scholarly journals Selection of the optimal type of the stapler cassette for distal pancreas resection

2021 ◽  
pp. 85-91
Author(s):  
E.S. Drozdov ◽  
◽  
A.I. Baranov ◽  
D.A. Shkatov ◽  
S.S. Klokov ◽  
...  
Keyword(s):  
Risk Factors ◽  
Significant Risk ◽  
Controlled Study ◽  
Pancreatic Stump ◽  
Stump Closure ◽  
Distal Pancreas ◽  
The Difference ◽  
Parenchymal Thickness ◽  
Resection Area ◽  
Selection Of

Aim of study. Investigation of risk factors in development of postoperative pancreatic fi stula (POPF) in patients aft er distal pancreatectomy (DP) involving application of a cutting stapler device (CS) as well as determination of the criteria for selection of the optimal cassette type for such devices making it possible to reduce the POPF development frequency. Material and methods. A two-centre retrospective/prospective controlled study was performed. A total of 46 patients (19 (41.3 %) male and 27 (58.7 %) female) were enrolled. All patients included in the study underwent DP surgery using CS for excision of the pancreas with closure of its stump. In all cases, measurement of the pancreas thickness in the resection area based on the data of preoperative computed tomography and calculation of the difference between the pancreatic parenchymal thickness in the resection area and the staple closure height (SCH). Th e patients were distributed between two groups: 1) without POPF of with biochemical leakage (BL); 2) with clinically relevant POPF (CR-POPF). Results. CR-POPF developed in 15 (32.6 %) cases (type-B POPF: 14 (93.3 %) cases, type-С: 1 (6.7 %) case). Statistically signifi cant diff erence in mean pancreatic parenchymal thickness in the resection area as well as mean SCH between the group without POPF or with BL and the group with CR-POPF (15.4±4.3mm versus 12.3±3.5mm, р=0.01 and 12.8±2.3mm versus 16.4±3.1mm, р<0.01, respectively). Th e frequency of CR-POPF development was reliably lower at the SCH varying from 8 to 14mm (9.5 %) as compared to cases with SCH below 8mm (55.6 %, p<0.01) and above 14mm (50.0 %, p<0.01). Conclusion. Upon analysis of risk factors in POPF development aft er DP, it has been established that a greater pancreatic parenchymal thickness in the resection area as well as SCH are statistically significant risk factors for this complication. Th e optimal SCH making it possible to achieve the minimal frequency of POPF aft er pancreatic stump closure using a CS is within the range of 8-14mm.

Retrospective Study Of Incidence Of Thromboses In Chinese Versus African Americans With Multiple Myeloma

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1121-1121
Author(s):  
Radha Raghupathy ◽  
Sabarish Ayyappan ◽  
Dhivya Prabhakar ◽  
Frankie KF Mo ◽  
Erica L. Campagnaro ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multiple Myeloma ◽  
Retrospective Study ◽  
Lower Risk ◽  
Conflicts Of Interest ◽  
Significant Risk ◽  
Chinese Patients ◽  
Asian Patients ◽  
Venous Thromboembolic Events ◽  
The Difference

