scholarly journals Two-Staged Implant-Based Breast Reconstruction: A Long-Term Outcome Study in a Young Population

Medicina ◽  
2019 ◽  
Vol 55 (8) ◽  
pp. 481 ◽  
Author(s):  
Oscar J. Manrique ◽  
Ali Charafeddine ◽  
Amjed Abu-Ghname ◽  
Joseph Banuelos ◽  
Steven R. Jacobson ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Young Patients ◽  
Retrospective Chart Review ◽  
Roc Curves ◽  
Adjuvant Radiation ◽  
Obese Women ◽  
Term Outcome ◽  
Long Term Outcome

Background and objectives: Differences in patient anatomy and physiology exist between young and older patients undergoing breast reconstruction after mastectomy. Breast cancer has been described as being more aggressive, more likely to receive radiation, contralateral mastectomy, as well as bilateral reconstruction in young patients. Our purpose is to report long-term experience on two-staged implant-based breast reconstruction (IBR) in young females, with complication sub-analysis based on obesity and adjuvant radiation. Materials and Methods: Retrospective chart review of all consecutive young patients who underwent two-staged IBR at our institution, between 2000 and 2016, was performed. Patients between 15 and 40 years old with least 1-year follow-up were included. Univariate logistic regression models and receiver operating characteristic (ROC) curves were created. Results: Overall 594 breasts met our inclusion criteria. The mean age was 34 years, and the median follow-up was 29.6 months. Final IBR was achieved in 98% of breasts. Overall, 12% of breasts had complications, leading to explantations of 5% of the devices. Adjuvant radiation was followed by higher rates of total device explantations (p = 0.003), while obese patients had higher rates of total complications (p < 0.001). For each point increase in BMI, the odds of developing complications increased 8.1% (p < 0.001); the cutoff BMI to predict higher complications was 24.81 kg/m2. Conclusions: This population demonstrates high successful IBR completion and low explantation rates. These data suggest that obese women and those with planned adjuvant radiation deserve special counseling about their higher risk of complications.

scholarly journals TP7.2.14 Long Term Outcome of Patients with Minimally Symptomatic Diverticular Stricture

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
P A Jayawardena ◽  
T S Hany ◽  
M R Peris
Keyword(s):  
Diverticular Disease ◽  
Retrospective Chart Review ◽  
Sigmoid Resection ◽  
Tertiary Referral Hospital ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Diagnosis Of Cancer ◽  
Colorectal Surgeon

Abstract Aims Minimally symptomatic diverticular stricture poses diagnostic and management dilemma for the Colorectal Surgeon. Long term outcome, risk of missing a cancer and complications are not well documented in the literature. This study aims at assessment of outcomes of patients with minimally symptomatic diverticular stricture who were treated conservatively. Methods Retrospective chart review of all patients with confirmed diverticular stricture on endoscopy and imaging scans who had minimal or mild symptoms over a 6-year period from January,2014 to June,2020 in a large tertiary referral hospital. Search methods included diverticular disease with stricture using ICD10 code K57 and K56.6. Outcome measures included complications while on conservative treatment including missed cancer, any subsequent surgery and complications including stomas. Results 29 patients fitted the inclusion criteria, 18 females with median age 75(43-92). Median follow up was 32.5 months (8-93). All had endoscopic and CT imaging confirmation of diverticular stricture. Repeat investigations were recorded as 16 endoscopies in 9 patients and 30 CT scans in 14 patients during follow up. Four patients had at least one episode of diverticulitis; only one underwent emergency surgery at 5 years from diagnosis. 2/29 (6.9%) patients presented with diverticular perforation requiring Hartmann’s procedure. One patient (3%) had elective sigmoid resection with average duration of follow up 29 months (11.5-59) months. There were no missed diagnosis of cancer and no mortality due to diverticular disease. Conclusions In this patient population, diverticular stricture runs a relatively benign course with few complications or surgical intervention during follow up.

scholarly journals Straight stem and threaded cup in patients under 60 years of age: 28.8–30.2 years of follow-up

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
L. Pisecky ◽  
J. Allerstorfer ◽  
B. Schauer ◽  
G. Hipmair ◽  
R. Hochgatterer ◽  
...  
Keyword(s):  
Survival Rate ◽  
Aseptic Loosening ◽  
Young Patients ◽  
Septic Loosening ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Straight Stem ◽  
Long Term Follow Up

