scholarly journals Intestinal Obstruction due to Bezoar in Elderly Patients: Risk Factors and Treatment Results

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Fatih Altintoprak ◽  
Eyup Gemici ◽  
Yasin Alper Yildiz ◽  
Mustafa Yener Uzunoglu ◽  
Taner Kivilcim
Keyword(s):  
Risk Factors ◽  
Peptic Ulcer ◽  
Surgical Technique ◽  
Abdominal Surgery ◽  
Elderly Patients ◽  
Intestinal Obstruction ◽  
History Of ◽  
Group 2 ◽  
Length Of Hospitalization ◽  
Group 1

Purpose. Bezoars are foreign particles from the accumulation of indigestible materials in the gastrointestinal system and a rare cause of mechanical intestinal obstruction. We aimed at investigating differences in risk factors for the development of intestinal obstruction associated with bezoar in elderly patients.Methods. Hospital records of patients who underwent surgery associated with phytobezoar between January 2004 and May 2016 were retrospectively evaluated. Patients were divided into two groups [<65 years (Group 1) and ≥65 years (Group 2)]. Data were examined regarding presence of comorbidity, history of abdominal surgery, operation time, bezoar site, surgical technique, length of hospitalization, morbidity, and mortality.Results. Of 121 patients enrolled, 48 (39.7%) were male and 73 (60.3%) were female (range: 24-86 years). Group 1 consisted of 69 patients aged < 65, while Group 2 consisted of 52 patients aged ≥ 65. Comorbidity was reported in 52 (42.9%) patients (mostly diabetes mellitus, 20.7%), while 60 patients (49.6%) had history of abdominal surgery (mostly peptic ulcer, 27.3%). No statistical differences were found between the two groups in terms of sex, bezoar site, surgical technique preferred, history of abdominal surgical intervention, pre- and postoperative CT examination, morbidity rates, and length of hospitalization. But, ratio of peptic ulcer operations history, presence of total comorbidity, and time of surgery decision was higher in Group 2 patients.Conclusion. In bezoar-related intestinal obstruction, duration and outcome of treatment are not affected by age distribution. Possibility of bezoar should primarily be considered in elderly patients with history of peptic ulcer operation.

Recurrent Vascular Access Site Thrombosis in Patients on Hemodialysis - a Problem of Thrombophilia?.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4018-4018 ◽  
Author(s):  
Robert Klamroth ◽  
Frank Seibt ◽  
Hartmut Rimpler ◽  
Helmut Landgraf
Keyword(s):  
Risk Factors ◽  
Factor Viii ◽  
Vascular Access ◽  
Platelet Rich Plasma ◽  
Light Transmittance ◽  
Access Site ◽  
Activated Platelets ◽  
History Of ◽  
Group 2 ◽  
Group 1

Abstract Introduction: Vascular access site thrombosis in patients receiving hemodialysis is a major cause of hospital admission and recurrent surgery. The underlying pathologic cause is often stenosis of the venous vessel due to fibromuscular hyperplasia. But in the case of early failure occasional studies have investigated that hypercoagulability could play an important role in this context. Aim of the study: Is there a higher prevalence of hereditary and acquired thrombophilic risk factors in patients with vascular access thrombosis in comparison to patients without? Patients: In 2002 and 2003 we examined 52 consecutive patients (mean age 66,1 years) receiving hemodialyisis. 27 patients (pts) in group 1 had a history of vascular access site thrombosis and 25 pts in group 2 had not and an open vascular access for longer than at least six months. All pts in group 1 had a history of at least two occlusions of vascular access. 10/27 pts in group 1 with prosthetic grafts had a history of thrombosis of arteriovenous fistula before implantation of PFTE graft. Methods: In every patient hereditary and acquired thrombophilic risk factors were determined including antithrombin (AT), protein C (PC), protein S (PS), factor V-G1691A-mutation (FVM), prothrombin-G20210A-mutation (FIIM), homocysteine, lipoproteine (a) (Lpa), lupus anticoagulant (LA), cardiolipin antibodies IgG and IgM (ACA), fibrinogen and factor VIII. Platelet hyperreactivity was studied by light transmittance aggregometry in platelet rich plasma (Aggregometer PAP 4, moelab inc.). Aggregation was recorded as the maximum percentage change in light transmittance from baseline using platelet poor plasma as a reference. We defined sticky platelets as platelet aggregation > 30% after induction with different concentrations of ADP (10, 1 and 0,5 μmol) in platelet rich plasma. Results: We found in 14/27 pts with vascular access site thrombosis antiphospholipd antibodies (LA and/or ACA) in comparison to only 2/25 in pts without thrombosis. Activated platelets like the sticky platelets syndrome was shown in 11/27 pts in group 1 and 4/25 pts in group 2. In both groups hyperhomocysteinaemia (23/27 pts and 21/25 resp.), factor VIII elevation (21/27 pts and 22/25 resp.), fibrinogen elevation (22/27 pts and 21/25 resp.) and high levels of Lpa (7/27 pts and 6/25 resp.) were quite similar. There were no significant differences in the number of hereditary risk factors like AT, PC, PS, FVM and FIIM in both groups. Conclusions: In patients receiving hemodialysis we found a high prevalence of acquired thrombophlic risk factors like elevation of factor VIII, homocysteine and fibrinogen. There seems to be causal relation between vascular access site thrombosis and espacially antiphospholpid antibodies and activated platelets (sticky platelets syndrome). The evaluation of these thrombophilic risk factors in patients with recurrent vascular access site thrombosis could lead to an improved antithrombotic therapy.

