Long-term foot outcomes following differential abatement of inflammation and osteoclastogenesis for active Charcot neuroarthropathy in diabetes mellitus

Aims Inflammatory osteolysis is sine-qua-non of active Charcot neuroarthropathy (CN) causing decreased foot bone mineral density (BMD) and fractures. We aimed to explore the effect of anti-inflammatory or anti-resorptive agents for effect on foot bone mineral content (BMC) and consequent long-term outcomes of foot deformities, fractures and amputation. Methods Forty-three patients with active CN (temperature difference >2°C from normal foot) were evaluated. Patients were off-loaded with total contact cast and randomized to receive either methylprednisolone (1gm) (group A), zoledronate (5mg) (group B) or placebo (100ml normal saline) (group C) once monthly infusion for three consecutive months. Change in foot BMC was assessed at 6 months or at remission and followed subsequently up to 4 years for the incidence of new-onset fracture, deformities, or CN recurrence. Results Thirty-six participants (24 male, 12 female) were randomized (11 in group A, 12 group B, 13 group C). The mean age was 57.7± 9.9 years, duration of diabetes 12.3± 5.8 years and symptom duration 6.5± 2.8 weeks. BMC increased by 36% with zoledronate (p = 0.02) but reduced by 13% with methylprednisolone (p = 0.03) and 9% (p = 0.09) with placebo at remission. There were no incident foot fractures, however, two patients sustained ulcers, and 3 had new-onset or worsening deformities and none required amputation during 3.36 ± 0.89 years of follow-up. Conclusion Bisphosphonate for active CN is associated with an increase in foot bone mineral content as compared to decrease with steroids or total contact cast but long-term outcomes of foot deformities, ulceration and amputation are similar. Trial registration ClinicalTrials.gov: NCT03289338.

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439 Conservative Versus Surgical Management of Complicated Diverticulitis - A Retrospective Study of Long-Term Outcomes

British Journal of Surgery ◽

10.1093/bjs/znab134.280 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

E Durity ◽

G Elliott ◽

T Gana

Keyword(s):

Complicated Diverticulitis ◽

Complication Rates ◽

Long Term Outcomes ◽

Female Ratio ◽

Stoma Reversal ◽

Group A ◽

Grade 3 ◽

Group B

Abstract Introduction Management of complicated diverticulitis has shifted towards a conservative approach over time. This study evaluates the feasibility and long-term outcomes of conservative management. Method We retrospectively evaluated a consecutive series of patients managed with perforated colonic diverticulitis from 2013-2017. Results Seventy-three (73) patients were included with a male to female ratio of 1:2. Thirty-one (31) underwent Hartmann’s procedure (Group A) and 42 patients were managed with antibiotics +/- radiological drainage (Group B). Mean follow-up was 64.9 months (range 3-7 years). CT Grade 3 and 4 disease was observed in 64.5% and 40.4% of Group A and Group B patients, respectively. During follow-up, 9 (21.4%) Group B patients required Hartmann’s. Group A had longer median length of stay compared to Group B (25.1 vs 9.2 days). Post-operative complications occurred in 80.6% with 40% being Clavien-Dindo grade III or higher in group A. Stoma reversal was performed in 8 patients (25.8%). Conclusions In carefully selected cases, complicated diverticulitis including CT grade 3 and 4 disease, can be managed conservatively with acceptable recurrence rates (16.7% at 30 days, 4.8% at 90 days, 19.0% at 5 years). Surgical intervention on the other hand, carries high post-operative complication rates and low stoma reversal rates.

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Clinical, Surgical Characteristics and Long-Term Outcomes of Lumbar Hernia.

10.21203/rs.3.rs-107783/v1 ◽

2020 ◽

Author(s):

Chaoyong Shen ◽

Guixiang Zhang ◽

Sen Zhang ◽

Yuan Yin ◽

Bo Zhang ◽

...

