ABSTRACT
BACKGROUND AND PURPOSE: Decreasing the time delay for thrombolysis, including intravenous thrombolysis (IVT) with tissue plasminogen activator and intra-arterial thrombectomy (IAT), is critical for decreasing the morbidity and mortality of patients experiencing acute stroke. We aimed to decrease the in-hospital delay for both IVT and IAT through a multidisciplinary approach that is feasible 24 h/day. METHODS: We implemented the Stroke Alert Team (SAT) on May 2, 2016, which introduced hospital-initiated ambulance prenotification and reorganized in-hospital processes. We compared the patient characteristics, time for each step of the evaluation and thrombolysis, thrombolysis rate, and post-thrombolysis intracranial hemorrhage from January 2014 to August 2016. RESULTS: A total of 245 patients received thrombolysis (198 before SAT; 47 after SAT). The median door-to-CT, door-to-MRI, and door-to-laboratory times decreased to 13 min, 37.5 min, and 8 min, respectively, after SAT implementation (P<0.001). The median door-to-IVT time decreased from 46 min (interquartile range [IQR] 36–57 min) to 20.5 min (IQR 15.8–32.5 min; P<0.001). The median door-to-IAT time decreased from 156 min (IQR 124.5–212.5 min) to 86.5 min (IQR 67.5–102.3 min; P<0.001). The thrombolysis rate increased from 9.8% (198/2,012) to 15.8% (47/297; P=0.002), and the post-thrombolysis radiological intracranial hemorrhage rate decreased from 12.6% (25/198) to 2.1% (1/47; P=0.035). CONCLUSIONS: SAT significantly decreased the in-hospital delay for thrombolysis, increased thrombolysis rate, and decreased post-thrombolysis intracranial hemorrhage. Time benefits of SAT were observed for both IVT and IAT and during office hours and after-hours.
Subject(s)
Humans , Ambulances , Cerebral Infarction , Intracranial Hemorrhages , Mortality , Stroke , Thrombectomy , Thrombolytic Therapy , Tissue Plasminogen ActivatorABSTRACT
OBJECTIVES: Mastoid obliteration is used to obliterate the mastoid cavity following a mastoidectomy or to prevent the formation of a retraction pocket. This study evaluated the effectiveness of beta-tricalcium phosphate and polyphosphate (beta-TPP) for mastoid obliteration in middle ear surgeries in prospective human and animal studies. METHODS: Twenty patients with chronic otitis media underwent mastoid obliteration using beta-TPP after a intact canal wall mastoidectomy or simple mastoidectomy. The clinical data were prospectively evaluated including: the diagnosis, temporal bone computed tomography (TBCT), otoscopic findings, pure tone audiogram, and complications. In the animal experiment, beta-TPP was applied into the right bulla in five rats, and the opposite bulla was used as the control in the non-obliterated state. The skulls of five other rats were drilled out and the holes were obliterated with beta-TPP. TBCT were obtained at 3, 6, and 9 months after the obliteration and histologic analysis was done at 3 and 9 months after surgery. RESULTS: In the human study, fourteen TBCTs were obtained at 12 months after the surgery. All demonstrated no bone resorption in the obliterated mastoids. Among the 15 cases displaying retracted tympanic membranes preoperatively, 11 showed no retraction, 2 showed retraction postoperatively, 1 was lost to follow-up and 1 was a case of postoperative wound infection. Among 20 cases, one case developed a postoperative infection that necessitated a second operation. Sixteen underwent ossiculoplasty; hearing improvements were obtained in 15 cases and 1 case showed decreased hearing. In the animal study, new bone formation without significant bone resorption in the radiologic and histologic findings were noted in both the skull and bulla groups. CONCLUSION: Although beta-TPP is a foreign material having the possibility of infection, mastoid obliteration with it can be a treatment option in middle ear surgeries to prevent retraction pockets or the recurrence of diseases.
