Posterior Glottic Insufficiency in Children

2017 ◽  
Vol 126 (4) ◽  
pp. 268-273 ◽  
Author(s):  
Reema Padia ◽  
Marshall E. Smith
Keyword(s):  
Chart Review ◽  
Diagnostic Procedures ◽  
Response To Treatment ◽  
Anatomical Location ◽  
Injection Laryngoplasty ◽  
Glottic Insufficiency ◽  
Institutional Review ◽  
Vocal Fold Injection ◽  
Impairment Ratings ◽  
Posterior Glottis

Background: Dysphonia secondary to posterior glottic insufficiency (PGI) can be difficult to identify and correct. Inadequate arytenoid approximation from medial arytenoid erosion results in a breathy, soft voice. The anatomical location of the gap is difficult to correct by vocal fold injection laryngoplasty. This study reviews the presentation, evaluation, and treatment for pediatric patients who were identified with PGI. Methods: An Institutional Review Board–approved chart review was performed on all patients who were diagnosed with PGI at our institution from 2013 to 2015. We studied the presentation, workup, and treatment for these patients, including laryngoscopy, parent or patient-based voice impairment ratings, and response to treatment. Results: Seven patients were identified. Erosion of the medial arytenoid was identified on microlaryngoscopy for all of these patients. The patients had suboptimal improvement from injection laryngoplasty. Three patients underwent surgical correction with an endoscopic posterior cricoid reduction laryngoplasty (EPCRL) with significant improvement in voice, assessed by perceptual, laryngoscopic, and patient-based measures. Conclusion: The key diagnostic procedures to identify posterior glottic insufficiency include laryngoscopic findings of a posterior glottal gap, microlaryngoscopy with close inspection of the posterior glottis and medial arytenoids, and suboptimal response to injection laryngoplasty. The EPCRL is an effective procedure to treat dysphonia from PGI.

Clinical and Cost Comparison Evaluation of Inpatient Versus Outpatient Administration of EPOCH-Containing Regimens in Non-Hodgkin Lymphoma

2016 ◽  
Vol 30 (4) ◽  
pp. 400-405 ◽  
Author(s):  
Sarah S. Evans ◽  
Arpita S. Gandhi ◽  
Amber B. Clemmons ◽  
David L. DeRemer
Keyword(s):  
Chart Review ◽  
Hospital Admissions ◽  
Antiviral Agents ◽  
Cost Savings ◽  
Outpatient Setting ◽  
Primary Objective ◽  
Cost Comparison ◽  
Non Hodgkin Lymphoma ◽  
Institutional Review ◽  
Stimulating Factor

Background: Etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin (EPOCH)-containing regimens are frequently utilized in non-Hodgkin’s lymphoma, however, the incidence of febrile neutropenia (FN) in patients receiving inpatient versus outpatient EPOCH has not been described. Additionally, no comparisons have been made regarding financial implications of EPOCH administration in either setting. This study’s primary objective was to compare hospital admissions for FN in patients receiving inpatient or outpatient EPOCH. Methods: A single-center, institutional review board-approved review was conducted for adults receiving EPOCH beginning January 2010. Clinical and financial data were collected through chart review and the institution’s financial department. Descriptive statistics were utilized for analysis. Results: A total of 25 patients received 86 cycles of an EPOCH-containing regimen (61 [70.9%] inpatient). Five (8.2%) inpatient cycles resulted in an admission for FN compared to 4 (16%) outpatient cycles. Prophylactic antifungal and antiviral agents were prescribed more often after inpatient cycles (>80%) compared to outpatient cycles (<50%). Overall, 27 (31.4%) of 86 cycles did not receive granulocyte colony-stimulating factor support. Outpatient EPOCH administration was associated with a cost savings of approximately US$141 116 for both chemotherapy costs and hospital day avoidance. Conclusion: EPOCH-containing regimens can be safely administered in the outpatient setting, which may result in cost savings for healthcare institutions.

