scholarly journals An analysis of the outcomes of totally implantable access port implantation performed by surgical residents

2021 ◽  
Vol 17 (1) ◽  
pp. 15-22
Author(s):  
Se-Beom Jeon ◽  
Youngbae Jeon ◽  
Kyoung-Won Han ◽  
Yong-Soon Chun ◽  
Jeong-Heum Baek

Purpose: This study aimed to investigate the clinical outcomes after totally implantable access port (TIAP) implantation performed by general surgery residents in patients with colorectal cancer.Methods: A total of 291 consecutive patients who underwent TIAP implantations were evaluated. The patients were divided into threegroups: second-, third-, and fourth-grade residents.Results: The mean follow-up was 22.1 months (range, 1–87 months). The total times of operation, puncture, and cannulation decreased as the resident grade increased (P<0.001). Early complications significantly decreased with higher resident grades (P=0.039). The non-use of ultrasonography and non-use of C-arm were identified as independent risk factors for complications. Resident grades between second and third (P=0.005) and between second and fourth (P=0.041) were identified as independent risk factors for optimal tip position.Conclusion: TIAP implantation can be safely and effectively performed by residents. Low-grade residents were associated with early complications.

2021 ◽  
Author(s):  
Hui Wang ◽  
Tun Wang ◽  
Hao He ◽  
Xin Li ◽  
Yuan Peng ◽  
...  

Abstract Backgrounds: The prognosis of thoracic aortic pseudoaneurysm (TAP) after thoracic endovascular aortic repair (TEVAR) remains unclear. This study investigates the early and midterm clinical outcome as well as relevant risk factors of TAP patients following TEVAR therapy.Methods: From July 2010 to July 2020, 37 eligible TAP patients who underwent TEVAR were selected into our research. We retrospectively explored their baseline, perioperative and follow-up data. Fisher exact test and Kaplan-Meier method were applied for comparing difference between groups. Risk factors of late survival were discerned using Cox regression analysis.Results: There were 29 men and 12 women, with the mean age as 59.5±13.0 years (range, 30-82). The mean follow-up time was 30.7±28.3 months (range, 1-89). For early result, early mortality (≦30days) happened in 3(8.1%) zone 3 TAP patients versus 0 in zone 4 (p= 0.028); acute arterial embolism of lower extremity and type II endoleak respectively occurred in 1(2.7%) case. For midterm result, survival at 3 months, 1 year and 5 years was 88.8±5.3%, 75.9±7.5% and 68.3±9.9%, which showed significant difference between zone 2/3 versus zone 4 group (56.3±14.8% versus 72.9±13.2%, p= 0.013) and emergent versus elective TEVAR groups (0.0±0.0% versus 80.1±8.0%, p= 0.049). On multivariate Cox regression, lesions at zone 2/3 (HR 4.605, 95%CI 1.095-19.359), concomitant cardiac disease (HR 4.932, 95%CI 1.086-22.403) and emergent TEVAR (HR 4.196, 95%CI 1.042-16.891) were significant independent risk factors for worse late clinical outcome. Conclusions: TEVAR therapy is effective and safe with satisfactory early and midterm clinical outcome for TAP patients. Lesions at zone 2/3, concomitant cardiac disease and emergent TEVAR were independent risk factors for midterm survival outcome.


2020 ◽  
Author(s):  
Mehdi Gholamzadeh Baeis ◽  
Abolfazl Mozafari ◽  
Fatemeh Movaseghi ◽  
Mehdi Yadollahzadeh ◽  
Ahmad Sohrabi ◽  
...  

Abstract Background: The outbreak of coronavirus disease 2019 (COVID-19) becomes an enormous threat to all human beings. Via this retrospective study conducted on medical records of confirmed COVID-19 pneumonia patients on admission, we investigate the CT manifestation and clinical and laboratory risk factors associated with progression to severe COVID-19 pneumonia and assessed the association among clinical and laboratory records, CT findings, and epidemiological features. The medical records and radiological CT Features of 236 confirmed COVID-19 patients were reviewed at one public hospital and one respiratory clinic in Quom, from 1 August to 30 September 2020. Results: Among a total of 236 confirmed Covid-19 cases, 62 were infected with moderate to severe COVID-19 disease and required hospital admission, and 174 were followed up on outpatient bases. A significant difference was verified in the mean age between outpatients and hospitalized groups. The incidences of bilateral lung involvement, consolidation, linear opacities, crazy-paving pattern, air bronchogram sign, and the number of lobe involvement were significantly higher in hospitalized groups. However, only the crazy-paving pattern was significantly associated with an SpO2 level lower than 90%, with clinical sign of cough severity. Our data indicate that this pattern is also significantly associated with inflammatory levels and the presence of this pattern along with SpO2 level lower than 90%, older age, diabetes, on admission are independent risk factors for COVID-19 progression to severe level.Conclusions: The crazy-paving pattern can predict the severity of COVID-19, which is of great significance for the management and follow-up of COVID-19 pneumonia patients. The clinical factors of aging, male gender, and diabetes, may be risk factors for the crazy-paving pattern, whereas severe coughing is considered to be the most important clinical symptom related to this pattern, and SpO2 level lower than 90%, which is a matter of more severity.


