scholarly journals Our comprehensive experience with tracheostomy in tertiary multi-speciality hospital over four years

2021 ◽  
Vol 7 (10) ◽  
pp. 1649
Author(s):  
Parth B. Kapadia ◽  
Manit M. Mandal ◽  
Ajay J. Panchal ◽  
Rakesh Kumar ◽  
Neel Parmar ◽  
...  
Keyword(s):  
Medical Education ◽  
Retrospective Study ◽  
Surgical Procedure ◽  
Case Series ◽  
Final Outcome ◽  
Patient Age ◽  
Significant Case ◽  
Surgical Emphysema ◽  
The Mean ◽  
Mean Time

<p class="abstract"><strong>Background:</strong> Tracheostomy is a common surgical procedure used to achieve a secure airway in patients in elective as well as emergency conditions. Our study accounts for our first-hand experience with the procedure in our tertiary multi-speciality hospital.</p><p class="abstract"><strong>Methods:</strong> It is a four year (January 2017 to February 2021) retrospective study in which all the 246 cases of tracheostomies were taken into account which were performed during this study period in the department of otorhinolaryngology (ENT), Surat Municipal Institute of Medical Education and Research (SMIMER), Surat (India). The patients were thoroughly followed up until the final outcome of the tracheostomy was established.  </p><p class="abstract"><strong>Results:</strong> A total of 246 tracheostomies were performed, 63.82% of which were in men. The mean patient age was 42 years. The majority (76%) were elective, performed for various indications, while the remaining 24% were emergency tracheostomies. All tracheostomies were performed by otorhinolaryngologists. Complications relating to tracheostomy were documented in 40 patients (16%) intra-operatively and/or post-operatively which included bleeding, surgical emphysema, granulations along the stomal site and rarely shock. The mean time to decannulation was 13.48 days.</p><p class="abstract"><strong>Conclusions:</strong> Our study takes into account and discusses the findings of all the 246 tracheostomies which were performed during the study period of 4 years. Elective cases form the majority although there is a significant case series of emergency tracheostomies performed for a range of pathologies.</p><p class="Default"> </p>

scholarly journals Management of Vertical Sternal Fracture Nonunion in Elite-Level Athletes

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110108
Author(s):  
Andrea Bardos ◽  
Sanjeeve Sabhrawal ◽  
Graham Tytherleigh-Strong
Keyword(s):  
Ct Scan ◽  
Constant Score ◽  
Case Series ◽  
Sternal Fracture ◽  
Elite Level ◽  
The Mean ◽  
Mean Time ◽  
Time From Injury ◽  
Sternal Fractures

Background: Sternal fractures are rare, and they can be treated nonoperatively. Vertical sternal fractures have rarely been reported. Purpose: To describe the management and surgical treatment of a series of elite-level athletes who presented with symptomatic nonunions of a vertical sternal fracture. Study Design: Case series; Level of evidence, 4. Methods: Patients with an established symptomatic nonunion of a vertical sternal fracture, as diagnosed by computed tomography (CT) or magnetic resonance imaging (MRI), underwent open reduction and internal fixation using autologous bone graft and cannulated lag screws. The patients were assessed preoperatively and at the final follow-up using the Rockwood sternoclavicular joint (SCJ) score; Constant score; and shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores. Bony union was confirmed on postoperative CT scan. Results: Five patients (4 men and 1 woman) were included; all were national- or international-level athletes (rugby, judo, show-jumping, and MotoGP). The mean age at surgery was 23.4 years (range, 19-27 years), the mean time from injury to referral was 13.6 months (range, 10-17 months), and the mean time from injury to surgery was 15.8 months (range, 11-20 months). The mean follow-up was 99.4 months (range, 25-168 months). There was a significant improvement after surgery in the mean Rockwood SCJ score (from 12.6 to 14.8 [ P < .05]), Constant score (from 84 to 96.4 [ P < .05]; 80% met the minimal clinically important difference [MCID] of 10.4 points), and QuickDASH (from 6.8 to 0.98 [ P < .05]; 0% met the MCID of 15.9 points). Four of the patients were able to return to sport at their preinjury level, and 1 patient retired for nonmedical reasons. All of the fractures had united on the postoperative CT scan. There were no postoperative complications. Conclusion: Vertical fractures of the sternum are very rare and tend to behave clinically like an avulsion fracture injury to the capsuloligamentous structure of the inferior SCJ. The requirement of advanced imaging to diagnose this injury means that the actual incidence and natural history are not known. For high-demand athletes, early identification, surgical reduction, and fixation are likely to achieve the best outcome.

