scholarly journals 1060 Upper Tract Urothelial Carcinoma (UTUC) – What Can We Learn from Historical Cases

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
N Nandra ◽  
K Rajan ◽  
G KandaSwamy ◽  
M Jefferies
Keyword(s):  
High Risk ◽  
Diagnostic Tests ◽  
Significant Risk ◽  
High Sensitivity ◽  
Significant Risk Factor ◽  
Curative Intent ◽  
Upper Tract ◽  
Palliative Intent ◽  
Risk Patients ◽  
Muscle Invasive

Abstract Background UTUC has a poor prognosis with many patients presenting late, often without cardinal symptoms such as visible haematuria. Aims of this study were to assess presenting features, diagnostic tests and outcomes of patients with UTUC. Method Retrospective data collection was performed for patients diagnosed with UTUC (ureteric /renal) between Jan 2013-Dec 2017. Data was collected on demographics, presenting features, diagnostic tests, presence of concurrent bladder UC and outcome/survival. Results 67 patients were diagnosed with UTUC, 37 renal pelvis and 30 ureteric. The median age was 74 years (Range 49-90 years), M:F-2:1. 39 (58.2%) presented with haematuria, 1 having non-visible. 9 (13.4%) had loin pain, 4 (6.0%) systemic features (weight loss/lethargy), 15 (22.4%) other (detected on surveillance imaging, renal impairment). 61 had an USS of which 12 (19.7%) were normal and 49 demonstrated hydronephrosis or mass (80.3%). 21 (31.3%) had concurrent bladder UC. 9 (13.4%) prior to UTUC diagnosis (2 post cystectomy and 7 prior superficial UC) and 12 post diagnosis. 50 (74.6%) of UTUC were treated curatively with surgery and 17 (25.4%) palliated. The 2- and 5-year survival for those treated with curative intent was 79.9% and 58.5% compared to 31.25 and 7.5% for those treated with palliative intent. Conclusions Most patients with UTUC presented with visible hematuria, pain, or systemic features. USS has a high sensitivity, but cases will still be missed. The presence of prior bladder cancer is a significant risk factor and regular upper tract monitoring should be performed in high-risk patients (post-cystectomy, high-risk non muscle-invasive UC).

scholarly journals O07 SHORT-TERM OUTCOMES OF A MULTICENTRE PROSPECTIVE STUDY USING A “VISIBLE” PVDF ONLAY MESH FOR THE PREVENTION OF MIDLINE INCISIONAL HERNIA

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Jose Rodicio ◽  
Carlos San Miguel ◽  
Javier López Monclús ◽  
Maria Moreno ◽  
Patricia López ◽  
...  
Keyword(s):  
High Risk ◽  
Incisional Hernia ◽  
Polyvinylidene Fluoride ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Short Term ◽  
High Risk Patients ◽  
Mesh Material ◽  
Risk Patients ◽  
Prophylactic Use

Abstract Aim Prophylactic meshes in high-risk patients prevent incisional hernias, although there are still some concerns about the best layer to place them in, the type of fixation, the mesh material, the significance of the level of contamination, and surgical complications. We aimed to provide answers to these questions and information about how the implanted material behaves based on its visibility under MRI. Material and Methods This is a prospective multicentre observational cohort study. Preliminary results from the first three months are presented. We included general surgical patients who had at least two risk factors for developing an incisional hernia. MRIs were performed six weeks after treatment. A polyvinylidene fluoride (PVDF) mesh loaded with iron particles was used in an onlay position. Results Between July 2016 and December 2020, 178 patients were enrolled in the study. Surgery was emergent in 30.3% of cases, contaminated in 10.7% and dirty in 11.8%. A total of 5.6% of cases had postoperative wound infections, with BMI being the only significant risk factor (OR = 1.14, 95% CI = 1.00-1.31, p = 0.048). The formation of a seroma was also associated with BMI (OR = 1.11, 95% CI = 1.02-1.21, p = 0.02). Conclusions The prophylactic use of onlay PVDF mesh in midline laparotomies in high-risk patients was safe and effective in the short term, regardless of the type of surgery or the level of contamination. MRI allowed us to understand how the mesh behaves during the early process of integration.

