Follow-up Moment Research Articles

Lower respiratory tract infections in children with congenital lung abnormalities.

We aimed to determine if the incidence of lower respiratory tract infections (LRTI) among children with asymptomatic, observationally managed congenital lung abnormalities (CLA) differed from that of symptomatic patients who underwent surgery. Second, we sought to compare the pre- and post-resection incidence of LRTI in patients who underwent surgery. This retrospective cohort study included patients born between 1999 and 2021 with CLA confirmed by CT scan who were enrolled in a prospective longitudinal follow-up program. The LRTI incidence rates at 1, 2, 5, 8, and 12 years were compared between surgically and observationally managed patients using incidence rate ratios (IRR). Differences in pre- and post-resection LRTI incidence rates among patients who underwent CLA-related surgery were assessed through IRR. Among 217 included patients, 81 (37%) had undergone surgery and 136 (63%) had been observationally managed. The LRTI incidence rates did not significantly differ at any follow-up moment between the surgical and observational groups. Among the children who underwent CLA-related surgery, the pre-resection LRTI incidence rates were significantly higher than the post-resection LRTI incidence rates (IRR of 3.57, 95% confidence interval: [2.00; 6.33], p < .001). We could not demonstrate differences in LRTI incidence throughout childhood between patients with surgically and observationally managed CLA. We recommend discussing cases of LRTI in patients with CLA in a multidisciplinary setting, using additional diagnostics such as chest X-ray to screen for CLA involvement, enabling a well-considered decision on surgical resection of the lesion.

The role of periodontal treatment in comprehensive cardiac rehabilitation

Abstract: (1) Background: Periodontitis is a chronic infectious, inflammatory disease associated with significant local disastrous effects due to alveolar bone destruction and systemic morbidities. Some associations between periodontitis and coronary and cerebrovascular diseases have been highlighted in the literature. The present study investigated a group of patients with atherosclerotic cardiovascular diseases and periodontitis and aimed to as-sess the comprehensive effects of nonsurgical periodontitis treatment. (2) Methods: The present study included 11 patients with atherosclerotic cardiovascular disease and perio-dontitis, that were diagnosed after a complete and a complex periodontal evaluation. These patients received periodontal treatment and periodontal reevaluation after 2 months from initial therapy. (3) Results: A significant improvement of the oral hygiene and gingival bleeding scores was recorded at two months follow-up. For moderate pockets of 5 mm, there was a significant reduction of their median values at two months follow-up moment (p=0.021). (4) Conclusion: The nonsurgical periodontal treatment significantly improves the clinical-related parameters of the periodontal tissues, as revealed by gingival bleeding and pocket closure.

Pincer Morphology Is Not Associated With Hip Osteoarthritis Unless Hip Pain Is Present: Follow-Up Data From a Prospective Cohort Study.

The objective of this study was to assess the relationship between pincer morphology and radiographic hip osteoarthritis (RHOA) over 2, 5, 8, and 10 years' follow-up and to study the interaction between pincer morphology and pain. Individuals from the prospective Cohort Hip and Cohort Knee study were drawn. Anteroposterior pelvic and false profile radiographs were obtained. Hips free of definite RHOA (Kellgren and Lawrence [KL] grade 0 or 1) at baseline were included. Pincer morphology was defined as a lateral or anterior center edge angle or both ≥40° at baseline. Incident RHOA was defined as KL ≥ 2 or total hip replacement at follow-up. Multivariable logistic regression with generalized estimating equations estimated the associations at follow-up. Associations were expressed as unadjusted odds ratios (ORs) and adjusted ORs with 95% confidence intervals (CIs). An interaction term was added to investigate whether pincer morphology had a different effect on symptomatic hips. Incident RHOA developed in 69 hips (5%) at2 years' follow-up, in 178 hips (14%) at 5 years' follow-up, in 279 hips (24%) at 8 years' follow-up, and in 495 hips (42%) at 10 years' follow-up. No significant associations were found between pincer morphology and incident RHOA (adjusted OR 0.35 [95% CI 0.06-2.15]; adjusted OR 1.50 [95% CI 0.94-2.38]). Significant interactions between pain and anterior pincer morphology in predicting incident RHOA were found at 5, 8, and 10 years' follow-up (OR 1.97 [95% CI 1.03-3.78]; OR 3.41 [95% CI 1.35-8.61]). No associations were found between radiographic pincer morphology and incident RHOA at any follow-up moment. Anteriorly located pincer morphology with hip pain, however, was significantly associated with incident RHOA. This highlights the importance of studying symptoms and hip morphology simultaneously.

