Natural History of Post-Allogeneic HSCT EBV-Reactivation: A Single Center Retrospective Survey.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3232-3232
Author(s):  
Helene M. Schoemans ◽  
Koen Theunissen ◽  
Marc Boogaerts ◽  
Johan Maertens
Keyword(s):  
Opportunistic Infections ◽  
Screening Tests ◽  
Rt Pcr ◽  
Post Transplantation ◽  
Hematopoietic Stem ◽  
Allogeneic Hsct ◽  
Ebv Reactivation ◽  
Number Of Patients ◽  
Significant Difference

Abstract Epstein Barr Virus (EBV) reactivation occurs in about 50% of the allogeneic hematopoietic stem cell transplantation (HSCT) population in the first year post-transplantation. About 1-7% of these patients run the risk of developing a post-transplant lymphoproliferative disorder (PTLD). Several authors have thus advocated systematic screening by EBV real time PCR (RT-PCR) to initiate pre-emptive treatment of reactivations using Rituximab (van Esser 2002). However, the positive predictive value of EBV RT-PCR is only of 40% (van Esser 2001), implying that this algorithm overtreats a number of patients. Methods: We have retrospectively analyzed 60 consecutive allogeneic HSCT patients transplanted in our center between 1/1/2004 and 31/3/2005. Four patients were excluded because of absence of EBV follow-up (n=2) or autologous reconstitution (n=2). EBV reactivation (EBV (+)) was defined by at least two consecutive episodes of EBV RT-PCR above 1000 copies/ml of whole blood. Any other result was considered as negative (EBV (−)). Results: 1175 EBV RT-PCR samples were collected over a median follow up of 215 days (range: 21–511). The population observed was essentially adults (median age 42 years, range: 1–65) with leukemia (29 leukemia, 11 lymphomas, 16 other diseases), mixed graft types (26 matched sibling donors, 26 matched unrelated donors, 4 haploidentical donors; 77% peripheral blood stem cells; 20% CD34+ selection) and mixed conditioning (52% non-myeloablative conditioning containing ATG, and 48% full conditioning). The EBV(+) and EBV(−) cohorts were similar for all characteristics analyzed. We observed a median of 18 EBV RT-PCR per patient (range: 4–105), with a median interval between two tests of 7 days (range: 3–45). There were 30 true reactivations, 2 intermittent reactivations (non consecutive EBV titer rises above threshold), 8 isolated reactivations and 16 patients with no reactivation episode. EBV RT-PCR was first performed at a median of 6 days post HSCT (range: 0–245), and reactivation was noted at a median of 44 days post HSCT (range: 6–375). There were no significant difference in PCR follow up (first day of screening, median test interval and length of biological follow up) except for the total number of screening tests per patient, which was higher in the EBV(+) group (p= 0.01). There was only one case of biopsy-proven PTLD in the EBV(+) cohort. No patient was administered Rituximab post- HSCT. Survival curves of the two cohorts were similar regardless of EBV reactivation (log-rank, p= 0.201). Discussion: The incidence of EBV reactivation (n= 30; 54%) and of PTLD (n=1;1.7%) were standard compared to previous studies, resulting in a standard specificity of 47% for EBV screening. However, within our limited group of patients, we could not show any significant differences in mortality between the EBV(+) and EBV (−) cohorts. Therefore, absence of preventive treatment for EBV reactivation did not result in an increase in mortality in our EBV reactivating cohort. This suggests that systematic prophylactic use of Rituximab may not affect overall mortality, whilst potentially increasing the risk of other opportunistic infections. Conclusion: Further prospective studies are needed to better define the patients at risk for developing EBV-related PTLD, within the EBV reactivating allogeneic transplant patients group, before prophylactic treatment of reactivation becomes a routine procedure.

Mesenchymal Stem Cells Vs. Mesenchymal Stem Cells Combined With Cord Blood For Treating Engraftment Failure Following Autologous Hematopoietic Stem Cell Transplantation: A Pilot Prospective Study

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3693-3693 ◽  
Author(s):  
YiYing Xiong ◽  
Fan Qian ◽  
Fen Huang ◽  
Yu Zhang ◽  
Yu Wang ◽  
...  
Keyword(s):  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Stem Cell ◽  
Research Funding ◽  
Post Transplantation ◽  
Hematopoietic Stem ◽  
Allogeneic Hsct ◽  
Significant Difference ◽  
Engraftment Failure

