scholarly journals Anatomy of Major Duodenal Papilla Influences ERCP Outcomes and Complication Rates: A Single Center Prospective Study

2020 ◽  
Vol 9 (6) ◽  
pp. 1637
Author(s):  
Gheorghe G. Balan ◽  
Mukul Arya ◽  
Adrian Catinean ◽  
Vasile Sandru ◽  
Mihaela Moscalu ◽  
...  

Background: Endoscopic retrograde cholangiopancreatography (ERCP) has been one of the most intensely studied endoscopic procedures due to its overall high complication rates when compared to other digestive endoscopy procedures. The safety and outcome of such procedures have been linked to multiple procedure- or patient-related risk factors. The aim of our study is to evaluate whether the morphology of the major duodenal papilla influences the ERCP outcomes and complication rates. Methods: A total of 322 patients with a native papilla have been included in the study over an eight month period. Morphology of the papilla has been classified into normal papilla and four anatomical variations (Type I-IV). All patients have been prospectively monitored over a 15 day period after ERCP. Procedural outcomes and complication rates have been registered. Results: Morphology of the papilla influences both overall complication rates (95%CI, p = 0.0066) and post-ERCP pancreatitis rates (95%CI, p = 0.01001) in univariate analysis. Type IV papillae have proven to be independent risk factors for post-ERCP pancreatitis in multivariate analysis (OR = 12.176, 95%CI, p = 0.005). Type I papillae have been significantly linked to difficult cannulation (AUC = 0.591, 95%CI, p = 0.008); Conclusions: In the monitored cohort morphology of the major duodenal papilla has significantly influenced both ERCP outcomes and post-procedural complication rates.

reportaendo ◽  
2018 ◽  
Vol 1 (4) ◽  
Author(s):  
JENNY GUERRERO FERRECCIO ◽  
CAMILA ADRIANA PERALTA MIER

