scholarly journals Management of Delayed Onset Postoperative Hemorrhage after Anastomotic Urethroplasty

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
L. A. Bertrand ◽  
S. P. Elliott ◽  
B. N. Breyer ◽  
B. A. Erickson
Keyword(s):  
Interventional Radiology ◽  
Risk Factor ◽  
Primary Anastomosis ◽  
Postoperative Hemorrhage ◽  
Corpus Spongiosum ◽  
Younger Patients ◽  
Surgical Interventions ◽  
Delayed Onset ◽  
Perioperative Hemorrhage ◽  
Anastomotic Urethroplasty

Excision with primary anastomosis (EPA) urethroplasty is generally the preferred method for short strictures in the bulbar urethra, given its high success rate and low complication rate compared to other surgical interventions. Bleeding is a presumed risk factor for any surgical procedure but perioperative hemorrhage after an EPA requiring hospitalization and/or reintervention is unreported with no known consensus on the best course for management. Through our experience with three separate cases of significant postoperative urethral hemorrhage after EPA, we developed an algorithm for treatment beginning with conservative management and progressing through endoscopic and open techniques, as well as consideration of embolization by interventional radiology. All the three of these cases were managed successfully though they did require multiple interventions. We theorize that younger patients with more robust corpus spongiosum and more vigorous spontaneous erections, patients that have undergone fewer prior urethral procedures and therefore have more prominent vasculature, and those patients managed with a two-layer closure of the ventral urethra without ligation of the transected bulbar arteries are at a higher risk for this complication.

Characteristics, outcomes, and risk factors of ICANS after axicabtagene ciloleucel: Does age matter?

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e19556-e19556
Author(s):  
Kitsada Wudhikarn ◽  
Radhika Bansal ◽  
Arushi Khurana ◽  
Matthew Hathcock ◽  
Michael Ruff ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Older Patients ◽  
Clinical Course ◽  
International Prognostic Index ◽  
Age Groups ◽  
Central Nervous System Involvement ◽  
Microvascular Disease ◽  
B Cell Lymphoma ◽  
Younger Patients

e19556 Background: CD19 chimeric antigen receptor T cell therapy possesses unique side effects including cytokine release syndrome (CRS) and immune effector cell associated neurotoxicity syndrome (ICANS). Age is a major risk factor for ICANS. However, whether ICANS in older patients is different compared to younger patients is unknown. Herein, we report clinical course, outcomes and risk factors for ICANS in older patients with large B cell lymphoma (LBCL) treated with axicabtagene ciloleucel (axi-cel). Methods: We comprehensively reviewed detailed clinical courses of ICANS in 78 adult patients with LBCL treated with axi-cel between June 2016 and October 2020. Incidence, manifestation, risk factors, treatment, and outcomes of ICANS were compared between patients age ≥60 (n=32) and <60 (n=46) years old. Results: Baseline characteristics were comparable between older and younger patients except higher proportion of high international prognostic index and underlying cerebral microvascular disease in older patients. ICANS was observed in 16 patients in the older and 24 patients in the younger age group, with a 30-day incidence of 52% and 50%, respectively. Median time to CRS and ICANS were similar between 2 age groups. The most common initial neurological findings included aphasia, dysgraphia and encephalopathy in both age groups. Table summarizes the characteristics, clinical course and interventions of ICANS in older and younger patients. In Cox regression model, the presence of CRS was the only factor associated with ICANS in both age groups. Age, history of central nervous system involvement and cerebral microvascular disease were not associated with ICANS. Importantly, all patients had complete resolution of ICANS. No elderly patients in our cohort experienced seizure as a manifestation of ICANS. Conclusions: In our study, older age was not a risk factor for ICANS. CRS was the only factor associated with ICANS in both younger and older patients. Incidence, clinical course and neurological outcomes of ICANS in older patients treated with axi-cel were comparable to younger patients. [Table: see text]

Delayed-onset peripheral blood cytopenia after rituximab: Frequency and risk factor assessment in a consecutive series of 77 treatments

2006 ◽  
Vol 47 (6) ◽  
pp. 1013-1017 ◽  
Author(s):  
Chiara Cattaneo ◽  
Pierangelo Spedini ◽  
Salvatore Casari ◽  
Alessandro Re ◽  
Alessandra Tucci ◽  
...  
Keyword(s):  
Risk Factor ◽  
Peripheral Blood ◽  
Consecutive Series ◽  
Risk Factor Assessment ◽  
Delayed Onset

