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  1. AU="Akbari, Syed Hassan A"
  2. AU="Lutfi H. Alfarsi"
  3. AU="Maria Rosaria Campitiello"
  4. AU="Kazzi, Ziad N"
  5. AU=Jain Somya
  6. AU="Ming, Xiu-Fen"
  7. AU="Gileadi, Opher"
  8. AU="Wang, Zeng-Liang"
  9. AU=Berman Jonathan M
  10. AU="Vivienne Clark"
  11. AU=Sheridan Brian S AU=Sheridan Brian S
  12. AU="Yang, Zuyu"
  13. AU="Suzuki, Tomo"
  14. AU="Horiguchi, Akihiko"
  15. AU="Band, Rebecca"
  16. AU=Pablos Isabel AU=Pablos Isabel
  17. AU="O'Flaherty, Vincent"
  18. AU="Jérémie, Riou"
  19. AU="Ma, Yunshu"
  20. AU="Pu, Junyi"
  21. AU="Benlloch, Sara"
  22. AU="Jay D Evans"
  23. AU=Unger Jean-Pierre
  24. AU="Soday, Lior"
  25. AU="Wan, Xuan"
  26. AU="Camille Fritzell"
  27. AU=Wei Huijun
  28. AU="Levine, Morgan E"
  29. AU="Chen, Yalei"
  30. AU="Rogaeva, Ekaterina" AU="Rogaeva, Ekaterina"
  31. AU="Jain, Ishaan"
  32. AU="Chatelier, Josh"
  33. AU="Passarelli, L."
  34. AU="Marques, R"
  35. AU="Restaino, Valeria"
  36. AU="Wang, Haochen"
  37. AU=Shoib Sheikh
  38. AU=Patel Ishan
  39. AU="Mongioì, Laura M"
  40. AU="Fernández-Pacheco, Borja Camacho"
  41. AU=Waghmare Alpana AU=Waghmare Alpana
  42. AU="Peyre, Marion"
  43. AU=Mulazimoglu L
  44. AU=Roy Satyaki
  45. AU="Li Yuanyuan"
  46. AU=Khan Shehryar
  47. AU=Cole Sarah L
  48. AU="Júnior, Raimundo Nonato Colares Camargo"
  49. AU="Feeney, Judith A"

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  1. Artikel: Failure of Endoscopic Third Ventriculostomy.

    Lane, Jessica / Akbari, Syed Hassan A

    Cureus

    2022  Band 14, Heft 5, Seite(n) e25136

    Abstract: Endoscopic third ventriculostomy (ETV) is an alternative to cerebrospinal fluid (CSF) shunting in the treatment of hydrocephalus. Careful patient selection is critical as patient age, etiology of hydrocephalus, and previous shunting have been shown to ... ...

    Abstract Endoscopic third ventriculostomy (ETV) is an alternative to cerebrospinal fluid (CSF) shunting in the treatment of hydrocephalus. Careful patient selection is critical as patient age, etiology of hydrocephalus, and previous shunting have been shown to influence ETV success rates. Intraoperatively, patient anatomy and medical stability may prevent or limit the completion of the ventriculostomy procedure, and findings such as a patulous third ventricular floor or cisternal scarring may portend a lower chance of successful hydrocephalus treatment. Patients in whom a ventriculostomy is completed may still experience continued symptoms of hydrocephalus or CSF leak, representing an early ETV failure. In other patients, the ETV may prove a durable treatment of hydrocephalus for several months or even years before recurrence of hydrocephalus symptoms. The failure pattern for ETV is different than that of shunting, with a higher early failure rate but improved long-term failure-free survival rates. The risk factors for failure, along with the presentation and management of failure, deserve review.
    Sprache Englisch
    Erscheinungsdatum 2022-05-19
    Erscheinungsland United States
    Dokumenttyp Journal Article ; Review
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.25136
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  2. Artikel ; Online: Cranial pilomatricoma: a diagnosis to consider.

