Distal superficial femoral vein versus axillary vein central catheter placement under ultrasound guidance for neonates with difficult access: A randomized clinical trial

2021 ◽  
pp. 112972982110118
Author(s):  
Yanzhe Tan ◽  
Lifei Liu ◽  
Zhenzhen Tu ◽  
Ying Xu ◽  
Jia Xie ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Ultrasound Guidance ◽  
Femoral Vein ◽  
Axillary Vein ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Superficial Femoral Vein ◽  
Group 4 ◽  
The Mean ◽  
Safe Access

Background: Epicutaneo-caval catheters (ECCs) are extensively used in premature and ill neonates. This prospective, randomized, observational study aimed to compare the outcomes of ECC placement in the distal superficial femoral and axillary veins in neonates with difficult ECC access. Methods: In a neonatal intensive care unit at a tertiary referral center, 60 neonates with difficult ECC access were randomized into two groups with catheters placed using the ultrasound-guided modified dynamic needle tip positioning (MDNTP) technique: distal superficial femoral vein (DSFV) and axillary vein (AV) groups. Results: The first attempt success rate was significantly higher in the DSFV group than in the AV group [23/30 (76.7%) vs 11/30 (36.7%), p = 0.001; odds ratio (OR), 0.176; 95% confidence interval (CI) 0.057–0.543]. The mean procedural duration was significantly shorter in the DSFV group than in the AV group [mean: 308.5 (standard deviation: 81.1) s vs 522.74 (134.8) s, t = −7.17, p < 0.001]. The incidence of complications was significantly lower in the DSFV group than in the AV group [4/30 (13.3%) vs 12/30 (40.0%), p = 0.019; OR, 4.333; 95% CI 1.203–15.604]. The number of attempts was significantly fewer in the DSFV group than in the AV group ( p = 0.012). Conclusions: The distal superficial femoral and axillary veins are two alternative and safe access points for ECC placement in premature neonates (weight < 2.5 kg) with difficult access. However, access through the distal superficial femoral vein was quicker, easier, and had fewer complications than through the axillary vein.

Amniotic Band Syndrome: A Single-Institutional Experience

2014 ◽  
Vol 37 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Corey W. Iqbal ◽  
S. Christopher Derderian ◽  
Yvonne Cheng ◽  
Hanmin Lee ◽  
Shinjiro Hirose
Keyword(s):  
Body Wall ◽  
Membrane Disruption ◽  
Common Site ◽  
Tertiary Referral ◽  
Fetal Intervention ◽  
Amniotic Band ◽  
Tertiary Referral Center ◽  
Amniotic Band Syndrome ◽  
Institutional Experience ◽  
The Mean

Introduction: Amniotic band syndrome (ABS) is uncommon. We review our single-institutional experience to define its natural history and outcomes. Materials andMethods: We conducted a retrospective analysis from a single, tertiary referral center of patients evaluated for and confirmed to have ABS from 1997 to 2012. Results: Twenty-eight patients had confirmed ABS. The mean ± SD maternal age was 27.9 ± 5.9 years, and the mean gestational age at diagnosis was 20.7 ± 3.8 months. Oligohydramnios was reported in 4 patients. Eleven patients had membrane disruption, of whom 4 had undergone a prior percutaneous intervention. Extremities were the most common site affected (n = 20), followed by the umbilical cord (n = 7), abdomen (n = 5), limb-body wall complex (n = 5), head (n = 1), and chest (n = 1). Nine patients were felt to be candidates for fetal intervention; 5 underwent fetoscopic amniotic band lysis with 4 survivors. Overall survival, excluding 3 terminations, was 74%. There were 5 fetal demises and one neonatal death. Cord involvement was higher in nonsurvivors (67%) compared to survivors (19%, p = 0.05). Discussion: ABS most commonly involves the extremities. Membrane disruption is not always present. Fetoscopic lysis is appropriate for select patients, and special consideration should be given for cord involvement, which is associated with a worse outcome.

scholarly journals Middle Ear Packing and External Ear Packing with Fibrin Glue Enhances the Success of Fat Myringoplasty without Hyaluronic Acid Disc

2021 ◽  
Author(s):  
Jongmin Kim ◽  
Chul Ho Jang
Keyword(s):  
Success Rate ◽  
Fibrin Glue ◽  
Middle Ear ◽  
Fat Graft ◽  
External Ear ◽  
Tertiary Referral ◽  
Closure Rate ◽  
Tertiary Referral Center ◽  
Significant Difference ◽  
The Mean

