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Chart Review (chart + review)
Kinds of Chart Review Selected AbstractsA RETROSPECTIVE CHART REVIEW OF THE TOLERABILITY AND EFFICACY OF INTRAVENOUS IMMUNOGLOBULIN IN THE TREATMENT OF ALZHEIMER'S DISEASEJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2008Gayatri Devi MD No abstract is available for this article. [source] Risk Factors for Delirium Tremens: A Retrospective Chart ReviewTHE AMERICAN JOURNAL ON ADDICTIONS, Issue 3 2006Tara Wright MD A retrospective chart review was performed within an inpatient VA hospital setting in an attempt to identify risk factors for delirium tremens (DTs). Cases of delirium tremens were compared to cases where patients' alcohol withdrawal during hospitalization did not progress to DTs. Significant differences were found in regard to prior histories of DTs and laboratory values at admission. The amount and duration of benzodiazepine use during hospitalization, antipsychotic use during hospitalization, and length of hospitalization were also statistically different between the groups. While not reaching statistical significance, there were differences in reason for admission and relapse rate upon follow-up between the groups. [source] Advance Directives in Skilled Nursing Facility Residents Transferred to Emergency DepartmentsACADEMIC EMERGENCY MEDICINE, Issue 12 2001Michael Lahn MD Abstract Objective: Ten years have passed since Congress enacted the Patient Self-Determination Act to promote the use of advance directives (ADs). This study was performed to determine the frequency, type, demographic distribution, and utility of ADs that accompany residents of skilled nursing facilities (SNFs) transferred to emergency departments (EDs). Methods: This was an observational, cross-sectional cohort of SNF residents, transferred to two urban, academic EDs. Chart review and physician interviews were conducted on consecutive patients arriving during 12-hour data collection shifts. Results: Among 715 patients entered, 315 [44%, 95% confidence interval (95% CI) = 40% to 48%] had an AD. Advance directives were significantly more prevalent among white (50%) than African American (34%) or Hispanic (39%) patients (p < 0.001), and varied from 0% to 94% among SNFs. Of the 315 patients with ADs, do-not-resuscitate (DNR) orders were the most prevalent (65%, 95% CI = 58% to 69%). Although 75% (95% CI = 69% to 81%) of the DNR orders addressed cardiopulmonary resuscitation (CPR), only 12% (95% CI = 8% to 16%) addressed intubation. Among 39 patients who required intubation or CPR, 44% had ADs, 82% (95% CI = 57% to 96%) of which were deemed useful. Conclusions: Despite a decade of legislation promoting their use, ADs are lacking in most SNF residents transferred to EDs for evaluation and in most settings in which a clinical indication exists for intubation or CPR. Variation in their prevalence appears to be associated with both ethnicity and SNF origin. Although about three-fourths of DNR ADs addressed CPR, only about one in ten offered guidance regarding intubation. When available, ADs are used in most instances to guide emergency care. [source] How reliable is an undetectable viral load?HIV MEDICINE, Issue 8 2009C Combescure Objectives An article by the Swiss AIDS Commission states that patients with stably suppressed viraemia [i.e. several successive HIV-1 RNA plasma concentrations (viral loads, VL) below the limits of detection during 6 months or more of highly active antiretroviral therapy (HAART)] are unlikely to be infectious. Questions then arise: how reliable is the undetectability of the VL, given the history of measures? What factors determine reliability? Methods We assessed the probability (henceforth termed reliability) that the n+1 VL would exceed 50 or 1000 HIV-1 RNA copies/mL when the nth one had been <50 copies/mL in 6168 patients of the Swiss HIV Cohort Study who were continuing to take HAART between 2003 and 2007. General estimating equations were used to analyse potential factors of reliability. Results With a cut-off at 50 copies/mL, reliability was 84.5% (n=1), increasing to 94.5% (n=5). Compliance, the current type of HAART and the first antiretroviral therapy (ART) received (HAART or not) were predictive factors of reliability. With a cut-off at 1000 copies/mL, reliability was 97.5% (n=1), increasing to 99.1% (n=4). Chart review revealed that patients had stopped their treatment, admitted to major problems with compliance or were taking non-HAART ART in 72.2% of these cases. Viral escape caused by resistance was found in 5.6%. No explanation was found in the charts of 22.2% of cases. Conclusions After several successive VLs at <50 copies/mL, reliability reaches approximately 94% with a cut-off of 50 copies/mL and approximately 99% with a cut-off at 1000 copies/mL. Compliance is the most important factor predicting reliability. [source] Teenage Pregnancy in the Texas PanhandleTHE JOURNAL OF RURAL HEALTH, Issue 3 2005Rosa Galvez-Myles MD ABSTRACT: Purpose: This study compares rural and small-city teenage and adult pregnancies, with respect to complication rates and pregnancy outcomes. Methods: Chart review of Medicaid patients (513 teenage [under 20 years] and 174 adult controls [ages 25,34]) delivered (excluding multiple gestation) in Amarillo, Texas, from January 1999 to April 2001. Demographic data collected included maternal race, gravidity, parity, smoking status, drug usage, presence of antenatally diagnosed sexually transmitted disease(s), county type (rural vs small city) and number of prenatal visits. Outcomes included mode of delivery, primary cesarean section rates, preterm birth (<34 or <37 weeks), birth weight, birth weight <2,500 g, preeclampsia, total maternal weight gain, hemoglobin changes after delivery, Apgar scores, and neonatal intensive care unit admissions. Statistical comparisons between groups were made for a number of factors and outcomes (P<.05). Results: Teenagers did not have a significantly higher frequency of either illicit drug or tobacco usage, but teenagers ,17 years had a greater incidence of sexually transmitted diseases (19.8% vs 10.4%, P<008) and preeclampsia (7.1% vs 2.3%, P<.025, odds ratio 3.2 [1.1 to 9.9]) when compared with adults. The total weight gain was highest for teens ,17 years (36.4 pounds vs adults: 28.2, P<.001). The primary cesarean section rate was higher in adults (all teens 18.5% vs adults 38.6%, P<.001). County rurality had no impact on any of