scholarly journals Efficacy and risk factor assessment of outcomes of self-expanding metal stents deployed in advanced oesophageal cancer: a case series of 69 patients from a tertiary referral centre of South India

2021 ◽  
Vol 8 (4) ◽  
pp. 1168
Author(s):  
Venkata Kapil Kishore Siddiraju ◽  
Ashok Kumar K. V. ◽  
Nagesh N. S.
Keyword(s):  
Risk Factor ◽  
Adverse Events ◽  
Oesophageal Cancer ◽  
Case Series ◽  
Mortality Data ◽  
Metal Stents ◽  
Tertiary Referral Centre ◽  
Risk Factor Assessment ◽  
Kaplan Meier ◽  
Common Location

Background: In India, Oesophageal cancer ranks as the 6th most common cause of cancer-related deaths. SCC is the most common histology with middle and lower third of the oesophagus as most common location. Often, it is diagnosed in elderly individuals with multiple comorbidities, and at an advanced stage with malignant strictures, where SEMS is treatment of choice. The current retrospective study aims to evaluate efficacy and the risk factor assessment of outcomes of SEMS deployment in patients with advanced oesophageal cancer.Methods: All consecutive patients referred to Department of SGE and LT of BMCRI, with advanced oesophageal cancer from March 2012 to October 2019 were studied. Patients details viz. demography, dysphagia grade, stricture details and SEMS related adverse events and 30-day, 90-day and long-term mortality data was charted and significance of these study parameters along with survival analysis was carried out by using relevant statistical tools.Results: Of the 69 patients, SCC in mid-oesophagus was the most common presentation. 36 patients (52.2%) received prior CRT, TEF (n=11) and distant metastasis (n=7). SEMS intention was palliation in all patients. Overall procedural success using 'Endoscopy alone' was achieved in all 69 patients (100%). Post SEMS period uneventful (n=36), transient haemorrhage (n=5) patients, aspiration (n=11), tumour overgrowth and ingrowth (n=11), SEMS on SEMS (n=5), double SEMS for TEF (n=2). Significant adverse events necessitating reinterventions were seen in 17 patients (24.5%). Kaplan-Meier graph showed lower survival in patients with metastasis and TEF and no statistical difference in-terms of adverse events was noted based on fully covered versus partially covered SEMS.Conclusions: SEMS aids in early resumption of oral feeds and the outcomes of fully covered and partially covered SEMS are comparable in a palliative setting.

scholarly journals Treatment of post-cholecystectomy biliary strictures with fully-covered self-expanding metal stents – results after 5 years of follow-up

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Andrea Tringali ◽  
◽  
D. Nageshwar Reddy ◽  
Thierry Ponchon ◽  
Horst Neuhaus ◽  
...  
Keyword(s):  
Adverse Events ◽  
National Study ◽  
Metal Stents ◽  
Biliary Strictures ◽  
Biliary Stents ◽  
Serious Adverse Events ◽  
Kaplan Meier ◽  
Benign Biliary Strictures ◽  
Self Expanding Metal Stents

