Case Series Regarding Parastomal Variceal Bleeding: Presentation and Management

2018 ◽  
Vol 17 (5) ◽  
pp. 0-10
Author(s):  
John Romano ◽  
Charles V. Welden ◽  
Jordan Orr ◽  
Brendan McGuire ◽  
Mohamed Shoreibah
Keyword(s):  
Portal Hypertension ◽  
High Risk ◽  
Literature Review ◽  
Variceal Bleeding ◽  
Coil Embolization ◽  
Case Series ◽  
Treatment Modalities ◽  
Post Procedure ◽  
Lost To Follow Up

Parastomal variceal bleeding (PVB) is a serious complication occurring in up to 27% of patients with an ostomy and concurrent cirrhosis and portal hypertension. The management of PVB is difficult and there are no clear guidelines on this matter. TIPS, sclerotherapy, and /or coil embolization are all therapies that have been shown to successful manage PVB. We present a case series with five different patients who had a PVB at our institution. The aim of this case series is to report our experience on the management of this infrequently reported but serious condition. We also conducted a systemic literature review focusing on the treatment modalities of 163 patients with parastomal variceal bleeds. In our series, patient 1 had embolization and sclerotherapy without control of bleed and expired on the day of intervention due to hemorrhagic shock. Patient 2 had TIPS in conjunction with embolization and sclerotherapy and had no instance of rebleed 441 days after therapy. Patient 3 did not undergo any intervention due to high risk for morbidity and mortality, the bleed self-resolved and there was no further rebleed, this same patient died of sepsis 73 days later. Patient 4 had embolization and sclerotherapy and had no instance of rebleed 290 days after therapy. Patient 5 had TIPS procedure and was discharged five days post procedure without rebleed, patient has since been lost to follow-up.

scholarly journals 321. Eleven-year Case Series of the Anatomy and Microbiology of Musculoskeletal Infections in People who Inject Drugs

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S232-S233
Author(s):  
Meredith A Schade ◽  
Abby London ◽  
Dan Lin
Keyword(s):  
Staphylococcus Aureus ◽  
Soft Tissue ◽  
Case Series ◽  
Axial Skeleton ◽  
Injection Drug ◽  
Treatment Modalities ◽  
Appendicular Skeleton ◽  
Diagnosis Codes ◽  
Lost To Follow Up

Abstract Background Complex musculoskeletal infections(MSKI) can be seen in injection drug users. The objective of the study was to describe the anatomic location and microbial etiology of MSKI. Methods This is a single center, eleven-year case series of adult patients admitted with infection of the musculoskeletal system from January 1, 2008 to December 31, 2018. Diagnosis codes for MSKI were used. As there are no diagnosis codes that specifically identify injection drug use, ICD-9 and ICD-10 codes for related diagnoses were used. The codes included opioid use disorder, drug abuse, heroin use, drug overdose, cocaine use, and methamphetamine use.Charts were then carefully reviewed to determine if a MSKI related to IDU had occurred. Fisher’s exact test was used to calculate P values. Results A total of 849 individual medical records were identified. Eighty-six distinct episodes of infection were found in eighty-two patients. Most patients were white, non-Hispanic, male, 50 years of age or younger. Tobacco use disorder(87.8%) and hepatitis C(64.6%) were common. Mental health disorders were identified in one third. The axial skeleton was involved in 61.6% and the appendicular in 25.6%. Soft tissue infection alone was present in 9%. Bacterial infections predominated with Staphylococcus aureus most frequent(67.4%) followed by Pseudomonas aeruginosa (11.6%). Candida species were uncommon. All soft tissue infections were polymicrobial. Infections of the appendicular skeleton were managed with antibiotics and surgery whereas infections of the axial skeleton were more likely to receive antibiotics alone. Seventy two percent had successfully completed treatment at one year. The remainder had relapsed due to same infection, died or were lost to follow up. Demographics of Study Population Anatomy and Microbiology of MSKI in PWID and 1-year Treatment Outcomes Anatomy and Microbiology of MSKI in PWID with Different Treatment Modalities Conclusion MSKI in PWID continue to be found in younger persons with relatively few comorbidities. The infections predominantly involve the axial skeleton and are caused most often by Staphylococcus aureus. Gram-negative infections also occur and are due to environmental bacteria. Spinal infections were managed medically whereas infections of peripheral joints were also managed with surgery. An unfortunate number had relapse of infection, died or were lost to follow-up at 1 year, demonstrating the challenges of managing MSKI in this unique population Disclosures All Authors: No reported disclosures

