scholarly journals Characteristics of a Breast Pathology Consultation Practice

2017 ◽  
Vol 141 (4) ◽  
pp. 578-584 ◽  
Author(s):  
Ellen G. East ◽  
Lili Zhao ◽  
Judy C. Pang ◽  
Julie M. Jorns
Keyword(s):  
Spindle Cell ◽  
Care Center ◽  
Tertiary Care ◽  
Routine Practice ◽  
Diagnostic Challenge ◽  
Breast Pathology ◽  
Prognostic Features ◽  
Tertiary Center ◽  
Lesion Classification

Context.— Intradepartmental consultation is a routine practice commonly used for new diagnoses. Expert interinstitutional case review provides insight into particularly challenging cases. Objective.— To investigate the practice of breast pathology consultation at a large tertiary care center. Design.— We reviewed breast pathology cases sent for private consultation and internal cases reviewed by multiple pathologists at a tertiary center. Requisitions and reports were evaluated for diagnostic reason for consultation, rate of multiple pathologist review at the tertiary center, use of immunohistochemistry, and, for private consultation cases, type of sender and concordance with the outside diagnosis. Results.— In the 985 private consultation cases, the most frequent reasons for review were borderline atypia (292 of 878; 33.3%), papillary lesion classification (151 of 878; 17.2%), evaluating invasion (123 of 878; 14%), subtyping carcinoma (75 of 878; 8.5%), and spindle cell (67 of 878; 7.6%) and fibroepithelial (65 of 878; 7.4%) lesion classification. Of 4981 consecutive internal cases, 358 (7.2%) were reviewed, most frequently for borderline atypia (90 of 358; 25.1%), subtyping carcinoma (63 of 358; 17.6%), staging/prognostic features (59 of 358; 16.5%), fibroepithelial lesion classification (45 of 358; 12.6%), evaluating invasion (37 of 358; 10.3%), and papillary (20 of 358; 5.6%) and spindle cell (18 of 358; 5.0%) lesion classification. Of all internal cases, those with a final diagnosis of atypia had a significantly higher rate of review (58 of 241; 24.1%) than those with benign (119 of 2933; 4.1%) or carcinoma (182 of 1807; 10.1%) diagnoses. Immunohistochemistry aided in diagnosis of 39.7% (391 of 985) and 21.2% (76 of 359) of consultation and internally reviewed cases, respectively. Conclusions.— This study confirms areas of breast pathology that represent diagnostic challenge and supports that pathologists are appropriately using expert consultation.

scholarly journals Profile and outcome of pediatric intussusception: a 5-year experience in a tertiary care center

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Aqeela J. Madan ◽  
Fayza Haider ◽  
Saeed Alhindi
Keyword(s):  
Seasonal Variation ◽  
Success Rate ◽  
Pediatric Population ◽  
Care Center ◽  
Tertiary Care ◽  
Operative Intervention ◽  
Secondary Outcome ◽  
Lead Point ◽  
Pneumatic Reduction ◽  
Tertiary Center

Abstract Background Intussusception is the most frequent cause of bowel obstruction in infants and toddlers; idiopathic intussusception occurs predominantly under the age of 3 and is rare after the age of 6 years; the highest incidence occurs in infants between 4 and 9 months; the gold standard for treatment of intussusception is non-operative reduction. This research will tackle the problem of pediatric intussusception in our center which is the largest tertiary center in our region. The primary outcome is to study the profile of intussusception; the secondary outcome is to assess the success rate of pneumatic reduction in the center’s pediatric population as well as to study the seasonal variation if present. Results During the study period, eighty-six (N=86) cases were identified, from which 10 cases were recurrent intussusception. Seventy-six (N=76) cases were included from the study period. N=68 (89%) were less than 3 years of age, and only N=2 (3%) were above 6 years. Seasonal variation was not significant; N=69 (91%) patients had successful pneumatic reduction under fluoroscopy while thirteen patients N=13 (17%) needed operative intervention. Conclusion Ileocolic intussusception is one of the most common pediatric surgical emergencies that can be successfully managed non-operatively in our institute; 89% of the cases were below 3 years of age, and no seasonal variation was demonstrated. Operative intervention was required in 13 cases with the main reason being lead point. The fact that the pediatric surgeon performs the reduction might have contributed to a high success rate reaching 91% in our center. This study provides a valuable opportunity for future regional data comparisons and pooled data analyses.

