Does pre-emptive onlay mesh reinforcement of midline laparotomies reduce incidence of incisional hernia in high–risk patients?

Background: One of the major morbidity after abdominal surgery is incisional hernia. In high risk patients its incidence reaches 11-20% despite various optimal closure techniques for midline laparotomy. Our aim is to evaluate the efficacy of onlay mesh placement in reducing the incidence of incisional hernia in those high risk patients.Methods: A total of 65 high risk patients suspected to develop post-operative incisional hernia underwent midline abdominal laparotomies. Patients were divided into two groups; group1 (30 patients) for whom the incision was closed by conventional method and group2 (35 patients) for whom the incision was closed with reinforcement by onlay polypropylene mesh. The primary end point was the occurrence of incisional hernia while the secondary end point was post-operative complications including subcutaneous seroma, chronic wound pain, and surgical site infection (SSI). Patients were followed up for two years.Results: The base line characteristics of the two groups were similar. The incidence of incisional hernia is significantly reduced 1/35 (2.8%) in group 2 while it was 6/30 (20%) in group 1. As regard seroma and chronic wound pain they increased in (group2) 6/35 (17.14%) and 5/35(14.28%) respectively compared to (group 1) which was 4/30 (13.33%) and 2/30 (6.66%). SSI occurred in 1/35 (2.85%) in group 2 and in 1/30 (3.33%) in group 1.Conclusions: Prophylactic onlay mesh reinforcement of the midline laparotomy for high risk patients can be used safely and markedly reduces the incidence of incisional hernia with little morbidity.

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Appropriate secondary prevention and clinical outcomes after acute myocardial infarction according to atherothrombotic risk stratification: The FAST-MI 2010 registry

European Journal of Preventive Cardiology ◽

10.1177/2047487318808638 ◽

2018 ◽

Vol 26 (4) ◽

pp. 411-419 ◽

Cited By ~ 3

Author(s):

Victoria Tea ◽

Marc Bonaca ◽

Chekrallah Chamandi ◽

Marie-Christine Iliou ◽

Thibaut Lhermusier ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

High Risk ◽

Secondary Prevention ◽

High Risk Patients ◽

Risk Patients ◽

St Elevation ◽

Group 3 ◽

Group 2 ◽

Group 1

Background Full secondary prevention medication regimen is often under-prescribed after acute myocardial infarction. Design The purpose of this study was to analyse the relationship between prescription of appropriate secondary prevention treatment at discharge and long-term clinical outcomes according to risk level defined by the Thrombolysis In Myocardial Infarction (TIMI) Risk Score for Secondary Prevention (TRS-2P) after acute myocardial infarction. Methods We used data from the 2010 French Registry of Acute ST-Elevation or non-ST-elevation Myocardial Infarction (FAST-MI) registry, including 4169 consecutive acute myocardial infarction patients admitted to cardiac intensive care units in France. Level of risk was stratified in three groups using the TRS-2P score: group 1 (low-risk; TRS-2P=0/1); group 2 (intermediate-risk; TRS-2P=2); and group 3 (high-risk; TRS-2P≥3). Appropriate secondary prevention treatment was defined according to the latest guidelines (dual antiplatelet therapy and moderate/high dose statins for all; new-P2Y12 inhibitors, angiotensin-converting-enzyme inhibitor/angiotensin-receptor-blockers and beta-blockers as indicated). Results Prevalence of groups 1, 2 and 3 was 46%, 25% and 29% respectively. Appropriate secondary prevention treatment at discharge was used in 39.5%, 37% and 28% of each group, respectively. After multivariate adjustment, evidence-based treatments at discharge were associated with lower rates of major adverse cardiovascular events (death, re-myocardial infarction or stroke) at five years especially in high-risk patients: hazard ratio = 0.82 (95% confidence interval: 0.59–1.12, p = 0.21) in group 1, 0.74 (0.54–1.01; p = 0.06) in group 2, and 0.64 (0.52–0.79, p < 0.001) in group 3. Conclusions Use of appropriate secondary prevention treatment at discharge was inversely correlated with patient risk. The increased hazard related to lack of prescription of recommended medications was much larger in high-risk patients. Specific efforts should be directed at better prescription of recommended treatment, particularly in high-risk patients.

