scholarly journals CONGENITAL HYDRONEPHROSIS: PROBLEMS IN DIAGNOSIS AND MANAGEMENT

1970 ◽  
Vol 17 (2) ◽  
Author(s):  
Yonas Immanuel Hutasoit ◽  
Irfan Wahyudi ◽  
Arry Rodjani
Keyword(s):  
Antenatal Care ◽  
Age Groups ◽  
Renal Scintigraphy ◽  
Age At Diagnosis ◽  
Diagnostic Tools ◽  
Voiding Cystourethrogram ◽  
Diagnosis And Management ◽  
Congenital Hydronephrosis ◽  
Significant Difference

Objective: To evaluate problems in diagnosis and management of congenital hydronephrosis. Material & methods: This study was retrospective. Data was collected from medical records of patients with congenital hydronephrosis, which were hospitalized or went to urologic outpatient clinic at Ciptomangunkusumo Hospital from January 1999 to December 2008 and Harapan Kita Maternal and Pediatric Hospital from January 2004 to December 2008. Data was analyzed with SPSS programme version 13.0. Statistical analysis was performed to find the relationship between age at diagnosis and kidney function (Mann-Whitney test) and between age at diagnosis and nephrectomy rate (Chi-Square test). Results: There were 15 patients who presented because of antenatal diagnosis. Of the 145 patients, we could collect antenatal history only from 63 patients.  Obstetricians provided antenatal care in 56 out of 63 patients. Antenatal ultrasound was performed in only 59 out of 63 patients and only 44,07% (26 patients) with hydronephrosis was detected antenatally. Eleven out of 26 antenatally diagnosed patients came to our clinic at a later age. Three standard studies (postnatal ultrasound, voiding cystourethrogram, and renal scintigraphy) were performed only in 12 out of 145 patients (8,27%). Ultrasound was performed in 108 patients (74,5%), voiding cystourethrogram in 79 patients (54,5%), and renal scintigraphy in only 26 ptients (17,9%). The suggested management was conducted in 115 patients; operative management in 95 patients (82,61%) and conservative treatment in 20 patients (17,39%). The most common operative procedures were ureteroneocystostomy, pyeloplasty, nephrectomy, and posterior urethral valveablation. Mean serum creatinine in below 12 months old group and above 12 months old group was 0,78±0,93mg/dl dan 1,03±0,88 mg/dl respectively(p<0,05). There was no significant difference in nephrectomy rate in both age groups (p>0,05). Nephrectomy was performed in 16 patients, with the most common indication was grade IV hydronephrosis with thin parenchyma in 11 patients (68,75%) and the most common etiology was UPJ obstruction in 10 patients (62,5%). We can only collect follow up data from 73 out of 115 managed patients (63,48%). Urinalysis, ultrasound/voiding cystourethrogram, and renal function studies were not routinely conducted during follow up. Conclusion: The management of congenital hydronephrosis in Indonesia needs improvements in antenatal care standards, particularly obstetric ultrasound, to improve early detection of congenital hydronephrosis. Better education for parents about the importance of follow up is needed, especially for antenatally diagnosed patients. A consensus regarding diagnostic tools used in managing congenital hydronephrosis must be established among urologists, pediatricians, and radiologists.

scholarly journals The Long-Term Follow-Up of Patients with Cystine Stones: A Single-Center Experience for 13 Years

2021 ◽  
Vol 10 (7) ◽  
pp. 1336
Author(s):  
Toshifumi Takahashi ◽  
Shinya Somiya ◽  
Katsuhiro Ito ◽  
Toru Kanno ◽  
Yoshihito Higashi ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Median Number ◽  
Small Sample ◽  
Age At Diagnosis ◽  
Surgical Interventions ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Cystine Stones

