scholarly journals Male-female specific aortic growth after 10 year follow-up in an aged population

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Thijssen ◽  
F.O Mutluer ◽  
J.E Van Der Toorn ◽  
L.R Bons ◽  
A.L Gokalp ◽  
...  
Keyword(s):  
Growth Rate ◽  
General Population ◽  
The Netherlands ◽  
Growth Rates ◽  
Cardiac Ct ◽  
Rotterdam Study ◽  
Antithrombotic Agents ◽  
Descending Aorta ◽  
Factors Associated

Abstract Background Aortic diameters are known to increase with age. However, longitudinal data on normal thoracic aortic growth rate over the adult life course are lacking. To better understand and recognize pathological aortic growth and factors influencing aortic dilatation, it is crucial to study aortic growth patterns in the general population. Purpose To study sex- and age-specific aortic growth rates in the general population, and to identify factors associated with aortic growth rate and developing aortic pathology. Methods Participants of the prospective population-based Rotterdam Study who underwent non-enhanced cardiac CT (2003–2006) were invited for a follow-up non-enhanced cardiac CT (2018–2019). On both CT-scans, diameters of the ascending (AA) and descending aorta (DA) were measured at the level of the pulmonary bifurcation. Mean aortic growth rates and 95th percentiles were calculated. Linear regression models were built to identify factors associated with aortic growth. Results In this preliminary analysis, 933 participants were included (52% females, median age 65 years). During a mean follow-up time of 14 years, the mean aortic growth rates of the ascending aorta (AA) were 0.08 mm/year in males and 0.07 mm/year in females. For the descending aorta (DA) these were 0.07 mm/year in males and 0.05mm/year in females. Participants with AA diameters of ≥40 mm (n=147) or DA diameters of ≥35 mm (n=11) at baseline did not show accelerated growth compared to the other participants. Higher systolic blood pressure (SBP), and use of antithrombotic agents were associated with less AA growth. Age, diastolic blood pressure (DBP) and male sex were associated with more AA growth. For the DA, higher DBP and smoking were associated with a higher growth rate. Higher SBP, diabetes and use of antithrombotic agents were associated with less DA growth. Conclusion Thoracic aortic growth rates in the general population are low. Differences in growth were found between men and women, although these differences may not be clinically relevant. Antithrombotic medication use was related to lower thoracic aortic growth rates, emphasizng the need for further investigation into the potential effect of this treatment. Funding Acknowledgement Type of funding source: Other. Main funding source(s): The Rotterdam Study is funded by Erasmus MC and Erasmus University, Rotterdam, the Netherlands; the Netherlands Organisation for Scientific Research (NWO); the Netherlands Organisation for Health Research and Development (ZonMw); the Research Institute for Diseases in the Elderly (RIDE); the Ministry of Education, Culture and Science; the Ministry for Health, Welfare and Sports; the European Commission (DG XII); and the Municipality of Rotterdam. MK is supported by a VENI grant (91616079) from ZonMw. JWR-H, LRB, CGET, ALG, MMM and JJMT are supported by the Dutch Heart Foundation (2013T093) and ZonMW (849200014).

scholarly journals Ultrasound Surveillance of Ectatic Abdominal Aortas

2008 ◽  
Vol 90 (6) ◽  
pp. 477-482 ◽  
Author(s):  
S Devaraj ◽  
SR Dodds
Keyword(s):  
Growth Rate ◽  
Growth Rates ◽  
Screening Programme ◽  
T Test ◽  
Aortic Aneurysms ◽  
Aortic Diameter ◽  
Ultrasound Screening ◽  
The Mean ◽  
Clinically Significant