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Outcome of Adult AML at First Relapse Following a Risk-Oriented Strategy: An Update of the Northern Italy Leukemia Group (NILG) Experience

Blood ◽

10.1182/blood.v112.11.4385.4385 ◽

2008 ◽

Vol 112 (11) ◽

pp. 4385-4385 ◽

Cited By ~ 1

Author(s):

Irene Cavattoni ◽

Enrico Morello ◽

Elena Oldani ◽

Tamara Intermesoli ◽

Ernesta Audisio ◽

...

Keyword(s):

Prognostic Factors ◽

High Risk ◽

Risk Category ◽

High Dose ◽

High Risk Patients ◽

Risk Patients ◽

First Relapse ◽

Group 2 ◽

Standard Risk ◽

Group 1

Abstract INTRODUCTION The impact on post-relapse survival of selected prognostic factors and salvage therapy (finalized to perform an allo-SCT) was retrospectively analyzed in 172 patients (patients) with relapsed non-APL AML, who had been initially treated with standard induction and risk-adapatiented consolidation. The aim was to identify factors associated with a better outcome at first relapse. METHODS All 172 patients were at first recurrence following consolidation of CR1 with high-dose Ara-C (HiDAC) multicycle therapy supported by blood stem cells (standard risk, as defined by mixed clinical-cytogenetic criteria) or allo-SCT in case of high-risk prognostic profile. Median age at relapse was 55 y (range 21–70). CR1 duration was <6 months in 50 patients (29%), ranging from 0.6 to 52,7 mo (median 9,1). High risk patients were 128/172 (74%) and 43/172 patients (25%) had an unfavourable cytogenetics (CG). One hundred-eleven patients (64%) received HiDAC and 24 (14%) an allo-SCT according to study design. RESULTS 140 patients (81%) received salvage treatment. The remaining 32 patients (19%) received palliation and all of them died. The median OS was 17.1 mo, with a 2yOS of 34%. Favorable prognostic factors identified by univariate analisys were: favourable or intermediate CG (p=0,007), standard risk category according to first line protocol (p=0.004), availibility of a HLA matched donor (p= 0.048), achievement of an early CR1(p=0,000), HiDAC as first line therapy(p=0,000), alloHSCT perfomed at relapse (p=0,000) and a DFS from CR1>12 mo (p=0,000). In multivariate analysis favourable or intermediate CG and DFS >12 mo were confirmed as independent prognostic factors (p=0,036 and p=0,001 respectively). Among the 140 patients, 50 received an allo-SCT following relapse (36%, group 1), and the remaining 90 (64%, group 2) received high dose chemotherapy alone (85), autologous SCT (2), or DLI (3, in case of previous alloSCT). Both groups were comparable regarding age >55 y, prior allo-SCT and risk class at diagnosis. After salvage therapy, 44 patients(88%) in the group 1 achieved CR2, compared to 26 patients (29%) in the group 2. The median duration of CR2 was 9 mo (range 2–64) and 3 mo (range 1–34) in group 1 and 2 respectively. NRM was 17/140: 12 patients (24%) in the allo-SCT group and 5 (6%) in group 2. The 2yOS was 57% and 23% respectively (p=0,000). Moreover, among 50 alloSCT patients, survival was affected by risk category at diagnosis: 2yOS of 19 (38%) standard risk patients was 83% compared to 42% in 31 high risk patients (62%) (p=0.01). This risk stratification has no impact on OS in the group 2. CONCLUSIONS DFS > 12 mo and standard risk category at diagnosis, according to NILG protocol, are the most important independent positive prognostic factors impacting OS of AML relapsed patients. The availibility of a HLA matched donor and a subsequent intensification with alloSCT may offer substantial salvage rates and its outcome is affected by the risk stratification at diagnosis. Nevertheless, high risk patients could benefit from alloSCT, reaching an 2yOS of 42%.

