Search Results (26)

Carotid pseudoaneurysms are rare and potentially life-threatening, often necessitating urgent surgical intervention. Patients with myeloproliferative disorders (MPD) are predisposed to thrombotic and inflammatory complications. Pyoderma gangrenosum (PG), a rare neutrophilic dermatosis, is often misdiagnosed in postoperative settings. In the following article, we present a case of a 58-year-old woman with Philadelphia-negative MPD, neutrophilic leukocytosis, thrombocytosis, osteoporosis, and hypothyroidism, who presented with a giant left common carotid artery pseudoaneurysm. She underwent urgent surgical revascularization via bypass using an autologous reversed saphenous vein graft from the right thigh and external carotid artery ligation. Immediately postoperatively, the patient developed left hemiparesis. Initial CT scans showed bypass graft occlusion and right MCA stroke. Immediate thrombolysis resulted in complete motor recovery, although the bypass remained occluded. On postoperative day 10, necrotic wound lesions developed, initially treated as infectious. After worsening post-debridement, dermatologic evaluation raised suspicion for PG, confirmed by biopsy. She responded well to corticosteroid therapy. Four weeks later, the thigh wound became superinfected with Pseudomonas aeruginosa and Klebsiella pneumoniae, successfully treated with broad-spectrum antibiotics. The patient fully recovered within two months. This case illustrates the complex interplay between vascular, thrombotic, and inflammatory complications in patients with MPD and emphasizes the importance of multidisciplinary care and early recognition of PG. Full article

Objective: We aimed to evaluate the feasibility, safety, and technical challenges of central aortic cannulation for total coronary revascularization via left anterior thoracotomy (TCRAT). Methods: A retrospective, single-center observational study was conducted on the first 29 TCRAT cases performed with central aortic cannulation. The primary outcomes included operative mortality, stroke, conversion to sternotomy, major aortic bleeding, and dissection; the secondary outcomes included delirium, reoperation, infection, ICU stay, and hospitalization. The descriptive statistics were reported as means ± SD or median (interquartile range [IQR]). Results: The mean age of the patients was 57.2 ± 9.8 years, with 72% of these being male. The most frequent comorbidities observed in the study population were hypertension (62%), diabetes (52%), and peripheral artery disease (28%). The mean cross-clamp time was found to be 63 ± 27 min, and the mean CPB time was 118.6 ± 41.6 min. The occurrence of stroke, aortic dissection, major bleeding, and sternotomy conversions was not observed. One patient died from severe pneumonia on the ninth post-operative day. The mean ICU stay was 1.2 ± 0.4 days, and the mean hospital stay was 5.3 ± 1.1 days. Conclusions: Central aortic cannulation appears to be a safe and feasible procedure for TCRAT, providing physiological antegrade flow and eliminating the complications associated with peripheral cannulation. The preliminary findings suggest that central arterial cannulation may be a safe and practical alternative for the TCRAT technique, but prospective comparative studies are required to confirm its benefits over the femoral and axillary approaches. Full article

Background: Ventricular assist devices serve as a critical bridge to transplantation for pediatric patients with end-stage heart failure. This study evaluated the outcomes of pediatric patients who received Berlin Heart EXCOR support for end-stage heart failure. Methods: We retrospectively analyzed data from 11 consecutive pediatric patients (63.64% male, median age 60 months) who underwent Berlin Heart implantation from November 2021 to April 2025. The majority (90.90%) had dilated cardiomyopathy, and 72.73% were INTERMACS class I. Results: Of the 11 patients, 54.54% received an LVAD only, 36.36% received a BiVAD, and 9.09% required an LVAD followed by an RVAD. The postoperative mean ICU stay was 140 ± 73 days, and total hospital stay was 192 ± 96 days. Significant post-implant complications included stroke (27.27%), bleeding requiring exploration (27.27%), and pneumonia (36.36%). Ten patients (90.91%) were successfully bridged to heart transplantation, with one pre-transplant mortality (9.09%) due to brain hemorrhage. The median time to transplantation was 88 days (interquartile range, IQR: 78–177). During a median follow-up of 17 months (IQR: 7–32), two patients died post-transplant, resulting in an overall survival rate of 67.50% at 3 years. Conclusions: Despite significant complications and prolonged hospitalization, the Berlin Heart demonstrated effectiveness as a mechanical circulatory support device for pediatric patients, with a high rate of successful bridging to transplantation and acceptable mid-term survival. These findings support its use as a viable bridge to transplantation in pediatric end-stage heart failure. Full article

