ABSTRACT
OBJECTIVES: The benefit of carotid endarterectomy (CEA) may be diminished by cranial nerve injury (CNI). Using a quality improvement registry, we aimed to identify the nerves affected, duration of symptoms (transient vs. persistent), and clinical predictors of CNI. METHODS: We identified all patients undergoing CEA in the Vascular Study Group of New England (VSGNE) between 2003 and 2011. Surgeon-observed CNI rate was determined at discharge (postoperative CNI) and at follow-up to determine persistent CNI (CNIs that persisted at routine follow-up visit). Hierarchical multivariable model controlling for surgeon and hospital was used to assess independent predictors for postoperative CNI. RESULTS: A total of 6,878 patients (33.8% symptomatic) were included for analyses. CNI rate at discharge was 5.6% (n = 382). Sixty patients (0.7%) had more than one nerve affected. The hypoglossal nerve was most frequently involved (n = 185, 2.7%), followed by the facial (n = 128, 1.9%), the vagus (n = 49, 0.7%), and the glossopharyngeal (n = 33, 0.5%) nerve. The vast majority of these CNIs were transient; only 47 patients (0.7%) had a persistent CNI at their follow-up visit (median 10.0 months, range 0.3-15.6 months). Patients with perioperative stroke (0.9%, n = 64) had significantly higher risk of CNI (n = 15, CNI risk 23.4%, p < .01). Predictors for CNI were urgent procedures (OR 1.6, 95% CI 1.2-2.1, p < .01), immediate re-exploration after closure under the same anesthetic (OR 2.0, 95% CI 1.3-3.0, p < .01), and return to the operating room for a neurologic event or bleeding (OR 2.3, 95% CI 1.4-3.8, p < .01), but not redo CEA (OR 1.0, 95% CI 0.5-1.9, p = .90) or prior cervical radiation (OR 0.9, 95% CI 0.3-2.5, p = .80). CONCLUSIONS: As patients are currently selected in the VSGNE, persistent CNI after CEA is rare. While conditions of urgency and (sub)acute reintervention carried increased risk for postoperative CNI, a history of prior ipsilateral CEA or cervical radiation was not associated with increased CNI rate.
Subject(s)
Cranial Nerve Injuries/etiology , Endarterectomy, Carotid/adverse effects , Aged , Aged, 80 and over , Chi-Square Distribution , Cranial Nerve Injuries/diagnosis , Cranial Nerve Injuries/physiopathology , Female , Humans , Male , Middle Aged , Multivariate Analysis , New England , Odds Ratio , Patient Discharge , Patient Selection , Quality Improvement , Quality Indicators, Health Care , Recovery of Function , Registries , Risk Assessment , Risk Factors , Time Factors , Treatment OutcomeSubject(s)
Carotid Artery Diseases/drug therapy , Endarterectomy, Carotid , Platelet Aggregation Inhibitors/therapeutic use , Surveys and Questionnaires , Aspirin/therapeutic use , Carotid Artery Diseases/surgery , Clopidogrel , Europe , Humans , Incidence , Platelet Aggregation Inhibitors/adverse effects , Postoperative Hemorrhage/chemically induced , Postoperative Hemorrhage/epidemiology , Prognosis , Risk Factors , Secondary Prevention , Ticlopidine/adverse effects , Ticlopidine/analogs & derivatives , Ticlopidine/therapeutic useABSTRACT
Mesenteric injury from blunt abdominal trauma is rare and can be difficult to diagnose. Twenty-seven cases were admitted over the past 5 years to our Level I trauma center. These cases have been retrospectively reviewed to better define the experience of patients with blunt mesenteric injury for the physician faced with making this diagnosis. It was found that the diagnosis of mesenteric injuries tends to be delayed in a certain subset of patients. Patients with a devascularizing, isolated injury or patients who are evaluated by abdominal CT scan (as opposed to DPL) tended to be more likely to experience a diagnostic delay. It was also found that motor vehicle accidents are the most common, though not the only, mechanism of injury and that the mesentery of the small bowel is injured approximately five times more frequently than the colonic mesenteries. These factors, however, did not result in earlier diagnostic decision making. To decrease the likelihood of a missed diagnosis, physicians should entertain the possibility of mesenteric injury in all patients presenting with blunt abdominal trauma, even if few clinical findings are initially present and/or an abdominal CT scan demonstrates no definitive intraabdominal injury.
Subject(s)
Abdominal Injuries/diagnosis , Mesentery/injuries , Wounds, Nonpenetrating/diagnosis , Abdominal Injuries/etiology , Abdominal Injuries/surgery , Accidents, Traffic , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Peritoneal Lavage , Retrospective Studies , Time Factors , Tomography, X-Ray Computed , Wounds, Nonpenetrating/etiology , Wounds, Nonpenetrating/surgeryABSTRACT
Parkinson's disease is a relatively-common and disabling neurological condition. The aim of this study was to gather clinical and sociodemographic data on a sample of patients with Parkinson's disease in Tasmania, and to determine the impact of the disease on the patients. Sixty patients were studied. The median age of the sample was 71 years, and the median duration of Parkinson's disease was six years. About two-thirds of the patients experienced difficulty with simple everyday activities, such as dressing and getting out of a chair. Disability was related significantly to the duration of the disease. The number of antiparkinsonian drugs that were prescribed increased in proportion with the duration of the disease and the disability of the patient. Parkinson's disease was responsible apparently for 40% of the patients retiring from employment early; 32% of patients who had been drivers had lost their driver's licence because of the disease. Although the condition affects motor function progressively, few patients received physiotherapy as part of their management.