Modelling clinicians' decisions to adjust loop diuretic dose based on patient-reported symptoms to inform decision-aids in daily care of chronic heart failure

Abstract Background To relieve congestion and prevent decompensation in chronic heart failure patients with reduced ejection fraction, the guidelines by the European Society of Cardiology recommend the use of loop diuretics.[1] The patient is encouraged to take an active role by tracking their symptoms and adjusting their dose accordingly.[1] Purpose To develop an exploratory prediction model of clinicians’ decisions to titrate loop diuretics based on patient-reported symptoms to create decision-aids. Methods We conducted a post hoc analysis of TIME-CHF.[2] Of the randomised participants at baseline, we selected those who did not withdraw consent during follow-up, had a furosemide-equivalent diuretic dose ≤600 mg at baseline and the first follow-up moment approximately 1 month after baseline, and had a recommendation registered on diuretic titration at the first follow-up. We developed logistic regression models for two outcomes at the first follow-up: up-titration versus no change, and down-titration versus no change. Predictors considered were: age, gender, furosemide-equivalent loop diuretic dose, NYHA class, angina, orthopnoea, paroxysmal nocturnal dyspnoea, nocturia, dry cough, dizziness, orthostasis, syncope, oedema, body mass index, systolic, diastolic, and systolic minus diastolic blood pressure, heart rate, jugular veins assessment, rales, hepatomegaly, third heart sound, serum-creatinine. These predictors separately and the intervention allocation (NT-proBNP versus symptom-guided therapy) were used to predict the outcomes. We explored symptoms occurring simultaneously with the outcome and change in symptoms between baseline and first follow-up. Ordinal predictors were modelled at the nominal and scale measurement level. We then selected a group of predictors deemed suitable in a daily care context per outcome. Analyses were performed based on complete cases and after multiple imputation. Performance metrics were R²Nagelkerke and C-statistics (apparent values and 95% confidence intervals via bootstrap). Results Of the 622 patients randomised at baseline, 500 fulfilled the selection criteria. There were 101 recommendations to up-titrate, 338 to keep the dose unchanged, and 61 to down-titrate. The complete case analysis did not differ substantively from analysis after multiple imputation due to the low number of missing values, therefore only the complete case analysis is reported here. Table 1 presents the results of the patient-reported symptoms modelled separately, collected simultaneously with the outcomes. For ordinal predictors, the scale measurement level is reported. Table 2 presents the results of the analysis using the groups of predictors. Conclusions This analysis may shape decision-aids by suggesting symptom importance in clinicians’ decisions. Oedema, NYHA class, and orthopnoea are tentatively the most important patient-reported symptoms in recommending up-titration, and orthostasis in recommending down-titration.

No differences in mid-term survival and clinical outcome between CT- and MRI-based patient-specific instrumentation for total knee arthroplasty, a randomized controlled trial.

The purpose of this prospective randomized controlled trial was to compare the clinical outcome and the survival rate of total knee arthroplasty between CT- and MRI-based patient-specific instrumentation 5 years after initial surgery. At a mean follow-up of 5.8years (SD 0.3), 98 patients (64% women, loss to follow-up 28%) were included in this analysis. To assess the differences in clinical outcome, patients fulfilled PROMs preoperatively and at each follow-up moment. At final follow-up, the Forgotten Joint Score was adjusted. At final follow-up, no new patients underwent revision surgery in both groups. Regarding the clinical outcome, no statistically significant difference between the groups was found. The Forgotten Joint Score was only performed at final follow-up and showed no significant difference between both groups. At mid-term follow-up, survival rates between CT- and MRI-based patient-specific instrumentation did not show a significant difference. Regarding clinical outcome, only the EQ-5D-VAS (p < 0.040) showed a statistically significant difference over time, in favor of the MRI-group. Level I.

