Efficacy of Yttrium-90 Zevalin Outside of Clinical Trials: Preliminary Results of a Retrospective Bi-Center Study

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 5015-5015
Author(s):  
Francesco Cicone ◽  
Francesco Scopinaro ◽  
Sebastien Baechler ◽  
Nicolas Ketterer ◽  
Franz Buchegger ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Clinical Setting ◽  
Patient Population ◽  
Statistical Significance ◽  
University Hospital ◽  
Low Grade ◽  
Number Of Patients ◽  
Significant Difference ◽  
Routine Clinical Setting

Abstract Background and Aim: Due to limited data regarding the efficacy of Radioimmunotherapy with 90Y-Zevalin (RIT-Z) outside of controlled clinical trials, we carried out a biinstitutional, international retrospective study to assess the efficacy of RIT-Z in a routine clinical setting. The relationship between the number of previous therapies and outcomes as well as the response to the last therapy was assessed. Possible differences in outcomes for patients treated in the two different centers were also analyzed. Materials and Methods: Forty-three consecutive patients treated at the University Hospital of Lausanne (CHUV, Switzerland) and at S. Andrea University Hospital of Rome (Italy) were evaluated, none of which had been previously included in clinical trials. Only 31 patients entered the final analysis: patients lost at follow up, undergoing autologous transplantation (ASCT), or treated within the last 3 months were excluded. Efficacy of therapy was evaluated in terms of Overall Survival (OS), Progression Free Survival (PFS), and Time to Next Treatment (TTNT). Survival curves were obtained with the Kaplan- Meier method (statistical significance = p<0.05). Results: Characteristics of the patient population are listed in Table 1. Although 50% of the patients had aggressive histologies, patients treated at S. Andrea had slightly more favorable features than those treated at CHUV. Fourteen patients (45%) had received at least 4 previous treatments, and all had received Rituximab. Fourteen patients (45%) had not responded to the last therapy, while 6 (19%), all treated at S.Andrea, were considered disease-free at the time of RIT-Z, which was administered for consolidation. Median follow up time was 20 months (11.5 vs. 25 months for S.Andrea and CHUV, respectively). Median PFS and TTNT were similar. After achieving a partial response, 2 patients were referred to Rituximab maintenance after RIT-Z and remain progression-free. Median OS was still not attained. Although not statistically significant, a trend towards better outcomes for S. Andrea patients was found. In comparing patients with indolent and aggressive lymphoma, only PFS was found to be significantly different (median PFS: 10 vs. 5 months, p<0.05). In patients with <4 and ≥ 4 previous therapies, twenty month OS was 88% vs. 53.6% (p=0.02), respectively; median TTNT was 22 vs. 5 months (p=0.013), while differences in PFS did not attain statistical significance. The duration of response in non-responders to their last therapy was shorter than in responders: 20-month OS- 44% vs. 94% (p=0.0015), median PFS and TTNT- 3.5 vs. 15 months (p=0.0002) and 4 vs. 15 months (p=0.0001), respectively. Median PFS and TTNT after RIT-Z did not differ from those found after the last therapy. A significant difference in outcomes for heavily pretreated or refractory patients was found in those with low grade follicular lymphoma. Conclusions: Poorer outcomes were found in our patient population treated in a routine clinical setting compared to those enrolled in clinical trials. This may be related to greater heterogeneity of our study cohort which included more patients with unfavorable conditions (e.g. aggressive NHL, ≥4 treatment courses including rituximab in all, and ASCT in 25%). Our results suggest that the best benefit may be expected with RIT-Z either for consolidation or relatively earlier in the course of NHL treatment. Table 1. Total CHUV S. Andrea Population Analyzed (72%) Number of patients 43 23 20 31 Median Age 61 63 58,5 62 Aggressive Histology (FL grade 3 or DLBCL) 18 (41,8%) 8 (34,7%) 10 (50%) 11 (35,5%) Indolent Histology (FL grade 1 or 2) (%) 25 (58,2%) 15 (65,3%) 10 (50%) 20 (64,5%) Patients with ≥4 previous treatments 19 (44,2%) 12 (52,1%) 7 (35%) 14 (45,2%) Patients with previous ASCT 11 (25,6%) 6 (26%) 5 (25%) 8 (25%)

