scholarly journals Super-Selective Mesenteric Embolization Provides Effective Control of Lower GI Bleeding

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Toan Pham ◽  
Bob Anh Tran ◽  
Kevin Ooi ◽  
Marcus Mykytowycz ◽  
Stephen McLaughlin ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Multidetector Ct ◽  
Clinical Success ◽  
Case Series ◽  
Effective Control ◽  
Gi Bleeding ◽  
Retrospective Case ◽  
Bowel Ischaemia ◽  
Radionuclide Scintigraphy ◽  
Lower Gi Bleeding

Introduction. We aimed to assess the efficacy and safety of digital subtraction angiography (DSA) and super-selective mesenteric artery embolization (SMAE) in managing lower GI bleeding (LGIB). Method. A retrospective case series of patients with LGIB treated with SMAE in our health service. Patients with confirmed active LGIB, on either radionuclide scintigraphy (RS) or contrast-enhanced multidetector CT angiography (CE-MDCT), were referred for DSA +/− SMAE. Data collected included patient characteristics, screening modality, bleeding territory, embolization technique, technical and clinical success, short-term to medium-term complications, 30-day mortality, and progression to surgery related to procedural failure or complications. Results. There were fifty-five hospital admissions with acute unstable lower gastrointestinal bleeding which were demonstrable on CE-MDCT or RS over a 31-month period. Eighteen patients proceed to embolization, with immediate success in all. Eight patients (44%) had clinical rebleeding after intervention, warranting repeated imaging. Only one case (5.6%) demonstrated radiological rebleeding and was reembolized. Complication rate was excellent: no bowel ischaemia, ischaemic stricture, progression to surgery, or 30-day mortality. Conclusion. SMAE is a viable, safe, and effective first-line management for localised LGIB. Our results overall compare favourably with the published experiences of other institutions. It is now accepted practice at our institution to manage localised LGIB with embolization.

An Active In-Home Physician Model of Palliative Care and Its Resulting Performance Indicators Related to Home Deaths, Unplanned Emergency Department Visits and Unplanned Hospital Admissions

2020 ◽  
Vol 36 (1) ◽  
pp. 46-49
Author(s):  
Colleen Webber ◽  
Aurelia Ona Valiulis ◽  
Peter Tanuseputro ◽  
Valerie Schulz ◽  
Tavis Apramian ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Hospital Admissions ◽  
Case Series ◽  
Palliative Care Team ◽  
Emergency Department Visits ◽  
Care Team ◽  
Retrospective Case ◽  
Palliative Care Teams ◽  
Unplanned Hospital Admissions

Background: Limited research has characterized team-based models of home palliative care and the outcomes of patients supported by these care teams. Case presentation: A retrospective case series describing care and outcomes of patients managed by the London Home Palliative Care Team between May 1, 2017 and April 1, 2019. Case management: The London Home Palliative Care (LHPC) Team care model is based upon 3 pillars: 1) physician visit availability 2) active patient-centered care with strong physician in-home presence and 3) optimal administrative organization. Case outcomes: In the 18 month study period, 354 patients received care from the London Home Palliative Care Team. Most significantly, 88.4% ( n = 313) died in the community or at a designated palliative care unit after prearranged direct transfer; no comparable provincial data is available. 21.2% ( n = 75) patients visited an emergency department and 24.6% ( n = 87) were admitted to hospital at least once in their final 30 days of life. 280 (79.1%) died in the community. These values are better than comparable provincial estimates of 62.7%, 61.7%, and 24.0%, respectively. Conclusion: The London Home Palliative Care (LHPC) Team model appears to favorably impact community death rate, ER visits and unplanned hospital admissions, as compared to accepted provincial data. Studies to determine if this model is reproducible could support palliative care teams achieving similar results.

scholarly journals COVID-19 hospitalizations in five California hospitals: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Miriam Nuño ◽  
Yury García ◽  
Ganesh Rajasekar ◽  
Diego Pinheiro ◽  
Alec J. Schmidt
Keyword(s):  
Mortality Rate ◽  
Hospital Admissions ◽  
Large Population ◽  
Case Series ◽  
The United States ◽  
Composite Outcome ◽  
Retrospective Case ◽  
Hospital System ◽  
Icu Admission ◽  
Increased Risk

