EPID-05. EVALUATION OF THE INCIDENCE OF CENTRAL NERVOUS SYSTEM TUMORS IN A CHILDHOOD CANCER TREATMENT CENTER AND THE CREATION OF A SPECIFIC GROUP

Central Nervous System Tumors (CNST) are the main solid neoplasm of childhood, representing 20% diagnosis. Based on this information, a search was carried out at a reference treatment center for childhood cancer in the state of Sao Paulo, belonging to University of Sao Paulo- ITACI/HCFMUSP, and at between 2017 and 2019, 352 new patients, 116 of which were neoplasm of CNS (32.9%). Aiming at an incidence of new cases, in 2019, an institutional group was created, with a team composed of Pediatric Oncologists, Neurosurgeons, Radiologists, Radiotherapists and Pathologists. In this first year, 31,8% of the 132 new patients were diagnosed with CNS tumor. According to WHO 2016, 15 patients were classified as a group that includes Diffuse Astrocytomas, Oligodendrioglial Tumors and Other Astrocytic Tumors. Among the other patients, 14.2% were Medulloblastomas, 4.7% Embryonic Tumors and 2.3% ART / RT. Patients diagnosed with diffuse brainstem glioma accounted for 11.9% of the total. The institution had a diagnosis of Angiocentric Glioma, Craniopharyngioma, Plexiform Neurofibroma and Anaplastic Ependymoma. Neuronal-glial tumors accounted for 9.5% of cases. Choroid plexus tumors represents 5%. Among them, 4.72% had metastatic tumors: Neuroblastoma and Ewing’s Sarcoma. Of the total of 42 patients, there were 5 deaths, 4 due to disease progression and one due to clinical complications. With the group, the discussions were carried out, allowing us to analyze that the presence of the Radiotherapy, Neurosurgery and Pathology team from the first moment, optimized the beginning of treatment and increased the patients’ survival.

Rapid Access to Contrast-Enhanced spectral mammogRaphy in women recalled from breast cancer screening: the RACER trial study design

BACKGROUND

In the Dutch breast cancer screening program, women recalled with a BI-RADS 0 score are referred for additional imaging, while those with BI-RADS 4/5 scores are also directed to an outpatient breast clinic. Approximately six out of ten women are recalled without being diagnosed with a malignancy. However, these recalls require additional imaging and doctor visits, which result in patient anxiety and increased health care costs. Conventional types of imaging used for additional imaging are full-field digital mammography and tomosynthesis. Contrast-enhanced spectral mammography has proved to have higher sensitivity and specificity than conventional imaging in women recalled from screening. Therefore, the aim is to study if CESM instead of conventional imaging is a more accurate, patient-friendly, and cost-effective strategy in the work-up of women recalled from breast cancer screening.

METHODS

This prospective, multicenter, randomized controlled trial will be conducted at four centers and will include 528 patients recalled for suspicious breast lesions from the Dutch breast cancer screening program. Participants are randomized in two groups: (1) standard care using conventional breast imaging techniques as initial imaging after recall versus (2) work-up primarily based on CESM. Written informed consent will be collected prior to study inclusion. The primary outcome is the diagnostic accuracy for detection of breast cancer. Secondary outcomes are numbers of additional diagnostic exams, days until final diagnosis, health care costs, and experienced patient anxiety.

DISCUSSION

Based on previously published retrospective studies, we expect to demonstrate in this prospective multicenter randomized controlled trial, that using CESM as a primary work-up tool in women recalled from breast cancer screening is a more accurate, cost-effective, and patient-friendly strategy.

TRIAL REGISTRATION

Netherlands Trial Register, NL6413/NTR6589. Registered on 6 July, 2017.

Endoscopic totally extraperitoneal (TEP) hernia repair for inguinal disruption (Sportsman's hernia): rationale and design of a prospective observational cohort study (TEP-ID-study)

INTRODUCTION

Chronic inguinal pain is a frequently occurring problem in athletes. A diagnosis of inguinal disruption is performed by exclusion of other conditions causing groin pain. Up to now, conservative medical management is considered to be the primary treatment for this condition. Relevant large and prospective clinical studies regarding the treatment of inguinal disruption are limited; however, recent studies have shown the benefits of the totally extraperitoneal patch (TEP) technique.This study provides a complete assessment of the inguinal area in athletes with chronic inguinal pain before and after treatment with the TEP hernia repair technique.

METHODS AND ANALYSIS

We describe the rationale and design of an observational cohort study for surgical treatment with the endoscopic TEP hernia repair technique in athletes with a painful groin (inguinal disruption).The study is being conducted in a high-volume, single centre hospital with specialty in TEP hernia repair. Patients over 18 years, suffering from inguinal pain for at least 3 months during or after playing sports, and whom have not undergone previous inguinal surgery and have received no benefit from physiotherapy are eligible for inclusion. Patients with any another cause of inguinal pain, proven by physical examination, inguinal ultrasound, X-pelvis/hip or MRI are excluded.Primary outcome is reduction in pain after 3 months. Secondary outcomes are pain reduction, physical functioning, and resumption of sport (in frequency and intensity).

