Comparing Outcomes of the Standard Technique of Endoscopic DCR with Its Modifications: A Retrospective Analysis

Objective To compare the outcomes of various techniques of endoscopic dacryocystorhinostomy (DCR). Study Design Retrospective case record analysis. Settings Tertiary care referral center. Subject and Methods Retrospective analysis of case records was carried out pertaining to the period from January 1996 to September 2017 with respect to patients who had undergone endoscopic DCR with either the standard technique or one of its modifications. Case notes showing well-documented preoperative evaluation, operative details, postoperative assessment, and minimum 6-month follow-up were considered. The outcomes were measured on the basis of patients’ postoperative symptoms, clinical examination, and sac-syringing results. Results A total of 423 patients were included in the study. Of these, 169 underwent standard endoscopic DCR; 87, endoscopic DCR with stent; 19, endoscopic DCR with mitomycin C; 62, powered DCR; 29, laser-assisted DCR; and 57, balloon DCR. There was no statistically significant difference in success rates, recurrences, or complications of various techniques at 3 or 6 months. Mean operating time was lowest for balloon DCR (mean ± SD, 27.1 ± 3.1 minutes), followed by standard endoscopic DCR (38.2 ± 3.6 minutes; P = .001). Conclusion Standard endoscopic DCR and its more sophisticated modifications were equally effective and safe in managing distal nasolacrimal drainage obstruction. Balloon DCR, followed by standard endoscopic DCR, was significantly faster than other techniques.

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Abnormal pathology seen on appendectomy in patients with predominant right-sided pelvic pain

Journal of Endometriosis and Pelvic Pain Disorders ◽

10.1177/2284026520924904 ◽

2020 ◽

Vol 12 (3-4) ◽

pp. 142-150

Author(s):

Catherine W Cai ◽

Katelin E Sisler ◽

Jeffrey A Gavard ◽

Jose D Eugenio-Colon ◽

Patrick P Yeung

Keyword(s):

Pelvic Pain ◽

Care Center ◽

Tertiary Care ◽

High Rate ◽

Retrospective Case ◽

Saint Louis ◽

Pain Location ◽

Significant Difference ◽

Incidental Appendectomy ◽

Abnormal Pathology

Introduction: Previous studies have linked chronic pelvic pain (CPP) to appendix pathologies. However, few studies have investigated appendix pathology specifically in the context of CPP that is right-side predominant (R-CPP). We hypothesized that women with R-CPP have higher rates of appendix pathology compared with women with CPP that is not right-side predominant (N-CPP). Methods: We conducted a retrospective case–control study of 220 women who underwent diagnostic laparoscopy and planned or incidental appendectomy for CPP and suspected endometriosis between January 2015 and December 2018 at a tertiary care center in Saint Louis, MO. Results: No significant difference in abnormal appendix pathology was found between women with R-CPP and women with N-CPP (30.9% vs 34.5%, p = 0.74, odds ratio = 0.85, 95% CI: (0.44, 1.62)). Gross abnormalities of the appendix were documented in 40 of 220 patients (18.2%), with the most common abnormal gross findings being adhesions (8.2%), followed by abnormal lesions (7.3%). Conclusion: In this study, the presence of abnormal pathology within the appendix did not correlate with R-CPP, indicating triage based on predominant pain location cannot help identify patients with underlying appendix pathology. However, consistent with previous studies, we identified a high rate of abnormal appendix pathology overall, supporting the practice of many surgeons to perform routine appendectomy in women with CPP.

