Is Thoracoscopic Decortication Sufficient for the Treatment of Empyema?

2010 ◽  
Vol 76 (10) ◽  
pp. 1050-1054 ◽  
Author(s):  
Jesse Manunga ◽  
Jemi Olak
Keyword(s):  
Length Of Stay ◽  
Chest Tube ◽  
Medical Center ◽  
Community Acquired Pneumonia ◽  
Institutional Review Board ◽  
Thoracoscopic Approach ◽  
Institutional Review ◽  
Postoperative Length ◽  
Subsequent Intervention

Before thoracoscopy became popular in the 1990s, thoracotomy and decortication was the treatment of choice for empyema thoracis not responding to tube thoracostomy. An Institutional Review Board-approved, retrospective review of all patients treated for empyema between September 1, 2006, and August 31, 2009, at Kern Medical Center was conducted. A total of 37 patients (male = 33; female = 4) with a mean age of 43.7 years were treated. Empyema developed after community-acquired pneumonia (CAP) in 27, traumatic hemothorax (TH) in nine, and other cause in one. For 34 of 36 patients (91%), a thoracoscopic approach was successful. Two of 36 patients required conversion to thoracotomy, whereas one patient required an initial thoracotomy in each case as a result of tenacious adhesions. Mean duration of the chest tube was 4.1 days in patients with CAP and 4.6 days in patients with TH. Mean length of stay after surgery was 6 days for patients with CAP and 9.1 days for patients with TH. Five of 37(13.5%) had complications and one patient died (2.7%). Follow-up was complete for 81.1 per cent of patients, none of whom required a subsequent intervention. Compared with the literature, it appears that the conversion rate to thoracotomy, length of chest tube duration, and postoperative length of stay have decreased as experience has increased.

scholarly journals Redo hypospadias repair: experience at a tertiary care children’s hospital

2012 ◽  
Vol 1 (1) ◽  
Author(s):  
Ahmed Al-Sayyad ◽  
John G. Pike ◽  
Michael P. Leonard
Keyword(s):  
Tertiary Care ◽  
Institutional Review Board ◽  
Hypospadias Repair ◽  
Urethral Plate ◽  
Institutional Review ◽  
Tubularized Incised Plate ◽  
Distal Shaft ◽  
The Status ◽  
Initial Severity

Objective: Treatment of patients with failed hypospadias repairs can be challenging.Our study aimed to determine the best type of redo repair dependingon the location and size of the urethral meatus, the status of the urethralplate and genital skin, the severity of residual chordee and the amount ofscar tissue.Methods: The Institutional Review Board approved our retrospective chart reviewof patients who had a redo hypospadias repair at our institution over the past6 years. We recorded the type and number of previous repair(s), the type andnumber of redo procedure(s),as well as the complications and functional outcomes.Results: There were 28 patients, aged 1–12 (mean 3.8) years, with failed hypospadiasrepairs. The initial severity of the hypospadias were as follows: perineal(1), penoscrotal (9), proximal shaft (1), mid-shaft (9), distal shaft (4), coronal(3) and mega-meatus (1). Of all the patients, 24 had 1 repair, 3 had 2 repairsand 1 had 3 repairs. The initial repairs comprised 11 tubularized island flaps(TIFs), 8 Snodgrass tubularized incised plate (TIP) techniques, 5 Mathieu repairs,1 Meatal Advancement and GlanuloPlasty Incorporated (MAGPI) technique,1 Pyramid, 1 Arap technique and 1 Thiersch-Duplay repair. Twenty-one of 28 patients had 1 redo operation, 5 had 2 redo operations, 1 had 3 redo operationsand 1 had 4 redo operations, for a total of 38 redo operations. Of these,26 were TIP techniques (68.4%), 3 were Mathieu (7.9%), 3 were TIF repairs(7.9%), 2 were onlay island flaps (5.3%) and 4 were buccal mucosal grafts(10.5%). Follow-up was 1–5 years (mean 3.5 yr). The final locations of urethralmeatus included glans (18), corona (6), mid-shaft (3) and penoscrotal (1).Complications after redo surgery comprised 4 urethrocutaneous fistulae, 2 meatalstenoses, 1 urethral stricture and 3 dehiscences. Sixteen patients were followedwith yearly uroflow with a Q-mean (mean uroflow) range of 3–14 mL/s (mean8.1 mL/s).Conclusion: The majority of hypospadias failures can be salvaged with one operation.The TIP repair is our procedure of choice in most cases. In the settingof a poor urethral plate, TIF or buccal mucosa may be necessary. Complicationsare not infrequent in redo procedures.