Risk of Hysterectomy After Endometrial Ablation: A Systematic Review and Meta-analysis.

To assess the risk of hysterectomy after nonresectoscopic endometrial ablation in patients with heavy menstrual bleeding. The EMBASE, MEDLINE, ClinicalTrials.gov and Cochrane databases were searched for eligible articles from inception until June 13, 2022. We used combinations of search terms for endometrial ablation and hysterectomy. Articles included in the review described the incidence of hysterectomy at a specific point in time after ablation with a minimum follow-up duration of 12 months. The literature search yielded a total of 3,022 hits. A total of 53 studies met our inclusion and exclusion criteria, including six retrospective studies, 24 randomized controlled trials, and 23 prospective studies. A total of 48,071 patients underwent endometrial ablation between 1992 and 2017. Follow-up duration varied between 12 and 120 months. Analyses per follow-up moment showed 4.3% hysterectomy rate at 12 months of follow-up (n=29 studies), 11.1% at 18 months (n=1 study), 8.0% at 24 months (n=11 studies), 10.2% at 36 months (n=12 studies), 7.6% at 48 months (n=2 studies), and 12.4% at 60 months (n=6 studies). Two studies reported a mean hysterectomy rate at 10 years after ablation of 21.3%. Minimal clinically relevant differences in hysterectomy rates were observed among the different study designs. Furthermore, we found no significant differences in hysterectomy rate among the different nonresectoscopic endometrial ablation devices. The risk of hysterectomy after endometrial ablation seems to increase from 4.3% after 1 year to 12.4% after 5 years. Clinicians can use the results of this review to counsel patients about the 12% risk of hysterectomy 5 years after endometrial ablation. PROSPERO, CRD42020156281.

Tolerability and beneficial effects of sacubitril/valsartan on systemic right ventricular failure

ObjectivePatients with a systemic right ventricle (sRV) in the context of transposition of the great arteries (TGA) after atrial switch or congenitally corrected TGA (ccTGA) are prone to sRV dysfunction....

Acetabular dysplasia and the risk of developing hip osteoarthritis at 2,5,8, and 10 years follow-up in a prospective nationwide cohort study (CHECK).

ObjectiveTo assess the relationship between acetabular dysplasia (AD) and the risk of incident and end-stage radiographic hip osteoarthritis (RHOA) over 2,5,8 and 10 years. DesignIndividuals (n = 1002) aged between 45 and 65 from the prospective Cohort Hip and Cohort Knee (CHECK) were studied. Anteroposterior pelvic radiographs were obtained at baseline and 2,5,8, and 10-years follow-up. False profile radiographs were obtained at baseline. AD was defined as a lateral center edge angle, an anterior center edge angle, or both <25° at baseline. The risk of developing RHOA was determined at each follow-up moment. Incident RHOA was defined by Kellgren & Lawrence (KL) grade ≥2 or total hip replacement (THR), end-stage RHOA by a KL grade ≥3 or THR. Associations were expressed in odds ratios (OR) using logistic regression with generalized estimating equations. ResultsAD was associated with the development of incident RHOA at 2 years follow-up (OR 2.46, 95% CI 1.00–6.04), 5 years follow-up (OR 2.28, 95% CI 1.20–4.31), and 8 years follow-up (OR 1.86, 95%CI 1.22–2.83). AD was only associated with end-stage RHOA at 5 years follow-up (OR 3.75, 95% CI 1.02–13.77). No statistically significant associations were observed between AD and RHOA at 10-years follow-up. ConclusionBaseline AD in individuals between 45 and 65 years is associated with an increased risk of developing RHOA within 2- and 5 years. However, this association seems to weaken after 8 years and disappears after 10 years.

