Results after Definitive Surgical Treatment in Patients with Enteroatmospheric Fistula

2018 ◽  
Vol 84 (1) ◽  
pp. 28-35 ◽  
Author(s):  
Jose L. Martinez ◽  
Enrique Luque-De-LeÓN ◽  
Luis Manuel Souza-Gallardo ◽  
Maricela JimÉNez-LÓPez ◽  
Eduardo Ferat-Osorio
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Surgical Treatment ◽  
Primary Anastomosis ◽  
Enterocutaneous Fistula ◽  
Univariate Analysis ◽  
Patient Status ◽  
Inflammatory State ◽  
Fistula Recurrence ◽  
Risk Factors For Recurrence

As enteroatmospheric fistulas (EAF) lack healthy overlying tissue, spontaneous healing is very unlikely. Our aim was to identify risk factors for recurrence and mortality after definitive surgical treatment for EAF. Sixty-two consecutive patients with a diagnosis of EAF were submitted to definitive surgical repair (fistula resection and primary anastomosis) during a 6-year period. Several patient, disease, and operative variables were assessed as risk factors associated to our endpoints: recurrence and mortality. All patients were followed-up until hospital discharge or death. Univariate and multivariate analysis were performed. There were 24 females and 38 males with a median age of 53 years (interquartile ranges 43–63). EAF recurred in 23 patients. Univariate analysis identified several risk factors for recurrence which included performing more than one anastomosis (20 vs 52%, P = 0.013), failure of achieving total abdominal closure (16 vs 47%, P = 0.025), intraoperative hemorrhage >400 cc (28 vs 65%, P = 0.007), presence of multiple fistulas (25 vs 61%, P = 0.008), and preoperative C-reactive protein >0.5 mg/dL (54 vs 82%, P = 0.029). The latter two remained significant after multivariate analysis. Final EAF closure was attained in 47 patients (76%) and 8 more (13%) had a low-output (<50 mL/day) enterocutaneous fistula. Timing of surgery was not related to fistula recurrence. Eight patients died (13%), and fistula recurrence was the only risk factor found related to mortality both through univariate (26 vs 5%, P = 0.043) and after multivariate analysis. EAF management represents a rather challenging problem. Timing for surgical treatment is controversial and is based mostly on patient status and surgeon's criteria. Recurrence is associated to EAF characteristics and an inflammatory state; it was also the only factor associated to mortality.

scholarly journals Cut-out Risk Factor Analysis after Intramedullary Nailing for the Treatment of Extracapsular Fractures of the Proximal Femur: A Retrospective Study

2021 ◽  
Author(s):  
Jae Youn Yoon ◽  
Saehan Park ◽  
Taehyun Kim ◽  
Gun-Il Im
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Surgical Treatment ◽  
Clinical Outcomes ◽  
Univariate Analysis ◽  
High Body Mass Index ◽  
Positive Correlation ◽  
Factors Associated ◽  
Group 2 ◽  
Group 1

Abstract BackgroundsThe basic method of surgical treatment for extracapsular hip fracture (ECF), including intertrochanteric fracture and basicervical fracture (BCF), is osteosynthesis. Intramedullary nails are among the most commonly used fixation devices for such fractures. Our study aimed to report the clinical outcomes of ECF treatment with two different nail devices and to analyze the risk factors associated with screw cut-out.MethodsWe retrospectively reviewed the medical records of 273 patients (300 cases) from a single institution who underwent surgical treatment for ECF between January 2013 and October 2018. Overall, 138 patients were eligible for the study and were divided into two groups according to the osteosynthesis device used. We evaluated the clinical outcomes of fracture surgery and performed univariate and multivariate regression analyses to identify risk factors associated with screw cut-out in each group.ResultsWe used proximal femoral nails (group 1) to treat 83 patients and cephalomedullary nails (group 2) to treat 55 patients. Nine cut-outs (group 1, 6 cases; group 2, 3 cases) occurred during follow-up. The patients’ high body mass index (BMI) (p=0.019), BCFs (p=0.007), non-extramedullary reduction in the anteroposterior and lateral planes (p=0.032 and p=0.043, respectively), and anti-rotation screw pull-outs (p=0.041) showed a positive correlation to screw cut-out in the univariate analysis of group 1. In group 2, only BCFs was positively correlated (p=0.020). In the multivariate analysis of group 1, the patients’ BMIs (p=0.024) and BCFs (p=0.024) showed a positive correlation with cut-out. Meanwhile, the multivariate analysis of group 2 did not identify any factors associated with cut-out.ConclusionsThe cut-out risk was significantly higher in the BCF cases, regardless of the nail design used. Considerable attention should be paid to treating such unstable fractures. We expect that new-generation nails using a helical blade, or interlocking derotation and interlocking screws may improve surgical outcomes.