the observed findings or variables tested. Conclusions: Young teenagers have a higher incidence of sexually transmitted diseases and preeclampsia and also gain significantly more weight with pregnancy than young adults. However, the pregnancy outcomes were no different for rural vs small city teens. [source] Evolution in the Assessment and Management of Trigeminal SchwannomaTHE LARYNGOSCOPE, Issue 2 2008Bharat Guthikonda MD Abstract Educational Objective: At the conclusion of this presentation, the participants should be able to understand the contemporary assessment and management algorithm used in the evaluation and care of patients with trigeminal schwannomas. Objectives: 1) Describe the contemporary neuroradiographic studies for the assessment of trigeminal schwannoma; 2) review the complex skull base osteology involved with these lesions; and 3) describe a contemporary management algorithm. Study Design: Retrospective review of 23 cases. Methods: Chart review. Results: From 1984 to 2006, of 23 patients with trigeminal schwannoma (10 males and 13 females, ages 14,77 years), 15 patients underwent combined transpetrosal extirpation, 5 patients underwent stereotactic radiation, and 3 were followed without intervention. Of the 15 who underwent surgery, total tumor removal was achieved in 9 patients. Cytoreductive surgery was performed in six patients; of these, four received postoperative radiation. One patient who underwent primary radiation therapy required subsequent surgery. There were no deaths in this series. Cranial neuropathies were present in 14 patients pretreatment and observed in 17 patients posttreatment. Major complications included meningitis (1), cerebrospinal fluid leakage (2), major venous occlusion (1), and temporal lobe infarction (1). Conclusions: Trigeminal schwannomas are uncommon lesions of the skull base that may occur in the middle fossa, posterior fossa, or both. Moreover, caudal extension results in their presentation in the infratemporal fossa. Contemporary diagnostic imaging, coupled with selective use of both surgery and radiation will limit mor-bidity and allow for the safe and prudent management of this uncommon lesion. [source] Nerve of Origin, Tumor Size, Hearing Preservation, and Facial Nerve Outcomes in 359 Vestibular Schwannoma Resections at a Tertiary Care Academic CenterTHE LARYNGOSCOPE, Issue 12 2007Abraham Jacob MD Abstract Objective: To determine nerve of origin, tumor size, hearing preservation rates, and facial nerve outcomes in a retrospective cohort study of patients undergoing translabyrinthine (TL), middle cranial fossa (MCF), and retrosigmoid/suboccipital (SO) approaches to vestibular schwannomas (VS). Study Design: Retrospective. Methods: Chart review. Results: Patient charts from 231 TL, 70 MCF, 53 SO, and 5 combined TL/SO procedures for VS were evaluated in 356 patients. The inferior vestibular nerve (IVN) was the nerve of origin in 84 of 359 cases (23.3%), while the superior vestibular nerve (SVN) was the nerve of origin in 36 patients (10%). In 239 of 359 cases (66.6%), the nerve of origin was not identified. Forty patients undergoing hearing preservation surgery had hearing results and nerve of origin data available for review. Functional hearing (<50dB PTA and >50% speech discrimination) was preserved in 10 of 15 patients (75%) with SVN tumors, while only 7 of 25 patients (28%) with IVN tumors retained functional hearing. Facial nerve outcomes and nerve of origin were recorded simultaneously in 109 patients. Seventy-one of 74 patients (95%) patients with IVN tumors achieved a House-Brackmann (HB) grade I,III, while 35 of 35 patients (100%) with SVN tumors retained HB I,III facial function. Looking at tumor size versus hearing preservation, functional hearing was preserved in 22 of 49 patients (45%) with <1-cm tumors, and 4 of 20 patients (20%) with 1- to 1.5-cm tumors. For all cases with documented facial nerve function, HB I,III were achieved in 96% of SO, 94% of MCF, and 88% of TL procedures. Conclusions: Our retrospective data indicated that IVN tumors were twice as common as SVN tumors. The nerve of origin did not affect facial nerve outcomes but did impact hearing preservation rates. Patients with tumors <1 cm in size had the best chance for hearing preservation. Overall facial nerve preservation was excellent with >90% achieving HB 1 to 3 function at final follow-up. [source] Surgical Outcomes of Drillout Procedures for Complex Frontal Sinus Pathology,THE LARYNGOSCOPE, Issue 5 2007Pete S. Batra MD Abstract Objectives: The purpose of this report is two-fold: 1) to determine the incidence and 2) to determine the efficacy of drillout procedures in the management of frontal sinus disease in a tertiary rhinology practice. Study Design: Retrospective data analysis. Methods: Chart review was performed for all patients undergoing frontal sinus surgery from May 1999 to April 2004. The incidence of drillout surgery was determined. Demographic data, symptomatology, type of drillout procedure, and primary pathology were determined. Postoperative outcome was assessed based on subjective symptomatology and objective endoscopic patency. Results: A total of 186 patients underwent 207 frontal sinus procedures during this time period; 25 patients (13.4%) required a total of 30 (14.5%) drillout procedures. The patient population had previously undergone an average of 3.2 procedures; four cases were primary and 26 were revision procedures. The breakdown of the procedures was as follows: Draf III, 17; Draf IIB, 7; and transseptal frontal sinusotomy, 6. The major indications included mucoceles (11 cases), chronic frontal sinusitis (6 cases), and tumors (5 cases). Postoperatively, presenting symptomatology resolved in 32%, improved in 56%, and remained unchanged in 12% of the patients. Endoscopic patency of the neo-ostium was noted in 23 cases (92%). Average follow-up was 16.3 months. Conclusions: In this series, drillout procedures were successfully used in 25 patients as an important adjunct to the standard endoscopic techniques for management of complex frontal sinus disease. Because the procedure was used only 30 times during a 5-year period, it was reserved for specific circumstances in carefully selected patients. [source] Tracheal Agenesis in NewbornsTHE LARYNGOSCOPE, Issue 9 2004Timothy A. Lander MD Abstract Objectives/Hypothesis: A series of three newborns with tracheal agenesis is described. The preferred methods of diagnosis, description of