scholarly journals Plasmapheresis in the treatment of myasthenia gravis: retrospective study of 26 patients

2004 ◽  
Vol 62 (2b) ◽  
pp. 391-395 ◽  
Author(s):  
Rosana Carandina-Maffeis ◽  
Anamarli Nucci ◽  
José F.C. Marques Jr ◽  
Eduardo G. Roveri ◽  
Beatriz H.M. Pfeilsticker ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Side Effects ◽  
Myasthenia Gravis ◽  
Plasma Exchange ◽  
Mortality Rates ◽  
Motor Deficit ◽  
Myasthenic Crisis ◽  
Clinical Hospital ◽  
The Mean ◽  
Mean Time

We analyzed the experience of Unicamp Clinical Hospital with plasma exchange (PE) therapy in myasthenia gravis (MG). About 17.8 % of a totality of MG patients had PE performed: 26 cases, 19 women and seven men. The mean age-onset of MG was 28 years, extremes 11 and 69. Minimum deficit observed in the group was graded IIb (O & G) or IIIa (MGFA scale). One patient had prethymectomy PE. In seven the procedures were performed due to myasthenic crisis and in 18 patients due to severe myasthenic symptoms or exacerbation of previous motor deficit. Two patients were also submitted to chronic PE considering refractoriness to other treatments. Twenty-six patients had 44 cycles of PE and 171 sessions. The mean number of sessions was 3.9 (SD ± 1.4) each cycle; median 5, extremes 2 and 6. The mean time by session was 106,5 minutes (SD ± 35.2); median 100.5 (extremes of 55 and 215). The mean volume of plasma exchanged in each session was 2396 ml (SD ± 561); median 2225 (extremes 1512 and 4500). Side effects occurred: reversible hypotension (seven cases), mild tremor or paresthesias (seven cases). Infection and mortality rates due to PE were zero. All patients had immediate benefit of each PE cycle and usually they also received prednisone or other immunosuppressors. Good acceptance of the procedure was observed in 80.7% of patients.

scholarly journals Risks associated with oral deferiprone in the treatment of infratentorial superficial siderosis

2019 ◽  
Vol 267 (1) ◽  
pp. 239-243 ◽  
Author(s):  
Y. Sammaraiee ◽  
G. Banerjee ◽  
S. Farmer ◽  
B. Hylton ◽  
P. Cowley ◽  
...  
Keyword(s):  
Side Effects ◽  
Case Series ◽  
Iron Chelator ◽  
Superficial Siderosis ◽  
Neutropenic Sepsis ◽  
Favourable Safety ◽  
Favourable Safety Profile ◽  
Life Threatening ◽  
The Mean ◽  
Mean Time

