1
|
Genet SAAM, Visser E, Youssef-El Soud M, Belderbos HNA, Stege G, de Saegher MEA, Westeinde SCV', Brunsveld L, Broeren MAC, van de Kerkhof D, Eduati F, van den Borne BEEM, Scharnhorst V. Strengths and challenges in current lung cancer care: Timeliness and diagnostic procedures in six Dutch hospitals. Lung Cancer 2024; 189:107477. [PMID: 38271919 DOI: 10.1016/j.lungcan.2024.107477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVES Timely diagnosis of lung cancer (LC) is crucial to achieve optimal patient care and outcome. Moreover, the number of procedures required to obtain a definitive diagnosis can have a large influence on the life expectancy of a patient. Here, adherence with existing Dutch guidelines for timeliness and type and number of invasive and imaging procedures was assessed. MATERIALS AND METHODS 1096 patients with suspected LC were enrolled in this multicenter prospective study (NL9146). The overall survival, time from referral to the first appointment with the pulmonologist, time to diagnosis and treatment, and the number of imaging and invasive procedures were evaluated. Patients were divided into different diagnostic groupsearly- and advanced stage non-small-cell lung cancer (NSCLC), small-cell lung cancer (SCLC), large cell neuroendocrine carcinoma of the lung (LCNEC), patients without LC and patients without a definitive diagnosis. RESULTS The majority of patients (66 %) received a definitive diagnosis within 5 weeks, although the time to diagnosis of early-stage LC patients and patients without LC was significantly longer comparted to advanced stage LC. An increase in invasive procedures was seen for early-stage LC compared to advanced stage LC and for 13 % of the advanced stage non-squamous NSCLC patients up to three additional invasive procedures were performed solely to obtain sufficient material for NGS. For patients without a definitive diagnosis, 50 % did undergo at least one invasive procedure, while 11 % did not wish to undergo any invasive procedures. CONCLUSION These insights could aid in improved LC diagnostics and efficient implementation of new techniques like liquid biopsy and artificial intelligence. This may lead to more timely LC care, a decreased number of invasive procedures, less variability between the diagnostic trajectory of different patients and aid in obtaining a definitive diagnosis for all patients.
Collapse
Affiliation(s)
- Sylvia A A M Genet
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, The Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Esther Visser
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Máxima Medical Center, Eindhoven/Veldhoven, The Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, The Netherlands
| | | | | | | | | | | | - Luc Brunsveld
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, The Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Maarten A C Broeren
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Máxima Medical Center, Eindhoven/Veldhoven, The Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, The Netherlands
| | - Daan van de Kerkhof
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, The Netherlands
| | - Federica Eduati
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, The Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands; Eindhoven Artificial Intelligence Systems Institute, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | - Volkher Scharnhorst
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, The Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands; Eindhoven Artificial Intelligence Systems Institute, Eindhoven University of Technology, Eindhoven, The Netherlands.
| |
Collapse
|
2
|
Grasso G, Teresi G, Noto M, Torregrossa F. Invasive Preoperative Investigations in Idiopathic Normal Pressure Hydrocephalus: A Comprehensive Review. World Neurosurg 2024; 181:178-183. [PMID: 37939878 DOI: 10.1016/j.wneu.2023.10.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023]
Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is a neurological disorder characterized by the triad of gait disturbance, cognitive impairment, and urinary incontinence. The condition is diagnosed mainly in older adults and is associated with ventricular enlargement without an increase in cerebrospinal fluid pressure. The clinical assessment involves a detailed medical history, physical examination, and cognitive testing. Neuroimaging is an essential part of the diagnostic workup for iNPH. However, to determine the suitability of patients for shunt surgery, a range of invasive preoperative investigations are employed. This narrative review aims to provide a comprehensive analysis of the current literature on invasive preoperative investigations in iNPH, focusing primarily on the lumbar infusion test, cerebrospinal fluid drainage tests, and continuous intracranial pressure monitoring. The strengths and limitations of each method, as well as their potential impact on treatment outcomes, are discussed.
Collapse
Affiliation(s)
- Giovanni Grasso
- Department of Biomedicine, Neurosurgical Unit, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy.
| | - Gaia Teresi
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Manfredi Noto
- Department of Biomedicine, Neurosurgical Unit, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Fabio Torregrossa
- Department of Biomedicine, Neurosurgical Unit, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| |
Collapse
|
3
|
Matthes A, Wolf F, Schmiemann G, Gágyor I, Bleidorn J, Markwart R. Point-of-care laboratory testing in primary care: utilization, limitations and perspectives of general practitioners in Germany. BMC Prim Care 2023; 24:96. [PMID: 37038122 PMCID: PMC10088261 DOI: 10.1186/s12875-023-02054-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/03/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Due to their fast turnaround time and user-friendliness, point-of-care tests (POCTs) possess a great potential in primary care. The purpose of the study was to assess general practitioners' (GPs) perspectives on POCT use in German primary care, including utilization, limitations and requirements. METHODS We conducted a cross-sectional survey study among GPs in Germany (federal states of Thuringia, Bremen and Bavaria (Lower Franconia), study period: 04/22-06/2022). RESULTS From 2,014 GPs reached, 292 participated in our study (response rate: 14.5%). The median number of POCTs used per GP was 7.0 (IQR: 5.0-8.0). Six POCTs are used by the majority of surveyed GPs (> 50%): urine dipstick tests (99%), glucose (urine [91%] and plasma [69%]), SARS-CoV-2 (80%), urine microalbumin (77%), troponin I/T (74%) and prothrombin time / international normalized ratio (65%). The number of utilized POCTs did not differ between GP practice type (p = 0.307) and population size of GP practice location (p = 0.099). The great majority of participating German GPs (93%) rated POCTs as useful diagnostic tools in the GP practice. GPs ranked immediate decisions on patient management and the increase in diagnostic certainty as the most important reasons for performing POCTs. The most frequently reported limitations of POCT use in the GP practice were economic aspects (high costs and inadequate reimbursement), concerns regarding diagnostic accuracy, and difficulties to integrate POCT-testing into practice routines (e.g. time and personnel expenses). CONCLUSION Although participating German GPs generally perceive POCTs as useful diagnostic tools and numerous POCTs are available, several test-related and contextual factors contribute to the relatively low utilization of POCTs in primary care.
