To evaluate and compare early radiographic and clinical outcomes of lower cervical and upper thoracic three-column osteotomies (3CO) for cervicothoracic kyphosis correction.
Methods
Patients who underwent 3CO at the cervicothoracic junction at two institutions were retrospectively reviewed. Patients were divided into two groups: lower cervical osteotomy (LCO) and upper thoracic osteotomy (UTO: T1–T5). Operative data, radiographic alignment, peri-operative complications, and clinical outcomes were compared between the groups.
Results
Forty-eight patients [male: 24; female: 24; average age 61 years (range 18–92 years); mean follow-up: 22 months] met inclusion criteria. A total of 24 pedicle subtraction osteotomies and 24 vertebral column resections were performed. Compared to UTO, LCO operative time was significantly shorter, average ICU and hospital stays were significantly longer, and the average pre-operative cervical sagittal vertical axis (SVA) and kyphosis were significantly greater (p < 0.05). For both groups, there was significant improvement in cervical SVA, cervical lordosis, segmental angle, Neck Disability Index (NDI), SRS Activity, and pain visual analog score (p < 0.05). Reoperation rates were similar between the groups (LCO: 33.3 %; UTO: 18 %, p = 0.28). Significantly, more patients required tracheostomy/gastrostomy tubes after LCO (3 vs. 0 in the UTO group, p = 0.03).
Conclusions
Three-column posterior osteotomies at the cervicothoracic junction restored regional sagittal alignment and improved quality of life in this series of patients with rigid cervicothoracic deformity, albeit with high complication rates. Lower cervical osteotomies provided greater cervical SVA correction and were shorter operations, although they were associated with more complications and longer hospital and ICU stays compared to upper thoracic osteotomies.
The objective of this study was to describe nosocomial infection (NI) rates, risk factors, etiologic agents, antibiotic susceptibility, invasive device utilization and invasive device associated infection rates in a burn intensive care unit (ICU) in Turkey.
Methods
Prospective surveillance of nosocomial infections was performed according to Centers for Disease Control and Prevention (CDC) and National Healthcare Safety Network (NHSN) criteria between 2001 and 2012. The data was analyzed retrospectively.
Results
During the study period 658 burn patients were admitted to our burn ICU. 469 cases acquired 602 NI for an overall NI rate of 23.1 per 1000 patient days. 109 of all the cases (16.5%) died. Pseudomonas aeruginosa (241), Acinetobacter baumannii (186) and Staphylococcus aureus (69) were the most common identified bacteria in 547 strains.
Conclusion
Total burn surface area, full thickness burn, older age, presence of inhalation injury were determined to be the significant risk factors for acquisition of NI. Determining the NI profile at a certain burn ICU can lead the medical staff apply the appropriate treatment regimen and limit the drug resistance. Eleven years surveillance report presented here provides a recent data about the risk factors of NI in a Turkish burn ICU. 相似文献
In this study, we aimed to evaluate the clinicopathologic characteristics and prognosis of breast cancer (BC) patients with symptomatic bone marrow metastasis (BMM). Fifty‐four BC patients, including patients with and without BMM, were evaluated retrospectively. In particular, the clinicopathologic features and survival of the patients with BMM (n = 27) were assessed and compared with the patients without BMM. All of the patients with BMM also had osseous metastases, and bone was the first site for distant recurrence in the majority of patients in the study group. Anemia was the most frequent symptom at presentation. The median time to BMM was 36.1 months (range 1.6–70.5 months, 95% CI). HER2(+) patients developed BMM earlier than HER2(?) patients (3.2 versus 38.3 months, 95% CI; p = 0.05). Patients with advanced disease at the time of initial BC diagnosis developed BMM earlier than patients with early disease (p = 0.04). Time to development of BMM was significantly shorter in tumors with perinodal infiltration (p = 0.001) and multicentric focus (p = 0.025). Median survival time after the diagnosis of apparent BMM was 6.43 months. Survival after BMM diagnosis in patients with grade III tumors was significantly shorter than in patients with grade I–II tumors (1.43 versus 5.36 months, 95% CI; p < 0.001). Systemic therapy after BMM diagnosis significantly prolonged survival (17.3 versus 0.93 months, 95% CI; p < 0.001). Hormone receptor‐positive, high‐grade, advanced‐stage tumors at the time of initial BC diagnosis were more common in patients with BMM. Invasive lobular histology was also more frequent in patients with BMM. In conclusion, the presence of hormone receptor‐positive, multicentric, grade III, advanced‐stage tumors may be important risk factors for the development of evident BMM in BC patients. Systemic single‐agent chemotherapy can prolong survival in these patients. However, multicenter analyses are required to verify these findings. 相似文献
