We sought to compare the obstetrical outcomes in patients who underwent midtrimester cerclage placement with or without prior amniocentesis in a single center cohort.
A retrospective medical record ...review in a single academic institution was undertaken of all patients who underwent either an exam or ultrasound indicated cerclage. This group was then divided into two groups: amniocentesis or no amniocentesis groups. Detailed maternal data was abstracted from the prenatal and hospital records. Amniocentesis fluid specimens were sent for Gram stain, aerobic and anaerobic bacterial culture, including mycoplasma and ureaplasma, as well as for glucose. Comparisons were performed utilizing Parametric 2-sample t-test for continuous variables and Fisher's exact test was utilized to compare categorical variables.
A total of 160 patients who underwent a cerclage were utilized for comparison. Sixty-five patients who had an amniocentesis performed prior to the cerclage were compared with 95 patients who underwent a cerclage without an amniocentesis. None of the amniocentesis results were positive for infection in those that received a cerclage. Patients that had an amniocentesis before cerclage were found to have an earlier gestational age at time of the procedure (20.30 ± 2.29 weeks versus 21.32 ± 1.81 weeks, p < .001), a shorter cervical length on presentation (0.93 ± 0.61 cm versus 1.45 ± 0.66 cm, p < .001), delivered at an earlier gestational age (GA 32.2 30.3 to 34.2 versus 36.3 35.2 to 37.3 weeks, p < .001) with shorter time from cerclage placement until delivery (13.9 0.0 to 24.0 versus 16.3 0.3 to 23.2 weeks, p = .010). The rates of chorioamnionitis and PPROM were significantly higher in the amniocentesis group (17 versus 2%, p = .0008 and 26 versus 13%, p = .03 respectively). Five patients who underwent an amniocentesis did not receive a cerclage, with one having a positive Gram stain and culture.
Amniocentesis use prior to cerclage placement in this single institution cohort was utilized in patients who presented earlier in gestation with shorter cervical length and more cervical dilation. The severity of presentation was the determining factor in the decision to perform an amniocentesis prior to cerclage placement, and, because of this difference in severity, outcomes for the amniocentesis group were predictably worse than those who did not undergo amniocentesis.
Objectives/Hypothesis
This study aimed to evaluate the changes in electrocochleography (EcohG) measurements after intratympanic (IT) dexamethasone therapy and to correlate them with the long‐term ...effects on the control of vertigo.
Study Design
Prospective outcomes research.
Methods
This study included 62 patients with unilateral Ménière's Disease (MD) refractory to medical therapy for at least 1 year. Each patient was treated with a fixed protocol of three consecutive weekly injections of a commercial 4 mg/mL dexamethasone preparation. The 1995 American Academy of Otolaryngology–Head and Neck Surgery (AAO–HNS) criteria for reporting treatment outcomes for MD were used.
Electrocochleography (EcohG) measurements were performed 1 month before and 1 and 12 months after IT steroid therapy. Caloric test and vestibular evoked myogenic potential (VEMPs) were performed before the IT treatment. The summating potential/action potential (SP/AP) ratio was measured before and after the IT treatment. A Kaplan‐Meier analysis was used to evaluate the control of vertigo over a 2‐year period.
Results
Complete vertigo control (class A) was achieved in 26 patients (41.9%) at the 12‐month follow‐up and in 12 patients (19.3%) at the 24‐month follow‐up. A significant reduction (P < 0.01) in the SP/AP ratio after the IT steroid treatment was observed in the first‐month determination, but no significant differences were found when the initial and 12‐month determination were compared.
Conclusions
IT dexamethasone provides an alternative treatment for patients with Ménière's Disease. A transitory reduction of the endolymphatic hydrops is detected by the EcohG 1 month after treatment. The hydrops levels returned to their initial values in the 1‐year EcohG follow‐up.
Level of Evidence
2b. Laryngoscope, 125:1183–1188, 2015
OBJECTIVE:To estimate the frequency and reasons for inadequate group B streptococci (GBS) prophylaxis at our institution and to estimate what proportion of cases can be avoided with perfect protocol ...adherence.
