Surgical Stabilization of Rib Fractures Improves Outcomes in the Geriatric Patient Population

Introduction Rib fractures in the ≥65-year-old population have been shown to strongly influence mortality and pneumonia rates. There is a growing body of evidence demonstrating improvements in the geriatric patient’s survival statistics and respiratory performances after surgical stabilization of rib fractures (SSRF). We have observed a strong survival and complication avoidance trend in geriatric patients who undergo SSRF. The purpose of our study was to evaluate the outcomes of geriatric patients with rib fractures treated with SSRF compared to those who only receive conservative therapies. Methods We performed a retrospective review of our trauma registry analyzing outcomes of patients ≥65 years with rib fractures. Patients admitted from 2015 to 2019 receiving SSRF (RP group) were compared to a nonoperative controls (NO group) admitted during the same time. Bilateral fractures were excluded. Independent variables analyzed = ISS, mortalities, hospital days, ICU days, pleural space complications, and readmissions. Follow-up was 60 days after discharge. Group comparison was performed using Kolmogorov-Smirnov, Shapiro-Wilk, and Mann-Whitney U tests. Results 257 patients were analyzed: 172 in the NO group with mean age of 75 (65-10) and 85 in the RP group with mean age of 74 (65-96). Mean ISS = 13 (1-38) for the NO group and 20 (9-59) for the RP group ( P < .001). Mean hospital days = 8 (1-39) and 15 (3-49) in NO and RP groups, respectively. Mean ICU days = 10 (1-32) and 8 (1-11) in NO and RP groups, respectively. Deaths, pneumonia, readmissions, and pleural effusions in the NO group were statistically significant ( P < .01). Analysis of complications revealed 4 RP patients (4.7%) with respiratory complications out to 60 days and 65 NO patients (37.8%) ( P < .001). Conclusions Surgical stabilization of rib fractures appears to be associated with a survival advantage and an avoidance of respiratory-related complications in the ≥65-year-old patient population.

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How Many Screws to Use: A Report of Outcomes After Surgical Stabilization of Rib Fractures Where less than the Manufacturer Recommended Screw Number Were Applied

The American Surgeon ◽

10.1177/00031348211065120 ◽

2021 ◽

pp. 000313482110651

Author(s):

Timothy Nowack ◽

Dudley Christie ◽

Cory Nonnemacher ◽

John Buchanan

Keyword(s):

Pleural Effusion ◽

Retrospective Analysis ◽

Chest Wall ◽

Thoracic Trauma ◽

Rib Fractures ◽

Screw Placement ◽

Respiratory Complications ◽

Effective Technique

Surgical stabilization of rib fractures in an effective technique for the management of bony thoracic trauma. However, rib fractures location or morphology may make the placement of the recommended 6 screws impossible. A retrospective analysis of patients receiving SSRF at our facility from 2009–2019 identified cases where less than the recommended screw placement was used. Respiratory complications and hardware integrity were analyzed using follow-up imaging and examinations when available. A total of 62 patients were identified that used less than the recommended number of screws. The majority of these were in the lateral and posterior chest wall positions. 1 pleural effusion, no pneumothoraces, deaths, or hardware dislodgments were identified. While the authors do not advocate for the routine deviation from manufacture recommendations, we concluded that in select circumstances, adequate fixation can be achieved with less than 6 screws across a plated fracture.

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Evaluation of Left Ventricular Functions after Aortic Valve Replacement in a Specific Young Male Patient Population with Pure Aortic Insufficiency or Aortic Stenosis: 5-Years Follow-up

The Heart Surgery Forum ◽

10.1532/hsf98.20061142 ◽

2007 ◽

Vol 10 (1) ◽

pp. E57-E63 ◽

Cited By ~ 1

Author(s):

Cengiz Bolcal ◽

Suat Doganci ◽

Oben Baysan ◽

Vedat Yildirim ◽

Murat Sargin ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Male Patient ◽

Patient Population ◽

Young Male ◽

Aortic Insufficiency ◽

Left Ventricular

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Respiratory Complications in Outpatient Endoscopy with Endoscopist-Directed Sedation

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.233.kf1 ◽

2014 ◽

Vol 23 (3) ◽

pp. 255-259 ◽

Cited By ~ 11

Author(s):

Kilian Friedrich ◽

Sabine G. Scholl ◽

Sebastian Beck ◽

Daniel Gotthardt ◽

Wolfgang Stremmel ◽

...

