scholarly journals A predictive model for calculating the likelihood of recurrent uterine fibroids after surgical intervention

2021 ◽  
Vol 6 (3) ◽  
pp. 64-70
Author(s):  
V. B. Tskhay ◽  
S. Zh. Badmaeva ◽  
A. N. Narkevich ◽  
I. I. Tskhay ◽  
A. V. Mikhaylova
Keyword(s):  
Predictive Model ◽  
Surgical Intervention ◽  
Classification Tree ◽  
Uterine Fibroids ◽  
Vegf Expression ◽  
Ki 67 ◽  
History Of ◽  
Weak Expression ◽  
Fibroid Growth ◽  
Significant Factors

Aim. To develop a predictive model for calculating the likelihood of recurrent uterine fibroids after myomectomy.Materials and Methods. We consecutively recruited 149 women aged 19 to 45 years who underwent myomectomy. Prediction of uterine fibroids was carried out using multivariate analysis including a classification tree (IBM SPSS Statistics). To construct a classification tree for predicting recurrent uterine fibroids, the following patient-related parameters were used as the input features: age, family history, nulliparity, past medical history of myomectomy, obesity, rapid fibroid growth, multiple fibroids at myomectomy, BCL-2, Ki-67, and VEGF expression.Results. When analyzing the resulting classification tree, we can conclude that the most significant factors defining the recurrence of uterine fibroids are low parity, multiple fibroids at myomectomy, intensive VEGF expression, and weak expression of BCL-2.Conclusion. Our original model allows the identification of the most significant predictors of recurrent uterine fibroids and might be proposed as a useful tool for clinical practice.

History of uterine fibroids reported by California women

2008 ◽  
Author(s):  
Zipora Weinbaum ◽  
Terri Throfinnson
Keyword(s):  
Uterine Fibroids ◽  
History Of

scholarly journals Mixed neuroendocrine–non-neuroendocrine neoplasms of the gallbladder: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Tatsuki Ishikawa ◽  
Katsunori Nakano ◽  
Masafumi Osaka ◽  
Kenichi Aratani ◽  
Kadotani Yayoi ◽  
...  
Keyword(s):  
System Analysis ◽  
Cancer Control ◽  
Staging System ◽  
Neuroendocrine Neoplasms ◽  
Ki 67 ◽  
Regional Lymph Nodes ◽  
Abdominal Ultrasonography ◽  
Case Presentation ◽  
History Of ◽  
Lymph Nodes Dissection

Abstract Background  Primary neuroendocrine tumors of the gallbladder (GB-NETs) are rare, accounting for 0.5% of all NETs and 2.1% of all gallbladder cancers. Among GB-NETs, mixed neuroendocrine–non-neuroendocrine neoplasms of the gallbladder (GB-MiNENs) are extremely rare. Case presentation We present the case of a 66-year-old woman who was referred to us for the management of a gallbladder tumor (incidentally found during abdominal ultrasonography indicated for gallbladder stones). The patient had no history of abdominal pain or fever, and the findings on a physical examination were unremarkable. Blood tests showed normal levels of tumor markers. Imaging studies revealed a mass of approximately 10 mm in diameter (with no invasion of the gallbladder bed) located at the fundus of the gallbladder. A gallbladder cancer was suspected. Therefore, an open whole-layer cholecystectomy with regional lymph nodes dissection was performed. The postoperative course was uneventful, and she was discharged on postoperative day 6. Pathological findings showed GB-MiNENs with invasion of the subserosal layer and no lymph node invasion (classified T2aN0M0 pStage IIA according to the Union for International Cancer Control, 8th edition staging system). Analysis of the neuroendocrine markers revealed positive chromogranin A and synaptophysin, and a Ki-67 index above 95%. Fourteen months after the operation, a local recurrence was detected, and she was referred to another hospital for chemotherapy. Conclusions  GB-MiNENs are extremely aggressive tumors despite their tumor size. Optimal therapy should be chosen for each patient.

scholarly journals Association between severity of prenatally diagnosed hydronephrosis and receipt of surgical intervention postnatally among patients seen at a fetal-maternal center

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zoë G. Baker ◽  
Arthi Hannallah ◽  
Melissa Trabold ◽  
Danielle Estell ◽  
Cherry Deng ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Renal Scarring ◽  
Tertiary Care ◽  
Rank Test ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
Age At Surgery ◽  
History Of ◽  
Pediatric Urologist ◽  
Tract Infections

