Outcomes of Individuals with Transfemoral and Contralateral Transtibial Amputation due to Dysvascular Etiologies

2009 ◽  
Vol 33 (1) ◽  
pp. 33-40 ◽  
Author(s):  
Sukhinder Bhangu ◽  
Michael Devlin ◽  
Tim Pauley
Keyword(s):  
Functional Outcome ◽  
Scale Score ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Walk Test ◽  
Amputation Level ◽  
Significant Difference ◽  
Transfemoral Prosthesis ◽  
Minute Walk

Objective: To evaluate the functional outcome of individuals with transfemoral and contralateral transtibial amputations secondary to peripheral vascular disease.Methods: A retrospective chart review followed by phone interview. The primary outcome measures were the discharge 2-minute walk test, Frenchay Activities Index, and the Houghton Scale.Results: There were 31 dysvascular individuals identified to have a combination of transfemoral/transtibial (TF/TT) amputation admitted to our institution for rehabilitation from February 1998 to June 2007. The mortality at follow up was 68%. There were eight surviving amputees. The average 2-minute walk test score was 31.9 m at the time of discharge from our inpatient program. Of these, the average Frenchay Activities Index was 15.3. The average Houghton Scale score for use of the transtibial prosthesis alone was 2.1. The average Houghton Scale score for use of both prostheses was 1.5. Comparisons between groups based on initial amputation level revealed a significant difference of being fitted with a transfemoral prosthesis. Those whom initially had a TT amputation were less likely to ultimately be fitted with a TF prosthesis ( X21,n=31 = 4.76, p < 0.05).Conclusion: The overall functional outcome of individuals with a combination of TF/TT amputation due to dysvascular causes is poor. These individuals have a low level of ambulation, activity, and prosthetic use.

scholarly journals Incidence, Etiology, and Outcomes of Altered Mental Status in the Perioperative Setting of Liver Transplantation

2017 ◽  
Vol 8 (3) ◽  
pp. 124-128 ◽  
Author(s):  
Christopher Lening ◽  
Vatche G. Agopian ◽  
Ronald W. Busuttil ◽  
David S. Liebeskind
Keyword(s):  
Liver Transplantation ◽  
Mental Status ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Altered Mental Status ◽  
Sudden Onset ◽  
Transplant Patients ◽  
Significant Difference ◽  
Presentation Group

Background: We examined neurologic consultations for altered mental status in perioperative liver transplant patients to determine the overall incidence, to assess the presumed etiology and the data reviewed to determine that etiology, and to assess outcomes. Methods: Retrospective chart review conducted for all 728 adult patients receiving orthotopic liver transplantation (OLT) between January 01, 2010, to June 30, 2014, with identification of 218 receiving neurology consults between 30 days pre-OLT and 90 days post-OLT, with review of all records necessary to determine initial findings and follow-up examination. Results: Seventy-three consults for 69 patients were identified, with 27 felt to be altered since a procedure, 20 with sudden-onset altered mentation, and 26 with gradual or waxing–waning course. A single underlying etiology was identified in only 19 cases, with multiple factors involved in all others, with metabolic, toxic, infectious, and structural etiologies most often implicated. There was no statistically significant difference in outcome for those with altered mental status consults versus the total OLT population, though the sudden-onset presentation group did show significantly increased mortality rates. Conclusions: This systematic study illustrates the variety of potential causes of altered mentation within the perioperative setting of liver transplantation. Workup including neuroimaging (preferably magnetic resonance imaging), infectious cultures, and expanded metabolic laboratory tests should be undertaken.

scholarly journals Chronological Impact of Earthquakes on Blood Pressure: A Literature Review and Retrospective Study of Hypertension in Haiti Before and After the 2010 Earthquake

2021 ◽  
Vol 8 ◽  
Author(s):  
Ayman R. Fath ◽  
Amro Aglan ◽  
Jeri Platt ◽  
Jordan R. Yaron ◽  
Kyle S. Varkoly ◽  
...  
Keyword(s):  
Literature Review ◽  
Chart Review ◽  
Retrospective Studies ◽  
Retrospective Chart Review ◽  
Chronic Effects ◽  
Significant Difference ◽  
Before And After ◽  
Early Health ◽  
Significant Change

