Subtotal Cholecystectomy versus Total Cholecystectomy in Complicated Cholecystitis

2012 ◽  
Vol 78 (7) ◽  
pp. 814-817 ◽  
Author(s):  
Brian Davis ◽  
Gino Castaneda ◽  
Jose Lopez
Keyword(s):  
Medical Center ◽  
El Paso ◽  
Group Versus ◽  
Retrospective Chart Review ◽  
Arterial Injury ◽  
Subtotal Cholecystectomy ◽  
Bile Duct Injuries ◽  
Time Period ◽  
Number Of Patients ◽  
Duodenal Injuries

Complicated cholecystitis can make dissections around the triangle of Calot difficult with a higher risk of duct and arterial injury. We reviewed a series of patients with cholecystitis receiving either partial or subtotal cholecystectomies and compared it with total cholecystectomies with respect to complications. A retrospective chart review was performed on all subtotal cholecystectomies performed for cholecystitis at University Medical Center of El Paso from June 2004 to December 2010. A similar number of patients who had total cholecystectomies for cholecystitis were selected as a comparison group from that same time period. A total of 116 patients who had subtotal and total cholecystectomies were reviewed (58 patients in each group). There were seven postoperative complications noted in the subtotal cholecystecomy (SC) group versus 14 for the total cholecystectomy (TC) group. Three patients in the SC group had cystic duct leaks, all successfully treated by endoscopic retrograde cholangiopancreatography with biliary stenting. There were two patients who had common bile duct injuries in the TC group and none in the SC group. Two patients had duodenal injuries in the TC group. Subtotal cholecystectomy is a viable alternative to total cholecystectomy in cases of complicated cholecystitis

Initial Experience of an Anesthesiology-based Service for Perioperative Management of Pacemakers and Implantable Cardioverter Defibrillators

2015 ◽  
Vol 123 (5) ◽  
pp. 1024-1032 ◽  
Author(s):  
G. Alec Rooke ◽  
Stefan A. Lombaard ◽  
Gail A. Van Norman ◽  
Jörg Dziersk ◽  
Krishna M. Natrajan ◽  
...  
Keyword(s):  
Medical Center ◽  
Strong Support ◽  
Retrospective Chart Review ◽  
High Volume ◽  
Management Plan ◽  
Implantable Cardioverter Defibrillators ◽  
Device Management ◽  
Number Of Patients ◽  
Cardioverter Defibrillators ◽  
Over Time

Abstract Background Management of cardiovascular implantable electronic devices (CIEDs), including pacemakers and implantable cardioverter defibrillators, for surgical procedures is challenging due to the increasing number of patients with CIEDs and limited availability of trained providers. At the authors’ institution, a small group of anesthesiologists were trained to interrogate CIEDs, devise a management plan, and perform preoperative and postoperative programming and device testing whenever necessary. Methods Patients undergoing surgery between October 1, 2009 and June 30, 2013 at the University of Washington Medical Center were included in a retrospective chart review to determine the number of devices actively managed by the Electrophysiology/Cardiology Service (EPCS) versus the Anesthesiology Device Service (ADS), changes in workload over time, surgical case delays due to device management, and errors and problems encountered in device programming. Results The EPCS managed 254 CIEDs, the ADS managed 548, and 227 by neither service. Over time, the ADS providers managed an increasing percentage of devices with decreasing supervision from the EPCS. Only two CIEDs managed by the ADS required immediate assistance from the EPCS. Patients who were unstable postoperatively were referred to the EPCS. Although numerous issues in programming were encountered, primarily when restoring demand pacing after programming asynchronous pacing for surgery, no patient harm resulted from ADS or EPCS management of CIEDs. Conclusions An ADS can provide safe CIED management for surgery, but it requires specialized provider training and strong support from the EPCS. Due to the complexity of CIED management, an ADS will likely only be feasible in high-volume settings.

