scholarly journals Surgical Outcomes of Myelomeningocele Repair: a 20-Year Experience from a Single Center in a Middle-Income Country

2021 ◽  
Author(s):  
Sina Zoghi ◽  
Maryam Feili ◽  
Mohammad Amin Mosayebi ◽  
Mohammad Amin Afifi ◽  
Afrooz Feili ◽  
...  
Keyword(s):  
Surgical Management ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Wound Dehiscence ◽  
P Value ◽  
Fars Province ◽  
Middle Income ◽  
Middle Socioeconomic Status ◽  
Myelomeningocele Repair ◽  
Complications And Mortality

Abstract Objective Spina bifida primarily affects people of low and middle socioeconomic status. Herein, we describe the outcome of myelomeningocele surgical management in Iran and predictors of its postoperative complications and mortality. Methods This retrospective chart review studies the children who underwent surgical management for myelomeningocele in Shiraz, Fars province, Iran, from May 2001 to September 2020. To this end, we investigated mortality and 30-day complications and the factors that determined the operation's outcome. Results 256 patients were enrolled. The median age at the operation was roughly eight days (IQR: 7). The most common site of involvement of Myelomeningocele (MMC) was Lumbosacral (86%, n = 204). At the evaluation conducted prior to operation, CSF leaking was observed in 7% (n=16) of the patients. Postoperatively, 5.7% of the patients were expired in the 30 days following the operation (n = 14), while 24% needed readmission (n = 47). The most common complications leading to readmission included wound dehiscence (n = 10, 42%) and wound purulence (n = 6, 25%). No variable was significantly associated with postoperative complication except for the site of the lesion (p-value = 0.035) and the presence of the lipid content in the defect (p-value = 0.044). Conclusions Most patients born with MMC are referred for the neurosurgical evaluation following their birth; however, as results show there is much left to be desired compared with the 48h recommended by The Congress of Neurological Surgeons. Here, we concluded that presence of lipid compartment in the lesion and the site of the lesion are the two factor that were associated with the rate of mortality. However, further investigation into preoperative interventions and risk factors to mitigate risk of postoperational complications and mortality is highly encouraged. We highly advocate for the investigation and dissemination of the outcome of the conventional surgical management of MMC in financially restrained areas; because they can show the limitation these settings are confronted with (that are in a way unique to them and different from the resourceful settings) and provide a model for other similar areas with limited suitable care.

scholarly journals Clopidogrel, an ADP-P2Y12 Receptor Antagonist, Can Prevent Severe Postoperative Pain: A Retrospective Chart Review

Life ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. 92
Author(s):  
Rikuhei Tsuchida ◽  
Masahiko Sumitani ◽  
Hiroaki Abe ◽  
Masae Ando ◽  
Kosuke Saita ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Abdominal Surgery ◽  
Chart Review ◽  
Stable State ◽  
Analgesic Efficacy ◽  
Retrospective Chart Review ◽  
Treated Group ◽  
P2y12 Receptor ◽  
Nociceptive Pain ◽  
P Value

The purinergic P2Y12 receptor regulates microglial activation, resulting in persistence and aggravation of pain in neuropathic and nociceptive pain models. We conducted a retrospective chart review to explore the analgesic potency of the P2Y12 receptor-specific antagonist, clopidogrel, for clinical management of postoperative pain in patients who underwent abdominal surgery. Twenty-seven patients with cardiovascular comorbidities, who underwent laparoscopic abdominal surgery and had ceased aspirin (ASP, n = 17) or clopidogrel (CLP, n = 10) for 14 days pre-operatively, were enrolled retrospectively. In both groups, the number of opioids and non-steroidal anti-inflammatory drugs (NSAIDs) consumed for managing postoperative pain was compared using the chi-square test and Mann–Whitney test. Our results showed that from postoperative day (POD) 0 to POD 3, the average numerical rating reflecting the postoperative pain was comparable between the two groups (CLP: 4.0 ± 1.4 vs. ASP: 3.7 ± 0.8, P-value = 0.56). However, at POD 7, opioid consumption in the CLP-treated group (fentanyl-equivalent dose: 0.49 ± 0.56 mg) was significantly lower than that in the ASP-treated group (1.48 ± 1.35 mg, P-value = 0.037). After reaching a stable state by repeated systemic administration, clopidogrel sustained the analgesic efficacy for a certain period. In conclusion, microglial P2Y12 receptors may mediate signal transduction of postoperative nociceptive pain and enhance clinical opioid analgesia.

