scholarly journals Endovascular Treatment of Right Heart Masses Utilizing the AngioVac System: A 6-Year Single-Center Observational Study

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Aashish Katapadi ◽  
Lauren Richards ◽  
William Fischer ◽  
Suhail Q. Allaqaband ◽  
Tanvir Bajwa ◽  
...  
Keyword(s):  
Retrospective Studies ◽  
Care Center ◽  
Tertiary Care ◽  
Surgical Excision ◽  
Outcome Data ◽  
Right Heart ◽  
Vacuum Aspiration ◽  
System A ◽  
Risk Patients ◽  
Single Center Observational Study

Objective. To describe our institution’s experience with the AngioVac system. Background. Intracardiac and intravascular masses previously required surgical excision, but now, there are a number of minimally invasive options. With the advent of vacuum aspiration, more specifically the AngioVac System (AngioDynamics, NY, USA), there exists a system with both low mortality and minor complications. However, the number of retrospective studies remains limited. Outcome data for high-risk patients are also limited. Methods. Data were collected and analyzed in patients who underwent AngioVac therapy at our tertiary care center from January 2014 to December 2020. Results. Our results demonstrated a 93.3% intraoperative success rate and a 100% intraoperative survival rate. However, a number of complications, including but not limited to hematomas, anemia, and hypotension, occurred, as described below. Conclusions. Our experiences demonstrated good outcomes and continue to support the usefulness of the AngioVac System. The data also support the use of AngioVac as a treatment option for the debulking or removal of right heart masses in critically ill patients.

scholarly journals To study the effectiveness of prophylactic use of ceftriaxone (single dose) in caesarean section in low risk patients in a tertiary care center, Moradabad, India

2017 ◽  
Vol 5 (12) ◽  
pp. 5278
Author(s):  
Ruby Kumari ◽  
Arti Sharma ◽  
. Sheetal ◽  
Pratibha Roy ◽  
. Anupriya
Keyword(s):  
Single Dose ◽  
Caesarean Section ◽  
Surgical Site Infection ◽  
Care Center ◽  
Tertiary Care ◽  
Infectious Complications ◽  
Low Risk ◽  
Tertiary Care Center ◽  
Site Infection ◽  
Risk Patients

Background: There is increasing incidence of caesarean section throughout the world. As caesarean section is associated with infectious complications which increase the rate of morbidity and mortality of mothers. For prevention of infectious complications antibiotics are used but careless use of antibiotics increasing incidence of antibiotic resistance. Many guidelines and studies recommend single dose antibiotic prophylaxis for women undergoing elective or non-elective caesarean section. The aim of this study was to assess the effectiveness of Ceftriaxone as prophylactic antibiotic (single dose) in caesarean section in low risk patients.Methods: A Prospective single blind study was carried out in the department of obstetrics and gynaecology, TMMC and RC Moradabad, a tertiary care center, in all low risk patients underwent for Elective and Emergency Lower segment caesarean section for 1 year from 1st June 2015 to May 2016 on 110 patients. Data was collected and analyzed by percentage and proportion.Results: Prevalence of caesarean section was maximum in women of 26-35years age group (52.72%),about 67.27% was emergency LSCS, most common indication of caesarean section was Fetal distress (29.09%),refusal for vaginal delivery after caesarean section (10.90%) was one of the cause for increasing rate of repeat caesarean section, 41.81% women in labour,72.27% cases were with intact membrane, in 9.09% cases, antibiotic had to change in post-operative period due to urinary tract infection and surgical site infection, most common post-operative complication was superficial surgical site infection with purulent discharge (2.72%). No major life-threatening complication occurred.Conclusions: Single dose of Ceftriaxone is effective for prevention of post-caesarean infectious complication.

