scholarly journals Dysphagia aortica

2021 ◽  
Author(s):  
Serena Grimaldi ◽  
Pamela Milito ◽  
Andrea Lovece ◽  
Emanuele Asti ◽  
Francesco Secchi ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Aortic Aneurysm ◽  
Early Recognition ◽  
Postoperative Mortality ◽  
Cochrane Library ◽  
High Morbidity ◽  
Aortoesophageal Fistula ◽  
Female Ratio ◽  
The Cochrane Library ◽  
Male To Female

Summary Background Dysphagia aortica is an umbrella term to describe swallowing obstruction from external aortic compression secondary to a dilated, tortuous, or aneurysmal aorta. We performed a systematic literature review to clarify clinical features and outcomes of patients with dysphagia aortica. Materials and methods We searched PubMed, EMBASE, Web of Science, and the Cochrane Library. The terms “aortic dysphagia,” “dysphagia aortica,” “dysphagia AND aortic aneurysm” were matched. We also queried the prospectively updated database of our esophageal center to identify patients with aortic dysphagia referred for diagnosis and treatment over the past two decades. Results A total of 57 studies including 69 patients diagnosed with dysphagia aortica were identified, and one patient from our center was added to the database. The mean age was 72 years (range 22–98), and the male to female ratio 1.1:1. Of these 70 patients, the majority (n = 63, 90%) had an aortic aneurysm, pseudoaneurysm, or dissection. Overall, 37 (53%) patients received an operative treatment (81.1% a vascular procedure, 13.5% a digestive tract procedure, 5.4% both procedures). Thoracic endovascular aortic repair (TEVAR) accounted for 60% of all vascular procedures. The postoperative mortality rate was 21.2% (n = 7/33). The mortality rate among patients treated conservatively was 55% (n = 11/20). Twenty-six (45.6%) studies were deemed at a high risk of bias. Conclusion Dysphagia aortica is a rare clinical entity with high morbidity and mortality rates and no standardized management. Early recognition of dysphagia and a high suspicion of aortoesophageal fistula may be lifesaving in this patient population.

Naphthalene Toxicity in Clinical Practice

2020 ◽  
Vol 21 (1) ◽  
pp. 63-66
Author(s):  
Ashok Kumar Pannu ◽  
Vidhi Singla
Keyword(s):  
Methylene Blue ◽  
G6pd Deficiency ◽  
Brain Dysfunction ◽  
Laboratory Evaluation ◽  
Cochrane Library ◽  
High Morbidity ◽  
High Quality ◽  
Quality Literature ◽  
Acute Brain Dysfunction ◽  
The Cochrane Library

Background: Naphthalene ingestion and skin or inhalational exposure (accidental or deliberate) is an under-recognized cause of a severe toxidrome in regions where it is commonly used (e.g., mothballs in households). Methods: This review is an update for the clinicians to understand the pharmacology, clinical features, laboratory evaluation, and treatment for naphthalene toxicity. High-quality literature for the past eight decades was collected and reviewed in this article. Several landmark articles were reviewed using PubMed, EMBASE Ovid, and the Cochrane Library, which have essential implications in the current toxicology practice. Results and Conclusion: Naphthalene toxicity usually occurs abruptly and leads to acute hemolysis, methemoglobinemia, renal failure, respiratory depression, and acute brain dysfunction that are difficult to manage. The toxicity is more marked in patients with G6PD deficiency and associated with high morbidity and mortality. The management should mainly focus on high-quality supportive care; however, severe methemoglobinemia (>20-30%) requires specific therapy with intravenous methylene blue. Methylene blue is a highly effective agent but contraindicated in severe G6PD deficiency.

scholarly journals Perioperative outcomes after laparoscopic cholecystectomy in elderly patients: a systematic review and meta-analysis

