scholarly journals Immediate Postoperative Parenteral Anticoagulant in the Patients with Mesenteric Infarction After Intestine Resection – A Retrospective Cohort Research in a Single Institute

2021 ◽  
Author(s):  
Hsiao-Tien Liu ◽  
Chia-Yu Lai ◽  
Jian-Jhou Liao ◽  
Yi-Ju Chen ◽  
Shao-Bin Cheng ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Confidence Interval ◽  
General Hospital ◽  
Odds Ratio ◽  
Intestinal Resection ◽  
Mesenteric Infarction ◽  
Enoxaparin Group ◽  
Group A ◽  
Bowel Gangrene ◽  
Group B

Abstract Background: Bowel gangrene represents a major fatal event in acute mesenteric infarction. Intestinal resection is inevitable in patients with peritonitis and bowel gangrene. This retrospective study aimed to elucidate the benefit of postoperative parenteral anticoagulant in patients with intestinal resection. Methods: Patients with acute mesenteric infarction and bowel gangrene were recruited retrospectively between January 2007 and December 2019. All patients underwent bowel resection. They were categorized into two groups: patients without immediate enoxaparin (group A) and those with immediate enoxaparin (group B). Both 30-day and 90-day mortalities were analyzed.Results: A total of 85 patients were included, with 29 patients in group A and 56 patients in group B. Patients in group B had both lower 30-day mortality (16.1%) and 90-day mortality (37.5%), compared to patients in group A (30-day mortality: 51.7%, p=0.001; 90-day mortality: 65.5%, p=0.021). In the 30-day mortality multivariate analysis, patients in group B had a better outcome (odds ratio = 0.087, 95% confidence interval between 0.017 and 0.446, p = 0.003). In the 90-day mortality multivariate analysis, patients in group B also had a better outcome (odds ratio = 0.252, 95% confidence interval between 0.065 and 0.983, p = 0.047).Conclusion: Immediate postoperative parenteral anticoagulant improves short-term prognosis in patients with acute mesenteric infarction and intestinal resection.Trial registration: This research was retrospectively approved by Institutional Review Board (IRB) I&II of Taichung Veterans General Hospital (TCVGH-IRB No.CE21256B) on July 28th, 2021. Informed consent waiver was also approved by IRB I&II of Taichung Veterans General Hospital. Declaration of Helsinki and ICH-GCP guidelines were followed during this study.

Hypercoagulability in Septic Shock Patients With Thrombocytopenia

2021 ◽  
pp. 088506662110241
Author(s):  
Sang-Min Kim ◽  
Sang-Il Kim ◽  
Gina Yu ◽  
June-Sung Kim ◽  
Seok In Hong ◽  
...  
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Multivariate Analysis ◽  
Platelet Count ◽  
Mortality Rate ◽  
Confidence Interval ◽  
Sofa Score ◽  
Odds Ratio ◽  
Fibrinogen Level ◽  
Limited Information

Background: Despite thrombocytopenia, patients with sepsis often experience hypercoagulability. However, limited information is available on the prevalence and effect of hypercoagulability in patients with sepsis-induced thrombocytopenia. Hence, we evaluated the prevalence of hypercoagulability and the association between hypercoagulability and clinical outcomes in septic shock patients with thrombocytopenia. Methods: Thromboelastography (TEG) was performed prospectively in 1294 patients with septic shock at the emergency department (ED) between January 2016 and December 2019. After excluding 405 patients who did not require resuscitation, refused enrollment, or developed septic shock after ED presentation, 889 patients were included. We defined thrombocytopenia as an admission platelet count lower than 150,000/µl according to SOFA score. We defined hypocoagulability and hypercoagulability as coagulation index (CI)< −3 and >3 on TEG, respectively. Results: Of the 889 septic shock patients (mean age 65.6 ± 12.7 years, 58.6% male), 473 (53.2%) had thrombocytopenia. Eighty-five (18.0%) patients showed hypercoagulable TEG and73 (15.4%) patients showed hypocoagulable TEG. The hypercoagulable TEG group had a significantly higher fibrinogen level and a lower 28-day mortality rate than the normal and hypocoagulable TEG groups (518 vs. 347 and 315 mg/dL; 7.1% vs. 21.1% and 36.8%, P < 0.01, respectively). In multivariate analysis, hypercoagulable TEG was associated with a decreased mortality rate (odds ratio: 0.395; 95% confidence interval, 0.162-0.965). Conclusions: In septic shock patients with thrombocytopenia, hypercoagulability was not uncommon. TEG can quickly distinguish the hypercoagulability and hypocoagulability states and serve as a valuable tool for evaluating the degree and risk in septic shock patients with thrombocytopenia.

