45-year Experience Research Articles

Scientific approaches to preserving the health of the population in the Siberian Federal District (45-year experience of the Research Institute for Complex Problems of Hygiene and Occupational Diseases)

The article presents a retrospective of the main directions of research on the preservation of the health of the population and labor resources of the Siberian Federal District based on the long-term work of the Scientific Research Institute of Complex Problems of Hygiene and Occupational Diseases in Novokuznetsk. There is the ecological and hygienic definition and justification of optimal human life conditions; the development and implementation of methods for the prevention, treatment, and rehabilitation of occupational, production-related, and general diseases; planning the strategy of medical services and organizations in the management of healthcare, taking into account the peculiarities of population reproduction, the specifics of working conditions and socio-economic development of regions.

A 45-year experience of uveal melanoma in Taiwan: Verification of American Joint Committee on Cancer staging system and prognostic factors

To verify the staging system of the American Joint Committee on Cancer (AJCC) 8th edition for uveal melanoma, and to propose the prognostic factors of uveal melanoma by a 45-year cohort study. We collected patients who underwent operation with pathological proof from 1973 to 2017. The demographic data including gender, age, laterality, metastatic pattern, and histopathology type were recorded. The predictability for survival and monotonicity of gradients of the AJCC 8th edition were evaluated. The prognostic factors for survival were analyzed by univariate and multivariate analysis. A total of 72 patients were collected. The median age was 55 year-old (range 24-100). No specific gender predilection was revealed in our study. About 75.9% of metastases events happened in the first five-year of follow-up, and hepatic involvement was the most common. By the AJCC 8th edition, the distribution for stage I: II: III was 8 (11.1%), 37 (51.4%), and 27 (37.5%). The prognostic staging groups manifested fair predictability and monotonicity of gradients for survival outcome. The tumors with epithelioid cell type and ciliary body involvements had higher tumor-related mortality. The AJCC 8th edition prognostic staging groups for outcome prediction was validated. Periodic screening for metastases should be more frequent in the first five-year follow-up. The tumors with epithelioid cell pattern and ciliary body involvements were at risk of higher tumor-related mortality in Taiwanese patients.

Surgical Management of FGFR2 Mutation-Related Syndromic Craniosynostosis: Retrospective Review of a 45-Year Experience By a Single Surgeon

PURPOSE: Mutations in the fibroblast growth receptor 2 (FGFR2) gene have been identified in syndromic craniosynostosis syndromes such as Apert, Crouzon, and Pfeiffer syndrome. Patients have severe malformations of the skull and face requiring multiple complex reconstructive procedures. As described by Paul Tessier, surgical correction of such patients is performed for 3 main reasons: functional, morphologic, and psychological. The surgical treatment algorithm has evolved over time. Despite numerous articles describing treatment of syndromic craniosynostosis, there are few reports of long-term results. Long-term follow up of patients after midface surgeries is important for evaluating which techniques result in consistent favorable outcomes, and which should be improved. We present a retrospective review reporting surgical procedures performed by a single surgeon in patients with Apert, Crouzon, and Pfeiffer Syndrome over a period of 45 years, with the intent to delineate procedures that have been effective over time. We also present our surgical treatment algorithm for pediatric patients with FGFR2 mutation–related syndromic craniosynostosis based on the senior author’s experience. METHODS: A retrospective review was performed of all patients with FGFR2 mutation–related syndromic craniosynostosis that underwent reconstruction for craniofacial defects, as performed by the senior author between 1975 and 2020. Patients without syndromic craniosynostosis were excluded. Inclusion criteria was limited to Apert, Crouzon, and Pfeiffer syndromes. Surgical procedures and complications were recorded for patients at all stages of the reconstructive process. RESULTS: A total of 68 patients were identified who had complete records for evaluation, including 30 patients with Apert syndrome, 27 patients with Crouzon syndrome and 11 patients with Pfeiffer syndrome. The average patient age was 30±15.8 years, with a range of 3–77 years of age. Mean long-term follow-up after initial surgery was 10.5 ± 10.1 years. Primary procedures performed for correction of craniofacial deformities included posterior distraction or expansion (10.3%), frontal expansion (14.7%), fronto-orbital advancement (39.7%), facial bipartition (11.8%), Le Fort III (19.1%), and Le Fort I (23.5%). Mean ages at which procedures were performed were 1.5 ± 1.6 years for posterior distraction or expansion, 1.1 ± 1.2 years for fronto-orbital advancement, 6.2 ± 3.8 years for monobloc frontoacial advancement, 4.6 ± 1.8 years for monobloc frontofacial advancement with facial bipartition, 13.2 ± 8.2 years for Le Fort III, and 17.0 ± 3.8 years for Le Fort I. Additional procedures commonly used included nasal bone grafts (25.0%) and lateral canthopexies (19.1%). CONCLUSIONS: This study, with an extensive long-term follow-up period, presents a pediatric surgical treatment algorithm for patients with FGFR2 mutation–related syndromic craniosynostosis. Our treatment algorithm entails a posterior distraction or expansion and fronto-orbital advancement at 6 months, monobloc frontofacial advancement ± facial bipartition at age 6 or 7, or a Le Fort III if morphologically indicated, and in most cases, a Le Fort I at age 17 or 18. Although multiple reconstructive procedures are necessary, complications are rare. This treatment algorithm results in good results in adolescence, allowing patients to integrate into mainstream life. However, patients tend to prematurely age, a problem that is not addressed by the current pediatric surgical treatment algorithm. Future directions include defining aesthetic surgical management of adults.