Abstract Background Engraftment failure (EF) is a formidable complication after autologous hematopoietic stem cell transplantation (auto-HSCT). Mesenchymal stem cells (MSCs) and cord blood (CB) have been found to support hematopoiesis. Thus, we designed a multicenter randomized clinical trial to investigate the effects and safety of MSCs alone or combined with CB infusion for patients with EF. Methods Twenty-two patients were randomly assigned to receive the treatment with MSCs alone (MSCs group, n=11) or MSCs combined with CB (CB group, n=11). MSCs were administered once every 2 weeks (2 doses were a cycle) in both groups, and single-unit CB was administered at the same day with the first application of MSCs in CB group; After one cycle of treatments (within 28 days), the patients who did not response to MSCs would receive the therapeutic schedule in CB group, and those patients with partial response (PR) in MSCs group and those without complete response (CR) in CB group would continue another cycle of MSCs treatment. If patients did not obtain CR after two cycles of treatments (within 56 days), they would receive other treatments including allogeneic HSCT. Results After the first treatment cycle, the effect rates were not significant difference in MSCs and CB groups (7/11 vs. 9/11, P=0.635), and the median time of hematopoietic reconstruction was 22 (18-28) and 17 (13-22) days, respectively (P=0.036) in MSCs and CB group. There was statistically significant difference regarding neutrophil engraftment, with 17 (range 9-28) and 8 (range 6-14) days respectively (P=0.030), but no difference regarding platelet engraftment, with 21 (range 18-28) and 18 (range 11-21) days respectively (P=0.092) between MSCs and CB groups. After two cycles of treatments, 17 patients obtained CR, 2 PR and 3 NR. CB chimerisms were not detected by short tandem repeat (STR) at +15 and +30 days after CB infusion. None of the patients experienced any adverse events of grade 3/4 with the Common Terminology Criteria for Adverse Events v3.0 (CTCAE v3.0) and acute GVHD or chronic GVHD during the period of study treatment and follow-up. One patient with PR in MSCs group and 1 NR in CB group received allogeneic HSCT at +249 and +273 days after auto-HSCT because of EF and primary disease relapse, respectively. At a median follow-up time of 345 (range 129–784) days post-transplantation, 16 patients remained alive, 3 died of relapse of primary diseases and 1 died of CMV pneumonia following allo-HSCT. None of patients developed EBV-DNA viremia and EBV-associated diseases in two groups. The 2-year overall survival, disease-free survival and tumor relapse post-transplantation were 75.2% (95% CI, 63.2-87.2%), 79.5% (95% CI, 70.1-88.9%) and 20.5% (95% CI, 11.1-29.9%) respectively. Conclusions Our data suggest that ex-vivo-expanded MSCs derived from HLA-mismatched BM alone or combined with unrelated CB are effective to EF after auto-HSCT. CB can facilitate the effect of MSCs to EF. Both two strategies do not result in GVHD or increase the risk of primary diseases relapse in patients with EF. This trial was registered at www.clinicaltrials.govas#NCT01763099. Disclosures: Liu: It was supported by 863 Program (No. 2011AA020105) and National Public Health Grand Research Foundation (Grant No. 201202017).: Research Funding; It was supported by National Natural Science Foundation of China (Grant No.81000231, No.81270647) and Science and Technology Program of Guangzhou of China (11A72121174). : Research Funding.

T Cell Depletion with Alemtuzumab Is Associated with a High Incidence of EBV Viraemia but Low Risk of PTLD Following Allogeneic Stem Cell Transplantation

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1177-1177
Author(s):  
Ben Carpenter ◽  
Maria Dimopoulou ◽  
Nilusha Manji ◽  
Tanzina Haque ◽  
Claire Atkinson ◽  
...  
Keyword(s):  
T Cell ◽  
Post Transplantation ◽  
Allogeneic Hsct ◽  
Ebv Reactivation ◽  
Unrelated Donors ◽  
Ebv Dna ◽  
High Level