Prophylactic Use of a Combination of an Anticoagulant and Ursodeoxycholic Acid for Sinusoidal Obstruction Syndrome after Allogeneic Myeloablative Hematopoietic Stem Cell Transplantation

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5755-5755
Author(s):  
Hiroshi Okamura ◽  
Mitsutaka Nishimoto ◽  
Takahiko Nakane ◽  
Hideo Koh ◽  
Yasuhiro Nakashima ◽  
...  
Keyword(s):  
Risk Factors ◽  
Research Funding ◽  
Gemtuzumab Ozogamicin ◽  
Adult Patients ◽  
Allogeneic Hsct ◽  
History Of ◽  
Group 3 ◽  
Group 2 ◽  
Prophylactic Use ◽  
Group 1

Abstract Introduction: Sinusoidal obstruction syndrome (SOS) is one of the potentially fatal complications of hematopoietic stem cell transplantation (HSCT). In particular, severe SOS frequently leads to multiple organ failure, and a worse prognosis. Thus, prophylaxis against development of SOS could contribute improved survival after HSCT. Previous reports demonstrated the effectiveness of the prophylactic use of ursodeoxycholic acid (UDCA) or certain anticoagulants, including unfractionated and low-molecular-weight heparin, for SOS. In two randomized controlled trials and two meta-analyses it was reported that UDCA, a hydrophilic bile acid, was an effective and safe drug for prophylaxis against SOS. The usefulness and feasibility of prophylactic use of anticoagulants after allogeneic HSCT are however still controversial. In addition, to our knowledge no study has evaluated the feasibility of usage of UDCA combined with an anticoagulant for SOS prevention after allogeneic HSCT in adult patients. To assess the efficacy and safety of use of UDCA combined with an anticoagulant as SOS prophylaxis, we performed a retrospective cohort study to examine the occurrences of SOS and hemorrhagic events in patients who underwent myeloablative allogeneic HSCT at our institution. We examined use of any anticoagulant together with simultaneous administration of UDCA, in comparison with UDCA alone for the prevention of SOS. Patients and methods: We reviewed the charts of consecutive adult patients in whom myeloablative allogeneic HSCT was performed at our hospital from November 1994 to May 2014, and who received either unfractionated heparin or dalteparin (low-molecular-weight heparin) with UDCA (group 1), danaparoid with UDCA (group 2), or UDCA only (group 3), used for prophylaxis against SOS. Results: A total of 280 patients (group 1: n=52; group 2: n=33; and group 3: n=195) were investigated. The proportions of patients with risk factors for SOS-including non-remission at the time of HSCT, a second or subsequent HSCT, high aspartate aminotransferase (AST) levels before HSCT, high ferritin levels before HSCT, a history of receiving gemtuzumab ozogamicin, and HLA disparity-were similar across the three groups. In group 1, a conditioning regimen containing busulfan was used less frequently (P = 0.002). SOS occurred in seven patients (13.7%) in group 1, five patients (15.2%) in group 2, and 28 patients (14.4%) in group 3, all meeting the Seattle criteria. None of the patients in group 1, two (6.1%) in group 2, and nine (4.6%) in group 3 had SOS diagnosed according to the Baltimore criteria. There was no significant difference in the incidence of SOS among the three groups. In addition, with regard to the cumulative incidence of severe SOS, no statistically significant difference was present among the three groups. The incidence of hemorrhagic events within 30 and 100 days following allogeneic HSCT was not significantly different across the three groups (30 days; 5.8%, 3.0%, 5.1%, P = 0.843, 100 days; 17.6%, 15.2%, 14.4%, P=0.843, respectively). Furthermore, the probabilities of OS and NRM until day 100 after allogeneic HSCT were similar among the three groups (P = 0.733 and P = 0.637, respectively). In a univariate model, a history of gemtuzumab ozogamicin treatment, high serum ferritin levels before HSCT, an HLA mismatched donor, and non-complete remission of disease at the time of allogeneic HSCT were found to be significant risk factors for SOS. Multivariate analysis revealed that a history of gemtuzumab ozogamicin therapy, a mismatched HLA donor, and non-complete remission of disease at the time of allogeneic HSCT were significant and independent risk factors for SOS. In the multivariate as well as univariate analyses, combined administration of UDCA and any anticoagulant for SOS prophylaxis did not have a significant effect on the incidence SOS, when compared to prophylaxis with UDCA alone. Conclusion: Our study results suggest that the combined use of UDCA and an anticoagulant for SOS prophylaxis after myeloablative allogeneic HSCT in adult patients was not beneficial. Establishment of an optimal strategy for prophylaxis against SOS after HSCT is still needed. Disclosures Nakane: Mundipharma KK: Research Funding. Koh:Pfizer: Consultancy, Honoraria. Hino:Pfizer: Honoraria, Research Funding; Nippon Shinyaku: Honoraria, Speakers Bureau; Alexion: Honoraria, Research Funding. Nakamae:Mochida Pharmaceutical Co., Ltd.: Honoraria, Research Funding; Pfizer: Consultancy, Honoraria; Novartis Pharma KK: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: travel/accommodation/meeting expenses, Research Funding.

