Mid-term results of vascular ring surgery

2021 ◽  
pp. 1-6
Author(s):  
Gabriel Amir ◽  
Niv Soffair ◽  
Elchanan Bruckheimer ◽  
Elchanan Nachum ◽  
Tommy Shoenfeld ◽  
...  
Keyword(s):  
Respiratory Symptoms ◽  
Respiratory Infections ◽  
Vascular Ring ◽  
Retrospective Chart Review ◽  
Residual Symptoms ◽  
Vascular Rings ◽  
Anatomic Variant ◽  
Age At Surgery ◽  
Mid Term Results

Abstract Background: Vascular rings cause respiratory symptoms in children. Treatment consists of surgical division; however, data regarding mid-term results are scarce. The purpose of this study was to evaluate clinical results of vascular ring surgery. Methods: Retrospective chart review of consecutive patients who underwent vascular ring surgery. Mid-term follow-up consisted of clinic visits and telephone questionnaire over a 1-year period sampling at five points in time. Results: Follow-up of 85 patients who underwent vascular rings surgery revealed significant symptomatic improvement within 6 months. In total, 50% were symptomatic to some degree at their last documented clinic visit complaining of stridor (36.8%), cough (34.2%), wheezing (10.5%), dyspnoea on exertion (10.5%), or recurrent respiratory infections (23.7%). By telephone questionnaires, 83% described a significant improvement in respiratory symptoms, 63.4% had some residual symptoms, 36.6% stridor, 38.8% chronic cough, 32.4% bronchodilator use,18.3% had at least one episode of pneumonia per year, 31% of children had dyspnoea or respiratory limitation, and 12.7% while doing physical activities. We found no association between the age at surgery or anatomic variant to the presence of symptoms at mid-term follow-up. Conclusions: Surgical division of vascular rings results in significant clinical improvement within 1 year; nevertheless, some patients remain symptomatic to some degree. We found no association between the age at surgery or anatomic variant to the presence of symptoms at mid-term follow-up. Further evaluation is warranted to assess the nature of residual symptoms and explore whether anatomical causes can be identified leading to surgical modifications.

Vascular ring surgery – can we do better?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Amir ◽  
N Soffair ◽  
G Frenkel ◽  
E Bruckheimer ◽  
E Nachum ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Respiratory Symptoms ◽  
Ductus Arteriosus ◽  
Vascular Ring ◽  
Symptomatic Relief ◽  
Mirror Image ◽  
Vascular Rings ◽  
Number Of Patients ◽  
Age At Surgery

Abstract Background Vascular anomalies of the Aortic arch can cause respiratory symptoms in children due to tracheal compression. Treatment consists of division of the vascular rings, nevertheless data regarding mid- term results is scarce. The purpose of this study was to evaluate clinical results of vascular ring surgery. Methods Between2007–2014, 85 children underwent vascular ring surgery. 51 had Double Aortic Arch (DAA, 60%), 31 Right Arch with Aberrant Subclavian Artery (RAA & ALSA, 36.5%) and 3 had RAA, mirror image branching & left ductus arteriosus (3.5%). Mean age and weight at operation were 12.4±13months and 8.6±4.1 kg respectively. Mid-term follow-up included clinical follow up by a pulmonologist (38 patients, 44.7%) and a telephone questionnaire (71 patients, 83%) performed 57±25.7 months after surgery. Results In most patients, symptomatic relief occurred in less than 6 months (table 1). Mid –term follow up revealed that although most parents described a significant improvement in their child's respiratory symptoms (95%), a significant number of patients described some residual respiratory symptoms (table 2). We did not find any significant association between age at surgery (under 6 month), or vascular ring anatomy (DAA vs. RAA&ASA) and the presence of residual symptoms at follow up Conclusions Surgical division of vascular rings results in a significant clinical improvement within one year, nevertheless many patients remain symptomatic to some degree. We found no association between the age at surgery or anatomic variant to the presence of symptoms in mid- term follow up. Further evaluation whether a more aggressive surgical approach is warranted in order to decrease the incidence long-term symptoms. Funding Acknowledgement Type of funding source: None

scholarly journals A 12-month follow-up of an influenza vaccination campaign based on voluntary adherence: report on upper-respiratory symptoms among volunteers and non-volunteers