Introduction: Cystine stone development is relatively uncommon among patients with urolithiasis, and most studies have reported only on small sample sizes and short follow-up periods. We evaluated clinical courses and treatment outcomes of patients with cystine stones with long-term follow-up at our center. Methods: We retrospectively analyzed 22 patients diagnosed with cystine stones between January 1989 and May 2019. Results: The median follow-up was 160 (range 6–340) months, and the median patient age at diagnosis was 46 (range 12–82) years. All patients underwent surgical interventions at the first visit (4 extracorporeal shockwave lithotripsy, 5 ureteroscopy, and 13 percutaneous nephrolithotripsy). The median number of stone events and surgical interventions per year was 0.45 (range 0–2.6) and 0.19 (range 0–1.3) after initial surgical intervention. The median time to stone events and surgical intervention was 2 years and 3.25 years, respectively. There was a significant difference in time to stone events and second surgical intervention when patients were divided at 50 years of age at diagnosis (p = 0.02, 0.04, respectively). Conclusions: Only age at a diagnosis under 50 was significantly associated with recurrent stone events and intervention. Adequate follow-up and treatment are needed to manage patients with cystine stones safely.

scholarly journals FRI0212 THE ROLE OF AGE ON THE CLINICAL PRESENTATION AND RELAPSE RATES IN A LARGE COHORT OF 720 PATIENTS WITH GIANT CELL ARTERITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 689.1-690
Author(s):  
S. Monti ◽  
L. Dagna ◽  
C. Campochiaro ◽  
A. Tomelleri ◽  
G. Zanframundo ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Relapse Rate ◽  
Clinical Presentation ◽  
Age Groups ◽  
Age At Diagnosis ◽  
First Relapse ◽  
Time To Relapse

Background:Giant cell arteritis (GCA) is the most frequent systemic vasculitis after the age of 50 years old. Recent interest in the processes of immune and vascular aging have been proposed as a disease risk factor. Data on the impact of age at diagnosis of GCA on the clinical course of the disease are scarceObjectives:To assess the role of age at diagnosis of GCA on the risk and time to relapseMethods:Centres participating in the Italian Society of Rheumatology Vasculitis Study Group retrospectively enrolled patients with a diagnosis of GCA until December 2019. The cohort was divided in tertiles according to age at diagnosis (≤ 72; 73-79; > 79 years old). Negative binomial regression was used to assess the relapse rate according to age groups, and Cox regression for time to first relapse.Results:Of 720 patients enrolled in 14 Italian reference centres, 711 had complete follow-up data (female 50%; mean age 75±7). Median follow-up duration was 34 months (IQR 16;70). Patients in the older group at diagnosis (> 79 years) had more frequent visual loss compared to the 73-79 and ≤ 72 age groups (31% vs 20% vs 7%; p<0.001), but lower rates of general symptoms (56% vs 70% vs 77%; p<0.001). Large-vessel (LV)-GCA was less frequent in the older group (18% vs 22% vs 43%; p<0.001). At least one relapse occurred in 47% of patients. Median time to relapse was 12 months (IQR 6;23). Age did not influence the rate of relapses [18 per 100 persons/years (95%CI 15;21) vs 19 (95% CI 17;22) vs 19 (95%CI 17;22)], nor the time to first relapse (Figure 1). LV-GCA, presentation with significantly elevated c-reactive protein (> 50 mg/L) and general symptoms were independent predictors of relapse.Conclusion:Age at diagnosis of GCA influenced the clinical presentation and risk of ischaemic complications, but did not affect the relapse rate during follow-up. LV-GCA occurred more frequently in younger patients and was an independent predictor of relapse risk, highlighting the need for a correct characterization of the clinical subtype at the early stages of disease.Disclosure of Interests:Sara Monti: None declared, Lorenzo Dagna Grant/research support from: Abbvie, BMS, Celgene, Janssen, MSD, Mundipharma Pharmaceuticals, Novartis, Pfizer, Roche, SG, SOBI, Consultant of: Abbvie, Amgen, Biogen, BMS, Celltrion, Novartis, Pfizer, Roche, SG, and SOBI, Corrado Campochiaro Speakers bureau: Novartis, Pfizer, Roche, GSK, SOBI, Alessandro Tomelleri: None declared, Giovanni Zanframundo: None declared, Catherine Klersy: None declared, Francesco Muratore: None declared, Luigi Boiardi: None declared, Roberto Padoan: None declared, Mara Felicetti: None declared, Franco Schiavon: None declared, Milena Bond: None declared, Alvise Berti: None declared, Roberto Bortolotti: None declared, Carlotta Nannini: None declared, Fabrizio Cantini: None declared, Alessandro Giollo: None declared, Edoardo Conticini: None declared, angelica gattamelata: None declared, Roberta Priori: None declared, Luca Quartuccio Consultant of: Abbvie, Bristol, Speakers bureau: Abbvie, Pfizer, Elena Treppo: None declared, Giacomo Emmi: None declared, Martina Finocchi: None declared, Giulia Cassone: None declared, Ariela Hoxha Speakers bureau: Celgene, UCB, Novartis, Sanofi, Werfen, Rosario Foti Consultant of: lilly, sanofi, MSD, Janssen, Abbvie, BMS, celgene, roche, Speakers bureau: lilly, sanofi, MSD, Janssen, Abbvie, BMS, celgene, roche, Michele Colaci: None declared, Roberto Caporali Consultant of: AbbVie; Gilead Sciences, Inc.; Lilly; Merck Sharp & Dohme; Celgene; Bristol-Myers Squibb; Pfizer; UCB, Speakers bureau: Abbvie; Bristol-Myers Squibb; Celgene; Lilly; Gilead Sciences, Inc; MSD; Pfizer; Roche; UCB, Carlo Salvarani: None declared, Carlomaurizio Montecucco: None declared