METHODS:This was a retrospective cohort study of neonates born to GBS-colonized women who received inadequate prophylaxis between April 30, 2013, and May 1, 2014. The maternal chart was analyzed to categorize each case as avoidable (adequate time on labor and delivery to receive antibiotics 4 hours before birth and β-lactam antibiotic-eligible) or unavoidable and to determine whether a violation of the 2010 Centers for Disease Control and Prevention (CDC) protocol (delayed or incorrect antibiotics) occurred.
RESULTS:A total of 197 of 488 (40.4%, 95% confidence interval 36.1–44.8%) newborns of group B-colonized women received inadequate prophylaxis. Of these, 157 cases (79.7%, 73.4–84.8%) were unavoidable and would have occurred even with perfect protocol adherence. The 40 (20.3%, 15.3–26.5%) avoidable cases due to protocol violations resulted from delayed antibiotic administration (first dose of antibiotics more than 1 hour after admission median 9.33 hours, range 3.83–25 hours in 25 patients; no antibiotics in four patients; total 29 patients, 72.5%) or incorrect antibiotic selection (11 patients, 27.5%).
CONCLUSIONS:Forty percent of patients received inadequate prophylaxis, and four of five cases are unavoidable with our current labor management and the 2010 CDC guidelines. Timeliness and selection of antibiotics remain areas for improvement, but the overall effects on sepsis prevention will be modest.
Our study aimed to explore whether the hair cortisol concentration (HCC), a measure of long-term cortisol output, is associated with poorer cognitive functioning in adolescents with attention deficit ...and hyperactivity disorder (ADHD). We further aimed to test the potential moderating effects of sex and childhood maltreatment.
In this cross-sectional study, fifty-three adolescents with ADHD were studied. The ADHD Rating Scale (ADHD-RS) and Childhood Trauma Questionnaire (CTQ) were administered. Seven cognitive tasks from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were administered, and two cognitive factors (attention and memory and executive functioning) were identified by confirmatory factor analysis. A 3-cm hair sample from the posterior vertex region of the head was obtained. HCCs were determined by a high-sensitivity enzyme immunoassay kit. Multiple linear regression analyses were used to explore the association between HCCs and either cognitive performance or ADHD severity while adjusting for sex, childhood maltreatment and the ADHD-RS total score.
Sex moderated the relationship between HCCs and attention/memory confirmatory factor analysis (CFA) scores, with better performance in boys with higher HCCs. HCCs were not associated with executive functioning or ADHD symptoms. Childhood maltreatment was associated with inattention symptoms in adolescents with ADHD.
Our study suggests that HCCs are positively associated with attention and memory performance in adolescents with ADHD, with a moderating effect of sex (the relationship is strongest in boys).
Low-grade inflammation has been repeatedly associated with both excess weight and psychosis. However, no previous studies have addressed the direct effect of body mass index (BMI) on basal serum ...cytokines in individuals with first-episode psychosis (FEP).
The aim of this study is to analyze the effect of BMI on basal serum cytokine levels in FEP patients and control subjects, separating the total sample into two groups: normal-weight and overweight individuals.
This is a prospective and open-label study. We selected 75 FEP patients and 75 healthy controls with similar characteristics to patients according to the following variables: sex, age, and cannabis and tobacco consumption. Both controls and patients were separated into two groups according to their BMI: subjects with a BMI under 25 were considered as normal weight and those with a BMI equal to or more than 25 were considered as overweight. Serum levels of 21 cytokines/chemokines were measured at baseline using the Human High Sensitivity T Cell Magnetic Bead Panel protocol from the Milliplex® Map Kit. We compared the basal serum levels of the 21 cytokines between control and patient groups according to their BMI.
In the normal-weight group, IL-8 was the only cytokine that was higher in patients than in the control group (p = 0.001), whereas in the overweight group, serum levels of two pro-inflammatory cytokines (IL-6, p = 0.000; IL-1β, p = 0.003), two chemokines (IL-8, p = 0.001; MIP-1β, p = 0.001), four Th-1 and Th-2 cytokines (IL-13, p = 0.009; IL-2, p = 0.001; IL-7, p = 0.001; IL-12p70, p = 0.010), and one Type-3 cytokine (IL-23, p = 0.010) were higher in patients than in controls.
Most differences in the basal serum cytokine levels between patients and healthy volunteers were found in the overweight group. These findings suggest that excess weight can alter the homeostasis of the immune system and therefore may have an additive pro-inflammatory effect on the one produced by psychosis in the central nervous system.
