Overall Recurrence Rate Research Articles

Can Computed Tomography Findings Predict the Recurrence of Sinonasal Inverted Papilloma?

To evaluate the correlation between the ability to predict the attachment site of sinonasal inverted papilloma by computed tomography and the long-term surgical outcome. Retrospective cohort study. Five tertiary medical centers. Study patients underwent attachment-oriented resection of inverted papilloma. The primary outcome was tumor recurrence. Among 195 patients eligible for the study, focal hyperostosis was recognized on computed tomography in 65% (n = 127), in 71% of primary cases (n = 101), and in 50% of revision procedures (n = 26). There was a trend for a higher incidence of squamous cell carcinoma among the patients without detectable hyperostosis (P = .051). Location of hyperostosis coincided with the actual tumor attachment site in 114 patients (90%). Discordance between these parameters did not differ significantly (P = .463) between 11 primary and 2 revision cases. The overall rate of recurrence was 9.7% (n = 19), with a mean time to recurrence of 20 months (range, 7-96 months). The rate of recurrence did not correlate with any of the following: tumor stage, surgical approach, presence of squamous cell carcinoma, whether the surgery was primary or revision, and the presence or location of focal hyperostosis on computed tomography. Inverted papilloma recurred significantly more often (38.5%) when the intraoperative findings of the tumor attachment site did not match the location of hyperostosis observed on computed tomography (odds ratio, 6.5; 95% CI, 1.78-23.66). Detectability of focal hyperostosis on preoperative computed tomography does not affect the long-term outcome of inverted papilloma resection.

The Effect of Prophylactic Central Neck Dissection During Hemithyroidectomy on Locoregional Recurrence in Patients With Papillary Thyroid Carcinoma: A Meta-Analysis.

Objectives.Hemithyroidectomy is commonly performed in patients with low- to intermediate-risk papillary thyroid carcinoma. The purpose of this meta-analysis was to evaluate the effect of prophylactic central neck dissection on locoregional recurrence in patients undergoing hemithyroidectomy.Methods.A meta-analysis was performed of full-text publications published in English retrieved from the Embase database.Results.The rate of regional recurrence in the central compartment after hemithyroidectomy, with or without prophylactic central neck dissection, was 0.17% and 1.78%, respectively. This difference was statistically significant. Recurrence in the lateral compartment or contralateral thyroid was not affected by prophylactic central neck dissection; the overall rate of recurrence was 1.3% and 5.4%, respectively.Conclusion.Prophylactic central neck dissection significantly reduced the risk of recurrence in the central compartment in patients undergoing hemithyroidectomy.

The Effect of Prophylactic Central Neck Dissection During Hemithyroidectomy on Locoregional Recurrence in Patients With Papillary Thyroid Carcinoma: A Meta-Analysis.

Hemithyroidectomy is commonly performed in patients with low- to intermediate-risk papillary thyroid carcinoma. The purpose of this meta-analysis was to evaluate the effect of prophylactic central neck dissection on locoregional recurrence in patients undergoing hemithyroidectomy. A meta-analysis was performed of full-text publications published in English retrieved from the Embase database. The rate of regional recurrence in the central compartment after hemithyroidectomy, with or without prophylactic central neck dissection, was 0.17% and 1.78%, respectively. This difference was statistically significant. Recurrence in the lateral compartment or contralateral thyroid was not affected by prophylactic central neck dissection; the overall rate of recurrence was 1.3% and 5.4%, respectively. Prophylactic central neck dissection significantly reduced the risk of recurrence in the central compartment in patients undergoing hemithyroidectomy.

Radiofrequency Ablation of Symptomatic Non-Functioning Benign Thyroid Nodules: An Early Experience in Egyptian Patients Using Monopolar Electrodes

Abstract Background: Thyroid nodules are noted as a common condition, some of them may need management for compres-sive effects or cosmetic reasons. As surgery has many disad-vantages, minimally invasive procedures are taking place, particularly radiofrequency (RF) ablation that proved to be safe and effective since 2006. Aim of Study: To study the safety and clinical results of (RF) ablation of benign non-functioning symptomatic thyroid nodules. Methods: We assessed 27 non-functioning benign thyroid solid nodules in 20 patients, after treatment by radiofrequency (RF) ablation and follow-up for 12 months. RF ablation was done by Cool-Tip RF system and cooled internal electrode. Nodule volume, cosmetic and symptom scores were calculated earlier prior to treatment and throughout the follow-up. We assessed all efficacy related factors and reported complications. Results: The mean follow-up duration was 11±2.6 months. The volume of the thyroid nodule decreased significantly at the final assessment from an average of 12.2ml before ablation to 6ml (p<0.001). Also there was markedly improved cosmetic and symptom ratings (p<0.001). The overall rate of recurrence was 4% (1/27). The overall rate of complication was 3% (6/20). Conclusion: RF ablation is effective in decreasing the volume of sizable benign thyroid nodules for a one year post-interventional follow-up. There were no complications that threatened life. Thus, patients with non-functioning benign thyroid nodules can be treated by RF ablation as a minimally invasive treatment.

