Video-Assisted Thoracoscopic Surgery of Parapneumonic Empyema – a 10-year Single-Centre Experience

Pneumologie ◽  
2018 ◽  
Vol 72 (12) ◽  
pp. 843-850 ◽  
Author(s):  
H. Höfken ◽  
D. Herrmann ◽  
S. Ewig ◽  
J. Volmerig ◽  
E. Hecker
Keyword(s):  
Hospital Mortality ◽  
Thoracoscopic Surgery ◽  
Stage Ii ◽  
Stage Iii ◽  
Success Rates ◽  
Single Centre ◽  
Younger Patients ◽  
Conversion Rates ◽  
Advanced Stages ◽  
Parapneumonic Empyema

Abstract Objectives Evaluation of a standardised management for the treatment of patients with parapneumonic empyema. Methods A retrospective 10-year single-centre analysis of all patients with parapneumonic empyema undergoing a standardised thoracoscopic treatment approach. We describe referral and age patterns, microbiological results, overall and stage-dependent success rates, conversion rates, 30-day and in-hospital mortality. Results From May 2003 to April 2013, 248 patients with parapneumonic empyemas were treated in our centre. Most patients were referred at weekends, and younger patients had advanced stages. The cure rate in stage I was 97.6 % and reached 80.3 % in stage II and 63.1 % in stage III. 6 patients (2.4 %) (all stage III) needed conversion to an open procedure. A revision was required in 19.7 % of cases in stage II and 27.7 % in stage III. 30-day mortality was 4.8 %, in-hospital mortality was 8.1 %. Conclusion A standardised approach, including VATS, is associated with a high cure, low revision and moderate conversion rates. In view of a still considerable mortality, a higher index of suspicion and detection of advanced stages, especially in younger patients, is required to improve outcomes.

Uptake of adjuvant chemotherapy for colon cancer in older and younger patients in the Irish population.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 478-478
Author(s):  
Seamus Coyle ◽  
Zia Rehman ◽  
Chalen Lee ◽  
Sandra Deady ◽  
Harry Comber ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Clinical Practice ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Older Patients ◽  
The Elderly ◽  
Stage Ii ◽  
Stage Iii ◽  
Younger Patients ◽  
The Impact

478 Background: Colon cancer is predominantly a disease of the elderly, with recent evidence supporting the use of adjuvant chemotherapy in the older population. However, it remains unclear to what degree such patients are receiving adjuvant therapy in clinical practice. We examined uptake of adjuvantchemotherapy and it’s impact on survival in older patients with stage II and stage III colon cancer in a national cohort. Methods: Using the National cancer Registry of Ireland, we identified 3,486 patients with stage II and III colon cancer who were treated with curative resection from 2004-2009. Clinopathological features and chemotherapy use were compared between those ≥70 years and those < 70 years. Results: A total of 2,026 patients with stage II disease were identified, 56% male and 60% ≥ 70 years. T3 tumors accounted for 81%, T4 19% and 89% were grade 2/3. Adjuvant chemotherapy was utilized in 10% and 40% of ≥ 70 and <70 years, respectively (p<0.0001). A benefit for chemotherapy over observation alone was seen in both the older [HR 0.36; 95% CI 0.36 – 0.68; p <0.0001] and younger patient groups [HR 0.43; 95% CI 0.2701 - 0.6881; p<0.0004]. Of 1,460 patients with stage III disease, 51% were ≥ 70 years, 54% male. 34% of older and 83% of younger patients received adjuvant therapy (p<0.0001). A similar magnitude of benefit from chemotherapy compared to observation was seen in patients ≥ 70 years [HR 0.30; 95% CI 0.29 - 0.45 ; p <0.0001] and <70 years [HR 0.22 95%CI 0.1 – 0.2; p<0.0001] with stage III disease. Conclusions: Adoption of adjuvant chemotherapy appears to be associated with significant survival benefit in older patients (age ≥ 70 years), however, is still underutilized in clinical practice. The impact of sociodemographic and clinicopathological features as potential drivers of treatment decisions in a cohort of this population will be reported.

