High Treatment Success Rate Research Articles

CYP2C93 variant is associated with antidiabetes efficacy of gliclazide in Chinese type 2 diabetes patients.

Aims/IntroductionThe objective of the present study was to investigate the effects of CYP2C9*3 polymorphisms on the therapeutic response to gliclazide in type 2 diabetes patients.Materials and MethodsA total of 746 incident type 2 diabetes patients were included in this study. After enrolment, patients went on 4‐week gliclazide monotherapy. Fasting plasma glucose was measured before and after treatment. Hypoglycemia episodes and lifestyle information were collected by weekly follow up. Genotyping of rs1057910 was carried out using the single base primer extension method. The t‐test, analysis of variance and chisquare‐test were used to evaluate the effects of rs1057910 alleles on the therapeutic response to gliclazide.ResultsAfter the therapy, fasting plasma glucose decreased significantly from 11.2 ± 2.7 mmol/L to 8.0 ± 2.2 mmol/L (P < 0.001). Patients with AC/CC genotypes of rs1057910 had a greater reduction of fasting plasma glucose (3.6 vs 3.0 mmol/L, P < 0.001; 31.4 vs 24.5%, P < 0.001) and a higher rate of treatment success (54.7 vs 37.5%, P < 0.001; 51.4 vs 32.3%, P < 0.001; 71.6 vs 48.3%, P < 0.001 for criterion 1, 2 and 3, respectively).ConclusionsThe present study showed that the polymorphism at rs1057910 significantly affected the therapeutic response of gliclazide in type 2 diabetes mellitus patients. The risk allele is associated with a greater decrease of fasting blood glucose and a higher rate of treatment success with gliclazide monotherapy.

Determining treatment outcome of smear-positive pulmonary tuberculosis cases in Afar Regional State, Ethiopia: A retrospective facility based study

Objective/background: The World Health Organization (WHO) declared tuberculosis (TB) as a global public health emergency and recommended directly observed treatment, short-course (DOTS) as a standard strategy to control the disease. In Ethiopia the strategy was started in 1992 as a pilot in the Arsi and Bale zone, Oromia Region. The DOTS strategy has been subsequently scaled up in the country and implemented at a national level reaching better coverage, although there are recognizable variations from region to region and district to district. The aim of this study was to assess the impact of the DOTS strategy on smear-positive pulmonary TB case findings and their treatment outcomes in the Afar Regional State, Ethiopia, from 2003 to 2012 and from 2002 to 2011, respectively.Methods: A health facility-based retrospective study was conducted. Data were collected and reported on a quarterly basis using the WHO reporting format for TB case findings and their treatment outcomes from all DOTS-implementing health facilities in all zones of the region to the Federal Ministry of Health.Results: A total of 34,894 of TB cases had been registered in the period from 2003 to 2012. Out of these, 11,595 (33.2%) were smear-positive pulmonary TB, 13,859 (39.7%) smear-negative pulmonary TB, and 9838 (28.2%) extrapulmonary TB. The case detection rate (CDR) of smear-positive pulmonary TB had increased from 18.3% to 37.2%, with the average value being 32% (standard deviation=6.8) from the total TB cases to its peak of 39% in 2008. The treatment success rate (TSR) had an average value of 86.2% from 2002 to 2011 with its peak value being 96.5% in 2007. Moreover, the average values of treatment defaulter and treatment failure rate were 2.9% and 2.7%, respectively.Conclusion: The implementation for the DOTS strategy in the area improved the CDR of smear-positive TB, although it is unacceptably lower than the recommended WHO target of 70%. Additionally, the WHO target of 85% for TSR had already been achieved in the region. However, continued efforts should be in place to increase the CDR and maintain the high TSR registered.

