scholarly journals Papillary Fibroelastoma of the Aortic Valve: Analysis of 21 Cases, Including a Presentation with Cardiac Arrest

2015 ◽  
Vol 42 (2) ◽  
pp. 131-135 ◽  
Author(s):  
Hirohisa Ikegami ◽  
Adin-Cristian Andrei ◽  
Zhi Li ◽  
Patrick M. McCarthy ◽  
S. Chris Malaisrie
Keyword(s):  
Cardiac Arrest ◽  
Aortic Valve ◽  
Surgical Resection ◽  
Tumor Size ◽  
Tumor Recurrence ◽  
Papillary Fibroelastoma ◽  
Patient Age ◽  
Asymptomatic Patients ◽  
Patient Âgé

Cardiac papillary fibroelastoma is a rare, benign tumor, arising predominantly from cardiac valves. This tumor can cause a variety of symptoms due to thromboembolism. We describe our single-center surgical experience with papillary fibroelastoma of the aortic valve. From April 2004 through June 2013, 6,530 patients underwent cardiac surgery. Of those, 6,098 patients were included in the final analysis. Twenty-one patients (0.34%) underwent surgical resection of 30 papillary fibroelastomas of the aortic valve. Most patients (67%) were incidentally diagnosed to have cardiac papillary fibroelastoma. The usual symptom was cerebral infarction (in 5 of 7 symptomatic patients). A rare presentation of papillary fibroelastoma in one patient was cardiac arrest caused by left main coronary artery ostial obstruction. Tumor size was not related to patient age (Pearson correlation coefficient, 0.34; P=0.13). Neither the number of tumors (1.43 ± 0.72 vs 1.43 ± 0.62) nor tumor size (8.14 ± 2.42 vs 8.07 ± 3.31 mm) was significantly different between symptomatic and asymptomatic patients. All lesions were resected by means of the simple shave technique. There were no operative or 30-day deaths. Follow-up echocardiograms showed no tumor recurrence (mean follow-up duration, 17 ± 14 mo). We identified no significant relationship among tumor size, number of tumors, symptoms, or patient age. Because simple shave excision of the tumor can be safely achieved without evidence of tumor recurrence, we conclude that surgical resection can be reasonable in asymptomatic patients.

Predicting Aggressive Behavior in Nonfunctional Pancreatic Neuroendocrine Tumors With Emphasis on Tumor Size Significance and Survival Trends: A Population-Based Analysis of 1787 Patients

2020 ◽  
Vol 86 (5) ◽  
pp. 458-466
Author(s):  
Amir H. Fathi ◽  
Jonathan Romanyshyn ◽  
Mehdi Barati ◽  
Uzair Choudhury ◽  
Allen Chen ◽  
...  
Keyword(s):  
Aggressive Behavior ◽  
Surgical Resection ◽  
Neuroendocrine Tumors ◽  
Tumor Size ◽  
Cox Proportional Hazards ◽  
Pancreatic Neuroendocrine Tumors ◽  
Clinicopathologic Characteristics ◽  
Patient Age ◽  
Patient Âgé ◽  
The Impact

Background Nonfunctional pancreatic neuroendocrine tumors (NF-PNETs) are rare tumors with continued controversies in management. This study aims to identify demographic and clinicopathologic characteristics associated with aggressive behavior and survival. Methods The Surveillance, Epidemiology, and End Results database was used to identify patients with NF-PNETs from 1988 to 2012. Multivariate regression analysis and Cox proportional hazards modeling were used to assess the impact of patient, tumor, and treatment characteristics on tumor behavior and overall survival. Results In 1787 patients identified, size was a major determinant of aggressive behavior. The probability of aggressiveness increased 100% for tumor size ≥2 cm. For tumors ≥2 cm, every 1-cm increase in size was associated with an increase in probability of aggressive behavior by 11.3%. Patient age, tumor grade, and surgical resection were independent predictors of survival. Surgical resection was associated with improved survival but not grade I or II tumors with size <2 cm. Discussion Patient age, tumor size, and grade should be in the decision-making process around the surgical management of NF-PNETs. For tumors ≤2 cm with histologic grades of I or II, the probability of aggressive behavior is low, and surgical resection does not appear to afford survival benefit. Therefore, close observation could be justified.