A prospective study to validate various clinical criteria used in classification of leprosy: a study from a tertiary care center in India

2018 ◽  
Vol 57 (9) ◽  
pp. 1107-1113 ◽  
Author(s):  
Manisha Thapa ◽  
Muthu Sendhil Kumaran ◽  
Tarun Narang ◽  
Uma N. Saikia ◽  
Gitesh U. Sawatkar ◽  
...  
Keyword(s):  
Prospective Study ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Clinical Criteria ◽  
A Prospective Study

Management of Endometriosis—A Two Years Study at a Tertiary Care Center

2010 ◽  
Vol 2 (1) ◽  
pp. 41-43
Author(s):  
K Kapur ◽  
M Biswas ◽  
GS Joneja ◽  
R Sharma ◽  
P Talwar
Keyword(s):  
Pelvic Pain ◽  
Ovulation Induction ◽  
Care Center ◽  
Tertiary Care ◽  
Expectant Management ◽  
Male Factor ◽  
Number Of Patients ◽  
Tertiary Center ◽  
Operative Endoscopy ◽  
Ivf Et

ABSTRACT Objective The purpose of this study was to analyze the line of treatment and its outcome in cases of endometriosis presenting with infertility and pelvic pain at a tertiary center having facilities of operative endoscopy and assisted reproductive technology. Methods All cases of Infertility and pelvic pain over a period of two years were subjected to laparoscopy. Patients who were diagnosed with endometriosis were classified into categories. Different system of classification was used for patients of Infertility and pelvic pain. A large number of patients were subjected to expectant management. Selected cases underwent IUI, IVF-ET and ICSI. The numbers of pregnancies were recorded in these cases. Patients with pelvic pain were treated with hormonal therapy. Results 1038 patients were studied over a period of 2 years out of which 983 presented with Infertility and 55 with pelvic pain. 294 cases of infertility were detected and biopsy proven to be having endometriosis and 20 of the 55 cases of pelvic pain were also detected to have endometriosis. In the infertility group 76 patients were found to have bilateral tubal block. 215 patients were detected to have various grades of lesions but with patent bilateral/unilateral tubes. 6 patients with blocked tubes and 11 patients with patent tube/tubes also were associated with male factor infertility. 88 patients with blocked tubes and/or male factor received treatment with IVF-ET/ICSI. 178 patients underwent ovulation induction and 28 were simply observed. There were 42.8% pregnancies in the observation group, 49.4% in the ovulation induction-IUI group and 45.4% in IVF-ET/ICSI group. Conclusion 30% of the cases of Infertility had endometriosis. Following operative endoscopy treatment for all cases, the occurrence of pregnancy was similar in patients who were simply observed and those who received treatment with ovulation induction-IUI. Those with mechanical problems of sperm-egg union are best treated with IVF-ET where facilities exist.

scholarly journals Comparison of Tubeless Mini Percutaneous Nephrolithotomy with Conventional Technique in a Tertiary Care Center

2022 ◽  
Vol 19 (1) ◽  
pp. 34-36
Author(s):  
Dipesh Kumar Gupta ◽  
Arun Gnyawali ◽  
Deepak Jaiswal
Keyword(s):  
Postoperative Pain ◽  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Care Center ◽  
Tertiary Care ◽  
Postoperative Blood Loss ◽  
Routine Practice ◽  
Standard Group ◽  
Nephrostomy Tube ◽  
Analgesic Requirement

