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Sample records for single centre retrospective

  1. Wilms' tumor: single centre retrospective study from South India.

    PubMed

    Guruprasad, B; Rohan, B; Kavitha, S; Madhumathi, D S; Lokanath, D; Appaji, L

    2013-09-01

    Wilms' tumor is the most common malignant renal tumor in paediatric age group, and is classically managed by multimodal treatment which involves surgery, radiotherapy and chemotherapy. The last few decades have seen a dramatic change in the prognosis of this disease, which once was a uniformly lethal malignancy. While there is plenty of data in world literature on the outcome of Wilms' tumor, there is paucity of data from India. Hence, we conducted the present study to analyze the outcome of Wilms' tumor at our institute. To study the clinicopathologic profile and outcome of Wilms' tumor with NWTS (National Wilms' Tumor Study Group) IV protocol. Sixty-one patients with histopathological proven diagnosis of Wilms' tumor and had received treatment at our institute from Jan 2003 through Dec 2010 were included for analysis. Patients received treatment based on NWTS IV protocol. Patients were analysed for overall survival and event free survival and these outcomes were correlated with age, sex, stage at presentation and histology. Favourable histology which included focal anaplasia was found in 80.3 % while unfavourable histology was elicited in 19.7 % of the cases. The estimated 5 year event-free survival was 83.3 % and overall survival was 85.2 %. Tumour histology was the single most important factor predicting the survival. Patients with childhood Wilms' still present very late in our setting, this poses management challenges as large tumor are technically difficult to deliver at surgery. Histology has a crucial role in outcome of this disease. With multidisciplinary approach, similar survival rates to National Wilms' Tumor Study Group seems to be achievable even in Indian scenario.

  2. Palliative patients under anaesthesiological care: a single-centre retrospective study on incidence, demographics and outcome.

    PubMed

    Lassen, Christoph L; Aberle, Susanne; Lindenberg, Nicole; Bundscherer, Annika; Klier, Tobias W; Graf, Bernhard M; Wiese, Christoph H

    2015-11-13

    While anesthesiologist's involvement in palliative care has been widely researched, extensive data on palliative patients under anesthesiological care in the operating room is missing. This study was performed to assess the incidence, demographics, and outcome of palliative patients under anesthesiological care. We conducted a single-center retrospective chart review of all palliative patients under anesthesiological care at a university hospital in 1 year. Patients were classified as palliative if they fulfilled all predefined criteria (a) incurable, life-threatening disease, (b) progression of the disease despite therapy, (c) advanced stage of the disease with limited life-expectancy, (d) receiving or being in need of a specific palliative therapy. Demographics, periprocedural parameters, symptoms at evaluation, and outcome were determined using different medical records. Of 17,580 patients examined, 276 could be classified as palliative patients (1.57%). Most contacts with palliative patients occurred in the operating room (68.5%). In comparison to the non-palliative patients, procedures in palliative patients were significantly more often urgent or emergency procedures (39.1% vs. 27.1%., P < 0.001), and hospital mortality was higher (18.8% vs. 5.0%, P < 0.001). Preprocedural symptoms varied, with pain, gastrointestinal, and nutritional problems being the most prevalent. Palliative patients are treated by anesthesiologists under varying circumstances. Anesthesiologists need to identify these patients and need to be aware of their characteristics to adequately attend to them during the periprocedural period.

  3. Initiation of non-invasive ventilation in amyotrophic lateral sclerosis and clinical practice guidelines: Single-centre, retrospective, descriptive study in a national reference centre.

    PubMed

    Georges, Marjolaine; Golmard, Jean-Louis; Llontop, Claudia; Shoukri, Amr; Salachas, François; Similowski, Thomas; Morelot-Panzini, Capucine; Gonzalez-Bermejo, Jésus

    2017-02-01

    In amyotrophic lateral sclerosis (ALS), respiratory muscle weakness leads to respiratory failure. Non-invasive ventilation (NIV) maintains adequate ventilation in ALS patients. NIV alleviates symptoms and improves survival. In 2006, French guidelines established criteria for NIV initiation based on limited evidence. Their impact on clinical practice remains unknown. Our objective was to describe NIV initiation practices of the main French ALS tertiary referral centre with respect to guidelines. In this retrospective descriptive study, 624 patients followed in a single national reference centre began NIV between 2005 and 2013. We analysed criteria used to initiate NIV, including symptoms, PaCO2, forced vital capacity, maximal inspiratory pressures and time spent with SpO2 <90% at night. At NIV initiation, 90% of patients were symptomatic. Median PaCO2 was 48 mmHg. The main criterion to initiate NIV was 'symptoms' followed by 'hypercapnia' in 42% and 34% of cases, respectively. NIV was initiated on functional parameters in only 5% of cases. Guidelines were followed in 81% of cases. In conclusion, despite compliance with French guidelines, the majority of patients are treated at the stage of symptomatic daytime hypoventilation, which suggests that NIV is initiated late in the course of ALS. Whether this practice could be improved by changing guidelines or increasing respiratory-dedicated resources remains to be determined.

  4. Lessons to be learnt in managing the breech presentation at term: an 11-year single-centre retrospective study.

    PubMed

    Borbolla Foster, Ailsa; Bagust, Annalise; Bisits, Andrew; Holland, Matthew; Welsh, Alec

    2014-08-01

    The 2000 publication of the Term Breech Trial significantly impacted obstetric practice in Australia with a rapid increase in delivery of term breech singletons by caesarean section. More reassuring data from European centres who continued to offer vaginal breech deliveries to carefully selected women have led to a softening of international guidelines which now support an individualised approach to management. The application of this principle to an Australian population, particularly in the wake of such a major change in obstetric practice, has not previously been demonstrated. To compare short-term neonatal and maternal morbidity for infants with a singleton breech presentation born after 37 weeks, according to planned mode of delivery. Eleven-year single-centre retrospective study with intention-to-treat analysis based on intended mode of delivery. Two hundred and forty-three of 766 (31.7%) eligible women elected for planned vaginal breech delivery. The overall success rate in this group was 58%. Morbidity rates were low and compare favourably with similar international studies. However, there was a nonsignificant trend towards higher rates of short-term serious neonatal and maternal morbidity in the planned vaginal delivery group (1.6 vs 0.4%, P = 0.08 and 8.2 vs 4.8%, P = 0.06, respectively). Attempted vaginal delivery for breech presentation remains an option in carefully selected women under strict obstetric protocols. © 2014 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  5. A Review of the Multidisciplinary Diagnosis of Interstitial Lung Diseases: A Retrospective Analysis in a Single UK Specialist Centre

    PubMed Central

    Chaudhuri, Nazia; Spencer, Lisa; Greaves, Melanie; Bishop, Paul; Chaturvedi, Anshuman; Leonard, Colm

    2016-01-01

    The accurate diagnosis and management of individuals with interstitial lung diseases (ILDs) poses an interesting challenge in clinical practice. A multidisciplinary team (MDT) approach is considered the gold standard. This is a single-centre retrospective review spanning a five-year period. We assessed the accuracy of prior ILD diagnosis, the methodology used to establish a correct diagnosis and how an MDT approach affected subsequent management. Our data supports an MDT approach in an experienced specialist ILD centre. We have demonstrated that diagnosis is often changed after an MDT review and that this impacts the subsequent management. Our results demonstrate that an MDT approach to diagnosis can establish a diagnosis in the majority of cases when prior diagnosis is uncertain (76%). We also show that a prior diagnosis of idiopathic pulmonary fibrosis is deemed inaccurate in over 50% of cases after MDT discussion. We have shown that during diagnostic uncertainty the considered gold standard of proceeding to a lung biopsy is not always feasible due to disease severity and comorbidities. In these circumstances, an MDT approach to diagnosis of ILDs combines clinical data with serial lung function and disease behavior, with or without responses to previous treatment trials to establish an accurate expert diagnosis. PMID:27472372

  6. Craniofacial implants at a single centre 2005-2015: retrospective review of 451 implants.

    PubMed

    Elledge, R; Chaggar, J; Knapp, N; Martin, T; White, N; Evriviades, D; Edmondson, S; Parmar, S

    2017-04-01

    Craniofacial endosseous implants are regularly used to support prostheses in the rehabilitation of complex defects, but reported success rates vary. To review our own clinical practice over 10 years, and particularly to examine the impact of radiotherapy and the timing of placement on the survival of implants, we retrospectively audited the records for all patients who had endosseous implants for prosthetic rehabilitation in our unit between 2005 and 2015. We reviewed 167 records, which gave 451 implants, of which, 222 (49%) were auricular, 98 (22%) nasal, and 131 (29%) orbital. Most were placed after ablative operations for cutaneous malignancy (n=103 patients, 62%). The failure rate of implants placed in bone that was irradiated either before or after placement was significantly higher than that of those placed in non-irradiated bone (univariate analysis: 11% compared with 2%, p<0.001: Kaplan-Meier survival analysis: p<0.001). The timing of placement in relation to radiotherapy (before compared with after) seemed to have no impact on success (p=0.96). Our findings are in keeping with previous reports, and the principal observation is that radiotherapy adversely affects success. We work closely with our maxillofacial prosthetists and place implants at the time of ablation. Our findings seem to support this practice regardless of whether or not the patient will later require adjuvant radiotherapy.

  7. Unplanned intensive care unit admission after general anaesthesia in children: A single centre retrospective analysis.

    PubMed

    Mitchell, John; Clément de Clety, Stephan; Collard, Edith; De Kock, Marc; Detaille, Thierry; Houtekie, Laurent; Jadin, Laurence; Bairy, Laurent; Veyckemans, Francis

    2016-06-01

    To determine the main causes for unplanned admission of children to the paediatric intensive care unit (PICU) following anaesthesia in our centre. To compare the results with previous publications and propose a data sheet for the prospective collection of such information. Inclusion criteria were any patient under 16 years who had an unplanned post-anaesthetic admission to the PICU from 1999 to 2010 in our university hospital. Age, ASA score, type of procedure, origin and causes of the incident(s) that prompted admission and time of the admission decision were recorded. Out of a total of 44,559 paediatric interventions performed under anaesthesia during the study period, 85 were followed with an unplanned admission to the PICU: 67% of patients were younger than 5 years old. Their ASA status distribution from I to IV was 13, 47, 39 and 1%, respectively. The cause of admission was anaesthetic, surgical or mixed in 50, 37 and 13% of cases, respectively. The main causes of anaesthesia-related admission were respiratory or airway management problems (44%) and cardiac catheterisation complications (29%). In 62%, the admission decision was taken in the operating room. Unplanned admission to the PICU after general anaesthesia is a rare event. In our series, most cases were less than 5 years old and were associated with at least one comorbidity. The main cause of admission was respiratory distress and the main type of procedure associated with admission was cardiac catheterisation. Copyright © 2016 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

  8. Managing real world venous leg ulcers with fetal bovine acellular dermal matrix: a single centre retrospective study.

    PubMed

    Paredes, J A; Bhagwandin, S; T, Polanco; Lantis, J C

    2017-10-01

    As compression treatment offers moderate improvement, especially to recurrent venous leg ulcers (VLUs), several alternative therapies using cellular based and/or tissue-derived products (CTPs) have emerged from bovine, porcine, and equine sources. Our aim was to look at the effect of a CTP in 'real-life' VLUs. This study looked at complex patients with chronic, large wounds in a single-centre retrospective review. All patients were treated with fetal bovine acellular dermal matrix (FBADM) for VLUs at our outpatient urban wound care programme. A total of 40 wounds in 33 patients were analysed. At week four, 6% of wounds were closed; at week eight, 9% were closed; at week 12, 25% were closed; and at week 16, 38% of wounds were closed. The median time to wound closure was 67 days (range: 23-100 days) and the median percent wound closure through re-epithelialisation was 11% per week (range: 7-30% per week). At 4 weeks the median area reduction of all wounds was 23.5%, with 40% of VLUs having a ≥40% area reduction at the same point in time. There are limitations to any retrospective review; however; patients deemed to have a limited chance of closure at 4 months did better than expected, either healing or having a wound area reduction at 16 weeks, making their wound care much easier. Prospective studies should be conducted to optimise the treatment algorithm to determine if better clinical outcomes can be obtained for the 'real-life' VLU population.

  9. Utilisation of Blood Components in Cardiac Surgery: A Single-Centre Retrospective Analysis with Regard to Diagnosis-Related Procedures

    PubMed Central

    Geissler, Raoul Georg; Rotering, Heinrich; Buddendick, Hubert; Franz, Dominik; Bunzemeier, Holger; Roeder, Norbert; Kwiecien, Robert; Sibrowski, Walter; Scheld, Hans H.; Martens, Sven; Schlenke, Peter

    2015-01-01

    Background More blood components are required in cardiac surgery than in most other medical disciplines. The overall blood demand may increase as a function of the total number of cardiothoracic and vascular surgical interventions and their level of complexity, and also when considering the demographic ageing. Awareness has grown with respect to adverse events, such as transfusion-related immunomodulation by allogeneic blood supply, which can contribute to morbidity and mortality. Therefore, programmes of patient blood management (PBM) have been implemented to avoid unnecessary blood transfusions and to standardise the indication of blood transfusions more strictly with aim to improve patients' overall outcomes. Methods A comprehensive retrospective analysis of the utilisation of blood components in the Department of Cardiac Surgery at the University Hospital of Münster (UKM) was performed over a 4-year period. Based on a medical reporting system of all medical disciplines, which was established as part of a PBM initiative, all transfused patients in cardiac surgery and their blood components were identified in a diagnosis- and medical procedure-related system, which allows the precise allocation of blood consumption to interventional procedures in cardiac surgery, such as coronary or valve surgery. Results This retrospective single centre study included all in-patients in cardiac surgery at the UKM from 2009 to 2012, corresponding to a total of 1,405-1,644 cases per year. A blood supply was provided for 55.6-61.9% of the cardiac surgery patients, whereas approximately 9% of all in-patients at the UKM required blood transfusions. Most of the blood units were applied during cardiac valve surgery and during coronary surgery. Further surgical activities with considerable use of blood components included thoracic surgery, aortic surgery, heart transplantations and the use of artificial hearts. Under the measures of PBM in 2012 a noticeable decrease in the number of

  10. Utilisation of blood components in cardiac surgery: a single-centre retrospective analysis with regard to diagnosis-related procedures.

    PubMed

    Geissler, Raoul Georg; Rotering, Heinrich; Buddendick, Hubert; Franz, Dominik; Bunzemeier, Holger; Roeder, Norbert; Kwiecien, Robert; Sibrowski, Walter; Scheld, Hans H; Martens, Sven; Schlenke, Peter

    2015-03-01

    More blood components are required in cardiac surgery than in most other medical disciplines. The overall blood demand may increase as a function of the total number of cardiothoracic and vascular surgical interventions and their level of complexity, and also when considering the demographic ageing. Awareness has grown with respect to adverse events, such as transfusion-related immunomodulation by allogeneic blood supply, which can contribute to morbidity and mortality. Therefore, programmes of patient blood management (PBM) have been implemented to avoid unnecessary blood transfusions and to standardise the indication of blood transfusions more strictly with aim to improve patients' overall outcomes. A comprehensive retrospective analysis of the utilisation of blood components in the Department of Cardiac Surgery at the University Hospital of Münster (UKM) was performed over a 4-year period. Based on a medical reporting system of all medical disciplines, which was established as part of a PBM initiative, all transfused patients in cardiac surgery and their blood components were identified in a diagnosis- and medical procedure-related system, which allows the precise allocation of blood consumption to interventional procedures in cardiac surgery, such as coronary or valve surgery. This retrospective single centre study included all in-patients in cardiac surgery at the UKM from 2009 to 2012, corresponding to a total of 1,405-1,644 cases per year. A blood supply was provided for 55.6-61.9% of the cardiac surgery patients, whereas approximately 9% of all in-patients at the UKM required blood transfusions. Most of the blood units were applied during cardiac valve surgery and during coronary surgery. Further surgical activities with considerable use of blood components included thoracic surgery, aortic surgery, heart transplantations and the use of artificial hearts. Under the measures of PBM in 2012 a noticeable decrease in the number of transfused cases was observed

  11. Efficacy and safety of super selective bronchial artery coil embolisation for haemoptysis: a single-centre retrospective observational study

    PubMed Central

    Ishikawa, Hideo; Hara, Masahiko; Ryuge, Misaki; Takafuji, Jun; Youmoto, Mihoko; Akira, Masanori; Nagasaka, Yukio; Kabata, Daijiro; Yamamoto, Kouji; Shintani, Ayumi

    2017-01-01

    Objectives Evidence on the safety and long-term efficacy of super selective bronchial artery embolisation (ssBAE) using platinum coils in patients with haemoptysis is insufficient. The objective of the present study was to evaluate the safety and the 3-year postprocedure haemoptysis-free survival rate of de novo elective ssBAE using platinum coils rather than particles for the treatment of haemoptysis. Design A single-centre retrospective observational study. Setting Hemoptysis and Pulmonary Circulation Center in Japan. Participants A total of 489 consecutive patients with massive and non-massive haemoptysis who underwent de novo elective ssBAE without malignancy or haemodialysis. Interventions ssBAE using platinum coils. All patients underwent CT angiography before the procedure for identifying haemoptysis-related arteries (HRAs) and for procedural planning. Primary and secondary outcome measures The composite of the 3-year recurrence of haemoptysis and mortality from the day of the last ssBAE session. Each component of the primary end point and procedural success defined as successful embolisation of all target HRAs were also evaluated. Results The median patient age was 69 years, and 46.4% were men. The total number of target vessels was 4 (quartile 2–7), and the procedural success rate was 93.4%. There were 8 (1.6%) major complications: 1 aortic dissection, 2 symptomatic cerebellar infarctions and 5 mediastinal haematoma cases. The haemoptysis-free survival rates were estimated by the Kaplan-Meier analysis at 86.9% (95% CI 83.7% to 90.2%) at 1 year, 79.4% (74.8% to 84.3%) at 2 years and 57.6% (45.1% to 73.4%) at 3 years. Although not statistically significant by the adjusted analysis of variance with multiple imputation of missing variables, cryptogenic haemoptysis tended to show the most favourable outcome and non-tuberculous mycobacterium showed the worst outcome (adjusted p=0.250). Conclusions We demonstrated the safety and long-term efficacy of

  12. Clinical features and laboratory findings of dengue fever in German travellers: A single-centre, retrospective analysis.

    PubMed

    Tavakolipoor, Pulad; Schmidt-Chanasit, Jonas; Burchard, Gerd Dieter; Jordan, Sabine

    2016-01-01

    Dengue fever (DF) is one of the most relevant human arboviral infections worldwide and has become a frequent cause of fever in the returning traveller. This retrospective study aimed to characterize epidemiological and clinical features and laboratory findings of dengue fever in German travellers. This descriptive study analyzed medical records of patients diagnosed with DF presenting at the Section of Tropical Medicine of the University Medical Centre Hamburg-Eppendorf from 2007 to 2011. Data were collected and analyzed retrospectively. In total, data of 119 DF patients (52 female, 67 male) were included in this study. The median age of the patients was 35 (range 15-75 years). DF was most frequently acquired in South-East Asia (n = 65; 54.7%), and in particular in Thailand (n = 23; 19.7%). A considerable percentage of DF infections (n = 14; 11.8%) was imported from Africa. Patients predominantly presented with fever, headache, rash, myalgia and arthralgia but also with gastrointestinal symptoms, i.e. diarrhoea. Nine patients showed signs of minor haemorrhagic manifestations. Neurological complications occurred in 13 patients. Low platelet count, leukopenia and elevated liver enzymes were the most relevant laboratory findings. Twenty patients (17.8%) had to be hospitalized. Overall, the clinical course was mostly mild to moderate, 13 patients (10.9%) showed DF warnings signs, no fatalities occurred. DF presented as a mostly mild to moderate disease in this study cohort. Outpatient treatment was adequate for the majority of patients. Still, detailed knowledge of clinical symptoms and laboratory features is essential for appropriate triage. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Predictors of Perioperative Acute Kidney Injury in Obese Patients Undergoing Laparoscopic Bariatric Surgery: a Single-Centre Retrospective Cohort Study.

    PubMed

    Abdullah, Hairil Rizal; Tan, Tze Ping; Vaez, Mercedeh; Deb, Chameli; Farag, Naguib; Jackson, Timothy D; Wong, David Tai

    2016-07-01

    Obesity has been associated with increased risk of perioperative acute kidney injury (AKI). We aim to establish the incidence of AKI among patients undergoing laparoscopic bariatric surgery and identify potential risk factors. Records of 1230 patients who underwent laparoscopic bariatric surgery in a tertiary centre from 1 December 2009 to 31 January 2014 were retrospectively studied. AKI diagnosis was made by comparing the baseline and post-operative serum creatinine to determine the presence of predefined significant change based on the Kidney Disease: Improving Global Outcomes (KDIGO) definition. Univariate analyses were performed to determine significant clinical factors, and multiple logistic regression analysis was subsequently done to determine independent predictors of AKI. Thirty-five (2.9 %) patients developed AKI during the first 72 h post-surgery. Multivariate logistic regression analysis revealed impaired renal function (OR 10.429, 95 % CI 3.560 to 30.552), use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers (OR 3.038, 95 % CI 1.352 to 6.824), and body mass index (OR 1.048, 95 % CI 1.005 to 1.093) as independent predictors of perioperative acute kidney injury in the obese patients who underwent laparoscopic bariatric surgery. We found that the incidence of perioperative AKI among patients who underwent laparoscopic bariatric surgery is at 2.9 %. Impaired renal function, use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers and raised body mass index were found to be independent predictors of AKI. Patients with these risk factors could be considered at risk for developing perioperative AKI, and extra perioperative vigilance should be undertaken.

  14. Antibiotic prophylaxis in elective cholecystectomy: Protocol adequacy and related outcomes in a retrospective single-centre analysis.

    PubMed

    Rodríguez-Caravaca, Gil; Gil-Yonte, Pablo; Risco-Risco, Carlos; Latasa Zamalloa, Pello; Villar del Campo, M Concepcion; Fernández-Cebrián, Jose M; Valverde-Núñez, Ignacio; Lucendo, Alfredo J

    2016-01-01

    Antibiotic prophylaxis is an effective tool to reduce surgical infection rates. However, antibiotic prophylaxis in cholecystectomy is controversial when non-high risk patients are considered. This research aims to evaluate the adherence with antibiotic prophylaxis protocol in patients undergoing cholecystectomy, and its impact in the outcomes of surgical infection. This single-center observational and retrospective study analyzed all elective cholecystectomy procedures carried out at the Fundación Alcorcón University Hospital in the period 2007-2014. Data were recovered from hospital records; rates of adherence to the available hospital protocols were evaluated for choice, initiation, duration, administration route and dosages of antibiotics, and the starting and duration of the prophylaxis. The overall adequacy rate to protocol was 72%. The adherence rates in both the administration route and dose were 100%. The most common violations of the protocol included the choice of antibiotic agent (19%), followed by the moment of initiating its administration (8.9%). The overall wound infection rate was lower in case of laparoscopy than in laparotomy cholecystectomy (1.4% vs. 4.3%, p < 0.05; odds rate [OR] 0.29, 95% confidence interval [CI] 0.1-0.6). No relationship between adequacy of antibiotic prophylaxis and surgical infection rate was documented, neither considering overall gallbladder surgeries (crude OR 0.26, 95% CI 0.1-2.0), nor laparoscopy vs. open surgery (MH adjusted OR 0.24, 95% CI 0.2-2.1). The overall adequacy rate to antibiotic prophylaxis protocol recommended for elective cholecystectomy in our hospital was high (72%). No significant association between the adequacy or antibiotic prophylaxis and surgical infection was found.

  15. Anaesthesia in patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: retrospective analysis of a single centre three-year experience

    PubMed Central

    2014-01-01

    Background Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is a treatment option for selected patients with peritoneal carcinomatosis. There are limited data available on anaesthesia management and its impact on patients’ outcome. Our aim was to retrospectively analyze and evaluate perioperative management and the clinical course of patients undergoing CRS/HIPEC within a three-year period. Methods After ethic committee approval, patient charts were retrospectively reviewed for patient characteristics, interventions, perioperative management, postoperative course, and complications. Analysis was intervention based. Data are presented as median (range). Results Between 2009 and 2011, 54 consecutive patients underwent 57 interventions; median anaesthesia time was 715 (range 370 to 1135) minutes. HIPEC induced hyperthermia with an overall median peak temperature of 38.1 (35.7-40.2)°C with active cooling. Bleeding, expressed as median blood loss was 0.8 (0 to 6) litre and large fluid shifts occurred, requiring a total fluid input of 8.4 (4.2 to 29.4) litres per patient. Postoperative renal function was dependent on preoperative function and the type of fluids used. Administration of hydroxyethyl starch colloid solution had a significant negative impact on renal function, especially in younger patients. Major complications occurred after 12 procedures leading to death in 2 patients. Procedure time and need for blood transfusion were associated with a significantly higher risk for major complications. Conclusions Cytoreductive surgery with HIPEC is a high-risk surgical procedure associated with major hemodynamic and metabolic changes. As well as primary disease and complexity of surgery, we have shown that anaesthesia management, the type and amount of fluids used, and blood transfusions may also have a significant effect on patients’ outcome. PMID:24886171

  16. Analysis of the Influence of Lunar Cycle on the Frequency of Spontaneous Deliveries: A Single-centre Retrospective Study.

    PubMed

    Laganà, A S; Burgio, M A; Retto, G; Pizzo, A; Sturlese, E; Granese, R; Chiofalo, B; Ciacimino, L; Triolo, O

    2014-01-01

    Man, since ancient times, has been convinced of, and has researched scientific evidence that the barometric and gravitational forces play an important role in structural and biological variation of the planets, influencing the various forms of life. In particular, the synergistic relationships between variations in atmospheric pressure and gravitational forces on human gestation period have been the subject of rigorous observations and statistical calculations, which have not led to a universal conclusion in literature. The aim of our work was to check whether there is a higher incidence of spontaneous deliveries, during the periods of full Moon than during the other phases of the Moon. We performed a retrospective analysis of 327 non-induced vaginal deliveries in a year, divided by month. We subsequently analyzed the incidence of these deliveries during periods of full Moon Vs other lunar phases. We evidenced a statistically significant difference between the annual total spontaneous deliveries happened in full Moon periods Vs all other Moon phases (T= 2,3948; p=0,0256). However, we reported a discordant trend of deliveries in full Moon period, depending on each considered month. Since these differences were found both in increase and decrease, it is unacceptable the assumption of a linear correlation between periods of full Moon and increased frequency of spontaneous deliveries. For this reason, our data allow us to conclude that there is no need to increase the number of doctors and midwives in obstetric units during these periods.

  17. Acetabular spacers in 2-stage hip revision: is it worth it? A single-centre retrospective study.

    PubMed

    Burastero, Giorgio; Basso, Marco; Carrega, Giuliana; Cavagnaro, Luca; Chiarlone, Francesco; Salomone, Carlo; Papa, Gabriele; Felli, Lamberto

    2017-03-31

    The aim of this work is to evaluate an acetabular antibiotic loaded bone cement spacer in 2-stage revision surgery as a potential approach able to reduce complications during the inter-stage period (i.e. dislocation, acetabular wear), as well as simplify 2-stage hip revision surgery and improve hip biomechanics. We performed a retrospective comparative study and evaluated clinical, radiological and surgical data of 71 patients affected by periprosthetic hip infection who were treated with 2-stage exchange. 31 patients were treated using an acetabular spacer in addition to the femoral (group A) while 40 underwent a standard revision surgery (femoral spacer only, group B). Mean time of surgery for the first stage was 148 ± 59 minutes and 142 ± 45 minutes for group A and B respectively; we noted a statistically significant reduction (26 min, p = 0.015) in the same parameter for the second stage (83 ± 35 minutes for group A and 109 ± 36 minutes for group B). We observed the following interstage complications: 5 femoral spacer dislocations (1 for group A and 4 for group B); 1 spacer fracture (group B), 1 spacer fracture (group A), 2 periprosthetic fractures (group B) and 2 patients with acetabular spacer instability (group B). Additionally, we observed a significant improvement in leg length restoration for group A (p = 0.03). Our data show that the acetabular spacer technique is able to reduce the interstage complication rate and allow improved hip biomechanics restoration.

  18. First-line use of rituximab correlates with increased overall survival in late post-transplant lymphoproliferative disorders: retrospective, single-centre study.

    PubMed

    Martínez-Calle, Nicolás; Alfonso, Ana; Rifón, José; Herrero, Ignacio; Errasti, Pedro; Rábago, Gregorio; Merino, Juana; Panizo, Ángel; Pardo, Javier; Prósper, Felipe; García-Muñoz, Ricardo; Lecumberri, Ramón; Panizo, Carlos

    2017-01-01

    This retrospective study evaluates the impact of rituximab on PTLD response and survival in a single-centre cohort. PTLD cases between 1984 and 2009, including heart, kidney, liver and lung transplant recipients, were included. Survival was analysed taking into account the type of PTLD (monomorphic vs. polymorphic), EBV infection status, IPI score, Ann Arbor stage and use of rituximab. Among 1335 transplanted patients, 24 developed PTLD. Median age was 54 yr (range 29-69), median time to diagnosis 50 months (range 0-100). PTLD type was predominantly late/monomorphic (79% and 75%), mostly diffuse large B-cell type. Overall response rate (ORR) was 62% (66% rituximab vs. 50% non-rituximab; P = 0.5). R-CHOP-like regimens were used most frequently (72% of patients treated with rituximab). Median overall survival was 64 months (CI 95% 31-96). OS was significantly increased in patients treated with rituximab (P = 0.01; CI 95% rituximab 58-79 months; non-rituximab 1-30 months). Post-transplant immunosuppression regimen had no effect on survival or time to PTLD, except for cyclosporine A (CyA), which associated with increased time to PTLD (P = 0.02). Rituximab was associated with increased survival in our single-centre series, and it should be considered as first-line therapy for PTLD patients. The possible protective effect of CyA for development of PTLD should be prospectively evaluated. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  19. Oncologic safety of breast conserving surgery after tumour downsizing by neoadjuvant therapy: a retrospective single centre cohort study.

    PubMed

    Fitzal, F; Riedl, O; Mittlböck, M; Dubsky, P; Bartsch, R; Steger, G; Jakesz, R; Gnant, M

    2011-05-01

    The objective of this study is to analyse local recurrence rates in patients receiving neoadjuvant chemotherapy (nCT) comparing mastecomized (MX) patients with those undergoing breast conserving therapy (BCT). Patients undergoing breast cancer surgery after nCT (3xCMF or 3-6xED) between 1995 and 2007 at our department were retrospectively analysed. The median follow up was 60 months for 308 patients. Patients who were downsized from MX to BCT with partial or complete response (n = 104) had a similar local recurrence free survival (LRFS) compared to patients who did not experience successful downsizing (n = 67) and finally undergoing MX (LRFS MX-BCT 81% vs. MX-MX 91%; P = 0.79). Uni- and multivariate analyses demonstrated that BCT itself was not an independent prognostic factor for a worse LRFS (P = 0.07 and 0.14). After no pathologic change or progressive disease the risk of local recurrence was increased in patients undergoing BCT (MX-BCT; n = 6 LRFS 66%) compared with MX (n = 44; LRFS 90%; P = 0.04). Overall survival in general was better for the BCT group (n = 197) compared with MX group (n = 111) regardless of clinical response (92% vs. 72%; P < 0.0001). Breast conservation, nodal negativity and low or medium grade histology were prognostic factors for an improved OS (P = 0.02, 0.01, 0.004). In conclusion, our study suggests that BCT is oncologically safe after tumour downsizing by nCT in patients primarily scheduled for mastectomy. These patients, however, should not be treated with breast conservation in the absence of any proven response after nCT.

  20. Retrospective review of 200 children hospitalised with acute asthma. Identification of intervention points: a single centre study.

    PubMed

    Giarola, Blake F; McCallum, Gabrielle B; Bailey, Emily J; Morris, Peter S; Maclennan, Carolyn; Chang, Anne B

    2014-04-01

    Indigenous Australians with asthma have higher morbidity and mortality compared with non-Indigenous Australians. In children hospitalised with acute asthma, we aimed to (i) determine if acute severity, risk factors and management differed between Indigenous and non-Indigenous children; and (ii) identify intervention points to reduce morbidity and mortality of asthma. Retrospective review of 200 children hospitalised to Royal Darwin Hospital with asthma. We compared admission characteristics, severity indices, treatment, discharge plans and readmissions in Indigenous and non-Indigenous children. Median age was 3.6 years (interquartile range 2.2, 6.8). A significantly higher proportion of Indigenous children (95.2%) were exposed to tobacco smoke compared with non-Indigenous children (45.7%). The difference in proportions was -0.41 (95% confidence interval (CI) -0.60, -0.22). Other risk factors, asthma severity (moderate 83.9% vs. 83.3%; severe 16% vs. 16.1%), length of stay (1.9 vs. 1.3 days) and readmission rate (27.4% vs. 27.5%) were similar between Indigenous and non-Indigenous children. Indigenous children were significantly more likely to be followed up in a community clinic (difference in proportions = 0.10, 95% CI 0.1, 0.17) and less likely by a paediatrician. Only 62.5% of all children had an asthma action plan on discharge. Unlike other common respiratory diseases requiring hospitalisation, biological factors are unlikely major contributors to the known gap in asthma outcomes between Indigenous and non-Indigenous children. Intervention points include better identification, documentation and management of tobacco smoke exposure, delivery of salbutamol and discharge planning (including education and utilisation of asthma action plans). © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  1. Survival in refractory coeliac disease and enteropathy-associated T-cell lymphoma: retrospective evaluation of single-centre experience.

    PubMed

    Al-Toma, A; Verbeek, W H M; Hadithi, M; von Blomberg, B M E; Mulder, C J J

    2007-10-01

    Coeliac disease may be regarded as refractory disease (RCD) when symptoms persist or recur despite strict adherence to a gluten-free diet. RCD may be subdivided into types I and II with a phenotypically normal and aberrant intraepithelial T-cell population, respectively. RCD I seems to respond well to azathioprine/prednisone therapy. RCD II is usually resistant to any known therapy and transition into enteropathy-associated T-cell lymphoma (EATL) is common. To provide further insight into RCD and the development of EATL, by reporting on long-term survival and risk of transition of RCD into EATL in a large cohort of patients with complicated coeliac disease. Retrospective comparison of responses to therapy in four groups of patients with complicated coeliac disease: 43, RCD I; 50, RCD II (total), of whom 26 with RCD II developed EATL after a period of refractoriness to a gluten-free diet (secondary EATL) and 13 were EATL patients without preceding history of complicated coeliac disease (de novo EATL). No coeliac-disease-related mortality was recognised in the RCD I group. The overall 5-year survival in the RCD I group it was 96%; in the RCD II (total) group was 58%; and in the RCD II group after developing EATL it was only 8%. The 2-year survival in the de novo EATL group was 20% versus 15% in secondary EATL group (p = 0.63). Twenty-eight (56%) of the 50 patients with RCD II died, 23 (46%) due to EATL, 4 due to a progressive refractory state with emaciation and 1 from neurocoeliac disease. Remarkably, no patient with RCD I developed RCD II or EATL within the mean follow-up period of 5 years (range 2-15 years). A total of 52% of the RCD II patients developed EATL within 4-6 years after the diagnosis of RCD II. More aggressive and targeted therapies seem necessary in RCD II and EATL.

  2. Prognostic indicators following curative pancreatoduodenectomy for pancreatic carcinoma: A retrospective multivariate analysis of a single centre experience.

    PubMed

    Petrou, Athanasios; Soonawalla, Zahir; Silva, Michael-Antony; Manzelli, Antonio; Moris, Demetrios; Tabet, Patric-Paul; Friend, Peter

    2016-01-01

    Survival after curative resection of pancreatic, ampullary and lower common bile duct cancer remains very poor. The aim of this study was to assess important prognostic factors in patients with resectable pancreatic cancer. From 2006 to 2010, 156 patients underwent pancreatoduodenectomy (PD) for malignancies of pancreatic, ampullary or lower common bile duct in our institution. Based on the inclusion criteria 101 patients were selected in our retrospective statistical analysis. Of these 101 cases of malignancies, 65.4% were located in the pancreatic head, 18.8% in the ampulla and 15.8% in the lower bile duct. 48.5% of patients underwent classical PD, and 51.5% pylorus-preserving pancreatoduodenectomy (PPPD). Clinical and pathological data were collected, Kaplan-Meier method and Cox proportional hazard models were used to evaluate prognostic factors. Multivariate analysis revealed that blood transfusion, vascular invasion, T4 vs T1 stage, and R0 resection margins were significant negative predictors of survival. Conversely, ampullary (vs pancreatic ductal) and adjuvant chemotherapy were significantly associated with longer survival. Lymph node ratio (LNR), in all its forms, was not found to have a significant effect on survival. For all patients, tumor grading (p=0.042), resection margins (p=0.004), T stage (p=0.001), perineural invasion (p=0.029), vascular invasion (p=0.007) and age >65 years (p=0.009) were factors that impacted survival. Surgical resection margins, tumor grade, T stage, perineural invasion, vascular invasion, age >65 and adjuvant chemotherapy are the strongest predictors of survival after surgical resection of pancreatic, ampullary and lower common bile duct cancer. In this series, lymph node ratio did not impact survival.

  3. Development of a specific algorithm to guide haemostatic therapy in children undergoing cardiac surgery: a single-centre retrospective study.

    PubMed

    Faraoni, David; Willems, Ariane; Romlin, Birgitta S; Belisle, Sylvain; Van der Linden, Philippe

    2015-05-01

    Although rotational thromboelastometry (ROTEM) is increasingly used to guide haemostatic therapy in a bleeding patient, there is a paucity of data guiding its use in the paediatric population. The objective of this study is to develop an algorithm on the basis of ROTEM values obtained in our paediatric cardiac population to guide the management of the bleeding child. A retrospective analysis. Department of Anaesthesiology, Queen Fabiola Children's University Hospital. Data were collected between September 2010 and January 2012. All children who underwent elective cardiac surgery requiring cardiopulmonary bypass (CPB) were reviewed. None. Significant postoperative bleeding was defined as blood loss more than 10% of the child's estimated blood volume within the first six postoperative hours, dividing our population according to high blood loss (HBL) or low blood loss (LBL). Factors independently associated with postoperative bleeding determined the bleeding probability. Receiving operating characteristics (ROC) curves were constructed with the aim of determining relevant ROTEM parameters (including clot amplitude 10 min after administration of protamine [A10]) to be used in our algorithm. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were determined for the developed algorithm. One-hundred and fifty children were included in our study. Univariate and multivariate logistic regression analysis revealed that preoperative weight (kg), presence of a cyanotic disease (yes/no) and wound closure duration (min) were independent predictors of postoperative bleeding. Analysis of our ROTEM parameters revealed that clotting time (CT) ≥ 111 s, A10 ≤ 38 mm measured on the EXTEM and A10 ≤ 3 mm obtained on the FIBTEM tests were the three relevant parameters to guide haemostatic therapy. If the ROTEM-based algorithm was applied according to the bleeding risk (n = 65), 27 out of 29 of the HBL and 24 out of 36

  4. Twenty years later: a single-centre, repeat retrospective analysis of equine perioperative mortality and investigation of recovery quality.

    PubMed

    Dugdale, Alexandra H A; Obhrai, Jessica; Cripps, Peter J

    2016-03-01

    To determine the mortality rates associated with equine anaesthesia for elective and emergency (colic and non-colic) cases in one equine, university teaching hospital and to investigate the effect of several horse- and anaesthetic-related variables on anaesthetic recovery quality. Retrospective data analysis. In total, 1416 horses undergoing anaesthesia between May 2010 and December 2013. Patient information and details of the anaesthetic, recovery period and immediate complications were extracted from an archiving database. Statistical evaluation of factors affecting mortality included chi-squared tests and binary logistic regression. Factors affecting recovery quality were investigated using univariable and multivariable ordinal logistic regression. Statistical significance was set at p < 0.05. Anaesthesia/recovery-related mortality was 1.1% for all cases, 0.9% for elective cases, 1.6% for colics and 0% for non-colic emergencies. Fractures and dislocations accounted for the majority (71.4%) of deaths. No intra-operative deaths occurred during the study period. Risk factors for mortality included increasing age and American Society of Anesthesiologist's (ASA) status but these and other factors were confounded by 'colic'. Non-fatal complications in the immediate recovery period included postanaesthetic myopathy/neuropathy and postanaesthetic respiratory obstruction. Recovery quality was associated with body mass (p = 0.016), ASA status 3 and 4 (p = 0.020 and 0.002, respectively), duration of anaesthesia (p < 0.001) and out-of-hours anaesthesia (p = 0.013). Although recovery quality was also influenced by age and breed-type, these factors were removed from the final model as age was highly associated with both ASA status (p < 0.001) and colic surgery (p < 0.001), and breed-type was a determinant of body mass. Anaesthetic/recovery-associated mortality was comparable to previously reported figures except intra-operative deaths were not reported. Fractures remained

  5. Duodenal stump fistula after gastric surgery for malignancies: a retrospective analysis of risk factors in a single centre experience.

    PubMed

    Orsenigo, Elena; Bissolati, Massimiliano; Socci, Carlo; Chiari, Damiano; Muffatti, Francesca; Nifosi, Jacopo; Staudacher, Carlo

    2014-10-01

    Duodenal stump fistula (DSF) is the most severe surgical complication after gastrectomy. This study was designed to assess the incidence, to observe the consequences, and to identify the risk factors associated with DSF after gastrectomy. All procedures involving total or sub-total gastrectomy for cancer, performed between January 1987 and June 2012 in a single institution, were prospectively entered into a computerized database. Risk factors analysis was performed between DSF patients, patients with complete uneventful postoperative course and patients with other major surgical complications. Over this 25 years period, 1287 gastrectomies were performed. DSF was present in 32 cases (2.5 %). Mean post-operative onset was 6.6 days. 19 patients were treated conservatively and 13 surgically. Mean DSF healing time was 31.2 and 45.2 days in the two groups, respectively. Mortality was registered in 3 cases (9.37 %), due to septic shock (2 cases) and bleeding (1 case). In monovariate analysis, heart disease (p < 0.001), pre-operative lymphocytes number (p = 0.003) and absence of manual reinforcement over duodenal stump (p < 0.001) were found to be DSF-specific risk factors, whereas liver cirrhosis (p = 0.002), pre-operative albumin levels (p < 0.001) and blood losses (p = 0.002) were found to be non-DSF-specific risk factors. In multivariate analysis heart disease (OR 5.18; p < 0.001), liver cirrhosis (OR 13.2; p < 0.001), bio-humoral nutritional status impairment (OR 2.29; p = 0.05), blood losses >300 mL (OR 4.47; p = 0.001) and absence of manual reinforcement over duodenal stump (OR 30.47; p < 0.001) were found to be independent risk factors for DSF development. Duodenal stump fistula still remains a life-threatening complication after gastric surgery. Co-morbidity factors, nutritional status impairment and surgical technical difficulties should be considered as important risk factors in developing this awful complication.

  6. Treatment with lenalidomide (Revlimid®), cyclophosphamide (Endoxan®) and prednisone (REP) in relapsed/refractory multiple myeloma patients: results of a single centre retrospective study.

    PubMed

    Zelis, N; Devos, T; Dierickx, D; Janssens, A; Raddoux, J; Verhoef, G; Delforge, M

    2014-04-01

    Lenalidomide (Revlimid®) combined with intermittent dexamethasone (the RD regimen) is one of the current standards for treatment of patients with relapsed/refractory multiple myeloma (MM). However, since the disease in the majority of patients will become resistant to RD, or treatment with RD needs to be discontinued due to side effects, we evaluated the combination lenalidomide, low-dose oral cyclophosphamide, with prednisone (REP) in patients with relapsed/refractory MM previously exposed to RD. For this purpose, we performed a single centre retrospective study of the efficacy of REP in 19 patients with relapsed/refractory MM. Overall response rate (partial response or better) with REP was 68% compared with 83% with RD, but with a shorter time to response with the triplet REP. Time to progression after REP was 6 months. Overall the REP regimen was better tolerated compared to RD. We conclude that the REP regimen is an effective treatment regimen for patients with relapsed/refractory MM with good tolerance, warranting further exploration in prospective randomized trials.

  7. MRI and thallium features of pigmented villonodular synovitis and giant cell tumours of tendon sheaths: a retrospective single centre study of imaging and literature review.

    PubMed

    Lynskey, Samuel J; Pianta, Marcus J

    2015-01-01

    The purpose of this study was to characterize the MRI and thallium-201 ((201)TI) scintigraphy attributes of pigmented villonodular synovitis (PVNS) and giant cell tumours of tendon sheaths (GCTTS). The epidemiology of these uncommon lesions was also assessed and less commonly encountered pathology reported on including multifocality, necrosis and concurrent malignancy. A retrospective single centre review of MRI and (201)TI scintigraphy findings for 83 surgically proven or biopsy-proven consecutive cases of PVNS was undertaken. Radiological findings including lesion size, (201)TI uptake (as a marker of metabolic activity), location, extent and patient demographics were correlated with biopsy and surgical specimen histology. Typical appearances are described, as well as less common imaging manifestations. The study period encompassed all patients presenting or referred to a tertiary bone and soft-tissue tumour referral centre with PVNS or GCTTS between 1 January 2007 and the 1 December 2013. Lesions occur most commonly around the knee joint in the fourth decade of life, with younger patients showing a tendency to occur in the hip. Features of PVNS and GTTS include bone erosion, ligamentous and cartilage replacement, muscle infiltration and multifocality. MR signal characteristics were variable but post-contrast enhancement was near-universal. 14 of 83 cases showed no uptake of (201)TI and revealed a statistically significant smaller average axial dimension of 19.8 mm than lesions displaying active (201)TI uptake of 36.4 mm, p = 0.016. Four lesions demonstrated central necrosis on gross histology, two of each from both the (201)TI-avid and (201)TI-non-avid groups. MR is the imaging modality of choice when considering the diagnosis of these uncommon tumours. (201)TI scintigraphy as a marker of metabolic activity further adds minimal value although small lesions can appear to lack (201)TI avidity. This article depicts typical imaging findings of PVNS/GCTTS and

  8. MRI and thallium features of pigmented villonodular synovitis and giant cell tumours of tendon sheaths: a retrospective single centre study of imaging and literature review

    PubMed Central

    Pianta, Marcus J

    2015-01-01

    Objective: The purpose of this study was to characterize the MRI and thallium-201 (201TI) scintigraphy attributes of pigmented villonodular synovitis (PVNS) and giant cell tumours of tendon sheaths (GCTTS). The epidemiology of these uncommon lesions was also assessed and less commonly encountered pathology reported on including multifocality, necrosis and concurrent malignancy. Methods: A retrospective single centre review of MRI and 201TI scintigraphy findings for 83 surgically proven or biopsy-proven consecutive cases of PVNS was undertaken. Radiological findings including lesion size, 201TI uptake (as a marker of metabolic activity), location, extent and patient demographics were correlated with biopsy and surgical specimen histology. Typical appearances are described, as well as less common imaging manifestations. The study period encompassed all patients presenting or referred to a tertiary bone and soft-tissue tumour referral centre with PVNS or GCTTS between 1 January 2007 and the 1 December 2013. Results: Lesions occur most commonly around the knee joint in the fourth decade of life, with younger patients showing a tendency to occur in the hip. Features of PVNS and GTTS include bone erosion, ligamentous and cartilage replacement, muscle infiltration and multifocality. MR signal characteristics were variable but post-contrast enhancement was near-universal. 14 of 83 cases showed no uptake of 201TI and revealed a statistically significant smaller average axial dimension of 19.8 mm than lesions displaying active 201TI uptake of 36.4 mm, p = 0.016. Four lesions demonstrated central necrosis on gross histology, two of each from both the 201TI-avid and 201TI-non-avid groups. Conclusion: MR is the imaging modality of choice when considering the diagnosis of these uncommon tumours. 201TI scintigraphy as a marker of metabolic activity further adds minimal value although small lesions can appear to lack 201TI avidity. Advances in knowledge: This article

  9. A retrospective study on the aetiology, management, and outcome of brain abscess in an 11-year, single-centre study from China.

    PubMed

    Zhang, Chenran; Hu, Liuhua; Wu, Xiaojun; Hu, Guohan; Ding, Xuehua; Lu, Yicheng

    2014-06-06

    Brain abscesses continue to pose diagnostic and therapeutic challenges in developed and developing countries. Their aetiology and management remain complex and unclear, making improvement of treatments and outcome difficult. To determine the demographics, management, and the variables that affect the outcome in subjects with brain abscesses treated at a single centre over an 11-year period, we retrospectively analysed data in 60 patients with brain abscesses surgically treated with stereotactically guided aspiration or open craniotomy excision in Shanghai Changzheng Hospital between January 2001 and December 2011. Such variables as age, gender, Glasgow Coma Scale (GCS) score at admission, clinical presentation, location, number of lesions, predisposing factors, mechanism of infection, aetiological agent, and therapy were analysed independently. Our analysis demonstrated that patient age and gender were factors that influence the occurrence of brain abscess; female patients and patients greater than 40 years of age were most likely to suffer a brain abscess. We also found that a patient's GCS score upon admission did not influence outcome. While frequency of successful culturing of the infectious agent was low, positive cultures were obtained in only 8 of the cases (13.33%), in which the most common isolate was Streptococcus milleri. Outcome was favourable in 78.33% of the subjects, while the mortality rate was 20%. The outcome of one patient was poor due to the abscess in the basal ganglia region. Stereotactically guided aspiration is an effective treatment for brain abscess with an overall favourable outcome. Mortality due to brain abscess was not directly related to surgery nor surgical technique. Additional studies will continue to reveal patients trends that may improve treatment for brain abscess.

  10. A retrospective study on the aetiology, management, and outcome of brain abscess in an 11-year, single-centre study from China

    PubMed Central

    2014-01-01

    Background Brain abscesses continue to pose diagnostic and therapeutic challenges in developed and developing countries. Their aetiology and management remain complex and unclear, making improvement of treatments and outcome difficult. Methods To determine the demographics, management, and the variables that affect the outcome in subjects with brain abscesses treated at a single centre over an 11-year period, we retrospectively analysed data in 60 patients with brain abscesses surgically treated with stereotactically guided aspiration or open craniotomy excision in Shanghai Changzheng Hospital between January 2001 and December 2011. Such variables as age, gender, Glasgow Coma Scale (GCS) score at admission, clinical presentation, location, number of lesions, predisposing factors, mechanism of infection, aetiological agent, and therapy were analysed independently. Results Our analysis demonstrated that patient age and gender were factors that influence the occurrence of brain abscess; female patients and patients greater than 40 years of age were most likely to suffer a brain abscess. We also found that a patient’s GCS score upon admission did not influence outcome. While frequency of successful culturing of the infectious agent was low, positive cultures were obtained in only 8 of the cases (13.33%), in which the most common isolate was Streptococcus milleri. Outcome was favourable in 78.33% of the subjects, while the mortality rate was 20%. The outcome of one patient was poor due to the abscess in the basal ganglia region. Conclusions Stereotactically guided aspiration is an effective treatment for brain abscess with an overall favourable outcome. Mortality due to brain abscess was not directly related to surgery nor surgical technique. Additional studies will continue to reveal patients trends that may improve treatment for brain abscess. PMID:24903315

  11. Cytogenetic analysis of the retained products of conception after missed abortion following blastocyst transfer: a retrospective, large-scale, single-centre study.

    PubMed

    Segawa, Tomoya; Kuroda, Tomoko; Kato, Keiichi; Kuroda, Masako; Omi, Kenji; Miyauchi, Osamu; Watanabe, Yoshiaki; Okubo, Tsuyoshi; Osada, Hisao; Teramoto, Shokichi

    2017-02-01

    Cytogenetic analysis of the retained products of conception (POC) is the most effective test for identifying miscarriage causes. However, there has been no large-scale study limited to blastocyst transfer. This study retrospectively reports the findings of 1030 cases in which POC analysis was performed after missed abortion following single blastocyst transfer performed at the Shinbashi Yume Clinic. We identified 19.4% as normal karyotypes and 80.6% as aneuploid. These cases broke down into: 62.3% trisomy; 7.8% double trisomy; 0.5% triple or quadruple trisomy; 1.3% monosomy 21; 3.2% monosomy X; 0.1% 47,XXY; 1.0% polyploidy; 1.0% mixed; 1.1% embryonic mosaicism; and 2.4% structural anomalies. In samples with normal karyotypes, 49.5% were female while 50.5% were male. The occurrence of trisomy and double trisomy were both significantly more frequent in the ≥38 years group than in the ≤37 years group (P < 0.01). Trisomy was significantly more frequently associated with fetal heartbeat (P < 0.01); double trisomy, polyploidy and normal karyotype were significantly more frequent with no fetal heartbeat (P < 0.01). There was no significant difference in the frequency of chromosomal abnormalities between the number of miscarriages or blastocyst quality. Thus, POC cytogenetic testing is highly valuable for ascertaining the cause of miscarriage.

  12. The role of surgery in the treatment of invasive fungal infection in paediatric haematology patients: a retrospective single-centre survey.

    PubMed

    Cesaro, Simone; Pegoraro, Anna; Tridello, Gloria; Pillon, Marta; Cannata, Elisa; Faggin, Stefano; Cecchetto, Giovanni

    2014-07-01

    Surgery may improve the control of fungal disease and patient survival. The aim of this study was to report a single-centre experience in using surgery for the treatment of paediatric invasive fungal infection (IFI). From 2001 to 2009, 18 paediatric onco-haematology patients underwent 24 surgical procedures as treatment of IFI. At surgery, severe thrombocytopenia and neutropenia were present in four and one episodes respectively. Complications were one pleural effusion, one pleural effusion and surgical wound infection, one pneumothorax with wound dehiscence and one wound dehiscence. None of them required repeat surgery. The median duration of hospitalisation for four complicated procedures was 11 days, range 3-16, and 7 days, range 2-13, for the 20 uncomplicated procedures. No surgery-related deaths occurred. Fourteen patients resumed chemotherapy after a median of 26 days, range 9-77, whereas nine patients underwent hematopoietic stem cell transplantation after a median of 42 days, range 27-110. At 3 months from IFI, 17 patients were alive (94%) and one patient (6%) died from mycosis; the 3-month overall survival (OS) being 94.4%, CI 66.6-99.2. After a median follow-up of 7.1 years (CI 2.8-7.5), the OS was 54.5%, CI 29.2-74.2. Surgery is a feasible and valuable option in paediatric patients because it is associated with a low incidence of complications and an acceptable delay in resuming the chemotherapeutic plan.

  13. Optimal timing for nasal fracture manipulation - is a two week target really necessary? A single-centre retrospective analysis of 50 patients.

    PubMed

    Perkins, V; Vijendren, A; Egan, M; McRae, D

    2017-04-04

    Nasal bone fractures represent the most common isolated facial fracture and are involved in as many as 50% of facial fractures ((1)) . Its relative prominence in the centre of the face as well as its relatively thin, fragile structures makes it particularly susceptible to injury. Acute management is centred on restoring an aesthetically acceptable external nose with minimal airflow limitation. Conventional UK management typically involves assessment 5-7 days following injury, followed by closed reduction within two weeks, to avoid problems associated with fracture healing and bone remodelling ((2)) . This article is protected by copyright. All rights reserved.

  14. Posaconazole for primary antifungal prophylaxis in patients with acute myeloid leukaemia or myelodysplastic syndrome during remission induction chemotherapy: a single-centre retrospective study in Korea and clinical considerations.

    PubMed

    Cho, Sung-Yeon; Lee, Dong-Gun; Choi, Su-Mi; Choi, Jae-Ki; Lee, Hyo-Jin; Kim, Si-Hyun; Park, Sun Hee; Choi, Jung-Hyun; Yoo, Jin-Hong; Kim, Yoo-Jin; Kim, Hee-Je; Min, Woo-Sung

    2015-09-01

    Posaconazole was introduced as the primary antifungal prophylaxis (PAP) in acute myeloid leukaemia (AML) or myelodysplastic syndrome (MDS) patients during remission induction chemotherapy. Data on breakthrough invasive fungal infections (IFIs) from various centres are essential, as there are several considerations in treating IFIs in the posaconazole era. The aim of this study was to evaluate the effectiveness of posaconazole PAP and identify characteristics of IFIs at a single centre in Korea. We retrospectively reviewed consecutive patients with AML/MDS undergoing remission induction chemotherapy between December 2010 and November 2013. Of the 424 patients, 140 received posaconazole and 284 received fluconazole prophylaxis. The incidence of breakthrough proven/probable IFIs (15.5% vs. 2.9%, P < 0.001) and empirical antifungal treatment (EAFT) (45.8% vs. 12.9%, P < 0.001) decreased in the posaconazole group compared to the fluconazole group. In the posaconazole PAP group, two cases of breakthrough mucormycosis were noted among 13 proven/probable/possible IFI cases (15.4%). Overall and IFI-related mortality was 12.1% and 1.9% respectively. Fungus-free survival was significantly higher in the posaconazole group (74.7% vs. 87.1%, P = 0.028). Breakthrough IFIs and EAFT decreased significantly after posaconazole PAP. The benefit in fungus-free survival was noted with posaconazole PAP. Clinicians should be vigilant to identify non-Aspergillus IFIs with active diagnostic effort.

  15. Predictors of free flap loss in the head and neck region: A four-year retrospective study with 451 microvascular transplants at a single centre.

    PubMed

    Mücke, Thomas; Ritschl, Lucas M; Roth, Maximilian; Güll, Florian D; Rau, Andrea; Grill, Sonja; Kesting, Marco R; Wolff, Klaus-Dietrich; Loeffelbein, Denys J

    2016-09-01

    Microvascular free flaps have become an essential part of reconstructive surgery following head and neck tumour ablation. The authors' aim was to investigate the influence of cardiovascular risk factors, preoperative irradiation, previous operations and metabolically active medication on free flap loss in order to predict patients at risk and to improve their therapy. All patients who underwent reconstructive surgery with microvascular free flaps in the head and neck region between 2009 and 2013 were retrospectively analysed. Uni- and multivariate logistic regressions were performed to determine the association between possible predictor variables for free flap loss. We included 451 patients in our analysis. The overall free flap failure rate was 4.0%. Multivariate regression analysis revealed significantly increased risks of free flap failure depending on prior attempts at microvascular transplants (p < 0.001, OR = 14.21) and length of hospitalisation (p = 0.007, OR = 1.05). With consistently low rates of flap failure, microvascular reconstruction of defects in the head and neck region has proven to be highly reliable, even in patients with comorbidities. The expertise of the operating team seems to remain the main factor affecting flap success. The only discerned independent predictor was previously failed attempts at microvascular reconstruction. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  16. Serum posaconazole levels among haematological cancer patients taking extended release tablets is affected by body weight and diarrhoea: single centre retrospective analysis.

    PubMed

    Miceli, Marisa H; Perissinotti, Anthony J; Kauffman, Carol A; Couriel, Daniel R

    2015-07-01

    The posaconazole extended release tablet formulation was developed to improve bioavailability relative to the oral suspension. Therapeutic drug monitoring has been used to optimise posaconazole dosing to achieve a target trough level ≥0.7 μg ml(-1). We retrospectively evaluated 28 patients with haematological malignancies who received posaconazole tablets for antifungal prophylaxis. Posaconazole serum trough levels were obtained 5 days after initiation of therapy. Mean trough level was 1.19 ± 0.63 μg ml(-1), and 71% achieved a trough level ≥0.7 μg ml(-1). Diarrhoea was associated with lower mean trough levels (0.65 ± 0.08 μg ml(-1) vs. 1.31 ± 0.13 μg ml(-1)), P = 0.002. Mean trough levels were lower in patients ≥90 kg (0.74 ± 0.09 μg ml(-1)) vs. <90 kg (1.32 ± 0.14 μg ml(-1)), P = 0.002 and in patients with body mass index (BMI) ≥30 (0.89 ± 0.13 μg ml(-1)) vs. BMI <30 (1.29 ± 0.14 μg ml(-1)), P = 0.05. Posaconazole delayed release tablets attain appropriate trough levels in most patients, but patients with a higher weight and those experiencing diarrhoea are more likely to have lower levels.

  17. The German Middleway as Precursor for Single Embryo Transfer. A Retrospective Data-analysis of the Düsseldorf University Hospital's Interdisciplinary Fertility Centre - UniKiD.

    PubMed

    Kliebisch, T K; Bielfeld, A P; Krüssel, J S; Baston-Büst, D M

    2016-06-01

    Introduction: Patients receiving fertility treatment in Germany appear to be disadvantaged in comparison to those in other countries due to the restrictive Embryo Protection Act ("Embryonenschutzgesetz, ESchG"), which prohibits the selection of a "top" embryo. The so-called German Middleway ("Deutscher Mittelweg, DMW") now provides for a liberal interpretation of the ESchG by allowing the culture of numerous pronuclear stages (2PN stage). Materials and Methods: Retrospective cohort study of 2 assisted reproduction treatment cycles in n = 400 patients between the ages of 21 and 45 years, either treated 2× conservatively or 1× conservatively and 1× liberally according to DMW. Results: Pregnancy was achieved in 35 % of patients in the DMW group and 31 % of controls. The birth rate among controls was 28.5 % and 30.5 % in the DMW group. Most pregnancies resulted from the culture of 4 × 2PN stages. Conclusion: Patients in the DMW group had significantly higher pregnancy and birth rates compared to their previous cycles despite significantly increased age and significantly fewer transferred embryos. Key factors were the number of 2PNs generated and the quality of embryos transferred. Thus it can be assumed that particularly older patients with adequate ovarian reserves will benefit from DMW, i.e. the transfer of fewer embryos of the best possible quality.

  18. Tumour size is related to the curability of signet ring cell early gastric cancer with endoscopic submucosal dissection: a retrospective single centre study.

    PubMed

    Kim, Mi Na; Kim, Hyun Ki; Shim, Choong Nam; Lee, Hyun Jik; Lee, Hyuk; Park, Jun Chul; Shin, Sung Kwan; Lee, Sang Kil; Lee, Yong Chan

    2014-10-01

    Endoscopic submucosal dissection is applied in selected cases of signet ring cell early gastric cancer. However, factors related to curability of signet ring cell early gastric cancer with this method have not been fully evaluated. Our aim was to evaluate factors related to incomplete resection in signet ring cell early gastric cancer with endoscopic submucosal dissection. A retrospective analysis was performed on a total of 126 consecutive patients with signet ring cell early gastric cancer who had undergone endoscopic submucosal dissection at the Severance Hospital in Korea, between March 2007 and March 2012. The clinical outcomes were reviewed and factors related to incomplete resection were analysed. Multivariate analysis showed that large tumour size was the only significant factor related to incomplete resection (P=0.006; hazard ratio, 1.040; 95% confidence interval, 1.101-1.084). In addition, large tumour size was the only significant factor related to endoscopic size underestimation (P<0.001; hazard ratio, 1.391; 95% confidence interval, 1.221-1.586). The rate of endoscopic size underestimation was significantly higher in tumours with a size ≥20mm (P<0.001). To improve the curability of signet ring cell early gastric cancer with endoscopic submucosal dissection, larger tumours (especially tumour with a size ≥20mm) should be resected with a larger margin. Copyright © 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  19. Bleeding phenotype and correlation with factor XI (FXI) activity in congenital FXI deficiency: results of a retrospective study from a single centre.

    PubMed

    Santoro, C; Di Mauro, R; Baldacci, E; De Angelis, F; Abbruzzese, R; Barone, F; Bochicchio, R A; Ferrara, G; Guarini, A; Foà, R; Mazzucconi, M G

    2015-07-01

    Bleeding phenotype in factor XI (FXI)-deficient patients is variable, and not related to baseline FXI:Act. Aims of our study were to describe the characteristics and the management of surgery and deliveries in FXI-deficient patients, and to investigate the relationship between the haemorrhagic phenotype and the baseline FXI:Act. Ninety-five patients were diagnosed and followed in our centre for a median follow-up of 0.9 years (0.1-36.2); median FXI:Act of all patients: 38% (0.5-69%). Fifty-six patients (59%) experienced bleeding episodes not surgery-related. Prior to diagnosis, 64 patients underwent 132 surgeries, and after diagnosis, 23 patients underwent 36 surgeries. Globally 26 of 168 surgeries were prophylactically treated, whereas 142 of 168 were not. As regard as surgeries performed without prophylaxis, 30 bleeding events (21%) occurred in 21 patients. At diagnosis, the median FXI:Act of bleeding and non-bleeding patients was 28% and 37%, respectively, without statistically significant difference between the two groups (P = 0.26). As regard as surgeries performed under prophylactic treatment just 1 bleeding event occurred. Prior to diagnosis, 31 spontaneous deliveries (SD) and eight caesarian sections (CS) were performed without prophylaxis: 4 postpartum haemorrhages (10.5%) occurred (patients FXI:Act: 2%, 6%, 27%, 52.3% respectively). After diagnosis, four SD and five CS were performed with prophylaxis: no postpartum haemorrhages occurred. We confirm the wide bleeding phenotype variability in FXI-deficient patients, not related to the baseline FXI:Act levels. We highlight the importance of performing a correct diagnosis and follow-up, because a good management of prophylactic treatment, dramatically reduces the bleeding rate in case of surgery or deliveries. © 2015 John Wiley & Sons Ltd.

  20. The impact of Down syndrome screening on Taiwanese Down syndrome births: a nationwide retrospective study and a screening result from a single medical centre.

    PubMed

    Lin, Shin-Yu; Hsieh, Chia-Jung; Chen, Yi-Li; Shaw, S W Steven; Steven Shaw, Sheng-Wen; Lin, Ming-Wei; Chen, Pau-Chung; Lee, Chien-Nan

    2013-01-01

    A retrospective analysis of the Taiwanese National Birth Defect Registration and Notification System was conducted in order to determine the live birth- and stillbirth rates in infants with Down syndrome, trisomy 18, trisomy 13 and Turner syndrome between 2001 and 2010. The objective was to investigate the impact of Down syndrome screening on the Taiwanese Down syndrome live birth rate. In addition, the results of first-trimester Down syndrome screening between 2006 and 2011, and of second-trimester quadruple testing between 2008 and 2011, were obtained from the National Taiwan University Hospital. All Taiwanese infants born between 2001 and 2010 were included in the first part of the analysis, and women receiving first-trimester Down syndrome screening or second-trimester quadruple testing from the National Taiwan University Hospital were included in the second part. The live birth rate of infants with Down syndrome, per 100 000 live births, decreased from 22.28 in 2001 to 7.79 in 2010. The ratio of liveborn DS to total DS was 48.74% in 2001, and then decreased to 25.88% in 2006, when first-trimester screening was widely introduced in Taiwan. This ratio dropped to 20.64% in 2008, when the second-trimester quadruple test was implemented. The overall positive rate in first-trimester screening in the National Taiwan University Hospital was 3.1%, with a Down syndrome detection rate of 100%; the quadruple test had values of 9.0% and 75%, respectively. The use of first-trimester screening and the second-trimester quadruple test may be responsible for the marked decrease in the Taiwanese Down syndrome live birth rate observed between 2001 and 2010.

  1. Should a Patients BMI Status be Used to Restrict Access to Total Hip and Knee Arthroplasty? Functional Outcomes of Arthroplasty Relative to BMI - Single Centre Retrospective Review

    PubMed Central

    Lash, H.; Hooper, G.; Hooper, N.; Frampton, C.

    2013-01-01

    We reviewed the experience of a dedicated orthopaedic elective service to determine whether we could establish a BMI group where arthroplasty was no longer effective as assessed by the patient’s functional outcome. This was a prospective observational study with retrospective analysis of data collected on 1439 total hip arthroplasty, 934 total knee arthroplasty and 326 unicompartment knee arthroplasty patients. Functional scores (WOMAC, Oxford hip and knee scores and HAAS) were obtained preoperatively and at 12 months post op. Patients had their BMI recorded at the preoperative assessment and were divided into BMI groups (BMI<25, BMI 25-30, BMI 30-35 and BMI > 35). Patients with a BMI of ≤ 30 had significantly better functional scores at 12 months post op compared to those with a BMI of > 35. The absolute gain in functional scores from pre op to 12 months post op did not differ significantly between BMI groups, the only significant difference we found for absolute gain showed patients with a BMI of > 35 have a greater increase in HAAS scores following total hip arthroplasty compared to patients with a BMI of 30 or less (p = 0.0435). Our patients with higher BMI’s had worse preoperative and post operative functional scores but their benefit from surgery measured by the change in functional scores showed no difference compared to patients with lower BMI. We could find no reason on the basis of the 12-month results to limit surgery to obese patients because of an expected poorer functional outcome. PMID:24155808

  2. Comparison of renal response to four different induction therapies in Japanese patients with lupus nephritis class III or IV: A single-centre retrospective study.

    PubMed

    Hanaoka, Hironari; Kiyokawa, Tomofumi; Iida, Harunobu; Ishimori, Kana; Takakuwa, Yukiko; Okazaki, Takahiro; Yamada, Hidehiro; Ichikawa, Daisuke; Shirai, Sayuri; Koike, Junki; Ozaki, Shoichi

    2017-01-01

    The recent recommendations for the management of lupus nephritis suggest that racial background should be considered while choosing induction therapy. However, the responses to different induction regimens have been poorly studied in Japanese population. Here, we assessed the renal response to different induction therapies in Japanese patients with lupus nephritis class III or IV. The records of 64 patients with biopsy-proven lupus nephritis class III or IV were retrospectively evaluated according to therapy received: monthly intravenous cyclophosphamide (IVCY), the Euro-lupus nephritis trial (ELNT) protocol-IVCY, tacrolimus (TAC), or mycophenolate mofetil (MMF). We investigated cumulative complete renal response (CR) rates and relapse rates for each group for 3 years. Organ damage was assessed with the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). There were 22 patients on monthly IVCY, 18 on ELNT-IVCY, 13 on TAC, and 11 on MMF. Lower systemic lupus erythematosus disease activity index (SLEDAI) and higher CH50 were found in the TAC group at baseline (p<0.01 and p<0.01, respectively). There were no significant differences of cumulative CR rates and relapse free survival for 3 years among the four different therapeutic regimens (p = 0.2 and p = 0.2, respectively). There was a tendency to have early response and early relapse in TAC group and late response in MMF group. The SDI increase over 3 years was found more frequently in the TAC group than in the monthly-IVCY group (p = 0.04). Multivariate analysis indicated that CR at 3 months was independent prognosticator for low damage accrual. Regarding lower damage accrual, early CR achievement might be essential in induction therapy regardless of immunosuppressant choice.

  3. Risk factors for the development of right ventricular failure after left ventricular assist device implantation-a single-centre retrospective with focus on deformation imaging†.

    PubMed

    Boegershausen, Nadia; Zayat, Rashad; Aljalloud, Ali; Musetti, Giulia; Goetzenich, Andreas; Tewarie, Lachmandath; Moza, Ajay; Amerini, Andrea; Autschbach, Rüdiger; Hatam, Nima

    2017-05-08

    Right heart failure (RHF) after the implantation of a left ventricular assist device (LVAD) remains a dreaded postoperative complication. Using 2D speckle-tracking echocardiography, it is possible to acquire right ventricular global and regional function. The aim of our study was to assess whether speckle-tracking echocardiography values will better predict the RHF post-continuous-flow LVAD implantation. From January 2014 to January 2016, 54 patients who underwent LVAD implantation were included and retrospectively analysed. Clinical, invasive haemodynamic (right and left heart catheterization), laboratory and transthoracic echocardiography data were reviewed. Multivariable logistic regression was performed using RHF as dependent variable. Thirteen patients (24%) developed RHF. These patients had significantly elevated procalcitonin ( P  =   0.011), elevated central venous pressure (CVP) pre- and post-LVAD implantation ( P  =   0.002 and 0.031, respectively), higher right ventricular (RV) and pulmonary systolic pressure ( P  =   0.016 and 0.013, respectively), higher Michigan Risk Score ( P  =   0.001) and a lower peak systolic longitudinal strain of the basal RV free wall ( P  =   0.032). Haemoglobin, procalcitonin, RV systolic pressure, basal right ventricular free wall and pre-CVP entered the final multivariable analysis, only basal right ventricular free wall ( P  <   0.001) and pre-CVP ( P  <   0.001) remained significant predictors of RHF. The sensitivity and specificity of the final model were 85.7% and 95.4%, respectively. The negative predictive value reached 94%. 2D strain parameters of the RV free wall seem to be auspicious for RV function and predicting RHF. Moreover, intraoperative CVP should not be neglected since elevated values proved to be highly associated with RHF. Our results represent a valuable supplement to other scores by considering both echocardiography and intraoperative data.

  4. Single centre experience of combat-related vascular injury in victims of Syrian conflict: Retrospective evaluation of risk factors associated with amputation.

    PubMed

    Şişli, Emrah; Kavala, Ali Aycan; Mavi, Mustafa; Sarıosmanoğlu, Osman Nejat; Oto, Öztekin

    2016-09-01

    To elucidate the risk factors associated with amputation in cases with combat-related vascular injury (CRVI). This retrospective study included 90 cases with CRVI treated between May 2011 and July 2013. The patients were divided into group I (n=69), in which the limb was salvaged and group II (n=21), in which the patients received amputation. The overall and the secondary amputation rates were 23% and 18%, respectively. There were no amputations with the MESS of nine or less, increasing proportions of amputations at 10 and 11, with a level of 12 leading to 100% amputation rate. The mortality rate was 2%. Among the 52 (58%) cases with the mangled extremity severity score (MESS) ≥7, the limb salvage rate was 60%. The patients in group II were more likely to have a combined artery and vein injury (p=0.042). They were also more likely to be injured as a result of an explosion (p=0.004). Along with the MESS (p<0.001), the duration of ischemia (DoI) (p<0.001) were higher in group II. The rate of bony fracture (p<0.001) and wound infection (p=0.011) were higher in group II. For the overall amputation, the odds ratio of the bony fracture (OR: 61.39, p=0.011), nerve injury (OR: 136.23, p=0.004), DoI (OR: 2.03, p=0.003), vascular ligation (OR: 8.65, p=0.040) and explosive device injury (OR: 10.8, p=0.041) were significant. Although the DoI (p<0.001) and the MESS (p=0.004) were higher in whom a temporary vascular shunt (TVS) was applied, the utilisation of a TVS did not influence the amputation rate (p=1.0). The DoI and the variables indicating the extent of tissue disruption were the major determinants of amputation. While statistically non-significant, the benefit of the application of a TVS is non-negligible. MESS is a valid scoring system but should not be the sole foundation for deciding on amputation. Extremities which were doomed to amputation with the MESS>7 seem to benefit from revascularisation with initiation of reperfusion at once. The validity of MESS merits

  5. Retrospective cohort study of the performance of the Pinnacle metal on metal (MoM) total hip replacement: a single-centre investigation in combination with the findings of a national retrieval centre

    PubMed Central

    Langton, David John; Sidaginamale, Raghavendra Prasad; Avery, Peter; Waller, Sue; Tank, Ghanshyabhai; Lord, James; Joyce, Thomas; Cooke, Nick; Logishetty, Raj; Nargol, Antoni Viraf Francis

    2016-01-01

    Objectives To determine risk factors for revision in patients implanted with a commonly used metal on metal (MoM) hip replacement. Design Retrospective cohort study in combination with a prospective national retrieval study (Northern Retrieval Registry (NRR)). Setting Combined orthopaedic unit in combination with the NRR. Participants All patients implanted with a DePuy Pinnacle MoM hip prostheses by the 2 senior authors were invited to attend for a review which included clinical examination, blood metal ion measurements, radiographs and targeted imaging. Explanted components underwent wear analysis using validated methodology and these results were compared with those obtained from the NRR. Results 489 MoM Pinnacle hips were implanted into 434 patients (243 females and 191 males). Of these, 352 patients attended the MoM recall clinics. 64 patients had died during the study period. For the purposes of survival analysis, non-attendees were assumed to have well-functioning prostheses. The mean follow-up of the cohort as a whole was 89 months. 71 hips were revised. Prosthetic survival for the whole cohort was 83.6% (79.9–87.3) at 9 years. The majority of explanted devices exhibited signs of taper junction failure. Risk factors for revision were bilateral MoM prostheses, smaller Pinnacle liners, and implantation in 2006 and later years. A significant number of devices were found to be manufactured out of their specifications. This was confirmed with analysis of the wider data set from the NRR. Conclusions This device was found to have an unacceptably high revision rate. Bilateral prostheses, those implanted into female patients and devices implanted in later years were found to be at greater risk. A significant number of explanted components were found to be manufactured with bearing diameters outside of the manufacturer's stated tolerances. Our findings highlight the clinical importance of hitherto unrecognised variations in device production. PMID:27130159

  6. Retrospective cohort study of the performance of the Pinnacle metal on metal (MoM) total hip replacement: a single-centre investigation in combination with the findings of a national retrieval centre.

    PubMed

    Langton, David John; Sidaginamale, Raghavendra Prasad; Avery, Peter; Waller, Sue; Tank, Ghanshyabhai; Lord, James; Joyce, Thomas; Cooke, Nick; Logishetty, Raj; Nargol, Antoni Viraf Francis

    2016-04-29

    To determine risk factors for revision in patients implanted with a commonly used metal on metal (MoM) hip replacement. Retrospective cohort study in combination with a prospective national retrieval study (Northern Retrieval Registry (NRR)). Combined orthopaedic unit in combination with the NRR. All patients implanted with a DePuy Pinnacle MoM hip prostheses by the 2 senior authors were invited to attend for a review which included clinical examination, blood metal ion measurements, radiographs and targeted imaging. Explanted components underwent wear analysis using validated methodology and these results were compared with those obtained from the NRR. 489 MoM Pinnacle hips were implanted into 434 patients (243 females and 191 males). Of these, 352 patients attended the MoM recall clinics. 64 patients had died during the study period. For the purposes of survival analysis, non-attendees were assumed to have well-functioning prostheses. The mean follow-up of the cohort as a whole was 89 months. 71 hips were revised. Prosthetic survival for the whole cohort was 83.6% (79.9-87.3) at 9 years. The majority of explanted devices exhibited signs of taper junction failure. Risk factors for revision were bilateral MoM prostheses, smaller Pinnacle liners, and implantation in 2006 and later years. A significant number of devices were found to be manufactured out of their specifications. This was confirmed with analysis of the wider data set from the NRR. This device was found to have an unacceptably high revision rate. Bilateral prostheses, those implanted into female patients and devices implanted in later years were found to be at greater risk. A significant number of explanted components were found to be manufactured with bearing diameters outside of the manufacturer's stated tolerances. Our findings highlight the clinical importance of hitherto unrecognised variations in device production. Published by the BMJ Publishing Group Limited. For permission to use (where not

  7. A large retrospective single-centre study to define the best image acquisition protocols and interpretation criteria for white blood cell scintigraphy with ⁹⁹mTc-HMPAO-labelled leucocytes in musculoskeletal infections.

    PubMed

    Glaudemans, Andor W J M; de Vries, Erik F J; Vermeulen, Liliane E M; Slart, Riemer H J A; Dierckx, Rudi A J O; Signore, Alberto

    2013-10-01

    The diagnosis of infection is often based on clinical, pathological and microbiological results. However, these investigations lack specificity. White blood cell (WBC) scintigraphy is considered the gold standard nuclear imaging technique for diagnosing infections in bone and soft tissues (except spondylodiscitis). However, image acquisition and interpretation criteria differ amongst centres throughout the world, leading to differences in reported results. The aim of this study was to identify the most accurate WBC scintigraphy acquisition and interpretation protocols for diagnosis of bone and soft tissue infections. Included in this retrospective study were 297 patients with suspected bone or soft tissue infection who underwent WBC scintigraphy with (99m)Tc-HMPAO-labelled leucocytes between 2009 and 2012. Sensitivity, specificity, accuracy, and positive and negative predictive values of WBC scintigraphy were determined for two different dual time point acquisition protocols (fixed-time acquisition and time decay-corrected acquisition) and five image interpretation methods (visual and semiquantitative with four different reference regions of interest). Final diagnosis was based on pathological and microbiological reports, and when these were not available, on clinical follow-up of at least 6 months. The best acquisition protocol was 4 h and 20 - 24 h dual time-point acquisition with time decay-corrected acquisition. When using this acquisition protocol, visual qualitative interpretation led to a sensitivity of 85.1 %, a specificity of 97.1 %, a diagnostic accuracy of 94.5 %, a positive predictive value of 88.8 % and a negative predictive value of 95.9 %. For semiquantitative analysis, the best results were found when lesion-to-reference ratios were calculated with the contralateral side as the reference tissue, except for osteomyelitis and infected osteosynthesis, for which the contralateral bone marrow was found to be the best reference tissue. Results of the

  8. [Infectious sacroiliitis in tunisian centre: retrospective study of 25 cases].

    PubMed

    Bellazreg, Foued; Alaya, Zeineb; Hattab, Zouhour; Lasfar, Nadia Ben; Ayeche, Mohamed Laziz Ben; Bouajina, Elyes; Letaief, Amel; Hachfi, Wissem

    2016-01-01

    Infectious sacroiliitis are rare but they can be complicated by disabling functional sequelae. To describe the clinical and bacteriological characteristics of infectious sacroiliitis among patients treated in Sousse Medical Center, Tunisia. A retrospective, descriptive study, of infectious sacroiliitis among patients hositalized in Sousse between 2000 and 2015. The diagnosis was made on the basis of medical signs, imaging, microbiological indicators. In the study were enrolled twenty five patients, 10 men and 15 women; the average age was 41 years (19-78). Sacroiliitis were due to pyogenic bacteria in 14 cases (56%), brucella bacteria in 6 cases (24%) and tuberculosis bacteria in 5 cases (20%). The mean duration of symptoms was 61, 45 and 402 days respectively. The most common clinical signs were buttock pain (92%) and fever (88%). Standard radiographic evaluation was abnormal in 75% of cases. CT scan and MRI of the sacroiliac joints was performed in all cases. The diagnosis was bacteriologically confirmed in 24 cases (96%). The average duration of antibiotic treatment was 83 days in the pyogenic sacroiliitis, and 102 days in brucellar sacroiliitis. The evolution was favorable in 12 patients (48%), 9 patients (36%) had sequelae of sacroiliac joint pain and 4 patients (16%) died. In our study, time frame of infectious sacroiliitis evolution did not predict the causative bacterium, hence the need for bacteriological documentation in order to prescribe appropriate antibiotic therapy.

  9. Native NIR-emitting single colour centres in CVD diamond

    NASA Astrophysics Data System (ADS)

    Gatto Monticone, D.; Traina, P.; Moreva, E.; Forneris, J.; Olivero, P.; Degiovanni, I. P.; Taccetti, F.; Giuntini, L.; Brida, G.; Amato, G.; Genovese, M.

    2014-05-01

    Single-photon sources are a fundamental element for developing quantum technologies, and sources based on colour centres in diamonds are among the most promising candidates. The well-known nitrogen vacancy centres are characterized by several limitations, and thus few other defects have recently been considered. In the present work, we characterize, in detail, native efficient single colour centres emitting in the near infra-red (λ = 740-780 nm) in both standard IIa single-crystal and electronic-grade polycrystalline commercial chemical vapour deposited (CVD) diamond samples. In the former case, a high-temperature (T > 1000 °C) annealing process in vacuum is necessary to induce the formation/activation of luminescent centres with good emission properties, while in the latter case the annealing process has marginally beneficial effects on the number and performance of native centres in commercially available samples. Although displaying significant variability in several photo-physical properties (emission wavelength, emission rate instabilities, saturation behaviours), these centres generally display appealing photophysical properties for applications as single photon sources: short lifetimes (0.7-3 ns), high emission rates (˜50-500 × 103 photons s-1) and strongly (>95%) polarized light. The native centres are tentatively attributed to impurities incorporated in the diamond crystal during the CVD growth of high-quality type-IIa samples, and offer promising perspectives in diamond-based photonics.