Subject(s)
Animals , Humans , Rats , Animal Experimentation , Blister , Bone Resorption , Calcium Phosphates , Cholesteatoma , Ear, Middle , Hearing , Lost to Follow-Up , Mandrillus , Mastoid , Osteogenesis , Otitis Media , Prospective Studies , Recurrence , Skull , Surgical Wound Infection , Temporal Bone , Tympanic MembraneABSTRACT
PURPOSE: The pulsatility index (PI), measured by transcranial Doppler (TCD), is a surrogate marker for distal vascular resistance in cerebral arteries, and elevated plasma total homocysteine (tHcyt) is regarded as a cause of ischemic stroke, including lacunar infarction. We investigated the relationship between the PI of cerebral arteries and plasma tHcyt in patients with lacunar infarction. MATERIALS AND METHODS: Plasma tHcyt level and TCD examination were performed in 94 patients with lacunar infarction. Mean flow velocity (MFV) and PI were assessed at the ipsilateral middle cerebral artery (MCA) and contralateral MCA, relative to the infarction, and the basilar artery (BA). Multivariate regression analysis was conducted between log-transformed tHcyt levels (logHcyt) and the PI of individual arteries. RESULTS: There was a significant correlation between logHcyt and the PI in all tested arteries (ipsilateral MCA: r=0.21, p=0.03; contralateral MCA: r=0.21, p=0.04; BA: r=0.35, p=0.01). In multivariate regression analysis, this significance remained unchanged after adjusting for vascular risk factors, creatinine, hematocrit and platelet count (ipsilateral MCA: beta=0.26, p=0.01; contralateral MCA: beta=0.21, p=0.04; BA: beta=0.39, p=0.001). There was no significant association between logHcyt and MFV of individual arteries. CONCLUSION: A significant association between plasma tHcyt and the PI of cerebral arteries indicates that homocysteine plays a role in the increase of distal arterial resistance in lacunar infarction.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Basilar Artery/diagnostic imaging , Cerebral Arteries/physiopathology , Hematocrit , Homocysteine/blood , Middle Cerebral Artery/diagnostic imaging , Regression Analysis , Risk Factors , Stroke, Lacunar/blood , Ultrasonography, Doppler, Transcranial , Vascular ResistanceABSTRACT
Myeloid sarcoma is a rare solid, extramedullary tumor composed of immature granulocytes, occurring in a granulocytic leukemia. In rare cases, they can represent the initial manifestation of a relapsed form in patients with acute myelogenous leukemia in remission status. There have been only a few reports of myeloid sarcoma involving the temporal bone. We report a case of facial nerve paralysis caused by temporal bone myeloid sarcoma as the presenting symptom of leukemic relapse in a 27-year-old female, who was affected by acute myelogenous leukemia.
Subject(s)
Adult , Female , Humans , Facial Nerve , Granulocytes , Leukemia, Myeloid , Leukemia, Myeloid, Acute , Paralysis , Recurrence , Sarcoma, Myeloid , Temporal BoneABSTRACT
No abstract available.
Subject(s)
Humans , Hepatitis C, Chronic , Hepatitis, Chronic , Interferon-alpha , Interferons , Polyneuropathies , Polyradiculoneuropathy, Chronic Inflammatory DemyelinatingABSTRACT
BACKGROUND AND OBJECTIVES: Bondy operation is a type of modified radical mastoidectomy whose operation window is through an external auditory canal via removal of superior and posterior walls without management of the middle ears. However, the usefulness of this operation is unclear. This study aimed to review our clinical experience of modified Bondy operations and to clarify its usefulness. MATERIALS AND METHODS: Fifteen patients underwent a modified Bondy operation at the Department of Ajou University Hospital between 1996 and 2010. Their clinical data were retrospectively reviewed including age, gender, chief complaint, diagnosis, pure tone average (PTA, a mean threshold of 0.5, 1, 2, and 3 kHz before and 3 months after the operation), otoscopic finding, temporal bone computed tomography, and recurrence rate. RESULTS: The mean age of the 15 patients was 35.3+/-14 (range 18-65) years. Post-operative diagnosis of all cases was cholesteatoma (nine attic, three external auditory canal, one sinus, and two recurrent). Pre- and postoperative PTAs were 27.4+/-18.3 dBHL and 26.0+/-10.7 dBHL, respectively (p=0.72). No postoperative recurrence or complications were noted over at least a 3-month follow-up. CONCLUSIONS: Modified Bondy operation is a good option to preserve hearing and prevent recurrence after operations in cases of cholesteatoma with relatively preserved middle ears.