2019 ◽  
Vol 13 (12) ◽  
pp. 1485-1491 ◽  
Author(s):  
Michiel E De Jong ◽  
Sanne B Van Tilburg ◽  
Loes H C Nissen ◽  
Wietske Kievit ◽  
Iris D Nagtegaal ◽  
...  

AbstractBackground and AimsThe long-term risk of high-grade dysplasia [HGD] and colorectal cancer [CRC] following low-grade dysplasia [LGD] in inflammatory bowel disease [IBD] patients is relatively unknown. We aimed to determine the long-term cumulative incidence of advanced neoplasia [HGD and/or CRC], and to identify risk factors for advanced neoplasia in a nationwide IBD cohort with a history of LGD.MethodsThis is a nationwide cohort study using data from the Dutch National Pathology Registry [PALGA] to identify all IBD patients with LGD between 1991 and 2010 in the Netherlands. Follow-up data were collected until January 2016. We determined the cumulative incidence of advanced neoplasia and identified risk factors via multivariable Cox regression analysis.ResultsWe identified 4284 patients with colonic LGD with a median follow-up of 6.4 years after initial LGD diagnosis. The cumulative incidence of subsequent advanced neoplasia was 3.6, 8.5, 14.4 and 21.7%, after 1, 5, 10 and 15 years, respectively. The median time to develop advanced neoplasia after LGD was 3.6 years. Older age [≥ 55 years] at moment of LGD (hazard ratio [HR] 1.73, 95% confidence interval [CI] 1.44–2.06), male sex [HR 1.33, 95% CI 1.10–1.60], and follow-up at an academic [vs non-academic] medical centre [HR 1.37, 95% CI 1.07–1.76] were independent risk factors for advanced neoplasia following LGD.ConclusionsIn a large nationwide cohort with long-term follow-up of IBD patients with LGD, the cumulative incidence of advanced neoplasia was 21.7% after 15 years. Older age at LGD [≥55 years], male sex and follow-up by a tertiary IBD referral centre were independent risk factors for advanced neoplasia development after initial LGD.


2017 ◽  
Vol 19 (4) ◽  
pp. 440-447 ◽  
Author(s):  
Kazunori Hayashi ◽  
Hiromitsu Toyoda ◽  
Hidetomi Terai ◽  
Akinobu Suzuki ◽  
Masatoshi Hoshino ◽  
...  

OBJECTIVE Numerous reports have been published on the effectiveness and safety of correction of the coronal Cobb angle and thoracolumbar sagittal alignment in patients with adolescent idiopathic scoliosis (AIS). Suboptimal sagittal alignment, such as decreased thoracic kyphosis (TK), after corrective surgery, is a possible cause of lumbar or cervical spinal degeneration and junctional malalignment; however, few reports are available on reciprocal changes outside of the fused segments, such as the cervical lordotic angle (CLA). This study aimed to investigate the relationship between the perioperative CLA and other radiographic factors or clinical results in AIS, and to identify independent risk factors of postoperative cervical hyperkyphosis. METHODS A total of 51 AIS patients who underwent posterior spinal fusion with the placement of pedicle screw (PS) constructs at thoracic levels were included in the study. Clinical and radiographic follow-up of patients was conducted for a minimum of 2 years, and the postoperative course was evaluated. The authors measured and identified the changes in the CLA and other radiographic parameters using whole-spine radiography, with the patient in the standing position, performed immediately before surgery, 2 weeks after surgery, and 2 years after surgery. The postoperative cervical hyperkyphosis group included patients whose CLA at 2-year follow-up was smaller than −10°. The reciprocal changes of the CLA and other parameters were also investigated. Univariate and multivariate analyses were conducted to determine the associated risk factors for postoperative cervical hyperkyphosis. RESULTS This study comprised 48 females and 3 males (mean age 16.0 years). The mean follow-up period was 47 months (range 24–90 months). The main coronal thoracic curve was corrected from 54.6° to 16.4°, and the mean correction rate was 69.8% at 2 years. The CLA significantly increased from the mean preoperative measurement (−5.4° ± 14°) to the 2-year follow-up measurement (−1.7° ± 11°) (p = 0.019). Twelve of the 51 patients had postoperative cervical hyperkyphosis. This group exhibited significantly smaller preoperative CLA and TK measurements (p = 0.001 and 0.004, respectively) than the others. After adjusting for confounding factors, preoperative CLA less than −5° and preoperative TK less than 10° were significantly associated with postoperative cervical hyperkyphosis (p < 0.05; OR 12.5 and 8.59, respectively). However, no differences were found in the clinical results regardless of cervical hyperkyphosis. CONCLUSIONS The CLA increased significantly from preoperatively to 2 years after surgery. Preoperative small CLA and TK measurements were independent risk factors of postoperative cervical hyperkyphosis. However, there was no difference in the clinical outcomes regardless of cervical hyperkyphosis.


