scholarly journals Modified Target Angle as a Predictor of Success in Strabismus Management after Orbital Fracture

2022 ◽  
Vol 11 (2) ◽  
pp. 287
Author(s):  
Chih-Kang Hsu ◽  
Meng-Wei Hsieh ◽  
Hsu-Chieh Chang ◽  
Yi-Hao Chen ◽  
Ke-Hung Chien
Keyword(s):  
Retrospective Chart Review ◽  
Successful Outcome ◽  
Orbital Fracture ◽  
Surgical Results ◽  
Success Rates ◽  
Reconstruction Surgery ◽  
Target Angle ◽  
Ocular Movement ◽  
Group 2 ◽  
Group 1

Surgery for strabismus secondary to orbital fracture reconstruction surgery has had low success rates and high reoperation rates due to its incomitant nature and complex underlying mechanisms. There has been no consensus as to which of the various methods for improving the surgical results are best. We proposed a modified target angle criteria that combined the regular target angle and a favorable Hess area ratio percentage (HAR%) threshold to evaluate surgical results within the first postoperative week and conducted a retrospective chart review. According to the criteria of the modified target angle at the first postoperative week, a total of 63 patients were divided into two groups: Group 1, patients who fulfilled the criteria (49 patients); and Group 2, those who did not (14 patients). Sex, type of fracture, and the use of porous polyethylene sheets and titanium mesh during reconstruction surgery were significantly different between the groups. Group 1 showed a significantly higher percentage of patients who met the criteria of HAR% > 65% at the first week and >85% (i.e., a successful outcome) at the 6-month visit (p < 0.01). Additionally, Group 1 had a higher HAR% at the first postoperative week (p < 0.01). In conclusion, the patients meeting the criteria of the modified target angle at the first postoperative week had a favorable outcome at the 6-month visit in both ocular alignment and ocular movement.

Single-Stage Repair of Coarctation of the Aorta and Ventricular Septal Defect: A Comparison of Surgical Strategies and Resource Utilization

2017 ◽  
Vol 8 (5) ◽  
pp. 559-563 ◽  
Author(s):  
Connor Callahan ◽  
David Saudek ◽  
Amanda Shillingford ◽  
Sara Creighton ◽  
Garick Hill ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Resource Utilization ◽  
Septal Defect ◽  
Coarctation Of The Aorta ◽  
Retrospective Chart Review ◽  
Single Stage ◽  
Surgical Approaches ◽  
Off Pump ◽  
Group 2 ◽  
Group 1

Background: We sought to compare clinical outcomes and resource utilization for two surgical approaches for single-stage repair of coarctation of the aorta and ventricular septal defect (VSD). Methods: This was a retrospective chart review of 21 consecutive neonates and infants undergoing single-stage repair of coarctation of the aorta and VSD. Group 1 included 13 patients with both arch repair and VSD repair completed via sternotomy. Group 2 included eight patients with off-pump arch repair via left thoracotomy followed by repositioning and VSD repair via sternotomy. Primary clinical outcome was arch reintervention. Secondary outcomes included various measures of resource utilization. Results: Group 1 patients demonstrated younger age at repair (median of 10 days vs 57 days for group 2; P = .05) and lower proximal arch z scores (−4.2 vs −2.3 for group 2; P = .003). Arch reintervention occurred in 0 of 8 patients in group 2 and 1 (7.7%) of 13 patients in group 1 ( P = nonsignificant). Group 2 was associated with lower total charges (US$68,301 vs US$211,723 for group 1; P = .0007), shorter length of stay (8 days vs 23 days for group 1; P = .004), and shorter duration of postoperative mechanical ventilation (0.5 days vs 4.0 days for group 1; P = .0008). Group 2 was also associated with shorter total cardiopulmonary bypass time (86 minutes vs 201 minutes for group 1; P = .0009). Conclusion: Single-stage two-incision repair of coarctation and VSD in appropriately selected patients may be associated with higher value of care. Confirmation of this finding will require further study based on larger numbers of patients.

scholarly journals Bioresorbable Material in Secondary Orbital Reconstruction Surgery

