scholarly journals Metachronous neoplasms in patients with laterally spreading tumours during surveillance

2020 ◽  
pp. 205064062096531
Author(s):  
Roel MM Bogie ◽  
Bjorn Winkens ◽  
Sean JJ Retra ◽  
Chantal MC le Clercq ◽  
Mariëlle W Bouwens ◽  
...  
Keyword(s):  
Colorectal Neoplasms ◽  
Colorectal Neoplasm ◽  
Submucosal Invasion ◽  
High Grade Dysplasia ◽  
High Grade ◽  
Age And Gender ◽  
Metachronous Neoplasms ◽  
Metachronous Colorectal Cancer ◽  
And Gender

Background Laterally spreading tumours represent a major challenge for endoscopic detection and resection. Objective To examine synchronous and metachronous neoplasms in patients with laterally spreading tumours. Methods We prospectively collected colonoscopy and histopathology data from patients who underwent colonoscopy in our centre at up to 6 years’ follow-up. Post-resection surveillance outcomes between laterally spreading tumours, flat colorectal neoplasms 10 mm or greater, and large polypoid colorectal neoplasms, polypoid colorectal neoplasms 10 mm or greater, were compared. Results Between 2008 and 2012, 8120 patients underwent colonoscopy for symptoms (84.6%), screening (6.7%) or surveillance (8.7%). At baseline, 151 patients had adenomatous laterally spreading tumours and 566 patients had adenomatous large polypoid colorectal neoplasms. Laterally spreading tumour patients had more synchronous colorectal neoplasms than large polypoid colorectal neoplasm patients (mean 3.34 vs. 2.34, P < 0.001). Laterally spreading tumour patients significantly more often developed metachronous colorectal neoplasms (71.6% vs. 54.2%, P = 0.0498) and colorectal neoplasms with high grade dysplasia/submucosal invasion than large polypoid colorectal neoplasm patients (36.4% vs. 15.8%, P < 0.001). After correction for age and gender, laterally spreading tumour patients were more likely than large polypoid colorectal neoplasm patients to develop a colorectal neoplasm with high grade dysplasia or submucosal invasion (hazard ratio 2.9, 95% confidence interval 1.8–4.6). The risk of metachronous colorectal cancer was not significantly different in laterally spreading tumours compared to large polypoid colorectal neoplasm patients. Conclusion Patients with laterally spreading tumours developed more metachronous colorectal neoplasms with high grade dysplasia/submucosal invasion than large polypoid colorectal neoplasm patients. Based on these findings endoscopic treatment and surveillance recommendations for patients with laterally spreading tumours should be optimised.

scholarly journals Urothelial carcinoma and its association with age and gender.

2019 ◽  
Vol 26 (10) ◽  
pp. 1719-1723
Author(s):  
Rukhsana Parveen Samo ◽  
Asim Mehmood ◽  
Sana Kashif
Keyword(s):  
Urothelial Carcinoma ◽  
Male Gender ◽  
Health Science ◽  
P Value ◽  
Low Grade ◽  
High Grade ◽  
Histological Grading ◽  
Age And Gender ◽  
Significant Difference ◽  
And Gender

Objectives: To determine the urothelial carcinoma and its association with age and gender. Study Design: Retrospective study. Setting: Pathology department of Liaquat university of Medical and Health Science. Period: One year from January 2016 to December 2016. Material and Methods: Four micrometer thick paraffin-embedded and formalin-fixed sections were prepared from transurethral resection6of bladder6tumor (TURBT) samples of urothelial carcinoma patients and were examined. Histological grading was categorized as low and high grades. All the data was collected by self-made proforma. Data was analyzed by SPSS version 20. Results: Total 83 cases were enrolled in current study; their mean age was 49.19+12.33 years. Males were found in the majority 51(61.4%) and females were 32(38.6%). Most common age group was 46-60 years 36(43.4%). According to the histological grading high grade was most common as 65.10%, and low grade urothelial carcinoma was 34.90%. There was no significant difference according to age of histological grading. Male gender was most common, while progression of disease was higher among females in contrast to males as high grade carcinoma was significantly higher among females, p-value 0.014. Conclusion: It was concluded that male gender is the contributing factor of urothelial carcinoma, but disease progression significantly high among females. No significant association has been found according to age.

