Pharyngoesophageal Suturing Technique May Decrease the Incidence of Pharyngocutaneous Fistula following Total Laryngectomy

Objectives. A pharyngocutaneous fistula (PCF) following total laryngectomy is associated with increased morbidity and severe life threatening complications. We aimed to review our experience with the PCF following total laryngectomy and determine the impact of previously reported risk factors on the development of PCF in our patients.Methods. The medical records of 20 patients who had a total laryngectomy operation were retrospectively analyzed. The association between the proposed risk factors and the incidence of the PCF was investigated.Results. Comparison of the suture techniques used for the closure of the pharynx (either continuous Cushing type or interrupted) yielded that primary interrupted sutures had a significantly higher incidence of PCF formation(p<0.05). Although it was not statistically significant, diabetes mellitus was also associated with increased PCF formation(p>0.05). No significant difference was observed between the PCF and non-PCF groups in terms of other proposed risk factors(p>0.05). Conclusions. The main risk factor associated with PCF was found to be the type of pharyngeal closure technique. A vertical closure with a Cushing type continuous suture may be more successful than interrupted sutures in preventing a PCF.

Download Full-text

A review of pharyngeal mucosal closure technique in total laryngectomy

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20185303 ◽

2018 ◽

Vol 5 (1) ◽

pp. 145

Author(s):

Gopu Govindasamy ◽

Subbiah Shanmugam ◽

Arul Murugan

Keyword(s):

Medical Records ◽

Total Laryngectomy ◽

Salvage Surgery ◽

Pharyngocutaneous Fistula ◽

Closure Technique ◽

Carcinoma Of The Larynx ◽

The Impact ◽

Salvage Laryngectomy ◽

Radiotherapy Failure ◽

Hospital Center

Background: The purpose of this retrospective analysis was to review our single institute based experience with the pharyngocutaneous fistula following total laryngectomy and to determine the impact of pharyngeal closure technique in the development of PCF in our patients.Methods: The medical records of the patients, who underwent total laryngectomy for squamous cell carcinoma of the larynx and hypopharynx in Government Royapettah Hospital, center for oncology between January 2010 and December 2017, were retrospectively reviewed. Results: 26 patients were included in the study of which 25 were male and 1 was female. Mean age of the patients were 58 years. Horizontal closure was done in 9 patients (35%) and T closure was done in 17 patients (65%). PCF was observed in 1 of 9 patients in horizontal closure. Remaining 17 patients underwent T closure of whom 8 patients developed PCF (p=0.06). Eight out of 18 patients (44%) developed PCF after salvage surgery after radiotherapy failure, Remaining 8 patients underwent primary laryngectomy for advanced stage cancers with cartilage involvement, of whom 1 patient developed PCF (12.5%) (p=0.11). In salvage laryngectomy (n=18), 1 of 6 cases developed PCF in horizontal closure and 7 of 12 cases in T closure technique (p=0.09).Conclusions: The incidence of fistula in our study was 34%. Horizontal closure was associated with decreased incidence of PCF when compared to ‘T’ closure of the defect. Prior radiotherapy had increased incidence of PCF.

Download Full-text

What is the knowledge of tubercular patients about risk factors contributing to development of their disease

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh06s2122i ◽

2006 ◽

Vol 134 (Suppl. 2) ◽

pp. 122-127 ◽

Cited By ~ 1

Author(s):

Miroslav Ilic

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Main Risk Factor ◽

Active Pulmonary Tuberculosis ◽

Anonymous Questionnaire ◽

Number Of Patients ◽

Significant Difference ◽

Level Of Knowledge ◽

Basic Characteristics

INTRODUCTION. Present knowledge of population on basic characteristics of tuberculosis is a significant issue of prevention of tuberculosis. OBJECTIVE. The objective of our study was to determine the level of knowledge on risk factors of tuberculosis among tubercular patients. METHOD. A total of 115 new patients with the active pulmonary tuberculosis were interviewed by means of anonymous questionnaire, who has been treated at the Institute of Pulmonary Diseases, Sremska Kamenica during six-month period (October 2003-March 2004). RESULTS. The patients fulfilled the questionnaire; 37.6 % had no or finished only elementary school, and 58.6 % considered genetics the main risk factor of tuberculosis. Every second patient believed that he could not catch tuberculosis if he suffered from diabetes mellitus or any kind of tumor. 8.7 % of patients who suffered from diabetes mellitus had been informed by their physicians that could catch tuberculosis one day. Every third patient did not possess sewage system and nearly 20% lived in moist flats. Around 85% had no regular salaries or these were significantly under the average Serbian income per capita in this period (12820 dinars-CSD). Leading risk factors that can contribute to development of tuberculosis were as follows: irregular nutrition (91.4 %), smoking (74.2 %), alcohol consumption (65.5%) and associated diseases (diabetes mellitus, tumors). Only 15% of them believed that all these risk factors (smoking, alcohol, irregular diet) could participate together in development of tuberculosis, and not as individual factors. Analyzing the patients? knowledge on risk factors of tuberculosis, in relation to their educational level and alcohol and cigarettes consumption, there was no significant difference (p<0.05). Nevertheless, analyzing the quality of life in patients? houses, in relation to salary and bad habits (alcohol, cigarettes) as risk factors of tuberculosis, significant statistical difference was found (p>0.05). CONCLUSION. Intensive and permanent education of population is necessary primarily considering the knowledge on tuberculosis that would be the basis of reducing the number of patients and leading to possible eradication of this disease.