2001 ◽  
Vol 119 (4) ◽  
pp. 142-145 ◽  
Author(s):  
Páris Ali Ramadan ◽  
Francisco Barreto de Araújo ◽  
Mario Ferreira Junior
Keyword(s):  
Respiratory Symptoms ◽  
Respiratory Infections ◽  
Vaccination Campaign ◽  
Influenza Like Illness ◽  
Upper Respiratory Infections ◽  
Medical Consultations ◽  
History Of ◽  
Upper Respiratory ◽  
Upper Respiratory Symptoms

CONTEXT: Routine immunization of groups at high risk for influenza has been progressively implemented as a matter of Brazilian public health policy. Although the benefits of the vaccination for healthy young adults are still controversial, it has been offered yearly to hundreds of thousands of Brazilian workers, generally as part of wellness initiatives in the workplace. OBJECTIVE: To study the characteristics of subjects that accepted or refused to be vaccinated against influenza and to report on respiratory symptoms in both groups, one year after the campaign date. DESIGN: A prospective observational study. SETTING: Workers at a subsidiary of an international bank in São Paulo, Brazil. PARTICIPANTS: 124 persons that did not accept and 145 that voluntarily accepted the vaccine completed 12 months of follow-up. MAIN MEASUREMENTS: Data concerning gender, age, tobacco use, and any history of chronic respiratory illness such as asthma, bronchitis, rhinitis, and repetitive upper-respiratory infections, were recorded at the time of vaccination. After that, workers were asked monthly by questionnaire or telephone about respiratory symptoms, days of work lost and medical consultations. RESULTS: The results showed statistically significant differences regarding age (P = 0.004) with the vaccinated group (V) being younger than the non-vaccinated (NV) one, and with reference to previous repetitive upper-respiratory infections being higher among the V group (P < 0.0001). During the follow-up, the V group reported more occurrences of upper respiratory symptoms (P < 0.0001), due to both non-influenza (P < 0.0001) and influenza-like illness (P = 0.045). Differences were also found between V and NV groups concerning days off work and number of medical consultations due to upper-respiratory symptoms and non-influenza illness. Gender and history of repetitive upper-respiratory infections were the best predictors of influenza-like illness-related events. CONCLUSIONS: The making of previous reference to repetitive upper-respiratory infections was a major difference between those who accepted or rejected the vaccine. The vaccination itself was not sufficient to reduce the number of occurrences of respiratory symptoms and related absenteeism to levels similar to those found among non-vaccinated people.

Video-Assisted Thoracoscopic Division of Vascular Rings in Pediatric Patients

2005 ◽  
Vol 71 (4) ◽  
pp. 289-291 ◽  
Author(s):  
Curt S. Koontz ◽  
Amina Bhatia ◽  
Joe Forbess ◽  
Mark L. Wulkan
Keyword(s):  
Aortic Arch ◽  
Pediatric Patients ◽  
Vascular Ring ◽  
Operating Time ◽  
Surgical Techniques ◽  
Retrospective Chart Review ◽  
Ligamentum Arteriosum ◽  
Vascular Rings ◽  
Computed Tomographic ◽  
Video Assisted

Vascular rings are usually repaired via left thoracotomy. We report our series of pediatric patients with vascular rings that were repaired thoracoscopically. From February 2002 to September 2004, 13 patients underwent video-assisted thoracoscopic surgical techniques (VATS) division of their vascular ring. Chest magnetic resonance arterography (MRA) and/or computed tomographic arteriography (CTA) were used to evaluate the vascular ring in most patients. Patients were chosen for VATS repair based on surgeon's choice and type of vascular ring. Data are expressed as mean ± SD. The Children's Healthcare of Atlanta Institutional Review Board approved this retrospective chart review. Age and weight was 1.5 ± 1.8 years (range: 4 months–17 years) and 16.0 ± 12.5 kg (range: 6.0–22.1 kg), respectively (n = 13). Associated diseases included congenital heart disease (n = 2). Symptoms included respiratory complaints (n = 6), dysphagia (n = 2), dysphagia and shortness of breath (n = 1), pneumonia (n = 2), tracheal deviation (n = 1), and one patient was asymptomatic. Vascular ring types included double aortic arch (n = 4) and right aortic arch with an aberrant left subclavian artery and a left ligamentum arteriosum (n = 9). Operating time was 70 ± 20 minutes (range: 46–122 minutes). One patient had to be opened because of a large arch. Length of stay was 1.9 ± 0.9 days (range: 1–3 days). There were no complications, and all patients improved clinically at follow-up. Thoracoscopic repair of certain types of vascular rings seems to be safe and effective in children. More patients, however, need to be studied.

