scholarly journals Recurrent Intrahepatic Cholangiocarcinoma – Review

2021 ◽  
Vol 11 ◽  
Author(s):  
Yuki Bekki ◽  
Dagny Von Ahrens ◽  
Hideo Takahashi ◽  
Myron Schwartz ◽  
Ganesh Gunasekaran
Keyword(s):  
Risk Factors ◽  
Intrahepatic Cholangiocarcinoma ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Early Recurrence ◽  
Current Data ◽  
High Rate ◽  
Locoregional Therapy ◽  
Liver Malignancy ◽  
Term Survival

Intrahepatic cholangiocarcinoma (ICC) is the second-most common primary liver malignancy after hepatocellular carcinoma. While surgical resection with negative margin is the only curative treatment, ICC has very high rate of recurrence, up to 60-70% after curative resection. We reviewed the current data available on risk factors for ICC recurrence, recurrence pattern (location and timing), treatment options, and future directions. The risk factors for recurrence include elevated preoperative CA19-9, presence of liver cirrhosis, nodal metastasis, positive margins, and vascular invasion. Understanding different recurrence patterns, timing course, and risk factors for early recurrence is important to tailor postoperative surveillance and select treatment strategies including systemic or locoregional therapy. Re-resection can be considered for a selected patient population at experienced centers, and can yield long-term survival. ICC remains a dismal disease given the high likelihood of recurrence. Advances in our understanding of the genomic landscape of ICC are beginning to identify targetable alterations in ICC in subsets of patients that allow for personalized treatment.

scholarly journals Failures in periodontal therapy

1970 ◽  
Vol 9 (4) ◽  
pp. 193-198
Author(s):  
KD Jithendra ◽  
A Bansali ◽  
SS Ramachandra
Keyword(s):  
Risk Factors ◽  
Periodontal Disease ◽  
Treatment Options ◽  
Medical Science ◽  
Treatment Strategies ◽  
Periodontal Therapy ◽  
Plaque Control ◽  
Natural Dentition ◽  
Oral Hygiene Instructions ◽  
Biomechanical Factors

Studies have shown that modern periodontal therapies are effective in maintaining a healthy natural dentition as well as controlling periodontal disease. Numerous treatment strategies and various techniques have been designed & described to treat periodontal disease. Most of these procedures had drawbacks which were identified, leading to the modifications of the original techniques which lead to better treatment options, but still very less emphasis has been laid on failures. Without a regular program of clinical re-evaluation, plaque control, oral hygiene instructions, and reassessment of biomechanical factors the benefits of treatment are often lost and inflammatory disease in the form of recurrent periodontitis may result. So, this review describes the most common failures noticed in periodontal therapies and also discusses the possible solutions to reduce the incidence of failures in periodontal therapy.Key words: Periodontal therapy; risk factors; failures.DOI: 10.3329/bjms.v9i4.6680Bangladesh Journal of Medical Science Vol.09 No.4 July 2010 pp.193-198

European differences in characteristics, treatments and outcomes in patients with non-ST-elevation myocardial infarction – novel insights from four national real-world registries

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Edfors ◽  
T Jernberg ◽  
C Lewinter ◽  
J Eha ◽  
P Asser ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Real World ◽  
European Countries ◽  
High Rate ◽  
Lipid Lowering ◽  
Hospital Treatment ◽  
Funding Source ◽  
Term Survival ◽  
St Elevation

Abstract Background Large-scale collection of standardized variables in patients with myocardial infarction (MI) in national real-world registries are only available in a few European countries and there is lack of cross-country comparisons. Purpose To compare demography, risk factors, hospital treatment and short- and long-term survival in patients hospitalized for non-ST elevation MI (NSTEMI) in four different European countries. Methods NSTEMI patients hospitalized and enrolled in national MI registries; EMIR (Estonia), HUMIR (Hungary), NORMI (Norway (2013–2016)) and SWEDEHEART (Sweden) from 2014 to 2017 were included. Results In total 119,191 patients with NSTEMI were included. The mean age at admission ranged from 70 years (Hungary) to 75 years (Estonia). The proportion of women was 36% in Sweden and 44% in Estonia. In Norway 24% were smokers, as compared to 17% in Sweden. Patients in Hungary had a high rate of diabetes mellitus (37%) and antihypertensive treatment (84%) but a low rate of lipid lowering treatment (32%). The proportion of patients with prior MI ranged from 28% (Norway) to 37% (Sweden). The presence of previous peripheral artery disease ranged from 7% (Sweden) to 17% (Hungary). The absolute proportion of performed coronary angiographies (58% versus 75%) and percutaneous coronary interventions (38% versus 56%), differed most between Norway and Hungary. Dual antiplatelet therapy ranged from 60% (Estonia) to 81% (Hungary) and statins from 78% (Norway) to 89% (Hungary), at discharge. The crude mortality rates at 1 month and 1 year are listed in table 1. Conclusion Cross-comparison of four national European MI registries provide new insights in differences in risk factors, treatment and outcomes. Possible reasons for the observed differences, include differences in the underlying expected mortality in the populations, inclusion-criteria and coverage of the registries and variable definitions, that need to be further explored. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Estonian Research Council