scholarly journals Partial pulpotomy without age restriction: a retrospective assessment of permanent teeth with carious pulp exposure

2021 ◽  
Author(s):  
Florin Eggmann ◽  
Thomas J. W. Gasser ◽  
Hanjo Hecker ◽  
Mauro Amato ◽  
Roland Weiger ◽  
...  
Keyword(s):  
Survival Rates ◽  
Age Groups ◽  
Permanent Teeth ◽  
Eligibility Criteria ◽  
Presumptive Diagnosis ◽  
Tooth Discoloration ◽  
Significant Difference ◽  
Pulp Exposure ◽  
The Mean

Abstract Objectives This study aimed to retrospectively evaluate clinical and radiographic outcomes of partial pulpotomy performed in permanent teeth with carious pulp exposure. Materials and methods Records of patients undergoing treatment at an undergraduate dental clinic between 2010 and 2019 were screened for partial pulpotomies in teeth with a presumptive diagnosis of normal pulp or reversible pulpitis. The follow-up had to be ≥ 1 year. Patient data were retrieved and analyzed using Mantel-Cox chi square tests and Kaplan–Meier statistics. The level of significance was set at α = 0.05. Results Partial pulpotomy was performed in 111 cases, of which 64 (58%) fulfilled the eligibility criteria. At the time of partial pulpotomy, the mean age was 37.3 (± 13.5) years (age range 18–85). The mean observation period was 3.1 (± 2.0) years. Two early failures (3.1%) and five late failures (7.7%) were recorded. The overall success rate of maintaining pulp vitality was 89.1%, with 98.4% tooth survival. The cumulative pulp survival rates of partial pulpotomy in patients aged < 30 years, between 30 and 40 years, and > 40 years were 100%, 75.5%, and 90.5%, respectively, with no significant difference between the age groups (p = 0.225). At follow-up, narrowing of the pulp canal space and tooth discoloration were observed in 10.9% and 3.1% of cases, respectively. Conclusions Across age groups, partial pulpotomy achieved favorable short and medium-term outcomes in teeth with carious pulp exposure. Clinical relevance Adequate case selection provided, partial pulpotomy is a viable operative approach to treat permanent teeth with deep carious lesions irrespective of patients’ age.

