DOZ047.42: The value of rigid tracheobronchoscopy for the diagnosis of tracheomalacia in esophageal atresia patients

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
I P Aanen ◽  
B Pullens ◽  
J van Rosmalen ◽  
R M H Wijnen
Keyword(s):  
Sensitivity And Specificity ◽  
Esophageal Atresia ◽  
Surgical Intervention ◽  
Medical Center ◽  
Primary Repair ◽  
Demographic Data ◽  
P Value ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Low Sensitivity

Abstract Aim of the Study The aim of this study is to evaluate routine airway endoscopy prior to the closure of the trachea-esophageal fistula (TOF) and esophageal atresia (EA) repair in a tertiary medical center concerning pre- and postoperative tracheomalacia. Methods We evaluated all patients with EA born between 2013 and 2016 who underwent routine rigid tracheobronchoscopy (TBS) before primary repair of the EA at our center. Inclusion criteria included peroperative rigid TBS performed by an otolaryngologist. Exclusion criteria included impossibility to determine pre- and or postoperative TM (because of logistic or medical reasons). Demographic data, comorbidities, surgical intervention, TBS findings, and subsequent surgical management were analyzed. Main Results Twenty-four patients with EA were included in this study. Eight of the 24 patients developed postoperative TM. Of these 8 patients with TM, 5 were diagnosed at the preoperative TBS (62.5%). Of the 16 patients without postoperative TM, there were 6 patients (37.5%) with peroperative diagnosed TM. So the sensitivity and specificity of routine airway endoscopy prior to EA-repair are, respectively, 62.5% (CI 30.4%–86.5%) and 62.5% (CI 38.5%–81.6%). Concerning postoperative TM, there is a significant higher appearance in females versus males (P-value 0.021). There was no significant causality between mean gestational age, birth weight, type of EA, type of surgery (open or thoracoscopic), presence of gastroesophageal reflux disease, and the appearance of postoperative TM. Conclusions Preoperative TBS can be useful for the evaluation of tracheoesophageal fistula but has a low sensitivity and specificity to detect postoperative TM.

scholarly journals Restorative minimally invasive interventions in patients with colostomy

2018 ◽  
Vol 99 (6) ◽  
pp. 1004-1008
Author(s):  
F Sh Akhmetzyanov ◽  
N A Valiev ◽  
A N Daminov ◽  
B Sh Bikbov
Keyword(s):  
Surgical Intervention ◽  
Surgical Trauma ◽  
Distal Stump ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Intestinal Continuity ◽  
Intestinal Stoma ◽  
The Right ◽  
Medical Indications ◽  
Oncology Center

Aim. To show the benefits of performing mini-access restorative phase on the colon in patients with colostomy. Methods. A retrospective analysis of the results of closure stomy operations in 2011-2017 in two emergency cancer departments of Republican Clinical Oncology Center MH RT was conducted. The inclusion criteria of the study were: 1) surgical intervention for acute intestinal obstruction in colorectal cancer performed in RCOC; 2) mandatory removal of the primary tumor during the first surgery; 3) the presence of a functioning intestinal stoma formed during the first surgery; 4) fixation of both stumps in one stoma. The exclusion criteria were refusal to restore the continuity of the colon for medical indications and the patient's refusal to undergo the surgery. Results. The study included 11 males (44 %) and 14 females (56 %). The age interval was 49 to 81 years, of which 12 patients were over 70 years old (48 %), the average age was 67.7 ± 5.4 years. The tumor removed at the first stage was localized in the right parts of the colon in 5 patients (20 %), and in the left in 20 patients (80 %). By the stages of the malignant process, the patients were distributed as follows: stage B - 14 cases (56 %), stage C - 10 (40 %), stage D - 1 (4 %). The average duration of the surgery was 53 ± 14.38 minutes (40 to 123). The postoperative period was 10.8 ± 1.92 days on average (5 to 18). Conclusion. Restoration of intestinal continuity through mini-paracolostomy access is technically rational, as due to the mini-access the patient undergoes minor surgical trauma; the anatomical proximity of the anastomosed bowel stumps excludes the difficulties associated with the search for the distal stump in the traditional method of recovery; the duration of the postoperative hospital stay decreases significantly.