  10. Management of Epistaxis - A Single Centre Experience and Economic Considerations.

    PubMed

    Keane, E; Subramaniam, T; Khan, A H; Patil, N

    2016-06-10

    Epistaxis represents the most common ENT emergency and its management has been a focus of audit recently, with consideration given to the associated economic burden. The aim of our study is to evaluate the management of epistaxis in terms of treatments used, duration of stay, recurrence and cost. A retrospective review of hospital inpatient enquiry (HIPE) data from a single secondary referral centre was undertaken during a four year period. Four hundrefd and thirty-four patients were identified. The majority (n= 262, 60.3%) were male and the average age was 64.2 years. The vast majority (n=362, 83.4%) were managed non-operatively. Only 15 patients (3.4%) were managed surgically. The average length of stay was 2.5 days and did not vary greatly between the treatment groups. The recurrence rate was 8.2% (n=36). Approximate costs of packing vs EUA and cautery suggest that packing alone is more economical but more data is needed to fully compare the options.

  11. Splenectomy in haematology--a 5-year single centre experience.

    PubMed

    Wood, Lucille; Baker, Peter M; Martindale, Anna; Jacobs, Peter

    2005-12-01

    To define indications and outcome in haematologic cases undergoing splenectomy. A retrospective review of clinical records from consecutive patients having open or laparoscopic removal of the spleen in an academic centre in the private sector. Endpoints were survival, operating time, spleen size, histopathology, requirements for blood or related products complications and average costs. In the total group (n = 69) there were two deaths. Referrals were for immune thrombocytopaenia (41%), acquired haemolytic anaemia (10%), myeloproliferative syndrome (9%), acute or chronic leukaemia (19%), lymphoma (13%) and a miscellaneous group (8%), comprising cholelithiasis, aplasia or as a diagnostic procedure for otherwise unexplained splenomegaly. An open midline approach was predicated by spleens greater than twice normal size and a history of any bleeding disorder. Here the mean operating time was 83 min (range 40-295) whereas for laparoscopy this was 251 min (range 181-272). Careful stratification between the two options facilitated optimum haemostasis and consequently reduced requirement for packed red cells and platelets. Neither underlying pathology nor the choice of treatment influenced morbidity or mortality. Overall local experience is consistent with published international standards of surgical practice. Outcome is directly proportional to the number of each procedure carried out by a single team, observance of consistent protocols for preoperative evaluation and standardized proactive management through the recovery period.

  12. The German Middleway as Precursor for Single Embryo Transfer. A Retrospective Data-analysis of the Düsseldorf University Hospitalʼs Interdisciplinary Fertility Centre – UniKiD

    PubMed Central

    Kliebisch, T. K.; Bielfeld, A. P.; Krüssel, J. S.; Baston-Büst, D. M.

    2016-01-01

    Introduction: Patients receiving fertility treatment in Germany appear to be disadvantaged in comparison to those in other countries due to the restrictive Embryo Protection Act (“Embryonenschutzgesetz, ESchG”), which prohibits the selection of a “top” embryo. The so-called German Middleway (“Deutscher Mittelweg, DMW”) now provides for a liberal interpretation of the ESchG by allowing the culture of numerous pronuclear stages (2PN stage). Materials and Methods: Retrospective cohort study of 2 assisted reproduction treatment cycles in n = 400 patients between the ages of 21 and 45 years, either treated 2× conservatively or 1× conservatively and 1× liberally according to DMW. Results: Pregnancy was achieved in 35 % of patients in the DMW group and 31 % of controls. The birth rate among controls was 28.5 % and 30.5 % in the DMW group. Most pregnancies resulted from the culture of 4 × 2PN stages. Conclusion: Patients in the DMW group had significantly higher pregnancy and birth rates compared to their previous cycles despite significantly increased age and significantly fewer transferred embryos. Key factors were the number of 2PNs generated and the quality of embryos transferred. Thus it can be assumed that particularly older patients with adequate ovarian reserves will benefit from DMW, i.e. the transfer of fewer embryos of the best possible quality. PMID:27365539

  13. Brain metastasis from colorectal carcinoma: a single cancer centre experience.

    PubMed

    Tevlin, R; Larkin, J O; Hyland, J M; O'Connell, P R; Winter, D C

    2015-09-01

    Brain metastases (BM) from colorectal cancer (CRC) are rare. As survival increases in patients with metastatic CRC, it is hypothesised that new metastatic patterns will emerge: for instance, as CRC with limited metastatic involvement of the liver and lung can now be successfully resected, we propose that sites, previously rarely involved in metastatic spread, will become more common. The objective of this study was to describe the experience with BM from CRC in a single cancer centre. A prospectively compiled database (1988-2012) of patients with CRC treated in a tertiary referral hospital was retrospectively examined. Patients with a histological diagnosis of CRC and radiologically documented BM were included. Clinical information (including patient demographics, primary and metastatic disease factors) was obtained from medical records. Eleven patients (0.3 % of 4219 patients) were identified (8 male, 3 female). The median age at CRC diagnosis was 70 years (range 55-80 years) while the median age at diagnosis of BM was 73 years (range 56-83 years). Three patients diagnosed with synchronous metastases underwent palliative treatment while eight patients had undergone surgical resection of the primary tumour with curative intent a median of 24 months (range 0-48 months) prior to diagnosis of BM. 10/11 patients were symptomatic at diagnosis of BM. All were diagnosed using computed tomography and managed palliatively. The cerebellum was most the frequently involved site. The median overall survival time following diagnosis of BM was 2.5 months (range 2-9 months). Notably, 8/11 patients were diagnosed in the latter 8 years of the study period (between 2004 and 2012). With increased survival, improved systemic therapy and aggressive approaches to surgical management of "classical" metastases from CRC, it is likely that a changing pattern of metastases will emerge. As survival rates increase, we propose that metastatic sites, which were previously considered rare (e

  14. Bilateral adrenal masses: a single-centre experience

    PubMed Central

    Bandgar, Tushar; Khare, Shruti; Jadhav, Swati; Lila, Anurag; Goroshi, Manjunath; Kasaliwal, Rajeev; Khadilkar, Kranti; Shah, Nalini S

    2016-01-01

    Background Bilateral adrenal masses may have aetiologies like hyperplasia and infiltrative lesions, besides tumours. Hyperplastic and infiltrative lesions may have coexisting hypocortisolism. Bilateral tumours are likely to have hereditary/syndromic associations. The data on clinical profile of bilateral adrenal masses are limited. Aims To analyse clinical, biochemical and radiological features, and management outcomes in patients with bilateral adrenal masses. Methods Retrospective analysis of 70 patients with bilateral adrenal masses presenting to a single tertiary care endocrine centre from western India (2002–2015). Results The most common aetiology was pheochromocytoma (40%), followed by tuberculosis (27.1%), primary adrenal lymphoma (PAL) (10%), metastases (5.7%), non-functioning adenomas (4.3%), primary bilateral macronodular adrenal hyperplasia (4.3%), and others (8.6%). Age at presentation was less in patients with pheochromocytoma (33 years) and tuberculosis (41 years) compared with PAL (48 years) and metastases (61 years) (P<0.001). The presenting symptoms for pheochromocytoma were hyperadrenergic spells (54%) and abdominal pain (29%), whereas tuberculosis presented with adrenal insufficiency (AI) (95%). The presenting symptoms for PAL were AI (57%) and abdominal pain (43%), whereas all cases of metastasis had abdominal pain. Mean size of adrenal masses was the largest in lymphoma (5.5cm) followed by pheochromocytoma (4.8cm), metastasis (4cm) and tuberculosis (2.1cm) (P<0.001). Biochemically, most patients with pheochromocytoma (92.8%) had catecholamine excess. Hypocortisolism was common in tuberculosis (100%) and PAL (71.4%) and absent with metastases (P<0.001). Conclusion In evaluation of bilateral adrenal masses, age at presentation, presenting symptoms, lesion size, and biochemical features are helpful in delineating varied underlying aetiologies. PMID:27037294

  15. Light-induced ESR centres in single crystal rutile

    NASA Astrophysics Data System (ADS)

    Hodgskiss, S. W.; Thorp, J. S.

    1983-04-01

    Electron spin resonance studies have been made on Verneuil-grown rutile single crystals, which were doped with a variety of transition gorup ions. Measurements were made at 9 GHz, both before and after UV irradiation, at temperatures in the range from 4.2 to 300 K. UV irradiation had two effects: (a) to affect the relative intensities of esr lines due to species already present, (b) to generate new esr spectra. Both effects are interpreted as representing a redistribution of charge amongst trapping centres. Seven UV generated centres have been identified and characterised in terms of their spin Hamiltonian parameters. Isochronal annealing techniques have been used to determine the ionisation temperatures of the traps. Observation of interactions and charge transfers between centres during isochronal annealing was used to determine the polarity and type of each centre.

  16. Sperm banking for male reproductive preservation: a 6-year retrospective multi-centre study in China.

    PubMed

    Ping, Ping; Zhu, Wen-Bing; Zhang, Xin-Zong; Yao, Kang-Shou; Xu, Peng; Huang, Yi-Ran; Li, Zheng

    2010-05-01

    Sperm banking can preserve male fertility effectively, but the current conditions of sperm cryopreservation in China have not been investigated. This retrospective investigation was based on data collected at multiple centres in China from January 2003 to December 2008. The collected data included urogenital history, indication for cryopreservation, semen parameters, use rate, type of assisted reproductive technique (ART) treatment and pregnancy outcome. The study population included 1 548 males who had banked their semen during the study period at one of the clinics indicated above. Approximately 1.9% (30/1 548) of the cryopreserved semen samples were collected from cancer patients; about 88.8% (1 374/1 548) of the patients had banked their semen for ART and 8.6% (134/1 548) had a male infertility disease (such as anejaculation, severe oligozoospermia and obstructive azoospermia). The total use rate of cryopreserved semen was 22.7% (352/1 548), with 119 live births. The cancer group use rate was 6.7% (2/30), with one live birth by intracytoplasmic single sperm injection (ICSI). The ART group use rate was 23.2% (319/1 374), with 106 live births. The reproductive disease group use rate was 23.1% (31/134), with 12 live births. The semen parameters in each category varied; the cancer patient and infertility disease groups had poor semen quality. In vitro fertilization (IVF) and ICSI were the most common ART treatments for cryopreserved sperm. Semen cryopreservation as a salvage method is effective, but in many conditions it is underutilized, especially in cancer patients. Lack of awareness, urgency of cancer treatment and financial constraints are the main causes of the low access rate. The concept of fertility preservation should be popularized to make better use of this medical service in China.

  17. [Experience in data management of the clinical retrospective project in Czech and Slovak oncology centres (IKARUS Project)].

    PubMed

    Chroust, K; Fínek, J; Zemánek, P; Brabec, P; Dusek, L

    2009-01-01

    The retrospective part of the IKARUS Project (Incidence of Skeletal Related Events in Breast Cancer) was focused on monitoring the incidence of skeletal related events in patients with metastatic breast cancer treated in the Czech and Slovak Republics.The aim was to describe the experience with data collection management in the conditions of the Czech and Slovak Republics. Retrospective collection of data in multi-centre, non-interventional, epidemiological and explorative studies. Female patients diagnosed since 2000 were involved in the project in order to respect the five-year period of monitoring and to describe the treatment of the period. During the initiation phase of the retrospective study each of the 18 Complex Cancer Centres in the Czech Republic (see www.linkos.cz) and 18 chosen oncology centres in the Slovak Republic were addressed. In the end, data were collected from 13 oncology centres in the Czech Republic and 12 oncology centres in the Slovak Republic. The initial plan to enrol 650 patients was not completed; data on 254 patients from the Czech Republic and 125 patients from the Slovak Republic were finally analysed.The effectiveness of retrospective data collection in the conditions of Czech and Slovak oncology corresponded with the possibilities of access to data of formerly diagnosed and treated patients. In searching for retrospective data the present hospital information systems could not be used in most oncology centres.Therefore, the cost of retrospective data collection was estimated and was shown to be relatively high. The binding methodical conclusion is that unless a systemic change is made in the functionality of hospital information systems and standardised electronic documentation is introduced, the retrospective collection of clinical data in our conditions will be associated with high costs and a relatively low recovery factor.

  18. The use of aromasticks at a cancer centre: a retrospective audit.

    PubMed

    Dyer, Jeannie; Cleary, Lise; Ragsdale-Lowe, Maxine; McNeill, Sara; Osland, Caroline

    2014-11-01

    To consider the use of aromasticks in a cancer centre in the UK: the reasons for their use, the choice of essential oils used in them and the demographics of the patients to whom they were given. Aromasticks are personal aromatherapy inhaler devices, used in this hospital by the complementary therapy team to improve patients' well-being and quality of life by helping with symptom control. A retrospective audit of aromastick use covering a 28 month period from January 2011-April 2013. A total of 514 aromasticks were given out, to patients with a variety of cancer diagnoses and symptoms. The most common reasons for aromastick use were to alleviate nausea or to encourage relaxation. Lavender (Lavandula angustifolia), lemon (Citrus limon), frankincense (Boswellia carterii), bergamot (Citrus bergamia), orange sweet (Citrus sinensis) and peppermint (Mentha x piperita) were the essential oils used most often. Copyright © 2013 Elsevier Ltd. All rights reserved.

  19. [A retrospective study of animal poisoning reports to the Swiss Toxicological Information Centre (1997 - 2006)].

    PubMed

    Curti, R; Kupper, J; Kupferschmidt, H; Naegeli, H

    2009-06-01

    The purpose of this retrospective study was to analyse the etiology, frequency and outcome of toxicological cases recorded by the consultation service of the Swiss Toxicological Information Centre (STIC) hotline over a 10-year period, from 1997 to 2006. A detailed analysis of this database indicates that common human drugs not intended for use in animals, as well as pesticides and toxic plants represent the most prominent hazards involved in the reported cases of animal poisonings. The comparison with a previous survey from the years 1976 - 1985 revealed new toxic risks due to the accidental uptake of cannabis products, castor seeds or chocolate by dogs. In addition, there is a striking increase of serious poisonings with pyrethroids in cats. The follow-up reports delivered by veterinarians also reflect novel pharmacological and technological trends in the management of poisonings.

  20. Single centre outcomes from definitive chemo-radiotherapy and single modality radiotherapy for locally advanced oesophageal cancer

    PubMed Central

    Gray, Joanna; McDonald, Alexander; McIntosh, David; MacLaren, Vivienne; Hennessy, Aisling; Grose, Derek

    2016-01-01

    Background Definitive chemo-radiotherapy (dCRT) has been advocated as an alternative to surgical resection for the treatment of locally advanced oesophageal cancer (OC). We have retrospectively reviewed 4 years’ experience of patients (pts) who underwent contemporary staging and were treated with concurrent chemo-radiotherapy (dCRT) or single modality radical radiotherapy (RT) with curative intent. Methods Retrospective analysis permitted identification of consecutive patients who underwent contemporary staging prior to non-surgical treatment for locally advanced oesophageal carcinoma. The primary outcomes were overall survival (OS) and disease-free survival (DFS), adjusted for baseline differences in age, tumour staging and histological cell type. All patients were treated with either dCRT or single modality RT within a single centre between 2009 and 2012. Results We identified 235 patients in total [median age 69.8 years, male =130 pts, female =105 pts, adenocarcinoma (ACA) =85 pts, squamous =150 pts]. A total of 190 pts received dCRT and 45 patients were treated with RT. All patients were staged with CT of chest, abdomen and pelvis, 226 patients underwent endoscopic ultrasound (EUS), and 183 patients had PET-CT. Patients treated with dCRT demonstrated longer OS (27 vs. 25 months respectively, P=0.02) and DFS (31 vs. 16 months respectively, P=0.01) compared to those treated with RT. More advanced tumour stage (stage 3 vs. stage 1/2) at presentation conferred poorer OS (32 vs. 38.2 months, P=0.02) and DFS (11 vs. 28 months, P=0.013). We demonstrated an acceptable toxicity profile with only 77 patients (32.8%) suffering grade 3 toxicity and 9 patients (4.2%) experiencing grade 4 toxicity by CTC criteria. The NG/PEG feeding rates were 4% across all treated patients. Conclusions This retrospective analysis is in keeping with current treatment paradigms emphasising the importance and safety of concurrent CRT in maximising curative potential for patients undergoing

  1. Biobrane: a retrospective analysis of outcomes at a specialist adult burns centre.

    PubMed

    Hubik, Daniel John; Wasiak, Jason; Paul, Eldho; Cleland, Heather

    2011-06-01

    This study is a retrospective analysis of 168 adult burns patients who received definitive treatment for partial thickness burns with Biobrane at a specialist burns centre. Our aim was to establish whether Biobrane served as a reliable, definitive treatment option or whether further treatment and allocation of surgical and nursing resources was required after application. We conducted a retrospective two year chart review (January 1 2007 and December 31 2008) of patients admitted to the Victorian Adult Burns Service, in Melbourne, Australia. Use of Biobrane was associated with the need for further treatment interventions in a total of 74 patients (44%). Of these, Biobrane failure was found to be associated with infection in 28 cases (37.8%) and 48 (65%) patients underwent further surgery. A total of 87 patients (52%) had burns that took greater than three weeks from the time of injury to full re-epithelisation. Factors found to be associated with Biobrane failure were female gender, increasing percentage surface area of Biobrane application and when Biobrane was used in conjunction with split skin grafting to another area. The application of Biobrane to burns of mid-dermal or 'indeterminate' depth in our institution has resulted in high rates of return to theatre, positive wound cultures and delayed healing, and the recognition of the need to re-conceptualise the principles of use of this product. The use of Biobrane in smaller mid dermal or mixed depth burns may lead to increased operations and use of other hospital resources, without clear evidence of improved outcomes. Copyright © 2011 Elsevier Ltd and ISBI. All rights reserved.

  2. Pregnancy in polymyositis or dermatomyositis: retrospective results from a tertiary centre in China.

    PubMed

    Zhong, Zhiqiang; Lin, Fuan; Yang, Jing; Zhang, Fengchun; Zeng, Xiaofeng; You, Xin

    2017-08-01

    To examine if patients with PM/DM are at higher risk of complicated pregnancies. In a retrospective cohort in a large tertiary centre in North China, the outcomes of 144 pregnancies were evaluated in 62 women with PM/DM. Generalized linear mixed effect models were fitted to assess the effect of pregnancy occurring after disease on pregnancy outcomes including preterm birth (PTB), abortion (spontaneous or induced) and normal delivery. Adjustment for confounding factors including parity, maternal age and pregnancy-disease interval were achieved with a multivariable model. For women who became pregnant after disease onset, there was significantly higher risk of either PTB or spontaneous abortion (adjusted odds ratio, OR = 9.36, 95% CI: 1.10, 79.88; P = 0.041). The odds increase was more prominent if PM/DM was also active during pregnancy (adjusted OR = 435.35, 95% CI: 5.32, 35628.18; P = 0.007). Disease flare upon conception was observed in 4 of 22 post-PM/DM pregnancies (P = 0.125), and responded well to steroids and IVIG but resulted in PTB or spontaneous abortion. PM/DM, especially those less well controlled, might contribute to an increased risk of complicated pregnancy.

  3. Heart transplantation: 25 years' single-centre experience.

    PubMed

    Bruschi, Giuseppe; Colombo, Tiziano; Oliva, Fabrizio; Botta, Luca; Morici, Nuccia; Cannata, Aldo; Vittori, Claudia; Turazza, Fabio; Garascia, Andrea; Pedrazzini, Giovanna; Frigerio, Maria; Martinelli, Luigi

    2013-09-01

    Heart transplantation (HTx) is still one of the most effective therapies for end-stage heart disease for patients with no other medical or surgical therapy. We report the results of our 25-year orthotropic HTx single-centre experience. From November 1985, 905 orthotopic heart transplants have been performed at our centre. We exclude from the present analysis 13 patients who underwent re-transplantation and 14 pediatric cases (age at HTx <15 years). The present study collected the data of 878 primary adult orthotopic HTx performed at our centre. Mean age at HTx was of 49.6 ± 11.6 years. Mean donor age was 36.9 ± 14.8 years. Hospital mortality was 11.6% (102 patients), early graft failure was the principal cause of death (58 patients) followed by infections (18 cases) and acute rejection (7 patients). Overall actuarial survival was 78.1% at 5 years and 63.8% and 47.5%, respectively, at 10 and 15 years from HTx. Mean survival was 10.74 years; 257 late deaths were reported (33.1%); main causes were neoplasm in 83 patients, and cardiac causes included coronary allograft vasculopathy in 78 patients. Freedom from any infection at 5, 10 and 15 years was 52.2, 44.1 and 40.1%, respectively. Freedom from rejection at 5 years was 36.2%, with 493 patients experiencing at last one episode of rejection, the majority occurring during the first 2 months after transplantation. The long-term survival of HTx recipients is limited in large part by the development of coronary artery vasculopathy and malignancies. In our experience freedom from coronary allograft vasculopathy at 10 years was 66.9%, and 85 patients underwent percutaneous coronary revascularization. In our study population, 44 patients experienced posttransplant lymphoproliferative disorder and 91 patients experienced a solid neoplasm, mean survival free from neoplasm was 12.23 years. Over the past four decades the field of HTx has evolved considerably, with improvements in surgical techniques and postoperative

  4. The General Single-Dish Data format: A retrospective

    NASA Astrophysics Data System (ADS)

    Jenness, Tim; Stobie, Elizabeth B.; Maddalena, Ronald J.; Garwood, Robert W.; Fairclough, Jon H.; Prestage, Richard M.; Tilanus, Remo P. J.; Padman, Rachael

    2015-09-01

    The General Single-Dish Data format (GSDD) was developed in the mid-1980s as a data model to support centimeter, millimeter and submillimeter instrumentation at NRAO, JCMT, the University of Arizona and IRAM. We provide an overview of the GSDD requirements and associated data model, discuss the implementation of the resultant file formats, describe its usage in the observatories and provide a retrospective on the format.

  5. Cytogenetic analysis of 6,142 amniocentesis cases: A 6-year single centre experience.

    PubMed

    Ekin, A; Gezer, C; Taner, C E; Ozeren, M; Avci, M E; Uyar, I; Ertas, I E

    2014-10-01

    The aim of our study was to evaluate the incidences and chromosomal abnormality detection rates of various indications for genetic amniocentesis. We retrospectively analysed 6,142 amniocentesis cases performed in a single centre between January 2007 and April 2013. We assessed the indications for prenatal diagnosis, fetal karyotypes, maternal ages, fetal ultrasound findings and maternal serum screening results. The most common indication for genetic amniocentesis was an abnormal maternal serum-screening test (36.6%), followed by advanced maternal age (28%), advanced maternal age and an abnormal maternal serum screening test (14.9%) and abnormal ultrasound findings (11.2%). The highest positive predictive values obtained from the indications included abnormal ultrasound findings and abnormal maternal serum screening test (12.9%) and advanced maternal age (12.2%). Although advanced maternal age and abnormal maternal serum screening tests were the most common indicators, their association with abnormal ultrasound findings should be identified to increase the efficacy of genetic amniocentesis.

  6. Pigmented villonodular synovitis of the knee: A retrospective analysis of 214 cases at a UK tertiary referral centre.

    PubMed

    Patel, K H; Gikas, P D; Pollock, R C; Carrington, R W; Cannon, S R; Skinner, J A; Briggs, T W; Aston, W J S

    2017-08-01

    Pigmented villonodular synovitis (PVNS) is a rare, locally aggressive and potentially recurrent synovial disease. We present the largest single-centre experience of knee PVNS. Our aim was to evaluate our tertiary hospital's experience in the management of knee PVNS. Retrospective data collection of consecutive cases of knee PVNS from 2002 to 2015. In total, 214 cases of knee PVNS were identified which represented 53.4% of all PVNS (12.1% were recurrent at presentation). 100 were localised PVNS (LPVNS), 114 diffuse PVNS (DPVNS) and two malignant PVNS. Knee PVNS was more likely to occur in females with a mean age of 39. Following surgery, 47.6% had recurrence with DPVNS as opposed to 8.6% with LPVNS. In LPVNS, there was no significant difference in recurrence between open and arthroscopic synovectomy (8.7% vs 9.1%, P>0.05). However, in DPVNS, there was a significantly higher risk of recurrence with arthroscopic compared to open synovectomy (83.3% vs 44.8%, RR=1.86 95% CI 1.32-2.62, P=0.0004). PVNS can be difficult to treat. We found no difference in local recurrence rates between open and arthroscopic treatment of LPVNS but significantly increased rates of recurrence for DPVNS following arthroscopic treatment. We would therefore recommend open synovectomy for DPVNS. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

  7. Urological complications after renal transplantation – a single centre experience

    PubMed Central

    Dembowski, Janusz; Kołodziej, Anna; Małkiewicz, Bartosz; Tupikowski, Krzysztof; Matuszewski, Michał; Chudoba, Paweł; Boratyńska, Maria; Klinger, Marian; Zdrojowy, Romuald

    2016-01-01

    Introduction Urological complications after renal transplantation occur in between 2.5% and 30% of all graft recipients. The aim of the study was to present 7 years of experience in urological treatment of patients with a transplanted kidney. We aimed to identify retrospectively late urological complications in renal transplant recipients at a single center and analyze the treatment modalities and their outcome. Material and methods Between January 2008 and December 2014, a total of 58 patients after KTX were treated in the Department of Urology because of post-transplant urological complications that occurred during follow-up at the Transplant Outpatient Department. Retrieved data were analysed in retrospectively. Results In the group of 38 patients with ureteral stenosis (Clavien grade III), 29 patients underwent endoscopy, 8 open surgical procedures and one both endoscopic and open operation. Ten patients were admitted with symptomatic lymphocoele (Clavien III), of which 9 were successfully treated with drainage and one with surgical marsupialization. Because of urolithiasis in the grafted kidney (Clavien grade III), 4 patients were treated with ureterorenoscopic lithotripsy (URSL) and one only with the extracorporeal shock wave lithotripsy (ESWL) procedure. Five urethral strictures plasties and one graftectomy because of purulent pyelonephritis were also conducted. The average age in the group of recipients who experienced urologic complications was similar (46.1 vs. 47.8) to those without complications. There was no vesicoureteral reflux or ureteral necrosis requiring surgical intervention, no graft loss and death related to urological complication and treatment. Conclusions Most complications could be successfully treated with endourological procedures. The kidney function improved in the majority of patients. PMID:27730001

  8. Complications in Advanced Diabetics in a Tertiary Care Centre: A Retrospective Registry-Based Study

    PubMed Central

    Ankush; Gomes, Edwin; Dessai, Ankush

    2016-01-01

    Introduction Diabetes is a major public health problem in our country and complications of diabetes are a major cause of morbidity and mortality. There is a need to quantify the complications in order to improve our strategies for prevention and management. Aim To measure the prevalence of complications in type 2 diabetics following up at a tertiary care centre and to study its association with the socio-demographic and clinical parameters. Materials and Methods A retrospective record based study was conducted on 3261 type 2 diabetic patients on insulin therapy, recorded in the diabetic registry maintained at Goa Medical College from Aug 2009 to May 2012. Data on anthropometric measurements, demographic characteristics, complications and other details were extracted from these records. Results Out of the 3261 patients 1025 (31.4%) had macrovascular complications and 1122 (34.4%) had at least one microvascular complication. The prevalence of peripheral vascular disease, coronary artery disease and stroke were 6.7%, 21.3% and 6.6% respectively and were significantly higher in males. The prevalence of diabetic retinopathy, nephropathy and neuropathy were 16.7%, 16.5% and 16.3% respectively with diabetic nephropathy being significantly higher in males. Trend analysis showed significant association of rising prevalence of all complications with age (p<0.05). Duration of diabetes also showed significantly positive trend for all complications (p<0.05) except stroke. Conclusion The study presents the prevalence of diabetic complications in patients reporting to a tertiary hospital in Goa. Coronary artery disease was found to be the most common complication. As age and duration of diabetes were found to be significantly associated, efforts should be made towards promoting earlier diagnosis of diabetes so as to improve management and decrease the chances of complications. PMID:27190861

  9. A Retrospective Epidemiological Study of Rhinosporidiosis in a Rural Tertiary Care Centre in Pondicherry

    PubMed Central

    Vijayasundaram, S.; Pulimoottil, Davis Thomas

    2016-01-01

    Introduction Rhinosporidiosis is an age old endemic scourge which has affected various parts of the world, most notably India and Sri Lanka. Although a large body of literature exists regarding this problem, postoperative recurrence rates continue to vary, and the effect of public health education in the eradication of this disease has not been taken into account. Aim The aim of this study was to find out the site, presentation and postoperative recurrence rate in patients with rhinosporidiosis. Materials and Methods This was a retrospective study involving operated cases of rhinosporidiosis in the Department of Ear, Nose and Throat of a rural tertiary care referral centre over a period of 3 years. The behavioural pattern of the disease, its epidemiology, rate of recurrence and outcomes of surgical management were analysed. Results A statistically significant correlation could be found between male gender and rural residential status and incidence of rhinosporidiosis. Bathing in rivers and ponds were found to be strongly associated with rhinosporidiosis (p=0.005). Almost all patients were found to be of low socioeconomic status. Nasal obstruction and epistaxis were the most common presenting complaints. Conclusion Rhinosporidiosis is strongly associated with male gender, young and middle aged adults, agricultural occupations, rural residential status, a history of bathing in ponds and rivers and a low socioeconomic status. Post-surgical recurrence of rhinosporidial masses can be avoided with careful and complete clearance of the mass and cauterization of the base. Appropriate and consistent public health education helps to reduce the incidence of rhinosporidiosis in endemic communities. PMID:27437252

  10. Delivering tertiary centre specialty care to ALS patients via telemedicine: a retrospective cohort analysis.

    PubMed

    Selkirk, Stephen M; Washington, Monique O; McClellan, Frances; Flynn, Broderick; Seton, Jacinta M; Strozewski, Richard

    2017-08-01

    This study was undertaken to determine if ALS patients evaluated via telemedicine received the same quality of care as patients evaluated by traditional face-to-face encounters. A retrospective cohort study design was used. Participants were patients diagnosed with ALS that received multidisciplinary care at the tertiary Cleveland VA ALS Centre between 1 March 2008- and 31 anuary 2015. Participants were not randomised, but chose telemedicine based on preference, disability level or distance from the clinic. Telemedicine in this study consisted of a video conferencing platform enabling remote rather than face-to-face encounters with participants. There was no significant association between receiving quality ALS care and the mode of care. There was a trend for telemedicine patients to utilise home health care less often than those that received clinic care (AOR 0.50; 95% CI 0.16-1.59). There was no significant difference in survival time between the two groups (log-rank test χ(2) = 3.62, df = 1, p = 0.05). Patients receiving telemedicine had a higher probability of remaining stable or having <30% decrease in ALSFRS-R over time (log-rank test χ(2) = 4.46, df = 1, p = 0.03). There was a significantly lower risk of disease progression for patients receiving telemedicine (HR = 0.39, 95% CI = 0.16-0.93). Patients managed by telemedicine received the same quality of care and had similar outcomes to those patients seen via traditional face-to-face encounters. Telemedicine is an effective platform for delivering high quality tertiary ALS care.

  11. Hand-assisted laparoscopic donor nephrectomy: a single centre experience

    PubMed Central

    Macech, Michał; Alsharabi, Amro; Romanowski, Łukasz; Grochowiecki, Tadeusz; Lewandowska, Dorota; Kaliciński, Piotr; Durlik, Magdalena; Pączek, Leszek; Nazarewski, Sławomir

    2016-01-01

    Introduction The advantages of a minimally invasive nephrectomy are a faster recovery and better quality of life for the donors. Until recently, the majority of donor nephrectomies in Poland were done by open surgery. Aim To present a single centre experience in hand-assisted laparoscopic donor nephrectomy (HALDN). Material and methods The first videoscopic left donor nephrectomy in Poland was performed in our department in 2003 using a hand-assisted retroperitoneal approach. From 2011, we changed the method to a transperitoneal approach and started to harvest also right kidneys. Since then, it has become the method of choice for donor nephrectomy and has been performed in 59 cases. Preoperatively, kidneys were assessed by scintigraphy and by angio-computed tomography. We harvested 32 left and 27 right kidneys. There were double renal arteries in 2 cases and triple renal arteries in 1 case. The warm ischaemia time (WIT) was 80–420 s (average 176.13 s); operative time was 85–210 min (average 140 min). Results All procedures were uncomplicated, and all donors were discharged after 2–8 days with normal creatinine levels. The average follow-up period lasted 23 months (1–51 months). Out of all of the cases, 1 case had two minor complications, while all others were uneventful. None of the donors were lost to follow-up. All of the kidneys were transplanted. There were 2 cases of delayed graft function (DGF) and 2 cases of ureter necrosis. One of those kidneys was lost in the third postoperative week. Conclusions Our limited experience shows that HALDN is a safe method and should be used routinely instead of open surgery. PMID:28194249

  12. MRSA-retrospective analysis of an outbreak in the burn centre Aachen.

    PubMed

    Fuchs, Paul Ch; Kopp, Jürgen; Häfner, Helga; Kleiner, Ullrich; Pallua, Norbert

    2002-09-01

    The growing interest in methicillin-resistant Staphylococcus aureus (MRSA) has been caused by its increased appearance in hospital and community populations. In our burn centre, an outbreak of MRSA was noticed during an 8-month period. We were able to isolate MRSA in eight patients. DNA analysis by pulsed-field gel electrophoresis (PFGE) demonstrated the development of five different strains during this period. Only two patients developed an infection caused by MRSA colonisation. The infections were proven by positive blood culture or catheter colonisation. One patient developed a clinical vancomycin-resistant sepsis which was treated successfully with the additional application of Quinupristin/Dalfopristin. THIS ANALYSIS SHOWS THAT: (1) the development of MRSA in a burn unit is often created in a single patient by long-term antibiotic therapy and not a result of cross-infection, (2) manifest MRSA infection seldom occurs even in colonised burn patients, and (3) a clinically vancomycin-resistant MRSA infection in burn patients can be treated sufficiently with Quinupristin/Dalfopristin.

  13. Consumer concerns about paracetamol: a retrospective analysis of a medicines call centre

    PubMed Central

    Lau, Stephanie M; McGuire, Treasure M; van Driel, Mieke L

    2016-01-01

    Objectives To identify consumer information needs about paracetamol, the most commonly used analgesic and antipyretic worldwide. Design Retrospective analysis of medicines questions from the public. Setting Australian consumer medicines call centre. Participants Callers to National Prescribing Service Medicines Line between September 2002 and June 2010 (n=123 217). Main outcome measures Enquiry profile: demographics, enquiry type and concurrent medicines included in paracetamol calls; question themes derived from subset of call narratives. Results Paracetamol comprised part of the enquiry in 5.2% of calls (n=6367). The caller age distribution for paracetamol calls was skewed towards a younger cohort, with 45.2% made by those aged 25–44 vs 37.5% in ‘rest of calls’. Significantly more paracetamol-related calls were made for a child (23.7%) compared with ‘rest of calls’ (12.7%, p<0.001). The most frequent concurrently asked about medicines were codeine (11%, n=1521) and ibuprofen (6.4%, n=884). Questions underpinned by paracetamol risk (interaction, use in pregnancy/lactation or other safety concerns) predominated (55.8%). When individual paracetamol enquiry types were compared with ‘rest of calls’, efficacy was most frequent (24.9% vs 22.8%); however, interaction (21.5% vs 14.8%), administration (15.5% vs 11%) and pregnancy/lactation (13.8% vs 8.3%) categories were more prevalent for paracetamol calls (all p<0.001). Enquiry type frequency also varied by patient age group, with questions about administration more common in younger groups and efficacy dominating in those over 45. Narrative analysis of over-represented paracetamol enquiry types showed specific concerns relevant to life stages: young children, those of reproductive age and the elderly. Conclusions Consumers have many concerns about the use of paracetamol that may be under-recognised by healthcare providers, with the nature of enquiries differing across life stages. These concerns are not

  14. Biliary complications after right lobe living donor liver transplantation: a single-centre experience

    PubMed Central

    Yaprak, Onur; Dayangac, Murat; Akyildiz, Murat; Demirbas, Tolga; Guler, Necdet; Bulutcu, Fisun; Bassullu, Nuray; Akun, Elif; Yuzer, Yildiray; Tokat, Yaman

    2012-01-01

    Background Biliary complications that developed after right lobe liver transplantation from living donors were studied in a single centre. Methods From 2004 to 2010, 200 consecutive living donor right lobe liver transplantations were performed. The database was evaluated retrospectively. Biliary complications were diagnosed according to clinical, biochemical and radiological tests. The number of biliary ducts in the transplanted graft, the surgical techniques used for anastomosis, biliary strictures and bile leakage rates were analysed. Results Of a total of 200 grafts, 117 invloved a single bile duct, 77 had two bile ducts and in six grafts there were three bile ducts. In 166 transplants, the anastomosis was performed as a single duct to duct, in 21 transplants double duct to ducts, in one transplant, three duct to ducts and in 12 transplants as a Roux-en-Y reconstruction. In all, 40 bile leakages (20%) and 17 biliary strictures (8.5%) were observed in 49 patients resulting in a total of 57 biliary complications (28.5%). Seventeen patients were re-operated (12 as a result of bile leakages and five owing to biliary strictures). Conclusion Identification of more than one biliary orifice in the graft resulted in an increase in the complication rates. In grafts containing multiple orifices, performing multiple duct-to-duct (DD) or Roux-en-Y anastomoses led to a lower number of complications. PMID:22151451

  15. Incremental peritoneal dialysis: a 10 year single-centre experience.

    PubMed

    Sandrini, Massimo; Vizzardi, Valerio; Valerio, Francesca; Ravera, Sara; Manili, Luigi; Zubani, Roberto; Lucca, Bernardo J A; Cancarini, Giovanni

    2016-12-01

    Incremental dialysis consists in prescribing a dialysis dose aimed towards maintaining total solute clearance (renal + dialysis) near the targets set by guidelines. Incremental peritoneal dialysis (incrPD) is defined as one or two dwell-times per day on CAPD, whereas standard peritoneal dialysis (stPD) consists in three-four dwell-times per day. Single-centre cohort study. Enrollement period: January 2002-December 2007; end of follow up (FU): December 2012. incident patients with FU ≥6 months, initial residual renal function (RRF) 3-10 ml/min/1.73 sqm BSA, renal indication for PD. Median incrPD duration was 17 months (I-III Q: 10; 30). There were no statistically significant differences between 29 patients on incrPD and 76 on stPD regarding: clinical, demographic and anthropometric characteristics at the beginning of treatment, adequacy indices, peritonitis-free survival (peritonitis incidence: 1/135 months-patients in incrPD vs. 1/52 months-patients in stPD) and patient survival. During the first 6 months, RRF remained stable in incrPD (6.20 ± 2.02 vs. 6.08 ± 1.47 ml/min/1.73 sqm BSA; p = 0.792) whereas it decreased in stPD (4.48 ± 2.12 vs. 5.61 ± 1.49; p < 0.001). Patient survival was affected negatively by ischemic cardiopathy (HR: 4.269; p < 0.001), peripheral and cerebral vascular disease (H2.842; p = 0.006) and cirrhosis (2.982; p = 0.032) and positively by urine output (0.392; p = 0.034). Hospitalization rates were significantly lower in incrPD (p = 0.021). Eight of 29 incrPD patients were transplanted before reaching full dose treatment. IncrPD is a safe modality to start PD; compared to stPD, it shows similar survival rates, significantly less hospitalization, a trend towards lower peritonitis incidence and slower reduction of renal function.

  16. Fluorescence Polarization Switching from a Single Silicon Vacancy Colour Centre in Diamond

    PubMed Central

    Liu, Yan; Chen, Gengxu; Rong, Youying; McGuinness, Liam Paul; Jelezko, Fedor; Tamura, Syuto; Tanii, Takashi; Teraji, Tokuyuki; Onoda, Shinobu; Ohshima, Takeshi; Isoya, Junichi; Shinada, Takahiro; Wu, E; Zeng, Heping

    2015-01-01

    Single-photon emitters with stable and uniform photoluminescence properties are important for quantum technology. However, in many cases, colour centres in diamond exhibit spectral diffusion and photoluminescence intensity fluctuation. It is therefore essential to investigate the dynamics of colour centres at the single defect level in order to enable the on-demand manipulation and improved applications in quantum technology. Here we report the polarization switching, intensity jumps and spectral shifting observed on a negatively charged single silicon-vacancy colour centre in diamond. The observed phenomena elucidate the single emitter dynamics induced by photoionization of nearby electron donors in the diamond. PMID:26202940

  17. Vertebro-basilar junction aneurysms: a single centre experience and meta-analysis of endovascular treatments.

    PubMed

    Graziano, Francesca; Ganau, Mario; Iacopino, Domenico Gerardo; Boccardi, Edoardo

    2014-12-01

    Vascular lesions of the vertebrobasilar junction (VBJ) are challenging in neurosurgical practice, and their gold-standard therapy is still under debate. We describe the operative strategies currently in use for the management of these complex vascular lesions and discuss their rationale in a literature meta-analysis and single centre blinded retrospective study. The single centre study included a review of initial presentation, angiographic features and clinical outcome (with modified Rankin Scale [mRS] scores) over a long-term follow-up. In our series, small aneurysms were effectively treated by endosaccular coil embolization, whereas a strategy including flow-diverter devices combined with endosaccular coil embolization was the option of choice in large and giant aneurysms, leading to satisfactory outcomes in most cases. Our Medline review showed that endovascular treatment was chosen in most VBJ cases, whereas the microsurgical option was assigned to only a few cases. Among the endovascular treatments, the most common techniques used for the treatment of VBJ aneurysms were: coiling, stent-assisted coiling and flow diversion. Our study highlights that aneurysm morphology, location and patient-specific angio-architecture are key factors to be considered in the management of VBJ aneurysms. Most case series, including our own, show that parent artery reconstruction using a flow-diverter device is a feasible and successful technique in some cases of giant and complex aneurysms (especially those involving the lower third of the basilar artery) while a "sit back, wait and see" approach may represent the safest and most reasonable option.

  18. Vertebro-Basilar Junction Aneurysms: A Single Centre Experience and Meta-Analysis of Endovascular Treatments

    PubMed Central

    Graziano, Francesca; Ganau, Mario; Iacopino, Domenico Gerardo; Boccardi, Edoardo

    2014-01-01

    Summary Vascular lesions of the vertebrobasilar junction (VBJ) are challenging in neurosurgical practice, and their gold-standard therapy is still under debate. We describe the operative strategies currently in use for the management of these complex vascular lesions and discuss their rationale in a literature meta-analysis and single centre blinded retrospective study. The single centre study included a review of initial presentation, angiographic features and clinical outcome (with modified Rankin Scale [mRS] scores) over a long-term follow-up. In our series, small aneurysms were effectively treated by endosaccular coil embolization, whereas a strategy including flow-diverter devices combined with endosaccular coil embolization was the option of choice in large and giant aneurysms, leading to satisfactory outcomes in most cases. Our Medline review showed that endovascular treatment was chosen in most VBJ cases, whereas the microsurgical option was assigned to only a few cases. Among the endovascular treatments, the most common techniques used for the treatment of VBJ aneurysms were: coiling, stent-assisted coiling and flow diversion. Our study highlights that aneurysm morphology, location and patient-specific angio-architecture are key factors to be considered in the management of VBJ aneurysms. Most case series, including our own, show that parent artery reconstruction using a flow-diverter device is a feasible and successful technique in some cases of giant and complex aneurysms (especially those involving the lower third of the basilar artery) while a "sit back, wait and see" approach may represent the safest and most reasonable option. PMID:25489898

  19. Percutaneous closure of post-myocardial infarction ventricular septal rupture - A single centre experience.

    PubMed

    Premchand, Rajendra Kumar; Garipalli, Ravikanth; Padmanabhan, T N C; Manik, Geetesh

    2017-04-01

    Post-infarction ventricular septal rupture (VSR) is a rare but lethal mechanical complication of an acute myocardial infarction (AMI). Survival to 1 month without intervention is 6%. Given high surgical mortality, transcatheter closure has emerged as a potential strategy in selected cases. Indian data on percutaneous device closure of post AMI-VSR is scarce hence we report our single-centre experience with ASD occluder device (Amplatzer and lifetech) for closure of post-AMI VSR. In this single-centre, retrospective, cohort study, patients who underwent transcatheter closure of post-MI VSR between 2005 and 2015 at KIMS Hospital were included. Primary outcome was mortality rate at 30 days. Seven patients were included in the study (mean age, 58.29±9.8 years). 5 patients had anterior wall myocardial infarction (AWMI) & 2 had inferior wall myocardial infarction (IWMI). None of the patients received thrombolytic therapy. Device was successfully placed in 5 patients (71.4%) with minimal residual shunt in 2 patients (40%). Out of 7 cases 2 patients survived (29% survival rate) and are doing well on follow up at 1 and 5 years respectively. Cardiogenic shock, IWMI and serpigenious form of VSR were associated with poor outcomes. Delayed revascularization (PCI) was associated with better outcomes. Percutaneous closure is a potential technique in a selected group of patients. The presence of cardiogenic shock, IWMI and serpigeneous form of VSR constitutes important risk factors for mortality. Device implantation is in general successful with few procedure-related complications and should be applied on a case-by-case basis. Copyright © 2016. Published by Elsevier B.V.

  20. Force-induced chemical reactions on the metal centre in a single metalloprotein molecule.

    PubMed

    Zheng, Peng; Arantes, Guilherme M; Field, Martin J; Li, Hongbin

    2015-06-25

    Metalloproteins play indispensable roles in biology owing to the versatile chemical reactivity of metal centres. However, studying their reactivity in many metalloproteins is challenging, as protein three-dimensional structure encloses labile metal centres, thus limiting their access to reactants and impeding direct measurements. Here we demonstrate the use of single-molecule atomic force microscopy to induce partial unfolding to expose metal centres in metalloproteins to aqueous solution, thus allowing for studying their chemical reactivity in aqueous solution for the first time. As a proof-of-principle, we demonstrate two chemical reactions for the FeS4 centre in rubredoxin: electrophilic protonation and nucleophilic ligand substitution. Our results show that protonation and ligand substitution result in mechanical destabilization of the FeS4 centre. Quantum chemical calculations corroborated experimental results and revealed detailed reaction mechanisms. We anticipate that this novel approach will provide insights into chemical reactivity of metal centres in metalloproteins under biologically more relevant conditions.

  1. Changing epidemiology of AA amyloidosis: clinical observations over 25 years at a single national referral centre.

    PubMed

    Lane, Thirusha; Pinney, Jennifer H; Gilbertson, Janet A; Hutt, David F; Rowczenio, Dorota M; Mahmood, Shameem; Sachchithanantham, Sajitha; Fontana, Marianna; Youngstein, Taryn; Quarta, Candida C; Wechalekar, Ashutosh D; Gillmore, Julian D; Hawkins, Philip N; Lachmann, Helen J

    2017-09-01

    Systemic AA amyloidosis is a serious complication of chronic inflammation; however, there are relatively few published data on its incidence. We investigated the changing epidemiology of AA amyloidosis over a 25-year period at a single national referral centre. We conducted a retrospective study of all patients diagnosed with AA amyloidosis who had attended the centre between 1990 and 2014 inclusive. Six hundred and twenty-five patients were studied in three cohorts: C1: 1990-1997; C2: 1998-2006; C3: 2007-2014. Mean age at presentation increased from 46 in C1 to 56 in C3 (p < .0001). The proportion of South Asian patients increased from 4% in C1 to 17% in C3 (p = .0006). Comparison of underlying diseases between C1 and C3 revealed a reduction in patients with juvenile idiopathic arthritis from 25% to 2% (p < .0001), but an increase in patients with chronic infection due to intravenous recreational drug use from 1% to 13% (p < .0001), and uncharacterized inflammatory disorders from 10% to 27% (p <.0001). More patients were in end-stage renal failure at presentation in C3 (29%) than C1 (15%) (p = .0028). Median age at death was later in C3 (62 years) than C1 (54 years) (p = .0012). These data suggest both falling incidence and better outcome in AA amyloidosis over a quarter of a century, reflecting advances in therapeutics and overall management of complex chronic disease in an ageing population. AA amyloidosis of uncertain aetiology presents an emerging major problem. Newer techniques such as next-generation sequencing may aid diagnosis and effective treatment, thereby improving overall survival.

  2. Laparoscopic inguinal hernia repair in the Armed Forces: A 5-year single centre study

    PubMed Central

    Jakhmola, C.K.; Kumar, Ameet

    2015-01-01

    Background Surgery for inguinal hernia continues to evolve. The most recent development in the field of surgery for inguinal hernia is the emergence of laparoscopic inguinal hernia surgery (LIHS) which is challenging the gold standard Lichtenstein's tension free mesh repair. Our centre has the largest series of LIHS from any Armed Forces hospital. The aim of this study was to analyze the short and long term outcomes at our center since its inception. Methods Retrospective review of prospectively maintained data base of 501 LIHS done in 434 patients by a single surgeon between April 2008 and October 2013. Preoperative, intraoperative, postoperative and follow-up data was analyzed with emphasis on the recurrence rates and the incidence of inguinodynia. Results 402 (92.6%) patients had primary hernias and 367 (84.6%) patients had unilateral hernias. Of the 501 repairs, 453 (90.4 %) were done totally extraperitoneal approach and 48 (9.6 %) were done by the transabdominal preperitoneal approach. The mean operative time for unilateral and bilateral repairs was 40.9 ± 11.2 and 76.2 ± 15.0 minutes, respectively. The conversion rate to open surgery was 0.6%. The intraoperative, and early and late postoperative complication rates were 1.7%, 6.2% and 3%, respectively. The incidence of chronic groin pain was 0.7% and the recurrence rate was 1.6%. The median hospital stay was 1 day (1–5 days). Conclusion We, in this series of over 500 repairs have demonstrated that feasibility as well as safety of LIHS at our centre with good short and long term outcomes. PMID:26663957

  3. Comparison of peritoneal dialysis catheter insertion techniques: Peritoneoscopic, radiological and laparoscopic : A single-centre study.

    PubMed

    Sun, Tina Y-T; Voss, David; Beechey, Denise; Lam-Po-Tang, Michael

    2016-05-01

    Our centre introduced peritoneoscopic insertion of peritoneal dialysis (PD) catheter by nephrologists as a new method in August 2009 for its potential benefits. The aim of this study was to compare perioperative complications and catheter survival of three techniques: peritoneoscopic, surgical and radiological techniques within a single dialysis centre. This study used retrospective analysis of all PD catheter inserted from 1 August 2009 to 31 July 2013 within Counties Manukau DHB, Auckland, New Zealand. During the study period, 293 PD catheters were inserted, 84 (29%) peritoneoscopic (P), 140 (48%) surgical (S) and 69 (23%) radiological (R). Total duration of follow-up was 5848 catheter-months, with median follow-up of 17 months. There was no difference in perioperative exit-site infections and overall early infections. There was however increased overall perioperative complications in P compared with R (HR 2.08; P < 0.05), predominantly from catheter removal within 60 days. Although there was no difference observed in first catheter 1-year and overall survival between insertion techniques, there was poorer complication-free survival comparing P to S (HR 1.82, P = 0.001) but not to R. Analyses of the latter cohort of P confirmed improvement in catheter survival compared with an earlier cohort and to other insertion techniques. Peritoneoscopic PD catheter insertion is demonstrated to be a suitable alternative technique. As with any new procedure, 'learning curve' effects and development of operator expertise need to be taken into consideration. © 2015 Asian Pacific Society of Nephrology.

  4. Single centre experience of the upper limb replantation and revascularisation.

    PubMed

    Visnjic, Milan M; Kovacevic, Predrag T; Paunkovic, Ljiljana M; Milenkovic, Sasa S

    2004-01-01

    Replantation is defined as reattachment of the amputated limb using the neurovascular and musculoskeletal structures in order to obtain the recovery of the limb. Fortunately, injuries causing limb amputation are rare. Adequate treatment within the optimal time scale can provide successful rehabilitation of the shape and function of the replanted part. We report the experience of our Clinical Centre (regional replantation centre) in the replantation of five forearms/hands and revascularisation of six hands between 1997 and 2001. The most frequent site of injury was the distal part of the forearm, while the major cause of injuries was a wood processing machine. The surgical procedures were performed under general anaesthesia within 2-6 hours after injury. Vascular anastomoses, nerve repair and muscle repair were performed following the external bone fixation. All patients were given anticoagulation treatment postoperatively. Thrombosis in the anastomotic site developed as an early complication in two patients who underwent thrombectomy; one of these patients developed gangrene and underwent amputation. Late postoperative results were good in 10 patients. One patient developed acral epidermolysis. Postoperative results after revascularisation were good in all patients.

  5. Retrospective Evaluation of Pediatric Oral Biopsies from A Dental and Maxillofacial Surgery Centre in Salem, Tamil Nadu, India

    PubMed Central

    Krishnan, Ramesh; Ramesh, Maya; Paul, George

    2014-01-01

    Aim: The aim of the study was to evaluate the pediatric oral biopsies received between 2002-2011 from a dental and maxillofacial centre in Salem, Tamilnadu, India retrospectively based on age, sex, site and type of the pathologies. Materials and Methods: The records of dental and maxillofacial surgery centre were taken and a retrospective evaluation of the pediatric lesions biopsied over a period of ten years (2002-2011) was done. Patients aged 15 years and below were considered as pediatric patients and pathologies were grouped into 8 categories, according to age, gender, anatomic location and pathologic diagnosis. Results: A total of nine hundred twenty five biopsies were studied, of which 97 cases were from pediatric patients. The pathologies were predominant in mandible to maxilla (47:29).The distribution of the pathologies were 44 odontogenic pathologies, 18 connective tissue tumours, 3 salivary gland tumours, 5 fibro osseous lesions and 25 tumour like lesions. Out of this 44 odontogenic pathologies, 39 were odontogenic cysts, and 5 were odontogenic tumours. Conclusion: Unlike other studies, the lesions were more common in the mandible with a female predilection. The majority of oral and maxillofacial lesions detected in pediatric population were benign similar to the previous reports. PMID:24596780

  6. Prenatal screening of Cystic Fibrosis: a single centre experience

    PubMed Central

    Bizzoco, Domenico; Mesoraca, Alvaro; Cima, Antonella; Sarti, Monica; Di Giacomo, Gianluca; Scerra, Giovanna; Barone, Maria Antonietta; Di Natale, Manuela; Gabrielli, Ivan; Tamburino, Caterina; Scargiali, Claudia; Ernandez, Cristina; D’Aleo, Maria Pia; Todini, Michele; Pompili, Rita; Mobili, Luisa; Mangiafico, Lucia; Carcioppolo, Ornella; Coco, Claudio; Cignini, Pietro; D’Emidio, Laura; Girgenti, Alessandra; Brizzi, Cristiana; Cavaliere, Alessandro; Giorlandino, Claudio

    2008-01-01

    Objective: The gene responsible for the pathogenesis of cystic fibrosis has been known for over 15 years and represent the most common autosomal recessive disease in the european population. We aimed to investigate the incidence of this condition during fetal life. Methods: In the past 10 years we examined in our centre 25393 fetuses of women underwent to amniocentesis. We carried out the examination of the most frequent mutations which enable, according to the literature data, the identification of almost 80% of the affected alleles. Result: We identified 922 heterozygous and 9 homozygous for the mutation. The frequency of heterozygousin the examined sample was 1/27,5 while that of the affected was 1/2821. Conclusion: We encourage new thoughts regarding the diagnostic validity of the most frequent panel of mutations among the italian population in order to exclude never encountered mutations and the insertion of other more significant mutations. PMID:22439019

  7. Hepatic venous outflow obstruction in piggyback liver transplantation: single centre experience.

    PubMed

    Arudchelvam, Joel; Bartlett, Adam; McCall, John; Johnston, Peter; Gane, Edward; Munn, Stephen

    2017-03-01

    Hepatic venous outflow obstruction (HVOO) is a rare but serious complication in liver transplantation (LT). We conducted a retrospective analysis of HVOO with venography and gradient measurement in consecutive LT from a single centre. Five hundred and six LTs were performed in 486 patients with a median age of 49 years (range 3 months to 71 years). Nineteen (3.8%) cases of HVOO were identified. Diagnosis was confirmed at a median of 26 days post-LT (1-2312). The incidence fell from 5.5% in the first 253 LT, to 2.0% in the second 253 (P = 0.03). Seventeen were due to narrowing at the anastomosis and two cases were due to thrombosis. In adult patients, reconstruction of the supra-hepatic donor inferior vena cava (IVC) onto two veins versus modified 2-3 hepatic veins did not alter the likelihood of HVOO. 17/19 cases were managed successfully by stenting or venoplasty. Two paediatric patients with early onset HVOO had attempted surgical thrombectomy, one was successful and the other required retransplantation. The incidence of HVOO appears to fall with increasing experience and does not appear to be related to the number of veins the donor IVC is anastomosed to in adult recipients. © 2015 Royal Australasian College of Surgeons.

  8. Surgical outcome and patterns of recurrence for retroperitoneal sarcoma at a single centre.

    PubMed

    Hogg, H D J; Manas, D M; Lee, D; Dildey, P; Scott, J; Lunec, J; French, J J

    2016-03-01

    Retroperitoneal sarcoma is a surgically managed condition that can recur locally following macroscopically complete resection. Owing to the low incidence of the condition, advances in treatment are reported infrequently but complete compartmental resection and adjuvant or neoadjuvant radiotherapy are areas under investigation. Given the practical difficulty of randomised trials, observational data can highlight advantages from progressive treatment approaches. A retrospective database of consecutive retroperitoneal sarcoma resections performed at a single referral centre between March 1997 and March 2013 was interrogated. Histological, radiological and clinical data were collected. Univariate and multivariate analyses for disease free and overall survival were performed to establish independent predictors of disease recurrence and patient survival. A total of 79 patients underwent 90 resections (63 primary). The mean five-year overall and disease free survival rates were 55.3% and 24.8% respectively. Higher patient age, high tumour grade, presence of extraretroperitoneal disease and invasive tumour phenotype were found to significantly predict survival following multivariate analysis. Half (50%) of the tumours displayed invasive behaviour on histopathology and 42% of locoregional recurrence was intraperitoneal. Retroperitoneal sarcoma is commonly an infiltrative tumour and often recurs outside of the retroperitoneum. These features limit the therapeutic impact of interventions that focus on gaining local control such as complete compartmental resection and radiotherapy. It seems likely that future advances in the management of this cancer will involve new systemic agents to treat this frequently systemic disease.

  9. [Is cobalamin measurement overprescribed by physicians? Results of an eight-year single academic centre survey].

    PubMed

    Arlet, J-B; Rachas, A; Colombet, I; Pouchot, J; Chiche, L

    2015-07-01

    Cobalamin (Cb) blood level is widely measured among inpatients, while relevant indications for ordering this assay in clinical practice are limited and tended to decline in the recent years. We evaluated retrospectively, in a single academic centre, changes in volume of Cb measurement in an eight-year period. The annual number of Cb assays has doubled between 2005 and 2012, from 3049 to 6158, in the medical departments of our hospital. The proportion of patients in which Cb was measured increased to 84% in the same period. The increase was of 36% in the internal medicine department. In this department, 30% of the 1753 patients admitted in 2012 had Cb measurement. The significant changes in the volume of Cb assay in recent years are not justified by any new scientific data about new indications for ordering Cb measurement. It seems necessary to establish robust national and international guidelines for inpatient Cb measurement. Copyright © 2014 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  10. Surgical outcome and patterns of recurrence for retroperitoneal sarcoma at a single centre

    PubMed Central

    Hogg, HDJ; Manas, DM; Lee, D; Dildey, P; Scott, J; Lunec, J; French, JJ

    2016-01-01

    Introduction Retroperitoneal sarcoma is a surgically managed condition that can recur locally following macroscopically complete resection. Owing to the low incidence of the condition, advances in treatment are reported infrequently but complete compartmental resection and adjuvant or neoadjuvant radiotherapy are areas under investigation. Given the practical difficulty of randomised trials, observational data can highlight advantages from progressive treatment approaches. Methods A retrospective database of consecutive retroperitoneal sarcoma resections performed at a single referral centre between March 1997 and March 2013 was interrogated. Histological, radiological and clinical data were collected. Univariate and multivariate analyses for disease free and overall survival were performed to establish independent predictors of disease recurrence and patient survival. Results A total of 79 patients underwent 90 resections (63 primary). The mean five-year overall and disease free survival rates were 55.3% and 24.8% respectively. Higher patient age, high tumour grade, presence of extraretroperitoneal disease and invasive tumour phenotype were found to significantly predict survival following multivariate analysis. Half (50%) of the tumours displayed invasive behaviour on histopathology and 42% of locoregional recurrence was intraperitoneal. Conclusions Retroperitoneal sarcoma is commonly an infiltrative tumour and often recurs outside of the retroperitoneum. These features limit the therapeutic impact of interventions that focus on gaining local control such as complete compartmental resection and radiotherapy. It seems likely that future advances in the management of this cancer will involve new systemic agents to treat this frequently systemic disease. PMID:26876538

  11. Renal diseases in adults with cystic fibrosis: a 40 year single centre experience.

    PubMed

    Wilcock, M J; Ruddick, A; Gyi, K M; Hodson, M E

    2015-10-01

    There is a sizable literature describing renal disease in patients with cystic fibrosis. Previous studies have focused on single disease processes alone, most commonly renal stone disease or acute kidney injury. In this study we report for the first time on the prevalence of all forms of renal disease in a cystic fibrosis population. A retrospective review of adult patients with cystic fibrosis attending the Adult Cystic Fibrosis Department at the Royal Brompton Hospital was carried out by searching the department's database to identify patients with renal problems and subsequently retrieving clinical information from medical notes. The prevalence of all renal diseases in our population was 5.1 %. The most commonly identified problem was renal stones. At 2.0 % the prevalence of renal stones in adult patients with cystic fibrosis was comparable to the general population. A range of other renal diseases were identified, the next most common being drug-induced acute kidney injury. A range of cystic fibrosis independent and attributable diseases has been identified but no cystic fibrosis specific disease. In contrast to other cystic fibrosis centres no increased prevalence of renal stones was found.

  12. Pneumocystis jiroveci pneumonia in rheumatic disease: a 20-year single-centre experience.

    PubMed

    Mecoli, Christopher A; Saylor, Deanna; Gelber, Allan C; Christopher-Stine, Lisa

    2017-01-01

    Pneumocystis jiroveci pneumonia (PJP) is an opportunistic infection with high mortality among patients with underlying rheumatologic conditions. Given the paucity of prospective data to guide treatment, clinical guidelines to initiate PJP prophylaxis are based on expert opinion and identify patients on ≥20 mg daily prednisone for ≥4 weeks duration for treatment. Herein we describe the PJP experience in rheumatic disease over a 20-year period at a single academic medical centre to investigate this 20 mg threshold and risk associated with lymphocyte counts, co-existing lung disease and immunosuppressive medications. We conducted a retrospective review of all admitted patients who received a PJP or PCP ICD-9 code (136.3) from January 1996 through October 2015. Twenty-one cases of confirmed PJP (by immunofluorescence or polymerase chain reaction) were reviewed, averaging to one case/year. The most common underlying rheumatologic conditions were inflammatory myopathy, lupus, and granulomatosis with polyangiitis. None of these 21 patients was receiving PJP prophylaxis upon admission. Eighteen (86%) were receiving ≥20 mg prednisone daily at the time of PJP diagnosis. Of the 3 treated with <20 mg prednisone, all received concomitant immunosuppressive medications, 2 with cyclophosphamide. Overall, there was a 43% (9/21) mortality rate. Immunosuppressant medication use, interstitial lung disease, or lymphocyte count did not impact mortality risk. PJP portends high mortality yet is a largely preventable complication of rheumatic disease treatment. Consideration to initiate prophylaxis should be made for patients exceeding the daily 20 mg prednisone threshold, and those receiving cyclophosphamide.

  13. Fitz-Hugh-Curtis Syndrome: single centre experiences.

    PubMed

    Hong, D G; Choi, M H; Chong, G O; Yi, J H; Seong, W J; Lee, Y S; Park, I S; Cho, Y L

    2010-04-01

    This study was conducted to report 10 cases of Fitz-Hugh-Curtis Syndrome (FHCS) diagnosed with CT and 101 cases of FHCS-like lesion that suggested perihepatitis during laparoscopic surgery. We reviewed retrospectively the images of 3,674 laparoscopies for obstetrical and gynaecological diseases and analysed 10 cases of FHCS diagnosed by clinical patterns and CT. All the 10 cases showed liver capsular enhancement on CT. Among the 3,674 laparoscopies, we found 101 cases (2.7%) with FHCS like lesion. Among them, 23 cases were during laparoscopic procedure for endometriosis, 16 for gynaecological malignant tumours, 16 for benign adnexal diseases excluding endometriosis, 13 for uterine leiomyoma, 7 for pelvic inflammatory disease, 2 had peritoneal tuberculosis and 21 for other gynaecological diseases. Further consideration should be given for the causes of FHCS other than N. gonorrhoeae and C. trachomatis. Because FHCS may represent various clinical phases, other considerations and clinical classifications are necessary for treatment.

  14. Continuous intracranial pressure monitoring in pseudotumour cerebri: Single centre experience.

    PubMed

    Toma, Ahmed K; Tarnaris, Andrew; Kitchen, Neil D; Watkins, Laurence D

    2010-10-01

    Investigating pseudotumour cerebri (PTC) patients who do not fulfil the diagnostic criteria, or those presenting post-shunt insertion with recurrent symptoms and signs, with no clear evidence of shunt malfunction, present a diagnostic challenge. PTC patients who underwent continuous intracranial pressure (ICP) monitoring in our unit were reviewed retrospectively. Twenty-six ICP monitoring procedures were done on 20 patients. Eleven patients had normal pressure, 2 overdrainage/low pressure, 11 underdrainage/high pressure and 2 variable pressures. On the basis of these results 12 patients were managed conservatively: 11 patients were referred to headache team and 1 patient had readjustment of an adjustable valve shunt setting; of those 3 patients had improved symptoms on their first post-operative clinic review. On the other hand, 14 patients had surgery: 5 had shunt revision and 9 had shunt insertion; of those 5 patients improved. ICP monitoring using an intraparenchymal probe is a safe and effective diagnostic technique in investigating PTC when indicated. A multidisciplinary approach achieves best results in terms of successful management and follow-up.

  15. Campylobacter bacteraemia: 16 years of experience in a single centre.

    PubMed

    Hussein, Khetam; Raz-Pasteur, Ayelet; Shachor-Meyouhas, Yael; Geffen, Yuval; Oren, Ilana; Paul, Mical; Kassis, Imad

    2016-01-01

    Campylobacter bacteraemia (CB) is rare and usually occurs in immune-compromised patients. In this study we examined the incidence and epidemiology of CB in one institution over 15.5 years. The medical records of all the consecutive patients with CB admitted to our hospital from 2000 to 2015 were retrospectively reviewed. Clinical characteristics, microbiologic and outcome data were collected. During the study period, 65 patients with CB were identified. The majority of the patients were middle aged and immune-compromised. Campylobacter jejuni was the most commonly identified species (33/47, 70%). The main underlying conditions were haematological malignancies (43%) and chronic liver disease (14%). Fifty-seven percent of the patients were receiving immunosuppressive therapy at the time of bacteraemia. The most common presenting symptoms were fever (85%), diarrhoea (40%), abdominal pain (40%), and nausea and vomiting (40%). Of the isolates tested, 97% were susceptible to macrolides, and only 35% were susceptible to quinolones. Susceptibility to quinolones decreased over the years. Most patients did not receive adequate empiric antibiotic treatment (81.5%) and about 20% never received directed therapy. Mortality and relapse rates were low (5% each). There was no association between adequate empirical or definitive antibiotic therapy and adverse outcomes. The main predisposing factor for Campylobacter bacteraemia in our cohort was immunosuppression. Prognosis was generally favourable regardless of appropriateness of antibiotic therapy.

  16. Common variable immunodeficiency: 20-yr experience at a single centre.

    PubMed

    Llobet, M Pilar; Soler-Palacin, Pere; Detkova, Drahomira; Hernández, Manuel; Caragol, Isabel; Espanol, Teresa

    2009-03-01

    Common variable immunodeficiency (CVID) is the most common symptomatic primary immunodeficiency. It can present at any age in patients with a history of recurrent bacterial infections, with or without a family history of other primary immunodeficiencies (PID), and shows a wide range of clinical manifestations and immunological data. Diagnosis is based on low IgG, IgM and/or IgA levels. Delayed diagnosis and therapy can lead to bronchiectasis and malabsorption. The aim of this study was to describe a paediatric population diagnosed of CVID and its evolution in the population. Memory B-cell (MB) classification carried out in these patients was correlated with clinical manifestations and outcome. Clinical and immunological data of 22 CVID children under 18 yr treated at our centre between 1985 and 2005 are presented. Immunological studies included those for diagnosis and MB quantification. Differences in form of presentation, familial incidence and MB classification were reviewed. A statistical descriptive analysis was made. Infections were the commonest manifestation, affecting mainly respiratory (19/22) and gastrointestinal (10/22) tracts. Bronchiectasis was present in seven cases, and detected prior to CVID diagnosis in five. Replacement therapy led to a significant reduction in the number of infections. Severe complications appeared mostly in patients without MB. Patients of the same family share the same MB group. Family members had also been diagnosed of CVID in seven cases. Early diagnosis and therapy are essential to improve outcome in these patients. MB studies are useful in children to orient prognosis and further genetic studies.

  17. Kidney transplant in Nigeria: a single centre experience

    PubMed Central

    Okafor, Umezurike Hughes

    2016-01-01

    Introduction Kidney transplant is the preferred renal replacement therapy for patients with end stage kidney disease. However management of patients with kidney transplant in resource poor countries is evolving and groaning under several mental, financial and infrastructural challenges. The objective of the study is to evaluate the management of patients with kidney transplant in a kidney care Centre in Nigeria. Methods This was a non-randomized prospective study. The study population were post-transplant patients presenting between 1st August 2010 and 31st December 2014.The biodata, pre and post-transplant details of these patients were documented. The data was analysed using SPSS Vs 17. Results A total of 47 patients were studied with M: F ratio of 4:1, the mean age was 45.4 ± 13.6 years. Chronic glomerulonephritis, hypertension, diabetes mellitus and HIV related kidney disease were the commonest cause of CKD. Financial constraint delayed transplant in 66% and non-availability of donor in 17.2%. About 90% of the transplants were in India and 81% either financed the transplant either directly or through a relation. There was no cadaveric transplant and about 70% of the donors were not related. Tacrolimus, mycophenolate and prednisolone were most frequently used immunosuppressive combination. The one and three years graft survival were 95.3% and 67.6% respectively while corresponding patients survival were 97.7% and 82.4% respectively. Septicaemia, acute rejection and urinary tract infection were most common complications. Conclusion Management of patients with kidney transplant has good prospect despite the challenges. PMID:28292075

  18. Anal intraepithelial neoplasia: a single centre 19 year review.

    PubMed

    Cotter, M B; Kelly, M E; O'Connell, P R; Hyland, J; Winter, D C; Sheahan, K; Gibbons, D

    2014-10-01

    There is debate about whether the traditional three-tiered grading of anal intraepithelial neoplasia (AIN) should be replaced by a more reproducible two-tiered system. In this study, we review our experience with AIN to determine the most suitable classification system. We performed a retrospective review of all histological reports over a 19 year period. All specimens were graded on haemataloxin and eosin appearance and those with dysplasia had immunohistochemistry for p16 and Ki67 performed. Cases included 25 condyloma acuminata, 11 dysplastic cases and 24 invasive squamous cell carcinomas. On review, 18 were classified as condyloma acuminata without dysplasia. Seven had AIN I, five had AIN II and six had AIN III when using a three-tiered system. All cases classified as dysplastic (n = 18) showed an increased proliferation index as measured by Ki67. p16 positivity was seen in all AIN III, two AIN II and none of the AIN I cases. Recurrence was not observed in any of the AIN I cases. Five of eleven AIN II and AIN III cases recurred or persisted at a similar, higher or lower grade. Both of the AIN II cases which recurred or persisted were p16 positive. None of the AIN II cases that were p16 negative recurred. Three of the p16-positive AIN III cases did not recur. None of the 18 AIN cases progressed to carcinoma. The findings support the slow progression of AIN as described in the literature. In our small series, a two-tiered system with further subclassification of the traditional AIN II group using p16 appears to be clinically useful. Colorectal Disease © 2014 The Association of Coloproctology of Great Britain and Ireland.

  19. Injuries and allegations of oral rape: A retrospective review of patients presenting to a London sexual assault referral centre.

    PubMed

    Brew-Graves, Emmeline; Morgan, Louise

    2015-08-01

    A retrospective review was carried out of patients seen at the Haven sexual assault referral centre in South East London between January 2009 and September 2010 to determine the frequency and nature of oral injuries found in people reporting oral rape. Ninety five eligible patients were identified and relevant information was extracted from standardised Haven forms completed during forensic medical examination. The main outcome measures were prevalence, type and location of oral injury. Eighteen (19%) were found to have sustained an oral injury. The most common injury was abrasions, followed by bruising and petechiae. The lips were the most common site of injury followed by the soft palate and the inside of the cheeks. It was concluded that injuries in the mouth were not common after an allegation of oral rape. Injuries were minor and did not require treatment. Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  20. Antibiogram of multidrug resistant Acinetobacter baumannii isolated from clinical specimens at King Hussein Medical Centre, Jordan: a retrospective analysis.

    PubMed

    Batarseh, A; Al-Sarhan, A; Maayteh, M; Al-Khatirei, S; Alarmouti, M

    2016-02-01

    This study was conducted to determine the prevalence and the local antibiogram of multidrug-resistant Acinetobacter baumannii isolates in Al-Hussein Hospital at King Hussein Medical Centre in Amman, Jordan. In a retrospective study from January to December 2013, data on 116 non-repetitive positive clinical samples were retrieved from patients' laboratory records. The resistance rates of A. baumannii isolates were high for ceftriaxone, cefotaxime and ticarcillin (100%), ceftazidime, cefepime and piperacillin (98.3%), imipenem (97.4%), piperacillin/tazobactam (96.6%), quinolones (94.8%), ampicillin/sulbactam (89.7%), gentamicin, (87.9%), tobramycin and tetracycline (76.7%) and trimethoprim/sulfamethoxazole (75.9%), but lower for minocycline (26.7%) and colistin (1.7%). A. baumannii in our hospital were highly resistant to all antibiotics, including tigecycline, except for minocycline and colistin which are considered the last resort treatment for multidrug-resistant A. baumannii.

  1. Epidemiological trends of leprosy in an urban leprosy centre of Delhi: a retrospective study of 16 years.

    PubMed

    Tiwary, P K; Kar, H K; Sharma, P K; Gautam, R K; Arora, T C; Naik, H; Dhir, V

    2011-01-01

    This study was done by collecting the retrospective data from 1994 to 2009 of patients attending the urban leprosy centre attached to the department of dermatology, STD & leprosy of PGIMER & Dr. R M L Hospital, New Delhi. The data was analysed according to age, sex, type of leprosy, leprosy reactions, deformities and relapse and compared with the national figures by comparison of proportions after taking the national data per 10,000 population. A total of 3659 patients attended our ULC (Urban Leprosy Centre) among which 2741 were male and 945 females (M:F-3:1). 669 patients (18.2%) were children. The data analysed show a gradual decline in new case detection rate with a marginal rise in 2005 and 2008. Percentage of MB cases was falling consistently till 2005 after which it showed an abrupt rise. The incidence of type 1 reaction varied from 21% in 1994 to 10% in 2009 in PB patients and from 6% in 1994 to 8% in 2009 in MB patients. The trend of type 2 reactions in MB patients showed a slow declining trend. MDT completion rate showed an impressive improvement from 56% in 1994 to 90% in 2009. The number of patients revisiting the ULC with features of relapse also showed a decrease in number. The pattern of visible deformities showed an almost constant trend similar to national figures. Improved MDT completion rate helps in reducing the disease transmission, severity, reactions and disabilities.

  2. Cumulative success rates following mild IVF in unselected infertile patients: a 3-year, single-centre cohort study.

    PubMed

    Bodri, Daniel; Kawachiya, Satoshi; De Brucker, Michaël; Tournaye, Herman; Kondo, Masae; Kato, Ryutaro; Matsumoto, Tsunekazu

    2014-05-01

    A 3-year, retrospective, single-centre cohort study was conducted in a private infertility centre to determine cumulative live birth rates (LBR) per scheduled oocyte retrieval following minimal ovarian stimulation/natural-cycle IVF in unselected infertile patients. A total of 727 consecutive infertile patients were analysed who underwent 2876 (median 4) cycles with scheduled oocyte retrieval from November 2008 to December 2011. Natural-cycle IVF or clomiphene-based minimal ovarian stimulation was coupled with single-embryo transfer and increased use of delayed vitrified-warmed blastocyst transfer. Main outcome measures were crude and expected age-specific cumulative LBR per scheduled oocyte retrieval. Crude cumulative LBR were 65%, 60%, 39%, 15% and 5% in patients aged 26-34, 35-37, 38-40, 41-42 and 43-44 years, respectively. No live births occurred in patients aged ⩾ 45 years. Dropout rates per cycle were 13-25%. Success rates gradually reached a plateau, with few additional live births after six cycles. Most of the expected success rate was reached within 6 months with almost maximal rates within 15 months of the first oocyte retrieval. Acceptable cumulative LBR are reached with an exclusive minimal ovarian stimulation/single-embryo transfer policy especially in patients aged <38 years but also in intermediate aged patients (38-40 years).

  3. The management of malignant polyps in colorectal cancer screening programmes: A retrospective Italian multi-centre study.

    PubMed

    Fasoli, Renato; Nienstedt, Richard; De Carli, Nicola; Monica, Fabio; Guido, Ennio; Valiante, Flavio; Armelao, Franco; de Pretis, Giovanni

    2015-08-01

    Although recognition of colorectal malignant polyps is increasing, treatment plans lack the evidence of randomised trials. To retrospectively evaluate presentation, management and outcomes of screen-detected colorectal malignant polyps, with special focus on the role of histological factors in therapeutic decision-making. We retrospectively analysed data regarding malignant polyps detected during faecal immuno-chemical test-based screening programmes in five centres in North-Eastern Italy between April 2008 and April 2013. 306 malignant polyps in 306 patients were included; 72 patients underwent surgery directly (23.6%). Of 234 patients treated endoscopically, 133 subsequently underwent radicalisation surgery (56.8%) and in 17 there was evidence of residual disease (12.8%). Involved, unsafe (<1mm) or invaluable resection margins and sessile morphology represented the most frequent determinants of subsequent surgery. The mean number of nodes harvested during radicalisation surgery was 7.1±6.4 (range 0-29). Histological diagnosis was re-evaluated according to new guidelines in 125 cases (41%); in 18 this led to modification of the risk class (14.4%). Although the rate of surgical treatment following endoscopic resection is similar to other studies, residual disease at surgery was lower than most international series. Adhering to the new histological reporting system and respecting guidelines on node harvesting may favourably influence prognosis. Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  4. Ten years of specialized adult care for phenylketonuria - a single-centre experience.

    PubMed

    Mütze, Ulrike; Thiele, Alena Gerlinde; Baerwald, Christoph; Ceglarek, Uta; Kiess, Wieland; Beblo, Skadi

    2016-03-24

    Specialized adult care of phenylketonuria (PKU) patients is of increasing importance. Adult outpatient clinics for inherited errors of metabolism can help to achieve this task, but experience is limited. Ten years after establishment of a coordinated transition process and specialised adult care for inherited metabolic diseases, adult PKU care was evaluated with respect to metabolic control, therapy satisfaction, life satisfaction, sociodemographic data, economical welfare as well as pregnancy outcome. All PKU patients transferred from paediatric to adult care between 2005 and 2015 were identified. A retrospective data analysis and a cross-sectional survey in a sub-cohort of 30 patients including a questionnaire for assessing quality of life (FLZm) were performed as a single-centre investigation at the metabolic department of the University Hospital Leipzig, Germany. For statistical analysis, Mann-Whitney-U-test, t-test for independent samples, ANOVA and chi square test were used as appropriate. 96 PKU patients (56 females/40 males; median age 32 years, range 18-62) were included. In the last 3-year period, 81% of the transferred patients still kept contact to the adult care centre. Metabolic control was stable over the evaluation period and dried blood phenylalanine concentrations mostly remained within the therapeutic range (median 673.0 μmol/l, range 213.0-1381.1). Sociodemographic data, economical welfare and life satisfaction data were comparable to data from the general population. However, differences could be revealed when splitting the cohort according to time of diagnosis and to management during childhood. 83% of the PKU adults were satisfied with the transition process and current adult care. 25 completed pregnancies were supervised; three newborns, born after unplanned pregnancy, showed characteristic symptoms of maternal PKU syndrome. Continuous care for adult PKU patients in a specialized outpatient clinic is successful, leading to good to

  5. Dengue fever in Czech travellers: A 10-year retrospective study in a tertiary care centre.

    PubMed

    Trojánek, Milan; Maixner, Jan; Sojková, Naděžda; Kynčl, Jan; Roháčová, Hana; Marešová, Vilma; Stejskal, František

    2016-01-01

    Dengue fever is a frequent cause of morbidity in travellers. The objective was to describe the epidemiological and clinical characteristics of dengue fever in Czech travellers. This descriptive study includes patients with acute dengue fever diagnosed at Hospital Na Bulovce during 2004-2013. Data were collected and analysed retrospectively. A total of 132 patients (83 males and 49 females) of median age 33 years (IQR 29-40) were included. Diagnosis was established by NS1 antigen detection in 87/107 cases (81.3%) and/or RT-PCR in 50/72 (69.4%) and by serology in 25 cases (18.9%). Dengue was acquired in South-East Asia in 69 cases (52.3%), followed by South Asia (48 cases; 36.3%), Latin America (14; 10.6%) and Sub-Saharan Africa (1; 0.8%). The most frequent symptoms included fever, rash and headache. Initial leukocyte and lymphocyte counts were lower in patients who presented in the early phase (0-4 days), however, platelet count was lower and AST, ALT and LDH activity higher in patients with a longer symptoms duration (≥5 days). The clinical course was mostly uncomplicated. Dengue fever is becoming a frequent cause of fever in Czech travellers. Clinicians should be familiar with the typical clinical findings and novel diagnostic methods. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Surgical treatment of chronic pancreatitis using Frey's procedure: a Brazilian 16-year single-centre experience.

    PubMed

    Gestic, Martinho Antonio; Callejas-Neto, Francisco; Chaim, Elinton Adami; Utrini, Murillo Pimentel; Cazzo, Everton; Pareja, Jose Carlos

    2011-04-01

    Surgical treatment of chronic pancreatitis is indicated for intractable pain. Frey's procedure is an accepted treatment for this disease. The aim of the present study was to describe a single-centre experience in the treatment of chronic pancreatitis using Frey's procedure. A retrospective analysis of 73 patients who underwent a Frey's procedure between 1991 to 2007 and had at least 1 year of follow-up. Demographics, indication for surgery, peri-operative complications and late outcomes were analysed. The median age was 39.9 years. Seventy out of the 73 (95.8%) patients were male. The median pre-operative body mass index (BMI) was 19.1 kg/m(2). All patients had abdominal pain, 34 (46.6%) of them daily and 13 (17.8%) weekly, with moderate or severe intensity in 98.6% (n= 72). The aetiology was secondary to alcohol in 70 patients (95.9%), with a median consumption of 278 g per day. The surgical morbidity rate was 28.7%; there were no deaths. Median post-operative follow-up was 77.0 months; 64 patients (91.4%) had complete pain relief and post-operative BMI was 22.4 kg/m(2) (P<0.001). All patients with pre-operative endocrine and exocrine insufficiencies showed no reversal of the situation. New onset insufficiencies appeared late. Frey's procedure was a safe and effective therapeutic option for the surgical treatment of patients with intractable pain caused by chronic pancreatitis. © 2011 International Hepato-Pancreato-Biliary Association.

