scholarly journals Prospective switch study comparing two irrigation systems for transanal irrigation in children

2021 ◽  
Vol 84 (2) ◽  
pp. 295-298
Author(s):  
K Van Renterghem ◽  
M Sladkov ◽  
L Matthyssens ◽  
D Van de Putte ◽  
P Pattyn ◽  
...  
Keyword(s):  
Rectal Balloon ◽  
Patient Control ◽  
Transanal Irrigation ◽  
Control Switch ◽  
Parametric Statistics ◽  
Bristol Stool Scale ◽  
Selection For ◽  
Irrigation Volume ◽  
Switch Study

Background and study aims: Transanal irrigation (TAI) is used in children to treat constipation and incontinence. Belgium has 2 systems available: Colotip® (cheaper, however not designed for TAI) or Peristeen®. Patients and methods: This patient-control switch study is the first to compare 2 TAI systems. Children regularly using Colotip® for TAI were asked to participate, after consent, a visual analogue scale (VAS) rating the system and a 2-week diary (fecal continence, self-reliance, time spent on the toilet, pain, Bristol stool scale, irrigation volume and frequency of enema) were completed. Non-parametric statistics were used. Results: Out of 26 children using Colotip®, 18 (69%) children participated and 5 refused (fear n=1, satisfaction Colotip® system n=7). Of these 18 children (interquartile range: 3-18 years, median 12.5 years, 9 girls) 5 patients stopped Peristeen® (pain n=1, fear n=1 and balloon loss n=3) and 2 were lost from follow up. Dropouts and included patients showed no statistical difference. In the 11 remaining patients, pseudo-continence (p 0.015), independence (p 0.01) and VAS score (p 0.007) were significantly better with Peristeen®, no difference was found in time spent on the toilet (p 0.288) and presence of pain (p 0.785). Conclusions: In children Peristeen® offered significantly higher pseudo-continence and independency. 30% refused participation because of satisfaction with the Colotip® and 30% spina bifida patients reported rectal balloon loss due to sphincter hypotony. To diminish Peristeen® failure, a test-catheter could be of value. Considering Colotip® satisfaction, both systems should be available. Patient selection for Peristeen® needs further research.

scholarly journals Holmium laser enucleation of the prostate with Virtual Basket mode: faster and better control on bleeding

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Giorgio Bozzini ◽  
Matteo Maltagliati ◽  
Umberto Besana ◽  
Lorenzo Berti ◽  
Albert Calori ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Operative Time ◽  
Randomized Study ◽  
Urine Volume ◽  
Holmium Laser ◽  
Laser Enucleation ◽  
Holmium Laser Enucleation ◽  
Irrigation Volume

Abstract Background To compare clinical intra and early postoperative outcomes between conventional Holmium laser enucleation of the prostate (HoLEP) and Holmium laser enucleation of the prostate using the Virtual Basket tool (VB-HoLEP) to treat benign prostatic hyperplasia (BPH). Methods This prospective randomized study enrolled consecutive patients with BPH, who were assigned to undergo either HoLEP (n = 100), or VB-HoLEP (n = 100). All patients were evaluated preoperatively and postoperatively, with particular attention to catheterization time, operative time, blood loss, irrigation volume and hospital stay. We also evaluated the patients at 3 and 6 months after surgery and assessed maximum flow rate (Qmax), postvoid residual urine volume (PVR), the International Prostate Symptom Score (IPSS) and the Quality of Life score (QOLS). Results No significant differences in preoperative parameters between patients in each study arm were found. Compared to HoLEP, VB-HoLEP resulted in less hemoglobin decrease (2.54 vs. 1.12 g/dl, P = 0.03) and reduced operative time (57.33 ± 29.71 vs. 42.99 ± 18.51 min, P = 0.04). HoLEP and VB-HoLEP detrmined similar catheterization time (2.2 vs. 1.9 days, P = 0.45), irrigation volume (33.3 vs. 31.7 l, P = 0.69), and hospital stay (2.8 vs. 2.7 days, P = 0.21). During the 6-month follow-up no significant differences in IPSS, Qmax, PVR, and QOLS were demonstrated. Conclusions HoLEP and VB-HoLEP are both efficient and safe procedures for relieving lower urinary tract symptoms. VB-HoLEP was statistically superior to HoLEP in blood loss and operative time. However, procedures did not differ significantly in catheterization time, hospital stay, and irrigation volume. No significant differences were demonstrated in QOLS, IPSS, Qmax and PVR throughout the 6-month follow-up. Trial Registration: Current Controlled Trials ISRCTN72879639; date of registration: June 25th, 2015. Retrospectively registred.

