Splenic Primary Solid Tumors

2020 ◽  
pp. 000313482095148
Author(s):  
Mauricio Gonzalez-Urquijo ◽  
Mario Rodarte-Shade ◽  
Gerardo Gil-Galindo
Keyword(s):  
Solid Tumors ◽  
Case Series ◽  
Laparoscopic Approach ◽  
Needle Aspiration ◽  
Medical Centers ◽  
Academic Medical ◽  
Histopathologic Diagnosis ◽  
Splenic Tumor ◽  
Median Operative Time ◽  
Median Blood Loss

Background The present study aims to present a case series of patients who underwent splenectomy for splenic primary solid tumors without preoperative histopathologic diagnosis. Methods From 2013 to 2019, 12 patients underwent splenectomy for solid primary splenic tumors at 3 different academic medical centers. All electronic medical records were retrospectively reviewed. Results Seven (58.3%) patients were women, and 5 (41.6%) were male. The median age was 48 years (range: 25-72 years). In 8 (66.6%) patients, a conventional approach was performed. In 2 (16.6%), a hand-assisted laparoscopic surgery procedure was completed, and in other 2 (16.6%) patients, a laparoscopic approach was auspiciously achieved. Median operative time was 135 minutes (range: 60-210 minutes), and median blood loss was 500 mL (range: 200-1500 mL). Procedure-related morbidity was found in 2 (16.6%) patients, and the mortality rate was 0%. The final histopathologic diagnosis was lymphoma in 5 (41.6%) patients, lymphangioma in 3 (25%) patients, hamartoma in 2 (16.6%) patients, angiosarcoma, and sclerosing angiomatoid nodular transformation (SANT) in 1 (8.3%) case each. Conclusion Splenectomy should be the treatment of choice when encountering a primary splenic tumor without the need for preoperative fine-needle aspiration biopsy, avoiding the complications this technique entails.

scholarly journals Cerebrovascular Disease in Patients with COVID-19: A Review of the Literature and Case Series

2020 ◽  
Vol 12 (2) ◽  
pp. 199-209 ◽  
Author(s):  
Sujan T. Reddy ◽  
Tanu Garg ◽  
Chintan Shah ◽  
Fábio A. Nascimento ◽  
Rajeel Imran ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cerebrovascular Disease ◽  
Incidental Finding ◽  
Diagnostic Testing ◽  
Case Series ◽  
Hemorrhagic Transformation ◽  
Laboratory Findings ◽  
Medical Centers ◽  
Academic Medical ◽  
Unclear Etiology

COVID-19 has been associated with a hypercoagulable state causing cardiovascular and neurovascular complications. To further characterize cerebrovascular disease (CVD) in COVID-19, we review the current literature of published cases and additionally report the clinical presentation, laboratory and diagnostic testing results of 12 cases with COVID-19 infection and concurrent CVD from two academic medical centers in Houston, TX, USA, between March 1 and May 10, 2020. To date, there are 12 case studies reporting 47 cases of CVD in COVID-19. However, only 4 small case series have described the clinical and laboratory findings in patients with COVID-19 and concurrent stroke. Viral neurotropism, endothelial dysfunction, coagulopathy and inflammation are plausible proposed mechanisms of CVD in COVID-19 patients. In our case series of 12 patients, 10 patients had an ischemic stroke, of which 1 suffered hemorrhagic transformation and two had intracerebral hemorrhage. Etiology was determined to be embolic without a clear cause identified in 6 ischemic stroke patients, while the remaining had an identifiable source of stroke. The majority of the patients had elevated inflammatory markers such as D-dimer and interleukin-6. In patients with embolic stroke of unclear etiology, COVID-19 may have played a direct or indirect role in the processes that eventually led to the strokes while in the remaining cases, it is unclear if infection contributed partially or was an incidental finding.