scholarly journals Utility of Groin Flap in Penile Reconstruction

2020 ◽  
Vol 16 (3) ◽  
pp. 150-157
Author(s):  
Ji-An Choi ◽  
Jung-Ha Kwak ◽  
Kwang-Ryeol Lim ◽  
Chung-Min Yoon
Keyword(s):  
Chart Review ◽  
Donor Site ◽  
Retrospective Chart Review ◽  
Wound Dehiscence ◽  
Donor Site Morbidity ◽  
Postoperative Patient ◽  
Groin Flap ◽  
Volumetric Reconstruction ◽  
Tissue Defects

Background: Reconstruction surgery for skin and soft tissue defects of the penis would ideally secure sufficient volume, be safe in procedure, and involve a simple surgical technique. Among the wide variety of techniques that have been employed, the groin flap-based technique is considered a relatively simple option for volumetric reconstruction. In this retrospective study, the authors report cases of penile reconstructive surgery using a groin flap.Methods: We performed a retrospective chart review of patients with penile defects treated in our department. Reconstructive surgeries were carried out using pedicled groin flaps. Charts were reviewed to investigate duration of the surgeries, recovery and follow-up periods, and bulkiness at one and 10 months after surgery. Patients were observed postoperatively for complications, urination, and erectile function.Results: Six patients hospitalized from March 2009 to September 2013 for penile defects underwent surgery in our department. All patients recovered without any flap loss. The most common complication after surgery was wound dehiscence. Circumferences of penile shafts were measured at 1 and 10 months after surgery, and penile bulkiness at rest were found to be maintained at >86%. There were no patients with contracture, and in all patients, urination and erectile functions were satisfactory.Conclusion: Reconstructing penile defects using groin flaps was found to be favorable in terms of volumetric reconstruction and postoperative patient satisfaction. Furthermore, the surgery and recovery periods are short, and rates of complication and donor site morbidity are also low.

Conservative Non-surgical Management of High Risk IPMNs: A Retrospective Chart Review

2015 ◽  
Vol 110 ◽  
pp. S38
Author(s):  
Rabia Ali ◽  
Anjali Mone ◽  
Justin Ream ◽  
Alec Megibow ◽  
Mark Pochapin ◽  
...  
Keyword(s):  
High Risk ◽  
Surgical Management ◽  
Chart Review ◽  
Retrospective Chart Review

scholarly journals Optical Coherence Tomography based indices in predicting functional outcomeof macular hole surgery: A retrospective chart review

2021 ◽  
Vol 37 (5) ◽  
Author(s):  
Haroon Tayyab ◽  
Rehman Siddiqui ◽  
Sana Jahangir ◽  
Shiraz Hashmi
Keyword(s):  
Optical Coherence Tomography ◽  
Functional Outcome ◽  
Macular Hole ◽  
Functional Outcomes ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
P Value ◽  
Optical Coherence ◽  
Macular Hole Surgery ◽  
Hole Index

Objectives: The objective of this study was to assess the utility of novel macular hole indices of Optical Coherence Tomography (OCT) and predicting the functional outcome of surgery. Methods: This was a retrospective chart review of 28 eyes who underwent surgery for idiopathic Full Thickness Macular Hole (FTMH) at The Aga Khan University Hospital (AKUH), Karachi from January 2016 to March 2020. Data of preoperative OCTs were recovered from data server of OCT machine. Measurements of the pre-operative OCTs were calculated using caliper function of OCT software by two independent technicians. Parameters included Macular Hole Index (MHI), Traction Hole Index (THI), Hole Form Factor (HFF) and Diameter Hole Index (DHI) were recorded. Receiver operating characteristic (ROC) curve was used to evaluate the performance of DHI, THI, HFF and MHI for improved BCVA after surgery, by looking at sensitivity, specificity and area under curve (AUC). P-value of <0.05 was considered significant. Results: Out of 30 eyes, final data analysis was done for 28 eyes. Mean age was 61.5 ± 6.2 years. Mean pre-operative and 6 months post-operative LogMAR best corrected visual acuity (BCVA) was 0.84 ± 0.23 and 0.32 ± 0.30 (p-value <0.001). Area under the curve with 95% confidence interval estimated for DHI, THI, HFF, and MHI was [0.750 (0.559 to 0.889)], [0.827 (0.637 to 0.943)], [0.846 (0.660 to 0.954)], [0.827 (0.637 to 0.943)]. Cut off values for predicting good functional outcome (post-op BCVA equal or better that 0.4) for DHI, THI, HFF and MHI were 0.454, 1.086, 0.856 and 0.501 respectively. All ROC value of less than 0.5 were considered unlikely to predict functional outcomes with macular hole indices. Conclusion: Novel macular hole indices can be used as a tool to predict the functional outcomes of macular hole surgery. Larger studies may be required to assess their wider effectiveness. doi: https://doi.org/10.12669/pjms.37.5.4126 How to cite this:Tayyab H, Siddiqui R, Jahangir S, Hashmi S. Optical Coherence Tomography based indices in predicting functional outcome of macular hole surgery: A retrospective chart review. Pak J Med Sci. 2021;37(5):---------. doi: https://doi.org/10.12669/pjms.37.5.4126 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Outcomes of surgical treatment of neonates with intestinal stomas in a regional perinatal center