    Lane, Jessica R / Cochran, Eric / Akbari, Syed Hassan A

    Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery

    2022  Band 39, Heft 3, Seite(n) 821–824

    Abstract: Pilomatricomas are benign tumors of the hair follicle that occur frequently in the scalp region. They occur most often in children. We describe a case of pilomatricoma in a teenager, referred to neurosurgery for excision. This diagnosis should be ... ...

    Abstract Pilomatricomas are benign tumors of the hair follicle that occur frequently in the scalp region. They occur most often in children. We describe a case of pilomatricoma in a teenager, referred to neurosurgery for excision. This diagnosis should be considered in the workup of scalp lesions, and this case report should serve to draw attention to this entity.
    Mesh-Begriff(e) Child ; Adolescent ; Humans ; Pilomatrixoma/diagnostic imaging ; Pilomatrixoma/surgery ; Skin Neoplasms/diagnostic imaging ; Skin Neoplasms/surgery ; Hair Diseases/diagnostic imaging ; Hair Diseases/surgery ; Scalp/pathology ; Skull/pathology
    Sprache Englisch
    Erscheinungsdatum 2022-10-25
    Erscheinungsland Germany
    Dokumenttyp Case Reports ; Journal Article
    ZDB-ID 605988-0
    ISSN 1433-0350 ; 0302-2803 ; 0256-7040
    ISSN (online) 1433-0350
    ISSN 0302-2803 ; 0256-7040
    DOI 10.1007/s00381-022-05716-z
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  3. Artikel ; Online: Corpus callosotomy performed with laser interstitial thermal therapy.

    Roland, Jarod L / Akbari, Syed Hassan A / Salehi, Afshin / Smyth, Matthew D

    Journal of neurosurgery

    2019  Band 134, Heft 1, Seite(n) 314–322

    Abstract: Objective: Corpus callosotomy is a palliative procedure that is effective at reducing seizure burden in patients with medically refractory epilepsy. The procedure is traditionally performed via open craniotomy with interhemispheric microdissection to ... ...

    Abstract Objective: Corpus callosotomy is a palliative procedure that is effective at reducing seizure burden in patients with medically refractory epilepsy. The procedure is traditionally performed via open craniotomy with interhemispheric microdissection to divide the corpus callosum. Concerns for morbidity associated with craniotomy can be a deterrent to patients, families, and referring physicians for surgical treatment of epilepsy. Laser interstitial thermal therapy (LITT) is a less invasive procedure that has been widely adopted in neurosurgery for the treatment of tumors. In this study, the authors investigated LITT as a less invasive approach for corpus callosotomy.
    Methods: The authors retrospectively reviewed all patients treated for medically refractory epilepsy by corpus callosotomy, either partial or completion, with LITT. Chart records were analyzed to summarize procedural metrics, length of stay, adverse events, seizure outcomes, and time to follow-up. In select cases, resting-state functional MRI was performed to qualitatively support effective functional disconnection of the cerebral hemispheres.
    Results: Ten patients underwent 11 LITT procedures. Five patients received an anterior two-thirds LITT callosotomy as their first procedure. One patient returned after LITT partial callosotomy for completion of callosotomy by LITT. The median hospital stay was 2 days (IQR 1.5-3 days), and the mean follow-up time was 1.0 year (range 1 month to 2.86 years). Functional outcomes are similar to those of open callosotomy, with the greatest effect in patients with a significant component of drop attacks in their seizure semiology. One patient achieved an Engel class II outcome after anterior two-thirds callosotomy resulting in only rare seizures at the 18-month follow-up. Four others were in Engel class III and 5 were Engel class IV. Hemorrhage occurred in 1 patient at the time of removal of the laser fiber, which was placed through the bone flap of a prior open partial callosotomy.
    Conclusions: LITT appears to be a safe and effective means for performing corpus callosotomy. Additional data are needed to confirm equipoise between open craniotomy and LITT for corpus callosotomy.
    Sprache Englisch
    Erscheinungsdatum 2019-12-13
    Erscheinungsland United States
    Dokumenttyp Journal Article
    ZDB-ID 3089-2
    ISSN 1933-0693 ; 0022-3085
    ISSN (online) 1933-0693
    ISSN 0022-3085
    DOI 10.3171/2019.9.JNS191769
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  4. Artikel ; Online: Socioeconomic characteristics and postoperative outcomes of patients undergoing prenatal vs. postnatal repair of myelomeningoceles.

