scholarly journals Comparison of Clinical and Pathological Characteristics Between Extremely Multiple GGNs and Single GGNs

2021 ◽  
Vol 11 ◽  
Author(s):  
Xin Wang ◽  
Manqi Wu ◽  
Haifeng Shen ◽  
Yuntao Nie ◽  
Kai Zhang ◽  
...  
Keyword(s):  
Pulmonary Nodules ◽  
Demographic Characteristics ◽  
Smoking History ◽  
Tumor Characteristics ◽  
Invasive Adenocarcinoma ◽  
Pathological Characteristics ◽  
Surgical Methods ◽  
Ground Glass Nodules ◽  
Multiple Nodules

ObjectiveThis study aims to compare the clinical and pathological characteristics between patients undergoing surgery for extremely multiple ground-glass nodules (GGNs) and those for single GGN.MethodsWe defined extremely multiple GGNs as follows: (i) number of GGNs ≥3, (ii) GGN diameter between 3 and 30 mm, and (iii) no less than three nodules that were surgically removed and pathologically diagnosed. Patients with extremely multiple GGNs and single GGNs who underwent surgery at the same time were retrospectively analyzed. The patients were divided into three groups according to the number of nodules: exceedingly multiple nodules (EMN) group (>10), highly multiple nodules (HMN) group (three to 10), and single nodule (SN) group. The clinical and pathological characteristics, surgical methods and prognosis were analyzed.ResultsNinety-nine patients with single nodules and 102 patients with extremely multiple nodules were enrolled. Among the patients with extremely multiple nodules, 43 (42.2%) had >10 nodules. There were no significant differences in demographic characteristics, such as age, sex, and smoking history, between the groups, but there were differences in tumor characteristics. All patients with >10 nodules showed bilateral pulmonary nodules and presented with both pure and mixed GGNs. The single GGNs were smaller in diameter, and the proportion of mixed GGNs and pathologically invasive adenocarcinoma was lower than that of the primary nodules in the exceedingly multiple GGNs group (p < 0.05). However, the proportion of both mixed GGNs and malignant nodules decreased significantly with the increasing number of total lesions. During postoperative follow-up, one patient in the highly multiple nodules group had a local recurrence, and 16 (15.7%) patients in the extremely multiple GGNs group and 10 (9.8%) patients in the single GGN group had enlarged unresected GGNs or additional GGNs.ConclusionsOur study revealed the clinical and pathologic characteristics, surgical methods, and prognosis of patients with extremely multiple GGNs and compared them with those of patients with a single GGN. Although the primary nodules in extremely multiple GGNs may have higher malignancy than those in the single nodule group, the proportion of both mGGNs and malignant nodules decreased significantly with the increasing number of lesions, and the prognosis of patients with extremely multiple GGNs was satisfied.

Implementing a care model to enhance patient outcomes and limit liability in patients with incidental pulmonary nodules.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18247-e18247
Author(s):  
Ruth Raleigh ◽  
Vita McCabe ◽  
Alisa Soos ◽  
Alice Pichan ◽  
Beth Irene Lavasseur ◽  
...  
Keyword(s):  
Health Care ◽  
At Risk ◽  
Care Delivery ◽  
Pulmonary Nodules ◽  
Smoking History ◽  
Inpatient Setting ◽  
Care Model ◽  
Radiology Reports ◽  
Nurse Navigator

