scholarly journals Efficacy of Combined Laparoscopic and Hysteroscopic Repair of Post-Cesarean Section Uterine Diverticulum: A Retrospective Analysis

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Cuilan Li ◽  
Shiyan Tang ◽  
Xingcheng Gao ◽  
Wanping Lin ◽  
Dong Han ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Combined Treatment ◽  
Clinical Manifestations ◽  
Abnormal Uterine Bleeding ◽  
Lower Uterine Segment ◽  
Improvement Rate ◽  
Uterine Scar ◽  
Lost To Follow Up

Background. Diverticulum, one of the long-term sequelae of cesarean section, can cause abnormal uterine bleeding and increase the risk of uterine scar rupture. In this study, we aimed to evaluate the efficacy of combined laparoscopic and hysteroscopic repair, a newly occurring method, treating post-cesarean section uterine scar diverticulum.Methods. Data relating to 40 patients with post-cesarean section uterine diverticulum who underwent combined laparoscopic and hysteroscopic repair were retrospectively analyzed. Preoperative clinical manifestations, size of uterine defects, thickness of the lower uterine segment (LUS), and duration of menstruation were compared with follow-up findings at 1, 3, and 6 months after surgery.Results. The average preoperative length and width of uterine diverticula and thickness of the lower uterine segment were recorded and analyzed. The average durations of menstruations at 1, 3, and 6 months after surgery were significantly shorter than the preoperative one (p<0.05), respectively. At 6 months after surgery, the overall success improvement rate of surgery was 90% (36/40). Three patients (3/40 = 7.5%) developed partial improvement, and 1/40 (2.5%) was lost to follow-up.Conclusions. Our findings showed that combined treatment with laparoscopy and hysteroscopy was an effective method for the repair of post-cesarean section uterine diverticulum.

Symptom Combinations Associated with Outcome and Therapeutic Effects in a Cohort of Cases with SARS

2006 ◽  
Vol 34 (06) ◽  
pp. 937-947 ◽  
Author(s):  
Shao Li ◽  
Ruiqin Wang ◽  
Yulong Zhang ◽  
Xuegong Zhang ◽  
A. Joseph Layon ◽  
...  
Keyword(s):  
Combined Treatment ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Adverse Outcomes ◽  
Therapeutic Effects ◽  
Treatment Protocols ◽  
Oxyhemoglobin Saturation ◽  
Treatment Groups ◽  
Lost To Follow Up

Severe acute respiratory syndrome (SARS) is an infectious disease and some of its symptoms were clinically indistinguishable of those from similar diseases. This study aimed to find the symptom combinations associated with adverse outcome and the therapeutic effects in a cohort of patients with probable SARS retrospectively. In 2003, 123 SARS cases in Beijing were subjected to a strictly western medicine (WM) treatment, or a combined treatment (WM plus Herba houttuyniae injection, addition of individualized herbal treatments when necessary), of which 115 were followed till death or discharge; 8 were transferred and lost to follow-up. In both treatment groups, clinical manifestations were evaluated daily; development of signs and symptoms, and their possible relationship with outcome, were assessed. The relationships between these sign/symptom complexes and outcome under two treatment protocols were evaluated and differences were noted. Dynamic symptom combinations, dividing into the early, the medium-term and the durational symptom clusters, were identified as likely being related to the adverse outcomes of SARS ( p < 0.05, p < 0.01). Compared with a strictly WM treatment, the combined treatment resulted in a longer hospital stay ( p = 0.028), a non-statistically significant mortality rate decrease (combined treatment: 9.6% versus WM: 11.1%), and a significant improvement of arthralgia and myalgia ( p < 0.05) in the early symptom cluster. Additionally, the combined protocol improved arterial oxyhemoglobin saturation significantly at day 22 ( p < 0.05). In conclusion, the progress and outcome of SARS may be associated with specific temporal patterns of development in combination of several non-specific signs and symptom complexes, which are also helpful for evaluating the therapeutic effects on SARS patients.

scholarly journals Clinical presentations and long term prognosis of childhood onset polyarteritis nodosa in single centre of Korea

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jeong-Seon Lee ◽  
Joong-Gon Kim ◽  
Soyoung Lee
Keyword(s):  
Polyarteritis Nodosa ◽  
Clinical Manifestations ◽  
Long Term Outcomes ◽  
Childhood Onset ◽  
Laboratory Findings ◽  
Clinical Presentations ◽  
Long Term Prognosis ◽  
Digital Amputation

