Predictive Value of Additional Clinical and Radiological Parameters for Discrimination of Malignancy in Bosniak 3 Cysts

2020 ◽  
pp. 1-6
Author(s):  
Ertugrul Sefik ◽  
Ibrahim Halil Bozkurt ◽  
Gulsen Yucel Oguzdogan ◽  
Serdar Çelik ◽  
Ismail Basmaci ◽  
...  
Keyword(s):  
Cyst Wall ◽  
Renal Cysts ◽  
Lesion Size ◽  
Smoking History ◽  
Tumor Diameter ◽  
Independent Predictive Factor ◽  
Radiological Parameters ◽  
Malignant Group ◽  
Group 2 ◽  
Group 1

<b><i>Introduction:</i></b> Almost half of the cystic renal lesions are still overdiagnosed and overtreated. New clinical and radiological parameters are needed to distinguish the malignant Bosniak 3 lesions from the benign ones. We aimed to evaluate the clinical and radiological parameters that may be related to malignancy risk for Bosniak category 3 renal cysts. <b><i>Materials and Methods:</i></b> Patients who underwent surgical resection of a histopathologically confirmed Bosniak 3 renal cyst between March 2007 and September 2019 were evaluated. Two experienced uro-radiologists have reevaluated the last preoperative computed tomography and/or MRI images of the patients and reclassified the lesions according to the Bosniak classification. They also reported cystic features such as nodularity, septation, focal thickening, enhancement, and calcification. Clinical, pathological, and oncological outcomes were recorded. Then patients were divided into 2 groups as Group 1 (benign pathology) and Group 2 (malignant pathology) according to final histopathological report. <b><i>Results:</i></b> A total of 79 patients were included in this study. Mean follow-up time was 47 ± 34 months. There were 30 patients in Group 1 and 49 patients in Group 2. Hypertension (<i>p</i> = 0.001) and smoking history (<i>p</i> = 0.008) were more common in malignant group. Among the radiological findings, lower tumor diameter (<i>p</i> = 0.024), presence of cyst wall enhancement (<i>p</i> = 0.025), presence of nodularity (<i>p</i> = 0.002), and presence of focal thickening (<i>p</i> = 0.031) were found to be statistically significant for malignancy. Most of the tumors were at pathological T1 stage and Fuhrmann Grade 1–2. Only nodularity was found to be independent predictive factor for malignancy in multivariate analysis. <b><i>Conclusion:</i></b> Clinical factors including hypertension and smoking, radiological factors including lower lesion size, cyst wall enhancement, nodularity, and focal thickening were predictors for malignancy of Bosniak 3 cysts.

Cardiac Tamponade After Removal of Temporary Pacer Wires

2012 ◽  
Vol 21 (6) ◽  
pp. 432-440 ◽  
Author(s):  
Linda Mahon ◽  
James F. Bena ◽  
Shannon M. Morrison ◽  
Nancy M. Albert
Keyword(s):  
Cardiac Tamponade ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Vital Signs ◽  
Smoking History ◽  
Initial Surgery ◽  
Temporary Pacemaker ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background After removal of temporary pacemaker wires, nurses measure vital signs frequently to assess for cardiac tamponade; however, evidence for this procedure is limited. Objectives To determine risk factors for cardiac tamponade after temporary pacemaker wire removal. Methods Retrospective review of data for coronary artery bypass graft and valve surgery (N = 23 717) performed from January 1999 to December 2008. Patients were categorized by reason for reoperation: bleeding less than 3 days after initial surgery (n = 812, group 1), bleeding 3 days or more after index surgery but not for cardiac tamponade (n = 171, group 2), bleeding 3 days or more after index surgery for cardiac tamponade after temporary pacemaker wire removal (n = 23, group 3), and no reoperation (n = 22 711, group 4). Results Less than 1% (9.7 cases/10 000) of patients required reoperation for cardiac tamponade after removal of temporary pacer wires. Of patient-related factors studied, only smoking history differed for group 3 vs group 1 (P = .03) and group 2 (P = .01). Of vital sign changes, 1 patient (4%) had tachycardia and 3 patients had cardiac arrest, but only 1 of the 3 had hypotension before the arrest. In total, 12 patients (52%) had hypotension; however, it was mild or intermittent in 5 cases, and did not occur within the 4 hours after wire removal in 3 cases. After removal of temporary pacing wires, common early signs/symptoms were bleeding (26%) and dyspnea (26%). Other documented changes were pressure in the chest, diaphoresis, cold and clammy skin, dizziness, and mental status changes. Conclusions Tamponade related to pacer wire removal was rare and not consistently associated with changes in vital signs. Dyspnea, bleeding, and other factors may indicate early onset of cardiac tamponade after removal of temporary pacer wires.