Download Full-text

Prevalence of Hepatitis B among Food Vendors in Wurukum Market, Makurdi Benue State

South Asian Journal of Research in Microbiology ◽

10.9734/sajrm/2018/v2i329262 ◽

2018 ◽

pp. 1-5

Author(s):

V. U. Obisike ◽

C. M. Uke ◽

E. U. Amuta

Keyword(s):

Risk Factors ◽

Liver Disease ◽

Hepatitis B Virus ◽

Hepatitis B ◽

Age Groups ◽

Hbv Infection ◽

Test Strips ◽

Significant Difference ◽

B Virus ◽

Life Threatening

Hepatitis B is a life threatening infectious liver disease caused by hepatitis B virus (HBV). The aim of this study was to determine the prevalence of HBV among food vendors in Wurukum, a highly commercial section of metropolitan Makurdi in Benue State. The test was carried out with the use of an immunochromatographic micropoint HBsAg test strips and a HBsAg buffer screen for the virus. Out of the 250 non-vaccinated food vendors sampled, 27(10.8%) had HBV infection, with more in males (21.7%) than in females (6.6%). No significant difference (p>0.05) was found among age groups in spite of the observed highest prevalence of 14.3% among the 20-29 year olds. Therefore, the need for routine screening cannot be overemphasized in spite of known risk factors among food vendors.

Download Full-text

An unexpectedly high occurrence of aciclovir-induced neuropsychiatric symptoms in patients treated for herpesvirus CNS infection: a prospective observational study

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkz357 ◽

2019 ◽

Vol 74 (12) ◽

pp. 3565-3572 ◽

Cited By ~ 1

Author(s):

Johan Lindström ◽

Anders Helldén ◽

Jan Lycke ◽

Anna Grahn ◽

Marie Studahl

Keyword(s):

Risk Factors ◽

Renal Function ◽

Medical Records ◽

Regression Models ◽

Prospective Observational Study ◽

Neuropsychiatric Symptoms ◽

Cns Infection ◽

Albumin Ratio ◽

Number Of Patients ◽

The Impact

Abstract Background Aciclovir is effective in herpesvirus infections of the CNS. Aciclovir-induced neuropsychiatric symptoms (AINS) have been reported and are associated with high CSF concentrations of aciclovir metabolite 9-carboxymethoxymethylguanine (CMMG). Risk factors except for renal failure have not been explored, and disruption of the blood–brain barrier (BBB) in acute CNS infection may be of interest. Objectives To investigate the impact of risk factors on aciclovir and CMMG concentrations, and to relate the results to AINS. Methods We investigated 21 consecutively included, consenting patients treated with aciclovir or valaciclovir for herpesvirus CNS infection. Regression models were constructed to study the impact of risk factors including BBB disruption, as measured with CSF:serum albumin ratio, on CSF aciclovir and CMMG concentrations. Medical records were assessed retrospectively to identify patients with AINS. Results Increased CSF:serum albumin ratio, as well as decreased renal function and high aciclovir doses, was associated with increased aciclovir and CMMG concentrations in the CSF. We identified five patients with new neuropsychiatric symptoms; four of those were considered to have AINS and had increased CSF CMMG concentrations. Only one patient without suspicion of AINS had an increased CSF CMMG concentration. Conclusions In patients with herpesvirus CNS infections, BBB disruption is associated with increasing aciclovir and CMMG CSF concentrations. We also found an unexpectedly high number of patients with AINS. Evaluation of CSF:serum albumin ratios, renal function and CSF concentrations of aciclovir and CMMG may all contribute to the optimization of aciclovir dosing and avoidance of AINS.

