Is radioiodine therapy conducted too late in patients suffering from thyroid autonomy?

SummaryAim: The effectiveness of radioiodine therapy (RIT) is proven. The aim of this study was to determine, how much time passes between diagnosis of thyroid autonomy or occurrence of functional and/or local symptoms on one hand and RIT on the other hand. Patients, methods: This retrospective study comprises 196 patients, who were treated with radioiodine for thyroid autonomy between 2002 and 2005. Evaluated parameters are begin of functional and/ or local symptoms, first scintigraphy with relevant Tc-Uptake as time point of primary diagnosis of thyroid autonomy and time point of implementation of RIT. Results: Between first scintigraphy with relevant Tc-Uptake and implementation of RIT 0–72 months passed (median: 3 months). 160 patients (81.6%) had a prior diagnosis of goitre by their general practitioner and 163 patients (83.3%) had a prior diagnosis of TSH suppression. The time period between first recommendation of RIT and implementation of RIT was 0–89 months (median: 2 months). In 142 patients (71.4%) functional and/or local symptoms were present over 73 months (median; range: 0–180 months) before the first scintigraphy with therapy relevant Tc-Uptake was conducted. Conclusion: Despite clear recommendations in corresponding guidelines too much time passes between first symptoms (median: 73 months), primary diagnosis of therapy relevant thyroid autonomy (median: 2 months) and implementation of RIT. Patients with functional and/or local symptoms should be examined for thyroid autonomy early. If thyroid autonomy is proven, RIT should be planned immediately, especially in high-risk patients.

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The effects of a preoperative multidisciplinary conference on outcomes for high-risk patients with challenging surgical treatment options: a retrospective study

BMC Anesthesiology ◽

10.1186/s12871-021-01257-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Masayoshi Koike ◽

Mie Yoshimura ◽

Yasushi Mio ◽

Shoichi Uezono

Keyword(s):

Patient Safety ◽

Retrospective Study ◽

High Risk ◽

Treatment Plan ◽

Treatment Options ◽

High Risk Patients ◽

Appropriate Treatment ◽

Risk Patients ◽

Treatment Plans ◽

Multidisciplinary Conference

Abstract Background Surgical options for patients vary with age and comorbidities, advances in medical technology and patients’ wishes. This complexity can make it difficult for surgeons to determine appropriate treatment plans independently. At our institution, final decisions regarding treatment for patients are made at multidisciplinary meetings, termed High-Risk Conferences, led by the Patient Safety Committee. Methods In this retrospective study, we assessed the reasons for convening High-Risk Conferences, the final decisions made and treatment outcomes using conference records and patient medical records for conferences conducted at our institution from April 2010 to March 2018. Results A total of 410 High-Risk Conferences were conducted for 406 patients during the study period. The department with the most conferences was cardiovascular surgery (24%), and the reasons for convening conferences included the presence of severe comorbidities (51%), highly difficult surgeries (41%) and nonmedical/personal issues (8%). Treatment changes were made for 49 patients (12%), including surgical modifications for 20 patients and surgery cancellation for 29. The most common surgical modification was procedure reduction (16 patients); 4 deaths were reported. Follow-up was available for 21 patients for whom surgery was cancelled, with 11 deaths reported. Conclusions Given that some change to the treatment plan was made for 12% of the patients discussed at the High-Risk Conferences, we conclude that participants of these conferences did not always agree with the original surgical plan and that the multidisciplinary decision-making process of the conferences served to allow for modifications. Many of the modifications involved reductions in procedures to reflect a more conservative approach, which might have decreased perioperative mortality and the incidence of complications as well as unnecessary surgeries. High-risk patients have complex issues, and it is difficult to verify statistically whether outcomes are associated with changes in course of treatment. Nevertheless, these conferences might be useful from a patient safety perspective and minimize the potential for legal disputes.

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Morbidity and Mortality of Carotid Endarterectomy under Local Anesthesia: A Retrospective Study

Neurosurgery ◽

10.1227/00006123-198810000-00007 ◽

1988 ◽

Vol 23 (4) ◽

pp. 445-450 ◽

Cited By ~ 17

Author(s):

Mario Zuccarello ◽

Hwa-shain Yeh ◽

John M. Tew

Keyword(s):

Retrospective Study ◽

High Risk ◽

Carotid Endarterectomy ◽

Local Anesthesia ◽

Perioperative Complications ◽

Minor Stroke ◽

Perioperative Mortality ◽

Occlusive Vascular Disease ◽

Risk Patients ◽

Ischemic Attack

Abstract It has been shown that carotid endarterectomy reduces the incidence of stroke in patients with symptomatic extracranial occlusive vascular disease in the absence of major perioperative complications such as stroke or death. We present a retrospective study of 106 carotid endarterectomies performed under local anesthesia in 100 patients in whom transient ischemic attack (TIA) or minor stroke had occurred. Nonfatal stroke occurred in 2%, and TIA occurred in 1%. There was no perioperative mortality. Our study suggests that, under local anesthesia, even high risk patients can be operated safely and the majority of carotid endarterectomies can be performed without the use of an indwelling shunt. Meticulous surgical technique is of great importance for achieving low perioperative complications.