The Effect of Sarcopenia on Outcomes in Geriatric Blunt Trauma

2017 ◽  
Vol 83 (11) ◽  
pp. 1203-1208 ◽  
Author(s):  
Mahdi Malekpour ◽  
Kelly Bridgham ◽  
Kathryn Jaap ◽  
Ryan Erwin ◽  
Kenneth Widom ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Confidence Interval ◽  
Blunt Trauma ◽  
Odds Ratio ◽  
Lumbar Vertebra ◽  
Objective Measure ◽  
Trauma Patients ◽  
The Third ◽  
Increased Risk ◽  
Axial Ct

Elderly patients are at a higher risk of morbidity and mortality after trauma, which is reflected through higher frailty indices. Data collection using existing frailty indices is often not possible because of brain injury, dementia, or inability to communicate with the patient. Sarcopenia is a reliable objective measure for frailty that can be readily assessed in CT imaging. In this study, we aimed to evaluate the effect of sarcopenia on the outcomes of geriatric blunt trauma patients. Left psoas area (LPA) was measured at the level of the third lumbar vertebra on the axial CT images. LPA was normalized for height (LPA mm2/m2) and after stratification by gender, sarcopenia was defined as LPA measurements in the lowest quartile. A total of 1175 patients consisting of 597 males and 578 females were studied. LPAs below 242.6 mm2/m2 in males and below 187.8 mm2/m2 in females were considered to be sarcopenic. We found sarcopenia in 149 males and 145 females. In multivariate analysis, sarcopenia was associated with a higher risk of in-hospital mortality (odds ratio [OR]: 1.61, 95% confidence interval [CI]: 1.01–2.56) and a higher risk of discharge to less favorable destinations (OR: 1.42, 95% CI: 1.05–1.97). Lastly, sarcopenic patients had an increased risk of prolonged hospitalization (hazard ratio: 1.21, 95% CI: 1.04–1.40).

Stent-Associated Flow Remodeling Causes Further Occlusion of Incompletely Coiled Aneurysms

Neurosurgery ◽  
2011 ◽  
Vol 69 (3) ◽  
pp. 598-604 ◽  
Author(s):  
Matthew F. Lawson ◽  
William C. Newman ◽  
Yueh-Yun Chi ◽  
J. D. Mocco ◽  
Brian L. Hoh
Keyword(s):  
Multivariate Analysis ◽  
Confidence Interval ◽  
Packing Density ◽  
Odds Ratio ◽  
Senior Author ◽  
Neck Size ◽  
Increased Risk ◽  
Coil Occlusion ◽  
Stented Group

Abstract BACKGROUND: Incomplete coil occlusion is associated with increased risk of aneurysm recurrence. We hypothesize that intracranial stents can cause flow remodeling, which promotes further occlusion of an incompletely coiled aneurysm. OBJECTIVE: To study our hypothesis by comparing the follow-up angiographic outcomes of stented and nonstented incompletely coiled aneurysms. METHODS: From January 2006 through December 2009, the senior author performed 324 initial coilings of previously untreated aneurysms, 145 of which were Raymond classification 2 and 3. Follow-up angiographic studies were available for 109 of these aneurysms (75%). Angiographic outcomes for stented vs nonstented incompletely coiled aneurysms were compared. A multivariate analysis was performed to identify factors related to the progression of occlusion at follow-up, with adjustment for aneurysm location, size, neck size, Hunt-Hess grade, stent use, initial Raymond score, packing density, age, sex, and medical comorbidities. RESULTS: Of the 109 aneurysms, 37 were stented and 72 were not stented. With a median follow-up time of 15.4 months, 33 stented aneurysms (89%) progressed to complete occlusion compared with 29 nonstented aneurysms (40%). Recanalization rates were lower in the stented group (8.1%) compared with the nonstented group (37.5%; P &lt; .001). On multivariate analysis, stent use (odds ratio, 18.5; 95% confidence interval, 4.3-76.9) and packing density (odds ratio, 1.093; 95% confidence interval, 1.021-1.170) were significant predictors of the progression of occlusion. Aneurysm size was negatively correlated with the progression of occlusion (odds ratio, 0.844; 95% confidence interval, 0.724-0.983). CONCLUSION: Stent-assisted coiling causes progression of occlusion, possibly by a flow remodeling effect. The odds of progression of occlusion of stent-coiled aneurysms were 18.5 times that of nonstented aneurysms.