Association between Directly Observed Therapy and Treatment Outcomes in Multidrug-Resistant Tuberculosis: A Systematic Review and Meta-Analysis

BackgroundMultidrug-resistant tuberculosis (MDR-TB) represents a major obstacle towards successful TB control. Directly observed therapy (DOT) was recommended by WHO to improve adherence and treatment outcomes of MDR-TB patients, however, the effectiveness of DOT on treatment outcomes of MDR-TB patients was mixed in previous studies. We conducted this systematic review and meta-analysis to assess the association between DOT and treatment outcomes and to examine the impact of different DOT providers and DOT locations on successful treatment outcomes in MDR-TB patients.MethodsWe searched studies published in English between January 1970 and December 2015 in major electronic databases. Two reviewers independently screened articles and extracted information of DOT, treatment success rate and other characteristics of studies. Random effects model was used to calculate the pooled treatment success rate and 95% confidence interval (CI). Sub-group analyses were conducted to access factors associated with successful treatment outcomes.ResultsA total of 31 articles 7,466 participants were included. Studies reporting full DOT (67.4%, 95% CI: 61.4–72.8%) had significantly higher pooled treatment success rates than those reporting self-administration therapy (46.9%, 95% CI: 41.4–52.4%). No statistically difference was found among DOT provided by healthcare providers (65.8%, 95% CI: 55.7–74.7%), family members (72.0%, 95% CI: 31.5–93.5%) and private DOT providers (69.5%, 95% CI: 57.0–79.7%); and neither did we find significantly difference on pooled treatment success rates between patients having health facility based DOT (70.5%, 95% CI: 61.5–78.1%) and home-based DOT (68.4%, 95% CI: 51.5–81.5%).ConclusionProviding DOT for a full course of treatment associated with a higher treatment success rate in MDR-TB patients.

Lip Cancer: A Clinicopathological Study and Treatment Outcomes in a 25-Year Experience

There are few clinical studies focusing on treatment outcomes of lip cancer. This study investigated the clinicopathologic variables of a large sample of patients with lip squamous cell carcinoma (LSCC) treated in a reference head and neck cancer center for the past 25years and analyzed the influence of these variables on treatment outcomes. This retrospective cohort study reviewed the clinical records of patients with LSCC. Epidemiologic data were age, gender, ethnicity, type of occupation, tobacco smoking, alcohol consumption, comorbid conditions, and family cancer history. Clinicopathologic features included the lip location of the tumor, TNM classification, clinical staging, histopathologic grade, surgical margin analysis, and treatment modality. Local recurrence, second primary tumor, and survival were the outcome variables. Statistical analysis was performed by χ(2) test, Fisher exact test, and binary logistic regression analysis. Survival analysis was assessed through the Kaplan-Meier curve. Level of statistical significance was set at a P value less than .05 for all tests. In total, 144 patients with LSCC were studied. There were 117 men (81.25%) and 27 women (18.75%) with a mean age of 60.21years. One hundred thirty-four patients (93.05%) were considered of white ethnicity, and in 57 cases (39.58%), the patients reported an occupation that was related to long-term solar exposure. Most cancers had initial clinical staging of 1 or 2 (84.02%). Microscopically, lesions were predominantly well (43.05%) and moderately (40.96%) differentiated tumors. Clinical staging was related to a specific higher survival rate (P= .0049). One hundred twelve cases (77.78%) underwent surgical treatment and only 6 patients (4.80%) had local recurrence, which was directly associated with compromised surgical margins (P= .0320). A high success rate in LSCC treatment was observed in this study. Compromised surgical margin was associated with tumor recurrence and is a critical event in lip cancer treatment.

Failure of endodontic treatment: The usual suspects.

Inappropriate mechanical debridement, persistence of bacteria in the canals and apex, poor obturation quality, over and under extension of the root canal filling, and coronal leakage are some of the commonly attributable causes of failure. Despite the high success rate of endodontic treatment, failures do occur in a large number of cases and most of the times can be attributed to the already stated causes. With an ever increasing number of endodontic treatments being done each day, it has become imperative to avoid or minimize the most fundamental of reasons leading to endodontic failure. This paper reviews the most common causes of endodontic failure along with radiographic examples.

Endoscopic versus percutaneous drainage of symptomatic pancreatic fluid collections: a 14-year experience from a tertiary hepatobiliary centre.

