scholarly journals Initial Esophageal Anastomosis Diameter Predicts Treatment Outcomes in Esophageal Atresia Patients With a High Risk for Stricture Development

2021 ◽  
Vol 9 ◽  
Author(s):  
Osama Baghdadi ◽  
Susannah Clark ◽  
Peter Ngo ◽  
Jessica Yasuda ◽  
Steven Staffa ◽  
...  
Keyword(s):  
High Risk ◽  
Treatment Outcomes ◽  
Esophageal Atresia ◽  
Surgical Repair ◽  
Anastomotic Stricture ◽  
Initial Diameter ◽  
Esophageal Anastomosis ◽  
Long Term Treatment ◽  
Significant Difference ◽  
The Relationship

Background and Aims: Children with esophageal atresia (EA) who undergo surgical repair are at risk for anastomotic stricture, which may need multiple dilations or surgical resection if the stricture proves refractory to endoscopic therapy. To date, no studies have assessed the predictive value of anastomotic diameter on long-term treatment outcomes. Our aim was to evaluate the relationship between anastomotic diameter in the early postoperative period and need for frequent dilations and stricture resection within 1 year of surgical repair.Methods: A retrospective chart review was performed of patients who had EA repair or stricture resection (SR). Medical records were reviewed to evaluate the diameter of the anastomosis at the first endoscopy after surgery, number and timing of dilations needed to treat the anastomotic stricture, and need for stricture resection. A generalized estimating equations (GEE) modeling with a logit link and binomial family was done to analyze the relationship between initial endoscopic anastomosis diameter and the outcome of needing a stricture resection. Median regression was implemented to estimate the association between number of dilations needed based on initial diameter.Results: A total of 121 patients (56 females) with a history of EA (64% long-gap EA) were identified who either underwent Foker repair at 46% or stricture resection with end-to-end esophageal anastomosis at 54%. The first endoscopy occurred a median of 22 days after surgery. Among all cases, a narrower anastomoses were more likely to need stricture resection with an OR of 12.9 (95% CI, 3.52, 47; p < 0.001) in patients with an initial diameter of <3 mm. The number of dilations that patients underwent also decreased as anastomotic diameter increased. This observation showed a significant difference when comparing all diameter categories when looking at all surgeries taken as a whole (p < 0.008).Conclusion: Initial anastomotic diameter as assessed via endoscopy performed after high-risk EA repair predicts which patients will require more esophageal dilations as well as the likelihood for stricture resection. This data may serve to stratify patients into different endoscopic treatment plans.

DOZ047.15: Esophageal anastomosis diameter at initial endoscopy after surgery predicts treatment outcomes in patients with esophageal atresia or stricture

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
S J Clark ◽  
P D Ngo ◽  
S J Staffa ◽  
C J Smithers ◽  
T E Hamilton ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Esophageal Atresia ◽  
Anastomotic Stricture ◽  
Primary Repair ◽  
Retrospective Chart Review ◽  
Exact Test ◽  
Initial Diameter ◽  
Wilcoxon Rank Sum Test ◽  
Esophageal Anastomosis ◽  
Long Gap Esophageal Atresia

