Current management of borderline ovarian tumors: A multicenter survey of 323 clinics in Germany, on behalf of the North-Eastern German Society of Gynecological Oncology (NOGGO)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16568-e16568
Author(s):  
R. Chekerov ◽  
A. Coumbos ◽  
J. Sehouli ◽  
D. Schaedel ◽  
G. Oskay-Oezcelik ◽  
...  
Keyword(s):  
Secondary Care ◽  
Frozen Section ◽  
Tertiary Care ◽  
Diagnostic Procedures ◽  
German Society ◽  
University Hospital ◽  
Ca 125 ◽  
Borderline Tumor ◽  
University Hospitals ◽  
Multicenter Survey

e16568 Background: The aim of this survey was to analyze the standard of care in diagnostic, surgery, chemotherapy and aftercare management of patients with Borderline tumor of the ovary (BOT) in Germany. Methods: A structured questionnaire comprising different dimensions of treatment of BOT was sent to all 1,114 gynecological departments in Germany. The questionnaire could be returned anonymously. Results: The overall response rate was 29.0% (323 departments). The most departments were on secondary care (71.8%), tertiary care (23.2%) or university hospital (5.0%) level. The most clinicians performed not more than 5 BOT operations (89.2%) per year. 93.2% of the gynecological departments used additional preoperative diagnostic procedures to the classical bimanual examination and vaginal ultrasound in a case of unclear ovarian tumor: CA-125 or CEA detection (95%), CT-scan (76%), Doppler ultrasound (66%), MRI (36%), or PET-CT (1.7%) techniques. In university hospitals (87%), tertiary care (80%), secondary care (68%) and most of the general practitioners’ hospitals (64%) a regular fresh frozen section was the intraoperative diagnostic standard. For diagnosis of BOT mostly laparotomy (48%) and laparoscopy (15%) were performed, whereas 19% used a diagnostic laparoscopy, followed by laparotomy for completion in a second intervention or switch from laparoscopy to laparotomy in the primary surgical session (18%). In young women with desire to preserve fertility clinicians performed much seldom unilateral salpingo-oophorectomy (92%) and only in 53% biopsies of the contra lateral ovary and in 67% peritoneal biopsies. Generally biopsies of the contra lateral ovary were performed in 4% to 53% of all patients. Chemotherapy was the second therapy option (64%) after surgery (97%) for BOT, mostly favored in “high-risk” patients with tumor residual, micro invasion or invasive implants. Conclusions: These data demonstrate a high clinical unsureness in the clinical management of borderline tumors of the ovary. No significant financial relationships to disclose.

REFERRAL PATTERN AND OUTCOMES OF NEONATES FROM SECONDARY CARE SETTING OF AGA KHAN UNIVERSITY HOSPITAL TO TERTIARY CARE CENTERS IN PAKISTAN

2021 ◽  
pp. 1-13
Author(s):  
Suneeta khemani ◽  
Nazia Shamim ◽  
Adnan Mirza ◽  
Nadia Muhammad ◽  
Safdar Kagazwala ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Neonatal Mortality ◽  
Secondary Care ◽  
Surgical Intervention ◽  
Tertiary Care ◽  
Neonatal Outcomes ◽  
University Hospital ◽  
P Value ◽  
Tertiary Care Centers ◽  
Tertiary Care Hospitals

