Retrospective Comparison of Using or Not Using Donor Lymphocyte Transfusion in the Treatment of Hematological Relapse after Allogeneic Stem Cell Transplantation in 489 Adults with Acute Myeloid Leukemia.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 298-298
Author(s):  
Christoph Schmid ◽  
Myriam Labopin ◽  
Juergen Finke ◽  
Gerhard Ehninger ◽  
Olle Ringden ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
De Novo ◽  
Patient Age ◽  
Entire Cohort ◽  
Post Transplant ◽  
Patient Âgé ◽  
Retrospective Comparison ◽  
De Novo Aml

Abstract Relapsed AML after allogeneic SCT has a poor prognosis. So far, no standard therapy could be defined. Donor lymphocyte transfusion (DLT) has been effective in a minority, however, no data is available to identify patients who will benefit from the procedure. Neither, the outcome of patients treated with or without DLT have been compared. We retrospectively evaluated overall survival (OS) of 489 adults with de novo AML in hematological relapse after SCT, receiving DLT (n=190) or not (n=299). DLT and noDLTgroups were well balanced in terms of patient age (median:37y in both groups), donor age, cytogenetics (good:5vs7%, intermediate:83vs79%, poor:12%vs14%), WBC at diagnosis, donor type (geno-id:71vs72%, MUD:18% both, mismatched:11vs10%), status at transplantation (CR1:38vs41%, CR2:13vs15%, advanced:49vs44%), conditioning, source of stem cells, and time from transplant to relapse (5vs4.5 months). However, DLT patients had a median of 39% BM blasts, as compared to 54% for the noDLT group (p=0.03). Follow-up was 32 and 30 months. Within the DLT group, chemotherapy was additionally given in 130 cases. Nevertheless, only 33% of patients received DLT in CR or aplasia, 67% had measurable disease. AGvHD developed in 41% of patients following DLT. CR and PR were achieved in 31.1% and 4.8% of DLT patients. In a multivariate analysis, younger patient age (<36 years) (HR=1.53,p=0.02) and a longer interval (> 5 months) from transplant to relapse (HR=7.74,p=0.002) were associated with better OS after DLT. When comparing the outcome of patients receiving or not DLT, OS at 2 years was 10±1% for the entire cohort, 18±3% for DLT and 6±1% for noDLT (p<.0001). In a multivariate analysis, use of DLT (HR=2.11,p<0.0001); recipient’s age<36 y (HR=1.69, p<0.001); longer interval (>5 months) from transplant to relapse (HR=2.40, p<0.0001) and number of BM blasts (<48%) at relapse (HR=1.56,p=0.002) were favorable for OS. In this retrospective analysis the results suggest that DLT may be of advantage in the treatment of AML relapse post transplant, at least in younger patients with a longer post transplant remission and relapsing with smaller amounts of blasts in BM. However, patients receiving DLT might represent a positive selection among all relapsed cases, since a considerable number from the noDLT cohort had died too early to proceed to DLT. An intetion-to-treat analysis and further prospective studies should investigate the role of DLT and other approaches, such as second reduced intensity SCT.

Risk of hemorrhage from de novo cerebral aneurysms

2013 ◽  
Vol 118 (1) ◽  
pp. 58-62 ◽  
Author(s):  
William J. Kemp ◽  
Daniel H. Fulkerson ◽  
Troy D. Payner ◽  
Thomas J. Leipzig ◽  
Terry G. Horner ◽  
...  
Keyword(s):  
Risk Factors ◽  
De Novo ◽  
Patient Age ◽  
Patient Âgé ◽  
Long Term Follow Up ◽  
De Novo Aneurysm ◽  
The Mean ◽  
Risk Of Hemorrhage