Abstract Objective Deferiprone is an iron chelator that has recently been used to treat patients with infratentorial superficial siderosis (iSS). It is considered to have a generally favourable safety profile but concerns have been raised due to the risk of agranulocytosis. We aimed to evaluate the safety and tolerability of oral deferiprone as a treatment for patients with iSS. Methods We present a case series of 10 consecutive patients presenting with classical iSS treated with deferiprone. Results Ten patients were followed up for a mean period of 2.3 years (range 0.5–5.5 years). Four patients (40%) were withdrawn from treatment because of treatment-related side effects. The reasons for treatment discontinuation were neutropenic sepsis (n = 3) and fatigue (n = 1). In 2 out of the 3 cases of neutropenic sepsis, patients initially developed neutropenia without sepsis. The mean time to neutropenic sepsis following deferiprone was 1.2 years (range 0.3–2.5) with mean neutrophil count of 0.4 (range 0.3–0.5). Six patients (60%) reported no change in neurological function while on treatment, and four patients (40%) reported that their condition deteriorated. Conclusions Deferiprone was poorly tolerated, with 40% of patients withdrawing from treatment, most commonly due to neutropenic sepsis, after an average of 2 years on treatment. This study increases the number of reported cases of agranulocytosis in patients with iSS treated with deferiprone. Clinicians treating iSS patients with deferiprone should be aware that this drug has a potentially life-threatening side effect of neutropenic sepsis, and should ensure that appropriate haematological monitoring is in place.

scholarly journals Epidemiological and clinical characteristics of 671 COVID-19 patients in Henan Province, China

2020 ◽  
Vol 49 (4) ◽  
pp. 1085-1095
Author(s):  
Yifei Nie ◽  
Jitian Li ◽  
Xueyong Huang ◽  
Wanshen Guo ◽  
Xiaobai Zhang ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Case Series ◽  
Henan Province ◽  
X Rays ◽  
Illness Onset ◽  
Medical Disorders ◽  
History Of ◽  
The Mean ◽  
Wet Market ◽  
Mean Time

Abstract Background Despite many reports on the characteristics of coronavirus disease 2019 (COVID-19) in Wuhan, China, relatively little is known about the transmission features of COVID-19 outside Wuhan, especially at the provincial level. Methods We collected epidemiological, demographic, clinical, laboratory, radiological and occupation information, along with contact history, of 671 patients with laboratory-confirmed COVID-19 reported from January 23 to February 5, 2020, in Henan province, China. We described characteristics of these cases, compared the diagnostic accuracy and features of blood testing, computed tomography (CT) scans and X-rays, and analysed SARS-CoV-2 transmission sources and patients’ occupations in Henan province. Results The mean age of patients in this case series was 43 years, 56.2% were male and 22.4% had coexisting medical disorders. The death rate was 0.3%. Fourteen patients did not show any symptoms. Lymphocyte percentage was associated with disease severity (χ2 = 6.71, P = 0.035) but had a large variation in each sample group. The mean time from illness onset to diagnosis was 5.6 days. A total of 330 patients had ever lived in or visited Wuhan, 150 had contact with confirmed cases, 323 had been to a hospital and 119 had been to a wet market. There were 33 patients who did not have a traceable transmission source, with 21.2% of these being farmers and 15.2% being workmen. Conclusions Lymphocyte percentage was a sign of severe COVID-19 in general but was not a good diagnostic index. Longer time from illness onset to diagnosis was associated with higher COVID-19 severity, older age, higher likelihood of having coexisting cardiovascular diseases including hypertension, and being male. Farming was found to be a high-risk occupation in Henan province, China.

The Safety and Effectiveness of the Percutaneous Flexor Tenotomy in Healing Neuropathic Apical Toe Ulcers in the Outpatient Setting

2019 ◽  
Vol 13 (2) ◽  
pp. 123-131
Author(s):  
Simon E. Smith ◽  
Julie Miller
Keyword(s):  
Patient Satisfaction ◽  
Ulcer Healing ◽  
Case Series ◽  
Outpatient Setting ◽  
The Mean ◽  
Prospective Case Series ◽  
Protective Sensation ◽  
Loss Of Protective Sensation ◽  
Mean Time ◽  
Flexor Tenotomy

