Cephalic arch stenosis in the arteriovenous fistula: A retrospective analysis of predisposing factors

Background: Cephalic Arch Stenosis (CAS) is a frequently observed complication in brachiocephalic and radiocephalic arteriovenous fistulae (AVF) associated with high morbidity and healthcare expenditure. The predisposing factors and preventative strategies for CAS remain unclear. Our aim was to examine predisposing factors for CAS development in the AVF. Methods: A retrospective case-control study was performed at Gold University Coast Hospital on patients with AVFs created from 2009 to 2018 with ⩾18 months follow-up. CAS was defined as a >50% narrowing on angiographic assessment with clinically significant symptoms (dialysis dysfunction, arm swelling, prolonged bleeding after access). Results: About 187 patients with AVF were included in the analysis (36 brachiocephalic, 151 radiocephalic). CAS developed in 22 of 36 (61%) of brachiocephalic AVF and 9 of 151 (6%) of radiocephalic AVFs. Brachiocephalic AVF were ⩾12 times more likely to develop CAS than radiocephalic AVF (Hazard Ratio (HR) 12.7, 95% CI [5.6–28.3], p < 0.001). Each 1 mL/min increase in flow rate through the AVF, correlated with a 0.07% increase in the probability of development of CAS (HR 1.0007, 95% CI [1.0001–1.0012], p = 0.011). Brachiocephalic AVFs with CAS were associated with a higher number of interventional procedures per access-year compared with their non-CAS counterparts (Median [Interquartile range]: 1.76 [0.74, 3.97] vs 0.41 [0.27, 0.67], p = 0.003). Conclusion: Brachiocephalic AVF with higher access flow rates are more likely to develop CAS and earlier than radiocephalic AVF, and in a dose dependent fashion. AVF flow rate is a major factor in CAS development within brachiocephalic AVF and has potential utility in surveillance thresholds for prophylactic blood flow reduction procedures. AVFs with CAS are associated with a greater number of interventional procedures per access-year, heralding higher patient morbidity and healthcare expenditure. Further prospective studies will help define an AVF access flow rate threshold in the implementation of prophylactic strategies for CAS.

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One-year experience of government-funded magnetic resonance imaging prior to prostate biopsy: A case for omitting biopsy in men with a negative magnetic resonance imaging

Journal of Clinical Urology ◽

10.1177/20514158211004334 ◽

2021 ◽

pp. 205141582110043

Author(s):

Hanna J El-Khoury ◽

Niranjan J Sathianathen ◽

Yuxin Jiao ◽

Reza Farzan ◽

Dennis Gyomber ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Prostate Cancer ◽

Magnetic Resonance ◽

Prostate Biopsy ◽

Multivariable Analysis ◽

Transrectal Ultrasound ◽

Resonance Imaging ◽

Retrospective Case ◽

Level Of Evidence ◽

Clinically Significant

Objectives: This study aimed to characterise the accuracy of multiparametric magnetic resonance imaging (mpMRI) as an adjunct to prostate biopsy, and to assess the effect of the new Australian Medicare rebate on practice at a metropolitan public hospital. Patients and methods: We identified patients who underwent transrectal ultrasound (TRUS)-guided prostate biopsy at a single institution over a two-year period. Patients were placed into two groups, depending upon whether their consent was obtained before or after the introduction of the Australian Medicare rebate for mpMRI. We extracted data on mpMRI results and TRUS-guided biopsy histopathology. Descriptive statistics were used to demonstrate baseline patient characteristics as well as MRI and histopathology results. Results: A total of 252 patients were included for analysis, of whom 128 underwent biopsy following the introduction of the Medicare rebate for mpMRI. There was a significant association between Prostate Imaging Reporting and Data System v2 (PI-RADS) classification and the diagnosis of clinically significant prostate cancer ( p<0.01). Only one man with PI-RADS ⩽2 was found to have clinically significant prostate cancer. Four men with a PI-RADS 3 lesion were found to have clinically significant cancer. A PI-RADS 4 or 5 lesion was significantly associated with the diagnosis of clinically significant cancer on multivariable analysis. Conclusion: mpMRI is an important adjunct to biopsy in the diagnosis of clinically significant prostate cancer. Our findings support the safety of omitting/delaying prostate biopsy in men with negative mpMRI. Level of evidence: Level 3 retrospective case-control study.

