The Use of Transanal Hemorrhoidal Dearterialization for Treatment of Hemorrhoid Disease at a Single Institution

2016 ◽  
Vol 82 (12) ◽  
pp. 1160-1162 ◽  
Author(s):  
Ivy N. Haskins ◽  
Jeremy Holzmacher ◽  
Vincent Obias ◽  
Samir Agarwal
Keyword(s):  
Retrospective Chart Review ◽  
Postoperative Hemorrhage ◽  
Single Institution ◽  
George Washington ◽  
Invasive Approach ◽  
Institutional Review ◽  
Improve Patient Selection ◽  
Ferguson Hemorrhoidectomy ◽  
Feasible Alternative ◽  
Grade Ii

Transanal hemorrhoidal dearterialization (THD) is a relatively new, minimally invasive approach for the treatment of hemorrhoid disease. Despite increasing use of this procedure, there remains scarce United States-based data on the perioperative variables affected by this surgical technique. This article details the experience with THD at a single institution. This is a single-institution study that includes consecutive patients that underwent THD at George Washington University from November 2011 to April 2014. After Institutional Review Board approval, retrospective chart review was performed. Patient demographic information, preoperative management of hemorrhoid disease, and quality of life indicators after THD were collected for all patients. A total of 96 patients underwent THD during the period of investigation. A majority of the patients were male and all patients had grade II or III hemorrhoids. Most patients who underwent THD presented with rectal bleeding. Four patients required postoperative admission to the hospital for pain control, eight patients experienced constipation postoperatively, and one patient had recurrence of their hemorrhoid disease at 30-day follow-up. No patients required admission to the hospital for postoperative hemorrhage and none experienced urinary retention or incontinence of flatus or stool. THD is a feasible alternative to Ferguson hemorrhoidectomy for the surgical treatment of grade II and III hemorrhoidal disease. Future prospective studies are needed to help improve patient selection for each respective surgical approach.

scholarly journals Characterizing Posterior Neck Masses: A Single-Institution Retrospective and Systematic Review

2019 ◽  
pp. 014556131988184
Author(s):  
William J. Moss ◽  
Andrey Finegersh ◽  
Ajay Narayanan ◽  
Danielle Gillard ◽  
Joseph Califano ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chart Review ◽  
Case Reports ◽  
Retrospective Chart Review ◽  
Neck Mass ◽  
Single Institution ◽  
Neck Masses ◽  
Risk Of Malignancy ◽  
Posterior Neck ◽  
The Masses

Objective: Posterior neck masses are a relatively poorly characterized entity. The authors attempt to further characterize the anatomy and pathology of the posterior neck by way of a combined single-institution retrospective chart review and systematic review of the literature. Methods: A single-institution retrospective chart review was undertaken for all patients undergoing excision of a posterior neck mass between January 1, 2012, and January 1, 2017. A systematic review of the Medline, Embase, Web of Science, and Cochrane database was undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in search of case reports and series describing posterior neck masses. Results: A total of 28 patients who underwent excision of a posterior neck mass were encountered during the retrospective chart review. All pathologies were benign, the most prevalent of which was lipoma (22/28, 79%). A total of 19 articles describing a collective 36 posterior neck masses were encountered during the systematic review. Lipomas were the most common pathology (15/36, 42%). All but one of the masses reported were benign (35/36, 97%). Conclusions: Patients presenting with posterior neck masses can be reassured of a low risk of malignancy. The majority of posterior neck masses can be appropriately evaluated via physical examination and ultrasound.