scholarly journals Surgical Management and Early Outcome of Encephalocele

2021 ◽  
Vol 10 (1) ◽  
pp. 42-45
Author(s):  
Prakash Kafle ◽  
Mohan Raj Sharma ◽  
Sushil Krishna Shilpakar ◽  
Gopal Sedain ◽  
Amit Pradhanang ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Care Center ◽  
Tertiary Care ◽  
Surgical Excision ◽  
Clinical Profile ◽  
Bony Defect ◽  
Female Ratio ◽  
Early Outcome ◽  
Good Outcome ◽  
Occipital Encephalocele

Background: There are limited studies pertaining to management of encephalocele in Nepal. So the present study seems justifiable to bridge the gap in the literature on encephalocele from Nepal on its clinical profile and early outcome. This study aims to characterize the clinical profile, management and outcome of largest series of encephalocele at tertiary care center in Nepal. Materials and Methods: A retrospective analysis of encephalocele, managed surgically at two tertiary care centers between 2015 and 2020, was performed. Results: Total of 25 cases was surgically managed in the present study. The median age of study population was 2.5 months. There were 11 male and 14 female with male to female ratio of 1:1.26. Occipital encephalocele was the most common variant. Lump in the head (n=11) was the commonest clinical presentation followed by hyperteliorism (n=10). One patient presented with cleft lip and one had CSF discharge in a case of occipital encephalocele. Bony defect was the common radiological findings. Excision and repair was the most common mode of surgery leading to good outcome. Mortality rate was 4% with morbidity of 20%. Conclusion: Early surgical excision and tight dural closure with repair of bony defect is the standard treatment with relatively good outcome.

Voice and Swallowing Dysfunction in Neurofibromatosis 2

2017 ◽  
Vol 158 (3) ◽  
pp. 505-510 ◽  
Author(s):  
Simon R. Best ◽  
Julie Ahn ◽  
Shannon Langmead ◽  
Vaninder Dhillon ◽  
Alexander T. Hillel ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Care Center ◽  
Tertiary Care ◽  
Surgical Excision ◽  
Velopharyngeal Insufficiency ◽  
Neurofibromatosis 2 ◽  
Cross Sectional ◽  
Surgical Interventions ◽  
Swallowing Dysfunction

Objective Neurofibromatosis 2 (NF2) is a neuro-oncologic condition that presents with bilateral vestibular schwannomas of the cerebellopontine angle (CPA). Voice and swallowing impairment can occur from direct involvement or compression of the vagus nerve or as the result of surgical excision of CPA tumors. The objectives in this study are to (1) assess the prevalence of voice and swallowing impairments and (2) analyze the effects of vagal dysfunction in patients with NF2. Study Design Cross-sectional. Setting Academic tertiary care center. Subjects and Methods Patients at a neurofibromatosis center were mailed Voice Handicap Index and Sydney Swallow Questionnaire surveys. Stroboscopic, voice, and swallowing evaluations were performed for patients who elected to participate in screening exams. Results There were high rates of self-assessed and objective voice and swallowing handicaps in this population. Fourteen of 40 (35%) patients had a self-assessed voice handicap, and 20 of 40 (50%) patients had a self-assessed swallow handicap. Vocal fold motion impairment (VFMI) was observed in 22 of 31 (71%) patients examined, with 27 of 62 (44%) possible vocal cords affected. Velopharyngeal insufficiency (45%) and piriform sinus pooling or residue (39%) were seen in a significant percentage of patients. There was a significant relationship between vocal cord motion impairment and CPA surgical intervention ipsilateral to the impairment ( P = .002). The presence of VFMI was strongly associated with voice ( P = .002) and swallowing ( P = .01) impact on quality of life. Conclusion Speech and swallowing impairments are highly prevalent in patients with NF2, cause significant impact on quality of life, and are most commonly related to surgical interventions in the CPA region.

scholarly journals Duplicate Type and Screen Testing: Waste in the Clinical Laboratory

