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2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
N Thompson ◽  
I Street

Abstract Introduction Tonsillectomies are one of the most commonly performed procedures., with one particular leading tertiary paediatric centre performing 1,067 tonsillectomies within the last year. Post-tonsillectomy haemorrhage is a considerable complication leading to further primary care costs, readmission, and surgical intervention. Previous national audits have suggested that post-tonsillectomy haemorrhage rates are between 3.0-3.5%1 and readmission rates are approximately 8.8%2. Aim Assess post-tonsillectomy haemorrhage and readmission rates at a leading tertiary paediatric centre. Method A prospective phone survey was completed for every patient receiving a tonsillectomy 6 weeks post-operatively, using a 2-month inclusion period. Results Of the 51 patients included, 51 responded to phone survey. The total post-tonsillectomy haemorrhage rate was 23.5%. Of the 51 respondents, 10 (19.6%) were readmitted through A&E, all of which had extracapsular tonsillectomies. 1 (10%) of those readmitted had further surgical intervention whilst the remaining 9 (90%) were treated conservatively. A further 4 (7.8%) attended their GP, with 3 (75%) of those requiring antibiotics. Conclusions This data shows that both the post-tonsillectomy haemorrhage and readmission rates at the tertiary paediatric centre were higher than the national average. We suggest that previous national data audits describing bleeding rates lack the granularity to reveal true post-operative complication rates. Our prospective cohort has demonstrated that there may be a large proportion of patients with morbidity that never reach the attention of the ENT surgeon and additionally that subgroups in particular may benefit from interventions designed to minimise patients’ post-operative risks, including specific perioperative management and advice.


2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Tania Villagrasa ◽  
José Luis Garcia ◽  
Sonia Cleofe Jimenez Mendoza ◽  
Mario Lado Fuentes ◽  
Paloma Livianos Arias-Camisón ◽  
...  

Abstract Background and Aims Monotherapy immunotherapy with “check-point inhibitors” (anti PD-1, Anti PD-L1) is an effective therapy to advanced-stage cancer patients. Little is known about our experience and its renal implication, although it is related to fluid and electrolyte disorders or acute kidney failure (AKI). To evaluate changes in natremia or acute renal impairment (primary endpoints) in IV stage cancer patients with lung, bladder or melanoma neoplasm who have received monotherapy with pembrolizumab (PEM), atezolizumab (ATZ) or nivolumab (NIV). At the same time, analyze if there are differences between drug administered, underlying disease or having received cisplatin previously (secondary outcomes). Method single-center retrospective analysis. Inclusion period: January 2015 to September 2020. Dose administered: PEM 2mcg/kg/21 days; ATZ 1200mg/21 days; NIV 3mg/kg/ 21 days. Changes in natremia and GFR (CDK-EPI) were evaluated in 0,1,3 months of follow-up. Patients with combined chemotherapy were excluded. Results 137 patients were included. Mean age: 64 years. Men: 71.6%. Neoplasm: lung (76.8%), bladder (7.2%), melanoma (15.9%). Patients received 27.5% PEM; 26.1% ATZ; 46.4% NIV. Between all of them, 76% had received platinum previously. Up to 13.6% developed hyponatremia and 12.40% AKI 3 months later. The decrease in GFR was significantly greater in bladder neoplasm (mean GFR 42ml / min / m2 p <0.01) at three months. Bladder cancer was also the most frequent (but not significant) in reduced natremia (mean Na 135mEq / L p = 0.08). There were no differences according to drug administration or having received platinum previously. 61% were death, but none of them due to a renal event. Conclusion


2021 ◽  
Vol 10 (6) ◽  
pp. 1162
Author(s):  
Quentin Scanvion ◽  
Laurent Pascal ◽  
Thierno Sy ◽  
Lidwine Stervinou-Wémeau ◽  
Anne-Laure Lejeune ◽  
...  

Although pulmonary events are considered to be frequently associated with malignant haemopathies, they have been sparsely studied in the specific context of myelodysplastic syndromes (MDS). We aimed to describe their different types, their relative proportions and their relative effects on overall survival (OS). We conducted a multicentre retrospective cohort study. Patients with MDS (diagnosed according to the 2016 WHO classification) and pulmonary events were included. The inclusion period was 1 January 2007 to 31 December 2017 and patients were monitored until August 2019. Fifty-five hospitalized patients were included in the analysis. They had 113 separate pulmonary events. Thirteen patients (23.6%) had a systemic autoimmune disease associated with MDS. Median age at diagnosis of MDS was 77 years. Median time to onset of pulmonary events was 13 months. Pulmonary events comprised: 70 infectious diseases (62%); 27 interstitial lung diseases (23.9%), including 13 non-specific interstitial pneumonias and seven secondary organizing pneumonias or respiratory bronchiolitis–interstitial lung diseases; 10 pleural effusions (8.8%), including four cases of chronic organizing pleuritis with exudative effusion; and six pulmonary hypertensions (5.3%). The median OS of the cohort was 29 months after MDS diagnosis but OS was only 10 months after a pulmonary event. The OS was similar to that of the general myelodysplastic population. However, the occurrence of a pulmonary event appeared to be either an accelerating factor of death or an indicator for the worsening of the underlying MDS in our study. More than a third of pulmonary events were non-infectious and could be systemic manifestations of MDS.


