224 Malignancy associated pericardial effusion- do we need to drain them all?

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
C Ho ◽  
P H Lee ◽  
T C So ◽  
M C S Chiang ◽  
M H Wong ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Cancer Patients ◽  
Queen Elizabeth Hospital ◽  
Close Monitoring ◽  
Short Term ◽  
Pericardial Drainage ◽  
Significant Difference ◽  
Tamponade Effect

Abstract On Behalf Cardiac Team, Department of Medicine, Queen Elizabeth Hospital Background Management of significant pericardial effusion in cancer patients is controversial. These patients have poor prognosis, and avoiding unnecessary intervention is important. Close monitoring of symptoms and echocardiogram is often a reasonable option, but inherits risk of cardiac tamponade. Whether pericardial drainage by means of percutaneous pericardiocentesis or surgical pericardiotomy could prevent future deterioration or affect survival is unknown. Purpose To evaluate the benefit of elective pericardial drainage in malignancy associated pericardial effusion without echocardiographic or clinical evidence of tamponade effect. Methods From 1st Jul 2014 to 31st Dec 2017, all patients with new onset malignancy-associated pericardial effusion with size more than 1cm were retrospectively analyzed. Patients with clinical or echocardiographic evidence of cardiac tamponade were excluded. We compared pericardial drainage versus monitoring for short-term (30-day), mid-term (90-day) and long term (1 year) survival without need for drainage. Results 101 patients were retrospectively analyzed. 40 (39.6%) patients underwent drainage. Overall median survival free from drainage was 4 months. There were no significant difference in short-term (30-day), mid-term (90-day) and long term (1-year) survival free from drainage or mortality between treatment and monitoring group. Size of pericardial effusion did not predict mortality or future need of drainage. Chemotherapy was associated with improved 30-day mortality (RR 0.53 CI 0.32-0.87 p = 0.025) but not survival free from drainage or longer term mortality. Conclusion Close monitoring could be a feasible strategy in cancer patients with significant pericardial effusion without tamponade effect. Baseline characteristics Factor Drainage (n = 40) monitoring (n = 61) p-value method of drainage pericardiocentesis alone 17 NA pericardiotomy alone 13 both 10 Male 19 (47.5%) 27 (44.3%) 0.749 mean size (cm) 1.93 2.77 <0.001 mean age 60.9 63.1 0.357 on chemotherapy 27 (67.5%) 38 (62.3%) 0.593 Abstract 224 Figure. Survival free from drainage

Remnant pancreatic volume to predict short-term and long-term outcomes in patients with resected pancreatic cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15713-e15713
Author(s):  
Ryoichi Miyamoto ◽  
Yukio Oshiro ◽  
Nobuhiro Ohkohchi
Keyword(s):  
Pancreatic Cancer ◽  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Cancer Patients ◽  
Perioperative Outcomes ◽  
Long Term Outcomes ◽  
Short Term ◽  
Significant Difference ◽  
Pancreatic Volume

e15713 Background: Remnant pancreatic volume (RPV) is a well-known marker for short-term outcomes in patients with resectable pancreatic cancer. However, in terms of the long-term outcomes, the significance of the RPV remains unclear. Here, we addressed whether the RPV is a predictor of long-term outcomes in pancreatic cancer patients by comparing various cancer-, patient-, and surgery-related prognostic factors and systemic inflammatory response markers in a retrospective cohort. Methods: The RPV was measured on the 3D image, revealing the actual pancreatic parenchymal remnant volume. Ninety-one patients who underwent pancreaticoduodenectomy (PD) were retrospectively enrolled. We divided the cohort into high- and low-RPV groups based on a cut-off value ( > 35.5 cm3, n = 66 and ≤ 35.5 cm3, n = 25, respectively). The patient characteristics, perioperative outcomes and median survival times (MSTs) were respectively compared between the two groups. Using multivariate analysis, the RPV and other well-known prognostic factors were independently assessed. Results: A significant difference in the RPV value was observed with respect to the incidence of postoperative pancreatic fistula (high, 18 [55%] vs. low, 9 [16%], p < 0.001). The MSTs (days) were significantly different between the two groups (high, 823 vs. low, 482, p = 0.001). Multivariate analysis identified the RPV (≤ 31.5 cm3) (hazard ratio [HR], 2.015; p = 0.011), lymph node metastasis (HR, 8.415; p = 0.002), adjuvant chemotherapy (HR, 5.352; p < 0.001), presence of stage III/IV disease (HR, 2.352; p = 0.029), and pathological fibrosis (HR, 1.771; p = 0.031) as independent prognostic factors. Conclusions: The present study suggests that the RPV is an additional useful predictor of both long-term and short-term outcomes in pancreatic cancer patients after PD.

