Use of Inhaled Corticosteroids or Oral Steroids in a COVID-19 Telemedicine Cohort: Retrospective Chart Review (Preprint)

2021 ◽  
Author(s):  
Michele Cellai
Keyword(s):  
Chart Review ◽  
Inhaled Corticosteroids ◽  
Symptom Relief ◽  
Retrospective Chart Review ◽  
Oral Steroid ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Persistent Symptoms ◽  
Oral Steroids

BACKGROUND We identified patients with coronavirus disease 2019 that were followed by a telemedicine clinic and eventually referred to a post COVID clinic due to persistent symptoms of COVID-19. Of those patients requiring referral to the post COVID clinic, equal percentages of patients treated acutely with inhaled corticosteroids (ICS) and/ or oral steroids required referral to a pulmonary specialist. OBJECTIVE To determine if there was a difference in long term outcomes when prescribed ICS versus oral steroids METHODS Chart review comparing new prescription ICS to new prescription oral steroid RESULTS No difference in long term outcome between the groups CONCLUSIONS It is safe to prescribe ICS or oral steroids for symptom relief, but cost may be an issue

Long-term outcome in outpatients with depression treated with acute and maintenance intravenous ketamine: A retrospective chart review

2020 ◽  
Vol 276 ◽  
pp. 660-666 ◽  
Author(s):  
Hitoshi Sakurai ◽  
Felipe Jain ◽  
Simmie Foster ◽  
Paola Pedrelli ◽  
David Mischoulon ◽  
...  
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Intravenous Ketamine

scholarly journals TP7.2.14 Long Term Outcome of Patients with Minimally Symptomatic Diverticular Stricture

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
P A Jayawardena ◽  
T S Hany ◽  
M R Peris
Keyword(s):  
Diverticular Disease ◽  
Retrospective Chart Review ◽  
Sigmoid Resection ◽  
Tertiary Referral Hospital ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Diagnosis Of Cancer ◽  
Colorectal Surgeon

Abstract Aims Minimally symptomatic diverticular stricture poses diagnostic and management dilemma for the Colorectal Surgeon. Long term outcome, risk of missing a cancer and complications are not well documented in the literature. This study aims at assessment of outcomes of patients with minimally symptomatic diverticular stricture who were treated conservatively. Methods Retrospective chart review of all patients with confirmed diverticular stricture on endoscopy and imaging scans who had minimal or mild symptoms over a 6-year period from January,2014 to June,2020 in a large tertiary referral hospital. Search methods included diverticular disease with stricture using ICD10 code K57 and K56.6. Outcome measures included complications while on conservative treatment including missed cancer, any subsequent surgery and complications including stomas. Results 29 patients fitted the inclusion criteria, 18 females with median age 75(43-92). Median follow up was 32.5 months (8-93). All had endoscopic and CT imaging confirmation of diverticular stricture. Repeat investigations were recorded as 16 endoscopies in 9 patients and 30 CT scans in 14 patients during follow up. Four patients had at least one episode of diverticulitis; only one underwent emergency surgery at 5 years from diagnosis. 2/29 (6.9%) patients presented with diverticular perforation requiring Hartmann’s procedure. One patient (3%) had elective sigmoid resection with average duration of follow up 29 months (11.5-59) months. There were no missed diagnosis of cancer and no mortality due to diverticular disease. Conclusions In this patient population, diverticular stricture runs a relatively benign course with few complications or surgical intervention during follow up.

scholarly journals RARE-09. PRESERVATION OF ENDOCRINE FUNCTION AFTER OMMAYA RESERVOIR INSERTION IN CHILDREN WITH CYSTIC CRANIOPHARYNGIOMA

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii443-iii443
Author(s):  
Laura-Nanna Lohkamp ◽  
Abhaya Kulkarni ◽  
James Drake ◽  
James T Rutka ◽  
Peter Dirks ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Invasive Procedure ◽  
Retrospective Chart Review ◽  
Ommaya Reservoir ◽  
Endocrine Function ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Sick Children