Bertolotti Syndrome With Articulated L5 Transverse Process Causing Intractable Back Pain: Surgical Video Showcasing a Minimally Invasive Approach for Disconnection: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Zachary D Johnson ◽  
Salah G Aoun ◽  
Vin Shen Ban ◽  
Tarek Y E l Ahmadieh ◽  
Benjamin Kafka ◽  
...  
Keyword(s):  
Back Pain ◽  
Minimally Invasive ◽  
Clinical Symptoms ◽  
Symptomatic Relief ◽  
Transverse Process ◽  
Ethical Review ◽  
Invasive Approach ◽  
University Of Texas ◽  
Institutional Review ◽  
Patient Consent

Abstract Bertolotti syndrome is a commonly missed cause of intractable back pain that affects 4% to 8% of the general population. It involves the congenital malformation of a transitional lumbosacral vertebra, with total or partial and unilateral or bilateral transverse process (TP) fusion or articulation to the sacrum. The pain can be debilitating, and the tethering of the spine to the sacrum can encourage deformity formation in the coronal plane and lead to early degenerative changes, especially if present only unilaterally. We present the case of a 24-yr-old woman with no notable prior medical history who presented with years of lower axial back pain radiating to her thighs, which limited her activities of daily living and was resistant to conservative management. Her imaging showed an abnormally large left L5 TP, which was articulated to the sacrum, and signs of early coronal deformity. She had responded almost completely to repeated steroid injections into the TP-sacral joint, but that effect was very transient. Informed patient consent was obtained prior to her surgery. She underwent a minimally invasive tube disconnection of the abnormal joint with partial distal resection of the TP, and her symptoms completely resolved. This case highlights the importance of correlating clinical symptoms with aberrant anatomy, and the role of selective surgery in providing symptomatic relief. This case report was written in compliance with our institutional ethical review board approval, and patient consent was waived in light of the retrospective and deidentified nature of the data presented in accordance with the University of Texas Southwestern institutional review board.

Prothrombin Complex Concentrate Versus Plasma in Patients With Liver Disease

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S23-S24 ◽  
Author(s):  
Christopher Knoeckel ◽  
Sammie Roberts ◽  
Paul Pokrandt ◽  
Amber Stokes ◽  
Mary Berg
Keyword(s):  
Liver Disease ◽  
Prothrombin Complex Concentrate ◽  
Severe Disease ◽  
Retrospective Chart Review ◽  
Meld Score ◽  
Institutional Review ◽  
Significant Difference ◽  
Similar Disease ◽  
The Difference ◽  
Warfarin Reversal

Abstract Prothrombin complex concentrate (PCC) is FDA approved for warfarin reversal but is often used for coagulopathy and hemorrhage in patients with liver disease. While studies have explored its use during liver transplant, less is known about its safety and efficacy for other indications in patients with liver disease. Our objective was to retrospectively compare INR and mortality in patients with liver disease treated with PCC versus plasma. After obtaining institutional review board approval, we conducted retrospective chart review of patients with liver disease who received PCC. Control patients with liver disease who received plasma alone were matched based on indication for treatment. Outcomes were first post-PCC or post-plasma INR and mortality during admission. Twenty-one patients with liver disease who received PCC were identified; 21 who received plasma alone were matched. Two PCC patients and 1 plasma patient were excluded due to insufficient data in the medical record to calculate MELD scores. Statistics were calculated in Microsoft Excel (Version 1901). The most frequent indications were coagulopathy reversal and hemorrhage. The most common liver disease etiologies in both groups were alcohol and hepatitis C. The mean MELD score for the PCC group was higher than that for the plasma group (35 ± 7 vs 27 ± 9, P = .01). Mean baseline INR was similar between groups (PCC group, 4.0 ± 2.8 vs plasma group, 3.8 ± 3.8, P = .88). While INR decreased somewhat without a significant difference between groups (PCC group, 2.8 ± 1.5 vs plasma group, 2.4 ± 1.2, P = .44), mortality during admission was significantly higher in patients who received PCC (15 [71%] vs 5 [33%], P < .01). Of the 15 PCC patients who died, 5 died with hemorrhage as a contributing factor, 3 with disseminated intravascular coagulopathy, and 1 with both; 1 other patient died with TIPS thrombus as a contributing factor. Of the 5 plasma patients who died during admission, 2 died with hemorrhage as a contributing factor, and none died with clotting complications. The difference in mortality between groups is likely confounded by more severe disease in the PCC group as evidenced by higher mean MELD score. It is unclear whether the higher number of bleeding and clotting complications in the PCC group is related to PCC administration or is a consequence of more advanced liver disease in these patients. The higher mean MELD score in the PCC group may reflect a tendency for providers to prescribe PCC for patients with more severe liver disease, who may not tolerate the large fluid boluses required for coagulopathy reversal with plasma. In conclusion, PCC does not appear to be superior to plasma for INR reversal in patients with liver disease. Further study is needed to determine efficacy and safety of PCC in patients with liver disease and should include comparison of patient groups with similar disease severity.

