scholarly journals Does the source of referral affect outcomes for paediatric testicular torsion?

2019 ◽  
Vol 101 (6) ◽  
pp. 411-414 ◽  
Author(s):  
R Peeraully ◽  
M Jancauskaite ◽  
S Dawes ◽  
S Green ◽  
N Fraser

Introduction This single centre study retrospectively analysed the intraoperative findings relative to source of referral for emergency scrotal explorations performed in a tertiary level paediatric surgery department. Methods All patients who underwent emergency scrotal exploration under the care of paediatric surgeons in our unit between April 2008 and April 2016 were identified. Clinical data were obtained from contemporaneous records. Results Over the 8-year study period, 662 boys underwent emergency scrotal exploration: 6 (1%) were internal referrals, 294 (44%) attended our emergency department (ED) directly, 271 (41%) were referred from primary care and 91 (14%) were transferred from other hospitals. Excluding procedures in neonates, testicular torsion was present in 100 cases (15%). Testicular detorsion with bilateral 3-point testicular fixation was performed in 66 (66%) and orchidectomy with contralateral fixation in 34 (34%) where the torted testis was non-viable intraoperatively. The orchidectomy rate in the presence of torsion was 23% in ED referrals (12/52), 43% in primary care referrals (12/28) and 50% for transfers (10/20). The difference in rates between ED referrals and patients transferred from other hospitals was significant (p=0.026). There was no significant difference in median age between any of the groups (p=0.10). Conclusions Boys undergoing emergency scrotal exploration had a higher orchidectomy rate when transferred from other hospitals to our unit. This difference was statistically significant when compared with boys presenting directly to our ED. This supports advice from The Royal College of Surgeons of England for undertaking paediatric scrotal explorations in the presenting hospital when safe to do so rather than delaying the care of these patients by transferring them to a tertiary paediatric surgical unit.

2017 ◽  
Vol 85 (1) ◽  
pp. 15-18 ◽  
Author(s):  
Thomas Ripert ◽  
Jean Pierrevelcin

Study design: Retrospective, non-randomised, single-centre study. Objectives: Comparative study of urodynamic tests in patients presenting social continence after AMS 800 or ZSI 375 insertion. Materials and methods: Study was open to patients with social continence, implanted with AMS 800 or ZSI 375. Vesical pressure (VP), urethral functional length (FL), maximal urethral pressure (MUP), maximal urethral closure pressure (MUCP), maximal urinary flow rate (Qmax) were registered with standard urodynamic equipment. Results: From March 2012 to September 2014, 27 male patients with AMS 800 and 28 with ZSI 375 were recruited. In the AMS 800 group mean VP was 25.03 cmH2O (range 13-47), mean FL 31.96 mm (range 20-52), mean MUCP 88.29 cmH2O (range 32-160), mean MUP 119.55 cmH2O (range 77-180), mean Qmax 22.86 mL/s (range 5.6-54.6). In the ZSI 375 group, mean VP was 24.89 cmH2O (range 6-40), mean FL 30.53 mm (range 12-87), mean MUCP 70.11 cmH2O (range 38-108), mean MUP 99.89 cm H2O (range 63-134), and mean Qmax 19.25 mL/s range (7.3-39.6). Discussion: Results of urodynamic tests are similar for both artificial urinary sphincters. AMS 800 cuff pressure over 70 cmH2O could be explained by the pelvis pressure and the difference of altitude between the pressure-regulating balloon (PRB) and the cuff. ZSI 375 pressure-regulating tank (PRT) is not influenced by these factors. Very high MUP could be explained with too tightened cuffs. Conclusions: AMS 800 and ZSI 375 urodynamic tests are similar. Pressure of the pelvis and difference of altitude between the AMS balloon and the cuff can lead to high MUP.


CJEM ◽  
2017 ◽  
Vol 20 (6) ◽  
pp. 850-856 ◽  
Author(s):  
Jonathan L. Kwong ◽  
Garry Ross ◽  
Linda Turner ◽  
Chris Olynyk ◽  
Sheldon Cheskes ◽  
...  

