The Experts below are selected from a list of 182217 Experts worldwide ranked by ideXlab platform
Jan Claassen - One of the best experts on this subject based on the ideXlab platform.
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evaluating ct perfusion deficits in global cerebral Edema after aneurysmal subarachnoid hemorrhage
American Journal of Neuroradiology, 2015Co-Authors: Hediyeh Baradaran, V Fodera, K Kesavobhotla, Jana Ivanidze, U Ozbek, Jan Claassen, Pina C SanelliAbstract:BACKGROUND AND PURPOSE: Global cerebral Edema is an independent predictor of mortality and poor outcomes after aneurysmal SAH. Global cerebral Edema, a complex disease process, is thought to be associated with an altered cerebral autoregulatory response. We studied the association between cerebral hemodynamics and early global cerebral Edema by using CTP. MATERIALS AND METHODS: We retrospectively studied consecutive patients with aneurysmal SAH with admission CTP performed at days 0–3. Two neuroradiologists classified global cerebral Edema and hydrocephalus on NCCT performed concurrently with CTP. Global cerebral Edema was defined as diffuse effacement of the sulci and/or basal cisterns or diffuse disruption of the cerebral gray-white matter junction. CTP was postprocessed into CBF and MTT maps by using a standardized method. Quantitative analysis of CTP was performed by using standard protocol with ROI sampling of the cerebral cortex. The Fisher exact test, Mann-Whitney test, and independent-samples t test were used to determine statistical associations. RESULTS: Of the 45 patients included, 42% (19/45) had global cerebral Edema and 58% (26/45) did not. Patient groups with and without global cerebral Edema were well-matched for demographic and clinical data. Patients with global cerebral Edema were more likely to have qualitative global CTP deficits than those without global cerebral Edema ( P = .001) with an OR = 13.3 (95% CI, 2.09–138.63). Patients with global cerebral Edema also had a very strong trend toward statistical significance, with reduced quantitative CBF compared with patients without global cerebral Edema ( P = .064). CONCLUSIONS: Global perfusion deficits are significantly associated with global cerebral Edema in the early phase after aneurysmal SAH, supporting the theory that hemodynamic disturbances occur in global cerebral Edema.
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global cerebral Edema after subarachnoid hemorrhage frequency predictors and impact on outcome
Stroke, 2002Co-Authors: Jan Claassen, Ricardo J Carhuapoma, Kurt T Kreiter, Evelyn Y Du, Sander E Connolly, Stephan A MayerAbstract:Background and Purpose — Cerebral Edema visualized by CT is often seen after subarachnoid hemorrhage (SAH). Inflammatory or circulatory mechanisms have been postulated to explain this radiographic observation after SAH. We sought to determine the frequency, causes, and impact on outcome of early and delayed global cerebral Edema after SAH. Methods — We evaluated the presence of global Edema on admission and follow-up CT scans in 374 SAH patients admitted within 5 days of onset to our Neurological Intensive Care Unit between July 1996 and February 2001. Using multivariate analysis, we identified predictors of global cerebral Edema and evaluated the impact of global Edema on outcome 3 months after onset with the modified Rankin Scale. Results — Global Edema was present on admission CT scans in 8% (n=29) and developed secondarily in 12% (n=44) of the patients. Global Edema on admission was predicted by loss of consciousness at ictus and increasing Hunt-Hess grade. Delayed global Edema was predicted by aneurysm size >10 mm, loss of consciousness at ictus, use of vasopressors, and increased SAH sum scores. Thirty-seven percent (n=137) of the patients were dead or severely disabled (modified Rankin Scale 4 to 6) at 3 months. Death or severe disability was predicted by any global Edema, aneurysm size >10 mm, loss of consciousness at ictus, increased National Institutes of Health Stroke Scale scores, and older age. Conclusions — Global Edema is an independent risk factor for mortality and poor outcome after SAH. Loss of consciousness, which may reflect ictal cerebral circulatory arrest, is a risk factor for admission global Edema, and vasopressor-induced hypertension is associated with the development of delayed global Edema. Critical care management strategies that minimize Edema formation after SAH may improve outcome.
Pina C Sanelli - One of the best experts on this subject based on the ideXlab platform.