Abstract Re-activation of latent EBV infection is a significant risk following T-cell depleted (TCD) allogeneic HSCT. The clinical course can range from asymptomatic viraemia to the development of post-transplantation lymphoproliferative disease (PTLD) and death. Since alemtuzumab depletes both T and B cells, it has been proposed that the risk of PTLD will be reduced compared to other TCD protocols. In an attempt to determine the risk of EBV viraemia or PTLD following allogeneic HSCT employing alemtuzumab-containing conditioning protocols, we reviewed outcomes in 91 consecutive adult patients treated at our institution. Of these, 84 patients had >6 months follow-up and are included in this analysis. Two strategies of TCD were employed in this cohort: in vivo TCD with alemtuzumab (median dose 100mg) as part of a reduced intensity regimen (fludarabine based n=51); and in vitro TCD of the PBSC graft with 20 mg alemtuzumab ‘in the bag’ following conventional myeloablative conditioning (n=33). We have shown previously that alemtuzumab antibody levels persist for longer periods (up to 8 weeks ) following this in vivo depletion strategy compared to the in vitro approach [Morris et al. Blood 2003 102:404–6]. The median follow-up is 337 days and median age was 43 years (range 16–67 years). Diagnoses were AML/MDS (n=39), NHL (n=16), Hodgkins lymphoma (n=11), MPD (n=7), CLL (n=5) and other (n=6). 41/84 had HLA-identical sibling donors, 2 mismatched sibling donors, 21 matched unrelated donors and 20 mismatched unrelated donors. Monitoring for EBV load was performed by TaqMan whole blood real time PCR on a weekly basis for 100 days post transplantation and then as seen for follow-up. Positive results defined as >200 copies/ml of EBV DNA. All patients with high levels of EBV viraemia (EBV DNA level > 40,000 copies/ml) underwent CT imaging, bone marrow examination and lumbar puncture followed by withdrawal of immunosuppression and a single infusion of 375mg/m2 Rituximab as per institution policy. Of 82 patients where serostatus was available, 92.7 % were anti-EBV IgG positive. The 12-month cumulative incidence (CI) of EBV reactivation was 34.5% (39.2% following in vivo TCD versus 27.3% following in vitro TCD, p=0.2). Median peak viral load was 1,922 copies/ml (range 205–6,210,000). The 12 month CI of high-level EBV viraemia (>40,000 copies/ml) was 11.9% (7.84% following in vivo TCD versus 18.2% following in vitro TCD, p=0.19). Patients re-activated EBV at a median of 86 days post transplant (range 21–380 days). The median duration of viraemia was 42 days (range 1–460 days). The 12-month CI of recurrent EBV re-activation (>1 episode) was 21.4% (15.5% following in vivo TCD versus 25.5% following in vitro TCD, p=0.4). Of 10 patients with high-level EBV viraemia, 1 patient had PTLD as confirmed by histology. 8 of 10 patients received a single dose of Rituximab and this was associated with a rapid decline in EBV DNA load to undetectable levels in all cases. No adverse events secondary to Rituximab were noted. The patient with PTLD was given a second dose of Rituximab and attained a CR that persists at 334 days post treatment. 12-month non-relapse mortality was 10% in patients who had EBV reactivation and 27.7% in patients without EBV reactivation (p=0.06). Baseline and post-transplantation characteristics of sex, age, diagnosis, in vivo vs. in vitro alemtuzumab, donor type, CMV viraemia and presence of past or active acute GVHD were not related to re-activation of EBV by uni- or multivariate analysis in this patient cohort. In summary, this report demonstrates that TCD using alemtuzumab-containing conditioning protocols is associated with a high frequency of EBV viraemia but low risk of PTLD or non-relapse death in a cohort of patients treated pre-emptively with Rituximab for high EBV DNA loads.

scholarly journals Randomized Trial of Erythromycin and Azithromycin for Treatment of Chlamydial Infection in Pregnancy

1995 ◽  
Vol 3 (6) ◽  
pp. 241-244 ◽  
Author(s):  
Marc F. Rosenn ◽  
George A. Macones ◽  
Neil S. Silverman
Keyword(s):  
Side Effects ◽  
Screening Tests ◽  
Number Of Patients ◽  
Significant Difference ◽  
Gastrointestinal Side Effects ◽  
The Cost ◽  
Cure Rates ◽  
To Receive ◽  
In Pregnancy

Objective:The purpose of this study was to compare erythromycin and azithromycin in the treatment of chlamydial cervicitis during pregnancy with regard to efficacy, side effects, and compliance.Methods:In a prospective manner, 48 pregnant patients with cervical chlamydial infections diagnosed by routine screening tests were randomly assigned to receive either erythromycin, 500 mg q.i.d. for 7 days (N = 24), or azithromycin, 1 g as a one-time dose (N = 24). All sexual partners were given prescriptions for doxycycline, 100 mg b.i.d. for 7 days. The treatment efficacy was assessed by follow-up chlamydia testing 3 weeks after the therapy was completed. The side effects, intolerance to therapy, and overall compliance were evaluated by means of a standardized posttreatment questionnaire.Results:There was no significant difference in cure rates noted between the erythromycin group and the azithromycin group (77% vs. 91%, respectively;P= 0.24). Gastrointestinal side effects were reported more frequently among patients treated with erythromycin compared with patients treated with azithromycin (45% vs. 17%, respectively;P= 0.004). The patients who received erythromycin reported intolerance to therapy secondary to side effects more frequently than patients who received azithromycin (23% vs. 4%, respectively;P= 0.07). Furthermore, the patients in the azithromycin group were more likely to complete their course of therapy as prescribed than the patients in the erythromycin group (100% vs. 61%, respectively;P= 0.002).Conclusions:Azithromycin is efficacious and well tolerated for the treatment of chlamydial cervicitis in pregnancy. Erythromycin, though efficacious, is poorly tolerated, as demonstrated by the number of patients reporting significant side effects during the course of therapy. Since the cost of azithromycin is comparable to that of generic erythromycin, the present study supports the use of azithromycin as an alternative to erythromycin for the treatment of chlamydial cervicitis in pregnancy.

scholarly journals Bronchiolitis Obliterans Occurring after Allogenic Hematopoietic Stem Cell Transplant: Comparison of Outcome Between Patients Equipped or Not with Home Spirometry Monitoring

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3161-3161
Author(s):  
Clémence Loiseau ◽  
Francois Lemonnier ◽  
Odile Randrianarivelo ◽  
Raphael Itzykson ◽  
Marie Hélène Becquemin ◽  
...  
Keyword(s):  
Stem Cell ◽  
Pulmonary Function ◽  
Hematopoietic Stem Cell ◽  
Median Time ◽  
Bronchiolitis Obliterans ◽  
Time Dependent ◽  
Post Transplantation ◽  
Hematopoietic Stem ◽  
Significant Difference

