Abstract 251: Long-term Outcomes and Implantable Cardioverter Defibrillator Use in Peripartum Cardiomyopathy

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Madeline Mahowald ◽  
Nivedita Basu ◽  
Kris Kawamoto ◽  
Melinda Davis
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Subsequent Pregnancy ◽  
Peripartum Cardiomyopathy ◽  
Full Recovery ◽  
Implantable Cardioverter Defibrillators ◽  
Icd9 Code ◽  
One Year

Background: Many studies of outcomes in peripartum cardiomyopathy (PPCM) are limited by short-term follow-up of 6-12 months. Long-term mortality rates and outcomes are largely unknown. Prior research has also suggested under-utilization of implantable-cardioverter defibrillators (ICD) in this population. Methods: Patients with PPCM at a tertiary care center were retrospectively identified using ICD9 code 674.5x from 2000-2011, and each chart was manually reviewed. Clinical, demographic, and echocardiographic data were reviewed, with follow-up through November 2016. Recovery was defined as ejection fraction (EF) >= 55%. Results: Of 60 patients, 35 were white (58.3%) and 16 were black (26.7%). Mean age at diagnosis was 29.6 years (range 18-44 years) and average follow-up was 5.8 years. Mean EF at time of diagnosis was 20.2 +/- 4%, at 6-months follow-up it was 39.6 +/- 4%, and at final follow-up was 38.7 +/- 3%. Recovery (EF>=55%) occurred in 38%. Of those who did not recover (62%), the final mean EF was 25%. ICD was placed in 19 patients (51%). Only one patient with an ICD later recovered at one year follow-up. LVAD or transplant occurred in 8 patients, and death occurred in 7 patients with a mean survival of 4.4 +/- 1.4 years. Five patients experienced subsequent deterioration in their EF (with a range of 10-35%) in the absence of a subsequent pregnancy, with a mean decrease in EF of 23.2%. Three of these patients had achieved full recovery (EF>=55%) prior to subsequent decline. Conclusions: Patients with PPCM who have initial improvement in EF or even full recovery, can later suffer deterioration, even in the absence of subsequent pregnancy. This finding warrants continued surveillance and raises the question whether lifelong medical therapy may be indicated despite recovery. This study also shows a higher rate of ICD utilization than prior reports.

Nephrocalcinosis, Renal Dysfunction, and Calculi in Patients With Primary Hypoparathyroidism on Long-Term Conventional Therapy

2020 ◽  
Vol 105 (4) ◽  
pp. e1215-e1224 ◽  
Author(s):  
Soma Saha ◽  
Devasenathipathy Kandasamy ◽  
Raju Sharma ◽  
Chandrasekhar Bal ◽  
Vishnubhatla Sreenivas ◽  
...  
Keyword(s):  
Renal Dysfunction ◽  
Conventional Therapy ◽  
Care Center ◽  
Tertiary Care ◽  
Fractional Excretion ◽  
Renal Calculi ◽  
Serum Total Calcium ◽  
Calcium Phosphorus

Abstract Context There are concerns about the long-term safety of conventional therapy on renal health in patients with hypoparathyroidism. Careful audit of these would help comparisons with upcoming parathyroid hormone therapy. Objective We investigated nephrocalcinosis, renal dysfunction, and calculi, their predictors and progression over long-term follow-up in patients with primary hypoparathyroidism (PH). Design and Setting An observational study at a tertiary care center was conducted. Participants and Methods A total of 165 PH patients receiving conventional therapy were evaluated by radiographs, ultrasonography, and computed tomography. Their glomerular filtration rate (GFR) was measured by Tc-99m-diethylenetriamine penta-acetic acid clearance. Clinical characteristics, serum total calcium, phosphorus, creatinine, hypercalciuria, and fractional excretion of phosphorus (FEPh) at presentation and during follow-up were analyzed as possible predictors of renal complications. Controls were 165 apparently healthy individuals. Results Nephrocalcinosis was present in 6.7% of PH patients but not in controls. Patients younger than 15 years at presentation and with higher serum calcium-phosphorus product were at higher risk. Nephrocalcinosis showed no significant association with cataract and intracranial calcification. Prevalence of renal calculi was comparable between hypoparathyroid patients and controls (5% vs 3.6%, P = .58). Fourteen percent of patients had a GFR less than 60 mL/min/1.73 m2. Increased FEPh during follow-up was the significant predictor of low GFR. Nephrocalcinosis developed in 9% of patients over 10 years of conventional therapy. Conclusion A total of 6.7% of PH patients had nephrocalcinosis, and 14% showed renal dysfunction. Prevalence of renal calculi was similar in patients and controls. Nine percent of patients developed nephrocalcinosis over 10 years of conventional therapy.