scholarly journals Time Required for Institutional Review Board Review at One Veterans Affairs Medical Center

JAMA Surgery ◽  
2015 ◽  
Vol 150 (2) ◽  
pp. 103 ◽  
Author(s):  
Daniel E. Hall ◽  
Barbara H. Hanusa ◽  
Roslyn A. Stone ◽  
Bruce S. Ling ◽  
Robert M. Arnold
Keyword(s):  
Medical Center ◽  
Veterans Affairs ◽  
Institutional Review Board ◽  
Institutional Review ◽  
Institutional Review Board Review ◽  
Board Review ◽  
Time Required

Outcomes of PD Patients at 6 Months

2017 ◽  
Vol 37 (1) ◽  
pp. 116-118 ◽  
Author(s):  
William Hoffman ◽  
Heena Sheth ◽  
Filitsa Bender ◽  
Beth Piraino
Keyword(s):  
Quality Care ◽  
Institutional Review Board ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
The Past ◽  
Institutional Review ◽  
Strong Focus ◽  
Comorbidity Index

The peritoneal dialysis (PD) patient population has grown rapidly in the past few years with concern over poor early outcomes. We report 6-month outcomes of incident PD patients in an experienced program with a strong focus on quality care. We analyzed data from an Institutional Review Board (IRB)- approved registry of all incident PD patients from January 1, 1991, to December 31, 2013, with follow-up to June 30, 2014. Time at risk began on the first day of training. Age, gender, race, diabetes mellitus (DM), Charlson comorbidity index (CCI), and albumin were collected at PD start. Exit-site infection (ESI), peritonitis, hospitalizations, and reasons for stopping PD were recorded. Multivariate analysis was done to examine outcomes.

scholarly journals BOugie or stylet in patients UnderGoing Intubation Emergently (BOUGIE): protocol and statistical analysis plan for a randomised clinical trial

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e047790
Author(s):  
Brian Driver ◽  
Matthew W Semler ◽  
Wesley H Self ◽  
Adit A Ginde ◽  
Sheetal Gandotra ◽  
...  
Keyword(s):  
Medical Center ◽  
Randomised Trial ◽  
Randomised Clinical Trial ◽  
Orotracheal Intubation ◽  
Statistical Analysis Plan ◽  
Institutional Review Board ◽  
Secondary Outcome ◽  
Intubation Attempt ◽  
Institutional Review ◽  
The Usa

IntroductionIntubation-related complications are less frequent when intubation is successful on the first attempt. The rate of first attempt success in the emergency department (ED) and intensive care unit (ICU) is typically less than 90%. The bougie, a semirigid introducer that can be placed into the trachea to facilitate a Seldinger-like technique of tracheal intubation and is typically reserved for difficult or failed intubations, might improve first attempt success. Evidence supporting its use, however, is from a single academic ED with frequent bougie use. Validation of these findings is needed before widespread implementation.Methods and analysisThe BOugie or stylet in patients Undergoing Intubation Emergently trial is a prospective, multicentre, non-blinded randomised trial being conducted in six EDs and six ICUs in the USA. The trial plans to enrol 1106 critically ill adults undergoing orotracheal intubation. Eligible patients are randomised 1:1 for the use of a bougie or use of an endotracheal tube with stylet for the first intubation attempt. The primary outcome is successful intubation on the first attempt. The secondary outcome is severe hypoxaemia, defined as an oxygen saturation less than 80% between induction until 2 min after completion of intubation. Enrolment began on 29 April 2019 and is expected to be completed in 2021.Ethics and disseminationThe trial protocol was approved with waiver of informed consent by the Central Institutional Review Board at Vanderbilt University Medical Center or the local institutional review board at an enrolling site. The results will be submitted for publication in a peer-reviewed journal and presented at scientific conferences.Trial registration numberClinicalTrials.gov Registry (NCT03928925).

scholarly journals Does morbid obesity influence perioperative outcomes after video-assisted thoracic surgery (VATS) lobectomy for non-small cell lung cancer? Analysis of the Italian VATS group registry