Abstract Introduction Bronchiolitis obliterans (BO) is a frequent and severe complication of allogeneic hematopoietic stem cell transplantation (allo HSCT), strongly associated with chronic Graft versus Host Disease (cGvHD). Home spirometry monitoring of pulmonary function has shown to be a useful tool for early BO diagnosis after lung transplantation. The aim of this study was to compare the outcome of allo HSCT recipients with or without home spirometry post-transplant monitoring. Methods Inclusion criteria: Consecutive patients transplanted in Pitié-Salpêtrière hospital between June 2001 and November 2008 were included if they had a minimal post transplantation follow-up of one hundred days post transplantation, excluding those who relapsed or had not been discharged of hospital by 100 days post transplantation. Definition: B0 was defined as an obstructive and non-reversible ventilatory impairment above 20% of the baseline (before HSCT) values of the forced expiratory volume per second (FEV1) with exclusion of acute respiratory tract infection. Home spirometry monitoring: It was performed with a portable spirometer (Spirotel®, M-Elect France) twice a week and transmitted by phone to the respiratory function testing laboratory hospital. Patients living in the Paris area and having a landline telephone could be equipped with Spirotel (Sp); the other patients, as well as those who didn't consent to Sp monitoring, were included in the non Spirotel (No-Sp) arm. Results Two hundred and twelve patients were analyzed: 107 in the Sp and 105 in the No-Sp arms. The 2 groups were comparable in term of age at transplant (mean 44.6 years, range 14.2 - 66), diagnosis, disease risk index at transplant and transplant modalities (conditioning regimen, stem cell source, donor type). The median interval from transplant to onset of pulmonary function monitoring was 4.36 months, with a median time of equipment of 16 months. According to the criteria published by Kugler (Transplantation 2011), 37% of patients were good adherers, 30% moderate adherers, and 33% non-adherers. Non relapse mortality (NRM) was lower in the Sp arm: Hazard ratio (HR) 0.36, 95% confidence interval (CI) 0.18 - 0.69, p= 0.002. During the follow-up, 35 BO were diagnosed (24 in the Sp and 11 in the No-Sp arms), leading to a 5-year cumulative incidence (CI) of 16.3%. Among the 24 BO occurring in the Sp arm, 13 were diagnosed after a Spirotel warning while 11 were not (including 4 BO with onset after the end of monitoring); then, Spirotel can detect 65% of BO (13/20) occurring during the monitoring. Since BO could occur in the Sp arm after the end of the equipment, comparisons of incidence of BO between the Sp and No-Sp groups were performed using Spirotel monitoring as a time-dependent variable. By time-dependent Mantel-Byar method, CI of BO was not statistically different between the two groups (HR 1.17, 95 % CI 0.60 - 2.29, p=0.636). Median time from transplant to BO diagnosis (15 months) was similar between the 2 groups. Of the 35 BO patients, 5 died without relapse, leading to a 5-year NRM of 16.5%: 2 (8.3%) in the Sp group and 3 (27%) in the No-Sp group (Odd ratio (OR) 0.25, 95% CI 0.02 - 2.64, p= 0.3). Compared to pre-transplant values, the drop of FEV1 at diagnosis of BO and the maximal drop of FEV1 observed during the follow-up were respectively 36 % versus 43 % (p=0.51) in the Sp group, and 47 % versus 55 % (p=0.42), with no significant difference. Conclusion In this study comparing the outcome of allo HSCT recipients monitored or not with Spirotel, NRM of patients with BO was lower than usually reported, especially in the Sp group. Home spirometry equipment allows detection of two third of BO occurring during the monitoring. Contrary to what is observed in lung transplanted patients, only one third of patients achieved a good adherence. It could explain both the failure of Spirotel to detect some BO and the lack of significant difference in the severity of BO diagnosed or not by Spirotel. Disclosures No relevant conflicts of interest to declare.

Long-Term Follow-up of Multiple Myeloma Patients Treated by Bortezomib (Velcade®): A Study on Efficacy, Tolerance, Survival and Time to Progression

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 5197-5197
Author(s):  
Mauricette Michallet ◽  
Mohamad Sobh ◽  
Quoc Hung Le ◽  
Fiorenza Barraco ◽  
Charles Dumontet ◽  
...  
Keyword(s):  
Negative Impact ◽  
Time To Progression ◽  
Hematopoietic Stem ◽  
Allogeneic Hsct ◽  
Significant Difference ◽  
Population Figure ◽  
Group 3 ◽  
Group 1

