Stapled Intestinal Anastomosis in Neonates: Validation of Safety and Efficacy

2010 ◽  
Vol 76 (6) ◽  
pp. 644-646 ◽  
Author(s):  
Jon D. Simmons ◽  
Joseph W. Gunter ◽  
Justin D. Manley ◽  
David E. Sawaya ◽  
Christopher J. Blewett
Keyword(s):  
Small Bowel ◽  
Gestational Age ◽  
Medical Center ◽  
Intestinal Anastomosis ◽  
Outcome Data ◽  
High Rate ◽  
Average Weight ◽  
Colon Anastomosis ◽  
Long Term Effects ◽  
Intestinal Anastomoses

The safety and effectiveness of a stapled intestinal anastomosis in adults and children is well documented. However, the role of this technique in neonates is not well validated. We report our experience with stapled intestinal anastomoses in the neonate at the University of Mississippi Medical Center. All patients from the neonatal intensive care unit who had a stapled intestinal anastomosis between February 2007 and May 2008 were identified. A stapled side-to-side functional end-to-end intestinal anastomosis was performed in all patients using a gastrointestinal anastomosis stapler. Demographic, management, and outcome data were collected via chart review. Variables collected included: birth weight, estimated gestational age at birth and surgery, weight at surgery, the use of vasopressors, associated diagnoses, location of the anastomosis, and postoperative clinic visits. A total of 18 patients were identified during the study period. Nine had small bowel to small bowel, eight had ileum to colon, and one had a colon to colon anastomosis. The average weight at time of operation was 2.8 kilograms (Kg) and the average estimated gestational age at surgery was 38.7 weeks. The only complication reported was a partial small bowel obstruction on postoperative day 12, which was successfully treated nonoperatively. Two patients died from problems not associated with the anastomosis. There were no anastomotic leaks or strictures. The literature regarding the use of stapled bowel anastomoses in neonates is scant. Stapled intestinal anastomoses can be performed safely in neonates without a high rate of complication. The long term effects of stapled intestinal anastomoses in the neonate are unknown. Future areas of interest would include effects on postoperative feeding and operative time.

scholarly journals Development of Repository From a Pediatric Gender Clinic

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A797-A797
Author(s):  
Michele Gortakowski ◽  
Chelsea C Gordner
Keyword(s):  
Health Outcomes ◽  
Hormone Therapy ◽  
Behavioral Health ◽  
Medical Center ◽  
Pediatric Population ◽  
Gender Diversity ◽  
Outcome Data ◽  
Long Term Effects ◽  
Tertiary Referral Center ◽  
The Creation

Abstract Objectives: With the publication of updated guidelines for care of transgender and gender non-conforming individuals, there has been an increase in the presence of gender diversity in both mainstream media and medical literature. Several gaps currently exist in medical knowledge regarding long term effects of gender-affirming therapies. There is a lack of standardization in study design, patient sampling, and outcome measures, and most studies are retrospective. Here we describe the creation of both a retrospective and prospective repository of patients who presented to the Massachusetts Medical School-Baystate Medical Center (UMass-Baystate) pediatric gender program. Methods: Baystate Medical Center is located in western MA and is a tertiary referral center. A pediatric gender clinic was created in 2014. A repository containing both retrospective and prospective data was approved by the UMass-Baystate IRB to include patients ages 2 to 24 years of age who presented to our gender clinic. Retrospective data was obtained using the McKesson billing database. Sociodemographic, clinical and behavioral health data were collected. We are consenting individuals as they present to the clinic for the prospective component. Those that have consented fill out a survey at each visit. The repository has been approved to follow outcome data for 25 years. Results: To date, we have 218 individuals in the repository, 75 of which are in the prospective component. Age of presentation ranged from 6 yrs to 24 yrs with an average age of 15 yrs. 62% identified as transmale, 31% as transfemale and the remainder as gender fluid or other. 75% have been prescribed gender affirming hormone therapy (56% GnRH agonist therapy, 20% estrogen, 58% testosterone). Of those being followed prospectively, 76% identified as white, 19% Hispanic. 79% were satisfied or very satisfied with their care. Conclusions: Here we describe the demographic and clinical characteristics of patients that have presented to our gender clinic since 2014. The creation of our gender repository will allow us to assess sociodemographic, clinical and behavioral health outcomes of treatment, including metabolic parameters, bone health, and mental health outcomes in our pediatric population. Future projects include assessment of the change in cardiovascular risk in individuals on gender-affirming hormone therapy.

