S149 – Sinonasal Mucosal Melanoma: A 12-Year Experience

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P126-P126
Author(s):  
Kailash Narasimhan ◽  
Omer Kucuk ◽  
Robert Mathog ◽  
Michael A Carron
Keyword(s):  
Patient Characteristics ◽  
Mucosal Melanoma ◽  
Recurrence Rates ◽  
Patients Âgés ◽  
The Past ◽  
Medial Maxillectomy ◽  
Melanoma Patients ◽  
Anatomic Locations ◽  
Disease Free

Objectives 1) Describe the Sinonasal Mucosal Melanoma patients (SNMM) our institution has treated. 2) Assess outcomes of surgical and adjuvant therapies for this disease. Methods Records of 18 patients diagnosed between 1995 and 2007 were reviewed, with a focus on patient characteristics, treatment outcomes, and modalities. Results Patients’ ages ranged from 31 to 85. Most common anatomic locations were maxillary sinus in 12 patients and lateral nasal walls in 6. 5 patients had cribriform plate involvement, and 3 had orbital involvement. Tumor thickness averaged 3.1 cm. 15 of the 18 patients had definitive surgical resection of their primary. Most common surgical procedure was medial maxillectomy. 6 patients were operated on despite disease in prognostically poor locations such as skull base, orbit, cribiform plate, and nasopharynx. Margins ranged from 0.5 to 4 cm. 10 patients received chemo- or immunotherapy, 11 received radiotherapy, and 6 received both. Recurrence rate was 10/18 (55%), while distant metastatic rate was 6/18 (33%), the lung being the most common metastatic location (4 patients). Average follow-up was 38.6 months, with disease-free intervals ranging from 8 to 39 months in patients with recurrences. After 2000, patients only received limited surgical resections, and were treated at stages I-II. Conclusions Despite the poor prognosis of SNMM, over the past 13 years at our institution the trend has been towards patients being diagnosed and treated at an earlier stage and having less extensive surgical resections. Advances in imaging, negative margins, radiation, and the use of immunotherapy may have influenced patient outcomes and recurrence rates.

scholarly journals Long-term outcomes of transvaginal mesh surgery for pelvic organ prolapse: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaojuan Wang ◽  
Yisong Chen ◽  
Changdong Hu ◽  
Keqin Hua
Keyword(s):  
Pelvic Organ Prolapse ◽  
Patient Characteristics ◽  
Pelvic Organ ◽  
Transvaginal Mesh ◽  
Recurrence Rates ◽  
Kaplan Meier ◽  
Mesh Surgery ◽  
Patient Global Impression

Abstract Background The objective of this study was to evaluate the overall outcomes and complications of transvaginal mesh (TVM) placement for the management of pelvic organ prolapse (POP) with different meshes with a greater than 10-years of follow-up. Methods We performed a retrospective review of patients with POP who underwent prolapse repair surgery with placement of transvaginal mesh (Prolift kit or self-cut Gynemesh) between January 2005 and December 2010. Baseline of patient characteristics were collected from the patients’ medical records. During follow-up, the anatomical outcomes were evaluated using the POP Quantification system, and the Patient Global Impression of Improvement (PGI-I) was used to assess the response of a condition to therapy. Overall postoperative satisfaction was assessed by the following question: “What is your overall postoperative satisfaction, on a scale from 0 to 10?”. Relapse-free survival was analyzed using Kaplan–Meier curves. Results In total, 134 patients were included. With a median 12-year (range 10–15) follow-up, 52 patients (38.8%) underwent TVM surgery with Prolift, and Gynemesh was used 82 (61.2%). 91% patients felt that POP symptom improved based on the PGI-I scores, and most satisfied after operation. The recurrence rates of anterior, apical and posterior compartment prolapse were 5.2%, 5.2%, and 2.2%, respectively. No significant differences in POP recurrence, mesh-associated complications and urinary incontinence were noted between TVM surgery with Prolift versus Gynemesh. Conclusions Treatment of POP by TVM surgery exhibited long-term effectiveness with acceptable morbidity. The outcomes of the mesh kit were the same as those for self-cutmesh.

