ABSTRACT
Background@#and Purpose In real-world practice, the benefit of mechanical thrombectomy (MT) is uncertain in stroke patients with very favorable or poor prognostic profiles at baseline. We studied the effectiveness of MT versus medical treatment stratifying by different baseline prognostic factors. Methods Retrospective analysis of 2,588 patients with an ischemic stroke due to large vessel occlusion nested in the population-based registry of stroke code activations in Catalonia from January 2017 to June 2019. The effect of MT on good functional outcome (modified Rankin Score ≤2) and survival at 3 months was studied using inverse probability of treatment weighting (IPTW) analysis in three pre-defined baseline prognostic groups: poor (if pre-stroke disability, age >85 years, National Institutes of Health Stroke Scale [NIHSS] >25, time from onset >6 hours, Alberta Stroke Program Early CT Score 3), good (if NIHSS <6 or distal occlusion, in the absence of poor prognostic factors), or reference (not meeting other groups’ criteria). @*Results@# Patients receiving MT (n=1,996, 77%) were younger, had less pre-stroke disability, and received systemic thrombolysis less frequently. These differences were balanced after the IPTW stratified by prognosis. MT was associated with good functional outcome in the reference (odds ratio [OR], 2.9; 95% confidence interval [CI], 2.0 to 4.4), and especially in the poor baseline prognostic stratum (OR, 3.9; 95% CI, 2.6 to 5.9), but not in the good prognostic stratum. MT was associated with survival only in the poor prognostic stratum (OR, 2.6; 95% CI, 2.0 to 3.3). @*Conclusions@# Despite their worse overall outcomes, the impact of thrombectomy over medical management was more substantial in patients with poorer baseline prognostic factors than patients with good prognostic factors.
ABSTRACT
Background@#and Purpose In real-world practice, the benefit of mechanical thrombectomy (MT) is uncertain in stroke patients with very favorable or poor prognostic profiles at baseline. We studied the effectiveness of MT versus medical treatment stratifying by different baseline prognostic factors. Methods Retrospective analysis of 2,588 patients with an ischemic stroke due to large vessel occlusion nested in the population-based registry of stroke code activations in Catalonia from January 2017 to June 2019. The effect of MT on good functional outcome (modified Rankin Score ≤2) and survival at 3 months was studied using inverse probability of treatment weighting (IPTW) analysis in three pre-defined baseline prognostic groups: poor (if pre-stroke disability, age >85 years, National Institutes of Health Stroke Scale [NIHSS] >25, time from onset >6 hours, Alberta Stroke Program Early CT Score 3), good (if NIHSS <6 or distal occlusion, in the absence of poor prognostic factors), or reference (not meeting other groups’ criteria). @*Results@# Patients receiving MT (n=1,996, 77%) were younger, had less pre-stroke disability, and received systemic thrombolysis less frequently. These differences were balanced after the IPTW stratified by prognosis. MT was associated with good functional outcome in the reference (odds ratio [OR], 2.9; 95% confidence interval [CI], 2.0 to 4.4), and especially in the poor baseline prognostic stratum (OR, 3.9; 95% CI, 2.6 to 5.9), but not in the good prognostic stratum. MT was associated with survival only in the poor prognostic stratum (OR, 2.6; 95% CI, 2.0 to 3.3). @*Conclusions@# Despite their worse overall outcomes, the impact of thrombectomy over medical management was more substantial in patients with poorer baseline prognostic factors than patients with good prognostic factors.
ABSTRACT
A medição dos gases sangüíneos foi realizada em cães submetidos à técnica de toracotomia em bloco. A medicação pré-anestésica constou de acetilpromazina administrada pela via intravenosa. Com injeção intravenosa de tiopental sódico foram providas a indução, intubação orotraqueal e manutenção da anestesia cirúrgica. O traqueotubo foi conectado a um respirador mecânico pressométrico, que manteve o animal oxigenado durante a operação. Foram colhidas amostras de sangue arterial por punção da artéria femoral para determinação do pH, pressão de dióxido de carbono (PCO2), pressão de oxigênio (PO2), excesso de base (BE) e bicarbonato (HCO3-). Nos animais do grupo II, no final da cirurgia (Tempo 1) e 24 horas após (Tempo 2), foi feita anestesia local dos nervos intercostais junto das costelas seccionadas para comparação das prováveis alterações da mecânica respiratória. A técnica da toracotomia em bloco promoveu excelente exposição das vísceras do tórax, com recuperação satisfatória, sem desconforto e complicação pós-operatória.
Blood gas analysis were measured in dogs submitted to en bloc thoracotomy. Preanesthetic medication consisted of acepromazine maleate injected intravenously. The animal was anesthetized with thiopental sodium intravenously, and the surgical field prepared. The trachea was intubated and mechanical ventilator was used. A radical thoracotomy was performed. Arterial samples of blood were collected from the femoral artery. Arterial blood pH value, carbon dioxide pressure (PCO2), PO2 level, base excess and standard bicarbonato level (HCO3-) were determined. Local anesthesia of intercostal nerves of the thorax, dose to the thoracotomy, were also performed on dogs in group II at end of surgery (T1) and 24 hours (T2) after the surgery. The dog recovered satisfactonly and in the following 7 days had no observable discomfort. It is anticipated that the results of this study will be useful to those using the en bloc thoracotomy, which provided excellent exposure ot the thoracic viscera with no postoperative complications.
ABSTRACT
Estudou-se o uso de placas de compressäo dinâmica na fixaçäo interna de osteotomias transversais diafisárias da tíbia, em quatro cäes. Constatou-se um rápido retorno à funçäo normal do membro operado nas duas primeiras semanas do pós-operatório. As radiografias mostraram mínima formaçäo de calo ósseo, indicando a excelente estabilidade da fixaçäo da tíbia com placas de compressäo dinâmica. Em três cäes, os implantes foram removidos com sucesso sete meses após a cirurgia