The Use of Alternative Routes for the Delivery of Intra-Arterial Chemotherapy for Retinoblastoma

Neurosurgery ◽  
2020 ◽  
Vol 87 (5) ◽  
pp. 956-963 ◽  
Author(s):  
Ahmad Sweid ◽  
Batoul Hammoud ◽  
Pavlos Texakalidis ◽  
Vivian Xu ◽  
Kavya Shivashankar ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Survival Rates ◽  
Retrospective Chart Review ◽  
External Carotid Artery ◽  
External Carotid ◽  
Drug Infusion ◽  
Effective Treatment Option ◽  
Feasible Alternative ◽  
Alternative Approaches ◽  
Alternative Routes

Abstract BACKGROUND The introduction of intra-arterial chemotherapy (IAC) for treatment of retinoblastoma considerably changed the paradigm by which this disease is managed, with event-free survival rates being above 70%. OBJECTIVE To analyze efficacy of IAC treatment using alternative approaches to ophthalmic artery catheterization (OAC), such as external carotid artery approach or balloon-assisted drug delivery. METHODS This is a retrospective chart review for subjects receiving IAC for retinoblastoma. The primary approach was OAC. In cases in which selective OAC was not feasible, alternative routes including catheterization of the external carotid artery or use of a balloon-assisted drug infusion were used. RESULTS This study included 197 consecutive patients with 207 retinoblastomas who underwent 658 IAC procedures overall. The mean age at diagnosis was 24 mo, and 54.5% of the study population was male. Success rate with IAC was 97% (639). Alternative approaches to OAC were, in total, 42 cases (6.4%)—external carotid artery catheterization and use of ICA balloon were performed in 22 (3.3%) and 20 (3%) cases, respectively. A mean of 3.1 IAC cycles were performed for each patient. In total, there were 23 technical failures of the primary OAC technique (3.4%). Periprocedural adverse events occurred in 4 procedures (0.6%). Use of an alternative technique for chemotherapy delivery other than selective OAC in at least one IAC cycle was not a predictor of enucleation. CONCLUSION IAC is a safe and effective treatment option for retinoblastoma. Chemotherapy delivery using alternative techniques is as effective as selective OAC.

Thromboelastography in Trauma: A 1-Year Institutional Experience

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S1-S2
Author(s):  
David Wells ◽  
John R Hess ◽  
Daniel E Sabath
Keyword(s):  
Tranexamic Acid ◽  
Retrospective Chart Review ◽  
Turnaround Time ◽  
First Year ◽  
Trauma Patients ◽  
Liver Transplants ◽  
Institutional Review ◽  
Trauma Population ◽  
Three Samples ◽  
Institutional Experience

