scholarly journals Clinicoradiographic predictors of progression of an intermediate hepatic lesion (LI-RADS 3) to hepatocellular carcinoma (LI-RADS 5)

2021 ◽  
Author(s):  
Lindsay M. Hannan ◽  
Patricia I. Ojeda ◽  
Rebecca J. Mieloszyk ◽  
William P. Harris ◽  
James O. Park ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Interval Censoring ◽  
Final Model ◽  
Risk Of Progression ◽  
History Of ◽  
Early Exploration ◽  
The Difference ◽  
The University ◽  
Univariate Analyses

Aim: We sought to identify predictors of progression of an indeterminate observation (LI-RADS 3) to hepatocellular carcinoma (LI-RADS 5). Methods: Imaging reports with LI-RADS (LR) assignments were identified among patients at the University of Washington, 2013-2017. Patients with an LR3 lesion and follow-up scan within 1 year of LR3 lesion date were included (n = 313). Features of interest were abstracted from chart review. Survival analyses employing interval censoring were performed, with variables potentially predictive of LR3 progression identified in univariate analyses. Backwards elimination (P < 0.05) was used to obtain the final multivariate model. Results: 20.4% of LR3 lesions progressed to LR5; 73% remained LR3, 8% LR4. The cohort was predominantly male (61%), Caucasian (54%), older than 55 (63%). 47% had a history of hepatitis C virus (HCV), 33% with alcohol abuse, not mutually exclusive. Alpha-fetoprotein (AFP) at the time of LR3 scan was low if available (39% with AFP < 5, 29% unknown). CT was the most common exam (56%). Men (HR = 2.0, P = 0.02), earlier scan year (HR = 0.47 per year, P < 0.0001), and older age (HR = 1.48, P = 0.03), appeared as predictors of LR progression in the final model. HCV and alcohol use were more common among men but did not appear to explain the difference in LR progression by sex. Conclusion: Our analysis is an early exploration of characteristics that may predict the risk of progression of an LR3 observation to hepatocellular carcinoma. Future efforts may allow for risk stratification to identify high-risk indeterminate lesions that may benefit from earlier intervention or more frequent surveillance.

The IPI Predicts Outcome in Patients with Diffuse Large B-Cell Lymphoma (DLBCL) Treated with Immunochemotherapy: A Report of the University of Iowa/Mayo Clinic SPORE

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1279-1279
Author(s):  
Thomas M. Habermann ◽  
B.K. Link ◽  
M.J. Maurer ◽  
J.E. Wooldridge ◽  
S.M. Geyer ◽  
...  
Keyword(s):  
Strong Predictor ◽  
Predictive Ability ◽  
B Cell Lymphoma ◽  
University Of Iowa ◽  
History Of ◽  
Observational Cohort ◽  
Factor Index ◽  
The Difference ◽  
The University

Abstract The International Prognostic Factor Index (IPI) predicts survival in DLBCL in patients treated with chemotherapy. The Revised IPI (R-IPI) has been reported to be a simpler and more accurate predictor of outcome in patients treated with immunochemotherapy (rituximab and anthracycline-based chemotherapy). We evaluated the predictive value of the IPI and the R-IPI in an observational cohort of unselected patients treated with R-CHOP. Consecutive, newly diagnosed patients age 18 years and older with DLBCL were prospectively offered enrollment into our Lymphoma SPORE Registry. Pathology was centrally reviewed, and composite lymphomas and history of concurrent or prior cancers were excluded. All patients were actively followed for progression free progression (PFS) and overall survival (OS). Here we report on patients enrolled from 9/2002 – 6/2006. 229 patients with a median age of 62 years (range 20–93) were evaluated. 56% were >60 years of age, 16% had a performance score ≥2, 54% had an elevated LDH, 19% had >1 extranodal site, and 51% were stage III/IV. During follow-up, there were 63 progressions (28%) and 45 deaths (20%), and the median follow-up time for living patients was 34 months (range 6–61 months). As shown in the table and figure, the IPI and R-IPI were predictive for both PFS and OS (all p<0.001). The predictive ability of the IPI as measured by 3-year concordance index was stronger for the IPI (0.71) compared to the R-IPI (0.67) and the bootstrap 95% confidence interval for the difference (0.01, 0.08) indicates that this difference was statistically significant. While all factors in the IPI were statistically significant (p<0.05) predictors of OS individually, when included in a multivariate model, an elevated LDH (HR=1.5; p = 0.32) and >1 extranodal sites (HR=1.0; p = 0.96) were no longer significant; similar results were obtained for PFS. The IPI remains a strong predictor of PFS and OS in the immunochemotherapy era. Figure Figure Group % Pats 3 Y PFS HR 95% CI 3 Y OS HR 95% CI Standard IPI Low (0,1) 41% 87% 1.0 ref 93% 1.0 ref Low-Int (2) 22% 62% 3.1 (1.4, 6.8) 74% 4.2 (1.6, 11.1) High-Int (3) 21% 60% 3.1 (1.4, 6.8) 77% 3.4 (1.2, 9.7) High (4,5) 15% 39% 7.2 (3.4, 15.2) 47% 10.2 (4.0, 26.5) R-IPI Very good (0) 11% 96% 1.0 ref 100% 1.0 ref Good (1,2) 53% 74% 6.2 (0.8, 46.0) 84% - - Poor (3–5) 36% 52% 13.5 (1.8, 98.9) 65% - -