Keyword(s):

General Anesthesia ◽

Local Anesthesia ◽

Lumbar Hernia ◽

Consecutive Series ◽

Long Term Outcomes ◽

Anesthesia Group ◽

History Of ◽

Group A ◽

Group B

Abstract Background/AimLumbar hernia is extremely rare which resulting from a defect in the abdominal wall. Due to its rarity, there is no established optimal treatment available for lumbar hernia yet. Thus, we here investigated the clinical, surgical characteristics and outcomes of lumbar hernia by collecting 28 such patients in our hospital. MethodsPatients diagnosed with lumbar hernia from our institution between April 2011 and August 2020 were retrospectively collected in this study. Demographics, clinical characteristics and surgical information were recorded. ResultsA consecutive series of 28 patients with lumbar hernia were retrospectively collected, including 13 males (46.4%) and 15 females (53.6%). The ages of the patients ranged from 5 to 79 years (median: 55 years), with a mean age of 55.6±14.9 years. A total of 7 cases had a history of previous lumbar trauma or surgery. There were 11 (39.3%), 15 (53.6%) and 2 (7.1%) cases had right, left and bilateral lumbar hernia, respectively. Superior and inferior lumbar hernia were found in 25 (89.3%) and 3 (10.7%) patients. General anesthesia was applied in 16 cases (group A), whereas 12 patients received local anesthesia (group B). Patients in the group B had a shorter hospital stay than that of the group A (3.5±1.3 days vs. 7.1±3.2 days, p=0.001), as well as total hospitalization expenses between the two groups (8309.3±1467.1 CNY vs. 19117.3±8116.1 CNY, p<0.001). ConclusionsLumbar hernia is a relatively rare entity, and inferior lumbar hernia is rarer. It is feasible to repair lumbar hernia under local anesthesia, and it may be more suitable than general anesthesia in some selected cases.

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Abstract 15439: Lesion Complexity and Long-term Outcomes According to Mean Observed Blood Pressure After Percutaneous Coronary Intervention

Circulation ◽

10.1161/circ.142.suppl_3.15439 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Jong Il Park ◽

Byung Jun Kim ◽

Hun Tae Kim ◽

Jung Hee Lee ◽

Ung Kim ◽

...

Keyword(s):

Blood Pressure ◽

Percutaneous Coronary Intervention ◽

Independent Predictor ◽

Coronary Intervention ◽

Long Term Outcomes ◽

Percutaneous Coronary ◽

Group A ◽

Group B ◽

Group D

Background: The guideline recommended strict blood pressure (BP) control for the patients treated with percutaneous coronary intervention (PCI). We aimed to evaluate the relationship between mean observed BP and long-term outcomes for patients with or without lesion complexity. Methods: A total of 1,470 patients who underwent PCI were investigated. We categorized the study population into four groups based on mean observed BP and lesion complexity (left main & three-vessel disease, chronic total occlusion, total stent length ≥60mm, or bifurcation two stenting): Group A (non-complex & systolic BP ≤120mmHg, n=310), Group B (non-complex & systolic BP >120mmHg, n=674), Group C (complex & systolic BP ≤120mmHg, n=131), and Group D (complex & systolic BP >120mmHg, n=355). We evaluated major adverse cardiovascular and cerebrovascular events (MACCEs), defined as cardiac death, myocardial infarction (MI), repeat target vessel revascularization, or stroke. Results: Well-controlled BP group (Group A&C) showed significantly lower systolic BP than uncontrolled BP group (Group B&D) (114.3±6.1mmHg vs. 130.7±7.6mmHg, p<0.001). MACCEs occurred less frequently in Group A (18.9%) than Group B (23.6%), Group C (22.7%), and Group D (33.6%) (p=0.001) at 8 years. After multivariate analysis, with Group A as a reference, the adjusted hazard ratio (HR) for MACCEs was 1.382 (95% confidence interval [CI] 0.978-1.954, p=0.067) for Group B, 1.559 (95% CI 0.957-2.540, p=0.075) for Group C, and 1.872 (95% CI 1.296-2.705, p=0.001) for Group D. In Cox regression model, although lesion complexity was not associated with MACCE, systolic BP≤120mmHg was an independent predictor for reduced rate of MACCE (HR 0.667, 95% CI 0.485-0.918, p=0.013). Conclusions: Mean observed systolic BP ≤120mmHg after PCI was independent predictor for reduced MACCEs regardless of lesion complexity. Key Words: Blood Pressure; Percutaneous Coronary Intervention; Lesion Complexity; Treatment Outcome

