scholarly journals Prophylactic colectomy and rectal preservation in FAP: systematic endoscopic follow-up and adenoma destruction changes natural history of polyposis

2021 ◽  
Vol 09 (07) ◽  
pp. E1014-E1022
Author(s):  
Arnaud Pasquer ◽  
Nicolas Benech ◽  
Mathieu Pioche ◽  
Antoine Breton ◽  
Jerome Rivory ◽  
...  
Keyword(s):  
Endoscopic Treatment ◽  
Total Colectomy ◽  
Ileoanal Anastomosis ◽  
University Hospital ◽  
Prophylactic Surgery ◽  
Safe Alternative ◽  
Oncological Safety ◽  
History Of ◽  
Surgical Guidelines

Abstract Background and study aims Prophylactic surgery of familial adenomatous polyposis (FAP) includes total colectomy with ileorectal anastomosis (IRA) to proctocolectomy with ileoanal anastomosis (IAA). Surgical guidelines rely on studies without systematic endoscopic follow-up and treatment. Our aim was to report our experience based on a different approach: therapeutic follow-up, comparing in this setting IRA and IAA in terms of oncological safety and quality of life. Patients and methods Between January 1965 and November 2015, all patients who underwent prophylactic surgery for FAP with therapeutic endoscopic follow-up in Lyon University hospital: systematic endoscopic treatment of adenomas, were retrospectively and prospectively (since 2011) included. Results A total of 296 patients were analyzed: 92 had proctocolectomy with IAA (31.1 %), 197 total colectomy with IRA (66.5 %), and seven abdominoperineal resections (2.4 %). Median follow-up was 17.1 years (range, 0–38.1). Incidence of secondary cancer (IR vs. IAA) was 6.1 % vs. 1.1 % (P = 0.06; 95 %CI 0.001–0.36). The 15-year cancer-free and overall survival (IR vs. IAA) were 99.5 % vs 100 % (P = 0.09) and 98.9 % vs. 98.8 % (P = 0.82), respectively. Postoperative morbidity occurred in 44 patients: 29 (14.7 %) in the IRA and 15 (16.3 %) in the IAA group (P = 0.72). The mean number of stools per day in the respective groups were 4.4 (2.5) vs. 5.5 (2.6) (P = 0.001). Fecal incontinence occurred in 14 patients (7.1 %) in the IRA vs. 16 (17.4 %) in the IAA group (P = 0.03). Conclusions A combination of therapeutic endoscopic treatment and extended rectal preservation appears to be a safe alternative to ileoanal J-pouch anastomosis.

scholarly journals Coronary risk of patients with valvular heart disease: prospective validation of CT-Valve Score

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001380
Author(s):  
Rasmus Bo Hasselbalch ◽  
Mia Marie Pries-Heje ◽  
Sarah Louise Kjølhede Holle ◽  
Thomas Engstrøm ◽  
Merete Heitmann ◽  
...  
Keyword(s):  
Heart Disease ◽  
Valvular Heart Disease ◽  
Primary Outcome ◽  
Multislice Ct ◽  
Cost Effective ◽  
University Hospital ◽  
Before And After ◽  
History Of ◽  
Artery Disease

ObjectiveTo prospectively validate the CT-Valve score, a new risk score designed to identify patients with valvular heart disease at a low risk of coronary artery disease (CAD) who could benefit from multislice CT (MSCT) first instead of coronary angiography (CAG).MethodsThis was a prospective cohort study of patients referred for valve surgery in the Capital Region of Denmark and Odense University Hospital from the 1 February 2015 to the 1 February 2017. MSCT was implemented for patients with a CT-Valve score ≤7 at the referring physician’s discretion. Patients with a history of CAD or chronic kidney disease were excluded. The primary outcome was the proportion of patients needing reevaluation with CAG after MSCT and risk of CAD among the patients determined to be low to intermediate risk.ResultsIn total, 1149 patients were included. The median score was 9 (IQR 3) and 339 (30%) had a score ≤7. MSCT was used for 117 patients. Of these 29 (25%) were reevaluated and 9 (7.7%) had CAD. Of the 222 patients with a score ≤7 that did not receive an MSCT, 14 (6%) had significant CAD. The estimated total cost of evaluation among patients with a score ≤7 before implementation was €132 093 compared with €79 073 after, a 40% reduction. Similarly, estimated total radiation before and after was 608 mSv and 362 mSv, a 41% reduction. Follow-up at a median of 32 months (18–48) showed no ischaemic events for patients receiving only MSCT.ConclusionThe CT-Valve score is a valid method for determining risk of CAD among patients with valvular heart disease. Using a score ≤7 as a cut-off for the use of MSCT is safe and cost-effective.

