scholarly journals Serial neuroimaging in infants with abusive head trauma: timing abusive injuries

2013 ◽  
Vol 12 (2) ◽  
pp. 110-119 ◽  
Author(s):  
Ray Bradford ◽  
Arabinda K. Choudhary ◽  
Mark S. Dias
Keyword(s):  
Head Trauma ◽  
Small Sample Size ◽  
Medical Center ◽  
Abusive Head Trauma ◽  
Time Frame ◽  
Small Sample ◽  
Ct Scans ◽  
Imaging Studies ◽  
T1 Hyperintensity ◽  
Clinical Records

Object The appearance and evolution of neuroimaging abnormalities following abusive head trauma (AHT) is important for establishing the time frame over which these injuries might have occurred. From a legal perspective this frames the timing of the abuse and therefore identifies and excludes potential perpetrators. A previous pilot study involving 33 infants with AHT helped to refine the timing of these injuries but was limited by its small sample size. In the present study, the authors analyzed a larger group of 210 cases involving infants with AHT to chronicle the first appearance and evolution of radiological (CT, MRI) abnormalities. Methods All children younger than 24 months admitted to the Penn State Hershey Medical Center with AHT over a 10-year period were identified from a medical record review; the time of injury was determined through an evaluation of the clinical records. All imaging studies were analyzed, and the appearance and evolution of abnormalities were chronicled on serial neuroimaging studies obtained in the days and weeks after injury. Results One hundred five infants with specific injury dates and available imaging studies were identified; a subset of 43 children additionally had documented times of injury. In infants with homogeneously hyperdense subdural hematomas (SDHs) on initial CT scans, the first hypodense component appeared within the SDH between 0.3 and 16 days after injury, and the last hyperdense subdural component disappeared between 2 and 40 days after injury. In infants with mixed-density SDHs on initial scans, the last hyperdense component disappeared between 1 and 181 days. Parenchymal hypodensities appeared on CT scans performed as early as 1.2 hours, and all were visible within 27 hours after the injury. Rebleeding into SDHs was documented in 17 cases (16%) and was always asymptomatic. Magnetic resonance imaging of the brain was performed in 49 infants. Among those with SDH, 5 patterns were observed. Patterns I and II reflected homogeneous SDH; Pattern I (T1 hyperintensity and T2/FLAIR hypointensity, “early subacute”) more commonly appeared on scans performed earlier after injury compared with Pattern II (T1 hyperintensity and T2/FLAIR hyperintensity, “late subacute”), although there was considerable overlap. Patterns III and IV reflected heterogeneous SDH; Pattern III contained relatively equal mixtures having different intensities, whereas Pattern IV had fluid that was predominantly T1 hypointense and T2/FLAIR hyperintense. Again, Pattern III more commonly appeared on scans performed earlier after injury compared with Pattern IV, although there was significant overlap. Conclusions These data extend the preliminary data reported by Dias and colleagues and provide a framework upon which injuries in AHT can be timed as well as the limitations on such timing estimates.

Abstract 248: Initiation and Assessment of Timekeeping Roles During In-Hospital Cardiac Arrests to Track Rhythm Checks and Epinephrine Dosing

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Conor Crowley ◽  
Peter Clardy ◽  
Jessica McCannon ◽  
Rebecca Logiudice
Keyword(s):  
Small Sample Size ◽  
Medical Center ◽  
Academic Medical Center ◽  
Small Sample ◽  
Post Intervention ◽  
Epinephrine Administration ◽  
Team Members ◽  
Minute Post ◽  
Chaotic Nature ◽  
Strongly Agree

