Impact of Supine Radiographs to Assess Curve Flexibility in the Treatment of Adolescent Idiopathic Scoliosis

2021 ◽  
pp. 219256822098827
Author(s):  
Subaraman Ramchandran ◽  
Ali Monsour ◽  
Alexander Mihas ◽  
Kevin George ◽  
Thomas Errico ◽  
...  
Keyword(s):  
External Validity ◽  
Roc Analysis ◽  
Single Institution ◽  
Contingency Table Analysis ◽  
Predictive Values ◽  
Table Analysis ◽  
Side Bending ◽  
Supine Radiograph

Study Design: Retrospective cohort study. Objectives: The purpose of the study is to evaluate the role of supine radiographs in determining flexibility of thoracic and thoracolumbar curves. Methods: Ninety operative AIS patients with 2-year follow-up from a single institution were queried and classified into MT structural and TL structural groups. Equations were derived using linear regression to compute cut-off values for MT and TL curves. Thresholds were externally validated in a separate database of 60 AIS patients, and positive and negative predictive values were determined for each curve. Results: MT supine values were highly predictive of MT side-bending values (TL group: 0.63, P < 0.001; MT group: 0.66, P = 0.006). Similarly, TL supine values were highly predictive of TL side-bending values (TL group: 0.56, P = 0.001 MT group: 0.68, P = 0.001). From our derived equations, MT and TL curves were considered structural on supine films if they were ≥ 30° and 35°, respectively. Contingency table analysis of external validity sample showed that supine films were highly predictive of structurality of MT curve (Sensitivity = 0.91, PPV = 0.95, NPV = 0.81) and TL curve (Sensitivity = 0.77, PPV = 0.81, NPV = 0.94). ROC analysis revealed that the area under curve for MT structurality from supine films was 0.931 (SEM: 0.03, CI: 0.86-0.99, P < 0.001) and TL structurality from supine films was 0.922 (SEM: 0.03, CI- 0.84-0.98, P < 0.001). Conclusions: A single preoperative supine radiograph is highly predictive of side-bending radiographs to assess curve flexibility in AIS. A cut-off of ≥ 30° for MT and ≥ 35° for TL curves in supine radiographs can determine curve structurality.

Role of contrast-enhanced spectral mammography in the post biopsy management of B3 lesions: Preliminary results

2018 ◽  
Vol 105 (5) ◽  
pp. 378-387 ◽  
Author(s):  
Giulia Bicchierai ◽  
Jacopo Nori ◽  
Diego De Benedetto ◽  
Cecilia Boeri ◽  
Ermanno Vanzi ◽  
...  
Keyword(s):  
Breast Imaging ◽  
Surgical Excision ◽  
Surgical Biopsy ◽  
Predictive Values ◽  
Contrast Enhanced ◽  
B3 Lesions ◽  
Malignant Lesions ◽  
Sensitivity Specificity

PurposeTo evaluate the role of contrast-enhanced spectral mammography (CESM) in the post biopsy management of breast lesions classified as lesions of uncertain malignant potential (B3) by core needle biopsy and vacuum-assisted biopsy (VAB).MethodsThe local ethics committee approved this retrospective study and for this type of study formal consent is not required. A total of 42 B3 lesions in 40 women aged 41–77 years were included in our study. All patients underwent CESM 2–3 weeks after the biopsy procedure and surgical excision was subsequently performed within 60 days of the CESM procedure. Three radiologists reviewed the images independently. The results were then compared with histologic findings.ResultsThe sensitivity, specificity, and positive and negative predictive values for confirmed demonstration of malignancy at CESM were 33.3%, 87.2%, 16.7%, and 94.4% for reader 1; 66.7%, 76.9%, 18.2%, and 96.7% for reader 2; 66.7%, 74.4%, 16.7%, and 96.7% for reader 3. Overall agreement on detection of malignant lesions using CESM among readers ranged from moderate to substantial (κ = .451–.696), for categorization of BPE from moderate to substantial (κ = .562–.711), and for evaluation of lesion intensity enhancement from fair to moderate (κ = .346–.459).ConclusionIn cases of Breast Imaging Reporting and Data System (BI-RADS) 1, BI-RADS 2, or BI-RADS 3 results at CESM, follow-up or VAB rather than surgical biopsy might be performed.