Haemorheological Proælein Chronic Venous Insufæciency

1999 ◽  
Vol 14 (3) ◽  
pp. 105-110
Author(s):  
G. Azaceta ◽  
S. Romero ◽  
C. Lorente ◽  
J. A. Moreno ◽  
T. Olave ◽  
...  
Keyword(s):  
Shear Rate ◽  
Blood Viscosity ◽  
Chronic Venous Insufficiency ◽  
Strong Influence ◽  
Venous Insufficiency ◽  
Stage Ii ◽  
Stage Iii ◽  
Erythrocyte Aggregation ◽  
High Shear ◽  
Advanced Stages

Background: In recent years, pathophysiological studies and treatment approaches of chronic venous insufficiency (CVI) have focused on haemorheology. Objective: To analyse erythrocyte aggregation (EA) and blood viscosity (BV) in mild and severe stages of CVI. Methods: In 147 patients (three severity stages), EA was measured with a photometric aggregometer, and BV with a cone-plate viscosimeter. Patients with concomitant pathologies affecting haemorheology were excluded. Results: EA was higher in patients (mean EA 10M: 16.4 vs 14.5 control), increasing progressively with the evolution of CVI ( p<0.001). Greatest differences were found for stage III (mean EA 10M: 17.6) vs stage II (15.7) and stage 0 (14.5) respectively ( p<0.001), but rheological abnormalities exist in early grades (I: 16.7) ( p<0.01). Fibrinogen and age had a strong influence on EA ( p<0.003 and p<0.001 respectively). When a covariance analysis avoided their effect, significant global differences between CVI groups persisted. BV at high shear rate was increased at advanced stages (III: mean 3.3 centipoise (cp); I: 3.1 cp) ( p<0.05). Conclusions: We found progressive impairment of the haemorheological profile with the worsening stages of CVI, related to age, severity stage and fibrinogen. Rheological impairment is likely to play a part in the pathophysiology of CVI, and perhaps may be useful in its management.

Adjuvant chemotherapy for stage II and stage III colon cancer—What is happening in routine practice?

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15046-e15046
Author(s):  
S. Ananda ◽  
S. Kosmider ◽  
L. Lim ◽  
F. Barnett ◽  
J. Desai ◽  
...  
Keyword(s):  
Colon Cancer ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Stage Ii ◽  
Stage Iii ◽  
Routine Practice ◽  
Younger Patients ◽  
Stage Iii Colon Cancer ◽  
Co Morbidity ◽  
Practice Methods

e15046 Background: Randomised studies have defined adjuvant chemotherapy as standard treatment for stage III colon cancer (SIIICC), with multiple options available. For stage II (SII) disease, the selection of patients for adjuvant treatment remains controversial. There remains limited data on clinician decision making regarding adjuvant chemotherapy in routine clinical practice. Methods: A review of patients treated with SII & IIICC at 4 hospitals, utilising data from BioGrid Australia, where clinician choice and rationale were prospectively documented. Results: 372 patients (37%) with SII and 307 (30%) with SIIICC were identified from 1015 CC patients treated from January 2003 till November 2008. Median age was 68 years, 51% were male; 49% female. 66 (25%) of patients with SIIICC were not offered chemotherapy, predominantly due to advanced age or co-morbidity. Since oxaliplatin and capecitabine became widely available in 2005, 66% of treated patients have received oxaliplatin based therapy, 15% bolus 5-FU alone and 19% capecitabine. For SII disease, overall 81 (26%) pts received adjuvant chemotherapy. Age was the dominant influence on treatment choice with 41% aged 70 (p<0.001) receiving treatment. Patients with high risk features were also more likely to receive adjuvant therapy. (p= 0.006 for those with lymphovascular invasion and p= 0.0068 for those with T4 tumours). Dose reductions and completion rates were similar for SII and III disease, and for older and younger patients. Conclusions: Over 25% of patients with SIIICC do not receive adjuvant chemotherapy in routine practice, with physicians basing non-treatment recommendations predominantly on patient age and co-morbidity. Where treatment is used, oxaliplatin-based therapy is the dominant regimen, except in older patients. In SIICC, adjuvant chemotherapy is used in one in four patients, more frequently in younger patients and those with high risk features. No significant financial relationships to disclose.