Abstract Background Children with esophageal atresia (EA) are at risk for anastomotic stricture that may ultimately need surgical resection. No studies have examined the relationship between anastomotic diameter at the time of initial postop endoscopy and treatment outcomes. Methods A retrospective chart review was performed of patients with EA who underwent a Foker procedure for repair of long-gap esophageal atresia (LGEA), primary repair of EA, or stricture resection for refractory stricture who were seen between January 2016 and May 2018. A refractory stricture was defined as one requiring ≥5 dilations ≤5 months after surgery. The anastomosis diameter was estimated by the endoscopist. We divided diameter sizes into the following groups: 1–2.9 mm, 3–4.9 mm, 5–6.9 mm, 7–8.9 mm, 9–10.9 mm, and 11–14 mm. The Wilcoxon rank sum test and Fisher's exact test were used. Results Forty-five patients who had a Foker procedure, 37 who had primary repair, and 58 who had stricture resection were identified. The first EGD occurred a median of 22 days (IQR 21–28) after surgery. Among all EA patients with initial diameter of <3 mm, 82% developed refractory stricture and 41% required stricture resection. Of all patients with initial diameter <5 mm, 74% developed refractory stricture and 33% required stricture resection. Of patients who underwent a Foker procedure with initial diameter <3 mm, 56% required stricture resection; of these patients with initial diameter <5 mm, 53% required stricture resection. Among all EA patients, refractory strictures were significantly more likely in patients with smaller initial diameters (P < 0.001), from 18 patients (82%) with stricture 1–2 mm to 0 patients (0%) with stricture 11–14 mm. Patients with smaller anastomoses were more likely to need stricture resection (P = 0.020); 9 patients (41%) with size 1–2 mm underwent stricture resection, while none (0%) with size 11–14 mm needed stricture resection. These differences remained statistically significant for patients who underwent a Foker procedure (P ≤ 0.001 for stricture resection and refractory stricture). Conclusion Endoscopy performed shortly after EA repair or stricture resection can help predict which patients are more likely to develop a refractory stricture or require a stricture resection.

The Relationship between Heart Rate Deflection and Ventilatory Threshold in Children Following Heart Surgery

1995 ◽  
Vol 7 (3) ◽  
pp. 263-269 ◽  
Author(s):  
Ralph K.L. Rogers ◽  
Tony Reybrouck ◽  
Maria Weymans ◽  
Monique Dumoulin ◽  
Marc Gewillig ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Surgery ◽  
Surgical Repair ◽  
Ventilatory Threshold ◽  
Linear Regression Analysis ◽  
Accurate Predictor ◽  
Graded Exercise Test ◽  
Significant Difference ◽  
Graded Exercise ◽  
The Relationship

This study assessed the relationship between the VO2 measured at ventilatory threshold (VT) and the VO2 measured at the point of deflection from linearity of heart rate (HRD). Twelve children (10 boys and 2 girls) with a mean age of 11.3 years (±4.8) performed a graded exercise test to determine VT and HRD. All children had undergone surgical repair for d-transposition of the great arteries at approximately 13 months of age. Because of failure to demonstrate HRD, the data from 4 patients were excluded from statistical analysis. For the remaining 8 patients there was no significant difference between mean VO2 (ml/kg/min) at VT and HRD (26.6 ± 6.4 vs. 26.3 ± 6.8; p > 0.25). Linear regression analysis revealed a correlation of r = 0.92 between the VO2 measured at VT and the VO2 measured at HRD. Only 8 of the 12 patients (66%) in this study satisfied criteria needed to identify the HRD. Therefore HRD may be an accurate predictor of VT in most but not all children who have had surgery for d-transposition of the great arteries.

scholarly journals Colposcopy results in Smear negative, High-risk HPV positive patients

2018 ◽  
Vol 4 (2) ◽  
pp. 43
Author(s):  
Deha Denizhan Keskin
Keyword(s):  
High Risk ◽  
Menopausal Status ◽  
Severe Dysplasia ◽  
Significant Difference ◽  
Hpv Types ◽  
The Mean ◽  
Histopathological Results ◽  
High Risk Hpv ◽  
The Relationship ◽  
Menopausal State