scholarly journals Association of Haemoglobin and C-Reactive Protein level with Different Risk Factors among Acute Coronary Syndrome Patients

2019 ◽  
Vol 5 (2) ◽  
pp. 156-160
Author(s):  
Md Mahboob Morshed ◽  
Md Joynul Islam ◽  
ATM Ashadullah ◽  
Khondker Shaheed Hussain ◽  
Mohammad Ahtashamul Haque
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Reactive Protein ◽  
Coronary Syndrome ◽  
Group 4 ◽  
History Of ◽  
Study Population ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: Different risk factors may be related with the haemoglobin and CRP level among the acute coronary syndrome patients. Objective: The purpose of the present study was to see the association of haemoglobin and CRP level with different type of risk factors among the acute coronary syndrome patients. Methodology: This cross-sectional study was conducted in the Department of Cardiology at Mymensingh Medical College, Mymensingh, Bangladesh from December 2010 to November 2011 for a period of two (02) years. Patients of ACS who were presented within 12 hours of chest pain were included as study population. Study population were categorized in four groups according to the level of hemoglobin and C-reactive protein. Age, cardiovascular risks factor, history, family history of cardiovascular disease, treatment history and ECG were taken during admission. Blood sample was collected for baseline laboratory investigations like Troponin-I, Random Blood Sugar (RBS), Blood urea, Serum creatinine, lipid profile, Hemoglobin & CRP level. Sample were then send to standard laboratory/Biochemistry department of MMCH. Result: The mean age of the population was 52.18±8.88 years. Smoking was the highest percentage in Group 1 which was 54(50.0%) cases (P=0.001). Hypertension was found most common in group 1 (47.6%), Group 2 (33.3%), Group 3 (10.7%) and Group 4 (8.3%). Smoking (p=0.001) and hypertension (p=0.016) was found statistically significant. Diabetes was found in Group 1 (37.7%), Group 2 (43.5%), Group 3 (11.6%) and Group 4 (7.2%). Group 1 (50%) and Group 2 (50%) patients were dyslipidaemic. Family history of IHD was present group-1 (36.8%), Group 2 (44.7%), Group 3 (73.2%) and Group 4 (53%). Among the smoker patient 65.6% cases had CRP level ˃12 mg/l; 39.8% cases had CRP level ˂12mg/L. Among the nonsmoker 34.4% cases had CRP level ˃12mg/l and 60.2% cases had CRP level ˂12mg/L. The finding was statistically significant. Conclusion: In conclusion haemoglobin and CRP level is associated with different type of risk factors among the acute coronary syndrome patients. Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 156-160