Abstract INTRODUCTION Children with craniopharyngiomas (CP) can be subjected to significant morbidities caused by radical surgery and/or radiation with severe long-term consequences. Ommaya reservoir Insertion (ORI) into cystic CP represents a minimally invasive procedure that aims to preserve endocrine, hypothalamic and neurocognitive function. The purpose of this study was to determine the relevance of upfront ORI (+/- intracystic treatment) for preservation of endocrine function. METHODS A retrospective chart review of children with CP treated at the Hospital for Sick Children between 01/01/2000 and 15/01/2020 was undertaken. Endocrine function was reviewed at the time of initial ORI or surgical resection and throughout the course of follow-up. Event free survival (EFS) was defined as the time to additional surgical resection or irradiation. RESULTS Fifty-five patients with sufficient endocrine follow-up data were included. The median age of diagnosis was 8.3 years (range 2.1–18.0 years), 31 were males. ORI was performed as upfront treatment in 30 patients, gross total or partial resection in 24 patients and radiation in 1 patient, respectively. Endocrine function remained stable after ORI with a median EFS of 19.2 (0 – 105.3) months while the majority of patients who underwent surgical resection had documented worsened endocrine function postoperatively (median of 0; range 0 – 29.4 months) (p< 0.001). The event most commonly related to secondary endocrine deterioration was initial or delayed surgical resection. CONCLUSIONS Endocrine function was preserved in patients with upfront ORI (+/- intracystic treatment). Further studies will elucidate the implications of ORI with respect to ophthalmological, vascular and neurocognitive long-term outcome.

Pump Removal in Infected Patients with Hepatic Chemotherapy Pumps: When is it Necessary?

2006 ◽  
Vol 72 (10) ◽  
pp. 880-884
Author(s):  
Jonathan J. Roybal ◽  
Eric C. Feliberti ◽  
Layla Rouse ◽  
Lawrence D. Wagman
Keyword(s):  
Colorectal Liver Metastases ◽  
Chart Review ◽  
Systemic Infection ◽  
Clinical Scenario ◽  
Wound Infections ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Pocket Infection ◽  
Premature Removal

Hepatic chemotherapy pumps have been shown to be an effective and well-tolerated treatment for metastatic colorectal cancer confined to the liver. The importance of completing chemotherapy in long-term outcome makes it desirable to salvage hepatic pumps where possible. Concerns of persistent and systemic infection have resulted in premature removal of pumps in patients with infection. We report our experience in this clinical scenario. We placed 75 hepatic chemotherapy pumps from January 1998 to August 2005 for treatment of colorectal liver metastases. Information was collected on the patients’ courses of treatment, complications, and demographics via chart review. The rate of infection was 22.7% (n = 17), including eight infections localized to the abdomen (entailing five wound infections, three hepatic abscesses, and two pump pocket infections). Of these, two pumps had to be removed because of pump pocket infection, and these patients received more cycles of chemotherapy compared with the four removed for noninfectious complications (12.3 vs 3.2, P = 0.0349). Time to infection was found to be significantly higher in these patients (12.5 months) than in the patients with infections overall (4.87 months, P = 0.029), and age was found to be lower (42.5 vs 57.6 years, P = 0.0068).

scholarly journals Diagnosis and Outcome of Cardiac Paragangliomas: A Retrospective Observational Cohort Study in China

2022 ◽  
Vol 8 ◽  
Author(s):  
Xueqi Dong ◽  
Xu Meng ◽  
Ting Zhang ◽  
Lin Zhao ◽  
Fang Liu ◽  
...  
Keyword(s):  
Symptom Relief ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Contrast Enhanced ◽  
Octreotide Scintigraphy ◽  
Great Vessels ◽  
Observational Cohort ◽  
Biochemical Remission ◽  
Enhanced Computed Tomography

