scholarly journals National trends in spinal arteriovenous malformations

2009 ◽  
Vol 26 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Shivanand P. Lad ◽  
Justin G. Santarelli ◽  
Chirag G. Patil ◽  
Gary K. Steinberg ◽  
Maxwell Boakye
Keyword(s):  
Hospital Stay ◽  
Arteriovenous Malformations ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Endovascular Embolization ◽  
Outcome Data ◽  
Vascular Lesions ◽  
Hospital Treatment ◽  
Management Options ◽  
Spinal Arteriovenous Malformations

Object Spinal arteriovenous malformations (AVMs) are rare and understudied vascular lesions that cause neurological insult by mass effect, venous obstruction, and vascular steal. These lesions are challenging entities to treat because of their complicated anatomy and physiology. Current management options include open microsurgery, endovascular embolization, and stereotactic radiosurgery. Methods Our study used the National Inpatient Sample database to analyze outcome data for spinal AVMs treated nationwide over an 11-year period from 1995 through 2006. Trends in procedural management, hospital course, and epidemiology of spinal AVMs are investigated. Results Annually, an average of 300 patients presented with spinal AVMs requiring hospital treatment. The average length of hospital stay for this treatment has declined from more than 9 days in 1995 to 6 days in 2006. However, the average cost of a hospital stay has increased from < $30,000 to nearly $70,000. Whereas one-half of spinal AVMs were treated operatively in 1995, one-third were managed operatively in 2006. Conclusions Spinal AVMs are being increasingly treated by endovascular, radiosurgical, or combined means. A discussion of modern strategies to treat these disorders is presented.

Pilonidal Sinus: How to Choose Between Excision and Open Granulation Versus Excision and Primary Closure?

Swiss Surgery ◽  
2002 ◽  
Vol 8 (6) ◽  
pp. 255-258 ◽  
Author(s):  
Perruchoud ◽  
Vuilleumier ◽  
Givel
Keyword(s):  
Hospital Stay ◽  
Pilonidal Sinus ◽  
Primary Closure ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Healing Time ◽  
Incision And Drainage ◽  
The Mean ◽  
Primary Healing

Aims: The purpose of this study was to evaluate excision and open granulation versus excision and primary closure as treatments for pilonidal sinus. Subjects and methods: We evaluated a group of 141 patients operated on for a pilonidal sinus between 1991 and 1995. Ninety patients were treated by excision and open granulation, 34 patients by excision and primary closure and 17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus. Results: The first group, receiving treatment of excision and open granulation, experienced the following outcomes: average length of hospital stay, four days; average healing time; 72 days; average number of post-operative ambulatory visits, 40; average off-work delay, 38 days; and average follow-up time, 43 months. There were five recurrences (6%) in this group during the follow-up period. For the second group treated by excision and primary closure, the corresponding outcome measurements were as follows: average length of hospital stay, four days; average healing time, 23 days; primary healing failure rate, 9%; average number of post-operative ambulatory visits, 6; average off-work delay, 21 days. The average follow-up time was 34 months, and two recurrences (6%) were observed during the follow-up period. In the third group, seventeen patients benefited from an incision and drainage as unique treatment. The mean follow-up was 37 months. Five recurrences (29%) were noticed, requiring a new operation in all the cases. Discussion and conclusion: This series of 141 patients is too limited to permit final conclusions to be drawn concerning significant advantages of one form of treatment compared to the other. Nevertheless, primary closure offers the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for socio-economical and comfort reasons.

scholarly journals Detection of influenza virus in rectal swabs of patients admitted in hospital for febrile illnesses in Thailand

2021 ◽  
Vol 9 ◽  
pp. 205031212198963
Author(s):  
Artit Sangkakam ◽  
Pasin Hemachudha ◽  
Abhinbhen W Saraya ◽  
Benjamard Thaweethee-Sukjai ◽  
Thaniwan Cheun-Arom ◽  
...  
Keyword(s):  
Influenza Virus ◽  
Gastrointestinal Tract ◽  
Hospital Stay ◽  
Rectal Swab ◽  
Average Length ◽  
Gastrointestinal Symptoms ◽  
Virus Detection ◽  
Length Of Hospital Stay ◽  
Nasopharyngeal Swab ◽  
Influenza Virus Detection

