External Ventricular Drain Infection

2007 ◽  
Vol 107 (1) ◽  
pp. 248 ◽  
Author(s):  
George K. C. Wong ◽  
Wayne W. S. Poon
Keyword(s):  
Major Trauma ◽  
Independent Predictor ◽  
External Ventricular Drain ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
External Ventricular Drainage ◽  
Infection Rates ◽  
The Mean ◽  
The Relationship ◽  
Shed Light

Object The authors explored the relationship among the duration of external ventricular drainage, revision of external ventricular drains (EVDs), and cerebrospinal fluid (CSF) infection to shed light on the practice of electively revising these drains. Methods In a retrospective study of 199 patients with 269 EVDs in the intensive care unit at a major trauma center in Australasia, the authors found 21 CSF infections. Acinetobacter accounted for 10 (48%) of these infections. Whereas the duration of drainage was not an independent predictor of infection, multiple insertions of EVDs was a significant risk factor. Second and third EVDs in previously uninfected patients were more likely to become infected than first EVDs. An EVD infection was initially identified a mean of 5.5 ±0.7 days postinsertion (standard error of the mean); these data—that is, the number of days—were normally distributed. Conclusions This pattern of infection is best explained by EVD-associated CSF infections being acquired by the introduction of bacteria on insertion of the drain rather than by subsequent retrograde colonization. Elective EVD revision would be expected to increase infection rates in light of these results, and thus the practice has been abandoned by the authors' institution.

External ventricular drain infections are independent of drain duration: an argument against elective revision

2007 ◽  
Vol 106 (3) ◽  
pp. 378-383 ◽  
Author(s):  
Cheng H. Lo ◽  
Denis Spelman ◽  
Michael Bailey ◽  
D. James Cooper ◽  
Jeffrey V. Rosenfeld ◽  
...  
Keyword(s):  
Major Trauma ◽  
Independent Predictor ◽  
External Ventricular Drain ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
External Ventricular Drainage ◽  
Infection Rates ◽  
The Mean ◽  
The Relationship ◽  
Shed Light

Object The authors explored the relationship among the duration of external ventricular drainage, revision of external ventricular drains (EVDs), and cerebrospinal fluid (CSF) infection to shed light on the practice of electively revising these drains. Methods In a retrospective study of 199 patients with 269 EVDs in the intensive care unit at a major trauma center in Australasia, the authors found 21 CSF infections. Acinetobacter accounted for 10 (48%) of these infections. Whereas the duration of drainage was not an independent predictor of infection, multiple insertions of EVDs was a significant risk factor. Second and third EVDs in previously uninfected patients were more likely to become infected than first EVDs. An EVD infection was initially identified a mean of 5.5 ± 0.7 days postinsertion (standard error of the mean); these data—that is, the number of days—were normally distributed. Conclusions This pattern of infection is best explained by EVD-associated CSF infections being acquired by the introduction of bacteria on insertion of the drain rather than by subsequent retrograde colonization. Elective EVD revision would be expected to increase infection rates in light of these results, and thus the practice has been abandoned by the authors' institution.

scholarly journals Relationship between the frequency of electrocautery of Hunner lesions and changes in bladder capacity in patients with Hunner type interstitial cystitis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yoshiyuki Akiyama ◽  
Masayoshi Zaitsu ◽  
Daiji Watanabe ◽  
Itsuki Yoshimura ◽  
Aya Niimi ◽  
...  
Keyword(s):  
Interstitial Cystitis ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Bladder Capacity ◽  
Clinical Parameters ◽  
Mixed Effect ◽  
Promising Treatment ◽  
The Mean ◽  
The Relationship ◽  
First Session

AbstractElectrocautery is a promising treatment option for patients with Hunner type interstitial cystitis (HIC), but frequently requires multiple sessions due to recurrence of the lesions. In the present study, we assessed the relationship between the frequency of electrocautery of Hunner lesions and changes in maximum bladder capacity (MBC) at hydrodistension in a large cohort of 118 HIC patients. Three mixed-effect linear regression analyses were conducted for MBC against (1) the number of sessions; (2) the number of sessions and the time between each session and the first session; and (3) other relevant clinical parameters in addition to the Model (2). The mean number of sessions was 2.8 times. MBC decreased approximately 50 mL for each additional electrocautery session, but this loss was offset by 10 mL for each year the subsequent session was postponed. MBC of < 400 mL at the first session was a significant risk factor for MBC loss with further sessions. No other clinical parameters were associated with MBC over time. This study demonstrates a significant relationship between the frequency of electrocautery of Hunner lesions and MBC changes in HIC patients. Low MBC at the first session is a poor prognostic marker for MBC loss over multiple sessions.

