Management of prolonged pregnancy.
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Cost-Benefit Analysis↗
Biomedical subjects
A Lukes
Publications and source records attributed to A Lukes.
Evaluation of the Contribution of CAS in Combination with the Subcranial/Subfrontal Approach in Anterior Skull Base Surgery.
In this study, 31 cases with different anterior skull base lesions mandating broad exposure, including the sphenoidal, parasellar, and clival region, were surgically treated using the frameless computer assisted surgery (CAS) system. The contribution of navigated surgery in relation to the broad exposure and direct visualization of this region rendered by the subcranial-subfrontal approach was evaluated. In group I, consisting of extensive tumors, the contribution of CAS was only given in five cases for the exposure of the tumor extensions located to the parasellar sphenoclival complex with concomitant distortion of the anatomic landmarks. No advantages were experienced in the more anterior locations along the ethmoidal compartment and frontal sinus. In the cases in group II, consisting of congenital anomaly implying fronto-orbital advancement and a meningoencephalocele as well as extensive mucoceles, the CAS was only helpful in those cases with an extremely aberrative anatomy in these regions.
Journal Article↗
[Results and role of carotid endarterectomy].
BACKGROUND: The indications for carotid endarterectomy have been defined on the basis of several large prospective randomised trials. Today this operation is widely performed as primary and secondary stroke prevention in patients with high grade carotid artery stenosis. Permanent quality control of the surgical results is mandatory to ensure optimal stroke prevention and further reduce perioperative complications. METHODS: In this retrospective study we analyse the surgical results of 272 consecutive carotid endarterectomies performed in 260 patients with special emphasis on the prevention of intraoperative brain ischaemia. Patients were operated on in general anaesthesia and moderate hypothermia. Before clamping the arteries at the neck, a fast-acting barbiturate or propofol was administered intravenously to obtain burst suppression on the EEG. Transcranial Doppler sonography allowed continuous intraoperative monitoring of brain perfusion and detection of emboli. Intraoperative shunting was performed only when the collateral circulation was insufficient. RESULTS: The postoperative course was uneventful in 249 endarterectomies (91.5%). The internal carotid artery was sonographically recanalised at hospital discharge and at 6-week follow-up in all 249 cases. Ischaemic cerebral complications were observed in 7 patients (2.6%): minor reversible brain ischaemia in 4 (1.5%), and major brain ischaemia with infarction in 3 (1.1%). Three patients died in the perioperative period, representing a mortality rate of 1.1% in this series. The overall combined stroke and death rate was 3.7%. The combined major stroke and death rate was 2.2%. Various non cerebral complications occurred in 13 patients (4.8%). CONCLUSIONS: These results confirm that endarterectomy is a safe and efficient treatment for atherosclerotic carotid stenosis at the neck. Very low complication rates can be attained by non-invasive diagnostic methods combined with intraoperative monitoring of cerebral blood flow velocity. New upcoming endovascular therapies such as percutaneous angioplasty and stenting need to be compared with these current surgical results with regard not only to perioperative morbidity and mortality but also patency rate, restenosis, and intracerebral blood flow restoration.
Adult↗
Practical, reliable, comprehensive method for characterizing pharmacists' clinical activities.
A method for rating the value of pharmacists' clinical services was studied. An instrument was developed to measure the severity of medication errors and the value of pharmacists' clinical interventions. Pharmacists at a hospital pharmacy department used the instrument at the time they made an intervention. A single pharmacist reviewed and adjusted the scores assigned by the pharmacist who made the intervention. An expert panel consisting of two clinical pharmacists and two physicians also scored all the interventions using the same instrument. All rankings were compared using kappa (kappa) and weighted kappa statistics, and symmetry tests were applied to examine whether specific raters consistently rated higher or lower than other raters. Data were extracted from the pharmacy department's intervention database to rate 300 interventions. Agreement between the raters was substantial, both overall and for each dimension individually. However, the physicians rated severity of error and value of service lower than their pharmacist counterparts. The study indicated that severity of error and value of service are clearly related, but not linearly. Services can be identified as high value even when there are no prescribing errors. Pharmacists found the instrument usable and practical. A literature-based instrument for simultaneously assessing the severity of errors in medication orders and the value of pharmacists' interventions was constructed, tested in a hospital, and determined to be reliable.
Humans↗
Extracellular matrix degradation by metalloproteinases and central nervous system diseases.