AbstractChildhood-onset polyarteritis nodosa (PAN) is a rare and systemic necrotising vasculitis in children affecting small- to medium-sized arteries. To date, there have been only a few reports because of its rarity. Thus, we aimed to investigate the clinical manifestations, laboratory findings, treatment, and long-term outcomes in patients with childhood-onset PAN and to evaluate the usefulness of the paediatric vasculitis activity score (PVAS). We retrospectively analysed the data of nine patients with childhood-onset PAN from March 2003 to February 2020. The median ages at symptom onset, diagnosis, and follow-up duration were 7.6 (3–17.5), 7.7 (3.5–17.6), and 7.0 (1.6–16.3) years, respectively. All patients had constitutional symptoms and skin manifestations, while five exhibited Raynaud’s phenomenon. Organ involvement was observed in one patient. The median PVAS at diagnosis was 7 (range: 2–32). Prednisolone was initially used for induction in all patients, and other drugs were added in cases refractory to prednisolone. All patients survived, but three patients with high PVAS at diagnosis experienced irreversible sequelae, including intracranial haemorrhage and digital amputation. In conclusion, early diagnosis and treatment may minimise sequelae in patients with childhood-onset PAN. This study suggests that high PVAS score at diagnosis may be associated with poor prognosis.

How to Find Patients Who are 'Lost to Follow-up'

2010 ◽  
Vol 92 (3) ◽  
pp. 98-101 ◽  
Author(s):  
LC Biant ◽  
VK Eswaramoorthy ◽  
RE Field
Keyword(s):  
Surgical Interventions ◽  
Loss To Follow Up ◽  
Medical Interventions ◽  
Follow Up Studies ◽  
Long Term Follow Up ◽  
Lost To Follow Up

Long-term surveillance of patients is necessary to ascertain the outcome of medical interventions. The rate of 'loss to follow-up' is the largest controllable variable in long-term follow-up studies. Such surveillance programmes are of particular importance to surgical interventions as differences between techniques or implants may take years to become apparent.

Electrocautery Adenoidectomy Outcomes: A Metaanalysis

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P33-P34
Author(s):  
Jeremy T. Reed ◽  
Shankar K. Sridhara ◽  
Scott E Brietzke
Keyword(s):  
Sample Size ◽  
Random Effects ◽  
English Language ◽  
Operative Time ◽  
Inclusion Criteria ◽  
Subjective Success ◽  
Random Effects Modeling ◽  
Lost To Follow Up

Objective Review and assess the current published literature regarding clinical outcomes of suction electrocautery adenoidectomy (ECA) in pediatric patients. Methods The MEDLINE database was systematically reviewed for articles reporting on the use of ECA. Inclusion criteria included English language, sample size greater than 5, and presentation of extractable data regarding pediatric outcomes with ECA. Random effects modeling was used to estimate summary outcomes. Results 9 studies met the inclusion criteria. There were 2 level 1b studies, 2 level 3b studies, and 5 level 4 studies. The mean sample size was 276 patients with a grand mean age of 6.0 years. Random effects modeling of summary estimates of intra-operative hemorrhage (4.1 cc vs. 24.0 cc 95% CI of difference = 16.5–23.1, p<0.001) and operative time (10.0 minutes vs. 11.9 minutes 95% CI of difference=0.82–2.90, p<0.001) favored ECA vs. traditional curette adenoidectomy. Subjective success was reported in 95.0% (95% CI=92.7–97.3%, p<0.001) of ECA patients with a grand mean of 5.8 months of postoperative follow-up and a grand mean lost to follow-up rate of 23.2%. Adenoid regrowth was evaluated objectively (endoscopy or X-ray) in only 116 of 2,132 (5.4%) total patients with an observed regrowth rate of 2.8% (95% CI=0–5.5%, p=0.052) with 846 total person years of follow-up. Conclusions The preponderance of evidence favors ECA versus curette adenoidectomy in terms of decreased intraoperative hemorrhage and decreased operative time. Long-term outcomes data for ECA are scarce, despite the fact that the procedure is likely performed hundreds of times each day, but suggest a low regrowth rate.

scholarly journals Diagnostic Accuracy of Lower Uterine Segment Scar Thickness ≤1.6mm in Prediction of Scar Dehiscence in patients

2021 ◽  
Vol 15 (10) ◽  
pp. 2682-2684
Author(s):  
Fiza Asif ◽  
Sobia Zafar ◽  
Tehmina Zafar ◽  
Tayyaba Majeed ◽  
Zahid Mahmood
Keyword(s):  
Cesarean Section ◽  
Diagnostic Accuracy ◽  
Gold Standard ◽  
Lower Uterine Segment ◽  
Transvaginal Sonography ◽  
Cross Sectional ◽  
Standard Material ◽  
Lower Segment Cesarean Section ◽  
Study Results ◽  
Uterine Scar