Local recurrence and its risk factors after cold snare polypectomy of colorectal polyps.

Local recurrence after cold snare polypectomy (CSP) of colorectal polyps has not been well analyzed. In this study, we analyzed the characteristics of local recurrence. We retrospectively reviewed consecutive lesions resected by CSP from 2014 to 2016 and lesions that were followed up at ≥ 10months after CSP, were analyzed. Our indication for CSP was a benign tumor of < 15mm in size. We analyzed local recurrence and its risk factors using multivariate analyses. In addition, we compared lesions of ≥ 10mm and < 10mm. Moreover, therapeutic methods for recurrence were analyzed. Finally, we analyzed 554 cases out of 820 consecutive cases. The mean polyp size was 5.3 ± 2.8mm and the en bloc resection and histopathological complete resection rates were 99.3% and 70.2%, respectively. The overallrecurrence rate was 1.9% (mean follow-up period: 13.0 ± 4.0months). Significant differences were observed between 11 recurrent lesions and 543 lesions without recurrence regarding polyp size (8.0 ± 3.7mm vs. 5.2 ± 2.7mm, p < 0.001), rate of sessile-serrated polyp (27.3% vs. 3.0%, p < 0.001), and histopathological positive margin (45.4% vs. 3.7%, p = 0.019). Multivariate analyses showed that a histopathological positive margin was the only significant risk factor for local recurrence (OR 16.600, 95% CI 3.707-74.331, p < 0.001). Regarding the comparison between 74 lesions of ≥ 10mm and 480 lesions of < 10mm, significant differences were observed in the en bloc resection rate (93.2% vs. 100%, p < 0.001), high-grade dysplasia rate (8.1% vs. 0.8%, p < 0.001), and histopathological complete resection rate (54.0% vs. 72.7%, p = 0.001). The recurrence rates of these two groups were 5.4% and 1.4%, respectively (p = 0.069). All recurrent cases could be resected with repeat CSP. The local recurrence rate after CSP for lesions of < 10mm was 1.4%. CSP was not recommended for lesions of ≥ 10mm due to high rates of recurrence and malignancy.

Triweekly carboplatin as a potential de-intensification agent in concurrent chemoradiation for early-stage HPV-associated oropharyngeal cancer

ObjectiveWe compared high-dose cisplatin (HDC) vs. triweekly carboplatin (TC)-based chemoradiation in patients with HPV-associated oropharyngeal squamous cell carcinoma (OPSCC). Materials and MethodsA retrospective review was conducted from 2006 to 2015 of 421 patients with locally advanced p16-positive OPSCC receiving definitive radiotherapy concurrent with 3 cycles of HDC (100 mg/m2, n = 230) or TC (AUC = 5, n = 191). Three-year locoregional recurrence (LRR), distant metastasis (DM), overall recurrence rate (ORR), overall survival (OS), and cause-specific survival (CSS) are reported. HDC and TC were compared accounting for age, sex, comorbidity index score, smoking history, T stage, and N stage. ResultsFor all-comers, no difference was observed between HDC and TC for any outcome except for ORR which was lower in patients receiving HDC (12% vs. 17%, p = 0.03). On stage-based analysis, no difference was observed between agents for any outcome for stage I or II disease. However, patients with stage III disease receiving HDC had lower rates of LRR (9% vs. 21%, p = 0.03), DM (7% vs. 28%, p = 0.006), and ORR (14% vs. 40%, p = 0.002), and superior OS (89% vs. 78%, p = 0.04) and CSS (95% vs. 80%, p = 0.02). Patients receiving HDC experienced higher rates of grade 3 leukopenia (25% vs. 11%, p < 0.001), weight loss ≥20% from baseline (21% vs. 8%, p < 0.001), and gastrostomy-tube placements (66% vs. 27%, p < 0.001). ConclusionTC demonstrated comparable outcomes to HDC for stage I or II HPV-associated OPSCC but was inferior to HDC for stage III disease. TC was associated with less toxicity and may be a potential de-intensification agent for early-stage disease.