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 Cognitive Functions in Repeated Glioma Surgery

Cancers ◽  
2020 ◽  
Vol 12 (5) ◽  
pp. 1077
Author(s):  
Gabriele Capo ◽  
Miran Skrap ◽  
Ilaria Guarracino ◽  
Miriam Isola ◽  
Claudio Battistella ◽  
...  
Keyword(s):  
Cognitive Functions ◽  
Inferior Frontal Gyrus ◽  
Insular Cortex ◽  
Malignant Degeneration ◽  
Low Grade ◽  
Normal Range ◽  
Glioma Surgery ◽  
Number Of Patients ◽  
Significant Difference

Low-grade gliomas (LGG) are slow-growing brain tumors infiltrating the central nervous system which tend to recur, often with malignant degeneration after primary treatment. Re-operations are not always recommended due to an assumed higher risk of neurological and cognitive deficits. However, this assumption is relatively ungrounded due to a lack of extensive neuropsychological testing. We retrospectively examined a series of 40 patients with recurrent glioma in eloquent areas of the left hemisphere, who all completed comprehensive pre- (T3) and post-surgical (T4) neuropsychological assessments after a second surgery (4-month follow up). The lesions were most frequent in the left insular cortex and the inferior frontal gyrus. Among this series, in 17 patients the cognitive outcomes were compared before the first surgery (T1), 4 months after the first surgery (T2), and at T3 and T4. There was no significant difference either in the number of patients scoring within the normal range between T3 and T4, or in their level of performance. Further addressing the T1–T4 evolution, there was no significant difference in the number of patients scoring within the normal range. As to their level of performance, the only significant change was in phonological fluency. This longitudinal follow-up study showed that repeated glioma surgery is possible without major damage to cognitive functions in the short-term period (4 months) after surgery.

scholarly journals Bilateral internal thoracic artery grafting in haemodialysis patients with diabetic nephropathy

2020 ◽  
Vol 31 (6) ◽  
pp. 774-780
Author(s):  
Kohei Hachiro ◽  
Takeshi Kinoshita ◽  
Tomoaki Suzuki ◽  
Tohru Asai
Keyword(s):  
Diabetic Nephropathy ◽  
Internal Thoracic Artery ◽  
Cox Regression ◽  
Statistical Significance ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
University Hospital ◽  
Deep Sternal Wound Infection ◽  
Significant Difference

Abstract OBJECTIVES To compare postoperative outcomes in patients with diabetic nephropathy receiving haemodialysis and undergoing isolated coronary artery bypass grafting (CABG) using bilateral or single skeletonized internal thoracic artery (ITA). METHODS Among 1441 consecutive patients undergoing isolated CABG between 2002 and 2019 at our university hospital, we retrospectively analysed data for 107 patients with diabetic nephropathy receiving haemodialysis. After inverse probability of treatment weighting, we found no statistically significant differences regarding patients’ preoperative characteristics. RESULTS All patients underwent myocardial revascularization using the off-pump technique. There was no statistical significance in postoperative deep sternal wound infection (P = 0.902) and 30-day mortality (P = 0.755). However, the bilateral ITA group had a lower rate of postoperative stroke versus the single group (0% vs 5.5%, respectively; P = 0.021). Follow-up was completed in 95.3% (102/107) of the patients, and the mean follow-up duration was 3.3 years. Thirty-eight deaths occurred in the bilateral ITA group and 18 in the single ITA group. There was no significant difference in all-cause death (P = 0.558) and cardiac death rates (P = 0.727). Multivariable Cox regression models showed that the independent predictors of all-cause death were age [hazard ratio (HR) 1.031; P = 0.010], previous percutaneous intervention (HR 1.757; P = 0.009) and gastroepiploic artery grafting (HR 0.582; P = 0.026). CONCLUSIONS Bilateral ITA grafting in patients with diabetic nephropathy receiving haemodialysis did not improve mid-term outcomes.

