Atropine: A Cure for Persistent Post Laparoscopic Pyloromyotomy Emesis?

Background: Atropine has been used as a successful primary medical treatment for hypertrophic pyloric stenosis. Several authors have reported a higher rate of incomplete pyloromyotomy with the laparoscopic approach compared to open. In this study, we evaluated the use of atropine as a medical treatment for infants with emesis persisting greater than 48 hours after a laparoscopic pyloromyotomy.Materials and Methods: We performed a retrospective chart review of infants receiving a laparoscopic pyloromyotomy between November 1998 and November 2012. Infants with emesis that persisted beyond 48 hours postoperatively were given 0.01mg/kg of oral atropine 10 minutes prior to feeding. Infants remained inpatient until they tolerated two consecutive feedings without emesis.Results: 965 patients underwent laparoscopic pyloromyotomy; 816 (84.6%) male and 149 (15.4%) female. Twenty-four (2.5%) received oral atropine. The mean length of stay for patients who received atropine was 5.6 ± 2.6 days, an average of 3 additional days. They were discharged home with a one-month supply of oral atropine. Follow up evaluation did not reveal any complications from receiving atropine. The median follow up was 21 days. None returned to the operating room for incomplete pyloromyotomy. There were 17 (1.8%) operative complications in our series; 9 mucosal perforations, 2 duodenal perforations, and 6 conversions to open for equipment failure or poor exposure. There were 4 (0.4%) post-operative complications: 2 episodes of apnea requiring reintubation and 2 incisional hernias that required a second operation. There were no deaths.Conclusion: Oral atropine is a viable treatment for persistent emesis after a pyloromyotomy and reduces the need for a second operation due to incomplete pyloromyotomy.

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SAT0267 ROLE OF AGGRESSIVE IMMUNOSUPPRESSION ON SUBGLOTTIC STENOSIS IN GRANULOMATOSIS WITH POLYANGIITIS: RETROSPECTIVE ANALYSIS OF A MONOCENTRIC COHORT

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.2582 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1076.1-1077

Author(s):

L. Moroni ◽

L. Giudice ◽

G. A. Ramirez ◽

S. Sartorelli ◽

A. Cariddi ◽

...

Keyword(s):

