3,368 results match your criteria rt-pa management

A case of acute cerebral infarction with a favorable prognosis after rt-PA administration by a general physician with telestroke support.

J Rural Med 2021 Apr 1;16(2):119-122. Epub 2021 Apr 1.

Department of Neurosurgery, Faculty of Medicine, University of Miyazaki, Japan.

Herein, we report a patient with acute cerebral infarction with a favorable prognosis after being managed by a general physician with support from the telestroke program. An 85-year-old man was transferred to a regional hospital due to sudden onset of dysarthria and left hemiparesis. As no neurosurgeons or neurologists were available in that hospital or area, the patient was examined by a general physician who diagnosed him with cardioembolic stroke on the left middle cerebral artery territory. Read More

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Distance Neurological Supervision Using Telestroke Does Not Increase Door-to-Needle Time in Acute Ischemic Stroke Management: The Experience of Two Regional Stroke Units.

Front Neurol 2021 19;12:616620. Epub 2021 Mar 19.

Neurology Unit, Hôpital Fribourgeois, Fribourg, Switzerland.

Timely administration of recombinant tissue plasminogen activator (r-tPA) improves clinical outcomes in acute ischemic stroke patients. This study aims to explore the influence of the systematic presence on site of a neurologist compared with telestroke management on door-to-needle time in acute ischemic stroke outside of working hours (OWH). This retrospective cohort study included all r-tPA-treated patients in the emergency rooms of two Swiss stroke units, Nyon Hospital [Groupement Hospitalier de l'Ouest Lémanique (GHOL)] and Fribourg Hospital [Hôpital de Fribourg (HFR)], between February 2014 and September 2018. Read More

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Adult Pleomorphic Rhabdomyosarcomas: Assessing Outcomes Associated with Radiotherapy and Chemotherapy Use in the National Cancer Database.

Sarcoma 2021 13;2021:9712070. Epub 2021 Mar 13.

Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA.

Purpose: Practice patterns for treatment of localized adult pleomorphic rhabdomyosarcoma (PRMS) remain quite variable given its rarity. Current national guidelines recommend management similar to that of other high-grade soft tissue sarcomas (STS), which include surgery with perioperative radiation (RT) with or without chemotherapy. Using the National Cancer Database (NCDB), we assessed practice patterns and overall outcomes of patients with localized PRMS. Read More

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A step toward understanding the mechanism of action of audit and feedback: a qualitative study of implementation strategies.

Implement Sci 2021 Apr 1;16(1):35. Epub 2021 Apr 1.

Stroke Program, University of Michigan Medical School, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.

Background: Audit and feedback (A&F) is a widely used implementation strategy. Understanding mechanisms of action of A&F increases the likelihood that the strategy will lead to implementation of an evidence-based practice. We therefore sought to understand one hospital's experience selecting and implementing an A&F intervention, to determine the implementation strategies that were used by staff and to specify the mechanism of action of those implementation strategies using causal pathway models, with the ultimate goal of improving acute stroke treatment practices. Read More

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Intrapleural Fibrinolytics and Deoxyribonuclease for Treatment of Indwelling Pleural Catheter-Related Pleural Infection: A Multi-Center Observational Study.

Respiration 2021 Mar 30:1-9. Epub 2021 Mar 30.

Sir Charles Gairdner Hospital, Perth, Washington, Australia.

Background: Indwelling pleural catheters (IPC) are increasingly used for management of recurrent (especially malignant) effusions. Pleural infection associated with IPC use remains a concern. Intrapleural therapy with tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) significantly reduces surgical referrals in non-IPC pleural infection, but data on its use in IPC-related pleural infection are scarce. Read More

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Successful Management of Urinary Bladder Clot with Intravesical Tissue Plasminogen Activator Infusion in a Cat.