scholarly journals Does Birthweight Represent Imprinting for Life? Preliminary Findings from the Level and Timing of Diabetic Hyperglycemia in Utero: Transgenerational Effect on Adult Morbidity (TEAM) Study

Reports ◽  
2020 ◽  
Vol 3 (4) ◽  
pp. 36
Author(s):  
Jane C. Khoury ◽  
Mekibib Altaye ◽  
Shelley Ehrlich ◽  
Suzanne Summer ◽  
Nicholas J. Ollberding ◽  
...  
Keyword(s):  
Birth Weight ◽  
Gestational Diabetes ◽  
Gestational Age ◽  
Medical Center ◽  
In Utero ◽  
Clinic Visit ◽  
High Rate ◽  
Large For Gestational Age ◽  
Obesity Status ◽  
To Come

Women with pre-gestational diabetes have a high rate of large for gestational age (LGA) babies compared to women without diabetes. In particular, there is a high rate of asymmetric LGA defined as ponderal index (PI) > 90th percentile for gestational age. We examined the association of birth weight and PI, with body mass index (BMI) and obesity status in adulthood, in a cohort of offspring of women with pre-gestational diabetes. The women participated in the Diabetes in Pregnancy (DiP) study at the University of Cincinnati from 1978 to 1995. The offspring of these women are the cohort participating in an observational study being conducted at Cincinnati Children’s Hospital Medical Center. Once located, the offspring were invited to come in for a one-day clinic visit to assess anthropometrics, and their metabolic, renal and cardiovascular status. Linear and logistic regression was used to assess the association between birth weight and PI with current BMI. We report on 107 offspring. A statistically significant association was found between offspring current BMI with birth PI (β = 1.89, 95% CI 0.40–3.38), and between offspring current obesity status and birth asymmetric LGA (aOR = 2.44, 95% CI 1.01–5.82). This is consistent with in utero “metabolic programming”.

scholarly journals Difference in Procedure-Related Risk of Miscarriage between Early and Mid-Trimester Amniocentesis: A Retrospective Cohort Study

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1098
Author(s):  
Kelly Steinfort ◽  
Ellen Van Houtven ◽  
Yves Jacquemyn ◽  
Bettina Blaumeiser ◽  
Philip Loquet
Keyword(s):  
Cohort Study ◽  
Gestational Age ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Fetal Loss ◽  
Outcome Data ◽  
High Rate ◽  
Safe Alternative ◽  
Related Risk ◽  
Significant Difference

Early amniocentesis (EA)—before 15 gestational weeks—is not recommended because of a high rate of miscarriages. Most studies performed amniocentesis at very early stages of pregnancy (11–13 weeks of gestational age). However, amniocentesis performed at 14 gestational weeks could be an important alternative to mid-trimester amniocentesis (MA) because it shortens the time period between the screening (non-invasive prenatal test (NIPT)) and the diagnostic test (amniocentesis). This study aimed to compare the procedure-related risk of miscarriage between MA (15 + 0 to 17 + 6 weeks of gestational age) and EA (14 + 0–6 weeks of gestational age). This is a multicentric, retrospective cohort study from 1 January 2007 to 21 November 2018, comparing the MA to the EA cohort. Procedure-related fetal loss is defined as spontaneous abortion occurring within 4 weeks of the procedure. Multiple gestations, amniocenteses performed after 17 or before 14 weeks, indications other than prenatal genetic diagnoses and procedures performed by less experienced gynaecologists were excluded. Complete outcome data were available for 1107 out of 1515 women (73.1%): 809 (69.9%) in the MA and 298 (83.2%) in the EA cohort. No significant difference was found (EA 0.82% vs. MA 0.36%; p = 0.646). The difference was 0.46% (odds ratio = 0.673; 95% confidence interval = 0.123–3.699). This study found no significant difference in the procedure-related risk of miscarriage when EA was compared to MA. EA might be considered a safe alternative, though further research is necessary.