2020 ◽  
Author(s):  
Esther Nadine van der Zee ◽  
Fabian Termorshuizen ◽  
Dominique D. Benoit ◽  
Nicolette F. de Keizer ◽  
Jan Bakker ◽  
...  

Abstract BackgroundOver the last decades, a decrease in short-term mortality in cancer patients admitted to the ICU has been described in literature. However, it is unclear whether this decrease also results in a decrease in long-term mortality. Therefore, we examined the 1-year mortality of cancer patients (either haematological or solid) with an unplanned ICU admission.Methods and dataAll adult patients registered in the National Intensive Care Evaluation registry with an unplanned ICU admission in the Netherlands between 2008 and 2017 were included. The primary outcome was 1-year mortality, analysed with a mixed-effects cox-proportional hazard regression. We examined the trend in mortality rates over the inclusion period. Furthermore, we compared the 1-year mortality of cancer patients to that of patients without cancer. ResultsWe included 470,305 patients: 10,401 with haematological cancer, 35,920 with solid tumours, and 423,984 without cancer. The 1-year mortality rates were 60.1%, 46.2%, and 28.3% (p<0.01), respectively. While no statistically significant trend was found (p=0.58), a visual inspection of the graph showed a slightly decreasing trend in 1-year mortality over the inclusion period. Although we found a statistical significant difference in 1-year mortality in patients with a solid tumour (p<0.01), visual inspection showed a wide variety per year. We found a decreasing trend in 1-year mortality in ICU patients without a malignancy (p<0.01). Cancer patients surviving their critical illness and hospital admission had a 30% mortality at 1 year. ConclusionThe 1-year mortality in cancer patients with an unplanned ICU admission (either haematological or solid) was significantly higher than that of patients without cancer. A visual inspection showed a slight decrease in 1-year mortality in haematological patients, while the 1-year mortality in patients with a solid tumour varied per year. After hospital discharge, a considerable part of the patients with a malignancy died within 1 year. Physicians should discuss the long-term prognosis after an ICU admission with patients and relatives in order to manage treatments and expectations. Future research should focus on identifying cancer patients who will benefit from an ICU admission.


Diagnostics ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. 352
Author(s):  
Claus Madsen ◽  
Peter Østergren ◽  
Christian Haarmark

Background: Inconclusive bone scans are a challenge but there is no consensus about follow-up imaging. We evaluated the use of 68gallium-labelled prostate-specific membrane antigen (68Ga-PSMA) PET/CT if 18F-sodium fluoride (18F-NaF) PET/CT was inconclusive. Methods: This retrospective study included patients with no previously known bone metastases who had one or more equivocal bone lesions on 18F-NaF PET/CT and underwent additional 68Ga-PSMA PET/CT. The bone lesions were deemed as true metastases or not based on follow-up by surveying supplemental imaging modalities and hospital records. A subgroup of patients with “most valid follow-up” was created, which included patients with unmeasurable PSA after prostatectomy or subsequent imaging (additional 18F-NaF PET/CT, 68Ga-PSMA PET/CT, CT, or MRI). Results: Of the 2918 patients referred for 18F-NaF PET/CT from the department of urology in the inclusion period, 51 (1.7%) were inconclusive regarding bone metastases and underwent additional 68Ga-PSMA PET/CT. Thirteen of these patients (25%) were ultimately diagnosed with bone metastases. Patient-based sensitivity, specificity, and accuracy of additional 68Ga-PSMA PET/CT were 100%, 95%, and 96%, respectively. In patients with “most valid follow-up”, the same parameters were 100%, 93%, and 94%, respectively. Conclusion: 68Ga-PSMA PET/CT is an excellent complementary modality in when 18F-NaF PET/CT is equivocal.


