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Outcomes of bypass surgery in asymptomatic moyamoya angiopathy: A multicenter study with propensity-score weighting.
No full textINTRODUCTION: Asymptomatic moyamoya angiopathy (MMA) is increasingly detected through noninvasive imaging; however, its optimal management remains controversial. This multicenter retrospective cohort study compared outcomes in asymptomatic versus symptomatic MMA patients undergoing surgical revascularization.
PATIENTS AND METHODS: A total of 475 patients treated with bypass surgery across multiple academic centers were included, with 56 (11.8%) classified as asymptomatic and 419 (88.2%) as symptomatic. Baseline demographics, surgical characteristics, and outcomes-including perioperative stroke, intraoperative complications, and follow-up stroke events-were collected. Asymptomatic MMA was defined as the absence of any prior ischemic or hemorrhagic stroke, seizures, or other neurological symptoms at the time of diagnosis. Both unadjusted analyses and propensity score weighting using inverse probability of treatment weighting (IPTW) were performed to adjust for potential confounders.
RESULTS: In the unadjusted analysis, asymptomatic patients had significantly lower rates of all perioperative strokes (1.7% vs 11.4%; p = 0.05) and intraoperative complications (1.7% vs 11.2%; p = 0.05) compared to symptomatic patients. Additionally, follow-up stroke rates were lower in the asymptomatic group (1.7% vs 11.2%; p = 0.05). After IPTW adjustment, the reduction in intraoperative complications (OR: 0.08, 95% CI: 0.01-0.64; p = 0.01) and follow-up stroke rates (OR: 0.12, 95% CI: 0.01-0.91; p = 0.04) persisted, while differences in overall perioperative stroke were not statistically significant.
CONCLUSION: Bypass surgery in selected asymptomatic MMA patients is associated with reduced intraoperative complications, and fewer follow-up stroke rates. These findings support the careful consideration of surgical intervention in asymptomatic patients, emphasizing the importance of patient selection for optimal outcomes
Development and Validation of a SNP-Based cfDNA Test for Vanishing Twin Pregnancies: The VANISH Trial
No full textOCT-Based Differentiation of First Acute Optic Neuritis: An International Study of 111 Patients With NMOSD and MOGAD.
No full textBACKGROUND AND OBJECTIVES: Severe optic neuritis (ON) is a common clinical manifestation in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and neuromyelitis optica spectrum disorder (NMOSD). Given distinct prognoses and often the necessity of early plasma exchange in NMOSD, prompt differentiation is crucial. In this study, we investigated the utility of optical coherence tomography (OCT) in differentiating between first acute NMOSD-ON and MOGAD-associated optic neuritis (MOGAD-ON), as well as specific factors associated with disc edema.
METHODS: In this retrospective multicenter study, 111 adult patients with MOGAD or aquaporin-4 antibody-positive NMOSD who experienced a first ON and underwent OCT within 2 weeks of symptom onset were included from 14 centers across 8 countries. Peripapillary retinal nerve fiber layer (pRNFL) thickness in µm was analyzed, including the average of both eyes in cases of bilateral manifestation.
RESULTS: Eighty-three patients with MOGAD (51 women; 124 ON eyes; bilateral ON 48.2%) and 28 with NMOSD (24 women; 36 ON eyes; bilateral ON 21.4%) were enrolled. A significant increase in pRNFL thickness (\u3e2SD), suggestive of disc edema, was observed in 73.4% of MOGAD-ON eyes and 11.1% of NMOSD-ON eyes (
DISCUSSION: Acute-stage OCT contributes to the rapid and accurate differentiation between MOGAD-ON and NMOSD-ON prior to antibody confirmation, which can be critical for timely therapeutic decisions
Morgagni hernia associated with ipsilateral lateral chest wall defect: a case report of transdiaphragmatic intercostal hernia in an adult.
No full textINTRODUCTION AND IMPORTANCE: Transdiaphragmatic intercostal hernias (TDIHs) are rare and typically posttraumatic. The coexistence of a TDIH with congenital anomalies, such as a Morgagni hernia (MH) and chest wall defect, is exceptionally uncommon. This report details a unique case of MH associated with an ipsilateral intercostal hernia in an adult, underscoring key diagnostic and surgical challenges.
CASE PRESENTATION: A 71-year-old man with multiple comorbidities presented with acute abdominal pain and a right-sided chest wall bulge. Computed tomography revealed a large right lateral diaphragmatic and intercostal hernia between the right 9th and 10th ribs, with bowel loops protruding through the intercostal defect. The symptoms spontaneously improved, and repeat imaging showed a reduction of the hernia content. Thoracotomy revealed an omental herniation through an anteromedial diaphragmatic defect (MH) and a congenital chest wall defect with stretched intercostal muscles. The MH was primarily repaired using nonabsorbable sutures, and rib approximation was performed with absorbable sutures to address the chest wall defect.
CLINICAL DISCUSSION: This case is remarkable for the association of two congenital defects: an MH and a TDIH. Unlike typical posttraumatic TDIHs, the intercostal defect in this case stemmed from congenital chest wall maldevelopment. Preoperative diagnosis was challenging, with the MH initially missed on imaging. This emphasizes the importance of considering congenital variants in atypical hernias.
CONCLUSION: To our knowledge, this is the first documented case of a TDIH occurring in conjunction with an MH, both likely congenital. Prompt recognition and tailored interventions are crucial for avoiding missed diagnoses and complications
