52426 research outputs found
Sort by
From Aortic Stenosis to Cardiomyopathy: The Hidden Impact of Undiagnosed Acommissural Unicuspid Aortic Valve.
No full textUnicuspid aortic valve (UAV) is a rare congenital anomaly, diagnosed in individuals aged 30 to 50. It is associated with aortic stenosis or aortic regurgitation, potentially leading to heart failure. We report a case of a 28-year-old male with an acommissural UAV, aortopathy, critical aortic stenosis, and heart failure with reduced ejection fraction, presenting with shortness of breath. This case is notable for late presentation of an acommissural UAV, which typically manifests in childhood
Extended Length of Stay After Mechanical Thrombectomy for Stroke: A Single-Center Analysis of 703 Patients.
No full textBACKGROUND AND OBJECTIVES: Mechanical thrombectomy (MT) is crucial for improving functional outcomes for acute ischemic stroke. Length of stay (LOS) is a reimbursement metric implemented to incentivize value-based care. Our study aims to identify predictors of LOS in patients undergoing MT at a high-volume center in the United States.
METHODS: This was a retrospective study of patients who underwent MT at a single institution from 2017 to 2023. Patients who experienced mortality during their course of hospital stay were excluded from this study. Extended LOS (eLOS) was defined as the upper quartile (≥75th) of the median duration of hospital stay. Univariate and multivariate analyses were performed, with P values \u3c .05 denoting statistical significance.
RESULTS: Seven hundred three patients met criteria for inclusion. The median age of the cohort was 72 years (IQR: 61-82), and 57.2% was female. The median LOS was 6, IQR: 4-10. A total of 28.9% of the cohort (n = 203) patients experienced eLOS. The multivariate regression model identified age (odds ratio [OR]: 0.98, 95% CI: 0.97-0.99), diabetes mellitus (OR: 1.68, 95% CI: 1.15-2.44), and hemorrhagic transformation of stroke (OR: 2.89, 95% CI: 0.39-0.90) as predictors of eLOS, whereas antiplatelet use before admission (OR: 0.55, 95% CI: 0.34-0.89) and higher baseline modified Rankin Scale before stroke were associated with lower odds (OR: 0.59 [0.39-0.90]; P \u3c .05) of eLOS.
CONCLUSION: By identifying predictors of eLOS, we provide a foundation for targeted interventions aimed at optimizing post-thrombectomy care pathways and improving patient outcomes. The implications of our study extend beyond clinical practice, offering insights into healthcare resource utilization, reimbursement strategies, and value-based care initiatives
Comparing stand-alone endovascular embolization versus stereotactic radiosurgery in the treatment of arteriovenous malformations with Spetzler-Martin grades I-III: a propensity score matched study.
No full textBACKGROUND: Arteriovenous malformations (AVMs) are uncommon cerebral lesions that can cause significant neurological complications. Surgical resection is the gold standard for treatment, but endovascular embolization and stereotactic radiosurgery (SRS) are viable alternatives.
OBJECTIVE: To compare the outcomes of endovascular embolization versus SRS in the treatment of AVMs with Spetzler-Martin grades I-III.
METHODS: This study combined retrospective data from 10 academic institutions in North America and Europe. Patients aged 1 to 90 years who underwent endovascular embolization or SRS for AVMs with Spetzler-Martin grades I-III between January 2010 and December 2023 were included.
RESULTS: The study included 244 patients, including 84 who had endovascular embolization and 160 who had SRS. Before propensity score matching (PSM), complete obliteration at the last follow-up was achieved in 74.5% of the SRS group compared with 57.8% of the embolization group (OR=0.47; 95% CI 0.26 to 0.48; P=0.01). After propensity score matching, SRS still achieved significantly higher occlusion rates at last follow-up (78.9% vs 55.3%; OR=0.32; 95% CI 0.12 to 0.90; P=0.03).Hemorrhagic complications were higher in the embolization group than in the SRS group, although this difference did not reach statistical significance after PSM (13.2% vs 2.6%; OR=5.6; 95% CI 0.62 to 50.47; P=0.12). Similarly, re-treatment rate was higher in the embolization group (10.5% vs 5.3%; OR=2.11; 95% CI 0.36 to 12.31; P=0.40) compared with the SRS group.
CONCLUSION: Our findings indicate that SRS has a significantly higher obliteration rate at last follow-up compared with endovascular embolization. Also, SRS has a higher tendency for fewer hemorrhagic complications and lower re-treatment rate. Further prospective studies are needed
Understanding disparities in cerebral atherosclerosis mortality across the United States: An analysis of the CDC WONDER database.