Background: To date, FM using middle ear packing has rarely reported. In this study, we hypothesized that middle ear packing with dexamethasone soaked gelfoam and fibrin glue over the fat graft could promote the success rate of TMP closure regardless of perforation size. Methods: Between January 2005 and July 2020, a total of 209 patients who underwent fat myringoplasty due to chronic TMP at tertiary referral center were encountered and analyzed. The success rate and audiologic outcome was analyzed. Results: The mean successful TM closure rate was 88.0 %. The success rate by different age generation was not significant difference. The size of the perforation grade showed no significant difference. The perforation site by anterior or posterior was not significant. The preoperative mean threshold of AC, BC and ABG were 55.71, 12.98 and 42.73 dB respectively. The postoperative mean threshold of AC, BC and ABG were 23.67, 12.98 and 10.69 dB. The change of preoperative and postoperative hearing showed statistically significant. Conclusion: From our results, the simple trimming of the perforation edge and middle ear packing with external ear canal packing using fibrin glue induced the stable adhesion between the remnant TM and the fat graft.

The effect of migraine and motion sickness on symptoms evoked by the caloric vestibular test

2021 ◽  
pp. 1-10
Author(s):  
Ozlem Gedik Soyuyuce ◽  
Pinar Yalinay Dikmen ◽  
Nazim Korkut
Keyword(s):  
Data Analysis ◽  
Motion Sickness ◽  
Retrospective Data ◽  
Tertiary Referral ◽  
Sensory Stimuli ◽  
Tertiary Referral Center ◽  
Retrospective Data Analysis ◽  
Increased Risk ◽  
Vestibular Symptoms ◽  
The Mean

BACKGROUND: The caloric vestibular test (CVT) may evoke headache and vestibular symptoms in susceptible people. Patients with migraines have higher susceptibility to motion sickness. In migraines, impaired habituation to repetitive stimuli is a well-known interictal abnormality. OBJECTIVE: This study is aimed at evaluating CVT-evoked headache, nausea, vomiting, and imbalance in patients with and without migraine and/or motion sickness. METHODS: A retrospective data analysis was performed on 554 patients with a complaint of dizziness who underwent bithermal CVT at a tertiary referral center. The occurrences of CVT-evoked headache, nausea, vomiting, and imbalance were observed in four groups: patients with only migraine (MG; n = 94), those with only motion sickness (MSG; n = 89), those with migraine and motion sickness (MMSG; n = 122), and those without migraine and motion sickness (non-MMSG; n = 146). The differences between the groups were assessed. RESULTS: The mean ages of groups were similar (p = 0.534). The proportions of females were higher in the MG, MSG, and MMSG (p = 0.001). The severity of nausea and headache for each gender was higher in the MG, MSG, and MMSG (p <  0.001). Vomiting was more common in MMSG among males (p = 0.003), while there was no difference between groups among females (p = 0.099). Imbalance was more common in MMSG among females (p <  0.001). A relationship was detected between age and imbalance (p <  0.001), where an increased risk for imbalance was evident with greater age. Three patients in the MMSG needed hospitalization after CVT. CONCLUSIONS: Special caution is needed when performing caloric testing for patients with migraines or MS since CVT-evoked symptoms may occur with higher incidence and intensity, which might be related to a lack of habituation in neuronal information processing after robust sensory stimuli like CVT.

scholarly journals Is systematic screening for thyroid disorders indicated in subfertile men?

2006 ◽  
Vol 154 (3) ◽  
pp. 363-366 ◽  
Author(s):  
K Poppe ◽  
D Glinoer ◽  
H Tournaye ◽  
U Maniewski ◽  
P Haentjens ◽  
...  
Keyword(s):  
Thyroid Autoimmunity ◽  
Thyroid Disorders ◽  
Tertiary Referral ◽  
Systematic Screening ◽  
Tertiary Referral Center ◽  
Semen Characteristics ◽  
The Mean ◽  
Group 2 ◽  
Serum Tsh ◽  
Group 1