2021 ◽  
Author(s):  
Jin Mei ◽  
Lili Pang ◽  
Zhongchao Jiang

Abstract Background Core decompression and nonvascularized bone grafting are used in the early stage of osteonecrosis of femoral head for a period. Since the comparison of the core decompression and nonvascularized bone grafting are less reported, the purpose of our study was to investigate the clinical outcomes of two procedures in patients with earlier stages of the osteonecrosis of femoral head. Methods Between January 2018 and January 2019, 46 patients (48 hips) are divided into core decompression group and non-vascularized allogeneic fibula grafting group according to their procedures. The mean follow-up were 28.31±3.7 months (24–36 months) and 29.23±4.7months(24–36 months) respectively. the primary outcomes were VAS and HHS. Survivorship was analyzed with the collapse of femoral head or conversion to total hip arthroplasty (THA) as the endpoint. Results At the final follow-up, two hips underwent THA in core decompression group and three hips in non-vascularized allogeneic fibula grafting group. The radiographic survival rates are 76.9% and 77.3% in the two groups. Statistically significant improvements were seen in both groups on the VAS and HHS. The radiographic survival rate of hips was significantly inferior in lateral type lesion (P = 0.03; CI,0.765–2.114) and ARCO III stage (P = 0.28; CI, 1.254–58.752) in core decompression group. ARCO III stage (P = 0.02; CI, 1.351–49.344) and BMI>25 (P = 0.35; CI, 0.999–2.131) were independent risk factors for the collapse of femoral head in non-vascularized allogeneic fibula grafting group. Conclusion In this study, two procedures all can reduce the patient’s pain and improve functional activity. Arco stage III is a common risk factor for the collapse of femoral head in both groups. lateral lesion and BMI>25 are risk factors for the collapse of femoral head in core decompression group and non-vascularized allogeneic fibula grafting group, respectively. Both groups had good hip survival rates during the follow-up period.


2015 ◽  
Vol 95 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Maria Angela Cerruto ◽  
Carolina D'Elia ◽  
Francesca Maria Cavicchioli ◽  
Stefano Cavalleri ◽  
Matteo Balzarro ◽  
...  

Background: Pelvic organ prolapse is a common condition, affecting about 50% of women with children. The aim of our study was to evaluate results and complication rates in a consecutive series of female patients undergoing robot-assisted laparoscopic hysterosacropexy (RALHSP). Materials and Methods: We performed a medical record review of female patients with uterine prolapse who had consecutively undergone RALHSP from February 2010 to 2013 at our department. Results: Fifteen patients were included in the analysis. All patients had uterine prolapse stage ≥II and urodynamic stress urinary incontinence. The mean age was 58.26 years. According to the Clavien-Dindo system, 4 out of 15 patients (26.6%) had grade 1 early complications and 1 patient had a grade 2 complication. At a median follow-up of 36 months, there was a significant prolapse relapse rate of 20% (3/15). Conclusion: In our hands RALHSP is easy to perform, with satisfying mid-term outcomes and a low complication rate.


Author(s):  
Maria Värendh ◽  
Christer Janson ◽  
Caroline Bengtsson ◽  
Johan Hellgren ◽  
Mathias Holm ◽  
...  