Abstract 092: No Change in Peripartum Cardiomyopathy Outcomes or Risk Factors Over the Past Decade

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Nivedita Basu ◽  
Madeline Mahowald ◽  
Kris Kawamoto ◽  
Melinda Davis
Keyword(s):  
Risk Factors ◽  
Maternal Age ◽  
Care Center ◽  
Tertiary Care ◽  
Temporal Trends ◽  
Peripartum Cardiomyopathy ◽  
Icd Implantation ◽  
The Past ◽  
Increased Risk

Background: Few studies have evaluated temporal trends in outcomes and risk factors for peripartum cardiomyopathy (PPCM). Prior research using administrative data could only assess short-term in-hospital adverse events. It has also been hypothesized that the incidence of PPCM is rising due to advancing maternal age and increased risk factors. Therefore, we examined long-term outcomes and prognostic factors to determine if there has been any change over the past decade. Methods: Patients seen at a tertiary care center between 2000 and 2011 with a diagnosis of PPCM were identified by ICD9 code 674.5x and confirmed by manual chart review. Year of diagnosis, clinical and demographic variables, echocardiographic data, and outcomes including myocardial recovery (defined as EF>=55%), ICD placement, LVAD, transplant, and death were reviewed for follow-up through November 2016. Results: Of 60 patients, 31 (52%) were diagnosed recently (2006-2011) and 29 (48%) were diagnosed prior to 2006 (1996-2005). There were no significant differences in the recent group compared to the past group in initial EF (19% vs 22%), final EF (39% vs 39%), and final recovery status (52% vs 48%). Similarly, there were no differences in rates of ICD implantation, LVAD/transplant, mortality, and years of survival. There were no differences in age at diagnosis or in rates of hypertension, smoking, or diabetes. Few patients in either category underwent a subsequent pregnancy. Mean years of follow-up (through 2016) were longer for those diagnosed prior to 2006 (8.3 years vs 3.4 years, p<0.001). Conclusions: There has been no improvement in outcomes for patients diagnosed with PPCM in the past decade. Maternal age and risk factors do not appear to be increasing. Despite advances in heart failure treatment and increased awareness of PPCM, more research about the management and follow-up of young mothers with PPCM is needed.

Long-Term Hearing Outcomes following Total Ossicular Reconstruction with Titanium Prostheses

2019 ◽  
Vol 161 (1) ◽  
pp. 123-129 ◽  
Author(s):  
C. Burton Wood ◽  
Robert Yawn ◽  
Anne Sun Lowery ◽  
Brendan P. O’Connell ◽  
David Haynes ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Ossicular Chain ◽  
Tertiary Care Center ◽  
Ossicular Chain Reconstruction ◽  
The Mean ◽  
Hearing Outcomes

