scholarly journals Esophageal melanoma: a systematic review and exploratory recurrence and survival analysis

2019 ◽  
Author(s):  
D Schizas ◽  
K S Mylonas ◽  
G Bagias ◽  
A Mastoraki ◽  
M Ioannidi ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cox Regression ◽  
Case Reports ◽  
Case Series ◽  
Common Symptom ◽  
Prognostic Information ◽  
Management Options ◽  
Patient Age ◽  
Patient Âgé ◽  
Rare Malignancy

SUMMARY Esophageal melanoma is a rare and poorly described malignancy. We sought to review all available data on the clinicopathological features, management options, and outcomes of patients with esophageal melanoma to guide clinicians working to treat these uncommon tumors. A systematic literature search of the PubMed, Embase, and Cochrane databases was performed. Exploratory recurrence and survival analyses were performed using previously-validated pooled Cox and logistic regression techniques for case reports and case series. Quality assessment of included studies was performed using the tools developed by the Joanna Briggs and the National Heart, Lung, and Blood Institutes. Fifty-nine studies were reviewed. A total of 93 patients with esophageal melanoma were identified. The mean patient age was 61.2 ± 10.6 years. Esophageal melanoma usually developed at the lower esophagus (48.4%). 90.3% of the patients were symptomatic at presentation, with dysphagia being the most common symptom (72%). Esophagectomy was performed in 91.4% of the patients. Postoperatively, 14 patients (15.1%) received adjuvant chemotherapy. Tumor recurrence was seen in 37 patients (39.8%). The median time to recurrence was 6 months. Disease-specific mortality was 43%. All-cause mortality was 46.1%. On multivariable Cox regression, older patient age (hazard ratio [HR] = 0.91, P = 0.008) and higher Melan-A expression (HR = 0.21; P = 0.029) were associated with a significantly lower risk of mortality. Higher S100 levels (HR = 37.4; P = 0.001) were predictive of poor survival. On logistic regression, large, ulcerated, lower esophageal tumors were significantly more likely to recur (P = 0.018, P = 0.013, and P = 0.027 respectively). Esophageal melanoma is a rare malignancy that tends to present with dysphagia. Most surgically-treated patients undergo esophagectomy. Large, ulcerated, lower esophageal lesions recur more frequently. Immunohistochemistry provides prognostic information regarding survival.

scholarly journals Atrial High-Rate Event Incidence and Predictors in Patients With Permanent Pacemaker Implantation

2021 ◽  
Vol 8 ◽  
Author(s):  
Jian Hua Chen ◽  
Guo Yao Chen ◽  
Hong Zheng ◽  
Quan He Chen ◽  
Fa Yuan Fu ◽  
...  
Keyword(s):  
Cox Regression ◽  
Previous History ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
High Rate ◽  
Atrial Pacing ◽  
Patient Age ◽  
Cox Regression Analysis ◽  
Patient Âgé

Objective: The present study aims to investigate the incidence and predictors of atrial high-rate events (AHREs) in patients with permanent pacemaker implants.Methods: A total of 289 patients who were implanted with a dual-chamber pacemaker due to complete atrioventricular block or symptomatic sick sinus syndrome (SSS) and had no previous history of atrial fibrillation were included in the present study. AHREs are defined as events with an atrial frequency of ≥175 bpm and a duration of ≥5 min. The patients were divided into two groups according to whether or not AHREs were detected during the follow-up: group A (AHRE+, n = 91) and group N (AHRE–, n = 198).Results: During the 12-month follow-up period, AHREs were detected in 91 patients (31.5%). The multivariate Cox regression analysis revealed that patient age [odds ratio [OR] = 1.041; 95% confidence interval [CI], 1.018–1.064; and P < 0.001], pacemaker implantation due to symptomatic SSS (OR = 2.225; 95% CI, 1.227–4.036; and P = 0.008), and the percentage of atrial pacing after pacemaker implantation (OR = 1.010; 95% CI, 1.002–1.017; and P = 0.016) were independent AHRE predictors.Conclusion: The AHRE detection rate in patients with pacemaker implants was 31.5%. Patient age, pacemaker implantation due to symptomatic SSS, and the percentage of atrial pacing after pacemaker implantation were independent AHRE predictors.

