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Biomedical subjects

Y Krespi

Publications and source records attributed to Y Krespi.

16 recordsLinked to original sources
PubMed2003

Stroke unit versus neurology ward--a before and after study.

INTRODUCTION: Few studies have tested the hypothesis of whether the beneficial effect of Stroke Units (SUs) can be reproduced in routine clinical practice and whether SU are also superior to neurological wards [NWs]. We aimed to compare the outcomes of patients of a newly implemented SU to the outcomes of patients hospitalized in a NW. METHODS: We made a before-after comparison of 352 SUs and 352 NWs patients after adjusting for case-mixes by the multivariate method. Subgroup analyses were also performed to evaluate which patient groups benefit the most. In-hospital case-fatality, proportion of independent patients at discharge, length of hospital stay (LOHS), medical complication rate were the main outcome measures. RESULTS: Adjusted in-hospital case fatality was significantly reduced in the SUs (OR: 0.44, 95 % CI: 0.26-0.76; p = 0.003). The proportion of independent patients at discharge and patients having medical complications was not different. Length of hospital stay was shorter in SU patients (13.76 days vs. 16.72 days, p = 0.003). Treatment in the SUs decreased case fatality in many subgroups [men, elderly, early admitted, severe stroke, co-morbidity present and ischemic stroke groups]. DISCUSSION: The results of randomized trials in favor of SUs can be reproduced in routine clinical practice. The benefit of SU care seems to be more apparent with advancing age and increasing stroke severity. Stroke Unit seems to be a better alternative to an experienced NW.

Activities of Daily Living↗
PubMed2002

Endoscopic treatment of Zenker's diverticulum using CO2 laser.

OBJECTIVES: The objective of the present study was to review the technique of endoscopic laser-assisted esophagodiverticulostomy (ELAED) for the treatment of Zenker's diverticulum. METHODS: We reviewed 83 cases of ELAED performed for the treatment of Zenker's diverticuli during the past decade. RESULTS: ELAED-treated patients had a reduced hospital stay and were able to start an oral diet earlier than were patients who underwent other surgical procedures. Two (2.4%) of our patients developed small fistulas, which closed spontaneously. An additional 2 (2.4%) of our patients required conversion to an open approach due to inadequate endoscopic exposure, and 5 (6%) required a revision endoscopic procedure for persistent symptoms. CONCLUSIONS: Our series of 83 patients treated at 2 large academic centers during the past decade with an average follow-up of 4 years demonstrates that ELAED is a safe and effective procedure for the management of Zenker's diverticulum.

Belgium↗
PubMed2001

Cerebral vasculitis and ischaemic stroke in Behçet's disease: report of one case and review of the literature.

INTRODUCTION: Behçet's disease (BD) is a multisystemic, recurrent, inflammatory disorder. Neurological involvement is well-known but cerebral vasculitis and ischaemic stroke are unusual. CASE DESCRIPTION: A 43-year-old male patient presented with acute left hemiparesis, he had recurrent oral aphthae and scrotal ulcerations. Two episodes of transient brainstem ischaemia and an episode of right hemiparesis were reported in the past 2 years. Cranial magnetic resonance (MR) imaging showed a right striatocapsular infarction and multiple segmental stenosis, fusiform enlargement and beading of the arteries of the polygone of Willis were seen on angiography. Cerebro-spinal fluid (CSF) examination disclosed lymphocytic pleocytosis. Skin pathergy test was positive. A diagnosis of BD with cerebral vasculitis was made and immunosuppressive therapy was started. Some improvement of the arterial lesions on MR angiography and normalization of CSF were observed after 1 year of treatment. DISCUSSION: Low grade chronic meningo-encephalitis is the core neuropathological process in neuro-Behçet's disease. Nevertheless BD is a systemic disease known to cause vasculitis and can exceptionally lead to cerebral vasculitis and brain infarction. While BD is usually not part of the differential diagnosis of cerebral vasculitis, it should be borne in mind especially in endemic areas of the disease and in patients from these areas.

Adult↗
PubMed2001

Venous infarction of brainstem and cerebellum.

The authors describe 2 cases of posterior fosa venous infarction. A 56-year-old woman with essential thrombocytemia presented with fluctuating complaints of headache, nausea, vomiting, left-sided numbness-weakness, and dizziness and became progressively stuporous. Cranial magnetic resonance imaging (MRI) showed bilateral parasagittal fronto-parietal and left cerebellar contrast-enhancing hemorrhagic lesions. On magnetic resonance venography, the left transverse and sigmoid sinuses were occluded. The second patient, a 39-year-old woman, presented with acute onset of diplopia, numbness of the tongue, vertigo, and right-sided weakness following a gestational age stillbirth. MRI revealed lesions in the right half of midbrain and pons and in the superior part of the right cerebellar hemisphere. Digital subtraction angiography showed right transverse and sigmoid sinus occlusion. The authors suggest that one should investigate the possibility of venous infarction in the presence of posterior fossa lesions that are often hemorrhagic and are not within any arterial territory distribution but respect a known venous drainage pattern. Recognition of the observed clinical and neuroimaging features can lead to earlier diagnosis and, potentially, more effective management.

