Survival impact of aggressive treatment on patients with oligometastatic non-small cell lung cancer (NSCLC).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e20669-e20669
Author(s):  
Camille Gauvin ◽  
Normand Blais ◽  
Mustapha Tehfe ◽  
Marie Florescu
Keyword(s):  
Lung Cancer ◽  
Survival Data ◽  
Prospective Trial ◽  
Primary Lung Cancer ◽  
Disease Stage ◽  
Cancer Disease ◽  
Radical Treatment ◽  
Significant Difference ◽  
Group A ◽  
Group B

e20669 Background: The new 2016lung cancer classification differentiates oligometastatic (M1b) better prognostic from plurimetastatic (M1c) disease. A prospective study presented at 2016 ASCO showed improved PFS in patients with oligometastatic brain disease treated aggressively compared to a more palliative treatment but OS data is pending. Methods: This study is a single-center retrospective study including 643 patients with metastatic lung cancer diagnosed in an University center (CHUM) from 2005-2015 and followed more than 6 months (median follow up 13.3mo) . Only 67 patients (10.4%) were found to have synchronous oligometastatic disease at diagnosis. Results: Amongst the 67 patients, the localization of metastatic disease was as follows: 74% brain (n = 50), 9% adrenal gland (n = 6), 7% contralateral pulmonary lobe (n = 5), 6% bone (n = 4) and 3% liver (n = 2). 29 patients received radical treatment to primary and metastatic site (group A) and 36 patients received non-aggressive treatments (group B). There was no statistically significant difference between the two groups in terms of demographic and histological characteristics. The radical treatment group A had a mOS of 26mo and a mPFS of 12.8m compared to mOS of 5mo (p = 0.0001) and mPFS of 4.8mo (p = 0.010) for group B. This difference was observed when stratifying according to stage of primary lung disease (stage I mOS 42mo vs 16mo, stage II mOS 34mo vs 6mo and stage III mOS 22mo vs 4mo) and according to to oligometastatic site. Interestingly, addressing aggressively the primary lung cancer improved median survival even when the oligometastasis was not resected (26mo v and 24mo respectively), but not when oligometastasis only was resected and primary was treated palliatively (5mo vs 3 mo). Adjuvant chemotherapy given after radical treatment did not improve mPFS or mOS (12.83 vs12.47 months, p = 0.860). Conclusions: Radical treatment of oligometastatic NSCLC in this unselected population improved mPFS and mOS compared to other treatment strategies. As overall survival data of the prospective trial presented at 2016 ASCO meeting is pending, the more radical approach should be emphasized when patients present with oligometastatic lung cancer disease.

scholarly journals Proprioceptive elbow training reduces pain and improves function in painful lateral epicondylitis—a prospective trial

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
B. Schiffke-Juhász ◽  
K. Knobloch ◽  
P. M. Vogt ◽  
L. Hoy
Keyword(s):  
Grip Strength ◽  
Prospective Trial ◽  
Lateral Epicondylitis ◽  
Dash Score ◽  
Level Of Evidence ◽  
Link Type ◽  
Significant Difference ◽  
Proprioceptive Training ◽  
Group A ◽  
Group B