scholarly journals P015: Implementing the Canadian CT Head Rule in a community emergency department

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S83-S83
Author(s):  
G. Bock ◽  
R. Setrak ◽  
S. Freeman
Keyword(s):  
Emergency Department ◽  
Demographic Data ◽  
Ct Scans ◽  
P Value ◽  
Relative Reduction ◽  
Exclusion Criteria ◽  
Head Ct ◽  
Preliminary Results ◽  
Ct Head ◽  
Significant Injury

Introduction: The Canadian CT Head Rule (‘the rule’) is widely used across the country and its use is specifically recommended by Choosing Wisely Canada. Studies in Canadian hospitals have shown appropriate declines in CT scans when decision tools have been made readily available and useable at the point of care. Research into the implementation of the Canadian CT Head Rule in particular has shown that barriers to its use include an inability to accurately recall each criteria and forgetting to attempt to apply the rule altogether. In an attempt to provide our clinicians with effective access to the rule, we modified CT requisitions and order procedures to facilitate the use of the rule for every head CT in our emergency department (ED). Methods: A quality improvement (QI) approach was used to pilot, implement, and evaluate the modified CT requisition at our hospital. Several Plan-Do-Study-Act cycles involving stakeholders in the hospital resulted in iterative changes to the requisition leading to the implemented version. The new requisition required physicians to indicate which rules or exclusion criteria were met and this was made mandatory for all head CTs ordered. Demographic data was collected on all patients presenting to the ED on age, gender, CTAS level, disposition, and length of stay. Data on which exclusion criteria were appropriate, the rules met leading to CT scans, whether each requisition was used appropriately, and whether there was a significant injury found was collected for each patient receiving a head CT after implementation. Results: In our primary outcome (% of ED visits receiving a head CT), preliminary results have demonstrated a relative reduction in head CT ordering of 10.9%. Our study at completion is powered to detect a ~10% relative change in ordering behaviour, and a Chi square of the data to date yields a P-value of 0.0147. There are no significant differences in visit volume or any of the demographics collected to date. Final results including analysis are anticipated in March, 2016. Conclusion: Preliminary results on this simple, no-cost intervention are very promising. The reduction in head CTs ordered suggests that with mandated access to an easy-to-use, well validated decision tool, ED physicians have been able to confidently defer scans that have a very low risk of having any significant injury present, reducing cost, radiation exposure, and perhaps time in department.

scholarly journals Colonic injuries; is primary repair a safe option?

2016 ◽  
Vol 12 (2) ◽  
Author(s):  
Intesarur Rashid Khan ◽  
Khalid Irshad ◽  
Muhammad Akmal Shafiq ◽  
Bahzad Akram Khan ◽  
Abdul Majeed Cuahdhry
Keyword(s):  
Primary Repair ◽  
Fecal Diversion ◽  
Ileocolic Anastomosis ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Safe Option

Objectives: This study was conducted at Mayo Hospital, Lahore from April 2004 to May 2005 to compare the results of primary repair and exteriorization in cases of large gut injuries .Materials and methods: :80 patients, presenting in emergency between Jan. 2004 and December 2005, were selected out of which 63 were males and 17 were females. Colonic injuries were divided into five categories and were dealt accordingly. Inclusion criteria: All colonic injuries presenting to emergency in study period except. Exclusion criteria: Injuries requiring ileocolic anastomosis, repair and proximal fecal diversion and distal colonic injuries requiring Hartmann`s procedure.

scholarly journals Comparison of the Microwave-Heated Ziehl-Neelsen Stain and Conventional Ziehl-Neelsen Method in the Detection of Acid-Fast Bacilli in Lymph Node Biopsies