Medical Treatment ◽

Clinical Characteristics ◽

Granulomatosis With Polyangiitis ◽

Balloon Catheter ◽

Subglottic Stenosis ◽

Damage Accrual ◽

The Mean ◽

The One

Background:Subglottic stenosis (SGS) is defined as airway narrowing below the vocal cords and is a common and potentially life-threatening manifestation of Granulomatosis with Polyangiitis (GPA), with an estimated prevalence of 16-23% (1). Balloon catheter dilation is effective in GPA-related SGS, but relapses are frequent. Little is known about the role of immunosuppression in this setting.Objectives:to analyse the clinical characteristics of a monocentric GPA cohort, describe phenotype differences among patients with and without SGS and investigate the role of surgical and medical treatments on relapse risk and general outcome.Methods:Biopsy-proven patients with SGS were identified by review of medical charts among a cohort of patients with GPA, classified according to the algorithm of the European Medicine Agency (2). The clinical characteristics of patients with SGS were retrospectively collected over a median follow-up time of 15.9 years and compared to those of patients without SGS.Results:Fourteen patients with SGS-GPA were identified, with a female to male ratio of 1:1 and a prevalence of 29.2% among the cohort. The mean ± SD age at GPA onset was 30.8 ± 14.4 years, with a mean time from GPA diagnosis to SGS onset of 4.7 ± 4.2 years. ANCA were positive in 78.6% (54.0% anti-PR3, 18.1% anti-MPO and 27.9% IFI only). The mean Birmingham Vasculitis Activity Score (BVAS) at onset was 10.0 ± 5.6. The main clinical manifestations associated with SGS were crusty rhinitis (100%), sinusitis (78%), pulmonary disease (72.7%), otitis/mastoiditis (50%), glomerulonephritis (42.9%), orbital pseudotumor (28.6%). Six patients (42.9%) received medical treatment only, other six (42.9%) had one to three balloon dilations and two (14.2%) underwent four or more procedures. Eight patients had no SGS relapse (maximum one dilation) and they all received immunosuppression with rituximab (RTX), cyclophosphamide (CYC) or azathioprine (AZA). All patients who received no immunosuppression, methotrexate (MTX) or mycophenolate (MMF) had at least one relapse. Patients treated with MTX or MMF had a mean relapse-free survival of 13.1 months, which was comparable to the one of patients not receiving medical treatment (40.2 months; p=NS) and shorter than the one of patients receiving CYC or RTX (153.2 months; p=0.032). CYC use also inversely correlated with the number of surgical procedures (r=-0.691, p=0.006). Compared to patients without SGS (31 consecutive patients with at least 4 years of follow-up), patients with SGS-GPA had an earlier disease onset (mean age 30.8 vs 50.4 years; p<0.001), but with lower BVAS (mean 10.0 vs 15.3; p=0.013) and showed a higher prevalence of crusty rhinitis (100% vs 67.7%; p=0.019). No difference was observed in damage accrual over time between the two groups.Conclusion:Subglottic stenosis is highly prevalent in patients with GPA and may define a milder disease subset occurring more frequently in younger patients. MTX and MMF might be insufficient to prevent SGS relapses requiring balloon dilation. Aggressive immunosuppression (CYC or RTX) might have a non-redundant role in this setting and reduce the risk of relapses.References:[1]Quinn KA, et al. Subglottic stenosis and endobronchial disease in granulomatosis with polyangiitis. Rheumatology 2019; 58 (12), 2203-2211.[2]Watts R, et al. Development and validation of a consensus methodology for the classification of the ANCA associated vasculitides and polyarteritis nodosa for epidemiological studies. Ann Rheum Dis 2007; 66: 222-7.Disclosure of Interests:Luca Moroni: None declared, Laura Giudice: None declared, Giuseppe Alvise Ramirez: None declared, Silvia Sartorelli: None declared, adriana cariddi: None declared, Angelo Carretta: None declared, Enrica Bozzolo: None declared, Lorenzo Dagna Grant/research support from: The Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR) received unresctricted research/educational grants from Abbvie, Bristol-Myers Squibb, Celgene, Janssen, Merk Sharp & Dohme, Mundipharma Pharmaceuticals, Novartis, Pfizer, Roche, Sanofi-Genzyme, and SOBI., Consultant of: Prof Lorenzo Dagna received consultation honoraria from Abbvie, Amgen, Biogen, Bristol-Myers Squibb, Celltrion, Novartis, Pfizer, Roche, Sanofi-Genzyme, and SOBI.

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Late endoscopic evaluation of the ostium size after external dacryocystorhinostomy

European Journal of Ophthalmology ◽

10.1177/1120672120976044 ◽

2020 ◽

pp. 112067212097604

Author(s):

Reem R Al Huthail ◽

Yasser H Al-Faky

Keyword(s):

Chart Review ◽

Retrospective Chart Review ◽

Tertiary Hospital ◽

Nasal Endoscope ◽

Long Term Follow Up ◽

Mean Size ◽

External Dacryocystorhinostomy ◽

The Mean

Objective: To evaluate the effect of chronicity on the size of the ostium after external dacryocystorhinostomy (DCR) with intubation. Methods: Design: A retrospective chart review of patients who underwent external DCR with intubation over 10 years from January 2003 at a tertiary hospital. All patients were recruited and examined with rigid nasal endoscope. Results: A total number of 66 (85 eyes) patients were included. The mean age at the time of evaluation was 53.1 years with gender distribution of 54 females (81.8 %). The mean duration ±SD between the date of surgery and the date of evaluation was 33.2 ± 33.6 (6–118 months). Our study showed an overall anatomical and functional success of 98.8% and 95.3%, respectively. The mean size of the ostium (±SD) was 23.0 (±15.7) mm2 (ranging from 1 to 80.4 mm2). The size of the ostium was not a significant factor for failure ( p = 0.907). No statistically significant correlation was found between the long-term duration after surgery and the size of the ostium ( R: 0.025, p = 0.157). Conclusions: Nasal endoscopy after DCR is valuable in evaluating the ostium with no observed potential correlation between the long-term follow-up after surgery and the size of the ostium.

