1
|
Development and internal validation of a nomogram predicting 3-year chronic kidney disease upstaging following robot-assisted partial nephrectomy. Int Urol Nephrol 2024; 56:913-921. [PMID: 37848745 DOI: 10.1007/s11255-023-03832-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE Aim of the present study was to develop and validate a nomogram to accurately predict the risk of chronic kidney disease (CKD) upstaging at 3 years in patients undergoing robot-assisted partial nephrectomy (RAPN). METHODS A multi-institutional database was queried to identify patients treated with RAPN for localized renal tumor (cT1-cT2, cN0, cM0). Significant CKD upstaging (sCKD-upstaging) was defined as development of newly onset CKD stage 3a, 3b, and 4/5. Model accuracy was calculated according to Harrell C-index. Subsequently, internal validation using bootstrapping and calibration was performed. Then nomogram was depicted to graphically calculate the 3-year sCKD-upstaging risk. Finally, regression tree analysis identified potential cut-offs in nomogram-derived probability. Based on this cut-off, four risk classes were derived with Kaplan-Meier analysis tested this classification. RESULTS Overall, 965 patients were identified. At Kaplan-Meier analysis, 3-year sCKD-upstaging rate was 21.4%. The model included baseline (estimated glomerular filtration rate) eGFR, solitary kidney status, multiple lesions, R.E.N.A.L. nephrometry score, clamping technique, and postoperative acute kidney injury (AKI). The model accurately predicted 3-year sCKD-upstaging (C-index 84%). Based on identified nomogram cut-offs (7 vs 16 vs 26%), a statistically significant increase in sCKD-upstaging rates between low vs intermediate favorable vs intermediate unfavorable vs high-risk patients (1.3 vs 9.2 vs 22 vs 54.2%, respectively, p < 0.001) was observed. CONCLUSION Herein we introduce a novel nomogram that can accurately predict the risk of sCKD-upstaging at 3 years. Based on this nomogram, it is possible to identify four risk categories. If externally validated, this nomogram may represent a useful tool to improve patient counseling and management.
Collapse
|
2
|
Perioperative and functional outcomes of off-clamp robotic partial nephrectomy for “purely hilar” versus “abutting the hilum” and “central” tumors. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01297-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
3
|
Robot assisted radical cystectomy with intracorporeal padua ileal neobladder: assessing the role of learning curve in a high-volume center large consecutive series. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01116-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
4
|
Laparoscopic vs. Robot-assisted nephroureterectomy: Propensity score matched comparison of surgical and early oncologic outcomes. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00381-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
5
|
On-clamp versus off-clamp robotic partial nephrectomy for totally endophytic deep renal masses: Propensity score-matched comparison of perioperative, oncologic and functional outcomes of a multicenter analysis (ROSULA database). Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00420-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
6
|
Robot-assisted video-endoscopic radical inguinal lymphadenectomy for penile cancer: surgical anatomy and technique. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01289-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
7
|
Inguinal lymph node dissection for penile cancer: Results of a minimally invasive approach from a multicenter database. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00766-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
8
|
Nephrometry scores predicting value of Trifecta achievement in a multicenter analysis (ROSULA database) of Robotic Partial Nephrectomy for totally endophytic “deep” renal masses. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00146-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
9
|
Avoiding renorraphy at the end of off-clamp robotic partial nephrectomy does not jeopardize surgical and functional outcomes: A single center analysis. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00428-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
10
|
Expanding the limits of nephron-sparing surgery: Surgical technique and mid-term outcomes of purely off-clamp robotic partial nephrectomy for totally endophytic renal tumors. Int J Urol 2022; 29:282-288. [PMID: 34973156 DOI: 10.1111/iju.14763] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/25/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To report surgical technique, perioperative, oncological, and mid-term functional outcomes in a single-center purely off-clamp robotic partial nephrectomy series for totally endophytic masses. METHODS A retrospective analysis of a prospectively collected, institutional review board-approved renal cancer database was carried out to include patients with a totally endophytic renal tumor treated with off-clamp robotic partial nephrectomy between January 2013 and December 2020 at our center. Our database was queried to identify cases that had been assigned 3 points for the "E" domain of the R.E.N.A.L. nephrometry score and 3 points for the "exophytic rate" domain of the PADUA (Preoperative Aspects and Dimensions Used for an Anatomical) nephrometry score. Preoperative indocyanine green renal mass marking was performed in 33 patients, in whom the tumor was vascularized by a specific feeding artery. Surgical steps, perioperative, oncological and functional data were reported. RESULTS Fifty-six consecutive patients with totally endophytic renal masses were treated. The median tumor diameter was 3 cm, and median PADUA and R.E.N.A.L. scores were both 10. The median operative time was 82 min. Low-grade Clavien complications occurred in two patients (3.6%) and high-grade Clavien complications were observed in four patients (7.1%). Positive surgical margins were detected in one patient; 2-year recurrence-free, cancer-specific, and overall survival rates were 100%, 100%, and 98.2%, respectively. At a median follow-up of 24 months, new onset of chronic kidney disease stage 3b occurred in one patient. At last follow-up, the median estimated glomerular filtration rate was 77 mL/min, with a median estimated glomerular filtration rate percent decrease of 5.5%. Trifecta was achieved in 91% of patients. CONCLUSIONS Purely off-clamp robotic partial nephrectomy is a feasible and safe surgical approach, even in totally endophytic renal tumors, providing a favorable perioperative complications rate, excellent oncological outcomes, and negligible impact on renal function at mid-term follow-up. Indocyanine green preoperative marking of endophytic renal tumors represents a useful tool for rapid intraoperative identification of the mass, real-time control of resection margins, and a more precise dissection.