Abstract 14338: Prevalence, Associations and Outcomes of Double Orifice and Parachute Mitral Valve

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
uzoma obiaka ◽  
Anna Chow ◽  
Jen Lie Yau ◽  
Valeria Matto Morina ◽  
Shubhika Srivastava
Keyword(s):  
Mitral Valve ◽  
Age At Diagnosis ◽  
Text Search ◽  
Associated Lesions ◽  
Significant Difference ◽  
Parachute Mitral Valve ◽  
Valve Function ◽  
Echocardiographic Images ◽  
Double Orifice

Background: The incidence of congenital mitral valve disease is 0.4%; Double Orifice Mitral Valve (DOMV) and Parachute Mitral Valve (PMV) are two morphologic pathologies that may result in mitral valve dysfunction. The objectives of this study are 1) To describe valve function and progression and 2) To define factors contributing to disease progression. Methods: Retrospective database review. Fyler codes for DOMV, PMV and text search was performed. Echocardiographic images, echo reports, and chart review were used to identify mitral regurgitation (MR), mitral stenosis (MS), morphology, and associated lesions. Results: 39 patients with DOMV and 76 patients with PMV were identified. In the DOMV cohort, 51% were male, median age at diagnosis was 0.17 years (IQR 0.01, 3.88); median follow-up of 5.92 years (IQR 0.46, 10.22). In the PMV cohort, 44% were male, median age at diagnosis at was 0.01 years (IQR 0, 0.34); median follow-up of 2.56 years (IQR 0.25, 9.55). 41% of DOMV and 23% of patients with PMV had normal valve function at initial visit. DOMV was associated with MR (p=0.04), and PMV with MS (p<0.0001). 23% of patients in the PMV cohort had progressive MS compared to 5% of patients in the DOMV cohort (p<0.0001). There was no significant difference in MR progression between both groups (p=0.02). Papillary muscle (PM) morphology was evaluated in 37 (excluding canals) of 76 patients in the PMV cohort. 5 had true PMV (single PM), 32 had variant PMV with two PM groups of which 62.5% had dominant posterior medial PM. 67% of those with posterior medial PM dominance had progressive MS irrespective of association with Shone’s complex. The anterolateral PM muscle group dominant PMV were not associated with Shone’s complex and progressive MS. Conclusion: DOMV are more likely to have MR while PMV are more likely to have MS. DOMV has non progressive MR and MS. Posterior medial PM dominance in PMV is more likely to have progressive MS.

scholarly journals Incidence of Infection of Enterovirus 71 and Coxsackieviruses A6 and A16 among Household Contacts of Index Cases in Dong Thap Province, Southern Vietnam

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
C. Q. Hoang ◽  
H. D. Nguyen ◽  
N. X. Ho ◽  
T. H. T. Vu ◽  
T. T. M. Pham ◽  
...  
Keyword(s):  
Neutralizing Antibodies ◽  
Geometric Mean ◽  
Age Groups ◽  
Enterovirus 71 ◽  
Foot And Mouth Disease ◽  
Household Contacts ◽  
Significant Difference ◽  
Antibody Titers ◽  
Index Cases

Background. Scarce information exists about immunity to hand, foot, and mouth disease (HFMD) among household contacts of index cases in Vietnam and what that means for reducing ongoing HFMD transmission in the community. Methods. We analyzed neutralizing antibodies (NT) and the incidence of enterovirus (EVs) infection among household contacts of index cases in a province where HFMD remains endemic. Throat swab and 2 mL blood samples from household contacts were collected at enrollment, during and after 2 weeks follow-up. Results. The incidence of EV-A71 infection among household contacts was 40/84 (47.6%, 95% Cl: 36.9-58.3%), compared with 106/336 (31.5%, 95% Cl: 26.6-36.5%) for CV-A6 and 36/107 (33.6%, 95% Cl: 24.7-42.6%) for CV-A16. The incidence of CV-A6 infection was fairly constant across ages; in contrast, CV-A71 and CV-A16 had some variation across ages. At baseline, higher geometric mean titer (GMT) of EV-A71, CV-A6, and CV-A16 antibody titers was found for 25-34-year groups (range 216.3 to 305.0) compared to the other age groups. There was a statistically significant difference in GMT values of CV-A6 and CV-A16 between those who had an infection or did not have infection among households with an index case of these serotypes. Conclusions. Our results indicated that adults were becoming infected with HFMD and could be contributing to the transmission. There is, therefore, a need for considering the household setting as an additional target for intervention programs for HFMD.