Cervix cancer is an HPV (Human papillomavirus) related cancer, and HPV positivity is necessary even if there is no cytology abnormality. We aimed to determine the ratios of 13 high-risk HPV types in cases with high-risk HPV positivity without cervical smear pathology referred to our clinic and to determine the relation of HPV types with age, parity, menopausal status, and abnormal histopathological results. Two hundred forty-one cases included in the study, which referred to us because of HPV positivity and colposcopically biopsied between January 2014 to January 2018. HPV prevalences were investigated. The relationship between HPV types and variables such as age, parity, menopausal status examined. The mean age of 241 patients included in the study was 46,1+8,8. The parity average was 2,4+1,1. Sixty-five of the patients (27%) were postmenopausal. Of the 241 HPV-positive patients, 172 (71,4%) had only high-risk HPV viruses. The frequency ranking of HPV types was as follow; 16, 31, 51, 56, 18, 52, 35, 58, 39, 68, 45, 33 and 59. According to the HPV types, the average ages were as follow; 18 (43,6 years), 33 (40,1 years) and 51 (41,9 years) were younger than the average age. 35 (48,7 years), 39 (48,5 years), 52 (49,1 years) and 68 (51,3 years) were older than the average age. 16 (44,9 years), 31 (47,9 years), 45 (44,3 years), 56 (47,3 years), 58 (46,9 years) and 59 (46,7 years) was similar the average age. There was no significant difference between the parities according to HPV types (2 to 2,7). According to the HPV types, the menopausal state was as follows; 39 (50%), 56 (50%) and 68 (53,8%) mostly observed in the postmenopausal period; A small proportion of 33 cases (12,5%) was postmenopausal. The rate of severe dysplasia according to colposcopic biopsy related with HPV types was; 58 (40%), 56 (30,8%), 18 (28%), 45 (27,3%), 31 (26,1%), 39 (25%), 59 (16,7%), 35 (14,3%), 51 (13,8%), 33 (12,5%), 16 (11,8%), 52 (8,3%). The prevalence of HPV types, the age at which they saw, the menopausal status and the potential for the formation of severe dysplasia are highly variable. We think that routine screening programme, colposcopy indications and vaccination program should cover all HPV types according to data.

Compliance and convenience: do physicians and patients see depot medication differently?

2004 ◽  
Vol 16 (6) ◽  
pp. 314-318 ◽  
Author(s):  
Pierre Chue
Keyword(s):  
Side Effects ◽  
Treatment Outcomes ◽  
Term Treatment ◽  
Crucial Importance ◽  
Collaborative Process ◽  
Long Term Treatment ◽  
Short And Long Term ◽  
The Relationship ◽  
Depot Medication

Physicians' attitudes to depot medication are often focused on improved compliance (adherence), and thus, short- and long-term treatment outcomes. By contrast, patients receiving such formulations tend to have a quite different viewpoint of medication. Factors such as convenience, side-effects and their beliefs about their illness play an important role in determining whether patients will adhere to their prescribed treatment regimen. The relationship between the patient and physician is of crucial importance in determining a patient's attitude to their medication; it is becoming increasingly clear that managing the illness in the long-term and avoiding relapse, while ensuring compliance, should be reframed as a collaborative process between the patient and physician.

Anastomotic stricture after surgical repair of esophageal atresia: frequency, risk factors, and efficacy of esophageal bougie dilatations

2010 ◽  
Vol 45 (7) ◽  
pp. 1459-1462 ◽  
Author(s):  
Lydia Serhal ◽  
Frédéric Gottrand ◽  
Rony Sfeir ◽  
Dominique Guimber ◽  
Patrick Devos ◽  
...  
Keyword(s):  
Risk Factors ◽  
Esophageal Atresia ◽  
Surgical Repair ◽  
Anastomotic Stricture

scholarly journals EDUKASI PRENATAL ATTACHMENT DAPAT MENINGKATKAN KELEKATAN IBU DAN JANIN PADA IBU HAMIL RISIKO TINGGI

2020 ◽  
Vol 8 (01) ◽  
pp. 34-51
Author(s):  
Mariani Mariani ◽  
Shinta Wahyusari ◽  
Nova Hikmawati
Keyword(s):  
High Risk ◽  
Pregnant Women ◽  
Sampling Technique ◽  
First Trimester ◽  
Average Score ◽  
P Value ◽  
Prenatal Attachment ◽  
Significant Difference ◽  
Before And After ◽  
The Relationship

