Early postoperative measurement of growth hormone level for prognosis of surgical outcomes in acromegaly

Aim.To investigate the value of 24 hours post-surgery measurement of growth hormone (GH) level for prognosis of surgical outcomes in acromegaly. Materials and methods.A prospective cohort study included 45 patients with newly diagnosed acromegaly. The degree of parasellar extension was measured on the preoperative sellar magnetic resonance imaging according to the Knosps classification. All patients underwent a transsphenoid adenomectomy performed by one neurosurgeon. Basal GH level was measured at 24 hours after surgery. The efficacy of transsphenoidal adenomectomy evaluated at 12 months after surgery. Results.Acromegaly remission was achieved in 19 (42%) of 45 patients at 12 months after surgery. Pituitary microadenomas and the absence of paracellular invasion, corresponding to Knosp Grade 02, had low prognostic value for long-term remission due to low sensitivity (31.6%) and low specificity (38.5%), respectively. The highest prognostic value for acromegaly remission was showed for 24 hours post-surgery GH level with cut-off 1.30 ng/ml with sensitivity of 96.2% (95% confidence interval 81.199.8%) and specificity of 84.2% (95% confidence interval 62.494.4%). Conclusion.The study demonstrated the possibility of using GH level at 24 after surgery as a predictor for acromegaly remission. GH level 1.30 ng/ml at 24 hours after surgery showed better predictive value for long-term remission compared with the presence of microadenomas and Knosp Grade 02. The absence of decrease of GH level on the first day after surgery may serve as a reason for more close monitoring of patients in the postoperative period. Further studies in a larger number of observers are required to confirm our findings.

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Blood Pressure Variability, Mortality, and Cardiovascular Outcomes in CKD Patients

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.04030318 ◽

2019 ◽

Vol 14 (2) ◽

pp. 233-240 ◽

Cited By ~ 11

Author(s):

Francesca Mallamaci ◽

Giovanni Tripepi ◽

Graziella D’Arrigo ◽

Silvio Borrelli ◽

Carlo Garofalo ◽

...

Keyword(s):

Confidence Interval ◽

Cardiovascular Events ◽

Prognostic Value ◽

Clinic Visit ◽

Hazard Ratio ◽

Interquartile Range ◽

Short Term ◽

End Point

Background and objectivesShort-term BP variability (derived from 24-hour ambulatory BP monitoring) and long-term BP variability (from clinic visit to clinic visit) are directly related to risk for cardiovascular events, but these relationships have been scarcely investigated in patients with CKD, and their prognostic value in this population is unknown.Design, setting, participants, & measurementsIn a cohort of 402 patients with CKD, we assessed associations of short- and long-term systolic BP variability with a composite end point of death or cardiovascular event. Variability was defined as the standard deviation of observed BP measurements. We further tested the prognostic value of these parameters for risk discrimination and reclassification.ResultsMean ± SD short-term systolic BP variability was 12.6±3.3 mm Hg, and mean ± SD long-term systolic BP variability was 12.7±5.1 mm Hg. For short-term BP variability, 125 participants experienced the composite end point over a median follow-up of 4.8 years (interquartile range, 2.3–8.6 years). For long-term BP variability, 110 participants experienced the composite end point over a median follow-up of 3.2 years (interquartile range, 1.0–7.5 years). In adjusted analyses, long-term BP variability was significantly associated with the composite end point (hazard ratio, 1.24; 95% confidence interval, 1.01 to 1.51 per 5-mm Hg higher SD of office systolic BP), but short-term systolic BP variability was not (hazard ratio, 0.92; 95% confidence interval, 0.68 to 1.25 per 5-mm Hg higher SD of 24-hour ambulatory systolic BP). Neither estimate of BP variability improved risk discrimination or reclassification compared with a simple risk prediction model.ConclusionsIn patients with CKD, long-term but not short-term systolic BP variability is related to the risk of death and cardiovascular events. However, BP variability has a limited role for prediction in CKD.