2021 ◽  
Author(s):  
Francesco Guerrera ◽  
Paraskevas Lyberis ◽  
Paolo Olivo Lausi ◽  
Riccardo Carlo Cristofori ◽  
Roberto Giobbe ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Length Of Stay ◽  
Blood Loss ◽  
Chest Tube ◽  
Surgical Margin ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Surgical Time ◽  
Vats Lobectomy ◽  
Postoperative Length

Abstract Objectives Obesity in Europe, and worldwide, has been an increasing epidemic during the past decades. Moreover, obesity has important implications regarding technical issues and the risks associated with surgical interventions. Nevertheless, there is a lack of evidence assessing the influence of obesity on video-assisted thoracic surgery (VATS) lobectomy results. Our study aimed to assess the impact of morbid obesity on perioperative clinical and oncological outcomes after VATS lobectomy using a prospectively maintained nationwide registry. Methods The Italian VATS lobectomy Registry was used to collect all consecutive cases from 55 Institutions. Explored outcome parameters were conversion to thoracotomy rates, complication rates, intra-operative blood loss, surgical time, hospital postoperative length of stay, chest tube duration, number of harvested lymph-node, and surgical margin positivity. Results From 2016 to 2019, a total of 4412 patients were collected. 74 patients present morbid obesity (1.7%). Multivariable-adjusted analysis showed that morbid obesity was associated with a higher rate of complications (32.8% vs 20.3%), but it was not associated with a higher rate of conversion, and surgical margin positivity rates. Moreover, morbid obesity patients benefit from an equivalent surgical time, lymph-node retrieval, intraoperative blood loss, hospital postoperative length of stay, and chest tube duration than non-morbid obese patients. The most frequent postoperative complications in morbidly obese patients were pulmonary-related (35%). Conclusion Our results showed that VATS lobectomy could be safely and satisfactorily conducted even in morbidly obese patients, without an increase in conversion rate, blood loss, surgical time, hospital postoperative length of stay, and chest tube duration. Moreover, short-term oncological outcomes were preserved.

scholarly journals 622 PD-L1 is a potential predictive biomarker for response to RM-1929 treatment in recurrent head and neck squamous cell carcinoma patients

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A658-A658
Author(s):  
C Daniel De Magalhaes Filho ◽  
Chung-Wein Lee ◽  
Nikolai Suslov ◽  
Jerry Fong ◽  
Miguel Garcia-Guzman
Keyword(s):  
Head And Neck ◽  
Response Rate ◽  
Medical Center ◽  
Predictive Biomarker ◽  
Institutional Review Board ◽  
Cancer Center ◽  
University Of Texas ◽  
University Of Oklahoma ◽  
Institutional Review ◽  
Oklahoma Health