Collapse
|
11
|
Purely off-clamp robot-assisted partial nephrectomy for totally endophytic renal tumors: Surgical technique and mid-term outcomes of a single center series. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01634-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
12
|
Avoiding renorraphy at the end of off-clamp robotic partial nephrectomy does not jeopardize surgical and functional outcomes: A multicenter analysis. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00968-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
13
|
Sutureless purely off-clamp robotic partial nephrectomy: Surgical technique and outcomes. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01633-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
14
|
Physical activity decreases the risk of cancer reclassification in patients on active surveillance: a multicenter retrospective study. Prostate Cancer Prostatic Dis 2021; 24:1151-1157. [PMID: 34007014 DOI: 10.1038/s41391-021-00375-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 04/13/2021] [Accepted: 04/23/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Physical activity (PA) is associated with favorable outcomes in prostate cancer (PCa) patients. We assessed its effect on the risk of PCa reclassification (PCaR) during active surveillance. METHODS Anthropometric, demographic, and clinical data concerning men diagnosed with a low-risk PCa and initially managed with active surveillance at the two participating institutions were retrospectively collected. The Physical Activity Scale for the Elderly (PASE) was used for patients' self-assessment of their daily exercise and their consequent stratification into three groups: sedentary (PASE ≤ 65), moderately active (65 < PASE < 125), active (PASE ≥ 125). Kaplan-Meier model was used to evaluate the predictive role of PA on PCaR, computed at 2, 5, 10 years after diagnosis; differences between lifestyle groups were assessed using the log-rank and uni-/multivariable Cox analyses applied to identify predictors of reclassification. RESULTS Eighty-five patients were included in the analysis, with a median age of 66 years (IQR: 59-70); 16% were active, 45% were former smokers, and 3 presented with metabolic syndrome (MetS). Prostate-specific antigen (PSA) density was 0.12 (IQR: 0.07-0.15); 34 men showed a PSA doubling time <10 years. The Median PASE score was 86 (IQR: 61.5-115.8): 24 patients were sedentary, 46 moderately active, and 15 active. At a median follow-up of 37 months (IQR: 14-53), 25% of patients experienced PCaR. These were less physically active (PASE score 69.3 vs 87.8; p = 0.056) and presented with significantly smaller prostates (46 ml vs 50.7 ml; p = 0.001) and a higher PSAD (0.14 vs 0.10; p = 0.019). At 2 years, the risk of reclassification was 25 ± 5%, while it was 38 ± 7% at both 5 and 10 years. The risk was significantly different in the three PA groups (Log Rank p = 0.033). PASE score was the only independent predictor of PCaR (HR: 0.987; 95%CI: 0.977-0.998; p = 0.016). CONCLUSIONS PA influences PCa evolution, as increasing levels are associated with a significantly reduced risk of tumor reclassification among patients undergoing active surveillance.
Collapse
|
15
|
Impact of the COVID-19 pandemic on surgery for thyroid cancer in Italy: nationwide retrospective study. Br J Surg 2021; 108:e166-e167. [PMID: 33659983 PMCID: PMC7989577 DOI: 10.1093/bjs/znab012] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/19/2020] [Accepted: 01/06/2021] [Indexed: 12/25/2022]
|
16
|
Outcomes of robot-assisted partial nephrectomy for completely endophytic renal tumors: A multicenter analysis. Eur J Surg Oncol 2021; 47:1179-1186. [DOI: 10.1016/j.ejso.2020.08.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/30/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022] Open
|
17
|
Abstract
BACKGROUND The role of robot-assisted partial nephrectomy (RAPN) in the management of renal masses has exponentially grown over the past 10 years. Nevertheless, data on long term outcomes of the procedure remains limited. Herein we report oncological and functional outcomes of patients who underwent RAPN for a malignant mass with a median follow-up of 7 years, the longest follow-up to date. METHODS A retrospective analysis of an international multicenter database was performed. All consecutive patients undergoing surgery between 2009 and 2013 with a minimum of 3-year follow-up and complete data on renal function were included. Demographics, surgical and perioperative outcomes were analyzed. Overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) were evaluated using Kaplan-Meier analysis. RESULTS Overall, our study cohort was composed of eighty-five patients with a median follow-up of 88 months. Median clinical tumor size was 3 cm, with mostly (74.1%) clinical stage T1a, and median RENAL score 6. Final histopathologic analysis revealed clear cell RCC in 76.5% of cases. PSM was present in seven patients (8.2%). Eleven overall deaths (12.9%) occurred in the cohort during the follow-up period. Two of these (2.33%) were attributed to metastatic RCC. The OS, CSS, and DFS rates were 91.7%, 97.7%, and 91.7% at 84 months, respectively. Regarding the renal functional outcomes, seventeen patients (20.1%) presented a CKD upstaging in our cohort. CONCLUSIONS Our findings show excellent 7-year oncologic and functional outcomes of the procedure, which duplicate those achieved in historical series of open and laparoscopic surgery.
Collapse
|
18
|
Abstract
BACKGROUND The role of robot-assisted partial nephrectomy (RAPN) in the management of renal masses has exponentially grown over the past 10 years. Nevertheless, data on long term outcomes of the procedure remains limited. Herein we report oncological and functional outcomes of patients who underwent RAPN for a malignant mass with a median follow-up of 7 years, the longest follow-up to date. METHODS A retrospective analysis of an international multicenter database was performed. All consecutive patients undergoing surgery between 2009 and 2013 with a minimum of 3-year follow-up and complete data on renal function were included. Demographics, surgical and perioperative outcomes were analyzed. Overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) were evaluated using Kaplan-Meier analysis. RESULTS Overall, our study cohort was composed of eighty-five patients with a median follow-up of 88 months. Median clinical tumor size was 3 cm, with mostly (74.1%) clinical stage T1a, and median RENAL score 6. Final histopathologic analysis revealed clear cell RCC in 76.5% of cases. PSM was present in seven patients (8.2%). Eleven overall deaths (12.9%) occurred in the cohort during the follow-up period. Two of these (2.33%) were attributed to metastatic RCC. The OS, CSS, and DFS rates were 91.7%, 97.7%, and 91.7% at 84 months, respectively. Regarding the renal functional outcomes, seventeen patients (20.1%) presented a CKD upstaging in our cohort. CONCLUSIONS Our findings show excellent 7-year oncologic and functional outcomes of the procedure, which duplicate those achieved in historical series of open and laparoscopic surgery.