scholarly journals Cardiologic evaluation of patients undergoing chemoterapy

2015 ◽  
Vol 82 (2) ◽  
Author(s):  
Barbara Bordoni ◽  
Stefano Urbinati ◽  
Alicia Tosoni ◽  
Graziana Labanti ◽  
Alba Brandes
Keyword(s):  
Ventricular Dysfunction ◽  
Troponin I ◽  
Coronary Spasm ◽  
Left Ventricular ◽  
Cardiac Damage ◽  
Common Risk Factors ◽  
Selection For ◽  
Chemotherapy Cardiotoxicity

Life expectancy in patients affected by cancer has recently increased because of early diagnosis and actual therapies. In recent years, Oncology and Cardiology developed a tight relationship because of common risk factors (i.e. obesity, smoking, alcool intake, etc…), and for preventing the prothrombotic status due to cancer and the potential cardiotoxicity of chemotherapy. Cardiotoxicity incidence is reported from 1% up to 70% in retrospective analyses of drug protocols, mainly representing by left ventricular dysfunction (both reversible or irreversible), but also by arrhythmias, hypertension, atrioventricular block, coronary spasm, and arterial or venous thromboembolism. The early detection of the chemoterapy induced cardiotoxicity is now mandatory and can be obtained through a proper patients selection for different treatments and a strict monitoring during the follow-up period. The role of biomarkers of early cardiac damage, mainly, troponin I and brain natriuretic peptide-BNP, has been recently challenged, and algorithms are currently available. In the present paper, we propose how to perform a cardiological evaluation of patients undergoing chemoterapy tailored by the known adverse effects of the drugs.

scholarly journals Risk stratification and prognostic value of CMR in DCM; parametric mapping and GLS- value beyond EF and LGE?

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
P Brown ◽  
A Dimarco ◽  
J Bradley ◽  
G Nucifora ◽  
C Miller ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Prognostic Value ◽  
Nyha Class ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Youden Index ◽  
Private Company ◽  
Parametric Mapping ◽  
Selection For

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Dr Pamela Brown was suppoerted by funding from Alliance Medical. Background; Arrhythmia risk stratification and device implantation in dilated cardiomyopathy (DCM) poses significant challenges and as demonstrated by the DANISH trial appears to have reached the asymptote of clinical efficacy. A body of evidence now demonstrates that risk stratification of and device selection for DCM patients may be enhanced by inclusion of patients" LGE-status. Furthermore, it has been suggested that CMR based parametric mapping and strain analysis may further advance risk stratification. Methods; 703 patients with DCM undergoing clinically indicated CMR scans and prospectively enrolled into the UHSM-CMR study (NCT02326324) between 03/2015-12/2018 were analysed. Multivariable Cox proportional hazard models and Youden index driven C-statistics were used to assess additive prognostic value of GLS, T1 and ECV mapping on the combined endpoint of cardiovascular death, cardiac transplantation, LVAD  insertion  or hospitalisation for heart failure in models incorporating NHYA class, EF and LGE status. Additionally. the value of GLS, T1, and ECV on predicting significant arrhythmic events (SAV) (ventricular arrhythmia (VA), resuscitated cardiac arrest (rCA) or sudden cardiac death (SCD)) was assessed. Results; Patients (mean age 59, 66% male, 60% ≥NYHA II, mean EF 42%, mean GLS -12%, mean ECV 27%) were on good medical therapy (beta blocker 74%%, ACE 79%, MRA 38%, Entresto 5%, CRT 23%). Mean follow-up was 21 months; the combined endpoint occurred in 34 patients (5%). On univariate analysis NYHA class (HR 2.44 (1.67-3.57), p < 0.001), ECV (HR 1.14 (1.05-1.22), p < 0.001), GLS% (HR 1.14 (1.07-1.21) p < 0.001,) T1 (HR 1.06 (1.005-1.1), p = 0.03), RVEF (HR 0.95 (0.93-0.98), p < 0.001), LVEF (HR 0.92 (0.9-0.95), p < 0.001) were all significantly associated with outcome. On multivariate analysis only EF and NYHA class was associated with outcome. SAV occurred as the first manifestation of disease or during follow up in 27 patients (4%). At univariate analysis LGE, ECV, GLS, EF and NYHA class were all associated with SAV. However, on multivariable analysis only EF, LGE  and ECV (HR 1.11 (1.01-1.22), p = 0.03) but not GLS remained independently predictive in a model already incorporating EF, NYHA and LGE. Conclusion Optimally treated DCM populations have very low event rates. CMR based assessment of fibrosis status/burden with both LGE and ECV assessment has the potential to enhance patient selection for ICD therapy. Whilst GLS is increasingly recognised as a sensitive imaging biomarker of early disease detection it provides no additive value,  likely because of it’s high co-linearity with EF, in models already containing EF, NYHA class and LGE status.

