The impact of carotid plaque presence and morphology on mortality outcome in cardiological patients

BACKGROUND: Carotid plaque severity and morphology can affect cardiovascular prognosis. We evaluate both the importance of echographically assessed carotid artery plaque geometry and morphology as predictors of death in hospitalised cardiological patients. METHODS: 541 hospitalised patients admitted in a cardiological division (age = 66 ± 11 years, 411 men), have been studied through ultrasound Duplex carotid scan and successively followed-up for a median of 34 months. Echo evaluation assessed plaque severity and morphology (presence of heterogeneity and profile). RESULTS: 361 patients showed carotid stenosis (67% with <50% stenosis, 18% with 50–69% stenosis, 9% with >70% stenosis, 4% with near occlusion and 2% with total occlusion). During the follow-up period, there were 83 all-cause deaths (15% of the total population). Using Cox's proportional hazard model, age (RR 1.06, 95% CI 1.03–1.09, p = 0.000), ejection fraction > 50% (RR = 0.62, 95% CI 0.4–0.96, p = 0.03), treatment with statins (RR = 0.52, 95% CI 0.29–0.95, p = 0.34) and the presence of a heterogeneous plaque (RR 1.6; 95% CI, 1.2 to 2.14, p = 0.002) were independent predictors of death. Kaplan – Meier survival estimates have shown the best outcome in patients without plaque, intermediate in patients with homogeneous plaques and the worst outcome in patients with heterogeneous plaques (90% vs 79% vs 73%, p = 0.0001). CONCLUSION: In hospitalised cardiological patients, carotid plaque presence and morphology assessed by ultrasound are independent predictors of death

Combined endoscopic third ventriculostomy and tumor biopsy in the management of pineal region tumors, safety considerations

Abstract Background Pineal region tumor is considered an ideal indication for endoscopic third ventriculostomy (ETV), with success rate up to 92%. The ultimate advantage is the ability to obtain tumor biopsy for histopathological diagnosis and for further treatment strategy plan design. Objectives To investigate the safety considerations to minimize tumor biopsy-related bleeding, increase diagnostic accuracy, and establish a successful ETV procedure. Methods Retrospective study including 25 patients of pineal region tumor with concomitant triventricular hydrocephalus. Preoperative planning to perform ETV and obtain tumor biopsy was achieved either through single more anteriorly located precoronal burr-hole (17 patients) or two separate burr-holes (eight patients). The patients’ age ranged from 9 months to 65 years with a mean age of 26.5 years. Preoperative MRI brain with coronal T2- and sagittal T1-weighted images was used to design trajectory. Results No significant intraventricular bleeding reported. A diagnostic tumor biopsy yield was successful in 22 patients. Ventriculoperitoneal shunt insertion was required in 1 patient failed to improve. Conclusion Endoscopic tumor biopsy is relatively safe with high diagnostic yield that helps in management protocol plus shunt independent control of associated hydrocephalus

Propofol versus meperidine and midazolam as a conscious sedation in percutaneous vertebroplasty: Prospective randomized trial

Background: Percutaneous vertebroplasty is a minimally invasive procedure, usually performed under local anesthesia with either general anesthesia or conscious sedation. In this study, we compared the efficacy and safety of propofol versus the combined use of meperidine and midazolam for conscious sedation in percutaneous vertebroplasty. Methods: This prospective randomized study was conducted within 6 months on sixty patients undergoing percutaneous vertebroplasty. The patients were divided into two equal groups: Group I received propofol, while Group II received meperidine and midazolam. The time required to achieve sufficient sedation, emergence time, recovery time, hemodynamic monitoring throughout the procedure, patient's and surgeon's satisfaction, and incidence of postprocedural complications were all recorded. Bispectral index and end-tidal carbon dioxide measurement were used to assess sedation level and to ensure patient safety throughout the procedure. Results: Demographic data from both groups were comparable. The time taken to reach sufficient sedation, emergence time, and recovery time were shorter in Group I than that in Group II (P = 0.001). Patients in both groups were hemodynamically stable throughout the procedure. Surgeon's satisfaction was higher in Group I (96%) than that in Group II (80%), while patient's satisfaction was nearly equal in both groups, without significant postoperative complications. Conclusions: Propofol was superior to the combined use of midazolam and meperidine for conscious sedation in percutaneous vertebroplasty. It helped in achieving a moderate sedation level in less time and offered rapid emergence from sedation, with shorter recovery time

Minimally invasive insertion of thecoperitoneal shunts using ventriculoscope

Background: Thecoperitoneal shunt insertion is an effective widely used procedure for treatment of idiopathic intracranial hypertension. Laparoscopic insertion of the peritoneal end minimizes extraperitoneal insertion, shunt migration, and shunt obstruction. However, this needs availability of laparoscopy sets and experienced laparoscopic surgeon. The aim of this study is to evaluate feasibility, safety and effectiveness of minimally invasive thecoperitoneal shunt insertion using ventriculoscope. Methods: Prospective study of 15 patients with IIH operated for minimally invasive thecoperitoneal shunt insertion using ventriculoscope. Operative time, intraoperative and post-operative complication, and clinical outcome were recorded. Results: All patients were females with mean age 27.2 years. The mean body mass index was 44.4. Headache and papilledema were present in all cases with mean CSF manometry 41.7 cm. Mean operative time was 48.9 min. Clinical improvement was achieved in all patients except one patient who developed shunt infection and meningitis. Conclusion: Minimally invasive thecoperitoneal shunt insertion using ventriculoscope is easy and safe. It minimizes complication of shunt obstruction, migration and extraperitoneal insertion in obese patients