scholarly journals Efficacy of Short-Term Oral Prednisolone Treatment in the Management of Pericardial Effusion Following Pediatric Cardiac Surgery

2021 ◽  
Author(s):  
Masahiro Mizumoto ◽  
Naoki Masaki ◽  
Sadahiro Sai
Keyword(s):  
Cardiac Surgery ◽  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Oral Prednisolone ◽  
Pediatric Cardiac Surgery ◽  
Postoperative Treatment ◽  
Maximum Diameter ◽  
Short Term ◽  
Pericardial Drainage ◽  
Prednisolone Treatment

AbstractA standard treatment for pericardial effusion without cardiac tamponade after pediatric cardiac surgery has not been established. We evaluated the efficacy of short-term oral prednisolone administration, which is the initial treatment for postoperative pericardial effusion without cardiac tamponade at our institution. Between October 2008 and March 2020, 1429 pediatric cardiac surgeries were performed at our institution. 91 patients required postoperative treatment for pericardial effusion. 81 were treated with short-term oral prednisolone. Pericardial effusion was evaluated using serial echocardiography during diastole. Pericardial drainage was performed for patients with circumferential pericardial effusion with a maximum diameter of ≥ 10 mm or signs of cardiac tamponade. Short-term oral prednisolone treatment was administered to patients with circumferential pericardial effusion with a maximum diameter of < 10 mm or localized pericardial effusion with a maximum diameter of ≥ 5 mm. Patients with localized pericardial effusion with a maximum diameter of < 5 mm were observed. Prednisolone (2 mg/kg/day) was administered orally for 3 days, added as needed. Short-term oral prednisolone treatment was effective in 71 cases and 90% of patients were regarded as responders. The remaining patients were deemed non-responders who required pericardial drainage. Overall, 55 responders were deemed early responders whose pericardial effusion disappeared within 3 days. There were no cases of deaths, infections, or recurrence of pericardial effusion. The amount of drainage fluid on the day of surgery was higher in the non-responders. In conclusion, short-term oral prednisolone treatment is effective and safe for treating pericardial effusion without cardiac tamponade after pediatric cardiac surgery.

scholarly journals Gut microbiome diversity is an independent predictor of survival in cervical cancer patients receiving chemoradiation

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Travis T. Sims ◽  
Molly B. El Alam ◽  
Tatiana V. Karpinets ◽  
Stephanie Dorta-Estremera ◽  
Venkatesh L. Hegde ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Gut Microbiota ◽  
Cancer Patients ◽  
Gut Microbiome ◽  
Compositional Variation ◽  
Short Term ◽  
Microbiome Diversity ◽  
Term Survivor

AbstractDiversity of the gut microbiome is associated with higher response rates for cancer patients receiving immunotherapy but has not been investigated in patients receiving radiation therapy. Additionally, current studies investigating the gut microbiome and outcomes in cancer patients may not have adjusted for established risk factors. Here, we sought to determine if diversity and composition of the gut microbiome was independently associated with survival in cervical cancer patients receiving chemoradiation. Our study demonstrates that the diversity of gut microbiota is associated with a favorable response to chemoradiation. Additionally, compositional variation among patients correlated with short term and long-term survival. Short term survivor fecal samples were significantly enriched in Porphyromonas, Porphyromonadaceae, and Dialister, whereas long term survivor samples were significantly enriched in Escherichia Shigella, Enterobacteriaceae, and Enterobacteriales. Moreover, analysis of immune cells from cervical tumor brush samples by flow cytometry revealed that patients with a high microbiome diversity had increased tumor infiltration of CD4+ lymphocytes as well as activated subsets of CD4 cells expressing ki67+ and CD69+ over the course of radiation therapy. Modulation of the gut microbiota before chemoradiation might provide an alternative way to enhance treatment efficacy and improve treatment outcomes in cervical cancer patients.