Abstract Purpose The aim of this retrospective observational study of one cohort was to evaluate the long-term outcome in patients younger than 60 years after total hip arthroplasty using a straight uncemented stem and an uncemented threaded cup. Methods Between 1986 and 1987, 75 hips of 75 patients (mean age, 53.35 ± 6.17 years) were consecutively implanted with an Alloclassic Zweymüller/Alloclassic SL stem and an Alloclassic CSF cup. Forty-four patients had died over the last 30 years. The remaining 31 patients (mean age, 82.9 ± 6.4 years) were reinvited for follow-up examinations. Clinical and radiographic evaluations were carried out. Results At a mean follow-up of 29.5 (28.8–30.2), 4 patients (5.3%) were lost to follow-up. For the endpoint aseptic loosening (defined as the removal of stem or the cup for 2 cases), the overall survival rate is 97.3%. For the endpoint revision for any reason (22 patients), the survival rate is 70.6%. Eleven patients needed an exchange of head and liner, caused by wear. The average time from implantation until change of head and liner was 21.44 years (SD 5.92). Other reasons for revision surgery were septic loosening (3 cases), aseptic loosening of stem and cup (1 case), aseptic loosening of stem (1 case), periprosthetic calcification (2 cases), implant fracture (1 case), periprosthetic fracture (1 case), intraoperative fissure of stem (1 case), and total wear of liner including cup (1 case). Conclusion The combination of a straight stem (Alloclassic) and a screw cup (CSF) shows excellent results in young patients under the age of 60 at ultra-long-term follow-up at 30 years. Revisions due to wear of the polyethylene liner are more likely than in the older patients.

scholarly journals The Modified Skate Flap: A New Technique for Nipple-Areola Complex Reconstruction in Implant-Based Breast Reconstruction

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Lee L Q Pu ◽  
Ping Song
Keyword(s):  
Breast Reconstruction ◽  
Senior Author ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Nipple Areola Complex ◽  
Fat Grafts ◽  
Areola Complex ◽  
A Minor

Abstract Nipple-areola complex (NAC) reconstruction is an important part of breast reconstruction. Although several techniques for NAC reconstruction have been described in the literature, the long-term outcomes after NAC reconstruction remain less satisfactory, especially following implant-based breast reconstruction. The authors reported their newly developed technique for NAC reconstruction in implant-based breast reconstruction. The authors describe their modified skate flap, by preserving more dermal tissues from the skate flap, for NAC reconstruction, following implant-based breast reconstruction. Additional derma-fat grafts, harvested from the full-thickness skin graft site, are also added to the reconstructed nipple to ensure long-term shape, size, and projection of the reconstructed nipple. A total of 30 patients underwent such a NAC reconstruction after successful implant-based breast reconstruction by the senior author. The minimum follow-up time was 1 year. No significant surgical complications have been observed in their series of 30 patients, and only a minor office procedure was performed subsequently in 6 patients (4 unilateral and 2 bilateral) to improve the shape of the reconstructed nipple. During a minimum of a 1-year follow-up period, outcomes with the authors’ technique in 30 patients are satisfactory; good size, shape, and projection of the reconstructed nipple are maintained. The long-term outcome of NAC reconstruction after implant-based breast reconstruction can be optimized with their modified skate flap by using all available flap tissue and with the addition of derma-fat grafts. The authors’ technique can be used safely for NAC reconstruction after implant-based breast reconstruction with good outcome and high patient satisfaction.

Aortic Valve–Sparing Root Replacement (David I Procedure) in Adolescents: Long-Term Outcome

2019 ◽  
Author(s):  
Erik Beckmann ◽  
Andreas Martens ◽  
Heike Krueger ◽  
Wilhelm Korte ◽  
Tim Kaufeld ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Connective Tissue Diseases ◽  
Young Patients ◽  
Term Outcome ◽  
Term Survival ◽  
Long Term Outcome ◽  
Initial Surgery ◽  
Valve Sparing

Introduction Aortic valve-sparing root replacement (David's procedure) is an especially appealing treatment option for young patients. Here, we present the short-, mid, and long-term outcomes of this operation in adolescent patients. Methods Between September 1994 and March 2014, 29 patients aged 6 to 21 years underwent the David-I procedure at our center. We conducted a retrospective study with follow-up. Results The mean age was 16.8 ± 3.4 years and 90% (n = 26) were male. Marfan's syndrome was present in 86% (n = 25) of cases. Ninety-seven percent (n = 28) of cases were performed electively, and one case (3%) was performed emergently for acute aortic dissection type A. There were no early perioperative deaths (0%). Follow-up, which was completed on 100% of patients, comprised a total of 394 patient years and a mean follow-up time of 13.6 ± 5.4 years. The estimates for survival at 1, 5, and 10 years after initial surgery were 100, 97, and 93%, respectively. During follow-up, there were four (14%) late deaths and five (17%) aortic valve-related reoperations. The 1-, 5-, and 10-year estimates for freedom from valve-related reoperation were 100, 86, and 83%, respectively. The perioperative mortality for these five reoperations was 0%. Discussion Aortic valve–sparing root replacement can be performed in adolescents with a very low perioperative risk. Long-term survival seems to be affected by connective tissue diseases.