No full textBACKGROUND: Cerebral atherosclerosis is a significant contributor to ischemic stroke, accounting for approximately 50% of ischemic strokes in some populations. Its prevalence and associated mortality exhibit variation across demographics, yet no prior studies have assessed the location of death for individuals succumbing to cerebral atherosclerosis. This study evaluates trends in mortality, racial disparities, and location of death in the United States.
METHODS: Data from the CDC WONDER database were analyzed, including all deaths attributed to cerebral atherosclerosis. We conducted analyses using both underlying cause of death (primary cause) and multiple causes of death (any mention of the condition). Variables analyzed included race, ethnicity, sex, age group, year of death, geographic region, urban-rural status, and location of death. A multinomial logistic regression model was used to assess factors influencing the location of death, with odds ratios (ORs) calculated.
RESULTS: From 1999 to 2022, cerebral atherosclerosis was listed as the underlying cause of death in 83,978 cases and as either an underlying or contributing cause in 162,489 deaths. Decedents were predominantly White (87.7 % underlying, 88.5 % multiple) and female (65.9 % underlying, 63.8 % multiple), with the majority aged ≥ 85 years (68.6 % underlying, 62.9 % multiple). The most common locations of death were nursing homes (42.2 % underlying, 42.2 % multiple) and home (38.4 % underlying, 33.6 % multiple). Older age was consistently associated with a higher likelihood of death outside the hospital, particularly at home (OR ≥ 85 years: 3.08 underlying, 4.24 multiple) or in hospice (OR ≥ 85 years: 2.00 underlying, 4.24 multiple). African American decedents had lower odds of dying at home (OR: 0.52 underlying, 0.57 multiple) and in nursing homes (OR: 0.35 underlying, 0.40 multiple). Year, geographic region, and urban/rural status also significantly influenced the location of death in both analyses, demonstrating complex regional and temporal trends.
CONCLUSION: Significant demographic and racial disparities exist in the location of death for individuals with cerebral atherosclerosis. These findings highlight the need for targeted interventions to address disparities in end-of-life care and improve access to preferred settings of death, particularly for minority populations
Facial follicular porokeratosis simulating discoid lupus erythematosus in an African American woman.
No full textInfantile Hemangioma With Aggressive, Early-Onset Ulceration, and Kasabach-Merritt-Like Phenomenon in a Newborn.
No full textInfantile hemangiomas (IH) are the most common benign tumors of infancy and progress through recognized stages of evolution including early proliferation, plateau, and involution. Ulceration is a common complication of IHs typically observed during the early proliferative stage characterized by rapid growth. In rare cases, ulceration is the primary clinical manifestation of IHs. We present the case of a newborn with an IH manifesting as an aggressive, early-onset ulcerative lesion on the lower extremity associated with transient thrombocytopenia and coagulation abnormalities
Tendon Inversion Improves Tendon-to-Bone Healing in a Rat Bicep Tenodesis Model.
No full textPURPOSE: Tendon-to-bone repair remains a surgical challenge. Although bone tunnel fixation is a common surgical technique whereby soft tissue is expected to heal against a bone tunnel interface, contemporary methods have yet to recapitulate biomechanical similarity to the native enthesis. In this study, we aimed to understand how inside-out longitudinal tendon inversion affects bone tunnel healing with the hypothesis that inversion removes the gliding epitenon surface to facilitate interface healing.
METHODS: Forty male Sprague-Dawley rats underwent either native tendon tenodesis (control group) or tendon inversion tenodesis (experimental group). Interface tissue was harvested 8 weeks after surgery. Biomechanical testing was performed to assess tensile strength and modes of failure. Histology was performed to assess tissue architecture, and immunohistochemistry confirmed the disruption of epitendinous lubricin from interface tissues.
RESULTS: Maximum tensile strength increased after tendon inversion compared with control surgery. The extracellular matrix protein lubricin was reduced with tendon inversion, and specimens with tendon inversion had greater healing scores and collagen fibril alignment at the healing interface.
CONCLUSIONS: Tendon inversion has the potential to improve bone tunnel healing in rats.
CLINICAL RELEVANCE: Our findings suggest that longitudinal tendon inversion, or inverse tubularization, in a rat biceps model improves tendon-to-bone healing in part because of disruption of the epitendinous surface at the bone healing interface. This work provides molecular insight into future improvements for tendon-to-bone repair surgical techniques