Abstract Background Risk of arterial (ATE) and venous thromboembolic events (VTE) is increased in multiple myeloma (MM). Immunomodulator therapy (Imid) concurrent with steroids further increases this risk. Retrospective single arm studies suggest that Asian patients with MM may have a lower risk of TE than in other ethnicities. We performed a retrospective study comparing Chinese (C) and African American (AA) patients in two centers, the Department of Clinical Oncology, Prince of Wales Hospital, the Chinese University of Hong Kong (PWH) and the University hospitals, Case Medical Center, Cleveland, Ohio (CMC), for ethnic differences in incidence of TE in MM. Methods 120 Chinese patients from PWH and 100 AA patients from CMC fulfilling IMWG consensus criteria for MM diagnosis between Jan 1st 2000 and Dec 31st 2011 were identified and selected for analysis. Data regarding demographics, comorbidities, myeloma characteristics, therapy and thrombotic complications were collected by electronic and paper chart review. Data collection was censored as of Dec 31st 2012. Results The Chinese cohort comprised more men, lower baseline incidence of diabetes (DM), hypertension (HTN) and non-myeloma related renal failure (CRF), advanced myeloma at diagnosis and more IgA subtype than AA. Over 90% of patients of both groups received chemotherapy. 72% of Chinese and 80% of AA received Imid based treatment. Lenalidomide with steroids was used more often in AA (36.8% AA vs 3.6%C, p<0.0001), Chinese received more thalidomide with steroids. (62.2% C vs 42.1%, p:0.004) Use of thromboprophylaxis (TP) is not routine in PWH, less Chinese were on TP during the disease course (11.7% vs 68%, p<0.0001) or during Imid based treatment. (16% vs 85%, p: 0.0001) Relative rates of aspirin, low molecular weight heparin and warfarin usage for TP were similar across both groups. Despite lower TP rates, a significantly lower rate of symptomatic VTE was observed in the Chinese. (3.3% vs 22%, p:0.001) The difference in VTE detection persisted on correction for number of imaging studies performed, 24 imaging tests in Chinese and 145 in AA. (16.7% vs 48.3%, p:0.004). Amongst the Chinese, all 4 events (100%) occurred on thalidomide dexamethasone (TD), 3 events (75%) in the absence of TP. In the AA, 21 of 26 events (81%) occurred on Imid based treatment. 12 events (46%) occurred in the absence of TP. On binary logistic regression using race, gender, prior venous thrombosis, any TP, TD and lenalidomide dexamethasone therapy as covariates, AA race (OR: 5.022, 95% CI:1.3- 19.4) and TD therapy (OR: 4.07, 1.26- 3.13) emerged as significant risk factors for VTE. Overall incidence of VTE on TD treatment was 4.5% in Chinese versus 22% in AA. (p:0.002) An increased number of arterial events were seen in the Chinese (9.2% vs 3% in AA) but the difference did not reach statistical significance. Of the 11 arterial events in Chinese, 5 (46%) occurred on Imid based therapy, 9 events (82%) were in the absence of TP. 7 were cardiac and 4 cerebrovascular. Of the 3 arterial events in AA, 1 (33.3%) occurred on Imids and all patients were receiving TP. 1 was cardiac, 1 abdominal and 1 upper limb. Conclusion Our study suggests that the Chinese have a lower risk of VTE than AA in the setting of MM. However , despite lower prevalence of most vascular risk factors in Chinese, ATE rates in Chinese were higher than AA, while not statistically significant. Larger studies are necessary to further elucidate these differences in thrombosis risk and to develop specific guidelines for TP in Asian patients with MM Disclosures: No relevant conflicts of interest to declare.

Hospital-Acquired Diarrhea in Adults: A Prospective Case-Controlled Study in Mexico

1991 ◽  
Vol 12 (6) ◽  
pp. 349-355 ◽  
Author(s):  
Mussaret Zaidi ◽  
Samuel Ponce de Leon ◽  
Rosa Maria Ortiz ◽  
Sergio Ponce de Leon ◽  
Juan J. Calva ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diarrheal Disease ◽  
Significant Risk ◽  
Severity Of Illness ◽  
Controlled Study ◽  
General Internal ◽  
Nosocomial Diarrhea ◽  
Nasogastric Tubes ◽  
Potential Pathogen ◽  
Immunodeficiency Syndrome

AbstractObjective:To know the incidence, etiology, risk factors, morbidity, and mortality of nosocomial diarrhea in adults.Design:Nested case-control study, matched by service, length of stay, date of admission, and presence of leukopenia and/or the acquired immunodeficiency syndrome (AIDS). Cases were those who developed nosocomial diarrhea. Controls were those who did not develop nosocomial diarrhea during a comparative period nor during the next ten days. Stool samples were processed in search for parasites, yeasts, bacteria, and rotavirus.Setting:Third-level referral center, in Mexico City, Mexico, for general internal medicine and surgical problems.Patients:Eligible subjects were all new admissions to the hospital from November 1987 to September 1988. Reasons for exclusion were presence of chronic diarrheal disease or melena. There were 115 cases and 111 controls.Results:Overall risk of acquiring nosocomial diarrhea was 5.5%, or 1.8 episodes per 100 patient-weeks. A potential pathogen was found in 59%. Yeasts and Entamoeba histolytica were the most frequently isolated pathogens. Mortality in cases was 18%, as compared with 5% in controls (p<.01). Multivariate analysis showed enteral feeding, recent enemas, presence of Candida species, use of antacids/Hz-blockers, and presence of nasogastric tubes as significant risk factors for nosocomial diarrhea.Conclusions:Diarrhea is a common complication in hospitalized patients. It occurs more often than previously suspected and is linked with a substantial mortality, The spectrum of etiologic agents is different from that reported in pediatric hospitals. Given that nosocomial diarrhea may constitute, at least, a marker of severity of illness, it should receive more attention in general hospitals.