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Over-under cartilage tympanoplasty: technique, results and a call for improved reporting

The Journal of Laryngology & Otology ◽

10.1017/s0022215120001978 ◽

2020 ◽

Vol 134 (10) ◽

pp. 875-881

Author(s):

I D Erbele ◽

M R Fink ◽

G Mankekar ◽

L S Son ◽

R Mehta ◽

...

Keyword(s):

Tertiary Care ◽

Case Series ◽

Senior Author ◽

Retrospective Case ◽

Closure Rate ◽

Hearing Results ◽

Middle Ear Cholesteatoma ◽

Cartilage Tympanoplasty ◽

The Mean ◽

Clinically Significant

AbstractObjectiveThis study aimed to describe the microscopic over-under cartilage tympanoplasty technique, provide hearing results and detail clinically significant complications.MethodThis was a retrospective case series chart review study of over-under cartilage tympanoplasty procedures performed by the senior author between January 2015 and January 2019 at three tertiary care centres. Cases were excluded for previous or intra-operative cholesteatoma, if a mastoidectomy was performed during the procedure or if ossiculoplasty was performed. Hearing results and complications were obtained.ResultsSixty-eight tympanoplasty procedures met the inclusion criteria. The median age was 13 years (range, 3–71 years). The mean improvement in pure tone average was 6 dB (95 per cent confidence interval 4–9 dB; p < 0.0001). The overall perforation closure rate was 97 per cent (n = 66). Revision surgery was recommended for a total of 6 cases (9 per cent) including 2 post-operative perforations, 1 case of middle-ear cholesteatoma and 3 cases of external auditory canal scarring.ConclusionOver-under cartilage tympanoplasty is effective at improving clinically meaningful hearing with a low rate of post-operative complications.

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Self-retained cryopreserved amniotic membrane for treating severe corneal ulcers: a comparative, retrospective control study

Scientific Reports ◽

10.1038/s41598-020-73672-2 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Han Y. Yin ◽

Anny M. S. Cheng ◽

Sean Tighe ◽

Philip Kurochkin ◽

Jamie Nord ◽

...

Keyword(s):

Visual Acuity ◽

Adjuvant Therapy ◽

Corneal Ulcer ◽

Control Group ◽

Retrospective Case ◽

Corneal Ulcers ◽

Initial Visual Acuity ◽

Snellen Visual Acuity ◽

Clinically Significant ◽

Control Study

Abstract To compare the effectiveness of self- retained cryopreserved AM as an adjuvant therapy for infectious corneal ulcers. Retrospective, case–control study of 24 eyes of 24 consecutive patients with central and paracentral corneal infectious ulcers and initial visual acuity worse than 20/200. Among them, 11 eyes of 11 patients received additional placement of self-retained cryopreserved AM. Epithelialization and Best Corrected Snellen Visual Acuity (BCSVA) were compared between the two groups. At baseline, both groups had comparable age, gender, visual acuity (VA), size and location of corneal ulcer. Patients receiving additional placement of cryopreserved AM had significantly faster epithelialization within 3.56 ± 1.78 weeks vs 5.87 ± 2.20 weeks (p = 0.01) and achieved complete epithelialization in significantly more patients (72.7% vs 23.1% p = 0.04) despite overall larger baseline defect size (32.7 ± 19.5 mm2 vs 21.5 ± 10.7 mm2, p = 0.11). Consequently, the AM group had clinically significant BCSVA (> 3 lines) (81.8% vs 38.4%, p = 0.047) and total VA improvement (log MAR 0.7 ± 0.6 vs 1.6 ± 0.9, p = 0.016) compared to the control group at the time of complete epithelialization. In-office sutureless AM may be an effective adjuvant therapy in treating sight-threatening infectious corneal ulcers by promoting faster corneal epithelialization and overall better recovery of the VA.

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Candidiasis Causing Vocal Fold Leukoplakia: Review of Clinical and Pathological Results of 289 Cases With Vocal Fold Leukoplakia

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489419848792 ◽

2019 ◽

Vol 128 (10) ◽

pp. 903-910 ◽

Cited By ~ 1

Author(s):

Murat Gumussoy ◽

Ulku Kucuk

Keyword(s):