Upfront cytoreductive surgery versus neoadjuvant chemotherapy in advanced epithelial ovarian cancer in Indian patients

2021 ◽  
Author(s):  
Mukur Dipi Ray ◽  
Suryanarayana S.V. Deo ◽  
Lalit Kumar ◽  
Manish Kumar Gaur
Keyword(s):  
Ovarian Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Ovarian Carcinoma ◽  
Cytoreductive Surgery ◽  
Advanced Ovarian Cancer ◽  
Advanced Stages ◽  
Selection For ◽  
Selection Of Patients ◽  
Selection Of

In cases of ovarian carcinoma, primary cytoreductive surgery (CRS) is the standard treatment up to stage IIIB, but patient selection for neoadjuvant chemotherapy (NACT) in selected cases is controversial. A total of 200 patients with advanced ovarian cancer were analyzed retrospectively, according to specific selection criteria. Primary CRS was performed in 95 patients (47.5%) and interval CRS after 3–6 cycles of NACT was performed in 105 patients (52.5%). After median follow-up of 35 months, 5-year overall survival was 53.7% in the upfront CRS group and 42.2% in the NACT group. Primary CRS is the standard in advanced stages of ovarian carcinoma, but in certain subset of patients, NACT is preferred. Identifying that group is challenging but feasible. Proper selection of patients is key to successful outcomes.

scholarly journals Galaxy And Mass Assembly (GAMA): assimilation of KiDS into the GAMA database

2020 ◽  
Vol 496 (3) ◽  
pp. 3235-3256 ◽  
Author(s):  
Sabine Bellstedt ◽  
Simon P Driver ◽  
Aaron S G Robotham ◽  
Luke J M Davies ◽  
Cameron R J Bogue ◽  
...  
Keyword(s):  
Near Infrared ◽  
Data Set ◽  
The Galaxy ◽  
Analysis Package ◽  
Selection For ◽  
Mass Assembly ◽  
A New Technique ◽  
Source Extraction ◽  
Homogeneous Data

ABSTRACT The Galaxy And Mass Assembly Survey (GAMA) covers five fields with highly complete spectroscopic coverage (>95 per cent) to intermediate depths (r < 19.8 or i < 19.0 mag), and collectively spans 250 deg2 of equatorial or southern sky. Four of the GAMA fields (G09, G12, G15, and G23) reside in the European Southern Observatory (ESO) VST KiDS and ESO VISTA VIKING survey footprints, which combined with our GALEX, WISE, and Herschel data provide deep uniform imaging in the $FUV/NUV/u/g/r/i/Z/Y/J/H/K_s/W1/W2/W3/W4/P100/P160/S250/S350/S500$ bands. Following the release of KiDS DR4, we describe the process by which we ingest the KiDS data into GAMA (replacing the SDSS data previously used for G09, G12, and G15), and redefine our core optical and near-infrared (NIR) catalogues to provide a complete and homogeneous data set. The source extraction and analysis is based on the new ProFound image analysis package, providing matched-segment photometry across all bands. The data are classified into stars, galaxies, artefacts, and ambiguous objects, and objects are linked to the GAMA spectroscopic target catalogue. Additionally, a new technique is employed utilizing ProFound to extract photometry in the unresolved MIR–FIR regime. The catalogues including the full FUV–FIR photometry are described and will be fully available as part of GAMA DR4. They are intended for both standalone science, selection for targeted follow-up with 4MOST, as well as an accompaniment to the upcoming and ongoing radio arrays now studying the GAMA 23h field.

scholarly journals Epidemiology of Parkinson’s Disease

1984 ◽  
Vol 11 (S1) ◽  
pp. 156-159 ◽  
Author(s):  
A.H. Rajput
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Mortality Rate ◽  
Index Date ◽  
Chronic Illnesses ◽  
Smoking Habits ◽  
Annual Incidence Rate ◽  
Case Selection ◽  
Selection For