Nutrition Knowledge of Elderly Women: Effect of Two Food and Nutrition Education Programs

Objective To compare the effect of two programs of Food and Nutrition Education (FNE) on the Nutrition knowledge of elderly women, Brazil. Methods Randomized field trial. Community-based elderly women over 60 years (n = 36) participated in a twelve-week intervention in either of two FNE programs: Psychopedagogical Program (PP) or Culinary Workshop Program (CWP). There were three moments of data collection in the study; pre-intervention knowledge data); post intervention and follow up (after 6 months upon intervention completion). A questionnaire about knowledge of food and Nutrition was administered at every data collection moment. Results In the analysis performed by the Generalized Estimation Equation Models (GEE) there was a significant interaction effect (P = 0.033) in the diabetes block in which the percentage of correct answers in the follow-up moment was higher compared to the pre-intervention moment in the CWP group (65.65% and 45.66%, respectively). In the knowledge blocks: total percentage of correct answers, hypertension, food processing, the evaluation effect was observed, regardless of the intervention performed. Conclusions Three blocks of knowledge, including the block of the total percentage of correct answers in knowledge in Nutrition, presented a significant evaluation effect, which suggests that the interventions were important for the gain of knowledge, regardless of the type of intervention performed. Elderly-focused FNE programs should include a methodology that encompasses recreational education activities, and practical activities, such as culinary workshops.

Surgical treatment of neuromuscular Early Onset Scoliosis with a bilateral posterior one-way rod compared to the Spring Distraction System: study protocol for a limited-efficacy Randomized Controlled Trial (BiPOWR)

BackgroundEarly Onset Scoliosis (EOS) is a progressive spinal deformity in children, and a potentially life-threatening disease. “Growth-friendly” surgical techniques aim to control the deformity, while allowing the spine and trunk to maintain growth. Current “growth-friendly” systems such as the traditional growing rod (TGR) and magnetically controlled growing rod (MCGR) have limitations that reduce their efficacy and cost-effectiveness. Recently, two “growth-friendly” systems have been developed that mitigate many of these limitations, the Spring Distraction System (SDS) and the One Way Self-Expanding Rod (OWSER). The purpose of the multicenter BiPOWR trial is to investigate, describe and compare the 1-year limited-efficacy and -safety of both strategies in the treatment of neuromuscular EOS.MethodsAfter informed consent, 28 neuromuscular EOS patients will be randomized to receive either the SDS or the OWSER. Patients and caregivers will be blinded to allocation until after surgery. Primary outcomes will be maintenance of coronal curve correction and the occurrence of serious adverse events. In addition, spinal growth, implant lengthening, and perioperative findings are recorded systematically. At each follow-up moment, the Early Onset Scoliosis Questionnaire (EOSQ-24) will be used to assess health-related quality of life. All outcomes will be compared between groups.DiscussionThe BiPOWR trial is the first randomized controlled trial that compares two specific “growth-friendly” implants in a specified EOS population. It will determine the 1-year limited-efficacy and safety of the SDS and OWSER implants.Trial registrationClinicaltrials.gov: NCT04021784 (13–06-2019). CCMO registry: NL64018.041.17 (06–05-2019).

Risk factors for potentially inappropriate medication use in older adults: a cohort study.