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Transsphenoidal adenomectomy for growth hormone-secreting pituitary adenomas in acromegaly: outcome analysis and determinants of failure

Journal of Neurosurgery ◽

10.3171/jns.1993.78.2.0205 ◽

1993 ◽

Vol 78 (2) ◽

pp. 205-215 ◽

Cited By ~ 83

Author(s):

George T. Tindall ◽

Nelson M. Oyesiku ◽

Nelson B. Watts ◽

Richard V. Clark ◽

James H. Christy ◽

...

Keyword(s):

Growth Hormone ◽

Tumor Grade ◽

Tumor Stage ◽

Outcome Analysis ◽

Content Type ◽

Transsphenoidal Adenomectomy ◽

Postoperative Serum ◽

Surgical Failure ◽

Fine Print

✓ The results of transsphenoidal adenomectomy for growth hormone (GH)-secreting pituitary adenomas in acromegaly performed over a 17-year period were analyzed retrospectively to determine which preoperative factors significantly influenced the long-term surgical outcome. These variables were then used to develop a logistic regression model to determine the probability of surgical failure. The series consisted of 103 patients. Long-term follow-up study (mean duration 102 ± 64 months) was performed to derive outcome analysis and determinants of failure. Surgical control was defined as a long-term postoperative serum basal GH level of less than 5 µg/liter, a long-term postoperative serum somatomedin C (SM-C) level of less than 2.2 U/ml, and a favorable clinical response. Eighteen (17.5%) patients did not meet these criteria. The overall control rate by the GH criteria was 81.3% and by the SM-C criteria 76.2%. By multivariate logistic regression analysis, tumor stage was the strongest predictor of outcome (p < 0.05). The preoperative GH level, tumor grade, and preoperative SM-C level were significant univariate predictors (p < 0.05). There were statistically significant differences in mean preoperative GH and SM-C levels (p < 0.05, t-test) and tumor stage (p < 0.05, chi-squared test) between patients whose acromegaly was controlled by surgery and those whose acromegaly was not. Furthermore, estimates were derived of the probability of surgical failure based on preoperative GH level, preoperative SM-C level, and tumor grade and stage. The authors believe these findings will enhance clinical decision-making for neurosurgeons considering transsphenoidal microsurgery in patients with acromegaly.

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SIGNIFICANT ELEVATION OF GROWTH HORMONE LEVEL IMPACTS SURGICAL OUTCOMES IN ACROMEGALY

Endocrine Practice ◽

10.4158/ep14587.or ◽

2015 ◽

Vol 21 (9) ◽

pp. 1001-1009 ◽

Cited By ~ 10

Author(s):

Jeremy R. Anthony ◽

Ula Abed Alwahab ◽

Naman K. Kanakiya ◽

Diana M. Pontell ◽

Emir Veledar ◽

...

Keyword(s):

Growth Hormone ◽

Surgical Outcomes ◽

Hormone Level ◽

Growth Hormone Level ◽

Significant Elevation

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Stress perfusion CMR provides strong long-term prognostic value to cardiac events irrespective of patient sex

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.290 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

T Pezel ◽

F Sanguineti ◽

M Kinnel ◽

V Landon ◽

P Garot ◽

...

Keyword(s):