Randomized Comparison of IV PEG and IM E. Coli Asparaginase in Children and Adolescents with Acute Lymphoblastic Leukemia: Results of the DFCI ALL Consortium Protocol 05-01

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 874-874 ◽  
Author(s):  
Lewis B. Silverman ◽  
Kristen Stevenson ◽  
Lynda M Vrooman ◽  
Jeffrey G Supko ◽  
Barbara Asselin ◽  
...  
Keyword(s):  
Enzyme Activity ◽  
Children And Adolescents ◽  
Lymphoblastic Leukemia ◽  
Age Groups ◽  
Serum Samples ◽  
Childhood All ◽  
E Coli ◽  
Significant Difference ◽  
Consolidation Phase

Abstract Abstract 874 E. coli L-asparaginase (E. coli ASP) is an important component of treatment for childhood ALL, but is associated with multiple toxicities, including allergy, pancreatitis, and thrombosis. It is typically given intramuscularly (IM). Because most pediatric ALL patients have indwelling venous catheters, intravenous (IV) administration of asparaginase would be a more convenient and less painful option than IM injection. PEG-asparaginase (PEG), the polyethylene glycol conjugate of E. coli ASP, has a longer circulating half-life and so may be given less frequently. We have previously demonstrated that a single dose of PEG 2500 IU/m2 given IV is tolerable in children with ALL, with potentially therapeutic serum enzyme activity (≥ 0.1 IU/mL) maintained for at least 18 days in most patients.[Blood 2010;115:1351-3] On DFCI ALL Consortium Protocol 05-01, all patients (pts) with newly diagnosed ALL aged 1–18 years (yrs) who achieved complete remission were eligible to participate in a randomized comparison of IM E. coli ASP and IV PEG during the 30-week (wk) multi-agent post-induction Consolidation phase. Beginning at week 7 of therapy, pts received either IM E. Coli ASP 25000 IU/m2 weekly × 30 wks or IV PEG 2500 IU/m2 every 2 wks × 30 wks. Serum samples were obtained every 6 wks just prior to an ASP dose and were assayed for ASP enzyme activity by a validated biochemical assay. Between 2005–2010, 463 pts were enrolled in the randomized comparison. Median age was 5 yrs (range 1.2–17.9 yrs). There was no significant difference in presenting characteristics between the two arms, except that more pts on the E. coli ASP arm presented with a mediastinal mass (9% vs 3%, p=0.04). Median follow-up was 2.8 years. Median nadir serum ASP activity (NSAA) at each assayed timepoint during the Consolidation phase was significantly higher with IV PEG than with IM E. coli ASP (Table 1). An NSAA of ≥ 0.1 IU/mL was achieved in ≥ 95% of IV PEG pts compared with < 50% of IM E. coli ASP pts (p<0.01 at each timepoint). There was no significant difference in ASP-related toxicities (allergy, pancreatitis, thrombosis) between the two types of ASP (Table 2). Older pts (≥ 10 yrs old) had a significantly higher overall rate (p<0.01) of pancreatitis (18% vs 7%) and thrombosis (18% vs 4%), but not of allergy (p=0.49) or infection (p=0.21), compared to younger pts. There was no significant difference in the rates of ASP-related toxicities when comparing IM E. coli ASP vs IV PEG separately within the two age groups (≥10 yrs and < 10 yrs). We conclude that every 2-week IV PEG is no more toxic than weekly IM E. coli ASP in children and adolescents with ALL, and is associated with higher serum ASP activity. Longer follow-up is necessary to determine whether there is any difference in event-free survival between the two treatment arms.Table 1:Nadir Serum ASP activity (NSAA) during 30-week Consolidation phaseIV PEGIM ECOLISample Time (wks)*NMedian IU/mL% pts with NSAA ≧ 0.10 IU/mLNMedian IU/mL% pts with NSAA ≧ 0.10 IU/mL5840.6795%920.09448%11700.7197%740.09447%17730.7697%860.09247%23600.70100%760.09446%29680.70100%630.09544%*Number of weeks after start of Consolidation phaseTable 2:Toxicities by ASP type during 30-week Consolidation phaseToxicityIV PEG # of pts (%)IM E. COLI # of pts (%)p-valueNumber of Patients232231Asparaginase Toxicity59 (25)58 (25)>0.99    Allergy26 (11)20 (9)0.44    Pancreatitis25 (11)21 (9)0.64        Mild/Moderate13 (6)13 (6)        Severe12 (5)8 (3)    Thrombosis14 (6)21 (9)0.22Infection (bacteremia, invasive fungal disease)35 (15)46 (20)0.18 Disclosures: Silverman: Enzon Pharmaceuticals: Honoraria. Supko:Enzon Pharmaceuticals: Research Funding. Sallan:Enzon Pharmaceuticals: Honoraria.

