Cancer Incidence in Epic-Italy at First Follow-Up

2003 ◽  
Vol 89 (6) ◽  
pp. 656-664 ◽  
Author(s):  
Rosario Tumino ◽  
Graziella Frasca ◽  
Domenico Palli ◽  
Giovanna Masala ◽  
Giovanna Tagliabue ◽  
...  
Keyword(s):  
Cancer Incidence ◽  
Uterine Cancer ◽  
Descriptive Analysis ◽  
Cancer Registries ◽  
Pooled Data ◽  
Cancer Occurrence ◽  
Starting Point ◽  
Lost To Follow Up

A descriptive analysis was performed in order to evaluate the completeness of follow-up and to explore the occurrence of malignancy in the Italian section of the European Prospective Investigation into Cancer and Nutrition (EPIC-Italy) at the first follow-up for cancer incidence. The EPIC-Italy cohort consisted of 47,749 subjects, aged 35-65 years, who voluntarily accepted to participate in the project from 1992-1997. Tabulations of the enrolled subjects are presented by sex, age groups, population at risk and person-years as calculated at the first follow-up in 1998; alive, lost to follow-up and dead subjects were tabulated by sex and centers. Cancer occurrence is described by quality indexes of data collected and the lapse of time between the date of recruitment and date of diagnosis. External comparisons for each center and pooled data were carried out by calculation of standard incidence ratios (SIRs) using the rates of the population-based cancer registries covering the areas of EPIC Italian centers. Similarly, an internal comparison was also performed using as the reference population the EPIC-Italy center with the lowest crude cancer incidence rates. A total of 148,968 person-years (43,568 men and 105,400 women) was calculated as the denominator; the percentages of lost to follow-up were 1.34% for men and 0.9% for women. We found 781 malignancies (216 in males and 565 in females), 17 in situ breast cancers and 8 in situ cervical cancers. In men 65 malignant cases (30.1%) and in women 186 malignancies (32.9%) occurred in the first year following enrollment. The proportion of microscopically verified cancers was 93.1%. In pooled data for men, statistically significant SIRs of less than 1 were calculated for all cancer sites combined (SIR = 0.81), lung (SIR = 0.49) and bladder (SIR = 0.62), whereas statistically significant excesses of observed cases were found for melanoma and cancers of ill-defined sites within respiratory system and intrathoracic organs (ICD-0-2 = C39). In pooled data for women, none of the SIRs were statistically significant. For men, SIRs disaggregated by center showed statistically significant excesses of cases only in Florence for the thyroid (SIR = 5.01). For women, statistically significant excesses of observed cases were computed in Florence and Varese for breast cancer (SIRs, 1.36 and 1.27, respectively), Florence for uterine cancer NOS (SIR = 20.3) and Varese for kidney (SIR 2.24). Internal comparisons showed some evidence of an excess of cases in northern compared to southern centers. In conclusion, after an average follow-up of 3 years, nearly 99% of the enrolled individuals were traced and checked for their vital status. Cancer occurrence in women was not far from that expected in comparison to the local general population, whereas in men significantly fewer cases than expected were observed. This preliminary descriptive analysis will be used as a starting point for monitoring the validity of EPIC-Italy over time.

scholarly journals Cryoablation of Small Renal Tumors in Patients with Solitary Kidneys: Initial Experience

2008 ◽  
Vol 2008 ◽  
pp. 1-3 ◽  
Author(s):  
Ravi Munver ◽  
Grant I. S. Disick ◽  
Salvatore A. Lombardo ◽  
Vladislav G. Bargman ◽  
Ihor S. Sawczuk
Keyword(s):  
Tumor Location ◽  
Renal Tumors ◽  
Minimal Risk ◽  
Contralateral Kidney ◽  
Nephron Sparing ◽  
Feasible Alternative ◽  
Lost To Follow Up