AbstractObjectiveLimited evidence supports primary care paramedic (PCP) direct transport of ST-segment elevation myocardial infarction (STEMI) patients for percutaneous coronary intervention (PCI). The goal of this study was to evaluate an urban-based PCP STEMI bypass guideline.MethodsWe reviewed consecutive Toronto Paramedic Services call reports between April 7, 2015, and May 31, 2016, regarding STEMI patients identified by PCPs. The primary outcome was patient assignment (stable versus unstable) according to guideline criteria. Secondary outcomes were the proportion of PCP-transported patients who had an indication for an advanced care intervention (ACI) or who received an ACI when PCPs rendezvoused with an advanced care paramedic (ACP). Lastly, we reviewed prehospital outcomes of cardiac arrest patients and calculated the difference in transport intervals between direct PCP bypass and a PCI-centre and predicted transport interval to the closest emergency department (ED).ResultsOf 361 patients, 232 were PCP transports and 129 were ACP-rendezvous transports. There was a significant difference in the distribution of stable and unstable patients between PCPs and ACPs (p<0.001). For PCP patients, 21/232 (9.1%) had indications for an ACI, whereas 34/129 (26.4%) ACP patients received an ACI. Eleven patients experienced cardiac arrest; 10 were successfully resuscitated (5 of these by PCPs). The median difference between direct PCP bypass and a PCI-centre versus transport to the closest ED was 5.53 minutes (IQR=6.71).ConclusionsWe found a significant difference in the distribution of stable and unstable patients and fewer patients with indications for an ACI in PCP patients. This PCP STEMI bypass guideline appears feasible.


2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
M Goeller ◽  
H Duncker ◽  
D Dey ◽  
M Moshage ◽  
D Bittner ◽  
...  

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Kaltenbach scholarship of the german heart foundation Background  Increased attenuation of pericoronary adipose tissue (PCAT) around the right coronary artery (RCA) is a new imaging biomarker to detect coronary inflammation derived from routine coronary CT angiography (CTA) and has been shown to be associated with cardiac mortality. Increased volume of epicardial adipose tissue (EAT) has been reported be associated with myocardial ischemia. Purpose  We aimed to investigate for the first time a potential association between CTA-derived PCAT measures and myocardial ischemia as assessed by adenosine stress CMR perfusion imaging.  Methods In this single-centre study 109 stable individuals (mean age of 62 ± 11 years, 77% males) with coronary artery disease underwent CTA followed by adenosine stress CMR perfusion imaging to detect myocardial ischemia. PCAT CT attenuation (HU) and PCAT volume (cm³) was measured around the RCA (10 to 50 mm from RCA ostium), the proximal 40 mm of the left anterior descending artery (LAD) and the circumflex artery (LCX) using semi-automated software. Per patient PCAT CT attenuation was calculated as followed: (PCAT attenuation of RCA + LAD + LCX)/3). Non-contrast CT data sets were used for coronary calcium scoring and the quantification of EAT (located between the myocardial surface and the pericardium) and paracardial adipose tissue (PAT; intrathoracic and outside of the pericardium).  Results  Between patients with evidence of significant myocardial ischemia as assessed by adenosine stress CMR (n = 35) and patients without myocardial ischemia (n = 74) there was no significant difference in the PCAT CT attenuation of RCA (-85.3 vs. -85.7  HU, p = 0.87), LAD (-84.8 vs. -85.7 HU, p = 0.66) and LCX (-82.8 vs. -83.2 HU, p = 0.79) as well as in the per patient PCAT CT attenuation (-84.2 vs. -84.9 HU, p = 0.76). Neither did patients with myocardial ischemia within the RCA territory show increased RCA PCAT CT attenuation (-87.7 vs. -85.3 HU, p = 0.40); nor was such a relationship found for the territory of the LAD (-80.6 vs.  85.8 HU, p = 0.11) or LCX (-83.1 vs. -83.0 HU, p = 0.99). The CT attenuation of EAT (-77.9 vs. -78.7 HU, p = 0.65) and PAT (-89.9 vs. -90.0 HU, p = 0.93) did not differ significantly between patients with myocardial ischemia compared to patients without myocardial ischemia. Between patients with myocardial ischemia and patients without myocardial ischemia there was no significant difference in the volumes of EAT (118.1 vs. 110.6 cm³, p = 0.55), PAT (279.5 vs. 240.9 cm³, p = 0.20) and the per patient PCAT volume (1021.9 vs. 1015.5 cm³, p = 0.90). In logistic regression analysis the volume and CT attenuation of the different intrathoracic fat compartments PCAT, EAT and PAT were not independently associated with the presence of myocardial ischemia (n.s.).  Conclusions In this single-centre study CTA-derived quantified CT attenuation and volume of PCAT, EAT and PAT were not associated with myocardial ischemia as assessed by adenosine stress CMR perfusion imaging.


