Postoperative de novo epilepsy after craniotomy: a nationwide register-based cohort study

Background and objectivesThe risks of postoperative risk of epilepsy after a craniotomy is widely believed to be raised. A study is warranted to quantify the risks for any neurosurgical indication. In this unselected register-based nationwide cohort study with virtually complete follow-up, the short-term and long-term cumulative risks of postoperative de novo epilepsy for all major neurosurgical indications were estimated.MethodsThe study was based on 8948 first-time craniotomy patients in Denmark 1 January 2005 to 31 December 2015 with follow-up until 31 December 2016. The patients were classified according to their underlying neurosurgical pathology. Patients with preoperative epilepsy were excluded. The postcraniotomy risks of de novo epilepsy were estimated using the Aalen-Johansen estimator in a multistate model.ResultsThe overall cumulative 1-year risk of postcraniotomy de novo epilepsy was 13.9% (95% CI 13.2 to 14.6). For patients with intracranial tumour the cumulative 1-year risk was 15.4% (95% CI 14.4 to 16.5), for spontaneous intracranial haemorrhage 11.3% (95% CI 10.1 to 12.6), for traumatic intracranial haemorrhage 11.1% (95% CI 9.6 to 12.9), for cerebral abscess 27.6% (95% CI 22.8 to 33.5) and for congenital malformations 3.8% (95% CI 1.3 to 11.7). The 6-month, 1-year and 5-year risks for all major indications by specific subtypes are provided.ConclusionsThe cumulative risk of de novo epilepsy following craniotomy is high for patients with any indication for craniotomy, as compared with the background population. The results provide comprehensive data to support future recommendations regarding prophylactic antiepileptic treatment and driving restrictions.

Download Full-text

Cancer Development and Mortality Differences in Patients with Glomerulonephritis after Renal Biopsy: A Single Center Retrospective Cohort Study

10.21203/rs.3.rs-19316/v1 ◽

2020 ◽

Author(s):

Hyunjin Ryu ◽

Kipyo Kim ◽

Jiwon Ryu ◽

Hyung-Eun Son ◽

Ji-Young Ryu ◽

...

Keyword(s):

Cohort Study ◽

Renal Biopsy ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Clinical Characteristics ◽

De Novo ◽

Hazard Ratio ◽

Cancer Development ◽

De Novo Cancer

Abstract Background: The association between glomerulonephritis (GN) and cancer has been well known for decades. However, studies evaluating long-term de novo cancer development in patients with GN are limited. This study aimed to evaluate the incidence of cancer development among patients with renal biopsy-proven GN during post-biopsy follow-up and the differences in outcomes according to cancer occurrence. Methods: We conducted a retrospective cohort study of adult patients who underwent renal biopsy at Seoul National Bundang Hospital between 2003 and 2017. After excluding 671 patients who are inappropriate for the analysis, 929 patients were included in the analysis. Data on baseline clinical characteristics, renal biopsy results, and types and doses of immunosuppressant agents used during follow-up were collected from electronic medical records. The incidence of cancer was censored on the date when the first cancer was diagnosed. We evaluated rates of mortality and end-stage renal disease (ESRD) development during follow-up. Results: During a mean follow-up period of 52.4 (range: 1.0–166.7) months, 49 subjects (5.3%) developed de novo cancer. A comparison of clinical characteristics between subjects who did and did not develop cancer revealed that cancer patients were older and had higher comorbidities and immunosuppressant use. Overall, patients with GN had an elevated standardized incidence ratio (SIR) of 7.17 (95% confidence interval (CI): 5.3–9.51) relative to the general population. In particular, the SIR was significantly higher in GNs such as membranous nephropathy (MN), IgA nephropathy, lupus nephritis, and focal segmental glomerulosclerosis. Multivariable Cox proportional hazard model adjusted for confounding variables revealed that patients with a pathologic diagnosis of MN had an increased risk of cancer development, with a hazard ratio of 2.6 [95% CI: 1.32–5.30]. Patients with MN who developed cancer had a significantly higher risk of mortality (hazard ratio: 5.95; 95% CI: 1.36–26.09, P=0.018) than those without cancer, but there was a non-significant difference in ESRD development. Conclusions: Patients with GN without concurrent cancer, particularly those with MN, have significantly higher risks of cancer development and subsequent mortality and should remain aware of the potential development of malignancy during follow-up.