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Retrospective comparison of long-term outcomes in patients with stage II/III (UICC-TNM6th) esophageal squamous cell carcinoma treated with 60 Gy or 50.4 Gy of definitive chemoradiotherapy with fluorouracil and platinum.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.109 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 109-109

Author(s):

Hidekazu Hirano ◽

Ken Kato ◽

Shoko Nakamura ◽

Yusuke Sasaki ◽

Naoki Takahashi ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Multivariate Analysis ◽

Prognostic Factors ◽

Stage Ii ◽

Long Term Outcomes ◽

Definitive Chemoradiotherapy ◽

Concurrent Radiotherapy ◽

Group A ◽

Group B

109 Background: Deﬁnitive chemoradiotherapy (dCRT) is one of the treatment options for stage II/III esophageal squamous cell carcinoma (ESCC). RTOG9405 demonstrated that a higher dose of radiation (64.8 Gy) offered no additional survival benefit over the standard dose (50.4 Gy). We compared the long-term outcomes of dCRT with radiation doses of 60 Gy and 50.4 Gy for ESCC. Methods: Selection criteria included thoracic ESCC, stage II/III (non T4), performance status (PS) 0-2, age 20-75 years, adequate organ function and no other active malignancy. We retrospectively analyzed patients who received dCRT as a first-line therapy between Jan. 2000 and Nov. 2011 in our hospital. Group A (n = 180) received 2 cycles of cisplatin (C) (40 mg/m2 on day 1 and 8) with fluorouracil (F) infusion (400 mg/m2/day on day 1-5 and 8-12), or 2 cycles of C (70 mg/m2 on day 1) with F infusion (700 mg/m2/day on day 1-4) repeated every 4 weeks and concurrent radiotherapy at a dose of 60 Gy. Group B (n = 62) received 2 cycles of C (75 mg/m2 on day 1) with F infusion (1000 mg/m2/day on days 1–4) repeated every 4 weeks and concurrent radiotherapy at a dose of 50.4 Gy. Overall survival (OS) and progression free survival (PFS) were estimated with the Kaplan-Meier method and compared with log-rank test. The Cox regression model was used for multivariate analysis to assess the prognostic factors for OS. Results: Characteristics of both groups were as follows (Group A: Group B): median age, 64:62; male/female, 154/26:55/7; PS 0/1/2, 81/98/1:46/16/0; T1/2/3, 39/27/114:19/9/34; N0/1, 41/139:6/56. Median follow-up period was longer than 40 months for both groups. 5-year survival rates were 44.5% for Group A and 60.0% for Group B. Median PFS and median OS were 16.5 months and 36.2 months for Group A, 41.1 months and 98.3 months for Group B. By multivariate analysis, Group B (hazard ratio [HR] 0.617: 95% confidence interval [CI]:0.400-0.951, p = 0.029), T1/2([HR] 0.383: 95% [CI]: 0.260-0.566, p < 0.001) were significant prognostic factors for OS. Conclusions: CRT with 50.4 Gy showed better long-term survival than with 60 Gy.

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The Short- and Long-Term Outcomes of Pancreatic Resection for Pancreatic Adenocarcinoma in Patients Older Than 75 Years

International Surgery ◽

10.9738/intsurg-d-16-00192.1 ◽

2016 ◽

Vol 101 (11-12) ◽

pp. 554-561

Author(s):

Toru Aoyama ◽

Masaaki Murakawa ◽

Yosuke Atsumi ◽

Keisuke Kazama ◽

Manabu Shiozawa ◽

...