Collapse
|
19
|
Robot-assisted partial nephrectomy for completely endophytic renal tumors: A multicenter outcome analysis. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35531-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
20
|
Late complications of robot-assisted radical cystectomy with totally intracorporeal urinary diversion. World J Urol 2020; 39:1903-1909. [PMID: 32747981 PMCID: PMC8217047 DOI: 10.1007/s00345-020-03378-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/20/2020] [Indexed: 01/02/2023] Open
Abstract
Introduction and objectives To evaluate late complications in a large cohort of patients undergoing robot-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion (ICUD). Materials and methods We prospectively enrolled patients who underwent RARC and ICUD between August 2012 and June 2019. We excluded patients with Ejection fraction < 36%, retinal vasculopathy, ventriculoperitoneal shunts, and those treated without curative intent. All complications and their onset date have been recorded, defined, and graded according to Clavien classification adapted for radical cystectomy. Results 210 patients were included, 76% of whom were men, with a mean age of 62 years. Urinary diversions used were Padua Ileal Bladder (PIB) in 80% of cases, and ileal conduit (IC) in 20% of patients (generally older and with more comorbidity). The mean follow-up was 30 ± 22 months. The stenosis rate of uretero-ileal anastomosis was 14%, while a reduction in eGFR (≥ 20%) was observed in about half of the cases. UTIs occurred in 37% of the patients, especially in the first 12 months. Only 2% of patients had bowel occlusion, whereas incisional hernia, lymphocele, and systemic events (metabolic acidosis and major cardiovascular events) occurred respectively in 20%, 10%, and 1% of cases. Conclusions Our study evaluates first late complications in a cohort of patients who underwent RARC with ICUD. These data are encouraging and in line with findings from a historical series of open radical cystectomy (ORC). This study is a further step in supporting RARC as a safe and effective surgical option for the treatment of muscle-invasive bladder cancer (MIBC) in tertiary referral centers. Electronic supplementary material The online version of this article (10.1007/s00345-020-03378-7) contains supplementary material, which is available to authorized users.
Collapse
|
21
|
ICG-guided robotic-assisted partial adrenalectomy. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34248-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
22
|
Pushing the limits of robotic assisted partial nephrectomy: Off-clamp approach for bilateral, hilar and totally endophytic renal masses. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34261-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
23
|
Robot assisted partial nephrectomy for hilar tumors: Technique, perioperative, oncologic and functional outcomes from a single center series. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34184-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
24
|
Trifecta achievement after partial nephrectomy helps predicting long term oncologic and functional outcomes: A multicenter study. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33903-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
25
|
Transarterial ICG delivery before purely off-clamp robot-assisted partial nephrectomy for totally endophytic renal tumors: Technique and outcomes. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34183-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
26
|
Purely off-clamp robot-assisted partial nephrectomy for totally endophytic renal tumors: Mid-term outcomes from a single-center series. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34186-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
27
|
Urinary expression of let-7c cluster as non-invasive tool to assess the risk of disease progression in patients with high grade non-muscle invasive bladder Cancer: a pilot study. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2020; 39:68. [PMID: 32303246 PMCID: PMC7164295 DOI: 10.1186/s13046-020-01550-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 02/19/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND High grade non-muscle-invasive bladder cancer (HG-NMIBC) is a heterogeneous disease with variable risk of progression. Urinary microRNAs are promising biomarkers for BC detection and surveillance. Let-7c-5p miRNA, clustered with miR-99a-5p and -125b-5p, is deregulated in cancer, including BC. The aim of this study is to evaluate urinary let-7c cluster expression in Ta/T1 HG-NMIBC patients and its impact on progression-free survival (PFS). METHODS Quantitative Real-Time-Polymerase-Chain-Reaction (qRT-PCR) was used to analyze the let-7c cluster expression in 57 urine and 49 neoplastic paired tissue samples prospectively collected from transurethral resection (TUR) HG-NMIBC patients. Twenty urine and 10 bladder tissue samples were collected and analyzed as normal controls. QRT-PCR was also used to detect intra-/extra-cellular let-7c cluster in BC cells. Receiver Operating Characteristic (ROC) curves were used to identify urinary miRNAs cut-off values predicting T-stage and PFS. Uni/multivariable Cox regression was performed to identify predictors of PFS. A nomogram predicting progression risk and a decision curve analysis (DCA) were performed. RESULTS Urinary let-7c was significantly up-regulated in patients compared with controls, while the whole cluster was down-regulated in tumor tissues. Supporting these findings, in vitro comparison of extra-/intra-cellular ratios of cluster levels between BC cells, showed a higher ratio for let-7c in HG-NMIBC versus low-grade cells. Urinary let-7c cluster expression was increased in higher T-stage and was an independent predictor of progression. Lower EORTC-score and downregulation of urinary cluster were predictors of higher PFS on univariable Cox regression, while on multivariable analysis only cluster expression was an independent progression predictor. On DCA, a benefit was evident for patients with a PFS probability > 20%. CONCLUSIONS Urinary let-7c cluster evaluation may improve prognosis, identifying patients at risk of progression and addressing early radical treatment.