Confidence Interval ◽

Prognostic Value ◽

Cardiovascular Death ◽

Hazard Ratio ◽

Stress Perfusion ◽

Inducible Ischemia ◽

Stress Cmr ◽

Perfusion Cmr

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Compelling evidence indicates that women with coronary artery disease (CAD) experience worse outcomes than men due to a lack of early diagnosis and management. Numerous clinical studies have shown that stress cardiovascular magnetic resonance (CMR) detects evidence of myocardial ischemia and infarction at high accuracy. However, long-term prognosis data are limited. PURPOSE The aim of this study was to test the hypothesis that stress perfusion CMR imaging can provide robust prognostic value in women presenting with suspected ischemia, to the same extent as in men. METHODS Consecutive patients referred for vasodilator stress perfusion CMR with dipyridamole were followed for the occurrence of major adverse cardiovascular events (MACE) defined as cardiovascular death or non-fatal myocardial infarction (MI). The secondary endpoint was cardiovascular death. The safety of the CMR was assessed by clinical monitoring for 1 hour after the end of the CMR. Univariable and multivariable Cox regressions for MACE were performed to determine the prognostic value of inducible ischemia or late gadolinium enhancement (LGE) by CMR in each sex. RESULTS Of 3436 patients referred for stress CMR in a single French center, 3322 (97%) completed the CMR protocol (59.9 ± 11.8 years, 57% men), and among those 3033 (91%) completed the follow-up (median follow-up 5.4 ± 0.2 years). Reasons for failure to complete CMR included renal failure (n = 29), claustrophobia (n = 26), poor gating (n = 22), intolerance to stress agent (n = 19) and declining participation (n = 18). Stress CMR was well tolerated without occurrence of death or severe disabling adverse event. Using Kaplan-Meier analysis, the presence of inducible myocardial ischemia identified the occurrence of MACE for both women (hazard ratio HR 2.36 ; 95% confidence interval CI: 1.54–3.62; p < 0.001) and men (HR 3.57 ; 95% confidence interval CI: 2.75 – 4.64; p < 0.001) (Figure). Moreover, inducible ischemia was associated with cardiovascular death for both women (hazard ratio HR 1.92; 95% confidence interval CI: 1.12 – 2.74; p = 0.04) and men (HR 2.71 ; 95% confidence interval CI: 1.98 – 4.41; p < 0.001). In a multivariable stepwise Cox regression including clinical characteristics and CMR, presence of inducible ischemia was an independent predictor of a higher incidence of MACE for both women (hazard ratio HR 1.85 ; 95% confidence interval CI: 1.18 – 2.92; p = 0.008) and men (HR 3.55 ; 95% confidence interval CI: 2.73 – 4.63; p < 0.001). Moreover, inducible ischemia was associated with cardiovascular death for men (HR 1.99; 95% confidence interval CI: 1.65 – 3.01; p < 0.01) but not for women (p = 0.11). CONCLUSION Stress CMR is feasible, safe and has a good discriminative prognostic value to predict the occurrence of MACE in patients of either sex presenting with inducible ischemia. However, inducible ischemia is an independent predictor of a higher incidence of CV mortality only in men. Abstract Figure.

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Prognostic and Predictive Value of the Pretreatment Albumin-bilirubin Score for Short and Long-term Survival in Patients With Non-Hodgkin Lymphoma-associated Hemophagocytic Lymphohistiocytosis With Hepatic Injuries

10.21203/rs.3.rs-1151055/v1 ◽

2022 ◽

Author(s):

Guangli Yin ◽

Wanying Cheng ◽

Yongqian Shu ◽

Hongxia Qiu ◽

Limin Duan

Keyword(s):

Overall Survival ◽

Confidence Interval ◽

Hemophagocytic Lymphohistiocytosis ◽

Prognostic Value ◽

Operating Characteristic ◽

Term Survival ◽

Non Hodgkin Lymphoma ◽

Short And Long Term ◽

Hepatic Injuries

Abstract Purpose: This study aimed to assess the prognostic value of pretreatment albumin-bilirubin (ALBI) on short-term mortality (30 days) and long-term (≥ 1 year) survivalThe aim of this study was to construct a prognosis model of non-Hodgkin lymphoma-associated secondary hemophagocytic lymphohistiocytosis (NHL-sHLH) patients with hepatic injuries by the combination of ALBI score and clinical parameters.Material and methods: This retrospective study included 168 NHL-sHLH patients with hepatic injuries between February 1, 2014, and February 1, 2020. Multivariable logistic/Cox models and restricted cubic spline models were conducted to evaluate the relationships between the ALBI score and short- and long-term survival. The predictive performance of the ALBI score was assessed and compared using time-dependent receiver operating characteristic (ROC) analysis.Results: Among 168 adult NHL-sHLH patients, 82 (48.8%) patients died within 30 days after admission, and 144 (85.7%) patients died during the follow-up period. Multivariate logistic regression indicated that ALBI grade could be an independent risk factor for predicting the prognosis of patients with 30-day mortality and overall survival (odds ratios [OR]30 days 5.37, 95% confidence interval 2.41-12.64, P < 0.001; hazard ratios [HR]OS 1.52, 95% confidence interval 1.06-2.18, P = 0.023), respectively. The restricted cubic spline curve displayed a linear and positive relationship between the ALBI score and risk of mortality (P for nonlinearity =0.503). Furthermore, receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) for predicting mortality by integrative analysis of the ALBI score and ferritin was significantly improved compared to the ALBI score (AUC 30 days: 0.820 vs 0.693, P = 0.001; AUC1 year: 0.754 vs 0.681, P = 0.043) or ferritin (AUC30 days: 0.820 vs 0.724, P = 0.005; AUC1 year: 0.754 vs 0.658, P = 0.031) alone.Conclusions: These results suggest that the ALBI score could be a useful indicator of 30-day mortality and overall survival (≥1 year) for NHL-sHLH patients with hepatic injuries, and the combination analysis of the ALBI score and ferritin provides incremental prognostic value for clinical use.