Adult↗
PubMed2001

Internuclear ophthalmoplegia and cerebellar ataxia: report of one case.

Deep hemispheric or brainstem small infarcts can lead to atypical lacunar syndromes. Unilateral internuclear ophthalmoplegia (INO) and cerebellar ataxia has not been reported previously. A 57-year-old hypertensive female presented with bilateral appendicular and left truncal cerebellar ataxia and right INO. Cranial MRI showed a right paramedian infarct of lacunar size located in the tegmentum of caudal mesencephalon. At this level the involvement of medial longitudinal fascicle (MLF) led to right INO and the lesion of brachium conjunctivum caused the bilateral cerebellar ataxia. Ipsilateral involvement of both cerebellofugal fibers, before and after decussation, was responsible for bilateral cerebellar ataxia.

Brain Infarction↗
PubMed1995

[Downbeat nystagmus and vertebrobasilar arterial dolichoectasia].

A 66-year-old man presented with a downbeat nystagmus. The underlying cause was unknown. A dolichoectasia of the vertebrobasilar artery was the only identifiable abnormality at Magnetic Resonance Image which also disclosed distortion of the anterolateral aspect of the medulla. Compression of the caudal brain-stem by an enlarged and tortuous vertebrobasilar arterial system may be the cause of downbeat nystagmus in cases unassociated with the more commonly recognized causes.

Aged↗
PubMed1994

[POEMS syndrome].

POEMS syndrome has been defined as an association of plasma cell dyscrasia with polyneuropathy, organomegaly, endocrinopathy, M protein and skin changes. Although certain authors do not distinguish this syndrome from osteosclerosing myeloma, syndromes comparable to POEMS have been observed without bone lesions. Others have described the clinical features involved under the terms of Crow-Fukase's syndrome, PEP syndrome (pigmentation, oedema, plasma cell dyscrasia, or Takatsuki's syndrome. Seen in men twice as often as in women, usually between the ages of 40-50 years, all five clinical features are not always present or may be accompanied by other signs. The first sign of the peripheral polyneuropathy is usually sensorial impairment followed by distal then proximal motor deficit. The deficit is usually severe and 50% of the patients become unable to walk. Cranial nerves are rarely involved. Liver, spleen and lymph node enlargement are observed. The most frequent signs of an endocrinopathy are gynaecomastia, atrophy of the testicules, impotence and amenorrhoea. Testosterone levels are low and oestrogen levels are increased in men together with luteinizing hormone, follicle stimulating hormone and prolactin. Hypothyroidism is frequent and diabetes mellitus is observed in 50% of the patients. Protein M is a monoclonal immunoglobulin (IgG or IgA), almost always with a light lambda chain. Skin changes include hyperpigmentation, hypertrichosis, hyperhidrosis, thickening of the skin suggestive of sclerodermia and papillary angiomas. Other signs, especially peripheral oedema often occur early in the disease course and may precede the peripheral neuropathy. POEMS syndrome is often associated with a myeloma (up to 50% of the cases in certain series). Although immunoglobulin deposit on myelin sheaths, anti-endocrine antibodies and receptors of lambda chains have been proposed as playing a role, no mechanism of pathogenesis has been determined. The natural history of the disease leads to a severe polyneuropathy. The patients become totally bedridden and death results from complications of decubitus rather from the direct effect of the underlying dyscrasia. When bone lesions are minor, radiotherapy or surgery can improve the neuropathy and resection of a solitary plasmocytoma can lead to total remission. Chemotherapy or corticosteroids may improve the polyneuropathy in certain cases. Plasma exchange has not been successful.

Adrenal Cortex Hormones↗
PubMed1994

[Hippocampothalamic infarction. A limited form of infarction in the posterior cerebral artery area].

Infarction of the hippocampus and the right ventroposterolateral thalamus was observed. Angiography revealed a posterior cerebral artery occluded near its origin, immediately upstream from the posterior communicating artery. The infarction was limited to the areas irrigated by the branches originating in the proximal part of the artery. More distal branches for the calcarine scissure and the temporooccipital gyruses were not involved.

Adult↗
PubMed1991

The oxygen and nitrous oxide indices of flammability of endotracheal tubes determined by laser ignition.

This study determines the flammability of polyvinylchloride (PVC), red rubber (RR), and silicone (Si) endotracheal tubes in oxygen- and nitrous-oxide-enriched atmospheres. Flammability is measured by using the oxygen and nitrous oxide indices of flammability with laser ignition. The laser-ignited oxygen (O2) index of flammability of the endotracheal tubes is: PVC, 0.25; RR, 0.19; Si, 0.20. The laser-ignited nitrous oxide (N2O) index of flammability of the endotracheal tubes is: PVC, 0.45; RR, 0.37; and Si, 0.41. These results are similar to the previously reported O2 and N2O indices of flammability with propane-torch ignition. This study validates the concept that the indices of flammability are useful measures of endotracheal tube flammability and are independent of the ignition source.