Collapse
|
28
|
Self-monitoring of Blood Pressure in Patients With Hypertension-Related Multi-morbidity: Systematic Review and Individual Patient Data Meta-analysis. Am J Hypertens 2020; 33:243-251. [PMID: 31730171 PMCID: PMC7162426 DOI: 10.1093/ajh/hpz182] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/11/2019] [Accepted: 11/13/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Studies have shown that self-monitoring of blood pressure (BP) is effective when combined with co-interventions, but its efficacy varies in the presence of some co-morbidities. This study examined whether self-monitoring can reduce clinic BP in patients with hypertension-related co-morbidity. METHODS A systematic review was conducted of articles published in Medline, Embase, and the Cochrane Library up to January 2018. Randomized controlled trials of self-monitoring of BP were selected and individual patient data (IPD) were requested. Contributing studies were prospectively categorized by whether they examined a low/high-intensity co-intervention. Change in BP and likelihood of uncontrolled BP at 12 months were examined according to number and type of hypertension-related co-morbidity in a one-stage IPD meta-analysis. RESULTS A total of 22 trials were eligible, 16 of which were able to provide IPD for the primary outcome, including 6,522 (89%) participants with follow-up data. Self-monitoring was associated with reduced clinic systolic BP compared to usual care at 12-month follow-up, regardless of the number of hypertension-related co-morbidities (−3.12 mm Hg, [95% confidence intervals −4.78, −1.46 mm Hg]; P value for interaction with number of morbidities = 0.260). Intense interventions were more effective than low-intensity interventions in patients with obesity (P < 0.001 for all outcomes), and possibly stroke (P < 0.004 for BP control outcome only), but this effect was not observed in patients with coronary heart disease, diabetes, or chronic kidney disease. CONCLUSIONS Self-monitoring lowers BP regardless of the number of hypertension-related co-morbidities, but may only be effective in conditions such obesity or stroke when combined with high-intensity co-interventions.
Collapse
|
29
|
Vitamin D Deficiency as a Predictive Factor of Transient Hypocalcemia after Total Thyroidectomy. Int J Endocrinol 2020; 2020:8875257. [PMID: 33101410 PMCID: PMC7569460 DOI: 10.1155/2020/8875257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/16/2020] [Accepted: 09/28/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Total thyroidectomy (TT) is recommended in the treatment of malignant and benignant thyroid diseases, and, to date, transient hypocalcemia is the most frequent complication after the procedure. We prospectively evaluated the role of vitamin D deficiency as a predictor of postoperative hypocalcemia. METHODS This is a prospective cohort study which was conducted between January 2016 and April 2019. A total of 177 consecutive patients (141 (79.7%) women and 36 (20.3%) men) who underwent TT were included in the current study. Hypocalcemia occurred when serum calcium levels were below 8.0 mg/dL or 1.10 mmol/L. Patients were divided into two groups (Group 1, normocalcemic; Group 2, hypocalcemic) and were assessed taking into consideration preoperative serum 25-hydroxy vitamin D (25-OHD) levels, preoperative serum calcium levels, thyroid hormone levels, sex, body mass index (BMI), and smoking habits. Vitamin D deficiency was defined as 25-OHD levels <25 ng/mL. RESULTS The incidence of postoperative asymptomatic and symptomatic hypocalcemia in the two groups was 19.8% and 15.8%, respectively. Preoperative 25-OHD level was significantly different between Group 1 and Group 2 (31.5 ± 15.0 ng/mL vs 18.7 ± 9.8 ng/mL,p=0.017). Logistic regression analysis revealed that preoperative vitamin D deficiency was a significant predictive factor of postoperative hypocalcemia (p=0.012), and, specifically, the risk of hypocalcemia increased 15-fold in patients with a preoperative vitamin D level <25 ng/mL (odds ratio [OR], 14.8). CONCLUSIONS Postoperative hypocalcemia is significantly associated with low preoperative levels of serum 25-OHD. Our studies demonstrate that vitamin D deficiency (<25 ng/mL) is an independent predictive factor of postoperative hypocalcemia.
Collapse
|
30
|
Primary Whole-gland Cryoablation for Prostate Cancer: Biochemical Failure and Clinical Recurrence at 5.6 Years of Follow-up. Eur Urol 2019; 75:208-214. [PMID: 30274702 PMCID: PMC9827755 DOI: 10.1016/j.eururo.2018.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 09/04/2018] [Indexed: 01/11/2023]
Abstract
We retrospectively evaluated complications and functional and oncologic outcomes of 94 consecutive men who underwent primary whole-gland cryoablation for localized prostate cancer (PCa) from 2002 to 2012. Kaplan-Meier and multivariable Cox regression analyses were performed using a landmark starting at 6 mo of follow-up. In total, 75% patients had D'Amico intermediate- (48%) or high- (27%) risk PCa. Median follow-up was 5.6 yr. Median time to prostate-specific antigen (PSA) nadir was 3.3 mo, and 70 patients reached PSA <0.2ng/ml postcryoablation. The 90-d high-grade (Clavien Grade IIIa) complication rate was 3%, with no rectal fistulas reported. Continence and potency rates were 96% and 11%, respectively. The 5-yr biochemical failure-free survival (PSA nadir+2ng/ml) was 81% overall and 89% for low-, 78% for intermediate-, and 80% for high-risk PCa (p=0.46). The median follow-up was 5.6 and 5.1 yr for patients without biochemical failure and with biochemical failure, respectively. The 5-yr clinical recurrence-free survival was 83% overall and 94% for low-, 84% for intermediate-, and 69% for high-risk PCa (p=0.046). Failure to reach PSA nadir <0.2ng/ml within 6 mo postcryoablation was an independent predictor for biochemical failure (p=0.006) and clinical recurrence (p=0.03). The 5-yr metastases-free survival was 95%. Main limitation is retrospective evaluation. Primary whole-gland cryoablation for PCa provides acceptable medium-term oncologic outcomes and could be an alternative for radiation therapy or radical prostatectomy. PATIENT SUMMARY: Cryoablation is a safe, minimally-invasive procedure that uses cold temperatures delivered via probes through the skin to kill prostate cancer (PCa) cells. Whole-gland cryoablation may offer an alternative treatment option to surgery and radiotherapy. We found that patients had good cancer outcomes 5 yr after whole-gland cryoablation, and those with a prostate-specific antigen value ≥0.2ng/ml within 6 mo after treatment were more likely to have PCa recurrence.