Changes in Peritoneal Transport during the First Month of Peritoneal Dialysis

1995 ◽  
Vol 15 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Michael V. Rocco ◽  
Jean R. Jordan ◽  
John M. Burkart
Keyword(s):  
Peritoneal Dialysis ◽  
Medical Center ◽  
Group Versus ◽  
Dialysis Patients ◽  
Dialysis Unit ◽  
Peritoneal Transport ◽  
Time Period ◽  
Initiation Of Dialysis ◽  
Calculated Mass

Objective To determine if peritoneal transport characteristics change during the initial month of peritoneal dialysis. Design Retrospective review of peritoneal equilibration test (PET) results in patients who received their first PET during the first two weeks of peritoneal dialysis (early PET group) versus patients who received their first PET between four and 28 weeks after the initiation of dialysis (late PET group). The initial PET values were compared to subsequent PET results obtained approximately seven months after the initial PET. Setting Peritoneal dialysis unit of a tertiary medical center. Outcome Measures PET results and calculated mass transfer area coefficient (MT AC) values. Patients Thirty-four peritoneal dialysis patients in the early PET group and 17 peritoneal dialysis patients in the late PET group. Results In the early PET group, there was a statistically significant increase from the initial to follow-up values for both dialysate-to-plasma (DIP) creatinine and MTAC creatinine (p < 0.01) as well as a significant decrease for four-hour dialysate to initial dialysate ratios (DID) glucose (p = 0.08) and MTAC glucose (p < 0.05). In the late PET group, there was no significant change in any of these parameters with time. However, in the late PET group, there was a significant decrease in DIP urea values with time (p < 0.01), but not with MTAC urea. In addition, there were no differences over time in either group for serum albumin or hematocrit values. Conclusion During the first two weeks of peritoneal dialysis, there tends to be a change in peritoneal transport characteristics in some patients. PET data obtained during this time period should be interpreted as preliminary.

78 A Retrospective Review of Contact Burns Occurring over the Past Five Years and the Impact of Daily High Temperatures

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S54-S54
Author(s):  
Kevin N Foster ◽  
Tiffany Hockenberry ◽  
Derek Murray ◽  
Karen J Richey
Keyword(s):  
High Temperatures ◽  
External Surface ◽  
Group Versus ◽  
Retrospective Chart Review ◽  
Climate Data ◽  
Burn Center ◽  
Number Of Patients ◽  
June July ◽  
Hot Surface ◽  
The Impact

Abstract Introduction Thermal burns as a result of contact with a hot surface are a frequent cause of injury. A unique subset of contact burns are those sustained as a result of exposure to a hot surface during summer days in geographic areas with excessive ambient temperatures. Under these conditions, external surface temperatures can reach 180 degrees Fahrenheit, and deep cutaneous burns can happen with only a brief contact. Often exposure occurs in patients with impairments that prevent them from removing themselves from such contact in an expeditious fashion leading to severe injury. The purpose of this study was to review and analyze patients admitted to a southwest burn center with burns caused by contact with a hot external surface during the summertime months. Methods This was a retrospective chart review of patients admitted to our regional burn center over a 6-year period, whose burns were sustained from contact with the ground during the months of June, July, and August. Patients were stratified into two groups those whose injuries occurred from 2015 – 2019 and those that occurred in 2020. Climate data was collected from the National Oceanic and Atmospheric Administration website. Results The mean high daily temperature for June, July, and August 2020 was 108.5oF compared to 106.3oF for June, July and August of the preceding five years 2015 to 2019 (p &lt; 0.0001) The number of days during this 3-month period with high temperatures exceeding 110oF was 48 for 2020 compared to a mean of 24 for years 2015 to 2019 (p &lt; 0.0001). Correspondingly, there were 104 inpatient admissions for contact burns during this 3-month period in 2020 compared to a mean of 70 patients each year for 2015 to 2019, a 49% increase. There was no difference in age, gender, % TBSA burned, length of stay, or comorbidities in the two groups of patients. There were differences noted in the ethnicity compositions between the two groups. While alcohol use was not different between the two groups, the admission blood alcohol level was significantly greater in the 2020 group versus the 2015–2019 group (p=.0477). Additionally, the 2020 group demonstrated significantly greater illicit drug use than the 2015 to 2019 group (p.0098). Conclusions This study shows that increasing summertime temperatures in the southwest USA results in a corresponding increase in the number of patients with hot surface contact burns, and this increase is also associated with significantly great drug and alcohol abuse.