MO292MALIGNANT DISEASE IS MORE COMMON WITH DETERIORATING KIDNEY FUNCTION IN PATIENTS WITH MEMBRANOUS NEPHROPATHY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Ivana Vukovic Brinar ◽  
Karlo Kurtov ◽  
Mario Laganovic ◽  
Zivka Dika ◽  
Marijana Ćorić ◽  
...  
Keyword(s):  
Kidney Function ◽  
Membranous Nephropathy ◽  
Malignant Disease ◽  
Initial Therapy ◽  
University Hospital ◽  
Long Term Follow Up ◽  
History Of ◽  
Kdigo Guidelines ◽  
Informatic System

Abstract Background and Aims Membranous nephropathy (MN) can be associated with tumor and present a paraneoplastic condition. Recently, development of tumors during the course of follow up is more in focus. It is especially interested whether patient with MN are prone to tumors, or tumors are condition indipendent of membranous nephropathy or consequence of imunosupressive therapy (IS). Method Retrospective data of all adult patients diagnosed with MN from 1987 to 2017 at the Department of Nephrology of University Hospital Centre Zagreb were analysed. Medical data regarding antropometric measeures and preexsisting comorbid disease at presentation and during follow up were derived from medical records and hospital informatic system. Furthermore, data regarding kidney function were used, namely serum creatinine (SCr), proteinuria. Renal function was assessed using CKD-EPI equation. CKD stages, partial and complete remission were defined according to KDIGO guidelines. Results From 1987 till 2017 a total of 122 patients were diagnosed with MN. Eighty nine (72.9%) were treated with imunosupressive therapy. Most commonly prescribed initial therapy was combination of corticosteroids and cyclophosphamide (N=66; 74%). Three (0,02%) patients had history of tumor with median of 3y (min – max 1-4 y) before glomerular disease presentation, two solid tumor, adenocarcinoma pulmonum and carcinoma prostatae, and one condition after allogenic haematopoetic transplantation due to acute myeloid leukemia. There was no difference in clinical presentation between those with positive history of malignant disease and others (proteinura 11.7 g/du (25-75C 3.4-15.7) vs. 5.8 g/dU (25-75C 3.4 – 8.5); p=0.232 and eGFR 57 ml/min/1,73m2 (25C-75C 14 – 59) vs. 81 ml/min/1.73m2 (25-75C 54 – 100); p=0.066). During follow up 11 (9%) patients developed tumor, median age of pts 67 y (min – max 59 – 71); nine solid tumors most comonly of gastrointestinal origin (pancreas, colon N=5 (45%)), then pulmonum (N=2(18%)) and urogenithal origin (ca renis and prostate N=2 18%). Also two hematological malignancies (B-ALL, B-NHL) occurred. Median time till confirmed malignant disease was 9 y (min – max 5 -24). At the time of detecting the tumor six (54%) patients were in complete and partial remission (4 and 2) and 2 (18%) patients had nephrotic syndrome. No difference was observed in proteinuria between those with malignant condition and other MN patients (1,4 g/dU (25 – 75C 0.2 – 5.6) vs. 0,29 g/dU (25 – 75C 0.13 – 0.74); P=0.154). MN patients with malignant disease during follow up had lower estimated glomerular filtration rate (eGFR 45 ml/min/1,73m2 (25 – 75C 22 – 70) vs. 77 (25 – 75C 58 – 92); p=0.010). There was no difference in cummulative dose of cyclophosphamide between those who developed tumor with others (24 g(25 – 75C13.5 – 30) vs. 27 g(25 – 75C 15 – 38)p=0.592). Conclusion Our data emphasize the need for long term follow up of patients with membranous nephropathy despite accomplishing remission of MN and period screening for malignant disease, especially in those with deteriorating kidney function.