Collapse
|
31
|
Abstract
Pelvic floor rehabilitation is frequently recommended for defecation disorders, in both constipation and fecal incontinence. However, the lack of patient selection, together with the variety of rehabilitation methods and protocols, often jeopardize the results of this approach, causing difficulty in evaluating outcomes and addressing proper management, and above all, in obtaining scientific evidence for the efficacy of these methods for specific indications. The authors represent different gastroenterological and surgical scientific societies in Italy, and their aim was to identify the indications and agree on treatment protocols for pelvic floor rehabilitation of patients with defecation disorders. This was achieved by means of a modified Delphi method, utilizing a working team (10 members) which developed the statements and a consensus group (15 members, different from the previous ones) which voted twice also suggesting modifications of the statements.
Collapse
|
32
|
Different perception of chronic constipation between patients and gastroenterologists. Neurogastroenterol Motil 2018; 30:e13336. [PMID: 29575454 DOI: 10.1111/nmo.13336] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 02/13/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is a certain number of subjects that consider themselves to be constipated (self diagnosed constipation; SDC). The Rome Criteria separate FC from IBS-C, but some SDC patients do not meet the Rome criteria (no Rome Constipation; NRC). Our aims were to evaluate the percentage of SDC subjects with a diagnosis of FC and IBS-C and to compare demographic and clinical features, symptoms, and quality of life in the different SDC groups (FC, IBS-C, NRC). METHODS During a 2-month period, 934 patients and 980 accompanying persons (AP) were asked to complete a survey. The presence of FC or IBS-C was assessed. SDC subjects were invited to record the stool consistency (Bristol scale) and to fill in the Constipation Severity Index (CSI), obstructed defecation syndrome (ODS) and patient assessment of constipation-quality of life (PAC-QoL). The use of laxatives and enemas was evaluated. KEY RESULTS The probability of the ROME III criteria being present was higher in SDC compared with no-SDC (OR 20.5). NRC was present in 13.5% of the SDC. In the patients' group the agreement between a diagnosis of Rome III and SDC was good (K 0.62), whereas in the AP it was moderate (K 0.56). NRC showed lower mean values of ODS, CSI and PAC-QoL, higher Bristol scale and a lower use of laxatives and enemas compared to IBS-C and FC. No differences were found between IBS-C and FC. CONCLUSIONS AND INFERENCES The Rome III criteria identify subjects with a greater clinical impact, but separation of FC and IBS-C does not seem justified.
Collapse
|
33
|
MP100-14 HIGH INTENSITY FOCUSED ULTRASOUND KIDNEY ABLATION: PRE-CLINICAL SAFETY AND EFFICACY EVALUATION IN A PORCINE MODEL USING A 15MM LAPAROSCOPIC PROBE. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.3121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
34
|
A Shock Team Improves Survival in Cardiogenic Shock by Decreasing Time to Intervention. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
35
|
Simple RVOT Doppler Measurements in Addition to Hemodynamic Variables Can Help Identify Need for RVAD at Time of LVAD Placement. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
36
|
Which differences do elderly patients present in single-stage treatment for cholecysto-choledocholithiasis? Int J Surg 2014; 12 Suppl 2:S160-S163. [PMID: 25157986 DOI: 10.1016/j.ijsu.2014.08.358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/15/2014] [Indexed: 02/03/2023]
Abstract
Patients with symptomatic gallstones present common bile duct stones in approximately 10% of cases. It is possible to resolve both gallbladder and bile duct stones with a single procedure. The aim of this study is to determine the effectiveness of a single stage procedure for gallbladder and bile duct stones in the elderly patients and to expose the differences between the various techniques. From January 2008 to December 2013, we treated 1540 patients with gallbladder stones. In 152 cases, we also found bile duct stones. 150 of these were treated in a single stage procedure. We divided our patients into 2 groups: Group A was younger than 65 (104 patients); Group B was 65 or older (46 patients). We retrospectively compared sex, ASA score, conversion rate, success rate, post-operative complications, hospital stay, and treatment method. We had no intra-operative mortality. 1 patient in Group B, heart condition (ASA 4), died with multiple organ failure (MOF) 10 days after his operation. ASA score: 3.5 ± 0.5 in A vs 2 ± 0.9 in B (P 0.001), post-operative complications 6% in A vs 18.1% in B (P 0.0325) and hospital stay 4.1 ± 2.3 in A vs 9.5 ± 5.5 in B (P 0.0001) were significantly higher in Group B. No differences were found in term of success rate: 94% in A vs 90% in B (P 0.4944). The procedure used to obtain the clearance of the bile duct showed a different success rate across the two groups: for the patients under 65 years old, trans-cystic clearance (TC-CBDE) was successful in 90% of cases, and only 51% for those older than 65, where we had to recall 49% for laparo-endoscopic rendez-vous (RV-IOERC) (P 0.0014). In conclusion, single stage treatment is safe and effective also to elderly patients. The methods used in patients being younger than 65 years old is what appeared to be significantly different.