2019 ◽  
Vol 7 (6) ◽  
pp. 903-907
Author(s):  
Gehan Mohammed Ahmed ◽  
Ali Seed Ahmed Mohammed ◽  
Albadawi Abdulbagi Taha ◽  
Ahmad Almatroudi ◽  
Khaled S. Allemailem ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sensitivity And Specificity ◽  
Demographic Data ◽  
Chronic Inflammatory Disease ◽  
Military Hospital ◽  
Routine Practice ◽  
Predictive Values ◽  
Acid Fast Bacilli ◽  
Lymph Node Tuberculosis ◽  
Low Sensitivity

BACKGROUND: Tuberculosis is a chronic inflammatory disease with lymphadenopathy being the most common extra-pulmonary manifestation. The conventional Ziehl–Neelsen method plays an essential role in the diagnosis of tuberculosis; however, it has a low sensitivity in detecting acid-fast bacilli. AIM: The present study emphasises the role of the microwave-heated method (modified Ziehl–Neelsen) over conventional Ziehl-Neelsen stain and to set at the best condition for irradiation. MATERIAL AND METHODS: The study included 90 patients with clinically suspected tuberculous lymphadenopathy who were referred to the Department of Pathology at Omdurman Military Hospital, Sudan. Demographic data such as age, sex, and site of swelling were documented for each patient. Specimens were stained with conventional Ziehl-Neelsen, fluoresce and the modified methods. RESULTS: Patient’s age ranged from 20 to 70 year. Of the total 90 cases with clinically suspected tuberculous lymphadenopathy, 18 cases were positive for AFB in conventional Ziehl-Neelsen method giving a sensitivity of 13.3%, while in microwave-heated method 82 cases of TB were detected positive for AFB yielded sensitivity and specificity of 97.6% and 85.7%, respectively, and positive and negative predictive values of 98.8% and 75.0% respectively compared to fluorescence methods. CONCLUSION: In the present study, the microwave-heated Ziehl-Neelsen method, was found to have sensitivity and specificity of 97.6% and 85.7%, respectively which matches the fluorescence technique. It has specificity in detecting lymph node tuberculosis that makes it superior over all other modified methods. However, the availability and cost-effectiveness might limit the use of fluorescence in routine practice. Furthermore, the study set the best staining temperature is provided at power 1 level (60 w) for 1.5 minutes.

scholarly journals Optic Nerve Drusen Is Highly Prevalent Among Children With Pseudotumor Cerebri Syndrome

2021 ◽  
Vol 12 ◽  
Author(s):  
Jacob Genizi ◽  
Doron Meiselles ◽  
Elisheva Arnowitz ◽  
Idan Segal ◽  
Rony Cohen ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Medical Records ◽  
Medical Center ◽  
Pseudotumor Cerebri ◽  
Inclusion Criteria ◽  
Increased Intracranial Pressure ◽  
Exclusion Criteria ◽  
Pseudotumor Cerebri Syndrome ◽  
Optic Nerve Drusen ◽  
Rule Out

Introduction: The clinical presentation of pseudotumor cerebri syndrome (PTCS) usually includes headache, nausea, and vomiting with normal physical examination apart from papilledema and diplopia. However, pseudopapilledema, which can be caused by optic nerve drusen, may lead to misdiagnosis. The prevalence of optic nerve drusen in the general population is 0.5–2%. The purpose of our study was to evaluate the prevalence and risk factors of optic nerve drusen among patients with PTCS.Materials and Methods: Medical records of children evaluated in the pediatric department at Bnai Zion Medical Center due to PTCS between 2008 and 2020 were assessed. Inclusion criteria were children age under 18 years with a PTCS diagnosis and ophthalmic B-mode ultrasonography (US). Exclusion criteria were secondary intracranial hypertension.Results: Thirty-four children were included with a mean age 10.1 years which included 50% boys. A majority of the patients, 24 (72.4%), complained of headaches, while 15 (45.5%) complained of transient visual obscuration, and 9 (26.5%) of vomiting. Visual acuity on presentation was normal (20/20–20/30) in 23 of the children (67%), moderately diminished (20/40–20/80) in 9 (26%), and showing profound loss (20/200) in 2 (7%). Five patients (14.7%) were diagnosed with optic nerve drusen via B-mode ophthalmic ultrasonography (US). However, they still fulfilled the diagnostic criteria for PTCS, and disc swelling improved after treatment. There were no statistically significant differences between the group with optic nerve drusen and the rest of the patients.Conclusions: Optic nerve drusen are common among pediatric patients with PTCS. Diagnosis of optic nerve drusen should not rule out the presence of increased intracranial pressure.

