Dysphagia after pediatric functional hemispherectomy

Object Functional hemispherectomy is a well-recognized surgical option for the treatment of unihemispheric medically intractable epilepsy. While the resultant motor deficits are a well-known and expected consequence of the procedure, the impact on other cortical functions has been less well defined. As the cortical control of swallowing would appear to be threatened after hemispherectomy, the authors retrospectively studied a pediatric population that underwent functional hemispherectomy for medically intractable epilepsy to characterize the incidence and severity of dysphagia after surgery. Methods A retrospective cohort (n = 39) of pediatric patients who underwent hemispherectomy at a single institution was identified, and available clinical records were reviewed. Additionally, the authors examined available MR images for integrity of the thalamus and basal ganglia before and after hemispherectomy. Clinical and video fluoroscopic assessments of speech pathology were reviewed, and the presence, type, and duration of pre- and postoperative dysphagia were recorded. Results New-onset, transient dysphagia occurred in 26% of patients after hemispherectomy along with worsening of preexisting dysphagia noted in an additional 15%. Clinical symptoms lasted a median of 19 days. Increased duration of symptoms was seen with late (> 14 days postoperative) pharyngeal swallow dysfunction when compared with oral dysphagia alone. Neonatal stroke as a cause for seizures decreased the likelihood of postoperative dysphagia. There was no association with seizure freedom or postoperative hydrocephalus. Conclusions New-onset dysphagia is a frequent and clinically significant consequence of hemispherectomy for intractable epilepsy in pediatric patients. This dysphagia was always self-limited except in those patients in whom preexisting dysphagia was noted.

Download Full-text

The fast-track outpatient clinic significantly decreases hospitalisation rates among polymyalgia rheumatica patients

BMC Rheumatology ◽

10.1186/s41927-021-00210-6 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Stavros Chrysidis ◽

Philip Rask Lage-Hansen ◽

Nikoletta Svendsen ◽

Andreas P. Diamantopoulos

Keyword(s):

Polymyalgia Rheumatica ◽

Fast Track ◽

Clinical Symptoms ◽

Classification Criteria ◽

Duration Of Symptoms ◽

Prednisolone Dose ◽

South West ◽

Hospitalised Patients ◽

Number Of Patients ◽

The Impact

Abstract Objectives This study aimed to investigate the hospitalisation rates and the reasons for hospitalisation in patients with polymyalgia rheumatica (PMR). Furthermore, it aimed to clarify the impact of a newly established Fast Track Clinic (FTC) approach on hospitalisation rates in connection with PMR diagnosis. Methods Patients diagnosed with PMR at South-West Jutland Hospital, Denmark, between 2013 and 2018 were included retrospectively. Only patients fulfilling the 2012 EULAR/ACR classification criteria were included in our cohort. An FTC for patients suspected of having PMR was established in the rheumatologic department of South-West Jutland Hospital in January 2018. Results Over 6 years (2013 to 2017), 254 patients were diagnosed with PMR, 56 of them while hospitalised. Hospitalised patients were more likely to have a higher initial CRP mean ± standard deviation (SD) 99.53 ± 59.36 vs 45.82 ± 36.96 mg/lt (p < 0.0001) and a shorter duration of symptoms (p = 0.0018). After implementing the FTC, a significant decrease in hospitalisation rates (from 20.4% to 3,5%) and inpatient days of care (mean ± SD 4.15 ± 3.1 vs 1 ± 0) were observed. No differences between the two groups were observed regarding clinical symptoms, laboratory values and initial prednisolone dose. Conclusion A substantial number of patients are hospitalised in connection with the PMR diagnosis. The FTC approach can decrease the hospitalisation rates significantly among these patients. Trial registration Retrospectively registered.

Download Full-text

Reoperative Hemispherectomy for Intractable Epilepsy

Neurosurgery ◽

10.1227/neu.0b013e31825979bb ◽

2012 ◽

Vol 71 (2) ◽

pp. 388-393 ◽

Cited By ~ 28

Author(s):

Sumeet Vadera ◽

Ahsan N.V. Moosa ◽

Lara Jehi ◽

Ajay Gupta ◽

Prakash Kotagal ◽

...