Abstract Background In painful epicondylitis, previous studies reported deficiencies in elbow proprioception. In line, proprioceptive training of the lower limb has been reported substantial beneficial in a number of indications. Therefore, we have asked if a specified proprioceptive training using training devices that are capable of activating the deep musculature in the upper limb is able to reduce the symptoms of epicondylitis. Materials and methods We included 71 patients with painful lateral epicondylitis > 3 months. Interventions: Group A: Proprioceptive training intervention with a Flexibar® (9 min daily for 12 weeks). Group B: at least 40 min running or walking/week with the XCO® in addition to the proprioceptive training with the Flexibar® (9 min daily for 12 weeks), follow-up for 12 weeks. Primary end point: Pain on visual analogue scale (VAS, 0-10); secondary end points: DASH-Score (0 = very good, 100 = very poor), grip strength according to Jamar dynamometer (kg), vibration sensation measured with a 128 Hz tuning fork. Results The pain on VAS in group A was reduced significantly. 3.6 ± 2.0 to 2.4 ± 2.1 (−33%, p = 0.013), and from 3.7 ± 2.4 to 2.2 ± 1.9 (−41%, p = 0.004) in group B after 12 weeks. There was no significant difference between A and B (p = 0.899). In both groups, there was a significant improvement of the DASH-Score (A: 32 ± 15 to 14 ± 12, −56%, p < 0.001; B: 27 ± 12 to 12 ± 11, −55%, p = 0.001) without any difference between groups A and B (p = 0.339). Grip strength improvement in group A from 24 ± 12 to 33 ± 11 kg (+38%, p < 0.001), and from 29 ± 14 to 34 ± 11 kg (+15%, p < 0.001) in group B. In line, vibration sensation improved in both groups (A: 6.3 ± 0.6 to 6.5 ± 0.5, p = 0.0001; B: 6.3 ± 0.7 to 6.6 ± 0.5, p = 0.003). Conclusion A 12-week proprioceptive training with the Flexibar® improves pain, quality of life, grip strength and vibration sensation in patients with painful lateral epicondylitis. Level of evidence Ib, randomised clinical trial Trial registration German Clinical Trials Register, DRKS00024857, registered on 25 March 2021—retrospectively registered, http://apps.who.int/trialsearch/

scholarly journals Systemic inflammation, TNM staging and survival in patients with lung cancer

Pneumologia ◽  
2020 ◽  
Vol 69 (2) ◽  
pp. 81-86
Author(s):  
Ionela Erhan ◽  
Stefan Dumitrache-Rujinski ◽  
Claudia Toma ◽  
Miron Bogdan
Keyword(s):  
Lung Cancer ◽  
Systemic Inflammation ◽  
Complete Blood Count ◽  
Cancer Staging ◽  
Tnm Staging ◽  
Additional Tool ◽  
Lymphocyte Ratio ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Background It is recognised that systemic inflammation plays an important role in the development and progression of lung cancer. Several affordable biomarkers could be used to evaluate systemic inflammation: neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and erythrocyte sedimentation rate (ESR). These biomarkers may be linked with survival in lung cancer. Aim To assess the relation between systemic inflammation evaluated by NLR, PLR and ESR, tumour nodes metastasis (TNM) staging and negative outcome in lung cancer. Materials and methods Patients with lung cancer were classified (7th TNM lung cancer staging) into two groups: Group A (resectable stages) and Group B (nonresectable stages). Each group was divided into two subsets: survivors (As, Bs) and deceased (Ad, Bd) patients. Complete blood count (CBC) and ESR were determined. NLR and PLR were calculated. NLR, PLR and ESR values were compared between the two groups and their subsets. Results 102 consecutive patients completed the protocol. In Group A (31 patients): NLR: 2.74 (0.87–12.94), PLR: 33.95 (21.61–416.66), ESR: 35 mm/h (6–135). Subgroup As: NLR: 2.36 (0.87–8.36), PLR: 138.82 (21.61–416.66), ESR: 15 mm/h (6–110). Subgroup Ad: NLR: 2.77 (1.25–12.94), PLR: 132.57 (41.11–371.17), ESR: 62 mm/h (11–135). In Group B (71 patients): NLR: 3.51(0.76–25.60), PLR: 170.37 (3.38–651.25), ESR:40 mm/h (3–120). Subgroup Bs: NLR: 1.40 (1.32–1.73), PLR: 112.89 (91.14–140.54), ESR: 31 mm/h (9–90). Subgroup Bd: NLR: 3.59 (0.70–25.60), PLR: 183.50 (3.38–651.25), ESR: 44 mm/h (3–120). NLR and PLR values were significantly higher (p: 0.04; p: 0.05) in Group B versus Group A. No significant difference was noted for ESR values between the two groups. In patients with nonresectable stages who were deceased (subgroup Bd), NLR and PLR values were significantly higher (p: 0.01; p: 0.03) versus survivals. In patients with resectable stages who were deceased (subgroup Ad), only the ESR value was significantly higher versus survivals. Conclusions Systemic inflammation assessed by affordable biomarkers as NLR and PLR is more prominent in advanced, nonresectable lung cancer. It may be a contributor, along with TNM staging, to the poor outcome of patients with nonresectable lung cancer. Clinical implication NLR and PLR may represent a valuable additional tool in the clinical management of patients with nonresectable lung cancer.

scholarly journals Intrathecal Pethidine: An Alternative Anaesthetic for Transurethral Resection of Prostate?