Abstract 18908: Transcutaneous Aortic Valve Replacement - 30 Day and 1 Year Outcomes Using Conscious Sedation in Patients Stratified by STS Risk Score

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Anitha Rajamanickam ◽  
Sandeep Basnet ◽  
Kaylan Mucci ◽  
Ravinder Rao ◽  
Jimmy Yee ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Conscious Sedation ◽  
Statistical Significance ◽  
Vascular Complications ◽  
The Elderly ◽  
Number Of Patients ◽  
Significant Difference

Introduction: Transcutaneous Aortic Valve Replacement [TAVR] is usually performed under general anesthesia [GA]. We sought to examine the feasibility and safety of monitored conscious sedation [CS] as opposed to GA . METHODS: 196 patients [116 self expanding and 80 balloons expandable] underwent TAVR from December 2010 to August 2012 at our institution. 1 month follow up was completed on all patients and 1 year follow up was available on 105 patients. 39 patients [20%] underwent CS. Only one patient crossed over from CS to GA. We divided the patients into 3 groups [STS <8, STS of 8 to <12, STS ≥ 12 with the primary endpoints of all-cause mortality at 1 month and 1 year [See Table 1] RESULTS: Though the study did not meet statistical significance due to low number of patients, there was a trend towards improved mortality with CS. Also, there was no statically significant difference with regards to procedural complications including periprocedural MI, major bleeding, emergency CABG or major vascular complications. All 5 patients with periprocedural stroke had GA. The CS patients had a shorter length of stay [5 +2.87 days] as compared to GA patients [8 days+7.86 days] CONCLUSION: Use of CS suggested an improved mortality trend in higher risk patients [STS≥ 12]. This is of great importance as complications of GA, most importantly respiratory complications, are higher in the elderly TAVR patients and these can be avoided with CS . Also CS enables us to monitor neurological status during the procedure which is of vital importance given the high rates of stroke with TAVR

Comparison CHOP Like Vs Rituximab (R) + CHOP in Non Hodgkin Lymphomas (NHL): Nine Years Uruguayan University Hospital Experience

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4976-4976
Author(s):  
Carolina Oliver ◽  
Paula Martinez ◽  
Cecilia Guillermo ◽  
Lilián Díaz
Keyword(s):  
B Cell Lymphoma ◽  
University Hospital ◽  
Bulky Disease ◽  
Prolymphocytic Leukemia ◽  
Free Survival ◽  
Number Of Patients ◽  
Significant Difference ◽  
Ann Arbor ◽  
Extranodal Disease

