Long-term results of plaque excision combined with aggressive pharmacotherapy in high-Risk patients with advanced peripheral artery disease (SAVE a LEG registry)

2018 Background: Due to the rarity of medulloblastoma (MB) in adults, the few studies available on this condition are retrospective, and the follow-up tends to be short. Furthermore, the different therapeutic strategies used in these patients makes it difficult to assess survival rates and prognostic factors. Methods: Between January 1989 and February 2001, a prospective phase II trial was performed to evaluate the efficacy of treatment for adults with medulloblastoma. Patients were completely staged with a neuroradiological examination of the brain and neuraxis and by CSF cytology, according to Chang’s staging system. Low risk patients received radiotherapy alone, while high risk patients were given 2 cycles of upfront chemotherapy followed by radiotherapy and adjuvant chemotherapy. The results of the preliminary analysis of this study at a median follow-up of 3.7 years are reported elsewhere. The present papers reports on the long- term results of the same trial. Results: After a median follow up of 7.6 years, among a total of 36 enrolled adults with medulloblastoma, overall progression free survival (PFS) and overall survival (OS) at 5 years were 72% (range 59% to 84%) and 75% (62% to 91%), respectively. No difference was found between low and high risk patients in terms of PFS and OS at 5 years: in low-risk patients the 5-year PFS was 80% (range, 59–100%) and the 5-year OS, 80% (range, 58 - 100%); in high-risk patients the 5-year PFS was 69% (range, 54 -89%) and the 5-year OS, 73% (range, 58 - 92%). Conclusions: A long-term follow-up is essential to evaluate the real impact of treatments in adult patients with MB. Since there is no significant difference between low-risk and high-risk patients for PFS and OS, the use of chemotherapy is also questionable in low-risk patients. No significant financial relationships to disclose.

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Abstract 266: Are Outpatient Cardiologists Asking about Peripheral Artery Disease Clinical Symptoms in Low and High Risk Patients in accordance with ACC/AHA Guidelines?

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.5.suppl_1.a266 ◽

2012 ◽

Vol 5 (suppl_1) ◽

Author(s):

Ankitkumar K Patel ◽

Rajesh M Kabadi ◽

Rajani Sharma ◽

Rita Schmidt ◽

Elias Iliadis

Keyword(s):

Risk Factors ◽

At Risk ◽

High Risk ◽

Peripheral Artery Disease ◽

Clinical Symptoms ◽

Low Risk ◽

Peripheral Artery ◽

Symptom Screening ◽

Risk Patients ◽

Artery Disease

Background: Lower extremity peripheral artery disease (PAD) is a common syndrome that afflicts many individuals and leads to significant morbidity. The American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines for the Management of Peripheral Artery Disease (PAD) (JACC, 2006) outlines four clinical symptoms (claudication, walking impairment, exertional leg complaints and poorly healing wounds) that should be asked to at risk patients. Outpatient cardiology practices often take care of individuals at risk for PAD and have the opportunity to screen and improve quality of medical care in accordance with professional guidelines. Methods: A group of 367 outpatients seen in a large academic cardiology practice from September 2011 underwent chart review. Risk factors for PAD that were assessed include history of smoking, hypertension, diabetes, hyperlipidemia, homocysteine levels, and CRP. Those that had three or more risk factors or a previous diagnosis of known PAD were classified as high risk and those with less than 2 risk factors were classified as low risk. Documentation of whether clinical symptoms were asked was obtained from outpatient chart. Fisher exact test was utilized for statistical analysis. Results: Fifty-seven percent (N=208) of our population were classified as high risk for PAD and forty-three percent (N=158) were low risk. Table 1 below shows assessment of clinical symptoms in high and low risk patients. Conclusions: Though both high risk and low risk PAD patients are assessed at equivalent rates for clinical symptoms, the vast majority of patients overall are underassessed. Lack of knowledge of clinical symptoms can lead to underscreening of PAD and thus undertreatment. Increasing clinical symptom screening in the outpatient cardiology setting can lead to quality improvement and adherence to ACC/AHA Guidelines.

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