A 45-year experience with the Fontan procedure: tachyarrhythmia, an important sign for adverse outcome

This study aims to evaluate our 45-year experience with the Fontan procedure and to identify risk factors for late mortality and morbidity. Demographic, preoperative, perioperative and postoperative characteristics were retrospectively collected for all patients who underwent a Fontan procedure in a single centre between 1972 and 2016. The study included 277 Fontan procedures (44 atriopulmonary connections, 28 Fontan-Björk, 42 lateral tunnels and 163 extracardiac conduits). Early failure occurred in 17 patients (6.1%). Median follow-up of the study cohort was 11.9 years (Q1-Q3 7.6-17.5). Longest survival estimates were 31% [95% confidence intervals (CI) 18-44%] at 35 years for atriopulmonary connection/Björk, 87% (95% CI 63-96%) at 20 years for lateral tunnel and 99% (95% CI 96-100%) at 15 years for extracardiac conduit. Estimated freedom from Fontan failure (death, heart transplant, take-down, protein-losing enteropathy, New York Heart Association III-IV) at 15 years was 65% (95% CI 52-76%) for atriopulmonary connection/Björk, 90% (95% CI 73-97%) for lateral tunnel and 90% (95% CI 82-94%) for extracardiac conduit. The development of tachyarrhythmia was an important predictor of Fontan failure [hazard ratio (HR) 2.6, 95% CI 1.2-5.8; P = 0.017], thromboembolic/neurological events (HR 3.6, 95% CI 1.4-9.4; P = 0.008) and pacemaker for sinus node dysfunction (HR 3.7, 95% CI 1.4-9.6; P = 0.008). Prolonged pleural effusion (>21 days) increased the risk of experiencing protein-losing enteropathy (HR 4.7, 95% CI 2.0-11.1; P < 0.001). With modern techniques, survival and freedom from Fontan failure are good. However, Fontan patients remain subject to general attrition. Tachyarrhythmia is an important sign for an adverse outcome. Prevention and early treatment of tachyarrhythmia may, therefore, be paramount in improving the long-term outcome.

Gender and Racial Disparities in Survival After Surgery Among Papillary and Patients With Follicular Thyroid Cancer: A 45-Year Experience.