Abstract Purpose Humans have a preference for nasal breathing during sleep. This 10-year prospective study aimed to determine if nasal symptoms can predict snoring and also if snoring can predict development of nasal symptoms. The hypothesis proposed is that nasal symptoms affect the risk of snoring 10 years later, whereas snoring does not increase the risk of developing nasal symptoms. Methods In the cohort study, Respiratory Health in Northern Europe (RHINE), a random population from Denmark, Estonia, Iceland, Norway, and Sweden, born between 1945 and 1973, was investigated by postal questionnaires in 1999–2001 (RHINE II, baseline) and in 2010–2012 (RHINE III, follow-up). The study population consisted of the participants who had answered questions on nasal symptoms such as nasal obstruction, discharge, and sneezing, and also snoring both at baseline and at follow-up (n = 10,112). Results Nasal symptoms were frequent, reported by 48% of the entire population at baseline, with snoring reported by 24%. Nasal symptoms at baseline increased the risk of snoring at follow-up (adj. OR 1.38; 95% CI 1.22–1.58) after adjusting for age, sex, BMI change between baseline and follow-up, and smoking status. Snoring at baseline was associated with an increased risk of developing nasal symptoms at follow-up (adj. OR 1.22; 95% CI 1.02–1.47). Conclusion Nasal symptoms are independent risk factors for development of snoring 10 years later, and surprisingly, snoring is a risk factor for the development of nasal symptoms.


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1563.3-1563
Author(s):  
H. Tamaki ◽  
S. Fukui ◽  
T. Nakai ◽  
G. Kidoguchi ◽  
S. Kawaai ◽  
...  

Background:Currently it is hypothesized that many systemic autoimmune diseases occur due to environmental risk factors in addition to genetic risk factors. Anti-Neutrophil Cytoplasmic Antibody (ANCA) is mainly associated with three systemic autoimmune disease including granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), eosinophilic granulomatosis with polyangiitis (EGPA). It is known that ANCA can be positive before clinical symptoms in patients with known diagnosis of GPA and ANCA titers rise before clinical manifestations appear. However, prevalence of ANCA among general population is not well known. It has not been described as well how many of people with positive ANCA eventually develop clinical manifestations of ANCA associated Vasculitis.Objectives:This study aims to estimate prevalence of ANCA in general population without ANCA associated Vasculitis. It also describes natural disease course of people with positive ANCA without ANCA associated Vasculitis. Risk factors for positive ANCA are also analyzed.Methods:This is a single center retrospective study at Center for Preventive Medicine of St. Luke’s International Hospital in Tokyo. ANCA was checked among the patients who wished to between 2018 and 2019. St. Luke’s Health Check-up Database (SLHCD) was utilized to collect the data. The patients whose serum was measured for ANCA were identified. The data for basic demographics, social habits, dietary habits and laboratory data were extracted. The charts of the patients with positive ANCA were reviewed.Results:Sera of total 1204 people were checked for ANCA. Of these 1204 people, 587 (48.8%) are male and the mean age was 55.8 years (32.6 to 79). There were total 11 patients with positive ANCA. Myeloperoxidase ANCA (MPO-ANCA) was positive for 3 patients and proteinase 3 ANCA (PR3-ANCA) was positive for 8 patients. Of these 11 patients, 5 were male (45.5%) and the mean age was 54.6 years. Two patients had history of autoimmune disease (primary biliary cirrhosis and ulcerative colitis). Five patients were evaluated by rheumatologists with the median follow-up period of 274 days. None of them developed clinical signs and symptoms of ANCA associated Vasculitis. Four out of five patients had ANCA checked later, two of which turned negative. The prevalence of ANCA in this cohort was 0.9% (95% confidence interval [95% CI]: 0.5% to 1.6%). Univariate analysis was performed to identify risk factors of positive ANCA. The variables analyzed include age, gender, body mass index (BMI), smoking habits, alcohol intake, dietary habits (fruits, fish, red meat), hypertension, dyslipidemia, and laboratory data. None of these variables demonstrated statistically significant differences except for positive rheumatoid factor (ANCA positive group: 33 % vs ANCA negative group: 9.1%, p value = 0.044).Conclusion:The prevalence of ANCA in this cohort was 0.9% (95% CI: 0.5% to 1.6%). None of them who had a follow-up developed ANCA associated Vasculitis during the follow-up period. Longer follow-up and more patients are necessary to determine natural course of people with positive ANCA.Disclosure of Interests:None declared


2021 ◽  
pp. 239936932110319
Author(s):  
Yihe Yang ◽  
Zachary Kozel ◽  
Purva Sharma ◽  
Oksana Yaskiv ◽  
Jose Torres ◽  
...  