Spontaneous coronary artery dissection (SCAD) is an extremely rare cause of myocardial ischemia. It is more prevalent in young women, particularly in the peripartum period. We report a case of SCAD occurring in a 40-year-old non-pregnant woman who presented with acute coronary syndrome. Coronary angiography revealed dissection in the mid and distal portions of left anterior descending artery. She was treated with medical therapy and repeat coronary angiography at 2 months showed no signs of the previous dissection. 相似文献
To examine the predictive value of pre-procedural CRP level in patients undergoing percutaneous coronary intervention (PCI) regardless of having unstable or stable angina pectoris or myocardial infarction. Blood sampling for CRP measurement in patients undergoing PCI: 116 consecutive patients who underwent single vessel PCI were evaluated. Exclusion criteria were multilesion PCI, total occlusion, left ventricular ejection fraction <30%, left bundle branch block and intercurrent inflammatory conditions known to be associated with an acute phase response. Major adverse coronary events (MACE) were defined as the occurrence of death, fatal or nonfatal myocardial infarction, and need for coronary artery revascularization with either bypass grafting or repeat angioplasty. End-points were assessed at hospital discharge, 30 days, 3 and 6 months following the index procedure. 62 (53%) patients had CRP levels <0.5 mg/dl, and 54 (47%) had >0.5 mg/dl. There were no significant difference in the occurrence of MACE in early in-hospital and 30 days follow up periods, between the two groups (0 vs. 5.5%) (p = ns) whereas the incidence of MACE after 3 months of the procedure was significantly different between the two groups (1.6 vs. 11%) (p < 0.05) and also after 6 months (9.5 vs 24.5%) (p < 0.05). The negative predictive value of CRP measurement is 98.4%. High levels of pre-procedural CRP show association with the higher incidence of MACE after 3 months of the follow-up period and negative CRP tests seems to have high predictive value to compare the patients who will be free of MACE after successful PCI. 相似文献
Quality of life, which is impaired in patients with chronic spontaneous urticaria (CSU), is influenced by comorbid mental disorders. Headaches could be another comorbid mental disorder that affects quality of life in children with CSU.
Objectives
To investigate the effect of headaches on urticaria symptoms, disease activity and quality of life in children with CSU.
Methods
A total of 83 patients with CSU were enrolled in the study and were separated into two groups as those with or without headache. Demographic and clinical characteristics were studied with the Urticaria Activity Score (UAS7), Urticaria Control test (UCT) and Chronic Urticaria Quality of Life Questionnaire (CU-Q2QoL). The headache questionnaire designed according to the Department of International Classification of Headache Disorders, second edition (ICHD-II) was used and VAS (Visual Analogue Scale) and NRS (Numerical Rating Scale) were used to assess the pain measurement. In patients diagnosed with migraine, the paediatric Migraine Disability Assessment Scale (PedMIDAS) was applied.
Results
CU-QoL total scores were significantly higher in patients with CSU with headache than in those without headache (p = 0.015). In the five domains of CU-QoL, impact of daily life activities domain and sleep problems domain had higher scores in CSU with headache (p = 0.008, 0.028, respectively). There was no significant relationship between UCT, UAS and CU-QoL and headache severity (p < 0.05). No differences were found between the groups in respect of duration of urticaria, UAS7 and UCT.
Conclusion
Headache may be an important factor that affects and impairs quality of life in children with chronic urticaria. 相似文献
A 50-year-old male with a history of inferior myocardial infarction and stent implantation to the right coronary artery 20 days prior this admission presented with acute inferior myocardial re-infarction. Diagnostic right coronary angiography revealed a massive thrombus within the previously implanted stent. After manual aspiration through a guiding catheter, a large, fresh thrombus was removed. Subsequently, thrombolysis in myocardial infarction (TIMI) 3 flow was established, and no further intervention was required. The patient was discharged uneventfully on medical therapy. 相似文献