e18247 Background: Patients with incidental pulmonary nodules are at risk for loss to follow-up due to fragmented health care delivery systems. The purpose of this study is to describe implementation of a care model to eliminate gaps in care for these patients. Methods: A multifaceted intervention was implemented to improve follow-up of incidental pulmonary nodules in at-risk patients. The intervention included education of all patients with incidental nodules in the emergency room and inpatient setting upon discharge. Other key steps included: (i) engagement of physician leadership, (ii) development of a patient tracking database, (iii) designation of a nurse navigator to ensure timely notification of radiological findings, (iv) ensuring patients received timely follow-up and (v) coordination communication with the primary care physician (PCP) or assistance in establishing a relationship with a PCP. Finally, smoking history was added to all CT body radiology reports to stratify risk and determine follow-up intervals using nationally accepted guidelines. The study was reviewed by the St Joseph Mercy Health System Institutional Review Board and was considered exempt. Results: Over the course of 36 months, 7,962 patients with incidental pulmonary nodules were identified by radiologists and flagged for entry into the follow-up program. 2.6% of patients enrolled were found to have lung neoplasms (68% of which were stage I, II or III non-small cell lung cancer). Conclusions: Integrated care models with a seamless combination of nurse navigation and optimal use of health information technology improves care and outcomes for patients with incidental pulmonary nodules while simultaneously mitigating liability for physicians and health care institutions.

The natural history of preoperative indeterminate pulmonary nodules in patients with resectable pancreatic adenocarcinoma.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 161-161
Author(s):  
Dennis C. Nguyen ◽  
Stephanie Chang ◽  
Zhou Gongfu ◽  
Andrea Wang-Gillam ◽  
David Linehan ◽  
...  
Keyword(s):  
Overall Survival ◽  
Natural History ◽  
Pancreatic Adenocarcinoma ◽  
Preoperative Evaluation ◽  
Pulmonary Nodules ◽  
Metastatic Adenocarcinoma ◽  
History Of ◽  
Head Of The Pancreas ◽  
Ground Glass Nodules

161 Background: Preoperative abdominal imaging often detects indeterminate pulmonary nodules (IPN) in patients with resectable pancreatic adenocarcinoma. The natural history of IPN in this setting is not well characterized. Methods: Patients with adenocarcinoma of the head of the pancreas who underwent pancreaticoduodenectomy (PD) were queried from a prospectively maintained database. Pre- and postoperative imaging was reviewed and IPN characterized and analyzed for associations with nodule progression and overall survival (OS). Results: 463 patients underwent PD for adenocarcinoma of the head of the pancreas from 2000-2010. Of these, 329 (71%) had reviewable pre-operative imaging. 48 patients (15%) had pre-operative IPN (non-calcified) identified with follow-up imaging available for review. The only pre-operative factor associated with the presence of IPN was increasing age (68 v. 64 years; p=0.003). 8 patients (12%) had new or enlarging nodules, of whom 5 (7%) had confirmed pulmonary metastatic adenocarcinoma. There was no difference in OS between patients with or without pre-operative IPN (2-year OS 41% v. 38%, respectively; p=0.37). Further, no radiographic criteria of IPN (including # of, size of, bilateral, calcified, solid, spiculated, smooth, lobular, or ground-glass nodules) was associated with OS. On follow-up, new or enlarging nodules were not associated with OS. Conclusions: IPN are often found in patients undergoing PD for pancreatic adenocarcinoma. The majority of IPN remain stable on post-operative imaging. Neither the presence of IPN nor nodule characteristics was associated with OS. These data do not support the routine additional workup of pre-operative IPN in patients with resectable adenocarcinoma of the head of the pancreas; however, larger studies are needed to further characterize the significance of IPN in the preoperative evaluation of patients with pancreatic adenocarcinoma.

Evaluating pulmonary nodules to detect lung cancer: Does Fleishner criteria really work?

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e13053-e13053
Author(s):  
Muhammad Azharuddin ◽  
Aamir Malik ◽  
Noor Adamo ◽  
Douglas S Livornese
Keyword(s):  
Lung Cancer ◽  
Pulmonary Nodules ◽  
Smoking History ◽  
Ct Scans ◽  
Screening Methods ◽  
Cancer History ◽  
Entire Cohort ◽  
Risk Of Malignancy ◽  
Small Pulmonary Nodules