Vocal Fold ◽

Inhaled Corticosteroids ◽

Medical Center ◽

Age Groups ◽

Significant Risk ◽

Case Series ◽

Predisposing Factors ◽

Retrospective Case ◽

Vocal Fold Leukoplakia

Objective: In laryngology practice, vocal fold leukoplakia is frequently evaluated by suspension laryngoscopy and biopsy examination upon the patient’s complaints of hoarseness and dysphonia. The purpose of the present study is to investigate and analyze risk factors, diagnosis, treatment, and follow-up results of cases with Candida leukoplakia. Study Design: Retrospective case control study. Setting: Tertiary medical center. Subjects and Methods: Patients with a diagnosis of vocal fold leukoplakia who underwent direct laryngoscopy and biopsy between 2007 and 2017 and diagnosed as candida or noncandida in their histopathology were assigned into 2 groups. Then they were compared in terms of their demographic characteristics, predisposing factors, diagnosis, treatment, and follow-up results. Results: Of the 289 vocal fold leukoplakia cases, 36 were candida, and 253 were noncandida. The mean age of the patients with Candida leukoplakia was 60.86 years. As for the age groups, the largest group (26.1%) was in the seventh decade ( P < .001). The use of inhaled corticosteroids was a significant risk factor ( P < .001). For their medical therapy, the patients were administered fluconazole 200 mg per day for 3 weeks, and the treatment yielded successful results in 91.66% of them. In 5 of the patients, candida leukoplakia and superficial epithelial dysplasia were observed, and no malignant transformation was observed during a mean follow-up of 28 ± 13 months. Conclusion: Candidiasis causing vocal fold leukoplakia is rare, and we report the findings of the largest published case series to date. Eliminating predisposing factors and administrating oral fluconazole 200 mg for 3 weeks are sufficient for medical treatment.

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Prenatal predisposing factors associated with neonatal lupus erythematosus

Lupus ◽

10.1177/09612033211066455 ◽

2022 ◽

pp. 096120332110664

Author(s):

Sanitra Anuwutnavin ◽

Varisa Chuenchitkultavorn ◽

Rattanavalai Nitiyarom ◽

Thanapa Rekhawasin ◽

Supaluck Kanjanauthai ◽

...

Keyword(s):

Multivariate Analysis ◽

Lupus Erythematosus ◽

Protective Factor ◽

Predisposing Factors ◽

Neonatal Lupus ◽

Retrospective Case ◽

Female Fetus ◽

Neonatal Lupus Erythematosus ◽

Increased Risk ◽

Female Baby

Objectives To identify the prenatal predisposing factors related to neonatal lupus erythematosus (NLE). Materials and Methods A retrospective case-control study was made of 131 pregnant women with positive anti-Ro or anti-La autoantibodies and known neonatal outcomes between January 2002 and December 2019 at Siriraj Hospital, Bangkok, Thailand. There were 101 unaffected neonates and 30 NLE cases confirmed postnatally. Demographic and clinical data of the mothers and neonates with and without NLE were statistically compared. Results NLE was diagnosed in 30 out of 131 cases. A multivariate analysis identified the following significant factors for NLE: maternal anti-La antibodies (odds ratio (OR), 3.591; p = 0.030); and maternal treatment with either hydroxychloroquine (OR, 0.082; p = 0.001) or prednisolone (OR, 0.136; p = 0.017). Of the significant variables examined in the multivariate analysis models, high levels of maternal anti-La antibodies were found to be the strongest predictor of noncardiac NLE (OR, 4.558; p = 0.032), while a female baby was significantly higher in pregnancies complicated by cardiac NLE (OR, 5.374; p = 0.046). Hydroxychloroquine still provided a protective effect for both cardiac and noncardiac NLE ( p = 0.039 and 0.032, respectively). Conclusions The maternal anti-La antibodies were a beneficial predictor for NLE, especially as their high titers were influentially associated with noncardiac features. A female fetus seemed to present an increased risk for developing a congenital heart block. Nevertheless, the treatment with hydroxychloroquine during the pregnancies demonstrated a potentially protective factor against both cardiac and noncardiac manifestations.

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Surfactant Therapy In Neonates With Respiratory Deterioration Due to Pulmonary Hemorrhage

PEDIATRICS ◽

10.1542/peds.95.1.32 ◽

1995 ◽

Vol 95 (1) ◽

pp. 32-36

Author(s):

Paresh B. Pandit ◽

Michael S. Dunn ◽

Enza A. Colucci

Keyword(s):