NCOG-10. RADIATION THERAPY CAN BE SAFELY DEFERRED IN OLIGODENDROGLIOMAS

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi153-vi154
Author(s):  
Alexis Demopoulos ◽  
Jonathan Knisely
Keyword(s):  
Radiation Therapy ◽  
Management Practice ◽  
Young Patients ◽  
Memory Loss ◽  
Progression Free Survival ◽  
Long Term Results ◽  
Term Outcome ◽  
Long Term Outcome

Abstract Deferring multimodal aggressive therapies in young patients to delay treatment-induced toxicity without jeopardizing long-term outcome would be of great benefit to our patients. After IRB approval, we retrospectively reviewed 80 confirmed IDH mutant and 1p19q codeleted oligodendrogliomas treated at one institution between 2005 and 2020. Median follow-up was 5 (range 1-26) years. All patients underwent maximal safe resection, followed by observation with routine imaging (n=28), chemotherapy alone (n=27), or radiation with chemotherapy (n=25) as initial upfront therapy. Median progression free survival was 36 (range 1-203), 54 (range 1-306), and 57 (range 4-281) months, respectively. Median overall survival was not reached, with 85% (67/80) alive, 8 on treatment and 59 stable off therapy. Among 35 patients who died or were followed for 10 years, median PFS was 12, 15, and 10 years for observation (n=9), chemotherapy (n=11) and chemoradiotherapy (n=15), with deaths or KPS below 50 in 3, 6, and 8, respectively. Three deaths in the observation group occurred 12, 12 and 17 years after diagnosis; one at 95 years old and another tumor-unrelated. Among 44 patients eventually receiving radiation, 15 suffered toxicity, including pathologically proven necrosis (n=6), cognitive decline with KPS&lt; 50 (n=5), memory loss with KPS &gt; 50 (n=3), and optic neuropathy (n=1). Myelosuppression from PCV was more pronounced after chemoradiation than in the upfront setting. Temozolomide after PCV chemotherapy was well tolerated. Long term follow-up of oligodendroglioma patients is challenging, but essential in determining late toxicities and treatment efficacy. Long-term results of European and North American multicenter cooperative group trials contradicted earlier publications reporting no benefit from early chemotherapy. Some management practice guidelines established a half-century ago persist (i.e., administer radiation therapy early), despite potentially crippling late effects. Deferring upfront radiation therapy is safe, less toxic, and equally efficacious in codeleted oligodendrogliomas.

scholarly journals RARE-09. PRESERVATION OF ENDOCRINE FUNCTION AFTER OMMAYA RESERVOIR INSERTION IN CHILDREN WITH CYSTIC CRANIOPHARYNGIOMA

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii443-iii443
Author(s):  
Laura-Nanna Lohkamp ◽  
Abhaya Kulkarni ◽  
James Drake ◽  
James T Rutka ◽  
Peter Dirks ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Invasive Procedure ◽  
Retrospective Chart Review ◽  
Ommaya Reservoir ◽  
Endocrine Function ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Sick Children

Abstract INTRODUCTION Children with craniopharyngiomas (CP) can be subjected to significant morbidities caused by radical surgery and/or radiation with severe long-term consequences. Ommaya reservoir Insertion (ORI) into cystic CP represents a minimally invasive procedure that aims to preserve endocrine, hypothalamic and neurocognitive function. The purpose of this study was to determine the relevance of upfront ORI (+/- intracystic treatment) for preservation of endocrine function. METHODS A retrospective chart review of children with CP treated at the Hospital for Sick Children between 01/01/2000 and 15/01/2020 was undertaken. Endocrine function was reviewed at the time of initial ORI or surgical resection and throughout the course of follow-up. Event free survival (EFS) was defined as the time to additional surgical resection or irradiation. RESULTS Fifty-five patients with sufficient endocrine follow-up data were included. The median age of diagnosis was 8.3 years (range 2.1–18.0 years), 31 were males. ORI was performed as upfront treatment in 30 patients, gross total or partial resection in 24 patients and radiation in 1 patient, respectively. Endocrine function remained stable after ORI with a median EFS of 19.2 (0 – 105.3) months while the majority of patients who underwent surgical resection had documented worsened endocrine function postoperatively (median of 0; range 0 – 29.4 months) (p&lt; 0.001). The event most commonly related to secondary endocrine deterioration was initial or delayed surgical resection. CONCLUSIONS Endocrine function was preserved in patients with upfront ORI (+/- intracystic treatment). Further studies will elucidate the implications of ORI with respect to ophthalmological, vascular and neurocognitive long-term outcome.

