Efficacy of percutaneous cryoablation of renal cell carcinoma in older patients with medical comorbidities: Outcome study in 70 patients

Introduction: The aim of this study was to establish the efficacy of cryoablation for incidentally discovered small renal cell carcinomas in older patients with medical comorbidities.Methods: We carried out a retrospective chart analysis of outcomes of 70 patients treated by cryoablation. The inclusion criteria were age >56 years, medical comorbidities (Charlson class I–III), and suitability for cryoablation established by urologists and interventional radiologists. In total, 43 patients were male, 27 female, and the age range was 56 to 89. The lesions measured 1.5 to 4 cm; 29 were high-grade Fuhrman and 41 were low grade. All lesions were treated by 2 10-minute freezing cycles separated by an 8-minute thawing period. One to seven cryoprobes were inserted according to a preoperative, 3D computed tomography (CT)-based plan.Results: Results were assessed on follow-up CTs (at 8–9 months). Of the 70 patients, 68 were treated by cryoablations and surgical salvage procedures; these patients were free of disease for 23 to 72 months (mean 39). One patient experienced recurrence and the other was lost to follow-up. One or two cryoablations rendered 66 patients tumour-free and additional surgery rendered another 2 patients tumour-free. The location and configuration of the lesion affected outcomes. Of the 27 posterior lesions, there was 1 failure; of the postero-lateral lesions, there were 4 failures; of the anterior lesions, there were 5 lesions; finally of the 32 central or deep seated lesions, there were 9 failures. Implants with one and two cryoprobes had a high recurrence rate. Three major complications were managed by minor interventions. The mean hospitalization was 1.3 days and the procedure times were variable.Conclusion: Percutaneous cryoablation is recommended as a minimally invasive nephron-sparing treatment for amenable lesions in older patients with medical comorbidities.

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NCOG-42. INITIAL PRESENTATION AND OUTPATIENT VISIT COMPLIANCE OF INMATES WITH BRAIN TUMORS

Neuro-Oncology ◽

10.1093/neuonc/noaa215.580 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii138-ii138

Author(s):

Iyad Alnahhas ◽

Appaji Rayi ◽

Yasmeen Rauf ◽

Shirley Ong ◽

Pierre Giglio ◽

...

Keyword(s):

Brain Tumors ◽

Civil Liberties ◽

Delayed Diagnosis ◽

Low Grade ◽

Small Series ◽

Initial Symptoms ◽

The Ohio State University ◽

American Civil Liberties Union ◽

Lost To Follow Up

Abstract INTRODUCTION While advocacy for inmates with cancer has recently gained momentum, little is known about management of brain tumors in inmates. Delays in acknowledging or recognizing nonspecific initial symptoms can lead to delayed diagnosis and treatment. Inmates with cancer are reported to either be ignored or receive substandard care due in part to cost or logistics (American Civil Liberties Union; ASCO Post 2018). METHODS In this retrospective study, we identified inmates with gliomas seen in the Ohio State University Neuro-oncology Center between 1/1/2010-4/20/2019. RESULTS Twelve patients were identified. Median age at presentation was 39.5 years (range 28-62). Eleven patients were Caucasian and one was African American. Diagnoses included glioblastoma (GBM) (n=6), anaplastic astrocytoma (n=1), anaplastic oligodendroglioma (n=1), low-grade astrocytoma (n=3) and anaplastic pleomorphic xanthroastrocytoma (n=1). Patients were more likely to present early after seizures or focal neurologic deficits (9/12) than after headaches alone. Patients with GBM started RT 12-71 days after surgery (median 34.5). One patient’s post-RT MRI was delayed by a month and another with GBM had treatment held after 4 cycles of adjuvant temozolomide (TMZ) due to “incarceration issues”. For one patient who received adjuvant TMZ, the facility failed to communicate with the primary team throughout treatment. Two patients suffered significant nausea while on chemotherapy due to inability to obtain ondansetron in prison, or due to wrong timing. 7/12 (58%) patients were lost to follow-up for periods of 3-15 months during treatment. Three patients refused adjuvant treatment. CONCLUSIONS Although this is a small series, our results highlight the inequities and challenges faced by inmates with gliomas who are more likely to forego treatments or whose incarceration prevents them from keeping appropriate treatment and follow-up schedules. Additional studies are needed to define and address these deficiencies in the care of inmates with brain tumors and other cancers.