e13053 Background: The Fleishner Society recommends interval computed tomography (CT) follow-up for managing incidental small pulmonary nodules detected in CT scans. This study evaluates the clinical application of 2013 Fleishner criteria using a large cohort of patients at high risk for lung cancer with low-dose CT screening. Methods: During 2012-2016, a retrospective study of 176 patients was reviewed for incidental lung nodules. Patient eligibility included: men and women aged 55-74; 30 pack-year smoking history who quit in the last 15 years; no cancer history in the last 5 years; and no previous CT chest scan done. Follow-up and management was calculated using the Fleishner criteria. Nodules were classified based on several features including size and shape. Nodule characteristics were tabulated and analyzed. Results: Out of 176 patients, 117 had nodules and a total of 210 nodules were detected. Table 1 categorizes all nodule features including Fleishner Criteria. Of the entire cohort, two patients (1.1%) showed malignancy: one part-solid nodule of 10.2mm, and one multiple subsolid groundglass nodule (GGN) of 20.1mm. Twenty-one patients (17.9%) had undergone unnecessary follow-up CT scans, including those with solid nodules, and solitary pure GGNs. Conclusions: This study emphasizes the need to revise the Fleishner guidelines to more accurately estimate the risk of malignancy, including minimizing over-diagnosis, unnecessary follow-up CTs, and invasive procedures for benign pulmonary nodules. Further analysis of lung cancer contributory factors is also required. [Table: see text]

scholarly journals Factors distinguishing invasive from pre-invasive adenocarcinoma presenting as pure ground glass pulmonary nodules

2020 ◽  
Author(s):  
Huan-Huan Yang ◽  
Yi-Lv Lv ◽  
Xing-Hai Fan ◽  
Zhi-Yong Ai ◽  
Xiu-Chun Xu ◽  
...  
Keyword(s):  
Multivariable Analysis ◽  
Pulmonary Nodules ◽  
Ground Glass ◽  
Invasive Adenocarcinoma ◽  
Maximal Diameter ◽  
Serum Carcinoembryonic Antigen ◽  
Mean Diameter ◽  
Ct Density ◽  
Lung Adenocarcinomas

Abstract Background: To investigate predictors of pathological invasiveness and prognosis of lung adenocarcinoma in patients with pure ground-glass nodules (pGGNs). Methods: Clinical and computed tomography (CT) features of invasive adenocarcinomas (IACs) and pre-IACs were retrospectively compared in 641 consecutive patients with pGGNs and confirmed lung adenocarcinomas who had undergone postoperative CT follow-up. Potential predictors of prognosis were investigated in these patients. Results: Of 659 pGGNs in 641 patients, 258 (39.1%) were adenocarcinomas in situ, 265 (40.2%) were minimally invasive adenocarcinomas, and 136 (20.6%) were IACs. Respective optimal cutoffs for age, serum carcinoembryonic antigen concentration, maximal diameter, mean diameter, and CT density for distinguishing pre‑IACs from IACs were 53 years, 2.19 ng/mL, 10.78 mm, 10.09 mm, and −582.28 Hounsfield units (HU). Univariable analysis indicated that sex, age, maximal diameter, mean diameter, CT density, and spiculation were significant predictors of lung IAC. In multivariable analysis age, maximal diameter, and CT density were significant predictors of lung IAC. During a median follow-up of 41 months no pGGN IACs recurred. Conclusions: pGGNs may be lung IACs, especially in patients aged > 55 years with lesions that are > 1 cm in diameter and exhibit CT density > −600 HU. pGGN IACs of < 3 cm in diameter have good post-resection prognoses.

scholarly journals Unilateral lateral rectus recession is an effective surgery for intermittent exotropia in young children

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Oriel Spierer ◽  
Abraham Spierer
Keyword(s):  
Young Children ◽  
Success Rate ◽  
Lateral Rectus ◽  
Intermittent Exotropia ◽  
Age At Surgery ◽  
Surgical Methods ◽  
Before And After ◽  
The Mean ◽  
Consecutive Esotropia