Introducción: El tratamiento endodontico representa en la actualidad una gran rama en el área de la odontología de importancia para la preservación de piezas dentales, que se verían afectadas por el ataque de agentes externos y que comprometen su funcionabilidad y estética, pero la complejidad de la anatomía de los conductos de todos los dientes en general aún sigue siendo un problema, más aun en los premolares, ya que estos a diferencia de las demás piezas dentarias, tienen diferentes formas y cantidad de conductos radiculares. (6) Propósito: El propósito de este estudio es demostrar la importancia del conocimiento sobre la anatomía radicular y sus variaciones anatómicas, para minimizar el fracaso al realizar una terapia endodontica. Objetivo: El objetivo directo de este estudio es determinar las variaciones anatómicas de premolares superiores e inferiores y su relación con estructuras anatómicas de pacientes atendidos endodónticamente, el año 2016, en la clínica Nexodent de la ciudad de Guayaquil, mediante el uso de sus tomografías previas a  su tratamiento.Materiales y métodos: Se analizaron 70 tomografías de 41 pacientes atendidos en el año 2016 en la clínica Nexodent de la ciudad de Guayaquil. Al momento de analizar cada tomografía se tomaron tres fotografías de cortes tomografcos: coronal, axial y sagital para obtener una información variada de su anatomía. Resultados: De las tomografías revisadas, el 71% fue de género femenino. El 29% de género masculino. Los resultados encontrados del número de conductos en las piezas dentales registradas señalan que el 56% de los casos presenta 1 sólo conducto. En cuanto a la variación anatómica de las piezas dentales estudiadas, se utilizó la clasifcación de Vertucci. El 56% de las piezas dentales es de Tipo I, el 26% es de Tipo IV, el 11% es de Tipo II, y el restante son de Tipo V. Se analizó la distancia entre cada premolar maxilar hasta el seno maxilar y en promedio la distancia fue de 5,3 mm. La distancia promedio de los premolares mandibulares hasta el foramen mentoniano fue de 6,21 mm. La principal localización encontrada para el orifcio del foramen apical fue el centro con el 58% de los casos.Discusión: Se obtuvo mayoría de aciertos sobre los estudios realizados con los estudios de las referencias bibliográfcas excepto en; La incidencia de los conductos en los segundos premolares superiores en que se obtuvo mayoria de un conducto en lugar de dos. En la distancia promedio del apice de los primeros premolares mandibulares con el agujero mentoniano en donde las distancias promedios fueron mayores. En la localizacion del foramen apical en la pieza #35, en que hubo mayor localizacion del foramen en el centro y no hacia distal.Conclusión: Se puede concluir que el mejor examen complementario para analizar la anatomía de conductos es la tomografía y que los resultados obtenidos en esta investigación no fueron muy distintos en comparación a investigaciones realizadas por otros autores.    AbstractIntroduction: Endodontic treatment currently represents a large branch in the area of dentistry of importance for the preservation of dental pieces, which would be afected by the attack of external agents and compromise its functionality and aesthetics, but the complexity of the root Canals anatomy of all teeth in general still remains a problem, even more so in the premolars as these unlike other teeth, have diferent forms and quantity of root Canals. 6 Purpose: The purpose of this study is to demonstrate the importance of knowledge about the root canal anatomy and its anatomical variations, in order to minimize the failure in an endodontic therapy.Objective: The direct objective of this study is to determine the anatomical variations of upper and lower premolars and their relationship with anatomical structures of endodontically treated patients, in 2016, at the Nexodent Clinic of the city of Guayaquil, using their tomography prior to its treatment. Materials and methods: We analyzed 70 CT scans of 41 patients seen in 2016 at the Nexodent clinic in the city of Guayaquil. At the moment of analyzing each tomography three photographs were taken: coronal, axial and sagittal to obtain al the information of its anatomy. Results: Of the CT scans reviewed, 71% were female, 29% male. The results found of the number of root canals in the registered dental pieces indicate that 56% of the cases present 1 only conduit. Regarding the anatomical variation of the studied dental pieces, the Vertucci classifcation was used 56% of the teeth are Type I, 26% are Type IV, 11% are Type II, and the rest are Type V. The average distance between the maxillary premolars to the maxillary sinus was 5.3 mm. The mean distance from the mandibular premolars to the mental foramen was 6.21 mm. The main location found for the apical foramen was the center with 58% of the cases. Discussion: the mayority of the studies carried out with the studies of the bibliographical references where equal except in; The incidence of root canals in the upper second premolars where the mayority of one root was obtained instead of two. In the average distance of the apex of the frst mandibular premolars with the mental foramen where the average distances were greater. In the location of the apical foramen in # 35, in which there was greater location of foramen in the center and not distal. Conclusion: It can be concluded that the best complementary exam to analyze the anatomy of root Canals is the tomography and that the results obtained in this investigation were not very diferent  in comparison to investigations realized by other authors. 


2017 ◽  
Vol 38 (4Supl1) ◽  
pp. 2845
Author(s):  
Renata Bezerra Marujo ◽  
Helio Langoni ◽  
Leila Sabrina Ullmann ◽  
Maysa Pellizzaro ◽  
Ramiro Das Neves Dias Neto ◽  
...  

Toxoplasmosis is a parasitic zoonosis with worldwide distribution and different wild species either are involved in maintenance of the pathogen in the environment as definitive or intermediate hosts serving as font of feeding or prey to definitive hosts. The present study aimed to investigate Toxoplasma gondii antibodies and the risk factors relating to infection in mammals at Sorocaba Zoo, state of São Paulo, Brazil. Serum samples collected from 153 animals were analyzed using the modified agglutination test (MAT; cutoff ? 25). Seropositivity was found in 62 animals (40.5%; 95% CI: 33.1-48.5%), with different titers. Significant differences were observed in relation to the ages of the animals, origin, presence of free-ranging animals in the enclosure and feeding habits, through univariate analysis (p ? 0.05). Multivariate logistic regression analysis showed that only age (p = 0.03) had significance for the study. Adult animals were 3.5 more likely to become infected than were young ones. In relation to feeding habits, herbivores (80%) and carnivores (46.5%) were the animals most affected. These results highlight the presence of T. gondii in animals at Brazilian zoos, and suggest that continuous transmission is occurring at zoos.