ABSTRACTEpidemiology of parkinsonism for 13 years (1967 to 1979) in Rochester, Minnesota is evaluated. For each patient, two age- and sex-matched controls with comparable medical follow-up (mean 40 years before diagnosis) were selected from the same community. Smoking habits, dementia, acute and chronic illnesses and mortality patterns in the two groups are compared. The annual incidence rate was 20.5/100,000, which is virtually unchanged from previous reports on Rochester population. Cigarette smoking habits of cases and the controls before the index date were not significantly different. Prior to diagnosis of Parkinson’s disease, dementia was diagnosed significantly more frequently among the patients than the controls (P = 0.048). After diagnosis of parkinsonism dementia emerged nearly three times more frequently in patients than among the controls. Mortality rate in the entire parkinsonian population was similar to that reported from the same community between 1935 and 1966. Only 50% of the patients were treated with levodopa. Among those treated with levodopa the mortality rate was comparable to their controls. Because there were no definite criteria for administering levodopa therapy, higher frequency of dementia and prolonged survival in those treated with this drug could be attributed to the bias of case selection for treatment.

Risk of missing advanced stage or high grade tumors during active surveillance (AS) even in favorable-risk prostate cancer (PC).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 5069-5069
Author(s):  
Jeri Kim ◽  
John Francis Ward ◽  
Curtis A. Pettaway ◽  
Xuemei Wang ◽  
Deborah A. Kuban ◽  
...  
Keyword(s):  
Selection Criteria ◽  
Early Stage ◽  
Specific Antigen ◽  
Local Therapy ◽  
Study Entry ◽  
Single Institution ◽  
Endorectal Mri ◽  
Risk Prostate Cancer ◽  
Selection For

5069 Background: Owing to tumor heterogeneity, no standard selection criteria exist among prospective AS cohorts. Generally, men with low-stage, -volume, and -grade PC and low prostate-specific antigen (PSA) are eligible. In our prospective single-institution AS trial, men with early-stage PC were stratified: Gr I (favorable risk), II (pt’s choice), or III [competing comorbidities prevent local therapy (Tx)]. We report our experience with Gr I. Methods: Eligibility for Gr I: Gleason score (GS) ≤6, 1 positive (pos) core (<3 mm), and PSA <4 ng/mL or GS 7 (3+4), 1 pos core (<2 mm), and PSA <4 ng/mL. Monitoring q6mo included PSA, testosterone, and digital rectal exam. All pts had repeat biopsy (re-BX) at 1 y and then on predetermined BX scheme. Later, re-BX was required within 6 mo of study entry per an 11-core BX scheme (also used during AS). Definitive Tx was offered to pts who met reclassification based on clinical, BX (upgrading, ↑ in pos core BX, and/or ↑ tumor length), and/or radiographic progression. Imaging studies [bone/CT scans, endorectal MRI (eMRI)] were at physician’s discretion. Results: From 2/2006 to 2/2012, 585 pts enrolled; 191 met Gr I criteria (41 before, 150 after re-BX requirement). Median age was 64 y (range, 36–83); 82% were white, 8% African-American, 8% Hispanic, 2% Asian; 4% had cT1a/cT1b, 84% cT1c, and 12% cT2 disease. Most (189/191) had GS 6 [1 had GS 5, and 1, GS 7 (3+4)]. Median PSA was 3.3 (range, 0.2–10). With median follow-up of 36.2 mo (95% CI: 30.6–41.7), 32/191 (17%) were reclassified [20/41 (49%) before and 12/150 (8%) after re-BX requirement]. Of 32 reclassified, 17 were due to GS: 11 to GS 7 (3+4), 4 to GS 7 (4+3), and 2 to GS 8 (4+4). Ten of the 32 reclassified chose Tx [4 radical prostatectomy (RP); 4 radiation; 2 cryotherapy]. RP showed a pT2N0 GS9 (4+5) apical tumor in 1 at 5 y, a pT3aN0 GS7 (4+3) tumor in 1 at 3 y, a pT2N0 GS7 (4+3) tumor in 1 at 1 y, and a T2N0 GS 7 (3+4) tumor in 1 at 2 y. Conclusions: Restrictive selection criteria and re-BX at study entry improve clinical risk classification; however, other improvements, including imaging and markers of disease progression could enhance pt selection for AS.