Percutaneous flexor tenotomy is a minimally invasive procedure that involves cutting one or both flexor digitorum tendons underneath the toe. It is an alternative to open surgical procedures performed in an operating theatre. This project is a prospective case series investigating the utility, effectiveness, and participant satisfaction of the percutaneous flexor tenotomy when performed in the outpatient setting. People with diabetes, digital flexion deformity, and loss of protective sensation with an apical ulcer or preulcerative lesion presenting to the Austin Health Foot Ulcer Specialist Outpatient Clinic were enrolled in the study. The procedure was performed under sterile technique with an 18-gauge needle or fine scalpel blade. Participants were reviewed weekly until the incision and/ or ulcer healed. Participants were then followed up at 3 and 6 months. Time to ulcer healing, reulceration rate, frequency of complications, and patient satisfaction were recorded. There were 11 toe ulcers and 41 preulcerative lesions. A total of 76 tenotomy procedures were performed on the 23 participants across 35 episodes of care. The mean time to ulcer healing following tenotomy was 10.2 ± 4.3 days. There were no recurrences of ulceration. The infection rate per episode of care was 2.8%. There were 11 toes (14.5%) that sustained a transfer lesion post the index procedure. The mean time to development of a transfer lesion was 95.5 ± 98.1 days. All participants strongly agreed that they were satisfied with the outcome of the procedure. The flexor tenotomy is an effective procedure to expedite the healing of apical toe ulcers in people with loss of protective sensation and flexion digital deformity. It has a low infection rate and high patient satisfaction rate when performed in the outpatient setting. There is a moderate risk of transfer preulcerative lesions to an adjacent digit. Levels of Evidence: Level IV: Prospective case series

scholarly journals Multispecialty tracheostomy experience

2020 ◽  
Vol 102 (5) ◽  
pp. 343-347 ◽  
Author(s):  
G Lipton ◽  
M Stewart ◽  
R McDermid ◽  
R Docking ◽  
C Urquhart ◽  
...  
Keyword(s):  
Critical Care ◽  
Case Series ◽  
Neck Surgery ◽  
Health Board ◽  
Percutaneous Procedures ◽  
Retrospective Audit ◽  
Large Head ◽  
Significant Case ◽  
The Mean ◽  
The Uk

Introduction Tracheostomy is a common surgical procedure used to create a secure airway in patients, now performed by a variety of specialties, with a notable rise in critical care environments. It is unclear whether this rise is seen in units with large head and neck surgery departments, and how practice in such units compares with the rest of the UK. Methods A three-year retrospective audit was carried out between anaesthetic, surgical and critical care departments. All tracheostomy procedures were recorded anonymously. Results A total of 523 tracheostomies were performed, 66% of which were in men. The mean patient age was 60 years. The majority (83%) were elective, performed for various indications, while the remaining 17% were emergency tracheostomies performed for pending airway obstruction. A fifth of the tracheostomies were percutaneous procedures. Most emergency tracheostomies (78%) were performed by otolaryngology. Three cricothyroidotomies were performed within critical care and theatres. Complications related to tracheostomy occurred in 47 cases (9%), most commonly lower respiratory tract infection. The mean time to decannulation was 12.8 days. Conclusions This paper discusses the findings of a comprehensive, multispecialty audit of tracheostomy experience in a large health board, with over 150 tracheostomies performed annually. Elective cases form the majority although there is a significant case series of emergency tracheostomies performed for a range of pathologies. Around a quarter of those requiring tracheostomy ultimately died, mostly as a result of advanced cancer.

scholarly journals Intra operative assessment of the coronal balance in spinal deformity surgery : a technical note and retrospective study

2021 ◽  
Vol 87 (1) ◽  
pp. 175-179
Author(s):  
Thibault Dewilde ◽  
Sebastiaan Schelfaut ◽  
Sven Bamps ◽  
Matthias Papen ◽  
Pierre Moens
Keyword(s):  
Retrospective Study ◽  
Case Series ◽  
Technical Note ◽  
Coronal Alignment ◽  
Level Of Evidence ◽  
Coronal Balance ◽  
Scoliotic Deformity ◽  
Significant Difference ◽  
The Mean ◽  
The Right