Abstract Background The novel coronavirus pandemic has had a differential impact on communities of color across the US. The University of California hospital system serves a large population of people who are often underrepresented elsewhere. Data from hospital stays can provide much-needed localized information on risk factors for severe cases and/or death. Methods Patient-level retrospective case series of laboratory-confirmed COVID-19 hospital admissions at five UC hospitals (N = 4730). Odds ratios of ICU admission, death, and a composite of both outcomes were calculated with univariate and multivariate logistic regression based on patient characteristics, including sex, race/ethnicity, and select comorbidities. Associations between comorbidities were quantified and visualized with a correlation network. Results Overall mortality rate was 7.0% (329/4,730). ICU mortality rate was 18.8% (225/1,194). The rate of the composite outcome (ICU admission and/or death) was 27.4% (1298/4730). Comorbidity-controlled odds of a composite outcome were increased for age 75–84 (OR 1.47, 95% CI 1.11–1.93) and 85–59 (OR 1.39, 95% CI 1.04–1.87) compared to 18–34 year-olds, males (OR 1.39, 95% CI 1.21–1.59) vs. females, and patients identifying as Hispanic/Latino (OR 1.35, 95% CI 1.14–1.61) or Asian (OR 1.43, 95% CI 1.23–1.82) compared to White. Patients with 5 or more comorbidities were exceedingly likely to experience a composite outcome (OR 2.74, 95% CI 2.32–3.25). Conclusions Males, older patients, those with multiple pre-existing comorbidities, and those identifying as Hispanic/Latino or Asian experienced an increased risk of ICU admission and/or death. These results are consistent with reported risks among the Hispanic/Latino population elsewhere in the United States, and confirm multiple concerns about heightened risk among the Asian population in California.

Integrating urgent multidetector CT scanning in the diagnostic algorithm of active lower GI bleeding

2010 ◽  
Vol 72 (2) ◽  
pp. 402-405 ◽  
Author(s):  
Andrew Copland ◽  
Craig A. Munroe ◽  
Shai Friedland ◽  
George Triadafilopoulos
Keyword(s):  
Multidetector Ct ◽  
Diagnostic Algorithm ◽  
Ct Scanning ◽  
Gi Bleeding ◽  
Lower Gi Bleeding

Traditional medicine poisoning in Zimbabwe: clinical presentation and management in adults

2002 ◽  
Vol 21 (11) ◽  
pp. 579-586 ◽  
Author(s):  
D Tagwireyi ◽  
D E Ball ◽  
C F B Nhachi
Keyword(s):  
Traditional Medicine ◽  
Hospital Admissions ◽  
Case Series ◽  
Signs And Symptoms ◽  
Adverse Outcomes ◽  
Therapeutic Modality ◽  
African Countries ◽  
Retrospective Case ◽  
Traditional Medicines ◽  
Referral Hospitals

Traditional medicines (TMs) have been reported as major causes of hospital admissions in some African countries including Zimbabwe. There is, however, still a paucity of information with regards to their clinical presentations. We carried out a retrospective case series of all cases of traditional medicine poisoning (TMP) at eight main referral hospitals in Zimbabwe (January 1998–December 1999 inclusive) to describe the most common signs and symptoms, reasons for, and management of TMP in adults. Where the reasons for taking the TM were known, most cases had taken the medicine for either abdominal pains or aphrodisiac purposes. Nonspecific adverse effects including vomiting, abdominal pains, and diarrhoea were the most commonly encountered. A large proportion of patients with TMP also suffered from genito-urinary tract adverse outcomes especially haematuria and dysuria. Intravenous fluids were the most commonly employed therapeutic modality for TMP, probably in an effort to dilute or increase excretion of the toxins. Further research is required to elucidate the toxic components responsible for the observed ill effects and whether these effects are due to the medicines themselves or to co-existing illnesses.