scholarly journals Risk Factor Analysis for Infection after Medial Open Wedge High Tibial Osteotomy

2021 ◽  
Vol 10 (8) ◽  
pp. 1727
Author(s):  
Ta-Wei Liu ◽  
Chih-Hao Chiu ◽  
Alvin Chao-Yu Chen ◽  
Shih-Sheng Chang ◽  
Yi-Sheng Chan
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Multivariate Analysis ◽  
High Tibial Osteotomy ◽  
Univariate Analysis ◽  
Arthroscopic Surgery ◽  
Underlying Disease ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Wedge High Tibial Osteotomy

Background: Medial open wedge high tibial osteotomy (MOWHTO) is a well-established treatment for osteoarthritis of the medial tibiofemoral compartment. Surgical site infection (SSI) after MOWHTO is a devastating complication that may require further surgery. In this study, we aimed to identify the risk factors for infection after MOWHTO over 1 to 4 years of follow-up. Methods: Fifty-nine patients who underwent MOWHTO combined with knee arthroscopic surgery were included in this prospective study. Artificial bone grafts were used in all cases. Possible risk factors, including sex, age, body mass index (BMI), underlying disease, hospitalization length, correction angle, and surgery time, were recorded. Both univariate and multivariate analysis were used. Results: A total of 59 patients who underwent 61 operations were included. Eleven patients (18.0%) were reported to have SSI. Univariate analysis showed that smoking and diabetes mellitus were positively associated with SSI. Multivariate analysis showed that smoking and age were positively associated with SSI. Three patients (4.9%) were reported to suffer from deep SSI, requiring surgical debridement, all of whom were male smokers. Conclusion: Smoking, diabetes mellitus, and old age were identified to be possible risk factors of SSI after MOWHTO. These findings are common risk factors of SSI after orthopedic surgery according to the literature. Patient selection should be performed cautiously, and postoperative prognosis for MOWHTO should be carefully explained to patients who smoke.

scholarly journals Prediction of Outcome for Transabdominal Cerclage in Women with Cervical Insufficiency

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Ji Eun Song ◽  
Keun Young Lee ◽  
Ga Hyun Son
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Cohort Study ◽  
Pregnancy Outcomes ◽  
Retrospective Cohort ◽  
Multivariate Analyses ◽  
Univariate Analysis ◽  
Cervical Length ◽  
Cervical Insufficiency ◽  
Prediction Of Outcome

We investigated pregnancy outcome following transabdominal cerclage (TAC) in women with cervical insufficiency (CI) and explored parameters for predicting pregnancy outcomes following TAC. In this retrospective cohort study, we included 161 women with TAC. We considered demographic, obstetric, and gynecologic histories, pre- and postoperative cervical length (CL), and CL at 20–24 weeks as parameters for predicting outcomes following TAC. Univariate and multivariate analyses were used to identify risk factors for predicting delivery before 34 weeks after TAC. 182 pregnancies occurred after TAC, and 290 pregnancies prior to TAC were identified. The rate of delivery <34 weeks significantly decreased following TAC (5% versus 82%,P<0.001). Univariate analysis demonstrated that a short CL (<25 mm) at 20–24 weeks and adenomyosis were associated with delivery at <34 weeks’ gestation following TAC (P=0.015andP=0.005, resp.). However, multivariate analysis demonstrated that only a short CL (<25 mm) at 20–24 weeks was a significant predictor (P=0.005). TAC is an efficacious procedure that prolongs pregnancy in women with CI. A short CL at 20–24 weeks may predict the delivery at <34 weeks’ gestation following TAC.