Collapse
Affiliation(s)
- Anni Matthes
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany
- InfectoGnostics Research Campus Jena, Jena, Germany
| | - Florian Wolf
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Guido Schmiemann
- Institute for Public Health and Nursing Sciences, Department for Health Services Research, Bremen University, Bremen, Germany
| | - Ildikó Gágyor
- Department of General Practice, University Hospital Wuerzburg, Würzburg, Germany
| | - Jutta Bleidorn
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Robby Markwart
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany.
- InfectoGnostics Research Campus Jena, Jena, Germany.
| |
Collapse
|
4
|
Wiśniewska K, Wolski J, Gaffke L, Cyske Z, Pierzynowska K, Węgrzyn G. Misdiagnosis in mucopolysaccharidoses. J Appl Genet 2022; 63:475-495. [PMID: 35562626 DOI: 10.1007/s13353-022-00703-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 02/05/2023]
Abstract
Mucopolysaccharidosis (MPS) is a group of 13 hereditary metabolic diseases identified in humans (or 14 diseases if considering one MPS type described to date only in mice) in which an enzymatic defect results in the accumulation of glycosaminoglycans (GAG) in the lysosomes of cells. First of all, as a result of GAG storage, the proper functioning of the lysosome is disturbed; then, the cells, and finally, tissue, organs, and the whole organism malfunctions are observed. Due to the rarity, heterogeneity, and multi-systemic and progressive nature of MPS, they present a major diagnostic challenge. Due to the wide variation in symptoms and their similarity to other diseases, MPS is often misdiagnosed, usually as neurological diseases (like autism spectrum disorders, psychomotor hyperactivity, and intellectual disability) or rheumatology and orthopedic disorders (like juvenile idiopathic arthritis, Perthes disease, rickets, and muscular dystrophy). In this review article, we present the problems associated with the possibility of misdiagnosing MPS, discuss what diseases they can be confused with, and suggest ways to reduce these problems in the future.
Collapse
Affiliation(s)
- Karolina Wiśniewska
- Department of Molecular Biology, Faculty of Biology, University of Gdańsk, Wita Stwosza 59, 80-308, Gdańsk, Poland
| | - Jakub Wolski
- Psychiatry Ward, 7th Navy Hospital in Gdańsk, Polanki 117, 80-305, Gdańsk, Poland
| | - Lidia Gaffke
- Department of Molecular Biology, Faculty of Biology, University of Gdańsk, Wita Stwosza 59, 80-308, Gdańsk, Poland
| | - Zuzanna Cyske
- Department of Molecular Biology, Faculty of Biology, University of Gdańsk, Wita Stwosza 59, 80-308, Gdańsk, Poland
| | - Karolina Pierzynowska
- Department of Molecular Biology, Faculty of Biology, University of Gdańsk, Wita Stwosza 59, 80-308, Gdańsk, Poland
| | - Grzegorz Węgrzyn
- Department of Molecular Biology, Faculty of Biology, University of Gdańsk, Wita Stwosza 59, 80-308, Gdańsk, Poland.
| |
Collapse
|
5
|
Mallik A, Das N, Mukherjee S, Datta S. A systematic review and meta-analysis of different diagnostic procedures to detect gonococcus infection in resource-limited scenario. Indian J Med Microbiol 2020; 38:299-306. [PMID: 33154239 DOI: 10.4103/ijmm.ijmm_20_312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Context Neisseria gonorrhoeae is a Gram-negative diplococcus, an obligate human pathogen, and the etiologic agent of the sexually transmitted infection (STI), gonorrhoea. culture is the standard procedure for diagnosis, which may be supported by nucleic acid tests and microscopy. Aims To determine the best possible method of diagnosis for Gonococcus infection in resource-limited settings. Settings and Design The meta-analyses were designed to determine the difference in diagnosis between Culture and nucleic acid amplification tests (NAATs) and also between the different Amplification Tests and widely available Roche COBAS AMPLICOR test. Subjects and Methods Databases searched were Pubmed, Medline, Google Scholar and Cochrane reviews. Risk ratio (RR) with 95% confidence intervals was estimated for the dichotomous outcomes. The random-effect model was applied for all the studies in the analysis. Statistical Analysis Used The meta-analysis was computed in RevMan Version 5.3, Copenhagen, Denmark. Results In the first analysis, NAATs significantly improved the chances of detection in comparison to the standard culture and final RR was 1.24 (1.05-2.51), which put the diamond on the right of no-effect axis, indicating more positives by NAATs. In the second analysis, AMPLICOR had the more positive results, which may have indicated better detection rate, as well as less specificity and final RR was 0.809 (0.737-0.888), which put the diamond on the left of the non-effect axis, indicating more positives by AMPLICOR. Conclusions In a resource-limited scenario like India, the syndromic management of STIs are considered to be the norm. A positive diagnosis is only given if the tests are confirmed by Culture, as it is still considered to be the gold standard of diagnosis. However, in many cases, due to suboptimal transportation and lack of proper handling, culture in unable to grow even if the patient is infected. In such cases, Nucleic Acid Tests should be able to detect an infection.