Background: Cesarean section uterine scar dehiscence (CSD) is a rare but notable complication of Lower segment cesarean section (LSCS) surgery. The cause for a uterine scar dehiscence is based on the etiology behind the uterine scar defect or any event that would predispose the cesarean scar to dehisce. Globally accepted option for assessing the CS scar is transvaginal ultrasonography of the non-pregnant uterus. Objective: To determine the diagnostic accuracy of lower uterine segment scar thickness≤1.6mm in the prediction of scar dehiscence in patients with previous one LSCS who are undergoing repeat LSCS after trial of labour taking intraoperative findings as gold standard. Material and methods: This cross sectional study was conducted in Services Hospital, Lahore for 6 months. The Non probability consecutive sampling technique was used to include women with previous one LSCS at 36-38 weeks were asked to get their TVS done for scar thickness. Women with scar thickness≤1.6mm and scar thickness>1.6mm were identified. Their intraoperative findings of scar dehiscence were confirmed. All the data was entered and analyzed on SPSS version 20. Results: The mean age of patients was 29.87±6.07 years. The emergency LSCS was done in 599(49.1%) patients and elective LSCS was done in 621(50.9%) patients. The sensitivity, specificity & diagnostic accuracy of TVS was 98.31%, 99.05% & 98.69% respectively. Conclusion: According to our study results the TVS for uterine scar is a very useful and effective tool in the prediction of scar dehiscence in patients with previous one LSCS taking intraoperative findings as gold standard. Keywords: Transvaginal sonography, TVS, Uterine, Scar, dehiscence, LSCS, Intraoperative

scholarly journals Combined treatment for acromegaly with long-acting somatostatin analogs and pegvisomant: long-term safety for up to 4.5 years (median 2.2 years) of follow-up in 86 patients

2009 ◽  
Vol 160 (4) ◽  
pp. 529-533 ◽  
Author(s):  
SJCMM Neggers ◽  
WW de Herder ◽  
JAMJL Janssen ◽  
RA Feelders ◽  
AJ van der Lely
Keyword(s):  
Combined Therapy ◽  
Combined Treatment ◽  
Somatostatin Analogs ◽  
Pituitary Surgery ◽  
Median Dosage ◽  
Previously Treated ◽  
Long Acting

BackgroundWe previously reported on the efficacy, safety, and quality of life (QoL) of long-acting somatostatin analogs (SSA) and (twice) weekly pegvisomant (PEG-V) in acromegaly and improvement after the addition of PEG-V to long-acting SSA.ObjectiveTo assess the long-term safety in a larger group of acromegalic patients over a larger period of time: 29.2 (1.2–57.4) months (mean (range)).DesignPegvisomant was added to SSA monotherapy in 86 subjects (37 females), to normalize serum IGF1 concentrations (n=63) or to increase the QoL. The median dosage was 60.0 (20–200) mg weekly.ResultsAfter a mean treatment period of 29.2 months, 23 patients showed dose-independent PEG-V related transient liver enzyme elevations (TLEE). TLEE occurred only once during the continuation of combination therapy, but discontinuation and re-challenge induced a second episode of TLEE. Ten of these patients with TLEE also suffered from diabetes mellitus (DM). In our present series, DM had a 2.28 odds ratio (CI 1.16–9.22; p=0.03) higher risk for developing TLEE. During the combined therapy, a clinical significant decrease in tumor size by more than 20% was observed in 14 patients. Two of these patients were previously treated by pituitary surgery, 1 with additional radiotherapy and all other patients received primary medical treatment.ConclusionLong-term combined treatment with SSA and twice weekly PEG-V up to more than 4 years seems to be safe. Patients with both acromegaly and DM have a 2.28 higher risk of developing TLEE. Clinical significant tumor shrinkage was observed in 14 patients during combined treatment.