Safety and efficacy of electroconvulsive therapy for depression following cerebrovascular accident

2012 ◽  
Vol 24 (4) ◽  
pp. 226-229 ◽  
Author(s):  
Magdalena Romanowicz ◽  
Bruce Sutor ◽  
Christopher Sola
Keyword(s):  
Electroconvulsive Therapy ◽  
Cerebrovascular Accident ◽  
Chart Review ◽  
Short Term Memory ◽  
Retrospective Chart Review ◽  
Neurological Deficits ◽  
Response To Treatment ◽  
Short Term ◽  
Memory Problems ◽  
Depressive Syndromes

Introduction: Depressive syndromes are common following cerebrovascular accident (CVA) and many patients do not respond to pharmacotherapy. Electroconvulsive therapy (ECT) is a safe and effective treatment for mood disorders arising with many comorbid medical conditions. In this paper, we describe the successful treatment of post-CVA depression with ECT.Methods: Retrospective chart review of 24 patients hospitalised for depression on an in-patient Medical Psychiatry unit between 2000 and 2010. Medical, neurologic and psychiatric histories, physical examination findings, results of laboratory, imaging and neurophysiologic investigations and treatment response with medications and ECT were recorded.Results: Twenty patients (83%) showed a positive response to treatment with ECT. None had worsening of depression after the ECT or experienced exacerbation of post-stroke neurological deficits. Three patients suffered from minor complications of ECT (prolonged confusion or short-term memory problems).Conclusions: This review supports the use of ECT after a stroke with appropriate clinical observation. The treatment was well tolerated and the majority obtained clinical benefit.

Differential clinical features and long-term prognosis of acute aortic syndrome according to disease entity

2019 ◽  
Vol 40 (32) ◽  
pp. 2727-2736 ◽  
Author(s):  
Jung-Min Ahn ◽  
Hoyun Kim ◽  
Osung Kwon ◽  
Sang Yong Om ◽  
Ran Heo ◽  
...  
Keyword(s):  
Clinical Features ◽  
Type A ◽  
Response To Treatment ◽  
Anatomical Location ◽  
Acute Aortic Syndrome ◽  
Disease Entity ◽  
Type B ◽  
Long Term Prognosis ◽  
Location Type

Abstract Aims To evaluate the acute and long-term prognosis of acute aortic syndrome (AAS) according to the disease entity [intramural haematoma (IMH) vs. aortic dissection (AD)] and the anatomical location (type A vs. B). Methods and results A total of 1012 patients [672 with AD and 340 with IMH (33.6%)] were enrolled between 1993 and 2015. Compared with AD patients, IMH patients were older and had higher frequency of female sex and distal aorta involvement. The overall crude in-hospital mortality of AAS was 8.6%; type A AD [15.0%; adjusted hazard ratio (aHR) 30.4; 95% confidence interval (CI) 8.62–107.3; P < 0.001], type A IMH (8.0%; aHR 4.85; 95% CI 1.29–18.2; P = 0.019), type B AD (5.0%; aHR 3.51; 95% CI 1.00–12.4; P = 0.051), and type B IMH [1.5%; aHR 1.00 (reference)]. During a median follow-up duration of 8.5 years (interquartile range: 4.0–13.5 years), AD (aHR 2.78; 95% CI 1.87–4.14; P < 0.001) and type A (aHR 2.28; 95% CI 1.45–3.58; P < 0.001) was associated with a higher risk of aortic death. After 90 days, a risk of aortic death was no longer associated with anatomical location (aHR 0.74; 95% CI 0.40–1.36; P = 0.33), but remained associated with disease entity (aHR 1.83; 95% CI 1.10–3.04; P = 0.02). Conclusion The clinical features, response to treatment strategy, and outcomes of IMH patients were distinct from those of AD patients. Both early and late survival was better for IMH than for AD. In addition to the anatomical location of AAS, the disease entity is an independent factor associated with both acute and long-term mortality in patients with AAS. Further investigation is necessary to confirm the prognostic implication of disease entity in different patient populations.

scholarly journals The Paisley Pattern Breast Reduction

2019 ◽  
Vol 27 (2) ◽  
pp. 189-194
Author(s):  
Devra B. Becker
Keyword(s):  
Chart Review ◽  
Operative Time ◽  
Breast Reduction ◽  
Proof Of Concept ◽  
Flap Necrosis ◽  
Institutional Review ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Wise Pattern

