Clinical study of use of large C suture in procedure for prolapse and hemorrhoids for treatment of mixed hemorrhoids

Objective To investigate the clinical use of a large C suture in the procedure for prolapse and hemorrhoids (PPH) for treatment of mixed hemorrhoids. Methods Patients with mixed hemorrhoids (grade III or IV) who underwent treatment with a large C suture during PPH in the Affiliated Hospital (Group) of Putian University from 1 April 2018 to 31 March 2019 were enrolled in this retrospective study. The incidences of anastomotic stenosis and anastomotic hemorrhage after the operation were observed. Results The study population comprised 126 patients (46 men and 80 women) ranging in age from 30 to 78 years (mean, 46.1 ± 2.5 years). Of these patients, 60 had circular mixed hemorrhoids, 36 had grade III circular internal hemorrhoids, and 30 had grade IV circular internal hemorrhoids. The onset time among all patients ranged from 0.5 to 25 years. All patients underwent 6 months of postoperative follow-up. None of the patients with mixed hemorrhoids developed anastomotic stenosis, although two patients developed secondary anastomotic bleeding. Conclusion Placement of a large C suture during PPH is a reliable technique for treatment of mixed hemorrhoids. It is simple, effective, and applicable and can be helpful for a large number of patients in primary hospitals.

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P14.78 Hypofractionated stereotactic radiotherapy as a salvage therapy for recurrent high-grade gliomas: Single-center experience

Neuro-Oncology ◽

10.1093/neuonc/noz126.313 ◽

2019 ◽

Vol 21 (Supplement_3) ◽

pp. iii86-iii86

Author(s):

T Reynaud ◽

A Bertaut ◽

W Farah ◽

D Thibouw ◽

G Crehange ◽

...

Keyword(s):

Prognostic Factors ◽

Stereotactic Radiotherapy ◽

Tumor Control ◽

High Grade ◽

Single Center ◽

Hypofractionated Stereotactic Radiotherapy ◽

Number Of Patients ◽

High Grade Gliomas ◽

Grade Iii

Abstract BACKGROUND The standard of care for patients with recurrent glioblastoma or grade III glioma has not yet been clearly defined and many approaches are available for salvage strategies. These include surgery, re-irradiation or systemic agents. For the treatment of High-Grade (HGG) recurrence by radiation therapy, Hypofractionated Stereotactic Radiotherapy (HFSRT) is an interesting approach because it is minimally invasive, ambulatory, short-lasting and well tolerated. The aim of this study was to evaluate the efficacy of and safety to HFSRT as alvage treatment for patients suffering from HGG relapse in our cancer center and to compare these results with the literature. MATERIAL AND METHODS Between March 2012 and March 2017, 32 consecutive patients (12 women, 20 men) treated in a single-center were retrospectively included included in this study.Grade III gliomas were diagnosed in 14 patients and grade IV in 18 patients. Thirty-four lesions were treated with HFSRT on LINAC. HFSRT delivered a dose of 30 Gy in six fractions of 5Gy (27 Gy in three fractions for one patient) with two or three fractions per week. The treatment plans were normalized to 100% at the isocenter, and prescribed to the 80 % isodose line. Clinical outcomes and prognostic factors were analyzed. RESULTS HFSRT characteristics: The median tumor volume was of 6.1 (0.1–42.2) cm3 and the median PTV was 15 (0.6–67.5) cm3. The median maximum dose, median minimum dose and median mean dose were 38.7 (32.7–42.0) Gy, 29.1 (14.0–32.4) Gy and 35.1 (31.5–37.5) Gy, respectively. Median follow-up was 20.9 months. Median overall survival (OS) following HFSRT was 15.6 months (Median OS for patients patients with GBM and grade III glioma were 8.2 and 19.5 months, respectively; p=0.0496). Progression-free survival (PFS) was 3.7 months (Median PFS for patients with GBM and grade III glioma were 3.6 and 4.5months, respectively; p=0.2424). In multivariate analysis, tumor grade III (p=0.0027), an ECOG status <2 at the time of reirradiation (p=0.0023) and a mean dose >35 Gy (p=0.0055) significantly improved OS. A maximum reirradiation dose above 38 Gy (p=0.0179) was significantly associated with longer PFS. Treatment was well tolerated, no acute toxicity > grade 2 was observed. During the follow-up, ten patients (31.25%) had suspected radionecrosis. In six patients, this suspicion corresponded to tumor progression. For the other patients, radionecrosis was suggested on multi-modal MRI. CONCLUSION HFSRT appears to be a feasible and effective salvage treatment option for recurrent high-grade gliomas, with OS of 15.6 months. Prognostic factors associated with longer OS were a good general state of health and grade III glioma. Dosimetric data suggested that the dose gradient had an impact on tumor control and indicate that a study with dose-escalation is warranted. These results need to be confirmed in a prospective study with a greater number of patients.