INTRODUCTION Some studies have considered abdominal aortas of 2.6–2.9 cm diameter (ectatic aortas) at age 65 years as being abnormal and have recommended surveillance, whereas others have considered these normal and surveillance unnecessary. It is, therefore, not clear how to manage patients with an initial aortic diameter between 2.6–2.9 cm detected at screening. The aim of this study was to evaluate growth rates of ectatic aortas detected on initial ultrasound screening to determine if any developed into clinically significant abdominal aortic aneurysms (AAAs; > 5.0 cm) and clarify the appropriate surveillance intervals for these patients. PATIENTS AND METHODS Data were obtained from a prospective AAA screening programme which commenced in 1992. The group of patients with initial aortic diameters of 2.6–2.9 cm with a minimum of 1-year follow-up were included in this study (Group 2). This was further divided into two subgroups (Groups 3a and 3b) based on a minimum follow-up interval obtained from outcome analysis. Mean growth rate was calculated as change in aortic diameter with time. The comparison of growth rates in Groups 3a and 3b was performed using the t-test. The number and proportion of AAAs that expanded to ≥ 3.0 cm and ≥ 5.0 cm in diameter were also calculated. RESULTS Out of 999 patients with AAA ≥ 2.6 cm with minimum 1-year follow-up, 358 (36%) were classified as ectatic aortas (2.6–2.9 cm) at initial ultrasound screening with the mean growth rate of 1.69 mm/year (95% CI, 1.56–1.82 mm/year) with a mean follow-up of 5.4 years. Of these 358 ectatic aortas, 314 (88%) expanded into ≥ 3.0 cm, 45 (13%) expanded to ≥ 5.0 cm and only 8 (2%) expanded to ≥ 5.5 cm over a mean follow-up of 5.4 years (range, 1–14 years). No ectatic aortas expanded to ≥ 5.0 cm within the first 4 years of surveillance. Therefore, the minimum follow-up interval was set at 4 years and this threshold was then used for further analysis. The mean growth rate in Group 3a (< 5.0 cm at last scan) was 1.33 mm/year (95% CI, 1.23–1.44 mm/year) with a mean follow-up of 7 years compared to Group 3b (≥ 5.0 cm at last scan) with the mean growth rate of 3.33 mm/year (95% CI 3.05–3.61 mm/year) and a mean follow-up of 8 years. The comparison of mean growth rates between Groups 3a and 3b is statistically significant (t-test; T = 13.00; P < 0.001). CONCLUSIONS One-third of patients undergoing AAA screening will have ectatic aortas (2.6–2.9 cm) and at least 13% of these will expand to a size of ≥ 5.0 cm over a follow-up of 4–14 years. A threshold diameter of 2.6 cm for defining AAAs in a screening programme is recommended and ectatic aortas detected at age 65 years can be re-screened at 4 years after the initial scan. A statistically significant difference was found in the growth rates of ectatic aortas with minimum 4 years follow-up, expanding to ≥ 5.0 cm compared to those less than 5.0 cm at last surveillance scan. Further studies are required to test the hypothesis of whether growth rate over the first 4 years of surveillance will identify those who are most likely to expand to a clinically significant size (> 5.0 cm).

Sex Differences in Factors Associated With Progression of Aortic Valve Calcification in the General Population

2022 ◽  
Author(s):  
Axel Diederichsen ◽  
Jes Sanddal Lindholt ◽  
Jacob Eifer Møller ◽  
Oke Gerke ◽  
Lars Melholt Rasmussen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Sex Differences ◽  
Aortic Valve ◽  
General Population ◽  
Incidence Rate ◽  
Interquartile Range ◽  
Aortic Valve Calcification ◽  
Valve Calcification ◽  
Factors Associated

Background: Guidelines recommend measurement of the aortic valve calcification (AVC) score to help differentiate between severe and nonsevere aortic stenosis, but a paucity exists in data about AVC in the general population. The aim of this study was to describe the natural history of AVC progression in the general population and to identify potential sex differences in factors associated with this progression rate. Methods: Noncontrast cardiac computed tomography was performed in 1298 randomly selected women and men aged 65 to 74 years who participated in the DANCAVAS trial (Danish Cardiovascular Screening). Participants were invited to attend a reexamination after 4 years. The AVC score was measured at the computed tomography, and AVC progression (ΔAVC) was defined as the difference between AVC scores at baseline and follow-up. Multivariable regression analyses were performed to identify factors associated with ΔAVC. Results: Among the 1298 invited citizens, 823 accepted to participate in the follow-up examination. The mean age at follow-up was 73 years. Men had significantly higher AVC scores at baseline (median AVC score 13 Agatston Units [AU; interquartile range, 0–94 AU] versus 1 AU [interquartile range, 0–22 AU], P <0.001) and a higher ΔAVC (median 26 AU [interquartile range, 0–101 AU] versus 4 AU [interquartile range, 0–37 AU], P <0.001) than women. In the fully adjusted model, the most important factor associated with ΔAVC was the baseline AVC score. However, hypertension was associated with ΔAVC in women (incidence rate ratios, 1.58 [95% CI, 1.06–2.34], P =0.024) but not in men, whereas dyslipidemia was associated with ΔAVC in men (incidence rate ratio: 1.66 [95% CI, 1.18–2.34], P =0.004) but not in women. Conclusions: The magnitude of the AVC score was the most important marker of AVC progression. However, sex differences were significant; hence, dyslipidemia was associated with AVC progression only among men; hypertension with AVC progression only among women. REGISTRATION: URL: https://www.isrctn.com ; Unique identifier: ISRCTN12157806.