Context: Data on the prevalence of thyroid disorders in male subfertility remain scarce. Objective: To investigate the prevalence of thyroid dysfunction and thyroid autoimmunity in men with normal and abnormal semen characteristics. Setting: Tertiary referral center for reproductive medicine of the University Hospital AZ-VUB, Brussels, Belgium. Patients and design: Two hundred and ninety-two men were stratified according to the presence of normal (group 1; n = 39) or abnormal (group 2; n = 253) semen characteristics. Thyroid function was assessed by serum thyrotropin (TSH) and free thyroxine (FT4), and thyroid peroxidase antibodies (TPO-Ab) for thyroid autoimmunity (TAI or TPO-Ab > 34 kU/l); both were correlated with semen characteristics. Main outcome measures: Semen characteristics were determined by World Health Organisation criteria (rapid + slow motility ≥ 50% and concentration ≥ 20 × 106) and Kruger criteria (morphology ≥ 14% normal cells). Results: In group 1, the mean (± s.d.) age was 33 ± 4 years; serum TSH was 1.6 (0.3–29.6) mU/l (median (range)) and FT4 was 12.2 (8.8–15.6) ng/l. In group 2, the mean age was 33 ± 5 years, serum TSH was 1.3 (0.3–5.2) mU/l and FT4 was 12.5 (8.4–17.5) ng/l; (compared with group 1 P = 0.008 for TSH and P = 0.037 for FT4). In both groups, one patient had increased TSH (2.6% and 0.4%; P = not significant (ns)). In group 1, one patient had TAI and in group 2 twelve patients had TAI (2.6% compared with 4.7%; P = ns). FT4 was an independent determinant for semen characteristics. Conclusions: The prevalence of thyroid dysfunction and autoimmunity is comparable between men with normal and abnormal semen characteristics. On the basis of these data, we do not advise systematic screening for thyroid disorders in subfertile men consulting a tertiary referral center for reproductive medicine.

Minimal Clinically Important Difference of the Standardized Cosmesis and Health Nasal Outcomes Survey

2019 ◽  
Vol 39 (8) ◽  
pp. 837-840 ◽  
Author(s):  
Cherian K Kandathil ◽  
Mikhail Saltychev ◽  
Mohamed Abdelwahab ◽  
Emily A Spataro ◽  
Sami P Moubayed ◽  
...  
Keyword(s):  
Nasal Obstruction ◽  
Minimal Clinically Important Difference ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Clinically Important Difference ◽  
Symptom Evaluation ◽  
The Mean ◽  
O 18 ◽  
Preoperative Score

AbstractBackgroundThe minimal clinically important difference (MCID) for the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) has not been determined.ObjectivesThe authors sought to define the MCID for both domains of the SCHNOS questionnaire.MethodsThis prospective cohort study included patients who underwent functional, cosmetic, or combined rhinoplasty operation from June 2017 to June 2018 at a tertiary referral center. The average preoperative, postoperative, and change in scores were calculated for the nasal obstruction symptom evaluation scale (NOSE) and SCHNOS. Anchor-based MCIDs were estimated for both SCHNOS subscales to define change in obstruction and cosmesis perceived after the rhinoplasty.ResultsEighty-seven patients (69% women, 31% males) with a mean age (standard deviation [SD]) of 38 years (14.7) at the time of surgery were included. The mean postoperative follow-up period (SD) was 145 days (117). The mean preoperative score (SD) for the NOSE was 52 (32), SCHNOS for nasal obstruction (SCHNOS-O) score was 55 (33), and SCHNOS for nasal cosmesis (SCHNOS-C) score was 50 (26) points. Postoperatively, the NOSE score was 23 (22), SCHNOS-O score was 24 (23), and SCHNOS-C score was 13 (18) points. The mean change in scores (SD) for NOSE, SCHNOS-O, and SCHNOS-C was −29 (37), −31 (38), and −37 (28), respectively. The calculated MCID for SCHNOS-O was 26 (16) and for SCHNOS-C was 22 (15) points. The MCID for NOSE was 24 (13) points. A sensitivity test for the patients with a follow-up ≥3 months showed only slightly different MCID estimates: 28 (17) for SCHNOS-O, 18 (13) for SCHNOS-C, and 24 (15) points for NOSE.ConclusionsFor the obstruction domain SCHNOS-O, the MCID was 28 points. For the cosmetic domain SCHNOS-C, the MCID was 18 points.

scholarly journals Ocular involvement in systemic lupus erythematosus patients: a paradigm shift based on the experience of a tertiary referral center

Lupus ◽  
2020 ◽  
Vol 29 (3) ◽  
pp. 283-289 ◽  
Author(s):  
A Dias-Santos ◽  
J Tavares Ferreira ◽  
S Pinheiro ◽  
J P Cunha ◽  
M Alves ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Optical Coherence Tomography ◽  
Lupus Erythematosus ◽  
Ocular Involvement ◽  
Optical Coherence ◽  
Systemic Lupus ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Referral Center ◽  
The Mean