Clinical Course of Different Types of Immune Reactions following Keratoplasty

2021 ◽  
Author(s):  
Philip Keye ◽  
Thabo Lapp ◽  
Daniel Böhringer ◽  
Sonja Heinzelmann ◽  
Philip Maier ◽  
...  
Keyword(s):  
Clinical Course ◽  
Corneal Graft ◽  
Long Term Outcomes ◽  
Immune Mediated ◽  
Corneal Graft Rejection ◽  
Different Types ◽  
Lost To Follow Up

Abstract Background Immune-mediated corneal graft rejection (IR) is a leading cause of corneal graft failure. The endothelium, stroma, epithelium, or a combination can be affected. Little is known about the long-term outcomes of different types of IR. Methods We reviewed the medical records of all keratoplasties that had been performed at our eye centre between 2003 and 2016 (n = 3934) for any kind of IR that occurred between the surgery and 2019. All patients with a definite diagnosis of IR and sufficient clinical data were included in the analysis. IRs were grouped according to the affected part of the graft (endothelial, stromal, epithelial, and mixed). We analysed the dynamics of recovery and the clinical outcomes. Results We identified a total of 319 patients with IR. Twenty-seven of those were lost to follow-up and were excluded from further analysis. Of the IRs, 89% affected the endothelium. Endothelial IR resulted more frequently in a considerable loss of endothelial cell density than other forms of IR. Stromal IR showed a lower relapse rate and a better visual recovery than other types of IR and resulted less often in a failure of the graft. Conclusions We herein report comprehensive data about the prognosis regarding functional recovery after different types of IR following keratoplasty. Our data underline that timely recognition and correct classification of IR are important because they determine the clinical course and prognosis.

Sight-threatening progressive corneo-scleral involvement in porphyria cutanea tarda

2021 ◽  
Vol 14 (10) ◽  
pp. e245160
Author(s):  
Sonali Prasad ◽  
Vidhata Vidhata ◽  
Subhash Prasad
Keyword(s):  
Porphyria Cutanea Tarda ◽  
Clinical Manifestations ◽  
Ocular Involvement ◽  
Slit Lamp ◽  
Uroporphyrinogen Decarboxylase ◽  
Progressive Loss ◽  
The Right ◽  
Lost To Follow Up ◽  
Test Serum

Porphyria cutanea tarda is the most common type of porphyria. It is associated with a deficiency of uroporphyrinogen decarboxylase enzyme responsible for heme synthesis. Clinical manifestations are predominantly dermatological and very rarely present with ocular involvement. Although scleral thinning in the interpalpebral area is a well-documented entity, sight-threatening corneal involvement is rarely described. We, herein report a case of a 58-year-old man who presented with ocular surface dryness, photophobia and mild redness. Slit-lamp biomicroscopy revealed corneo-scleral thinning in both eyes. The diagnosis was confirmed with a urine porphyrin test, serum iron and serum ferritin levels. We started him on conservative management after which he was lost to follow-up. He presented again after 6 years with total corneal opacification and progressive loss of vision in the right eye.

scholarly journals Comparison of robot-assisted retroperitoneal laparoscopic adrenalectomy versus retroperitoneal laparoscopic adrenalectomy for large pheochromocytoma: a single-centre retrospective study

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sheng-Qiang Fu ◽  
Chang-Shui Zhuang ◽  
Xiao-Rong Yang ◽  
Wen-Jie Xie ◽  
Bin-Bin Gong ◽  
...  
Keyword(s):  
Laparoscopic Adrenalectomy ◽  
Operative Time ◽  
Haemodynamic Instability ◽  
Robot Assisted ◽  
Improvement Rate ◽  
Long Term Follow Up ◽  
Tumour Characteristics ◽  
Group 1

Abstract Background To evaluate the feasibility and safety of robot-assisted retroperitoneal laparoscopic adrenalectomy (RARLA) for large pheochromocytomas (PHEOs; size≥6 cm) compared with retroperitoneal laparoscopic adrenalectomy (RLA). Methods Fifty-one patients who underwent adrenalectomy for large PHEOs between March 2016 and January 2019 were enrolled and divided into two groups, including 32 RLA cases and 19 RARLA cases. We compared the perioperative efficacy and long-term follow-up results between the two groups. Results Preoperative data, including demographics, comorbidities and tumour characteristics, were similar between the groups. Intraoperatively, the RARLA group had a lower incidence of haemodynamic instability (26.3% vs. 56.2%, P = 0.038) and less intraoperative blood loss (100 ml vs. Two hundred milliliter, P = 0.042) than the RLA group. The groups showed no significant differences in operative time or transfusion rates. Postoperatively, the time to diet resumption, time to ambulation, time to drainage removal and postoperative hospital stay were shorter in the RARLA group than in the RLA group (1 d vs. 2 d, P = 0.027; 1 d vs. 2 d, P = 0.034; 3 d vs. 5 d, P = 0.002; 5 d vs. 6 d, P = 0.02, respectively). The groups exhibited no significant differences in the duration of anaesthetic use, complications, or long-term follow-up results for the blood pressure (BP) improvement rate. Conclusions Compared with RLA, RARLA is a safe, feasible and even optimized procedure for large PHEOs.

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