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Identification of miR-20a-5p as Robust Normalizer for Urine microRNA Studies in Renal Cell Carcinoma and A Profile of Dysregulated microRNAs

International Journal of Molecular Sciences ◽

10.3390/ijms22157913 ◽

2021 ◽

Vol 22 (15) ◽

pp. 7913

Author(s):

Julia Oto ◽

Raquel Herranz ◽

Emma Plana ◽

José Vicente Sánchez-González ◽

Javier Pérez-Ardavín ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Diagnostic Value ◽

Diagnostic Model ◽

Low Grade ◽

Non Invasive ◽

Good Expression ◽

Independent Cohort

Renal cell carcinoma (RCC) is the third most frequent urinary malignancy and one of the most lethal. Current diagnostic and follow-up techniques are harmful and unspecific in low-grade tumors. Novel minimally invasive markers such as urine microRNAs (miRNAs) are under study. However, discrepancies arise among studies in part due to lack of consent regarding normalization. We aimed to identify the best miRNA normalizer for RCC studies performed in urine samples together with a miRNA profile with diagnostic value and another for follow-up. We evaluated the performance of 120 candidate miRNAs in the urine of 16 RCC patients and 16 healthy controls by RT-qPCR followed by a stability analysis with RefFinder. In this screening stage, miR-20a-5p arose as the most stably expressed miRNA in RCC and controls, with a good expression level. Its stability was validated in an independent cohort of 51 RCC patients and 32 controls. Using miR-20a-5p as normalizer, we adjusted and validated a diagnostic model for RCC with three miRNAs (miR-200a-3p, miR-34a-5p and miR-365a-3p) (AUC = 0.65; Confidence Interval 95% [0.51, 0.79], p = 0.043). let-7d-5p and miR-205-5p were also upregulated in patients compared to controls. Comparing RCC samples before surgery and fourteen weeks after, we identified let-7d-5p, miR-152-3p, miR-30c-5p, miR-362-3p and miR-30e-3p as potential follow-up profile for RCC. We identified validated targets of most miRNAs in the renal cell carcinoma pathway. This is the first study that identifies a robust normalizer for urine RCC miRNA studies, miR-20a-5p, which may allow the comparison of future studies among laboratories. Once confirmed in a larger independent cohort, the miRNAs profiles identified may improve the non-invasive diagnosis and follow-up of RCC.

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Oral Abstract

10.1055/s-0039-1685335 ◽

2016 ◽

Author(s):

Dharma Ram

Keyword(s):

Survival Data ◽

Eligible Patient ◽

Stage Iv ◽

Endometrial Stromal Sarcoma ◽

Uterine Sarcoma ◽

Low Grade ◽

Uterine Leiomyosarcoma ◽

High Grade ◽

Lost To Follow Up

Introduction: Uterine sarcoma accounts for nearly 3% of all uterine malignancies. They have 4 major pathology includes endometrial stromal sarcoma high grade, ESS low grade, uterine leiomyosarcoma (uLMS) and undifferentiated uterine sarcoma (UUS). Recent WHO classification 2014, recognizes low grade ESS and high grade ESS as distinct entity. They differ from endometrial carcinoma in their aggressive nature and poor prognosis. We review our database and found total 44 eligible patient treated at our institute. Materials and Methods: Its retrospective analysis of computer based database of our institute from January 2009 to December 2015. We analyzed demographic, pathological, treatment and survival data. Results: Total 44 patient treated for uterine sarcoma at our institute. Among these 16 were operated at our institute during study period. Here we reporting results of operated patients at our institute. The histological diagnosis LMS (5/16), ESS-L (4/16), MMMT (3/16), UUS (3/16) and ESS-H (1/16). Stage distribution was stage I, (6/16) stage II, (5/16) stage III, (3/16) stage IV, (0/16) and unknown stage (2/16). Two patients underwent completion surgery for outside myomectomy. The adjuvant treatment was CT in 3/16, CT with RT in 7/16, HT in 4/16 and one lost to follow up with one was put on observation. Median follow up is 30 month with 14 patients alive and one lost to follow up. At last follow up 4 patients alive with metastatic disease and 10 patients alive with no evidence of disease. Conclusion: Uterine sarcoma are uncommon disease with

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99 Barriers of Follow Up within the Burn and Wound Population.

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.103 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S67-S68

Author(s):

Erika Tay ◽

Ché R Ochtli ◽

Katharine A Kirby ◽

Melissa Carmean ◽

Nicole O Bernal ◽

...

