The literature on cost-utility for treating spinal disorders is limited. Studies addressing cost-utility of nonoperative and operative management of low back pain encompass a broad spectrum of diagnoses and direct comparison of treatments based on cost-utility thresholds for comparative effectiveness is limited by diversity among disorders and methods to assess cost-utility. Future research will benefit from uniform methods and comparison of treatments in cohorts with well-defined pathology.
obJect Vasopressor-induced hypertension (VIH) is an established treatment for patients with aneurysmal subarachnoid hemorrhage (SAH) who develop vasospasm and delayed cerebral ischemia (DCI). However, the safety of VIH in patients with coincident, unruptured, unprotected intracranial aneurysms is uncertain. methods This retrospective multiinstitutional study identified 1) patients with aneurysmal SAH and 1 or more unruptured, unprotected aneurysms who required VIH therapy (VIH group), and 2) patients with aneurysmal SAH and 1 or more unruptured, unprotected aneurysms who did not require VIH therapy (non-VIH group). All patients had previously undergone surgical or endovascular treatment for the presumed ruptured aneurysm. Comparisons between the VIH and non-VIH patients were made in terms of the patient characteristics, clinical and radiographic severity of SAH, total number of aneurysms, number of ruptured/unruptured aneurysms, aneurysm location/size, number of unruptured and unprotected aneurysms during VIH, severity of vasospasm, degree of hypervolemia, and degree and duration of VIH therapy. results For the VIH group (n = 176), 484 aneurysms were diagnosed, 231 aneurysms were treated, and 253 unruptured aneurysms were left unprotected during 1293 total days of VIH therapy (5.12 total years of VIH therapy for unruptured, unprotected aneurysms). For the non-VIH group (n = 73), 207 aneurysms were diagnosed, 93 aneurysms were treated, and 114 unruptured aneurysms were left unprotected. For the VIH and non-VIH groups, the mean sizes of the ruptured (7.2 ± 0.3 vs 7.8 ± 0.6 mm, respectively; p = 0.27) and unruptured (3.4 ± 0.2 vs 3.2 ± 0.2 mm, respectively; p = 0.40) aneurysms did not differ. The authors observed 1 new SAH from a previously unruptured, unprotected aneurysm in each group (1 of 176 vs 1 of 73 patients; p = 0.50). Baseline patient characteristics and comorbidities were similar between groups. While the degree of hypervolemia was similar between the VIH and non-VIH patients (fluid balance over the first 10 days of therapy: 3146.2 ± 296.4 vs 2910.5 ± 450.7 ml, respectively; p = 0.67), VIH resulted in a significant increase in mean arterial pressure (mean increase over the first 10 days of therapy relative to baseline: 125.1% ± 1.0% vs 98.2% ± 1.2%, respectively; p < 0.01) and systolic blood pressure (125.6% ± 1.1% vs. 104.1% ± 5.2%, respectively; p < 0.01). coNclusioNs For small, unruptured, unprotected intracranial aneurysms in SAH patients, the frequency of aneurysm rupture during VIH therapy is rare. The authors do not recommend withholding VIH therapy from these patients.
Objective: To analyse the frequency, demographics, primary disease, and cumulative effective dose of patients undergoing two or more 18F-FDGPET/CT examinations in a year. Methods: In a retrospective study performed at a tertiary care hospital, patients who underwent ≥2 18F-FDGPET/CT scans in a calendar year were identified for two consecutive years. The CT radiation dose was calculated using dose-length-product and sex-specific conversion factors. The primary malignancy of patients was retrieved from electronic medical records. Results: 10,714 18F-FDG PET/CT exams were performed for 6,831 unique patients in 2 years, yielding an average of 1.6 exams per patient. The maximum number of 18F-FDG PET/CT examinations any patient underwent in a single year was seven. 20.9% patients had ≥2 18F-FDG PET/CT exams in any single year. Thirty nine percent patients in the cohort were below 60 years age. The median dose for 18F-FDG PET/CT examination was 25.1 mSv and maximum value reaching 1.7 to 2.9 times the median value. Cumulative effective dose (CED) was ≥100 mSv in 12–13% of the patients. The cumulative dose for both years combined demonstrated the 25th percentile, 50th percentile and 75th percentile as well as the mean to be over 100 mSv, with the 25th percentile being 109 mSv. The dominant primary malignancies contributing to serial 18F-FDG PET/CTs in decreasing frequency were melanoma, non-Hodgkin’s lymphoma (NHL), gastrointestinal cancer, breast cancer and Hodgkin’s lymphoma. Conclusions: A sizeable number of patients undergo ≥2 18F-FDG PET/CT exams with one out of every 8 patients receiving cumulative dose ≥100 mSv and that includes patients with long life expectancy. Advances in knowledge: The study found that 1 of 5 patients had ≥2 18F-FDG PET/CT exams in a calendar year, 1 of 4 patients in two years and 1 of 8 patients received cumulative dose ≥100 mSv. Top malignancies associated with serial imaging in decreasing order of frequency included melanoma, non-Hodgkin’s lymphoma (NHL), gastrointestinal cancer, breast cancer and Hodgkin’s lymphoma.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.