13C-sodium acetate breath test for evaluation of gastric emptying times in dogs with gastric dilatation-volvulus

2013 ◽  
Vol 41 (02) ◽  
pp. 87-92 ◽  
Author(s):  
S. Schmitz ◽  
N. Jansen ◽  
K. Failing ◽  
R. Neiger
Keyword(s):  
Gastric Emptying ◽  
Abdominal Surgery ◽  
Sodium Acetate ◽  
Breath Test ◽  
Solid Phase ◽  
Gastric Dilatation ◽  
Non Invasive ◽  
History Of ◽  
Group 2 ◽  
Group 1

Summary Objective: The aim of the study was to assess solid phase gastric emptying via non-invasive 13C-sodium acetate breath test in large breed dogs with or without gastric dilatation-volvulus (GDV). Material and methods: Dogs were recruited into one of the following groups: group 1 = healthy large breed dogs with no history of GDV, group 2 = dogs that underwent elective abdominal surgery for reasons unrelated to the gastrointestinal tract, and group 3 = dogs that underwent laparotomy and gastropexy to correct GDV. The dogs were fed a test meal containing 100 mg 13C-sodium acetate (for group 2 and 3, this was < 48 hours post-operatively). Breath samples were obtained at baseline and every 30 minutes for 3 hours, then every hour for a total of 7 hours. 12CO2/13CO2 ratio was measured for each breath sample via non-dispersive infrared spectroscopy and 25%, 50% and 75% gastric emptying times were calculated and compared between groups. Results: Gastric emptying times were significantly prolonged in dogs undergoing surgery (group 2) compared to group 1 and 3. Also, gastric emptying times of dogs with GDV were significantly prolonged compared to controls, but not to the same extent as dogs in group 2. Conclusion and clinical significance: There was a significant effect of abdominal surgery on gastric emptying times. Surprisingly, dogs after GDV surgery and gastropexy had shorter gastric emptying times than dogs undergoing laparotomy for reasons other than GDV, but still prolonged compared to healthy controls. The reason for these differences requires further study.

scholarly journals Risk factors for rebleeding in patients with peptic ulcer bleeding

2020 ◽  
Vol 101 (3) ◽  
pp. 435-440
Author(s):  
M V Valeev ◽  
Sh V Timerbulatov
Keyword(s):  
Risk Factors ◽  
Peptic Ulcer ◽  
Postoperative Mortality ◽  
Posterior Wall ◽  
Ulcer Bleeding ◽  
Peptic Ulcer Bleeding ◽  
Results Of Treatment ◽  
Group 2 ◽  
Lesser Curvature ◽  
Group 1

Aim. To analyze the results of treatment of patients with ulcerative bleeding, to identify the main risk factors for rebleeding in patients with peptic ulcer bleeding. Methods. A retrospective analysis of the treatment results of 240 patients with acute peptic ulcer bleeding who were hospitalized in the Beloretsk Central District Hospital from 2008 to 2018 was carried out. Patients were divided into two groups: group 1 52 patients with rebleeding, group 2 188 patients in whom rebleeding did not occur. Results. Rebleeding in patients with peptic ulcer was observed in 21.7% of cases. The surgical rate was 22.9% and mortality 6.3%. Based on the obtained data, rebleeding should recognize as a risk factor for death [odds ratio (OR) 68.9; 95% confidence interval (CI) 8.8 to 539.7; p 0.001]. Surgical treatment for rebleeding had unsatisfactory results (postoperative mortality in group 1 26.8%, in group 2 0). Risk factors for rebleeding in peptic ulcer bleeding include localization of the ulcer on the lesser curvature of the stomach (OR=2.37; 95% CI=1.18 to 4.74) and the posterior wall of the duodenum (OR=3.84; 95% CI=1.69 to 8.73), as well as Forrest type IIA ulcer (OR=2.67; 95% CI=1.55 to 6.48). Forrest IIc and III ulcers reduce the risk of rebleeding (OR=0.24; 95% CI=0.10 to 0.56). It was found that a shock index, a decreased level of total protein and red blood cells, and an increasing level of urea have a statistically significant relationship with rebleeding in peptic ulcer bleeding. Conclusion. Rebleeding in patients with peptic ulcer is a serious complication of the disease that significantly increases mortality, and predicting the risk of rebleeding is one of the possible tools that can improve treatment outcomes and reduce mortality.

