scholarly journals Basosquamous Carcinoma: A Single Centre Clinicopathological Evaluation and Proposal of an Evidence-Based Protocol

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Jordan W. Oldbury ◽  
Richard A. J. Wain ◽  
Sameera Abas ◽  
Christopher M. Dobson ◽  
Srinivasan S. Iyer
Keyword(s):  
Surgical Excision ◽  
Metastatic Potential ◽  
Specific Information ◽  
Evidence Based ◽  
Patient Demographics ◽  
Skin Malignancy ◽  
Included Patient ◽  
Excision Margins ◽  
Evidence Based Guideline

Basosquamous carcinoma (BSC) is an uncommon skin malignancy with significant invasive and metastatic potential. There are currently no clear management guidelines. This study evaluates the management and outcomes of patients diagnosed with BSC over a 7-year period. We present an evidence-based unit protocol for the management of BSC. All patients treated for BSC between 2009 and 2015 were reviewed. Data collected included patient demographics, tumour-specific information, management strategy, presence of recurrence or metastasis, and details of follow-up. 74 patients were identified, making this one of the largest cohorts of BSC patients reported. Mean age at diagnosis was 75.4 years, with a male:female ratio of 1.6:1. The most common tumour site was the head and neck (n=43, 58.1%). All tumours were graded at pT1 (n=51) or pT2 (n=23). Inadequate excision occurred in 17 patients (23%). Mean excision margins were >4mm peripherally and deep. Inadequately excised BSCs were further treated with wide local excision (n=6) or radiotherapy (n=5), or both (n=1). There were no cases of local recurrence or metastatic disease. This study demonstrates a cohort of patients with BSCs that appear less aggressive than previously reported. Current management with surgical excision appears to produce adequate results. However, an evidence-based guideline is still lacking.

scholarly journals Value of Three-Dimensional Digital Subtraction Angiography for Detection and Classification of Intracranial Aneurysm Remnants After Clipping

2021 ◽  
Author(s):  
Serge Marbacher ◽  
Matthias Halter ◽  
Deborah R Vogt ◽  
Jenny C Kienzler ◽  
Christian T J Magyar ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Digital Subtraction Angiography ◽  
Diagnostic Yield ◽  
Three Dimensional ◽  
P Value ◽  
Digital Subtraction ◽  
Patient Demographics ◽  
Included Patient ◽  
2D And 3D

Abstract BACKGROUND The current gold standard for evaluation of the surgical result after intracranial aneurysm (IA) clipping is two-dimensional (2D) digital subtraction angiography (DSA). While there is growing evidence that postoperative 3D-DSA is superior to 2D-DSA, there is a lack of data on intraoperative comparison. OBJECTIVE To compare the diagnostic yield of detection of IA remnants in intra- and postoperative 3D-DSA, categorize the remnants based on 3D-DSA findings, and examine associations between missed 2D-DSA remnants and IA characteristics. METHODS We evaluated 232 clipped IAs that were examined with intraoperative or postoperative 3D-DSA. Variables analyzed included patient demographics, IA and remnant distinguishing characteristics, and 2D- and 3D-DSA findings. Maximal IA remnant size detected by 3D-DSA was measured using a 3-point scale of 2-mm increments. RESULTS Although 3D-DSA detected all clipped IA remnants, 2D-DSA missed 30.4% (7 of 23) and 38.9% (14 of 36) clipped IA remnants in intraoperative and postoperative imaging, respectively (95% CI: 30 [ 12, 49] %; P-value .023 and 39 [23, 55] %; P-value = <.001), and more often missed grade 1 (< 2 mm) clipped remnants (odds ratio [95% CI]: 4.3 [1.6, 12.7], P-value .005). CONCLUSION Compared with 2D-DSA, 3D-DSA achieves a better diagnostic yield in the evaluation of clipped IA. Our proposed method to grade 3D-DSA remnants proved to be simple and practical. Especially small IA remnants have a high risk to be missed in 2D-DSA. We advocate routine use of either intraoperative or postoperative 3D-DSA as a baseline for lifelong follow-up of clipped IA.