scholarly journals Comparison between Robot-Assisted Laparoscopic Hysterectomy and Total Laparoscopic Hysterectomy: A Cohort Study

2012 ◽  
Vol 2012 ◽  
pp. 1-4
Author(s):  
Khaled Sakhel ◽  
Armen Kirakosyan ◽  
Suneet Chauhan ◽  
James Lukban ◽  
James Hines
Keyword(s):  
Blood Loss ◽  
Group Versus ◽  
Retrospective Chart Review ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Procedure Time ◽  
Robot Assisted ◽  
Safe Alternative ◽  
Operative Outcomes ◽  
Number Of Patients

Objective. To compare the operative outcomes in patients who underwent robot-assisted total laparoscopic hysterectomy (RLH) versus total laparoscopic hysterectomy (TLH). Study Design. Retrospective chart review. All women who underwent RLH in hospital A and TLH in hospital B by a single surgeon were included. Results. 136 patients were included (73 in the RLH group and 63 in the TLH group). There were no conversions to laparotomy in the RLH group versus 7 (11.1%) in the TLH group (). The mean induction time was significantly greater (by 6 minutes) for RLH, independent of docking time, as compared to TLH (). Total procedure time was significantly less in the RLH group (82 minutes) as compared to TLH (108 minutes) (). Mean blood loss was less for RLH (46 mL) as compared to TLH (114 mL) (). A greater number of patients who underwent RLH were discharged on postoperative day 0 as compared to those receiving TLH (). Conclusion. RLH is a safe alternative to TLH and may offer some operative advantages, including fewer conversions to laparotomy, reduced procedure time, less blood loss, and earlier discharge.

scholarly journals 250. An Assessment of the Penicillin Allergy Label in Patients Undergoing Orthopedic Procedures at a VA Medical Center

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S232-S233
Author(s):  
Sherin Meledathu ◽  
MacKenzie Firek ◽  
Angelike P Liappis ◽  
Pratish C Patel
Keyword(s):  
Medical Center ◽  
Skin Testing ◽  
Group Versus ◽  
Retrospective Chart Review ◽  
Penicillin Allergy ◽  
Orthopedic Procedures ◽  
Secondary Outcome ◽  
Washington Dc ◽  
Hospital Stays ◽  
Alternative Antibiotic

Abstract Background Approximately 10% of the population is labeled as penicillin (PCN) allergic, while only 1% of these individuals have a true IgE mediated allergy. This label influences the prescription of the most appropriate antibiotic and ultimately leads to antimicrobial resistance, hospital readmission, increased length of hospital stays, use of critical care beds, and greater healthcare costs. Post-surgical complications in patients undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA) are also increased when patients receive an alternative antibiotic due to PCN allergy. Methods A retrospective chart review identified patients who underwent a TKA or THA during the 2018-2020 calendar years at the Washington DC VA Medical Center. Multiple operations at different times on the same patient were regarded as separate events. The primary outcome was patients who were evaluable for penicillin allergy de-labeling and the secondary outcome was perioperative antibiotic choice. Results Patients in both groups were predominantly male, Black, and over the age of 60. Of a total of 317 procedures performed, we identified 28 procedures in which patients carried a PCN allergy label (PAL) and received a β-lactam alternative antibiotic for surgical prophylaxis. No patients in the PAL group received cefazolin for prophylaxis, compared to 87% of the non-PAL group who were appropriately given cefazolin. In the group carrying the PAL, 62% of patients received vancomycin and 29% of patients received clindamycin for pre-operative prophylaxis. Only one of these patients had a formal allergy consult note, but the PCN allergy was not addressed during that visit. Fewer patients (4%) required ICU admission during their hospitalization in the non-PAL group versus 10% of patients in the PAL group. Table 1. Patient Demographics and Procedure Detail Conclusion The use of alternative antibiotics in pre-procedural prophylaxis can contribute to adverse events associated with high-risk broader spectrum antimicrobials as well as increased costs associated with antimicrobials such as vancomycin. Our facility began implementation of a penicillin de-labeling program in 2018 via skin testing and direct oral challenge in collaboration with colleagues from Allergy and Immunology. Removal of PAL in this population can increase rates of appropriate prophylaxis. Disclosures All Authors: No reported disclosures