Comparison of aortic remodelling after conservative treatment or thoracic endovascular repair in type B dissections

2019 ◽  
Vol 30 (3) ◽  
pp. 458-464 ◽  
Author(s):  
Migdat Mustafi ◽  
Mateja Andic ◽  
Oana Bartos ◽  
Gerd Grözinger ◽  
Christian Schlensak ◽  
...  
Keyword(s):  
Growth Rate ◽  
Treatment Group ◽  
Conservative Treatment ◽  
Acute Type ◽  
Type B ◽  
Descending Aorta ◽  
Group A ◽  
The Mean ◽  
Group B

Abstract OBJECTIVES Our aim was to compare aortic remodelling in type B dissections after thoracic endovascular aortic repair (TEVAR) or conservative treatment. METHODS We conducted a retrospective analysis of computed tomography (CT) data sets at dissection onset and at the last follow-up in a group with conservative (group A) and TEVAR treatment (group B). An additional analysis of the preoperative CT images was performed in patients from group A, who were converted to TEVAR during follow-up. Diameters and lengths of all aortic segments were measured and growth rates were calculated. RESULTS We included 74 patients: 50 patients in group A (follow-up time: 1625 ± 209 days) and 24 patients in group B (follow-up time: 554 ± 129 days). The mean aortic diameter growth rate was significantly higher in group A than in group B in the mid-descending aorta (A: +7 mm/year; B: −4 mm/year; P = 0.003). Length growth difference was only present in the abdominal aortic segment and was more pronounced in group A (+2 vs ±0 mm/year; P = 0.009). The conversion rate from conservative treatment to TEVAR was 36% (n = 18). A false lumen diameter of &gt;22 mm at baseline was associated with a higher rate of conversion (P = 0.036). After conversion, the mean growth rate in the proximal descending and mid-descending aorta decreased from preoperative +11 and +18 mm/year to postoperative −9 and −14 mm/year, respectively (P &lt; 0.001). CONCLUSIONS In acute type B dissections, TEVAR stops aortic enlargement in the thoracic aorta, but promotes distal dilatation compared to the conservative treatment group. After conversion to TEVAR in conservatively pretreated chronic type B dissections, a more pronounced diameter decrease in the descending aorta was observed than in patients treated in the acute phase.

Prevalence, growth rate and complications of splenic artery aneurysms in chronic liver disease patients

VASA ◽  
2020 ◽  
pp. 1-6
Author(s):  
Marcelo Assis Rocha ◽  
Eduardo Saltão Silva Marques ◽  
Layra Ribeiro de Sousa Leão ◽  
Thiago Raspa Freitas Magdalena ◽  
Aline Andrade Dórea ◽  
...  
Keyword(s):  
Growth Rate ◽  
Liver Transplantation ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Growth Rates ◽  
Splenic Artery ◽  
Artery Aneurysm ◽  
Chronic Liver ◽  
Post Transplantation