Is small cusp size a limitation for aortic valve repair?†

2019 ◽  
Vol 56 (3) ◽  
pp. 497-502 ◽  
Author(s):  
Tatsuhiko Komiya ◽  
Takeshi Shimamoto ◽  
Michihito Nonaka ◽  
Takehiko Matsuo
Keyword(s):  
Computed Tomography ◽  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Body Height ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Patient Age ◽  
Patient Âgé ◽  
Small Cusp

Abstract OBJECTIVES We sought to investigate cusp size limitations for valve repair in patients with aortic regurgitation (AR). METHODS Preoperative computed tomography was performed in 105 patients. Cusp geometric height (GH) and annulus size were measured. Mean patient age was 60.7 ± 13.7 years. Mean GH of 3 cusps was used in the analysis. Annulus cusp mismatch was graded using predicted coaptation length. Patients were categorized by mean GH into group S (GH <16 mm; n = 35) or L (GH ≥16 mm; n = 70). RESULTS Preoperative mean GH was 17.1 ± 2.3 mm. GH and body height were significantly correlated (r = 0.61). Intraoperative mean GH (18.8 ± 2.2 mm) was larger than preoperative mean GH (P < 0.0001). However, postoperative (17.1 ± 2.0 mm) and preoperative mean GH did not differ. Moderate AR was not present on predischarge echocardiography. Mild AR was observed in 51% and 17% of patients in groups S and L, respectively (P = 0.006). During follow-up, moderate or severe AR was observed in 14% and 10% of patients in groups S and L, respectively (P = 0.74). Two patients in group S required reoperation for a regurgitant valve. Twenty (83%) and 15 (21%) patients in groups S and L, respectively, had severe annulus cusp mismatch before surgery. Annulus cusp mismatch resolved in most patients in group L postoperatively, whereas more than half the patients in group S still had severe mismatch. CONCLUSIONS Small cusp size (GH <16 mm) is not necessarily a contraindication in aortic valve repair. However, most patients in this group had annulus cusp mismatch. Root replacement or secure annulus plication is mandatory to correct annulus cusp mismatch.

Extent of resection and the long-term durability of vestibular schwannoma surgery

2011 ◽  
Vol 114 (5) ◽  
pp. 1218-1223 ◽  
Author(s):  
Michael E. Sughrue ◽  
Rajwant Kaur ◽  
Martin J. Rutkowski ◽  
Ari J. Kane ◽  
Gurvinder Kaur ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Tumor Size ◽  
Tumor Recurrence ◽  
Cox Regression ◽  
Extent Of Resection ◽  
Tumor Control ◽  
Patient Age ◽  
Patient Âgé ◽  
Microsurgical Resection ◽  
The Impact

Object With limited studies available, the correlation between the extent of resection and tumor recurrence in vestibular schwannomas (VSs) has not been definitively established. In this prospective study, the authors evaluated 772 patients who underwent microsurgical resection of VSs to analyze the association between total tumor resection and the tumor recurrence rate. Methods The authors selected all cases from a prospectively collected database of patients who underwent microsurgical resection as their initial treatment for a histopathologically confirmed VS. Recurrence-free survival was analyzed using Kaplan-Meier analysis. The authors studied the impact of possible confounders such as patient age and tumor size using stepwise Cox regression to calculate the proportional hazard ratio of recurrence while controlling for other cofounding variables. Results The authors analyzed data obtained in 571, 89, and 112 patients in whom gross-total, near-total, and subtotal resections, respectively, were performed. A gross-total resection was achieved in 74% of the patients, and the overall recurrence rate in these patients 8.8%. There was no significant relation between the extent of resection and the rate of tumor recurrence (p = 0.58). As expected, the extent of resection was highly correlated with patient age, tumor size, and surgical approach (p < 0.0001). Using Cox regression, the authors found that the approach used did not significantly affect tumor control when the extent of resection was controlled for. Conclusions While complete tumor removal is ideal, the results presented here suggest that there is no significant relationship between the extent of resection and tumor recurrence.

Risk of hemorrhage from de novo cerebral aneurysms

2013 ◽  
Vol 118 (1) ◽  
pp. 58-62 ◽  
Author(s):  
William J. Kemp ◽  
Daniel H. Fulkerson ◽  
Troy D. Payner ◽  
Thomas J. Leipzig ◽  
Terry G. Horner ◽  
...  
Keyword(s):  
Risk Factors ◽  
De Novo ◽  
Patient Age ◽  
Patient Âgé ◽  
Long Term Follow Up ◽  
De Novo Aneurysm ◽  
The Mean ◽  
Risk Of Hemorrhage