2020 ◽  
Vol 34 (11) ◽  
pp. 4727-4740 ◽  
Author(s):  
Sivesh K. Kamarajah ◽  
Santhosh Karri ◽  
James R. Bundred ◽  
Richard P. T. Evans ◽  
Aaron Lin ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Elderly Population ◽  
Meta Analysis ◽  
Postoperative Mortality ◽  
The Elderly ◽  
Cochrane Library ◽  
The Cochrane Library ◽  
Bile Leaks

Abstract Background Laparoscopic cholecystectomy is increasingly performed in an ever ageing population; however, the risks are poorly quantified. The study aims to review the current evidence to quantify further the postoperative risk of cholecystectomy in the elderly population compared to younger patients. Method A systematic literature search of PubMed, EMBASE and the Cochrane Library databases were conducted including studies reporting laparoscopic cholecystectomy in the elderly population. A meta-analysis was reported in accordance with the recommendations of the Cochrane Library and PRISMA guidelines. Primary outcome was overall complications and secondary outcomes were conversion to open surgery, bile leaks, postoperative mortality and length of stay. Results This review identified 99 studies incorporating 326,517 patients. Increasing age was significantly associated with increased rates of overall complications (OR 2.37, CI95% 2.00–2.78), major complication (OR 1.79, CI95% 1.45–2.20), risk of conversion to open cholecystectomy (OR 2.17, CI95% 1.84–2.55), risk of bile leaks (OR 1.50, CI95% 1.07–2.10), risk of postoperative mortality (OR 7.20, CI95% 4.41–11.73) and was significantly associated with increased length of stay (MD 2.21 days, CI95% 1.24–3.18). Conclusion Postoperative outcomes such as overall and major complications appear to be significantly higher in all age cut-offs in this meta-analysis. This study demonstrated there is a sevenfold increase in perioperative mortality which increases by tenfold in patients > 80 years old. This study appears to confirm preconceived suspicions of higher risks in elderly patients undergoing cholecystectomy and may aid treatment planning and informed consent.

scholarly journals Lemierre’s Syndrome: A Thing of the Past?

2020 ◽  
Author(s):  
Nehal Dhaduk ◽  
Sudeepti Vedula ◽  
Aparna Govindan ◽  
Evelyne Kalyoussef
Keyword(s):  
Mortality Rate ◽  
Case Reports ◽  
Case Series ◽  
Lemierre’S Syndrome ◽  
Female Ratio ◽  
Clinical Presentations ◽  
Life Threatening ◽  
Lemierre's Syndrome ◽  
High Index Of Suspicion ◽  
Male To Female

Abstract Introduction: Lemierre’s syndrome (LS), infectious thrombophlebitis of the internal jugular vein, is a rare, life-threatening complication of oropharyngeal infections underrepresented in literature. We reviewed the etiology, clinical characteristics, treatment regiments and prognosis of LS in pediatric patients.Methods: PubMed and MEDLINE were searched from February 10, 2018 to July 28, 2018 for relevant studies. A systematic review was performed using the terms LS and pediatric case. Our criteria included reviews, case reports, and case series with patients under 18 years with a diagnosis of LS. Results: 70 cases of pediatric LS were identified. The male to female ratio was 1:1.7 with an average age of 10.7 years (5 weeks to 17 years). The most common initial clinical presentations were fever (90.0%), sore throat (38.6%), and neck pain or tenderness (35.7%), while the most frequent findings on physical exam were fever (31.4%) and neck involvement (28.6%). F. necrophorum was the predominant organism cultured (62.9%). Septic emboli were seen in 51.4% of cases with the lungs affected in 40 patients. Most commonly used treatments were antibiotics (91.4%) followed by anticoagulation (50.0%) and the overall mortality rate was 8.6%. The average time from initial presentation to diagnosis was 4.9 days. Conclusion: LS is a deadly condition with a staggering mortality rate despite the advent of antibiotic measures. Early identification and a high index of suspicion are necessary to prevent complications associated with LS. Despite its rarity it should remain on the differential for any patient with toxic signs and localized neck findings.

