scholarly journals Long-Term Follow-Up After Fat Graft Myringoplasty: Do Size and Location Matter?

2020 ◽  
pp. 014556132097355
Author(s):  
Alfonso Rodriguez Diaz ◽  
Carlos O’Connor Reina ◽  
Guillermo Plaza ◽  
Elena Rodriguez Posadas ◽  
Francisco Valdeon Arevalo ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Case Series ◽  
Care Facility ◽  
Clinical Results ◽  
Fat Graft ◽  
Closure Rate ◽  
Tertiary Care Facility ◽  
Long Term Follow Up ◽  
Prospective Case Series

Objective: To assess clinical and functional outcomes of a fat graft myringoplasty under local in an office setting. Study Design: Prospective case series. Setting: Tertiary care facility. Patients: Patients with a tympanic membrane (TM) perforation presenting between December 2005 and June 2019. Inclusion criteria included perforation size >25% of the surface of the pars tensa of the TM, entire perforation margins visualized through a transcanal view, and lack of spontaneous closure at the 6-month follow-up. The exclusion criteria were the presence of cholesteatoma, wet appearance of the mucosa in the tympanic cavity, ear discharge in the 3 months before surgery, or signs of ossicular inconsistency. Intervention: In-office fat graft myringoplasty technique under local anesthesia. Main outcome Measures: Complete perforation closure rate and audiometric outcomes. Results: A total of 121 patients underwent the procedure, of whom 21 had bilateral sequential procedures (total 142 ears). Average age was 51.1 ± 18.4 years (range, 3-78 years). The size of perforation was <25% of TM in 39 (27.5%) ears, 25% to 50% of TM in 49 (34.55%) ears, 50% to 75% of TM in 34 (23.91%) ears, and 75% to 100% of TM in 20 (14.10%) ears. Complete perforation closure was evident in 130 (91.55%) of the 142 ears. Preoperative mean air conduction threshold was 59.3 dB (17-95 dB) and significantly improved into 35.6 dB (10-85 dB; P < .0004) after surgery. Preoperative air–bone gap was 30.2 dB (5-70 dB) and also significantly improved into 10.2 dB (5-65 dB; P < .0001) after surgery. Conclusion: In office fat graft myringoplasty, in adult and pediatric patients with variable perforation sizes, is a well-tolerated procedure with very satisfactory clinical results.

What is the Long-Term Follow-Up of Nonoperatively Treated Patients with Appendicitis?

2019 ◽  
Vol 85 (5) ◽  
pp. 462-465
Author(s):  
Andrew Felber ◽  
Deven Catalano ◽  
Caitlin Stafford ◽  
Todd D. Francone ◽  
Patricia L. Roberts ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Care Facility ◽  
Nonoperative Treatment ◽  
Interval Appendectomy ◽  
Tertiary Care Facility ◽  
Long Term Follow Up ◽  
Mean Time ◽  
Emergent Surgery

In this study, we determine outcomes after nonoperative treatment of appendicitis. First, we abstracted data for patients discharged with a diagnosis of appendicitis from a tertiary care facility from August 1, 2007, through June 30, 2017. For patients treated nonoperatively, we collected additional medical treatment for appendicitis, future surgical treatment, and date of last follow-up. In our study, we identified 487 patients treated for appendicitis. From this group, 66 patients were successfully treated nonoperatively. Eight patients (12%) had an interval appendectomy at a mean follow-up time of two months. Of the 58 remaining patients, 20 (34%) did not have any further appendicitis-related issues over a mean follow-up period of 25 months. A total of 38 (66%) had recurring or additional concerns requiring further treatment or emergent surgery within a mean time of four months. A large proportion, 76 per cent (n = 29), required unscheduled or emergent appendectomy. There were more patients diagnosed with an abscess (55%) in the group that had further appendicitis issues. In conclusion, nonoperative treatment of appendicitis is associated with significant likelihood of future appendicitis-related treatment or emergency surgery (66%). In addition, patients diagnosed with an abscess are at particularly high risk of future appendicitis-related issues.

Clinical Outcomes of Endoscopic and Endoscopic-Assisted Resection of Inverted Papillomas: A 15-Year Experience

2007 ◽  
Vol 21 (5) ◽  
pp. 591-600 ◽  
Author(s):  
Bradford A. Woodworth ◽  
Geeta A. Bhargave ◽  
James N. Palmer ◽  
Alexander G. Chiu ◽  
Noam A. Cohen ◽  
...  
Keyword(s):  
Demographic Data ◽  
Tertiary Care ◽  
Case Series ◽  
Care Facility ◽  
Recurrence Rates ◽  
Time To Recurrence ◽  
Tertiary Care Facility ◽  
Inverted Papillomas