2019 ◽  
Vol 6 (1) ◽  
pp. 17
Author(s):  
Shengbin Zhang ◽  
Zhelin Yun ◽  
Erdengsuhe E ◽  
Baoqin Liu

Objective: The aim of the study is to analyze the risk factors of hepatic echinococcosis in mass epidemiological studies in Inner Mongolia of China and Mongolia and provide a basis for related authorities to make appropriate preventive measures.Methods: Eight areas in Inner Mongolia and Zamyn-Üüd region of Mongolia were selected as epidemiological fields. By distributing epidemiological questionnaires to local residents and performing serological examinations and abdominal ultrasound examinations, the data results were collected and analyzed to obtain the risk factors.Results: In this research, there were 7,373 cases of valid data in the area of Inner Mongolia and 1,500 cases in the area of Mongolia. The mean age of the whole survey samples was 52.86 ± 13.90, and the ratio of the female (58.35%) was much higher than that of the male (41.65%). Both univariate analysis and multivariate analysis in this study showed that the female (14.7%) had a higher risk of hepatic echinococcosis than the male (10.9%). From the perspective of profession, children, educators and medical personnel had a lower incidence, herdsmen had the highest positive rate of the disease (15.8%). Living in pastoral areas, having been to pastoral areas, eating uncooked food and drinking unboiled water, raising dogs and surrounding activities of foxes and voles can also increase the risk of positivity.Conclusions: Our findings demonstrate that the most important risk factor of hepatic echinoccosis is unhealthy lifestyles and customs in farmers and herdsmen. It is possible to provide a basis for related authorities to make effective protective measures aiming at hepatic echinococcosis.


2019 ◽  
Vol 9 ◽  
Author(s):  
Kyle K. Kesler ◽  
Timothy S. Brown ◽  
J. Ryan Martin ◽  
Bryan D. Springer ◽  
Jesse Otero

Aims: In the setting of rising healthcare costs, more cost efficiency in total hip arthroplasty (THA) is required. Following THA, most patients are monitored with serial hemoglobin testing despite few needing blood transfusions.  This testing adds cost and may not be necessary in most patients.  This study aims to identify factors associated with transfusion, therefore guiding hemoglobin monitoring following THA.Patients and Methods: Patients who underwent primary THA in 2015 were identified using the National Surgical Quality Improvement Project (NSQIP) database.  Patient discharged on the day of surgery were excluded. Patients were classified into those receiving transfusion versus no transfusion. Demographics and comorbidities were compared between groups followed by univariate and multivariate analysis, allowing identification of patient characteristics and comorbidities associated with transfusion. Results: Overall, 28664 patients who underwent THA patients were identified.  Within this group, 6.1% (n=1737) had a post-operative transfusion.  Patients receiving a blood transfusion were older, had lower body mass index, and had higher rates of chronic obstructive pulmonary disease (COPD), heart failure, dialysis, prior transfusion, and were more frequently ASA class 3-4 (p<0.001).  Univariate analysis demonstrated that patients requiring transfusion had higher complication rates (4.3% vs. 12.8%, p<0.0001).  Multivariate analysis identified age >70, diabetes, smoking, COPD, prior transfusion, and operative time >2 hours as independent risk factors for transfusion.Conclusion: Among THA patients, characteristics and comorbidities exist that are associated with increased likelihood of transfusion.  Presence of these factors should guide hemoglobin monitoring post-operatively. Selective hemoglobin monitoring can potentially decrease the cost of THA. 


2017 ◽  
Vol 38 (4Supl1) ◽  
pp. 2845 ◽  
Author(s):  
Renata Bezerra Marujo ◽  
Helio Langoni ◽  
Leila Sabrina Ullmann ◽  
Maysa Pellizzaro ◽  
Ramiro Das Neves Dias Neto ◽  
...  

Toxoplasmosis is a parasitic zoonosis with worldwide distribution and different wild species either are involved in maintenance of the pathogen in the environment as definitive or intermediate hosts serving as font of feeding or prey to definitive hosts. The present study aimed to investigate Toxoplasma gondii antibodies and the risk factors relating to infection in mammals at Sorocaba Zoo, state of São Paulo, Brazil. Serum samples collected from 153 animals were analyzed using the modified agglutination test (MAT; cutoff ? 25). Seropositivity was found in 62 animals (40.5%; 95% CI: 33.1-48.5%), with different titers. Significant differences were observed in relation to the ages of the animals, origin, presence of free-ranging animals in the enclosure and feeding habits, through univariate analysis (p ? 0.05). Multivariate logistic regression analysis showed that only age (p = 0.03) had significance for the study. Adult animals were 3.5 more likely to become infected than were young ones. In relation to feeding habits, herbivores (80%) and carnivores (46.5%) were the animals most affected. These results highlight the presence of T. gondii in animals at Brazilian zoos, and suggest that continuous transmission is occurring at zoos.