Much of the knowledge on the use of potentially inappropriate medications (PIM) in older adults is derived from cross-sectional studies, with little known about the risk factors over time. Longitudinal analysis was applied to estimate the occurrence and risk factors of PIM use among older adults in a 10-year follow-up. Longitudinal study with 418 older adult residents of a capital city of Central-West Brazil. The PIM were classified according to the Beers criteria 2019. The usage rate was calculated at baseline (2008) and at the 10-year follow-up moment (2018). Analysis of predictors (sociodemographic, self-rated health, hospitalization, number of comorbidities, polypharmacy, diabetes, hypertension, hypercholesterolemia and nutritional status) was performed using Generalized Estimating Equation (GEE) models. Mean age at baseline was 70.6years (SD 7.1) and 76% were women; 221 older adults took part in the follow up. The rate of PIM use was 50.4% at baseline and 57.5% at the 10-year follow-up. Multiple analysis showed that PIM use in the cohort was statistically higher in the older adults with a history of hospitalization (RRadj 1.20; 95% CI 1.01-1.40), with three or more diseases (RRadj 1.41; 95% CI 1.14-1.74), with polypharmacy (RRadj 1.81; 95% CI 1.47-2.24) and with diabetes mellitus (RRadj 1.24; 95% CI 1.05-1.47). A high level of potentially inappropriate medication use was observed, reaching 50% of the older adults, with a 7% increase in the prevalence over the 10-year follow-up period. Hospitalization, multimorbidities, polypharmacy and diabetes mellitus were associated with the use of these medications. Interventions for surveillance of the deprescribing process need to be encouraged to avoid potential harm caused by the use of medications.

Predictive Value of the (Quick)DASH Tool for Upper Extremity Dysfunction Following Percutaneous Coronary Intervention.

PurposeThe use of the Disability of the Arm, Shoulder and Hand (DASH) questionnaire and its shortened version, the QuickDASH, have been used to assess upper extremity function following a transradial percutaneous coronary intervention (TR-PCI). However, the use of these scores has not yet been validated for TR-PCI induced complications in the upper extremity. The aim of this study was to establish the validity of the DASH and the QuickDASH, for the assessment of upper extremity dysfunction following a transradial percutaneous coronary intervention (TR-PCI).Patients and MethodsThis study was a diagnostic retrospective analysis of the ARCUS study, of whom 440 underwent TR-PCI and 62 control patients were treated via the transfemoral approach. All participants completed the DASH and QuickDASH questionnaire prior to the procedure and at each follow-up visit up to six months of follow-up. Receiver operating characteristics (ROC) were constructed to determine the validity of the questionnaires, using physical examinations to determine the occurrence of upper extremity dysfunction, according to the ARCUS study.ResultsAt each follow-up moment, the area under the curve (AUC) showed a poor ability of the DASH and QuickDASH to discriminate between patients with and without upper extremity dysfunction (AUC: 0.565–0.586). There was no significant difference between the questionnaires (p > 0.05).ConclusionThe DASH and QuickDASH questionnaires are both equally incapable of discriminating between patients with and without upper extremity dysfunction following a TR-PCI. Study results suggest that the DASH and QuickDASH questionnaires are incapable of discerning changes in upper extremity function as a result of procedural complications following a TR-PCI vs cardiac induced activity cessation.

Clinical Relevance of Epidural Steroid Injections on Lumbosacral Radicular Syndrome-related Synptoms: Systematic Review and Meta-Analysis.

Epidural steroid injections (ESIs) can be used to reduce lumbosacral radicular syndrome (LRS) related pain. The clinical relevance of ESIs are currently unknown. This systematic review and meta-analyses aims to assess whether ESIs are clinically relevant for patients with LRS. Comprehensive literature searches for randomized controlled trials regarding steroid injections for LRS were conducted in PudMed, EMBASE, CINAHL, and CENTRAL from their inception to September 2018 (December 2019 for PubMed). For each homogenous comparison, the outcomes function, pain intensity and health-related quality of life at different follow-up intervals were pooled separately. The GRADE approach was used to determine the overall certainty of the evidence. Seventeen studies were included. Two different homogenous comparisons were identified for which the randomized controlled trials could be pooled. In 36 of the 40 analyses no clinically relevant effect was found. The certainty of evidence varied between very low to high. Four analyses found a clinically relevant effect, all on pain intensity and health-related quality of life, but the certainty of the evidence was either low or very low. Two of the 33 subgroup analyses showed a clinically relevant effect. However, according to the GRADE approach the certainty of these findings are low to very low. On the basis of the analyses we conclude there is insufficient evidence that ESIs for patients with LRS are clinically relevant at any follow-up moment. High-quality studies utilizing a predefined clinical success are necessary to identify potential clinically relevant effects of ESIs. Until the results of these studies are available, there is reason to consider whether the current daily practice of ESIs for patients with LRS should continue.