scholarly journals Role of dorsal onlay buccal mucosal graft urethroplasty for long anterior urethral strictures

2021 ◽  
Vol 9 (10) ◽  
pp. 3110
Author(s):  
Vedamurthy Reddy Pogula ◽  
Ershad Hussain Galeti ◽  
Venkatesh Velivela ◽  
Bhargava Reddy Kanchi
Keyword(s):  
Statistical Difference ◽  
Age Groups ◽  
Factors Affecting ◽  
Urethral Strictures ◽  
Buccal Mucosal Graft ◽  
Significant Difference ◽  
Dorsal Onlay ◽  
The Mean

Background: Treatment of the urethral strictures is challenging and with appropriate evaluation preoperatively and surgery planning it is possible to achieve good results. The objective of the study was to evaluate the efficacy of dorsal onlay buccal mucosal graft urethroplasty in treating long anterior urethral strictures.Methods: Between August 2018 to July 2019 a total of 25 patients with anterior urethral stricture were treated with dorsal onlay buccal mucosal graft urethroplasty. Age, etiology of the stricture, stricture length (≤ 7 cm, and > 7 cm), and site of the stricture were assessed as the factors affecting the success rate.Results: The clinical outcome as Success was defined as the patient not needing any form of urethral instrumentation postoperatively. The mean follow-up period was 18 months. Of 25 patients, 22 (92%) were successful and 3 (8%) were a failure. There was no statistically significant difference between the age groups, etiology of the stricture and success rate (p=0.21 and p=0.444). The statistical difference was significant for the site and length of the stricture by means of success (p=0.005 and p=0.025).Conclusions: Our results show stricture length and localization are the most important variables for good success. Because of less failure rate, single-stage dorsal onlay buccal mucosal graft urethroplasty may be offered as an alternative to staged urethroplasty in case of long urethral strictures.  

Clinical trial enrollment and follow-up visit rates among survivors of childhood cancer.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 22-22
Author(s):  
Kelley Kennedy Hutchins ◽  
Sureyya Savasan ◽  
Ronald Thomas ◽  
Laura Strathdee ◽  
Jeffrey Warren Taub
Keyword(s):  
Clinical Trial ◽  
Cancer Treatment ◽  
Childhood Cancer ◽  
Survival Rates ◽  
Age At Diagnosis ◽  
Treatment Center ◽  
Increased Risk ◽  
Significant Difference