Palliative Treatment of Hepatocellular Carcinoma with Transcatheter Arterial Embolization

1993 ◽  
Vol 34 (1) ◽  
pp. 26-29 ◽  
Author(s):  
S. Savastano ◽  
G. P. Feltrin ◽  
D. Neri ◽  
P. da Pian ◽  
M. Chiesura-Corona ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Transcatheter Arterial Embolization ◽  
Palliative Treatment ◽  
Arterial Embolization ◽  
Percutaneous Ethanol Injection ◽  
Ethanol Injection ◽  
History Of ◽  
The Mean ◽  
Hcc Recurrence

Thirty-three consecutive patients with previously untreated hepatocellular carcinoma (HCC) and 6 patients with recurrent HCC were treated with transcatheter arterial embolization (TAE). The patients were not eligible for surgical resection or percutaneous ethanol injection. TAE was performed with Lipiodol Ultra-Fluid, epidoxorubicin and Gelfoam, with a mean of 1.7 treatments per patient. CT was performed 15 days after TAE. The mean cumulative survival was 14.2 months in patients with previously untreated HCC. The survival of patients stages Okuda I and II did not differ significantly (p > 0.05); tumor size did not affect survival (p > 0.05). Two patients with recurrent HCC died 7.0 and 9.3 months after the diagnosis of tumor recurrence; the remaining 4 patients are still alive with a maximum follow-up of 22.5 months from the diagnosis of HCC recurrence. Ten complications occurred in 8 patients, and were controlled by medical therapy. Eleven patients died during the study; no death was related to TAE. The series was not randomized, but comparison with the natural history of HCC suggests that TAE is effective as palliative treatment of advanced or recurrent HCC.

scholarly journals Nonfatal Stroke and All-Cause Mortality among Community-Dwelling Older Adults Living in Rural Ecuador: A Population-Based, Prospective Study

2018 ◽  
Vol 09 (04) ◽  
pp. 551-555
Author(s):  
Oscar H. Del Brutto ◽  
Robertino M. Mera ◽  
Victor J. Del Brutto
Keyword(s):  
Older Adults ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Rural Setting ◽  
Nonfatal Stroke ◽  
All Cause Mortality ◽  
History Of ◽  
Univariate Analyses

ABSTRACT Background: Stroke is a leading cause of disability in developing countries. However, there are no studies assessing the impact of nonfatal strokes on mortality in rural areas of Latin America. Using a population-based, prospective cohort study, we aimed to assess the influence of nonfatal strokes on all-cause mortality in older adults living in an underserved rural setting. Methods: Deaths occurring during a 5-year period in Atahualpa residents aged ≥60 years were identified from overlapping sources. Tests for equality of survivor functions were used to estimate differences between observed and expected deaths for each covariate investigated. Cox proportional hazards models were used to estimate Kaplan–Meier survival curves of variables reaching significance in univariate analyses. Results: Of 437 individuals enrolled over 5 years, follow-up was achieved in 417 (95%), contributing 1776 years of follow-up (average 4.3 ± 1.3 years). Fifty-one deaths were detected, for an overall cumulative 5-year mortality rate of 12.2% (8.9%–15.6%). Being older than 70 years of age, having poor physical activity, edentulism, and history of a nonfatal stroke were related to mortality in univariate analyses. A fully adjusted Cox proportional hazards model showed that having history of a nonfatal stroke (P = 0.024) and being older than 70 years of age (P = 0.031) independently predicted mortality. In contrast, obesity was inversely correlated with mortality (P = 0.047). Conclusions: A nonfatal stroke and increasing age increase the risk of all-cause mortality in inhabitants of a remote rural village. The body mass index is inversely related to death (obesity paradox).