Abstract Background Hydronephrosis (HN) is the most common abnormality detected on prenatal ultrasound. This study sought to stratify outcomes of patients by severity of prenatal HN with postnatal outcomes. Methods This was a retrospective review of patients referred to a tertiary care fetal-maternal clinic with diagnosis of prenatal HN from 2004 to 2019. HN severity was categorized as mild, moderate, or severe. Data were analyzed to determine the association between HN severity and surgical intervention. Decision for surgery was based on factors including history of multiple urinary tract infections, evidence of renal scarring, and/or reduced renal function. Surgery-free survival time was represented by the Kaplan–Meier method, and hazard ratios were calculated using the log-rank test. Results 131 kidneys among 101 infants were prenatally diagnosed with hydronephrosis; 35.9% had mild HN, 29.0% had moderate HN, and 35.1% had severe HN. 8.5% of patients with mild HN, 26.3% of patients with moderate HN, and 65.2% of patients with severe HN required surgery. Patients with severe HN were 12.2 (95% CI 6.1–24.4; p < 0.001) times more likely to undergo surgery for HN than patients with mild HN and 2.9 (95% CI 1.5–5.3; p = 0.003) times more likely to undergo surgery than patients with moderate HN. Patients with moderate HN were 4.3 times more likely to require surgery than patients with mild HN (95% CI 1.5–12.9; p = 0.01). Median age at surgery was 11.8 months among patients with mild HN (IQR 11.7–14.1 months), 6.6 months among patients with moderate HN (IQR 4.2–16.4 months), and 5.4 months among patients with severe HN (3.7–12.4 months). Conclusion Among this cohort of referrals from a fetal-maternal clinic, severity of HN correlated with increased likelihood of surgical intervention. Continued assessment of patients with prenatal HN should be evaluated to best determine the role of the pediatric urologist in cases of prenatal HN.

scholarly journals An analysis from the Quality Outcomes Database, Part 1. Disability, quality of life, and pain outcomes following lumbar spine surgery: predicting likely individual patient outcomes for shared decision-making

2017 ◽  
Vol 27 (4) ◽  
pp. 357-369 ◽  
Author(s):  
Matthew J. McGirt ◽  
Mohamad Bydon ◽  
Kristin R. Archer ◽  
Clinton J. Devin ◽  
Silky Chotai ◽  
...  
Keyword(s):  
Decision Making ◽  
Lumbar Spine ◽  
Predictive Model ◽  
Spine Surgery ◽  
Smoking Status ◽  
Lumbar Spine Surgery ◽  
Symptom Duration ◽  
Quality Outcomes ◽  
Pain Outcomes ◽  
History Of

OBJECTIVEQuality and outcomes registry platforms lie at the center of many emerging evidence-driven reform models. Specifically, clinical registry data are progressively informing health care decision-making. In this analysis, the authors used data from a national prospective outcomes registry (the Quality Outcomes Database) to develop a predictive model for 12-month postoperative pain, disability, and quality of life (QOL) in patients undergoing elective lumbar spine surgery.METHODSIncluded in this analysis were 7618 patients who had completed 12 months of follow-up. The authors prospectively assessed baseline and 12-month patient-reported outcomes (PROs) via telephone interviews. The PROs assessed were those ascertained using the Oswestry Disability Index (ODI), EQ-5D, and numeric rating scale (NRS) for back pain (BP) and leg pain (LP). Variables analyzed for the predictive model included age, gender, body mass index, race, education level, history of prior surgery, smoking status, comorbid conditions, American Society of Anesthesiologists (ASA) score, symptom duration, indication for surgery, number of levels surgically treated, history of fusion surgery, surgical approach, receipt of workers’ compensation, liability insurance, insurance status, and ambulatory ability. To create a predictive model, each 12-month PRO was treated as an ordinal dependent variable and a separate proportional-odds ordinal logistic regression model was fitted for each PRO.RESULTSThere was a significant improvement in all PROs (p < 0.0001) at 12 months following lumbar spine surgery. The most important predictors of overall disability, QOL, and pain outcomes following lumbar spine surgery were employment status, baseline NRS-BP scores, psychological distress, baseline ODI scores, level of education, workers’ compensation status, symptom duration, race, baseline NRS-LP scores, ASA score, age, predominant symptom, smoking status, and insurance status. The prediction discrimination of the 4 separate novel predictive models was good, with a c-index of 0.69 for ODI, 0.69 for EQ-5D, 0.67 for NRS-BP, and 0.64 for NRS-LP (i.e., good concordance between predicted outcomes and observed outcomes).CONCLUSIONSThis study found that preoperative patient-specific factors derived from a prospective national outcomes registry significantly influence PRO measures of treatment effectiveness at 12 months after lumbar surgery. Novel predictive models constructed with these data hold the potential to improve surgical effectiveness and the overall value of spine surgery by optimizing patient selection and identifying important modifiable factors before a surgery even takes place. Furthermore, these models can advance patient-focused care when used as shared decision-making tools during preoperative patient counseling.