2017 ◽  
Vol 142 (3) ◽  
pp. 358-363
Author(s):  
Margaret L. Compton ◽  
Penny C. Szklarski ◽  
Garrett S. Booth
Keyword(s):  
Clinical Laboratory ◽  
Care Center ◽  
Tertiary Care ◽  
The United States ◽  
Transfusion Medicine ◽  
Laboratory Cost ◽  
System A ◽  
Medicine Service ◽  
Additional Education ◽  
Clinical Laboratory Testing

Context.— In the United States, approximately $65 billion dollars is spent per year on clinical laboratory testing, of which 20% to 30% of all testing is deemed inappropriate. There have been multiple studies in the field of transfusion medicine regarding evidence-based transfusion practices, but limited data exist regarding inappropriate pretransfusion testing and its financial and clinical implications. Objective.— To assess duplicative testing practices in the transfusion medicine service. Design.— A 24-month retrospective review was performed at a 1025-bed tertiary care center, identifying all duplicate type and screen (TS) tests performed within 72 hours of the previous TS. Duplicative testing was classified as appropriate or inappropriate by predetermined criteria. The level of underordering was analyzed through a query of the electronic event reporting system. A cost analysis was performed to determine the financial impact of inappropriate duplicative TS. Results.— The mean rate of inappropriate, duplicative TS orders was 4.13% (standard deviation ± 4.09%). Rates of inappropriate ordering ranged from 0.01% to 15.5% depending on the clinical service and did not correlate with volume of tests ordered. There were 8 reported cases of delayed blood delivery due to lack of a valid TS during the study period, demonstrating that underordering is also a harmful practice. The laboratory cost of inappropriate testing for the study period was $80,434, and phlebotomy costs were $45,469. Conclusions.— Our study demonstrates that inappropriate TS ordering is costly, both financially and clinically. By evaluating the percentage of inappropriate TS tests by clinical services, we have identified services that may benefit from additional education and technologic intervention.

Incidence and Operative Excision of Presacral Masses: An Institutional Analysis

2015 ◽  
Vol 81 (12) ◽  
pp. 1237-1239
Author(s):  
David J. Hiller ◽  
Gregory S. Waters ◽  
Jaime L. Bohl
Keyword(s):  
Standard Deviation ◽  
Posterior Approach ◽  
Multimodality Imaging ◽  
Care Center ◽  
Tertiary Care ◽  
Digital Rectal Examination ◽  
Surgical Excision ◽  
Palpable Mass ◽  
Rectal Pain ◽  
Multiple Imaging

Presacral masses are rare lesions that encompass a broad range of pathologic findings. Most presacral masses are benign. The aim of this study was to analyze the clinical presentation, pathology, and surgical treatment of presacral masses at a single academic institution over a decade. In this retrospective study, we reviewed all surgically excised presacral tumors between 2003 and 2013. Clinical and pathologic data were recorded. Thirteen patients had surgical excision of a presacral mass. The median age was 42 years (standard deviation ± 19.7) and average follow-up was 11.9 months (standard deviation ± 17.5). The majority of patients were symptomatic. Forty-six per cent (6/13) had sacral or rectal pain. Thirty-eight per cent (5/13) of patients had a palpable mass on digital rectal examination. Sixty-nine per cent of patients had an MRI, 84.6 per cent a CT, and 61.5 per cent multimodality imaging. Most presacral masses were benign (10/13,77%). Twenty-three per cent (3/13) were malignant. A majority were excised via posterior approach (9/13, 69%), but 31 per cent (4/13) required an anterior or combined approach. Presacral masses are rare, even at a high-volume tertiary care center. They are commonly evaluated with a multiple imaging modalities, are most likely benign, and can be excised via posterior approach.

scholarly journals Indications and outcome of patients undergoing cutaneous ureterostomy as a mode of urinary diversion after radical cystectomy: an experience from a tertiary care center

