Optimizing pediatric histrelin implantation to improve success rates in clinic without sedation

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Vikram Krishna ◽  
Steven L. Lee ◽  
Daniel A. DeUgarte
Keyword(s):  
Risk Factor ◽  
Retrospective Study ◽  
Gender Dysphoria ◽  
Success Rates ◽  
Exact Test ◽  
The Past ◽  
Wilcoxon Rank Sum Test ◽  
Younger Age ◽  
Procedural Complication ◽  
Wound Problem

Abstract Objectives The purpose of this study was to review our success rate performing the histrelin implant procedure in clinic without sedation. Methods A retrospective study was performed for histrelin implant procedures done at our institution from 2008 to 2020. Wilcoxon rank-sum test or Fisher’s exact test was utilized to identify significant differences (p<0.05). Results A total of 73 patients underwent 184 histrelin implant procedures from 2008 to 2020. In the past few years, there has been a decrease in procedures for precocious puberty and an increase for gender dysphoria. The majority of procedures were performed in clinic without sedation (82%). The only risk factor associated with requiring sedation was younger age (median 9 vs. 10 years; p<0.003). Complications (i.e. implant fracture or need for counter-incision) were noted in 10 of the procedures (5%). The only risk factor identified for a procedural complication during implant removal/replacement was interval time from insertion (21 vs. 13 months; p<0.01). The only documented wound problem reported was dermatitis in 1 patient (no suture granuloma, dehiscence, or implant extravasation). Conclusions Procedural refinements and distraction therapy have enabled us to perform the majority of procedures in clinic without sedation. In our experience, procedural difficulty and complications appear to increase with prolonged implant duration. Histrelin implantation is increasingly being performed for gender dysphoria.

Severe toxicity risk factor analysis of salvage radiotherapy for oligo-recurrence in the lymph nodes (LN) of esophagus carcinoma: From multi-institutional retrospective study.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 186-186
Author(s):  
Toshihiko Matsumoto ◽  
Tomohiro Nishina ◽  
Yuzuru Niibe ◽  
Hideomi Yamashita ◽  
Kuniaki Katsui ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Retrospective Study ◽  
Lymph Nodes ◽  
Severe Toxicity ◽  
Regional Lymph Nodes ◽  
Exact Test ◽  
Esophageal Bleeding ◽  
Esophagus Carcinoma ◽  
Radiation Induced

186 Background: This multi-institutional retrospective study suggested that salvage radiotherapy (RT) or chemoradiation therapy (CRT) for oligo-recurrence in the lymph nodes (LN) of esophagus carcinoma was one of therapeutic options. However risk factors of severe toxicities of these therapies are unclear. Methods: Between January 2000 and April 2015, a total of 237 cases that met the study criteria of oligo-recurrence were treated by RT or CRT in five hospitals. We investigated risk factors of severe toxicities in these patients. We used the fisher’s exact test and Cox proportional hazard model. Toxicities were evaluated by CTCAE v4.0. Results: The median follow-up time for 93 living cases was 29.6 months (range; 1.9-154.0 months). Systemic chemotherapy was administrated to 210 cases (88.6%). Median biological effective dose(BED) was 72 Gy(range: 48-84Gy).The 3-year overall survival (OS) was 37%, local control was 45%, progression-free survival was 24%. Radiation induced Grade 3 or worse adverse events were observed in 11 patients (4.6%), which were fistula (4patients,1.7%), pneumonia (2patients,0.8%), pleural effusion (2patients,0.8%), esophageal bleeding (1 patient, 0.4%), esophageal stenosis (1patient,0.4%), cardiac tamponade (1patient,0.4%), and hyperglycemia (1patient,0.4%) ) Treatment related death occurred in 4 patients, these deaths were attributed to drug-induced or radiation-induced interstitial pneumoniae, pleural effusion, esophageal bleeding, and esophago-bronchial fistula. Severe toxicity was only observed in patients with oligo-recurrence in regional lymph nodes or BED ³a60 Gy. In univariate analysis by Fisher’s exact test, Karnofsky performance status (KPS) <80 (p=0.0006) and oligo-recurrence in regional lymph nodes (p=0.0078) were the risk factor of severe toxicity. In multivariate analysis, KPS<80 (HR:11.81,95% CI: 2.67-51.29, p=0.0017) was the risk factor of severe toxicity. Conclusions: This study suggested that KPS<80 and oligo-recurrence in regional lymph nodes is the risk factor for severe toxicity in patients who received RT or CRT for oligo-recurrence in the LNs of esophagus.