The 2 Gene Coding Sequence T807/A873 of the Platelet Collagen Receptor Integrin 2β1 Might Be a Genetic Risk Factor for the Development of Stroke in Younger Patients

Blood ◽  
1999 ◽  
Vol 93 (11) ◽  
pp. 3583-3586 ◽  
Author(s):  
Lena E. Carlsson ◽  
Sentot Santoso ◽  
Carsten Spitzer ◽  
Christof Kessler ◽  
Andreas Greinacher
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Independent Risk Factor ◽  
Epidemiological Studies ◽  
Receptor Expression ◽  
Stroke Patients ◽  
Younger Patients ◽  
Gene Coding ◽  
Collagen Receptor ◽  
Conventional Risk Factors

The polymorphisms C807T and G873A of the platelet integrin 2β1 (collagen receptor glycoprotein [GP] Ia-IIa) are linked to the expression density of this receptor. The GPIa T807/A873 allele causes a higher receptor expression, enhancing platelet binding to collagen. This might present a genetic predisposition for the development of thromboembolic complications. In this case-control study, the genotypes of the GPIa C807T polymorphism and presence of conventional risk factors (hypertension, diabetes mellitus, and smoking) were compared in stroke patients and patients without cerebrovascular disease (non-CVD patients) ≤50 years of age (n = 45 and 41, respectively) and in stroke patients and non-CVD patients more than 50 years of age (n = 182 and 129, respectively. In patients ≤50 years of age, the T807 allele was the only overrepresented variable (P = .023; odds ratio, 3.02; 95% confidence interval, 1.20 to 7.61) and an independent risk factor, whereas the presence of conventional risk factors was similar between stroke patients ≤50 years of age and non-CVD patients ≤50 years of age. Large epidemiological studies should prove whether the platelet collagen receptor GPIa-IIa T807 allele is an independent risk factor for the development of stroke in younger patients.

scholarly journals Risk Factor and Surgical Outcome of Petersen’s Hernia After Gastrectomy in Gastric Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
Song Liu ◽  
Qiongyuan Hu ◽  
Peng Song ◽  
Liang Tao ◽  
Shichao Ai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Risk Factor ◽  
Distal Gastrectomy ◽  
Univariate Analysis ◽  
Time Interval ◽  
Bowel Necrosis ◽  
Surgical Interventions ◽  
Petersen’S Hernia ◽  
Factor Evaluation

BackgroundPetersen’s hernia is a life-threatening complication after gastrectomy. This study is dedicated to identify risk factors for Petersen’s hernia and compare clinical outcomes between patients receiving early or delayed surgical interventions.MethodsData from all patients who received gastrectomy due to gastric cancer were collected. Clinical characteristics were compared between Petersen and non-Petersen groups, bowel necrosis and non-necrotic groups. Propensity score matching (PSM) was conducted to generate two comparative groups. Univariate analysis and multivariate logistic regression were performed for risk factor evaluation.ResultsA total of 24 cases of Petersen’s hernia were identified from 1,481 cases of gastrectomy. PSM demonstrated that lower body mass index [BMI; odds ratio (OR) = 0.2, p &lt; 0.01] and distal gastrectomy (OR = 6.2, p = 0.011) were risk factors for Petersen’s hernia. Longer time interval from emergence visit to laparotomy (p = 0.042) and elevated preoperative procalcitonin (p = 0.033) and C-reactive protein (CRP; p = 0.012) were associated with higher risk of bowel necrosis in Petersen’s hernia. Early surgical intervention resulted in less bowel necrosis rate (p = 0.012) and shorter length of necrotic bowel (p = 0.0041).ConclusionsLow BMI and distal gastrectomy are independent risk factor for Petersen’s hernia after gastrectomy. Curtailing observing time and executing prompt surgery are associated with bowel viability and better outcome in patients with Petersen’s hernia.

scholarly journals Evaluation of a Newly Developed Smartphone App for Risk Factor Management in Young Patients With Ischemic Stroke: A Pilot Study

2022 ◽  
Vol 12 ◽  
Author(s):  
Viktoria Fruhwirth ◽  
Lisa Berger ◽  
Thomas Gattringer ◽  
Simon Fandler-Höfler ◽  
Markus Kneihsl ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Risk Factor ◽  
Ischemic Stroke ◽  
Intervention Group ◽  
Smoking Behavior ◽  
Smartphone App ◽  
Younger Patients ◽  
Risk Factor Management ◽  
Post Stroke