Object A small percentage of patients will develop a completely new or de novo aneurysm after discovery of an initial aneurysm. The natural history of these lesions is unknown. The authors undertook this statistical evaluation a large cohort of patients with both ruptured and unruptured de novo aneurysms with the aim of analyzing risk factors for rupture and estimating a risk of subarachnoid hemorrhage (SAH). Methods A review of a prospectively maintained database of all aneurysm patients treated by the vascular neurosurgery service of Goodman Campbell Brain and Spine from 1976–2010 was performed. Of the 4718 patients, 611 (13%) had long-term follow-up imaging. The authors identified 27 patients (4.4%) with a total of 32 unruptured de novo aneurysms from routine surveillance imaging. They identified another 10 patients who presented with a new SAH from a de novo aneurysm after treatment of their original aneurysm. The total study group was thus 37 patients with a total of 42 de novo aneurysms. The authors then compared the 27 patients with incidentally discovered aneurysms with the 10 patients with SAH. A statistical analysis was performed, comparing the 2 groups with respect to patient and aneurysm characteristics and risk factors. Results Thirty-seven patients were identified as having true de novo aneurysms. This group had a female predominance and a high percentage of smokers. These 37 patients had a total of 42 de novo aneurysms. Ten of these 42 aneurysms hemorrhaged. De novo aneurysms in both the SAH and non-SAH group were anatomically small (< 10 mm). The estimated risk of hemorrhage over 5 years was 14.5%, higher than the expected SAH risk of small, unruptured aneurysms reported in the ISUIA (International Study of Unruptured Intracranial Aneurysms) trial. There was no statistically significant correlation between hemorrhage and any of the following risk factors: hypertension, diabetes, tobacco and alcohol use, polycystic kidney disease, or previous SAH. There was a statistically significant between-groups difference with respect to patient age, with the mean patient age being significantly older in the SAH aneurysm group than in the non-SAH group (p = 0.047). This is likely reflective of longer follow-up and discovery time, as the mean length of time between initial treatment and discovery of the de novo aneurysm was longer in the SAH group (p = 0.011). Conclusions While rare, de novo aneurysms may have a risk for SAH that is comparatively higher than the risk associated with similarly sized, small, initially discovered unruptured saccular aneurysms. The authors therefore recommend long-term follow-up for all patients with aneurysms, and they consider a more aggressive treatment strategy for de novo aneurysms than for incidentally discovered initial aneurysms.

scholarly journals Autologous Stem Cell Transplantation for Primary Mediastinal B Cell Lymphoma in the Rituximab Era: A Retrospective Study By the EBMT Lymphoma Working Party

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1195-1195
Author(s):  
Irit Avivi ◽  
Ariane Boumendil ◽  
Hervé Hervé Finel ◽  
Arnon Nagler ◽  
Aïda Sousa Bothello ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Stem Cell ◽  
Retrospective Study ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Refractory Disease ◽  
Post Transplant ◽  
The Impact