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Selected High-Risk Patients With Upper Tract Urothelial Carcinoma Treated With Radical Nephroureterectomy for Adjuvant Chemotherapy: A Multi-Institutional Retrospective Study

Clinical Genitourinary Cancer ◽

10.1016/j.clgc.2017.10.014 ◽

2018 ◽

Vol 16 (3) ◽

pp. e669-e675 ◽

Cited By ~ 5

Author(s):

Masaomi Ikeda ◽

Kazumasa Matsumoto ◽

Takahiro Hirayama ◽

Dai Koguchi ◽

Yasukiyo Murakami ◽

...

Keyword(s):

Retrospective Study ◽

High Risk ◽

Adjuvant Chemotherapy ◽

Urothelial Carcinoma ◽

Upper Tract Urothelial Carcinoma ◽

Radical Nephroureterectomy ◽

Upper Tract ◽

High Risk Patients ◽

Risk Patients

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Using the Reverse Shock Index at the Injury Scene and in the Emergency Department to Identify High-Risk Patients: A Cross-Sectional Retrospective Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph13040357 ◽

2016 ◽

Vol 13 (4) ◽

pp. 357 ◽

Cited By ~ 9

Author(s):

Wei-Hung Lai ◽

Cheng-Shyuan Rau ◽

Shiun-Yuan Hsu ◽

Shao-Chun Wu ◽

Pao-Jen Kuo ◽

...

Keyword(s):

Emergency Department ◽

Retrospective Study ◽

High Risk ◽

Shock Index ◽

Reverse Shock ◽

Cross Sectional ◽

High Risk Patients ◽

Risk Patients

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Comparison of Oncological Outcomes Between Radical Prostatectomy and Radiotherapy by Type of Radiotherapy in Elderly Prostate Cancer Patients

Frontiers in Oncology ◽

10.3389/fonc.2021.708373 ◽

2021 ◽

Vol 11 ◽

Author(s):

Xiao-Xiao Guo ◽

Hao-Ran Xia ◽

Hui-Min Hou ◽

Ming Liu ◽

Jian-Ye Wang

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Radical Prostatectomy ◽

External Beam Radiotherapy ◽

The Other ◽

Oncologic Outcomes ◽

Intermediate Risk ◽

High Risk Patients ◽

Significant Difference ◽

Risk Patients

ObjectiveWe aimed compare the oncologic outcomes of radical prostatectomy (RP) with those of external beam radiotherapy (EBRT), brachytherapy (BT), or EBRT + BT (EBBT) in elderly patients with localised prostate cancer (PCa).MethodsLocalised PCa patients aged ≥70 years who underwent RP, EBRT, BT, or EBBT between 2004 and 2016 were identified from the Surveillance, Epidemiology, and End Results database. Multivariable competing risks survival analyses were used to estimate prostate cancer-specific mortality (CSM) and other-cause mortality (OCM). Subgroup analyses according to risk categories were also conducted.ResultsOverall, 14057, 37712, 8383, and 5244 patients aged ≥70 years and treated with RP, EBRT, BT, and EBBT, respectively, were identified. In low- to intermediate-risk patients, there was no significant difference in CSM risk between RP and the other three radiotherapy modalities (all P > 0.05). The corresponding 10-year CSM rates for these patients were 1.2%, 2.3%, 2.0%, and 1.8%, respectively. In high-risk patients, EBRT was associated with a higher CSM than RP (P = 0.003), whereas there was no significant difference between RP and BT or RP and EBBT (all P > 0.05). The 10-year CSM rates of high-risk patients in the RP, EBRT, BT, and EBBT groups were 7.5%, 10.2%, 8.3%, and 7.6%, respectively. Regarding OCM, the risk was generally lower in RP than in the other three radiotherapy modalities (all P < 0.001).ConclusionsAmong men aged ≥70 years with localised PCa, EBRT, BT, and EBBT offer cancer-specific outcomes similar to those of RP for individuals with low- to intermediate-risk disease. In patients with high-risk disease, EBBT had outcomes equally favourable to those of RP, but RP is more beneficial than EBRT. More high-quality trials are warranted to confirm and expand the present findings.

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Do we need to extend CMV prophylaxis course in high risk patients post transplant? A single centre retrospective study of CMV infection in kidney transplant patients

10.26226/morressier.5873668fd462b80292384010 ◽

2017 ◽

Author(s):

Mayar Ghazal Aswad

Keyword(s):

Retrospective Study ◽

High Risk ◽

Kidney Transplant ◽

Cmv Infection ◽

Single Centre ◽

Post Transplant ◽

Transplant Patients ◽

Risk Patients ◽

Kidney Transplant Patients ◽

Cmv Prophylaxis

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Survival and Response Outcomes to Different Treatment Schedules in CML Patients Starting Therapy with Imatinib. Results from the CML Spanish Registry (RELMC)

Blood ◽

10.1182/blood.v116.21.1237.1237 ◽

2010 ◽

Vol 116 (21) ◽

pp. 1237-1237

Author(s):

Luis Felipe Casado ◽

Isabel Massague ◽

Pilar Giraldo ◽

Manuel Perez-Encinas ◽

Raquel De Paz ◽

...

