scholarly journals Small Bowel Tumors: Clinical Presentation, Prognosis, and Outcome in 33 Patients in a Tertiary Care Center

2008 ◽  
Vol 2008 ◽  
pp. 1-5 ◽  
Author(s):  
Mirna H. Farhat ◽  
Ali I. Shamseddine ◽  
Kassem A. Barada
Keyword(s):  
Small Bowel ◽  
Clinical Presentation ◽  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
Treatment Modalities ◽  
R0 Resection ◽  
Small Bowel Tumors ◽  
Stromal Tumors ◽  
Pathologic Features

Introduction. Small bowel cancers are rare. Accumulation of data regarding their clinical presentation, pathologic features, prognostic factors, treatment modalities, and outcome is difficult.Methods. This is a retrospective study of the medical records of 33 patients with small bowel cancers treated at the American University of Beirut-Medical Center over a 20-year period.Results. The study included 25 males (76%) and 8 females (24%). Median age at presentation was 56 years. Most common symptoms were abdominal pain (66.7%) and weight loss (57.6%). Thirteen patients presented with abdominal emergencies (39.3%). Lymphoma was the most common malignant tumor (36.4%), followed by adenocarcinoma (33.3%), leiomyosarcoma (15.2%), gastrointestinal stromal tumors (12.1%), and neuroendocrine tumors (3.0%). Tumors were located in the duodenum in 30% of patients, jejunum in 33%, and ileum in 36%. Resectability rate was 72.7% and curative R0 resection was achieved in 54.1% (13/24) of patients. 5-year survival of the 33 patients was 24.2%.Conclusion. Small bowel cancers are difficult to diagnose because of the nonspecific symptoms. Most patients present with advanced disease and have poor prognosis. Adenocarcinoma and duodenal location have the worst 5-year survival in contrast to stromal tumors and those with ileal location which have the best survival.

scholarly journals Clinical Presentation and Treatment Outcomes of Children and Adolescents With Pheochromocytoma and Paraganglioma in a Single Center in Korea

2021 ◽  
Vol 11 ◽  
Author(s):  
Hyojung Park ◽  
Min-Sun Kim ◽  
Jiwon Lee ◽  
Jung-Han Kim ◽  
Byong Chang Jeong ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Treatment Outcomes ◽  
Genetic Screening ◽  
Clinical Presentation ◽  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
Screening Tests ◽  
Laboratory Findings ◽  
Presenting Symptoms

PurposePheochromocytoma (PCC) and paraganglioma (PGL) (PPGL) are rare neuroendocrine tumors, and data on managing these conditions in children and adolescents are lacking. The objective of this study was to demonstrate the clinical presentation and treatment outcomes in children and adolescents with PPGL in a single tertiary care center in Korea.MethodsThis retrospective study included 23 patients diagnosed with PCC (n = 14) and PGL (n = 9) before the age of 21 at Samsung Medical Center (from June 1994 to June 2019). We describe age, gender, family history, clinical characteristics, laboratory findings, pathologic findings, therapeutic approaches, and treatment outcomes.ResultsOf the 23 patients, 14 had PCC and nine had PGL. The median age at diagnosis was 16.8 years (range, 6.8–20.8 years). The common presenting symptoms were hypertension (n = 10), headache (n = 9), palpitation (n = 4), and sweating (n = 4). The plasma or 24-hour urine catecholamine and/or metabolite concentrations were markedly elevated in 22 patients with PPGL, but were normal in one patient with carotid body PGL. All tumors were visualized on computed tomography. Genetic tests were performed in 15 patients, and seven patients showed mutations in RET (n = 3), SDHB (n = 3), and VHL (n = 1). All patients underwent surgery, and complete excision was performed successfully. Three patients with metastasis underwent postoperative adjuvant therapy.ConclusionThis study suggests that pediatric PPGL tends to be extra-adrenal and bilateral and shows a higher potential for genetic mutations. Considering the hereditary predisposition of pediatric PPGL, genetic screening tests are strongly recommended, and lifelong follow-up is needed to detect recurrence and metastasis. Further research with a larger sample size and routine genetic screening is needed to better understand the genetic conditions and long-term prognosis of PPGL.

