scholarly journals Indications for repeated enema reduction of intussusception in children

2014 ◽  
Vol 142 (5-6) ◽  
pp. 320-324 ◽  
Author(s):  
Dragana Vujovic ◽  
Marija Lukac ◽  
Aleksandar Sretenovic ◽  
Tamara Krstajic ◽  
Vesna Ljubic ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Therapeutic Option ◽  
Operative Procedure ◽  
Predictor Variable ◽  
Symptom Duration ◽  
Ultrasound Guided ◽  
Abdominal Emergency ◽  
Presenting Symptoms ◽  
Intussusception Reduction ◽  
Enema Reduction

Introduction. Intussusception is a common abdominal emergency in early childhood. It is idiopathic in more than 90% of cases with incidence of 1.5-4 per 1,000 live births. The treatment of choice is nonoperative hydrostatic or air enema reduction. Objective. The aim of the study was to evaluate the influence of clinical presentation and symptom duration in non-operative treatment, considering the indications for delayed enema reduction and its efficacy. Methods. From the total number of 107 patients with intusussception, aged from 2 months to 14 years (median 9 months), 102 (95%) patients with ileo-colic intussusceptions were treated initially by ultrasound guided saline enema. Records were reviewed for patients with failed initial treatment and delayed repeated enemas or operative procedure. The predictor variable included duration of presenting symptoms. Results. Successful treatment by hydrostatic saline enemas had 58/102 (57%) patients. Success in reduction was greater if symptom duration was <24 hours (54/62 cases; 87%, p<0.001), compared with >24 hours, (4/45 cases; 9%). Despite failed initial attempts, enema reduction was reattempted in 12 patients, with success in 7/12 (60%) patients. Children with symptom duration >24 hours had a greater risk of requiring surgery (41/45 cases; 91%, p<0.001), including 5 (5%) patients with ileo-ileal intussusceptions. Conclusion. The accuracy of ultrasound guided saline enema in intussusception reduction is high. Delay in presentation decreases success of non-operative treatment. Delayed enema reduction is important therapeutic option for intussusceptions. Surgical treatment is indicated in cases of complications.

scholarly journals Percutaneous Vertebroplasty Combined with Percutaneous Pediculoplasty for Lytic Vertebral Body and Pedicle Lesions of Metastatic Tumors

2015 ◽  
Vol 3;18 (3;5) ◽  
pp. E347-E353
Author(s):  
Zhong-Liang Deng
Keyword(s):  
Observational Study ◽  
Vertebral Body ◽  
Percutaneous Vertebroplasty ◽  
Management Practice ◽  
Medical Center ◽  
Therapeutic Option ◽  
Retrospective Observational Study ◽  
Symptom Duration ◽  
Single Center ◽  
Metastatic Tumors

Background: Percutaneous pediculoplasty (PP) consists of the injection of Poly(methyl methacrylate) (PMMA) into the fractured pedicle or lytic vertebral pedicle lesions, as a technique derived from vertebroplasty. Objectives: To evaluate the short-term analgesic effect of percutaneous vertebroplasty (PV) and percutaneous pediculoplasty (PP) in patients with lytic vertebral body and pedicle lesions of metastatic tumors. Study Design: Single-center retrospective observational study. Setting: An interventional pain management practice, a medical center, major metropolitan city, China. Methods: Single-center retrospective observational study of all patients managed with PV and PP for painful vertebral body and pedicle metastatic tumors between 2007 and 2013. For each patient, symptom duration and pain intensity were recorded. PP was performed under local analgesia, in the prone position, with C-arm fluoroscopy guidance. The mixture of PMMA and Doxorubicin was delivered into the vertebral body with a non-beveled needle for the initial treatment followed by the mixture delivery into the lytic pedicle during needle withdrawal. Results: Nine patients (5 women, 4 men) were enrolled in the study with a mean age of 65.9 years (range 57 – 75). Technical success was defined as the ability to access the lesion using the approach. A positive clinical response for pain relief was achieved in these patients in whom vertebroplasty and pediculoplasty had been performed. Pain level was not significantly reduced in 3 patients in whom just vertebroplasty has been performed because the medial wall of the pedicle was destroyed by the metastatic lesion. Limitations: This study is limited by its sample size. Conclusions: PV and PP via the transpedicular approach for infiltrated vertebral bodies and infiltrated pedicles of metastatic tumors may be considered a valid therapeutic option. Key words: Percutaneous pediculoplasty, percutaneous vertebroplasty, lytic pedicular lesions, bone cement