Introduction: Mini Percutaneous Nephrolithotomy (mPCNL) is a safe and efficient method for management of nephrolithiasis. Post procedure nephrostomy tube drainage is considered as the standard practice. In recent years, tubeless mPCNL with the use of double J (DJ) stent alone has replaced the placement of the nephrostomy tube. Aims: This study intends to evaluate the safety and efficacy of tubeless Mini Percutaneous Nephrolithotomy. Methods: A total of 80 patients with Nephrolithiasis, admitted to Urology Unit of Nepalgunj Medical College, between September 2018 and September 2019 were enrolled in the study and divided into two groups: Tubeless group where tube was omitted and Standard Group where it was placed. The two groups were compared with respect to hemoglobin drop and blood transfusion requirement, hospital stay and analgesic requirement in the post-operative period. Results: Mean age of the patients was 34.30 ± 13.19 years. Mean stone size was 19.03 mm. The mean change in hemoglobin after standard mPCNL was 1.68 gm/dl and that in the tubeless group was 1.11 (p=0.018). The tubeless group had a significantly (p=0.001) shorter hospital stay (3.05 ± 1.23 days) compared to standard group (3.85 ± 0.86). The postoperative pain as assessed by visual analogue scale, was more in the standard group necessitating additional analgesia. It was significantly higher in the standard group at 12, 24, 48 hours, as compared to the tubeless group. Conclusion:  Placement of nephrostomy tube can be omitted as a routine practice as Tubeless mini PCNL has an added advantage of significantly reduced postoperative pain, less analgesic requirement, shorter hospital stay, less postoperative blood loss.

scholarly journals AN OBSERVATIONAL STUDY ON ASSESSMENT OF POSTOPERATIVE COMPLICATIONS AMONG PERFORATION PERITONITIS USING CLAVIEN-DINDO CLASSIFICATION IN TERTIARY CARE CENTER OF CENTRAL INDIA

2021 ◽  
Vol 9 (02) ◽  
pp. 922-937
Author(s):  
Ankur Deshwali ◽  
◽  
Sanjay Prasad ◽  
Akhilesh Kumar Patel ◽  
Rohan Chaphekar ◽  
...  
Keyword(s):  
Observational Study ◽  
Abdominal Surgery ◽  
Care Center ◽  
Tertiary Care ◽  
P Value ◽  
Complication Rates ◽  
Medical College ◽  
Sri Aurobindo ◽  
Perforation Peritonitis