  7. 3066 consecutive Gamma Nails. 12 years experience at a single centre

    PubMed Central

    2010-01-01

    Background Fixation of trochanteric hip fractures using the Gamma Nail has been performed since 1988 and is today well established and wide-spread. However, a number of reports have raised serious concerns about the implant's complication rate. The main focus has been the increased risk of a subsequent femoral shaft fracture and some authors have argued against its use despite other obvious advantages, when this implant is employed. Through access to a uniquely large patient data base available, which is available for analysis of trochanteric fractures; we have been able to evaluate the performance of the Gamma Nail over a twelve year period. Methods 3066 consecutive patients were treated for trochanteric fractures using Gamma Nails between 1990 and 2002 at the Centre de Traumatologie et de l'Orthopedie (CTO), Strasbourg, France. These patients were retrospectively analysed. Information on epidemiological data, intra- and postoperative complications and patients' outcome was retrieved from patient notes. All available radiographs were assessed by a single reviewer (AJB). Results The results showed a low complication rate with the use of the Gamma Nail. There were 137 (4.5%) intraoperative fracture-related complications. Moreover 189 (6.2%) complications were detected postoperatively and during follow-up. Cut-out of the lag screw from the femoral head was the most frequent mechanical complication (57 patients, 1.85%), whereas a postoperative femoral shaft fracture occurred in 19 patients (0.6%). Other complications, such as infection, delayed healing/non-union, avascular femoral head necrosis and distal locking problems occurred in 113 patients (3.7%). Conclusions The use of the Gamma Nail in trochanteric hip fractures is a safe method with a low complication rate. In particular, a low rate of femoral shaft fractures was reported. The low complication rate reported in this series can probably be explained by strict adherence to a proper surgical technique. PMID

  8. Respiratory and general outcome in neonates with renal oligohydramnios--a single-centre experience.

    PubMed

    Mehler, Katrin; Beck, Bodo B; Kaul, Ingrid; Rahimi, Gohar; Hoppe, Bernd; Kribs, Angela

    2011-11-01

    Renal oligohydramnion (ROH) is predominantly caused by congenital abnormalities of the kidney and urogenital tract (CAKUT). Although the number of neonates born with chronic renal failure is small, they provide many challenges, and among the most problematic are respiratory management and long-term treatment of chronic renal failure. We studied the value of prenatal and perinatal variables to predict survival and the general long-term outcome of our ROH population. Method. A single-centre retrospective chart review was conducted in 36 neonates with ROH treated between 1996 and 2007. Respiratory data sets including minimum inspiratory oxygen concentration (FiO(2), 1d), best oxygenation index (BOI, 1d) and minimum arterial partial carbon dioxide (pCO(2), 1d) at the first day of life were available in 23 children requiring intubation. ROH causes were obstructive uropathy (n = 19), polycystic kidney disease [autosomal recessive polycystic kidney disease (ARPKD) n = 5 and autosomal dominant polycystic kidney disease n = 1], renal agenesis/dysplasia (n = 10) and bilateral renal vein thrombosis (n = 1). Survival until discharge was 64% (23/36), and overall survival was 58% (21/36). Seven patients died within 48 h from respiratory failure. Non-survivors had a higher minimum FiO(2) and pCO(2) (1d) compared to survivors (P < 0.001). Mean BOI (1d) was 6.2 in survivors versus 43.9 in the non-surviving group (P < 0.001). Logistic regression showed that BOI (28 gestational weeks) retained significance in predicting survival until discharge. The attitude toward initiating dialysis in neonates is changing and long-term outcome in the absence of severe comorbidity is promising. Prenatal prediction concerning respiratory and renal outcome in fetuses with ROH is difficult. Our data suggest that BOI (1d) and onset of ROH may be reliable predictors of respiratory prognosis in children born with ROH.

  9. Outcomes of combined phacoemulsification and deep sclerectomy: a 10-year UK single-centre study

    PubMed Central

    Mercieca, K; Shevade, B; Anand, N

    2015-01-01

    Purpose To report the outcomes of combined phacoemulsification and -deep sclerectomy (phaco-DS) from a single UK centre over a 10-year period. Methods Retrospective analysis of phaco-DS data extracted from an ongoing glaucoma surgery database within Calderdale and Huddersfield NHS Trust. Two hundred and ninety-six eyes of 282 patients were included. Data included patient demographics, pre- and postoperative intraocular pressure (IOP), use of mitomycin C (MMC), spacer device implantation, and follow-up details including surgical success rates. IOP success criteria were: (A) IOP <19 mm Hg and/or 20% decrease from baseline and (B) IOP <16 mm Hg and/or 30% drop from baseline. Results Mean follow-up was 63.5±35.3 months. MMC was applied in 145 eyes (49%). Kaplan–Meier success rates in all eyes for criteria A were 89.1% and 80% with glaucoma medications (qualified success) and 81.2% and 68.3% without medications (unqualified success) at 2 and 5 years, respectively. Qualified success for criteria B was 72.4 and 61.4% and unqualified rates were 67.2 and 55.2% for the same time periods. Repeated-measures ANOVA showed significantly lower IOP in the phaco-DS with MMC group up to 3 years postoperatively (P=0.002). Cox's proportional hazards for criteria B, however, showed no significant effect of MMC application in the long term (P=0.2). Increasing age and laser goniopuncture were positively associated with success, whereas the absence of spacer devices was negatively associated. At last follow-up, 20% of eyes were on glaucoma medications. Complication rates were low with hypotony rates of 0.68%. Conclusions This study confirms the long-term safety and efficacy of phaco-DS as a primary glaucoma procedure. PMID:26337945

  10. Surgical treatment of chronic pancreatitis using Frey's procedure: a Brazilian 16-year single-centre experience

    PubMed Central

    Gestic, Martinho Antonio; Callejas-Neto, Francisco; Chaim, Elinton Adami; Utrini, Murillo Pimentel; Cazzo, Everton; Pareja, Jose Carlos

    2011-01-01

    Background Surgical treatment of chronic pancreatitis is indicated for intractable pain. Frey's procedure is an accepted treatment for this disease. The aim of the present study was to describe a single-centre experience in the treatment of chronic pancreatitis using Frey's procedure. Methods A retrospective analysis of 73 patients who underwent a Frey's procedure between 1991 to 2007 and had at least 1 year of follow-up. Demographics, indication for surgery, peri-operative complications and late outcomes were analysed. Results The median age was 39.9 years. Seventy out of the 73 (95.8%) patients were male. The median pre-operative body mass index (BMI) was 19.1 kg/m2. All patients had abdominal pain, 34 (46.6%) of them daily and 13 (17.8%) weekly, with moderate or severe intensity in 98.6% (n = 72). The aetiology was secondary to alcohol in 70 patients (95.9%), with a median consumption of 278 g per day. The surgical morbidity rate was 28.7%; there were no deaths. Median post-operative follow-up was 77.0 months; 64 patients (91.4%) had complete pain relief and post-operative BMI was 22.4 kg/m2 (P < 0.001). All patients with pre-operative endocrine and exocrine insufficiencies showed no reversal of the situation. New onset insufficiencies appeared late. Conclusions Frey's procedure was a safe and effective therapeutic option for the surgical treatment of patients with intractable pain caused by chronic pancreatitis. PMID:21418132

  11. Erythromelalgia: Incidence and clinical experience in a single centre in Sweden.

    PubMed

    Alhadad, Alaa; Wollmer, Per; Svensson, Ake; Eriksson, Karl-Fredrik

    2012-01-01

    Erythromelalgia (EM) incidence has not been well studied and there are only two studies published on this subject as far as we know. The aims are to study the incidence of this rare condition in the south of Sweden, to report the clinical experience from a single centre including characterisation of comorbidity and to report on prognosis. Retrospective study of a population-based analysis of data from the southernmost part of Sweden corresponding to the median age of the patients (Statistics Sweden). The diagnosis of EM is based on the medical record reflecting the triad of redness, burning pain and increased temperature of the feet or hands or both. We evaluated the presence or absence of EM triad by recording the history, physical examination, laboratory analysis, cold provocation test and laser Doppler imaging, and by searching for any confounding disease in cases of suspected EM. During a 10.5 year period we clinically identified 27 patients with EM. Median age was 49 [IQR (34 - 68)] years, 19 (70 %) were women. The mean delay from the onset of the symptoms to the time of diagnosis was 4.5 (SD ± 3.9) years. Gender and age adjusted incidence of EM for our region was calculated to be 0.36 per 100 000 persons per year. Three patients developed intraabdominal cancer during the follow up, but there was no mortality directed related to EM. The overall population-based incidence of erythromelalgia was 0.36 per 100 000 which is identical with a previous report in a Scandinavian population.

  12. Postpartum obstetric red cell transfusion practice: A retrospective study in a tertiary obstetric centre.

    PubMed

    Stephens, Benjamin; Sethna, Farah; Crispin, Philip

    2017-08-04

    Traditional management of anaemia due to postpartum haemorrhage (PPH) has relied upon salvage therapy with red cell transfusion. Recently published guidance recommends a change in approach toward holistic patient blood management. To determine whether postpartum red cell transfusion practices are consistent with best practice and to identify opportunities for improvement. A retrospective audit of postpartum red cell transfusions was conducted at a tertiary level obstetrics unit. Relevant clinical and laboratory data were collected for all cases of postpartum red cell transfusions and PPH. Clinical decision making and appropriateness of transfusions were evaluated. Among the 3235 women who delivered in 2013, 110 (3.4%) received a postpartum red cell transfusion. About 101 of the transfusions were associated with primary PPH. Overall PPH complicated 460 (14.2%) deliveries. Antenatal anaemia was identified as a major correctable risk factor for transfusion in women who experienced PPH (odds ratio 6.55, 95% CI: 3.17-13.6). Volume of blood loss and the aetiology of PPH were additional risk factors for transfusion. Transfusion was associated with lower birth weight and increased maternal length of stay. Transfusion triggers were more likely to be appropriate when transfusion took place in the operating theatre, within 12 h of delivery and when prescribed by anaesthetists. Post-transfusion Hb levels were uniformly above target for all women transfused. A significant number of red cell transfusions were outside the recommendations of the new guidelines. Maximising red cell mass during pregnancy and improving transfusion practices were identified as opportunities for future improvement. © 2017 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  13. STEMI Outcomes in Guangzhou and Hong Kong: Two-Centre Retrospective Interregional Study.

    PubMed

    Chen, Xiaohui; Li, Min; Jiang, Huilin; Li, Yunmei; Mo, Junrong; Lin, Peiyi; Graham, Colin A; Rainer, Timothy H

    2016-01-01

    Healthcare systems are organized very differently in Hong Kong (HK) and Guangzhou (GZ). This study compared managements of the emergency departments (ED) and one-year mortalities of ST-segment elevation myocardial infarction (STEMI) patients in two teaching hospitals in Guangzhou and Hong Kong. Retrospective observational study of STEMI mortalities and treatments in the Prince of Wales Hospital (PWH) and the Second Affiliated Hospital of Guangzhou Medical University (AHGZMU), was conducted between January and December 2010. The primary outcome was one-year all cause mortality. Univariate analysis of 76 cases from PWH and 111 cases from AHGZMU showed similar clinical characteristics, except for lower proportions of males (74% vs 92%, P = 0.002), hyperlipidemia (5% vs 25%, P<0.001), and Killip class I (56% vs 91%; P<0.001) in AHGZMU. The onset-to-door time of STEMI patients in AHGZMU was longer than in PWH (median 205 min [(IQR: 95-432) vs 120 min (IQR: 55-225), P = 0.001]. In AHGZMU, 85 (77%) patients received primary percutaneous coronary intervention (PPCI) as the main reperfusion treatment, whereas 18 (24%) received PPCI and 51 (67%) patients received thrombolytic therapy in PWH. Overall the one-year mortality in AHGZMU was 20%, whilst in PWH it was 14% (P = 0.436). The standardized one-year all-cause mortality ratios for AHGZMU and PWH were comparable (18.7 vs. 18.2%, P = 0894). Independent predictors of one-year mortality included older age (>67 years) and hyperglycemia (>10 mmol/L). Aged over 65 years, presence of anterior wall infarct, body weight ≤65 kg, SBP <100 mmHg at ED and glucose level >10 mmol/L were the independent predictors of in-hospital MACE. There was no statistically significant difference between the standardized one-year all-cause mortalities of STEMI patients in the setting mainly using thrombolysis with shorter door-to-treatment time and the setting mainly using PCI with longer door-to-treatment time. Aged over 67 years and glucose level

  14. The impact of single and shared rooms on family-centred care in children's hospitals.

    PubMed

    Curtis, Penny; Northcott, Andy

    2017-06-01

    To explore whether and how spatial aspects of children's hospital wards (single and shared rooms) impact upon family-centred care. Family-centred care has been widely adopted in paediatric hospitals internationally. Recent hospital building programmes in many countries have prioritised the provision of single rooms over shared rooms. Limited attention has, however, been paid to the potential impact of spatial aspects of paediatric wards on family-centred care. Qualitative, ethnographic. Phase 1; observation within four wards of a specialist children's hospital. Phase 2; interviews with 17 children aged 5-16 years and 60 parents/carers. Sixty nursing and support staff also took part in interviews and focus group discussions. All data were subjected to thematic analysis. Two themes emerged from the data analysis: 'role expectations' and 'family-nurse interactions'. The latter theme comprised three subthemes: 'family support needs', 'monitoring children's well-being' and 'survey-assess-interact within spatial contexts'. Spatial configurations within hospital wards significantly impacted upon the relationships and interactions between children, parents and nurses, which played out differently in single and shared rooms. Increasing the provision of single rooms within wards is therefore likely to directly affect how family-centred care manifests in practice. Nurses need to be sensitive to the impact of spatial characteristics, and particularly of single and shared rooms, on families' experiences of children's hospital wards. Nurses' contribution to and experience of family-centred care can be expected to change significantly when spatial characteristics of wards change and, as is currently the vogue, hospitals maximise the provision of single rather than shared rooms. © 2016 John Wiley & Sons Ltd.

  15. Hypofractionated stereotactic radiotherapy of limited brain metastases: a single-centre individualized treatment approach

    PubMed Central

    2012-01-01

    Background We retrospectively report treatment results of our single-centre experience with hypofractionated stereotactic radiotherapy (hfSRT) of limited brain metastases in primary and recurrence disease situations. Our aim was to find the most effective and safe dose concept. Methods From 04/2006 to 12/2010, 75 patients, with 108 intracranial metastases, were treated with hfSRT. 52 newly diagnosed metastases (48%), without up-front whole brain radiotherapy (WBRT), received hfSRT as a primary treatment. 56 metastases (52%) received a prior WBRT and were treated in this study in a recurrence situation. Main fractionation concepts used for primary hfSRT were 6-7x5 Gy (61.5%) and 5x6 Gy (19.2%), for recurrent hfSRT 7-10x4 Gy (33.9%) and 5-6x5 Gy (33.9%). Results Median overall survival (OS) of all patients summed up to 9.1 months, actuarial 6-and 12-month-OS was 59% and 35%, respectively. Median local brain control (LC) was 11.9 months, median distant brain control (DC) 3.9 months and intracranial control (IC) 3.4 months, respectively. Variables with significant influence on OS were Gross Tumour Volume (GTV) (p = 0.019), the biological eqivalent dose (calculated on a 2 Gy single dose, EQD2, α/β = 10) < and ≥ median of 39 Gy (p = 0.012), extracerebral activity of the primary tumour (p < 0.001) and the steroid uptake during hfSRT (p = 0.03). LC was significantly influenced by the EQD2, ≤ and > 35 Gy (p = 0.004) in both uni- and multivariate Cox regression analysis. Median LC was 14.9 months for EQD2 >35 Gy and 3.4 months for doses ≤35 Gy, respectively. Early treatment related side effects were usually mild. Nevertheless, patients with a EQD2 >35 Gy had higher rates of toxicity (31%) than ≤35 Gy (8.3%, p=0.026). Conclusion Comparing different dose concepts in hfSRT, a cumulative EQD2 of ≥35 Gy seems to be the most effective concept in patients with primary or recurrent limited brain metastases. Despite higher rates of only mild toxicity, this concept

  16. Intralesional meglumine antimoniate for the treatment of localised cutaneous leishmaniasis: a retrospective review of a Brazilian referral centre.

    PubMed

    Silva, Rosiana Estéfane da; Toledo, Antonio; Senna, Maria Camilo; Rabello, Ana; Cota, Gláucia

    2016-08-01

    Although intralesional meglumine antimoniate (MA) infiltration is considered an option for cutaneous leishmaniasis (CL) therapy and is widely used in the Old World, there have been few studies supporting this therapeutic approach in the Americas. This study aims to describe outcomes and adverse events associated with intralesional therapy for CL. This retrospective study reviewed the experience of a Brazilian leishmaniasis reference centre using intralesional MA to treat 31 patients over five years (2008 and 2013). The median age was 63 years (22-86) and the median duration time of the lesions up to treatment was 16 weeks. In 22 patients (71%), intralesional therapy was indicated due to the presence of contraindications or previous serious adverse events with systemic MA. Other indications were failure of systemic therapy or ease of administration. Intralesional treatment consisted of one-six infiltrations (median three) for a period of up to 12 weeks. The initial (three months) and definitive (six months) cure rates were 70.9% and 67.7%, respectively. Most patients reported mild discomfort during infiltration and no serious adverse events were observed. In conclusion, these results show that the intralesional MA efficacy rate was very similar to that of systemic MA treatment, and reinforce the need for further studies with adequate design to establish the efficacy and safety of this therapeutic approach.

  17. Intralesional meglumine antimoniate for the treatment of localised cutaneous leishmaniasis: a retrospective review of a Brazilian referral centre

    PubMed Central

    da Silva, Rosiana Estéfane; Toledo, Antonio; Senna, Maria Camilo; Rabello, Ana; Cota, Gláucia

    2016-01-01

    Although intralesional meglumine antimoniate (MA) infiltration is considered an option for cutaneous leishmaniasis (CL) therapy and is widely used in the Old World, there have been few studies supporting this therapeutic approach in the Americas. This study aims to describe outcomes and adverse events associated with intralesional therapy for CL. This retrospective study reviewed the experience of a Brazilian leishmaniasis reference centre using intralesional MA to treat 31 patients over five years (2008 and 2013). The median age was 63 years (22-86) and the median duration time of the lesions up to treatment was 16 weeks. In 22 patients (71%), intralesional therapy was indicated due to the presence of contraindications or previous serious adverse events with systemic MA. Other indications were failure of systemic therapy or ease of administration. Intralesional treatment consisted of one-six infiltrations (median three) for a period of up to 12 weeks. The initial (three months) and definitive (six months) cure rates were 70.9% and 67.7%, respectively. Most patients reported mild discomfort during infiltration and no serious adverse events were observed. In conclusion, these results show that the intralesional MA efficacy rate was very similar to that of systemic MA treatment, and reinforce the need for further studies with adequate design to establish the efficacy and safety of this therapeutic approach. PMID:27508321

  18. Multi-centre retrospective study of long-term outcomes following traumatic elbow luxation in 37 dogs.

    PubMed

    Sajik, D; Meeson, R L; Kulendra, N; Jordan, C; James, D; Calvo, I; Farrell, M; Kulendra, E

    2016-08-01

    Limited guidelines exist regarding the optimal treatment of traumatic canine elbow luxation, and there is a lack of information on long-term functional outcome. Here we report reduction and stabilisation techniques for a series of traumatic elbow luxations and describe clinical outcome plus long-term questionnaire-based follow-up. Retrospective review of canine traumatic elbow luxations (2006 to 2013) treated at five referral centres. Data recorded included signalment, luxation aetiology, time to reduction, reduction technique, surgical procedure, post-reduction care and complications. Questionnaire follow-up was attempted for all cases with owners completing the Canine Brief Pain Inventory. Thirty-seven dogs were included. The most frequent cause of luxation was road traffic accident (n=22). Twenty cases were treated surgically. Seven dogs suffered major postoperative complications: reluxation (n=6), infection requiring implant removal (n=1). Four of the six reluxations occurred in dogs that had other orthopaedic injuries. Twenty-two owners completed the Canine Brief Pain Inventory questionnaire: there were 13 excellent, 6 very good, 1 good and 2 fair outcomes. Outcome was not associated with the reduction technique. Initial closed reduction, followed by surgical stabilisation if unsuccessful, results in good-to-excellent outcomes in the majority of traumatic canine elbow luxations. Reluxation was the most common major complication and there was a higher incidence of reluxation in patients with multiple orthopaedic injuries. © 2016 British Small Animal Veterinary Association.

  19. [Human Single Drug Exposures to Non-opioid Analgesics Reported to the Poisons Information Centre Erfurt from 2003 to 2012].

    PubMed

    Hentschel, H; Prasa, D; Bergmann, I; Enden, G; Plenert, B; Frimlova, G; Just, S; Liebetrau, G; Stürzebecher, A; Deters, M

    2016-01-01

    Because of their frequency, non-opioid analgesics (NOA) single drug exposures registered by Poisons Information Centre (PIC) Erfurt have been studied over a decade. A retrospective analysis of frequencies, circumstances of exposure, symptom severity, and age groups in NOA single drug exposures received by the PIC Erfurt from the beginning of 2003 to the end of 2012 was undertaken. Of all 4749 NOA single drug exposures, the 10 most frequent were caused by paracetamol (n=1 686), ibuprofen (n=1 439), acetylsalicylic acid (n=456), dipyrone (n=274), diclofenac (n=267), flupirtine (n=138), naproxen (n=41), etoricoxib (n=36), indomethacin (n=24), and dexketoprofen (n=19). Paracetamol single drug exposures increased from 158 in 2003 to 216 in 2007 and fell afterwards to 133 in 2012. Ibuprofen single drug exposures continously rose from 57 in 2003 to 258 in 2012. Adults were more often involved in NOA (53.8%) and all single drug exposures (54.1%) than children (45.9% and 45.6%, respectively). Suicidal attempts were more frequent in NOA (43.1%) than in all single drug exposures (34.2%), whereas accidental exposures or exposures in abuse were less often (33.4 and 0.2%, 46.0 and 0.9% respectively). NOA single drug exposures resulted mostly in none to minor symptoms (77.0%) and rarely in moderate (2.1%) or severe symptoms (1.0%). One adult was found dead after probable ingestion of 32 g of acetylsalicylic acid in suicidal intention. Because many NOA are over-the-counter drugs, it is difficult to obtain data on their use. PIC data could provide information on the NOA use in the population. © Georg Thieme Verlag KG Stuttgart · New York.

  20. Trends in tertiary breast reconstruction: literature review and single centre experience.

    PubMed

    Mohan, Anita T; Al-Ajam, Yazan; Mosahebi, Afshin

    2013-04-01

    Autologous flap reconstruction can improve aesthetic results after failed implant reconstruction and be considered following previous failed autologous flap reconstruction. This study presents a review of the indications, motivation and outcomes of tertiary breast reconstruction. A comprehensive literature review was conducted using Pubmed, Embase, Web of Science and Google Scholar. Articles were identified using key search terms and through citations. A single centre, retrospective, review of all patients who underwent autologous flap reconstruction following previous breast reconstruction between 2004 and 2010. Details on patient demographics, surgical outcomes and patient satisfaction were collected. Out of 580 autologous flap breast reconstructions, 31 patients had 36 tertiary breast reconstructions with an autologous free or pedicled flap. Indications for surgery included: capsule contracture with discomfort (n = 24), asymmetry (n = 8), extrusion of implant (n = 4), exposed implant (n = 1). and previous failed autologous flap reconstruction (n = 7). The mean age our cohort was 50.1 years, BMI of 26.1, 52.3% had radiotherapy (n = 19) and 51.6% had chemotherapy. We performed free DIEP(n = 22), LD with or without an implant (n = 11) and free TRAM flap (n = 3). 5 were bilateral procedures. Flap complications included total flap loss (n = 2), partial skin necrosis (n = 1) and fat necrosis (n = 1). Mean follow up time was 20 months. Overall satisfaction, excluding the two flap failures was good. Only small case series were published on tertiary breast reconstruction. More recent literature had larger patient samples. A total of 7 studies were identified, with a total of 532 flaps, following unsatisfactory or failed implant reconstruction. The Deep Inferior Epigastric Artery Perforator (DIEP) flap was the most favourable first choice for autologous tertiary reconstruction. Breast cancer was the commonest indication for primary surgery

  1. Management of Cushing syndrome in children and adolescents: experience of a single tertiary centre.

    PubMed

    Güemes, Maria; Murray, Philip G; Brain, Caroline E; Spoudeas, Helen A; Peters, Catherine J; Hindmarsh, Peter C; Dattani, Mehul T

    2016-07-01

    The diagnosis and management of paediatric Cushing syndrome (CS) is highly challenging. This study aims to characterise its presentation, diagnosis, management and outcome by a retrospective case review of 30 patients (14 females) followed at a single tertiary paediatric endocrinology centre over a 30-year period. At presentation, median age was 8.9 years (0.2-15.5) and the commonest manifestations were weight gain (23/30), hirsutism (17/30), acne (15/30) and hypertension (15/30). Growth retardation was present in 11/30. Median body mass index (BMI) was +2.1 standard deviation score (SDS) (-6.5 to +4.6). Urinary free cortisol (UFC) was abnormal in 17/18 (94 %), midnight cortisol in 27/27 (100 %) and low-dose dexamethasone suppression (LDDS) test in 20/20 (100 %). High-dose dexamethasone suppression (HDDS) test was abnormal in 6/6 (100 %) of adrenal tumours, 1/10 (10 %) of Cushing disease (CD) and 1/2 (50 %) of ectopic tumours. Bilateral inferior petrosal sinus sampling (IPSS) identified five CD cases and one ectopic tumour. All patients underwent surgery and subsequently required cortisol replacement. Final diagnoses were 16 CD, 11 adrenal disease, 2 ectopic ACTH-secreting lesions and 1 case of unidentified aetiology. One year post-diagnosis, median BMI was 0.5 SDS (-2.5 to +3.7), hypertension was present in 4/14 (28 %), and 43 % (12/30) of individuals were off hydrocortisone. The prevalence of the clinical manifestations differs from that reported in other series. Screening tests were highly sensitive, with UFC, midnight cortisol and LDDS performing well. One year post-treatment, BMI and BP normalised in the majority of patients and almost half of them were able to discontinue replacement hydrocortisone. •Cushing syndrome is an extremely rare entity in the paediatric and adolescent age groups, so not many cohort studies have been published in this population. •Several tests can be employed to firstly diagnose hypercortisolaemia and secondly identify

  2. The impact of codeine re-scheduling on misuse: a retrospective review of calls to Australia's largest poisons centre.

    PubMed

    Cairns, Rose; Brown, Jared A; Buckley, Nicholas A

    2016-10-01

    Codeine is the most commonly used opioid in the world, and is available over the counter (OTC) in many countries, including Australia. Several countries are reconsidering codeine's OTC status due to concerns over addiction and misuse, with serious morbidity and mortality being reported. Australia's Therapeutic Goods Administration restricted codeine containing analgesics to 'Pharmacist Only' in 2010, and has recently been considering further up-scheduling to make codeine 'Prescription Only'. This paper estimated Australian trends of codeine misuse over the past 12 years, and examined whether trends changed following previous rescheduling efforts in 2010. A retrospective review of calls regarding codeine misuse made to the New South Wales Poisons Information Centre (NSWPIC, Australia's largest poisons centre), 2004-15. Joinpoint software was used to quantify the average annual change in calls, and whether there was a significant change in trend at any time, including following rescheduling. Australia. Four hundred patients about whom a call was made to the NSWPIC. Calls per year, patient age, gender, tablets taken per day, formulation used, symptom disposition. The NSWPIC database contained 400 cases of codeine combination analgesic misuse from 2004 to 2015. Joinpoint analysis showed that the frequency of cases increased significantly from 2004 to 2015, with an average annual percentage change (AAPC) of 19.5% [95% confidence interval (CI) = 13.8-25.5% P < 0.0001] for paracetamol/codeine and 17.9% (95% CI = 7.9-28.9%, P < 0.01) for ibuprofen/codeine. No significant change in trend was seen at any time, including following 2010 rescheduling. The median age of patients was 34 and 27 years for paracetamol/codeine and ibuprofen/codeine cases, respectively. Gender distribution was approximately equal. Clinical features reported were consistent with codeine, paracetamol and ibuprofen toxicity. Misuse of codeine combination products appears to be

  3. Penile brachytherapy-Retrospective review of a single institution.

    PubMed

    Pimenta, Ana; Gutierrez, Cristina; Mosquera, David; Pera, Juan; Martínez, Evelyn; Londres, Bradley; Pino, Francisco; Moreno, Sergio; Garcia, Marc; Guedea, Ferran

    2015-01-01

    To analyze the results of exclusive brachytherapy (BT) to treat patients with penile squamous cell carcinoma confined to the glans or prepuce. Retrospective analysis of 25 patients treated for T1-T2 penile cancer with exclusive interstitial BT between July 1989 and March 2014 at our institution. Median followup was 9.2 years (range, 0-19). The mean patient age was 65.3 years (range, 51-80). Most patients underwent exclusive low-dose-rate BT (56%; n = 14) or pulsed-dose-rate BT (40%; n = 10). Only 1 patient received high-dose-rate BT (4%). The median prescribed dose was 60 Gy. Eight patients died during follow-up because of systemic progression (one case) and other intercurrent causes (seven cases). Two failures were recorded (one local and one regional), both at 4 months after BT. The remaining patients continued follow-up at our institution and maintained response. Two patients underwent partial phallectomy for toxicity. At the time of this report, 12 of the 25 patients are alive and free of disease. The most common late toxicities were telangiectasia, urethral stenosis, and atrophy, in 48%, 43%, and 17.4% of patients, respectively. BT with low dose rate/pulsed dose rate provides excellent locoregional control for small (≤4 cm) T1-T2 squamous cell carcinoma of the penile glans. Copyright © 2015 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  4. A retrospective study of single frozen-thawed blastocyst transfer

    PubMed Central

    Ryu, Eun Kyung; Song, Seung Hyun; Yoon, San Hyun; Lim, Kyung Sil; Lee, Won Don; Lim, Jin Ho

    2016-01-01

    Objective To study the clinical outcomes of single frozen-thawed blastocyst transfer cycles according to the hatching status of frozen-thawed blastocysts. Methods Frozen-thawed blastocysts were divided into three groups according to their hatching status as follows: less-than-expanded blastocyst (≤EdB), hatching blastocyst (HgB), and hatched blastocyst (HdB). The female age and infertility factors of each group were evaluated. The quality of the single frozen-thawed blastocyst was also graded as grade A, tightly packed inner cell mass (ICM) and many cells organized in the trophectoderm epithelium (TE); grade B, several and loose ICM and TE; and grade C, very few ICM and a few cells in the TE. The clinical pregnancy and implantation rate were compared between each group. The data were analyzed by either t-test or chi-square analysis. Results There were no statistically significant differences in average female ages, infertility factors, or the distribution of blastocyst grades A, B, and C in each group. There was no significant difference in the clinical pregnancy and implantation rate of each group according to their blastocyst grade. However, there was a significant difference in the clinical pregnancy and implantation rate between each group. In the HdB group, the clinical pregnancy and implantation rate were similar regardless of the blastocyst quality. Conclusion There was an effect on the clinical outcomes depending on whether the blastocyst hatched during single frozen-thawed blastocyst transfer. When performing single frozen-thawed blastocyst transfer, the hatching status of the frozen-thawed blastocyst may be a more important parameter for clinical outcomes than the quality of the frozen-thawed blastocyst. PMID:27358829

  5. A retrospective study of single frozen-thawed blastocyst transfer.

    PubMed

    Hur, Yong Soo; Ryu, Eun Kyung; Song, Seung Hyun; Yoon, San Hyun; Lim, Kyung Sil; Lee, Won Don; Lim, Jin Ho

    2016-06-01

    To study the clinical outcomes of single frozen-thawed blastocyst transfer cycles according to the hatching status of frozen-thawed blastocysts. Frozen-thawed blastocysts were divided into three groups according to their hatching status as follows: less-than-expanded blastocyst (≤EdB), hatching blastocyst (HgB), and hatched blastocyst (HdB). The female age and infertility factors of each group were evaluated. The quality of the single frozen-thawed blastocyst was also graded as grade A, tightly packed inner cell mass (ICM) and many cells organized in the trophectoderm epithelium (TE); grade B, several and loose ICM and TE; and grade C, very few ICM and a few cells in the TE. The clinical pregnancy and implantation rate were compared between each group. The data were analyzed by either t-test or chi-square analysis. There were no statistically significant differences in average female ages, infertility factors, or the distribution of blastocyst grades A, B, and C in each group. There was no significant difference in the clinical pregnancy and implantation rate of each group according to their blastocyst grade. However, there was a significant difference in the clinical pregnancy and implantation rate between each group. In the HdB group, the clinical pregnancy and implantation rate were similar regardless of the blastocyst quality. There was an effect on the clinical outcomes depending on whether the blastocyst hatched during single frozen-thawed blastocyst transfer. When performing single frozen-thawed blastocyst transfer, the hatching status of the frozen-thawed blastocyst may be a more important parameter for clinical outcomes than the quality of the frozen-thawed blastocyst.

  6. Cleft lip and palate treatment of 530 children over a decade in a single centre.

    PubMed

    Vlastos, I M; Koudoumnakis, E; Houlakis, M; Nasika, M; Griva, M; Stylogianni, E

    2009-07-01

    We sought to evaluate the process of care and the outcomes of cleft lip and palate operations carried by a multidisciplinary team at a centre of craniofacial anomalies with a high patients' volume. A retrospective review of all cleft lips and/or palates cases treated in the centre from 1995 to 2007 was performed. Direct and long term complication rates, clinical, audiologic, speech intelligibility and dental arch assessments were analyzed. A total of 530 children have been operated this period in the centre (64 isolated cleft lip closures). A detailed presentation of the outcomes is performed in relation to the various types of cleft lip and palates. The majority of parents (70%) reported very good or excellent results 2-5 years after the lip closure with the Millard technique, although those with bilateral clefts were significantly less satisfied (P<0.002). Forty-two percent of children with cleft palate and otitis media with effusion were self-improved 2-8 months after palate reconstruction and 83.3% of children treated with the two flaps palatoplasty technique had a rather high or very high intelligibility score. Muscles' retropositioning had a significant effect on intelligibility (P=0.04). Children with cleft lips and palates have a variety of conditions and functional limitations even after the surgical correction of their problem that need to be evaluated and treated by several specialists. The treatment protocol utilized by the multidisciplinary team of our centre is efficient with a relative low percentage of complications and unfavorable results.

  7. Magnetic resonance imaging predicts survival and occult metastasis in oral cancer: a dual-centre, retrospective study.

    PubMed

    Boland, Paul W; Watt-Smith, Steve R; Hopper, Colin; Golding, Stephen J

    2013-12-01

    The purpose of this study was to investigate the effectiveness of tumour variables measured on magnetic resonance imaging (MRI) to predict 2-year disease-related survival and occult cervical lymph node metastasis in oral carcinoma. In this retrospective, dual-centre study the volume and thickness of tumours were measured using archived MRI staging scans of 199 patients who had curative primary resection for histologically confirmed oral carcinoma. Tumour volume predicted survival when grouped using the median (3.0 cm(3), HR 3.41, p 0.005) and first and third quartiles (0.5 cm(3), HR 8.22, p 0.04; 8.0 cm(3), HR 18.6, p 0.005). Tumour thickness predicted survival using a median of 11.0 mm (HR 2.65, p 0.02). Volume predicted occult cervical lymph node metastasis using a median of 3.0 cm(3) (HR 5.02, p<0.001) and quartiles of 0.5 cm(3) (HR 6.92, p=0.01) and 8.0 cm(3) (HR 11.3, p 0.005); thickness predicted it using a median of 11.0 mm (HR 4.39, p 0.002) and quartiles of 4.0 mm (HR 4.33, p 0.06) and 16 mm (HR 11.9, p 0.003). The thickness and volume of tumour measured on MRI may predict 2-year disease-related survival and occult cervical lymph node metastasis in oral cancer.

  8. A single-center retrospective study of pediatric hepatoblastoma

    PubMed Central

    Zhang, Yi; Zhang, Weiling; Tang, Suoqin; Chen, Liping; Yi, You; Zhang, Pinwei; Liu, Aiping; Zhi, Tian; Huang, Dongsheng

    2016-01-01

    Hepatoblastoma is a malignant liver tumor generally diagnosed in infants and children <3 years old. The current retrospective study aimed to investigate the associations of tumor stage, pathological type, metastasis and chemotherapy with clinical outcomes. In the current study, a total of 102 patients with hepatoblastoma were enrolled between September 2006 and June 2014. Clinical records and follow-up information for each of patient were obtained to conduct a Kaplan-Meier survival analysis and log-rank test. The median age of the subjects was 1.5 years, and 98 patients had stage III or IV hepatoblastoma. Complete or partial remittance occurred in 72 subjects, and 91 underwent surgical operation. The survival rate differed significantly among patients with different tumor stages (P=0.015, χ2=8.359). The mortality rate of stage IV subjects with intrahepatic metastasis was significantly higher than that of those without (P=0.004). Among the 45 subjects with relapsed hepatoblastoma, the mortality rate was higher in the subjects that abandoned chemotherapy than in patients who continued regular chemotherapy. In total, 27 of 45 subjects with relapsed hepatoblastoma succumbed to the disease; 20 of them abandoned chemotherapy treatment; and the remaining 7 patients underwent regular chemotherapy and succumbed to the disease by the end of follow-up. The present study indicates that the increased mortality rate was associated with postoperative residual-induced intrahepatic metastasis and relapsed hepatoblastoma; and that regular chemotherapy is necessary for patient to achieve complete or partial remission following surgical operation. PMID:27895749

  9. Prognosis of single molar implants: a retrospective study.

    PubMed

    Kim, Young-Kyun; Kim, Su-Gwan; Yun, Pil-Young; Hwang, Jung-Won; Son, Mee-Kyoung

    2010-08-01

    The purpose of this study was to evaluate the short- and mid-term prognosis of maxillary and mandibular single molar implants, prosthetic complications, and factors mediating the effects seen on them. Eighty-seven patients were enrolled consecutively in this study and 96 implants were placed into a single molar defect site by one oral and maxillofacial surgeon from March 2004 to December 2006. Primary osseointegration failure developed in two implants and delayed implant failure occurred at four implants. The fraction surviving interval was 97% to 100%, and at the last follow-up observation, the cumulative survival rate was 91.1%. All failed implants occurred in second molar sites, and the failure rate, according to implant site, showed a significant difference. Prosthetic complications, such as screw loosening, showed a significant correlation to the mesiodistal cantilever. Furthermore, crestal bone loss 3 years after loading was 0.2 mm on average and a very stable result was obtained. Based on the results, the risk of failure for maxillary and mandibular single molar implants is high and the possibility of developing prosthetic complications during loading is also high. Therefore, to minimize the cantilever, implants must be placed precisely and followed carefully and maintained for a long period of time.

  10. Outcomes following 'mini' percutaneous nephrolithotomy for renal calculi in children. A single-centre study.

    PubMed

    Brodie, K E; Lane, V A; Lee, T W J; Roberts, J P; Raghavan, A; Hughes, D; Godbole, P P

    2015-06-01

    This retrospective review was undertaken to identify the postoperative outcomes of children undergoing 'mini' percutaneous nephrolithotomy (MPCNL) at a single institution. Outcomes measured included: percentage of stone clearance, postoperative analgesia requirements, the need for intraoperative or postoperative blood transfusion, length of stay and morbidity. A total of 46 patients were reviewed over a two-and-a-half-year period; the mean age was 7.3 years (range: 1-16 years). The MPCNL was performed with a radiological-guided peripheral puncture, followed by dilatation of the nephrostomy tract to a maximum Amplatz sheath size of 16-French; an 11-French nephroscope was used. Stone disintegration was achieved either with pneumatic or laser lithotripsy. Complete stone clearance was achieved in 35/46 children (76%). The remaining 11 children had a stone clearance rate of over 80%. No patients required intraoperative/postoperative blood transfusion. A total of 39% of patients were managed on simple/non-opiate based analgesia, with 54% requiring opioid analgesia postoperatively for less than 24 h. There were no procedure-related complications and no mortalities. The mean length of stay was 2.24 days. The management of urolithiasis can be challenging in children. The use of percutaneous nephrolithotomy, is becoming increasingly popular in the treatment of paediatric urolithiasis. The stone clearance rate in children undergoing standard PCNL, has been reported to be 50-98% in the literature [1,2,3,4]. Samad et al. [2] in 2006, reported their experience in 188 consecutive PCNLs, using a 17Fr or 26Fr nephroscope. Their largest sub group included children aged >5-16 yrs. Within this group, 57% were treated with a 17Fr nephroscope and 43% with the 26Fr nephroscope, achieving stone clearance of only 47% with PCNL monotherapy. In this group the transfusion rate was 3% [2]. Badawy et al., reported their experience of 60 children in 1999, using a 26 or 28Fr Amplatz sheath. They

  11. Ultrafast all-optical coherent control of single silicon vacancy colour centres in diamond

    PubMed Central

    Becker, Jonas Nils; Görlitz, Johannes; Arend, Carsten; Markham, Matthew; Becher, Christoph

    2016-01-01

    Complete control of the state of a quantum bit (qubit) is a fundamental requirement for any quantum information processing (QIP) system. In this context, all-optical control techniques offer the advantage of a well-localized and potentially ultrafast manipulation of individual qubits in multi-qubit systems. Recently, the negatively charged silicon vacancy centre (SiV−) in diamond has emerged as a novel promising system for QIP due to its superior spectral properties and advantageous electronic structure, offering an optically accessible Λ-type level system with large orbital splittings. Here, we report on all-optical resonant as well as Raman-based coherent control of a single SiV− using ultrafast pulses as short as 1 ps, significantly faster than the centre's phonon-limited ground state coherence time of about 40 ns. These measurements prove the accessibility of a complete set of single-qubit operations relying solely on optical fields and pave the way for high-speed QIP applications using SiV− centres. PMID:27841265

  12. Frequency of haemoglobinopathies: a single-centre, cross-sectional study from Islamabad, Pakistan.

    PubMed

    Waheed, U; Satti, H S; Farooq, N; Zaheer, H A

    2012-12-01

    Thalassaemia is the most frequent hereditary disorder in Pakistan, with an estimated 8-10 million carriers. This single-centre study reported the frequency of haemoglobinopathies among 504 consecutive cases visiting Islamabad Diagnostic Centre for haemoglobin electrophoresis from July 2010 to February 2011. Haemoglobin electrophoresis was performed on cellulose acetate membrane, followed by staining and densitometric scanning of bands. A total of 143 (28.4%) subjects had haemoglobinopathies. The most predominant was thalassaemia trait (25.6%), followed by thalassaemia major (1.4%) and HbS or HbD (1.4%). The gene frequencies for thalassaemia trait and major were 0.256 and 0.0139 respectively. The study provides support for continuing efforts towards early detection and characterization of haemoglobinopathies to control the affected births in Pakistan.

  13. Systemic lupus erythematosus pregnancies: ten-year data from a single centre in Malaysia.

    PubMed

    Teh, C L; Wan, S A; Cheong, Y K; Ling, G R

    2016-08-13

    We performed a retrospective study of all systemic lupus erythematosus (SLE) pregnancies during a 10-year period (2006-2015) to describe the clinical features, maternal and foetal outcomes in our centre. There were 115 pregnancies in 86 women with SLE. Our patients had a mean age of 29.1 years (SD 5.80) and a mean disease duration of 44.63 months (SD 41.17). Fifteen patients had antiphospholipid syndrome (APS). Our patients had complicated pregnancies: 26.1% had SLE flares, 13.9% had pre-eclampsia and 45.1% needed caesarean sections. There were 23.3% foetal losses and 25% preterm deliveries in our patients. There was a higher rate of unplanned pregnancies and lupus flare among pregnancies with active SLE at conception. Pregnancies in lupus nephritis have higher incidence of lupus flares during pregnancy but similar maternal and foetal outcomes compared to those without nephritis. The prognostic indicators for adverse foetal outcome in our patients were flare of SLE (HR 4.08 [CI 95% 1.65-10.13, p < 0.01]) and APS (HR 3.07 [CI 95% 1.12-8.42, p < 0.05]) and the prognostic indicator for adverse maternal outcome was hypertension (HR 3.58 [CI 95% 1.30-9.90, p < 0.05]). Lupus pregnancies in our centre remained as high-risk pregnancies with significant maternal and foetal complications.

  14. Cost of illness of inflammatory bowel disease in the UK: a single centre retrospective study

    PubMed Central

    Bassi, A; Dodd, S; Williamson, P; Bodger, K

    2004-01-01

    Background and aims: The potentially high costs of care associated with inflammatory bowel disease (IBD) are recognised but we have little knowledge of the scale, profile, or determinants of these costs in the UK. This study aimed to describe costs of illness for a group of IBD patients and determine factors associated with increased healthcare costs. Setting: A university hospital serving a target population of approximately 330 000. Patients and methods: A six month cohort of IBD patients receiving any form of secondary care was identified, comprising 307 cases of ulcerative (or indeterminate) colitis and 172 cases of Crohn’s disease. Demographic and clinical data were abstracted from clinical records and individual resource use was itemised for all attributable costs (including extraintestinal manifestations). Item costs were derived from national and local sources. Cost data were expressed as mean six month costs per patient (with 95% confidence interval (CI)) obtained using non-parametric bootstrapping. Determinants of cost were analysed using generalised linear regression modelling. A postal survey of patients was undertaken to examine indirect costs, out of pocket expenses, and primary care visits. Results: Inpatient services (medical and/or surgical) were required by 67 patients (14%) but accounted for 49% of total secondary care costs. Drug costs accounted for less than a quarter of total costs. Individual patient costs ranged from £73 to £33 254 per six months. Mean (95% CI) six month costs per patient were £1256 (£988, £1721) for colitis and £1652 (£1221, £2239) for Crohn’s disease. Hospitalisation, disease severity grade, and disease extent correlated positively with cost of illness but costs were independent of age or sex. Compared with quiescent cases of IBD, disease relapse was associated with a 2–3-fold increase in costs for non-hospitalised cases and a 20-fold increase in costs for hospitalised cases. Survey data suggested average six month costs were <£30 per patient for primary care visits (both diseases) and median loss of earnings were £239 for colitis and £299 for Crohn’s disease. Conclusions: This study represents the first detailed characterisation of the scale and determinants of costs of illness for IBD in a British hospital. Hospitalisation affected a minority of sufferers but accounted for half of the total direct costs falling on the healthcare system. PMID:15361497

  15. Are patients with cancer with sepsis and bacteraemia at a higher risk of mortality? A retrospective chart review of patients presenting to a tertiary care centre in Lebanon

    PubMed Central

    Abou Dagher, Gilbert; El Khuri, Christopher; Chehadeh, Ahel Al-Hajj; Chami, Ali; Bachir, Rana; Zebian, Dina; Bou Chebl, Ralphe

    2017-01-01

    Objective Most sepsis studies have looked at the general population. The aim of this study is to report on the characteristics, treatment and hospital mortality of patients with cancer diagnosed with sepsis or septic shock. Setting A single-centre retrospective study at a tertiary care centre looking at patients with cancer who presented to our tertiary hospital with sepsis, septic shock or bacteraemia between 2010 and 2015. Participants 176 patients with cancer were compared with 176 cancer-free controls. Primary and secondary outcomes The primary outcome of this study was the in hospital mortality in both cohorts. Secondary outcomes included patient demographics, emergency department (ED) vital signs and parameters of resuscitation along with laboratory work. Results A total of 352 patients were analysed. The mean age at presentation for the cancer group was 65.39±15.04 years, whereas the mean age for the control group was 74.68±14.04 years (p<0.001). In the cancer cohort the respiratory system was the most common site of infection (37.5%) followed by the urinary system (26.7%), while in the cancer-free arm, the urinary system was the most common site of infection (40.9%). intravenous fluid replacement for the first 24 hours was higher in the cancer cohort. ED, intensive care unit and general practice unit length of stay were comparable in both the groups. 95 (54%) patients with cancer died compared with 75 (42.6%) in the cancer-free group. The 28-day hospital mortality in the cancer cohort was 87 (49.4%) vs 46 (26.1%) in the cancer-free cohort (p=0.009). Patients with cancer had a 2.320 (CI 95% 1.225 to 4.395, p=0.010) odds of dying compared with patients without cancer in the setting of sepsis. Conclusions This is the first study looking at an in-depth analysis of sepsis in the specific oncology population. Despite aggressive care, patients with cancer have higher hospital mortality than their cancer-free counterparts while adjusting for all other

  16. Mortality on the Waiting List for Lung Transplantation in Patients with Idiopathic Pulmonary Fibrosis: A Single-Centre Experience.

    PubMed

    Bennett, David; Fossi, Antonella; Bargagli, Elena; Refini, Rosa Metella; Pieroni, Maria; Luzzi, Luca; Ghiribelli, Claudia; Paladini, Piero; Voltolini, Luca; Rottoli, Paola

    2015-10-01

    Lung transplantation (LTX) is nowadays accepted as a treatment option for selected patients with end-stage pulmonary disease. Idiopathic pulmonary fibrosis (IPF) is characterized by the radiological and histologic appearance of usual interstitial pneumonia. It is associated with a poor prognosis, and LTX is considered an effective treatment to significantly modify the natural history of this disease. The aim of the present study was to analyse mortality during the waiting list in IPF patients at a single institution. A retrospective analysis on IPF patients (n = 90) referred to our Lung Transplant Program in the period 2001-2014 was performed focusing on patients' characteristics and associated risk factors. Diagnosis of IPF was associated with high mortality on the waiting list with respect to other diagnosis (p < 0.05). No differences in demographic, clinical, radiological data and time spent on the waiting list were observed between IPF patients who underwent to LTX or lost on the waiting list. Patients who died showed significant higher levels of pCO2 and needed higher flows of O2-therapy on effort (p < 0.05). Pulmonary function tests failed to predict mortality and no other medical conditions were associated with survival. Patients newly diagnosed with IPF, especially in small to medium lung transplant volume centres and in Countries where a long waiting list is expected, should be immediately referred to transplantation, delay results in increased mortality. Early identification of IPF patients with a rapid progressive phenotype is strongly needed.

  17. Clinical Characteristics of Cerebral Venous Sinus Thrombosis in Patients with Systemic Lupus Erythematosus: A Single-Centre Experience in China.

    PubMed

    Wang, Li; Chen, Hua; Zhang, Yao; Liu, Wanli; Zheng, Wenjie; Zhang, Xuan; Zhang, Fengchun

    2015-01-01

    Clinical characteristics of systemic lupus erythematosus (SLE) patients complicated with cerebral venous sinus thrombosis (CVST) between 2000 and 2013 were analyzed through this retrospective, single-centre study. Of 4747 hospitalized SLE patients, 17 (0.36%, 12 females, average age 30) had CVST. Headache (88.2%) was the most common neurological symptom followed by nausea or vomiting (47.1%), conscious disturbance (41.2%), edema of eyelids or conjunctiva (35.3%), blurred vision or diplopia (35.3%), and seizure (35.3%). Increased intracranial pressure (ICP) occurred in 13 cases (76.5%). Magnetic resonance venography (MRV) detected thrombosis in the transverse (82.4%), sigmoid (52.9%), and sagittal (35.3%) sinuses, with frequent (70.6%) multiple sinus occlusions. Compared to SLE patients without CVST, SLE patients with CVST had a higher prevalence of thrombocytopenia and positive antiphospholipid antibodies and a higher SLE disease activity index (SLEDAI) score. 13 patients achieved improvement following glucocorticoids and immunosuppressants treatment, as well as anticoagulants, while 3 patients died at the hospital. CVST is relatively rare in SLE and tends to occur in active lupus patients. Intracranial hypertension is common but nonspecific clinical feature, so MRV evaluation is necessary to establish a diagnosis. Aggressive treatment for the rapid control of SLE activity combined with anticoagulants can improve the prognosis.

  18. Single port laparoscopic repair of paediatric inguinal hernias: Our experience at a secondary care centre

    PubMed Central

    Kumar, Ameet; Ramakrishnan, T S

    2013-01-01

    BACKGROUND: Congenital inguinal hernias are a common paediatric surgical problem and herniotomy through a groin incision is the gold standard. Over the last 2 decades minimally invasive surgery (MIS) has challenged this conventional surgery. Over a period, MIS techniques have evolved to making it more minimally invasive – from 3 to 2 and now single port technique. All studies using single port technique are from tertiary care centres. We used a modification of the technique described by Ozgediz et al. and reviewed the clinical outcome of this novel procedure and put forth our experience at a secondary level hospital. MATERIALS AND METHODS: Prospective review of 37 hernias in 31 children (29 male and 2 female) (8 months - 13 years) performed laparoscopically by a single surgeon at a single centre between September 2007 and June 2010. Under laparoscopic guidance, the internal ring was encircled extraperitoneally using a 2-0 non-absorbable suture and knotted extraperitoneally. Data analyzed included operating time, ease of procedure, occult patent processus vaginalis (PPV), complications, and cosmesis. RESULTS: Sixteen right (52%), 14 left (45%) and 1 bilateral hernia (3%) were repaired. Five unilateral hernias (16.66%), all left, had a contralateral PPV that was repaired (P = 0.033). Mean operative time for a unilateral and bilateral repair were 13.20 (8–25) and 20.66 min (17 -27 min) respectively. Only one of the repairs (2.7%) recurred and another had a post operative hydrocoele (2.7%). One case (2.7%) needed an additional port placement due to inability to reduce the contents of hernia completely. There were no stitch abscess/granulomas, obvious spermatic cord injuries, testicular atrophy, or nerve injuries. CONCLUSION: Single port laparoscopic inguinal hernia repair can be safely done in the paediatric population. It permits extension of benefits of minimal access surgery to patients being managed at secondary level hospitals with limited resources. The

  19. A Retrospective Analysis of Apheresis Donor Deferral and Adverse Reactions at a Tertiary Care Centre in India

    PubMed Central

    Garg, Ketan; Kaushik, Ankit; Sharma, Richa; Rawat, DS; Mandal, AK

    2016-01-01

    Introduction With increasing demand of platelet component each day, blood bank plays a pivotal role in ensuring supply of safe blood as and when required. Plateletpheresis procedure is a relatively simple, safe and important adjunct to blood bank inventory. However, recruitment of healthy blood donors is a challenge that the health industry is facing today. Aim To determine the reasons and rates of apheresis donor deferral along with investigation of adverse reactions encountered during the procedure. Materials and Methods Records of single donor apheresis were retrospectively analysed from 1st January 2010 to 31st December 2014. The study was carried out at Blood Bank, Safdarjung Hospital, New Delhi, India. The donor details that were studied included – age, sex, type of donation (voluntary/replacement/ repeat), reason for donor deferral and type of adverse reaction, if encountered during the procedure. Results Among the 478 donors screened for plateletpheresis procedure during a study period of 5 years, 134 (28.03%) were deferred. Temporary deferrals accounted for majority (93.28%) of the deferrals. Low platelet count (50.75%) was the main reason of donor deferral followed by low haemoglobin (20.89%). Amongst the 344 selected donors, 15 (4.36%) had some type of adverse reaction associated with the procedure. Conclusion We suggest that the selection criteria for plateletpheresis donors should be revised to deal with shortage of apheresis donors. The criteria regarding minimum pre-procedure platelet count (above1.5 lac/μl) and haemoglobin (above 12.5 g/dl) need to be lowered so as to suit the Indian scenario. The lower adverse reaction rates, 14/344 (4.06%) associated with this procedure encourages safety of donors and is important in recruitment of new donors. PMID:28050376

  20. [Evaluation of corticosteroid administration in situations of suspected imminent preterm delivery: a retrospective cohort study in a tertiary centre].

    PubMed

    Pinto, Pedro Filipe Viana Ferreira; Ferraz, Tiago José Santos Matos; Ramalho, Carla Maria Almeida; Montenegro, Nuno Aires Mota de Mendonça

    2015-10-01

    The administration of a single-course antenatal corticosteroid treatment is recommended for pregnant women between 24 and 34 weeks with risk of premature birth. The maximum effect is achieved when antenatal corticosteroids are administered between 24h and 7 days before delivery. The objective of this study was to evaluate the occurrence of birth within seven days of corticosteroid therapy in major obstetric situations with risk of preterm birth. Retrospective cohort study including 209 pregnant women hospitalized in risk of preterm delivery, submitted to corticosteroid therapy for fetal lung maturation. The study was carried out between January 2012 and March 2014 at a university hospital. Main outcome measure was the number of women who delivered within 7 da ys after antenatal corticosteroid administration. Two groups were defined according to the reason for starting corticosteroids: threatened preterm labour (Group APPT) and other indications for corticosteroid therapy (Group RPPT). A Kaplan-Meier survival analysis was performed and a p value <0.05 was considered statistically significant. 46.4% (n=97) of pregnant women gave birth in the seven days following corticosteroid administration. Delivery within 7 days occurred more frequently on group 2 in comparison to group 1 (57.3 versus 42.4%; p=0.001). There is a statistically significant difference between the survival curve for groups 1 and 2, with a hazard ratio for delivery within 7 days 1.71 times higher for group 2 (95%CI 1.23-2.37; p<0.001). It can be concluded that the probability of an event (birth within 7 days after corticosteroids) is smaller in the group of pregnant women admitted in the context of threatened preterm labor than for other indications. The use of corticosteroids in pregnant women admitted for suspected preterm labor should be subject to rigorous clinical evaluation.

  1. Length of stay in asylum centres and mental health in asylum seekers: a retrospective study from Denmark

    PubMed Central

    Hallas, Peter; Hansen, Anne R; Stæhr, Mia A; Munk-Andersen, Ebbe; Jorgensen, Henrik L

    2007-01-01

    Background The length of stay in asylum centres is generally mentioned as a possible health risk to asylum seekers. Medical staff working with asylum seekers has claimed that long lengths of stay in asylum centres might cause or aggravate mental disorders. We used records from a large, multiethnic group of asylum seekers to study if the incidence of mental disorders increased with length of stay. Methods The study population was asylum seekers in Danish asylum centres run by the Danish Red Cross. General medical care was provided by Red Cross staff who could refer selected cases to medical specialists. If an asylum seeker needed more than three specialist consultations for mental illness or five consultations for physical illness the referrals had to be approved by The Danish Immigration Service. Between July 2001 – December 2002 the Red Cross prospectively registered health related data on all new applications (n = 4516) to the Immigration Service regarding referrals to medical specialists. We used these records to analyse the association between length of stay in the asylum centres and overall rate of referral for mental disorders. Data was analysed using weighted linear regression. Results We found that referrals for mental disorders increased with length of stay in asylum centres in a large, multiethnic population of asylum seekers. The association was found in all the categories of psychiatric illness studied and for a majority of the nationality groups studied. Conclusion Length of stay in asylum centres was associated with an increase in referrals for mental disorders in a large, multiethnic group of asylum seekers. The present study supports the view that prolonged length of stay in an asylum centre is a risk factor for mental health. The risk of psychiatric illness among asylum seekers should be addressed by political and humanitarian means, giving prevention of illness the highest priority. PMID:17931414

  2. Midterm results after arterial switch operation for transposition of the great arteries: a single centre experience

    PubMed Central

    2012-01-01

    Background The arterial switch operation (ASO) has become the surgical approach of choice for d-transposition of the great arteries (d-TGA). There is, however an increased incidence of midterm and longterm adverse sequelae in some survivors. In order to evaluate operative risk and midterm outcome in this population, we reviewed patients who underwent ASO for TGA at our centre. Methods In this retrospective study 52 consecutive patients with TGA who underwent ASO between 04/1991 and 12/1999 were included. To analyze the predictors for mortality and adverse events (coronary stenoses, distortion of the pulmonary arteries, dilatation of the neoaortic root, and aortic regurgitation), a multivariate analysis was performed. The follow-up time was ranged from 1–10 years (mean 5 years, cumulative 260 patient-years). Results All over mortality rate was 15.4% and was only observed in the early postoperative period till 1994. The predictors for poor operative survival were low APGAR-score, older age at surgery, and necessity of associated surgical procedures. Late re-operations were necessary in 6 patients (13.6%) and included a pulmonary artery patch enlargement due to supravalvular stenosis (n = 3), coronary revascularisation due to coronary stenosis in a coronary anatomy type E, aortic valve replacement due to neoaortic valve regurgitation (n = 2), and patch-plasty of a pulmonary vein due to obstruction (n = 1). The dilatation of neoaortic root was not observed in the follow up. Conclusions ASO remains the procedure of choice for TGA with acceptable early and late outcome in terms of overall survival and freedom of reoperation. Although ASO is often complex and may be associated with morbidity, most patients survived without major complications even in a small centre. PMID:22958234

  3. Transcatheter Retrieval of Cardiovascular Foreign Bodies in Children: A 15-Year Single Centre Experience.

    PubMed

    Kudumula, Vikram; Stumper, Oliver; Noonan, Patrick; Mehta, Chetan; De Giovanni, Joseph; Stickley, John; Dhillon, Rami; Bhole, Vinay

    2017-08-01

    There has been a rapid increase in the practice of interventional catheter treatment of congenital heart disease. Catheter retrieval of embolized cardiac devices and other foreign bodies is essential, yet no large studies have been reported in the paediatric population. Retrospective 15-year review of all children who underwent transcatheter foreign body retrieval in a tertiary cardiac centre from January 1997 to September 2012. Transcatheter retrieval of foreign bodies from the cardiovascular system was attempted in 78 patients [median age 4 (0.02-16) years and median weight 15 (1.7-74) kg] including 46 embolized devices. Transcatheter retrieval was successful in 70/78 (90%), surgical retrieval was required in 6. In two patients, small embolized coils were left in situ. Gooseneck snare was the most commonly used retrieval device. Median procedure and screening times were 90 (15-316) and 31 (2-161) min, respectively. There were no procedural deaths. Transient loss of foot pulses occurred in 5 and 2 patients required blood transfusion. Transcatheter retrieval of cardiovascular foreign bodies can be performed safely in the majority of children thus obviating the need for surgery. It is essential to have a comprehensive inventory of retrieval equipment and interventional staff conversant with its use.

  4. Therapeutic requirements in active ulcerative proctitis: A single-centre study.

    PubMed

    Calafat, Margalida; Lobatón, Triana; Mañosa, Míriam; Marín, Laura; Caballero, Noemí; Larraín, Macarena; Cabré, Eduard; Domènech, Eugeni

    2017-06-27

    Ulcerative proctitis (UP) presents distinctive clinical characteristics, outcomes and therapeutic approaches as compared to left-sided and extensive ulcerative colitis (UC). To describe the current therapeutic requirements and clinical outcomes in patients with active UP. Retrospective observational study conducted in a referral IBD centre. Patients with UP in follow-up between 1989 and 2014 were included. The clinical characteristics, as well as the different treatments and drug formulations administered to treat flares, were recorded. Out of 687 UC patients, 101 patients (15%) with UP were included. Median follow-up was 8 years (IQR 3-14) and 49% of patients presented disease activity during the study period. Topical mesalazine monotherapy (90%) was the most commonly administered treatment for disease activity (mostly as suppositories), followed by topical steroids (47%) and oral mesalazine (56%) in monotherapy or combination therapy. Only 14% and 16% of patients required oral prednisone and beclomethasone, respectively. In clinical practice, active UP presents mostly favourable outcomes. Mesalazine suppositories are by far the most used treatment for these patients. Copyright © 2017 Elsevier España, S.L.U., AEEH y AEG. All rights reserved.

  5. A ten year review of civilian iliac vessel injuries from a single trauma centre.

    PubMed

    Oliver, J C; Bekker, W; Edu, S; Nicol, A J; Navsaria, P H

    2012-08-01

    To report the surgical management and outcome of iliac vessel (IV) injuries in a civilian trauma centre with a high incidence of penetrating trauma. A retrospective record review of patients with IV injuries treated between January 2000 and December 2009. Sixty nine patients, 59 with gunshot wounds, sustained 108 iliac vessel injuries. Mean revised trauma and injury severity scores was 7.06 and 28.4, respectively. Twenty nine patients required damage control laparotomy. Common or external iliac arteries were repaired by primary repair (10), temporary shunt with delayed graft (6), interposition graft (5) or ligation if limb non-viable (3). Forty-seven patients had injuries to the common or external iliac vein, 42 were ligated. Mortality was 25% and 6 survivors required amputation. In a stable patient a primary arterial repair is preferred but a temporary shunt can be a life and limb saving option in the unstable patient. Ligating the common or external iliac veins is associated with a low incidence of prolonged leg swelling. Copyright © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  6. Robot-assisted ureterocalycostomy: A single centre contemporary experience in adults.

    PubMed

    Chhabra, Jaspreet S; Balaji Sudharsan, S; Singh, Abhishek; Mishra, Shashikant; Ganpule, Arvind; Sabnis, Ravindra; Desai, Mahesh R

    2016-03-01

    To present our technique and experience of robot-assisted ureterocalycostomy (RAUC) in managing secondary pelvi-ureteric junction obstruction (PUJO) in adults. We retrospectively reviewed all patients from our centre who underwent RAUC, between 2011 and 2015, for secondary PUJO resulting from previous surgical intervention. Six procedures in five patients, including a bilateral RAUC were performed. The median (range) patient age was 33.7 (18-41) years. The outcome variables included operative time, duration of hospital stay, and objective evidence of unimpeded drainage on urography. The mean (range) operating time was 172 (144-260) min and estimated blood loss was 100 (50-250) mL. There were no conversions to open or laparoscopic surgery, and no intraoperative complications. Two patients had Clavien-Dindo Grade I complications that were managed conservatively and one patient had a Grade IIIb complication, which required balloon dilatation and re-stenting. After a median (range) follow-up of 11 (7-48) months, five of the six renal units had successful outcomes. The robot-assisted approach appears to be ideally suited for redo cases demanding fine dissection with meticulous suturing. In our present series of adult patients, we could safely and successfully perform RAUC with minimal morbidity. However, a larger multi-institutional outcome analysis is required to substantiate the role of the robot-assisted approach in performing UC.

  7. Robot-assisted ureterocalycostomy: A single centre contemporary experience in adults

    PubMed Central

    Chhabra, Jaspreet S.; Balaji Sudharsan, S.; Singh, Abhishek; Mishra, Shashikant; Ganpule, Arvind; Sabnis, Ravindra; Desai, Mahesh R.

    2016-01-01

    Objective To present our technique and experience of robot-assisted ureterocalycostomy (RAUC) in managing secondary pelvi-ureteric junction obstruction (PUJO) in adults. Patients and methods We retrospectively reviewed all patients from our centre who underwent RAUC, between 2011 and 2015, for secondary PUJO resulting from previous surgical intervention. Six procedures in five patients, including a bilateral RAUC were performed. The median (range) patient age was 33.7 (18–41) years. The outcome variables included operative time, duration of hospital stay, and objective evidence of unimpeded drainage on urography. Results The mean (range) operating time was 172 (144–260) min and estimated blood loss was 100 (50–250) mL. There were no conversions to open or laparoscopic surgery, and no intraoperative complications. Two patients had Clavien–Dindo Grade I complications that were managed conservatively and one patient had a Grade IIIb complication, which required balloon dilatation and re-stenting. After a median (range) follow-up of 11 (7–48) months, five of the six renal units had successful outcomes. Conclusion The robot-assisted approach appears to be ideally suited for redo cases demanding fine dissection with meticulous suturing. In our present series of adult patients, we could safely and successfully perform RAUC with minimal morbidity. However, a larger multi-institutional outcome analysis is required to substantiate the role of the robot-assisted approach in performing UC. PMID:26966590

  8. A modified Chevrel technique for ventral hernia repair: long-term results of a single centre cohort.

    PubMed

    Mommers, E H H; Leenders, B J M; Leclercq, W K G; de Vries Reilingh, T S; Charbon, J A

    2017-08-01

    To evaluate the short- and long-term results after a modified Chevrel technique for midline incisional hernia repair, regarding surgical technique, hospital stay, wound complications, recurrence rate, and postoperative quality of life. These results will be compared to the literature derived reference values regarding the original and modified Chevrel techniques. In this large retrospective, single surgeon, single centre cohort all modified Chevrel hernia repairs between 2000 and 2012 were identified. Results were obtained by reviewing patients' medical charts. Postoperative quality of life was measured using the Carolina Comfort Scale. A multi-database literature search was conducted to compare the results of our series to the literature based reference values. One hundred and fifty-five patients (84 male, 71 female) were included. Eighty patients (52%) had a large incisional hernia (width ≥ 10 cm) according the definition of the European Hernia Society. Fourteen patients (9%) underwent a concomitant procedure. Median length-of-stay was 5 days. Within 30 days postoperative 36 patients (23.2%) had 39 postoperative complications of which 30 were mild (CDC I-II), and nine severe (CDC III-IV). Thirty-one surgical site occurrences were observed in thirty patients (19.4%) of which the majority were seroma (16 patients 10.3%). There was no hernia-related mortality during follow-up. Recurrence rate was 1.8% after a median follow-up of 52 months (12-128 months). Postoperative quality of life was rated excellent. The modified Chevrel technique for midline ventral hernias results in a moderate complication rate, low recurrence rate and high rated postoperative quality of life.

  9. Persons with Haemophilia in Sweden- Experiences and Strategies in Everyday Life. A Single Centre Study.

    PubMed

    Brodin, Elisabeth; Sunnerhagen, Katharina S; Baghaei, Fariba; Törnbom, Marie

    2015-01-01

    Haemophilia is caused by deficiency in coagulation factor VIII or IX. Treatment with the missing coagulation factors has been available in most developed countries for several decades. The aim was to explore the experiences of adults living with severe or moderate haemophilia and their coping strategies at a single centre in Sweden. The interview study had a qualitative empirical approach and was analyzed on the basis of the method empirical phenomenological psychology. The sample included 14 participants, mean age 42 (19-80 y), who met the inclusion criteria and to saturation of information. General characteristics were; All were satisfied with and grateful for access to medication. An acceptance of the disorder and willingness to live a normal life was identified among all participants. They were all content with the care provided by Haemophilia Treatment Centre (HTC) and felt supported by its multidisciplinary team. Four typologies were identified; Protective adults and assertive children during up-bringing, finding a role in social context, symptoms and treatments, fear of limited resources in the future. Task-, emotional- and avoidance coping strategies were seen in the interviews. The most prominent coping strategy was task oriented. This interview study with Swedish PWH shows that they strive for normality and adaptation in social activities throughout life finding their own niche. The PWH expressed the importance of knowledge and support from the comprehensive medical team at HTC and therefore it seems important to continue comprehensive medical care at HTC in order to follow-up the haemophilia persons regularly.

  10. Effects of closure of an urban level I trauma centre on adjacent hospitals and local injury mortality: a retrospective, observational study.

    PubMed

    Crandall, Marie; Sharp, Douglas; Wei, Xiong; Nathens, Avery; Hsia, Renee Y

    2016-05-10

    To determine the association of the Martin Luther King Jr Hospital (MLK) closure on the distribution of admissions on adjacent trauma centres, and injury mortality rates in these centres and within the county. Observational, retrospective study. Non-public patient-level data from the state of California were obtained for all trauma patients from 1999 to 2009. Geospatial analysis was used to visualise the redistribution of trauma patients to other hospitals after MLK closed. Variance of observed to expected injury mortality using multivariate logistic regression was estimated for the study period. A total of 37 131 trauma patients were admitted to the five major south Los Angeles trauma centres from the MLK service area between 1999 and 2009. (1) Number and type of trauma admissions to trauma centres in closest proximity to MLK; (2) inhospital injury mortality of trauma patients after the trauma centre closure. During and after the MLK closure, trauma admissions increased at three of the four nearby hospitals, particularly admissions for gunshot wounds (GSWs). This redistribution of patient load was accompanied by a dramatic change in the payer mix for surrounding hospitals; one hospital's share of uninsured more than tripled from 12.9% in 1999 to 44.6% by 2009. Overall trauma mortality did not significantly change, but GSW mortality steadily and significantly increased after the closure from 5.0% in 2007 to 7.5% in 2009. Though local hospitals experienced a dramatic increase in trauma patient volume, overall mortality for trauma patients did not significantly change after MLK closed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  11. Effects of closure of an urban level I trauma centre on adjacent hospitals and local injury mortality: a retrospective, observational study

    PubMed Central

    Crandall, Marie; Sharp, Douglas; Wei, Xiong; Nathens, Avery; Hsia, Renee Y

    2016-01-01

    Objective To determine the association of the Martin Luther King Jr Hospital (MLK) closure on the distribution of admissions on adjacent trauma centres, and injury mortality rates in these centres and within the county. Design Observational, retrospective study. Setting Non-public patient-level data from the state of California were obtained for all trauma patients from 1999 to 2009. Geospatial analysis was used to visualise the redistribution of trauma patients to other hospitals after MLK closed. Variance of observed to expected injury mortality using multivariate logistic regression was estimated for the study period. Participants A total of 37 131 trauma patients were admitted to the five major south Los Angeles trauma centres from the MLK service area between 1999 and 2009. Main outcome measures (1) Number and type of trauma admissions to trauma centres in closest proximity to MLK; (2) inhospital injury mortality of trauma patients after the trauma centre closure. Results During and after the MLK closure, trauma admissions increased at three of the four nearby hospitals, particularly admissions for gunshot wounds (GSWs). This redistribution of patient load was accompanied by a dramatic change in the payer mix for surrounding hospitals; one hospital's share of uninsured more than tripled from 12.9% in 1999 to 44.6% by 2009. Overall trauma mortality did not significantly change, but GSW mortality steadily and significantly increased after the closure from 5.0% in 2007 to 7.5% in 2009. Conclusions Though local hospitals experienced a dramatic increase in trauma patient volume, overall mortality for trauma patients did not significantly change after MLK closed. PMID:27165650

  12. Nipple-areola-complex sparing mastectomy: five years of experience in a single centre.

    PubMed

    Tancredi, Antonio; Ciuffreda, Luigi; Petito, Lucia; Natale, Francesca; Murgo, Roberto

    2013-12-01

    This study aimed at assessing the outcomes of nipple-areola-complex-sparing mastectomy (NSM) of breast cancer in a single-centre and single-surgeon series after 5 years of experience. From June 2007 to January 2012, 58 female patients with breast cancer were admitted for NSM at our unit and 55 of these underwent NSM. All patients underwent a preoperative clinical and instrumental evaluation. The clinical evaluation consisted of physical examination by taking measurements of the prosthesis and through anamnesis. The instrumental evaluation used were mammography, chest X-ray, abdominal and breast ultrasound, blood test and, if necessary, magnetic resonance imaging. Specific inclusion criteria have been met in recruiting patients: clinically negative axillas, tumours < 3 cm in any of the quadrants, tumours more than 1 cm away from the NAC. The patients underwent a surgical and oncological follow-up. The surgical follow-up consisted in treating wounds, managing drainages and tissue expanders and then planning the replacement surgeries. The oncological follow-up consisted of periodical medical (such as blood tests including cancer markers) and radiological evaluations (such as mammography, chest X-ray, abdominal and transvaginal ultrasound scan and/or thorax-abdomen computed tomography) to assess the disease progression, and, if necessary the patients underwent chemotherapy or hormonal therapy. Out of 58 recruited patients undergoing NSM, only 3 patients (5.1 %) had an occult tumour in the NAC at intraoperative extemporaneous histological examination and required the NAC removal. The other 55 patients (94.9 %) did not have neoplastic involvement of NAC and at an average follow-up period of 21.7 months (range 3-55 months) only 4 (7.2 %) had disease progression. Nipple-Sparing Mastectomy is a highly specialized and oncologically sure procedure to be performed only in reference centres on selected patients.

  13. Effects of a Home-Based Family-Centred Early Habilitation Program on Neurobehavioural Outcomes of Very Preterm Born Infants: A Retrospective Cohort Study

    PubMed Central

    Poggioli, Michela; Minichilli, Fabrizio; Bononi, Tiziana; Meghi, Pasquina; Andre, Paolo; Crecchi, Alessandra; Rossi, Bruno; Carboncini, Maria Chiara; Ottolini, Alberto

    2016-01-01

    Preterm children have an increased risk of neurodevelopmental impairments which include psychomotor and language retardation. The objectives of the present retrospective cohort study were to examine the effects of an individually adapted, home-based, and family-centred early developmental habilitation program on neurodevelopmental and behavioural outcomes of very preterm children compared with a standard follow-up at 2 years' corrected age. Enrolled infants were retrospectively assigned to the intervention group (61 subjects) or to the control group (62 subjects) depending on whether they had or had not carried out a home-based family-centred early developmental habilitation program focused on environmental enrichment, parent-guided environmental interaction, and infant development. Developmental outcome was assessed for both groups at 24 months' corrected age using the Bayley Scales of Infant Development 2nd Edition. Intervention significantly improved both cognitive and behavioural outcomes. In addition, males had significantly lower scores than females either before or after treatment. However, the treatment was effective in both genders to the same extent. In conclusion, a timely updated environment suitable to the infant's developmental needs could provide the best substrate where the parent-infant relationship can be practised with the ultimate goal of achieving further developmental steps. PMID:28090357

  14. Effects of a Home-Based Family-Centred Early Habilitation Program on Neurobehavioural Outcomes of Very Preterm Born Infants: A Retrospective Cohort Study.

    PubMed

    Poggioli, Michela; Minichilli, Fabrizio; Bononi, Tiziana; Meghi, Pasquina; Andre, Paolo; Crecchi, Alessandra; Rossi, Bruno; Carboncini, Maria Chiara; Ottolini, Alberto; Bonfiglio, Luca

    2016-01-01

    Preterm children have an increased risk of neurodevelopmental impairments which include psychomotor and language retardation. The objectives of the present retrospective cohort study were to examine the effects of an individually adapted, home-based, and family-centred early developmental habilitation program on neurodevelopmental and behavioural outcomes of very preterm children compared with a standard follow-up at 2 years' corrected age. Enrolled infants were retrospectively assigned to the intervention group (61 subjects) or to the control group (62 subjects) depending on whether they had or had not carried out a home-based family-centred early developmental habilitation program focused on environmental enrichment, parent-guided environmental interaction, and infant development. Developmental outcome was assessed for both groups at 24 months' corrected age using the Bayley Scales of Infant Development 2nd Edition. Intervention significantly improved both cognitive and behavioural outcomes. In addition, males had significantly lower scores than females either before or after treatment. However, the treatment was effective in both genders to the same extent. In conclusion, a timely updated environment suitable to the infant's developmental needs could provide the best substrate where the parent-infant relationship can be practised with the ultimate goal of achieving further developmental steps.

  15. Retrospective review of injury severity, interventions and outcomes among helicopter and nonhelicopter transport patients at a Level 1 urban trauma centre

    PubMed Central

    Hannay, R. Scott; Wyrzykowski, Amy D.; Ball, Chad G.; Laupland, Kevin; Feliciano, David V.

    2014-01-01

    Background Air ambulance transport for injured patients is vitally important given increasing patient volumes, the limited number of trauma centres and inadequate subspecialty coverage in nontrauma hospitals. Air ambulance services have been shown to improve patient outcomes compared with ground transport in select circumstances. Our primary goal was to compare injuries, interventions and outcomes in patients transported by helicopter versus nonhelicopter transport. Methods We performed a retrospective 10-year review of 14 440 patients transported to an urban Level 1 trauma centre by helicopter or by other means. We compared injury severity, interventions and mortality between the groups. Results Patients transported by helicopter had higher median injury severity scores (ISS), regardless of penetrating or blunt injury, and were more likely to have Glasgow Coma Scale scores less than 8, require airway control, receive blood transfusions and require admission to the intensive care unit or operating room than patients transported by other means. Helicopter transport was associated with reduced overall mortality (odds ratio 0.41, 95% confidence interval 0.33–0.39). Patients transported by other methods were more likely to die in the emergency department. The mean ISS, regardless of transport method, rose from 12.3 to 15.1 (p = 0.011) during our study period. Conclusion Patients transported by helicopter to an urban trauma centre were more severely injured, required more interventions and had improved survival than those arriving by other means of transport. PMID:24461227

  16. DCD liver transplant infection: experience from a single centre in China.

    PubMed

    Tu, Z; Xiang, P; Xu, X; Zhou, L; Zhuang, L; Wu, J; Wang, W; Zheng, S

    2016-06-01

    The purpose of our study was to evaluate the incidence, timing, location and risk factors for bacterial and fungal infections after donation after cardiac death (DCD) liver transplant and clearly delineate any relationship between infection and survival in DCD liver transplant recipients. We retrospectively reviewed 257 consecutive patients undergoing DCD liver transplant between October 2010 and May 2015 at our centre. A total of 133 patients (51.8%) developed at least one bacterial or fungal infection episode. The predominant infection site was the respiratory tract, followed by the blood stream. Most of the infections occurred within the first week after liver transplant (61.9%). A recipient respiratory support time greater than 7 days (p = 0.041), post-transplant hospital time greater than 24 days (p = 0.002) and renal failure after DCD liver transplant (p = 0.039) were independent predictors of bacterial and fungal infection. The area under the receiver operating characteristic (ROC) curve (AUC) of the transplant infection risk assessment model was 0.788. The 1- and 3-year survival rates for recipients without infection were significantly increased compared with recipients with infection (96.1% and 89.0% vs. 81.5% and 75.9%, p = 0.007). This is the first study that offers detailed data revealing the timing and incidence of bacterial and fungal infection among adult DCD liver transplant recipients. Bacterial and fungal infection occurs at a high rate during the first week after DCD liver transplant, especially in patients with prolonged respiratory support time and renal failure, and infection is related to increased hospital stay. © 2016 John Wiley & Sons Ltd.

  17. Three-dimensional printing in cardiac surgery and interventional cardiology: a single-centre experience.

    PubMed

    Schmauss, Daniel; Haeberle, Sandra; Hagl, Christian; Sodian, Ralf

    2015-06-01

    In individual cases, routine preoperative imaging might not be sufficient for optimal planning of cardiovascular procedures. Three-dimensional printing (3D), a widely used technique to build life-like replicas of anatomical structures that has proven value in different medical disciplines, might overcome these shortcomings. However, data on 3D printing in cardiovascular medicine are limited to single reports. This stimulated us to present our single-centre experience with 3D printing models in cardiac surgery and interventional cardiology. Between the years 2006 and 2013, we fabricated 3D printing models using preoperative computed tomography or magnetic resonance imaging data in paediatric and adult cardiac surgery, as well as interventional cardiology. We present the 8 most representative cases. The models were very helpful for perioperative planning and orientation, as well as simulation of procedures due to the exact and life-like illustration of the cardiovascular anatomy. The fabrication of 3D printing models is feasible for perioperative planning and simulation in a variety of complex cases in paediatric and adult cardiac surgery, as well as in interventional cardiology. Further studies including more patients and providing more data are expected to demonstrate that the use of 3D printing may decrease morbidity and mortality of complex, non-routine procedures in cardiovascular medicine. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  18. Persons with Haemophilia in Sweden- Experiences and Strategies in Everyday Life. A Single Centre Study

    PubMed Central

    2015-01-01

    Introduction/Aim Haemophilia is caused by deficiency in coagulation factor VIII or IX. Treatment with the missing coagulation factors has been available in most developed countries for several decades. The aim was to explore the experiences of adults living with severe or moderate haemophilia and their coping strategies at a single centre in Sweden. Method The interview study had a qualitative empirical approach and was analyzed on the basis of the method empirical phenomenological psychology. The sample included 14 participants, mean age 42 (19–80 y), who met the inclusion criteria and to saturation of information. Results: General characteristics were; All were satisfied with and grateful for access to medication. An acceptance of the disorder and willingness to live a normal life was identified among all participants. They were all content with the care provided by Haemophilia Treatment Centre (HTC) and felt supported by its multidisciplinary team. Four typologies were identified; Protective adults and assertive children during up-bringing, finding a role in social context, symptoms and treatments, fear of limited resources in the future. Task-, emotional- and avoidance coping strategies were seen in the interviews. The most prominent coping strategy was task oriented. Conclusion This interview study with Swedish PWH shows that they strive for normality and adaptation in social activities throughout life finding their own niche. The PWH expressed the importance of knowledge and support from the comprehensive medical team at HTC and therefore it seems important to continue comprehensive medical care at HTC in order to follow-up the haemophilia persons regularly. PMID:26431432

  19. Single-centre experience of retroperitoneoscopic approach in urology with tips to overcome the steep learning curve

    PubMed Central

    Srivastava, Aneesh; Sureka, Sanjoy Kumar; Vashishtha, Saurabh; Agarwal, Shikhar; Ansari, Md Saleh; Kumar, Manoj

    2016-01-01

    CONTEXT: The retroperitoneoscopic or retroperitoneal (RP) surgical approach has not become as popular as the transperitoneal (TP) one due to the steeper learning curve. AIMS: Our single-institution experience focuses on the feasibility, advantages and complications of retroperitoneoscopic surgeries (RS) performed over the past 10 years. Tips and tricks have been discussed to overcome the steep learning curve and these are emphasised. SETTINGS AND DESIGN: This study made a retrospective analysis of computerised hospital data of patients who underwent RP urological procedures from 2003 to 2013 at a tertiary care centre. PATIENTS AND METHODS: Between 2003 and 2013, 314 cases of RS were performed for various urological procedures. We analysed the operative time, peri-operative complications, time to return of bowel sound, length of hospital stay, and advantages and difficulties involved. Post-operative complications were stratified into five grades using modified Clavien classification (MCC). RESULTS: RS were successfully completed in 95.5% of patients, with 4% of the procedures electively performed by the combined approach (both RP and TP); 3.2% required open conversion and 1.3% were converted to the TP approach. The most common cause for conversion was bleeding. Mean hospital stay was 3.2 ± 1.2 days and the mean time for returning of bowel sounds was 16.5 ± 5.4 h. Of the patients, 1.4% required peri-operative blood transfusion. A total of 16 patients (5%) had post-operative complications and the majority were grades I and II as per MCC. The rates of intra-operative and post-operative complications depended on the difficulty of the procedure, but the complications diminished over the years with the increasing experience of surgeons. CONCLUSION: Retroperitoneoscopy has proven an excellent approach, with certain advantages. The tips and tricks that have been provided and emphasised should definitely help to minimise the steep learning curve. PMID:27073300

  20. Impact of stage and comorbidities on five-year survival after radical cystectomy in Poland: single centre experience.