Abstract Abstract 4976 Between January 2002 and December 2010, we treated 207 NHL at the Hospital de Clínicas, Uruguayan University Hospital. These are 10 % of the NHL diagnosed in our country. There were 72 Diffuse Large B Cell Lymphoma (DLBCL), 34 Follicular Lymphoma (FL), 33 Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma, 11 Mantle Cell, 10 T Cell, 7 MALT, 7 Anaplasic T, 6 Burkitt, 6 Lymphoblastic Lymphoma, 5 Lymphoplasmocytic, 4 Mycosis Fungoides, 3 Burkitt like, 2 Hairy cell Leukemia, 2 Esplenic Marginal zone, 2 LLGG, 2 angioinmunoblastic, 1 Prolymphocytic Leukemia. The mean of this retrospective study is to analyze the improvement in Overall Survival (OS) with the use of R in DLBCL and FL in HIV negative Uruguayan patients. The DLBCL were 72 patients, we analyze 61 because 5 were HIV positive and 6 were Primary CNS. There were 34 males and 27 females. The median age was 60 years (25-82). At diagnostics, the Ann Arbor Stratification was: 26 I-II, 10 with B symptoms, 35 III – IV, 20 with B symptoms. Nineteen (31 %) had Bulky disease and 18 (30 %) were primary extranodal disease. The International Prognostic Index was: 30%: 0–1; 28,5 %: 2; 28,5 %: 3; 13 %: 4. The delay between the first consult and treatment was 31 days (1-456). The Chemotherapy regimens used were in 35 CHOP-like (CHOP, CAPVE, CEOP, CMVP, CVP, m-BACOD) with a median of cycles of 6 (1-8), and in 22 R-CHOP with a median of cycles of 6 (1-8). Results DLBCL: In DLBCL treated with CHOP-like regimens the Overall Response (OR) (Complete Remission (CR) and Partial Remission (PR)) was 60 % with 37 % of CR and 23 % of PR. With R-CHOP the OR was 100 %, CR: 91 % and PR: 9 %. With a median of follow up of 23 month (0,8-106), the OS in patients treated with CHOP-like is 34,3 months and in R-CHOP it has not been reached yet, but it is not statistically significant: log rank (p=0,121). The OS at 24 months is 52 % in CHOP-like vs 80 % in R-CHOP. These results are very promising for the R- CHOP group. The Disease Free Survival (DFS) was 39,6 month (IC: 0–114,4) in CHOP-like and it has not been reached yet in patients with R-CHOP, but this is not statistically significant, log rank (p= 0,645). At 24 month the DFS was 60 % in CHOP-like and 67 % in R-CHOP. There were 34 patients with FL, we analyze 33 because we exclude HIV +. There were 19 females and 14 males. The median age was 62,5 years (33-79). At diagnostics, the Ann Arbor stratification was: 8 patients I -II, 3 with B symptoms, 25 III – IV, 12 with B symptoms. Twelve percent were bulky and 15 % begun with extranodal disease. Forty four percent had FLIPI 0–1, 36 % FLIPI 2 and 20 % 3 or more. The histological grade was in 3 % G1, 79 % G2 and 18 % G3 (15 % G3a and 3 % G3b). The median delay between the first consult and diagnostic was 24 days (5-765). The Chemotherapy regimens used were: in 18 patients CHOP like (CHOP, CAVPE, m-BACOD), median number of cycles 5 (1-6), in 9 patients R-CHOP with median of cycles of 6 (3-8) and in 3 patients R-CHOP-like (R-CAPVE, FCR, R-CVP), median of cycles 5 (3-6). Results FL: In FL treated with R-CHOP or R-CHOP-like regimens the OR was 92 % with 59 % CR and 33 % PR. With CHOP-like regimens the OR was 55 % with 17 % CR and 38 % PR. With a median follow up of 36 month (3-111), the median OS hasn't been reached. The OS at 24 and 36 month in patients treated with R-CHOP or R-CHOP-like was 82 % and 58 %, and in patients treated with CHOP-like 82 % and 67 % respectively. These are not statistically significant, log rank p=0,923. The median Progression Free Survival (PFS) in patients treated with CHOP-like regimens was 17 month (0-44) and it hasn't been reached in treated with R-Chemotherapy (R-CT). The PFS at 24 and 36 month was 36 % and 18 % in CHOP-like patients and 68 % and 55 % in R-CT patients. These difference also is not statistically significant, log rank p=0,66, but there is a great trend in benefit of R-CT. Discussion and conclusion: the use of the monoclonal antibodies in NHL's treatment has been an important issue and it is now use in first line treatment because it's benefits in OR, CR and OS. R was introduced in Uruguay in 2005 and it is government funded through Fondo Nacional de Recursos. In our series, there is an improvement in CR and a trend towards better results in OS and DFS when R-CHOP is used. In spite of the fact that it was not possible to demonstrate a statistically significant difference in view of the low number of patients, we think that this sample is highly representative of the reality of our country. Disclosures: No relevant conflicts of interest to declare.

Analysis of the relationship between different prognosis factors in patients with advanced colon cancer and progression-free survival.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e15518-e15518
Author(s):  
Eduardo Richardet ◽  
Ignacio Magi ◽  
Luciana Paola Acosta ◽  
Maria gimena Ferreira ◽  
Matias Molina ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Statistical Significance ◽  
Progression Free Survival ◽  
Free Survival ◽  
Advanced Colon Cancer ◽  
Number Of Patients ◽  
Significant Difference ◽  
One Year ◽  
The Relationship