Comparison Of Distant Relapse Rates Of Immune Thromocytopenia In Patients Treated With Steroids Versus Anti-Rh(D) with/Without Steroids Versus Rituximab with/Without Steroids

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4760-4760
Author(s):  
Mala Varma ◽  
Michael L. Grossbard
Keyword(s):  
Platelet Count ◽  
Off Label Use ◽  
Contingency Table Analysis ◽  
Chi Square ◽  
Distant Relapse ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Table Analysis ◽  
Relapse Rates

Background Among therapies for immune thrombocytopenia (ITP) that achieve long unmaintained remissions, distant relapse rates have not been compared. Specific Aims To compare relapse rates following umaintained remissions exceeding 1 year in patients with ITP treated with steroids versus anti-Rh(D) with/without steroids versus rituximab with/without steroids. Methods Institutional Review Board approval was obtained. The charts of 52 consecutive patients with ITP followed in a hematology practice between 07/01/03 and 06/30/13 were reviewed. Remission was defined as a platelet count > 100,000/µL. Patients with the aforementioned treatment and remission characteristics were identified. Steroids were administered alone as dexamethasone 40 mg PO daily for 4 days. Anti-Rh(D) was administered as 75 mcg/kg IV with or without prednisone 60-85 mg PO daily tapered over 4 weeks or dexamethasone 40 mg PO daily for 4 days. Rituximab was administered as 375 mg/m2 IV weekly for 4 weeks or as a single dose with or without dexamethasone 40 mg PO daily for 4 days. Relapse was defined as a platelet count < 30,000/µL. Statistical calculations included ANOVA to compare demographics and chi-square contingency table analysis to compare distant relapse rates (http://www.physics.csbsju.edu/stats). Results There were 16 unmaintained remissions exceeding 1 year in 13 patients following treatment with steroids, anti-Rh(D) with/without steroids, or rituximab with/without steroids. Mean age on presentation, sex ratio, duration of ITP prior to therapy, and duration of follow-up after therapy were similar for the 3 groups (Table 1). Distant relapse rates were 100%, 14.2%, and 66.7% for the steroid, anti-Rh(D) with/without steroid, and rituximab with/without steroid groups, respectively, P = 0.03 (Table 2). Conclusion Among patients who achieve long unmaintained remissions of ITP with steroids, anti-Rh(D) with/without steroids, or rituximab with/without steroids, those treated with anti-Rh(D)-based therapy are the most likely to have extended remission. Disclosures: Off Label Use: Rituximab therapy of ITP.

scholarly journals Chromogranin A as a marker of neuroendocrine neoplasia: an Italian Multicenter Study

2007 ◽  
Vol 14 (2) ◽  
pp. 473-482 ◽  
Author(s):  
Maria Chiara Zatelli ◽  
Mirella Torta ◽  
Antonette Leon ◽  
Maria Rosaria Ambrosio ◽  
Massimo Gion ◽  
...  
Keyword(s):  
Chromogranin A ◽  
Roc Analysis ◽  
Operating Characteristic ◽  
Biochemical Marker ◽  
Predictive Values ◽  
Multicenter Observational Study ◽  
Diagnostic Usefulness ◽  
Low Sensitivity ◽  
Active Disease