Abstract Background Different surgical methods have been suggested for the correction of intermittent exotropia. Unilateral lateral rectus recession has been described as a surgical alternative for small and moderate-angle exotropia. In general, previous studies did not focus on the outcomes of unilateral lateral rectus recession in young children with intermittent exotropia. The purpose of this study is to evaluate the surgical outcomes of unilateral lateral rectus recession in the treatment of moderate-angle exotropia (≤ 25 PD (prism diopters)) in children. Methods The charts of all patients younger than 12 years of age with moderate-angle exotropia (up to 25 PD) who were operated during the years 2006–2018 were retrospectively reviewed. Fifty-eight patients underwent unilateral lateral rectus recession and had a minimum follow up of 6 months. The angle of exotropia (PD) before and after surgery and the success rate were documented. Results Mean age at surgery was 6.4 ± 1.9 (range 3.5–11.0) years. Exotropia improved from a preoperative angle of 21.4 ± 4.0 PD to 3.5 ± 5.9 PD postoperatively (p < 0.001). Success rate, defined as deviation of ≤ 10 PD, was achieved in 86.2%. There were 2 (3.4%) cases of overcorrection (consecutive esotropia). There were no intra- or postoperative complications. The mean follow-up duration after surgery was 2.3 ± 1.7 years. Conclusions In children with moderate angle exotropia, good postoperative success rate was achieved by performing unilateral lateral rectus recession.

scholarly journals Logistic regression analysis on risk factors of augmented vertebra recompression after percutaneous vertebral augmentation

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Zhongcheng An ◽  
Chen Chen ◽  
Junjie Wang ◽  
Yuchen Zhu ◽  
Liqiang Dong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Bone Cement ◽  
Vertebral Compression Fracture ◽  
Univariate Analysis ◽  
Compression Fracture ◽  
Osteoporotic Vertebral Compression Fracture ◽  
Vertebral Augmentation ◽  
Surgical Methods

Abstract Objective To explore the high-risk factors of augmented vertebra recompression after percutaneous vertebral augmentation (PVA) in the treatment of osteoporotic vertebral compression fracture (OVCF) and analyze the correlation between these factors and augmented vertebra recompression after PVA. Methods A retrospective analysis was conducted on 353 patients who received PVA for a single-segment osteoporotic vertebral compression fracture from January 2017 to December 2018 in our department according to the inclusion criteria. All cases meeting the inclusion and exclusion criteria were divided into two groups: 82 patients in the recompression group and 175 patients in the non-compression group. The following covariates were reviewed: age, gender, body mass index (BMI), injured vertebral segment, bone mineral density (BMD) during follow-up, intravertebral cleft (IVC) before operation, selection of surgical methods, unilateral or bilateral puncture, volume of bone cement injected, postoperative leakage of bone cement, distribution of bone cement, contact between the bone cement and the upper or lower endplates, and anterior height of injured vertebrae before operation, after surgery, and at the last follow-up. Univariate analysis was performed on these factors, and the statistically significant factors were substituted into the logistic regression model to analyze their correlation with the augmented vertebra recompression after PVA. Results A total of 257 patients from 353 patients were included in this study. The follow-up time was 12–24 months, with an average of 13.5 ± 0.9 months. All the operations were successfully completed, and the pain of patients was relieved obviously after PVA. Univariate analysis showed that in the early stage after PVA, the augmented vertebra recompression was correlated with BMD, surgical methods, volume of bone cement injected, preoperative IVC, contact between bone cement and the upper or lower endplates, and recovery of anterior column height. The difference was statistically significant (P < 0.05). Among them, multiple factors logistic regression elucidated that more injected cement (P < 0.001, OR = 0.558) and high BMD (P = 0.028, OR = 0.583) were negatively correlated with the augmented vertebra recompression after PVA, which meant protective factors (B < 0). Preoperative IVC (P < 0.001, OR = 3.252) and bone cement not in contact with upper or lower endplates (P = 0.006, OR = 2.504) were risk factors for the augmented vertebra recompression after PVA. The augmented vertebra recompression after PVP was significantly less than that of PKP (P = 0.007, OR = 0.337). Conclusions The augmented vertebra recompression after PVA is due to the interaction of various factors, such as surgical methods, volume of bone cement injected, osteoporosis, preoperative IVC, and whether the bone cement is in contact with the upper or lower endplates.

scholarly journals Enlarged inflammatory multiple ground-glass nodules of the lung over five years' follow-up: A surgical case report

2015 ◽  
Vol 29 (7) ◽  
pp. 890-895
Author(s):  
Naoya Yokomakura ◽  
Hiroo Nishijima ◽  
Masakazu Yanagi ◽  
Kazuhiro Wakida ◽  
Aya Harada ◽  
...  
Keyword(s):  
Case Report ◽  
Ground Glass ◽  
Surgical Case ◽  
Ground Glass Nodules

scholarly journals Providing Antismoking Socialization to Children After Quitting Smoking: Does It Help Parents Stay Quit?