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Hui Pan ◽  
Zhenzhen Zhang ◽  
Weiwei Tang ◽  
Zhengkang Li ◽  
Yuan Deng
Keyword(s):  
Retrospective Chart Review ◽  
Fracture Repair ◽  
Orbital Fracture ◽  
Ocular Motility ◽  
Orbital Fractures ◽  
Orbital Reconstruction ◽  
Primary Surgery ◽  
Ocular Movement ◽  
Bioresorbable Material ◽  
Secondary Orbital Reconstruction

Purpose. To validate the potential of bioresorbable implantation in secondary revisional reconstruction after inadequate primary orbital fracture repair, with assessment of pre- and postoperative clinical characteristics and computed tomography image findings. Methods. A retrospective chart review was conducted on 16 consecutive patients treated for orbital fractures at Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, with inadequate prior surgeries between July 2010 and June 2017; patients who had suffered orbital blowout fractures had undergone primary surgeries elsewhere. Secondary repair of orbital fractures used bioresorbable material following unsatisfactory primary orbital repair. Patients’ demographics, degree of enophthalmos, ocular motility, diplopia test results, primary implants, and surgical complications were reviewed. Results. All 16 patients had primary orbital implants consisting of Medpor, titanium mesh, hydroxyapatite, or poly-L-lactide. Of the 16 cases, 14 had malpositioned implants posteriorly and two had implant infections. Findings following primary surgery included enophthalmos (12/16), diplopia (9/16), intraorbital abscess (2/16), and ocular movement pain (1/16). Mean preoperative enophthalmos was 3.8 ± 0.8 mm. Secondary reconstruction resulted in a mean reduction of enophthalmos by 3.1 ± 0.9 mm (P<0.01). Nine in ten patients experienced improvements in postoperative ocular motility and diplopia following secondary surgery. Intraorbital abscesses and eyeball movement-associated pain were cured. Conclusions. This study demonstrates that secondary orbital reconstruction of previously repaired orbital fractures using bioresorbable material can achieve excellent functional and aesthetic results with minimal complications. Bioresorbable material should be considered in secondary orbital reconstruction when clinically indicated.

scholarly journals 1552. Correlation Between Vancomycin Serum Trough Concentrations and Area Under the Curve in Pediatric Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S566-S567
Author(s):  
Krista Weaver ◽  
Madan Kumar ◽  
Allison Nelson ◽  
Palak Bhagat
Keyword(s):  
Pediatric Patients ◽  
Retrospective Chart Review ◽  
Primary Study ◽  
Pharmacokinetic Parameters ◽  
Optimal Method ◽  
Study Objective ◽  
Serum Trough ◽  
Trough Concentrations ◽  
Group 2 ◽  
Group 1

Abstract Background Despite years of experience with vancomycin (VAN), the optimal method to monitor VAN therapy in pediatric patients is still unknown. Recent pediatric data indicate serum trough concentrations lower than 10–20 mg/L or 15–20 mg/L based on indication may achieve an AUC24> 400 mg hours/L. The primary study objective was to compare AUC24 to goal VAN serum trough concentrations (STC). Methods A retrospective chart review of pediatric patients who received intravenous VAN June 1, 2018 to December 31, 2018 was completed. AUC24 was calculated using a trapezoidal method with 2 steady-state serum concentrations. A serum peak concentration was drawn 1 hour and 15 minutes following the end of infusion and an STC was drawn 30 minutes prior to infusion. Results During 25 admissions, 12 patients had a first AUC24 at goal and 13 patients had a first AUC24 below goal. Of 41 AUC24 calculations, 27 AUC24s were ≥400 mg hours/L (group 1), and 14 AUC24s were <400 mg hours/L (group 2). Median AUC24 was 561 mg hours/L for group 1 vs. 344.5 mg hours/L for group 2 (P < 0.001). Correlating Cmin and Ctrough (Ctr) for group 1 and group 2 were 12 mg/L and 13.5 mg/L vs. 6.4 mg/L and 7.3 mg/L, respectively (P < 0.001). Figure 1 shows the pharmacokinetic parameters for each group. Spearman correlation between AUC24 and Cmin was 0.87. Of the 35 subtherapeutic VAN STCs, 20 (57.1%) achieved an AUC24 ≥400 mg hours/L (P = 0.08). Subgroup analysis of AUC24 400–600 mg hours/L showed a median AUC24 of 519 mg hours/L with correlating Cmin and Ctr of 10.6 mg/L and 11.9 mg/L, respectively. The MIC was <1 in 90.9% of cases (Figure 2). The mean VAN dose required to achieve an AUC24 ≥400 mg hours/L was 77.7 mg/kg/day; dosing frequency did not appear to affect AUC24 outcome. Time to culture clearance was 2 days in group 1 and 6.5 days in group 2 (P = 0.24). No cases of nephrotoxicity were identified despite AUC24 values ranging from 265–1294 mg hours/L. Conclusion AUC24 monitoring using a 2-sample trapezoidal method was successfully implemented at this institution. The results of this study align with previous pediatric studies, supporting the use of lower serum trough concentration goals of 10–15 mg/L. Disclosures All authors: No reported disclosures.

