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1.
Interact Cardiovasc Thorac Surg ; 25(5): 765-771, 2017 11 01.
Article in English | MEDLINE | ID: mdl-29049525

ABSTRACT

OBJECTIVES: This study prospectively evaluates the impact of the Haga Braincare Strategy (HBS) on the occurrence of haemodynamic and embolic stroke in a cohort of patients who underwent coronay artery bypass grafting (CABG), valve replacement of a combination of both types of surgery between 2012 and 2015 at the Haga Teaching Hospitals. METHODS: The HBS is a dual strategy based on a preoperative vascular work-up of the cerebral circulation by transcranial Doppler and a perioperative monitoring of the cerebral circulation by cerebral oximetry. Duplex of the carotid arteries and/or computed tomography angiography prior to surgery was performed in high-risk patients. Patients with severe carotid artery stenosis were scheduled for carotid angioplasty prior to surgery or waived from surgery. RESULTS: A total of 1065 patients were included. Poor cerebral haemodynamics were identified by transcranial Doppler in 2.1% of patients (n = 22). Based on the HBS, 3 patients were waived from surgery, 4 received preoperative carotid angioplasty followed by cardiac surgery and the remaining patients were operated while being monitored with bilateral cerebral oximetry sensors. In all, 2.2% of the study group experienced a stroke (n = 23), of which none were classified as haemodynamic. Most of the remaining presumed embolic strokes showed a minor to moderate stroke severity. CONCLUSIONS: In this single-centre prospective follow-up study, surveillance of cerebral perfusion by the HBS eliminated the occurrence of haemodynamic stroke while most of the residual strokes had a good to favourable prognosis.


Subject(s)
Cardiac Surgical Procedures/adverse effects , Cerebrovascular Circulation , Intracranial Embolism/diagnosis , Oximetry/methods , Aged , Computed Tomography Angiography , Female , Follow-Up Studies , Humans , Incidence , Intracranial Embolism/epidemiology , Intracranial Embolism/etiology , Magnetic Resonance Imaging , Male , Netherlands/epidemiology , Prospective Studies , Severity of Illness Index , Ultrasonography, Doppler, Transcranial
2.
Eur Radiol ; 13(3): 527-30, 2003 Mar.
Article in English | MEDLINE | ID: mdl-12594555

ABSTRACT

Our objective was to evaluate the safety and diagnostic efficacy of the ultrasound-guided renal biopsy procedure using an automated biopsy device (Biopty gun) with a 14-gauge needle. Five hundred fifteen consecutive ultrasound-guided renal biopsies performed in two large university hospitals were retrospectively reviewed. Three hundred forty-five biopsies were performed on renal allografts and 170 on native kidneys. The tissue specimen was adequate for histological evaluation in 95.3% of the cases (94.8% in the transplanted kidney group, 96.5% in the native kidney group). The overall complication rate was 12.2% and was significantly higher in the native kidney group (19.4%) than in the renal allograft group (8.7%). Major complications occurred in 2.7% of the cases (2.9% of the renal allografts and 2.4% of the native kidney biopsies), including one procedure-related death and the loss of the renal allograft in two other patients. Minor complications were noted in 9.5% of the biopsies and there were significantly more in the group of the native kidneys (17.1%) than in the group of the transplanted kidneys (5.8%). Renal biopsy with an automated device using a 14-gauge needle has a high tissue recovery rate, but it is associated with a small risk of serious complications.


Subject(s)
Biopsy, Needle/adverse effects , Hematoma/etiology , Hematuria/etiology , Kidney Diseases/pathology , Kidney Transplantation/pathology , Biopsy, Needle/instrumentation , Cohort Studies , Female , Hematoma/epidemiology , Hematuria/epidemiology , Humans , Incidence , Kidney Diseases/diagnostic imaging , Kidney Diseases/mortality , Kidney Transplantation/diagnostic imaging , Kidney Transplantation/mortality , Male , Reference Values , Retrospective Studies , Risk Assessment , Risk Factors , Severity of Illness Index , Survival Rate , Transplantation, Homologous/pathology , Ultrasonography
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