    Kalluri, Anita L / Jiang, Kelly / Abu-Bonsrah, Nancy / Ammar, Adam / Reynolds, Rebecca / Alomari, Safwan / Odonkor, Michelle N / Bhimreddy, Meghana / Ram, Natasha / Robinson, Shenandoah / Akbari, Syed Hassan A / Groves, Mari L

    Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery

    2023  Band 40, Heft 4, Seite(n) 1177–1184

    Abstract: Purpose: To investigate differences in sociodemographic characteristics and short-term outcomes between patients undergoing prenatal versus postnatal myelomeningocele repair.: Methods: Patients who underwent myelomeningocele repair at our institution ...

    Abstract Purpose: To investigate differences in sociodemographic characteristics and short-term outcomes between patients undergoing prenatal versus postnatal myelomeningocele repair.
    Methods: Patients who underwent myelomeningocele repair at our institution were stratified based on prenatal or postnatal timing of repair. Baseline characteristics and outcomes were compared. Multivariate analysis was performed to identify whether prenatal repair was a predictor of outcomes independent of socioeconomic measures.
    Results: 49 patients underwent postnatal repair, and 30 underwent prenatal repair. Patients who underwent prenatal repair were more likely to have private insurance (73.3% vs. 42.9%, p = 0.03) and live farther from the hospital where they received their repair (251.5 ± 447.4 vs. 72.5 ± 205.6 miles, p = 0.02). Patients who underwent prenatal repair had shorter hospital stays (14.3 ± 22.7 days vs. 25.3 ± 20.1 days, p = 0.03), fewer complications (13.8% vs. 42.9%, p = 0.01), fewer 30-day ED visits (0.0% vs. 34.0%, p < 0.001), lower CSF diversion rates (13.8% vs. 38.8%, p = 0.02), and better functional status at 3-months (13.3% vs. 57.1% delayed, p = 0.009), 6-months (20.0% vs. 56.7% delayed, p = 0.03), and 1-year (29.4% vs. 70.6% delayed, p = 0.007). On multivariate analysis, prenatal repair was an independent predictor of inpatient complication (OR(95%CI): 0.19(0.05-0.75), p = 0.02) and 3-month (OR(95%CI): 0.14(0.03-0.80) p = 0.03), 6-month (OR(95%CI): 0.12(0.02-0.73), p = 0.02), and 1-year (OR(95%CI): 0.19(0.05-0.80), p = 0.02) functional status.
    Conclusion: Prenatal repair for myelomeningocele is associated with better outcomes and developmental functional status. However, patients receiving prenatal closure are more likely to have private health insurance and live farther from the hospital, suggesting potential barriers to care.
    Mesh-Begriff(e) Pregnancy ; Female ; Humans ; Meningomyelocele/surgery ; Hydrocephalus/surgery ; Neurosurgical Procedures/adverse effects ; Insurance, Health ; Socioeconomic Factors
    Sprache Englisch
    Erscheinungsdatum 2023-12-22
    Erscheinungsland Germany
    Dokumenttyp Journal Article
    ZDB-ID 605988-0
    ISSN 1433-0350 ; 0302-2803 ; 0256-7040
    ISSN (online) 1433-0350
    ISSN 0302-2803 ; 0256-7040
    DOI 10.1007/s00381-023-06254-y
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  5. Artikel ; Online: Bartonella henselae infection presenting as cervical spine osteomyelitis: case report.

    Akbari, Syed Hassan A / Averill, Christine E / Roland, Jarod L / Orscheln, Rachel / Strahle, Jennifer

    Journal of neurosurgery. Pediatrics

    2018  Band 22, Heft 2, Seite(n) 189–194

    Abstract: Bartonella henselae is a gram-negative bacillus implicated in cat-scratch disease. Cat-scratch disease is usually self-limiting and results in local lymphadenopathy. In rare circumstances, patients may develop endocarditis, neuroretinitis, or ... ...

