Incidence Of Early Recurrence Research Articles

Incidence, Risk Factors and Management of Postoperative Complications in Horizontal Strabismus Surgery

ABSTRACT Objective To report the incidence, risk factors and management of postoperative complications after horizontal strabismus surgery. Design Retrospective Cohort study. Participants The study assessed 1,273 patients with 1,035 cases of exotropia and 238 cases of esotropia, with a minimum 18-month follow-up. Methods Retrospective review of strabismus operation patients’ medical records included baseline demographics, age at surgery, pre/postoperative visual acuity, and deviation. Complications were categorized as surgical site (infection, scarring, cyst, granuloma, ischemia) and strabismus-related (recurrence, diplopia), with analysis of incidence, risk factors, and management. Results Among surgical site complications, the incidence of infection, pyogenic granuloma, and anterior segment ischemia were similar between the exotropia (0.3%, 0.3%, 0.2%) and esotropia (0.8%, 0%, 0.4%) groups (p = .221, 0.406, 0.515). In contrast, the esotropia group presented a higher risk of conjunctival inclusion cyst and conjunctival scar than the exotropia group, with incidences of 5.0% vs 2.2% and 6.3% vs 1.3%, respectively (p = .004, <0.001). Regarding strabismus complications, the incidence of early recurrence was not significant between the two groups, with 10.0% in the exotropia group and 10.5% in the esotropia group (p = .553). Older age and poor initial visual acuity were associated with early recurrence (p < .001). The esotropia group had a higher risk of persistent diplopia than the exotropia group, with incidences of 4.2% vs 2.0%, respectively (p = .003). Conclusion Esotropia carries a higher risk of conjunctival inclusion cysts, conjunctival scarring, and persistent diplopia compared to the exotropia group, while both groups exhibit similar rates of early recurrence and other surgical site complications.

Development and validation of nomogram to predict very early recurrence of combined hepatocellular-cholangiocarcinoma after hepatic resection: a multi-institutional study

Background and objectivesCombined hepatocellular cholangiocarcinoma (cHCC) has a high incidence of early recurrence. The objective of this study is to construct a model predicting very early recurrence (VER) (i.e., recurrence within 6 months after surgery) of cHCC.MethodsOne hundred thirty-one consecutive patients from Eastern Hepatobiliary Surgery Hospital served as a development cohort to construct a nomogram predicting VER by using multi-variable logistic regression analysis. The model was internally and externally validated in a validation cohort of 90 patients from Mengchao Hepatobiliary Hospital using the C concordance statistic, calibration analysis, and decision curve analysis (DCA).ResultsThe VER nomogram contains microvascular invasion (MiVI), macrovascular invasion (MaVI), and CA19-9 > 25 mAU/mL. The model shows good discrimination with C-indexes of 0.77 (95% CI: 0.69–0.85) and 0.76 (95% CI: 0.66–0.86) in the development cohort and validation cohort respectively. Decision curve analysis demonstrated that the model is clinically useful and the calibration of our model was favorable. Our model stratified patients into two different risk groups, which exhibited significantly different VER.ConclusionsOur model demonstrated favorable performance in predicting VER in cHCC patients.

ПОШУКОВЕ ДОСЛІДЖЕННЯ ПРЕДИКТОРІВ ПІЗНІХ РЕЦИДИВІВ АРИТМІЇ У ПАЦІЄНТІВ З ПЕРСИСТУЮЧОЮ ФІБРИЛЯЦІЄЮ ПЕРЕДСЕРДЬ ПІСЛЯ КАРДІОВЕРСІЇ

Introduction. The existing guidelines do not contain a clear algorithm for predicting the late recurrences of atrial fibrillation (AFib). Objectives. We have studied the predictors of late recurrence of arrhythmia in patients with persistent AFib after the restoration of sinus rhythm (SR). Research methods. A prospective single-center study included 120 hospitalized patients with persistent AFib who underwent successful cardioversion. The recurrence of AFib was assessed in the early period after cardioversion by recording 12-channel ECG, Holter ECG monitoring and event ECG monitoring. After a nine-month period follow-up visit was performed. Baseline demographic, clinical-functional features and comorbidities were compared in group with (n = 87) and without (n = 33) late recurrences of Afib. Results. There were no differences in demographic, anthropometric data and comorbidities. Patients with late recurrence of AFib had a lower heart rate (HR) after SR recovery (p &lt;0.001). Early recurrences of AFib were found in 43 (49.4%) patients with late recurrences of arrhythmia and only in two (6.0%) without late recurrences (p &lt;0.001). Patients with late recurrences of arrhythmia had a lower average daily HR (p &lt;0.001), a higher number of single atrial extrasystoles (p = 0.001), atrial pairs and runs (p = 0.01) recorded by Holter ECG monitoring. Conclusions. Late recurrences of arrhythmia during the nine-month follow-up period were reported in 72.5% of patients. Groups of patients with and without late recurrence of arrhythmia had significant differences in the incidence of early recurrences, mean HR on SR, and the presence of atrial extrasystoles after rhythm recovery.

