scholarly journals Doctor! Will I be dry? Factors determining recurrence after vesicovaginal fistula repair

2018 ◽  
Vol 13 (2) ◽  
Author(s):  
Aziz Abdullah ◽  
Sher Shah Syed ◽  
Nuzhat Farooqui ◽  
Sajjad Siddiqui
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Vesicovaginal Fistula ◽  
Surgical Repair ◽  
Recurrence Risk ◽  
Fistula Repair ◽  
Careful Evaluation ◽  
Delayed Reconstruction

Aims: To evaluate various prognostic factors which determine outcome after surgical repair of VVF. Methods: A retrospective analysis of the record of 640 patients which underwent surgical repair of VVF during a period from Jan 2006 to June 2011. Multivariate analysis of the record was done using SPSS-19 software determining odds ratio with 95% confidence interval. Results: 640 patients underwent surgical repair of VVF. Overall success rate was 87.2%. Multivariate analysis determined that recurrence of VVF was significantly related to multiplicity (5 fold recurrence risk), pre-operative size of VVF (3 fold risk), secondary repair (3 fold risk) and etiology of the fistula (2 fold risk). Interposition of flap and delayed reconstruction was related to successful surgical outcome. Age, parity, route of repair and location of fistula were not significant prognostic factors for recurrence. Conclusions: Successful surgical repair of VVF require careful evaluation of various factors including number, size, previous attempts to surgical repair and etiology of VVF. One should opt for transabdominal route with delayed reconstruction and interposition of flap if above mentioned factors are present. 

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.

scholarly journals Prognostic Marker for Severe Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Analysis of Diffusing Capacity of the Lung for Carbon Monoxide (DLCO) and Forced Expiratory Volume in One Second (FEV1)

2021 ◽  
Author(s):  
Juwhan Choi ◽  
Jae Kyeom Sim ◽  
Jee Youn Oh ◽  
Young Seok Lee ◽  
Gyu Young Hur ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Length Of Hospital Stay ◽  
Forced Expiratory Volume ◽  
Curve Analysis ◽  
Chronic Obstructive ◽  
Diffusing Capacity ◽  
Roc Curve Analysis ◽  
Obstructive Pulmonary Disease

Abstract Background: It is important to assess the prognosis and classify patients in chronic obstructive pulmonary disease (COPD) and acute exacerbation of COPD (AECOPD) treatment. Recently, it was suggested that diffusing capacity of the lung for carbon monoxide (DLCO) should be added to multidimensional tools for assessing COPD. This study aimed to compare the DLCO and forced expiratory volume in one second (FEV1) to identify better prognostic factors for admitted patients with AECOPD.Methods: We retrospectively analyzed 342 patients with AECOPD receiving inpatient treatment. We classified 342 severe AECOPD events using DLCO and FEV1. We defined the prognostic factors of severe AECOPD as the length of hospital stay, mortality in hospital, experience of mechanical ventilation, and experience of intensive care unit (ICU) care. We analyzed the prognostic factors by multivariate analysis using logistic regression. In addition, we conducted a correlation analysis and receiver operating characteristic (ROC) curve analysis.Results: In univariate and multivariate analyses, DLCO was shown to predict mortality rate (odds ratio = 4.408; 95% confidence interval, 1.070–18.167; P = 0.040), experience of ventilator (odds ratio = 2.855; 95% confidence interval, 1.216–6.704; P = 0.016) and ICU (odds ratios = 2.685; 95% confidence interval, 1.290–5.590; P = 0.008). However, there was no statistically significant difference in mortality rate when using FEV1 classification (P = 0.075). In the correlation analysis, both DLCO and FEV1 showed a negative correlation with length of hospital stay. The correlation rate was more pronounced in the DLCO (DLCO; B = -0.103, P < 0.001) (FEV1; B = -0.075, P = 0.007). In addition, DLCO showed better predictive ability than FEV1 in ROC curve analysis. The area under the curve (AUC) of DLCO was greater than 0.68 for all prognostic factors, and in contrast, the AUC of FEV1 was less than 0.68.Conclusion: DLCO was likely to be as good as or better prognostic marker than FEV1 in severe AECOPD.

scholarly journals Colorectal Perforation in Patients with Connective Tissue Disease

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Kiichi Sugimoto ◽  
Kazuhiro Sakamoto ◽  
Yu Okazawa ◽  
Rina Takahashi ◽  
Kosuke Mizukoshi ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Connective Tissue ◽  
Connective Tissue Disease ◽  
Odds Ratio ◽  
Colorectal Perforation ◽  
Fecal Peritonitis ◽  
Colonoscopic Examination ◽  
Cumulative Survival ◽  
Significant Difference