Background:Demographic disparities have been described for survival after thyroid cancer surgery using national registries and databases. At the institution level, we hypothesized that assessing survival after thyroid cancer surgery in a long-term cohort with diverse gender and racial groups would reveal disparities in survival.Methods:We examined medical records of patients with papillary or follicular thyroid cancer undergoing thyroidectomy, lobectomy, and other surgical procedures from 1971 to 2016 at a tertiary referral center. We obtained information on demographics, cancer stage, procedure, and radioactive iodine (RAI). We measured survival using Kaplan-Meier estimates and Cox proportional hazards models.Results:A total of 1440 (91%) patients with papillary cancer and 144 (9%) patients with follicular thyroid cancer underwent total thyroidectomy (1297, 82%), lobectomy (261, 16.5%), and other surgical procedures (26, 1.5%). Most patients (1131, 71%) were woman, and 909 (57%) were older than 45 years. Race/ethnicity included 805 (51%) white, 161 (10%) African Americans, and 618 (39%) other race/ethnicities. Both 10- and 20-year survival rates in nonwhite males were worse compared with nonwhite females (P < .0001). After controlling for age, cancer type, stage, surgical procedure, RAI, and year of surgery, nonwhite males had a higher mortality risk compared with nonwhite females (P = .0376, confidence interval (CI): 1.03-2.43), white males (P < .0001, CI: 1.88-6.54), and white females (P < .0001, CI: 3.31-9.90).Conclusions:Our diverse cohort demonstrates significant gender and racial disparities in survival after thyroid cancer surgery. To improve health outcomes and reduce health disparities among nonwhite males, interventions and long-term care management should target potentially modifiable causes of worse outcomes in this group.

Forces Driving Change in the US Exercise Industry Today

In this commentary three issues for reader consideration are presented which the author believes have a dominant influence on the health fitness industry today - issues that will continue to markedly influence opportunities and performance expectations for practitioners in the years ahead. While several scholarly and opinion articles are cited, this viewpoint is rooted in the principal author's 45-year experience in developing and evaluating clinical exercise services, competency-based certification, related standards and guidelines for professional organizations, and extensive service as an expert witness in exercise injury litigation. While some influencers have been transitory and short-lasting, others have been persistent and likely to have even greater impact in the future.

A 45-Year Experience with Abdominal Melanoma Metastases: Is Surgical Cure Still Relevant in the Era of Modern Systemic Therapy?

Deutsch, Gary B. MD, MPH; Kirchoff, Daniel D. MD; Flaherty, Devin C. DO, PhD; Lee, Jihey PhD; Foshag, Leland MD, FACS; Faries, Mark B. MD, FACS; Bilchik, Anton J. MD, PhD, FACS Author Information

Commentary on ‘Lymphovenous Microsurgical Shunts in Treatment of Lymphedema of Lower Limbs: A 45-year Experience of One Surgeon/One Center’

Commentary on ‘Lymphovenous Microsurgical Shunts in Treatment of Lymphedema of Lower Limbs: A 45-year Experience of One Surgeon/One Center’

Lymphovenous Microsurgical Shunts in Treatment of Lymphedema of Lower Limbs: A 45-year Experience of One Surgeon/One Center

RationaleThe use of microsurgical lymphovenous shunts is one of the generally accepted treatments for limb lymphedema. AimThe 45-year personal experience of one surgeon in indications, technique and results of lymphovenous shunt operations in lower limb lymphedema of varying etiology is presented. MaterialOne thousand three hundred patients were followed up in the period 1966–2011. Patients were classified into groups according to the etiology of lymphedema as postinflammatory/posttraumatic, postsurgical, idiopathic and hyperplastic. Decrease in limb circumference, heaviness and pain, and increase in joint flexing were evaluated. ResultsThe most satisfactory results, reaching 80–100% improvement, were obtained in the congenital non-hereditary hyperplastic lymphedema group, with large lymphatics not previously damaged by infection. Results were also satisfactory in the group of cancer patients after iliac lymphadenectomy, reaching 80%. A less satisfactory outcome was observed in the postinflammatory group, not exceeding 30–40%. In idiopathic lymphedema results were satisfactory in only a few cases. ConclusionsPatients with lymphedema with local segmental obstruction but still partly patent distal lymphatics and without an active inflammatory process in the skin, subcutaneous tissue and lymph vessels present satisfactory results.