2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S231-S231
Author(s):  
Elizabeth Cusack ◽  
Kaylee Maynard ◽  
Ted Louie ◽  
John Gorczyca ◽  
Courtney M Jones ◽  
...  

Abstract Background Surgical site infection is concerning after an open fracture. The Eastern Association for the Surgery of Trauma guidelines provide antibiotic selection and duration recommendations based on open fracture type. Risk factors for open fracture complications (e.g. infection, acute kidney injury [AKI], multi-drug resistant organisms [MDRO], or Clostridioides infection [C. difficile]) and overall guideline adherence are unclear at our institution. Methods This was a single center, retrospective study of adult patients with an open fracture who received antibiotic prophylaxis and were admitted for at least 24 hours between March 2011 and October 2020. Patients were excluded if open fracture was due to gun-shot wound, had a history of renal replacement therapy, MDRO, or C. difficile infection, were an outside hospital transfer, received antibiotics for another indication, or had a delayed presentation. The primary outcome was to identify risk factors for infection and secondary outcomes to identify risk factors for AKI, MDRO, C. difficile infection, and to evaluate guideline adherence. Patient demographics including injury details and management, microbiologic cultures, and antibiotic information were collected. Data were analyzed by univariate analysis, as appropriate, and logistic regression. Results A total of 401 patients met study criteria; median age 46 years, 62% male, and 77% white. Fracture classifications were similar: 30% type I, 39% type II, and 30% type III. Infection occurred in 18% of patients, AKI in 18%, MDRO in 3%, and no patients developed C. difficile. Of those with culture-positive infection, 51% grew gram-positive organisms. In bivariate analysis, fracture classification (p=0.023), medical fracture management (p=0.034), and antibiotic choice (p=0.004) were associated with infection. The only independent risk factor associated with AKI was receiving a nephrotoxic medication (p=0.012). Eighty-one percent received guideline adherent antibiotics and of those that received too narrow antibiotics, 36% developed an infection (p=0.004). Conclusion Appropriate fracture classification and antibiotic choice is crucial to reduce infection following open fracture. Reducing concomitant exposure to nephrotoxic agents may reduce the risk of AKI. Disclosures All Authors: No reported disclosures


2021 ◽  
Vol 9 (4) ◽  
pp. 8145-8150
Author(s):  
Shivaleela C ◽  
◽  
Khizer Hussain Afroze M ◽  
Ramesh P ◽  
Lakshmiprabha S ◽  
...  

Background: In cervical vertebrae, the costal and transverse elements are connected to each other around the foramen transversarium of the transverse process. The adult cervical vertebrae are characterized by the presence of Foramen Transversarium (FT) in transverse process. These transverse foramina are found to have variations in size, shape and numbers and may be absent, incomplete or duplicate, which may lead to various symptoms. Aim: To study the anatomical variations of cervical vertebrae. Materials and methods: The present observational study was performed on 182 dry human cervical vertebrae of unknown sex and age. Intact cervical vertebrae without any degenerative or traumatic disorders were included in this study. Deformed and damaged vertebrae were excluded from the study Results: Out of these 364 foramen transversarium, 98 (27%) foramen transversarium were of type-I. Type -I was the most common presentation in the present study. Type -II foramen transversarium were seen in 33 (09%) foramen transversarium. Out of 364 foramen transversarium 88 (24%) foramen transversarium were of type-III. Type-IV foramen transversarium were seen in 62 (17%) foramen transversarium. Type-V foramen transversarium were seen on 83 (23%) foramen transversarium. Out of 182 vertebrae 40 (22%) showed complete double foramen transversarium. Incomplete double foramen transversarium were seen in 24 (13%) of vertebrae. One side complete & other side incomplete foramen transversarium were seen in 04 (02%) vertebrae. Conclusion: Knowledge of such variations is important for Physicians, Neurologists Otorhinolaryngologists, radiologists and Orthopedicians. Presence of accessory foramen transversarium especially of incomplete variety, the second part of vertebral artery may be dislodged and prone to get damaged easily during posterior cervical injuries. It helps in radiological imaging, neurological diagnosis and complex surgical procedures in the cervical area. KEY WORDS: Cervical Vertebrae, Foramen transversarium, Accessory Foramen Transversarium.