Introduction: Compliance to ACLS cardiac arrest algorithm is low and associated with worse outcomes from in-hospital cardiac arrests (IHCA). Reasons for non-compliance include reduced communication due to chaotic nature of IHCAs and difficulty timing epinephrine administration and rhythm check intervals. Hypothesis: Delegating two separate code team members for rhythm and epinephrine timing will increase adherence to ACLS algorithm during IHCAs. Methods: This is a pre-post interventional study of IHCAs at a single academic medical center. Two stopwatches were placed on all code carts and two new timekeeping roles were created. Education was provided to staff regarding the alteration of existing code team member roles for the use of stopwatches. Algorithm adherence was analyzed pre and post implementation of timekeeper roles. Deviation from the 2-minute rhythm check or 3-5-minute epinephrine administration was counted as one deviation. Anonymous surveys were delivered to evaluate providers perceived benefits of timekeeper roles for IHCAs. Results: Data from 13 pre intervention IHCAs were compared to 12 IHCAs post intervention. The initial rhythm was PEA/asystole in 69% pre-intervention vs 83% post intervention. Prior to implementation 82 deviations vs. 11 deviations post implementation occurred (p=0.006). The mean time until first dose of epinephrine was administered pre intervention was 2.3 ± 3.3 minutes vs 0.4 ±1 minute post. Pre-implementation ROSC rate was 53.8% vs. 66.7% post intervention. Surveys were delivered to 100% of code team members post intervention, with a 79% response rate. Surveys demonstrate providers felt time keeping roles made it easier to track epinephrine administration and rhythm checks. On a Likert scale, 78% of providers “strongly agree” that the use of timekeeping roles and devices improved code team communication. Conclusion: Two separate timekeeper roles during IHCAs improved algorithm compliance, code team function and communication, and was favored by code team members. Timekeeper roles may be associated with improved rates of ROSC and less time until the first dose of epinephrine is administered. This study is limited by its small sample size, single center and requires validation.

Attentional functioning in patients with posttraumatic stress disorder: a preliminary study

CNS Spectrums ◽  
2013 ◽  
Vol 18 (2) ◽  
pp. 90-94 ◽  
Author(s):  
Michael David Horner ◽  
Jacobo E. Mintzer ◽  
Travis H. Turner ◽  
Keith R. Edmiston ◽  
Olga Brawman-Mintzer
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Substance Dependence ◽  
Stress Disorder ◽  
Small Sample Size ◽  
Medical Center ◽  
Digit Span ◽  
Cognitive Disorders ◽  
Small Sample ◽  
Psychiatric Diagnoses

ObjectiveTo compare patients with posttraumatic stress disorder (PTSD) to patients without psychiatric or cognitive disorders on neuropsychological measures of attention.MethodsThe sample included 19 patients with PTSD and 22 participants with no cognitive or psychiatric diagnosis. All had been referred for clinical neuropsychological evaluation at a VA Medical Center. None were diagnosed with dementia, delirium, or current substance dependence except nicotine or caffeine, and none had a history of stroke or of traumatic brain injury with loss of consciousness. Patients were excluded if they failed to exert adequate effort on testing.ResultsPTSD patients performed significantly more poorly than patients without psychiatric diagnoses on Digit Span.ConclusionPTSD patients were impaired relative to participants without psychiatric diagnoses on a measure of focused attention. Several factors, including the small sample size, suggest that the results should be considered preliminary.

scholarly journals The Effects of Gastroretentive Gabapentin (Gralise®) on Spinal Stenosis Patients with Radicular Pain

2014 ◽  
Vol 2;17 (2;3) ◽  
pp. 169-178
Author(s):  
Alan David Kaye
Keyword(s):  
Pain Intensity ◽  
Spinal Stenosis ◽  
Small Sample Size ◽  
Medical Center ◽  
Radicular Pain ◽  
Small Sample ◽  
Open Label ◽  
Sleep Diaries ◽  
Significant Positive Change ◽  
Global Impression Of Change