Cervicothoracic radiculopathy treated using posterior cervical foraminotomy/discectomy

2003 ◽  
Vol 98 (2) ◽  
pp. 131-136 ◽  
Author(s):  
James S. Harrop ◽  
Marco T. Silva ◽  
Ashwini D. Sharan ◽  
Steven J. Dante ◽  
Frederick A. Simeone
Keyword(s):  
Morbidity Rate ◽  
Symptom Duration ◽  
Specific Information ◽  
Disc Disease ◽  
Content Type ◽  
Included Patient ◽  
Posterior Cervical Foraminotomy ◽  
Disc Herniations ◽  
Fine Print

Object. The authors conducted a study to identify the effectiveness and morbidity rate associated with treating cervicothoracic disc disease (radiculopathy) via a posterior approach. Methods. Nineteen patients underwent posterior cervicothoracic laminoforaminotomy during a 5.6-year period. Medical records, imaging studies, office charts, hospital records, and phone interview data were reviewed. Specific information analyzed included patient demographics, side of lesion, and conservative treatment, symptoms, and pre- and postoperative pain levels. Pain was rated using a visual analog scale and classified into a radicular and neck component. Data in 19 patients (seven women and 12 men) who underwent 20 procedures (one patient underwent separate bilateral foraminotomies) were analyzed. The mean patient age was 54.8 years (range 38–73 years), and the follow-up period ranged from 23 to 62 months. Symptom duration ranged from 1 to 14 months (mean 3.4 months) and consisted of weakness, numbness, and painful radiculopathies in 11, 16, and 20 cases, respectively. Motor weakness was identified in 11 of 19 patients (mean grade of 4.35), and postoperatively strength normalized in eight of 11 (mean grade of 4.79). The improvement in motor scores was significant (p = 0.007). Pain was the most common presenting symptom. Preoperative radiculopathies were rated between 0 and 10 (mean 7.45), and postoperatively scores were reduced to 0 to 3 (mean 0.2) which was significant (p < 0.0001). Preoperative neck pain was rated between 0 and 8 (mean 2.55), and on follow up ranged from 0 to 2 (mean 0.5), which was also significant (p = 0.001). Conclusions. Posterior cervicothoracic foraminotomy was a safe and effective procedure in the treatment of patients with laterally located disc herniations.

scholarly journals Pancreatic cancer.Evidence based management guidelines of the Hungarian Pancreatic Study Group

2015 ◽  
Vol 156 (8) ◽  
pp. 326-339 ◽  
Author(s):  
Richárd Szmola ◽  
Gyula Farkas ◽  
Péter Hegyi ◽  
László Czakó ◽  
Zsolt Dubravcsik ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Scientific Evidence ◽  
Surgical Care ◽  
Study Group ◽  
Evidence Based ◽  
Management Guidelines ◽  
International Guidelines ◽  
Evidence Based Guideline ◽  
Cancer Network

Pancreatic cancer is a disease with a poor prognosis usually diagnosed at a late stage. Therefore, screening, diagnosis, treatment and palliation of pancreatic cancer patients require up-to-date and evidence based management guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available scientific evidence and international guidelines. The preparatory and consultation board appointed by the Hungarian Pancreatic Study Group translated and complemented/modified the recent international guidelines. 37 clinical statements in 10 major topics were defined (Risk factors and genetics, Screening, Diagnosis, Staging, Surgical care, Pathology, Systemic treatment, Radiation therapy, Palliation and supportive care, Follow-up and recurrence). Evidence was graded according to the National Comprehensive Cancer Network (NCCN) grading system. The draft of the guideline was presented and discussed at the consensus meeting in September 12, 2014. Statements were accepted with either total (more than 95% of votes, n = 15) or strong agreement (more than 70% of votes, n = 22). The present guideline is the first evidence based pancreatic cancer guideline in Hungary that provides a solid ground for teaching purposes, offers quick reference in everyday patient care and guides patient financing options. The authors strongly believe that these guidelines will become a standard reference for pancreatic cancer treatment in Hungary. Orv. Hetil., 2015, 156(8), 326–339.