ABSTRACT:Objective: To determine the reasons of neonatal referrals from secondary care settings of Aga Khan University Hospital (AKUH) to tertiary care centers of Karachi, Pakistan and to assess the neonatal outcomes for referred cases. Methodology: This retrospective observational study was conducted at AKUH from July 2015 tjune 2019. All neonates born after 32 weeks of gestation at AKUH secondary care(Kharadar, Garden & Karimabad)and referred to tertiary care hospitals were consecutively enrolled. The reason for referral, i.e. surgical intervention, respiratory support, care of prematurity; need of mechanical ventilation, referral place and neonatal outcomes like discharge in stable condition, left against medical advice (LAMA) and mortality, were noted. Results: Of 348 referred cases, 306 (87.9%)were reported alive. neonatal mortality was reported in 42 (12.1%) of the cases. Of these 306 alive participants, 284 (92.81%) were discharged from the hospital whereas 22 (7.18%) LAMA. Of 348 patients, the referral place of most of the patients was outside AKU,i.e.189(56.3%).The need of mechanical ventilation was reported in, 63 (18.1%) patients. A significant association of mechanical ventilation in tertiary centers was observed in neonates born with low APGAR score at 1 and 5 min (p-value <0.001), shorter duration of stay at secondary care(p-value 0.007),and aggressive resuscitation requirement at birth (p-value <0.001). Conclusion: Most common reasons for referral of newborns to tertiary care hospital was respiratory diseases requiring respiratory support and surgical intervention. Neonatal mortality noted for referrals made to AKUH were much less as compared to cases referred to other tertiary care hospitals. Continuous...  

Outcomes of treatment of carcinoma gall bladder undergoing curative intent surgery.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15621-e15621
Author(s):  
Arun Chaturvedi ◽  
Vijay Kumar ◽  
Sameer Gupta ◽  
Naseem Akhtar ◽  
Shiv Rajan Saini ◽  
...  
Keyword(s):  
Gall Bladder ◽  
Frozen Section ◽  
Tertiary Care ◽  
Surgical Oncology ◽  
University Hospital ◽  
North India ◽  
Curative Intent ◽  
Adjacent Organ ◽  
Radical Cholecystectomy ◽  
Unresectable Disease

e15621 Background: Gall bladder carcinoma (GBC) is the most common malignancy of the biliary tract. North India reports one of the highest incidences of GBC in the world. Majority of patients present with advanced disease where surgery is not possible. We report the results of patients undergoing curative intent surgery at a tertiary care University hospital in North India. Methods: Data of 270 patients undergoing curative intent surgery for GBC at the Department of Surgical Oncology, King George’s Medical University, Lucknow (India) between January 2014 and December 2018 was retrospectively studied. We have analysed the collected data using descriptive and survival statistics. Results: During the period of study 270 patients were operated for GBC. Mean age of patients was 50.2 years and majority (75.2%) were females. On surgical exploration 82 (30.4%) had unresectable disease and only a biopsy or palliative procedure was done. Simple cholecystectomy was done where frozen section showed benign calculus cholecystitis in 26 (9.6%) patients. Radical cholecystectomy was performed in 162 (60%) patients. Final histopathology revealed Xanthogranulomatous cholecystitis in 28 (17.3%) of these 162 patients. Adjacent organ resection was done in 29 of the 134 (24.1%) patients undergoing radical cholecystectomy for pathologically proven GBC. Colon and CBD were the most common adjacent organs resected. Completion radical cholecystectomy was done in 22 patients with incidental GBC. Adjuvant chemotherapy as per our institutional protocol was given to 68 (50.7%) patients having Stage 3 or more disease. After a mean follow-up of 19 months the median disease free interval (DFI) is 38 months and the median overall survival (OS) has not been reached. Patients undergoing adjacent organ resection had an inferior median OS of 20 months compared to those without it where the median has not been reached (Log Rank P = 0.006). Conclusions: Nearly a third of GBC patients planned for curative intent surgery are found to have unresectable disease on exploration. This proportion needs to be brought down. Radical cholecystectomy in properly selected GBC patients without adjacent organ involvement gives satisfactory survival outcomes.