Collapse
Affiliation(s)
- Aromita Mallik
- Department of Biotechnology, Amity University, Kolkata, West Bengal, India
| | - Nibedita Das
- Regional STI Laboratory, Institute of Serology, Kolkata, West Bengal, India
| | - Swati Mukherjee
- Regional STI Laboratory, Institute of Serology, Kolkata, West Bengal, India
| | - Shibani Datta
- Department of Health Promotion and Education, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India
| |
Collapse
|
6
|
Sauer H, Lobenhofer M, Abdul-Khaliq H. Analgosedation for diagnostic and interventional procedures: a countrywide survey of pediatric centers in Germany. Ital J Pediatr 2020; 46:14. [PMID: 32014023 PMCID: PMC6998146 DOI: 10.1186/s13052-020-0783-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/29/2020] [Indexed: 11/15/2022] Open
Abstract
Background As more and more diagnostic and interventional options are becoming available for use in pediatric patients, techniques of procedural sedation analgesia (PSA) are being administered in considerably growing numbers as well. Aims The objective of this research effort was to conduct the first countrywide survey on the status quo of sedation analgesia as delivered to children and adolescents in Germany. Methods We dispatched letters to all pediatric hospital settings in Germany (n = 305), including a questionnaire that had been developed with existing guidelines taken into account. Its items were designed to elucidate the current practice of PSA throughout these pediatric centers regarding (a) organizational structures and (b) standards of medication and staffing. Results A total of 138 centers returned the questionnaire, hence the response rate was 45.2%. Numerous centers had implemented adequate structures and staffing standards. Deficits were nevertheless identified, most notably in terms of on-location equipment and staff provided to deliver sedations. Essential items of equipment were not provided in up to 26.8% of centers. Adequate staffing was not provided in up to 44.2% of centers, depending on the diagnostic or interventional procedures for which the PSA was delivered. The most widely used sedative agents were midazolam, ketamine/esketamine, and propofol. Conclusions Adequate care structures for the management of procedural sedation analgesia have been implemented by many pediatric centers in Germany. On the downside, these findings also reveal deficits that will take efforts to be eliminated.
Collapse
Affiliation(s)
- Harald Sauer
- Department of Pediatric Cardiology, University Hospital of Saarland, Kirrberger Strasse, Building 9, 66421, Homburg (Saar), Germany.
| | - Marie Lobenhofer
- Department of Gynecology, St. Theresa Hospital Nuremberg, Nuremberg, Germany
| | - Hashim Abdul-Khaliq
- Department of Pediatric Cardiology, University Hospital of Saarland, Kirrberger Strasse, Building 9, 66421, Homburg (Saar), Germany
| |
Collapse
|
7
|
Vlasák A, Skalický P, Mládek A, Vrána J, Beneš V, Bradáč O. Structural volumetry in NPH diagnostics and treatment-future or dead end? Neurosurg Rev 2020; 44:503-514. [PMID: 31980974 DOI: 10.1007/s10143-020-01245-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/23/2019] [Accepted: 01/15/2020] [Indexed: 12/18/2022]
Abstract
To assess automated volumetric analysis as a potential presurgical diagnostic tool or as a method to potentially shed light on normal pressure hydrocephalus (NPH) pathophysiology. MRI imaging according to our protocol was performed in 29 NPH patients, 45 non-NPH (but suspected) patients and 15 controls. Twenty patients underwent a second MRI 3 months after ventriculoperitoneal (VP) shunt surgery. All structures relevant to NPH diagnosis were automatically segmented using commercial software. The results were subsequently tested using ANOVA analysis. Significant differences in the volumes of the corpus callosum, left hippocampus, internal globus pallidus, grey and white matter and ventricular volumes were observed between NPH group and healthy controls. However, the differences between NPH and non-NPH groups were non-significant. Three months after, VP shunt insertion decreased ventricular volume was the only clearly significant result (p value 0.0001). Even though a detailed volumetric study shows several significant differences, volumetric analysis as a standalone method does not provide a simple diagnostic biomarker, nor does it shed a light on an unknown NPH aetiology.