2-OR: Impact of N Terminal Pro B-Type Natriuretic Peptide and High Sensitivity Cardiac Troponin on the Prediction of Death and Cardiovascular Events in High-Risk Patients with Type 2 Diabetes

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 2-OR
Author(s):  
MARCUS V.B. MALACHIAS ◽  
PARDEEP JHUND ◽  
BRIAN CLAGGETT ◽  
MAGNUS O. WIJKMAN ◽  
RHONDA BENTLEY-LEWIS ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
High Risk ◽  
Natriuretic Peptide ◽  
Cardiac Troponin ◽  
Cardiovascular Events ◽  
High Sensitivity ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals Problem-Orientated Antenatal Notekeeping: A Useful Primary Health Care Tool

Curationis ◽  
1978 ◽  
Vol 1 (3) ◽  
Author(s):  
J.V. Larsen
Keyword(s):  
Risk Factors ◽  
South Africa ◽  
Health Care ◽  
Primary Health Care ◽  
High Risk ◽  
Significant Risk ◽  
Obstetric Care ◽  
Antenatal Screening ◽  
Primary Health ◽  
Risk Patients

It has recently been demonstrated that about 56 percent of patients delivering in a rural obstetric unit had significant risk factors, and that 85 percent of these could have been detected by meticulous antenatal screening before the onset of labour. These figures show that the average rural obstetric unit in South Africa is dealing with a large percentage of high risk patients. In this work, it is hampered by: 1. Communications problems: i.e. bad roads, long distances. and unpredictable telephones. 2. A serious shortage of medical staff resulting in primary obstetric care being delivered by midwives with minimal medical supervision.

Decreasing Troponin Redraws by Validating Tiered Hemolysis Thresholds

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S11-S12
Author(s):  
Katherine Turner ◽  
Tanya Harnish ◽  
Zahra Madani ◽  
Erin Kaleta ◽  
Christine Snozek
Keyword(s):  
High Risk ◽  
Troponin T ◽  
Cardiac Injury ◽  
Significant Risk ◽  
Myocardial Infarctions ◽  
H Index ◽  
High Risk Patients ◽  
Risk Patients ◽  
The Mean ◽  
Serial Measurements

Abstract Cardiac troponin T (cTnT) assays are used for the diagnosis of acute myocardial infarctions and require serial measurements. Hemolysis is a common analytical interference for cTnT immunoassays, causing a false decrease in analyte concentration. Recollection of specimens that do not meet the recommended hemolysis threshold (H-index = 100) causes reporting delays and mistiming of serial measurements. This has been particularly disruptive to our emergency department and creates significant risk for patients whose diagnosis could be delayed by recollection due to hemolysis. Here we aimed to reevaluate the limits for acceptable hemolysis by determining the magnitude of cTnT concentration depression from hemolysis to evaluate whether more detailed thresholds could be established. To quantify the effects of hemolysis on cTnT, patient pools were prepared from residual serum with cTnT concentrations ranging from 10 to 100 ng/L and spiked with hemolysate prepared from lysed red blood cells to create H-indices ranging from 120 to 200. Samples were run in triplicate by the Elecsys Troponin T Gen. 5 STAT assay. Results demonstrated consistent percent decreases in cTnT across all concentrations tested for each level of hemolysis. The mean percent changes in cTnT concentrations in the presence of hemolysis for H-indices of 120, 140, 160, 180, and 200 were –3.4 ± 1.3%, –4.1 ± 1.2%, –6.3 ± 1.2%, –8.0 ± 1.7%, and –10.7 ± 1.22%, respectively. The observed decrease in cTnT was linearly related to the H index; predicted differences at higher H-indices (>200) agreed well with prior publications evaluating greater degrees of hemolysis. In our practice, a 2-hour delta ≥10 ng/L is considered significant for acute cardiac injury, <4 ng/L is a nonsignificant delta, and a delta of 4 to 9 ng/L is considered indeterminate. Baseline cTnT results of ≥100 ng/L result in immediate triage to cardiology. Approximately one-third of our patients with cTnT testing have baseline results within the reference range (≤15 ng/L males, ≤10 ng/L females). Based on the spiking data, H-index cutoffs were chosen to minimize recollections for low-risk and high-risk patients. Cutoffs for intermediate cTnT results were more restrictive to ensure delta interpretation would not change significantly. This resulted in a H-index of 300 for samples ≤8 ng/L, 200 for 9 to 40 ng/L, 160 for 41 to 70 ng/L, 140 for 71 to 99 ng/L, and 300 for ≥100 ng/L. These data quantify the percent change for cTnT in the presence of varying levels of hemolysis. At lower cTnT values, a larger degree of hemolysis can be tolerated because the percentage of depression results in a small absolute change, thus leading to less impact on the delta. The tiered H-index cutoffs allow minimal disruption to patient care for low- and high-risk patients, while maintaining the integrity of serial measurements for those with intermediate cTnT concentrations. Therefore, laboratories may consider releasing some hemolyzed cTnT specimens with a comment to decrease redraws and mistiming of serial measurements.