2001 ◽  
Vol 44 (3) ◽  
pp. 181-182 ◽  
Author(s):  
Eustachio Nettis ◽  
Porzia Dambra ◽  
Anna Lucia Soccio ◽  
Maria Paola Loria ◽  
Antonio Ferrannini ◽  
...  

2001 ◽  
Vol 10 (2) ◽  
pp. 112-116 ◽  
Author(s):  
LC Hussey ◽  
L Hynan ◽  
B Leeper

BACKGROUND: Differences between men and women in complication rates after cardiac surgery have been reported. The rate of one of the most severe postoperative complications, sternal wound infection, has not been compared between the sexes. OBJECTIVE: To compare the frequencies of 21 risk factors for sternal wound infection between men and women. METHODS: Records of 306 patients who had cardiac surgery between 1989 and 1999 at 3 different hospitals in the southwestern and southeastern United States were reviewed for 21 risk factors. Of the 306 patients, 115 (25 women and 90 men) had experienced a sternal wound infection and 191 randomly selected patients (52 women and 139 men) had not. RESULTS: Three risk factors occurred at significantly different rates in men and women. Smoking and use of a single internal mammary artery for grafting were more common in men than women. Women were older than men at the time of cardiac surgery. Logistic regression analyses showed that the 3 dichotomous risk factors (use of single internal mammary artery for grafting, smoking, age &gt; 70 years) that univariate analysis indicated were significantly related to sex could also be used to predict infection group. CONCLUSIONS: This study contributes to the awareness of the possible differences between men and women in the risk of sternal wound infection developing after cardiac surgery. Although 3 risk factors occurred at significantly different rates in men and women, further research is needed to determine the effects that these differences in risk factors may have on the occurrence of sternal wound infection in men and women.


2021 ◽  
Vol 30 (4) ◽  
pp. 268-274
Author(s):  
Anna Bekiari ◽  
George Pappas-Gogos ◽  
Dimitrios Dimopoulos ◽  
Efthalia Priavali ◽  
Konstantina Gartzonika ◽  
...  

Objective: Surgical site infections (SSIs) are associated with protracted hospitalisation, antibiotics administration, and increased morbidity and mortality. This work investigated the incidence rate of SSIs in the Department of General Surgery at the University Hospital of Ioannina, Greece, the associated risk factors and pathogens responsible. Method: In this prospective cohort study, patients who underwent elective procedures under general anaesthesia were enrolled. Risk factors monitored included age, sex, body mass index, smoking, alcohol consumption, preoperative length of stay, chemoprophylaxis, intensive care unit (ICU) stay, American Society of Anesthesiology (ASA) score, and the National Nosocomial Infections Surveillance System (NNIS) basic SSI risk index. Results: Of the 1058 enrolled patients, 80 (7.6%) developed SSIs. Of the total cohort, 62.5% of patients received chemoprophylaxis for >24 hours. A total of 20 different pathogens, each with multiple strains (n=108 in total), were identified, 53 (49.5%) Gram-negative rods, 46 (42%) Gram-positive cocci, and nine (8.4%) fungi (Candida spp.). Escherichia coli was the prevalent microorganism (24.3%). SSI-related risk factors, as defined by univariate analysis, included: ICU stay, ASA score >2 (p<0.001), NNIS score >0, and wound classes II, III, and IV. Also, serum albumin levels <3.5g/dl were associated with increased rate of SSIs. The multivariate model identified an NNIS score of >0 and wound classes II, III, and IV as independent SSI-related risk factors. Conclusion: This study showed high SSI rates. Several factors were associated with increased SSI rates, as well as overuse of prophylactic antibiotics. The results of the present study could be a starting point for the introduction of a system for recording and actively monitoring SSIs in Greek hospitals, and implementation of specific guidelines according to risk factors.


Sign in / Sign up

Export Citation Format

Share Document