IGFBP-3 levels after ischemic stroke may independently predict functional outcome after one year.
In our study, right insular involvement was a prognostic marker for mortality after ischaemic stroke. A selection bias towards patients able to give informed consent warrants further studies.
Introduction Foetal macrosomia is associated with various obstetrical complications and is a common reason for inductions and primary or secondary Caesarean sections. The objective of this study is the generation of descriptive data on the mode of delivery and on maternal and foetal complications in the case of foetal macrosomia. The causes and consequences of foetal macrosomia as well as the rate of shoulder dystocia are examined in relation to the severity of the macrosomia. Patients The study investigated all singleton births ≥ 37 + 0 weeks of pregnancy with a birth weight ≥ 4000 g at the Charité University Medicine Berlin (Campus Mitte 2001 – 2017, Campus Virchow Klinikum 2014 – 2017). Results 2277 consecutive newborns (birth weight 4000 – 4499 g [88%], 4500 – 4999 g [11%], ≥ 5000 g [1%]) were included. Maternal obesity and gestational diabetes were more common in the case of newborns weighing ≥ 4500 g than newborns weighing 4000 – 4499 g (p = 0.001 and p < 0.001). Women with newborns ≥ 5000 g were more often ≥ 40 years of age (p = 0.020) and multipara (p = 0.025). The mode of delivery was spontaneous in 60% of cases, vaginal-surgical in 9%, per primary section in 14% and per secondary section in 17%. With a birth weight ≥ 4500 g, a vaginal delivery was more rare (p < 0.001) and the rate of secondary sections was increased (p = 0.011). Women with newborns ≥ 4500 g suffered increased blood loss more frequently (p = 0.029). There was no significant difference with regard to the rate of episiotomies or serious birth injuries. Shoulder dystocia occurred more frequently at a birth weight of ≥ 4500 g (5 vs. 0.9%, p = 0.000). Perinatal acidosis occurred in 2% of newborns without significant differences between the groups. Newborns ≥ 4500 g were transferred to neonatology more frequently (p < 0.001). Conclusion An increased birth weight is associated with an increased maternal risk and an increased rate of primary and secondary sections as well as shoulder dystocia; no differences in the perinatal outcome between newborns with a birth weight of 4000 – 4499 g and ≥ 4500 g were seen. In our collective, a comparably low incidence of shoulder dystocia was seen. In the literature, the frequency is indicated with a large range (1.9 – 10% at 4000 – 4499 g, 2.5 – 20% at 4500 – 5000 g and 10 – 20% at ≥ 5000 g). One possible cause for the low rate could be the equally low prevalence of gestational diabetes in our collective. A risk stratification of the pregnant women (e.g. avoidance of vacuum extraction, taking gestational diabetes into account during delivery planning) is crucial. If macrosomia is presumed, it is recommended that delivery take place at a perinatal centre in the presence of a specialist physician, due to the increased incidence of foetal and maternal complications.
Introduction: The association between insular infarction and mortality has often been described. However, whether this is simply due to higher lesion volumes is still controversial. Hypothesis: We hypothesized that there is an association between insular infarction and mortality independent of lesion volume. Methods: We included consecutive stroke patients between 01.09.2008 and 11.11.2012 from the 1000Plus data base with an acute ischemic lesion on diffusion-weighted imaging on day one and a completed 90 days follow-up. Insular location of the infarction was determined using the Stroke Lesion Atlas (SLA). The SLA is an in-house developed spatial database for analyses of imaging studies (Figure). In multivariate regression analyses of mortality and insular infarcts we adjusted for age, lesion volume, atrial fibrillation, NIHSS, capsular infarcts, and left hemispheric infarcts. Results: We included 718 patients. Out of 165 patients with insular infarcts 20 patients died; among the 553 patients with lesions outside the Insula 16 patients died (mortality 12% vs. 3%; p<.001). In analyses adjusting for all mentioned confounders insular infarction was not an independent predictor of mortality. After exclusion of NIHSS insular infarcts were independently associated with mortality (OR=3.003, CI 1.41 - 6.38, p=.004). Right insular infarction was an independent mortality predictor adjusted for all confounders including the NIHSS (OR=2.793, CI 1.27 - 6.15, p=.011). Conclusion: Right insular involvement is an independent predictor of mortality in ischemic stroke and may be used to improve identification of patients at risk. Figure. Lesion overlap of patients who survived (A) or died (B). Red indicates voxels involved in at least 15% of patients. Deceased patients show a maximum lesion overlap in the right Insula.
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