Clinical, Immunological, and Virological Outcomes Among Youths With Perinatal HIV After Transition to Adult Units in Spain From 1997 to 2016.

Children living with HIV are reaching adulthood and transitioning to adult clinics. This study aimed to describe clinical and immunovirological status after transition in patients with perinatal HIV. Patients participating in the Spanish multicenter pediatric HIV cohort (CoRISpe) transferred to adult care (FARO cohort) from 1997 to 2016 were included. Clinical and immunovirological data were collected from 12 years old to the last follow-up moment after transition (up to December 2017). We used mixed-effect models to analyze changes in CD4 counts or viral suppression and multivariate analysis for risk factors for virological failure (VF) and immune status after transition. Transition years were classified into 5-year periods. Three hundred thirty-two youths were included. The median age at transition was 18 years (interquartile range: 16.3-18.9) and 58.1% women. The median follow-up time after transition was 6.6 years (interquartile range: 4.6-9.8), and 11 patients (3.3%) died. The immunovirological status at transition improved over the last periods. Globally, VF decreased from 27.7% at transition to 14.4% at 3 years post-transition (P < 0.001), but no changes were observed in the last 2 transition periods. There were no significant differences in CD4 over the transition period. Risk factors for VF after transition were female sex, being born abroad and VF at transition, and for lower CD4 after transition were Romani heritage, younger age at transition, lower CD4 nadir, and CD4 at transition. After transition, virological suppression improved in the early transition periods, and immunological status remained stable. Nevertheless, some patients had higher risk of worse outcomes. Identifying these patients may aid during transition.

A long-term neuropsychological evaluation in Fabry disease.

Fabry disease (FD) is a X-linked multi-systemic metabolic disorder with mainly renal, cardiac and neurological dysfunction. The neuropsychological impact is still unclear, with previous study results ranging from disturbance of speed of information processing and executive functions to a normal cognitive profile. The aim of our study was to gain further insight into the neuropsychological involvement of FD. Patients with genetically proven FD were enrolled at the Ghent University Hospital by their treating neurologist. We evaluated the cognitive status of each patient by a thorough neuropsychological test battery and these exact same neuropsychological assessments were repeated after a follow-up period of 2-4years and at a second follow-up moment 1-4years after the first follow-up. Thirteen patients with FD were included (8 female) with mean age of 41.5years (SD ± 13.9) at baseline. All patients had normal neuropsychological test results on the subtests included in the cognitive battery at baseline, according to age-, gender- and education matched normative data. At the first follow-up moment (2-4years after baseline), six patients were included (3 male), mean age 45.3years. At the second follow-up (1-4years after first follow-up), four patients (2 male) were included, with mean age 45years. Both at the first and second follow-up moments, all patients obtained normal scores on the subtests. The cognitive functioning appeared to be in the normal range at baseline and did not decline over a follow-up period of 3-8years, suggesting that cognition in FD patients may be well-preserved in time.

Pharmacological and Non-Pharmacological Interventions for Depression after Moderate-to-Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis.