Download Full-text

One-year outcomes in a multicentre cohort study of incident rare diffuse parenchymal lung disease in children (ChILD)

Thorax ◽

10.1136/thoraxjnl-2019-213217 ◽

2019 ◽

Vol 75 (2) ◽

pp. 172-175 ◽

Cited By ~ 3

Author(s):

Steve Cunningham ◽

Catriona Graham ◽

Morag MacLean ◽

Paul Aurora ◽

Michael Ashworth ◽

...

Keyword(s):

Cohort Study ◽

Lung Disease ◽

Low Oxygen ◽

Child Survivors ◽

Diffuse Parenchymal Lung Disease ◽

Multicentre Cohort Study ◽

Observational Cohort ◽

One Year ◽

First Time

We performed a prospective, observational, cohort study of children newly diagnosed with children’s interstitial lung disease (ChILD), with structured follow-up at 4, 8, 12 weeks and 6 and 12 months. 127 children, median age 0.9 (IQR 0.3–7.9) years had dyspnoea (68%, 69/102), tachypnoea (75%, 77/103) and low oxygen saturation (SpO2) median 92% (IQR 88–96). Death (n=20, 16%) was the most common in those <6 months of age with SpO2<94% and developmental/surfactant disorders. We report for the first time that ChILD survivors improved multiple clinical parameters within 8–12 weeks of diagnosis. These data can inform family discussions and support clinical trial measurements.

Download Full-text

P246 Long-term prognosis of ulcerative colitis and its temporal changes between 1986 and 2015 in a population-based cohort in the Songpa-Kangdong district of Seoul, Korea

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.375 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S271-S271

Author(s):

J M Cha ◽

S H Park ◽

K H Rhee ◽

S N Hong ◽

Y H Kim ◽

...

Keyword(s):

Ulcerative Colitis ◽

Cox Regression ◽

Cumulative Risk ◽

Population Based ◽

Natural Course ◽

Cox Regression Analysis ◽

Mortality Ratio ◽

Cumulative Risks

Abstract Background No population-based study has evaluated the natural course of ulcerative colitis (UC) over three decades in non-Caucasians. We aimed to assess the long-term natural course of Korean patients with UC in a population-based cohort. Methods This Korean population-based SK-IBD cohort included all patients (N = 1013) newly diagnosed with UC during 1986–2015. Disease outcomes and their predictors were evaluated. Results During the median follow-up of 105 months, the overall use of systemic corticosteroids, thiopurines, and anti-tumour necrosis factor (TNF) agents was 40.8%, 13.9%, and 6.5%, respectively. Over time, the cumulative risk of commencing corticosteroids decreased, whereas that of commencing thiopurines and anti-TNF agents increased. During follow-up, 28.7% of 778 patients with proctitis or left-sided colitis at diagnosis experienced proximal disease extension. A total of 28 patients (2.8%) underwent colectomy, demonstrating cumulative risks of colectomy at 1, 5, 10, 20, and 30 years after diagnosis of 1.0%, 1.9%, 2.2%, 5.1%, and 6.4%, respectively. Multivariate Cox regression analysis revealed that extensive colitis at diagnosis (hazard ratio [HR] 8.249, 95% confidence interval [CI] 2.394–28.430), ever use of corticosteroids (HR 6.437, 95% CI 1.440–28.773), and diagnosis in the anti-TNF era (HR 0.224, 95% CI 0.057–0.886) were independent predictors of colectomy. The standardised mortality ratio in UC patients was 0.725 (95% CI 0.508–1.004). Conclusion Korean UC patients may have a better clinical course than Western patients, as indicated by a lower colectomy rate. The overall colectomy rate has continued to decrease over the past three decades.

Download Full-text

Magnetic Resonance Evolution of De Novo Formation of a Cavernoma in a Thrombosed Developmental Venous Anomaly

Neurosurgery ◽

10.1227/neu.0000000000000002 ◽

2013 ◽

Vol 73 (4) ◽

pp. E739-E745 ◽

Cited By ~ 9

Author(s):

I-Chang Su ◽

Pradeep Krishnan ◽

Sapna Rawal ◽

Timo Krings

Keyword(s):