Nodal metastases in the central compartment are frequent in papillary thyroid cancer (PTC). However, they are mostly micrometastases with no impact on survival and their relevance on the risk of ...locoregional relapse is controversial.
There is no consensus regarding optimal management of the central neck in patients with PTC cN0. In our center, we do not perform prophylactic central neck dissection (pCND). The objective of this study is to review our long-term results and compare them with the most recent literature.
Retrospective review of patients with PTC who underwent total thyroidectomy (TT) without CND between 2005 and 2017. Primary result was disease-free survival in the neck (DFS).
321 patients were identified, mostly T1-T2 tumors (94.1%). Median follow-up was 90 months. DFS in the central compartment was excellent (96.1% at 10 year’s follow-up). 19 patients had cervical recurrence, of which 15 underwent salvage surgery.
On their last visit, including salvage surgery when appropriate, 77% of patients had excellent response, 18.7% had indeterminate response, 3.1% had biochemically incomplete response and 1.2% had morphologically incomplete response. Recurrent laryngeal nerve (RLN) paralysis after TT was transient in 4.7% of patients and permanent in 0.9% of patients. There were no RLN paralysis after salvage surgery. Permanent hypoparathyroidism occurred in 3.4% of patients. Only one patient had hypoparathyroidism after salvage surgery and it was permanent.
Based on long-term results and low rate of complications associated with salvage surgery in our experience, we consider routine pCND is not justified.
Las metástasis ganglionares en el compartimento central son frecuentes en el cáncer papilar de tiroides (PTC), pero suelen ser micrometástasis que no impactan en la supervivencia, con un papel controvertido sobre el riesgo de recidiva locorregional.
No existe consenso acerca del manejo del compartimento central en pacientes con PTC cN0. En nuestro centro no realizamos vaciamiento central electivo (pCND). El objetivo de este estudio es revisar nuestros resultados a largo plazo y compararlos con la literatura reciente.
Estudio retrospectivo de pacientes con PTC tratados con tiroidectomía total (TT) sin CND entre 2005 y 2017. El objetivo principal fue la supervivencia libre de enfermedad cervical (DFS).
321 pacientes fueron identificados, la mayoría T1-T2 (94,1%). La mediana de seguimiento fue 90 meses. La DFS en el compartimento central fue excelente (96,1% a 10 años). 19 pacientes tuvieron recidiva cervical, de los cuales 15 fueron reintervenidos. En su última revisión, incluyendo reintervenciones, el 77% de los pacientes tenía una respuesta excelente, el 18,7% indeterminada, el 3,1% bioquímica incompleta y el 1,2% morfológica incompleta.
Tras la TT, el 4,7% de los pacientes tuvo parálisis recurrencial transitoria, y el 0,9% permanente. No hubo ningún caso de parálisis recurrencial tras las reintervenciones. La tasa de hipoparatiroidismo permanente fue del 3,4%. Sólo un paciente tuvo hipoparatiroidismo tras la reintervención, y fue permanente.
Basándonos en nuestros resultados a largo plazo y las escasas complicaciones asociadas a las reintervenciones, consideramos que no está justificado realizar pCND de forma rutinaria.
El Gerbode es un defecto septal infrecuente que origina un cortocircuito entre el ventrículo izquierdo y la aurícula derecha. Presentamos el caso de un paciente de 68 años con insuficiencia aórtica ...moderada en seguimiento y antecedentes de neurocirugía reciente para resección de malformación arteriovenosa cerebral, con epilepsia de difícil control posterior. Ingresó en nuestro centro por fiebre secundaria a tromboflebitis y hemocultivos positivos a Staphylococcus aureus resistente a meticilina. En el ecocardiograma transesofágico no se observaron signos de endocarditis y se instauró tratamiento antibiótico dirigido. Seis días después presentó parada cardiorrespiratoria en el contexto de bloqueo auriculoventricular completo y bajo gasto cardiaco. Ingresó en la UCI, donde se implantó un marcapasos transitorio, sufriendo una crisis tónico-clónica que obligó a intubación. Un nuevo ecocardiograma demostró insuficiencia aórtica masiva y engrosamiento de la continuidad mitroaórtica, decidiéndose reemplazo valvular aórtico emergente. El paciente tuvo una buena evolución posquirúrgica inicial hasta que a la semana se detectó en eco de control una masa en la aurícula derecha asociada a comunicación tipo Gerbode. Se decidió manejo conservador pero a los 15 días del diagnóstico, coincidiendo con un claro empeoramiento clínico, se objetivó importante aumento del shunt, indicándose corrección quirúrgica urgente mediante cierre del orificio de salida en la aurícula derecha. El eco de control poscirugía mostró una prótesis aórtica normofuncionante, ausencia de shunt residual y válvula tricúspide competente. La evolución posterior discurrió sin incidencias y el paciente fue dado de alta al finalizar el tratamiento antibiótico.