scholarly journals Risk Factors for Progression in Vestibular Schwannomas After Incomplete Resection: A Single Center Retrospective Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Jiuhong Li ◽  
Xueyun Deng ◽  
Daibo Ke ◽  
Jian Cheng ◽  
Si Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Tumor Size ◽  
Tumor Volume ◽  
Univariate Analysis ◽  
Residual Tumor ◽  
Vestibular Schwannomas ◽  
Incomplete Resection ◽  
Cystic Component

Background and Purpose: The risk factors for progression in vestibular schwannomas (VSs) after incomplete resection (IR) remain to be elucidated. The purpose of this study was to investigate the risk factors for progression in remnant VSs after surgery.Methods: From January 2009 to January 2018, 140 consecutive patients who underwent IR of VSs via suboccipital retrosigmoid approach in our institution were retrospectively analyzed. During follow-up, if progression was detected, the patient was classified into Progressive Group (PG); if the residual tumor was stable or shrank, the patient was classified into Stable Group (SG). Univariate analysis and multivariate analysis were used to evaluate the risk factors for progression after IR of VSs.Results: After a mean follow-up of 80.4 months (range, 24–134 months), 35 (25.0%) patients (PG) had a progression, and no progression was detected in 105 (75.0%) patients (SG). The average tumor size was 36.5 ± 8.9 mm in PG and 31.0 ± 9.8 mm in SG, respectively. The residual tumor volume was 304.6 ± 443.3 mm3 in PG and 75.9 ± 60.0 mm3 in SG, respectively. Univariate analysis showed that preoperative tumor size, residual tumor volume, and irregular internal auditory canal (IAC) expansion were significantly different between the two groups, whereas gender, age, cystic component, or Ki-67 labeling index (LI) did not differ significantly between the two groups. Multivariate analysis showed residual tumor volume was the independent risk factor for progression.Conclusions: VSs that underwent IR with larger preoperative size, greater residual tumor volume, or irregular IAC expansion may have a higher progression rate. Strict follow-up with shorter interval in these patients to detect early progression is necessary.

scholarly journals Predictive factors of posttreatment fracture by definitive radiotherapy for uterine cervical cancer

2020 ◽  
Author(s):  
Kazuki Ishikawa ◽  
Tsuneo Yamashiro ◽  
Takuro Ariga ◽  
Takafumi Toita ◽  
Wataru Kudaka ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Cervical Cancer ◽  
Multivariate Analysis ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
Clinical Characteristics ◽  
Univariate Analysis ◽  
Uterine Cervical Cancer

Abstract Purpose Fractures are known to shorten life expectancy and worsen the quality of life. The risk of fractures after radiation therapy in cervical cancer patients is known to be multifactorial. In this study, we examined risk factors for fractures in cervical cancer patients, especially by evaluating bone densities and DVH parameters for fractured bones. Materials and Methods For 42 patients, clinical characteristics, pretreatment CT bone densities, and radiation dose were compared between patients with and without fractures. Results Posttreatment fractures occurred in 25 bones among ten patients. Pretreatment CT bone densities were significantly lower in patients with fractures (P < 0.05–0.01 across sites, except for the ilium and the ischium). Although DVH parameters were also significantly associated with fractures in univariate analysis, only CT densities were significantly associated with fractures in multivariate analysis. Conclusion Pretreatment CT densities of spinal and pelvic bones, which may reflect osteoporosis, have a significant impact on the risk for posttreatment fractures.

scholarly journals CMET-07. TUMOR RELATED IMPAIRMENTS OF NEUROCOGNITIVE FUNCTIONS IN PATIENTS WITH BRAIN METASTASES

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi52-vi52
Author(s):  
Junjie Zhen ◽  
Shaoqun Li ◽  
Zhangrui Peng ◽  
Lei Wen ◽  
Mingyao Lai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Brain Metastases ◽  
Physical Examination ◽  
Univariate Analysis ◽  
Neurocognitive Impairment ◽  
Neurocognitive Functions ◽  
Neurocognitive Assessment ◽  
Wide Range ◽  
Assessment Results