Introduction: The prevalence of chronic kidney disease (CKD) is high among kidney neoplasm patients because of the overlapping risk factors. Our purpose is to identify kidney cancer survivors with higher CKD risk. Methods: We studied a retrospective cohort of 361 kidney tumor patients with partial or radical nephrectomy. Linear mixed model was performed. Results: Of patients with follow-up >3 months, 84% were identified retrospectively to fulfill criteria for CKD diagnosis, although CKD was documented in only 15%. Urinalysis was performed in 205 (57%) patients at the time of nephrectomy. Multivariate analysis showed interstitial fibrosis and tubular atrophy (IFTA) >25% ( p = 0.005), severe arteriolar sclerosis ( p = 0.013), female gender ( p = 0.024), older age ( p = 0.012), BMI ⩾ 25 kg/m2 ( p < 0.001), documented CKD ( p < 0.001), baseline eGFR ⩽ 60 ml/min/1.73 m2 ( p < 0.001), and radical nephrectomy ( p < 0.001) were independent risk factors of lower eGFR at baseline and during follow-up. Average eGFR decreased within 3 months post nephrectomy. However, patients with different risk levels showed different eGFR time trend pattern at longer follow-ups. Multivariate analysis of time × risk factor interaction showed BMI, radical nephrectomy and baseline eGFR had time-dependent impact. BMI ⩾ 25 kg/m2 and radical nephrectomy were associated with steeper eGFR decrease slope. In baseline eGFR > 90 ml/min/1.73 m2 group, eGFR rebounded to pre-nephrectomy levels during extended follow-up. In partial nephrectomy patients with baseline eGFR ⩾ 90 ml/min/1.73 m2 ( n = 61), proteinuria ( p < 0.001) and BMI ( p < 0.001) were independent risk factors of decreased eGFR during follow up. Conclusions: As have been suggested by others and confirmed by our study, proteinuria and CKD are greatly under-recognized. Although self-evident as a minimum workup for nephrectomy patients to include SCr, eGFR, urinalysis, and proteinuria, the need for uniform applications of this practice should be reinforced. Non-neoplastic histology evaluation is valuable and should include an estimate of global sclerosis% (GS) and IFTA%. Patients with any proteinuria and/or eGFR ⩽ 60 at the time of nephrectomy or in follow-up with urologists, and/or >25% GS or IFTA, should be referred for early nephrology consultation.


Author(s):  
Iván Galtier ◽  
Antonieta Nieto ◽  
María Mata ◽  
Jesús N. Lorenzo ◽  
José Barroso

ABSTRACT Objective: Subjective cognitive decline (SCD) and mild cognitive impairment (MCI) in Parkinson’s disease (PD) are considered as the risk factors for dementia (PDD). Posterior cortically based functions, such as visuospatial and visuoperceptual (VS-VP) processing, have been described as predictors of PDD. However, no investigations have focused on the qualitative analysis of the Judgment of Line Orientation Test (JLOT) and the Facial Recognition Test (FRT) in PD-SCD and PD-MCI. The aim of this work was to study the VS-VP errors in JLOT and FRT. Moreover, these variables are considered as predictors of PDD. Method: Forty-two PD patients and 19 controls were evaluated with a neuropsychological protocol. Patients were classified as PD-SCD and PD-MCI. Analyses of errors were conducted following the procedure described by Ska, Poissant, and Joanette (1990). Follow-up assessment was conducted to a mean of 7.5 years after the baseline. Results: PD-MCI patients showed a poor performance in JLOT and FRT total score and made a greater proportion of severe intraquadrant (QO2) and interquadrant errors (IQO). PD-SCD showed a poor performance in FRT and made mild errors in JLOT. PD-MCI and QO2/IQO errors were independent risk factors for PDD during the follow-up. Moreover, the combination of both PD-MCI diagnosis and QO2/IQO errors was associated with a greater risk. Conclusions: PD-MCI patients presented a greater alteration in VS-VP processing observable by the presence of severe misjudgments. PD-SCD patients also showed mild difficulties in VS-SP functions. Finally, QO2/IQO errors in PD-MCI are a useful predictor of PDD, more than PD-MCI diagnosis alone.


Sign in / Sign up

Export Citation Format

Share Document