Abstract We conducted a retrospective single institution analysis to evaluate the immediate and long-term efficacy, tolerance, survival and time to progression of MM patients (pts) who received VELCADE (Vel.) as induction and in those who relapsed or were refractory after standard therapies. A total of 92 pts were included, 62 (67%) males and 30 (33%) females. Median age at treatment was 60 years [35–79]. At diagnosis, there were 48 (52%) IgG, 24 (26%) IgA, 2 (2%) IgD, 15 (16%) light chains and 3 (4%) plasma cell leukaemias, 11pts (12%) were in stage I A, 12 (13%) stage IIA and 69 (75%) stage III (51 A and 18B). The median level of β2 microglobulin was 3.28 mg/l (1.12–24). Among 42 evaluated del(13), 19 (45%) were + in which there was two t(4;14)+. We defined 3 groups: group1:16 (17%) pts who received Vel. as induction, group2:58 (63%) pts who received Vel. as 2nd line n=41 or 3rd line n=17, group 3:18 (12%) pts who received Vel. as ≥ 4th line. Prior to Vel.(groups 2 and 3), 53 (70%) pts had received an autologous hematopoietic stem cell transplantation (HSCT), 13 (14%) allogeneic HSCT and 35 (46%) thalidomide (Thal.) (median dose of 200mg/day, median duration of 4 months). The median interval between diagnosis and Vel. initiation was 28.3 months (0.2–125); 28 pts had an interval less than 12 months (16 in 1st line), 27 pts between 12 and 36 months and 37 pts with more than 36 months. The median number of Vel. cycles in group 1, 2 and 3 were 4[2–9], 5[2–12] and 5[3–12] respectively with a standard dose of 1.3 mg/m2 decreased to 1.0 mg/m2 in case of toxicity (<3 cycles: n=18, 4–6: n=52; 7–8: n=14; >8: n=8). Fifty-two (57%) pts received an association of dexamethasone (40mg/day). There were 6 Vel. discontinuation (<3 Vel.cycles) and 25 (27%) dose reduction due to neuropathy [3cycles n=2 (17%), 4–6 cycles n=12 (23%), 7–8 cycles, n=7 (50%) and ≥9 n=4 (50%)]. Peripheral neuropathy occurred in 61 pts (66%) [32 (52%)gr1, 18 (30%)gr2, 9 (15%)gr3 and 4 (3%)gr4], in which, 25 (41%) had previously received Thal. [12 (48%)gr1, 8 (32%)gr2, 5 (20%)gr3]. The most other common toxicities were, fatigue n=35 (38%), constipation n=18(20%), diarrhea n= 11(12%), nausea n=14(15%) and vomiting n=7(8%). The overall response rate was observed in 67 (73%) pts [13 (14%)CR, 22 (24%)VGPR and 32 (35%)PR]. With a median follow-up of 23.4 months, the median overall survival (OS) for the whole population and for group 1 and 2 was not reached, and was 17 months for group 3. The probability of OS at 3 years for the whole population was 61%[50–73.5] (Figure 1) and were: 80%[62–100], 66%[54–81] and 45%[25–82.5] for groups 1, 2 and 3 respectively (Figure 2). The probability of OS at 5 years for the whole population from MM diagnosis was 72.5%[63–84]. The median time to progression (TTP) was 25.5 months for the whole population; it was not reached for group 1, were 25.5 and 13 months for group 2 and 3 respectively. The probability of progression-free survival (PFS) at 2 years was 51%[40–64,5] for the whole population and 66%[45–96], 52%[39–70] and 29%[12–71] for group 1, 2 and 3 respectively. We showed no significant difference in term of OS (p=0,166) and PFS (p=0.495) between the patients with del(13) [51% (31–83) and 42(23–78)] and without del(13) [83%(68,5–99,6) and 58%(40–85,5)]. Finally we observed a better PFS at 2 years for pts receiving lenalidomide after Vel. versus those who did not, 64%[42–96] and 48%[36–63] respectively. The multivariate analysis (studying: age, sex, stage, beta2M, del(13), previous lines, allogeneic HSCT, Thal., and interval diag-Vel.) showed only a significant impact of thalidomide HR=3.06 (1.37–6.85) (p=0,006), and a trend for interval diag-Vel. In conclusion, this analysis showed a very good percentage of long-term OS with a median not reached for Vel. naïve or 2nd, 3rd Vel line MM pts. Moreover, we showed a significant negative impact of previous Thal. treatment and no impact of del(13). Figure 1. Probability of OS for the whole population Figure 1. Probability of OS for the whole population Figure 2. Probability of OS for groups 1, 2 and 3 Figure 2. Probability of OS for groups 1, 2 and 3

scholarly journals 288. Follow-Up Blood Cultures in Gram-Negative Bacteremia: How Do They Impact Outcomes

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S144-S144
Author(s):  
Azza Elamin ◽  
Faisal Khan ◽  
Ali Abunayla ◽  
Rajasekhar Jagarlamudi ◽  
aditee Dash
Keyword(s):  
Clinical Outcomes ◽  
Antibiotic Treatment ◽  
Readmission Rate ◽  
Blood Cultures ◽  
Categorical Variables ◽  
Gram Negative ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