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MP09: Canadian Community Utilization of Stroke Prevention Pilot Study-Emergency Department (C-CUSP ED)

CJEM ◽

10.1017/cem.2017.175 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S68 ◽

Cited By ~ 1

Author(s):

R. Parkash ◽

K. Magee ◽

M. McMullen ◽

M.B. Clory ◽

M. D’Astous ◽

...

Keyword(s):

Stroke Prevention ◽

Phase 1 ◽

Retrospective Chart Review ◽

Phase 2 ◽

Phase 3 ◽

Three Phase ◽

Rigorous Study ◽

The Mean ◽

Prior Risk

Introduction: Atrial fibrillation (AF) is the most common sustained arrhythmia affecting 1-2% of the population. Oral anticoagulation (OAC) reduces stroke risk by 60-80% in AF patients, but only 50% of indicated patients receive OAC. Many patients present to the ED with AF due to arrhythmia symptoms, however; lack of OAC prescription in the ED has been identified as a significant gap in the care of AF patients. Methods: This was a multi-center, pragmatic, three-phase before-after study, in three Canadian sites. Patients who presented to the ED with electrocardiographically (ECG) documented, nonvalvular AF and were discharged home were included. Phase 1 was a retrospective chart review to determine OAC prescription of AF patients in each ED; Phase 2 was a low-intensity knowledge translation intervention where a simple OAC-prescription tool for ED physicians with subsequent short-term OAC prescription was used, as well as an AF patient education package and a letter to family physicians; phase 3 incorporated Phase 2 interventions, but added immediate follow-up in a community AF clinic. The primary outcome of the study was the rate of new OAC prescriptions at ED discharge in AF patients who were OAC eligible and were not on OAC at presentation. Results: A total of 632 patients were included from June, 2015-November, 2016. ED census ranged from 30000-68000 annual visits. Mean age was 71±15, 67±12, 67±13 years, respectively. 47.5% were women, most responsible ED diagnosis was AF in 75.8%. The mean CHA2DS2-VASc score was 2.6±1.8, with no difference amongst groups. There were 266 patients eligible for OAC and were not on this at presentation. In this group, the prescription of new OAC was 15.8% in Phase 1 as compared to 54% and 47%, in Phases 2 and 3, respectively. After adjustment for center, components of the CHA2DS2-VASc score, prior risk of bleeding and most responsible ED diagnosis, the odds ratio for new OAC prescription was 8.0 (95%CI (3.5,18.3) p<0.001) for Phase 3 vs 1, and 10.0 (95%CI (4.4,22.9) p<0.001), for Phase 2 vs 1). No difference in OAC prescription was seen between Phases 2 and 3. Conclusion: Use of a simple OAC-prescription tool was associated with an increase in new OAC prescription in the ED for eligible patients with AF. Further testing in a rigorous study design to assess the effect of this practice on stroke prevention in the AF patients who present to the ED is indicated.

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Follow-up results in tuberculous cervical lymphadenitis

The Journal of Laryngology & Otology ◽

10.1017/s002221510500277x ◽

2005 ◽

Vol 120 (2) ◽

pp. 129-132 ◽

Cited By ~ 7

Author(s):

Mehmet F Oktay ◽

Ismail Topcu ◽

Abdurrahman Senyigit ◽

Aslan Bilici ◽

Adem Arslan ◽

...

Keyword(s):

Medical Treatment ◽

Residual Disease ◽

Surgical Excision ◽

X Rays ◽

Test Results ◽

Cervical Lymphadenitis ◽

Antituberculous Treatment ◽

High Incidence ◽

The Mean

Objective: To investigate the efficacy of medical antituberculous treatment in patients with tuberculous cervical lymphadenitis (TCL).Methods: In the period 1996–2002, 73 TCL patients were reviewed and the results of clinical and laboratory testing were documented. The efficacy of a four-drug chemotherapy regimen was investigated.Results: Purified protein derivatives (PPD) skin test results were positive in 58 (79 per cent) patients. Chest X-rays revealed changes consistent with tuberculosis in nine (12.3 per cent) patients. The mean duration of medical treatment was 10.04 months. In follow-up evaluation, 14 (20 per cent) patients were considered suspicious for resistant TCL and total excision of all nodes was performed. Histopathology confirmed TB in only 10 of these cases.Conclusion: The high incidence of residual disease in our study indicates that medical treatment (at least nine months of four combined antituberculous drugs) did not seem to be effective. If lymphadenopathy persists, total surgical excision of lymph nodes should be the treatment of choice.