Objective(1) Characterize a large cohort of patients undergoing total ossicular chain reconstruction with titanium prosthesis. (2) Analyze long-term hearing outcomes of the same cohort.Study DesignCase series with chart review.SettingTertiary care center.Subject and MethodsThis study reviews patients who underwent total ossicular chain reconstruction (OCR) with titanium prostheses (TORPs) at a single tertiary care center from 2005 to 2015. Patient charts were reviewed for demographic data, diagnosis, and operative details. Patients were included in statistical analysis if length of follow-up was 2 years or more. Evaluation of hearing improvement was made by comparing preoperative air-bone gap (ABG) and ABG at follow-up at 2 years.ResultsIn total, 153 patients were identified who met inclusion criteria. The mean age of included patients was 40 years (range, 6-89 years). Sixty patients (39%) had a history of OCR, and 120 patients (78%) had a diagnosis of cholesteatoma at the time of OCR. Preoperatively, the mean ABG was 36 ± 12, whereas the mean ABG at 2-year follow-up improved to 26 ± 13. This was statistically significant ( P < .0001) using a Wilcoxon matched-pairs signed rank test. Twelve patients (8%) required revision OCR. Two revisions were performed due to prosthesis extrusion (<1%).ConclusionTitanium prostheses lead to significant improvement in hearing over long periods. The results are sustained as far out as 5 years following surgery. In addition, rates of revision surgery with titanium TORPs are low. Based on this series, there are no readily identifiable predictors for outcomes following total OCR.

Carcinoids of the ampulla: Long-term follow-up after endoscopic resection.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 430-430
Author(s):  
George Nyasha Baison ◽  
Nadav Sahar ◽  
Morgan M Bonds ◽  
Janelle F Rekman ◽  
Flavio G. Rocha ◽  
...  
Keyword(s):  
Endoscopic Resection ◽  
Care Center ◽  
Benign Lesion ◽  
Tertiary Care ◽  
Case Series ◽  
World Health ◽  
Long Term Follow Up ◽  
Well Differentiated

430 Background: Neuroendocrine tumors (NET) or carcinoids of the ampulla are exceedingly rare in comparison to duodenal NET. Surgical management is widely accepted as the treatment of choice, but for patients that refuse surgery or are poor operative candidates, endoscopic resection may be option. We present a consecutive case series at a tertiary care center describing our experience with endoscopic resection of ampullary NET. Methods: This is a restrospective review with a long-term follow-up of patients with ampullary NET that were endoscopically resected. Outcomes were analyzed based on the histopathologic classification system proposed by the World Health Organization in 2000. Results: Twelve patients (9 male, 3 female), ranging in age from 41 to 86 (mean 59) underwent endoscopic ampullectomy for ampullary NET, with a mean follow-up time of 5 years. Patients had refused surgery or were poor surgical candidates. All, but one incidentally found case, were symptomatic on presentation, with gastrointestinal bleeding being the main symptom. No patients had a hormonal syndrome. The mean size of the lesions was 21 mm (6 mm to 35 cm). Six (50%) patients had a well-differentiated, benign lesion, 6 (50%) patients had a well-differentiated NET with unknown malignant potential (gangliocytic paragangliomas). Eight (67%) were completely excised during the initial endoscopy with 4 requiring re-excision. Only 2 patients developed recurrence, after 2.5 and 10 years and this necessitated a pancreaticoduodenectomy. Five patients had complications (2 for bleeding and 3 for post-ERCP pancreatitis), with zero deaths. Conclusions: Unlike duodenal carcinoids, ampullary NET are rare. Pancreaticoduodenectomy can be offered to fit patients except for gangliocytic paragangliomas that do not require an aggressive operation. However, for those that refuse surgery or are poor candidates, endoscopic ampullectomy can be an option with acceptable short and long-term outcomes.

Long-term follow-up of jaw osteomyelitis associated with bisphosphonate use in a tertiary-care center

2014 ◽  
Vol 32 (1) ◽  
pp. 18-22 ◽  
Author(s):  
Carlos Pigrau-Serrallach ◽  
Evelyn Cabral-Galeano ◽  
Benito Almirante-Gragera ◽  
Roger Sordé-Masip ◽  
Dolors Rodriguez-Pardo ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Long Term Follow Up