Repeated Measures ◽

Neonatal Intensive Care ◽

Controlled Trial ◽

Case Series ◽

Pulmonary Hemorrhage ◽

Oxygenation Index ◽

Surfactant Therapy ◽

Exogenous Surfactant ◽

Retrospective Case ◽

Clinically Significant

Objective. To study the effect of exogenous bovine surfactant on oxygen and ventilatory requirements in neonates with respiratory deterioration due to pulmonary hemorrhage. Design. Retrospective case series. Setting. Three regional neonatal intensive care units. Methods. Infants who received surfactant following a clinically significant pulmonary hemorrhage during the time period July 1991 to December 1993 were identified from a database. Infants were excluded if any other cause was found to explain their deterioration. The primary outcome was change in respiratory status following surfactant therapy, as reflected by oxygenation index (OI) and arterial/Alveolar oxygen ratio. Data points were taken as averages of 3 through 6 hours and 0 through 3 hours for the 6 hours before and after surfactant. Differences were analyzed using analysis of variance for repeated measures, with treatment and time as co-variates. Results. Fifteen patients fulfilled inclusion criteria. Median values (range): birth weight, 960 g (595 to 4045); age at pulmonary hemorrhage, 24.4 hours (0.3 to 62); and interval between pulmonary hemorrhage and surfactant therapy, 10 hours (3.7 to 46.5). Mean OI improved from 24.6, at 0 to 3 hours presurfactant, to 8.6 at 3 to 6 hours postsurfactant (P .001). No patient deteriorated following surfactant therapy. The primary respiratory diagnosis was respiratory distress syndrome (RDS) in 8, meconium aspiration syndrome in 3, and isolated pulmonary hemorrhage in 4. All those with RDS had also received surfactant before their pulmonary hemorrhage. Conclusions. Exogenous surfactant appears to be useful adjunctive therapy in neonates with a clinically significant pulmonary hemorrhage. Its use for this indication should be further investigated by a randomized controlled trial.

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Chest Radiographs Are Valuable in Demonstrating Clinically Significant Pacemaker Complications that Require Reoperation

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2010.04.016 ◽

2011 ◽

Vol 62 (4) ◽

pp. 288-295 ◽

Cited By ~ 2

Author(s):

Diane Belvin ◽

David Hirschl ◽

Vineet R. Jain ◽

Alla Godelman ◽

Marjorie W. Stein ◽

...

Keyword(s):

Correct Diagnosis ◽

Chest Radiographs ◽

Right Atrial ◽

Fisher Exact Test ◽

Retrospective Case ◽

Exact Test ◽

Lead Perforation ◽

Pacemaker Dysfunction ◽

Clinically Significant ◽

Pacemaker Complications

Purpose To evaluate the utility of chest radiography in demonstrating clinically significant pacemaker complications that required reoperation. Methods In this retrospective case-controlled series, we identified 14 consecutive adults who required pacemaker reoperation and who had chest radiographs available for review (6 men, 8 women; mean age, 71 years [range, 43–95 years]). Ten patients had pacemakers implanted at our institution, and 4 were referred for reoperation. Forty-two controls, 3 for each patient, had postoperative chest radiographs and normal device function (25 men, 17 women; mean age 76 years [range, 37–96 years]). All postoperative chest radiographs, including 1-year follow-ups, were blindly reviewed by at least 2 of 4 radiologists for lead perforation and position of right atrial and right ventricular leads. Follow-up radiographs were assessed for lead perforation, lead displacement, and lead fracture. Data were analysed by using the Fisher exact test. Results Of the patients, 1.7% (10/581) required reoperation for pacemaker dysfunction (noncapture, oversensing, abnormal atrial and ventricular thresholds, failing impedance), extracardiac stimulation, and lead perforation and/or displacement. There were no lead fractures. Chest radiographs demonstrated pacemaker complications in 57% of patients (8/14) at a median of 2 days (<1–32 days) after implantation and in 5% of the controls (2/42) ( P < .0001). None of the abnormalities were noted on the official reports. Among subgroups, chest radiographs were abnormal for the following indications: pacemaker dysfunction in 4 of 7 patients versus 0 of 21 controls ( P = .0017), extracardiac stimulation in 1 of 3 patients vs 0 of 9 controls ( P = .25), and lead perforation and/or displacement in 3 of 4 patients vs 2 of 12 controls ( P = .06). Conclusions Chest radiographs are useful after pacemaker placement and demonstrate the majority of complications that require reoperation. Familiarity with the expected normal position of the leads, appearances of pacemaker complications, and comparison with prior radiographs is crucial in rendering a correct diagnosis that guides patient management.

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Pancreatic carcinoma and Trousseau's syndrome: experience at a large cancer center.