Summary: Background: Chronic liver disease (CLD) patients are at greater risk for developing splenic artery aneurysm (SAA). Treatment for aneurysms > 2.5 cm in this population is considered. However, the procedure might be challenging in CLD patients, and complications may interfere in liver transplantation. We, therefore, sought to estimate the prevalence, growth rate and complications of SAA in patients with CLD. As secondary objective, we sought to evaluate whether those features differ in pre and post transplantation follow-up and among aneurysms with diameters greater or less than 2.5 cm at diagnosis. Patients and methods: We searched for the terms “SAA” and “CLD” on CT or MRI reports from January 2009 to December 2016. Patients with single examination or less than 6 months follow-up were excluded. Results: Fifty nine out of 2050 CLD patients presented SAA (prevalence of 2.9%). Fifteen patients were excluded (due to exclusion criteria). Forty-four CLD patients (mean age 55.9 years) presented 76 SAA (follow-up median of 27.2 months). Aneurysms presented mean size of 1.5 ± 0.74 cm at diagnosis and growth rate of 0.12 ± 0.14 cm/y. Two (4.5%) patients presented mild complications (aneurysm thrombosis). No significant differences were observed in the growth rates of aneurysms < 2.5 cm and ≥ 2.5 cm or in the initial size and growth rates of aneurysms of patients submitted to and not submitted to liver transplantation. Conclusions: The estimated prevalence of SAA in patients with DLC in the Brazilian population is 2.9% (CI95% 2.2–3.6%). Although SAA in CLD patients are less likely to remain stable and grow faster than in general population, aneurysms are usually diagnosed at smaller size and complications are rare. These findings might support conservative management with close surveillance, especially in smaller aneurysms.

O-077 Cancer risk in a nationwide cohort of children and young adults conceived by assisted reproductive technology in 1983-2012

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
M Spaan ◽  
M Goddijn ◽  
T Roseboom ◽  
C Lambalk ◽  
F Van Leeuwen
Keyword(s):  
General Population ◽  
Cancer Risk ◽  
The Netherlands ◽  
Assisted Reproductive Technology ◽  
Health Risks ◽  
Reproductive Technology ◽  
Cancer Risks ◽  
Maternal Risk ◽  
Specific Cancer

Abstract Study question Are children conceived by assisted reproductive technology (ART) at increased cancer risk, compared with the general population and with non-ART conceived offspring from subfertile women? Summary answer Overall cancer risk was not increased in ART-conceived offspring compared with non-ART conceived offspring from subfertile women (median follow-up, 17 years). What is known already There is growing evidence that ART procedures could perturb epigenetic processes during the pre-implantation period. Although the results of most studies are reassuring for children born after in vitro fertilization (IVF), recent studies showed (non-)significantly increased cancer risks after intracytoplasmic sperm injection (ICSI) and frozen embryo transfer (FET). Since the proportion of children born after these techniques increased dramatically over the past decades, it is important from a public health perspective to investigate cancer risk after ICSI and FET in larger studies. Study design, size, duration Data were used from the OMEGA-cohort, a historical nationwide cohort with prospective follow-up in the Netherlands. Offspring of women who were treated in one of the 13 IVF clinics or 2 regional fertility centers between 1983-2012 were included. Of 98,165 live-born children, 53,154 were ART-conceived and 45,211 were non-ART conceived (conceived naturally with or without ovarian hyperstimulation) by subfertile women. Participants/materials, setting, methods Data on type of fertility treatment and maternal risk factors were available from medical records from the mothers and the Dutch Perinatal registry. Cancer incidence was ascertained through linkage with the Netherlands Cancer Registry. Cancer risk in ART-conceived children was compared with risk in children not conceived by ART from subfertile women (hazard ratios [HRs]) and with children from the general population (standardized incidence ratios [SIRs]). Main results and the role of chance The median age at end of follow-up was 17 years and was shorter in ART-conceived children (16.1 years) compared with non-ART children (19.1 years). In total, 382 cancers were observed, 166 in the ART group and 222 in the non-ART group. In preliminary analyses, overall cancer risk was not increased in ART-conceived children, neither compared with children not conceived by ART from subfertile women (HR:0.98, 95% confidence interval (CI) = 0.79-1.22) nor compared with the general population (SIR:0.98, 95% CI = 0.81-1.11). Risks were also not significantly increased in children conceived by ICSI or FET (HR:1.20, 95%CI = 0.85-1.70; 1.25, 95%CI = 0.68-2.43, respectively). From 18 years of age onwards, the HR of cancer in ART-conceived versus non-ART individuals was 1.22 (95%CI = 0.86-1.74). There were no significantly increased site-specific cancer risks in ART-conceived children compared with non-ART children and the general population. Risk of lymphoblastic leukaemia was not increased in the ART group compared with the non-ART group (HR: 1.03, 95% CI = 0.58-1.82). Limitations, reasons for caution Despite the large cohort and long-term follow-up the number of cancer cases was limited which hampered some subgroup analyses, especially for analyses according to specific cancer types and children born after FET. Wider implications of the findings The results from this study importantly contribute to the current knowledge about health risks in ART-offspring. Physicians may inform parents who consider ART about potential health risks for ART-conceived children. Furthermore, pediatric oncologists caring for ART-conceived children/adolescents with cancer need evidence-based information about the association between ART and cancer risk. Trial registration number n.a.