Renal Toxicity of Long-Term Therapy With Tenofovir in HIV-Infected Patients

2012 ◽  
Vol 25 (5) ◽  
pp. 552-559 ◽  
Author(s):  
Maricelle O. Monteagudo-Chu ◽  
Mei H. Chang ◽  
Horatio B. Fung ◽  
Norbert Bräu
Keyword(s):  
Renal Toxicity ◽  
Care Center ◽  
Tertiary Care ◽  
Term Therapy ◽  
Kaplan Meier ◽  
Ckd Stage ◽  
Advanced Stages ◽  
Long Term Therapy

Data are sparse on long-term renal toxicity of tenofovir as measured by estimated glomerular filtration rate (eGFR) and progression to advanced stages of chronic kidney disease (CKD). The objective of the study is to determine the incidence of renal impairment associated with the use of tenofovir in HIV-infected patients, using abacavir as a control. In a single tertiary care center, all HIV-infected patients with baseline CKD stage 0 or 1 (CKD-1), who were started on either tenofovir or abacavir from 1998 to 2008 and had at least 1 follow-up eGFR measure on therapy, were included in this retrospective analysis. Progression to CKD stages 2 to 5 was compared using Kaplan-Meier analysis. Progression to CKD-2 and CKD-3 occurred more frequently in patients who received tenofovir than those receiving abacavir (CKD-2, 2-year actuarial frequency, 48.8% vs 23.7%; P < .001, log rank; CKD-3, 5.8% vs 0.0%; P = .028). Only 1 patient in the tenofovir group progressed to CKD-4 and none to CKD-5. Treatment with tenofovir was the only independent factor associated with progression to CKD-2 (hazard ratio [HR], 2.12; 95% confidence interval [CI]: 1.41-3.18; P < .001) and to CKD-3 (HR, 4.91; 95% CI, 1.02-23.7; P = .048). In HIV-infected patients, long-term therapy with tenofovir is associated with mild-to-moderate nephrotoxicity which is significantly higher than in abacavir-treated patients.

scholarly journals Long-term Outcomes in Peripartum Cardiomyopathy

2019 ◽  
Vol 13 (1) ◽  
pp. 13-23 ◽  
Author(s):  
Madeline K Mahowald ◽  
Nivedita Basu ◽  
Latha Subramaniam ◽  
Ryan Scott ◽  
Melinda B. Davis
Keyword(s):  
Adverse Events ◽  
Left Ventricular ◽  
Subsequent Pregnancy ◽  
Peripartum Cardiomyopathy ◽  
Left Ventricular Ejection ◽  
Long Term Outcomes ◽  
Ventricular Assist ◽  
Ventricular Ejection Fraction

Background: Prior studies of Peripartum Cardiomyopathy (PPCM) are limited by short-term follow-up. Contemporary long-term outcomes and change in myocardial function over time are poorly characterized. Methods and Results: This retrospective cohort study included women with PPCM at the University of Michigan (2000-2011), with follow-up on March 31, 2017. Subsequent pregnancies were excluded. Recovery was sustained left ventricular Ejection Fraction (EF) ≥55%. Major Adverse Events (MAE) included death, cardiac transplantation, left ventricular assist device, or inotrope-dependence. A total of 59 women were included (mean [SD] age at diagnosis, 29.5 [6.8]; 28.8% Black), with a mean follow-up of 6.3 years. Recovery occurred in 22 women (37%); of these, 8 women (36%) had delayed recovery (>12 months). All cause mortality was 20% (12/59) with median survival 4.2 years; of these, 9 women (75%) died after the first year (range 2 - 10 years). MAE occurred in 19 women (32%); of these, 11 women (42%) had MAE >12 months from time of diagnosis (range 2-20 years). Deterioration in EF by >10% from the time of diagnosis occurred in 16 women (27%). This group had worse long-term outcomes, including lower final EF (mean 25 vs 42%, p=0.010), less recovery (12 vs 46%, p=0.016), and higher rates of death (38 vs 14%, p=0.046) and MAE (56 vs 23%, p=0.016). Conclusion: Women with PPCM have long-term risks of mortality, MAE, and subsequent decline in EF, even in the absence of a subsequent pregnancy. Deterioration in EF is associated with adverse events; thus, long-term management is important.

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