the clinical course, and a review of the pertinent embryology, associated anomalies, and clinical management are presented. Study Design: A retrospective study of a clinical series of referred patients from 2002 to 2003 who were seen at a single institution. Methods: Chart review for clinical course and pathological specimens was performed in all cases. Three patients were identified with tracheal agenesis. Results: All three newborns died within 48 hours of birth. All of the children underwent emergency laryngoscopy and neck exploration. Gross and microscopic pathological examination was accomplished on all patients. Conclusion: Although tracheal agenesis is rare, it may be more common than previously thought. The diagnosis is not straightforward, and the prognosis is grim. The embryology of the trachea and other foregut derivatives is closely related, and associated birth defects are common. [source] Diagnosis and Management of the Lateralized Tympanic Membrane,THE LARYNGOSCOPE, Issue 12 2000Neil M. Sperling MD Abstract Objective Lateralization of the tympanic membrane (TM) is associated with significant morbidity. In a series of 14 patients, we make observations to illuminate this condition for the diagnosing and treating physician. Study Design Chart review of 14 consecutively treated patients. Methods We analyzed the presenting signs and symptoms, etiology, audiometric data, and operative findings of patients with a lateralized tympanic membrane (TM). Results The etiology was postsurgical in 13 patients (there were four aural atresia repairs and nine tympanoplasties), with 2 patients having had multiple previous surgeries. Presentation averaged more than 5 years after the latest surgery. Presenting symptoms included hearing loss in 10, tinnitus in 3, vertigo in 3, and otorrhea in 2 patients; 3 patients were nonsymptomatic at the time of presentation. The average air,bone gaps were 39 dB before treatment and 29 dB after treatment. Operative findings included cholesteatoma in six patients. Eight patients healed with the TM in the normal position; one had TM retraction, one had a TM perforation, and three had a recurrent lateralization. Conclusion The lateralized TM is primarily, but not necessarily, a complication of otological surgery. It may be associated with considerable morbidity, including hearing loss and cholesteatoma. Patients may present several years after their surgery, occasionally as an incidental finding. Surgical repair is often necessary for significant underlying disease, but re-establishment of a normal TM can be challenging. [source] Reconstruction of Nasal Defects Larger Than 1.5 Centimeters in Diameter ,THE LARYNGOSCOPE, Issue 8 2000Stephen S. Park MD Abstract Objective To review the repair of larger nasal defects (>1.5 cm in diameter) and the vascular supply to the forehead flap. Study Design Retrospective chart review (1994,1999) and cadaver analysis of forehead flap vasculature. Methods Chart review was made of patients with cutaneous nasal defects greater than 1.5 cm in diameter. An intravascular silicone cast was used to detail the arterial supply to forehead flaps focusing on contribution from the supratrochlear and angular vessels. Results In 127 patients with nasal defects, 76 defects were greater than 1.5 cm in diameter and were repaired with a midline forehead flap (44 [58%]), paramedian forehead flap (3 [4%]), single-stage midline forehead flap (8 [11%]), interpolated melolabial flap (5 [7%]), local nasal flap (7 [9%]), or skin graft (9 [12%]). All original defects were modified to some degree with an aggressive application of the nasal esthetic subunit principle. Forty-three patients (57%) had cartilage grafts, 18 (24%) had a full-thickness defect requiring repair of the internal lining, and 11 (14%) had some degree of complication, although no patient had full-thickness necrosis of a flap or required a second flap. Analysis of the vascular pedicle to the midline and paramedian forehead flaps demonstrated significant contributions from the angular artery. Skin paddles from a midline and paramedian forehead flap had similar vascular arcades. Conclusions Nasal reconstruction has reached a standard of consistent esthetic results with restoration of nasal function. The midline forehead flap is dependable and robust and leaves a donor site scar consistent with the principle of esthetic units. [source] Emergency Thoracic Ultrasound in the Differentiation of the Etiology of Shortness of Breath (ETUDES): Sonographic B-lines and N-terminal Pro-brain-type Natriuretic Peptide in Diagnosing Congestive Heart FailureACADEMIC EMERGENCY MEDICINE, Issue 3 2009Andrew S. Liteplo MD Abstract Objectives:, Sonographic thoracic B-lines and N-terminal pro-brain-type natriuretic peptide (NT-ProBNP) have been shown to help differentiate between congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD). The authors hypothesized that ultrasound (US) could be used to predict CHF and that it would provide additional predictive information when combined with NT-ProBNP. They also sought to determine optimal two- and eight-zone scanning protocols when different thresholds for a positive scan were used. Methods:, This was a prospective, observational study of a convenience sample of adult patients presenting to the emergency department (ED) with shortness of breath. Each patient had an eight-zone thoracic US performed by one of five sonographers, and serum NT-ProBNP levels were measured. Chart review by two physicians blinded to the US results served as the criterion standard. The operating characteristics of two- and eight-zone thoracic US alone, compared to, and combined with NT-ProBNP test results for predicting CHF were calculated using both dichotomous and interval likelihood ratios (LRs). Results:, One-hundred patients were enrolled. Six were excluded because of incomplete data. Results of 94 patients were analyzed. A positive eight-zone US, defined as at least two positive zones on each side, had a positive likelihood ratio (LR+) of 3.88 (99% confidence interval [CI] = 1.55 to 9.73) and a negative likelihood ratio (LR,) of 0.5 (95% CI = 0.30 to 0.82), while the NT-ProBNP demonstrated a LR+ of 2.3 (95% CI = 1.41 to 3.76) and LR, of 0.24 (95% CI = 0.09 to 0.66). Using interval LRs for the eight-zone US test alone, the LR for a totally positive test (all eight zones positive) was infinite and for a totally negative test (no zones positive) was 0.22 (95% CI = 0.06 to 0.80). For