scholarly journals Correlation between low-level viremia and hepatitis B-related hepatocellular carcinoma and recurrence: a retrospective study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Furong Sun ◽  
Zhifei Liu ◽  
Bingyuan Wang
Keyword(s):  
Hepatocellular Carcinoma ◽  
Hepatitis B ◽  
Limit Of Detection ◽  
Hbv Dna ◽  
Tumor Diameter ◽  
Low Level ◽  
Group 2 ◽  
Hepatocellular Carcinoma Recurrence ◽  
Curative Hepatectomy ◽  
Group 1

Abstract Background Low-level viremia generally refers to detectable HBV DNA levels lower than 2000 IU/mL. Studies show that low-level viremia is a risk factor for hepatocellular carcinoma. The aim of this study was to explore the characteristics of low-level viremia patients with hepatitis B-related hepatocellular carcinoma and identify prognostic factors after curative hepatectomy. Methods Data from chronic hepatitis B patients with hepatocellular carcinoma receiving curative hepatectomy for the first time in the first hospital of China Medical University were studied. Patients were divided into two groups based on preoperative HBV DNA levels: group 1 (low-level viremia group, HBV DNA < 2000 IU/mL) and group 2 (HBV DNA ≥ 2000 IU/mL). Results Of the 212 patients, 104 patients were in group 1 and 108 patients were in group 2. There was a lower proportion of patients with HBsAg levels > 250 IU/mL (the upper limit of detection in our laboratory) in group 1 than in group 2 (71.2% vs. 86.1%, P < 0.01). The percentage of patients with a tumor diameter < 5 cm was 67.3% in group 1 and 37.0% in group 2 (P < 0.000). The percentage of tumor recurrence was 40.4% (42) in group 1 and 54.6% (59) in group 2 (P < 0.05). Median recurrence-free survival was 30.1 months in group 1 and 17.6 months in group 2 (P < 0.01). Multivariate analysis showed that a tumor diameter ≥ 5 cm (hazard ratio [HR] = 1.819, 95% confidence interval [CI] 1.193–2.775, P = 0.005), intrahepatic metastasis (HR = 1.916, 95% CI 1.077–3.407, P = 0.027), and an HBV DNA level ≥ 100 IU/mL (the lower limit of detection in our laboratory, HR = 2.943, 95% CI 1.916–4.520, P < 0.000) were independent prognostic factors associated with an increased risk of hepatocellular carcinoma recurrence. Conclusion Preoperative low-level viremia was related with a long tumor recurrence interval and complete virologic response after curative hepatectomy was associated with a lower risk of hepatocellular carcinoma recurrence.

P2679Normal high sensitive troponin I and suspected myocardial infarction, is the rapid rule out algorythm for all?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Marcusohn ◽  
D Epstein ◽  
A Roguin ◽  
R Zukermann
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Chest Pain ◽  
Smoking History ◽  
Coronary Ct ◽  
All Cause Mortality ◽  
Group 2 ◽  
High Sensitive Troponin ◽  
Rule Out ◽  
Group 1

