scholarly journals 1477 Epistaxis Management During The COVID-19 Pandemic First Wave- Do We Need to Admit Patients with Rapid Rhinos? A Complete Loop Audit

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S McCrossan ◽  
K O'Doherty ◽  
R Adair
Keyword(s):  
Traditional Approach ◽  
Management Plan ◽  
Nasal Packing ◽  
Mortality And Morbidity ◽  
Patient Demographics ◽  
Bed Days ◽  
Group 5 ◽  
Time Of Admission

Abstract Introduction Epistaxis is a common ENT emergency, which if management requires nasal-packing, usually results in an inpatient admission. We audited our management of nasal-packing practices in the pre- and intra-pandemic era. Method Review of medical notes including patient demographics, reason for admission, time of admission, bed-day numbers, management plan and 30-day mortality and morbidity (M&M). 1st-cycle- January 2020, 2nd-cycle during the 1st-wave of the COVID-19 pandemic April-June 2020. Change implemented- patients were sent home with their nasal-pack in-situ. Results Pre-pandemic we admitted 100% (n = 15) of patients requiring rapid-rhino (RR) insertion compared to 7% (n = 1) of patients during the 1st-wave with an average age of 69 and 74-years respectively. 67% of patients in each group were on an antiplatelet or anticoagulant. Most common co-morbidities were hypertension (67%v40%), atrial-fibrillation (27%v53%) and cognitive impairment (13%v20%). 60% of patients attended in the out-of-hours period (5pm-8am). There was no difference in M&M. Bed-day average was 3.9-days and 2-days in the first and second groups. In the first group 5 patients (33%) needed arterial ligation with only one (7%) patient in the second group requiring ligation. Conclusions RR insertion and discharge with outpatient follow up is safe with no difference in M&M. Total bed-days were 57v4 bed-days in group one compared to group two, with £222/bed-day (NICE costings statement) the total-price was £12654v£888. We hope that the traditional approach of admitting every patient with RR may be reconsidered as the standard and only required when necessary.

scholarly journals Effect of 2% Lignocaine Solution in Pain During Removal of Nasal Pack

2019 ◽  
Vol 15 (2) ◽  
pp. 80-83
Author(s):  
Ashish Dhakal ◽  
Bikash Lal Shrestha ◽  
Monika Pokharel
Keyword(s):  
Normal Saline ◽  
Saline Group ◽  
Nasal Packing ◽  
Distilled Water ◽  
Left Nostril ◽  
Normal Saline Group ◽  
Nasal Pack ◽  
Control Side ◽  
Group 5

Background: Nasal packing is commonly done after septal surgeries. Nonabsorbable nasal pack is used to minimize bleeding from surgery site, support the mucoperichondrial flaps, and minimize the risk of formation of septal hematomas and adhesions. However, these materials cause pain and discomfort in-situ as well as during removal. This study was done to evaluate the effect of 2% lignocaine rehydration of nasal pack on pain during pack removal. Methods: This prospective study was conducted on 60 patients who had undergone septoplasty. The patients were divided into 2 groups: Lignocaine and Normal saline group, with 30 patients each. In the Lignocaine group, 2.5 ml of 2% of lignocaine was diluted with 2.5 ml of distilled water and was injected into the nasal pack; and in Normal saline group, 5 ml of normal saline was injected into the nasal pack. Nothing was injected to the left nostril, which acted as a control, in both groups. All patients were asked severity of pain during removal of nasal packing by VAS. Results: In lignocaine group, mean pain score was 3.73 ± 1.63 on lignocaine side and 6.23 ± 1.69 on control side (U=109.5, p<0.001). In Normal saline group, it was 6.5 ± 1.7 on normal saline side and 6.23 ± 1.96 on control side (U=425.5, p=0.711). On comparing VAS between lignocaine and normal saline group, pain was significantly lower in the lignocaine group (U=112.5, p<0.001) Conclusion: Rehydrating nasal pack with 2% topical lignocaine is a useful method to reduce pain during nasal pack removal.