Keyword(s):

Seizure Frequency ◽

Medical Records ◽

Cleveland Clinic ◽

Intractable Epilepsy ◽

Patient Characteristics ◽

Cortical Dysplasia ◽

Seizure Freedom ◽

Management Options ◽

Functional Hemispherectomy

Abstract BACKGROUND: In patients with medically intractable epilepsy and diffuse unilateral hemispheric disease, functional or disconnective hemispherectomy is a widely accepted and successful treatment option. If recurrent seizures develop after disconnective hemispherectomy, management options become more complex and include conversion to anatomic hemispherectomy. OBJECTIVE: To present the outcomes of all patients undergoing reoperative hemispherectomy in 1 institution by 1 surgeon since 1998. METHODS: The medical records, operative reports, and imaging studies for 36 patients undergoing reoperative hemispherectomy for continuing medically intractable epilepsy from 1998 to 2011 at Cleveland Clinic were reviewed. Patient characteristics, cause of seizure, imaging findings, surgery-related complications, and long-term seizure outcomes were evaluated. RESULTS: Patients presented with a variety of seizure origins, including Rasmussen encephalitis, perinatal infarction, cortical dysplasia, and hemimegalencephaly. Overall, 19% of patients were seizure free after conversion to anatomic hemispherectomy, and 45% reported a decrease in seizure frequency by ≥ 90%. An additional 36% reported no improvement. Generalized ictal electroencephalography tended to confer a poorer prognosis, as did cortical dysplasia as the underlying diagnosis. CONCLUSION: The possibility that residual epileptogenic tissue in the operated hemisphere remains connected should be considered after failed functional hemispherectomy because our data suggest that improvement in seizure frequency is possible after reoperative hemispherectomy, although the chance of obtaining seizure freedom is relatively low. The decision to proceed with reoperative hemispherectomy should be made after proper discussion with the patient and family and informed consent is given.

Download Full-text

The Impact of Intraoperative Electrocorticography on Seizure Outcome After Resection of Pediatric Brain Tumors: A Cohort Study

Neurosurgery ◽

10.1093/neuros/nyy342 ◽

2018 ◽

Vol 85 (3) ◽

pp. 375-383 ◽

Cited By ~ 1

Author(s):

Faith C Robertson ◽

Nicole J Ullrich ◽

Peter E Manley ◽

Hasan Al-Sayegh ◽

Clement Ma ◽

...

Keyword(s):

Pediatric Patients ◽

Focal Cortical Dysplasia ◽

Tumor Resection ◽

Cortical Dysplasia ◽

Class I ◽

Gross Total Resection ◽

Seizure Outcome ◽

Seizure Freedom ◽

Total Resection ◽

The Impact

AbstractBACKGROUNDIntraoperative electrocorticography (ECoG) has been utilized in patients with tumor-associated seizures; however, its effectiveness for seizure control remains controversial.OBJECTIVETo evaluate clinical outcomes in pediatric patients undergoing lesionectomy with or without ECoG.METHODSPatients undergoing brain tumor resection at Boston Children's Hospital were examined retrospectively (2005-2014). Inclusion criteria involved diagnosis of a supratentorial tumor, ≥2 unequivocal seizures, and ≥6 mo follow-up. Patients with isolated cortical dysplasia or posterior fossa tumors were excluded. Logistic regression models evaluated predictors of ECoG use, and the impact of ECoG, gross total resection, and focal cortical dysplasia with tumors on seizure freedom by Engel Class and anti-epileptic drug use (AED).RESULTSA total of 119 pediatric patients were included (n = 69 males, 58%; median age, 11.3 yr). Forty-one patients (34.5%) had ECoG-guided surgery. Preoperative seizure duration and number and duration of AED use were significant predictors for undergoing ECoG. There were no differences in seizure freedom (Engel Class I) or improved Engel Score (Class I-II vs III-IV) in patients who did or did not have ECoG at 30 d, 6 mo, and 1, 2, or 5 yr. Patients undergoing ECoG required a greater number of AEDs at 6 mo (P = .01), although this difference disappeared at subsequent time intervals. Gross total resection predicted seizure freedom at 30 d and 6 mo postsurgery (P = .045).CONCLUSIONThis retrospective study, one of the largest evaluating the use of ECoG during tumor resection, suggests that ECoG does not provide improved seizure freedom compared to lesionectomy alone for children.