scholarly journals The effects of previous open renal stone surgery types on PNL outcomes

2016 ◽  
Vol 10 (7-8) ◽  
pp. 246 ◽  
Author(s):  
Faruk Ozgor ◽  
Onur Kucuktopcu ◽  
Burak Ucpinar ◽  
Omer Sarilar ◽  
Akif Erbin ◽  
...  
Keyword(s):  
Renal Stone ◽  
Complication Rates ◽  
Success Rates ◽  
Anesthetic Agents ◽  
History Of ◽  
Renal Stone Surgery ◽  
Retrospective Nature ◽  
Group 2 ◽  
Free Status ◽  
Group 1

<p><strong>Introduction:</strong> Our aim was to demonstrate the effect of insicion of renal parenchyma during open renal stone surgery (ORSS) on percutaneous nephrolithotomy (PNL) outcomes.</p><p><strong>Methods:</strong> Patients with history of ORSS who underwent PNL operation between June 2005 and June 2015 were analyzed retrospectively. Patients were divided into two groups according to their type of previous ORSS. Patients who had a history of ORSS with parenchymal insicion, such as radial nephrotomies, anatrophic nephrolithotomy, lower pole resection, and partial nephrectomy, were included in Group 1. Other patients with a history of open pyelolithotomy were enrolled in Group 2. Preoperative characteristics, perioperative data, stone-free status, and complications were compared between the groups. Stone-free status was defined as complete clearance of stone(s) or presence of residual fragments smaller than 4 mm. The retrospective nature of our study, different experience level of surgeons, and lack of the evaluation of anesthetic agents and cost of procedures were limitations of our study.</p><p><strong>Results:</strong> 123 and 111 patients were enrolled in Groups 1 and 2, respectively. Preoperative characteristics were similar between groups. In Group 1, the mean operative time was statistically longer than in Group 2 (p=0.013). Stone-free status was significantly higher in Group 2 than in Group 1 (p=0.027). Complication rates were similar between groups. Hemorrhage requiring blood transfusion was the most common complication in both groups (10.5% vs. 9.9%).</p><p><strong>Conclusions:</strong> Our study demonstrated that a history of previous ORSS with parenchymal insicion significantly reduces the success rates of PNL procedure.</p>

Multicenter, Randomized, Comparative Cost-effectiveness Study Comparing 0, 1, and 2 Diagnostic Medial Branch (Facet Joint Nerve) Block Treatment Paradigms before Lumbar Facet Radiofrequency Denervation

2010 ◽  
Vol 113 (2) ◽  
pp. 395-405 ◽  
Author(s):  
Steven P. Cohen ◽  
Kayode A. Williams ◽  
Connie Kurihara ◽  
Conner Nguyen ◽  
Cynthia Shields ◽  
...  
Keyword(s):  
Positive Response ◽  
The United States ◽  
Successful Outcome ◽  
Medial Branch ◽  
Cost Effective Treatment ◽  
Pain Clinics ◽  
Radiofrequency Denervation ◽  
Diagnostic Block ◽  
Group 2 ◽  
Group 1