scholarly journals Study on clinical characteristics and related factors of schizophrenic patients with intestinal obstruction

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Mingchao Li ◽  
Ping Guo ◽  
Jihua Zeng ◽  
Chi Li ◽  
Qiuming Ji ◽  
...  
Keyword(s):  
Risk Factors ◽  
Abdominal Surgery ◽  
Intestinal Obstruction ◽  
Hospital Stay ◽  
Clinical Characteristics ◽  
Related Factors ◽  
Course Of Disease ◽  
Related Risk ◽  
History Of ◽  
Visiting Time

Abstract Background There are still few studies on the clinical characteristics and related risk factors of schizophrenia patients with intestinal obstruction. Our aim is to explore the clinical characteristics and related risk factors of schizophrenia patients with intestinal obstruction. Methods This study focused on schizophrenia patients with intestinal obstruction who were hospitalized in the psychiatric department of a hospital in Wuhan from January 2007 to December 2020 as the main research object. We intend to retrospectively analyze the clinical characteristics and related risk factors of schizophrenia patients with intestinal obstruction. Results In the 1937 persons with schizophrenia included in this study, 97 patients were complicated with intestinal obstruction, and the incidence was 5.01%.The results of the study showed that patients with age ≥ 60 years old, visiting time ≥ 24 h, hospital stay ≥ 90 days, history of abdominal surgery, course of disease ≥ 5 years, male, and patients with cardiovascular and cerebrovascular diseases are prone to intestinal obstruction; Logistic multiple regression analysis showed that the related risk factors of schizophrenia patients with intestinal obstruction mainly included the patient's age, visiting time, length of hospital stay, history of abdominal surgery, course of disease and gender. Conclusion The older the age, the longer the hospital stay, the longer the course of the disease, the history of previous surgery, and the male schizophrenia who do not see a doctor within 24 h of the onset, the risk of intestinal obstruction is higher, and it is easy to be misdiagnosed and even life-threatening.

scholarly journals Increased risk of falls, fall-related injuries and fractures in people with type 1 and type 2 diabetes - a nationwide cohort study.

2020 ◽  
Vol 15 ◽  
Author(s):  
Nicklas Højgaard Rasmussen ◽  
Jakob Dal ◽  
Joop Van den Bergh ◽  
Frank de Vries ◽  
Morten Hasselstrøm Jensen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Alcohol Abuse ◽  
Increased Risk ◽  
Risk Of Falls ◽  
History Of ◽  
Group 2 ◽  
Risk Factors For Falls ◽  
Group 1

Introduction: People with diabetes could have an increased risk of falls as they show more complications, morbidity and use of medication compared to the general population. This study aimed to estimate the risk of falls and to identify risk factors associated with falls in people with diabetes. The second aim was to estimate fall-related injuries including lesions and fractures including their anatomic localization in people with diabetes compared with the general population. Methods: From the Danish National Patient Register we identified people with Type 1 Diabetes (T1D) (n=12,896), Type 2 Diabetes (T2D) (n=407,009). The cohort was divided into two groups with respective control groups matched on age and sex (1:1). All episodes of people hospitalized with a first fall from 1996 to 2017 were analyzed using a Cox proportional-hazards model. Risk factors such as age, sex, diabetic complications, a history of alcohol abuse and the use of medication were included in an adjusted analysis. The incidence rate and rate ratio of falls and the anatomic localization of fall-related injuries as lesions and fractures were identified. Results and Discussion: The cumulative incidence, of falls requiring hospital treatment, was 13.3% in T1D, 11.9% in T2D. In the adjusted analysis T1D and T2D were associated with a higher risk of falls [T1D, Hazard Ratio (HR): 1.33 (95% CI: 1.25 - 1.43), T2D, HR: 1.19 (95% CI:1.16 - 1.22), respectively]. Women [group 1, HR 1.21 (CI:95%:1.13 – 1.29), group 2, HR 1.61 (CI:95%:1.58–1.64)], aged >65 years [groups 1, HR 1.52 (CI:95%:1.39 – 1.61), group 2, HR 1.32 (CI:95%:1.58–1.64)], use of selective serotonin receptor inhibitors (SSRI) [group 1, HR 1.35 (CI:95%:1.1.30 – 1.40), group 2, HR 1.32 (CI:95%:1.27–1.38)], opioids [group 1, HR 1.15 (CI:95%:1.12 – 1.19), group 2, HR 1.09 (CI:95%:1.05–1.12)] and a history of alcohol abuse [group 1, HR 1.77 (CI:95%:1.17 – 2.15), group 2, HR 1.88 (CI:95%:1.65–2.15)] were significantly associated with an increased risk of falls in both groups. The incidence rate ratios (IRR) of fall-related injuries as hip, pelvis/lower-back and skull/facial fractures were higher in people with T2D than controls [IRR 1.08 (CI:95%:1.02-1.15), IRR 1.21 (CI:95%: 1.12-1.48) and IRR 1.11 (CI:95%:1.02-1.21)]. Conclusion: People with diabetes have an increased risk of first fall and a higher incidence of fall-related injuries including fractures. Advanced aging and sex are non-modifiable risk factors, whereas diabetes, the use of SSRIs and opioids and alcohol abuse could be potentially modifiable risk factors for falls. Gaining information on risk factors for falls could guide the management of diabetes treatment i.e. choice of drugs, which enables us to improve treatment particularly in people with a high risk of falls and fractures associated with high mortality.