2-cm versus 4-cm surgical excision margins for primary cutaneous melanoma thicker than 2 mm: long-term follow-up of a multicentre, randomised trial

The Lancet ◽  
2019 ◽  
Vol 394 (10197) ◽  
pp. 471-477 ◽  
Author(s):  
Deborah Utjés ◽  
Jonas Malmstedt ◽  
Jüri Teras ◽  
Krzysztof Drzewiecki ◽  
Hans Petter Gullestad ◽  
...  
Keyword(s):  
Cutaneous Melanoma ◽  
Randomised Trial ◽  
Surgical Excision ◽  
Primary Cutaneous Melanoma ◽  
Long Term Follow Up ◽  
Excision Margins

scholarly journals Pipeline Flex embolisation device with Shield Technology for the treatment of patients with intracranial aneurysms: periprocedural and 6 month outcomes

2020 ◽  
Vol 33 (6) ◽  
pp. 471-478
Author(s):  
James Yeomans ◽  
Lilian Sandu ◽  
Anand Sastry
Keyword(s):  
Antiplatelet Therapy ◽  
Case Series ◽  
Interventional Neuroradiology ◽  
Flow Diverter ◽  
Patient Demographics ◽  
Post Procedure ◽  
Time Period ◽  
Included Patient ◽  
Procedural Complications

Background and purpose The Pipeline Flex embolisation device with Shield Technology (Pipeline Shield) is a novel flow diverter which reduces intra-vessel thrombogenicity. This study summarises periprocedural outcomes and 6-month follow-up results following its introduction in a tertiary interventional neuroradiology centre. Materials and methods This prospective, single-arm study assessed 32 aneurysms treated over a 21-month time period from the time of procedure to 6 months post-procedure. Data collected included patient demographics, aneurysm features and intraprocedural and 6-month post-procedural complications. Results The mean age of the cohort was 58.8 ± Standard Deviation 8.5 years. Twenty-eight aneurysms were treated electively and four acutely. The elective cases received dual antiplatelet therapy post-procedure. The acute cases received single antiplatelet therapy post-procedure. Of the target aneurysms, 16/32 (50%) were small (<10 mm), 13/32 (41%) were large (10–25 mm) and 3/32 (9%) were giant (≥25 mm). There was no mortality in the series. There were two periprocedural complications (2/32, 6.2%): a stroke and a dissection. There were no post-procedural complications. At 6 months post-procedure, satisfactory occlusion (defined as Raymond–Roy 1 or 2) was achieved in 90.6% and 93.8% by way of magnetic resonance angiography and digital subtraction angiography assessment, respectively. There was no implant migration, no significant intraluminal hyperplasia or in-stent stenosis and no cases of aneurysm recurrence. Conclusion The Pipeline Shield has an excellent 6- month safety profile with an acceptable rate of intraprocedural complications, no post-procedure complications and no mortality in this case series of 32 acute and elective cases.

scholarly journals 795 Adequacy of Surgical Excision Margins in Lentigo Maligna: An Audit

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
K Chan ◽  
K Maheshwari ◽  
A Yousif
Keyword(s):  
Retrospective Study ◽  
Surgical Excision ◽  
Electronic Records ◽  
Lentigo Maligna ◽  
Nice Guidelines ◽  
Patient Demographics ◽  
Excision Margin ◽  
History Of ◽  
Excision Margins ◽  
Operative Notes

Abstract Aim The optimal excision margin for Lentigo Maligna (LM) lesions has been a frequent topic of debate. An audit was carried out to compare the excision margins used for LM excisions with current NICE guidelines, and to assess the adequacy of these excision margins. Method A retrospective study was carried out to analyse all excisions of LM lesions in 2018. 33 patients were identified from the plastic surgery departmental database. Patient demographics, the site and distribution of LM lesions, and any history of previous skin cancer were analysed. Patient electronic records, operative notes, and histopathological reports were examined to determine the number of excisions done for each LM lesion along with the peripheral and deep surgical excision margins, and the histological clearance achieved. Complete histological clearance was determined by the Multidisciplinary team for each lesion. Results 60 cases were identified. 60% of cases were located on the head and neck. The average peripheral surgical excision margin at first excision was 2.3mm. 55% of patients had a 2nd excision. The average peripheral surgical excision margin at 2nd excision was 5.4mm. 70.6% of cases achieved complete histological clearance at 2nd excision. 72.7% of lesions excised at 2nd excision with a 5mm or less surgical excision margin achieved complete histological clearance. Conclusions Taking &gt;5mm surgical excision margins did not increase the rate of complete histological clearance for Lentigo Maligna lesions.