Background: Cardiac paragangliomas (CPGLs) are rare neuroendocrine tumors that are easily overlooked and difficult to diagnose. Detailed comprehensive data regarding CPGL diagnosis and outcome are lacking.Methods: We retrospectively analyzed a cohort of 27 CPGL patients. This cohort represents the largest such cohort reported to date.Results: The prevalence of trilogy symptoms (concurrent palpitations, hyperhidrosis, and headache) was frequent (9/27, 33.3%). Sensitivity of echocardiography and contrast-enhanced computed tomography for localization of CPGL were 81.8% and 87%, respectively. Octreotide scintigraphy showed 100% sensitivity for detecting GPCLs, while sensitivity of I131-metaiodoben-zylguanidine scintigraphy was only 32.9%. Multiple tumors were found in 29.6% of patients. Most CPGLs originated from the epicardium or root of the great vessels (92.9%) and were mostly supplied by the coronary arteries and their branches (95.7%). Twenty-four patients underwent surgical treatment. Although local invasion was present in 40.0% of patients, it did not affect long-term outcome. Mean follow-up was 6.9 ± 3.6 years. Biochemical remission was achieved in 85% of patients. The recurrence rate was 15%.Conclusions: Manifestations of CPGLs are non-specific and they can be difficult to detect on imaging examinations. Octreotide scintigraphy should be performed in patients with suspected paragangliomas to screen for multiple lesions. Surgical resection of CPGLs can achieve symptom relief and biochemical remission.

Long-term outcome after perineural injection with 5% dextrose for carpal tunnel syndrome: a retrospective follow-up study

Rheumatology ◽  
2020 ◽  
Author(s):  
Tsung-Ying Li ◽  
Si-Ru Chen ◽  
Yu-Ping Shen ◽  
Chih-Ya Chang ◽  
Yu-Chi Su ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Symptom Relief ◽  
Injection Therapy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Perineural Injection ◽  
Tunnel Syndrome

Abstract Objective Perineural injection therapy with 5% dextrose water is progressively becoming a mainstream method for treating carpal tunnel syndrome. However, its long-term outcome is still unknown. Hence, the purpose of this retrospective study was to investigate the long-term outcome after perineural injection therapy using 5% dextrose water. Methods A total of 185 patients diagnosed with carpel tunnel syndrome at least 1 year post-therapy were enrolled. All the patients underwent ultrasound-guided perineural injection therapy using 10 ml of 5% dextrose water at the outpatient department. In a structured telephone interview, the patients were asked about the outcome post-therapy compared with pre-injection. A symptom relief ≥50% indicated effective outcome, and a symptom relief <50% was indicative of a poor outcome. Results In total, 88.6% patients reported an effective outcome, and 11.4% rated the outcome as poor, after a mean of 2.2 injections with a mean of 1–3 years’ post-injection follow-up. The outcome was significantly related with severity level, and the patients that reported a poor outcome had a significantly higher incidence of severe grade compared with those who reported an effective outcome (52.4% vs 31.7%, P = 0.03). Patients with mild, moderate and severe grades, respectively, required an average of 1.7 (0.1), 2.4 (0.2) and 2.6 (0.3) injections to reach an effective outcome (P = 0.006) (severe vs mild, P = 0.008; moderate vs mild, P = 0.062). Conclusion Perineural injection therapy is a novel approach for treatment of carpal tunnel syndrome with safe and outstanding long-term effects.