Abstract TP174: Identifying Predictors for Final Diagnosis of Ischemic Events in an Emergency Department Observation Unit

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Arooshi Kumar ◽  
Koto Ishida ◽  
Ava Liberman ◽  
Cen Zhang ◽  
Shadi Yaghi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Features ◽  
Univariate Analysis ◽  
Final Diagnosis ◽  
Minor Stroke ◽  
Symptom Duration ◽  
Facial Weakness ◽  
Presenting Symptoms ◽  
History Of ◽  
Ischemic Events

Introduction: Transient neurologic events have high rates of diagnostic uncertainty. Emergency department observation units (ED-OU) allow an accelerated diagnostic work up for suspected transient ischemic attacks (TIAs). However, clinical decision support regarding which patients to admit to these units is lacking. This study aimed to identify clinical features that differentiate true ischemic events from nonischemic transient neurological attacks (NI-TNA) among patients admitted to an ED-OU for suspected TIA. Methods: A retrospective analysis was performed on consecutive patients admitted to the ED-OU at a single academic center for suspected TIA. Demographics, vascular risk factors, presenting symptoms, and details of the clinical presentation were abstracted from chart review. Final discharge diagnosis was dichotomized to either ischemic event (TIA or minor stroke, TIAMS) or NI-TNA based on the treating vascular neurologist’s final diagnosis. Standard statistical tests were used for comparison testing between the two groups. Significantly different factors with p<0.2 on univariate analysis were carried forward in a multivariable logistic regression model. Results: Of 186 consecutive patients, 101 (54%) had a final diagnosis of NI-TNA and 85 (46%) of TIAMS. The median population ABCD2 score was 4 [IQR 3-4]. On univariate analysis, older age (63 vs. 70, p<0.01), history of atrial fibrillation (AF) (12% vs. 26%, p=0.01), and facial weakness (5% vs. 14% p=0.03) were associated with TIAMS. Headache (24% vs. 12%, p=0.04) and symptom duration>60min (57% vs. 40%, p=0.02) were associated with NI-TNA. On multivariable analysis, only symptom duration>60 minutes predicted NI-TNA (OR 0.39, p=0.04) and only history of AF (OR 2.53, p=0.03) predicted TIAMS. Facial weakness was strongly predictive of TIAMS (OR 3.22, p=0.05), but not significant. Conclusion: We identified two clinical features that distinguished TIAMS from NI-TNA among patients admitted to an ED-OU for suspected TIA.These may be helpful in emergency room triage of TIAMS. Data from ED-OU can be used to identify factors associated with cerebral ischemia and improve current care pathways for patients with suspected TIA, so diagnostic evaluation is received in the most appropriate setting.

Treatment practices, response to therapy and adverse events in ANCA-associated vasculitis patients in Europe: top-line findings from a retrospective observational study

2019 ◽  
Author(s):  
Peter Rutherford ◽  
Dieter Goette
Keyword(s):  
Adverse Events ◽  
Clinical Outcomes ◽  
Real World ◽  
Response To Therapy ◽  
Remission Induction ◽  
Induction Treatment ◽  
Symptom Duration ◽  
Similar Distribution ◽  
Presenting Symptoms ◽  
Anca Associated Vasculitis