scholarly journals Combined Androgen Blockade in Localized Prostate Cancer Treated With Definitive Radiation Therapy

2019 ◽  
Vol 17 (12) ◽  
pp. 1497-1504
Author(s):  
Lucas K. Vitzthum ◽  
Chris Straka ◽  
Reith R. Sarkar ◽  
Rana McKay ◽  
J. Michael Randall ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
High Risk ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Short Term ◽  
Combined Androgen Blockade ◽  
Significant Difference ◽  
Androgen Blockade

Background: The addition of androgen deprivation therapy to radiation therapy (RT) improves survival in patients with intermediate- and high-risk prostate cancer (PCa), but it is not known whether combined androgen blockade (CAB) with a gonadotropin-releasing hormone agonist (GnRH-A) and a nonsteroidal antiandrogen improves survival over GnRH-A monotherapy. Methods: This study evaluated patients with intermediate- and high-risk PCa diagnosed in 2001 through 2015 who underwent RT with either GnRH-A alone or CAB using the Veterans Affairs Informatics and Computing Infrastructure. Associations between CAB and prostate cancer–specific mortality (PCSM) and overall survival (OS) were determined using multivariable regression with Fine-Gray and multivariable Cox proportional hazards models, respectively. For a positive control, the effect of long-term versus short-term GnRH-A therapy was tested. Results: The cohort included 8,423 men (GnRH-A, 4,529; CAB, 3,894) with a median follow-up of 5.9 years. There were 1,861 deaths, including 349 resulting from PCa. The unadjusted cumulative incidences of PCSM at 10 years were 5.9% and 6.9% for those receiving GnRH-A and CAB, respectively (P=.16). Compared with GnRH-A alone, CAB was not associated with a significant difference in covariate-adjusted PCSM (subdistribution hazard ratio [SHR], 1.05; 95% CI, 0.85–1.30) or OS (hazard ratio, 1.02; 95% CI, 0.93–1.12). For high-risk patients, long-term versus short-term GnRH-A therapy was associated with improved PCSM (SHR, 0.74; 95% CI, 0.57–0.95) and OS (SHR, 0.82; 95% CI, 0.73–0.93). Conclusions: In men receiving definitive RT for intermediate- or high-risk PCa, CAB was not associated with improved PCSM or OS compared with GnRH alone.

scholarly journals Can a simple, short-term memory task help to screen dyslexia?

2019 ◽  
Author(s):  
Nick Perham ◽  
Toni Howell ◽  
Andy Watt
Keyword(s):  
High Frequency ◽  
Short Term Memory ◽  
Memory Task ◽  
Compulsory Education ◽  
Low Frequency ◽  
Short Term ◽  
Term Order ◽  
Significant Difference ◽  
Support Students

AbstractFunding to support students with dyslexia in post-compulsory education is under pressure and more efficient assessments may offset some of this shortfall. We tested potential tasks for screening dyslexia: recall of adjective-noun, compared to noun-adjective, pairings (syntax) and recall of high versus low frequency letter pairings (bigrams). Students who reported themselves as dyslexic failed to show a normal syntax effect (greater recall of adjective-noun compared to noun-adjective pairings) and no significant difference in recall between the two types of bigrams whereas students who were not dyslexic showed the syntax effect and a bias towards recalling high frequency bigrams. Findings are consistent with recent explanations of dyslexia suggesting that those affected find it difficult to learn and utilise sequential long-term order information (Szmalec et al. Journal of Experimental Psychology: Learning, Memory & Cognition, 37(5) ,1270-1279, 2011). Further, ROC curve analyses revealed both tasks showed acceptable diagnostic properties as they were able to discriminate between the two groups of participants.

Does meloxicam provide adequate pain management as a post-operative analgesic in canine ovariohysterectomy patients?