Background: Skin resection patterns inform the shape and scars after breast reduction. The 2 most commonly performed skin resection patterns, the Wise pattern and vertical pattern, each have limitations. The most common challenge is addressing excess lateral skin while avoiding medial scars. The Paisley Pattern breast reduction addresses this by incorporating lateral dogear excision in the skin resection design. Methods: Thirty consecutive patients received a Paisley Pattern breast reduction. After institutional review board approval, a chart review was performed to evaluate resection weight, operative time, American Society of Anesthesiologists class, flap necrosis, and seroma. Results: Operative times were comparable to published times for the Wise and vertical pattern techniques. No patients had lateral flap necrosis, and no patients required a return to the operating room during the follow-up period. One patient developed a unilateral seroma that was drained by interventional radiology. Conclusions: This report of a novel skin resection design demonstrates a proof of concept that the skin resection pattern can be performed safely in a wide variety of patients. Although there is a learning curve to the technique to prevent over-resection laterally, it provides efficient and aesthetically acceptable alternative to the Wise and vertical skin resection patterns for both large and small reductions.

scholarly journals Changes in Abnormal Muscle Tension Pattern after Fiberoptic Injection Laryngoplasty

2017 ◽  
Vol 96 (12) ◽  
pp. 472-476 ◽  
Author(s):  
Georges Ziade ◽  
Ghassan Haddad ◽  
Sarah Assaad ◽  
Maher Kasti ◽  
Abdul-Latif Hamdan
Keyword(s):  
Medical Records ◽  
Vocal Fold ◽  
Chart Review ◽  
Muscle Tension ◽  
Retrospective Chart Review ◽  
Injection Laryngoplasty ◽  
Before And After ◽  
Glottal Insufficiency ◽  
The Mean ◽  
Positive Effect

We performed a retrospective chart review to compare the presence and types of abnormal muscle tension patterns (MTPs) in patients who had been diagnosed with glottal insufficiency before and after fiberoptic injection laryngoplasty. The main cause of glottal insufficiency had been unilateral vocal fold paralysis. Our review included an analysis of the medical records and laryngeal videostroboscopic recordings of 16 patients—9 men and 7 women, aged 25 to 87 years (mean: 59). Stroboscopic frames were analyzed for the presence of one or more types of abnormal MTP. Statistical analysis was performed to determine the significance of the change in scores for type II and type III MTP before injection and 1 month after injection. Before injection laryngoplasty, 15 of the 16 patients exhibited evidence of an abnormal MTP; 10 patients had MTP II only, 2 had MTP III only, and 3 patients had both. The mean percentage of frames showing MTP (i.e., MTP score) in patients with MTP II was 66.2% before the injection and 28.9% 1 month after; the decrease was statistically significant (p = 0.001). For MTP III, the corresponding figures were 71.6 and 37.7% (p = 0.043). We conclude that injection laryngoplasty has a positive effect on reducing muscle tension in patients with glottal insufficiency.

Nurses' Finnegan Scoring of Newborns with Neonatal Abstinence Syndrome Not Affected by Time or Day of the Week

2019 ◽  
Vol 37 (02) ◽  
pp. 224-230 ◽  
Author(s):  
Alla Kushnir ◽  
Jennifer L. Bleznak ◽  
Judy G. Saslow ◽  
Gary Stahl
Keyword(s):  
Neonatal Intensive Care ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Time Of Day ◽  
Behavioral Changes ◽  
Neonatal Abstinence Syndrome ◽  
Abstinence Syndrome ◽  
Institutional Review ◽  
Day Of The Week ◽  
Scoring Tool

Abstract Objective Newborns exposed to drugs in utero are at risk of developing neonatal abstinence syndrome (NAS), characterized by behavioral changes and physiologic instability. Finnegan scoring tool quantifies severity of symptoms and guides treatment. This article evaluates whether time of day and the number of shift hours affects modified Finnegan scores, and the subjective component of these scores. Study Design Institutional review board-approved, retrospective chart review of newborns admitted to neonatal intensive care or transitional nursery from 2011 to 2014. Inclusion criteria: > 35 weeks' gestation, known maternal substance use, positive maternal or newborn urine, or meconium drug screen, NAS treatment. Results A total of 101 charts were evaluated. Mean treatment duration was 31.8 days (standard deviation ±18.3). There was no significant relationship between observer shift hour and high scores (> 8) (p = 0.83). Highest scores occurred in the afternoon, decreased at night (p = 0.03), and throughout admission (p < 0.0001). Weekend and weekday scores were similar (p = 0.4). The objective component of the scores remained similar throughout the day (p = 0.91) and week (p = 0.52). Conclusion Finnegan scores given by nurses were not influenced by shift hour. Time of day did not influence overall high scores or the proportion of objective to total Finnegan score. Inter-rater reliability was maintained regardless of time of day or day of the week.