Background: The health and efficacy profiles of Gralise® in the treatment of pain from spinal stenosis and radicular symptomatology have not been measured. A review of the current literature indicates that no studies exist that evaluate the safety and efficacy profiles of Gralise® in the treatment of pain from spinal stenosis and radicular symptomatology. Objective: Our study is aimed at determining whether Gralise is a safe and effective pharmacotherapy for the pain from spinal stenosis and radicular symptomatology. Study Design: A 4-week prospective open label single arm and single center study of patients with MRI diagnosis of spinal stenosis with radicular pain. Methods: The primary measure of efficacy was a change in average daily pain (ADP) score from baseline to completion of Gralise therapy for 4 weeks. The secondary efficacy endpoints were the patients’ Patients Global Impression of Change Scale (PGIC), the clinician’s Clinical Global Impression of Change Scale (CGI) reports, and the Medical Outcomes Study (MOS) sleep scale of improvement from baseline to completing 4 weeks of Gralise therapy. The safety and tolerability were evaluated by the incidence of adverse events reported while on Gralise therapy. Setting: The study was performed at the Clinical Research Facilities at Tulane Medical Center, New Orleans, Louisiana, in the period from December 1, 2012, to August 30, 2013. Results: Thirty-five patients achieved an efficacy point of one-week Gralise medication treatment. Twenty-seven of 35 (77.2%) patients completed all 5 visits. The PGIC noted a significant positive change in: (1) activity limitations; (2) symptoms; (3) emotions and overall quality of life when related to their condition from first visit as well as improved degree of change when related to their condition from first to last visit. The MOS sleep scale and sleep diaries noted a significant increase of hours slept on average (an increase in over one hour per night — 5.8 hours versus 6.86 hours) from the beginning of the study to the end. The CGI noted a majority of 10 out of 27 with marked significant therapeutic effect with no side effects. The ADP rating from pain intensity scale and pain diaries noted significant improvement of lesser levels of pain experienced (P =.5907 and P =.8547 respectively). No significant adverse effects were noted in the study. Limitations: Variation in degree of spinal stenosis, small sample size. Conclusions: Gralise demonstrated moderate efficacy with reduced pain intensity and increased sleep and was well tolerated in spinal stenosis patients with radicular symptoms. Key words: Spinal stenosis, gabapentin, Gralise®, radicular pain, neuropathic pain

scholarly journals Symptomatic Cervical Vertebral Hemangioma Treated by Percutaneous Vertebroplasty

2013 ◽  
Vol 4;16 (4;7) ◽  
pp. E419-E425
Author(s):  
Wang Jian
Keyword(s):  
Percutaneous Vertebroplasty ◽  
Management Practice ◽  
Small Sample Size ◽  
Medical Center ◽  
Benign Lesion ◽  
Cement Leakage ◽  
Small Sample ◽  
Vertebral Hemangioma ◽  
Cement Distribution

Background: Vertebral hemangioma (VH) is considered to be a benign lesion of bone with a rich vasculature. Most incidentally discovered hemangiomas are asymptomatic. Percutaneous vertebroplasty (PVP) has demonstrated efficacy in the treatment of symptomatic thoracic and lumbar VHs. To our knowledge, the reports concerning PVP on symptomatic cervical VHs are quite rare. Objective: Our intent was to assess PVP as treatment for symptomatic cervical hemangiomas. Study Design: Prospective evaluation. Setting: An inteventional pain management practice, single medical center. Methods: Eight patients with symptomatic cervical VHs were enrolled between December 2008 and February 2012, all of whom underwent magnetic resonance imaging (MRI) of the cervical spine. The patients with 8 vertebral bodies of VHs were treated by using PVP. The clinical and radiological data were collected and analyzed. Postoperative outcomes were determined using a visual analog scale. Results: Surgical levels include C3 (2 patients), C4 (3 patients), C5 (2 patients), and C6 (one patient). The average follow-up period was 27.4 months, with a minimum of 12 months. Mean operative time and x-ray exposure time were respectively 35 ± 7.1 minutes and 25 ± 7.7 seconds. The visual analogue scale for neck pain decreased significantly from 6.9 ± 0.6 preoperatively to 1.3 ± 0.5 (P < 0.01) on the second day after surgery, with a final score of 1.2 ± 0.5 (P < 0.01). Cement distribution was always diffuse and homogeneous. No cement leakage was observed in all cases except for 2 patients. There were no other major complications at the time of last follow-up evaluation. Limitations: An observational clinical trial with a relatively small sample size. Conclusion: Short-term results indicate that PVP appears to be an effective and safe treatment for symptomatic cervical VHs. Key words: Percutaneous vertebroplasty, symptomatic, cervical vertebral, hemangiomas

Abstract WP55: A Comparison of Outcomes in Patients Selected for Endovascular Stroke Treatment with and without the Aid of CT Perfusion Imaging

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Gregory Ferenz ◽  
Raymond Reichwein
Keyword(s):  
Clinical Outcomes ◽  
Ct Perfusion ◽  
Small Sample Size ◽  
Medical Center ◽  
Outcome Data ◽  
Small Sample ◽  
Treatment Selection ◽  
Control Group ◽  
Stroke Treatment ◽  
Significant Difference