Single Centre Experience in Patients with Primary Hyperparathyroidism: Sporadic, Lithium-associated and in Multiple Endocrine Neoplasia

2019 ◽  
Vol 128 (10) ◽  
pp. 693-698
Author(s):  
Sabine Dillenberger ◽  
Detlef K. Bartsch ◽  
Elisabeth Maurer ◽  
Peter Herbert Kann
Keyword(s):  
Primary Hyperparathyroidism ◽  
Multiple Endocrine Neoplasia ◽  
University Hospital ◽  
Primary Surgery ◽  
Endocrine Neoplasia ◽  
Single Centre Experience ◽  
Significant Difference ◽  
History Of ◽  
The University

Abstract Purpose It is assumed that primary hyperparathyroidism (pHPT) in Multiple Endocrine Neoplasia (MEN) and lithium-associated pHPT (LIHPT) are associated with multiple gland disease (MGD), persistence and recurrence. The studies purpose was to determine frequencies, clinical presentation and outcome of sporadic pHPT (spHPT), LIHPT and pHPT in MEN. Additional main outcome measures were the rates of MGD and persistence/recurrence. Methods Retrospective analysis of medical records of 682 patients with pHPT who had attended the University Hospital of Marburg between 01–01–2004 and 30–06–2013. All patients were sent a questionnaire asking about their history of lithium medication. Results Out of 682 patients, 557 underwent primary surgery (532 spHPT, 5 LIHPT, 20 MEN), 38 redo-surgery (31 spHPT, 7 MEN), 55 were in follow-up due to previous surgery (16 spHPT, 1 LIHPT, 38 MEN) and 37 were not operated (33 spHPT, 1 LIHPT, 3 MEN). Primary surgeries were successful in 97.4%, revealed singular adenomas in 92.4%, double adenomas in 2.9% and MGD in 3.4% of the cases. Rates of MGD in MEN1 (82.35%) were significantly higher than in spHPT (3.8%), while there was no significant difference between LIHPT (20%) and spHPT. Rates of persistence/recurrence did not significantly differ due to type of surgery (bilateral/unilateral) or type of HPT (spHPT/LIHPT/MEN). Conclusions History of lithium medication is rare among pHPT patients. While MGD is common in MEN1, rates of MGD, persistence or recurrence in LIHPT were not significantly higher than in spHPT.

Incidence and prognosis of patients with spinal metastasis as the initial manifestation of malignancy

2019 ◽  
Vol 101-B (11) ◽  
pp. 1379-1384 ◽  
Author(s):  
Jin-Sung Park ◽  
Se-Jun Park ◽  
Chong-Suh Lee
Keyword(s):  
Surgical Treatment ◽  
Spinal Metastasis ◽  
Spinal Disease ◽  
Primary Malignancy ◽  
Initial Manifestation ◽  
Kaplan Meier ◽  
History Of ◽  
The Mean ◽  
The Difference

Aims This study aimed to evaluate the incidence and prognosis of patients with spinal metastasis as the initial manifestation of malignancy (SM-IMM). Patients and Methods We retrospectively reviewed the electronic medical records of 338 patients who underwent surgical treatment for metastatic spinal disease. The enrolled patients were divided into two groups. The SM-IMM group included patients with no history of malignancy whose site of primary malignancy was diagnosed after the identification of spinal metastasis. The other group included patients with a history of treatment for primary malignancy who then developed spinal metastasis (SM-DTM). The incidence of SM-IMM by site of primary malignancy was calculated. The difference between prognoses after surgical treatment for SM-IMM and SM-DTM was established. Results The median follow-up period was 11.5 months (interquartile range (IQR) 3.2 to 13.4) after surgical treatment. During the follow-up period, 264 patients died; 74 patients survived. The SM-IMM group consisted of 94 patients (27.8%). The site of primary malignancy in the SM-IMM group was lung in 35/103 patients (34.0%), liver in 8/45 patients (17.8%), kidney in 10/33 patients (30.3%), colorectum in 3/29 patients (10.3%), breast in 3/22 patients (13.6%), prostate in 3/10 patients (30%), thyroid in 4/8 patients (50%), and ‘other’ in 28/88 patients (31.8%). On Kaplan–Meier survival analysis, the SM-IMM group showed a significantly longer survival than the SM-DTM group (p = 0.013). The mean survival time was 23.0 months (95% confidence interval (CI) 15.5 to 30.5) in the SM-IMM group and 15.5 months (95% CI 11.8 to 19.2) in the SM-DTM group. Conclusion Of the 338 enrolled patients who underwent surgical treatment for spinal metastasis, 94 patients (27.8%) underwent surgical treatment for SM-IMM. The SM-IMM group had an acceptable prognosis with surgical treatment. Cite this article: Bone Joint J 2019;101-B:1379–1384.

