Intravenous Thrombolysis of Occlusion in the Middle Cerebral and Retinal Arteries from Presumed Ventricular Myxoma

Background. Although thrombolytic therapy has been shown to be beneficial to stroke patients, the effectiveness of intravenous thrombolysis in ischemic stroke patients with ventricle myxoma is unknown. Case Description. A 22-year-old woman with left hemiplegia was sent to the emergency department at a teaching hospital. The magnetic resonance angiography showed occlusion of the right middle cerebral artery, and the echocardiography showed a mass in the left ventricle. Intravenous recombined tissue plasminogen activator (rt-PA) was administrated, and the postthrombolysis transcranial Doppler exam showed that her right middle cerebral artery was circulative. The patient's condition improved gradually, and no complication was observed up to 16 months of follow-up. Conclusion. Intravenous rt-PA is a reasonable treatment for stroke patients with ventricle myxoma

A Parallel Thrombolysis Protocol with Nurse Practitioners As Coordinators Minimized Door-to-Needle Time for Acute Ischemic Stroke

Introduction. Quick thrombolysis after stroke improved clinical outcomes. The study objective was to shorten door-to-needle time for thrombolysis. Methods. After identifying the sources of in-hospital delays, we developed a protocol with a parallel algorithm and recruited nurse practitioners into the acute stroke team. We applied the new protocol on stroke patients from October 2009 to September 2010. Patients from the previous two years were used for comparison. Results. For ischemic stroke patients within 3 hours of onset, the median time from arrival to computed tomography scanning was reduced from 29 to 20 minutes (P < 0.001) and the median time from arrival to neurology evaluation decreased from 61 to 43 minutes (P < 0.001). For those patients who received thrombolysis, the median door-to-needle time was shortened from 68.5 to 58 minutes (P < 0.05). Conclusions. The parallel thrombolysis protocol successfully improved the median door-to-needle time to below the guideline-recommended 60 minutes

Proposal for Improvement of Processes on the Production Line

Import 05/08/2014Cílem práce bylo najít úzké místo na lince obrábění a následně navrhnout možné kroky na zlepšení procesů. Nejprve bylo nutné se seznámit s výrobním procesem a jednotlivými operacemi, kterými musí výrobek projít. Úzké místo bylo nalezeno pomocí naměřených časů jednotlivých operací a časů linek. Tyto časy nám umožnily nalézt nejpomalejší úsek ve výrobě. Závěr diplomové práce se opírá o vypočtenou výrobní kapacitu, se kterou se pracovalo při návrzích na zlepšení.The main aim of this thesis was to find out a narrow place of the concrete machine tool and then suggest the possible steps to improve the processes. Firstly, it was necessary to become familiarized with the production process and the various operations in which the product must go through. The bottleneck was found out by accurate recording the operations and the production lines. These times showed us the slowest part of the production. The conclusion of this thesis relies on the calculated capacity which was used when the improvement suggestions were hand in.152 - Katedra podnikohospodářskávýborn

Clinical Study Underestimated Rate of Status Epilepticus according to the Traditional Definition of Status Epilepticus

properly cited. Purpose. Status epilepticus (SE) is an important neurological emergency. Early diagnosis could improve outcomes. Traditionally, SE is defined as seizures lasting at least 30 min or repeated seizures over 30 min without recovery of consciousness. Some specialists argued that the duration of seizures qualifying as SE should be shorter and the operational definition of SE was suggested. It is unclear whether physicians follow the operational definition. The objective of this study was to investigate whether the incidence of SE was underestimated and to investigate the underestimate rate. Methods. This retrospective study evaluates the difference in diagnosis of SE between operational definition and traditional definition of status epilepticus. Between July 1, 2012, and June 30, 2014, patients discharged with ICD-9 codes for epilepsy (345.X) in Chia-Yi Christian Hospital were included in the study. A seizure lasting at least 30 min or repeated seizures over 30 min without recovery of consciousness were considered SE according to the traditional definition of SE (TDSE). A seizure lasting between 5 and 30 min was considered SE according to the operational definition of SE (ODSE); it was defined as underestimated status epilepticus (UESE). Results. During a 2-year period, there were 256 episodes of seizures requiring hospital admission. Among the 256 episodes, 99 episodes lasted longer than 5 min, out of which 61 (61.6%) episodes persisted over 30 min (TDSE) and 38 (38.4%) episodes continued between 5 and 30 min (UESE). In the 38 episodes of seizure lasting 5 to 30 minutes, only one episode was previously discharged as SE (ICD-9-CM 345.3). Conclusion. We underestimated 37.4% of SE. Continuing education regarding the diagnosis and treatment of epilepsy is important for physicians