Download Full-text

Impact of Magnetic Resonance Imaging in Management of Pediatric Crohn's Disease

The American Surgeon ◽

10.1177/000313481307900709 ◽

2013 ◽

Vol 79 (7) ◽

pp. 672-675 ◽

Cited By ~ 1

Author(s):

Cristen Litz ◽

Paul D. Danielson ◽

Michael Wilsey ◽

Nicole M. Chandler

Keyword(s):

Crohn’S Disease ◽

Magnetic Resonance ◽

Crohn's Disease ◽

Pediatric Patients ◽

Demographic Data ◽

Clinical History ◽

Radiographic Evaluation ◽

The Impact ◽

Active Disease ◽

New Onset

Crohn's disease (CD) is a chronic illness and radiographic evaluation is frequently used. Consequently, pediatric patients with CD who are diagnosed in childhood are at risk for high levels of radiation exposure during their lifetimes. We sought to evaluate the impact of magnetic resonance enterography (MRE) in management of pediatric patients with known or suspected Crohn's disease. A retrospective review of patients with known or suspected CD who underwent MRE for new onset of symptoms was conducted. All demographic data, clinical history, and results of all radiographic, endoscopic, and pathology studies were recorded. Twenty-eight patients with known or suspected CD underwent 31 MRE examinations. MRE showed active disease in 16 (52%), fistula or abscess in seven (22%), and no evidence of active disease in eight (26%). Sixty-five per cent of patients underwent MRE with no other radiation-based imaging used. Surgical intervention was deemed necessary after the MRE in 16 per cent. In all cases, surgical findings were consistent with MRE results. Nearly 60 per cent of patients with CD are managed based on the findings of MRE without additional radiographic evaluation. Based on the results of this retrospective study, we propose a clinical pathway for use of MRE in patients with known or suspected CD with new onset of symptoms.

Download Full-text

Follow-up survey of patients with occupational asthma

Occupational Medicine ◽

10.1093/occmed/kqaa049 ◽

2020 ◽

Vol 70 (4) ◽

pp. 231-234

Author(s):

J Feary ◽

J Cannon ◽

B Fitzgerald ◽

J Szram ◽

S Schofield ◽

...

Keyword(s):

Occupational Health ◽

Occupational Asthma ◽

Negative Impact ◽

Postal Questionnaire ◽

Specialist Care ◽

Duration Of Symptoms ◽

Additional Information ◽

Clinical Records ◽

Almost All ◽

The Impact

Abstract Background Occupational asthma (OA) is often associated with a poor prognosis and the impact of a diagnosis on an individual’s career and income can be significant. Aims We sought to understand the consequences of a diagnosis of OA to patients attending our clinic. Methods Using a postal questionnaire, we surveyed all patients attending our specialist occupational lung disease clinic 1 year after having received a diagnosis of OA due to a sensitizer (n = 125). We enquired about their current health and employment status and impact of their diagnosis on various aspects of their life. Additional information was collected by review of clinical records. Results We received responses from 71 (57%) patients; 77% were referred by an occupational health (OH) provider. The median duration of symptoms prior to referral was 18 months (interquartile range (IQR) 8–48). At 1 year, 79% respondents were no longer exposed to the causal agent. Whilst the unexposed patients reported an improvement in symptoms compared with those still exposed (82% versus 53%; P = 0.023), they had poorer outcomes in terms of career, income and how they felt treated by their employer; particularly those not currently employed. Almost all (>90%) of those still employed had been referred by an OH provider compared with 56% of those currently unemployed (P = 0.002)x. Conclusions The negative impact of OA on people’s careers, livelihood and quality of life should not be underestimated. However, with early detection and specialist care, the prognosis is often good and particularly so for those with access to occupational health.

