Outcome Features Analysis in Intramedullary Tumors of the Cervicomedullary Junction: A Surgical Series

2021 ◽  
Author(s):  
Leonardo Tariciotti ◽  
Giacoma Maria Floriana Brunetto ◽  
Alessandro Landi ◽  
Fabrizio Gregori ◽  
Francesca Santoro ◽  
...  
Keyword(s):  
Low Grade ◽  
Lower Grade ◽  
Functional Evaluation ◽  
High Grade ◽  
Total Resection ◽  
Intramedullary Tumors ◽  
Macroscopic Appearance ◽  
Cervicomedullary Junction ◽  
The Impact

Abstract Object The aim of this study is to investigate the impact of surgery for different cervicomedullary lesions on symptomatic pattern expression and postoperative outcome. We focused on specific outcome features of the early and late postoperative assessments. The former relies on surgery-related transient and permanent morbidity and feasibility of radicality in eloquent areas, whereas the latter on long-term course in lower grade tumors and benign tumorlike lesions (cavernomas, etc.). Material and Methods We retrospectively analyzed 28 cases of intramedullary tumors of the cervicomedullary junction surgically treated at our institution between 1990 and 2018. All cases were stratified for gender, histology, macroscopic appearance, location, surgical approach, and presence of a plane of dissection (POD). Mean follow-up was 5.6 years and it was performed via periodic magnetic resonance imaging (MRI) and functional assessments (Karnofsky Performance Scale [KPS] and modified McCormick [MC] grading system). Results In all, 78.5% were low-grade tumors (or benign lesions) and 21.5% were high-grade tumors. Sixty-one percent underwent median suboccipital approach, 18% a posterolateral approach, and 21% a posterior cervical approach. Gross total resection was achieved in 54% of cases, near-total resection (>90%) in 14%, and subtotal resection (50–90%) in 32% of cases. Early postoperative morbidity was 25%, but late functional evaluation in 79% of the patients showed KPS > 70 and MC grade I; only 21% of cases showed KPS < 70 and MC grades II and III at late follow-up. Mean overall survival was 7 years in low-grade tumors or cavernomas and 11.7 months in high-grade tumors. Progression-free survival at the end of follow-up was 71% (evaluated mainly on low-grade tumors). Conclusions The surgical goal should be to achieve maximal cytoreduction and minimal postoperative neurologic damage. Functional outcome is influenced by the presence of a POD, radicality, histology, preoperative status, and employment of advanced neuroimaging planning and intraoperative monitoring.

Endoscopic Surveillance Practice for Barrett's Oesophagus in Scotland and Early Experience in Implementing Local Guidelines

2003 ◽  
Vol 48 (2) ◽  
pp. 43-45 ◽  
Author(s):  
E F Shen ◽  
S Gladstone ◽  
G Milne ◽  
S Paterson-Brown ◽  
I D Penman
Keyword(s):  
Early Experience ◽  
High Grade Dysplasia ◽  
Low Grade ◽  
High Grade ◽  
Wide Variability ◽  
Low Grade Dysplasia ◽  
Surveillance Practice ◽  
Four Quadrant ◽  
The Impact

Management of columnar lined oesophagus (CLO; Barrett s oesophagus) is controversial. We prospectively audited surveillance practices in Scotland and prospectively assessed the impact of introducing local guidelines for Barrett s surveillance in Edinburgh. Most respondents were gastroenterologists. The majority take random, not four quadrant, biopsies from the CLO. In Edinburgh during 2000, 80 patients underwent surveillance. The guideline protocol was not followed in 30 (37.5%) patients. Follow up of patients without dysplasia generally conformed to the guidelines. Follow up of patients with low grade dysplasia was highly variable while management of those with high grade dysplasia followed the guidelines. Overall we found a wide variability in the management and surveillance of CLO. Early experience suggests that implementation of guidelines is helpful but there is still variation in practice.

Intraoperative duplex ultrasonography in carotid endarterectomy: The impact on indication for immediate revision and intermediate-term outcome

VASA ◽  
2008 ◽  
Vol 37 (2) ◽  
pp. 151-156 ◽  
Author(s):  
Ott ◽  
Heller ◽  
Odermatt ◽  
Furrer
Keyword(s):  
Duplex Ultrasonography ◽  
Low Grade ◽  
High Grade ◽  
Term Outcome ◽  
Technical Errors ◽  
Group A ◽  
Group B ◽  
The Impact ◽  
Symptomatic Stenosis