Abstract Introduction: The addition of rituximab to induction therapy had improved the outcome of patients with primary mediastinal B cell lymphoma (PMBCL). For those patients who are primary refractory or relapse after having achieved a remission, high-dose therapy and autologous stem cell transplantation (ASCT) is considered as standard treatment. Only scanty information, however, is available regarding the role of ASCT in patients with relapsed / refractory PMBCL in the rituximab era. Moreover, the impact of pre- and post-transplant irradiation remains uncertain. The objective of the current study was to investigate the results of ASCT for PMBCL in the rituximab era, identify variables predictive for outcome, and assess the role of adjuvant radiotherapy. Patients and methods: For this retrospective study, all EBMT registered patients with PMBCL aged between 18 and 70 years who were treated with a first ASCT between 2000 and 2012 were eligible. Baseline patient, disease, and transplant data were collected from MED-A forms. Centers with potentially eligible patients were contacted to provide additional treatment and follow-up information including a written histopathology report. Statistical analysis used log rank test to assess the impact of baseline characteristics on survival endpoints. In multivariate analysis, the relevance of prognostic factors was estimated using Cox regression models. Curves of cumulative incidence of relapse (IR) were compared by Gray's test. Multivariate analysis of IR used Fine and Gray models. Results: 86 patients with confirmed PMBCL were eligible and had the full data set required for this analysis. 51% were female, median age was 34 years (range 20-69). Median time from diagnosis to ASCT was 12 months (12-299). 63.5% of the patients presented with a bulky mediastinal mass, larger than 10cm at diagnosis, 30.5% had stage IV disease, and 44% had B symptoms. 92% had received at least 2 lines of therapies, 85% had rituximab and 30% had received radiotherapy prior to transplantation. At ASCT, 11% still had a mass greater than 10 cm, and 19% a mass of 5-10cm. Remission status at ASCT was CR/PR1 in 21% of the patients, CR/PR>1 in 51%, and refractory disease in 28%. 31 patients (41%) received irradiation post-transplant. Thirteen patients of 24 patients (54%) transplanted in PR attained CR at day +100 post ASCT. With a median follow-up of 39 months (24-73), 3-year non-relapse mortality, IR, event-free survival (EFS) and overall survival (OS) for the whole series were 9%, 33%, 58% and 71%, respectively. By univariate analysis, refractory disease at ASCT and residual mass > 5cm at ASCT were significant adverse predictors for IR, EFS, and OS. 3-year EFS was 35% in refractory subjects vs 66% in chemosensitive patients (p=0.001), and 100% in those autografted in CR/PR1 vs 60% in those transplanted in more advanced response p=0.018. Notably, patients transplanted with refractory disease with a history of irradiation prior to ASCT had a superior outcome compared with non-irradiated refractory patients.Multivariate analysis suggested post-transplant irradiation to be associated with a significantly reduced IR (HR=0.24; p=0.028) and improved EFS (HR=0.24; p=0.018) and OS (HR=0.21; p=0.032). Discussion: In conclusion, this analysis gives first specific evidence that ASCT can provide durable remissions in patients with relapsed / refractory PMBCL in the rituximab era. Pre or post-transplant irradiation appears to be important, though deserves further studies. Disclosures No relevant conflicts of interest to declare.

Promising Outcome for Patients with AML-MRC Following Cord Blood Transplantation: Is Induction Chemotherapy Before Transplant Necessary?

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3132-3132
Author(s):  
Naoyuki Uchida ◽  
Kazuhiro Masuoka ◽  
Hikari Ota ◽  
Aya Nishida ◽  
Kazuya Ishiwata ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Induction Chemotherapy ◽  
De Novo ◽  
Cord Blood Transplantation ◽  
Prior History ◽  
Post Transplant ◽  
Blood Transplantation ◽  
Gvhd Prophylaxis ◽  
History Of ◽  
De Novo Aml