Introduction Endoscopic transmural drainage (ED) or percutaneous drainage (PD) has mostly replaced surgery for the initial management of patients with symptomatic pancreatic fluid collections (PFCs). This study aimed to compare outcomes for patients undergoing ED or PD of symptomatic PFCs.MethodsBetween January 2000 and December 2013, all patients who required PD or ED of a PFC were included. Rates of treatment success, length of hospital stay, adverse events, re-interventions and length of follow-up were recorded retrospectively in all cases.ResultsIn total, 164 patients were included in the study; 109 patients underwent ED; and 55 had PD alone. During the 14-year study period, the incidence of ED increased and PD fell. In the 109 patients who were managed by ED, treatment success was considerably higher than in those managed by PD (70 vs. 31 %). Rates of procedural adverse events were higher in the ED cohort compared to the PD group (10 vs. 1 %), but patients managed by ED required fewer interventions (median of 1.8 vs. 3.3) had lower rates of residual collections (21 vs. 67 %) and need for surgical intervention (4 vs. 11 %). In the ED group, treatment success was similar for walled-off pancreatic necrosis (WOPN) and pseudocysts (67 vs. 72 %, P = 0.77). There were no procedure-related deaths.ConclusionCompared with PD, ED of symptomatic PFCs was associated with higher rates of treatment success, lower rates of re-intervention, including surgery and shorter lengths of hospital stay. Outcomes in WOPN were comparable to those in patients with pseudocysts.

Paediatric dermatology emergencies in a tertiary hospital

Abstract Introduction In recent years, the increasing demand for dermatological consultations in the Emergency Department has resulted in the publication of a variety of studies on this subject. However, most of them deal with the general population, without taking into account the changes in frequencies found in young children (ages 0–14). Objectives To determine the frequency of various dermatological diagnoses made by the on-call paediatrician in the Emergency Department, and after referral to paediatric dermatology. Materials and methods Firstly, a descriptive retrospective study was performed that included all patients aged between 0 and 14 years old who were seen after being referred to the emergency paediatric dermatologist by the on-call paediatrician from June 2010 to December 2013. Secondly, an analytical study was carried out by calculating the kappa index calculus, in order to establish the diagnostic concordance between the emergency paediatrician and the paediatric dermatologist. Results A total of 861 patients, with a mean age of 4.5 years were included. More than half of the skin disorders analysed were eczema (27%) and infections (26%). The five main diagnoses were: atopic dermatitis (16%), acute prurigo simplex (5%), tinea (5%), pyogenic granuloma (4%), and molluscum contagiosum (4%). Additional tests were only required in 16% of the cases. The kappa index obtained was 0.206 (95% CI : 0.170–0.241). Conclusions The dermatology consultations in the Emergency Department were shown to be frequent and mostly involved minor diseases. Collaboration between paediatricians and dermatologists resulted in a high treatment success rate, leading to a low percentage of additional tests required and a high rate of discharges.

Antibiotics alone versus appendectomy to treat uncomplicated acute appendicitis in adults: what do meta-analyses say?

BackgroundPrimary appendectomy is the current standard of care for treating uncomplicated acute appendicitis, but interest in conservative treatment with antibiotics alone has been increasing in recent years. Clinical trials so far have shown controversial results.MethodsA series of meta-analyses were reviewed. Studies comparing surgery versus antibiotics alone for treating uncomplicated acute appendicitis in adults were included. Descriptive statistics and data on treatment effects were retrieved and summarized.ResultsThe conservative approach has a success rate of around 60 % and is associated with shorter pain duration, reduced analgesic medication, faster resolution of the inflammation process, lower expenses and quicker return to work. On the other hand, medical treatment leads to high (up to 20 %) readmission rates and more often requires surgery. An operative approach is associated with higher treatment success rates (>90 %) and very a low mortality rate.ConclusionBased on the current body of evidence, the use of antibiotics for primary treatment of uncomplicated acute appendicitis cannot be routinely recommended. Appendectomy remains the gold-standard treatment.

Adherence to Anti-tuberculosis treatment and treatment outcomes among tuberculosis patients in Alamata District, northeast Ethiopia.