Subject(s)
Humans , Cholesteatoma , Ear Canal , Ear, Middle , Hearing , Recurrence , Retrospective Studies , Temporal BoneABSTRACT
BACKGROUND AND OBJECTIVES: Bondy operation is a type of modified radical mastoidectomy whose operation window is through an external auditory canal via removal of superior and posterior walls without management of the middle ears. However, the usefulness of this operation is unclear. This study aimed to review our clinical experience of modified Bondy operations and to clarify its usefulness. MATERIALS AND METHODS: Fifteen patients underwent a modified Bondy operation at the Department of Ajou University Hospital between 1996 and 2010. Their clinical data were retrospectively reviewed including age, gender, chief complaint, diagnosis, pure tone average (PTA, a mean threshold of 0.5, 1, 2, and 3 kHz before and 3 months after the operation), otoscopic finding, temporal bone computed tomography, and recurrence rate. RESULTS: The mean age of the 15 patients was 35.3+/-14 (range 18-65) years. Post-operative diagnosis of all cases was cholesteatoma (nine attic, three external auditory canal, one sinus, and two recurrent). Pre- and postoperative PTAs were 27.4+/-18.3 dBHL and 26.0+/-10.7 dBHL, respectively (p=0.72). No postoperative recurrence or complications were noted over at least a 3-month follow-up. CONCLUSIONS: Modified Bondy operation is a good option to preserve hearing and prevent recurrence after operations in cases of cholesteatoma with relatively preserved middle ears.
Subject(s)
Humans , Cholesteatoma , Ear Canal , Ear, Middle , Hearing , Recurrence , Retrospective Studies , Temporal BoneABSTRACT
Langerhans cell histiocytosis (LCH) refers a group of disorders of the reticuloendothelial system characterized by a proliferation of histiocytes, which includes eosinophilic granuloma, Lettere-Siwe diseases, and Hand-Schuler Christian disease. The clinical presentation of LCH depends on the site of involvement. It can range from multifocal lesions to a solitary lesion. Tissues characteristically involved in LCH are bone, skin, lung, liver, spleen, bone marrow, lymph nodes and the hypothalamic-pituitary region, although the involvement of other organs such as the bowel can occur. We experienced a case of external auditory canal stenosis in LCH of multiple organ involvement in a 28-year-old male, and report it with a review of the relevant literature.
Subject(s)
Adult , Humans , Male , Bone Marrow , Constriction, Pathologic , Ear Canal , Eosinophilic Granuloma , Histiocytes , Histiocytosis, Langerhans-Cell , Liver , Lung , Lymph Nodes , Mononuclear Phagocyte System , Skin , Spleen , Temporal BoneABSTRACT
Langerhans cell histiocytosis (LCH) refers a group of disorders of the reticuloendothelial system characterized by a proliferation of histiocytes, which includes eosinophilic granuloma, Lettere-Siwe diseases, and Hand-Schuler Christian disease. The clinical presentation of LCH depends on the site of involvement. It can range from multifocal lesions to a solitary lesion. Tissues characteristically involved in LCH are bone, skin, lung, liver, spleen, bone marrow, lymph nodes and the hypothalamic-pituitary region, although the involvement of other organs such as the bowel can occur. We experienced a case of external auditory canal stenosis in LCH of multiple organ involvement in a 28-year-old male, and report it with a review of the relevant literature.
Subject(s)
Adult , Humans , Male , Bone Marrow , Constriction, Pathologic , Ear Canal , Eosinophilic Granuloma , Histiocytes , Histiocytosis, Langerhans-Cell , Liver , Lung , Lymph Nodes , Mononuclear Phagocyte System , Skin , Spleen , Temporal BoneABSTRACT
BACKGROUND: An alpha2-adrenergic receptor (alpha2-AR, ADRA2) mediates induction of hypotension and inhibition of lipolysis and insulin secretion. We evaluated whether single nucleotide polymorphisms (SNPs) of alpha2A (ADRA2A), alpha2B (ADRA2B), and alpha2C (ADRA2C) adrenergic receptors are associated with cerebral white matter lesion (cWML). METHODS: Total 336 study subjects who had no stroke were enrolled in this study. The Indices of cWML include total WML (TWML), periventricular WML (PVWML), and subcortical WML (SCWML) on brain fluid-attenuated inversion recovery (FLAIR) image. Common genetic variants of ADRA2A (1780G>A), ADRA2B (Ins/Del301-303), and ADRA2C (Ins/Del322-325) were examined. RESULTS: Among 336 study subjects, cWML was found in 66 patients (20%). In multivariate analysis, there were no significant effects of all tested ADRA2 polymorphisms on TWML. Significant association of ADRA2A 1780 AA genotype was found in PVWML (OR: 3.368, 95% CIs: 1.280-8.865, adjusted p-value after false discovery rate (FDR) correction=0.014) but not SCWML. CONCLUSION: Although SNPs of three ADRA2 subtypes failed to reach a significance in overall risk for cWML, the ADRA2A 1780G>A polymorphism may be associated with development of PVWML.