Follow-up Status Research Articles

Osseous versus Nonosseous Spinal Epidural Arteriovenous Fistulas: Experiences of 13 Patients.

Spinal epidural arteriovenous fistulas are rare vascular malformations. We present 13 patients with spinal epidural arteriovenous fistulas, noting the various presenting symptom patterns, imaging findings related to bone involvement, and outcomes. Among 111 patients with spinal vascular malformations in the institutional data base from 1993 to 2017, thirteen patients (11.7%) had spinal epidural arteriovenous fistulas. We evaluated presenting symptoms and imaging findings, including bone involvement and mode of treatment. To assess the treatment outcome, we compared initial and follow-up clinical status using the modified Aminoff and Logue Scale of Disability and the modified Rankin Scale. The presenting symptoms were lower back pain (n = 2), radiculopathy (n = 5), and myelopathy (n = 7). There is overlap of symptoms in 1 patient (No. 11). Distribution of spinal epidural arteriovenous fistulas was cervical (n = 3), thoracic (n = 2), lumbar (n = 6), and sacral (n = 2). Intradural venous reflux was identified in 7 patients with congestive venous myelopathy. The fistulas were successfully treated in all patients who underwent treatment (endovascular embolization, n = 10; operation, n = 1) except 2 patients who refused treatment due to tolerable symptoms. Transarterial glue (n = 7) was used in nonosseous types; and transvenous coils (n = 3), in osseous type. After 19 months of median follow-up, the patients showed symptom improvement after treatment. Although presenting symptoms were diverse, myelopathy caused by intradural venous reflux was the main target of treatment. Endovascular treatment was considered via an arterial approach in nonosseous types and via a venous approach in osseous types.

2273. Neurosyphilis in Pacients With HIV Infection: Clinical Presentation of 94 Cases

BackgroundSyphilis remains highly prevalent, particularly in men with HIV infection (HIV+), in whom atypical manifestations and neurosyphilis (NS) are frequent. NS may be asymptomatic and IM benzathine penicillin treatment is ineffective. Although ideal-but not practical-all cases of syphilis in HIV+ patients (patients) should have CSF study to rule out NS. The objective of this study was to quantify and characterize NS cases in HIV+ patients with syphilis.MethodsRetrospective study from 01-02-2013 to 04-30-2018 at Fundación Arriarán in Santiago, Chile of 618 coinfected patients with CSF study due to neurological, visual or auditory symptoms, or serum VDRL ≥ 1:32. Any positive VDRL titer in CSF was considered demonstrated NS (dNS) and isolated pleocytosis ≥ 20 cells/μL considered probable NS (pNS). Status of HIV infection, syphilis, CSF analysis, NS treatment, and follow-up were characterized.ResultsNS was diagnosed in 94/618 patients (15.2%) with CSF study, (3 women), 80.8% were dNS and 19.2% pNS. Median age was 32 years (range 20–67); median CD4 cell count was 317 cells/μL (IQR of 188–473). In 41.5% NS was diagnosed at entry into care; syphilis was classified as primary in 2.1%, secondary in 22.3%, early–latent in 29.8% and late latent in 45.8%. Most cases of NS (84%) were neurologically asymptomatics (88.8% in pNS). Median CSF leukocytes in dNS was 5 cells/μL (range 0–338), and in pNS 31 cells/μL (range 16–90). Treatment was with IV ceftriaxone in 57/94 (60.6%), and in 39.4% with IV sodium penicillin. Follow-up data with serum VDRL at 3, 6 and 12 months were obtained in 44/94 (41.4%), 37.6% and 24.4% of patients respectively, who presented a decrease of 2-fold serum VDRL in 35/44 (79.5%), 82.5% and 92.3% with data, according to baseline, respectively.ConclusionNS is an important complication of syphilis in HIV+ patients; and it should be suspected and actively investigated throughout their care given the high rate of asymptomatic status, even in NSd. Positivity of VDRL in CSF is associated with more symptoms. Ceftriaxone is an alternative therapy, but that requires larger and longer prospective studies for confirmation. The decrease of 2-fold serum VDRL in 6 months may predict treatment success. The role of CSF study post treatment to evaluate this outcome and the criteria for cure have not been well established.Disclosures All authors: No reported disclosures.

