scholarly journals A comparative discussion of incisional methods in total capsulectomy of the breast

2021 ◽  
Vol 27 (4) ◽  
pp. 117-124
Author(s):  
Tae Hyung Kim ◽  
Seok Min Yoon ◽  
Syeo Young Wee ◽  
Hyok Sue Oh ◽  
Hyun Gyo Jeong
Keyword(s):  
Statistical Analysis ◽  
Physical Examination ◽  
Chart Review ◽  
Capsular Contracture ◽  
Retrospective Chart Review ◽  
Posterior Wall ◽  
Bleeding Tendency ◽  
En Bloc ◽  
Periareolar Incision ◽  
Secondary Operations

Background Capsular contracture is a frequent complication of breast augmentation that constitutes one of the most common reasons for secondary operations. Capsular contracture is treated surgically, often with total capsulectomy. Therefore, in this study, we aimed to study correlations among intraoperative observations, physical examination findings, and characteristics of the previous operation in patients with capsular contracture who underwent total capsulectomy.Methods A retrospective chart review was conducted for patients treated from May 2017 to April 2019, analyzing 24 breasts in 12 female patients. The patients were classified in terms of the Baker grade, incision type, implant type, and implant plane. During the operation, we evaluated the ease of dissection based on intraoperative features such as anterior and posterior wall dissection, bleeding tendency, and scar length. Statistical analysis was performed to identify association between variablesResults The implant was changed in eight patients, while only explantation was performed in the remaining four patients. The ease of capsule dissection had a proportional correlation with the Baker grade (P=0.005). Intraoperative dissection was significantly easier in the inframammary fold (IMF) group than in the periareolar group (P=0.035).Conclusions An IMF incision is preferable for planning en bloc capsulectomy. However, for aesthetic concerns, a periareolar incision would be preferable. In addition, a lower Baker grade (grade I or II) was associated with easier dissection. Therefore, surgeons should choose the incision type depending on the necessity of performing en bloc capsulectomy, Baker grade, and scar length.

scholarly journals A comparative discussion of incisional methods in total capsulectomy of the breast

2021 ◽  
Vol 27 (4) ◽  
pp. 117-124
Author(s):  
Tae Hyung Kim ◽  
Seok Min Yoon ◽  
Syeo Young Wee ◽  
Hyok Sue Oh ◽  
Hyun Gyo Jeong
Keyword(s):  
Statistical Analysis ◽  
Physical Examination ◽  
Chart Review ◽  
Capsular Contracture ◽  
Retrospective Chart Review ◽  
Posterior Wall ◽  
Bleeding Tendency ◽  
En Bloc ◽  
Periareolar Incision ◽  
Secondary Operations

Background Capsular contracture is a frequent complication of breast augmentation that constitutes one of the most common reasons for secondary operations. Capsular contracture is treated surgically, often with total capsulectomy. Therefore, in this study, we aimed to study correlations among intraoperative observations, physical examination findings, and characteristics of the previous operation in patients with capsular contracture who underwent total capsulectomy.Methods A retrospective chart review was conducted for patients treated from May 2017 to April 2019, analyzing 24 breasts in 12 female patients. The patients were classified in terms of the Baker grade, incision type, implant type, and implant plane. During the operation, we evaluated the ease of dissection based on intraoperative features such as anterior and posterior wall dissection, bleeding tendency, and scar length. Statistical analysis was performed to identify association between variablesResults The implant was changed in eight patients, while only explantation was performed in the remaining four patients. The ease of capsule dissection had a proportional correlation with the Baker grade (P=0.005). Intraoperative dissection was significantly easier in the inframammary fold (IMF) group than in the periareolar group (P=0.035).Conclusions An IMF incision is preferable for planning en bloc capsulectomy. However, for aesthetic concerns, a periareolar incision would be preferable. In addition, a lower Baker grade (grade I or II) was associated with easier dissection. Therefore, surgeons should choose the incision type depending on the necessity of performing en bloc capsulectomy, Baker grade, and scar length.