Introduction. The purpose of this study was to evaluate the role of renal cryoablation in patients with solitary kidneys with the goals of tumor destruction and maximal renal parenchymal preservation.Methods. Eleven patients with single tumors were treated with cryoablation, of which 10 patients had solitary kidneys and 1 had a nonfunctioning contralateral kidney. All procedures were performed via an open extraperitoneal approach; ten tumors were treated with in-situ cryoablation and 1 tumor was treated with cryo-assisted partial nephrectomy.Results. Cryoablation was successfully performed without any preoperative complications. Mean patient age was 62.4 years (range 49–79), tumor location included: 6 (upper pole), 2 (mid-kidney), 3 (lower pole). The mean and median tumor size was 2.6 cm and 2.8 cm (range 1.2–4.3 cm), mean operative time 205 minutes (range 180–270 minutes), blood loss 98.5 ml (range 40–250 ml), and hospitalization 4.6 days (range 3–8 days). Creatinine values included: preoperative 1.43 mg/dL (range 1.2–1.9), postoperative 1.67 mg/dL (range 1.5–2.5), and nadir 1.57 mg/dL (range 1.3–2.1). All patients were followed postoperatively with magnetic resonance imaging for surveillance. At a median follow-up of 43 months, 9 patients had no evidence of recurrence, 1 patient has an enhancing indeterminate area, and 1 patient was lost to follow-up.Conclusion. Intermediate-term results suggest that renal cryoablation offers a feasible alternative for patients that require a maximal nephron-sparing effort with preservation of renal function and minimal risk of tumor recurrence.

scholarly journals 1054 A Simple Intervention to Minimise the Incidence of The Forgotten Ureteric Stent: Updating the Surgical Discharge Summary

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Wong ◽  
R Sehgal ◽  
A Goyal ◽  
D Allen
Keyword(s):  
Discharge Summary ◽  
Sufficient Information ◽  
Health Seeking ◽  
Post Intervention ◽  
Discharge Letter ◽  
Red Flag ◽  
Considerable Morbidity ◽  
Lost To Follow Up

Abstract Introduction Ureteric stents are routinely used in ureteric obstruction, however, have considerable morbidity with major complications, such as encrustation, obstruction, urosepsis, and renal failure if left in situ for longer than six months. Despite an electronic stent register, there are still multiple emergency admissions of complications from forgotten stents, as well as those presenting with significant stent symptoms. Often stents are inserted as an emergency procedure with minimal information given on their discharge summary. A discharge template was therefore introduced that could also serve as a patient information leaflet to help minimise the incidence of forgotten stents. Method A discharge template was designed based off the trust-endorsed and British Association of Urological Surgeons (BAUS) patient leaflet and distributed amongst the juniors. A total of 28 patients were interviewed via telephone questionnaires – 21 randomly selected pre-intervention and 7 post-intervention from a one-month scale either side of the intervention. The template included: information on stents, common stent symptoms, indications to seek healthcare advice, and contact details to use in the event they are lost to follow-up. Results Patients aware that stents should be changed within six months went from 52% to 100%. Awareness of stent symptoms and red-flag symptoms went from 52% to 91%, and 57% to 100% respectively. Those who felt they had sufficient information on the discharge letter to understand their stent increased from 52 to 89%. Conclusions Significant improvement in patient understanding of stents and therefore hopefully in appropriate health-seeking behaviour, patient rapport, safety, and improvement in stents removed within target.

scholarly journals The Palliative Management of Refractory Cirrhotic Ascites Using the PleurX©Catheter

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Jason Reinglas ◽  
Kayvan Amjadi ◽  
Bill Petrcich ◽  
Franco Momoli ◽  
Thomas Shaw-Stiffel
Keyword(s):  
High Risk ◽  
Patency Rate ◽  
Spontaneous Bacterial Peritonitis ◽  
Treatment Options ◽  
Technical Success ◽  
Bacterial Peritonitis ◽  
Large Volume Paracentesis ◽  
Lost To Follow Up

