scholarly journals To Anticoagulate or Not? That Is the Question. Management of High-Risk Patients with Mechanical Mitral and Double Valves: A Case Series

2019 ◽  
Vol 22 (4) ◽  
pp. E277-E280
Author(s):  
Mark Joseph
Keyword(s):  
High Risk ◽  
High Risk Patient ◽  
Case Series ◽  
Case Review ◽  
Anticoagulation Management ◽  
Mechanical Valves ◽  
Intracranial Bleed ◽  
Tilting Disc Valve ◽  
Different Types ◽  
Risk Patients

The Achilles heel of mechanical valves appears to be the need for anticoagulation. Several different types of mechanical valves have come and gone. The success or lack thereof of these valves depended on their various designs. We compared the two most promising mechanical valves of different eras and the need for anticoagulation through a case review. Both the Medtronic-Hall tilting disc valve and the bileaflet On-X valve were compared and contrasted in terms of durability and management of anticoagulation in high-risk patient populations. We present two cases of challenging anticoagulation management: a patient who underwent a mitral valve replacement with a Medtronic-Hall tilting disc valve who was off anticoagulation for close to six years, and a patient who underwent On-X mitral and aortic valve replacements and suffered a subsequent intracranial bleed requiring surgical intervention. We explore the ethical dilemmas associated with these patients and the risk of restarting anticoagulation for each.

A nomogram based on Psoas muscle index and prognostic nutritional index predicts the prognosis of intrahepatic cholangiocarcinoma after surgery: a multi-center cohort study

2021 ◽  
Author(s):  
Wenming Bao ◽  
Liming Deng ◽  
haitao Yu ◽  
bangjie He ◽  
Zixia Lin ◽  
...  
Keyword(s):  
High Risk ◽  
Intrahepatic Cholangiocarcinoma ◽  
Poor Prognosis ◽  
High Risk Patient ◽  
Malignant Neoplasm ◽  
Psoas Muscle ◽  
Prognostic Nutritional Index ◽  
Nutritional Index ◽  
Risk Patients ◽  
Patient Prognosis

Abstract Background Intrahepatic cholangiocarcinoma (ICC) is a malignant neoplasm with a poor prognosis. Prediction of prognosis is critical for the individualized clinical management of patients with ICC. The purpose of this study is to establish a nomogram based on the psoas muscle index (PMI) and prognostic nutritional index (PNI) to identify the high risk-patient with ICC after curative resection. Methods ICC Patients after hepatectomy in multi-hospital from August 2012 to October 2019 were enrolled. The overall survival (OS) and recurrence-free survival (RFS) rates were analyzed by Kaplan-Meier. The independent factors were identified by univariate and multivariate Cox regression analyses. A nomogram based on independent factors was established to predict ICC patient prognosis. Results 178 ICC patients were included. The OS was worst in the patients with a combination of low PMI combined low PNI (p < 0.01). PMI, PNI, lymph node metastasis and tumor differentiation were the independent prognostic risk factors; these factors were used to establish the nomogram was established by it. The calibration curve revealed that the nomogram survival probability prediction model was in good agreement with the actual observation results. The nomogram has good reliability in predicting ICC patient prognosis (OS C-index = 0.692). The area under the receiver operating characteristic curve (AUC) for the nomogram's 3-year predicted survival was 0.752. Based on the stratified by nomogram, the median survival for low-risk patients was 59.8 months, compared with 16.2 months for high-risk patients (p༜0.001). Conclusion The nomogram based on the PMI and PNI can identify patients with the highest risk of poor prognosis after curative hepatectomy. It is a good decision-making tool for individualized treatment.