Risk factors for poor outcomes of early rehabilitation after total en bloc spondylectomy: a retrospective chart review of 140 patients

Spinal Cord ◽  
2020 ◽  
Vol 58 (8) ◽  
pp. 900-907
Author(s):  
Yuki Kurokawa ◽  
Hideki Murakami ◽  
Satoru Demura ◽  
Satoshi Kato ◽  
Noriaki Yokogawa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Early Rehabilitation ◽  
En Bloc ◽  
Total En Bloc Spondylectomy ◽  
En Bloc Spondylectomy ◽  
Bloc Spondylectomy ◽  
Poor Outcomes

Sleep Disturbance Following Concussion Is a Risk Factor for a Prolonged Recovery

2016 ◽  
Vol 56 (14) ◽  
pp. 1280-1285 ◽  
Author(s):  
Harry Bramley ◽  
Alyssa Henson ◽  
Mechelle M. Lewis ◽  
Lan Kong ◽  
Christy Stetter ◽  
...  
Keyword(s):  
Risk Factor ◽  
Statistical Analysis ◽  
Sleep Disturbance ◽  
Recovery Time ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Fold Increase ◽  
Anticipatory Guidance ◽  
Inclusion Criteria ◽  
Prolonged Recovery

Sleep disturbance is a common problem following concussion. A retrospective chart review was conducted at a regional concussion clinic on patients 13 to 18 years of age between 2005 and 2011. Statistical analysis evaluated sleep disturbance and duration of concussion, as well as the use and effectiveness of melatonin. A total of 417 patients met inclusion criteria. One hundred twenty-three (34%) reported disturbance in sleep. There was no difference in sleep disturbance based on age, gender, or past number of concussions. Sleep disturbance was associated with a 3- to 4-fold increase in recovery time. Non–sport-related concussions were more likely to be associated with sleep disturbance compared to sport-related concussions (45% vs 29%, P = .01). Melatonin improved sleep disturbance in 67% of the patients. Evaluating sleep disorders following concussion is an important part of the assessment. These findings will help clinicians provide anticipatory guidance and treatment for adolescents recovering from concussion.

Bupropion in the treatment of postural orthostatic tachycardia syndrome (POTS): a single-center experience

2020 ◽  
Vol 68 (6) ◽  
pp. 1156-1158
Author(s):  
Rohit Vyas ◽  
Zeid Nesheiwat ◽  
Mohammed Ruzieh ◽  
Zaid Ammari ◽  
Mohammad Al-Sarie ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Gold Standard ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Potential Treatment ◽  
Single Center ◽  
Single Center Experience ◽  
Dopamine Reuptake ◽  
Dopamine Reuptake Inhibitor

Postural orthostatic tachycardia syndrome (POTS) is estimated to impact millions of people each year. However, there is no established gold standard for its treatment. Bupropion is a norepinephrine and a dopamine reuptake inhibitor and has been implicated as a potential treatment for POTS. We performed a non-randomized retrospective chart review on 47 patients with POTS with statistical analysis evaluating for significant findings including reduced orthostasis and improvement of symptoms with the use of bupropion. Bupropion was not associated with a statistically significant improvement in orthostatic vitals but there was an overall reduction in reported syncope. While the use of bupropion does not show a statistically significant impact on orthostatic vitals in patients with POTS, it did show a degree of improvement in syncope and as such might be useful in patients with syncope-predominant POTS.

scholarly journals Anatomic Implants in Breast Reconstruction: A Comparison of Outcomes and Aesthetic Results Compared to Smooth Round Silicone Implants

2019 ◽  
Vol 39 (8) ◽  
pp. NP322-NP330 ◽  
Author(s):  
Nneamaka Agochukwu-Nwubah ◽  
Ashley Boustany ◽  
Margaret Wetzel ◽  
Jacob Maus ◽  
Brian Rinker
Keyword(s):  
Breast Reconstruction ◽  
Chart Review ◽  
Capsular Contracture ◽  
Retrospective Chart Review ◽  
Well Being ◽  
Silicone Implants ◽  
Body Type ◽  
Level Of Evidence ◽  
Aesthetic Results ◽  
Implant Reconstruction