    PubMed

    Dybowski, Bartosz; Ossoliński, Krzysztof; Ossolińska, Anna; Peller, Michał; Bres-Niewada, Ewa; Radziszewski, Piotr

    2015-01-01

    Long-term outcomes of patients treated for invasive bladder cancer in Poland are poorly documented in the literature. Impact of various clinical parameters on their survival is even less well studied. Radical cystectomy is a major surgery, so the patients' condition can be equally important as cancer stage. The aim of the study was to assess 5-year overall survival (OS) after cystectomy and impact of comorbidity on OS in a single Polish academic centre. Clinical data of all patients who underwent cystectomy in years 2004-2006 for urothelial cancer were retrospectively reviewed. Survival status was determined at least 5 years after surgery. Pathological variables, comorbidities, surgery delay and complications were evaluated as potential predictors of OS. Kaplan-Meier estimates of the survival function as well as Cox proportional hazards models were utilized. Thirty-day, 1-year and 5-year OS for 63 patients was 98.4%, 58.7% and 31.7%, respectively. None of the investigated parameters were significantly related to five-year OS. However, a composite parameter consisting of stage, diabetes status and postoperative course was found as a significant predictor. Five-year OS in 16 patients with pT1-2 and without diabetes and without post-operative complications was higher than in the remaining 47 patients (56% vs. 23%; P = 0.02). Five-year OS in our group was lower than in most published international series but concordant with a previous Polish report. Improvement in survival after radical cystectomy may be expected when early diagnosis will be accompanied by optimal care of patients with diabetes mellitus and avoidance of postoperative complications.

  1. Single-centre experience of retroperitoneoscopic approach in urology with tips to overcome the steep learning curve.

    PubMed

    Srivastava, Aneesh; Sureka, Sanjoy Kumar; Vashishtha, Saurabh; Agarwal, Shikhar; Ansari, Md Saleh; Kumar, Manoj

    2016-01-01

    The retroperitoneoscopic or retroperitoneal (RP) surgical approach has not become as popular as the transperitoneal (TP) one due to the steeper learning curve. Our single-institution experience focuses on the feasibility, advantages and complications of retroperitoneoscopic surgeries (RS) performed over the past 10 years. Tips and tricks have been discussed to overcome the steep learning curve and these are emphasised. This study made a retrospective analysis of computerised hospital data of patients who underwent RP urological procedures from 2003 to 2013 at a tertiary care centre. Between 2003 and 2013, 314 cases of RS were performed for various urological procedures. We analysed the operative time, peri-operative complications, time to return of bowel sound, length of hospital stay, and advantages and difficulties involved. Post-operative complications were stratified into five grades using modified Clavien classification (MCC). RS were successfully completed in 95.5% of patients, with 4% of the procedures electively performed by the combined approach (both RP and TP); 3.2% required open conversion and 1.3% were converted to the TP approach. The most common cause for conversion was bleeding. Mean hospital stay was 3.2 ± 1.2 days and the mean time for returning of bowel sounds was 16.5 ± 5.4 h. Of the patients, 1.4% required peri-operative blood transfusion. A total of 16 patients (5%) had post-operative complications and the majority were grades I and II as per MCC. The rates of intra-operative and post-operative complications depended on the difficulty of the procedure, but the complications diminished over the years with the increasing experience of surgeons. Retroperitoneoscopy has proven an excellent approach, with certain advantages. The tips and tricks that have been provided and emphasised should definitely help to minimise the steep learning curve.

  2. The "basic" approach: a single-centre experience with a cost-reducing model for paediatric cardiac extracorporeal membrane oxygenation.

    PubMed

    Padalino, Massimo A; Tessari, Chiara; Guariento, Alvise; Frigo, Anna C; Vida, Vladimiro L; Marcolongo, Andrea; Zanella, Fabio; Harvey, Michael J; Thiagarajan, Ravi R; Stellin, Giovanni

    2017-04-01

    Extracorporeal membrane oxygenation (ECMO) is a lifesaving but expensive therapy in terms of financial, technical and human resources. We report our experience with a 'basic' ECMO support model, consisting of ECMO initiated and managed without the constant presence of a bedside specialist, to assess safety, clinical outcomes and financial impact on our health system. We did a retrospective single-centre study of paediatric cardiac ECMO between January 2001 and March 2014. Outcomes included postimplant complications and survival at weaning and at discharge. We used activity based costing to compare the costs of current basic ECMO with those of a 'full optional' dedicated ECMO team (hypothesis 1); ECMO with a bedside nurse and perfusionist (hypothesis 2), and ECMO with a bedside perfusionist (hypothesis 3). Basic cardiac ECMO was required for 121 patients (median age 75 days, median weight 4.4 kg). A total of 107 patients (88%) had congenital heart disease; 37 had univentricular physiology. The median duration of ECMO was 7 days (interquartile range [IQR], 4-15 days). Overall survival at weaning and at 30 days in the neonatal and paediatric age groups was 58.6% and 30.6%, respectively; these results were not significantly different from Extracorporeal Life Support Organization data. Cost analysis revealed a saving of €30 366, €22 144 and €13 837 for each patient on basic ECMO for hypotheses 1, 2 and 3, respectively. Despite reduced human, technical and economical resources, a basic ECMO model without a bedside specialist was associated with satisfactory survival and lower costs.

  3. CT-guided microcoil VATS resection of lung nodules: a single-centre experience and review of the literature

    PubMed Central

    Nguyen, Elsie T.; Chung, Tae-Bong; Kha, Lan-Chau; Cypel, Marcelo; Darling, Gail E.; de Perrot, Marc; Keshavjee, Shaf; Pierre, Andrew F.; Waddell, Thomas K.; Yasufuku, Kazuhiro

    2016-01-01

    Background Video-assisted thoracoscopic surgery (VATS) is standard of care for small lung resections at many centres. Computed tomography (CT)-guided insertion of microcoils can aid surgeons in performing VATS resections for non-palpable lung nodules deep to the lung surface. Methods Retrospective analysis of CT-guided microcoil insertions prior to VATS lung resection at a single institution from October 2008 to January 2014. Results A total of 63 patients were included (37% male, mean age 61.6±11.4 years). Forty-two patients (67%) had a history of smoking, with 10 current smokers. Sixty one (97%) patients underwent wedge resection and 3 (5%) patients had segmentectomy. Three (5%) patients required intra-operative staple line re-resection for positive or close margins. Eleven (17%) patients had a completion lobectomy, 5 of which were during the same anaesthetic. The average time between the CT-guided insertion and start of operation was 136.6±89.0 min, and average operative time was 84.0±53.3 min. The intra-operative complication rate was 5% (n=3), including 1 episode of hemoptysis, and 2 conversions to thoracotomy. The post-operative complication rate was 8% (5 patients), and included 2 air leaks, 1 hemothorax (drop in hemoglobin), 1 post chest tube removal pneumothorax, and one venous infarction of the lingula after lingula-sparing lobectomy requiring completion lobectomy. . Average post-operative length of stay was 2.2 days. A diagnosis was made for all patients. Conclusions CT-guided microcoil insertion followed by VATS lobectomy is safe, with short operative times, short length of stay and 100% diagnosis of small pulmonary nodules. This technique will become more important in the future with increasing numbers of small nodules detected on CT as part of lung cancer screening programs. PMID:27621851

  4. A single-centre cohort study of National Early Warning Score (NEWS) and near patient testing in acute medical admissions.

    PubMed

    Abbott, Tom E F; Torrance, Hew D T; Cron, Nicholas; Vaid, Nidhi; Emmanuel, Julian

    2016-11-01

    The utility of an early warning score may be improved when used with near patient testing. However, this has not yet been investigated for National Early Warning Score (NEWS). We hypothesised that the combination of NEWS and blood gas variables (lactate, glucose or base-excess) was more strongly associated with clinical outcome compared to NEWS alone. This was a prospective cohort study of adult medical admissions to a single-centre over 20days. Blood gas results and physiological observations were recorded at admission. NEWS was calculated retrospectively and combined with the biomarkers in multivariable logistic regression models. The primary outcome was a composite of mortality or critical care escalation within 2days of hospital admission. The secondary outcome was hospital length of stay. After accounting for missing data, 15 patients out of 322 (4.7%) died or were escalated to the critical care unit. The median length of stay was 4 (IQR 7) days. When combined with lactate or base excess, NEWS was associated with the primary outcome (OR 1.18, p=0.01 and OR 1.13, p=0.03). However, NEWS alone was more strongly associated with the primary outcome measure (OR 1.46, p<0.01). The combination of NEWS with glucose was not associated with the primary outcome. Neither NEWS nor any combination of NEWS and a biomarker were associated with hospital length of stay. Admission NEWS is more strongly associated with death or critical care unit admission within 2days of hospital admission, compared to combinations of NEWS and blood-gas derived biomarkers. Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  5. Impact of stage and comorbidities on five-year survival after radical cystectomy in Poland: single centre experience

    PubMed Central

    Dybowski, Bartosz; Ossoliński, Krzysztof; Ossolińska, Anna; Peller, Michał; Radziszewski, Piotr

    2015-01-01

    Introduction Long-term outcomes of patients treated for invasive bladder cancer in Poland are poorly documented in the literature. Impact of various clinical parameters on their survival is even less well studied. Radical cystectomy is a major surgery, so the patients’ condition can be equally important as cancer stage. The aim of the study was to assess 5-year overall survival (OS) after cystectomy and impact of comorbidity on OS in a single Polish academic centre. Material and methods Clinical data of all patients who underwent cystectomy in years 2004-2006 for urothelial cancer were retrospectively reviewed. Survival status was determined at least 5 years after surgery. Pathological variables, comorbidities, surgery delay and complications were evaluated as potential predictors of OS. Kaplan-Meier estimates of the survival function as well as Cox proportional hazards models were utilized. Results Thirty-day, 1-year and 5-year OS for 63 patients was 98.4%, 58.7% and 31.7%, respectively. None of the investigated parameters were significantly related to five-year OS. However, a composite parameter consisting of stage, diabetes status and postoperative course was found as a significant predictor. Five-year OS in 16 patients with pT1-2 and without diabetes and without post-operative complications was higher than in the remaining 47 patients (56% vs. 23%; P = 0.02). Conclusions Five-year OS in our group was lower than in most published international series but concordant with a previous Polish report. Improvement in survival after radical cystectomy may be expected when early diagnosis will be accompanied by optimal care of patients with diabetes mellitus and avoidance of postoperative complications. PMID:26568866

  6. Variability in practice and factors predictive of total crystalloid administration during abdominal surgery: retrospective two-centre analysis.

    PubMed

    Lilot, M; Ehrenfeld, J M; Lee, C; Harrington, B; Cannesson, M; Rinehart, J

    2015-05-01

    Variation in clinical practice in the perioperative environment and intensive care unit is a major challenge facing modern medicine. The objective of the present study was to analyse intraoperative crystalloid administration practices at two academic medical centres in the USA. We extracted clinical data from patients undergoing intra-abdominal procedures performed at UC Irvine (UCI) and Vanderbilt University (VU) Medical Centres. Limiting data to uncomplicated elective surgery with minimal blood loss, we quantified variability in fluid administration within individual providers, between providers, and between types of procedures using a corrected coefficient of variation (cCOV). Regression was performed using a general linear model to determine factors most predictive of fluid administration. For provider analysis and model building, 1327 UCI and 4585 VU patients were used. The average corrected crystalloid infusion rate across all providers at both institutions was 7.1 (sd 4.9) ml kg(-1) h(-1), an overall cCOV of 70%. Individual providers ranged from 2.3 (sd 3.7) to 14 (sd 10) ml kg(-1) h(-1). The final regression model strongly favoured personnel as predictors over other patient predictors. Wide variability in crystalloid administration was observed both within and between individual anaesthesia providers, which might contribute to variability in surgical outcomes. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  7. Treatment of sports injuries referred for physiotherapy at a national sports medicine centre in Nigeria: a retrospective study.

    PubMed

    Owoeye, O B A; Odebiyi, D O; Odunaiya, N; Ogunkunle, E

    2009-01-01

    Physiotherapists are important members of the sports medicine team and are involved in the prevention and management of injured athletes right from the acute stage of injury to the stage of rehabilitation. However, the type of treatments rendered to injured athletes and level of physiotherapy utilisation in terms of injury referrals for physiotherapy in sports medicine in Nigeria is not fully known. To find out the extent of referral of sports injuries for physiotherapy and types of treatments rendered to injured athletes referred for physiotherapy at the National Sports Medicine Centre (NSMC), Lagos, South-West, Nigeria. All case files at the general records unit from January 1995 to December 2002 were investigated. Information on athlete's sport, body part treated and physiotherapy modalities used between January 1997 and December 2002 were also extracted from the treatment register at the physiotherapy department of the sports medicine centre. A total of 171 sports related injuries were reported at the general records unit of the NSMC, with a male to female ratio of 2:1. Of this number, 121 (70.8%) were referred for physiotherapy with strain (n = 57, 33.3%) constituting the majority of physiotherapy referrals. At the physiotherapy department, the knee (n = 43, 30.1%) and the thigh (n = 33, 25.4%) were the most treated body parts. Track and field events (n = 48, 36.9%) recorded the highest number of injuries treated. Exercise therapy (n = 81, 25.5%) was the most frequently used modality, followed closely by transcutenous electrical nerve stimulation therapy (n = 73, 20.3%). The frequency of referral of sports injuries for physiotherapy at the NSMC was high. Exercise therapy was the most frequently used treatment modality and injuries affecting the lower limbs were mostly treated. Emphasis should therefore be laid on prevention of lower limb injuries.

  8. Treatment of open hand injuries: does timing of surgery matter? A single-centre prospective analysis.

    PubMed

    Juon, Bettina H; Iseli, Michelle; Kreutziger, Janett; Constantinescu, Mihai A; Vögelin, Esther

    2014-10-01

    The 6-hour paradigm for surgical treatment of open injuries should be re-evaluated in the era of systematic use of antiseptic solutions and systemic antibiotics. The current study investigates prospectively the impact of timing of surgery on the outcome of open hand injuries. The prospective evaluation included adult patients presenting with open hand injuries between 1 September 2009 and 30 June 2010 to the emergency department of the University Hospital of Berne, Switzerland. Multiple trauma, bilateral hand injuries, bite injuries, and infections were excluded. All patients underwent a standardised treatment protocol with antiseptic solution, sterile dressing, antibiotic prophylaxis, and surgical treatment upon admission. Demographic data, injury details, and delay from trauma to therapy were recorded. Microbiology was gained at surgery. Outcome measurements included infections, complications, pain, and function (clinically, DASH, Mayo score). From 116 patients (mean age 43 years) six patients suffered an infection (5.2%). The observed infections were statistically not associated with delay to surgery, treatment protocol, or to injury complexity. Neither complications, pain, nor functional outcome were statistically associated with delay to surgery, wound disinfection, or administration of antibiotics. In conclusion, early or late timing of surgical treatment of open hand injuries did not show any impact on outcome (infections, complications, pain, function) in this prospective single-centre patient evaluation.

  9. Perventricular device closure of isolated muscular ventricular septal defect in infants: A single centre experience☆

    PubMed Central

    Thakkar, Bhavesh; Patel, Nehal; Shah, Shaunak; Poptani, Vishal; Madan, Tarun; Shah, Chirag; Shukla, Anand; Prajapati, Vaishali

    2012-01-01

    Objectives To evaluate prospective single centre experience of mid-term safety and efficacy of perventricular device closure of isolated large muscular ventricular septal defect (mVSD) in high-risk infants. Background Surgical closures of large mVSD in infants represent a challenge with significant morbidity. Methods Between August 2008–2010, perventricular closure was attempted in 24 infants of 6.01 ± 2.37 months age and 4.27 ± 0.56 kg weight under TEE guidance. Results The device was successfully deployed in 21/24 infants. Size of mVSD was 8.42 ± 1.46 mm (6.1–12 mm). Mean procedure time was 28.8 ± 11.7 min. The closure rate was 84% immediately and 100% at 6 months. Four patients suffered major complications: 2-died, 1-esophageal perforation, 1-persistent CHB. At 26.23 ± 6.63 months follow-up two patients were symptomatic: 1-required device retrieval, 1-died of severe gastroenteritis. Conclusion Perventricular device closure of isolated mVSD appears feasible option at mid-term follow-up and may either substitute or complement the conventional surgical technique in selected cases depending on institutional paediatric cardiac surgery performance. PMID:23253407

  10. Recurrent Pneumonia in Children: A Reasoned Diagnostic Approach and a Single Centre Experience

    PubMed Central

    Montella, Silvia; Corcione, Adele; Santamaria, Francesca

    2017-01-01

    Recurrent pneumonia (RP), i.e., at least two episodes of pneumonia in one year or three episodes ever with intercritical radiographic clearing of densities, occurs in 7.7%–9% of children with community-acquired pneumonia. In RP, the challenge is to discriminate between children with self-limiting or minor problems, that do not require a diagnostic work-up, and those with an underlying disease. The aim of the current review is to discuss a reasoned diagnostic approach to RP in childhood. Particular emphasis has been placed on which children should undergo a diagnostic work-up and which tests should be performed. A pediatric case series is also presented, in order to document a single centre experience of RP. A management algorithm for the approach to children with RP, based on the evidence from a literature review, is proposed. Like all algorithms, it is not meant to replace clinical judgment, but it should drive physicians to adopt a systematic approach to pediatric RP and provide a useful guide to the clinician. PMID:28146079

  11. Optimising treatment strategies in spinal ependymoma based on 20years of experience at a single centre.

    PubMed

    Keil, Vera C; Schmitt, Anne J; Martin, Sean C; Cadoux-Hudson, Tom A D; Pereira, Erlick A C

    2016-07-01

    Spinal ependymomas are rare tumours, with total resection favoured where possible. Several case series assessing the outcome following neurosurgical treatment for spinal ependymoma advocate the usage of adjuvant radiotherapy in cases of subtotal resection, or in unencapsulated tumours. We assessed the outcome of 61 consecutive cases of spinal ependymoma in a single centre over a 20year period using a variety of outcome measures. Sex distribution was equal, with a mean age at surgery of 43.6years (range 5-76years). Overall, most tumours occurred in the lumbosacral region (70.5%), with fewer in the thoracic (27.9%) and cervical regions (18.0%). Myxopapillary features were seen in 41.0% of tumours, and were more common when occurring in the lumbar region (51.2%). Gross total resection was achieved in 52.5%, subtotal resection in 37.7% and biopsy alone in 9.8% of patients and 31.1% received adjuvant radiotherapy. Two-thirds of patients achieved an excellent post-operative neurological outcome (Frankel grade E). Tumour recurrence was rare. Gross total resection and good preoperative neurological condition were most strongly predictive of good outcome. Post-operative radiotherapy did not seem to confer survival benefit in this case series, even in cases of incomplete resection, leading us to question its utility for all cases of spinal cord ependymoma.

  12. Recurrent Pneumonia in Children: A Reasoned Diagnostic Approach and a Single Centre Experience.

    PubMed

    Montella, Silvia; Corcione, Adele; Santamaria, Francesca

    2017-01-29

    Recurrent pneumonia (RP), i.e., at least two episodes of pneumonia in one year or three episodes ever with intercritical radiographic clearing of densities, occurs in 7.7%-9% of children with community-acquired pneumonia. In RP, the challenge is to discriminate between children with self-limiting or minor problems, that do not require a diagnostic work-up, and those with an underlying disease. The aim of the current review is to discuss a reasoned diagnostic approach to RP in childhood. Particular emphasis has been placed on which children should undergo a diagnostic work-up and which tests should be performed. A pediatric case series is also presented, in order to document a single centre experience of RP. A management algorithm for the approach to children with RP, based on the evidence from a literature review, is proposed. Like all algorithms, it is not meant to replace clinical judgment, but it should drive physicians to adopt a systematic approach to pediatric RP and provide a useful guide to the clinician.

  13. The European experience of Novacor left ventricular assist (LVAS) therapy as a bridge to transplant: a retrospective multi-centre study.

    PubMed

    El-Banayosy, A; Deng, M; Loisance, D Y; Vetter, H; Gronda, E; Loebe, M; Vigano, M

    1999-06-01

    Artificial heart devices have suffered from a negative press based on the early Jarvik experience of the 1980s. This is in stark contrast to realities of current left ventricular assist (LVAS) therapy. The Novacor N100 PC wearable left ventricular assist system (LVAS) was introduced in Europe in late 1993. This system allows implanted recipients to be completely autonomous with the system controlled by a small computer and powered by rechargeable batteries. This report represents the initial European experience with the Novacor LVAS. Since the system was introduced with regulatory approval as a commercial product, clinicians were not bound by the constraints of a study protocol and only minimal data were collected. This report presents the results of a retrospective study of 118 consecutive patients who had the LVAS implanted as a bridge to transplant, in 19 centres over the three year period ending in November 1996. Mortality and morbidity varied widely between centres. The median implant time was 115 days (0-585 days) and 33% of patients returned home, supported by the LVAS. The overall survival on LVAS was 64%. The major causes of death were infection (14%) and MOF (6%). There were no significant device or system failures despite a cumulative patient experience of 24.8 years outside of a hospital environment. Patient selection and management varied greatly between centres and this was reflected in disparate outcomes. Optimal selection and management of LVAS patients has still to be established. While the data available for this report lacked the detail necessary to demonstrate direct causal relationships between selection and management, it was clear from the inter-centre differences that these two factors have a major impact on outcomes. This early experience has directed attention towards improved management regimes. Given the results obtained from the best centres and the ability to discharge patients to lead near-normal lives in the community, the authors

  14. Radiological insertion of Tenckhoff catheters for peritoneal dialysis: a 1-year single-centre experience

    PubMed Central

    Quach, Trung; Tregaskis, Peter; Menahem, Solomon; Koukounaras, Jim; Mott, Nigel; Walker, Rowan G.

    2014-01-01

    Background Peritoneal dialysis (PD) is an important home-based dialysis modality for patients with end-stage kidney disease (ESKD). The initiation of PD requires timely and skilled insertion of a Tenckhoff catheter (TC). At most centres, TCs are inserted laparoscopically by surgeons under general anaesthetic. This requires access to increasingly scarce surgical, anaesthetic and hospital inpatient resources. Radiological insertion of TCs performed as a day procedure under local anaesthetic allows for easier access to the TC insertion with reduced resource requirements. We report our 1-year experience following the introduction of this technique to our PD programme. Methods This is a retrospective review of the outcomes for all patients who had TCs inserted radiologically (percutaneously with the assistance of ultrasound and fluoroscopy) over the 12-month period from December 2011 to December 2012. Relevant patient demographics collected included age, gender, body mass index (BMI), previous abdominal surgery and cause of ESKD. Extended details of the insertion procedure were also obtained including length of stay, early complications and time to first use of the catheter for PD. Results Thirty Argyle™ Swan Neck TCs were inserted under radiological guidance during the study period. The mean age of patients was 56 (SD ± 14). The male-to-female ratio was 2:1. The mean BMI was 25.7 (SD ± 4.8). PD was the initial dialysis modality in 22 (73%) patients. Of the 30 patients, 14 (46.7%) had previously undergone extraperitoneal abdominal surgery. All catheters were inserted successfully as day cases except four patients (13.3%) who had catheters inserted during an inpatient hospital admission. Most catheters were not accessed for a minimum of 10 days to reduce the chance of exit site leakage, in two cases the catheters were used within 5 days without complication. There were no cases of peritonitis or exit site infection during the observation period. Catheter migration

  15. A single platelet-rich plasma injection for chronic midsubstance achilles tendinopathy: a retrospective preliminary analysis.

    PubMed

    Murawski, Christopher D; Smyth, Niall A; Newman, Hunter; Kennedy, John G

    2014-10-01

    The purpose of this study was to evaluate a series of patients undergoing a single platelet-rich plasma (PRP) injection for the treatment of chronic midsubstance Achilles tendinopathy, in whom conservative treatment had failed. Thirty-two patients underwent a single PRP injection for the treatment of chronic midsubstance Achilles tendinopathy and were evaluated at a 6-month final follow-up using the Foot and Ankle Outcome Score and Short Form 12 general health questionnaire. Magnetic resonance imaging was performed on all patients prior to and 6 months after injection. Twenty-five of 32 patients (78%) reported that they were asymptomatic at the 6-month follow-up visit and were able to participate in their respective sports and daily activities. The remaining 7 patients (22%) who reported symptoms that did not improve after 6 months ultimately required surgery. Four patients went on to have an Achilles tendoscopy, while the other 3 had an open debridement via a tendon splitting approach. A retrospective evaluation of patients receiving a single PRP injection for chronic midsubstance Achilles tendinopathy revealed that 78% had experienced clinical improvement and had avoided surgical intervention at 6-month follow-up. Therapeutic, Level IV: Retrospective case series. © 2014 The Author(s).

  16. PFAPA syndrome: clinical characteristics and treatment outcomes in a large single-centre cohort.

    PubMed

    Król, Petra; Böhm, Marek; Sula, Viktor; Dytrych, Petra; Katra, Rami; Nemcová, Dana; Dolezalová, Pavla

    2013-01-01

    This paper aims to describe clinical and laboratory features and disease outcome in a single-centre cohort of patients with PFAPA syndrome (Periodic Fever, Aphtous stomatitis, Pharyngitis, and Adenitis) and to test performance of diagnostic and therapeutic algorithms. Patients fulfilling criteria were selected from the fever clinic population. Prospective follow-up together with recruitment of newly diagnosed patients followed pre-defined guidelines. Diagnostic and therapeutic algorithms and definitions of outcome and therapy response were formulated. Paired blood samples during febrile and afebrile periods were compared. Out of 176 patients referred for suspected periodic fever 125 children fulfilled criteria. Their age at onset was 23 months, median episode duration 3.5 days at 4-week intervals. Fever was associated with pharyngitis (91%), cervical adenitis (78%) and aphtae (41%). Among therapeutic options, episodic prednisone proved to be the most common first-line treatment. Administered to 77 patients, it reduced symptoms in 94%. Tonsillectomy led to the full symptom resolution in all 18 patients. Forty-six patients reached disease remission. Distribution of typical symptoms, response to therapies and disease outcome in a large patient cohort were documented. We offer diagnostic and therapeutic algorithms that have proven effective during this prospective trial. Our findings support the general belief of benign nature of this aetiologically unclear condition, despite proportion of patients having persistent disease for years. Maintenance of normal findings in afebrile intervals, striking response to a single dose of prednisone and normal growth and development together with spontaneous tendency towards prolongation of afebrile intervals are important confirmatory features of PFAPA syndrome.

  17. Commercial renal transplantation: A risky venture? A single Canadian centre experience

    PubMed Central

    Kapoor, Anil; Kwan, Kevin G.; Whelan, J. Paul

    2011-01-01

    Background: Canada, akin to other developed nations, faces the growing challenges of end-stage renal disease (ESRD). Even with expanded donor criteria for renal transplantation (the treatment of choice for ESRD), the supply of kidneys is outpaced by the escalating demand. Remuneration for kidney donation is proscribed in Canada. Without an option of living-related transplantation (biological or emotional donors), patients often struggle with long waiting lists for deceased donor transplantation. Accordingly, many patients are now opting for more expedient avenues to obtaining a renal transplant. Through commercial organ retrieval programs, from living and deceased donors, patients are travelling outside Canada to have the procedure performed. Methods: Between September 2001 and July 2007, 10 patients (7 males, 3 females) underwent commercial renal transplantation outside Canada. We describe the clinical outcomes of these patients managed postoperatively at our single Canadian transplant centre. Results: Six living unrelated and 4 deceased donor renal transplantations were performed on these 10 patients (mean age 49.5 years). All procedures were performed in developing countries and the postoperative complications were subsequently treated at our centre. The mean post-transplant serum creatinine was 142 μmol/L. The average follow-up time was 29.8 months (range: 3 to 73 months). One patient required a transplant nephrectomy secondary to fungemia and subsequently died. One patient had a failed transplant and has currently resumed hemodialysis. Acute rejection was seen in 5 patients with 3 of these patients requiring re-initiation of hemodialysis. Only 1 patient had an uncomplicated course after surgery. Discussion: Despite the kidney trade being a milieu of corruption and commercialization, and the high risk of unconventional complications, patients returning to Canada after commercial renal transplantation are the new reality. Patients are often arriving without any

  18. Chronic Total Occlusion - Percutaneous Coronary Intervention (CTO-PCI) Experience in a Single, Multi-operator Australian Centre: Need for dedicated CTO-PCI programs.

    PubMed

    BoganaShanmugam, Vimalraj; Psaltis, Peter J; Wong, Dennis T; Seneviratne, Sujith; Cameron, James; Meredith, Ian T; Malaiapan, Yuvaraj

    2016-07-01

    Chronic total occlusions (CTOs) represent a unique set of lesions for percutaneous coronary intervention (PCI) because of the complexity of techniques required to treat them. We retrospectively reviewed the CTO-PCI experience between January 2010 and December 2012, in a multi-operator single centre, which is one of the largest volume PCI centres in Australia. Eighty-two patients (62.6±11.3 years, 85% males) who had CTO-PCIs were included. The most common site of CTO was the right coronary artery (44%), followed by the left circumflex (30%) and left anterior descending (26%) arteries. Using the Japanese CTO scoring system, 34% of lesions were classified as easy, 37% intermediate, 23% difficult and 6% very difficult. All PCIs were performed by antegrade approach. Selected procedural characteristics included: re-attempt procedure 10%; multiple access sites 21%; more than one guidewire 77%; additional support modality 60%; drug-eluting stents 97%; stent number 1.6±0.8; total stent length 40.1±24.5mm; fluoroscopy time 33±17min; contrast volume 257.2±110.8mL. Overall CTO success rate was 60%. In-hospital adverse outcomes included 1.2% mortality, 9.8% peri-procedural myocardial infarction, 4.9% emergency bypass surgery, 3% cardiac tamponade and 4.9% contrast induced nephropathy. We report modest success rates in a single Australian centre experience in a relatively conservative cohort of CTO-PCI prior to the initiation of a dedicated CTO revascularisation program. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  19. Drug-induced liver injury from antituberculous treatment: a retrospective study from a large TB centre in the UK.

    PubMed

    Abbara, Aula; Chitty, Sarah; Roe, Jennifer K; Ghani, Rohma; Collin, Simon M; Ritchie, Andrew; Kon, Onn Min; Dzvova, John; Davidson, Harriet; Edwards, Thomas E; Hateley, Charlotte; Routledge, Matthew; Buckley, Jim; Davidson, Robert N; John, Laurence

    2017-03-24

    We describe drug-induced liver injury (DILI) secondary to antituberculous treatment (ATT) in a large tuberculosis (TB) centre in London; we identify the proportion who had risk factors for DILI and the timing and outcome of DILI. We identified consecutive patients who developed DILI whilst on treatment for active TB; patients with active TB without DILI were selected as controls. Comprehensive demographic and clinical data, management and outcome were recorded. There were 105 (6.9%) cases of ATT-associated DILI amongst 1529 patients diagnosed with active TB between April 2010 and May 2014. Risk factors for DILI were: low patient weight, HIV-1 co-infection, higher baseline ALP, and alcohol intake. Only 25.7% of patients had British or American Thoracic Society defined criteria for liver test (LT) monitoring. Half (53%) of the cases occurred within 2 weeks of starting ATT and 87.6% occurred within 8 weeks. Five (4.8%) of seven deaths were attributable to DILI. Only a quarter of patients who developed DILI had British or American Thoracic Society defined criteria for pre-emptive LT monitoring, suggesting that all patients on ATT should be considered for universal liver monitoring particularly during the first 8 weeks of treatment.

  20. Enterocutaneous fistula: analysis of clinical outcomes from a single Victorian tertiary referral centre.

    PubMed

    Leang, Yit J; Bell, Stephen W; Carne, Peter; Chin, Martin; Farmer, Chip; Skinner, Steward; Wale, Roger; Warrier, Satish K

    2016-07-24

    Enterocutaneous fistulas (ECFs) are complex and can result in significant morbidity and mortality. The study aimed to evaluate ECF outcomes in a single tertiary hospital. A retrospective study of all patients treated with ECF between the period of January 2009 and June 2014 was conducted. Baseline demographic data assessed included the primary aetiology of the fistula, site of the fistula and output of the fistula. Outcomes measures assessed included re-fistulation rate, return to theatre, wound complications, fistula closure rate and death over the study period. A total of 16 patients with ECF were recorded within the study period. Mean age of the patient cohort was 55.8 ± 11.8 years with a female predominance (11 females, 5 males). Primary aetiology were Crohn's disease (31%), post intra-abdominal surgery not related to bowel neoplasia (50%) and post intra-abdominal surgery related to bowel neoplasia (19%). Majority of the fistulas developed from the small bowel (75%) and had low output (63%). Operative intervention was required in 81% of patients with an overall closure rate of 100%. Median operations required for successful closure was 1.15 operations. Mean duration between index operation and curative operation was 8 ± 12.7 months. Appropriate bundle of care (perioperative care, surgical timing and surgical technique) can produce excellent results in patients with ECF. © 2016 Royal Australasian College of Surgeons.

  1. Arteriovenous fistula formation using transposed basilic vein: extensive single centre experience.

    PubMed

    Harper, S J F; Goncalves, I; Doughman, T; Nicholson, M L

    2008-08-01

    The expanding haemodialysis population has lead to increased requirement for more complex vascular access. The aim of this study is to present the results of an extensive series of brachiobasilic arteriovenous fistulae. BBAVF were performed using single-stage vein transposition. A retrospective review of case notes was performed. One hundred and sixty eight BBAVF were created in 144 patients. This was the first access procedure in only 30 cases and the fourth or fifth in 30. At 24h, 165 fistulas (98%) were patent. One hundred and eleven fistulas (66%) were used for haemodialysis and 57 (34%) were never used, of which 39 (23%) were due to fistula failure. The cumulative secondary patency at 1, 2 and 3 years was 66%, 50% and 41% respectively. There were 201 complications in 119 patients (71%), including thrombosis (29%), arm oedema (17%), infection (13%) and arterial steal syndrome (11%). Ten angioplasties and 48 operative procedures were performed for complications. Pre-operative ipsilateral subclavian catheter had been placed in 62 cases (37%) and was associated with poor patency. BBAVF represents an important option for vascular access with acceptable patency rates, although complication rates remain significant.

  2. A ten year (1999-2008) retrospective study of amoebiasis in University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia.

    PubMed

    Farhana, F; Jamaiah, I; Rohela, M; Abdul-Aziz, N M; Nissapatorn, V

    2009-12-01

    This is a ten year (1999-2008) retrospective study of amebiasis in patients admitted to UMMC. A total of 34 cases were analyzed. The most common were amebic liver abscess 22(65%) and the rest were amoebic dysentery 12(35%). Majority of the cases occurred among Malaysians 29(85%), with Chinese 14(41%), followed by the Malays 9(26%) and the Indians 6(18%). Foreigners made up of one Indonesian, one Pakistani and three Myanmarese and constituted 5(15%) of the total cases. Males 24(71%) were more commonly affected. Most of the cases occurred between the age group of 40-49 years, 8(23%) and 60 years and above, 8(23%). Age group of 20-50 years constituted 20(60%) of the cases. The most common clinical presentations were fever with chills and rigors 26(76%), diarrhoea 20 (59%), right hypochondrium pain 17(50%), abdominal pain 17(50%), hepatomegaly 16 (47%) and jaundice 7(20%). All were discharged well after treatment except for one case of death in a 69-year-old Chinese male with amebic liver abscess.

  3. Epidemiology of coeliac disease in a single centre in Southern Derbyshire 1958–2014

    PubMed Central

    Holmes, Geoffrey K T; Muirhead, A

    2017-01-01

    Objective To determine trends in diagnosis of coeliac disease (CD) in patients attending a single centre 1958–2014 and provide figures for prevalence and incidence in those born in Derby city over 4 decades. To explore a link between deprivation and prevalence and characteristics of CD in Asians. Design An unselected, consecutive series of 2410 adult patients with CD diagnosed in the catchment area of the Derby hospitals was identified. 1077 born within Derby city identified by postcodes was used to determine changes in prevalence and incidence over 4 decades. 191 patients were Asian. Population numbers were obtained from National Census information. Results In the quinquennium 2010–2014, 20 times more patients were diagnosed than during 1975–1979. 27% were diagnosed at ≥60 years. A paucity of diagnoses in young men was observed. Women were diagnosed most often in age band ≥35<45, 15 years earlier than men. The largest increase in diagnosis rates occurred in young women and the elderly. In 2014, overall prevalence was 1:188; women 1:138. 4.6% of the variation was attributed to deprivation. Diagnosis rates in Asians increased markedly although only 5% were diagnosed at ≥60 years, much lower than for whites. Conclusions The dramatic increase in number of patients with CD presents challenges for follow-up and new models of care need to be explored. Healthcare workers should be alert to the diagnosis in young men and elderly Asians. A dedicated coeliac clinic is an excellent facility to increase diagnosis rates. PMID:28761688

  4. Epidemiology of coeliac disease in a single centre in Southern Derbyshire 1958-2014.

    PubMed

    Holmes, Geoffrey K T; Muirhead, A

    2017-01-01

    To determine trends in diagnosis of coeliac disease (CD) in patients attending a single centre 1958-2014 and provide figures for prevalence and incidence in those born in Derby city over 4 decades. To explore a link between deprivation and prevalence and characteristics of CD in Asians. An unselected, consecutive series of 2410 adult patients with CD diagnosed in the catchment area of the Derby hospitals was identified. 1077 born within Derby city identified by postcodes was used to determine changes in prevalence and incidence over 4 decades. 191 patients were Asian. Population numbers were obtained from National Census information. In the quinquennium 2010-2014, 20 times more patients were diagnosed than during 1975-1979. 27% were diagnosed at ≥60 years. A paucity of diagnoses in young men was observed. Women were diagnosed most often in age band ≥35<45, 15 years earlier than men. The largest increase in diagnosis rates occurred in young women and the elderly. In 2014, overall prevalence was 1:188; women 1:138. 4.6% of the variation was attributed to deprivation. Diagnosis rates in Asians increased markedly although only 5% were diagnosed at ≥60 years, much lower than for whites. The dramatic increase in number of patients with CD presents challenges for follow-up and new models of care need to be explored. Healthcare workers should be alert to the diagnosis in young men and elderly Asians. A dedicated coeliac clinic is an excellent facility to increase diagnosis rates.

  5. Increased Cardiovascular Events and Subclinical Atherosclerosis in Rheumatoid Arthritis Patients: 1 Year Prospective Single Centre Study

    PubMed Central

    Ruscitti, Piero; Cipriani, Paola; Masedu, Francesco; Romano, Silvio; Berardicurti, Onorina; Liakouli, Vasiliki; Carubbi, Francesco; Di Benedetto, Paola; Alvaro, Saverio; Penco, Maria; Valenti, Marco; Giacomelli, Roberto

    2017-01-01

    Objectives Several studies showed the close relationship between Rheumatoid Arthritis (RA) and cerebro-cardiovascular events (CVEs) and subclinical atherosclerosis. In this study, we investigated the occurrence of CVEs and subclinical atherosclerosis during the course of RA and we evaluated the possible role of both traditional cardiovascular (CV) and disease related risk factors to predict the occurrence of new CVEs and the onset of subclinical atherosclerosis. Methods We designed a single centre, bias-adjusted, prospective, observational study to investigate, in a homogeneous subset of RA patients, the occurrence of new onset of CVEs and subclinical atherosclerosis. Statistical analyses were performed to evaluate the role of traditional CV and disease-related risk factors to predict the occurrence of new CVEs and subclinical atherosclerosis. Results We enrolled 347 RA patients prospectively followed for 12 months. An increased percentage of patients experienced CVEs, developed subclinical atherosclerosis and was affected by systemic arterial hypertension (SAH), type 2 diabetes mellitus and metabolic syndrome (MS), at the end of follow up. Our analysis showed that the insurgence of both SAH and MS, during the follow up, the older age, the CVE familiarity and the lack of clinical response, were associated with a significantly increased risk to experience CVEs and to develop subclinical atherosclerosis. Conclusions Our study quantifies the increased expected risk for CVEs in a cohort of RA patients prospectively followed for 1 year. The occurrence of both new CVEs and subclinical atherosclerosis in RA patients may be explained by inflammatory burden as well as traditional CV risk factors. PMID:28103312

  6. Multiple sclerosis and pregnancy: a single-centre prospective comparative study.

    PubMed

    Cuello, J P; Martínez Ginés, M L; Martin Barriga, M L; de Andrés, C

    2017-03-01

    Multiple sclerosis (MS) is a autoimmune disorder which preferentially affects young women of childbearing age. During pregnancy, the annualized relapse rate (AAR) is modified, but pregnancy has no harm effect on the long-term course of the disease. We aimed to study the clinical course of our MS patients during pregnancy, and compare their obstetrics outcomes with a control group of non-MS patients. A single centre prospective observational study was conducted. We assessed the reproductive history, MS history, pregnancy course and new-born outcome of a cohort of MS patients who had had a pregnancy between january 2007 and july 2012. We compared the global outcomes with a control cohort of 58 age-matched healthy pregnancies. Complete data from 35 consecutive women were analyzed, 40 deliveries. Control groups: 58 patients, 60 deliveries. EDSS at pregnancy 0,7. ARR before pregnancy 0,5. During pregnancy 0,3, after pregnancy 0,4. Twelve patients were on disease-modifying drugs (DMD) before pregnancy, 4 prenatal exposure occurs. The comparison between relapse rate and EDSS before, during and after delivery showed no statistically significant difference. In addition, compared to control group, there were also no differences in the obstetric outcomes. In MS cohort, we found a higher incidence of assisted reproductive treatments and lower breastfeeding rate, both statistically significant. Our series confirms that pregnancy has no negative long term impact on the progression of MS and also suggest that there is no additional morbidity in the pregnancy, comparing to the rest of the population. Copyright © 2014 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. A retrospective analysis of dermatoses in the perimenopausal population attending a tertiary care centre in South India

    PubMed Central

    Aboobacker, Shamma; Saritha, Mohanan; Karthikeyan, Kaliaperumal

    2015-01-01

    Introduction: Menopausal is a normal physiologic aging process in women characterized by decreasing estrogen levels. The skin is an organ dependant on hormones, estrogen being the most important in case of females, thereby influencing both the biology of skin and composition. Studies show that the systemic effects of estrogen deprivation occur years after attaining menopausal, however cutaneous features have been noticed earlier. The purpose of this study is to evaluate the common disorders occurring in perimenopausal women of Indian ethnicity. Materials and Methods: A retrospective observational study of outpatient records from Dermatology clinic between 2005 and 2012. All female patients between 45-55 years of age from an outpatient register that outlines the final diagnosis made by a qualified dermatologist after investigations. The data was entered according to the pattern of dermatoses and their seasonal variation and analyzed were included. Results: A total of 8,156 cases were found. After analysis of the many variables, the most common dermatoses in the perimenopausal population were eczematous disorders (23.6%), followed by urticaria (12.4%) and papulosquamous disorders (10.7%). Of the eczematous disorders, allergic and photosensitive disorders were found to be more frequent. Conclusion: The leading dermatoses being eczema and urticaria in the perimenopausal population probably accounts for a tendency of exaggerated response to external factors. The population studied in the current study might be of significance due to complete lack of treatment in the form of hormone replacement therapy (HRT), while routine sun exposure and cultural practices predominate. However, evaluation with respect to individual factors is beyond the scope of the current study and may be necessary to define a causal relationship. PMID:26538988

  8. Clinical Analysis of Ectopic Pregnancies in a Tertiary Care Centre in Southern India: A Six-Year Retrospective Study

    PubMed Central

    Daniel, Mary; Solomon, Preethy

    2016-01-01

    Introduction Ectopic Pregnancy (EP) is a life-threatening emergency commonly encountered by medical practitioners where diagnosis can often be missed. Any woman in the reproductive age group, presenting with lower abdominal pain or vaginal bleeding must raise the suspicion of an ectopic pregnancy to prevent mortality and morbidity. Aim To review all cases of EP and determine the incidence of EP. To study the high risk factors and know the types of clinical presentation, methods of diagnosis, outcome and complications. Materials and Methods This was a retrospective cohort study, conducted at a tertiary care medical teaching hospital in Pondicherry, India. Medical records of all women with an EP between 2009 and 2015 were retrieved. Demographic data, parity, risk factors, clinical features, mode of management and need for blood transfusion was noted. Main outcome measures studied were the incidence of EP, risk factors, mortality and morbidity in these women. Statistical Analysis Data was entered in Microsoft Excel spreadsheet and analysed using SPSS software version 19.0. For categorical variables, data was compiled as frequency and percent. For continuous variables, data was calculated as mean ± SD. Results Seventy-two EP were diagnosed during the six-year period with an incidence of 9.1/1000 pregnancies. Majority of women were aged 21-30years (51.39%), 27.8% women were nulliparous. The most common risk factors were previous abortion (36.1%) and pelvic surgery (37.50%). Fifteen cases (20.8%) were diagnosed in women who had tubectomy. The classic triad of lower abdominal pain, amenorrhoea and vaginal bleeding was seen in 29(40.3%) cases. Ultrasonography was required to arrive at a diagnosis in 28(38.9%) cases. Urine pregnancy test was positive in 100% of cases. Majority (94.4%) were tubal ectopic pregnancies. Medical management with methotrexate alone benefitted 10(13.89%) of patients while another four required surgery for failed medical management. More than half

  9. Single tooth replacement of missing molars: a retrospective study of 78 implants.

    PubMed

    Schwartz-Arad, D; Samet, N; Samet, N

    1999-04-01

    As experience with osseointegrated implants has grown, greater use has been made of placement in the posterior jaw. The aim of this study is to present the survival rate of 78 osseointegrated single implants, inserted in the molar area and to evaluate the prosthetic rehabilitation on these teeth. This retrospective study presents findings of 55 consecutive patients with 78 restored single osseointegrated implants in the molar area. The patients went through a clinical and radiological evaluation. The same maxillofacial surgeon inserted all implants. Three of the implants were inserted into the maxilla and 75 into the mandible; 4 of the 78 implants were immediate implants. The cumulative survival rate after one year was 93.6%. Follow-up was up to 80 months, with an average of 27 months. Out of all the implants, 6 failed (7. 7%): 5 failed in the surgical stage, and 1 after prosthetic loading. The main implant failures were among the titanium screw implants. Prosthetic complications occurred in 11 cases (14%), which included loosening of the abutment and/or the crown (9 cases), fracture of the abutment (1 case), and porcelain fracture (1 case). No incident of implant fracture occurred. Within the limits of this study, replacement of a single molar by a single implant is a valid and successful surgical treatment modality, with a high survival rate.

  10. Endovascular Management of True Renal Arterial Aneurysms: Results from a Single Centre

    SciTech Connect

    Chung, Raymond; Touska, Philip; Morgan, Robert; Belli, Anna-Maria

    2016-01-15

    PurposeTo report a single centre’s experience of the endovascular treatment of renal arterial aneurysms, including techniques and outcomes.Materials and MethodsThis is a retrospective analysis of true renal arterial aneurysms (TRAAs) treated using endovascular techniques over a period of 12 years and 10 months. The clinical presentations, aneurysm characteristics, endovascular techniques and outcomes are reported.ResultsThere were nine TRAA cases with a mean aneurysm size of 21.0 mm, located at the main renal arterial bifurcation in all cases. Onyx{sup ®} was used as the embolic agent of choice (88.9 % cases), with concurrent balloon remodelling. The overall primary technical success rate was 100 %. Repeat intervention was carried out in 1 case, secondary to reperfusion >8 years post-initial treatment. Long-term clinical follow-up was available in 55.6 % of cases (mean 29.8 months; range 3.3–90.1 months). Early post-procedural renal function, as measured by serum creatinine, remained within the normal reference range. Renal parenchymal loss post-embolisation was ≤20 % in 77.8 % of cases, as estimated on imaging. Minor complications included non-target embolization of Onyx{sup ®} with no clinical sequelae (n = 1), transient pain requiring only oral analgesia with no prolongation of hospital stay (n = 2). No major complications occurred as a consequence of embolisation.ConclusionEndovascular therapy is an effective and safe primary therapy for TRAA with high success rate and low morbidity, supplanting surgery as primary therapy. Current experience in the use of Onyx{sup ®} in TRAA is primarily limited to individual case reports, and this represents the largest case series of Onyx{sup ®}-treated TRAAs to date.

  11. Endoscopic sphincterotomy with sphincteroplasty for the management of choledocholithiasis: a single-centre experience.

    PubMed

    Ho, Simon; Rayzan, Daniel; Fox, Adrian; Kalogeropoulos, George; Mackay, Sean; Hassen, Sayed; Banting, Simon; Cade, Richard

    2017-09-01

    Balloon dilatation of the ampulla at endoscopic retrograde cholangiopancreatography (ERCP) is increasingly utilized in the management of large bile duct stones. The aim of this study was to review and compare the outcomes of using endoscopic sphincterotomy with endoscopic balloon dilatation (sphincteroplasty) in a combined approach as a single-stage (immediate) or a two-stage procedure (delayed). A retrospective review of medical records for all patients undergoing ERCP and balloon dilatation for choledocholithiasis between January 2010 and December 2012 was undertaken. Outcomes measured included patient demographics, stone size, degree of dilatation performed, success of stone extraction, number of procedures required for duct clearance and procedure-related complications. One hundred and thirty-six ERCPs were performed with balloon sphincteroplasty. One hundred and four had a previous sphincterotomy with a delayed balloon dilatation and 32 had sphincterotomy with immediate dilatation. The overall clearance rate of the common bile duct for immediate and delayed groups was 93% (28/30) and 93% (81/87), respectively. Bile duct clearance after the first procedure was achieved in 70% (21/30) of patients in the immediate group and 74% (64/87) in the delayed group. There were six complications in the delayed group and four in the immediate group. The most frequently used balloon size was 10 mm for both groups with mean sizes of 10.34 (2.93) and 11.73 (2.87) in the immediate and delayed groups, respectively. Our study suggests that use of a combined approach is safe and effective and may provide benefits over using endoscopic balloon dilatation or endoscopic sphincterotomy alone in the treatment of choledocholithiasis. © 2015 Royal Australasian College of Surgeons.

  12. Safety and efficacy of microwave ablation for medically inoperable colorectal pulmonary metastases: Single-centre experience.

    PubMed

    Ferguson, Craig D; Luis, Chris R; Steinke, Karin

    2017-04-01

    To evaluate the safety and therapeutic efficacy of percutaneous microwave ablation (MWA) for colorectal pulmonary metastases. Retrospective review of CT-guided lung MWA at a single tertiary institution. Adverse events within 30 days of MWA were considered procedure-related complications. Imaging follow-up was with 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT and contrast-enhanced CT. Response of index tumours was assessed using modified response evaluation criteria in solid tumours (mRECIST). The CT-guided lung MWA was performed in 14 patients with treatment of 20 colorectal pulmonary metastases during 19 procedures. Mean follow-up from completion of the treatment protocol was 24.4 ± 11.8 months. Primary and secondary technique effectiveness rates were 75% and 50% respectively. Mean pre- and post-procedural carcino-embryonic antigen (CEA) levels were 7.9 ± 10.8 µg/L and 2.5 ± 2.1 µg/L respectively. Procedure-related complications were major in three procedures (15.8%) and minor in six procedures (31.6%). No procedure-related deaths occurred. Microwave ablation is safe and efficacious in the local control of colorectal pulmonary metastases. The frequent systemic disease progression despite local control would favour a minimally invasive treatment option over invasive surgery in the setting of oligometastatic disease. © 2017 The Royal Australian and New Zealand College of Radiologists.

  13. A descriptive single-centre experience of the management and outcome of maternal alloantibodies in pregnancy.

    PubMed

    Chatziantoniou, V; Heeney, N; Maggs, T; Rozette, C; Fountain, C; Watts, T; Harrison, C; Pasupathy, D; Sankaran, S; Kyle, P; Robinson, S

    2017-08-01

    Haemolytic disease of the fetus and newborn (HDFN) occurs when maternal IgG alloantibodies to fetal red blood cell antigens cross the placenta, causing haemolysis in the fetus and/or neonate. After delivery, the main concern is hyperbilirubinaemia, which can cause neurological damage. To summarise our current management and outcome data to inform health-care professionals counselling women whose pregnancies are at risk of HDFN and to compare these data with relevant studies. This is a retrospective descriptive study of all high-risk pregnancies at risk of HDFN at Guy's and St. Thomas' NHS Foundation Trust (GSTFT) Maternity Unit over a 7-year period. We defined high-risk pregnancies as those in whom anti-D, anti-c, anti-K or high (>32 or doubling strength) titres of all other antibodies were identified. A total of 130 pregnancies in 112 women were followed up. A single alloantibody was found in 93 pregnancies (71.5%) and multiple alloantibodies in 37 pregnancies (28.5%). Anti-D was most commonly encountered (n = 48, 36.9%), followed by anti-c (n = 31, 23.8%) and anti-E (n = 15, 11.5%). In 65 of 130 pregnancies (50%), antibody concentrations triggered scans to screen for fetal anaemia. Of 130 pregnancies, 6 (4.6%) required intrauterine transfusions, and 31 of 130 (26%) neonates required post-natal intervention. Overall, morbidity was 0.1% and mortality 0.002%. This study demonstrates that morbidity and mortality caused by HDFN is minimal. These results are reassuring for women at risk of HDFN as even severely affected cases are successfully managed in most instances. Further studies are needed to identify predictors of disease severity. © 2017 British Blood Transfusion Society.

  14. A single-centre observational cohort study of admission National Early Warning Score (NEWS).

    PubMed

    Abbott, Tom E F; Vaid, Nidhi; Ip, Dorothy; Cron, Nicholas; Wells, Matt; Torrance, Hew D T; Emmanuel, Julian

    2015-07-01

    Early warning scores are commonly used in hospitals to identify patients at risk of deterioration. The National Early Warning Score (NEWS) has recently been introduced to UK practice. However, it is not yet widely implemented. We aimed to compare NEWS to the early warning score currently used in our hospital--the Patient at Risk Score (PARS). We conducted a prospective observational cohort study of all adult general medical patients admitted to a single hospital over a 20-day period. Physiological data and early warning scores recorded in bedside charts were collected on admission and a NEWS score was retrospectively calculated. The patient notes were reviewed at 48 h after admission. The primary outcome was a composite of critical care admission or death within 2 days of admission. The secondary outcome was hospital length of stay. NEWS was more strongly associated with the primary outcome than PARS (odds ratio 1.54, p < 0.001 compared to 1.42, p = 0.056). A NEWS of 3 or more was associated with the primary outcome (odds ratio 7.03, p = 0.003). Neither score was correlated with hospital length of stay. NEWS on admission is superior to PARS for identifying patients at risk of death or critical care admission within the first 2 days of hospital stay. Current guidelines advocate a threshold of 5 for triggering a clinical review. However, since a score of 3 or more was associated with a poor outcome, this recommendation should be reviewed. Both scores were poor predictors of hospital length of stay. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  15. A single unit lymphoma experience: outcome in a Cape Town academic centre.

    PubMed

    Wood, Lucille; Robinson, Rowan; Gavine, Lindsey; Juritz, June; Jacobs, Peter

    2007-08-01

    initially given pulsed chlorambucil and sustained response was over 90% with low bulk, but declined to reach 30% as prognostic score rose. The miscellaneous categories (n<5 each) managed variably, but using the same criteria, were pooled and are presently at 62% and 30% for high and low grades. It is concluded that precise diagnosis, accurate staging and therapy on standardised risk-stratified programmes, delivered uniformly by a single multidisciplinary group, creates the all-important centre effect; matching figures are unlikely to apply outside these disciplined circumstances. The expectation from patients and referring physicians alike is that, since lymphomas are potentially curable, such an approach to comprehensive management will be regarded as standard even in an under resourced or Third World country. It follows that late referral and prior therapy will adversely affect performance status and compromise life span: These alternative approaches are inappropriate and strongly discouraged.

  16. Total knee arthroplasty revision with trabecular tantalum cones: Preliminary retrospective study of 51 patients from two centres with a minimal 2-year follow-up.

    PubMed

    Girerd, D; Parratte, S; Lunebourg, A; Boureau, F; Ollivier, M; Pasquier, G; Putman, S; Migaud, H; Argenson, J N

    2016-06-01

    Successful management of large bone defects is of crucial importance when performing revision total knee arthroplasty (TKA). Trabecular tantalum cones may improve prosthesis fixation via their potential for reconstructing a stable metaphyseal support. The objective of this study was to evaluate the clinical and radiological outcomes and the complications of tantalum cones in revision TKA. Trabecular tantalum cones provide stable and durable metaphyseal reconstruction when used during revision TKA. Trabecular Metal™ cones (Zimmer, Warsaw, IN, USA) were used for 52 revision TKAs in 51 patients (mean age, 68±9 years) managed in two centres between 2008 and 2013. A rotating hinge prosthesis was chosen for 38 (73%) knees and a condylar constrained knee prosthesis for 14 (27%) knees, with 37 tibial and 34 femoral cones. The two most common reasons for revision surgery were aseptic loosening (n=22, 42%) and infection (n=19, 37%). The bone loss was severe in most cases. At each centre, after a mean follow-up of 34 months (range, 24-52 months), two independent observers assessed the Knee Society Score (KSS), range of motion, mechanical axis, and osteo-integration for each patient. Mean KSS increased from 46 preoperatively to 77 (P=0.001) at last follow-up and the mean KSS function from 39 to 57 (P=0.007). Mean range of motion improved from 93° (45°-120°) to 110° (65°-130°) (P=0.001). Mean postoperative mechanical axis was 180° (172°-190°). Radiographic evaluation showed evidence of osteo-integration for all cones. Four revisions were performed for recurrence of infection but none for mechanical failure. The findings of our study confirm the biomechanical and biological reliability of Trabecular Metal™ cones used to fill metaphyseal bone defects during revision TKA. IV, retrospective therapeutic study. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  17. The use of erythropoietin-stimulating agents versus supportive care in newborns with hereditary spherocytosis: a single centre's experience.

    PubMed

    Morrison, Jacqueline F; Neufeld, Ellis J; Grace, Rachael F

    2014-08-01

    Hereditary Spherocytosis (HS) is a common haemolytic anaemia in which 75% of cases are autosomal dominant. As most newborns with HS have a family history of disease, haematologists often see these infants before their physiologic haemoglobin nadir, which is exaggerated in comparison with healthy infants. The objective of this study was to evaluate the frequency of implementation and cost of erythropoietin-stimulating agents (EPO) versus transfusion in infants with HS at a single paediatric programme. In the last decade, only 15% of infants with HS at our centre have been treated with EPO, which costs twice that of a single transfusion and EPO treated infants did not always avoid transfusion. Infrequent prescription of EPO therapy to infants with HS at our centre may be related to the incomplete data supporting its use.

  18. Cervical necrotizing fasciitis: descriptive, retrospective analysis of 59 cases treated at a single center.

    PubMed

    Elander, Johanna; Nekludov, Michael; Larsson, Agneta; Nordlander, Britt; Eksborg, Staffan; Hydman, Jonas

    2016-12-01

    To provide retrospective, descriptive information on patients with cervical necrotizing fasciitis treated at a single center during the years 1998-2014, and to evaluate the outcome of a newly introduced treatment strategy. Retrospective analysis of clinical data obtained from medical records. Mortality, pre-morbidity, severity of illness, primary site of infection, type of bacteria, time parameters. The observed 3-month mortality was 6/59 (10 %). The most common initial foci of the infection were pharyngeal, dental or hypopharyngeal. The most common pathogen was Streptococcus milleri bacteria within the Streptococcus anginosus group (66 % of the cases). Using a combined treatment with early surgical debridement combined with hyperbaric oxygen treatment, it is possible to reduce the mortality rate among patients suffering from cervical necrotizing fasciitis, compared to the expected mortality rate and to previous historical reports. Data indicated that early onset of hyperbaric oxygen treatment may have a positive impact on survival rate, but no identifiable factor was found to prognosticate outcome.

  19. ALPPS Procedure for Extended Liver Resections: A Single Centre Experience and a Systematic Review

    PubMed Central

    Vivarelli, Marco; Vincenzi, Paolo; Montalti, Roberto; Fava, Giammarco; Tavio, Marcello; Coletta, Martina; Vecchi, Andrea; Nicolini, Daniele; Agostini, Andrea; Ali Ahmed, Emad; Giovagnoni, Andrea; Mocchegiani, Federico

    2015-01-01

    Aim To report a single-centre experience with the novel Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) technique and systematically review the related literature. Methods Since January 2013, patients with extended primary or secondary liver tumors whose future liver remnant (FLR) was considered too small to allow hepatic resection were prospectively assessed for the ALPPS procedure. A systematic literature search was performed using PubMed, Scopus and the Cochrane Library Central. Results Until July 2014 ALPPS was completed in 9 patients whose mean age was 60±8 years. Indications for surgical resection were metastases from colorectal cancer in 3 cases, perihilar cholangiocarcinoma in 3 cases, intrahepatic cholangiocarcinoma in 2 cases and hepatocellular carcinoma without chronic liver disease in 1 case. The calculated FLR volume was 289±122 mL (21.1±5.5%) before ALPPS-1 and 528±121 mL (32.2±5.7%) before ALLPS-2 (p<0.001). The increase in FLR between the two procedures was 96±47% (range: 24–160%, p<0.001). Additional interventions were performed in 4 cases: 3 patients underwent Roux-en-Y hepaticojejunostomy, and one case underwent wedge resection of a residual tumor in the FLR. The average time between the first and second step of the procedure was 10.8±2.9 days. The average hospital stay was 24.1±13.3 days. There was 1 postoperative death due to hepatic failure in the oldest patient of this series who had a perihilar cholangiocarcinoma and concomitant liver fibrosis; 11 complications occurred in 6 patients, 4 of whom had grade III or above disease. After a mean follow-up of 17.1±8.5 months, the overall survival was 89% at 3–6 and 12 months. The recurrence-free survival was 100%, 87.5% and 75% at 3-6-12 months respectively. The literature search yielded 148 articles, of which 22 articles published between 2012 and 2015 were included in this systematic review. Conclusion The ALPPS technique effectively increased the

  20. The role of red blood cell exchange for severe imported malaria in the artesunate era: a retrospective cohort study in a referral centre.

    PubMed

    Calvo-Cano, Antonia; Gómez-Junyent, Joan; Lozano, Miguel; Castro, Pedro; Cid, Joan; Nicolás, Jose María; Quintó, Llorenç; Martin, Maite; Muñoz, Jose; Gascon, Joaquim

    2016-04-14

    Intravenous artesunate has replaced quinine as the first-line therapy for severe imported malaria, given its anti-malarial superiority shown in clinical trials conducted in endemic countries. Evidence for red blood cell (RBC) exchange in patients with severe malaria treated with artesunate is lacking. This retrospective cohort study describes the experience at Hospital Clinic of Barcelona with the use of artesunate for severe malaria and the joint use of RBC exchange in selected cases. Patients treated for severe malaria at Hospital Clinic of Barcelona between August 2013 and January 2015 were included in this retrospective study. Severe malaria was defined according to WHO criteria. Data were extracted from electronic hospital records. A log-linear mixed model approach was used to estimate parasite clearance times. Within the study period, 42 patients were diagnosed of malaria at this centre, of which 38 had Plasmodium falciparum (90.5 %). Sixteen patients (42 %) had severe malaria cases and were treated with intravenous artesunate. Four patients underwent RBC exchange within a period of 15 h after the first dose of artesunate (range 9-21 h). The procedure lasted a median of 2 h (IQR 1.8-2 h), using a median of 12 (IQR 11-14) units of packed RBCs to replace a median of 3794 ml (IQR 2977-4343). The technique was well-tolerated without haemodynamic complications. There were no deaths. The regression model showed an estimated time to 95 % decay of 21.6 h (95 % CI 17.3-28.8). When assessing effect modification by RBC exchange, there was no difference in the parasite elimination rate (p = 0.286). In this study RBC exchange failed to show benefits in terms of parasite clearance probably due to the small number of patients analysed. The evidence for exchange transfusion remains limited.

  1. PFO closure with only fluoroscopic guidance: 7 years real-world single centre experience.

    PubMed

    Mangieri, Antonio; Godino, Cosmo; Montorfano, Matteo; Arioli, Francesco; Rosa, Isabella; Ajello, Silvia; Piraino, Daniela; Monello, Alberto; Pavon, Anna Giulia; Viani, Giacomo; Magni, Valeria; Cappelletti, Alberto; Margonato, Alberto; Colombo, Antonio

    2015-07-01

    To evaluate the safety and the efficacy of fluoroscopy-guided only (Fluo-G) and of echocardiography-guided (Echo-G; trans-esophageal echocardiography-TEE-or intracardiac echocardiography-ICE) percutaneous closure of patent foramen ovale (PFO). Single center retrospective registry enrolling 368 consecutive patients (mean age 50.5 years) who underwent PFO closure between June 2004 and December 2011. Most patients had prior cryptogenic stroke (n = 126; 34.2%), TIA (n = 218; 51.1%); some of these had recurrent neurological events [multiple strokes n = 28 (7.8%); multiple TIAs n = 72 (18.6%)]. All the patients underwent a preprocedure TEE. PFO closure was performed with Echo-G in 187 patients (50.8%) (TEE n = 69, 36.8% and ICE n = 124, 66.3%). In Fluo-G cases, PFO with atrial septal aneurysm (ASA) was significantly less present (P < 0.005) and smaller devices (<25 mm) were implanted more frequently (P < 0.001). Both fluoroscopy and total procedural time were lower in the Fluo-G group (P < 0.0001). No differences were found in terms of successful device deployment (98.3% Fluo-G vs. 98.3% Echo-G) and RtL-shunt at follow-up (11.7% Fluo-G vs. 7.6% Echo-G). The rate of conversion from Fluoro-G to Echo-G procedure was 4.4% (n = 8). At a median follow-up of 4 years, freedom from recurrent embolic events rate was similar between the two groups (Echo-G 94.5 vs. Fluo-G 95.7%). In our experience Fluoro-G PFO closure was performed mainly in cases of simple anatomy, with similar results in terms of safety and efficacy compared to Echo-G cases. Both fluoroscopy and total procedural times were lower in the Fluo-G cases. © 2015 Wiley Periodicals, Inc.

  2. High-dose chemotherapy and autologous stem cell transplantation for primary central nervous system lymphoma: a multi-centre retrospective analysis from the United Kingdom.

    PubMed

    Kassam, S; Chernucha, E; O'Neill, A; Hemmaway, C; Cummins, T; Montoto, S; Lennard, A; Adams, G; Linton, K; McKay, P; Davies, D; Rowntree, C; Easdale, S; Eyre, T A; Marcus, R; Cwynarski, K; Fox, C P

    2017-09-01

    The prognosis of patients with primary central nervous system lymphoma (PCNSL) has improved in recent years. This has partly been achieved by remission induction protocols incorporating high-dose methotrexate (HD-MTX) and rituximab. Given the high rates of relapse, consolidation therapy is usually considered in first response. Whole brain radiotherapy may prolong PFS but appears to confer no long-term survival advantage and is associated with significant neurocognitive dysfunction. Attempts to improve efficacy and reduce neurotoxicity of consolidation therapy have included thiotepa-based high-dose chemotherapy and autologous stem cell transplant (HDC-ASCT). This multi-centre, retrospective study reports the outcome of 70 patients undergoing HDC-ASCT for PCNSL in the United Kingdom. The median age at diagnosis was 56 years and all patients received HD-MTX-containing induction regimens. All patients underwent HDC-ASCT in first response. The rate of complete response increased from 50% before HDC-ASCT to 77% following HDC-ASCT. Treatment-related mortality was 6%. At a median follow-up of 12 months from HDC-ASCT, the estimated 1- and 2-year PFS rates were 71.5% and overall survival 86.4% and 83.3%, respectively. These data are comparable to published studies of HDC-ASCT for PCNSL, supporting its feasibility and efficacy.

  3. [IKARUS Project--incidence of bone events in breast cancer: retrospective analysis of patients in oncological centres in the Czech Republic and Slovakia].

    PubMed

    Fínek, J; Prausová, J; Cmejlová, V; Cwiertka, K; Svébisová, H; Vyzula, R; Holánek, M; Bodorová, M; Slavícek, L; Kubecová, M; Loukotková, L; Neumanová, R; Lepeyová, K; Lysý, M; Smejkal, J; Soumarová, R; Rysková, J; Kalisová, K; Machanová, J; Bohusová, M; Alaksa, V; Stresko, M; Samanová, T; Kůta, M; Vanásek, J; Vondrácková, K; Vargovcíková, M; Petera, J; Pritzová, E; Bednarík, O; Hlavácová, A; Jancoková, I; Szeghöová, O; Dammak, A; Lesková, J; Chroust, K; Dusek, L

    2009-01-01

    Bone incidents today represent, in terms of frequency and the overall effect on the quality of life of patients with breast cancer, a serious health problem. In a number of clinical studies bisphosphonates have been shown to have a positive impact on reducing the risk of bone events and therefore to be effective in the prevention of bone events. The primary objective of this project was to identify the incidence of bone events in patients with metastatic breast cancer treated in the Czech and Slovak Republics. Retrospective, multi-centre, non-interventional, epidemiological and explorative studies to identify the incidence of bone events in the defined group of patients and a description of the practice of prevention and treatment of skeletal events in the years 2000-2005. Enrolled were patients with advanced metastatic breast cancer diagnosed in 2000. Analysis of overall survival and survival to disease progression, analysis of patterns of treatment of bone events and the practice of the use of bisphosphonates in the prevention of bone events in metastatic skeleton affection in the normal conditions of clinical practice, analysis of patient compliance in the treatment with bisphosphonates, analysis of the time interval between the occurrence of bone metastases and the occurrence of bone events and, last but not least, survival analysis of patients in relation to bone events. This work has shown that the practice of treatment with bisphosphonates since 2000 and assessed the survival of patients with metastatic breast cancer.

  4. Clinical profile and factors associated with mortality in hospitalized patients with HIV/AIDS: a retrospective analysis from Tripoli Medical Centre, Libya, 2013.

    PubMed

    Shalaka, N S; Garred, N A; Zeglam, H T; Awasi, S A; Abukathir, L A; Altagdi, M E; Rayes, A A

    2015-10-02

    In Libya, little is known about HIV-related hospitalizations and in-hospital mortality. This was a retrospective analysis of HIV-related hospitalizations at Tripoli Medical Centre in 2013. Of 227 cases analysed, 82.4% were males who were significantly older (40.0 versus 36.5 years), reported injection drug use (58.3% versus 0%) and were hepatitis C virus co-infected (65.8% versus 0%) compared with females. Severe immunosuppression was prevalent (median CD4 count = 42 cell/μL). Candidiasis was the most common diagnosis (26.0%); Pneumocystis pneumonia was the most common respiratory disease (8.8%), while cerebral toxoplasmosis was diagnosed in 8.4% of patients. Current HAART use was independently associated with low risk of in-hospital mortality (OR 0.33), while central nervous system symptoms (OR 4.12), sepsis (OR 6.98) and low total lymphocyte counts (OR 3.60) were associated with increased risk. In this study, late presentation with severe immunosuppression was common, and was associated with significant in-hospital mortality.

  5. Comparison of clinical outcomes in diabetic and non-diabetic burns patients in a national burns referral centre in southeast Asia: A 3-year retrospective review.

    PubMed

    Low, Zhao-Kai; Ng, Wai-Yee; Fook-Chong, Stephanie; Tan, Bien-Keem; Chong, Si-Jack; Hwee, Jolie; Tay, Sook-Muay

    2017-03-01

    Diabetic burns patients may be at risk of worse clinical outcomes. This study aims to further investigate the impact of diabetes mellitus on clinical outcomes in burns patients in Singapore. A 3-year retrospective review was performed at the Singapore General Hospital Burns Centre (2011-2013). Pure inhalational burns were excluded. Diabetic (N=53) and non-diabetic (N=533) patients were compared, and the impact of diabetes on clinical outcomes, adjusting for confounders, was investigated using multivariate logistic regression. The diabetic group had a significantly higher incidence of wound infection and severe renal impairment, as well as a longer length of stay, higher number of operations and higher rate of unplanned readmission. ICU admission was significantly associated with hyperglycaemia (OR 5.44 [2.61-11.35], p<0.001) and a higher total body surface area of burn (OR per 1% TBSA 1.07 [1.05-1.09], p<0.001). Unplanned readmission was significantly associated with wound infection (OR 4.29 [1.70-10.83], p=0.002), and mortality associated with a higher TBSA (OR per 1% TBSA 1.1 [1.07-1.14], p<0.001). After adjusting for confounders, diabetes mellitus was not significantly associated with unplanned readmission or mortality. Diabetic burns patients have an increased risk of worse clinical outcomes, including wound infections, renal impairment and longer length of stay. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  6. Impact of single centre kidney paired donation transplantation to increase donor pool in India: a cohort study.

    PubMed

    Kute, Vivek B; Patel, Himanshu V; Shah, Pankaj R; Modi, Pranjal R; Shah, Veena R; Rizvi, Sayyed J; Pal, Bipin C; Shah, Priyadarshini S; Modi, Manisha P; Butala, Beena P; Wakhare, Pavan S; Varyani, Umesh T; Shinde, Saiprasad G; Ghodela, Vijay A; Kasat, Govind S; Patil, Mayur V; Patel, Jaydeep C; Kumar, Deepk P; Trivedi, Varsha B; Patel, Minaxi H; Trivedi, Hargovind L

    2017-07-01

    In a living donor kidney transplantation (LDKT) dominated transplant programme, kidney paired donation (KPD) may be a cost-effective and valid alternative strategy to increase LDKT in countries with limited resources where deceased donation kidney transplantation (DDKT) is in the initial stages. Here, we report our experience of 300 single-centre KPD transplantations to increase LDKT in India. Between January 2000 and July 2016, 3616 LDKT and 561 DDKT were performed at our transplantation centre, 300 (8.3%) using KPD. The reasons for joining KPD among transplanted patients were ABO incompatibility (n = 222), positive cross-match (n = 59) and better matching (n = 19). A total of 124 two-way (n = 248), 14 three-way (n = 42), one four-way (n = 4) and one six-way exchange (n = 6) yielded 300 KPD transplants. Death-censored graft and patient survival were 96% (n = 288) and 83.3% (n = 250), respectively. The mean serum creatinine was 1.3 mg/dl at a follow-up of 3 ± 3 years. We credit the success of our KPD programme to maintaining a registry of incompatible pairs, counselling on KPD, a high-volume LDKT programme and teamwork. KPD is legal, cost effective and rapidly growing for facilitating LDKT with incompatible donors. This study provides large-scale evidence for the expansion of single-centre LDKT via KPD when national programmes do not exist. © 2017 Steunstichting ESOT.

  7. Active charge state control of single NV centres in diamond by in-plane Al-Schottky junctions

    NASA Astrophysics Data System (ADS)

    Schreyvogel, C.; Polyakov, V.; Wunderlich, R.; Meijer, J.; Nebel, C. E.

    2015-07-01

    In this paper, we demonstrate an active control of the charge state of a single nitrogen-vacancy (NV) centre by using in-plane Schottky-diode geometries with aluminium on hydrogen-terminated diamond surface. A switching between NV+, NV0 and NV- can be performed with the Al-gates which apply electric fields in the hole depletion region of the Schottky junction that induces a band bending modulation, thereby shifting the Fermi-level over NV charge transition levels. We simulated the in-plane band structure of the Schottky junction with the Software ATLAS by solving the drift-diffusion model and the Poisson-equation self-consistently. We simulated the IV-characteristics, calculated the width of the hole depletion region, the position of the Fermi-level intersection with the NV charge transition levels for different reverse bias voltages applied on the Al-gate. We can show that the field-induced band bending modulation in the depletion region causes a shifting of the Fermi-level over NV charge transition levels in such a way that the charge state of a single NV centre and thus its electrical and optical properties is tuned. In addition, the NV centre should be approx. 1-2 μm away from the Al-edge in order to be switched with moderate bias voltages.

  8. AT-09BEVACIZUMAB AND GLIOBASTOMA OF THE ELDERLY: A SINGLE-CENTER RETROSPECTIVE ANALYSIS

    PubMed Central

    Barrascout, Eduardo; Lamuraglia, Michele; Gervais, Claire; Tiako, Manuela; Gaillard, Stephan; Aldea, Sorin; Mabro, May; Gachet, Julie; Theodore, Christine

    2014-01-01

    PURPOSE: The primary objective of this study was to determine any difference in progression free survival (PFS), overall survival (OS), clinical benefit and tolerability between elderly and non-elderly patients receiving bevacizumab at recurrence for glioblastoma in a single center. PATIENTS AND METHODS: We retrospectively analyzed 32 patients with recurrent glioblastoma receiving bevacizumab (10 mg/kg every 14 days) between January 2011 and December 2013 in second line. Bevacizumab was introduced for all patients at recurrence after a treatment of first line by temozolomide. A cohort of 14 patients was older than 70 years against 18 patients were under 70 years. RESULTS: No statistically significant difference was detected in terms of PFS and OS. PFS was 2.8 months for elderly patients against 2.9 for non-elderly patients (p >0.5). OS from recurrence in elderly and non-elderly patients was respectively 4.3 and 5.5 months (p >0,5). Clinical improvement in neurological symptoms was observed in 3 of 14 elderly patients (21.1%) and 11 of 18 young patients (61.1%). A more important improvement in performance status was observed in young patients. Regarding toxicity, 3 of the 14 elderly patients experienced grade II or III hypertension. In younger patients, 5 adverse events have been observed (2 proteinuria, 1 hypertension, 1 hemorrhage and 1 anal abscess). CONCLUSION: Despite small number of patients in this retrospective study, the efficacy and safety of bevacizumab in recurrent glioblastoma appears similar in elderly and non-elderly patients. However, clinical benefit seemed to be less important in elderly patients. A prospective multicentric study integrating geriatric assessment tools and quality of life would be interesting in this patient's population.

  9. Human tuberculosis caused by Mycobacterium bovis: a retrospective comparison with Mycobacterium tuberculosis in a Mexican tertiary care centre, 2000-2015.

    PubMed

    Torres-Gonzalez, Pedro; Cervera-Hernandez, Miguel E; Martinez-Gamboa, Areli; Garcia-Garcia, Lourdes; Cruz-Hervert, Luis P; Bobadilla-Del Valle, Miriam; Ponce-de Leon, Alfredo; Sifuentes-Osornio, Jose

    2016-11-08

    Human tuberculosis caused by Mycobacterium bovis is believed to be frequent in developing countries. Transmission is usually through ingestion of unpasteurized dairy products, although airborne contagion is possible. Disease caused by M. tuberculosis or M. bovis is clinically indistinguishable from each other. The aim of this study was to determine the factors associated with M. bovis disease. Retrospective analysis of all culture-positive cases of M. bovis and M. tuberculosis from 2000 to 2015, in a Mexican tertiary-care centre. Sociodemographic, clinical, and radiographic data from medical records were compared. Disease site was classified as pulmonary, extrapulmonary, or pulmonary and extrapulmonary, based on cultures. We evaluated 533 cases, 372 (69.7 %) of which were caused by M. tuberculosis and 161 (30.2 %) by M. bovis. Characteristics associated with M. bovis disease were: younger age (aOR 0.97, 95 % CI 0.95-0.98), glucocorticoid use (aOR 2.27, 95 % CI 1.42-3.63), and extrapulmonary disease (aOR 1.80, 95 % CI 1.21-2.69). M. tuberculosis was associated with lower socioeconomic status (aOR 0.52, 95 % CI 0.28-0.97). When we analysed only pulmonary cases, younger age (aOR 0.97, 95 % CI 0.96-0.99), glucocorticoid use (aOR 2.41, 95 % CI 1.30-4.46), and smoking (aOR 1.94, CI 95 % 1.15-3.27) were associated with M. bovis. Both groups showed similar proportions of direct microscopy smear results (respiratory samples) and chest X-ray cavitations. Younger age, glucocorticoid use, and extrapulmonary disease were associated with M. bovis as the causative agent of tuberculosis in a group of patients from a tertiary care centre in a country where bovine tuberculosis is endemic. Further studies must be conducted in the general population to determine pathogen-specific associated factors and outcomes.

  10. Triple-negative breast cancer: the impact of guideline-adherent adjuvant treatment on survival--a retrospective multi-centre cohort study.

    PubMed

    Schwentner, L; Wolters, R; Koretz, K; Wischnewsky, M B; Kreienberg, R; Rottscholl, R; Wöckel, A

    2012-04-01

    Triple-negative breast cancer (TNBC) (ER-/PGR-/erb-2-) constitutes an aggressive subtype in breast cancer because it is accompanied by a significant decrease in overall survival (OAS) and recurrence-free survival (RFS) compared with hormone receptor positive breast cancers. This retrospective cohort study investigates the following issues: (1) Is there an impact of guideline-adherent treatment on RFS and OAS in TNBC? (2) Which adjuvant treatment has the most important impact on RFS and OAS in TNBC? This German retrospective multi-centre cohort study included 3,658 patients with primary breast cancer recruited from 2000 to 2005. The definition of guideline adherence was based on the German national S3 guideline for diagnosis and treatment of breast cancer (2004). A total of 371 patients (10.1%) had TNBC. Compared with HR+/erb-2- breast cancer (P = 0.001; HR = 1.75; 95% CI: 1.27-2.40), the recurrence rate of TNBC was significantly higher (P < 0.001; HR = 2.86; 95% CI: 2.17-3.76). Furthermore, the 5-year RFS and OAS was significantly lower in TNBC (RFS: 74.8% [95% CI: 68.8-80.8%] vs. 86.5% [95% CI: 84.6-88.4%] [log-rank P = 0.0001]) (OAS: 75.8% [95% CI: 69.9-81.8%] vs. 86.0% [95% CI: 84.1-87.9%] [log-rank P = 0.0001]). The most important parameters predicting RFS and OAS in TNBC after receiving guideline-conform chemotherapy are guideline-adherent surgery, radiotherapy, nodal status and grading. Overall, 66.8% TNBC were found with one or more (18%) guideline violations, which subsequently impaired OAS and RFS. The most important impact on OAS and RFS in TNBC patients was because of guideline violations (GV) concerning adjuvant radiotherapy and GV concerning adjuvant chemotherapy. Patients with TNBC primarily have a worse prognosis in terms of RFS and OAS than patients of a primarily non-TNBC phenotype. There is a strong association between guideline-adherent adjuvant treatment and improved survival outcome in TNBC. The outcome significantly decreases with the number

  11. Maternal and Fetal Outcomes After Lamotrigine Use in Pregnancy: A Retrospective Analysis from an Urban Maternal Mental Health Centre in New Zealand

    PubMed Central

    Prakash, Chandni; Hatters-Friedman, Susan; Moller-Olsen, Charmian; North, Abigail

    2016-01-01

    Introduction Pregnancy is a vulnerable period for recurrence of bipolar disorder. Discontinuation of mood stabilisers during pregnancy and the postpartum period can significantly increase the risk of recurrence of bipolar disorder. Lamotrigine is an anti-epileptic drug that has been approved for the maintenance treatment of bipolar disorder. Epilepsy literature has indicated that lamotrigine has a reassuring safety profile in pregnancy but there is little information on its effectiveness and safety in pregnant women with mental disorders. Method We conducted a retrospective review of all pregnant women who presented to an urban maternal mental health centre in Auckland, New Zealand between 2012 and 2014 and were treated with antipsychotics and/or mood stabilisers. Pregnancy outcome, obstetric and perinatal complications, congenital malformations and maternal mental health in the postnatal period were considered. Results Here, we present the outcomes in the subset of six women who were treated with lamotrigine 100–400 mg/day for the entire pregnancy. Five were diagnosed with bipolar disorder and one with major depression. Three women received additional psychotropic medication during pregnancy. No women needed psychiatric hospitalisation. All babies were live birth after 36 weeks gestation. Two babies had low birth weight and required NICU admissions. Two women required lower segment caesarean section and the other 4 were induced. A trachea-esophageal fistula was noted in one baby. Four babies who were breastfed while their mothers received uninterrupted treatment with lamotrigine, experienced no complications. Discussion This naturalistic study indicates that lamotrigine can be an effective treatment option for maintenance of bipolar illness in women of childbearing age. PMID:27738382

  12. Thulium Vaporesection of the Prostate and Thulium Vapoenucleation of the Prostate in Patients on Oral Anticoagulants: A Retrospective Three-Centre Matched-Paired Comparison.