Abstract Abstract 3132 Introduction: In year 2008 version of WHO classification for myeloid malignancies, a category of AML with myelodysplasia-related changes (AML-MRC) was defined which included both de novo AML with dysplasia and AML secondary to MDS. It is characterized by poor chemosensitivity for which allogeneic transplantation (allo-SCT) has been a viable option to cure. Umbilical cord blood transplantation (UCBT) is a possible treatment strategy that can be performed for those who lack suitable donors due to rapid availability and less stringent HLA matching required. So far, there have been sparse reports available on UCBT for those with AML-MRC. This study was conducted to see the current update in our institute and to see whether the presence of induction chemotherapy before transplant is better for the outcome. Design and Methods: We retrospectively reviewed patients diagnosed as AML-MRC who underwent UCBT at our institute from Mar. 2002 to Mar. 2011 consecutively. Patients who lacked appropriate adult PB/BM donors underwent UCBT. Patients who had prior history of transplantation, were in poor performance status (ECOG PS >3), had active bacterial or fungal infections at the time of conditioning were excluded. Results: Eighty-one patients were included. 52 (64%) were males, and median age was 61 years (range, 17–72). 35 (43%) were de novo AML, and 46 (57%) were AML secondary to MDS. Median time from diagnosis to transplantation was 346 days (range, 42–7997). 39 (48%) did not receive induction chemotherapy before transplant. 76 (94%) were not in remission, 29 (36%) were in high, and 52 (64%) were in very high WPSS risk group, just before transplant. 54 (67%) received reduced-intensity conditionings. 65 received GVHD prophylaxis of tacrolimus-based, while 16 did cyclosporine alone. Median observation time for survivors was 646 days (range 32–2456). Median days of neutrophil recovery (> 500/ul) was 20 days (range, 11–45), and cumulative incidence of engraftment was 76.5 % up to day 50 post-transplant. Cumulative incidences of relapse and non-relapse mortality at 2 years post-transplant were 37.8 % and 33.3 %, respectively. Higher incidence of relapse was observed in those with prior history of MDS in univariate analysis (51.8 % vs. 21.2 % at 2 years post-transplant, P = 0.004), which was the only significant factor associated with higher relapse rate in multivariate analysis (P = 0.020). More NRM was observed in those received transplant early period from 2002 to 2005 vs. those who did from 2006 to 2010 (45.1 % vs. 25.5 % at 2 years post-transplant, P = 0.001), and in those received GVHD prophylaxis using CsA alone vs. others (72.0 % vs. 24.8 % at 2 years post-transplant, P = 0.0002). In multivariate analysis, higher degree of HLA mismatch (2 antigens vs. less than 2) and GVHD prophylaxis using CsA alone were associated with higher incidence of NRM (P = 0.024 and P = 0.00047, respectively). Overall survival (OS) was estimated as 42.1 % at 2 years post-transplant. Better OS was observed in those who received conditioning containing 12.8mg/kg of iv busulfan (60.8% vs. 32.4% at 2 years post-transplant, P = 0.0337), in those received tacrolimus-based GVHD prophylaxis vs CsA alone (47.9 % vs. 17.0 % at 2 years post-transplant, P = 0.0024), and in those received transplant in recent period from 2006 to 2010 vs. those who did from 2002 to 2005 (52.1 % vs. 26.1 % at 2 years post-transplant, P = 0.0248). In multivariate analysis, GVHD prophylaxis using CsA alone and poor WPSS risk category just before transplant were the factors significantly asssociated with poor OS (P < 0.0001 and P = 0.001, respectively). There were no significant differences between presence or absence of prior induction chemotherapy in terms of cumulative incidence of neutrophil recovery (71.4 % vs. 82.1% up to day 50 post-transplant, P = 0.88), relapse (38.0 % vs. 36.1%, P = 0.94), NRM (30.7 % vs. 35.4 %, P = 0.87), and OS (47.7 % vs. 36.2%, P= 0.72) at 2 years post-transplant. Conclusions: These data indicate that CBT is a feasible and promising treatment approach for those with AML-MRC, including elderly patients. More intensive GVHD prophylaxis was beneficial in reducing NRM and improving OS for the population studied. Presence of prior induction chemotherapy before transplant was not associated with higher rate of engraftment or better OS, suggesting tumor reduction before pre-transplant conditioning may not be necessary for successful outcome in our transplant settings. Disclosures: No relevant conflicts of interest to declare.

scholarly journals ATG2B/Gskip in De Novo Acute Myeloid Leukemia (AML): High Prevalence of Germline Predisposition in French West Indies and Potential Role of Overexpression in Acquired AML

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 1482-1482
Author(s):  
Jean Pegliasco ◽  
Barbara Panneau-Schmaltz ◽  
Jean-Edouard Martin ◽  
Samy Chraibi ◽  
Clemence Legoupil ◽  
...  
Keyword(s):  
Complete Remission ◽  
West Indies ◽  
Research Funding ◽  
De Novo ◽  
French West Indies ◽  
Entire Cohort ◽  
Caribbean Islands ◽  
History Of ◽  
De Novo Aml