Collapse
Affiliation(s)
- Aleš Vlasák
- Department of Neurosurgery and Neurooncology, Military University Hospital and Charles University, First Medical Faculty, U Vojenské nemocnice 1200/1, 162 00, Prague 6, Czech Republic
| | - Petr Skalický
- Department of Neurosurgery and Neurooncology, Military University Hospital and Charles University, First Medical Faculty, U Vojenské nemocnice 1200/1, 162 00, Prague 6, Czech Republic
| | - Arnošt Mládek
- Department of Neurosurgery and Neurooncology, Military University Hospital and Charles University, First Medical Faculty, U Vojenské nemocnice 1200/1, 162 00, Prague 6, Czech Republic.,Department of Cognitive Systems and Neurosciences, Czech Institute of Informatics, Robotics, and Cybernetics, Czech Technical University, Prague, Czech Republic
| | - Jiří Vrána
- Department of Radiology, Military University Hospital, Prague, Czech Republic
| | - Vladimír Beneš
- Department of Neurosurgery and Neurooncology, Military University Hospital and Charles University, First Medical Faculty, U Vojenské nemocnice 1200/1, 162 00, Prague 6, Czech Republic
| | - Ondřej Bradáč
- Department of Neurosurgery and Neurooncology, Military University Hospital and Charles University, First Medical Faculty, U Vojenské nemocnice 1200/1, 162 00, Prague 6, Czech Republic.
| |
Collapse
|
8
|
Abstract
The new regulations of the German Federal Medical Chamber for the specialization in urology have been published in November 2018 and can now be transferred into official regulations by the different Medical Chambers of the German Länder. The new concept consists of different subjects which are each subdivided into different levels of competence. Required numbers for procedures have been kept to a minimum as the emphasis is on everyday procedures of outpatient urology. The scope of urology is well represented and all subspecialities have been incorporated with their basic contents. Higher qualifications in certain subspecialities are available.
Collapse
Affiliation(s)
- Oliver W Hakenberg
- Klinik und Poliklinik für Urologie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland.
| |
Collapse
|
9
|
Witzel I, Laakmann E, Weide R, Neunhöffer T, Park-Simon TJ, Schmidt M, Fasching PA, Hesse T, Polasik A, Mohrmann S, Würschmidt F, Schem C, Bechtner C, Würstlein R, Fehm T, Möbus V, Burchardi N, Loibl S, Müller V. Treatment and outcomes of patients in the Brain Metastases in Breast Cancer Network Registry. Eur J Cancer 2018; 102:1-9. [PMID: 30099223 DOI: 10.1016/j.ejca.2018.07.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 07/03/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Brain metastases (BMs) have a major impact on life expectancy and quality of life for many breast cancer patients. Knowledge about treatment patterns and outcomes is limited. METHODS We analysed clinical data of 1712 patients diagnosed with BMs from breast cancer between January 2000 and December 2016 at 80 institutions. RESULTS Median age at diagnosis of BMs was 56 years (22-90 years). About 47.8% (n = 732) of patients had HER2-positive, 21.4% (n = 328) had triple-negative and 30.8% (n = 471) had hormone receptor (HR)-positive, HER2-negative (luminal-like) primary tumours. The proportion of patients with HER2-positive BMs decreased comparing the years 2000-2009 with 2010-2015 (51%-44%), whereas the percentage of patients with luminal-like tumours increased (28%-34%; p = 0.0331). Patients with BMs in the posterior fossa were more often HER2 positive (n = 169/314, 53.8%) than those diagnosed with triple-negative (n = 65/314, 20.7%) or luminal-like primary breast cancer (n = 80/314, 25.5%), (p < 0.0001). Median overall survival (OS) time after development of BMs for the overall cohort was 7.4 months (95% confidence interval [CI]: 6.7-8.0 months). One-year survival rate was 37.7% (95% CI: 35.2-40.1). Patients with HER2-positive tumours had the longest median OS of 11.6 months (95% CI: 10.0-13.4) compared with 5.9 months (95% CI: 5.0-7.2) for patients with luminal-like and 4.6 months (95% CI: 3.9-5.4) for patients with triple-negative tumours. Patients with HER2-positive tumours who received anti-HER2 treatment had longer median OS than those without (17.1 months versus 7.2 months, p < 0.0001). CONCLUSIONS Prognosis of patients after developing BMs varies significantly according to the subtype. The outcome in this cohort is similarly poor in triple-negative and HR-positive/HER2-negative patients. Our results underline the high medical need for improvement of treatment and prevention strategies for BMs in breast cancer patients.
Collapse
Affiliation(s)
- I Witzel
- University Medical Center Hamburg-Eppendorf, Department of Gynecology, Hamburg, Germany.
| | - E Laakmann
- University Medical Center Hamburg-Eppendorf, Department of Gynecology, Hamburg, Germany.
| | - R Weide
- Oncological Outpatient Department, Koblenz, Germany.
| | - T Neunhöffer
- HELIOS Dr. Horst Schmidt Clinic Wiesbaden, Wiesbaden, Germany.
| | - T-J Park-Simon
- Hannover Medical School, Department of Gynecology, Hannover, Germany.
| | - M Schmidt
- Department of Gynecology, University Medical Center of the Johannes Gutenberg University Mainz, Germany.
| | - P A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
| | - T Hesse
- Agaplesion Diakonie Clinic Rotenburg, Department of Gynecology, Rotenburg, Germany.
| | - A Polasik
- Department of Gynecology and Obstetrics, University Medical Center Ulm, Germany.
| | - S Mohrmann
- Duesseldorf University Hospital, Department of Gynecology, Duesseldorf, Germany.
| | - F Würschmidt
- Radiologische Allianz Hamburg, Hamburg, Germany.
| | - C Schem
- University Medical Center-UKSH, Department of Gynecology, Kiel, Germany; Mammazentrum, Krankenhaus Jerusalem, Hamburg, Germany.
| | - C Bechtner
- Frauenklinik, Memmingen Hospital, Germany.