Objective: We review prior studies on the incidence of hypertension (HTN) after earthquakes and present a retrospective analysis of HTN after the 2010 earthquake in Haiti.Methods: Prior reports on HTN incidence were reviewed and a retrospective chart review for diagnosis of HTN in 4,308 patient charts was performed over a 7 year period (five clinics). A retrospective cohort study (RCS) was then performed on 11 patients with linear follow-up.Results: The Literature review revealed a significant increase in acute and subacute HTN following earthquakes. However, the chronic effects of earthquakes varied. Our chart review uncovered no significant difference in diagnosed HTN in a Fort-Liberté clinic 128 kilometers (km) distant and 4 weeks post-event. A secondary linear RCS for 11 individuals, prior to and after the earthquake, also did not detect a significant change in HTN prevalence.Conclusion: Prior studies demonstrate acute and subacute, increases in HTN after earthquakes, but late changes have varied. Retrospective studies in the Fort-Liberté clinic, 128 km distant and 4 weeks post-event, revealed no significant change in HTN, confirming prior findings that changes in HTN after earthquakes are early and local events. Further work examining HTN after earthquakes is needed to improve early health care after natural disasters.

scholarly journals Conventional Thermal versus Water-Cooled Genicular Nerve Radiofrequency Lesioning: A Retrospective Chart Review

2019 ◽  
pp. 16-172
Author(s):  
Cristina Shea
Keyword(s):  
Knee Pain ◽  
Chart Review ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Pain Clinic ◽  
Fisher Exact Test ◽  
Pain Scores ◽  
Chronic Knee Pain ◽  
Significant Difference

Background: Genicular nerve radiofrequency lesioning (RFL) is an interventional approach to chronic knee pain. It is currently unknown whether conventional thermal RFL (CT-RFL) or watercooled RFL (WC-RFL) yields better outcomes. Objective: The objective of this research was to analyze and compare outcomes of genicular nerve conventional thermal radiofrequency lesioning (CT-RFL) vs water-cooled radiofrequency lesioning (WC-RFL) for the treatment of chronic knee pain. Study Design: We used retrospective chart review. Setting: The research took place in an outpatient pain clinic at a large academic medical center. Methods: Patients who participated in the study were those aged 18 and older who received genicular nerve RFL for chronic knee pain between January 1, 2014 and December 31, 2016. Random intercepts models were used to examine Visual Analog Scale (VAS) pain scores across the first year of follow-up, adjusting for age, gender, and prior history of knee surgery. Results: Overall, VAS scores were significantly reduced from baseline (mean = 6.66, standard deviation [SD] = 1.36) by 1.46 points during the first follow-up month (95% confidence interval [CI], 0.6-2.3, P = .001), 2.22 points during the second follow-up month (95% CI, 1.4-3.1, P = < .001), and 1.24 points during the sixth follow-up month (95% CI, 0.1-2.4, P = .035) but were not significantly reduced at other months during the one-year followup time period. There was no statistically significant difference in follow-up pain scores (mean difference = 0.73, 95% CI, -0.14-1.59, P = .116) or rates of complications (P = .10, 2-tailed Fisher exact test) between RFL types. Limitations: Study shortcomings include patient loss to follow-up, heterogeneity of CT-RFL techniques, and heterogeneity of study patients. Conclusions: Genicular RFL is a promising strategy for long-term management of treatment-resistant chronic knee pain. In this study, no significant difference in outcomes was detected between CT-RFL and WC-RFL techniques. Larger prospective studies are warranted to compare outcomes of these techniques and guide future care. Key words: Radiofrequency lesioning, knee pain, chronic pain, osteoarthritis, genicular, cooled radiofrequency lesioning, water-cooled radiofrequency lesioning, conventional radiofrequency lesioning