J Am Anim Hosp Assoc 2021 May;57(3)

A 5 yr old male neutered domestic shorthair with intermittent signs of urinary tract obstruction was suspected of having a blood clot in the urinary bladder secondary to trauma. The cat was hospitalized and received standard supportive therapy for urinary tract obstruction with urinary catheterization, with the addition of intravesical saline flushes in an attempt to promote bladder clot lysis. The cat was subsequently discharged after voluntary urination was observed. Read More

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Differences in Acute Ischemic Stroke Management and Prognosis between Multiple Large-Vessel Occlusion and Single Large-Vessel Occlusion: Subanalysis of the RESCUE-Japan Registry 2.

Cerebrovasc Dis 2021 Mar 23:1-8. Epub 2021 Mar 23.

Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan,

Introduction: The management and prognosis of acute ischemic stroke due to multiple large-vessel occlusion (LVO) (MLVO) are not well scrutinized. We therefore aimed to elucidate the differences in patient characteristics and prognosis of MLVO and single LVO (SLVO).

Methods: The Recovery by Endovascular Salvage for Cerebral Ultra-Acute Embolism Japan Registry 2 (RESCUE-Japan Registry 2) enrolled 2,420 consecutive patients with acute LVO who were admitted within 24 h of onset. Read More

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The management of surgical patients in the emergency setting during COVID-19 pandemic: the WSES position paper.

World J Emerg Surg 2021 03 22;16(1):14. Epub 2021 Mar 22.

Department of Emergency and Trauma Surgery, Parma University Hospital, Parma, Italy.

Background: Since the COVID-19 pandemic has occurred, nations showed their unpreparedness to deal with a mass casualty incident of this proportion and severity, which resulted in a tremendous number of deaths even among healthcare workers. The World Society of Emergency Surgery conceived this position paper with the purpose of providing evidence-based recommendations for the management of emergency surgical patients under COVID-19 pandemic for the safety of the patient and healthcare workers.

Method: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) through the MEDLINE (PubMed), Embase and SCOPUS databases. Read More

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Use of Intravenous Thrombolysis in Acute Ischemic Stroke Management in Patients with Active Malignancies: A Topical Review.

J Stroke Cerebrovasc Dis 2021 Mar 17;30(6):105728. Epub 2021 Mar 17.

Cleveland Clinic Akron General, Akron, Ohio, USA; Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA. Electronic address:

Objectives: Our review aims to present existing data on the safety of Intravenous thrombolysis (IVT) use in acute ischemic stroke (AIS) patients with concomitant central nervous system or systemic malignancies, with attention to special circumstances pertaining to specific cancer subtypes to help in acute decision making, especially for neurologists and emergency medicine physicians.

Methods: A literature search was conducted on electronic databases inclusive of Medline, EMBASE and CINAHL for articles published or available in English between January 1, 2000 to June 1, 2020 using the following search terms: "acute ischemic stroke," "cerebrovascular disease," "Intravenous thrombolysis," "tissue plasminogen activator," "cancer patients," and "neoplasm".

Conclusion: Recognition of stroke symptoms in patients with active cancer, in particularly those involving the brain, requires astute clinical judgement. Read More

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Silver Jubilee of Stroke Thrombolysis With Alteplase: Evolution of the Therapeutic Window.

Front Neurol 2021 1;12:593887. Epub 2021 Mar 1.

Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

In 1995, the results of a landmark clinical trial by National Institute of Neurological Disorders and Stroke (NINDS) made a paradigm shift in managing acute cerebral ischemic stroke (AIS) patients at critical care centers. The study demonstrated the efficacy of tissue-type plasminogen activator (tPA), alteplase in improving neurological and functional outcome in AIS patients when administered within 3 h of stroke onset. After about 12 years of efforts and the results of the ECASS-III trial, it was possible to expand the therapeutic window to 4. Read More

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Diagnosis and Management of Transient Ischemic Attack and Acute Ischemic Stroke: A Review.

JAMA 2021 Mar;325(11):1088-1098

Department of Neurology, University of Chicago, Chicago, Illinois.

Importance: Stroke is the fifth leading cause of death and a leading cause of disability in the United States, affecting nearly 800 000 individuals annually.

Observations: Sudden neurologic dysfunction caused by focal brain ischemia with imaging evidence of acute infarction defines acute ischemic stroke (AIS), while an ischemic episode with neurologic deficits but without acute infarction defines transient ischemic attack (TIA). An estimated 7. Read More

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Fibrinolytics-facilitated chronic subdural haematoma drainage - a systematic review.