Introduction :Surgical team always tries to provide consistently low incidence of major complications for patient undergoing any operation. Clavien-Dindo (CD) classification is the simplest way of reporting all complications. The main aim of this study was to test the usefulness of Clavien-Dindo classification in patients undergoing the abdominal surgery. In this study Clavien-Dindo classification has been used for assessment of postsurgical complications after major abdominal surgery. Material and method: It was an observational study of all perforation peritonitis patients admitted in sri aurobindo medical college and post graduate institute between november 2017 to may 2019 (1 and 1/2 Year) on the basis of Clavien-Dindo classification. Results :This was an observational prospective study was carried out in Department of General Surgery, Sri Aurobindo Medical College and P.G. Institute, Indore, which includes total 60 patients of perforation peritonitis admitted and treated in the department, During the period of November 2017 to May 2019. In our study Most common symptoms in patients presenting with perforation is Abdominal pain in 60 (100%) patients. 45(75%) patients had constipation & obstipation, 41 (68.33%) patients had vomiting ,33(55%) of patients had fever 17 (28.33%) patients had abdominal distensions the other common symptoms. Out of 60 patients, all 60(100%) patients had abdominal tenderness and guarding, 47 (78.33%) patients had absent bowel sounds, 42(70%) patients had tachycardia, 26 (43.33%) patients had hypotension, 23 (38.33%) patients had tachypnoea and 21 (35%) patients had low urinary output. In 16 (26.6%) patients comorbid conditions were present. In 10 (16.66%) patients multiple perforations were found out of which only 01 (10%) patient is haemodynamically stable and 09 (90%) patients were unstable. Complication occurred in 09(90%) patients and no complication were only in 01 (10%) patients. In this group 04(40%) patients got discharged and 6(60%) patient expired. P Value was 0.001 which is significant. In our study most common site of perforation was gastric perforation 30(49.18%) Complication according to clavien -dindo classification 14 out of 60 (23.33%) patients had no complications, 4 (6.66%) had grade I complication, 5 (8.33%) had grade II complications, 12 (20%) had grade III complications, 11 (18.33%) had grade IV complications, and 14 (23.33%) had grade V complication rates. Conclusion :Perforation peritonitis is a life-threatening condition and requires urgent hospital care, resuscitation and surgery. Early resuscitation and surgery are required to decrease morbidity and mortality. On the basis of risk stratification in Peritonitis patients its management requires lots of expensive modalities, skill, monitoring and treatment to provide better care to the patient. For the classification of complications, a new system is proposed by Clavien–Dindo which is very helpful during perforation surgery.Clavien- Dindo classification helps us to distinguish a normal postoperative course and the severity of complications, which allows us to compare postoperative morbidity and evaluate the outcomes. We also recommend a larger study with a bigger sample size for better analysis of clavien-dindo classification of complications and to confirm the findings of our study.

scholarly journals Study of pattern of congenital anomalies at tertiary center in Maharashtra, India

2018 ◽  
Vol 7 (7) ◽  
pp. 2802
Author(s):  
B. B. Yadav ◽  
S. B. Yadav ◽  
P. K. Damase
Keyword(s):  
Congenital Anomalies ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Second Trimester ◽  
Community Based ◽  
Common Pattern ◽  
Medical College ◽  
Obstetrics And Gynaecology ◽  
Tertiary Center

Background: To highlight common pattern of congenital malformation seen at hospital population of tertiary care center in Maharashtra.Methods: The study was a descriptive prospective study and conducted in the department of obstetrics and gynaecology of government medical college Latur, Maharashtra for a period of six months. Study includes all womens coming for 2nd trimester MTP due to congenital anomalies in foetus and women’s admitted in labour having anomalous foetus. Details of maternal age, parity, type of anomaly present and sex of fetus were noted.Results: Total babies born in the study period were 3482 (including the second trimester abortions). Total babies with congenital abnormality were 75, making the prevalence 2.15%. 10 cases (13.33) had multiple anomalies involving more than one system. The predominant system involved was central nervous system 40 (53.33%) followed by gastrointestinal system 15 (20%). In this study male babies affected more than females.Conclusions: Prevalence of the congenital anomalies will be definitely higher at tertiary care center and to know prevalence in community, more community based studies are required. Increased awareness about preventable risk factors may help in reducing the incidence of congenital anomalies.

scholarly journals Profile of Skin Biopsies and Patterns of Granulomatous Skin Diseases in a Tertiary Care Center of Western Nepal

2020 ◽  
Vol 3 (2) ◽  
pp. 288-293
Author(s):  
Ajay Kumar ◽  
Saujan Subedi ◽  
Jenny Pun ◽  
Binamra Basnet ◽  
Raja Babu Giri ◽  
...  
Keyword(s):  
Skin Diseases ◽  
Care Center ◽  
Tertiary Care ◽  
Cost Effective ◽  
Skin Lesions ◽  
Clinical Impression ◽  
Clinicopathological Correlation ◽  
Diagnostic Challenge ◽  
Cross Sectional ◽  
Skin Biopsies