scholarly journals Pharyngeal carriage of Neisseria meningitidis and Neisseria lactamica in households with infants within areas with high and low incidences of meningococcal disease

1991 ◽  
Vol 106 (3) ◽  
pp. 445-457 ◽  
Author(s):  
S. F. Olsen ◽  
B. Djurhuus ◽  
K. Rasmussen ◽  
H. D. Joensen ◽  
S. O. Larsen ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Neisseria Meningitidis ◽  
Meningococcal Disease ◽  
Odds Ratio ◽  
Lower Risk ◽  
Household Survey ◽  
Faroe Islands ◽  
Odds Ratios ◽  
Neisseria Lactamica ◽  
Group B

SUMMARYIn a household survey in the Faroe Islands, an isolated community with hyperendemic occurrence of meningococcal disease due to serogroup B 15, 1604 persons were examined for pharyngeal carriage of Neisseria meningitidis and N. lactamica. Two areas were chosen having experienced high (HIA), and two having experienced low incidences (LIA) of disease. Living in HIA compared with LIA was associated with higher risk of N. meningitidis B 15 carriage and lower risk of N. lactamica carriage, with odds ratios of 2·7 (95% confidence interval (CI) 1·4–5·1, P = 0·003) and 0·41 (95% CI 0·31–0·53, P < 0·0001), respectively. In HIA the risk of N. meningitidis carriage was much lower in non-carriers than carriers of N. lactamica, with an odds ratio of 0·19 (95% CI 0·08–0·47, P = 0·0003); in LIA this association (odds ratio 0·51, P = 0·05) was much weaker. Children 0–14 years had substantially higher risk of being carriers of N. meningitidis group B 15 if the mothers were so, with an odds ratio of 11 (95% CI 4–29, P < 0·0001).

Advanced stage, elevated LDH, primary sites, but not adolescent (A) age (≥ 15 years) as risk factors for disease progression in childhood (C) and adolescent (A) mature B-NHL: Report of the FAB/LMB 96 international trial

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 10032-10032
Author(s):  
M. S. Cairo ◽  
R. Sposto ◽  
M. Gerrard ◽  
I. Waxman ◽  
S. Goldman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Risk Factor ◽  
Risk Group ◽  
Significant Risk ◽  
High Risk Group ◽  
Stage Iii ◽  
Group A ◽  
Independent Risk Factors ◽  
Group B

10032 Background: We recently reported the results in C & A with low risk (group A), intermediate risk (group B) and high risk (group C) mature B-NHL treated on FAB/LMB 96 (Gerrard et al, Br J Haematol, 2008; Patte et al, Blood, 2007; Cairo et al, Blood, 2007, respectively). Adolescent age (15–21 yrs) has historically been considered to be an independent risk factor for poor outcome in subsets of mature B-NHL (Hochberg/Cairo et al, Br J Haematol, 2008; Burkhardt et al, Br J Haematol 2005; Cairo et al, Br J Haematol, 2003). Methods: We analyzed the EFS of all pts treated on FAB/LMB 96 and the following risk factors were significant in a univariate and Cox multivariate analysis: age (<15 vs ≥15 yrs), stage I/II vs III/IV, primary sites, LDH <2 vs ≥2 NL and histology (DLBCL vs BL/BLL). Results: 1111 pts (15%, 15–21 years) were treated with group A (N = 132), group B (N = 744), and group C (N = 235) therapy. Five year EFS (CI95) for all, A, B, C pts was 86% (84%,88%), 98% (93%, 100%), 87%% (84%, 89%), and 79%% (73%,84%), respectively. Age (≥15 yrs), LDH ≥2NL, stage III/IV, and BM+/CNS+ and histology were significant univariate risk factors for decreased EFS (P<0.045, <0.0001, <0.0001, <0.0001, and <0.0001 respectively). Multivariate analysis demonstrated age ≥15 yrs and DLBCL histology were no longer independent significant risk factors (p = .82 and 0.08, respectively), but LDH (RR 2.0, p = .001), stage III/IV (RR 3.8, p<0.001), and primary sites including PMBL (RR 4.0, p<.001) and BM+/CNS+ (RR 2.8, p<0.001) were independent significant risk factors for poorer outcome. Conclusions: With the use of modern short but intense FAB-LMB 96 therapy, adolescent age is no longer a poor risk factor in children with mature B-NHL. The independent risk factors identified in this study (stage, LDH, primary site) for decreased EFS in C & A mature B-NHL will form the basis of the next risk adapted international pediatric mature B-NHL trial. No significant financial relationships to disclose.