Spontaneous cerebrospinal fluid leaks in the anterior skull base: a surgical challenge

2015 ◽  
Vol 129 (4) ◽  
pp. 358-364 ◽  
Author(s):  
G Martínez-Capoccioni ◽  
R Serramito-García ◽  
B Huertas-Pardo ◽  
A García-Allut ◽  
C Martín-Martín
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Patient Characteristics ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Recurrence Rates ◽  
Closure Rate ◽  
Cerebrospinal Fluid Leaks ◽  
Additional Therapy

AbstractObjective:This retrospective study aimed to evaluate the effective closure rate for spontaneous cerebrospinal fluid leaks with functional endoscopic sinus surgery and identify patient characteristics that may be associated with a need for additional therapy.Method:A retrospective analysis of patients with spontaneous cerebrospinal fluid leaks was performed. Data on the nature of presentation, patient body mass index, defect location and size, intracranial pressure, clinical follow up, and complications were collected.Results:Twenty-five patients had spontaneous cerebrospinal fluid leaks with evidence of idiopathic intracranial hypertension. The most common sites were the cribriform plate, followed by the ethmoid roof and sphenoid lateral pterygoid recess. All patients underwent endonasal endoscopic surgery to repair the defect. Post-operatively, all patients underwent lumbar drainage and acetazolamide therapy.Conclusion:Spontaneous cerebrospinal fluid leaks represent a surgical challenge because of their high recurrence rates. The most important factor for obtaining a successful repair in these patients is reducing their intracranial pressure through nutritional, medical or surgical means.

scholarly journals Assertive outreach teams in London: Patient characteristics and outcomes

2003 ◽  
Vol 183 (2) ◽  
pp. 148-154 ◽  
Author(s):  
Stefan Priebe ◽  
Walid Fakhoury ◽  
Joanna Watts ◽  
Paul Bebbington ◽  
Tom Burns ◽  
...  
Keyword(s):  
Substance Misuse ◽  
Patient Characteristics ◽  
Violent Behaviour ◽  
Assertive Outreach ◽  
The Past ◽  
Outreach Services ◽  
Wide Range ◽  
The Uk ◽  
Team Types

BackgroundAlthough the model of assertive outreach has been widely adopted, it is unclear who receives assertive outreach in practice and what outcomes can be expected under routine conditions.AimsTo assess patient characteristics and outcome in routine assertive outreach services in the UK.MethodPatients (n=580) were sampled from 24 assertive outreach teams in London. Outcomes – days spent in hospital and compulsory hospitalisation – were assessed over a 9-month follow-up.ResultsThe 6-month prevalence rate of substance misuse was 29%, and 35% of patients had been physically violent in the past 2 years. During follow-up, 39% were hospitalised and 25% compulsorily admitted. Outcome varied significantly between team types. These differences did not hold true when baseline differences in patient characteristics were controlled for.ConclusionsRoutine assertive outreach serves a wide range of patients with significant rates of substance misuse and violent behaviour. Over a 9-month period an average of 25% of assertive outreach patients can be expected to be hospitalised compulsorily. Differences in outcome between team types can be explained by differences in patient characteristics.

scholarly journals A rare case of polypoid primary anorectal melanoma with subsequent giant stomach metastasis: a gastrointestinal involvement of both primary and metastatic mucosal melanoma

2021 ◽  
Author(s):  
Vincenzo De Giorgi ◽  
Federica Scarfi ◽  
Carlo Boselli ◽  
Giacomo Sacchetti ◽  
Nicola Natalizi ◽  
...  
Keyword(s):  
Multidisciplinary Approach ◽  
Treatment Strategies ◽  
Mucosal Melanoma ◽  
Melanoma Metastasis ◽  
Gastric Metastasis ◽  
Complete Excision ◽  
Metastatic Lesions ◽  
Complete Tumour ◽  
Disease Free

Introduction: Melanoma can involve the gastrointestinal apparatus as both primary and metastatic lesions. Primary anorectal mucosal melanoma (ARMM) and metastatic gastric melanoma are rare entities and usually resulted in a poor prognosis. Case: We presented a case of a 61-year-old man who after the complete excision of an ARMM developed a gastric metastasis after almost three years form the complete tumour excision. Upon esophagogastroduodenoscopy, a giant ulcered mass resulted in melanoma metastasis. The patient underwent a near-total gastrectomy. After five months of follow-up, the patient is disease-free. Conclusion: The incidence of ARMMs is increasing, highlighting the necessity of new prevention and treatment strategies in order to achieve a better prognosis for these patients. There are no known risk factor for ARMMs but surgery, together with the combination of anti-CTLA-4 and anti-PD-1 antibodies, are promising therapeutic options. Early and aggressive treatments are required, together with a strict multidisciplinary approach.

