Mean Lag Time Research Articles

A systematic review of the characteristics of thyroid metastases from clear cell renal cell carcinoma.

e16113 Background: Thyroid gland is an uncommon site for metastases from clear cell renal cell carcinoma (CCRCC) and literature is scarce. Due to the variable and often long lag time before development of metastases in patients with CCRCC, thyroid nodules may be misdiagnosed initially as benign. This systematic review aims at a better understanding of the nature of these metastases. Methods: A bibliographic search was performed using PubMed (1990-2019), key words being “renal cell carcinoma, thyroid, kidney cancer, clear cell.” 147 cases were analyzed. The patient’s characteristics assessed were: age, sex, stage, size of metastases, lag time, diagnostic modality, initial symptoms, treatment and outcome in last documented follow up. Binary logistic regression, spearman and ANOVA were performed to identify differences between the existing variables. Results: The mean age (±SE) was 64± (10) years in males and 64 (±11) in females. The mean lag time to diagnosis of thyroid metastasis was 8.7 (±6.3) years. Gender distribution of the patients was 46.3% male, 52.4% female. There was a weak correlation between lag time and size of metastases, not statistically significant. Size of metastases was significantly higher in symptomatic patients (6.06±3.51cm) compared to those with painless mass (4.6±0.29cm) and asymptomatic ones (3.93±1.99cm) (p = 0.03). Fine Needle Aspiration (FNA) was diagnostic in 29.4% of cases, 47.1% were non diagnostic. Most patients (80.3%) underwent thyroid surgery. At 1 year follow up, 55.6% of patients operated were alive versus 35.3% who did not have surgery, though this was not statistically significant (p = 0.1). Conclusions: A larger size of thyroid metastasis was more likely to present with symptomatology. A high index of suspicion is warranted when evaluating thyroid nodules in CCRCC patients. There was no significant difference in outcome between patients who underwent surgery and those who did not. With the wider use of immune check-point and tyrosine kinase inhibitors in metastatic CCRCC, surgery may eventually be reserved only for palliative purposes.

Long-Term Lung Function and Exercise Capacity in Postinfectious chILD.

Background: Severe postinfectious diffuse pulmonary disease may clinically mimic other entities of children's interstitial lung disease and is clinically challenging comprising various disease severities despite treatment. Long-term lung function trend and physical capacity in children with postinfectious diffuse pulmonary disease are rarely reported. We investigated trends in pulmonary function by long-term follow-up and assessed physical capacity in such patients.Methods: We performed a descriptive, single-center follow-up study in children with biopsy-verified postinfectious diffuse pulmonary disease. Patients with completed primary treatment course were eligible for follow-up, including pulmonary function and exercise (VO2peak) testing.Results: Thirty patients with postinfectious diffuse pulmonary disease were identified and included. Median (range) age at diagnose was 27.5 (2–172) months after a mean lag time of 23 months. H. influenzae and rhinovirus were the most frequent pathogens. Fifteen patients were available for follow-up after mean (range) 7.6 (2–15) years of treatment completion. Lung clearance index (LCI2.5), forced expiratory volume in 1 second (FEV1), and bronchodilator responsiveness were abnormal in 80%, 53%, and 44%, respectively. Diffusion capacity for monoxide was abnormal in 7% and total lung capacity in 33%. Only 8% demonstrated low VO2peak, while 40% reported difficulties during physical exertion. Longitudinal data on spirometry (n = 14) remained unchanged from end of treatment throughout follow-up. A significant association was found between zLCI2.5 and zFEV1 (multiple linear regression; r2 = 0.61; P = 0.0003).Conclusion: Postinfectious diffuse pulmonary disease in children carries a varying degree of chronic pulmonary impairment with onset of symptoms in the first months of life and a typical considerable lag time before diagnosis. Follow-up several years after the initial injury demonstrated moderate-to-severe peripheral airway impairment although no further lung function decline was found years after completion of treatment. Despite acceptable VO2peak, a considerable proportion struggled during heavy exercise.

Osteoradionecrosis of the Temporal Bone: An Evidence-Based Approach.