High Dropout & Early Deaths on Chemotherapy in Real World Sounds Alarm Bells: Audit from Department of Medical Oncology of a Tertiary Care Cancer Centre in South India

Background: Comprehensive data on early outcome of cancer management including treatment drop out, mortality, follow-up and survival, for all registered cases is scarce.Methods: From a prospectively maintained record system in the department of Medical Oncology, an audit was done for all patients registered in the calendar year 2015 for diagnosis, treatment course, follow-up and vital status. We follow a system of outpatient clinic booked appointment and for patients who default, serial phone calls are made to counsel about compliance and give a next review date.Results: Of total 1173 cases registered, 73.5% had solid (n = 863), and 25.5% had hematological malignancies (n = 300). Median age was 48 (1 month – 85 years); 11% pediatric, 72% adults and 17% were elderly. Male to female ratio was 0.74:1. Five most common cancers were breast (27.7%), lymphoma (11.6%) acute leukemia (9.4%), esophago-gastric (9.2%), followed by ovarian and lung carcinoma, 7% each. Almost a quarter (28%) were lost to follow up (LTFU) on different treatment phases and another one third (33%) had died during the study period. Almost half of all deaths were for patients on chemotherapy with either curative or palliative intent. Significantly higher rate of LTFU was noted for patients’ age > 18 years, with solid malignancies and with longer distance (>100 kilometres) from hospital.Conclusion: Periodic audit is essential for effective functioning of any cancer treatment program. High rates of treatment defaults and early deaths on chemotherapy demands strengthening of counselling and supportive care services to improve overall outcomes.

Prognostic impact of combining whole-body PET/CT and brain PET/MR in patients with lung adenocarcinoma and brain metastases.

The role of brain FDG-PET in patients with lung cancer and brain metastases remains unclear. Here, we sought to determine the prognostic significance of whole-body PET/CT plus brain PET/MR in predicting the time to neurological progression (nTTP) and overall survival (OS) in this patient group. Of 802 patients with non-small cell lung cancer who underwent primary staging by a single-day protocol of whole-body PET/CT plus brain PET/MR, 72 cases with adenocarcinoma and brain metastases were enrolled for a prognostic analysis of OS. On the basis of the available follow-up brain status, only 52 patients were eligible for prognostic analysis of nTTP. Metastatic brain tumors were identified on post-contrast MR imaging, and the tumor-to-brain ratio (TBR) was measured on PET images. Multivariate analysis revealed that FDG-PET findings and eligibility for initial treatment with targeted therapy were significant independent predictors of nTTP and OS. A new index, termed the molecular imaging prognostic (MIP) score, was proposed to define three disease classes. MIP scores were significant predictors of both nTTP and OS (P < 0.001). Pre-existing prognostic indices such as Lung-molGPA scores were significant predictors of OS but did not predict nTTP. When staging is performed with whole-body PET/CT plus brain PET/MR, our new prognostic index may be helpful to stratify the outcomes of patients with lung adenocarcinoma and brain metastases. The superior prognostic power of this index for nTTP might be used to select appropriate patients for intracranial control and thereby achieve better quality of life.

Initial and Long-Term Outcomes of Complex Bifurcation Aneurysms Treated by Y-Stent-Assisted Coiling with Low-Profile Braided Stents.

Coiling complex intracranial bifurcation aneurysms often necessitates the implantation of double stents in various configurations, such as Y-stent placement. Low-profile braided stents have been introduced recently to facilitate the endovascular treatment of wide-neck aneurysms. We aimed to investigate the feasibility, safety, efficacy, and durability of Y-stent-assisted coiling with double low-profile braided stents for the treatment of complex bifurcation aneurysms. A retrospective review was performed to identify patients who were treated using Y-stent-assisted coiling with low-profile braided stents. Technical success was assessed, as were initial and follow-up clinical and angiographic outcomes. Periprocedural and delayed complications were reviewed. Preprocedural and follow-up clinical statuses were assessed using the modified Rankin Scale. Forty patients with 40 intracranial aneurysms were included in the study. Y-stent placement was successfully performed in all cases. Immediate postprocedural digital subtraction angiography images revealed total aneurysm occlusion in 72.5% of cases. The mean angiographic follow-up time was 24.8 months. The last follow-up angiograms showed complete occlusion in 85% of patients. During follow-up, only 1 patient showed an increase in the filling status of the aneurysm and that patient did not require retreatment. There was no mortality in this study. The overall procedure-related complication rate, including asymptomatic complications, was 17.5%. A permanent morbidity developed in 1 patient (2.5%). The long-term angiographic and clinical outcomes of this retrospective study demonstrate that Y-stent-assisted coiling using low-profile braided stents is an effective, relatively safe, and durable endovascular treatment for wide-neck and complex bifurcation aneurysms.