scholarly journals Revision Tympanomastoid Surgery

2002 ◽  
Vol 81 (10) ◽  
pp. 718-729 ◽  
Author(s):  
Cliff A. Megerian ◽  
Mathew J. Cosenza ◽  
Suzanna E. Meyer
Keyword(s):  
Retrospective Study ◽  
Bone Conduction ◽  
Chronic Otitis Media ◽  
Success Rates ◽  
Cell Disease ◽  
Previous Surgery ◽  
The Past ◽  
Mastoid Surgery ◽  
Causes Of Failure

We conducted a retrospective study of 50 ears in 48 patients in whom we performed revision tympanomastoid surgery for chronic otitis media. We found that the most common probable causes for the failure of previous surgery were incomplete lowering of the facial ridge (94% of cases), persistent sinodural-angle air-cell disease (92%), persistent tegmental air-cell disease (88%), recurrent or persistent cholesteatoma (66%), persistent mastoid-tip air-cell disease (62%), a small meatus (60%), and persistent hypotympanic air-cell disease (56%). After a mean postoperative follow-up of 26 months, we found no appreciable difference in success rates between patients who had undergone only one previous surgery (93%) and those who had undergone more than one previous surgery (95%) prior to referral to our center. Follow-up hearing data revealed a statistically significant improvement in air and bone conduction and a nonsignificant reduction in the air-bone gap. We conclude that revision mastoid surgery following multiple earlier surgical failures does not carry an appreciably higher risk of failure than does initial revision surgery. Moreover, there appears to have been no change in the causes of failure following mastoid surgery over the past 3 decades.

Risk Factor Of Substitution ARV First Line People Living With HIV/AIDS In General Hospital Buleleng Bali

2020 ◽  
Vol 9 (1) ◽  
pp. 190-197
Author(s):  
Luh Putu Desy Puspaningrat ◽  
Gusti Putu Candra ◽  
Putu Dian Prima Kusuma Dewi ◽  
I Made Sundayana ◽  
Indrie Lutfiana
Keyword(s):  
Risk Factor ◽  
General Hospital ◽  
Medical Records ◽  
Secondary Data ◽  
District General Hospital ◽  
People Living With Hiv ◽  
First Line ◽  
The Past ◽  
Factor Substitution ◽  
Living With Hiv

Substitution is still a threat to the failure of ARV therapy so that no matter how small it must be noted and monitored in ARV therapy. The aims  was analysis risk factor substitution ARV first line in therapy ARV. This study was an analytic longitudinal study with retrospective secondary data analysis in a cohort of patients receiving ARV therapy at the District General Hospital of Buleleng District for the period of 2006-2015 and secondary data from medical records of PLHA patients receiving ART.  Result in this study that the percentage of first-line ARV substitution events is 9.88% (119/1204) who received ARV therapy for the past 11 years. Risk factors that increase the risk of substitution in ARV therapy patients are zidovudine (aOR 4.29 CI 1.31 -2.65 p 0.01), nevirapine (aOR1.86 CI 2.15 - 8.59 p 0.01) and functional working status (aOR 1.46 CI 1.13 - 1.98 p 0.01). 