Background/Objectives: Infections are common complications in patients with spontaneous intracerebral hemorrhage (ICH). This study investigated whether early surgical hematoma evacuation can reduce post-ICH infections and the impact of residual hematomas on infectious complications. Methods: Demographic, radiological, and clinical outcome data were collected for 174 patients with spontaneous ICH. The patients were classified according to treatment (Group A, without surgery; Group B, hematoma evacuation with residual hematoma volume ≥10 mL; Group C, hematoma evacuation with residual hematoma volume <10 mL). Kaplan–Meier analysis was used to evaluate infectious complications following ICH, while multivariate logistic regression analysis was used to identify risk factors for infectious complications. Results: Groups A, B, and C included 88 (50.6%), 25 (14.4%), and 61 (35.0%) patients, respectively. A total of 68 patients (39.0%) experienced 88 infectious complications, most frequently pneumonia and urinary tract infections. Group C had a significantly lower frequency of infectious complications compared with Groups A and B (p = 0.016). The independent risk factors for infectious complications included age, higher National Institutes of Health Stroke Scale score at admission, motor weakness, intraventricular hemorrhage, Group A, and Group B. Patients with infections had longer hospital stays. The frequencies of poor clinical outcomes at one and six months in patients with infection were lower than those in patients without infection (both p < 0.01). Conclusions: Surgical hematoma evacuation can reduce the risk of post-hemorrhagic stroke infections. Moreover, residual hematoma after surgical evacuation was associated with the risk of cytotoxic effects and subsequent infectious complications. Full article

Background/Objectives: Colorectal surgeons continue to care for an aging cancer population with increasing comorbidities and frailty. Frailty, characterized by a systemic physiologic decline associated with aging, is an increasingly popular focus in surgical outcomes research. This retrospective study investigates how frailty impacts outcomes in the octogenarian and nonagenarian populations undergoing surgical treatment for colon cancer. Methods: Data from the National Surgical Quality Improvement Program (NSQIP) colectomy-targeted variables dataset from 2015 to 2021 were utilized for this analysis, including patients 80 years of age and older. Frailty was assessed using the five-factor modified frailty index (mFI-5). The study examined post-operative outcomes across frailty groups in this population. Results: From 2015–2021, there were 10,671 patients aged 80 years and older who underwent colectomy for colon cancer, of whom 1259 (11.8%) were 90 years or older and 2844 (26.7%) were severely frail. Frailty significantly impacted post-operative colectomy outcomes in this population. On univariate analysis, frail patients had higher rates of pneumonia (p = 0.015), unplanned intubation (p = 0.012), stroke (p < 0.001), myocardial infarction (p = 0.011), readmission (p < 0.001), long length of stay (p < 0.001), and mortality (p < 0.001) compared to non-frail patients. On multivariate analysis, severe frailty (mFI-5 of 2 or more) was associated with an increased odds of unplanned intubation (aOR 2.41, 95% CI 1.27–4.59), long length of stay (aOR 1.73, 95% CI 1.44–2.09), readmission (aOR 1.84, 95% CI 1.42–2.39), and mortality (aOR 1.95, 95% CI 1.20–3.15) compared to non-frail patients. Conclusions: Frailty plays a critical role in influencing the outcomes of octogenarians and nonagenarians undergoing colectomy for colon cancer within the NSQIP dataset. Future work should investigate whether addressing frailty prior to surgery in this population can improve patients’ post-operative courses. Full article

Seizure clusters can be observed in patients with epilepsy as well as in individuals without a previous history of epilepsy. However, there are no data on whether seizure clusters differ between these two populations. The purpose of this study was to investigate the clinical presentation, diagnostic findings, presence of seizure triggers, outcomes and complications of seizure clusters in patients with epilepsy and individuals without epilepsy in their medical history. The results indicate that epilepsy history was not independently associated with the number of seizures during cluster; however, increasing age was significantly associated with a lower seizure burden, and pneumonia demonstrated a marginal positive association. Structural brain lesions were prevalent in both groups; particularly chronic post-stroke lesions and frontal lobe lesions were significantly more common among epilepsy patients. Over half of patients without prior epilepsy received a new epilepsy diagnosis following the cluster event. No severe complications, including status epilepticus or postictal psychosis, were observed. Our findings suggest that age, acute comorbidities, and structural brain pathology likely exert greater influence on frequency of seizures during cluster. Chronic post-stroke lesions, which have not yet been reported as a risk factor for seizure clusters, were the most frequent brain pathology in both groups and may thus be considered as an additional risk factor for this clinical entity. Prospective and larger-scale studies are needed to further clarify these associations. Full article