Enrolment of adolescents and young adults with cancer (AYAWC) to clinical trials at the Children’s Hospital of Eastern Ontario (CHEO).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18043-e18043
Author(s):  
Sarah Lum ◽  
Isabelle Laforest ◽  
Kenneth Tang ◽  
Lesleigh S. Abbott
Keyword(s):  
Clinical Trials ◽  
Chart Review ◽  
Tertiary Care ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Pediatric Hospital ◽  
Best Interest ◽  
Younger Patients ◽  
Time Period ◽  
Number Of Patients

e18043 Background: Five-year survival among AYAWC has seen less improvement than in other age groups. One hypothesized reason is low accrual to clinical trials, for which the reasons need further determination. Our objectives were to determine the enrolment of AYAWC on treatment clinical trials at CHEO, a tertiary care pediatric hospital in Ottawa, Canada and to determine barriers to enrolment of AYAWC compared to younger patients. Methods: A retrospective chart review of patients diagnosed at CHEO over 10 years from January 1, 2006 to December 31, 2015 was performed. AYAWC included 15-18 year olds, and younger patients included 0-14 year olds. Patients 18 years and older are treated at adult centers. The number of patients enrolled on an upfront treatment clinical trial was collected while those not enrolled were reviewed for documented non-enrolment reasons. Clinical trials available at CHEO during this time period were also recorded. Results: A total of 733 patients were diagnosed with 96 AYAWC and 637 younger patients. The proportion of patients enrolled on clinical trials was 19.8% (19) AYAWC and 27.3% (174) younger patients (p = 0.12). Trials were not available for 57.3% (55) of AYAWC and 53.7% (342) of younger patients for their disease type (p = 0.51). For the remaining 41 AYAWC, 46.3% were enrolled. For AYAWC not enrolled, 40.9% had a reason documented: for 22.2% a physician felt it was not in the patient’s best interest, 44.4% did not meet eligibility, 33.3% of families/patients declined. For the remaining 295 of younger patients that had trials available, 59% enrolled on a trial. For younger patients not enrolled, 25.6% had another reason documented: for 25.8% a physician felt it was not in the patient’s best interest, 45.2% did not meet trial eligibility, 25.8% of families/patients declined, 3.2% other reason. Conclusions: There were fewer AYAWC enrolled on trials compared to younger children. There were not fewer trials available for AYAWC patients than younger children. For patients not enrolled, the majority did not have an open trial available and otherwise, reasons for non-enrolment did not differ significantly between groups. Next steps could include data from local adult centers.

scholarly journals Adherence and Systemic Reaction Rates to Allergy Immunotherapy among Veterans

2016 ◽  
Vol 7 (3) ◽  
pp. ar.2016.7.0170 ◽  
Author(s):  
Joseph T. Ellenburg ◽  
Jay A. Lieberman ◽  
Debendra Pattanaik
Keyword(s):  
Medical Center ◽  
Group Versus ◽  
Systemic Reaction ◽  
Retrospective Chart Review ◽  
Reaction Rates ◽  
Veterans Affairs ◽  
Adherence Rate ◽  
Systemic Reactions ◽  
History Of ◽  
Facility Age