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AS-265: Incidence After the Use of Clopidogrel 150 mg + Aspirin 81 mg in Group 1 Versus Clopidogrel 75 mg + Aspirin 81 mg in Group 2 After Drug-Eluting Stenting for 1 Month in High-Risk Patients

The American Journal of Cardiology ◽

10.1016/j.amjcard.2009.01.323 ◽

2009 ◽

Vol 103 (9) ◽

pp. 112B

Author(s):

Saad Mohammed Alkasab ◽

Menwar M. Alanazi ◽

Mohammad Alshehri ◽

Rida Nourallah ◽

Yahya Alhebaishi ◽

...

Keyword(s):

High Risk ◽

High Risk Patients ◽

Risk Patients ◽

Drug Eluting ◽

Group 2 ◽

Group 1

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Results of neuroblastoma treatment in Lithuania: a single centre experience

Acta medica Lituanica ◽

10.6001/actamedica.v24i2.3494 ◽

2017 ◽

Vol 24 (2) ◽

pp. 128-137 ◽

Cited By ~ 2

Author(s):

Austėja Juškaitė ◽

Indrė Tamulienė ◽

Jelena Rascon

Keyword(s):

Survival Rate ◽

High Risk ◽

Age At Diagnosis ◽

Mycn Amplification ◽

Disease Group ◽

High Risk Patients ◽

Risk Patients ◽

Group 3 ◽

Group 2 ◽

Group 1

Background. Neuroblastoma (NB) is the most common extracranial solid tumour in children. This is a very rare disease with heterogeneous biology varying from complete spontaneous regression to a highly aggressive tumour responsible for 15% of malignancy-related death in early childhood. Analyses of survival rates in Europe have shown a considerable difference between Northern/Western and Eastern European countries. Treatment results of NB in Lithuania have never been analyzed. Aim. To assess the survival rate of children with NB according to initial spread of the disease, age at diagnosis, the MYCN amplification, risk group, and treatment period. Patients and methods. A retrospective single-centre analysis of patients’ records was performed. Children diagnosed and treated for NB between 2000 and 2015 at the Centre of Paediatric Oncology and Haematology of the Children’s Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos were included. The patients were divided into three groups according to the spread of the disease: group 1 – patients with local NB older than 12 years of age; group 2 – stage IV patients, also called the M stage; group 3 – infants with stages 4S and MS. The patients were stratified into three risk groups – low, intermediate and high risk. Estimates of five-year overall survival (OS5y) were calculated using the Kaplan-Meier method comparing survival probability according to spread of the disease, age at diagnosis, the MYCN amplification, risk group and treatment period (2000–2007 vs 2008–2015). Results. Overall 60 children (31 girls and 29 boys) with NB were included. The median age at diagnosis was 1.87 years (ranged from 4 days to 15 years). Seventy-eight percent of cases were found to be differentiated or undifferentiated NB, 22% – ganglioneuroblastoma. The local form of the disease was predominant: 57% (34/60) of patients were allocated to the group 1, 37% (22/60) with initial metastatic disease were assigned to group 2, and infants with 4S or MS stage comprising 7% (4/60) allocated to group 3, respectively. The probability of OS5y for the entire cohort was 71% with the median follow-up of 8.8 ± 4.8 years. The probability of OS5y for local disease (group 1) was significantly higher compared to metastatic disease (group 2) (94% vs. 34%, p = 0.001, respectively) as well as for infants compared to children older than 12 months at the time of diagnosis (90% vs 60%, p = 0.009, respectively). The MYCN gene amplification had a negative influence on OS5y, with 78% of MYCN-negative patients surviving in comparison to 40% of MYCN-positive patients who did not survive (p = 0.153). The high-risk patients had significantly worse OS5y than children with intermediated or low risk (35% vs. 82% vs. 100%, respectively, p = 0.001). Comparison of OS5y between two treatment periods in the entire patient population revealed a non-significant increase in survival from 66% in the 2000–2007 period to 82% in the 2008–2015 period (p = 0.291), mostly due to a dramatic improvement achieved for high-risk patients whose survival rate increased from 9% in the 2000–2007 period to 70% in the 2008–2015 period (p = 0.009). Conclusions. There was a slight predominance of low-risk patients, probably due to a higher number of infants. A better probability of OS5y was confirmed in infants with local disease and in MYCN-negative patients. The OS5y for children treated for NB at our institution over 16 years increased from 66% in the 2000–2007 period to 82% in the 2008–2015 period with the most significant improvement achieved for high risk patients. The current survival rate of children treated for NB at our institution is in line with the reported numbers in Northern and Western European countries.