Keyword(s):

Drug Dependence ◽

Multiple Logistic Regression Analysis ◽

Univariate Analysis ◽

Patient Characteristics ◽

Psychiatric Disease ◽

Medical Comorbidities ◽

Burn Care ◽

Neuropsychiatric Comorbidities ◽

Lost To Follow Up

Abstract Introduction Access to quality health care services is important for acute burn care, but comprehensive burn care goes beyond acute hospitalization. Follow up is an essential part of recovery, where providers can assess late effects of burn and help the patients with community re-integration, injury rehabilitation, and mental health. However, not all patients return for follow up after burn injury due to barriers in care and patient characteristics. We hypothesized that patients with neuropsychiatric comorbidities and 0–10% of total body surface (TBSA%) are more likely to be lost at follow up compared to patients with no neuropsychiatric comorbidities and higher TBSA. Methods A retrospective analysis was completed on patients that were admitted to a verified Burn Center from January 2016 to June 2019. Patients that were under 18 years of age and patients that died prior to discharge were excluded. Patient characteristics included were age, gender, TBSA, discharge location, payer, and comorbidities. Univariate analysis was completed using Tableau and multiple logistic regression analysis using Stata. Neuropsychiatric comorbidities were defined as dementia, alcoholism, major psychiatric disease, and drug dependence. Lost to follow up was defined as no follow up in clinic after inpatient discharge date within 1 month. Results Of 562 patients, 35.94% (n=202) were female and 65.12% (n=366) were Caucasian followed by Asian 13.7% (n=77) and Other Race 13.7% (n=77). Of the 562 patients, 157 (27.95%) were lost to follow up. After adjusting for insurance type, race, and medical comorbidities, patients with neuropsychiatric comorbidities had double the risk (OR 2.052; 1.377 - 3.057 p< 0.001) to be lost at follow up compared with those that did not have neuropsychiatric disorders. Homelessness was collinear with neuropsychiatric comorbidities suggesting an association. Patients with a TBSA >20% (n=37) were 3 times more likely to be lost at follow up in comparison with patients with 0–10% TBSA. (OR 2.921; 1.455–5.861 p< 0.003). Race, medical comorbidities, and insurance status had no significant impact on follow up. Conclusions Patients with dementia, alcoholism, major psychiatric disease, and drug dependence were more likely to be lost at follow up. Contrary to intuition, patients with burns >20% TBSA were also less likely to follow-up. Additional research is needed to better identify how psychosocial factors affect follow up in our burn patients and how to address those barriers. By focusing on our population and their needs, we can adjust our practices to make sure that we are providing holistic burn care.

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Succinate Dehydrogenase–Deficient Renal Cell Carcinoma

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2018-0024-rs ◽

2018 ◽

Vol 143 (5) ◽

pp. 643-647 ◽

Cited By ~ 6

Author(s):

Tsung-Heng Tsai ◽

Wen-Ying Lee

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Succinate Dehydrogenase ◽

Renal Cell ◽

World Health ◽

Low Grade ◽

Long Term Follow Up ◽

Health Organization

Succinate dehydrogenase (SDH)–deficient renal cell carcinoma is a recently recognized distinct subtype of renal cell carcinoma in the 2016 World Health Organization classification. It is associated with SDH gene germline mutations, which also cause paraganglioma/pheochromocytoma, gastrointestinal stromal tumor, and pituitary adenoma. The tumor most commonly presents in young adulthood. The tumors are arranged in solid nests or in tubules and frequently show cystic change. The tumors are composed of cuboidal to oval cells with round nuclei, dispersed chromatin, and inconspicuous nucleoli. The cytoplasm is eosinophilic or flocculent but not truly oncocytic. The most distinctive histologic feature is the presence of cytoplasmic vacuoles or inclusions. Loss of SDH subunit B immunostaining is needed for a definite diagnosis. The prognosis is good for low-grade tumors but worse for tumors with high-grade nuclei, sarcomatoid change, or coagulative necrosis. Long-term follow-up is indicated.

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Results after Laparoscopic Fundoplication: Does Age Matter?

The American Surgeon ◽

10.1177/000313480607200904 ◽

2006 ◽

Vol 72 (9) ◽

pp. 778-784 ◽

Cited By ~ 6

Author(s):

Sarah M. Cowgill ◽

Dean Arnaoutakis ◽

Desiree Villadolid ◽

Sam Al-Saadi ◽

Demetri Arnaoutakis ◽

...