Abstract In 2015, a germline copy number variation of chromosome 14 (CNVdup14) including ATG2B and GSKIP genes was described as a predisposition genetic factor responsible of familial myeloproliferative neoplasms from French West Indies (Saliba et al, Nat Gen 2015), frequently progressing to AML. In this study, we looked at the presence of this CNVdup14 in a cohort of Caribbean islands patients (pts) with non-secondary aggressive hematological malignancies (HM). We also studied the expression of ATG2B and GSKIP genes in a cohort of acquired AML pts. This is a retrospective multicenter study of adults Caribbean islands pts treated at Gustave Roussy Cancer Center (Villejuif, France) and at the French West Indian hospitals (Martinique and Guadeloupe) between May 2000 and May 2018. We included pts with AML, acute undifferentiated leukemia (AUL), acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LL). Pts with personal history of myeloproliferative or myelodysplastic syndromes before the onset of aggressive HM were not included in this study. The presence of the CNVdup14 was carried out by PCR analyses in all the pts. For the second part of the study, expression of ATG2B and GSKIP genes were assessed in newly diagnosed de novo AML pts with normal karyotype or trisomy 8 (samples from the GOELAMSTHEQUE) by quantitative RT-PCR and expressed as relative expression PPIA/HPRT/H2A.Z. One hundred pts were analyzed. Median age was 52 years (IQ 40-62) with male predominance (61%). Fifty eight pts came from Martinique, 42 pts from the rest of the Caribbean islands (including 28, 4, 3, 2 pts from Guadeloupe, Haiti, Saint Martin, Dominican Republic, respectively). Seventy eight pts had AML. Among them, according to revised MRC cytogenetic classification, 11 (14%) were favorable, 47 (60%) intermediate and 20 (26%) adverse. Seventeen pts had ALL, 3 LL, and 2 AUL. On the entire cohort, all except nine pts were treated with intensive chemotherapy, 80 reached complete remission, 29 relapsed, 46 pts died. Thirty two pts received hematopoietic stem cell transplantation (HSCT). Six pts were positive for the CNVdup14 by PCR (confirmed by SNP array in the 5 pts with leftover DNA available). All had an AML (no pts with favorable AML) and were originated from Martinique. These pts represented 14% of the 43 AML from Martinique in our cohort (17% if we excluded favorable AML). One was known to be part of an ATG2B/GSKIP family, 2 pts had no familial history of myeloid malignancies and 2 new families were discovered. Median white blood cell, hemoglobin and platelets counts were 17.7 G/l (IQ 6.7-48), 8.15 g/dl (6.9-9.7) and 58 G/l (20-132), respectively. Median age at AML diagnosis was 49 years (34-55), 3/6 (50%) had extramedullary localization compared to 11/78 (14%) for others AML pts. Karyotype was normal for 4, or showed a monosomy 7 for 2 pts. NGS panel showed distinct abnormalities compared to the entire cohort (Fig A). None had JAK2, MPL, CALR, P53, RUNX1, DNMT3A, FLT3-ITD mutations. All harbored an epigenetic and/or spliceosome mutation (IDH n=3, TET2 n=3, ASLX1 n=3, SRSF2 n=3). Five out of the six pts received intensive treatment and 4 achieved complete remission. Two received HSCT, 2 relapsed and 4 died. Median overall survival (OS) of the entire cohort was 35.7 months (22.5-89.5) and progression free survival (PFS) 27.6 months (15.6 -56.1). As CNVdup14 pts had AML only, we next evaluated survival according to the predisposition status in the AML cohort. Pts with CNVdup14 had a median OS and PFS of 19 (6.5-29) and 11.4 (6.5-29) months, respectively, compared with 52.6 (22.9-100.2) and 30 months (15.6-60) in CNV wild-type counterparts (PFS Fig B). We next evaluated ATG2B and GSKIP expression in a cohort of 46 random de novo AML pts (GOELAMS-LAM-IR-2006 multicenter trial). Median expression of ATG2B and GSKIP were 4.8 (2.6-12.9) and 5.3 (0.3-5.1) respectively. No CNVdup14 was detected. Interestingly we found a correlation between the two genes expression (Pearson Correlation Coefficients 0.55 and linear regression p< 0.001, Fig C). Expression of ATG2B and GSKIP was also correlated with leukocytosis (p=0.003 and p=0.07) (Fig D). We found no impact on OS and PFS. For the first time, we described a high percentage of the germline CNVdup14 in de novo AML pts from Martinique (14%). Moreover evaluation of ATG2B and GSKIP expression suggested that the role of theses 2 genes in leukemogenesis is not limited to pts with the CNVdup14. Figure. Figure. Disclosures de Botton: Agios: Research Funding; Celgene: Honoraria, Research Funding. Benabelali:CERBA laboratory: Employment.