Abstract Viscoelastic testing to assess the overall clotting ability of a patient’s whole blood, such as thromboelastography (TEG), has risen in popularity over the past several years due its holistic assessment and rapid turnaround time, most notably in the realm of liver transplants and complex cardiac surgery. In the setting of trauma and assessing the concomitant coagulopathy, the rapid turnaround time and ability to assess for hyperfibrinolytic states had led to it being requested at our institution despite variable result interpretation and lack of reproducibility in previous studies. In response, our institution’s laboratory made this available at our hospital, which includes a large level 1 trauma center serving multiple states, with the aim of reassessing its utility after a 1-year period. Following the first year of use, data that were evaluated included TEG values and conventional laboratory testing temporally associated with the TEG order, including platelet count and fibrinogen level. Retrospective chart review was also performed to determine indication and context of testing, as well as for assessment of resulting interventions. Seventy-three samples from 58 patients were tested during the 1-year period, 30 of whom were admitted for trauma and 20 of whom were evaluated during the critical initial acute resuscitation period. Among the trauma patients, the majority of TEG samples (75.6%) did not demonstrate any abnormality. A primary reason cited by trauma surgeons for the need for TEG was its ability to accurately identify states of hyperfibrinolysis to determine the need for therapeutic agents such as tranexamic acid. In this regard, no evidence of hyperfibrinolysis was identified in any of the trauma patients. In fact, only a single hyperfibrinolytic sample was identified, corresponding to a nontrauma patient who had received a thrombolytic agent (alteplase) prior to TEG testing. Additionally, 75% of acute trauma patients received tranexamic acid, which was nearly always administered prior to the TEG sample being drawn. No evidence of TEG results affecting patient management was identified. As a result of the retrospective review of the data, use of TEG in the trauma population at our institution dramatically declined. We present this institutional review as an example of performing data review to influence test utilization practices.

scholarly journals PEDIATRIC IDIOPATHIC INTERVERTEBRAL DISC CALCIFICATION: A SINGLE INSTITUTION CASE SERIES OF A RARE DISORDER

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e41-e41
Author(s):  
Molly Dushnicky ◽  
Ronald Laxer ◽  
Abhaya Kulkarni ◽  
Manohar Shroff ◽  
Hidehiro Okura
Keyword(s):  
Intervertebral Disc ◽  
English Language ◽  
Medical Condition ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Spinal Pain ◽  
Single Institution ◽  
Intervertebral Disc Calcification ◽  
Age Range

Abstract BACKGROUND Paediatric idiopathic intervertebral disc calcification (PIIVDC) is a rare, poorly understood condition with just over 300 reported cases in the literature since the first report in 1924. The condition is characterized by calcification of an intervertebral disc which can progress to inflammation or extrusion and lead to neck or spinal pain in some patients. OBJECTIVES We report a series of patients seen at a single institution with PIIVDC and outline the disease course, management and outcome and review the literature. DESIGN/METHODS A retrospective chart review was performed at a single institution spanning the period between January 2001 and February 2016 for diagnoses of PIIVDC. Patient age, gender, symptoms, and medical history and physical and neurologic findings were reviewed. Laboratory and imaging findings, management, follow-up, and outcome were also studied. A literature review was carried out by MEDLINE and Embase, using the search terms “pediatric disc calcification” and “disc calcification in children” between the years 1997 and 2017, in the English language. Articles were reviewed and data was extracted. RESULTS Nine cases of PIIVDC were identified (6 males, 3 females) with an age range of 1 to 14 years. Two patients were asymptomatic and PIIVDC was discovered incidentally. Of the remaining patients, five presented with neck/back pain, one painless torticollis, and one painful torticollis. One patient was noted to have pain radiating along one dermatome. Disc spaces affected were five cervical, five thoracic, and two lumbar, with two patients having more than one space affected. All patients were managed conservatively. In one case, symptoms and lesions persisted after 5-years, but the remainder had complete symptom resolution, generally within 6 months. CONCLUSION Although the etiology of PIIVDC remains unknown it appears to occur spontaneously, without preceding trauma or underlying medical condition. A conservative approach to patients without severe neurologic deficit with out-patient close follow-up is supported.

scholarly journals Institutional review of glial tumors treated with chemotherapy: the first description of PCV-related pseudoprogression

2018 ◽  
Vol 6 (1) ◽  
pp. 22-29 ◽  
Author(s):  
Ankur M Sharma ◽  
Michael Willcock ◽  
Oliver Bucher ◽  
Thelina Amaratunga ◽  
M Nazir Khan ◽  
...  
Keyword(s):  
Decision Making ◽  
Adjuvant Radiotherapy ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
World Health ◽  
Tumor Treatment ◽  
Institutional Review ◽  
Grade Ii ◽  
Health Organization ◽  
Treatment Window