Abstract OBJECTIVE To study whether the neurocognitive functions were affected by brain metastases in patients, and what are the potential risk factors. METHODS A total of 172 patients with brain metastases were retrospectively analyzed. Prior to radiotherapy of brain metastases, the neurocognitive functions were evaluated by a wide range of tests including MOCA, VFT, HVLT-R, TMT-A, TMT-B and TOL. Kappa test was used to analyze the consistency of physical examination and neurocognitive assessment results. The related factors were analyzed with univariate and multivariate analysis. RESULTS 53 out of 172 patients (30.8%) were identified with cognitive impairments by physical examination. The assessment with neurocognitive scales revealed that there were 148 cases of cognitive impairment (86.0%) and 24 cases of normal cognition (14.0%). Kappa=0.025, indicating that the difference between neurocognitive assessment results and physical examination was significant. The univariate analysis on the factors related to neurocognitive impairment revealed that the risk factors that may affect the neurocognitive functions included age, KPS, m-GPA score, RPA classification, whether the original tumor was under control, with or without brain metastases. After adjusting for education, the multivariate analysis showed that age≥45 years old, KPS≤70, RPA classification &gt;2 and m-GPA score&lt; 3 were independent risk factors for neurocognitive impairment. CONCLUSION Patients with brain metastases were found to have various degrees of neurocognitive impairment prior to radiotherapy. The neurocognitive functions of patients can be more precisely evaluated by a comprehensive scale assessment. Age, KPS, RPA classification and m-GPA score are the main factors associated with neurocognitive impairment.

scholarly journals Exceeding Pitch Count Recommendations In Youth Baseball Increases The Elbow Injuries

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0012
Author(s):  
Tetsuya Matsuura ◽  
Toshiyuki Iwame ◽  
Koichi Sairyo
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Multivariate Analysis ◽  
Univariate Analysis ◽  
The United States ◽  
Injury Incidence ◽  
Elbow Pain ◽  
Increased Risk ◽  
Youth Baseball ◽  
Elbow Injuries

Objectives: With the incidence of Little League elbow increasing, pitch limit recommendations for preventing throwing injuries have been developed in the United States and Japan. In 1995, the Japanese Society of Clinical Sports Medicine announced limits of 50 pitches per day and 200 pitches per week to prevent throwing injuries in younger than 12 years old. However the relationship between pitch limit recommendation and elbow injuries among pitchers has not been adequately studied. The aim of our study was to evaluate the association between pitch counts and elbow injuries in youth pitchers. Methods: A total of 149 pitchers without prior elbow pain were observed prospectively for 1 season to study injury incidence in relation to specific risk factors. Average age was 10.1 years (range, 7-11 years). One year later, all pitchers were examined by questionnaire. Subjects were asked whether they had experienced any episodes of elbow pain during the season. The questionnaire was also used to gather data on pitch counts per day and per week, age, number of training days per week, and number of games per year. We investigated the following risk factors for elbow injury: pitch counts, age, position, number of training days per week, and number of games per year. Data were analyzed by multivariate logistic regression models and presented as odds ratio (OR) and profile likelihood 95% confidence interval (CI) values. The likelihood-ratio test was also performed. A two-tailed P value of less than .05 was considered significant. All analysis was done in the SAS software package (version 8.2). Results: Of the 149 subjects, 66 (44.3%) reported episodes of pain in the throwing elbow during the season. 1. Analysis for pitch count per day Univariate analysis showed that elbow pain was significantly associated with more than 50 pitches per day. Multivariate analysis showed that more than 50 pitches per day (OR, 2.44; 95% CI, 1.22-4.94), and more than 70 games per year (OR, 2.47; 95% CI, 1.24-5.02) were risk factors significantly associated with elbow pain. Age and number of training days per week were not significantly associated with elbow pain. 1. Analysis for pitch count per week Univariate analysis showed that elbow pain was significantly associated with more than 200 pitches per week. Multivariate analysis showed that more than 200 pitches per week (OR, 2.04; 95% CI, 1.03-4.10), and more than 70 games per year (OR, 2.41; 95% CI, 1.22-4.87) were risk factors significantly associated with elbow pain. Age was not significantly associated with elbow pain. Conclusion: A total of 44.3% of youth baseball pitchers had elbow pain during the season. Multivariable logistic regression revealed that elbow pain was associated with more than 50 pitches per day, more than 200 pitches per week, and more than 70 games per year. Previous studies have revealed the risk factor with the strongest association to injury is pitcher. Our data suggest that compliance with pitch limit recommendations including limits of 50 pitches per day and 200 pitches per week may be protective against elbow injuries. Those who played more than 70 games per year had a notably increased risk of injury. With increasing demand on youth pitchers to play more, there is less time for repair of bony and soft tissues in the elbow. In conclusion, among youth pitchers, limits of 50 pitches per day, 200 pitches per week, and limits of 70 games per year may protect elbow injuries.