Endoscopic Surveillance Practice for Barrett's Oesophagus in Scotland and Early Experience in Implementing Local Guidelines

2003 ◽  
Vol 48 (2) ◽  
pp. 43-45 ◽  
Author(s):  
E F Shen ◽  
S Gladstone ◽  
G Milne ◽  
S Paterson-Brown ◽  
I D Penman
Keyword(s):  
Early Experience ◽  
High Grade Dysplasia ◽  
Low Grade ◽  
High Grade ◽  
Wide Variability ◽  
Low Grade Dysplasia ◽  
Surveillance Practice ◽  
Four Quadrant ◽  
The Impact

Management of columnar lined oesophagus (CLO; Barrett s oesophagus) is controversial. We prospectively audited surveillance practices in Scotland and prospectively assessed the impact of introducing local guidelines for Barrett s surveillance in Edinburgh. Most respondents were gastroenterologists. The majority take random, not four quadrant, biopsies from the CLO. In Edinburgh during 2000, 80 patients underwent surveillance. The guideline protocol was not followed in 30 (37.5%) patients. Follow up of patients without dysplasia generally conformed to the guidelines. Follow up of patients with low grade dysplasia was highly variable while management of those with high grade dysplasia followed the guidelines. Overall we found a wide variability in the management and surveillance of CLO. Early experience suggests that implementation of guidelines is helpful but there is still variation in practice.

Risk of High-Grade Dysplasia and Cancer at Follow-up After Colorectal Endoscopic Mucosal Resection (EMR)

2015 ◽  
Vol 110 ◽  
pp. S583
Author(s):  
Bhaumik Brahmbhatt ◽  
Abhishek Bhurwal ◽  
Michael Bartel ◽  
Jose Melendez ◽  
Massimo Raimondo ◽  
...  
Keyword(s):  
Endoscopic Mucosal Resection ◽  
High Grade Dysplasia ◽  
High Grade ◽  
Mucosal Resection

Long-term follow-up of patients with Barrett esophagus: Progression to high-grade dysplasia and esophageal adenocarcinoma according to histology at presentation.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 20-20 ◽  
Author(s):  
Allon Kahn ◽  
Vishnu Kommineni ◽  
Jonathan Callaway ◽  
Rahul Pannala ◽  
David Fleischer ◽  
...  
Keyword(s):  
Esophageal Adenocarcinoma ◽  
Large Cohort ◽  
High Grade Dysplasia ◽  
Continuous Treatment ◽  
Barrett Esophagus ◽  
Low Grade ◽  
High Grade ◽  
Upper Endoscopy ◽  
Early Stage Disease

20 Background: Esophageal adenocarcinoma (EAC) incidence is rising and prognosis is uniformly poor, even with early stage disease. Barrett esophagus (BE) serves as a premalignant marker for EAC, with an estimated progression of 0.5% per year. Low-grade (LGD) and high-grade dysplasia (HGD) confer a higher risk of progression, providing an opportunity for intervention and surveillance. Aims: To evaluate a large cohort of patients undergoing endoscopic evaluation of BE and thereby better understand the natural history of BE and dysplasia. Methods: A retrospective review of endoscopic databases was conducted for all patients with the diagnosis of BE undergoing upper endoscopy at a tertiary academic medical center from 1991-2010. All endoscopy and accompanying pathology reports were reviewed. Only those patients with 2 biopsies documenting specialized intestinal metaplasia were analyzed. Results: 848 patients underwent upper endoscopy for evaluation of BE. Of these, 674 patients met inclusion criteria, at a mean follow up of 66.6 months. Table 1 depicts the distribution of patients according to their histology at presentation. 22 (3.2%) patients presented with established EAC, while EAC developed in 51 (7.6%). Of patients with HGD, LGD, or no dysplasia (ND) at presentation, EAC ultimately developed in 30.6%, 6.6%, and 2.7%, respectively. EAC developed in 4 patients despite RFA treatment for ND (2) or LGD (2). HGD developed in 6 such patients after treatment for ND (3) and LGD (3). Only 1 patient in each RFA-treated cohort required esophagectomy, while the others cleared dysplasia or EAC with continuous treatment. Conclusions: In this large cohort of patients with Barrett’s esophagus, higher grade of dysplasia at first endoscopy was associated with development of EAC. Continuous surveillance during and after endoscopic treatment is necessary and often results in clearance of dysplasia and EAC. [Table: see text]

scholarly journals LV-GLS is a predictor of all-cause death and cardiovascular MACE events in patients with neuro-immunological disorders

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Khanna ◽  
I Wen ◽  
A Gupta ◽  
A Thakur ◽  
A Bhat ◽  
...  
Keyword(s):  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Autoimmune Encephalitis ◽  
Left Ventricular ◽  
Major Adverse Cardiovascular Events ◽  
Age And Gender ◽  
Immunological Disorders ◽  
Significant Difference ◽  
And Gender