scholarly journals Multiple intestinal anastomosis in newborns and infants

2021 ◽  
Vol 25 (3) ◽  
pp. 153-157
Author(s):  
Yu. A. Kozlov ◽  
M. N. Mochalov ◽  
K. A. Kovalkov ◽  
S. S. Poloyan ◽  
P. Zh. Baradieva ◽  
...  
Keyword(s):  
Small Intestine ◽  
Short Bowel Syndrome ◽  
Necrotizing Enterocolitis ◽  
Average Length ◽  
Intestinal Anastomosis ◽  
Abdominal Cavity ◽  
Average Weight ◽  
Intestinal Anastomoses ◽  
Short Bowel ◽  
Second Surgery

Introduction. The present trial systematizes data, taken from one surgical center as an example, on treating patients with intestinal atresia and necrotizing enterocolitis with multiple intestinal anastomoses.Material and methods. The trial is a retrospective review on the treatment of 13 newborn infants who since 2010 have been put multiple intestinal anastomoses; the treatment was approved by the Hospital Ethics Committee. The average gestational age of patients was 31.2 weeks. The average age at the time of surgery – 7,9 days. Average weight - 2007 grams. The average number of anastomoses was 3.7 (range: 2-7). The average length of remained small intestine after the second surgery was 67.4 cm (range: 12-120 cm). No other surgical procedures, including gastrostomy or enterostomy, were performed. In all cases, surgical intervention ended with hermetic suturing of the abdominal cavity. Among them, there were 6 patients with the multifocal form of necrotizing enterocolitis; 6 patients had type IV atresia of the small intestine; 1 patient had the Ladd’s syndrome. Connection of intestinal segments was made by constructing several “end-to-end” anastomoses, double-row precision seam with PDS II 7/0 suture.Results. In the postoperative period, complications associated with anastomosis construction, such as leakage and narrowing, were not recorded. Transit function of the gastrointestinal tract restored on day 4, on average, after the surgery (range: 2-6 days). There were no early lethal outcomes within the first 28 days after the surgery which were associated with the surgery. 2 patients with short bowel syndrome (remained small intestine was 12 and 25 cm) and multivisceral disorders died on day 72 and 64 after the surgery. Survived patients were transferred to full enteral feeding in 56 days, in average, after the second surgery (range - 15-120 days).Conclusion. In our study, we have demonstrated potentials of a new surgical approach: one-stage formation of multiple intestinal anastomoses in case of multiple intestinal atresias as well as in case of multifocal forms of necrotizing enterocolitis. Maintaining the bowel length with multiple bowel anastomoses is very important factor for better survival of patients with the short bowel syndrome.  

Outcomes after Emergency Admission with a Diabetic Foot Attack Indicate a High Rate of Healing and Limb Salvage But Increased Mortality: 18-Month Follow-up Study

2020 ◽  
Author(s):  
Erika Vainieri ◽  
Raju Ahluwalia ◽  
Hani Slim ◽  
Daina Walton ◽  
Chris Manu ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Diabetic Foot ◽  
Emergency Admission ◽  
Arterial Disease ◽  
Major Amputation ◽  
Outcome Data ◽  
High Rate ◽  
Free Survival ◽  
Peripheral Arterial