scholarly journals Benign Endobronchial Tumors: A Clinicopathologic Review

2021 ◽  
Vol 8 ◽  
Author(s):  
Joshua E. Insler ◽  
Christopher W. Seder ◽  
Karina Furlan ◽  
Fatima Mir ◽  
Vijaya B. Reddy ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Benign Neoplasm ◽  
Diagnosis And Treatment ◽  
Treatment Modalities ◽  
Histologic Diagnosis ◽  
Radiographic Findings ◽  
Pathologic Features ◽  
Hospital Deaths

Purpose: Benign endobronchial tumors are rare entities that can be difficult to diagnose because they often present with non-specific symptoms and vague radiographic findings. The current study reviews the clinical, radiologic and pathologic features, diagnosis, and treatment of patients with benign endobronchial tumors.Methods: We examined the charts of all patients who presented with biopsy-proven benign endobronchial tumors at a tertiary-care academic medical center between 1993 and 2018. Pertinent clinicopathologic and radiologic data were analyzed, with particular attention paid to treatment modalities and mean overall patient survival.Results: A total of 28 cases were identified. The most common benign neoplasm was hamartoma (37%), followed by lipoma (19%), squamous papilloma (11%), pleomorphic adenoma (7%), mucin gland adenoma (7%), papillary adenoma (3%), hemangioma (3%), neurofibroma (3%), leiomyoma (3%), and papillomatosis (3%). Cough (58%), shortness of breath (44%), and hemoptysis (15%) were the most frequent presentations. Most cases demonstrated well-defined submucosal or pedunculated endobronchial lesions with segmental pneumonia or atelectasis on imaging. Histologic diagnosis was obtained by endobronchial resection in 43% of patients, thoracoscopic lobectomy in 36%, endobronchial biopsy in 18%, and thoracoscopic wedge resections in 3%. All procedures were performed with no intraoperative or in-hospital deaths (mean overall survival: 20.2 years).Conclusion: Benign endobronchial tumors typically present as well-defined submucosal and/or pedunculated lesions, and may lead to post-obstructive complications. Endobronchial resection is the preferred strategy for diagnosis and treatment of these tumors.

scholarly journals Promoting COVID-19 vaccination among healthcare personnel: a multifaceted intervention at a tertiary care center in Japan

2021 ◽  
pp. 1-26
Author(s):  
Akane Takamatsu ◽  
Hitoshi Honda ◽  
Tomoya Kojima ◽  
Kengo Murata ◽  
Hilary Babcock
Keyword(s):  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
Vaccination Rate ◽  
Multifaceted Intervention ◽  
Vaccine Hesitancy ◽  
Healthcare Personnel ◽  
Tertiary Care Center ◽  
Post Intervention ◽  
Post Vaccination

Abstract Objective The COVID-19 vaccine may hold the key to ending the pandemic, but vaccine hesitancy is hindering the vaccination of healthcare personnel (HCP). Design Before-after trial Participants and setting Healthcare personnel at a 790-bed tertiary care center in Tokyo, Japan. Interventions A pre-vaccination questionnaire was administered to HCP to examine their perceptions of the COVID-19 vaccine. Then, a multifaceted intervention involving (1) distribution of informational leaflets to all HCP, (2) hospital-wide announcements encouraging vaccination, (3) a mandatory lecture, (4) an educational session about the vaccine for pregnant or breastfeeding HCP, and (5) allergy testing for HCP at risk of allergic reactions to the vaccine was implemented. A post-vaccination survey was also performed. Results Of 1,575 HCP eligible for enrollment, 1,224 (77.7%) responded to the questionnaire, 43.5% (n =533) expressed willingness to be vaccinated, 48.4% (n = 593) were uncertain, and 8.0% (n=98) expressed unwillingness to be vaccinated. The latter two groups were concerned about the vaccine’s safety rather than its efficacy. Post-intervention, the overall vaccination rate reached 89.7% (1,413/1,575), with 88.9% (614/691) of the pre-vaccination survey respondents who answered “unwilling” or “unsure” eventually receiving a vaccination. In the post-vaccination questionnaire, factors contributing to increased COVID-19 vaccination included information and endorsement of vaccination at the medical center (26.4%; 274/1,037). Conclusions The present, multifaceted intervention increased COVID-19 vaccinations among HCP at a Japanese hospital. Frequent support and provision of information were crucial for increasing the vaccination rate and may be applicable to the general population as well.