1997 ◽  
Vol 25 (6) ◽  
pp. 650-654 ◽  
Author(s):  
A. T. H. Sia ◽  
M. Y. H. Chow ◽  
C. K. Koay ◽  
J. L. Chong
Keyword(s):  
Heart Rate ◽  
Transurethral Resection ◽  
Motor Block ◽  
Prospective Trial ◽  
Sensory Block ◽  
Transurethral Resection Of Prostate ◽  
Significant Difference ◽  
Group A ◽  
Randomized Prospective Trial ◽  
Group B

We aimed to determine the usefulness of intrathecal pethidine as the sole anaesthetic for transurethral resection of prostate (TURP) while comparing the incidence of hypotension with intrathecal bupivacaine. A double-binded randomized prospective trial was conducted involving 40 patients for TURP. The patients were divided equally into two groups; group A received 2 ml 0.5% bupivacaine intrathecally and group B received 40 mg pethidine intrathecally. Changes in blood pressure and heart rate were measured over the first 30 minutes. The highest sensory block and the time to reach it were documented. The degree of motor blockade was also recorded. There was no significant difference in the incidence of hypotension. The pethidine group had significantly greater reduction in heart rate, a lower degree of motor block, shorter period before requests for postoperative analgesia but a higher incidence of sedation, nausea and vomiting. Intrathecal pethidine did not offer any advantage over intrathecal bupivacaine for TURP.

scholarly journals Anterior Shoulder Dislocation Reduction Managed Either with Midazolam or Propofol in Combination with Fentanyl

2014 ◽  
Vol 21 (6) ◽  
pp. 346-353 ◽  
Author(s):  
T Cimilli Ozturk ◽  
O Guneysel ◽  
H Akoglu
Keyword(s):  
Emergency Medicine ◽  
Prospective Trial ◽  
Vital Signs ◽  
Respiratory Compromise ◽  
Intravenous Fentanyl ◽  
Orthopaedic Surgeons ◽  
Dislocation Reduction ◽  
Significant Difference ◽  
Group A ◽  
Group B

Objective Procedural Sedation and Analgesia is used in managing emergency painful procedures. The aim of this study is to compare the effects of propofol and midazolam on haemodynamic parameters when used in combination with fentanyl in isolated anterior shoulder dislocations and to measure the patient and physician satisfactions. Methods The study is a randomised single blind prospective trial. All procedural sedations were performed by emergency medicine specialists and the shoulder reductions were performed by orthopaedic surgeons. Two groups were defined. Group A received intravenous fentanyl and midazolam and Group B received intravenous fentanyl and propofol. The orthopaedic surgeons were not informed about the drugs. The emergency medicine specialist observed the patients. The patients and the orthopaedic surgeons were asked for a satisfaction scoring. Results Midazolam group consisted of 37 patients and propofol group consisted of 38 patients. Both groups were similar in demographic characteristics and pre-procedural vital signs. There was only one statistically significant difference at one time and it was the 5th minutes SpO2 levels between groups. There were statistically significant changes in the measurements of vital parameters in both groups when compared with the baseline levels. However none of them was clinically important. In midazolam and propofol group, 10.8% and 10.5% respectively had respiratory compromise. Patient and physician satisfactions were similar in both groups. Conclusions Midazolam and propofol are both relatively safe drugs using in combination with fentanyl in anterior shoulder dislocations. Patients and physicians can be highly satisfied with the two groups of drugs. (Hong Kong j.emerg.med. 2014;21:346-353)

DeVega versus ring annuloplasty in severe functional tricuspid insufficiency and their impact on the right ventricle