Fires↗
PubMed1990

[A new operative technique for deformations of the nose and septum].

Deviations of the external nasal pyramid, together with the nasal septum, are quite common but unfortunately, difficult to manage. We present our experience in 310 operations using the transfixion approach and repositioning of the nasal septum in the midline. This is done by scoring the septal cartilage in its basal attachment to the maxillary crest, providing a "swinging door" which can be sutured finally as desired. Our studies in dogs demonstrated that this technique does not cause long-term perforation of the nasal septum.

Animals↗
PubMed1988

Is routine triple endoscopy cost-effective in head and neck cancer?

The multicentric occurrence of tumors of the upper aerodigestive tract has been well described, with an incidence ranging from 5 to 16 percent. Detection of a synchronous primary tumor at the time of initial work-up is crucial both for management and final outcome. However, there is a diversity of opinions regarding the extent of the work-up to search for a second primary tumor. Some investigators consider routine panendoscopy to be essential for every patient with a head and neck primary tumor. Routine esophagoscopy and bronchoscopy with bronchial washings in the absence of specific symptoms appear to have minimal benefit and high cost. In our study of 140 consecutive patients with primary squamous cell carcinoma of the head and neck seen over a period of 3 years, detailed history, thorough head and neck examination, routine chest radiograph, and barium swallow when indicated were sufficient to identify 18 patients (13 percent) with a second primary tumor in the upper aerodigestive tract. The synchronous tumors of eight patients were in the head and neck area, seven patients had carcinoma of the lung, and three patients had a second primary in the esophagus. Two patients had three synchronous primaries. Follow-up of these patients ranged from 1 to 4 years. Panendoscopy with cytologic washings was performed routinely. We questioned the cost-effectiveness of routine triscopy in every patient with head and neck cancer.

Adult↗
PubMed1988

Prosthetic reconstruction of the trachea.

Tracheal reconstruction has been a difficult and challenging problem over the years, mainly because of graft infection and extrusion. A small segment of the trachea can be resected and primary anastomosis can be performed easily with satisfactory results. The problem is always complex when a substantial portion of the trachea must be resected. A variety of prosthetic materials have been used, both in experimental animals and human subjects, with limited short-term success. This study describes an experiment using polytetrafluoroethylene (PTFE) grafts in dogs. PTFE patch and interposition grafts were used for tracheal reconstruction with very satisfactory results. Inflammatory reaction near the grafts and nonincorporation of long graft segments continue to be problems, but despite this, prosthetic reconstruction of the trachea using PTFE provided very satisfactory results in our experimental study.

Animals↗
PubMed1985

Analysis of complete responders after initial treatment with chemotherapy in head and neck cancer.

We treated 60 patients with cisplatin-based combination chemotherapy before definitive surgery and/or radiation. All had squamous cell tumors of the head and neck, stages II to IV, M0. Twelve patients (20%) achieved a complete remission after chemotherapy. Eight of these patients showed no histologic evidence of residual disease after biopsy or surgery. Definitive local therapy with surgery and/or radiation was carried out on almost all patients regardless of the extent of the response to preceding chemotherapy. Chemotherapy-induced complete responders have had an improved survival rate in comparison with patients achieving a partial response or less. The extent of primary tumor correlates inversely with a complete response to chemotherapy.

Adult↗
PubMed1984

Preoperative combination chemotherapy for advanced stage head and neck cancer. Promising early results.

We treated 19 consecutive patients with cisplatin, bleomycin, and methotrexate before definitive surgery or radiation therapy. Fourteen patients (74 percent) had partial or complete tumor regression after chemotherapy. With a minimum follow-up time of 27 months, none of the 4 patients who had a major histologic response relapsed, and only 2 of the remaining 15 patients continued disease-free. The achievement of a complete histologic response after preoperative chemotherapy may correlate with long-term disease-free survival after surgery and radiation therapy for head and neck cancer.

Aged↗
PubMed1983

Cutaneous sarcoidosis associated with sarcoidosis of the upper airway.

The diagnosis of laryngeal sarcoidosis is frequently delayed because it is rare and often develops insidiously. A 24-year-old woman with the annular scarring form of cutaneous sarcoidosis later contracted laryngeal sarcoidosis. Despite a two-year history of upper respiratory tract symptoms, the patient's progressive respiratory distress was attributed to sarcoidal pulmonary involvement. Dermatologists should be aware of the risk of airway obstruction from laryngeal granulomas in patients with cutaneous sarcoidosis. Although most commonly associated with the lupus pernio form of sarcoidosis, upper airway granulomas also develop in patients with other cutaneous manifestations of sarcoidosis.

Adult↗