Background: Poststroke dysphagia is a common condition that can lead to complications such as aspiration pneumonia and malnutrition, significantly affecting the quality of life. Most patients recover their swallowing function spontaneously, but in others difficulties persist beyond six months. Can we predict this in advance? On the other hand, there have been recent attempts to use machine learning to predict disease prognosis. Therefore, this study aims to investigate whether machine learning can predict the long-term prognosis for poststroke dysphagia using early videofluoroscopic swallowing study (VFSS) data. Methods: Data from VFSSs performed within 1 month of onset and swallowing status at 6 months were collected retrospectively in patients with dysphagia who experienced their first acute stroke at a university hospital. We selected 14 factors (lip closure, bolus formation, mastication, apraxia, tongue-to-palate contact, premature bolus loss, oral transit time, triggering of pharyngeal swallow, vallecular residue, laryngeal elevation, pyriform sinus residue, coating of the pharyngeal wall, pharyngeal transit time, and aspiration) from the VFSS data, scored them, and analyzed whether they could predict the long-term prognosis using five machine learning algorithms: Random forest, CatBoost classifier, K-neighbor classifier, Light gradient boosting machine, Extreme gradient boosting. These algorithms were combined through an ensemble method to create the final model. Results: In total, we collected data from 448 patients, of which 70% were used for training and 30% for testing. The final model was evaluated using accuracy, precision, recall, F1-score, and Area Under the Receiver Operating Characteristic Curve (AUC), resulting in values of 0.98, 0.94, 0.84, 0.88, and 0.99, respectively. Conclusions: Machine learning models using early VFSS data have shown high accuracy and predictive power in predicting the long-term prognosis of patients with poststroke dysphagia, and they are likely to provide useful information for clinicians. Full article

Background: Stress hyperglycemia may deteriorate stroke outcomes, but its impact on the prognosis following mechanical thrombectomy remains unclear. This study aimed to evaluate the effects of stress hyperglycemia on in-hospital and 3-month outcomes in stroke patients with anterior circulation occlusion undergoing mechanical thrombectomy. Methods: A total of 415 patients who had mechanical thrombectomy in the anterior circulation were enrolled. The stress hyperglycemia ratio (SHR) was calculated as the fasting glucose to glycated hemoglobin ratio and was categorized into tertiles (i.e., SHR1–3). In-hospital and 3-month outcomes were compared using multivariable regression models. The impact of SHR stratified by diabetes status was evaluated and the predictive accuracy of the Totaled Health Risks in Vascular Events (THRIVE)-c risk score was explored with the inclusion of SHR. Results: Compared to the SHR1–2 groups, the SHR3 group exhibited significantly higher rates of 24 h symptomatic intracranial hemorrhage (adjusted odds ratio [aOR], 4.088; 95% confidence interval [CI], 1.551–10.772; p = 0.004) and 72 h early neurological deterioration (aOR, 3.505; 95% CI, 1.984–6.192; p < 0.001), while the incidence of post-stroke pneumonia did not differ significantly between the groups (aOR, 1.379; 95% CI, 0.838–2.268; p = 0.206). At three months, the SHR3 group had a worse distribution of modified Rankin scale (aOR, 2.261; 95% CI, 1.495–3.421; p < 0.001) and faced a higher risk of functional dependence (adjusted hazard ratio [aHR], 1.629; 95% CI, 1.230–2.158; p = 0.001) as well as all-cause mortality (aHR, 1.986; 95% CI, 1.235–3.194; p = 0.005). The adverse effects of an elevated SHR were more pronounced in non-diabetic patients, and incorporating SHR significantly enhanced the predictive accuracy of the THRIVE-c score for poor stroke outcomes. Conclusions: Stress hyperglycemia could be related to the risks of in-hospital complications and 3-month poor outcomes following mechanical thrombectomy in the anterior circulation. Full article