Background: Thromboembolic complications in relation to carotid endarterectomies (CEA) are frequently associated with technical errors. We analyzed prospectively the impact of intraoperative duplex ultrasonography (IODS) in CEA on immediate revision and postoperative results. Patients and methods: We have observed 70 patients with 74 CEA. Indications for surgery were asymptomatic high grade stenosis (70–99%) or symptomatic stenosis of > 50%. IODS findings were rated as "relevant", "minor" or "normal". Relevant findings were immediately repaired. Peri- and postoperative neurological events were analyzed in Duplex Scans controls in a median length of follow-up of 17.3 months. Outcome of patients with "minor" findings (group A) were compared with patients having "normal" or corrected "relevant" findings (group B). Results: In 8/74 cases (11%) we found relevant findings leading to immediate revision. In 25/74 (34%) cases minor findings were detected which were not revised. In group A (n = 25, 34%) two asymptomatic occlusions and one recurrent high grade stenosis were found during follow-up. In group B (n = 49, 66%) we detected two high and two low grade stenosis. The 30 day death and stroke rate was 1.4% (n = 1). Conclusions: IODS is a sensitive method to detect immediately pathological findings. Its correction seems to reduce the incidence of early occlusions and therefore early neurological events.

scholarly journals Impact of the quantity of intradiscal cement leak on the progression of intervertebral disc degeneration

2017 ◽  
Vol 99 (7) ◽  
pp. 529-533 ◽  
Author(s):  
B Jamjoom ◽  
S Patel ◽  
R Bommireddy ◽  
Z Klezl
Keyword(s):  
Disc Degeneration ◽  
Degenerative Changes ◽  
Low Grade ◽  
High Grade ◽  
Disc Space ◽  
Rate Of Progression ◽  
Adjacent Vertebral Fracture ◽  
Cement Leak ◽  
The Impact

Introduction We aim to assess the impact of the quantity of intradiscal cement leak during kyphoplasty on the rate of progression of degenerative changes in the affected disc. Methods Of 316 kyphoplasty procedures, we identified 32 episodes of intradiscal cement leak in 26 patients. The quantity of cement leaked was graded from I to IV. Disc degenerative changes were assessed at presentation and follow-up using radiographical scoring and magnetic resonance imaging (MRI) grading systems. Data for low-grade leaks (grade I) were compared with the medium- and high-grade leaks (grades II–IV) using a chi-squared test. Results Median follow-up radiographic and MRI assessments were made at 18 and 21 months, respectively. Medium- and high-grade leaks were associated with a significantly higher radiographic disc degeneration scores compared with low-grade leaks (P = 0.04295) but no difference was found in MRI disc degeneration grades and in adjacent vertebral fracture rates. Conclusions Our findings indicate that the quantity of cement leaking into the disc space significantly influences the rate of progression of disc degeneration.

scholarly journals Severe tricuspid regurgitation worsens prognosis outcome after edge-to-edge mitral valve repair

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Groeger ◽  
K Zeiml ◽  
J Scheffler ◽  
F Schoesser ◽  
L Schneider ◽  
...  
Keyword(s):  
Heart Failure ◽  
Functional Outcome ◽  
Tricuspid Regurgitation ◽  
Low Grade ◽  
High Grade ◽  
Funding Sources ◽  
Kaplan Meier ◽  
Diuretic Drugs ◽  
The Impact