scholarly journals Wide-neck bifurcation aneurysms of the middle cerebral artery and basilar apex treated by endovascular techniques: a multicentre, core lab adjudicated study evaluating safety and durability of occlusion (BRANCH)

2018 ◽  
Vol 11 (1) ◽  
pp. 31-36 ◽  
Author(s):  
Reade A De Leacy ◽  
Kyle M Fargen ◽  
Justin R Mascitelli ◽  
Johanna Fifi ◽  
Lena Turkheimer ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Endovascular Techniques ◽  
Mortality And Morbidity ◽  
Patient Demographics ◽  
Procedural Information ◽  
Morbidity Data ◽  
Aneurysm Morphology ◽  
Wide Neck

Background and purposeBRANCH (wide-neck bifurcation aneurysms of the middle cerebral artery and basilar apex treated by endovascular techniques) is a multicentre, retrospective study comparing core lab evaluation of angiographic outcomes with self-reported outcomes.Materials and methodsConsecutive patients were enrolled from 10 US centres, aged between 18 and 85 with unruptured wide-neck middle cerebral artery (MCA) or basilar apex aneurysms treated endovascularly. Patient demographics, aneurysm morphology, procedural information, mortality and morbidity data and core lab and self-reported modified Raymond Roy (RR) outcomes were obtained.Results115 patients met inclusion criteria. Intervention-related mortality and significant morbidity rates were 1.7% (2/115) and 5.8% (6/103) respectively. Core lab adjudicated RR1 and 2 occlusion rates at follow-up were 30.6% and 32.4% respectively. The retreatment rate within the follow-up window was 10/115 (8.7%) and in stent stenosis at follow-up was 5/63 (7.9%). Self-reporting shows a statistically significant direction to angiographic RR one outcomes at follow-up compared with core lab evaluation, with OR 1.75 (95% CI 1.08 to 2.83).ConclusionEndovascular treatment of wide-neck MCA and basilar apex aneurysms resulted in a core lab adjudicated RR1 occlusion rate of 30.6%. Self-reported results at follow-up favour better angiographic outcomes, with OR 1.75 (95% CI 1.08 to 2.83). These data demonstrate the need for novel endovascular devices specifically designed to treat complex intracranial aneurysms, as well as the importance of core lab adjudication in assessing outcomes in such a trial.

Recurrent Aortoenteric Fistula: Two Different Bridge Solutions

Vascular ◽  
2007 ◽  
Vol 15 (4) ◽  
pp. 235-237 ◽  
Author(s):  
Emiliano Chisci ◽  
Gianmarco de Donato ◽  
Francesco Setacci ◽  
Andrea Stella ◽  
Carlo Setacci
Keyword(s):  
Aortoenteric Fistula ◽  
Mortality And Morbidity ◽  
In Situ Replacement ◽  
Endovascular Grafting ◽  
Significant Mortality

A “recurrent” aortoenteric fistula (AEF) is very rare and in literature anecdotic. Currently, graft excision and extra-anatomic bypass are considered the treatments of choice, but are associated with significant mortality and morbidity. Herein, we describe the case of a “recurrent” AEF treated before definitive extra-anatomic bypass, by two different, staged bridge solutions: allograft in situ replacement and endovascular grafting. At 1, 3 and 6-month follow-up, the patient was asymptomatic and normally active.

In situ revascularisation for femoropopliteal graft infection: ten years of experience with silver grafts

Vascular ◽  
2013 ◽  
Vol 22 (5) ◽  
pp. 323-327 ◽  
Author(s):  
P Matic ◽  
S Tanaskovic ◽  
S Babic ◽  
P Gajin ◽  
D Jocic ◽  
...  
Keyword(s):  
Patient Survival ◽  
Graft Infection ◽  
Graft Patency ◽  
Major Amputation ◽  
Perioperative Mortality ◽  
Prosthesis Infection ◽  
Mortality And Morbidity ◽  
Secondary Endpoints

