scholarly journals P.133 A retrospective analysis of the clinical utility of the Tokuhashi scale, and its impact in surgical management of spinal metastatic disease

2016 ◽  
Vol 43 (S2) ◽  
pp. S51-S51
Author(s):  
E Leck ◽  
A Dakson ◽  
M Butler ◽  
G Thibault-Halman ◽  
S Christie
Keyword(s):  
Metastatic Disease ◽  
Clinical Utility ◽  
Spinal Metastasis ◽  
Spinal Instability ◽  
Vertebral Augmentation ◽  
Surgical Interventions ◽  
Tokuhashi Score ◽  
Group 3 ◽  
Surgical Group ◽  
Group 1

Background: The evaluation of patients presenting with spinal metastatic disease is often challenging. The Tokuhashi scale intends to facilitate this process. We conducted this study to investigate its clinical utility in surgical-decision making in patients with spinal metastasis. Methods: The oncology database was used to allocate 285 patients with spinal metastasis between 2010 and 2015. The Tokuhashi scale components were determined from a chart review. Results: Based on the Tokuhashi scale, there was 69.1% in the non-operative/radiation group (group 1), 23.2% in the palliative/excisional surgical group (group2) and 7.7% in the surgical group (group 3). Using Kaplan-Meiers estimate, survival time was significantly different across the three groups with means 232.8±30.8, 352.3±49.2 and 568.3±206.1 days, respectively. A significantly higher proportion of patients (84.6%) were treated non-surgically in group 1, compared to 45.5% in group 3 (X2=19.5, P<0.001). However, there was no correlation between the type of surgical interventions (i.e. instrumented decompression, decompression alone, percutaneous vertebral augmentation and instrumented vertebral augmentation) and the Tokuhashi score. Conclusions: This review illustrates the utility of the Tokuhashi scale in predicting survival. However, it does not address the new role of emerging different surgical strategies for the treatment of spinal metastasis and lacks information concerning spinal instability.

scholarly journals P.128 The clinical utility of the spinal instability neoplastic score (SINS) and its role in surgical management of patients with spinal metastatic disease

2016 ◽  
Vol 43 (S2) ◽  
pp. S49-S49
Author(s):  
A Dakson ◽  
E Leck ◽  
M Butler ◽  
G Thibault-Halman ◽  
S Christie
Keyword(s):  
Decision Making ◽  
Metastatic Disease ◽  
Clinical Utility ◽  
Spinal Metastasis ◽  
Intervention Group ◽  
Spinal Instability ◽  
Vertebral Augmentation ◽  
Mechanical Instability ◽  
Surgical Decision ◽  
Surgical Decision Making

Background: The Spinal Instability Neoplastic Score (SINS) is used to assess mechanical instability based on radiographic and clinical factors. We conducted this study to evaluate the clinical utility of SINS in surgical decision-making in spinal metastasis and its association with metastatic epidural spinal cord compression (MESCC). Methods: We allocated 285 patients with spinal metastatic disease through a retrospective review. SINS was calculated using good-quality computed tomography. The degree of MESCC was assessed using 0 to 3 grading system. Results: Based on SINS, patients were categorized into stable (35.1%), potentially unstable (52.3%) and unstable (12.6%) groups. In the surgical intervention group, there was 69.5% treated with decompression and instrumented fusion, 17% with decompression alone, 8.5% with percutaneous vertebral augmentation and 5% with instrumented vertebral augmentation. A significantly higher proportion of patients with stable SINS (63.6%) were treated surgically without instrumentation (X2=10.6, P=0.005), whereas instrumentation was utilized in 87.5% of patients with unstable SINS. Grade 3 MESCC occurred in 65.5% of patients with unstable SINS, whereas 71.4% of patients with stable SINS had grade 0 MESCC (X2=42.1, P<0.001). Conclusions: SINS is associated with higher degrees of MESCC and plays an important role in surgical decision-making, facilitating assessment and recognition of spinal instability in need of urgent appropriate surgical interventions.

scholarly journals Usefulness of Tokuhashi Score in Survival Prediction of Patients Operated for Vertebral Metastatic Disease

2017 ◽  
Vol 7 (3) ◽  
pp. 260-265 ◽  
Author(s):  
Marcelo Gruenberg ◽  
Maximiliano E. Mereles ◽  
Gastón O. Camino Willhuber ◽  
Marcelo Valacco ◽  
Matias G. Petracchi ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Spinal Metastasis ◽  
Survival Prediction ◽  
Survival Times ◽  
Primary Tumor Site ◽  
Tokuhashi Score ◽  
Group 3 ◽  
Group 2 ◽  
Almost All ◽  
Group 1