scholarly journals Retinoblastoma. Part 2. Treatment strategies for intraocular retinoblastoma

2020 ◽  
Vol 20 (4) ◽  
pp. 197-203
Author(s):  
S.V. Ivanova ◽  
◽  
S.A. Kuleva ◽  
N.N. Sadovnikova ◽  
M.I. Komissarov ◽  
...  
Keyword(s):  
Risk Factors ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Study Groups ◽  
First Line ◽  
Transpupillary Thermotherapy ◽  
Significant Development ◽  
The Past ◽  
Intravitreal Chemotherapy ◽  
Intraocular Retinoblastoma

Retinoblastoma is one of the most common retinal tumors in young children. Current early diagnostic and treatment strategies focus on the possibility to implement eye-preserving therapies. The 5-year overall survival for children with retinoblastoma is now 100%. First-line eye removal is recommended in extensive intraocular seeding and poor visual prognosis. The volume of adjuvant therapy is based on the histological risk factors for disease progression. This paper discusses the algorithms to determine risk factors and further systemic treatment strategy in several large study groups. Eye and even vision preservation is now possible in at least 65–75% of retinoblastoma patients. The paper also describes in detail the methods of locally administering chemotherapy which are considered eye-preserving treatment options, i.e., selective intra-arterial chemotherapy and intravitreal chemotherapy. Various physical methods of eye-preserving treatment which underwent significant development over the past decade are highlighted. In conclusion, the authors emphasize that retinoblastoma survivors, their siblings and offspring should be carefully monitored.Keywords: children, retinoblastoma, enucleation, polychemotherapy, selective intra-arterial chemotherapy, intravitreal chemotherapy, laser photocoagulation, transpupillary thermotherapy, cryotherapy, brachytherapy, monitoring.For citation: Ivanova S.V., Kuleva S.A., Sadovnikova N.N. et al. Retinoblastoma. Part 2. Treatment strategies for intraocular retinoblastoma. Russian Journal of Clinical Ophthalmology. 2020;20(4):197–203. DOI: 10.32364/2311-7729-2020-20-4-197-203.

scholarly journals Epidemiology of Cardiovascular Diseases in Morocco: A Systematic Review

2021 ◽  
Vol 17 (2) ◽  
pp. 57-67
Author(s):  
Rida Elyamani ◽  
Abdelmajid Soulaymani ◽  
Hind Hami
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Cardiovascular Diseases ◽  
English Language ◽  
Local Population ◽  
Treatment Strategies ◽  
Epidemiological Studies ◽  
High Rate ◽  
Systematic Analysis ◽  
Moroccan Population

OBJECTIVE: To provide a systematic review of studies on cardiovascular diseases (CVD) and their risk factors in the Moroccan population. METHODS: A systematic analysis was performed based on PRISMA guidelines by retrieving data bases (Medline, Embase, and other) using technical keywords in addition to manual research on official websites. Published studies in the English or French language, conducted in Morocco or concerning the Moroccan population within the last two decades, were identified. RESULTS: This is the first systematic review of CVD in Morocco. Data from 159 studies were retrieved and analyzed. Most studies were written in the English language (75.89%) and published between 2010 and 2019 (85.47%). The mortality rate caused by CVD in Morocco has reached 38%, with ischemic heart disease and stroke as the main events causing death (31.0% and 22.5% respectively). The risk factors present in the population studied were headed by tobacco smoking (45- 50%), followed by physical inactivity (21.1%), elevated rate of hypertension (25.3%), and depression (5.47%). Impacted by a high rate of illiteracy and poverty and an unprepared health care system in Morocco, these numbers are expected to increase over the next decade. CONCLUSIONS: Based on these alarming incidences, investment in scientific research and epidemiological studies should be increased to determine the needs of the local population. The available evidence shows that the risk of cardiovascular disease and the associated mortality is very high in Morocco and will rise in the next years prospectively, which calls for urgent multi-sectorial approaches and treatment strategies.