scholarly journals 549. Monoclonal Antibody Therapy for COVID-19 Infection in Michigan: The Flint Experience

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S376-S377
Author(s):  
Mariam Younas ◽  
Danielle Osterholzer ◽  
Brandon R Flues ◽  
Carlos Rios-Bedoya ◽  
Philip McDonald ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
High Risk ◽  
Mortality Rate ◽  
Medical Center ◽  
Demographic Data ◽  
Severe Disease ◽  
Antibody Therapy ◽  
Hospitalization Rate ◽  
P Value ◽  
Underserved Area

Abstract Background Bamlanivimab (BAM), a neutralizing IgG1 monoclonal antibody (mAb), received emergency use authorization (EUA) by the U.S. Food and Drug Administration (FDA) for treatment of mild to moderate COVID-19 infection in patients 12 years of age and older weighing at least 40 kg at high risk for progressive and severe disease on Nov 10, 2020. The purpose of this study is to describe our experience with this treatment modality. Methods Hurley Medical Center (HMC), is a 443-bed inner city teaching hospital in Flint, MI. HMC administered its first BAM infusion on Nov 19, 2020. Through April 30, 2021, 407 patients with confirmed SARS-CoV-2 infection, received a mAb infusion. 62/407 patients received the combination mAb therapy of BAM + Etesevimab, as the EUA for BAM monotherapy was revoked on 04/16/21. We retrospectively collected basic demographic data and hospitalization to our facility within 14 days of receiving mAb therapy on these patients. Results During the 5.5 month study period, patients receiving mAb therapy at HMC had a mean age of 56 years (yrs) (± standard deviation) (± 15.4) and a mean Body Mass Index (BMI) of 34 kg/m² (± 8.5) (Tables 1,2). African Americans (AA) comprised 48% (194/407) (Table 3) and females comprised 54% (220/407) of the cohort. 6% (25/407) of the patients required hospitalization within 14 days of mAb infusion, had a mean age of 58 yrs (± 17) (p-value 0.62) and a mean BMI of 32 kg/m² (± 9) (p-value 0.33). Females and AA comprised 56% (14/25) and 48% (12/25) of this subgroup respectively (p-value 1.0). No deaths were reported within 30 days of infusion in this cohort. Conclusion Previously published reports cite a hospitalization rate in untreated high-risk COVID-19 infected patients of 9-15%. During the period of study, the county hospitalization rate and county mortality rate for all comers with COVID-19 was 6.6% and 2.7% respectively while our high risk cohort had a hospitalization rate of 6% and with no deaths reported. Our cohort had much lower rates of hospitalization and death than would be expected especially in a group which comprised of 48% AA in an underserved area. mAb therapy seems to have a protective effect with significant reduction in the hospitalization and mortality rate among high-risk patients with COVID-19 infection and should be prioritized for administration. Disclosures All Authors: No reported disclosures

Unrepaired Complete Tracheal Rings: Natural History and Management Considerations

2018 ◽  
Vol 158 (4) ◽  
pp. 729-735 ◽  
Author(s):  
Lyndy J. Wilcox ◽  
Catherine K. Hart ◽  
Alessandro de Alarcon ◽  
Claudia Schweiger ◽  
Nithin S. Peddireddy ◽  
...  
Keyword(s):  
Conservative Management ◽  
Chart Review ◽  
Surgical Intervention ◽  
Case Series ◽  
Strong Positive Correlation ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Select Group ◽  
Academic Center ◽  
Over Time