Clamping of chest drain before removal in spontaneous pneumothorax

BackgroundIn spontaneous pneumothorax, clamping the chest drain before its removal may avoid reinsertion in case of early recurrence, but may be unsafe and may prolong hospital stay. The objective of this study was to examine the incidence of early recurrence in both clamped and unclamped pneumothorax episodes, and factors associated with it.MethodsRetrospective chart review of primary and secondary spontaneous pneumothorax episodes in which chest drain was inserted during the period April 2012 to March 2014.ResultsData of 122 episodes were analysed. There were 36 primary pneumothorax and 86 secondary pneumothorax episodes. Mean age was 59 years with 92% males. Clamping of the chest drain was done in 68 episodes (55.7%), and not done in 54. The clamping group was significantly younger, had more primary pneumothorax, and had shorter time from cessation of air leak to clamp/removal. Recurrence within 24 h were seen in 12 (17.6%) clamped episodes and 4 (7.4%) non-clamped episodes, although in only eight episodes were reinsertion of chest drain saved. Significantly more previous pneumothorax episodes were seen in the early recurrence group. We observed no new onset of tension pneumothorax or subcutaneous emphysema associated with clamping.ConclusionThe practice of clamping the chest drain before removal in spontaneous pneumothorax appear safe. Clamping saved chest drain reinsertion in 11.8% of cases, and has the potential to save more if clamped for up to 24 h. However, clamping may result in more early recurrences. Prospective randomised studies are needed.

Abstract 15237: Serum Galectin-3 Level Predicts Late Recurrence Following Cryoballoon-based Pulmonary Vein Isolation in Lone Atrial Fibrillation Patients

BACKGROUND: Left atrial(LA) interstitial fibrosis is known to be a key contributor to atrial fibrillation(AF) development and maintenance. The role of galectin-3 in the pathogenesis of cardiac fibrosis has been demonstrated in previous studies. We aimed to determine whether serum galectin-3 level is an independent predictor for the late AF recurrence in patients with lone AF who underwent cryoballoon- based pulmonary ven isolation(PVI). METHODS: 100 patients (43.80% male, 56.95± 11.36 years) with lone AF who underwent cryoballoon-based PVI were included in the study. Pre-procedural galectin-3 levels were measured with ELISA. RESULTS: At a follow-up of 12 months, 76 (76%) patients were free of late AF recurrence. Body mass index(BMI) ( 25.04± 1.54 vs. 23.93± 2.08 kg/m2, p=0.002), AF duration [7 (3- 20) vs. 5 (1- 24) months, p=0.024], serum galectine-3 levels [11.10 (4.20- 33.80) vs. 5.70 (2.60- 12.40) ng/mL, p&lt;0.001], left atrial diameter(LAD) (4.30± 0.40 vs.3.79± 0.42 cm, p&lt;0.001) and incidence of early recurrence (60 vs 2%, p&lt;0.001) were found to be significantly higher in patients with late AF recurrence. Serum galectin-3 levels (HR: 1.16, p&lt;0.001), LAD (HR: 3.38, p= 0.042) and early recurrence (HR: 10.92, p&lt;0.001) were found to be independent predictors of late AF recurrence in the multivariate Cox regression analysis. A cut-off level for serum galectin-3 level of 7.9 ng/mL predicted late AF recurrence in lone AF patients with a sensitivity of 93.33% and specificity of 87.76% (AUC: 0.910, p&lt;0.001). CONCLUSION: Pre-procedural serum galectin-3 level is an independent predictor of late AF recurrence following cryoballoon-based PVI in patients with lone AF. Galectin-3 may serve as a novel biomarker to identify patients with high recurrence risk following AF ablation.