The Management of Newly-Diagnosed Non-muscle Invasive Bladder Cancer in Veterans Integrated Services Network 02 of the Veterans Health Administration

2019 ◽  
Author(s):  
Joseph M Caputo ◽  
George Moran ◽  
Benjamin Muller ◽  
Alison T Keller ◽  
Gen Li ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
High Risk ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Newly Diagnosed ◽  
Health Administration ◽  
Muscle Invasive Bladder Cancer ◽  
High Risk Patients ◽  
Risk Patients ◽  
Muscle Invasive

Abstract Introduction Over 1,500 bladder cancers were diagnosed among US Veterans in 2010, the majority of which were non-muscle invasive bladder cancer (NMIBC). Little is known about NMIBC treatment within the Veterans Health Administration. The objective of the study was to assess the quality of care for Veterans with newly-diagnosed NMIBC within Veterans Integrated Service Network (VISN) 02. Materials and Methods We used ICD-9 and ICD-10 codes to identify patients with newly-diagnosed bladder cancer from 1/2016–8/2017. We risk-stratified the patients into low, intermediate, and high-risk based on the 2016 American Urological Association Guidelines on NMIBC. Our primary objectives were percentages of transurethral resection of bladder tumors (TURBTs) with detrusor, repeat TURBT in high-risk and T1 disease, high-risk NMIBC treated with induction intravesical therapy (IVT), and responders treated with maintenance IVT. We performed logistic regression for association between distance to diagnosing hospital and receipt of induction IVT in high-risk patients. Results There were 121 newly-diagnosed NMIBC patients; 16% low-risk, 28% intermediate-risk, and 56% high-risk. Detrusor was present in 80% of all initial TURBTs and 84% of high-risk patients. Repeat TURBT was performed in 56% of high-risk NMIBC and 60% of T1. Induction IVT was given to 66% of high-risk patients and maintenance IVT was given to 59% of responders. On multivariate logistic regression, distance to medical center was not associated with receipt of induction IVT (OR = 0.99, 95% CI [0.97,1.01], p = 0.52). Conclusions We observed high rates of sampling of detrusor in the first TURBT specimen, utilization of repeat TURBT, and administration of induction and maintenance intravesical BCG for high-risk patients among a regional cohort of US Veterans with NMIBC. While not a comparative study, our findings suggest high quality NMIBC care in VA VISN 02.

Targeted Screening For Prostate Cancer In High Risk Families: Early Onset Is A Significant Risk Factor For Disease In First Degree Relatives

2002 ◽  
Vol 168 (2) ◽  
pp. 483-487 ◽  
Author(s):  
Antoine Valeri ◽  
Luc Cormier ◽  
Marie-Pierre Moineau ◽  
Geraldine Cancel-Tassin ◽  
Rahmene Azzouzi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Risk Factor ◽  
High Risk ◽  
Early Onset ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
First Degree Relatives ◽  
Targeted Screening ◽  
High Risk Families

Screening for Leptomeningeal Disease by High-Sensitivity Flow Cytometry in High Risk Patients with Aggressive Non-Hodgkin’s Lymphoma.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4397-4397
Author(s):  
Joy Mangel ◽  
Jazmin Marlinga ◽  
Mike Keeney ◽  
Jan Popma ◽  
Anargyros Xenocostas ◽  
...  
Keyword(s):  
Flow Cytometry ◽  
High Risk ◽  
High Sensitivity ◽  
B Cell Lymphoma ◽  
Leptomeningeal Disease ◽  
Cns Involvement ◽  
Lymphoma Cells ◽  
High Risk Patients ◽  
Csf Analysis ◽  
Risk Patients