To perform a systematic review evaluating etiologies, associated complications, and management of osteoradionecrosis of the temporal bone (ORNTB). The authors searched the PubMed, Embase, and Cochrane Library databases for relevant literature. Patient demographics, etiologies, treatments, and other clinical characteristics were obtained. Treatment success was defined as resolution of symptoms at last follow-up. Results were reported using the preferred reporting systems for systematic reviews and meta-analysis (PRISMA) guidelines. Thirty-eight studies encompassing 364 patients with ORNTB were identified. The most common etiologies necessitating radiotherapy included: nasopharyngeal carcinoma (n = 133 [36.8%]), parotid tumors (n = 73 [20.2%]), and external auditory canal pathology (n = 59 [16.3%]). The mean dose of radiation was 58.0 Gy. The mean lag time between radiotherapy and osteoradionecrosis (ORN) symptoms was 7.9 years. The most common presenting symptoms were purulent otorrhea (33.3%), hearing loss (29.1%), and otalgia (17%). ORNTB complications included tympanic membrane perforation (n = 102 [63.8%]) and chronic otitis media (n = 16 [10%]). Treatments included lateral temporal bone resection (n = 99 [28.3%]), conservative treatment (n = 92 [26.3%]), and mastoidectomy (n = 82 [23.5%]) with 90.9, 89.13, and 59.76% considered successful, respectively. ORNTB is a rare complication of radiotherapy that may present years after initial radiation exposure. Management should be aimed at relief of presenting symptoms and treatment of ORNTB associated complications. Both conservative and surgical measures may adequately control the disease process and symptomatology; however, randomized controlled studies comparing treatments would serve to further corroborate these findings.

Targeted next generation sequencing for the diagnosis of patients with rare congenital anemias.

Most patients with anemia are diagnosed through clinical phenotype and basic laboratory testing. Nonetheless, in cases of rare congenital anemias, some patients remain undiagnosed despite undergoing an exhaustive workup. Genetic testing is complicated by the large number of genes involved in rare anemias and the similarities in the clinical presentation of the different syndromes. We aimed to enhance the diagnosis of patients with congenital anemias by using targeted next-generation sequencing. Genetic diagnosis was performed by gene capture followed by next-generation sequencing of 76 genes known to cause anemia syndromes. Genetic diagnosis was achieved in 13 out of 21 patients (62%). Six patients were diagnosed with pyruvate kinase deficiency, 4 with dehydrated hereditary stomatocytosis, 2 with sideroblastic anemia, and 1 with CDA type IV. Eight novel mutations were found. In 7 patients, the genetic diagnosis differed from the pretest presumed diagnosis. The mean lag time from presentation to diagnosis was over 13years. Targeted next-generation sequencing led to an accurate diagnosis in over 60% of patients with rare anemias. These patients do not need further diagnostic workup. Earlier incorporation of this method into the workup of patients with congenital anemia may improve patients' care and enable genetic counseling.

The Influence of Race on Plasma Thrombin Generation In Healthy Subjects In Singapore.

Race is touted as an independent risk factor for venous thromboembolism (VTE), although the basis for this is varied and contentious. Comparison of plasma thrombin generation (TG) using calibrated automated thrombogram (CAT) across races offers a modality that objectively measures global hemostatic function to evaluate this influence. Direct comparative data across races are currently not available. Aim is to establish the influence of race on plasma TG. Sixty normal participants, matched for age and gender, equally representing 4 races—Caucasian, Chinese, Indian, and Malay—were recruited. Thrombin generation parameters (lag time, time to peak, peak, and endogenous thrombin potential [ETP]) in platelet-poor plasma were measured using CAT. The mean ETP (standard deviation) for the different races were Caucasians: 1338.18 (194.19) nM·min; Chinese, 1318.91 (108.90) nM·min; Indians, 1389.81 (182.61) nM·min; and Malays, 1436.21 (184.24) nM·min. Caucasians had the longest mean lag time of 2.59 ± 0.37 seconds; Indians had the highest mean peak of 284.22 ± 30.74 nM, and Malays had the longest mean time to peak of 5.47 ± 0.59 seconds. Analysis based on race did not demonstrate any significant difference for all TG parameters. The greatest mean difference of ETP between any 2 races (Malays and Chinese) was 117.30 nM·min (95% confidence interval: −45.86 to 280.46 nM·min) which was within the predefined limit of equivalence. In a cohort of healthy participants, TG mediated by plasma factors is not influenced by race and does not explain the reported racial differences in VTE incidence. For the 4 racial groups studied, the use of separate normal ranges for plasma TG might not be essential.