Background Although allergen immunotherapy (AIT) is effective and safe, nonadherence is common. Limited data exist regarding adherence to ATT, factors that affect adherence, and systemic reactions associated with ATT among veteran populations. Objective To evaluate adherence to AIT and the prevalence of reactions secondary to AIT among patients at the Veterans Affairs Medical Center, Memphis, Tennessee. Methods A retrospective chart review was performed of veterans who received AIT at a single Veterans Affairs facility. Age, race, sex, the total number of shots, travel distance, a diagnosis of posttraumatic stress disorder (PTSD), and the number of severe adverse reactions were compared between the veterans who were adherent and veterans who were nonadherent. Results The overall adherence rate was 60.9%. Factors associated with adherence were a chart diagnosis of PTSD (293% [adherent group] versus 13.6% [nonadherent group]; p = 0.03) and home residence being a further distance from the facility (21.9 miles / 35.2 kilometers [adherent group] versus 18.0 miles/28.9 kilometers [nonadherentgroup]; p = 0.03). Patients who were adherent received an average of more total injections compared with patients who were nonadherent. Age, sex, race, and history of systemic reactions during AIT displayed no statistically significant differences between the groups. There were a total of 20 systemic reactions, and the systemic reaction rate was 0.2% per AIT encounter and 0.1% per injection. Conclusion AIT adherence and systemic reaction rates among veterans at our facility was comparable with similar studies. Adherence was associated with a chart diagnosis of PTSD and home residence that was further away from the clinic.

scholarly journals Rapid PCR Influenza Testing Decreases Inappropriate Empiric Antibiotic Use

2020 ◽  
Vol 41 (S1) ◽  
pp. s366-s366
Author(s):  
Avnish Sandhu ◽  
Jordan Polistico ◽  
Ashwin Ganesan ◽  
Erin Goldman ◽  
Jennifer LeRose ◽  
...  
Keyword(s):  
Antibacterial Agents ◽  
Clinical Decision Making ◽  
Medical Center ◽  
Tertiary Care ◽  
Group Versus ◽  
Molecular Testing ◽  
Care Hospital ◽  
Rt Pcr ◽  
Influenza Like Illness ◽  
Number Of Patients

Background: The clinical picture of influenza-like illness can mimic bacterial pneumonia, and empiric treatment is often initiated with antibacterial agents. Molecular testing such as polymerase chain reaction (PCR) is often used to diagnose influenza. However, traditional PCR tests have a slow turnaround time and cannot deliver results soon enough to influence the clinical decision making. The Detroit Medical Center (DMC) implemented the Xpert Flu test for all patients presenting with influenza-like illness (ILI). We evaluated antibacterial use after implementation of rapid influenza PCR Xpert Flu. Methods: We conducted a retrospective study comparing all pediatric and adult patients tested using traditional RT PCR during the 2017–2018 flu season to patients tested using the rapid influenza Xpert Flu during the 2018–2019 flu season in a tertiary-care hospital in Detroit, Michigan. These patients were further divided into 3 groups: not admitted (NA), admitted to acute-care floor (ACF), or admitted to intensive care unit (ICU). The groups were then compared with respect to percentage of antibacterial use after traditional RT PCR versus rapid influenza Xpert Flu testing during their hospital visit for ILI. The χ2 test was used for statistical analyses. Results: In total, 20,923 patients presented with influenza-like illness during the study period: 26% (n = 5,569) had the rapid influenza Xpert Flu and 73.4% (n= 15,354) had traditional RT PCR. For a comparison of the number of patients in 3 groups (NA, ACF, and ICU) and type of influenza PCR performed among these patients, please refer to Table 1. When comparing antibacterial use in the NA group, the proportions of patients who received antibacterial agents in the traditional RT PCR group versus the rapid influenza Xpert Flu group were 24.4% (n = 695) versus 3.9% (n = 450), respectively (P < .0001). In the ACF group, the proportions of patients who received antibacterial agents in the traditional RT PCR group versus the rapid influenza Xpert Flu group was 62.3% (n = 1,406) versus 27.7% (n = 994), respectively (P < .001). In the ICU group, the proportions of patients who received antibacterials in the traditional RT PCR group versus the rapid influenza Xpert Flu group were 80.3% (n = 382) versus 38.3% (n = 204), respectively (P < .0001). Conclusions: With rising antimicrobial resistance and increasing influenza morbidity and mortality, rapid diagnostics not only can help diagnose influenza faster but also can reduce inappropriate antimicrobial use.Funding: NoneDisclosures: None