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Stress perfusion CMR provides strong long-term prognostic value to cardiac events irrespective of patient sex

European Heart Journal ◽

10.1093/ehjci/ehaa946.0248 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

T Pezel ◽

F Sanguineti ◽

M Kinnel ◽

V Landon ◽

P Garot ◽

...

Keyword(s):

Confidence Interval ◽

Prognostic Value ◽

Cardiovascular Death ◽

Hazard Ratio ◽

Stress Perfusion ◽

Inducible Ischemia ◽

Kaplan Meier ◽

Stress Cmr ◽

Perfusion Cmr

Abstract Background Compelling evidence indicates that women with coronary artery disease (CAD) experience worse outcomes than men due to a lack of early diagnosis and management. Numerous clinical studies have shown that stress cardiovascular magnetic resonance (CMR) detects evidence of myocardial ischemia and infarction at high accuracy. However, long-term prognosis data are limited. Purpose The aim of this study was to test the hypothesis that stress perfusion CMR imaging can provide robust prognostic value in women presenting with suspected ischemia, to the same extent as in men. Material Consecutive patients referred for vasodilator stress perfusion CMR with dipyridamole were followed for the occurrence of major adverse cardiovascular events (MACE) defined as cardiovascular death or non-fatal myocardial infarction (MI). The secondary endpoint was cardiovascular death. The safety of the CMR was assessed by clinical monitoring for 1 hour after the end of the CMR. Univariable and multivariable Cox regressions for MACE were performed to determine the prognostic value of inducible ischemia or late gadolinium enhancement (LGE) by CMR in each sex. Results Of 3436 patients referred for stress CMR in a single French center, 3322 (97%) completed the CMR protocol (59.9±11.8 years, 57% men), and among those 3033 (91%) completed the follow-up (median follow-up 5.4±0.2 years). Reasons for failure to complete CMR included renal failure (n=29), claustrophobia (n=26), poor gating (n=22), intolerance to stress agent (n=19) and declining participation (n=18). Stress CMR was well tolerated without occurrence of death or severe disabling adverse event. Using Kaplan-Meier analysis, the presence of inducible myocardial ischemia identified the occurrence of MACE for both women (hazard ratio HR 2.36; 95% confidence interval CI: 1.54–3.62; p<0.001) and men (HR 3.57; 95% confidence interval CI: 2.75–4.64; p<0.001) (Figure). Moreover, inducible ischemia was associated with cardiovascular death for both women (hazard ratio HR 1.92; 95% confidence interval CI: 1.12–2.74; p=0.04) and men (HR 2.71; 95% confidence interval CI: 1.98–4.41; p<0.001). In a multivariable stepwise Cox regression including clinical characteristics and CMR, presence of inducible ischemia was an independent predictor of a higher incidence of MACE for both women (hazard ratio HR 1.85; 95% confidence interval CI: 1.18–2.92; p=0.008) and men (HR 3.55; 95% confidence interval CI: 2.73–4.63; p<0.001). Moreover, inducible ischemia was associated with cardiovascular death for men (HR 1.99; 95% confidence interval CI: 1.65–3.01; p<0.01) but not for women (p=0.11). Conclusion Stress CMR is feasible, safe and has a good discriminative prognostic value to predict the occurrence of MACE in patients of either sex presenting with inducible ischemia. However, inducible ischemia is an independent predictor of a higher incidence of CV mortality only in men. Kaplan-Meier curves for MACE in each sex Funding Acknowledgement Type of funding source: None

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Prognostic value of lateral spread response during microvascular decompression for hemifacial spasm

Journal of International Medical Research ◽

10.1177/0300060519839526 ◽

2019 ◽

Vol 47 (12) ◽

pp. 6120-6128

Author(s):

Hongmei Song ◽

Songbai Xu ◽

Xiushuang Fan ◽

Mingxin Yu ◽

Jiachun Feng ◽

...