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Surgical technique and results of cable graft interpositioning of the facial nerve in lateral skull base surgeries: experience with 213 consecutive cases

Journal of Neurosurgery ◽

10.3171/2016.9.jns16997 ◽

2018 ◽

Vol 128 (2) ◽

pp. 631-638 ◽

Cited By ~ 6

Author(s):

Sampath Chandra Prasad ◽

Karthikeyan Balasubramanian ◽

Enrico Piccirillo ◽

Abdelkader Taibah ◽

Alessandra Russo ◽

...

Keyword(s):

Facial Nerve ◽

Skull Base ◽

Skull Base Tumor ◽

Nerve Function ◽

Postoperative Result ◽

Lateral Skull Base ◽

Number Of Patients ◽

Study Results ◽

Grade Iii

OBJECTIVEThe aim in this study was to review the technique and outcomes of cable graft interpositioning of the facial nerve (FN) in lateral skull base surgeries.METHODSThe authors retrospectively evaluated data from patients who had undergone cable graft interpositioning after nerve sacrifice during skull base tumor removal between June 1987 and May 2015. All patients had undergone lateral skull base approaches to remove tumors at a quaternary referral center in Italy. Facial nerve function was evaluated before and after surgery using the House-Brackmann (HB) grading system.RESULTSTwo hundred thirteen patients were eligible for study. The mean follow-up was 44.3 months. The most common pathology was vestibular schwannoma (83 cases [39%]), followed by FN tumor (67 cases [31%]). Facial nerve tumors had the highest incidence of nerve interruption (67 [66%] of 102 cases). Preoperative FN function was normal (HB Grade I) in 105 patients (49.3%) and mild (HB Grade II) in 19 (8.9%). At the last postoperative follow-up, 108 (50.7%) of the 213 patients had recovered to Grade III nerve function. Preoperative HB grading of the FN was found to have a significant effect on outcome (p = 0.002).CONCLUSIONSCable graft interpositioning is a convenient and well-accepted procedure for immediate restoration of the FN. The study results, over a large number of patients, showed that the stitch-less fibrin glue–aided coaptation technique yields good results. The best possible postoperative result achieved was an HB Grade III. The chances of a good postoperative result increase when FN function is normal preoperatively. Slow-growing tumors of the cerebellopontine angle had a favorable outcome after grafting.

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Outcome and evaluation of 1p and 19q deletion by chromogenic in situ hybridization (CISH) in patients with diagnosis of oligodendroglioma (OD) and oligoastrocitoma (OA).

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e21025 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e21025-e21025

Author(s):

Santiago Rafael Bella ◽

Jose Roberto Llugdar ◽

Alejo Lingua ◽

Ricardo Alejandro Theaux ◽

Francisco Papalini ◽

...