Background Among patients presenting with axial low back pain, facet arthropathy accounts for approximately 10-15% of cases. Facet interventions are the second most frequently performed procedures in pain clinics across the United States. Currently, there are no uniformly accepted criteria regarding how best to select patients for radiofrequency denervation. Methods A randomized, multicenter study was performed in 151 subjects with suspected lumbar facetogenic pain comparing three treatment paradigms. Group 0 received radiofrequency denervation based solely on clinical findings; group 1 underwent denervation contingent on a positive response to a single diagnostic block; and group 2 proceeded to denervation only if they obtained a positive response to comparative blocks done with lidocaine and bupivacaine. A positive outcome was predesignated as &gt; or =50% pain relief coupled with a positive global perceived effect persisting for 3 months. Results In group 0, 17 patients (33%) obtained a successful outcome at 3 months versus eight patients (16%) in group 1 and 11 (22%) patients in group 2. Denervation success rates in groups 0, 1, and 2 were 33, 39, and 64%, respectively. Pain scores and functional capacity were significantly lower at 3 months but not at 1 month in group 2 subjects who proceeded to denervation compared with patients in groups 0 and 1. The costs per successful treatment in groups 0, 1, and 2 were $6,286, $17,142, and $15,241, respectively. Conclusions Using current reimbursement scales, these findings suggest that proceeding to radiofrequency denervation without a diagnostic block is the most cost-effective treatment paradigm.

scholarly journals Exercise in a Healthy Heart Program: A Cohort Study

2013 ◽  
Vol 7 ◽  
pp. CMC.S12654 ◽  
Author(s):  
J. Meikle ◽  
A. Al-Sarraf ◽  
M. Li ◽  
K. Grierson ◽  
J. Frohlich
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Lipid Profile ◽  
Retrospective Chart Review ◽  
Secondary Outcome ◽  
The Mean ◽  
Group 2 ◽  
Prevention Clinic ◽  
Group 1

Objective To assess the effects of exercise on resting heart rate (RHR), weight, lipid profile, and blood pressure. We hypothesized that the participants who increased their physical activity would show improvement in their cardiovascular risk factors compared to those who did not. Design Retrospective chart review over the mean duration of 4.9 years of follow-up. Setting Healthy Heart Program Prevention Clinic at St. Paul's Hospital, Vancouver, British Columbia, Canada. Participants We reviewed 300 charts of patients randomly selected from those who attended the Prevention Clinic between 1984 and 2009. 248 (82.7%) patients were referred for primary prevention and 52 (17.3%) for secondary prevention. Primary and secondary outcome measures Weight, RHR, lipid profile, and blood pressure were recorded at the initial and last visit. Results During a mean of 4.9 years of follow-up, 55% of participants improved their exercise. The mean decrease in the RHR for these patients (group 1) was 5.9 beats per minute (bpm) versus the mean increase of 0.3 bpm for the “no change” group (group 2) ( P < 0.01). The mean net weight increase in group 1 was 0.06 kg/year versus 0.25 kg/year in group 2. Because of medications, all patients had a significant improvement in their lipid profiles. Furthermore, there was a statistically significant greater reduction in Framingham Risk Score (FRS) in group 1 versus group 2 (11.8% versus 15.1%, P < 0.01). Conclusion Participation in the program significantly reduces modifiable risk factors for cardiovascular disease. Improved exercise regimen results in lower RHR and greater reduction in FRS. However, even in a Prevention Program, despite strong advocacy of the importance of exercise, a significant percentage of participants does not improve their exercise habits.

scholarly journals The Results of Trabeculectomy with Antimetabolites in Elderly Patients: A Retrospective Study