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evaluating ct perfusion deficits in global cerebral Edema after aneurysmal subarachnoid hemorrhage
American Journal of Neuroradiology, 2015Co-Authors: Hediyeh Baradaran, V Fodera, K Kesavobhotla, Jana Ivanidze, U Ozbek, Jan Claassen, Pina C SanelliAbstract:BACKGROUND AND PURPOSE: Global cerebral Edema is an independent predictor of mortality and poor outcomes after aneurysmal SAH. Global cerebral Edema, a complex disease process, is thought to be associated with an altered cerebral autoregulatory response. We studied the association between cerebral hemodynamics and early global cerebral Edema by using CTP. MATERIALS AND METHODS: We retrospectively studied consecutive patients with aneurysmal SAH with admission CTP performed at days 0–3. Two neuroradiologists classified global cerebral Edema and hydrocephalus on NCCT performed concurrently with CTP. Global cerebral Edema was defined as diffuse effacement of the sulci and/or basal cisterns or diffuse disruption of the cerebral gray-white matter junction. CTP was postprocessed into CBF and MTT maps by using a standardized method. Quantitative analysis of CTP was performed by using standard protocol with ROI sampling of the cerebral cortex. The Fisher exact test, Mann-Whitney test, and independent-samples t test were used to determine statistical associations. RESULTS: Of the 45 patients included, 42% (19/45) had global cerebral Edema and 58% (26/45) did not. Patient groups with and without global cerebral Edema were well-matched for demographic and clinical data. Patients with global cerebral Edema were more likely to have qualitative global CTP deficits than those without global cerebral Edema ( P = .001) with an OR = 13.3 (95% CI, 2.09–138.63). Patients with global cerebral Edema also had a very strong trend toward statistical significance, with reduced quantitative CBF compared with patients without global cerebral Edema ( P = .064). CONCLUSIONS: Global perfusion deficits are significantly associated with global cerebral Edema in the early phase after aneurysmal SAH, supporting the theory that hemodynamic disturbances occur in global cerebral Edema.
Katrin Wacker - One of the best experts on this subject based on the ideXlab platform.
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hyperosmolar eye drops for diurnal corneal Edema in fuchs endothelial dystrophy a double masked randomized controlled trial
Ophthalmology, 2021Co-Authors: Daniel Zander, Daniel Bohringer, Marianne Fritz, Viviane Grewing, Philip Maier, Thabo Lapp, Thomas Reinhard, Katrin WackerAbstract:Purpose The Eye Drops for Early Morning-Associated Swelling (EdemaS) trial assessed the efficacy of hyperosmolar eye drops on corneal Edema resolution. Design Double-masked, randomized controlled trial of hyperosmolar eye drops. Participants Participants with Fuchs’ dystrophy scheduled for Descemet membrane endothelial keratoplasty. Methods One eye was randomized to hyperosmolar eye drops (treatment); the fellow eye was randomized to artificial tears (placebo). After baseline examination in the afternoon, corneas were examined using Scheimpflug tomography after eye opening in the morning. Participants received eye drops twice. Imaging was repeated every 30 minutes up to 4 hours. Main Outcome Measures Decrease in central corneal thickness 1 hour after eye opening (primary end point), corneal thickness, subjective visual function, glare, visual acuity, and adverse events (AEs) (secondary end points). Results A total of 68 participants received the allocated intervention (59 eyes received treatment; 55 eyes received placebo). All eyes had stromal Edema; none had epithelial Edema. Corneal thickness was 626 μm in the treatment arm and 622 μm in the placebo arm after eye opening, indicating an early morning Edema compared with baseline of +21 μm and +24 μm, respectively. Decrease in corneal thickness after 1 hour was −10.5 μm in the treatment arm (95% confidence interval [CI], −12.8 to −8.2) and −11.2 μm (95% CI, −13.6 to −8.9) in the placebo arm (between-arm difference, 0.7 μm, 95% CI, −2.0 to 3.5; P = 0.59), indicating no clinically relevant effect of hyperosmolar eye drops on early morning corneal Edema. Results were not compatible with a relevant treatment effect on corneal thickness, visual acuity, and glare over the entire course of the study. Increase in subjective visual function was less rapid in the treatment arm than in the placebo arm. Adverse events, most commonly burning after eye drop application, were more common with treatment (30 eyes) than placebo (1 eye; risk difference, 49 percentage points; 95% CI, 36–62). Conclusions In this double-masked, randomized controlled trial, resolution of early morning stromal Edema was not accelerated by hyperosmolar eye drops, which more frequently caused AEs. These results are not compatible with a clinically relevant effect of hyperosmolar eye drops and do not support their routine use.