scholarly journals Experience with Tetanus in a Tertiary Care Hospital in Sudan: A Retrospective Review

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Mumen Abdalazim Dafallah ◽  
Esraa Ahmed Ragab ◽  
Omer Ali Mohamed Ahmed Elawad
Keyword(s):  
Mortality Rate ◽  
Rural Areas ◽  
Tertiary Care ◽  
Cardiovascular Complications ◽  
Lower Limbs ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Care Hospital ◽  
Female Ratio ◽  
Central Sudan

Introduction. Tetanus is still a major health issue, especially in rural areas, and is associated with high morbidity and mortality rate. This study was conducted to describe the pattern of presentation and treatment outcome among adult patients infected with tetanus in our environment. Materials and Methods. This is a descriptive retrospective hospital-based study conducted in Wad Medani teaching hospital, central Sudan. A total of thirty-one patients were enrolled in this study in the period between January 2018 and December 2020. Results. Thirty-one patients were infected with tetanus during the study period. They were 23 (74.2%) males and 8 (25.8%) females with a male-to-female ratio of 2.875 : 1. Their ages ranged from 20 to 70 years, and most of them (48.4%) were free workers. Acute injuries were the most common portal of entry (64.51%), and commonly involved the lower limbs (48.38%). Lock jaw (54.8%), muscle spasm (51.6%), and neck pain and stiffness (45.2%) were the most common presentation. Supportive measures along with surgical toilet and debridement, human tetanus immunoglobulin, antibiotics, and muscle relaxants were initiated in all patients. The most common antibiotics used were Penicillin V and Ceftriaxone. A muscle relaxant was administered to aid in relieving the spasms. Complication rate was 61.29% and included pulmonary and cardiovascular complications. Fifteen patients died accounting for an overall mortality rate of 48.4%. Conclusions. Tetanus remains a disease with high morbidity and mortality. The unknown/incomplete vaccination status among study participants, inadequate management, and lack of equipped resources lead to a devastating outcome as in Sudan.

scholarly journals Exxtraintestinal Manifestations of Crohn's Disease in Bangladesh

2013 ◽  
Vol 21 (2) ◽  
pp. 58-59
Author(s):  
Rajib Barua ◽  
Dewan Saifuddin Ahmed ◽  
ASMA Raihan ◽  
Mohammad Abul Kalam Azad ◽  
Sadesh Kumar Chakrovortty ◽  
...  
Keyword(s):  
Early Recognition ◽  
Individual Case ◽  
Asia Pacific ◽  
Aphthous Ulcer ◽  
Extraintestinal Manifestations ◽  
Extraintestinal Manifestation ◽  
Female Ratio ◽  
Important Differential Diagnosis ◽  
Medical University ◽  
Male To Female

Crohn’s disease has been considered to be uncommon in Asia Pacific region The study was undertaken to know the extraintestinal manifestations of Crohn’s disease in Bangladesh and to compare the result with that of other Asian and Western countries. This was an observational study consisting of patients seen in the department of gastroenterology, Bangabandhu Sheikh Mujib Medical University for 20 years (between 1991 and 2010). Individual case records were carefully reviewed with regard to gender, sex and extraintestinal manifestations. A total of 41 patients with Crohn’s disease were identified. 70.7% were male and 29.3% were female with male to female ratio was 2.4:1. Mean age was 34±11.8 years and peak age group was 21-30 years. The chief extraintestinal manifestations were arthritis, aphthous ulcer in the oral cavity, erythema nodosum and episcleritis. Arthritis was the most frequent among the extraintestinal manifestations. So, Crohn’s disease should be considered as an important differential diagnosis when a patient presents with bowel symptoms associated with extraintestinal manifestation and thus early recognition and treatment could be possible. DOI: http://dx.doi.org/10.3329/bjmed.v21i2.13611 Bangladesh J Medicine 2010; 21: 58-59

scholarly journals P.033 Biopsy versus subtotal versus gross total resection in patients with low-grade glioma: a systematic review and meta-analysis