Abstract Background: Central nervous system (CNS) involvement by non-Hodgkin’s lymphoma (NHL) portends a very poor prognosis. There is no consensus in the literature on the “high- risk” features that predict for leptomeningeal disease, and no standardized clinical guidelines exist regarding CNS surveillance, prophylaxis or treatment for patients at increased risk. 2–4 colour flow cytometry (FCM) has been reported to be more sensitive than standard cytology in detecting occult leptomeningeal disease (Blood 2005,105:496). The current study evaluates the utility of a high-sensitivity (5-colour) flow cytometry technique for detecting occult lymphoma cells in the cerebrospinal fluid (CSF) of high-risk patients with NHL. Method: Patients with a new diagnosis of histologically aggressive B or T cell NHL were included in this study if they displayed one or more “high-risk” features for CNS involvement. Patients suspected of CNS relapse of NHL were also eligible for participation. Patients underwent routine staging investigations, with the addition of a diagnostic lumbar puncture (LP) during initial assessment. CSF was tested by standard cytology, cell count and biochemistry, and an additional 5 ml was obtained for analysis by high-sensitivity FCM on a Beckman Coulter FC500. The antibody panel (5 antibodies per tube) was customized according to the phenotype of the lymphoma. The key markers for B cell lymphoma were CD19/kappa/lambda with CD5 or CD10. CD45 was used to identify all white blood cells in the sample. Results: Seventeen patients (8M/9F) with a median age of 59 (range 36–85) have been tested. Patients displayed anywhere from 2–6 “high-risk” features for CNS involvement. These included: HIV positivity (2), primary mediastinal B-cell lymphoma (4), bone marrow (5), multifocal bone (2), paraspinal (1), nasopharyngeal (2) or orbital (1) involvement, elevated serum LDH (12), multiple extranodal sites of disease (5), poor performance status (2), high IPI (3), B-symptoms (9), stage IV disease (11), and otherwise unexplained neurological symptoms (3). 14 patients underwent CSF analysis at time of initial diagnosis, one of whom had cranial nerve palsies secondary to a nasopharyngeal mass extending to the skull base. The other 3 were tested at relapse, transformation, and suspected CNS relapse ultimately diagnosed as a stroke. Despite the presence of these features, CSF analysis was negative for lymphoma cells by both cytology and FCM in all but one of the patients tested. However this patient had very high numbers of circulating lymphoma cells in the peripheral blood (PB), and the positive result was felt to be due to PB contamination of the CSF during a “bloody tap.” One patient with vague neurological symptoms had a negative LP at diagnosis, and later developed frank CNS involvement by lymphoma, but was too unwell to undergo a repeat LP. Conclusions: Given the limited number of patients enrolled thus far and the low prevalence of patients with NHL and CNS involvement (2/17), it is difficult to fully assess the utility of high-sensitivity FCM in the diagnosis of occult leptomeningeal disease. It is of interest that CSF analysis was negative even in the patient with cranial nerve palsies and in the patient who later developed multiple CNS lesions secondary to lymphoma, suggesting that this technique may have limited sensitivity in diagnosing leptomeningeal disease. The systematic screening of high-risk patients cannot yet be recommended as standard clinical practice.

Promethazine Adverse Events after Implementation of a Medication Shortage Interchange

2005 ◽  
Vol 39 (2) ◽  
pp. 255-261 ◽  
Author(s):  
Heena S Sheth ◽  
Margaret M Verrico ◽  
Susan J Skledar ◽  
Adele L Towers
Keyword(s):  
Adverse Drug Events ◽  
Medical Center ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
University Of Pittsburgh ◽  
Concurrent Use ◽  
Naranjo Algorithm ◽  
Risk Patients ◽  
Therapeutic Interchange ◽  
Incident Rate

BACKGROUND: Prochlorperazine and droperidol were commonly used antiemetics at the University of Pittsburgh Medical Center– Presbyterian Hospital until a shortage of prochlorperazine occurred and a black box warning was added to droperidol prescribing information. Subsequently, promethazine was selected as the approved intravenous antiemetic for therapeutic interchange in December 2001. Promethazine use and adverse drug events (ADEs) were investigated following review of a serious ADE that identified promethazine use as a probable contributing factor. OBJECTIVE: To illustrate ADEs associated with promethazine and characterize high-risk patients. METHODS: An ADE database analysis identified promethazine ADEs reported from 2000 to 2003. Promethazine utilization and ADEs were compared with those of other antiemetics during the pre- and post-interchange periods. RESULTS: Promethazine utilization increased significantly during the post-interchange period compared with all other antiemetics (p < 0.001). Promethazine ADEs increased from one event during the pre-interchange period to 13 events during the post-interchange period. Causality assessment using the Naranjo algorithm ranged from possible to probable. The promethazine ADE rate per 10 000 doses was significantly higher than the combined ADE rate for all other antiemetics (p < 0.001; incident rate ratio [IRR] 4.32). Elderly patients (aged ≥65 y) experienced more promethazine ADEs than younger patients (p = 0.005; IRR 4.68). Concurrent use of opioids and/or sedating drugs contributed to promethazine ADEs in 11 of 14 (78.6%) patients. CONCLUSIONS: Geriatric status is a significant risk factor for promethazine ADEs. Concomitant use of sedating drugs may further increase the risk for ADEs. Therapeutic interchange programs should be monitored for both ADEs and utilization.

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