Increased Bone Marrow Iron Stores, Severe Mucositis and Large Area under the Curve (AUC) of Profound Neutropenia Predict Severe Infection in 382 Myeloma Patients Undergoing Melphalan - Autologous Stem Cell Transplantation (MEL-ASCT).

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1158-1158
Author(s):  
Elias J. Anaissie ◽  
Marisa H. Miceli ◽  
Li Dong ◽  
Monica L. Grazziutti ◽  
Sabitha Rajan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Marrow ◽  
Multivariate Analysis ◽  
Univariate Analysis ◽  
Severe Infection ◽  
Severe Neutropenia ◽  
Large Area ◽  
Iron Stores ◽  
Severe Infections ◽  
Severe Mucositis

Abstract Background: MEL-ASCT is standard therapy for multiple myeloma (MM) but is associated with severe infections, at times life-threatening. Objective: To determine the risk factors for severe infection (bacteremia, septic shock, colitis, pneumonia) following MEL - ASCT for MM. Materials and Methods: 382 consecutive MM patients (pts) enrolled in our Total Therapy 2 protocol and who received their first MEL - ASCT between 10/1998 and 12/2002 were included. Variables evaluated included age, sex and MM remission status, severity of mucositis and others. Because of the known association between increased body iron stores and infection, pre-ASCT bone marrow (BM) iron stores were also evaluated. The AUC for severe neutropenia (<100 absolute neutrophils (ANC) / mL) was used as a single variable accounting for both the depth and duration of neutropenia. Results: Median age was 56 years (range: 30–76) and 235 pts (62 %) were males. Severe infections developed in 77 pts (20%) including pneumonia (42 pts). Pre-ASCT risk factors for infection by univariate analysis were increased BM iron stores (OR= 3.601; 95%CI 1.795–7.222; p<0.0007) and low platelets counts (OR for -1000 platelets/μL = 0.997; 95% CI 0.994 – 1; p=0.0381). Increased BM iron stores remained significant by multivariate analysis (OR= 3.601; 95% CI 1.795–7.222; p<0.0007). Post-ASCT risk factors that were significant by both univariate and multivariate analysis were severe mucositis (Grades 3–4 by NCI Common Toxicity Criteria) (OR=1.916; 95% 1.093–3.36; p=0.02) and AUC of severe neutropenia (OR= 1.001/unit; 95% 1–1.002; p=0.03). Neither the duration (days with ANC <1000 / mL) nor the depth of moderate neutropenia (AUC < 1000 neutrophils / mL) predicted infection. Conclusion: MM pts scheduled to undergo MEL - ASCT and who have increased BM iron stores, and those who develop severe mucositis and / or prolonged and profound neutropenia following ASCT should be considered at greater risk for developing severe infection. AUC of severe neutropenia is a useful single marker of both depth and duration of neutropenia and should be included in studies evaluating risk for infection in neutropenic pts.

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