2018 ◽  
Vol 45 (s2) ◽  
pp. S24-S24
Author(s):  
K Yang ◽  
S Nath ◽  
A Koziarz ◽  
M Sourour ◽  
D Catana ◽  
...  
Keyword(s):  
Malignant Transformation ◽  
Seizure Control ◽  
Meta Analysis ◽  
Postoperative Mortality ◽  
Progression Free Survival ◽  
Low Grade Glioma ◽  
Cochrane Library ◽  
Low Grade ◽  
Free Survival ◽  
The Cochrane Library

Background: The role of extent of surgical resection (EOR) on clinical outcomes in patients with low-grade glioma requires further examination. Methods: We systematically searched MEDLINE, Embase, and the Cochrane Library for studies published between January 1, 1990 and January 5, 2018 on predefined patient outcomes regarding different EOR of low-grade glioma. Results: Our literature search yielded 60 studies including 13,289 patients. Pooled estimates of overall survival showed an increase from 3.79 years (95% CI, 2.37–5.22) in the biopsy group to 6.68 years (95% CI, 4.19–9.16) in STR to 10.65 years (95% CI, 6.78–14.52) in GTR. When compared to STR, GTR prolonged progression-free survival by 2.08 years (95% CI, 0.26–3.89; P=0.025). Pooled estimates of seizure control showed an improvement from 47.8% (95% CI, 26.7–69.6) with biopsy to 54.2% (95% CI, 48.7–59.6) with STR to 81.0% (95% CI, 74.6–86.2) with GTR. Compared to STR, GTR delayed malignant transformation (RR, 0.43; 95% CI, 0.20–0.93; P=0.032), without increasing postoperative mortality (RR, 0.38; 95% CI, 0.07–1.97; P=0.250) or morbidity (RR, 1.22; 95% CI, 0.65–2.28; P=0.540). Conclusions: Among patients with low grade gliomas, higher degrees of safe EOR, were associated with longer overall and progression-free survival, better seizure control, and delayed malignant transformation, without increased mortality or morbidity.

scholarly journals Childhood Intussusception: A Prospective Institutional Study at BPKIHS

2011 ◽  
Vol 31 (1) ◽  
pp. 6-10 ◽  
Author(s):  
VC Shakya ◽  
CS Agrawal ◽  
AK Sinha ◽  
NK Bhatta ◽  
S Khaniya ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Abdominal Mass ◽  
Delayed Diagnosis ◽  
Health Sciences ◽  
Lead Point ◽  
Female Ratio ◽  
Infancy And Childhood ◽  
Ileocaecal Junction ◽  
Time Of Presentation ◽  
Male To Female

Introduction: Intussusception is the commonest cause of bowel obstruction in infancy and childhood. The present study deals with the presentation, management and outcome of children presenting with intussusception at the Department of Surgery, B. P. Koirala Institute of Health Sciences, Dharan, Nepal. Materials and Methods: Forty-seven children presenting at Department of Surgery, B. P. Koirala Institute of Health Sciences over a 5-year period were prospectively studied. Results: There were 27 (58.6%) males and 20 (41.4%) females, with male-to-female ratio of 1.4:1. The ages ranged from 2 months to 13 years, with a median age of 30 months. The mean duration of presentation was 10.7 ± 30.66 days (range 1-180 days). The triad of abdominal pain, bloody mucoid stools and palpable abdominal mass was seen in 10 (21%) of the cases. Surgical exploration was done in 42 (89.3%) patients. The commonest lead point was non-specific hyperplastic lymph nodes, occurring in 22 (54.3%), followed by idiopathic variety (16.6%), Meckel's diverticulum (9.5%), ileocaecal junction (7.1%), submucous lipoma (4.7%), Non- Hodgkin's lymphoma (4.7%), appendix (2.3%) and a mucosal polyp (2.3%). Overall mortality rate was 6.3%. Conclusion: The presenting age group and the time of presentation are higher than other studies. The mortality rate of 6.3% is comparable to other studies in the developing world. Earlier presentation could have avoided surgery, with a higher possibility of cases being managed conservatively. Key words: Delayed diagnosis; intussusception; lead point DOI: 10.3126/jnps.v31i1.3682J Nep Paedtr Soc 2010;31(1):6-10