High serum lactate as an adjunct in the early prediction of anastomotic leak following oesophagectomy

BackgroundAnastomotic leak (AL) following oesophagectomy carries a high mortality and morbidity. Early detection and intervention is required for a successful outcome. We have examined the role of a high postoperative serum lactate in predicting which patients are at risk of developing an anastomotic leak(AL). Materials and methodsAll patients who underwent transthoracic oesophagectomy over a 3-year period were identified from a prospectively collected database. Medical records were reviewed to identify the highest serum lactate recorded from blood gas analysis over each 24hr post-operative period. Patients who underwent transhiatal and left thoraco-abdominal oesophagectomies were excluded. Patients who developed a chyle leak were excluded. ResultsOf a total of 136 oesophagectomies included for analysis, 18 developed an AL (13.2%). Of these patients, 10 underwent thoracoscopic oesophageal mobilization with cervical anastomosis and the rest an Ivor Lewis procedure.Predictive factors for AL included neoadjuvant chemotherapy (15/18 83.3% vs 55/118 46.6% p = 0.0046) and number of positive lymph nodes (mean 4.2 vs control mean 2.3 p = 0.045). Overall net fluid balance was comparable between the 2 groups, although AL patients received slightly more fluid on Day 3. High lactate levels on days 1–3 were associated with an AL. Using a Day 2 lactate of 1.7 mmol/L, the sensitivity of predicting AL was 72% and specificity 88%. The mean lag time using existing diagnostic modalities was 7.9 days. ConclusionA serum lactate of >1.7 mmol/l on day 2 should raise the possibility of a potential AL. Such patients should be selected for more intensive monitoring, optimization and selective gastroscopy.

Patients’ perspective on current treatment options for Parkinson’s Disease

To date, current data on the treatment situation of patients with Parkinson’s disease (PD) are limited. Therefore cross sectional surveys in 4485 patients and in addition, in office based neurologists, were performed. Patients were questioned about their disease history and current treatment, as well as their therapy satisfaction.The mean lag time between first diagnosis of PD and the first prescription of medication was in 68.9% of patients less than 3 months, in 15.6% between 3 and 6 months, in 7.1% 7 to 12 months, in 3.3% up to 2 years, and in 3.1% more than 2 years. Patient rated themselves in 9.7% to be in the initial course of PD, 44.3% in a progressed stage and 41.3% in an advanced stage. The success of therapy rated 4.9% as very good, 22.6% as good, 43.4% as satisfactory, 23.0% as unsatisfactory, and 2.1% as poor (4.1% no response).Treatment success was dependent on motor symptoms in the view of 51.3% of patients, on non-motor symptoms in 6.5%, in 23.4% with cognitive ability, in 57.0% with quality of life and in 21.5% with impairment caused by medication. With respect to current therapy 41.8% of patients were affected by frequency of drug intake, 3.2% by type of administration, 12.3% by number of drugs, 27.7% by unsatisfactory efficacy, and 41.3% by side effects (several answers possible).Overall, only 27.5% of patients rated their current PD medication as very good or a good, in contrast to the physicians (treatment success very good or good in 75.8%). Physicians named control of motor symptoms (89.7%) and quality of life (86.7%) as key criteria for successful therapy.In summary, PD patients report deficits in drug treatment. There is a clear need for action with regard to the information transfer to patients (including the explanation of side effects or differentiation of symptoms of the PD) and possibly for a change of the medication schedules including other drugs or combination therapies.

Kaplan-Meier Meets Chemical Kinetics: Intrinsic Rate of SOD1 Amyloidogenesis Decreased by Subset of ALS Mutations and Cannot Fully Explain Age of Disease Onset.