Evaluating the use of text message communication in a postpartum patient navigation program for publicly insured women

ObjectiveTo compare communication between navigators and women according to follow-up status in a postpartum patient navigation program (“Navigating New Motherhood” [NNM]). MethodsThis is a mixed methods secondary analysis of text message and email transcripts from NNM. Transcripts were analyzed by number of messages sent, received, and unanswered. Message themes were qualitatively analyzed using constant comparative technique. Bivariable and multivariable tests were conducted. ResultsMost women (98.2%) communicated with navigators via text message. Women who completed postpartum follow-up sent and received more texts than women who did not (7.8 vs. 3.7, p < 0.001 and 11.5 vs. 8.0, p < 0.05, respectively); exchange of ≥6 messages was associated with greater odds of follow-up (adjusted odds ratio 2.89, 95% CI1.13–7.41). Lack of patient response was also associated with lack of follow-up (p < 0.001). Four categories of message themes were identified: Rapport-building, Postpartum Care Coordination, Maternal Health, and Motherhood. Message threads with more Rapport-building or Maternal Health messages were associated with more frequent patient follow-up (p < 0.01 and p < 0.05, respectively), as was average number of emoticons per message thread (2.1 vs. 1.2, p = 0.01). ConclusionMore frequent and multidimensional communication was associated with follow-up in a postpartum patient navigation program. Practice ImplicationsText messaging can serve as a favorable communication platform within patient navigation.

Prediction of uptake and retention of conventional hearing aids in Korean pediatric patients with unilateral hearing loss

ObjectiveThe purpose of this study was to describe and predict hearing aid uptake and retention in Korean pediatric patients with unilateral hearing loss (UHL) in a secondary referral hospital. MethodsThis was a retrospective study using clinical data collected at the time of UHL diagnosis. The study included data collected from 2009 to 2016. Serial audiograms were extracted from clinical charts, and follow-up status and rehabilitation decisions were analyzed. ResultsOf 102 children and adolescents (9.5 ± 5.1 years, 64 male), 52.9% followed a check-up schedule, and 31 (30.4%) obtained a hearing aid. Hearing threshold and speech discrimination scores were predictive parameters of hearing aid uptake. Among those who used a hearing aid, 17 (56.7%) subjects used it successfully based on significant predictive parameters of channel number. ConclusionHearing aid retention in pediatric patients seems less predictable than in adults with UHL. No good predictable parameter for hearing aid retention was identified except channel number for pediatric UHL cases. Regular monitoring of hearing and selection of a multi-channel hearing aid are crucial to minimize the potential negative effects of UHL.

Low‐grade squamous intraepithelial lesion, cannot rule out high‐grade lesion: Diagnosis, histological outcomes and human papillomavirus results