scholarly journals Comparison of Risk Factors for Postoperative Complications Across Age Groups in Patients Undergoing ORIF of the Ankle

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0029
Author(s):  
Haley McKissack ◽  
Matthew Anderson ◽  
John T. Wilson ◽  
Leonardo V. M. Moraes ◽  
Gean C. Viner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Elderly Patients ◽  
Illicit Drugs ◽  
Age Groups ◽  
Wound Dehiscence ◽  
Implant Failure ◽  
Increased Risk ◽  
Group 2 ◽  
Group 1

Category: Ankle, Trauma Introduction/Purpose: Ankle fractures are commonly-seen orthopaedic injuries across all age groups, and often warrant operative management. Postoperative complications are particularly common among elderly patients, and can lead to a progressive culmination of negative outcomes. Although several studies have focused on the risk factors for and prevention of such complications in elderly patients, a paucity of literature exists addressing risk of postoperative complications in younger patient populations. The purpose of this study was to compare the incidence of and risk factors for various postoperative complications between younger and older patient populations. Methods: Patients who underwent open reduction and internal fixation for an ankle fracture at a single institution between the years 2008 and 2018 were retrospectively identified based on seven different Current Procedural Terminology (CPT) codes: 27829, 27784, 27822, 27814, 27769, 27792, and 27766. Patient charts were reviewed for demographic data and comorbid conditions. Patients with open fractures, pilon fractures, and polytraumatic injuries were excluded. The sample was stratified into two cohorts based on age in years: 18-49 (group 1), and 50 and older (group 2). Incidence of various postoperative complications—including infection, wound dehiscence, sepsis, DVT, implant failure, revision surgery, and non-union— was compared between groups. Secondary analysis was conducted to compare risk factors for these complications between ages 18- 49 and older than 50. Results: 881 patients were included. A significantly greater number of patients in group 2 experienced wound dehiscence (p = 0.033) and nonunion (p<0.001) postoperatively in comparison to those in group 1. Risk of infection was significantly increased among patients with hypertension, CHF, and CKD compared to patients without these comorbidities in both group 1 and group 2. Risk of wound dehiscence was significantly increased among patients using tobacco and illicit drugs in group 1 (RR=3.39, p=0.0223 and RR=3.07, p=0.0201 respectively), but not in group 2 (RR = 1.12, p = 0.8021 and RR = 1.77, p = 0.4203 respectively). Risk of implant failure was significantly increased among tobacco users in group 2 (RR=3.82, p = 0.0005), but not in group 1 (RR = 0.75, p=0.4709). Conclusion: Patients age 50 and older may be at significantly increased risk for postoperative wound dehiscence and nonunion in comparison to patients who are younger than 50. Additionally, younger patients who use tobacco and illicit drugs may be at increased risk of wound dehiscence, while tobacco use among patients 50 years and older may increase risk of implant failure. Understanding the risk factors associated with negative outcomes may help physicians to optimize individual patient care based on existing comorbidities and age.