2017 ◽  
Vol 32 (5) ◽  
pp. 1257-1263 ◽  
Author(s):  
Kim A. Hayes ◽  
Christine Jackson ◽  
Denise M. Dickinson ◽  
Audra L. Miller
Keyword(s):  
New York ◽  
Controlled Trial ◽  
Preliminary Evidence ◽  
Parenting Program ◽  
Smoking History ◽  
Group Differences ◽  
Quit Smoking ◽  
Home Based ◽  
Quitting Smoking

Purpose: To test whether an antismoking parenting program provided to parents who had quit smoking for ≥24 hours increased parents’ likelihood of remaining abstinent 2 and 3 years postbaseline. Design: Two-group randomized controlled trial with 3-year follow-up. Setting: Eleven states (Colorado, Indiana, Michigan, Minnesota, Montana, New York, Ohio, Pennsylvania, South Dakota, Utah, and Vermont). Participants: Five hundred seventy-seven adults (286 treatment and 291 control) who had smoked ≥10 cigarettes daily at baseline, had quit smoking for ≥24 hours after calling a Quitline, and were parents of an 8- to 10-year-old child; 358 (62%) completed the 2-year follow-up interview, and 304 (53%) completed the 3-year follow-up interview. Intervention: Theory-driven, home-based, self-help parenting program. Measures: Sociodemographic, smoking history, and 30-day point prevalence. Analysis: Multivariable regression analyses tested for group differences in 30-day abstinence. Attriters were coded as having relapsed. Results: Between-group differences in abstinence rates were 5.6% and 5.9% at 2 and 3 years, respectively. Treatment group parents had greater odds of abstinence, an effect that was significant only at the latter time point (odds ratio [OR] = 1.49, P = .075 at 2 years; OR = 1.70, P = .026 at 3 years). Conclusions: This study obtained preliminary evidence that engaging parents who recently quit smoking as agents of antismoking socialization of children has the potential to reduce the long-term odds of relapse.

Primary Intrapulmonary Thymomas: Case Report and Review of the Literature

2009 ◽  
Vol 37 (4) ◽  
pp. 1252-1257 ◽  
Author(s):  
L Gong ◽  
Y-H Li ◽  
X-L He ◽  
Q Wang ◽  
L Yao ◽  
...  
Keyword(s):  
Epithelial Membrane Antigen ◽  
Immunohistochemical Analysis ◽  
Lung Tumour ◽  
Review Of The Literature ◽  
Malignant Tumours ◽  
Pathological Characteristics ◽  
Immunological Phenotype ◽  
Type A Thymoma

Primary intrapulmonary thymomas (PIT), which are intrapulmonary tumours without an associated mediastinal component, are very rare; only 29 cases of PIT have been described in the literature since 1951. This report presents a case of PIT in a 59-year old Chinese woman with a type A thymoma (including its pathogenesis, clinical pathological characteristics, immunological phenotype, treatment and prognosis), in the context of a review of the current literature. The origin of thymomas in this unusual location remains unknown. In this case, immunohistochemical analysis demonstrated that the epithelial component was strongly positive for cytokeratin and focally reactive for epithelial membrane antigen. It is concluded that PIT should be considered when the histopathological appearance of a lung tumour is not typical of other pulmonary neoplasms. Complete resection appears sufficient in non-malignant tumours, while in cases of partial resection or malignancy, adjuvant radiotherapy should be considered. Long-term regular clinical follow-up is also warranted, due to the risk of late local recurrence.

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