2021 ◽  
Vol 22 (Supplement_3) ◽  
Author(s):  
M Goeller ◽  
H Duncker ◽  
D Bittner ◽  
F Ammon ◽  
M Moshage ◽  
...  

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): German Heart Foundation e.V. Introduction  Increased attenuation of pericoronary adipose tissue (PCAT) around the right coronary artery (RCA) is a new imaging biomarker to detect coronary inflammation derived from routine coronary CT angiography (CTA) and has been shown to be associated with cardiac mortality. Increased volume of epicardial adipose tissue (EAT) has been reported be associated with myocardial ischemia. Purpose  We aimed to investigate a potential association between CTA-derived PCAT measures and myocardial ischemia as assessed by adenosine stress CMR perfusion imaging.  Methods In this single-centre study 109 stable individuals (mean age of 62 ± 11 years, 77% males) with coronary artery disease underwent CTA followed by adenosine stress CMR perfusion imaging to detect myocardial ischemia. PCAT CT attenuation (HU) and PCAT volume (cm3) was measured around the RCA (10 to 50 mm from RCA ostium), the proximal 40 mm of the left anterior descending artery (LAD) and the circumflex artery (LCX) using semi-automated software. Per patient PCAT CT attenuation was calculated as followed: (PCAT attenuation of RCA + LAD + LCX)/3). Non-contrast CT data sets were used for coronary calcium scoring and the quantification of EAT (located between the myocardial surface and the pericardium) and paracardial adipose tissue (PAT; intrathoracic and outside of the pericardium).  Results  Between patients with evidence of significant myocardial ischemia as assessed by adenosine stress CMR perfusion imaging (n = 35) and patients without myocardial ischemia (n = 74) there was no significant difference in the CT attenuation of RCA (-85.3 HU vs. -85.7  HU, p = 0.87), LAD (-84.8 HU vs. -85.7 HU, p = 0.66) and LCX (-82.8 HU vs. -83.2 HU, p = 0.79) as well as in the per patient PCAT CT attenuation (-84.2 HU vs. -84.9 HU, p = 0.76). Neither did patients with myocardial ischemia within the RCA territory show increased RCA PCAT CT attenuation (-87.7 HU vs. -85.3 HU, p = 0.40); nor was such a relationship found for the territory of the LAD (-80.6 HU vs.  85.8 HU, p = 0.11) or LCX (-83.1 HU vs. -83.0 HU, p = 0.99). The CT attenuation of EAT (-77.9 vs. -78.7 HU, p = 0.65) and PAT (-89.9 HU vs. -90.0 HU, p = 0.93) did not differ between patients with myocardial ischemia compared to patients without myocardial ischemia. Between patients with myocardial ischemia and patients without myocardial ischemia there was no significant difference in the volumes of EAT (118.1 cm3 vs. 110.6 cm3, p = 0.55), PAT (279.5 cm3 vs. 240.9 cm3, p = 0.20) and the per patient PCAT volume (1021.9 mm3 vs. 1015.5 mm3, p = 0.90). In logistic regression analysis the volume and CT attenuation of the different intrathoracic fat compartments PCAT, EAT and PAT were not independently associated with the presence of myocardial ischemia (n.s.).  Conclusions   In this single-centre study CTA-derived quantified CT attenuation and volume of PCAT, EAT and PAT were not associated with myocardial ischemia as assessed by adenosine stress CMR perfusion imaging.


2018 ◽  
Vol 28 (11) ◽  
pp. 1306-1315 ◽  
Author(s):  
Piers C. A. Barker ◽  
Gregory H. Tatum ◽  
Michael J. Campbell ◽  
Michael G. W. Camitta ◽  
Angelo S. Milazzo ◽  
...  