Keyword(s):

Antibiotic Treatment ◽

Respiratory Infection ◽

Endoscopic Procedure ◽

Shortness Of Breath ◽

Respiratory Complications ◽

Endoscopic Procedures ◽

Increased Risk ◽

High Incidence ◽

Respiratory Complaints

Background & Aims: Respiratory complications represent an important adverse event of endoscopic procedures. We screened for respiratory complications after endoscopic procedures using a questionnaire and followed-up patients suggestive of respiratory infection.Method: In this prospective observational, multicenter study performed in Outpatient practices of gastroenterology we investigated 15,690 patients by questionnaires administered 24 hours after the endoscopic procedure.Results: 832 of the 15,690 patients stated at least one respiratory symptom after the endoscopic procedure: 829 patients reported coughing (5.28%), 23 fever (0.15%) and 116 shortness of breath (SOB, 0.74%); 130 of the 832 patients showed at least two concomitant respiratory symptoms (107 coughing + SOB, 17 coughing + fever, 6 coughing + coexisting fever + SOB) and 126 patients were followed-up to assess their respiratory complaints. Twenty-nine patients (follow-up: 22.31%, whole sample: 0.18%) reported signs of clinically evident respiratory infection and 15 patients (follow-up: 11.54%; whole sample: 0.1%) received therefore antibiotic treatment. Coughing or vomiting during the endoscopic procedure resulted in a 156.12-fold increased risk of respiratory complications (95% CI: 67.44 - 361.40) and 520.87-fold increased risk of requiring antibiotic treatment (95% CI: 178.01 - 1524.05). All patients of the follow-up sample who coughed or vomited during endoscopy developed clinically evident signs of respiratory infection and required antibiotic treatment while this occurred in a significantly lower proportion of patients without these symptoms (17.1% and 5.1%, respectively).Conclusions: We demonstrated that respiratory complications following endoscopic sedation are of comparably high incidence and we identified major predictors of aspiration pneumonia which could influence future surveillance strategies after endoscopic procedures.

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A framework for the evaluation of patients with congenital facial weakness

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-021-01736-1 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Bryn D. Webb ◽

Irini Manoli ◽

Elizabeth C. Engle ◽

Ethylin W. Jabs

Keyword(s):

Genetic Counseling ◽

Genetic Testing ◽

Patient Population ◽

Clinical Care ◽

Diagnostic Algorithm ◽

Accurate Diagnosis ◽

Facial Weakness ◽

The Core ◽

Follow Up Studies

AbstractThere is a broad differential for patients presenting with congenital facial weakness, and initial misdiagnosis unfortunately is common for this phenotypic presentation. Here we present a framework to guide evaluation of patients with congenital facial weakness disorders to enable accurate diagnosis. The core categories of causes of congenital facial weakness include: neurogenic, neuromuscular junction, myopathic, and other. This diagnostic algorithm is presented, and physical exam considerations, additional follow-up studies and/or consultations, and appropriate genetic testing are discussed in detail. This framework should enable clinical geneticists, neurologists, and other rare disease specialists to feel prepared when encountering this patient population and guide diagnosis, genetic counseling, and clinical care.

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Morphological Changes in Lamellar Macular Holes According to SD-OCT Examination over a Long Observation Period

Diagnostics ◽

10.3390/diagnostics11071145 ◽

2021 ◽

Vol 11 (7) ◽

pp. 1145

Author(s):

Magdalena Kal ◽

Izabela Chojnowska-Ćwiąkała ◽

Mateusz Winiarczyk ◽

Monika Jasielska ◽

Jerzy Mackiewicz

Keyword(s):