scholarly journals Venous thromboembolism and bleeding in a community setting

2009 ◽  
Vol 101 (05) ◽  
pp. 878-885 ◽  
Author(s):  
Joel Gore ◽  
George Reed ◽  
Darleen Lessard ◽  
Luigi Pacifico ◽  
Cathy Emery ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Total Mortality ◽  
Community Setting ◽  
Patient Characteristics ◽  
Recurrence Rates ◽  
Increased Risk ◽  
History Of ◽  
Recurrent Vte ◽  
The Impact

SummaryBleeding is the most frequent complication of antithrombotic therapy for venous thromboembolism (VTE). However, little attention has been paid to the impact of bleeding after VTE in the community setting. The purpose of this investigation was to describe the incidence rate of bleeding after VTE, to characterize patients most at risk for bleeding, and to assess the impact of bleeding on rates of recurrent VTE and all-cause mortality. The medical records of residents of the Worcester (MA, USA) metropolitan area diagnosed with ICD-9 codes consistent with potential VTE during 1999, 2001, and 2003 were individually validated and reviewed by trained data abstracters. Clinical characteristics, acute treatment, and outcomes (including VTE recurrence rates, bleeding rates, and mortality) over follow-up (up to 3 years maximum) were evaluated. Bleeding occurred in 228 (12%) of 1,897 patients with VTE during our follow-up. Of these, 115 (58.8%) had evidence of early bleeding occurring within 30 days of VTE diagnosis. Patient characteristics associated with bleeding included impaired renal function and recent trauma. Other than a history of prior VTE, the occurrence of bleeding was the strongest predictor of recurrent VTE (hazard ratio [HR] 2.18; 95% confidence interval [CI] 1.54–3.09) and was also a predictor of total mortality (HR 1.97; 95%CI 1.57–2.47). The occur-rence of bleeding following VTE is associated with an increased risk of recurrent VTE and mortality. Future study of antithrombotic strategies for VTE should be informed by this finding. Advances that result in decreased bleeding rates may paradoxically decrease the risk of VTE recurrence.

scholarly journals Carcinosarcoma prostate with osteosarcomatous differentiation: a rare de novo presentation

2019 ◽  
Vol 12 (6) ◽  
pp. e230116 ◽  
Author(s):  
Sumeet Aggarwal ◽  
Swarupa Mitra ◽  
Abhinav Dewan ◽  
Garima Durga
Keyword(s):  
Risk Factors ◽  
De Novo ◽  
Specific Antigen ◽  
The Past ◽  
Pathological Review ◽  
History Of ◽  
Modern Era ◽  
Disease Free ◽  
Localised Disease

Carcinosarcoma is a rare histological event in the history of prostatic malignancies. Historically aggressive tumours with dismal outcomes reported in scarce literature available so far. Very few recent studies suggest good outcomes with modern era surgery and radiotherapy techniques in localised disease. The case presented here had no history of known risk factors like prior adenocarcinoma or prior radiation therapy. This case presented with obstructive urinary symptoms with no prostate-specific antigen elevation, diagnosed with imaging, managed aggressively with robotic surgery. Detailed immunohistochemistry and pathological review suggested diagnosis as carcinosarcoma with osteosarcomatous differentiation. Very rare such cases were reported in the past with complete clinical, radiological, pathological details and managed aggressively with good outcomes. The patient is disease free after 6 months of follow-up.

Treatment of Hepatitis-Associated Aplastic Anemia with High Dose Cyclophosphamide.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 975-975
Author(s):  
William J. Savage ◽  
Patricia A. DeRusso ◽  
Linda M. Resar ◽  
Allen R. Chen ◽  
Meghan A. Higman ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Aplastic Anemia ◽  
Median Time ◽  
Patient Characteristics ◽  
Severe Aplastic Anemia ◽  
High Dose ◽  
Infection Prophylaxis ◽  
Patients Âgés ◽  
Transfusion Independence