scholarly journals Prevalence of non-infectious dermatoses in patients attending a tertiary care center in Rajasthan

2019 ◽  
Vol 5 (1) ◽  
pp. 192
Author(s):  
Bhagirath Singh ◽  
Indira Subhadarshini Paul
Keyword(s):  
Clinical Evidence ◽  
Clinical Presentation ◽  
Skin Diseases ◽  
Genetic Disorders ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Pigmentary Disorders ◽  
Protozoal Infection

<p class="abstract"><strong>Background:</strong> Pediatric dermatoses require a separate view from adult dermatoses as there are important differences in clinical presentation, treatment and prognosis. There is very little epidemiological study available on non-infectious childhood dermatoses in India. The aims of the study were to find the prevalence, clinical profile and various etiological factors associated with childhood non-infectious dermatoses and to determine the prevalence of most common non-infectious childhood dermatoses.</p><p class="abstract"><strong>Methods:</strong> This cross-sectional observational study conducted at tertiary care centre in Rajasthan, India. Children with age 13 years and below with clinical evidence of cutaneous disorders were studied. Parents who have not given consent for the study, acutely ill children, Children having infectious dermatoses (bacterial, fungal, viral, arthropods, parasitic and protozoal infection) were excluded from the study.<strong></strong></p><p class="abstract"><strong>Results:</strong> A total of 232 cases were studied which showed a female preponderance of 55.60%. Most of the skin diseases were seen in the 5 to 13 years (school children) age group. The most common dermatoses was eczematous (36.63%), among eczema atopic diathesis was the commonest (17;20%) followed by hypersensitivity dermatoses (21.12%), genetic disorders (13.36%), disorders of genetic disorders (7.4%), sweat gland disorders (8.18%), pigmentary disorders (4.31%), papulo squamous disorders (4.74%), Nevi (6.46%).</p><p class="abstract"><strong>Conclusions:</strong> Eczematous dermatoses were the most commonly noted in the study, followed by hypersensitivity dermatoses. Atopic diathesis was the commonest endogenous eczemas. Acne, insect bite reaction and miliaria were the other common dermatoses. There was no significant association of various dermatoses with systemic diseases in the study.</p>

scholarly journals 1764. The Gut: A Veiled Reservoir for Multidrug-resistant Organisms (MDROs) Below the Tip of the Iceberg

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S63-S63
Author(s):  
Teppei Shimasaki ◽  
Yoona Rhee ◽  
Rachel D Yelin ◽  
Michelle Ariston ◽  
Stefanie Ollison ◽  
...  
Keyword(s):  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Resistance Mechanisms ◽  
Targeted Prevention ◽  
Prevention Measures ◽  
Carbapenem Resistant ◽  
Multidrug Resistant Organisms ◽  
Clinical Culture

Abstract Background Clinical culture results are sometimes used to estimate the burden of multidrug-resistant organisms (MDROs) in hospitals. The association between positive clinical culture results and prevalence of MDROs in the gut is incompletely understood. Methods Rectal swab or stool samples were collected daily from adult medical intensive care unit (MICU) patients and cultured for target MDROs using selective media between January 2017 and January 2018 at Rush University Medical Center, a 676-bed tertiary-care center in Chicago. Resistance mechanisms were confirmed by phenotypic methods and/or polymerase chain reaction. Clinical culture results during MICU stay were extracted from the hospital information system. Target MDROs included vancomycin-resistant Enterococci (VRE), carbapenem-resistant Enterobacteriaceae (CRE), extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL), carbapenem-resistant Pseudomonas aeruginosa (CRPA) and carbapenem-resistant Acinetobacter baumannii (CRAB). Patients with either a study or clinical culture positive for a target MDRO were analyzed. Results We collected 5,086 study samples from 1,661 unique admissions (1,419 patients) and included here data from 413 unique admissions (397 patients) with completed microbiologic analysis. Median (IQR) patient age was 65 (51–75) years and length of MICU stay was 3 (3–4) days. A total of 156 (37.8%) patients had a target MDRO detected from a study sample at any point; 57 (36.5%) patients had &gt;1 MDRO detected. Overall prevalence of these MDROs was found to be 22.5% VRE, 6.5% CRE, 19.8% ESBL, 4.4% CRPA, and 0.7% CRAB. New MDRO acquisition was observed in 58 (14.6%) patients (figure). Once a target MDRO was detected in a study sample, 82.2% of subsequent study samples were positive for that MDRO. Only 13 (5.8%) patients had a positive clinical culture for any target MDRO during their MICU stay (table). Conclusion Clinical cultures capture only the tip of the resistance iceberg and alone are insufficient to guide MDRO-targeted prevention strategies. Universal infection prevention measures are an alternative that may be preferred in settings where overall prevalence of MDROs is moderate or high and patients may be colonized with &gt;1 MDRO. Disclosures All authors: No reported disclosures.