Gender and Regional Differences in In-Hospital Mortality in Patients with Sickle Cell Anemia (SCA) in the United States: Results from the Nationwide Inpatient Sample (NIS) 1993-2003.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 461-461
Author(s):  
Carlton Haywood ◽  
Sophie Lanzkron
Keyword(s):  
Logistic Regression ◽  
Hospital Mortality ◽  
Hospital Death ◽  
Age At Death ◽  
Patient Age ◽  
Time Period ◽  
Patient Âgé ◽  
The Mean ◽  
Over Time ◽  
Age Of Death

Abstract Background: The purpose of this study was to use the NIS to describe hospital utilization and in-hospital mortality among adults with SCA in the US between 1993-2003. Methods: The NIS is designed to approximate a 20% stratified sample of U.S. community hospitals. We restricted our analyses to discharge records with ICD-9-CM diagnosis codes 28261 or 28262 (SCA without/with crisis), and where the age was listed as 18 or older. Analyses were conducted using tests of linear combinations of coefficients, χ2, and linear and logistic regression. Results: There were an estimated 705,080 hospitalizations over the time period (mean of 64,098 hospitalizations/year). 54% of all hospitalizations were for females. 50% of the hospitalizations were expected to be paid for by Medicaid. The mean patient age over the time period was 31.3 yrs. The mean patient age increased from 30.3 in 1993 to 32.1 in 2003 (p < 0.001). Mean age over time increased even after adjusting for the gender makeup and hospital region (β=0.162, p < 0.001). There were no gender differences in the median age (30) of patients. Mean length of stay (LOS) was 6.5 days for the time period. LOS decreased from 7.5 days in 1993 to 6.4 days in 2003 (p=0.001). Adult women experienced longer LOS than adult men (6.8 days vs. 6.3 days, p <0.001). This difference remained significant even after controlling for age, time, insurance status, and hospital region (β = 0.49, p<0.001). Mean charges/discharge increased from $16,799 in 1993 to $22,281 in 2003, even after adjusting for inflation (p < 0.001). There were an estimated 4497 in-hospital deaths during the time period (0.64% of hospitalizations). The median age at death was 38. The median age at death increased from 35 in 1993 to 42 in 2003 (p = 0.0061). This was due to an increase in age of death (39) for women (p=0.0052). In men the median age of death (37) did not change over time(p=0.4352). In bivariate analyses of median age at death, women were older than men (39 vs. 37 p=0.0056). A simple logistic regression of deaths over time found no significant trends in the odds of an in-hospital death over the time period. In a multivariate model of death over time patients in the South and the West experienced higher odds of an in-hospital death than patients in the Northeast and Midwest. Conclusions: Our analysis shows that women with SCA have longer in-hospital LOS than men, and are older in age at death than men. While the median age at death among persons hospitalized with SCA has been increasing since 1993, this increase is seen exclusively in women. There has been no change in longevity in men hospitalized with SCA over the time period studied.

Adverse Events after Infusions of Cryopreserved Hematopoietic Stem Cells Depend on Non-Mononuclear Cell in Infused Suspension and on Patient Age.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5244-5244
Author(s):  
Giuseppe Milone ◽  
Valeria Pinto ◽  
Salvatore Mercurio ◽  
Aurora Strano ◽  
Stefania Coppoletta ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Adverse Events ◽  
Progenitor Cells ◽  
Mononuclear Cells ◽  
Patient Age ◽  
Hematopoietic Stem ◽  
Actual Time ◽  
Patient Âgé ◽  
Hemopoietic Progenitor ◽  
Hemopoietic Progenitor Cells

Abstract We have prospectively collected data on Adverse Events (AE) that occurred in 179 Hemopoietic Progenitor Cell (HPC) infusions performed in patients affected with haematological neoplasm, after high dose chemotherapy. Stem cell source was Hemopoietic Progenitor Cells Aphaeresis (HPC-A) in 157 cases and Hemopoietic Progenitor Cells Bone Marrow (HPC-BM) in 22 cases. In all cases, an endotoxin-free DMSO was used. One or more AE were registered in 51/179 infusions (28.6%). Frequency of AE was higher after HPC-A than after HPC-BM (31.3% versus 4.5%, (chi square test: p=0.008). In univariate logistic regression other factors found important for AE were: Age (p=0.028), Number of Total Nucleated Cells infused/kg (P=0.002), Volume/kg infused (p=0.057), Volume of Packed Red Blood Cells (p=0.019), a content of Non-Mononuclear Cells >0.500 × 108/Kg (<p=0.0001) and Actual Time of infusion (p=0.058). When all aforementioned factors were evaluated in multivariate logistic regression only Age of patient (P=0.024) and a content of Non-Mononuclear Cells > 0.5×108/kg (P=0.0003) remained significant. No cardiovascular events were recorded during infusions. A significant correlation existed between reduction of cardiac frequency both with Volume/Kg infused (r 0.221; p=0.02) and with Actual Time of infusion (r 0.269; p=0.005). In conclusion, while Cardiovascular Changes are influenced by Volume/Kg infused and by Actual Time of infusion, Non-Cardiovascular AE are dependent on patient Age and on contamination by Non-Mononuclear Cells in apheretic harvests.

