scholarly journals Ureteric Stent Use - Part of the Solution and Part of the Problem

2017 ◽  
Vol 11 (3) ◽  
pp. 126-130 ◽  
Author(s):  
Victor G. Ilie ◽  
Vlad I. Ilie
Keyword(s):  
Infectious Complications ◽  
Diabetic Patients ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Chronic Renal Impairment ◽  
Institutional Practice ◽  
Ureteric Stent ◽  
Significant Difference ◽  
Period Data ◽  
Stent Complications

Background: The aim of the study is to comprehensively report on a single tertiary referral center experience with the use of ureteric stents, assess complication burden and determine risk factors to further inform institutional practice. Materials and Methods: The retrospectively analyzed cohorts includes 529 patients treated over a 12 months period. Data regarding details of the index pathology, stent characteristics and complications were collected retrospectively. Results: Most stents (58.9%) were used in the context of stone surgery. Stent encrustation occurred in 14.5% of patients and sepsis in 4.3%. There was a statistically significant difference between the complications of the stents removed after 90 days and the rest of the cohort. Infectious complications were more frequent in diabetic patients and in patients with chronic renal impairment. At our institution, we managed to avoid forgotten stents and catastrophic complications. Conclusion: Stent complications are the complex outcome of interplay between the foreign body and the collecting system environment, influenced by the nature and timing of surgery. Longer stent dwelling times are associated with increased complications rates, especially in patients with significant comorbidities.

scholarly journals Middle Ear Packing and External Ear Packing with Fibrin Glue Enhances the Success of Fat Myringoplasty without Hyaluronic Acid Disc

2021 ◽  
Author(s):  
Jongmin Kim ◽  
Chul Ho Jang
Keyword(s):  
Success Rate ◽  
Fibrin Glue ◽  
Middle Ear ◽  
Fat Graft ◽  
External Ear ◽  
Tertiary Referral ◽  
Closure Rate ◽  
Tertiary Referral Center ◽  
Significant Difference ◽  
The Mean

Background: To date, FM using middle ear packing has rarely reported. In this study, we hypothesized that middle ear packing with dexamethasone soaked gelfoam and fibrin glue over the fat graft could promote the success rate of TMP closure regardless of perforation size. Methods: Between January 2005 and July 2020, a total of 209 patients who underwent fat myringoplasty due to chronic TMP at tertiary referral center were encountered and analyzed. The success rate and audiologic outcome was analyzed. Results: The mean successful TM closure rate was 88.0 %. The success rate by different age generation was not significant difference. The size of the perforation grade showed no significant difference. The perforation site by anterior or posterior was not significant. The preoperative mean threshold of AC, BC and ABG were 55.71, 12.98 and 42.73 dB respectively. The postoperative mean threshold of AC, BC and ABG were 23.67, 12.98 and 10.69 dB. The change of preoperative and postoperative hearing showed statistically significant. Conclusion: From our results, the simple trimming of the perforation edge and middle ear packing with external ear canal packing using fibrin glue induced the stable adhesion between the remnant TM and the fat graft.

Clinical features and management of presumed ocular tuberculosis: A long-term follow-up cohort study in a tertiary referral center in Brazil

2021 ◽  
pp. 112067212110446
Author(s):  
Yuslay Fernández Zamora ◽  
Luciana Peixoto Finamor ◽  
Luci Meire P Silva ◽  
Denise S Rodrigues ◽  
Ricardo P Casaroli-Marano ◽  
...  
Keyword(s):  
Clinical Features ◽  
Oral Prednisone ◽  
Interferon Gamma Release Assay ◽  
Tertiary Referral ◽  
Ocular Tuberculosis ◽  
Tertiary Referral Center ◽  
Referral Center ◽  
Significant Difference ◽  
Presumed Ocular Tuberculosis