Purpose The purpose of this study was to analyze clinical outcome of patients for femoropopliteal graft infection who were treated by in situ reconstruction with a silver-coated prosthesis. Basic methods From December 2001 to December 2011, 27 patients were treated for femoropopliteal graft infection. Twenty patients (74%) were male and seven (26%) were female. Mean age was 65 years. The primary endpoint was recurrence of infection. Secondary endpoints were early and late mortality and morbidity, primary graft patency, major amputation rates and patient survival. Principal findings Early reinfection occurred in 11% and late in 8% of patients. Perioperative mortality was 7% and late was 4%. Above-knee amputation was performed in 4% of patients during early postoperative course and in 12% of patients during follow-up. Early and late graft patency was 96% and 72%, respectively. Conclusions Results of in situ implantation of silver-coated grafts for femoropopliteal prosthesis infection are according to our opinion acceptable, but the risk of reinfection remains.

scholarly journals Melanocytic lesions ≤ 6mm: Prospective series of 481 melanocytic trunk and limb lesions in Brazil

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252162
Author(s):  
Gabriella Campos-do-Carmo ◽  
Aretha Brito Nobre ◽  
Tullia Cuzzi ◽  
Giuseppe Argenziano ◽  
Carlos Gil Ferreira ◽  
...  
Keyword(s):  
Excisional Biopsy ◽  
Benign Lesions ◽  
Cutaneous Lesions ◽  
Predictive Values ◽  
Mortality And Morbidity ◽  
Melanocytic Lesions ◽  
Sensitivity Specificity ◽  
Breslow Index

Early diagnosis when melanoma is still small and thin is essential for improving mortality and morbidity. However, the diagnosis of small size melanoma might be particularly difficult, not only clinically but also dermoscopically. This study aimed to define clinical and dermatoscopic parameters in the diagnosis of suspicious pigmented cutaneous lesions with a diameter of ≤ 6mm and determine the sensitivity, specificity, positive and negative predictive values as well as the accuracy of each clinical and dermatoscopic criterion. This is a transversal, descriptive and analytical study of dermatoscopic analysis with the gold standard being the pathologic examination obtained from the excisional biopsy of suspicious melanocytic lesions with a diameter of ≤ 6mm. Trunk and limb lesion data from a public health service and a private clinic were prospectively collected from 2011 to 2017 by a unique observer. In total, 481 melanocytic lesions were included, with 73.8% being ≤ 4mm in diameter. Overall, 123 were diagnosed as melanoma, 56.0% in situ and 22.0% as thin melanomas (Breslow index 0.1 to 1.0mm). Melanoma presented symmetry in 53.7% of cases, regular borders in 54.5% and a single color in 60.2%. Regarding evolution, 13.8% of melanomas versus 10.9% of benign lesions (p = 0.116) were new by comparing photos from baseline with photos from the follow-up. The majority of melanomas (65%) were found on the limbs compared to 37.2% of the benign lesions at this location (p<0.001). A multiple logistic regression model adjusted for age, gender and location was created. The independent variables associated with the diagnosis of melanoma ≤ 6mm, adjusted for age, gender and location, were: streaks (adjusted Odds Ratio [aOR] 2.5; 95% CI 1.3–4.7; p = 0.006), and the presence of a structureless area (aOR 2.2, 95% CI 1.2–4.0, p = 0.011). Conversely, a symmetric typical pigment network was a protection variable (aOR 0.4, 95% 0.7–0.9, p = 0.040). In conclusion, dermatoscopic criteria have been identified which help to diagnose cases of small size melanoma. These include streaks and structureless areas that can be taken, particularly in consideration for the diagnosis of this subset of small difficult melanomas.

Prediction of Morbidity in Hemophilus influenzae Meningitis

PEDIATRICS ◽  
1977 ◽  
Vol 59 (1) ◽  
pp. 35-39 ◽  
Author(s):  
Victor C. Herson ◽  
James K. Todd
Keyword(s):  
Significant Risk ◽  
Spinal Fluid ◽  
Blood Cell Count ◽  
Major Morbidity ◽  
Mortality And Morbidity ◽  
Risk Of Death ◽  
Spastic Quadriplegia ◽  
Time Of Admission