The objective of this study was to systematically review the literature and perform a meta-analysis of randomized controlled trials (RCTs) on the effectiveness of pharmacological and non-pharmacological interventions for depression in patients with moderate-to-severe traumatic brain injury. Databases searched were: Embase, PubMed, PsycInfo, Cochrane Central, Web of Science, and Google Scholar. Depression score on a self-report questionnaire was the outcome measure. Outcomes were collected at baseline and at the first follow-up moment. Data extraction was executed independently by two researchers. Thirteen RCTs were identified: five pharmacological and eight non-pharmacological. Although not all individual studies had significant results, the overall standardized mean difference (SMD) was -0.395, p ≤ 0.001, indicating that interventions improved the depression scores in patients with TBI. The difference in effectiveness between pharmacological interventions and non-pharmacological interventions was not significant (ΔSMD: 0.203, p = 0.238). Further subdivision into methylphenidate, sertraline, psychological, and other interventions showed a significant difference in effectiveness between methylphenidate (ΔSMD: -0.700, p = 0.020) and psychological interventions (reference). This difference was not found if other depression outcomes in four of the included studies were analyzed. The SMD of low-quality studies did not differ significantly from moderate- and high-quality studies (ΔSMD: 0.321, p = 0.050). Although RCTs targeting interventions for depression after TBI are scarce, both pharmacological and non-pharmacological interventions appear to be effective in treating depressive symptoms/depression after moderate-to-severe TBI. There is a need for high-quality RCTs in which the add-on effects of pharmacological and non-pharmacological interventions are investigated.

Long term outcome after minimally invasive and open Warshaw and Kimura techniques for spleen-preserving distal pancreatectomy: International multicenter retrospective study

BackgroundThe Warshaw (WT) and the Kimura (KT) techniques are both used for open or minimally invasive (MI) spleen preserving distal pancreatectomy (SPDP). Multicenter studies on long-term outcome of WT and KT are lacking. MethodsMulticenter retrospective study with transversal follow-up moment, including patients who underwent SPDP from 2000 to 2017 at three high-volume centers in Italy and the Netherlands. Primary endpoint was the incidence of short and long term complications. Patients without regular follow-up were interviewed about symptoms and complications. ResultsIn total, 164 patients were enrolled, 55 WT (33.5%) and 109 kT (66.5%), of which 95 (57.9%) MI. There was no 30-day mortality (0%).The only significant difference in short-term outcome was more delayed gastric emptying (DGE) after WT (9.1% vs 1.8%, p = 0.043). MI-SPDP was associated with less blood loss (median 150 vs 250 ml, respectively, p < 0.001), less DGE (0% vs 10%, p = 0.002), less abdominal abscesses (8.4% vs 18.4%, p = 0.03) and less splenic infarctions (3.2% vs. 13%, p = 0.042), than open SPDP. Long-term follow-up (median 41 months) was available for 111 patients (67.7%) of whom 18 (16.2%) had an SPDP-related long-term sequela, mostly perigastric varices (n = 11, 9%) but without differences between WT and KT. Less long-term sequelae were reported after MI as compared to open SPDP (12.5% vs 21.2%, p = 0.032). ConclusionsIn this international retrospective study, the WT and KT had comparable short- and long-term outcomes. If a KT does not seem feasible during SPDP, a WT is recommended, rather than performing a splenectomy. MI-SPDP was associated with less short- and long term complications as compared to an open SPDP.

The effect of Metformin treatment in obese insulin-resistant patients with euthyroid goiter

Objective The study’s objective was to evaluate the thyroid parameters in obese insulin-resistant patients with euthyroid diffuse or nodular goiter, following Metformin treatment.Patients and methods The study was experimental, open, and prospective. Fifty-three patients aged 18–68 were enrolled for two years. Obese insulin-resistant patients (cut-off Homeostasis-Model-Assessment of Insulin Resistance-HOMA-IR ≥ 2.5) with euthyroid nodular/diffuse goiter were included. Subjects with diabetes, hypo-/hyper-thyroidism, autoimmune thyroiditis, psychiatric disorders, liver or heart failure were excluded. Patients were randomly assigned to one of the following treatment: Metformin 1000 mg/day + Levothyroxine 25 μg/day (M + LT4 group) and only Levothyroxine 25 μg/day (LT4 group). Thyroid and metabolic parameters’ evolution was investigated over six months.Results The two groups were comparable at baseline (p ≥ 0.10). TSH, waist/hip ratio (WHR), visceral fat thickness (VFT), insulin, and HOMA-IR decreased significantly more in M + LT4 group compared to LT4 group. TSH decrease correlated with WHR reduction (p = 0.002) only in M + LT4 group. Moreover, the multivariate regression analysis revealed that insulin’s and HOMA-IR levels’ decrease was an independent factor associated with FT4’s increase (p = 0.031, p = 0.033) just in M + LT4 group. No other independent association between the evolution (Δ) of TSH, thyroid volume (TTV), thyroid nodules-maximum diameter (TN-MD), and metabolic parameters was found. In addition, no significant threshold between groups was reached when ΔFT4, ΔTTV, ΔTN-MD were compared (p > 0.07), although their significant improvement was recorded between the baseline and the follow-up moment in each group (p < 0.003).Conclusion Metformin added to obese insulin-resistant patients treated with Levothyroxine for diffuse/nodular goiter determined a significant decrease in TSH and metabolic parameters, compared to those treated with Levothyroxine alone, but no significant difference regarding thyroid morphology after 6 months.