Comparative Morbidity Profile of Elective vs Therapeutic Neck Dissection

2021 ◽  
pp. 019459982110089
Author(s):  
Quinn Dunlap ◽  
James Reed Gardner ◽  
Amanda Ederle ◽  
Deanne King ◽  
Maya Merriweather ◽  
...  
Keyword(s):  
Neck Dissection ◽  
Surgical Complications ◽  
Chart Review ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Neck Surgery ◽  
Continuous Variables ◽  
Significant Difference ◽  
History Of

Objective Neck dissection (ND) is one of the most commonly performed procedures in head and neck surgery. We sought to compare the morbidity of elective ND (END) versus therapeutic ND (TND). Study Design Retrospective chart review. Setting Academic tertiary care center. Methods Retrospective chart review of 373 NDs performed from January 2015 to December 2018. Patients with radical ND or inadequate chart documentation were excluded. Demographics, clinicopathologic data, complications, and sacrificed structures during ND were retrieved. Statistical analysis was performed with χ2 and analysis of variance for comparison of categorical and continuous variables, respectively, with statistical alpha set a 0.05. Results Patients examined consisted of 224 males (60%) with a mean age of 60 years. TND accounted for 79% (n = 296) as compared with 21% (n = 77) for END. Other than a significantly higher history of radiation (37% vs 7%, P < .001) and endocrine pathology (34% vs 2.6%, P < .001) in the TND group, no significant differences in demographics were found between the therapeutic and elective groups. A significantly higher rate of structure sacrifice and extranodal extension within the TND group was noted to hold in overall and subgroup comparisons. No significant difference in rate of surgical complications was appreciated between groups in overall or subgroup analysis. Conclusion While the significantly higher rate of structure sacrifice among the TND population represents an increased morbidity profile in these patients, no significant difference was found in the rate of surgical complications between groups. The significant difference seen between groups regarding history of radiation and endocrine pathology likely represents selection bias.

scholarly journals Impact of Face Masks on 6-Minute Walk Test in Healthy Volunteers

2021 ◽  
Vol 11 (1) ◽  
pp. 204589402098843
Author(s):  
Kevin M. Swiatek ◽  
Charnetta Lester ◽  
Nicole Ng ◽  
Saahil Golia ◽  
Janet Pinson ◽  
...  
Keyword(s):  
Healthy Volunteers ◽  
Face Mask ◽  
Walk Test ◽  
Six Minute Walk Test ◽  
Significant Difference ◽  
6 Minute Walk Test ◽  
The Impact ◽  
Minute Walk

Our objective was to establish the impact of wearing a face mask on the outcome of six-minute walk test in healthy volunteers. In a study of 20 healthy volunteers who each completed two 6MWTs, one with a mask and one without, there was no difference in distance walked. However, there was a significant difference in perception of dyspnea between the two groups.

scholarly journals Outcomes of Mastoidectomy With Antibiotic Catheter Irrigation for Patients With Draining Ventilation Tubes

2021 ◽  
pp. 014556132110257
Author(s):  
Joel W. Jones ◽  
Daniel P. Ballard ◽  
Todd A. Hillman ◽  
Douglas A. Chen
Keyword(s):  
Chart Review ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Otitis Media With Effusion ◽  
Tympanostomy Tube ◽  
Indwelling Catheter ◽  
Intravenous Antibiotics ◽  
Significant Difference ◽  
Ventilation Tubes ◽  
Catheter Irrigation