Elevated circulating chromogranin A (CgA) levels are found in neuroendocrine tumors (NETs), but the diagnostic usefulness of this marker is still debatable. To assess the role of CgA for the diagnosis of gastroenteropancreatic (GEP) NETs and the identification of metastatic patients, an Italian multicenter observational study has been performed. CgA was evaluated in 202 GEP NET patients by IRMA and ELISA. The cutoffs for diagnosis and presence of metastases were identified by receiver-operating characteristic (ROC) curve. We found good correlation between IRMA and ELISA. The ROC analysis identified a cutoff of 53 ng/ml for IRMA and 16 U/l for ELISA as discriminating between controls and patients with active disease (sensitivity 71.3 and 84%; specificity 71 and 85% respectively). Metastases were present in 123 patients, having significantly higher CgA levels than patients without metastases. ROC analysis identified a cutoff of 146 ng/ml for IRMA and 67.3 U/l for ELISA as discriminating between patients with and without metastases (sensitivity 57 and 63.3%; specificity 55.6 and 71.4% respectively). For pancreatic NETs positive and negative predictive values were 84 and 78% respectively (90% specificity and 68% sensitivity). We found lower CgA levels in patients with extensive metastatic spread than in those with liver metastases only. These data assess the role of CgA evaluation in GEP NETs, and demonstrate that higher CgA levels associate with metastatic disease, confirming that CgA levels can provide a helpful practical biochemical marker for the clinical management of NETs, but with low sensitivity and specificity.

scholarly journals Serum NT-pro-BNP Levels Predict Cardiovascular Events in Acromegaly Patients

2021 ◽  
Author(s):  
Marta Ragonese ◽  
Gianluca Di Bella ◽  
Federica Spagnolo ◽  
Loredana Grasso ◽  
Angela Alibrandi ◽  
...  
Keyword(s):  
Heart Failure ◽  
General Population ◽  
Brain Natriuretic Peptide ◽  
Roc Curve ◽  
Cardiovascular Events ◽  
Roc Analysis ◽  
Middle Term ◽  
Increased Risk

Abstract Background Acromegaly is associated with an increased risk of fatal and non-fatal cardiovascular (CV) events. Controlling acromegaly decreases, but does not normalize this risk. Brain natriuretic peptide (BNP) assessment is used in the general population for the diagnosis of heart failure and to predict ischemic recurrences and mortality. This is a retrospective, longitudinal, monocenter study that evaluates the role of serum N-terminal fragment of BNP (NT-pro-BNP) for predicting CV events in acromegaly patients. Methods Serum NT-pro-BNP levels were measured in 76 patients with acromegaly (23 males, 57.7±1.5 years), and compared with other predictors of CV events. NT-pro-BNP cut-off value discriminating the occurrence of CV events was determined by ROC analysis. CV events were recorded during a follow-up of 78.6±6.4 months. Results CV events occurred in 9.2% of patients. Mean log(NT-pro-BNP) concentration was higher in patients who experienced CV events than in those who did not (p<0.01) and in patients who died due to CV events than in those who died due to other causes (p<0.01). Based on the ROC curve, a cut-off value of 91.55 pg/mL could predict CV events (OR 19.06). Log(NT-pro-BNP) was lower in surgically treated patients by surgery (p<0.05), and in those cured by neurosurgery (p<0.02). Conclusions High NT-pro-BNP value is an independent middle-term predictor of fatal or non-fatal CV events in patients with acromegaly. According to this parameter, surgically treated patients show lower CV risk than those managed with medical therapy, especially if the disease is cured.

scholarly journals Baseline and Cumulative Blood Pressure in Predicting the Occurrence of Cardiovascular Events

2021 ◽  
Vol 8 ◽  
Author(s):  
Yingting Zuo ◽  
Deqiang Zheng ◽  
Shuohua Chen ◽  
Xinghua Yang ◽  
Yuxiang Yan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Medical Records ◽  
Roc Analysis ◽  
Routine Clinical Practice ◽  
Baseline Blood Pressure ◽  
Predictive Values ◽  
Hazard Ratios ◽  
The Mean ◽  
Single Baseline