Factors influencing macular atrophy growth rates in neovascular age-related macular degeneration treated with ranibizumab or aflibercept according to an observe-and-plan regimen

2018 ◽  
Vol 103 (7) ◽  
pp. 900-905 ◽  
Author(s):  
Irmela Mantel ◽  
Marta Zola ◽  
Sophie De Massougnes ◽  
Ali Dirani ◽  
Ciara Bergin
Keyword(s):  
Growth Rate ◽  
Growth Rates ◽  
Pigment Epithelium ◽  
Age Related Macular Degeneration ◽  
Square Root ◽  
Factors Associated ◽  
Macular Atrophy ◽  
Age Related ◽  
Lower Baseline ◽  
Fellow Eyes

Background/aimsTo investigate the factors associated with macular atrophy (MA) growth rates in neovascular age-related macular degeneration treated with either ranibizumab or aflibercept.MethodsWe obtained data from two identical prospective studies using ranibizumab or aflibercept under observe-and-plan variable dosing regimens. We analysed eyes that presented MA within 2 years. After applying square root transformations to MA sizes, we calculated MA growth rate from baseline to the year 2 endpoint and used univariate and multivariate analyses to detect ocular and treatment factors associated with the MA growth rate.ResultsIncluded were 109 eyes from 101 patients (mean age 80.6 years). The mean square-root-transformed MA growth rate was 0.54±0.34 mm/year. The univariate analyses revealed that MA growth rates were significantly associated with lower baseline visual acuities (p=0.001) and thicker subretinal tissue complexes (p=0.006) and near-significantly associated with the presence of pigment epithelium detachment (p=0.057) and choroidal neovascularisation subtypes (p=0.069). Our multivariate analysis confirmed the significance of lower baseline visual acuities (p=0.008) and pigment epithelium detachments higher than 200 µm (p=0.035). Furthermore, MA growth rates in neovascular eyes significantly correlated with MA growth rates in non-neovascular fellow eyes (n=61; p=0.003).ConclusionMA growth rates were associated with ocular factors in the study eyes and the fellow eyes but not with the drug or the number of injections within this variable dosing regimen.

Recovery from Depression: A Two-Year Follow-Up Study of General Population Subjects

2006 ◽  
Vol 52 (1) ◽  
pp. 19-28 ◽  
Author(s):  
Heimo Viinamäki ◽  
Antti Tanskanen ◽  
Kirsi Honkalampi ◽  
Heli Koivumaa-Honkanen ◽  
Risto Antikainen ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
General Population ◽  
Health Services ◽  
Life Events ◽  
Beck Depression Inventory ◽  
Factors Associated ◽  
Follow Up Study ◽  
Use Of Health Services

Background: The recovery from depression and factors associated with it are not well known in the general population. Aims: To conduct a two-year follow-up of general population subjects and investigate their recovery from depression. Methods: Individuals who were assessed as suffering from depression on the basis of Beck Depression Inventory (BDI) scores were monitored for two years. Results: Sixty-five per cent were still depressed after two years of follow-up. Negative life events had occurred more often in those who had remained depressed than in the others. Logistic regression analysis revealed that a high initial BDI score and a worsening of a subject's economic situation during the follow-up period were associated with failure to recover. Lack of use of health services was associated with non-recovery. Conclusion: Depression may be more chronic in the general population than previously has been thought.