Introduction: The prevalence of high-risk pregnancies in Indonesia is still quite high. Mothers who suffer from illness and pregnancy complications can influence the outcome of the pregnancy, which risks the occurrence of maternal and fetal morbidity and mortality. The psychological effects of high-risk pregnancies are anxiety, stress, and the mother experiences a crisis that can affect the relationship between mother and fetus. These conditions can continue in the relationship between mother and baby after birth. Therefore there needs to be an effort to increase the attachment of the mother and fetus, one of which can be done by providing education. This study aims to determine the effect of prenatal attachment education on maternal and fetal attachment in high-risk pregnant women in Paiton Subdistrict, Probolinggo Regency. Method: The study was conducted in Paiton Subdistrict, Probolinggo Regency in Mei-Juni 2019. The research method used was quasy experiment using pre-post test design. The population in this study were all high risk pregnant women in Dringu Subdistrict, Probolinggo Regency. The sampling technique used in this study was purposive sampling by determining the sample in accordance with the inclusion criteria. The number of samples to be used was 20 respondents. Data collection techniques using a questionnaire. Data were analyzed using Wilcoxon using SPSS. Results and Analysis: The results obtained showed the average score of attachment of the mother and fetus before the intervention was 52.15 and after the intervention was 60.50. There was a significant difference in the attachment of the mother and fetus before and after the intervention with a p value of 0,000 (p <0,000). Discussion: Prenatal care education needs to be included in the prenatal classroom program and started being given to pregnant women since the first trimester.   Keywords: attachment, prenatal attachment, high risk pregnant women

Sa2043 ESOPHAGEAL ANASTOMOSIS DIAMETER AT INITIAL ENDOSCOPY AFTER SURGERY PREDICTS TREATMENT OUTCOMES IN PATIENTS WITH ESOPHAGEAL ATRESIA

2019 ◽  
Vol 89 (6) ◽  
pp. AB281-AB282
Author(s):  
Susannah J. Clark ◽  
Peter D. Ngo ◽  
Steven J. Staffa ◽  
Michael A. Manfredi
Keyword(s):  
Treatment Outcomes ◽  
Esophageal Atresia ◽  
Esophageal Anastomosis

scholarly journals Endoscopic Stenting and Clipping for Anastomotic Stricture and Persistent Tracheoesophageal Fistula after Surgical Repair of Esophageal Atresia in an Infant

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Mohammed Amine Benatta ◽  
Amine Benaired ◽  
Ahmed Khelifaoui
Keyword(s):  
Esophageal Atresia ◽  
Tracheoesophageal Fistula ◽  
Surgical Repair ◽  
Anastomotic Stricture ◽  
Balloon Dilation ◽  
Endoscopic Stenting ◽  
Recurrent Fistula ◽  
Metal Type ◽  
Esophageal Strictures

Anastomotic stricture (AS) and recurrent tracheoesophageal fistula (TEF) are two complications of surgical repair of esophageal atresia (EA). Therapeutic endoscopic modalities include stenting, tissue glue, and clipping for TEF and endoscopic balloon dilation bougienage and stenting for esophageal strictures. We report herein a two-month infant with both EA and TEF who benefited from a surgical repair for EA, at the third day of life. Two months later he experienced deglutition disorders and recurrent chest infections. The esophagogram showed an AS and a TEF confirmed with blue methylene test at bronchoscopy. A partially covered self-expanding metal type biliary was endoscopically placed. Ten weeks later the stent was removed. This allows for easy passage of the endoscope in the gastric cavity but a persistent recurrent fistula was noted. Instillation of contrast demonstrated a fully dilated stricture but with a persistent TEF. Then we proceeded to placement of several endoclips at the fistula site. The esophagogram confirmed the TEF was obliterated. At 12 months of follow-up, he was asymptomatic. Stenting was effective to alleviate the stricture but failed to treat the TEF. At our knowledge this is the second case of successful use of endoclips placement to obliterate recurrent TEF after surgical repair of EA in children.

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