Background/Objectives: Coronary artery bypass surgery (CABG) with multiple arterial grafting (MAG) has shown potential to improve patient survival compared to single arterial bypass grafting. Whether this superiority in survival also exists in diabetics is uncertain. We therefore aimed to compare short and long-term outcomes of MAG in diabetic versus non-diabetic patients. Methods: In this retrospective study, we investigated short- and long-term clinical outcomes of diabetic (n = 256) and non-diabetic (n = 800) patients undergoing CABG with MAG between January 1999 and December 2019 at our institution. Results: Diabetics had a significantly higher EuroScore II (1.37 ± 2.4 vs. 0.88 ± 1.58, p < 0.0001) and underwent significantly less bilateral internal thoracic artery (BITA) grafting (51.95% vs. 67.75%; p < 0.0001) compared to non-diabetics. The incidence of postoperative adverse events, such as pneumonia, stroke, and sepsis, did not differ between the two groups. However, diabetics suffered significantly more often from post-cardiotomy cardiogenic shock, renal failure requiring dialysis, and sternal wound infections over the entire follow-up period. Non-diabetics had a significantly higher median survival time of 19.6 years compared to 14.54 years found in diabetic patients (p < 0.0001). Conclusions: Among patients undergoing MAG, diabetic individuals were found to have a significantly lower overall median survival. This emphasizes the importance of diabetes as a risk factor in choosing individual surgical strategies. Full article

Background and Purpose: Nutritional status can influence the outcomes and mortality of various diseases. The association between initial nutritional status and ischemic stroke outcomes, however, remains poorly understood. This study investigated whether the Controlling Nutritional Status (CONUT) score at admission could predict functional recovery, complications, and survival following an ischemic stroke. Methods: We enrolled a total of 938 patients experiencing their first acute ischemic stroke and categorized them into three groups based on their CONUT score at admission: CONUT 0–1, CONUT 2–4, and CONUT 5–12. The CONUT score was assessed using the serum albumin, total cholesterol, and lymphocyte count. We evaluated the incidence of complications during their hospital stay. Outcomes, including the Modified Rankin Scale (mRS), Functional Independence Measurement (FIM), Functional Ambulatory Classification (FAC), and mortality, were assessed at baseline, as well as at three and six months post-stroke. Results: CONUT scores were significantly associated with functional outcomes (mRS, FIM, and FAC) and mortality during the six-month follow-up period post-stroke (all p < 0.05). The CONUT 5–12 group exhibited significantly poorer improvements in mRS, FIM, and FAC scores (all p < 0.05) and a lower survival rate (p < 0.01) during the six-month follow-up compared to the CONUT 0–1 and CONUT 2–4 groups. Additionally, the incidence of pneumonia, urinary tract infections, pressure sores, falling injuries, and fractures was significantly higher in the CONUT 5–12 group than in the other groups (all p < 0.01). Conclusions: CONUT scores at admission are associated with functional recovery, mortality, and the incidence of complications following a first-ever ischemic stroke. Consequently, the early identification of patients at risk of malnutrition via CONUT scores can be crucial in enhancing patient assessment after an acute stroke. Full article

Background: Frailty is common in stroke, where it exerts disease- and treatment-modifying effects. However, there has been little work evaluating how frailty influences outcomes after percutaneous endoscopic gastrostomy (PEG) tube insertion. This study investigates the relationship between pre-stroke frailty and one-year mortality following PEG insertion. Methods: A pre-stroke frailty index (FI) was calculated for individuals with post-stroke dysphagia who underwent PEG insertion between March 2019 and February 2021. Mortality was recorded at one year, as well as instances of post-PEG pneumonia and discharge destination. Results: Twenty-nine individuals underwent PEG insertion, eleven (37.9%) of whom died in the subsequent year. The mean (SD) FI for those who survived was 0.10 (0.09), compared to 0.27 (0.19) for those who died (p = 0.02). This remained significant after adjustment for age and sex, with each 0.1 increase in the FI independently associated with an increased odds of one-year mortality (aOR 1.39, 95% CI 1.17–1.67). There was no association between frailty and post-PEG pneumonia (0.12 (0.21) in those who aspirated versus 0.11 (0.18) in those who did not, p = 0.75). Conclusions: Pre-stroke frailty is associated with increased one-year mortality after PEG, a finding that may help inform shared clinical decision-making in complex decisions regarding PEG feeding. Full article

The aim of this study was to examine the frequency of dysphagia in patients with ischaemic stroke. It was crucial to evaluate the relationship between swallowing disorders and selected demographic and clinical indicators. Additionally, the association between various patient feeding methods and selected demographic and clinical factors was assessed. Based on the analysis of medical documentation, we identified the most important clinical parameters, including demographic data, the frequency of stroke risk factors, the location of the ischaemic lesion, cortical involvement, stroke severity as measured by the NIHSS (Nationale Institutes of Health Stroke Scale), and the methods of feeding post-stroke patients. Dysphagia was observed in 65.9% of the patients in the study group. Hypertension was the most common chronic illness in the studied population of ischemic stroke patients (91.8% of patients). Diet modification (35.7%) and PEG (25%) were the frequent methods of feeding in patients with confirmed dysphagia. Age played a significant role in determining the feeding methods in patients with dysphagia. Patients with a PEG (Percutaneous Endoscopic Gastrostomy) tube were the oldest (79.37 ± 10.80) and 75% of them had pneumonia. Early identification of swallowing difficulties in stroke patients is critical in determining an appropriate and safe feeding plan, as well as initiating logopedics therapy to improve swallowing efficacy and minimize pulmonary complications. Full article