BackgroundNon-adherence to tuberculosis (TB) treatment can result in an emergence of new strains, prolonged infectiousness, drug resistance and poor treatment outcomes. Thus, assessment of the level of adherence to anti-TB treatment, treatment outcomes and identifying factors associated with non-adherence and poor treatment outcomes are vital for improving TB treatment adherence and treatment outcomes in the study area. The main objectives of the current study were to assess the level of adherence to anti-TB treatment among patients taking anti-TB drug treatment and to identify factors associated with non-adherence. Whereas, the secondary objectives were to assess treatment outcomes and factors associated with poor treatment outcomes among TB patients previously treated at the health institutions of Alamata District, northeast Ethiopia.MethodsIn a health facility-based cross-sectional study, TB patients who were taking anti-TB drug treatment were interviewed using a structured questionnaire to evaluate level of adherence to anti-TB treatment. TB treatment outcomes were evaluated using data generated from a record review of previous TB patients who were treated at health facilities of Alamata District from January 2007 to June 2012. Adherence data and treatment outcomes data were computerized separately using Epi-Data version 3.1 and analyzed using STATA version 10.0.ResultsBetween November 2012 and January 2013, 116 (58.0 %) male TB patients and 84 (42.0 %) female TB patients were interviewed, of whom 77.5 % were new cases, 23.5 % were smear-positive pulmonary TB (SPPTB) cases, 26.5 % were smear-negative PTB (SNPTB) cases and 50.0 % were extra pulmonary (EPTB) cases. The overall adherence rate to anti-TB treatment was 88.5 %. The main reasons for the non-adherent patients were forgetting to take medication, being away from home, drug side effects, being unable to go to the health facilities on the date of appointment and being hospitalized. In the TB treatment outcomes component of the current study, records of 4,275 TB patients were reviewed and the overall treatment success rate was 90.1 %. Two-hundred fifteen (5.0 %) patients had unsuccessful treatment outcomes, of whom 76 (35.3 %) defaulted, 126 (58.6 %) died and 13 (6.1 %) had treatment failure. Significant predictors of unsuccessful treatment outcomes were being positive for human immunodeficiency virus (HIV) infection [adjusted odds ratio (aOR) = 2.1, 95 % CI 1.5–3.0], being SPPTB case (aOR = 3.4, 95 % CI 2.4–4.8), being SNPTB case (aOR = 2.0, 95 % CI 1.5–2.8)], and being re-treatment cases (aOR = 2.6, 95 % CI 1.5–3.7).ConclusionIn the present study area, there was a high level of adherence to anti-TB treatment and also a high TB treatment success rate. However, still further effort like health education to patient or family is needed to reduce those factors which affect adherence and treatment success rates in order to ensure higher rates of adherence and treatment success than the currently observed in the present study area.

Different Therapeutic Outcomes of Benznidazole and VNI Treatments in Different Genders in Mouse Experimental Models of Trypanosoma cruzi Infection.

The lack of translation between preclinical assays and clinical trials for novel therapies for Chagas disease (CD) indicates a need for more feasible and standardized protocols and experimental models. Here, we investigated the effects of treatment with benznidazole (Bz) and with the potent experimental T. cruzi CYP51 inhibitor VNI in mouse models of Chagas disease by using different animal genders and parasite strains and employing distinct types of therapeutic schemes. Our findings confirm that female mice are less vulnerable to the infection than males, show that male models are less susceptible to treatment with both Bz and VNI, and thus suggest that male models are much more suitable for selection of the most promising antichagasic agents. Additionally, we have found that preventive protocols (compound given at 1 dpi) result in higher treatment success rates, which also should be avoided during advanced steps of in vivo trials of novel anti-T. cruzi drug candidates. Another consideration is the relevance of immunosuppression methods in order to verify the therapeutic profile of novel compounds, besides the usefulness of molecular diagnostic tools (quantitative PCR) to ascertain compound efficacy in experimental animals. Our study aims to contribute to the development of more reliable methods and decision gates for in vivo assays of novel antiparasitic compounds in order to move them from preclinical to clinical trials for CD.

ERCP in patients with prior Billroth II gastrectomy

Objective To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) by using a duodenoscope in patients with prior Billroth Ⅱ gastrectomy. Methods Data of 98 patients(including 7 who underwent Billroth Ⅱand Braun)with prior Billroth Ⅱ gastrectomy who underwent ERCP from January 2008 to May 2014 at Endoscopy Center of Ruijin Hospital were retrospectively studied. Results A total of 98 patients accepted 111 ERCP procedures, the overall success rate was 75.7%(84/111). The success rate of accessing Vater's papilla was 82.0%(91/111)and the selective cannulations success rate was 92.3%(84/91). In the cases of successful access, therapeutic procedures were achieved in 100.0%(84/84)of all patients. The overall rate of complications was 4.5%(5/111), with mild post-procedure pancreatitis occurring in 3 cases, cholangitis in 2 cases, respectively. Conclusion ERCP using a duodenoscope can be safely and effectively performed in patients with prior Billroth Ⅱ gastrectomy with high cannulation and treatment success rates. Key words: Cholangiopancreatography, endoscopic retrograde; Gastrectomy; Gastroenterostomy; Duodenoscope