scholarly journals 1270. Early Real-world Evidence in the Use of Eravacycline for the Management of Draconian Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S651-S652
Author(s):  
Amy Carr ◽  
Amer El Ghali ◽  
Parminder Kaur ◽  
Sarah B Minor ◽  
Anthony M Casapao
Keyword(s):  
Clinical Outcome ◽  
Median Duration ◽  
Real World ◽  
Clinical Success ◽  
Infection Type ◽  
Case Series ◽  
Retrospective Case ◽  
Off Label ◽  
Carbapenem Resistant

Abstract Background Eravacycline (ERV) is a next-generation tetracycline approved for complicated intra-abdominal infections (cIAI) with in-vitro activity to multidrug-resistant organisms such as carbapenem resistant Enterobacteriaceae, extended spectrum beta-lactamase, and carbapenem-resistant Acinetobacter baumannii (CRAB). The purpose of this study was to identify the utility of ERV in clinical practice. Methods Retrospective case series was conducted on patients at AdventHealth that received at least two doses of ERV. Primary endpoint for the study was clinical success while on ERV, meeting none of the following criteria: changing therapy, mortality, or lack of improvement from sign/symptoms. Results Of 23 patients, 74% were males with a mean age of 55 ±18 years and mean body weight of 79 ±27 kg. Mean APACHE II and Charleson scores were 20 (±11) and 6 (±4), respectively. 91% received ERV for an off-label indication or organism. Infection types were respiratory (44%), cIAI (35%), skin (9%), and other (13%). All patients had positive cultures, while 61% were treated as a polymicrobial infection and 17% had bacteremia. Microorganisms included A. xylosoxidans, S. maltophilia, CRAB, and K pneumoniae. 48% had ERV susceptibilities from .06-4 mcg/mL, including two MIC ≥32mcg/mL for S. maltophilia. 70% were given another antibiotic prior to ERV with a median duration of 5 (1-35) days. Median duration of ERV was 8 (3-30) days. 83% percent received ERV in combination with another antibiotic. During treatment, 26% had a Child-Pugh Class C at baseline and 30% had elevated liver function tests. No adverse drug reactions were reported. Upon discharge, 35% continued ERV. Clinical success was observed in 57% (12/21) of patients. Clinical outcome by infection type is summarized in Figure 1. Of 9 cases of clinical failure, 14% were changed to alternative, 19% died while on ERV, and 10% failed to resolve signs/symptoms. Two cases of M. abscessus infections had insufficient follow-up to assess clinical outcome. Figure 1. Eravacycline Clinical Outcome by Infection Type Conclusion Initial real-world experience with ERV differs significantly from the trials regarding severity of illness, types of infection, and clinical outcomes. Further evaluation is necessary for using ERV as combination therapy and in off-label indications. Disclosures All Authors: No reported disclosures

scholarly journals Endoscopic ultrasound-guided transmural gallbladder drainage in malignant obstruction using a novel lumen-apposing stent: a case series (with video)

2019 ◽  
Vol 07 (05) ◽  
pp. E655-E661
Author(s):  
Jonathan Chang ◽  
Elizabeth Dong ◽  
Karl Kwok
Keyword(s):  
Adverse Events ◽  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Medical Center ◽  
Case Series ◽  
Pancreatic Head ◽  
Metallic Stent ◽  
Retrospective Case ◽  
Malignant Obstruction ◽  
Gallbladder Drainage

Abstract Background and aims Current endoscopic methods of biliary decompression in malignant pancreatic neoplasms are often limited by anatomical and technical challenges. In this case series, we report our experience with endoscopic ultrasound (EUS)-guided placement of an electrocautery-enhanced, lumen-apposing self-expandable metallic stent (LAMS) via transmural gallbladder drainage. Methods This is a retrospective case series of nine patients (five male, mean age 63.1 years) who underwent EUS-guided LAMS placement for malignant, obstructive jaundice in the pancreatic head. All nine cases were performed by an experienced interventional endoscopist at a single, tertiary medical center. We review the technical and clinical success rates as well as the incidence of procedural adverse events across the nine patients. Results LAMS placement was technically successful in all cases and there were no procedural adverse events. Seven of nine (77.78 %) patients showed clinical and laboratory improvement immediately following the procedure. One case required re-intervention with interventional radiology guided biliary drain placement. The mean fluoroscopy time was 1.02 minutes. Conclusions EUS-guided LAMS placement for transmural gallbladder drainage in malignant obstruction appears to be a safe and effective technique, allowing patients to proceed to surgery, chemotherapy, or hospice care.