Object A small percentage of patients will develop a completely new or de novo aneurysm after discovery of an initial aneurysm. The natural history of these lesions is unknown. The authors undertook this statistical evaluation a large cohort of patients with both ruptured and unruptured de novo aneurysms with the aim of analyzing risk factors for rupture and estimating a risk of subarachnoid hemorrhage (SAH). Methods A review of a prospectively maintained database of all aneurysm patients treated by the vascular neurosurgery service of Goodman Campbell Brain and Spine from 1976–2010 was performed. Of the 4718 patients, 611 (13%) had long-term follow-up imaging. The authors identified 27 patients (4.4%) with a total of 32 unruptured de novo aneurysms from routine surveillance imaging. They identified another 10 patients who presented with a new SAH from a de novo aneurysm after treatment of their original aneurysm. The total study group was thus 37 patients with a total of 42 de novo aneurysms. The authors then compared the 27 patients with incidentally discovered aneurysms with the 10 patients with SAH. A statistical analysis was performed, comparing the 2 groups with respect to patient and aneurysm characteristics and risk factors. Results Thirty-seven patients were identified as having true de novo aneurysms. This group had a female predominance and a high percentage of smokers. These 37 patients had a total of 42 de novo aneurysms. Ten of these 42 aneurysms hemorrhaged. De novo aneurysms in both the SAH and non-SAH group were anatomically small (< 10 mm). The estimated risk of hemorrhage over 5 years was 14.5%, higher than the expected SAH risk of small, unruptured aneurysms reported in the ISUIA (International Study of Unruptured Intracranial Aneurysms) trial. There was no statistically significant correlation between hemorrhage and any of the following risk factors: hypertension, diabetes, tobacco and alcohol use, polycystic kidney disease, or previous SAH. There was a statistically significant between-groups difference with respect to patient age, with the mean patient age being significantly older in the SAH aneurysm group than in the non-SAH group (p = 0.047). This is likely reflective of longer follow-up and discovery time, as the mean length of time between initial treatment and discovery of the de novo aneurysm was longer in the SAH group (p = 0.011). Conclusions While rare, de novo aneurysms may have a risk for SAH that is comparatively higher than the risk associated with similarly sized, small, initially discovered unruptured saccular aneurysms. The authors therefore recommend long-term follow-up for all patients with aneurysms, and they consider a more aggressive treatment strategy for de novo aneurysms than for incidentally discovered initial aneurysms.

Abstract 47: Using Ultrasound and Inflammation to Improve Prediction of Ischemic Stroke: A Secondary Analysis of MESA

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Adam H de Havenon ◽  
Ka-Ho Wong ◽  
J Scott McNally ◽  
Jennifer Majersik
Keyword(s):  
Ischemic Stroke ◽  
Total Cholesterol ◽  
Primary Outcome ◽  
Epidemiologic Study ◽  
Secondary Analysis ◽  
Serum Marker ◽  
Patient Age ◽  
Cox Models ◽  
Patient Âgé

Background: The Multi-Ethnic Study of Atherosclerosis (MESA) is a large prospective epidemiologic study of the clinical factors that can predict transition from asymptomatic to symptomatic cardiovascular disease. Although prior studies have looked at ischemic stroke, they have not systematically examined the relationship between baseline ultrasound and inflammation measurements and subsequent primary stroke risk. Methods: The primary outcome is incident ischemic stroke during follow-up. The predictors are 9 ultrasound-derived measurements and 5 serum measurements related to inflammation. We fit Cox models to ischemic stroke and adjusted for patient age, hypertension, diabetes, total cholesterol, and smoking. Using DeLong’s method, we compared the AUC of the baseline adjusted model to the AUC of the model with predictor variables that were significant in the Cox models, to determine if they improved stroke prediction. Results: We included 6,095 patients with an average age of 61.9 years. The primary outcome of ischemic stroke was seen in 107 patients (1.8%) and the mean follow-up time was 7.7 years. In the Cox models, we found that small artery elasticity (SAE), carotid distensibility (CD), carotid stenosis (CS), and interleukin-6 (IL6) were associated with incident stroke. The AUC of the baseline model to predict stroke, which included patient age, hypertension, diabetes, total cholesterol, and smoking, was 0.745. When we added tertiles of SAE, CD, IL6 and categories of CS, the AUC improved to 0.765 (p=0.021 for difference). Conclusions: In a multiethnic cohort of patients without CVD at baseline, we found several ultrasound measurements and a serum marker of inflammation which predicted the occurrence of a primary ischemic stroke. Adding these basic ultrasound and serum measurements significantly improved the prediction of stroke, which could have implications for primary prevention efforts.

scholarly journals Self-reported health status, treatment decision and survival in asymptomatic and symptomatic patients with aortic stenosis in a Western Norway population undergoing conservative treatment: a cross-sectional study with 18 months follow-up