A Critical Appraisal of the Role of Neoadjuvant Chemotherapy for Colorectal Liver Metastases: A Case-Controlled Study

The aim of this study was to analyze the outcome of patients that received neoadjuvant chemotherapy prior to resection for colorectal liver metastases (CRLM) and compare them with a matched cohort of patients that underwent resection followed by adjuvant chemotherapy. 687 patients have undergone curative resection between January 1993 and January 2006. In this period, 84 patients received neo-adjuvant chemotherapy and 71 of this group went on to resection. A control group was chosen, matched with these patients, made up of patients who underwent resection followed by adjuvant chemotherapy. There was no difference in clinico-pathological features between the neoadjuvant and the control group. However patients in the control group had more-extended resections and longer hospital stays than those in the neoadjuvant group (p = 0.015). Patients in the control group had an increased incidence of early recurrences (p < 0.001). Despite this, there was no significant difference in either the cancer-specific or the disease-free survival between the two groups of patients. Neoadjuvant chemotherapy has a role in the management of patients with disease that is considered initially unresectable as a down-sizing technique. In patients with resectable disease, the test-of-time approach that neoadjuvant therapy offers is yet to be proven.

Outcomes and Management of Patients with Cushing’s Disease without Pathological Confirmation of Tumor Resection after Transsphenoidal Surgery

Despite the success of transsphenoidal surgery (TSS) for the treatment of Cushing's disease, in a number of cases, an ACTH-staining pituitary adenoma is not identified histologically. The clinical significance of lack of histological confirmation remains unclear. This was a retrospective review of patients treated at the University of Virginia Medical Center. Of 490 TSS procedures for Cushing's disease between 1993 and 2004, we identified 111 cases without histological adenoma confirmation. Remission and recurrence of Cushing's disease were measured. Overall, 50% of these patients achieved remission, a figure lower than for our entire series (79%) and for patients with histological confirmation of an ACTH-staining adenoma (88%) (P < 0.001). Patients with a history of two prior TSS achieved remission less often than patients with a history of fewer TSS (P = 0.026). No other factors influenced remission rates. Although the overall recurrence rate (21%, seven of 33 evaluated) was not different from previously published long-term studies, in three of seven cases of recurrence, early recurrences were noted between 2 and 4 months after remission. In patients who did not achieve remission, the most common and effective treatment options were repeat TSS, gamma-knife radiosurgery, and bilateral adrenalectomy. The lower remission rate in patients without histological evidence of an adenoma is most likely a result of a decreased rate of adenoma extirpation. The incidence of early recurrence may be a unique feature of this patient population; patients without histological confirmation of tumor resection therefore require close and consistent monitoring postoperatively.

Comparison of Topical Glyceryl Trinitrate Ointment and Oral Nifedipine in the Treatment of Chronic Anal Fissure

This study was designed to compare the effect of topical glyceryl trinitrate (GTN) and oral nifedipine treatments on maximal anal resting pressure (MarP) and subsequently to assess their effectiveness in healing of chronic anal fissure (CAF). Patients were allocated randomly to receive either oral nifedipine retard (10 patients) 20 mg twice daily or instructed to apply glyceryl trinitrate (0.2 percent) ointment (10 patients) into the lower half of the anal canal twice daily. They were reviewed and assessed at the first visit and every fortnight for measurement of MARP, pain scores, blood pressure, pulse rate, healing of the fissure and adverse effects. Treatment were continued until healing had occurred or for up to 8 weeks. MARP values before and after application of the GTN ointment was 113.2 cm H2O and 72.5 cm H2O respectively (P < 0.001). Nifedipine caused a reduction in mean MARP from 105.2 to 74.0 cm H2O (P < 0.001). Linear analogue pain scores were significantly reduced after 2 weeks treatment with GTN and nifedipine (P < 0.001) and continued throughout the treatment period. At the end of the study; 7 of the 10 patients in the GTN group were deemed to be healed (5) or improved (2), compared with 6 of the 10 patients in the nifedipine group (5 healed, 1 improved). Headaches occurred in 3 patients in the GTN group, compared with one patient in the nifedipine group. There was no significant difference between GTN and nifedipine in terms of reduction in MARP and pain score, healing of the fissure and incidence of early recurrence and side effects of treatments. We conclude that GTN ointment and oral nifedipine are equally effective in the treatment of chronic anal fissure.