Magnetic Resonance ◽

Clinical Presentation ◽

De Novo ◽

Developmental Venous Anomaly ◽

Venous Anomaly ◽

Unique Case ◽

Causative Relationship ◽

Salt And Pepper ◽

First Time

Abstract BACKGROUND AND IMPORTANCE: Mechanisms that lead to de novo formations of nonfamilial-type cavernomas are not well understood. One of the interesting hypotheses is the causative relationship between developmental venous anomaly (DVA) and cavernoma formation. We report a unique case in which serial imaging demonstrated the evolution of de novo formation of a cavernoma in association with a thrombosed DVA. A detailed review of the causal hypothesis between a DVA and cavernoma is also provided. CLINICAL PRESENTATION: We report a 37-year-old female patient in whom a cavernoma-like lesion arose 1 year after the progressive thrombosis of a medullary (or caput medusa) vein of a DVA. The presence of an acute angulation in the draining vein may have prompted an intrinsic outflow restriction. Possible worsening of venous disequilibrium led to subsequent thrombus progression, venous congestion, and occlusion of the vein with venous dilation and signs of stasis on follow-up magnetic resonance imaging. Finally, this developed into a lobulated lesion with salt-and-pepper appearance at the converging region of medullary tributaries, which typified the classic features of a cavernoma. CONCLUSION: Compared with other published cases of de novo cavernoma formation in relation to a DVA, our case, for the first time, allows us to witness the temporal evolution from a thrombosed DVA to the birth of a cavernoma around it. This supports the hypothesis that the cavernoma can be an acquired disease that arises from a DVA.

Download Full-text

Breast cancer risk in hyperprolactinemia: a population-based cohort study and meta-analysis of the literature

Acta Endocrinologica ◽

10.1530/eje-15-0282 ◽

2015 ◽

Vol 173 (2) ◽

pp. 269-273 ◽

Cited By ~ 9

Author(s):

O M Dekkers ◽

V Ehrenstein ◽

M Bengtsen ◽

D Kormendine Farkas ◽

A M Pereira ◽

...

Keyword(s):

Breast Cancer ◽

Cohort Study ◽

Meta Analysis ◽

Population Based ◽

Incidence Rates ◽

Increased Risk ◽

Combining Data ◽

First Time ◽

Time Diagnosis

ObjectiveTo enhance the precision of the risk estimate for breast cancer in hyperprolactinemia patients by collecting more data and pooling our results with available data from former studies in a meta-analysis.DesignPopulation-based cohort study and meta-analysis of the literature.MethodsUsing nationwide registries, we identified all patients with a first-time diagnosis of hyperprolactinemia during 1994–2012 including those with a new breast cancer diagnoses after the start of follow-up. We calculated standardised incidence ratios (SIRs) as a measure of relative risk (RR) using national cancer incidence rates. We performed a meta-analysis, combining data from our study with data in the existing literature.ResultsWe identified 2457 patients with hyperprolactinemia and 20 breast cancer cases during 19 411 person-years of follow-up, yielding a SIR of 0.99 (95% CI 0.60–1.52). Data from two additional cohort studies were retrieved and analyzed. When the three risk estimates were pooled, the combined RR was 1.04 (95% CI 0.75–1.43).ConclusionsWe found no increased risk of breast cancer among patients with hyperprolactinemia.

Download Full-text

Follow up colonoscopy may be omissible in uncomplicated left-sided acute diverticulitis diagnosed with CT- a retrospective cohort study

Scientific Reports ◽

10.1038/s41598-019-56641-2 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Nollaig O’Donohoe ◽

Pankaj Chandak ◽

Marina Likos-Corbett ◽

Janelle Yee ◽

Katherine Hurndall ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Acute Diverticulitis ◽

Low Grade ◽

Hyperplastic Polyps ◽

Single Centre ◽

Advanced Adenomas ◽

First Time

AbstractInternational guidelines recommend colonoscopy following hospitalisation for acute diverticulitis. There is a paucity of evidence supporting the efficacy of colonoscopy in this context, particularly for patients with CT-diagnosed uncomplicated left-sided diverticulitis. This study aims to investigate the frequency that colorectal cancer (CRC) and advanced adenomas (AA) are identified during follow-up colonoscopy after hospitalisation with CT-proven left-sided diverticulitis for the first time in a UK population. In this single-centre retrospective-cohort study all patients presenting with CT-diagnosed uncomplicated left-sided diverticulitis between 2014 and 2017 were identified. The incidence of histologically confirmed CRC and AA identified at follow-up colonoscopy 4–6 weeks following discharge was assessed. 204 patients with CT proven uncomplicated left-sided diverticulitis underwent follow-up colonoscopy. 72% were female and the median age was 63 years. There were no major complications. 22% of patients were found to have incidental hyperplastic polyps or adenomas with low-grade dysplasia. No CRC or AA were found. Routine colonoscopy following acute diverticulitis in this cohort did not identify a single CRC or AA and could arguably have been omitted. This would significantly reduce cost and pressure on endoscopy departments, in addition to the pain and discomfort that is commonly associated with colonoscopy.