Abstract OBJECTIVE: Demonstrate that high dose cyclophosphamide (CY) induces durable hematologic remissions in patients with hepatitis-associated aplastic anemia (HAA). INTRODUCTION: HAA is a rare variant of aplastic anemia that accounts for 5% of cases. The hepatitis is seronegative and most often spontaneously resolves. The aplastic anemia that follows presents within a few months after the onset of hepatitis and is often fatal. The one other study that investigated treatment for HAA used antithymocyte globulin and cyclosporine, which induced remissions in 7 of 10 patients, with up to one year of follow-up. In that study, there were 3 deaths related to treatment failure and 1 relapse. High dose CY has induced durable remissions in severe aplastic anemia (SAA) and other autoimmune diseases, and we hypothesized that it could induce durable remissions in HAA as well. METHODS: Five patients (ages 6–17 years) with HAA and without a matched sibling BMT option were treated with CY (50 mg/kg/day IV x 4 days) plus mesna. Serology/PCR for HAV, HBV, HCV, EBV, and CMV were negative. All patients met criteria for very severe aplastic anemia pretreatment: bone marrow cellularity <25%, ANC <200/μL platelet count <20,000/μL, absolute reticulocyte count <60,000/μL. Infection prophylaxis consisted of trimethoprim/sulfamethoxazole, G-CSF, and fluconazole. RESULTS: All patients were transfusion dependent for erythrocytes and platelets prior to high dose CY. Other baseline and current values are shown in Table I. Four patients demonstrated hematopoietic recovery. Median time to ANC>500/μL was 51 days (range 44–369). Median time to transfusion independence for erythrocytes and platelets was 109 (range 57–679) and 160 (range 48–679) days, respectively. The 4 patients with hematopoietic responses are in remission up to 6 years after treatment without further immune suppression beyond high dose CY. Patient 2 met criteria for autoimmune hepatitis (AIH), and her AIH remains in remission, as well. Patient 5 had no hematopoietic response and died 3 months after BMT of multi-organ failure. CONCLUSIONS: High dose CY induced durable remissions in hepatitis-associated aplastic anemia in 4 of 5 patients based on follow-up from 1–6 years. Treatment failure led to one death in this series. The remission of HAA and AIH in one patient suggests that high dose CY may be an alternative and effective treatment for AIH, which is a disease characterized by long-term dependence on immunosuppression and recurrent relapses. Table I: Pre-Treatment and Current Patient Characteristics Age/Sex Follow Up ANC (cells/μL) ALT (U/L) Hgb (g/dL) Platelets (1000/μL) Nadir/Current Peak/Current Current Current * ANA titer >1:640 and anti-smooth muscle Ab titer 1:40. † Had no hematologic response and proceeded to unrelated BMT after 5 months 17/F 6 y 138 / 3430 1832 / 16 11.1 99 9/F* 2 y 178 / 2500 1186 / 11 13 140 14/M 16 mo 0 / 2380 2800 / 31 13.7 98 6/F 13 mo 0 / 669 2213 / 21 13.9 37 16/F 5 mo † 0 / † 3051 / † † †

Interferon alfa-2b treatment following therapeutic vaccination with mRNA electroporated dendritic cells results in skin depigmentation and tumor regression in patients with advanced melanoma

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 8537-8537 ◽  
Author(s):  
B. Neyns ◽  
J. Corthals ◽  
K. Thielemans
Keyword(s):  
Dendritic Cells ◽  
Tumor Regression ◽  
Advanced Melanoma ◽  
Interferon Alfa ◽  
Therapeutic Vaccination ◽  
Skin Reactions ◽  
Local Skin ◽  
Melanoma Patients ◽  
Disease Free

8537 Background: Therapeutic vaccination with autologous dendritic cells (DC) and Interferon alfa-2b (IFNa) both have low activity in patients with advanced melanoma. Combination therapy might be advantageous because of their complementary mechanism of action. Methods: We are investigating the safety and activity of an autologous DC-based melanoma vaccine in patients with advanced melanoma in a single institution phase IB clinical trial. Following leucapheresis and enrichment in a semi-closed culture system, adherent PBMC are cultured in IL-4 and GM-CSF supplemented medium for 6 days and cryo-preserved. Upon thawing, 15.106 DC are electroporated with synthetic mRNA that encodes a fusion protein between LAMP and one of 6 melanoma associated antigens (MAGE.A-1, MAGE.A-3, MAGE.C2, MELANA/MART1, Tyrosinase and gp100). DC vaccines are administered by 6 bi-weekly ID/SC injections and every 6–8w thereafter. Results: 15 pts (10M/5F; median age 52, range 27–72) with stage IIIC-IV melanoma have been recruited. Ten pts were able to receive ≥ 6 vaccinations. Toxicity was limited to grade 1 or 2 local skin reactions at the vaccine administration sites in all pts. Two pts had a regression of subcutaneous (sc) metastases during DC vaccination and one of these pts remains disease-free after 18 mths of follow-up (following the resection of a single residual metastasis). An additional pt remains disease-free following surgery of in transit metastases at 8 months of follow-up. Three out of four pts who were treated with IFNa-2b (5 106 U 3x/week sc) at progression developed skin depigmentation (leucoderma punctata) and in 2 of these pts an objective tumor response was documented (PR and CR, including complete regression of skin, lymph, liver and skeletal metastases). Both responses are ongoing at 9 and 11 months of follow-up. Conclusions: These preliminary observations indicate a potential for IFNa-2b to mediate auto-immune breakthrough and tumor regression in advanced melanoma patients vacinated with a mRNA electroporated DC-vaccine. Further investigation of this combination immunotherapy in advanced melanoma patients is ongoing. No significant financial relationships to disclose.