scholarly journals Stent patency and outcome of TIPS through the left versus the right portal branches

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Mohamed S. Alwarraky ◽  
Hasan A. Elzohary ◽  
Mohamed A. Melegy ◽  
Anwar Mohamed
Keyword(s):  
Portal Hypertension ◽  
Clinical Outcome ◽  
Portal Vein ◽  
Variceal Bleeding ◽  
Patency Rate ◽  
Hospital Admissions ◽  
Stent Patency ◽  
Left Branch ◽  
The Right

Abstract Background Our purpose is to compare the stent patency and clinical outcome of trans-jugular intra-hepatic porto-systemic shunt (TIPS) through the left branch portal vein (TIPS-LPV) to the standard TIPS through the right branch (TIPS-RPV). We retrospectively reviewed all patients (n = 54) with refractory portal hypertension who were subjected to TIPS-LPV at our institute (TIPS-LPV) between 2016 and 2018. These patients were matched with 56 control patients treated with the standard TIPS-RPV (TIPS-RPV). The 2 groups were compared regarding the stent patency rate, encephalopathy, and re-interventions for 1 year after the procedure. Results TIPS-LPV group showed 12 months higher patency rate (90.7% compared to 73.2%) (P < 0.005). The number of the encephalopathy attacks in the TIPS-LPV group was significantly lower than that of the TIPS-RPV group at 6 and 12 months of follow-up [P = 0.012 and 0.036, respectively]. Re-bleeding and improvement of ascites were the same in the two groups [P > 0.05]. Patients underwent TIPS-LPV needed less re-interventions and required less hospitalizations than those with TIPS-RPV [P = 0.039 and P = 0.03, respectively]. Conclusion The new TIPS approach is to extend the stent to LPV. This new TIPS-LPV approach showed the same clinical efficiency as the standard TIPS-RPV in treating variceal bleeding and ascites. However, it proved a better stent patency with lower rates of re-interventions, encephalopathy, and hospital admissions than TIPS through the right branch.

scholarly journals Splenic Artery Embolisation for the Emergency Treatment of Sinistral Portal Hypertension: A Systematic Review

2021 ◽  
Vol 5 (02) ◽  
pp. 079-085
Author(s):  
Harriet Grout-Smith ◽  
Ozbil Dumenci ◽  
N. Paul Tait ◽  
Ali Alsafi
Keyword(s):  
Systematic Review ◽  
Portal Hypertension ◽  
Variceal Bleeding ◽  
Splenic Artery ◽  
Splenic Vein ◽  
Treatment Modalities ◽  
Portal System ◽  
Technical Success Rate ◽  
Randomized Controlled Studies ◽  
Sinistral Portal Hypertension

Abstract Objectives Sinistral portal hypertension (SPH) is caused by increased pressure on the left portal system secondary to splenic vein stenosis or occlusion and may lead to gastric varices. The definitive management of SPH is splenectomy, but this is associated with significant mortality and morbidity in the acute setting. In this systematic review, we investigated the efficacy and safety of splenic artery embolisation (SAE) in managing refractory variceal bleeding in patients with SPH. Methods A comprehensive literature search was conducted using MEDLINE and Embase databases. A qualitative analysis was chosen due to heterogeneity of the studies. Results Our search yielded 339 articles, 278 of which were unique. After initial screening, 16 articles relevant to our search remained for full text review. Of these, 7 were included in the systematic review. All 7 papers were observational, 6 were retrospective. Between them they described 29 SAE procedures to control variceal bleeding. The technical success rate was 100% and there were no cases of rebleeding during follow up. The most common complication was post-embolisation syndrome. Four major complications occurred, two resulting in death. These deaths were the only 30-day mortalities recorded and were in patients with extensive comorbidities. Conclusions Although there is a distinct lack of randomized controlled studies comparing SAE to other treatment modalities, it appears to be safe and effective in treating hemorrhage secondary to SPH.