Objective To evaluate ocular involvement in a cohort of systemic lupus erythematosus (SLE) patients of a tertiary referral center and to compare the results with the existing literature. Methods Patients underwent a complete ophthalmological evaluation, including visual acuity, slit-lamp examination, fluorescein staining, Schirmer-I test, Goldmann applanation tonometry, fundoscopy, 10-2 automated threshold visual fields, fundus autofluorescence and spectral-domain optical coherence tomography to screen for hydroxychloroquine (HCQ) macular toxicity. Results A total of 161 patients (16 men and 145 women) were enrolled in this study. The mean age was 47.6 years and the mean disease duration was 11.5 years. Fifty patients (31.1%) had at least one ocular manifestation of SLE. The most frequent manifestation was dry eye syndrome (12.4%), immediately followed by cataracts (11.2%) and HCQ macular toxicity (11.2%). Among patients with HCQ maculopathy, two presented with an atypical spectral-domain optical coherence tomography pattern. Five patients (3.1%) presented with glaucoma, two patients (1.2%) presented with SLE retinopathy while only one presented with lupus choroidopathy (0.6%). Conclusions Compared with previous studies, we conclude there has been a significant reduction in disease-related ocular complications, particularly those associated with poor systemic disease control. On the other hand, drug and age-related complications are assuming a prominent role in the ophthalmic care of these patients.

Evaluation of Factors Concerning the Olfaction Using the Sniffin’ Sticks Test

2011 ◽  
Vol 146 (2) ◽  
pp. 240-246 ◽  
Author(s):  
Kadir Serkan Orhan ◽  
Burak Karabulut ◽  
Nesil Keleş ◽  
Kemal Değer
Keyword(s):  
Educational Status ◽  
Turkish Population ◽  
Education Level ◽  
Normative Values ◽  
Prospective Clinical Study ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Highly Educated ◽  
The Mean ◽  
The Relationship

Objective. This study aimed to research the normative values of olfactory function in the Turkish population using the Sniffin’ Sticks test and to relate olfactory performance to age, sex, smoking, educational level, and the side examined. It also aimed to compare the results with other countries’ normative values, especially Europe, using the same test and procedure. Study Design. Prospective clinical study. Setting. Tertiary referral center. Subjects and Methods. This study was a prospective clinical trial conducted in a tertiary clinic. A total of 100 healthy subjects were included in the study. Of these, 50 were men and 50 were women. The mean (SD) age of the subjects was 37.7 (14.8) years (range, 18-77 years). Results. Odor scores were lower than the scores of other countries, and the scores decreased significantly with age. There was no relationship between olfaction and sex or smoking. Subjects with a lower educational status had lower scores compared with the scores of median and highly educated subjects. Conclusion. This is the first study that evaluated the relationship between education level and olfaction. According to the results, the cultural differences, education level, and age seemed to influence odor scores. The Sniffin’ Sticks test can be used to assess olfactory performance in a Turkish population, but identification of odors in this test battery may show variability because of local and cultural factors.

Prevalence, Clinical Characteristics, and Causes of Vision Loss in Patients with Ocular Toxoplasmosis

2011 ◽  
Vol 21 (6) ◽  
pp. 811-819 ◽  
Author(s):  
Nikolas J.S. London ◽  
Anna Hovakimyan ◽  
Leo D.P. Cubillan ◽  
Carlos D. Siverio ◽  
Emmett T. Cunningham
Keyword(s):  
Vision Loss ◽  
Young Male ◽  
Scar Formation ◽  
Ocular Toxoplasmosis ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Younger Age ◽  
The Mean ◽  
Atypical Presentations ◽  
Active Disease

Purpose. To describe the prevalence, demographics, clinical features, and contributors to vision loss at presentation in a large cohort of patients with ocular toxoplasmosis seen at a tertiary referral center in northern California. Methods. A retrospective review of the charts of 233 patients with ocular toxoplasmosis examined over 24 years. Results. Ocular toxoplasmosis was diagnosed in 233 (8.4%) of 2761 patients with uveitis. The mean age at presentation was 27.2 years. Patients with ocular toxoplasmosis were more likely to be young (p<0.01), male (p<0.001), and Latino (p<0.001) as compared with patients in the entire uveitis cohort. At presentation, 159 patients (68.2%) had active disease, which was unilateral in all but one. Among the 160 eyes with active disease, 145 (90.6%) presented with a focal retinochoroiditis, 57.2% of which had an adjacent retinochoroidal scar. Atypical presentations occurred in 11 patients (6.9%). Of eyes with active disease, the main contributors to vision loss at presentation were intraocular inflammation (74.8%) and macular involvement (24.3%), whereas in eyes with inactive lesions the main contributors to vision loss were macular scar formation (67.9%) and amblyopia (11.3%). Younger age was the single significant predictor of macular involvement. Conclusions. Ocular toxoplasmosis is a common cause of uveitis. Our patients were more likely than general uveitis patients to be young, male, and Latino, often having emigrated from Mexico or Central or South America. The most common contributors to decreased vision in eyes with active lesions were inflammation and macular involvement, whereas in eyes with inactive lesions they were macular scar formation and amblyopia.