Acta Medica ◽  
2021 ◽  
pp. 1-5
Author(s):  
Özlem Dikmetaş ◽  
Sepideh Lotfisadigh, ◽  
Merve Kaşıkçı ◽  
Ali Bülent Çankaya ◽  
Sibel Kocabeyoğlu
Keyword(s):  
Intraocular Pressure ◽  
Retrospective Study ◽  
Elderly Patients ◽  
Mitomycin C ◽  
Open Angle Glaucoma ◽  
Success Rates ◽  
Topical Medication ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Objective: To examine the effectiveness and results of primary trabeculectomy with 5-fluorouracil (group 1) or mitomycin-C (group 2) in elderly patients. Materials and Methods: This was a retrospective study including 67 eyes with primary open-angle glaucoma that underwent primary trabeculectomy with group 1 or group 2. Patients who were followed up for less than 1 year or were under 55 years of age were excluded from the study. Surgical success was evaluated according to a decrease in cup/disk ratio and reduction of intraocular pressure without any topical medication. Results: The mean ages of participants were 65.7 years (range 59–88) and 65.9 years (range 59–74) in groups 1 and 2, respectively. The mean preoperative and postoperative intraocular pressure values were 31.3 ± 5.7 mmHg (range 17–46) and 14.8 ± 0.4 mmHg (range 10–21) in group 1 (p < 0.001) and 31.5 ± 7.4 mmHg (range 18–52) and 14.8 ± 2.9 mmHg (range 10–21) in group 2 (p < 0.001). Conclusion: The use of 5-fluorouracil or mitomycin-C during primary trabeculectomy is associated with high postoperative success rates. There were no significant differences between 5-fluorouracil and mitomycin-C in terms of intraocular pressure reduction.

scholarly journals 1314. Neonatal Serum Gentamicin Concentrations following Maternal Once-daily Gentamicin Dosing

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S669-S669
Author(s):  
Genene A Wilson ◽  
Allison Nelson ◽  
Palak Bhagat ◽  
Deborah Bondi ◽  
Pooja Shah ◽  
...  
Keyword(s):  
Serum Concentration ◽  
Compliance Rate ◽  
Retrospective Chart Review ◽  
Population Based ◽  
Serum Concentrations ◽  
Once Daily ◽  
The Mean ◽  
Group 2 ◽  
Clinically Significant ◽  
Group 1

Abstract Background Gentamicin is commonly used for peripartum infections. Given literature supporting efficacy of once-daily dosing (ODD) of 5 mg/kg for chorioamnionitis, University of Chicago Medicine made the change from three times daily dosing (TIDD) to ODD. As gentamicin readily cross the placenta, it would be expected that maternal ODD would result in higher gentamicin neonatal serum concentrations following birth. Methods This was a single-center, retrospective chart review of all neonates born to mothers receiving peripartum ODD gentamicin within 12 hours of delivery between October 2019 and March 2020. A STAT random gentamicin serum concentration was obtained upon admission in neonates when initiation of antibiotics was desired. Specific dosing recommendations (Table 1) were developed utilizing neonatal population-based pharmacokinetics. The primary outcome was initial neonatal gentamicin serum concentration at birth. Other outcomes were also evaluated. Results were evaluated in two groups based on neonatal serum concentrations of less than 2 mcg/mL (Group 1) versus 2 mcg/mL or greater (Group 2). Table 1: Neonatal gentamicin dosing algorithm Results Thirty-two mother-newborn dyads were included in this study. Baseline demographics are shown in Table 2. Newborns had a median gestational age of 39.4 weeks and median birth weight of 3.39 kilograms. The mean initial gentamicin concentration was supratherapeutic at 3.06 + 1.92 mcg/mL among all newborns (Table 3). The mean maternal dose in Group 1 (n=11) was 3.52 mg/kg (3.34, 4.77) based on actual body weight and 4.78 mg/kg (4.34, 5.18) in Group 2 (n=21) (p=0.025). The median time between maternal gentamicin administration and time of delivery varied between the groups at 0.5 hours versus 2.63 hours, respectively (p=0.005). All newborn gentamicin concentrations were less than 2 mcg/mL for maternal doses given less than 1 hour prior to delivery (n=8) (Figure 1). Overall protocol compliance rate was 81.3%. There were no significant differences in nephrotoxicity or ototoxicity between groups. Table 2. Baseline Demographics Table 3. Outcomes Figure 1. Comparison of maternal gentamicin time from administration to delivery and neonatal serum gentamicin concentrations Conclusion This study suggests peripartum ODD of gentamicin may lead to clinically significant serum concentrations in neonates if administered between 1 to 12 hours of birth. Further studies are warranted to evaluate the effects of maternal ODD of gentamicin on newborns. Disclosures All Authors: No reported disclosures

scholarly journals Bupivacaine-lidocaine versus Ropivacaine-lidocaine Retrobulbar Anesthesia in Vitreoretinal Surgery