    Abstract Bartonella henselae is a gram-negative bacillus implicated in cat-scratch disease. Cat-scratch disease is usually self-limiting and results in local lymphadenopathy. In rare circumstances, patients may develop endocarditis, neuroretinitis, or osteomyelitis. Osteomyelitis of the cervical spine is exceedingly rare, especially in the pediatric population, and to date there have been only 4 previously reported cases of cervical spine osteomyelitis caused by B. henselae, all of which were treated surgically. In this article, the authors report the case of a 7-year-old boy who presented with neck swelling and was found to have a C2-4 paravertebral B. henselae abscess with osteomyelitis of C-3 and epidural extension. To the authors' knowledge, this represents the first case in the literature of a cervical spine B. henselae infection managed conservatively.
    Mesh-Begriff(e) Anti-Bacterial Agents/therapeutic use ; Bartonella henselae/pathogenicity ; C-Reactive Protein/metabolism ; Cat-Scratch Disease/complications ; Cat-Scratch Disease/diagnostic imaging ; Cat-Scratch Disease/etiology ; Cat-Scratch Disease/microbiology ; Cervical Cord/diagnostic imaging ; Cervical Cord/pathology ; Child ; Humans ; Magnetic Resonance Imaging ; Male ; Osteomyelitis/diagnostic imaging ; Osteomyelitis/etiology ; Osteomyelitis/microbiology ; Tomography Scanners, X-Ray Computed
    Chemische Substanzen Anti-Bacterial Agents ; C-Reactive Protein (9007-41-4)
    Sprache Englisch
    Erscheinungsdatum 2018-05-25
    Erscheinungsland United States
    Dokumenttyp Case Reports ; Journal Article
    ZDB-ID 2403985-8
    ISSN 1933-0715 ; 1933-0707
    ISSN (online) 1933-0715
    ISSN 1933-0707
    DOI 10.3171/2018.2.PEDS17600
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    Uk I Zs.135 -Pediatrics-: Hefte anzeigen Standort:
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  6. Artikel ; Online: Care for Chiari malformation type I: the role of socioeconomic disadvantage and race.

    Akbari, Syed Hassan A / Oates, Gabriela R / Gonzalez-Sigler, Irina / Arynchyna, Anastasia A / McCroskey, Justin / Alford, Elizabeth N / Leon, Tofey J / Rutland, Sarah / Johnston, James M / Blount, Jeffrey P / Rozzelle, Curtis J / Rocque, Brandon G

    Journal of neurosurgery. Pediatrics

    2021  Band 29, Heft 3, Seite(n) 305–311

    Abstract: Objective: There is little research on the effect of social determinants of health on Chiari malformation type I (CM-I). The authors analyzed data on all children evaluated for CM-I at a single institution to assess how socioeconomic factors and race ... ...