2018 ◽  
Vol 5 (9) ◽  
pp. 3038
Author(s):  
Shikhar Agarwal ◽  
Rajeev Sarpal ◽  
Shivam Dang ◽  
Yogesh Kalra ◽  
Manoj Biswas
Keyword(s):  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Operative Time ◽  
Care Center ◽  
Tertiary Care ◽  
High Morbidity ◽  
Tertiary Care Center ◽  
Viable Option ◽  
Risk Patients ◽  
Cutaneous Ureterostomy

Background: Radical cystectomy is associated with high morbidity, especially in elderly patients. Most of the associated complications are related to the urinary diversion. Cutaneous ureterostomy (CU) is usually an uncommon form of urinary diversion and is avoided because of the frequent complication of stomal stenosis.Methods: In this study the authors retrospectively analyzed 84 patients who underwent radical cystectomy. 17 Patients who underwent single stoma CU were included in the study who required lifelong monthly stent changes. Varied indication and outcome of these patients were analyzed.Results: Patients in which CU was used as a mode of urinary diversion had less blood loss, less operative time and discharged without ICU stay.Conclusions:  It seems that single stoma CU is a viable option in elderly, high risk patients and in post radiotherapy patients who require radical cystectomy. Although the patient requires lifelong stent changes, postoperative complications are reduced.        

scholarly journals Impact of Chest Pain Protocol Targeting Intermediate Cardiac Risk Patients in an Observation Unit of an Academic Tertiary Care Center

2016 ◽  
Vol 8 (2) ◽  
pp. 111-115 ◽  
Author(s):  
Tariq Yousuf ◽  
Hesam Keshmiri ◽  
Jeffrey Ziffra ◽  
Ankur Dave ◽  
Shoeb Hussain ◽  
...  
Keyword(s):  
Chest Pain ◽  
Care Center ◽  
Tertiary Care ◽  
Cardiac Risk ◽  
Tertiary Care Center ◽  
Observation Unit ◽  
Risk Patients ◽  
Cardiac Risk Patients

scholarly journals Clinical Characteristics and Outcome of Staphylococcus aureus Prostate Abscess From Ten Years of Experience at a Tertiary Care Center

2019 ◽  
Vol 6 (10) ◽  
Author(s):  
Bryan Walker ◽  
Eric Heidel ◽  
Mahmoud Shorman
Keyword(s):  
Staphylococcus Aureus ◽  
Rare Complication ◽  
Care Center ◽  
Tertiary Care ◽  
Care Hospital ◽  
Risk Patients ◽  
History Of ◽  
A Site ◽  
Lost To Follow Up

Abstract Objective Prostatic abscess (PA) is an uncommon infection that is generally secondary to Escherichia coli and other members of the Enterobacteriaceae family. In recent years, although rare, more reports of Staphylococcus aureus (S. aureus) PA have been reported, especially with increasing reports of bacteremia associated with injection drug use (IDU). Method This was a retrospective review of adult patients admitted to a tertiary care hospital between 2008 and 2018 and who had a diagnosis of S. aureus PA. Results Twenty-one patients were included. The average age was 46 years. Fourteen (67%) patients presented with genitourinary concerns. Main risk factors included concurrent skin or soft tissue infections (52%), history of genitourinary disease or instrumentation (48%), IDU (38%), and diabetes mellitus (38%). Methicillin-resistant Staphylococcus aureus (MRSA) was identified in 57% and concomitant bacteremia in 81% of patients. Surgical or a radiologically guided drainage was performed in 81% of patients. Antibiotic treatment duration ranged from 3 to 8 weeks. Six patients were lost to follow-up. Clinical resolution was observed in the remaining 15 (81%) patients who had follow-up. Conclusions S. aureus PA continues to be a rare complication of S.aureus infections. In most published reports, MRSA is the culprit. In high risk patients with persistent bacteremia, physicians need to consider the prostate as a site of infection.

Sign in / Sign up

Export Citation Format

Share Document