Download Full-text

Az ellenoldali csípőtáji törésig eltelt időt befolyásoló prognosztikai tényezők vizsgálata

Orvosi Hetilap ◽

10.1556/650.2018.31179 ◽

2018 ◽

Vol 159 (38) ◽

pp. 1543-1547

Author(s):

Krisztina Juhász ◽

Imre Boncz ◽

Péter Kanizsai ◽

Andor Sebestyén

Keyword(s):

Risk Factors ◽

Prognostic Factors ◽

Hip Fracture ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Hip Fractures ◽

Age Groups ◽

Significant Difference ◽

Neck Fracture ◽

The Impact

Abstract: Introduction: Although several national studies reported on the risk factors for contralateral hip fracture, there are no data about the prognostic factors of the time until contralateral hip fractures. Aim: The aim of the study was to analyse the impact of different prognostic factors on the time until the development of contralateral fracture and to determine the incidence of contralateral hip fractures after femoral neck fractures. Method: Patients aged 60 years and over with contralateral hip fracture between 01 Jan 2000 and 31 Dec 2008 were identified among those who suffered their femoral neck fracture in Hungary in 2000. Risk factors as age, sex, comorbidities, type of fracture and surgery, place of living and hospitals providing treatment for primary fracture were analysed by one way ANOVA focusing on the time until the development of contralateral hip fracture. Results: 312 patients met the inclusion criteria. The incidence of contralateral hip fracture after femoral neck fracture ranged between 1.5% and 2.1%, the cumulative incidence was 8.24%. The mean time until the development of contralateral hip fracture was 1159.8 days. The incidence of contralateral hip fracture showed no significant deviation. Significantly shorter time (p = 0.010) was detected until the contralateral hip fracture in older patients with femoral neck fracture. Conclusions: The yearly incidence of contralateral hip fracture showed no significant difference by patients with femoral neck fracture over 60 years. The shorter time until the contralateral hip fracture by the older age groups highlights the need of elaboration of prevention strategies. Orv Hetil. 2018; 159(38): 1543–1547.

Download Full-text

Coronavirus disease 2019 and stroke in Iran: a case series and effects on stroke admissions

International Journal of Stroke ◽

10.1177/1747493020937397 ◽

2020 ◽

pp. 174749302093739 ◽

Cited By ~ 2

Author(s):

M Mehrpour ◽

A Shuaib ◽

M Farahani ◽

HR Hatamabadi ◽

Z Fatehi ◽

...

Keyword(s):

Case Series ◽

Absolute Number ◽

Stroke Severity ◽

Stroke Patients ◽

Pathological Characteristics ◽

Significant Difference ◽

Duration Of Hospitalization ◽

Life Threatening ◽

Treatment Plans ◽

The Impact

Objective The coronavirus disease 2019 pandemic has affected healthcare systems around the globe and massively impacted patients with various non-infectious, life-threatening conditions. Stroke is a major neurological disease contributing to death and disability worldwide, and is still an ongoing issue during the pandemic. Here we investigate the impact of the coronavirus disease 2019 outbreak on stroke manifestations, treatment courses, the outcome of stroke patients, and the hospitalization rate in a referral center for stroke management in Tehran, Iran. Methods We extracted data regarding 31 stroke patients (10 patients with laboratory-confirmed coronavirus disease 2019) and compared the demographic and pathological characteristics of the patients with or without coronavirus disease 2019 infection. The association of demographic/pathological characteristics of stroke patients during the coronavirus disease 2019 pandemic and a corresponding period during the previous year (49 patients) and an earlier period during the same year as the pandemic (50 patients) was also evaluated. Results The absolute number of admissions decreased about 40% during the coronavirus disease 2019 pandemic. Except for the stroke severity (P = 0.002), there were no significant changes in the demographic and pathological characteristics of the stroke patients during the three studied periods. A significantly higher mean of age (75.60 ± 9.54 versus 60.86 ± 18.45; P = 0.007), a significant difference in the type of stroke (P = 0.046), and significantly higher stroke severity (P = 0.024) were observed in stroke patients with coronavirus disease 2019 compared with those of stroke patients without coronavirus disease 2019. Treatment approaches, duration of hospitalization, and mortality rates did not differ significantly. Conclusions This report shows that the pandemic caused the number of acute stroke admissions to plummet compared to other periods. Although the pandemic did not affect the treatment plans and care of the patients, stroke cases with coronavirus disease 2019 had higher age, more large vessel ischemic stroke, and more severe stroke. Further studies are urgently needed to realize the probable interaction of the coronavirus disease 2019 pandemic and the neurologic disease.

Download Full-text

Pharyngocutaneous fistula after total laryngectomy: multivariate analysis of risk factors and a severity-based classification proposal

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-018-5200-4 ◽

2018 ◽

Vol 276 (1) ◽

pp. 143-151 ◽

Cited By ~ 7

Author(s):

Maria Casasayas ◽

Aina Sansa ◽

Jacinto García-Lorenzo ◽

Montserrat López ◽

César Orús ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Total Laryngectomy ◽

Pharyngocutaneous Fistula

Download Full-text

The Impact of Pharyngeal Repair Time and Suture Frequency on the Development of Pharyngocutaneous Fistula After Total Laryngectomy

Journal of Craniofacial Surgery ◽

10.1097/scs.0000000000000826 ◽

2014 ◽

Vol 25 (3) ◽

pp. 775-779 ◽

Cited By ~ 3

Author(s):

Salih Aydin ◽

Umit Taskin ◽

Israfil Orhan ◽

Bengül Altas ◽

Sertuğ Sinan Ege ◽

...