Cirurgia Paliativa em Pacientes com Tumor Periampular Irressecável: Estudo Retrospectivo de 5 Anos em um Hospital em São José dos Campos – SP/Surgical Palliation in Patients with Unresectable Periampullary Tumor: a Retrospective Study of 5 Years in a Hosp

1970 ◽  
Vol 3 (4) ◽  
pp. 9-20
Author(s):  
José Henrique Gomes Torres ◽  
Rosyane Rena De Freitas
Keyword(s):  
Pancreatic Cancer ◽  
Retrospective Study ◽  
Survival Rates ◽  
Periampullary Tumor ◽  
The Past ◽  
Palliative Procedure ◽  
Surgical Palliation ◽  
Head Of The Pancreas ◽  
Keywords Pancreatic Cancer ◽  
Main Complication

Objetivo: Avaliar diferentes métodos paliativos quanto a sua resolução, complicações e sobrevida em pacientes com tumor periampular irressecável. Materiais e métodos: Estudo retrospectivo com análise dos prontuários de pacientes com tumor periampular irressecável e que foram submetidos a procedimento paliativo no Hospital Municipal Dr José de Carvalho Florence nos últimos cinco anos. Resultados: O principal tumor periampular foi o de cabeça de pâncreas, com incidência de 94%, acometendo pacientes com média de 66 anos, sem preferência por sexo. Os procedimentos mais realizados foram derivação biliar e colocação de endoprótese através de colangiopancreatografia endoscópica retrógrada, apresentando sobrevidas de 586 e 56 dias, respectivamente. Conclusão: A coledocojejunostomia foi o procedimento mais realizado e apresentou menor tempo de internação e maiores sobrevida e tempo de permanência anictérico. Pneumonia foi a complicação mais frequente.  Palavras chave: Câncer pancreático, Colangiocarcinoma, Cuidados paliativos.  Objective: To evaluate different palliative methods concerning its resolution, complications and survival in patients with unresectable periampular tumor. Materials and methods: Retrospective study analysing records of patients with unresectable periampullary tumor and who underwent palliative procedure in the Hospital Municipal Dr José de Carvalho Florence in the past five years. Results: The main periampullary tumor was the head of the pancreas, with an incidence of 94%, affecting patients with an average of 66 years old, regardless of gender. The most common procedures were bypass and biliary stent, with survival rates of 586 and 56 days, respectively. Conclusion: Coledocojejunostomy was the procedure which was the most often performed and showed a shorter hospital stay and longer survival time and time without jaundice. Pneumonia was the main complication.  Keywords: Pancreatic cancer, Cholangiocarcinoma, Palliative care  

Transjugular intrahepatic porto-systemic shunt is a risk factor for liver dysplasia but not hepatocellular carcinoma: A retrospective study of explanted livers

2015 ◽  
Vol 47 (1) ◽  
pp. 57-61 ◽  
Author(s):  
Patrick Borentain ◽  
Stephane Garcia ◽  
Emilie Gregoire ◽  
Vincent Vidal ◽  
Pascal Ananian ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Risk Factor ◽  
Retrospective Study

scholarly journals Pulsed electromagnetic field stimulation may improve fusion rates in cervical arthrodesis in high-risk populations

2018 ◽  
Vol 7 (2) ◽  
pp. 124-130 ◽  
Author(s):  
D. Coric ◽  
D. E. Bullard ◽  
V. V. Patel ◽  
J. T. Ryaby ◽  
B. L. Atkinson ◽  
...  
Keyword(s):  
Electromagnetic Field ◽  
Risk Factor ◽  
High Risk ◽  
Clinical Risk Factor ◽  
Field Stimulation ◽  
Pulsed Electromagnetic Field ◽  
Exact Test ◽  
High Risk Populations ◽  
Pulsed Electromagnetic ◽  
Pemf Treatment