Background. Treatment options are limited for patients with refractory cirrhotic ascites (RCA). As such, we assessed the safety and effectiveness of the PleurX catheter for RCA.Methods. A retrospective analysis was performed on all patients with RCA who have undergone insertion of the PleurX catheter between 2007 and 2014 at our clinic.Results. Thirty-three patients with RCA were included in the study; 4 patients were lost to follow-up. All patients were still symptomatic despite bimonthly large volume paracentesis and were not candidates for TIPS or PV shunt. Technical success was achieved in 100% of patients. The median duration the catheter remained in situ was 117.5 days, with 95% CI of 48–182 days. Drain patency was maintained in 90% of patients. Microorganisms consistent with spontaneous bacterial peritonitis (SBP) from a catheter source were isolated in 38% of patients. The median time to infection was 105 days, with 95% CI of 34–233 days. All patients were treated for SBP successfully with antibiotics.Conclusion. Use of the PleurX catheter for the management of RCA carries a high risk for infection when the catheter remains in situ for more than 3 months but has an excellent patency rate and did not result in significant renal injury.

scholarly journals Cancer Incidence in World Trade Center Rescue and Recovery Workers: 14 Years of Follow-Up

2021 ◽  
Author(s):  
Jiehui Li ◽  
Janette Yung ◽  
Baozhen Qiao ◽  
Erin Takemoto ◽  
David G Goldfarb ◽  
...  
Keyword(s):  
Cancer Risk ◽  
Cancer Incidence ◽  
World Trade ◽  
Cox Regression ◽  
World Trade Center ◽  
Cancer Registries ◽  
Increased Risk ◽  
Long Term Follow Up ◽  
Trade Center

Abstract Background Statistically significantly increased cancer incidence has been reported from 3 cohorts of World Trade Center (WTC) disaster rescue and recovery workers. We pooled data across these cohorts to address ongoing public concerns regarding cancer risk 14 years after WTC exposure. Methods From a combined deduplicated cohort of 69 102 WTC rescue and recovery workers, a sample of 57 402 workers enrolled before 2009 and followed through 2015 was studied. Invasive cancers diagnosed in 2002-2015 were identified from 13 state cancer registries. Standardized incidence ratios (SIRs) were used to assess cancer incidence. Adjusted hazard ratios (aHRs) were estimated from Cox regression to examine associations between WTC exposures and cancer risk. Results Of the 3611 incident cancers identified, 3236 were reported as first-time primary (FP) cancers, with an accumulated 649 724 and 624 620 person-years of follow-up, respectively. Incidence for combined FP cancers was below expectation (SIR = 0.96, 95% confidence interval [CI] = 0.93 to 0.99). Statistically significantly elevated SIRs were observed for melanoma-skin (SIR = 1.43, 95% CI = 1.24 to 1.64), prostate (SIR = 1.19, 95% CI = 1.11 to 1.26), thyroid (SIR = 1.81, 95% CI = 1.57 to 2.09), and tonsil (SIR = 1.40, 95% CI = 1.00 to 1.91) cancer. Those arriving on September 11 had statistically significantly higher aHRs than those arriving after September 17, 2001, for prostate (aHR = 1.61, 95% CI = 1.33 to 1.95) and thyroid (aHR = 1.77, 95% CI = 1.11 to 2.81) cancers, with a statistically significant exposure-response trend for both. Conclusions In the largest cohort of 9/11 rescue and recovery workers ever studied, overall cancer incidence was lower than expected, and intensity of WTC exposure was associated with increased risk for specific cancer sites, demonstrating the value of long-term follow-up studies after environmental disasters.

scholarly journals Retained plastic biliary stent presenting with obstructive jaundice: a case report

2021 ◽  
Vol 8 (9) ◽  
pp. 2792
Author(s):  
Gayatri Muley ◽  
Waqar Ansari ◽  
Atish Parikh ◽  
Dhiraj Kachare ◽  
Urvashi Jain ◽  
...  
Keyword(s):  
Case Report ◽  
Obstructive Jaundice ◽  
Biliary Obstruction ◽  
Biliary Stent ◽  
Plastic Stent ◽  
History Of ◽  
Lost To Follow Up ◽  
Cbd Exploration