Abstract Background As opposed to Staphylococcus. aureus bacteremia, there are no guidelines to recommend repeating blood cultures in Gram-negative bacilli bacteremia (GNB). Several studies have questioned the utility of follow-up blood cultures (FUBCs) in GNB, but the impact of this practice on clinical outcomes is not fully understood. Our aim was to study the practice of obtaining FUBCs in GNB at our institution and to assess it’s impact on clinical outcomes. Methods We conducted a retrospective, single-center study of adult patients, ≥ 18 years of age admitted with GNB between January 2017 and December 2018. We aimed to compare clinical outcomes in those with and without FUBCs. Data collected included demographics, comorbidities, presumed source of bacteremia and need for intensive care unit (ICU) admission. Presence of fever, hypotension /shock and white blood cell (WBC) count on the day of FUBC was recorded. The primary objective was to compare 30-day mortality between the two groups. Secondary objectives were to compare differences in 30-day readmission rate, hospital length of stay (LOS) and duration of antibiotic treatment. Mean and standard deviation were used for continuous variables, frequency and proportion were used for categorical variables. P-value < 0.05 was defined as statistically significant. Results 482 patients were included, and of these, 321 (67%) had FUBCs. 96% of FUBCs were negative and 2.8% had persistent bacteremia. There was no significant difference in 30-day mortality between those with and without FUBCs (2.9% and 2.7% respectively), or in 30-day readmission rate (21.4% and 23.4% respectively). In patients with FUBCs compared to those without FUBCs, hospital LOS was longer (7 days vs 5 days, P < 0.001), and mean duration of antibiotic treatment was longer (14 days vs 11 days, P < 0.001). A higher number of patients with FUBCs needed ICU care compared to those without FUBCs (41.4% and 25.5% respectively, P < 0.001) Microbiology of index blood culture in those with and without FUBCs Outcomes in those with and without FUBCs FUBCs characteristics Conclusion Obtaining FUBCs in GNB had no impact on 30-day mortality or 30-day readmission rate. It was associated with longer LOS and antibiotic duration. Our findings suggest that FUBCs in GNB are low yield and may not be recommended in all patients. Prospective studies are needed to further examine the utility of this practice in GNB. Disclosures All Authors: No reported disclosures

scholarly journals Comparative study between fat plug and inlay butterfly cartilage grafts for myringoplasty in adults

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Ahmed Gamal Khafagy ◽  
Mohamed El-Begermy ◽  
Marwa Mohamed El-Begermy ◽  
Pretty O. Afifi
Keyword(s):  
Tympanic Membrane ◽  
Chronic Otitis Media ◽  
Fat Graft ◽  
Cartilage Graft ◽  
Tympanic Membrane Perforations ◽  
Number Of Patients ◽  
Significant Difference ◽  
Hearing Outcomes ◽  
Age Range

Abstract Background This study aims to compare the graft uptake rate and hearing improvement of fat graft versus inlay butterfly tragal cartilage in the repair of perforations in chronic otitis media mucosal in adults. In this retrospective study, twenty-eight patients were included with small dry anteroinferior tympanic membrane perforations (less than 1/3 of the tympanic membrane). The age range was 18 to 44 years old. Myringoplasty was done under general anesthesia for 8 patients with a fat graft (FG) and 20 patients with inlay butterfly cartilage graft (IBCG). Six months postoperatively, a follow-up evaluation was done for successful graft uptake and hearing outcomes. Results The success rate of graft uptake in the first group (fat graft) was 6/8 cases (75%) while in the second group (IBCG) was 19/20 (95%) with no statistically significant difference (P = 0.0148). Also, there was no statistical difference between the two groups as regards postoperative ABG, improvement changes in ABG, and number of patients with improved hearing. Conclusions Inlay butterfly cartilage graft is a useful graft in repairing small tympanic membrane perforations as regard graft take and hearing outcomes.

scholarly journals Postoperative craniospinal radiotherapy of medulloblastoma in children and young adults

2003 ◽  
Vol 131 (5-6) ◽  
pp. 226-231
Author(s):  
Ivana Golubicic ◽  
Jelena Bokun ◽  
Marina Nikitovic ◽  
Jasmina Mladenovic ◽  
Milan Saric ◽  
...  
Keyword(s):  
High Risk ◽  
Brain Stem ◽  
Wilcoxon Test ◽  
Time Interval ◽  
Tumor Removal ◽  
Shunt Placement ◽  
Craniospinal Radiotherapy ◽  
Number Of Patients ◽  
Significant Difference