scholarly journals Multiple Victims of Carbon Monoxide Poisoning in the Aftermath of a Wildfire: A Case Series

2018 ◽  
Vol 31 (3) ◽  
pp. 146 ◽  
Author(s):  
Luís Ramos dos Santos ◽  
Magna Alves-Correia ◽  
Margarida Câmara ◽  
Manuela Lélis ◽  
Carmo Caldeira ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Hyperbaric Oxygen ◽  
Clinical Symptoms ◽  
Carbon Monoxide Poisoning ◽  
Case Series ◽  
Neurological Syndrome ◽  
High Flow Oxygen ◽  
Lost To Follow Up ◽  
Mean Time

Introduction: Carbon monoxide poisoning may occur in several contexts.Material and Methods: Retrospective of 37 carbon monoxide poisoning cases that underwent hyperbaric oxygen during wildfires in Funchal in August 2016.Results: The studied sample included 37 patients, mean age of 38 years, 78% males. Ten were firefighters, four children and two pregnant victims. Neurological symptoms were the most reported. Median carboxyhemoglobin level was 3.7% (IQR 2.7). All received high-flow oxygen from admission to delivery of hyperbaric oxygen. Persistence of symptoms was the main indication for hyperbaric oxygen. Median time to hyperbaric oxygen was 4.8 hours (IQR 9.5), at 2.5 ATA for 90 minutes, without major complications. Discharge in less than 24 hours occurred in 92% of the cases. Thirty days follow-up: five patients presented clinical symptoms of late neurological syndrome; twelve patients were lost to follow-up. Carboxyhemoglobin levels on admission and mean time to hyperbaric oxygen were no different between those who did and did not develop the syndrome at 30 days (p = 0.44 and p = 0.58, respectively).Discussion: Late neurological syndrome at 30 days occurred in 20% and no new cases were reported at 12 months.Conclusion: Use of hyperbaric oxygen appears to have reduced the incidence of the syndrome. This seems to be the first Portuguese series reporting use of hyperbaric oxygen in carbon monoxide poisoning due to wildfires. The authors intend to alert to the importance of referral of these patients because the indications and benefits of this treatment are well documented. This is especially important given the ever-growing issue of wildfires in Portugal.

WHO IS LOST TO FOLLOW-UP?

PEDIATRICS ◽  
1989 ◽  
Vol 84 (5) ◽  
pp. A38-A38
Author(s):  
Student
Keyword(s):  
High Risk ◽  
Major Effect ◽  
Dropout Rates ◽  
Time Interval ◽  
Environmental Characteristics ◽  
Developmental Status ◽  
Loss To Follow Up ◽  
High Risk Infants ◽  
Lost To Follow Up

The belief that impaired infants are more likely to continue in follow-up is. . .not supported. The infant's developmental status significantly influenced loss to follow-up only between the 18-to 36-month time interval. Here, more babies in the dubious (vs abnormal) category withdrew. In general our findings suggest that environmental characteristics exert the major effect on dropout rates in high risk infants and their controls.