Medulloblastoma in childhood: an epidemiological study

1984 ◽  
Vol 61 (4) ◽  
pp. 657-664 ◽  
Author(s):  
Jacqueline R. Farwell ◽  
George J. Dohrmann ◽  
John T. Flannery
Keyword(s):  
Mortality Rate ◽  
Survival Rates ◽  
Female Ratio ◽  
Tumor Registry ◽  
Content Type ◽  
Probability Of Survival ◽  
Number Of Children ◽  
Male To Female ◽  
Fine Print

✓ The authors have reviewed 143 cases of medulloblastoma in children aged 19 years or younger who were treated in a 42-year period and reported in the Connecticut Tumor Registry. About 20 cases have occurred in each 5-year period since 1950, but 31 were seen between 1955 and 1959. Correspondingly, an excessive number of children born in the period 1954 to 1958 have developed medulloblastomas. A relationship to polio vaccine contaminated with SV40 virus may exist. Children with medulloblastomas had an increased number of immediate family members with brain tumors, leukemia, and childhood cancer when compared to controls. In this series, the male to female ratio was 1.33:1. Average age at diagnosis was 6½ years, with most children being diagnosed at 3 years old and fewer cases appearing in each successive hemidecade from birth to 20 years of age. Probability of survival at 6 months was 0.687; at 1 year, 0.444; at 2 years, 0.314; and at 5 years, 0.222. Survival probability was statistically significantly better in the years 1968 to 1977 than in previous decades, in part due to fewer autopsy diagnoses and lowered operative mortality, but also due to a decreased mortality rate in children several years after diagnosis. Fifty-one percent were treated with operation and irradiation, 17% with operation alone, 12% with irradiation alone, and 5% with operation, irradiation, and chemotherapy. Fifteen percent were not treated. One- and 5-year survival rates in patients with operation and irradiation were, respectively, 0.615 and 0.307; with operation, 0.125 and 0.042; with irradiation, 0.688 and 0.277; and with operation, irradiation, and chemotherapy, 0.857 and 0.643. All seven children who received chemotherapy were diagnosed after 1968, and five are still alive. Perhaps due to short follow-up time, the course and mortality rate of children treated with all three modalities were not statistically significantly different from those of children treated since 1968 with operation and radiation therapy.

scholarly journals Epidemiologic Characteristics of Suicide in Panama, 2007–2016

Medicina ◽  
2020 ◽  
Vol 56 (9) ◽  
pp. 442
Author(s):  
Virginia Núñez-Samudio ◽  
Aris Jiménez-Domínguez ◽  
Humberto López Castillo ◽  
Iván Landires
Keyword(s):  
Mortality Rate ◽  
Statistical Significance ◽  
Age Groups ◽  
Multidimensional Poverty ◽  
Suicide Mortality ◽  
Female Ratio ◽  
Multidimensional Poverty Index ◽  
Suicide Rates ◽  
Male To Female ◽  
Related Mortality