Genetic Relatedness AmongCandida tropicalisIsolates From Sporadic Cases of Fungemia in Two University Hospitals in Korea

2004 ◽  
Vol 25 (8) ◽  
pp. 634-640 ◽  
Author(s):  
Jong Hee Shin ◽  
Mi-Na Kim ◽  
Dong Hyeon Shin ◽  
Sook-In Jung ◽  
Kwang Jin Kim ◽  
...  
Keyword(s):  
Genetic Relatedness ◽  
Medical Center ◽  
Tertiary Care ◽  
Venous Catheter ◽  
University Hospital ◽  
University Hospitals ◽  
National University ◽  
Average Similarity ◽  
Asan Medical ◽  
Sporadic Cases

AbstractObjective:To compare the epidemiology and genetic relatedness ofCandida tropicalisisolates causing bloodstream infection (BSI) in two hospitals.Setting:Two tertiary-care hospitals in Korea.Methods:A retrospective molecular epidemiologic analysis using pulsed-field gel electrophoresis (PFGE) was performed with 49C. tropicalisisolates from sporadic cases of BSI. The isolates were collected from 27 patients at Chonnam National University Hospital (CUH) during a 6-year period and 22 patients at Asan Medical Center (AMC) during a 2-year period.Results:Based on the PFGE patterns, the average similarity value (SAB) for the 27 isolates from CUH was 0.84 ± 0.08, which was significantly higher than that for the 22 isolates from AMC (0.78 ± 0.06;P< .001). Of the 49 strains from patients at the 2 hospitals, 9 isolates were placed into 3 subtypes with SABvalues of 1.0, which indicated that they were identical. All 9 of these strains were isolated from CUH patients, and each type strain was isolated sporadically during a period ranging from 4 months to 3 years. On comparison of the clinical characteristics of the patients of the 2 hospitals, the CUH strains were isolated more frequently from non-neutropenic patients and patients with central venous catheter–related fungemia; cases from CUH had a better outcome than those from AMC (P< .05).Conclusions:These data show that the clinical and epidemiologic characteristics ofC. tropicalisfungemia may differ markedly among hospitals and that some cases ofC. tropicalisfungemia may be caused by endemic strains within a hospital.

scholarly journals Patterns of care analysis for salivary gland cancer: a survey within the German Society of Radiation Oncology (DEGRO) and recommendations for daily practice

2021 ◽  
Author(s):  
Jens von der Grün ◽  
Claus Rödel ◽  
Sabine Semrau ◽  
Panagiotis Balermpas ◽  
Daniel Martin ◽  
...  
Keyword(s):  
Salivary Gland ◽  
Radiation Oncology ◽  
Treatment Strategies ◽  
Daily Practice ◽  
German Society ◽  
Target Volume ◽  
University Hospital ◽  
Salivary Gland Cancer ◽  
University Hospitals ◽  
Frequency Distributions

Abstract Background Salivary gland cancer (SGC) is rare and a heterogeneous type of cancer. Prospective randomized trials are lacking. No guideline focusing on standard procedures of radiotherapy (RT) in the treatment of SGC exists. Therefore, we surveyed the members of the German Society of Radiation Oncology (DEGRO) to gain information about current therapeutic strategies of SGC. Methods An anonymous questionnaire was designed and made available on the online platform umfrageonline.com. The corresponding link was sent to all DEGRO members who provided their user data for contact purposes. Alternatively, a PDF printout version was sent. Frequency distributions of responses for each question were calculated. The data were also analyzed by type of institution. Results Sixty-seven responses were received, including answers from 21 university departments, 22 non-university institutions, and 24 radiation oncology practices. Six participants reported that their departments (practice: n = 5, non-university hospital: n = 1) did not treat SGC, and therefore the questionnaire was not completed. Concerning radiation techniques, target volume definition, and concomitant chemotherapy, treatment strategies varied greatly among the participants. Comparing university vs. non-university institutions, university hospitals treat significantly more patients with SGC per year and initiated more molecular pathological diagnostics. Conclusion SGC represents a major challenge for clinicians, as reflected by the inhomogeneous survey results regarding diagnostics, RT approaches, and systemic therapy. Future prospective, multicenter clinical trials are warranted to improve and homogenize treatment of SGC and to individualize treatment according to histologic subtypes and risk factors.