2021 ◽  
Vol 25 (3) ◽  
pp. 158-164
Author(s):  
S. D. Ivanov ◽  
G. V. Slizovskij ◽  
D. A. Balaganskiy ◽  
V. G. Pogorelko ◽  
A. B. Yushmanova
Keyword(s):  
Surgical Treatment ◽  
Liver Failure ◽  
Statistical Processing ◽  
Wound Dehiscence ◽  
P Value ◽  
Safe Alternative ◽  
Stoma Formation ◽  
Perinatal Center ◽  
Adhesive Obstruction ◽  
Complications And Mortality

Introduction. Emergency intestinal surgeries in neonates can lead to stoma formation. Indications for stoming, associated complications and ways to prevent them are being actively discussed. The aim of this study was to analyze results of surgical treatment of neonates with intestinal stomas in a perinatal center for the last 10 years.Material and methods. 81 children with intestinal obstruction (32), necrotizing enterocolitis (27), meconium ileus (14) and others abdominal pathologies (8) were included into the study. Statistical processing was carried out using the SPSS v.26 package; differences were significant at p-value ≤0.05. Complications were assessed with the Clavien-Dindo Сlassification (CDC).Results. There were 59 premature infants (72.8%); 32 had body weight below 1000 grams (54.2%). Initially performed: 15 (18.5%) colostomies, 49 (60.5%) enterostomies, 17 (21%) T-anastomoses. A compression clip was put in six children with double-barreled ileostomies. Complications were the following: prolapse (12.3%), skin excoriation (43.2%), bleeding (19.8%), large losses of intestinal chyme (17.3%), liver failure (19.8%), sepsis (17.3%), wound dehiscence (6.2%), adhesive obstruction (16%), necrosis (9.9%) and stenosis (7.4%). 16 (19.7%) patients had no complications. 28 (43%) patients had complications by CDC of grade <III, and 37 (57%) - by CDC of grade ≥III. Stomas were closed in 32 children (39.5%) after 35 days, on average (6-126 days). Mortality was 28.4%, mainly in children weighing less than 1000 gramm (p = 0.03).Conclusion. If a neonate patient has contraindications to primary anastomosing, double-barreled enterostomy with a compression clip is a safe alternative to it. The enterostomy technique in premature newborns does not increase the rate of complications and mortality. Skin excoriation, increased bleeding from the stoma, and liver failure are most common in neonates with enterostomy.

Relationship of Treatment Effects On Hemoglobin and M-Protein Levels in Relapsed or Refractory Multiple Myeloma: Final Analysis of a Retrospective Chart Review Study.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4892-4892 ◽  
Author(s):  
Donna E. Reece ◽  
Faraz Zaman ◽  
Young Trieu ◽  
Giovanni Piza Rodriguez ◽  
Bruno Teixeira ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Inverse Relationship ◽  
Chart Review ◽  
Surrogate Marker ◽  
Retrospective Chart Review ◽  
M Protein ◽  
P Value ◽  
Protein Levels ◽  
Ortho Biotech ◽  
Over Time