PURPOSE The aim of this study was: 1. to evaluate treatment results of combined therapy (surgery, postoperative craniospinal radiotherapy with or without chemotherapy) and 2. to assess factors affecting prognosis (extend of tumor removal, involvement of the brain stem, extent of disease postoperative meningitis, shunt placement, age, sex and time interval from surgery to start of postoperative radiotherapy). PATIENTS AND METHODS During the period 1986-1996, 78 patients with medulloblastoma, aged 1-22 years (median 8.6 years), were treated with combined modality therapy and 72 of them were evaluable for the study end-points. Entry criteria were histologically proven diagnosis, age under 22 years, and no history of previous malignant disease. The main characteristics of the group are shown in Table 1. Twenty-nine patients (37.2%) have total, 8 (10.3%) near total and 41 (52.5%) partial removal. Seventy-two of 78 patients were treated with curative intent and received postoperative craniospinal irradiation. Radiotherapy started 13-285 days after surgery (median 36 days). Only 13 patients started radiotherapy after 60 days following surgery. Adjuvant chemotherapy was applied in 63 (80.7%) patients. The majority of them (46 73%) received chemotherapy with CCNU and Vincristine. The survival rates were calculated with the Kaplan-Meier method and the differences in survival were analyzed using the Wilcoxon test and log-rank test. RESULTS The follow-up period ranged from 1-12 years (median 3 years). Five-year overall survival (OS) was 51% and disease-free survival (DFS) 47% (Graph 1). During follow-up 32 relapses occurred. Patients having no brain stem infiltration had significantly better survival (p=0.0023) (Graph 2). Patients with positive myelographic findings had significantly poorer survival compared to dose with negative myelographic findings (p=0.0116). Significantly poorer survival was found in patients with meningitis developing in the postoperative period, with no patient living longer than two years (p=0.0134) (Graph 3). By analysis of OS and DFS in relation to presence of the malignant cells in liquor, statistically significant difference, i. e. positive CSF cytology was not obtained, which was of statistical importance for survival (p=0.8207). Neither shunt placement nor shunt type showed any impact on survival (p=0.5307 and 0.7119, respectively). Children younger than three years had significantly poorer survival compared to those older than 16 years (p=0.0473). Although there was a better survival rate in females than in males this was not statistically significant (p=0.2386).The analysis results of treatment showed that significantly better survival occurred in patients in whom total or subtotal tumor removal was possible (p=0.0022) (Graph 4). Patients who started radiotherapy within two months after surgery have better survival, but again this was not statistically significant, probably due to the small number of patients receiving delayed radiotherapy (p=0.2231)(Graph5). CONCLUSION Based on this factors standard and high risk group could be defined. Combined chemotherapy should to be investigated particularly for high risk subgroup. Future research should be done to define new therapeutic modalities (gene therapy, compounds active in tumor antiangiogenesis etc).

scholarly journals Reguliuojamos skrandžio apjuosimo juostos: lyginamųjų studijų apžvalga

2011 ◽  
Vol 9 (1-2) ◽  
pp. 0-0
Author(s):  
Tomas Abalikšta ◽  
Gintautas Brimas ◽  
Kęstutis Strupas
Keyword(s):  
Weight Loss ◽  
Comparative Studies ◽  
University Hospital ◽  
Cochrane Library ◽  
Band Slippage ◽  
Lap Band ◽  
Number Of Patients ◽  
Significant Difference ◽  
Gastric Bands