Interventions to improve adherence to treatment for paediatric tuberculosis in low- and middle-income countries: a systematic review and meta-analysis

ObjectiveTo assess the design, delivery and outcomes of interventions to improve adherence to treatment for paediatric tuberculosis in low- and middle-income countries and develop a contextual framework for such interventions.MethodsWe searched PubMed and Cochrane databases for reports published between 1 January 2003 and 1 December 2013 on interventions to improve adherence to treatment for tuberculosis that included patients younger than 20 years who lived in a low- or middle-income country. For potentially relevant articles that lacked paediatric outcomes, we contacted the authors of the studies. We assessed heterogeneity and risk of bias. To evaluate treatment success – i.e. the combination of treatment completion and cure – we performed random-effects meta-analysis. We identified areas of need for improved intervention practices.FindingsWe included 15 studies in 11 countries for the qualitative analysis and of these studies, 11 qualified for the meta-analysis – representing 1279 children. Of the interventions described in the 15 studies, two focused on education, one on psychosocial support, seven on care delivery, four on health systems and one on financial provisions. The children in intervention arms had higher rates of treatment success, compared with those in control groups (odds ratio: 3.02; 95% confidence interval: 2.19–4.15). Using the results of our analyses, we developed a framework around factors that promoted or threatened treatment completion.ConclusionVarious interventions to improve adherence to treatment for paediatric tuberculosis appear both feasible and effective in low- and middle-income countries.

Understanding and Treating Vaginismus

This article was written to raise the awareness of clinicians about vaginismus, an underdiagnosed and inadequately treated condition characterized by painful intercourse. Although it was first described over 150 years ago, vaginismus is rarely taught in medical schools and residencies or discussed at medical meetings. Despite numerous hypotheses on possible causes, its etiology is unknown. Vaginismus affects 5% to 17% of women seen in a clinical setting. Its true incidence is unknown, because many patients remain silent about this problem. Women with this disorder cannot tolerate vaginal penetration via intercourse, tampons, vaginal dilators, or gynecological examinations because of severe pain resulting from involuntary spasm of the vaginal muscles. Vaginal penetration is impossible for these women despite their desire to achieve it. Because of inadequate education and training, many clinicians are unable to diagnose and treat vaginismus. Women with primary vaginismus have never experienced pain-free intercourse, whereas those with secondary vaginismus were comfortable with intercourse at one time in their lives prior to progression to painful intercourse. A carefully constructed medical and psychosexual history and use of the Female Sexual Function Index facilitate the diagnosis of this disorder. The ability to successfully treat severe vaginismus requires a careful consideration of its diagnostic features, which include (1) a history of intercourse feeling such as hitting a wall that is suggestive of vaginal spasm of the introitus and (2) the inability to tolerate a gynecological examination. The presence of spasm or its severity and the degree of fear and anxiety over vaginal penetration distinguish between mild and severe forms of this disorder. Women with situational vaginismus cannot tolerate certain forms of penetration such as intercourse, but insertion of tampons or finger penetration is possible. Women with complete vaginismus are unable to tolerate any vaginal penetration. There is potential for a high rate of treatment success in patients with vaginismus unlike other sexual pain disorders such as vulvodynia and vestibulodynia. Vaginismus is a physical and psychological condition, and both components must be treated. Treatments that have been used to help women overcome vaginismus include dilators, physical therapy, sex counseling, psychotherapy, hypnotherapy, cognitive behavioral therapy, and a multimodal program using botulinum toxin A (onabotulinum toxin A). Kegel exercises, hymenectomy, lubricants, topical anesthetics, antidepressants, antianxiety medication, sedatives, alcohol, hallucinogenic drugs, and muscle relaxants are not shown to be helpful. For 10 years, the author has been developing a treatment program utilizing botulinum toxin A injections, bupivacaine injections, progressive dilation under anesthesia, and posttreatment counseling. This article describes his prospective pilot study that involved 30 patients with vaginismus. Effectiveness was assessed using Female Sexual Function Index scores and daily logs. At 1 year after treatment with this multimodal program, comfortable intercourse (or use of large dilator by single women without partners) was achieved in 97% of the patients. No recurrences or adverse events were noted. Long-term follow-up and blinded, randomized studies are needed to confirm these findings. No improvement in the diagnosis or management of this treatable disorder can be achieved without greater awareness among clinicians and physicians in training. The emotional needs of patients must be addressed whatever treatment is used. Stratifying the severity of vaginismus is important to determine the best course of treatment. Posttreatment counseling and follow-up are essential for success regardless of the treatment program used.