The 2014 Bethesda System for Reporting Cervical Cytology classifies squamous intraepithelial lesions (SILs) of cervix into two main categories: low-grade SIL (LSIL) and high-grade SIL (HSIL). In some clinical practices, the LSIL cannot rule out high-grade lesion (LROH) interpretive category is used in cases with LSIL and findings that may raise the possibility of HSIL. Our purpose is to assess follow-up histopathology and high-risk human papillomavirus (hrHPV) results in patients with LROH, in comparison with LSIL, atypical squamous cells, cannot rule out HSIL (ASC-H), and HSIL in our institution. Cervical Papanicolaou tests with LROH, LSIL, ASC-H and HSIL interpretation, surgical follow-up, and hrHPV status were retrieved from the computer database from May 2014 to December 2016. Of 109963 total Papanicolaou tests, LROH comprised 0.3%, LSIL 3.1%, ASC-H 0.2% and HSIL 0.4%. Only 3272 cases with surgical diagnoses were included in the study. The most common histological outcome for ASC-H was cervical intraepithelial neoplasia (CIN)2/3 (32.6%); LSIL was CIN 1 (45.7%); LROH was CIN 1 (46.7%) and HSIL was CIN 2/3 (64.4%). For LROH and LSIL, 31.1% and 7.5% respectively, had CIN 2/3. Approximately 79% of cases were hrHPV positive. Of LROH cases with surgical follow-up, 86.9% tested hrHPV positive, accounting for the second most common positive group after HSIL (92.6%). In our study cohort, LROH interpretation is associated with a higher number of CIN 2 or higher lesions on follow-up compared to patients with LSIL (P<0.0001), and is associated with a significant percentage of positive other hrHPV, supporting LROH as a useful diagnostic category that triggers appropriate follow-up in affected women.

Follow-up status, patient retention and data collection of the “Joven & Fuerte” cohort for young women with breast cancer in Mexico

Background: Understanding the characteristics of young women with breast cancer (YWBC) in limited-resource settings and the issues they face is of great relevance to the medical community, in order to tailor clinical interventions and supportive care. Thus, the Mexican cohort “Joven & Fuerte” was established in November 2014, with the aim of comprehensively characterizing YWBC in Mexico using patient- and physician-based questionnaires. Patients are evaluated at diagnosis, and follow-up evaluations are scheduled after 6 months (m), and annually for 5 years (y). For the completion of patients’ surveys, our team reaches out to patients on the date of their medical appointments. We aim to describe the current progress of our cohort, assess patient retention and data collection, and plan adjustments to minimize losses during follow-up.

Recovery Kinetics of Radiographic and Implant-Related Revision Patients Following Adult Spinal Deformity Surgery

Prior studies have observed similar health-related quality of life (HRQL) in revisions and nonrevision (NR) patients following adult spinal deformity (ASD) correction. However, a novel comparison approach may allow better comparisons in spine outcomes groups. To determine if ASD revisions for radiographic and implant-related complications undergo a different recovery than NR patients. Inclusion: ASD patients with complete HRQL (Oswestry Disability Index, Short-Form-36 version 2 (SF-36), Scoliosis Research Society [SRS]-22) at baseline, 6 wk, 1 yr, 2 yr. Generated revision groups: nonrevision (NR), revised-complete data (RC; with follow-up 2 yr after revision), and revised-incomplete data (RI; without 2-yr follow-up after revision). In a traditional analysis, analysis of variance (ANOVA) compared baseline HRQLs to follow-up changes. In a novel approach, integrated health state was normalized at baseline using area under curve analysis before ANOVA t-tests compared follow-up statuses. Two hundred fifty-eight patients were included with 50 undergoing reoperations (19.4%). Rod fractures (n=15) and proximal joint kyphosis (n=9) were most common. In standard HRQL analysis, comparing RC index surgery and RC revision surgery HRQLS revealed no significant differences throughout the 2-yr follow-up from either the initial index or revision procedure. Using normalized HRQL/integrated health state, RI displayed worse scores in SF-36 Physical Component Score, SRS activity, and SRS appearance relative to NR (P<.05), indicating less improvement over the 2-yr period. RC were significantly worse than RI in SF-36 Mental Component Score, SRS mental, SRS satisfaction, and SRS total (P<.05). ASD patients indicated for revisions for radiographic and implant-related complications differ significantly in their overall 2-yr recovery compared to NR, using a normalized integrated health state method. Traditional methods for analyzing revision patients' recovery kinetics may overlook delayed improvements.

Comparison of the Clinical Results of Attic Cholesteatoma Treatment: Endoscopic Versus Microscopic Ear Surgery.