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e016489 ◽  
Author(s):  
Kjersti Oterhals ◽  
Rune Haaverstad ◽  
Jan Erik Nordrehaug ◽  
Geir Egil Eide ◽  
Tone M Norekvål
Keyword(s):  
Mental Health ◽  
Aortic Valve ◽  
Treatment Decision ◽  
Physical And Mental Health ◽  
Cross Sectional ◽  
Western Norway ◽  
Asymptomatic Patients ◽  
Reported Health ◽  
Self Reported Health Status

ObjectivesTo investigate symptoms and self-reported health of patients conservatively treated for aortic stenosis (AS) and to identify factors associated with treatment decision and patient outcomes.DesignA cross-sectional survey with an 18-month follow-up.SettingOne tertiary university hospital in Western Norway.ParticipantsIn all, 1436 patients were diagnosed with AS between 2000 and 2012, and those 245 still under conservative treatment in 2013 were included in this study.Primary and secondary outcome measuresPrimary outcome measures were symptoms and self-reported health status. Secondary outcomes were treatment decision and patient survival after 18 months.ResultsA total of 136 patients with mean (SD) age 79 (12) years, 52% men responded. Among conservatively treated patients 77% were symptomatic. The symptom most frequently experienced was dyspnoea. Symptomatic patients reported worse physical and mental health compared with asymptomatic patients (effect size 1.24 and 0.74, respectively). In addition, symptomatic patients reported significantly higher levels of anxiety and depression compared with asymptomatic patients. However, symptom status did not correlate with haemodynamic severity of AS. After 18 months, 117 (86%) were still alive, 20% had undergone surgical aortic valve replacement (AVR) and 7% transcatheter aortic valve implantation (TAVI). When adjusting for age, gender, symptomatic status, severity of AS and European system for cardiac operative risk evaluation (EuroSCORE), patients with severe AS had more than sixfold chance of being scheduled for AVR or TAVI compared with those with moderate AS (HR 6.3, 95% CI 1.9 to 21.2, p=0.003). Patients with EuroSCORE ≥11 had less chance for undergoing AVR or TAVI compared with those with EuroSCORE ≤5 (HR 0.06, 95% CI 0.01 to 0.46, p=0.007).ConclusionsSymptoms affected both physical and mental health in conservatively treated patients with AS. Many patients with symptomatic severe AS are not scheduled for surgery, despite the recommendations in current guidelines. The referral practice for AVR is a path for further investigation.

scholarly journals Impact of mass effect, tumor location, age, and surgery on the cognitive outcome of patients with high-grade gliomas: a longitudinal study

2017 ◽  
Vol 4 (4) ◽  
pp. 229-240 ◽  
Author(s):  
Monica Dallabona ◽  
Silvio Sarubbo ◽  
Stefano Merler ◽  
Francesco Corsini ◽  
Giuseppe Pulcrano ◽  
...  
Keyword(s):  
Tumor Volume ◽  
High Grade Glioma ◽  
Joint Effect ◽  
Cognitive Outcome ◽  
Tumor Localization ◽  
High Grade ◽  
Patient Age ◽  
Patient Âgé ◽  
High Grade Gliomas

Abstract Background High-grade gliomas are the most frequently occurring brain tumors and carry unfavorable prognosis. Literature is controversial regarding the effects of surgery on cognitive functions. Methods We analyzed a homogenous population of 30 patients with high-grade glioma who underwent complete resection. Patients underwent extensive neuropsychological analysis before surgery, 7 days after surgery, and approximately 40 days after surgery, before adjuvant treatments. Thirty-four neuropsychological tests were administered in the language, memory, attention, executive functions, and praxis domains. Results The preoperative percentage of patients with impairment in the considered tests ranged from 0% to 53.3% (mean 20.9%). Despite a general worsening at early follow-up, a significant recovery was observed at late follow-up. Preoperative performances in language and verbal memory tasks depended on the joint effect of tumor volume, volume of surrounding edema, and tumor localization, with major deficits in patients with left lateralized tumor, especially insular and temporal. Preoperative performances in attention and constructive abilities tasks depended on the joint effect of tumor volume, volume of surrounding edema, and patient age, with major deficits in patients ≥ 65 years old. Recovery at late follow-up depended on the volume of resected tumor, edema resorption, and patient age. Conclusions Longitudinal neuropsychological performance of patients affected by high-grade glioma depends, among other factors, on the complex interplay of tumor volume, volume of surrounding edema, tumor localization, and patient age. Reported results support the definition of criteria for surgical indication based on the above factors. They may be used to propose more customized surgical, oncological, and rehabilitative strategies.