Su1516 Treatment Failure and Delayed Complication Due to Shedding of the Over-the Scope Clip: Experience in Three Cases

The over the scope clip (OTSC) was designed to close acute perforations, fistulas, and to provide hemostasis. Small case series suggest a high rate of treatment success but it has not previously been emphasized that delayed shedding of the clip can lead to secondary treatment failure and perforation. Our experience: Case #1 was a 73-year-old man with hematochezia. Colonoscopy showed a bleeding diverticulum in the sigmoid colon that did not respond to use of standard clips, injection with epinephrine and banding.

Mo1485 Comparison of Direct Endoscopic Injection (DEI) and EUS-Guided Fine Needle Injection (EUS-FNI) of 2-Octyl-Cyanoacrylate for Treatment of Gastric Varices

Mo1485 Comparison of Direct Endoscopic Injection (DEI) and EUS-Guided Fine Needle Injection (EUS-FNI) of 2-Octyl-Cyanoacrylate for Treatment of Gastric Varices

Mo1486 The Diagnostic Utility of Endoscopic Ultrasonography in Assessing the Depth of Tumor Invasion in Early Gastric Cancer

Mo1486 The Diagnostic Utility of Endoscopic Ultrasonography in Assessing the Depth of Tumor Invasion in Early Gastric Cancer

Highly successful treatment outcome of multidrug-resistant tuberculosis in the Netherlands, 2000–2009

Resistance to the two key anti-tuberculosis drugs isoniazid and rifampicin is a characteristic of multidrug-resistant tuberculosis (MDR-TB). MDR-TB is a scourge requiring toxic, prolonged treatment and is associated with poor outcomes. The Netherlands is a country with a long-standing, integrated, well-resourced TB service where all patients are offered culture-confirmed diagnosis by a central reference laboratory. To assess the treatment outcomes of MDR-TB patients over a period of 10 years in The Netherlands. Demographic, clinical and microbiological features of all patients with MDR-TB who started treatment in 2000-2009 in the Netherlands were analysed from national registry and patient records. Characteristics of the 113 MDR-TB patients were as follows: male/female ratio 1.57, 96% foreign born, median age 29 years, 96 (85%) pulmonary TB, 56 (50%) smear-positive, 14 (12%) human immunodeficiency virus (HIV) co-infected. Of the 104 (92%) patients who started MDR-TB treatment, 86% had a successful outcome using a median of six active drugs; eight underwent pulmonary surgery. HIV negativity was associated with successful outcome (adjusted OR 2.1, 95%CI 1.1-3.8). High success rates for MDR-TB treatment were achieved with close collaboration of all stakeholders, reaching the targets set for drug-susceptible TB. HIV remained an independent risk factor for unsuccessful treatment outcome.