Single Centre Experience in Patients with Primary Hyperparathyroidism: Sporadic, Lithium-associated and in Multiple Endocrine Neoplasia

2019 ◽  
Vol 128 (10) ◽  
pp. 693-698
Author(s):  
Sabine Dillenberger ◽  
Detlef K. Bartsch ◽  
Elisabeth Maurer ◽  
Peter Herbert Kann
Keyword(s):  
Primary Hyperparathyroidism ◽  
Multiple Endocrine Neoplasia ◽  
University Hospital ◽  
Primary Surgery ◽  
Endocrine Neoplasia ◽  
Single Centre Experience ◽  
Significant Difference ◽  
History Of ◽  
The University

Abstract Purpose It is assumed that primary hyperparathyroidism (pHPT) in Multiple Endocrine Neoplasia (MEN) and lithium-associated pHPT (LIHPT) are associated with multiple gland disease (MGD), persistence and recurrence. The studies purpose was to determine frequencies, clinical presentation and outcome of sporadic pHPT (spHPT), LIHPT and pHPT in MEN. Additional main outcome measures were the rates of MGD and persistence/recurrence. Methods Retrospective analysis of medical records of 682 patients with pHPT who had attended the University Hospital of Marburg between 01–01–2004 and 30–06–2013. All patients were sent a questionnaire asking about their history of lithium medication. Results Out of 682 patients, 557 underwent primary surgery (532 spHPT, 5 LIHPT, 20 MEN), 38 redo-surgery (31 spHPT, 7 MEN), 55 were in follow-up due to previous surgery (16 spHPT, 1 LIHPT, 38 MEN) and 37 were not operated (33 spHPT, 1 LIHPT, 3 MEN). Primary surgeries were successful in 97.4%, revealed singular adenomas in 92.4%, double adenomas in 2.9% and MGD in 3.4% of the cases. Rates of MGD in MEN1 (82.35%) were significantly higher than in spHPT (3.8%), while there was no significant difference between LIHPT (20%) and spHPT. Rates of persistence/recurrence did not significantly differ due to type of surgery (bilateral/unilateral) or type of HPT (spHPT/LIHPT/MEN). Conclusions History of lithium medication is rare among pHPT patients. While MGD is common in MEN1, rates of MGD, persistence or recurrence in LIHPT were not significantly higher than in spHPT.

Recurrence of First Afebrile Unprovoked Seizure and Parental Consanguinity: A Hospital-Based Study

2020 ◽  
Vol 35 (10) ◽  
pp. 643-648
Author(s):  
Miral A. Al Momani ◽  
Basima Almomani ◽  
Salar Bani Hani ◽  
Andrew Lux
Keyword(s):  
University Hospital ◽  
Unprovoked Seizure ◽  
Recurrent Attack ◽  
Parental Consanguinity ◽  
Pediatric Clinic ◽  
Increased Risk ◽  
High Incidence ◽  
History Of

Purpose: The aim of the current study was to determine the incidence, clinical characteristics, and risk factors associated with the recurrence of first unprovoked seizure in children. Methods: A retrospective, observational study was conducted at King Abdullah University Hospital in Jordan. Children aged from 1 month to 16 years old who attended the hospital between January 2013 to December 2017 were evaluated on the basis of medical records, from the first visit and for a 1-year follow-up period. Results: During the study period, a total of 290 cases with first unprovoked seizure were included. The incidence of first unprovoked seizure was 441 cases per 100 000 patient visits to the pediatric clinic. More than half of the cases developed a second attack (55.3%). Children with parental consanguinity were almost 3 times more likely to develop a second attack of seizure compared to those without parental consanguinity (odds ratio [OR] = 2.785, 95% confidence interval [CI] = 1.216-6.378, P = .015) and patients who had a history of focal type of seizure were almost twice as likely to develop seizure recurrence (OR = 1.798, 95% CI = 1.013-3.193, P = .045). Conclusions: The current results showed a high incidence of first unprovoked seizure among children in Jordan. Parental consanguinity and focal seizure were associated with the increased risk of recurrent attack. This finding highlights the need for public education regarding the outcomes of parental consanguinity to improve the patient’s quality of life.