Abstract Background ANCA-associated vasculitis patient outcome data in the real world setting is scarce. This study measures key clinical outcomes and adverse effects over the first 12 months of remission induction therapy.Methods This was a retrospective study of 929 newly diagnosed [ND] and 268 relapsing patients [RP] conducted online by 399 clinicians. Each clinician completed a survey for 3 patients meeting the following criteria: initiated remission induction treatment for new or relapsing disease between Nov 2014 and Feb 2017, ≥ 6 months of therapy including ≥ 1 course of induction therapy, under continuous care for ≥12 months. Data were collected relating to baseline presentation and at 1, 3, 6, and 12 months.Results 58% were >55 years old with more granulomatosis with polyangiitis (GPA, 54%) versus microscopic polyangiitis (MPA, 46%), and <20% of patients had Birmingham Vasculitis Activity Scoring (BVAS) performed. Median symptom duration prior to diagnosis was 6 to 7 weeks. Presenting symptoms were similar between ND and RP, noted differences (≥ 5%) were more fever, rash, and neuropathy, and less renal disease in RP. The majority (68% ND and 84% RP) had at least one comorbidity at diagnosis, with a similar distribution. Glucocorticoids (GC) were used by 83% ND and 76% RP; >50% were still receiving GC at 12 months. Most common treatments were cyclophosphamide+GC for ND (59%) and rituximab+GC for RP (44%). Many patients had slow and/or partial response to therapy, by 12 months >60% had a full response. 81% of patients with response by month 1 maintained full response through month 12. Adverse events and infections were common, especially during the first 3 months when GC use is highest.Conclusions Real world data show that both ND and RP ANCA-associated vasculitis patients respond variably to induction remission treatment and many experience adverse events and infections over the first 12 months of treatment. The presence of comorbidities at treatment initiation in most patients compounded the adverse impacts of disease and treatment. This study improves our understanding of the reality of clinical outcomes in ANCA-associated vasculitis and the need for targeted therapeutic approaches.

scholarly journals Selective Retina Therapy with Real-Time Feedback-Controlled Dosimetry for Treating Acute Idiopathic Central Serous Chorioretinopathy in Korean Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Ye Ji Kim ◽  
Youn Gon Lee ◽  
Dong Won Lee ◽  
Jae Hui Kim
Keyword(s):  
Real Time ◽  
Central Serous Chorioretinopathy ◽  
Therapeutic Option ◽  
Subretinal Fluid ◽  
Symptom Duration ◽  
Short Term Treatment ◽  
Foveal Thickness ◽  
Clinical Trial Registration ◽  
Korean Patients ◽  
Selective Retina Therapy

Purpose. To evaluate short-term treatment outcomes following selective retina therapy (SRT) with real-time feedback-controlled dosimetry in Korean patients with acute idiopathic central serous chorioretinopathy (CSC). Methods. Sixteen eyes (16 patients) with acute idiopathic CSC (symptom duration < 3 months) were included in this retrospective study. All patients underwent a single session of SRT with real-time feedback-controlled dosimetry. Best-corrected visual acuity (BCVA) and central foveal thickness (CFT) before and 3 months after treatment were examined and compared. Results. The logarithm of minimal angle of resolution BCVA was significantly better 3 months after treatment (0.16 ± 0.18) than at the time of diagnosis (0.27 ± 0.18, P=0.002). Additionally, subretinal fluid had resolved in all 16 eyes 3 months after treatment and CFT was significantly lower 3 months after treatment (215.6 ± 17.9 μm) than at baseline (441.4 ± 124.8 μm, P<0.001). No notable SRT-related complications were observed during the study period. Conclusion. The results of the present study suggest that SRT is a useful therapeutic option for patients with acute idiopathic CSC. Further studies are required to better understand the long-term efficacy of this treatment. This trial is registered with clinical trial registration number NCT03339856.

Ultrasound-Guided Mechanical Fragmentation of Sialoliths

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P48-P48
Author(s):  
Urban Geisthoff ◽  
Steffen Maune
Keyword(s):  
Therapeutic Option ◽  
Secondary Treatment ◽  
Sublingual Gland ◽  
Line Treatment ◽  
Ultrasound Guided ◽  
Stone Fragmentation ◽  
A New Technique ◽  
Mechanical Fragmentation ◽  
Minimally Invasive Methods ◽  
Residual Stones