Download Full-text

Prevalence of coronary artery calcification in a non-specific chest pain population in emergency and cardiology departments compared with the background population: a prospective cohort study in Southern Denmark with 12-month follow-up of cardiac endpoints

BMJ Open ◽

10.1136/bmjopen-2017-018391 ◽

2018 ◽

Vol 8 (3) ◽

pp. e018391 ◽

Cited By ~ 2

Author(s):

Nivethitha Ilangkovan ◽

Christian Backer Mogensen ◽

Hans Mickley ◽

Annmarie Touborg Lassen ◽

Jess Lambrechtsen ◽

...

Keyword(s):

Cohort Study ◽

Chest Pain ◽

Coronary Artery ◽

Coronary Artery Calcification ◽

Cardiac Events ◽

Background Population ◽

Significant Difference ◽

Registration Number ◽

Double Blinded

ObjectivesTo examine and compare the prevalence of coronary artery calcification (CAC) and the frequency of cardiac events in a background population and a cohort of patients with non-specific chest pain (NSCP) who present to an emergency or cardiology department and are discharged without an obvious reason for their symptom.DesignA double-blinded, prospective, observational cohort study that measures both CT-determined CAC scores and cardiac events after 1 year of follow-up.SettingEmergency and cardiology departments in the Region of Southern Denmark.SubjectsIn total, 229 patients with NSCP were compared with 722 patients from a background comparator population.Main outcomes measuresPrevalence of CAC and incidence of unstable angina (UAP), acute myocardial infarction (MI), ventricular tachycardia (VT), coronary revascularisation and cardiac-related mortality 1 year after index contact.ResultsThere was no significant difference in the prevalence of CAC (OR 0.9 (95% CI 0.6 to 1.3), P=0.546) or the frequency of cardiac endpoints (P=0.64) between the studied groups. When compared with the background population, the OR for patients with NSCP for a CAC >100 Agatston units (AU) was 1.0 (95% CI 0.6 to 1.5), P=0.826. During 1 year of follow-up, two (0.9%) patients with NSCP underwent cardiac revascularisation, while none experienced UAP, MI, VT or death. In the background population, four (0.6%) participants experienced a clinical cardiac endpoint; two had an MI, one had VT and one had a cardiac-related death.ConclusionThe prevalence of CAC (CAC >0 AU) among patients with NSCP is comparable to a background population and there is a low risk of a cardiac event in the first year after discharge. A CAC study does not provide notable clinical utility for risk-stratifying patients with NSCP.Trial registration numberNCT02422316; Pre-results.

Download Full-text

Digital dermoscopic changes during follow‐up of de‐novo and nevus‐associated melanoma: a cohort study

International Journal of Dermatology ◽

10.1111/ijd.14918 ◽

2020 ◽

Vol 59 (7) ◽

pp. 813-821

Author(s):

Riccardo Pampena ◽

Valeria Manfreda ◽

Athanassios Kyrgidis ◽

Michela Lai ◽

Stefania Borsari ◽

...

Keyword(s):

Cohort Study ◽

De Novo

Download Full-text

P659 The impact of total colectomy on the course of extraintestinal manifestations in Swiss IBD cohort study patients

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.787 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S543-S544

Author(s):

R Roth ◽

S Vavrick ◽

M Scharl ◽

P Schreiner ◽

T Greuter ◽

...