Hearing Screening of High-Risk Newborns with Brainstem Auditory Evoked Potentials: A Follow-up Study

PEDIATRICS ◽  
1984 ◽  
Vol 73 (1) ◽  
pp. 22-26 ◽  
Author(s):  
Dorothy A. Shannon ◽  
Jacob K. Felix ◽  
Allan Krumholz ◽  
Phillip J. Goldstein ◽  
Kenneth C. Harris
Keyword(s):  
Hearing Loss ◽  
High Risk ◽  
Predictive Value ◽  
Screening Test ◽  
Normal Hearing ◽  
Hearing Screening ◽  
Auditory Evoked Potential ◽  
Hearing Level ◽  
Lost To Follow Up

Numerous techniques have been used in attempts to find a reliable and efficient screening method for determining auditory function in the newborn. The brainstem auditory evoked potential (BAEP) is the latest method advocated for that purpose. The BAEP was evaluated as a hearing screening test in 168 high-risk newborns between 35 and 45 weeks of conceptual age. Follow-up data were obtained after 1 year (mean 17.3 months) on 134 of the infants (80%). Normal hearing was defined as a reproducible response in both ears to a 25 dB normal hearing level (nHL) click stimulus; 21 infants (12.5%) failed the initial screening test. Follow-up on 19/21 infants revealed 18 infants with normal hearing and one infant with an 80 dB nHL bilateral hearing loss substantiated. One infant with an abnormal screening test died before retesting, and the other infant was lost to follow-up but had only a unilaterally abnormal BAEP. None of the infants with a normal BAEP screening study had evidence of hearing loss on retesting. Sensitivity of the BAEP was 100%, specificity was 86%, predictive value of a positive test was 5.26%, and the predictive value of a negative test was 100%. The incidence of significant hearing loss in our population was between 0.75% (1/134 infants) confirmed, and 2.24% (3/134 infants) including infants who failed screening but were lost to follow-up. The BAEP is a sensitive procedure for the early identification of hearing-impaired newborns. However, the yield of significant hearing abnormalities was less than predicted in other studies using BAEP for newborn hearing screening.

scholarly journals Consecutive Case Series of Healed Single-Molar Sites Immediately Restored with Wide-Diameter Implants: A 1-Year Evaluation

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Hadi Antoun ◽  
Pierre Cherfane ◽  
Bouchra Sojod
Keyword(s):  
Success Rate ◽  
Case Series ◽  
Marginal Bone Loss ◽  
Wide Diameter ◽  
Bone Level ◽  
One Year ◽  
Lost To Follow Up ◽  
Single Crowns

Introduction. To evaluate outcomes of wide-diameter (6 mm) implants immediately provisionalized with cement-retained single crowns in posterior molar sites.Materials and Methods. Forty-eight consecutive patients received a total of 53 moderately rough-surface, 6 mm diameter implants in healed sites. All implants were immediately provisionalized with a cement-retained provisional crown. Final prosthesis with cement-retained porcelain fused to metal crowns was delivered 3–6 months later. Patients were followed up for 1 year. Outcome measures were implant failures and success rate, complications, marginal bone levels, bone level changes, papilla index, bleeding on probing, and inflammation.Results. One patient was lost to follow-up. At one year, the implant survival and success rate were 98.1%. The mean marginal bone loss after 1 year was −0.17±1.84 mm. Ideal papilla score was recorded at 83.8% of the sites. More than 95.6% of the sites showed no bleeding or inflammation. No procedure-related or device-related adverse events were reported.Conclusion. Wide-diameter (6 mm) implants can safely and successfully replace single posterior molars. Longer follow-up studies are necessary to evaluate the long-term success of these implants.

LVIS Jr ‘shelf’ technique: an alternative to Y stent-assisted aneurysm coiling

2016 ◽  
Vol 8 (12) ◽  
pp. 1256-1259 ◽  
Author(s):  
Elizabeth Hai Yen Du ◽  
Jai Jai Shiva Shankar
Keyword(s):  
High Risk ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Case Series ◽  
Cell Design ◽  
Short Term ◽  
Aneurysm Neck ◽  
Closed Cell ◽  
Double Stent ◽  
Aneurysm Coiling