Objectives To document the natural growth pattern of unrepaired complete tracheal rings (UCTRs) and describe the patient population managed conservatively. Study Design Case series with chart review. Setting Tertiary pediatric academic center. Subjects/Methods Medical records of patients with confirmed complete tracheal rings on bronchoscopy from 1993 to 2017 were reviewed. Patients aged 0 to 18 who had documented tracheal sizing over time and did not require surgical intervention were included. Exclusion criteria included tracheal stenosis not caused by complete tracheal rings. Comorbidities and airway characteristics were documented in addition to endoscopic findings. These were compared with children requiring surgical repair. Results In total, 149 patients with complete tracheal rings were identified. Twenty-five had UCTRs for an overall 16.8% rate of conservative management. Nineteen patients met inclusion criteria and underwent a total of 90 microlaryngoscopy and bronchoscopies (MLBs) with sizing. The growth of the UCTRs over time, based on MLB sizing, was chronicled. The median airway growth noted was 0.38 mm/y. A moderately strong positive correlation was seen between age and airway size ( rs = 0.72, P < .0001). Children with UCTRs were less likely to have long-segment involvement than those who required repair (92%, P = .024). Conclusions A select group of children with complete tracheal rings can be managed expectantly without surgical intervention. Conservative management may be less successful in children with long-segment complete tracheal rings. Airway growth does occur in this population and can be monitored over time. Having a standardized method for sizing UCTRs allows for more effective communication between providers and assurance of continued growth of the airway while following these patients.

Abstract 13688: Shocking: Cardioversion in Cardiogenic Shock Has Limited Success

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
William A Janes ◽  
Wendy Y Craig ◽  
Jonathan M Nichols ◽  
Henry W Sesselberg
Keyword(s):  
Cardiogenic Shock ◽  
Medical Center ◽  
Sinus Bradycardia ◽  
P Value ◽  
Newly Diagnosed ◽  
Inclusion Criteria ◽  
Limited Success ◽  
Hemodynamic Deterioration ◽  
Maine Medical ◽  
Vasopressor Use

Introduction: Atrial fibrillation (AF) and atrial flutter (Aflutter) are common in cardiogenic shock patients in the Cardiac ICU (CICU). Electrical cardioversion (CV) can restore sinus rhythm, but carries the risk of transient hemodynamic deterioration. There has been little research in the efficacy and safety of electrical CV for AF/Aflutter in the CICU. Objective: Describe success of CV in AF/Aflutter in cardiogenic shock patients in the CICU. Methods: We identified Maine Medical Center CICU patients from 1/1/2015 to 12/31/19 who were in cardiogenic shock and underwent electrical CV for AF/Aflutter. Cardiogenic shock was defined by depressed cardiac index (<2.2L/m^2 or inotrope use), hypotension (systolic BP <90 mmHg, MAP <65 mmHg, or vasopressor use), and Lactate > 2mmol/L. If a patient had multiple CVs, only the first was analyzed. Results: Twenty patients met the inclusion criteria. Initially, 16 of 20 CVs were successful, however only 10 patients were in SR 24 hours after CV and only 7 were in SR at CICU discharge (Figure 1). The median LVEF was 20%, similar between groups (p-value = 0.52 initially, 0.37 at 24 hours, and 0.18 at CICU discharge). Only 1 patient was on mechanical support. The type of AF was varied (35% newly diagnosed, 55% paroxysmal, and 10% persistent). In patients with new AF, 85% were in SR initially, 57% at 24 hours, and 28% at CICU discharge. All patients received amiodarone. Inotrope use was similar, however no patients on vasopressors were in SR at CICU discharge (5/13 vs 0/7, p=0.11). Only 1 patient suffered an adverse effect (sinus bradycardia). Diabetes (p = 0.064) was the only characteristic to nearly predict lack of CV success at CICU discharge. Conclusions: 1. Electrical CV in patients admitted to the CICU in cardiogenic shock had a high initial success rate, however success was short-lived. 2. CV did not cause serious adverse effects. 3. Larger registries/trials are needed to predict which subgroups of CICU patients benefit from CV for Afib/Aflutter.