World Neurosurg 2021 Mar 12. Epub 2021 Mar 12.

Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 2/F, Professorial Block, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China. Electronic address:

Background: The current treatment options of chronic subdural haematoma (CSDH) include burr hole drainage (BHD), twist drill drainage (TD) and craniotomy with or without post-operative catheter drainage. Though generally effective, these treatments continue to be complicated by recurrence, especially in partially haemolysed or septated haematomas. Recently, there has been an increasing interest in using fibrinolytics as an adjunct to surgical treatment to address this limitation. Read More

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Intracameral r-tPA for the management of severe fibrinous reactions in TASS after cataract surgery.

Eur J Ophthalmol 2021 Mar 15:11206721211002064. Epub 2021 Mar 15.

Ophthalmology Department, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Background: To describe the use of intracameral recombinant tissue plasminogen activator (r-tPA) in the treatment of severe fibrinous reactions in toxic anterior segment syndrome (TASS) after cataract surgery.

Methods: A case series of 59 eyes of 59 patients with severe fibrinous anterior chamber reaction following cataract surgery who received intracameral r-tPA (25 µg/0.1 ml). Read More

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A Smartphone Application as a Telemedicine Tool for Stroke Care Management.

Neurol Med Chir (Tokyo) 2021 Mar 12. Epub 2021 Mar 12.

Department of Neurosurgery, The Jikei University School of Medicine.

Since smartphone applications are revolutionizing telemedicine, a new application specifically for stroke care (JOIN) was designed. Addition of the JOIN smartphone application to the stroke treatment workflow in our hospital was assessed. JOIN has key functions that may improve the care of stroke patients, including the ability to (1) exchange information such as patient data and medical images in real-time throughout the entire process of patient management; (2) track each step of the protocol from door to discharge; and (3) facilitate real-time interaction of all team members via text, audio, and a video chat system. Read More

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Inside the Thrombus: Association of Hemostatic Parameters With Outcomes in Large Vessel Stroke Patients.

Front Neurol 2021 22;12:599498. Epub 2021 Feb 22.

Laboratory of Atherothrombosis, CIMA-Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra, IdisNA, Pamplona, Spain.

Actual clinical management of ischemic stroke (IS) is based on restoring cerebral blood flow using tissue plasminogen activator (tPA) and/or endovascular treatment (EVT). Mechanical thrombectomy has permitted the analysis of thrombus structural and cellular classic components. Nevertheless, histological assessment of hemostatic parameters such as thrombin-activatable fibrinolysis inhibitor (TAFI) and matrix metalloproteinase 10 (MMP-10) remains unknown, although their presence could determine thrombus stability and its response to thrombolytic treatment, improving patient's outcome. Read More

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February 2021

High Genetic Addiction Risk Score (GARS) in Chronically Prescribed Severe Chronic Opioid Probands Attending Multi-pain Clinics: an Open Clinical Pilot Trial.

Mol Neurobiol 2021 Mar 8. Epub 2021 Mar 8.

Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.

Millions of Americans experience pain daily. In 2017, opioid overdose claimed 64,000 lives increasing to 84,000 lives in 2020, resulting in a decrease in national life expectancy. Chronic opioid use results in dependency, drug tolerance, neuroadaptation, hyperalgesia, potential addictive behaviors, or Reward Deficiency Syndrome (RDS) caused by a hypodopaminergia. Read More

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Management of Central Retinal Artery Occlusion: A Scientific Statement From the American Heart Association.

Stroke 2021 Mar 8:STR0000000000000366. Epub 2021 Mar 8.

Purpose: Central retinal artery occlusion (CRAO) is a form of acute ischemic stroke that causes severe visual loss and is a harbinger of further cerebrovascular and cardiovascular events. There is a paucity of scientific information on the appropriate management of CRAO, with most strategies based on observational literature and expert opinion. In this scientific statement, we critically appraise the literature on CRAO and provide a framework within which to consider acute treatment and secondary prevention. Read More

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Improving Hemocompatibility: How Can Smart Surfaces Direct Blood To Fight against Thrombi.