Background: Efficient treatment of modifiable vascular risk factors decreases reoccurrence of ischemic stroke, which is of uttermost importance in younger patients. In this longitudinal pilot study, we thus assessed the effect of a newly developed smartphone app for risk factor management in such a cohort.Methods: The app conveys key facts about stroke, provides motivational support for a healthy lifestyle, and a reminder function for medication intake and blood pressure measurement. Between January 2019 and February 2020, we consecutively invited patients with ischemic stroke aged between 18 and 55 years to participate. Patients in the intervention group used the app between hospital discharge and 3-month follow-up. The control group received standard clinical care. Modifiable risk factors (physical activity, nutrition, alcohol consumption, smoking behavior, obesity, and hypertension) were assessed during the initial hospital stay and at a dedicated stroke outpatient department three months post-stroke.Results: The study cohort comprised 21 patients in the app intervention group (62% male; age = 41 ± 11 years; education = 12 ± 3 years) and 21 sex-, age- and education-matched control patients with a comparable stroke risk factor profile. Baseline stroke severity was comparable between groups (intervention: median NIHSS = 3; control: median NIHSS = 4; p = 0.604). Three months post-stroke, patients in the intervention group reported to be physically almost twice as active (13 ± 9 h/week) compared to controls (7 ± 5 h/week; p = 0.022). More intense app usage was strongly associated with higher physical activity (r = 0.60, p = 0.005) and lower consumption of unhealthy food (r = −0.51, p = 0.023). Smoking behavior (p = 0.001) and hypertension (p = 0.003) improved in all patients. Patients in the intervention group described better self-reported health-related quality of life three months post-stroke (p = 0.003).Conclusions: Specifically designed app interventions can be an easily to implement and cost-efficient approach to promote a healthier lifestyle in younger patients with a stroke.

scholarly journals Surgical Explantation of Bone-Anchored Hearing Devices: A 10-year Single Institution Review

2019 ◽  
Vol 162 (1) ◽  
pp. 95-101 ◽  
Author(s):  
Christian G. Fritz ◽  
Dennis I. Bojrab ◽  
Kenny F. Lin ◽  
Christopher A. Schutt ◽  
Seilesh C. Babu ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Normal Hearing ◽  
Single Institution ◽  
Younger Patients ◽  
Surgical Interventions ◽  
Targeted Interventions ◽  
Clinical Variables ◽  
Hearing Devices

Objective To identify clinical variables associated with the decision to surgically discontinue bone-anchored hearing device function. Study Design Retrospective chart review. Setting Tertiary neurotology referral center. Subjects and Methods This study examines surgical interventions performed on existing bone-anchored hearing devices at a single institution from 2008 to 2018. Patient characteristics, indications for implantation, and complications prompting surgical intervention were assessed. Results Seventy-seven cases were included in this study. Among patients in the younger cohort (<37 years old), 100% (13 of 13) of those discontinuing their device had a contralateral normal-hearing ear. Conversely, 0% (0 of 14) of the younger patients with bilateral hearing loss surgically discontinued their devices. Within the older cohort (≥37 years old), female patients ( P = .002) and those with an increased body mass index ( P = .035) were more likely to surgically discontinue their devices. Multivariate analysis revealed that a contralateral normal-hearing ear ( P = .001) and infection without soft tissue overgrowth of the abutment ( P = .026) were the strongest predictors of device discontinuation, after adjusting for potential confounders. Conclusion Surgical discontinuation is associated with several clinical variables. Targeted interventions that are viable alternatives to removal, such as device relocation, should be presented to younger patients with a contralateral normal-hearing ear who experience persistent complications. Patients with persistent infection in the absence of soft tissue overgrowth would especially benefit from enhanced counseling on proper hygiene.

Thrombotic and Hemorrhagic Complications after Surgery in Patients with Essential Thrombocythemia and Polycythemia Vera.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2693-2693 ◽  
Author(s):  
Marco Ruggeri ◽  
Francesco Rodeghiero ◽  
Alberto Tosetto ◽  
Giancarlo Castaman ◽  
Francesca Scognamiglio ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Polycythemia Vera ◽  
Surgical Procedures ◽  
Essential Thrombocythemia ◽  
Arterial Thrombosis ◽  
Surgical Interventions ◽  
Antithrombotic Prophylaxis ◽  
Unfractioned Heparin ◽  
Hemorrhagic Complications