Pigmentary Glaucoma After Cataract Surgery with Single-Piece Hydrophobic Intraocular Lens Implanted into the Ciliary Sulcus: Case Report

2021 ◽  
Vol 5 (1) ◽  
Keyword(s):  
Intraocular Pressure ◽  
Intraocular Lens ◽  
Corneal Endothelium ◽  
Surgical Intervention ◽  
Posterior Segment ◽  
The Other ◽  
Pigmentary Glaucoma ◽  
Single Piece ◽  
History Of ◽  
Capsular Bag

A 59 years old man presented with a history of phacoemulsification with an hydrophobic intraocular lens implant in his left eye 4 years ago. The biomicroscopy revealed pigments in the corneal endothelium (Krukenberg’s spindle), peripheral transillumination of the iris and intraocular pressure of 52 mmHg in the left eye. Gonioscopy revealed hyperpigmentation of the posterior trabeculate. Posterior segment examination and visual field revealed a cup/disc 0.9 with significant field damage in strategy 10-2. Biomicroscopic ultrasonography showed asymmetric implantation of the IOL loops in the left eye (one loop in the ciliary sulcus and the other in the capsular bag). He underwent antiglaucomatous treatment with adequate control of intraocular pressure, with no need for surgical intervention.

Abstract TP417: An Autoregulation-Derived Prediction Model for Midline Shift After Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Andrew Silverman ◽  
Anson Wang ◽  
Sreeja Kodali ◽  
Sumita Strander ◽  
Alexandra Kimmel ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Predictive Model ◽  
Infarct Volume ◽  
Classification Tree ◽  
Brain Mri ◽  
Projection Pursuit ◽  
Midline Shift ◽  
Vessel Occlusion ◽  
Patient Disposition ◽  
Hemodynamic Variables

Introduction: Identification of patients likely to develop midline shift (MLS) after large-vessel occlusion (LVO) stroke is essential for appropriate triage and patient disposition. Studies have identified clinical and radiographic predictors of MLS, but with limited accuracy. Using an innovative assessment of cerebral autoregulation, we sought to develop an accurate predictive model for MLS. Methods: We prospectively enrolled 73 patients with LVO stroke. Beat-by-beat cerebral blood flow (transcranial Doppler) and arterial pressure (arterial catheter or finger photoplethysmography) were recorded within 24 hours of the stroke, and a 24-hour brain MRI was obtained to determine infarct volume and MLS. Autoregulatory function was quantified from pressure-flow relation via projection pursuit regression (PPR), allowing for characterization of 5 hemodynamic markers (Figure 1A). We assessed the predictive relation of autoregulatory capacity and radiological and clinical variables to MLS using recursive classification tree models. Results: PPR successfully quantified autoregulatory function in 50/73 (68.5%) patients within 24 hours of LVO ischemic stroke (age 63.9±13.6, 66% F, NIHSS 15.8±6.7). Of these 50 patients, most (78%) underwent endovascular therapy. Thirteen (26%) experienced 24-h MLS; in these patients, infarct volumes were larger (140.2 vs. 48.6 mL, P<0.001 ), and ipsilateral (but not contralateral) falling slopes were steeper (1.1 vs. 0.7 cm·s -1 ·mmHg -1 , P=0.001 ). Among all clinical, demographic, and hemodynamic variables, only two (infarct volume, ipsilateral falling slope) significantly contributed to prediction of MLS (accuracy 94%; Figure 1B). Conclusions: This predictive model of MLS wields translatable potential for triaging level of care in patients suffering from LVO ischemic stroke, but further research, including optimization of the PPR algorithm as well as prospective use of the predictive model, is needed.