Purpose: To evaluate the clinical features and management of presumed ocular tuberculosis (OTB). Method: A prospective 3-year follow-up study of patients with ocular inflammation that performed Interferon-gamma release assay (IGRA) and tuberculin skin test (TST) was conducted in a tertiary referral center in Brazil. Patients with clinical signs highly suspect of OTB with a positive TST and/or IGRA with other causes ruled out were prescribed anti-tuberculosis therapy (ATT) during 9 months. Clinical features and treatment outcomes were recorded. Results: Seventy-two patients (mean age 48.3 ± 15.7 years) were included in the study, and most were female (65.3%, n = 47). Posterior uveitis (43.1%, n = 31) was the main clinical feature. Multifocal choroiditis (25%, n = 18) was the most common choroidal involvement. Concomitant oral prednisone (45.8%, n = 33) during ATT was associated with more recurrences ( p = 0.04). A significant difference ( p < 0.001) between initial and final best-corrected visual acuity after ATT conclusion was observed. Cure or remission was observed in 58 (85.3%) patients that completed follow-up ( n = 68). Conclusion: In our cohort some variation in demographics and ocular phenotypes of presumed OTB was observed. The high rates of cure or remission of our patients strongly support the ATT in presumed OTB. Oral corticosteroids during ATT were associated with higher recurrences rates.

scholarly journals P1225PREVALENCE AND PROGNOSTIC SIGNIFICANCE OF DIABETES IN PERITONEAL DIALYSIS: TECHNIQUE AND PATIENT SURVIVAL

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Amel Ayed ◽  
Meriem Ben salem ◽  
Faouzi Haouala ◽  
Ayed Sinda ◽  
Imen Chemli ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Median Survival ◽  
Patient Survival ◽  
Infectious Complications ◽  
Diabetic Group ◽  
The Other ◽  
Diabetic Patients ◽  
Ultrafiltration Failure ◽  
Significant Difference ◽  
The Mean

Abstract Background and Aims Diabetes in recent years is climbing up as the number one cause of chronic kidney disease (CKD). Clinical statistics suggest that Diabetics on peritoneal dialysis (PD) tend to have a poorer prognosis than others. Thus, the aim of this study is to determine the clinical outcomes and to evaluate the survival rates as well as the predictors of mortality among this group. Method It‘s a retrospective study carried out in the nephrology Department of Fattouma Bourguiba Hospital (Monastir, Tunisia) from 1990 to 2017 including 304 PD patients. We compared two groups: diabetic and non diabetic patients in term of survival and factors in correlation. Results A total of 110 diabetic versus 194 non diabetic patients were reported. The mean age of diabetic group was 55.14 ± 15 years with a sex ratio 2.33 (men/women). In addition to diabetes, comorbid diseases included hypertension (47.3%) and cardiopathy (32.7%). The mean Charlson score of diabetic group was 5.22±1.5 versus 2.72±1.23 in the other group. A total of 62.7% (n=69) of the patients performed PD with the help of another person mostly a member of the family. The PD modality often used was CAPD (71%). Only six patients made a compulsory choice to begin PD due to vascular access while sixty diabetics chose PD to maintain autonomy (54.5%). During the follow-up period, transfers to hemodialysis (40.9%) and death (53.6%) were the most common cause of withdrawal from PD. In total, 45 patients were transferred to hemodialysis because of infectious complications (31%), Ultrafiltration failure (31%), catheter dysfunction (27%), and psychological intolerance (11%). The death was unrelated to PD in 83% of cases mostly due to considerable burden of cardiovascular events (23 patients). The median survival of the diabetic patients was 15.8 years versus 20.8 years in non diabetic ones with significant difference between the 2 groups (p=0.0001). Diabetes was associated with worse prognosis (OR:147, p=0.0001). The median survival adjusted to the diabetes group was 180 months. Kaplan–Meier analysis showed that diabetes was associated with a significant increase in mortality (p=0.006). Global median survival of the technique was estimated to 68 months (95%, IC [47 ,90]), and it was correlated to the presence or the absence of diabetes. In fact, the technique survival among diabetic patients was estimated to 80% after 12 years and 25% after 20 years whereas, in the other group it approaches 90% and 35% respectively. Conclusion This study confirms the pejorative impact of diabetes in the technique and patient survival in DP. So, it stresses the importance of organizing appropriate care upstream to prevent the development of cardiovascular morbidities and infectious complications in DP.