Myocardial perfusion scintigraphy in Germany

2007 ◽  
Vol 46 (02) ◽  
pp. 49-55 ◽  
Author(s):  
W. Burchert ◽  
F. M. Bengel ◽  
R. Zimmermann ◽  
J. vom Dahl ◽  
W. Schäfer ◽  
...  
Keyword(s):  
Nuclear Medicine ◽  
Myocardial Perfusion ◽  
Attenuation Correction ◽  
Working Group ◽  
Primary Care Physicians ◽  
Gated Spect ◽  
Myocardial Perfusion Scintigraphy ◽  
German Society ◽  
University Hospitals ◽  
Perfusion Scintigraphy

SummaryThe working group Cardiovascular Nuclear Medicine of the German Society of Nuclear Medicine (DGN), in cooperation with the working group Nuclear Cardiology of the German Cardiac Society (DGK), decided to conduct a national survey on myocardial perfusion scintigraphy (MPS). Method: A questionnaire to evaluate MPS for the year 2005 was sent. Results: 346 completed questionnaires had been returned (213 private practices, 99 hospitals and 33 university hospitals). MPS of 112 707 patients were reported with 110 747 stress and 95 878 rest studies. The majority (>75%) was performed with 99mTc-MIBI or tetrofosmin. 201Tl stress-redistribution was used in 22 637 patients (20%). The types of stress were exercise in 78%, vasodilation with adenosine or dipyridamol in 21% and dobutamine in 1%. 99.97% of all MPS were SPECT studies. Gated SPECT was performed in 36% of the stress and in 32% of the rest studies. An attenuation correction was used in 21%. 29 institutions (8%) performed gated SPECT (stress and rest) and attenuation correction. 47% of all MPS were requested by ambulatory care cardiologists, 17% by internists, 12% by primary care physicians, 21% by hospital departments and 2% by others. Conclusion: In Germany, MPS is predominantly performed with 99mTc-perfusion agents. The common type of stress is ergometry. Gated SPECT and attenuation correction do not yet represent standards of MPS practice in Germany, which indicates some potential of optimization.

TO DETERMINE THE ROLE OF CA125 IN THE DIAGNOSIS OF ACUTE APPENDICITIS

2020 ◽  
Vol 4 (7) ◽  
Author(s):  
Vinod Kumar ◽  
Bhupen Songra ◽  
Richa Jain ◽  
Deeksha Mehta
Keyword(s):  
Acute Appendicitis ◽  
Clinical Diagnosis ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Ca 125 ◽  
Care Hospital ◽  
Serum Samples ◽  
Roc Curve Analysis ◽  
Surgery Department

Background: the present study was under taken to determine the role of CA-125 in the diagnosis of acute appendicitis (AA), to prevent its complications and also in preventing negative appendicectomies in tertiary care hospital. Methods: The study was conducted at a tertiary care and research center between 01/03/2018 to 30/06/2019. Patients admitted to the surgery department with diagnosis of AA were considered for the study. After informed consent, a, standardized history was obtained as a case Performa. Serum samples from all the cases with clinical diagnosis of AA were obtained and stored. Only the cases with histopathologically approved AA were included in the study. Cases operated for clinical diagnosis of AA, but not histopathologically proven AA was not included in the study. CA125 levels in cases with definitive diagnosis of AA were measured. Results: In present study, ROC curve analysis revealed the sensitivity of 87.27 % and specificity of 90.91 % when the CA 125 cut-off value of > 16.8 was taken to diagnose acute appendicitis. AUC was 0.911 with a standard error of 0.0292. Conclusion: In this study we have observed that CA125 showed a positive correlation with acute appendicitis, that was statistically not significant (P>0.05). We didn’t evaluate the correlation with the disease severity. We consider that CA125 can be used as a marker in acute appendicitis cases although further research is still needed. Keywords: CA125, Acute Appendicitis, Surgery.