scholarly journals Prenatal Diagnosis of Neuroblastoma

2014 ◽  
Vol 8 (3) ◽  
pp. 321-327
Author(s):  
Mona Zvanca ◽  
Cristian Andrei
Keyword(s):  
Prenatal Diagnosis ◽  
Case Reports ◽  
Case Series ◽  
Expectant Management ◽  
Individual Case ◽  
Management Options ◽  
Tertiary Center ◽  
Low Incidence ◽  
Tumor In Childhood

ABSTRACT Fetal malignancies are rare complications during pregnancies, but when they appear, they are very challenging for the perinatology team. Because of their low incidence, the information is limited, with data provided from individual case reports or small case series. Although neuroblastoma is the most frequent extracranial solid tumor in childhood, prenatal diagnosis by ultrasound is very rare and almost always discovered during routine third trimester ultrasound. Expectant management is usually indicated prenatally, with serial ultrasound examination. Delivery should be planned in a tertiary center together with pediatric oncologists and surgeons to allow appropriate postnatal management. We present two cases of neuroblastoma diagnosed at 36 and 33 weeks of gestation with multiple aspects of this tumor identified by ultrasound. Both cases needed surgery and had a favorable outcome. The key role of ultrasound in diagnosis and follow-up of neuroblastoma in pregnancy is discussed, together with the management options recommended in literature. How to cite this article Andrei C, Vladareanu R, Zvanca M, Vladareanu S. Prenatal Diagnosis of Neuroblastoma. Donald School J Ultrasound Obstet Gynecol 2014;8(3):321-327.

scholarly journals Adenosquamous carcinoma of the esophagus: A literature review

2018 ◽  
Vol 6 (2) ◽  
pp. 70-73 ◽  
Author(s):  
Dimitrios Schizas ◽  
Panagiotis Kapsampelis ◽  
Konstantinos S. Mylonas
Keyword(s):  
Esophageal Cancer ◽  
Patient Outcomes ◽  
Adenosquamous Carcinoma ◽  
Case Reports ◽  
Clinical Manifestations ◽  
Case Series ◽  
Rare Type ◽  
Unique Type ◽  
Carcinoma Of The Esophagus ◽  
Rare Malignancy

Abstract Adenosquamous carcinoma (ASC) of the esophagus is an uncommon type of esophageal cancer that contains both adenocarcinoma and squamous cell carcinoma elements. Data on this biologically unique type of cancer are limited and mainly stem from case reports and small case series. We performed an audit of the available literature and synthesized a review on the epidemiology, pathogenesis, histopathology, clinical manifestations, diagnosis, treatment and prognosis of ASCs. Adenosquamous carcinoma of the esophagus is a rare type of esophageal cancer. Histological examination is necessary to confirm the diagnosis of ASC and patients usually receive multimodal treatment. Patient outcomes are not well defined and further research could help us better understand the pathophysiology and unique needs of patients with this rare malignancy.

Diagnosis and management of carotid free-floating thrombus: A systematic literature review

2019 ◽  
Vol 14 (3) ◽  
pp. 247-256 ◽  
Author(s):  
Sebastian Fridman ◽  
Stephen P Lownie ◽  
Jennifer Mandzia
Keyword(s):  
Transient Ischemic Attack ◽  
Large Scale ◽  
Cox Regression ◽  
Case Reports ◽  
Case Series ◽  
Duplex Ultrasound ◽  
Stroke Patients ◽  
Ischemic Attack ◽  
Associated Risk Factors

Background There is no consensus regarding the management of carotid free-floating thrombi in patients with acute ischemic stroke and transient ischemic attack. Aims This systematic review aims to (1) describe the current imaging methods for diagnosis of carotid free-floating thrombi and its associated risk factors, (2) estimate the proportion of carotid free-floating thrombi diagnosed in stroke patients, (3) estimate the proportion of carotid free-floating thrombi patients treated medically and surgically, and (4) evaluate 30-day outcomes. Methods We searched MEDLINE, EMBASE, and manually for references reporting carotid free-floating thrombi from 1960 until June 2017. We estimated the frequency of carotid free-floating thrombi and evaluated 30-day outcomes using Cox regression. We defined the timing of surgical intervention as early (less than 72 h) and delayed (more or equal to 72 h). Summary of review We retrieved 525 carotid free-floating thrombi cases from 58 case series and 83 case reports. Carotid free-floating thrombi were present in 1.53% of stroke patients. Carotid free-floating thrombi diagnosis was made by digital subtraction angiography (38.1%), carotid duplex ultrasound (29.5%), and computed tomography angiography (29.5%). The 30-day risk of transient ischemic attack, silent brain ischemia, any stroke or death was 17.1%. In multivariate analyses, there were no differences in outcome for any anticoagulation regime or timing of revascularization procedure. Conclusions The diagnosis of carotid free-floating thrombi is more common due to the increased use of early noninvasive vascular imaging in transient ischemic attack and stroke. It poses a high short-term risk of stroke and death, but there is as yet no established treatment. The low quality of evidence in the carotid free-floating thrombi literature limits the interpretation of our results and warrants a large-scale prospective cohort study in carotid free-floating thrombi.