Abstract Introduction MitraClip has been well established for treatment of severe mitral regurgitation (MR). MR and tricuspid regurgitation (TR) often occur simultaneously and symptoms of biventricular heart failure can overlap. While it has been shown that TR grade regression can be achieved through repair of MR1, presence of moderate to severe TR can increase all-cause mortality after MitraClip2. There is currently no consensus on the management of combined MR and TR. We evaluated the impact of TR on echocardiographic and functional outcome after MitraClip. Methods 370 patients underwent MitraClip for moderate to severe MR at our center from 2010 to 2018. Patients were dichotomized into low grade TR (grade &lt;I - I (trace - mild)) and high grade TR (grade III - V (severe - torrential)). Moderate TR (grade II) was excluded. After MitraClip for MR, patients were followed up for 12 months and their echocardiographic and functional outcome was evaluated. Use of diuretic drugs throughout 12 month follow-up was registered. Results Low grade TR (&lt;I - I) occurred in 225 patients (67.0%), high grade TR (III - V) was present in 111 patients (33.0%). 34 patients (9.2%) with moderate TR (II) were excluded. Patients with high grade TR had an increased morbidity (higher age, worse renal function, higher prevalence of atrial fibrillation, higher levels of natriuretic peptides, increased left atrial and right heart diameters, higher TR gradient). These patients also received significantly higher doses of torasemid (33.5±36.7 mg vs. 21.6±20.9 mg, p=0.003) and furosemid (163.4±155.5 mg vs. 75.8±72.3 mg, p=0.01). Average grade of MR at baseline was similar in both groups (2.9±0.46 vs. 2.8±0.5, p=0.66). Procedural success of MR repair was achieved similarly in both groups (96.4% vs. 96.9%, p=0.82) and residual MR grade immediately after device implantation was comparable (p=0.61). However, recurrent MR in the high grade TR group increased during follow up, while MR further decreased in the low grade TR group (3 months: 1.24±0.7 vs. 1.16±0.7, p=0.5; 12 months: 1.46±0.93 vs. 1.12±0.61, p=0.04). Accordingly, use of diuretic drugs after 12 months rose in the high grade TR group while it did not change or even decreased in the low grade TR group (torasemid: 40.2±48.4 mg vs. 24.1±30.0 mg, p=0.04; furosemid: 197.5±251.0 mg vs. 67.1±81.8 mg, p=0.22). Kaplan-Meier-Analysis showed significantly higher mortality (24.9 vs. 14.1%, p=0.01), higher risk for heart failure induced rehospitalisation (25,4 vs. 12,5%, p=0.005) and for major adverse cardiac and cerebrovascular events (MACCE: 42.3 vs. 29.1%, p=0.008) in the high grade TR group after 12 months. Conclusion MitraClip patients for MR with concomitant high grade TR (≥ III) had an increased morbidity at baseline compared to low grade TR patients. By MitraClip comparable reduction of MR was achieved. However, during 12 month follow-up in the high grade TR group recurrent MR occurred more often while use of diuretics increased. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals RONC-12. TREATMENT AGE AND NEUROCOGNITIVE OUTCOMES FOLLOWING PROTON BEAM RADIOTHERAPY FOR PEDIATRIC LOW GRADE GLIOMA

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii457-iii458
Author(s):  
Andrew Heitzer ◽  
Lisa Kahalley ◽  
David Grosshans ◽  
M Fatih Okcu ◽  
Kimberly Raghubar ◽  
...  
Keyword(s):  
Cognitive Functioning ◽  
Low Grade Glioma ◽  
Gross Total Resection ◽  
Low Grade ◽  
Total Resection ◽  
Prospective Longitudinal Study ◽  
Prospective Longitudinal ◽  
The Impact ◽  
Over Time

Abstract INTRODUCTION Younger age at radiotherapy increases cognitive risk for patients with pediatric low grade glioma (LGG). We examined the impact of age at treatment on cognitive trajectories in LGG patients treated with proton radiotherapy (PRT) compared to patients treated without radiotherapy (surgery only; SO). METHODS We examined cognitive scores of 48 LGG patients on a prospective, longitudinal study. General linear mixed models evaluated change in cognitive scores over time. RESULTS The sample included 16 patients treated with PRT and 32 with SO (median follow-up=3.1 years, range 0.9–6.1). Median age of PRT patients was 8.2 years at diagnosis (range 1.0–14.4) and 9.4 years at PRT (range 4.2–16.7). 13 PRT patients also received surgery: 53.8% biopsy, 30.8% subtotal resection, 15.4% gross total resection. Tumor sites included: 31.2% hypothalamic/suprasellar, 25.0% optic pathway, 18.8% temporal, 25.0% other. Median age of SO patients was 8.2 years at diagnosis (range 2.9–18.6). Surgical outcomes were: 75.0% gross total resection, 21.9% biopsy/other. There were no group differences in diagnosis age, tumor volume, or shunt history (all p&gt;0.05). Both PRT and SO groups displayed stable cognitive functioning over time (all p&gt;0.1). Slopes (i.e., change in scores over time) did not differ between groups (all p&gt;0.1). Age at treatment was not associated with slope or performance at last follow-up in either group (all p&gt;0.05). CONCLUSIONS We observed stable cognitive functioning, independent of age at treatment, following PRT for LGG. Outcomes were similar to patients receiving surgery only. Further examination in a larger sample is warranted.

