Care Referral Center (care + referral_center)

Distribution by Scientific Domains
Medical Sciences100%

Kinds of Care Referral Center

  • tertiary care referral center
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    Selected Abstracts

    Incidence of Traumatic Lumbar Puncture

    ACADEMIC EMERGENCY MEDICINE, Issue 2 2003
    Kaushal H. Shah MD
    Abstract Objective: To determine the incidence of traumatic lumbar puncture (LP). Methods: A retrospective study was conducted at an urban, university tertiary care referral center with 50,000 annual emergency department (ED) visits. The study population included all patients who had cerebrospinal fluid (CSF) samples sent to the laboratory between August 15, 2000, and August 14, 2001. The numbers of red blood cells (RBCs) recorded in the first and last CSF tubes, the location where the LP was performed, and the discharge summary and the discharge diagnoses from the particular visit were obtained. All patients with intracranial pathology and CSF obtained via neurosurgical procedure or fluoroscopic guidance were excluded from the study group. Given no clear definition of traumatic LP in the literature, the incidence of traumatic LP was calculated using a cutoff of greater than 400 RBCs (visual threshold for bloody fluid) and 1,000 RBCs (arbitrary threshold selected by other authors) in CSF tube 1. Proportions were compared using chi-square statistics. Results: Seven hundred eighty-six CSF samples were recorded over one year. Twenty-four samples were obtained from patients with intracranial pathology or were obtained via a neurosurgical procedure. Of the remaining 762 CSF samples in the study population, 119 (15.6%) were traumatic using a cutoff of 400 RBCs, and 80 (10.5%) were traumatic, using a cutoff of 1,000 RBCs in tube 1. Five hundred three LPs were done in the ED and 259 were attributed to all other locations in the hospital. Using a cutoff of 400 RBCs, the incidence of traumatic LP in the ED was 13.3%, compared with 20% in the rest of the hospital (p < 0.025). Similarly, using a cutoff of 1,000 RBCs, the incidence of traumatic LP in the ED was 8.9%, compared with 13.5% in the rest of the hospital (p = 0.1). The incidence of "champagne taps" (defined as zero RBCs in the first and last tubes) in the ED was 34.4%, compared with 24.3% in the rest of the hospital (p < 0.01). Conclusions: The incidence of traumatic lumbar puncture is approximately 15% using a cutoff of 400 RBCs and 10% using a cutoff of 1,000 RBCs. In this study, the rate of traumatic lumbar puncture was significantly less (with a cutoff of 400 RBCs) and the rate of champagne tap was significantly greater for LPs done in the ED compared with the rest of the hospital. [source]

    Closed lesser sac lavage in the management of pancreatic necrosis

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 9 2004
    JAI DEV WIG
    Abstract Background and Aim:, Surgery for pancreatic necrosis complicating acute severe pancreatitis carries a high risk of morbidity and mortality. We evaluated the efficacy of necrosectomy and closed lesser sac lavage as a method of management of pancreatic necrosis. Methods:, Fifty-eight patients with pancreatic necrosis who underwent pancreatic necrosectomy consecutively in a tertiary care referral center were retrospectively analyzed. The technique of necrosectomy and postoperative lavage is described in detail. Details regarding the patient profile, disease severity, surgical details, postoperative morbidity, repeat interventions and the mortality are presented. Results:, Of the 58 patients, irrigation was able to be started in 48. Lavage was able to be continued until disease resolution or death in all but 10 patients. Post-operative locoregional complications were residual abscesses in 10, bleeding in eight, enteric fistulae in 12 and pancreatic fistulae in nine. Six patients needed postoperative percutaneous procedures, while 16 patients needed repeat surgery. Seventeen patients died (29%), all of whom had multiple organ failure involving more than two organs, while 11 developed sepsis. Conclusion:, Pancreatic necrosectomy and postoperative closed lesser sac lavage is an effective method of managing these patients, with acceptable morbidity, re-operation rates and mortality. [source]