| | - R Würstlein
- Department of Gynecology and Obstetrics, Ludwig-Maximilian-University Munich, Germany.
| | - T Fehm
- Translational Research Board of the Gynecological Oncology Working Group (AGO-Trafo), Germany.
| | - V Möbus
- Breast Study Group of the Gynecological Oncology Working Group (AGO-B), Germany.
| | - N Burchardi
- German Breast Group GmbH, Neu-Isenburg, Germany.
| | - S Loibl
- German Breast Group GmbH, Neu-Isenburg, Germany.
| | - V Müller
- University Medical Center Hamburg-Eppendorf, Department of Gynecology, Hamburg, Germany.
| |
Collapse
|
10
|
Massa I, Balzi W, Altini M, Bertè R, Bosco M, Cassinelli D, Vignola V, Cavanna L, Foca F, Dall'Agata M, Nanni O, Rossi R, Maltoni M. The challenge of sustainability in healthcare systems: frequency and cost of diagnostic procedures in end-of-life cancer patients. Support Care Cancer 2018; 26:2201-2208. [PMID: 29387995 PMCID: PMC5982433 DOI: 10.1007/s00520-018-4067-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 01/22/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Literature data on the overuse and misuse of diagnostic procedures leading to end-of-life aggressiveness are scarce due to the limited amount of estimated economic waste. This study investigated the potential overuse of diagnostic procedures in a population of end-of-life patients. METHODS This is a retrospective study on consecutive advanced patients admitted into two Italian hospices. Frequency and relative costs of X-ray imaging, CT scans, MRI, and interventional procedures prescribed in the 3 months before admission were collected in patient electronic charts and/or in administrative databases. We conducted a deeper analysis of 83 cancer patients with a diagnosis of at least 1 year before admission to compare the number of examinations performed at two distant time periods. RESULTS Out of 541 patients, 463 (85.6%) had at least one radiological exam in the 3 months before last admission. The mean radiological exam number was 3.9 ± 3.2 with a relative mean cost of 278.60 ± 270.20 € per patient with a statistically significant (p < 0.001) rise near death. In the 86-patient group, a higher number of procedures was performed in the last 3 months of life than in the first quarter of the year preceding last admission (38.43 ± 28.62 vs. 27.95 ± 23.21, p < 0.001) with a consequent increase in cost. CONCLUSIONS Patients nearing death are subjected to a high level of "diagnostic aggressiveness." Further studies on the integration of palliative care into the healthcare pathway could impact the appropriateness of interventions, quality of care, and, ultimately, estimated costs.
Collapse
Affiliation(s)
- Ilaria Massa
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli 40, 47014, Meldola, Italy.
| | - William Balzi
- Healthcare Administration, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli 40, 47014, Meldola, Italy
| | - Mattia Altini
- Healthcare Administration, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli 40, 47014, Meldola, Italy
| | - Raffaella Bertè
- Palliative Care Unit, Department of Oncology and Hematology, Guglielmo da Saliceto Hospital, Via Taverna 49, 29100, Piacenza, Italy
| | - Monica Bosco
- Palliative Care Unit, Department of Oncology and Hematology, Guglielmo da Saliceto Hospital, Via Taverna 49, 29100, Piacenza, Italy
| | - Davide Cassinelli
- Palliative Care Unit, Department of Oncology and Hematology, Guglielmo da Saliceto Hospital, Via Taverna 49, 29100, Piacenza, Italy
| | - Valentina Vignola
- Palliative Care Unit, Department of Oncology and Hematology, Guglielmo da Saliceto Hospital, Via Taverna 49, 29100, Piacenza, Italy
| | - Luigi Cavanna
- Department of Oncology and Hematology, Guglielmo da Saliceto Hospital, Via Taverna 49, 29100, Piacenza, Italy
| | - Flavia Foca
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli 40, 47014, Meldola, Italy
| | - Monia Dall'Agata
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli 40, 47014, Meldola, Italy
| | - Oriana Nanni
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli 40, 47014, Meldola, Italy
| | - Romina Rossi
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli 40, 47014, Meldola, Italy
| | - Marco Maltoni
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli 40, 47014, Meldola, Italy.,Palliative Care Unit, Valerio Grassi Hospice, Forlimpopoli Hospital, Via Duca D'Aosta 33, 47034, Forlimpopoli, Italy
| |
Collapse
|
11
|
Arafa MA, Farhat KH. Recent diagnostic procedures for colorectal cancer screening: Are they cost-effective? Arab J Gastroenterol 2017; 18:136-139. [PMID: 28988790 DOI: 10.1016/j.ajg.2017.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 05/27/2017] [Indexed: 12/28/2022]
Abstract
Colorectal cancer (CRC) is the third most common cancer worldwide and the fourth most common cause of death. Reduction in mortality rates in some countries worldwide are most likely ascribed to CRC screening and/or improved treatments. We reviewed the most relevant articles which discuss the cost-effectiveness of colorectal cancer screening procedures, in particular, the recent ones through the last eight years. The effectiveness of screening estimated by discounted life years gained (LYGs) compared to no screening, differed considerably between the studies. Despite these differences, all studies consistently emphasized that screening for CRC was cost-effective compared with no screening for each of the recognized screening strategies. Newer technologies for colorectal cancer screening, including computed tomographic colonography (CTC), faecal DNA test, and Pillcam Colon are less invasive and accurate, however, they are not cost-effective, as their cost was higher than all other established screening strategies. When compliance and adherence to such new techniques are increased more than the established strategies they would be more cost-effective particularly CTC.