two-zone US, interval LRs were 4.73 (95% CI = 2.10 to 10.63) when inferior lateral zones were positive bilaterally and 0.3 (95% CI = 0.13 to 0.71) when these were negative. These changed to 8.04 (95% CI = 1.76 to 37.33) and 0.11 (95% CI = 0.02 to 0.69), respectively, when congruent with NT-ProBNP. Conclusions:, Bedside thoracic US for B-lines can be a useful test for diagnosing CHF. Predictive accuracy is greatly improved when studies are totally positive or totally negative. A two-zone protocol performs similarly to an eight-zone protocol. Thoracic US can be used alone or can provide additional predictive power to NT-ProBNP in the immediate evaluation of dyspneic patients presenting to the ED. [source] Postoperative analgesic requirements , total laparoscopic hysterectomy versus vaginal hysterectomyAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2005Marcelo Carraro NASCIMENTO Abstract Background:, There is limited information available on the requirement for postoperative analgesic drugs in patients submitted to total laparoscopic hysterectomy (TLH) compared with patients undergoing vaginal hysterectomy (VH). Aim:, To compare the postoperative analgesic requirements in patients who underwent a TLH with patients who had a VH. Methods:, Chart review of 53 patients who had TLH and 47 who had VH and were seen postoperatively by an acute pain management service in order to assess postoperative analgesic requirements. Patient controlled analgesia (PCA) was part of the standard protocol for postoperative pain management. Analgesic requirement was recorded as the mean doses of morphine and number of days that patients used non-steroidal anti-inflammatory drugs (NSAIDs), oxycodone and tramadol. Results:, The requirement for total morphine was approximately half the dose in patients who had a TLH (10.8 ± 12.6 mg) compared with patients who had a VH (19.4 ± 21.9 mg) (P 0.017). The length of use of NSAIDs was significantly reduced in patients who had undergone a TLH (2.0 ± 0.95 days) as compared with patients who had a VH (2.85 ± 1.1 days) (P < 0.0001). Conclusions:, Patients submitted to TLH require less postoperative analgesic drugs when compared with patients who had VH. Prospective randomised trials are warranted to compare analgesic requirements between patients submitted to TLH and VH. [source] Refining diagnoses: applying the DC-LD to an Irish population with intellectual disabilityJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 11 2005A. Felstrom Abstract Background The diagnostic criteria for psychiatric disorders for use with adults with learning disabilities/mental retardation (DC-LD) is a diagnostic tool developed in 2001 to improve upon existing classification systems for adults with learning disability. The aim of this study was to apply the classification system described by the DC-LD to a residential intellectual disability (ID) population to examine whether it improved our diagnostic understanding of residents. Methods Chart reviews of 113 of 178 people in a residential ID service were conducted. For each resident, information was recorded according to the DC-LD multi-axial system. Each resident's case was then discussed with a member of nursing staff familiar with the resident. If diagnosis was unclear, the case was discussed with a senior clinical psychiatrist. Results The percentage of residents with a moderate to profound ID was 87.6%. In total, 94 diagnoses of psychiatric illness (Axis III, Level B, DC-LD) were made. Of those 94 diagnoses, seven new diagnoses were found because of DC-LD criteria. Of the total number of psychiatric diagnoses made, 72.3% were non-specific, residual category diagnoses. A total of 79 residents (69.9%) had at least one behaviour problem diagnosed on Axis III, Level D, Problem behaviours. Fifty-six (49.6%) of residents in this sample had co-morbid epilepsy. Conclusions In people with moderate to profound learning disabilities, diagnosis continues to be challenging. The DC-LD is a useful tool in helping to clarify diagnoses in this population by providing revised criteria and a system to classify problem behaviours. The DC-LD would be more helpful if specific axes were included to document medical and psychosocial problems independently from other diagnoses. Further research is warranted to determine whether the DC-LD hierarchical approach to diagnosis improves diagnostic validity. [source] Repair of buccal defects with anterolateral thigh flapsMICROSURGERY, Issue 3 2006Ömer Özkan M.D. The ideal reconstructive method for the buccal mucosa should provide durable, stable coverage and a natural contour, while simultaneously minimizing morbidity of both the defect and donor sites. Since the first report of the anterolateral thigh flap in 1984, it has become one of the most commonly used flaps for the reconstruction of various soft-tissue defects. From March 2004,April 2005, 24 free anterolateral thigh flaps were used to reconstruct buccal defects, including the retromolar trigone and as far as the oral commissure, and in some cases with extension to the neighboring palatal region and tongue. The study comprised 1 female and 23 male patients, with ages ranging from 26,63 years (mean age, 45.8 years). Two flaps required reoperation due to vascular compromise, and both were salvaged with arterial and venous anastomosis revisions, giving an overall success rate of 100%. Primary thinning of the flap was performed in 10 cases. In 2 cases, additional vastus lateralis muscle was included in the flap to fill the large defect. In 2 cases, marginal necrosis with dehiscence of the flap was observed, one of these patients having a history of atherosclerosis and diabetes mellitus (marginal skin necrosis and infection of the donor area were also observed in this patient). In 2 patients, seroma collection was observed in the neck at the dissection site. Chart reviews showed that most patients had a history of betel-nut chewing (95.8%) or a combination of smoking and betel-nut chewing (79.2%). During the follow-up period of 4,12 months, a sufficient level of mouth-opening with interincisal distances of 34 mm, 44 mm, and 48 mm was achieved in all 3 cases reconstructed after release of the trismus. Although it has some variations in the vascular pedicle, irregularity in derivation from the main vessels, and minimal morbidity of the donor site, the anterolateral thigh flap, with its evident functional, structural, and cosmetic advantages, can be considered an excellent