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D. Arunachalam S. Pendem P. Ravi K.K. Raja V.B. 《The British journal of oral & maxillofacial surgery》2019,57(6):566-571
Patients with cleft palate have a high incidence of otitis media (OM), which, even after palatal repair, can persist and lead to auditory dysfunction. We aimed to identify what predisposes such patients to develop OM and correlate it with auditory function. We designed a prospective case-control study of adults who had had their cleft palates repaired in childhood. We examined the anatomy of the eustachian tube and the paratubal muscles of the soft palate with magnetic resonance imaging (MRI), assessed auditory function, and correlated the results to evaluate the impact of the pathological anatomy on the function of the middle ear. A total of 64 ears in 32 patients were evaluated (Group A, n = 16) (Group B, controls = 16). MRI showed a short eustachian tube with a shortened tensor attachment in Group A when compared with Group B. The pterygoid hamulus was found to be intact in both groups, but extensive perihamular fibrosis was seen in Group A. A total of 15 ears in Group A had loss of hearing (prevalence ratio (PR) 1.08), (13 mild loss, and 2 moderate loss), and impedance audiometry showed effusion of the middle ear in 12 ears in 16 patients, and dysfunction of the eustachian tube with high negative pressure in the middle ear in four ears in the 16 patients (PR 4.6). These could be positively correlated with the pathological anatomy using Pearson’s correlation coefficient. Otitis media is persistent and can lead to conductive hearing loss in adults who have been operated on for cleft palate. This can be attributed to abnormalities in the development of the eustachian tube and the paratubal musculature. 相似文献
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Vishnu Ambur Peter Park John P. Gaughan Scott Golarz Frank Schmieder Paul Van Bemmelen Eric Choi Ravi Dhanisetty 《Journal of vascular surgery》2019,69(2):491-496
Objective
Patient selection for open lower extremity revascularization in patients with chronic kidney disease (CKD) remains a clinical challenge. This study investigates the impact of CKD on early graft failure, postoperative complications, and mortality in patients undergoing lower extremity bypass for critical limb ischemia.Methods
The National Surgical Quality Improvement Program database was queried for all patients with critical limb ischemia from 2012 to 2015 who underwent lower extremity bypass using the targeted vascular set. The glomerular filtration rate was calculated using the Chronic Kidney Disease Epidemiology Collaboration Study equation. CKD categories were determined from the National Kidney Foundation Kidney Disease Outcomes Quality Initiative staging criteria. Patients were classified into three groups: CKD stages 3 or lower (mild to moderate CKD), CKD stages 4 or 5 (severe CKD), and on hemodialysis (HD). Multiple variable analysis was used to examine graft failure, mortality, and postoperative complications.Results
The Surgical Quality Improvement Program database identified 6978 patients who underwent infrainguinal lower extremity arterial bypass during the study period. There were 6101 patients (87.4%) with mild to moderate CKD, 327 (4.7%) with severe CKD, and 550 (7.9%) on HD. Patients with severe CKD and on HD were more likely to have revascularization for tissue loss (54.9% vs 68.8% and 74.7%; P < .01). Patients with severe CKD and those on HD had higher rates of early graft failure, postoperative myocardial infarction, and rates of reoperation. Multiple variable analysis confirmed these results showing that HD was associated with postoperative myocardial infarction, readmission, and increased mortality. It also demonstrated that severe CKD was associated with graft failure (odds ratio [OR], 1.67; 95% confidence interval [CI], 1.12-2.50; P = .01), postoperative myocardial infarction (OR, 2.16; 95% CI, 1.35-3.45; P < .01), and readmission (OR, 1.38; 95% CI, 1.06-1.80; P = .02). Other factors associated with graft failure include functional status (OR, 1.39; 95% CI, 1.08-1.80; P = .01), African American race (OR, 1.72; 95% CI, 1.39-2.13; P < .01), and distal bypass (OR, 1.33; 95% CI, 1.09-1.61; P < .01).Conclusions
CKD is a significant predictor of perioperative morbidity after lower extremity bypass. Patients with severe CKD have worse postoperative outcomes without increased mortality. Those on HD have worse survival and postoperative outcomes. 相似文献7.
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