Introduction: Influenza virus favours the respiratory tract as its primary site of host entry and replication, and it is transmitted mainly via respiratory secretions. Nasopharyngeal swab is the gold standard specimen type for influenza detection, but several studies have also suggested that the virus replicates in the human gastrointestinal tract. Methods: A retrospective study was conducted on all patients positive for influenza virus and initially recruited as part of the PREDICT project from 2017 to 2018. The objectives of the study were to investigate whether rectal swab could aid in improving influenza detection, and if there was any correlation between gastrointestinal disturbances and severity of infection, using length of hospital stay as an indicator of severity. Results: Of the 51 influenza-positive patients, 12 had detectable influenza virus in their rectal swab. Among these 12 rectal swab positive patients, influenza virus was not detected in the nasopharyngeal swab of three of them. Gastrointestinal symptoms were observed for 28.2% patients with a negative rectal swab negative and 25.0% patients with a positive rectal swab. Average length of hospital stay was 4.2 days for rectal swab positive group and 3.7 days for rectal swab negative group. This difference was not statistically significant (p = 0.288). Conclusions: There is no correlation between influenza virus detection in rectal swab and gastrointestinal disturbances or disease severity, and there is currently insufficient evidence to support replicative ability in the gastrointestinal tract.

Management of spinal dural arteriovenous malformations

1989 ◽  
Vol 70 (6) ◽  
pp. 832-836 ◽  
Author(s):  
Michael K. Morgan ◽  
W. Richard Marsh
Keyword(s):  
Arteriovenous Malformations ◽  
Primary Treatment ◽  
Endovascular Embolization ◽  
Content Type ◽  
Early Improvement ◽  
Time To Treatment Failure ◽  
Spinal Arteriovenous Malformations ◽  
Progressive Paraparesis ◽  
Dural Avm

✓ Dura-based spinal arteriovenous malformations (AVM's) are being diagnosed with increasing frequency. The optimal management of such lesions remains a topic of discussion. In an effort to guide this discussion, the authors review their experience with 17 cases of spinal dural AVM treated between January, 1984, and July, 1987. All patients presented with a slowly progressive paraparesis. The abnormalities were initially identified on myelography and confirmed by selective spinal angiography. Fourteen patients underwent endovascular embolization as a primary treatment, and a total of 18 embolization procedures were performed. After all but two of these, obliteration was confirmed at angiography. Patients' symptoms improved following 15 or these procedures but early improvement was not sustained in 10 instances; patients were unchanged after two procedures and worse after one. Follow-up angiography was performed at varying intervals after 15 of the 18 procedures, and recanalization of the previously obliterated spinal dural AVM was demonstrated in 13 instances. Eight patients ultimately underwent surgical treatment of their dura-based spinal AVM. No patient suffered deterioration of symptoms following operation. While embolization may allow angiographic obliteration of a spinal dural AVM and early clinical improvement, for the majority of patients these are not sustained. The average time to treatment failure was 5 months. Newer embolization materials will be necessary to effect permanent treatment in many of these patients.

scholarly journals Critical Pathway and Hospital-Hospital Cooperation in Acute Stroke Reduction of the Length of Hospital Stay

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 251-255 ◽  
Author(s):  
Y. Hashimoto ◽  
T. Terasaki ◽  
T. Yonehara ◽  
M. Tokunaga ◽  
T. Hirano ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Stay ◽  
Acute Stroke ◽  
Neurological Disease ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Stroke Patients ◽  
Critical Pathway ◽  
Hospital Days ◽  
Other Neurological Disease

Stroke patients tend to stay longer in one hospital compared to patients with other neurological disease. After the introduction of 3 types of critical pathway dedicated for various severity of acute ischemic stroke in 1995, the average length of in-hospital days declined from 30.0 days (1993) to 15.3 days (1998), ie 49% reduction. This reduction was achieved by the use of critical pathway and the hospital-hospital cooperation.