Download Full-text

Can Symptoms Differentiate Between Chronic Adenoiditis and Chronic Rhinosinusitis in Pediatric Patients

Ear Nose & Throat Journal ◽

10.1177/0145561319840133 ◽

2019 ◽

Vol 98 (5) ◽

pp. 279-282 ◽

Cited By ~ 2

Author(s):

Phillip R. Purnell ◽

Jad H. Ramadan ◽

Hassan H. Ramadan

Keyword(s):

Chronic Rhinosinusitis ◽

Facial Pain ◽

Pediatric Patients ◽

Clinical Symptoms ◽

Tertiary Care ◽

Care Facility ◽

Duration Of Symptoms ◽

Presenting Symptoms ◽

Tertiary Care Facility ◽

Chronic Adenoiditis

The purpose of this article is to differentiate pediatric patients with chronic adenoiditis from those with chronic rhinosinusitis (CRS) based on presenting symptoms. A chart review from a tertiary care facility with pediatric patients who presented with suspected CRS from 2006 to 2014 was identified. We compared patient characteristics, clinical symptoms, duration of symptoms, and past medial history using univariate and multivariate logistic regression models. Based on recent literature, utilizing the computed tomography (CT) score, we identified those children with CRS versus those with chronic adenoiditis. Of the 99 pediatric patients included, 22 patients had diagnosis of adenoiditis and 77 had diagnosis of CRS. When purulent rhinorrhea was present with facial pain, CRS was statistically more prevalent than chronic adenoiditis ( P = .017). Symptoms including cough ( P = .022), rhinorrhea ( P = .27), and facial pressure ( P = .98) were not predictive of one diagnosis over the other. Past medical history of asthma or allergy was similar in both groups. Smoke exposure was associated with CT scores >5 (odds ratio 2.4, 95% confidence interval, 0.799-7.182). We conclude that purulent rhinorrhea in the presence of facial pain is more indicative of CRS versus chronic adenoiditis. For all other children, an adenoidectomy without the need for a CT scan can be entertained.

Download Full-text

Comparing the Desmopressin (DDAVP) Challenge Test to DDAVP Clinical Response in Pediatric Patients with Von Willebrand's Disease: A Single Center Experience

Blood ◽

10.1182/blood.v126.23.1101.1101 ◽

2015 ◽

Vol 126 (23) ◽

pp. 1101-1101

Author(s):

Divya Nadella ◽

Maha Al-Ghafry ◽

Hamayun Imran ◽

Abdul H. Siddiqui

Keyword(s):

Pediatric Patients ◽

Clinical Symptoms ◽

Conflicts Of Interest ◽

Symptom Control ◽

Challenge Test ◽

Laboratory Data ◽

Fold Increase ◽

Von Willebrand's Disease ◽

Von Willebrand’S Disease ◽

Clinical Records

Abstract Introduction Von Willebrand's disease (VWD) is the most common inherited bleeding disorder. It is characterized by both quantitative and qualitative defects of the von Willebrand Factor (VWF) and generally manifests as menorrhagia, epistaxis and easy bruising. Initial treatment involves the use of desmopressin (DDAVP) that induces the release of VWF from the endothelium. Patients undergo a DDAVP challenge test that involves intravenous DDAVP (IV-DDAVP) infusion with multiple blood draws to determine an increase in the VWD panel. Due to the DDAVP challenge test being a costly and lengthy process, we sought to evaluate the prognostic utility of the challenge test in patients who responded favorably. Methods A retrospective cohort study was conducted in pediatric patients aged 18 years or younger with a laboratory diagnosis of VWD who underwent the DDAVP challenge test between 2005 and 2015 at our institution. VWD panel results pre and post DDAVP challenge test were obtained from clinical records. A complete response was defined as a 2-fold increase at 1-3 hours or at least 1.5-fold increase at 4-6 hours post-infusion. Patients' clinical records were reviewed for initial presentation and response to DDAVP. SPSS version 23.0.0 was used to analyze demographic and laboratory data, with frequencies and paired t-tests performed for comparison where appropriate. Results Seventy two pediatric patients were identified with a diagnosis of VWD: 34 (47%) were VW type 1, 51 (72%) were females and 50 (69%) were Caucasian. Challenge results were available for 48 patients (66%): Post-DDAVP levels were significantly higher than baseline (p = <0.001) in the VWD panel for either times (1-3 or 4-6 hours). Thirty-seven patients (51%) had both challenge results and clinical symptoms reported with 78% (29/37) considered responders and 22% (8/37) considered non-responders to IV-DDAVP. 86% (25/29) of responders were initially placed on intranasal DDAVP (IN-DDAVP) alone while the others received combined therapy with addition of a plasma derived product (PDP). All non-responders initially received DDAVP therapy with some improvement in their clinical symptoms. Eleven (38% of responders) and four (50% of non-responders) were switched to a PDP, mostly for better symptom control. Six responders (16%) had side-effects with DDAVP. Conclusion A high proportion of our patients with VWD responded to the DDAVP challenge test, but subsequently required therapy with a PDP; and half of non-responders were able to use DDAVP. In our pediatric patient population, an initial IV-DDAVP challenge test did not identify those that would respond clinically to IN-DDAVP therapy long-term. Thus, more studies addressing the utility of the challenge test in VWD would be needed before drawing further conclusions on its prognostic value. Disclosures No relevant conflicts of interest to declare.