Collapse
Affiliation(s)
- Mostafa Ahmed Arafa
- Cancer Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Karim Hamda Farhat
- Cancer Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| |
Collapse
|
12
|
Lachaud L, Gangneux JP. [Mycological and parasitological examinations in the management of lung infections]. Rev Mal Respir 2017; 34:1114-1123. [PMID: 28918972 DOI: 10.1016/j.rmr.2017.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 02/13/2017] [Indexed: 10/18/2022]
Abstract
Pulmonary parasitic diseases are rare whereas pulmonary fungal infections are increasing. The diversity of clinical presentations requires laboratory tests to confirm the diagnosis. Direct examination of lung samples and antibody detection are the basis of parasitological diagnosis. With regard to mycoses, the range of biological tests is broader. The conventional mycological examination allows identification of any type of fungus except Pneumocystis jirovecii. Its specificity is excellent but it lacks sensitivity. Detection of antibodies, antigens or nucleic acid complements the diagnostic tools. With regard to aspergillosis, there is a broad nosological set with variable prognosis. The choice of appropriate laboratory procedures depends on the clinical presentation and patient risk factors. The search for galactomannan antigen is effective and a new technique, "Lateral Flow Device", seems very promising. The detection of antibodies is also informative but various techniques are used. A good knowledge of the performance and limitations of these techniques allows targeted prescription. The use of PCR for the diagnosis of pulmonary fungal infections has limited indications. Biological and clinical co-operation is essential for the choice and interpretation of laboratory tests for parasitic or fungal pulmonary disease.
Collapse
Affiliation(s)
- L Lachaud
- Laboratoire de parasitologie-mycologie, faculté de médecine de Montpellier-Nîmes, CHU de Montpellier, 39, avenue Charles-Flahault, 34295 Montpellier cedex 5, France.
| | - J P Gangneux
- Laboratoire de parasitologie-mycologie, CHU Pontchaillou, 2, rue Henri-Le-Guillou, 35033 Rennes cedex 09, France
| |
Collapse
|
13
|
Uozumi M, Sanui M, Komuro T, Iizuka Y, Kamio T, Koyama H, Mouri H, Masuyama T, Ono K, Lefor AK. Interruption of enteral nutrition in the intensive care unit: a single-center survey. J Intensive Care 2017; 5:52. [PMID: 28794882 PMCID: PMC5545034 DOI: 10.1186/s40560-017-0245-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 07/17/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Interruption of enteral nutrition (EN) in the intensive care unit (ICU) occurs frequently for various reasons including feeding intolerance and the conduct of diagnostic and therapeutic procedures. However, few studies have investigated the details of EN interruption practices including reasons for and duration of interruptions. There is no standard protocol to minimize EN interruptions. METHODS This is a retrospective review of 100 patients in the ICU staying more than 72 h and receiving EN in a 12-bed, medical/surgical ICU in a tertiary care center in 2013. Data collected include total time designated for EN; the number of EN interruption episodes; reason for each interruption categorized as diagnostic study, therapeutic intervention, or gastrointestinal (GI) event, and their individual subcategories; duration of each interruption; and the presence of written orders for interruptions. RESULTS One hundred patients staying in the ICU for at least 72 h and receiving EN were included. There were 567 episodes of EN interruption over a median ICU length of stay of 17.1 (interquartile range 8.0-22.0) days. There were a median of three EN interruption episodes per patient. EN interruption was performed for undetermined reasons (166 episodes, 29%), airway manipulation (103 episodes, 18%), GI events (78 episodes, 14%), and intermittent dialysis (71 episodes, 13%). Median duration of EN interruption in all patients was 5.5 (3.0-10.0) h. The cumulative interruption time corresponds to 19% of the total time designated for EN. Duration of EN interruption varied according to reason, including airway manipulation (9.0 [5.0-21.0] h), tracheostomy (9.5 [7.5-14.0] h), and GI events (6.5 [3.0-14.0] h). The average calorie deficits due to interruptions were 11.5% of daily target calories. Only 60 episodes (12%) had clear written orders for interruption. CONCLUSIONS Based on this single-center retrospective chart review, interruption of EN in the ICU is frequent, reasons for and duration of interruption varied, and airway procedures are associated with a relatively longer duration of interruption. Documentation and orders were frequently missing. These results warrant development of a protocol for EN interruption.