ObjectivesWe aimed to compare clinical outcomes including hearing improvement and cholesteatoma recurrence between endoscopic and conventional microscopic surgeries in patients with attic cholesteatoma.MethodsWe collected data from patients with attic cholesteatoma who were treated using endoscopic (10 patients) and microscopic (10 patients) approaches by a single surgeon. The data were retrospectively reviewed for patient characteristics, intraoperative findings, hearing levels, and follow-up clinical status. Recurrence of the cholesteatoma, improvement of hearing, and operation time were evaluated.ResultsOssiculoplasty was performed in four patients in the endoscopic group and two patients in the microscopic group. Lempert endaural incision II was used in all the patients in the microscopic group, whereas Lempert I incision was used in all the patients in the endoscopic approach group. There were no significant differences between the two groups regarding hearing improvement and operating time. And, there were no recurrences during the follow-up period in both groups.ConclusionThe endoscopic approach for the management of attic cholesteatoma is as useful as the microscopic approach.

Investigation of characteristics of residents in RCHEs associated with MRSA colonization after implementation of infection control training program

Background: Residential care homes for the elderly (RCHEs) are considered potential reservoirs for transmission of Methicillin-resistant Staphylococcus aureus (MRSA). Infection control strategies have been introduced in RCHEs to curb the spread of MRSA. However, the effectiveness of these strategies in reducing MRSA is questionable. MRSA has remained prevalent in economically well-developed regions such as UK and the US despite the implementation of multiple intervention programs. We aim to investigate the characteristics of residents associated with MRSA colonization after implementation of common infection control strategies. Methods & Materials: Residents from selected RCHEs in Kwai Tsing and Tsuen Wan district in New Territories West, Hong Kong were recruited from March 2011 to April 2012. They were interviewed about their health condition and nasal specimens for MRSA screening twice in the study period, with 2-13 months apart. Additional wound specimens were also collected if wounds were identified. Infection control intervention was represented by healthcare staff training and education in the study RCHEs between two screening tests. We defined subjects as being colonized with MRSA if either nasal or wound specimen was tested positive. A multivariable random-effect regression model on follow-up MRSA colonization status was applied. Results: A total of 1832 residents from 32 RCHEs were recruited. The overall point prevalence of MRSA colonisation during the follow-up (after implementation of the training program) was 14.5%(265/1832). Upon adjusting for age, the model which best describes the association between follow-up MRSA colonization and health condition of residents includes the following characteristics: Low mobility indicated by Barthel Index 50 or below (adjusted OR = 1.79;1.23,2.60), presence of skin conditions (adjusted OR = 7.72;4.15,14.36), use of medical device (adjusted OR = 2.25;1.55, 3.24) and presence of MRSA at baseline (OR = 5.23;3.81,7.19). Conclusion: We identified a strong association between health conditions of residents and MRSA colonization. MRSA colonization among residents with low mobility suggested that the service setting and environmental contamination may possibly be sources of MRSA transmission. Device care should be a crucial component in the strategic plan, as shown by the association of colonisation with the use of the medical device. Our findings highlighted the importance of the evaluation of intervention strategies for informing infection control policies.

Is Single Low-Profile Visualized Intraluminal Support (LVIS)-Assisted Coiling of Wide-Necked Ruptured Multiple Intracranial Aneurysms in One Stage Feasible?

There is no previous reports available on stent-assisted coiling of ruptured multiple intracranial aneurysms using single Low-Profile Visualized Intraluminal Support (LVIS) in one stage. In the present study, we investigated the efficacy and feasibility of using single LVIS to bridge multiple intracranial aneurysms in one stage. From April 2014 to August 2016, 24 patients treated with single LVIS to bridge 2 aneurysms in one stage were reviewed. The aneurysm morphology, clinical outcome, angiographic results, progressive occlusion, recurrence, and procedure-related complications were analyzed retrospectively. In the present study, middle term clinical outcome showed that 9 patients were had a modified Rankin Scale (mRS) score of 0, 11 patients had mRS 1, and 4 patients had mRS 2. A total of 20 patients (83.3%) achieved a good outcome, 4 patients (16.7%) had poor outcomes, and 7 of 18 patients (38.9%) displayed improved clinical neurologic status in long-term follow-up. Immediate angiographic results postprocedure showed Raymond Scale (RS) I in 33 aneurysms (68.8%), RS II in 11 aneurysms (22.9%), and RS III in 4 aneurysms (8.3%). The angiographic follow-up results showed RS I in 41 aneurysms (85.4%), RS II in 5 aneurysms (10.4%), and RS III in 2 aneurysms (4.2%). Of 15 incomplete occlusion aneurysms postprocedure, 10 aneurysms (66.7%) achieved to progressed occlusion on follow-up imaging, and no recanalization or mortality occurred in this group. Single LVIS bridging wide-neck ruptured multiple intracranial aneurysms was effective and feasible in one stage. However, the procedure-related complications should be emphasized and long-term follow-up requires further evaluation.