scholarly journals Intramural Ectopic Pregnancy: Clinical Characteristics, Risk Factors for Uterine Rupture and Hysterectomy

2021 ◽  
Vol 8 ◽  
Author(s):  
Xiaoran Chen ◽  
Lingyun Gao ◽  
Hongna Yu ◽  
Meijuan Liu ◽  
Shujun Kong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Ectopic Pregnancy ◽  
Uterine Rupture ◽  
Clinical Characteristics ◽  
Treatment Options ◽  
Management Strategies ◽  
Treatment Strategies ◽  
Expectant Management ◽  
Preoperative Imaging

Background: Intramural ectopic pregnancy is defined as the gestational sac (GS) is entirely within the myometrium, separate from the endometrial cavity and fallopian tubes, which is unsustainable and potentially life-threatening. The data investigating the clinical characteristics, management strategy, and fertility outcomes after treatment of intramural ectopic pregnancies are very limited due to its extreme rarity.Methods: To investigate the clinical characteristics, treatment options, and fertility outcomes in patients with intramural ectopic pregnancy, a retrospective study included 56 patients was conducted. We also used logistic regression to identify potential risk factors for uterine rupture and hysterectomy in these patients.Results: The mean age of patients was 31.1 years, with an average gestational age (GA) of 10.0 weeks, and the majority of the patient cohort (83.9%) had uterine or endometrial surgical history. 55.4% of the intramural pregnancy was diagnosed by preoperative imaging examination and 67.7% was detected by ultrasound. There was no dominant predisposed zone of the GS. Common treatment strategies included laparotomy surgery (41.1%) and laparoscopic surgery (35.7%), followed by methotrexate (7.1%) and expectant management (5.4%). Uterine rupture occurred in 9 patients and 8 patients underwent a hysterectomy, but no maternal demise was found. Logistic regression showed that a GA >10 weeks predicted a significantly higher risk of uterine rupture (Odds ratio [OR] 8.000, 95% confidence interval [CI] 1.456–43.966, P = 0.017) and hysterectomy (OR 12.333, 95% CI 2.125–71.565, P = 0.005), and GS located in the fundus also predicted higher probability of uterine rupture (OR 7.000,95% CI 1.271–38.543, P = 0.025). Among the ten patients who had a desire for fertility, 6 of them succeeded and 4 of them successfully delivered with a GA ≥ 34 weeks.Conclusion: GA > 10 weeks was the risk factor for both uterine rupture and hysterectomy, while patients with GS located in the uterine fundus had a significantly higher risk of uterine rupture. The fertility outcomes were moderate after treatment. The management strategies should be individualized according to disease conditions and the desire for fertility, and early diagnosis is essential for optimizing clinical outcomes.

Clinical and pathologic factors associated with survival in BRAFV600E colorectal cancers.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 4047-4047
Author(s):  
Van K. Morris ◽  
Bryan K. Kee ◽  
Michael J. Overman ◽  
David R. Fogelman ◽  
Arvind Dasari ◽  
...  
Keyword(s):  
Targeted Therapies ◽  
Treatment Options ◽  
Tumor Biology ◽  
Mapk Signaling ◽  
Hepatic Flexure ◽  
Locoregional Therapy ◽  
Cancer Center ◽  
Term Survival ◽  
Primary Tumors ◽  
Pathologic Features

4047 Background: BRAFV600E mutations occur in fewer than 10% of all patients (pts) with metastatic colorectal cancer (mCRC) and arise from sessile serrated adenomas. Despite efficacy with targeted therapies against MAPK signaling and with immunotherapies in this population, survival outcomes for pts with BRAFV600E mCRC in general are poor. Characteristics distinguishing pts with BRAFV600E mCRC with favorable versus unfavorable outcomes have not been well annotated. Methods: Records of 188 pts with BRAFV600E mCRC evaluated at MD Anderson Cancer Center between 3/2010-1/2020 were reviewed. Pts with the shortest and longest metastatic survival (N = 25 for each group) were compared. Associations between prognostic group and clinical/pathologic features were measured by odds ratio and for median survival by log-rank testing. Results: Median metastatic survival differed between the 2 BRAFV600E mCRC populations (8.6 vs 84 months, p < .0001). Pts with poor survival more commonly had primary tumors arising from the hepatic flexure/proximal transverse colon (44% vs 16%, p = .04) and more frequent hepatic involvement (75% vs 28%, p = .001). Pts with favorable survival were more likely to develop metachronous metastases (52% vs 16%, p = .01), have fewer distant organ involvement (median 1 vs 2, p = .02), and undergo definitive locoregional therapy to metastatic disease (44% vs 0%, p = .01). Microsatellite instability (36% vs 4%, p = .008) and a history of tobacco use (44% vs 16%, p = .04) were associated with a favorable prognosis. Durable responses to MAPK-targeted therapies (5/25) and immunotherapy (3/25) were noted in the favorable group. Conclusions: Pts with BRAFV600E mCRC can achieve excellent long-term survival which belies conventional context and is driven by locoregional and systemic treatment options alike. Anatomic localization of the primary tumor and prior exposures may highlight environmental influences on tumor biology which account for the clinical heterogeneity of pts with BRAFV600E mCRC.