    Abstract Objective: There is little research on the effect of social determinants of health on Chiari malformation type I (CM-I). The authors analyzed data on all children evaluated for CM-I at a single institution to assess how socioeconomic factors and race affect the surgical treatment of this population.
    Methods: Medical records of patients treated for CM-I at the authors' institution between 1992 and 2017 were reviewed. Area Deprivation Index (ADI) and Rural-Urban Commuting Area (RUCA) codes for each patient were used to measure neighborhood disadvantage. Non-Hispanic White patients were compared to non-White patients and Hispanic patients of any race (grouped together as non-White in this study) in terms of insurance status, ADI, and RUCA. Patients with initially benign CM-I, defined as not having undergone surgery within 9 months of their initial visit, were then stratified by having delayed symptom presentation or not, and compared on these same measures.
    Results: The sample included 665 patients with CM-I: 82% non-Hispanic White and 18% non-White. The non-White patients were more likely to reside in disadvantaged (OR 3.4, p < 0.001) and urban (OR 4.66, p < 0.001) neighborhoods and to have public health insurance (OR 3.11, p < 0.001). More than one-quarter (29%) of patients underwent surgery. The non-White and non-Hispanic White patients had similar surgery rates (29.5% vs 28.9%, p = 0.895) at similar ages (8.8 vs 9.7 years, p = 0.406). There were no differences by race/ethnicity for symptoms at presentation. Surgical and nonsurgical patients had similar ADI scores (3.9 vs 4.2, p = 0.194), RUCA scores (2.1 vs 2.3, p = 0.252), and private health insurance rates (73.6% vs 74.2%, p = 0.878). A total of 153 patients underwent surgery within 9 months of their initial visit. The remaining 512 were deemed to have benign CM-I. Of these, 40 (7.8%) underwent decompression surgery for delayed symptom presentation. Patients with delayed symptom presentation were from less disadvantaged (ADI 3.2 vs 4.2; p = 0.025) and less rural (RUCA 1.8 vs 2.3; p = 0.023) areas than those who never underwent surgery.
    Conclusions: Although non-White patients were more likely to be socioeconomically disadvantaged, race and socioeconomic disadvantage were not associated with undergoing surgical treatment. However, among patients with benign CM-I, those undergoing decompression for delayed symptom presentation resided in more affluent and urban areas.
    Sprache Englisch
    Erscheinungsdatum 2021-11-26
    Erscheinungsland United States
    Dokumenttyp Journal Article
    ZDB-ID 2403985-8
    ISSN 1933-0715 ; 1933-0707
    ISSN (online) 1933-0715
    ISSN 1933-0707
    DOI 10.3171/2021.9.PEDS21258
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  7. Artikel ; Online: Focal traumatic rupture of a dermoid cyst in a pediatric patient: case report and literature review.

    Akbari, Syed Hassan A / Somasundaram, Aravind / Ferguson, Cole J / Roland, Jarod L / Smyth, Matthew D / Strahle, Jennifer M

    Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery

    2018  Band 34, Heft 12, Seite(n) 2485–2490

    Abstract: Background: Dermoid cysts are rare congenital teratomas that can occasionally rupture and cause chemical meningitis, neurological deficit, or hydrocephalus. Rarely, dermoid cysts in the pediatric population can rupture spontaneously and even more rarely ...

    Abstract Background: Dermoid cysts are rare congenital teratomas that can occasionally rupture and cause chemical meningitis, neurological deficit, or hydrocephalus. Rarely, dermoid cysts in the pediatric population can rupture spontaneously and even more rarely rupture due to trauma. To date, there are only five documented cases of traumatic rupture of a dermoid cyst. A 2-year-old male presented with 5 days of left eye ptosis and ophthalmoplegia after suffering a fall and was found to have a ruptured left anterior clinoid dermoid cyst that was surgically resected. The patient had significant improvement postoperatively.
    Significance: To the authors' knowledge, this is the first reported case in the literature of a ruptured dermoid cyst after trauma in a pediatric patient and the first case of a traumatically ruptured dermoid cyst presenting with neurological deficit.
    Mesh-Begriff(e) Accidental Falls ; Brain Neoplasms/pathology ; Child, Preschool ; Dermoid Cyst/pathology ; Humans ; Male ; Rupture
    Sprache Englisch
    Erscheinungsdatum 2018-06-30
    Erscheinungsland Germany
    Dokumenttyp Case Reports ; Journal Article ; Review
    ZDB-ID 605988-0
    ISSN 1433-0350 ; 0302-2803 ; 0256-7040
    ISSN (online) 1433-0350
    ISSN 0302-2803 ; 0256-7040
    DOI 10.1007/s00381-018-3879-6
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  8. Artikel ; Online: Validation of the Disabilities of the Arm, Shoulder, and Hand in Patients Undergoing Cervical Spine Surgery.

    Khalifeh, Jawad M / Akbari, Syed Hassan A / Khandpur, Umang / Johnston, William / Wright, Neill M / Hawasli, Ammar H / Dorward, Ian / Santiago, Paul / Ray, Wilson Z

    Spine

    2019  Band 44, Heft 23, Seite(n) 1676–1684

    Abstract: Study design: Retrospective cohort study.: Objective: To evaluate the performance and convergent validity of the disabilities of the arm, shoulder, and hand (DASH) in comparison with the visual analog scale (VAS) for pain, and neck disability index ( ... ...