    PubMed

    Netsch, Christopher; Magno, Carlo; Butticè, Salvatore; Macchione, Luciano; Mucciardi, Giuseppe; Herrmann, Thomas R W; Gross, Andreas J

    2016-01-01

    To evaluate the short-term results of thulium vaporesection of the prostate (ThuVEP) and thulium vapoenucleation of the prostate (ThuVARP) in patients with benign prostatic obstruction on oral anticoagulants (OA). A 3-centre retrospective matched-paired comparison of patients treated by ThuVEP (n = 26) or ThuVARP (n = 26) was performed. Thirty-four patients were on aspirin/ticlopidin, 7 on clopidogrel or clopidogrel and aspirin, and 11 on phenprocoumon at the time of surgery. Haemoglobin decrease was higher after ThuVEP compared to ThuVARP (1.5 vs. 0.3 g/dl, p < 0.001). The rate of postoperative blood transfusions (3.9 vs. 0%), clot retention (3.9 vs. 0%), and re-operation (7.7 vs. 0%) was not different between ThuVEP and ThuVARP (p = 0.274). Catheterization time was shorter for ThuVARP (1 vs. 2 days, p < 0.01). Qmax was significantly higher after ThuVEP at 6-month follow-up (31 vs. 21.5 ml/s, p < 0.001), while improvements in International Prostate Symptom Score, quality of life, and post-voiding residual urine showed no differences between the groups. Urethral or bladder neck strictures did not occur during the 6-month follow-up in both groups. ThuVEP and ThuVARP are safe and efficacious procedures in patients on OA. Although patients assigned to ThuVEP had higher Qmax at 6-month follow-up, ThuVARP resulted in similar functional outcomes. © 2015 S. Karger AG, Basel.

  13. Causes of Morbidity in Wild Raptor Populations Admitted at a Wildlife Rehabilitation Centre in Spain from 1995-2007: A Long Term Retrospective Study

    PubMed Central

    Molina-López, Rafael A.; Casal, Jordi; Darwich, Laila

    2011-01-01

    Background Morbidity studies complement the understanding of hazards to raptors by identifying natural or anthropogenic factors. Descriptive epidemiological studies of wildlife have become an important source of information about hazards to wildlife populations. On the other hand, data referenced to the overall wild population could provide a more accurate assessment of the potential impact of the morbidity/mortality causes in populations of wild birds. Methodology/Principal Findings The present study described the morbidity causes of hospitalized wild raptors and their incidence in the wild populations, through a long term retrospective study conducted at a wildlife rehabilitation centre of Catalonia (1995–2007). Importantly, Seasonal Cumulative Incidences (SCI) were calculated considering estimations of the wild population in the region and trend analyses were applied among the different years. A total of 7021 birds were analysed: 7 species of Strigiformes (n = 3521) and 23 of Falconiformes (n = 3500). The main causes of morbidity were trauma (49.5%), mostly in the Falconiformes, and orphaned/young birds (32.2%) mainly in the Strigiformes. During wintering periods, the largest morbidity incidence was observed in Accipiter gentillis due to gunshot wounds and in Tyto alba due to vehicle trauma. Within the breeding season, Falco tinnunculus (orphaned/young category) and Bubo bubo (electrocution and metabolic disorders) represented the most affected species. Cases due to orphaned/young, infectious/parasitic diseases, electrocution and unknown trauma tended to increase among years. By contrast, cases by undetermined cause, vehicle trauma and captivity decreased throughout the study period. Interestingly, gunshot injuries remained constant during the study period. Conclusions/Significance Frequencies of morbidity causes calculated as the proportion of each cause referred to the total number of admitted cases, allowed a qualitative assessment of hazards for

  14. [Fingolimod: effectiveness and safety in routine clinical practice. An observational, retrospective, multi-centre study in Navarra, Gipuzkoa and La Rioja].

    PubMed

    Ayuso, T; Marzo-Sola, M E; Castillo-Trivino, T; Soriano, G; Otano, M A; Lopez, M A; Croitoru, I M; Olascoaga, J

    2016-09-05

    To evaluate the effectiveness and safety of fingolimod in clinical practice in Navarra, Gipuzkoa and La Rioja regions. We conducted a retrospective multi-centre study with recurrent multiple sclerosis patients treated with fingolimod, following the product data sheet. The following data were evaluated: annualised relapse rate (ARR), percentage of patients free from relapses, disability using the Expanded Disability Status Scale (EDSS) and the percentage of patients without gadolinium-enhancing lesions. A total of 113 patients were treated with fingolimod: 6% were naive, and 58% and 35% were patients previously treated with an immunomodulator and natalizumab, respectively. Fingolimod lowered the ARR after the first (67%; 1 to 0.3; p < 0.0001) and second (89%; 1 to 0.1; p < 0.0001) years of treatment, and thus the number of patients free from relapses during the treatment increased. The baseline EDSS was 3 and after treatment with fingolimod was 2.5 in both years. The percentage of patients without gadolinium-enhancing lesions after the first year of treatment was 77%. Similar results were observed in naive patients and in those previously treated with an immunomodulator. In patients previously treated with natalizumab no changes were observed following the treatment. The use of fingolimod in clinical practice showed an effectiveness similar to that observed in clinical trials. There were no changes in the ARR after changing from natalizumab, and only one patient presented a 'relapse' after withdrawal of natalizumab. Fingolimod acts like a safe drug, with scarce side effects and a low percentage of drop-outs.

  15. Causes of morbidity in wild raptor populations admitted at a wildlife rehabilitation centre in Spain from 1995-2007: a long term retrospective study.

    PubMed

    Molina-López, Rafael A; Casal, Jordi; Darwich, Laila

    2011-01-01

    Morbidity studies complement the understanding of hazards to raptors by identifying natural or anthropogenic factors. Descriptive epidemiological studies of wildlife have become an important source of information about hazards to wildlife populations. On the other hand, data referenced to the overall wild population could provide a more accurate assessment of the potential impact of the morbidity/mortality causes in populations of wild birds. The present study described the morbidity causes of hospitalized wild raptors and their incidence in the wild populations, through a long term retrospective study conducted at a wildlife rehabilitation centre of Catalonia (1995-2007). Importantly, Seasonal Cumulative Incidences (SCI) were calculated considering estimations of the wild population in the region and trend analyses were applied among the different years. A total of 7021 birds were analysed: 7 species of Strigiformes (n = 3521) and 23 of Falconiformes (n = 3500). The main causes of morbidity were trauma (49.5%), mostly in the Falconiformes, and orphaned/young birds (32.2%) mainly in the Strigiformes. During wintering periods, the largest morbidity incidence was observed in Accipiter gentillis due to gunshot wounds and in Tyto alba due to vehicle trauma. Within the breeding season, Falco tinnunculus (orphaned/young category) and Bubo bubo (electrocution and metabolic disorders) represented the most affected species. Cases due to orphaned/young, infectious/parasitic diseases, electrocution and unknown trauma tended to increase among years. By contrast, cases by undetermined cause, vehicle trauma and captivity decreased throughout the study period. Interestingly, gunshot injuries remained constant during the study period. Frequencies of morbidity causes calculated as the proportion of each cause referred to the total number of admitted cases, allowed a qualitative assessment of hazards for the studied populations. However, cumulative incidences based on

  16. Long-term, retrospective evaluation (implant and patient-centred outcome) of the two-implants-supported overdenture in the mandible. Part 1: survival rate.

    PubMed

    Vercruyssen, M; Marcelis, K; Coucke, W; Naert, I; Quirynen, M

    2010-04-01

    This retrospective analysis evaluated the long-term outcome of two implants supporting an overdenture in the mandible, as well as the significance of some confounding factors (smoking, implant length, bone quality). All mandibular overdenture cases (n=495) treated during the past 25 years in our centre (with > or = 5 years loading of the implants) were included in this study. General information (medical history, implant data, report on surgery) was retrieved from the patient's file. A large number of patients (n=248) were willing to visit the clinic for an additional follow-up visit. For the others, information on implant survival was collected by phone (n=121), or contact was impossible (57 had died, three were hospitalized and 66 could not be reached). In the latter group, information was used, up to their last visit to the clinic. An implant was considered as surviving if it was still in function in the mouth, without clear adverse effects (pain, swelling, mobility). A failure was defined as early if it occurred within the window, insertion-final prosthesis placement; afterwards, it was considered as late. Most of the inserted implants (Brånemark type) were of the turned (machined) type (95.5%), the remainder was anodized (TiUnite). The anchoring system was either a bar (86.3%), ball attachments (11.7%) or magnets (1.6%), and only some patients changed from one to the other (0.4%). Kaplan-Meier analyses showed a survival rate of 95.5% after 20 years of loading. Factors that influenced the outcome included smoking (90% rate for smokers) and the surgical protocol (reduced survival rate for one-stage-placed implants). Implant length and bone quality had no impact. These results fully support the two-implant overdenture concept in the mandible even in the long run.

  17. EVALUATION AND MANAGEMENT OF DIFFICULT AIRWAY IN OBESITY A SINGLE CENTER RETROSPECTIVE STUDY.

    PubMed

    Ayhan, Asude; Kaplan, Serife; Kayhan, Zeynep; Arslan, Gulnaz

    2016-03-01

    The primary aim of this single center retrospective study was to evaluate difficult mask ventilation (DMV) and difficult laryngoscopy (DL) in a unique group of obese patients. A total of 427 adult patients with body mass index (BMI) ≥ 25 and surgically treated for endometrial cancer from 2011 to 2014 were assessed. Additional increase in BMI, comorbidities, bedside screening tests for risk factors, and the tools used to manage the patients were noted and their effects on DMV and/or DL investigated. Every escalation in the number of risk factors increased the probability of DMV 2.2-fold, DL 1.8-fold and DMV+DL 3.0-fold. Among bedside tests, limited neck movement (LNM), short neck (SN) and absence of teeth were significant for DMV (p < 0.05), LNM, SN and obstructive sleep apnea for DL (p < 0.05), and LNM and SN for DMV+DL (p < 0.05). However, a 10-point increase of BMI was not an independent risk factor when patients with BMI > 25% were considered. In conclusion, LNM and SN are independent risk factors for developing DMV and/or DL in obese endometrial cancer patients, while BMI increase over 30 was not additionally affecting difficult airway.

  18. The Prognostic Impact of the Carcinoembryonic Antigen in Ampullary Cancer - A Retrospective Single Center Study

    PubMed Central

    Fuellgraf, Hannah; Schilling, Oliver; Lai, Zon Weng; Kulemann, Birte; Timme, Sylvia; Makowiec, Frank; Shahinian, Jasmin H.; Hoeppner, Jens; Werner, Martin; Hopt, Ulrich T.; Wellner, Ulrich F.; Bronsert, Peter

    2017-01-01

    Background: Carcinoembryonic antigen cell adhesion molecule (CEA) is a commonly immunohistochemically used antibody in pathological routine diagnostics with an overexpression in different cancers. We aimed to examine the immunohistochemically detectable CEA level in ampullary cancer and to correlate it with clinico-pathological data. Methods: Shot-gun proteomics revealed CEA in undifferentiated ampullary cancer cell lines. Next, tumor tissue of 40 ampullary cancers of a retrospective single center cohort of 40 patients was stained immunohistochemically for CEA; CEA expression was determined and correlated with clinico-pathological data. Results: Thirty-six patient specimens were included in statistical analysis. CEA expression and lymph node ratio (LNR) were the only independent predictors of overall survival in multivariate analysis. Conclusion: To our knowledge, cell line and patient cohorts are the largest and characterized cohorts examined for CEA so far. Hereby, CEA expression in ampullary cancer cells permits an estimation of outcome and suggests an opportunity for individualized CEA-directed therapy. Further trials with larger cohorts are needed to verify our results and to integrate CEA immunohistochemistry into clinical routine. PMID:28367245

  19. Retrospective Assessment of the Implementation of Critical Pathway in Stroke Patients in a Single University Hospital

    PubMed Central

    Kim, Jin Hoan; Byun, Ha Young; Son, Seungnam; Lee, Joong Hoon; Yoon, Chul Ho; Lee, Eun Shin; Shin, Heesuk

    2014-01-01

    Objective To evaluate the effects of the implementation of critical pathway (CP) in stroke patients treated at a single university hospital. Methods A retrospective medical review collected data from 497 patients who had suffered acute stroke in the rehabilitation center. Stroke outcomes were compared between before and after the implementation of CP based on factors including demographic factors, stroke characteristics, pre-existing medical conditions, medical complications, functional states, and length of stay (LOS). Results After the implementation of CP, the patients showed significantly higher stage for upper proximal (p=0.008) and lower extremity (p=0.001) on Brunnstrom stage and significantly lower scores for modified Rankin Scale (p=0.003) at transfer. For those with pre-existing medical conditions, there were significantly increased osteoarthritis (p=0.002) and valvular heart disease (p=0.011). Regarding medical complications during acute inpatient rehabilitation, there were significantly decreased shoulder pain (p=0.001) and dysphagia (p=0.017), and significantly increased gastrointestinal symptoms (p=0.001). Functional gain and efficiency of stroke patients during rehabilitation center hospitalization did not significantly change after implementation of CP. But, shorter LOS of total hospitalization, pre-rehabilitation center hospitalization, and rehabilitation center hospitalization were evident. Conclusion After the implementation of CP, patients less often developed complications and displayed no changes in functional gain and efficiency. They had shorter LOS of total hospitalization, pre-rehabilitation center hospitalization and rehabilitation center hospitalization. PMID:25379489

  20. Relevance of blood cultures in acute pyelonephritis in a single-center retrospective study.

    PubMed

    Ledochowski, Stanislas; Abraham, Paul-Samuel; Jacob, Xavier; Dumitrescu, Oana; Lina, Gérard; Lepape, Alain; Piriou, Vincent; Wallet, Florent; Friggeri, Arnaud

    2015-08-01

    Pyelonephritides are frequently encountered diagnosis in Emergency Departments. Urinalyses have a central place in the management of this situation but the usefulness of blood cultures is not clear. We conducted a single-center retrospective study of 24 months to study the microbiological relevance of blood cultures in pyelonephritis. We included patients with blood cultures (BC) and urine cultures (UC) drawn at the same time, if they were not exposed to antibiotics prior to these tests. Of our 264 patients, 39 (15 %) had no bacteriological documentation. There were 83 (31 %) bacteremic patients. Seven patients had contaminated or sterile UC with positive BC. Four patients had positive UC and BC with the latter allowing identification of a pathogen absent from the UC (n = 1) or identifying the main pathogen in three cases. A total of 11 patients theoretically benefited from BC representing 4.2 % of our population. Excluding one patient who was known to be infected with multi-drug resistant bacteria, all empirical antibiotics regimens were effective against the identified pathogens. We did not reveal any significant therapeutic impact of blood cultures in the management of pyelonephritis, when BC and UC are performed before any antimicrobials treatment.

  1. Perineal pain secondary to tethered cord syndrome: retrospective review of single institution experience.

    PubMed

    Robbins, J Will; Lundy, Paige A; Gard, Andrew P; Puccioni, Mark J

    2015-11-01

    Tethered cord syndrome (TCS) encompasses a spectrum of neurological dysfunction related to excessive tension on the distal spinal cord resulting in anatomic deformation and metabolic disturbance. Symptoms typically manifest as back/leg pain, neurogenic bladder dysfunction, constipation, sphincter abnormalities, and scoliosis. To date, among the least well-described symptoms of TCS is pain or hypersensitivity in the perineal region. The authors reviewed their experience with spinal cord detethering to identify and further characterize those who present with perineal pain or hypersensitivity. Cases of spinal cord detethering at a single institution were retrospectively reviewed. Patients were initially identified by procedural codes. Cases were reviewed for presenting symptoms, specifically perineal pain or hypersensitivity. Magnetic resonance image (MRI) findings, clinical outcome, and length of follow-up were also noted. Of the 491 patients identified, seven patients (1.4%) were identified as having preoperative perineal pain or hypersensitivity. All of these patients had complete resolution of perineal pain/hypersensitivity at the time of last follow-up. Furthermore, five (71%) of these patients experienced resolution of all initial symptoms. Perineal pain or hypersensitivity can be an important symptom of spinal cord tethering. Spinal cord detethering may result in a good outcome and relief of perineal pain or hypersensitivity.

  2. Parallel enzyme-linked immunosorbent assay screening for human immunodeficiency virus among blood donors in five Chinese blood centres: a retrospective analysis.

    PubMed

    Zeng, P; Liu, J; Wang, J; Dong, X; Li, J; Bi, X; Ma, H; Wen, X; He, M; Liu, Y; Ness, P; Shan, H

    2015-08-01

    To evaluate the strategy of parallel screening with different enzyme-linked immunosorbent assays (ELISA) among Chinese blood donors. Parallel screening with ELISA has been the main strategy to detect human immunodeficiency virus (HIV) in blood donations in China for more than a decade. The performance of the strategy should be analysed. A total of 821,927 donations collected from five Chinese blood centres in 2008-2010 were tested using two third-generation ELISAs by different manufacturers licenced and confirmed by the Western blot (WB) in this study. The confirmatory positive predictive values (PPV), false positive rates (FPR), false negative rates (FNR) and potential risks for transfusion resulting from single or sequential ELISA screening were evaluated. A total of 5318 (0·647%) of donations screened HIV reactive and were discarded. WB confirmatory results on 1668 available samples suggested that PPVs for dual ELISA, one round ELISA reactive and grey zone samples were 75·1, 0·7 and 0·5%, respectively. Eight out of 1124 one round ELISA reactive and 1 out of 195 grey zone samples were WB confirmed positive. All but one ELISA assay displayed comparable PPVs but variable FPRs and FNRs that differed by blood centre. In the absence of nucleic acid testing (NAT), parallel ELISA screening prevented a substantial number of HIV infected donations from entering the Chinese blood supply. However, the loss of false positive donors should be re-evaluated especially given the frequently reported blood supply shortage in China. © 2015 British Blood Transfusion Society.

  3. No Scalpel Vasectomy (NSV) with Ligation and Excision: A Single Centre Experience.

    PubMed

    Bhuyan, K; Ali, I; Sarma, G; Das, U

    2015-12-01

    No scalpel vasectomy (NSV) has proved to be a safe and simple procedure for permanent sterilization for men. Ligation and excision of the vas deferens followed by fascial interposition is the procedure of choice. It is believed that vas excision without fascial interposition has a risk of failure. The objective of this study was to evaluate the technique of NSV with ligation and excision only. No scalpel vasectomy performed in an urban centre was taken for this prospective study. Only ligation and excision procedure was applied in its execution. It was demonstrated and performed under the supervision of an expert. Information regarding early and late complications including failure was gathered. A total number of 3,392 NSVs were performed in an urban training centre between Apr' 2009 to Mar' 2013. The procedure applied was only excision and ligation of the vas deferens. The fascial interposition was not included in the procedure. Haematoma (1), bleeding (3), foreign body granuloma (1), scrotal pain (3), epididymitis (1) and sinus formations (1) were encountered. There was only one failure in the whole group of acceptors. NSV with ligation and excision is a simple and easy procedure to learn and perform. Complications and failures are negligible. The additional fascial interposition needs more surgical skill and is time-consuming, hence can be avoided where a large number of acceptors need to undergo NSV in a rural camp.

  4. Pulsed radiofrequency in clinical practice - A retrospective analysis of 238 patients with chronic non-cancer pain treated at an academic tertiary pain centre.

    PubMed

    Lindquist, Jan; Bäckryd, Emmanuel

    2016-07-01

    Pulsed radiofrequency is a non-neurodestructive invasive pain treatment which, in contrast to conventional continuous radiofrequency treatment, does not entail nerve tissue destruction. The aim of this study was to retrospectively analyse the short-term benefits of a broad use of pulsed radiofrequency in clinical practice. The medical records of all patients treated with pulsed radiofrequency, or who received a diagnostic test block with a local anaesthetic in view of such a treatment, were retrospectively analysed. The patients had been referred to a tertiary pain centre in Sweden. The treatment effect one month after pulsed radiofrequency was retrospectively graded as follows, based on the wordings of the medical records: major improvement; minor improvement; no change; or worsened. A total of 238 patients received 587 interventions from 2009 to 2014. Chronic low back pain (CLBP) was by far the most common treatment indication (57% of patients), followed by CLBP with sciatica (9%). The age at first pulsed radiofrequency was 55 (15-94) years (mean, range), and 65% were female. Thirty-six patients (15%) underwent only a diagnostic test block using a local anaesthetic, i.e., the test block did not lead to treatment with pulsed radiofrequency. A total of 445 pulsed radiofrequency interventions were performed on 202 patients. Dichotomizing data into responders (i.e., minor or major improvement) and non-responders (i.e., worsened or no change), we found that, out of 63 responders to a median branch diagnostic test block (either at the cervical or lumbar level), 33 were responders to the first following median branch pulsed radiofrequency. Hence the positive predictive value of a median branch test block was 52%. In 127 patients, the lumbar level was targeted for median branch pulsed radiofrequency because of clinically suspected lumbar facetogenic pain. Looking at the first treatment, 30% experienced major improvement after 1 month, 16% minor improvement, 36% no change

  5. Single-lung transplantation in emphysema: Retrospective study analyzing survival and waiting list mortality

    PubMed Central

    Borro, José M; Delgado, María; Coll, Elisabeth; Pita, Salvador

    2016-01-01

    AIM: To performed remains a subject of debate and is the principal aim of the study. METHODS: This retrospective analysis included 73 patients with emphysema (2000-2012). The outcomes of patients undergoing single-lung transplantation (SL) (n = 40) or double-lung transplant (DL) (n = 33) were compared in a Cox multivariate analysis to study the impact of the technique, postoperative complications and acute and chronic rejection on survival rates. Patients were selected for inclusion in the waiting list according to the International Society of Heart Lung Transplantation criteria. Pre and postoperative rehabilitation and prophylaxis, surgical technique and immunosuppressive treatment were similar in every patients. Lung transplantation waiting list information on a national level and retrospective data on emphysema patient survival transplanted in Spain during the study period, was obtained from the lung transplantation registry managed by the National Transplant Organization (ONT). RESULTS: Both groups were comparable in terms of gender and clinical characteristics. We found significant differences in the mean age between the groups, the DL patients being younger as expected from the inclusion criteria. Perioperative complications occurred in 27.6% SL vs 54% DL (P = 0.032). Excluding perioperative mortality, median survival was 65.3 mo for SL and 59.4 mo for DL (P = 0.96). Bronchiolitis obliterans and overall 5-year survival were similar in both groups. Bacterial respiratory infection, cytomegalovirus and fungal infection rates were higher but not significant in SL. No differences were found between type of transplant and survival (P = 0.48). To support our results, national data on all patients with emphysema in waiting list were obtained (n = 1001). Mortality on the waiting list was 2.4% for SL vs 6.2% for DL. There was no difference in 5 year survival between 235 SL and 430 DL patients transplanted (P = 0.875). CONCLUSION: Our results suggest that SL

  6. [Biopsy findings of low-risk prostate disease: are they real? Single centre experience].

    PubMed

    Cova, Giandavide; Beniamin, Francesco; Lamon, Claudio; Maccatrozzo, Luigino

    2012-12-30

    Clinically insignificant prostate cancer is characterized by limited biologic malignancy and, possibly, it is suitable for non-radical treatment. We performed a retrospective analysis of 1028 patients who underwent radical prostatectomy (118 of them with clinically insignificant prostate cancer), in order to assess the predictors of cancer-related outcome. Only 19% of the patients undergoing radical prostatectomy for clinically insignificant prostate cancer had clinically insignificant cancer in the prostatectomy specimen, whereas in 19% of the cases we found a high-risk disease. The risk of overtreatment is present but currently counterbalanced by the risk of undertreatment.

  7. Pediatric Infectious Endophthalmitis: A 271-case Retrospective Study at a Single Center in China

    PubMed Central

    Zhang, Meng; Xu, Ge-Zhi; Jiang, Rui; Ni, Ying-Qin; Wang, Ke-Yan; Gu, Rui-Ping; Ding, Xin-Yi

    2016-01-01

    Background: Pediatric infectious endophthalmitis is a serious sight-threatening disease for children. The purpose of this study was to investigate the etiology, microbiological spectrum, and visual outcomes of infectious endophthalmitis in children at a single institution in China. Methods: It is a retrospective study of the medical records of all patients under 14 years of age with histories of infectious endophthalmitis, treated at a single institution from January 1, 2009 to January 1, 2015. The clinical characteristics, etiology, microbiological spectrum, and management, as well as the visual outcomes, were analyzed. The Kappa test and Chi-square test were used in the statistical evaluation. Results: A total of 271 children were identified, with a mean age of 5.61 ± 2.93 years (range 5 months to 14 years). Ocular trauma (94.8%) and previous ocular surgery (3.0%) were the most common etiologies. Overall, 147 (54.2%) cases had positive cultures, and 176 organisms were isolated from these patients. A single species was isolated in 120 (81.6%) cases, with multiple organisms in 27 (18.4%) cases, and the most commonly identified organisms were coagulase-negative Staphylococcus and Streptococcus species, comprising 29.5% and 26.8% of the isolates, respectively. Moreover, of 176 isolates, 142 (80.8%) were Gram-positive organisms, 23 (13.0%) were Gram-negative organisms, and 11 (6.2%) were fungi. The final visual outcomes were 20/200 or better in 66 (24.4%) eyes, counting fingers to 20/200 in 34 (12.5%), hand motions in 30 (11.1%), light perception in 33 (12.2%), no light perception in 32 (11.8%), and 9 (3.3%) eyes were enucleated or eviscerated. The visual outcomes were not available in 67 (24.7%) patients. Conclusions: Penetrating ocular trauma is the most frequent cause of pediatric endophthalmitis in China. Streptococcus and Staphylococcus species are the most commonly identified organisms in exogenous pediatric endophthalmitis whereas Fusarium species are commonly

  8. [Single centre experience of endoscopic submucosal dissection (ESD) in premalignant and malignant gastrointestinal neoplasia].

    PubMed

    Höbel, S; Baumbach, R; Dautel, P; Oldhafer, K J; Stang, A; Feyerabend, B; Yahagi, N; Faiss, S

    2014-02-01

    Worldwide endoscopic submucosal dissection (ESD) of early GI cancers or premalignant neoplasia is becoming increasingly important. In Germany ESD is restricted to larger endoscopic institutions and only a few literature reports are available. The aim of the present study is to describe the results of 46 ESDs conducted in a German endoscopic centre. Between June 2007 and May 2012 46 ESDs in 45 patients (33 men, 12 women, mean age 66.1 years) were performed in the oesophagus (n = 17), stomach (n = 23) and rectum (n = 6). Data were collected for the en-bloc, R0 and R0 en-bloc resection rates as well as for complications, the curative resection and the local recurrence rates. In order to demonstrate a learning curve, results were evaluated for two periods (June 2007 to November 2010 vs. December 2010 to May 2012). ESD was technically possible in 93.5%. En-bloc, R0, R0 en-bloc and curative resection rates were 90.7%, 74.4%, 67.4% and 65.1%, respectively. The complication rate was 13%. In the second period en-bloc and R0 en-bloc resection rates increased from 81% to 100% and, respectively, from 52.4% to 81.8%. After a medium follow-up of 11.4 months, local tumour recurrence occurred in 10%. In cases of curative R0 en bloc resection of malignant tumours no tumour recurrence occurred. Despite the small number of patients, the present data underline the value of ESD, especially in cases of R0 en-bloc resections in the therapy for premalignant and early malignant GI tumours. Due to the required learning curve, ESD should be restricted to larger endoscopic centres in Germany. © Georg Thieme Verlag KG Stuttgart · New York.

  9. Components of treatment delay in rheumatoid arthritis differ according to autoantibody status: validation of a single-centre observation using national audit data

    PubMed Central

    Lendrem, Dennis; Hargreaves, Ben; Aslam, Osman; Galloway, James B.; Isaacs, John D.

    2016-01-01

    Objective. To determine whether time to treatment following symptom onset differs between RA patients according to autoantibody status. Methods. A single-centre retrospective analysis of a UK early RA inception cohort was first undertaken to identify those components of the patient journey that differed by serological subtype. Data from a UK national audit of early inflammatory arthritis patients was accessed to replicate the key finding. Results. A total of 173 RA patients were diagnosed over a 31-month period, of whom 80 (46%) were ACPA/RF double-seropositive (ACPA+/RF+), 53 (31%) ACPA−/RF−, 17 (10%) ACPA+/RF− and 23 (13%) RF+/ACPA−. Overall, ACPA+/RF+ patients experienced significantly longer symptom duration before DMARD initiation. This was accounted for by delays in their presentation to primary care following symptom onset—a finding that was robustly confirmed in an independent dataset of 2192 UK early RA patients. In contrast, ACPA−/RF− patients were significantly more likely to experience delays in DMARD initiation after presenting to secondary care. Conclusion. Causes of treatment delays in early RA differ according to patients’ autoantibody status. More insidious symptom onset and/or distinct health-seeking behaviours among ACPA+/RF+ patients may contribute to late presentations in primary care, whereas ACPA−/RF− patients experience delayed diagnosis and treatment in secondary care. These observations inform the research agenda, potentially influencing the design of service delivery for early arthritis patients. PMID:27373893

  10. Clinical and laboratory characterization of 114 cases of Castleman disease patients from a single centre: paraneoplastic pemphigus is an unfavourable prognostic factor.

    PubMed

    Dong, Yujun; Wang, Mingyue; Nong, Lin; Wang, Lihong; Cen, Xinan; Liu, Wei; Zhu, Sainan; Sun, Yuhua; Liang, Zeyin; Li, Yuan; Ou, Jinping; Qiu, Zhixiang; Ren, Hanyun

    2015-06-01

    This study retrospectively collected the clinical and laboratory data of 114 patients with Castleman disease (CD) from a single medical centre. Clinical classification identified 62 patients (54·4%) with unicentric Castleman disease and 52 (45·6%) with multi-centric Castleman disease. Pathological classification revealed 68 cases (59·6%) of hyaline vascular variant, 16 (14·1%) mixed cellular variant (Mix) and 30 (26·3%) plasmacytic variant. Clinical complications occurred in 69 CD patients, including 37 cases of paraneoplastic pemphigus (PNP) and 25 cases with renal complications. Haematological involvement, pleural effusion and/or ascites and POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes) were also found. Univariate analysis showed that presence of clinical complications and PNP were both risk factors relating to CD patient survival. Prognostic factors showing P < 0·15 in univariate analysis and those with clinical significance were subjected to multivariate analysis using a Cox regression model. PNP presence and age over 40 years both significantly adversely affected survival. Thus, only presence of PNP was identified as an independent unfavourable survival risk factor in both univariate and multivariate analyses. Overall, the present data provide a panoramic description of CD cases and emphasize that the presence of PNP is an adverse prognostic factor. © 2015 John Wiley & Sons Ltd.

  11. Incidence and risk factors for Central Nervous System thrombosis in paediatric acute lymphoblastic leukaemia during intensive asparaginase treatment: a single-centre cohort study.

    PubMed

    Duarte, Ximo; Esteves, Susana; Neto, Ana M; Pereira, Filomena

    2016-07-01

    Central Nervous System (CNS) thrombosis is a complication of acute lymphoblastic leukaemia (ALL) treatment that is potentially associated with significant morbidity and neurological sequelae. Its presumably multifactorial aetiology is poorly characterized. We conducted a single-centre, retrospective cohort study on 346 ALL paediatric patients (1-16 years old) treated with asparaginase intensive Dana Farber Cancer Institute (DFCI) protocols from 1998 to 2011. The incidence, risk factors and outcome of CNS thrombosis were evaluated. CNS thrombosis occurred in 3·8% (13/346) of the patients (95% confidence interval 2·0-6·3%). Twelve events were diagnosed during intensification, all of which resolved within 2 weeks without neurological sequelae or significant impact in survival. Obesity (body mass index above 95th percentile) and asparaginase formulation were the only factors associated with CNS thrombosis, with an increase in the odds of event in obese patients [odds ratio (OR) = 3·37; P = 0·064] and a reduction in patients receiving Erwinia asparaginase (OR = 0·12; P = 0·018). No association could be demonstrated for age, gender, DFCI risk-group, ALL phenotype, steroid or doxorubicin use, central venous line use or CNS radiotherapy. CNS thrombosis is a rare but manageable adverse event without significant sequelae or detrimental effects in survival. Increased awareness is recommended in obese patients particularly during intensive asparaginase use. © 2016 John Wiley & Sons Ltd.

  12. Comparison of pacing algorithms to avoid unnecessary ventricular pacing in patients with sick sinus node syndrome: a single-centre, observational, parallel study.

    PubMed

    Poghosyan, Hermine R; Jamalyan, Smbat V

    2012-10-01

    Reduction of unnecessary ventricular pacing (uVP) is an essential component in the treatment strategy in any pacing population in general. The aim of this study was to evaluate the efficacy of different algorithms to reduce uVP in an adult population with sick sinus syndrome (SSS) treated outside of clinical trials. Evaluation of the relationship between different types of pacing algorithms and clinical outcomes is also provided. This was a single-centre, observational, parallel study, based on retrospective analysis of the Arrhythmology Cardiology Center of Armenia electronic clinical database. This study evaluated atrial pacing percentage (AP%), ventricular pacing percentage (VP%), and the incidence of atrial high rate episodes in 56 patients with SSS using three different pacing strategies: managed VP, search atrioventricular (AV), and fixed long AV. We did not find statistically significant differences in the amount of VP between the groups. Although the atrial high rate percentage (AHR%) tended to be higher in the fixed long AV group, this difference was not statistically significant. Mean VP% and AP% were similar in all three groups. In our study, all three programmed strategies produced the same mean AP% and VP%, and were equally efficient in uVP reduction. There was no relationship between chosen algorithms and the incidence of pacemaker syndrome, hospitalizations, or change in New York Heart Association class. The percentage of AHR was not associated with pacing strategy or co-morbidities but showed borderline correlation with left atrial size.

  13. Third-generation cephalosporin-resistant spontaneous bacterial peritonitis: a single-centre experience and summary of existing studies.

    PubMed

    Chaulk, Jennifer; Carbonneau, Michelle; Qamar, Hina; Keough, Adam; Chang, Hsiu-Ju; Ma, Mang; Kumar, Deepali; Tandon, Puneeta

    2014-02-01

    Spontaneous bacterial peritonitis (SBP) is the most prevalent bacterial infection in patients with cirrhosis. Although studies from Europe have reported significant rates of resistance to third-generation cephalosporins, there are limited SBP-specific data from centres in North America. To evaluate the prevalence of, predictors for and clinical impact of third-generation cephalosporin-resistant SBP at a Canadian tertiary care centre, and to summarize the data in the context of the existing literature. SBP patients treated with both antibiotics and albumin therapy at a Canadian tertiary care hospital between 2003 and 2011 were retrospectively identified. Multivariate logistic regression was used to determine independent predictors of third-generation cephalosporin resistance and mortality. In 192 patients, 25% of infections were nosocomial. Forty per cent (77 of 192) of infections were culture positive; of these, 19% (15 of 77) were resistant to third-generation cephalosporins. The prevalence of cephalosporin resistance was 8% with community-acquired infections, 17% with health care-associated infections and 41% with nosocomial acquisition. Nosocomial acquisition of infection was the only predictor of resistance to third-generation cephalosporins (OR 4.0 [95% CI 1.04 to 15.2]). Thirty-day mortality censored for liver transplantation was 27% (50 of 184). In the 77 culture-positive patients, resistance to third-generation cephalosporins (OR 5.3 [1.3 to 22]) and the Model for End-stage Live Disease score (OR 1.14 [1.04 to 1.24]) were independent predictors of 30-day mortality. Third-generation cephalosporin-resistant SBP is a common diagnosis and has an effect on clinical outcomes. In an attempt to reduce the mortality associated with resistance to empirical therapy, high-risk subgroups should receive broader empirical antibiotic coverage.

  14. Peripherally inserted central venous catheter safety in burn care: a single-center retrospective cohort review.

    PubMed

    Austin, Ryan E; Shahrokhi, Shahriar; Bolourani, Siavash; Jeschke, Marc G

    2015-01-01

    The use of peripherally inserted central catheter (PICC) line for central venous access in thermally injured patients has increased in recent years despite a lack of evidence regarding safety in this patient population. A recent survey of invasive catheter practices among 44 burn centers in the United States found that 37% of burn units use PICC lines as part of their treatment protocol. The goal of this study was to compare PICC-associated complication rates with the existing literature in both the critical care and burn settings. The methodology involved is a single institution retrospective cohort review of patients who received a PICC line during admission to a regional burn unit between 2008 and 2013. Fifty-three patients were identified with a total of seventy-three PICC lines. The primary outcome measurement for this study was indication for PICC line discontinuation. The most common reason for PICC line discontinuation was that the line was no longer indicated (45.2%). Four cases of symptomatic upper extremity deep vein thrombosis (5.5%) and three cases of central line-associated bloodstream infection (4.3%, 2.72 infections per 1000 line days) were identified. PICC lines were in situ an average of 15 days (range 1 to 49 days). We suggest that PICC line-associated complication rates are similar to those published in the critical care literature. Though these rates are higher than those published in the burn literature, they are similar to central venous catheter-associated complication rates. While PICC lines can be a useful resource in the treatment of the thermally injured patient, they are associated with significant and potentially fatal risks.

  15. Single-port laparoscopic surgery in acute appendicitis: retrospective comparative analysis for 618 patients.

    PubMed

    Kang, Byung Mo; Hwang, Ji Woong; Ryu, Byoung Yoon

    2016-11-01

    Transumbilical single-port laparoscopic appendectomy (SPLA) is a promising procedure that features less pain, faster recovery of postoperative bowel function and superior cosmetic results. We performed a retrospective comparative analysis of SPLA versus conventional laparoscopic surgery (CLA) to evaluate the safety and efficacy in acute appendicitis. From December 2008 to November 2013, laparoscopic surgery was performed on 636 patients with acute appendicitis at the Department of Surgery, Chuncheon Sacred Heart Hospital. Under approval of Institutional Review Board, data concerning baseline characteristics, operative outcomes, postoperative complications and postoperative functional recovery were compared between both procedures. After exclusion of 18 patients, 618 patients treated for acute appendicitis were included. SPLA was performed in 375 patients and CLA in 243 patients. Complicated appendicitis was more prevalent in the CLA group (26.3 %) than in the SPLA group (17.1 %) (p = 0.005). There was no difference between groups in operation time (p = 0.235), postoperative duration of hospital stay (p = 0.672) and readmission rate (p = 0.688). The rate of postoperative complications was similar in both groups (10.7 % in SPLA vs. 11.1 % in CLA, p = 0.862). In subgroup analysis of complicated appendicitis, more patients needed conversion to open surgery in the SPLA group (15.6 vs. 1.6 %, p = 0.005). In uncomplicated appendicitis, SPLA can be performed safely and efficiently. However, more selective indication for SPLA should be applied in cases of complicated appendicitis because of the greater risk of open conversion.

  16. Single-Use Detergent Sacs: A Retrospective Multicenter Canadian Review of Emergency Department Cases.

    PubMed

    Rosenfield, Daniel; Eltorki, Mohamed; VandenBerg, Stephanie; Allain, Dominic; Freedman, Stephen B; Beno, Suzanne

    2016-07-12

    Single-use detergent sacs (SUDS) are widely used in North America and Europe with emerging literature on their toxicity. This is the first Canadian multicenter study aimed to quantify and compare SUDS exposures to traditional detergent exposures. A retrospective review of the Canadian Hospitals Injury Reporting and Prevention Program databases was conducted at the Hospital for Sick Children in Toronto, Alberta Children's Hospital in Calgary and the Stollery Children's Hospital in Edmonton. All exposures presenting to these 3 centers between 2009 and 2014 were identified, a case form was completed, and data were analyzed. Forty cases of SUDS exposure were identified alongside 35 cases of traditional detergent exposure during the study period resulting in an incidence of 3.16 SUDS exposures per million children per year presenting to tertiary pediatric emergency departments (EDs). In contrast, traditional detergent exposures had an incidence of 2.78 exposures per million children per year presenting to tertiary pediatric EDs over the study period. Although there was no change in incidence of exposure to traditional detergent over the study period, there was an increase in the incidence of SUDS exposures from 2010 to 2013, with a decrease seen in 2014. There was no significant difference seen in age, sex, location of exposure, transportation to hospital, morbidity, or mortality associated with SUDS exposures compared with traditional detergent exposure. Although not statistically more likely to cause long-term complications, SUDS-exposed children required more follow-up visits to health care providers than traditional detergents. This multicenter study is the first to establish the incidence of SUDS and traditional detergent exposure in 3 Canadian cities. Overall, the frequency of exposure to detergents-both traditional and SUDS-is very low. Given the increase in SUDS exposure seen from 2011 to 2013, alongside larger sales of SUDS, continued efforts are required to

  17. Pulmonary Fungal Diseases in Immunocompetent Hosts: A Single-Center Retrospective Analysis of 35 Subjects.

    PubMed

    Yan, XiaoPei; Zong, Feng; Kong, Hui; Wang, YanLi; Zhao, XinYun; Liu, WenRui; Wang, ZaiLiang; Xie, WeiPing

    2016-08-01

    Pulmonary fungal disease is an emerging issue in immunocompetent patients, for whom the characteristics are only partially understood. We conducted a single-center retrospective study of histologically verified pulmonary fungal disease in Eastern China from 2006 to 2014 to understand the demographics, clinical manifestations, therapeutic approaches, and factors associated with prognosis in this population. All cases were diagnosed according to the 2008 European Organization for the Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infection Diseases Mycoses Study Group definition criteria. A total of 112 cases of pulmonary fungal diseases were enrolled (35 proven, 16 probable, 61 possible), and we analyzed the 35 patients with histologically proven pulmonary fungal diseases in this study. The main fungal species identified were Aspergillus (51.4 %), Cryptococcus (22.9 %), and Mucor (2.4 %). Treatment consisted of antifungal therapeutic agents (54.3 %), surgery and postsurgical agents (25.7 %), or surgery alone (14.3 %). The overall crude mortality rate was 14.3 %, and the mortality due to pulmonary fungal infections was 2.9 %. Significant predictors of mortality by univariate analysis were hypoalbuminemia (P = 0.005), cancer (P = 0.008), and positive culture (P = 0.044). Additionally, hypoalbuminemia was the only risk factor for mortality by multivariate analysis (RR = 7.56, 95 % CI 1.38-41.46). Pulmonary fungal disease in immunocompetent patients, with Aspergillus as the most common identified species, had a prognosis that was influenced by the level of serum albumin.

  18. Polycythemia as rare secondary direct manifestation of acromegaly: management and single-centre epidemiological data.

    PubMed

    Zoppoli, Gabriele; Bianchi, Federico; Bruzzone, Andrea; Calvia, Alessandro; Oneto, Caterina; Passalia, Caterina; Balleari, Enrico; Bedognetti, Davide; Ponomareva, Elena; Nazzari, Elena; Castelletti, Lara; Castellan, Lucio; Minuto, Francesco; Ghio, Riccardo; Ferone, Diego

    2012-06-01

    Polycythemia associated with acromegaly is usually caused by the systemic manifestations of the disease, such as sleep-apnea or concomitant erythropoietin-secreting kidney tumors. The recognition of underlying pathologies requires a thorough diagnostic process. We report a unique case of acromegaly with polycythemia, not caused by commonly described manifestations of the disease, and receding with octreotide therapy. The medical history of 141 acromegalic patients followed by the Endocrinology Unit of the San Martino University Hospital in Genoa has been also reviewed, together with the literature evidence for similar cases. The diagnostic workflow and 2-years follow-up of a 43-years old acromegalic, polycythemic man with a history of past smoking, moderate hypertension, and mental retardation are described. The hematological parameters of our cohort was retrospectively compared with those of a healthy, age/gender-related control group as well. Therapy with octreotide LAR, 20 mg i.m. q28d was begun soon after diagnosis of acromegaly in the polycythemic patient. Haematocrit level, hormonal setting, as well as pituitary tumor size and visual perimetry during treatment were recorded. Octreotide LAR treatment normalized hormonal alterations, as well as hematological parameters. Polycythemia has not recurred after 2 years of therapy. The median hemoglobin and hematocrit levels of the retrospectively analyzed cohort of acromegalic were significantly lower than normal ranges of a healthy, age/sex- related control population. In conclusions, polycythemia can be a direct, albeit rare, secondary manifestation of acromegaly, that must be considered during the diagnostic work-up of acromegalic patients presenting with such disorder.

  19. Mortality in systemic sclerosis-a single centre study from the UK.

    PubMed

    Strickland, Gemma; Pauling, John; Cavill, Charlotte; Shaddick, Gavin; McHugh, Neil

    2013-10-01

    This study aims to determine the cause and predictors of mortality in a cohort of patients with systemic sclerosis (SSc) and assess whether the mortality rate differs significantly from the general population. Patients enrolled onto the Royal National Hospital for Rheumatic Diseases Connective Tissue Disease database between 1999 and 2010 were included in this study. The NHS Strategic Tracing Service and UK Registry of Births, Marriages and Deaths were used to establish date and cause of deaths. A retrospective case note review collected information on clinical phenotype and serology. A standardised mortality ratio (SMR) was calculated and survival was determined using Kaplan-Meier estimates. Univariate and multivariate predictors of survival were assessed using proportional hazards regression modelling. Amongst this cohort of 204 patients (25 males, 40 diffuse SSc), the mean age at diagnosis was 51.6 years (SD13.7) and the mean duration of follow-up was 12.5 years (SD 8.8 years). In the deceased group (53 patients), the mean age of death was 72.0 years (SD 12.3 years). The mean disease duration at death was 14.2 years (SD 8.5 years). The overall SMR was 1.34 (95 % confidence interval (CI) 1.00-1.75). The SMR was higher in males (1.54 [95 % CI 0.67-3.04] vs. 1.30 [95 % CI 0.95-1.74]). The leading causes of death in this cohort were infection, respiratory disease and malignancy. The most common cause of SSc-related mortality was pulmonary complications. Factors adversely affecting survival were older age at diagnosis, male gender, interstitial lung disease (ILD) and anti-RNA polymerase III antibody. The mortality rate of our cohort, who had predominantly limited disease, was higher than that of the general population; although not as high as reported in previous retrospective studies.

  20. Early T-cell precursor acute lymphoblastic leukaemia in children treated in AIEOP centres with AIEOP-BFM protocols: a retrospective analysis.

    PubMed

    Conter, Valentino; Valsecchi, Maria Grazia; Buldini, Barbara; Parasole, Rosanna; Locatelli, Franco; Colombini, Antonella; Rizzari, Carmelo; Putti, Maria Caterina; Barisone, Elena; Lo Nigro, Luca; Santoro, Nicola; Ziino, Ottavio; Pession, Andrea; Testi, Anna Maria; Micalizzi, Concetta; Casale, Fiorina; Pierani, Paolo; Cesaro, Simone; Cellini, Monica; Silvestri, Daniela; Cazzaniga, Giovanni; Biondi, Andrea; Basso, Giuseppe

    2016-02-01

    Early T-cell precursor acute lymphoblastic leukaemia was recently recognised as a distinct leukaemia and reported as associated with poor outcomes. We aimed to assess the outcome of early T-cell precursor acute lymphoblastic leukaemia in patients from the Italian Association of Pediatric Hematology Oncology (AIEOP) centres treated with AIEOP-Berlin-Frankfurt-Münster (AIEOP-BFM) protocols. In this retrospective analysis, we included all children aged from 1 to less than 18 years with early T-cell precursor acute lymphoblastic leukaemia immunophenotype diagnosed between Jan 1, 2008, and Oct 31, 2014, from AIEOP centres. Early T-cell precursors were defined as being CD1a and CD8 negative, CD5 weak positive or negative, and positive for at least one of the following antigens: CD34, CD117, HLADR, CD13, CD33, CD11b, or CD65. Treatment was based on AIEOP-BFM acute lymphoblastic leukaemia 2000 (NCT00613457) or AIEOP-BFM acute lymphoblastic leukaemia 2009 protocols (European Clinical Trials Database 2007-004270-43). The main differences in treatment and stratification of T-cell acute lymphoblastic leukaemia between the two protocols were that in the 2009 protocol only, pegylated L-asparaginase was substituted for Escherichia coli L-asparaginase, patients with prednisone poor response received an additional dose of cyclophosphamide at day 10 of phase IA, and high minimal residual disease at day 15 assessed by flow cytometry was used as a high-risk criterion. Outcomes were assessed in terms of event-free survival, disease-free survival, and overall survival. Early T-cell precursor acute lymphoblastic leukaemia was diagnosed in 49 patients. Compared with overall T-cell acute lymphoblastic leukaemia, it was associated with absence of molecular markers for PCR detection of minimal residual disease in 25 (56%) of 45 patients; prednisone poor response in 27 (55%) of 49 patients; high minimal residual disease at day 15 after starting therapy in 25 (64%) of 39 patients (bone marrow

  1. Traumatic spinal injuries in children at a single level 1 pediatric trauma centre: report of a 23-year experience

    PubMed Central

    Kim, Christopher; Vassilyadi, Michael; Forbes, Jason K.; Moroz, Nicholas W.P.; Camacho, Alexandra; Moroz, Paul J.

    2016-01-01

    Background With a reported incidence of up to 10% compared to all spinal trauma, spinal injuries in children are less common than in adults. Children can have spine fractures with or without myelopathy, or spinal cord injuries without radiological abnormalities (SCIWORA). Methods We retrospectively reviewed the cases of children with spinal injuries treated at a level 1 pediatric trauma centre between 1990 and 2013. Results A total of 275 children were treated during the study period. The mean age at admission was 12 ± 4.5 years, and the male:female ratio was 1.4:1. Spinal injuries were more common in children of ages 12–16 years, with most injuries among ages 15–16 years. The top 3 mechanisms of spinal injury were motor vehicle–related trauma (53%), sports (28%) and falls (13%). Myelopathy occurred in 12% and SCIWORA occurred in 6%. The most common spine levels injured were L2–sacrum, followed by O–C2. Associated injuries, including head injuries (29%), and fractures/dislocations (27%) occurred in 55% of children. Overall mortality was 3%. Surgical intervention was required in 14%. Conclusion The creation of a pediatric spinal injury database using this 23-year retrospective review helped identify important clinical concepts; we found that active adolescent boys had the highest risk of spine injury, that noncontiguous spine injuries occured at a rate higher than reported previously and that nonaccidental spine injuries in children are under-reported. Our findings also emphasize the importance of maintaining a higher index of suspicion with trauma patients with multiple injuries and of conducting detailed clinical and radiographic examinations of the entire spine in children with a known spinal injury. PMID:27240286

  2. Risk stratification of survival in injured patients with cardiopulmonary resuscitation within the first hour of arrival to trauma centre: retrospective analysis from the national trauma data bank.

    PubMed

    Ahmed, Nasim; Greenberg, Patricia; Johnson, Victor M; Davis, John Mihran

    2017-05-01

    The purpose of this study was to evaluate overall survival and associated survival factors for patients with trauma who had cardiopulmonary resuscitation (CPR) within 1 hour after arrival to a hospital. Retrospective patient data was retrieved from the 2007-2010 edition of the US National Trauma Data Bank. Inhospital survival was the primary outcome; only patients with a known outcome were included in the analysis. Summary statistics and univariate analyses were first reported. Eighty per cent of the patients were then randomly selected and used for multivariate logistic regression analysis. The identified risk factors were further assessed for discrimination and calibration with the remaining patients with trauma using area under the curve (AUC) analysis and a Hosmer-Lemeshow test. From 19 310 total cases that were reviewed, only 2640 patients required CPR within 1 hour of hospital arrival and met the additional inclusion criteria. Of these patients, 2309 (87.5%) died and 331 (12.5%) survived to discharge. There were statistical differences for race (p=0.003), initial systolic BP (p<0.001), initial pulse (p<0.001), cause of injury (p<0.001), presence of head injury (p=0.02), Injury Severity Score (ISS) (p<0.001), Glasgow Coma Scale (GCS) total score (p<0.001) and GCS motor score (p<0.001); though not all were clinically significant. The multiple logistic regression model (AUC=0.72) identified lower ISS, higher GCS motor score, Caucasian race, American College of Surgeons (ACS) level 2 trauma designation and higher initial SBP as the most predictive of survival to hospital discharge. Approximately 13% of patients who had CPR within an hour of arrival to a trauma centre survived their injury. Therefore, implementation of an aggressive first hour in-hospital resuscitation strategy may result in better survival outcomes for this patient population. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved

  3. A fibreoptic endoscopic study of upper gastrointestinal bleeding at Bugando Medical Centre in northwestern Tanzania: a retrospective review of 240 cases.

    PubMed

    Jaka, Hyasinta; Koy, Mheta; Liwa, Anthony; Kabangila, Rodrick; Mirambo, Mariam; Scheppach, Wolfgang; Mkongo, Eliasa; McHembe, Mabula D; Chalya, Phillipo L

    2012-07-03

    Upper gastrointestinal (GI) bleeding is recognized as a common and potentially life-threatening abdominal emergency that needs a prompt assessment and aggressive emergency treatment. A retrospective study was undertaken at Bugando Medical Centre in northwestern Tanzania between March 2010 and September 2011 to describe our own experiences with fibreoptic upper GI endoscopy in the management of patients with upper gastrointestinal bleeding in our setting and compare our results with those from other centers in the world. A total of 240 patients representing 18.7% of all patients (i.e. 1292) who had fibreoptic upper GI endoscopy during the study period were studied. Males outnumbered female by a ratio of 2.1:1. Their median age was 37 years and most of patients (60.0%) were aged 40 years and below. The vast majority of the patients (80.4%) presented with haematemesis alone followed by malaena alone in 9.2% of cases. The use of non-steroidal anti-inflammatory drugs, alcohol and smoking prior to the onset of bleeding was recorded in 7.9%, 51.7% and 38.3% of cases respectively. Previous history of peptic ulcer disease was reported in 22(9.2%) patients. Nine (3.8%) patients were HIV positive. The source of bleeding was accurately identified in 97.7% of patients. Diagnostic accuracy was greater within the first 24 h of the bleeding onset, and in the presence of haematemesis. Oesophageal varices were the most frequent cause of upper GI bleeding (51.3%) followed by peptic ulcers in 25.0% of cases. The majority of patients (60.8%) were treated conservatively. Endoscopic and surgical treatments were performed in 30.8% and 5.8% of cases respectively. 140 (58.3%) patients received blood transfusion. The median length of hospitalization was 8 days and it was significantly longer in patients who underwent surgical treatment and those with higher Rockall scores (P < 0.001). Rebleeding was reported in 3.3% of the patients. The overall mortality rate of 11.7% was significantly

  4. Pregnancy and its management in women with GSD type III - a single centre experience.

    PubMed

    Ramachandran, Radha; Wedatilake, Yehani; Coats, Caroline; Walker, Fiona; Elliott, Perry; Lee, Philip J; Lachmann, Robin H; Murphy, Elaine

    2012-03-01

    We present a review of our experience and pregnancy outcome in patients with GSD III managed by our centre. Between 1997 and 2010 there were 15 pregnancies in seven women with GSD III. Four women had GSD IIIb (nine pregnancies) and three GSD IIIa (six pregnancies). There was a successful outcome in all 15 pregnancies with delivery of 15 liveborn infants. Four infants were of low birthweight (<2nd centile) but all have developed normally apart from one with behavioural/psychiatric problems. Three women had pre-existing cardiomyopathy prior to pregnancy. One of these women had deterioration of her cardiomyopathy during pregnancy and again in the post-partum period. Women with GSD III do not seem to have any issues with fertility. Overall the outcome of pregnancy for both mother and child is good. Care needs to be taken to avoid maternal hypoglycemia which may be associated with intrauterine growth restriction and low birth weight. Cardiac function should be monitored carefully particularly in those with pre-existing cardiomyopathy.

  5. Early management of mesenteric cyst prevents catastrophes: a single centre analysis of 17 cases.

    PubMed

    Prakash, Advait; Agrawal, Amit; Gupta, Rahul K; Sanghvi, Beejal; Parelkar, Sandesh

    2010-01-01

    Mesenteric cysts are rare intra-abdominal masses in the paediatric age group with varied presentation, ranging from an asymptomatic mass to acute abdomen. This study reviews our experience in the diagnosis and treatment of 17 mesenteric cysts in our centre, with especial reference to acute abdominal symptoms. Seventeen patients (age less than 10 years) with mesenteric cysts were managed in our hospital. The age ranged from 15 days to 10 years. Patients were admitted with acute or chronic symptoms. They were evaluated with complete history, clinical examination, blood investigations and radiological investigations (x-ray abdomen erect, ultrasound abdomen (USG) and computed tomography (CT) scan in selected cases) to reach a provisional diagnosis. The diagnosis was proven on laparotomy and histologically confirmed. The main presenting symptoms were abdominal pain or lump. The most common mode of presentation was acute small intestinal obstruction. USG was not conclusive in all. Abdominal CT scan with intravenous contrast was diagnostic in nine patients. Five patients had volvulus on exploration. Cysts were located in small intestinal mesentery in 14 cases and three were in the sigmoid mesentery. Seven patients had complete excision, intestinal resection was required in four and marsupialisation with cauterisation of margins was done in six patients. Histologically, all were lymphangiomatous mesenteric cysts. The diagnosis of mesenteric cysts should be kept in mind in any patient presenting with acute abdominal symptoms. Small bowel volvulus with mesenteric cyst constituted a significant number in children with acute abdominal symptoms. Early diagnosis and treatment yields excellent outcome.

  6. Nasoalveolar Molding in Cleft Care—Experience in 40 Patients from a Single Centre in Germany

    PubMed Central

    Rau, Andrea; Ritschl, Lucas M.; Mücke, Thomas; Wolff, Klaus-Dietrich; Loeffelbein, Denys J.

    2015-01-01

    Nasoalveolar molding (NAM) has gained wide acceptance and evidence in cleft therapy. However, standardized treatment protocols and experiences recorded from European centres are lacking. The results of 40 infants with cleft lip and palate treated with presurgical NAM according to the Grayson technique were analyzed. Standardized parameters of cleft width and nasal symmetry were measured in pre- and posttreatment plaster casts and in digitalized 3-dimensional STL models. Statistical analyses were performed by using Student´s t-test in a per-protocol manner. 27 out of 40 infants completed NAM and were analyzed. In 13 patients NAM was either temporarily interrupted or terminated prematurely due to skin irritations or lack of parental support. These cases were excluded from statistical analysis, resulting in a drop-out rate of 32.5%. Intersegmental alveolar distance (ISAD), intersegmental lip distance (ISLD), nostril height (NH), nostril width (NW) and columella deviation angle (CDA) were significantly changed in unilateral cleft lip and palate (UCLP) (n = 8). In unilateral cleft lip (UCL) (n = 9), only ISLD, NH and CDA were significantly changed. ISAD of the right and left side, ISLD of the right and left side, premaxilla deviation angle, nostril height and columella length were changed significantly in bilateral cleft lip and palate (BCLP) cases (n = 10). NAM is a suitable presurgical treatment modality. A positive effect has been seen in UCLP and BCLP infants, as compared with their birth status. PMID:25734535

  7. Early Experience in Da Vinci Robot-Assisted Partial Nephrectomy: An Australian Single Centre Series

    PubMed Central

    Ting, Francis; Savdie, Richard; Chopra, Sam; Yuen, Carlo; Brenner, Phillip

    2015-01-01

    Introduction and Objectives. To demonstrate the safety and efficacy of the robot-assisted partial nephrectomy (RAPN) technique in an Australian setting. Methods. Between November 2010 and July 2014, a total of 76 patients underwent 77 RAPN procedures using the Da Vinci Surgical System© at our institution. 58 of these procedures were performed primarily by the senior author (PB) and are described in this case series. Results. Median operative time was 4 hours (range 1.5–6) and median warm ischaemic time (WIT) was 8 minutes (range 0–30) including 11 cases with zero ischaemic time. All surgical margins were clear with the exception of one patient who had egress of intravascular microscopic tumour outside the capsule to the point of the resection margin. Complications were identified in 9 patients (15.8%). Major complications included conversion to open surgery due to significant venous bleeding (n = 1), reperfusion injury (n = 1), gluteal compartment syndrome (n = 1), DVT/PE (n = 1), and readmission for haematuria (n = 1). Conclusion. This series demonstrates the safety and efficacy of the RAPN technique in an Australian setting when performed by experienced laparoscopic surgeons in a dedicated high volume robotic centre. PMID:26167299

  8. Critical care after lung resection: CALoR 1, a single-centre pilot study.

    PubMed

    McCall, P J; Macfie, A; Kinsella, J; Shelley, B G

    2015-12-01

    Lung resection is associated with significant perioperative morbidity, and a proportion of patients will require intensive care following surgery. We set out to characterise this population, assess their burden of disease and investigate the influence of anaesthetic and surgical techniques on their admission rate. Over a two-year period, 1169 patients underwent surgery, with 30 patients (2.6%) requiring unplanned intensive care. Patients requiring support had a higher mortality (0.2% vs 26.7%, p < 0.001). Logistic regression (following adjustment for Thoracoscore) revealed that an open surgical approach was associated with higher likelihood of admission (p = 0.025, odds ratio = 5.25). There was also a trend towards increased likelihood of admission in patients who received volatile anaesthesia (p = 0.061, odds ratio = 2.08). This topic has been selected for further investigation as part of the 2015 Association of Cardiothoracic Anaesthetists (ACTA) second national collaborative audit, with this study providing pilot data before a multi-centre study. © 2015 The Association of Anaesthetists of Great Britain and Ireland.

  9. Ovarian tissue cryopreservation in girls undergoing haematopoietic stem cell transplant: experience of a single centre.

    PubMed

    Biasin, E; Salvagno, F; Berger, M; Nesi, F; Quarello, P; Vassallo, E; Evangelista, F; Marchino, G L; Revelli, A; Benedetto, C; Fagioli, F

    2015-09-01

    Fertility after childhood haemopoietic stem cell transplant (HSCT) is a major concern. Conditioning regimens before HSCT present a high risk (>80%) of ovarian failure. Since 2000, we have proposed cryopreservation of ovarian tissue to female patients undergoing HSCT at our centre, to preserve future fertility. After clinical and haematological evaluation, the patients underwent ovarian tissue collection by laparoscopy. The tissue was analysed by histologic examination to detect any tumour contamination and then frozen following the slow freezing procedure and cryopreserved in liquid nitrogen. From August 2000 to September 2013, 47 patients planned to receive HSCT, underwent ovarian tissue cryopreservation. The median age at diagnosis was 11.1 years and at the time of procedure it was 13 years, respectively. Twenty-four patients were not pubertal at the time of storage, whereas 23 patients had already experienced menarche. The median time between laparoscopy and HSCT was 25 days. Twenty-six out of 28 evaluable patients (93%) developed hypergonadotropic hypogonadism at a median time of 23.3 months after HSCT. One patient required autologous orthotopic transplantation that resulted in one live birth. Results show a very high rate of iatrogenic hypergonadotropic hypogonadism, highlighting the need for fertility preservation in these patients.

  10. Epidemiology and outcomes of patients with invasive mould infections: a retrospective observational study from a single centre (2005-2009).

    PubMed

    Klingspor, Lena; Saaedi, Baharak; Ljungman, Per; Szakos, Attila

    2015-08-01

    Invasive mould infection (IMI) is an important cause of morbidity and mortality in immunocompromised patients. However, Swedish epidemiology data are lacking. The aim of this study was to investigate the epidemiology and outcome of IMI. Cases of proven/probable IMI at Karolinska University Hospital, Stockholm, from 2005 to 2009, were included. A total of 100 patients with 104 episodes of IMI were enrolled. Identified isolates included 101 mould isolates. The majority of the isolates were Aspergillus spp. (74.3%), followed by Mucorales spp. (13.9%), Fusarium spp. (4.9%) and other mould spp. (6.9%). In 13% of the episodes, more than one mould caused the IMI. The lung was most often affected (88.5%). The most frequent underlying disease was haematological malignancies (70%). Following diagnosis, 83.7% initially received antifungal monotherapy, 9.6% received combination therapy and 6.7% no treatment. The overall 90-day and 1-year overall survival was 49% and 46% respectively. Survival at 90 days post diagnosis was 71.4% in the solid tumour cohort, 62.5% in patients with solid organ transplants, 43.5% in haematological malignancy (HMs) and 37% in those undergoing allogeneic haematopoietic stem cell transplantation (HSCT). Overall survival was poor in the studied cohort, but is variable among different host categories, with particular opportunities for improvement in patients with underlying HMs and allogeneic HSCT.

  11. Pregnancy in Women with Systemic Lupus Erythematosus: A Retrospective Study of 83 Pregnancies at a Single Centre

    PubMed Central

    Chen, Shanying; Sun, Xuejuan; Wu, Bide; Lian, Xuejian

    2015-01-01

    Objective: To evaluate the outcome of 80 pregnant women with systemic lupus erythematosus (SLE) and explore the risk factors for lupus flare, obstetric complications and fetal loss. Methods: 83 pregnancies in 80 women were divided into three groups. Group A: patients in remission for > 6 months before pregnancy, proteinuria < 0.5 g per day, without renal failure and discontinuation of cytotoxic drugs for > one year; Group B: patients with SLE disease activity in the six months before pregnancy; Group C: patients with new onset SLE during pregnancy. Results: In group A, 76.47% pregnancies achieved full-term deliveries and 80.39% achieved live born infants. In group B and C, the outcome was poor. Among 62 patients (64 pregnancies) diagnosed as SLE before pregnancy, SLE flares occurred in 27 (42.19%) pregnancies. SLE disease activity in the six months before pregnancy was significantly associated with lupus flare (OR 5.00, 95% CI 1.14–21.87, p = 0.03) and fetal loss. New onset lupus during pregnancy was independently associated with obstetric complications (OR 7.22, 95% CI 2.14–24.38, p = 0.001). Conclusions: The current study confirmed the previous report that SLE should be considered a high risk of pregnancy. If pregnancy is planned after remission for > 6 months, the favorable outcome can be achieved. PMID:26295404

  12. Endovascular Management of Acute Embolic Occlusion of the Superior Mesenteric Artery: A 12-Year Single-Centre Experience

    SciTech Connect

    Raupach, J. Lojik, M. Chovanec, V. Renc, O.; Strýček, M.; Dvořák, P. Hoffmann, P.; Guňka, I. Ferko, A.; Ryška, P.; Omran, N.; Krajina, A. Čabelková, P.; Čermáková, E.; Malý, R.

    2016-02-15

    PurposeRetrospective evaluation of 12-year experience with endovascular management of acute mesenteric ischemia (AMI) due to embolic occlusion of the superior mesenteric artery (SMA).Materials and methodsFrom 2003 to 2014, we analysed the in-hospital mortality of 37 patients with acute mesenteric embolism who underwent primary endovascular therapy with subsequent on-demand laparotomy. Transcatheter embolus aspiration was used in all 37 patients (19 women, 18 men, median age 76 years) with embolic occlusion of the SMA. Adjunctive local thrombolysis (n = 2) and stenting (n = 2) were also utilised.ResultsWe achieved complete recanalization of the SMA stem in 91.9 %. One patient was successfully treated by surgical embolectomy due to a failed endovascular approach. Subsequent exploratory laparotomy was performed in 73.0 % (n = 27), and necrotic bowel resection in 40.5 %. The total in-hospital mortality was 27.0 %.ConclusionPrimary endovascular therapy for acute embolic SMA occlusion with on-demand laparotomy is a recommended algorithm used in our centre to treat SMA occlusion. This combined approach for the treatment of AMI is associated with in-hospital mortality rate of 27.0 %.

  13. 125 Cases of duodenoduodenostomy in pancreas transplantation: a single-centre experience of an alternative enteric drainage.

    PubMed

    Walter, Martin; Jazra, Martin; Kykalos, Stylianos; Kuehn, Petra; Michalski, Stefan; Klein, Thomas; Wunsch, Andreas; Viebahn, Richard; Schenker, Peter

    2014-08-01

    Several exocrine drainage procedures have been successfully developed to perform pancreas transplantation (PT). Retroperitoneal graft placement allows exocrine drainage via direct duodenoduodenostomy (DD). This technique provides easy access for endoscopic surveillance and biopsy. A total of 241 PT procedures were performed in our centre between 2002 and 2012. DD was performed in 125 patients, and duodenojejunostomy (DJ) in 116 patients. We retrospectively compared our experience with these two types of enteric drainage, focusing on graft and patient survivals, as well as postoperative complications. With a mean follow-up of 59 months, both groups demonstrated comparable patient and graft survivals. 14 (11%) of 125 cases in the DD group and 21 (18%) of 116 cases in the DJ group had pancreatic graft loss (P = 0.142). Graft thrombosis [5 (4%) vs. 18 (16%) P = 0.002], anastomotic insufficiency [2 (1.6%) vs. 8 (7%) P = 0.052] and relaparotomy [52 (41%) vs. 56 (48%) P = 0.29] occurred more frequently in the DJ group, whereas gastrointestinal bleeding [14 (11%) vs. 4 (3%) P = 0.026] occurred more often in the DD group. DD is a feasible and safe technique in PT, with no increase in enteric complications. It is equivalent to other established techniques and extends the feasibility of anastomotic sites, especially in recipients who have undergone a second transplantation. © 2014 Steunstichting ESOT.

  14. Time trends in breast cancer survival: experience in a single centre, 1975-89.

    PubMed Central

    Bradburn, M. J.; Altman, D. G.; Smith, P.; Fentiman, I. S.; Rubens, R. D.

    1998-01-01

    The aim of this retrospective cohort study was to investigate whether survival of patients with breast cancer has changed over the period 1975-89. A total of 2604 women diagnosed as having invasive breast cancer at a clinical oncology unit in London were followed up for between 5 and 20 years. Patients were divided into four groups according to menstrual status (pre or post) and the staging of cancer (operable or inoperable). For each group, survival from diagnosis was compared between three consecutive 5-year cohorts, both with and without adjustments made for relevant prognostic factors. No temporal patterns were found in patients with inoperable cancer, in whom the survival rate was consistently low. Of women with operable cancers, differences were seen only among post-menopausal women, for whom the best survival patterns were seen in patients diagnosed between 1985-89. This is probably due to tamoxifen being commonly prescribed as adjuvant treatment for this cohort of patients. We cannot explain an apparently worse survival in the group of patients presenting in the early 1980s compared with that observed in the late 1970s. PMID:9667672

  15. Early single centre experience of flow diverting stents for the treatment of cerebral aneurysms.

    PubMed

    Toma, Ahmed K; Robertson, Fergus; Wong, Ken; Joshi, Yogish; Haridas, Avinash; Grieve, Joan; Watkins, Laurence D; Kitchen, Neil D; Brew, Stefan

    2013-10-01

    The flow diverting stent (FDS) is a relatively new endovascular therapeutic tool specifically designed to reconstruct the parent artery and divert blood flow along the normal anatomical course and away from the aneurysm neck and dome. Retrospective review of prospectively built clinical and imaging database of patients treated with FDS at the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK was done. Between 18/03/2008 and 10/11/2011, 80 patients underwent 84 FDS insertion procedures for various indications. Mean duration of clinical follow-up was 11.3 ± 9.3 months and of imaging follow-up was 10.6 ± 9.3 months. Sixty-seven had anterior circulation aneurysms while 17 had posterior circulation aneurysms. Seven (8.3%) patients died (two probably not related, giving a procedure-related mortality of 5.9%), eight had permanent new deficit (9.5%), 20 had transient deficit (23%) and 49 (58%) had no complications. There was a trend towards bad outcome with larger posterior circulation aneurysms. Angiographic follow-up showed 38% cure rate at 6 months and 61% at 12 months. FDS should only be used following multidisciplinary discussion in selected patients. Further data is required regarding long-term safety, efficacy and indications.

  16. Seizure control in Unverricht-Lundborg disease: a single-centre study.

    PubMed

    Roivainen, Reina; Karvonen, Matti K; Puumala, Tarja

    2014-06-01

    New antiepileptic drug (AED) options for generalised seizure types have been adopted for use as treatment for Unverricht-Lundborg disease. Whether this has led to improved seizure control or functional outcome in ULD patients remains obscure. We retrospectively identified all patients seen at Helsinki University Hospital due to Unverricht-Lundborg disease during 2003-2008 in order to determine which AED treatments had been retained for long-term use. The majority of the patients had severe functional disabilities. In the year preceding the last hospital visit, all patients (n=20) were receiving polytherapy and 14 patients had been free of tonic-clonic seizures. During follow-up, improvement in myoclonia had been recorded for the majority of patients with either add-on piracetam, topiramate, or levetiracetam, but valproate was still in use by all patients. Treatment with lamotrigine had been started and retained less often relative to other AEDs. Add-on AED treatment was often associated with significant adverse effects. Unverricht-Lundborg disease patients may benefit from add-on treatment with levetiracetam or topiramate for seizure control. Treatment of eventual comorbidities with other than AEDs is also discussed.

  17. Complications after tenckhoff catheter insertion: a single-centre experience using multiple operators over four years.

    PubMed

    Liu, Wen Jiun; Hooi, Lai Seong

    2010-01-01

    To analyze the complications after Tenckhoff catheter insertion among patients with renal failure needing dialysis. ♢ The open, paramedian approach is the commonest technique to insert the 62-cm coiled double-cuffed Tenckhoff peritoneal catheter. All patients with catheters inserted between January 2004 and November 2007 were retrospectively analyzed for demographics and followed for up to 1 month for complications. We excluded patients whose catheters had been anchored to the bladder wall and who underwent concurrent omentectomy or readjustment without removal of a malfunctioning catheter (n = 7). Intravenous cloxacillin was the standard preoperative antibiotic prophylaxis. ♢ Over the 4-year study period, 384 catheters were inserted under local anesthetic into 319 patients [201 women (62.8%); mean age: 49.4 ± 16.7 years (range: 13 - 89 years); 167 (52.2%) with diabetes; 303 (95%) with end-stage renal disease] by 22 different operators. All Tenckhoff catheters were inserted by the general surgical (n = 223) or urology (n = 161) team. There were 29 cases (7.6%) of catheter migration, 22 (5.7%) of catheter obstruction without migration, 24 (6.3%) of exit-site infection, 12 (3.1%) of leak from the main incision, 14 (3.6%) of culture-proven wound infection, 11 (2.9%) post-insertion peritonitis, and 1 (0.3%) hemoperitoneum. No deaths were attributed to surgical mishap. ♢ The most common complication was catheter migration. The paramedian insertion technique was safe, with low complication rates.

  18. Congenital Lumbar Hernia: A 15-Year Experience at a Single Tertiary Centre

    PubMed Central

    Rattan, K. N.; Dhiman, Ankur; Rattan, Ananta

    2016-01-01

    Aim. Congenital lumbar hernia is an uncommon anomaly with only few cases reported in the English literature. This study was done to study the incidence, age at presentation, sex, associated anomalies, surgical management, and postoperative morbidity and mortality of congenital lumbar hernia in pediatric patients. Methods. Retrospective analysis of all patients of CLH over a period of 15 years (January 2000 to December 2015) was analyzed. Results. A total of 14 patients were encountered in this series. All presented within first 2 years of age. 12 were males and 2 were females. All of them presented with swelling in lumbar region. 13 were unilateral and 1 was bilateral. Left sided hernia was observed in 2 cases only. Lumbocostovertebral syndrome was found in all the patients in addition to other rare anomalies. All cases were managed with open surgical repair. Wound infection was seen in 2 cases. There was no mortality in our series. Conclusion. CLH is very rare among hernias. Surgery should be carried out within 1 year of age. For a defect of <5 cm, primary repair is done. For a defect of >5 cm, meshplasty should be considered. Prognosis is excellent. PMID:27994626

  19. Diverse manifestations and management options in Klippel-Trenaunay syndrome: a single centre 10-year experience.

    PubMed

    Sreekar, Harinatha; Dawre, Sandeep; Petkar, Kiran S; Shetty, Rahul B; Lamba, Shashank; Naik, Sukriya; Gupta, Ashish K

    2013-09-01

    Klippel-Trenaunay syndrome is a well-known conglomeration of capillary malformations, bony or soft tissue hypertrophy, and abnormal deep or superficial veins. Although it generally presents with grossly enlarged limbs, it can present with more serious features like haematuria, haematochezia, and seizures. This retrospective study included patients admitted with the diagnosis of Klippel-Trenaunay syndrome in this institute from 2001-2010. The patients' demographic data, clinical features, associated findings, and treatments given were tabulated. A total of 19 patients were included in the study. Two patients presented with haematocezia and had to undergo bowel resection. Five presented with bleeding and ulceration. Debulking surgery was done in three of them. Patients also presented with abdominal distension, jaundice, seizures, and haematuria. Although the common presentation of varicose veins was treated with sclerotherapy, the treatment was tailored to each patient. Klippel-Trenaunay syndrome is a multifaceted disorder which can manifest in a number of different ways. These features may be missed by an unwary plastic surgeon treating them only for the limb hypertrophy.

  20. 155 burns caused by hair straighteners in children: a single centre's experience over 5 years.

    PubMed

    Sarginson, Julia H; Estela, Catalina; Pomeroy, Shirin

    2014-06-01

    Hair straighteners have become a popular and common household appliance. The incidence of burns from these devices is rising, and is of particular concern given that the main casualties are infants. We present the largest case series in the literature of paediatric burns from hair straightening devices. Retrospective data collection of all burns by hair straightening devices presenting to our unit between 2007 and 2011. Details on demographics, time and mechanism of injury, size and depth of injury and treatment received were recorded. There were 155 cases in the five-year period. The mean age was 19 months. The majority of the burns were caused by a 'touch/grab' (49%) or 'stepped-into' (14%) mechanism. The area most frequently burnt was the hand with 60% of the injuries. 8 out of the 155 required excision and grafting. Hair straightening devices can reach temperatures of over 220°C and can cause significant full thickness injuries. Our study shows that infants and toddlers are at most risk. These are preventable burns that warrant our attention, and we would advocate the use of heat-resistant pouches and closure clips on the devices to help minimise the risk of injury. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

  1. Assessment of tumors in children with tuberous sclerosis: a single centre's experience.

    PubMed

    Emir, Suna; Hacısalihoğlu, Şadan; Özyörük, Derya; Ekici, Filiz; Değerliyurt, Aydan; Güven, Alev; Çetin, İlker

    2017-03-01

    As a result of mutations in TSC1 (9q34) and TSC2 (16p13.3) tumor supressor genes, the mammalian target of the rapamycin (mTor) signaling pathway is overactivated in patients with tuberous sclerosis. Abnormal cell proliferation and differentiation is responsible for the growth several different tumors. The aim of this study was to review tumors in our patients with tuberous sclerosis. Thirty-six patients with tuberous sclerosis were reviewed retrospectively in terms of age, sex, family history, clinical findings, presence of tumors, and treatments. Our study included 36 patients (18/18:M/F) aged between two days and 17 years with a median age of 6 years. There were hypopigmented spots in 30 patients, seizures in 28 patients, and a family history in 11 patients. Tumors related to tuberous sclerosis were renal angiomyolipomas in 21 patients, cardiac rhabdomyomas in 11, subependymal giant cell astrocytomas in seven, and non renal hamartoma in one patient. Everolimus treatment was used in only two patients because of hemodynamic instability. Tuberous sclerosis is a multisystemic disease characterized by the presence of various benign tumors and neurologic disorders. Renal angiomyolipomas, cardiac rhabdomyomas, and subependymal giant cell astrocytomas are commonly observed in patients with tuberous sclerosis. mTOR inhibitors such as everolimus and sirolimus have been increasingly used in the treatment of these tumors. However, the duration and optimal dose of mTOR inhibitors is still controversial and should be used in selected cases.

  2. Standardized testing with chlorhexidine in perioperative allergy--a large single-centre evaluation.

    PubMed

    Opstrup, M S; Malling, H-J; Krøigaard, M; Mosbech, H; Skov, P S; Poulsen, L K; Garvey, L H

    2014-10-01

    Perioperative allergic reactions to chlorhexidine are often severe and easily overlooked. Although rare, the prevalence remains unknown. Correct diagnosis is crucial, but no validated provocation model exists, and other diagnostic tests have never been evaluated. The aims were to estimate (i) the prevalence of chlorhexidine allergy in perioperative allergy and (ii) the specificity and sensitivity for diagnostic tests for chlorhexidine allergy. We included all patients investigated for suspected perioperative allergic reactions in the Danish Anaesthesia Allergy Centre during 2004-2012. The following tests were performed: specific IgE (Immunocap® ; Phadia AB, Sweden), histamine release test (HR) (RefLab ApS, Denmark), skin prick test (SPT) and intradermal test (IDT). Positivity criteria were as follows: specific IgE >0.35 kUA/l; HR class 1-12; SPT mean wheal diameter ≥3 mm; IDT mean wheal diameter ≥ twice the diameter of negative control. Chlorhexidine allergy was post hoc defined as a relevant clinical reaction to chlorhexidine combined with two or more positive tests. Based on this definition, sensitivity and specificity were estimated for each test. In total, 22 of 228 patients (9.6%) met the definition of allergy to chlorhexidine. Estimated sensitivity and specificity were as follows: specific IgE (sensitivity 100% and specificity 97%), HR (sensitivity 55% and specificity 99%), SPT (sensitivity 95% and specificity 97%) and IDT (sensitivity 68% and specificity 100%). In patients investigated for suspected perioperative allergic reactions, 9.6% were diagnosed with allergy to chlorhexidine. Using our definition of chlorhexidine allergy, the highest combined estimated sensitivity and specificity was found for specific IgE and SPT. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Pattern of high voltage electrical injuries in the Kashmir valley: a 10-year single centre experience

    PubMed Central

    Kasana, R.A.; Baba, P.U.F.; Wani, A.H.