scholarly journals Accurate and reproducible aortic growth rate mapping via registration of serial contrast-enhanced computed tomography angiograms

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
L Dux-Santoy ◽  
J F Rodriguez Palomares ◽  
G Teixido-Tura ◽  
A Ruiz-Munoz ◽  
G Casas ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Growth Rate ◽  
Image Registration ◽  
Thoracic Aorta ◽  
Growth Rates ◽  
Aortic Root ◽  
Clinical Management ◽  
Current Standard ◽  
Contrast Enhanced

Abstract Introduction Accurate assessment of aortic diameters and growth rates is key for clinical management of patients with aortic aneurysms [1]. Manual assessment on multiplanar reformatted views of computed tomography angiograms (CTA) is recommended [1], although its reproducibility in the assessment of growth rates has not been reported [2]. Image registration has been proposed to provide 3D maps of aortic diameters and growth [3], but its accuracy and reproducibility have not been established. Purpose To quantify accuracy and inter-observer reproducibility of aortic root and thoracic aorta diameters and growth rate by registration of serial CTAs compared to current standard. Methods Forty non-operated patients with ≥2 contrast-enhanced ECG-gated CTA acquired at least 6 months apart were included. Aortic diameters and growth rates were measured in the aortic root and thoracic aorta by two independent observers, both with the current standard and with the registration-based technique. To perform registration-based assessment, each observer semi-automatically segmented the aorta at baseline and located typical anatomical landmarks (Fig. 1A). Then, deformable image registration was used to map baseline and follow-up CT scans and deformation was applied to the baseline aortic surface points to obtain their location at follow-up (Fig. 1B). Finally, aortic root diameters and growth rate and 3D maps of thoracic aortic diameters and growth rate were automatically obtained (Fig. 1C). Agreement between techniques and their inter-observer reproducibility were calculated. Results Follow-up duration was 3.3±1.5 years (range 0.52–6.2). Compared with manual assessment, registration-based aortic diameters presented low bias and excellent agreement in the aortic root (0.42 mm, ICC=0.99) and the thoracic aorta (0.55 mm, ICC=0.99), and similar inter-observer reproducibility (ICC=0.99 for both). Compared with manual assessment, registration-based growth rates presented low bias and good agreement in the aortic root (0.12 mm/y, ICC=0.84) and the thoracic aorta (0.03 mm/y, ICC=0.77) (Fig. 2A), and much higher inter-observer reproducibility (ICC=0.96 vs 0.68 in the aortic root, ICC=0.96 vs 0.80 in the thoracic aorta) (Fig. 2B and C). Registration-based aortic growth rates reproducibility at 6 months follow-up was comparable to that obtained by manual assessment at 2.7 years (LoA = [−0.01, 0.33] and LoA = [−0.13, 0.21], respectively). Aortic diameters and growth rate 3D maps were highly reproducible (ICC&gt;0.9) in the whole thoracic aorta. Conclusions Progressive aortic dilation assessment via registration of CTAs is accurate and more reproducible than the current standard even over follow-ups as short as 6 months, and further provides robust 3D mapping of aortic diameters and growth rates. Its application may provide new insights in aneurysms pathophysiology and improve the clinical management of these patients. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This study has received funding from the Instituto de Salud Carlos III (PI17/00381). Guala A. has received funding from Spanish Ministry of Science, Innovation and Universities (IJC2018-037349-I). Figure 1. Methodology. Figure 2. Growth rate comparison.

P14.02 The Natural History of a Residual Intracranial Meningioma- Volumetric Growth and Predictors of Progression

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii38-ii38
Author(s):  
C S Gillespie ◽  
G E Richardson ◽  
M A Mustafa ◽  
A I Islim ◽  
S M Keshwara ◽  
...  
Keyword(s):  
Growth Rate ◽  
Prognostic Factors ◽  
Skull Base ◽  
Growth Rates ◽  
Multivariable Analysis ◽  
Volumetric Growth ◽  
Who Grade ◽  
Cox Regression Analysis ◽  
Base Location