scholarly journals Rate of Incidental Parathyroidectomy in a Pediatric Population

OTO Open ◽  
2021 ◽  
Vol 5 (4) ◽  
pp. 2473974X2110590
Author(s):  
Grace Sahyouni ◽  
Beth Osterbauer ◽  
Soyun Park ◽  
Connie Paik ◽  
Juliana Austin ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Practical Method ◽  
Related Factors ◽  
Patient Demographics ◽  
Final Multivariable Model ◽  
Included Patient ◽  
Potential Risk Factors ◽  
Pathology Reports

Objective Incidental parathyroidectomy is a relatively common occurrence in thyroid surgery, which may lead to hypoparathyroidism and postoperative hypocalcemia, but it is not well studied in children. The objectives of this study were to determine the rate of incidental parathyroidectomy, identify potential risk factors, and investigate postoperative complications in children undergoing thyroidectomy. Study Design Retrospective cohort study. Setting Patients who underwent thyroidectomy over a 10-year period at a tertiary children’s hospital. Methods Pathology reports were reviewed to determine incidental parathyroid gland tissue. Additional data collected included patient demographics, type of procedure, underlying thyroid pathology, as well as immediate and long-term postoperative clinical outcomes. Results Of 209 patients, 65 (31%) had incidental parathyroidectomy. Several variables were associated with incidental parathyroidectomy on univariable analysis. However, in the final multivariable model, only thyroidectomy with lymph node dissection was associated with increased odds of having incidental parathyroidectomy (odds ratio, 3.3; P = .04; 95% CI, 1.1-9.8). After a median follow up of 1 year, a significantly higher percentage of patients with incidental parathyroidectomy had evidence of long-term hypoparathyroidism (9/62 [15%] vs 3/144 [2%], P = .001). Conclusion Incidental parathyroidectomy was relatively common in our pediatric thyroidectomy population, which may be a result of several anatomic, clinical, and surgeon-related factors. Close attention to parathyroid preservation with meticulous surgical technique is the most practical method of preventing long-term hypoparathyroidism and hypocalcemia.

scholarly journals Rates, Indications, and Speech Perception Outcomes of Revision Cochlear Implantations

2021 ◽  
Vol 10 (15) ◽  
pp. 3215
Author(s):  
Doron Sagiv ◽  
Yifat Yaar-Soffer ◽  
Ziva Yakir ◽  
Yael Henkin ◽  
Yisgav Shapira
Keyword(s):  
Speech Perception ◽  
Cochlear Implant ◽  
Outcome Analysis ◽  
Tertiary Referral Center ◽  
Patient Demographics ◽  
Included Patient ◽  
Decision Making Processes ◽  
Surgical Failure ◽  
Improved Performance

Revision cochlear implant (RCI) is a growing burden on cochlear implant programs. While reports on RCI rate are frequent, outcome measures are limited. The objectives of the current study were to: (1) evaluate RCI rate, (2) classify indications, (3) delineate the pre-RCI clinical course, and (4) measure surgical and speech perception outcomes, in a large cohort of patients implanted in a tertiary referral center between 1989–2018. Retrospective data review was performed and included patient demographics, medical records, and audiologic outcomes. Results indicated that RCI rate was 11.7% (172/1465), with a trend of increased RCI load over the years. The main indications for RCI were device-related failures (soft-45.4%, hard-23.8%), medical failure (14%), trauma (8.1%), and surgical failure (6.4%). Success rate was 98.8%. Children comprised 78% (134) of the cohort and were more likely than adults to undergo RCI. Most (70%) of the RCIs were performed within 10 years from primary implantation. Speech perception outcome analysis revealed unchanged or improved performance in 85% of the cases and declined performance in 15%. Current findings confirm that RCI is a safe with high clinical efficacy; however, the non-negligible percentage of patients that exhibited declined performance post-RCI should be considered in decision-making processes regarding RCI. Routine follow-up during their first years post-implantation is warranted.