ETHICS AND DISSEMINATION

An unrestricted research grant for general study purposes was assigned to the Hernia Centre. This study itself is not directly subject to the above mentioned research grant or any other financial sponsorship. We intend to publish the outcome of the study, regardless of the findings. All authors will give final approval of the manuscript version to be published.

[Frontotemporal dementia and schizophrenia in later life: a comparison of executive and general cognitive functioning]

BACKGROUND

Frontotemporal dementia (FTD) is characterised clinically by progressive changes in behaviour and personality; these changes are followed by cognitive disorder. FTD needs to be differentiated from other forms of dementia and from psychiatric conditions such as schizophrenia. Both FTD and schizophrenia lead to cognitive disorders and particularly to executive impairments.

AIM

To compare executive and general cognitive functioning in patients with FTD and in patients with schizophrenia in later life.

METHOD

As cognitive screening instruments we used the 'Frontal Assessment Battery' (FAB) and the 'Mini-Mental State Examination' (MMSE). The FAB en MMSE test results (retrieved from the database of the Alzheimer centre of the VU medical centre) for 25 outpatients diagnosed as having FTD were compared with the test results (retrieved from the 'SOUL' study database) for 31 elderly schizophrenia patients.

RESULTS

In both the fab and the MMSE tests the scores for the patients with FTD were significantly lower than the scores for the patients with schizophrenia.

CONCLUSION

Our study suggests that, despite the clinical similarities, there are differences between patients with FTD and elderly patients with schizophrenia with regard to executive and general cognitive functioning. Further studies are needed in order to differentiate between the two illnesses.

Practical issues in the methadone management of pregnant heroin users

Methadone management of pregnant heroin-using patients has become a standard approach to this particular population of patients. This paper discusses the establishment and running of an out-patient stabilization programme and highlights areas of difficulty experienced in this exercise. Guidelines are suggested for those who wish to establish such a service in the future.

Alternative medicine use in HIV-positive men and women: demographics, utilization patterns and health status

Between 1995 and 1997, 1,675 HIV-positive men and women using complementary and alternative medicine (CAM) were enrolled into the Bastyr University AIDS Research Center's Alternative Medicine Care Outcomes in AIDS (AMCOA) study. Funded by the National Institutes of Health (NIH) Office of Alternative Medicine (OAM) and National Institute of Allergy and Infectious Diseases (NIAID), the AMCOA study collected information on participant demographics, health status and use of conventional and CAM therapies. Participants from 46 states completed a baseline questionnaire, while additional clinical information (such as CD4 count and HIV-RNA viral load) was obtained from laboratory records. AMCOA participants reported using more than 1,600 different types of CAM therapies (1,210 CAM substances, 282 CAM therapeutic activities and 119 CAM provider types) for treating HIV/AIDS. Approximately two-thirds (63% n = 1,054) of the AMCOA cohort reported using antiretroviral drug therapy (ART) during the six-months previous to completing the baseline questionnaire, while 37% (n = 621) indicated they were not using ART. Of those not using ART, 104 subjects reported never having used any conventional medications for their HIV and 12 subjects used only non-prescription diarrhoea medications. The most frequently reported CAM substances were vitamin C (63%), multiple vitamin and mineral supplements (54%), vitamin E (53%) and garlic (53%). CAM provider types most commonly consulted by the AMCOA cohort were massage therapists (49%), acupuncturists (45%), nutritionists (37%) and psychotherapists (35%). CAM activities most commonly used were aerobic exercise (63%), prayer (58%), massage (53%) and meditation (46%). The choice of CAM therapies among the AMCOA cohort does not appear to be solely based on scientific evidence of efficacy of individual therapies. The majority of AMCOA subjects could be characterized as using integrated medicine, since an overwhelming proportion of the cohort consult with both conventional and CAM providers and use both conventional and CAM medications, yet few subjects reported that their conventional and CAM providers work as a team. These data and this cohort set the stage for conducting studies of health status changes associated with specific CAM therapies.

Outpatient methadone programme for pregnant heroin using women

A prospective study of pregnant narcotic users who attended the antenatal clinic at Westmead Hospital was undertaken to determine the practicality and safety of an outpatient methadone programme for these women. Forty-six women were commenced and managed on a methadone maintenance programme based at the Drug and Alcohol Clinic at Westmead Hospital (GROUP I), 12 women were maintained on long-term methadone therapy by outside prescribers (GROUP II), 12 women not on methadone continued to use heroin through the pregnancy (GROUP III), 14 women used heroin intermittently (GROUP IV). These were compared with a group of 52 women who were non-drug using (GROUP V). Women on the hospital based methadone programme had an earlier first antenatal clinic visit (p less than 0.001) than those women on outside methadone programmes or on heroin and had a longer pregnancy (p less than 0.001) than those women on heroin. The birth-weights on babies delivered to women on the Westmead Methadone Programme were significantly higher than those on babies born to women using heroin (p less than 0.05). A disappointing aspect of the study was a lower number of antenatal clinic visits (p less than 0.001) for all narcotic using women when compared with the comparison group. The outcome of the Westmead Methadone Programme women showed that better maternal and neonatal outcome followed entry into a hospital monitored methadone programme with attendant antenatal care.