Keyword(s):

Total Laryngectomy ◽

Repair Time ◽

Pharyngocutaneous Fistula ◽

The Impact

Download Full-text

RISK FACTORS FOR ESTROGEN EXPOSURE IN VARIOUS GRADES OF ENDOMETRIOID CARINOMA

Indonesian Midwifery and Health Sciences Journal ◽

10.20473/imhsj.v4i1.2020.40-50 ◽

2021 ◽

Vol 4 (1) ◽

pp. 40

Author(s):

Ma’rifatu Ulfa Hidayati ◽

Pungky Mulawardhana ◽

Nila Kurniasari

Keyword(s):

Risk Factors ◽

Endometrial Cancer ◽

General Hospital ◽

Medical Records ◽

Type I ◽

Endometrioid Carcinoma ◽

Test Results ◽

Early Menarche ◽

Estrogen Exposure ◽

Significant Difference

AbstractBackground: Incidence endometrial cancer in Southeast Asia it is estimated that 41% of new cases emerge. The incidence of endometrial cancer in Dr. Soetomo General Hospital has increased every year. In 2016 there were 119 new cases of endometrial cancer and in 2017 there were 160 cases. 75%-80% is type I endometrial cancer (endometrioid carcinoma). Risk factors for estrogen exposure (early menarche, parity, obesity) are risk factors for endometrial cancer. The prognosis of endometrial cancer depends on the grade. This study aims to determine differences in risk factors for estrogen exposure in various grades of type I endometrial cancer (endometrioid carcinoma) in the Poli Onkologi Satu Atap Dr. Soetomo General Hospital Surabaya. Methods: the research method was analytic observational with cross-sectional design. Sample size of 40 medical records was taken by total sampling technique. Research variables include age of menarche, parity, BMI, and grade of endometrial cancer. The instrument used was a data collection sheet and medical records. Data analysis using chi-square test. Results: The results showed 52% patients were grade 1-2, there were 95% of menarche patients in the age range of 12-14 years, 62.5% patients had parity of 1-2 and 52% patients, BMI was underweight-normal category. Test results based on early menarche did not show significant differences between grades 1-2 and grade 3 in endometrioid carcinoma (p = 0.168). Likewise, parity in various grades of endometrial cancer type I (endometrioid carcinoma) there was no significant difference (p = 0.220) and BMI also no significant difference (p = 0.987). Conclusions: risk factors for estrogen exposure which include menarche, parity, obesity do not make a significant differences to the grades of endometrioid carcinoma.

Download Full-text

Development of Pharyngocutaneous Fistula after Total Laryngectomy: The Predictive Value of C-reactive Protein/Albumin Ratio

Acta Medica (Hradec Kralove Czech Republic) ◽

10.14712/18059694.2020.58 ◽

2020 ◽

Vol 63 (4) ◽

pp. 159-163

Author(s):

Abitter Yücel ◽

Hilal Yücel ◽

Fuat Aydemir ◽

Mert Mutaf ◽

Mehmet Akif Eryılmaz ◽

...

Keyword(s):

Postoperative Period ◽

Total Laryngectomy ◽

Linear Regression Analysis ◽

Multiple Linear Regression Analysis ◽

Early Postoperative Period ◽

Pharyngocutaneous Fistula ◽

C Reactive Protein ◽

Albumin Ratio ◽

Reactive Protein ◽

Significant Difference

Background: We aimed to evaluate whether C-reactive protein(CRP)/ Albumin ratio (CAR) performed in the early postoperative period after total laryngectomy could be a predictive factor for the development of pharyngocutaneous fistula (PCF). Methods: The files of patients with laryngeal squamous cell carcinoma who underwent total laryngectomy between January 2005 and January 2019 were retrospectively reviewed. Patients were divided into two groups: patients with PCF (PCF group) and without (Non-PCF group). CAR values and risk factors were compared between groups. Results: The overall incidence of PCF was 23.2%. There was a statistically significant difference between the two groups in terms of CRP and CAR levels (p = 0.001). The CAR value of 27.05 (sensitivity = 75.0% , specificity 68.2%, area under curve (AUC) = 0.742, 95% confidence interval 0.616–0.868) was determined as a cutoff value to describe the development of fistula in the early postoperative period. In multiple linear regression analysis, there was an independent relationship between presence of PCF and previous RT and CAR value. Conclusions: CAR, performed in the early postoperative period, may be a new and useful marker for predicting PCF after total laryngectomy.

Download Full-text