2019 ◽  
Vol 1 (4) ◽  
pp. 133-139
Author(s):  
Yasser Hamdy ◽  
Mohammed Mahmoud Mostafa ◽  
Ahmed Elminshawy
Keyword(s):  
Right Ventricular ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Early Postoperative Period ◽  
Tricuspid Valve Repair ◽  
Ring Annuloplasty ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
The Right

Background: Functional tricuspid valve regurgitation secondary to left-sided valve disease is common. DeVega repair is simple, but residual regurgitation with subsequent impairment of the right ventricular function is a concern. This study aims to compare tricuspid valve repair using DeVega vs. ring annuloplasty and their impact on the right ventricle in the early postoperative period and after six months. Methods: This is a prospective cohort study of 51 patients with rheumatic heart disease who underwent tricuspid valve repair for secondary severe tricuspid regurgitation. Patients were divided into two groups: group A; DeVega repair (n=34) and group B; ring annuloplasty repair (n=17). Patients were assessed clinically and by echocardiography before discharge and after six months for the degree of tricuspid regurgitation, right ventricular diameter and tricuspid annular plane systolic excursion (TAPSE). Results: Preoperative echocardiographic assessment showed no difference in left ventricular end-systolic diameter, end-diastolic diameter, ejection fraction and right ventricular diameter, however; group A had significantly better preoperative right ventricular function measured by TAPSE (1.96 ± 0.27 vs1.75 ± 0.31 cm; p=0.02). Group B had significantly longer cardiopulmonary bypass time (127.65 ± 13.56 vs. 111.74 ± 18.74 minutes; p= 0.003) and ischemic time (99.06 ± 11.80 vs. 87.15 ± 16.01 minutes; p= 0.009). Pre-discharge, there was no statistically significant difference in the degree of tricuspid regurgitation, but the right ventricular diameter was significantly lower in group B (2.66 ± 0.41 and 2.40 ± 0.48 cm; p=0.049). After six months of follow up, the degree of tricuspid regurgitation (p= 0.029) and the right ventricular diameter were significantly lower in the ring annuloplasty group (2.56 ± 0.39 and 2.29 ± 0.44 cm; p=0.029). Although there was a statistically significant difference in preoperative TAPSE, this difference disappeared after six months. Conclusion: Both DeVega and ring annuloplasty techniques were effective in the early postoperative period, ring annuloplasty was associated with lesser residual regurgitation and better right ventricular remodeling in severe functional tricuspid regurgitation than DeVega procedure after 6-months of follow up.

Effect of short-term use of oral contraceptive pills on intraocular pressure

2020 ◽  
Vol 35 (3) ◽  
Author(s):  
Tayyaba Gul Malik ◽  
Hina Nadeem ◽  
Eiman Ayesha ◽  
Rabail Alam
Keyword(s):  
Oral Contraceptive ◽  
Childbearing Age ◽  
Short Term ◽  
Oral Contraceptive Pills ◽  
Contraceptive Pills ◽  
Time Period ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Short Time

Objective: To study the effect of short-term use of oral contraceptive pills on intra-ocular pressures of women of childbearing age.   Methods: It was a comparative observational study, conducted at Arif memorial teaching hospital and Allied hospital Faisalabad for a period of six months. Hundred female subjects were divided into two groups of 50 each. Group A, included females, who had been taking oral contraceptive pills (OCP) for more than 6 months and less than 36 months. Group B, included 50 age-matched controls, who had never used OCP. Ophthalmic and systemic history was taken. Careful Slit lamp examination was performed and intraocular pressures (IOP) were measured using Goldman Applanation tonometer. Fundus examination was done to rule out any posterior segment disease. After collection of data, we analyzed and compared the intra ocular pressures between the two groups by using ANOVA in SPSS version 21.   Results: Average duration of using OCP was 14.9 months. There was no significant difference of Cup to Disc ratios between the two groups (p= 0.109). However, significant difference was noted between the IOP of OCP group and controls. (p=0.000). Conclusion: OCP significantly increase IOP even when used for short time period.