Abstract Background Neuro-immunological disorders encompass several disease states, including multiple sclerosis (MS), autoimmune encephalitis (AE) and myasthenia gravis (MG). These autoimmune conditions are mediated via pro-inflammatory cytokines, and there is growing evidence to suggest cardiovascular involvement within these inflammatory states. Left ventricular global longitudinal strain (LV-GLS) is proposed to be a more sensitive measure of LV systolic function when compared to standard two-dimensional measures such as LV ejection fraction (LVEF). Purpose The purpose of this study was to assess for subclinical cardiac dysfunction in a cohort of patients with neuro-immunological disorders and correlate this with the development of outcomes on follow-up. Methods Consecutive patients with MS, AE and MG admitted to our institution during 2013–2020 were assessed (n=102). Patients without pre-existing cardiovascular disease, LVEF &lt;50% or lack of comprehensive transthoracic echocardiography during their index admission were included (n=55). This group was compared to age- and gender-matched controls (n=55) LV-GLS was measured offline using vendor-independent software (TomTec Arena, Germany v4.6) by two cardiologists blinded to the patient group or outcomes. These patients were followed for up for the composite outcome of all-cause death and major adverse cardiovascular events (MACE). Results A total of 55 patients (31 MS, 14 AE and 10 MG) were age- and gender- matched to 55 controls. There was no significant difference in baseline demographic characteristics or cardiovascular risk factors between groups. Patients with neuro-immunological disorders demonstrated impaired LV-GLS (−17.6±3.5 vs −20.8±1.9; p&lt;0.01) when compared to healthy controls, despite an LVEF within the normal range (60.9±7.7 vs 64.1±5.7; p=0.02) in both groups. There were a total of 9 (16.4%) outcomes during a mean follow-up of 41.0±33.0 months. LV-GLS was the only significant echocardiographic predictor of all-cause death and MACE events (p=0.013) on multi-variate analysis. Conclusions Our results suggest that patients with neuro-immunological disorders have subclinical LV dysfunction as assessed by LV-GLS which has prognostic capacity in this population. Further larger studies are required to further characterize this phenomenon. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Age- and gender-related differences in the evolution of psychological and cognitive status after the lockdown for the COVID-19 outbreak: a follow-up study

2021 ◽  
Author(s):  
Gianpaolo Maggi ◽  
Ivana Baldassarre ◽  
Andrea Barbaro ◽  
Nicola Davide Cavallo ◽  
Maria Cropano ◽  
...  
Keyword(s):  
Cognitive Status ◽  
Age And Gender ◽  
Follow Up Study ◽  
And Gender

scholarly journals The association of tissue doppler E/e' ratio with poor survival is modified by gender and is attenuated with advanced age

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
Y Wasserstrum ◽  
R Gilead ◽  
R Kuperstein ◽  
S Ben-Zekry ◽  
O Vatury ◽  
...  
Keyword(s):  
Cox Regression ◽  
Mitral Annulus ◽  
Tissue Doppler ◽  
Outcome Data ◽  
Poor Survival ◽  
Age And Gender ◽  
Risk Of Death ◽  
Increased Risk ◽  
And Gender

Abstract Introduction Contemporary guidelines recommend a universal cutoff of 14 for the ratio between early mitral flow wave and early diastolic mitral annulus velocity measured by tissue doppler (E/e' ratio). While age-dependent normal E/e' values have been suggested, outcome data is lacking. Purpose We sought to evaluate the modification effect of age and gender on the prognostic value of the E/e' ratio. Methods Consecutive patients who underwent echocardiographic evaluation between 2009 and 2021 (N=104,315) in a single tertiary cardiovascular center. Patients with left or right ventricular dysfunction, any significant valvular disease, structural heart disease or evidence of pulmonary hypertension were excluded. Cancer and mortality data were available for all subjects from national registries. Patients with a metastatic malignancy at baseline or during follow up were excluded. Cox regression models were applied. Results Overall, 44,541 patients were included in the final analysis. Mean age was 55±17, 59% were male and 63% of the exams were performed in an outpatient setting. An elevated E/e' ratio above 14 was documented in 2,598 (7%) patients. During a median follow-up of 5.7 (IQR 2.8–9.1) years, 5,015 (11.3%) patients died. Kaplan Meier survival analysis demonstrated that the cumulative probability of death at 6 years was 23.4% (21.6–25.3) among patients with elevated E/e' ratio compared with 9.7% (9.3–10.0) among patients with E/e'&lt;14 (p Log rank &lt;0.001). This difference was less significant as age progressed (figure 1). Multivariate cox-regression model yielded consistent results such that an elevated E/e' ratio was associated with 2.66-fold increased risk of death during follow up (95% CI 2.44–2.89, p&lt;0.001), and there was a decline in the increased risk and significant as age advanced in both genders (figure 2). Interaction analysis was significant for both gender and age such the association of elevated E/e' ratio with poor survival was more significant among men compared with women and among young vs. older subjects. Among women, elevated E/e' was associated with 2.4-fold increased risk of death versus 2.7-fold increased risk among men. Similarly, the hazard ratio for death associated with elevated E/e' was 2.29 (95% CI 1.74–3.02), 1.8 (95% CI 1.5–2.1), 1.13 (95% CI 0.97–1.31) and 1.07 (95% CI 0.92–1.25) for the age groups of &lt;60, 60–70, 70–80 and &gt;80, respectively. In a sensitivity analysis, similar findings were seen in when excluding patients with mild hypertrophy (maximal wall thickness &gt;12mm) and without any mitral annulus calcification. Conclusion In apparently normal hearts, an elevated E/e' ratio is independently associated with increased mortality. This association is more pronounced among men and is attenuated with increased age. This study supports the need for gender-specific and age-specified outcome data with respect to measures of diastolic dysfunction. FUNDunding Acknowledgement Type of funding sources: None. Survival by age and gender groups E/e' &gt;14 and mortality by age and gender