Study Design: Retrospective study. Objective: Spinal metastasis can produce pain, deformity, neurological compromise and can decrease life expectancy. Surgical management is usually indicated for pain control, neurological decompression, and to avoid deformity progression. Tokuhashi et al created a scoring system to estimate survival and stratify surgical treatment based on established parameters. Our objective was to evaluate the usefulness of Tokuhashi scoring (TS) system by comparing the predicted and real survival times and analyze the survival time according to the type of tumor. Methods: From 2004 to 2014, 105 patients with vertebral metastasis who underwent surgical treatment were enrolled and retrospectively analyzed. Preoperative TS was performed in all cases. Patients were classified into 3 groups according to TS; group 1 (TS 0-8), group 2 (TS 9-11), and group 3 (TS 12-15). Patients’ average age was 61.5 years, main primary tumor site were as follows: kidney (23%), lung (19%), and breast (18%). Results: The Tokuhashi general concordance was 67.6%. Per group concordance was as follows: group 1 80%, in group 2, only 33% of concordance was observed. In group 3, 100% of concordance was observed. In group 2, the most common primary sites were breast and kidney and the mean survival was 20 and 22.3 months, respectively, both longer than that expected for this group. Conclusions: Tokuhashi concordance was acceptable in our study, particularly in lower and higher scores. The lesser concordance observed in group 2 (33.3%) was observed in almost all tumors. For our practice, TS constitutes an acceptable tool to define survival, particularly in lower and higher scores.

scholarly journals Palliative esophagectomy in unexpected metastatic disease: sense or nonsense?

2018 ◽  
Vol 26 (7) ◽  
pp. 552-557 ◽  
Author(s):  
Lieven P Depypere ◽  
Johnny Moons ◽  
Toni E Lerut ◽  
Willy Coosemans ◽  
Hans Van Veer ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Nodes ◽  
Metastatic Disease ◽  
Palliative Resection ◽  
Oligometastatic Disease ◽  
Group 3 ◽  
Group 2 ◽  
Curative Esophagectomy ◽  
Group 1 ◽  
Single Organ

Background Despite integrated positron emission tomography and computed tomography screening before and after neoadjuvant treatment in patients with locally advanced esophageal cancer, unexpected metastatic disease is still found in some patients during surgery. Should then esophagectomy be aborted or is there a place for palliative resection? Methods Between 2002 and 2015, 681 patients with potentially resectable esophageal cancer were sheduled for neoadjuvant therapy and subsequent esophagectomy. In 552 patients, a potentially curative esophagectomy was performed. In 12 patients, unexpected disease was discovered during surgery but esophagectomy was performed with synchronous resection of metastases; 10 of them had oligometastatic disease (≤4 single-organ metastases). Esophagectomy was not performed in 117 patients (because of disease progression in 50); 14 were also single-organ oligometastatic. Data of 10 single-organ oligometastatic patients who underwent esophageal resection (group 1) were compared those of 10 non-resected but treated counterparts (group 2) and with 228 patients who underwent potentially curative esophagectomy with persistent pathological lymph nodes (group 3). Results Five oligometastatic esophagectomy patients had lung metastases: 1 peritoneal, 2 adrenal, 1 pleural, and 1 pancreatic. Two oligometastatic non-resected patients had lung, 5 liver, and 3 brain metastases. Median overall survival was 21.4, 12.1, and 20.2 months in the respective groups (group 1 vs. group 2  p = 0.042; group 2 vs. group 3  p = 0.002; group 1 vs. group 3  p = 0.88). Conclusions Survival is longer in patients undergoing palliative esophagectomy with unexpected single-organ oligometastatic disease and comparable to survival in patients with persistent pathological lymph nodes. Palliative resection in these patients seems to be justified.

scholarly journals Clinical Utility of 18F-PSMA-1007 Positron Emission Tomography/Magnetic Resonance Imaging in Prostate Cancer: A Single-Center Experience

2021 ◽  
Vol 10 ◽  
Author(s):  
Ao Liu ◽  
Miao Zhang ◽  
Hai Huang ◽  
Chuanjie Zhang ◽  
Xiaohao Ruan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Clinical Utility ◽  
Multimodal Therapy ◽  
Resonance Imaging ◽  
Positron Emission ◽  
Psma Pet ◽  
Group 3 ◽  
Group 2 ◽  
Management Changes ◽  
Group 1