Programs on mobility, status of follow-up and CD(4)(+)T cell testing among people living with HIV/AIDS, in China 2011-2015

Objective: To analyze the mobility, status of follow-up and CD(4)(+)T cell testing (CD(4) testing) programs among people living with HIV (PLHIV) between 2011 and 2015 and to improve the prevention program on HIV secondary transmission. Methods: Data were collected from both Case Reporting Cards and Follow-up Cards through the National HIV/AIDS Comprehensive Control and Prevention data system. Changes of residence among the newly reported cases and survival cases between 2011 and 2015 were analyzed by SPSS 24.0 software. Results: The number of newly reported inter-provincial mobile PLHIV had been increasing, with proportions of the total reported cases from 10.0% (5 576/55 805) in 2011 to 13.3% (15 348/115 231) in 2015. After adjusting for related confounders, percentages of follow-up and CD(4) testing were lower in inter-provincial and inter-prefectural mobile cases than those without. Conclusion: Service regarding the follow-up and CD(4) testing programs was affected by mobility of people living with HIV/AIDS. Programs on communication and personal contact should be strengthened in the follow-up management services for PLHIV. Information on potential mobility of PLHIV should be gathered timely by health workers during the subsequent follow-up period to avoid the loss of follow-up and CD(4) testing on patients.

Determinants of breast cancer early detection for cues to expanded control and care: the lived experiences among women from Western Kenya

BackgroundEstimately, 70–80% of cancer cases are diagnosed in late stages in Kenya with breast cancer being a common cause of mortality among women where late diagnosis is the major ubiquitous concern. Numerous studies have focused on epidemiological and health policy dynamics essentially underestimating the determining factors that shape people’s choices and cues to health care service uptake. The study sought to evaluate the knowledge, attitude and health seeking behavior towards breast cancer and its screening in a quest to explain why women present for prognosis and treatment when symptomatic pointers are in advanced stages, impeding primary prevention strategies.MethodsEight focus groups (6–10 members per group) and four key informant interviews were conducted among adult participants from rural and urban settings. Sessions were audio-recorded and transcribed. A thematic analysis of the data was based on the concepts of the health belief model. Data analysis was conducted using NVIVO10.ResultsMost women perceived breast cancer as a fatal disease and conveyed fear of having early screening. Rural women preferred self-prescribed medications and the use of alternative medicine for long periods before presenting for professional care on suspicion that the lump is cancerous. Accessibility to equipped health facilities, lack of information to establish effective follow-up treatment and low-income status were underscored as their major health seeking behavior barriers whereas, urban women identified marital status as their main barrier. Key informant interviews revealed that health communication programs emphasized more on communicable diseases. This could in part explain why there is a high rate of misconception and suspicion about breast cancer among rural and urban women in the study setting.ConclusionsCreating breast cancer awareness alongside clear guidelines on accessing screening and treatment infrastructure is critical. It was evident, a diagnosis of breast cancer or lump brings unexpected confrontation with mortality; fear, pain, cultural barriers, emotional and financial distress. Without clear referral channels to enable those with suspicious lumps or early stage disease to get prompt diagnosis and treatment, then well-meaning awareness will not necessarily contribute to reducing morbidity and mortality.