Platelets and Immature Neutrophils in Preterm Infants with Feeding Intolerance

2020 ◽  
Author(s):  
Moath M.A. Alhamad ◽  
Ambuj Kumar ◽  
Hala Chaaban ◽  
Karen M. Wickline ◽  
Thao T.B. Ho
Keyword(s):  
Preterm Infants ◽  
Sensitivity And Specificity ◽  
Feeding Intolerance ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Chromosomal Disorders ◽  
Hematological Indices ◽  
Key Points ◽  
History Of ◽  
Hematological Changes

Objective Feeding intolerance (FI) is a common presentation of necrotizing enterocolitis (NEC) and sepsis. NEC and sepsis are associated with hematological changes, but these changes alone are not reliable biomarkers for early diagnosis. This study examined whether the combination of hematological indices and FI can be used as an early diagnostic tool for NEC or sepsis. Study Design This retrospective cohort study included infants born at <1,500 g or <30 weeks who had symptoms of FI. The exclusion criteria were congenital or chromosomal disorders, thrombocytopenia or platelet transfusion before the onset of FI, and history of bowel resection. We compared the hematological indices from infants with pathologic FI (due to NEC or sepsis) to infants with benign FI. Results During the study period, 211 infants developed FI; 185 met the inclusion criteria. Infants with pathologic FI (n = 90, 37 cases with NEC and 53 with sepsis) had lower birth gestational age and weight compared with 95 infants with benign FI (n = 95). Pathologic FI was associated with lower platelet count (median 152 × 103/μL vs. 285 × 103/μL, p < 0.001) and higher immature-to-total neutrophil (I/T) ratio (median 0.23 vs. 0.04, p < 0.001) at the onset of FI. Pathologic FI was also associated with a decrease in baseline platelets compared with an increase in benign FI. For diagnosis of pathologic FI, a decrease ≥10% in platelets from baseline had a sensitivity and specificity of 0.64 and 0.73, respectively, I/T ratio ≥0.1 had a sensitivity and specificity of 0.71 and 0.78, respectively, and the combination of both parameters had a sensitivity and specificity of 0.50 and 0.97, respectively. Conclusion FI caused by NEC or sepsis was associated with a decrease in platelets from baseline, and a lower platelet level and higher I/T ratio at the onset of FI. These findings can help clinicians in the management of preterm infants with FI. Key Points

scholarly journals The Influence of Family Support on Providing Complete Primary Immunizations

2020 ◽  
Vol 8 (2) ◽  
pp. 198
Author(s):  
Ilhami Ilhami ◽  
Malik Afif
Keyword(s):  
Family Support ◽  
Emotional Support ◽  
Health Centre ◽  
Simple Random Sampling ◽  
P Value ◽  
Instrumental Support ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Health Card ◽  
The Social

Background: Primary immunizations is a series of vaccination given to babies before the age of one, and it can actively increase immunity to diseases such as Hepatitis B, Poliomyelitis, Tuberculosis, Diphtheria, Pertussis, Tetanus, Pneumonia, and Meningitis caused by Hemophilus influenza type B, and measles. Family support is one of the essential factors for the completeness of immunization because it will encourage parents to immunize their children. The social support theory was used here since it assumes that the source of support from families such as parents, siblings, children, relatives, and partners provides examples for individuals to perform or suggest a positive behavior. Objective: This study aimed to determine the effect of family support on the provision of complete primary immunization at the Sidotopo Health Center in Surabaya. Methods: This research used a descriptive-analytic method with a simple random sampling of 54 respondents with a degree of significance (α=0.05). Sample inclusion criteria include mothers who have children aged 12-24 months, have a health card (KMS), and live around the area of Sidotopo Health Centre. The exclusion criteria are those who were not willing to be respondents. Results: The effect of family support on immunization has a significant value of 0.015 (P Value <0.05) on emotional support, while the support of appreciation, instrumental support, and informative support are not substantial (P Value>0.05). Conclusion: Family support for complete primary immunizations includes emotional support, appreciation support, instrumental support, and informative support. Overall, emotional support has a direct influence on providing immunization. Therefore, appreciation support, instrumental support, and informative support did not significantly affect immunization.

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