A dramatic decrease in mortality from Hesnophilus influenzae meningitis has occurred in recent years. Morbidity and long-term sequellae remain significant problems. A follow-up investigation of 73 cases of H. influenzae meningitis seen over a three-year period revealed: 2 deaths, 6 children with major sequellae (retardation, spastic quadriplegia, blindness, persistent seizure disorder), 10 with minor residua, and 55 with no detectable disability. Statistical analysis of clinical parameters demonstrated a significant risk of death or major morbidity in those patients who, at the time of admission, had seizures, coma, hypothermia, shock, age less than 12 months, hemoglobin less than 11 gm/100 ml, pretreatment symptoms for longer than three days, a spinal fluid white blood cell count less than 1,000/cu mm, or a spinal fluid glucose value less than 20 mg/100 ml. Using these parameters, those patients at highest risk of having lasting major morbidity with H. influenzae meningitis can be predicted, allowing more vigorous intensive care which may reduce the mortality and morbidity further.

Frequency and clinical impact of different definitions of moderate aortic stenosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y.U Du ◽  
G.O Hashimoto ◽  
J Cavalcante ◽  
M Goessl ◽  
S Garcia ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Stroke Volume Index ◽  
High Rate ◽  
Volume Index ◽  
Funding Source ◽  
Aortic Valve Area ◽  
Mortality And Morbidity ◽  
Patient Demographics

Abstract Background Current echocardiographic guidelines recommend five parameters to define severity of aortic stenosis (AS): peak velocity (PV), mean gradient (MG), aortic valve area (AVA), index AVA (AVAi), and dimensionless index (DI). However, the clinical utility of these parameters for patients with moderate AS largely remain unknown. Objective To investigate the clinical profiles and outcomes of patients with moderate AS according to five different definitions for severity. Methods Using standard echocardiographic definitions, we identified patients with moderate AS who were evaluated in our health care system from 2011 to 2012. Patient demographics, morbidities, and adverse events were reviewed, including death, heart failure (HF) admission, and aortic valve replacement (AVR). Results We enrolled 1,042 patients (age, 75±12 yrs; 40% women). Very few patients (4%) met all five criteria for moderate AS, while 49% had only one or two criteria met. DI was the most common parameter for defining moderate AS, employed in 93% of patients. Patients with area-based indices (i.e., AVA, AVAi, DI) had lower stroke volume index, lower mean gradients, lower peak velocities, and more morbidities in comparison to those flow-based definitions of severity (i.e., PV, MG). During a median follow-up of 5.7 years, overall survival was poor with all-cause mortality of 62.8%. Notably, there was no difference in the rates of mortality (range, 56.4 to 63.3%) or HF hospitalization (range, 28.9 to 32.2%) for groups defined by the five parameters, though patients with flow-based definitions more likely had AVR in follow-up. Conclusions Most patients with moderate AS meet the definition for severity with one or few criteria. Regardless of the method of definition for severity, a high rate of mortality and morbidity can occur in patients with moderate AS. Further study to optimize the clinical outcomes of patients with moderate AS is warranted. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Minneapolis Heart Institute Foundation

Secondary aorto-enteric fistula - still a devastating complication of major vascular surgery

VASA ◽  
2011 ◽  
Vol 40 (2) ◽  
pp. 139-145 ◽  
Author(s):  
Lukasiewicz ◽  
Molski
Keyword(s):  
Vascular Surgery ◽  
Graft Infection ◽  
Therapeutic Modality ◽  
Mortality And Morbidity ◽  
Stump Closure ◽  
Massive Gastrointestinal Bleeding ◽  
Major Vascular Surgery ◽  
In Situ Replacement