scholarly journals Metastatic adrenal pheochromocytoma to the thoracic spine

2010 ◽  
Vol 9 (3) ◽  
pp. 343-346 ◽  
Author(s):  
Michael T. Scalfani ◽  
Paul M. Arnold ◽  
Karen K. Anderson
Keyword(s):  
Differential Diagnosis ◽  
Surgical Intervention ◽  
Hepatic Metastases ◽  
Posterior Fixation ◽  
Original Diagnosis ◽  
Average Survival ◽  
Progression Of Disease ◽  
Adrenal Pheochromocytoma ◽  
History Of ◽  
Work Up

To report on a case of pheochromocytoma metastases to the spine occurring more than 20 years after initial diagnosis. A 34-year-old female with a history of metastatic pheochromocytoma diagnosed at age 12 presented with weakness, heart palpitations, and circumferential back pain of five months duration. The patient had undergone multiple laparatomies for abdominal and hepatic metastases. Work-up revealed a destructive lesion at T9. After two weeks of preoperative phenoxybenzamine to control her hypertension, she underwent decompression, posterior fixation and fusion. Surgical intervention was followed by radiation therapy, zoledronic acid, and only one cycle of chemotherapy due to intolerance of side effects. The patient survived 25 years after original diagnosis, which far exceeds the average survival of less than 15 years. The patient died 26 months postoperatively due to progression of disease. Pheochromocytoma with spine metastases occurring more than 20 years after diagnosis is very uncommon, and should be considered in the differential diagnosis of a patient with a history of pheochromocytoma.

scholarly journals Community-Acquired MRSA Pyomyositis: Case Report and Review of the Literature

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Douglas P. Olson ◽  
Sarita Soares ◽  
Sandhya V. Kanade
Keyword(s):  
Epidural Abscess ◽  
Surgical Intervention ◽  
Cauda Equina ◽  
Spinal Epidural Abscess ◽  
Paraspinal Muscles ◽  
Sensory Deficits ◽  
Antibiotic Management ◽  
History Of ◽  
Spinal Epidural ◽  
Repeat Imaging

Community-acquired methicillin-resistantStaphylococcus aureus(CA-MRSA) is responsible for a broad range of infections. We report the case of a 46-year-old gentleman with a history of untreated, uncomplicated Hepatitis C who presented with a 2-month history of back pain and was found to have abscesses in his psoas and right paraspinal muscles with subsequent lumbar spine osteomyelitis. Despite drainage and appropriate antibiotic management the patient's clinical condition deteriorated and he developed new upper extremity weakness and sensory deficits on physical exam. Repeat imaging showed new, severe compression of the spinal cord and cauda equina from C1 to the sacrum by a spinal epidural abscess. After surgical intervention and continued medical therapy, the patient recovered completely. This case illustrates a case of CA-MRSA pyomyositis that progressed to lumbar osteomyelitis and a spinal epidural abscess extending the entire length of the spinal canal.

Predictive Models for Post-operative Nausea and Vomiting in Patients Using Patient-controlled Analgesia

2007 ◽  
Vol 35 (4) ◽  
pp. 497-507 ◽  
Author(s):  
YY Lee ◽  
KH Kim ◽  
YH Yom
Keyword(s):  
Predictive Model ◽  
Oral Fluid ◽  
Individual Characteristics ◽  
Nausea And Vomiting ◽  
Patient Controlled Analgesia ◽  
Related Data ◽  
Post Operative Pain ◽  
Post Operation ◽  
History Of ◽  
Post Operative Nausea

This study identified predictive factors for post-operative nausea and vomiting (PONV) in patients using patient-controlled analgesia (PCA) and developed five predictive model pathways to calculate the probability of PONV using decision tree analysis. The sample consisted of 1181 patients using PCA. Data were collected using: a specifically designed check-off form to collect patient-, surgery-, anaesthesia- and post-operation-related data; the Beck Anxiety Inventory® to measure pre-operative anxiety; and a visual analogue scale, to measure post-operative pain. The incidence of PONV was 27.7%. Nine factors were highly predictive of PONV in our five model pathways: gender, obesity, anxiety, history of previous PONV, history of motion sickness, inhalation of nitrous oxide during operation, use of inhalational agents, starting oral fluid/food intake after operation, and post-operative pain. With these five predictive model pathways, we can predict the probability of PONV in an individual patient according to their individual characteristics.

Sign in / Sign up

Export Citation Format

Share Document