Keyword(s):

Myocardial Infarction ◽

High Risk ◽

Older Patients ◽

Laparoscopic Fundoplication ◽

Nissen Fundoplication ◽

Younger Patients ◽

Before And After ◽

Laparoscopic Nissen ◽

Age Range

Antireflux fundoplications are undertaken with hesitation in older patients because of presumed higher morbidity and poorer outcomes. This study was undertaken to determine if symptoms of gastroesophageal reflux disease (GERD) could be safely abrogated in a high-risk/reward population of older patients. One hundred eight patients more than 70 years of age (range, 70–90 years) underwent laparoscopic Nissen fundoplications undertaken between 1992 and 2005 and were compared with 108 concurrent patients less than 60 years of age (range, 18–59 years) to determine relative outcomes. Before and after fundoplication, patients scored the severity of reflux and dysphagia on a Likert Scale (0 = minor, 10 = severe). Before fundoplication, older patients had lower reflux scores ( P < 0.01), but not lower dysphagia scores or DeMeester scores. One patient (86 years old) died from myocardial infarction; otherwise, complications occurred infrequently, inconsequentially, and regardless of age. At similar durations of follow-up, reflux and dysphagia scores significantly improved ( P < 0.01) for older and younger patients. After fundoplication, older patients had lower dysphagia scores ( P < 0.01) and lower reflux scores ( P < 0.01). At the most recent follow-up, 82 per cent of older patients rated their relief of symptoms as good or excellent. Similarly, 81 per cent of the younger patients reported good or excellent results. Ninety-one per cent of patients 70 years of age or more versus 85 per cent of patients less than 60 years would undergo laparoscopic Nissen fundoplication again, if necessary. With fundoplication, symptoms of GERD improve for older and younger patients, with less symptomatic dysphagia and reflux in older patients after fundoplication. Laparoscopic fundoplication safely ameliorates symptoms of GERD in elderly patients with symptomatic outcomes superior to those seen in younger patients.

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Toe To Hand Transfer in Children

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(96)80176-8 ◽

1996 ◽

Vol 21 (6) ◽

pp. 723-734 ◽

Cited By ~ 67

Author(s):

S. P. KAY ◽

M. WIBERG

Keyword(s):

Clinical Psychologist ◽

Additional Surgery ◽

Hand Deformities ◽

And Function ◽

Age Range ◽

Toe Transfer ◽

Technical Considerations

Between 1988 and 1994 40 children (age range 9 months–14 years) with either congenital (85%) or acquired hand deformities underwent reconstruction by microvascular autotransplantation of one or more toes. Fourteen underwent a single toe transfer whilst 26 had two second toes transferred to one hand. In 14 of these cases both second toes were transferred at one operation. Whether one or two toes were transferred, the children spent on average 9 days in hospital. None of the transfers failed but 75% of the children underwent staged additional surgery to improve appearance and function. Thirty-seven of the 40 children attended with their parents for follow-up examination by an independent surgeon, a physiotherapist and a clinical psychologist in order to evaluate the results and consequences of surgery. This paper presents the technical considerations for this surgery and examines the influence of the transfer on growth.

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Brain Biopsy in Tuberculoma: The Risks and Benefits

Neurosurgery ◽

10.1227/00006123-199103000-00011 ◽

1991 ◽

Vol 28 (3) ◽

pp. 405-409 ◽

Cited By ~ 38

Author(s):

A. Bouchama ◽

M. Zuheir Al-Kawi ◽

I. Kanaan ◽

R. Coates ◽

A. Jallu ◽

...

Keyword(s):

Postoperative Mortality ◽

Brain Biopsy ◽

Drug Compliance ◽

Antituberculous Therapy ◽

Additional Surgery ◽

The Central Nervous System ◽

Histological Confirmation ◽

Lost To Follow Up ◽

The Brain

Abstract In developing countries, 5 to 8% of the space-occupying lesions of the central nervous system are tuberculomas. Diagnosis can be difficult in the absence of extracranial tuberculosis; computed tomography is suggestive only. To assess the value of brain biopsies in tuberculomas, the records of 15 patients aged 6 to 80 years were reviewed. Histological confirmation was obtained in 15 patients, and acid-fast bacilli were cultured from 12 patients. Intracranial hypertension was the principal sign in 11 patients; other neurological signs were related to the location of the tuberculoma. One patient had evidence of extracranial tuberculosis. Biopsy-related complications consisted of an epidural hematoma in 1 patient and hydrocephalus in another; both required additional surgery. One case of tuberculous meningitis was probably related to surgery and poor drug compliance. There was no postoperative mortality. Thirteen patients (2 were lost to follow-up) were cured after an average of 16 months of antituberculous therapy. It was concluded that the brain biopsy is useful in diagnosing tuberculoma but that there is some associated risk.