Background: Granulomatous skin diseases are one of the leading causes of morbidity in tropical countries like Nepal. These granulomatous skin lesions often pose diagnostic challenge to clinicians as well as to dermatopathologists. Histopathologic examination of a biopsy specimen represents one of the most informative and cost-effective procedure and may help to avoid other, costlier and invasive diagnostic workup. Materials and Methods: This cross-sectional observational study from October 2018 to October 2019, at department of dermatology, enrolled 142 cases of skin biopsies. Correlation between clinical impression and histopathological findings was evaluated. Results: Out of 13940 dermatology visits/ consultations, 142 (1.01%) skin biopsies were performed. Head, neck and face were the commonest sites of biopsies (29.6%). The most common biopsy technique was incisional type in 70 (50.4%). Histopathology showed granulomatous features in 49 (34.8%) cases, out of which tuberculoid type was the commonest, in 29 (58.0%). Positive clinicopathological correlation was seen in 117/142 (82.4%) for all biopsies and 41/49 (85%) for granulomaous skin lesions. Conclusion: Tuberculoid type was the most common cutaneous granuloma. High clinicopathological correlation in our study supports histopathology as an important tool for diagnosis of granulomatous as well overall skin disorders.

P1007Efficacy and safety of atrial ablation procedures in patients with complete d-TGA and atrial switch at a Swiss tertiary center

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N Nozica ◽  
B Asatryan ◽  
F Noti ◽  
S H Baldinger ◽  
A Lam ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Slow Pathway ◽  
Complete Transposition ◽  
Atrial Ablation ◽  
Atrial Switch ◽  
Tertiary Center ◽  
Procedural Complications ◽  
Repeat Procedures

Abstract Introduction Patients with complete transposition of the great arteries (d-TGA) and atrial switch face a high lifetime risk of arrhythmias. Interventions in these patients are challenging because of their particular anatomy. Reports on ablation procedures in this patient population are scarce and missing for Switzerland. Method We retrospectively analyzed all ablation procedures performed in the above-mentioned population at a Swiss tertiary care center. Results Among 73 d-TGA pts. (71% male; N=37 Senning; N=36 Mustard) followed at our center, 17 ablations were performed in 11 pts. (15%; one ablation in 8 pts., two in 2 pts. and five in 1 patient). Median age at first ablation was 34 years (range 15–49 years). A total of 17 different intra-atrial reentry tachycardias (IART) and 3 AVNRT were targeted. Of the IART, 10 were cavotricuspid isthmus (CTI)-dependent and 7 were not. In two procedures (12%) only the systemic venous (SV) baffle was accessed for ablation. In 15 procedures (88%), ablation was performed within the pulmonary venous (PV) baffle. Access to the PV baffle was retrograde via the aorta in 6 cases (35%), via a baffle leak in 3 (18%) and via baffle puncture in 6 (35%). All procedures with retrograde approach to the PV baffle or with SV baffle only ablation were performed up to January 2012 and all remaining procedures afterwards. The 3 pts. requiring repeat procedures had retrograde or SV baffle approaches initially, and one additional ablation via baffle puncture was successful. The CTI was targeted in 10 pts. (91%) and ablation was finally successful in all with bidirectional block demonstrated in 8 pts. The coronary sinus was found to drain into the SV baffle in 5 pts. (46%) and useful for assessment of CTI block. The seven CTI-independent IART were scar-related micro-reentries. Ablation of all 3 AVNRTs was successful after one procedure without recurrence. Slow pathway ablation was performed in the SV baffle in two and in the PV baffle in one case (Figure). After a median follow-up of 7 months (range 2–186 months) 9 pts. are without recurrence and in 2 pts. rare self-limited arrhythmias still occur. No procedural complications occurred. Conclusion Arrhythmias in patients with complete d-TGA and atrial switch are mainly CTI-dependent IART or scar-related micro-reentries, and a few patients also have AVNRT. Ablation of these arrhythmias is safe and successful if PV baffle access is achieved via a baffle leak or baffle puncture.