PurposeThis study aimed to evaluate the clinical utility of 18F-PSMA-1007 positron emission tomography (PSMA PET)/magnetic resonance imaging (MRI) imaging in patients with suspected or defined prostate cancer.MethodsIn the pilot study, we retrospectively investigated 62 patients who underwent PSMA-PET/MRI for suspected or defined PCa between June 2019 and June 2020. Patients were grouped into three subgroups: (1) suspected PCa without histological evidence, (2) primary PCa, (3) biochemical recurrent prostate cancer (BRPCa). Two nuclear physicians independently interpreted the results of PSMA-PET/MRI. Management strategies before PSMA-PET/MRI were retrospectively reported, and the management strategy was re-evaluated for each patient considering the PSMA-PET/MRI result. The changes in strategies were recorded. Besides, the correlation between prostate specific antigen (PSA) level and management changes was also accessed by Fisher exact test, and two-side p &lt; 0.05 was assumed as statistical significance.ResultsThere were 28 patients in the suspected PCa group (group 1), 12 in the primary PCa group (group 2), and 22 in the BRPCa group (group 3). Overall, the intended decisions were changed in 26 (41.9%) of 62 patients after PSMA-PET/MRI, including 11/28 (39.3%) in suspected PCa group, 1/12 (8.4%) in primary PCa group, and 14/24 (63.6%) in BCR group. In group 1, the main impact on subsequent management included decreased active surveillance (from 20 to 9) and increased prostate biopsy (from 8 to 19). PSA levels were not significantly associated with management changes in suspected PCa patients (p = 0.865). In group 2, the main impact on subsequent management included decreased radical surgery (from 8 to 7), and multimodal therapy appearance (n = 1). Only in the category of PSA levels of ≥20 ng/ml, the management of primary PCa was changed. In group 3, the main impact on subsequent management included decreased salvage radiotherapy (from 5 to 2), increased systemic therapy (from 6 to 7), and increased multimodal therapy (from 11 to 13). The highest proportion of management changes occurred in BCR patients with 0.5≤PSA&lt;1 ng/ml.ConclusionFrom our preliminary experience, PSMA-PET/MRI may be a valued tool for defining PCa lesions and changing management. The biggest impact of management intent was in patients with BRPCa, especially in patients with 0.5≤PSA&lt;1 ng/ml. However, further studies are needed to confirm our pilot findings.

Outcomes in different age groups with primary Ewing sarcoma of the spine: a systematic review of the literature

2019 ◽  
Vol 30 (5) ◽  
pp. 664-673 ◽  
Author(s):  
Garrett K. Berger ◽  
Peyton L. Nisson ◽  
Whitney S. James ◽  
Kristen N. Kaiser ◽  
R. John Hurlbert
Keyword(s):  
Ewing Sarcoma ◽  
Age Groups ◽  
Favorable Outcome ◽  
Adjunctive Treatment ◽  
Age Group ◽  
Surgical Interventions ◽  
Increased Risk ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

OBJECTIVEEwing sarcoma (ES) is among the most prevalent of bone sarcomas in young people. Less often, it presents as a primary lesion of the spine (5%–15% of patients with ES).METHODSA systematic literature search was performed, querying several scientific databases per PRISMA guidelines. Inclusion criteria specified all studies of patients with surgically treated ES located in the spine. Patient age was categorized into three groups: 0–13 years (age group 1), 14–20 years (age group 2), and > 21 (age group 3).RESULTSEighteen studies were included, yielding 28 patients with ES of the spine. Sixty-seven percent of patients experienced a favorable outcome, with laminectomies representing the most common (46%) of surgical interventions. One-, 2-, and 5-year survival rates were 82% (n = 23), 75% (n = 21), and 57% (n = 16), respectively. Patients in age group 2 experienced the greatest mortality rate (75%) compared to age group 1 (9%) and age group 3 (22%). The calculated relative risk score indicated patients in age group 2 were 7.5 times more likely to die than other age groups combined (p = 0.02).CONCLUSIONSPrimary ES of the spine is a rare, debilitating disease in which the role of surgery and its impact on one’s quality of life and independence status has not been well described. This study found the majority of patients experienced a favorable outcome with respect to independence status following surgery and adjunctive treatment. An increased risk of recurrence and death was also present among the adolescent age group (14–20 years).

scholarly journals Implementation of a new Single-Pass Whole-Body Computed Tomography Protocol: Is it safe, effective and efficient in patients with severe trauma?