scholarly journals Atrial High-Rate Event Incidence and Predictors in Patients With Permanent Pacemaker Implantation

2021 ◽  
Vol 8 ◽  
Author(s):  
Jian Hua Chen ◽  
Guo Yao Chen ◽  
Hong Zheng ◽  
Quan He Chen ◽  
Fa Yuan Fu ◽  
...  
Keyword(s):  
Cox Regression ◽  
Previous History ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
High Rate ◽  
Atrial Pacing ◽  
Patient Age ◽  
Cox Regression Analysis ◽  
Patient Âgé

Objective: The present study aims to investigate the incidence and predictors of atrial high-rate events (AHREs) in patients with permanent pacemaker implants.Methods: A total of 289 patients who were implanted with a dual-chamber pacemaker due to complete atrioventricular block or symptomatic sick sinus syndrome (SSS) and had no previous history of atrial fibrillation were included in the present study. AHREs are defined as events with an atrial frequency of ≥175 bpm and a duration of ≥5 min. The patients were divided into two groups according to whether or not AHREs were detected during the follow-up: group A (AHRE+, n = 91) and group N (AHRE–, n = 198).Results: During the 12-month follow-up period, AHREs were detected in 91 patients (31.5%). The multivariate Cox regression analysis revealed that patient age [odds ratio [OR] = 1.041; 95% confidence interval [CI], 1.018–1.064; and P &lt; 0.001], pacemaker implantation due to symptomatic SSS (OR = 2.225; 95% CI, 1.227–4.036; and P = 0.008), and the percentage of atrial pacing after pacemaker implantation (OR = 1.010; 95% CI, 1.002–1.017; and P = 0.016) were independent AHRE predictors.Conclusion: The AHRE detection rate in patients with pacemaker implants was 31.5%. Patient age, pacemaker implantation due to symptomatic SSS, and the percentage of atrial pacing after pacemaker implantation were independent AHRE predictors.

scholarly journals Comprehensive Treatment of Mediastinal Neuroendocrine Tumor: A Case Report

2021 ◽  
Author(s):  
Qi Yu ◽  
Zhen Li ◽  
Xinwei Han
Keyword(s):  
Case Report ◽  
Neuroendocrine Tumor ◽  
Surgical Resection ◽  
Neuroendocrine Tumors ◽  
Tumor Recurrence ◽  
Transcatheter Arterial Chemoembolization ◽  
Comprehensive Treatment ◽  
Drug Eluting ◽  
Arterial Chemoembolization

Abstract Neuroendocrine tumors in the mediastinum are relatively rare. We report a patient with mediastinal neuroendocrine tumor that was successfully resected after descending stage by drug-eluting embolic transcatheter arterial chemoembolization had been performed. No tumor recurrence was found in the 1-year follow-up after surgical resection.

Biologic and clinicopathologic factors as indicators of specific relapse types in node-negative breast cancer.

1995 ◽  
Vol 13 (3) ◽  
pp. 697-704 ◽  
Author(s):  
R Silvestrini ◽  
M G Daidone ◽  
A Luisi ◽  
P Boracchi ◽  
M Mezzetti ◽  
...  
Keyword(s):  
Cell Proliferation ◽  
Tumor Size ◽  
Locoregional Recurrence ◽  
Hormone Receptors ◽  
Distant Metastases ◽  
Locoregional Therapy ◽  
Patient Age ◽  
Node Negative ◽  
Patient Âgé ◽  
Different Types

PURPOSE AND METHODS We evaluated, in 1,800 patients with node-negative tumors treated with locoregional therapy until relapse, the competitive risks for different types of metastasis by cell proliferation (3H-thymidine labeling index [3H-dT LI]), estrogen receptors (ERs), and progesterone receptors (PgRs), and by the integration of biologic and clinicopathologic information. RESULTS Hormone receptor status and proliferative activity of the primary tumor were not indicative of contralateral failures. Hormone receptors failed to predict the 8-year incidence of locoregional recurrence, but they were significant indicators of distant metastasis and overall survival. The latter finding was confirmed even in multivariate analysis. Conversely, cell proliferation predicted both locoregional and distant metastases and survival, regardless of patient age, tumor size, and ER and PgR status. Recursive partitioning and amalgamation analysis ascribed to cell proliferation an important prognostic role for locoregional recurrence together with patient age and tumor size. CONCLUSION Biologic markers, in particular cell proliferation, provide information for the different types of relapse and could complement the predictive role of pathologic staging.

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