scholarly journals Intracranial Pressure during External Ventricular Drainage Weaning Is an Outcome Predictor of Traumatic Brain Injury

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Jia-cheng Gu ◽  
Hong Wu ◽  
Xing-zhao Chen ◽  
Jun-feng Feng ◽  
Guo-yi Gao ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
External Ventricular Drainage ◽  
Unfavorable Outcome ◽  
Ventricular Drainage ◽  
Outcome Group ◽  
Significant Difference ◽  
The Mean ◽  
The Relationship

External ventricular drainage (EVD) is widely used in patients with a traumatic brain injury (TBI). However, the EVD weaning trial protocol varies and insufficient studies focus on the intracranial pressure (ICP) during the weaning trial. We aimed to establish the relationship between ICP during an EVD weaning trial and the outcomes of TBI. We enrolled 37 patients with a TBI with an EVD from July 2018 to September 2019. Among them, 26 were allocated to the favorable outcome group and 11 to the unfavorable outcome group (death, post-traumatic hydrocephalus, persistent vegetative state, and severe disability). Groups were well matched for sex, pupil reactivity, admission Glasgow Coma Scale score, Marshall computed tomography score, modified Fisher score, intraventricular hemorrhage, EVD days, cerebrospinal fluid output before the weaning trial, and the complications. Before and during the weaning trial, we recorded the ICP at 1-hour intervals to calculate the mean ICP, delta ICP, and ICP burden, which was defined as the area under the ICP curve. There were significant between-group differences in the age, surgery types, and intensive care unit days (p=0.045, p=0.028, and p=0.004, respectively). During the weaning trial, 28 (75.7%) patients had an increased ICP. Although there was no significant difference in the mean ICP before and during the weaning trial, the delta ICP was higher in the unfavorable outcome group (p=0.001). Moreover, patients who experienced death and hydrocephalus had a higher ICP burden, which was above 20 mmHg (p=0.016). Receiver operating characteristic analyses demonstrated the predictive ability of these variables (area under the curve AUC=0.818 [p=0.002] for delta ICP and AUC=0.758 [p=0.038] for ICP burden>20 mmHg). ICP elevation is common during EVD weaning trials in patients with TBI. ICP-related parameters, including delta ICP and ICP burden, are significant outcome predictors. There is a need for larger prospective studies to further explore the relationship between ICP during EVD weaning trials and TBI outcomes.

scholarly journals Hydroureteronephrosis in women with pelvic organ prolapse: a prospective cohort study

2018 ◽  
Vol 7 (9) ◽  
pp. 3664
Author(s):  
Pushplata Kumari ◽  
Emily Divya Ebenezer ◽  
Caroline Salomi ◽  
Vaibhav Londhe ◽  
Aruna Nitin Kekre
Keyword(s):  
Chronic Kidney Disease ◽  
Risk Factor ◽  
Pelvic Organ Prolapse ◽  
Kidney Disease ◽  
Prospective Observational Study ◽  
Surgical Repair ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Pelvic Organ ◽  
The Mean

Background: Pelvic organ prolapses (POP) is a common problem in women. The prevalence of POP increase with age. The true prevalence and risk factor for developing hydroureteronephrosis (HUN) in women with pelvic organ prolapse is still unclear due to lack of prospective studies on sufficiently large cohorts. This prospective study was done to study the prevalence of HUN in women with POP and to identify the risk factors for developing HUN.Methods: In this prospective observational study 219 patients were recruited for surgical repair for pelvic organ prolapse for 2 years.  Preoperatively, all patients had transabdominal scan to assess the uterus, adnexa and to look for Hydroureteronephrosis (HUN). Women with presence of HUN were followed postoperatively look for the resolution of HUN.Results: The prevalence of bilateral HUN was 6.85%. The mean age of women with HUN ranged from 51-69 years. Diabetes and hypertension were significant risk factor for development of HUN (OR 4.70, 95% CI -1.59-13.88 and OR 3.72, 95% CI- 1.23-11.1 respectively). There was a statistically significant correlation between chronic kidney disease and HUN. (OR 1 with 95%: CI 9.49-30.42). The correlation between stage of pelvic organ prolapse and HUN was not statistically significant (p = 0.062). There was a statistically significant correlation between the duration (2years -15 years) of POP to HUN. (OR 0.233, 95%0.13-0.419). Patients were followed up post operatively for resolution of HUN. HUN resolved in 9 women (60%) and persisted in 6 (40%).Conclusions: The prevalence of bilateral HUN in women with pelvic organ prolapse was 6.8%. Presence of hypertension, diabetes and chronic kidney disease was a risk factor for HUN. HUN resolved in 60% of women after pelvic reconstructive surgery.

