scholarly journals Repeat adrenal vein sampling in aldosteronism: reproducibility and interpretation of persistently discordant results

2020 ◽  
Author(s):  
Gregory A Kline ◽  
Alexander Ah-Chi Leung ◽  
Davis Sam ◽  
Alex Chin ◽  
Benny So
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Final Diagnosis ◽  
Adrenal Vein ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Moderate Correlation ◽  
Initial Attempt ◽  
Adrenal Vein Sampling

Abstract Context The reproducibility of adrenal vein sampling(AVS) is unknown. Objective Determine reproducibility of biochemical results and diagnostic lateralization in patients undergoing repeat AVS. Design Retrospective chart review of single-center, single-operator AVS procedures. Setting Tertiary care center. Patients Patients with confirmed PA undergoing repeat AVS due to concerns about technical success or discordant diagnostic results. Intervention Simultaneous AVS by an experienced operator using a consistent protocol of both pre-and post-cosyntropin infusion. Main Outcome Measures Among successfully catheterized adrenal veins(selectivity index ≥ 2) the correlation of the adrenalaldosterone/cortisol ratio between the first and second AVS. Secondary outcome measure was diagnostic agreement in repeat AVS lateralization(lateralization index ≥ 3). Results There were 46 sets of AVS from 23 patients, median 3 months apart. There was moderate correlation in aldosterone/cortisol ratios in adrenal veins and IVC(Spearman r = 0.49-0.59, p<0.05) pre-cosyntropin. Post-cosyntropin, the correlation was better(Spearman r=0.67-0.76, p<0.05). In technically successful AVS, there was moderate correlation between the repeated lateralization indices(Spearman r=0.53, p<0.05). In 15 patients where repeat AVS was done due to apparent lateralization discordance with CT imaging, the final diagnosis was the same in the second AVS procedure. Initial failed AVS was successful 75% of the time upon repeat attempt. Conclusions Repeat AVS was feasible and usually successful when an initial attempt failed. There was modest correlation between individual repeat adrenal aldosterone/cortisol ratios and lateralization indices when AVS was done twice. Final lateralization diagnosis was identical in all cases. This demonstrates that AVS is a reliable and reproducible localizing test in PA.

scholarly journals Adrenal vein sampling using rapid cortisol assays in primary aldosteronism is useful in centers with low success rates

2011 ◽  
Vol 165 (2) ◽  
pp. 301-306 ◽  
Author(s):  
Matthias J Betz ◽  
Christoph Degenhart ◽  
Evelyn Fischer ◽  
Anna Pallauf ◽  
Volker Brand ◽  
...  
Keyword(s):  
Success Rate ◽  
Primary Aldosteronism ◽  
Femoral Vein ◽  
Tertiary Care ◽  
Control Period ◽  
Retrospective Chart Review ◽  
University Hospital ◽  
Adrenal Vein ◽  
Success Rates ◽  
Adrenal Vein Sampling

ObjectiveAdrenal vein sampling (AVS) is considered the gold standard in the differential diagnosis of primary aldosteronism (PA), but success rates vary between centers. We hypothesized that rapid (intraprocedure) cortisol measurement can improve performance in a center with initially low AVS success rate.DesignWe analyzed 46 patients with confirmed PA studied between 2008 and 2010. Forty-seven PA patients studied between 2004 and 2008 identified by retrospective chart review served as controls. All patients were treated at a single tertiary care university hospital.MethodsStarting in 2008, rapid cortisol assays (RCA) were performed in all patients during the AVS procedure. A cortisol gradient of ≥2.0 between adrenal vein and a femoral vein sample was used as success criterion. Up to two repeat samples were drawn if adrenal vein cortisol was below this threshold.ResultsDuring the control period 26 of 47 AVS were successful (55%). After introduction of RCA, 39 out of 46 AVS (85%) were successful (P=0.003). In 21 of the 46 cases (46%) a resampling was necessary. The increase in overall success was due to an increase in successful right AVS (85 vs 62% before introduction of RCA; P=0.02) and a training effect (P=0.024 for trend).ConclusionRCA during AVS are useful in centers with an initially low AVS success rate.

scholarly journals Management of post-operative Junctional Ectopic Tachycardia in symptomatic neonates and infants at a tertiary care center in a developing country: Lessons learned!