Forgotten stents may lead to serious complications. We present a case report of a forgotten common bile duct (CBD) fully covered plastic stent presenting with Obstructive Jaundice. A 66 years-old female patient presented with features of obstructive jaundice. Further enquiry revealed a history of ERCP guided biliary stent placement 12 years ago, after which she was lost to follow up. An endoscopic attempt to retrieve the old stent and relieve biliary obstruction was unsuccessful, and a fresh stent was placed across the CBD following a sphincterotomy. CT showed evidence of a stent in situ, alongside calcified fragments of the previous stent and multiple CBD stones. Patient was taken up for surgery and Roux-en-y hepaticojejunostomy was performed following CBD exploration and retrieval of the stent-stone complex.

scholarly journals Cancer Incidence and Mortality in 260,000 Nordic Twins With 30,000 Prospective Cancers

2019 ◽  
Vol 22 (2) ◽  
pp. 99-107 ◽  
Author(s):  
Axel Skytthe ◽  
Jennifer R. Harris ◽  
Kamila Czene ◽  
Lorelei Mucci ◽  
Hans-Olov Adami ◽  
...  
Keyword(s):  
General Population ◽  
Cancer Incidence ◽  
Cancer Registries ◽  
Incidence Rates ◽  
Malignant Neoplasms ◽  
Cancer Risk Factors ◽  
Background Population ◽  
Incidence And Mortality ◽  
Risk Of Cancer

AbstractThe Nordic countries have comprehensive, population-based health and medical registries linkable on individually unique personal identity codes, enabling complete long-term follow-up. The aims of this study were to describe the NorTwinCan cohort established in 2010 and assess whether the cancer mortality and incidence rates among Nordic twins are similar to those in the general population. We analyzed approximately 260,000 same-sexed twins in the nationwide twin registers in Denmark, Finland, Norway and Sweden. Cancer incidence was determined using follow-up through the national cancer registries. We estimated standardized incidence (SIR) and mortality (SMR) ratios with 95% confidence intervals (CI) across country, age, period, follow-up time, sex and zygosity. More than 30,000 malignant neoplasms have occurred among the twins through 2010. Mortality rates among twins were slightly lower than in the general population (SMR 0.96; CI 95% [0.95, 0.97]), but this depends on information about zygosity. Twins have slightly lower cancer incidence rates than the general population, with SIRs of 0.97 (95% CI [0.96, 0.99]) in men and 0.96 (95% CI [0.94, 0.97]) in women. Testicular cancer occurs more often among male twins than singletons (SIR 1.15; 95% CI [1.02, 1.30]), while cancers of the kidney (SIR 0.82; 95% CI [0.76, 0.89]), lung (SIR 0.89; 95% CI [0.85, 0.92]) and colon (SIR 0.90; 95% CI [0.87, 0.94]) occur less often in twins than in the background population. Our findings indicate that the risk of cancer among twins is so similar to the general population that cancer risk factors and estimates of heritability derived from the Nordic twin registers are generalizable to the background populations.

Shimodaira-Taniguchi Conization Method: Its Utility and Reliability

2010 ◽  
Vol 20 (6) ◽  
pp. 1025-1030 ◽  
Author(s):  
Maki Matsumura ◽  
Tsuyoshi Ota ◽  
Nobuhiro Takeshima ◽  
Ken Takizawa
Keyword(s):  
Operation Time ◽  
Intraepithelial Neoplasia ◽  
Adenocarcinoma In Situ ◽  
Secondary Hemorrhage ◽  
Stage Ia ◽  
Cancer Of The Cervix ◽  
Lost To Follow Up ◽  
Frequency Current