Keyword(s):

Cohort Study ◽

Disease Burden ◽

De Novo ◽

Extraintestinal Manifestations ◽

Course Of Disease ◽

Complete Cessation ◽

Number Of Patients ◽

Using Data ◽

The Impact

Abstract Background Extraintestinal manifestations (EIM) are reported to occur in a highly variable frequency of between 6% and up to 47% of patient with IBD during the course of disease and may substantially contribute to the overall disease burden. Little is known on the impact of colectomy in UC or CD patients on the course of EIM, neither regarding pre-existing vs. de novo EIM occurring after colectomy nor regarding potential differences between EIM typically known to follow a parallel vs. independent course of activity to disease activity of underlying IBD. Methods Using data from the Swiss IBD Cohort Study (SIBDCS) we aimed to analyze the course of EIM in UC and CD patients undergoing colectomy during the prospective SIBDCS follow-up. Results Amongst a total of 3620 IBD patients (53.6% CD, 42.8% UC, 3.6% IBD unclassified), 115 IBD patients (33 CD and 82 UC) underwent colectomy. One or more EIM had been present at any time antecedent to colectomy in 35.7% of these patients (27.3% and 39% in CD and UC patients, respectively). Within the 115 IBD patients undergoing colectomy any EIM was present only before colectomy in 21 patients (18.3% of all patients undergoing colectomy), i.e. entirely ceased thereafter in 51.2% of patients with any EIM prior to colectomy. After colectomy, overall 30 out of the 115 patients (26.1%) suffered from any EIM after colectomy. Out of these, two thirds (20 patients) already had any EIM prior to colectomy, while in one third (10 patients) occurrence of EIM represented a de-novo event after colectomy. Overall, amongst all patient with no EIM prior to undergoing colectomy 13.5% of patients developed a de-novo EIM after colectomy. The fraction of patients with complete cessation of EIM after colectomy was numerically higher in patients with UC vs. CD with 56.3% vs. 33.3% of patients with EIM prior to colectomy, respectively (51.2% in IBD patients overall). An overview over the frequency of EIM overall and individual EIM is provided in Figure 1. Conclusion In IBD patients with undergoing colectomy, any EIM present prior to surgical intervention will persist in about half of patients. Although our results are based on a limited number of patients our findings indicate, that complete cessation of EIM after colectomy may be less common in CD than in UC patients. Absence of EIM prior to colectomy does not equal freedom from any EIM thereafter as up to one in seven IBD patients may develop de-novo EIM after colectomy.

Download Full-text

Surgery for trapeziometacarpal osteoarthritis in relation to cumulative occupational hand force requirements: a Danish nationwide cohort study

Occupational and Environmental Medicine ◽

10.1136/oemed-2020-106654 ◽

2020 ◽

pp. oemed-2020-106654

Author(s):

Lone Kirkeby ◽

Susanne Wulff Svendsen ◽

Torben Bæk Hansen ◽

Poul Frost

Keyword(s):

Cohort Study ◽

Time Windows ◽

Cumulative Exposure ◽

Hazard Rates ◽

Job Exposure Matrix ◽

Trapeziometacarpal Osteoarthritis ◽

Hand Force ◽

Surgery Rates ◽

First Time

ObjectivesTo evaluate if higher cumulative occupational hand force requirements are associated with higher risks of surgery for trapeziometacarpal osteoarthritis and with surgery earlier in life.MethodsThe study was based on Danish national registers. Among all persons born in Denmark 1931 to 1990, we included those who had been employed for at least 5 years since 1991 by the end of 2000, or later when this employment criterion was reached, up until the end of 2016. Cumulative exposure estimates for 10-year time windows (force-years) were assessed by combining individual year-by-year information on occupational codes with an expert based hand-arm job exposure matrix. First-time events of surgery for trapeziometacarpal osteoarthritis 2001 to 2017 constituted the outcome. Surgery rates were analysed by a logistic regression technique equivalent to discrete survival analysis using a 1-year lag. We also calculated rate advancement periods.ResultsA total of 2 860 448 persons contributed with around 48 million person-years of follow-up, during which 3977 cases appeared (821 among men and 3156 among women). Compared with <5 force-years, the adjusted OR (ORadj) for ≥5 to <10 force-years was 1.39 (95% CI 1.14 to 1.68) and for ≥10 to 30 force-years 1.47 (95% CI 1.26 to 1.71) among men and 1.64 (95% CI 1.50 to 1.78) and 1.29 (95% CI 1.16 to 1.43) among women. The sex combined ORadj were 1.59 (95% CI 1.47 to 1.72) and 1.36 (95% CI 1.25 to 1.48). Among the exposed, surgery was advanced by 3 to 7 years.ConclusionMedium/high cumulative hand force requirements were associated with elevated hazard rates of surgery for trapeziometacarpal osteoarthritis and advanced the time of surgery by several years.

Download Full-text