Tomas Abalikšta, Gintautas Brimas, Kęstutis Strupas Vilniaus universiteto Medicinos fakultetas, M. K. Čiurlionio g. 21, LT-03101 VilniusVilniaus universiteto ligoninės Santariškių klinikų Pilvo chirurgijos centras,Santariškių g. 2, LT-08661 VilniusEl. paštas: [email protected] Darbo tikslas: Remiantis literatūros duomenimis palyginti skirtingas skrandžio apjuosimo reguliuojamas juostas, naudojamas chirurginiam nutukimo gydymui. Tyriamoji medžiaga ir metodai: Publikacijų paieška atlikta elektroninėse MEDLINE, Current Contents ir Cochrane Library duomenų bazėse. Apžvelgtos visos skrandį apjuosiančių reguliuojamų juostų lyginamųjų studijų publikacijos, paskelbtos iki 2010 m. sausio 1 d. Rezultatai: Atlikus literatūros šaltinių paiešką rasta 10 publikacijų, lyginančių skirtingas skrandį apjuosiančias reguliuojamas juostas. Išsamiai atlikta viena studija: perspektyvi, atsitiktinių imčių, jos tiriamųjų skaičius didelis ir stebėjimo laikotarpis ilgas, įvertinti visi gydymo rezultatai. Statistiškai reikšmingo skirtumo tarp SAGB ir LAP-BAND juostų šioje studijoje nerasta. Kitos lyginamosios juostų studijos turi trūkumų: keturios buvo ne atsitiktinių imčių (dvi iš jų retrospektyvios), trijose tiriamųjų imtis maža, visų stebėjimo laikas trumpas. Vienoje iš šių studijų nustatytas kūno masės kritimo skirtumas tarp grupių: LAP-BAND grupėje pradinė viršnorminė kūno masė sumažėjo 41,7 %, Heliogast – 28,3 %. Mechaninių juostų komplikacijų dažnis skyrėsi vienoje studijoje: LAP-BAND – 7 %, SAGB – 1 %. Skirtumas tarp „mažo skrandžio“ išsiplėtimo arba juostos nuslinkimo dažnio rastas trijose studijose (MiniMizer Extra – 0 % ir LAP-BAND – 10,8 %; SAGB – 2,4 % ir LAP-BAND – 27,6 %; SAGB – 2 % ir LAP-BAND – 23 %). Skirtumo tarp gretutinių ligų ir gyvenimo kokybės pokyčio, hospitalizacijos trukmės, juostos reguliavimų skaičiaus/dažnio, juostos penetracijos/migracijos į skrandį bei infekcinių komplikacijų dažnio nerasta. Išvados: Tik viena studija atlikta laikantis šiuolaikinių įrodymais pagrįstos medicinos keliamų reikalavimų, skirtumo tarp lygintų juostų nerasta. Reikalingos perspektyvios, atsitiktinių imčių ilgalaikės (>5 metų) lyginamosios studijos, vertinančios juostų konstrukcijos ar formos skirtumų įtaką gydymo efektyvumui ar komplikacijoms. Reikšminiai žodžiai: nutukimas, bariatrinė chirurgija, skrandžio apjuosimo reguliuojama juosta operacija. Adjustable gastric bands: review of comparative studies Tomas Abalikšta, Gintautas Brimas, Kęstutis Strupas Vilnius University Medical Faculty, M. K. Čiurlionio Str. 21, LT-03101 Vilnius, LithuaniaVilnius University Hospital Santariškių Klinikos Centre of Abdominal Surgery,Santariškių Str. 2, LT-08661 Vilnius, LithuaniaEl. paštas: [email protected] Objective: The objective of this review is to compare different adjustable gastric bands according to the data of comparative studies. Materials and Methods: A search of articles published in any language before January 2010 was carried out through the MEDLINE, Current Contents and Cochrane Library electronic databases. All articles about comparative studies of different adjustable gastric bands were eligible for review. All possible data were extracted from accepted studies and reviewed. Results: Ten comparative studies of different adjustable gastric bands were accepted. Only one comparative study of the bands was accomplished properly. It was a prospective randomised study type with a large number of patients and a long follow-up period with all possible results evaluated. No statistically significant difference between SAGB and LAP-BAND gastric bands was found in this study. The other band studies had shortcomings: four studies were non-randomised (two of them retrospective), a small number of patients in three studies, and a too short follow-up period in all studies. The difference in weight loss was stated in one of these studies: 41.7% of initial excess weight loss in the LAP-BAND group and 28.3% in the Heliogast group. Band leakage frequency was different in one study: LAP-BAND – 7%, SAGB – 1%. A difference between pouch dilatation or band slippage frequency was found in three studies (MiniMizer Extra – 0% and LAP-BAND – 10.8%; SAGB – 2.4% and LAP-BAND – 27.6%; SAGB – 2% and LAP-BAND – 23%). There was no difference between the resolution of comorbidities, improvement of the quality of life, hospital stay, band adjustment frequency, band migration or band infection rate. Conclusion: Only one accepted study was accomplished properly. There was no difference between compared adjustable gastric bands in this study. Prospective randomised long-term (more than 5 years) comparative studies are needed for a proper evaluation of band construction or shape influence on weight loss and complications. Keywords: obesity, bariatric surgery, adjustable gastric banding.

scholarly journals SP9.1.1 The Impact of Anaesthetic Use on Healing in Sub-cutaneous Abscess Management: A Retrospective Before and After Cohort Study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Hannah Elkadi ◽  
Eleanor Dodd ◽  
Theodore Poulton ◽  
William Bolton ◽  
Joshua Burke ◽  
...  
Keyword(s):  
Wound Healing ◽  
Local Anaesthetic ◽  
Surrogate Endpoints ◽  
Incision And Drainage ◽  
Number Of Patients ◽  
Significant Difference ◽  
Patient Reported ◽  
Before And After ◽  
The Impact

Abstract Aims Despite being the most common surgical procedure, there is wide variation that exists in the management of simple subcutaneous abscesses with no national guideline describing best practice. During the COVID-19 Pandemic national guidelines promoted the use of regional or local anaesthetic (LA) instead of general anaesthesia (GA) to avoid aerosol generating intubation associated with GA. This study aimed to assess the impact of anaesthetic choice in outcomes following incision and drainage of subcutaneous abscesses. Methods Two cohorts of patients undergoing abscess incision and drainage at St. James’ University Hospital Leeds were retrospectively identified over a 14-week period before and after the introduction of the new COVID-19 anaesthetic guidelines. Wound healing surrogate endpoints were used: i) total number of follow up appointments and ii) attendance to healthcare services after 30 days from I&D. Result 133 patients were included. Significantly more procedures were performed under LA after the intervention (84.1% vs 5.7%; p < 0.0001) with a significant reduction in wound packing (68.3% vs 87.1%. p=0.00473). Follow up data found no significant difference in the average number of follow-up appointments (7.46 vs 5.11; p = 0.0731) and the number of patients who required ongoing treatment after 30 days (n = 14 vs n = 14, p = 0.921). Conclusion Drainage of simple subcutaneous abscess under 5 cm is safe under local anaesthetic with no significant difference in surrogate endpoints of wound healing observed in this patient cohort. Recurrent packing may not be required. Future work should explore patient reported measures such as pain management and the health economics of this intervention.

Sign in / Sign up

Export Citation Format

Share Document