Wide-necked bifurcation intracranial aneurysms have traditionally not been amenable to coil embolization with the use of a single stent due to the high risk of coil prolapse. Y-configuration double stent-assisted coil embolization (‘Y-stenting’) of this aneurysm type has been shown to have generally good clinical outcomes, although the technique is complex with various challenges described in the literature. The compliant and flexible closed-cell design of braided stents such as the LVIS Jr allows for the creation of a ‘shelf’ across the aneurysm neck sufficient to prevent coil prolapse. We describe this novel ‘shelf’ technique and present a small case series of LVIS Jr stent-assisted wide-necked bifurcation intracranial aneurysm coiling in eight patients. Our small, albeit important, case series demonstrates that the ‘shelf’ technique is feasible and safe with very good short-term clinical and angiographic outcomes, and may obviate the need for Y-stenting.

scholarly journals Macroglossia Secondary to Systemic Amyloidosis: Case Report and Literature Review

2005 ◽  
Vol 84 (6) ◽  
pp. 358-361 ◽  
Author(s):  
Sandra Doria Xavier ◽  
Ivo Bussoloti Filho ◽  
Helena Müller
Keyword(s):  
Multiple Myeloma ◽  
Case Report ◽  
Literature Review ◽  
Clinical Condition ◽  
Abdominal Fat ◽  
Systemic Amyloidosis ◽  
Systemic Nature ◽  
Lost To Follow Up ◽  
Different Tissues

Amyloidosis is characterized by an abnormal extracellular deposition of amyloid in different tissues and organs, where it usually causes some type of dysfunction. Its cause is unknown. The two main forms of amyloidosis are systemic and localized; the latter is rare. No satisfactory treatment for systemic amyloidosis has been discovered, and mean survival is poor, ranging from 5 to 15 months depending on the presence or absence of multiple myeloma. We report a case of primary systemic amyloidosis in a 71-year-old man. The diagnosis of amyloidosis was established by tongue biopsy, and its systemic nature was identified by analysis of aspirated abdominal fat. At the 1-year follow-up, the patient's clinical condition had not changed, and he was thereafter lost to follow-up.

scholarly journals Long-term outcomes of acromegaly treated with fractionated stereotactic radiation: case series and literature review

2017 ◽  
Vol 4 (4) ◽  
pp. 255-262
Author(s):  
Ryan Rhome ◽  
Isabelle M Germano ◽  
Ren-Dih Sheu ◽  
Sheryl Green
Keyword(s):  
Systematic Review ◽  
Literature Review ◽  
Case Series ◽  
Tumor Control ◽  
Pituitary Neoplasms ◽  
Review Of The Literature ◽  
Biochemical Control ◽  
Low Incidence

Abstract Background Growth hormone (GH)-secreting pituitary adenomas represent an uncommon subset of pituitary neoplasms. Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) have been used as primary or adjuvant treatment. The purpose of this study is to report the long-term tumor control and toxicity from our institution and to perform a systematic literature review of acromegaly patients treated with FSRT. Methods We retrospectively reviewed all patients treated with FSRT (median dose 50.4 Gray [Gy], range 50.4–54 Gy) between 2005 and 2012 who had: 1) GH-secreting adenoma with persistently elevated insulin growth factor-1 (IGF-1) despite medical therapy and 2) clinical follow up >3 years after FSRT. Patients were treated with modern FSRT planning techniques. Biochemical control was defined as IGF-1 normalization. Systematic review of the literature was performed for FSRT in acromegaly. Results With a median follow-up of 80 months, radiographic control was achieved in all 11 patients and overall survival was 100%. Long-term biochemical control was achieved in 10 patients (90.9%) with either FSRT alone (36.4%) or FSRT with continued medical management (45.5%). No patient experienced new hypopituitarism, cranial nerve dysfunctions, or visual deficits. Our systematic review found published rates of biochemical control and hypopituitarism vary, with uniformly good radiographic control and low incidence of visual changes. Conclusions Adjuvant FSRT offered effective long-term biochemical control and radiographic control, and there was a lower rate of complications in this current series. Review of the literature shows variations in published rates of biochemical control after FSRT for acromegaly, but low incidence of serious toxicities.

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