e15518 Background: Colon tumors are a heterogeneous group of disease. As a result of the accumulation of different genetic and epigenetic alterations, the mutation of the RAS, BRAF oncogene and microsatellite instability stands out. A new line of research are immunological and inflammatory factors, the infiltrating lymphocytes of the tumor stroma (TILs) and the neutrophil to lymphocyte radio (NLR) have been studied by our work team. We understood could that these factors were associated with the survival rate in our patients. The main objective of this reseach is to determine the relationship between NLR and progression-free survival (PFS) in patients with advanced colon cancer. Secondary objective is to determine the relationship between the location of the primary tumor, RAS status, TILs, and PFS. in the same group of patients. Methods: A total of 93 medical records of patients with advanced colon cancer was analyzed. Those pts who had recieved first-line chemotherapy treatment with a FOLFOX scheme plus a monoclonal antibody were included. All patients had to have a minimum follow-up of 12 months. Regarding NLR, the patients were classified into two groups: high ( = > 4) and low ( < 4). Four TILs cut-off points were determined: > 40% intense; between 11-40% moderate, 1-10% mild, and 0% absent, which were group into two categories: intense and moderate; slight and absent. Localization was divided into left and right, and KRAS status was divided into mutated and wild-type (WT). PFS was calculated using the Kaplan-Meier test. Results: The median PFS of the general population was 8.74 (7.39-11.07) months. The median PFS was 9.86 (7.82-13.41) vs 5.09 (4.43-10.84) months for low and high NLR respectively, with statistical significance (p: 0.01). When the percentage of patients without progression after one year of treatment was analyzed, the difference was 45% vs 14% in favor of NLR < 4 on ≥4, this difference was also statistically significant (p: 0.02). PFS in relation to TILs after one year of follow up was 33% (8.61 months) for moderate-intense infiltrate vs 30% of mild-absent (7.10 months). PFS was 9.79 months for KRAS WT pts vs 7.82 months for mutated KRAS. In terms of location, PFS was 9.79 months for the left colon vs 8.28 months for the right colon. These factors did not have a statistically significant difference. Conclusions: The results of the study show how NLR < 4 is a prognostic factor with a positive impact on PFS. It should be noted that the median survival rates were numerically higher in moderate-intense vs mild-absent TILs, also in KRAS WT vs mutated and in left vs right location. It should also be noted that the possibly there was not a statistically significant difference between them due to the limited number of patients per what we will continue working on in the recruitment and analysis of these patients.

scholarly journals Patterns of pain-free response in 497 cases of classic trigeminal neuralgia treated with Gamma Knife surgery and followed up for least 1 year

2012 ◽  
Vol 117 (Special_Suppl) ◽  
pp. 181-188 ◽  
Author(s):  
Constantin Tuleasca ◽  
Romain Carron ◽  
Noémie Resseguier ◽  
Anne Donnet ◽  
Philippe Roussel ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
University Hospital ◽  
Recurrence Rates ◽  
Clear Cut ◽  
Number Of Patients ◽  
Significant Difference ◽  
Patient Groups