Neurosurgical management of neurenteric cysts in children

2013 ◽  
Vol 11 (5) ◽  
pp. 511-517 ◽  
Author(s):  
Ibrahim H. Al-Ahmed ◽  
Mohamed Boughamoura ◽  
Peter Dirks ◽  
Abhaya V. Kulkarni ◽  
James T. Rutka ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Retrospective Chart Review ◽  
Craniocervical Junction ◽  
Outcome Data ◽  
Limb Weakness ◽  
Term Outcome ◽  
Population Total ◽  
Long Term Outcome ◽  
Incomplete Excision

Object Neurenteric cysts (NCs) are endothelium-lined structures of presumed endodermal origin. There have been few pediatric series of intracranial NCs reported previously. The authors present their experience in the management of these lesions. Methods A retrospective chart review of all cases of NCs identified between 1977 and 2007 was carried out. Demographics, details of clinical presentation, surgical therapy, and outcome data were extracted. Results Eleven cases were identified, involving 6 girls and 5 boys. The patients' average age was 4.6 years (range 1 day–14 years). Limb weakness was the most common presenting symptom. The location of the cysts was cervical in 2 cases, cervicothoracic in 4 cases, and thoracic in 3 cases. One cyst was anterior to the pons with extension to the left cerebellopontine angle and 1 cyst was at the craniocervical junction. Five patients had an apparently complete initial excision, with 1 recurrence. Four patients were initially treated with incomplete excision and/or cyst drainage, usually into an Ommaya reservoir. A neonate with a large cervicothoracic cyst died of multiple congenital anomalies without any intervention. All other patients were alive at last follow-up. One patient with a radiologically identified presumed cyst, which remained stable, was simply followed up. Several patients required multiple procedures and 1 patient developed hydrocephalus after aseptic meningitis and was treated with CSF shunting. Conclusions Neurenteric cysts are rare in the pediatric population. Total resection, if possible, provides the best long-term outcome. Incomplete excision may lead to multiple procedures, including cyst drainage, but can lead to long-term stability.

scholarly journals Two-Staged Implant-Based Breast Reconstruction: A Long-Term Outcome Study in a Young Population

Medicina ◽  
2019 ◽  
Vol 55 (8) ◽  
pp. 481 ◽  
Author(s):  
Oscar J. Manrique ◽  
Ali Charafeddine ◽  
Amjed Abu-Ghname ◽  
Joseph Banuelos ◽  
Steven R. Jacobson ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Young Patients ◽  
Retrospective Chart Review ◽  
Roc Curves ◽  
Adjuvant Radiation ◽  
Obese Women ◽  
Term Outcome ◽  
Long Term Outcome

Background and objectives: Differences in patient anatomy and physiology exist between young and older patients undergoing breast reconstruction after mastectomy. Breast cancer has been described as being more aggressive, more likely to receive radiation, contralateral mastectomy, as well as bilateral reconstruction in young patients. Our purpose is to report long-term experience on two-staged implant-based breast reconstruction (IBR) in young females, with complication sub-analysis based on obesity and adjuvant radiation. Materials and Methods: Retrospective chart review of all consecutive young patients who underwent two-staged IBR at our institution, between 2000 and 2016, was performed. Patients between 15 and 40 years old with least 1-year follow-up were included. Univariate logistic regression models and receiver operating characteristic (ROC) curves were created. Results: Overall 594 breasts met our inclusion criteria. The mean age was 34 years, and the median follow-up was 29.6 months. Final IBR was achieved in 98% of breasts. Overall, 12% of breasts had complications, leading to explantations of 5% of the devices. Adjuvant radiation was followed by higher rates of total device explantations (p = 0.003), while obese patients had higher rates of total complications (p < 0.001). For each point increase in BMI, the odds of developing complications increased 8.1% (p < 0.001); the cutoff BMI to predict higher complications was 24.81 kg/m2. Conclusions: This population demonstrates high successful IBR completion and low explantation rates. These data suggest that obese women and those with planned adjuvant radiation deserve special counseling about their higher risk of complications.

scholarly journals Update on Postnatal Corticosteroids to Prevent or Treat Bronchopulmonary Dysplasia