Introduction:Introduced in 1992, the Shimodaira-Taniguchi conization procedure addresses the disadvantages of the loop electrosurgical excision procedure by relying on a high frequency current of 150 W and a triangular probe with a 0.25-mm linear excision electrode to extract a single informative specimen. We conducted a retrospective study to evaluate Shimodaira-Taniguchi conization as a conservative therapy for cervical intraepithelial neoplasia (CIN) and microinvasive cancer of the cervix.Methods:Subjects were 455 patients who underwent Shimodaira-Taniguchi conization for CIN, carcinoma in situ, adenocarcinoma in situ, or stage IA microinvasive cervical carcinoma at our hospital from January 2005 to December 2008. Patient follow-up ranged from 13 to 60 months. Clinical data were obtained and evaluated.Results:Mean operation time was 11 minutes, and average blood loss was 9.9 mL. Margins were positive in 178 (39.1%) cases. Postsurgical complications occurred in 61 patients, with secondary hemorrhage occurring in 46 patients. None required transfusion. None were lost to follow-up, and there was no disease-related death. Disease recurred in 6 (1.3%) patients: 4 with a positive excision margin and 2 with a negative margin. Cervical stenosis occurred in 15 (3.3%) patients, 3 of whom suffered cervical obstruction, including 1 with dysmenorrhea who underwent hysterectomy. In most cases (n = 357, 78%), a single adequate specimen was extracted.Conclusions:As a conservative treatment for CIN and microinvasive cervical cancer, Shimodaira-Taniguchi conization is useful. It is easy, provides adequate histologic specimens (often singular), and results in few postoperative complications.

SP1.1.4The Walking Thread – What happens to fistula-in-ano patients who are lost to follow up? A Service Improvement Study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Ellen Murgitroyd ◽  
Blair Wilson ◽  
Darja Kremel ◽  
David Anderson
Keyword(s):  
Current Practice ◽  
Single Point ◽  
Perianal Abscess ◽  
Service Improvement ◽  
Fistula In Ano ◽  
Best Management ◽  
Retrospective Audit ◽  
Lost To Follow Up

Abstract Aims Management of perianal abscess and resultant fistula-in-ano remains controversial. Studies suggest that 1/3 of idiopathic cryptoglandular abscesses can result in fistula-in-ano. Our current practice is to incise and drain primary abscesses and for patients to return as necessary. Known fistula patients will be appointed for Examination Under Anaesthetic (EUA) at 6-12 weeks. Does this result in best management or do they become “elective emergencies”? Methods A retrospective audit of management of fistula-in-ano over 4 years was conducted, utilising precollected data of Cryptoglandular abscesses, excluding inflammatory, radiation or malignant causes. Patients lost to follow up were analysed including presentation, fistula diagnosed at first or subsequent attendance, number of operations, number of attendances and seton placement. Results 512 patients underwent operations for cryptoglandular abscess causing fistula-in-ano between 2013 and 2017. 10% (N = 50) were lost to follow up despite documented follow up plans for 32. Of these, 18 were elective attendances, 14 emergency. 24 of the 32 had a Seton sited prior to being lost to follow up. Conclusions The various presentations (emergency, elective, clinic) and waiting lists mean these patients are presenting as emergencies whilst awaiting follow-up. Many are simply lost to follow up, with Setons in-situ.   We propose a fortnightly hot-clinic system, run by second on-call registrars to assess and manage these patients. This would provide an elective clinic to allow single point of access to fistula-in-ano patients ensuring prompt follow-up and reduction in unnecessary EUA, as well as improving senior colorectal trainees exposure to perianal disease and its management.

scholarly journals High rates of culture conversion and low loss to follow-up in MDR-TB patients managed at Regional Referral Hospitals in Uganda

2019 ◽  
Author(s):  
Martin Kayitale Mbonye ◽  
John-Paul Otuba ◽  
Sara Riese ◽  
Hilary Alima ◽  
Frank Mugabe ◽  
...  
Keyword(s):  
Treatment Initiation ◽  
Descriptive Analysis ◽  
Scale Up ◽  
Health Concern ◽  
Tb Treatment ◽  
Referral Hospitals ◽  
Mdr Tb ◽  
Lost To Follow Up ◽  
Hiv Negative