2021 ◽  
Vol 62 (12) ◽  
pp. 1600-1606
Author(s):  
Yeong A Choi ◽  
Areum Jeong ◽  
Min Sagong
Keyword(s):  
Vitreoretinal Surgery ◽  
Pain Scale ◽  
Gaze Direction ◽  
Visual Analog Pain Scale ◽  
Sensory Blockade ◽  
Retrobulbar Anesthesia ◽  
Ocular Movement ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Purpose: To compare efficacies of bupivacaine-lidocaine and ropivacaine-lidocaine mixtures in terms of inducing retrobulbar anesthesia during vitrectomy.Methods: Sixty patients who underwent retrobulbar anesthesia during vitrectomy were divided into two groups. Patients in group 1 received a mixture of bupivacaine and lidocaine (n = 30); patients in group 2 received a mixture of ropivacaine and lidocaine (n = 30). The effects of the two combinations were retrospectively compared and analyzed. The onset times of analgesia and akinesia were measured. Two hours after surgery, sensory blockade was assessed by touching the corneas with cotton swabs and by communicating with patients. Ocular movement was evaluated in four gaze direction quadrants. A 10-point visual analog pain scale was used to assess pain during and 2 hours after surgery. Intra- and postoperative complications were recorded.Results: The mean analgesia onset times in groups 1 and 2 were 94.62 ± 28.87 and 92.32 ± 35.53 seconds, respectively (p = 0.071); the mean akinesia onset times were 147.89 ± 59.35 and 132.57 ± 76.38 seconds (p = 0.223), respectively. Patients in group 2 reported significantly less postoperative pain and exhibited less postoperative ocular movement, compared with patients in group 1 (both p = 0.002). One patient in group 1 experienced respiratory depression after retrobulbar blockade.Conclusions: When retrobulbar anesthesia is required during vitrectomy, a ropivacaine-lidocaine mixture and a bupivacaine-lidocaine mixture induce anesthesia with similar rapidity. However, the ropivacaine-lidocaine mixture is safer and affords better-quality intra- and postoperative anesthesia.

scholarly journals Evaluation of an Interprofessional Academic-Practice Partnership in End of Life Care

2021 ◽  
Vol 12 (4) ◽  
pp. 22
Author(s):  
Katie F Leslie ◽  
M. Kate Probst ◽  
Taylor L Hawkins
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Value Added ◽  
Retrospective Chart Review ◽  
Life Care ◽  
Academic Practice ◽  
Team Members ◽  
Interprofessional Care ◽  
Group 2 ◽  
Group 1

Introduction: The purpose of this mixed-methods study was to evaluate an interprofessional academic-practice partnership in end of life care by examining patient medication outcomes, the contributions of student pharmacists and a pharmacy preceptor to care teams, and student learning experiences. Methods: Retrospective chart review assessed polypharmacy differences in hospice patients with a primary terminal diagnosis of non-Alzheimer’s dementia between two patient groups; Group 1 managed on interprofessional care teams within the pharmacy partnership, and Group 2, managed on teams without a pharmacist. Team members who interacted with student pharmacists and the pharmacy preceptor participated in semi-structured key informant interviews to document perceptions of pharmacy contributions to care teams and the organization. At the end of their APPE, students completed reflective writings regarding their learning.   Results: Patients in Group 1 were on statistically significant fewer medications than Group 2 at both week 4 and weeks 7-12 following admission.  Five conceptual themes emerged from interviews: pharmacists as team medication experts, improved patient outcomes, interprofessional collaboration, patient/caregiver trust in medication regimens, and desire for sustainability. Student reflections included the following learning themes: teamwork, respect, value, and patient-centered care. Conclusions: The addition of a pharmacist on interprofessional care teams decreased the average number of medications in the non-Alzheimer’s end of life patient population. Team members identified value-added contributions of student pharmacists and the pharmacy preceptor that enhanced team efficiency and patient care. Student pharmacists recognized these contributions and the experience served as an exemplar of interprofessional practice.

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