Gerbode is a rare septal defect that causes a shunt between the left ventricle and the right atrium. We present the case of a 68-year-old patient with moderate aortic regurgitation under follow-up and a history of recent neurosurgery for resection of a cerebral arteriovenous malformation, with residual epilepsy difficult to control. He was admitted to our center due to fever secondary to thrombophlebitis and positive blood cultures for methicillin-resistant Staphylococcus aureus. Transesophageal echocardiogram showed no signs of endocarditis and targeted antibiotic treatment was started. 6 days later, he presented cardiorespiratory arrest in the context of complete atrioventricular block and low cardiac output. He was admitted to the ICU, where a temporary pacemaker was implanted, suffering a tonic-clonic seizure that required intubation. A new echocardiogram showed massive aortic insufficiency and thickening of the mitro-aortic continuity, so emergent aortic valve replacement was indicated. The patient had a good initial post-surgical evolution but, a week later, a mass in the right atrium associated with a Gerbode-type communication was detected in a control echo. Conservative management was decided, but 15 days after the diagnosis of the shunt, coinciding with a clear clinical worsening, a significant increase in the shunt was observed, and he underwent urgent surgical correction by closing the outlet orifice in the right atrium. Post-surgery control echo showed normally functioning aortic prosthesis, absence of residual shunt and competent tricuspid valve. Postoperative recovery was uneventful and patient was discharge after finishing antibiotic treatment.
Recurrent tonsillitis might reduce the immunological capability of fighting against the infection of tonsil tissue. Polypodium leucotomos (Anapsos) immunomodulating effect has been subject of ...research in the last years. The aim of this research is to test the in vitro immunomodulating capacity of Anapsos in a child palatine tonsil explants model.
Palatine tonsils explants of children undergoing amigdalectomy were stimulated with mononuclear cells obtained from their own blood by density gradient centrifugation. Some were then treated with Anapsos while others rest untreated. Cytokines were measured by ELISA, immune cells activation was measured by flow cytometry and activation of immunoglobulins was appreciated by indirect immunofluorescence in tonsils tissue.
Anapsos activates Natural Killers cells. It increases IL-2 and IFN-γ levels by the activation of Th2 lymphocytes, and IL-10, by the Th1 lymphocytes. Anapsos also increases immunoglobulins IgM, IgD and IgG4 by B-lymphocyte activation in tonsils tissue.
Anapsos has an immunomodulating effect, both in humoral and cellular responses, which might benefit children suffering of recurrent tonsillitis as it could enhance their immune system. This effect might reduce the number of episodes suffered and therefore the number of children undergoing surgery.
Abstract
Conclusions: Intratympanic (IT) dexamethasone provides an alternative for patients with Ménière's disease (MD). A reduction of the endolymphatic hydrops is detected by the EcohG 1 month ...after the treatment. Objective: The use of intratympanic corticoid injections for MD has become popular due to the lack of reported adverse effects, but the mechanism of action is not well established. This study aimed to evaluate the changes in electrocochleography (EcohG) measurements during IT dexamethasone therapy. Methods: This study included 53 patients with unilateral MD refractory to medical therapy for at least 1 year. Each patient was treated with a fixed protocol of three consecutive weekly injections of a commercial 4 mg/ml dexamethasone preparation. EcohG measurements were performed 1 month before and 1 month after IT steroid therapy. The SP/AP ratio was measured before and after the IT treatment. A Kaplan-Meier analysis was used to evaluate the control of vertigo over a 2-year period. Results: Complete vertigo control (class A) was achieved in 22 patients (41.5%) at the 12-month follow-up and 8 patients (15.1%) at the 24-month follow-up. A significant reduction (p < 0.01) in the SP/AP ratio after the IT steroid treatment was observed.
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