Abstract Background: Multi-drug resistant – tuberculosis (MDR-TB) is an emerging public health concern in Uganda, with only just over 200 new cases notified by 2014. Prior to 2013, MDR-TB treatment in Uganda was only being provided at the national referral hospital and two private-not-for profit clinics. From 2013, MDR-TB treatment was scaled up to seven regional referral hospitals (RRH). We analyzed data on the first cohort of patients started on MDR-TB treatment at the seven RRH. Methods: This study was a retrospective descriptive analysis of data collected on a cohort of 69 patients started on MDR-TB treatment at 7 RRHs between 1st April 2013 and 30th June 2014. Results: Of the 69 patients, 21 (30.4%) were female and 39 (56.5%) were HIV-negative. Thirty (43.5%) were resistant to both isoniazid and rifampicin and 57 (82.6%) were category 1 or 2 failures. Median age at the start of MDR-TB treatment was 35 years (SD 13.5), mean time-to-treatment initiation was 96.1 days and out of the 30 HIV-positive patients, 27 (90.0%) were on anti-retroviral treatment with a mean CD4 count of 258. Within six months of treatment, 59 (86.0%) patients’ culture converted, of which 45 (65.2%) converted by the second month and 14 (20.3%) by the sixth month, one (1.5%) did not culture convert, three (4.4%) died and six (8.8%) were lost-to-follow up. Thirty-two (46.4%) patients experienced at least one severe drug adverse event, while 40 (67.8%) gained weight (mean 4.7 kilograms). Conclusions: Despite MDR-TB treatment initiation delays, most patients culture converted early, while few were lost to follow-up. These interim outcomes indicate a successful scale-up of MDR-TB treatment at RRH. Reasons for the high proportion of HIV-negative patients on MDR-TB treatment should be investigated.

scholarly journals 1129 UK Based Experience of The Elipsetm Intragastric Balloon; Short Term Safety and Effectiveness

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Sandhya ◽  
B Oyewole ◽  
I Stefanova ◽  
S Mangat ◽  
S Monkhouse
Keyword(s):  
Weight Loss ◽  
Average Weight ◽  
Gastric Balloon ◽  
Short Term ◽  
X Ray ◽  
Sustained Weight Loss ◽  
Lost To Follow Up

Abstract Aim Intra Gastric Balloons (IGB) have been used over the last three decades as a minimally invasive, non-surgical weight-loss option. The ElipseTM gastric balloon (EIGB) is a ‘procedure-less’ gastric balloon which can be placed in an average of 20 minutes without the need of endoscopy or sedation. The aim of our study is to investigate the first cohort of patients in uk who underwent IGB capsule and short term follow up. Method Single centre retrospective study of the first consecutive 202 patients that had the Eclipse IGB inserted between May 2018 and November 2020. Patients swallow the ElipseTM capsule and pre-inflation x-ray is taken to confirm correct positioning after which the gastric balloon is inflated with 550mls of sterile water and a post-inflation x-ray is taken. The balloon is designed to be in-situ for 4 months and then automatically deflates. Results Out of 202 patients 24 were lost to follow-up, 146 patients followed up to an average of 15 weeks, while 26 patients followed up to 4 weeks. Average weight loss at 4 weeks was 6% Total Weight Loss (%TWL) while at last follow up 9.63% TWL. Majority of patients experienced post procedural reflux, abdominal pain, bloating and vomiting. 6 patients had early removal of the balloon due to severe symptoms (4), pancreatitis (1) and hyperinflation (1). 1 had early expulsion at 2 months. Conclusions Eclipse IGB is safe and effective in selective patients, however long-term follow is needed to compare it with the other balloons in terms of significant and sustained weight loss.

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