Abstract Background Direct comparison studies of outcomes and aesthetic satisfaction of anatomic implants compared to other implants are scarce in the literature. Objectives The objective of this study was to compare outcomes and aesthetic satisfaction of patients who underwent breast reconstruction with anatomic implants vs other implants (smooth round silicone). Methods A retrospective chart review was performed of patients who underwent implant-based breast reconstruction over 3 years. Outcomes including complications, number of surgeries, need for revisions, and aesthetic satisfaction of patients were tracked and compared. Results A total of 156 patients met inclusion criteria for this study. A total of 123 underwent reconstruction with a round implant, and 33 underwent reconstruction with an anatomic implant. Of the 156 patients, 38 underwent a 1-stage direct-to-implant reconstruction and the remainder underwent a 2-stage implant reconstruction. The round and anatomic implant groups did not differ with regards to number of surgeries, revisions, utilization of contralateral symmetry procedures, implant-related reoperations, complications, implant loss, infection, capsular contracture, and seroma. The Breast Q survey had a response rate of 27%. On all parameters, the round and anatomic implant groups did not significantly differ. Conclusions There were no significant differences among round and shaped implants in regards to complications, revision surgeries, and overall outcomes. Furthermore, patients showed no differences regarding satisfaction and well-being when surveyed on the Breast Q survey. The decision of implant choice in breast reconstruction should be based on surgeon comfort and the patient’s needs/body type. Level of Evidence: 4

Propranolol for infantile haemangiomas: initiating treatment on an outpatient basis

2011 ◽  
Vol 22 (4) ◽  
pp. 424-429 ◽  
Author(s):  
Joshua L. Dyme ◽  
Ashis Thampan ◽  
Eugenia J. Han ◽  
Themba L. Nyirenda ◽  
Mohy E. Kotb ◽  
...  
Keyword(s):  
Adverse Events ◽  
Physical Examination ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Outpatient Basis ◽  
Cardiac Evaluation ◽  
Pre Treatment ◽  
Clinically Significant ◽  
Infantile Haemangiomas

AbstractIntroductionPropranolol was recently discovered to be an effective treatment for infantile haemangiomas, and varying doses and monitoring regimens have been proposed. Adverse events, although uncommon, have been reported.Materials and methodsThis was a retrospective chart review of infants with haemangiomas who were started on propranolol at a dose of 3 milligrams per kilogram per day on an outpatient basis. After a baseline cardiac evaluation including an electrocardiogram and an echocardiogram, treatment was initiated during 6 hours of observation.ResultsA total of 15 patients were identified; however, only 13 returned for at least one follow-up visit. This cohort was followed up for a median of 2.8 months with a range from 0.2 to 10.0. No hypotension, hypoglycaemia, bronchospasm, or clinically significant bradycardia occurred during treatment. All patients had clinical improvement of their haemangiomas.ConclusionsThis study suggests that initiating treatment during outpatient observation may be a reasonable alternative to inpatient admission. In addition, expensive testing may not be necessary during pre-treatment screening when the physical examination is normal.

scholarly journals Diagnostic Accuracy, Prescription Behavior, and Watchful Waiting Efficacy for Pediatric Acute Otitis Media

2018 ◽  
Vol 58 (1) ◽  
pp. 60-65 ◽  
Author(s):  
David L. Brinker ◽  
Erina L. MacGeorge ◽  
Nicole Hackman
Keyword(s):  
Physical Examination ◽  
Otitis Media ◽  
Chart Review ◽  
Watchful Waiting ◽  
Acute Otitis Media ◽  
Retrospective Chart Review ◽  
Antibiotic Use ◽  
Central Pennsylvania ◽  
Current Guidelines ◽  
Prescription Behavior

Current guidelines recommend “watchful waiting” (WW) as an alternative to immediate antibiotic treatment. Continued high rates of antibiotic use suggest that WW may be underutilized. We conducted a retrospective chart review of 474 pediatric acute otitis media (AOM) cases at a clinic in central Pennsylvania. We assessed physical examination findings, diagnostic behavior, WW utilization, prescription writing, and filling in cases of pediatric AOM to evaluate the underutilization of WW. We evaluate diagnostic consistency with published guidelines and rates of antibiotic prescription resulting from misdiagnosis. We report WW instructions and compliance, and prescription filling behaviors. Fifty percent of AOM diagnoses in this sample were not supported by physical examination findings. The majority of these AOM diagnoses received antibiotic prescriptions, suggesting that unsupported diagnoses translated to injudicious prescribing. WW instructions corresponded to 57% fewer filled prescriptions and longer fill delay. We discuss the implications and recommendations to improve antibiotic stewardship.