Background: Both baseline blood pressure (BP) and cumulative BP have been used to estimate cardiovascular event (CVE) risk of higher BP, but which one is more reliable for recommendation to routine clinical practice is unclear.Methods: In this prospective study, conducted in the Kailuan community of Tanshan City, China, a total of 95,702 participants free of CVEs at baseline (2006–2007) were included and followed up until 2017. Time-weighted cumulative BP that expresses the extent of cumulative BP exposure is defined as the sum of the mean of two consecutive systolic or diastolic BP times the interval between the two determinations, then normalized by the total follow-up duration. Incident CVEs during 2006–2017 were confirmed by review of medical records. We performed a competing risk regression analysis to assess CVE risk of the different durations of higher BP exposure. ROC analysis was performed to assess the predictive value of higher BP on CVE occurrence.Results: We found that when the risk of higher BP on CVE occurrence was estimated based on time-weighted cumulative BP, the hazard ratios (HRs) increased with the increase in duration of higher BP exposure in each of the four BP groups: &lt;120/&lt;80, 120–129/&lt;80, 130–139/80–89, and ≥140/≥90 mmHg; this time trend also occurred across the four different BP groups, with the higher BP group exhibiting CVE risk earlier during the follow-up. These results were confirmed by the same analysis performed on participants without baseline hypertension. However, such reasonable time trends did not occur when a single baseline BP was used as the primary estimation. We also demonstrated that the predictive values of baseline systolic and diastolic BP that predict CVE occurrence were only 0.6–3.2 and 0.2–3.1% lower, respectively, than those of cumulative BP combined with baseline BP during follow-up.Conclusions: Baseline BP remains a useful indicator for predicting future occurrence of CVEs. Nevertheless, time-weighted cumulative BP could more reliably estimate the CVE risk of higher BP exposure than baseline BP.

scholarly journals Role of radiation therapy in treating intracranial meningiomas

2007 ◽  
Vol 23 (4) ◽  
pp. E4 ◽  
Author(s):  
Leland Rogers ◽  
Minesh Mehta
Keyword(s):  
Radiation Therapy ◽  
Survival Rates ◽  
External Beam Radiation ◽  
Single Institution ◽  
Total Resection ◽  
Beam Radiation ◽  
Free Survival ◽  
Primary Focus

✓Surgery is the mainstay for many patients with meningiomas, and it remains the standard. In large single-institution series, gross-total resection has been reported to achieve 5-, 10-, and 15-year recurrence-free survival rates of approximately 90, 80, and 70%, respectively. There are a growing number of series of patients with prolonged follow-up in which authors have evaluated fractionated external-beam radiation therapy (EBRT) either as an adjuvant to surgery for subtotally resected, recurrent, or higher-grade meningiomas, or as an alternative to surgery. The primary focus of this review is EBRT, but to lend perspective, a comparative analysis of surgery and radiosurgery is also provided.

scholarly journals 18F-Fluorocholine-PET/CT for Localizing Hyperfunctioning Parathyroid Glands and Optimizing Surgical Treatment in Patients With Hyperparathyroidism

2021 ◽  
Author(s):  
Jörn-Markus Gass ◽  
Corinna Wicke ◽  
Carolina Mona ◽  
Klaus Strobel ◽  
Werner Müller ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Diagnostic Accuracy ◽  
Imaging Techniques ◽  
False Negative ◽  
Single Institution ◽  
Predictive Values ◽  
Surgical Exploration ◽  
Pet Ct ◽  
Normal Calcium

Abstract PurposeHyperparathyroidism (HPT) is a common disorder. Cure can only be achieved by removal of all diseased glands. Exact localization of hyperfunctioning glands is of importance to prevent extensive surgical exploration. The number of false negative/inconclusive results in standard imaging techniques is high. We aimed to evaluate the diagnostic accuracy of 18F-Fluorocholine-PET/CT (FCH-PET/CT) and its sensitivity in patients with primary, secondary/tertiary and familial HPT with negative and/or discordant findings in ultrasound and/or 99mTc-sestamibi scintigraphy/SPECT/CT.Methods96 patients with HPT and negative/equivocal conventional imaging were referred for FCH-PET/CT. 69 patients who have undergone surgery and histopathologic workup were analyzed in this retrospective single institution study. 60 patients suffered from primary HPT, 4 from secondary or tertiary HPT and 5 from familial HPT. Sensitivities, positive predictive values, and accuracies were calculated.ResultsAll patients showed normalized serum calcium levels in the postoperative period. The follow-up rate was 97%. 58 of 60 patients with primary HPT and 4 of 4 patients with secondary/tertiary HPT showed normal calcium- and PTH-levels after 6 months and were cured. 4 of 5 patients with familial HPT were cured. Sensitivity/positive predictive value (PPV) per lesion for primary HPT was 87.5/98.3%, for secondary/tertiary HPT 75/100% and for familial HPT 14.6/100%, respectively. Sensitivity/PPV per patient was 91.5/98.2% for primary HPT, 100/100% for secondary/tertiary HPT and 50/100% for familial HPT, respectively.ConclusionDiagnostic accuracy of 18F-Fluorocholine-PET/CT for patients with pHPT is excellent. 18F-Fluorocholine-PET/CT is a valuable tool for endocrine surgeons to optimize the surgical treatment of patients with hyperparathyroidism.