    2016-01-01

    Summary The objective was to study the clinical profile of high voltage electrical injuries in Kashmir, and various prevention and safety measures to bring down the incidence of such injuries in the future. All patients (176) with high voltage electrical injuries reporting to our centre from January 2001 to December 2010 were included in the study. The most common age group was 20-40 years, with mean age of 29.77 ± 8.98 years. Incidence was higher among the rural population (68.75%) than in urban areas (31.25%), and in the winter months. Electricians comprised 47.16% of victims. The most common mode of injury was touching a live wire directly or indirectly, and was seen in 63.64% of victims. Average total body surface burned was 15.27 ± 10.15 percent. Right upper limb was most commonly involved (64.20% of patients). Compartment syndrome was seen in 40.34% of patients, and fasciotomies on all the affected limbs saved around half of them. An average of 3.91 surgical procedures per patient were performed. Around one-third of the victims required major amputations. Reconstructive procedures were required in 49.43% of patients. Average hospital stay was 26.81 days. Average mortality rate was 2.27%. High voltage electrical injuries are not uncommon in the Kashmir Valley, and electrical workers are at higher risk. The incidence of high voltage injuries would not be so high if the workers were properly trained, hazards of high-tension lines were explained and the use of safety equipment was made mandatory. PMID:28289358

  4. Luminescence of lead-related centres in single crystalline films of Lu2SiO5

    NASA Astrophysics Data System (ADS)

    Gorbenko, V.; Krasnikov, A.; Mihokova, E.; Nikl, M.; Zazubovich, S.; Zorenko, Yu

    2012-09-01

    The steady-state and time-resolved emission and excitation spectra and luminescence decay kinetics of nominally undoped Lu2SiO5 single crystalline films (SCFs) grown by the liquid phase epitaxy method from the PbO-based flux are studied in the range 4.2-300 K. Due to the preparation method, the films contain lead ions. Luminescence characteristics of Pb-related centres of different types are identified. A weak 3.65 eV emission is ascribed to the radiative decay of the triplet relaxed excited state (RES) of Pb2+ ions substituting for Lu3+ ions in the Lu1 lattice sites of the X2 structure. Possible origins of the intense complex lead-related ≈2.8 eV emission are discussed. We propose phenomenological models describing the excited-state dynamics of the studied luminescence centres. We also determine the characteristic parameters of the corresponding RESs, in particular, the energy separations between the excited states and the rates of the radiative and non-radiative transitions from these states.

  5. The use of drug eluting stents in single and multivessel disease: results from a single centre experience

    PubMed Central

    Mikhail, G W; Airoldi, F; Tavano, D; Chieffo, A; Rogacka, R; Carlino, M; Montorfano, M; Sangiorgi, G; Corvaja, N; Michev, I; Orlic, D; Di Mario, C; Colombo, A

    2004-01-01

    Objective: Drug eluting stents have been shown to reduce the rate of in-stent restenosis in cases where single lesions are treated. The performance of these stents, in patients with multivessel disease and complex lesions, however, remains unknown. Our experience with sirolimus eluting stents in such patients is presented. Design and patients: This study includes all consecutive patients treated at San Raffaele Hospital and EMO Centro Cuore Columbus, Milan, Italy treated with sirolimus eluting stents. Results: Between April 2002 and March 2003, 486 patients with 1027 lesions were treated (437 males, 49 females) with a mean (SD) age of 62.2 (10.5) years. Of all patients studied, 19.1% had single vessel disease, 33.8% had two vessel disease, and 47.1% had three vessel disease. Of the whole study group, 20.3% of patients had diabetes mellitus. A mean (SD) of 2.3 (0.4) stents per patient and 1.1 (0.2) stents per lesion were implanted. The baseline mean reference diameter was 2.7 (0.6) mm with a mean minimal luminal diameter of 0.9 (0.5) mm. Post-stenting, the acute gain was 1.8 (0.6) mm. During hospital stay one patient died (0.2%) and 13 (2.7%) patients had in-hospital myocardial infarction (MI). One patient required urgent repeat percutaneous coronary intervention. Six months clinical follow up was performed in all 347 eligible patients. Six months mortality was 2.0% (n  =  7) and acute MI occurred in 0.3% (n  =  1). Target lesion revascularisation occurred in 9.5% (n  =  33) of the patients and target vessel revascularisation (TVR) in 11.5% (n  =  40) of the patients. Major adverse cardiac event rate was 13.8% (n  =  48). TVR was 4.5% for single vessel disease and 13.2% for multivessel disease. Diabetes mellitus was the only significant predictor for TVR. Conclusion: The use of drug eluting stents in single and multivessel coronary disease produces good short and medium term results with a low rate of revascularisation. Longer term follow-up is

  6. Clinical application of a nomogram based on age, serum FSH and AMH to select the FSH starting dose in IVF/ICSI cycles: a retrospective two-centres study.

    PubMed

    Papaleo, Enrico; Zaffagnini, Stefano; Munaretto, Maria; Vanni, Valeria Stella; Rebonato, Giorgia; Grisendi, Valentina; Di Paola, Rossana; La Marca, Antonio

    2016-12-01

    To externally validate a nomogram based on ovarian reserve markers as a tool to optimize the FSH starting dose in IVF/ICSI cycles. A two-centres retrospective study including 398 infertile women undergoing their first IVF/ICSI cycle (June 2013-June 2014). IVF data were retrieved from two independent IVF centres in Italy (San Raffaele Hospital, Centre 1; Verona Hospital, Centre 2). A central lab for the routine measurement of AMH and FSH was used for both centres. All women were treated based on physical and hormonal characteristics according to locally adopted protocols. The nomogram was then retrospectively applied to the patients comparing the calculated starting dose to the one actually given. In Centre 1, 64/131 women (48.8%) had an ovarian response below the target. While 45 of these patients were treated with a maximal FSH starting dose (≥225 IU), n=19/131 (14.5%) were treated with a submaximal dose. The vast majority of them (n=17/19) would have received a higher FSH starting dose by using the nomogram. Seventeen patients (n=17/131) had hyper response and about half of them would have been treated with a reduced FSH starting dose according to the nomogram. In Centre 2, 142/267 patients (53.2%) had an ovarian response below the target. While 136 of these were treated with a maximal FSH starting dose (≥225 IU), n=6/267 were treated with a submaximal dose. The majority of them (n=5/6) would have received a higher FSH starting dose. Thirty-two (n=32/267) patients had hyper response and more than half of them would have been treated with a reduced FSH dose. In both Centres, applying the nomogram would have resulted in more appropriate FSH starting doses compared to the the ones actually given based on clinicians choices. The use of an objective algorithm based on patient's age, serum FSH and AMH levels may thus be an effective advice on the selection of the tailored FSH starting dose. Hence, the use of this easily available nomogram could increase the

  7. Single-centre experience of granulomatous interstitial nephritis—time for a new approach?

    PubMed Central

    Jayawardene, Satish; Shah, Sapna

    2017-01-01

    Abstract Background: Differentiating between renal-limited sarcoidosis and tuberculosis (TB) infection as a cause of granulomatous interstitial nephritis (GIN) can be difficult. This series compares clinical features and response to treatment between the different underlying aetiologies in order to propose a management algorithm for GIN to assist with diagnosis and treatment. Methods: This retrospective study reports on all patients presenting with a histological diagnosis of GIN between 2000 and 2012 at our unit. Results: Twenty-one patients were identified, 57% were male and the mean age was 53 years. Eight cases were associated with sarcoidosis with evidence of extra-renal disease and five with renal-limited sarcoidosis. Five patients had GIN that may have been related to TB infection or to renal-limited sarcoidosis, and three were idiopathic or drug related. All those with sarcoidosis were treated with steroids and renal function, as measured by estimated glomerular filtration rate (eGFR), improved from a mean of 24 mL/min at baseline to 37 mL/min at 1 year. Baseline eGFR was 19 mL/min in those with possible TB infection. Four received steroids as well as anti-TB drugs. Anti-TB therapy was delayed in four patients by a mean of 22 months due to difficulties in diagnosis. Two patients with TB developed end-stage kidney disease and the remaining three patients had a mean eGFR of 28 mL/min at 1 year. Conclusions: This series represents the largest cohort of patients with GIN in the UK and supports previous findings that patients with sarcoid have a favourable outcome with steroid treatment. Those with TB have an inferior prognosis, perhaps due to delayed diagnosis. We suggest an algorithm when investigating a diagnosis of GIN with the aim of expediting diagnosis and considering a trial of anti-TB therapy in order to prevent deterioration of renal function. PMID:28396742

  8. Clinicopathological and immunohistological features in childhood IgA nephropathy: a single-centre experience.

    PubMed

    Topaloglu, Rezan; Orhan, Dicle; Bilginer, Yelda; Karabulut, Erdem; Ozaltin, Fatih; Duzova, Ali; Kale, Gulsev; Besbas, Nesrin

    2013-04-01

    IgA nephropathy is a glomerular disease diagnosed by renal biopsy and is characterized by a highly variable course ranging from a completely benign condition to rapidly progressive renal failure. We aimed to evaluate the clinical, histopathological and inflammatory characteristics of children with IgA nephropathy. Data of 37 patients with IgA nephropathy diagnosed between the years 1980 and 2008 were retrospectively reviewed. Immunohistochemistry was performed in 24 patients. Expression of CD3, CD4, CD8, CD20, CD68, IL-1β, IL-10, IL-17, TGF-β, TNF-α and the newly proposed tubulointerstitial fibrosis marker nestin were evaluated. The median age at diagnosis was 10 years. Recurrent macroscopic haematuria (66%) was the most common clinical manifestation, and 35% of the patients had synpharyngitic presentation. A significant correlation was found between proteinuria and increase in mesangial matrix (r = 0.406, P = 0.013). The presence of CD4+ T lymphocytes and CD68+ macrophages were also significantly associated with proteinuria >1 g/day. While cytokines IL-1β, IL-10 and TNF-α were mainly expressed in tubular epithelial cells, TGF-β was evident in glomeruli but they had no correlation to clinical features and severity of the disease. Nestin was detected at the tubules in almost half of the patients with no correlation to proteinuria and tubulointersititial fibrosis. We found a correlation between proteinuria and mesangial matrix expansion. The presence of CD4+ T-lymphocytes and CD68+ macrophages were also significantly associated with proteinuria >1 g/day. Although there are many evidences, for immunological basis of IgA nephropathy, the immunological markers were not fully expressed in children to evaluate glomerular and tubulointerstitial inflammation, and progression of the disease. Further studies with the extended number of children are needed to shed light on the immunological basis of the disease.

  9. Obstetric risks and outcomes of refugee women at a single centre in Toronto.

    PubMed

    Kandasamy, Tharani; Cherniak, Rebecca; Shah, Rajiv; Yudin, Mark H; Spitzer, Rachel

    2014-04-01

    Women who are refugees during pregnancy may be exposed to homelessness, poor nutrition, and limited access to health care, yet the pregnancy outcomes of this vulnerable population have not been systematically evaluated. We undertook a study to determine the risk of adverse obstetric and perinatal outcomes among refugee women in Toronto. Using a retrospective cohort design, we examined pregnancy outcomes for refugee and non-refugee women delivering at St. Michael's Hospital in Toronto, between January 1, 2008, and December 31, 2010. The primary outcome measures were preterm delivery (< 37 weeks' gestational age), low birth weight (< 2500 g), and delivery by Caesarean section. Multiparous refugee women had a significantly higher rate of delivery by Caesarean section (36.4%), and a 1.5-fold increase in rate of low birth weight infants when compared with non-refugee women. In subgroup analysis by region of origin, women from Sub-Saharan Africa had significantly higher rates of low birth weight infants and Caesarean section than non-refugee control subjects. Further, compared with non-refugee control subjects, refugee women had significantly increased rates of prior Caesarean section, HIV-positive status, homelessness, social isolation, and delays in accessing prenatal care. Refugee women constitute a higher-risk population with increased rates of adverse obstetric and perinatal outcomes. These findings provide preliminary data to guide targeted public health interventions towards meeting the needs for obstetric care of this vulnerable population. Recent changes to the Interim Federal Health Program have highlighted the importance of identifying and diminishing disparities in health outcomes between refugee and non-refugee populations.

  10. Predictors for a successful external cephalic version: a single centre experience.

    PubMed

    Ebner, Florian; Friedl, Thomas W P; Leinert, Elena; Schramm, Amelie; Reister, Frank; Lato, Kristian; Janni, Wolfgang; DeGregorio, Nikolaus

    2016-04-01

    The external cephalic version (ECV) is one of the options patients presenting with a breech pregnancy should be offered. Various fetal, maternal and other predictors for a successful ECV have been published in the past. This is a retrospective multivariate analysis of our ECV patient database at the Department of Obstetrics and Gynaecology at the University Hospital Ulm. In an outpatient setting, patients with fetal breech position were routinely offered an ECV attempt after 36 weeks of gestation if the patient was willing to consent. Contraindications for ECV were placental abruption, placenta praevia, uterus malformations, regular contractions, premature rupture of membranes, and non-reassuring fetal heart rate patterns. From January 1st 2010 to July 31st 2013, 444 patients with a minimum of 36 weeks gestational age (i.e. >35 + 6 weeks) attended our clinic with a breech presentation. Of those 118 had an ECV attempt and an extended ultrasound examination within 21 days. In 33 patients the procedure was successful (success rate 28 %). A multivariate binary logistic regression analysis revealed that an increased Amniotic Fluid Index (AFI; p < 0.001), at least one prior vaginal delivery (p = 0.002) or a high estimated fetal weight (p = 0.045) were significant independent predictors for a successful ECV. In our series no delivery occurred within 48 h after the ECV. An ECV is a safe procedure. ECV should be offered as an option for the mother-to-be on the basis of an informed consent. Identified fetal and maternal factors can help to estimate the chances of success and in particular multi-parity and increased amniotic fluid seem to be associated with successful ECV.

  11. Percutaneous Closure in Transfemoral Aortic Valve Implantation: A Single-Centre Experience.

    PubMed

    Barbier, Charlotte Ebeling; Lundin, Elin; Melki, Vilyam; James, Stefan; Nyman, Rickard

    2015-12-01

    To report the experience of a percutaneous closure device used for transfemoral transcatheter aortic valve implantation (TAVI) in an unselected patient and operator population. Eighty-two consecutive patients (32 women, 50 men) who underwent transfemoral TAVI between September 2009 and February 2014 at our hospital were retrospectively reviewed for percutaneous closure device (PCD) failure, vascular complications, and bleeding. The diameter and calcification of the common femoral artery (CFA) and the thickness of the subcutaneous fat layer in the groin were assessed on computed tomography images. The incidences of PCD failure and minor and major vascular complications were 19.5% (n = 16/82), 19.5% (n = 16/82), and 7% (n = 6/82) respectively. 8.5% (n = 7/82) had a minor perioperative bleeding, 6% (n = 5/82) had a major bleeding, and none had any life-threatening bleeding. When PCD failed, haemostasis was obtained with fascia suturing, covered stent placement, or with surgical cutdown. Thirty-day mortality and 1-year all-cause mortality were 8.5% (n = 7/82) and 19.5% (n = 16/82), respectively. In a multiple regression analysis, the CFA diameter and the presence of severe calcification were independently related to PCD failure (correlation coefficient = -0.24, p = 0.027 and correlation coefficient = 0.23, p = 0.036, respectively). PCD failure was related to a small CFA diameter and to a severely calcified CFA. Failure could largely be managed with minimally invasive techniques such as covered stents or fascia suturing.

  12. Laparoscopic modified subtotal cholecystectomy for difficult gall bladders: A single-centre experience

    PubMed Central

    Harilingam, Mohan Raj; Shrestha, Ashish Kiran; Basu, Sanjoy

    2016-01-01

    AIM: Laparoscopic cholecystectomy (LC) is considered the ‘gold standard’ intervention for gall bladder (GB) diseases. However, to avoid serious biliovascular injury, conversion is advocated for distorted anatomy at the Calot's triangle. The aim is to find out whether our technique of laparoscopic modified subtotal cholecystectomy (LMSC) is suitable, with an acceptable morbidity and outcome. PATIENTS AND METHODS: A retrospective analysis of prospectively collected data of 993 consecutive patients who underwent cholecystectomy was done at a large District General Hospital (DGH) between August 2007 and January 2015. The data are as follows: Patient's demographics, operative details including intra- and postoperative complications, postoperative stay including follow-up that was recorded and analysed. RESULTS: A total of 993 patients (263 males and 730 female) were included. The median age was 52*(18-89) years. Out of the 993 patients, 979 (98.5%) and 14 (1.5%) were listed for laparoscopic and open cholecystectomy, respectively. Of the 979 patients, 902 (92%) and 64 (6.5%) patients underwent LC ± on-table cholangiography (OTC) and LMSC ± OTC, respectively, with a median stay of 1* (0-15) days. Of the 64 patients, 55 (86%) had dense adhesions, 22 (34%) had acute inflammation, 19 (30%) had severe contraction, 12 (19%) had empyema, 7 (11%) had Mirizzi's syndrome and 2 (3%) had gangrenous GB. The mean operative time was 120 × (50-180) min [Table 1]. Six (12%) patients required endoscopic retrograde cholangiopancreatography (ERCP) postoperatively, and there were four (6%) readmissions in a follow-up of 30 × (8-76) months. The remaining 13 (1.3%) patients underwent laparoscopic cholecystectomy converted to an open cholecystectomy. The median stay for open/laparoscopic cholecystectomy converted to open cholecystectomy was 5 × (1-12) days. CONCLUSION: Our technique of LMSC avoided conversion in 6.5% patients and believe that it is feasible and safe for difficult GBs

  13. Intensive care unit admission of obstetric cases: a single centre experience with contemporary update.

    PubMed

    Ng, Vivian K S; Lo, T K; Tsang, H H; Lau, W L; Leung, W C

    2014-02-01

    OBJECTIVES. To review the characteristics of a series of obstetric patients admitted to the intensive care unit in a regional hospital in 2006-2010, to compare them with those of a similar series reported from the same hospital in 1989-1995 and a series reported from another regional hospital in 1998-2007. DESIGN. Retrospective case series. SETTING. A regional hospital in Hong Kong. PATIENTS. Obstetric patients admitted to the Intensive Care Unit of Kwong Wah Hospital from 1 January 2006 to 31 December 2010. RESULTS. From 2006 to 2010, there were 67 such patients admitted to the intensive care unit (0.23% of total maternities and 2.34% of total intensive care unit admission), which was a higher incidence than reported in two other local studies. As in the latter studies, the majority were admitted postpartum (n=65, 97%), with postpartum haemorrhage (n=39, 58%) being the commonest cause followed by pre-eclampsia/eclampsia (n=17, 25%). In the current study, significantly more patients had had elective caesarean sections for placenta praevia but fewer had had a hysterectomy. The duration of intensive care unit stay was shorter (mean, 1.8 days) with fewer invasive procedures performed than in the two previous studies, but maternal and neonatal mortality was similar (3% and 6%, respectively). CONCLUSION. Postpartum haemorrhage and pregnancy-induced hypertension were still the most common reasons for intensive care unit admission. There was an increasing trend of intensive care unit admissions following elective caesarean section for placenta praevia and for early aggressive intervention of pre-eclampsia. Maternal mortality remained low but had not decreased. The intensive care unit admission rate by itself might not be a helpful indicator of obstetric performance.

  14. Toxoplasmosis after allogeneic stem cell transplantation--a single centre experience.

    PubMed

    Busemann, Christoph; Ribback, Silvia; Zimmermann, Kathrin; Sailer, Verena; Kiefer, Thomas; Schmidt, Christian A; Schulz, Katrin; Steinmetz, Ivo; Dombrowski, Frank; Dölken, Gottfried; Krüger, William H

    2012-07-01

    Toxoplasmosis is a rare but possibly underestimated complication following allogeneic stem cell transplantation with a high mortality rate. One reason might be the limitation of the diagnostic instruments relying mainly on imaging and molecular-based techniques. In this report, we present three cases of toxoplasmosis identified among 155 allograft recipients treated at Greifswald University Hospital. Widely disseminated toxoplasmosis was detected post-mortem in two patients allografted for high-risk multiple myeloma. Clinical signs suspicious for toxoplasmosis occurred after days +32 and +75, respectively. In one case, serology and conventional Toxoplasma gondii PCR, targeting the B1 gene, revealed negative results, while in the other patient, toxoplasmosis was not investigated. Both patients received pentamidine for Pneumocystis jirovecii pneumonia (PcP) prophylaxis. The third patient, a 68-year-old woman allografted for AML, developed cerebral toxoplasmosis from day +395 after allogeneic SCT with typical signs in magnetic resonance tomography. Toxoplasma DNA was amplified from one of two samples of cerebrospinal fluid. The patient died of disseminated toxoplasmosis despite immediate initiation of therapy. Retrospective comparative testing of clinical specimens by the conventional T. gondii PCR and by a real-time PCR targeting a 529-bp genomic fragment suggests a higher sensitivity of the latter method in our patients. In conclusion, we suggest a rigorous real-time PCR monitoring for high-risk patients or patients with signs of infections suspicious for toxoplasmosis, even though low-copy results are presently difficult to interpret. Our reported cases might also encourage the use of trimethoprim-sufmethoxazole instead of pentamidine for PcP prophylaxis in those patients.

  15. Clinicopathological and immunohistological features in childhood IgA nephropathy: a single-centre experience

    PubMed Central

    Topaloglu, Rezan; Orhan, Dicle; Bilginer, Yelda; Karabulut, Erdem; Ozaltin, Fatih; Duzova, Ali; Kale, Gulsev; Besbas, Nesrin

    2013-01-01

    Background IgA nephropathy is a glomerular disease diagnosed by renal biopsy and is characterized by a highly variable course ranging from a completely benign condition to rapidly progressive renal failure. We aimed to evaluate the clinical, histopathological and inflammatory characteristics of children with IgA nephropathy. Methods Data of 37 patients with IgA nephropathy diagnosed between the years 1980 and 2008 were retrospectively reviewed. Immunohistochemistry was performed in 24 patients. Expression of CD3, CD4, CD8, CD20, CD68, IL-1β, IL-10, IL-17, TGF-β, TNF-α and the newly proposed tubulointerstitial fibrosis marker nestin were evaluated. Results The median age at diagnosis was 10 years. Recurrent macroscopic haematuria (66%) was the most common clinical manifestation, and 35% of the patients had synpharyngitic presentation. A significant correlation was found between proteinuria and increase in mesangial matrix (r = 0.406, P = 0.013). The presence of CD4+ T lymphocytes and CD68+ macrophages were also significantly associated with proteinuria >1 g/day. While cytokines IL-1β, IL-10 and TNF-α were mainly expressed in tubular epithelial cells, TGF-β was evident in glomeruli but they had no correlation to clinical features and severity of the disease. Nestin was detected at the tubules in almost half of the patients with no correlation to proteinuria and tubulointersititial fibrosis. Conclusions We found a correlation between proteinuria and mesangial matrix expansion. The presence of CD4+ T-lymphocytes and CD68+ macrophages were also significantly associated with proteinuria >1 g/day. Although there are many evidences, for immunological basis of IgA nephropathy, the immunological markers were not fully expressed in children to evaluate glomerular and tubulointerstitial inflammation, and progression of the disease. Further studies with the extended number of children are needed to shed light on the immunological basis of the disease. PMID:24175085

  16. Single-centre experience of granulomatous interstitial nephritis-time for a new approach?

    PubMed

    Oliveira, Ben; Jayawardene, Satish; Shah, Sapna

    2017-04-01

    Background: Differentiating between renal-limited sarcoidosis and tuberculosis (TB) infection as a cause of granulomatous interstitial nephritis (GIN) can be difficult. This series compares clinical features and response to treatment between the different underlying aetiologies in order to propose a management algorithm for GIN to assist with diagnosis and treatment. Methods: This retrospective study reports on all patients presenting with a histological diagnosis of GIN between 2000 and 2012 at our unit. Results: Twenty-one patients were identified, 57% were male and the mean age was 53 years. Eight cases were associated with sarcoidosis with evidence of extra-renal disease and five with renal-limited sarcoidosis. Five patients had GIN that may have been related to TB infection or to renal-limited sarcoidosis, and three were idiopathic or drug related. All those with sarcoidosis were treated with steroids and renal function, as measured by estimated glomerular filtration rate (eGFR), improved from a mean of 24 mL/min at baseline to 37 mL/min at 1 year. Baseline eGFR was 19 mL/min in those with possible TB infection. Four received steroids as well as anti-TB drugs. Anti-TB therapy was delayed in four patients by a mean of 22 months due to difficulties in diagnosis. Two patients with TB developed end-stage kidney disease and the remaining three patients had a mean eGFR of 28 mL/min at 1 year. Conclusions: This series represents the largest cohort of patients with GIN in the UK and supports previous findings that patients with sarcoid have a favourable outcome with steroid treatment. Those with TB have an inferior prognosis, perhaps due to delayed diagnosis. We suggest an algorithm when investigating a diagnosis of GIN with the aim of expediting diagnosis and considering a trial of anti-TB therapy in order to prevent deterioration of renal function.

  17. Patient-based decision for resuming activity after ACL reconstruction: a single-centre experience.

    PubMed

    Jenny, Jean-Yves; Clement, Xavier

    2016-12-01

    The purpose of the study was to report the functional outcome following anterior cruciate ligament (ACL) reconstruction in patients who decide when to resume work and normal sporting activity post-operatively. The hypothesis tested was that patient-based decision to return to work and sport was possible without compromising functional outcome and increased the rate of repeat rupture in comparison with the existing literature. This was a monocentric, retrospective study. Seventy-two patients requiring primary ACL reconstruction were included. All patients were followed up for a mean period of 4.3 years. Return to work and to sporting activity was allowed based on patient's decision. No restriction was suggested by the physician. Delays to return to work and sports and occurrence of graft failure were documented. Sixty-six patients (92 %) returned to any sporting activity. The mean delay was 4.1 months for running, 6.1 months for pivoting sports, and 6.6 months for contact sports. Return to competitive sport was possible in 82 % of patients after a mean delay of 7.1 months. Return to work was possible for 96 % of patients after a mean delay of 2.3 months. Index Tegner score normalized in 71 % of patients. Four repeat ruptures (6 %) were observed, all of them following a significant knee injury. Patient-based decision to return to work and sport was possible without compromising functional outcome. The post-operative restrictions implemented by orthopaedic surgeons following ACL reconstructions may be relaxed and more patient based.

  18. Outcome of gastroplasty and gastric bypass in a single centre in the UK

    PubMed Central

    Okoro, T; Sintler, M; Khan, A

    2009-01-01

    Background Morbid obesity is defined as BMI>40 kg/m2. It affects 124,000 men and 412,000 women in England and Wales (NICE, July 2002). According to NICE guidelines, Bariatric surgery is indicated if the treatments for obesity such as exercise, diet and drugs fail. Procedures include laparoscopic gastric banding (LGB), vertical banded gastroplasty (VBG), and Gastric Bypass (GB). Aims The aim of this audit was to determine if NICE guidelines on the use of Bariatric surgery in the Manor Hospital, Walsall was being adhered to. Secondary aims were also to establish if Bariatric surgery is achieving its goal in the long-term and if weight reduction is being maintained in this group of patients. Methods A retrospective cohort study was carried out on patients who underwent Bariatric surgery between 1990 and 2004. Retrieved records were scrutinised and the following parameters were collated: pre-operative morbidities, intra and post-operative complication rates and weight reduction on follow-up. Results 129 patients were operated on in the 14 year period. For VBG, 40 out of 105 patients had weight gain by the 5th follow-up visit. This compared with 5 out of 18 patients after the same timescale for the GB group and 1 out of 6 in the LGB group. The most common post-operative complication was stenosis (28% of VBG group). Conclusion Bariatric surgery is relatively safe as an intervention for morbid obesity. Weight loss however is not maintained in the long term. VBG and LGB are short term interventions. Further research is required to look into the merits of gastric bypass surgery. PMID:19747401

  19. Identification and prevalence of PTSD risk factors in ECMO patients: A single centre study.

    PubMed

    Tramm, Ralph; Hodgson, Carol; Ilic, Dragan; Sheldrake, Jayne; Pellegrino, Vincent

    2015-02-01

    Extracorporeal membrane oxygenation (ECMO) is one of the most invasive rescue therapies for acute heart and/or lung failure. Survivors have high rates of adverse mental health outcomes, such as post-traumatic stress symptoms (PTSS) and manifest post-traumatic stress disorder (PTSD). Yet no study to date has identified and explored PTSD risk factors in these patients. The primary aim of this study was to determine and explore post-traumatic stress risk factors for patients treated with ECMO. It also aimed to provide a baseline profile for future hypothesis testing with respect to risk factor exposure, level of exposure and post-traumatic stress outcomes in these patients. Retrospective cohort study. The study was conducted at the Alfred Hospital Melbourne, Australia. Patients were selected in 2012 from an Intensive Care Unit (ICU) registry that prospectively included all patients admitted to ICU and treated with ECMO. Data were extracted from the ICU ECMO registry, ICU and ward charts, progress notes, referrals, drug charts and discharge letters. Data were descriptively analysed. Patients treated with ECMO are exposed to almost all investigated PTSD risk factors. These included psychiatric history (psychiatric comorbidities), admission to ICU and treatment (prolonged ventilation during prolonged ICU stay), and drug therapy (all patients treated with PTSD risk related drugs). ECMO patients are exposed to PTSD risk factors such as young age, mechanical ventilation, drug administration, delirium and agitation. Younger age, heterogeneous conditions, profound illness severity and prolonged ICU stay describe the case complexity of patients and may explain these findings. Patients in ICU are increasingly conscious during active treatment and this may have positive or negative psychological effects. "Awake" ECMO in which patients are conscious while on active life support may represent a unique PTSD risk factor in this perspective. Copyright © 2014. Published by Elsevier

  20. Factors predicting haematopoietic recovery in patients undergoing autologous transplantation: 11-year experience from a single centre.

    PubMed

    Bai, Lijun; Xia, Wei; Wong, Kelly; Reid, Cassandra; Ward, Christopher; Greenwood, Matthew

    2014-10-01

    Engraftment outcomes following autologous transplantation correlate poorly to infused stem cell number. We evaluated 446 consecutive patients who underwent autologous transplantation at our centre between 2001 and 2012. The impact of pre-transplant and collection factors together with CD34(+) dosing ranges on engraftment, hospital length of stay (LOS) and survival endpoints were assessed in order to identify factors which might be optimized to improve outcomes for patients undergoing autologous transplantation using haemopoietic progenitor cells-apheresis (HPC-A). Infused CD34(+) cell dose correlated to platelet but not neutrophil recovery. Time to platelet engraftment was significantly delayed in those receiving low versus medium or high CD34(+) doses. Non-remission status was associated with slower neutrophil and platelet recovery. Increasing neutrophil contamination of HPC-A was strongly associated with slower neutrophil recovery with infused neutrophil dose/kg recipient body weight ≥3 × 10(8)/kg having a significant impact on time to neutrophil engraftment (p = 0.001). Higher neutrophil doses/kg in HPC-A were associated with days of granulocyte colony stimulation factor (G-CSF) use, HPC-A volumes >500 ml and higher NCC in HPC-A. High infused neutrophil dose/kg and age >65 years were associated with longer hospital LOS (p = 0.002 and 0.011 respectively). Only age, disease and disease status predicted disease-free survival (DFS) and overall survival (OS) in our cohort (p < 0.005). Non-relapse mortality was not affected by low dose of CD34(+) (<2 × 10(6)/kg). In conclusion, our study shows that CD34(+) remains a useful and convenient marker for assessing haemotopoietic stem cell content and overall engraftment capacity post-transplant. Neutrophil contamination of HPC-A appears to be a key factor delaying neutrophil recovery. Steps to minimize the degree of neutrophil contamination in HPC-A product may be associated with more rapid neutrophil engraftment and

  1. Biochemical aspirin resistance in stroke patients - a cross-sectional single centre study.

    PubMed

    Azmin, Shahrul; Sahathevan, Ramesh; Rabani, Remli; Nafisah, Wan Y; Tan, Hui J; Raymond, Azman A; Hamidon, Basri B; Shamsul, Azhar S; Norlinah, Mohamed Ibrahim

    2013-01-01

    Aspirin use is known to reduce the recurrence of stroke. However, the clinical response to aspirin has been mixed. The rate of stroke recurrence whilst on aspirin treatment is still unacceptably high. A plausible explanation for this may be resistance to the effects of aspirin. The causes of aspirin resistance are manifold and multi-factorial. We conducted a study to investigate the prevalence rate of biochemical aspirin resistance in a cohort of aspirin-naïve stroke patients. We also sought to determine the inherent factors that may predispose towards the development of aspirin resistance. This was a cross-sectional, observational study conducted on patients admitted to our centre with an acute stroke who were aspirin-naïve. The diagnosis of an acute stroke was confirmed by clinical history and brain imaging. Fifty consecutive patients were prospectively enrolled. Socio-demographic data were collected and baseline blood investigations were performed. Patients were tested for biochemical aspirin resistance using Multiplate platelet analyser (Dynabyte, Munich, Germany) after 5 doses of aspirin, corresponding to a total dose of 900 mg. The median age of patients was 65.5 years and 54 % of patients were female. There were 11 smokers; of these 10 were male. Twenty-six (52 %) patients were Chinese, 21 (41 %) were Malay and 3 (6.0 %) were Indian. Aspirin resistance was present in 14 % of our patients. There was an inverse relationship between the presence of aspirin resistance and plasma HDL levels (r = -0.394; p = 0.005). There was no relationship observed between aspirin resistance and total cholesterol, triglycerides, LDL, HbA1c, ALT, ALP, urea and creatinine levels. There were no significant differences in demographic profiles or smoking status between the aspirin resistant and non-aspirin resistant groups. We did not find any link between ethnicity and aspirin resistance. Our results indicate that a lower HDL level is associated with biochemical aspirin resistance

  2. Breast phyllodes tumor: a review of literature and a single center retrospective series analysis.

    PubMed

    Spitaleri, Gianluca; Toesca, Antonio; Botteri, Edoardo; Bottiglieri, Luca; Rotmensz, Nicole; Boselli, Sabrina; Sangalli, Claudia; Catania, Chiara; Toffalorio, Francesca; Noberasco, Cristina; Delmonte, Angelo; Luini, Alberto; Veronesi, Paolo; Colleoni, Marco; Viale, Giuseppe; Zurrida, Stefano; Goldhirsch, Aron; Veronesi, Umberto; De Pas, Tommaso

    2013-11-01

    Complete surgical resection is the standard treatment for localized breast phyllodes tumors. Post-surgical treatments are still a matter of debate. We carried out an overview of the literature to investigate the clinical outcome of patients with phyllodes tumor. A retrospective analysis of mono-institutional series has been included as well. We reviewed all the retrospective series reported from 1951 until April 2012. We analyzed cases treated at our institution from 1999 to 2010. Eighty-three articles (5530 patients; 1956 malignant tumors) were reviewed. Local recurrences were independent of histology. Distant recurrences were more frequent in the malignant tumors (22%). A total of 172 phyllodes tumors were included in the retrospective analysis. Prognosis of phyllodes tumors is excellent. There are no convincing data to recommend any adjuvant treatment after surgery. Molecular characterization may well provide new clues to permit identification of active treatments for the rare poor prognosis cases. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  3. Laparoscopic single site (LESS) and classic video-laparoscopic cholecystectomy in the elderly: A single centre experience.

    PubMed

    Aprea, Giovanni; Rocca, Aldo; Salzano, Andrea; Sivero, Luigi; Scarpaleggia, Mauro; Ocelli, Prisida; Amato, Maurizio; Bianco, Tommaso; Serra, Raffaele; Amato, Bruno

    2016-09-01

    Laparoscopic cholecystectomy (LC) is the gold-standard surgical method used to treat gallbladder diseases. Recently Laparoendoscopic single site surgery (LESS) has gained greater interest and diffusion for the surgical treatment of several pathologies. In elderly patients, just few randomized controlled trials are present in the literature that confirm the clinical advantages of LESS compared with the classic laparoscopic procedures. We present in this paper the preliminary results of this randomized prospective study regarding the feasibility and safety of LESS cholecystectomy versus classic laparoscopic technique. We demonstrated that LESS technique compared with traditional technique show some advantages like: acceptable operative times, lower post-operative discomfort and sometimes reduction added complications. In addition we also demonstrate that fewer incisions and less scarring which mean less pain, and fewer parietal complications are related to this surgical procedure. In conclusion in the elderly LESS cholecystectomy technique is to be considered a suitable alternative to traditional three-port cholecystectomy.

  4. Outcomes of sprayed cultured epithelial autografts for full-thickness wounds: a single-centre experience.

    PubMed

    Lee, Haguen

    2012-09-01

    The lack of autograft donor sites with major burns provides the impetus to develop innovative solutions due to the difficulty of wound closure. Autograft donor sites are particularly limited in patients with burns involving over 50% total body surface area (TBSA). The introduction of cultured epithelial cell autografts offers a potential solution to assist in wound closure. The objective of this study was the assessment of clinical results after sprayed application of the cultured epithelial autograft (CEA, Keraheal™, Seoul, Korea, MCTT) suspension onto the wounds of extensively burned patients. This retrospective clinical audit of major burn patients (n=16) describes the use of CEA which was combined with 6:1 meshed expansion grafts in those with the burn over 40% TBSA in our hospital between the period of August 2007 and January 2010. The burn patients included 12 males and 4 females with a mean age 41.5 and a burn area of 51.3 ± 3.1% TBSA (30-70%; median: 50.5%) and a mean third burn area of 32.5 ± 3.0% TBSA (median 34.0%). The take rates were 37.6%, 68.0% and 90.0% on average at 2, 4 and 8 weeks after treatment with the suspension, respectively, and the transplantation of the cultured cells was applied to full-thickness burns, with the coverage of a skin area of 497.5 cm(2) per 1 ml of the cultured cells. For clinical follow-up, 12 patients were observed for 21.5 months on average, with a maximum follow-up period of 39 months. Six patients were excluded from the surveillance because two died during hospitalisation and the other four were impossible to trace. The use of a sprayed cultured epithelial cell autograft (Keraheal™) in treating a full-thickness skin wound in severely burned patients results in favourable quality of scars and also good potential to save lives by providing epidermal cover. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.

  5. Characteristics of Hollow Viscus Injury following Blunt Abdominal Trauma; a Single Centre Experience from Eastern India

    PubMed Central

    Jha, Nawal Kishore; Yadav, Sanjay Kumar; Sharma, Rajshekhar; Sinha, Dipendra Kumar; Kumar, Sandip; Kerketta, Marshal Daud; Sinha, Mini; Anand, Abhinav; Gandhi, Anjana; Ranjan, Satish Kumar; Yadav, Jitin

    2014-01-01

    Objective: To determine the presentation, anatomical distribution, diagnostic method, management and outcome of hollow viscus injury (HVI) from blunt abdominal trauma. Methods: This  was  a  retrospective  cross-ecnal  study  including  patients  with  blunt  abdominal  trauma leading to HVI admitted at Rajendra Institute of Medical Sciences, Ranchi, over a period of 4.5 years (January 2009 to July 2014). Data were retrieved from patients’ medical records. Total 173 patients with HVI due to blunt abdominal trauma, who underwent laparotomy at our institute, were reviewed. Data regarding clinical presentation, anatomical distribution, management and outcome were recorded and analysed. Results: Out of 173 patients 87.1% were men and 12.9% were women. Mean age of patients was 29±14.02 years. The most common site of injury was ileum (46.2%) followed by jejunum (44.5%). There were 5 gastric perforations (2.9%), 2 (1.15%) duodenal, 2 (1.15%) colonic, 2 (1.15%) sigmoidal and 2 (1.15%) rectal injuries. One caecal injury was also recorded. Road traffic accident was the most common mechanism of injury (57.2%) followed by fall from height (36.4%) and assault (6.4%). Free gas under diaphragm on erect abdomen radiography was seen in 85.5% of cases while preoperative CT Abdomen was done in 11.6% of cases. Treatment consisted of simple closure of the perforation (66.5%), resection and anastomosis (11.0%) and stoma (22.5%). Major complication was anastamotic leak which was recorded in 6.4% cases and 15.6% patients developed burst abdomen. Average hospital stay was 13±6 days. Overall mortality rate was 12.7%. Conclusion: Although early recognition of intestinal injuries from blunt abdominal trauma may be difficult in all cases, it is very important due to its tremendous life threatening potential. Age of the patient, anatomical site and time of presentation are probably main prognostic factors. PMID:27162889

  6. Organophosphate poisoning in the developed world - a single centre experience from here to the millennium.

    PubMed

    Hrabetz, Heidi; Thiermann, Horst; Felgenhauer, Norbert; Zilker, Thomas; Haller, Bernhard; Nährig, Jörg; Saugel, Bernd; Eyer, Florian

    2013-12-05

    Organophosphate (OP) poisoning is still associated with high morbidity and mortality rates, both in resource-poor settings and in well-developed countries. Despite numerous publications dealing with this particular poison, detailed clinical data on more severe overdoses with these agents are relatively sparsely reported. A retrospective study was consequently conducted on 33 patients with OP poisoning admitted to our intensive care unit (ICU) to provide additional data on clinical features. We included moderate to severe poisonings between 2000 and 2012 who required admission to ICU. Patients ingested dimethyl-OPs in 19 cases, diethyl-OPs in 8 cases and otherwise classified OPs in 6 cases. Death (5/33) occurred rather late and only one of these fatalities died during on-going cholinergic crisis. Of the survivors (28/33), 71% recovered fully while 29% showed predominantly neurological disabilities before being transferred to neurologic rehabilitation. Aspiration pneumonia predominated in 27/33 patients and one patient died in refractory acute respiratory distress syndrome (ARDS). The intermediate syndrome occurred twice and cardiopulmonary resuscitation had to be performed in 6/33 patients. Fatalities showed a higher Poison-severity-score, APACHE-II-score and SOFA-score on admission compared with survivors and they showed significantly longer QTc-time in the ECG, lower systolic blood pressure and heart rate, a lower pH and a lower base excess on admission. Patients with diethyl-OPs required intubation significantly earlier and showed lower and more sustained inhibited activity of the plasma-cholinesterase on admission compared with patients ingesting dimethyl-OPs. Treatment with atropine and obidoxime was comparable between these groups and severity of poisoning, outcome, hemodynamics on admission, duration of mechanical ventilation and length of stay in the ICU did not significantly differ between the involved group of dimethyl- and diethyl-OPs. We conclude that

  7. Invasive mould sinusitis in patients with haematological malignancies: a 10 year single-centre study.

    PubMed

    Davoudi, S; Kumar, V A; Jiang, Y; Kupferman, M; Kontoyiannis, D P

    2015-10-01

    Invasive mould sinusitis (IMS) is a severe infection in patients with haematological malignancies. Because of a paucity of contemporaneous data about IMS, we sought to evaluate clinical aspects and outcome of IMS in these patients. The records of adult haematological malignancy patients with proven or probable IMS over a 10 year period were reviewed retrospectively. We identified 44 patients with IMS. Mucorales were isolated in 13 (35.1%) patients and Fusarium and Aspergillus were isolated in 9 (24.3%) patients each. Patients with IMS owing to Mucorales were more likely to have a history of diabetes mellitus (P = 0.003) and high-dose corticosteroid use (P = 0.03). Thirty-five (80%) patients received antifungal combinations and 36 (82%) underwent surgical debridement. The 12 week IMS-attributable mortality was 36.4% (16 patients). A relapsed and/or refractory haematological malignancy was an independent risk factor for 6 week IMS-attributable (P = 0.038), 12 week all-cause (P = 0.005) and 12 week IMS-attributable (P = 0.0015) mortality. Neutrophil count <100/µL and lymphocyte count <200/µL were associated with increased 12 week IMS-attributable and 6 week all-cause mortality, respectively (P = 0.044 and 0.013). IMS due to Aspergillus was an independent risk factor for both 12 week all-cause (P = 0.011) and IMS-attributable (P = 0.026) mortality. Initial antifungal therapy with a triazole-containing regimen was associated with decreased 6 week all-cause (P = 0.032) and IMS-attributable (P = 0.038) mortality. Surgery was not an independent factor for improved outcome. Despite combined medical and surgical therapy, IMS had high mortality. Mortality risk factors were relapsed and/or refractory malignancy, cytopenia and Aspergillus infection in this study. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  8. [Home parenteral nutrition in patients with advanced cancer: experience of a single centre over ten years].

    PubMed

    Moreno Villares, J M; Gomis Muñoz, P; Valero Zanuy, Ma A; León Sanz, M

    2004-01-01

    The use of Home Parenteral Nutrition (HPN) in patients with advanced cancer without the possibility of curative treatment continues to be a controversial subject entailing a considerable emotional burden. Nonetheless, this group of patients constitutes the main indication for HPN in many programmes. To present the characteristics of a series of patients included on an HPN programme over the last ten years. Retrospective study of the case histories of the 11 patients who received HPN over this period. The demographic and clinical details were noted along with their complications and evolution for comparison with those of a control group of patients with benign disease receiving HPN over the same period. For the comparisons, Student's t test and the chi-squared test were used as and when indicated. Results were considered statistically significant if p < 0.05. Eleven patients received HPN, nine of them because of an irresoluble intestinal obstruction and two because of a high flow fistula. The mean age at the start of HPN was 50.8 +/- 12.7 years versus 37.3 +/- 17.2 years for the group with benign disease (p < 0.05). The mean duration of HPN was 71.05 +/- 217 days in the first group, notably less than the second (387.15 +/- 995.85; p < 0.05), with a range between 5 and 760 days. The patients received the infusion through a previously implanted subcutaneous reservoir (n = 9) and on two occasions, electively, through a tunnelled catheter. The infection rate was higher in the group with cancer (0.34 episodes per patient and 1,000 days on HPN) than in the group with benign disease (0.08 episodes; p < 0.05). HPN was suspended in only one of the patients more than 5 days prior to death due to clinical deterioration. Two patients required admission due to a complication associated with the technique. In both cases, a fungal infection of the blood made it necessary to withdraw the catheter. The quality of life, measured by means of an activity scale, was similar at the start

  9. Comparison of Extracorporeal Shock Wave Lithotripsy for Urolithiasis Between Children and Adults: A Single Centre Study

    PubMed Central

    Assad, Salman; Rahat Aleman Bhatti, Joshua; Hasan, Aisha; Shabbir, Muhammad Usman; Akhter, Saeed

    2016-01-01

    Objective To retrospectively evaluate the effectiveness of extracorporeal shock wave lithotripsy (ESWL) for urolithiasis and compare the results between children and adults. Materials and methods From January 2011 to January 2015 (four years), ESWL was performed in 104 children and 300 adults for urolithiasis. MODULITH® SLX-F2 lithotripter (Storz Medical AG, Tägerwilen, Switzerland) equipment was used for ESWL. The stone-free rates, the number of ESWL sessions required, complication rates and ancillary procedures used were evaluated in a comparative manner. Results The mean age ± standard deviation (SD) of children was 7.84±4.22 years and of adults was a 40.22±1.57 years. Mean ± SD of the stone size was 1.28±61 cm in the adults while 1.08 ± 0.59 cm in the children. In adults, the complications included steinstrasse in six (1.98%) patients, fever in 15 (4.95%), hematuria in 19 (6.28%) and sepsis in six (1.98%) patients. In children, steinstrasse was observed in two (1.9%), mild fever in two (1.9%), hematuria in six (5.7%) and sepsis was seen in four (3.8%) patients. The overall complication rate in the adults and in the children, it was found to be 46/300 (15%) and in the children, it was seen to be 14/104 (13%). No statistical difference was found in post-ESWL complications between children and adults (P>0.05). Ancillary procedures including double J (DJ) stent were used in 13 (12.5%) children and 87 (29%) adults. There was a better stone clearance rate in children i.e. 79% as compared to 68% in adults (X2: P=0.036). Conclusion Children can achieve high stone-free rates after ESWL with a lower need for repeat ancillary procedures as compared to adults. However, there is a difference in the post-ESWL complications between these groups. PMID:27800291

  10. Role of the transumbilical laparoscopic-assisted single-channel, single-port procedure in an interval appendectomy for pediatric mass-forming appendicitis: a preliminary retrospective analysis.

    PubMed

    Ohno, Yasuharu

    2014-08-01

    A transumbilical laparoscopic-assisted single-channel, single-port procedure was introduced during laparoscopic interval appendectomy for mass-forming appendicitis in children. The aim of this study was to evaluate the results of the original laparoscopic interval appendectomy. This study analyzed 31 children who underwent laparoscopic interval appendectomy using a single-channel, single-port procedure. The appendectomy was usually planned 8-12 weeks following initial conservative treatment. The procedure was a single-channel surgery using a 12-mm single port. Both a 5-mm telescope and grasper were inserted simultaneously into the single channel. The grasper held the appendix, and an extracorporeal appendectomy was performed. Appendectomy was planned for 29 patients, as 2 patients deviated from the protocol. The procedure was successful in 21 patients (72.4%). An accessory port was necessary in eight patients, two of whom successfully underwent laparoscopic surgery; the remaining six were converted to open appendectomy. The average length of surgery was 43 min in the single-channel, single-port procedure. No postoperative complications occurred in any patient. The single-channel, single-port procedure was successfully performed in over 70% of the patients. This preliminary retrospective analysis indicates that the procedure is safe and potentially beneficial in children with mass-forming appendicitis who require laparoscopic interval appendectomy. © 2014 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

  11. Kidney transplantation from related and unrelated living donors in a single German centre.

    PubMed

    Voiculescu, Adina; Ivens, Katrin; Hetzel, Gerd Rüdiger; Hollenbeck, Markus; Sandmann, Wilhelm; Grabitz, Klaus; Balzer, Kai; Schneider, Frank; Grabensee, Bernd

    2003-02-01

    Organ transplantation began in 1954 with living related donation (LRD). Because of organ shortage from cadavers, unrelated kidney donation (LURD) has been proposed and shown to have good results despite complete HLA mismatching. This study aims to look at differences and similarities comparing LRD and LURD performed in our centre since the implementation of the German transplant law in 1997. Between January 1997 and July 2001, 62 out of 112 potential living donors and their recipients were accepted. Immunosuppression consisted of triple therapy (steroids, cyclosporin, mycophenolate) in patients with three or fewer mismatches, or quadruple therapy including mono- or polyclonal antibody treatment in patients with four or more mismatches or cytotoxic antibodies. LRD and LURD groups were compared for number and type of rejections, complications and kidney function at the end of observation (median 15.5 months, range 1-50 months). Out of 112 pairs presenting, transplantation was performed in only 62 cases (55.4%). Reasons to deny transplantation were medical problems of the potential donors in 19, psychological problems in 13, recipient problems in seven and other reasons in 11 pairs. In 38 cases LRD transplantation and in 24 cases LURD transplantation was carried out. Recipient age was significantly lower in the LRD group (37.7+/-12.1 years) compared with the LURD group (53.6+/-7.8 years). Mean donor age was 49.7+/-9.2 years in the LRD group and 50.3+/-9.1 years in the LURD group (ns). The number of mismatches was lower in LRD (2.1+/-1) than in LURD (4.4+/-0.9) (P=0.001) transplantation. The acute rejection rate was similar in both groups (52.2 vs 54.2%). OKT3 and tacrolimus rescue therapy for more severe rejections was more often applied in the LRD group but the difference did not reach the level of significance. There were more infectious complications in LURD transplantation (66.7 vs 36.4%, P=0.036) and a trend towards more surgical complications in LRD

  12. Vitamin D deficiency: A single centre analysis of patients from 136 countries.

    PubMed

    Haq, Afrozul; Svobodová, Jitka; Imran, Samira; Stanford, Charles; Razzaque, Mohammed S

    2016-11-01

    Vitamin D deficiency is a global problem, thought to be related to lack of sunlight exposure, and usually accompanied by reduced dietary intake. This study was designed to determine vitamin D status of 60,979 patients admitted to the Burjeel Hospital of VPS healthcare in Abu Dhabi, United Arab Emirates (UAE) from October 2012 to September 2014. The total concentrations of vitamin D [25(OH)D] of all the studied patients were measured in a single laboratory. Of the studied patients, 57.5% were female and 42.5% were male. Serum 25(OH)D (total) measurements showed 82.5% of the studied patients have vitamin D deficiency to insufficiency. 26.4% of females and 18.4% of males have extreme deficiency of 25(OH)D. There was higher variability of vitamin D in group of females then males according to coefficient of variation. In our studied cohort teenagers (13-19 years) have shown the lowest levels of serum vitamin D (data not shown and will be communicated as a separate publication). The prevalence of hypovitaminosis D is significantly high among population of UAE, Saudi Arabia and many Middle Eastern countries, especially among women, despite abundant sunshine. 86.1% UAE nationals and 78.9% visitors of other nationalities were found <75nmol/L of 25(OH)D. 28.4% of UAE nationals and 17.5% of visitors of other nationalities have extreme deficiency of 25(OH)D. Our results are significant, as all of our patients are residing permanently in the UAE or visitors that has yearlong sunlight. In addition, measuring 25(OH)D concentrations in a single laboratory minimized test level variations. Our current study formed the basis of further studies to determine if vitamin D deficiency and insufficiency can aggravate systemic diseases, including hypertension, diabetes or obesity that are also wide-spread in the Middle Eastern region. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Peripheral neuropathy is a common manifestation of mitochondrial diseases: a single-centre experience.

    PubMed

    Luigetti, M; Sauchelli, D; Primiano, G; Cuccagna, C; Bernardo, D; Lo Monaco, M; Servidei, S

    2016-06-01

    Peripheral neuropathy in mitochondrial diseases (MDs) may vary from a subclinical finding in a multisystem syndrome to a severe, even isolated, manifestation in some patients. To investigate the involvement of the peripheral nervous system in MDs extensive electrophysiological studies were performed in 109 patients with morphological, biochemical and genetic diagnosis of MD [12 A3243G progressive external ophthalmoplegia (PEO)/mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS), 16 myoclonic epilepsy with ragged-red fibres (MERRF), four mitochondrial neurogastrointestinal encephalomyopathy (MNGIE), 67 PEO with single or multiple deletions of mitochondrial DNA, 10 others]. A neuropathy was found in 49 patients (45%). The incidence was very high in MNGIE (100%), MELAS (92%) and MERRF (69%), whilst 28% of PEO patients had evidence of peripheral involvement. The most frequent abnormality was a sensory axonal neuropathy found in 32/49 patients (65%). A sensory-motor axonal neuropathy was instead detected in 16% of the patients and sensory-motor axonal demyelinating neuropathy in 16%. Finally one Leigh patient had a motor axonal neuropathy. It is interesting to note that the great majority had preserved tendon reflexes and no sensory disturbances. In conclusion, peripheral involvement in MD is frequent even if often mild or asymptomatic. The correct identification and characterization of peripheral neuropathy through electrophysiological studies represents another tile in the challenge of MD diagnosis. © 2016 EAN.

  14. Different techniques for management of common bile duct stones: a single centre experience.

    PubMed

    El Wakil, Mohamed Reda M; Abdelkader, Nadia A; Salem, Hossam El-Deen M; Halima Abo, Ahmed Samir

    2014-12-01

    Local experience on the combined technique of endoscopic sphincterotomy followed by endo: scopic balloon dilation is scarce. This study clarified whether this crombined technique will offer any advantages, with respect to therapeutic outcome and complications rate, as compared with endoscopic sphincterotomy (ES) and endoscopic balloon dilatation (EBD) alone for the extraction of large and/or multiple common bile duct stones. For a total of 76 patients, extraction of large and/or multiple common bile duct (CBD) stones during endoscopic retrograde cholangiopancreatography was performed. According to the used technique, they were categorized into 3 groups; Endoscopic sphincterotomy, endoscopic balloon dilatation or combined technique. The success rate of complete stone removal and the incidence of procedure-related complications were compared among the three groups. Success rate after one session was recorded to be comparable among the three groups. Relative Risk Ratio assessment of success rate after single session among the three groups showed no statistically significant difference. Regarding bleeding, only 3 (10%) cases were recorded in the ES group with no cases in the, other 2 groups. No significant difference was noted among the three groups regarding other complication. The combined technique of ES followed by EBD is an effective and safe technique enables extraction of multiple and/or relatively large stones. It could be a reasonable alternative option when standard techniques are inadequate to remove bile duct stones.

  15. Delayed Stenting for ST-Elevation Acute Myocardial Infarction in Daily Practice: A Single-Centre Experience.

    PubMed

    Pascal, Julien; Veugeois, Aurélie; Slama, Michel; Rahal, Saliah; Belle, Loic; Caussin, Christophe; Amabile, Nicolas

    2016-08-01

    The minimalist immediate mechanical intervention (MIMI) strategy aims to restore normal anterograde flow in the culprit artery (by using manual thrombectomy or small-sized balloon predilation) and to defer potential stent implantation. This study evaluated the applicability and midterm clinical results of the MIMI strategy for ST-elevation myocardial infarction (STEMI) management. This observational study included consecutive patients admitted for ongoing STEMI (<24 hours' evolution) at 1 institution between June 2010 and June 2013. Revascularization was performed at the physician's discretion. We compared retrospectively "intentional immediate stenting" (standard technique) and "intentional delayed stenting" (MIMI technique). Twenty percent of the 279 included patients were treated with the MIMI strategy. These patients were significantly younger and were more frequently men and smokers compared with patients who underwent the standard procedure. The rate of acute reocclusion of the culprit artery related to STEMI in the MIMI group was 1.8%. Drug-eluting stents were used more frequently in the MIMI group (52% vs 27% in the standard group; P < 0.001). The culprit lesion was stented less frequently in the patients treated with MIMI compared with patients in the other group (28.5% vs 9%; P < 0.001). The 1-year actuarial survival free from major adverse cardiovascular events was higher in the MIMI group than in the standard group (96.3% ± 1.8% vs 83.8% ± 2.5%; P = 0.01). The MIMI strategy can be applied in selected patients with STEMI. In our centre, this strategy is associated with less systematic culprit lesion stenting and more implantation of drug-eluting stents. However, this needs to be evaluated further in a randomized trial. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  16. Single-centre experience with nonmyeloablative allogeneic stem cell transplantation in patients with multiple myeloma: prolonged remissions induced.

    PubMed

    van Dorp, S; Meijer, E; van de Donk, N W C J; Dekker, A W; Nieuwenhuis, K; Minnema, M C; Petersen, E; Schutgens, R; Verdonck, L F; Lokhorst, H M

    2007-05-01

    The role of allogeneic stem cell transplantation in multiple myeloma is not yet established. We retrospectively evaluated the outcome of nonmyeloablative allogeneic stem cell transplantation (NMA) in patients with multiple myeloma treated at the Department of Haematology of the University Medical Centre Utrecht. Thirty-six patients received NMA as part of the first-line treatment; 23 patients as part of salvage therapy. Conditioning regimen was low-dose total body irradiation (TBI, 2 Grays) only; fludarabine was added in patients without previous autologous stem cell transplantation and patients with matched unrelated donors received antithymocyte globulin in addition to fludarabine and TBI. Following NMA overall response increased from 84 to 90%, complete remission rate from 15 to 32%. As part of first-line treatment NMA induced complete remission in 50% of patients vs one patient (4%) treated for relapsed multiple myeloma. Median progression-free survival was 26 months (13 months for the salvage group, 38 months for the 'upfront' patients). Median overall survival has not been reached yet. The achievement of complete remission following NMA as part of first-line treatment was associated with prolonged progression-free and overall survival. Major toxicities were acute and chronic graft-vs-host disease occurring in 64% (23% grade 3-4) and in 54% (49% extensive) patients, respectively. Seven patients (12%) died from nonrelapse mortality, five patients (9%) directly related to toxicity of NMA. NMA in multiple myeloma is feasible, is associated with acceptable nonrelapse mortality and may induce prolonged complete remission. In pretreated patients the result of NMA is disappointing which urges new strategies.

  17. Late complications of electrotherapy - a clinical analysis of indications for transvenous removal of endocardial leads: a single centre experience.

    PubMed

    Polewczyk, Anna; Kutarski, Andrzej; Tomaszewski, Andrzej; Polewczyk, Maciej; Janion, Marianna

    2013-01-01

    Despite advances in electrotherapy, late complications constitute an increasing clinical and therapeutic problem. Transvenous lead extraction (TLE) is becoming a safe and effective approach to the treatment of such complications. To assess indications for TLE and to evaluate safety and efficacy of TLE procedures. A retrospective clinical analysis of 100 patients with complications of electrotherapy admitted to a tertiary care centre in 2008-2011. In 2008-2011, the number of electrotherapy complications increased markedly. The most frequent reason for TLE was lead dysfunction (62% of patients, including 31% with an implanted cardioverter-defibrillator [ICD] and 31% with a pacemaker [PM]). The most common type of lead dysfunction was conductor damage (38% of patients, including 23% with ICD, 15% with PM), followed by late myocardial perforation (14% of patients, including 7% with ICD, 7% with PM), abnormal course of the lead (7% of patients, including 1% with ICD, 6% with PM), and lead insulation failure (3% of patients). Other reasons for TLE were infectious complications (24% of patients, including 15% with PM pocket infection), venous insufficiency (17% of patients, including 10% in whom an indwelling lead was a direct obstacle to switching the pacing mode), and the need to switch the pacing mode (4% of patients). Procedural efficacy was 96% (lead fragments were left in place in 4% of patients). No significant clinical complications were observed in any of the patients in the periprocedural period. Clinical manifestations of electrotherapy complications in the study group varied and included a relatively small number of infectious complications (24%) and a relatively large number of late myocardial perforations (14%). Efficacy and safety of the procedures were very high.

  18. Stapled Mesh stomA Reinforcement Technique (SMART) in the prevention of parastomal hernia: a single-centre experience.

    PubMed

    Ng, Z Q; Tan, P; Theophilus, M

    2017-06-01

    Parastomal hernia remains a frequent complication following creation of an abdominal stoma. Previous interests have centred around the exploration of methods to repair; however, prophylactic mesh placement has demonstrated its efficacy in reduction of parastomal hernia. The aim of this retrospective analysis was to evaluate the outcomes of Stapled Mesh stomA Reinforcement Technique (SMART) in terms of parastomal hernia occurrence rate and mesh-related complications. All patients operated with an abdominal perineal resection or Hartmann's procedure with SMART from November 2013 to March 2016 were included. Patient demographics, operative details and stoma-related symptoms were collected. Patients were examined clinically by the medical team and also reviewed independently by a specialist stoma care nurse for signs of stoma-related complications. As part of oncological follow-up, CT scans were available for review for evidence of parastomal herniation. 14 patients (mean age 76 years) were included in the analysis. All the SMART cases were successfully completed with no intraoperative or immediate post-operative complications. No cases of mesh-related complications such as infection, immediate stomal prolapse, stenosis, retraction, stomal obstruction, mesh erosion or fistulation were observed. No mesh removal was required. There were two cases of parastomal hernia detected on CT scan. Both cases have remained asymptomatic no intervention was required at this stage. Median follow-up was 24 months. Our medium-term experience has demonstrated the efficacy of SMART in the reduction of parastomal hernia occurrence. With appropriate learning curve, parastomal hernia can be prevented.

  19. Aspiration in head and neck cancer patients: a single centre experience of clinical profile, bacterial isolates and antibiotic sensitivity pattern.

    PubMed

    Lakshmaiah, K C; Sirsath, Nagesh T; Subramanyam, Jayshree R; Govind, Babu K; Lokanatha, D; Shenoy, Ashok M

    2013-07-01

    Most patients with head and neck cancer have dysphagia and are at increased risk of having aspiration and subsequent pneumonia. It can cause prolonged hospitalization, treatment delay and/or interruption and mortality in cancer patients. The treatment of these infections often relies on empirical antibiotics based on local microbiology and antibiotic sensitivity patterns. The aim of present study is to analyse respiratory tract pathogens isolated by sputum culture in head and neck cancer patients undergoing treatment at a tertiary cancer centre in South India who presented with features of aspiration. The study is carried out to establish empirical antibiotic policy for head and neck cancer patients who present with features of aspiration. This was a retrospective study. The study included sputum samples sent for culture and sensitivity from January 2011 to December 2012. Analysis of microbiologic species isolated in sputum specimen and the antibiotic sensitivity pattern of the bacterial isolates was performed. A detailed study of case files of all patients was done to find out which is the most common site prone for producing aspiration. There were 47 (31.54 %) gram positive isolates and 102 (68.45 %) gram negative isolates. The most common bacterial isolates were Klebsiella pneumoniae (25.50 %), Pseudomonas aeruginosa (16.77 %) and Haemophilus influenzae (15.43 %). Levofloxacin was the most effective antibiotic with excellent activity against both gram positive and gram negative isolates. Most patients with aspiration had laryngeal cancer (34.89 %). Aspiration pneumonia was present in 14 (9.39 %) patients. Gram negative bacteria are common etiologic agents in head and neck cancer patients presenting with features of aspiration. Levofloxacin should be started as empirical antibiotic in these patients while awaiting sputum culture sensitivity report. As aspiration in head and neck cancer is an underreported event such institutional antibiotic sensitivity

  20. Reducing the immediate availability of red blood cells in cardiac surgery, a single-centre experience.

    PubMed

    Haanschoten, M C; van Straten, A H M; Verstappen, F; van de Kerkhof, D; van Zundert, A A J; Soliman Hamad, M A

    2015-01-01

    In our institution, we have redefined our criteria for direct availability of red blood cell (RBC) units in the operation room. In this study, we sought to evaluate the safety of applying this new logistical policy of blood transfusion in the first preliminary group of patients. In March 2010, we started a new policy concerning the elective availability of RBC units in the operation room. This policy was called: No Elective Red Cells (NERC) program. The program was applied for patients undergoing primary isolated coronary artery bypass grafting (CABG) or single valve surgery. No elective RBC units were preoperatively ordered for these patients. In case of urgent need, blood was delivered to the operating room within 20 min. The present study includes the first 500 patients who were managed according to this policy. Logistic regression analyses were performed to investigate the impact of biomedical variables on fulfilling this NERC program. The majority of patients (n = 409, 81 %) did not receive any RBCs during the hospital stay. In patients who did receive RBCs (n = 91, 19 %), 11 patients (2.2 %) received RBCs after 24 h postoperatively. Female gender, left ventricular ejection fraction (LVEF) and EuroSCORE were significant predictors for the need of blood transfusion (OR = 3.12; 2.79; 1.17 respectively). In a selected group of patients, it is safe to perform cardiac surgery without the immediate availability of RBCs in the operating room. Transfusion was avoided in 81 % of these patients. Female gender, LVEF and EuroSCORE were associated with blood transfusion.

  1. An Audit of Clinical Practice in a Single Centre in Kuwait: Management of Children on Continuous Subcutaneous Insulin Infusion and Cardiovascular Risk Factors Screening

    PubMed Central

    Omar, Dina; Alsanae, Hala; Al Khawari, Mona; Abdulrasoul, Majedah; Rahme, Zahraa; Al Refaei, Faisal; Behbehani, Kazem; Shaltout, Azza

    2017-01-01

    Objectives: To audit the current clinical practice of continuous subcutaneous insulin infusion (CSII) for the treatment of type 1 diabetes mellitus (T1D) in children and adolescents attending a single centre in Kuwait. Methods: A one year retrospective audit was performed in children and adolescents with T1D on CSII, who attended the paediatric diabetes clinic, Dasman Diabetes Institute during 2012. The primary outcome measure was glycaemic control as evidenced by glycated haemoglobin (HbA1c) level and the secondary outcome measures were the frequency of monitoring of the risk for microvascular complications and occurrence of acute complications and adverse events. Results: 58 children and adolescents (mean age ± SD: 12.6 ± 4.1 years) were included. Mean HbA1c at baseline was 8.8% (72.7 mmol/mol) and 8.9% (73.8 mmol/mol) at the end of a 12 months observation period. Children with poor control (HbA1c >9.5% (80 mmol/mol) had a significant 1.4% reduction in HbA1c compared with the overall reduction of 0.1% (p=0.7). Rate of screening for cardiovascular risk factors and for long term complications were well documented. However, there was underreporting of acute complications such as severe hypoglycaemia and diabetic ketoacidosis. Only 1.7% of patients discontinued the pump. Conclusion: There was no significant change in HbA1c values at the end of 12 months follow up. However, HbA1c values in poorly controlled children improved. CSII requires care by skilled health professionals as well as education and selection of motivated parents and children. PMID:28400862

  2. Screening for infectious diseases among asylum seekers newly arrived in Germany in 2015: a systematic single-centre analysis.

    PubMed

    Kortas, A Z; Polenz, J; von Hayek, J; Rüdiger, S; Rottbauer, W; Storr, U; Wibmer, T

    2017-08-08

    During the migrant crisis in 2015, Germany was the largest single recipient of new asylum seekers in Europe. The German asylum law requires a screening examination for certain infectious diseases in asylum seekers upon arrival. The aim of this work was to analyse the rate of certain infectious diseases among asylum seekers screened at a reception centre in Southern Germany. Retrospective medical record review. Medical records of 2602 asylum seekers screened by a local public health authority in Germany in 2015 were systematically analysed. The majority of screened subjects came from Afghanistan and Syria. The mean age was 22.1 (±12.0) years. The majority of subjects were male (75.4%). Most individuals were of normal weight or overweight, more subjects were obese than underweight. A total of 78 (3.9%) individuals were infected with hepatitis B and eight (0.4%) with HIV. In 31 cases, chest radiographs suggested active tuberculosis (1.6%), which was confirmed in four cases (0.2%). The physical examination uncovered 44 (1.7%) cases of scabies, nine (0.3%) cases of lice, eight (0.3%) of upper respiratory tract infections, two (0.1%) of varicella and 13 (0.5%) of other skin infections. In the majority of subjects none of the screened infectious diseases were found. No evidence was found that the overall prevalence of certain infectious diseases screened for in the present analysis was considerably higher than in previous migration studies. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  3. Centre characteristics and procedure-related factors have an impact on outcomes of allogeneic transplantation for patients with CLL: a retrospective analysis from the European Society for Blood and Marrow Transplantation (EBMT).

    PubMed

    Schetelig, Johannes; de Wreede, Liesbeth C; Andersen, Niels S; Moreno, Carol; van Gelder, Michel; Vitek, Antonin; Karas, Michal; Michallet, Mauricette; Machaczka, Maciej; Gramatzki, Martin; Beelen, Dietrich; Finke, Jürgen; Delgado, Julio; Volin, Liisa; Passweg, Jakob; Dreger, Peter; Schaap, Nicolaas; Wagner, Eva; Henseler, Anja; van Biezen, Anja; Bornhäuser, Martin; Iacobelli, Simona; Putter, Hein; Schönland, Stefan O; Kröger, Nicolaus

    2017-08-01

    The best approach for allogeneic haematopoietic stem cell transplantations (alloHCT) in patients with chronic lymphocytic leukaemia (CLL) is unknown. We therefore analysed the impact of procedure- and centre-related factors on 5-year event-free survival (EFS) in a large retrospective study. Data of 684 CLL patients who received a first alloHCT between 2000 and 2011 were analysed by multivariable Cox proportional hazards models with a frailty component to investigate unexplained centre heterogeneity. Five-year EFS of the whole cohort was 37% (95% confidence interval [CI], 34-42%). Larger numbers of CLL alloHCTs (hazard ratio [HR] 0·96, P = 0·002), certification of quality management (HR 0·7, P = 0·045) and a higher gross national income per capita (HR 0·4, P = 0·04) improved EFS. In vivo T-cell depletion (TCD) with alemtuzumab compared to no TCD (HR 1·5, P = 0·03), and a female donor compared to a male donor for a male patient (HR 1·4, P = 0·02) had a negative impact on EFS, but not non-myeloablative versus more intensive conditioning. After correcting for patient-, procedure- and centre-characteristics, significant variation in centre outcomes persisted. In conclusion, further research on the impact of centre and procedural characteristics is warranted. Non-myeloablative conditioning appears to be the preferable approach for patients with CLL. © 2017 John Wiley & Sons Ltd.

  4. Measuring satisfaction and anesthesia related outcomes in a surgical day care centre: A three-year single-centre observational study.

    PubMed

    Teunkens, A; Vanhaecht, K; Vermeulen, K; Fieuws, S; Van de Velde, M; Rex, S; Bruyneel, L

    2017-09-28

    To evaluate patient satisfaction and patient reported anaesthesia related outcome parameters after outpatient surgery. A three-year (2013-2016) observational study. A surgical day care centre embedded in a tertiary care, university hospital. Adult Dutch-speaking patients who underwent surgery under general or regional anaesthesia on an outpatient basis (n=5424). A questionnaire was developed to evaluate patients' satisfaction with care during their hospitalisation in the surgical day centre, as well as to assess their reports of anaesthesia related outcomes. Various aspects of care were measured, including care by nurses, care by doctors, organisational and safety items. Variation in satisfaction and surgery and anaesthesia related outcomes as a function of different categories (gender, age, education, type of anaesthesia, discipline and era) were also investigated. Confirmatory factor analysis showed an excellent fit to the hypothesized factors of the survey. Satisfaction scores were very high for different aspects of care, resulting in 98% of patients being (very) satisfied (59.1% very satisfied, 38.9% satisfied). Male (p=0.0003), higher educated (p<0.0001) and older patients (p<0.0001) were more likely to be very satisfied. Postoperative nausea and vomiting (PONV) were frequent (nausea: 13.9%, vomiting: 3.3%), and more present in female than in male patients (p<0.0001). Pain scores at the PACU differed among disciplines (p<0.0001) were higher in female patients compared to male patients (3.41% versus 2.54%, p<0.0001) and after general anaesthesia compared to regional anaesthesia (3.25% versus 0.39%, p<0.0001) and decreased with higher age (p=0.0001) and education level (p=0.0033). Whereas satisfaction with all aspects of care is generally high, the results regarding pain and PONV should inspire quality improvement initiatives. The questionnaire developed in this study can be a vehicle to assess and improve the quality of care in surgical day care centres

  5. Neurologic Injury With Severe Adult Respiratory Distress Syndrome in Patients Undergoing Extracorporeal Membrane Oxygenation: A Single-Center Retrospective Analysis.

    PubMed

    Klinzing, Stephanie; Wenger, Urs; Stretti, Federica; Steiger, Peter; Rushing, Elisabeth J; Schwarz, Urs; Maggiorini, Marco

    2017-08-31

    This retrospective single-center study investigated the incidence of neurologic injury as determined by autopsy or cerebral imaging in 74 patients undergoing extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome. Seventy-three percent of patients were treated with venovenous and 27% with venoarterial ECMO. ECMO-associated intracerebral hemorrhage was diagnosed in 10.8% of patients. There were no cases of ischemic stroke. Clinical characteristics did not differ between patients with and without neurologic injury. Six-month survival was 13% (Wilson confidence interval, 2%-47%) in patients with severe intracerebral hemorrhage compared to an overall survival rate of 57% (Wilson confidence interval, 45%-67%).

  6. Thrombophilia diagnosis: a retrospective analysis of a single-center experience.

    PubMed

    Spychalska-Zwolińska, Marta; Zwoliński, Tomasz; Mieczkowski, Artur; Budzyński, Jacek

    2015-09-01

    It is estimated that 30-50% of patients suffering from deep vein thrombosis (DVT) could be diagnosed with congenital or acquired thrombophilia. Its diagnosis, however, rarely changes the clinical management, but is associated with significant costs and negative psychological and social aspects. The aim of this study was to perform a retrospective analysis of the causes and clinical consequences of diagnostics for thrombophilia. A retrospective review of the medical records of 5600 patients was performed, 62 of whom had, at the time, been diagnosed for thrombophilia because of a thromboembolic event. A review of the current literature on the validity of diagnostic tests for hypercoagulability in certain clinical conditions was also performed. The most common reason for thrombophilia testing was episodes of lower limb DVT (56%). The most frequently diagnosed abnormalities were the heterozygous form of the V Leiden gene (18%), protein S deficiency (11%), and the anti cardiolipin antibody IgG (11%). In 45% of the patients, laboratory results did not confirm the presence of any congenital thrombophilia. After receiving the results, 11% of the respondents completed oral anticoagulation therapy after 3 months, and 28% of patients qualified for indefinite use of oral anticoagulant therapy. In most of the cases examined, the diagnosis of thrombophilia did not significantly affect the treatment. A common aberration identified in patients with a history of thromboembolic incidents was the coexistence of risk factors for atherosclerosis.

  7. Candida infections in paediatrics: Results from a prospective single-centre study in a tertiary care children's hospital.

    PubMed

    Mesini, Alessio; Bandettini, Roberto; Caviglia, Ilaria; Fioredda, Francesca; Amoroso, Loredana; Faraci, Maura; Mattioli, Girolamo; Piaggio, Giorgio; Risso, Francesco M; Moscatelli, Andrea; Loy, Anna; Castagnola, Elio

    2017-02-01

    To describe the epidemiology of invasive Candida infection in a tertiary care paediatric hospital. Prospective single-centre survey on all Candida strains isolated from normally sterile fluids and urines in the period 2005-2015 . A total of 299 ICI were documented in 262 patients. Urinary tract infection represented the most frequent diagnosis (62%), followed by fungaemia (34%) and peritonitis (4%). Fungaemia was most frequent in children with cancer (59%) or in low birth weight neonates (61%), while urinary tract infections were more frequent in patients with urinary tract malformation. C.albicans was the most frequently isolated species (60%) compared with C. non-albicans, but differences were present according to the site of isolation and underlying conditions. Overall 90-day mortality was 7%, 13% in fungaemias, 8% in peritonitis and 2% in urinary tract infections. The rates of invasive Candida infection increased during the study period. Invasive Candida infection is diagnosed with increasing frequency in children. Site of isolation and aetiology are frequently related with the presence of underlying, favouring conditions. Mortality was not negligible, especially in the presence of more invasive infections and specific underlying conditions. © 2016 Blackwell Verlag GmbH.

  8. Impaired laparoscopic performance of novice surgeons due to phone call distraction: a single-centre, prospective study.

    PubMed

    Yang, Cui; Heinze, Julia; Helmert, Jens; Weitz, Juergen; Reissfelder, Christoph; Mees, Soeren Torge

    2017-06-08

    Distractions such as phone calls during laparoscopic surgery play an important role in many operating rooms. The aim of this single-centre, prospective study was to assess if laparoscopic performance is impaired by intraoperative phone calls in novice surgeons. From October 2015 to June 2016, 30 novice surgeons (medical students) underwent a laparoscopic surgery training curriculum including two validated tasks (peg transfer, precision cutting) until achieving a defined level of proficiency. For testing, participants were required to perform these tasks under three conditions: no distraction (control) and two standardised distractions in terms of phone calls requiring response (mild and strong distraction). Task performance was evaluated by analysing time and accuracy of the tasks and response of the phone call. In peg transfer (easy task), mild distraction did not worsen the performance significantly, while strong distraction was linked to error and inefficiency with significantly deteriorated performance (P < 0.05). Precision cutting (difficult task) was not slowed down by mild distraction, but surgical and cognitive errors were significantly increased when participants were distracted (P < 0.05). Compared to mild distraction, participants reported a more severe subjective disturbance when they were diverted by strong distraction (P < 0.05). Our data reveals that phone call distractions result in impaired laparoscopic performance under certain circumstances. To ensure patient safety, phone calls should be avoided as far as possible in operating rooms.

  9. Long Term Outcomes in Stress Echocardiography: Ten Year Follow up of a Cohort in a Single Centre

    PubMed Central

    Ashrafi, Reza; McKay, Ewan; Jones, Julia; Amadi, Aham

    2012-01-01

    Backgroud The high service burden for acute admissions and referrals via rapid access chest pain clinics for evaluation of possible coronary artery disease means that many patients are now undergoing an investigation such as stress echocardiography as part of their evaluation. We aimed to see if the reassurance provided by negative stress echocardiography correlates with long-term event free survival. Methods A cohort of all patients who were referred at a single centre for stress echocardiography for diagnosis of coronary artery disease between January 1st 1999 and December 31st 2000 were followed up at least 10 years following theirs stress echocardiogram for further major cardiovascular events and mortality. Results A total of 64 patients were identified where records could be obtained for analysis. There were 16 positive scans, 37 negative scans and 11 inconclusive scans. The indeterminacy rate of scans was 17%, the sensitivity rate for detecting significant disease as indexed to invasive angiography was 88 % and the specificity rate compared with angiography was 75%. There were no myocardial infarctions or new diagnoses of heart failure in the negative echocardiogram group. There were seven deaths in the total population and only one death from cardiovascular causes in the negative echocardiogram group. Conclusion Stress echocardiography even in this small group predicts long-term outcomes as well as invasive coronary angiography.

  10. Temporal trends in nitrate utilization for acute heart failure in elderly emergency patients: A single-centre observational study.

    PubMed

    Lemachatti, Najla; Philippon, Anne-Laure; Bloom, Benjamin; Hausfater, Pierre; Riou, Bruno; Ray, Patrick; Freund, Yonathan

    2016-01-01

    We previously conducted a pilot study that reported the safety of isosorbide dinitrate boluses for elderly emergency patients with acute heart failure syndrome. To assess the temporal trend in the rate of elderly patients treated with isosorbide dinitrate, and to evaluate subsequent outcome differences. This was a single-centre study. We compared patients aged>75 years who attended the emergency department with a primary diagnosis of acute pulmonary oedema in the years 2007 and 2014. The primary endpoint was the rate of patients who received isosorbide dinitrate boluses in the emergency department. Secondary endpoints included in-hospital mortality, need for intensive care and length of stay. We analysed 368 charts, 232 from patients included in 2014 (63%) and 136 in 2007 (37%). The mean age was 85±6 years in both groups. There was a significant rise in the rate of patients treated with isosorbide dinitrate between 2007 and 2014: 97 patients (42%) in 2014 vs. 24 patients (18%) in 2007 (P<0.01). Comparing the two periods, we report similar in-hospital mortality rates (8% vs. 11%; P=0.5), rates of admission to the intensive care unit (13% vs. 17%; P=0.3) and lengths of stay (10 days in both groups). We observed a significant rise in the rate of elderly patients treated with isosorbide dinitrate boluses for acute heart failure. However, we did not observe any significant improvement in outcomes. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  11. Kidney retransplantation from HLA incompatible living donors: a single centre study of 3(rd) /4(th) transplants.

    PubMed

    Barnes, J C H; Goodyear, S J; Imray, C E A; Lam, F T; Kashi, S H; Tan, L C; Higgins, R; Imray, C H E

    2017-09-04

    The demand for kidney retransplantation following graft failure is rising. Repeat transplantation is often associated with poorer outcomes due to both immunological and surgical challenges. The aim of this study was to compare surgical and functional outcomes of kidney retransplantation in recipients that had previously had at least 2 kidney transplants with a focus on those with antibody incompatibility. We analysed 66 patients who underwent renal transplantation at a single centre between 2003 and 2011. Consecutive patients receiving their 3(rd) or 4(th) kidney were case-matched with an equal number of 1(st) and 2(nd) transplants. Twenty-two 3(rd) and 4(th) kidney transplants were matched with 22 first and 22 second transplants. Operative times and length of stay were equivalent between the subgroups. Surgical complication rates were similar in all groups (22.7% in 1(st) and 2(nd) transplants, and 27.2% in 3(rd) /4(th) transplants). There was no significant difference in patient or graft survival over 5 years. Graft function was similar between transplant groups at 1, 3 and 5 years. Third and fourth kidney transplants can be performed safely with similar outcomes to 1(st) and 2(nd) transplants. Kidney retransplantation from antibody incompatible donors may be appropriate for highly sensitised patients. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  12. [Management of gastroesophageal reflux in children. Single centre experience in conventional and laparoscopic Nissen fundoplication in the last 15 years].