Background: Selection of patients for endovascular stroke treatment has traditionally been based on time since symptom onset. CT perfusion (CTP) imaging has raised the possibility of patient selection on objective measures other than time from stroke onset. However, previous studies have failed to show significant outcome improvement in patients selected for endovascular stroke treatment based on CTP, but have been limited by small sample size, lack of outcomes past time of discharge, or lack of control group. Objective: To determine if endovascular stroke treatment selection with the aid of CTP is associated with improved clinical outcomes at 90 days as compared to patients undergoing endovascular stroke treatment without the aid of CTP. Methods: This study retrospectively reviewed a prospectively collected database of all patients who underwent endovascular stroke treatment at Penn State Hershey Medical Center between 1/1/2009 and 12/31/2011. Patients with posterior circulation strokes and those enrolled in other treatment trials were excluded. Patients were divided into two groups based on whether they had undergone a CTP study prior to endovascular stroke treatment or not. The variables measured included age, sex, and NIHSS on admission. Outcome data measured from the patients 90 day post stroke follow up appointments included an NIHSS improvement by 4 or more, a modified Rankin Score (mRS) of 2 or less, and mortality. Results: Of 41 patients included in the study, there was no significant difference in outcomes at 90 days as measured by an improvement of NIHSS of 4 or more (p=0.106) or modified Rankin score of 0-2 (p=0.475). Table 1 summarizes the results. Conclusion: Endovascular stroke treatment selection with the use of CTP was not associated with improved clinical outcomes at 90 days as measured by NIHSS improvement of 4 or more or a mRS of 0-2.

62cuatsm and 62cuptsm PET is a useful imaging tool for hypoxia and perfusion in lung cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e22166-e22166
Author(s):  
Tian Zhang ◽  
Shiva K. Das ◽  
Jeffrey Crawford ◽  
Terence Wong ◽  
Mark W. Dewhirst ◽  
...  
Keyword(s):  
Pet Imaging ◽  
Lung Tumor ◽  
Imaging Techniques ◽  
Small Sample Size ◽  
Medical Center ◽  
Clinical Care ◽  
Tumor Hypoxia ◽  
Small Sample ◽  
Unique Challenge ◽  
Pet Scans

e22166 Background: Hypoxia is a characteristic of many tumors and portends a worse prognosis in lung, cervical, prostate, and rectal cancers. Unlike the others, lung cancers present a unique challenge in measuring hypoxia, with invasive biopsies and higher rates of complications. Noninvasive imaging studies detecting hypoxia using isotopes of copper-diacetyl-bis (N4-methylthiosemicarbazone), CuATSM, have predicted prognosis and treatment outcomes in some small feasibility trials. These images, however, may not identify all areas of hypoxia. Hence, we hypothesize that the addition of another positron emission tomography (PET) imaging agent, copper-pyruvaldehyde-bis (N4-methylthiosemicarbazone), 62CuPTSM, which can detect areas of perfusion, can augment the information obtained in 62CuATSM PET scans. Methods: In order to characterize tumors based on both perfusion and hypoxia, ten patients were studied using both 62CuATSM and 62CuPTSM PET scans. All patients signed informed consent; the protocol was approved by the Duke University Medical Center institutional review board. 62CuATSM and 62CuPTSM SUV values at steady state were tabulated and the ratios of 62CuATSM to 62CuPTSM calculated. In addition, proteomic arrays looking at specific proangiogenic, survival, and proinflammatory targets were assessed. Results: Six out of ten patients had fully evaluable PET scans. Our initial experience of characterizing lung tumor hypoxia using 62CuATSM/62CuPTSM PET scans showed that visualization of areas with hypoxia normalized for perfusion is feasible. All studied tumors exhibited some hypoxia. Despite the small sample size, a positive relationship was noted between serum epidermal growth factor (EGF) levels and 62CuATSM detected hypoxia. Conclusions: This initial series of 62CuATSM/62CuPTSM PET scans demonstrate that evaluating pulmonary lesions by visualizing hypoxia and perfusion is a feasible and novel technique to provide more information. Further investigation is warranted to assess the potential role of 62CuATSM and 62CuPTSM PET imaging techniques combined with proteomics as alternatives to invasive biopsy techniques in clinical care.

scholarly journals Perioperative, Single-Surgeon Experience in Cerebrovascular Bypass Procedures at Academic Medical Center and Community Hospital