Efficacy evaluation of the CEUS-LI-RADS-v2017 system in differential diagnosis of liver tumors

2019 ◽  
pp. 57-67
Author(s):  
A. N. Katrich ◽  
V. A. Porkhanov ◽  
N. S. Ryabin
Keyword(s):  
Risk Factors ◽  
Differential Diagnosis ◽  
Liver Tumors ◽  
Morphological Data ◽  
Malignant Neoplasms ◽  
Diagnostic Efficiency ◽  
Efficacy Evaluation ◽  
General Group ◽  
Group 2 ◽  
Group 1

Objective: efficacy evaluation of the CEUS LI RADS v2017® system for differential diagnosis of liver tumors in patients with and without cirrhosis.Materials and methods. Retrospective analysis of diagnostic results of the 165 patients with liver tumors (177 nodules) was done. All patients underwent CEUS with results interpretation in accordance to the CEUS LIRADSv2017 ® criteria. Patients were divided into 2 groups based on clinical and morphological data. Group 1 included 62 patients with cirrhosis and/or CVH. Group 2 included 110 patients without risk factors for HCC.Results. Diagnostic efficiency of CEUS LI RADS v2017® for HCC identification was: group 1 – Se – 100%, Sp – 88%, Ac – 95.5%; group 2 – Se – 100%, Sp – 68.8%, Ac – 72.7%; general group Se – 100%, Sp – 72.2%, Ac – 81.4%. In the 2nd group, 21 out of 22 neoplasms, confirmed morphologically as FNH, we classified as LR 4. By applying benign character and specific contrasting patterns of FNG, they were transferred from LR 4 to LR 3. This allowed to increase sensitivity and specificity of differential diagnosis in group 2 (Se – 100%, Sp – 90.6%, Ac – 91.8%) and in general group (Se – 100%, Sp – 90.1%, Ac – 93.2%). Diagnostic efficiency of the criteria for non hepatocellular malignant neoplasms (LR M) was: group 1 – Se – 77.8%, Sp – 100%, Ac – 97%; group 2 – Se – 90%, Sp – 96.7%, Ac – 93.6%; general group- Se – 88.1%, Sp – 98.3%, Ac – 94.9%.Conclusion. Our study confirmed high accuracy of the CEUS LI RADS v2017® system in the differential diagnosis of focal liver tumors. Modification of the system (in particular, transfer of typical FNG forms from the LR 4 category) will make it possible to increase the accuracy of diagnostics by 20%. It will allow to use the LI RADS v2017® system for interpretation CEUS not only among patients with liver cirrhosis, but also in a general group without risk factors of GCC.

scholarly journals Transvenous lead extraction: procedural outcomes and in-hospital mortality in octogenarian patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Giannotti Santoro ◽  
L Segreti ◽  
G Zucchelli ◽  
V Barletta ◽  
A Di Cori ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hospital Mortality ◽  
Electronic Device ◽  
Clinical Success ◽  
Similar Efficacy ◽  
Lead Extraction ◽  
Tertiary Referral Center ◽  
Major Complications ◽  
Group 2 ◽  
Group 1

Abstract Background Managing elderly patients with infection or malfunction deriving from a cardiac implantable electronic device (CIED) may be challenging. The aim of this study was to evaluate safety and efficacy of mechanical transvenous lead extraction (TLE) in elderly patients. Methods Patients who had undergone TLE in single tertiary referral center were divided in two groups (Group 1: ≥80 years; group 2:&lt;80 years) and their acute and chronic outcomes were compared. All patients were treated with manual traction or mechanical dilatation. Results Our analysis included 1316 patients (group 1: 202, group 2: 1114 patients), with a total of 2513 leads extracted. Group 1 presented more comorbidities and more pacemakers, whereas the dwelling time of the oldest lead was similar, irrespectively of patient's age. In group 1 the radiological success rate for lead was higher (99.0% vs 95.9%; P&lt;0.001) and the fluoroscopy time lower (13.0 vs 15.0 minutes; P=0.04) than in group 2. Clinical success was reached in 1273 patients (96.7%), without significant differences between groups (group 1: 98.0% vs group 2: 96.4%; P=0.36). Major complications occurred in 10 patients (0.7%) without significative differences between patients with more or less than 80 years (group 1: 1.5% vs group 2: 0.6%; P=0.24). In the elderly group no in-hospital mortality occurred (0.0% vs 0.5%; P=0.42). Conclusions Mechanical TLE in elderly patients is a safe and effective procedure. In the over-80s, a comparable incidence of major complications with younger patients was observed, with at least a similar efficacy of the procedure and no procedural-related deaths. Funding Acknowledgement Type of funding source: None

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