Endoscopic ultrasound-guided fine needle aspiration biopsy for splenic tumor: a case series

Endoscopy ◽  
2009 ◽  
Vol 41 (02) ◽  
pp. 179-182 ◽  
Author(s):  
T. Iwashita ◽  
I. Yasuda ◽  
H. Tsurumi ◽  
N. Goto ◽  
M. Nakashima ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Fine Needle Aspiration Biopsy ◽  
Case Series ◽  
Needle Aspiration ◽  
Aspiration Biopsy ◽  
Ultrasound Guided ◽  
Fine Needle ◽  
Splenic Tumor ◽  
Needle Aspiration Biopsy

Multi-institutional Evaluation of Medialization Laryngoplasty in the Elderly

2018 ◽  
Vol 160 (5) ◽  
pp. 876-884 ◽  
Author(s):  
Ramez Philips ◽  
Kevin Chorath ◽  
Brad DeSilva ◽  
L. Arick Forrest ◽  
C. Blake Simpson ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Assessment Tool ◽  
Voice Quality ◽  
Case Series ◽  
The Elderly ◽  
Complication Rates ◽  
Medical Centers ◽  
Academic Medical ◽  
Elderly Cohort ◽  
Medialization Laryngoplasty

Objective To evaluate voice outcomes of medialization laryngoplasty in the elderly population (65 years and older) and to identify swallow outcomes, complication rates, and predictors of voice outcomes. Study Design Case series with chart review. Setting Two tertiary academic medical centers. Subjects and Methods We retrospectively reviewed charts of 136 patients age 65 years and older undergoing medialization laryngoplasty between January 2008 and May 2016 at 2 tertiary academic institutions. Primary outcome was assessed using Voice Handicap Index 10 (VHI-10) score and Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) score. Secondary outcomes were assessed using the Eating Assessment Tool 10 (EAT-10) when dysphagia was present, stroboscopic analysis of glottic closure, and complication rates. A logistic regression analysis assessed predictors of voice improvement after medialization laryngoplasty. Results Total GRBAS and VHI-10 scores showed a significant improvement postoperatively ( P < .05). A ≥20% improvement was seen in 81.6% of patients, and a ≥50% improvement was seen in 53.7%. No patient had major complications. Minor complications occurred in 5.9% of patients. Multivariable logistic regression identified preoperative injection augmentation as an independent predictor of less improvement in VHI-10 score ( P = .015). Voice therapy prior to medialization did not affect voice outcomes ( P = .640). Conclusion Patient- and provider-perceived voice quality are significantly improved after medialization laryngoplasty in the elderly, and the procedure is associated with a low complication rate even in an elderly cohort. Improvement in patient-perceived voice outcomes after medialization laryngoplasty was diminished in patients with preoperative injection augmentation.

scholarly journals 1178. Risk factors for death among patients with Candida endocarditis: An observational study in US academic medical centers

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S614-S614
Author(s):  
Jonathan Huggins ◽  
Michael Z David ◽  
Samuel F Hohmann
Keyword(s):  
Risk Factors ◽  
Liver Failure ◽  
Case Series ◽  
Academic Medical Centers ◽  
Hospital Death ◽  
Hepatitis C Infection ◽  
Risk Of Death ◽  
Medical Centers ◽  
Opiate Abuse ◽  
Academic Medical

Abstract Background Candida endocarditis is a rare, sometimes fatal complication candidemia. Our understanding of this condition is limited to findings from case series and small observational studies. Using the Vizient clinical database, a repository for clinical and administrative data from 117 academic medical centers and more than 300 affiliated hospitals, we assembled the largest cohort of Candida endocarditis patients to date, reporting patient characteristics and risk factors for death. Methods Using ICD-10 code B37.6 (Candidal Endocarditis) we identified 703 inpatients at 179 United States hospitals from October 2015 through April 2019. We examined demographic, diagnostic, and procedural data from each patient’s initial encounter. With univariate and multivariate logistic regression analyses we identified predictors of in-hospital mortality. Results Of 703 patients, 402 (57.2%) were male, 421 (59.9%) used tobacco, 213 (30.3%) had documented opiate abuse, 128 (18.2%) had other illicit drug abuse documented, and 190 (27.0%) had documented hepatitis C infection. Among the 703 patients, 114 (16.2%) died during the index encounter. On multivariate analysis, liver failure was the strongest predictor of death (OR 8.4, 95% CI 4.4 – 15.9), and female sex (OR 1.8, 95% CI 1.1 – 2.9), transfer from an outside facility (OR 1.7, 95% CI 1.1 – 2.7), underlying aortic valve pathology (OR 2.8, 95% CI 1.5 – 4.9), hemodialysis (OR 2.0, 95% CI 1.0 – 3.8), cerebrovascular disease (OR 2.2, 95% CI 1.2 – 3.8), neutropenia (OR 2.5, 95% CI 1.3 – 4.7) and alcohol abuse (OR 2.9, 95% CI 1.3 – 6.7) were also associated with higher odds of in-hospital death. In the same analysis, opiate abuse was associated with a lower odds of in-hospital death (OR 0.4, 95% CI 0.2 – 0.8). Table 1. Characteristics of 703 patients with Candida endocarditis Table 2. Factors associated with in-hospital death in multivariate regression analysis Conclusion We found that for patients Candida endocarditis inpatient mortality was 16.2% and liver failure was associated with a high risk of death while opiate abuse was protective. Further investigation is necessary to better understand these associations. Disclosures Michael Z. David, MD PhD, GSK (Consultant)