Collapse
|
37
|
Early biomarkers of hypocalcemia following total thyroidectomy. Int J Surg 2014; 12 Suppl 1:S202-4. [DOI: 10.1016/j.ijsu.2014.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 05/03/2014] [Indexed: 10/25/2022]
|
38
|
Genetic characterization of Libyan date palm resources by microsatellite markers. 3 Biotech 2014; 4:21-32. [PMID: 28324455 PMCID: PMC3909576 DOI: 10.1007/s13205-013-0116-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 01/08/2013] [Indexed: 11/26/2022] Open
Abstract
Molecular typing of 377 female date palm trees belonging to 18 Libyan cultivars and representing common genotypes in the central Libyan oasis of Al Jufrah was performed using 16 highly polymorphic microsatellite or SSR loci. A total of 110 alleles with an average of 6.88 alleles per locus were scored indicating the high level of polymorphism existing among the cultivars thus allowing their genetic fingerprinting. Moreover 28 alleles out of 110 were fixed. All the cultivars were characterized by negative values of the Fixation Index (F) due to an excess of heterozygotes with respect to HW equilibrium. The pattern of genetic diversity among cultivars was estimated by codominant genetic distances and presented by principal coordinates analysis (PCoA). The observed pattern evidences the genetic diversity existing among cultivars that allow distinguishing them easily. The average dissimilarity internal to each cultivar ranged from 0 to 21. Seven cultivars showed value zero indicating no genetic difference within cultivar in agreement with their Fixation Index (F = 1). A varietal identification key was also built using multiloci genotyping with only three microsatellite loci that identified 23 alleles in total. The possibility to attribute the unknown male plant to a cultivar was also considered and male parentage analysis was performed. Fifty-five male plants out of 63 were assigned to a definite cultivar with high confidence level. The positive result obtained in identifying males confirmed the suitability of SSR for clone fingerprinting and cultivar identification, thus opening new prospects for date palm breeding.
Collapse
|
39
|
Abstract
Objective The objective of this paper is to evaluate the prevalence and characterize the main epidemiological, clinical and immunological features of annular erythema (AE) in non-Asian patients with primary Sjögren’s syndrome (SS). Methods We carried out a retrospective study searching for AE in 377 Spanish patients with primary SS fulfilling the 2002 American-European criteria. In addition, we searched PubMed (1994–2012) using the MeSH terms “annular erythema” and “primary Sjögren’s syndrome” for additional cases. All cases with AE reported in patients with SS associated with systemic lupus erythematosus were excluded. Results In our Spanish cohort, we found 35 (9%) patients diagnosed with AE. All were white females, with a mean age of 47 years at diagnosis of AE. AE preceded diagnosis of SS in 27 (77%) patients. Cutaneous AE lesions involved principally the face and upper extremities. All patients reported photosensitivity, with cutaneous flares being reported during the warmest months in 93% of patients. Immunological markers consisted of anti-Ro/La antibodies in 31 (89%) patients. In the literature search, we identified eight additional non-Asian patients with primary SS diagnosed with AE. In comparison with 52 Asian patients, the 43 non-Asian patients with AE related to primary SS were more frequently women (100% vs 78%, p = 0.008), and cutaneous lesions were less frequently reported in the face (55% vs 81%, p = 0.045) and more frequently in the neck (40% vs 14%, p = 0.041). Immunologically, non-Asian patients had a lower frequency of anti-Ro antibodies and a higher frequency of negative Ro/La antibodies, although the differences were not statistically significant. Conclusion AE is not an exclusive cutaneous feature of Asian patients with primary SS. In addition to the characteristic cutaneous expression, AE has a very specific clinical and immunological profile: often presenting before the fulfillment of SS criteria, overwhelmingly associated with anti-Ro antibodies but weakly associated with other immunological markers and the main systemic SS-related features.
Collapse
|
40
|
Thyroid surgery with harmonic focus, ligasure precise and conventional technique: a retrospective case-matched study. Hippokratia 2012; 16:154-159. [PMID: 23935272 PMCID: PMC3738418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND New surgical technologies have been introduced in thyroid surgery, to achieve vessel sealing and hemostasis. The aim of the study was to examine their effectiveness and compare the outcome of total thyroidectomy using the Harmonic Focus™, the LigaSure® Precise and the conventional technique of suture ligation. METHODS A retrospective case-matched study of all total thyroidectomies between October 2008 through May 2010 was conducted. Patients (n=240) underwent total thyroidectomy using three different methods; the Harmonic Focus™ (Group F, n=80), the LigaSure Precise® (Group L, n=80) and the conventional technique of suture ligation (Group C, n=80). RESULTS No significant differences were identified between the 3 groups in terms of demographics, thyroid gland weight, pathologic diagnosis, preoperative and postoperative calcium levels, postoperative complications, duration of hospital stay, and final outcome. The operative time was shorter with Harmonic Focus® by about 15%. Statistical analysis revealed a statistically significant difference between operations with F (62.7±14.1 minutes) and C (72.7±13.6minutes) with (p=0.019). CONCLUSION Both devices were safe and efficient. A significant reduction of the operative time was found with Harmonic Focus® compared to the other two techniques with no statistically significant differences in postoperative complications in the 3 groups.