Pelvic exenteration for recurrent gynecologic malignancy: Survival and morbidity analysis of the 45-year experience at UCLA

Objective. To retrospectively assess the outcome of patients undergoing pelvic exenteration for recurrent or persistence gynecologic malignancy and the clinical features associated with outcome and survival. Methods. A review was conducted of patients who underwent pelvic exenteration over a 45-year period (1956–2001) at the UCLA Medical Center. Numerous clinical variables were analyzed, including time to relapse, type of exenteration and reconstructive operation, early (<60 days) and late (>60 days) morbidity, and survival. Variables were analyzed by chi-square and life-table analysis. Results. Seventy-five patients (ages 26–74 years) had persistent cervical and vaginal (67) and uterine (8) cancer. Forty-six patients underwent total exenteration, 23 anterior, and 6 posterior. Sixty-nine (92%) patients underwent urinary diversion or neocystoplasty, 54 (72%) patients had a simultaneous neovagina created, and 43 of 52 (83%) patients who had a low colon resection had a primary reanastomosis. Twenty-nine patients died from recurrent malignancy, 28 were alive without disease, 11 were alive with disease, and 7 died from other causes at last follow-up. Survival for patients with cervical and vaginal cancer was 73% at 1 year, 57% at 3 years, and 54% at 5 years. Survival for patients with uterine cancer was 86% at 1 year, 62% at 3 and 5 years. The most frequent early morbidity was urinary tract infection, wound infection, and intestinal fistula; the most frequent late morbidity was urinary tract infection and intestinal obstruction. Conclusion. Pelvic exenteration in patients with recurrent cervical and vaginal malignancy is associated with a durable > 50% 5-year survival. Simultaneously performed pelvic reconstructive operations with a continent urinary diversion, the creation of a neovagina, and the reanastomosis of the colon with the formation of a J-pouch is now our standard; and these operations tend to improve the outcome of patients. Based on our initial experience, recurrent uterine corpus cancer in young women (< 55 years) should be included as an indication for the surgery.

Managing nasopharyngeal carcinoma with intracavitary brachytherapy: one institution's 45-year experience

Purpose: At our institution, we have been using intracavitary brachytherapy as a boost in selected cases of both primary and recurrent nasopharyngeal carcinoma. The local control, distant metastasis–free rate, overall survival, and morbidity are presented. Methods and Materials: Between January 1, 1955, and August 2000, 576 patients with a diagnosis of nasopharyngeal carcinoma were seen at the department of radiation oncology, University of California–San Francisco, and 55 patients received intracavitary brachytherapy as one part of their treatment. All patients were treated with megavoltage external beam radiation, including 43 patients treated for initial disease and 12 for recurrence. Brachytherapy was routinely used for early cases of T1 and T2 lesions and selected cases of more advanced lesions, as well as recurrent lesions. The median age was 48 years (range 22–85 years); there were 17 women and 38 men, and 39 patients were ethnic Chinese, 13 were white, and 3 were other races. Stage at treatment (primary and recurrent) was I ( n = 13), II ( n = 18), III ( n = 19), and IV ( n = 5); 18 patients had concurrent chemotherapy. The brachytherapy applicators used were Rotterdam ( n = 24), balloon ( n = 16), ovoid ( n = 14), and ribbon ( n = 1). The dose rate was high ( n = 24), low ( n = 29), or pulsed ( n = 2). External beam doses ranged from 54 to 72 Gy for primary disease and 30 to 42 Gy for recurrent disease. Brachytherapy doses ranged from 5 to 7 Gy for high dose rate and 10 to 54 Gy for low dose rate. Results: With a median follow-up of 36 months in those who were treated for primary carcinoma, the 5-year estimate of local control was 89%, the distant metastasis–free rate was 75%, and the overall survival estimate was 86%. Recurrent patients had a median follow-up of 50 months; the 5-year estimate of local control was 64%, the distant metastasis–free rate was 100%, and the overall survival estimate was 91%. Patients with Stage I or II disease had a longer overall survival compared with those with Stage III or IV ( p = 0.05). There was a significant difference in the rate of distant metastases due to nodal status (N0 vs. N1–N3, p = 0.02) or to overall stage (I/II vs. III/IV, p = 0.005). Conclusions: Intracavitary boost brachytherapy was found to be effective and well tolerated in selected cases of both primary and recurrent nasopharyngeal carcinoma.