Objectives Pulsed electromagnetic field (PEMF) stimulation was evaluated after anterior cervical discectomy and fusion (ACDF) procedures in a randomized, controlled clinical study performed for United States Food and Drug Administration (FDA) approval. PEMF significantly increased fusion rates at six months, but 12-month fusion outcomes for subjects at elevated risk for pseudoarthrosis were not thoroughly reported. The objective of the current study was to evaluate the effect of PEMF treatment on subjects at increased risk for pseudoarthrosis after ACDF procedures. Methods Two evaluations were performed that compared fusion rates between PEMF stimulation and a historical control (160 subjects) from the FDA investigational device exemption (IDE) study: a post hoc (PH) analysis of high-risk subjects from the FDA study (PH PEMF); and a multicentre, open-label (OL) study consisting of 274 subjects treated with PEMF (OL PEMF). Fisher’s exact test and multivariate logistic regression was used to compare fusion rates between PEMF-treated subjects and historical controls. Results In separate comparisons of PH PEMF and OL PEMF groups to the historical control group, PEMF treatment significantly (p < 0.05, Fisher’s exact test) increased the fusion rate at six and 12 months for certain high-risk subjects who had at least one clinical risk factor of being elderly, a nicotine user, osteoporotic, or diabetic; and for those with at least one clinical risk factor and who received at least a two- or three-level arthrodesis. Conclusion Adjunctive PEMF treatment can be recommended for patients who are at high risk for pseudoarthrosis. Cite this article: D. Coric, D. E. Bullard, V. V. Patel, J. T. Ryaby, B. L. Atkinson, D. He, R. D. Guyer. Pulsed electromagnetic field stimulation may improve fusion rates in cervical arthrodesis in high-risk populations. Bone Joint Res 2018;7:124–130. DOI: 10.1302/2046-3758.72.BJR-2017-0221.R1.

scholarly journals Influence of the COVID-19 Pandemic on Dental Emergency Admissions in an Urgent Dental Care Service in North Italy

2021 ◽  
Vol 18 (4) ◽  
pp. 1812 ◽  
Author(s):  
Maria Grazia Cagetti ◽  
Araxi Balian ◽  
Nicole Camoni ◽  
Guglielmo Campus
Keyword(s):  
Retrospective Study ◽  
Dental Care ◽  
Tooth Extraction ◽  
Care Service ◽  
Emergency Admissions ◽  
Exact Test ◽  
Remarkable Increase ◽  
Time Period ◽  
Dental Emergency ◽  
Second Wave

A retrospective study was performed to verify if the number of admissions for urgent dental care in the Urgent Dental Care Service of San Paolo Hospital in Milan (Italy) was directly related to the different phases of the COVID-19 pandemic. Different periods were analyzed: 25 March–5 April 2019 (pre-COVID); 23 March–3 April 2020 (lockdown); 8 June–19 June 2020 (reopening); and November 9–November 20 (second wave). Raw data regarding admissions, diagnoses, and treatments were extracted. Descriptive and bivariate analyses were performed. The survey included 901 admissions, 285 in pre-COVID, 93 during lockdown, 353 in reopening, and 170 in the second wave. In each time period, statistically significant differences were found in the prevalence of each kind of diagnoses (χ2(3) = 20.33 p = 0.01 for endodontic emergencies, χ2(3) = 29.05 p < 0.01 for cellulitis/phlegmon, χ2(3) = 28.55 p < 0.01 for periodontal emergencies, Fisher’s Exact Test p < 0.01 for trauma, and χ2(3) = 59.94 p < 0.01 for all other kinds of diagnosis). A remarkable increase in consultations (+186.36%) and other treatments (+90.63%) occurred during reopening. Tooth extraction was the most frequently delivered treatment, but suffered the largest reduction during lockdown (−79.82%). The COVID-19 pandemic has highly affected dental activity in north Italy, underling the weaknesses of a private dental system in a pandemic scenario.

scholarly journals Mandibular third molars as a risk factor for angle fractures: a retrospective study

2009 ◽  
Vol 8 (3) ◽  
pp. 237-240 ◽  
Author(s):  
K. Rajkumar ◽  
Sinha Ramen ◽  
Roy Chowdhury ◽  
P. K. Chattopadhyay
Keyword(s):  
Risk Factor ◽  
Retrospective Study ◽  
Third Molars ◽  
Mandibular Third Molars ◽  
Angle Fractures
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