scholarly journals Clinical significance and prospects of using ST2 in isсhemic heart failure patients

2020 ◽  
Vol 35 (2) ◽  
pp. 89-97
Author(s):  
E. V. Grakova ◽  
K. V. Kopeva ◽  
A. T. Teplyakov ◽  
A. V. Svarovskaya ◽  
O. N. Ogurkova ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Cardiovascular Events ◽  
Roc Analysis ◽  
Non Invasive ◽  
Group 2 ◽  
Traditional Risk Factors ◽  
Group 1

Objective: The objective of this study is to assess the role of soluble ST2 (sST2) in developing adverse cardiovascular events (ACE) and fatal outcomes in patients with chronic heart failure (HF) during 18 [12.5; 35.5]-month follow-up period.Results. Depending on the median of baseline sST2 levels, all patients were retrospectively divided into two groups: group 1 enrolled patients with sST2 levels < 31.5 ng/mL (n = 22); and group 2 comprised patients with sST2 levels ≥ 31.5 ng/mL (n = 26). In group 1, the sST2 levels were 27.27 [23.94; 29.23] ng/mL, which was 33.9% higher (p < 0.0000001) than in group 2 (41.28 [34.86; 50.17] ng/mL). ACEs were registered in 9 cases (40.9%) in group 1 and in 17 cases (65.4%) in group 2 (p = 0.025). Based on ROC-analysis, baseline ST2 levels ≥ 33.53 ng/mL were considered a biomarker to predict an unfavorable course of ischemic heart failure during 18 [12.5; 35.5] months of follow-up period with sensitivity of 78.9% and specificity of 62.2% (AUC 0.719; 95% CI 0.562–0.845; p = 0.0059).Conclusion. The baseline sST2 levels may be considered a non-invasive biomarker allowing to predict the development of adverse cardiovascular events (ACE) and fatal outcomes in patients with chronic heart failure (HF) during 18 [12.5; 35.5] months of follow-up in addition to traditional risk factors.

scholarly journals Large Difference between Proximal Junctional Angle and Rod Contouring Angle is a Risk Factor for Proximal Junctional Kyphosis

2019 ◽  
Author(s):  
Jie Wang ◽  
Ningning Yang ◽  
Ming Luo ◽  
Ning Li ◽  
Yonggang Fan ◽  
...  
Keyword(s):  
Risk Factor ◽  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Pearson Correlation ◽  
Spinal Instrumentation ◽  
Proximal Junctional Kyphosis ◽  
Single Institution ◽  
Junctional Kyphosis