Abstract Background Pseudoprogression refers to areas of enhancement on MRI postadjuvant chemoradiation that arise as a result of treatment-related effects. Pseudoprogression has been well described with temozolomide-based chemoradiation but has not been studied in the setting of procarbazine, lomustine, and vincristine (PCV) chemotherapy. We reviewed patients treated with PCV to investigate the occurrence of pseudoprogression. Methods Adults diagnosed with World Health Organization grade II or III gliomas between 2010 and 2015 and treated with PCV or temozolomide were identified. Patient, tumor, treatment, and MRI data were retrospectively collected and analyzed. Pseudoprogression was defined as new enhancement seen on MRI within 6 months of completion of adjuvant radiotherapy or concurrent chemoradiation, which improved or remained stable on subsequent scans without therapeutic intervention. If MRI showed areas of new enhancement outside the 6-month post-treatment window, which resolved or remained stable without treatment, or in patients who did not receive adjuvant treatment, it was referred to as “atypical pseudoprogression.” Results Fifty-seven patients were identified. Nine (16%) patients were identified as having pseudoprogression on MRI. Two (4%) of these patients were treated with PCV and 7 (12%) were treated with temozolomide. Seventeen (30%) patients had atypical pseudoprogression: 8 (14%) treated with temozolomide, 8 (14%) treated with PCV, and 1 (2%) treated with both types of chemotherapy. Conclusions We describe the first 2 cases of PCV-related pseudoprogression and 17 cases of atypical pseudoprogression. As the re-emergence of adjuvant PCV occurs in clinical practice, the occurrence of classical and atypical pseudoprogression could have a significant impact on clinical decision making.

Allogenic stem cell transplant in patients over the age of 70, including octogenarians, with hematologic malignancies: A single institution experience.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18538-e18538
Author(s):  
Robert E. Gaudet ◽  
Jan Cerny ◽  
Muthalagu Ramanathan ◽  
Glen Raffel ◽  
Zheng Zhou ◽  
...  
Keyword(s):  
Stem Cell ◽  
Treatment Modality ◽  
Stem Cell Transplant ◽  
Medical Center ◽  
Hematologic Malignancies ◽  
Cell Transplant ◽  
Single Institution ◽  
Allogenic Stem Cell Transplant ◽  
Unrelated Donors ◽  
Grade Ii

e18538 Background: Patient age is an important factor when considering allogenic stem cell transplant (aSCT) as a treatment modality for hematologic malignancies. Previous series exploring older age and outcome in aSCT have generally not included fit, older adults beyond the age of 80: a group typically considered ineligible for aSCT. This report describes our single-institution experience with aSCT in patients age 70 and older, including octogenarians, from March 2010 through April 2016. Methods: Retrospective analysis was performed on all patients older than 70 years undergoing aSCT at UMass Memorial Medical Center (UMMMC) between March 2010 and April 2016. The study was approved by the UMMMC IRB. Results: 32 patients were identified: 19 men and 13 women. 1 patient underwent a second aSCT in the study period. Median age at time of aSCT was 73 years (range 70-83). 4 patients were age >80. Diseases treated were AML (19 pts.), MDS (12 pts.), and CLL (1 pt.). 24 transplants were performed with unrelated donors: 17 with 10/10 match, 3 with 11/12 match, 3 with 10/12 match, and 1 with 9/12 match. 9 were performed with umbilical cord blood units. Grade II-IV acute GVHD developed in 9 patients (27%). Day 100 survival by age following the transplant were 11/18 (61%) for patients aged 70-75, 6/10 (60%) for patients aged 75-80 and 4/4 (100%) for patients aged 80-85. Conclusions: Allogenic Stem Cell Transplant is a viable treatment modality in highly-selected elderly patients with hematologic malignancies. Further studies are warranted in a prospective fashion. [Table: see text]

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