Download Full-text

Is postresective intraoperative electrocorticography predictive of seizure outcomes in children?

Journal of Neurosurgery Pediatrics ◽

10.3171/2012.1.peds11441 ◽

2012 ◽

Vol 9 (5) ◽

pp. 546-551 ◽

Cited By ~ 28

Author(s):

Carter D. Wray ◽

Sharon S. McDaniel ◽

Russell P. Saneto ◽

Edward J. Novotny ◽

Jeffrey G. Ojemann

Keyword(s):

Epilepsy Surgery ◽

Pediatric Patients ◽

Intractable Epilepsy ◽

Temporal Lobectomy ◽

Pediatric Epilepsy ◽

Seizure Freedom ◽

Low Grade ◽

Subtle Difference ◽

Epileptiform Discharges ◽

Pediatric Epilepsy Surgery

Object Intraoperative electrocorticography (ECoG) is commonly used to guide the extent of resection, especially in lesion-associated intractable epilepsy. Interictal epileptiform discharges on postresective ECoG (post-ECoG) have been predictive of seizure recurrence in some studies, particularly in adults undergoing medial temporal lobectomy, frontal lesionectomy, or low-grade glioma resection. The predictive value of postresective discharges in pediatric epilepsy surgery has not been extensively studied. Methods The authors retrospectively examined the charts of all 52 pediatric patients who had undergone surgery with post-ECoG and had more than 1 year of follow-up between October 1, 2003, and October 1, 2009. Results Of the 52 pediatric patients, 37 patients showed residual discharges at the end of their resection and 73% of these patients were seizure free, whereas 15 patients had no residual discharges and 60% of them were seizure-free, which was not significantly different (p = 0.36, chi-square). Conclusions Electrocorticography-guided surgery was associated with excellent postsurgical outcome. Although this sample size was too small to detect a subtle difference, absence of epileptiform discharges on post-ECoG does not appear to predict seizure freedom in all pediatric patients referred for epilepsy surgery. Future studies with larger study samples would be necessary to confirm this finding and determine whether post-ECoG may be useful in some subsets of pediatric epilepsy surgery candidates.

Download Full-text

Technology and Hospital Information System: A Case of Implementation of Electronic Clinical Records in Hospital Maternity Irene Neto in Lubango, Angola

Journal of Business and Economics ◽

10.15341/jbe(2155-7950)/11.10.2019/012 ◽

2019 ◽

Vol 10 (11) ◽

pp. 1131-1135

Author(s):

Tomas Hambili Paulo Sanjuluca ◽

◽

Ricardo Correia ◽

Anabela Antunes de Almeida ◽

Ana Gloria Diaz Martinez ◽

...

Keyword(s):

Maternity Hospital ◽

Management Support ◽

Retrospective Case ◽

System A ◽

Clinical Records ◽

Retrospective Case Study ◽

The Impact ◽

And Child Health

Introduction: In order to have a good assessment of the quality of maternal and child health care, it is essential that there is up-to-date and reliable information. Objective: To evaluate the impact of the implementation of a computerized database of clinical processes in the admission, archive and medical statistics section, of Maternity hospital Irene Neto/Lubango-Angola. Methodology: A descriptive study with a quantitative and qualitative approach to carry out a retrospective case study deliveries and newborns, records from 2014 to 2017. Final considerations: The implementation of this project may contribute to the improvement of clinical management support management of the hospital as well as facilitating access to information for research and scientific production.

Download Full-text