Time from first symptoms to diagnosis in GEP-NET patients: Results from a large German tertiary referral center.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 610-610
Author(s):  
Esra Koca ◽  
Christine Koch ◽  
Gabriele Husmann ◽  
Jörg Bojunga
Keyword(s):  
Incidental Findings ◽  
Cox Regression ◽  
Distant Metastases ◽  
Initial Diagnosis ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Referral Center ◽  
Asymptomatic Patients ◽  
Significant Difference ◽  
Specific Symptoms

610 Background: Patients with neuroendocrine tumors (NET) often go through a long phase between onset of symptoms and initial diagnosis. Methods: Retrospective analysis of 486 patients with GEP-NET (488 tumors) at tertiary referral center from 1984-2019; inclusion criteria: Patients > 18 years, diagnosis of GEP-NET; descriptive analysis using SPSS; Cox regression, Log rank test. Results: Demographics: Male 54% / 52.9% (all/GEP-NET), median age at first diagnosis 63y/58y (all /GEP-NET). Localizations: small intestine 145/488 (29.7%), pancreas 143/488 (29.3%), CUP 53/488 (10.9%), colon 49/488 (10%), stomach 45/488 (9.2%), rectum 27/488 (5.5%), other digestive organs 11/488 (2.3%), esophagus 5/488 (1%), other 10/488 (2%). Ki67 in 330/488 (67.6%) evaluable patients: < 3%: 155/330; 46.9%; ≥ 3%: 111/330; 33.6%; > 20%: 64/330;19.3%. 128/488 (26.2%) of patients had NET specific symptoms (abdominal pain 77/128; 60.2%, diarrhea 51/128; 39.8%, flush 19/128; 14.8%, carcinoid syndrome 8/128; 6.3% tachycardia 6/128; 4.7%). 122/488 (25%) patients showed other tumor-specific symptoms (weight loss 48/122; 39.3%, stool irregularity 21/122; 17.2%, hypoglycemia 10/122; 8.2%, painless jaundice 8/122; 6.6%). 154/ 488 (32%) of NET were incidental findings (imaging 39.6%, endoscopy 23.4%, surgery for other causes 18.8%, appendectomy 15.6%). 221/279 (initial diagnosis/any time; 79.2%) patients had distant metastases at initial diagnosis (187/221 liver metastases). Time from tumor manifestation to initial diagnosis: pNET 360 ± 116 days, siNET 309 ± 87 days, gastric NET 66 ± 47 days, colonic NET 98 ± 67 days. Time from onset of symptoms to diagnosis in symptomatic patients was significantly longer than in asymptomatic patients (388 ± 86 days vs. 174 ± 58 days, p = 0.001). No significant difference in patients with or without distant metastases (223 ± 78 days vs. 259 ± 57 days, p = 0.355). Conclusions: A large proportion of NET are incidental findings and only about half of all patients are symptomatic at the time of diagnosis. Diagnosis for symptomatic patients takes significantly longer than for asymptomatic, which might be due to mainly unspecific symptoms. Presence of metastases has no influence on time to diagnosis.

scholarly journals Elevated HbA1c is not a risk factor for wound complications following total joint arthroplasty: a prospective study

2020 ◽  
Vol 30 (1_suppl) ◽  
pp. 19-25
Author(s):  
Mustafa Citak ◽  
Bastian Toussaint ◽  
Hussein Abdelaziz ◽  
Felix Klebig ◽  
Alexandra Dobinsky ◽  
...  
Keyword(s):  
Elevated Serum ◽  
Infectious Complications ◽  
Wound Complications ◽  
Diabetic Patients ◽  
Study Cohort ◽  
German Population ◽  
Consecutive Series ◽  
Postoperative Wound ◽  
Uncontrolled Diabetes ◽  
Significant Difference