Abstract Introduction Since the introduction of High sensitive troponin assays, many studies showed that patients presenting to the ED with cardiac chest pain and HsTnI under 5 ng/dl have very good prognosis and extremely low risk for major cardiovascular events at follow up. These studies led to a few rapid rule out algorythms for MI according to undetectable HsTnI in first hours following admission. Purpose The aim of the study was to examine whether a maximal HsTnI under 5 ng/dl, in a hemodynamicaly stable patient, is sufficient to discharge a patient without further testing. Methods Retrospective analysis of patients admitted to the emergency depatment due to suspected myocardial infarction between February 2016 and December 2018. All patients had a HsTnI under 5 ng/dl and were either discharged home or admitted for further observation and testing. The collection of data was performed by the MDCLONE software from the electronic medical records in our medical center. Results Between February 2016 and December 2018, 10,936 patients were admitted to the emergency department due to chest pain or suspected MI. In 7925 (72%) the maximal HsTnI value was under 5 ng/dl. Group 1 included 6699 (85%) patients who did not undergo any further test and group 2 included 1226 (15%) who were admitted for further testing. Further testing included Coronary CT in 999 (81%) and Stress myocardial perfusion imaging (MPI) in 227 (19%). 11 patients underwent both tests. Out of the 999 patients examined with coronary CT, 114 (11%) needed further evaluation with coronary angiogiography and 41 required angioplasty and stening. 18 (7%) patients that were evaluated using stress MPI needed angio and 7 (3%) required stenting. Comparing the group 1 and 2, patients who went through further testing were more likely to be older, with higher prevalence of diabetes, hypertenstion, smoking history and after CABG in the past. Group 1 had 0.07%, 0.16% and 0.33% all cause mortality in 30, 90 and 360 days respectivly. Group 2 had no mortality in 30 and 90 days, and 0.25% all cause mortality in 360 days. No statistical significance was reached in all time points. There was no difference in re-admissions in the first 90 days after discharge between the groups. Conclusions Based on our data, patients admitted to the emergency department due to suspected myocardial infarction and known cardiovascular risk factors but with HsTnI under the 5 ng/dl, the use of rapid rule out algorithms may be questionable. Acknowledgement/Funding None

scholarly journals The Benign Renal Masses that Were Exposed after Nephron-Sparing Surgery

2021 ◽  
Vol 9 (1) ◽  
pp. 1-8
Author(s):  
Mehmet Balasar ◽  
Serkan Ozkent ◽  
Arif Aydın ◽  
Hakan Hakkı Taşkapu ◽  
Ahmet Atıcı ◽  
...  
Keyword(s):  
Primary Repair ◽  
Nephron Sparing Surgery ◽  
University Hospital ◽  
Tumor Diameter ◽  
Fatty Tissue ◽  
Renal Masses ◽  
Number Of Patients ◽  
Nephron Sparing ◽  
Group 2 ◽  
Group 1

After nephron-sparing surgery (NSS), postsurgical fatty tumor could be mistakenly reported as angiomyolipoma during radiologic imaging of some patients. In the present paper, we studied the postsurgical fatty tumor detected after NSS but not covered before in the literature. In addi-tion, we also evaluated whether the postsurgical fatty tumor was related to the surgical technique employed. Patients admitted to the urology department of our university hospital from 2014 to 2019 and operated with open NSS were evaluated retrospectively. We detected those 156 patients were operated with NSS. Nine patients with angiomyolipoma as primary pathology and four patients with surgical border positivity were excluded from the study. The patients were divided into two groups based on the repair of tumor extraction region. In Group 1, fatty tissue was used for repair, and Group 2 is the primary repair group. In all, 143 patients (Group 1 = 79, and Group 2 = 64) were included in the study. No demographic and radiologic differences, such as number of patients, age, gender, positioning of tumor, mass localization, tumor diameter, and RENAL nephrometry scoring system, were detected between the two groups. Postsurgical fatty tumors were detected in 28 patients in Group 1 and in two patients in Group 2 (P < 0.001). In patients with negative surgical margins after partial nephrectomy, lesions that were radiologically detected mimicking as angiomyolipoma were defined as “postsurgical fatty tumor.” This mass containing adipose tissue only nei-ther depicted vascularization and enhancement nor increase in size for at least 1 year. We assumed that these lesions must be followed as benign lesions not requiring additional treatment.