Comparative Clinical study of Jatyadi Taila and Jatyadi Ghrita in the management of Dushta Vrana

2018 ◽  
Vol 3 (3) ◽  
Author(s):  
Rajendra Joshi ◽  
N. B. Mashetti ◽  
Rakesh Kumar Gujar
Keyword(s):  
Clinical Study ◽  
Burning Sensation ◽  
Normal Process ◽  
Surgical Practice ◽  
Local Factors ◽  
Significant Difference ◽  
Comparative Clinical Study ◽  
Group A ◽  
Contaminated Wound ◽  
Group B

Dushta Vrana is a common and frequently encountered problem faced in surgical practice. The presence of Dushta Vrana worsens the condition of the patient with different complications and may become fatal. Local factors on wound like slough, infection and foreign body, affect the normal process of healing. A healthy wound in a normal body heals earlier with a minimum scar as compared to a contaminated wound. Therefore in this study all the efforts are made to make a Dushta Vrana into a Shuddha Vrana. Once the Vrana becomes Shuddha, Ropana of the Vrana will start. The objective of the study was to evaluate the clinical efficacy of Jatyadi Taila and Jatyadi Ghrita in Dushta Vrana. Clinically diagnosed 60 Patients of Dushta Vrana were randomly divided into two groups, each consisting of 30 Patients. Group A were treated with the Jatyadi Taila and Group B was treated by Jatyadi Ghrita. The results observed was based on the relief obtained on the subjective and objective parameters taken for consideration for this study viz, size of ulcer, discharge, smell, pain, burning sensation, itching and granulation were found significant (P Lass Than 0.05). On the basis of assessment criteria and overall result of treatment, the patients of Jatyadi Taila group showed better results when compared to Jatyadi Ghrita group. Even though statistically there is no much significant difference between the two groups, but by seeing the effect on individual parameters (subjective and objective) and over all response, Jatyadi Taila seems to be effective when compared to Jatyadi Ghrita. It is having more Ropana qualities when compared to Shodhana.

Clinical effect of Suvarna Bindu Prashan

2017 ◽  
Vol 2 (3) ◽  
Author(s):  
Patil Aniket ◽  
Dindore Pallavi ◽  
Arbar Aziz ◽  
Kadam Avinash ◽  
Saroch Vikas
Keyword(s):  
Physical Health ◽  
Eating Habits ◽  
Control Group ◽  
Inform Consent ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Immune Booster ◽  
Mental And Physical Health ◽  
Apparently Healthy

The quest for excellence in mental and physical health is not new. We find various references and formulations in Ayurvedic classics meant for promoting mental and physical health of a child. Suvarna Prashan is one of the formulations explained in age old Ayurvedic classic Kashyap Samhita. This formulation is very widely used now days as a memory and immune booster for children. But there is very little systematic documented study which can be used to evaluate the efficacy of the formulation. Suvarna Bhasma was prepared in Ayurved Rasayani Pharmacy, Pune. Madhu and Ghrita were collected from KLE Ayurveda Pharmacy, Belgaum. Suvarna Bindu Prashan was prepared in KLE Ayurved pharmacy, Belgaum. It contains Suvarna Bhasma, Ghrita and Madhu. Twenty apparently healthy male and female children with age group of three to four years were ready to sign inform consent form were selected into two groups each. Subjects in Group A received Suvarna Bindu Prashan where as Group B (Control group) did not receive any treatment. Both the groups were observed for six months. Children in Suvarna Bindu Prashan group showed significant reduction in the scores of eating habits, behavior, mood, temperament and scores of event of illness. However there was no significant difference in the score of sleeping habit. There was significant increase in IQ percentage.

scholarly journals Microsurgical unilateral laminotomy for bilateral decompression of degenerative lumbar canal stenosis: a comparative study

2019 ◽  
Vol 55 (1) ◽  
Author(s):  
Mohamed I. Refaat ◽  
Amr K. Elsamman ◽  
Adham Rabea ◽  
Mohamed I. A. Hewaidy
Keyword(s):  
Patient Satisfaction ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Invasive Technique ◽  
Decompression Surgery ◽  
Microsurgical Decompression ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