Keyword(s):

High Risk ◽

Cumulative Incidence ◽

Research Funding ◽

The Other ◽

Molecular Response ◽

Newly Diagnosed ◽

High Risk Patients ◽

Advisory Boards ◽

Best Response ◽

Risk Patients

Abstract Abstract 1237 Background: The RELMC is a multicentric, 17-hospitals-based cancer registry whose aim is to describe the treatments received by patients with CML, their outcomes, and the variables that influence treatment choices. Aim: To study the response and survival outcomes, in newly diagnosed CML patients treated with Imatinib (Im) as first line treatment. Patients and methods: 249 newly diagnosed CML patients have been included. They are distributed in the following subgroups according to treatments received Im400. 166 patients received only Im400. Result: A summary of response and outcome is included in Table 1. Complete cytogenetic response with regards to the best response, the CCyR rate was lower in patients with Im400-HDIm-2GTKI (60%) and Im400-2GTKI (62%). The rates were 84% in Im400, 83% in Im400-HDIm and 85% in HDIm; P Chi2 8,381(a) p=0,079. The CCyR cumulative incidence was also lower in patients with Im400-HDIm-2GTKI and Im400-2GTKI in comparison to the other groups, although second line response was faster in patients who changed to 2GTKI after Im400. The frequency of CCyR as best response in the Hasford high risk patients was low in all groups (66%,50%,50%,50&55%). Major molecular response MMR as best response was lower in patients with Im400-HDIm-2GTKI (50%) and Im400-2GTKI (47%). The rates were 83%, 81% and 77% in the Im400, Im400-HDIm and HDIm groups respectively; P Chi2 19,4(a)p=0,001. The MMR cumulative incidence was higher in the HDIm group, lower in those treated with Im400-HDIm-2GTKI, and intermediate and similar in the other three groups. MMR as best response in the Hasford high risk patients was also low in all groups (60%, 75%, 50%, 50% & 33%). Complete molecular response regarding best response, the CMR rate was lower in patients with Im400-HDIm-2GTKI (37,5%), Im400-2GTKI (31,6%) and Im400-HDIm (34%). In the other groups, the rate was 48% (Im400), and 72% (HDIm); P Chi2 17,4(a) p=0,002. The CMR cumulative incidence was higher in the HDIm group, and nil in those treated with Im400-HDIm-2GTKI. Salvage therapy after suboptimal response (SR) or Failure (F). Two-thirds of patients with SR or F were able to obtain an optimal response and avoid transformation with a timely therapy change. All but one of the options (Im400-HDIm-2GTKI group) were similarly effective. Survival: 6 patients progressed (2,4%) (4 AP, 2 BC), and died; 6 patients changed to allo BMT and were censored; 6 patients died of non-CML related causes. Conclusion: Disclosures: Palomera: Janssen Cilag: Honoraria. Steegmann:Bristol-Myers Squibb: Honoraria, Participated in advisory boards, Research Funding; Novartis: Participated in advisory boards, Research Funding.

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Factors contributing to delayed diagnosis in nasopharyngeal carcinoma

The Journal of Laryngology & Otology ◽

10.1017/s0022215100144718 ◽

1999 ◽

Vol 113 (7) ◽

pp. 633-636 ◽

Cited By ~ 11

Author(s):

Jern-Lin Leong ◽

Kam-Weng Fong ◽

Wong-Kein Low

Keyword(s):

Retrospective Study ◽

High Risk ◽

Nasopharyngeal Carcinoma ◽

Delayed Diagnosis ◽

Atypical Presentation ◽

Newly Diagnosed ◽

Therapeutic Radiology ◽

Singapore General Hospital ◽

Risk Patients

AbstractNasopharyngeal carcinoma (NPC) can be difficult to diagnose. Not only is the post-nasal space (PNS) inaccessible to examination, it is frequently occupied by normal lympho-epithelium which can make differentiation from NPC difficult. Together with its frequent atypical presentation, it is not surprising that the diagnosis is missed or delayed. This is undesirable as the treatment of early NPC carries an excellent prognosis. The aim of this study is to ascertain the extent of the problem of missed or delayed diagnosis and to study the factors responsible.This was a retrospective study of all newly diagnosed patients with NPC from the Singapore General Hospital and treated in the Department of Therapeutic Radiology in the year 1996 (1 January-31 December).A total of 126 patients were studied. Eighteen patients (14.3 per cent) were found to have delayed diagnosis of more than a month. The delay ranged from 1.2 to 25 months (mean 7.2 months). Factors identified which contributed to delayed diagnosis included i) Clinicians not considering a diagnosis of NPC ii) Clinicians suspecting NPC but misled by the results of investigations iii) Patients refusing investigation or defaulting follow-up.Nearly a fifth of patients with NPC had delayed diagnosis. Many of the factors responsible for the delays appear to be preventable by better patient education and counselling, doctors having sharper clinical acument and skills in NPC diagnosis and the hospital administration having a system of tracking down high risk patients who default.

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