scholarly journals Incidence of Coexisting Talar and Tibial Osteochondral Lesions Correlates With Patient Age and Lesion Location

2018 ◽  
Vol 6 (8) ◽  
pp. 232596711879096 ◽  
Author(s):  
Rebecca M. Irwin ◽  
Yoshiharu Shimozono ◽  
Youichi Yasui ◽  
Robin Megill ◽  
Timothy W. Deyer ◽  
...  
Keyword(s):  
Older Patients ◽  
Distal Tibia ◽  
Case Series ◽  
Lesion Size ◽  
Magnetic Resonance Images ◽  
Osteochondral Lesions ◽  
Level Of Evidence ◽  
Patient Age ◽  
Morphologic Characteristics ◽  
Patient Âgé

Background: The incidence of coexisting osteochondral lesions (OCLs) of the tibia and talus has been negatively correlated with successful clinical outcomes, yet these lesions have not been extensively characterized. Purpose: To determine the incidence of coexisting tibial and talar OCLs, assess the morphologic characteristics of these lesions, and evaluate whether these characteristics are predictive of outcome. Study Design: Case series; Level of evidence, 4. Methods: A total of 83 patients who underwent surgery for a talar OCL were evaluated for coexisting OCLs of the distal tibia with preoperative magnetic resonance images. Size, location, containment, International Cartilage Repair Society (ICRS) grade, patient age, and patient sex were analyzed for predictors of coexisting lesions or patient outcome. The talar and tibial surfaces were each divided into 9 zones, with 1 corresponding to the most anteromedial region and proceeding laterally and then posteriorly. The Foot and Ankle Outcome Score (FAOS) was evaluated pre- and postoperatively. Results: Twenty-six patients (31%) had coexisting tibial and talar OCLs, with 9 (35%) identified as kissing lesions. Age correlated with coexisting lesion incidence, as older patients were more likely to have a coexisting tibial OCL ( P = .038). More than half of talar OCLs were found in zone 4 (61%), whereas the majority of tibial OCLs were located in zones 2, 4, and 5 (19% each). Patients with coexisting lesions were more likely to have a lateral talar OCL ( P = .028), while those without a coexisting tibial lesion were more likely to have a talar OCL in zone 4 ( P = .016). There was no difference in FAOS result or lesion size between patients with and without coexisting OCLs, but patients with coexisting lesions were more likely to have an ICRS grade 4 talar OCL ( P = .034). For patients with coexisting lesions, kissing lesions were more likely to be located in zone 6 ( P = .043). There was no difference in OCL size or containment between kissing and nonkissing coexisting OCLs. Conclusion: The incidence of coexisting talar and tibial OCLs may be more prevalent than what previous reports have suggested, with older patients being more likely to present with this pathology. The location of a talar OCL correlates with the incidence of a coexisting tibial OCL.

Papillary Tumor of the Pineal Region: Systematic Review and Analysis of Prognostic Factors

Neurosurgery ◽  
2019 ◽  
Vol 85 (3) ◽  
pp. E420-E429 ◽  
Author(s):  
Vitor Nagai Yamaki ◽  
Davi Jorge Fontoura Solla ◽  
Renan Ribeiro Ribeiro ◽  
Saul Almeida da Silva ◽  
Manoel Jacobsen Teixeira ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Tumor Size ◽  
Cox Regression ◽  
Case Reports ◽  
Treatment Options ◽  
Multivariable Analysis ◽  
Case Series ◽  
Pineal Region ◽  
Biological Behavior ◽  
Final Sample