Abstract Background The quest for better patient outcomes is driving to the development of minimally invasive spine surgical techniques. There are several evidences on the use of microsurgical decompression surgery for degenerative lumbar spine stenosis; however, few of these studies compared their outcomes with the traditional laminectomy technique. Objectives The aim of our study was to compare outcomes following microsurgical decompression via unilateral laminotomy for bilateral decompression (ULBD) of the spinal canal to the standard open laminectomy for cases with lumbar spinal stenosis. Subjects and methods Cases were divided in two groups. Group (A) cases were operated by conventional full laminectomy; Group (B) cases were operated by (ULBD) technique. Results from both groups were compared regarding duration of surgery, blood loss, perioperative complication, and postoperative outcome and patient satisfaction. Results There was no statistically significant difference between both groups regarding the improvement of visual pain analogue, while improvement of neurogenic claudication outcome score was significant in group (B) than group (A). Seventy-three percent of group (A) cases and 80% of group (B) stated that surgery met their expectations and were satisfied from the outcome. Conclusion Comparing ULBD with traditional laminectomy showed the efficacy of the minimally invasive technique in obtaining good surgical outcome and patient satisfaction. There was no statistically significant difference between both groups regarding the occurrence of complications The ULBD technique was found to respect the posterior spinal integrity and musculature, accompanied with less blood loss, shorter hospital stays, and shorter recovery periods than the open laminectomy technique.

scholarly journals The Role of Obesity in Predicting the Clinical Outcomes of COVID-19

Obesity Facts ◽  
2021 ◽  
pp. 1-9
Author(s):  
Serdar Sahin ◽  
Havva Sezer ◽  
Ebru Cicek ◽  
Yeliz Yagız Ozogul ◽  
Murat Yildirim ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Health Care Providers ◽  
Study Groups ◽  
Normal Weight ◽  
Overweight And Obesity ◽  
Care Providers ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Group D

<b><i>Introduction:</i></b> The aim of this was to describe the predictors of mortality related to COVID-19 infection and to evaluate the association between overweight, obesity, and clinical outcomes of COVID-19. <b><i>Methods:</i></b> We included the patients &#x3e;18 years of age, with at least one positive SARS-CoV-2 reverse transcriptase-polymerase chain reaction. Patients were grouped according to body mass index values as normal weight &#x3c;25 kg/m<sup>2</sup> (Group A), overweight from 25 to &#x3c;30 kg/m<sup>2</sup> (Group B), Class I obesity 30 to &#x3c;35 kg/m<sup>2</sup> (Group C), and ≥35 kg/m<sup>2</sup> (Group D). Mortality, clinical outcomes, laboratory parameters, and comorbidities were compared among 4 groups. <b><i>Results:</i></b> There was no significant difference among study groups in terms of mortality. Noninvasive mechanical ventilation requirement was higher in group B and D than group A, while it was higher in Group D than Group C (Group B vs. Group A [<i>p</i> = 0.017], Group D vs. Group A [<i>p</i> = 0.001], and Group D vs. Group C [<i>p</i> = 0.016]). Lung involvement was less common in Group A, and presence of hypoxia was more common in Group D (Group B vs. Group A [<i>p</i> = 0.025], Group D vs. Group A [<i>p</i> &#x3c; 0.001], Group D vs. Group B [<i>p</i> = 0.006], and Group D vs. Group C [<i>p</i> = 0.014]). The hospitalization rate was lower in Group A than in the other groups; in addition, patients in Group D have the highest rate of hospitalization (Group B vs. Group A [<i>p</i> &#x3c; 0.001], Group C vs. Group A [<i>p</i> &#x3c; 0.001], Group D vs. Group A [<i>p</i> &#x3c; 0.001], Group D vs. Group B [<i>p</i> &#x3c; 0.001], and Group D vs. Group C [<i>p</i> = 0.010]). <b><i>Conclusion:</i></b> COVID-19 patients with overweight and obesity presented with more severe clinical findings. Health-care providers should take into account that people living with overweight and obesity are at higher risk for COVID-19 and its complications.

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