Abstract Background Endoscopic treatment of post-cholecystectomy biliary strictures (PCBS) with multiple plastic biliary stents placed sequentially is a minimally invasive alternative to surgery but requires multiple interventions. Temporary placement of a single fully-covered self-expanding metal stent (FCSEMS) may offer safe and effective treatment with fewer re-interventions. Long-term effectiveness of treatment with FCSEMS to obtain PCBS resolution has not yet been studied. Methods In this prospective multi-national study in patients with symptomatic benign biliary strictures (N = 187) due to various etiologies received a FCSEMS with scheduled removal at 6–12 months and were followed for 5 years. We report here long-term outcomes of the subgroup of patients with PCBS (N = 18). Kaplan Meier analyses assessed long-term freedom from re-stenting. Adverse events were documented. Results Endoscopic removal of the FCSEMS was achieved in 83.3% (15/18) of patients after median indwell of 10.9 (range 0.9–13.8) months. In the remaining 3 patients (16.7%), the FCSEMS spontaneously migrated and passed without complications. At the end of FCSEMS indwell, 72% (13/18) of patients had stricture resolution. At 5 years after FCSEMS removal, 84.6% (95% CI 65.0–100.0%) of patients who had stricture resolution at FCSEMS removal remained stent-free. In addition, at 75 months after FCSEMS placement, the probability of remaining stent-free was 61.1% (95% CI 38.6–83.6%) for all patients. Stent or removal related serious adverse events occurred in 38.9% (7/18) all resolved without sequalae. Conclusions In patients with symptomatic PCBS, temporary placement of a single FCSEMS intended for 10–12 months indwell is associated with long-term stricture resolution up to 5 years. Temporary placement of a single FCSEMS may be considered for patients with PCBS not involving the main hepatic confluence. Trial registration numbers NCT01014390; CTRI/2012/12/003166; Registered 17 November 2009.

scholarly journals Outcomes of phacoemulsification and endoscopic cyclophotocoagulation performed with dual blade ab interno trabeculectomy or trabecular micro-bypass stent insertion

Eye ◽  
2021 ◽  
Author(s):  
Emma Klug ◽  
Marika Chachanidze ◽  
Abraham Nirappel ◽  
Enchi K. Chang ◽  
Nathan Hall ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Proportional Hazards ◽  
Case Series ◽  
Cox Proportional Hazards ◽  
Stent Insertion ◽  
Tertiary Referral Centre ◽  
Kaplan Meier ◽  
Ab Interno Trabeculectomy ◽  
The Mean ◽  
Ab Interno

Abstract Background/Objective To report the initial outcomes of phacoemulsification, endoscopic cyclophotocoagulation, and dual blade ab interno trabeculectomy (PEcK), and compare them to those of phacoemulsification, endoscopic cyclophotocoagulation, and trabecular micro-bypass stent insertion (ICE-1). Subjects/Methods Patients from January 2018 to December 2019 that underwent PEcK or ICE-1 at a tertiary referral centre were included in this retrospective comparative case series. Patients were excluded if they had additional concomitant procedures, less than 6 weeks (42 days) of follow-up or were not at least 18 years old. Intraocular pressure (IOP), number of glaucoma medications, and best-corrected visual acuity were collected preoperatively and postoperatively at 6 weeks, 3, 6, and 12 months. Kaplan–Meier survival analysis and Cox proportional-hazards regression were conducted to elucidate any factors associated with survival time. Results The mean preoperative IOP was 18.3 ± 5.9 mmHg in the PEcK group (53 eyes) and 14.7 ± 4.3 mmHg in the ICE-1 group (23 eyes) (p = 0.004) on 3.3 ± 1.3 and 1.7 ± 0.93 glaucoma medications (p < 0.001), respectively. Twelve months postoperatively the mean IOP reduction was 5.1 ± 4.4 mmHg and 2.3 ± 4.0 mmHg (p = 0.08), and the mean medication reduction was 1.6 ± 1.5 and 0.97 ± 0.66 (p = 0.10), in the PEcK and ICE-1 groups, respectively. Kaplan–Meier survival analysis did not reveal any differences in treatment survival. Conclusions Both PEcK and ICE-1 provide clinically relevant reductions in IOP and glaucoma medication burden, however the PEcK procedure may confer greater reductions in IOP. The procedures did not differ with regard to Kaplan–Meier survival probability.