Keyword(s):

In Situ Hybridization ◽

Tumor Tissue ◽

Complete Response ◽

Number Of Patients ◽

Response To Chemotherapy ◽

Pathological Evaluation ◽

Grade Ii ◽

Grade Iii

e21025 Background: In OD and OA, the 1p and 19q deletion has prognostic value in survival. It is also a predictive factor for response to chemotherapy. Fluorescence in situ hybridization (FISH) is the standard method for its evaluation. CISH could be an alternative that has already been validated in other neoplasias. In OD and OA, this combined deletion is present in about 50% of patients when analyzed with FISH. Methods: Patients resected at Clinica Reina Fabiola from january 2006 to january 2010 and diagnosed of OD and OA were propectivelly included. Paraffin-embebed tumor tissue was analyzed for 1p19q deletions by CISH. The results were correlated to the histology (OD and OA) and grade (II and III) of the tumors. Results: The demographic features of the patients from the present study coincide with literature. The 1p and 19q deletion was found in 3 of the 24 patients analyzed (13%). The combined deletion was only found in those with grade II OD. No combined deletion was found in patients diagnosed of grade III OD and grade II and III OA. In the subgroup of patients with grade II OD, the combined deletion was observed in 3 of 11 patients (27%). The 3 patients in which the deletion in both chromosomes was observed, received treatment with chemotherapy and radiotherapy, all of them with complete response. 5 years DFS was 90%-median follow up 36,8 (CI: 30,5-42,98) Conclusions: The detection of the combined deletion with CISH technique was inferior (13%) than the literature. We cannot demonstrate that CISH is a reliable method for the detection of the 1p and 19q deletion. The possible reasons of this difference could be attributed to the number of patients of the study, to deviations in the procedures of the test or to the fact that the CISH method is not coincident with FISH. This prospectivelly monoinstitutional results are also different to our previous report, and may be due to different pathological evaluation.

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Variation in COVID-19 Mortality Across 117 US Hospitals in High- and Low-Burden Settings

Journal of Hospital Medicine ◽

10.12788/jhm.3612 ◽

2021 ◽

Author(s):

Brian L Block ◽

Thomas M Martin ◽

W John Boscardin ◽

Kenneth E Covinsky ◽

Michele Mourad ◽

...

Keyword(s):

Odds Ratio ◽

Adjusted Odds Ratio ◽

Hospital Death ◽

Hospital Level ◽

Large Variability ◽

Large Sample ◽

Number Of Patients ◽

Study Population

Some hospitals have faced a surge of patients with COVID-19, while others have not. We assessed whether COVID-19 burden (number of patients with COVID-19 admitted during April 2020 divided by hospital certified bed count) was associated with mortality in a large sample of US hospitals. Our study population included 14,226 patients with COVID-19 (median age 66 years, 45.2% women) at 117 hospitals, of whom 20.9% had died at 5 weeks of follow-up. At the hospital level, the observed mortality ranged from 0% to 44.4%. After adjustment for age, sex, and comorbidities, the adjusted odds ratio for in-hospital death in the highest quintile of burden was 1.46 (95% CI, 1.07-2.00) compared to all other quintiles. Still, there was large variability in outcomes, even among hospitals with a similar level of COVID-19 burden and after adjusting for age, sex, and comorbidities.

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Importance of Additional Mutation Analysis in Chorionic Villous Sample for Prenatal Diagnosis of Thalassemia

Blood ◽

10.1182/blood.v126.23.4572.4572 ◽

2015 ◽

Vol 126 (23) ◽

pp. 4572-4572

Author(s):

Soumita Choudhuri ◽

Maitreyee Bhattacharyya ◽

Aditi Sen ◽

Debmalya Bhattacharyya ◽

Siddhartha Sankar Ray

Keyword(s):