    The Spectrum of Skin Disease Among Indian Children

    PEDIATRIC DERMATOLOGY, Issue 1 2009
    D.N.B., Kabir Sardana M.D., M.N.A.M.S.
    A retrospective study was designed to evaluate the epidemiologic features of pediatric dermatoses in India. The setting was a tertiary care referral center in India (Kalawati Saran Children's Hospital, New Delhi) during January 1997 to December 2003. A total of 30,078 children less than 12 years of age with 32,341 new dermatoses were recorded, with a male to female ratio of 1.07:1. Most of the disease was seen in the 1- to 5-year age group (44.94%). The most common skin diseases were infections and infestations (47.15%) consisting of bacterial infections (58.09%) and scabies (21.54%), followed by eczemas (26.95%), infantile seborrheic dermatitis, scabies, and pityriasis alba. Other unique dermatoses in our settings were papular uticaria (3.59%), miliaria (5.46%), postinflammatory pigmentary abnormalities (1.68%), and nutritional deficiency dermatoses (0.45%). A majority of patients were diagnosed clinically and special diagnostic tests were conducted in 2.6% of patients. The most common diagnostic test used was KOH mount (59.2%), followed by skin biopsy (39%). Nearly 90% of patients were seen without any referral and in the remaining, a majority were referred by pediatricians (75%). A majority of patients were diagnosed to have infection followed by dermatitis in our setting. [source]

    Nasal Pepsin Assay and pH Monitoring in Chronic Rhinosinusitis

    THE LARYNGOSCOPE, Issue 5 2008
    Süay Ozmen MD
    Abstract Objectives/Hypothesis: The primary objective of this study was to determine the relationship between chronic rhinosinusitis (CRS) and laryngopharyngeal reflux (LPR). We also investigated the diagnostic value of pepsin in nasal lavage by means of fluorometric assay as compared with 24-hour dual-probe pH monitoring. Study Design and Methods: This is a controlled, prospective study from a retrospective dataset of 33 patients recruited for endoscopic sinus surgery between 2005 and 2006 in a tertiary care referral center (Hacettepe University Medical Center). All patients underwent 24-hour dual-probe pH monitoring and nasal lavage fluid investigation for pepsin. A fluorometric pepsin assay using casein-fluorescein isothiocyanate in nasal lavage fluid was used to detect LPR. The control group included 20 patients who were proven not to have sinusitis. Results: A higher incidence of pharyngeal acid reflux events was found in patients with CRS (29 of 33, 88%) compared with the control patients (11 of 20, 55%). The difference was statistically significant (P = .01). The fluorometric pepsin assay was correlated to the results of 24-hour dual-probe monitoring for LPR diagnosis with a 100% sensitivity and 92.5% specificity. These data suggest that an association between CRS and LPR is present and that the detection of pepsin in nasal lavage fluid may provide a noninvasive and feasible method of LPR screening. [source]

    Monitoring of Cochlear Function During Cochlear Implantation

    THE LARYNGOSCOPE, Issue 6 2006
    Oliver Adunka MD
    Abstract Objective: To report the feasibility of monitoring cochlear function during cochlear implantation. Study Design: Case report. Setting: Tertiary care referral center. Methods: A child with audiologic features typical of bilateral auditory neuropathy underwent cochlear implantation. The scala tympani was entered inferior and slightly anterior to the round window membrane margin and smooth electrode insertion was achieved. Using single polarity click stimuli, the cochlear microphonic was measured at several steps during surgery. Results: Cochlear microphonics were present at all stages during the implantation process and were clearly distinguished from neural responses by stimulus polarity inversion and constant latencies, despite changes in stimulus level. With the electrode in situ, amplitudes were smaller but persisted until the final measurement at 10 minutes after insertion. At follow-up 2 weeks after surgery, behavioral audiometry results indicated profound hearing loss in the operated ear. Conclusions: This paper demonstrates the feasibility of monitoring cochlear function during cochlear implantation. The routine surgical approach did not appear to adversely affect the functional measurements. Standard size, full electrode insertion did diminish the amplitude of the cochlear microphonics, possibly as a result of intracochlear mechanical impairment. Ultimately, profound hearing loss was documented, indicating that factors other than immediate changes induced by electrode insertion were likely responsible for the loss of cochlear function. [source]