2021 ◽  
Vol 9 (40) ◽  
pp. 14-19
Author(s):  
Mostafa Abohelwa ◽  
Marwan Refaat ◽  
Amal Gharamti ◽  
Mohamed Ahmed ◽  
Amr Elgehiny ◽  
...  
Keyword(s):  
Heart Defects ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Lessons Learned ◽  
Tertiary Care Center ◽  
Initial Attempt ◽  
Junctional Ectopic Tachycardia ◽  
Post Surgery ◽  
Neonates And Infants

Purpose: Junctional ectopic tachycardia (JET) is an uncommon form of arrhythmia that occurs after surgical correction of congenital heart defects. Data on neonates and infants are rare. This study highlights the epidemiology, incidence, and management of neonates and infants with JET at a tertiary care center in Lebanon. Methods: We conducted a retrospective chart review between January 1, 2013, and December 31, 2017. All Patients with documented symptomatic junctional ectopic tachycardia on electrocardiogram who required medical treatment post-surgery were included. Results: A total of 9 patients were included. The median age was 18 days, and six were males. Six out of nine (66.67%) were successfully treated with cooling and amiodarone on the initial attempt. The other three cases failed initial treatment with adenosine. However, they were successfully treated with cooling and amiodarone as second-line therapy. All cases of junctional ectopic tachycardia occurred post-surgery at an average of 1.67 ± 1.11 days. Conclusion: Junctional ectopic tachycardia mostly occurs after corrective cardiac surgery and can be successfully treated with cooling and amiodarone. Timely diagnosis significantly affects the outcome.

Prevalence, Correlates and Management of Hyperglycemia in Diabetic Non-critically Ill Patients at a Tertiary Care Center in Lebanon

2019 ◽  
Vol 15 (2) ◽  
pp. 133-140 ◽  
Author(s):  
Ghada El Khoury ◽  
Hanine Mansour ◽  
Wissam K. Kabbara ◽  
Nibal Chamoun ◽  
Nadim Atallah ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Center ◽  
Descriptive Analysis ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Diabetic Patients

Background: Diabetes Mellitus is a chronic metabolic disease that affects 387 million people around the world. Episodes of hyperglycemia in hospitalized diabetic patients are associated with poor clinical outcomes and increased morbidity and mortality. Therefore, prevention of hyperglycemia is critical to decrease the length of hospital stay and to reduce complications and readmissions. Objective: The study aims to examine the prevalence of hyperglycemia and assess the correlates and management of hyperglycemia in diabetic non-critically ill patients. Methods: The study was conducted on the medical wards of a tertiary care teaching hospital in Lebanon. A retrospective chart review was conducted from January 2014 until September 2015. Diabetic patients admitted to Internal Medicine floors were identified. Descriptive analysis was first carried out, followed by a multivariable analysis to study the correlates of hyperglycemia occurrence. Results: A total of 235 medical charts were reviewed. Seventy percent of participants suffered from hyperglycemia during their hospital stay. The identified significant positive correlates for inpatient hyperglycemia, were the use of insulin sliding scale alone (OR=16.438 ± 6.765-39.941, p=0.001) and the low frequency of glucose monitoring. Measuring glucose every 8 hours (OR= 3.583 ± 1.506-8.524, p=0.004) and/or every 12 hours (OR=7.647 ± 0.704-79.231, p=0.0095) was associated with hyperglycemia. The major factor perceived by nurses as a barrier to successful hyperglycemia management was the lack of knowledge about appropriate insulin use (87.5%). Conclusion: Considerable mismanagement of hyperglycemia in diabetic non-critically ill patients exists; indicating a compelling need for the development and implementation of protocol-driven insulin order forms a comprehensive education plan on the appropriate use of insulin.

Comparative Morbidity Profile of Elective vs Therapeutic Neck Dissection

2021 ◽  
pp. 019459982110089
Author(s):  
Quinn Dunlap ◽  
James Reed Gardner ◽  
Amanda Ederle ◽  
Deanne King ◽  
Maya Merriweather ◽  
...  
Keyword(s):  
Neck Dissection ◽  
Surgical Complications ◽  
Chart Review ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Neck Surgery ◽  
Continuous Variables ◽  
Significant Difference ◽  
History Of

Objective Neck dissection (ND) is one of the most commonly performed procedures in head and neck surgery. We sought to compare the morbidity of elective ND (END) versus therapeutic ND (TND). Study Design Retrospective chart review. Setting Academic tertiary care center. Methods Retrospective chart review of 373 NDs performed from January 2015 to December 2018. Patients with radical ND or inadequate chart documentation were excluded. Demographics, clinicopathologic data, complications, and sacrificed structures during ND were retrieved. Statistical analysis was performed with χ2 and analysis of variance for comparison of categorical and continuous variables, respectively, with statistical alpha set a 0.05. Results Patients examined consisted of 224 males (60%) with a mean age of 60 years. TND accounted for 79% (n = 296) as compared with 21% (n = 77) for END. Other than a significantly higher history of radiation (37% vs 7%, P < .001) and endocrine pathology (34% vs 2.6%, P < .001) in the TND group, no significant differences in demographics were found between the therapeutic and elective groups. A significantly higher rate of structure sacrifice and extranodal extension within the TND group was noted to hold in overall and subgroup comparisons. No significant difference in rate of surgical complications was appreciated between groups in overall or subgroup analysis. Conclusion While the significantly higher rate of structure sacrifice among the TND population represents an increased morbidity profile in these patients, no significant difference was found in the rate of surgical complications between groups. The significant difference seen between groups regarding history of radiation and endocrine pathology likely represents selection bias.