    PubMed

    Betancourth-Alvarenga, Josué Eduardo; Garrido Pérez, José Ignacio; Castillo Fernández, Aurora Lucía; Murcia Pascual, Francisco Javier; Cárdenas Elias, Miguel Angel; Escassi Gil, Alvaro; Paredes-Esteban, Rosa María

    2017-04-01

    Nissen fundoplication (NF) is the most used and effective technique for the treatment of gastroesophageal reflux in children. The laparoscopic approach (LNF) is safe, with low morbidity and high success rate, although some cases require a conventional approach (CNF). The aim of the study is to compare the results between LNF and CNF in our centre. A retrospective review was performed on patients <14years after NF between 2000 and 2015. A comparison was made of the complications, hospital stay, and follow-up for both approaches. Of the total 75 NF performed, 49 (65.3%) were LNF, 23 (30.7%) CNF, and 3 (4.0%) reconversions. Concomitant laparoscopic gastrostomy was performed in 10.7%, and open gastrostomy in 5.3% of cases. Prior to NF, 10.7% had a gastrostomy. The mean age was 4 years and 68.7% were male. Of the diagnoses, 36% had encephalopathy, 14.7% hiatal hernia, 5.4% oesophageal atresia, and 5.4% an acute life-threatening event. No differences were found in operation time. More than two-thirds (36%) had complications, which were more frequent in the CNF (OR=3.30, 95%CI: 1.1-9.6). The hospital-stay decreased by 9 days in the LNF (95%CI: 5.5-13.5). Mean follow-up was 26 months (95%CI: 20.9-31.6). Mortality during follow-up was of 5.3% (5 respiratory failure, 1 sudden cardiac death, and 2 due to complications of the encephalopathy), 4.2% required re-fundoplication, 15.8% had symptomatic improvement, and 64.0% had absence of symptoms. The LNF is an effective technique for the treatment of gastroesophageal reflux, with lower morbidity and shorter hospital stay than CNF. It is recommended as the first surgical option. Copyright © 2015 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. The impact of transcatheter aortic valve implantation on left ventricular performance and wall thickness – single-centre experience

    PubMed Central

    Szymański, Piotr; Dąbrowski, Maciej; Zakrzewski, Dariusz; Michałek, Piotr; Orłowska-Baranowska, Ewa; El-Hassan, Kamal; Chmielak, Zbigniew; Witkowski, Adam; Hryniewiecki, Tomasz

    2015-01-01

    Introduction Transcatheter aortic valve implantation (TAVI) is a treatment alternative for the elderly population with severe symptomatic aortic stenosis (AS) at high risk for surgical aortic valve replacement (SAVR). Aim To assess the impact of TAVI on echocardiographic parameters of left ventricular (LV) performance and wall thickness in patients subjected to the procedure in a single-centre between 2009 and 2013. Material and methods The initial group consisted of 170 consecutive patients with severe AS unsuitable for SAVR. Logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) was 21.73 ±12.42% and mean age was 79.9 ±7.5 years. Results The TAVI was performed in 167 (98.2%) patients. Mean aortic gradient decreased significantly more rapidly after the procedure (from 58.6 ±16.7 mm Hg to 11.9 ±4.9 mm Hg, p < 0.001). The LV ejection fraction (LVEF) significantly increased in both short-term and long-term follow-up (57 ±14% vs. 59 ±13%, p < 0.001 and 56 ±14% vs. 60 ±12%, p < 0.001, respectively). Significant regression of interventricular septum diameter at end-diastole (IVSDD) and end-diastolic posterior wall thickness (EDPWth) was noted in early (15.0 ±2.4 mm vs. 14.5 ±2.3 mm, p < 0.001 and 12.7 ±2.1 mm vs. 12.4 ±1.9 mm, p < 0.028, respectively) and late post-TAVI period (15.1 ±2.5 mm to 14.3 ±2.5 mm, p < 0.001 and 12.8 ±2.0 mm to 12.4 ±1.9 mm, p < 0.007, respectively). Significant paravalvular leak (PL) was noted in 21 (13.1%) patients immediately after TAVI and in 13 (9.6%) patients in follow-up (p < 0.001). Moderate or severe mitral regurgitation (msMR) was seen in 24 (14.9%) patients from the initial group and in 19 (11.8%) patients after TAVI (p < 0.001). Conclusions The TAVI had an immediate beneficial effect on LVEF, LV walls thickness, and the incidence of msMR. The results of the procedure are comparable with those described in other centres. PMID:25848369

  14. ERCP in a cohort of 759 cases: A 6-year experience of a single tertiary centre in Libya.

    PubMed

    Tumi, Ali; Magadmi, Masoud; Elfageih, Salah; Rajab, Abdul-Fatah; Azzabi, Masoud; Elzouki, Abdel-Naser

    2015-03-01

    The aim of this study was to review the indications, findings, technical success, and outcomes of endoscopic retrograde cholangiopancreatography (ERCP) procedures in a large cohort of patients admitted to a single tertiary centre in Libya. A total of 759 consecutive ERCP procedures were performed in 704 patients from January 2005 through December 2010 at the Endoscopy Unit of Central Hospital, Tripoli, Libya. The patients' demographic characteristics, clinical information, ERCP indications, laboratory parameters, and post-ERCP complications were reviewed. Formal written consent was obtained from all patients prior to each procedure. The study included 280 (36.9%) males and 479 (63.1%) females with mean age ± standard deviation (SD) of 56.8 ± 18.7 years. Papillotomy was performed in 670 (88.3%) cases of the ERCP procedures. Common bile duct (CBD) stones were reported in 389 (51.3%) cases and were more frequent in females (234 cases, 60.1%) than males (155, 39.9%) (p = 0.01). The majority of the CBD stones were successfully retrieved with balloon extraction (304 cases, 78.2%), while mechanical lithotripsy (67 cases, 17.2%) and Dormia basket (11 cases, 2.8%) were used for difficult stones. Only seven (1.8%) cases were referred for surgery. Malignancy was found in 151 (19.9%) of the cases and was significantly more common in males than females (102, 67.5% vs. 49, 32.5%, respectively, p = 0.001). Stents for bile drainage were inserted in 26 (17.2%) of these cases. The complications encountered were acute pancreatitis in 30 cases (3.9%), minor bleeding in nine cases (1.2%), major bleeding in one case (0.15%), cholangitis in four cases (0.52%), and perforation in one case (0.15). Mortality was reported in three cases (0.4%). The ERCP indications and the related complications, in our centre in Libya, are comparatively consistent with those reported data in other countries. Successful biliary cannulation was achieved in most of the patients, and post-ERCP complications

  15. Active and fast charge-state switching of single NV centres in diamond by in-plane Al-Schottky junctions

    PubMed Central

    Polyakov, Vladimir; Burk, Sina; Fedder, Helmut; Denisenko, Andrej; Fávaro de Oliveira, Felipe; Wunderlich, Ralf; Meijer, Jan; Zuerbig, Verena; Wrachtrup, Jörg; Nebel, Christoph E

    2016-01-01

    In this paper, we demonstrate an active and fast control of the charge state and hence of the optical and electronic properties of single and near-surface nitrogen-vacancy centres (NV centres) in diamond. This active manipulation is achieved by using a two-dimensional Schottky-diode structure from diamond, i.e., by using aluminium as Schottky contact on a hydrogen terminated diamond surface. By changing the applied potential on the Schottky contact, we are able to actively switch single NV centres between all three charge states NV+, NV0 and NV− on a timescale of 10 to 100 ns, corresponding to a switching frequency of 10–100 MHz. This switching frequency is much higher than the hyperfine interaction frequency between an electron spin (of NV−) and a nuclear spin (of 15N or 13C for example) of 2.66 kHz. This high-frequency charge state switching with a planar diode structure would open the door for many quantum optical applications such as a quantum computer with single NVs for quantum information processing as well as single 13C atoms for long-lifetime storage of quantum information. Furthermore, a control of spectral emission properties of single NVs as a single photon emitters – embedded in photonic structures for example – can be realized which would be vital for quantum communication and cryptography. PMID:28144522

  16. Retrospective analysis of factors that affect the success of single-dose methotrexate treatment in ectopic pregnancy.

    PubMed

    Var, Altan; Özyurt, Ramazan; Şık, Bulat Aytek; Kumbasar, Serkan; Sever, Erman; Deveci, Mustafa; Çöt, Özgür; Salman, Süleyman; Güzel, Yılmaz

    2015-12-01

    Detection of factors that affect the success of single-dose methotrexate treatment in ectopic pregnancy. We investigated 99 patients who had been treated with single-dose methotrexate for ectopic pregnancy in our clinic between January 2009 and June 2014. Demographic, clinical, and laboratory results of possible factors that affect treatment success were retrospectively analyzed. Successfully and unsuccessfully treated patients were compared based on their pre-treatment results. The success rate of single-dose methotrexate treatment was found to be 70.7%. No significant difference was found between succesfully and unsuccessfully treated patients before treatment in terms of factors such as gestational weeks, mass size, presence of yolk sac, and presence of free fluid (p=0.224, p=0.201, p=0.200, p=0.200). Serum β-hCG values in patients whose treatment was unsuccessful was found to be higher compared with the successfully treated group (mean β-hCG value of unsuccessful group: 4412±3501 mIU/mL; mean β-hCG value of successful group: 1079±942 mIU/mL; p<0.001). Single-dose methotrexate treatment is an effective and reliable method in the treatment of ectopic pregnancy. Elevation of serum β-hCG value stands as the main prognostic factor that affects the success of single-dose methotrexate treatment.

  17. Optimised paediatric CT dose at a tertiary children's hospital in Japan: a 4-y single-centre analysis.

    PubMed

    Nakada, Y; Fujiwara, M; Yakami, M; Yokoyama, T; Shirayama, A; Yamamoto, H; Nabatame, K; Obara, S; Akahane, K; Blyth, B J; Miyazaki, O; Date, H; Yagi, K; Hoshioka, A; Shimada, Y

    2016-01-01

    Since diagnostic reference levels (DRLs) for children are not currently established in Japan, the authors determined local DRLs for the full range of paediatric CT examinations in a single tertiary care children's hospital. A retrospective review of 4801 CT performance records for paediatric patients (<15 y old) who had undergone CT examinations from 2008 to 2011 was conducted. The most frequent examinations were of the head (52 %), followed by cardiac (15 %), temporal bone (9 %), abdomen (7 %), chest (6 %) and others (11 %). Approximately one-third of children received two or more CT scans. The authors' investigation showed that mean CTDIvol and DLP for head, chest and abdomen increased as a function of age. Benchmarking of the results showed that CTDIvol, DLP and effective dose for chest and abdomen examinations in this hospital were below average, whereas those for the head tended to be at or slightly above average of established DRL values from five countries. The results suggest that CT examinations as performed in a tertiary children's hospital in Japan are well optimised.

  18. Pulmonary artery rupture as a complication of Swan-Ganz catheter application. Diagnosis and endovascular treatment: a single centre's experience.

    PubMed

    Rudziński, Piotr N; Henzel, Jan; Dzielińska, Zofia; Lubiszewska, Barbara M; Michałowska, Ilona; Szymański, Piotr; Pracoń, Radosław; Hryniewiecki, Tomasz; Demkow, Marcin

    2016-01-01

    The placement of a Swan-Ganz catheter into the pulmonary artery may lead to a number of complications (2-17%). In less than 0.2% of cases Swan-Ganz catheterization results in serious vascular damage - pulmonary artery rupture (PAR). This paper presents two distinct forms of iatrogenic PAR treated endovascularly using different vascular devices. To evaluate the effectiveness of endovascular treatment and the application of different types of vascular devices in the management of pulmonary artery rupture caused by Swan-Ganz catheterization. In this retrospective study we evaluated 2 patients in whom Swan-Ganz catheter application was used for perioperative monitoring and resulted in pulmonary artery rupture. This complication was treated endovascularly by means of interventional cardiology. We report the cases of 2 patients with a pulmonary artery pseudoaneurysm formed in the perioperative period. In case 1, a single, 4-loop, 3 mm diameter coil was implanted. In case 2, a 5 mm Amplatzer Vascular Plug IV was applied. In both cases, the endovascular approach resulted in total occlusion of the feeding artery and reduced further extravasation of the blood. Despite its extremely low incidence, iatrogenic PAR is a serious, life-threatening complication of Swan-Ganz catheterization that requires urgent attention. Among available methods of treatment, percutaneous embolization is a relatively quick, safe, accurate and highly effective alternative to traumatizing surgery.

  19. A Retrospective Analysis of Ventriculoperitoneal Shunt Revision Cases of a Single Institute

    PubMed Central

    Park, Man-Kyu; Kim, Myungsoo; Park, Ki-Su; Park, Seong-Hyun; Hwang, Jeong-Hyun

    2015-01-01

    Objective Ventriculoperitoneal (VP) shunt complication is a major obstacle in the management of hydrocephalus. To study the differences of VP shunt complications between children and adults, we analyzed shunt revision surgery performed at our hospital during the past 10 years. Methods Patients who had undergone shunt revision surgery from January 2001 to December 2010 were evaluated retrospectively by chart review about age distribution, etiology of hydrocephalus, and causes of revision. Patients were grouped into below and above 20 years old. Results Among 528 cases of VP shunt surgery performed in our hospital over 10 years, 146 (27.7%) were revision surgery. Infection and obstruction were the most common causes of revision. Fifty-one patients were operated on within 1 month after original VP shunt surgery. Thirty-six of 46 infection cases were operated before 6 months after the initial VP shunt. Incidence of shunt catheter fracture was higher in younger patients compared to older. Two of 8 fractured catheters in the younger group were due to calcification and degradation of shunt catheters with fibrous adhesion to surrounding tissue. Conclusion The complications of VP shunts were different between children and adults. The incidence of shunt catheter fracture was higher in younger patients. Degradation of shunt catheter associated with surrounding tissue calcification could be one of the reasons of the difference in facture rates. PMID:26113963

  20. A single-center retrospective study of pregnancy outcomes after emergency cerclage for cervical insufficiency.

    PubMed

    Wang, Sheng; Feng, Ling

    2017-10-01

    To compare maternal and perinatal outcomes after emergency cerclage with those after elective cerclage. In a retrospective review, data were assessed from women with a viable singleton pregnancy who underwent elective or emergency cerclage for cervical insufficiency at the Tongji Hospital, Wuhan, China, between January 2010 and July 2015. Subgroup analyses based on cervical length (CL; ≤15, 15-25, and 25-30 mm) were also conducted among women undergoing emergency cerclage. In total, 68 women underwent elective cerclage and 53 underwent emergency cerclage. The suture-to-delivery interval was significantly longer in the elective group (19.17 ± 5.86 weeks) than in the emergency group (11.29 ± 7.27 weeks; P<0.001). There was no difference between the elective and emergency groups in mean pregnancy length at delivery, frequency of Apgar score below 7 at 5 minutes (live births only), or birth weight (live births only). An inverse trend in the degree of CL shortening with pregnancy outcomes was observed; women with a CL of 25-30 mm had the best outcomes. Pregnancy outcomes were similar after emergency and elective cerclage. There was an inverse trend in the degree of CL shortening with pregnancy outcomes in the emergency cerclage group, with better outcomes observed for women with longer CL. © 2017 International Federation of Gynecology and Obstetrics.

  1. A 10-year retrospective review of pediatric lung abscesses from a single center

    PubMed Central

    Madhani, Kavi; McGrath, Eric; Guglani, Lokesh

    2016-01-01

    INTRODUCTION: Pediatric lung abscesses can be primary or secondary, and there is limited data regarding response to treatments and patient outcomes. OBJECTIVES: To assess the clinical and microbiologic profile of pediatric patients with lung abscess and assess the differences in outcomes for patients treated with medical therapy or medical plus surgical therapy. METHODS: A retrospective review of all pediatric patients ≤ 18 years of age that were treated as an inpatient for lung abscess between the dates of August 2004 and August 2014 was conducted. Patients were divided into two subgroups based on the need for surgical intervention. RESULTS: A total of 39 patients with lung abscess (30 treated with medical therapy alone, 9 also required surgical interventions) were included. Fever, cough, and emesis were the most common presenting symptoms, and most of the patients had underlying respiratory (31%) or neurologic disorders (15%). Staphylococcus aureus was the most common organism in those that had culture results available, and ceftriaxone with clindamycin was the most common combination of antibiotics used for treatment. Comparison of medical and surgical subgroups identified the duration of fever and abscess size as risk factors for surgical intervention. CONCLUSIONS: Pediatric lung abscesses can be managed with medical therapy alone in most cases. Presence of prolonged duration of fever and larger abscess size may be predictive of the need for surgical intervention. Good clinical response to prolonged therapy with ceftriaxone and clindamycin was noted. PMID:27512508

  2. Prophylactic pancreatic stent placement for endoscopic duodenal ampullectomy: a single-center retrospective study.

    PubMed

    Chang, Woo Ik; Min, Yang Won; Yun, Hwan Sic; Lee, Kwang Hyuck; Lee, Jong Kyun; Lee, Kyu Taek; Rhee, Poong Lyul

    2014-05-01

    We investigated the efficacy of prophylactic pancreatic stent placement for preventing postprocedure pancreatitis in patients undergoing endoscopic papillectomy. This retrospective study included 82 consecutive patients who underwent endoscopic papillectomy for benign ampullary neoplasm at Samsung Medical Center between August 2002 and June 2011. The patients were subdivided into two groups, namely, those who received prophylactic pancreatic stent placement and those who did not. Patient demographics, baseline blood test, tumor characteristics, and endoscopic treatment data were collected. The primary endpoint was postprocedure pancreatitis. There was no difference in the development of postprocedure pancreatitis between the stent group and the no stent group (6/54, 10.5% and 2/28, 7.14%, respectively; p=1.00). At baseline, there were no significant differences between the two groups in terms of their risk factors for pancreatitis except pancreatic duct dye injection. The stent group was more likely to have dye injection than the nonstent group (100% vs 42.8%, p<0.001). However, in a logistic regression analysis, no significant difference was observed in the risk factors for pancreatitis including dye injection. Our data suggest that routine prophylactic pancreatic duct stent placement in all patients undergoing endoscopic papillectomy may not be necessary and that large-scale prospective studies are required to identify the subgroup of patients who would benefit.

  3. Predictors of Infections following Cranioplasty: A Retrospective Review of a Large Single Center Study

    PubMed Central

    Starke, Robert M.; Hann, Shannon; Bovenzi, Cory D.; Saigh, Mark P.; Schwartz, Eric W.; Kunkel, Emily S. I.; Efthimiadis-Budike, Alexandra S.; Jabbour, Pascal; Rosenwasser, Robert H.; Tjoumakaris, Stavropoula I.

    2014-01-01

    Introduction. The variables that predispose to postcranioplasty infections are poorly described in the literature. We formulated a multivariate model that predicts the risk of infection in patients undergoing cranioplasty. Method. Retrospective review of all patients who underwent cranioplasty following craniectomy from January, 2000, to December, 2011. Tested predictors were age, sex, diabetic status, hypertensive status, reason for craniectomy, urgency status of craniectomy, location of cranioplasty, reoperation for hematoma, hydrocephalus postcranioplasty, and material type. A multivariate logistic regression analysis was performed. Results. Three hundred forty-eight patients met the study criteria. Infection rate was 26.43% (92/348). Of these cases with infection, 56.52% (52/92) were superficial (supragaleal), 43.48% (40/92) were deep (subgaleal), and 31.52% (29/92) were present in both the supragaleal and subgaleal spaces. The predominant pathogen was coagulase-negative staphylococcus (30.43%) followed by methicillin-resistant Staphylococcus aureus (22.83%) and methicillin-sensitive Staphylococcus aureus (15.22%). Approximately 15.22% of all cultures were polymicrobial. Multivariate analysis revealed convex craniectomy, hemorrhagic stroke, and hydrocephalus to be associated with an increased risk of infection (OR = 14.41; P < 0.05, OR = 4.33; P < 0.05, OR = 1.90; P = 0.054, resp.). Conclusion. Many of the risk factors for infection after cranioplasty are modifiable. Recognition and prevention of the risk factors would help decrease the infection's rate. PMID:25401136

  4. Acquisition and retention of laparoscopic skills is different comparing conventional laparoscopic and single-incision laparoscopic surgery: a single-centre, prospective randomized study.

    PubMed

    Ellis, Scott Michael; Varley, Martin; Howell, Stuart; Trochsler, Markus; Maddern, Guy; Hewett, Peter; Runge, Tina; Mees, Soeren Torge

    2016-08-01

    Training in laparoscopic surgery is important not only to acquire and improve skills but also avoid the loss of acquired abilities. The aim of this single-centre, prospective randomized study was to assess skill acquisition of different laparoscopic techniques and identify the point in time when acquired skills deteriorate and training is needed to maintain these skills. Sixty surgical novices underwent laparoscopic surgery (LS) and single-incision laparoscopic surgery (SILS) baseline training (BT) performing two validated tasks (peg transfer, precision cutting). The novices were randomized into three groups and skills retention testing (RT) followed after 8 (group A), 10 (group B) or 12 (group C) weeks accordingly. Task performance was measured in time with time penalties for insufficient task completion. 92 % of the participants completed the BT and managed to complete the task in the required time frame of proficiency. Univariate and multivariate analyses revealed that SILS (P < 0.0001) and precision cutting (P < 0.0001) were significantly more difficult. Males performed significantly better than females (P < 0.005). For LS, a deterioration of skills (comparison of BT vs RT) was not identified; however, for SILS a significant deterioration of skills (adjustment of BT and RT values) was demonstrated for all groups (A-C) (P < 0.05). Our data reveal that complex laparoscopic tasks (cutting) and techniques (SILS) are more difficult to learn and acquired skills more difficult to maintain. Acquired LS skills were maintained for the whole observation period of 12 weeks but SILS skills had begun to deteriorate at 8 weeks. These data show that maintenance of LS and SILS skills is divergent and training curricula need to take these specifics into account.

  5. Error reporting from the da Vinci surgical system in robotic surgery: A Canadian multispecialty experience at a single academic centre

    PubMed Central

    Rajih, Emad; Tholomier, Côme; Cormier, Beatrice; Samouëlian, Vanessa; Warkus, Thomas; Liberman, Moishe; Widmer, Hugues; Lattouf, Jean-Baptiste; Alenizi, Abdullah M.; Meskawi, Malek; Valdivieso, Roger; Hueber, Pierre-Alain; Karakewicz, Pierre I.; El-Hakim, Assaad; Zorn, Kevin C.

    2017-01-01

    Introduction The goal of the study is to evaluate and report on the third-generation da Vinci surgical (Si) system malfunctions. Methods A total of 1228 robotic surgeries were performed between January 2012 and December 2015 at our academic centre. All cases were performed by using a single, dual console, four-arm, da Vinci Si robot system. The three specialties included urology, gynecology, and thoracic surgery. Studied outcomes included the robotic surgical error types, immediate consequences, and operative side effects. Error rate trend with time was also examined. Results Overall robotic malfunctions were documented on the da Vinci Si systems event log in 4.97% (61/1228) of the cases. The most common error was related to pressure sensors in the robotic arms indicating out of limit output. This recoverable fault was noted in 2.04% (25/1228) of cases. Other errors included unrecoverable electronic communication-related in 1.06% (13/1228) of cases, failed encoder error in 0.57% (7/1228), illuminator-related in 0.33% (4/1228), faulty switch in 0.24% (3/1228), battery-related failures in 0.24% (3/1228), and software/hardware error in 0.08% (1/1228) of cases. Surgical delay was reported only in one patient. No conversion to either open or laparoscopic occurred secondary to robotic malfunctions. In 2015, the incidence of robotic error rose to 1.71% (21/1228) from 0.81% (10/1228) in 2014. Conclusions Robotic malfunction is not infrequent in the current era of robotic surgery in various surgical subspecialties, but rarely consequential. Their seldom occurrence does not seem to affect patient safety or surgical outcome. PMID:28503234

  6. Single-Centre Experience with Percutaneous Cryoablation of Breast Cancer in 23 Consecutive Non-surgical Patients

    SciTech Connect

    Cazzato, Roberto Luigi; Lara, Christine Tunon de; Buy, Xavier Ferron, Stéphane Hurtevent, Gabrielle; Fournier, Marion; Debled, Marc; Palussière, Jean

    2015-10-15

    AimTo present our single-centre prospective experience on the use of cryoablation (CA) applied to treat primary breast cancer (BC) in a cohort of patients unsuitable for surgical treatment.Materials and MethodsTwenty-three consecutive post-menopausal female patients (median age 85 years; range 56–96) underwent percutaneous CA of unifocal, biopsy-proven BC, under ultrasound/computed tomography (US/CT) guidance. Clinical and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) follow-ups were systematically scheduled at 3, 12, 18 and 24 months. Local tumour control was assessed by comparing baseline and follow-up DCE-MRI.ResultsTwenty-three BC (median size 14 mm) were treated under local anaesthesia (78.3 %) or local anaesthesia and conscious sedation (21.7 %). Median number of cryo-probes applied per session was 2.0. A “dual-freezing” protocol was applied for the first ten patients and a more aggressive “triple-freezing” protocol for the remaining 13. Median follow-up was 14.6 months. Five patients recurred during follow-up and two were successfully re-treated with CA. Five patients presented immediate CA-related complications: four hematomas evolved uneventfully at 3-month follow-up and one skin burn resulted in skin inflammation and skin retraction at 3 and 12 months, respectively.ConclusionsPercutaneous CA is safe and well tolerated for non-resected elderly BC patients. Procedures can be proposed under local anaesthesia only. Given the insulation properties of the breast gland, aggressive CA protocols are required. Prospective studies are needed to better understand the potential role of CA in the local treatment of early BC.

  7. Outcomes of HeartWare Ventricular Assist System support in 141 patients: a single-centre experience.

    PubMed

    Wu, Long; Weng, Yu-Guo; Dong, Nian-Guo; Krabatsch, Thomas; Stepanenko, Alexander; Hennig, Ewald; Hetzer, Roland

    2013-07-01

    A third-generation ventricular assist device, the HeartWare Ventricular Assist System, has demonstrated its reliability and durability in animal models and clinical experience. However, studies of a large series of applications are still lacking. We evaluate the safety and efficacy of the HeartWare pump in 141 patients with end-stage heart failure at a single centre. A total of 141 patients (116 men and 25 women with a mean age of 52 years) in New York Heart Association (NYHA) Class IV received implantation of the HeartWare Ventricular Assist System between August 2009 and April 2011 at the Deutsches Herzzentrum Berlin. The outcomes were measured in terms of laboratory data, adverse events, NYHA functional class and survival during device support. The HeartWare system provided an adequate haemodynamic support for patients both inside and outside the hospital. NYHA class improved to I-II. Organ function and pulmonary vascular resistance improved significantly. In this cohort of patients, 14 patients underwent heart transplantation, one had had the device explanted following myocardial recovery, one had changed to another assist device, 81 were on ongoing support and 44 died. The overall actuarial survival rates at 6 and 12 months were 70 and 67%, respectively, and the 3-, 6- and 12-month survival rates on a left ventricular assist device (LVAD) support for bridge to transplantation patients were 82, 81 and 79%, respectively. Infection and bleeding were the main adverse events. Four patients underwent an LVAD exchange for pump thrombosis. The HeartWare system provides a safe and effective circulatory support in a population with a wide range of body surface areas, with a satisfactory actuarial survival time and an improved quality of life. It can be used for univentricular or biventricular support, being implanted into the pericardial space with simplified surgical techniques.

  8. Impact of the introduction of a standardised ICD programming protocol: real-world data from a single centre.

    PubMed

    Sunderland, Nicholas; Kaura, Amit; Li, Anthony; Kamdar, Ravi; Petzer, Ed; Dhillon, Para; Murgatroyd, Francis; Scott, Paul A

    2016-09-01

    Randomised trials have shown that empiric ICD programming, using long detection times and high detection zones, reduces device therapy in ICD recipients. However, there is less data on its effectiveness in a "real-world" setting, especially secondary prevention patients. Our aim was to evaluate the introduction of a standardised programming protocol in a real-world setting of unselected ICD recipients. We analysed 270 consecutive ICD recipients implanted in a single centre-135 implanted prior to protocol implementation (physician-led group) and 135 after (standardised group). The protocol included long arrhythmia detection times (30/40 or equivalent) and high rate detection zones (primary prevention lower treatment zone 200 bpm). Programming in the physician-led group was at the discretion of the implanter. The primary endpoint was time-to-any therapy (ATP or shocks). Secondary endpoints were time-to-inappropriate therapy and time-to-appropriate therapy. The safety endpoints were syncopal episodes, hospital admissions and death. At 12 months follow-up, 47 patients had received any ICD therapy (physician-led group, n = 31 vs. standardised group, n = 16). There was a 47 % risk reduction in any device therapy (p = 0.04) and an 86 % risk reduction in inappropriate therapy (p = 0.009) in the standardised compared to the physician-led group. There was a non-significant 30 % risk reduction in appropriate therapy (p = 0.32). Results were consistent across primary and secondary prevention patients. There were no significant differences in the rates of syncope, hospitalisation, and death. In unselected patients in a real-world setting, introduction of a standardised programming protocol, using long detection times and high detection zones, significantly reduces the burden of ICD therapy without an increase in adverse outcomes.

  9. Ten years of biophotonics single-photon SPAD imager applications: retrospective and outlook

    NASA Astrophysics Data System (ADS)

    Bruschini, Claudio; Homulle, Harald; Charbon, Edoardo

    2017-02-01

    SPAD (single-photon avalanche diode) arrays are single-photon imagers that can provide unparalleled timeresolved sensing performance. Since their inception in standard CMOS technologies (2003), a host of architectures and target applications have been explored, ranging from simple pixel arrays, with off-chip data processing electronics, to fully integrated "smart" imagers with in-pixel time-stamping electronics and/or on-chip data processing fabric. Applications include (endoscopic) FLIM, (multi-beam multiphoton) FLIM-FRET, SPIMFCS, time-resolved Raman, NIROT, super-resolution microscopy, and PET, to name a few. We will review some representative sensors and applications, the corresponding challenges, and provide an outlook on the future of this fascinating technology

  10. Neonatal opiate withdrawal and rooming-in: a retrospective analysis of a single center experience.

    PubMed

    Hünseler, C; Brückle, M; Roth, B; Kribs, A

    2013-09-01

    To evaluate our treatment of neonatal abstinence syndrome (NAS), our experience with rooming-in of opiate-dependent mothers and to examine the influence of rooming-in on short term outcome of infants exposed to opiates in utero. Retrospective analysis of maternal and perinatal data of newborn infants with NAS treated between 2004 and 2011 in a level 3 academic children's hospital in a German metropolis. Therapy of NAS and duration of therapy, length of hospital stay and costs were considered in particular. Data of 77 newborns with NAS were analysed. 84.6% of infants were treated with tincture of opium (79.2% rooming-in, 88.7% no rooming-in). Infants with rooming-in (n=24) had a 17% shorter median duration of therapy [27.0 d (IQR 24.0-38.5), no rooming-in (n=53) 32.5 d (IQR 25.0-54.5)] and shorter median length of hospital stay [33.0 d (IQR 28.0-48.0), no rooming-in 41.5 d (IQR 30.3-54.5)]. Demographic data was comparable between newborns and mothers with or without rooming-in. Costs were median 13 457 € (IQR 8 967-17 494)/patient [rooming-in: 9 547 € (IQR 7 024-16 135), no rooming-in: 14 486 € (IQR 9 479-19 352)]. Rooming-in in NAS should be encouraged to shorten duration of therapy and length of hospital stay and thereby reduce costs. No major problems arose in the care of the infants with NAS when parents stayed with their infants but close monitoring of the newborn and strict instruction of parents are required. © Georg Thieme Verlag KG Stuttgart · New York.

  11. A retrospective analysis of survival and prognostic factors of male breast cancer from a single center

    PubMed Central

    2014-01-01

    Background Less than 1% of all breast cancer cases are found in men, who reportedly have inferior outcomes compared with matched women patients. Ethnic differences may also affect their prognosis. Here, we investigated overall survival (OS) and major prognostic factors for male breast cancer (MBC) in a cohort of Egyptian patients. Methods We retrospectively analyzed OS in a cohort of 69 male patients with MBC who were surgically treated at the Mansoura Cancer Center, Egypt between 2000 and 2007. We registered demographic data, age, height, weight and body mass index, tumor size, histology, number of infiltrated axillary lymph nodes, hormone receptor (HR) status and metastatic presence, and TNM staging. Patients’ OS was the primary endpoint. Patients received treatment to the medical standards at the time of their diagnosis. Results In the 69 patients who met the inclusion criteria and had complete stored patient data, tumors ranged from T1c to T3. We could gather cancer-related survival data from only 56 patients. The collective 5-year survival in this cohort was 46.4%. Only five patients had distant metastasis at diagnosis, but they showed a null percent 5-year survival, whereas those with no lymph node infiltration showed a 100% 5-year survival. Lymph node status and tumor grading were the only prognostic factors that significantly affected OS. Conclusions Lymph node status and tumor grade are the most important prognostic factors for overall survival of MBC in Egyptian male patients; whereas even remarkably low HR expression in MBC did not significantly affect OS. Further research is needed to understand the factors that affect this disease. PMID:24673740

  12. Role of apheresis and dialysis in pediatric living donor liver transplantation: a single center retrospective study.

    PubMed

    Sanada, Yukihiro; Mizuta, Koichi; Urahashi, Taizen; Ihara, Yoshiyuki; Wakiya, Taiichi; Okada, Noriki; Yamada, Naoya; Koinuma, Toshitaka; Koyama, Kansuke; Tanaka, Shinichiro; Misawa, Kazuhide; Wada, Masahiko; Nunomiya, Shin; Yasuda, Yoshikazu; Kawarasaki, Hideo

    2012-08-01

    In the field of pediatric living donor liver transplantation, the indications for apheresis and dialysis, and its efficacy and safety are still a matter of debate. In this study, we performed a retrospective investigation of these aspects, and considered its roles. Between January 2008 and December 2010, 73 living donor liver transplantations were performed in our department. Twenty seven courses of apheresis and dialysis were performed for 19 of those patients (19/73; 26.0%). The indications were ABO incompatible-liver transplantation in 11 courses, fluid management in seven, acute liver failure in three, renal replacement therapy in two, endotoxin removal in two, cytokine removal in one, and liver allograft dysfunction in one. Sixteen courses of apheresis and dialysis were performed prior to liver transplantation for 14 patients. The median IgM antibody titers before and after apheresis for ABO blood type-incompatible liver transplantation was 128 and eight, respectively (P < 0.05). Eleven courses of apheresis and dialysis were performed post liver transplantation for 10 patients. The median PaO2/FiO2 ratio before and after dialysis for fluid overload was 159 and 339, respectively (P < 0.05). No bleeding or technical complications attributable to apheresis and dialysis occurred. The 1-year survival rate of the patients was 100%. Apheresis and dialysis in pediatric living donor liver transplantation are effective for antibody removal in ABO-incompatible liver transplantation, and fluid management for acute respiratory failure. © 2012 The Authors. Therapeutic Apheresis and Dialysis © 2012 International Society for Apheresis.

  13. Acute kidney injury in a single pediatric intensive care unit in Poland: a retrospective study.

    PubMed

    Miklaszewska, Monika; Korohoda, Przemysław; Sobczak, Alina; Horbaczewska, Anna; Filipiak, Agata; Zachwieja, Katarzyna; Kobylarz, Krzysztof; Tkaczyk, Marcin; Drożdż, Dorota; Pietrzyk, Jacek A

    2014-01-01

    The recent improvements of management of patients in pediatric intensive care units (PICU) are associated with improved outcome. However, this decrease in mortality is associated with an increased number of children with acute kidney injury (AKI), especially in patients with multiorgan failure. The report presents a retrospective analysis of 25 cases of AKI (assessed based on the pRIFLE criteria) in PICU within 7 years. AKI was diagnosed in 1.24% of all hospitalized children. AKI percentage duration (as compared to the total hospitalization time) in the children who died vs. the survivors was 79.55% vs. 46.19%, respectively (p<0.05). The mortality rate of AKI patients was 40% which was 4.4-times higher as compared to the total mortality rate in PICU. The final cumulative survival ratio (FCSR) of patients meeting the oliguria criterion (which was met in 48% of AKI patients) was 37% vs. 49% in non-oliguric children. Averaged urine output values in the first week of hospitalization in the deceased vs. survivors were 1.49 vs. 2.57 ml/kg/h, respectively (p<0.05). Oliguria should not be considered as a sensitive parameter for AKI diagnosing in children below one year of age. A decreased mean urine output in the first week of PICU hospitalization (less than 1.4 ml/kg/h) should be considered as a poor prognostic factor. In many cases AKI was diagnosed too infrequently and too late. © 2014 S. Karger AG, Basel.

  14. Immunosuppressive Therapy in Patients with Aplastic Anemia: A Single-Center Retrospective Study

    PubMed Central

    Jalaeikhoo, Hasan; Khajeh-Mehrizi, Ahmad

    2015-01-01

    Background Aplastic anemia (AA) is a rare disease in which hematopoietic stem cells are severely diminished resulting in hypocellular bone marrow and pancytopenia. Etiology of AA includes auto immunity, toxins, infection, ionizing radiation, drugs and rare genetic disorders, but in the majority of cases no cause can be identified. In the present study we assessed response rate, survival, relapse and clonal evolution in patients with AA treated with immunosuppressive therapy. Methods Patients with AA who received immunosuppressive therapy between May 1998 and September 2013 were included in this study. Patients with non-severe AA (NSAA) were treated with cyclosporine (CsA) and danazol while patients with severe AA (SAA) as well as patients with NSAA who progressed to SAA after beginning of the treatment, were candidates for receiving antithymocyte globulin in addition to CsA and danazol. Results Among the 63 studied patients, 29 (46%) had NSAA and 34 (54%) had SAA. Three months after treatment, overall response was 58.6% in NSAA and 12.9% in patients with SAA. Survival of all patients at 5, 10 and 15 years were 73%, 55% and 49%, respectively. Survival rates were significantly higher in patients with NSAA compared to patients with SAA as well as in patients who responded at 6 months compared to non-responders. The relapse risk was 39.7% at 10 years. Relapse occurred in patients who discontinued the therapy more than those who continued taking CsA (p value<0.01). The risk of clonal evolution was 9.9% at 10 years and 22.8% at 15 years after treatment. Conclusion This long-term retrospective study indicated that immunosuppressive therapy should be recommended to patients with AA. Also, our experience indicated that immunosuppressive therapy should not be discontinued after response to therapy in patients with both NSAA and SAA due to high risk of relapse. Low dose of CsA should be continued indefinitely. PMID:25970182

  15. Ovulation induction and controlled ovarian stimulation using letrozole gonadotropin combination: A single center retrospective cohort study.

    PubMed

    Arya, Sushila; Kupesic-Plavsic, Sanja; Mulla, Zuber D; Dwivedi, Alok K; Crisp, Zeni; Jose, Jisha; Noble, Luis S

    2017-09-23

    To assess the effect of letrozole in combination with low dose gonadotropins for ovulation induction in anovulatory infertility from polycystic ovary syndrome (PCOS) and controlled ovarian stimulation for endometriosis, and unexplained infertility patients. Retrospective cohort study in a setting of private Reproductive Endocrinology and Infertility Clinic affiliated with the University. Three hundred couples (650 cycles) requiring OI/COS for PCOS (92 patients, 195 cycles), endometriosis (89 patients, 217 cycles), and unexplained infertility (119 patients, 238 cycles). Patients received 2.5mg or 5mg letrozole for 5days (D3-D7) and recombinant follicle-stimulating hormone on alternating D3-D7 and human menopausal gonadotropin-highly purified alternating D5-D10 until growth of ideally 2 mature follicles. Ovulation was triggered with 10,000 IU of HCG. Maximum number of cycles per patient was four. Main outcome measures were clinical pregnancy rates, multiple order pregnancy rates, miscarriage rates, number of follicles and endometrial thickness on the day of HCG administration. The cumulative incidence of pregnancy was estimated as 35% (95%CI: 29%-41%) overall and was highest in patients with PCOS (36.6%), followed by unexplained infertility (34.6%) and endometriosis (32.5%). The pregnancy rates per cycle in PCOS, endometriosis and unexplained infertility patients were 17%, 13.2% and 17.2% respectively, no statistically significant difference between the groups. There were three twin pregnancies in PCOS, and one in unexplained infertility group. Monofolliculogenesis was noted in 48% of patients. Letrozole-low dose gonadotropins combination appears to be effective across different causes of infertility for superovulation. The letrozole-low dose gonadotropin combination resulted in high rate of monofolliculogenesis, low occurrence of multiple gestations and no case of OHSS or cycle cancellation. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. [Ocular Metastasis in Lung Cancer: a Retrospective Analysis in a Single Chinese Hospital and Literature Review].

    PubMed

    Xu, Yan; Sun, Yiduo; Zhao, Jing; Chen, Minjiang; Jiangde, Lina; Li, Longyun; Zhong, Wei; Wang, Mengzhao

    2017-05-20

    Eye is a rare site of lung cancer metastasis, and ocular metastasis is one of the largest challenges to cancer patients' quality of life (QOL). Here we present our experience on ocular metastasis of lung cancer and review relevant literature in an attempt to investigate the clinical features, treatment, and prognosis of these tumors. The records of 9 patients with ocular metastasis of lung cancer treated at our hospital were analyzed. A literature review identified 42 cases reported in the last 10 years and their medical records were retrospectively estimated. The median age of our patients was 51 years (range 41-61). Diagnosis of lung cancer included non-small cell lung carcinoma (NSCLC) in 7 patients, in which adenocarcinoma (ADC) were recorded in 6 patients, small cell lung carcinoma (SCLC) in 1 patient, and unknown in 1 patient. The site of ocular metastasis included choroid (n=8) and iris (n=1). In the literature review, SCLC constituted 21.4% (n=9) and ADC constituted 47.6% (n=20). Choroid presented to be the most common site for eye metastasis (66.7%, n=28). As for disease control rate, systemic chemotherapy for lung cancer patients with ocular metastasis presented to be only 28%. Meanwhile, combination of systemic treatment with ocular treatment could improve patients' eye symptoms effectively. The most common lung cancer that metastasizes to the eye is ADC. The choroid is the most common site for ocular metastasis. Ocular treatment can improve patients' eye symptoms, while the effect of systemic chemotherapy treatment is limited.

  17. Outcomes of labor epidural analgesia among women aged over 40: A single-institution retrospective study.

    PubMed

    Okazaki, Atsuko; Fukushima, Risa; Nagashima, Sayuri; Mazda, Yusuke; Tamura, Kazumi; Terui, Katsuo; Tanaka, Motoshi

    2016-12-01

    The purpose of this study was to investigate the effects of labor epidural analgesia (LEA) on maternal and neonatal outcomes among parturients aged 40 years or older. We retrospectively reviewed medical records of all laboring, singleton and cephalic deliveries at ≥36 weeks' gestation at the Saitama Medical Center from April 2003 to September 2012. Women aged ≥40 years who received LEA (≥40 with LEA group) were compared with women aged ≥40 years who delivered without LEA (≥40 without LEA group) and women <40 years who received LEA (<40 with LEA group). Extracted outcomes included mode of delivery, oxytocin augmentation, duration of labor, amount of estimated blood loss, umbilical artery pH, Apgar scores, and neonatal intensive care unit admission. This study included 4441 women. There were 74 women in the ≥40 with LEA group, 369 in the ≥40 without LEA group, and 601 in the <40 with LEA group. The maternal outcomes of emergency cesarean delivery rate (9.5%, 12.5%, 9.0%), instrumental delivery rate (33.8%, 10.3%, 28.3%), duration of labor (521 min, 321 min, 565 min), and estimated blood loss (524 g, 351 g, 412 g) were reported for the ≥40 with LEA, ≥40 without LEA, and <40 with LEA groups, respectively. Neonatal outcomes were not different between these groups. LEA use was not associated with emergency cesarean delivery in the multivariable analysis. Our study showed that parturients aged ≥40 with LEA can expect similar LEA-associated labor outcomes to younger parturients with LEA. © 2016 Japan Society of Obstetrics and Gynecology.

  18. Platinum desensitization in patients with carboplatin hypersensitivity: A single-institution retrospective study.

    PubMed

    Altwerger, Gary; Gressel, Gregory M; English, Diana P; Nelson, Wendelin K; Carusillo, Nina; Silasi, Dan-Arin; Azodi, Masoud; Santin, Alessandro; Schwartz, Peter E; Ratner, Elena S

    2017-01-01

    The carboplatin desensitization (CD) protocol presented here allows patients with either a positive skin test or a prior hypersensitivity reaction (HSR) to safely, rapidly and effectively continue with carboplatin infusions. Newly described factors can identify patients at risk for developing adverse events during CD. A retrospective review was performed on patients with gynecologic cancer who underwent CD between 2005 and 2014. The CD protocol uses a four-step dilution process over 3.5h. 129 patients underwent CD and completed a total of 788cycles. The desensitization protocol prevented HSRs in 96% (753 out of 788) of these cycles. Patients achieved an average of 6.1cycles (SD±4.55, range 0-23) with CD. The CD protocol allowed 73% (94 of 129) of the patients to undergo carboplatin infusion without reaction. Patients with moderate to life-threatening HSRs (grade 2 through 4) were 10.5years younger at initial CD than patients with grades 0 or 1 HSRs (52.3 vs. 63, P = 0.0307). One patient death occurred during her thirteenth desensitization cycle. The HSR in this case was complicated by pre-exisiting pulmonary hypertension. This is the largest study of its kind showing a safe, effective and rapid (3.5h) CD protocol. The majority of patients with a history of either carboplatin hypersensitivity reaction or a positive skin test completed the CD protocol without HSRs. Age was identified as a risk factor for HSR severity during CD. Age can be employed along with pre-load dependent cardiac conditions as a way to help risk stratify patients undergoing CD. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. The effects of weather on pediatric seizure: A single-center retrospective study (2005-2015).

    PubMed

    Kim, Sung Hoon; Kim, Joon Soo; Jin, Mi Hyeon; Lee, Jun Hwa

    2017-12-31

    Several studies have reported an association between seizure and the weather. However, reports are conflicting. Thus, we investigated whether emergency department visits due to seizure are affected by weather. We retrospectively analyzed 108,628 emergency department visits to Samsung Changwon Hospital by pediatric patients from January 2005 to December 2015. Among them, there were 3484 (3.2%) visits for any type of seizure. Seizures were categorized as febrile seizure, afebrile seizure, epilepsy, or status epilepticus. We used a distributed lag non-linear model with quasi-Poisson distribution to investigate the association between weather and pediatric seizure. During this 11-year study period, over the half of total pediatric seizure patients were febrile seizure (53.5%) and the proportion for status epilepticus were the lowest (5.9%). Mean of mean temperature and diurnal temperature range were 14.7°C and 8.3°C. Mean humidity was 62.1%, mean of atmospheric pressure was 1015.5hPa and mean of sunshine was 6.3Hr. When considering the overall 0-15days lagged effect of weather, only mean temperature was significantly associated with emergency department visits. At lower temperatures, the number of emergency department visits increases and decreases at higher temperatures. All 4 types of seizure also showed similar patterns. In particular, only visits of febrile seizure were significantly associated with mean temperature. We investigated the association weather and pediatric seizure by considering 0-15day lags. In particular, low mean temperature increase the emergency department visits for pediatric seizure and high mean temperature decrease the pediatric seizure. In addition, only febrile seizure of 4 seizure types was affected by mean average temperature. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Single vector boson production in e+e- collisions at centre-of-mass energies from 183 to 209 GeV

    NASA Astrophysics Data System (ADS)

    ALEPH Collaboration; Schael, S.; Barate, R.; Brunelière, R.; de Bonis, I.; Decamp, D.; Goy, C.; Jézéquel, S.; Lees, J.-P.; Martin, F.; Merle, E.; Minard, M.-N.; Pietrzyk, B.; Trocmé, B.; Bravo, S.; Casado, M. P.; Chmeissani, M.; Crespo, J. M.; Fernandez, E.; Fernandez-Bosman, M.; Garrido, Ll.; Martinez, M.; Pacheco, A.; Ruiz, H.; Colaleo, A.; Creanza, D.; de Filippis, N.; de Palma, M.; Iaselli, G.; Maggi, G.; Maggi, M.; Nuzzo, S.; Ranieri, A.; Raso, G.; Ruggieri, F.; Selvaggi, G.; Silvestris, L.; Tempesta, P.; Tricomi, A.; Zito, G.; Huang, X.; Lin, J.; Ouyang, Q.; Wang, T.; Xie, Y.; Xu, R.; Xue, S.; Zhang, J.; Zhang, L.; Zhao, W.; Abbaneo, D.; Barklow, T.; Buchmüller, O.; Cattaneo, M.; Clerbaux, B.; Drevermann, H.; Forty, R. W.; Frank, M.; Gianotti, F.; Hansen, J. B.; Harvey, J.; Hutchcroft, D. E.; Janot, P.; Jost, B.; Kado, M.; Mato, P.; Moutoussi, A.; Ranjard, F.; Rolandi, L.; Schlatter, D.; Sguazzoni, G.; Teubert, F.; Valassi, A.; Videau, I.; Badaud, F.; Dessagne, S.; Falvard, A.; Fayolle, D.; Gay, P.; Jousset, J.; Michel, B.; Monteil, S.; Pallin, D.; Pascolo, J. M.; Perret, P.; Hansen, J. D.; Hansen, J. R.; Hansen, P. H.; Kraan, A. C.; Nilsson, B. S.; Kyriakis, A.; Markou, C.; Simopoulou, E.; Vayaki, A.; Zachariadou, K.; Blondel, A.; Brient, J.-C.; Machefert, F.; Rougé, A.; Videau, H.; Ciulli, V.; Focardi, E.; Parrini, G.; Antonelli, A.; Antonelli, M.; Bencivenni, G.; Bossi, F.; Capon, G.; Cerutti, F.; Chiarella, V.; Laurelli, P.; Mannocchi, G.; Murtas, G. P.; Passalacqua, L.; Kennedy, J.; Lynch, J. G.; Negus, P.; O'Shea, V.; Thompson, A. S.; Wasserbaech, S.; Cavanaugh, R.; Dhamotharan, S.; Geweniger, C.; Hanke, P.; Hepp, V.; Kluge, E. E.; Putzer, A.; Stenzel, H.; Tittel, K.; Wunsch, M.; Beuselinck, R.; Cameron, W.; Davies, G.; Dornan, P. J.; Girone, M.; Marinelli, N.; Nowell, J.; Rutherford, S. A.; Sedgbeer, J. K.; Thompson, J. C.; White, R.; Ghete, V. M.; Girtler, P.; Kneringer, E.; Kuhn, D.; Rudolph, G.; Bouhova-Thacker, E.; Bowdery, C. K.; Clarke, D. P.; Ellis, G.; Finch, A. J.; Foster, F.; Hughes, G.; Jones, R. W. L.; Pearson, M. R.; Robertson, N. A.; Smizanska, M.; van der Aa, O.; Delaere, C.; Leibenguth, G.; Lemaitre, V.; Blumenschein, U.; Hölldorfer, F.; Jakobs, K.; Kayser, F.; Kleinknecht, K.; Müller, A.-S.; Renk, B.; Sander, H.-G.; Schmeling, S.; Wachsmuth, H.; Zeitnitz, C.; Ziegler, T.; Bonissent, A.; Coyle, P.; Curtil, C.; Ealet, A.; Fouchez, D.; Payre, P.; Tilquin, A.; Ragusa, F.; David, A.; Dietl, H.; Ganis, G.; Hüttmann, K.; Lütjens, G.; Männer, W.; Moser, H.-G.; Settles, R.; Villegas, M.; Wolf, G.; Boucrot, J.; Callot, O.; Davier, M.; Duflot, L.; Grivaz, J.-F.; Heusse, Ph.; Jacholkowska, A.; Serin, L.; Veillet, J.-J.; Azzurri, P.; Bagliesi, G.; Boccali, T.; Foà, L.; Giammanco, A.; Giassi, A.; Ligabue, F.; Messineo, A.; Palla, F.; Sanguinetti, G.; Sciabà, A.; Spagnolo, P.; Tenchini, R.; Venturi, A.; Verdini, P. G.; Awunor, O.; Blair, G. A.; Cowan, G.; Garcia-Bellido, A.; Green, M. G.; Medcalf, T.; Misiejuk, A.; Strong, J. A.; Teixeira-Dias, P.; Clifft, R. W.; Edgecock, T. R.; Norton, P. R.; Tomalin, I. R.; Ward, J. J.; Bloch-Devaux, B.; Boumediene, D.; Colas, P.; Fabbro, B.; Lançon, E.; Lemaire, M.-C.; Locci, E.; Perez, P.; Rander, J.; Tuchming, B.; Vallage, B.; Litke, A. M.; Taylor, G.; Booth, C. N.; Cartwright, S.; Combley, F.; Hodgson, P. N.; Lehto, M.; Thompson, L. F.; Böhrer, A.; Brandt, S.; Grupen, C.; Hess, J.; Ngac, A.; Prange, G.; Borean, C.; Giannini, G.; He, H.; Putz, J.; Rothberg, J.; Armstrong, S. R.; Berkelman, K.; Cranmer, K.; Ferguson, D. P. S.; Gao, Y.; González, S.; Hayes, O. J.; Hu, H.; Jin, S.; Kile, J.; McNamara, P. A.; Nielsen, J.; Pan, Y. B.; von Wimmersperg-Toeller, J. H.; Wiedenmann, W.; Wu, J.; Wu, Sau Lan; Wu, X.; Zobernig, G.; Dissertori, G.

    2005-01-01

    The cross sections for single vector boson production in the Weν and Zee channels are measured from the data collected by the ALEPH detector at LEP for centre-of-mass energies between 183 and 209  GeV. These data correspond to a total integratedluminosity of 683 pb-1. Single-W production is studied in both hadronic and leptonic decay channels. Hadronic and dimuon decays are used for single-Z production. The measured cross sections agree with the Standard Model predictions.

  1. How Quickly Do Asymptomatic Infrarenal Abdominal Aortic Aneurysms Grow and What Factors Affect Aneurysm Growth Rates? Analysis of a Single Centre Surveillance Cohort Database.

    PubMed

    Ahmad, Mehtab; Mistry, Rakesh; Hodson, James; Bradbury, Andrew W

    2017-09-04

    Abdominal aortic aneurysm (AAA) maximum antero-posterior diameter (MAPD) is the parameter most commonly used to inform the timing of surgical intervention. However, other factors, such as growth rates and patient comorbidities are likely to be important considerations as they may influence AAA related complications including rupture, operative outcomes, and the clinical and cost effectiveness of continued surveillance. This was a retrospective analysis of a 20 year period of a single centre AAA surveillance database. In total, 5363 AAA measurements in 692 patients were analysed for patient demographics, including comorbidity and drug history, growth and rupture rates, and cause of death. A significant proportion of patients (n = 73; 11%) were kept under surveillance despite having a MAPD < 30 mm. Overall, mean aneurysm growth rate was 2.3 mm/year. Elective repair was undertaken in 20.1% and those who required surgical intervention had significantly faster growth rates. Only 3.9% of patients in surveillance ruptured, 40.7% of whom had a MAPD <55 mm at their last scan. Of the 214 deaths recorded, only 11.7% were related to AAA. The majority of patients who died in surveillance did so from malignancy. Patients with larger AAA (MAPD > 40 mm) on entry into surveillance were significantly more likely to receive surgical intervention, as were those whose AAA expanded >4 mm/year. Females had significantly higher growth rates, and those with diabetes had significantly smaller growth rates. Other comorbidities and drug history were not associated with AAA growth, or 5 and 10 year surgery free survival. The results highlight several areas for service improvement. Specifically, it is important not to maintain surveillance in patients who are very unlikely to ever grow to a point where AAA surgery would be contemplated on grounds or age and/or comorbidity. Similarly, patients should be discharged from surveillance when this likelihood becomes apparent. Crown

  2. Obesity and post-cardiopulmonary bypass-associated acute kidney injury: a single-center retrospective analysis.

    PubMed

    Kumar, Avinash B; Bridget Zimmerman, M; Suneja, Manish

    2014-06-01

    The authors specifically explored the association of obesity (based on body mass index [BMI]) and the risk of developing acute kidney injury after cardiopulmonary bypass (AKICPB). Single-center retrospective study. Academic medical center. After IRB approval, 376 eligible adults who underwent cardiac surgery with cardiopulmonary bypass between 2006-2010 were included in the final retrospective analysis. Patients undergoing "off-pump" procedures, cardiac transplants, repair of congenital heart disease, and patients with preoperative circulatory assist devices were excluded. The overall incidence of developing AKICPB in this population based on the Acute Kidney Injury Network serum creatinine criteria was 39% (147 of 376). Among the BMI classes, the morbidly obese cohort (ie, BMI>40 kg/m(2)) had a significantly greater risk of developing AKICPB than those in lower BMI classes. BMI>40 kg/m(2) was significantly associated with development of AKICPB even after accounting for covariates (ie, diabetes mellitus, hypertension, age, severity of illness, and CPB time) (overall p = 0.018). The odds ratio of AKICPB in the BMI>40 kg/m(2) cohort relative to BMI<25 kg/m(2) was 2.39 (95% CI: 0.98, 5.82; p = 0.055), with no significant difference in risk of developing AKICPB among the 4 lower BMI classes. BMI>40 kg/m(2) is associated with a significantly higher risk of developing of AKICPB. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Re-irradiation for locoregionally recurrent tumors of the thorax: a single-institution, retrospective study.

    PubMed

    Sumita, Kiyomi; Harada, Hideyuki; Asakura, Hirofumi; Ogawa, Hirofumi; Onoe, Tsuyoshi; Murayama, Shigeyuki; Nakamura, Satoaki; Tanigawa, Noboru; Takahashi, Toshiaki; Nishimura, Tetsuo

    2016-08-02

    Re-irradiation (re-RT) of the thorax is challenging due to the impact of prior therapies on normal tissues, and there are few reports of definitive re-RT. The treatment toxicities and efficacy of re-RT are not well known. The aim of the present study was to assess the safety and efficacy of definitive re-RT of the thorax. Patients who were treated with thoracic re-RT between March 2007 and December 2014 were retrospectively analyzed. Primary and re-irradiation plans were required to have an overlap of dose distributions for the 80 % isodose level. All doses were recalculated to an equivalent dose of 2 Gy per fraction (EQD2). When possible, analysis of dose accumulation was carried out using the medical image merge (MIM) (®) software program (version 6.5, MIM Software Inc., Cleveland, OH). Administration dosages for organs at risk were defined. Fourteen (67 %) and seven (33 %) patients with non-small cell carcinoma (NSCLC) and small cell carcinoma (SCLC), respectively, were identified. The patients' median age was 72 (range 53-85) years. Fifteen patients (71 %) had "proximal" tumors, defined as tumors at the distal 2 cm of the trachea, carina, and main bronchi. The median interval from initial RT to re-RT was 26.8 (range 11.4-92.3) months. Re-RT was delivered by X-ray beam and proton beam therapy in 20 (95 %) patients and 1 (5 %) patient, respectively. The median radiation dose of re-RT was 60 (range 54-87.5) Gy10 and 50 (range 50.0-87.5) Gy10 for patients with NSCLC and SCLC, respectively. Grade 3 acute radiation pneumonitis occurred in only one patient. There were no other serious complications. The median follow-up time was 22.1 (range 2.3-56.4) months. The median local progression-free survival time (LPFS) and overall survival time (OS) were 12.9 (95 % confidence interval (CI): 8.9-27.9) months and 31.4 (95 % CI: 16.9-45.9) months, respectively. Patients receiving ≥ 60 Gy10 at re-RT had longer LPFS (p = 0.04). Good safety with longer OS than in previous

  4. Retrospective analysis of 140 cases of medullary thyroid carcinoma followed-up in a single institution

    PubMed Central

    SIMÕES-PEREIRA, JOANA; BUGALHO, MARIA JOÃO; LIMBERT, EDWARD; LEITE, VALERIANO

    2016-01-01

    Familial cases of medullary thyroid carcinoma (MTC) may be diagnosed by genetic screening, while in sporadic tumors the diagnosis relies mainly on fine-needle aspiration cytology. The aim of the present study was to determine the demographic, clinical and pathological characteristics of MTC patients followed-up at the Portuguese Institute of Oncology Francisco Gentil (Lisbon, Portugal). For that purpose, a retrospective analysis of 140 MTC patients diagnosed between 1990 and 2010 was performed. The results indicated that patients with hereditary MTC (11.4%) were significantly younger than patients with sporadic MTC. Of the latter, 34.3% had no clinical suspicion of MTC prior to surgery. The sensitivity of cytology and calcitonin (CT) assay in diagnosing MTC were 51.3 and 98.7%, respectively. All familial index cases and 69.0% of sporadic cases presented with advanced stage disease at the time of diagnosis, while 73.0% of familial MTC detected by genetic/pentagastrin screening were diagnosed at the early stage of the disease. Biochemical cure (BC) was achieved in 39.7% of patients and, of these, only 6.5% relapsed. The 5 and 10-year survival rates were 79.3 and 73.6%, respectively. Age >45 years (P=0.026), advanced stage at diagnosis (P<0.001) and absence of BC (P<0.001) were predictors of a worse prognosis on univariate analysis. However, when the patients detected by genetic/pentagastrin screening were excluded from the analysis, age was no longer a prognostic factor, although disease stage remained a significant prognostic factor. On multivariate analysis, BC was the only factor with a significant impact on prognosis (P=0.031). In addition, the present study confirmed that the majority of patients were diagnosed at advanced stages, and CT determination was observed to be more sensitive than cytology to diagnose MTC. Patients at early stages were more prone to achieve BC, which was a favorable prognostic factor. To the best of our knowledge, the present study

  5. Adherence to guidelines for perioperative management of anticoagulation results in decreased bleeding complications: a single-centre experience.

    PubMed

    DeSancho, Maria T; Bardarova, Svetoslava; Chapin, John

    2015-06-01

    Guidelines describing the perioperative management of antithrombotic therapy in patients requiring temporary interruption of vitamin K antagonists (VKAs) were first published in 2008. The objective of this study is to evaluate the perioperative management of anticoagulation of patients on chronic VKA and the incidence of bleeding and thrombotic complications pre and postpublication of the 2008 American College of Chest Physicians (ACCP) guidelines. A retrospective review of 40 patients on chronic VKA requiring temporary discontinuation of VKA due to an invasive or surgical procedure who were referred to a single haematology practice from January 2006 to June 2010. Demographics, indications of VKA, risk factors for thrombosis, type of procedure, bridging regimen and bleeding complications were recorded pre and post-2008 ACCP guidelines. Sixty-one procedures were performed in 40 patients; 60% were women. Indications for anticoagulation were secondary prevention of venous thrombosis (n = 27), arterial thrombosis (n = 8) or both arterial thrombosis and venous thrombosis (n = 4), and primary prevention of arterial thrombosis (n = 1). Twenty patients (50%) had thrombophilia. The most common surgical and invasive procedures were gastrointestinal (33%), gynaecological (15%) and orthopaedic (11%). Bridging regimen with therapeutic-dose subcutaneous low molecular heparin (LMWH) was used in 27 (67.5%) patients, prophylactic-dose LMWH in 12 (30%) and a combination of LMWH therapeutic and prophylactic-dose doses in 11 (27.5%). Three bleeding complications occurred prepublication of the 2008 ACCP practice guidelines, although no bleeding complications occurred after the guidelines were published. Adherence to the 2008 ACCP guidelines for the perioperative management of anticoagulation reduced bleeding complications in patients on chronic VKA treatment.

  6. Transumbilical thoracic sympathectomy: a single-centre experience of 148 cases with up to 4 years of follow-up†.

    PubMed

    Zhu, Li-Huan; Chen, Weisheng; Chen, Long; Yang, Shengsheng; Lu, Zhao-Tong

    2016-01-01

    Thoracic sympathectomy is considered as the most effective method to treat palmar hyperhidrosis (PH). Here, we report our experience of transumbilical thoracic sympathectomy with an ultrathin flexible endoscope for PH in a series of 148 patients with up to 4 years of follow-up. A prospective database was used in this retrospective analysis of 148 patients (61 males, 87 females, with a mean age of 21.3 years) with PH who were operated on by the same surgeon in a single institution from April 2010 to March 2014. All procedures were performed under general anaesthesia involving intubation with a double-lumen endotracheal tube. Demographic, postoperative and long-term data of patients were recorded and statistical analyses were performed. All patients were followed up at least 6 months post procedure through clinic visits or telephone/e-mail interviews. The procedure was performed successfully in 148 of the 150 patients. Two patients had to be converted to conventional thoracoscopic procedure because of severe pleural adhesions. The mean operating time was 43 min (ranging from 39 to 107 min) and the mean postoperative length of stay was 1 day (range 1-4 days). All patients were interviewed 6-48 months after surgery and no diaphragmatic hernia or syndrome was observed. The rate of resolution of PH and axillary hyperhidrosis was 98 and 74.6%, respectively. Compensatory sweating was reported in 22.3% of patients. Almost all of the patients were satisfied with the surgical results and the cosmetic outcome of the incision. This preliminary human experience suggested that transumbilical thoracic sympathectomy was a safe and efficacious alternative to the conventional approach. This technique avoided the chronic pain and chest wall paraesthesia that are associated with the chest incision. In addition, this novel procedure afforded maximum cosmetic benefits. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio

  7. Pesticide poisoning trend analysis of 13 years: a retrospective study based on telephone calls at the National Poisons Information Centre, All India Institute of Medical Sciences, New Delhi.

    PubMed

    Peshin, Sharda Shah; Srivastava, Amita; Halder, Nabanita; Gupta, Yogendra Kumar

    2014-02-01

    The study was designed to analyze the incidence and pattern of pesticide poisoning calls reported to the National Poisons Information Centre (NPIC), AIIMS, New Delhi and highlight the common classes of pesticides involved in poisoning. The telephone calls received by the Centre during the thirteen year period (1999-2012) were entered into a preset proforma and then into a retrievable database. A total of 4929 calls of pesticide poisoning were recorded. The data was analyzed with respect to age, gender, mode and type of poisoning. The age ranged from 1 to 65 years with the preponderance of males (M = 62.19%, F = 37.80%). The age group mainly involved in poisoning was 18-35 years. While 59.38% calls pertained to household pesticides, 40.61% calls related to agricultural pesticides. The common mode of poisoning was intentional (64.60%) followed by accidental (34.40%) and unknown (1%). Amongst the household pesticides, the highest number of calls were due to pyrethroids (26.23%) followed by rodenticides (17.06%), organophosphates (6.26%), carbamates (4.95%) and others (4.86%). In agricultural pesticides group, the organophosphates (9.79%) ranked the first followed by, aluminium phosphide (9.65%), organochlorines (9.31%), pyrethroids (3.87%), herbicides, weedicides and fungicides (3.20%), ethylene dibromide (2.82%), and others (1.70%). The data analysis shows a high incidence of poisoning due to household pesticides as compared to agricultural pesticides, clearly emphasizing the need for creating awareness and education about proper use and implementation of prevention programmes.

  8. Congenital heart defects in newborns with apparently isolated single gastrointestinal malformation: A retrospective study.

    PubMed

    Schierz, Ingrid Anne Mandy; Pinello, Giuseppa; Giuffrè, Mario; La Placa, Simona; Piro, Ettore; Corsello, Giovanni

    2016-12-01

    Congenital gastrointestinal system malformations/abdominal wall defects (GISM) may appear as isolated defects (single or complex), or in association with multiple malformations. The high incidence of association of GISM and congenital heart defects (CHD) in patients with syndromes and malformative sequences is known, but less expected is the association of apparently isolated single GISM and CHD. The aim of this study was to investigate the frequency of CHD in newborns with isolated GISM, and the possibility to modify the diagnostic-therapeutic approach just before the onset of cardiac symptoms or complications. Anamnestic, clinical, and imaging data of newborns requiring abdominal surgery for GISM, between 2009 and 2014, were compared with a control group of healthy newborns. Distribution of GISM and cardiovascular abnormalities were analyzed, and risk factors for adverse outcomes were identified. Seventy-one newborns with isolated GISM were included in this study. More frequent GISM were intestinal rotation and fixation disorders. CHD were observed in 15.5% of patients, augmenting their risk for morbidity. Risk factors for morbidity related to sepsis were identified in central venous catheter, intestinal stoma, and H2-inhibitor-drugs. Moreover, 28.2% of newborns presented only functional cardiac disorders but an unexpectedly higher mortality. The high incidence of congenital heart disease in infants with apparently isolated GISM confirms the need to perform an echocardiographic study before surgery to improve perioperative management and prevent complications such as sepsis and endocarditis. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  9. Cumulative Success Rate of Short and Ultrashort Implants Supporting Single Crowns in the Posterior Maxilla: A 3-Year Retrospective Study

    PubMed Central

    Lombardo, Giorgio; Pighi, Jacopo; Marincola, Mauro; Nocini, Pier Francesco

    2017-01-01

    Aim To determine cumulative success rate (CSR) of short and ultrashort implants in the posterior maxilla restored with single crowns. Patients and Methods We performed a retrospective study in 65 patients with 139 implants. 46 were ultrashort and 93 short. Implants were placed with a staged approach and restored with single crowns. Success rate, clinical and radiographic outcomes, and crown-to-implant ratio (CIR) were assessed after three years. Statistical analysis was performed by descriptive and inferential statistics. A log-binomial regression model where the main outcome was implant success was achieved. Coefficients and 95% confidence intervals were reported. Analyses were performed with Stata 13.2 for Windows. Results 61.54% of patients were female and mean overall age was 51.9 ± 11.08 years old. Overall CSR was 97.1% (95% CI: 92.4–98.9): 97.9 and 95.1% for short and ultrashort, respectively (P value: 0.33). Four implants failed. Covariates were not associated with CSR (P value > 0.05). Regression model showed coefficients correlated with implant success for ultrashort implants (0.87) and most of covariates but none were statistically significant (P values > 0.05). Conclusions Our results suggest that short and ultrashort implants may be successfully placed and restored with single crowns in the resorbed maxillary molar region. PMID:28751913

  10. Functional outcome of extra-articular distal humerus fracture fixation using a single locking plate: A retrospective study.

    PubMed

    Trikha, Vivek; Agrawal, Prabhat; Das, Saubhik; Gaba, Sahil; Kumar, Arvind

    2017-01-01

    The optimal method for fixation of extra-articular distal humerus factures poses a management dilemma. Although various plate configurations have been proposed, anatomic shaped extra-articular distal humerus locking plates have emerged as a viable solution for these complex injuries. We assessed clinico-radiologic outcome in our retrospective case series of extra-articular distal humerus fractures managed with these plates. Forty-five patients of extra-articular distal humerus fractures, who were operated at our level 1 trauma centre between January, 2012 and December, 2016, were identified. After exclusion, 36 patients were available for the final assessment. All patients were operated with the triceps-reflecting modified posterior approach. Regular clinico-radiologic follow-up was done evaluating elbow functionality, fracture union, secondary displacement, non-union, implant failure and any complications; Mayo Elbow Performance score (MEPS) was used for the final functional assessment. Twenty-four (66.7%) male and 12 (33.3%) female patients constituted the study group, who had an average follow-up of 15 months. Preoperatively three patients and post-operatively one patient had radial nerve palsy; all had neurapraxia and recovered completely. Overall, 34 (94.4%) patients were adjudged to have complete radiological union within 3 months; 2 (5.5%) patients developed non-union. Mean flexion achieved was 122.9° ± 23°, and mean extension was -4.03° ± 6.5°; 1 patient with head injury developed flexion deformity of 45°. Average MEPS at the final follow-up was 90.8° ± 9.9°. Stable reconstruction and early initiation of physiotherapy are utilitarian to envision optimal outcome; the use of precontoured extra-articular distal humerus locking plates has yielded satisfactory results with minimal complications in our hands.

  11. Single-site Versus Multiport Robotic Hysterectomy in Benign Gynecologic Diseases: A Retrospective Evaluation of Surgical Outcomes and Cost Analysis.

    PubMed

    Bogliolo, Stefano; Ferrero, Simone; Cassani, Chiara; Musacchi, Valentina; Zanellini, Francesca; Dominoni, Mattia; Spinillo, Arsenio; Gardella, Barbara

    2016-01-01

    To compare the surgical outcomes and costs of robotic-assisted hysterectomy with the single-site (RSSH) or multiport approach (RH). A retrospective analysis of a prospectively collected database (Canadian Task Force classification II1). A university hospital. Consecutive women who underwent robotic-assisted total laparoscopic hysterectomy and bilateral salpingo-oophorectomy for the treatment of benign gynecologic diseases. Data on surgical approach, surgical outcomes, and costs were collected in a prospective database and retrospectively analyzed. The total operative time, console time, docking time, estimated blood loss, conversion rate, and surgical complications rate were compared between the 2 study groups. Cost analysis was performed. One hundred four patients underwent total robotic-assisted hysterectomy and bilateral salpingo-oophorectomy (45 RSSH and 59 RH). There was no significant difference in the indications for surgery and in the characteristics of the patients between the 2 study groups. There was no significant difference between the single-site and multiport approach in console time, surgical complication rate, conversion rate, and postoperative pain. The docking time was lower in the RH group (p = .0001). The estimated blood loss and length of hospitalization were lower in the RSSH group (p = .0008 and p = .009, respectively). The cost analysis showed significant differences in favor of RSSH. RSSH should be preferred to RH when hysterectomy is performed for benign disease because it could be at least as equally effective and safe with a potential cost reduction. However, because of the high cost and absence of clear advantages, the robotic approach should be considered only for selected patients. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

  12. Paclitaxel-Coated Balloons for the Treatment of Dysfunctional Dialysis Access. Results from a Single-Center, Retrospective Analysis.

    PubMed

    Kitrou, Panagiotis M; Spiliopoulos, Stavros; Papadimatos, Panagiotis; Christeas, Nicolaos; Petsas, Theodoros; Katsanos, Konstantinos; Karnabatidis, Dimitris

    2017-01-01

    To investigate the safety and effectiveness of lutonix paclitaxel-coated balloon (PCB) for the treatment of dysfunctional dialysis access. This was a single-center, single-arm, retrospective analysis of 39 patients (23 male, 59 %) undergoing 61 interventions using 69 PCBs in a 20-month period. There was a balance between arteriovenous fistulae (AVF) and grafts (AVG) (20 AVFs, 19AVGs), and the majority of lesions were restenotic (25/39, 64.1 %). Mean balloon diameter used was 6.6 mm and length 73.4 mm. Primary outcome measure was target lesion primary patency (TLPP) at 6 months, while secondary outcome measures included factors affecting TLPP and major complications. As there were lesions treated more than once with PCB, authors also compared patency results after first and second PCB angioplasty. TLPP was 72.2 % at 6 months with a median patency of 260 days according to the Kaplan-Meier survival analysis. No major complications occurred. TLPP between AVFs and AVGs (311 vs. 237 days, respectively; p = 0.29) and de novo and restenotic lesions was similar (270.5 vs. 267.5 days, respectively; p = 0.50). In 14 cases, in which lesions were treated with two PCB angioplasties, a statistically significant difference in TLPP after the second treatment was noted (first intervention 179.5 days vs. second intervention 273.5 days; p = 0.032). In this retrospective analysis, Lutonix PCB proved to be safe and effective in treating restenosis in dysfunctional dialysis access with results comparable to the literature available. Larger studies are needed to prove abovementioned results.

  13. Cleavage of hydrogen by activation at a single non-metal centre - towards new hydrogen storage materials.

    PubMed

    Grabowski, Sławomir J

    2015-05-28

    Molecular surfaces of non-metal species are often characterized by both positive and negative regions of electrostatic potential (EP) at a non-metal centre. This centre may activate molecular hydrogen which further leads to the addition reaction. The positive EP regions at the non-metal centres correspond to σ-holes; the latter sites are enhanced by electronegative substituents. This is why the following simple moieties; PFH2, SFH, AsFH2, SeFH, BrF3, PF(CH3)2 and AsF(CH3)2, were chosen here to analyze the H2 activation and its subsequent splitting at the P, As, S, Se and Br centres. Also the reverse H-H bond reforming process is analyzed. MP2/aug-cc-pVTZ calculations were performed for systems corresponding to different stages of these processes. The sulphur centre in the SFH moiety is analyzed in detail since the potential barrier height for the addition reaction for this species is the lowest of the moieties analyzed here. The results of calculations show that the SFH + H2 → SFH3 reaction in the gas phase is endothermic but it is exothermic in polar solvents.

  14. Does anterior plating maintain cervical lordosis versus conventional fusion techniques? A retrospective analysis of patients receiving single-level fusions.

    PubMed

    Troyanovich, Stephan J; Stroink, Ann R; Kattner, Keith A; Dornan, Wayne A; Gubina, Irina

    2002-02-01

    A retrospective review of medical records and radiographs of patients receiving anterior cervical discectomy and fusion (ACDF) without anterior plating and with anterior plating was performed. The objective of the study was to determine whether a difference exists in cervical lordotic alignment between subjects undergoing single-level ACDF with and without anterior cervical plating instrumentation for symptomatic cervical disc disease. Collapse or settling of grafted bone into the vertebral endplates with resulting kyphotic deformity of the cervical spine is a commonly described complication of anterior discectomy and fusion. Despite the increasing use of instrumentation for the treatment of cervical spine injuries and degenerative conditions, little is known regarding lordotic alignment of the cervical spine in patients who receive plating instrumentation compared with conventional fusion without plating. Accumulating evidence suggests that plating is superior to non-plating techniques in patients with multiple level cervical disc lesions in regard to fusion, return to work rates, and complication rates; however, little is known about maintenance of lordotic curve alignment in single- and multiple-level procedures. Neutral lateral cervical radiographs of 57 patients who underwent single-level ACDF between 1994 and 1999 with anterior screw plates (n = 26), and conventional single-level fusion without anterior screw plates (n = 21) were retrospectively assessed. Measurements were made on weight-bearing lateral cervical radiographs to assess overall sagittal spinal alignment and intersegmental sagittal alignment at the surgical site before surgery, immediately after surgery, 4 to 12 weeks after surgery, and 12+ months after surgery. The average magnitude of overall lordosis measured between C2 and C7 decreased 4.2 degrees in the non-plated group, while being preserved in the plated group. This finding did not reach statistical significance in the long-term follow

  15. Clinical experience with N-carbamylglutamate in a single-centre cohort of patients with propionic and methylmalonic aciduria.

    PubMed

    Burlina, Alberto; Cazzorla, Chiara; Zanonato, Elisa; Viggiano, Emanuela; Fasan, Ilaria; Polo, Giulia

    2016-09-01

    The effect of long-term N-carbamylglutamate (NCG) treatment on the rate and severity of decompensations due to propionic aciduria (PA) and methylmalonic aciduria (MMA) is unknown. This paper presents clinical experience from a single-centre cohort of patients with PA and MMA who received continuous long-term treatment with NCG. The effect of oral NCG treatment (initial dose: 50 mg/kg/day) was investigated in patients with PA or MMA who were experiencing frequent progressive episodes of metabolic decompensation, who had pathological levels of ammonia, and who were referred to the Division of Metabolic Diseases, University Hospital of Padova between August 2014 and December 2015. Clinical and biochemical data, including the number of metabolic decompensations, lactic acid, uric acid and plasma ammonia levels, protein intake and body weight, were collected before and after the initiation of NCG treatment. Eight patients with PA (n = 4) and MMA (n = 4) aged 2-20 years were treated with NCG (50 mg/kg/day) for 7-16 months. Metabolic decompensation episodes decreased in number and severity, with three of the patients having no episodes (pre-treatment: 24 episodes; post-treatment: 9 episodes). After NCG treatment, all episodes were treated at home and none required hospitalisation, lactic acid values were 1.3-2.1 mmol/L and uric acid values were 0.21-0.36 mmol/L. Significant reductions in blood ammonia levels after NCG initiation were observed in five patients, whereas levels were reduced or maintained in the normal range in the remainder. Over the treatment period, patients had an increase in natural protein intake of 20-50% and gained 0-6.5 kg in bodyweight. These observations suggest that, in addition to short-term benefits for the acute treatment of hyperammonaemia, NCG may be effective and well tolerated as a long-term treatment in patients with severe PA and MMA, and that further prospective studies are warranted.

  16. [Morbidity and mortality in diabetic patients on peritoneal dialysis. Twenty-five years of experience at a single centre].

    PubMed

    Coronel, F; Cigarrán, S; Herrero, J A

    2010-01-01

    To describe PD outcomes over 25 years in a single centre, comparing hospitalisation rate, technique withdrawal, and survival between diabetic (DM) and non-diabetic (NonDM) patients. Differences between type 1 (DM1) and type 2 (DM2) diabetics were also analysed. One hundred and eighteen DM patients (52 year old average, 74 men, 44 female) and 117 Non-DM (53 year old average, 64 men, 53 female), with at least 2 months on PD, 25±20 (2-109) and 29.4±27 (2-159) months respectively, were included. Diabetics were divided in 66 DM1 and 52 DM2. The survival and hospitalisation study was also analysed in two different time periods: before 1992 (1981-1992) and after 1992 (1993-2005). 93% Non-DM and 75% DM were self-sufficient to manage the PD technique (P<.001) as well as 65% of 44 blind patients. 28% of Non-DM and 15% of DM received a renal allograft (P<.001). There was no difference in transfer to haemodialysis. 18.6% of DM and 4.3% of Non-DM patients presented ≥4 comorbid factors on starting PD (P<.001). Hospitalisation (admissions/year) was higher in DM than in Non-DM (3.4 vs 1.8, P<.01) and also hospitalisation length (46 vs 22 days/year, P=.01), without differences between DM1 and DM2. Admissions due to cardiovascular events, infections, technical problems and peritonitis were more frequent in DM2 than in Non-DM and DM1 patients (P<.05). Mortality was 48% in DM and 22% in Non-DM (P<.001). Survival adjusted for comorbidity was higher in Non-DM (P<.001). Cerebrovascular disease was the highest risk factor for mortality in DM. Mortality was higher in DM2 than in DM1 and Non-DM (P<.001). Age (HR 1.052, P=.001), DM2 (HR 1.96, P<.01) and cerebrovascular disease (HR 4.01, P<.001) were the most important risk factors. In the post-1992 period, the hospitalisation rate and survival improved in DM1 and Non-DM patients. DM patients more often require outside assistance to perform PD and have more comorbidity, lower survival, and higher admissions than Non-DM, but there is no

  17. The Delta III reverse shoulder replacement for cuff tear arthropathy: a single-centre study of 50 consecutive procedures.

    PubMed

    Naveed, M A; Kitson, J; Bunker, T D

    2011-01-01

    The combination of an irreparable tear of the rotator cuff and destructive arthritis of the shoulder joint may cause severe pain, disability and loss of independence in the aged. Standard anatomical shoulder replacements depend on a functioning rotator cuff, and hence may fail in the presence of tears in the cuff. Many designs of non-anatomical constrained or semi-constrained prostheses have been developed for cuff tear arthropathy, but have proved unsatisfactory and were abandoned. The DePuy Delta III reverse prosthesis, designed by Grammont, medialises and stabilises the centre of rotation of the shoulder joint and has shown early promise. This study evaluated the mid-term clinical and radiological results of this arthroplasty in a consecutive series of 50 shoulders in 43 patients with a painful pseudoparalysis due to an irreparable cuff tear and destructive arthritis, performed over a period of seven years by a single surgeon. A follow-up of 98% was achieved, with a mean duration of 39 months (8 to 81). The mean age of the patients at the time of surgery was 81 years (59 to 95). The female to male ratio was 5:1. During the seven years, six patients died of natural causes. The clinical outcome was assessed using the American Shoulder and Elbow score, the Oxford Shoulder Score and the Short-form 36 score. A radiological review was performed using the Sirveaux score for scapular notching. The mean American Shoulder and Elbow score was 19 (95% confidence interval (CI) 14 to 23) pre-operatively, and 65 (95% CI 48 to 82) (paired t-test, p < 0.001) at final follow-up. The mean Oxford score was 44 (95% CI 40 to 51) pre-operatively and 23 (95% CI 18 to 28) (paired t-test, p < 0.001) at final follow-up. The mean maximum elevation improved from 55° pre-operatively to 105° at final follow-up. There were seven complications during the whole series, although only four patients required further surgery.

  18. No effect of traction in patients with low back pain: a single centre, single blind, randomized controlled trial of Intervertebral Differential Dynamics Therapy®

    PubMed Central

    de Kleuver, M.; Horsting, P. P.; Spruit, M.; Jacobs, W. C. H.; van Limbeek, J.