Collapse
|
41
|
Abstracts from EIR School ES01-ES25. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/ker439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
42
|
Bronchiectasis in primary Sjögren's syndrome: prevalence and clinical significance. Clin Exp Rheumatol 2010; 28:647-653. [PMID: 20883638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 03/22/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To analyse the prevalence and clinical significance of bronchiectasis in a large series of patients with primary Sjögren's syndrome (SS) and evaluate its impact on disease expression and outcomes. METHODS The study cohort included 507 patients with primary SS. Bronchiectasis were diagnosed according to pulmonary computed tomography (CT). As a control group, we included 37 consecutive SS patients evaluated by pulmonary CT during the same study period without pulmonary involvement. RESULTS Fifty primary SS patients had bronchiectasis according to the pulmonary CT. Nine patients were excluded due to non-autoimmune processes and 41 were classified as bronchiectasis associated with primary SS (40 women, mean age of 64 years). All cases of bronchiectasis were of the cylindrical type and were located in the inferior lobes in 29 cases (71%). Patients with bronchiectasis were older at diagnosis of SS (60.39 vs. 52.54 years, p=0.022) and had a higher frequency of hiatus hernia (41% vs. 16%, p=0.024) in comparison with controls. Immunologically, patients with bronchiectasis had a lower frequency of anti-Ro/SS-A antibodies (27% vs. 54%, p=0.022) but a higher frequency of anti-smooth muscle--SMAantibodies (82% vs. 60%, p=0.043). During follow-up, patients with bronchiectasis had a higher frequency of respiratory infections (56% vs. 3%, p<0.001) and pneumonia (29% vs. 3%, p=0.002) in comparison with those without. CONCLUSIONS Patients with primary SS and bronchiectasis are characterised by an older age, a high frequency of hiatus hernia, a specific immunologic pattern (low frequency of anti-Ro/SS-A and high frequency of anti-SMA) and during follow-up a much higher frequency of respiratory infections and pneumonia.
Collapse
|
43
|
[Comparison of conventional technique, Ligasure Precise and Harmonic Focus in total thyroidectomy]. G Chir 2010; 31:296-298. [PMID: 20646375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The aim of this study was to compare the results obtained using an electrothermal bipolar vessel sealing system (Ligasure Precise), a harmonic curved shears (Harmonic Focus) and traditional technique in total thyroidectomy. We have enrolled 93 patients and assigned randomly to three groups of 31 pt: groups L (Ligasure Precise), F (Harmonic Focus) and C (traditional thecnique). Recorded data were demographics, preoperative serum calcium levels, operation time, length of hospital stay, weight of exported gland and pathology, postoperative calcemia at one and two days and recurrent laryngeal nerve paralysis. The three groups did not present statistically significant differences in term of age, gender and pathology classification. No postoperative haemorrhages were observed. The overall incidence of hypocalcemia was 38.9% (36 pt) and the mean days of hospitalization were 2.3 days without statistically significant differences between the three groups. Only one patient (group F) presented temporary recurrent laryngeal nerve paralysis. Mean operation time (minutes) was significantly reduced by approximately 15% in group F (62.7+/-14.1) compared with group C (72.7+/-13.6; Kruskal-Wallis test: p<0.05). Both devices resulted safe and efficient. The only advantage observed was a significant reduction operation time when using Harmonic Foscus curved shears compared to the other techniques.
Collapse
|
44
|
28 PRELIMINARY ONCOLOGIC OUTCOME OF LAPAROSCOPIC ADRENALECTOMY FOR ISOLATED ADRENAL METASTASIS. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
45
|
Mannose-binding lectin-low genotypes are associated with milder systemic and immunological disease expression in primary Sjogren's syndrome. Rheumatology (Oxford) 2008; 48:65-9. [DOI: 10.1093/rheumatology/ken411] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
|
46
|
[Preliminary results in the use of a new composite prosthesis in incisional hernia repair]. G Chir 2007; 28:446-450. [PMID: 18035015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The repair of incisional hernias with the use of prosthetic biomaterials is the standard of care today. There are different prosthetic biomaterials that can be used to repair incisional hernias. These materials can be divided into products that are single component or a combination. Incisional hernia repair using the intraperitoneal implantation of a prosthesis requires mesh with impervious properties. This is preliminary study with a new composite non resorbable mesh in polyethylene terephthalate-polyurethane (HI-TEX PARP MP) used for incisional hernia repair in intraperitoneal implantation. This mesh has one permeable side in polyethylene terephthalate (PET) for rapid tissue fixation and another side in polyurethane (PEU), hydrophobic in order to avoid cell penetration. This is a preliminary study of medical records of 24 patients (17 women and 7 men) in whom intraperitoneal placement of composite prosthetics in polyethylene terephthalate-polyurethane (HI-TEX PARP MP) was used between September 2004 and September 2006. The incisional hernias were recurrent in 8 patients. The underside of the mesh was placed in direct contact with the visceral peritoneum, whereas the upper side made contact with the subcutaneous tissue. No intraoperative complications occurred. Postoperatively, 1 had seromas, 1 had phlegmon of the wound without removing prosthetics. There was 1 death but not dependent of the surgical performance. The follow-up, was 12 months (range 1 month-2 years); none had discomfort; only one patient had recurrence. Intraperitoneal placement of HI-TEX PARP MP has several advantages over other techniques including minimal adhesions, a decreased risk of infection and recurrences. In addition this mesh is more economics than the other prosthetics in use.
Collapse
|
47
|
Predicting adverse outcomes in primary Sjogren's syndrome: identification of prognostic factors. Rheumatology (Oxford) 2007; 46:1359-62. [PMID: 17569749 DOI: 10.1093/rheumatology/kem079] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To identify features present at diagnosis that were prospectively associated with adverse outcomes in a large cohort of patients with primary Sjögren's syndrome (SS). METHODS Two hundred and sixty-six patients diagnosed with primary SS in our department between 1984 and 2002 were consecutively included and followed up. Outcomes measured were vasculitis, B-cell lymphoma and death. Cox regression analysis was used to evaluate the effect of variables at diagnosis on outcomes. RESULTS Twenty-five (9%) patients developed vasculitis. Multivariate analysis identified parotid scintigraphy grades III or IV (HR 3.55, P = 0.05) and C4 levels <0.11 g/l (HR 8.26, P < 0.001) as variables predicting the development of vasculitis. Nine (3%) patients developed B-cell lymphoma. Multivariate analysis identified C3 levels <0.82 g/l (HR 7.54, P = 0.016) as a predictive factor of lymphoma development. Twenty-five (9%) patients died during follow-up. Systemic involvement (HR 4.51, P = 0.022), vasculitis (HR 4.58, P = 0.042), C4 levels <0.11 g/l (HR 5.47, P = 0.027) and cryoglobulins (HR 4.58, P = 0.013) were independently associated with death. The presence of at least two of the above-mentioned predictive factors (parotid scintigraphy, vasculitis, hypocomplementaemia and cryoglobulinaemia) was associated with a lower survival in comparison with patients with no factor (log rank and Breslow tests <0.001). CONCLUSION The main prognostic factors for an adverse outcome identified in our cohort of patients with primary SS were vasculitis, severe involvement in parotid scintigraphy, hypocomplementaemia and/or cryoglobulins at diagnosis. Patients with at least two of these factors need a closer follow-up.