scholarly journals Effect of late-life weight change on dementia incidence: a 10-year cohort study using claim data in Korea

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e021739 ◽  
Author(s):  
Susan Park ◽  
Soo-Min Jeon ◽  
Sun-Young Jung ◽  
Jinseub Hwang ◽  
Jin-Won Kwon
Keyword(s):  
Risk Factors ◽  
Weight Control ◽  
Significant Risk ◽  
Late Life ◽  
Claim Data ◽  
Health Screening ◽  
Weight Changes ◽  
Dementia Incidence ◽  
The Difference ◽  
Baseline Bmi

BackgroundThe association between body mass index (BMI) in late-life and dementia risk remains unclear. We investigated the association between BMI changes over a 2-year period and dementia in an elderly Korean population.MethodsWe examined 67 219 participants aged 60–79 years who underwent BMI measurement in 2002/2003 and 2004/2005 as part of the National Health Insurance Service-Health Screening Cohort. Baseline characteristics including BMI, socioeconomic status and cardiometabolic risk factors were measured at baseline (2002/2003). The difference between BMI at baseline and at the next health screening (2004/2005) was used to calculate the BMI change. After 2 years, the incidence of dementia was monitored for a mean 5.3 years from 2008 to 2013. Multivariate HRs for dementia incidence were estimated on the basis of baseline BMI and its changes after adjusting for various other risk factors. A subgroup analysis was conducted to determine the effects of baseline BMI and BMI changes.ResultsWe demonstrated a significant association between late-life BMI changes and dementia in both sexes (men: >−10% HR=1.26, 95% CI 1.08 to 1.46, >+10% HR=1.25, 95% CI 1.08 to 1.45; women: >−10% HR=1.15, 95% CI 1.03 to 1.29, >+10% HR=1.17, 95% CI 1.05 to 1.31). However, the baseline BMI was not associated with dementia, except in underweight men. After stratification based on the baseline BMI, the BMI increase over 2 years was associated with dementia in men with a BMI of <25 kg/m2and women with a BMI of 18.5–25 kg/m2, but not in the obese subgroup in either sex. However, BMI decrease was associated with dementia in those with a BMI of ≥18.5 kg/m2, but not in the underweight subgroup in either sex.ConclusionBoth weight gain and weight loss may be significant risk factors associated with dementia. Continuous weight control and careful monitoring of weight changes are necessary to prevent dementia development.

scholarly journals Carriage and Acquisition of Extended-spectrum β-Lactamase–producing Enterobacterales Among Neonates Admitted to Hospital in Kilifi, Kenya

2019 ◽  
Vol 69 (5) ◽  
pp. 751-759 ◽  
Author(s):  
Ngure Kagia ◽  
Patrick Kosgei ◽  
Michael Ooko ◽  
Leonard Wafula ◽  
Neema Mturi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Significant Risk ◽  
Sub Saharan Africa ◽  
Extended Spectrum ◽  
Sub Saharan ◽  
Neonatal Ward ◽  
Ward Patient ◽  
Carriage Prevalence ◽  
Selection Of