scholarly journals Mode of Presentation and Outcomes of COVID-19 Cases in a Tertiary Hospital in Nigeria

2021 ◽  
Author(s):  
Yakubu Egigogo Raji ◽  
Bala Waziri ◽  
Sadiq Aliyu Hussaini ◽  
Ahmad Idris Ja'agi ◽  
Umar Isah Alhaji ◽  
...  
Keyword(s):  
Case Series ◽  
Tertiary Hospital ◽  
Effective Control ◽  
Retrospective Case ◽  
Presenting Symptoms ◽  
Moderate Disease ◽  
Increased Risk ◽  
Global Understanding ◽  
The Mean ◽  
Study Participants

Coronavirus disease 2019 (COVID-19) has spread across the globe with its consequent human and economic challenges. To achieve effective control of the pandemic, efforts need to be holistic and global. Understanding patients demographics and clinical characteristics will assist in the control of the infection. However, there is a paucity of studies on the clinical presentation of COVID-19 patients from Nigeria and indeed Africa. Thus, this retrospective case series evaluated the medical records of COVID-19 patients admitted in a tertiary hospital in Nigeria. Patients demographics, and other clinical variables were assessed and presented. Data of 14 patients with complete records were included in the study. Most of the patients (78.6%) were males and the mean age of the study participants is 63.5 years (SD; 11.5). The commonest presenting symptoms were fever (93%), cough (71.4%), and dyspnoea (57.1%). At presentation, 13 patients had coexisting diseases while 8 (57.0%) patients had moderate disease and the remaining 6 (43.0%) had severe cases. After management, 1 patient died, two were referred and 11 recovered and were discharged alive. Thus, this study has identified advanced age, male gender, and comorbidity as increased risk factors for hospitalisation. The patient survival outcome in this study was also good.

scholarly journals One-Piece Titanium Implants: Retrospective Case Series

2021 ◽  
Vol 2021 ◽  
pp. 1-15
Author(s):  
Gunar Wagner ◽  
Dieter Hartung
Keyword(s):  
Clinical Success ◽  
Case Series ◽  
Treatment Method ◽  
Titanium Implants ◽  
Tissue Loss ◽  
Retrospective Case ◽  
Dental Surgery ◽  
Fixed Dental Prosthesis ◽  
Technical Features ◽  
Clinical Cases

Purpose. One-piece titanium implants are not routinely used for reconstruction after tooth loss. Several limitations seemed to be apparent although the concept provides a straightforward approach for different clinical situations. A clinical documentation of five prosthetic restorations with one-piece titanium implants serving as a relevant treatment option in dental surgery is pursued. We demonstrate the feasibility and benefits of one-piece titanium implants for fixed dental prosthesis. Detailed descriptions of the technical features and the surgical approach by means of clinical cases are given. The prosthetic workflow when working with one-piece titanium implants is depicted in detail as well as examples for implant-supported tooth replacement in the posterior region and the esthetic zone. Conditions of applications regarding different timing of implant placement using the system and its limitations are discussed. Results. Clinical cases with a follow-up period of up to 10 years are presented to prove the long-term success of one-piece titanium implants in terms of bone and soft-tissue stability respecting the biological criteria for periodontal health. Conclusions. One-piece titanium implants represent a reliable treatment method for single-tooth replacements. Clinical success with long-time bone stability around the implantation site can be achieved. Taken into account the requirements for periodontal tissue stability, uneventful healing without extensive tissue loss is demonstrated by means of clinical cases presenting patients with periodontitis.

SSRIs May Be Tied to Upper, Lower GI Bleeding

Ob Gyn News ◽  
2005 ◽  
Vol 40 (14) ◽  
pp. 25
Author(s):  
TIMOTHY F. KIRN
Keyword(s):  
Gi Bleeding ◽  
Lower Gi Bleeding
Sign in / Sign up

Export Citation Format

Share Document