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Excimer Laser Phototherapeutic Keratectomy for the Treatment of Clinically Presumed Fungal Keratitis

Journal of Ophthalmology ◽

10.1155/2014/963287 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Liang-Mao Li ◽

Li-Quan Zhao ◽

Ling-Hui Qu ◽

Peng Li

Keyword(s):

Excimer Laser ◽

Clinical Symptoms ◽

Retrospective Chart Review ◽

Fungal Keratitis ◽

Amniotic Membrane Transplantation ◽

Phototherapeutic Keratectomy ◽

Medication Therapy ◽

Hyperopic Shift ◽

The Mean

This retrospective study was to evaluate treatment outcomes of excimer laser phototherapeutic keratectomy (PTK) for clinically presumed fungal keratitis. Forty-seven eyes of 47 consecutive patients underwent manual superficial debridement and PTK. All corneal lesions were located in the anterior stroma and were resistant to medication therapy for at least one week. Data were collected by a retrospective chart review with at least six months of follow-up data available. After PTK, infected corneal lesions were completely removed and the clinical symptoms resolved in 41 cases (87.2%). The mean ablation depth was114.39±45.51 μm and diameter of ablation was4.06±1.07 mm. The mean time for healing of the epithelial defect was8.8±5.6days. Thirty-four eyes (82.9%) showed an improvement in best spectacle-corrected visual acuity of two or more lines. PTK complications included mild to moderate corneal haze, hyperopic shift, irregular astigmatism, and thinning cornea. Six eyes (12.8%) still showed progressed infection, and conjunctival flap covering, amniotic membrane transplantation, or penetrating keratoplasty were given. PTK is a valuable therapeutic alternative for superficial infectious keratitis. It can effectively eradicate lesions, hasten reepithelialization, and restore and preserve useful visual function. However, the selection of surgery candidates should be conducted carefully.

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Extended applications of the endoscopic modified Lothrop procedure

The Journal of Laryngology & Otology ◽

10.1017/s0022215116008483 ◽

2016 ◽

Vol 130 (9) ◽

pp. 827-832 ◽

Cited By ~ 2

Author(s):

N Choudhury ◽

A Hariri ◽

H Saleh

Keyword(s):

Frontal Sinus ◽

Ossifying Fibroma ◽

Outcome Parameter ◽

Surgical Indications ◽

Silent Sinus Syndrome ◽

Operative Complications ◽

Extended Range ◽

Cerebrospinal Fluid Leaks ◽

The Mean

AbstractObjective:The endoscopic modified Lothrop procedure is mainly used for refractory frontal sinusitis. However, we have used it as an access procedure to facilitate treatment for an extended range of additional frontal sinus pathologies.Methods:A retrospective review of patients who underwent the endoscopic modified Lothrop procedure for ‘alternative’ frontal sinus pathologies was conducted. Patient data were reviewed. The main outcome parameter measured was signs of recurrence.Results:Twelve patients (6 males, 6 females) from a 7-year study period, with a mean age of 45.2 years (range, 16–78 years), were analysed. The surgical indications included frontoethmoidal mucoceles, cerebrospinal fluid leaks within the frontal sinus, cystic fibrosis, frontal sinus osteoma, frontal sinus ossifying fibroma and frontal silent sinus syndrome. The mean follow-up period was 33.3 months. There were no known recurrences.Conclusion:We have used the endoscopic modified Lothrop procedure for a range of frontal sinus pathologies, safely and effectively, with no peri-operative complications.