Objective Assess the efficacy of ultrasound-guided mechanical intraductal stone fragmentation and removal of sialoliths (SonoFragmentation). SonoFragmentation has been described recently as a new technique for the treatment of sialolithiasis (Surg Endosc 2006;20(4):690–4). Methods Retrospective analysis of cases treated within the last 3 years. Results SonoFragmentation was used as a 2nd line treatment in 22/28 cases. 10 patients were free of stones (parotid gland [PG]: 2x, submandibular gland [SMG]: 7x, sublingual gland: 1x; in 2 cases sialendoscopy was additionally used). Residual stones persisted in 12 patients (PG: 2x, SMG: 10x). 6 patients with sialolithiasis of the GP were primarily treated with the technique. 4 of those patients were cured. Reasons for failure were lacking accessibility of the stone by the forceps (9x), impossibility to grasp the stone (5x) and/or the concomitant grabbing of soft tissue together with the stone (3x). Conclusions The efficacy of SonoFragmentation as a secondary treatment after failure of other minimally invasive methods is about 50% (10/22). Additionally, it is a promising primary therapeutic option (cure: 4/6 patients).

scholarly journals Some Observations on the Surgical Treatment of Urinary Incontinence

1939 ◽  
Vol 32 (7) ◽  
pp. 777-790 ◽  
Author(s):  
Terence Millin
Keyword(s):  
Nervous System ◽  
Urinary Incontinence ◽  
Surgical Treatment ◽  
Operative Treatment ◽  
Stress Incontinence ◽  
Surgical Repair ◽  
Operative Procedure ◽  
Male And Female ◽  
Developmental Abnormalities ◽  
Careful Investigation

Types: A. Essential. B. Paradoxical. C. False. D. True. True incontinence.—A. Congenital: (a) Developmental abnormalities. (b) Malformations of nervous system. B. Acquired: (a) Local abnormalities. (b) False passages. (c) Disturbance of innervation. Anatomy of sphincteric mechanism in male and female. Diagnosis: Need for careful investigation including cysto-urethroscopy, cysto-urethrography, and cysto-manometry. Treatment: A. Physiotherapy. B. Direct surgical repair. C. Surgical diversion of urine. Types of true incontinence amenable to direct surgical repair: A. Epispadias. B. Aberrant ureteric ostia. C. Fistulæ. D. Congenital or acquired defective sphincteric mechanism. Operative treatment of vesico-vaginal fistulæ. Transvesical operation for cure of congenitally defective sphincteric mechanism—report of seven cases. Stress incontinence.—Value of urethrograms to ascertain nature of defect. Operative treatment. Incontinence following prostatic surgery.—Types of operation advocated. New operative procedure utilizing ribbon catgut with demonstrative moving picture.

scholarly journals The Patient Profile of a Uk Osteopathic Student Out-patient Clinic: a Retrospective Descriptive Study

2020 ◽  
Author(s):  
Andrew MacMillan
Keyword(s):  
Patient Population ◽  
Statistical Tests ◽  
Statistical Significance ◽  
Demographic Data ◽  
Population Sample ◽  
Symptom Duration ◽  
Patient Records ◽  
Presenting Symptoms ◽  
Patient Profile ◽  
Age Range

Abstract Osteopathy is a healthcare discipline regulated by statute within the UK. Little is known regarding the day-to-day practice of osteopaths. The aim of this study was to investigate the patient profile within a teaching institution. Data regarding patients and their presenting symptoms are routinely collected at UK OEIs. The data were analysed from a sample spanning three years. The demographic data collected described the patient population sample in terms of age range, gender, occupation and ethnicity. The patient symptom data collected was comprised of site of pain, aetiology, symptom duration and symptom pattern. The study first profiles the clinic patient population, describing the prevalence of the types of presenting complaint, and then profiles the demographics of the sample. The study then compared the demographic data to the symptom data to assess for trends within the sample.Methods Data from a total of 3,760 patient records attending between 02/01/13 and 24/12/15 were analysed. This data was cleansed leaving 3243 complete patient records. The data was then analysed using descriptive and inferential statistics via the StatisticalPackage for Social Sciences. The statistical tests used were the nonparametric test, Kendall’s rank order correlation, and Pearson’s Chi-Square correlations for the ordinal data. Distributions and frequency counts were performed to describe the data using Microsoft excel.Results The sample of the clinic population analysed included 3243 patient records, of which 1834 were female (57%) and 1408 (43%) were male. The ethnic profile of included records was predominantly Caucasian at 68%, with 13% of Black Minority Ethnic origin and 12% South Asian. The age range is from 0 to 80+ years, and the majority of participants are aged 30-39 (31%). The most common sites of pain were: low back (33%), neck (23%), upper back (9%), mid back (7%), and shoulder (6%). The results suggest that gender may influence site of pain, and that ethnicity is not associated with symptom duration but may be associated with symptom site and pattern, however the association is weak and may not be generalizable beyond this cohort. No statistical significance was found between occupation and pain. Conclusion This study is a detailed profile of a UK OEIs clinic’s patient population. It investigated potential links between demographic data and presenting complaints. Further study with a larger sample size would allow more reliable analysis of data, repeating similar investigation at other institutions may enhance understanding of this topic and highlight if regional differences occur. This study highlights that there are no discernable correlation between pain presentation and occupation or ethnicity. IMPLICATIONS FOR PRACTICEThis study adds to the existing research literature by:Profiles the patient population of a UK OEI with reference to; ethnicity, age and gender.Demonstrates a relationship between gender and sites of pain and no link between occupation and presenting complaint.