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P106 PROPHYLACTIC MESH FOR PREVENTION OF INCISIONAL HERNIA IN HIGH-RISK PATIENTS: PVDF “VISIBLE” MESH BEHAVIOUR ON MRI

British Journal of Surgery ◽

10.1093/bjs/znab395.099 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Beatriz Carrasco Aguilera ◽

Marina da Silva Torres ◽

Jose Rodicio ◽

Ana Fernández del Valle ◽

Maria Moreno ◽

...

Keyword(s):

High Risk ◽

Incisional Hernia ◽

Gastrointestinal Surgery ◽

Safe Procedure ◽

Prophylactic Mesh ◽

Midline Laparotomy ◽

Linea Alba ◽

High Risk Patients ◽

Risk Patients

Abstract Aim According to the guidelines, prophylactic mesh placement appears to be an effective, safe procedure in high-risk patients for the prevention of incisional hernia (IH) after midline laparotomy, without its use being standardized. Knowing its radiological behaviour can resolve doubts about its use. Material and Methods This was a prospective observational cohort study. The included patients needed to have more than one risk factor for IH (age> 60 years old, Body Mass Index > 30kg/m2, diabetes, chronic bronchopathy, heart disease, smoking, kidney disease, neoplasia, liver disease, immunosuppression or an emergency operation). Follow-up included 6-week and 12-month postoperative magnetic resonance imaging (MRI). If MRI was not performed, we used the follow-up computed tomography (CT). Results Between July 2016 and March 2021, 54 patients were enrolled in the study. Surgery was emergent in 14.8% of cases, clean-contaminated in 87% and upper gastrointestinal surgery in 51.9%. A total of 43 MRI and 3 CT at 6-week and 30 MRI and 2 CT at 12-month were carried out. The median of the mesh area were 150.7 vs 150,1cm2 respectively. 91% of cases had the mesh lined to the fascia at 12 months. The bridging in the linea alba was zero in 61% at 6-weeks and 24% at 12-month follow-up, mean 9 vs 19mm (p = 0.001). Conclusions The use of imaging tests to know the postoperative behaviour of a Polyvinylidenfluorid (PVDF) “visible” mesh shows us that there is no mesh contraction at one year or detachment of the fascia, however we observe a significant tendency in the separation of the linea alba.

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Daratumumab Single Agent and Daratumumab Plus Pomalidomide and Dexametasone in Relapsed/Refractory Multiple Myeloma: A Real Life Retrospective Evaluation

Blood ◽

10.1182/blood.v128.22.4516.4516 ◽

2016 ◽

Vol 128 (22) ◽

pp. 4516-4516 ◽

Cited By ~ 8

Author(s):

Antonio Branca ◽

Amy Buros ◽

Donghoon Yoon ◽

Larry J Suva ◽

Niels Weinhold ◽

...

Keyword(s):