Voice Therapy With Seniors: Attendance, Outcomes, and Associated Patient Characteristics

2019 ◽  
Vol 4 (5) ◽  
pp. 814-824 ◽  
Author(s):  
Bonnie E. Smith ◽  
Ruth Huntley Bahr ◽  
Hector N. Hernandez
Keyword(s):  
Outcome Data ◽  
Voice Therapy ◽  
Similar Data ◽  
Success Rates ◽  
Reflux Symptom Index ◽  
Voice Change ◽  
Related Factors ◽  
Symptom Index ◽  
Younger Patients ◽  
Unsuccessful Treatment

Purpose The purpose of this study was to determine the attendance and success rates for seniors in voice therapy, identify any contributing patient-related factors, and compare results to existing findings for younger patients. Method This retrospective study included information from the voice records of 50 seniors seen by the same speech-language pathologist in a private practice. Analysis of attendance and outcome data divided participants into 6 groups. Outcomes for Groups 1–3 (64% of patients) were considered successful (positive voice change), while outcomes for Groups 4–6 (36% of patients) were considered unsuccessful. These data were compared to similar data collected for younger adults in a previous study. Results The attendance and success rates for seniors in this study were higher than those previously reported for younger patients. Further consideration of patient factors revealed that reports of increased stress, Reflux Symptom Index scores > 13, and higher Voice Handicap Index functional subscale scores were significant in distinguishing between patients in the successful and unsuccessful treatment outcome groups. Conclusions The relatively high attendance and success rates among this sample of seniors suggest the desire to achieve voice improvement does not diminish with age, and chances for success in voice therapy among nonfrail seniors may be greater than for younger patients.

Identification of biomarkers and functional modules from genomic data in stage-wise breast cancer

2020 ◽  
Vol 15 ◽  
Author(s):  
Athira K ◽  
Vrinda C ◽  
Sunil Kumar P V ◽  
Gopakumar G
Keyword(s):  
Breast Cancer ◽  
Expression Patterns ◽  
Differential Expression Analysis ◽  
Predictive Biomarkers ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Functional Modules ◽  
Incidence And Mortality ◽  
Multiple Stages

Background: Breast cancer is the most common cancer in women across the world, with high incidence and mortality rates. Being a heterogeneous disease, gene expression profiling based analysis plays a significant role in understanding breast cancer. Since expression patterns of patients belonging to the same stage of breast cancer vary considerably, an integrated stage-wise analysis involving multiple samples is expected to give more comprehensive results and understanding of breast cancer. Objective: The objective of this study is to detect functionally significant modules from gene co-expression network of cancerous tissues and to extract prognostic genes related to multiple stages of breast cancer. Methods: To achieve this, a multiplex framework is modelled to map the multiple stages of breast cancer, which is followed by a modularity optimization method to identify functional modules from it. These functional modules are found to enrich many Gene Ontology terms significantly that are associated with cancer. Result and Discussion: predictive biomarkers are identified based on differential expression analysis of multiple stages of breast cancer. Conclusion: Our analysis identified 13 stage-I specific genes, 12 stage-II specific genes, and 42 stage-III specific genes that are significantly regulated and could be promising targets of breast cancer therapy. That apart, we could identify 29, 18 and 26 lncRNAs specific to stage I, stage II and stage III respectively.