BackgroundRM-1929 is an antibody-dye conjugate comprised of cetuximab covalently linked to the photoactivable dye, IRDye® 700DX (IR700). After systemic infusion of RM-1929, illumination of the tumor with 690 nm non-thermal red light activates the drug and results in targeted and rapid tumor necrosis. Previous preclinical data have shown that RM-1929 treatment triggers immunogenic cell death and activates the innate and adaptive immune response. A retrospective analysis of PD-L1 expression from the phase I/IIa clinical trial in patients with recurrent head and neck squamous cell carcinoma (rHNSCC) (NCT02422979) was conducted. The analysis explored correlations of PD-L1 expression, including combined proportion score (CPS) and tumor proportion score (TPS), with clinical outcomes such as response rate and overall survival.MethodsPD-L1 expression prior to RM-1929 treatment was assessed by immunohistochemistry in 18 out of 30 patients enrolled in Part II of the trial, based on sample availability. PD-L1 expression was evaluated using TPS and CPS. Responders were defined as patients that achieved complete response or partial response, and non-responders had either stable disease or progressive disease. Overall survival (OS) was analyzed using the Kaplan-Meier method.ResultsResponders (n=10) had a TPS of 4.3±2.4 (mean±SEM), which was substantially lower than in non-responders (n=8) with a TPS of 39.4±11.8. Similarly, CPS was lower in responders (8.6±3.6) compared to non-responders (50.0±13.5). The best target response rate for all patients included in this analysis was 56%. Patients with CPS=40 had a response rate of 76.9% (n=13) compared to 0% in patients with CPS>40 (n=5). This suggests that a CPS cut-off of =40 led to enrichment of the best target response rate. The median OS of patients with CPS=40 (13.0±0.8 months) was also higher than in patients with CPS>40 (3.1±0.8 months) and in all patients (12.0±2.9 months).ConclusionsThese results suggest that rHNSCC patients with lower PD-L1 expression levels may be more responsive to RM-1929 treatment and CPS/TPS could potentially be predictive biomarkers in identifying patients with a higher probability of benefiting from this treatment. Given the limited number of patients in this analysis, additional clinical trials will be needed to validate PD-L1 expression as an effective predictive biomarker for RM-1929 treatment.AcknowledgementsThe authors would like to thank all patients and their families for their participation in this trial. The authors would also like to thank the following investigators for the contribution of samples included in this trial analysis: Dr. David Cognetti (Thomas Jefferson University Hospital), Dr. Ann M Gillenwater (University of Texas MD Anderson Cancer Center), Dr. Mary Jo Fidler (Rush University Medical Center), Dr. Samith T. Kochuparambil (Virginia Piper Cancer Institute ), Dr. John Campana (University of Colorado Head and Neck Specialists), and Dr. Nilesh R. Vasan (University of Oklahoma Health Sciences Center).Trial RegistrationNCT02422979Ethics ApprovalThe trial was approved by the following Instution Ethics Boards and IRB# as listed: UCSF Institutional Review Board (#17-21904), Thomas Jefferson University, IRB (#16C.328), University of Oklahoma Health Sciences Center Institutional Review Board (#5723), University of Texas MD Anderson Cancer Center - Institutional Review Board (#IRB 2 IRB00002203), Quorum Review IRB (#30458/1), Rush University Medical Center Institutional Review Board (#15030601-IRB01), and Catholic Health Initiatives Institute for Research and Innovation (CIRI) Institutional Review Board (CHIRB) (# IRB00009715).ConsentN/A

scholarly journals Characteristics and Management of Male Breast Parenchymal Cysts

2020 ◽  
Vol 2 (4) ◽  
pp. 330-335
Author(s):  
Santo Maimone ◽  
Idris T Ocal ◽  
Kristin A Robinson ◽  
Martha C Wasserman ◽  
Robert W Maxwell
Keyword(s):  
Breast Imaging ◽  
Patient Characteristics ◽  
Male Breast ◽  
Institutional Review Board ◽  
Rare Entity ◽  
Case Review ◽  
Breast Cyst ◽  
Radiology Reports ◽  
Institutional Review

Abstract Objective Parenchymal breast cysts are considered to be rare in men and are sparsely described in the literature. The purpose of this study was to review our institution’s experience with male breast cysts in an effort to improve overall understanding and management of this rare entity. Methods An institutional review board–exempt retrospective study was performed. Radiology reports for males who underwent mammogram and/or breast ultrasound at any of our institution’s primary or satellite locations from January 1995 to January 2020 were screened to find males with breast cysts. If cysts were reported and images were available, case review was performed to confirm parenchymal breast cyst(s) and patient characteristics were collated. Results Of 5425 male cases presenting for breast imaging, 19 (0.4%) cases of male breast cysts were confirmed, with a mean patient age of 41.6 years (range: 2–81 years). The most common indication leading to cyst discovery was a palpable lump, corresponding to the site of the cyst in 5 (26.3%) patients and near the site where cyst(s) were ultimately discovered in 7 (36.8%) patients. There were 8 (42.1%) instances of cysts without concurrent gynecomastia. Three (15.8%) men underwent needle sampling. There were no cases of atypia or malignancy on needle biopsy or on subsequent clinical follow-up, with median clinical follow-up of 70.3 months (range: 3.3–259.4 months). Conclusion Male breast parenchymal cysts are rare, but their prevalence is likely underestimated. If detected incidentally or upon targeted evaluation, biopsy may be averted if classic benign cyst features are identified.

scholarly journals Integrity of clinical information in computerized order requisitions for diagnostic imaging