A novel clinical decision aid to support personalized treatment selection for patients with CT1 renal cortical masses: Results from a multi-institutional competing risks analysis including performance status and comorbidity.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 610-610
Author(s):  
Sarah P. Psutka ◽  
Roman Gulati ◽  
Michael A.S. Jewett ◽  
Kamel Fadaak ◽  
Antonio Finelli ◽  
...  
Keyword(s):  
Competing Risks ◽  
Active Surveillance ◽  
Thermal Ablation ◽  
Prediction Models ◽  
Performance Status ◽  
Personalized Treatment ◽  
Risk Calculator ◽  
Selection For ◽  
Competing Causes

610 Background: Personalized treatment for clinical T1 renal cortical masses (RCMs) should account for competing risks related to tumor and patient characteristics. Using a contemporary multi-institutional cohort, we developed treatment-specific prediction models for cancer-specific mortality (CSM), other-cause mortality (OCM), and 90-day complication rates for patients managed with surgery, thermal ablation (TA), and active surveillance (AS). Methods: Preoperative clinical and radiological features were collected for eligible patients aged 18-91 years treated at four academic centers from 2000-2016. Prediction models used competing risks regressions for CSM and OCM and logistic regressions for 90-day Clavien >3 complications, adjusting for tumor size as well as patient age, sex, ECOG performance status (PS), and Charlson comorbidity index (CCI). Predictions accounted for missing data using multiple imputation. Results: After excluding 25 patients with no follow-up, the cohort included 4995 patients treated with radical nephrectomy (RN, n=1270), partial nephrectomy (PN, n=2842), thermal ablation (n=479), or active surveillance (n=404). Median follow-up was 5.1 years (IQR 2.5-8.5). Predictions from the fitted model are shown in an online calculator ( https://rgulati.shinyapps.io/rcc-risk-calculator ). To illustrate the use of this calculator for a specific patient, a 70-year-old female with a 5.5 cm RCM, PS of 2, and CCI of 3 has a predicted 5-year CSM of 4-7% across treatments, 5-year OCM of 34-49%, and 90-day risk of Clavien ≥3 complications of 4%, 10%, and 6% for RN, PN, and TA respectively. Conclusions: Personalized treatment selection for cT1 RCM is challenging. We present a competing risk calculator that incorporates pretreatment features to quantify competing causes of mortality and treatment-associated complications. Pending validation, this tool may be used in clinical practice to provide patients with estimated individualized treatment-specific probabilities of competing causes of death and complication risks to facilitate shared decision-making.

scholarly journals Gender-related differences in patient selection for and outcomes after pace and ablate for refractory atrial fibrillation: insights from a large multicenter cohort

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
T Baumgartner ◽  
M Kaelin-Friedrich ◽  
K Makowski ◽  
F Noti ◽  
B Schaer ◽  
...  
Keyword(s):  
Heart Failure ◽  
Gender Differences ◽  
Patient Selection ◽  
Funding Sources ◽  
Kaplan Meier ◽  
Number Of Patients ◽  
Male Patients ◽  
Selection For ◽  
Av Junction Ablation

Abstract Funding Acknowledgements Type of funding sources: None. Background A pace & ablate strategy may be performed in cases of severe refractory atrial arrhythmias. Purpose We aimed to assess gender related differences in patient selection and clinical outcomes after pace & ablate. Methods In a retrospective multicenter study, patients undergoing AV-junction-ablation between 2011 and 2019 were studied. Gender-related differences in terms of baseline characteristics, device-related complications, heart failure (HF) hospitalisations and death were assessed. Results Overall, 513 patients underwent AV-junction-ablation (median age 75 years, 50% males). At baseline, male patients were younger (72 vs. 78 years, p &lt; 0.001), more frequently had non-paroxysmal AF (82% vs. 72%, p = 0.006), a lower LVEF (35% vs. 55%, p &lt; 0.001) and more often received biventricular stimulation (75% vs. 25%, p &lt; 0.001). Interventional complications were rare in both gender (1.2% vs 1.6%, p = 0.72). Following AV-junction-ablation, improvement of EHRA-class by ≥1 and of LVEF by ≥5% occurred in 44% and 19% of patients respectively, without gender differences (p = 0.66 and p = 0.38). Patients were followed for a median of 42 months in survivors (IQR 22-62). Lead-related complications (11 patients, 2.1%), infections (1 patient, 0.2%) and upgrade to ICD or CRT (18 patients, 3.5%) were rare. In Kaplan Meier analysis, HF hospitalisations during 4 years of follow-up were more common in men (22% vs 11%, p = 0.02), as were death (28% vs 21%, p = 0.02) and the combination of death or HF hospitalisation (37% vs. 26%, p = 0.008, Figure). Gender remained an independent predictor of the combined endpoint of death or HF hospitalisation after adjustment for age, LVEF and type of stimulation. Conclusion A Pace & Ablate strategy is safe and results in improvement of EHRA class and LVEF in a substantial number of patients. We found significant gender differences in patient selection for pace & ablate. Female patients had a more favorable clinical course after AV-junction-ablation, which was independent of age, EF and type of stimulation. Abstract Figure. Comb. endpoint of death or heart failure

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