Minimally Invasive Microincision Vitrectomy Surgery with an Intraoperative Dexamethasone Implant for Refractory Diabetic Macular Edema

2016 ◽  
Vol 235 (3) ◽  
pp. 150-156 ◽  
Author(s):  
Dong Hoon Lee ◽  
Yoon Jeon Kim ◽  
Young Hee Yoon
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Retinal Thickness ◽  
Safe Alternative ◽  
Corrected Visual Acuity ◽  
Refractory Diabetic Macular Edema ◽  
History Of ◽  
Microincision Vitrectomy Surgery ◽  
Vitrectomy Surgery

Purpose: To evaluate the 1-year results of 25-gauge microincision vitrectomy surgery (MIVS25) combined with intraoperative dexamethasone (DEX) implant for persistent diabetic macular edema (DME). Methods: This study enrolled patients who had a history of DME for ≥12 months and underwent MIVS25 and DEX implant injection. Best corrected visual acuity (BCVA) and central retinal thickness (CRT) were assessed postoperatively. Results: Eighteen eyes were included in the analysis. Preoperatively, logMAR BCVA was 0.90 and CRT was 594 µm on average. CRT decreased until the 3-month follow-up visit and tended to increase at 6 months, but stabilized at 12 months with additional treatments in five eyes at 5 months postoperatively. Statistically significant improvement in BCVA was noted 1 month after treatment and at each subsequent follow-up visit (p < 0.001). Conclusion: MIVS25 combined with DEX implant injection might be utilized as an effective and safe alternative treatment for intractable DME.

Andreas Grüntzigs Ballon-Katheter zur Angioplastie von peripheren Arterien (PTA) ist 25 Jahre alt

VASA ◽  
1999 ◽  
Vol 28 (1) ◽  
pp. 58-64 ◽  
Author(s):  
Bollinger ◽  
Schlumpf
Keyword(s):  
Balloon Catheter ◽  
University Hospital ◽  
Large Numbers ◽  
Tendon Reflex ◽  
Double Lumen Catheter ◽  
Iliac Artery Stenosis ◽  
Lumen Catheter ◽  
History Of ◽  
Original Procedure

History of Andreas Grüntzig’s time spent in Angiology and Radiology of the Zürich University Hospital (1969–1975). First, the pioneer of catheter therapy discovered that the Achilles tendon reflex is significantly prolongued during claudication pain. Furthermore, he participated actively in the clinical evaluation of Doppler ultrasound. After a stay in the Aggertalklinik (Engelskirchen near Köln, Germany), where he learnt Charles Dotter’s original procedure with Eberhard Zeitler, he introduced catheter therapy of peripheral arteries in Zürich. In the same period he developed a new, rigid, sausage-shaped balloon catheter (polyvinylchloride), manufactered the device on his kitchen table together with his wife Michaela, Maria and Walter Schlumpf, and used it first on February 12, 1974 in a patient with intermittent claudication due to subtotal stenosis of the superficial femoral artery. The first successful dilatation of an iliac artery stenosis by his double-lumen catheter, which was modified later on into the famous coronary catheter, followed on January 23, 1975. Soon, the innovative catheter became commercially available (Cook and Schneider Companies). Andreas Grüntzig not only excelled in pioneering novel techniques, but also in patient care, in a prospective follow-up study of his own 242 patients lasting 15 years (results summarized in this article), in the teaching of Swiss scholars like Felix Mahler, Ernst Schneider and Bernhard Meier and many more in the world, and in organizing life demonstrations for large numbers of participants. His career in Cardiology, his work in Atlanta Georgia, USA, and his early tragic death in an airplane accident are briefly mentioned.

Triphalangeal Thumbs Associated With Hypoplastic Anemia

PEDIATRICS ◽  
1973 ◽  
Vol 52 (4) ◽  
pp. 609-612
Author(s):  
Barbara Jones ◽  
Havelock Thompson
Keyword(s):  
Case Report ◽  
University Hospital ◽  
Associated Anomalies ◽  
West Virginia University ◽  
Chronic Anemia ◽  
History Of ◽  
Original Report ◽  
Radial Aplasia ◽  
Hypoplastic Anemia

Aase and Smith1 reported male siblings with congenital hypoplastic anemia and triphalangeal thumbs, and distinguished their disorder as an entity separate from Fanconi's pancytopenia and radial aplasia-thrombocytopenia. Recently, Murphy and Lubin2 described a third patient, also a male, with a similar thumb anomaly, aregenerative anemia, and several associated anomalies not present in the siblings described in the original report. This report describes a fourth male patient with this syndrome and adds the data of an eight-year follow-up with hematologic response to prednisone therapy. CASE REPORT R.P. was initially evaluated at West Virginia University Hospital in 1964 at 10 years of age; he had a history of chronic anemia.

scholarly journals Decreased Probability of Initial Pain Cessation in Classic Trigeminal Neuralgia Treated With Gamma Knife Surgery in Case of Previous Microvascular Decompression