Background: Despite advances in vascular surgery and intensive care, secondary aorto-enteric fistulas (AEF) remain a serious threat of major vascular interventions. This report summarizes our experience in the treatment of this condition. Patients and methods: Nineteen patients with secondary AEF admitted between Jan 2004 and Dec 2008 were prospectively enrolled into this cohort observational study. Nine of them presented with massive gastrointestinal bleeding and hemorrhagic shock. Results: None of the patients died preoperatively. Graft in situ replacement was performed in eight patients (42 %), extraanatomic repair in five (26 %), proximal anastomotic reconstruction in five (26 %) and aortic stump closure in one (5 %). One patient died during the operation. Twelve other patients died during hospitalization (days 1 - 100 postop). Complications occurred in 83 % of patients surviving the operation. During follow-up two further patients died suddenly, both probably due to recurrence of fistula. Overall mortality was 79 %. Four remaining patients are alive and without signs of graft infection at a mean follow-up of 45 months (34 - 57). Conclusions: AEF treatment still carries a significant mortality and morbidity. It seems that extraanatomic reconstruction is the best possible therapeutic modality provided the patient’s condition allows for a prolonged operation. We advise cautious use of the silver-coated polyester prostheses for “in situ” reconstructions in cases with AEF.

scholarly journals Prospective Study of an Inferior Vena Cava Filter Management Pathway in a Tertiary Care and Trauma Centre

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 685-685
Author(s):  
Erica A. Peterson ◽  
Paul R. Yenson ◽  
Jacobus C. Kritzinger ◽  
Lauren J. Lee ◽  
Jay Chi ◽  
...  
Keyword(s):  
Inferior Vena ◽  
Vena Cava ◽  
Management Plan ◽  
Ivc Filter ◽  
Historical Cohort ◽  
Filter Retrieval ◽  
Filter Insertion ◽  
Lost To Follow Up

Abstract Background: In our institution, a retrospective analysis of inferior vena cava (IVC) filter usage demonstrated attempted removal in only 60% of patients. We performed a prospective cohort study to determine if an IVC filter management program (IVCFP) will improve retrieval rates. Methods: Consecutive patients receiving a retrievable IVC filter were approached for study enrollment within 48 hours of placement. Consenting patients received a visible “IVC Filter Identification Wristband” and pre-printed orders were placed in each patient's chart indicating that the wristband can only be removed by physician order if: 1) the filter has been retrieved; 2) a decision to make the filter permanent has been discussed and agreed upon with the patient; or 3) the patient has been referred to the Thrombosis Clinic for filter follow-up after hospital discharge. Educational pamphlets and Thrombosis Clinic referral information were provided to the patient and care team. All patients were followed up to time of hospital discharge and to the end of the study if the filter was still in situ. Baseline demographics, dates of filter insertion and retrieval, and data on filter indication, documentation of a follow-up plan, reasons for non-retrieval, and all-cause mortality were extracted from electronic and paper medical records using standard forms. The primary outcome was the proportion of patients who underwent attempted filter retrieval. Secondary outcomes included the proportion of patients who had a successful retrieval and documentation of a filter management plan. Results were compared with a historical cohort of 275 patients who had filters placed between Jan 2007 and Dec 2010. Group characteristics were compared using 2-sided t-tests for continuous variables and Chi-squared analysis for categorical variables. Results: Between Nov 2011 and Dec 2013, 92 of 111 eligible patients consented to participate. Mean age was 57.3 years and 67.4% were male. Compared to historical patients, IVCFP patients were more likely to be male (64.7% vs. 54.5%; p=0.03), less likely to have a prior history of venous thromboembolism (7.6% vs. 18.5%; p=0.01) and more likely to have received a filter for an acute VTE with contraindication to anticoagulation (76.1% vs. 72.4%; p=0.03) (see Table). At the end of study in June 2014, total length of follow-up for filter retrieval was 14,823 patient-days (median 48.5; range 4-956). No patient was lost to follow-up. Compared to historical data, the IVCFP significantly improved the proportion of patients with attempted retrieval (73/92 [79.3%] vs. 165/275 [60.0%]; p=0.001), documentation of an IVC filter management plan (91.3% vs. 73.8%; p<0.001) and successful retrieval (72.8% vs. 53.1%; p=0.001). Two patients in the IVCFP cohort and 28 historical controls did not have an attempted retrieval despite no clear reason for the filter to remain in situ permanently (2% vs. 10%; p=0.01). Of the 25 patients discharged with a filter in-situ, 20 were referred to our Thrombosis Clinic and 17 had a retrieval attempt post-discharge. Conclusions: Implementation of an IVCFP – consisting of a patient identification wristband, educational materials and referral for outpatient follow-up – was associated with significant increases in attempted filter retrieval and successful filter retrieval. The IVCFP represents an effective and low cost strategy to improve the follow-up and outcomes of patients receiving retrievable IVC filters. Table Historical Cohort N=275 Prospective Cohort N=92 P value Thrombotic risk factors, n (%) Acute VTE 213 (77.5) 78 (84.8) NS Prior VTE 51 (18.5) 7 (7.6) 0.01 Cancer 97 (35.3) 34 (37.0) NS Trauma 63 (22.9) 22 (23.9) NS Indications for filter insertion, n (%) Contraindication to AC 199 (72.4) 70 (76.1) 0.03 High risk for PE 31 (11.3) 10 (10.9) NS Primary prophylaxis 41 (14.9) 11 (12.0) NS Other 4 (1.5) 1 (1.1) NS Filter removal attempted, n (%) 165 (60.0) 73 (73.9) 0.001 Filter removal successful, n (%) 146 (53.1) 67 (72.8) 0.001 Documentation of a filter management plan, n (%) 203 (73.8) 84 (91.3) <0.001 Reasons for non-retrieval, n (%) Death in hospital/limited life expectancy 41 (14.9) 9 (9.8) NS Filter made permanent 22 (8.0) 4 (4.3) NS Persistent contraindication to AC 10 (3.9) 3 (3.3) NS High risk of PE despite AC 5 (1.8) 1 (1.1) NS Lost to follow-up 4 (1.5) 0 (0.0) NS Unknown 28 (10.2) 2 (2.2) 0.01 VTE, venous thromboembolism; PE, pulmonary embolism, NS, non-significant, AC, anticoagulation. Disclosures No relevant conflicts of interest to declare.