Abstract Aim The diabetic foot attack (DFA) is perhaps the most devastating form of diabetic foot infection, presenting with rapidly progressive skin and tissue necrosis, threatening both limb and life. However, clinical outcome data in this specific group of patients are not available. Methods Analysis of 106 consecutive patients who underwent emergency hospitalisation for DFA (TEXAS Grade 3B or 3D and Infectious Diseases Society of America (IDSA) Class 4 criteria). Outcomes evaluated were: 1) Healing 2) major amputation 3) death 4) not healed. The first outcome reached in one of these four categories over the follow-up period (18.4±3.6 months) was considered. We also estimated amputation free survival. Results Overall, 57.5% (n=61) healed, 5.6% (n=6) underwent major amputation, 23.5% (n=25) died without healing and 13.2% (n=14) were alive without healing. Predictive factors associated with outcomes were: Healing (age<60, p=0.0017; no Peripheral arterial disease (PAD) p= 0.002; not on dialysis p=0.006); major amputation (CRP>100 mg/L, p=0.001; gram+ve organisms, p=0.0013; dialysis, p= 0.001), and for death (age>60, p= 0.0001; gram+ve organisms p=0.004; presence of PAD, p=0.0032; CRP, p=0.034). The major amputation free survival was 71% during the first 12 months from admission, however it had reduced to 55.4% by the end of the follow-up period. Conclusions In a unique population of hospitalised individuals with DFA, we report excellent healing and limb salvage rates using a dedicated protocol in a multidisciplinary setting. An additional novel finding was the concerning observation that such an admission was associated with high 18-month mortality, almost all of which was after discharge from hospital.

scholarly journals Characteristics and Outcomes Among Hospitalized COVID-19-Positive Patients in a Nonurban Environment

2021 ◽  
Author(s):  
Robert P Lennon ◽  
Theodore J Demetriou ◽  
M Fahad Khalid ◽  
Lauren Jodi Van Scoy ◽  
Erin L Miller ◽  
...  
Keyword(s):  
New York ◽  
Medical Center ◽  
Academic Medical Center ◽  
Military Medicine ◽  
Case Series ◽  
Outcome Data ◽  
Urban Environments ◽  
Urban Setting ◽  
Published Data ◽  
Retrospective Case

ABSTRACT Introduction Virtually all hospitalized coronavirus disease-2019 (COVID-19) outcome data come from urban environments. The extent to which these findings are generalizable to other settings is unknown. Coronavirus disease-2019 data from large, urban settings may be particularly difficult to apply in military medicine, where practice environments are often semi-urban, rural, or austere. The purpose of this study is compare presenting characteristics and outcomes of U.S. patients with COVID-19 in a nonurban setting to similar patients in an urban setting. Materials and Methods This is a retrospective case series of adults with laboratory-confirmed COVID-19 infection who were admitted to Hershey Medical Center (HMC), a 548-bed tertiary academic medical center in central Pennsylvania serving semi-urban and rural populations, from March 23, 2020, to April 20, 2020 (the first month of COVID-19 admissions at HMC). Patients and outcomes of this cohort were compared to published data on a cohort of similar patients from the New York City (NYC) area. Results The cohorts had similar age, gender, comorbidities, need for intensive care or mechanical ventilation, and most vital sign and laboratory studies. The NYC’s cohort had shorter hospital stays (4.1 versus 7.2 days, P &lt; .001) but more African American patients (23% versus 12%, P = .02) and higher prevalence of abnormal alanine (&gt;60U/L; 39.0% versus 5.9%, P &lt; .001) and aspartate (&gt;40U/L; 58.4% versus 42.4%, P = .012) aminotransferase, oxygen saturation &lt;90% (20.4% versus 7.2%, P = .004), and mortality (21% versus 1.4%, P &lt; .001). Conclusions Hospitalists in nonurban environments would be prudent to use caution when considering the generalizability of results from dissimilar regions. Further investigation is needed to explore the possibility of reproducible causative systemic elements that may help improve COVID-19-related outcomes. Broader reports of these relationships across many settings will offer military medical planners greater ability to consider outcomes most relevant to their unique settings when considering COVID-19 planning.

scholarly journals Prostatic Artery Embolization: An Alternative Treatment for Benign Prostatic Hyperplasia