Abstract 47: Using Ultrasound and Inflammation to Improve Prediction of Ischemic Stroke: A Secondary Analysis of MESA

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Adam H de Havenon ◽  
Ka-Ho Wong ◽  
J Scott McNally ◽  
Jennifer Majersik
Keyword(s):  
Ischemic Stroke ◽  
Total Cholesterol ◽  
Primary Outcome ◽  
Epidemiologic Study ◽  
Secondary Analysis ◽  
Serum Marker ◽  
Patient Age ◽  
Cox Models ◽  
Patient Âgé

Background: The Multi-Ethnic Study of Atherosclerosis (MESA) is a large prospective epidemiologic study of the clinical factors that can predict transition from asymptomatic to symptomatic cardiovascular disease. Although prior studies have looked at ischemic stroke, they have not systematically examined the relationship between baseline ultrasound and inflammation measurements and subsequent primary stroke risk. Methods: The primary outcome is incident ischemic stroke during follow-up. The predictors are 9 ultrasound-derived measurements and 5 serum measurements related to inflammation. We fit Cox models to ischemic stroke and adjusted for patient age, hypertension, diabetes, total cholesterol, and smoking. Using DeLong’s method, we compared the AUC of the baseline adjusted model to the AUC of the model with predictor variables that were significant in the Cox models, to determine if they improved stroke prediction. Results: We included 6,095 patients with an average age of 61.9 years. The primary outcome of ischemic stroke was seen in 107 patients (1.8%) and the mean follow-up time was 7.7 years. In the Cox models, we found that small artery elasticity (SAE), carotid distensibility (CD), carotid stenosis (CS), and interleukin-6 (IL6) were associated with incident stroke. The AUC of the baseline model to predict stroke, which included patient age, hypertension, diabetes, total cholesterol, and smoking, was 0.745. When we added tertiles of SAE, CD, IL6 and categories of CS, the AUC improved to 0.765 (p=0.021 for difference). Conclusions: In a multiethnic cohort of patients without CVD at baseline, we found several ultrasound measurements and a serum marker of inflammation which predicted the occurrence of a primary ischemic stroke. Adding these basic ultrasound and serum measurements significantly improved the prediction of stroke, which could have implications for primary prevention efforts.

scholarly journals Impact of mass effect, tumor location, age, and surgery on the cognitive outcome of patients with high-grade gliomas: a longitudinal study

2017 ◽  
Vol 4 (4) ◽  
pp. 229-240 ◽  
Author(s):  
Monica Dallabona ◽  
Silvio Sarubbo ◽  
Stefano Merler ◽  
Francesco Corsini ◽  
Giuseppe Pulcrano ◽  
...  
Keyword(s):  
Tumor Volume ◽  
High Grade Glioma ◽  
Joint Effect ◽  
Cognitive Outcome ◽  
Tumor Localization ◽  
High Grade ◽  
Patient Age ◽  
Patient Âgé ◽  
High Grade Gliomas

Abstract Background High-grade gliomas are the most frequently occurring brain tumors and carry unfavorable prognosis. Literature is controversial regarding the effects of surgery on cognitive functions. Methods We analyzed a homogenous population of 30 patients with high-grade glioma who underwent complete resection. Patients underwent extensive neuropsychological analysis before surgery, 7 days after surgery, and approximately 40 days after surgery, before adjuvant treatments. Thirty-four neuropsychological tests were administered in the language, memory, attention, executive functions, and praxis domains. Results The preoperative percentage of patients with impairment in the considered tests ranged from 0% to 53.3% (mean 20.9%). Despite a general worsening at early follow-up, a significant recovery was observed at late follow-up. Preoperative performances in language and verbal memory tasks depended on the joint effect of tumor volume, volume of surrounding edema, and tumor localization, with major deficits in patients with left lateralized tumor, especially insular and temporal. Preoperative performances in attention and constructive abilities tasks depended on the joint effect of tumor volume, volume of surrounding edema, and patient age, with major deficits in patients ≥ 65 years old. Recovery at late follow-up depended on the volume of resected tumor, edema resorption, and patient age. Conclusions Longitudinal neuropsychological performance of patients affected by high-grade glioma depends, among other factors, on the complex interplay of tumor volume, volume of surrounding edema, tumor localization, and patient age. Reported results support the definition of criteria for surgical indication based on the above factors. They may be used to propose more customized surgical, oncological, and rehabilitative strategies.