Keyword(s):

Hemifacial Spasm ◽

Microvascular Decompression ◽

Surgical Outcomes ◽

Prognostic Value ◽

Prognostic Indicator ◽

Lateral Spread ◽

Short Term ◽

Group A ◽

Lateral Spread Response

Objective This study aimed to investigate the prognostic value of the lateral spread response (LSR) for predicting surgical outcomes following microvascular decompression (MVD) in patients with hemifacial spasm. Methods Seventy-three patients with hemifacial spasm underwent MVD with intraoperative LSR monitoring. Surgical outcomes were evaluated 1 week and 1 year after MVD and correlations between LSR characteristics and surgical outcomes were analyzed. Results The LSR disappeared completely in 61 patients during surgery (Group A; prior to insertion of Teflon felt pledgets in 11, after insertion of pledgets in 50), disappeared partially in nine patients (Group B), and remained unchanged in three patients (Group C). Fifty-five patients showed short-term and 61 patients showed long-term clinical cures during the follow-up period. The short-term and long-term cure rates were significantly higher in Group A than in Group C. There was no correlation between the time of complete LSR disappearance and surgical outcomes. Conclusions Disappearance of the LSR during MVD is correlated with the surgical outcomes. Intraoperative LSR monitoring is a reliable approach for predicting the prognosis of hemifacial spasm following MVD, but the time at which LSR disappears is not a prognostic indicator.

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Pre- and post-surgery treatments in rectal cancer: a long-term single-centre experience

Current Oncology ◽

10.3747/co.24.3229 ◽

2017 ◽

Vol 24 (1) ◽

pp. 24

Author(s):

H. Ozyurt ◽

A.S. Ozden ◽

Z. Ozgen ◽

C. Gemici ◽

G. Yaprak

Keyword(s):

Rectal Cancer ◽

Confidence Interval ◽

Folinic Acid ◽

Median Duration ◽

Distant Metastasis ◽

Locally Advanced ◽

Term Survival ◽

Post Surgery ◽

The Impact

BackgroundOur study evaluated long-term survival outcomes in rectal cancer patients treated with preoperative radiotherapy, and the impact on survival of concomitant and postoperative adjuvant chemotherapy (ctx), among other prognostic factors.Methods The study included 196 patients [median age: 58 years (range: 20–86 years); 63.0% men] with locally advanced rectal carcinoma and, in some cases, resectable liver metastasis. Rates of distant metastasis and local recurrence and of 5-year distant metastasis-free survival (dmfs) and overall survival (os) were determined.Results The 5-year os rate was 57.0%, with a median duration of 81.5 months (95% confidence interval: 73.7 months to 89.4 months), and the 5-year dmfs rate was 54.1%, with a median duration of 68.4 months (95% confidence interval: 40.4 months to 96.4 months). Prognostic factors for higher os and dmfs rates were downstaging (p = 0.013 and p = 0.005 respectively), radiotherapy dose (50 Gy vs. 56 Gy or 45–46 Gy, both p = 0.002), and concomitant ctx use (p = 0.004 and p = 0.001) and type (5-fluorouracil–leucovorin–folinic acid vs. tegafur–folinic acid, p = 0.034 and p = 0.043). Adjuvant ctx after neoadjuvant long-term concomitant chemoradiotherapy (ccrt) and surgery was associated with better5-year os rates for postoperative T0–T3 disease (p = 0.003) and disease at all lymph node stages (p = 0.001).Conclusions Our findings revealed a favourable survival outcome with long-term fractionated irradiation and concomitant 5-fluorouracil–based ctx, achieving 5-year os and dmfs rates of 57.0% and 54.1% respectively. Preoperative administration of radiotherapy (50 Gy) and postoperative adjuvant ctx were associated with a significant survival benefit. Radiation doses above 50 Gy and the interval between ccrt and surgery had no significant effect on survival.

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