Prenatal Diagnosis ◽

West Bengal ◽

Conflicts Of Interest ◽

Genetic Disorder ◽

Globin Gene ◽

Carrier Status ◽

Medical College ◽

Number Of Patients ◽

Study Population

Abstract Introduction: β thalassaemia is a genetic disorder of β globiin gene synthesis. Its presentation ranges from transfusion dependent to non transfusion dependent thalassaemia. Non transfusion dependent thalassaemia can have normal life with proper care whereas only curative option for transfusion dependent thalassaemia is bone marrow transplantation which is costly as well as requiring technical expertise. Carrier screening before marriage/conception, antenatal screening and prenatal diagnosis are the only way to prevent birth of a child with thalassaemia. Objective of prenatal diagnosis is to identify homozygous or double heterozygous baby by mutation study. However clinical course after birth may get altered depending on associated other mutation. Till date these associated mutations are not considered in cases of prenatal diagnosis. However, this approach may avoid termination of the baby. This study was carried out retrospectively in the prenatal samples to detect presence of phenotype-modifying mutations. Method and Material: The study was conducted at the Institute of Haematology and Transfusion Medicine, Medical College, Kolkata. Study population consisted of 145 CVS samples and samples of carrier mother and father. Carrier status was detected by HPLC and confirmed by ARMS- PCR for β thalassaemia mutation. Co- inheritance of α- thalassaemia was assessed by GAP- PCR and polymorphism with haplotype assessment was done by RFLP-PCR. 36 parent samples were analyzed for mutation for the carrier status and also for presence of α and Xmn 1 polymorphism. Result: Out of 145 CVS, 8.96% (13 samples) were found to be homozygous, 12.41% (18 samples) double heterozygous, 51.72% (75 samples) heterozygous, 23.44% (34 samples) normal and 3.44% (5 samples) with uncharacterized for β mutation. Our results designated that IVS 1-5 was the most common beta mutation in the state of West Bengal population (Table 1). Co-inheritance of α 3.7 deletion was found in only three affected CVS. Xmn1 polymorphism was detected in 9 CVS samples. Out of these, 3 were homozygous and 6 were heterozygous. Both co-inheritance of α mutation and xmn1 polymorphism were detected in 22 parents sample and 18 affected CVS sample ( Table: 2). Out of 31 affected sample, 18 samples showed presence of Xmn 1 and 4 for α deletion. Additional disease modifying mutations were detected in 6 samples (19.35%). In cases where the 18 parents' sample were positive for Xmn1 polymorphism and 3 for α deletion in CVS sample, either homozygous or double heterozygous for parents' mutation. Table 1. Common β globin gene mutation of CVS samples Beta genotype Homozygote Heterozygote Compound Heterozygote Normal Uncommon IVS 1-5 (G→ C) 7 48 - -- -- CD26(G→A) HbE 1 13 5 -- -- CD15(G→A) 8 9 - -- -- CD30 (G→ C) 5 -- -- -- -- CD41/42(-CTTT) 2 3 -- -- CD8/9(+G) 3 -- -- -- -- CD6 (A → T) 2 2 -- -- Total 13 75 5 34 18 Table 2. Affected CVS with additional mutations: Additional mutations Homozygous CVS Double heterozygous CVS Parents α deletion 1 -- 7 Homozygous Xmn1 +/+ 1 1 3 Heterozygous Xmn 1 -/+ 9 3 12 α deletion + Homozygous Xmn1 +/+ -- 1 -- α deletion + Homozygous Xmn1 -/+ -- 2 -- Discussion: Common thalassaemia subtypes prevalent in West Bengal are HbE beta and Beta thalassaemia . In cases where both the parents are carrier, beta mutation or mutation for HbE was first analyzed and subsequent decision for termination of baby was taken on the presence of both these mutations in the CVS sample. But phenotype is determined by presence of additional mutations like co-inheritance of α mutation and Xmn 1 polymorphism. From our study it became evident that around 19.35% cases the baby was expected to have intermedia or NTDT phenotype. Complete genotype analysis of CVS samples in prenatal diagnosis can save a life and that give a baby to the parents. However, further exploration with larger number of patients and post natal follow up is necessary to reach a definite conclusion. Conclusion: Alpha deletion and Polymorphism detection should be employed for prenatal diagnosis. While developing such program in the population, we save of multiple neonates. Disclosures No relevant conflicts of interest to declare.