Over 150 mutations in SOD1 (superoxide dismutase-1) cause amyotrophic lateral sclerosis (ALS), presumably by accelerating SOD1 amyloidogenesis. Like many nucleation processes, SOD1 fibrillization is stochastic (in vitro), which inhibits the determination of aggregation rates (and obscures whether rates correlate with patient phenotypes). Here, we diverged from classical chemical kinetics and used Kaplan-Meier estimators to quantify the probability of apo-SOD1 fibrillization (in vitro) from ∼103 replicate amyloid assays of wild-type (WT) SOD1 and nine ALS variants. The probability of apo-SOD1 fibrillization (expressed as a Hazard ratio) is increased by certain ALS-linked SOD1 mutations but is decreased or remains unchanged by other mutations. Despite this diversity, Hazard ratios of fibrillization correlated linearly with (and for three mutants, approximately equaled) Hazard ratios of patient survival (R2 = 0.67; Pearson's r = 0.82). No correlation exists between Hazard ratios of fibrillization and age of initial onset of ALS (R2 = 0.09). Thus, Hazard ratios of fibrillization might explain rates of disease progression but not onset. Classical kinetic metrics of fibrillization, i.e., mean lag time and propagation rate, did not correlate as strongly with phenotype (and ALS mutations did not uniformly accelerate mean rate of nucleation or propagation). A strong correlation was found, however, between mean ThT fluorescence at lag time and patient survival (R2 = 0.93); oligomers of SOD1 with weaker fluorescence correlated with shorter survival. This study suggests that SOD1 mutations trigger ALS by altering a property of SOD1 or its oligomers other than the intrinsic rate of amyloid nucleation (e.g., oligomer stability; rates of intercellular propagation; affinity for membrane surfaces; and maturation rate).

Early rising asexual parasitaemia in Nigerian children following a first dose of artemisinin-based combination treatments of falciparum malaria

BackgroundEarly rising asexual parasitaemia (ERAP), initially defined as ‘an increase in the parasite count over the baseline pre-treatment level during the first 24 h of treatment’ of falciparum malaria with artemisinin derivatives is well documented, but there is no characterization of its risk factors, kinetics, molecular features or relationship to late-appearing anaemia (LAA) in acute falciparum malaria in African children following oral artemisinin-based combination therapies (ACTs).MethodsERAP was defined as ≥5% increase in pre-treatment parasitaemia within 8 h of initiating treatment. Parasitaemia was quantified pre-treatment and 1–2 hourly for 8 h, and less frequently thereafter for 6 weeks following randomized treatment of acutely malarious children with artesunate-amodiaquine, artemether-lumefantrine or dihydroartemisinin-piperaquine. Risk factors were determined by stepwise multiple logistic regression model. Kinetics of release into and of elimination of asexual parasites and DNA clones from peripheral blood were evaluated by method of residuals and non-compartment model, respectively. Parasite population changes were evaluated morphologically and by molecular genotyping.ResultsERAP occurred in 205 of 416 children. A parasitaemia <100,000/μL and parasitaemia 1 day post-treatment initiation were independent predictors of ERAP. In children with ERAP: mean and peak time of increase in parasitaemia were 105.6% (95% CI 81–130.1) and 2.5 h (95% CI 2.2–2.7), respectively. Mean lag time, half-time and rate constant of release were 0.2 h (95% CI 0.2–0.3), 1 h (95% CI 0.9–1.1), and 0.9 h−1 (95% CI 0.8–1), respectively. Schizonts and young gametocytes were seen only in peripheral blood of few children with ERAP. In age-, gender-, baseline parasitaemia- and treatment-matched children with and without ERAP, parasite DNA clearance time and area under curve of number of DNA clones versus time were significantly higher in children with ERAP indicating peripheral retention of released parasites followed by elimination. DNA clone elimination was monoexponential.ConclusionERAP is common, occurs rapidly as first order process and may be due to mobilization of parasites from deep tissue following a first dose of ACTs of acute childhood falciparum malaria.Trials registrationPan African Clinical Trial Registry PACTR201508001188143, 3 July 2015; PACTR201510001189370, 3 July 2015; PACTR201508001191898, 7 July 2015 and PACTR201508001193368, 8 July 2015.

Modes of presentation, management and outcome of retinoblastoma treatment at University Teaching Hospital

