Inpatient vs outpatient evaluation of suspected paraneoplastic cerebellar degeneration

Objective:To determine the differences in outcomes of adult ataxic patients initially evaluated for paraneoplastic cerebellar degeneration (PCD) as inpatients or outpatients.Methods:In this retrospective cohort analysis, diagnosis, workup, and functional outcomes based on change in modified Rankin Scale (mRS) were compared between patients with ataxia who underwent workup for PCD initially as inpatients versus outpatients between March 2011 and June 2018 at Rush University Medical Center.Results:There were 78 patients included in the analysis; 59% were women, and the average age at symptom onset was 57 ± 19.5 years. Nineteen patients (24.3%) underwent evaluation as inpatients and 59 (75.6%) as outpatients. Admitted patients were more likely to receive immunotherapy (73.7% vs. 20.3%, p<0.0001) and received it faster than outpatients (0.40 months for inpatients, interquartile range (IQR) 0.03-1 vs. 6.6 months for outpatients, IQR 2-11.7; p=0.01). A greater percentage of inpatients improved based on mRS compared to those who underwent evaluation as outpatients (52.63% vs. 22.81%, p=0.01).Conclusions:More patients improved from baseline in the inpatient cohort.Classification of Evidence:This study provides Class III evidence that for patients undergoing initial evaluation for paraneoplastic cerebellar degeneration, patients undergoing inpatient evaluation have better outcomes compared to those undergoing outpatient evaluation.

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A retrospective cohort analysis of arthroscopic Bankart repair with or without remplissage in patients with off-track Hill-Sachs lesion evaluated for functional outcomes, recurrent instability, and range of motion

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2019.06.005 ◽

2020 ◽

Vol 29 (2) ◽

pp. 273-281 ◽

Cited By ~ 2

Author(s):

Vivek Pandey ◽

Lohith Gangadharaiah ◽

Sandesh Madi ◽

Kiran Acharya ◽

Shalini Nayak ◽

...

Keyword(s):

Range Of Motion ◽

Functional Outcomes ◽

Retrospective Cohort ◽

Cohort Analysis ◽

Bankart Repair ◽

Recurrent Instability ◽

Arthroscopic Bankart Repair ◽

Retrospective Cohort Analysis

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CEA in Evaluation of Adnexal Mass: Retrospective Cohort Analysis and Review of the Literature

The International Journal of Biological Markers ◽

10.5301/jbm.5000158 ◽

2015 ◽

Vol 30 (4) ◽

pp. 394-400 ◽

Cited By ~ 8

Author(s):

Lena Sagi-Dain ◽

Ofer Lavie ◽

Ron Auslander ◽

Shlomi Sagi

Keyword(s):

Predictive Value ◽

Retrospective Cohort ◽

Adnexal Mass ◽

Medical Center ◽

Cohort Analysis ◽

Adnexal Masses ◽

Retrospective Cohort Analysis ◽

Serum Carcinoembryonic Antigen ◽

Serum Ca125 ◽

Sensitivity Specificity

Background The aim of this study was to estimate the diagnostic accuracy of serum carcinoembryonic antigen (CEA) levels in conjunction with Ca125 in the triage of adnexal masses. Methods This retrospective cohort study was carried out in 495 patients referred to the Gynecology Department at Carmel Medical Center due to adnexal mass, between 2005 and 2012. All patients underwent surgery with histopathologically confirmed diagnosis and preoperative measurements of serum Ca125 and CEA. For each marker, sensitivity, specificity, positive predictive value, negative predictive value and risk ratio were calculated. Results Combination of CEA with Ca125, compared with Ca125 levels alone, yielded a nonsignificant effect on sensitivity (87.4% vs. 88.9%, respectively, p = 0.64) and specificity (79.3% vs. 74.3%, p = 0.18) in differentiating malignant from benign adnexal masses. CEA levels were higher in mucinous histological types, but were not helpful in detection of borderline tumors. Significantly higher CEA (21.4 ± 53.6 vs. 3.2 ± 11.9 ng/mL, p = 0.0002) and lower Ca125 values (103.9 ± 84.9 vs. 796 ± 1,331.5 U/mL, p = 0.0338) were demonstrated in the 17 metastatic cases compared with 181 primary ovarian malignancies. Conclusions The combination of the tumor markers CEA and Ca125 did not contribute significantly to the detection of malignant adnexal masses compared with Ca125 alone. As our results suggest that higher CEA levels could be useful in differentiating metastatic tumors from primary ovarian malignancy and in diagnosis of mucinous histology, this issue should be investigated in large, well-designed, prospective cohort trials.