Keyword(s):

Elderly Patients ◽

Pancreatic Adenocarcinoma ◽

Pancreatic Resection ◽

The Elderly ◽

Surgical Mortality ◽

Long Term Outcomes ◽

Group A ◽

Short And Long Term ◽

Group B

The short- and long-term outcomes of pancreatic resection for pancreatic adenocarcinoma have not been fully evaluated in elderly patients. This retrospective study selected patients who underwent curative surgery for pancreatic cancer at our institution. Patients were categorized into 2 groups: nonelderly patients (age < 75 years; group A) and elderly patients (age ≥ 75 years; group B). The surgical morbidity, surgical mortality, overall survival (OS), and recurrence-free survival (RFS) rates in the 2 groups were compared. A total of 221 patients were evaluated in the study. The overall complication rates were 44.8% in group A and 52.6% in group B. Surgical mortality was observed in 2 patients due to an abdominal abscess and cardiovascular disease in group A (1.1%) and in 1 patient due to postoperative bleeding in group B (2.6%). There were no significant differences (P = 0.379 and P = 0.456, respectively). Furthermore, the 5-year OS and RFS rates were similar between the elderly patients and nonelderly patients (18.55 versus 20.2%, P = 0.946 and 13.1% versus 16.0%, P = 0.829, respectively). The short-term outcomes and long-term survival after pancreatic resection for pancreatic adenocarcinoma were almost equal in the elderly and the nonelderly patients in this study. Therefore, it is unnecessary to avoid pancreatic resection for pancreatic adenocarcinoma in elderly patients simply because of their age.

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The impact of mild renal dysfunction on isolated cardiopulmonary coronary artery bypass grafting: a retrospective propensity score matching analysis

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-019-0998-4 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 3

Author(s):

Xian Wang ◽

Yifan Zhu ◽

Wen Chen ◽

Liangpeng Li ◽

Xin Chen ◽

...

Keyword(s):

Propensity Score ◽

Propensity Score Matching ◽

Artery Bypass ◽

Term Survival ◽

Group A ◽

Group B ◽

The Impact ◽

New Onset

Abstract Background Mild preoperative renal dysfunction (RD) is not rare in patients receiving isolated cardiopulmonary coronary artery bypass grafting (CCABG). However, there are not too many studies about the impact of mild preoperative RD on in-hospital and follow-up outcomes after isolated CCABG. This single-centre, retrospective propensity score matching study designed to study the impact of mild preoperative RD on in-hospital and long-term outcomes after first isolated CCABG. Methods After propensity score matching, 1144 patients with preoperative estimated glomerular filtration rate (eGFR) of more than 60 ml/min/1.73 m2 receiving first isolated CCABG surgery from January 2012 to December 2015 entered the study, who were divided into 2 groups: A group (eGFR ≥90 ml/min/1.73 m2, n = 572) and B group (eGFR of 60–89 ml/min/1.73 m2, n = 572). The in-hospital and long-term outcomes were recorded and analyzed. The mean follow-up time was 54.4 ± 10.7 months. Acute kidney injury (AKI) was defined and classified according to the Acute Kidney Injury Network (AKIN) criteria. Results The 2 propensity score-matched groups had similar baseline and procedure except the baseline eGFR. There were 8 patients died in A group (mortality is 1.4%) and 14 died in B group (mortality is 2.5%) during the in hospital and 30-day postoperatively(χ2 = 1.159, p = 0.282). There were totally 38 patients lost to follow-up, 18 in group A and 20 in group B. 21 patients died in group A and 37 died in group B during the follow-up, and long-term survival in group A was higher than in group B (96.2% vs 93.1%, χ2 = 4.336, p = 0.037). Comparing with group A, group B was associated with an increased rates and severity of AKI postoperatively (total AKI: 62 vs 144. AKIN stageI: 54 vs 113; AKIN stageII: 6 vs 22; AKIN stageIII: 2 vs 9, p<0.0001). During follow-up, group B also had a higher rate of new onset of dialysis (0 vs 6, χ2 = 4.432, p = 0.039). Multivariable logistic regression showed that comparing with A group, the HR for long-term mortality and new onset of dialysis in B group was 1.67 and 1.52 respectively (95%CI 1.09–2.90, p = 0.035; 95%CI 1.14–2.49, p = 0.027). Conclusions Comparing with normal preoperative renal function, patients with mild preoperative RD had a similar in-hosptial mortality, but with an increased in-hosptial rates and severity of AKI, and with a decreased long-term survival and increased long-term new onset of dialysis.