Abstract BACKGROUND Resection of meningioma leaves residual solid tumour in ~25% of patients. Selection for further treatment and follow-up strategy may benefit from knowledge of volumetric growth and associated prognostic factors. MATERIAL AND METHODS Growth rates were assessed using a linear mixed effects model, in a retrospective adult cohort that underwent subtotal resection of meningioma (2004–2018). Endpoints were re-treatment, end of follow-up or death. Cox regression analysis was used to identify prognostic factors for progression, defined using the Response Assessment in Neuro-Oncology (RANO) volumetric criteria. RESULTS 236 patients were included. Mean age at surgery was 56.3 years (SD=13.7) and 73.7% were female. WHO grades were 1 (n=195, 82.6%), 2 (n=40, 16.9%) and 3 (n=1, 0.5%). Adjuvant fractionated radiotherapy (fRT) was administered to 34 patients (14.4%), with no propensity towards higher WHO grade or residual volume. Median pre-operative meningioma and post-operative residual volumes were 34.0cm3 (IQR 16.0–63.0) and 2.0cm3 (IQR 0.8–5.2), respectively. Median follow-up was 64 months (IQR 42–104). Median absolute growth rate (AGR) and relative growth rate (RGR) were 0.1cm3/year and 4.3%/year, respectively. According to RANO criteria, 132 (55.9%) patients progressed, of which 13 (9.8%) developed symptoms. Median progression-free survival was 56 months (95% CI 43.1–69.0). Multivariable analysis identified adjuvant fRT (HR 1.7, [95% CI 1.0–2.8], P=0.046), skull base location (HR 1.5, [95% CI 1.0–2.4], P=0.047) and Ki-67 index (HR 3.7 [95% CI 1.3–10.8], P=0.017) as prognostic factors for volumetric progression. WHO grade was not significant (HR 1.0, [95% CI 0.5–1.7], P=0.905). Forty-nine patients who progressed (37.1%) underwent further treatment: fRT (n=19), re-operation (n=15), Stereotactic radiosurgery (SRS) (n=10) and surgery+adjuvant fRT (n=5). Of those, 8 (16.3%) progressed further (after re-operation [n=6] and SRS [n=2]). Seven were treated with a 2nd re-operation (n=3), fRT (n=3), and SRS (n=1). One patient progressed after a 2nd reoperation and was treated with SRS, after which they remained stable. Median survival was not reached. 5- and 10-year overall survival (OS) was 96% and 86% respectively. CONCLUSION Growth rates of a residual meningioma vary with a dichotomy observed in progression rates. Half of patients with a residual meningioma showed radiological progression requiring multiple treatment to control the tumour. The other half demonstrate a more indolent course. Skull base location and higher Ki67 are important prognostic factors for progression and therefore, should be considered to stratify patients for adjuvant radiotherapy.

scholarly journals Ipsilateral Testicular Catch-Up Growth Rate Following Microsurgical Inguinal Adolescent Varicocelectomy

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Orhun Sinanoglu ◽  
Seyit Erkan Eyyupoglu ◽  
Sinan Ekici
Keyword(s):  
Growth Rate ◽  
Growth Rates ◽  
Testicular Function ◽  
Primary Method ◽  
Fertility Status ◽  
Future Fertility ◽  
Testicular Size ◽  
Catch Up ◽  
The Right

Objective. To evaluate the ipsilateral catch-up growth rates compared to contralateral testicular growth in adolescents with varicocele undergoing microsurgical inguinal varicocelectomy.Materials and Methods. Between December 2005 and May 2007, 39 adolescent patients with grade 2-3 varicocele admitted to our clinic with complaints of pain and/or testicular asymmetry were operated. Preoperative mean age was 14.5 ± 1.96 (9–17). Testicular volumes were assessed with ultrasound every 3 months. The available followup was 39 months.Results. In our series, mean testicular preoperative volumes were9.07±3.19 mL for the right and5.90±1.74 mL for the left. Mean testicular volumes at the end of follow up were13.97±3.42 mL for the right and12.20±4.05 mL for the left. The testicular catch-up growth approximately begins after the 9th month and significant catch-up occurred in the 12–24 months (P<0.05).Conclusion. Since testicular volume is the primary method of assessing testicular function in adolescents, testicular size can predict future fertility status significantly 9 months after surgical varicocele correction.

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