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Exercise in a Healthy Heart Program: A Cohort Study

Clinical Medicine Insights Cardiology ◽

10.4137/cmc.s12654 ◽

2013 ◽

Vol 7 ◽

pp. CMC.S12654 ◽

Cited By ~ 1

Author(s):

J. Meikle ◽

A. Al-Sarraf ◽

M. Li ◽

K. Grierson ◽

J. Frohlich

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Lipid Profile ◽

Retrospective Chart Review ◽

Secondary Outcome ◽

The Mean ◽

Group 2 ◽

Prevention Clinic ◽

Group 1

Objective To assess the effects of exercise on resting heart rate (RHR), weight, lipid profile, and blood pressure. We hypothesized that the participants who increased their physical activity would show improvement in their cardiovascular risk factors compared to those who did not. Design Retrospective chart review over the mean duration of 4.9 years of follow-up. Setting Healthy Heart Program Prevention Clinic at St. Paul's Hospital, Vancouver, British Columbia, Canada. Participants We reviewed 300 charts of patients randomly selected from those who attended the Prevention Clinic between 1984 and 2009. 248 (82.7%) patients were referred for primary prevention and 52 (17.3%) for secondary prevention. Primary and secondary outcome measures Weight, RHR, lipid profile, and blood pressure were recorded at the initial and last visit. Results During a mean of 4.9 years of follow-up, 55% of participants improved their exercise. The mean decrease in the RHR for these patients (group 1) was 5.9 beats per minute (bpm) versus the mean increase of 0.3 bpm for the “no change” group (group 2) ( P < 0.01). The mean net weight increase in group 1 was 0.06 kg/year versus 0.25 kg/year in group 2. Because of medications, all patients had a significant improvement in their lipid profiles. Furthermore, there was a statistically significant greater reduction in Framingham Risk Score (FRS) in group 1 versus group 2 (11.8% versus 15.1%, P < 0.01). Conclusion Participation in the program significantly reduces modifiable risk factors for cardiovascular disease. Improved exercise regimen results in lower RHR and greater reduction in FRS. However, even in a Prevention Program, despite strong advocacy of the importance of exercise, a significant percentage of participants does not improve their exercise habits.

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Remnant gall bladder and cystic duct stump stone after cholecystectomy: tertiary multicenter experience

International Surgery Journal ◽

10.18203/2349-2902.isj20184612 ◽

2018 ◽

Vol 5 (11) ◽

pp. 3478 ◽

Cited By ~ 1

Author(s):

Samir A. A. Mageed ◽

Mohammed A. Omar ◽

Alaa A. Redwan

Keyword(s):

Retrospective Study ◽

Cystic Duct ◽

Operative Time ◽

Laparoscopic Approach ◽

Biliary Injury ◽

Endoscopic Retrograde ◽

Biliary Pain ◽

The Mean ◽

Experienced Team

Background: There is no doubt that cholecystectomy relieves pre-surgical symptoms of gallbladder (GB) disease. The persistence of symptoms mainly biliary pain was recorded in 10 - 20% of cases, with variety of causes. Residual GB/cystic duct stump stone is one of the most important un-expected cause. The present study was conducted to study and evaluate those patients, with their surgical treatment.Methods: This retrospective study was conducted on 27 cases with residual GB/cystic duct stump stone. The diagnosis was guided by ultrasound and magnetic resonance cholangio-pancreatography. All cases were managed by using completion cholecystectomy - either open or laparoscopic. All preoperative, operative, and postoperative data were collected.Results: Preoperative endoscopic retrograde cholangio-pancreatography and papillotomy were required in 13 patients whom were presented with obstructive jaundice. Open completion cholecystectomy techniques were done in the majority of cases (21 patients) while laparoscopic approach was feasible in only 6 cases with one conversion (1/6). The mean operative time was (89.57 ± 12.05 and 118.16 ± 12.6 min), and the mean blood loss was (195.5 ± 19.22 and 187.5 ± 23.61 ml) respectively. Intra-operative minor biliary injury occurred in two cases and repaired instantaneously. The mean hospital stay was (4.76 ± 2.81 and 2.33 ± 1.32 days) respectively. All patients were reported to be symptom-free at the follow-up after surgical treatment.Conclusions: Residual GB/cystic duct stump stone is a preventable and correctable cause of post-cholecystectomy complaint. Completion cholecystectomy is a proven treatment of choice to relieve symptoms and avoid complications; furthermore, it can be carried out laparoscopically with experienced team and facilities in spite of difficulties.

