Transport strategy for ischaemic stroke patients with large vessel occlusion

Introduction. There are today two models of transporting patients with acute ischaemic stroke because of large artery occlusion (AIS-LVO): mothership (MS) and drip-and-ship (DS). Our aim was to evaluate our ongoing transport strategy (OT), which is an MS/DS hybrid. In our OT, the patient is transported directly to the CT of the Primary Stroke Centre (PSC), where intravenous thrombolysis (IVT) is administered. The patient then continues without delay to a Comprehensive Stroke Centre (CSC) with the same medical rescue team (MRT). The distance between our centres is 73 km.Material and methods. We retrospectively analysed data of 100 consecutive AIS-LVO patients treated with mechanical thrombectomy (MT) between January 2017 and October 2019. OT, MS and DS groups were compared. 31 patients were transported as MS, 32 as DS, and 37 as OT.Results. DS had significantly longer time to groin puncture (185 min) compared to OT and MS (p < 0.0001). OT shortened time almost to MS level (OT 124 min, MS 110 min, p = 0.002. Time to IVT administration (from MRT departure) differed statistically significantly in favour of OT (OT 27 min, MS 63 min, p < 0.0001). Logistical change in PSC had a significant effect on decreasing the door-to-needle time (DNT) median from 37 min to 11 min (p < 0.0001). DNT reduction also occurred in patients with AIS and without an indication for MT.Conclusions. OT is highly effective, significantly reducing the time to IVT administration, and combining all the benefits, while eliminating all the disadvantages, of DS and MS. The OT concept gives all indicated patients a chance for MT to be performed, and does not overload the performing centre

Multidetector row computed tonography in trauma - influence of the localization, size and density of active extravasation on subseduent clinical management

Detection rate of active bleeding and number of nonoperative treatment is increasing in trauma evaluated by whole-body multi-detector row computed tomography (MDCT) imaging. The aim of the study is to evaluate a MDCT detection of the active bleeding in trauma patients. We reviewed MDCT images for the presence of active hemorrhage in our data files. The site and number of the bleeding sites was noted. The size, area, density and relative density of the hemorrhage was noted, together with the nature and size of the surrounding hemorrhage hematoma. We also evaluated clinical factors as age, sex, the Injury Severity Score (ISS), Glasgow Coma Scale (GCS), systolic blood pressure on admission (SBP), heart rate (HR), hemodynamic status of the patient (HDO) and fluid resuscitation. Results were compared with clinical follow up or intraoperative findings (nonoperative management vs. intervention, dead or alive pts. in 30 day). The authors evaluated consecutive trauma patients examined between 2004-2008 and 2010-2013 who underwent whole-body or abdominal MDCT, and were examined 967 patients. Active bleeding was detected in 128 (13,2 %) of 967 patients. A total of 183 sources of active extravasation were identified. Eighty-six (47 %) of 183 bleeding sites underwent immediate intervention - surgical or..

Multidetector row computed tonography in trauma - influence of the localization, size and density of active extravasation on subseduent clinical management

Detection rate of active bleeding and number of nonoperative treatment is increasing in trauma evaluated by whole-body multi-detector row computed tomography (MDCT) imaging. The aim of the study is to evaluate a MDCT detection of the active bleeding in trauma patients. We reviewed MDCT images for the presence of active hemorrhage in our data files. The site and number of the bleeding sites was noted. The size, area, density and relative density of the hemorrhage was noted, together with the nature and size of the surrounding hemorrhage hematoma. We also evaluated clinical factors as age, sex, the Injury Severity Score (ISS), Glasgow Coma Scale (GCS), systolic blood pressure on admission (SBP), heart rate (HR), hemodynamic status of the patient (HDO) and fluid resuscitation. Results were compared with clinical follow up or intraoperative findings (nonoperative management vs. intervention, dead or alive pts. in 30 day). The authors evaluated consecutive trauma patients examined between 2004-2008 and 2010-2013 who underwent whole-body or abdominal MDCT, and were examined 967 patients. Active bleeding was detected in 128 (13,2 %) of 967 patients. A total of 183 sources of active extravasation were identified. Eighty-six (47 %) of 183 bleeding sites underwent immediate intervention - surgical or...Souhrn Při celotělovém multidetektorovém CT vyšetření (MDCT) u poranění narůstá počet zobrazených aktivních krvácení a stoupá počet konzervativně ošetřených pacientů. Práce je zaměřena na hodnocení průkazu aktivního krvácení na MDCT kontrastním vyšetření u pacientů s traumaty. V našich datových souborech sledujeme lokalizaci, velikost a denzitu aktivního krvácení spolu s charakterem krvácení a velikostí okolního hematomu. Další zaznamenané klinické faktory jsou věk, pohlaví, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), systolický krevní tlak (sTK), tepová frekvence (TF), hemodynamický stav pacienta (HDO) a volumoterapie. Cílem práce je posouzení závislosti zvolené terapie a výsledku léčby pacientů na výše sledovaných veličinách (konzervativní postup vs. intervence, přežití oproti úmrtí do 30tého dne po úrazu). V našem souboru z let 2004-2008 a 2010-2013 je 967 po sobě jdoucích pacientů s celotělovým CT vyšetřením, případně vyšetřením hrudníku a břicha. Aktivní krvácení jsme detekovali u 128 pacientů z 967 vyšetřených (13,2 %). Celkem bylo nalezeno 183 zdrojů aktivního krvácení. Celkem 86 ložisek krvácení ze 183 (47 %) bylo léčeno pomocí intervence - chirurgické či endovaskulární. Volba léčebného postupu významně souvisí s lokalizací krvácení (p˂0,00001). Velikost (p˂0,000001), plocha (p˂0,000001),...Department of Diagnostic RadiologyRadiologická klinikaLékařská fakulta v Hradci KrálovéFaculty of Medicine in Hradec Králov