Journal of Clinical Oncology ◽

10.1200/jco.1986.4.4.509 ◽

1986 ◽

Vol 4 (4) ◽

pp. 509-514 ◽

Cited By ~ 46

Author(s):

R Pinzon ◽

B Drewinko ◽

J M Trujillo ◽

V Guinee ◽

G Giacco

Keyword(s):

Pancreatic Carcinoma ◽

Predisposing Factors ◽

The Body ◽

Cancer Center ◽

Common Belief ◽

Cancer Of The Pancreas ◽

Head Of The Pancreas ◽

Clinically Significant ◽

Adenocarcinoma Of The Pancreas ◽

The Relationship

It is common belief that carcinoma of the pancreas has an inherent and unique ability to induce a hypercoagulable diathesis that leads to clinically significant thrombosis. We evaluated 130 consecutive patients with adenocarcinoma of the pancreas to document the incidence and the predisposing factors related to the postulated increased association of thromboembolic disorder (TED) and pancreatic carcinoma. Only nine such patients (6.9%) demonstrated TED complications of the classical Trousseau syndrome. In these instances, the location of the tumor and its mucin-producing potential were significant predisposing factors. In our series, TED was usually associated with tumors of the body and tail, which had a greater likelihood to be mucinogenic as compared with those localized to the head of the pancreas. Routine tests for hemostasis were not helpful in predicting the development of TED except, perhaps, for decreased platelet counts. Therefore, we believe that the relationship between cancer of the pancreas and TED should be de-emphasized since it is neither unique nor especially common to pancreatic carcinoma and since it may be frequently encountered in other varieties of visceral malignancies of the cancer patient population.

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Iodinated contrast media-induced hyperthyroidism

Journal of Medical Science ◽

10.20883/medical.e439 ◽

2020 ◽

Vol 89 (2) ◽

pp. e439

Author(s):

Katarzyna Pelewicz ◽

Piotr Miśkiewicz

Keyword(s):

Contrast Media ◽

Interventional Procedures ◽

Thyroid Dysfunction ◽

Iodine Intake ◽

Prophylactic Therapy ◽

Iodinated Contrast Media ◽

Thyroid Status ◽

Contrast Administration ◽

Iodinated Contrast ◽

Clinically Significant

Currently, iodinated contrast media (ICM) is widely used in radiology, therefore numerous patients are exposed to contrast administration during diagnostic and interventional procedures. ICM contains an amount of iodine well above the recommended dietary allowance, which can lead to thyroid dysfunction. Indeed, individuals that are highly susceptible to increased iodine intake are often patients with pre-existing thyroid disease. ICM-induced hyperthyroidism (IIH) is usually transient, however, it may present as clinically significant thyrotoxicosis. Although IIH has been investigated in multiple studies, there is still a lack of consensus regarding prophylactic therapy of IIH and no specific guidelines. This review aimed to summarise previous literature concerning the influence of ICM exposure on thyroid status and prophylactic therapy of IIH.

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Thromboembolic Events Secondary to Endoscopic Cyanoacrylate Injection: Can We Foresee Any Red Flags?

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2018/1940592 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 3

Author(s):

Yujen Tseng ◽

Lili Ma ◽

Tiancheng Luo ◽

Xiaoqing Zeng ◽

Yichao Wei ◽

...

Keyword(s):

Literature Review ◽

Adverse Events ◽

Treatment Protocol ◽

Case Series ◽

Gastric Varices ◽

Patient Treatment ◽

High Morbidity ◽

Retrospective Case ◽

Case Series Study ◽

Severe Adverse Events

Background. Gastric varices (GV) are associated with high morbidity and mortality in patients with portal hypertension. Endoscopic cyanoacrylate injection is the first-line recommended therapy for GV obliteration. This study aims to explore the reason behind related adverse events and better prevent its occurrence. Methods. A retrospective case series study was conducted from January 1, 2013, to December 31, 2016, to identify patients who experienced severe adverse events secondary to endoscopic cyanoacrylate injection. A literature review of similar cases was performed on two medical databases, Medline and Embase. Results. A total of 652 patients underwent cyanoacrylate injection at our center within the study duration. Five cases of severe adverse events related to the use of tissue adhesives were identified. Detailed clinical presentation, patient treatment, and outcomes were reviewed and analyzed. Twenty-seven similar cases were identified based on the literature review providing further insight into the study. Conclusion. Although rare in incidence, systemic embolism associated with cyanoacrylate injection is often fatal or debilitating. This report may raise awareness in treatment protocol, including the necessity of preoperative angiographic studies, to avoid similar adverse events in clinical practice.

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