Computerized tomography and bronchoscopy demonstrated a sessile tumor on posterior tracheal wall obstructing 80% of the lumen. Partial tracheal resection with T-T anastomosis was performed. Pathologic analysis of resected mass revealed EMP. Additional investigations excluded multiple myeloma. There are no signs of disease recurrence after 7-year follow-up.
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Affiliation(s)
- R Stevic
- Faculty of Medicine, University of Belgrade; Center for Radiology and MRI, Clinical Center of Serbia, Belgrade, Serbia
| | - M Ercegovac
- Faculty of Medicine, University of Belgrade; Clinic for Thoracic Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - J Stojšić
- Department of Thoracopulmonary Pathology, Service of Pathology, Clinical Cener of Serbia, Belgrade, Serbia
| | - N Čolić
- Center for Radiology and MRI, Clinical Center of Serbia, Belgrade, Serbia
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Subotic D, Ercegovac M, Mandaric D, Herth F, Andric L, Gajic M. Does preoperatively created right to left shunt adequately reflect hypoxemia during pneumonectomy for lung cancer? Med Hypotheses 2011; 77:638-41. [PMID: 21802860 DOI: 10.1016/j.mehy.2011.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Revised: 06/04/2011] [Accepted: 07/01/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND No method is currently available for preoperative approximation of the patient's situation to the one existing during pneumonectomy in general anesthesia with alternations of single and double-lung ventilation in the lateral position. We hypothesized that a patient breathing the room air in the sitting position, with the main bronchus occluded by the inflatable catheter (aimed to predict a postpneumonectomy ventilatory function), could, at least in some aspects, simulate the intraoperative situation in certain clinical conditions discussed in the text. To evaluate the hypothesis, we used data of 15 candidates for pneumonectomy at increased risk, who underwent a spirometry with the left man bronchus occluded, as a part of the postoperative lung function prediction. Arterial blood samples (pO2, pCO2, saturation, and pH) were obtained before placement of the Fogarty catheter, than after at least 60s of normal breathing with the main bronchus occluded. Significant drop in pO2 (10.35±1.65 vs. 7.79±1.40 kPa) ensued within 1 min after occlusion of the main bronchus. All patients were able to perform spirometry in presence of induced hypoxemia without dyspnea that would require cessation of the procedure. These results, together with the absence of cardiac rhythm disorders, lead us to believe that they would behave in the same way during a pneumonectomy with alternations of single and double-lung ventilation. Such an assumption is based on the fact that breathing the room air is less favorable from the standpoint of oxygen delivery--the content of oxygen in the room air is smaller in the room air compared to that delivered through endotracheal tube. The practical implication of this hypothesis is that assessment of oxygenation during this procedure, additionally facilitates the preoperative risk assessment in patients undergoing pneumonectomy for lung cancer. Moreover, a slight postoperative oxygenation improvement and smaller loss in FEV1 in patients with moderate COPD, mean that COPD patients are likely to do a little bit better postoperatively than predicted.
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Affiliation(s)
- D Subotic
- Clinic for Thoracic Surgery, Clinical Center of Serbia, Belgrade, Serbia.
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Abstract
PURPOSE In patients with multiple sclerosis (MS), epileptic seizures occur more frequently than in the general population. The aim of this study was to analyze clinical characteristics of epilepsy in patients with MS, potential correlation between the semiology of seizures, EEG and magnetic resonance imaging (MRI) findings in these patients, as well as to examine the response to anticonvulsant therapy. METHODS In a series of 268 consecutive patients with definite MS hospitalized at the Institute of Neurology, Belgrade, we identified 20 (7.5%) patients with seizures or epilepsy. All patients with seizures or epilepsy were submitted to standard EEG and brain MRI with gadopentetate dimeglumine. RESULTS In four patients, epilepsy occurred 1-5 years before other clinical manifestations of MS. Eight patients had seizures only during MS relapses (provoked seizures). In two of them, seizures were the only manifestations of relapse. In 12 patients, seizures occurred regardless of the phase of MS (chronic epilepsy). In the majority of patients, seizures were partial with secondary generalization. Five patients experienced episodes of status epilepticus, and they all had dementia. Abnormal EEG pattern was found in 11 patients. Brain MRI disclosed cortical-subcortical lesions in nine patients and focal cortical atrophy in one, whereas in the remaining patients, findings were inconclusive. Probable EEG-MRI-seizure type correlation existed in 10 patients. CONCLUSIONS Our data suggest that epilepsy may represent an initial symptom of MS and a single clinical manifestation of a relapse, and further support the assumption of the existing correlation between the presence of cortical-subcortical lesions and epileptic seizures or epilepsy in patients with MS.
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Affiliation(s)
- D V Sokic
- Institute of Neurology, Clinical Center of Serbia, Dr Subotića 6, Belgrade 11000, Yugoslavia.
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Cemerikić-Martinović V, Trpinac D, Ercegovac M. Correlations between mitotic and apoptotic indices, number of interphase NORs, and histological grading in squamous cell lung cancer. Microsc Res Tech 1998; 40:408-17. [PMID: 9527050 DOI: 10.1002/(sici)1097-0029(19980301)40:5<408::aid-jemt7>3.0.co;2-m] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Proliferative activity of tumors is strongly associated with prognosis and response to therapy. The reason for faster and uncontrolled growth rate of tumors compared with normal tissue may be caused by the greater proliferation of cells, the smaller rate of cell death, or both. Cell production vs. cell loss rates, and their correlation with a grade of tumor cell differentiation (G) was estimated in 45 cases of squamous cell lung cancers (SCLC) by the use of mitotic indices (MI), number of interphase NORs, and apoptotic indices (AI) as parameters. The mitotic figures as well as apoptotic cells were observed on paraffin sections (4-microm thick) stained with haematoxylin and eosin, and with Feulgen reaction with Schiff-type reagent containing 0.5% Toluidine Blue. According to our results, all three parameters distinguish significantly (P < 0.05) between well and moderately or poorly differentiated groups, but not between the first two groups, and clearly discriminate between low- and high-grade malignancy. These results suggest classification of squamous cell lung cancers into two groups, a group of low and a group of high proliferative activity, despite their morphological appearance. Regression analysis revealed a significant (P < 0.0005) correlation between MI and AgNOR counts per cell nucleus as proliferative markers and AI as a marker of cell loss. The number of mitoses and apoptoses, especially when they are expressed as a percentage of the total number of tumor cells, are markers of tumor proliferation rate. They both can be used in biofunctional staging, based on cell kinetics, to provide more prognostic information about lung cancers than clinicopathological staging.
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Affiliation(s)
- V Cemerikić-Martinović
- Department of Lung Pathology, Institute for Pulmonary Diseases and Tuberculosis, CCS, Beograd, Yugoslavia
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