2020 ◽  
Author(s):  
Carlos Ordoñez ◽  
Carlos García ◽  
Michael W. Parra ◽  
Edison Angamarca ◽  
Mónica Guzmán-Rodríguez ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Injury Severity ◽  
Penetrating Trauma ◽  
Severe Trauma ◽  
Whole Body ◽  
Surgical Interventions ◽  
Single Pass ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Purpose: The objective of this study was to evaluate the implementation of a new Single-Pass WBCT Protocol in the management of patients with severe trauma. Methods: This was an observational, prospective study of polytrauma patients who underwent WBCT. Patients were divided into three groups: 1. Blunt trauma hemodynamically stable 2. Blunt trauma hemodynamically unstable and 3. Penetrating trauma. Demographics, WBCT parameters and outcome variables were evaluated. Results: 263 patients were included. Median Injury Severity Score (ISS) was 22 (IQR: 16-22). Time between arrival to the ED and completing the WBCT was under 30 minutes in most patients [Group 1: 28 minutes (IQR: 14-55), Group 2: 29 minutes (IQR: 16-57), and Group 3: 31 minutes (IQR: 13-50); p=0.96]. 172 patients (65.4%) underwent non-operative management. The calculated and the real survival rates did not vary among the groups either [Group 1: TRISS 86.4% vs. RSR 85% (p=0.69); Group 2: TRISS 69% vs. RSR 74% (p=0.25); Group 3: TRISS 93% vs. RSR 87% (p=0.07)]. Conclusion: This new Single-Pass WBCT Protocol was safe, effective and efficient to decide whether the patient with severe trauma requires a surgical intervention independently of the mechanism of injury or the hemodynamic stability of the patient. Its use could also potentially reduce the rate of unnecessary surgical interventions of patients with severe trauma including those with penetrating trauma.

scholarly journals P.129 Patterns of spinal metastatic disease and mechanical instability: a retrospective correlation with tumor histology

2016 ◽  
Vol 43 (S2) ◽  
pp. S50-S50
Author(s):  
A Dakson ◽  
E Leck ◽  
M Butler ◽  
G Thibault-Halman ◽  
S Christie
Keyword(s):  
Metastatic Disease ◽  
Spinal Metastasis ◽  
Spinal Metastases ◽  
Scoring Systems ◽  
Epidemiological Data ◽  
Spinal Instability ◽  
Mechanical Instability ◽  
Imaging Studies ◽  
Tumor Histology ◽  
Multiple Metastases

Background: This study aims to provide epidemiological data concerning spinal instability and patterns of metastatic invasion of the spine based on tumor histology. Methods: We allocated 285 patients with spinal metastatic disease through a retrospective review. SINS was calculated using good-quality computed tomography (CT) imaging studies. Spinal metastases were also grouped into intracompartmental, extracompartmental or multiple metastases. Results: Esophageal cancer was the least likely to be associated with instability with about 64% of cases being stable. The highest rate of instability scores was observed in breast carcinoma with 18% of cases graded as unstable. Renal cell carcinoma was associated with lytic spinal metastases whereas blastic metastases mostly occurred in prostate carcinoma (P<0.001). Whereas 68.1% of cases represented multiple metastases, the remainder was associated with either intracompartmental (13.3%) or extracompartmental (18.6%) disease. The highest degrees of spinal instability (intermediate and unstable categories) were associated with extra-compartmental metastatic disease (P<0.001). Conclusions: This study sheds light on the patterns of spinal metastatic disease and mechanical instability on the basis of tumor histology, utilizing standardized scoring systems. The utilization of such scoring systems allows for a standardized approach towards description and analysis of spinal metastasis facilitating clinical research in this avenue.

Spinal computed tomography and computed tomographic metrizamide myelography in the early diagnosis of metastatic disease.

1986 ◽  
Vol 4 (4) ◽  
pp. 576-583 ◽  
Author(s):  
T O'Rourke ◽  
C B George ◽  
J Redmond ◽  
H Davidson ◽  
P Cornett ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Metastatic Disease ◽  
Compression Fracture ◽  
Benign Disease ◽  
Plain Radiographs ◽  
Spinal Ct ◽  
Epidural Compression ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

New lesions were shown by Tc99m bone scans to have developed in sixty patients with known metastatic cancer or high-risk primary cancer and normal neurologic examinations; they were further evaluated with plain radiographs, spinal computed tomography (CT), and CT myelography (CT-M) according to an algorithm. Three groups were identified based on plain radiographs: group 1 (normal radiograph), group 2 (compression fracture as indicated by radiograph), group 3 (evidence of metastasis as indicated by radiograph). In group 1 (n = 18), spinal CT revealed that 33% of the patients had benign disease and 67%, metastases; epidural compression was seen in 25% of the patients with metastasis as indicated by CT-M. In group 2 (n = 26), CT-M disclosed that 38% had a benign compression fracture and 62% had metastases and that 63% of the patients with metastases had an epidural compression. In group 3 (n = 16), spinal CT revealed that 15 patients had metastases (one patient had benign disease). Epidural cord compression was seen in 47% of the patients with metastatic disease. In all groups, the presence of cortical bone discontinuity around the neural canal (seen in 31 patients) was highly associated with epidural compression (seen in 20 patients). Our approach allowed the early and accurate diagnosis of spinal metastasis and epidural tumor as well as the diagnosis of benign disease and was useful in planning optimal local therapy.