Cardiac transthyretin wild-type amyloidosis (ATTRwt): a prospective study of 400 patients followed at the Italian referral center

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Milani ◽  
L Obici ◽  
R Mussinelli ◽  
M Basset ◽  
G Manfrinato ◽  
...  
Keyword(s):  
Natural History ◽  
Median Survival ◽  
Troponin I ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Wild Type ◽  
Staging Systems ◽  
Significant Difference ◽  
History Of

Abstract Background Cardiac wild type transthyretin (ATTRwt) amyloidosis, formerly known as senile systemic amyloidosis, is an increasingly recognized, progressive, and fatal cardiomyopathy. Two biomarkers staging systems were proposed based on NT-proBNP (in both cases) and troponin or estimated glomerular filtration rate, that are able to predict survival in this population. The availability of novel effective treatments requires large studies to describe the natural history of the disease in different populations. Objective To describe the natural history of the disease in a large, prospective, national series. Methods Starting in 2007, we protocolized data collection in all the patients diagnosed at our center (n=400 up to 7/2019). Results The referrals to our center increased over time: 5 cases (1%) between 2007–2009, 33 (9%) in 2010–2012, 90 (22%) in 2013–2015 and 272 (68%) in 2016–2019. Median age was 76 years [interquartile range (IQR): 71–80 years] and 372 patients (93%) were males. One hundred and seventy-three (43%) had atrial fibrillation, 63 (15%) had a history of ischemic cardiomyopathy and 64 (15%) underwent pacemaker or ICD implantation. NYHA class was I in 58 subjects (16%), II in 225 (63%) and III in 74 (21%). Median NT-proBNP was 3064 ng/L (IQR: 1817–5579 ng/L), troponin I 0.096 ng/mL (IQR: 0.063–0.158 ng/mL), eGFR 62 mL/min (IQR: 50–78 mL/min). Median IVS was 17 mm (IQR: 15–19 mm), PW 16 mm (IQR: 14–18 mm) and EF 53% (IQR: 45–57%). One-hundred and forty-eight subjects (37%) had a concomitant monoclonal component in serum and/or urine and/or an abnormal free light chain ratio. In these patients, the diagnosis was confirmed by immunoelectron microscopy or mass spectrometry. In 252 (63%) the diagnosis was based on bone scintigraphy. DNA analysis for amyloidogenic mutations in transthyretin and apolipoprotein A-I genes was negative in all subjects. The median survival of the whole cohort was 59 months. The Mayo Clinic staging based on NT-proBNP (cutoff: 3000 ng/L) and troponin I (cutoff: 0.1 ng/mL) discriminated 3 different groups [stage I: 131 (35%), stage II: 123 (32%) and stage III: 127 (33%)] with different survival between stage I and II (median 86 vs. 81 months, P=0.04) and between stage II and III (median 81 vs. 62 months, P&lt;0.001). The UK staging system (NT-proBNP 3000 ng/L and eGFR 45 mL/min), discriminated three groups [stage I: 170 (45%), stage II: 165 (43%) and stage III: 45 (12%)] with a significant difference in survival: between stage I and stage II (86 vs. 52 months, P&lt;0.001) and between stage II and stage III (median survival 52 vs. 33 months, P=0.045). Conclusions This is one of the largest series of patients with cardiac ATTRwt reported so far. Referrals and diagnoses increased exponentially in recent years, One-third of patients has a concomitant monoclonal gammopathy and needed tissue typing. Both the current staging systems offered good discrimination of staging and were validated in our independent cohort. Funding Acknowledgement Type of funding source: None

The efficacy of adjuvant chemotherapy for resected high-risk stage II and stage III colorectal cancer in frail patients

2021 ◽  
Author(s):  
Kosuke Mima ◽  
Nobutomo Miyanari ◽  
Keisuke Kosumi ◽  
Takuya Tajiri ◽  
Kosuke Kanemitsu ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Stage Ii ◽  
Stage Iii ◽  
Frail Patients
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