22 Background: Childhood cancer treatment outcomes have improved substantially with five-year overall survival rates reaching greater than 80%. However, survivors are at increased risk of long-term complications, and long-term follow-up (LTFU) is critical. Distance from a cancer treatment center and increased time from completion of therapy have been associated with decreased LTFU rates. We studied whether lack of enrollment in a therapeutic clinical trial may be an additional barrier to receiving LTFU care. Methods: We conducted a retrospective review of 353 patient records at the Children’s Hospital of Michigan enrolled in our Children’s Oncology Group (COG) registry between 1/1/05-12/31/10. All patients were ≤ 25 years of age at diagnosis.Sixty-seven patients were excluded (died prior to follow-up, n = 61; still on therapy, n = 5; insufficient information, n = 1). A total of 286 patient charts were available for analysis after exclusion. One hundred sixty-two (57%) patients were enrolled in a therapeutic clinical trial, and 124 (43%) were enrolled in a biology study alone due to lack of an open therapeutic clinical trial at the time of diagnosis. One hundred eighty-six (65%) patients were < 10 years of age at diagnosis. Results: Follow-up rates at one-, two- and five-years following completion of therapy for patients enrolled in a therapeutic clinical trial were 94.5%, 91.9% and 74%, respectively, compared to 82.9% (p = 0.002), 74% (p < 0.001) and 66% (p = 0.029) for patients not enrolled. The follow-up rate at five-years for patients who were < 10 years of age was 77.5% compared to 70.7% (p = 0.007) for patients > 10 years. There was no significant difference at one- or two-years based on age at diagnosis. Conclusions: Our findings demonstrate that patients enrolled in a therapeutic clinical trial have significantly superior LTFU rates compared to patients enrolled in biology studies alone. Younger age at diagnosis demonstrated a superior rate at five-years of follow-up. Our findings suggest that additional resources/strategies must be utilized to ensure better LTFU for patients not enrolled in therapeutic clinical trials.

scholarly journals The usefulness of 99mTc-sestaMIBI thyroid scan in the differential diagnosis and management of amiodarone-induced thyrotoxicosis

2008 ◽  
Vol 159 (4) ◽  
pp. 423-429 ◽  
Author(s):  
M Piga ◽  
M C Cocco ◽  
A Serra ◽  
F Boi ◽  
M Loy ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Laboratory Data ◽  
Diagnostic Tools ◽  
Radioiodine Uptake ◽  
Free Thyroid Hormones ◽  
Hormone Synthesis ◽  
Therapeutic Implications ◽  
Diagnosis And Management ◽  
Mibi Scintigraphy

BackgroundAmiodarone-induced thyrotoxicosis (AIT) is caused by excessive hormone synthesis and release (AIT I) or a destructive process (AIT II). This differentiation has important therapeutic implications.PurposeTo evaluate 99mTc-sestaMIBI (MIBI) thyroid scintigraphy in addition to other diagnostic tools in the diagnosis and management of AIT.Subjects and methodsThyroid and 99mTc-MIBI scintigraphies were performed in 20 consecutive AIT patients, along with a series of biochemical and instrumental investigations (measurement of thyrotrophin, free thyroid hormones and thyroid autoantibodies; thyroid colour-flow Doppler sonography (CFDS) and thyroid radioiodine uptake (RAIU)).ResultsOn the basis of instrumental and laboratory data (excluding thyroid 99mTc-MIBI scintigraphy) and follow-up, AIT patients could be subdivided into six with AIT I, ten with AIT II and four with indefinite forms of AIT (AIT Ind). 99mTc-MIBI uptake results were normal/increased in all the six patients with AIT I and absent in all the ten patients with AIT II. The remaining four patients with AIT Ind showed low, patchy and persistent uptake in two cases and in the other two evident MIBI uptake followed by a rapid washout. MIBI scintigraphy was superior to all other diagnostic tools, including CFDS (suggestive of AIT I in three patients with AIT II and of AIT II in three with AIT Ind) and RAIU, which was measurable in all patients with AIT I, and also in four out of the ten with AIT II.ConclusionThyroid MIBI scintigraphy may be proposed as an easy and highly effective tool for the differential diagnosis of different forms of AIT.