ACS Appl Mater Interfaces 2021 Mar 3;13(10):11696-11707. Epub 2021 Mar 3.

DWI - Leibniz-Institute for Interactive Materials e.V., Forckenbeckstraße 50, Aachen D-52074, Germany.

Nature utilizes endothelium as a blood interface that perfectly controls hemostasis, preventing the uncontrolled formation of thrombi. The management of positive and negative feedback that finely tunes thrombosis and fibrinolysis is essential for human life, especially for patients who undergo extracorporeal circulation (ECC) after a severe respiratory or cardiac failure. The exposure of blood to a surface different from healthy endothelium inevitably initiates coagulation, drastically increasing the mortality rate by thromboembolic complications. Read More

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Rare severe hypofibrinogenemia induced by tissue plasminogen activator in stroke patients: Case report.

Medicine (Baltimore) 2021 Mar;100(9):e24978

Department of Neurology, Shenzhen University First Affiliated Hospital.

Rationale: Severe hypofibrinogenemia after intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) is rare and easily overlooked, but hypofibrinogenemia increases the risk of major bleeding. However, it is unclear when hypofibrinogenemia reaches the peak and when hypofibrinogenemia is resolved.

Patient Concerns: Case 1 was of a 66-year-old man who was hospitalized due to sudden onset of vague speech and right hemiplegia for 4 hours. Read More

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Use and Impact of Positron Emission Tomography/Computed Tomography Prior to Salvage Radiation Therapy in Men with Biochemical Recurrence After Radical Prostatectomy: A Scoping Review.

Eur Urol Oncol 2021 Feb 23. Epub 2021 Feb 23.

Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA. Electronic address:

Context: The use, common findings, and impact of modern molecular positron emission tomography (PET)/computed tomography (CT) imaging prior to salvage radiation therapy (RT) in men with biochemical recurrence after radical prostatectomy (RP) have not been evaluated comprehensively.

Objective: We performed a scoping systematic review of the literature assessing detection rates, detection patterns, changes in management, as well as changes in patient outcome resulting from molecular PET/CT imaging using three molecular tracers: F-fluciclovine, Ga prostate-specific membrane antigen (PSMA)-11, and F-DCFPyL.

Evidence Acquisition: A computerized bibliographic search of the Medline/PubMed database was carried out from inception to October 1, 2020. Read More

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February 2021

Acute bilateral internal carotid artery occlusion: A novel approach to management of a catastrophic clinical entity.

Clin Imaging 2021 Feb 10;76:166-174. Epub 2021 Feb 10.

Renown Regional Medical Center, Reno, NV, USA; University of Nevada, Reno School of Medicine, Reno, NV, USA; Renown Health, Acute Care Neurology Division, Reno, NV, USA.

Background: Acute bilateral internal carotid artery occlusion (ABICAO) represents a rare but potentially-lethal clinical entity. Guidelines for management remain to be established. However, emergent intervention is vital to prevent loss of brainstem reflexes and death. Read More

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February 2021

POSITIVE: Perfusion imaging selection of ischemic stroke patients for endovascular therapy.

J Neurointerv Surg 2021 Feb 25. Epub 2021 Feb 25.

Neurosurgery, Prisma Health Upstate, Greenville, South Carolina, USA.

Background: The PerfusiOn imaging Selection of Ischemic sTroke patIents for endoVascular thErapy (POSITIVE) trial was designed to evaluate functional outcome in patients with emergent large vessel occlusion (ELVO) presenting within 0-12 hours with pre-specified bifurcated arms of early and late window presentation, who were selected for endovascular thrombectomy with non-vendor specific commercially available perfusion imaging software. Recent trials demonstrating the benefit of thrombectomy up to 16-24 hours following ELVO removed equipoise to randomize late window ELVO patients and therefore the trial was halted.