Abstract Background: There are several risk factors for proximal junctional kyphosis (PJK) in adolescent idiopathic scoliosis (AIS) surgery. Decreased rod contouring angle (RCA) has been proposed as a risk factor for PJK, but the role of difference between proximal junctional angle (PJA) and RCA (PJA-RCA) has not been fully investigated. The aim of this study was to assess the role of PJA-RCA for the development of postoperative PJK in AIS. Methods: We performed a retrospective analysis of 96 AIS patients who underwent posterior segmental spinal instrumentation and fusion between the years 2012 and 2018 (minimum 1.5-year and average 2-year follow-up) at a single institution. Each patient was measured on preoperative, postoperative and final follow-up long-cassette standing radiographs. The PJA-RCA was regarded as a new definition that reflects the match degree between proximal rod contouring and vertebra curvature, and radiographic parameters were compared between PJK and non-PJK group. Results : Among the 96 patients with a mean age of 14.00 years (± 0.82), the overall incidence of PJK was 22%. PJK group showed a significantly greater preoperative SVA (P = 0.032) and larger correction of SVA (P = 0.007) than non-PJK group. At the last follow-up, PJK patients had significantly greater LL (P = 0.046). Patients in the PJK group had significantly greater preoperative PJA-RCA than the non-PJK group (4.07±3.30 vs. 1.42±4.28, P = 0.024). However, RCA was not significantly different between two groups (3.88 ± 4.34 vs. 2.86 ± 3.36, P = 0.405). In addition, Pearson correlation coefficient showed a significant correlation between the change of SVA and the last follow-up PJA (r = -0.208, P = 0.042). Preoperative PJA-RCA and postoperative PJA-RCA demonstrated similar results which showed a strong correlation with the last follow-up PJA (r = 0.528 and r = 0.532 respectively, P < 0.000). Conclusions: As a new reflex of improper rod contouring, large PJA-RCA is a risk factor for PJK in AIS, and PJK might be a compensation mechanism rather than complication when spine is shifted and overcorrected. Keywords: adolescent idiopathic scoliosis, proximal junctional kyphosis, proximal junctional angle, rod contouring angle.

Adjuvant chemotherapy and outcomes in esophageal carcinoma.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 181-181
Author(s):  
Nadia Saeed ◽  
Eric Albert Mellon ◽  
Kenneth L Meredith ◽  
Sarah E. Hoffe ◽  
Ravi Shridhar ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Retrospective Review ◽  
Single Agent ◽  
Case Control ◽  
Control Analysis ◽  
Single Institution ◽  
Significant Difference ◽  
Case Control Analysis

181 Background: Neoadjuvant chemoradiation (NCRT) and surgery is standard treatment for esophageal cancer (EC) in the U.S. The role of adjuvant chemotherapy (ACT) is unclear. Providers assign ACT inconsistently, and both its rationales and benefits have yet to be clearly defined. We sought to evaluate rationales and benefits for ACT in EC. Methods: This single institution retrospective review included 382 patients (pts) with EC who were treated at our tertiary referral center. All pts received NCRT and 46 received ACT. We reviewed medical records to obtain demographic and clinical information. Survival outcomes were analyzed with Kaplan-Meier method from date of death or last follow up and log-rank analysis. Case-control analysis was performed using a 2:1 nearest neighbor propensity score matching algorithm, and included 113 pts, 41 of which received ACT. Results: 46 of the 382 pts in our study who received NCRT and surgery for EC also underwent ACT; two pts had single agent paclitaxel, 9 had 5-F/U and leucovorin, 7 had 5-F/U and cisplatin, 5 had carboplatin and paclitaxel, 2 had carboplatin alone, and the remainder had other combinations. Pts who received ACT were younger (med. age = 60.2 v 63.8 yr, p = 0.047), more likely to have adenocarcinoma (91.3% v 85.1%, p = 0.034), and less likely to have positive LNs on pre-treatment EUS (60.1% v 77.4%, p = 0.018). Pts with pCR were less likely to receive further treatment (6.5% v 45.8%, p < 0.001), and pts with R1 resection were more likely to do so (15.2% v 4.2%, p = 0.007). With case-control analysis, no variables were significantly different between the two groups. The median follow-up times for the entire cohort and case-control analysis were 7.98 years and 8.89 years, respectively. There were no significant differences in overall (p = 0.975) or recurrence-free (p = 0.824) survival associated with ACT in either analysis. Conclusions: The role of CT following NCRT and surgical resection in pts with locally advanced ECis unclear. In the largest series to date, our single institution retrospective review found no significant difference in survival in pts who received ACT and those who did not. Prospective studies are needed to further identify the rationales for delivery of ACT, and to investigate any potential survival benefits.

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