and ideal flap option, and a first choice for most buccal defects. © 2006 Wiley-Liss, Inc. Microsurgery, 2006. [source] Identification of patients with Churg,Strauss syndrome (CSS) using automated dataPHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 10 2004Leslie R. Harrold MD Abstract Purpose Our aim was to identify individuals with Churg,Strauss syndrome (CSS) among asthma drug users, based on patterns of diagnostic and procedural codes (termed ,algorithms') contained in automated claims data. Methods A retrospective study was conducted among patients who had been dispensed asthma drugs at three HMOs. Individuals who received ,3 dispensings of an asthma drug during any consecutive 12-month period beginning 1 January 1994 through 20 June 2000 were identified. Information on patient age, gender, enrollment status, asthma drugs dispensed, inpatient and outpatient diagnoses and procedures were obtained from the HMO automated databases. Twelve combinations of diagnostic and billing codes (,algorithms') were developed using the claims data to identify potential cases of CSS. Chart reviews blinded to drug exposure were performed using a standardized abstraction form. A rheumatologist reviewed abstracted information on all subjects, and those who met two or more American College of Rheumatology (ACR) criteria for CSS were further reviewed by two clinical experts. Cases were classified as unlikely, possible, or probable/definite CSS. Each clinical expert independently rated the cases; disagreements were resolved by consensus. Results A total of 185,604 patients who had been dispensed asthma drugs were identified. Three hundred fifty subjects were selected for chart review, and 15 were classified as having ,probable/definite' CSS. The algorithms that were most successful in identifying patients with CSS were as follows: (1) two or more codes for vasculitis (13 confirmed cases from 129 reviewed; positive predictive value 10%); (2) codes for both vasculitis and neurologic symptoms (6 confirmed cases from 15 reviewed; positive predictive value 40%) and (3) codes for both eosinophilia and vasculitis (4 confirmed cases from 5 reviewed; positive predictive value 80%). Conclusion Automated claims data can be used to identify patients with CSS. This approach can facilitate better epidemiologic study of the risk factors for the condition. Copyright © 2003 John Wiley & Sons, Ltd. [source] Contribution of Dermatologic Surgery in WarDERMATOLOGIC SURGERY, Issue 1 2010MAJOR J. SCOTT HENNING DO BACKGROUND Despite the large contribution by dermatology to military readiness, there have been no published reports regarding dermatologic surgery or skin cancer in the combat environment. OBJECTIVE To outline the contribution of dermatologic surgery, including skin cancer and benign tumors, to deployed service men and women in Operation Iraqi Freedom. METHODS A retrospective chart review was performed of all dermatology visits at the 86th Combat Support Hospital, Ibn Sina, Iraq, between January 15, 2008 and July 15, 2008. RESULTS Two thousand six hundred ninety-six patients were seen in the combat dermatology clinic during the 6-month period reviewed; 8% (205/2,696) of the total visits were for skin cancer, and another 129 patients were treated for actinic keratosis. The specific diagnoses were basal cell carcinoma (n=70), in situ and invasive squamous cell carcinoma (n=68), mycosis fungoides (n=1), bowenoid papulosis (n=1), and in situ and invasive melanoma (n=9). Benign lesions and tumors accounted for 14% (357/2,696) of total patient visits. Three hundred seven surgeries were performed during the 6-month period (178 skin cancers and 129 benign lesions), and 20 patients were referred for Mohs micrographic surgery. The surgical complications included five postoperative wound infections (1 methicillin-resistant Staphylococcus aureus), one wound dehiscence, and seven allergic contact dermatitis. CONCLUSIONS To the authors' knowledge, this is the first publication regarding skin cancer and dermatologic surgery in the combat setting. This report outlines the important contribution of dermatologic surgery in the combat environment. The authors have indicated no significant interest with commercial supporters. [source] Prevalence of Methicillin-Resistant Staphylococcus aureus in the Setting of Dermatologic SurgeryDERMATOLOGIC SURGERY, Issue 3 2009ROGER S. SICA DO BACKGROUND The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the postoperative setting of dermatologic surgery is unknown. Such data could influence the empirical treatment of suspected infections. OBJECTIVE To examine the period prevalence of MRSA infections in the postoperative setting of dermatologic surgery. METHODS We performed chart reviews of 70 patients who had bacterial cultures taken from January 2007 to December 2007. In the 21 postsurgical cases, we analyzed age, risk factors, sites of predilection, method of repair, and pathogen of growth. RESULTS The mean age of the overall study population was 57, with the mean age of postsurgical MRSA-positive cases being 75.5. Of the 21 postsurgical cultures taken, 16 cultures grew pathogen, and two of the 16 (13%) pathogen-positive cultures grew MRSA. LIMITATIONS This is a retrospective chart review of a relatively small sample size in one geographic location. Our patient population is known to contain a large number of retirees. CONCLUSION The increasing prevalence of MRSA skin and soft tissue infections and recommendation to modify empirical antibiotic therapy have been well documented in particular patient populations, but we caution against the empirical use of MRSA-sensitive antibiotics in the postoperative setting of dermatologic surgery. We advocate culturing all infectious lesions upon presentation and reserve empirical use of MRSA-sensitive antibiotics for high-risk patients or locations. [source] Mohs Micrographic Surgery in the Treatment of Rare Aggressive Cutaneous Tumors: The Geisinger ExperienceDERMATOLOGIC SURGERY, Issue 3 2007CHADWICK JOHN THOMAS MD BACKGROUND Mohs micrographic surgery (MMS) offers high cure rates and maximum tissue preservation in the treatment of more common cutaneous malignancies, but its effectiveness in rare aggressive tumors is poorly defined. OBJECTIVE Evaluate the effectiveness of MMS in the treatment of six rare aggressive cutaneous malignancies as seen by Mohs surgeons working at a referral center. METHODS Retrospective chart review of 26,000 cases treated