Objectives: To establish the presentation, management and short-term outcomes of retinoblastoma treatment at UTH from January 2006- December 2012. treatment outcomes 6 months after initiation of treatment at The statistical analyses were performed using the statistical package SPSS version 20.&#x0D; Method: This was a retrospective case series study of the modes of presentation, management of retinoblastoma and UTH from January 2006- December 2012. The data was collected from registers for the eye unit inpatient and outpatient, histopathology laboratory, pediatric oncology department as well as patients' files. The data collected included demographics, clinical presentation, histopathology reports, treatment modalities, and treatment outcome at 6 months after initiation of treatment.&#x0D; Results: There were 57 African participants in the study of which 26 (45.6%) were males and 31 (54.4%) were females. The youngest was 0.75 months old while the oldest was 132 month old. The average age of the participants was 31.1 months old (with a standard deviation of 21.96). The average time lag from the onset of symptoms to treatment at UTH was 9.27 months with a minimum of one month and a maximum of 36 months. 71.2% had unilateral retinoblastoma, 28.8% had bilateral retinoblastoma however no trilateral retinoblastoma was observed. The most common presentations were proptosis (47.3%), leukocoria (36.8%), phthisis bulbi (4%), hyphema (2%), orbital cellulitis (1%) and uveitis (1%). The common treatment regimens were enucleation and chemotherapy (28.8%), exenteration and chemotherapy (15%), enucleation, chemotherapy and radiotherapy (3.4%). Moreover, 8.5% had enucleation only whilst 3.4% had exenteration, chemotherapy and radiotherapy treatment regimen. In the study, the treatment outcomes 6 months post initiation of treatment were abandoned treatment 17.5%, while 49.2% died and 33.3% were alive.&#x0D; Conclusion: The common presentation was proptosis (47.3%) and leukocoria (36.8%). The most common treatment outcome was death, alive followed by abandonment treatment. Treatment was completed in 22% of the participants. Delay in diagnosis of retinoblastoma remains a challenge as seen in the study by the high mean lag time and late presentation. The diagnosis of retinoblastoma from the referral centers was accurate in 50 % of the patients. Awareness of retinoblastoma to primary health care givers and parents will help to improve early referrals. Further, we recommend the integration of knowledge of retinoblastoma into the curriculum of primary health care giver to facilitate quick referral of patient.

Where does hydrolysis of nandrolone decanoate occur in the human body after release from an oil depot?

Long-term therapy of nandrolone (N) is recommended to increase mineral density and muscle strength. Using a parenteral sustained release drug formulation with nandrolone decanoate (ND), therapeutic N levels can be achieved and maintained. Until now, it is unknown if hydrolysis of ND into N occurs in tissue at the injection site or after systemic absorption. Therefore, hydrolysis studies were conducted to investigate the location and rate of ND hydrolysis after its release from the oil depot.ND hydrolysis was studied in porcine tissues, to mimic the human muscular and subcutaneous tissues. Additionally, the ND hydrolysis was studied in human whole blood, plasma and serum at a concentration range of 23.3–233.3μM.ND hydrolysis only occurred in human whole blood. The hydrolysis did not start immediately, but after a lag time. The mean lag time for all studied concentrations was 34.9±2.5min. Because of a slow penetration into tissue, hydrolysis of ND is found to be very low in surrounding tissue. Therefore the local generation of the active compound is clinically irrelevant.It is argued that after injection of the oil depot, ND molecules will be transported via the lymphatic system towards lymph nodes. From here, it will enter the central circulation and within half an hour it will hydrolyse to the active N compound.

Laparoscopic Repair of Perforated Peptic Ulcer: Outcome and Associated Morbidity and Mortality.

IntroductionThe mainstay of treatment for perforated peptic ulcer is Omental patch closure. With the advent of laparoscopic surgery, this approach is being used for the treatment of perforated peptic ulcer. The aim of this study was to evaluate the outcome of laparoscopy in Firoozgar general hospital over a period of 18 months. The outcome of the laparoscopic approach and the associated morbidity and mortality, operation time, conversion rate and hospital stay were assessed.MethodsA prospective analysis of 29 consecutive patients (mean age 37.5 years; 23 men) with perforated peptic ulcers and who had undergone laparoscopic surgery was carried over a period of 18 months from March 2014 until September 2015. Pre-operative, intra-operative, and post-operative clinical data were collectively analyzed by SPSS 19 for Windows.ResultsSeventeen patients had a history of cigarette smoking, 11 patients had a history of opium consumption, 19 were chronic NSAID users, 26 had Helicobacter pylori infections, and six had a co-morbid condition. Previous surgical history included laparotomy for pancreatic cancer in two patients, for sigmoid colon cancer in one patient, and for acute appendicitis in four patients. The average operating time for all cases was 47.5 + 20 min. The mean lag time between onset of symptoms and surgery was 20.4 hours. All patients underwent laparoscopic closure of the perforation with Omental patch closure. No morbidity was observed, and none of the patients needed conversion to open surgery. One patient died after 11 months of follow-up due to the progression of underlying pancreatic cancer. The mean postoperative hospital stay was 4.2 days.ConclusionsThe results of the laparoscopic approach for perforated peptic ulcer were promising, with no conversion to open surgery, no morbidity, and mortality.