scholarly journals Epilepsy surgery in tuberous sclerosis complex: the BC Children’s Hospital experience

2015 ◽  
Vol 42 (S1) ◽  
pp. S14-S14
Author(s):  
C Wilbur ◽  
C Sanguansermsri ◽  
H Chable ◽  
A Mihaela ◽  
P Steinbok ◽  
...  
Keyword(s):  
Tuberous Sclerosis ◽  
Epilepsy Surgery ◽  
Tuberous Sclerosis Complex ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Seizure Outcome ◽  
Corpus Callosotomy ◽  
Age At Surgery ◽  
Second Resection

Background: Epilepsy occurs in up to 90% of patients with Tuberous Sclerosis Complex (TSC) and is often refractory to medications. Our objective was to assess the safety and outcome of epilepsy surgery in children with TSC at our institution. Methods: We performed a systematic, retrospective chart review of children with TSC who underwent epilepsy surgery at our institution. Patients were identified through epilepsy and clinical neurophysiology databases. Results: 19 patients (out of 81 with TSC) underwent surgery between 1995-2014. Median age at surgery was 4.2 (Range 1.1-15.6) years, with patients having failed a median 4 (Range 0-10) anti-seizure medications. Surgery comprised corpus callosotomy in 2 and resection of one or more tubers in 17. 2 patients had a subsequent second resection. Minor neurologic deficits occurred after 14% of surgeries. Median follow-up was 2.4 years (Range 0.3 -13.8 years) following surgery . At last follow-up, 47% were seizure free, including 2 patients off anti-seizure medication. Conclusions: Epilepsy surgery is safe and effective in carefully selected TSC patients, with the majority having a good seizure outcome. Children with epilepsy secondary to TSC should be referred for epilepsy surgery assessment.

A single centre experience with an evolving approach for the repair of coarctation of the aorta

2019 ◽  
Vol 29 (7) ◽  
pp. 885-887
Author(s):  
Kelly Costopoulos ◽  
Joseph Philip ◽  
Dalia Lopez-Colon ◽  
Giridhar Kaliki ◽  
Arun Chandran ◽  
...  
Keyword(s):  
Chart Review ◽  
Median Sternotomy ◽  
Coarctation Of The Aorta ◽  
Retrospective Chart Review ◽  
Single Centre ◽  
Vocal Cord Paresis ◽  
Age At Surgery ◽  
Single Centre Experience ◽  
Lateral Thoracotomy

AbstractBackground:Isolated coarctation of the aorta can be repaired by either lateral thoracotomy or sternotomy approach with end-to-end anastomosis. Most commonly, neonates with coarctation of the aorta also have hypoplasia of the arch, requiring median sternotomy and extended end-to-side anastomosis with arch augmentation. The aim of this study was to describe our experience as the institution adopted the median sternotomy approach for repair, by reviewing complications, mortality, and reintervention.Methods:Retrospective chart review of 66 patients aged 0–1 year who had arch repair performed by a single surgeon over an 8-year period was performed. Median age at surgery was 22 days (4–232) and median weight was 3.08 kg (1.25–8.0). Forty-one (62%) patients underwent median sternotomy.Results:There was 1 death from a noncardiac cause. Eighteen per cent of our patients were ≤2.5 kg. Vocal cord paresis occurred in 16% of patients under 2.5 kg and 9.5% of patients 2.5 kg or above at the time of surgery. Hypertension at 6-month follow-up was greater in patients under 2.5 kg (44%) than patients 2.5 kg or above (15%). Total surgical reintervention rate was 6%. For patients above 2.5 kg, the surgical reintervention rate was 5.4% and for patients below 2.5 kg, the surgical reintervention rate was 8.3%.Conclusion:We concluded that for neonates with coarctation of the aorta and hypoplastic arch, median sternotomy is a safe surgical approach with low morbidity and mortality with the possible advantage of reduced surgical re-intervention and mortality in the population below 2.5 kg.