2020 ◽  
Vol 11 (4) ◽  
pp. 192-197
Author(s):  
Gavin Goldsbrough ◽  
Helen Reynolds
Keyword(s):  
Pain Management ◽  
Pain Score ◽  
Pain Scale ◽  
Short Term ◽  
Post Surgery ◽  
Pain Scores ◽  
Significant Difference ◽  
Time Frames ◽  
Adequate Pain Management

Background: Meloxicam is an analgesic agent with anti-inflammatory properties, commonly used in veterinary practices to treat a variety of different long-term medical conditions and is also used as a short-term pain relief following particularly traumatic surgeries. Aims: An observational study was conducted to determine whether meloxicam provides adequate pain management as a post-operative analgesic for canine ovariohysterectomies. Methods: 13 canines were admitted for ovariohysterectomy. Each patient was assessed using the Glasgow composite pain scale (CMPS) prior to surgery during the admission procedure, 15 minutes post-operatively, at discharge and at their post-operative check (POC) 3–5 days after surgery. Results: Data were statistically analysed to determine the overall effectiveness of meloxicam in reducing pain following canine ovariohysterectomy. The results showed a statistically significant difference (Kruskal-Wallis test: H3 =12.98, p=0.005) in pain scores between admission, 15 minutes post operatively, discharge and 3–5 days POC. The greatest decrease in pain score was between 15 minutes post-operatively and POC (Mann-Whitney U test: W=236, n=13, 13, p=0.0014) and between discharge and POC (Mann-Whitney U test: W=227, n=13, 13, p=0.0060). Overall, this demonstrated that there was an improvement in pain suggesting meloxicam is effective between these time frames. In addition, 69.2% (n=9) of patients in the study showed a pain score of 0, indicating an absence of pain, on their final POC. Statistical analysis was also used to determine if there was any difference in pain score between the 3, 4 or 5 day POC pain score. The results show there was no significant difference (Kruskal-Wallis test: H2 =0.090, p=0.638) suggesting that meloxicam's effectiveness was similar across this range of time post surgery. Conclusion: The results from the study indicate that meloxicam is an effective post-operative analgesic for canine patients undergoing an ovariohysterectomy.

Postoperative hemorrhage during the acute phase after direct or combined revascularization for moyamoya disease: risk factors, prognosis, and literature review

2020 ◽  
Vol 133 (5) ◽  
pp. 1450-1459
Author(s):  
Yu Chen ◽  
Li Ma ◽  
Junlin Lu ◽  
Xiaolin Chen ◽  
Xun Ye ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Phase ◽  
Moyamoya Disease ◽  
Disease Risk ◽  
Propensity Score Analysis ◽  
Postoperative Hemorrhage ◽  
Posterior Circulation ◽  
Short Term ◽  
Significant Difference

OBJECTIVEPostoperative hemorrhage during the acute phase is rarely observed after revascularization surgery for moyamoya disease (MMD) but can have severe complications. Its risk factors and outcomes are still unclear. The aim of this study was to investigate the predictors of postoperative hemorrhage during the acute phase in MMD and examine the outcomes of the hemorrhage.METHODSThe authors reviewed the preoperative clinical characteristics and radiographic features of 465 consecutive MMD cases (518 procedures) that had undergone direct or combined bypass surgery at their institution between 2009 and 2015. Patients with postoperative intracerebral hemorrhage (ICH) or ICH plus intraventricular hemorrhage (IVH) during the acute phase were screened, and then the incidence, location, and risk factors of hemorrhage in these patients were analyzed. Short-term and long-term outcomes (modified Rankin Scale scores) for these patients were also collected. Outcomes were compared between patients with and those without postoperative ICH using propensity score analysis to reduce the between-group differences in baseline characteristics.RESULTSPostoperative hemorrhage occurred in 11 (2.1%; ICH = 9, IVH = 2) of 518 procedures (mean patient age 39.82 ± 8.8 years). Hemorrhage occurred in the first 24 hours after the operation in 8 cases (72.7%). In the ICH group, most of the hemorrhage sites (77.8%) were located beneath the anastomosed area, and the mean hematoma volume was 16.98 ± 22.45 ml (range 3–57 ml). One case from the ICH group required hematoma evacuation. Among the adult patients (463 procedures [89.4%]), preoperative hypertension (p = 0.008), CT perfusion (CTP) stage > III (p = 0.013), and posterior circulation involvement (p = 0.022) were significantly associated with postoperative ICH. No significant differences between the postoperative ICH group and the no-hemorrhage group were detected in terms of postoperative neurofunctional status at discharge (p = 0.569) or at the last follow-up (p = 1.000). Neither was there a significant difference in future stroke risk (p = 0.538) between these two groups.CONCLUSIONSPreoperative hypertension, CTP stage > III, and posterior circulation involvement are independent risk factors for postoperative ICH after direct or combined revascularization for MMD. After appropriate perioperative management, postoperative ICH has no significant correlations with the postoperative short-term and long-term neurofunctional status.