scholarly journals Cardiac Health Awareness Among Women Presenting for Routine Health Checkup at Tertiary Care Center: Time Trends Over 15 Years

2019 ◽  
Vol 04 (02) ◽  
pp. 079-084
Author(s):  
Shibba Takkar Chhabra ◽  
Gurleen Kaur ◽  
Samir Kapoor ◽  
Gagandeep Nagi ◽  
Devanshi Kajal ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Treatment Modalities ◽  
Age Group ◽  
Tertiary Care Center ◽  
Health Awareness ◽  
Health Checkup ◽  
Cardiac Health ◽  
Presenting Symptoms ◽  
The Past

Abstract Background Women have been thought to be protected against the perils of cardiovascular disease (CVD) till late in their lives. But the literature suggests quite the opposite with CVD being a major cause of death even in young women. In contrast, the lack of awareness among women is disheartening and needs to be addressed radically. Methods The study was designed and conducted as retrospective cohort at a tertiary care center. Data was collected from patients presenting for routine cardiac health checkup over the past 15 years. The parameters observed included age at presenting, symptoms and/or signs, plus area of residence or domicile. Results A total of 32,831 patients presented for routine cardiac health checkup, of which 9,211 (28.1%) patients were women and 23,620 (71.9%) were men. On 5 yearly cumulative assessment, the mean attendance of women was 28.1 ± 2.5% as compared with 71.9 ± 2.6% men. Trend observed over the past 15 years revealed little change in the number of women versus men presenting for cardiac health checkup annually. Statistical significance was seen at p < 0.01. Among the women presenting for the checkup, it was observed that most women were in the postmenopausal age group (42.8%), followed by perimenopausal age group (34.6%), and least in premenopausal age group (22.5%) during the timeline of the study. A similar trend was observed in the male attendance; the input of males being higher at all instances. Noteworthy were trends of urban women (69.6%) presenting for health checkup more often as compared with 30.4% visiting from rural residence. Conclusions Coronary artery disease (CAD) is not uncommon in female gender. It is accompanied by varying symptom presentation with high mortality. It is seen that cardiac health awareness is significantly lacking among women as compared with men. There are almost static trends observed over the past 15 years, especially in premenopausal age group and rural domicile. Corrective actions inclining toward campaigns and communication to distribute information on cardiac disease prevention and treatment modalities among women are needed to curb CAD. This may promote early detection of CAD leading to early interventions to promote a healthy heart among women. Recommendations and necessary actions steps for a woman oriented cardiac program are the need of the hour.

scholarly journals The Experience of Hospital Death: Assessing the Quality of Care at an Academic Medical Center

2017 ◽  
Vol 35 (2) ◽  
pp. 189-197 ◽  
Author(s):  
Elise C. Carey ◽  
Ann M. Dose ◽  
Katherine M. Humeniuk ◽  
Yichen C. Kuan ◽  
Ashley D. Hicks ◽  
...  
Keyword(s):  
Medical Center ◽  
Care Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Cost Effective ◽  
Hospital Death ◽  
Personal Care ◽  
Predominately White ◽  
Dying Patients