Clinicopathological Risk Factors for Recurrence within One Year after Initial Hepatectomy for Hepatocellular Carcinoma

2011 ◽  
Vol 77 (5) ◽  
pp. 572-578 ◽  
Author(s):  
Michihiro Hayashi ◽  
Tetsunosuke Shimizu ◽  
Fumitoshi Hirokawa ◽  
Yoshihiro Inoue ◽  
Koji Komeda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
High Risk ◽  
Early Recurrence ◽  
Intrahepatic Metastasis ◽  
High Rate ◽  
Preoperative Imaging ◽  
Curative Intent ◽  
Initial Hepatectomy ◽  
Cancer Spread

Hepatocellular carcinoma (HCC) shows a high rate of recurrence after hepatectomy; predictive factors for early recurrence would help determine optimal therapeutic and management strategies. Among 163 patients with HCC undergoing hepatectomy with curative intent, 46 patients developed recurrence within 1 year. Clinicopathological data were retrospectively analyzed to identify predictive parameters for early recurrence. Survival rates in cases of recurrence within 1 year were worse than those of no recurrence within 1 year or recurrence after 1 year. Protein induced by vitamin K absence/antagonist II (PIVKA-II) greater than 150, positive fucosylated alpha-fetoprotein (L3-AFP), and deviancy from Milan criteria (MC) on preoperative imaging were associated with high risk of early recurrence and total number of these three risk factors predicted the survival. With multivariate analysis, 1) preoperatively, positive factors of two or more among three items of PIVKA-II, L3-AFP, and deviancy from MC; 2) and postoperatively, pathological cancer spread (microscopic vascular invasion and/or intrahepatic metastasis) both represented risks for early recurrence. A combination of three preoperative factors, PIVKA-II, L3-AFP, and MC status, in conjunction with the postoperative factor of cancer spread status represents a significant indicator for recurrence within 1 year. Improving the prognosis of patients with HCC would depend on how to adequately treat those at high risk of early recurrence.

scholarly journals Optic pathway–hypothalamic glioma hemorrhage: a series of 9 patients and review of the literature

2018 ◽  
Vol 129 (6) ◽  
pp. 1407-1415 ◽  
Author(s):  
Kirsten van Baarsen ◽  
Jonathan Roth ◽  
Natalia Serova ◽  
Roger J. Packer ◽  
Ben Shofty ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intracranial Hemorrhage ◽  
Clinical Course ◽  
Treatment Options ◽  
Fatal Outcome ◽  
Treatment Strategies ◽  
Optic Glioma ◽  
Recurrent Bleeding ◽  
Histopathological Diagnosis ◽  
Optic Pathway

OBJECTIVEHemorrhage (also known as apoplexy) in optic pathway gliomas (OPGs) is rare. Because of the variable presentations and low incidence of OPG hemorrhages, little is known about their clinical course and the best treatment options. The aim of this work was to review risk factors, clinical course, and treatment strategies of optic glioma hemorrhages in the largest possible number of cases.METHODSA total of 34 patients were analyzed. Nine new cases were collected, and 25 were identified in the literature. Data regarding demographics, radiological and histological features, treatment, and outcome were retrospectively reviewed.RESULTSThe majority of patients were younger than 20 years. Only 3 patients were known to have neurofibromatosis. The histopathological diagnosis was pilocytic astrocytoma in the majority of cases. Five patients had intraorbital hemorrhages, whereas 29 patients had intracranial hemorrhage; the majority of intracranial bleeds were treated surgically. Six patients, all with intracranial hemorrhage, died due to recurrent bleeding, hydrocephalus, or surgical complications. No clear risk factors could be identified.CONCLUSIONSIntracerebral OPG hemorrhages have a fatal outcome in 20% of cases. Age, hormonal status, neurofibromatosis involvement, and histopathological diagnosis have been suggested as risk factors for hemorrhage, but this cannot be reliably established from the present series. The goals of surgery should be patient survival and prevention of further neurological and ophthalmological deterioration.

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