Retrospective comparison of long-term outcomes in patients with stage II/III (UICC-TNM6th) esophageal squamous cell carcinoma treated with 60 Gy or 50.4 Gy of definitive chemoradiotherapy with fluorouracil and platinum.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 109-109
Author(s):  
Hidekazu Hirano ◽  
Ken Kato ◽  
Shoko Nakamura ◽  
Yusuke Sasaki ◽  
Naoki Takahashi ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Stage Ii ◽  
Long Term Outcomes ◽  
Definitive Chemoradiotherapy ◽  
Concurrent Radiotherapy ◽  
Group A ◽  
Group B

109 Background: Definitive chemoradiotherapy (dCRT) is one of the treatment options for stage II/III esophageal squamous cell carcinoma (ESCC). RTOG9405 demonstrated that a higher dose of radiation (64.8 Gy) offered no additional survival benefit over the standard dose (50.4 Gy). We compared the long-term outcomes of dCRT with radiation doses of 60 Gy and 50.4 Gy for ESCC. Methods: Selection criteria included thoracic ESCC, stage II/III (non T4), performance status (PS) 0-2, age 20-75 years, adequate organ function and no other active malignancy. We retrospectively analyzed patients who received dCRT as a first-line therapy between Jan. 2000 and Nov. 2011 in our hospital. Group A (n = 180) received 2 cycles of cisplatin (C) (40 mg/m2 on day 1 and 8) with fluorouracil (F) infusion (400 mg/m2/day on day 1-5 and 8-12), or 2 cycles of C (70 mg/m2 on day 1) with F infusion (700 mg/m2/day on day 1-4) repeated every 4 weeks and concurrent radiotherapy at a dose of 60 Gy. Group B (n = 62) received 2 cycles of C (75 mg/m2 on day 1) with F infusion (1000 mg/m2/day on days 1–4) repeated every 4 weeks and concurrent radiotherapy at a dose of 50.4 Gy. Overall survival (OS) and progression free survival (PFS) were estimated with the Kaplan-Meier method and compared with log-rank test. The Cox regression model was used for multivariate analysis to assess the prognostic factors for OS. Results: Characteristics of both groups were as follows (Group A: Group B): median age, 64:62; male/female, 154/26:55/7; PS 0/1/2, 81/98/1:46/16/0; T1/2/3, 39/27/114:19/9/34; N0/1, 41/139:6/56. Median follow-up period was longer than 40 months for both groups. 5-year survival rates were 44.5% for Group A and 60.0% for Group B. Median PFS and median OS were 16.5 months and 36.2 months for Group A, 41.1 months and 98.3 months for Group B. By multivariate analysis, Group B (hazard ratio [HR] 0.617: 95% confidence interval [CI]:0.400-0.951, p = 0.029), T1/2([HR] 0.383: 95% [CI]: 0.260-0.566, p < 0.001) were significant prognostic factors for OS. Conclusions: CRT with 50.4 Gy showed better long-term survival than with 60 Gy.

scholarly journals Novel Closing Method Using Subcutaneous Continuous Drain for Preventing Surgical Site Infections in Radical Cystectomy

ISRN Urology ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-5
Author(s):  
Yasuhiko Hirose ◽  
Taku Naiki ◽  
Ryosuke Ando ◽  
Akihiro Nakane ◽  
Toshiki Etani ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Confidence Interval ◽  
Radical Cystectomy ◽  
Dead Space ◽  
Odds Ratio ◽  
Wound Dressing ◽  
Subcutaneous Fat ◽  
Surgical Site Infections ◽  
New Method ◽  
Site Infection

To reduce the incidence of surgical site infection (SSI) after radical cystectomy, a new closing method using subcutaneous continuous aspiration drain was developed and compared to the conventional closing method. The new method involved (a) closed aspiration with an indwelling aspiration drain without suture of the subcutaneous fat and (b) covering with hydrocolloid wound dressing after suture of the dermis with 4-0 absorbable thread and reinforcement using strips. The incidence of SSI was significantly improved by using the new method. Furthermore, univariate and multivariate analysis associated with SSI revealed that the new closing method was statistically correlated with 85% reduction of SSI (odds ratio: 0.15, 95% confidence interval: 0.03–0.69).Our new method using continuous aspiration with subcutaneous drain is useful for preventing SSI through removal of effusions and reduction of dead space by apposition of the subcutaneous fat.