    2009-01-01

    Low back pain (LBP) poses a significant problem to society. Although initial conservative therapy may be beneficial, persisting chronic LBP still frequently leads to expensive invasive intervention. A novel non-invasive therapy that focuses on discogenic LBP is Intervertebral Differential Dynamics Therapy® (IDD Therapy, North American Medical Corp. Reg U.S.). IDD Therapy consists of intermittent traction sessions in the Accu-SPINA device (Steadfast Corporation Ltd, Essex, UK), an FDA approved, class II medical device. The intervertebral disc and facet joints are unloaded through axial distraction, positioning and relaxation cycles. The purpose of this study is to investigate the effect of IDD Therapy when added to a standard graded activity program for chronic LBP patients. In a single blind, single centre, randomized controlled trial; 60 consecutive patients were assigned to either the SHAM or the IDD Therapy. All subjects received the standard conservative therapeutic care (graded activity) and 20 sessions in the Accu-SPINA device. The traction weight in the IDD Therapy was systematically increased until 50% of a person’s body weight plus 4.45 kg (10 lb) was reached. The SHAM group received a non-therapeutic traction weight of 4.45 kg in all sessions. The main outcome was assessed using a 100-mm visual analogue scale (VAS) for LBP. Secondary outcomes were VAS scores for leg pain, Oswestry Disability Index (ODI), Short-Form 36 (SF-36). All parameters were measured before and 2, 6 and 14 weeks after start of the treatment. Fear of (re)injury due to movement or activities (Tampa Scale for Kinesiophobia), coping strategies (Utrecht Coping List) and use of pain medication were recorded before and at 14 weeks. A repeated measures analysis was performed. The two groups were comparable at baseline in terms of demographic, clinical and psychological characteristics, indicating that the random allocation had succeeded. VAS low back pain improved significantly from 61

  19. Impact of aprotinin and renal function on mortality: a retrospective single center analysis.

    PubMed

    Schloss, Brian; Gulati, Parul; Yu, Lianbo; Abdel-Rasoul, Mahmoud; O'Brien, William; Von Visger, Jon; Awad, Hamdy

    2011-08-30

    An estimated up to 7% of high-risk cardiac surgery patients return to the operating room for bleeding. Aprotinin was used extensively as an antifibrinolytic agent in cardiac surgery patients for over 15 years and it showed efficacy in reducing bleeding. Aprotinin was removed from the market by the U.S. Food and Drug Administration after a large prospective, randomized clinical trial documented an increased mortality risk associated with the drug. Further debate arose when a meta-analysis of 211 randomized controlled trials showed no risk of renal failure or death associated with aprotinin. However, only patients with normal kidney function have been studied. In this study, we look at a single center clinical trial using patients with varying degrees of baseline kidney function to answer the question: Does aprotinin increase odds of death given varying levels of preoperative kidney dysfunction? Based on our model, aprotinin use was associated with a 3.8-fold increase in odds of death one year later compared to no aprotinin use with p-value = 0.0018, regardless of level of preoperative kidney dysfunction after adjusting for other perioperative variables. Lessons learned from our experience using aprotinin in the perioperative setting as an antifibrinolytic during open cardiac surgery should guide us in testing future antifibrinolytic drugs for not only efficacy of preventing bleeding, but for overall safety to the whole organism using long-term clinical outcome studies, including those with varying degree of baseline kidney function.

  20. Dental extraction without stopping single or dual antiplatelet therapy: results of a retrospective cohort study.

    PubMed

    Lu, S-Y; Tsai, C-Y; Lin, L-H; Lu, S-N

    2016-10-01

    The aim of this study was to investigate the incidence of bleeding after dental extraction without stopping antiplatelet therapy. Postoperative bleeding was assessed in a total of 1271 patients who were divided into two groups: a study group comprising 183 patients on antiplatelet therapy (aspirin 125 patients/185 occasions; clopidogrel 42 patients/65 occasions; dual therapy 16 patients/24 occasions) who underwent 548 dental extractions on 274 occasions, and a control group comprising 1088 patients who were not receiving any antiplatelet or anticoagulant therapy and underwent 2487 dental extractions on 1472 occasions. The incidence of postoperative bleeding was higher in the study group (5/274, 1.8%) than in the control group (10/1472, 0.7%), and also in the dual antiplatelet subgroup (1/24, 4.2%) than in the single antiplatelet subgroups (clopidogrel: 2/65, 3.1%; aspirin: 2/185, 1.1%); however, these differences were not significant. Postoperative bleeding was managed successfully by repacking with Gelfoam impregnated with tranexamic acid powder in 12 patients and by resuturing in three of the control patients undergoing extraction of impacted teeth with flap elevation. These findings indicate that there is no need to interrupt antiplatelet drugs before dental extraction. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  1. Mechanical Revascularization for Acute Ischemic Stroke: A Single-Center, Retrospective Analysis

    SciTech Connect

    Jeromel, Miran Milosevic, Z. V. Kocijancic, I. J. Lovric, D.; Svigelj, V. Zvan, B.

    2013-04-15

    BackgroundEndovascular mechanical revascularization (thrombectomy) is an increasingly used method for intracranial large vessel recanalization in acute stroke. The purpose of the study was to analyze the recanalization rate, clinical outcome, and complication rate in our stroke patients treated with mechanical revascularization. A total of 57 patients with large vessel stroke (within 3 h for anterior and 12 h for posterior circulation) were treated with mechanical revascularization at a single center during 24 months. The primary goal of endovascular treatment using different mechanical devices was recanalization of the occluded vessel. Recanalization rate (reported as thrombolysis in cerebral infarction [TICI] score), clinical outcome (reported as National Institutes of Health Stroke Scale [NIHSS] score and modified Rankin scale [mRS] score), as well as periprocedural complications were analyzed. The mean age of the patients was 63.1 {+-} 12.9 years, with baseline median NIHSS score of 14 (interquartile range, 9.5-19). Successful recanalization (TICI 2b or 3) was achieved in 41 (72 %) patients. Twenty patients (35 %) presented with favorable outcome (mRS {<=}2) 30 days after stroke. Overall, significant neurological improvement ({>=}4 NIHSS point reduction) occurred in 36 (63 %) patients. A clinically significant procedure-related adverse events (vessel disruption, peri/postprocedural intracranial bleeding) defined with decline in NIHSS of {>=}4 or death occurred in three (5 %) patients. The study showed a high recanalization rate with improved clinical outcome and a low rate of periprocedural complications in our stroke patients treated with mechanical revascularization. Therefore, we could conclude that endovascular revascularization (primary or in combination with a bridging thrombolysis) was an effective and safe procedure for intracranial large vessel recanalization in acute stroke.

  2. A pragmatic randomised multi-centre trial of multifamily and single family therapy for adolescent anorexia nervosa.

    PubMed

    Eisler, Ivan; Simic, Mima; Hodsoll, John; Asen, Eia; Berelowitz, Mark; Connan, Frances; Ellis, Gladys; Hugo, Pippa; Schmidt, Ulrike; Treasure, Janet; Yi, Irene; Landau, Sabine

    2016-11-24

    Considerable progress has been made in recent years in developing effective treatments for child and adolescent anorexia nervosa, with a general consensus in the field that eating disorders focussed family therapy (often referred to as Maudsley Family Therapy or Family Based Treatment) currently offers the most promising outcomes. Nevertheless, a significant number do not respond well and additional treatment developments are needed to improve outcomes. Multifamily therapy is a promising treatment that has attracted considerable interest and we report the results of the first randomised controlled trial of multifamily therapy for adolescent anorexia nervosa. The study was a pragmatic multicentre randomised controlled superiority trial comparing two outpatient eating disorder focussed family interventions - multifamily therapy (MFT-AN) and single family therapy (FT-AN). A total of 169 adolescents with a DSM-IV diagnosis of anorexia nervosa or eating disorder not otherwise specified (restricting type) were randomised to the two treatments using computer generated blocks of random sizes to ensure balanced numbers in the trial arms. Independent assessors, blind to the allocation, completed evaluations at baseline, 3 months, 12 months (end of treatment) and 18 months. Both treatment groups showed clinically significant improvements with just under 60% achieving a good or intermediate outcome (on the Morgan-Russell scales) at the end of treatment in the FT-AN group and more than 75% in the MFT-AN group - a statistically significant benefit in favour of the multifamily intervention (OR = 2.55 95%; CI 1.17, 5.52; p = 0.019). At follow-up (18 months post baseline) there was relatively little change compared to end of treatment although the difference in primary outcome between the treatments was no longer statistically significant. Clinically significant gains in weight were accompanied by improvements in mood and eating disorder psychopathology. Approximately

  3. Treatment of metastatic uveal melanoma with adoptive transfer of tumour-infiltrating lymphocytes: a single-centre, two-stage, single-arm, phase 2 study.

    PubMed

    Chandran, Smita S; Somerville, Robert P T; Yang, James C; Sherry, Richard M; Klebanoff, Christopher A; Goff, Stephanie L; Wunderlich, John R; Danforth, David N; Zlott, Daniel; Paria, Biman C; Sabesan, Arvind C; Srivastava, Abhishek K; Xi, Liqiang; Pham, Trinh H; Raffeld, Mark; White, Donald E; Toomey, Mary Ann; Rosenberg, Steven A; Kammula, Udai S

    2017-06-01

    Uveal melanoma is a rare tumour with no established treatments once metastases develop. Although a variety of immune-based therapies have shown efficacy in metastatic cutaneous melanoma, their use in ocular variants has been disappointing. Recently, adoptive T-cell therapy has shown salvage responses in multiple refractory solid tumours. Thus, we sought to determine if adoptive transfer of autologous tumour-infiltrating lymphocytes (TILs) could mediate regression of metastatic uveal melanoma. In this ongoing single-centre, two-stage, phase 2, single-arm trial, patients (aged ≥16 years) with histologically confirmed metastatic ocular melanoma were enrolled. Key eligibility criteria were an Eastern Cooperative Oncology Group performance status of 0 or 1, progressive metastatic disease, and adequate haematological, renal, and hepatic function. Metastasectomies were done to procure tumour tissue to generate autologous TIL cultures, which then underwent large scale ex-vivo expansion. Patients were treated with lymphodepleting conditioning chemotherapy (intravenous cyclophosphamide [60 mg/kg] daily for 2 days followed by fludarabine [25 mg/m(2)] daily for 5 days, followed by a single intravenous infusion of autologous TILs and high-dose interleukin-2 [720 000 IU/kg] every 8 h). The primary endpoint was objective tumour response in evaluable patients per protocol using Response to Evaluation Criteria in Solid Tumors, version 1.0. An interim analysis of this trial is reported here. The trial is registered at ClinicalTrials.gov, number NCT01814046. From the completed first stage and ongoing expansion stage of this trial, a total of 21 consecutive patients with metastatic uveal melanoma were enrolled between June 7, 2013, and Sept 9, 2016, and received TIL therapy. Seven (35%, 95% CI 16-59) of 20 evaluable patients had objective tumour regression. Among the responders, six patients achieved a partial response, two of which are ongoing and have not reached maximum

  4. The effect of surgical treatment of phaeochromocytoma on concomitant arterial hypertension and diabetes mellitus in a single–centre retrospective study

    PubMed Central

    Pogorzelski, Ryszard; Toutounchi, Sadegh; Krajewska, Ewa; Fiszer, Patryk; Łykowski, Marcin; Szostek, Małgorzata; Jakuczun, Wawrzyniec; Pachucki, Janusz; Skórski, Maciej

    2014-01-01

    Introduction Phaeochromocytoma is one of the numerous causes of secondary hypertension. Furthermore, phaeochromocytoma may first present with type 2 diabetes mellitus. The objective of our study was to evaluate the effects of adrenalectomy on patient recovery with regards to normotension and well–controlled glycaemia. Material and methods The retrospective analysis involved 67 patients with phaeochromocytoma operated between 2006 and mid-2012. The pre–operative diagnoses were made in the departments of internal medicine and endocrinology. Based on laboratory tests and diagnostic imaging, we were able to confirm the diagnosis of phaeochromocytoma in 42 (62.7%) patients. We verified the influence of adrenalectomy on the level of patient recovery, with regards to normotension and glycaemic control: arterial pressure and fasting glycaemia levels were obtained on the day of hospital discharge, at follow–up 3 months post–operatively and 1 year after surgical intervention. Results Of the 67 patients operated for phaeochromocytoma, 48 (71.6%) were treated laparoscopically, whereas 19 (28.4%) underwent open adrenalectomy. Arterial hypertension was recorded in 53 (79.1%) cases. Furthermore, among this group, diabetes mellitus coexisted in 21 (31.3%) cases. Postoperatively, 70% of cases of arterial hypertension and 90% of type 2 diabetes mellitus were cured. Additionally, a high rate of patients reported a quantitative reduced use of antihypertensive medicines. Conclusions In the majority of patients, surgical treatment of symptomatic phaeochromocytoma leads to a regression of arterial hypertension, or a reduction of the number or doses of medicines taken in one's treatment, and glucose–intolerance symptoms. PMID:25667755

  5. The McGill University Health Centre Cancer Pain Clinic: A Retrospective Analysis of an Interdisciplinary Approach to Cancer Pain Management.

    PubMed

    Perez, Jordi; Olivier, Sara; Rampakakis, Emmanouil; Borod, Manuel; Shir, Yoram

    2016-01-01

    Context. The McGill University Health Center (MUHC) Cancer Pain Clinic offers an interdisciplinary approach to cancer pain management for patients. The core team includes a nurse clinician specialist in oncology and palliative care, a palliativist, an anaesthetist, and a radiation oncologist. This tailored approach includes pharmacological and nonpharmacological therapies offered concurrently in an interdisciplinary fashion. Objectives. Description of the interdisciplinary MUHC cancer pain approach and analysis of treatments and outcomes. Methods. A retrospective analysis of new outpatients completing two subsequent visits (baseline and follow-ups: FU1, FU2) was conducted. Variables included (a) symptom severity measured by the Edmonton Symptom Assessment Scale, (b) pain and disability measured with the Brief Pain Inventory, and (c) analgesic plan implementation including pharmacological and nonpharmacological therapies. Results. 71 charts were reviewed. Significant pain relief was achieved consistently at FU1 and FU2. The average pain severity decreased by 2 points between initial assessment and FU2. More than half (53%) of patients responded with a pain reduction greater than 30%. Severity of other symptoms (i.e., fatigue, nausea, depression, and anxiety) and disability also decreased significantly at FU2. The total consumption of opioids remained stable; however, the consumption of short acting preparations decreased by 52% whereas the prescription of nonopioid agents increased. Beyond drug management, 60% of patients received other analgesic therapies, being the most common interventional pain procedures and psychosocial approaches. Conclusion. The MUHC interdisciplinary approach to cancer pain management provides meaningful relief of pain and other cancer-related symptoms and decreases patients' disability.

  6. Is a black eye a useful sign of facial fractures in patients with minor head injuries? A retrospective analysis in a level I trauma centre over 10 years.

    PubMed

    Büttner, Michael; Schlittler, Fabian Lukas; Michel, Chantal; Exadaktylos, Aris Konstantinos; Iizuka, Tateyuki

    2014-07-01

    Orbital blunt trauma is common, and the diagnosis of a fracture should be made by computed tomographic (CT) scan. However, this will expose patients to ionising radiation. Our objective was to identify clinical predictors of orbital fracture, in particular the presence of a black eye, to minimise unnecessary exposure to radiation. A 10-year retrospective study was made of the medical records of all patients with minor head trauma who presented with one or two black eyes to our emergency department between May 2000 and April 2010. Each of the patients had a CT scan, was over 16 years old, and had a Glasgow Coma Score (GCS) of 13-15. The primary outcome was whether the black eye was a valuable predictor of a fracture. Accompanying clinical signs were considered as a secondary outcome. A total of 1676 patients (mean (SD) age 51 (22) years) and minor head trauma with either one or two black eyes were included. In 1144 the CT scan showed a fracture of the maxillofacial skeleton, which gave an incidence of 68.3% in whom a black eye was the obvious symptom. Specificity for facial fractures was particularly high for other clinical signs, such as diminished skin sensation (specificity 96.4%), diplopia or occulomotility disorders (89.3%), fracture steps (99.8%), epistaxis (95.5%), subconjunctival haemorrhage (90.4%), and emphysema (99.6%). Sensitivity for the same signs ranged from 10.8% to 22.2%. The most striking fact was that 68.3% of all patients with a black eye had an underlying fracture. We therefore conclude that a CT scan should be recommended for every patient with minor head injury who presents with a black eye. Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  7. Clinical, Trichoscopic, and Histopathological Features of Primary Cicatricial Alopecias: A Retrospective Observational Study at a Tertiary Care Centre of North East India

    PubMed Central

    Thakur, Binod Kumar; Verma, Shikha; Raphael, Vandana

    2015-01-01

    Background: The primary cicatricial alopecias (PCAs) are a rare group of diseases where hair follicle is the primary target of destruction. There are a few studies on histopathological and trichoscopic features of PCA. Aims: To study the clinical, trichoscopic, and histopathological characteristics of PCAs of the scalp and to find out the concordance between trichoscopic and histopathological diagnosis. Materials and Methods: We retrospectively analyzed the clinical, trichoscopic, and histopathological features of 24 PCA patients. Fisher's Chi-square exact test was done to find the significant trichoscopic and histopathological features. Cohen's kappa coefficient was used to determine the agreement between histopathological and trichoscopic diagnosis. Results: A total of 24 patients of PCA were seen with a male: female ratio of 2:1. There were 10 (41.7%) patients of discoid lupus erythematosus (DLE), 5 (20.8%) of lichen planopilaris (LPP), 3 (12.5%) of dissecting cellulitis of scalp, and 2 (8.3%) each of pseudopelade of brocq, folliculitis decalvans, and frontal fibrosing alopecia. The important histopathological findings of DLE were follicular plugging, vacuolar changes in the basal layer, necrotic keratinocytes, and superficial and deep perifollicular and perivascular lymphocytic infiltrate. Histopathology of LPP showed vacuolar changes in the basal layer and lichenoid infiltrate involving the infundibulum and isthmus. Trichoscopy of DLE showed follicular plugging, yellow dots, and thick arborizing blood vessels. The peripilar cast was important finding in LPP. The characteristic yellow dot with three-dimensional structure was noted in dissecting cellulitis of the scalp. The Cohen's kappa agreement was 0.89 between histopathological and trichoscopic diagnosis. Conclusion: The diagnosis of PCA is challenging because of overlapping features clinically and histopathologically. Trichoscopy may provide quick and reliable diagnosis and obviate the necessity of scalp

  8. The Effect of Inadequate Initial Empiric Antimicrobial Treatment on Mortality in Critically Ill Patients with Bloodstream Infections: A Multi-Centre Retrospective Cohort Study

    PubMed Central

    Savage, Rachel D.; Fowler, Robert A.; Rishu, Asgar H.; Bagshaw, Sean M.; Cook, Deborah; Dodek, Peter; Hall, Richard; Kumar, Anand; Lamontagne, François; Lauzier, François; Marshall, John; Martin, Claudio M.; McIntyre, Lauralyn; Muscedere, John; Reynolds, Steven; Stelfox, Henry T.; Daneman, Nick

    2016-01-01

    Hospital mortality rates are elevated in critically ill patients with bloodstream infections. Given that mortality may be even higher if appropriate treatment is delayed, we sought to determine the effect of inadequate initial empiric treatment on mortality in these patients. A retrospective cohort study was conducted across 13 intensive care units in Canada. We defined inadequate initial empiric treatment as not receiving at least one dose of an antimicrobial to which the causative pathogen(s) was susceptible within one day of initial blood culture. We evaluated the association between inadequate initial treatment and hospital mortality using a random effects multivariable logistic regression model. Among 1,190 patients (1,097 had bacteremia and 93 had candidemia), 476 (40%) died and 266 (22%) received inadequate initial treatment. Candidemic patients more often had inadequate initial empiric therapy (64.5% versus 18.8%), as well as longer delays to final culture results (4 vs 3 days) and appropriate therapy (2 vs 0 days). After adjustment, there was no detectable association between inadequate initial treatment and mortality among bacteremic patients (Odds Ratio (OR): 1.02, 95% Confidence Interval (CI) 0.70–1.48); however, candidemic patients receiving inadequate treatment had nearly three times the odds of death (OR: 2.89, 95% CI: 1.05–7.99). Inadequate initial empiric antimicrobial treatment was not associated with increased mortality in bacteremic patients, but was an important risk factor in the subgroup of candidemic patients. Further research is warranted to improve early diagnostic and risk prediction methods in candidemic patients. PMID:27152615

  9. Tumor biology in older breast cancer patients--what is the impact on survival stratified for guideline adherence? A retrospective multi-centre cohort study of 5378 patients.

    PubMed

    Ebner, Florian; van Ewijk, Reyn; Wöckel, Achim; Hancke, Katharina; Schwentner, Lukas; Fink, Visnja; Kreienberg, Rolf; Janni, Wolfgang; Blettner, Maria

    2015-06-01

    The tumor biology of older breast cancer patients (oBCP) is usually less aggressive, however applied adjuvant treatment is often less potent resulting in an impaired disease free survival and overall survival in this group. This study tries to answer the following questions for the biological subtypes of oBCP (70+ y): Between 1992 and 2008 the BRENDA ('BRENDA' = quality of BREast caNcer care unDer evidence-bAsed guidelines) study group recorded medical data of 17 participating certified breast cancer centers in Germany. We performed a retrospective multi-center database analysis of 5632 patient records. Guideline-adherent-treatment (GL+) of oBCP(n = 1918) was compared to GL+ of yBCP(n = 3714). OBCP were more likely to have hormone receptor positive (HR+) and HER2neu negative (HER2-) breast cancer (77.5% vs 74.5%). The rate of GL- was significantly different (p < 0.001) between the age groups and the biological subgroups (yBCP vs oBCP: 21.8%vs38.8% (HR+/HER2-); 30.6%vs49.7% (HR+/HER2+); 23.6%vs69.5% (HR-/HER2+); 31.4%vs67.8% (TNBC)). The survival parameters for HR+/HER2- and TNBC were significantly worse in case of GL- regarding chemotherapy, and if applicable endocrine therapy. A similar association only existed in HR-/HER2+ tumors for GL- for radiotherapy and in HR+/HER2+ tumors for chemotherapy. Beside the significantly different distribution of biological subtypes in the age groups there is an association between biological subtype, and GL+ influencing survival parameters in oBCP. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. The McGill University Health Centre Cancer Pain Clinic: A Retrospective Analysis of an Interdisciplinary Approach to Cancer Pain Management

    PubMed Central

    Perez, Jordi; Olivier, Sara; Rampakakis, Emmanouil; Borod, Manuel; Shir, Yoram

    2016-01-01

    Context. The McGill University Health Center (MUHC) Cancer Pain Clinic offers an interdisciplinary approach to cancer pain management for patients. The core team includes a nurse clinician specialist in oncology and palliative care, a palliativist, an anaesthetist, and a radiation oncologist. This tailored approach includes pharmacological and nonpharmacological therapies offered concurrently in an interdisciplinary fashion. Objectives. Description of the interdisciplinary MUHC cancer pain approach and analysis of treatments and outcomes. Methods. A retrospective analysis of new outpatients completing two subsequent visits (baseline and follow-ups: FU1, FU2) was conducted. Variables included (a) symptom severity measured by the Edmonton Symptom Assessment Scale, (b) pain and disability measured with the Brief Pain Inventory, and (c) analgesic plan implementation including pharmacological and nonpharmacological therapies. Results. 71 charts were reviewed. Significant pain relief was achieved consistently at FU1 and FU2. The average pain severity decreased by 2 points between initial assessment and FU2. More than half (53%) of patients responded with a pain reduction greater than 30%. Severity of other symptoms (i.e., fatigue, nausea, depression, and anxiety) and disability also decreased significantly at FU2. The total consumption of opioids remained stable; however, the consumption of short acting preparations decreased by 52% whereas the prescription of nonopioid agents increased. Beyond drug management, 60% of patients received other analgesic therapies, being the most common interventional pain procedures and psychosocial approaches. Conclusion. The MUHC interdisciplinary approach to cancer pain management provides meaningful relief of pain and other cancer-related symptoms and decreases patients' disability. PMID:27445602

  11. Angioplasty or Stenting in Adult Coarctation of the Aorta? A Retrospective Single Center Analysis Over a Decade

    SciTech Connect

    Macdonald, Sumaira Thomas, Steven M.; Cleveland, Trevor J.; Gaines, Peter A.

    2003-08-15

    For over 11 years, endovascular treatment by angioplasty (PTA) alone or stenting of adult coarctation at a single center was evaluated. We retrospectively reviewed 28 consecutive patients (31 interventions), median age 25 years, treated between 1991 and 2002, 20 of whom had native coarctation. Thirteen patients had PTA alone (16 procedures) (10 'kissing balloon' angioplasty comprising 12 interventions, and 3 single balloon angioplasty comprising 4 interventions) and 15 patients were stented(15 procedures), including 6 secondary and 9 primary stents. There were no procedural or 30-day complications. For the whole group, the median follow-up was 6.6 years (range 1-10 years). In the PTA group, median follow-up was 9 years (range 3-10) and in the stenting group it was 3 years (range 1-5). There were 9 restenoses in the PTA group (6 after 'kissing balloons' and 3 after single balloon) comprising 56% of the angioplasties (9/16 procedures). There was 1 restenosis in the stenting group diagnosed at computed tomography (CT). The patient was clinically well. For the whole group there were significant reductions in systolic blood pressure (BP) (p 0.0003), diastolic BP (p = 0.004) and number of drugs per patient (p = 0.045) at latest follow-up post-treatment. Five patients discontinued therapy.Analysis of the groups revealed that the reduction of systolic and diastolic BP and number of drugs did not reach statistical significance in the PTA group but were significant in the stent group. The endovascular management of adult coarctation is safe. Stents may be more effective than PTA alone but longer-term follow-up of stents is required.

  12. Posterior implant single-tooth replacement and status of adjacent teeth during a 10-year period: a retrospective report.

    PubMed

    Misch, Carl E; Misch-Dietsh, Francine; Silc, Jennifer; Barboza, Eliane; Cianciola, Louis J; Kazor, Christopher

    2008-12-01

    The purpose of this case series study was to evaluate posterior single-tooth implant survival and the long-term conditions of the adjacent teeth. A retrospective evaluation of 1,162 consecutive patients with a single missing posterior tooth treated with 1,377 external hex implants supporting 1,365 restorations surrounded by natural teeth over a 1- to 10-year period was reviewed from four private offices. Implant survival data were collected relative to stage I to stage II healing, stage II to prosthesis delivery, and prosthesis delivery to up to 10 years of follow-up. Long-term adjacent tooth conditions were assessed, including decay, endodontic therapy (root canal therapy [RCT]), and/or extraction during the follow-up period. Of the 1,377 implants inserted, there were 11 surgical failures from stage I to stage II healing. There was one failure from stage II healing to prosthesis delivery. There were two prosthetic-phase failures. The surgical success rate was 99.2%, whereas the overall survival rate was 98.9% at an average of 61 months of follow-up (range, 12 to 125 months). A total of 2,589 adjacent teeth were followed during the study. No natural adjacent tooth was lost during this period. Interproximal decay developed in 129 adjacent teeth (5%), and nine adjacent teeth required RCT (0.4%) as a result of decay or restoration. The use of single-tooth implants as replacements for posterior missing teeth is a viable long-term treatment. Adjacent natural teeth complications are minimal for as long as 10 years after implant insertion.

  13. Molecular fluorescence-guided surgery of peritoneal carcinomatosis of colorectal origin: a single-centre feasibility study.

    PubMed

    Harlaar, Niels J; Koller, Marjory; de Jongh, Steven J; van Leeuwen, Barbara L; Hemmer, Patrick H; Kruijff, Schelto; van Ginkel, Robert J; Been, Lukas B; de Jong, Johannes S; Kats-Ugurlu, Gursah; Linssen, Matthijs D; Jorritsma-Smit, Annelies; van Oosten, Marleen; Nagengast, Wouter B; Ntziachristos, Vasilis; van Dam, Gooitzen M

    2016-12-01

    Optimum cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is essential for the curative treatment of peritoneal carcinomatosis of colorectal origin. At present, surgeons depend on visual inspection and palpation for tumour detection. Improved detection of tumour tissue using molecular fluorescence-guided surgery could not only help attain a complete cytoreduction of metastatic lesions, but might also prevent overtreatment by avoiding resection of benign lesions. For this non-randomised, single-centre feasibility study, we enrolled patients with colorectal peritoneal metastases scheduled for cytoreductive surgery and HIPEC. 2 days before surgery, 4·5 mg of the near-infrared fluorescent tracer bevacizumab-IRDye800CW was administered intravenously. The primary objectives were to determine the safety and feasibility of molecular fluorescence-guided surgery using bevacizumab-IRDye800CW. Molecular fluorescence-guided surgery was deemed safe if no allergic or anaphylactic reactions were recorded and no serious adverse events were attributed to bevacizumab-IRDye800CW. The technique was deemed feasible if bevacizumab-IRDye800CW enabled detection of fluorescence signals intraoperatively. Secondary objectives were correlation of fluorescence with histopathology by back-table imaging of the fresh surgical specimen and semi-quantitative ex-vivo analyses of formalin-fixed paraffin embedded (FFPE) tissue on all peritoneal lesions. Additionally, VEGF-α staining and fluorescence microscopy was done. This study is registered with the Netherlands Trial Registry, number NTR4632. Between July 3, 2014, and March 2, 2015, seven patients were enrolled in the study. One patient developed an abdominal sepsis 5 days postoperatively and another died from an asystole 4 days postoperatively, most probably due to a cardiovascular thromboembolic event. However, both serious adverse events were attributed to the surgical cytoreductive surgery and HIPEC

  14. Donor site morbidity with reamer-irrigator-aspirator (RIA) use for autogenous bone graft harvesting in a single centre 204 case series.

    PubMed

    Qvick, Lars M; Ritter, Christopher A; Mutty, Christopher E; Rohrbacher, Bernhard J; Buyea, Cathy M; Anders, Mark J

    2013-10-01

    Donor site morbidity and complication rate using the reamer-irrigator-aspirator (RIA) system for intramedullary, non-structural autogenous bone graft harvesting were investigated in a retrospective chart and radiographic review at a University affiliated Level-1 Trauma Centre. 204 RIA procedures in 184 patients were performed between 1/1/2007 and 12/31/2010. RIA-indication was bone graft harvesting in 201 (98.5%), and intramedullary irrigation and debridement in 3 (1.5%) cases. Donor sites were: femur - antegrade 175, retrograde 4, tibia - antegrade 7, retrograde 18. Sixteen patients had undergone two RIA procedures, two had undergone three procedures, all using different donor sites. In 4 cases, same bone harvesting was done twice. Mean volume of bone graft harvested was 47 ± 22ml (20-85 ml). The complication rate was 1.96% (N=4). Operative revisions included 2 retrograde femoral nails for supracondylar femur fractures 6 and 41 days postoperatively (antegrade femoral RIA), 1 trochanteric entry femoral nail (subtrochanteric fracture) 17 days postoperatively (retrograde femoral RIA) and 1 prophylactic stabilization with a trochanteric entry femoral nail for intraoperative posterior femoral cortex penetration without fracture. In our centre, the RIA technique has a low donor site morbidity and has been successfully implemented for harvesting large volumes of nonstructural autogenous bone graft.

  15. Chemical abundances of M giants in the Galactic centre: A single metal-rich population with low [α/Fe

    NASA Astrophysics Data System (ADS)

    Ryde, N.; Schultheis, M.

    2015-01-01

    Context. The formation and evolution of the Milky Way bulge is still largely an unanswered question. Some of the most essential observations needed for its modelling are the metallicity distribution and the trends of the α elements, as measured in stars. While bulge regions beyond R ≳ 50 pc of the centre have been targeted in several surveys, the central part has escaped a detailed study due to the extreme extinction and crowding. The abundance gradients from the centre are, however, of large diagnostic value. Aims: We aim at investigating the Galactic centre environment by probing M giants in the field by avoiding supergiants and cluster members. Methods: For nine field M-giants in the Galactic centre region, we have obtained high- and low-resolution spectra observed simultaneously with CRIRES and ISAAC on UT1 and UT3 of the VLT. The low-resolution spectra provide a means of determining the effective temperatures, and the high-resolution spectra provide detailed abundances of Fe, Mg, Si, and Ca. Results: We find a metal-rich population at [ Fe / H ] = + 0.11 ± 0.15 and a lack of the metal-poor population, which is found further out in the bulge, corroborating earlier studies. Our [α/Fe] element trends, however, show low values, by following the outer bulge trends. A possible exception of the [Ca/Fe] trend is found and needs further investigation. Conclusions: The results of the analysed field M-giants in the Galactic centre region exclude a scenario with rapid formation, in which SNIIe played a dominated role in the chemical enrichment of the gas. The high metallicities with low α-enhancement seems to indicate a bar-like population that is, perhaps, related to the nuclear bar. Based on observations collected at the European Southern Observatory, Chile, program number 089.B-0312(A)/VM/CRIRES and 089.B-0312(B)/VM/ISAAC.Figures 8 and 9 are available in electronic form at http://www.aanda.org

  16. Clinical and morphological characteristics of osteoid osteoma and osteoblastoma: a retrospective single-center analysis of 204 patients.

    PubMed

    Yalcinkaya, Ulviye; Doganavsargil, Basak; Sezak, Murat; Kececi, Burcin; Argin, Mehmet; Basdemir, Gulcin; Oztop, Fikri

    2014-12-01

    Osteoid osteoma and osteoblastoma are histologically similar, benign bone-forming tumors. In this retrospective study, we aimed to evaluate the natural history; clinical, pathologic, and radiologic findings; and treatment results in 204 patients between 1959 and 2006 in a single institution. According to the World Health Organization's definition, tumors ≤1 cm in diameter were classified as osteoid osteoma, and those ≥2 cm, as osteoblastoma. For tumors between 1 cm and 2 cm, other criteria, such as the bone involved, the site, the presence of a nidus, and presence of peripheral sclerosis, were used for diagnosis. There were 131 patients with osteoid osteoma (93 male, 38 female) and 73 patients with osteoblastoma (40 male, 33 female). The mean age in the osteoid osteoma and osteoblastoma groups was 16.4 ± 7 and 19.6 ± 9.9 years, respectively. The osteoid osteoma cases were mostly localized in the extremities, whereas the osteoblastoma cases involved the vertebral column and sacrum. The nidus size varied between 0.2 and 1.5 cm in osteoid osteoma cases, and the tumor size range was 1.3-10 cm in the osteoblastoma cases. The pain was encountered in 89% of osteoid osteoma and 45% of osteoblastoma patients. Histopathology was similar in both cases. The treatment of choice was conservative surgery for both diagnoses. In conclusion, osteoblastoma is clinically and radiologically more aggressive than osteoid osteoma.

  17. Comparison of immune manifestations between refractory cytopenia of childhood and aplastic anemia in children: A single-center retrospective study.

    PubMed

    Wu, Jun; Cheng, Yifei; Zhang, Leping

    2015-12-01

    This retrospective single-center study assessed the incidence and clinical features of immune manifestations of refractory cytopenia of childhood (RCC) and childhood aplastic anemia (AA). We evaluated 72 children with RCC and 123 with AA between February 2008 and March 2013. RCC was associated with autoimmune disease in 4 children, including 1 case each with autoimmune hemolytic anemia, rheumatoid arthritis, systemic lupus erythematosus, and anaphylactoid purpura. No children with AA were diagnosed with autoimmune diseases. Immune abnormalities were common in both RCC and AA; the most significant reductions were in the relative numbers of CD3-CD56+ subsets found in RCC. Despite the many similar immunologic abnormalities in AA and RCC, the rate of autoimmune disease was significantly lower in childhood AA than RCC (p=0.008, χ2=6.976). The relative numbers of natural killer cells were significantly lower in RCC patients than AA patients. By month 6, there was no significant difference in autoimmune manifestations between RCC and AA in relation to the response to immunosuppressive therapy (p=0.907, χ2=0.014). The large overlap of analogous immunologic abnormalities indicates that RCC and childhood AA may share the same pathogenesis.

  18. Percutaneous High-Energy Microwave Ablation for the Treatment of Pulmonary Tumors: A Retrospective Single-Center Experience.

    PubMed

    Egashira, Yoshiaki; Singh, Saurabh; Bandula, Steve; Illing, Rowland

    2016-04-01

    To evaluate the safety and efficacy of percutaneous high-energy microwave ablation (MWA) for the treatment for pulmonary tumors. A retrospective review was undertaken of 44 patients (21 men, 23 women; median age, 66 y; range, 17-89 y) who underwent 62 sessions of high-energy MWA for 87 pulmonary tumors at a single tertiary referral center between June 2012 and June 2014. Primary tumor origin was sarcoma (n = 23), colorectal (n = 16), lung (n = 2), esophageal (n = 1), breast (n = 1), and bladder (n = 1). Median tumor size was 12 mm (range, 6-45 mm). Technical success was recorded contemporaneously, complication rate at 30 days was recorded prospectively, and technique effectiveness was assessed by longitudinal follow-up CT scan. Primary technical success was achieved in 94% of ablation sessions. The median follow-up interval was 15 months (range, 6.2-29.5 mo) during which time local tumor progression was observed in two of 87 tumors (technique effectiveness 98%). Pneumothorax requiring chest tube insertion occurred in 19%; delayed pneumothorax occurred in four patients. No hemoptysis, infection, or other complications were recorded. High-energy MWA is safe and effective for the destruction of lung tumors. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.

  19. Clinical implications of single- versus multiple-site keloid disorder: a retrospective study in an Asian population.

    PubMed

    Park, Tae Hwan; Park, Ji Hae; Tirgan, Michael H; Halim, Ahmad Sukari; Chang, Choong Hyun

    2015-02-01

    There is strong evidence of genetic susceptibility in individuals with keloid disorder. The purpose of this cross-sectional study was to determine the clinical relevance of our proposed variables on the multiplicity of keloids by further investigating the presence of other keloids and a family history. This was a retrospective review, using institutional review board-approved questionnaires, of patients with keloids who were seen at Kangbuk Samsung Hospital between December 2002 and February 2010. Eight hundred sixty-eight patients were included in our study. Comparisons between the 2 groups were made using Mann-Whitney tests for continuous variables and χ2 tests for categorical variables. In our patient group, younger age of onset and the presence of family history were significantly associated with the occurrence of keloids at multiple sites. The locations of extra-auricular keloids, in order of frequency, included the shoulder; anterior chest, including the breasts; deltoid; trunk and pubic area; upper extremities; lower extremities; and other sites. As compared to secondary keloids, primary keloids were significantly associated with both a lower degree of recurrence and the presence of other keloids. The presence or absence of family history was significantly associated with the presence or absence of other keloids and primary or secondary keloids. Keloid disorder is one of the most frustrating problems in wound healing and advances in our understanding of the differences of occurrence at a single site versus multiple sites might help in understanding pathogenesis and improving treatment.

  20. Dislocation “Bubble-Like-Effect” and the Ambient Temperature Super-plastic Elongation of Body-centred Cubic Single Crystalline Molybdenum

    PubMed Central

    Lu, Yan; Xiang, Sisi; Xiao, Lirong; Wang, Lihua; Deng, Qingsong; Zhang, Ze; Han, Xiaodong

    2016-01-01

    With our recently developed deformation device, the in situ tensile tests of single crystal molybdenum nanowires with various size and aspect ratio were conducted inside a transmission electron microscope (TEM). We report an unusual ambient temperature (close to room temperature) super-plastic elongation above 127% on single crystal body-centred cubic (bcc) molybdenum nanowires with an optimized aspect ratio and size. A novel dislocation “bubble-like-effect” was uncovered for leading to the homogeneous, large and super-plastic elongation strain in the bcc Mo nanowires. The dislocation bubble-like-effect refers to the process of dislocation nucleation and annihilation, which likes the nucleation and annihilation process of the water bubbles. A significant plastic deformation dependence on the sample’s aspect ratio and size was revealed. The atomic scale TEM observations also demonstrated that a single crystal to poly-crystal transition and a bcc to face-centred cubic phase transformation took place, which assisted the plastic deformation of Mo in small scale. PMID:26956918

  1. [Conduction disturbances and permanent cardiac pacing after transcatheter implantation of the CoreValve aortic bioprosthesis: initial single centre experience].

    PubMed

    Czerwińska, Katarzyna; Hryniewiecki, Tomasz; Oręziak, Artur; Dąbrowski, Maciej; Michałowska, Ilona; Witkowski, Adam; Demkow, Marcin; Stępińska, Janina; Orłowska Baranowska, Ewa; Rużyłło, Witold

    2012-01-01

    The rate of significant conduction disturbances requiring permanent pacemaker implantation (PPI) following surgical aortic valve replacement (AVR) is 2-8%. Transcatheter aortic valve implantation (TAVI) is an alternative management approach in patients with severe aortic stenosis who are not considered candidates for AVR. The TAVI using the CoreValve (CV) bioprosthesis is associated with a nearly 30% rate of conduction disturbances requiring postprocedural PPI. To provide an initial evaluation of the rate of conduction disturbances and the need for PPI, and to analyse factors that increase the risk of this complication in patients undergoing TAVI using CV bioprosthesis. In addition, we evaluated the rate of permanent conduction disturbances in patients who underwent PPI at one year after TAVI. We studies 22 initial patients in a single centre who underwent CV bioprosthesis implantation in 2009-2010. After exclusion of 6 patients with preprocedural PPI, we ultimately evaluated 16 patients. Uni- and multivariate analyses were performed using χ(2), Fisher, and Wilcoxon tests, and logistic regression analysis was performed using the SAS software. Overall, 8 (50%) patients in our study group required PPI after TAVI (TAVI + PPI), and the remaining 8 patients did not require PPI (TAVI). The most common indication for PPI was complete heart block. The decision to implant a pacemaker was made on average at 9 ± 7 days following TAVI (range 3 to 22 days). When we analysed risk factors for PPI that were unrelated to the TAVI procedure, we found that the TAVI + PPI group was characterised (vs the TAVI group) by a significantly larger diameter of the native aortic valve (p = 0.03) and a larger left ventricular outflow tract (LVOT) dimension in the frontal (p = 0.02) and the corresponding frontal dimension in the transverse view (p = 0.01) by computed tomography angiography. Logistic regression analysis showed that the risk of PPI increased more than 2.5 times for each increase

  2. Rescue policy for discarded liver grafts: a single-centre experience of transplanting livers ‘that nobody wants’

    PubMed Central

    McCormack, Lucas; Quiñonez, Emilio; Ríos, María Martha; Capitanich, Pablo; Goldaracena, Nicolás; Cabo, Javier Kerman; Anders, Margarita; Osatnik, Javier; Comignani, Pablo; Mezzadri, Norberto; Mastai, Ricardo Cesar

    2010-01-01

    Background There is a worldwide need to expand the donor liver pool. We report a consecutive series of elective candidates for liver transplantation (LT) who received ‘livers that nobody wants’ (LNWs) in Argentina. Methods Between 2006 and 2009, outcomes for patients who received LNWs were analysed and compared with outcomes for a control group. To be defined as an LNW, an organ is required to fulfil two criteria. Firstly, each liver must be officially offered and refused more than 30 times; secondly, the liver must be refused by at least 50% of the LT programmes in our country before our programme can accept it. Principal endpoints were primary graft non-function (PNF), mortality, and graft and patient survival. Results We transplanted 26 LNWs that had been discarded by a median of 12 centres. A total of 2666 reasons for refusal had been registered. These included poor donor status (n = 1980), followed by LT centre (n = 398) or recipient (n = 288) conditions. Incidences of PNF (3.8% vs. 4.0%), in-hospital mortality (3.8% vs. 8.0%), 1-year patient (84% vs. 84%) and graft (84% vs. 80%) survival were equal in the LNW and control groups. Conclusions Transplantable livers are unnecessarily discarded by the transplant community. External and internal supervision of the activity of each LT programme is urgently needed to guarantee high standards of excellence. PMID:20887319

  3. Single Port Transumbilical Laparoscopic Surgery versus Conventional Laparoscopic Surgery for Benign Adnexal Masses: A Retrospective Study of Feasibility and Safety

    PubMed Central

    Wang, Si-Yun; Yin, Ling; Guan, Xiao-Ming; Xiao, Bing-Bing; Zhang, Yan; Delgado, Amanda

    2016-01-01

    Background: Single port laparoscopic surgery (SPLS) is an innovative approach that is rapidly gaining recognition worldwide. The aim of this study was to determine the feasibility and safety of SPLS compared to conventional laparoscopic surgery for the treatment of benign adnexal masses. Methods: In total, 99 patients who underwent SPLS for benign adnexal masses between December 2013 and March 2015 were compared to a nonrandomized control group comprising 104 conventional laparoscopic adnexal surgeries that were performed during the same period. We retrospectively analyzed multiple clinical characteristics and operative outcomes of all the patients, including age, body mass index, size and pathological type of ovarian mass, operative time, estimated blood loss (EBL), duration of postoperative hospital stay, etc. Results: No significant difference was observed between the two groups regarding preoperative baseline characteristics. However, the pathological results between the two groups were found to be slightly different. The most common pathological type in the SPLS group was mature cystic teratoma, whereas endometrioma was more commonly seen in the control group. Otherwise, the two groups had comparable surgical outcomes, including the median operation time (51 min vs. 52 min, P = 0.909), the median decreased level of hemoglobin from preoperation to postoperation day 3 (10 g/L vs. 10 g/L, P = 0.795), and the median duration of postoperative hospital stay (3 days vs. 3 days, P = 0.168). In SPLS groups, the median EBL and the anal exsufflation time were significantly less than those of the conventional group (5 ml vs. 10 ml, P < 0.001; 10 h vs. 22 h, P < 0.001). Conclusions: SPLS is a feasible and safe approach for the treatment of benign adnexal masses. Further study is required to better determine whether SPLS has significant benefits compared to conventional techniques. PMID:27231167

  4. Retrospective Review of 516 Implantations of Option Inferior Vena Cava Filters at a Single Health Care System.

    PubMed

    Tsui, Brian; An, Tianzhi; Moon, Eunice; King, Russell; Wang, Weiping

    2016-03-01

    To retrospectively evaluate the safety, efficacy, and retrievability of Option inferior vena cava (IVC) filters. All patients (N = 516; 247 women; mean age, 67.1 y ± 15.1; range, 19.5-101.6 y) who received an Option filter between August 2009 and March 2015 at a single health care system were analyzed. The study duration was 68 months, with median clinical follow-up of 7.1 months (range, 1 d to 61.8 mo). During follow-up, 73 of 83 patients (88.0%) underwent successful filter retrieval, 153 died (including three after successful retrieval), and 293 remained alive with filters in situ. Seventeen cases of breakthrough pulmonary embolism (PE) occurred (3.4%). Among 323 patients with direct filter imaging, there were two cases of tilt > 15°, one case of filter deformity, 16 cases of intracaval migration > 2 cm, and no cases of filter fracture. There were six cases of caval occlusion, nine cases of thrombus trapped inside the filter, and 57 cases of limb penetration on computed tomography scans or radiographs of the IVC. Retrieval failures were attributed to filter tilt or tip embedment in the caval wall (n = 4), complete IVC thrombosis (n = 3), thrombus inside the filter (n = 2), or inability to disengage filter legs (n = 1). Recurrent deep vein thrombosis occurred in 34 patients, including 32 with filters in situ and two whose filters had been removed. Most Option filters were left in situ for permanent indications. Rates of successful retrieval, device-related complications, and breakthrough PE were similar to those associated with other retrievable filters. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.

  5. Retrospective analysis of 620 cases of brain abscess in Chinese patients in a single center over a 62-year period.

    PubMed

    Zhang, Zhen; Cai, Xinwang; Li, Jia; Kang, Xiaokui; Wang, Haining; Zhang, Lin; Yan, Rong; Gao, Nannan; Liu, Shengjie; Yue, Shuyuan; Zhang, Jianning; Yang, Shuyuan; Yang, Xinyu

    2016-04-01

    Despite advances in laboratory diagnostics, antibiotic regimens, and neurosurgical techniques, brain abscess (BA) remains a potentially fatal infectious disease. This study analyzed clinical and epidemiological aspects of BA in Chinese patients treated at a single center during a 62-year period. We retrospectively analyzed 620 BA patients treated at Tianjin Medical University General Hospital, Tianjin, PR China from 1952 to 2014. Because of the initiation of imaging technology use in 1992, and other specific changes, we analyzed data over three study periods: 1952-1972, 1980-1991, and 2002-2014. Information including incidence, sex, age, community distribution, BA size and location, therapeutic method, prognosis and outcome of BA patients was collected and evaluated. Our study included 620 BA patients. The percentage mortality significantly decreased from 22.8 % in 1952 to 6.3 % in 2014 (p < 0.001). Although the incidence of BA was higher in males than females, there was no significant change in the male/female incidence ratio over time: 2.5 in 1952-1972, 2.6 in 1980-1991, and 2.2 in 2002-2014. The cryptogenic infection incidence significantly increased over time (p < 0.001). The number of positive bacterial cultures significantly decreased over the three study periods (p < 0.01). The prognosis of patients with BA has gradually improved over the past 62 years in Tianjin, China. This may be because improvements in neurosurgical techniques, cranial imaging, and antimicrobial regimens have facilitated less invasive and more precise neurosurgical procedures.

  6. Endocrine-related adverse events following ipilimumab in patients with advanced melanoma: a comprehensive retrospective review from a single institution.

    PubMed

    Ryder, Mabel; Callahan, Margaret; Postow, Michael A; Wolchok, Jedd; Fagin, James A

    2014-04-01

    Novel immune checkpoint blockade with ipilimumab, an antibody blocking the cytotoxic T-lymphocyte antigen 4 (CTLA4), is revolutionizing cancer therapy. However, ipilimumab induces symptomatic, sometimes severe, endocrine immune-related adverse events (irAEs) that are inconsistently recognized and reported. The objective of this review was to comprehensively characterize the incidence, presentation, and management of endocrinopathies following ipilimumab therapy in a single center that is highly specialized in immune checkpoint blockade. We carried out a retrospective analysis of endocrine irAEs in melanoma patients receiving ipilimumab therapy in clinical trials between 2007 and 2013. A total of 256 patients were included in this analysis. We reviewed pituitary-, thyroid-, and adrenal-related hormone test results, as well as radiographic studies and the clinical histories of patients, to identify and characterize cases of hypophysitis, hypothyroidism, thyroiditis, and adrenal dysfunction. Following ipilimumab therapy, the overall incidence of hypophysitis was 8% and that of hypothyroidism/thyroiditis 6%. Primary adrenal dysfunction was rare. Therapy with a combination of ipilimumab and nivolumab, an anti-programmed cell death 1 (PDCD1, also called PD1) receptor antibody, was associated with a 22% incidence of either thyroiditis or hypothyroidism and a 9% incidence of hypophysitis. Symptomatic relief, in particular, for hypophysitis, was achieved in all patients with hormone replacement, although endogenous hormone secretion rarely recovered. In summary, we observed that CTLA4 blockade alone, and in particular in combination with PD1 blockade, is associated with an increased risk of symptomatic, sometimes severe, hypophysitis as well as thyroid dysfunction. Prompt initiation with hormone replacement reverses symptoms. Evaluation and reporting of endocrine irAEs in clinical trials should be done using standardized diagnostic criteria and terminology.

  7. Value of image fusion using single photon emission computed tomography with integrated low dose computed tomography in comparison with a retrospective voxel-based method in neuroendocrine tumours.

    PubMed

    Amthauer, H; Denecke, T; Rohlfing, T; Ruf, J; Böhmig, M; Gutberlet, M; Plöckinger, U; Felix, R; Lemke, A J

    2005-07-01

    The objective was the evaluation of single photon emission computed tomography (SPECT) with integrated low dose computed tomography (CT) in comparison with a retrospective fusion of SPECT and high-resolution CT and a side-by-side analysis for lesion localisation in patients with neuroendocrine tumours. Twenty-seven patients were examined by multidetector CT. Additionally, as part of somatostatin receptor scintigraphy (SRS), an integrated SPECT-CT was performed. SPECT and CT data were fused using software with a registration algorithm based on normalised mutual information. The reliability of the topographic assignment of lesions in SPECT-CT, retrospective fusion and side-by-side analysis was evaluated by two blinded readers. Two patients were not enrolled in the final analysis because of misregistrations in the retrospective fusion. Eighty-seven foci were included in the analysis. For the anatomical assignment of foci, SPECT-CT and retrospective fusion revealed overall accuracies of 91 and 94% (side-by-side analysis 86%). The correct identification of foci as lymph node manifestations (n=25) was more accurate by retrospective fusion (88%) than from SPECT-CT images (76%) or by side-by-side analysis (60%). Both modalities of image fusion appear to be well suited for the localisation of SRS foci and are superior to side-by-side analysis of non-fused images especially concerning lymph node manifestations.

  8. Radiosurgery in the management of brain metastasis: a retrospective single-center study comparing Gamma Knife and LINAC treatment.

    PubMed

    Tuleasca, Constantin; Negretti, Laura; Faouzi, Mohamed; Magaddino, Vera; Gevaert, Thierry; von Elm, Erik; Levivier, Marc

    2017-03-24

    OBJECTIVE The authors present a retrospective analysis of a single-center experience with treatment of brain metastases using Gamma Knife (GK) and linear accelerator (LINAC)-based radiosurgery and compare the results. METHODS From July 2010 to July 2012, 63 patients with brain metastases were treated with radiosurgery. Among them, 28 (with 83 lesions) were treated with a GK unit and 35 (with 47 lesions) with a LINAC. The primary outcome was local progression-free survival (LPFS), evaluated on a per-lesion basis. The secondary outcome was overall survival (OS), evaluated per patient. Statistical analysis included standard tests and Cox regression with shared-frailty models to account for the within-patient correlation. RESULTS The mean follow-up period was 11.7 months (median 7.9 months, range 1.7-32 months) for GK and 18.1 months (median 17 months, range 7.5-28.7 months) for LINAC. The median number of lesions per patient was 2.5 (range 1-9) in the GK group and 1 (range 1-3) in the LINAC group (p < 0.01, 2-sample t-test). There were more radioresistant lesions (e.g., melanoma) and more lesions located in functional areas in the GK group. Additional technical reasons for choosing GK instead of LINAC were limitations of LINAC movements, especially if lesions were located in the lower posterior fossa or multiple lesions were close to highly functional areas (e.g., the brainstem), precluding optimal dosimetry with LINAC. The median marginal dose was 24 Gy with GK and 20 Gy with LINAC (p < 0.01, 2-sample t-test). For GK, the actuarial LPFS rate at 3, 6, 9, 12, and 17 months was 96.96%, 96.96%, 96.96%, 88.1%, and 81.5%, remaining stable until 32 months. For LINAC the rate at 3, 6, 12, 17, 24, and 33 months was 91.5%, 91.5%, 91.5%, 79.9%, 55.5%, and 17.1% (log-rank p = 0.03). In the Cox regression with shared-frailty model, the risk of local progression in the LINAC group was almost twice that of the GK group (HR 1.92, p > 0.05). The mean OS was 16.0 months (95% CI 11

  9. Mitochondrial DNA quantification as a tool for embryo viability assessment: retrospective analysis of data from single euploid blastocyst transfers.

    PubMed

    Ravichandran, K; McCaffrey, C; Grifo, J; Morales, A; Perloe, M; Munne, S; Wells, D; Fragouli, E

    2017-06-01

    Does the amount of mitochondrial DNA (mtDNA) in blastocyst biopsy specimens have the potential to serve as a biomarker of euploid embryo implantation ability, independent of morphology? The results of this study strongly suggest that elevated mtDNA levels, above a previously defined threshold, are strongly associated with blastocyst implantation failure and represent an independent biomarker of embryo viability. Improved methods of embryo selection are highly desirable in order to increase the efficiency of IVF treatment. At present, even the transfer of chromosomally normal embryos of high morphological grade cannot guarantee that a pregnancy will follow. Recently, it has been proposed that the quantity of mtDNA in embryonic cells may be an indicator of developmental potential, with higher levels of mtDNA associated with reduced implantation. However, thus far reported data sets have been relatively small and in some cases have lacked appropriate validation. This large, blinded, retrospective study involved the analysis of relative mtDNA levels in 1505 euploid blastocysts obtained from 490 couples undergoing preimplantation genetic testing for aneuploidy. Implantation outcomes were compared to mtDNA levels in order to determine the capacity of the method to predict viability and to assess the validity of previously established thresholds. DNA from blastocyst biopsy samples was amplified and then subjected to aneuploidy analysis using next generation sequencing or array comparative genomic hybridization. Only those embryos classified as chromosomally normal had their mtDNA levels assessed. This analysis was undertaken retrospectively using quantitative real-time PCR, without knowledge of the outcome of embryo transfer. Predictions of implantation failure, based upon mtDNA levels were subsequently compared to the observed clinical results. All cycles involved the transfer of a single embryo. Of all blastocysts analyzed, 9.2% (139/1505) contained mtDNA levels above a

  10. Cefepime and amikacin as empirical therapy in patients with febrile neutropaenia: a single-centre phase II prospective survey.

    PubMed

    Mebis, J; Vandeplassche, S; Goossens, H; Berneman, Z N

    2009-01-01

    The aim of the survey was to prospectively evaluate the effectiveness of the combination therapy cefepime and amikacin in the initial treatment of haematology patients with febrile neutropaenia. Two hundred twenty (220) episodes of febrile neutropaenia were analysed in 54 males and 82 females (median age 58 years), most patients had a severe neutropaenia with in 72% of all periods a neutrophil count of less than 100. Microbiological infection was confirmed in 72 cases (32.8%). Sixty-one (61) bacteria were isolated from blood cultures of which 22 were identified as Gram-negative bacteria and 38 as Gram-positive bacteria. Sixty-three (63) episodes (28.6%) were clinically documented, 85 episodes (38.6%) were fever of unknown origin. Clinical cure was achieved in 123 febrile episodes (56%) after initiation of the current antibiotic protocol; another 22 patients (10%) became afebrile after modifying the initial antibiotic regimen 48 hours or longer after treatment initiation. In 61 cases (27.7%) there was persistent fever or re-occurrence of fever, these cases were considered as treatment failure. Eight patients (3.6%) died during the study. This survey has demonstrated that the combination therapy with cefepime and amikacin can be considered as an effective treatment for febrile neutropaenia in high-risk haematological patients in our centre with a high incidence of resistance to Gram-negative bacteria.

  11. Transperineal bulbo-prostatic anastomosis for posterior urethral stricture associated with false passage: a single-centre experience.

    PubMed

    Fu, Qiang; Zhang, Jiong; Sa, Ying-long; Jin, San-bao; Xu, Yue-min

    2011-10-01

    • To evaluate the management of traumatic posterior urethral stricture associated with false passage, as this remains a challenge for urologists. • From January 2000 to February 2010, 19 patients (mean (range) age 34 [25-52] years) with traumatic posterior urethral obliteration associated with false passage were evaluated and treated at our centre. • All patients underwent perineal excision and primary anastomotic urethroplasty using cystoscopy by the suprapubic route to insert a guidewire into the original bladder neck, allowing exposure of the normal posterior urethra. • Patients underwent voiding cysto-urethrography 1 month after the procedure. When symptoms of decreased force of stream were present and uroflowmetry was <15 mL/s, urethrography and urethroscopy were repeated. • Clinical outcome was considered a failure when any postoperative instrumentation was needed, including dilatation. • The mean (range) follow-up was 12 (9-14) months. The overall success rate was 84%. • Three patients (16%) with persistent voiding difficulty developed a short anastomotic stricture 1-3 months after surgery. • The mean maximum urinary flow rate after surgery was 20.01 mL/s and no patient had urinary incontinence. • The preoperative use of flexible cystoscopy via the suprapubic route represented a successful key point of urethroplasty for posterior urethral stricture associated with false passage. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

  12. Practice patterns of ANCA-associated vasculitis: exploring differences among subspecialties at a single academic medical centre.

    PubMed

    Forbess, Lindsy J; Griffin, Kenneth W; Spiera, Robert F

    2014-01-01

    Clinical trial data help guide physician treatment choices for ANCA-associated vasculitis (AAV), but when data are lacking, treatment choices are largely driven by physician preference. Our aim was to examine AAV treatment preferences to determine if patient gender and age, and physician subspecialty affect treatment choices. Rheumatologists, nephrologists and pulmonologists from an academic medical centre participated in a web-based survey. Three scenarios (remission induction in severe disease; remission maintenance in severe disease; remission induction in limited disease) were presented for 4 patient profiles (28- and 68-year-old female/male). Physician treatment choices and reasons for these choices were obtained. Differences between groups were analysed using Chi-Square and Fisher's exact tests. Physicians were significantly more likely to choose rituximab for young females for remission induction in severe AAV, with toxicity being the main reason for this choice. There was a trend toward rheumatologists choosing rituximab over cyclophosphamide compared with other subspecialties for this scenario. Most physicians switched to a less toxic agent for remission maintenance, but there was little agreement as to choice of maintenance therapy among subspecialties. For remission induction in limited disease, most physicians chose rituximab, particularly for young females. Currently, there are very few data for remission maintenance therapy following rituximab in severe disease, as well as the use of rituximab in limited disease. Choices for treatment of AAV differ among subspecialties, are affected by patient gender and age, and tend to be largely driven by physician preference when data are limited or lacking.

  13. Biofilm formation, antibiotic susceptibility and RAPD genotypes in Pseudomonas aeruginosa clinical strains isolated from single centre intensive care unit patients.

    PubMed

    Vaněrková, Martina; Mališová, Barbora; Kotásková, Iva; Holá, Veronika; Růžička, Filip; Freiberger, Tomáš

    2017-04-01

    The aim of this study was to analyse genotypes, antimicrobial susceptibility patterns and serotypes in Pseudomonas aeruginosa clinical strains, including the clonal dissemination of particular strains throughout various intensive care units in one medical centre. Using random amplified polymorphic DNA (RAPD-PCR) and P. aeruginosa antisera, 22 different genotypes and 8 serotypes were defined among 103 isolates from 48 patients. No direct association between P. aeruginosa strain genotypes and serotypes was observed. RAPD typing in strains with the same serotype revealed different genotypes and, on the contrary, most strains with a different serotype displayed the same amplification pattern. The resulting banding patterns showed a high degree of genetic heterogeneity among all isolates from the patients examined, suggesting a non-clonal relationship between isolates from these patients. A higher degree of antibiotic resistance and stronger biofilm production in common genotypes compared to rare ones and genetic homogeneity of the most resistant strains indicated the role of antibiotic pressure in acquiring resistant and more virulent strains in our hospital. In conclusion, genetic characterisation of P. aeruginosa strains using RAPD method was shown to be more accurate in epidemiological analyses than phenotyping.

  14. Laser welding of vesicovaginal fistula--outcome analysis and long-term outcome: single-centre experience.

    PubMed

    Dogra, Prem N; Saini, Ashish K

    2011-08-01

    The aim of this study is to evaluate the efficacy and safety of laser welding of vesicovaginal fistula (VVF) at our centre. Between January 1, 2001 and January 3, 2010, eight patients underwent laser welding of vesicovaginal fistula. The mean age was 44 years (35-55). The VVF were primary (failing to heal following conservative management) in five and secondary (recurring following primary repair) in three cases. The mean fistula size was 3 mm (range, 2-4). Neodymium yttrium aluminium garnet (YAG) laser was used for the initial case, and in the remaining seven cases, holmium YAG laser was used for circumferential welding of the fistula. Following the procedure, a catheter was kept for 3 weeks. The mean hospitalisation period was 1 day. The mean follow-up is 47 months (2-110). Seven patients were dry after catheter removal. In one patient, procedure was abandoned due to bleeding. Laser welding of VVF is a simple, safe and efficacious procedure in a select group of patients.

  15. No-needle, single-visit adult male circumcision with Unicirc: a multi-centre field trial.

    PubMed

    Millard, Peter S; Goldstuck, Norman D

    2015-01-01

    Voluntary medical male circumcision (VMMC) is a priority HIV preventive intervention. Current adult circumcision methods need improvement. Field trial in 3 primary care centres. Minimally invasive VMMC using the Unicirc instrument following topical lidocaine/prilocaine anesthetic. Men were followed up at 1 and 4 weeks. We circumcised 110 healthy volunteers. Two men complained of transient burning pain during circumcision, but none required injectable anaesthesia. Median blood loss was 1ml and median procedure time was 9.0 min. There were 7 (6.3%) moderate complications (5 (4.5%) post-operative bleeds requiring suture and 2 (1.8%) post-operative infections) affecting 7 men. No men experienced significant wound dehiscence. 90.4% of men were fully healed at 4 weeks of follow-up and all were highly satisfied. Use of topical anaesthesia obviates the need for injectable anesthetic and makes the Unicirc procedure nearly painless. Unicirc is rapid, easy to learn, heals by primary intention with excellent cosmetic results, obviates the need for a return visit for device removal, and is potentially cheaper and safer than other methods. Use of this method will greatly facilitate scale-up of mass circumcision programs. ClinicalTrials.gov NCT02091726.

  16. Does the two-week rule pathway improve the diagnosis of soft tissue sarcoma? A retrospective review of referral patterns and outcomes over five years in a regional sarcoma centre

    PubMed Central

    Pencavel, Tim D; Strauss, Dirk C; Thomas, Greg P; Thomas, J Meirion; Hayes, Andrew J

    2010-01-01

    INTRODUCTION The NHS Cancer Plan was introduced in 2000 and included guidelines for the rapid assessment and referral of cases of suspected malignancy. We wished to assess the efficiency and appropriateness of patients referred under the Department of Health's general practitioner referral guidelines implemented for sarcomas in December 2000. PATIENTS AND METHODS A retrospective case-note review was performed of all patients referred to our regional soft tissue sarcoma unit between 1 January 2004 and 31 December 2008. Patients referred under the two-week guidelines and all patients referred routinely were analysed. The main outcome measures were the total number of patients referred on the basis of the two-week guidelines and the proportion they constitute of all referrals. The referring criteria were noted and compared to the observed criteria recorded. The final histo-logical diagnosis of patients referred on the basis of the two-week guidelines are documented. RESULTS A total of 2746 referrals for suspected sarcoma were made from January 2004 to December 2008. Of these, 154 referrals were made under the two-week rule of which 102 were referred purely on the clinical criteria for suspected soft tissue sarcoma. The remaining patients were referred after non-urgent special investigations indicated the possibility of sarcoma. Twelve patients referred under the two-week rule were proved to have sarcoma, nine after specific investigations including imaging or histological diagnosis. Of the 102 patients referred on clinical suspicion of a sarcoma, two patients had proven soft tissue sarcomas and one patient a cutaneous sarcoma. Between 2004 and 2008, the number of 2-week referrals rose 25-fold but accounted for an increase of less than 1% of the sarcomas treated in this unit. CONCLUSIONS The numbers of all referrals for suspected sarcoma are increasing; however, the rate of increase of 2-week referrals is increasing faster than routine referrals and will exceed it in

  17. Racial Disparities in Colorectal Carcinoma Incidence, Severity and Survival Times Over 10 Years: A Retrospective Single Center Study

    PubMed Central

    Arshad, Hafiz Muhammad Sharjeel; Tetangco, Eula; Shah, Natasha; Kabir, Christopher; Raddawi, Hareth

    2016-01-01

    Background Colorectal cancer (CRC) is the third leading cause of cancer-related deaths in the United States. Although studies have been performed on malignancy behavior in African Americans and Caucasians, scant data are present on other minority racial groups. Methods A retrospective single center study was performed where 1,860 patient charts with a diagnosis of CRC from January 1, 2004 to December 31, 2014 were reviewed. Data collected on each patient included age, gender, ethnicity, primary site and histological stage at the time of diagnosis. Survival time over the course of 5 years was documented for patients from January 1, 2004 to December 31, 2009. Comparisons were made amongst different racial groups for the above mentioned factors. Results Study population consisted of 27.09% African Americans, 65.61% Caucasians, 3.86% Hispanics, 0.54% South Asians, 1.03% Arabs, 0.54% Asians and 0.22% American Indians. Mean age of CRC presentation was found to be significantly different (P < 0.05) between the three largest racial groups: 71 years for Caucasians, 69 years for African Americans, and 61 years for Hispanics. African Americans (27.09%) and Hispanics (28.79%) presented predominantly at stage IV in comparison to other racial groups. Caucasians presented predominantly at stage III (24.84%). The rectum was the most common site of CRC across all racial groups with the exception of Asians, where sigmoid colon was the predominant site (30%). Adenocarcinoma remained the predominant cancer type in all groups. Hispanics had relatively higher incidence rate of carcinoid tumor (12.68%). Survival time analysis showed that Caucasians tend to have better survival probability over 5 years after initial diagnosis as compared to African Americans and Hispanic (P < 0.05). Conclusion There is lack of studies performed on minority racial groups in North America. Our study highlighted some important clinical differences of CRC presentation in different racial groups which are not

  18. Takayasu arteritis in France: a single-center retrospective study of 82 cases comparing white, North African, and black patients.

    PubMed

    Arnaud, Laurent; Haroche, Julien; Limal, Nicolas; Toledano, Dan; Gambotti, Laetitia; Costedoat Chalumeau, Nathalie; Le Thi Huong Boutin, Du; Cacoub, Patrice; Cluzel, Philippe; Koskas, Fabien; Kieffer, Edouard; Piette, Jean-Charles; Amoura, Zahir

    2010-01-01

    We conducted a single-center retrospective study to compare the characteristics of Takayasu arteritis (TA) among white, North African, and black patients in a French tertiary care center (Hospital Pitié-Salpêtrière, Paris). Eighty-two patients were studied (82.9% female) during a median follow-up of 5.1 years (range, 1 mo to 30 yr). Among these 82 patients, 39 (47.6%) were white, 20 (24.4%) were North African, and 20 (24.4%) were black patients. Median age at diagnosis was 39.3 years (range, 14-70 yr) in white patients vs. 28.4 years (range, 12-54 yr) in North African (p = 0.02), and 28.0 years (range, 13-60 yr) in black patients (p = 0.08). Patients aged >40 years at TA onset were more frequently white than non-white (40.0% vs. 18.6%, p = 0.03). North African patients had more frequent occurrence of ischemic stroke (p = 0.03) and poorer survival (p = 0.01) than white patients. Type V of the Hata classification was the most frequent type among white (38.5%), North African (65.0%), and black patients (40.0%). Corticosteroids were used in 96.1% of patients. Fifty-three percent of white and North African patients, and 44% of black patients required a second line of immunosuppressive treatment (p = 0.60). Vascular surgical procedures were respectively performed in 46.1%, 50.0%, and 55.0% of white, North African, and black patients, p = 0.81. The 5-year and 10-year survival rates were 100% and 95.0%, respectively, in white patients; 67.4% at both 5 years and 10 years in North African patients; and 100% at both 5 years and 10 years in black patients. This study is one of the first direct comparisons of TA profiles among patients of distinct ethnic backgrounds. Our data support the idea that late-onset TA or an overlap between TA and large-vessel giant cell arteritis may be observed in white patients. North African patients have a higher occurrence of ischemic stroke and poorer survival than white patients.

  19. Chromosomal abnormalities not currently detected by cell-free fetal DNA: a retrospective analysis at a single center.

    PubMed

    Shani, Hagit; Goldwaser, Tamar; Keating, Jennifer; Klugman, Susan

    2016-06-01

    Cell-free fetal DNA analysis is used as a screening test to identify pregnancies that are at risk for common autosomal and sex chromosome aneuploidies. The purpose of this study was to investigate the chromosomal abnormalities that would not be detected by cell-free fetal DNA in a single medical center. This was a retrospective cohort analysis of 3182 consecutive invasive diagnostic procedures that were performed at Montefiore Medical Center's Division of Reproductive and Medical Genetics from January 1, 2009 to August 31, 2014. All patients underwent cytogenetic analysis; one-third of the patients (1037/3182) went through chromosomal microarray analysis. Clinically significant chromosomal abnormalities were detected in 220 of 3140 cases (7%) after we excluded multiple gestation pregnancies (n = 42). Of these 125 cases (57%) were diagnosed with the common autosomal trisomies that involved chromosomes 21, 18, and 13 and with sex chromosome aneuploidies. There were 23 mosaic karyotypes; 8 of them involved trisomy in chromosomes 21 and 13; 5 of them were sex chromosome mosaics, and 10 of them were other mosaic cases. Five cases of triploidy were detected. Additionally, 19 unbalanced chromosomal rearrangements, a rare autosomal trisomy, and 47 clinically significant findings on chromosomal microarray analysis were diagnosed. Based on the published detection rates of cell-free fetal DNA testing and considering the "no-results" rate, we calculated that 99 of 220 chromosomal changes (45%) could not have been detected by cell-free fetal DNA testing: 16 of the 125 common aneuploidies and sex chromosome aneuploidies, 1 of the 5 triploidy cases, 15 of the 23 mosaic cases, all cases of unbalanced chromosomal rearrangements (n = 19), rare autosomal trisomy (n = 1), and 47 clinically significant chromosomal microarray abnormalities. Current cell-free DNA testing could not detect up to one-half of the clinically significant chromosomal abnormalities that were found, which

  20. Safety and efficacy of factor XI (FXI) concentrate use in patients with FXI deficiency: a single-centre experience of 19 years.

    PubMed

    Ling, G; Kagdi, H; Subel, B; Chowdary, P; Gomez, K

    2016-05-01

    Factor XI (FXI) concentrate is a pooled human plasma-derived factor concentrate used as replacement therapy for patients with FXI deficiency, which provides a predictable response and consistent haemostatic cover in emergency or elective situations. It has previously been implicated in adverse events such as thrombosis and inhibitor formation, with rare case reports of fatal incidents. We sought to establish the incidence of such complications in a retrospective case series between 1994 and 2012 at the Haemophilia Comprehensive Care Centre at Royal Free Hospital, London, UK. Patients who received FXI concentrate had their medical records reviewed to extract information and specific adverse events recorded such as failure of treatment with further bleeding, suspected viral transfusion transmitted infection (TTI), thrombosis or inhibitor formation. Eighty-six patients received 242 treatment episodes of FXI concentrate. Ninety percent of treatment episodes were covered with BPL FXI concentrate and 10% with LFB Hemoleven. Twelve (5%) adverse events were recorded, with eight (3.3%) of all treatment episodes were related to persistent bleeding postconcentrate infusion and there were 4 (1.7%) non-bleeding adverse events. No viral TTIs were identified. There were two recorded inhibitors, one thrombotic event (central retinal artery occlusion) and one transfusion reaction. No patient suffering an adverse event resulted in long-term morbidity. Our experience of FXI concentrate use demonstrates infrequent minor adverse events related to its administration and is a safe product to use. © 2015 John Wiley & Sons Ltd.

  1. Anaesthesia and intensive care for simultaneous liver-kidney transplantation: A single-centre experience with 12 recipients

    PubMed Central

    Rajakumar, Akila; Gupta, Shiwalika; Malleeswaran, Selvakumar; Varghese, Joy; Kaliamoorthy, Ilankumaran; Rela, Mohamed

    2016-01-01

    Background and Aims: The perioperative management of patients presenting for simultaneous liver and kidney transplantation (SLKT) is a complex process. We analysed SLKTs performed in our institution to identify preoperative, intraoperative and post-operative challenges encountered in the management. Methods: We retrospectively studied the case records of 12 patients who underwent SLKT between 2009 and 2014 and analysed details of pre-operative evaluation and optimisation, intraoperative anaesthetic management and the implications of use of perioperative continuous renal replacement therapy (CRRT) and the post-operative course of these patients. Results: Of the total 12 cases, 4 were under 16 years of age. The indications for SLKT were primary hyperoxaluria (5), congenital hepatic fibrosis with polycystic kidney disease (2), ethanol-related end-stage liver disease (ESLD) with hepatorenal syndrome type 1 (1). Four patients had ESLD with end-stage renal disease due to other causes. Six recipients received live donor grafts and 6 patients received cadaveric grafts. Seven patients received intraoperative CRRT. Mean duration of surgery was 12.5 h. Cardiac output monitors used were trans-oesophageal echocardiogram (2), pulmonary artery catheter (1) and pulse contour cardiac output monitor (3). There was 1 sepsis-related mortality on 7th post-operative day. Conclusion: A thorough pre-operative evaluation and optimisation, knowledge and anticipation of potential problems, and meticulous intraoperative fluid management guided by appropriate monitoring and use of CRRT when needed can help in achieving successful outcomes. PMID:27512163

  2. Factors affecting adherence to treatment and follow-up of burns in children: A single centre experience

    PubMed Central

    Sener, Mustafa Talip; Aydın, Osman Enver; Ançı, Yuksel; Kara, Murat; Tan, Onder; Kok, Ahmet Nezih

    2015-01-01

    Aim: Children are prone to burn injury. Burns can be seen as a part of child abuse. The aim of this study was to investigate the factors affecting adherence to the treatment of burn patients, and to emphasize the role of the physician in identifying children's non-accidental burn injuries. Materials and Methods: Children who were hospitalized in the burn unit were analyzed retrospectively. Results were assessed for significance using the Chi-square test. Results: A total of 189 patients were included. Some patients (n = 52; 27.5%) were discharged against medical advice (DAMA) before completion of treatment. Although we could not demonstrate a relationship between non-accidental etiology and DAMA group, it was significant that these patients did not contact the outpatient clinic after discharge. It was evident from records that two of these cases were abused. The reasoning of the parents in the DAMA group for the early discharge was siblings at home, financial and accommodation problems. Conclusion: Although burns in children commonly occur due to an accident, each burn case should be examined for a non-accidental etiology and findings suggesting abuse should be noted. Physicians should be alert for the detection of signs of burn related child abuse. PMID:26807393

  3. Ethylene glycol poisoning: a rare but life-threatening cause of metabolic acidosis—a single-centre experience

    PubMed Central

    Kimmel, Martin; Alscher, Mark Dominik; Braun, Niko

    2012-01-01

    Background. Intoxication with ethylene glycol happen all around the world and without rapid recognition and early treatment, mortality from this is high. Methods. In our study, we retrospectively analysed six cases of ethylene glycol intoxication in our department. We measured ethylene glycol or glycolate levels, lactate levels and calculated the osmolal and anion gap. Results. Data from six patients admitted to the nephrology department between 1999 and 2011 with ethylene glycol poisoning are reported. All patients were men. The mean pH on admission was 7.15 ± 0.20 and the anion and osmolal gap were elevated in five of six patients. Four patients had an acute kidney injury and one patient had an acute-on-chronic kidney injury. All patients survived and after being discharged, two patients required chronic intermittent haemodialysis. Interestingly, at the time of admission, all patients had elevated lactate levels but there was no linear regression between toxic levels and lactate levels and no linear correlation was found between initial lactate levels and anion gap and osmolal gap. Conclusions. The initial diagnosis of ethylene glycol poisoning is difficult and poisoning with ethylene glycol is rare but life threatening and needs rapid recognition and early treatment. Therefore, intoxication with ethylene glycol should not be misdiagnosed as lactic acidosis in patients with metabolic acidosis and elevated lactate levels. PMID:25503773

  4. Travelling activity and travel-related risks after allogeneic haematopoietic stem cell transplantation - a single centre survey.

    PubMed

    Hollenstein, Yvonne; Elzi, Luigia; Hatz, Christoph; Passweg, Jakob; Weisser, Maja; Stöckle, Marcel; Halter, Joerg P; Egli, Adrian

    2015-01-01

    Travel activity and travel-related risks of patients after allogeneic haematopoietic stem cell transplantation (allo-HSCT) remain largely unknown. The aim of our study was to examine travel activity after allo-HSCT including travel behaviour and travel patterns. We analysed travel characteristics of allo-HSCT recipients by using a retrospective cross-sectional survey. Allo-HSCT patients were asked to complete a questionnaire during their annual health visits from 2010 to 2012. Overall, 118/153 (77%) participating patients reported travel activity for a total of 201 travelling episodes. Travellers versus non-travellers were receiving immunosuppressive treatment in 35.6% versus 65.7% (p=0.002), and had graft-versus-host-disease (GvHD) in 52.5% versus 62.9% (p=0.17). In a multivariate analysis, the time between the transplantation and the survey was the only factor associated with travel activity (p<0.0001) and taking pretravel advice (p<0.0001). In 34.8% of travel episodes pretravel advice was sought. Patients with pretravel advice reported travel-related symptoms more frequently. Minor respiratory (27/201) and gastrointestinal (23/201) symptoms were most frequently indicated. Four percent (8/201) of the patients were hospitalised while travelling. We conclude that travelling after allo-HSCT is frequent and linked to the time since transplantation. We could not define specific risks for any destination. Nevertheless, pretravel advice and preparation are highly recommended for immunosuppressed patients.

  5. Systemic sclerosis in Argentina: evaluation of a large cohort from a single centre and comparison with other international series.

    PubMed

    Scolnik, M; Lancioni, E; Saucedo, C; Marin, J; Sabelli, M; Bedran, Z; Soriano, E R; Catoggio, L J

    2014-01-01

    Prevalence of systemic sclerosis (SSc) and different clinical subsets varies across the world. Few data have been published on SSc patients in Latin America. Our objective was to describe a SSc cohort in Argentina and to compare clinical findings, disease subsets and antibodies with other international SSc populations. Patients with SSc (n=234) seen at the Rheumatology section of the Hospital Italiano de Buenos Aires between 2000-2011 were retrospectively analysed. Data on clinical manifestations, disease subsets and antibodies were obtained. Patients were classified into diffuse cutaneous (dc) and limited cutaneous (lc) subsets. Comparison with other cohorts (France, United States, Germany, Italy, Mexico, EUSTAR and Brazil) was made based on published information. A higher female:male ratio (12:1) and a higher limited subset prevalence (76.1%) was found in this Argentine cohort comparing with others. We also found a lower prevalence of diffuse disease, anti Scl-70 (antitopoisomerase) and nucleolar pattern antinuclear antibodies. Within each subset, clinical findings were similar with other SSc populations except for a very low prevalence in renal crisis (0.02% of dc SS). With slight variations perhaps due to genetic, environmental or referral factors, SSc in this cohort appears to be similar to that described in other parts of the world.

  6. Mycophenolate mofetil in low-risk renal transplantation in patients receiving no cyclosporine: a single-centre experience.

    PubMed

    Raheem, Omer A; Daly, Padraig J; O'Kelly, Patrick; Shields, William P; Zimmerman, Antonio J; Mohan, Ponnusamy; Power, Richard; Little, Dilly M; Conlon, Peter J; Hickey, David P

    2012-02-01

    We assess our long-term experience with regards the safety and efficacy of Mycophenolate Mofetil (MMF) in our low risk renal transplant population and compared it retrospectively to Azathioprine (AZA) immunosuppressive regimen. Patients and methods. Between January 1999 and December 2005, 240 renal transplants received MMF as part of their immunosuppressive protocol (MMF group). AZA group of 135 renal transplants was included for comparative analysis (AZA group). Patients received Cyclosporine was excluded from this study. The incidence of biopsy proven 3-month acute rejections was 30 (12.5%) in MMF group and 22 (16%) in AZA group respectively (P = 0.307). Patient survival rates at 1 and 5 years for the MMF group were 97 and 94%, respectively, compared to 100% and 91% at 1 and 5 years respectively for the AZA group (P = 0.61). Graft survival rates at 1 and 5 years for the MMF group were 95 and 83%, respectively, compared to 97 and 84% at 1 and 5 years, respectively for the AZA group (P = 0.62). There was no difference in acute rejection episodes between MMF and AZA based immunotherapy. Additionally, we observed no significant difference concerning graft survival in the MMF group when compared to AZA group.

  7. Preimplantation genetic diagnosis and screening by array comparative genomic hybridisation: experience of more than 100 cases in a single centre.

    PubMed

    Chow, J Fc; Yeung, W Sb; Lee, V Cy; Lau, E Yl; Ho, P C; Ng, E Hy

    2017-04-01

    Preimplantation genetic screening has been proposed to improve the in-vitro fertilisation outcome by screening for aneuploid embryos or blastocysts. This study aimed to report the outcome of 133 cycles of preimplantation genetic diagnosis and screening by array comparative genomic hybridisation. This study of case series was conducted in a tertiary assisted reproductive centre in Hong Kong. Patients who underwent preimplantation genetic diagnosis for chromosomal abnormalities or preimplantation genetic screening between 1 April 2012 and 30 June 2015 were included. They underwent in-vitro fertilisation and intracytoplasmic sperm injection. An embryo biopsy was performed on day-3 embryos and the blastomere was subject to array comparative genomic hybridisation. Embryos with normal copy numbers were replaced. The ongoing pregnancy rate, implantation rate, and miscarriage rate were studied. During the study period, 133 cycles of preimplantation genetic diagnosis for chromosomal abnormalities or preimplantation genetic screening were initiated in 94 patients. Overall, 112 cycles proceeded to embryo biopsy and 65 cycles had embryo transfer. The ongoing pregnancy rate per transfer cycle after preimplantation genetic screening was 50.0% and that after preimplantation genetic diagnosis was 34.9%. The implantation rates after preimplantation genetic screening and diagnosis were 45.7% and 41.1%, respectively and the miscarriage rates were 8.3% and 28.6%, respectively. There were 26 frozen-thawed embryo transfer cycles, in which vitrified and biopsied genetically transferrable embryos were replaced, resulting in an ongoing pregnancy rate of 36.4% in the screening group and 60.0% in the diagnosis group. The clinical outcomes of preimplantation genetic diagnosis and screening using comparative genomic hybridisation in our unit were comparable to those reported internationally. Genetically transferrable embryos replaced in a natural cycle may improve the ongoing pregnancy rate