Retinal Thickness ◽

Morphological Changes ◽

Outer Diameter ◽

Corrected Visual Acuity ◽

Macular Holes ◽

Kolmogorov Smirnov ◽

Inner Diameter ◽

Observation Period ◽

Sd Oct

Background: The aim of this study was to evaluate the quantitative morphological changes in lamellar macular holes (LMHs) based on SD-OCT examinations and to assess the correlations among minimal retinal thickness (MRT), reading vision (RV), and best corrected visual acuity (BCVA) over a 36-month follow-up period. Methods: A group of 40 patients (44 eyes) with LMH was evaluated, with an average age of 69.87 (SD = 10.14). The quantitative parameters monitored in the follow-up period (at 0, 3, 6, 12, 18, 24, 30, and 36 months) were tested for normality of distribution by Shapiro–Wilk and Kolmogorov–Smirnov tests. Results: The RV and BCVA values were stable, and no significant changes were found at any of the check-ups during the 36-month follow-up period (BCVA p = 0.435 and RV p = 0.0999). The analysis of individual quantitative LMH parameters during the 36-month follow-up period did not demonstrate statistically significant differences: MRT (p = 0.461), Max RT temporal (p = 0.051), Max RT nasal (p = 0.364), inner diameter (ID) (p = 0.089), and outer diameter (OD) (p = 0.985). Conclusions: The observations at 0, 6, 12, 18, 24, 30, and 36 months revealed moderate and significant correlations between RV and MRT. No significant correlation between BCVA and MRT was observed.

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Abstract 683: Regression of Plaque Volume in One Arterial Bed is not Necessarily Associated with Similar Changes in Other Vessels

Circulation ◽

10.1161/circ.118.suppl_18.s_597-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Takayuki Suzuki ◽

Takashi Nozawa ◽

Mitsuo Sobajima ◽

Takashi Ohori ◽

Akira Matsuki ◽

...

Keyword(s):

Population Based ◽

Plaque Volume ◽

Independent Variables ◽

Before And After ◽

Independent Variable ◽

Artery Disease ◽

Soft Plaque ◽

Major Factors ◽

Atherosclerotic Changes

Background: Population-based studies have shown good correlation between severity of atherosclerotic disease in one arterial bed and involvement of other vessels. However, in patients with coronary artery disease (CAD), it remains unclear whether atherosclerotic plaque in an artery might regress or progress in parallel with other vessels. Accordingly, the present study was performed in patients with CAD to compare changes in plaque volume (PV) between the left main (LMT) and right coronary arteries (RCA), thoracic descending aorta (TDA) and common carotid artery (CCA), and to clarify clinical factors and biomarkers which might affect changes in PV in each artery. Methods: Using 64-multislice computed tomography, PVs in each artery were determined before and after 2.0-year follow-up period in 52 patients with CAD (67.4±9.9yo). Based on our previous study using ultrasound, CCA-PV was determined at windows of 90–240HU and TDA-PV determined manually. Coronary soft plaque was determined at windows of 0–75HU. Plasma levels of hsCRP, matrix metalloproteinase (MMP)-9 and urinary 8-iso-prostaglandin F2 α (PGF) were determined at baseline. Results: At baseline, PVs of TDA were correlated with CCA-PV (r=0.38, p<0.02), but PVs of other arteries did not correlate to each other. Two-year later, PVs of LMT, RCA, TDA, and CCA were reduced in 41, 62, 27, and 39% of patients, respectively. Changes in LMT-PV were weakly related with those of TDA-PV (r=0.37, p=0.02) and RCA-PV (r=0.31, p=0.08), but there were no relation between other arteries. The multivariate analysis revealed that treatment with statin and low LDL-cholesterol (C, <100mg/dl) were independent variables regarding a reduction in DTA-PV, but, in LMT, only low LDL-C was independent variable. However, there were no independent variables in RCA or CCA. The ratio of soft PV to total PV was similar between LMT (45.2±7.1%) and RCA (45.7±4.9%) at baseline and was unchanged in the follow-up study. None of hsCRP, MMP-9 or PGF levels was related with PVs of any arteries at baseline and with changes in PVs. Conclusions: Regression of PV in one arterial bed dose not necessarily allow us to predict atherosclerotic changes in the other vessels. Major factors which affect changes in PV may not be homogeneous between arteries.

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Treatment Compliance as a Major Barrier to Optimal Cervical Cancer Treatment in Guatemala

Journal of Global Oncology ◽

10.1200/jgo.18.00243 ◽

2019 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Abigail S. Zamorano ◽

Joaquin Barnoya ◽

Eduardo Gharzouzi ◽

Camaryn Chrisman Robbins ◽

Emperatriz Orozco ◽

...