Matrix metalloproteinases (MMPs) are a gene family of neutral proteases involved in normal and pathological processes in the central nervous system (CNS). Normally released into the extracellular space, MMPs break down the extracellular matrix (ECM) to allow cell growth and to facilitate remodeling. Proteolysis becomes pathological when the normal balance between the proteases and their inhibitors, tissue inhibitors to metalloproteinases (TIMPs), is lost. Cancer cells secrete neutral proteases to facilitate spread through the ECM. MMPs increase capillary permeability, and they have been implicated in demyelination. Neurological diseases, such as brain tumors, multiple sclerosis, Guillain-Barré, ischemia, Alzheimer's disease, and infections, lead to an increase in the matrix-degrading proteases. Two classes of neutral proteases have been extensively studied, namely the MMPs and the plasminogen activators (PAs), which act in concert to attack the ECM. After proteolytic injury occurs, the process of ECM remodeling begins, which can lead to fibrosis of blood vessels and gliosis. TIMPs are increased after the acute injury and may add to the fibrotic buildup of ECM components. Thus, an imbalance in proteolytic activity either during the acute injury or in recovery may aggravate the underlying disease process. Agents that affect the proteolytic process at any of the regulating sites are potentially useful in therapy.
Animals↗
Surgical treatment of lumbar spinal stenosis in the elderly.
148 elderly patients, aged 70 years or more, diagnosed as having lumbar spinal stenosis, were operated upon at our institution during 1983 to 1995. Totally 161 operative procedures were performed. We analysed retrospectively the results of the surgical treatment. The most frequently performed procedure was multisegmental laminectomy, in 32% interlaminar fenestration and laminotomy were done. In 9 cases fusion was indicated, two of them being secondary operations. The mean hospital stay was 11 days. The morbidity was 6%, and there was one fatality (0.6%). The outcome was determined according to the six-grade classification proposed by Pappas and Sonntag [25]. Overall, in 91% of cases satisfactory-to-excellent results could be achieved. We conclude, that in elderly patients with symptomatic lumbar spinal stenosis, with no evidence of instability, decompressive surgery without stabilisation can be done in the majority of patients with low morbidity and high expectation of clinical improvement.
Aged↗
Fetal fibronectin as a predictor of preterm birth in patients with symptoms: a multicenter trial.
OBJECTIVE: Our aim was to determine whether the presence of fetal fibronectin in vaginal secretions of patients with symptoms suggestive of preterm labor predicts preterm delivery. STUDY DESIGN: Patients who were examined at the hospital between 24 weeks' and 34 weeks 6 days' gestation with intact membranes, no prior tocolysis, symptoms suggestive of preterm labor, and cervical dilation < 3 cm were recruited at 10 sites. Swabs of the posterior fornix were assayed for the presence of fetal fibronectin by monoclonal antibody assay, with a positive result defined as > or = 50 ng/ml. Results were not available to the managing physicians. Tocolysis was used when clinically indicated after specimen collection. RESULTS: A total of 763 patients had fetal fibronectin results and pregnancy outcome data available for analysis. Fetal fibronectin was detected in specimens from 150 (20%) patients. Compared with patients who had negative results, patients who had positive results for fetal fibronectin were more likely to be delivered within 7 days (relative risk 25.9 [95% confidence interval 7.8 to 86]), within 14 days (relative risk 20.4 [95% confidence interval 8.0 to 53]), and before 37 completed weeks (relative risk 2.9 [95% confidence interval 2.2 to 3.7]). The negative predictive values for delivery within 7 days, within 14 days, and at < 37 weeks were 99.5%, 99.2%, and 84.5%, respectively. When we used multiple logistic regression analysis to control for potential confounding variables among singleton pregnancies, only the presence of fetal fibronectin (odds ratio 48.8, 95% confidence interval 7.4 to 320), prior preterm birth (odds ratio 8.3, 95% confidence interval 1.5 to 46.6), and tocolysis (odds ratio 4.1, 95% confidence interval 1.0 to 16.0) were associated with birth within 7 days; fetal fibronectin (odds ratio 3.6, 95% confidence interval 2.2 to 5.9), prior preterm birth (odds ratio 2.5, 95% confidence interval 1.4 to 4.4), cervical dilatation > 1 cm (odds ratio 2.9, 95% confidence interval 1.6 to 5.2), and tocolysis (odds ratio 4.5, 95% confidence interval 2.8 to 7.2) were all independently associated with delivery before 37 weeks. CONCLUSION: In a population of patients with symptoms, the presence of fetal fibronectin in vaginal secretions best defines a subgroup at increased risk for delivery within 7 days; the high negative predictive value of fetal fibronectin sampling supports less intervention for patients with this result.
Adult↗
[Spinal stenosis: current aspects of imaging diagnosis and therapy].
Lumbar spinal stenosis typically manifests itself through low back pain and neurogenic claudication during walking. Cervical spinal stenosis may manifest itself through a multitude of symptoms. Spinal stenosis is classified into congenital or primary and acquired or secondary forms. Conventional X-rays of the spine often reveal only unspecific findings. Computed tomography (CT) is the preferred method of judging the width and anatomy of the spinal canal. Myelography remains a good method of imaging the spinal cord in its entirety and in addition allows functional imaging of the width of the spinal canal with functional stress images. CT performed directly after myelography (myelo-CT) allows specific imaging of areas still unclear. Magnetic resonance imaging (MRI) allows multiplanar imaging of the spine and better soft tissue definition. Surgical therapy is discussed in relation to the clinical and neuroradiological findings.
Aged↗