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Evaluating mortality and recovery of extreme hyperbilirubinemia in critically ill patients by phasing the peak bilirubin level: A retrospective cohort study

PLoS ONE ◽

10.1371/journal.pone.0255230 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0255230

Author(s):

Hong Seok Han ◽

Chi-Min Park ◽

Dae-Sang Lee ◽

Dong Hyun Sinn ◽

Eunmi Gil

Keyword(s):

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Retrospective Cohort ◽

Total Bilirubin ◽

Medical Center ◽

Cohort Analysis ◽

Grade Point ◽

Retrospective Cohort Analysis ◽

Grade 3

Background Hyperbilirubinemia is a devastating complication in patients admitted to an intensive care unit (ICU). The sequential organ failure assessment (SOFA) score classifies hyperbilirubinemia without further detailed analyses for bilirubin increase above 12 mg/dL. We evaluated whether the level of bilirubin increase in patients with extreme hyperbilirubinemia (total bilirubin ≥ 12 mg/dL) affects and also helps estimate mortality or recovery. Methods A retrospective cohort analysis comprising 427 patients with extreme hyperbilirubinemia admitted to the ICU of Samsung Medical Center, Seoul, Korea between 2011 and 2015 was conducted. Extreme hyperbilirubinemia was classified into four grades: grade 1 (12–14.9 mg/dL), grade 2 (15–19.9 mg/dL), grade 3 (20–29.9 mg/dL), and grade 4 (≥ 30 mg/dL). These grades were then assessed for their association with hospital mortality and recovery from hyperbilirubinemia to SOFA grade (point) 2 or below (total bilirubin < 6 mg/dL). The influences of various factors, some of which caused extreme hyperbilirubinemia, while others induced bilirubin recovery, were assessed. Results A total of 427 patients (mean age: 59.8 years, male: 67.0%) were evaluated, and the hospital mortality for these patients was very high (76.1%). Extreme hyperbilirubinemia was observed in 111 (grade 1, 26.0%), 99 (grade 2, 23.2%), 131 (grade3, 30.7%), and 86 (grade 4, 20.1%) patients with mortality rates of 62.2%, 71.7%, 81.7%, and 90.7%, respectively (p < 0.001). The peak bilirubin value correlated with the mortality (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.04–1.15, p < 0.001). Compared to those with grade 1 extreme hyperbilirubinemia, the mortality rate gradually increased as the grade increased (OR [95% CI]: 1.92 [0.70–5.28], 3.55 [1.33–9.48], and 12.47 [3.07–50.59] for grades 2, 3 and 4, respectively). The main causes of extreme hyperbilirubinemia were infection including sepsis and hypoxic hepatitis. The recovery from hyperbilirubinemia was observed in 110 (25.8%) patients. Mortality was lower for those who recovered from hyperbilirubinemia than for those who did not (29.1% vs. 92.4%, p < 0.001). The favorable factors of bilirubin recovery were albumin and ursodeoxycholic acid (UDCA). Conclusions This study determined that the level of extreme hyperbilirubinemia is an important prognostic factor in critically ill patients. We expect the results of this study to help predict the clinical course of and determine the optimal treatment for extreme hyperbilirubinemia.

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CA 19-9 in Evaluation of adnexal mass: retrospective cohort analysis and review of the literature

The International Journal of Biological Markers ◽

10.5301/jbm.5000139 ◽

2015 ◽

Vol 30 (3) ◽

pp. 333-340 ◽

Cited By ~ 6

Author(s):

Lena Sagi-Dain ◽

Ofer Lavie ◽

Ron Auslander ◽

Shlomi Sagi

Keyword(s):

Tumor Markers ◽

Retrospective Cohort ◽

Medical Center ◽

Cohort Analysis ◽

Serum Marker ◽

Ca 125 ◽

Ovarian Malignancy ◽

Adnexal Masses ◽

Retrospective Cohort Analysis ◽

Nonsignificant Effect

Objective The aim of this study was to estimate the diagnostic accuracy of serum marker CA 19-9 levels in the triage of adnexal masses. Methods This retrospective cohort study was carried out in patients referred to the Gynecology Department at Carmel Medical Center due to adnexal masses. All patients underwent preoperative measurements of serum CA 125 and CA 19-9 and surgery with histopathologically confirmed diagnosis. Results Between January 2005 and December 2012, 503 patients with adnexal masses were evaluated with serum tumor markers. Combination of CA 19-9 with CA 125, compared with CA 125 levels alone, suggested a nonsignificant effect on sensitivity (86.9% vs. 88.9%, respectively, p = 0.54) or specificity (79.5% vs. 73.5%, p = 0.1) in differentiating malignant from benign adnexal masses. CA 19-9 was not helpful in detecting mucinous histological types or borderline tumors. Mean CA 19-9 levels were higher in metastatic cases compared with primary ovarian malignancy (488.7 ± 1,457 vs. 46.3 ± 149.8 U/mL, respectively, p = 0.001). In mature cystic teratomas, mean CA 19-9 levels were higher and CA 125 levels were lower than in ovarian carcinoma (p = 0.049 and p = 0.0012, respectively). Conclusions The combination of the tumor markers CA 19-9 and CA 125 did not contribute significantly to the detection of malignant adnexal masses compared with CA 125 alone. As our results suggest that higher CA 19-9 levels could be helpful in differentiating metastatic tumors from primary ovarian malignancy; this issue should be investigated in large well-designed prospective cohort trials.