AbstractBackgroundInfants with prenatally diagnosed CHD are at high risk for adverse outcomes owing to multiple physiologic and psychosocial factors. Lack of immediate physical postnatal contact because of rapid initiation of medical therapy impairs maternal–infant bonding. On the basis of expected physiology, maternal–infant bonding may be safe for select cardiac diagnoses.MethodsThis is a single-centre study to assess safety of maternal–infant bonding in prenatal CHD.ResultsIn total, 157 fetuses with prenatally diagnosed CHD were reviewed. On the basis of cardiac diagnosis, 91 fetuses (58%) were prenatally approved for bonding and successfully bonded, 38 fetuses (24%) were prenatally approved but deemed not suitable for bonding at delivery, and 28 (18%) were not prenatally approved to bond. There were no complications attributable to bonding. Those who successfully bonded were larger in weight (3.26 versus 2.6 kg, p<0.001) and at later gestation (39 versus 38 weeks, p<0.001). Those unsuccessful at bonding were more likely to have been delivered via Caesarean section (74 versus 49%, p=0.011) and have additional non-cardiac diagnoses (53 versus 29%, p=0.014). There was no significant difference regarding the need for cardiac intervention before hospital discharge. Infants who bonded had shorter hospital (7 versus 26 days, p=0.02) and ICU lengths of stay (5 versus 23 days, p=0.002) and higher survival (98 versus 76%, p<0.001).ConclusionFetal echocardiography combined with a structured bonding programme can permit mothers and infants with select types of CHD to successfully bond before ICU admission and intervention.


BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e039454 ◽  
Author(s):  
Ralf E Harskamp ◽  
Bart van Straten ◽  
Jonathan Bouman ◽  
Bernadette van Maltha-van Santvoort ◽  
John J van den Dobbelsteen ◽  
...  

ObjectiveThere are widespread shortages of personal protective equipment as a result of the COVID-19 pandemic. Reprocessing filtering facepiece particle (FFP)-type respirators may provide an alternative solution in keeping healthcare professionals safe.DesignProspective, bench-to-bedside.SettingA primary care-based study using FFP-2 respirators without exhalation valve (3M Aura 1862+ (20 samples), Maco Pharma ZZM002 (14 samples)), FFP-2 respirators with valve (3M Aura 9322+ (six samples) and San Huei 2920V (16 samples)) and valved FFP type 3 respirators (Safe Worker 1016 (10 samples)).InterventionsAll masks were reprocessed using a medical autoclave (17 min at 121°C with 34 min total cycle time) and subsequently tested up to three times whether these respirators retained their integrity (seal check and pressure drop) and ability to filter small particles (0.3–5.0 µm) in the laboratory using a particle penetration test.ResultsWe tested 33 respirators and 66 samples for filter capacity. All FFP-2 respirators retained their shape, whereas half of the decontaminated FFP-3 respirators showed deformities and failed the seal check. The filtering capacity of the 3M Aura 1862 was best retained after one, two and three decontamination cycles (0.3 µm: 99.3%±0.3% (new) vs 97.0±1.3, 94.2±1.3% or 94.4±1.6; p<0.001). Of the other FFP-2 respirators, the San Huei 2920 V had 95.5%±0.7% at baseline vs 92.3%±1.7% vs 90.0±0.7 after one-time and two-time decontaminations, respectively (p<0.001). The tested FFP-3 respirator (Safe Worker 1016) had a filter capacity of 96.5%±0.7% at baseline and 60.3%±5.7% after one-time decontamination (p<0.001). Breathing and pressure resistance tests indicated no relevant pressure changes between respirators that were used once, twice or thrice.ConclusionThis small single-centre study shows that selected FFP-2 respirators may be reprocessed for use in primary care, as the tested masks retain their shape, ability to retain particles and breathing comfort after decontamination using a medical autoclave.