223 Procedural Safety of Stereotactic Laser Ablation (SLA) and Associated Hospital Stay: Outcome from the First Hundred Patient from LAANTERN Prospective Registry

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 261-261
Author(s):  
Clark C Chen ◽  
Robert Rennert ◽  
Usman Khan ◽  
Stephen B Tatter ◽  
Melvin Field ◽  
...  
Keyword(s):  
Laser Ablation ◽  
Hospital Stay ◽  
Radiation Treatment ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Invasive Procedure ◽  
Patient Discharge ◽  
Target Lesion ◽  
Hospital Length ◽  
Hospital Length Of Stay

Abstract INTRODUCTION We examined the procedural safety and length of hospital stay for patients who underwent stereotactic laser ablation (SLA). METHODS Patients undergoing stereotactic laser ablation were prospectively enrolled in the Laser Ablation of Abnormal Neurological Tissue using Robotic Neuroblate System (LAANTERN) registry. Data from the first 100 enrolled patients are presented. RESULTS >The demographic of the patient cohort consisted of 58% females and 42% males. The mean age and KPS of the cohort were 51 (±17) years and 83 (±15), respectively. 87% of the SLA-treated patients had undergone prior surgical or radiation treatment. In terms of indications, 84% of the SLAs were performed as treatment for brain tumor and 16% were performed as treatment for epilepsy. In terms of the procedure, 79% of the SLA patients underwent treatment of a single lesion. In 72% of the SLA treated patients, >90% of the target lesion was ablated. The average procedural time was 188.2 minutes (range: 48–368 minutes). The average blood loss per procedure was 17.7 cc (range: 0–300cc). In terms of hospitalization, the average length of Intensive Care stay was 38.1 hours (range 0335). The number of hours post-procedure before patient discharge was 61.1 hours (range 6–612). 85% of the patients were discharged home. There were 15 adverse events at the one-month follow-up (12%), with two events definitively related to the procedure (2%), including one patient with post-operative intraventricular hemorrhage and another with post-procedural gait compromise. CONCLUSION SLA is a minimally invasive procedure with favorable profile in terms of safety and hospital length of stay.

scholarly journals Consent for the discontinuation of life-prolonging treatment in cancer patients: a retrospective comparative analysis before and after the enforcement of the Life Extension Medical Decision law

2020 ◽  
Author(s):  
YuJin Chung ◽  
JinHo Beom ◽  
JiEun Lee ◽  
Incheol Park ◽  
Junho Cho
Keyword(s):  
Emergency Room ◽  
Hospital Stay ◽  
Cancer Patients ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Life Extension ◽  
Medical Decision ◽  
Patient Consent ◽  
Before And After ◽  
The Law

Abstract Background The Life Extension Medical Decision law enacted on February 4, 2018 in South Korea was the first to consider the suspension of nonsensical life-prolonging treatment, and its enactment raised big controversy in Korean society. However, there is no study on whether the actual life-prolonging treatment for patients has decreased after enforcing the law. This study aimed to compare the provision of patient consent before and after the enforcement of the law among cancer patients who visited a tertiary university hospital's emergency room to understand the effects of the law on cancer patients' clinical care. Methods This retrospective single cohort study included advanced cancer patients over 19 years of age who visited the emergency room at a tertiary university hospital. The two study periods were as follows: from February 2017 to January 2018 (before) and from May 2018 to April 2019 (after). The primary outcome was the average length of hospital stay. The consent rate for cardiopulmonary resuscitation (CPR), intubation, continuous renal replacement therapy (CRRT), and intensive care unit (ICU) admission were the secondary outcomes. Results The average length of hospital stay decreased after the law was enforced, from 4 days to 2 days (p= 0.001). The rates of direct transfers to secondary and nursing hospitals increased from 8.2% to 21.2% (p=0.001) and from 1.0% to 9.7%, respectively (p<0.001). The rate of provision of consent for admission to the ICU decreased from 6.7% to 2.3% (p=0.032). For CPR and CRRT, the rate of provision of consent decreased from 1.0% to 0.0% and from 13.9% to 8.8%, respectively, but the differences were not significant (p=0.226 and p=0.109, respectively). Conclusion According to previous research, for patients wishing only conservative treatment, the reduction in hospital stays at tertiary hospitals ultimately reduces the physical, emotional, financial burdens and also improves the quality of end-of-life at home or in a hospice facility. In this context, this research ultimately show that the purpose of the LEMD law has been achieved. Further research in several hospitals including those patients who completed the consent after hospitalization is needed to generalize the clinical implication of the LEMD law.

scholarly journals Optimization of Esophageal Ultrasound under Artificial Fish Swarm Algorithm and Its Adoption in Treatment of Ventricular Septal Defect

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Zhi Li ◽  
Guihe Chen ◽  
Feng Wang
Keyword(s):  
Ventricular Septal Defect ◽  
Hospital Stay ◽  
Septal Defect ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Control Group ◽  
Artificial Fish Swarm Algorithm ◽  
Artificial Fish Swarm ◽  
Swarm Algorithm ◽  
Experimental Group