Su1108 ONGOING GERD SYMPTOMS AND OBESITY ARE POTENTIAL RISK FACTORS FOR BARRETT'S ADENOCARCINOMA AND HIGH-GRADE DYSPLASIA AMONG PATIENTS UNDER 50 YEARS OF AGE

Recent guidelines recommend endoscopic screening for Barrett’s esophagus (BE) only in patients with multiple risk factors. While increased age (>50 years) is often considered the most important risk factor, esophageal adenocarcinoma (EAC) and/or high-grade dysplasia (HGD) continues to be observed in younger patients (≤50 years). However, it is unclear if this younger cohort differs regarding specific clinical characteristics from the more typical age category of BE neoplasia, and if so, whether these features could help guide screening recommendations. We conducted a retrospective analysis of a prospectively maintained database comprised of consecutive patients with early stage EAC (T1) and HGD at a single, tertiary-referral center from March 2001 to July 2017. Information regarding baseline clinical characteristics, drug and risk factor exposures, clinicopathological staging of EAC/HGD and follow-up status including treatment outcomes such as complete remission of dysplasia (CR-D), and complete remission of intestinal metaplasia (CR-IM) were determined. Univariate and multivariate analyses were performed to identify factors that differed significantly between patients older and younger than 50 years. We identified 511 patients with T1 EAC and HGD (383 and 128, respectively); 50 (10%) were age ≤50 years; 461 (90%) were age >50 years. Compared to the older age group, young patients were more likely to have ongoing GERD symptoms and to be obese (BMI >30) (55% vs. 39%, p=0.003; 47% vs. 32%, p=0.038, respectively) and less likely to have ever been smokers (57% vs. 76%, p=0.004) on univariate analysis, with the same pattern of differences maintained at an even greater magnitude of effect on multivariate analysis. However, there were no significant differences between young and old age groups in terms of tumor depth of invasion, differentiation, lymphovascular invasion or deep margin positivity. Furthermore, there were no significant differences between the groups regarding outcomes of endoscopic therapies with respect to CR-D, CR-IM, recurrence of dysplasia and recurrence of intestinal metaplasia with a mean follow-up period of 44.3 ± 30.2 months. Younger patients (≤50 years) with early stage EAC or HGD were more likely to have ongoing GERD symptoms and to be obese compared to older patients despite similar clinical outcomes with endoscopic therapies. While guidelines recommend BE screening in patients >50 years of age, younger patients should be considered for screening endoscopy if they suffer from obesity and GERD symptoms.

Partial nephrectomy for T1b renal masses: comparison of laparoscopic and robot-assisted approach

Objective To compare the operative-postoperative outcomes of laparoscopic and robot-assisted partial nephrectomy (LPN and RAPN) for patients with T1b renal masses. Methods A total of 169 T1b renal mass patients receiving LPN(n=69) or RAPN(n=100) in our center between October 2009 and October 2017 were retrospectively collected. There were 46 males and 23 females in LPN group, with a mean age of (55.0±11.9) years. The mean tumor size was(5.09±0.76)cm, and mean R. E.N.A.L score was 6.36±1.53. 49 procedures (71%) were performed via a retroperitoneal approach in LPN group. There were 59 males and 41 females in RAPN group with a mean age of (52.9±11.7) years. The mean tumor size was(4.95±0.66)cm, and mean R. E.N.A.L score was 8.17±1.50. 31 procedures (31%) were performed via a retroperitoneal approach in RAPN group. There was statistical significance between two groups in R. E.N.A.L score and surgery approach(P< 0.001). The group covariates were balanced through propensity score matching (PSM) using 1∶1 nearest neighbor matching method. After PSM, operating time, estimated blood loss, warm ischemia time, incidence of complications, hospital stay and postoperative follow-up status were compared between LPN(n=36)and RAPN(n=36)group. Results After PSM, patient distributions were closely balanced. In the LPN vs the RAPN group, there were significant different in warm ischemia time[(23.9±7.3)min vs.(20.4±6.7)min, P 0.05], variation of estimated glomerular filtration rate from baseline [(9.97±8.98)% vs.(9.27±9.19)%, P>0.05], positive surgical margin rate (1.4%vs.0, P>0.05) and rate of recurrence or metastasis(1.4% vs. 1.4%, P>0.05) between groups. Conclusion Considering operative, functional and oncologic outcomes, both RAPN and LPN performed by an experienced surgeon were acceptable for patients with T1b renal masses. If available, robotic approach may reduce operative trauma and complications. Key words: Kidney neoplasms; Partial nephrectomy; Robot-assisted laparoscopy; Laparoscopy

Long-term outcomes and prognosis in submandibular gland malignant tumors: A multicenter study.