scholarly journals Profile and outcome of pediatric intussusception: a 5-year experience in a tertiary care center

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Aqeela J. Madan ◽  
Fayza Haider ◽  
Saeed Alhindi
Keyword(s):  
Seasonal Variation ◽  
Success Rate ◽  
Pediatric Population ◽  
Care Center ◽  
Tertiary Care ◽  
Operative Intervention ◽  
Secondary Outcome ◽  
Lead Point ◽  
Pneumatic Reduction ◽  
Tertiary Center

Abstract Background Intussusception is the most frequent cause of bowel obstruction in infants and toddlers; idiopathic intussusception occurs predominantly under the age of 3 and is rare after the age of 6 years; the highest incidence occurs in infants between 4 and 9 months; the gold standard for treatment of intussusception is non-operative reduction. This research will tackle the problem of pediatric intussusception in our center which is the largest tertiary center in our region. The primary outcome is to study the profile of intussusception; the secondary outcome is to assess the success rate of pneumatic reduction in the center’s pediatric population as well as to study the seasonal variation if present. Results During the study period, eighty-six (N=86) cases were identified, from which 10 cases were recurrent intussusception. Seventy-six (N=76) cases were included from the study period. N=68 (89%) were less than 3 years of age, and only N=2 (3%) were above 6 years. Seasonal variation was not significant; N=69 (91%) patients had successful pneumatic reduction under fluoroscopy while thirteen patients N=13 (17%) needed operative intervention. Conclusion Ileocolic intussusception is one of the most common pediatric surgical emergencies that can be successfully managed non-operatively in our institute; 89% of the cases were below 3 years of age, and no seasonal variation was demonstrated. Operative intervention was required in 13 cases with the main reason being lead point. The fact that the pediatric surgeon performs the reduction might have contributed to a high success rate reaching 91% in our center. This study provides a valuable opportunity for future regional data comparisons and pooled data analyses.

Abstract 15502: Clinical Outcomes in Patients Undergoing Non-cardiac Surgery Within 1 Year of Pci

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Davide Cao ◽  
Matthew A Levin ◽  
Samantha Sartori ◽  
Anastasios Roumeliotis ◽  
Rishi Chandiramani ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Antiplatelet Therapy ◽  
Care Center ◽  
Tertiary Care ◽  
Coronary Intervention ◽  
Secondary Outcome ◽  
Cardiac Events ◽  
Bleeding Events ◽  
Target Vessel Revascularization ◽  
Increased Risk

Introduction: Perioperative cardiovascular events are an important cause of morbidity and mortality associated with non-cardiac surgery (NCS), especially in patients with recent percutaneous coronary intervention (PCI) who require dual antiplatelet therapy. Objective: To illustrate the types and timing of different noncardiac surgeries occurring within 1 year of PCI, and to evaluate the risk of thrombotic and bleeding events according to perioperative antiplatelet management. Methods: All patients undergoing NCS within 1 year of PCI at a tertiary-care center between 2011 and 2018 were included. The primary outcome was major adverse cardiac events (MACE; composite of death, myocardial infarction, stent thrombosis or target vessel revascularization). The key secondary outcome was major bleeding, defined as ≥2 units of blood transfusion. All outcomes were evaluated at 30 days after NCS. Results: A total of 1092 NCS (corresponding to 747 patients) were included and classified by surgical risk (low: 50.9%, intermediate: 38.4%, high: 10.7%) and priority (elective: 88.5%, urgent/emergent: 11.5%). High-risk and urgent/emergent surgeries tended to occur earlier post-PCI compared to low-risk and elective ones ( Figure-A ). The incidence of MACE and bleeding was time-dependent, with an increased risk in surgeries occurring in the first 6 months post-PCI ( Figure-B ). Perioperative antiplatelet cessation occurred in 487 (44.6%) NCS and was more likely for intermediate-risk procedures and after 6 months of PCI. There was no significant association between antiplatelet cessation and cardiac events. Conclusions: Among patients undergoing NCS within 1 year of PCI, the perioperative risk of MACE is inversely related to time from PCI. Preoperative interruption of antiplatelet therapy was observed in less than half of all cases and was not associated with an increased risk of cardiac events.

scholarly journals Diagnostic Accuracy of Neurological Problems in the Emergency Department