PTH-125 BSG VS UEG – Which Annual Meeting has The Highest Conversion Rate of Abstracts to Full Publication?

Introduction Abstract presentations at scientific meetings allow rapid dissemination of novel research and enables peer review before submission for publication. The percentage of abstracts that achieve full publication, however is variable ranging between 11–78% from other medical specialty meetings. This study evaluates the conversion rate of abstracts presented at the BSG annual meeting, and comperes the outcome from this national meeting with another internationally recognised gastrointestinal meeting (UEGW). Methods All abstracts presented at the BSG between 1994 and 2008 were reviewed in Nov 2012. UEGW meeting abstracts between 2009 and 2011 were reviewed in October 2014. Review dates for both the BSG and UEGW abstracts were at least 3 years post the last meeting evaluated, which is a previously reported upper limit timescale for subsequent full publication. PUBMED and EMBASE databases were reviewed using cross-referencing of first author, senior author and at least one key word from the abstract title. Abstracts and possible full publications were then examined in tandem to ensure they represented the same study. Abstracts that were withdrawn were excluded from the study. In addition to publication rates, data was collected on lag time to publication and journal impact factors. Statistical analyses were performed using contingency tables and chi squared statistics for categorical data using SPSS version 20.0. Results Over a 15 year period (1994–2008) the conversion rate of BSG abstracts to full publication was 33.4% (2273/6798, mean impact factor of published journal = 3.8). The mean lag time until publication was 23 months, with service development abstracts having the lowest conversion rate of 6.9% (8/116). Of the 6560 abstracts presented at UEGW meetings between 2009–2011, 31.0% (2033/6560) went on to full publication in indexed journals (mean impact factor = 3.93). The mean lag time between UEG abstract presentation and full publication was 16 months. The conversion rate of BSG abstracts is broadly comparable to UEGW, however it did achieve a statistically significant difference (33.4% vs.31.0% p = 0.003). Conclusion This study demonstrates that the BSG compares favourably to another internationally recognised gastroenterology meeting with regards to the outcomes of its abstracts. Findings from this work provides reassurances to researchers that submission to the BSG annual meeting is worthwhile, and that the peer-review process provided increases the likelihood of success in achieving subsequent full publication. Disclosure of Interest None Declared

Early detection of Zika virus infection among travellers from areas of ongoing transmission in China.

Nine imported Zika virus (ZIKV) infections (four through temperature monitoring and epidemiological investigation at entry and five by active surveillance tracking of index case contacts during follow-up; from Venezuela [n = 5], Samoa [n = 3] and both Samoa and Fiji [n = 1]) were detected in mainland China from February 1 to 29, 2016. The minimal incubation period lasted 5.2days, with mean lag time to diagnosis of 2.6days. Diagnosis relied on positive real-time reverse transcriptase polymerase chain reaction for ZIKV RNA in serum (n = 7), urine (n = 4) or saliva (n = 3), respectively. All cases recovered rapidly without serious complications.

Torsión anexial: presentación clínica y manejo en una serie retrospectiva de 17 años

Objetivos: Analizar y presentar la epidemiología descriptiva de pacientes con antecedente de torsión anexial. Diseño: Estudio observacional, descriptivo y retrospectivo. Institución: Hospital Universitario Doctor Peset, Valencia, España. Participantes: Mujeres diagnosticadas de torsión anexial. Intervenciones: Diagnóstico y tratamiento de 54 mujeres de entre 11 y 64 años entre el 1/02/1997 y 30/06/2014. Resultados: En las 54 pacientes incluidas, la edad media al diagnóstico fue 31,7 años; 6 (11,1%) pacientes habían sido intervenidas quirúrgicamente por patología anexial previa. El anexo más afectado fue el derecho; 34 (62,9%) pacientes presentaban masas anexiales. El síntoma de presentación en todas las pacientes fue el dolor pélvico agudo, y el tiempo medio transcurrido desde la aparición de la clínica hasta el tratamiento fue de 24 a 72 horas. En 14 (25,9%) pacientes se realizó laparotomía y en 40 (74,1%) laparoscopia; 3 (5,6%) pacientes presentaron recidiva de la torsión de forma posterior. Conclusiones: El cuadro de torsión anexial debe tenerse en cuenta en toda mujer que acude a urgencias con dolor abdominal agudo. Esta patología es considerada una urgencia quirúrgica, y un retraso en el diagnóstico y tratamiento puede dar lugar a la pérdida del anexo afecto. Hoy en día, la vía laparoscópica es la de elección para su tratamiento en estas pacientes.