Keyword(s):

Cervical Cancer ◽

Access To Care ◽

Cancer Treatment ◽

Patient Population ◽

Treatment Compliance ◽

External Beam Radiation ◽

Cervical Cancer Patient ◽

Beam Radiation ◽

Lost To Follow Up

PURPOSE Despite being the only hospital to provide comprehensive cervical cancer treatment to many medically underserved Guatemalan women, no assessment of the cervical cancer patient population at the Guatemala Cancer Institute has been performed. To understand the demographics of the patient population, their treatment outcomes, and access to care, we sought to assess treatment compliance of patients with cervical cancer at the Guatemala Cancer Institute and its effects on patient outcomes. METHODS A retrospective chart review was conducted of patients with cervical cancer between 2005 and 2007 and assessed for follow-up through December 2015. Demographics and clinical characteristics were tabulated. A Kaplan-Meier curve to model compliance was generated. RESULTS Ninety-two patients with invasive cancer were analyzed. Most presented with squamous cell carcinoma (73%) and at locally advanced stages (IIB, 51%; IIIB, 33%). Most (75 of 92, 81.5%) initiated treatment after diagnosis, but 18.5% (17 of 92) were lost to follow-up before treatment initiation. For treatment, 97% received external beam radiation, 84% brachytherapy, and 4% concomitant chemotherapy. Nearly 20% of patients were lost to follow-up in the first 6 months and 65% in the first 5 years. Of the 67 patients who completed treatment, only 15 (16% of the initial cohort) were diagnosed with a recurrence. No deaths were recorded. CONCLUSION The low recurrence rate and no documented deaths suggest a correlation with the low compliance rate and poor follow-up. This finding highlights the need to examine more fully the barriers to compliance and access to care among this population to optimize the treatment of cervical cancer.

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MENINGKATKAN HASIL BELAJAR KERJA BANGKU

Perspektif Ilmu Pendidikan ◽

10.21009/pip.262.3 ◽

2012 ◽

Vol 26 (XVII) ◽

pp. 108-114

Author(s):

Mochammad Sukarjo

Keyword(s):

High School ◽

Positive Relationships ◽

Vocational High School ◽

Learning Achievement ◽

Independent Variables ◽

School Year ◽

Independent Variable

The objective of this research is to determine the relationships between inductive thinking (X1) and student vocational attitude toward technician’s profession (X2) individually and simultanously and learning achievement (Y) in bench work subject. The research conducted in State Vocational High School in East Jakarta, in the school year of 200/2010 proved the positive relationships between the independent variables (X1 and X2, individually and simultanously) and the independent variable (Y). Based on the reseach findings, this research identified some implications and give a number of suggestions to follow up.

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The Hanging Chin Sign As A Mortality Predictor In Geriatric Patients At The Emergency Department: A Retrospective Cohort Study

10.21203/rs.3.rs-496256/v1 ◽

2021 ◽

Author(s):

Anneloes NJ Huijgens ◽

Laurens J van Baardewijk ◽

Carolina JPW Keijsers

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Geriatric Patients ◽

Lateral View ◽

X Ray ◽

Hospital Patients ◽

Chest X Ray

Abstract BACKGROUND: At the emergency department, there is a need for an instrument which is quick and easy to use to identify geriatric patients with the highest risk of mortality. The so- called ‘hanging chin sign’, meaning that the mandibula is seen to project over one or more ribs on the chest X-ray, could be such an instrument. This study aims to investigate whether the hanging chin sign is a predictor of mortality in geriatric patients admitted through the emergency department. METHODS: We performed an observational retrospective cohort study in a Dutch teaching hospital. Patients of ≥ 65 years who were admitted to the geriatric ward following an emergency department visit were included. The primary outcome of this study was mortality. Secondary outcomes included the length of admission, discharge destination and the reliability compared to patient-related variables and the APOP screener.RESULTS: 396 patients were included in the analysis. Mean follow up was 300 days; 207 patients (52%) died during follow up. The hanging chin sign was present in 85 patients (21%). Patients with the hanging chin sign have a significantly higher mortality risk during admission (OR 2.94 (1.61 to 5.39), p < 0.001), within 30 days (OR 2.49 (1.44 to 4.31), p = 0.001), within 90 days (OR 2.16 (1.31 to 3.56), p = 0.002) and within end of follow up (OR 2.87 (1.70 to 4.84),p < 0.001). A chest X-ray without a PA view or lateral view was also associated with mortality. This technical detail of the chest x-ray and the hanging chin sign both showed a stronger association with mortality than patient-related variables or the APOP screener. CONCLUSIONS: The hanging chin sign and other details of the chest x-ray were strong predictors of mortality in geriatric patients presenting at the emergency department. Compared to other known predictors, they seem to do even better in predicting mortality.

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