Evaluating Effectiveness of the Use of an Extremity Stabilization Device for Vascular Access Procedures in Pediatrics

2021 ◽  
Author(s):  
Tricia Templet ◽  
Roger Rholdon ◽  
Ansley Bienvenu
Keyword(s):  
Statistical Analysis ◽  
Vascular Access ◽  
Chart Review ◽  
Pediatric Patients ◽  
Traditional Approach ◽  
Retrospective Chart Review ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Procedure Time ◽  
Placement Success

AbstractThe purpose of this study is to evaluate the effectiveness of SafeBoard, a Food and Drug Administration–approved extremity stabilization device, as an assistive method in performing peripherally inserted central catheter procedures on children 0 to 3 years of age. This is a retrospective chart review (n = 59) of vascular access procedures where SafeBoard was utilized (n = 32) in comparison to those procedures which utilized a traditional approach to placement (n = 27). Statistical analysis demonstrated significant effect on length of procedure time, number of personnel needed for procedure, and success of placement when SafeBoard was utilized. Obtaining vascular access in pediatrics can be a challenging endeavor. Most young pediatric patients require procedural sedation and/or assistive personnel as a “holder” for successful vascular access placement to occur. An alternative option for extremity stabilization may provide improved workflow and improved placement success, which in turn may positively affect workflow.

scholarly journals MON-LB011 Retrospective Comparison of Cystic Fibrosis Related Diabetes Pediatric Screening Rates

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Einas H Alkhatib ◽  
Nader Kasim
Keyword(s):  
Cystic Fibrosis ◽  
Statistical Analysis ◽  
Data Collection ◽  
Glucose Tolerance ◽  
Chart Review ◽  
Pediatric Patients ◽  
Univariate Analysis ◽  
Retrospective Chart Review ◽  
Hospital Length Of Stay ◽  
Oral Glucose

Abstract Cystic fibrosis-related diabetes (CFRD) is the most common comorbidity in those with CF, affecting 20% of adolescents and 40-50% of adults with CF. If uncontrolled, it can cause worsened pulmonary outcomes, increased hospital length of stay, and increased mortality. It is typically clinically silent, and hemoglobin A1C and fasting plasma glucose are not sensitive enough to diagnose it. Per national guidelines, the proper outpatient screening method is oral glucose tolerance test (OGTT), annually beginning age 10. Inpatient diagnosis involves fasting glucose >126 mg/dl or 2 hour postprandial glucose >200 persisting for more than 48 hours. It is believed that national screening guidelines are unfortunately not being met, particularly while inpatient. At our institution, there are 137 pediatric patients with CF; of those, 8 have a diagnosis of CFRD, and 4 have impaired glucose tolerance. We aim to study the adherence of our institution to the best practice guidelines for CFRD screening in pediatric patients with Cystic Fibrosis. Retrospective chart review is occurring through our institution’s EMR for inpatient data, and through a CF database (PortCF) for outpatient data. Inclusion criteria includes pediatric patients (below 1 day or above 17 years and 364 days) with CF. Exclusion criteria is those outside this age range, and those with CFRD. Consent is waived, as this is a retrospective data collection. Several variables including demographics, glycemic status, CFTR modulator and class, corticosteroid and vitamin use, and feeding regimen are also being reviewed. REDCap is being used for secure data entry and analysis. Descriptive statistical analysis will be used. Categorical data will be expressed as frequency (percent). Numeric data will be expressed as mean ± standard deviation or median [25th, 75th percentile], depending on normality of the data. Univariate analysis, like Chi square or Fisher’s exact test, will be used between successful and unsuccessful inpatient screens for CFRD. Thus far, retrospective chart review of all outpatient data is complete. Preliminary analysis of those who should have received OGTT screening shows 11% have never been screened, and 32% were screened more than one year ago. Completion of inpatient data collection and all statistical analysis is anticipated within the next month. Future direction includes increasing inpatient CFRD screening with use of continuous glucose monitoring sensors during CF exacerbation admissions.

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