Effects of Implementing the Dual Papanicolaou Test Interpretation of ASC-H and LSIL Following Bethesda 2014

2020 ◽  
Vol 154 (4) ◽  
pp. 553-558
Author(s):  
Abha Goyal ◽  
Ami P Patel ◽  
Thomas L Dilcher ◽  
Susan A Alperstein
Keyword(s):  
Intraepithelial Neoplasia ◽  
Low Grade ◽  
High Grade ◽  
Squamous Intraepithelial Lesion ◽  
Papanicolaou Test ◽  
Cervical Intraepithelial Neoplasia Grade ◽  
Hpv Test ◽  
Intraepithelial Lesion ◽  
The Impact

Abstract Objectives To evaluate the impact of implementing the dual interpretation of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H) and low-grade squamous intraepithelial lesion (LSIL) after the Bethesda System 2014 and to compare it with other indeterminate interpretations. Methods Rates of high-risk human papillomavirus (HPV) positivity and histologic follow-up and the proportion of women with high-grade squamous intraepithelial lesion on histologic follow-up were compared for the combined interpretation of ASC-H and LSIL (ASCHL) and the categories of LSIL, cannot exclude high-grade squamous intraepithelial lesion (LSIL-H) and ASC-H. Results The percentage of ASCHL HPV-positive cases (86.0%) was similar to that of LSIL-H but significantly higher in comparison to that of ASC-H. The rates of cervical intraepithelial neoplasia grade 2 or higher (CIN 2+) and CIN 3+ for ASCHL (29.6% and 3.6%, respectively) were similar to those of LSIL-H and ASC-H. When stratified by HPV test results, the proportions of patients with CIN 2+ and CIN 3+ remained statistically similar to those with ASCHL and with LSIL-H and ASC-H. Conclusions Considering the similar risks of CIN 2+ and CIN 3+ for ASCHL and ASC-H, having a separate category of ASCHL for reporting cervical cytology appears to be redundant.

scholarly journals THU0389 OBESITY IS A STRONG PREDICTOR OF WORSE CLINICAL OUTCOMES AND TREATMENT RESPONSES TO BIOLOGICS IN PATIENTS WITH ANKYLOSING SPONDYLITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 429.2-429
Author(s):  
L. Hu ◽  
X. Ji ◽  
F. Huang
Keyword(s):  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Clinical Outcomes ◽  
Normal Weight ◽  
Low Grade ◽  
Hla B27 ◽  
Treatment Responses ◽  
The Impact ◽  
Overweight Or Obesity

Background:Obesity population are rising rapidly and have become a major health issue. Studies have shown that obesity is a low-grade inflammatory status characterized by increase in proinflammatory cytokines.Objectives:To examine the impact of overweight or obesity on disease activity and treatment responses to biologics in patients with ankylosing spondylitis (AS) in a real-world setting.Methods:Body mass index (BMI) is available in 1013 patients from the Chinese Ankylosing Spondylitis Imaging Cohort (CASPIC). Differences in clinical outcomes (such as BASDAI, ASDAS, BASFI, and ASAS HI) and treatment responses to biologics (ΔBASDAI and ΔASDAS) over 3, 6, 9, and 12 months are assessed between BMI categories (normal weight BMI <24 kg/m2; overweight BMI=24-28 kg/m2; obesity BMI ≥28 kg/m2) using Kruskal-Wallis test. The association between BMI and clinical characteristics and treatment responses to biologics was determined, and multivariate median regression analyses were conducted to adjust for confounders (such as age, gender, smoke, and HLA-B27).Results:Among 1013 patients with AS, overweight accounts for 33%, while obesity for 12.4%. There were significant differences between patients who were obese or overweight and those with a normal weight regarding clinical outcomes (BASDAI: 2.90/2.56 vs 2.21; ASDAS-CRP: 2.20/1.99 vs 1.81; BASFI: 2.13/1.69 vs 1.38; ASAS HI: 6.87/5.29 vs 5.12 and BASMI: 2.35/1.76 vs 1.62; all P<0.05). After adjusting for age, gender, smoke, and HLA-B27, obesity remained associated with higher disease activity (BASDAI: β=0.55, P=0.005; ASDAS-CRP: β=0.40, P<0.001), poorer functional capacity (BASFI: β=0.58, P=0.001), worse health index (ASAS HI: β=1.92, P<0.001) and metrology index (BASMI: β=0.71, P=0.013). For TNFi users, BMI was found to be negatively correlated with changes in disease activity (ΔBASDAI and ΔASDAS) in the multivariate regression model (all P<0.05), and overweight and obese patients showed an unsatisfactory reduction in disease activity during 3-month, 6-month, 9-month, and 12-month follow-up period, compared to normal weight patients (all P<0.05).Conclusion:Overweight or obesity impacts greatly on clinical outcomes and treatment responses to biologics in patients with ankylosing spondylitis, which argues strongly for obesity management to become central to prevention and treatment strategies in patients with AS.References:[1]Maachi M, Pieroni L, Bruckert E, et al. Systemic low-grade inflammation is related to both circulating and adipose tissue TNFalpha, leptin and IL-6 levels in obese women. Int J Obes Relat Metab Disord 2004;28:993–7.Figure 1.Changes of disease activity for TNFi users during 3-, 6-, 9- and 12-month follow-up according to BMI categories. a: vs. normal weight, P<0.05 in 3 months; b: vs. normal weight, P<0.05 in 6 months; c: vs. normal weight, P<0.05 in 9 months; d: vs. normal weight, P<0.05 in 12 months.Acknowledgments:We appreciate the contribution of the present or former members of the CASPIC study group.Disclosure of Interests:None declared