Background: Controversies exist regarding the association of elevated serum glycated haemoglobin (HbA1c) levels and postoperative surgical site infection (SSI) or prosthetic joint infection (PJI) in the setting of total hip and knee arthroplasty (THA and TKA). The purpose of the current study was to determine the prevalence of unknown and uncontrolled diabetes mellitus (DM) in a consecutive series and to investigate the association between postoperative wound complications or SSI/PJI and elevated HbA1c in patients undergoing TJA. Methods: In this prospective single-centre study, HbA1c was determined for patients undergoing elective primary, aseptic or septic revision THA and TKA, between September 2017 and March 2018. Prevalence of DM, unknown and uncontrolled diabetes were reported. Occurrence of 90-day wound healing disorders (WHD) as well as SSI or PJI were observed. Considering the HbA1c threshold ⩾6.5%, a comparative analysis between patients with and without WHD and SSI or PJI for the whole study cohort, as well as for each arthroplasty group, was performed. Receiver operating characteristic (ROC) curves were developed to quantify the predictive power of HbA1c with regard to WHD and infection complications. A total of 1488 patients were included for final analysis. There were 1127 primary THA and TKA (75.7%), 272 aseptic revisions (18.3%) and 89 septic revisions (6.0%). The known diabetic patients constituted 9.9% of the whole study cohort. Results: The majority had uncontrolled DM (67%). Prevalence of unknown DM was 11.1%. The results reveal the prevalence for the German population and might be different in other regions. A total of 57 patients (3.7%) experienced postoperative wound or infectious complications. PJI occurred in only 5 patients (0.03%). There was no significant difference between patients with HbA1c <6.5% and patients with HbA1c ⩾6.5% ( p = 0.092). Conclusions: We demonstrated that prevalence of unknown and uncontrolled DM in patients undergoing TJA is increasing, however; routine preoperative determination of the HbA1c value to prevent possible postoperative wound or infectious complications remains debatable. Larger studies investigating the optimal HbA1c level, as well as other predictors are required.

Ocular Vestibular Evoked Myogenic Potentials: Normative Findings in Children

2018 ◽  
Vol 29 (05) ◽  
pp. 443-450 ◽  
Author(s):  
Jeffery J. Kuhn ◽  
Violette H. Lavender ◽  
Lisa L. Hunter ◽  
Stephanie E. McGuire ◽  
Jareen Meinzen-Derr ◽  
...  
Keyword(s):  
Medical Center ◽  
Tone Burst ◽  
Vestibular Evoked Myogenic Potentials ◽  
Adult Group ◽  
Tertiary Referral ◽  
Stimulus Comparison ◽  
Vestibular Evoked Myogenic Potential ◽  
Tertiary Referral Center ◽  
Adult Participants ◽  
Significant Difference

AbstractTo add to the limited body of literature on ocular vestibular evoked myogenic potential (oVEMP) responses in children and to assess a different montage for oVEMP recording.To evaluate the characteristics of the oVEMP response in children and compare the results with that of a group of healthy adults.Prospective descriptive study from a tertiary referral center.Twenty-two children (mean age = 6.3 yr, standard deviation = ±1.5, range = 3.5–8.9 yr) were recruited from families whose parent(s) were employed by the Cincinnati Children’s Hospital Medical Center (CCHMC). Pediatric participants were categorized by age into three groups for data analysis. The comparison adult group of ten participants were members of the employee staff at CCHMC.Audiometric assessment was completed in all participants. The latency, amplitude, and threshold of the oVEMP responses were recorded using a modified electrode montage with reference at the chin and compared between the pediatric and adult participants.All participants completed testing and had bilateral measurable oVEMP responses using a 105-dB nHL, 500-Hz tone burst stimulus. Comparison between right and left ears across all participants for each oVEMP characteristic found no statistically significant difference. oVEMP testing showed no significant differences with respect to latency, amplitude, interaural amplitude asymmetry, and threshold of response as a function of age.oVEMP responses for ages ≥3 did not differ from responses in adults.