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EVALUATION THE SURGICAL TREATMENT OF HEMORRHOID DISEASE BY TRANSANAL HEMORRHOIDAL DEARTERIALISATION (THD)

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2013.5.12 ◽

2013 ◽

pp. 76-82

Author(s):

Van Lieu Nguyen ◽

Doan Van Phu Nguyen ◽

Thanh Phuc Nguyen

Keyword(s):

Surgical Treatment ◽

Postoperative Complications ◽

Hospital Stay ◽

Mucosal Prolapse ◽

Safe Procedure ◽

Average Hospital ◽

Rectal Mucosal Prolapse ◽

Internal Hemorrhoids ◽

Grade Iii

Introduction: Since 2006 Transanal hemorrhoidal dearterialization (THD), as a Doppler - guided Minimally Invasive Therapeutic Approach to Hemorrhoids, has been widely applied in European countries, America owing to its remarkable advantages over other surgical procedures such as less postoperative pain, shorter length of hospital stay, absence of serious complications, sooner recovery after surgery. Therefore, it has been widely indicated and accepted by surgeons. In Hue, THD has been implemented since April 2013. So far, this procedure has been in more or less common use to treat grade III and IV internal hemorrhoids with or without rectal mucosal prolapse. Method: From April 2013 through September 2013, 79 patients with grade III and IV hemorrhoids with or without rectal mucosal prolapse were treated by means of THD. During the study, postoperative complications, pains, hospital stay and patient’s satisfaction were monitored. Systematic follow-up of patients after surgery were carried out regularly 1 month and 3 months after surgery. Results: With 79 patients with grade III and IV hemorrhoids with or without rectal mucosal prolapse treated with THD, the following results were obtained: (i) THD was performed on 48 (60.8%) male patients, 31 (39.2%) female patients, mean age of 48.7±22.5 years; the youngest 18 and oldest 81 years old; (ii) Average hospital stay was 2.12 ± 1.25 days, the shortest stay 1 day and the longest 5 days. No surgical complications was reported. No serious postoperative complications was reported; (iii) Postoperative pains were found mild in 65 patients (82.2%), moderate in 13 patients (16.5%), and severe in 1 patient (1.3%). No case of postoperative urinary retention was recorded; (iv) Follow-up 1 month after surgery: good results in 71 patients (94.6%) patients, satisfactory results in 4 patients (5.4%) patients; (v) Follow-up 3 months after surgery: good results in 40 (95.2%) patients, satisfactory results in 2 patients (4.8%). Conclusion: Our research shows that surgical treatment of hemorrhoids with THD proves to be a safe procedure, causing less postoperative pains, shorter hospital stay and sooner resumption of work. Key words: Hemorrhoid disease, transanal hemorrhoidal dearterialisation (THD).

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Azacytidine (AZA) in MDS (including RAEB-t and CMML) in Patients (pts) ≥ 80 Years: Results of the French ATU Program.

Blood ◽

10.1182/blood.v114.22.1773.1773 ◽

2009 ◽

Vol 114 (22) ◽

pp. 1773-1773 ◽

Cited By ~ 2

Author(s):

Raphael Itzykson ◽

Sylvain Thépot ◽

Bechir Achour ◽

Bruno Quesnel ◽

Francois Dreyfus ◽

...

Keyword(s):