with MMS at the Geisinger Medical Center Department of Dermatology during a 16-year period with the following diagnoses: poorly differentiated squamous cell carcinoma (PDSCC), dermatofibrosarcoma protuberans (DFSP), microcystic adnexal carcinoma (MAC), extramammary Paget's disease (EMPD), Merkel cell carcinoma (MCC), and sebaceous carcinoma (SEB CA). Patient demographic data, tumor measurements, treatment characteristics, and marginal recurrence rates were compiled and evaluated. RESULTS The mean numbers of cases identified per year for each tumor type were as follows: PDSCC, 6.19; DFSP, 2.44; MAC, 1.63; and EMPD, 0.63. For PDSCC, 85 cases were available for follow-up with a local recurrence rate of 6% at a mean follow-up time of 45 months. For DFSP, there were 35 cases with no local recurrence at a mean follow-up of 39 months. For MAC, there were 25 cases with a local recurrence rate of 12% at a mean follow-up of 39 months. For EMPD, there were 10 cases with no local recurrences at a mean follow-up of 34 months. CONCLUSIONS Collectively, our data on PDSCC, DFSP, MAC, and EMPD, combined with other studies in the literature, show that MMS is the most effective therapy for these rare aggressive cutaneous malignancies. [source] Multiple Primary Acral Melanomas in African-Americans: A Case Series and Review of the LiteratureDERMATOLOGIC SURGERY, Issue 1 2007ANGELA C. S. HUTCHESON MD BACKGROUND Although melanoma accounts for only 4% to 5% of all skin cancers in the United States, it causes most skin cancer,related deaths. We describe a unique group of African-American patients with multiple primary acral lentiginous melanomas (ALMs). OBJECTIVE The purpose of this study was to review the case histories and management of a cohort of patients in the Mohs practice of our dermatologic surgeon with multiple primary ALM. METHODS This is a case series of patients with multiple ALM identified by chart review from 2000 to 2005. A thorough review of the literature was performed. RESULTS Four patients, all African-American, were identified with multiple ALM. All patients were managed with excision or Mohs micrographic surgery utilizing permanent sections. None of the patients with ALM had melanomas at nonacral sites or other types of skin cancer. Several had acral melanosis. Information in the literature on patients with multiple primary acral melanomas was insufficient. CONCLUSION Patients with multiple acral melanomas have not, to our knowledge, been reported thus far. It can be extrapolated from current literature, however, that appropriate management of these patients, including staging work and surgical intervention, is to be determined by the individual characteristics of the melanoma and the patient's concomitant risk factors, if any. [source] Complications from Injectable Polyacrylamide Gel, a New Nonbiodegradable Soft Tissue FillerDERMATOLOGIC SURGERY, Issue 12p2 2004Snehal P. Amin Background. Polyacrylamide gels, containing a hydrogel composed of polyacrylamide and water, are used for soft tissue augmentation and contour correction. There are no reports of significant complications after injection of this material into the face. Objective. We report an inflammatory reaction after injection of polyacrylamide gels for zygomatic facial augmentation. Methods. A retrospective chart review of single case is presented. Results. An inflammatory reaction at the sites of polyacrylamide gels injection was noted at 1 month after initial injection. Despite two ensuing courses of broad-spectrum antibiotics, the patient presented to us with persistent draining nodules. Intralesional steroid injections resulted in prompt resolution and no recurrence. Conclusion. Inflammatory reactions have been noted in patients receiving polyacrylamide gels for breast augmentation. Facial polyacrylamide gels injections may also be associated with an inflammatory reaction that responds to intralesional steroids. With increasing availability of a variety of soft tissue fillers, dermatologists should be aware of this delayed complication from polyacrylamide gels. [source] Combination Surgical Lifting with Ablative Laser Skin Resurfacing of Facial Skin: A Retrospective AnalysisDERMATOLOGIC SURGERY, Issue 9 2004Tina S. Alster MD Background. Cutaneous aging is manifested by rhytides, dyschromias, and skin laxity. Ablative laser skin resurfacing can effectively improve many signs of skin aging; however, the photoaged patient with facial laxity often requires a surgical lifting procedure in order to obtain optimal results. Concerns with delayed or impaired wound healing has led to reluctance to perform both procedures simultaneously. Objective. To report the clinical results and side effect profiles after concomitant surgical facial lifting procedures and ablative carbon dioxide or erbium:YAG laser resurfacing in a series of patients. Methods. A retrospective analysis and chart review was performed in 34 consecutive patients who underwent combination CO2 or erbium:YAG laser skin resurfacing and surgical lifting procedures, including S-lift rhytidectomy, blepharoplasty, and brow lift. Side effects and complication rates were tabulated. Results. The side effect profile of the combined surgical-laser procedures was similar to that reported after a laser-only procedure. The most common side effect was transient hyperpigmentation which occurred in 20.6% of treated patients. None of the patients experienced delayed reepithelialization, skin necrosis, or prolonged healing times. Conclusions. Concurrent laser skin resurfacing and surgical lifting of facial skin maximizes aesthetic results without increased incidence of adverse effects. Patients benefit from the consolidation of anesthesia and convalescent times as well as enhanced global clinical outcomes. [source] Laser Hair Removal: Long-Term Results with a 755 nm Alexandrite LaserDERMATOLOGIC SURGERY, Issue 11 2001Sorin Eremia MD Background. Hypertrichosis is a common problem for which laser hair removal is becoming the treatment of choice. Optimal wavelength, pulse duration, spot size, fluence, and skin cooling parameters for various skin types have not yet been firmly established. Objective. To evaluate the long-term efficacy and safety of a 3-msec 755 nm alexandrite laser equipped with a cryogen cooling device for patients with Fitzpatrick skin types I,V. Methods. Eighty-nine untanned patients with skin types I,V underwent a total of 492 treatments of laser hair removal over a 15-month