Diagnostic algorithm for gastrointestinal stromal tumor (GIST) using patient registry data impacts pathology guidelines.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e23519-e23519
Author(s):  
Sara Rothschild ◽  
Jerry Call ◽  
Christopher L. Corless ◽  
Anthony Gill ◽  
Markku Miettinen ◽  
...  
Keyword(s):  
Genetic Analysis ◽  
Large Scale ◽  
Genetic Counselor ◽  
Diagnostic Algorithm ◽  
Diagnostic Procedures ◽  
Patient Registry ◽  
Response To Treatment ◽  
Pathology Report ◽  
Medical Opinion

e23519 Background: The Life Raft Group (LRG) identified that succinate dehydrogenase (SDH) deficient GISTs are under-recognized. In the LRG Registry only 30% of KIT/PDGFRA wildtype patients had received the advanced mutational testing (or SDHB staining) required to identify this unique subtype of GIST with a different natural history and response to treatment, and very strong familial associations. We proposed that two changes would significantly increase the diagnosis of SDH-deficient GIST patients: 1. SDHB staining for all GIST patients with a stomach primary tumor at initial biopsy, 2. Initial pathology report should contain strong recommendations for specific mutational testing. Methods: The LRG collaborated with key medical opinion leaders on a diagnostic algorithm that illustrated the need for wider use of targeted diagnostic procedures and submitted the algorithm to the College of American Pathologists (CAP) GIST editorial board. Results: Because SDH-deficient GISTs require germline genetic analysis and, if mutation related, subsequent surveillance for paragangliomas/pheochromocytomas, and cascade genetic testing for family members, it is necessary to screen all gastric GISTs for loss of SDH by immunohistochemistry. This is best accomplished by immunohistochemical staining for SDHB, which is lost in all genetic subtypes of SDH-deficient GISTs. If SDHB is absent, additional staining for SDHA may be performed, as this protein is selectively lost in SDHA-mutant GISTs and this may help focus genetic analysis. All patients with SDH-deficient GIST should be referred to a genetic counselor. The CAP incorporated both SDHB and SDHA testing paradigms into the updated GIST protocols which were published in August 2019. Conclusions: We believe this will result in significantly better diagnosis and treatment for SDH-deficient GIST patients. We encourage other groups that advise on guidelines to develop similar recommendations. This is a great example of a patient advocacy group utilizing real world evidence derived from a patient registry to influence protocols for treatments that affect GIST patients on a large scale.

Cognitive Therapy in the Treatment of Adults With ADHD: A Systematic Chart Review of 26 Cases

1999 ◽  
Vol 13 (3) ◽  
pp. 215-226 ◽  
Author(s):  
Timothy E. Wilens ◽  
Stephen P. McDermott ◽  
Joseph Biederman ◽  
Ana Abrantes ◽  
Amy Hahesy ◽  
...  
Keyword(s):  
Cognitive Therapy ◽  
Potential Benefit ◽  
Chart Review ◽  
Psychiatric Comorbidity ◽  
Response To Treatment ◽  
Global Functioning ◽  
Hyperactivity Disorder ◽  
Psychotherapeutic Interventions ◽  
End Of Treatment ◽  
Multiple Variables

Despite the increasing awareness of attention deficit hyperactivity disorder (ADHD) in adults, psychotherapeutic interventions for this group remain unstudied. In this study we evaluated the potential benefit of an adapted form of Beck±s Cognitive Therapy (CT) for adults with ADHD. Consecutive outpatients with DSM-III-R ADHD treated naturalistically with CT were evaluated for response to treatment using multiple variables assessed both prospectively, and by retrospective review of the medical charts. As a result 26 adults with ADHD were identified of whom all had received prior psychotherapy, 96% had lifetime psychiatric comorbidity with ADHD, and 85% were receiving medications in combination with CT. Patients were treated for a mean (±SD) of 11.7 ± 8 months and 36 ± 24 sessions. Treatment was associated with significant improvements in ADHD, anxiety, and depressive symptoms as well as overall global functioning (p’s < .01). Overall, 69% of ADHD adults were considered to be much to very much improved in their ADHD at the end of treatment. The results of this chart review suggest that CT used generally in conjunction with medications appears useful for adults with ADHD. These pilot data further suggest the need for additional controlled investigations.

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