Routine Shunting During Carotid Endarterectomy in Patients With Acute Watershed Stroke

2017 ◽  
Vol 51 (5) ◽  
pp. 288-294 ◽  
Author(s):  
Paolo Perini ◽  
Domenico Marco Bonifati ◽  
Sebastiano Tasselli ◽  
Filippo Sogaro
Keyword(s):  
Carotid Endarterectomy ◽  
Postoperative Mortality ◽  
Protective Role ◽  
Morbidity Rate ◽  
Complete Regression ◽  
Independent Predictive Factor ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Group 2 ◽  
Group 1

Aim: To evaluate the protective role of routine shunting in patients with acute watershed stroke (WS) undergoing carotid endarterectomy (CEA). Methods: A total of 138 patients with symptomatic carotid stenosis (SCS) who underwent CEA after acute ischemic stroke from March 2008 to March 2015 were included in this study. Transient ischemic attacks were excluded. These patients were divided into 2 groups according to the topographic pattern of the stroke on magnetic resonance imaging: group 1, territorial strokes (TS) caused by emboli of carotid origin, and group 2, WS caused by a hemodynamic mechanism related to an SCS. Primary end points were 30-day mortality and postoperative neurological morbidity. The insertion of a Pruitt carotid shunt was performed systematically. Results: Ninety (65.2%) patients presented a TS of carotid origin and were included in group 1, and 48 (34.8%) of the 138 patients had a WS related to an SCS and were included in group 2. The median time between clinical onset of the cerebral ischemic event and surgery was 9 days (range: 0-89 days). Postoperative mortality was 0%. Seven (5.1%) patients had an aggravation of the neurological status during the postoperative period, of whom 2 presented a complete regression of the symptoms in less than 1 hour (definitive postoperative neurologic morbidity: 3.6%). Postoperative neurologic morbidity rate was significantly higher in the TS group (7 of 90; 7.8%) compared to the WS group (0 of 48; P = .04). No other independent predictive factor of neurologic morbidity after CEA for an SCS was found. Conclusions: Our results suggest that routine shunting should be considered in case of acute WS since it may play a protective role. Further studies are eagerly awaited to better define the timing and the best treatment option for both acute WS and TS related to an SCS in order to reduce postoperative neurologic morbidity.

Acquired Cystic Disease of the Kidney in Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients

1988 ◽  
Vol 8 (4) ◽  
pp. 273-275 ◽  
Author(s):  
Jose Carlos Rodriguez-Perez1 ◽  
Nicanor Vega ◽  
Tomas Camaño ◽  
Ana Fernandez ◽  
Celia Plaza ◽  
...  
Keyword(s):  
Renal Cortex ◽  
Renal Cysts ◽  
Cystic Disease ◽  
Initial Stage ◽  
Previously Treated ◽  
Group 3 ◽  
Male Patients ◽  
Group 2 ◽  
Acquired Cystic Disease ◽  
Group 1

Acquired Cystic Disease of the Kidney (ACDK) has been increasingly noted in patients with long-standing renal failure and in those treated with dialysis. We assessed the prevalence of different patterns of cysts in 48 randomly selected patients treated with CAPD (23.1 ± 16.0 months). Only 3 patients had been previously treated with hemodialysis. All patients underwent renal ultrasonography (US) and nine underwent computerized tomography (CT). In 22 patients no cysts were found. The other 24 patients were Included In three different groups. Group 1: Cysts that predominate In the renal cortex from 0.3 to 3.0 cm In diameter: 14 patients. Group 2: Cysts less than 0.3 cm in diameter (granular-microcystic pattern): 4 patients. Group 3: SolItary cysts 1 to 3: 6 patients. US and CT are relIable and sensitive enough to detect cysts even smaller than 0.3 cm in diameter. The incidence of patients with renal cysts increases with the duration of CAPD. Cysts less than 0.3 cm In diameter (Group 2) could correspond to an initial stage of Group 1 cysts or to a new aspect of ACDK. Group 1 and Group 2 cysts were predominant In male patients, while Isolated renal cysts were more frequent in females.