Transfusion Practices in Myelodysplastic Syndromes: Preliminary Results of An Epidemiologic and Economical Study

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4336-4336
Author(s):  
Matthieu Filloux ◽  
Adrien Chauchet ◽  
Yvan Beaussant ◽  
Chrystelle Vidal ◽  
Franck Leroux ◽  
...  
Keyword(s):  
Myelodysplastic Syndromes ◽  
Transfusion Requirement ◽  
Conflicts Of Interest ◽  
Age Groups ◽  
Iron Chelation ◽  
Low Risk ◽  
Economic Study ◽  
Transfusion Threshold ◽  
Significant Difference

Abstract Abstract 4336 Background Despite the improvements and promises of novel agents (demethylating and erythropoiesis stimulating agents), red blood cells (RBC) and platelets transfusion remains frequent and essential in the management of myelodysplastic syndromes (MDS). Reducing patients’ dependence to transfusion is a major outcome, linked with the disease prognosis, patients’ quality of life and economical issues. Few data in the literature have described transfusions practices and requirements in MDS patients. We report here an epidemiological study of the transfusion practices in our center and try to build an economical evaluation of direct transfusions costs. Design and Methods We conducted a retrospective, descriptive study including all new patients diagnosed with MDS in the department of haematology of Besan□ on between 2006 and 2009. Patients were classified as high risk (HR) MDS when IPSS was ≥ 1.5, and as low risk (LR) when IPSS was ≤ 1. We compared HR and LR groups and four categories of age (≤68; [68–76]; [76–83] and >83 years) according to transfusion data. The economic study compared direct costs of RBC transfusions and erythroipoiesis-stimulating agents for LR and HR patients, including the costs of hospital stays. Materials, transport, medical examinations, doctors’ and nurses’ wages and iron chelation were not considered in this analysis. T-test and χ2-test were used for comparisons. Results 205 patients were analysed, median age at diagnosis was 74.3 years (table 1), with a predominance of men (sex ratio 1.33). IPSS score was available for 75% of patients (n=154), 111 LR patients and 43 HR patients. Median follow-up was 32 months [10–57]. Twenty-three patients (11%) developed a secondary acute leukaemia and 11 (5%) received allogeneic stem cell transplantation. At diagnosis, hemoglobin (Hb) level was not significantly different between HR and LR patients. Platelets level was lower in the HR vs LR (109 vs. 178 G/L respectively, p<0.0001). 60.5% of patients (n=124/205) received labile blood products during the follow-up, more frequently RBC than platelets (87.5% vs. 12.5% respectively). The mean Hb threshold at transfusion was 8.1 g/dl without any significant difference between neither age groups nor IPSS; age did not influenced transfusion requirement (Table 2). In comparison to HR patients, LR patients were less transfused (55 vs. 79%, p<0.006, table 2), and had longer mean intervals between transfusions (32.5 vs. 16.9 days, p<0.001). Furthermore, a progressive shortening of transfusion intervals was observed for both groups along the time; this progression was faster for HR patients. The anti-erythrocyte immunization rates, excluding anti-RH or anti-Kell, was 6.7%. Economical analysis showed that annual costs of RBC transfusion were 11,409 euros in LR patients and 21,945 euros in HR patients versus 11,492 euros for EPO. Conclusion In our study, neither transfusion requirement nor transfusion threshold were correlated with age, whereas both were affected by IPSS. Furthermore, age did not appear to be a predictive factor concerning the transfusion dependence. Despite its limits, the economic study reveals that EPO and transfusion's annual costs are similar in low risk patients. Updated data will be presented on EPO and 5-azacytidine use in our cohort to assess their impact on transfusion practices. Disclosures: No relevant conflicts of interest to declare.

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