scholarly journals Straight stem and threaded cup in patients under 60 years of age. 28.8-30.2 years of follow-up

2020 ◽  
Author(s):  
Lorenz Pisecky ◽  
Jakob Allerstorfer ◽  
Bernhard Schauer ◽  
Günter Hipmair ◽  
Rainer Hochgatterer ◽  
...  
Keyword(s):  
Survival Rate ◽  
Aseptic Loosening ◽  
Young Patients ◽  
Septic Loosening ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Straight Stem ◽  
Total Wear

Abstract Purpose: The aim of this retrospective observational study of one cohort was to evaluate the long-term outcome in patients younger than 60 years after total hip arthroplasty using a straight uncemented stem and an uncemented threaded cup.Methods:Between 1986 and 1987, 75 hips of 75 patients (mean age: 53.35±6.17 years) were consecutively implanted with an Alloclassic Zweymüller/Alloclassic SL stem and an Alloclassic CSF cup. 44 patients had died over the last 30 years. The remaining 31 patients (mean age: 82.9±6.4years) were reinvited for follow-up examinations. Clinical and radiographic evaluations were carried out.Results: At a mean follow-up of 29.5 (28.8-30.2), 4 patients (5.3%) were lost to follow up.For the endpoint aseptic loosening (defined as the removal of stem or the cup for 2 cases), the overall survival rate is 97.3%. For the endpoint revision for any reason (22 patients), the survival rate is 70.6%. Eleven patients needed an exchange of head and liner, caused by wear. The average time from implantation until change of head and liner was 21.44 years (SD 5.92). Other reasons for revison surgery were septic loosening (3 cases), aseptic loosening of stem and cup (1 case), aseptic loosening of stem (1 case), periprosthetic calcification (2 cases), implant fracture (1 case), periprosthetic fracture (1 case), intraoperative fissure of stem (1 case), total wear of liner including cup (1 case).Conclusion: The combination of a straight stem (Alloclassic) and a screw cup (CSF) shows excellent results in young patients under the age of 60 at ultra-longterm follow up at 30 years. Revisions due to wear of the polyethylene liner are more likely than in the older patients.

Long-term outcome of breast cancer patients diagnosed ≤40 years according to breast cancer subtype in the absence of adjuvant systemic therapy: The PARADIGM initiative.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 535-535
Author(s):  
Gwen Dackus ◽  
Natalie D ter Hoeve ◽  
Mark Opdam ◽  
Willem Vreuls ◽  
Esther A Koop ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Triple Negative ◽  
Systemic Treatment ◽  
Young Patients ◽  
Breast Cancer Patients ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Adjuvant Systemic Treatment

535 Background: Young age at breast cancer diagnosis is considered a poor prognostic factor. As a result, many treatment guidelines advice adjuvant systemic treatment for young patients. Answering prognostic questions on young patients has therefore become a challenge. The PARADIGM (PAtients with bReast cAncer DIaGnosed preMenopausally) project aims to assess the long-term outcome of women diagnosed with breast cancer ≤40 years in the absence of adjuvant systemic therapy, using real world data from the nationwide Netherlands Cancer Registry (NCR) coupled with tissue biobanking. Methods: All women ≤40 years, diagnosed in the Netherlands between 1989-2000 with a primary invasive, histologically proven, TanyN0M0 breast cancer, without adjuvant systemic treatment were identified through the NCR. Back then N0 patients were considered low risk and did not receive adjuvant systemic treatment. Tissue specimens were revised by a team of dedicated breast pathologists. Cox regression was performed to estimate hazard ratios for recurrence-free (RFS) and overall survival (OS) according to immunohistochemical (IHC) subtype. Analyses were adjusted for grade, pathological T-stage, histological subtype and radiotherapy. Results: We included 2310 patients with a mean follow-up of 15.4 years (range 0-25 years). OS for the whole cohort was 68% and RFS 58.4% at 25 years. In total 740 deaths and 1043 recurrences were observed. Hormone receptor (HR)+/HER2+ patients had a significantly worse OS when compared to HR-HER2+ patients (adjusted Hazard Ratio 1.58; 95% confidence interval 1.05-2.38; p=0.029). No difference was observed between HR-HER2+ and the triple negative and HR+/HER2- subgroups at 25-years. RFS was similar for all IHC subtypes. Conclusions: In this large cohort of non-adjuvant systemically treated young breast cancer patients with long-term follow-up HR+/HER2+ patients have a significantly worse survival when compared to triple negative, HR-/HER2+ and HR+/HER2- patients. The latter three subtypes have similar OS at 25 years. Future molecular studies have been planned to distinguish the favorable from the unfavorable prognostic patients.