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Paraneoplastic Cerebellar Degeneration

Neurology Neuroimmunology & Neuroinflammation ◽

10.1212/nxi.0000000000000963 ◽

2021 ◽

Vol 8 (2) ◽

pp. e963

Author(s):

Ida Herdlevær ◽

Mette Haugen ◽

Kibret Mazengia ◽

Cecilie Totland ◽

Christian Vedeler

Keyword(s):

Western Blot ◽

Cerebellar Degeneration ◽

Paraneoplastic Cerebellar Degeneration ◽

Antibody Detection ◽

Confirmatory Test ◽

Related Protein ◽

Class Iii ◽

A Cell ◽

Paraneoplastic Neurologic Syndromes

ObjectiveInvestigate the value of including cerebellar degeneration-related protein 2-like (CDR2L) as a marker in commercial diagnostic tests for anti-Yo–associated paraneoplastic cerebellar degeneration (PCD).MethodsWe included sera and CSF samples from 24 patients with suspected PCD (6 of whom had PCD with underlying gynecologic or breast cancer), who were positive for Yo antibodies using the commercially available, paraneoplastic neurologic syndromes (PNS) 14 Line Assay from Ravo Diagnostika. The samples were further evaluated using the EUROLINE PNS 12 Ag Line Assay and a cell-based assay (CBA) from Euroimmun. For confirmation of positive lineblot results, we used indirect immunofluorescence of rat cerebellar sections. We also tested all samples in 2 assays developed in-house: a CBA for CDR2L and a Western blot analysis using recombinant cerebellar degeneration-related protein 2 (CDR2) and CDR2L proteins.ResultsIn PNS 14 and PNS 12 Ag Line Assays, anti-CDR2 reactivity was observed for 24 (100%) and 20 (83%) of the 24 samples, respectively. Thirteen of 24 subjects (54%) were also positive using the Euroimmun CBA. Rat cerebellar immunofluorescence was the best confirmatory test. In our in-house CBA for CDR2L and Western blot for CDR2 and CDR2L, only the 6 patients with confirmed PCD reacted with CDR2L.ConclusionsCommercially available tests for Yo antibody detection have low specificity for PCD because these assays use CDR2 as antigen. By adding a test for CDR2L, which is the major Yo antigen, the accuracy of PCD diagnosis greatly improved.Classification of EvidenceThis study provides Class III evidence that a CBA for CDR2L accurately identifies patients with PCD.

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Bennett’s Fracture Repair—Which Method Results in the Best Functional Outcome? A Retrospective Cohort Analysis and Systematic Literature Review of Patient-Reported Functional Outcomes

Journal of Hand and Microsurgery ◽

10.1055/s-0040-1703412 ◽

2020 ◽

Author(s):

Benjamin Langridge ◽

Michelle Griffin ◽

Mo Akhavani ◽

Peter E. Butler

Keyword(s):

Literature Review ◽

Systematic Literature Review ◽

Functional Outcomes ◽

Retrospective Cohort ◽

Cohort Analysis ◽

Bennett’S Fracture ◽

Retrospective Cohort Analysis ◽

Patient Reported ◽

Wire Fixation

AbstractSurgical fixation of Bennett’s fracture of the thumb is critical to prevent functional impairment; however, there is no consensus on the optimal fixation method. We performed an 11-year retrospective cohort analysis and a systematic literature review to determine long-term patient-reported outcomes following Bennett’s fracture fixation. Retrospective cohort analysis identified 49 patients treated with Kirschner (K)-wire fixation, 85% returned to unrestricted movement during hand therapy. Forty-seven patients (96%) completed the disabilities of the arm, shoulder, and hand (DASH) questionnaires at a mean of 5.55 years from injury, with a mean score of 7.75. Systematic literature review identified 14 studies with a cumulative 541 patients. Fixation included open or percutaneous methods utilizing K-wires, tension band wiring, lag screws, T-Plates, external fixation, and arthroscopic screw fixation. Functional outcomes reported included DASH, quickDASH (qDASH), and visual analogue scores. Superficial wound infection occurred in 4 to 8% of percutaneous K-wire fixation. Open reduction internal fixation (ORIF) methods were associated with a 4 to 20% rate of reintervention and 5 to 28% rate of persistent paresthesia. Closed reduction with percutaneous K-wire fixation should be the first choice surgical method, given excellent, long-term functional outcomes, and low risk of complications. ORIF should be utilized where closed reduction is not achievable; however, the current evidence does not support one method of ORIF above another.

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