Research Funding ◽

Low Dose ◽

Overall Response Rate ◽

Best Supportive Care ◽

Poor Survival ◽

Overall Response ◽

Number Of Patients ◽

Ortho Biotech ◽

Study Population

Abstract Abstract 1773 Poster Board I-799 Background Patients aged ≥ 80 years account for as many as 30 to 35% of MDS in large registries (Rollison Blood 2008; Germing Ann Hematol 2008). Those patients (pts), when they have high risk MDS, are rarely candidates for chemotherapy (CT), even at low dose like low-dose araC, due to the risk of myelosuppression, and generally receive best supportive care (BSC) only, with very poor survival. Azacytidine (AZA) improves survival in higher-risk MDS pts, including RAEB-t and in pts aged > 75, with more limited myelosuppression than CT (Lancet Oncol 2009). Methods An AZA compassionate program (ATU) was opened in France between Dec 2004 and Dec 2008 for higher risk MDS, and for AML not candidates or refractory to intensive chemotherapy (IC). We retrospectively analyzed the outcome of MDS (including RAEB-t and CMML) pts ≥ 80 years from the 42 centers with complete patient (pt) reporting, and having received ≥ 1 cycle of AZA. Results The study population included 41 pts (M/F: 22/19; median age 83y, range 80-91) WHO diagnosis was RMCD in 2, RAEB-1 in 12, RAEB-2 in 16, and RAEB-t in 8, CMML in 3; IPSS cytogenetic risk favorable (fav) in 16, intermediate (int) in 10, and unfavorable (unfav) in 9 (karyotype failure/not done in 6); IPSS was int-1 in 8, int-2 in 18 and high in 13, undetermined in 2. Six pts had previously been treated unsuccessfully with low-dose AraC. With a median follow-up of 12 months, pts had received a median of 4 cycles (1-12) of AZA, at FDA/EMEA-approved schedule (75 mg/m2/d x7d/4 w) in 54% or a less intensive schedule (5d/4w, or <75 mg/m2/d) in 46%. Dose reduction was more frequent than in pts < 80y (30%, p=0.04). Febrile neutropenia was reported in 36% pts, 67% of whom required hospitalization. Both rates were comparable to those observed in pts < 80 years (p=0.2 and p=0.5, respectively), and were not lower in pts treated by less intensive AZA dosing (p=0.7; and p=0.6 respectively). 5 pts (12%) died before completion of 4 cycles, compared to 10% below the age of 80y (p=0.7). According to IWG 2006 criteria, the overall response rate (ORR) was 34%, including CR in 6 pts (15%), PR in 2 (5%), marrow CR (mCR) in 3 (7%), stable disease (SD) with HI in 3 (7%), SD without HI in 9 (21%), progression in 12 (29%), and AZA discontinuation before 4 cycles in 6 (16% including 5 deaths, 1 SAE). The ORR did not significantly differ from that of pts < 80y (45% p=0.6). Median OS was 17.1 months and 1-y and 2-y OS were and 59.7% and 49.8% respectively, not significantly different from OS of pts < 80y (median OS: 15 months, p=0.27). The number of patients was too small to analyze prognostic factors of response to AZA and survival. Conclusion Although this cohort of higher risk MDS aged 80 or greater obviously included a selected population of relatively “fit” very old persons, our results suggest that treatment with AZA in this age group is associated with significant overall response rates and OS rates at 1 or 2 years. There was no clear evidence of increased toxicity such as a higher hospitalization rate for infection or increased death rate before 4 cycles, when compared to similar patients aged less than 80. Disclosures Fenaux: Celgene: Honoraria, Research Funding; Roche: Honoraria, Research Funding; Ortho Biotech: Honoraria, Research Funding; Amgen: Honoraria, Research Funding; Cephalon: Honoraria, Research Funding; Merck: Honoraria, Research Funding; Novartis: Honoraria, Research Funding.

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Update of the Swedish Two-County Trial of Breast Cancer Screening: Histologic Grade-Specific and Age-Specific Results

Swiss Surgery ◽

10.1024/1023-9332.5.5.199 ◽

1999 ◽

Vol 5 (5) ◽

pp. 199-204 ◽

Cited By ~ 17

Author(s):

Tabar ◽

Vitak ◽

Chen ◽

Prevost ◽

Duffy

Keyword(s):

Breast Cancer ◽

Markov Chain ◽

Breast Cancer Mortality ◽

Mammographic Screening ◽

Histologic Grade ◽

Mortality Benefit ◽

Markov Chain Models ◽

Study Population ◽

Grade Iii

The benefit of mammographic screening in reducing mortality from breast cancer is well established. Questions remain with respect to the magnitude of the long-term benefit of modern mammography screening, age specific benefits and the timing of these, and histology-specific effects. Methods. The Swedish Two-County Trial was set up in 1977, with 77080 women aged 40-74 randomised to invitation to mammographic screening for breast cancer (active study population, ASP) and 55985 women randomised to no invitation (passive study population, PSP). There is now follow-up for mortality to 31 December 1996, approximately 18 years average follow-up. We investigated the effect of invitation of screening on breast cancer mortality and incidence of advanced tumours by age group (40-49 and 50-74) and histologic type. In addition we estimated progression rates by histologic grade using markov chain models. Results. A significant 29% reduction in breast cancer mortality was observed in association with invitation to screening (relative risk = 0.71, 95% confidence interval 0.60-0.83), maintaining the effect observed at previous stages of follow-up. Age-specific analyses show a smaller and later mortality benefit in women aged 40-49. This is related to the fact that there is a considerable benefit from early detection in terms of mortality from aggressive, poorly differentiated cancers in women aged 50-74, whereas the major effect in women aged 40-49 is on the less aggressive tumours of good or intermediate differentiation. Among women aged 50-74, the incidence of grade III tumours in the ASP is significantly lower than in the PSP, but this is not the case for women aged 40-49. This is related to the greater prevalence and rapidity of progression with respect to histologic grade, as evidenced by the results of markov chain models and the proportions of grade III tumours by time since last screen. Conclusions. The substantial and significant mortality benefit of invitation to mammographic screening in women aged 40-74 is maintained at 18 years of follow-up. To achieve a substantial mortality benefit at an early stage in the screening program in women aged under 50 years, an interscreening interval of 12-18 months would be required.