    Abstract Study design: Retrospective cohort study.
    Objective: To evaluate the performance and convergent validity of the disabilities of the arm, shoulder, and hand (DASH) in comparison with the visual analog scale (VAS) for pain, and neck disability index (NDI) in patients undergoing cervical spine surgery.
    Summary of background data: Neck-specific disability scales do not adequately assess concurrent upper extremity involvement in patients with cervical spine disorders. The DASH is a patient-reported outcomes (PRO) instrument designed to measure functional disability due to upper extremity conditions but has additionally been shown to perform well in patients with neck disorders.
    Methods: We identified patients who underwent cervical spine surgery at our institution between 2013 and 2016. We collected demographic information, clinical characteristics, and PRO measures-DASH, VAS, NDI-preoperatively, as well as early and late postoperatively. We calculated descriptive statistics and changes from baseline in PROs. Correlation coefficients were used to quantify the association between PRO measures. The analysis was stratified by radiculopathy and myelopathy diagnoses.
    Results: A total of 1046 patients (52.8% male) with PROs data at baseline were included in the analysis. The mean age at surgery ± SD was 57.2 ± 11.3 years, and postoperative follow-up duration 12.7 ± 10.7 months. The most common surgical procedure was anterior cervical discectomy and fusion (71.1%). Patients experienced clinically meaningful postoperative improvements in all PRO measures. The DASH showed moderate positive correlations with VAS preoperatively (Spearman rho = 0.43), as well as early (rho = 0.48) and late postoperatively (rho = 0.60). DASH and NDI scores were strongly positively correlated across operative states (Preoperative rho = 0.74, Early Postoperative rho = 0.78, Late Postoperative rho = 0.82). Stratified analysis by preoperative diagnosis showed similar within-groups trends and pairwise correlations. However, radiculopathy patients experienced larger magnitude early and late change scores.
    Conclusion: The DASH is a valid and responsive PRO measure to evaluate disabling upper extremity involvement in patients undergoing cervical spine surgery.
    Level of evidence: 3.
    Mesh-Begriff(e) Adult ; Aged ; Arm/pathology ; Cervical Vertebrae/surgery ; Disability Evaluation ; Female ; Hand/pathology ; Humans ; Male ; Middle Aged ; Pain Measurement/standards ; Patient Reported Outcome Measures ; Reproducibility of Results ; Retrospective Studies ; Shoulder/pathology ; Spinal Diseases/diagnosis ; Spinal Diseases/surgery ; Treatment Outcome
    Sprache Englisch
    Erscheinungsdatum 2019-12-20
    Erscheinungsland United States
    Dokumenttyp Journal Article
    ZDB-ID 752024-4
    ISSN 1528-1159 ; 0362-2436
    ISSN (online) 1528-1159
    ISSN 0362-2436
    DOI 10.1097/BRS.0000000000003138
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  9. Artikel ; Online: Socioeconomic and demographic factors in the diagnosis and treatment of Chiari malformation type I and syringomyelia.

    Akbari, Syed Hassan A / Rizvi, Asad A / CreveCoeur, Travis S / Han, Rowland H / Greenberg, Jacob K / Torner, James / Brockmeyer, Douglas L / Wellons, John C / Leonard, Jeffrey R / Mangano, Francesco T / Johnston, James M / Shah, Manish N / Iskandar, Bermans J / Ahmed, Raheel / Tuite, Gerald F / Kaufman, Bruce A / Daniels, David J / Jackson, Eric M / Grant, Gerald A /
    Powers, Alexander K / Couture, Daniel E / Adelson, P David / Alden, Tord D / Aldana, Philipp R / Anderson, Richard C E / Selden, Nathan R / Bierbrauer, Karin / Boydston, William / Chern, Joshua J / Whitehead, William E / Dauser, Robert C / Ellenbogen, Richard G / Ojemann, Jeffrey G / Fuchs, Herbert E / Guillaume, Daniel J / Hankinson, Todd C / O'Neill, Brent R / Iantosca, Mark / Oakes, W Jerry / Keating, Robert F / Klimo, Paul / Muhlbauer, Michael S / McComb, J Gordon / Menezes, Arnold H / Khan, Nickalus R / Niazi, Toba N / Ragheb, John / Shannon, Chevis N / Smith, Jodi L / Ackerman, Laurie L / Jea, Andrew H / Maher, Cormac O / Narayan, Prithvi / Albert, Gregory W / Stone, Scellig S D / Baird, Lissa C / Gross, Naina L / Durham, Susan R / Greene, Stephanie / McKinstry, Robert C / Shimony, Joshua S / Strahle, Jennifer M / Smyth, Matthew D / Dacey, Ralph G / Park, Tae Sung / Limbrick, David D