CLINICAL EFFICACY AND ADVERSE EVENTS OF FULLY COVERED SELF-EXPANDABLE METAL STENTS (FC-SEMS) IN PANCREATOBILIARY STENOSIS

2018 ◽  
Author(s):  
C Huertas ◽  
M Figa ◽  
M Hombrados ◽  
H Uchima ◽  
D Busquets ◽  
...  
Keyword(s):  
Adverse Events ◽  
Clinical Efficacy ◽  
Metal Stents

Risk Factor Assessment Using Surface Electromyography and Electrogoniometer among Automobile Part Manufacturers

2005 ◽  
Vol 17 (4) ◽  
pp. 267
Author(s):  
Dongmug Kang ◽  
Cheol Ho Yee ◽  
Yong Chul Shin ◽  
Eun A Kim ◽  
Ji Hoon Woo ◽  
...  
Keyword(s):  
Risk Factor ◽  
Surface Electromyography ◽  
Automobile Part ◽  
Risk Factor Assessment

scholarly journals Feasibility and Safety of Endoluminal Radiofrequency Ablation as a Rescue Treatment for Bilateral Metal Stent Obstruction Due to Tumor Ingrowth in the Hilum: A Pilot Study

2021 ◽  
Vol 10 (5) ◽  
pp. 952
Author(s):  
Hoonsub So ◽  
Chi Hyuk Oh ◽  
Tae Jun Song ◽  
Hyun Woo Lee ◽  
Jun Seong Hwang ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Bile Duct ◽  
Adverse Events ◽  
Bile Duct Obstruction ◽  
Metal Stents ◽  
Metal Stent ◽  
Duct Obstruction ◽  
Tumor Ingrowth ◽  
Malignant Bile Duct Obstruction ◽  
Hilar Bile Duct

Background. Radiofrequency ablation (RFA) is a palliative method known for its application in the endoscopic treatment of malignant bile duct obstruction. It may be a useful rescue method for metal stent malfunction caused by tumor ingrowth. This study aimed to examine the feasibility and safety of endoluminal RFA for occluded bilateral hilar metal stents due to tumor ingrowth in patients with malignant hilar bile duct obstruction. Methods: From March 2016 to June 2018, 11 patients with unresectable malignant hilar bile duct stricture with occluded bilateral hilar metal stents due to tumor ingrowth were enrolled. Endoluminal RFA was performed through a novel temperature-controlled catheter at a setting of 7 W power for 120 s with a target temperature of 80 °C via endoscopic retrograde cholangiopancreatography (ERCP). The patients’ demographics, clinical outcomes, and adverse events were investigated. Results: The median age was 64 (interquartile range, 54–72) years. All RFA procedures were successful. Clinical success was achieved in eight patients (72.7%). During the follow-up, eight patients (72.7%) showed stent dysfunction, and the median patency after RFA was 50 days (95% confidence interval (CI): 34–not available (NA)). All stent dysfunctions were successfully managed with ERCP. Ten patients died, and the median overall survival was 289 days (95% CI, 107–NA) from RFA to death. There was one case of mild abdominal pain after the procedure without serious adverse events. Conclusions: As a rescue therapy for occluded bilateral hilar metal stents due to tumor ingrowth, endoluminal RFA seemed to be safe and useful in selected patients.

scholarly journals Thigh intramuscular fat predicts the prognosis in patients in non-ischemic cardiomyopathy with reduced ejection fraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Yoshida ◽  
A Shibata ◽  
A Tanihata ◽  
H Hayashi ◽  
Y Ichikawa ◽  
...  
Keyword(s):  
Adverse Events ◽  
Ischemic Cardiomyopathy ◽  
Cox Regression ◽  
Intramuscular Fat ◽  
Left Ventricular ◽  
Skeletal Muscle Atrophy ◽  
Measured Quantity ◽  
Ectopic Fat ◽  
Cox Regression Analysis ◽  
Kaplan Meier