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Mechanical Evaluation of Collapse Risk for Osteonecrosis of Femoral Head Post-Medical Treatment

10.21203/rs.3.rs-138877/v1 ◽

2021 ◽

Author(s):

Yuqian Mei ◽

Qi Tang ◽

Songhao Chen ◽

Duanduan Chen

Keyword(s):

Femoral Head ◽

Medical Treatment ◽

Early Stage ◽

Equivalent Stress ◽

Stress Index ◽

Patient Specific ◽

Relative Stress ◽

The Mean ◽

One Year

Abstract Background: Early-stage osteonecrosis of the femoral head can progressively induce the bone collapse and the accuracy of the collapse risk evaluation is limited. This study aims to propose a potential collapse indicator by biomechanical evaluating the treatment effectiveness. Methods: Six patient-specific models pre- (initial presentation) and post- medical treatment were established and elastic properties of the bone were assigned with a function of spatial-variant Hounsfield unit values. Morphological and mechanical analyses were compared between pre- and post-treatment models. Results: In the morphological study, four cases show the reduced ratio of low-density necrotic volume, but not consistent with one-year follow-up results. In the mechanical analysis, the equivalent stress variation near the Ward triangle shows consistency in the one-year outcome. Moreover, a parameter - relative stress index, the ratio between the mean volume stress index and the mean volume equivalent stress, is proposed. A smaller value of the relative stress index indicates stronger bone compressive strength and its variation is consistent with the follow-up results. Conclusions: Results implicate that to evaluate the effectiveness of medical treatments, the morphologic analysis should be considered but the mechanical capability and the loading transfer path through the necrotic and viable bone play a more important role.

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Single site multiport umbilical laparoscopic appendicectomy versus conventional multiport laparoscopic appendicectomy in acute settings

Annals of The Royal College of Surgeons of England ◽

10.1308/003588414x13946184901641 ◽

2014 ◽

Vol 96 (6) ◽

pp. 452-457 ◽

Cited By ~ 5

Author(s):

PA Jategaonkar ◽

SP Yadav

Keyword(s):

Statistical Significance ◽

Laparoscopic Approach ◽

Length Of Hospital Stay ◽

Single Site ◽

Laparoscopic Appendicectomy ◽

Acute Setting ◽

Pain Scores ◽

Cosmetic Outcomes ◽

The Mean

Introduction Although conventional multiport laparoscopic appendicectomy (CMLA) is preferred for managing acute appendicitis, the recently developed transumbilical laparoscopic approach is rapidly gaining popularity. However, its wide dissemination seems restricted by technical/technological issues. In this regard, a newly developed method of single site multiport umbilical laparoscopic appendicectomy (SMULA) was compared prospectively with CMLA to assess the former’s efficacy and the technical advantages in acute scenarios. Methods Overall, 430 patients were studied: 212 in the SMULA group and 218 in the CMLA group. The same surgeon performed all the procedures using routine laparoscopic instruments. The SMULA technique entailed three ports inserted directly at the umbilical mound through three distinct strategically placed mini-incisions without raising the umbilical flap. The CMLA involved the traditional three-port technique. Results Both groups were comparable in terms of demographic criteria, indications for surgery, intraoperative blood loss, time to ambulation, length of hospital stay and umbilical morbidity. Although the mean operative time was marginally longer in the SMULA group (43.35 minutes, standard deviation [SD]: 21.16 minutes) than in the CMLA group (42.28 minutes, SD: 21.41 minutes), this did not reach statistical significance. Conversely, the mean pain scores on day 0 and the cosmetic outcomes differed significantly and favoured the SMULA technique. None of the patients developed port site hernias over the follow-up period (mean 2.9 years). Conclusions The favourable outcomes for the SMULA technique are likely to be due to the three small segregated incisions at one place and better trocar ergonomics. The SMULA technique is safe in an acute setting and may be considered of value among the options for transumbilical appendicectomy.

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