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Effect of increased dietary phosphorus on calcium metabolism of young rats

Canadian Journal of Physiology and Pharmacology ◽

10.1139/y70-099 ◽

1970 ◽

Vol 48 (10) ◽

pp. 675-680 ◽

Cited By ~ 4

Author(s):

B. G. Shah ◽

J. C. Meranger

Keyword(s):

Bone Mineral ◽

Turnover Rate ◽

Dietary Phosphorus ◽

Weanling Rats ◽

Long Term Experiment ◽

Group A ◽

P Balance ◽

The Difference ◽

Group B

In a previous long-term experiment increased dietary phosphorus caused a decrease in bone mineral. The present experiment was undertaken to ascertain whether this effect was mediated through intestinal absorption of Ca and P or the turnover rate of bone mineral. Two groups of weanling rats which were injected with 45CaCl2 and fed stock diet for 9 days were fed diets containing 1.26% Ca, 0.55% P (group A) or 1.31% Ca, 1.15% P (group B) for about 5 weeks. Representative rats from each group were killed at 16, 26, 33, and 42 days, and blood, femur, and tibia collected. During the last week Ca and P balances were determined. The treatments did not affect the turnover rate of bone mineral, but the true absorption of calcium, allowing for the endogenous fecal loss, from diet A was 40% higher than from diet B. Although there was no difference in the P balance, the amount of Ca retained by rats in group A was 16% higher than the balance of Ca in group B, intake being approximately equal. The difference in femur Ca paralleled the Ca balance.

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The short- and long-term outcomes of pancreatic resection for pancreatic adenocarcinoma in patients older than 75 years.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.470 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 470-470

Author(s):

Keisuke Kazama ◽

Toru Aoyama ◽

Yosuke Atsumi ◽

Masaaki Murakawa ◽

Manabu Shiozawa ◽

...

Keyword(s):

Elderly Patients ◽

Pancreatic Adenocarcinoma ◽

Pancreatic Resection ◽

The Elderly ◽

Complication Rates ◽

Long Term Outcomes ◽

Group A ◽

Short And Long Term ◽

Group B

470 Background: The short- and long-term outcomes of pancreatic resection for pancreatic adenocarcinoma have not been evaluated in elderly patients. Methods: This retrospective study selected patients who underwent curative surgery for pancreatic cancer at our institution. Patients were categorized into two groups; non-elderly patients(age <75 years: group A) and non-elderly patients (age ≥75 years: group B). The surgical morbidity, motality, overall survival (OS), and recurrence-free survival (RFS) rates in the two groups were compared. Results: A total of 221 patients were evaluated in the study. The overall complication rates are 44.8% in Group A and 52.6% in Group B. Surgical mortality was observed in 2 patients due to an abdominal abcess and cardiovascular disease in Group A (1.1%) and in 1 patient due to postoperative bleeding in Group B (2.6%). There were no significant differences (p=0.379 and p=0.456, respectively). Furthermore, the 5-year OS and RFS rates were similar between the elderly patients and non-elderly patients (18.55% vs. 20.2%, p=0.946 and 13.1% vs. 16.0%, p=0.829 respectively). Conclusions: The short-term outcomes and long-term outcomes survival after pancreatic resection for pancreatic adenocarcinoma were almost equal in the elderly and the non-elderly patients in this study. Therefore, it is unnecessary to avoid pancreatic resection for pancreatic adenocarcinoma in elderly patients simply because of their age.