Spontaneous Subarachnoid Hemorrhage in a Patient with a Co-Existent Posterior Communicating Artery Aneurysm and Cervical Spine Aneurysm Associated with Ventral Arterio-Venous Fistula

Severe spontaneous subarachnoid hemorrhage (SAH) is predominantly caused by aneurysm rupture, with non-aneurysmal vascular lesions representing only a minority of possible causes. We present the case of a 58-year old lady with a coincidental posterior communicating artery (PCom) aneurysm and a high cervical spine arterio-venous fistula associated with a small ruptured aneurysm. After the emergency clipping of the PCom aneurysm, additional diagnostic procedures—repeated digital subtraction angiography and spinal magnetic resonance imaging, revealed the actual cause of the SAH, a type-A ventral intradural fistula at cervical level C2/3. The fistula was treated micro surgically via a ventral approach using C3 somatectomy and C2-4 stabilization after the initial failure of endovascular therapy. Furthermore, the patient was treated for complications associated with severe SAH, including acute hydrocephalus and meningitis. In cases where the SAH pattern and perioperative findings do not suggest an intracranial aneurysm as the source of SAH, further diagnostic investigation is warranted to discover the real cause. Patients with severe non-aneurysmal SAH require a similar algorithm in diagnosing the cause of the hemorrhage as well as complex conditions such as ruptured aneurysms

The Iatrogenic Development of an Anterior Cerebral Artery Pseudoaneurysm during Lamina Terminalis Fenestration–Genesis, Diagnosis and Therapy: Lessons Learned

Intracranial pseudoaneurysms (PSA) are scarcely presented in the literature. We describe the case of an intracranial PSA on the right anterior cerebral artery, which developed during the complicated surgical treatment of a ruptured right middle cerebral aneurysm. The pseudoaneurysm grew over time and was co-incidentally diagnosed 3 months after the original surgery. The PSA was successfully treated by coiling. In cases of vascular injuries during complicated brain surgery, the timely and careful radiological diagnosis of such a lesion is necessary to allow its fast and proper treatment and thus prevent the patient from potential risks

Indoor positioning system based on fuzzy logic and WLAN infrastructure

This paper deals with the issue of mobile device localization in the environment of buildings, which is suitable for use in healthcare or crisis management. The developed localization system is based on wireless Local Area Network (LAN) infrastructure (commonly referred to as Wi-Fi), evaluating signal strength from different access points, using the fingerprinting method for localization. The most serious problems consist in multipath signal propagation and the different sensitivities (calibration) of Wi-Fi adapters installed in different mobile devices. To solve these issues, an algorithm based on fuzzy logic is proposed to optimize the localization performance. The localization system consists of five elements, which are mobile applications for Android OS, a fuzzy derivation model, and a web surveillance environment for displaying the localization results. All of these elements use a database and shared storage on a virtualized server running Ubuntu. The developed system is implemented in Java for Android-based mobile devices and successfully tested. The average accuracy is satisfactory for determining the position of a client device on the level of rooms.Web of Science2016art. no. 449

Bypass Procedure Performed in the Field of a Decompressive Craniectomy in the Case of an MCA Dissecting Aneurysm: Case Report and Review of the Literature

Treatment of complex aneurysms often requires additional surgical tools including the use of the extra-intracranial (EC-IC) bypass. The following report depicts the utilization of the EC-IC bypass in treating a dissecting aneurysm several hours after a salvage emergent evacuation of an acute subdural hematoma via decompressive craniectomy (DC). Preserving the superficial temporal artery during the DC provided a donor artery for the bypass surgery