Follow-up of Acute Respiratory Disorders in Cyclists Competing in the 100th Giro d’Italia

2020 ◽  
Author(s):  
Luca Pollastri ◽  
Claudio Macaluso ◽  
Giovanni Vinetti ◽  
Giovanni Tredici ◽  
Francesca Lanfranconi
Keyword(s):  
Nitric Oxide ◽  
Respiratory Symptoms ◽  
Respiratory Infections ◽  
Clinical History ◽  
Exhaled Nitric Oxide ◽  
Respiratory Disorder ◽  
Non Invasive ◽  
Respiratory Inflammation ◽  
Elite Cyclists

AbstractAcute respiratory disorder is a common sub-clinical condition affecting elite cyclists. Monitoring the perturbations of the immunological cells in the respiratory tract, indicative of a likely proinflammatory state, during an International Cycling Union world tour is a challenging task. The aim of this study was to follow up on the sign and symptoms of upper way respiratory infections with or without asthma, using non-invasive methods, during a 21-day race (100° Giro d’Italia, 2017). Nine male elite cyclists of the Bahrain Merida Team were evaluated before the training season and daily during the race. Clinical history, skin prick and spirometric test, acute respiratory symptoms were measured using validated questionnaires, and values of fraction of exhaled nitric oxide were collected longitudinally. Four of the 9 athletes had allergies with/or consistent abnormal spirometric curves before the race. During the race, 5 athletes had a fraction of exhaled nitric oxide values >20 ppb which correlated with respiratory symptoms collected through questionnaires. These were related to the environmental characteristics of the places travelled through in the race. The athletes with a predisposition to chronic respiratory inflammation in the pre-competitive season were more likely to develop acute respiratory symptoms during the race

scholarly journals Ten-Year Minimum Follow-Up of 4-Corner Fusion for SLAC and SNAC Wrist

Hand ◽  
2016 ◽  
Vol 12 (6) ◽  
pp. 568-572 ◽  
Author(s):  
Purnell Traverso ◽  
Anselm Wong ◽  
Ronit Wollstein ◽  
Lois Carlson ◽  
Duffield Ashmead ◽  
...  
Keyword(s):  
Joint Destruction ◽  
Retrospective Chart Review ◽  
Functional Results ◽  
Long Term Results ◽  
Limited Information ◽  
Age At Surgery ◽  
Long Term Follow Up ◽  
Term Evaluation

Background: Scapholunate advanced collapse (SLAC) of the wrist is the most common degenerative condition of the wrist. Four-corner fusion (4CF) is performed as salvage surgery, though there is limited information on its long-term results. We hypothesized that 4CF is a durable surgery with good clinical long-term function. Methods: A retrospective chart review of patients undergoing 4CF as well as an interview and recent radiographs were obtained. Patients with a follow-up period of less than 10 years were excluded. Long-term evaluation included standard wrist radiographs, wrist range of motion, and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Radiographs were evaluated and described by the Kellgren-Lawrence classification. Results: Four hundred eighty-nine wrists underwent a 4CF for SLAC wrist from 1982 to 2003. Twelve patients (15 wrists) were available for follow-up. Average age at surgery was 49.1 years (range, 25-67 years). Average follow-up postsurgery was 18 years (11-27). Scapholunate advanced collapse was the etiology in 13 wrists and scaphoid nonunion advanced collapse in 2 wrists. Average extension/flexion arc was 68.6° (0°-96°), and radial/ulnar deviation arc was 32.9° (0°-5°). QuickDASH scores averaged 7.8 (range, 0-32.5), with only 1 score above 16. Seventy-three percent of radiographs showed minimal to moderate joint destruction, and 27% showed severe joint destruction. Conclusions: Scaphoid excision and 4CF remains a reliable procedure for patients with advanced wrist arthritis. Functional results were good at long-term follow-up despite radiographic changes in the radiolunate joint in 73% of patients. Patient satisfaction was high, and functional impairment was low.

Vision and Reading Deficits in Post-Concussion Patients: A Retrospective Analysis

2015 ◽  
pp. 206-213
Keyword(s):  
Retrospective Chart Review ◽  
Health Examination ◽  
Common Symptom ◽  
Reading Deficits ◽  
Grade Levels ◽  
Convergence Insufficiency ◽  
Return To Learn ◽  
Vision Deficits ◽  
Accommodative Facility

