23 research outputs found
Adenoma of the Papillae of Vater. Report of Eleven Cases
Eleven patients with a preoperative diagnosis of
adenoma of the papillae of Vater were followed up
during the fifteen-year period from 1984 till 1998 in
the Oulu University Hospital. Seven patients were
treated primarily by transduodenal excision without
any recurrences so far. One of these seven patients
was found to have adenocarcinoma in a histological
examination
Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Triggers, Causes, and Outcome (SECRETO): Rationale and design
Background: Worldwide, about 1.3 million annual ischaemic strokes (IS) occur in adults aged <50 years. Of these
early-onset strokes, up to 50% can be regarded as cryptogenic or associated with conditions with poorly documented
causality like patent foramen ovale and coagulopathies.
Key hypotheses/aims: (1) Investigate transient triggers and clinical/sub-clinical chronic risk factors associated with
cryptogenic IS in the young; (2) use cardiac imaging methods exceeding state-of-the-art to reveal novel sources for
embolism; (3) search for covert thrombosis and haemostasis abnormalities; (4) discover new disease pathways using
next-generation sequencing and RNA gene expression studies; (5) determine patient prognosis by use of phenotypic and
genetic data; and (6) adapt systems medicine approach to investigate complex risk-factor interactions.
Design: Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome
(SECRETO; NCT01934725) is a prospective multi-centre case–control study enrolling patients aged 18–49 years hospitalised
due to first-ever imaging-proven IS of undetermined etiology. Patients are examined according to a standardised
protocol and followed up for 10 years. Patients are 1:1 age- and sex-matched to stroke-free controls. Key study elements
include centralised reading of echocardiography, electrocardiography, and neurovascular imaging, as well as blood samples
for genetic, gene-expression, thrombosis and haemostasis and biomarker analysis. We aim to have 600 patient–
control pairs enrolled by the end of 2018.
Summary: SECRETO is aiming to establish novel mechanisms and prognosis of cryptogenic IS in the young and will
provide new directions for therapy development for these patients. First results are anticipated in 2019
Reliability of intracerebral hemorrhage classification systems: a systematic review
BACKGROUND: Accurately distinguishing non-traumatic intracerebral hemorrhage (ICH) subtypes is important since they may have different risk factors, causal pathways, management, and prognosis. We systematically assessed the inter- and intra-rater reliability of ICH classification systems. METHODS: We sought all available reliability assessments of anatomical and mechanistic ICH classification systems from electronic databases and personal contacts until October 2014. We assessed included studies' characteristics, reporting quality and potential for bias; summarized reliability with kappa value forest plots; and performed meta-analyses of the proportion of cases classified into each subtype. SUMMARY OF REVIEW: We included 8 of 2152 studies identified. Inter- and intra-rater reliabilities were substantial to perfect for anatomical and mechanistic systems (inter-rater kappa values: anatomical 0.78-0.97 [six studies, 518 cases], mechanistic 0.89-0.93 [three studies, 510 cases]; intra-rater kappas: anatomical 0.80-1 [three studies, 137 cases], mechanistic 0.92-0.93 [two studies, 368 cases]). Reporting quality varied but no study fulfilled all criteria and none was free from potential bias. All reliability studies were performed with experienced raters in specialist centers. Proportions of ICH subtypes were largely consistent with previous reports suggesting that included studies are appropriately representative. CONCLUSIONS: Reliability of existing classification systems appears excellent but is unknown outside specialist centers with experienced raters. Future reliability comparisons should be facilitated by studies following recently published reporting guidelines