Colorectal cancer at high risk of peritoneal metastases: long term outcomes of a pilot study on adjuvant laparoscopic HIPEC and future perspectives.

ObjectiveEarly detection of peritoneal metastases (PM) of colorectal cancer (CRC) is difficult and treatment options at a clinically overt stage are limited. Potentially, adjuvant laparoscopic hyperthermic intraperitoneal chemotherapy (HIPEC) is of value. The aim of this study was to present long term oncological outcomes of a pilot study on adjuvant HIPEC to reduce development of PMCRC, with systematic review of literature.MethodsLong term oncological outcomes of ten patients who underwent laparoscopic HIPEC within eight weeks after resection of primary CRC in the pilot study were retrospectively collected. A systematic search of literature was performed on studies describing the use of HIPEC in patients with CRC at high risk of developing PM.ResultsThe median follow-up was 54 months (range 49-63). All patients were alive at the last follow-up moment and none of them had developed PM. Two patients had developed pulmonary metastases. Systematic review revealed five small cohort studies, including two matched comparisons. Peritoneal recurrences were found in 0% to 9% after adjuvant HIPEC, which was 28% and 43% in the two control groups, respectively. Disease free and overall survival were significantly higher in favour of HIPEC.ConclusionLong term follow-up of ten patients included in a pilot study on adjuvant HIPEC revealed no peritoneal recurrences. This result is in line with other published pilot studies, a promising observation. However, the outcomes of the Dutch randomized COLOPEC trial and similar trials worldwide should be awaited for definitive conclusions on the effectiveness of adjuvant HIPEC.

Cauda Equina Syndrome: presentation, outcome, and predictors with focus on micturition, defecation, and sexual dysfunction

BackgroundEven though micturition, defecation, and sexual function are substantially affected in cauda equina syndrome (CES), data on outcome are scarce.MethodsMedical files of patients operated on lumbar herniated disc were screened for CES and retrospectively analyzed for baseline characteristics, outcome of micturition, defecation, and sexual function and possible predictors.ResultsSeventy-five CES patients (52% men) were included with a mean age of 44 years. L5–S1 was the most common affected level. Duration of CES complaints at presentation was, on average, 84 h (median 48 h). Prevalence of symptoms at presentation: sciatica (97%), altered sensation of the saddle area (93%), micturition dysfunction (92%), and defecation dysfunction (74%). Only 26 patients were asked about sexual dysfunction of whom 25 patients experienced dysfunction. Female gender was associated with more defecation dysfunction at presentation than male gender (OR 4.11; p = 0.039). All patients underwent decompressive surgery. Two post-operative follow-up (FU) moments took place after a mean of 75 h and 63 days. Outcomes at second FU moment: micturition dysfunction 48%, defecation dysfunction 42%, sexual dysfunction 53%, sciatica 48%, and altered sensation of the saddle area 57%. A shorter time to decompression was associated with more sciatica at FU 1 (p = 0.042) which effect had disappeared at FU 2.ConclusionThis study is unique in (1) displaying the presenting features in a large cohort of CES patients, (2) demonstrating that recovery after decompression is slow and far from complete in the majority of patients with regard to micturition, defecation, and sexual function and (3) evaluating predictors for outcome.