Background: The quality of perimortem care received by patients who died at our hospitals was unknown. Objective: To describe the quality of hospital care experienced in the last week of life, as perceived by decedents’ families. Design: Telephone survey that included established measures and investigator-developed content. Setting: Large, tertiary care center known for high-quality, cost-effective care. Participants: Family members of 104 patients who died in-hospital (10% of annual deaths) over the course of 1 year. Intervention: None. Measurements: Participant perceptions of the decedent’s care, including symptom management, personal care, communication, and care coordination. Results: Decedents were mostly male (64%), white (96%), married (73%), and Christian (91%). Most survey participants were spouses of the decedent (68%); they were predominately white (98%), female (70%), and Christian (90%) and had a median age of 70 years (range, 35-91 years). Overall satisfaction was high. Pain, dyspnea, and anxiety or sadness were highly prevalent among decedents (73%, 73%, and 55%, respectively) but largely well managed. Most participants believed that decedents were treated respectfully and kindly by staff (87%) and that sufficient help was available to assist with medications and dressing changes (97%). Opportunities for improvement included management of decedents’ anxiety or sadness (29%) and personal care (25%), emotional support of the family (57%), communication regarding decedents’ illness (29%), and receiving contradictory or confusing information (33%). Conclusion: Despite high satisfaction with care overall, we identified important unmet needs. Addressing these gaps will improve the care of dying patients.

Incidence of brain metastases and overall survival in patients with primary cardiac sarcoma: A retrospective case series.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 10584-10584
Author(s):  
Maryann Shango ◽  
Lili Zhao ◽  
Monika Leja ◽  
Jonathan B. McHugh ◽  
Scott Schuetze ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Cancer Center ◽  
R0 Resection ◽  
Left Heart ◽  
Retrospective Case ◽  
Imaging Evaluation ◽  
Presenting Symptoms ◽  
Primary Cardiac Sarcoma

10584 Background: Primary cardiac sarcoma (PCS) is the most common primary cardiac malignancy, but is a rare primary site of sarcoma. We present 21 cases from a tertiary care center to better understand this uncommon malignancy. Methods: A cancer center-based registry and pathology database were searched to identify pts diagnosed with PCS from 1992-2013 at University of Michigan. Kaplan-meier method was used to estimate survival. Cox proportional hazard model was used to associate variables to occurrence of metastases (mets) or death. Results: Atotal of 21 pts (F12, 9M) with PCS were identified, median age 36 (range 11-74). The most common presenting symptoms included dyspnea (16) and chest pain (6; 5 with associated pericardial effusion). Histologies included: angiosarcoma (9), leiomyosarcoma (4), undifferentiated pleomorphic (3), spindle cell (2), fibrosarcoma (1), rhabdomyosarcoma (1) and synovial (1). Sites of origin were R atrium (7), R ventricle (2), L atrium (10) and pericardium (2). Ten pts presented with mets; most common sites were lung (8), liver (2), brain (2), pancreas (2) and bone (2). Surgery was attempted in 12 pts, achieving 1 R0 resection. Pts received a median of 1 (0-7) systemic therapies. Median overall (OS) was 12.6 mos (range 3-79) from diagnosis. Pts without prior surgery were more likely to have mets or death (p=0.038). Brain mets were common, occurring in 7 of 21 pts after a median of 7 mos (range 1-75) from diagnosis. Median OS after diagnosis of brain mets was 8 mos. Of the 7 pts who developed brain metastasis, 5 had PCS originating in the left heart. Of the 2 pts with PCS in the right heart, one was evaluated for and had a right to left shunt. The likelihood of developing brain mets did not correlate with age, chemotherapy, or surgery. Conclusions: PCS portends an extremely poor prognosis, marked by inability to achieve complete resection and a high incidence of disseminated disease at diagnosis. Metastatic disease to the brain was much more common in PCS (33%) as compared to STS of any origin (approximately 1-8%), particularly in pts with PCS originating in the left heart. Clinicians should have a low threshold for brain imaging evaluation of PCS pts.

Gastrointestinal stromal tumors: A 10-year experience from a tertiary care center in India.

2014 ◽  
Vol 32 (15_suppl) ◽  
pp. e21509-e21509
Author(s):  
Nida Iqbal Shapoo ◽  
Atul Sharma ◽  
N. K. Shukla ◽  
BK Mohanti ◽  
S. V. S. Deo ◽  
...  
Keyword(s):  
Gastrointestinal Stromal Tumors ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Stromal Tumors
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