Course and long-term outcome of ’refractory’ secretory otitis media

2005 ◽  
Vol 119 (2) ◽  
pp. 113-118 ◽  
Author(s):  
Marie Ryding ◽  
Peter White ◽  
Olof Kalm
Keyword(s):  
Otitis Media ◽  
Acute Otitis Media ◽  
Young Patients ◽  
Secretory Otitis Media ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Ventilation Tubes ◽  
One Year

Objective: The course and the long-term outcome of ’refractory’ secretory otitis media (SOM), defined as continuous SOM for more than 6 years, were studied in 52 young patients. They had during childhood been treated for bilateral SOM on average for 12 years (range 6 to 26 years). The mean interval between resolution of SOM and examination was 7 years.Methods: At follow up the patients’ medical records were scrutinized with regards to transmyringeal ventilation tubes, adenoidectomy, sequelae and complications, and a questionnaire was filled in to document other diseases.Results: The onset of SOM showed two peaks, one at the age of one year and one at the age of 3.5 years. Patients whose onset of SOM was related to an episode of acute otitis media (AOM) were younger at SOM onset than those who had no such relation. Otorrhoea and AOM episodes were more frequent during the SOM periods, with blocked or expelled tubes, than during periods with patent tubes. Cholesteatoma were seen in 3 per cent and perforations in 5 per cent of patients.Conclusions: Extremely long-standing SOM does not necessarily result in myringeal perforation or cholesteatoma to a greater extent than that seen in patients with shorter durations of SOM. However, at follow up one-third of the patients reported hearing impairment and a majority felt discomfort when flying or diving.

scholarly journals P147 Progression to biologic treatment in very early onset inflammatory bowel disease patients- a long term follow up retrospective study

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S229-S230
Author(s):  
A Eindor ◽  
L Meleady ◽  
K Jacobson
Keyword(s):  
Young Patients ◽  
Biologic Treatment ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Disease Characteristics ◽  
Kaplan Meier ◽  
Inflammatory Bowel ◽  
Disease Location

Abstract Background Very early onset inflammatory bowel disease (VEOIBD) prevalence has been increasing over the last decades. These young patients have been known to have special disease characteristics and disease location. Although it is known that only a low percentage of these patients require biologic treatment after diagnosis, there is only scarce evidence about their long- term outcome and biologic requirements. We aimed to assess the long term outcome of VEOIBD patients and the time of progression to biologic treatment. Methods We retrospectively reviewed IBD patients diagnosed under 6 years of age, between January 2005 and December 2019, from the British Columbia (BC) Pediatric IBD database. Demographic data, disease characteristics and symptoms at diagnosis were documented. The disease location and severity were documented according to the Paris classification. Data collected retrospectively until the last appointment recorded in the electronic medical records included whether the patient received biologic treatment at the time of follow up, the time to intiation of the treatment, the type of biologic treatment and response. Kaplan meier curves were used to asses the number of years to progression to biologic treatment and the parameters influencing it. Results 89 patients under the age of 6 were diagnosed with IBD during the study period. 3 patients failed to meet inclusion criteria and were excluded. Median age at diagnosis was 3.8 (IQR 2.6–5.1). 45.3% of patients had Crohn’s disease (CD) and 62.8% were males. Median time of follow up was 6.39 (IQR 3.71–10.55). 68.1% of the ulcerative colitis (UC) patients had pancolitis and 48.7% of CD patients had ileocolonic disease. 39.5% of patients were started on biologic treatment and 7.1% underwent surgery. Kaplan Meier curves demonstrated that patients diagnosed in the years 2012 -2019 had shorter duration of progression to biologics than those diagnosed 2005–2011 (p=0.0047). In patients with CD those with perianal or stricturing disease progressed faster to biologic treatment (p=0.024,p=0.038, respectively) and in UC patients those with high severity of disease (p=0.017). 63.6% of patients were reported to be on clinical remission on the biologic treatment. Conclusion Although VEOIBD patients have more extensive diseas, they require less biologic treatment than previously reported in older patients. Factors influencing shorter duration of progression to biologics were the severity of disease and behaviour and not disease location. Patients diagnosed more recently had shorter duration to biologic treatment which might reflect physicians perception on using biologic treatment in these young patients rather than disease severity.

Sign in / Sign up

Export Citation Format

Share Document