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Facial Nerve Outcomes in Middle Cranial Fossa vs Translabyrinthine Approaches

Otolaryngology ◽

10.1016/j.otohns.2005.08.021 ◽

2005 ◽

Vol 133 (6) ◽

pp. 906-910 ◽

Cited By ~ 29

Author(s):

Brandon Isaacson ◽

Steven A. Telian ◽

Hussam K. El-Kashlan

Keyword(s):

Facial Nerve ◽

Tertiary Care ◽

Middle Cranial Fossa ◽

Vestibular Schwannomas ◽

Care Hospital ◽

Case Review ◽

Retrospective Case ◽

Increased Risk ◽

Significant Difference ◽

Cranial Fossa

OBJECTIVE: To compare the final facial nerve outcomes between middle cranial fossa (MCF) vs translabyrinthine (TL) resection of size-matched vestibular schwannomas. STUDY DESIGN AND SETTING: Retrospective case review at a tertiary care hospital. All patients who underwent resection utilizing either MCF or TL approaches with tumors 18 mm or smaller and complete data were included in the analysis. One hundred twenty-four patients were identified meeting the above criteria, with sixty-three in the translabyrinthine group and sixty-one in the middle fossa group. One-week-postoperative and final facial nerve examinations were compared in the two surgical groups. Patients were separately analyzed in subgroups: tumors smaller than 10 mm and those that were between 10 and 18 mm. RESULTS: The tumor size range for the MCF group was 3-18 mm while it was 4-18 mm for the TL group. No statistically significant difference was found in facial nerve outcomes between the two surgical groups, at the first postoperative visit week and at last follow-up. CONCLUSION: Facial nerve outcomes are similar using TL and MCF approaches for resection of vestibular schwannomas up to 18 mm in size. SIGNIFICANCE: Patients undergoing the MCF approach for hearing preservation can be counseled that there is no increased risk of permanent facial nerve weakness, compared to the TL approach. EBM RATING: B-3

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Systematic Functional Assessment of Nasal Dyspnea

Otolaryngology ◽

10.1177/0194599811415811 ◽

2011 ◽

Vol 145 (5) ◽

pp. 845-850 ◽

Cited By ~ 2

Author(s):

Daniel A. Larson ◽

Benjamin W. Cilento

Keyword(s):

Success Rate ◽

Preoperative Evaluation ◽

Tertiary Care ◽

Case Series ◽

Predictive Ability ◽

Preoperative Assessment ◽

Military Hospital ◽

Significant Difference ◽

Vas Scores ◽

Outcome Of Surgery

Objective. Evaluate the ability of a systematic preoperative evaluation to determine the most appropriate procedures for patients undergoing functional septorhinoplasty and to accurately predict postoperative outcomes. Study Design. Case series with chart review. Setting. Tertiary care military hospital. Subjects and Methods. Fifty-nine consecutive patients from a quality control database who underwent functional rhinoplasties for nasal dyspnea were evaluated. All patients underwent a full preoperative assessment using intranasal manipulation to determine the area(s) contributing to their nasal dyspnea. Rates of success for the predictive ability and for the functional outcome were determined for each side of the nose by comparing preoperative visual analog scale (VAS) scores (1-10) to postoperative scores. Results. Overall there was a 91% success rate in predicting the outcome of surgery and a 95% success rate in improving nasal dyspnea at 1 year. There was no statistically significant difference in improvement between different surgical groups (septoplasty ± alar strut grafts ± spreader grafts) or between primary surgeries and revisions. Conclusion. Using a systematic approach to evaluate patients for nasal dyspnea, it is possible to predict and improve outcomes by choosing the most appropriate surgery for each individual.

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Role of silicone stenting in endoscopic dacryocystorhinostomy

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20200136 ◽

2020 ◽

Vol 6 (2) ◽

pp. 248

Author(s):

Abdussalam M. Jahan ◽

Yousef M. Eldanfur ◽

Abdulhakim B. Ghuzi

Keyword(s):