Objectives: To evaluate the effectiveness of mastoidectomy with antibiotic catheter irrigation in patients with chronic tympanostomy tube otorrhea. Methods: A chart review of adult and pediatric patients with persistent tympanostomy tube otorrhea who had failed outpatient medical management and underwent mastoidectomy with placement of a temporary indwelling catheter for antibiotic instillation was performed. Patients were retrospectively followed for recurrent drainage after 2 months and outcomes were categorized as resolution (0-1 episodes of otorrhea or otitis media with effusion during follow-up), improvement (2-3 episodes), or continued episodic (>3 episodes). Results: There were 22 patients and 23 operated ears. Median age was 46 years (interquartile range, IQR = 29-65). The median duration of otorrhea from referral was 5.5 months (IQR = 2.8-12). Following surgery, 14 ears had resolution of drainage, 6 had improvement, and 3 had episodic. The observed percentage of resolved/improved ears (87%) was significant ( P = .0005, 95% CI = 67.9%-95.5%). Median follow-up time was 25 months (IQR = 12-59). Pre and postoperative pure tone averages improved (difference of medians = −3.3 dB, P = .02) with no significant difference in word recognition scores ( P = .68). Methicillin-resistant Staphylococcus aureus was the most common isolated microbe while no growth was most frequently noted on intraoperative cultures. Conclusions: Mastoidectomy with antibiotic catheter irrigation may be an effective surgical strategy, and single stage alternative to intravenous antibiotics, for select patients with persistent tube otorrhea who have failed topical and oral antibiotics.

Stereotactic Electroencephalography Is Associated With Reduced Pain and Opioid Use When Compared with Subdural Grids: A Case Series

2021 ◽  
Author(s):  
Jonathan P Scoville ◽  
Evan Joyce ◽  
Joshua Hunsaker ◽  
Jared Reese ◽  
Herschel Wilde ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Chart Review ◽  
Statistical Tests ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Opioid Use ◽  
Pain Scores ◽  
Surgical Methods ◽  
Significant Difference

Abstract BACKGROUND Minimally invasive surgery (MIS) has been shown to decrease length of hospital stay and opioid use. OBJECTIVE To identify whether surgery for epilepsy mapping via MIS stereotactically placed electroencephalography (SEEG) electrodes decreased overall opioid use when compared with craniotomy for EEG grid placement (ECoG). METHODS Patients who underwent surgery for epilepsy mapping, either SEEG or ECoG, were identified through retrospective chart review from 2015 through 2018. The hospital stay was separated into specific time periods to distinguish opioid use immediately postoperatively, throughout the rest of the stay and at discharge. The total amount of opioids consumed during each period was calculated by transforming all types of opioids into their morphine equivalents (ME). Pain scores were also collected using a modification of the Clinically Aligned Pain Assessment (CAPA) scale. The 2 surgical groups were compared using appropriate statistical tests. RESULTS The study identified 43 patients who met the inclusion criteria: 36 underwent SEEG placement and 17 underwent craniotomy grid placement. There was a statistically significant difference in median opioid consumption per hospital stay between the ECoG and the SEEG placement groups, 307.8 vs 71.5 ME, respectively (P = .0011). There was also a significant difference in CAPA scales between the 2 groups (P = .0117). CONCLUSION Opioid use is significantly lower in patients who undergo MIS epilepsy mapping via SEEG compared with those who undergo the more invasive ECoG procedure. As part of efforts to decrease the overall opioid burden, these results should be considered by patients and surgeons when deciding on surgical methods.

Late endoscopic evaluation of the ostium size after external dacryocystorhinostomy

2020 ◽  
pp. 112067212097604
Author(s):  
Reem R Al Huthail ◽  
Yasser H Al-Faky
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Tertiary Hospital ◽  
Nasal Endoscope ◽  
Long Term Follow Up ◽  
Mean Size ◽  
External Dacryocystorhinostomy ◽  
The Mean

Objective: To evaluate the effect of chronicity on the size of the ostium after external dacryocystorhinostomy (DCR) with intubation. Methods: Design: A retrospective chart review of patients who underwent external DCR with intubation over 10 years from January 2003 at a tertiary hospital. All patients were recruited and examined with rigid nasal endoscope. Results: A total number of 66 (85 eyes) patients were included. The mean age at the time of evaluation was 53.1 years with gender distribution of 54 females (81.8 %). The mean duration ±SD between the date of surgery and the date of evaluation was 33.2 ± 33.6 (6–118 months). Our study showed an overall anatomical and functional success of 98.8% and 95.3%, respectively. The mean size of the ostium (±SD) was 23.0 (±15.7) mm2 (ranging from 1 to 80.4 mm2). The size of the ostium was not a significant factor for failure ( p = 0.907). No statistically significant correlation was found between the long-term duration after surgery and the size of the ostium ( R: 0.025, p = 0.157). Conclusions: Nasal endoscopy after DCR is valuable in evaluating the ostium with no observed potential correlation between the long-term follow-up after surgery and the size of the ostium.