Background and objectives: We aim to describe the demographic characteristics associated with suicide in Panama, to estimate the suicide mortality rate and years of potential life lost (YPLL) to suicide, and to explore the correlation of suicide rates with the Multidimensional Poverty Index (MPI). We present a descriptive retrospective epidemiological report of suicide-related mortality (Panama, 2007–2016). Materials and Methods: Data were matched-merged to calculate unadjusted suicide mortality rates (overall, and by sex, age groups, and administrative region), YPLL, and coefficients (r) for the correlation of MPI and suicide rates. Results: There were 1475 deaths by suicide (86% among men, 47% between 20 and 39 years). The average mortality rate was estimated at 3.91 per 100,000 population with an average YPLL rate of 3.79 per 1000 population. There was a statistically significant trend to reduce YPLL over time (r = −0.93; p< 0.001). Exploratory analyses did not show a significant correlation between the MPI and suicide rates. Our study showed a 6:1 male-to-female ratio of suicide, mostly affecting the age groups of 20–29 and over 80 years. Conclusions: Exploratory analyses on the correlation of the MPI and the suicide rates did not achieve statistical significance, and alternative explanations, such as access to pesticides and alcohol, were further explored to inform potential interventions.

scholarly journals Results of laparoscopic and open distal gastrectomies in patients with gastric cancer. Meta-analysis of Russian and European studies.

2021 ◽  
Vol 67 (2) ◽  
pp. 181-189
Author(s):  
Stanislav Panin ◽  
Mihail Postolov ◽  
Andrey Beburishvili ◽  
Andrey Fedorov ◽  
Alexandr Bykov ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Nodes ◽  
Meta Analysis ◽  
Surgical Techniques ◽  
Postoperative Mortality ◽  
Cochrane Library ◽  
Sufficient Information ◽  
European Studies ◽  
High Level ◽  
The Cochrane Library

Objective: to compare the results of laparoscopic and open distal gastrectomy in patients with gastric cancer according to Russian and European studies. Materials and methods: we searched the e-library, the Cochrane Library and PubMed. Literary references, tables of contents of specialized journals and protocols of research not yet completed have been studied. Statistical calculations (mean difference - MD, odds ratios - OR, 95 % confidence interval – 95 % CI) and meta-analysis graphs were performed using RevMan 5.4 software. Results: ten primary sources met the inclusion criteria (4 researches from the Russian Federation and 6 from other European countries). Laparoscopic and open gastric resections did not differ in the number of lymph nodes removed (MD = ‒1.31, 95 % CI from 3.51 to 0.89, p = 0.24). At the same time, laparoscopic operations are accompanied by less intraoperative blood loss (MD = –163, 95 % CI ‒268 to ‒57, p = 0.002), and open operations are shorter (MD = –38, 95 % CI –71 to ‒17, p = 0.004). The period of hospital stay is shorter after laparoscopic resections (MD = –4.1, 95 % CI –8.02 to –0.14, p = 0.04). Differences in mortality are not statistically significant (OR = 0.83, 95 % CI from 0.45 to 1.54, p = 0.55), but significantly lower after laparoscopic operations (2.3 %, 12/516) than after open (3.4 %, 92/2702), as well as the frequency of complications - 31.8 % (153/481) and 35.7 % (935/2658), respectively (OR = 1.05, 95 % CI from 0.84 to 1.37, p = 0.67). The overall five-year survival rate after laparoscopic operations varies from 48.1 % to 63.6 %, after laparotomy - from 43.4 % to 55.7 %. However, scattered and incomplete information on long-term outcomes did not allow a formal meta-analysis on comparative survival at this stage. The high level of performance of technically complex surgical techniques made it possible to significantly reduce the differences in duration between open and laparoscopic interventions (RS = ‒27, 95 % CI from 77 to 22, p = 0.28) and the duration of inpatient treatment after minimally invasive operations (RS = - 8.97, 95 % CI from ‒13.48 to ‒4.47, p <0.0001) in the subgroup of domestic studies. Conclusion: the direct results of laparoscopic subtotal distal gastric resections in Russian and European studies do not differ in terms of the amount of harvested lymph nodes, the number of complications and postoperative mortality. It is difficult to reliably assess the life expectancy of patients due to the lack of sufficient information at this stage, which requires the continuation of further research.

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