Progression of Mild to Moderate Stenosis in the Internal Carotid Arteries of Patients With Ischemic Stroke

Background and purpose: Severe stenosis in the internal carotid artery may increase the risk of ischemic stroke. The factors that affect the progression of carotid artery stenosis in patients with ischemic stroke are poorly studied. No guidelines for the duration of follow-up of patients with ischemic stroke through carotid ultrasonography exist.Methods: In this retrospective study, 179 patients (108 men; mean age, 68 years) with ischemic stroke and mild to moderate stenosis in the internal carotid artery (ICA) were recruited. Carotid artery ultrasonography was performed over the period of January 2013 to June 2016 with a median follow-up of 36 months (mean 36.5 ± 3.5 months). The severity of carotid artery stenosis was estimated with the following equation: 1– (narrowest ICA diameter/total lumen diameter at the narrowest site). The severity of stenosis was categorized into grades I (0–29%), II (30–49%), III (50–59%), and IV (60–69%). The patient's stenosis grade was defined on the basis of the stenosis rate of the ICA side with most severe stenosis.Results: Stenosis progressed in 17.9% (64/358) of the vessels in 30.7% (55/179) of patients. The risk of stenosis progression increased as the severity of ICA stenosis increased. Patients with stenosis rates of above 50% are at a higher risk of stenosis progression than those with stenosis rate of &lt; 50%. Relative to the patient group with an ICA stenosis rate of 0–29%, the adjusted odds ratios of stenosis progression were 2.33 (p = 0.03; 95% CI: 1.05~5.17), 3.50 (p = 0.09; 95% CI: 0.81~15.84), and 6.61 (p = 0.03; 95% CI: 1.01~39.61) in patient groups with ICA stenosis rates of 30–49%, 50–59%, and 60–69%, respectively. Hyper-LDL-cholesterolemia (Hyper-LDL-c) also increased the risk of stenosis progression, with an adjusted odds ratio of 2.22 (p = 0.03; 95% CI: 1.05~4.71).Conclusion: The rate of ICA stenosis progression increases with stenosis grade. Patients with ICA stenosis severity &gt;50% and Hyper-LDL-c have high rates of stenosis progression. For the patients with stroke and ICA stenosis severity &gt;50%, annual follow up through carotid artery ultrasonography may be necessary

Efficacy of aspirin, clopidogrel, and ticlopidine in stroke prevention: A population-based case-cohort study in Taiwan.

BackgroundIn real-world practice settings, there is insufficient evidence on the efficacy of antiplatelet drugs, including clopidogrel, aspirin, and ticlopidine, in stroke prevention.PurposeTo compare the efficacies between aspirin and clopidogrel and aspirin and ticlopidine in stroke prevention.MethodsThis population-based case-cohort study utilized the data obtained from a randomized sample of one million subjects in the Taiwan National Health Insurance Research Database. Patients who were hospitalized owing to the primary diagnosis of ischemic stroke from January 1, 2000 to December 31, 2010 and treated with aspirin, ticlopidine, or clopidogrel were included in the study. Propensity score matching with a 1:4 ratio was performed to compare aspirin with ticlopidine and clopidogrel. The criteria for inclusion were the use of one of the three antiplatelet drugs for more than 14 days within the first month after the stroke and then continued use of the antiplatelet drugs until the study endpoint of recurrent stroke.ResultsDuring the 3-year follow-up period, the recurrent stroke rates were 1.62% (42/2585), 1.48% (3/203), and 2.55% (8/314) in the aspirin, ticlopidine, and clopidogrel groups, respectively. Compared with the patients treated with aspirin, those treated with clopidogrel and ticlopidine showed competing risk-adjusted hazard ratios of recurrent stroke of 2.27 (1.02-5.07) and 0.62 (0.08-4.86), respectively.ConclusionCompared with the patients treated with aspirin, those treated with clopidogrel were at a higher risk of recurrent stroke. For stroke prevention, aspirin was superior to clopidogrel whereas ticlopidine was not inferior to aspirin

Demographic characteristics of patients and manifestations of stroke (n = 195).

Demographic characteristics of patients and manifestations of stroke (n = 195).</p

Factors affecting insomnia in patients with ischemic stroke (n = 195).

Factors affecting insomnia in patients with ischemic stroke (n = 195).</p