Impact of Delay in Diagnosis in Outcomes in MEN1: Results From the Dutch MEN1 Study Group.

Identifying a germline mutation in the multiple endocrine neoplasia type 1 (MEN1) gene in an index case has consequences for a whole family. Eligible family members should be offered genetic counseling and MEN1 mutation testing. Subsequently, clinical screening of mutation carriers according to the guidelines should be initiated. We assessed whether there is a lag time from MEN1 diagnosis of the index case to MEN1 diagnosis of family members. In addition, we determined whether this lag time was associated with an increased morbidity and mortality risk. A cohort study was performed using the Dutch MEN1 database, including >90% of the Dutch MEN1 population >16 years of age (n = 393). Fifty-eight MEN1 families were identified, of whom 57 were index cases and 247 were non-index cases (n = 304). The median lag time in MEN1 diagnosis of family members was 3.5 (range, 0-30) years. At the time of MEN1 diagnosis, 30 (12.1%) non-index cases had a duodenopancreatic neuroendocrine tumor, of whom 20% had metastases with a mean lag time of 10.9 years, in comparison with 7.1 years without metastases. Twenty-five (10.1%) non-index cases had a pituitary tumor, of whom 80% had a microadenoma and 20% had a macroadenoma, with mean lag times of 7.2 and 10.6 years, respectively. Ninety-five (38.4%) non-index cases had a primary hyperparathyroidism with a mean lag time of 9.5 years in comparison with seven patients without a primary hyperparathyroidism with a mean lag time of 3 years (P = .005). Ten non-index cases died because of a MEN1-related cause that developed during or before the lag time. There is a clinically relevant delay in MEN1 diagnosis in families because of a lag time between the diagnosis of an index case and the rest of the family. More emphasis should be placed on the conduct of proper counseling and genetic testing in all eligible family members.

Campylobacter growth rates in four different matrices: broiler caecal material, live birds, Bolton broth, and brain heart infusion broth

BackgroundThe objective of this study was to characterise Campylobacter growth in enrichment broths (Bolton broth, brain heart infusion broth), caecal material (in vitro), and in the naturally infected live broilers (in vivo) in terms of mean lag periods and generation times as well as maximum growth rates and population (cell concentration) achieved.MethodsBolton and brain heart infusion broths and recovered caecal material were inoculated with 10 poultry strains of Campylobacter (eight Campylobacter jejuni and two Campylobacter coli), incubated under microaerobic conditions, and Campylobacter concentrations determined periodically using the ISO 10272:2006 method. Caeca from 10 flocks, infected at first thinning, were used to characterise Campylobacter growth in the live birds. Mean generation times (G) (early lag to exponential phase) were calculated using the formula: G=t/3.3 logb/B. Mean lag times and µmax were calculated using the Micro Fit© Software (Version 1.0, Institute of Food Research). Statistical comparison was performed using GENSTAT ver. 14.1 (VSN International Ltd., Hemel, Hempstead, UK).ResultsThe mean lag periods in Bolton broth, brain heart infusion broth, caecal material, and in the live bird were estimated to be 6.6, 6.7, 12.6, and 31.3 h, respectively. The corresponding mean generation times were 2.1, 2.2, 3.1, and 6.7 h, respectively; maximum growth rates were 0.7, 0.8, 0.4, and 2 generations h−1 and the maximum populations obtained in each matrix were 9.6, 9.9, 7.8, and 7.4 log10 CFU/g, respectively.ConclusionThis study provides data on the growth of Campylobacter in a range of laboratory media, caecal contents, and in broilers which may be used to develop predictive models and/or inform science-based control strategies such as the maximum time between flock testing and slaughter, logistical slaughter, and single-stage depopulation of broiler units.

Meningeal Solitary Fibrous Tumors with Delayed Extracranial Metastasis.