Urgencias dermatológicas pediátricas en un hospital de tercer nivel

IntroductionIn recent years, the increasing demand for dermatological consultations in the Emergency department has resulted in the publication of a variety of studies on this subject. However, most of them deal with the general population, without taking into account the changes in frequencies found in young children (ages 0-14). ObjectivesTo determine the frequency of various dermatological diagnoses made by the on-call paediatrician in the Emergency Department, and after referral to Paediatric Dermatology. Material and methodsFirstly, a descriptive retrospective study was performed that included all patients aged between 0 and 14 years old who were seen after being referred to the emergency paediatric dermatologist by the on-call paediatrician from June 2010 to December 2013. Secondly, an analytical study was carried by calculating the kappa index calculus, in order to establish the diagnostic concordance between the emergency paediatrician and the paediatric dermatologist. ResultsA total of 861 patients, with a mean age of 4.5 years were included. More than half of the skin disorders analysed were eczema (27%) and infections (26%). The 5 main diagnoses were: atopic dermatitis (16%), acute prurigo simplex (5%), tinea (5%), pyogenic granuloma (4%), and molluscum contagiosum (4%). Additional tests were only required in 16% of the cases. The kappa index obtained was 0.206 (95% CI: 0.170-0.241). ConclusionsThe dermatology consultations in the Emergency Department were shown to be frequent and mostly involved minor diseases. Collaboration between paediatricians and dermatologists resulted in a high treatment success rate, leading to a low percentage of additional tests required and a high rate of discharges.

Review of a 10-year single center experience in treatment of thoracoabdominal aortic trauma

Objective To review the case data and treatment methods in a single center so as to search for rational treatments for thoracoabdominal aortic trauma. Methods This retrospective analysis was performed for 34 cases (28 males and 6 females) sustaining thoracoabdominal aortic trauma treated from October 2002 to February 2013. The mean age was 41 years (range, 11-60 years). Causes of injury included traffic crashes in 14 cases, high falls in 7, stab wound in 3, abdominal crash injury in 3, aorticoesophageal fistula caused by a fish bone in 3, interventional therapy-induced aortic dissection in 2, abdominal aortic injury caused by the dropped ventricular septal defect occluder in 1, and accidental aortic injury in spinal operation in 1. There were 23 cases of thoracic aortic trauma (6 sharp and 17 blunt) and 11 cases of abdominal aortic trauma (4 sharp and 7 blunt). Preoperative imaging findings, treatment methods and follow-up data were studied. Results Personal treatment was produced based on the mechanism of injury and imaging findings. Of sharp thoracic aortic trauma, 2 cases were treated non-operatively but both died, and four cases had endovascular repair (one progressed, two cured, and one died). All the four cases of sharp abdominal aortic trauma had open surgery (three cured and one severely complicated). Of thoracic aortic trauma, four cases were treated non-operatively (three cured and one died), twelve cases had endovascular repair (11 cured and one died), and one case had open surgery and cured. Six cases of blunt abdominal aortic trauma were treated non-operatively and one had open surgery. Conclusions Treatment of aortic trauma should be based on injury condition, injury site, and occurrence of aortic rupture or impending of aortic rupture. Endovascular repair has a high success rate and good clinical outcome in treatment of thoracoabdominal aortic trauma. Key words: Aorta; Wounds and injures; Endovascular repair

Failure of Flow Diverter Treatment of Intracranial Aneurysms Related to the Fetal-type Posterior Communicating Artery.

PurposeThe pipeline embolization device (PED) is a flow diverter that has shown promise in the treatment of intracranial aneurysms. Close to one-fifth of aneurysms, however, fail to occlude after PED placement. This study aims to identify anatomical features and clinicopathologic factors that may predispose failed aneurysm occlusion with the PED.Materials and MethodsWe retrospectively reviewed all anterior circulation unruptured saccular aneurysms treated with the PED in a single-center. The primary outcome measure was angiographic occlusion. Anatomical features and potential predictors, including gender, aneurysm location, size, height, aspect ratio, neck width, prior treatment and the number of PED, were studied using binary logistic regression.Results29 anterior circulation unruptured saccular aneurysms with a mean size of 6.99 mm treated with the PED in a single center were retrospectively studied. The overall occlusion rate was 79.3% after a mean follow-up of 9.2 months. Four aneurysms were related to the fetal-type posterior communicating artery (PComA), and all were refractory to flow diverter treatment. Female gender was significantly associated with a higher occlusion rate. We present the anatomical features and propose possible pathophysiological mechanisms of these PComA aneurysms that failed flow diverter treatment.ConclusionA PComA aneurysm with persistent fetal-type circulation appears to be particularly refractory to flow diverter treatment, especially when the aneurysm incorporates a significant portion of the PComA. Our experience suggested that flow diverting stents alone may not be the ideal treatment for this subgroup of aneurysms, and alternative modalities should be considered. Female patients were found to have a significantly higher rate of treatment success.