The prevalence of vision deficits in the pediatric/young adult concussion population in the private optometric practice setting remains unknown. Thus, a retrospective chart review in this area was conducted in the practice of the first author. Twenty-five consecutive patients with a medical diagnosis of concussion received a comprehensive vision and ocular health examination, which also included an objectively-based Visagraph reading assessment and clinical vergence/accommodative facility testing. Three primary categories of oculomotor-based deficits were found: convergence insufficiency (56%), accommodative insufficiency (76%), and oculomotor-based reading dysfunctions (68-82%). The most common symptom was headaches (84%), with 25% of the symptoms related to reading. 68% (15/22) were categorized as reading at least 2 grade levels below their current school grade level for reading eye movements based on the Visagraph findings. These overall findings are consistent with the general oculomotor-based/reading findings in the concussion/mTBI literature. The present results have important practical ramifications regarding the importance of preconcussion baseline oculomotor and Visagraph testing, as well as post-concussion follow-up testing, to help assess a student’s ability to return-to-learn (RTL).

scholarly journals FRI0495 FOLLOW UP OF INTERSTITIAL PNEUMONIA WITH AUTOIMMUNE FEATURES – THE EXPERIENCE OF ONE CENTRE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 846.3-846
Author(s):  
N. Madeira ◽  
M. Alvarenga Santos ◽  
L. Cunha Miranda ◽  
S. Clemente ◽  
S. Furtado
Keyword(s):  
Interstitial Pneumonia ◽  
Respiratory Symptoms ◽  
Interstitial Lung Diseases ◽  
European Respiratory Society ◽  
High Resolution Computed Tomography ◽  
Disease Evolution ◽  
Clinical Criteria ◽  
Clinical Evolution ◽  
Relative Decline

Background:Interstitial Lung Diseases (ILD) may present features suggesting an underlying autoimmune process, which seem to differentiate them from idiopathic interstitial pneumonias, although without fully meeting the classification criteria (CC) for a specific connective tissue disease. Different terms had been used to describe these conditions and, to reach a consensus, the European Respiratory Society/American Thoracic Society proposed the CC for an entity named Interstitial Pneumonia with Autoimmune Features (IPAF). Clinical evolution and prognosis of this entity are still poorly understood.Objectives:To evaluate clinical evolution and prognosis of a population of patients with IPAF.Methods:Retrospective analysis of clinical files of patients followed by the Pulmonology Department since 02/2012 until 06/2019, who met the CC for IPAF, regarding clinical, functional and radiological evolution. Patients were considered to have a progressive phenotype in 24±3 months from their 1stevaluation if they fulfil 1 of the 4 criteria: relative decline in FVC ≥10% predicted; relative decline in FVC ≥5–<10% predicted and worsened respiratory symptoms; relative decline in FVC ≥5–<10% predicted and increased extent of fibrosis on High-resolution Computed Tomography (HRCT); worsened respiratory symptoms and increased extent of fibrosis on HRCT.Results:22 (7.4%) of 296 ILD patients met IPAF CC. 59.0% were female with an age at the 1stevaluation of 66.7±12.4 years. They were all non-smokers (63.6%) or ex-smokers (36.4%). Serologic and morphologic criteria were both present in 21 (95.4%) and clinical criteria in 5 patients (22.7%). Antinuclear antibodies (ANA) were identified in 19, rheumatoid factor in 4, SSA in 3 and anti-Jo-1 in 1 patient. HRCT patterns were identified in 21 patients: 15 nonspecific interstitial pneumonia (NSIP), 5 organizing pneumonia (OP) and 2 lymphocytic interstitial pneumonia (LIP). One NSIP and 1 LIP identified on HRCT were confirmed by histopathology. Three patients had inflammatory arthritis and 2 had Raynaud’s phenomenon. Immunosuppressive therapy was introduced in most cases (18 patients, including systemic corticotherapy in 17, azathioprine in 4, mycophenolate mofetil in 1), azithromycin was prescribed in 2 patients and 3 remained without therapy. Regarding the follow up at 24±3 months from the 1stevaluation (3 patients were excluded due to too recent follow-up), 4 patients (18.2%) had progressive phenotype, 7 (31.8%) had a favourable evolution and 3 (13.6%) patients had died. During a follow-up of 31.1±19.8 months, this number rose to 6 patients (27.3%), all of them died by respiratory cause and had NSIP pattern. No differences were found in age, last FVC, therapy and time of disease evolution between those who died and the others.Conclusion:Our study showed that a small proportion of IPAF patients had a progressive phenotype and the NSIP pattern seemed to be a poor prognosis factor for survival.References:[1]Ito Y, Arita M, Kumagai S, et al. Serological and morphological prognostic factors in patients with interstitial pneumonia with autoimmune features. BMC Pulm Med 2017; 17:111 10.1186/s12890-017-0453-zDisclosure of Interests:None declared

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