This work was aimed at exploring the adoption value of the optimized and upgraded esophageal ultrasound in the treatment of patients with ventricular septal defect (VSD) by artificial fish swarm algorithm. A model was built based on artificial fish swarm algorithm. A random ultrasonic optical signal in the database was decomposed several times and sparsity was optimized to complete partial optimization, which was then extended to global optimization. A total of 100 patients with ventricular septal defect were divided into control group who underwent cardiopulmonary bypass under the guidance of three-dimensional thoracic ultrasound and experimental group of ventricular septal defect occlusion under the guidance of esophageal ultrasound based on artificial fish swarm algorithm. The results showed that the number of successful cases in the experimental group was 12 cases of perimembranous type, 10 cases of septal type, 7 cases of simple membranous type, 13 cases of muscular type, 4 cases of subdry type, and 2 cases of ridge type. The average length of operation after surgery was 70.65 minutes, the average length of ventilator ventilation was 125.8 minutes, and the average length of intensive care unit was 377.9 minutes. The average length of hospital stay after surgery was 5.6 days, and the average total length of hospital stay was 8.2 days, which were better than the control group in many aspects, with statistical significance ( P < 0.05 ). In short, the artificial fish swarm algorithm for esophageal ultrasound-guided ventricular septal defect closure had short operation time and good postoperative effect, which was of high application value in the clinical treatment of patients with ventricular septal defect.

scholarly journals African experiences of laparoscopic hysterectomy about a continuous series of 52 cases by the same practitioner: indications, surgical procedures and complications

2018 ◽  
Vol 7 (3) ◽  
pp. 789
Author(s):  
Koffi Abdoul Koffi ◽  
Kacou Edele Aka ◽  
Minata Fomba ◽  
Konan Seni ◽  
Apollinaire Horo ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Average Length ◽  
Laparoscopic Approach ◽  
Length Of Hospital Stay ◽  
Laparoscopic Hysterectomy ◽  
Pelvic Surgery ◽  
Continuous Series ◽  
Average Size ◽  
A Prospective Study

Background: Laparoscopy is a modern surgical technique that began in 1940 with Raoul Palmer. The present study aimed to analyse the results of a fifty-two-laparoscopic hysterectomy performed.Methods: A prospective study over a period of seven years from 1st January 2010 to 31st December 2015. A total of 52 patients who underwent a laparoscopic hysterectomy were recruited at the teaching hospital of Yopougon-Abidjan.Results: The mean age was 50.2 years (±3.9 years) (36-62 years). The average parity was 3. Few patients had undergone anterior pelvic surgery for either myomectomy or caesarean section. Uterine fibroid was the major surgical indication with a rate of 61.54%. The average size of the uterus was 12 cm (8-18 cm). Total hysterectomies type II and III with or without adnexectomy were essentially performed with rates of 28.85% and 32.69%, respectively. Sometimes it was associated with a lymphadenectomy or a colpo-suspension. The average length of a hysterectomy is 170 minutes (87-385 minutes). Four cases of laparo-conversions have been noted. Blood loss was approximately 95 ml (±12 ml) with a maximum of 300 ml. The complications were mainly two digestive wounds and a bladder fistula. The average length of hospital stay is three days apart from any complication.Conclusions: The laparoscopic approach is less painful, is associated with less blood loss, shorter hospital stay, faster recovery, fewer complications, and better care. A training period of surgeons associated with the equipment of the health structures is necessary to popularize this procedure surgical.

Progressive Gait Dysfunction

2016 ◽  
Author(s):  
Ji Y. Chong ◽  
Michael P. Lerario
Keyword(s):  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Endovascular Embolization ◽  
Arteriovenous Fistulas ◽  
Progressive Myelopathy ◽  
Spinal Vascular Malformations ◽  
Gait Dysfunction ◽  
Dural Arteriovenous Fistulas ◽  
Neurological Change ◽  
Spinal Arteriovenous Malformations

Spinal vascular malformations are rare, with dural arteriovenous fistulas (AVFs) accounting for the majority of the pathology. Unlike spinal arteriovenous malformations, which cause abrupt neurological change as a result of hemorrhage, spinal dural AVFs tend to result in a progressive myelopathy through venous congestion and cord edema. If diagnosed and treated early with endovascular embolization or microsurgery, some deficits may be reversible.

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