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Percutaneous cryoablation of chondroblastoma and osteoblastoma in pediatric patients

Insights into Imaging ◽

10.1186/s13244-021-01036-z ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Elena Serrano ◽

Federico Zarco ◽

Anne E. Gill ◽

C. Matthew Hawkins ◽

Napoleón Macías ◽

...

Keyword(s):

Clinical Success ◽

Lumbar Vertebra ◽

Late Complications ◽

Primary Objective ◽

Percutaneous Cryoablation ◽

Pediatric Hospitals ◽

Age Range ◽

Femur Condyle ◽

Imaging Response

Abstract Background To review the safety and efficacy of percutaneous cryoablation for the treatment of chondroblastoma and osteoblastoma in the pediatric and adolescent population. Materials and methods A retrospective review from 2016 to 2020 was performed to evaluate clinical and imaging response to percutaneous cryoablation in 11 symptomatic patients with diagnosis of chondroblastoma and osteoblastoma treated from two pediatric hospitals with at least 12-month follow-up. Technical success (correct needle placement and potential full coverage of the tumor with the planned ablation zone) and clinical success (relief of the symptoms) were evaluated. The primary objective was to alleviate pain related to the lesion(s). Immediate and late complications were recorded. Patients were followed in clinic and with imaging studies such as MRI or CT for a minimum of 6 months. Results A total of 11 patients were included (mean 14 years, age range 9–17; male n = 8). Diagnoses were osteoblastoma (n = 4) and chondroblastoma (n = 7). Locations were proximal humerus (n = 1), femur condyle (n = 1), and proximal femur (n = 1) tibia (n = 3), acetabulum (n = 3), thoracic vertebra (n = 1) and lumbar vertebra (n = 1). Cryoablation was technically successful in all patients. Clinical success (cessation of pain) was achieved in all patients. No signs of recurrence were observed on imaging follow-up in any of the patients. One of the patients developed periprocedural right L2–L3 transient radiculopathy as major immediate complication. Conclusions Percutaneous image-guided cryoablation can be considered potentially safe and effective treatment for chondroblastoma and osteoblastoma in children and adolescents.

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Tonsillectomy in Adults: Analysis of Indications and Outcome in Sokoto, North Western Nigeria

Asian Journal of Medicine and Health ◽

10.9734/ajmah/2019/v16i230137 ◽

2019 ◽

pp. 1-7

Author(s):

D. Aliyu ◽

J. H. Solomon

Keyword(s):

Histopathological Analysis ◽

Recurrent Tonsillitis ◽

Common Procedure ◽

Female Ratio ◽

Case File ◽

Lost To Follow Up ◽

Age Range ◽

Male To Female ◽

Adult Tonsillectomy

Background: Tonsillectomy is a well-established surgical procedure practiced commonly by otolaryngologist for removal of tonsils. Although being a relatively simple and common procedure, it is not without considerable complications. This study aimed to profile the indication and outcome of adult tonsillectomy in our region. Method: This was a retrospective study of all adults who had tonsillectomy in the department of Otorhinolaryngology, Usman Danfodiyo Teaching Hospital, (UDUTH) Sokoto, over a seven-year period from 1st January 2011 to 31st December 2017. All information was carefully retrieved from each patient’s case file and from the operation register. The data retrieved was subsequently analysed. Results: A total of 55 adults patients had tonsillectomy over the period of study. Age range was 18 to 45 years with a mean age of 26.3 years. There were 16 males (29.1%) and 39 females (70.9%) with a male to female ratio of 1:2.4. Recurrent tonsillitis 28(50.9%) was the commonest indication; others include: post quinsy 13(23.6%), tonsillomegally 6(10.9%); suspected neoplasm 6(10.9%); recurrent otalgia secondary to tonsillomegally 2(3.6%) Five patients had unilateral tonsillectomy for suspected neoplasm while others had bilateral tonsillectomy. Cold dissection was used in 37 (67.2%) of the patients, while 18(32.7%)were by electro cautery (Bipolar diathermy). The commonest post-operative complication was pain in all patients, followed by otalgia (29.1%) and secondary post tonsillectomy bleed in two patients. No patient had blood transfusion. Hospital average stay was 3 days. Follow up was uneventful in 16 (29.1%) of patients while 4(7.3%) patients had squamous cell carcinoma and were refered to Oncologist. The remaining 35 patients were lost to follow up. Conclusion: The commonest indication for Adult tonsillectomy is chronic recurrent tonsillitis. Histopathological analysis of every tonsil specimen is advocated.

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