scholarly journals Oral Mucosal Lesions and DMFT Index Assessment in Rheumatoid Arthritis Patients in Birjand, Iran, in 2018

2020 ◽  
Vol 14 (1) ◽  
pp. 34-39
Author(s):  
Parvin Parvaei ◽  
Afsaneh Dorri-giv ◽  
Gholamreza Sharifzadeh ◽  
Hakimeh Malakimoghadam ◽  
Elham Atabati
Keyword(s):  
Rheumatoid Arthritis ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Index Score ◽  
Common Finding ◽  
Cross Sectional ◽  
Oral Mucosal Lesions ◽  
Dmft Index ◽  
The Mean ◽  
Mucosal Lesions

Introduction: Rheumatoid Arthritis (RA) may cause malfunction in the immune system and the inability to observe oral hygiene in patients due to physical deficits. A bacterial infection caused as such can constitute a significant risk factor for the development of systemic infection. The present study aimed to investigate the oral mucosal lesions, the DMFT index, and the Modified Gingival Index (MGI) in RA patients treated in Birjand city. Materials and Methods: This descriptive cross-sectional study was performed with 80 RA patients referred to rheumatology clinics of Birjand in 2018. Data were collected through observation, clinical examination, information forms, and medical records. After the patients were informed about the research purposes and signed consent forms for participation, they were examined at the rheumatology clinics. The collected data were analyzed in SPSS software (version 19). Results: Of the 80 patients, n = 64 (80%) had oral mucosal lesions. Dry mouth (66.3%) was the most common finding. The mean DMFT index score was 18.7. Conclusion: Oral mucosal lesions and the mean DMFT index score seem to be at high levels in RA patients, possibly due to the complications of the disease or the consumed medications.

scholarly journals Prevalence of Gastroesophageal Reflux in Infants with Recurrent Brief Apneic Episodes

1999 ◽  
Vol 6 (5) ◽  
pp. 401-404 ◽  
Author(s):  
Shahid Sheikh ◽  
Thomas C Stephen ◽  
Barbara Sisson
Keyword(s):  
Risk Factor ◽  
Gastroesophageal Reflux ◽  
Medical Records ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Acid Reflux ◽  
Diagnostic Dilemma ◽  
Esophageal Ph ◽  
Life Threatening ◽  
The Relationship

BACKGROUND: Apnea in an infant can be a diagnostic dilemma for the treating pediatrician. It is suggested that in some infants, gastroesophageal reflux (GER) might be a factor in the pathogenesis of apnea, although its role as a cause of apnea is still controversial.OBJECTIVE: To evaluate the prevalence of GER in infants presenting with recurrent brief apneic periods.PATIENTS AND METHODS: A retrospective review of the medical records of all the infants who underwent prolonged esophageal pH studies for brief apneic episodes (n=105) at the Kosair Children’s Hospital in the six years from January 1992 to December 1997 was performed. Infants presenting with apparent life-threatening episodes were excluded.RESULTS: Of 105 infants, 72 (68.6%) were younger than two months of age and 22 (21%) were born preterm. Fifty of 105 infants (47.6%) had positive esophageal pH studies for acid reflux. Among infants with positive pH studies, only 21 (42%) had associated gastrointestinal or feeding complaints.CONCLUSION: GER is present in a large number of infants presenting with brief apneic episodes. Though the relationship between the two is still not fully established, GER may be a significant risk factor for such apneic episodes in infants.

scholarly journals Relationship of Gallbladder Perforation and Bacteriobilia with Occurrence of Surgical Site Infections following Laparoscopic Cholecystectomy

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Nikhar Jain ◽  
Sushanto Neogi ◽  
Rajandeep Singh Bali ◽  
Niket Harsh
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Significant Risk ◽  
Surgical Site Infections ◽  
Significant Risk Factor ◽  
Gallbladder Perforation ◽  
E Coli ◽  
The Mean ◽  
Monomicrobial Infection ◽  
Relationship Of ◽  
Gallbladder Rupture

Aim. To assess the occurrence of SSIs in patients with spillage of gallbladder contents and bacteriobilia during laparoscopic cholecystectomy.Methods. We evaluated 113 patients who underwent laparoscopic cholecystectomy between September 2013 and April 2015. The SSIs and their relationship with gallbladder rupture and bacteriobilia were assessed.Results. The mean age of patients developing SSIs was 45.57 ± 8.89 years. 18 patients (16%) had spillage of bile from the gallbladder. Percentage of SSIs overall was 6%, while percentage of SSIs in gallbladder content spillage was 5.5%. Organism profile of the culture from surgical site showed monomicrobial infection: 58%Staphylococcus aureus, 14%Pseudomonas, and 14%E. coli. The occurrence of SSIs in patients with bacteriobilia was 16% as compared to 2% in patients without bacteriobilia.Conclusions. Gallbladder content spillage is not a significant risk factor leading to increase in SSIs. The occurrence of SSIs is significantly higher in patients with bacteriobilia.