Assessing risk of prosthetic joint infection

2018 ◽  
pp. 9-12
Author(s):  
Umraz Khan ◽  
Graeme Perks ◽  
Rhidian Morgan-Jones ◽  
Peter James ◽  
Colin Esler ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
High Risk ◽  
Prosthetic Joint Infection ◽  
Elective Surgery ◽  
Joint Infection ◽  
High Risk Patient ◽  
Prosthetic Joint ◽  
Risk Patients ◽  
Marginal Gain ◽  
Cellular Turnover

This chapter discusses assessing the risk of prosthetic joint infection (PJI) and includes discussion on high-risk patients (classified by age, skin colour, extracellular matrix, cellular turnover, diabetes, obesity, rheumatoid arthritis, previous periarticular fractures and skin disorders). The aim is to allow the practitioner to identify high-risk patient attributes that can be positively influenced such that the risk of PJI is reduced. There are some patients with more than one risk factor and, as such, every effort must be made to reduce each even if there is a marginal gain in each. Delaying elective surgery until the risks of PJI are reduced must be encouraged but must be balanced with alleviating patient symptoms.

scholarly journals Outcomes and risk factors of cholecystectomy in high risk patients: A case series

2020 ◽  
Vol 50 ◽  
pp. 35-40 ◽  
Author(s):  
A. Musbahi ◽  
P. Abdulhannan ◽  
J. Bhatti ◽  
R. Dhar ◽  
M. Rao ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Case Series ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals Detection of Silent Type I Choroidal Neovascular Membrane in Chronic Central Serous Chorioretinopathy Using En Face Swept-Source Optical Coherence Tomography Angiography

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Magdy Moussa ◽  
Mahmoud Leila ◽  
Hagar Khalid ◽  
Mohamed Lolah
Keyword(s):  
High Risk ◽  
Case Series ◽  
Detection Algorithm ◽  
Type I ◽  
Chronic Central Serous Chorioretinopathy ◽  
Swept Source ◽  
Bivariate Correlation ◽  
Risk Patients ◽  
Flow Detection

Purpose. To evaluate the efficacy of SS-OCTA in the detection of silent CNV secondary to chronic CSCR compared to that of FFA and SS-OCT. Patients and Methods. A retrospective observational case series reviewing the clinical data, FFA, SS-OCT, and SS-OCTA images of patients with chronic CSCR, and comparing the findings. SS-OCTA detects the CNV complex and delineates it from the surrounding pathological features of chronic CSCR by utilizing the blood flow detection algorithm, OCTARA, and the ultrahigh-definition B-scan images of the retinal microstructure generated by swept-source technology. The bivariate correlation procedure was used for the calculation of the correlation matrix of the variables tested. Results. The study included 60 eyes of 40 patients. Mean age was 47.6 years. Mean disease duration was 14.5 months. SS-OCTA detected type 1 CNV in 5 eyes (8.3%). In all 5 eyes, FFA and SS-OCT were inconclusive for CNV. The presence of foveal thinning, opaque material beneath irregular flat PED, and increased choroidal thickness in chronic CSCR constitutes a high-risk profile for progression to CNV development. Conclusion. Silent type 1 CNV is an established complication of chronic CSCR. SS-OCTA is indispensable in excluding CNV especially in high-risk patients and whenever FFA and SS-OCT are inconclusive.

scholarly journals Serious complications and risk of re-operation after Dupuytren’s disease surgery: a population-based cohort study of 121,488 patients in England

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Osaid Alser ◽  
Richard S. Craig ◽  
Jennifer C. E. Lane ◽  
Albert Prats-Uribe ◽  
Danielle E. Robinson ◽  
...  
Keyword(s):  
Cohort Study ◽  
High Risk ◽  
Case Series ◽  
Population Based ◽  
Dupuytren’S Disease ◽  
Dupuytren's Disease ◽  
Systemic Complications ◽  
Increased Risk ◽  
Risk Patients ◽  
Limited Fasciectomy

Abstract Dupuytren’s disease (DD) is a common fibro-proliferative disorder of the palm. We estimated the risk of serious local and systemic complications and re-operation after DD surgery. We queried England’s Hospital Episode Statistics database and included all adult DD patients who were surgically treated. A longitudinal cohort study and self-controlled case series were conducted. Between 1 April 2007 and 31 March 2017, 121,488 adults underwent 158,119 operations for DD. The cumulative incidence of 90-day serious local complications was low at 1.2% (95% CI 1.1–1.2). However, the amputation rate for re-operation by limited fasciectomy following dermofasciectomy was 8%. 90-day systemic complications were also uncommon at 0.78% (95% CI 0.74–0.83), however operations routinely performed under general or regional anaesthesia carried an increased risk of serious systemic complications such as myocardial infarction. Re-operation was lower than previous reports (33.7% for percutaneous needle fasciotomy, 19.5% for limited fasciectomy, and 18.2% for dermofasciectomy). Overall, DD surgery performed in England was safe; however, re-operation by after dermofasciectomy carries a high risk of amputation. Furthermore, whilst serious systemic complications were unusual, the data suggest that high-risk patients should undergo treatment under local anaesthesia. These data will inform better shared decision-making regarding this common condition.