Success Rate ◽

Medical Center ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

P Value ◽

Success Rates ◽

Duct Obstruction ◽

Significant Difference ◽

Silicone Stent ◽

Endoscopic Dcr

Background: Dacryocystorhinostomy (DCR) is a surgical procedure performed to relief nasolacrimal duct obstruction, which involves the creation of ostium at the lacrimal bone to form a shunt in the nasolacrimal pathway. Closure of the rhinostomy opening was considered a major factor for surgical failure. Use of silicone stent in endoscopic DCR to improve the success rate of the operation have been tried by many surgeons. In this study we assess the success rates of endoscopic DCR with and without silicone stents.Methods: Prospective study includes 30 patients were operated in the Department of ENT, Misrata Medical Center, from April 2017 to March 2018. They underwent endonasal endoscopic DCR for primary acquired nasolacrimal duct obstruction. These patients were randomly divided in two groups: A and B with 15 patients in each group. The group A patients underwent endoscopic DCR with silicone stent and group B patients underwent endoscopic DCR without stent. The results were statistically analyzed by chi-square test. Results: 30 patients were included in this study, their age ranged from 17 to 60 years, complaining of epiphora, 24 (80%) were females and 6 (20%) were males. The success rate was higher in patients with silicone stent (93.33%) as compared to patients without silicone stent (86.67%) but this difference in the results is not statistically significant (As p value is 0.542 which is >0.05).Conclusions: Endoscopic DCR is safe, successful procedure for treatment of nasolacrimal duct obstruction and there was no significant difference in the success rates of performing endonasal DCR with silicone or without silicone stents.

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Ultrasound-guided percutaneous renal biopsy at a university hospital: retrospective analysis of success and complication rates

Radiologia Brasileira ◽

10.1590/0100-3984.2020.0064 ◽

2021 ◽

Vol 54 (5) ◽

pp. 311-317

Author(s):

Orlando Vieira Gomes ◽

Bianca Alencar Dias de Almeida ◽

Leonardo Fernandes e Santana ◽

Mateus de Sousa Rodrigues ◽

Guilherme Bruno Pires Marques Locio ◽

...

Keyword(s):

Renal Biopsy ◽

Retrospective Analysis ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

University Hospital ◽

Complication Rates ◽

Care Hospital ◽

Success Rates ◽

Ultrasound Guided ◽

Second Procedure

Abstract Objective: To evaluate the success and complication rates of ultrasound-guided renal biopsy at a tertiary care hospital. Materials and Methods: This was a retrospective analysis of 97 ultrasound-guided renal biopsies, all performed by the same radiologist, between 1 March, 2017 and 31 October, 2019. Results: Of the 97 biopsies evaluated, 87 had a definitive pathological diagnosis. In five cases (5.4%), the biopsy results were inconclusive and a second procedure was required. In seven procedures (7.6%), there were complications, all of which were properly resolved. Conclusion: Ultrasound-guided renal biopsy has proven to be a safe, effective method for the diagnosis of nephropathies, with high success rates.

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First Canadian experience with robotic single-incision pyeloplasty: Comparison with multi-incision technique

Canadian Urological Association Journal ◽

10.5489/cuaj.3440 ◽

2016 ◽

Vol 10 (3-4) ◽

pp. 83 ◽

Cited By ~ 5

Author(s):

Jeffrey Law ◽

Neal Rowe ◽

Jason Archambault ◽

Sofia Nastis ◽

Alp Sener ◽

...

Keyword(s):

Single Incision ◽

Single Port ◽

Operating Time ◽

Length Of Hospital Stay ◽

Success Rates ◽

Access Port ◽

Significant Difference ◽

Site Access ◽

Da Vinci Robotic System ◽

Incision Technique

Introduction: We compared the outcomes of single-incision, robotassisted laparoscopic pyeloplasty vs. multiple-incision pyeloplasty using the da Vinci robotic system.Methods: We reviewed all consecutive robotic pyeloplasties by a single surgeon from January 2011 to August 2015. A total of 30 procedures were performed (16 single:14 multi-port). Two different single-port devices were compared: the GelPort (Applied Medical, Rancho Santa Margarita, CA) and the Intuitive single-site access port (Intuitive Surgical, Sunnyvale, CA).Results: Patient demographics were similar between the two groups. Mean operating time was similar among the single and multi-port groups (225.2 min vs. 198.9 minutes [p=0.33]). There was no significant difference in length of hospital stay in either group (86.2 hr vs. 93.2 hr [p=0.76]). There was no difference in success rates or postoperative complications among groups.Conclusions: Single-port robotic pyeloplasty is non-inferior to multiple-incision robotic surgery in terms of operative times, hospitalization time, success rates, and complications. Verifying these results with larger cohorts is required prior to the wide adoption of this technique. Ongoing objective measurements of cosmesis and patient satisfaction are being evaluated.