Tumor Mitotic Rate and Association with Recurrence in Sentinel Lymph Node Negative Stage II Melanoma Patients

2017 ◽  
Vol 83 (9) ◽  
pp. 972-978 ◽  
Author(s):  
Shachar Laks ◽  
Michael O. Meyers ◽  
Allison M. Deal ◽  
Jill S. Frank ◽  
Karyn B. Stitzenberg ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Patient Characteristics ◽  
Mitotic Rate ◽  
Cox Proportional Hazards ◽  
Stage Ii ◽  
Categorical Variable ◽  
Free Survival ◽  
Node Negative ◽  
Melanoma Patients

Tumor mitotic rate (TMR) is a known prognostic variable in thin melanoma patients. Its significance in stage II melanoma patients is yet to be demonstrated. Retrospective analysis of a prospective melanoma database from 9/1997 to 7/2015 was performed. All stage II melanoma, with documented TMR, and six months of follow-up were included. We evaluated the association of clinicopathologic variables, TMR, as a continuous and categorical variable with recurrence-free survival (RFS) and overall survival (OS) using Cox proportional hazards modeling. We used a statistical model, X-tile, to develop optimal categorizations of TMR. A total of 265 patient characteristics are included in this study. Recurrences occurred in 82 (30.9%) patients, including 5 local, 41 regional, and 36 distant patients. In multivariate model, ulceration, Breslow, and continuous TMR were associated with worse RFS\OS. Continuous TMR demonstrated worse RFS (hazards ratio [HR] 1.02 (1.00–1.05)) and OS (HR 1.02 (1.00–1.04)), whereas dichotomized TMR (≥1 vs <1) was not significant. TMR >10.4 mitoses/mm2 has a 5-year RFS\OS of 27.2 and 44.3 per cent, respectively, compared with 57.4 and 71.4 per cent, respectively, for TMR <3.2 mitoses/mm2. Continuous TMR predicts incidence of recurrence in stage II melanoma. We propose a new categorization method developed by statistical modeling for optimal stratification that may guide surveillance for this disparate patient population.

scholarly journals Characteristics of teams, staff and patients: associations with outcomes of patients in assertive outreach

2004 ◽  
Vol 185 (4) ◽  
pp. 306-311 ◽  
Author(s):  
Stefan Priebe ◽  
Walid Fakhoury ◽  
Ian White ◽  
Joanna Watts ◽  
Paul Bebbington ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
Favourable Outcome ◽  
Assertive Outreach ◽  
The Past ◽  
Eleven Patient ◽  
Team Working ◽  
Outreach Services ◽  
Burn Out ◽  
The Uk

BackgroundLittle is known about what characteristics of teams, staff and patients are associated with a favourable outcome of severe mental illness managed by assertive outreach.AimsTo identify predictors of voluntary and compulsory admissions in routine assertive outreach services in the UK.MethodNine features of team organisation and policy, five variables assessing staff satisfaction and burn-out and eleven patient characteristics taken from the baseline data of the Pan-London Assertive Outreach Study were tested as predictors of voluntary and compulsory admissions within a 9-month follow-up period.ResultsWeekend working, staff burn-out and lack of contact of the patient with other services were associated independently with a higher probability of both voluntary and compulsory admission. In addition, admissions in the past predicted further voluntary and compulsory admissions, and teams not working extended hours predicted compulsory admissions in the follow-up period.ConclusionsCharacteristics of team working practice, staff burn-out and patients' history are associated independently with outcome. Patient contact with other services is a positive prognostic factor.

Sign in / Sign up

Export Citation Format

Share Document