Abstract 3229: Criteria for Appropriate Utilization of Helicopter Interfacility Transfer of ICH Patients

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Dustin J Calhoun ◽  
Shana Bogenschneider ◽  
Phaniraj Iyengar ◽  
Andrew W Asimos
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
High Sensitivity ◽  
Brainstem Compression ◽  
Tertiary Center ◽  
Ich Score ◽  
Gcs Score ◽  
To Receive ◽  
Neurosurgical Intervention

Background: Many intracranial hemorrhage (ICH) patients are emergently transferred to tertiary neurosurgical centers by helicopter emergency medical services (HEMS), yet no guidelines exist for HEMS use in acute ICH. The American Stroke Association (ASA) publishes guidelines for neurosurgical intervention in ICH patients. Additionally, high ICH scores have been shown to predict lethal ICHs. We hypothesized that an algorithm including ASA guideline criteria and ICH score would identify patients for whom HEMS transportation might be appropriate. Objectives: To determine, in ICH patients transferred by HEMS, (1) the sensitivity of ASA guidelines for predicting emergent neurosurgical intervention, and (2) the ability of an ICH score ≥4 to predict early mortality and failure to receive intervention. Methods: We conducted a retrospective chart review of ICH patients transported by HEMS to one tertiary care center between September 2008 and February 2011. We reviewed medical records and brain CTs from the hospital of first presentation to calculate ICH scores and to evaluate for the seven ASA guideline criteria: GCS score ≤8, herniation, intraventricular hemorrhage, hydrocephalus, brainstem compression, lobar clot >30 mL within 1 cm of the paranchymal surface, and cerebellar hemorrhage. We reviewed tertiary center records for neurosurgical interventions and in-hospital mortality. Results: Review of 137 patient records identified 86 patients with an ICH and an available initial brain CT. All patients who received an emergent intervention met at least one of the criteria (sensitivity 100%), while 16 (18.6%) patients transferred by HEMS met no ASA criteria. No patient with an ICH score of ≥4 (n=19) received an emergent neurosurgical intervention, and only one such patient survived to hospital discharge. Comparison of this group to all others produced a hazard ratio of 5.86. Thirty-five (40.7%) patients had either no ASA criteria or an ICH score ≥4. Conclusions: The ASA guidelines have high sensitivity for detecting those patients who will receive emergent neurosurgical intervention after transfer, while patients with ICH scores of ≥4 almost uniformly have lethal hemorrhages and do not undergo emergent intervention. An algorithm including the presence of at least one of the seven ASA ICH neurosurgical intervention criteria and an ICH score <4 can be used to screen for appropriate use of HEMS transport in acute ICH.

scholarly journals Peripartum hysterectomy at a tertiary center

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Monica Gurung ◽  
Gehanath Baral
Keyword(s):  
Cesarean Section ◽  
Placenta Previa ◽  
Care Center ◽  
Tertiary Care ◽  
Bladder Injury ◽  
Abnormal Placentation ◽  
Peripartum Hysterectomy ◽  
Tertiary Center ◽  
Emergency Peripartum Hysterectomy ◽  
Ruptured Uterus

Aims: To find out the incidence, indications, complication of emergency peripartum hysterectomy in a tertiary care center. Methods: This was a retrospective study conducted over a period of 18 months from April 2017 to October 2018 at Paropakar Maternity and Women’s Hospital in Kathmandu. Data were obtained from the operation theater register and record section. Results: Out of 30917 deliveries in 18 months 18 had lifesaving emergency peripartum hysterectomy (0.58 per 1000 deliveries). The most common indication being morbidly adherent placenta/placenta previa (8; 44%) followed by ruptured uterus (5; 28%), uterine atony (4; 22%). The most common risk factor is attributed to previous cesarean section (11; 61%) followed by abnormal placentation (7; 39%). Most common morbidity was febrile morbidity followed by wound infection and bladder injury. Conclusion: Abnormal placentation and past cesarean section contributed to be the major indication of peripartum hysterectomy.

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