Predictors of 30-day Mortality and 90-day Functional Recovery after Primary Pontine Hemorrhage

The factors related to death and functional recovery after primary pontine hemorrhage (PPH) in Koreans has not been well defined. The authors sought to identify independent predictors of death and functional recovery after PPH using data obtained at a single institute. Data were collected retrospectively on 281 patients with PPH admitted to the Stroke Unit at our hospital between January 1, 2000 and December 31, 2009. Multivariate logistic regression analysis was used to evaluate the associations between selected variables and 30-day mortality and 90-day functional recovery after PPH. One-hundred and ten patients (39.1%) died within 30 days of PPH and 27 patients (9.6%) achieved functional recovery within 90 days. By multivariate analysis, unconsciousness, dilated pupils, abnormal respiration, systolic blood pressure < 100 mmHg, hydrocephalus, and conservative treatment were found to be predictors of 30-day mortality, whereas consciousness, intact motor function, no history of hypertension or diabetes mellitus, intact eye movement, a hematoma volume of < 5 mL, no ventricular hemorrhage, and normally sized ventricle were found to be predictors of 90-day functional recovery. The present findings suggest that systolic hypotension of less than 100 mmHg may predict 30-day mortality and a history of underlying hypertension and diabetes mellitus may predict 90-day functional recovery

Prior antithrombotic therapy, particularly anticoagulant is associated with unfavorable outcomes in primary spontaneous intracerebral hemorrhage patients receiving craniotomy: A nationwide population-based cohort study.

OBJECTIVE: The impact of antithrombotic agents on primary intracerebral hemorrhage (ICH) patients remains controversial, especially with patients that require emergent craniotomy. This study was to evaluate clinical outcomes in operated ICH patients with and without prior antithrombotic agents. METHODS: This is a retrospective cohort study. Between January 2001 to December 2013, all ICH patients that received emergent craniotomy and is present in Taiwan's National Health Insurance Research Database were screened, and divided into prior antiplatelet therapy, anticoagulant therapy and non-antithrombotic therapy according to patient's healthcare claims data within 3 months of index admission. The primary endpoints included in-hospital mortality and complication, and short-term outcome. RESULTS: Of 18,872 eligible patients, 16,251 (87.1%) patients did not receive any antithrombotic therapy, 2,267 patients had antiplatelet therapy and 354 patients had anticoagulation therapy. After propensity score matching, significantly higher amount of blood transfusion and number of craniectomy was identified in the patients with prior antithrombotic treatment compared with non-antithrombotic therapy. In comparison with the non-antithrombotic treatment cohort, patients under prior anticoagulant treatment had significantly higher in-hospital mortality rate (Odds ratio, 2.12; 95% confidence interval, 1.45-3.10). Furthermore, during the 6-month follow-up period, prior anticoagulant therapy was independently associated with a greater risk of all-cause mortality rates (P = 0.001). Interestingly, the in-hospital and 6-month all-cause mortality of patients with prior antiplatelet treatment was not significantly different to patients with non-antithrombotic treatment. CONCLUSION: These findings suggested an increased risk of in-hospital mortality and poor short-term outcome among operated ICH patients with prior antithrombotic therapy, particularly anticoagulant therapy, but not with antiplatelet therapy

Distal subgaleal-peritoneal shunt migration into the abdominal wall with subsequent formation of a pre-peritoneal pseudocyst: a rare complication

Distal ventriculo-peritoneal shunt migration and extra-peritoneal CSF pseudocyst formation are unusual complications of shunt placement. We present a 65-year-old-female who received a subgaleal-peritoneal shunt to decompress a post-surgical subgaleal fluid collection. Eight weeks later, shunt series showed tight coiling of the distal catheter, and operative exploration found the distal shunt tip to have migrated superficial to the rectus sheath, where it had become encapsulated in a pre-peritoneal CSF pseudocyst. Migration of the distal catheter into the abdominal wall was likely due to local inflammation of the inner surface of the abdomen, with pressure from intestinal peristaltic movements and intra-abdominal pressure, and continued inflammation at the distal catheter tip may have caused formation of a pre-peritoneal CSF pseudocystic dilatation. To date, this is the first reported case of distal shunt migration into the abdominal wall with subsequent formation of an extra-peritoneal pseudocyst and represents a rare event in the surgical management of peritoneal shunts

HIGH CAPACITY AND HIGH EFFICIENCY MULTI-STAGE AIR INTAKE SYSTEM

ABSTRACT An advanced three stage filtration/separation air intake system (Compact II) is introduced in this paper. The system was developed to meet the current and expected future market demands for gas turbine combustion air treatment in a marine environment. Developing and testing of the Compact II are subjects of this paper