scholarly journals Inpatient glycemic control and outcome of COVID-19 patients: A retrospective cohort

2021 ◽  
Vol 9 ◽  
pp. 205031212110391
Author(s):  
Christopher Lesniak ◽  
Raquel Ong ◽  
Monika S Akula ◽  
Steven Douedi ◽  
Arda Akoluk ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Glucose Control ◽  
Retrospective Cohort ◽  
Fasting Glucose ◽  
Diabetic Patients ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Glucose Levels ◽  
Multiple Variables ◽  
Mean Glucose

Objectives: Although there have been associations between diabetes and mortality in COVID-19 patients, it is unclear whether this is driven by the disease itself or whether it can be attributed to an inability to exhibit effective glucose control. Methods: We conducted a retrospective cohort study of 292 patients admitted to a tertiary referral center to assess the association of mortality and glycemic control among COVID-19-positive patients. We used a logistic regression model to determine whether average fasting glycemic levels were associated with in-hospital mortality. Results: Among the diabetic and non-diabetic patients, there were no differences between mortality or length of stay. Mean glucose levels in the first 10 days of admission were higher on average among those who died (150–185 mg/dL) compared with those who survived (125–165 mg/dL). When controlling for multiple variables, there was a significant association between mean fasting glucose and mortality (odds ratio = 1.014, p < 0.001). The associations between glucose and mortality remained when controlled for comorbidities and glucocorticoid use. Conclusion: The results of this retrospective study show an association between mortality and inpatient glucose levels, suggesting that there may be some benefit to tighter glucose control in patients diagnosed with COVID-19.

Abstract 207: Adherence to the 2010 American College of Cardiology Foundation Appropriate Use Criteria for Cardiac Computed Tomography: Quality Analysis at a Tertiary Referral Center

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Manavjot S Sidhu ◽  
Heidi Lumish ◽  
Leif Christopher-Engel ◽  
Shanmugam Uthamalingam ◽  
Suhny Abbara ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Stress Testing ◽  
Cardiac Computed Tomography ◽  
Quality Analysis ◽  
Provider Type ◽  
Tertiary Referral ◽  
Appropriateness Criteria ◽  
Tertiary Referral Center ◽  
Referral Center ◽  
Significant Difference

Background: In November 2010, the American College of Cardiology Foundation (ACCF) published the revised appropriateness criteria (AC) for cardiac computed tomography (CCT). We decided to evaluate adherence to these criteria at our tertiary referral center. Methods: Reports for 383 patients who underwent clinical CCT from December 1, 2010 to July 31, 2011 were reviewed by physicians with appropriate training in CCT. Scans were classified as appropriate, inappropriate or uncertain based on the revised 2010 AC. Studies that did not fall under any of the specified indications were labeled as unclassified. Adherence to the AC was also analyzed as a function of provider type. Research scans were excluded from this analysis. Results: 308 (80%) exams were classified as appropriate, 26 (7%) as inappropriate, 30 (8%) as uncertain, and 19 (5%) as unclassified (Table 1). Of the 19 (5%) unclassified CCT studies, the most common indication was for evaluation of suspected aortic dissection. 305 (80%) exams were referred by cardiologists, 73 (19%) by internists, and 5 (1%) by neurologists (Figure 1). Of the 305 cardiology-referred studies, 221 (73%) were ordered by general cardiologists, 28 (9%) by interventional cardiologists, and 56 (19%) by electrophysiologists. There was no significant difference in adherence to the criteria between provider specialties or between cardiology subspecialties (p>0.05) Conclusions: Adherence to the 2010 AC at our center was uniformly high across provider specialties. The distribution of inappropriate and uncertain studies suggests residual ambiguity in the value of CCT after stress testing and prior to noncardiac and noncoronary cardiac surgery. This highlights an area for monitoring and future educational intervention.

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