Evaluation of High-risk Patients Undergoing Spinal Surgery: A Matched Case Series

2010 ◽  
Vol 30 (5) ◽  
pp. 496-502 ◽  
Author(s):  
Nancy Hadley Miller ◽  
Elise Benefield ◽  
Laurel Hasting ◽  
Patrick Carry ◽  
Zhoaxing Pan ◽  
...  
Keyword(s):  
High Risk ◽  
Spinal Surgery ◽  
Case Series ◽  
High Risk Patients ◽  
Risk Patients ◽  
Matched Case

University of Wisconsin experience treating adult ALL with the BFM regimen

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 16501-16501
Author(s):  
S. C. Medlin ◽  
B. Kahl ◽  
W. Longo ◽  
E. Williams ◽  
J. Lionberger ◽  
...  
Keyword(s):  
Overall Survival ◽  
Young Adults ◽  
High Risk ◽  
Lymphoblastic Leukemia ◽  
Case Series ◽  
Adult Patients ◽  
Entire Group ◽  
Severe Toxicity ◽  
Risk Patients ◽  
Children And Young Adults

16501 Background: Berlin-Frankfurt-Munster therapy (BFM) is an effective regimen for acute lymphoblastic leukemia (ALL) in children and young adults (Lancet 2:921–924,1988). Treating children and young adults at higher risk for relapse with an augmented BFM was shown to increase both event free and overall survival (NEJM 338:23,1663–1671,1998). Outcomes using standard BFM or augmented BFM in adults are unknown. Methods: This is a case-series of 29 adult patients treated with the BFM regimen. Patients were stratified into low, intermediate and high-risk groups based upon the following characteristics: age, white blood cell count, adverse cytogenetics and absence of CD 10. Low risk patients received the standard BFM regimen. Intermediate risk patients were given augmented BFM if less than 50 years old, standard BFM if older than age 50. High-risk patients received augmented BFM. Cranial irradiation was omitted in most patients (25/29). Events were defined as relapse, death from any cause, and stopping treatment for any reason. Results: Fifteen patients (median age 38, range 19–70) were treated with standard BFM and 14 patients (median age 37, range 21–72) with augmented BFM. Complete remission at day 28 was 93% (27/29). For the entire group, the 3-year overall survival was 60% with a 3-year event free survival of 45%. Patients treated with augmented BFM experienced a 3-year EFS, PFS, OS of 26%, 43%, and 48% respectively. Patients treated with standard BFM had a 3-year EFS, PFS, OS of 60%, 78%, and 78% respectively. Toxicity was common with significant neuropathy and neutropenic fever occurring in 83% and 48% respectively. Septic shock occurred in 17% of patients. Severe toxicity resulted in 1 death and discontinuation of BFM in 3 patients. The entire regimen was completed in 33 % of those treated with augmented BFM and 71% of those treated with standard BFM. Conclusion: Standard BFM is an effective and tolerable regimen for treatment of adult ALL. Augmented BFM is a difficult regimen for adult patients to complete. For both regimens, the 3-year PFS and OS compare favorably to other published regimens. No significant financial relationships to disclose.

scholarly journals Treatment of acute colonic diverticular bleeding in high risk patients, using an over-the-scope clip: a case series

Endoscopy ◽  
2016 ◽  
Vol 48 (S 01) ◽  
pp. E383-E385 ◽  
Author(s):  
Edris Wedi ◽  
Daniel von Renteln ◽  
Carlo Jung ◽  
Irina Tchoumak ◽  
Victor Roth ◽  
...  
Keyword(s):  
High Risk ◽  
Case Series ◽  
Diverticular Bleeding ◽  
High Risk Patients ◽  
Risk Patients ◽  
Colonic Diverticular Bleeding ◽  
Over The Scope Clip
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