2018 ◽  
Vol 05 (03) ◽  
pp. 173-176
Author(s):  
Kathleen W. Nissman ◽  
Ali R. Zomorodi ◽  
Dhanesh K. Gupta ◽  
Ishwori Dhakal ◽  
Yi-Ju Li ◽  
...  
Keyword(s):  
Community Hospital ◽  
Small Sample Size ◽  
Medical Center ◽  
Academic Medical Center ◽  
Small Sample ◽  
Neurosurgical Procedures ◽  
Academic Medical ◽  
Tertiary Center ◽  
Significant Difference ◽  
Surgeon Experience

Abstract Background Little evidence exists for superiority of neurosurgical outcomes from care subspecialization. Outcomes of a single neurosurgeon after complex vascular neurosurgery in an academic medical center were compared against those in a community hospital. Methods In this retrospective analysis of extracranial-intracranial vascular bypass operations performed between July 1, 2013 and February 1, 2015, cases were identified by cross-referencing the electronic medical record with the surgeon's own records. Pre-, intra-, and postoperative variables were abstracted from cases performed at a tertiary center and a community hospital. Dichotomous postoperative data recorded included extubation in the operating room (OR), readmission, and survival to discharge, and length of stay was also analyzed. Due to small sample size and low readmission rate, Firth's penalized likelihood tests were incorporated in the logistic regression model for parameter estimation and testing. Results A total of 28 hemispheres in 26 patients were included: 18 hemispheres in 16 patients at the tertiary center and 10 hemispheres in 9 patients at the community hospital. Differences were found in operative time (tertiary mean: 7.21 + 2.5 hours, community mean: 5.19 + 0.9 hours, p = 0.0074) and readmission to the tertiary center (p = 0.078). However, significant difference was observed only for anesthetic type (more likely to include remifentanil and propofol at the tertiary center, p = 0.0104). Conclusion Subspecialty care alone may be insufficient to enhance outcome after complex neurosurgical procedures.

Initiation of Buprenorphine/Naloxone on Rates of Discharge Against Medical Advice

2020 ◽  
pp. 001857872098543
Author(s):  
Lindsey B. Kays ◽  
Emily D. Steltenpohl ◽  
Chelsey M. McPheeters ◽  
Emily K. Frederick ◽  
Laura B. Bishop
Keyword(s):  
Small Sample Size ◽  
Medical Center ◽  
Academic Medical Center ◽  
Small Sample ◽  
Medical Advice ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Against Medical Advice ◽  
Objective Evidence ◽  
Discharge Against Medical Advice

Objective: Evidence shows that patients with opioid use disorder (OUD) have an increased rate of discharge against medical advice (DAMA) as well as higher rates of hospital readmission. Therefore, the objective of this study was to determine if inpatient initiation of buprenorphine/naloxone in patients with OUD is associated with decreased rates of DAMA. Methods: This was a single center retrospective cohort study conducted at a level 1, academic medical center. The study included patients with OUD admitted to the Internal Medicine service from January through May of both 2018 and 2019 for an admitting diagnosis other than opioid withdrawal. The primary endpoint was rate of DAMA among OUD patients not initiated on opioid agonist therapy compared to those initiated on buprenorphine/naloxone. The secondary endpoint was the association between factors of the initiation process on rates of DAMA. Patients were excluded if they were discharged in less than 24 hours or received intermittent administration of buprenorphine/naloxone. Results: The rate of DAMA in OUD patients not initiated on buprenorphine/naloxone was 13.85% compared to 2.56% in those initiated on buprenorphine/naloxone ( P = .048). Conclusion: In OUD patients initiated on buprenorphine/naloxone, the rate of DAMA was significantly lower than those who were not. This data supports the importance of optimizing the opportunity to initiate buprenorphine/naloxone in the acute care setting to minimize withdrawal symptoms therefore reducing the rate of DAMA. Ultimately increasing the ability to adequately treat the primary reason for admission and potentially decreasing readmission rates. Further studies are needed to evaluate this impact as this study is limited to a small sample size therefore lacking adequate power.