Collapse
|
48
|
Self-perceived normality in defecation habits. Dig Liver Dis 2006; 38:103-8. [PMID: 16263343 DOI: 10.1016/j.dld.2005.09.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2005] [Revised: 09/23/2005] [Accepted: 09/29/2005] [Indexed: 02/07/2023]
Abstract
BACKGROUND Available information on normal bowel habits was mainly gathered by means of telephone interviews or mailed questionnaires. AIMS We undertook a prospective study to evaluate the defecatory habits in subjects perceiving themselves as normal concerning this function. SUBJECTS AND METHODS A questionnaire (4-week diary with "yes-no" daily answers to six questions concerning bowel habits) was distributed to 204 subjects perceiving their defecation behaviour as normal. RESULTS The completed questionnaire was returned by 140 subjects. No significant differences were found between sexes or age groups for any variable, even though straining at stool and feeling of incomplete and/or difficult evacuation showed a trend to increase with age. No subject had less than three bowel movements per week or more than three per day. The percentage of symptoms linked to an abnormal defecatory behaviour was well below 10%. Fifty-five percent of subjects reported at least one parameter of abnormal functioning; the most frequent was straining at stool and the rarer was the manual manoeuvres to help defecation. CONCLUSIONS In normal subjects the prevalence of symptoms considered in Rome II criteria as part of an abnormal defecatory behaviour (in more than 25% of defecations) is well below 10%, manual manoeuvres are almost never used to help defecation, and the frequency of defecations is at least three per week.
Collapse
|
49
|
Different anal pressure profiles in patients with anal fissure. Tech Coloproctol 2005; 8:151-6; discussion 156-7. [PMID: 15654521 DOI: 10.1007/s10151-004-0079-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2002] [Accepted: 05/10/2004] [Indexed: 12/14/2022]
Abstract
BACKGROUND A consistent debate exists about the association between anal fissure and hypertonic anal canal. The aim of this study was to determine if the manometric findings in patients with chronic anal fissures varied according to the topography of the fissure. PATIENTS AND METHODS Seventy-three outpatients (52 men, 71%) with chronic anal fissures and nine healthy volunteers (5 men, 55%) were examined. Patients were classified according to the topography of the anal fissures: posterior midline (group A), anterior midline (group B), and lateral position (group C). We use computerized anorectal manometry to evaluate anal resting pressure, maximal voluntary contraction, recto-anal inhibitory reflex, rectal sensations and rectum compliance. RESULTS In Group A, the mean pressure was higher than that of controls (p<0.05), and the resting pressure 2 cm from anal verge was higher than that of other groups and controls (p<0.05). Normotonic anal canal was found in 49.1% of patients in group A, in 66% of those in group B and in 57.1% of those in group C. Four elderly patients (7%) of group A had a hypotonic anal canal. No differences were found regarding maximal voluntary contraction, recto-anal inhibitory reflex, rectal sensations and rectum compliance between patients and controls. CONCLUSIONS Patients with chronic anal fissures may have several anal pressure profiles. The anal canal is often normotonic. Fissures with hypertonic or normo-hypotonic anal canal need different therapies.
Collapse
|
50
|
Should Female Patients Undergoing Parathyroid-Sparing Total Thyroidectomy Receive Routine Prophylaxis for Transient Hypocalcemia? Am Surg 2004. [DOI: 10.1177/000313480407000615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hypocalcemia following parathyroid-sparing total thyroidectomy is frequent and can prolong hospital stay. We undertook this study to identify preoperative predictors of postoperative hypocalcemia useful in the postoperative management of these patients. We examined patients undergoing total thyroidectomy for benign disease with preservation of at least three parathyroids from January 2000 to January 2001. Low serum calcium was considered below 8.0 mg/dL. Age, gender, preoperative serum calcium, thyroid stimulating hormone (TSH), T3, T4, albumin, cholesterol, and tryglicerides were compared in patients with normal and low serum calcium level on the second postoperative day and on discharge day by using χ2 test and a model of logistic regression. Data were reported using their frequency distribution among the two groups of patients. Eighty patients, 60 females (F) and 20 males (M), underwent parathyroid-sparing total thyroidectomy. On second postoperative day, hypocalcemia occurred in 42 patients, and 56 per cent were symptomatic. Only female gender (88% F vs 12% M) ( P < 0.05) and TSH <0.27 mUI/mL (38% vs 18%) ( P < 0.05) predicted hypocalcemia. Similarly, female gender predicted hypocalcemia in a logistic regression analysis ( P < 0.05). On the day of discharge, 22 patients had low serum calcium levels, and 50 per cent were symptomatic. At this time, only TSH value <0.27 mlU/mL significantly predicted hypocalcemia (48% vs 17%) ( P < 0.05). This was confirmed in a logistic regression analysis ( P < 0.05). All but one patient (98%) eventually returned to normal serum calium levels. Despite preservation of parathyroids, transient symptomatic hypocalcemia is common after total thyroidectomy. Female gender and low TSH serum level predicted hypocalcemia. Therefore, female patients undergoing total thyroidectomy with preoperative low TSH levels should receive calcium prophylaxis to decrease morbidity, shorten hospital stay, and decrease costs.
Collapse
|