Is Tumor Size Really Important for Prediction of Lymphatic Dissemination in Grade 1 Endometrial Carcinoma With Superficial Myometrial Invasion?

2017 ◽  
Vol 27 (7) ◽  
pp. 1393-1398 ◽  
Author(s):  
Murat Oz ◽  
Vakkas Korkmaz ◽  
Mehmet Mutlu Meydanli ◽  
Mustafa Erkan Sari ◽  
Zeliha Firat Cuylan ◽  
...  
Keyword(s):  
Myometrial Invasion ◽  
Median Number ◽  
Current Approach ◽  
Tumor Diameter ◽  
Surgical Morbidity ◽  
Gynecology And Obstetrics ◽  
Endometrioid Endometrial Cancer ◽  
Group 2 ◽  
Pathology Reports ◽  
Group 1

ObjectivesSelection of patients with endometrioid endometrial cancer (EEC), in whom systematic lymph node dissection (LND) is indicated, is an important part of management to maintain optimal oncological outcomes, while avoiding unnecessary morbidities. According to the current approach, LND is recommended for the patients with International Federation of Gynecology and Obstetrics (FIGO) grade 1 to 2 tumors and a primary tumor diameter (PTD) greater than 2 cm, even with myometrial invasion (MMI) of less than 50%. We aimed to determine incidence of LN metastasis in this particular group of patients with grade 1 tumors, superficial MMI, and a PTD greater than 2 cm.Materials and MethodsThis study only focused on women with FIGO grade 1 EEC having less than 50% MMI. Therefore, women with grade 2 or 3 tumors were excluded, as well as patients with 50% or greater MMI. We also excluded women with macroscopic extrauterine disease, as well as patients with cervical stromal involvement. Patients were divided into subgroups with regard to PTD; group 1 was composed of patients with PTD of 20 mm or less, whereas group 2 was composed of patients with PTD greater than 20 mm. All clinical and pathological variables were compared between the groups.ResultsFinal pathology reports of 484 women with EEC who underwent surgical staging were analyzed. Among these women, there were 123 women in group 1 (PTD ≤ 20 mm) and 120 women in group 2 (PTD > 20 mm), with FIGO grade 1 tumors and superficial MMI. The median number of total LNs removed was 54 (range, 20–151). There were no women with pelvic and/or para-aortic LN metastasis in group 2, as well as in group 1.ConclusionsOur results suggest that lymphadenectomy may be omitted in women with FIGO grade 1 EEC having superficial MMI regardless of PTD. Deferral of systematic LND in this subgroup of patients may lead to reductions in costs and surgical morbidity.

Simple Renal Cysts in Hypertensive Patients: Relation between Cyst Growing and Anti-Hypertensive Therapy

2003 ◽  
Vol 16 (2) ◽  
pp. 175-180 ◽  
Author(s):  
C. Schiavone ◽  
L. Salvatore ◽  
A. Primavera ◽  
F. Cuccurullo ◽  
N. Verna ◽  
...  
Keyword(s):  
Renal Cyst ◽  
Renal Cysts ◽  
Fluid Secretion ◽  
Control Group ◽  
Newly Diagnosed ◽  
Cyst Size ◽  
Group 3 ◽  
Group 2 ◽  
Hypertensive Therapy ◽  
Group 1

The study investigates relationship between simple renal cyst enlargement studied by ultrasonography and anti-hypertensive treatment. To this purpose we enrolled 42 patients with newly diagnosed hypertension affected by simple renal cysts. Fourteen were randomly assigned to treatment with ACE-Inhibitors (group 1), twelve to diuretics (group 2) and sixteen to Ca-Antagonists (group 3). Patient performed a basal ultrasonography to evaluate basal cyst dimension before starting anti-hypertensive treatment. Following 12 months of the anti-hypertensive regimen, a new echograph was performed to evaluate changes in cyst size. A control group consisting of 15 patients with normal blood pressure and simple renal cysts was enrolled (group 0). An enlargement of cysts was detected in all patients. However, the enlargement observed in patients treated by Ca-Antagonists was significantly greater than that observed in the other groups (p<0,05). Our study supports the hypothesis that Ca-Antagonists may favor cyst enlargement by enhancing cyclic AMP production. In fact, cAMP and cAMP agonists stimulate fluid secretion by lining cells of the cyst wall, inducing cyst enlargement.