Abstract Background Infections caused by extended-spectrum β-lactamase–producing Enterobacterales (ESBL-E) among hospitalized neonates in sub-Saharan Africa pose significant clinical challenges. Data on prevalence and acquisition of ESBL-E carriage among hospitalized neonates in the region are few, and risk factors for transmission are not clearly defined. Methods In a cohort study of consecutive neonatal admissions to Kilifi County Hospital from July 2013 through August 2014, we estimated ESBL-E carriage prevalence on admission using rectal swab cultures and identified risk factors using logistic regression. Using twice-weekly follow-up swabs, we estimated the incidence and identified risk factors for ESBL-E acquisition in hospital using Poisson regression. Results The prevalence of ESBL-E carriage at admission was 10% (59/569). Cesarean delivery, older neonatal age, and smaller household size were significant risk factors. Of the 510 infants admitted without ESBL-E carriage, 238 (55%) acquired carriage during their hospital stay. The incidence of acquisition was 21.4% (95% confidence interval, 19.0%–24.0%) per day. The rate was positively associated with the number of known neonatal ESBL-E carriers and with the total number of neonates on the same ward. Conclusions Carriage of ESBL-E was common among neonates on admission, and in-hospital acquisition was rapid. The dissemination and selection of ESBL-E appears to be driven by hospital exposures, operative delivery, and neonatal ward patient density. Further attention to infection control, patient crowding, and carriage surveillance is warranted.

Influence of fenestration on long-term Fontan survival

2021 ◽  
pp. 1-6
Author(s):  
Ondřej Materna ◽  
Vojtěch Illinger ◽  
Denisa Jičínská ◽  
Karel Koubský ◽  
Jan Kovanda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Significant Risk ◽  
Composite Endpoint ◽  
Total Cavopulmonary Connection ◽  
Term Survival ◽  
Fenestration Closure ◽  
The Difference ◽  
Group 2 ◽  
Cavopulmonary Connection

Abstract Introduction: Fenestration in the total cavopulmonary connection system may improve the outcome of patients with significant risk factors for Fontan haemodynamics. Our study aims to analyse the difference in long-term survival between non-fenestrated and fenestrated patients. Methods: All consecutive patients (n = 351) who underwent total cavopulmonary connection between 1992 and 2016 were identified. Six early deaths were excluded resulting in a group of 345 patients. Median (interquartile range,) length of follow-up was 14.4 (7.1–19.7) years. Freedom from the composite endpoint of death, total cavopulmonary connection take-down or indication for a heart transplant was analysed. Results: Fenestration was absent in 237 patients (68.7%, Group 1), was created and closed later in 79 patients (22.9%, Group 2), and remained open in 29 patients (8.4%, Group 3). Mean survival probability until composite endpoint was 97.1 and 92.9% at 10 and 20 years, respectively. Patients with patent fenestration had worse survival (p < 0.001) as compared to both the non-fenestrated and fenestration closure groups. Despite a similar outcome, exercise capacity was lower in Group 2 than 1 (p = 0.013). In 58 patients with interventional fenestration closure, Nakata index was lower at the time of closure than pre-operatively, and both the pressure in the circuit and oxygen saturation in the aorta increased significantly (p < 0.001). Conclusions: Patients with persisting risk factors preventing fenestration closure are at higher risk of reaching the composite endpoint. Patients after fenestration closure have the worse functional outcome; their survival is, however, not different from the non-fenestrated group.

Hypernatremic Dehydration Risk Factors in Newborns: Prospective Case-Controlled Study

2021 ◽  
Vol 233 (04) ◽  
pp. 194-199
Author(s):  
Kiymet Celik ◽  
Aylin Ozbek ◽  
Ozgur Olukman ◽  
Figen Isleten ◽  
Sebnem Calkavur
Keyword(s):  
Risk Factors ◽  
Breast Milk ◽  
Demographic Data ◽  
Significant Risk ◽  
Depression Scale ◽  
Controlled Study ◽  
Control Group ◽  
Study Group ◽  
Breastfeeding Support ◽  
Hypernatremic Dehydration