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determining subclinical Edema in fuchs endothelial corneal dystrophy revised classification using scheimpflug tomography for preoperative assessment
Ophthalmology, 2019Co-Authors: Katrin Wacker, Keith H Baratz, Sanjay V PatelAbstract:Purpose To determine if Scheimpflug tomography can identify subclinical corneal Edema in Fuchs endothelial corneal dystrophy (FECD), and to recommend a new classification of FECD for clinical practice and research. Design Cross-sectional study with follow-up of outcomes. Participants Ninety-three eyes from 57 subjects with a range of severity of FECD and 74 eyes from 40 subjects with normal corneas. Methods Corneas were clinically assessed for FECD and corneal Edema by using slit-lamp biomicroscopy, and categorized as having clinically definite Edema (obvious visible Edema), being suspicious for subclinical Edema (possible corneal thickening without obvious Edema on slit-lamp examination), or not having Edema (no clinical suspicion of Edema). Tomographic pachymetry and elevation maps derived from Scheimpflug images were evaluated by 3 masked observers for specific features believed to be consistent with corneal Edema. FECD clinical disease course and outcomes were reviewed from the time of Scheimpflug image acquisition to the last available follow-up. Main Outcome Measures Presence of tomographic features: (1) loss of parallel isopachs, (2) displacement of the thinnest point of the cornea, and (3) focal posterior corneal surface depression. Clinical outcomes included the change in central corneal thickness (CCT) and vision after endothelial keratoplasty (EK). Results The 3 specific tomographic features were all present in all FECD corneas with clinically definite Edema (n = 15), in ≥81% of FECD corneas suspicious for subclinical Edema (n = 16), in ≤42% of FECD corneas deemed not to have Edema (n = 62), and in ≤5% of normal corneas (n = 74). Corneas suspicious for subclinical Edema that subsequently underwent EK (n = 9) all had at least 2 of the tomographic features present before EK, and improvement in vision, CCT, and tomographic features after EK confirmed the presence of subclinical Edema preoperatively. Conclusions Subclinical corneal Edema in FECD can be detected by Scheimpflug tomography. We recommend classifying FECD corneas as having clinically definite Edema (based on slit-lamp examination), subclinical Edema (based on tomographic features without clinically definite Edema), or no Edema (no tomographic or slit-lamp features of Edema). This classification is independent of CCT and should be considered when evaluating FECD eyes for cataract surgery or EK.
Sinead Slattery - One of the best experts on this subject based on the ideXlab platform.
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palliative care Edema patient population causal factors and types of Edema referred to a specialist palliative care Edema service
Journal of Palliative Medicine, 2016Co-Authors: Shirley Real, Sinead Cobbe, Sinead SlatteryAbstract:Abstract Background: Edema in palliative care patients is a common symptom, however, the research base for all aspects of its care is extremely poor. Objective: To evaluate a specialist palliative care Edema service in order to report on the patient population referred, the types of Edema encountered, and the causes of Edema. Design: Prior to study, three different Edema types were described for evaluation: lymphEdema, nonlymphatic Edema, and a combination of the two. Retrospective chart evaluation was completed from August 2013 through January 2014. Subjects: Patients with Edema assessed by the specialist palliative care physiotherapy Edema service. Results: Sixty-three cases were included, comprising 10.5% of all new palliative care referrals during the study period. Ninety-two percent (n = 58) had a diagnosis of cancer and 57% (n = 36) were female. Age ranged from 45–97 years. The most common Edema type was a mixed Edema (46%, n = 29), followed by lymphEdema (27%, n = 18) and nonlymphatic Edema (16%, n...
Gerasimos Filippatos - One of the best experts on this subject based on the ideXlab platform.
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Effects of serelaxin on the outcome of patients with or without substantial peripheral Edema: A subgroup analysis from the RELAX-AHF trial.
American heart journal, 2017Co-Authors: Claudio Gimpelewicz, Marco Metra, John G.f. Cleland, Peter Szecsödy, Chuan Chuan Chang Wun, Leandro Boer-martins, Gad Cotter, Beth A. Davison, G.m. Felker, Gerasimos FilippatosAbstract:Background Acute heart failure (AHF) is a heterogeneous disorder, with most of the patients presenting with breathlessness along with varying degrees of peripheral Edema. The presence of peripheral Edema suggests that volume overload is the cause of decompensation leading to AHF, whereas breathlessness in the absence of Edema may reflect a “vascular phenotype.” This analysis investigated the characteristics, therapeutic response, and outcome of patients with AHF, with and without overt peripheral Edema in the RELAX-AHF trial. Methods Physician-assessed Edema scores at baseline were used to categorize the population into those with no/mild Edema (score 0 or 1+) and moderate/severe Edema (score 2+ or 3+). The effect of serelaxin vs placebo was assessed within each subgroup. Results Patients with moderate/severe Edema (n = 583; 50.5%) were more likely to have severe dyspnea, orthopnea (>30°), rales (≥1/3), and elevated jugular venous pressure (>6 cm) than the patients with little or no peripheral Edema (n=571; 49.5%). The relative benefits of serelaxin in terms of reduction in breathlessness, lower diuretic requirements, decreased length of initial hospital stay and days in intensive care unit/cardiac care unit, and improved prognosis (180-day cardiovascular and all-cause mortality) were generally similar for patients with or without peripheral Edema. However, because patients with moderate/severe peripheral Edema had worse outcomes, the absolute benefit was generally greater than in patients with no/mild Edema. Conclusions Overall, patients with AHF and moderate/severe peripheral Edema have a worse prognosis but appear to receive similar relative benefit and perhaps greater absolute benefit from serelaxin administration.