scholarly journals RADI-24. VENTRICULOMEGALY AFTER STEREOTACTIC RADIOSURGERY (SRS) FOR BRAIN METASTASES (BM): A PILOT ANALYSIS OF TWO INSTITUTIONAL EXPERIENCES

2019 ◽  
Vol 1 (Supplement_1) ◽  
pp. i26-i26
Author(s):  
Ali Alattar ◽  
Jiri Bartek ◽  
Brian HIrshman ◽  
Clark Chen
Keyword(s):  
Stereotactic Radiosurgery ◽  
Cerebral Atrophy ◽  
White Matter Injury ◽  
Whole Brain Radiation ◽  
History Of ◽  
Radiation Induced ◽  
A Prospective Study ◽  
The University ◽  
Brain Radiation

Abstract INTRODUCTION: Ventriculomegaly, or dilatation of the cerebrospinal fluid (CSF) space, occurs after whole-brain radiation (WBRT) of brain metastasis (BM) patients due to either 1) hydrocephalus or 2) cerebral atrophy from radiation-induced white matter injury. In this study, we examined whether cumulative radiation from repeat stereotactic radiosurgery (SRS) increases the risk of ventriculomegaly. METHODS: Patients were included if they underwent SRS of BM from 2007–2017 and had imaging follow-up. We examined a cohort of 214 patients treated at the University of California San Diego (1,106 BM) and a second cohort of 148 patients (1,760 BM) treated at Karolinska Institutet. Ventriculomegaly was defined according to established morphometric criteria. Patients were grouped according to the development of new ventriculomegaly at last follow-up. Demographic, clinical, and dosimetric factors were compared between groups using univariable and multivariable logistic regressions. RESULTS: In the UCSD cohort, 63 patients (29%) presented with ventriculomegaly before SRS. Of 151 remaining patients with normal ventricular size before first SRS, 30 (20%) developed new ventriculomegaly. The odds of developing ventriculomegaly increased with history of WBRT (OR 5.247, p&lt; 0.001) and trended toward significance with a greater number of SRS treatments (OR 1.296, p=0.075). In the Karolinska cohort, the odds of developing new ventriculomegaly trended towards significance with a greater number of SRS treatments (OR 1.605, p=0.26). To test whether this trend would achieve significance in a larger sample, we repeated the analysis in the combined cohort of 362 patients. The association between number of SRS treatments and developing ventriculomegaly reached significance (OR 1.254, p=0.049). CONCLUSIONS: These pilot findings suggest that cumulative radiation from repeat stereotactic radiosurgery (SRS) potentially increases the risk of ventriculomegaly. Based on our study, a prospective study of &gt;350 patients will be needed to further test this hypothesis.

Natural History of 656 Patients with Non IgM MGUS.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4860-4860
Author(s):  
Carolina Nobile ◽  
Maria T. Petrucci ◽  
Francesco Bartolozzi ◽  
Anna Levi ◽  
Marianna De Muro ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Natural History ◽  
Clinical History ◽  
Cumulative Probability ◽  
Rapid Progression ◽  
Female Ratio ◽  
Predictive Parameters ◽  
Risk Of Progression ◽  
History Of

Abstract A monoclonal gammopathy of undetermined significance (MGUS) occurs in about 1% of the population over 50 years of age. Of these, about 20% evolves in Multiple Myeloma (MM); however, so far, predictive parameters of progression have not yet been identified.The aim of this study was to analyse the natural history of a cohort of non IgM MGUS and to identify whether or not there were laboratory parameters at diagnosis which can be utilized as prognostic markers of stable MGUS or progression to MM. From February 1974 to July 2001, 656 non IgM MGUS, whose clinical history was concluded (lost to follow up or died), have been followed at the Hematology of the University “La Sapienza” in Rome. The duration of follow up ranged from 2 months to 324 months, male/female ratio was 1.14, median age was 65 years (range 19–92). In each patient we evaluated: hemoglobin, platelet count, serum protein electrophoresis, serum concentration of monoclonal protein, serum calcium, creatinine, uric acid, BUN and percentage of bone marrow plasma cells.A monoclonal component (MC) of IgG type was documented in 543 patients (83%) while in 106 (16%) it was of IgA type, 6 patients had biclonal MC and 1 had a λ light chain MC; BJ proteinuria was detected in 78 (11%) patients at diagnosis. After a median follow up of 60.1 months (range 2–324) the MC remained stable in 496 patients (75%), whereas in 160 cases (25%) increased to evolve in MM. According to the literature, cumulative probability of progression to MM was 3%, 7% and 17% at 5, 10 and 15 years respectively. Differently from what observed by other investigators, in this cohort of pts, the MGUS of IgA type was not associated with a higher risk of progression to MM. The median time of progression to MM was 60.7 months (range 3–256) and factors associated with a more rapid progression to MM were advanced age and a higher number of bone marrow plasmacells. At diagnosis of MM, the concentration of the serum MC was significantly higher (P<0.003) in patients who evolved from MGUS than in those with a newly diagnosed MM. None of the studied parameters at diagnosis of MGUS were predictive of evolution to MM even though, levels of MC <2.4 g/dl and bone marrow plasmacell infiltration <9% indicated a slower progression to overt MM.