period. Each patient in the study underwent a minimum of three treatment sessions spaced 4,6 weeks apart (mean treatments 5.6). Retrospective chart review and patient interviews were used to establish hair reduction results. Treatment sites included the axillae, bikini, extremities, face, and trunk. A 3-msec pulse width, 755 nm alexandrite laser equipped with a cryogen spray cooling device was used in this study. Spot sizes of 10,15 mm were used. A spot size of 10 mm was used for fluences greater than 40 J/cm2, a spot size of 12 mm was used for fluences of 35,40 J/cm2, and spot sizes of 12 and 15 mm were used for fluences less than 30 J/cm2. Fluences ranging from 20 to 50 J/cm2 (mean fluence 36 J/cm2) were used. Results. The patients had a mean 74% hair reduction. Skin type I patients had an average of 78.5% hair reduction using a mean fluence of 40 J/cm2 (35,50 J/cm2) and a 10,12 mm spot size (12 mm in more than 95% of treatments). Skin type II patients had a mean 74.3% hair reduction using a mean fluence of 38 J/cm2 (30,40 J/cm2) and a 12,15 mm spot size. Skin type III patients had a mean 73.4% hair reduction using a mean fluence of 37 J/cm2 (25,40 J/cm2) and a 12,15 mm spot size. Skin type IV patients had a mean 71.0% hair reduction using a mean fluence of 31 J/cm2 (25,35 J/cm2) and a 12,15 mm spot size. A patient with skin type V had a 60% hair reduction using a mean fluence of 23 J/cm2 (20,25 J/cm2) and a 12,15 mm spot size. The efficiency of hair removal directly correlates significantly with the fluence used. Rare side effects included transient postinflammatory hyperpigmentation (n = 9; 10%), burn with blisters (n = 1; 1%), and postinflammatory hypopigmentation (n = 2; 2%). All complications resolved without permanent scarring. Conclusion. The 3-msec cryogen cooling-equipped alexandrite laser can safely and effectively achieve long-term hair removal in patients with skin types I,V. The best results are achieved in untanned patients with skin types I,IV. [source] Long-term use of the ketogenic diet in the treatment of epilepsyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 12 2006Darcy K Groesbeck BS Long-term outcomes of the ketogenic diet in the treatment of epilepsy have not previously been reported. A retrospective chart review of children treated with the ketogenic diet for more than 6 years at the Johns Hopkins Hospital was performed. The response was documented at clinic visits and by telephone contacts; laboratory studies were obtained approximately every 6 to 12 months. Satisfaction and tolerability were assessed by means of a brief parental telephone questionnaire. In all, 28 patients (15 males, 13 females), currently aged 7 to 23 years, were identified. The median baseline seizure frequency per week at diet onset was 630 (range 1,1400). Diet duration ranged from 6 to 12 years; 19 remain on the diet currently. After 6 years or more, 24 children experienced a more than 90% decrease in seizures, and 22 parents reported satisfaction with the diet's efficacy. Ten children were at less than the 10th centile for height at diet initiation; this number increased to 23 at the most recent follow-up (p=0.001). Kidney stones occurred in seven children and skeletal fractures in six. After 6 years or more the mean cholesterol level was 201mg/dl, high-density lipoprotein was 54mg/dl, low-density lipoprotein was 129mg/dl, and triglycerides were 97mg/dl. Efficacy and overall tolerability for children are maintained after prolonged use of the ketogenic diet. However, side effects, such as slowed growth, kidney stones, and fractures, should be monitored closely. [source] The Gross Motor Function Classification System for Cerebral Palsy: a study of reliability and stability over timeDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 5 2000Ellen Wood MD MSc FRCP(C) Assistant Professor Children with cerebral palsy (CP) experience a change in motor function with age and development. It is important to consider this expected change in offering a prognosis, or in assessing differences in motor function after an intervention. The Gross Motor Function Classification System for CP (GMFCS) has been developed for these purposes. This study was based on a retrospective chart review of 85 children with CP followed from ,2 to ,12 years of age. The GMFCS was applied to clinical notes by two blinded raters four times throughout the study. Interrater reliability was high (G=0.93). Test-retest reliability was high (G=0.79). The positive predictive value of the GMFCS at 1 to 2 years of age to predict walking by age 12 years was 0.74. The negative predictive value was 0.90. The GMFCS can validly predict motor function for children with CP. The results are discussed in terms of their implications for clinical practice and future research. [source] Screening for Adolescent Depression in a Pediatric Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 5 2006Emily Gale Scott MD Abstract Objectives: To describe the prevalence of depressive symptoms in adolescents presenting to the emergency department (ED) and to describe their demographics and outcomes compared with adolescents endorsing low levels of depressive symptoms. Methods: The Beck Depression Inventory,2nd edition (BDI-II) was used to screen all patients 13,19 years of age who presented to the ED during the period of study. The BDI-II is a 21-item self-report instrument used to measure the presence and severity of depressive symptoms in adolescents and adults. Demographics and clinical outcomes of screening-program participants were abstracted by chart review. Patients were categorized into one of four severity categories (minimal, mild, moderate, or severe) and one of three presenting complaint categories (medical, trauma, mental health). Results: Four hundred eighty-seven patients were approached, and 351(72%) completed the screening protocol. Participants endorsed minimal (n= 192, 55%), mild (n= 52, 15%), moderate (n= 41, 11%), or severe depressive symptoms (n= 66, 19%). Those with moderate or severe depressive symptoms were more likely to be hospitalized. Of patients completing the BDI-II, 72% with psychiatric, 12% with traumatic, and 19% with medical chief complaints endorsed either moderate or severe depressive symptoms. Conclusions: Depressive symptoms are prevalent in this screening sample, regardless of presenting complaint. A substantial proportion of patients with nonpsychiatric chief complaints endorsed moderate or severe depressive