Risk of stroke in patients with Chagas cardiomyopathy is associated with depressed LV function but not with LV myocardial fibrosis or apical aneurysm: a study using cardiovascular magnetic resonance

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Schmidt ◽  
H Turin Moreira ◽  
G.J Volpe ◽  
M.F Braggion Santos ◽  
J.A Marin Neto
Keyword(s):  
Atrial Fibrillation ◽  
Magnetic Resonance ◽  
Myocardial Fibrosis ◽  
Age And Gender ◽  
Chagas Cardiomyopathy ◽  
History Of ◽  
And Gender ◽  
Apical Aneurysm ◽  
Normal Lvef

Abstract Background Chronic Chagas cardiomyopathy (CCC) is classically related to higher occurrence of thromboembolic events, especially stroke, particularly in patients with atrial fibrillation (AF). However, risk factors for stroke in patients with CCC but no atrial fibrillation have not been well established. Purpose We aimed to assess the relationship between left ventricular (LV) structure and function, as evaluated with cardiac magnetic resonance (CMR), with stroke in individuals with CCC. Methods We prospectively collected data from 141 patients with CCC who underwent CMR from October 2009 to December 2013 and who were thereafter followed for a median period of 6.8 years. The outcome was the occurrence of stroke during the follow-up period. The only exclusion criteria were history of previous stroke, AF or use of oral anticoagulant (OAC) at the time of CMR. CMR-derived LV parameters were: LV ejection fraction (LVEF), extension of LV myocardial fibrosis, assessed by late gadolinium enhancement, and presence of LV apical aneurysm. LVEF was classified as follows: (I) normal ≥55%; (II) mid-range &lt;55% and ≥40%; and (III) reduced &lt;40%. Age and gender were covariates in the adjusted Cox proportional hazard model. Results Of the initial 141 CCC participants, 25 subjects were excluded due to previous stroke (n=2), history of AF (n=11), or use of OAC (n=12). The remaining 116 individuals had a mean age of 56±14 years, 51% women. Normal, mid-range and reduced LVEF were found in 48 (41%), 43 (37%), and 25 (22%) patients, respectively. Myocardial fibrosis was detected in 79 of 111 (71%) subjects in whom the detection method was feasible. The extension of LV fibrosis was evaluated as a median of 4.6% [interquartile range: 0–10]. LV apical aneurysm was identified in 36 (31%) patients. During the follow-up (median 6.8 years), stroke was reported in 9 participants. In the univariate analysis, reduced LVEF was significantly associated with higher risk of stroke compared to normal LVEF (HR: 9.2, 95% CI: 1.8–48.4), while there was no significant difference between mid-range and normal LVEF (HR: 1.2, 95% CI: 0.2–8.2). The association of reduced LVEF and stroke remained significant in the multivariable model, adjusted for age and gender (HR: 12.6, 95% CI: 1.9–83.2). Kaplan-Meier curves are presented in figure 1 (logrank p-value &lt;0.001). Neither the extension of LV myocardial fibrosis (HR: 1.0, 95% CI: 0.9–1.1) nor the presence of LV apical aneurysm (HR: 1.9, 95% CI: 0.5–7.2) was related to higher risk of stroke. Conclusion In patients with CCC, reduced LVEF assessed by CMR, but not LV fibrosis or presence of apical aneurysm, was a significant predictor of stroke. Funding Acknowledgement Type of funding source: None

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