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Perioperative Chemotherapy versus Surgery Alone for Resectable Gastroesophageal Cancer

10.1093/med/9780199384075.003.0026 ◽

2017 ◽

Author(s):

Nicholas Manguso ◽

Miguel Burch

Keyword(s):

Gastric Cancer ◽

Study Design ◽

Perioperative Chemotherapy ◽

Gastroesophageal Cancer ◽

Population Number ◽

Number Of Patients ◽

Study Population ◽

Location Study ◽

Landmark Study

This chapter provides a summary of a landmark study in the management of gastric cancer (the MAGIC trial). Can the addition of perioperative chemotherapy to surgery improve outcomes in patients with potentially curable gastric cancer? Starting with this question, the chapter describes the basics of the study, including funding, year study began, year study was published, study location, study population, number of patients, study design, intervention, follow-up, endpoints, and criticisms. The chapter briefly reviews other relevant studies and information, gives a summary and discusses the implications and concludes with a clinical vignette to display how the study’s findings can be clinically applied.

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The onset time of amiodarone-induced thyrotoxicosis (AIT) depends on AIT type

Acta Endocrinologica ◽

10.1530/eje-14-0267 ◽

2014 ◽

Vol 171 (3) ◽

pp. 363-368 ◽

Cited By ~ 28

Author(s):

Luca Tomisti ◽

Giuseppe Rossi ◽

Luigi Bartalena ◽

Enio Martino ◽

Fausto Bogazzi

Keyword(s):

Onset Time ◽

Thyroid Volume ◽

Amiodarone Therapy ◽

Factors Affecting ◽

Pathogenic Mechanisms ◽

Number Of Patients ◽

Clinical Records ◽

Design And Methods

ObjectiveConsidering the different pathogenic mechanisms of the two main forms of amiodarone-induced thyrotoxicosis (AIT), we ascertained whether this results in a different onset time as well.Design and methodsWe retrospectively analyzed the clinical records of 200 consecutive AIT patients (157 men and 43 women; mean age 62.2±12.6 years) referred to our Department from 1987 to 2012. The onset time of AIT was defined as the time elapsed from the beginning of amiodarone therapy and the first diagnosis of thyrotoxicosis, expressed in months. Factors associated with the onset time of AIT were evaluated by univariate and multivariate analyses.ResultsThe median onset time of thyrotoxicosis was 3.5 months (95% CI 2–6 months) in patients with type 1 AIT (AIT1) and 30 months (95% CI 27–32 months, P<0.001) in those with type 2 AIT (AIT2). Of the total number of patients, 5% with AIT1 and 23% with AIT2 (P=0.007) developed thyrotoxicosis after amiodarone withdrawal. Factors affecting the onset time of thyrotoxicosis were the type of AIT and thyroid volume (TV).ConclusionsThe different pathogenic mechanisms of the two forms of AIT account for different onset times of thyrotoxicosis in the two groups. Patients with preexisting thyroid abnormalities (candidate to develop AIT1) may require a stricter follow-up during amiodarone therapy than those usually recommended. In AIT1, the onset of thyrotoxicosis after amiodarone withdrawal is rare, while AIT2 patients may require periodic tests for thyroid function longer after withdrawing amiodarone.

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