2021 ◽  
Vol 5 (02) ◽  
pp. 091-098
Author(s):  
James F. Pike ◽  
William F. Abel ◽  
Tyler B. Seckel ◽  
Christine M.G. Schammel ◽  
William Flanagan ◽  
...  
Keyword(s):  
Prostate Volume ◽  
Medical Center ◽  
Specific Antigen ◽  
Outcome Data ◽  
Artery Embolization ◽  
Prostatic Artery Embolization ◽  
Optimal Care ◽  
International Prostatic Symptom Score ◽  
Simple Prostatectomy ◽  
Prostatic Artery

Abstract Purpose Prostatic artery embolization (PAE) has emerged as a minimally invasive alternative for patients with prostates >80 mL and has demonstrated lower morbidity rates. We sought to evaluate PAE at a single tertiary medical center. Methods A retrospective review of all patients who underwent PAE was completed. Demographic, clinicopathologic, procedure, and outcome data were collected to include international prostatic symptom score (IPSS) and quality of life (QoL) assessments. Results The pre-PAE mean prostate-specific antigen (PSA) was 8.4 ng/mL, mean prostate volume was 146.9 mL (9% >200 mL), and mean postvoid residual (PVR) was 208.2 mL (21.9% 200–300 mL). IPSS mean was 19.8 and QoL was “mostly dissatisfied.” Following PAE, mean PSA was reduced by 3.2 ng/mL (38.1%, p = 0.3014), the mean prostate volume reduction was 59.2 mL (40.3%, n = 19, p < 0.0001), and the average PVR reduction was 150.3 mL (72.2%, n = 27, p = 0.0002). Average IPSS score was also lower (11.9; 60.1%, n = 25, p < 0.0001) and QoL was reduced to “mostly satisfied” (p < 0.0001). Technical success was 100% with 24% minor morbidities. Conclusion PAE is a successful treatment for patients with BPH resulting in large prostates that are not good candidates for simple prostatectomy, providing optimal care with less operative and postoperative complications.

scholarly journals Perinatal Asphyxia Among Neonates Admitted Jimma Medical Center, Jimma, Ethiopia

2020 ◽  
Vol 7 ◽  
pp. 2333794X2098130
Author(s):  
Ebissa Bayana Kebede ◽  
Adugna Olani Akuma ◽  
Yonas Biratu Tarfa
Keyword(s):  
Gestational Age ◽  
Medical Center ◽  
Perinatal Asphyxia ◽  
Mode Of Delivery ◽  
Large For Gestational Age ◽  
Systematic Sampling ◽  
P Value ◽  
Health Extension Workers ◽  
Severe Problem ◽  
Prolonged Labor

Background: Perinatal asphyxia is a severe problem which causes serious problem in neonates in developing countries. This study is aimed to determine magnitude of perinatal asphyxia and its associated factors. Methods: A cross-sectional study design was conducted among neonates admitted over a period of 4 years on 740 samples. Systematic sampling method was employed to get required samples from log book. Epi-data 3.1 is used for data entry and the entered data was exported to SPSS Version 23 for analysis. Bivariable and multiple variable logistic regressions analysis were applied to see the association between dependent and independent variables. Finally, P-value <.05 at 95% CI was declared statistically significant. Results: The main significant factor associated to perinatal asphyxia were prolonged labor ( P = .04, AOR = 1.68 95%CI: [1.00, 2.80]), being primipara ( P = .003, AOR = 2.06, 95%CI: [1.28, 3.30]), Small for Gestational Age (SGA) ( P = .001, AOR = 4.35, 95%CI: [1.85, 10.19]), Large for Gestational Age ( P = .001, AOR = 16.75, 95%CI: [3.82, 73.33]) and mode of delivery. Conclusion: The magnitude of perinatal asphyxia was 18%. Prolonged labor, parity, birth size, mode of delivery, and APGAR score at 1st minute were significantly associated with perinatal asphyxia. So, Nurses, Midwives, Medical Doctors, and health extension workers have to engage and contribute to on how to decrease the magnitude of perinatal asphyxia.

scholarly journals The Management of Myelomeningocele Study: Short-Term Neonatal Outcomes