Object The goal of this study was to establish whether clear patterns of initial pain freedom could be identified when treating patients with classic trigeminal neuralgia (TN) by using Gamma Knife surgery (GKS). The authors compared hypesthesia and pain recurrence rates to see if statistically significant differences could be found. Methods Between July 1992 and November 2010, 737 patients presenting with TN underwent GKS and prospective evaluation at Timone University Hospital in Marseille, France. In this study the authors analyzed the cases of 497 of these patients, who participated in follow-up longer than 1 year, did not have megadolichobasilar artery– or multiple sclerosis–related TN, and underwent GKS only once; in other words, the focus was on cases of classic TN with a single radiosurgical treatment. Radiosurgery was performed with a Leksell Gamma Knife (model B, C, or Perfexion) using both MR and CT imaging targeting. A single 4-mm isocenter was positioned in the cisternal portion of the trigeminal nerve at a median distance of 7.8 mm (range 4.5–14 mm) anterior to the emergence of the nerve. A median maximum dose of 85 Gy (range 70–90 Gy) was delivered. Using empirical methods and assisted by a chart with clear cut-off periods of pain free distribution, the authors were able to divide patients who experienced freedom from pain into 3 separate groups: patients who became pain free within the first 48 hours post-GKS; those who became pain free between 48 hours and 30 days post-GKS; and those who became pain free more than 30 days after GKS. Results The median age in the 497 patients was 68.3 years (range 28.1–93.2 years). The median follow-up period was 43.75 months (range 12–174.41 months). Four hundred fifty-four patients (91.34%) were initially pain free within a median time of 10 days (range 1–459 days) after GKS. One hundred sixty-nine patients (37.2%) became pain free within the first 48 hours (Group PF≤ 48 hours), 194 patients (42.8%) between posttreatment Day 3 and Day 30 (Group PF(>48 hours, ≤ 30 days)), and 91 patients (20%) after 30 days post-GKS (Group PF>30 days). Differences in postoperative hypesthesia were found: in Group PF≤ 48 hours 18 patients (13.7%) developed postoperative hypesthesia, compared with 30 patients (19%) in Group PF(>48 hours, ≤ 30 days) and 22 patients (30.6%) in Group PF>30 days (p = 0.014). One hundred fifty-seven patients (34.4%) who initially became free from pain experienced a recurrence of pain with a median delay of 24 months (range 0.62–150.06 months). There were no statistically significant differences between the patient groups with respect to pain recurrence: 66 patients (39%) in Group PF≤ 48 hours experienced pain recurrence, compared with 71 patients (36.6%) in Group PF(>48 hours, ≤ 30 days) and 27 patients (29.7%) in Group PF>30 days (p = 0.515). Conclusions A substantial number of patients (169 cases, 37.2%) became pain free within the first 48 hours. The rate of hypesthesia was higher in patients who became pain free more than 30 days after GKS, with a statistically significant difference between patient groups (p = 0.014).

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 &lt; 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 &lt; 0.001), and mean duration of antibiotic treatment was longer (14 days vs 11 days, P &lt; 0.001). A higher number of patients with FUBCs needed ICU care compared to those without FUBCs (41.4% and 25.5% respectively, P &lt; 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 Height in Adolescence as a Risk Factor for Glioma Subtypes: a Nationwide Retrospective Cohort Study of 2.2 Million Subjects

2021 ◽  
Author(s):  
Roi Tschernichovsky ◽  
Lior H Katz ◽  
Estela Derazne ◽  
Matan Ben-Zion Berliner ◽  
Maya Simchoni ◽  
...  
Keyword(s):  
Risk Factor ◽  
Statistical Significance ◽  
Positive Association ◽  
High Grade Glioma ◽  
Low Grade ◽  
Cox Proportional Hazard ◽  
Cox Proportional Hazard Models ◽  
Glioma Risk ◽  
Incident Cases

Abstract Background Gliomas manifest in a variety of histological phenotypes with varying aggressiveness. The etiology of glioma remains largely unknown. Taller stature in adulthood has been linked with glioma risk. The aim of this study was to discern whether this association can be detected in adolescence. Methods The cohort included 2,223,168 adolescents between the ages of 16-19. Anthropometric measurements were collected at baseline. Incident cases of glioma were extracted from the Israel National Cancer Registry over a follow-up period spanning 47,635,745 person-years. Cox proportional hazard models were used to estimate the hazard ratio for glioma and glioma subtypes according to height, body mass index (BMI) and sex. Results 1,195 patients were diagnosed with glioma during the study period. Mean(SD) age at diagnosis was 38.1 (11.7) years. Taller adolescent height (per 10cm increase) was positively associated with the risk for glioma of any type (HR 1.15; p=0.002). The association was retained in subgroup analyses for low-grade glioma (HR 1.17; p=0.031), high-grade glioma (HR 1.15; p=0.025), oligodendroglioma (HR 1.31; p=0.015), astrocytoma (HR 1.12; p=0.049), and a category of presumed IDH-mutated glioma (HR 1.17; p=0.013). There was a trend towards a positive association between height and glioblastoma, however this had borderline statistical significance (HR: 1.15; p=0.07). After stratification of the cohort by sex, height remained a risk factor for men, but not for women. Conclusions The previously - established association between taller stature in adulthood and glioma risk can be traced back to adolescence. The magnitude of association differs by glioma subtype.

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.

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