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A Structured Maternity Case Record to Improve Quality of Documentation in a Tertiary Care Hospital, Delhi

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/45693.14647 ◽

2021 ◽

Author(s):

AG Radhika ◽

Chetna Dengri ◽

Abhishek Kumar ◽

Shalini Singh

Keyword(s):

Tertiary Care ◽

Intervention Group ◽

Control Group ◽

Care Hospital ◽

Case Record ◽

Hospital Case ◽

Sequence Of Events ◽

Significant Difference ◽

Time Of Admission

Introduction: India contributes to about 18% of global maternal deaths and 22.6% of still births. Efforts to improve the quality of care are challenged by the lack of reliable documentation of data. Hence, a concise, structured maternity case sheet (PrasavRecord) was designed with the aim to bring about an improvement in documentation of treatment and events related to woman in labour from the time of admission till her discharge from the hospital. Aim: To study the improvement in quality of documentation from the time of admission till discharge of a woman in labour with the help of structured format i.e., PrasavRecord. Materials and Methods: The study was conducted in February 2017. A quasi experimental study design was used, and the completeness of data recorded by the resident doctors in the existing hospital case sheet (control group) with those recorded in PrasavRecord (intervention group) were assessed in a total of 65 deliveries in each arm. Details of the patient from admission to the labour room followed by the entire sequence of events during labour as well as hospital stay in postpartum period were recorded over 130 parameters under different sections in PrasavRecord. Statistical analysis was done by using SPSS version 21.0. Results: Completeness of the documentation in terms of history, investigations and findings at examination including those at labour, nearly, 92% of the doctors rated PrasavRecord as “good and very good” for appearance, recommended its routine use, and 75% agreed that the format will be useful for conversion to electronic medical record. There was highly significant difference between the average percentage of completeness in PrasavRecord 75.8 {95% CI (74.2-77.4)} and hospital case sheets 42.2 {95% CI (40.9-43.6)} i.e., z=5.38 p-value <0.001. Conclusion: PrasavRecord is a simple, acceptable and user-friendly data entry format which improves the quality of documentation of the processes and practices during childbirth. Larger trials are required to finetune it to facilitate its widespread use thereby, ensuring a uniform documentation process of labour and postpartum.

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Spectrum of Lysosomal Storage Disorders at Tertiary Centre: Retrospective Case-Record Analysis

Journal of Pediatric Genetics ◽

10.1055/s-0039-3402070 ◽

2020 ◽

Vol 09 (02) ◽

pp. 087-092 ◽

Cited By ~ 1

Author(s):

Ankur Singh ◽

Rajniti Prasad ◽

Om Prakash Mishra

Keyword(s):