scholarly journals CT features of normal lung change in asymptomatic elderly patients

2017 ◽  
Vol 9 (5) ◽  
pp. 613-623 ◽  
Author(s):  
Nattinee Leelakanok ◽  
Nitra Piyavisetpat
Keyword(s):  
Elderly Patients ◽  
Smoking History ◽  
Normal Lung ◽  
Wall Thickening ◽  
Study Cohort ◽  
Air Trapping ◽  
Bronchial Wall ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background Not all morphological lung changes in the elderly contribute to respiratory disease and may be a consequence of normal aging. Objectives To describe the changes in asymptomatic elderly patients compared with those in younger patients in a Thai population. Methods The study cohort comprised 60 participants without respiratory symptoms in three groups of 20 by age: 20-40 years, 41-60 years, and >60 years. Participants were prospectively selected from patients referred for computed tomography (CT) of the abdomen, or head and neck, and underwent sequential CT during deep breathing at four lung levels. Two observers scored images by consensus. We compared groups using Pearson chi-square and Fisher exact tests, and used receiver operating characteristic curves to categorize bronchiectasis and bronchial wall thickening by age. Results Air trapping was related to age (5/20 group 1, 7/20 group 2, and 18/20 group 3 (P <0.01)) and was most prevalent in lower lobes (78%, P < 0.01). Reticulation was found in only one middle aged patient (P = 0.36). Bronchiectasis was more common in patients <56 years (7/23) than <56 years (3/37), P = 0.035. Bronchial wall thickening (7/23 in patients >56 years and 2/37 in patients <56 years, P = 0.02) and extensive air trapping were related to age (0/6 group 1, 1/6 group 2, and 5/6 group 3, P = 0.02). Findings were independent of smoking history. Conclusions Asymptomatic older patients had higher prevalence of bronchiectasis, bronchial wall thickening, and air trapping, independent of smoking history.

scholarly journals Comparison of rarely seen tumors of the colorectal region clinicopathologically

2021 ◽  
Keyword(s):  
Malignant Melanoma ◽  
Lymph Nodes ◽  
Neuroendocrine Tumor ◽  
B Cell Lymphoma ◽  
Medullary Carcinoma ◽  
Application Rate ◽  
Tumor Diameter ◽  
Tumor Group ◽  
Group 2 ◽  
Group 1

Background: Majority of colorectal neoplasms are adenocarcinomas but there is a small percentage of tumors from other histological cell lines Method: One thousand one hundred patients who were applied surgical treatment due to colorectal cancer at general surgical clinic between years of 2010-2020 were examined. Patients have been grouped as Diffuse large b cell lymphoma (DLBCL) (group1), Malignant melanoma (group2), Medullary carcinoma (group3), Neuroendocrine tumor (group4) and they were included in the study in this way. In the groups,clinicopathological data of patients and their survival periods have been compared. Results: Twenty patients are included in our study: Group 1 was composed of 5, Group 2 was composed of 4, Group 3 was composed of 3, and Group 4 was composed of 8 patients. Emergency application rate (60%) was higher in Group 1 (p: 0.004). A verage age was above 50 in 4 groups and there was no difference between groups (p:0,966).Tumor diameter was on average (cm)(8 vs 6,55 vs 5,4 vs 3,75 p:0,073) in the groups, The number of lymph nodes dissected were (13 vs 14.5 vs 19 vs 19 p:0.373) The number of metastatic lymph nodes were ( 0 vs 1.5 vs 0 vs 0.5 p:0.188). Survival was significantly shorter in the malignant melanoma group, the longest survival was in the neuroendocrine tumor group (15.625vs8.5vs20 vs 40.857 p:0.001) Conclusions: Although clinicopathological features and postoperative follow-up results were similar, there were differences in survival among patients. Maligant melanoma histopathological type had a worse prognosis than other tumors

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