scholarly journals Long-term outcomes after surgery for catastrophic epilepsy in infants: institutional experience and review of the literature

2020 ◽  
Vol 26 (2) ◽  
pp. 157-164
Author(s):  
Vincent C. Ye ◽  
Ashish H. Shah ◽  
Samir Sur ◽  
Justin K. Achua ◽  
Shelly Wang ◽  
...  
Keyword(s):  
Young Patients ◽  
Intractable Epilepsy ◽  
Neurosurgical Procedures ◽  
Neurodevelopmental Outcomes ◽  
Mortality And Morbidity ◽  
Surgical Interventions ◽  
Patient Demographics ◽  
Institutional Experience ◽  
Catastrophic Epilepsy

OBJECTIVEUncontrolled epilepsy is associated with serious deleterious effects on the neurological development of infants and has been described as “catastrophic epilepsy.” Recently, there has been increased emphasis on early surgical interventions to preserve or rescue neurodevelopmental outcomes in infants with early intractable epilepsy. The enthusiasm for early treatments is often tempered by concerns regarding the morbidity of neurosurgical procedures in very young patients. Here, the authors report outcomes following the surgical management of infants (younger than 1 year).METHODSThe authors performed a retrospective review of patients younger than 1 year of age who underwent surgery for epilepsy at Miami (Nicklaus) Children’s Hospital and Jackson Memorial Hospital between 1994 and 2018. Patient demographics, including the type of interventions, were recorded. Seizure outcomes (at last follow-up and at 1 year postoperatively) as well as complications are reported.RESULTSThirty-eight infants (median age 5.9 months) underwent a spectrum of surgical interventions, including hemispherectomy (n = 17), focal resection (n = 13), and multilobe resections (n = 8), with a mean follow-up duration of 9.1 years. Hemimegalencephaly and cortical dysplasia were the most commonly encountered pathologies. Surgery for catastrophic epilepsy resulted in complete resolution of seizures in 68% (n = 26) of patients, and 76% (n = 29) had a greater than 90% reduction in seizure frequency. Overall mortality and morbidity were 0% and 10%, respectively. The latter included infections (n = 2), infarct (n = 1), and immediate reoperation for seizures (n = 1).CONCLUSIONSSurgical intervention for catastrophic epilepsy in infants remains safe, efficacious, and durable. The authors’ work provides the longest follow-up of such a series on infants to date and compares favorably with previously published series.

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