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TP9.2.8Conservative versus surgical management of complicated diverticulitis - a retrospective study of long-term outcomes

British Journal of Surgery ◽

10.1093/bjs/znab362.110 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Emily Durrity ◽

Grace Elliott ◽

Tabitha Gana

Keyword(s):

Complicated Diverticulitis ◽

Long Term Outcomes ◽

Stoma Reversal ◽

Operative Complications ◽

Group A ◽

Grade 3 ◽

Group B ◽

Post Operative Complications

Abstract Introduction The management of complicated diverticulitis has evolved over the years, with a shift towards a conservative approach. The aim of this study was to evaluate the feasibility and long-term outcomes of conservative management of an episode of complicated diverticulitis. Method We retrospectively evaluated patients presenting with perforated colonic diverticulitis between 2013 and 2017. Demographic, presentation and management data was recorded. CT grading system and Clavien-Dindo classification of complications was used. Results Ninety-two patients were included, with a male-to-female ratio of 1:2. Forty patients had a Hartmann’s procedure on the first admission (Group A), the remaining 52 patients were managed conservatively with antibiotics +/- radiological drainage (Group B). Mean follow-up was 64.9 months (range 3-7 years). CT Grade 3 and 4 disease was observed in 65% of Group A and in 40.4% of Group B patients. 14 (26.9%) patients re-presented with recurrent diverticulitis in Group B, 12 (23.1%) of whom required surgical resection in the course of follow-up. Group A had significantly increased morbidity and poorer outcomes compared to Group B with a longer median length of stay (23.5 vs 10.2 days). Post-operative complications affected 72.5% (29 patients), with 40% being grade III or higher. Stoma reversal was performed in 10 (25.8%). Conclusion In carefully selected cases, complicated diverticulitis including CT grade 3 and 4, can be managed conservatively with acceptable rates of recurrence. Better overall outcomes were observed compared to surgical intervention, which is associated with high rates of post-operative complications (72.5%) and low stoma reversal rates 25.8%.

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Management of occult obscure gastrointestinal bleeding patients based on long-term outcomes

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284818787408 ◽

2018 ◽

Vol 11 ◽

pp. 175628481878740 ◽

Cited By ~ 4

Author(s):

Sayoko Kunihara ◽

Shiro Oka ◽

Shinji Tanaka ◽

Akiyoshi Tsuboi ◽

Ichiro Otani ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Detection Rate ◽

Obscure Gastrointestinal Bleeding ◽

Long Term Outcomes ◽

Bleeding Source ◽

Group A ◽

Group B ◽

Indication For Treatment

Background: There is no consensus regarding the management of occult obscure gastrointestinal bleeding (OGIB) patients without a confirmed bleeding source. This study aimed to consider the management of occult OGIB patients based on their long-term outcomes. Methods: We retrospectively enrolled 357 consecutive occult OGIB patients (203 men; mean age: 59.7 years) who underwent capsule endoscopy (CE) at Hiroshima University Hospital, Japan and were followed up for more than 12 months (mean follow-up period; 50.2 months). Patients were divided into three groups as follows: Group A consisted of 98 of 157 patients who had positive findings and indication for treatment, Group B consisted of 59 of 157 patients who had positive findings but no indication for treatment, and Group C consisted of 200 patients who had negative small-bowel findings. We examined the rate of positive CE findings, detection rate and details of bleeding sources, overt bleeding rate, the rate of anemia exacerbation, 5-year anemia exacerbation rate, and overall survival rate. Results: The positive CE findings rate was 44% (157/357) and detection rate of bleeding source was 27% (98/357). The details of Group A were as follows: angioectasia ( n = 61), nonspecific ulceration ( n = 10), nonsteroidal anti-inflammatory drug-induced ulcer ( n = 8), and others ( n = 19). The details of Group B were as follows: erythema ( n = 31), angioectasia ( n = 25), and others ( n = 3). There were no patients with overt bleeding in Group B. Although six patients had anemia exacerbation in Group B, they had angioectasia without a bleeding source. Conclusion: The long-term outcomes of occult OGIB patients were good. Occult OGIB patients without bleeding source lesions may not require follow-up CE.

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