Effect of resistance of the exercise band on the peak femoral vein velocity during active ankle flexion

2019 ◽  
Vol 35 (3) ◽  
pp. 176-183
Author(s):  
Kouji Tsuda ◽  
Naonobu Takahira ◽  
Motoki Ejiri ◽  
Kenta Sakai ◽  
Miki Sakamoto ◽  
...  
Keyword(s):  
Femoral Vein ◽  
Plantar Flexion ◽  
Healthy Young Adult ◽  
Sitting Posture ◽  
Superficial Femoral Vein ◽  
Adult Men ◽  
Supine Posture ◽  
The Mean ◽  
The Right ◽  
Ankle Plantar Flexion

Objective To examine the resistance effect of using an exercise band on the lower extremity venous velocity during active ankle flexion. Methods Twenty healthy young adult men performed active ankle flexion every 2 s either with no band or with two exercise bands, marked red and silver in the order of increasing tension. They held the band in its natural length with an elbow in extension and an ankle in maximal dorsiflexion at initiation of each active plantar flexion in each posture. The peak velocity in the right superficial femoral vein was measured in each condition. Results Holm’s multiple comparisons revealed significant increases in the mean (individual 95% confidence intervals) peak velocities (cm/s) with no, red, and silver bands (35.8 (28.9–42.7), 46.5 (38.8–54.3), and 56.9 (47.0–66.8), respectively, in the sitting posture, and 50.7 (39.2–62.3), 60.7 (46.8–74.6), and 69.0 (55.3–82.7), respectively, in the supine posture; all p < 0.01). Conclusion Resistance with the exercise bands efficiently enhanced the femoral venous velocity during active ankle plantar flexion.

scholarly journals Real-world Efficacy and Safety of Dulaglutide in Korean Patients with Type 2 Diabetes Mellitus: A Retrospective Study in a Tertiary Referral Center

2020 ◽  
Author(s):  
Jee Hee Yoon ◽  
A Ram Hong ◽  
Wonsuk Choi ◽  
Ji Yong Park ◽  
Hee Kyung Kim ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Body Weight ◽  
Efficacy And Safety ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Korean Patients ◽  
The Mean

Abstract Background: This study was conducted to evaluate the efficacy and safety of once-weekly dulaglutide therapy as add-on to oral antidiabetic drugs (OADs) and basal insulin in Korean patients with type 2 diabetes mellitus (T2DM) in the real-world clinical practice.Methods: We retrospectively reviewed the medical records of 112 patients who received dulaglutide in a tertiary referral center. The primary efficacy endpoint was a change in glycated hemoglobin (HbA1c) between baseline and 6 months. The secondary endpoints were the percentage of patients achieving HbA1c <7.0% or ≤6.5% and the change of body weight at 6 months. Results: At baseline, the mean HbA1c was 8.7 % (8.8% in the add-on to OAD and 8.5% in the add-on to insulin group). The mean adjusted HbA1c at 6 months decreased by −1.13% in the overall patients (p < 0.001), and by −1.36 and −0.74% in the add-on to OAD and add-on to insulin group, respectively. A significant reduction of −2.9 kg in body weight was observed in the overall patients at 6 months (p < 0.001). Approximately 34.8% and 23.2% of patients achieved HbA1c <7.0% and ≤6.5%, respectively. Higher baseline HbA1c and no previous insulin therapy were associated with good response to dulaglutide on multivariate analysis. In subgroup analysis to evaluate the long-term efficacy of dulaglutide (n=82), the mean adjusted HbA1c decreased by −0.86% from baseline to 12 months (p < 0.001). Mild gastrointestinal issues (23.2%) were the most frequently observed adverse events.Conclusions: Dulaglutide is an effective and durable treatment option as add-on to OAD and basal insulin therapy in Korean patients with T2DM.

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