A 45-year experience with surgical treatment of peptic ulcer disease in children

Peptic ulcer disease (PUD) requiring surgical treatment has become rare with the availability of modern medical management. A retrospective study of all patients who required operations for PUD between 1949 and 1994 (n = 43) was done. The patients were classified into 3 groups: A (n = 38): pre-histamine-2 (H2) blocker era (1949–1975); B (n = 3): pre-hydrogen-potassium (H-K +) ATPase inhibitor era (1976–1988); C (n = 2): H-K + ATPase inhibitor era (1989–1994). Data, analyzed using χ 2 analysis ( P < .01), included preoperative medical therapy, surgical indications, type of operation performed, complications, and postoperative medical therapy. The indication for surgery in group A was bleeding (26), perforation (8), or obstruction (4); in group B the indication was obstruction (2) or perforation (1); in group C the indication was obstruction (1) or bleeding (1). The incidence of obstruction as an indication for surgery did not differ among the groups ( P < .01). Two of the three patients who had surgery for obstruction in groups B and C had biopsy-proven Helicobacter pylori. The postoperative morbidity rate was lower for groups B and C, although not significantly. The relative mortality among the groups did not change ( P > .01). Children with PUD can have complications similar to those of adults with PUD. Since the introduction of H2 antagonists, the recognition and treatment of H pylori, and the use of H-K + ATPase inhibition, the incidence of operations for bleeding and perforation has decreased dramatically. However, the incidence of surgery for obstruction remains the same.

The importance of clinical staging of minor salivary gland carcinoma

We reviewed a 45-year experience with 459 patients who had previously untreated minor salivary gland neoplasms, 378 (82%) of which were malignant. Data were adequate for retrospective clinical staging in 353 of the 378 patients with malignant tumors using criteria identical to those for squamous carcinoma in the same sites. Five-, 10-, and 15-year survival rates for the patients with malignant tumors treated after 1966 were 75%, 62%, and 56%, respectively, a significant improvement compared with results reported previously. Multivariate analysis confirms that survival was significantly influenced by the clinical stage and the histologic grade, but the applicability of grading was limited to patients with mucoepidermoid carcinoma or adenocarcinoma. Ten-year overall survival was 83%, 53%, 35%, and 24% for patients with stage I through stage IV, respectively. Results in these patients are similar to those we have recently reported in patients with major salivary gland carcinomas, but we are unable to demonstrate that postoperative radiotherapy improved survival.

Germ Cell Tumors in Infancy and Childhood: A 45-Year Experience

The clinical and pathologic features of germ cell tumors in 188 patients seen at the Childrens Hospital of Los Angeles from 1941 to 1986 are reviewed. There were 129 females and 59 males 19 years of age or younger. Tumors were seen in the ovary (73, 39%), sacrococcygeal region (67, 36%), testis (13, 7%), pineal region (10, 5%), mediastinum (8, 4%), and other sites (17, 9%). The mean age at diagnosis of patients with sacrococcygeal tumors was 11 months, and for those with ovarian tumors it was 9.3 years. Histologically, 56% of the tumors were benign, 15% had immature tissues, and 29% had frankly malignant tumors. Patients with immature tumors and elevated serum alpha-fetoprotein levels at diagnosis had a higher incidence of tumor relapse (p = .004). The histology of the recurrent tumors in these patients was embryonal carcinoma. Of 54 patients with malignant tumors, 27 are alive with no evidence of recurrence, 5 died of non-disease-related causes, and 22 (41%) had tumor recurrence within 3 years of initial diagnosis and eventually died of tumor progression. The 5-year survival rate for patients with benign tumors was 96%; for those with immature tumors, 83%; and for those with malignant tumors, 42%.