Interdisciplinary Evidence-Based Guideline for Diagnosis, Therapy and Follow-up of Adult Hodgkin Lymphoma Patients

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4230-4230
Author(s):  
Michaela Rancea ◽  
Andreas Engert ◽  
Peter Borchmann ◽  
Bastian von Tresckow ◽  
Teresa Halbsguth ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Health Care Professionals ◽  
Research Funding ◽  
Treatment Options ◽  
Evidence Based ◽  
High Quality ◽  
Male Patients ◽  
Strong Consensus ◽  
Evidence Based Guideline

Abstract Abstract 4230 Background: Hodgkin Lymphoma (HL) is one of the most common malignancies in young adults and has become curable for the majority of patients even in advanced stage. Nowadays, the main challenges are to develop strategies that decrease secondary malignancies and mortality, as well as to retain fertility after treatment. So far, there is no national or international evidence-based guideline giving recommendations for clinical practice in the treatment of HL patients. For this reason, various medical societies, clinical experts from the German Hodgkin Study Group (GHSG) and methodological experts from the Cochrane Haematological Malignancies Group (CHMG) have developed and consented a clinical practice guideline to improve and standardize diagnosis, treatment and follow-up for HL patients. This project was funded by the German Program for Guidelines in Oncology Implementation. Aims: To emphasize the clinically most relevant guideline recommendations related to diagnostics, treatment and follow-up of adult HL patients. Methods: Randomized controlled trials, systeamtic reviews, cohort studies and specific sensitive data included from systematic literature searches in CENTRAL and MEDLINE were appraised for quality and summarized in evidence tables. Based on these tables and trials, guideline authors generated high quality clinical recommendation in an intensive collaboration with the methodological experts clinical experts from different multi-interdisciplinary working-groups. During the final consensus conference, a total of 160 evidence-based recommendations were consented. Results: There is a strong consensus that all patients should be treated within a clinical trial. Chemotherapy is the mainstay of treatment for all stages of HL. The histological diagnosis should be confirmed by a reference pathologist. For early favorable stages, two cycles of ABVD followed by involved-field radiotherapy (IF-RT) at 20 Gy are strongly recommended; early unfavorable stages should be treated with 2 cycles of BEACOPP escalated followed by 2 cycles of ABVD and IF-RT of 30 Gy; for advanced stages six cycles of BEACOPP escalated followed by 30 Gy radiotherapy on PET-positive residual mass ≥ 2cm is strongly recommended. It is also recommended that patients with relapses or refractory disease, and without severe co-morbidities, receive autologous stem cell transplantation, but not myeloablative allogeneic stem cell transplantation. Additionally, treatment options of subgroups, such as nodular lymphocyte predominant HL, elderly patients or those with co-morbidities such as HIV, are specified in this guideline. The additional benefit of PET remains uncertain as of the lack of high-quality evidence, therefore different recommendations have been provided for staging, interim and follow-up evaluations. It is highly important that health care professionals discuss aspects of fertility protection with female and male patients before starting any treatment. Options for preserving fertility in women have to be adopted to treatment intensity. For male patients, it is recommended to cyropreserve sperm cells before starting the therapy, independently of treatment intensity. There is strong consensus that patients have to prevent to conceive a child during treatment. Health-care professionals should encourage patients to exercise and should discuss potential harms of complementary medicine with the patient. Due to their immunomudulating effect, it is not recommended to take mistletoes at any time. It is strongly recommended to motivate patients to give up smoking, due to the strong associated increased risk of secondary tumors, especially bronchial carcinoma. Structured follow-up care should be provided and should in particular detect relapses, long-term organ toxicities and secondary malignancies. Summary/Conclusions: The first evidence-based guideline on the treatment of patients with HL translates scientific evidence and expert knowledge into precise recommendations for these patients into clinical practice. In addition to this clinical value, the guideline will enable healthcare professionals to improve patient information and quality management. Disclosures: Engert: Takeda, Millennium: Honoraria, Research Funding. Borchmann:Millenium The Takeda Oncology Company: Research Funding, Travel Grants Other. von Tresckow:Millenium The Takeda Oncology Company: Honoraria, Travel Grants Other.

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