Abstract Abstract 4892 Introduction In multiple myeloma (MM), hemoglobin (Hb) levels have long been part of staging of the disease and an important determinant in assessing treatment options, response to therapy and prognosis. The causes of a low Hb level are complex, but reflect in part the extent of myeloma cell infiltration in the bone marrow. Changes in the level of the monoclonal immunoglobulin protein in the blood and/or urine (M protein) serve as the main surrogate marker for response to treatment and progression of disease in the majority of patients (pts). This analysis explores the longitudinal relationship between treatment response (using M protein levels from serum protein electrophoresis [SPEP] results) and Hb levels. Methods This retrospective chart review included all pts who initiated drug treatment for relapsed/refractory MM between Jan-06 and Dec-07, inclusive, at Princess Margaret Hospital, Toronto, ON. Hb and M protein (SPEP) results were collected before the start of each treatment cycle. These results were then plotted over time to explore the association between these 2 variables. Results 136 of 281 (48.4%) of pts treated for relapsed/refractory MM had at least one simultaneous measurement of Hb and serum M protein levels and were included in the analysis. Mean age was 66 (SD±9.7) years, 65% of pts were male. More than half (63.2%) of the pts were receiving treatment for 1st MM relapse. Treatments for relapsed/refractory MM included cyclophosphamide ± steroids (33.1%), bortezomib-based regimens (20.6%), thalidomide-based regimens (26.5%), steroid monotherapy (15.4%), and other regimens (4.4 %). Patients received between 1 and 17 cycles of therapy (mean = 2.5 ± 2.9 cycles). Supportive care measures included erythropoiesis stimulating agents (ESAs) in 33.8% [mean dose was 488 (SD±23) μg q3 weeks and 42,343 (SD±7,768) IU weekly for darbepoetin alfa and Epoetin alfa, respectively], RBC and/or platelet transfusions in 17% (14.1% RBC and 6.7% platelets), and G-CSF in 7.4% of pts. The plot below (Figure 1) demonstrates a decrease in serum M protein levels over time and an inverse relationship between Hb and serum M protein levels. Both the decrease of serum M protein levels (p-value <0.001)) and the relationship to rising Hb levels (p-value < 0.001) were found to be statistically significant based on mixed model analyses (linear model taking into account repeated measurements) after accounting for confounding factors such as transfusions and ESA use. Conclusion There was a statistically significant improvement in disease burden across all treatments as evidenced by the drop in serum M protein levels over the cycles of therapy, which was accompanied by a decrease in the level of anemia. A statistically significant inverse relationship between Hb and serum M protein levels was observed in this exploratory analysis. Further studies are required to assess the relevance of Hb change as a viable clinical surrogate marker of response in MM and its potential predictive impact on outcome over time. This research was funded by an unrestricted grant from Ortho Biotech (a division of Janssen-Ortho, Inc.), Toronto, ON, Canada. Disclosures Reece: Ortho Biotech: Honoraria, Research Funding. Teixeira:Ortho Biotech: Employment. Yoong:Janssen Ortho Inc: Employment. Camacho:Janssen Ortho Inc: Consultancy. Plante:Janssen Ortho: Employment.

Concordance and discordance in myeloma bone marrow studies.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e19508-e19508
Author(s):  
Vincent Louie Mendiola ◽  
Meghana Kesireddy ◽  
Bagi RP Jana
Keyword(s):  
Bone Marrow ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Study Groups ◽  
Tumor Burden ◽  
Descriptive Statistics ◽  
P Value ◽  
Exclusion Criteria ◽  
Cell Percentage ◽  
Tool Types

e19508 Background: Multiple myeloma (MM) diagnostic costs, including bone marrow (BM) studies: (flow (F), aspirate (manual differential) (A) and biopsy (Bx)) are increasing. BM studies already have underlying discordance issues that may lead to repetitive studies. Thus, elucidation of characteristics associated with concordant/discordant BM studies in identifying plasma cell percentage (PC%) of ≥10, a key MM diagnostic criteria, arises. Methods: A retrospective chart review (total of152 patients diagnosed with MM and managed at UTMB through 1/2016-1/2018) was completed. 56 subjects met inclusion, PC ≥10% in any BM study, and exclusion criteria. Subjects were grouped into BMA vs BMBx and BMF vs BMBx groups and subdivided into MM subtypes for exploratory review. Two-sample Independent t-test (CI 95%) and descriptive statistics were used for comparison of variables. Two-sided p value ≤ 0.05 was considered significant. Results: Sensitivities in identifying BM PC≥10% were as follows: BMA (66.1%), BMF (39.3%) and BMBx (96.4%) (Gold standard: BMA+BMF+BMBx (100%)). Concordance rates were at 60.7% between BMA and BMBx and 35.7% between BMF and BMBx. Larger BMBx spicule size (mean(cm) = 1.3(1.1-1.48) x 0.27(0.22- 0.31) x 0.21(0.19-0.22), p = 0.037) and higher B2 microglobulin (B2m) levels (mean(mcg/mL) = 11.92 (8.04- 15.79), p = 0.003) were associated with BMA and BMBx concordance in typical/secretory MM types but not in oligo-secretory and non-secretory subtypes of MM, nor is associated with BMF and BMB concordance or discordance. Meanwhile, # of BM acquisition attempts, tool types (hand trochar vs drill) for BM acquisition, LDH and CRP levels had no significant associations with concordance or discordance in any BM study groups. Conclusions: BMF is the least sensitive in identifying PC≥10% likely due to PC damage during flow cytometry, and it may be prudent to just perform BMA with BMBx to save on costs. The associations between larger spicule sizes and higher B2m levels to BMA and BMBx concordance are likely due to an increase in the chance of identifying monoclonal PCs in bigger samples, and greater monoclonal PC tumor burden, respectively, and may have predictability benefits.

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