scholarly journals Atrial High-Rate Event Incidence and Predictors in Patients With Permanent Pacemaker Implantation

2021 ◽  
Vol 8 ◽  
Author(s):  
Jian Hua Chen ◽  
Guo Yao Chen ◽  
Hong Zheng ◽  
Quan He Chen ◽  
Fa Yuan Fu ◽  
...  
Keyword(s):  
Cox Regression ◽  
Previous History ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
High Rate ◽  
Atrial Pacing ◽  
Patient Age ◽  
Cox Regression Analysis ◽  
Patient Âgé

Objective: The present study aims to investigate the incidence and predictors of atrial high-rate events (AHREs) in patients with permanent pacemaker implants.Methods: A total of 289 patients who were implanted with a dual-chamber pacemaker due to complete atrioventricular block or symptomatic sick sinus syndrome (SSS) and had no previous history of atrial fibrillation were included in the present study. AHREs are defined as events with an atrial frequency of ≥175 bpm and a duration of ≥5 min. The patients were divided into two groups according to whether or not AHREs were detected during the follow-up: group A (AHRE+, n = 91) and group N (AHRE–, n = 198).Results: During the 12-month follow-up period, AHREs were detected in 91 patients (31.5%). The multivariate Cox regression analysis revealed that patient age [odds ratio [OR] = 1.041; 95% confidence interval [CI], 1.018–1.064; and P &lt; 0.001], pacemaker implantation due to symptomatic SSS (OR = 2.225; 95% CI, 1.227–4.036; and P = 0.008), and the percentage of atrial pacing after pacemaker implantation (OR = 1.010; 95% CI, 1.002–1.017; and P = 0.016) were independent AHRE predictors.Conclusion: The AHRE detection rate in patients with pacemaker implants was 31.5%. Patient age, pacemaker implantation due to symptomatic SSS, and the percentage of atrial pacing after pacemaker implantation were independent AHRE predictors.

The Use oF Flexible Cystoscope in Posterior Urethroplasty

2009 ◽  
Vol 76 (2) ◽  
pp. 144-149
Author(s):  
E. Palminteri ◽  
E. Berdondini ◽  
S. Maruccia ◽  
M. Poluzzi ◽  
D. Vecchio ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Pelvic Trauma ◽  
Patient Age ◽  
Membranous Urethra ◽  
Urethral Strictures ◽  
Patient Âgé ◽  
Flexible Cystoscope ◽  
Age At Surgery

We present our experience with a simplified anastomotic posterior urethroplasty to highlight the necessity and usefulness of ancillary reconstructive maneuvers. We reviewed the records of 46 patients who had undergone anastomotic repair of posterior urethral strictures due to pelvic trauma between 2000 and 2007. Mean patient age at surgery was 43 years. Average stricture length was 2.3 cm. Repair was performed with a progressive perineal anastomotic procedure using flexible cystoscope by means of transcystostomic approach: after mobilization of the bulbo-membranous urethra and the corporal splitting, the prostatic apex is well visualized and the membranous urethra is sectioned proximally; the flexible cystoscope by means of transcystostomic approach facilitates to find the proximal urethral lumen and to perform the bulbo-prostatic anastomosis. Mean follow-up was 32 months. Of 46 cases, 40 (87 %) were successful and 6 (13 %) failed with recurrence of the stricture. Urinary incontinence did not develop in any patients. The operative details and maneuvers facilitate the preparation of the bulbo-membranous urethral tract and prostatic apex, and simplify the performance of the anastomotic repair.

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