Papilomatose laríngea recorrente: experiência de 10 anos

INTRODUÇÃO: Os papilomas de vias respiratórias são tumores benignos, de caráter recorrente e progressivo, induzidos por vírus. Sua etiologia está relacionada com infecções por papilloma virus humano, sendo descritas duas formas clínicas: juvenil e adulta. OBJETIVO: Comparar as duas formas de apresentação, juvenil e adulta, observando se há diferenças epidemiológicas ou clínicas entre elas. DESENHO DO ESTUDO: Coorte histórica. MATERIAL E MÉTODO: Realizou-se estudo dos pacientes atendidos na Clínica Otorrinolaringológica do HC-FMUSP com diagnóstico de papilomatose laríngea entre 1990 e 1999. Cinqüenta e um pacientes foram identificados, mas sete não confirmaram o diagnóstico. Assim, 44 indivíduos foram a base desta revisão, sendo 47,72% da forma juvenil e 52,27% da forma adulta. RESULTADOS: Não houve predomínio entre os sexos (p=0,98). A idade média de início dos sintomas foi de 5,3 anos na forma juvenil e 42,6 anos na forma adulta. A dispnéia foi mais prevalente na forma juvenil (p=0,03). A taxa de recidiva geral foi de 66%, sendo de 76,2% na forma juvenil e 56,5% na forma adulta (p=0,17). A incidência de recidiva precoce (&lt;3 meses) foi maior na forma juvenil (p&lt;0,001). Observamos 13% de transformação maligna na forma adulta da doença. CONCLUSÕES: Na forma juvenil, ocorreram recidivas precoces associadas a quadros de dispnéia, necessitando de múltiplas intervenções. Na forma adulta, também observamos alta taxa de recidivas, com índice elevado de transformação maligna. Tratamentos que aumentem o tempo entre as recidivas se fazem necessários nas duas formas de apresentação da doença.

Operation of du toit/roux for recurrent anterior dislocation of the shoulder

Restoration of stability and function of the shoulder. Recurrent posttraumatic anterior shoulder dislocation with detachment of the anterior part of the labrum and the capsule. Absence of detachment of anterior soft tissues in patients with habitual dislocation or multidirectional instability. Big Hill-Sachs lesion. Poor local skin conditions Poor general health. Anterolateral deltoperatoral approach. External rotation and exposure of the tendinous part of the subscapularis which is cut in a tongue shaped fashion. Exposure of the detachment of labrum and capsule at the scapular neck. After freshening of the rim of the glenoid labrum and capsule are fixed there with a staple. Stuture of the capsule. Reattachment of the subscapularis. Wound closure in layers. Immobilization in a shoulder-arm bandage (Gilchrist). Early functional after treatment. Clinical and radiological follow-up of 48 out of 55 operated patients after a mean of 2.8 years (1 to 10 years). Of this group 20 patients filled in a questionnaire after 11 to 12 years. The incidence of early recurrence was 2% and of late recurrence 5%. An excellent to good subjective result was reported by 90% of the patients, even at the longer follow-up.

Groin hernias ? four year results of two randomised prospective studies comparing the Shouldice operation and the Stoppa procedure using a totally pre-peritoneal laparoscopic approach (461 patients)

The aim of this study is to estimate, at a mean follow up period of 1464 days (4 years), the incidence of hernial recurrence after initial treatment by a laparoscopic approach (using a totally pre-peritoneal route-TPP) as compared with the Shouldice operation, and that of Stoppa. The patients were submitted to rigorous controls of inclusion and exclusion and were divided into two controlled studies. The operations were reviewed at one month, six months, one year and every year thereafter. The follow-up rate was 100% at one month, 90% at six months, 95% at one year, 92% at two years, 84% at three years, 79% at four years and 61% at five years. The incidence of early recurrence (one year) seems to be higher in the laparoscopic group (2.2%) as compared with the two other techniques (Shouldice 1.2% and Stoppa 0%) though this is not significant. At three years, the recurrence rate is comparable (not significant) in the three groups: 3.6% for laparoscopy, 5.1% for Shouldice, 5.2% for Stoppa. At four years, the incidence of recurrence was lower (not significant) for the laparoscopic approach 7.4% and for the two other techniques 12.5% and 10.5% respectively. Analysis of the factors for recurrence in the laparoscopic approach (TPP) made clear the determining role of the experience of the operator and of the size of the prosthesis which was used.