The Causative Organisms of Bacterial Meningitis and their Antimicrobial Resistance Profiles in Iranian Children in 2011-2016

2020 ◽  
Vol 20 (2) ◽  
pp. 229-236
Author(s):  
Sepideh Keshavarz Valian ◽  
Shima Mahmoudi ◽  
Babak Pourakbari ◽  
Maryam Banar ◽  
Mohammad Taghi Haghi Ashtiani ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Bacterial Meningitis ◽  
Medical Center ◽  
Blood Cultures ◽  
Gram Positive ◽  
Gram Negative ◽  
Number Of Patients ◽  
Resistance Patterns ◽  
Iranian Children ◽  
Surgery Department

Objective: The study aimed to describe the identity and antimicrobial resistance patterns of the causative agents of bacterial meningitis in children referred to Children’s Medical Center (CMC) Hospital, Tehran, Iran. Methods: This retrospective study was performed at CMC Hospital during a six-year period from 2011 to 2016. The microbiological information of the patients with a diagnosis of bacterial meningitis was collected and the following data were obtained: patients’ age, sex, hospital ward, the results of CSF and blood cultures, and antibiotic susceptibility profiles of isolated organisms. Results: A total of 118 patients with bacterial meningitis were admitted to CMC hospital. Sixty-two percent (n=73) of the patients were male. The median age of the patients was ten months (interquartile range [IQR]: 2 months-2 years) and the majority of them (n=92, 80%) were younger than two years of age. The highest number of patients (n=47, 40%) were admitted to the surgery department. Streptococcus epidermidis was the most frequent isolated bacterium (n=27/127, 21%), followed by Klebsiella pneumoniae (n=20/127, 16%), and Staphylococcus aureus (n=16/127, 12.5%). Blood culture was positive in 28% (n=33/118) of patients. Ampicillin-sulbactam and imipenem were the most effective antibiotics against Gram-negative bacteria isolated from CSF cultures. In the case of Gram-positive organisms, ampicillinsulbactam, vancomycin, and linezolid were the best choices. Imipenem was the most active drug against Gram-negative blood pathogens. Also, ampicillin and vancomycin had the best effect on Gram-positive bacteria isolated from blood cultures. Conclusion: Results of this study provide valuable information about the antibiotic resistance profiles of the etiologic agents of childhood meningitis, which can be used for prescription of more effective empirical therapies.

The ENT emergency clinic: does senior input matter?

2012 ◽  
Vol 127 (1) ◽  
pp. 15-19 ◽  
Author(s):  
A Mirza ◽  
L McClelland ◽  
M Daniel ◽  
N Jones
Keyword(s):  
Quality Of Care ◽  
Discharge Rate ◽  
Surrogate Marker ◽  
Operating Theatre ◽  
Number Of Children ◽  
Discharge Rates ◽  
Time Period ◽  
Number Of Patients

AbstractBackground:Many ENT conditions can be treated in the emergency clinic on an ambulatory basis. Our clinic traditionally had been run by foundation year two and specialty trainee doctors (period one). However, with perceived increasing inexperience, a dedicated registrar was assigned to support the clinic (period two). This study compared admission and discharge rates for periods one and two to assess if greater registrar input affected discharge rate; an increase in discharge rate was used as a surrogate marker of efficiency.Method:Data was collected prospectively for patients seen in the ENT emergency clinic between 1 August 2009 and 31 July 2011. Time period one included data from patients seen between 1 August 2009 and 31 July 2010, and time period two included data collected between 1 August 2010 and 31 July 2011.Results:The introduction of greater registrar support increased the number of patients that were discharged, and led to a reduction in the number of children requiring the operating theatre.Conclusion:The findings, which were determined using clinic outcomes as markers of the quality of care, highlighted the benefits of increasing senior input within the ENT emergency clinic.

Sign in / Sign up

Export Citation Format

Share Document