    Journal of neurosurgery. Pediatrics

    2021  Band 29, Heft 3, Seite(n) 288–297

    Abstract: Objective: The goal of this study was to assess the social determinants that influence access and outcomes for pediatric neurosurgical care for patients with Chiari malformation type I (CM-I) and syringomyelia (SM).: Methods: The authors used retro- ... ...

    Abstract Objective: The goal of this study was to assess the social determinants that influence access and outcomes for pediatric neurosurgical care for patients with Chiari malformation type I (CM-I) and syringomyelia (SM).
    Methods: The authors used retro- and prospective components of the Park-Reeves Syringomyelia Research Consortium database to identify pediatric patients with CM-I and SM who received surgical treatment and had at least 1 year of follow-up data. Race, ethnicity, and insurance status were used as comparators for preoperative, treatment, and postoperative characteristics and outcomes.
    Results: A total of 637 patients met inclusion criteria, and race or ethnicity data were available for 603 (94.7%) patients. A total of 463 (76.8%) were non-Hispanic White (NHW) and 140 (23.2%) were non-White. The non-White patients were older at diagnosis (p = 0.002) and were more likely to have an individualized education plan (p < 0.01). More non-White than NHW patients presented with cerebellar and cranial nerve deficits (i.e., gait ataxia [p = 0.028], nystagmus [p = 0.002], dysconjugate gaze [p = 0.03], hearing loss [p = 0.003], gait instability [p = 0.003], tremor [p = 0.021], or dysmetria [p < 0.001]). Non-White patients had higher rates of skull malformation (p = 0.004), platybasia (p = 0.002), and basilar invagination (p = 0.036). Non-White patients were more likely to be treated at low-volume centers than at high-volume centers (38.7% vs 15.2%; p < 0.01). Non-White patients were older at the time of surgery (p = 0.001) and had longer operative times (p < 0.001), higher estimated blood loss (p < 0.001), and a longer hospital stay (p = 0.04). There were no major group differences in terms of treatments performed or complications. The majority of subjects used private insurance (440, 71.5%), whereas 175 (28.5%) were using Medicaid or self-pay. Private insurance was used in 42.2% of non-White patients compared to 79.8% of NHW patients (p < 0.01). There were no major differences in presentation, treatment, or outcome between insurance groups. In multivariate modeling, non-White patients were more likely to present at an older age after controlling for sex and insurance status (p < 0.01). Non-White and male patients had a longer duration of symptoms before reaching diagnosis (p = 0.033 and 0.004, respectively).
    Conclusions: Socioeconomic and demographic factors appear to influence the presentation and management of patients with CM-I and SM. Race is associated with age and timing of diagnosis as well as operating room time, estimated blood loss, and length of hospital stay. This exploration of socioeconomic and demographic barriers to care will be useful in understanding how to improve access to pediatric neurosurgical care for patients with CM-I and SM.
    Sprache Englisch
    Erscheinungsdatum 2021-12-03
    Erscheinungsland United States
    Dokumenttyp Journal Article
    ZDB-ID 2403985-8
    ISSN 1933-0715 ; 1933-0707
    ISSN (online) 1933-0715
    ISSN 1933-0707
    DOI 10.3171/2021.9.PEDS2185
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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