Background The endoscopic resection of sinonasal inverted papillomas (IPs) has been well described. However, the majority of published reports in the literature are small case series with limited clinical follow-up. The aim of this retrospective study was to review the experience with the endoscopic and endoscopic-assisted resection of IPs at a major academic tertiary care facility and assess long-term outcomes. Methods A retrospective review of endoscopic and endoscopic-assisted resections of IP was performed. Charts were reviewed for standard demographic data, operative technique, adjuvant approaches, complications, and postoperative follow-up times. Results One hundred fourteen patients (average age, 56 years) underwent endoscopic or endoscopic-assisted resection for IPs with a mean disease-free follow-up of 40 months (7–135 months). Seventeen patients developed disease after endoscopic or endoscopic-assisted resection for a recurrence rate of 15%. Average time to recurrence was 23 months. Combined approaches were used when indicated in 34% (39/114) of patients, including adjuvant osteoplastic flap, midface degloving, trephine, or Caldwell-Luc approaches. Four patients (4%) had cerebrospinal fluid leaks that were successfully repaired endoscopically. Conclusion In this large series of endoscopically resected IPs with extensive clinical follow-up, recurrences occurred an average of 23 months after the procedure. This emphasizes the importance of long-term endoscopic follow-up to detect recurrences in all patients. Endoscopic or endoscopic-assisted resection of IPs is a valid technique in this series with recurrence rates comparable with open approaches.

scholarly journals First Bite Syndrome After Parotidectomy: A Case Series and Review of Literature

2020 ◽  
pp. 014556132098017
Author(s):  
Vivian Xu ◽  
Kurren S. Gill ◽  
Jared Goldfarb ◽  
Cory Bovenzi ◽  
Roxana Moayer ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Case Series ◽  
Care Facility ◽  
Cervical Region ◽  
Parotid Region ◽  
Tertiary Care Facility ◽  
Upper Cervical ◽  
Potential Risk Factors ◽  
First Bite Syndrome

Introduction: First bite syndrome (FBS) is a rare but potentially debilitating complication observed after surgery involving the upper cervical region. Patients classically complain of severe facial pain in the ipsilateral parotid region with the first few bites of a meal. Objective: The aim of this study is to shed light on the incidence and potential risk factors of FBS, including a series of cases depicting FBS observed after parotidectomy. Methods: Retrospective review of 419 patients who underwent parotidectomy at a single tertiary care facility between December 2016 and June 2020. Results: With a mean follow-up time of 16.5 months, 8 (2%) patients were documented to have symptoms of FBS after parotid gland surgery. Six of these patients underwent partial parotidectomy by dissection of the deep lobe of the parotid (DLP). Conclusion: Patients undergoing dissection of the DLP are particularly at risk for the development of FBS. All patients should be appropriately counseled during informed consent discussions, especially in high-risk cases.

Carcinoids of the ampulla: Long-term follow-up after endoscopic resection.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 430-430
Author(s):  
George Nyasha Baison ◽  
Nadav Sahar ◽  
Morgan M Bonds ◽  
Janelle F Rekman ◽  
Flavio G. Rocha ◽  
...  
Keyword(s):  
Endoscopic Resection ◽  
Care Center ◽  
Benign Lesion ◽  
Tertiary Care ◽  
Case Series ◽  
World Health ◽  
Long Term Follow Up ◽  
Well Differentiated

430 Background: Neuroendocrine tumors (NET) or carcinoids of the ampulla are exceedingly rare in comparison to duodenal NET. Surgical management is widely accepted as the treatment of choice, but for patients that refuse surgery or are poor operative candidates, endoscopic resection may be option. We present a consecutive case series at a tertiary care center describing our experience with endoscopic resection of ampullary NET. Methods: This is a restrospective review with a long-term follow-up of patients with ampullary NET that were endoscopically resected. Outcomes were analyzed based on the histopathologic classification system proposed by the World Health Organization in 2000. Results: Twelve patients (9 male, 3 female), ranging in age from 41 to 86 (mean 59) underwent endoscopic ampullectomy for ampullary NET, with a mean follow-up time of 5 years. Patients had refused surgery or were poor surgical candidates. All, but one incidentally found case, were symptomatic on presentation, with gastrointestinal bleeding being the main symptom. No patients had a hormonal syndrome. The mean size of the lesions was 21 mm (6 mm to 35 cm). Six (50%) patients had a well-differentiated, benign lesion, 6 (50%) patients had a well-differentiated NET with unknown malignant potential (gangliocytic paragangliomas). Eight (67%) were completely excised during the initial endoscopy with 4 requiring re-excision. Only 2 patients developed recurrence, after 2.5 and 10 years and this necessitated a pancreaticoduodenectomy. Five patients had complications (2 for bleeding and 3 for post-ERCP pancreatitis), with zero deaths. Conclusions: Unlike duodenal carcinoids, ampullary NET are rare. Pancreaticoduodenectomy can be offered to fit patients except for gangliocytic paragangliomas that do not require an aggressive operation. However, for those that refuse surgery or are poor candidates, endoscopic ampullectomy can be an option with acceptable short and long-term outcomes.