Multiple Myeloma ◽

Adverse Event ◽

High Risk ◽

Disease Progression ◽

Single Agent ◽

Low Risk ◽

High Risk Patients ◽

Risk Patients ◽

Group 2 ◽

Group 1

Abstract Background. In the last twenty years, the outcome of multiple myeloma (MM) has markedly improved. Daratumumab is the first anti-CD38 monoclonal antibody (mAb) recently approved for the treatment of relapsed refractory multiple myeloma (RRMM). In this study we have evaluated the efficacy of daratumumab single agent and daratumumab plus pomalidomide and dexamethasone in low and high risk RRMM patients. Design and Methods. From November 2015 to March 2016, 25 and 39 RRMM patients were treated with therapy using daratumumab single agent (Group 1: median age 67, range 40-83) and daratumumab plus pomalidomide and dexamethasone respectively (Group 2: median age 71, range 45-87). In both groups, patients received daratumumab IV 16 mg/kg once a week (weeks 1-8), followed by every other week (weeks 9-24) and then once a month until disease progression or unacceptable toxicities. In Group 2 pomalidomide was administered at dosages from 1 mg to 4 mg daily according to tolerability for 21 days every 28 days, along with dexamethasone 40 mg weekly. The median time form the time of diagnosis was 7.1 years and 5.5 years in Group 1 and Group 2 respectively. In both groups, patients had received a median of 4 prior treatments. In Group 1, 80% of the patients had disease refractory to the last therapy received, 68% had disease double refractory to IMiDs and PIs, and 28% (7 patients) had GEP high risk signature. In Group 2, 78% of the patients had disease refractory to last therapy, 84% had double refractory disease and 37% (14 patients) had high GEP risk signature. Results. In the single agent group, the overall response rate (ORR) was 28%: CR 4% (1 patient), 4% VGPR (1 patient), PR 20% (5 patients). With a median follow up of 3.5 months, 48% of patients were still on treatment and 52% had discontinued treatment for disease progression. The ORR according to last GEP70 was 40% and 0% in the low risk and high risk patients respectively. All high risk patients had discontinued treatment for disease progression within the second month of treatment. In the second group, the ORR was 41%: CR 5% (2 patients), 3% VGPR (1 patient), and 33% PR (13 patients). After a median follow up of 4 months, 77% (30 patients) of patients were still on treatment, 20% (8 patients) discontinued treatment for disease progression and 3% (1 patient) of patients had discontinued treatment for adverse event grade 4. The ORR was 50% (4% CR, 4% VGPR, and 42% PR) in low risk patients and 21% (7% CR and 14% PR) in high risk patients. Infusion-related reactions were mild (54% of patients had an event of any grade, and 4% and 2% had an adverse event of grade 3 in Group 1 and Group 2 respectively). The most common non hematological adverse event of grade 3 or 4 was pneumonia (4% and 8% in Group 1 and Group 2 respectively). PFS of Group 1 and 2 are shown in Figure 1. Conclusion. Daratumumab single agent had a favorable safety profile and encouraging efficacy in patients with heavily pretreated and refractory myeloma, and the combination of daratumumab with pomalidomide and dexamethasone was well tolerated and improved the outcome in low risk patients, even in double refractory disease. Encouraging results have been observed as well in patients with high risk GEP 70 signature. Figure 1 Figure 1. Disclosures Davies: Takeda: Consultancy, Honoraria; Celgene: Consultancy, Honoraria; Janssen: Consultancy, Honoraria. Morgan:Univ of AR for Medical Sciences: Employment; Celgene: Consultancy, Honoraria, Research Funding; Takeda: Consultancy, Honoraria; Bristol Meyers: Consultancy, Honoraria; Janssen: Research Funding.

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Efficacy of a clinical risk prediction tool to prioritize outreach for high-risk cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e13524 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e13524-e13524

Author(s):

Megan Croyle ◽

Nathan Handley ◽

Michael Li ◽

Adam F Binder ◽

Valerie Pracilio Csik

Keyword(s):

High Risk ◽

High Risk Group ◽

Risk Scores ◽

Control Group ◽

Case Group ◽

Control Groups ◽

High Risk Patients ◽

Risk Patients ◽

Group 2 ◽

Group 1

e13524 Background: Acute care utilization (ACU), including emergency department visits and hospitalizations, is common in patients with cancer. Prospectively identifying patients’ risk status may enable interventions to reduce ACU. We developed a REDUCE score (Reducing ED Utilization in the Cancer Experience for active oncology patients (defined as patients with an active cancer diagnosis in the last 12 months who had a Medical Oncology encounter in a 180-day period) to prospectively determine risk of ACU. The intended intervention was outreach to all high-risk patients. We evaluated the high risk group over an 11-month period (February through December 2020) to better characterize those who received outreach. Methods: Analysis of high-risk patients was conducted using a case-control method over two periods: February through June 2020 (Period 1) and July through December 2020 (Period 2) to account for a change in the type of outreach deployed. High risk was defined as REDUCE ≥2. High risk scores were stratified by those with REDUCE =2 and those with REDUCE >2. Control Group 1 consisted of high-risk patients with REDUCE =2 who did not receive outreach, and Control Group 2 included high-risk patients with REDUCE >2 who did not receive outreach. Case Group 1 consisted of high-risk patients with REDUCE =2 who had outreach, and Case Group 2 included patients with REDUCE >2 who had outreach. Average ACU per patient was compared across all groups over both periods. Descriptive statistics were applied. Results: Results are described in table 1. Average ACU per patient was higher in Periods 1 and 2 for both Case Groups, compared to both Control Groups. Over time, there was a trend in decreased ACU in the intervention group with stable to increasing ACU in the control groups. The proportion of patients who received outreach across both periods decreased in Case Group 1, but increased in Case Group 2. Conclusions: These findings suggest that patients who received outreach were at a higher risk of ACU. Further investigation revealed that there was not consistent prioritization of patients with the highest risk scores within the high-risk group for outreach. In addition to the REDUCE , ongoing efforts incorporate clinical judgment of the outreach team in assessing additional clinical risk factors to determine an intervention, which is meaningful. The REDUCE tool may provide value as an initial screening mechanism. Average ACU per patient by study group.[Table: see text]