Author(s):  
Sergey Panchenko

Issue of clinical polymorphism is especially important in the diagnosis of conditions that are clinically manifested by the complex of symptoms of a «floppy baby». It is not a separate nosological form, its clinical features are not specific, the course and outcome are variable. Diffuse muscular hypotonia can be a sign of a large number of somatic and neurological diseases, in particular, hereditary metabolic diseases and degenerative diseases of the nervous system. According to the level of damage, it can be classified into hypotonia of central and peripheral origin. Their differential diagnosis is carried out according to a number of criteria. Differences in treatment tactics and prognosis of opportunities during inclusion period determine importance of topical diagnosis of the degree of damage. Timely determination of this syndrome in a child allows to start searching for the causes of this condition and comprehensive treatment.


2019 ◽  
Vol 8 (3) ◽  
pp. 345 ◽  
Author(s):  
Tobias Kuster ◽  
Christian Nickel ◽  
Mirjam Jenny ◽  
Lana Blaschke ◽  
Roland Bingisser

The predictive power of certain symptoms, such as dyspnoea, is well known. However, research is limited to the investigation of single chief complaints. This is in contrast to patients in the emergency department (ED) presenting usually more than one symptom. We aimed to identify the most common combinations of symptoms and to report their related outcomes: hospitalisation, admission to intensive care units, and mortality. This is a secondary analysis of a consecutive sample of all patients presenting to the ED of the University Hospital Basel over a total time course of 6 weeks. The presence of 35 predefined symptoms was systematically assessed upon presentation. A total of 3960 emergency patients (median age 51, 51.7% male) were included. Over 130 combinations of two, 80 combinations of three, and 10 combinations of four symptoms occurred 42 times or more during a total inclusion period of 42 days. Two combinations of two symptoms were predictive for in-hospital mortality: weakness and fatigue (Odds ratio (OR) = 2.45), and weakness and headache (OR = 3.01). Combinations of symptoms were frequent. Nonspecific complaints (NSCs), such as weakness and fatigue, are among the most frequently reported combinations of symptoms, and are associated with adverse outcomes. Systematically assessing symptoms may add valuable information for prognosis and may therefore influence triage, clinical work-up, and disposition.


2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 111-111
Author(s):  
Alan Ainsworth ◽  
Michael Larsen ◽  
Claus Fristrup

Abstract Background Minimal invasive oesophagectomy has gained increasing popularity. This study reports the results of the first two years after introducing the technique at our department. Methods All procedures have been prospectively registered in a database. All patients were followed until death, 2 years after surgery, or end of the inclusion period. Results 140 procedures were performed (23 November 2015 to 1 February 2018). There were 19 women and 121 men. Median age was 67 years (range 16–83 years). Pathologic T-and N-stage is shown in table 1. Patients were divided into the first 70 patients and the last 70 patients. The mean procedure time was 352 minutes for the ‘first patients’ and 331 minutes for the ‘last patients’ (P < 0.001). The risk for conversion to open surgery in the abdominal procedure was 6% for the ‘first patients’ and 9% for the ‘last patients’ (NS). For the thoracic procedure the corresponding figures were 11% and 6% (NS), respectively. Median length of postoperative stay was 9 days for both groups. The risk of anastomotic leakage was 16% (‘first patients’) and 11% (‘last patients’) (NS). However, in only 4% and 7%, respectively, endoscopic or surgical treatment was required. For all 140 patients, pulmonary complications were observed in 26 cases (18%) and cardiac complications were registered in 15 cases (11%).The 30 day mortality rate was 3% (131 patients) and the 1 year survival rate was 83% (53 patients). Table 1: Pathologic T-and N-stage Conclusion Minimal invasive oesophagectomy can be introduced at a department with acceptable short time morbidity. Disclosure All authors have declared no conflicts of interest.


2015 ◽  
Vol 31 (3) ◽  
pp. 192-197 ◽  
Author(s):  
Charlotte L Deijen ◽  
Michiel A Schreve ◽  
Jan Bosma ◽  
A Jorianne de Nie ◽  
Vanessa J Leijdekkers ◽  
...  

Objectives Mechanochemical endovenous ablation is a novel technique for the treatment of great saphenous vein and small saphenous vein incompetence which combines mechanical injury of the endothelium with simultaneous infusion of liquid sclerosant. The main objective of this study was to evaluate early occlusion. Methods All consecutive patients who were eligible for the treatment with mechanochemical endovenous ablation were included. Inclusion period was from the introduction of the device in the hospitals (September 2011 and December 2011) until December 2012. Results A total of 449 patients were included representing 570 incompetent veins. In 506 treated veins, duplex ultrasonography was performed at follow-up: 457 veins (90%) were occluded at a follow-up of 6 to 12 weeks. In univariate and multivariate analysis, failure of treated great saphenous vein was associated with saphenofemoral junction incompetence (OR 4; 95% CI 1.0–17.1, P = 0.049). Conclusions The Clarivein device proves to be safe and had a high short-term technical effectiveness.


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