Abstract Background Skeletal muscle atrophy is an independent prognostic predictor for patients with chronic heart failure, and the concept of sarcopenia is drawing attention. Furthermore, the importance of not only muscle mass but also intramuscular fat (IMF) has been pointed out. However, there is a lack of consensus on the implications of ectopic fat for the prognosis in patients with non-ischemic cardiomyopathy. Purpose We investigated whether ectopic fat in the thigh affects the prognosis with non-ischemic cardiomyopathy. Methods We recruited 105 patients who were diagnosed with non-ischemic cardiomyopathy by cardiac catheterization and echocardiographic date between September 2017 and November 2019. Finally 73 patients with reduced EF (EF 40% or less) enrolled in this prospective study. Functional status was evaluated by using cardiopulmonary exercise test at baseline. All patients were measured quantity of epicardial fat and thigh IMF percentage (%IMF) using computed tomography scan. Demographic, laboratory and echocardiographic date were collected from the patients' medical records. Clinical endpoints were unexpected readmission. Results During the follow-up period 18 patients had adverse events. The %IMF was significantly higher in the group with adverse events than without (5.57±5.70 and 3.02±2.44%, respectively; p&lt;0.01). Spearman correlation coefficient analysis showed a modest correlation between %IMF and lower limb extension strength (Spearman r=−0.280; p=0.0315), but there was no significant correlation between %IMF and exercise tolerance such as anaerobic threshold and peak oxygen uptake. Patients were divided into 2 groups according to the median values of %IMF. Kaplan-Meier analysis demonstrated that events were significantly higher in the high %IMF group (log-rank p=0.033). Multivariate Cox regression analysis adjusted for left ventricular end-diastolic diameter and peak ventricular oxygen consumption found %IMF as an independent factor of adverse events (hazard ratio 1.545; 95% confidential interval 1.151–2.087; p=0.004). Conclusions In non-ischemic cardiomyopathy patients with reduced EF, %IMF may have important adverse consequences such as increased cardiac-related events. Kaplan-Meier curves Funding Acknowledgement Type of funding source: None

scholarly journals Olaparib dose re‐escalation in ovarian cancer patients who experienced severe and/or uncommon adverse events: A case series

2021 ◽  
Vol 17 (S3) ◽  
pp. 3-11
Author(s):  
Siew‐Fei Ngu ◽  
Ka‐Yu Tse ◽  
Mandy M. Y. Chu ◽  
Hextan Y. S. Ngan ◽  
Karen K. L. Chan
Keyword(s):  
Ovarian Cancer ◽  
Adverse Events ◽  
Cancer Patients ◽  
Case Series

scholarly journals Ocular adverse events associated with immune checkpoint inhibitors: a novel multidisciplinary management algorithm

2021 ◽  
Vol 13 ◽  
pp. 175883592199298
Author(s):  
Orthi Shahzad ◽  
Nicola Thompson ◽  
Gerry Clare ◽  
Sarah Welsh ◽  
Erika Damato ◽  
...  
Keyword(s):  
Adverse Events ◽  
Checkpoint Inhibitors ◽  
Case Reports ◽  
Case Series ◽  
Simple Algorithm ◽  
Cancer Therapeutics ◽  
Management Algorithm ◽  
Ocular Symptoms ◽  
Systemic Corticosteroids ◽  
Permanent Loss

Ocular immune-related adverse events (IrAEs) associated with use of checkpoint inhibitors (CPIs) in cancer therapeutics are relatively rare, occurring in approximately 1% of treated patients. Recognition and early intervention are essential because the degree of tissue damage may be disproportionate to the symptoms, and lack of appropriate treatment risks permanent loss of vision. International guidelines on managing ocular IrAEs provide limited advice only. Importantly, local interventions can be effective and may avoid the need for systemic corticosteroids, thereby permitting the continuation of CPIs. We present a single institution case series of eight affected patients managed by our multidisciplinary team. Consistent with previously published series and case reports, we identified anterior uveitis as the most common ocular IrAE associated with CPIs requiring intervention. Based on our experience, as well as published guidance, we generated a simple algorithm to assist clinicians efficiently manage patients developing ocular symptoms during treatment with CPIs. In addition, we make recommendations for optimising treatment of uveitis and address implications for ongoing CPI therapy.

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