2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
K Sapiano ◽  
A Borg

Abstract Background In the past, cardiac imaging modalities did not obtain much information about extracardiac structures. With the introduction of newer modalities such as CT and MRI, diagnostic quality images of structures surrounding the heart are now being obtained. This has led to the need for interpretation of images of extracardiac structures. Nowadays, this is being performed by cardiologists and radiologists; either separately or conjointly. Purpose To evaluate whether there is any difference in the rate of positive extracardiac findings (ECF) between radiologists and cardiologists and to assess whether these ECF are of any clinical importance. Methods All patients having had a cardiac MRI and cardiac CT performed in the year 2017 in a single centre were enrolled (n = 733). Reports of these images were reviewed retrospectively and information was obtained as regards to any differences in number of ECF picked up by cardiologists, radiologists or both working together. These ECF were then stratified according to their clinical importance and these subdivisions compared in the context of reporting physician. Results A total of 733 scans were reviewed, 219 (29.9%) of these had positive ECF whilst 514 (70.1%) had none. Of the total amount, 314 (42.8%) were reported by cardiologists, 318 (43.4%) by radiologists and 101 (13.8%) jointly by both a cardiologist and a radiologist. Cardiologists found positive ECF in 18.2% of scans reviewed, radiologists reported findings in 37.4% of scans and, of those reported jointly, 42.6% were positive, p= &lt;0.001. A pattern emerged where cardiologists found less clinically significant ECF with only 5.3% of findings classified as will definitely change management, in comparison to 19.3% by radiologists and 16.3% when reviewed jointly; and, only 15.8% of findings classified as will probably change management when compared to 23.5% by radiologists and 23.3% when reviewed jointly. However, it is important to note that this pattern was not statistically significant, p = 0.1432. Conclusions A strongly statistically significant difference in the reporting of extracardiac findings has been highlighted in this article with cardiologists picking up less than half of extracardiac findings reported by radiologists. There was a pattern of cardiologists recognising less clinically important extracardiac findings, however this was not found to be statistically significant. These results should be reviewed with caution, taking into consideration the limitations of results obtained from a single centre. However, should this pattern keep repeating itself, one might consider increasing cardiologist training in ECF or having cardiac imaging reported conjointly by a cardiologist and a radiologist. Further studies are also necessary to ascertain the clinical relevance of the difference in ECF between cardiologists, radiologists or both specialists working together.


QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Amr A Mabrouk ◽  
Iman M Alliethy ◽  
Niveen F Al Mahmoudy ◽  
Yara S El-sayed

Abstract Background Oro-facial clefts include a range of congenital deformities most commonly presenting as cleft lip with or without cleft palate (CLP) or isolated cleft palate (CP). CLP is the second most common congenital birth defect in the U.S. Aim of the Work to assess modified v-advancement vermilion flap combined with Tennison technique for vermilion repair in unilateral cleft lip regarding aesthetic outcome in comparison with repair of cleft lip by Tennison technique. Patients and methods This study was conducted in plastic, maxillofacial and reconstructive surgery department in Ain Shams University between September 2019 to February 2020. It included 20 patients divided into two group; the first group consisted of 10 patients who underwent repair of cleft lip by Tennison technique and the second group consisted of 10 patients who underwent repair by Tennison technique combined with v- advancement vermilion flap. Both groups were assessed postoperatively by Asher-McDade et. al. scoring system. Result The study showed statistically significant difference between the two groups as regard the white lip length which was more symmetrical in cases repaired by Tennison technique combined with modified v-advancement vermillion flap (P = 0.01). The bulge and the deficiency in the lateral vermilion were decreased in the group treated by Tennison technique with modified v-advancement vermilion flap. However the difference was statistically insignificant (P = 0.66). Conclusion The choice of a technique for surgical correction of UCL should be based on an evidence that this technique has the best functional and aesthetic outcomes. The findings of this study support the view that these two methods of cleft lip repair have their own advantages and disadvantages. Tennison technique combined with vadvancement vermilion flap achieved less bulge in the vermilion with no statistically significant difference.


2021 ◽  
pp. 175319342110391
Author(s):  
Alexandre Cerlier ◽  
Didier Guinard ◽  
André M Gay ◽  
Régis Legré

We evaluated secondary trapeziectomy for revision of trapeziometacarpal implants and compared this to primary trapeziectomy with a matched retrospective single centre study performed between October 2003 and February 2015. Thirty-one patients with trapeziometacarpal prosthesis failure who had a secondary trapeziectomy were matched with a primary trapeziectomy regarding sex, date of the operation and age. We evaluated function, mobility, autonomy, pain, strength, complications and shortening of the thumb on radiographs. The median time until removal of the implant was 37 months. The median age in both groups was similar. Median follow-up was more than 7 years in both groups. There was no statistically significant difference in terms of function, mobility, autonomy, pain, strength, complications and shortening of the thumb. Secondary trapeziectomy after revision of trapeziometacarpal implants provides results comparable with primary trapeziectomy. Level of evidence: III


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