2019 ◽  
Vol 36 (S 02) ◽  
pp. S58-S62 ◽  
Author(s):  
Marco Filippone ◽  
Daniel Nardo ◽  
Luca Bonadies ◽  
Sabrina Salvadori ◽  
Eugenio Baraldi
Keyword(s):  
Adverse Effects ◽  
Lung Disease ◽  
Bronchopulmonary Dysplasia ◽  
Lung Inflammation ◽  
Inhaled Corticosteroids ◽  
Therapeutic Option ◽  
Term Outcome ◽  
Severe Respiratory Distress ◽  
Long Term Outcome

AbstractBronchopulmonary dysplasia (BPD) is a major complication of premature birth that significantly affects mortality and long-term morbidity in numerous immature infants. Corticosteroids are particularly suitable for treating BPD, as lung inflammation is central to its pathogenesis. Corticosteroids have considerable, fast beneficial effects on lung function in premature infants with lung disease, but they are also associated with several serious adverse effects, which may have a detrimental impact on long-term outcome. Dexamethasone is the most often used corticosteroid for systemic administration. Despite its value in preventing and treating BPD, its use is associated with several alarming short-term effects and, worst of all, with an increased rate of cerebral palsy in the long term. Dexamethasone nonetheless remains an important therapeutic option for infants with severe lung disease beyond the second to third week of life. Hydrocortisone is an important alternative to dexamethasone, as its use does not appear to be associated with any neurotoxic effects. Its efficacy in the prevention and treatment of BPD has yet to be clearly demonstrated, however. Inhaled corticosteroids might reduce lung inflammation with fewer systemic adverse effects; however, a recent, large randomized trial showed that inhaled budesonide was associated with an excess mortality, despite its beneficial respiratory effects. In another study, instilling budesonide together with surfactant in the trachea of intubated infants with severe respiratory distress appeared safe and achieved a significant reduction in the rate of BPD at 36 postmenstrual weeks. This important finding needs to be confirmed in a larger trial currently underway.

scholarly journals Long-term outcome of large sylvian arachnoid cysts: the role of surgery has been exaggerated

2020 ◽  
Vol 26 (3) ◽  
pp. 221-227
Author(s):  
Kyung Hyun Kim ◽  
Ji Yeoun Lee ◽  
Ji Hoon Phi ◽  
Seung-Ki Kim ◽  
Byung-Kyu Cho ◽  
...  
Keyword(s):  
Symptom Relief ◽  
Arachnoid Cysts ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Type Iii ◽  
Large Size ◽  
National University ◽  
Seoul National University ◽  
Symptoms And Signs

OBJECTIVEThe surgical indications for some arachnoid cysts (ACs) are controversial. While surgical procedures can be effective when an AC is a definite cause of hydrocephalus or papilledema, most ACs do not cause any symptoms or signs. Some surgeons perform several procedures to treat ACs because of their large size. The purpose of this study was to compare the long-term outcomes of Galassi type III ACs between surgery and nonsurgery groups.METHODSThe medical records of 60 patients diagnosed with sylvian ACs (Galassi type III) who visited Seoul National University Children’s Hospital from July 1990 to March 2018 were analyzed. The authors compared the outcomes between those treated with surgery and those not treated with surgery.RESULTSOf the 60 patients, 27 patients had no symptoms, 19 patients had vague symptoms and signs associated with ACs, and the remaining 14 patients had definite AC-related symptoms and signs. Thirty-eight patients underwent surgery, and 22 patients underwent observation. Some operations were accompanied by complications. Among the 33 patients in the surgery group, excluding 5 with hydrocephalus or papilledema, 8 patients needed 18 additional operations. However, there were no patients in the nonsurgery group who needed surgical intervention during the follow-up period (mean 67.5 months), although the size of the AC increased in 2 patients. Changes in AC size were not correlated with symptom relief.CONCLUSIONSWhen patients with hydrocephalus or papilledema were excluded, there was no difference in the outcomes between the surgery and nonsurgery groups regardless of the size of the sylvian AC. Surgeons should be cautious when deciding whether to operate.

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