Risultati per: Tumore prostata, test della saliva piu’ attendibile del PSA

Stroke, Volume 53, Issue Suppl_1, Page AWMP34-AWMP34, February 1, 2022. Objective:Dysphagia is common in patients with acute ischemic stroke patients (AIS). Feeding tubes are often placed to prevent aspiration pneumonia and supply nutrition when swallow function impaired are detected. However, little is known about when and how to start oral feeding in AIS. The purpose of this study is to establish a feasibility and effective intervention for early oral feeding following removal of feeding tube in patients with AIS.Methods:A total of 37 patients with AIS who were removed feeding tubes and start oral feeding in our hospital from 2017 to 2021 were retrospectively analyzed. An intervention program for early oral feeding, which consisted of the modified volume-viscosity swallow test (V-VST) and mechanical soft diet, was fully operationalized from October 2020 to July 2021. Outcomes were compared between an early oral feeding intervention group of 17 patients and a historical control group of 20 patients from July 2017 to September 2020. We compared the baseline characteristics between the groups. To analyze aspiration pneumonia probability, the Kaplan-Meier method were used.Results:The length of stay in hospital was significantly longer in the control group compared with the early oral feeding group (16.70±5.24 vs 12.88±4.46; P=0.024). Patients in the control group tolerated tube feeding longer days ( 9.45±2.93 vs 6.59±3.57; P=0.011 ). A log-rank test found no significant difference in aspiration pneumonia between the two groups ( P =0.111).Conclusions:Our data suggest that the intervention for early oral feeding can be used safely and possibly.

Stroke, Volume 53, Issue Suppl_1, Page AWMP91-AWMP91, February 1, 2022. Introduction:Balloon test occlusion (BTO) with adjunctive single-photon emission computed tomography (SPECT) has been utilized to predict clinical tolerance after permanent internal carotid artery (ICA) occlusion. Cerebrovascular anatomical characteristics might predict BTO outcomes and identify patients susceptible to test failure.Methods:We performed a single center retrospective study of patients who underwent catheter based cerebral angiogram and ICA BTO from July 2013 to June 2020. SPECT imaging was completed in all the patients who passed the clinical BTO; technetium 99m-ethyl cysteinate dimer was injected intravenously after 15-30 min of occlusion and induced hypotension. The diameter of each of the vessels of the Circle of Willis was measured angiographically. The severity of hypoperfusion on SPECT imaging was classified as none, mild, low intermediate, high intermediate, and severe.Results:A total of 57 patients underwent BTO; neoplasia was the most common indication (n=43, 75%). Twelve patients (21.1%) developed neurologic symptoms and clinically failed the BTO; 45 patients (78.9%) passed and proceeded to SPECT. Contralateral dominant vertebral artery (p=0.02), smaller ACom (p=0.002) and ipsilateral PCom (p=0.03) diameters were correlated with clinical BTO failure. Smaller ACom was most predictive with an AUC of 0.907. The Youden index identified an ACom diameter threshold of 1.1 mm, which demonstrated a sensitivity of 91.7% and specificity of 77.8% (OR 0.026, 95% CI 0.003 – 0.226, ROC=0.847) for the prediction of BTO failure. Patients with severe SPECT asymmetry had significantly smaller caliber ACom arteries (ACom median diameter 0.95 mm vs. rest of cohort median 1.4; p=0.0073).Conclusions:BTO outcomes may be predicted using angiographic findings. A small (

Stroke, Volume 53, Issue Suppl_1, Page AWP2-AWP2, February 1, 2022. Introduction:Stroke accounts for 4% of patients with acute vertigo, which is missed in up to one third of cases.Hypothesis:We hypothesized that detection of stroke underlying acute vertigo using HINTS plus (head-impulse test, nystagmus type, test of skew, hearing loss) can be improved by videooculography for automated analysis of head-impulse test (V-HIT).Materials and Methods:We evaluated patients with acute vestibular syndrome (AVS) presenting to the emergency room using HINTS plus and V-HIT-assisted HINTS plus in a randomized sequence. In addition, patients underwent cranial MRI and caloric testing. Image-confirmed posterior circulation stroke or vertebrobasilar TIA were defined as reference standard to calculate accuracy of applied vertigo assessment protocols. After study completion, we repeated statistical analysis for a third protocol that was composed post hoc by replacing the results of head-impulse test with those derived from caloric testing in the HINTS plus protocol.Results:We included 30 AVS patients (ages 55.4 ± 17.2 years, 14 females). Of these, 11 (36.7%) had MRI-confirmed posterior circulation ischemic stroke (n=4) or vertebrobasilar TIA (n=7). Conducting V-HIT-assisted HINTS plus as part of the emergency work up was feasible and displayed a tendency toward higher accuracy than conventional HINTS plus (sensitivity: 81.8%, 95%CI 48.2-97.7%; specificity 31.6%, 95%CI 12.6-56.6% vs. sensitivity 72.7%, 95%CI 39.0-94.0%; specificity 36.8%, 95%CI 16.3-61.6%). (Figure) The new caloric-supported algorithm displayed high accuracy (sensitivity 100%, 95%CI 66.4%-100%; specificity 66.7%, 95%CI 41%-86.7%).Conclusions:Our study provides pilot data on the capacity of videooculography to improve accuracy of acute vertigo assessment using HINTS plus and indicates potential value of acute caloric testing as integrative part of standardized AVS emergency work up.

Circulation, Ahead of Print.

Comunicato del 14/12/2021 n°77

Circulation, Ahead of Print.