Abstract Background The prevalence of hypernatremic dehydration (HND) has increased in recent years most likely due to insufficient intake of breast milk as the most important factor. This study aimed to investigate risk factors of HND. Methods In this study, 47 neonates whom were diagnosed to have HND were included in the study group and 96 healty neonates whom were included in the control group. While demographic data of the patients were recorded, mothers were asked to fill out the sociodemographic/ psychosocial data form, Edinburgh Postpartum Depression Scale(EPDS) and STAI I and II State and Trait Anxiety Scale. Breast milk sodium concentrations were studied from mothers of all infants. The relationship between the development of neonatal HND and risk factors affecting this condition were evaluated. Results Being the first-born baby of the family was found to be a significant risk factor for HND. Breast milk sodium concentration was 25.8±7.9 mmol/L in the HND group which was significantly higher than the control group. Median depression score was similar in both groups and there was no statistical difference in terms of groups. The anxiety score was higher in the control group compared to the study group. There was no difference in terms of other sociodemographic / psychosocial data of mothers. Conclusion Primiparity or insufficient breastfeeding may result in elevated breast milk sodium levels and related neonatal HND. Breastfeeding support should principally target primiparous women to improve breastfeeding outcomes like as especially HND.

Apolipoprotein(a), Fibrinopeptide A and Carotid Atherosclerosis in Middle-Aged Men

1994 ◽  
Vol 72 (04) ◽  
pp. 563-566 ◽  
Author(s):  
Tuomo Rankinen ◽  
Sari Väisänen ◽  
Michele Mercuri ◽  
Rainer Rauramaa
Keyword(s):  
Risk Factors ◽  
Cardiovascular Diseases ◽  
Carotid Atherosclerosis ◽  
Intima Media Thickness ◽  
Carotid Bifurcation ◽  
Carotid Intima Media Thickness ◽  
Fibrinopeptide A ◽  
Carotid Imt ◽  
Apolipoprotein A ◽  
The Difference

SummaryThe association between apolipoprotein(a) [apo(a)], fibrinogen, fibrinopeptide A (FPA) and carotid intima-media thickness (IMT) was analyzed in Eastern Finnish men aged 50 to 60 years. Apo(a) correlated directly with carotid bifurcation (r = 0.26, p = 0.001), but not with common carotid IMT. Men in the lowest quartile of apo(a) had thinner (p = 0.013) IMT in bifurcation [1.59 mm (95% Cl 1.49; 1.68)] compared to the men in the highest [1.91 mm (95% Cl 1.73; 2.09)] apo(a) quartile. The difference remained (p=0.038) after adjusting for confounders. Plasma fibrinogen was not related to carotid IMT, whereas FPA correlated with common carotid (r = 0.21, p = 0.016) and carotid bifurcation (r = 0.21, p = 0.018) IMT. These associations abolished after adjusting for the confounders. The data suggest that apo(a) associate with carotid atherosclerosis independent of other risk factors for ischemic cardiovascular diseases.

Venous Thromboembolism and High Grade Gliomas

1993 ◽  
Vol 70 (03) ◽  
pp. 393-396 ◽  
Author(s):  
Mandeep S Dhami ◽  
Robert D Bona ◽  
John A Calogero ◽  
Richard M Hellman
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Medical Center ◽  
Significant Risk ◽  
Bleeding Complications ◽  
Fisher Exact Test ◽  
High Grade ◽  
Chi Square ◽  
Exact Test ◽  
High Grade Gliomas

SummaryA retrospective study was done to determine the incidence of and the risk factors predisposing to clinical venous thromboembolism (VTE) in patients treated for high grade gliomas. Medical records of 68 consecutive patients diagnosed and treated at Saint Francis Hospital and Medical Center from January 1986 to June 1991 were reviewed. The follow up was to time of death or at least 6 months (up to December 1991). All clinically suspected episodes of VTE were confirmed by objective tests. Sixteen episodes of VTE were detected in 13 patients for an overall episode rate of 23.5%. Administration of chemotherapy (p = 0.027, two tailed Fisher exact test) and presence of paresis (p = 0.031, two tailed Fisher exact test) were statistically significant risk factors for the development of VTE. Thrombotic events were more likely to occur in the paretic limb and this difference was statistically significant (p = 0.00049, chi square test, with Yates correction). No major bleeding complications were seen in the nine episodes treated with long term anticoagulation.We conclude that venous thromboembolic complications are frequently encountered in patients being treated for high grade gliomas and the presence of paresis and the administration of chemotherapy increases the risk of such complications.

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