In-vivo evaluation of the effect of cyanoacrylate on prosthetic vascular graft infection – does cyanoacrylate increase the severity of infection?

VASA ◽  
2020 ◽  
Vol 49 (4) ◽  
pp. 281-284
Author(s):  
Atıf Yolgosteren ◽  
Gencehan Kumtepe ◽  
Melda Payaslioglu ◽  
Cuneyt Ozakin
Keyword(s):  
Vascular Graft ◽  
Graft Infection ◽  
Vascular Graft Infection ◽  
Group 4 ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
Prosthetic Vascular Graft Infection ◽  
Group 1

Summary. Background: Prosthetic vascular graft infection (PVGI) is a complication with high mortality. Cyanoacrylate (CA) is an adhesive which has been used in a number of surgical procedures. In this in-vivo study, we aimed to evaluate the relationship between PVGI and CA. Materials and methods: Thirty-two rats were equally divided into four groups. Pouch was formed on back of rats until deep fascia. In group 1, vascular graft with polyethyleneterephthalate (PET) was placed into pouch. In group 2, MRSA strain with a density of 1 ml 0.5 MacFarland was injected into pouch. In group 3, 1 cm 2 vascular graft with PET piece was placed into pouch and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. In group 4, 1 cm 2 vascular graft with PET piece impregnated with N-butyl cyanoacrylate-based adhesive was placed and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. All rats were scarified in 96th hour, culture samples were taken where intervention was performed and were evaluated microbiologically. Bacteria reproducing in each group were numerically evaluated based on colony-forming unit (CFU/ml) and compared by taking their average. Results: MRSA reproduction of 0 CFU/ml in group 1, of 1410 CFU/ml in group 2, of 180 200 CFU/ml in group 3 and of 625 300 CFU/ml in group 4 was present. A statistically significant difference was present between group 1 and group 4 (p < 0.01), between group 2 and group 4 (p < 0.01), between group 3 and group 4 (p < 0.05). In terms of reproduction, no statistically significant difference was found in group 1, group 2, group 3 in themselves. Conclusions: We observed that the rate of infection increased in the cyanoacyrylate group where cyanoacrylate was used. We think that surgeon should be more careful in using CA in vascular surgery.

Abnormal Haemostasis and Blood Viscosity in Malignant Hypertension

1984 ◽  
Vol 52 (03) ◽  
pp. 253-255 ◽  
Author(s):  
C Isles ◽  
G D O Lowe ◽  
B M Rankin ◽  
C D Forbes ◽  
N Lucie ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Viscosity ◽  
Renal Damage ◽  
Antithrombin Iii ◽  
Plasma Viscosity ◽  
Malignant Hypertension ◽  
Fibrin Deposition ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

SummaryWe have previously shown abnormalities of haemostasis suggestive of intravascular coagulation in patients with malignant hypertension, a condition associated with retinopathy and renal fibrin deposition. To determine whether such abnormalities are specific to malignant hypertension, we have measured several haemostatic and haemorheological variables in 18 patients with malignant hypertension (Group 1), 18 matched healthy controls (Group 2), and 18 patients with non-malignant hypertension (Group 3) matched for renal pathology, blood pressure and serum creatinine with Group 1. Both Groups 1 and 3 had increased mean levels of fibrinogen, factor VIIIc, beta-thrombo- globulin, plasma viscosity and blood viscosity (corrected for haematocrit); and decreased mean levels of haematocrit, antithrombin III and platelet count. Mean levels of fast antiplasmin and alpha2-macroglobulin were elevated in Group 1 but not in Group 3. We conclude that most blood abnormalities are not specific to malignant hypertension; are also present in patients with non-malignant hypertension who have similar levels of blood pressure and renal damage; and might result from renal damage as well as promoting further renal damage by enhancing fibrin deposition. However increased levels of fibrinolytic inhibitors in malignant hypertension merit further investigation in relation to removal of renal fibrin.

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