Cholecystectomy for Biliary Hyperkinesia

2019 ◽  
Vol 85 (2) ◽  
pp. 219-222 ◽  
Author(s):  
Joshua Gazzetta ◽  
Betty Fan ◽  
Paul Bonner ◽  
John Galante
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Chart Review ◽  
Gallbladder Disease ◽  
Retrospective Chart Review ◽  
Biliary Colic ◽  
Study Cohort ◽  
Final Pathology ◽  
Pathology Reports ◽  
Histologic Changes

Patients with classic biliary colic symptoms and documented gallbladder ejection fractions on the higher end of the spectrum on hepatobiliary iminoacetic acid scans with cholecystokinin stimulation are presently understudied and the benefits of cholecystectomy are unclear. To determine whether patients with biliary-type pain and biliary hyperkinesia (defined as a gallbladder ejection fractions of 80% or greater) benefit from laparoscopic cholecystectomy, a retrospective chart review encompassing five community hospitals was performed. Patients 16 years and older with diagnosed biliary hyperkinesia who underwent laparoscopic cholecystectomy between January 1, 2010 and May 31, 2015 were included. Pathology reports were reviewed for histologic changes indicating cholecystitis. Resolution of biliary colic symptoms was reviewed one to three weeks after surgery in their postoperative follow-up documentation. Within our study cohort, we found 97 patients who underwent laparoscopic cholecystectomy for biliary hyperkinesia. Within this population, 84.5 per cent of patients undergoing laparoscopic cholecystectomy for biliary hyper-kinesia had positive findings for gallbladder disease on final pathology. Of the 77 patients with data available from their first postoperative visit, 70 (90.9%) reported improvement or resolution of symptoms. Our findings suggest that symptomatic biliary hyperkinesia may be treated successfully with surgery.

scholarly journals Open versus arthroscopic release for lateral patellar compression syndrome: a randomized-controlled trial

2021 ◽  
Author(s):  
Sherwan A. Hamawandi ◽  
Hazhar I. Amin ◽  
Ameer Kadhim Al-Humairi
Keyword(s):  
Functional Outcome ◽  
Patellar Instability ◽  
Controlled Trial ◽  
Lateral Release ◽  
Open Release ◽  
Arthroscopic Release ◽  
Compression Syndrome ◽  
Significant Difference ◽  
Lateral Patellar Compression Syndrome

Abstract Introduction Lateral patellar compression syndrome is one of the causes of anterior knee pain in young adults and resulted from tight lateral patellar retinaculum. The aim of our study is to compare between open and arthroscopic release of lateral patellar compression syndrome in relation of functional outcome, time of surgical procedure, length of hospital stays, intraoperative and postoperative complications as bleeding, infection, recurrence, and patellar instability with 2 years of follow-up. Materials and methods 80 patients, age (21–49 years), were divided randomly into 2 groups (A and B). Group A (40 patients) were treated with open release. Group B (40 patients) were treated by arthroscopic release. All these patients are diagnosed as lateral patellar compression syndrome depending on clinical features and MRI. All patients were assessed by Lysholm knee scoring scale before surgery and at periods of 2, 6 weeks, 6, 12, and 24 months after surgery. Results There is significant difference in functional outcome, measured by Lysholm knee scoring scale, between preoperative and postoperative assessment periods in both groups (P < 0.001). There is significantly better functional outcome at 2 years of follow-up with arthroscopic release (P = 0.018). There is no recurrence in both groups, but there were 4 patients develop medial patellar instability in the group of open release. Conclusion Both open and arthroscopic lateral release for patients with isolated lateral patellar compression syndrome can be effective surgical procedures, but arthroscopic release can achieve better functional outcome. Trial registration: NCT, NCT04130412. Retrospectively registered on 3rd of June, 2020 at ClinicalTrials.gov.

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