2018 ◽  
Vol 25 (12) ◽  
pp. 1651-1656 ◽  
Author(s):  
Ronilda Lacson ◽  
Romeo Laroya ◽  
Aijia Wang ◽  
Neena Kapoor ◽  
Daniel I Glazer ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Information ◽  
Clinical Decision ◽  
Accurate Diagnosis ◽  
Institutional Review Board ◽  
Institutional Review ◽  
Academic Medical ◽  
Potential Impact ◽  
Kappa Agreement

Abstract Objective Assess information integrity (concordance and completeness of documented exam indications from the electronic health record [EHR] imaging order requisition, compared to EHR provider notes), and assess potential impact of indication inaccuracies on exam planning and interpretation. Methods This retrospective study, approved by the Institutional Review Board, was conducted at a tertiary academic medical center. There were 139 MRI lumbar spine (LS-MRI) and 176 CT abdomen/pelvis orders performed 4/1/2016-5/31/2016 randomly selected and reviewed by 4 radiologists for concordance and completeness of relevant exam indications in order requisitions compared to provider notes, and potential impact of indication inaccuracies on exam planning and interpretation. Forty each LS-MRI and CT abdomen/pelvis were re-reviewed to assess kappa agreement. Results Requisition indications were more likely to be incomplete (256/315, 81%) than discordant (133/315, 42%) compared to provider notes (p < 0.0001). Potential impact of discrepancy between clinical information in requisitions and provider notes was higher for radiologist’s interpretation than for exam planning (135/315, 43%, vs 25/315, 8%, p < 0.0001). Agreement among radiologists for concordance, completeness, and potential impact was moderate to strong (Kappa 0.66-0.89). Indications in EHR order requisitions are frequently incomplete or discordant compared to physician notes, potentially impacting imaging exam planning, interpretation and accurate diagnosis. Such inaccuracies could also diminish the relevance of clinical decision support alerts if based on information in order requisitions. Conclusions Improved availability of relevant documented clinical information within EHR imaging requisition is necessary for optimal exam planning and interpretation.

scholarly journals Barriers to completing colonoscopy after a positive fecal occult blood test

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Revital Azulay ◽  
Liora Valinsky ◽  
Fabienne Hershkowitz ◽  
Einat Elran ◽  
Natan Lederman ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Screening Program ◽  
Occult Blood ◽  
Opinion Leaders ◽  
Institutional Review Board ◽  
Fecal Occult Blood ◽  
Fecal Occult ◽  
Institutional Review

Abstract Background Colorectal cancer leads to significant morbidity and mortality. Early detection and treatment are essential. Screening using fecal occult blood tests has increased significantly, but adherence to colonoscopy follow-up is suboptimal, increasing CRC mortality risk. The aim of this study was to identify barriers to colonoscopy following a positive FOBT at the level of the patient, physician, organization and policymakers. Methods This mixed methods study was conducted at two health care organizations in Israel. The study included retrospective analyses of 45,281 50–74 year-old members with positive fecal immunochemical tests from 2010 to 2014, and a survey of 772 patients with a positive test during 2015, with and without follow-up. The qualitative part of the study included focus groups with primary physicians and gastroenterologists and in-depth interviews with opinion leaders in healthcare. Results Patient lack of comprehension regarding the test was the strongest predictor of non-adherence to follow-up. Older age, Arab ethnicity, and lower socio economic status significantly reduced adherence. We found no correlation with gender, marital status, patient activation, waiting time for appointments or distance from gastroenterology clinics. Primary care physicians underestimate non-adherence rates. They feel responsible for patient follow-up, but express lack of time and skills that will allow them to ensure adherence among their patients. Gastroenterologists do not consider fecal occult blood an effective tool for CRC detection, and believe that all patients should undergo colonoscopy. Opinion leaders in the healthcare field do not prioritize the issue of follow-up after a positive screening test for colorectal cancer, although they understand the importance. Conclusions We identified important barriers that need to be addressed to improve the effectiveness of the screening program. Targeted interventions for populations at risk for non-adherence, specifically for those with low literacy levels, and better explanation of the need for follow-up as a routine need to be set in place. Lack of agreement between screening recommendations and gastroenterologist opinion, and lack of awareness among healthcare authority figures negatively impact the screening program need to be addressed at the organizational and national level. Trial registration This study was approved by the IRB in both participating organizations (Meuhedet Health Care Institutional Review Board #02–2–5-15, Maccabi Healthcare Institutional Review Board BBI-0025-16). Participant consent was waived by both IRB’s.

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