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P0245PERCUTANEOUS RENAL BIOPSY IN FRAIL AND HIGH RISK PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0245 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Dario Roccatello ◽

Roberta Fenoglio ◽

Joelle Kamgaing ◽

Emanuele De Simone ◽

Giulio Del Vecchio ◽

...

Keyword(s):

Diabetic Nephropathy ◽

High Risk ◽

Kidney Biopsy ◽

Histological Diagnosis ◽

Renal Amyloidosis ◽

Av Fistula ◽

Cast Nephropathy ◽

Risk Patients ◽

Group 2 ◽

Group 1

Abstract Background and Aims: Many patients with End Stage Kidney Disease do not undergo percutaneous kidney biopsy (KB) and do lack a definite diagnosis. Whether KB is beneficial in the extreme patients’ categories, i.e., age >75 years and very late referrals with kidney disease requiring renal replacement therapy at the first evaluation, remains controversial. Aim: To analyse the benefit/risk balance in terms of therapeutic options and general outcome of KB procedure in these borderline categories. Method Files for all biopsies performed in our Centre between 2013 and 2019 (# 903 inpatients’ native kidney) were retrospectively analysed with special focus on histological diagnosis, biopsy complications, and post-biopsy patient’s outcome. Two groups of high risk patients were identified 1. >75 years old patients, and 2. patients requiring dialysis at the first clinical evaluation. A rigorous protocol of screening of the bleeding risks was adopted. Results Of the 903 biopsies, 217 cases (24%) had group 1, and 92 (10%) group 2 criteria. Group 1: mean age 80 years (range 75-92), main histological diagnoses: ANCA associated vasculitis (AAV) (12,4%); membranous nephropathy (MN) (11,5%), diabetic nephropathy (10,1%), IgA glomerulonephritis (IgAGN) (9,2%), cast nephropathy (9,2%), renal amyloidosis (9.2%), focal segmental glomerulosclerosis (FSGS - 7,8 %). Group 2: mean age 60 years (range 20-92), most frequent histological diagnosis: AAV (26,1%); cast nephropathy (19,6 %), nephroangiosclerosis (9,8%), IgAGN (7,6 %), diabetic nephropathy (6,5%), renal amyloidosis (5,4%); FSGS (4,3%). Five major complications (2,3%), including AV fistula with spontaneous resolution in 4 patients and 1 case of severe bleeding requiring arterial embolization, and 14 minor complications (6,5%), including post biopsy haematomas <2cm in 12 patients and haematuria in 2 patients were observed in group 1. Only 1 (1%) major complication (AV fistula) and 4 minor complications (4,3%), including post biopsy <2cm haematomas in group 2 were identified in group 2. Histological diagnosis conditioned or changed treatment strategy in 71% of elderly patients (group 1), and 63% of patients in dialysis (group 2). Dialysis discontinuation was achieved in 30 out of 92 patients (36,6%) with a sparing of over 1 million euro/year. Conclusion Given its high diagnostic value (especially in patients who are willing to be transplanted), the prognostic significance (and the assessment of the extent of the renal sclerotic changes), and the potential impact on the treatment policy, indications to percutaneous kidney biopsy in elderly and dialysis patients should be probably revised.

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