Obtaining a spine that is well balanced after fusion for scoliotic deformity is primordial for the patients’ quality of life. A simple T-shaped instrument combined with standard intraoperative fluoroscopy can be of great help to evaluate the coronal alignment quickly. The aim of this study was to evaluate if a T-shaped device could predict the postoperative coronal balance. Before finalization of the rod fixation, the balance was checked by verifying the relationship between the T-shaped instrument and the upper instrumented vertebra (UIV), and final adjustments were made to correct the coronal balance. A retrospective study was conducted on 48 patients who underwent surgery to correct scoliotic deformity. Intraoperative and postoperative coronal alignment was measured independently by two observers. The mean intraoperative horizontal offset measured between T-shaped instrument and the center of the UIV was 1,69mm to the right with a standard deviation (SD) of 12,43 mm. On postoperative full spine radiographs, the mean offset between the centra sacral vertical line and the center of the UIV was 2,44mm to the left with a SD of 13,10mm. There is no significant difference in coronal balance between both measurements (p=0,12). With this technique we were able to predict the postoperative coronal balance in all but one patient (97,92%). We conclude that the use of a simple T-shaped instrument can provide adequate intraoperative assessment of coronal balance in correcting scoliotic deformity. Level of evidence : IV – case series

scholarly journals The Use of Sixty Degree Rotation of the Acetabulum for Treatment of Dogs With Canine Hip Dysplasia. A Short Case Series

2021 ◽  
Vol 8 ◽  
Author(s):  
Horia Elefterescu ◽  
Ciprian Andrei Ober ◽  
Andrei Timen ◽  
Christos Yiapanis ◽  
William McCartney ◽  
...  
Keyword(s):  
Hip Dysplasia ◽  
Case Series ◽  
Pelvic Osteotomy ◽  
Term Outcome ◽  
Secondary Osteoarthritis ◽  
Clinical Consequences ◽  
The Mean ◽  
Canine Hip Dysplasia ◽  
Mean Time

Triple pelvic osteotomy (TPO) is a prophylactic surgical procedure performed on dogs with canine hip dysplasia. The procedure is indicated in skeletally immature dogs without secondary osteoarthritis (OA). It has been suggested that 60° of rotation is excessive and is associated with poor outcome. The objective of the study was to assess the medium term outcome in dogs having undergone triple pelvic osteotomy (TPO) using 60° dedicated plates. Nine TPOs were performed in seven dogs with hip dysplasia. Eight of nine hips had 72–100% osseous union at the time of revisit. The mean time to final radiographic recheck was 200 days (range, 185–229 days). The mean time to follow-up was 11.5 months (range 11–12 months). All 7 dogs had regained full function and did not require supplemental analgesia. Pelvic canal narrowing was noted in the two dogs with bilateral surgeries, but no clinical consequences were noted according to owner's statement.If more than 40 degrees reduction angles at Ortolani test, 60° of rotation of the acetabulum can be used successfully in dogs with hip dysplasia. At the time of mid-term follow-up, all dogs in this case series had full function.

scholarly journals Laparoscopic versus open appendectomy retrospective study

2017 ◽  
Vol 4 (3) ◽  
pp. 620
Author(s):  
Haitham S. Rbihat ◽  
Khaled M. Mestareehy ◽  
Mohammad S. Al lababdeh ◽  
Talal M. Jalabneh ◽  
Mohammad E. Aljboor ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Postoperative Pain ◽  
Laparoscopic Appendectomy ◽  
Open Appendectomy ◽  
Advantages And Disadvantages ◽  
Abdominal Abscesses ◽  
Zero Rate ◽  
The Mean ◽  
The Cost ◽  
Mean Time