A prospective observational study on the effectiveness of risk of malignancy index score (RMI 3) in a tertiary care centre in Eastern India

2020 ◽  
Vol 11 (5) ◽  
pp. 54-60
Author(s):  
Apurba Mandal ◽  
Shibram Chattopadhyay ◽  
Sushanta Mondal ◽  
Arunava Biswas
Keyword(s):  
Ovarian Cancer ◽  
Adnexal Mass ◽  
Malignant Tumors ◽  
Histopathological Examination ◽  
Tertiary Care ◽  
Ca 125 ◽  
Tertiary Care Centre ◽  
Gynecology And Obstetrics ◽  
Risk Of Malignancy ◽  
Malignant Lesions

Background: Adnexal mass is a common presentation in today’s gynecological practice. The incidence of ovarian cancer is increasing day by day and diagnosis is often difficult to be made pre operatively with inadequate surgical exploration is a regular occurrence. Aims and Objectives: To assess and validate the importance of RMI-3 score as pre-operative diagnostic tool of differentiating benign from malignant adnexal mass for starting first line therapy of ovarian cancer and to find out the incidences of ovarian malignancy among study population. Material and Methods: The study was conducted in the Department of Gynecology and Obstetrics on (n=115) patients attending GOPD and indoor with adnexal mass fulfilling the inclusion and exclusion criteria using purposive sampling technique. All the selected cases underwent ultrasonography and serum CA- 125 level estimation necessary for calculating RMI score. A score of >200 was taken as suggestive of malignancy and confirmatory diagnosis was performed by histopathological examination obtained from staging laparotomy of adnexal mass. The individual scores were then correlated with final outcomes with statistical analyses. Results: The study revealed benign ovarian tumors are more under 50 years (78.46%) and patients with normal BMI are diagnosed with maximum of malignancy (n = 28). History of tubal ligation carried less risk of malignancy (p<0.0001). Histologically malignant tumors found mostly in 71.4% postmenopausal group whereas 94.1% benign pathology were present in perimenopausal group and there is no association found between parity and histopathology (p=0.058). Bilateral (p=0.013), multilocular (p=0.000) tumors with solid areas (p<0.0001) and thick papillary projections (p<0.0001) had statistically significant association with malignant lesions. RMI score (>200) had more efficacy than serum CA-125 level (>46) in differentiating malignant lesions from benign one in terms of specificity (96% vs 83.87%) and positive predictive value (95% vs 79.17%). Conclusions: RMI-3 score is a simple, reliable and effective tool in differentiating benign from malignant adnexal masses thereby help in quick referral and management of cases with increase chances of survival of the patients.

RESEARCH ON VALUE OF INTRAOPERATIVE FROZEN SECTION EXAMINATION OF THE COMMON TUMORS AT HUE UNIVERSITY HOSPITAL

2011 ◽  
pp. 67-73
Author(s):  
Cong Thuan Dang ◽  
Thi Thu Thao Le
Keyword(s):  
Sensitivity And Specificity ◽  
Frozen Section ◽  
Analysis Data ◽  
Poor Quality ◽  
University Hospital ◽  
Frozen Sections ◽  
Intraoperative Frozen Section ◽  
Frozen Section Examination ◽  
Incorrect Diagnosis ◽  
The Common

Background: To evaluate the accuracy and the pitfalls of frozen section examination in diagnosis the common tumors at Hue University Hospital. Materials and method: A retrospective analysis data of 99 consecutive patients from 2007 to 2009 were evaluated and analyzed the major pitfalls. In our 99 patients, 100% cases we compared histological diagnosis on frozen sections with those on paraffin sections. Results: The majority of frozen section examinations were the thyroid lesions 37.4%, breast lesions 25.2%, lymph nodes 16.1%, ovary 9.1% and less common in other diseases (12.1%). The accuracy, sensitivity and specificity of the intraoperative frozen section examination were 93.9%, 89.1% and 98.1% respectively. The main factors causing incorrect diagnosis in frozen section are: Misinterpretation, poor quality of frozen sections, improper sampling in sectioning and difficult to result interpretation. Conclusion: The frozen section analysis of suspect lesions displays good sensitivity and specificity characteristics.

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