Background: Radical cystectomy is a complex procedure imposing significant post-operation complications. Objective: Explore the impact of peri-operative pRBC transfusion on mortality and overall morbidity in a matched cohort. Methods: The American College of Surgeons—National Surgical Quality Improvement Program’s (ACS-NSQIP) dataset was used to select patients who underwent RC in 2008–2019. Patients who witnessed pre-operative transfusion and emergency cases were excluded. Peri-operative pRBC transfusion was defined as an intra-operative or up to 24-h post-operative pRBC transfusion. We matched patients who underwent peri-operative pRBC transfusion to patients who did not receive transfusion. Length of stay, mortality, and overall morbidity were compared between the two matched cohorts. Results: The match cohort was matched on all pre-operative demographics and medical history variables and yielded 3578 matched patients. Patients who underwent peri-operative pRBC transfusion had a longer length of hospital stay (9.3 days) as compared to patients who did not undergo transfusion (8.13 days) (p < 0.001). Furthermore, patients who underwent transfusion also had higher odds of mortality (OR = 1.934) and overall morbidity (OR = 1.443) (p < 0.03). Specifically, patients who underwent transfusion had higher odds of organ space SSI, pneumonia, unplanned intubation, pulmonary embolism, failure to wean off of ventilator, renal insufficiency, urinary tract infections, stroke, myocardial infarction, cardiac arrest requiring CPR, deep vein thrombosis, and septic shock (p < 0.047). Conclusion: Peri-operative pRBC transfusion in RC was associated with longer hospital stays, significant morbidity, and mortality. For this reason, pre-operative patient optimization and possible alternatives to common pRBC practices should be considered in RC to circumvent complications. Full article

Despite significant advances in medical imaging, thrombolytic therapy, and mechanical thrombectomy, acute ischemic strokes (AIS) remain a major cause of mortality and morbidity globally. Targeted temperature management (TTM) has emerged as a potential therapeutic intervention, aiming to mitigate neuronal damage and improve outcomes. This literature review examines the efficacy and challenges of TTM in the context of an AIS. A comprehensive literature search was conducted using databases such as PubMed, Cochrane, Web of Science, and Google Scholar. Studies were selected based on relevance and quality. We identified key factors influencing the effectiveness of TTM such as its timing, depth and duration, and method of application. The review also highlighted challenges associated with TTM, including increased pneumonia rates. The target temperature range was typically between 32 and 36 °C, with the duration of cooling from 24 to 72 h. Early initiation of TTM was associated with better outcomes, with optimal results observed when TTM was started within the first 6 h post-stroke. Emerging evidence indicates that TTM shows considerable potential as an adjunctive treatment for AIS when implemented promptly and with precision, thereby potentially mitigating neuronal damage and enhancing overall patient outcomes. However, its application is complex and requires the careful consideration of various factors. Full article

In this study, the relationship between the duration of physical rehabilitation and occurrence of pneumonia after ischemic stroke was examined. We included 426,508 patients aged $\ge$75 years with acute ischemic stroke. A multilevel logistic regression analysis nested at the hospital level was conducted to examine the association between the duration of physical rehabilitation and occurrence of pneumonia. The duration of physical rehabilitation refers to the hours of physical rehabilitation performed daily until the 7th day of hospitalization. In the multivariable analysis, the intensity of rehabilitation for durations of 20–39 min/day (adjusted odds ratio [aOR]: 0.78, 95% Confidence Interval [CI]: 0.75–0.81, p < 0.001), 40–59 min/day (aOR: 0.68, 95% CI: 0.66–0.71, p < 0.001), 60–79 min/day (aOR:0.56, 95% CI: 0.53–0.58, p < 0.001), and $\ge$80 min/day (aOR: 0.46, 95% CI: 0.44–0.48, p < 0.001) were significantly associated with a reduced incidence of pneumonia. In addition, the trend identified for duration of rehabilitation was significant (p < 0.001). The results of this study suggest the usefulness of high-duration physical rehabilitation for preventing pneumonia in older patients with ischemic stroke. Full article