Background: Laparoscopic cholecystectomy is taken into account as a standard method of performing cholecystectomy and has substituted the old method throughout the world, while laparoscopic appendectomy still not attaining that reputation. In this paper, a retrospective study was done to compare between both laparoscopic and open appendectomy.Methods: Two hundred eighty-five patients were analyzed after appendectomy using either open or laparoscopic procedures. The data was compared over a period of 36 months. Surgical technique was the same among 6 surgeons, standard postoperative care for all patient groups. The outcome measures included comparing of mean operative time, days of hospitalization, postoperative pain and rate of wound infection.Results: Concerning open appendectomy the mean time was 28 minutes with 2 days of hospitalization. The postoperative pain extent was for 36 hours and rate of wound infection was 8/159. While in laparoscopic appendectomy the mean time was 55 minutes with one day hospitalization. The postoperative pain was for 12 hours and zero rate of wound infection.Conclusions: In general laparoscopy has plenty of gains over open surgery as discussed before but laparoscopic appendectomy is not easier, nor does it avoid general anesthesia. The cost for laparoscopic appendectomy is higher than for open appendectomy. The operative and post-operative complications are more critical (e.g.: intra-abdominal abscesses & perforation of bowel) as compared to open appendectomy. We have to assess the advantages and disadvantages, indications and contraindications when taking a decision for laparoscopic surgery. We suppose it would be very early to say that laparoscopic appendectomy is superior or can replace open appendectomy.

scholarly journals Tectal gliomas: assessment of malignant progression, clinical management, and quality of life in a supposedly benign neoplasm

2018 ◽  
Vol 44 (6) ◽  
pp. E15 ◽  
Author(s):  
Malte Mohme ◽  
Friederike S. Fritzsche ◽  
Klaus C. Mende ◽  
Jakob Matschke ◽  
Ulrike Löbel ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Clinical Course ◽  
Case Series ◽  
Diffuse Astrocytoma ◽  
The Mean ◽  
Mean Time ◽  
Tectal Glioma ◽  
Astrocytoma Grade

OBJECTIVETectal gliomas constitute a rare and inhomogeneous group of lesions with an uncertain clinical course. Because these supposedly benign tumors are frequently followed up by observation over many years, the authors undertook this analysis of their own case series in an effort to demonstrate that the clinical course is highly variable and that there is a potential for a progressive biology.METHODSClinical data analysis of 23 cases of tectal glioma (involving 9 children and 14 adults) was performed retrospectively. Radiographic data were analyzed longitudinally and MR images were evaluated for tumor volume, contrast enhancement, and growth progression. Quality of life was assessed using the EORTC BN20 and C30 questionnaires during follow-up in a subgroup of patients.RESULTSThe patients’ mean age at diagnosis was 29.2 years. The main presenting symptom at diagnosis was hydrocephalus (80%). Six patients were treated by primary tumor resection (26.1%), 3 patients underwent biopsy followed by resection (13.1%), and 3 patients underwent biopsy only (13.1%). For additional treatment of hydrocephalus, 14 patients (60.9%) received shunts and/or endoscopic third ventriculostomy. Radiographic tumor progression was observed in 47.9% of the 23 cases. The mean time between diagnosis and growth progression was 51.5 months, and the mean time to contrast enhancement was 69.7 months. Histopathological analysis was obtained in 12 cases (52.2%), resulting in 5 cases of high-grade glioma (3 cases of glioblastoma multiforme [GBM], grade IV, and 2 of anaplastic astrocytoma, grade III), 5 cases of pilocytic astrocytoma, 1 diffuse astrocytoma, and 1 ganglioglioma. Malignant progression was observed in 2 cases, with 1 case progressing from a diffuse astrocytoma (grade II) to a GBM (grade IV) within a period of 13 years. Quality-of-life measurements demonstrated distinct functional deficits compared to a healthy sample as well as glioma control cohorts.CONCLUSIONSAnalysis of this case series shows that a major subpopulation of tectal gliomas show progression and malignant transformation in children as well as in adolescents. These tumors therefore cannot be considered inert lesions and require histological confirmation and close follow-up. Quality-of-life questionnaires show that tectal glioma patients might benefit from special psychological support in emotional, social, and cognitive functionality.

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