Care Center ◽

Tertiary Care ◽

Lysosomal Storage Disorders ◽

Lysosomal Storage ◽

Retrospective Case ◽

Case Record ◽

Consistent Finding ◽

Enzyme Replacement ◽

Storage Disorders

AbstractLysosomal storage disorders (LSDs) are relatively common slow progressive inborn error of metabolism encountered by clinicians. This work intends to highlight the more common LSDs, their clinical presentation, outcome, and mutation (wherever feasible) collected from the genetic clinic at tertiary care center in Eastern Uttar Pradesh. The data for analysis were collected retrospectively from genetic records from a follow-up clinic. All cases < 18 years of age were analyzed. Cases with LSDs with confirmed enzyme results were enrolled in this study. Clinical profile, screening test results, and outcome were collected. There were 32 cases including 27 males and 5 females in this cohort: 8 Gaucher disease (GD) patient and 24 non-GD patients. GD (type 1) is the commonest LSD in GD group. Anemia, thrombocytopenia, splenomegaly, and hepatomegaly were the consistent finding in patients with GD (type 1). L483P mutation was reported in two GD patients. One GD patient is on enzyme replacement therapy for 2 years and is currently doing well. The commonest disorders in non-GD were mucopolysaccharidosis (MPS) (n = 11), metachromatic leukodystrophy (n = 4), I-cell disease (n = 3), Niemann-Pick A/B (n = 3). MPS-II is the commonest MPS among non-GD group.

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Neurotologic Complications Following Microvascular Decompression: A Retrospective Study

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-1677688 ◽

2019 ◽

Vol 81 (01) ◽

pp. 037-042

Author(s):

Matthew Bartindale ◽

Ayah Mohamed ◽

Jason Bell ◽

Matthew Kircher ◽

Jacqueline Hill ◽

...

Keyword(s):

Hearing Loss ◽

Retrospective Study ◽

Microvascular Decompression ◽

Tertiary Care ◽

Significant Risk ◽

Complication Rates ◽

Case Review ◽

Inclusion Criteria ◽

Retrospective Case ◽

Significant Difference

Objective The main purpose of this article is to determine the frequency of neurotologic complications after posterior fossa microvascular decompression (MVD) surgery. Design Retrospective case review. Setting Tertiary care referral center. Participants A total of 215 consecutive MVD operations by a single surgeon between March 1996 and May 2016 were reviewed with 192 surgeries on 183 patients meeting inclusion criteria. Main Outcome Measures Neurotologic complications secondary to MVD. Results The 52 males and 131 females had a mean age of 58.52 years (range, 28–92 years). Indications for MVD were trigeminal neuralgia (n = 162), hemifacial spasm (n = 23), glossopharyngeal neuralgia (n = 13), vagal palsy (n = 1), and tinnitus (n = 1). The outcomes examined were postoperative hearing loss, tinnitus, vertigo, and hemifacial paresis. At least one of these complications was present in 17.7% of patients. There were 4.17% with permanent hearing loss, 6.77% with transient hearing loss, 5.21% with tinnitus, 5.73% with vertigo, and 0.52% with hemifacial paresis. There was no significant difference in complication rates based on surgical indication. Conclusions Neurotologic complications are a significant risk when performing MVD. It is important for otolaryngologists as well as neurosurgeons to be aware of such complications. We recommend perioperative audiometry in all patients undergoing MVD and believe there is utility in routine otolaryngologist involvement.

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Impact of school closings on hospital staff absenteeism: A case study

Journal of Emergency Management ◽

10.5055/jem.2007.0035 ◽

2007 ◽

Vol 5 (6) ◽

pp. 70

Author(s):

Nathan Timm, MD ◽

Jacqueline Grupp-Phelan, MD, MPH ◽

Joseph S. Kroner, MSN, RN

Keyword(s):

Child Care ◽

Tertiary Care ◽

Hospital Staff ◽

Retrospective Case ◽

School Closings ◽

Hospital Nursing ◽

Significant Difference ◽

Inpatient Nursing ◽

The Impact

Objective: Determine the impact school closings during snow emergencies have on hospital nursing absenteeism.Design: Retrospective case-control study.Setting: Large urban tertiary-care children’s hospital.Participants: Inpatient nursing staff.Main outcomes measured: Absenteeism rates due to lack of child care during snow emergency dates.Results: There is a statistically significant difference between nursing absenteeism due school closings compared with control dates (p = 0.01); however, the overall impact on hospital nursing staff availability is minimal (0.4 percent).Conclusions: Short-term school closings during snow emergencies do not result in significant rates of nursing absenteeism due to lack of child care.

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