2020 ◽  
Vol 47 (12) ◽  
pp. 865-872 ◽  
Author(s):  
Natalie E. Rintoul ◽  
Roberta L. Keller ◽  
William F. Walsh ◽  
Pamela K. Burrows ◽  
Elizabeth A. Thom ◽  
...  
Keyword(s):  
New England ◽  
Gestational Age ◽  
Periventricular Leukomalacia ◽  
Ductus Arteriosus ◽  
Outcome Data ◽  
Neonatal Outcomes ◽  
Increased Risk ◽  
Significant Difference ◽  
The Impact ◽  
Prenatal Surgery

<b><i>Introduction:</i></b> The Management of Myelomeningocele Study was a multicenter randomized trial to compare prenatal and standard postnatal repair of myelomeningocele (MMC). Neonatal outcome data for 158 of the 183 randomized women were published in <i>The New England Journal of Medicine</i> in 2011. <b><i>Objective:</i></b> Neonatal outcomes for the complete trial cohort (<i>N</i> = 183) are presented outlining the similarities with the original report and describing the impact of gestational age as a mediator. <b><i>Methods:</i></b> Gestational age, neonatal characteristics at delivery, and outcomes including common complications of prematurity were assessed. <b><i>Results:</i></b> Analysis of the complete cohort confirmed the initial findings that prenatal surgery was associated with an increased risk for earlier gestational age at birth. Delivery occurred before 30 weeks of gestation in 11% of neonates that had fetal MMC repair. Adverse pulmonary sequelae were rare in the prenatal surgery group despite an increased rate of oligohydramnios. There was no significant difference in other complications of prematurity including patent ductus arteriosus, sepsis, necrotizing enterocolitis, periventricular leukomalacia, and intraventricular hemorrhage. <b><i>Conclusion:</i></b> The benefits of prenatal surgery outweigh the complications of prematurity.

scholarly journals Clinical Performance of the BioPlex 2200 Syphilis Total & RPR Assay at a Tertiary Medical Center with a High Rate of Syphilis

2018 ◽  
Vol 57 (1) ◽  
Author(s):  
Merih T. Tesfazghi ◽  
Neil W. Anderson ◽  
Ann M. Gronowski ◽  
Melanie L. Yarbrough
Keyword(s):  
Clinical Performance ◽  
Medical Center ◽  
High Volume ◽  
High Rate ◽  
Rapid Plasma Reagin ◽  
Antibody Absorption ◽  
Traditional Algorithm ◽  
Syphilis Screening ◽  
Manual Methods ◽  
Positive Population

ABSTRACT Manual treponemal and nontreponemal serologic testing has historically been used for the diagnosis of syphilis. This approach is simple and reproducible but labor intensive. Recently, the FDA cleared the fully automated BioPlex 2200 Syphilis Total & RPR assay for the detection of treponemal and nontreponemal antibodies. We evaluated the clinical performance of this assay at a tertiary medical center with a high syphilis prevalence. Prospective consecutively collected (n = 400) and known RPR-positive (n = 100) specimens were compared using predicate manual rapid plasma reagin (RPR) and fluorescent treponemal antibody absorption (FTA) methods and the BioPlex 2200 Syphilis Total & RPR assay. Positive and negative percent agreements (PPA and NPA, respectively) between the assays were calculated. The PPA and NPA between the manual and BioPlex 2200 RPR results for the prospective population were 85% (17/20; 95% confidence interval [CI], 69% to 100%) and 98% (373/380; 95% CI, 97% to 99%), respectively. The PPA for the manual RPR-positive population was 88% (88/100; 95% CI, 82% to 94%). Overall, the manual and BioPlex 2200 RPR titers demonstrated 78% (99/127) concordance within ±1 dilution and 94% (120/127) within ±2 dilutions. An interpretation of the syphilis serologic profile using the traditional algorithm showed a concordance of 99.5% in the prospective population and 85% in the manual RPR-positive cohort. The performance of the BioPlex 2200 Syphilis Total & RPR assay is comparable to those of manual methods. The high NPA of this assay combined with the ability to automate a historically labor-intensive assay is an appealing attribute for syphilis screening in a high-volume laboratory.

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