scholarly journals 264. A 20-year Study of Intracranial Pyogenic Complications of Sinusitis in Children

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S238-S238
Author(s):  
Jennifer Tat ◽  
Mina Smiljkovic ◽  
Susan E Richardson ◽  
Aaron Campigotto ◽  
Sharon Cushing ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Retrospective Chart Review ◽  
International Classification Of Diseases ◽  
Symptom Duration ◽  
Upper Respiratory Tract ◽  
Streptococcus Anginosus ◽  
Presenting Symptoms ◽  
Pott’S Puffy Tumor ◽  
Classification Of Diseases ◽  
Intracranial Complications

Abstract Background Intracranial pyogenic complications of sinusitis in children are relatively uncommon but can lead to serious sequelae. The objective of this study was to characterize the clinical, epidemiologic and microbiologic characteristics of children with such complications over a 20-year period (2000- 2019). Methods Single-center retrospective chart review. Cases were identified based on International Classification of Diseases (ICD)-10 diagnostic codes (intracranial abscess or granuloma, extradural and subdural abscess, Pott’s puffy tumor, acute or chronic sinusitis) and by reviewing all microbiological samples of intracranial pus, tissue or fluid. Results 108 cases of clinically and/or radiologically diagnosed sinusitis were included after review of 1591 charts. The majority were adolescents (median age 12, IQR 9-14); 72 were male (67%). The most common presenting symptoms were fever (84%), headache (87%) and symptoms of upper respiratory tract infection (57%). Median symptom duration was 10 days (IQR 5-21) and 55 cases (51%) received oral antibiotics prior to admission. The most frequent complications were epidural empyema (n=50, 46%), subdural empyema (n=46, 43%) and Pott’s puffy tumor (n= 31, 29%). 50% (n=54) underwent neurosurgery, of which 20% (n=11) required multiple craniectomies. 38% (n=41) underwent otolaryngological surgery. Microbiological data from sterile specimens demonstrated single organisms in 36 cases (59%) and polymicrobial growth in 25 cases (41%). The most frequently identified pathogens were Streptococcus anginosus (n=40, 66%) followed by Fusobacterium species (n=10, 16%) and Prevotella species (n=10,16%). Most cases were treated with combination antibiotic therapy (n=68, 63%) and 14% (n=15) with a carbapenem. The median duration of intravenous antibiotic therapy was 51 days (IQR 42-80). One child died and 23% (n=25) suffered neurological sequelae (median follow-up 344 days). 48 cases (44%) occurred between 2014-2019. Conclusion Intracranial complications of sinusitis continue to cause significant morbidity in children. The predominant causative pathogen was Streptococcus anginosus. Polymicrobial infections are common, confirming the need for prolonged broad-spectrum antibiotic treatment. Disclosures Sharon Cushing, MD, MSc, FRCSC, Cochlear Corporation (Research Grant or Support)Cochlear Corporation (Speaker’s Bureau)Interacoustics (Speaker’s Bureau)Plural publishing (Other Financial or Material Support, Royalties: editor: manual of pediatric balance disorders)

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