Nurse-Led Neonatal Follow-Up Clinic: A New Emerging Concept in a Developing Country

2020 ◽  
Vol 34 (1-2) ◽  
pp. 19-23
Author(s):  
Poonam Joshi ◽  
Bindu Sarojini ◽  
Meena Joshi ◽  
Anu Thukral
Keyword(s):  
Developing Countries ◽  
Prospective Observational Study ◽  
Tertiary Care ◽  
Newborn Care ◽  
Care Facility ◽  
Essential Newborn Care ◽  
Tertiary Care Facility ◽  
Neonatal Assessment ◽  
The Mean

Objective: To investigate the feasibility and acceptance of nurse-led neonatal follow-up clinic (NLNFC) in a tertiary care facility. Materials and Methods: In a prospective observational study, total 105 stable mother-neonate dyads were independently followed up in both nurse led and neonatologist run follow-up clinics. The outcome was measured in terms of agreement between the nurse and neonatologist in the domains of neonatal assessment, counselling mothers on essential newborn care (ENC) and giving advice ( P < 0.05) and mothers’ acceptability for NLNFC. Results: Agreement between the trained neonatal nurse and neonatologist varied between 87 and 100%. The most unanimity was observed in neonatal assessment and counselling on ENC (93.3%-100%) followed by prescribing treatment (87%). The mean acceptability scores of the mothers for NLNFC was 33.13 ± 2.6 (25-35, maximum possible score 35). Conclusion: Establishing NLNFCs in developing countries is feasible. Nurses can be entrusted with the responsibility of following up stable neonates here and mothers will surely be satisfied with this type of clinic.

scholarly journals The Effectiveness of Prolotherapy for Recalcitrant Medial Tibial Stress Syndrome: A Prospective Case Series

2020 ◽  
Author(s):  
Nat Padhiar ◽  
Mark Curtin ◽  
Osama Aweid ◽  
Bashaar Awied ◽  
Dylan Morrissey ◽  
...  
Keyword(s):  
Case Series ◽  
Medial Tibial Stress Syndrome ◽  
Ultrasound Guided ◽  
Medium Term ◽  
Leg Injuries ◽  
Stress Syndrome ◽  
Long Term Follow Up ◽  
Prospective Case Series

Abstract Background: Medial tibial stress syndrome (MTSS) is one of the most common lower leg injuries in sporting populations. It accounts for between 6%-16% of all running injuries, and up to 53% of lower leg injuries in military recruits. Various treatment modalities are available with varying degree of success. In recalcitrant cases, surgery is often the only option.Objective: To evaluate whether ultrasound-guided injection of 15% dextrose for treatment of recalcitrant Medial Tibial Stress Syndrome decreases pain and facilitates a return to desired activity levels for those who may otherwise be considering surgery or giving up sport.Design: Prospective case seriesSetting: Private specialist CentrePatients: Eighteen patients: fifteen male and three female; (mean age=31.2 years) with MTSS were referred from sports injury clinics across the UK, having failed all available conservative treatment.Intervention: An ultrasound-guided sub-periosteal injection of 15% dextrose was administered by the same clinician (NP) along the length of the symptomatic area. Typically, 1 mL of solution was injected per cm of symptomatic area. Main Outcome Measures: Pain was assessed using a 10-cm visual analogue scale (VAS) at baseline, short-term, medium-term (mean 18 weeks) and long-term (mean one year) follow-up. Symptom resolution and return to activity were measured using a Likert scale at medium and long-term follow-up. Results: Patients reported a significant (p<0.01) reduction in median VAS pain score at medium and long-term follow-up compared to baseline. Median improvement per patient was 4.5/10. Patients rated their condition as ‘much improved’ at medium-term follow-up and median return to sport score was ‘returned to desired but not pre-injury level’ at medium-term and long-term follow-up. No adverse events were reported.Conclusions: Ultrasound-guided 15% dextrose prolotherapy injection has a significant medium-term effect on pain in MTSS. This benefit may be maintained long-term. More robust trials are required to validate these findings.Clinical Relevance: Clinicians should consider the use of ultrasound-guided injection of 15% dextrose as a viable treatment option to reduce pain and aid return to activity for patients with recalcitrant Medial Tibial Stress Syndrome.

scholarly journals A GHASTLY RISING RATE OF PREVENTABLE PEDIATRIC BURNS: WE NEED TO ACT