2008 ◽  
Vol 35 (3) ◽  
pp. 335-341 ◽  
Author(s):  
Jeremy J Moeller ◽  
Joelius Kurniawan ◽  
Gordon J Gubitz ◽  
John A Ross ◽  
Virender Bhan
Keyword(s):  
Emergency Department ◽  
Diagnostic Accuracy ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Primary Headache ◽  
Final Diagnosis ◽  
Initial Diagnosis ◽  
Educational Strategies ◽  
Diagnostic Uncertainty ◽  
Peripheral Vertigo

Background:Previous studies describe significant rates of misdiagnosis of stroke, seizure and other neurological problems, but there are few studies examining diagnostic accuracy of all emergency referrals to a neurology service. This information could be useful in focusing the neurological education of physicians who assess and refer patients with neurological complaints in emergency departments.Methods:All neurological consultations in the emergency department at a tertiary-care teaching hospital were recorded for six months. The initial diagnosis of the requesting physician was recorded for each patient. This was compared to the initial diagnosis of the consulting neurologist and to the final diagnosis, as determined by retrospective chart review.Results:Over a six-month period, 493 neurological consultations were requested. The initial diagnosis of the requesting physician agreed with the final diagnosis in 60.4% (298/493) of cases, and disagreed or was uncertain in 35.7% of cases (19.1% and 16.6% respectively). In 3.9% of cases, the initial diagnosis of both the referring physician and the neurologist disagreed with the final diagnosis. Common misdiagnoses included neurocardiogenic syncope, peripheral vertigo, primary headache and psychogenic syndromes. Often, these were initially diagnosed as stroke or seizure.Conclusions:Our data indicate that misdiagnosis or diagnostic uncertainty occurred in over one-third of all neurological consultations in the emergency department setting. Benign neurological conditions, such as migraine, syncope and peripheral vertigo are frequently mislabeled as seizure or stroke. Educational strategies that emphasize emergent evaluation of these common conditions could improve diagnostic accuracy, and may result in better patient care.

scholarly journals Incidental Petrous Apex Findings on Magnetic Resonance Imaging

2001 ◽  
Vol 80 (4) ◽  
pp. 200-206 ◽  
Author(s):  
John P. Leonetti ◽  
Harish Shownkeen ◽  
Sam J. Marzo
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Care Center ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Retrospective Chart Review ◽  
Petrous Apex ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Clinical Surveillance

We performed a retrospective chart review to categorize a group of petrous apex findings that were noted incidentally on magnetic resonance imaging (MRI) in 88 patients. These patients were among those who had been seen at a tertiary care center between July 1988 and July 1998. These incidental findings, which were unrelated to the presenting clinical manifestations, included asymmetric fatty bone marrow (n = 41), inflammation (19), cholesterol granulomas (14), cholesteatomas (9), and neoplasms (5). Followup imaging and clinical surveillance of these patients has not demonstrated any significant change in the incidentally detected lesions. In all cases, the incidental MRI findings represented benign pathology.

Extensive Acquired Cholesteatoma in Children: When the Penny Drops

2005 ◽  
Vol 114 (7) ◽  
pp. 539-542 ◽  
Author(s):  
Craig W. Semple ◽  
Murali Mahadevan ◽  
Robert G. Berkowitz
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Acute Otitis Media ◽  
Retrospective Chart Review ◽  
Computed Tomographic ◽  
Recurrent Acute Otitis Media ◽  
Tympanostomy Tubes ◽  
Acquired Cholesteatoma ◽  
High Index Of Suspicion ◽  
Conductive Hearing

Objectives: To determine the factors associated with the diagnosis of acquired cholesteatoma (AC) in children, we performed a retrospective chart review at a tertiary care center. Methods: We reviewed children with a diagnosis of AC that extended beyond the mesotympanum in the presence of a nonintact tympanic membrane who underwent surgical treatment over a 14-year period. Results: There were 116 children (78 male, 38 female) between 3 and 18 years of age (mean, 9.5 years). Their average period of management in a specialist otolaryngology clinic before the diagnosis of cholesteatoma was made was 3.2 years, and 68% of the children had previously undergone insertion of tympanostomy tubes. Symptoms and signs included chronic otorrhea (59%), recurrent acute otitis media (58%), and conductive hearing loss (51%). The diagnosis of AC was eventually made after office otoscopy (26%), temporal bone computed tomography (24%), or examination under anesthesia (17%). In 33% of children, the diagnosis was made only after surgical exploration of the middle ear and mastoid. Conclusions: Our data underscore the importance of maintaining a high index of suspicion for AC in managing children with long-standing otologic symptoms, and considering otomicroscopy, computed tomographic scanning, or tympanomastoid exploration if medical treatment fails.

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