Collapse
Affiliation(s)
- Midori Uozumi
- Emergency and Critical Care Medicine, Dokkyo Medical University, Mibumachi, Shimotsuga-gun, Tochigi, Japan
| | - Masamitsu Sanui
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiya-ku, Saitama-shi, Saitama, 330-8503 Japan
| | - Tetsuya Komuro
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiya-ku, Saitama-shi, Saitama, 330-8503 Japan
| | - Yusuke Iizuka
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiya-ku, Saitama-shi, Saitama, 330-8503 Japan
| | - Tadashi Kamio
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiya-ku, Saitama-shi, Saitama, 330-8503 Japan
| | - Hiroshi Koyama
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiya-ku, Saitama-shi, Saitama, 330-8503 Japan
| | - Hideyuki Mouri
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiya-ku, Saitama-shi, Saitama, 330-8503 Japan
| | - Tomoyuki Masuyama
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiya-ku, Saitama-shi, Saitama, 330-8503 Japan
| | - Kazuyuki Ono
- Emergency and Critical Care Medicine, Dokkyo Medical University, Mibumachi, Shimotsuga-gun, Tochigi, Japan
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi 329-0498 Japan
| |
Collapse
|
14
|
Riccabona M, Lobo ML, Ording-Muller LS, Thomas Augdal A, Fred Avni E, Blickman J, Bruno C, Damasio B, Darge K, Ntoulia A, Papadopoulou F, Vivier PH. European Society of Paediatric Radiology abdominal imaging task force recommendations in paediatric uroradiology, part IX: Imaging in anorectal and cloacal malformation, imaging in childhood ovarian torsion, and efforts in standardising paediatric uroradiology terminology. Pediatr Radiol 2017; 47:1369-1380. [PMID: 28852767 PMCID: PMC5574969 DOI: 10.1007/s00247-017-3837-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 12/18/2016] [Accepted: 03/09/2017] [Indexed: 12/21/2022]
Abstract
At the occasion of the European Society of Paediatric Radiology (ESPR) annual meeting 2015 in Graz, Austria, the newly termed ESPR abdominal (gastrointestinal and genitourinary) imaging task force set out to complete the suggestions for paediatric urogenital imaging and procedural recommendations. Some of the last missing topics were addressed and proposals on imaging of children with anorectal and cloacal malformations and suspected ovarian torsion were issued after intense discussions and a consensus finding process that considered all evidence. Additionally, the terminology was adapted to fit new developments introducing the term pelvicalyceal dilatation/distension (PCD) instead of the sometimes misunderstood hydronephrosis. The present state of paediatric urogenital radiology was discussed in a dedicated minisymposium, including an attempt to adapt terminology to create a standardised glossary.
Collapse
Affiliation(s)
- Michael Riccabona
- Department of Radiology, Division of Pediatric Radiology, University Hospital LKH Graz, Auenbruggerplatz 34, A-8036, Graz, Austria.
| | - Maria-Luisa Lobo
- 0000 0001 2295 9747grid.411265.5Department of Radiology, Hospital de Santa Maria-CHLN, University Hospital, Lisbon, Portugal
| | - Lil-Sofie Ording-Muller
- 0000 0004 0389 8485grid.55325.34Department of Radiology and Nuclear Medicine, Unit for Paediatric Radiology, Oslo University Hospital, Oslo, Norway
| | - A. Thomas Augdal
- 0000 0004 4689 5540grid.412244.5Department of Radiology, University Hospital of North Norway, N-9038 Tromsø, Norway
| | - E. Fred Avni
- Department of Pediatric Radiology, Jeanne de Flandre Hospital, CHRU de Lille, Lille Cedex, France
| | - Johan Blickman
- grid.438870.0Department of Radiology, Golisano Children’s Hospital, Rochester, NY USA
| | - Constanza Bruno
- 0000 0004 1756 948Xgrid.411475.2Radiology Institute, Department of Radiology, AOUI, Verona, Italy
| | - Beatrice Damasio
- 0000 0004 1760 0109grid.419504.dDepartment of Radiology, G. Gaslini Institute, Genoa, Italy
| | - Kassa Darge
- Department of Radiology, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA USA
| | - Akaterina Ntoulia
- Department of Radiology, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA USA
| | | | - Pierre-Hugues Vivier
- Radiologie, Hôpital Privé de l’ Estuaire, 505 rue Irène Joliot Curie, Le Havre, France
| |
Collapse
|
15
|
Pedersen KS, Johansen M, Angen O, Jorsal SE, Nielsen JP, Jensen TK, Guedes R, Ståhl M, Bækbo P. Herd diagnosis of low pathogen diarrhoea in growing pigs - a pilot study. Ir Vet J 2014; 67:24. [PMID: 25392732 PMCID: PMC4228118 DOI: 10.1186/2046-0481-67-24] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 10/08/2014] [Indexed: 11/25/2022] Open
Abstract
Background The major indication for antibiotic use in Danish pigs is treatment of intestinal diseases post weaning. Clinical decisions on antibiotic batch medication are often based on inspection of diarrhoeic pools on the pen floor. In some of these treated diarrhoea outbreaks, intestinal pathogens can only be demonstrated in a small number of pigs within the treated group (low pathogen diarrhoea). Termination of antibiotic batch medication in herds suffering from such diarrhoea could potentially reduce the consumption of antibiotics in the pig industry. The objective of the present pilot study was to suggest criteria for herd diagnosis of low pathogen diarrhoea in growing pigs. Data previously collected from 20 Danish herds were used to create a case series of clinical diarrhoea outbreaks normally subjected to antibiotic treatment. In the present study, these diarrhoea outbreaks were classified as low pathogen (<15% of the pigs having bacterial intestinal disease) (n =5 outbreaks) or high pathogen (≥15% of the pigs having bacterial intestinal disease) (n =15 outbreaks). Based on the case series, different diagnostic procedures were explored, and criteria for herd diagnosis of low pathogen diarrhoea were suggested. The effect of sampling variation was explored by simulation. Results The diagnostic procedure with the