Purpose: In Gastric Electrical Stimulation therapy (GES), presence of idiopathic Gastroparesis (Gp), with abdominal pain predominance and narcotic dependence are predictors of poor treatment outcome. Endoscopically placement of Temporary Electrical Stimulation(TES) would predict treatment response to permanent surgical placement of GES, thereby helping to prescreen patients with poor clinical predictors. Methods: The study protocol was approved by the institutional IRB. Five patients with idiopathic Gp, all females, age (23-46 years) with medically refractory symptoms, on narcotics for abdominal pain and with history of multiple hospitalizations, where consented for the TES. One patient (Pt B) had been on parenteral nutritional support. An initial 4 hour nuclear scintigraphic gastric emptying study (GET) was performed to confirm Gp. TES consisted of performing an endoscopy to rule out structural abnormalities and implantation of a cardiac lead into the body on the stomach 10 cm proximal to the pylorus. The lead was converted to transnasal and attached to an external neurosimulator. Stimulation parameters were set at the highest energy level of 10 V, pulse width of 330 microseconds, rate of 14 Hz and on/off cycle at 0.5/5 seconds. The mucosal lead was removed in a week. Patients with significant symptom response and improvement on the GCSI (Gastrointestinal Cardinal Symptom Index) scale proceeded with GES. 6 weeks post surgery the subject underwent a GET to assess improvement in gastric emtying (GE). Results: 3 patients had response to TES proceeded with GES, while 2 had aggravation of heartburn and abdominal pain symptoms and decision for GES was suspended. The 3 patients that displayed immediate symptom response on TES had sustained comparable response after surgical placement too. Pt B was able to wean off parenteral nutritional. There was a significant improvement in GE in the repeat 4 hr GET (P=0.048) the difference was even more robust when only the first 3 hours where taken into account (P=0.002). However the relative improvement in GE did not correlate with the degree of symptom resolution suggesting additional physiological changes contributing to symptom relief. Conclusion: Temporary electrical stimulation of the stomach is a good tool to predict treatment response in patients with otherwise poor clinical predictors for treatment response.Figure
Objectives: To describe national trends in the incidence and outcomes of patients with chordae tendineae rupture (CTR).Methods: Patients who were diagnosed with CTR between 2000 and 2012 were identified in National (Nationwide) Inpatient Sample (NIS) registry. CTR was defined using validated International Classification of Diseases, 9th Edition, Clinical Modification diagnosis (ICD9-CM) codes. Results: A total of 37,287 (14,833 mitral valve repair, 7780 mitral valve replacement) CTR cases were identified. Overall, in-hospital mortality in CTR decreased by 3% from 2000 to 2012 (P < 0.001). From 2000 to 2012, the rate of mitral valve repair increased from 27.2% to 46.4%, (P < 0.001) with a concurrent decrease in the rate of mitral valve replacement (from 27.8 to 17.7%, P < 0.001). After multivariate adjustment, patient age (OR = 1.04, 95% CI 1.03-1.06, P < 0.001), congestive heart failure (CHF) (OR = 2.08, 95% CI 1.19-3.64, P = 0.01), myocardial infarction (MI) (OR = 3.58, 95% CI 2.10-6.11, P < 0.001), Deyo/Charlson comorbidity index (OR = 1.23, 95% CI 1.07-1.41, P < 0.003) and use of the intra aortic balloon pump (IABP) (OR = 4.81 95% CI 2.71-8.55, P < 0.001) were found to be independently associated with greater odds of mortality in these patients. Additionally, mitral valve replacement was significantly associated with higher costs of hospitalization (coefficient 15693, 95% CI 12638-18749, P < 0.001)Conclusion: Mitral valve repair is associated with reduced inpatient mortality and costs compared with mitral valve replacement. A substantial increase in the percentage of cases undergoing mitral valve repair with a concurrent decrease in cases undergoing mitral valve replacement were observed. Increasing age and comorbidity index, history of CHF and MI, and use of IABP were identified as factors that could increase the risk of mortality in patients with CTR.
Introduction: Limited evidence exists regarding the impact of annual hospital volume on outcomes in patients receiving heart transplant. Hypothesis: To quantify the impact of annual hospital volume on in-hospital mortality among patients receiving heart transplantation. Methods: Data from the National (Nationwide) Inpatient Sample (years 2008 to 2012) were analyzed to identify 11,104 patients receiving heart transplant. The study population was identified using validated international Classification of Diseases, Ninth Revision, Clinical Modification diagnosis (ICD-9-CM) and procedure codes. Annual hospital volume was calculated using unique hospital identifiers. Hospitals were divided into tertiles based on the volume of transplant cases admitted over the study period (low: 1-65, medium: 65-125, high> 125). Multivariate regression analysis was used to identify independent predictors of mortality in patients undergoing heart transplant. Results: Between the years of 2008 and 2012, a total of 519 (4.67%) in-hospital deaths occurred among recipients of heart transplantation. In-hospital mortality was highest (5.8%) in the low hospital volume and lowest (3.9%) in hospitals with high annual volume (p Conclusion: Hospital volume is an independent determinant for in-hospital mortality among patient receiving heart transplants.
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