Methods: Up to 200 patients were to be enrolled in this FDA-cleared, prospective, randomized, multicenter international trial to compare thrombectomy and best medical management in patients with ELVO ineligible for or refractory to treatment with IV tissue plasminogen activator (IV-tPA) selected with perfusion imaging and presenting within 0-12 hours of last seen normal. Read More

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February 2021

The Role of Angioplasty Alone in Intracranial Atherosclerosis: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2021 Feb 11. Epub 2021 Feb 11.

Department of Radiology, Mayo Clinic, Rochester, Minnesota.

Intracranial atherosclerosis disease (IAD) is the cause of stroke in up to 10% of cases. Symptomatic IAD results mainly from hypoperfusion, embolic phenomenon, and occlusion. Treatment consists of conservative management with aggressive medical treatment, surgery, and endovascular therapy. Read More

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February 2021

Pediatric Hyperacute Arterial Ischemic Stroke Pathways at Canadian Tertiary Care Hospitals.

Can J Neurol Sci 2021 Feb 11:1-8. Epub 2021 Feb 11.

University of Ottawa, Faculty of Medicine, Ottawa, ON, Canada.

Background: Childhood acute arterial ischemic stroke (AIS) is diagnosed at a median of 23 hours post-symptom onset, delaying treatment. Pediatric stroke pathways can expedite diagnosis. Our goal was to understand the similarities and differences between Canadian pediatric stroke protocols with the aim of optimizing AIS management. Read More

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February 2021

Acute Ischemic Stroke.

Anesthesiol Clin 2021 Mar;39(1):113-125

University of Pittsburgh Medical Center, 200 Lothrop Street, Suite C-200, Pittsburgh, PA 15213, USA. Electronic address:

Anesthesiologists provide care to acute and subacute ischemic stroke (IS) patients and stroke survivors in interventional radiology, intensive care, and operating rooms. These encounters will become more frequent following studies that have extended the treatment window from last known well time for fibrinolytic and endovascular thrombectomy (EVT). The number of stroke centers certified to quickly and effectively initiate treatment of IS patients and the number of patients connected to them by telehealth continue to grow. Read More

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Fibrin-modulating nanogels for treatment of disseminated intravascular coagulation.

Blood Adv 2021 Feb;5(3):613-627

Joint Department of Biomedical Engineering of University of North Carolina-Chapel Hill and North Carolina State University, Raleigh, NC.

Disseminated intravascular coagulation (DIC) is a pathological coagulopathy associated with infection that increases mortality. In DIC, excessive thrombin generation causes symptoms from formation of microthrombi to multiorgan failure; bleeding risks can also be a concern because of clotting factor consumption. Different clinical events lead to DIC, including sepsis, trauma, and shock. Read More

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February 2021

Use of a Smartphone Platform to Help With Emergency Management of Acute Ischemic Stroke: Observational Study.

JMIR Mhealth Uhealth 2021 Feb 9;9(2):e25488. Epub 2021 Feb 9.

Beijing Municipal Health Commission, Beijing, China.

Background: To improve the outcomes of acute ischemic stroke (AIS), timely thrombolytic therapy is crucial. Series strategies were recommended to reduce door-to-needle (DTN) time for AIS. Mobile technologies are feasible and have been used in stroke management for various purposes. Read More

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February 2021

Pneumatic displacement for management of traumatic macular hole with submacular hemorrhage.

Oman J Ophthalmol 2020 Sep-Dec;13(3):158-160. Epub 2020 Nov 2.

Department of Vitreretina and Ocular Oncology, Sankara Eye Hospital, Bengaluru, Karnataka, India.

Complications of closed-globe injury such as submacular hemorrhage (SMH) and traumatic macular hole (TMH) can be visually devastating. It is observed that TMH occurs in 1.4% of closed-globe injuries and 0. Read More

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November 2020

Efficacy and Safety of the Telestroke Drip-And-Stay Model: A Systematic Review and Meta-Analysis.

J Stroke Cerebrovasc Dis 2021 Apr 2;30(4):105638. Epub 2021 Feb 2.

Dartmouth Hitchcock Medical Center, United States. Electronic address:

Objectives: To compare outcomes between two models of acute ischemic stroke care. Namely 1) "drip-and-stay", i.e. Read More

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