Abstract Essential Thrombocythemia (ET) and Polycythemia Vera (PV) are chronic myeloproliferative diseases characterized by frequent episodes of deep venous thrombosis (DVT), arterial thromboembolism (AT) and by hemorrhagic complications. Surgical procedures could represent a risk factor for thrombosis and bleeding, but no data on the real frequency of these complications are available. To estimate the frequency of thrombosis and haemorrhages after surgical procedures and their outcomes, a multicenters retrospective analysis was performed. Data from 105 PV and 150 ET patients (128 males, 127 females, median age at diagnosis 60, were analyzed, for a total of 311 surgical interventions. At least one risk factor for arterial thrombosis (diabetes mellitus, hypercholesterolemia, arterial hypertension, previous AT, smoke) was present in 128/255 (50.1%), more frequently in PV than in ET patients (58.5 vs. 46.8%, p=0.02). An excess of male and older patients in PV than in ET explained this finding (multivariate analysis). Previous DVT was present in 9/255 patients (3.5%). After diagnosis, antiplatelet drugs were given to 211/255 patients (82.7%); cytoreductive treatments to 188/255 (74%), warfarin to 16/255 (6.2%); all PV patients were phlebotomized. In 25/311 surgeries (8.0%), an emergency procedure was performed; 195 surgeries were done under general anaesthesia; 21/91 abdominal interventions (23%) were performed under laparoscopy. Major surgeries were 160/311 (51.4%). Data about antithrombotic prophylaxis were available for 292/311 surgeries: in 126 (43.2%) low molecular heparin, in 38 (13%) unfractioned heparin, in 5 (1.7%) warfarin and in 123 no anticoagulant therapy was administered. In 45/123 (36.6%) patients without antithrombotic prophylaxis, antiplatelet therapy was administered before surgery. 189/255 (74%) were on cytoreductive therapy before surgery; for 9 surgical procedures, a short cycle of chemotherapy was administered before surgery. Clinical outcomes after surgery were recorded with a 3 months follow-up. No event was observed in 259/311 procedures (83.2%); there were 12 arterial and 12 venous thrombotic events, 23 major and 7 minor hemorrhages and 5 deaths. AT were more frequent in ET patients (5.3 vs. 1.5%, p=0.08) while venous events were more frequent in PV patients (7.7 vs. 1.1%, p=0.002). There was a strong risk gradient for AT associated with the presence of one or more arterial risk factors (OR for 4 or more risk factors: 40.9, p=0.003). Platelet count and hematocrit at surgery (median 477 x 109 /l and 42.6%, respectively) were not associated with either venous or arterial thrombosis. There was no correlation between bleeding episodes and type of diagnosis, use of antithrombotic prophylaxis and type of surgery. In conclusion, despite an active approach (cytoreduction and antithrombotic prophylaxis in the majority of the cases) a high proportion of PV and ET surgeries was complicated by DVT and AT (7.7%) but also by major hemorrhages (7.3%), requiring more investigation on the optimal prophylaxis in these patients.

scholarly journals Foot osteoarthritis: latest evidence and developments

2018 ◽  
Vol 10 (4) ◽  
pp. 91-103 ◽  
Author(s):  
Edward Roddy ◽  
Hylton B. Menz
Keyword(s):  
Older Adults ◽  
Risk Factor ◽  
Randomized Trials ◽  
Metatarsophalangeal Joint ◽  
Epidemiological Studies ◽  
Controlled Trials ◽  
Foot Orthoses ◽  
First Metatarsophalangeal Joint ◽  
Surgical Interventions ◽  
Randomized Controlled

Foot osteoarthritis (OA) is a common problem in older adults yet is under-researched compared to knee or hand OA. Most existing studies focus on the first metatarsophalangeal joint, with evidence relating to midfoot OA being particularly sparse. Symptomatic radiographic foot OA affects 17% of adults aged 50 years and over. The first metatarsophalangeal joint is most commonly affected, followed by the second cuneometatarsal and talonavicular joints. Epidemiological studies suggest the existence of distinct first metatarsophalangeal joint and polyarticular phenotypes, which have differing clinical and risk factor profiles. There are few randomized controlled trials in foot OA. Existing trials provide some evidence of the effectiveness for pain relief of physical therapy, rocker-sole shoes, foot orthoses and surgical interventions in first metatarsophalangeal joint OA and prefabricated orthoses in midfoot OA. Prospective epidemiological studies and randomized trials are needed to establish the incidence, progression and prognosis of foot OA and determine the effectiveness of both commonly used and more novel interventions.

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