Neurosurgery ◽  
2015 ◽  
Vol 77 (1) ◽  
pp. 87-95 ◽  
Author(s):  
Constantin Tuleasca ◽  
Romain Carron ◽  
Noémie Resseguier ◽  
Anne Donnet ◽  
Philippe Roussel ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Microvascular Decompression ◽  
Gamma Knife Surgery ◽  
University Hospital ◽  
Lower Probability ◽  
Patient Reported ◽  
History Of ◽  
Global Population

Abstract BACKGROUND: Microvascular decompression (MVD) is the reference technique for pharmacoresistant trigeminal neuralgia (TN). OBJECTIVE: To establish whether the safety and efficacy of Gamma Knife surgery for recurrent TN are influenced by prior MVD. METHODS: Between July 1992 and November 2010, 54 of 737 patients (45 of 497 with &gt;1 year of follow-up) had a history of MVD (approximately half also with previous ablative procedure) and were operated on with Gamma Knife surgery for TN in the Timone University Hospital. A single 4-mm isocenter was positioned in the cisternal portion of the trigeminal nerve at a median distance of 7.6 mm (range, 3.9–11.9 mm) anterior to the emergence of the nerve. A median maximum dose of 85 Gy (range, 70–90 Gy) was delivered. RESULTS: The median follow-up time was 39.5 months (range, 14.1–144.6 months). Thirty-five patients (77.8%) were initially pain free in a median time of 14 days (range, 0–180 days), much lower compared with our global population of classic TN (P = .01). Their actuarial probabilities of remaining pain-free without medication at 3, 5, 7, and 10 years were 66.5%, 59.1%, 59.1%, and 44.3%. The hypoesthesia actuarial rate at 1 year was 9.1% and remained stable until 12 years (median, 8 months). CONCLUSION: Patients with previous MVD showed a significantly lower probability of initial pain cessation compared with our global population with classic TN (P = .01). The toxicity was low (only 9.1% hypoesthesia); furthermore, no patient reported bothersome hypoesthesia. However, the probability of maintaining pain relief without medication was 44.3% at 10 years, similar to our global series of classic TN (P = .85).

61 THE 5-YEAR RESULTS FOR ENDOSCOPIC TREATMENT OF SUPERFICIAL ESOPHAGEAL CANCER AT A NORWEGIAN UNIVERSITY HOSPITAL

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
T Hauge ◽  
T Hauge ◽  
M Franco-Lie ◽  
E Johnson
Keyword(s):  
Esophageal Cancer ◽  
Treatment Modality ◽  
Endoscopic Treatment ◽  
University Hospital ◽  
Low Grade ◽  
Superficial Esophageal Cancer ◽  
Radical Esophagectomy ◽  
Efficient Treatment ◽  
First Choice

Abstract   Superficial esophageal cancer (HGD = high grade dysplasia, T1a and T1b with no evidence of spread) accounts for about 20 % of all esophageal cancers. Traditionally, radical esophagectomy, with a significant degree of comorbidity has been the mainstay of treatment. Now most international guidelines, including the ESGE (European Society of Gastrointestinal Endoscopy) recommends endoscopic treatment as the first choice of treatment. The aim of this abstract was to present our data from 2014-2018. Methods From 2014 to 2018 (and ongoing) we have registered all patients endoscopically treated for LGD (low grade dysplasia) and superficial esophageal cancer, including some cases with T1b. The patient material, including treatment modality, histology, time of follow-up, the need for surgery and its outcome were registered. The majority of follow-ups took place at our hospital. Data was also retrieved from cases of late follow-up at other hospitals. Results 86 patients were endoscopically treated. The histology revealed LGD (24%), HGD (50%) and adenocarcinoma (21%). 15% were treated for a T1a tumor, 7% for T1b. 29% underwent endoscopic mucosal resection (EMR), 29% radiofrequency ablation (RFA) and 40% had both. The endoscopic treatment resulted in complete resolution of dysplasia in 64%, downstaging in 11%, whilst progression occurred in 11%. Five patients were operated for initial T1b or progression into T1b. The operation specimen showed no residual tumor in 3/5 patients. There were no serious complications. 90-days mortality was 1%. Conclusion Endoscopic treatment is a safe and efficient treatment option for superficial esophageal cancer. Few patients needed surgery and there was few and exclusively mild complications. This treatment modality will spare many patients for esophageal surgery with its associated high level of comorbidity.

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