Purpose.The goal of this retrospective study was to identify prognostic factors associated with mortality after surgery for colorectal perforation among patients with connective tissue disease (CTD) and to review postoperative outcomes based on these prognostic factors.Methods.The subjects were 105 patients (CTD group: n=26, 24.8%; non-CTD group: n=79, 75.2%) who underwent surgery for colorectal perforation at our department. Cases with iatrogenic perforation due to colonoscopic examination were excluded from the study. We retrospectively investigated perioperative clinicopathological factors in patients undergoing surgery for colorectal perforation.Results.There were 7 patients (6.7%) who died within 28 days after surgery in all patients. In multivariate analysis, CTD and fecal peritonitis emerged as significant independent prognostic factors (p=0.005, odds ratio=12.39; p=0.04, odds ratio=7.10, respectively). There were 5 patients (19.2%) who died within 28 days after surgery in the CTD group. In multivariate analysis, fecal peritonitis emerged as a significant independent prognostic factor in the CTD group (p=0.03, odds ratio=31.96). The cumulative survival curve in the CTD group was significantly worse than that in the non-CTD group (p=0.006). An analysis based on the presence of fecal peritonitis indicated no significant difference in cumulative survival curves for patients without fecal peritonitis in the CTD and non-CTD groups (p=0.55) but a significant difference in these curves for patients with fecal peritonitis in the two groups (p<0.0001).Conclusions.This study demonstrated that cumulative survival in patients with CTD is significantly worse than that in patients without CTD after surgery for colorectal perforation.

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 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 Predictors of technical difficulty with duodenal ESD

2019 ◽  
Vol 07 (12) ◽  
pp. E1755-E1760 ◽  
Author(s):  
Motohiko Kato ◽  
Motoki Sasaki ◽  
Mari Mizutani ◽  
Koshiro Tsutsumi ◽  
Yoshiyuki Kiguchi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Observational Study ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Scoring System ◽  
Technical Difficulty ◽  
Lesion Size ◽  
Procedure Time ◽  
Lesion Location

Abstract Background and study aims Duodenal endoscopic submucosal dissection (ESD) is still considered technically challenging; however, few studies have objectively analyzed predictors of the technical difficulty. Therefore, the aim of the current study was to elucidate predictors of the technical difficulty of duodenal ESD. Patients and methods This was a retrospective observational study. From June 2010 to June 2017, a total of 174 consecutive patients with superficial duodenal epithelial neoplasia who underwent ESD were included in this study. We tried to identify predictors for technical difficulty of ESD by defining technical difficulty as either procedure time > 100 minutes or intraprocedural perforation. Moreover, we constructed a scoring system consisting of factors that were significant in the multivariate analysis. Results The proportion of patients with technical difficulty was 34.5 %. In the multivariate analysis, lesion location in flexural part [odds ratio (OR), 2.61; 95 % confidence interval (CI), 1.02 – 6.68], larger lesion size (> 40 mm) (OR, 5.26; 95% CI, 2.15 – 12.9), and occupied circumference > 50 % of the duodenum (OR, 5.80; 95 % CI, 1.83 – 18.4) were associated with technical difficulty. Conclusion A lesion location in flexural part, lesion size >40 mm and occupied circumference > 50 % were risk factors for technical difficulty of duodenal ESD.

scholarly journals Success Rate of Urogenital Fistula Repair and Predictors of Success-An Audit of Ten Years Data

2018 ◽  
Vol 13 (2) ◽  
pp. 15-18
Author(s):  
Nasira Tasnim ◽  
Kauser Bangash ◽  
Oreekah Amin ◽  
Afshan Batool ◽  
Nosheela Javed
Keyword(s):  
Success Rate ◽  
Vesicovaginal Fistula ◽  
Surgical Repair ◽  
Previous Attempt ◽  
Medical Sciences ◽  
Fistula Repair ◽  
Urogenital Fistula ◽  
History Of ◽  
Repair Attempts ◽  
And Child Health

Aims: To evaluate the association of various predictive factors with the outcome of surgical repair of vesicovaginal fistula. Methods: The retrospective analysis was conducted at Maternal and Child Health, Pakistan Institute of Medical Sciences, Islamabad, and it comprised data related to patients having undergone vesicovaginal fistula repair from January 2008 to June 2018. Statistical analysis of the record was done using SPSS 21 software. Results: A total of 364 patients of urogenital fistula repair were reviewed, with an overall success in 318 (87.4%) cases. There were no significant differences in fistula duration (p0.4), size of fistula (p 0.34) and accessibility (p0.5) between successful and unsuccessful group. However, we found the association between the type of fistula and history of previous repair attempts with the success of fistula repair. Primary surgical repair of vesicovaginal (90.0%), vesicouterine (86%), ureteric (100%) and ureterovaginal (98%) were more successful as compared to repair with the history of 1 previous attempt (90.3%, 83.3%, 66.6% and 75% respectively). Success rate was found to further decrease with the history of more than one repair attempt of vesicovaginal (71.4%) and vesicouterine (66.5%) fistula. Further, successful fistula repair in women was also found to be significantly associated with parity less than 4 (p 0.038). Conclusion: Despite the higher success rate of urogenital fistula repair, it’s important to refer the urogenital fistula patients timely to specialized fistula centres in order to achieve best results.

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