Early clinical results of minimally invasive coracoclavicular ligament reconstruction can be maintained at a minimum of five years’ follow-up

2020 ◽  
Vol 102-B (7) ◽  
pp. 918-924
Author(s):  
Steffen B. Rosslenbroich ◽  
Katharina Heimann ◽  
Jan Christoph Katthagen ◽  
Clemens Koesters ◽  
Oliver Riesenbeck ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Constant Score ◽  
Clinical Results ◽  
Long Term Results ◽  
Short Term ◽  
Ac Joint ◽  
Ac Joint Dislocation ◽  
Significant Difference

Aims There is a lack of long-term data for minimally invasive acromioclavicular (AC) joint repair. Furthermore, it is not clear if good early clinical results can be maintained over time. The purpose of this study was to report long-term results of minimally invasive AC joint reconstruction (MINAR) and compare it to corresponding short-term data. Methods We assessed patients with a follow-up of at least five years after minimally invasive flip-button repair for high-grade AC joint dislocation. The clinical outcome was evaluated using the Constant score and a questionnaire. Ultrasound determined the coracoclavicular (CC) distance. Results of the current follow-up were compared to the short-term results of the same cohort. Results A total of 50 patients (three females, 47 males) were successfully followed up for a minimum of five years. The mean follow-up was 7.7 years (63 months to 132 months). The overall Constant score was 94.4 points (54 to 100) versus 97.7 points (83 to 100) for the contralateral side showing a significant difference for the operated shoulder (p = 0.013) The mean difference in the CC distance between the operated and the contralateral shoulder was 3.7 mm (0.2 to 7.8; p = 0.010). In total, 16% (n = 8) of patients showed recurrent instability. All these cases were performed within the first 16 months after introduction of this technique. A total of 84% (n = 42) of the patients were able to return to their previous occupations and sport activities. Comparison of short-term and long-term results revealed no significant difference for the Constant Score (p = 0.348) and the CC distance (p = 0.974). Conclusion The clinical outcome of MINAR is good to excellent after long-term follow-up and no significant differences were found compared to short-term results. We therefore suggest this is a reliable technique for surgical treatment of high-grade AC joint dislocation. Cite this article: Bone Joint J 2020;102-B(7):918–924.

Percutaneous Tracheostomy under Bronchoscopic Visualization Does Not Affect Short-Term or Long-Term Complications

2017 ◽  
Vol 83 (7) ◽  
pp. 696-698 ◽  
Author(s):  
Thomas S. Easterday ◽  
Joshuaw Moore ◽  
Meredith H. Redden ◽  
David V. Feliciano ◽  
Vernon J. Henderson ◽  
...  
Keyword(s):  
Trauma Registry ◽  
Percutaneous Tracheostomy ◽  
Trauma Patients ◽  
Complication Rates ◽  
Short Term ◽  
Significant Difference ◽  
Urban Level ◽  
Level I ◽  
Bronchoscopic Guidance

Percutaneous tracheostomy is a safe and effective bedside procedure. Some advocate the use of bronchoscopy during the procedure to reduce the rate of complications. We evaluated our complication rate in trauma patients undergoing percutaneous tracheostomy with and without bronchoscopic guidance to ascertain if there was a difference in the rate of complications. A retrospective review of all tracheostomies performed in critically ill trauma patients was performed using the trauma registry from an urban, Level I Trauma Center. Bronchoscopy assistance was used based on surgeon preference. Standard statistical methodology was used to determine if there was a difference in complication rates for procedures performed with and without the bronchoscope. From January 2007, to April 2016, 649 patients underwent modified percuteaneous tracheostomy; 289 with the aid of a bronchoscope and 360 without. There were no statistically significant differences in any type of complication regardless of utilization of a bronchoscope. The addition of bronchoscopy provides several theoretical benefits when performing percutaneous tracheostomy. Our findings, however, do not demonstrate a statistically significant difference in complications between procedures performed with and without a bronchoscope. Use of the bronchoscope should, therefore, be left to the discretion of the performing physician.

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