Nonjudicious Dispensing of Antibiotics by Drug Stores in Pratumthani, Thailand

2008 ◽  
Vol 29 (6) ◽  
pp. 572-575 ◽  
Author(s):  
Anucha Apisarnthanarak ◽  
Jeeraluk Tunpornchai ◽  
Korakot Tanawitt ◽  
Linda M. Mundy
Keyword(s):  
Multivariate Analysis ◽  
Confidence Interval ◽  
Antibiotic Therapy ◽  
Odds Ratio ◽  
Adjusted Odds Ratio

Mock patient presentations of 6 common syndromic ailments to drug stores in Pratumthani, Thailand, were conducted. Appropriate dispensing of antibiotic therapy for all 6 presentations occurred at 56 (20%) of 280 drug stores. By multivariate analysis, drug stores' proximity to a hospital was associated with appropriate dispensing of antibiotics (adjusted odds ratio, 34 [95% confidence interval, 15–83]; P < .001).

Use of Maximal Sterile Barrier Precautions and/or Antimicrobial-Coated Catheters to Reduce the Risk of Central Venous Catheter-Related Bloodstream Infection

2008 ◽  
Vol 29 (10) ◽  
pp. 947-950 ◽  
Author(s):  
Duk-hee Lee ◽  
Koo Young Jung ◽  
Yoon-Hee Choi
Keyword(s):  
Multivariate Analysis ◽  
Mortality Rate ◽  
Central Venous Catheter ◽  
Confidence Interval ◽  
Bloodstream Infection ◽  
Odds Ratio ◽  
Venous Catheter ◽  
Central Venous ◽  
Factors Associated ◽  
Catheter Related Bloodstream Infection

Central venous catheter-related bloodstream infection is clinically important because of its high mortality rate. This prospective study shows by multivariate analysis that the use of maximal sterile barrier precautions (odds ratio, 5.205 [95% confidence interval, 0.015-1.136]; P= .023) and the use of antimicrobial-coated catheters (odds ratio, 5.269 [95% confidence interval, 0.073-0.814]; P = .022) are independent factors associated with a lowered risk of acquiring a central venous catheter-related bloodstream infection.

scholarly journals To compare efficacy of Diclofenac by intramuscular route and rectal route in post surgical pain.

2021 ◽  
Vol 28 (09) ◽  
pp. 1269-1275
Author(s):  
Maryam Zulfiqar ◽  
Maimoona Ashraf ◽  
M. Imran Hassan Khan ◽  
Fareed Naeem ◽  
Salman Shakeel
Keyword(s):  
General Hospital ◽  
Cesarean Delivery ◽  
Diclofenac Sodium ◽  
Randomized Study ◽  
Double Blind ◽  
Surgical Pain ◽  
Rectal Route ◽  
Group A ◽  
Group B ◽  
Study Setting

Objective: This study was carried out in Lahore General Hospital, Lahore to test the results of Intramuscular vs Suppository form of Diclofenac Sodium on the severity of post-surgical pain in patients who underwent Cesarean delivery under Subarachnoid Block. Study Design: Randomized Study. Setting: Lahore General Hospital, Lahore. Period: April 2019 to September 2019. Material & Methods: This was a double-blind run on 100 patients who underwent for cesarean delivery irrespective of any indication for the procedure. The pain sufferers had been randomly divided into 2 groups. The group A: who received Diclofenac Sodium in the form of suppository and Group B: who received intramuscular Diclofanec Sodium? The pain severity was assessed using VAS scale at categorically unique times. Data was then analyzed using SPSS 23 version and the results were compiled in the form of mean and percentage. Results: The mean age (Years) of patients was (25.27±6.07). There was a big statistical difference between the 2 groups regarding pain score after the intervention (p=0.018). Conclusion: To reaffirm the effectiveness of Diclofenac for Post-Caesarean section, the physique part (Suppository) is established to hold advantages over the contractile organ (muscles).

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