highest combined herd-level sensitivity and specificity was qPCR testing of a pooled sample containing 20 randomly selected faecal samples. The criteria for a positive test result (high pathogen diarrhoea outbreak) were an average of 1.5 diarrhoeic faecal pools on the floor of each pen in the room under investigation and a pathogenic bacterial load ≥35,000 per gram in the faecal pool tested by qPCR. The bacterial load was the sum of Lawsonia intracellularis, Brachyspira pilosicoli and Escherichia coli F4 and F18 bacteria per gram faeces. The herd-diagnostic performance was (herd-level) diagnostic sensitivity =0.99, diagnostic specificity =0.80, positive predictive value =0.94 and negative predictive value =0.96. Conclusions The pilot study suggests criteria for herd diagnosis of low pathogen diarrhoea in growing pigs. The suggested criteria should now be evaluated, and the effect of terminating antibiotic batch medication in herds identified as suffering from low pathogen diarrhoea should be explored. Electronic supplementary material The online version of this article (doi:10.1186/2046-0481-67-24) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Ken Steen Pedersen
- Pig Research Centre, Danish Agriculture & Food Council, Axelborg, Axeltorv 3, DK-1609 Copenhagen V, Denmark
| | - Markku Johansen
- Pig Research Centre, Danish Agriculture & Food Council, Axelborg, Axeltorv 3, DK-1609 Copenhagen V, Denmark
| | - Oystein Angen
- National Veterinary Institute, Technical University of Denmark, Bülowsvej 27, 1790 Copenhagen V, Denmark
| | - Sven Erik Jorsal
- National Veterinary Institute, Technical University of Denmark, Bülowsvej 27, 1790 Copenhagen V, Denmark
| | - Jens Peter Nielsen
- HERD - Centre for Herd-oriented Education, Research and Development, Department of Large Animal Sciences, University of Copenhagen, Groennegaardsvej 2, DK-1870 Frederiksberg C, Denmark
| | - Tim K Jensen
- National Veterinary Institute, Technical University of Denmark, Bülowsvej 27, 1790 Copenhagen V, Denmark
| | - Roberto Guedes
- Department of Veterinary Clinics and Surgery, Veterinary School, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, MG 31.270-901 Brazil
| | - Marie Ståhl
- National Veterinary Institute, Technical University of Denmark, Bülowsvej 27, 1790 Copenhagen V, Denmark
| | - Poul Bækbo
- Pig Research Centre, Danish Agriculture & Food Council, Axelborg, Axeltorv 3, DK-1609 Copenhagen V, Denmark
| |
Collapse
|
16
|
Hsu CY, Chen CL, Huang WC, Lee PT, Fang HC, Chou KJ. Retrospective evaluation of standard diagnostic procedures in identification of the causes of new-onset syndrome of inappropriate antidiuresis. Int J Med Sci 2014; 11:192-8. [PMID: 24465165 PMCID: PMC3894404 DOI: 10.7150/ijms.6295] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 12/24/2013] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Many diagnostic procedures are conducted in patients with syndrome of inappropriate antidiuresis (SIAD). However, the contribution in identification of the cause of SIAD remains unknown. METHODS The study was conducted at Kaohsiung Veterans General Hospital in southern Taiwan. From January 2000 to December 2009, medical records of 439 adult patients hospitalized for new-onset SIAD at a single center were retrospectively collected. All diagnostic procedures during hospitalization were divided into four groups: chest/lung, central nervous system, abdomen, and bone marrow to evaluate their positive rate leading to the cause of SIAD. Factors associated with "procedures leading to the cause" were also analyzed to improve efficacy of survey. RESULTS Cause of SIAD was identified in 267 (60.8%). Of them, 150 were pulmonary disorders, 44 were drugs, 37 were central nervous system disorders, 32 were malignancy and 4 were post-surgery. Survey for chest/lung, central nervous system, abdomen, and bone marrow were performed in 96.6%, 29.2%, 38.0% and 3.6% of patients, respectively; positive findings leading to the cause of SIAD were 39.6%, 12.5%, 5.3% and 6.3%, respectively. Among the diagnostic procedures, chest x-ray (424/439, 96.6%) was most frequently performed with the highest identification rate of 34.7% (147 cases). Major significant independent factors that associated with "procedure leading to a cause" were: absence of SIAD-associated drug history, presence of fever/chills, and presence of respiratory symptoms. Cause of SIAD became evident later during the follow-up period in 10 of 172 (5.8%) patients who were initially thought to be cause-unknown. Malignancy was the cause for 5 cases and pulmonary tuberculosis was for the other five. Eight of these causes became evident within one year after the diagnosis of SIAD. CONCLUSIONS SIAD with unidentified causes were prevalent. Current diagnostic procedures remain not satisfying in determining the cause of SIAD, but chest radiograph did demonstrate higher diagnostic rate, especially in patients presented with fever, chills, respiratory symptoms, and without SIAD-associated drug history. Patients with unidentified cause should be followed for at least one year when most hidden causes (e.g. malignancy and tuberculosis) become obvious.
Collapse
Affiliation(s)
- Chih-Yang Hsu
- 1. Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chieh-Liang Chen
- 1. Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan ; 2. National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Wei-Chieh Huang
- 1. Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Po-Tsang Lee
- 1. Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan ; 2. National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Hua-Chang Fang
- 1. Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan ; 2. National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Kang-Ju Chou
- 1. Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan ; 2. National Yang-Ming University, School of Medicine, Taipei, Taiwan
| |
Collapse
|