scholarly journals Impact of Pathological Stratification on the Clinical Outcomes of Advanced Well-Differentiated/Dedifferentiated Liposarcoma Treated with Trabectedin

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1453
Author(s):  
Chiara Fabbroni ◽  
Giovanni Fucà ◽  
Francesca Ligorio ◽  
Elena Fumagalli ◽  
Marta Barisella ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Proportional Hazards ◽  
Case Series ◽  
Progression Free Survival ◽  
Cox Proportional Hazards ◽  
Low Grade ◽  
High Grade ◽  
Retrospective Case ◽  
Well Differentiated ◽  
The Impact

Background. We previously showed that grading can prognosticate the outcome of retroperitoneal liposarcoma (LPS). In the present study, we aimed to explore the impact of pathological stratification using grading on the clinical outcomes of patients with advanced well-differentiated LPS (WDLPS) and dedifferentiated LPS (DDLPS) treated with trabectedin. Patients: We included patients with advanced WDLPS and DDLPS treated with trabectedin at the Fondazione IRCCS Istituto Nazionale dei Tumori between April 2003 and November 2019. Tumors were categorized in WDLPS, low-grade DDLPS, and high-grade DDLPS according to the 2020 WHO classification. Patients were divided in two cohorts: Low-grade (WDLPS/low-grade DDLPS) and high-grade (high-grade DDLPS). Results: A total of 49 patients were included: 17 (35%) in the low-grade cohort and 32 (65%) in the high-grade cohort. Response rate was 47% in the low-grade cohort versus 9.4% in the high-grade cohort (logistic regression p = 0.006). Median progression-free survival (PFS) was 13.7 months in the low-grade cohort and 3.2 months in the high-grade cohort. Grading was confirmed as an independent predictor of PFS in the Cox proportional-hazards regression multivariable model (adjusted hazard ratio low-grade vs. high-grade: 0.45, 95% confidence interval: 0.22–0.94; adjusted p = 0.035). Conclusions: In this retrospective case series, sensitivity to trabectedin was higher in WDLPS/low-grade DDLPS than in high-grade DDLPS. If confirmed in larger series, grading could represent an effective tool to personalize the treatment with trabectedin in patients with advanced LPS.

scholarly journals Oral Abstract

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

CASE STUDY ON CIRCUMSCRIBED GLIOMAS, THEIR CLINICOPATHOLOGICAL CORRELATION IN A TERTIARY CARE CENTER

2021 ◽  
pp. 42-45
Author(s):  
Esther Alffi Papang ◽  
K. Rama
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Tertiary Care ◽  
Biological Behavior ◽  
Low Grade ◽  
Lower Grade ◽  
Who Grade ◽  
Primary Tumors ◽  
Short Period ◽  
The Impact

The histogenesis and biological behavior of primary tumors of the central nervous system(CNS) are very diverse. The majority of present gliomas as benign, slow growing lesions classied as by the WHO classicati grade I or II (Low grade gliomas) on of CNS tumors. However, a signicant fraction of gliomas develop over a short period of time and progress rapidly and are therefore classied as WHO grade III or IV(High grade gliomas). Astrocytomas are primary central nervous system tumours that can develop in adults or in children. They arise from the Astrocytes. They can be divided into diffuse that generally have a higher grade and poorer prognosis and those that are localised that tend to be of a lower grade and have a better prognosis. In this study, we outline the basic histological spectrum and features, epidemiological aspects and grade of circumscribed gliomas (localised) or other Astrocytic tumours according to WHO classication . These are the Pilocytic Astrocytoma, Pilomyxoid Astrocytoma, Subependymal giant cell Astrocytoma, Pleomorphic xanthoastrocytoma and Anaplastic astrocytoma . The knowledge of these tumours are important as they are one of the commonest cause of mortality and morbidity in both the young and old, accounting for about 60% of the glial tumours. Therefore neuropathological diagnosis and tumour characteristics will therefore profoundly inuence the impact of treatment strategies.

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