2020 ◽  
Vol 70 (6) ◽  
pp. 1622-28
Author(s):  
Muhammad Rizwan Aslam ◽  
Taokeer Ahmed Rizvi ◽  
Muhammad Tariq Munawar ◽  
Asad Maqbool ◽  
Shahid Naqvi
Keyword(s):  
Tertiary Care ◽  
Case Series ◽  
Care Facility ◽  
Paediatric Population ◽  
First Aid ◽  
Incident Type ◽  
Tertiary Care Facility ◽  
Case Series Study ◽  
Pediatric Burns ◽  
Electric Burns

ABSTRACT Objective: To ascertain the increase in paediatric burn admissions in our tertiary care facility. Find various causes of this trend and assess the morbidity and mortality in paediatric population, and suggest remedies. Study Design: This is a “descriptive case series study” Place of Study: This Study was conducted during September 2017 to August 2019 at Department of Burns & Plastic surgery. Materials and Methods: Total number of acute burn admissions under 12 years were recorded. Subdivided this group into 0 to 2 years and 2 to 12 years.  We assessed epidemiology, sex, cause of burn, mode of admission, location of incident, type of first aid given, mortality, and compared results during two equal halves of this period. We used SPSS 20 for data analysis. Results: 504 (49.85%) were pediatric acute burn admissions. Their age ranged from 25 days to 12 years (mean 5 ±1.2 years). 152 were infants/toddlers aged 0-2 years. 270 male and 234 females. 316 were direct admissions. There were 72.43% more pediatric burn admissions. 381 were scalds, 91 flame burns, 21 electric burns and 11 chemical burns. There was 11.94% improved survival among burn patients. Two temporal peaks, largest in summer from May to Jul and second in Dec to Feb. Conclusion: There is an increasing trend in acute pediatric burn admissions. Majority of victims did not receive proper first aid. We need to start a very aggressive campaign on print and electronic media for public education.   

scholarly journals Clinical Features and Surgical Outcomes of Posterior Segment Intraocular Foreign Bodies in Children in East China

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Ting Zhang ◽  
Hong Zhuang ◽  
Keyan Wang ◽  
Gezhi Xu
Keyword(s):  
Clinical Features ◽  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Visual Outcome ◽  
Posterior Segment ◽  
Poor Visual Outcome ◽  
Long Term Follow Up ◽  
The Mean

Purpose. To report the long-term follow-up results of posterior segment intraocular foreign body (IOFB) removal in children and to determine the prognostic factors for visual outcome. Methods. Design: retrospective, noncomparative, interventional case series; a single tertiary care center study. Participants or samples: eleven eyes (11 patients) under 16 years of age with posterior segment IOFB injuries from May 2014 to November 2017. Main outcome measures: clinical features of injury, visual acuity, and complications. Results. The mean age was 6.8 years, and the mean follow-up was 20.2 months. The main IOFB sources were accidental penetration of the eye by materials in the playground (6 cases) or by pencil lead at school (4 cases). The mean IOFB size was 3.8 (range 1–6) mm. At the last visit, the visual acuities were 20/40 or better in 40.0% of patients and better than 20/200 in 70.0%. Poor visual outcome was correlated with intraoperative rhegmatogenous retinal detachment (P=0.0083). Postoperative complications included elevated transient intraocular pressure, retinal redetachment, and secondary glaucoma. Conclusions. The clinical features of pediatric posterior segment IOFBs suggest insufficient awareness of such injuries both on the playground and at school. Visual outcomes from surgical treatment were relatively favorable in this series.

Mortality in Patients with Primary Unipolar Depression, Secondary Unipolar Depression, and Bipolar Affective Disorder: A Comparison with General Population Mortality

1988 ◽  
Vol 17 (4) ◽  
pp. 351-360 ◽  
Author(s):  
Donald W. Black ◽  
George Winokur ◽  
Amelia Nasrallah
Keyword(s):  
Affective Disorder ◽  
Bipolar Affective Disorder ◽  
Tertiary Care ◽  
Geographical Area ◽  
Care Facility ◽  
Unipolar Depression ◽  
Mortality Data ◽  
Initial Portion ◽  
Tertiary Care Facility

Mortality data are presented from a two to fourteen year follow-up of 705 primary unipolar depressives, 302 secondary unipolar depressives, and 586 patients with bipolar affective disorder (BAD) hospitalized at a tertiary care facility. Death ascertainment was made through a record-linkage process. Using sex- and age-standardized mortality ratios (SMRs), the mortality experience of the study population was compared with that of Iowa, the geographical area served by the admitting medical facility for this study group. Results show that risk for all-cause mortality was most pronounced during the first two years following hospital discharge, although secondary unipolar depressives continued to show a significant excess of deaths throughout the entire follow-up period. Deaths occurring from natural causes were significantly excessive only during the initial portion of the follow-up. Deaths from unnatural causes were significantly excessive throughout follow-up except for patients with bipolar affective disorder.

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