Abstract BACKGROUND Clinical outcomes and biological behavior of papillary tumors of the pineal region (PTPR) are still under investigation. The best therapeutic strategy has not been defined. OBJECTIVE To perform a comprehensive patient-level analysis of all PTPR cases and identify their clinical features, treatment options, and prognostic factors. METHODS A search of the medical databases for case series and reports on PTPRs from January 2003 to June 2017 was performed. Data addressing PTPR’s clinical presentation, imaging, treatment, and histological features were. Variables associated with the primary outcome of 36-mo survival were identified through Cox regression models. RESULTS The initial search yielded 1164 studies, of which 71 were included (60 case reports and 11 case series), containing 177 patients (mean age 33.0 ± 15.3 yr and 53.2% male). Intracranial hypertension and hydrocephalus prevailed as the clinical picture. Surgery was performed on 82.0% and gross total resection (GTR) was achieved on 71.4%. A total of 56.8% recurred after a median 29 mo (quartiles 10.5-45.5). The 36-mo survival rate was 83.5% (95% confidence interval [CI] 76.2-89.2%). Good functional outcomes (Glasgow Outcome Scale 4/5) were observed in 60.0%. The variables of interest were inconsistently reported and the multivariable analysis final sample was 133 patients. After adjustment for age, tumor size (each additional centimeter, hazard ratio [HR] 1.99, 95% CI 1.12-3.53, P = .019) and surgical treatment (HR 0.16, 95% CI 0.05-0.45, P = .001) were associated with 36-mo survival. CONCLUSION Tumor size and surgery are associated with improvement in 36-mo survival. We did not observe any significant benefits from GTR or adjuvant treatments.

Clinical Toxicology of Ethylene Glycol Monoal Ethers

1994 ◽  
Vol 13 (5) ◽  
pp. 325-335 ◽  
Author(s):  
Randall G. Browning ◽  
Steven C. Curry
Keyword(s):  
Ethylene Glycol ◽  
Animal Studies ◽  
Case Reports ◽  
Case Series ◽  
Epidemiological Studies ◽  
Acute Poisoning ◽  
Clinical Toxicology ◽  
Glycol Ethers ◽  
Management Options ◽  
Household Products

The glycol ethers constitute a family of organic solvents commonly found in industrial and household products. Because of their widespread availability and potential for serious toxicity, physicians should be aware of the clinical toxicology of these compounds. Until recently, knowledge of the toxic effects of glycol ethers has been derived from animal studies and a limited number of case reports and small case series. A growing body of data from epidemiological studies, controlled human studies, and studies using human tissue now allows for advancement in the understanding of the acute and chronic toxicity of these compounds. This review summarizes and evaluates human and pertinent animal literature on the clinical toxicology of glycol ethers, with a focus on the commonly encountered monoalkyl ethers of ethylene glycol. Management options for acute poisoning, as well as measures for the control of workplace exposures, are discussed.

Orofacial Granulomatosis Associated with Crohn’s Disease: a Multicentre Case Series

2021 ◽  
Author(s):  
Frank Phillips ◽  
Bram Verstockt ◽  
Malgorzata Sladek ◽  
Nanne de Boer ◽  
Konstantinos Katsanos ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Case Reports ◽  
Case Series ◽  
Symptom Burden ◽  
Management Options ◽  
Orofacial Granulomatosis ◽  
Tract Involvement ◽  
Collection Form ◽  
Upper Gastrointestinal

Abstract Background Orofacial granulomatosis [OFG] is a rare syndrome that may be associated with Crohn’s disease [CD]. We aimed to characterise this relationship and the management options in the biologic era. Methods This multicentre case series was supported by the European Crohn’s and Colitis Organisation [ECCO], and performed as part of the Collaborative Network of Exceptionally Rare case reports [CONFER] project. Clinical data were recorded in a standardised collection form. Results This report includes 28 patients with OFG associated with CD: 14 males (mean age of 32 years, ±12.4 standard deviation [SD]) and 14 females [40.3 years, ±21.0 SD]. Non-oral upper gastrointestinal tract involvement was seen in six cases and perianal disease in 11. The diagnosis of OFG was made before CD diagnosis in two patients, concurrently in eight, and after CD diagnosis in 18. The distribution of OFG involved the lips in 16 cases and buccal mucosa in 18. Pain was present in 25 cases, with impaired swallowing or speaking in six. Remission was achieved in 23 patients, notably with the use of anti-tumour necrosis factors [TNFs] in nine patients, vedolizumab in one, ustekinumab in one, and thalidomide in two. A further five cases were resistant to therapies including anti-TNFs. Conclusions OFG associated with CD may occur before, concurrently with, or after the diagnosis of CD. Perianal and upper gastrointestinal [UGI] disease are common associations and there is a significant symptom burden in many. Remission can be obtained with a variety of immunosuppressive treatments, including several biologics approved for CD.

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