scholarly journals Multicenter point prevalence evaluation of the utilization and safety of drug therapies for COVID-19 at the onset of the pandemic timeline in the United States

2021 ◽  
Author(s):  
Nathaniel J Rhodes ◽  
Atheer Dairem ◽  
William J Moore ◽  
Anooj Shah ◽  
Michael J Postelnick ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Drug Therapy ◽  
Supportive Care ◽  
The United States ◽  
Primary Objective ◽  
Point Prevalence ◽  
Medical Centers ◽  
Academic Medical ◽  
History Of ◽  
Secondary Objective

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose There are currently no FDA-approved medications for the treatment of coronavirus disease 2019 (COVID-19). At the onset of the pandemic, off-label medication use was supported by limited or no clinical data. We sought to characterize experimental COVID-19 therapies and identify safety signals during this period. Methods We conducted a non-interventional, multicenter, point prevalence study of patients hospitalized with suspected/confirmed COVID-19. Clinical and treatment characteristics within a 24-hour window were evaluated in a random sample of up to 30 patients per site. The primary objective was to describe COVID-19–targeted therapies. The secondary objective was to describe adverse drug reactions (ADRs). Results A total of 352 patients treated for COVID-19 at 15 US hospitals From April 18 to May 8, 2020, were included in the study. Most patients were treated at academic medical centers (53.4%) or community hospitals (42.6%). Sixty-seven patients (19%) were receiving drug therapy in addition to supportive care. Drug therapies used included hydroxychloroquine (69%), remdesivir (10%), and interleukin-6 antagonists (9%). Five patients (7.5%) were receiving combination therapy. The rate of use of COVID-19–directed drug therapy was higher in patients with vs patients without a history of asthma (14.9% vs 7%, P = 0.037) and in patients enrolled in clinical trials (26.9% vs 3.2%, P &lt; 0.001). Among those receiving drug therapy, 8 patients (12%) experienced an ADR, and ADRs were recognized at a higher rate in patients enrolled in clinical trials (62.5% vs 22%; odds ratio, 5.9; P = 0.028). Conclusion While we observed high rates of supportive care for patients with COVID-19, we also found that ADRs were common among patients receiving drug therapy, including those enrolled in clinical trials. Comprehensive systems are needed to identify and mitigate ADRs associated with experimental COVID-19 treatments.

scholarly journals Clinical Value of CT-Guided Fine Needle Aspiration and Tissue-Core Biopsy of Thoracic Masses in the Dog and Cat

Animals ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 883
Author(s):  
Massimo Vignoli ◽  
Roberto Tamburro ◽  
Andrea Felici ◽  
Francesca Del Signore ◽  
Annalisa Dettori ◽  
...  
Keyword(s):  
Fine Needle Aspiration ◽  
Core Biopsy ◽  
Needle Aspiration ◽  
Clinical Value ◽  
Reliable Technique ◽  
Ct Guided ◽  
Fine Needle ◽  
Tissue Core ◽  
Histopathologic Diagnosis ◽  
Ct Guided Biopsy