A multicenter nonrandomized controlled trial to evaluate the efficacy of surgery versus radiofrequency ablation for small hepatocellular carcinoma (SURF cohort trial).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 4581-4581
Author(s):  
Ryosuke Tateishi ◽  
Kiyoshi Hasegawa ◽  
Yoshikuni Kawaguchi ◽  
Tadatoshi Takayama ◽  
Namiki Izumi ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiofrequency Ablation ◽  
Early Stage ◽  
Controlled Trial ◽  
Patient Characteristics ◽  
Small Hepatocellular Carcinoma ◽  
Multicenter Randomized Controlled Trial ◽  
Early Hcc ◽  
The Difference

4581 Background: In parallel with a multicenter randomized controlled trial that reported an equal recurrence-free survival (RFS) of early-stage hepatocellular carcinoma (HCC) patients who underwent either surgery (SUR) or radiofrequency ablation (RFA), we also enrolled HCC patients who fulfilled the enrollment criteria but did not give consent to participate in the RCT. Methods: All patients gave informed consent to participate in this study. Inclusion criteria were as follows: primary HCC with less than or equal to 3 tumors, each measuring 3 cm or smaller; without vascular invasion or extrahepatic metastasis; Child-Pugh score of 7 or less; and ages between 20 and 79 years. The feasibility for both treatments was confirmed by a joint chart review by surgeons and hepatologists. The primary endpoint was RFS and overall survival. A pre-specified interim analysis was performed to compare RFS. Results: Between April 2009 and August 2015, 740 patients (371 in SUR, 369 in RFA) were enrolled from 49 participating hospitals in Japan. The SUR group had significantly fewer patients with chronic hepatitis C (56.6% vs. 69.4%), higher median value of platelet count (145 vs. 120 × 109/L), and more patients with > 2 cm tumors (49.9% vs. 27.9%); most patients had a single tumor (91.1% vs. 88.3%). During the median follow-up period of 5 years, tumor recurrence was observed in 192 of SUR and 218 of RFA with 3-year RFS being 66.0% and 61.7%, respectively ( P = 0.091). In subgroup analysis, RFS was significantly better in SUR in patients with ≤ 2 cm tumors (62.9% vs. 51.7% in 3 years; hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.56-0.93; P = 0.014), whereas the difference was not significant in those with > 2 cm tumors (52.7% vs. 46.4%; HR 0.85, 95% CI 0.63-1.18; P = 0.34). The adjusted HR for RFS using inversed probability of treatment weighting was 0.89 (95% CI, 0.72-1.10; P = 0.287). Conclusions: The imbalance in patient characteristics reflected a real-world practice. Factors related to background liver disease rather than tumor characteristics might have a larger impact on the recurrence in early HCC. Clinical trial information: C000001796 .

Teaching the History of Technical Communication: A Lesson with Franklin and Hoover

2003 ◽  
Vol 33 (1) ◽  
pp. 65-81 ◽  
Author(s):  
Jeff Todd
Keyword(s):  
Technical Communication ◽  
English Language ◽  
Industrial Revolution ◽  
Technical Writing ◽  
Benjamin Franklin ◽  
Teaching History ◽  
Before And After ◽  
History Of ◽  
The Difference ◽  
The University

The first part of this article shows that research in the history of technical communication has increased in quantity and sophistication over the last 20 years. Scholarship that describes how to teach with that information, however, has not followed, even though teaching the history of the field is a need recognized by several scholars. The article provides and defends four guidelines as a foundation to study ways to incorporate history into classroom lessons: 1) maintain a continued research interest in teaching history; 2) limit to technical rather than scientific discourse; 3) focus on English-language texts; and 4) focus on American texts, authors, and practices. The second part of the essay works within the guidelines to show a lesson that contrasts technical texts by Benjamin Franklin and Herbert Hoover. The lesson can help students see the difference in technical writing before and after the Industrial Revolution, a difference that mirrors their own transition from the university to the workforce.

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