    Clinical Manifestations of Superior Semicircular Canal Dehiscence,

    THE LARYNGOSCOPE, Issue 10 2005
    Lloyd B. Minor MD
    Abstract Objectives/Hypotheses: To determine the symptoms, signs, and findings on diagnostic tests in patients with clinical manifestations of superior canal dehiscence. To investigate hypotheses about the effects of superior canal dehiscence. To analyze the outcomes in patients who underwent surgical repair of the dehiscence. Study Design: Review and analysis of clinical data obtained as a part of the diagnosis and treatment of patients with superior canal dehiscence at a tertiary care referral center. Methods: Clinical manifestations of superior semicircular canal dehiscence were studied in patients identified with this abnormality over the time period of May 1995 to July 2004. Criteria for inclusion in this series were identification of the dehiscence of bone overlying the superior canal confirmed with a high-resolution temporal bone computed tomography and the presence of at least one sign on physiologic testing indicative of superior canal dehiscence. There were 65 patients who qualified for inclusion in this study on the basis of these criteria. Vestibular manifestations were present in 60 and exclusively auditory manifestations without vestibular symptoms or signs were noted in 5 patients. Results: For the 60 patients with vestibular manifestations, symptoms induced by loud sounds were noted in 54 patients and pressure-induced symptoms (coughing, sneezing, straining) were present in 44. An air-bone on audiometry in these patients with vestibular manifestations measured (mean ± SD) 19 ± 14 dB at 250 Hz; 15 ± 11 dB at 500 Hz; 11 ± 9 dB at 1,000 Hz; and 4 ± 6 dB at 2,000 Hz. An air-bone gap 10 dB or greater was present in 70% of ears with superior canal dehiscence tested at 250 Hz, 68% at 500 Hz, 64% at 1,000 Hz, and 21% at 2,000 Hz. Similar audiometric findings were noted in the five patients with exclusively auditory manifestations of dehiscence. The threshold for eliciting vestibular-evoked myogenic potentials from affected ears was (mean ± SD) 81 ± 9 dB normal hearing level. The threshold for unaffected ears was 99 ± 7 dB, and the threshold for control ears was 98 ± 4 dB. The thresholds in the affected ear were significantly different from both the unaffected ear and normal control thresholds (P < .001 for both comparisons). There was no difference between thresholds in the unaffected ear and normal control (P = .2). There were 20 patients who were debilitated by their symptoms and underwent surgical repair of superior canal dehiscence through a middle cranial fossa approach. Canal plugging was performed in 9 and resurfacing of the canal without plugging of the lumen in 11 patients. Complete resolution of vestibular symptoms and signs was achieved in 8 of the 9 patients after canal plugging and in 7 of the 11 patients after resurfacing. Conclusions: Superior canal dehiscence causes vestibular and auditory symptoms and signs as a consequence of the third mobile window in the inner ear created by the dehiscence. Surgical repair of the dehiscence can achieve control of the symptoms and signs. Canal plugging achieves long-term control more often than does resurfacing. [source]

    Eliminating the Limitations of Manual Crimping in Stapes Surgery?

    THE LARYNGOSCOPE, Issue 2 2005
    A Preliminary Trial with the Shape Memory Nitinol Stapes Piston
    Abstract Objective: Manual piston malcrimping in stapedotomy may be the major cause of the occurrence of the significant, interindividual variations of postoperative air-bone gap (ABG), air-bone gap closures (ABGC), and postoperative recurrences of conductive hearing loss. To eliminate the effects of manual crimping on stapedotomy outcomes, the self-crimping, shape memory alloy Nitinol stapes piston was investigated and hearing evaluated. Study design: Prospective, preliminary case-control study in a tertiary care referral center. Methods: Sixteen patients with otosclerosis undergoing reversed stapedotomy using the Nitinol stapes piston were matched to reference patients out of our conventional titanium piston database. The effects of the self-crimping Nitinol piston on the postoperative ABGC, the postoperative air-bone gap (ABG) variations, and the postoperative short-term hearing results were investigated 3, 6 and 9 months postoperatively. These data were statistically compared with the results of the control patients in our titanium stapes piston database. Results: The mean postoperative ABG and the interindividual variations of the postoperative ABG were significantly smaller in the Nitinol group, the extent of ABGC greater in the Nitinol piston group, but not significant. The postoperative short-term stability of ABGC was similar in both groups. No infections or adverse reactions occurred during follow-up. Conclusion: Our preliminary results suggest that the self-crimping shape memory alloy Nitinol stapes piston eliminates the limitations of manual malcrimping in stapedotomy, thus optimising the surgical procedure. This allows reliable, safe, and consistent air-bone-gap closure in patients with otosclerosis up to 1 year after surgery. [source]