Diagnosis of thoracic lesions on the basis of history and physical examination is often challenging. Diagnostic imaging is therefore of paramount importance in this field. Radiology has traditionally been considered the diagnostic procedure of choice for these diseases. Nevertheless, it is often not possible to differentiate inflammatory/infectious lesions from neoplastic diseases. A correct cytological and histopathologic diagnosis is therefore needed for an accurate diagnosis and subsequent prognostic and therapeutic approach. In human medicine, Computed Tomography (CT) and CT-guided biopsy are used in the presence of lesions which are not adequately diagnosed with other procedures. In the present study, thoracic lesions from 52 dogs and 10 cats of different sex, breed and size underwent both CT-guided fine-needle aspiration (FNAB) and tissue-core biopsy (TCB). Clinical examination, hematobiochemical analysis and chest radiography were performed on all animals. In this study, 59 of 62 histopathological samples were diagnostic (95.2%). Cytology was diagnostic in 43 of 62 samples (69.4%). General sensitivity, accuracy and PPV for FNAB and TCB were 67.7%, 67.7% and 100% and 96.7%, 95.2% and 98.3%, respectively. Combining the two techniques, the overall mean accuracy for diagnosis was 98.4%. Nineteen of 62 cases showed complications (30.6%). Mild pneumothorax was seen in 16 cases, whereas mild hemorrhage occurred in three cases. No major complications were encountered. CT-guided FNAB cytology can be considered a useful and reliable technique, especially for small lesions or lesions located close to vital organs and therefore dangerous to biopsy in other way.

Hospital Volume is Not a Predictor of Outcomes after Gastrectomy for Neoplasm

2009 ◽  
Vol 75 (10) ◽  
pp. 932-936 ◽  
Author(s):  
Kevin M. Reavis ◽  
Marcelo W. Hinojosa ◽  
Brian R. Smith ◽  
James B. Wooldridge ◽  
Sindhu Krishnan ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Gastric Surgery ◽  
National Database ◽  
Medical Centers ◽  
Outcome Relationship ◽  
Academic Medical ◽  
Low Volume ◽  
Poor Outcomes ◽  
The University

Studies have shown conflicting data with regard to the volume and outcome relationship for gastrectomy. Using the University HealthSystem Consortium national database, we examined the influence of the hospital's volume of gastrectomy on outcomes at academic centers between 2004 and 2008. Outcome measures, including length of stay, 30-day readmission, morbidity, and in-hospital mortality, were compared among high- (13 or greater), medium- (6 to 12), and low-volume (five or less) hospitals. There were 10 high- (n = 593 cases), 36 medium- (n = 1076 cases), and 75 low-volume (n = 500 cases) hospitals. There were no significant differences between high- and low-volume hospitals with regard to length of stay, overall complications, 30-day readmission rate, and in-hospital mortality (2.4 vs 4.4%, respectively, P = 0.06). Despite the small number of gastrectomies performed at the low-volume hospitals, these same hospitals performed a large number of other types of gastric surgery such as gastric bypass for the treatment of morbid obesity (102 cases/year). Within the context of academic medical centers, lower annual volume of gastrectomy for neoplasm is not a predictor of poor outcomes which may be explained by the gastric operative experience derived from other types of gastric surgery.

Unplanned Reoperation and Implant Revision After Total Wrist Arthroplasty

Hand ◽  
2020 ◽  
pp. 155894471989881 ◽  
Author(s):  
Taylor M. Pong ◽  
Wouter F. van Leeuwen ◽  
Kamil Oflazoglu ◽  
Philip E. Blazar ◽  
Neal Chen
Keyword(s):  
Risk Factors ◽  
Implant Removal ◽  
Academic Medical Centers ◽  
Implant Design ◽  
Factors Associated ◽  
Medical Centers ◽  
Total Wrist Arthroplasty ◽  
Academic Medical ◽  
Related Risk ◽  
Wrist Arthroplasty

Background: Total wrist arthroplasty (TWA) is a treatment option for many debilitating wrist conditions. With recent improvements in implant design, indications for TWA have broadened. However, despite these improvements, there are still complications associated with TWA, such as unplanned reoperation and eventual implant removal. The goal of this study was to identify risk factors for an unplanned reoperation or implant revision after a TWA at 2 academic medical centers between 2002 and 2015. Methods: In this retrospective study, 24 consecutive TWAs were identified using CPT codes. Medical records were manually reviewed to identify demographic, patient- or disease-related, and surgery-related risk factors for reoperation and implant removal after a primary TWA. Results: Forty-six percent of wrists (11 of 24 TWAs performed) had a reoperation after a median of 3.4 years, while 29% (7 of 24) underwent implant revision after a median of 5 years. Two patients had wrist surgery prior to their TWA, both eventually had their implant removed ( P = .08). There were no risk factors associated with reoperation or implant removal. Conclusion: Unplanned reoperation and implant removal after a primary TWA are common. Approximately 1 in 3 wrists are likely to undergo revision surgery. We found no factors associated with reoperation or implant removal; however, prior wrist surgery showed a trend toward risk of implant removal after TWA.

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