Apremilast in Combination With an Interleukin 17A Inhibitor in the Treatment of Recalcitrant Palmoplantar Psoriasis

2018 ◽  
Vol 3 (4) ◽  
pp. 122-125 ◽  
Author(s):  
Abdulaziz Alomran ◽  
Pedro Zancanaro ◽  
Lisa Prussick ◽  
Minawaer Abudu ◽  
Min Ji Her ◽  
...  
Keyword(s):  
Sample Size ◽  
Small Sample Size ◽  
Medical Center ◽  
Descriptive Analysis ◽  
Retrospective Chart Review ◽  
Small Sample ◽  
Interleukin 17 ◽  
Inflammatory Disorder ◽  
Physician Global Assessment ◽  
Carry Over

Background: Palmoplantar psoriasis (PPP) is a chronic, immune-mediated, inflammatory disorder affecting the palms and soles. Despite marked improvement in patient outcomes with use of biologic therapies, PPP remains hard to treat as the efficacy of systemic agents does not fully carry over to PPP trials. Methods: The study was approved by the institutional review board of Tufts Medical Center. It is a retrospective chart review of patients seen in Tufts Medical Center’s dermatology outpatient clinic who met the criteria of being diagnosed with PPP and received an anti-interleukin 17 A (IL-17A) concurrently with apremilast for a period of no less than 12 weeks. Four patients who met the criteria were included in the study, and descriptive analysis was performed due to the small sample size. Results: All 4 patients analyzed showed improvement in Palmoplantar Physician Global Assessment (PPPGA) while on combination apremilast and anti-IL17A therapy. Prior to anti-IL17A therapy, the first 3 patients had baseline PPPGAs of mild to severe. They then had PPPGAs of moderate while on anti-IL17A therapy and PPPGAs of clear/almost clear while on the combination of anti-IL17A therapy and apremilast. Patient 4 had a PPPGA of almost clear while on adalimumab, methotrexate, and acitretin and a PPPGA of clear after treatment with ixekizumab, apremilast, and methotrexate. Minimal side effects were reported on combination treatment. Conclusion: All 4 patients who were treated with combination anti-IL17A and apremilast achieved a PPPGA of clear or almost clear. Although the sample size is small, these encouraging results merit further investigation into combination therapy in the treatment of recalcitrant PPP.

Does abiraterone withdrawal syndrome (AWS) exist also in metastatic castration-resistant prostate cancer (mCRPC) first-line setting?

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 344-344
Author(s):  
Francesca Maines ◽  
Orazio Caffo ◽  
Chiara Trentin ◽  
Antonello Veccia ◽  
Enzo Galligioni
Keyword(s):  
Withdrawal Syndrome ◽  
Small Sample Size ◽  
Objective Response ◽  
Clinical History ◽  
Abiraterone Acetate ◽  
Small Sample ◽  
Castration Resistant Prostate Cancer ◽  
First Line ◽  
Clinical Role ◽  
Clinical Records

344 Background: AWS is a recently phenomenon observed in mCRPC patients (pts) characterized by a PSA reduction with or without objective response after abiraterone acetate (AA) discontinuation. This syndrome has clinical features similar to antiandrogen withdrawal syndrome and was described in pts who treated with AA in the post-docetaxel setting. At the best of our knowledge, to date AWS was never described in chemo-naïve mCRPC pts. Methods: We retrospectively reviewed clinical records of mCRPC pts treated with first-line AA at our Institution. All pts were treated with AA 1,000 mg + prednisone (PDN) 10 mg po daily; the treatment was continued until progression disease (PD) which required an imaging confirmation too. After PD, we also discontinued the PDN administration. For each pt we recorded pre and post-AA clinical history, treatment details and outcomes. AWS was defined by PSA reduction ≥ 25% compared to the AA-end values observed in the first month after AA stop. Results: From September 2014, eight pts received first-line AA and, to date, 6 patients (75%) who discontinued the treatment due to PD are evaluable for AWS occurrence. We observed an AWS in 2/6 (33.3%). The first patient, a 76 year-old man, who experienced a PD after 12 wks AA treatment, had a 69% reduction in PSA with PSA dropping from 60 ng/mL to 19.47 ng/mL after about 30 days from the discontinuation. The second patient, 83 years old, treated with AA for 12 weeks, had a reduction in PSA from 112.2 ng/mL to 55 ng/mL at one-month (51% reduction) and to 35.36 ng/mL at two months (68.5% reduction) after AA and PDN discontinuation; after 9 wks the AWS is still ongoing. Conclusions: Notwithstanding the limits of the small sample size, our data shows for the first time that AWS can be observed also in mCRPC patients receiving AA as first-line treatment. Larger observations are needed to establish frequency and clinical role of this phenomenon. Although pathogenetic mechanisms and predictive factors are still unclear, AWS may represent a possibility to delay the second line start for mCRPC pts.

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