Background:The term solitary fibrous tumor (SFT) is preferred over meningeal hemangiopericytoma (HPC), because <i>NAB2-STAT6</i> gene fusion has been observed in both intracranial and extracranial HPCs. HPCs are now considered cellular variants of SFTs.Methods:This study analyzes 19 patients with STAT6-confirmed SFTs, who were followed for over 11 years in a single institution. Ten patients (10/19, 56.2%) had extracranial metastases (metastatic group), while the remainder (9/19) did not (non-metastatic group). These two groups were compared clinicopathologically.Results:In the metastatic group, the primary metastatic sites were the lungs (n = 6), bone (n = 4), and liver (n = 3). There was a mean lag time of 14.2 years between the diagnosis of the initial meningeal tumor to that of systemic metastasis. The median age at initial tumor onset was 37.1 years in the metastatic group and 52.5 in the non-metastatic group. The 10-year survival rates of the metastatic- and non-metastatic groups were 100% and 33%, respectively. The significant prognostic factors for poor outcomes on univariate analysis included advanced age (≥45 years) and large initial tumor size (≥5 cm). In contrast, the patients with higher tumor grade, high mitotic rate (≥5/10 high-power fields), high Ki-67 index (≥5%), and the presence of necrosis or CD34 positivity showed tendency of poor prognosis but these parameters were not statistically significant poor prognostic markers.Conclusions:Among patients with SFTs, younger patients (<45 years) experienced longer survival times and paradoxically had more frequent extracranial metastases after long latent periods than did older patients. Therefore, young patients with SFTs require careful surveillance and follow-up for early detection of systemic metastases.

Simulation and evaluation of different statistical functions for describing lag time distributions of a bacterial growth curve

The objective of this study was to simulate the lag time distribution of individual bacterial cells in a population incubated under an isothermal condition. Spores of Clostridium sporogenes PA 3679 inoculated to ground beef were incubated at 37 °C to develop a growth curve and determine its apparent lag time. The lag times of individual cells were simulated using normal, lognormal, Gumbel, gamma, Weibull, and exponential distributions. The growth process was modeled using the McKellar model. A 4th order Runge–Kutta method was used to solve the McKellar model in conjunction with the Nelder–Mead method. The objective of the numerical analysis was to search for the parameters in each lag time distribution model and the kinetic parameters (specific growth rate and mean lag time) of the growth model such that a minimized residual sum of squared errors (RSS) was found.Although different in shapes, the simulation results showed that the performance of normal, lognormal, Gumbel, and gamma distributions was practically the same when used to fit the growth curve, yielding the same estimates of initial and stationary phase bacterial concentrations, specific growth rate, and mean lag time as well as RSS. The lognormal, Gumbel, and gamma distributions of the lag times were slightly skewed to the right of the mean. The standard deviations of the lag times with these distributions were relatively small, suggesting that cells may leave the lag phase almost simultaneously. The Weibull and exponential distributions were also suitable for describing the distribution of lag times, but with larger standard deviations. In general, all these statistical distributions were found suitable for simulating the distribution of lag times of individual cells in a population.

Radiation-Induced Necrosis of the Temporal Bone: Diagnosis and Management.

To document our experience with osteoradionecrosis (ORN) of the temporal bone. Retrospective case review. Tertiary care medical center. Patients who developed exposed necrotic bone of the external auditory canal after radiation therapy to the head and neck. Temporal bone ORN was managed conservatively in all patients with a combination of systemic antibiotics, antibiotic ear drops, and in-office debridement. Three patients required surgery, two of which were for a cholesteatoma. The need for surgical intervention in the management of ORN. Twenty-three patients with ORN of the temporal bone comprise the study group. The average age of patients at the time of diagnosis was 58 years (range, 34-75 yr). The parotid gland was the most common primary tumor site (n = 10). The mean lag time from completion of radiotherapy to diagnosis of ORN was 11 years (range, 2-48 yr). The most common presenting symptom was hearing loss (n = 18), followed by tinnitus (n = 13) and otorrhea (n = 13). All 23 patients were managed conservatively with antibiotic therapy and in-office debridement of necrotic bone. None of the patients required temporal bone resection and/or free-flap reconstruction. ORN of the temporal bone is a rare adverse event that can occur after radiotherapy for a variety of neoplasms of the head, neck, and central nervous system. Conservative management, which includes directed antibiotic therapy and regular in-office debridement of necrotic bone, can adequately control the disease process and symptomatology, thus avoiding more invasive surgical interventions.