symptoms. A screening program might allow earlier identification and referral of patients at risk for depression. [source] Prognostic Value of 12-Lead Electrocardiogram During Dobutamine Stress EchocardiographyECHOCARDIOGRAPHY, Issue 5 2000Milind R. Dhond M.D. The aim of this study was to assess the prognostic value of the 12-lead electrocardiogram (ECG) obtained during dobutamine stress echocardiography (DSE) in predicting subsequent cardiac events. We retrospectively analyzed 345 patients undergoing DSE in 1992,1994 and selected those patients with negative echo results for ischemia. Of the 200 patients with negative DSE results, a separate analysis of their ECG data was performed with results reported as either positive, negative, or nondiagnostic for ischemia. Follow-up was performed through a physician chart review and direct telephone contact. Event rates were determined for hard (myocardial infarction or cardiac death) and soft (hospitalization for angina and/or congestive heart failure, coronary angioplasty, or coronary artery bypass graft surgery) cardiac events occurring after the negative DSE for up to 6 years after the test. Death was also determined by referencing the patients' data with mortality data available on the Internet. There were 143 patients with ECG data reported as negative and 40 patients with ECG data reported as positive for ischemia. The hard and soft event rates were 1.5% and 9% per patient per year in the ECG negative group and 2% and 11% in the ECG positive group. There were no statistical differences in event rates between the two groups during the 5-year follow-up period. Our results suggest that the ECG result obtained during DSE does not confer any incremental prognostic value over the echo result. [source] Hemispheric Surgery in Children with Refractory Epilepsy: Seizure Outcome, Complications, and Adaptive FunctionEPILEPSIA, Issue 1 2007Sheikh Nigel Basheer Summary:,Purpose: To describe seizure control, complications, adaptive function and language skills following hemispheric surgery for epilepsy. Methods: Retrospective chart review of patients who underwent hemispheric surgery from July 1993 to June 2004 with a minimum follow-up of 12 months. Results: The study population comprised 24 children, median age at seizure onset six months and median age at surgery 41 months. Etiology included malformations of cortical development (7), infarction (7), Sturge-Weber Syndrome (6), and Rasmussen's encephalitis (4). The most frequent complication was intraoperative bleeding (17 transfused). Age <2 yr, weight <11 kg, and hemidecortication were risk factors for transfusion. Postoperative complications included aseptic meningitis (6), and hydrocephalus (3). At median follow-up of 7 yr, 79% of patients are seizure free. Children with malformations of cortical development and Rasmussen's encephalitis were more likely to have ongoing seizures. Overall adaptive function scores were low, but relative strengths in verbal abilities were observed. Shorter duration of epilepsy prior to surgery was related significantly to better adaptive functioning. Conclusions: Hemispheric surgery is an effective therapy for refractory epilepsy in children. The most common complication was bleeding. Duration of epilepsy prior to surgery is an important factor in determining adaptive outcome. [source] Prognostic Significance of Failure of the Initial Antiepileptic Drug in Children with Absence EpilepsyEPILEPSIA, Issue 6 2001Elaine Wirrell Summary: ,Purpose: In children with childhood absence epilepsy (CAE) and juvenile absence epilepsy (JAE), to determine the impact of failure of initial antiepileptic drug (AED) for lack of efficacy in eventual seizure control and long-term remission of epilepsy. Methods: Centralized EEG records for the province of Nova Scotia allowed identification of all children seen with CAE or JAE between 1977 and 1985. Information regarding success or failure of initial AED in fully controlling seizures and long-term seizure control and remission of epilepsy was collected by patient questionnaire and chart review. Results: Eighty-six of 92 eligible patients were followed up (75 CAE, 11 JAE). Initial AED treatment was successful in 52 (60%) of 86. Success tended to be greater for valproate (VPA) than for other AEDs (p = 0.07), and lower if generalized tonic,clonic or myoclonic seizures coexisted (p < 0.004 and p < 0.03). Terminal remission was more likely if the initial AED was successful than if it had failed (69% vs. 41%; p < 0.02). Compared with those in whom the initial AED was successful, subjects whose initial AED had failed were more likely to progress to juvenile myoclonic epilepsy (JME) at last follow-up (32% vs. 10%; p < 0.02) and to develop intractable epilepsy (17% vs. 2%; p < 0.04). Conclusions: Initial AED was successful in 60% of children with AE. If the first AED failed, the outcome was less favorable, with a lower rate of terminal remission and a higher rate of progression to JME and intractable epilepsy. [source] Premature termination of treatment in an inpatient eating disorder programmeEUROPEAN EATING DISORDERS REVIEW, Issue 4 2007Philip C. Masson Abstract This retrospective study was conducted to explore rates, timing and predictors of two forms of premature termination of treatment (PTT) in an inpatient eating disorders programme: patient dropout (DO) and administrative discharge (AD). A chart review was conducted to obtain demographic, Eating Disorder Inventory-2 (EDI-2), and Resident Assessment Instrument-Mental Health (RAI-MH) data for 186 patients being treated for bulimia nervosa (BN), anorexia nervosa (AN), or eating disorder not otherwise specified (EDNOS). Overall, of the 37.6% of patients who terminated treatment prematurely, 22.1% of patients dropped out, and 15.5% of patients were administratively discharged. Time at which discharge occurred was found to be associated with the type of premature termination. The presence of DSM-IV Axis-I comorbidity was found to be the only factor associated with an increased risk of being administratively discharged. No factors were predictive of patients dropping out of treatment. The findings support the notion that AD and patient DO are different events that may have different factors influencing their rates and timing. Implications for future research and programme planning are discussed. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association. [source] | |||||||||||||||||||||||||||||||||||||