Submandibular gland tumors (SMGTs) are rare and characterized by heterogeneity in histologic profiles. The aim of the present study was to retrieve data on submandibular gland (SMG) malignancies and identify factors influencing survival. Retrospective study. A multicenter, retrospective study on patients who underwent primary surgery for SMGTs at three referral centers was performed. Among 204 patients with SMGTs, 50 (24.5%) with SMG malignancies were analyzed in detail. Definitive pT status was: 21 (42%) pT1, 14 (28%) pT2, 10 (20%) pT3, and five (10%) pT4. Nodal metastases and perineural spread were diagnosed in 15 (30%) and 25 (50%) patients, respectively. High-grade lesions were identified in 32 (64%) patients. Follow-up status, available for 49 (98%) patients, was as follows: 23 (47%) patients were alive without disease, 11 (22.5%) died of disease, five (10.2%) alive with disease, and 10 (20.4%) died of other causes. Five- and 10-year overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were 66.4% and 57.1%, 76.6% and 72.1%, 69.1% and 62.4%, respectively. At univariate analysis, OS, DSS, and RFS were influenced by pT status, pN status, and perineural spread. OS and RFS were also affected by the presence of facial palsy and pain. RFS was negatively influenced by positive margins. Multivariate analysis confirmed that OS, DSS, and RFS were independently affected by perineural spread, whereas nodal involvement influenced only RFS. The malignancy rate of SMGTs is comparable to that reported for parotid tumors. Most patients presented with high-grade lesions. pT status, pN status, and perineural spread significantly affected prognosis. 4 Laryngoscope, 128:2745-2750, 2018.

WITHDRAWN: Evaluation of multifunctional imaging parameters in gastro-oesophageal cancer using F-18-FDG-PET/CT with integrated perfusion CT.

Ahead of Print article withdrawn by publisher.

Craniotomy for subdural hematoma after deep brain stimulation surgery: Outcomes and satisfaction in a case series of two patients

ObjectiveTo determine whether salvage of DBS hardware is beneficial for Parkinson’s Disease (PD) patients by looking at follow-up patient’s outcomes and satisfaction after their craniotomy operation. Patients and methodsThis was a retrospective review of a prospective, single-center deep brain stimulation (DBS) database between 2002–2016 identifying patients with PD who developed subdural hematomas (SDH) due to trauma after their DBS surgery. Of the 636 DBS cases that were performed, 3 PD-DBS patients with significant traumatic SDH managed via craniotomy were identified. Out of these 3 patients, only 2 permitted outcome analysis. At follow-up, functional and neurologic status, UPDRS motor score, and overall satisfaction with DBS were assessed. ResultsTwo patients were followed for a period of 10 and 9 months. At last follow-up, the DBS settings in patient 1 increased from a stimulation amplitude of 3.5 V to 4.5 V on the right and 3.3 V to 6.0 V on the left with an increase in the pulse width as well (70–80 ms and 80–140 ms on the right and left, respectively). Stimulation frequency remained 160 Hz on the right while increasing from 145 to 160 Hz on the left. Patient 2 experienced an increase in stimulation amplitude from 4.5 V to 4.8 V on the right while remaining the same on the left. Pulse width increased from 60 to 70 ms bilaterally as well as the frequency (160–185 Hz bilaterally). Despite craniotomy, both patients experienced substantial improvement in UPDRS motor score with DBS at last follow-up (53–25 and 20–17 for patient 1 and 2, respectively). At last follow-up, CT imaging provided evidence of complete SDH resolution with no persistent hemorrhage, mass effect or any obvious lead displacement. Patients expressed satisfaction with DBS and affirmed that they would undergo surgery again for the same outcome. ConclusionPatients with PD are at higher risk for falls and may experience an increased risk of falling associated with SDH in the post-operative period after DBS implantation. Despite brain shift from SDH potentially distorting DBS leads, DBS implants still provided significant benefit in patients requiring craniotomy for SDH and patient satisfaction with DBS remained high. Salvage of DBS hardware is recommended since significant symptomatic improvement with DBS programming may still be attainable even in the setting of emergent craniotomy for SDH.