Mechanical thrombectomy beyond 6 hours in acute ischaemic stroke with large vessel occlusion in the carotid artery territory: experience at a tertiary hospital.

INTRODUCTION: Thrombectomy in the carotid artery territory was recently shown to be effective up to 24 hours after symptoms onset. METHODS: We conducted a retrospective review of a prospective registry of patients treated at our stroke reference centre between November 2016 and April 2019 in order to assess the safety and effectiveness of mechanical thrombectomy performed beyond 6 hours after symptoms onset in patients with acute ischaemic stroke and large vessel occlusion in the carotid artery territory. RESULTS: Data were gathered from 59 patients (55.9% women; median age, 71 years). In 33 cases, stroke was detected upon awakening; 57.6% of patients were transferred from another hospital. Median baseline NIHSS score was 16, and median ASPECTS score was 8, with 94.9% of patients presenting > 50% of salvageable tissue. Satisfactory recanalisation was achieved in 88.1% of patients, beyond 24 hours after onset in 5 cases. At 90 days of follow-up, 67.8% were functionally independent; those who were not were older and presented higher prevalence of atrial fibrillation, greater puncture-to-recanalisation time, and higher NIHSS scores, both at baseline and at discharge. CONCLUSION: In our experience, mechanical thrombectomy beyond 6 hours was associated with good 90-day functional outcomes. Age, NIHSS score, puncture-to-recanalisation time, and presence of atrial fibrillation affected functional prognosis. The efficacy of the treatment beyond 24 hours after onset merits study.

Mechanical thrombectomy beyond 6hours in acute ischaemic stroke with large vessel occlusion in the carotid artery territory: Experience at a tertiary hospital. / Trombectomía mecánica más allá de 6horas en ictus isquémico agudo con oclusión de gran vaso en territorio carotídeo: experiencia en un hospital terciario.

INTRODUCTION: Thrombectomy in the carotid artery territory was recently shown to be effective up to 24hours after symptoms onset. METHODS: We conducted a retrospective review of a prospective registry of patients treated at our stroke reference centre between November 2016 and April 2019 in order to assess the safety and effectiveness of mechanical thrombectomy performed beyond 6hours after symptoms onset in patients with acute ischaemic stroke and large vessel occlusion in the carotid artery territory. RESULTS: Data were gathered from 59 patients (55.9% women; median age, 71 years). In 33 cases, stroke was detected upon awakening; 57.6% of patients were transferred from another hospital. Median baseline NIHSS score was 16, and median ASPECTS score was 8, with 94.9% of patients presenting>50% of salvageable tissue. Satisfactory recanalisation was achieved in 88.1% of patients, beyond 24hours after onset in 5 cases. At 90 days of follow-up, 67.8% were functionally independent; those who were not were older and presented higher prevalence of atrial fibrillation, greater puncture-to-recanalisation time, and higher NIHSS scores, both at baseline and at discharge. CONCLUSION: In our experience, mechanical thrombectomy beyond 6hours was associated with good 90-day functional outcomes. Age, NIHSS score, puncture-to-recanalisation time, and presence of atrial fibrillation affected functional prognosis. The efficacy of the treatment beyond 24hours after onset merits study.

Laparoscopic vs open resection for rectal carcinoma--a prospective analysis.

UNLABELLED: In the recent years, laparoscopic surgery has established itself worldwide as a method of treatment for colorectal cancer. Several prospective randomized trials comparing laparoscopic with open resection of the colon, showing the advantages of laparoscopic surgery in terms of a shorter hospital stay, faster recovery of intestinal transit and physical activity in equivalent survival and recurrence rate. However, in many of the studies the data on laparoscopic resection for rectal cancer are scarce and it is still controversial. AIM: In this report, we aimed to make a comparative analysis of the clinical and oncological outcomes after laparoscopic and open rectal resection in patients with a rectal cancer. MATERIAL AND METHODS: We compare and analyze prospectively data from two groups of patients with rectal cancer--66 undergoing laparoscopic and 47 undergoing open rectal resection respectively. Both groups were selected with comparable demographic characteristics (gender, age, body mass index), ASA class (American Society of Anesthesiologists), tumor stage, type of neoadjuvant radiochemotherapy and operations. The data were statistically processed. RESULTS: The mean age was 61, body mass index ranged from 18 to 42. The frequency of conversion was 6.06%. Postoperative complications were similar in both groups, except for wound infection was lower for the laparoscopic group (p = 0.02). The laparoscopic group had a shorter hospital stay (7 and 5 days respectively p < 0.01), faster recovery of intestinal motility (3 and 4.5 days respectively, p < 0.001) compared with the open group. Three-year survival rate and the rate of local and late recurrences were identical in both groups. CONCLUSIONS: Laparoscopic surgery is applicable in the treatment of rectal cancer with similar oncologic outcomes compared with conventional surgery and has all the advantages of miniinvasive methods. There is a need for further randomized studies to refine the applicability of laparoscopic rectal resection for cancer.

Surgical treatment of benign diseases of the gastroesophageal junction in clinic of endoscopic surgery at MMA during the period 2005-2012: pathophysiology, surgical techniques and trends of their use.

UNLABELLED: Treatment of the diseases of the gastroesophageal junction is one of the serious problems faced by gastroenteorologist and surgeons. In contrast to the proton pump inhibitors (PPI) surgery achieves a long symptoms free period. Laparoscopic surgery has its advantages as an alternative to conventional surgery. The purpose of this study was to compare the obtained results from patients treated with laparoscopic surgical methods to the results of the patients treated with conventional surgery and conservative treatment with PPI. MATERIALS AND METHODS: The present study includes 99 patients: 90 patients with diaphragmatic hernia and gastroesophageal reflux disease (GERD), 8 patients with achalasia and a benign stricture of the lower third of the esophagus. All patients were operated by laparoscopic techniques. 72% of the 99 patients were women and 28% men. The average age of patients was 62 years. RESULTS: The majority of our patients had mixed hiatal hernia--55.5%, followed by axial (23.3%) and hiatal (13.3%). The most common method we used was anterior fundoplication (85.5%), we used the Nissen fundoplication in 7.8% of the patients, crurorhaphy with mesh in 4.4% and plain crurorhaphy in 2.2%. All patients had a mild postoperative period. Analgesia with prophenid is done only in the first 24 hr. The average hospital stay of the patients was 3 days. CONCLUSIONS: Partial laparoscopic fundoplication is a method of choice for the anti-reflux surgery compared to conventional surgery and drug therapy. Dysphagia is rare in patients with anterior fundoplication and is easily influenced by conservative treatment, that's why is our preferred method.