scholarly journals The Relationship Between Padi4 -94G/A Polymorphism and Rheumatoid Arthritis: A Meta-analysis in Multi Ethnic Groups

2020 ◽  
Author(s):  
Changchun Jian ◽  
Jingsong Pu
Keyword(s):  
Rheumatoid Arthritis ◽  
Ethnic Groups ◽  
Meta Analysis ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Peptidylarginine Deiminase ◽  
Increased Risk ◽  
Different Populations ◽  
The Relationship ◽  
Strength Of Association

Abstract Background: A number of studies have reported the association between peptidylarginine deiminase 4 (PADI4) -94G/A polymorphisms and rheumatoid arthritis (RA) risk in different populations, however, the results remained inconclusive. Objecitve: We therefore aim to address this association by performed an updated meta-analysis in multi ethnic groups. Methods: The PubMed and Chinese related databases were searched up to January 2019. The strength of association between PADI -94G/A polymorphism and RA susceptibility was assessed with odds ratios (ORs) and 95% confidence intervals (CIs). Results: A total of 22 studies with 14514 RA cases and 21138 controls were finally included in the analysis. Six ethnic groups such as China, Japan, USA, UK, Sweden and Spain were contained. In the overall population, it revealed that PADI -94G/A polymorphism was significantly associated with an increased risk of RA. In the subgroup analyses by ethnicity, significant association was found in China as well as in Japan and USA. Conclusions: This meta-analysis demonstrates that the PADI4 -94G/A polymorphisms may represent a significant risk factor for RA in China, in Japan and USA. Further studies are needed to clarify this finding, since most available studies were conducted among Chinese and Japanese in this study.

scholarly journals External ventricular drainage for posthemorrhagic ventricular dilatation in preterm infants: insights on efficacy and failure

2021 ◽  
pp. 1-9
Author(s):  
Laura C. De Angelis ◽  
Alessandro Parodi ◽  
Marianna Sebastiani ◽  
Alessandro Consales ◽  
Giuseppe M Ravegnani ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Infants ◽  
Free Group ◽  
Gestational Age ◽  
External Ventricular Drain ◽  
External Ventricular Drainage ◽  
Ventricular Dilatation ◽  
Ventricular Drainage ◽  
Posthemorrhagic Hydrocephalus ◽  
The Mean

OBJECTIVE The objective of this study was to describe the clinical and neuroradiological characteristics of a cohort of preterm infants who had undergone external ventricular drain insertion as a temporary measure to treat posthemorrhagic ventricular dilatation. In addition, the authors investigated the factors predicting permanent shunt dependency. METHODS The authors retrospectively reviewed the medical records of a cohort of preterm infants who had undergone external ventricular drain insertion at Gaslini Children’s Hospital (Genoa, Italy) between March 2012 and February 2018. They also analyzed clinical characteristics and magnetic resonance imaging data, including diffusion- and susceptibility-weighted imaging studies, which were obtained before both catheter insertion and removal. RESULTS Twenty-eight infants were included in the study. The mean gestational age was 28.2 ± 2.7 weeks, and the mean birth weight was 1209 ± 476 g. A permanent ventriculoperitoneal shunt was inserted in 15/28 (53.6%) infants because of the failure of external ventricular drainage as a temporary treatment option. Compared with the shunt-free group, the shunt-dependent group had a significantly lower gestational age (29.3 ± 2.3 vs 27.2 ± 2.7 weeks, p = 0.035) and tended toward a lower birth weight (p = 0.056). None of the clinical and neuroradiological characteristics significantly differed between the shunt-free and shunt-dependent groups at the time of catheter insertion. As expected, ventricular parameters as well as the intraventricular extension of intracerebral hemorrhage, as assessed using the intraventricular hemorrhage score, were reportedly higher in the shunt-dependent group than in the shunt-free group before catheter removal. CONCLUSIONS External ventricular drainage is a reliable first-line treatment for posthemorrhagic hydrocephalus. However, predicting its efficacy as a unique treatment remains challenging. A lower gestational age is associated with a higher risk of posthemorrhagic hydrocephalus progression, suggesting that the more undeveloped the mechanisms for the clearance of blood degradation products, the greater the risk of requiring permanent cerebrospinal fluid diversion, although sophisticated MRI investigations are currently unable to corroborate this hypothesis.

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