Long-term outcome and chronic pain in atraumatic fibrin glue versus staple fixation of extra light titanized meshes in laparoscopic inguinal hernia repair (TAPP): a single-center experience

Inguinal hernia repair belongs to the most frequently performed surgical procedures. Endoscopic techniques like TAPP and TEP have become standard of care together with the conventional open techniques. Especially in endoscopic techniques, there is a confusing amount of different meshes and fixation techniques with impact on perioperative and long-term outcome. We present the first single-center data on the use of titanized extra lightweight meshes and fibrin glue fixation compared to staple fixation regarding long-term outcome, especially chronic pain. A clinical trial with retrospective analysis of patient- and procedure-related data and questionnaire-based follow-up of TAPP procedures performed in 2012-2014 was conducted in a specialized hernia center. Standard TAPP technique was used with placement of TiMesh extra light (16g/m2) and either fibrin glue or staple fixation. Procedure- and patient-related data are compared after propensity score matching regarding perioperative complications and long-term outcome. Of 612 TAPP procedures 372 procedures were included in analysis after propensity score matching. Fibrin glue was used in n = 279 and staple fixation in n = 93 cases. There were significant differences regarding duration of the surgical procedures (p = 0.001) and distribution of mesh size. No differences were noted regarding perioperative complications such as seroma or hematoma formation and need for re-laparoscopy. During a mean follow-up of 32.1 ± 20.6month with a follow-up rate of 79%, there was no difference in long-term outcome, especially for rate of recurrence (p = 0.112) and development of chronic pain (p = 0.846). The overall rate of recurrence was 3.0% (n = 11), and in 2.4% (n = 9) patients complained of chronic pain. Inguinal hernia repair using extra lightweight titanized meshes and fibrin glue fixation is safe and feasible compared to staple fixation even in large and combined hernia defects, if mesh size is adjusted to size of hernia defect. The rate of chronic pain was extremely low at 2.4%.

Recurrent early stage endometrial cancer: Patterns of recurrence and results of salvage therapy

ObjectiveTo analyze our institutional experience and oncologic outcomes for salvage treatment for the recurrence of early-stage endometrial cancer patients. MethodsWe included women of all ages diagnosed with FIGO stage I-II, any grade endometrial cancer from 2000 to 2016 at our institutions who were treated with at least a hysterectomy. Recurrences in the pelvis and/or vagina were considered locoregional recurrences (LRR). Overall survival (OS) was assessed using Kaplan-Meier survival analysis. Univariate (UV) and multivariate (MV) Cox proportional hazards modeling was also used. ResultsA total of 2691 women were analyzed. The majority had endometrioid histology (91%), stage IA disease (61%), and were grade 1 (57%). With a median follow-up of 6.1 years, the overall rate of recurrence was 7.2%, and the rate of LRR was 3.7%. Women with vaginal-only recurrences had a longer median OS after recurrence (14.0 years) compared to both pelvic (1.2 years) and distant (1.0 year) failures. For women with vaginal-only recurrences, salvage radiotherapy (RT) was the only factor associated with improved OS on MVA (HR 0.1, p = .04). For women with pelvic recurrences, salvage surgery (HR 0.3, p = .01), salvage RT (HR 0.3, p < .01), and salvage chemotherapy (HR 0.4, p = .03) were associated with improved OS. ConclusionsFailure rates for women with early-stage endometrial cancer are low. Women with vaginal-only recurrences have improved OS compared to pelvic or distant recurrences. Salvage RT appears to be an important factor for treatment of women with vaginal-only recurrences. Aggressive multimodality treatment may be beneficial for women with pelvic recurrences.

Comparison of high-dose Cisplatin-based chemoradiotherapy and Cetuximab-based bioradiotherapy for p16-positive oropharyngeal squamous cell carcinoma in the context of revised HPV-based staging.

To perform a comparison of Cisplatin vs. Cetuximab in p16-positive oropharyngeal squamous cell carcinoma (OPSCC) in the context of the revised HPV-based staging. Previous reports comparing these agents in head and neck cancer have included heterogenous disease and p16-status. A retrospective review was conducted from 2006 to 2016 of patients with p16-positive OPSCC who underwent definitive radiotherapy concurrent with either triweekly Cisplatin (n = 251) or Cetuximab (n = 40). AJCC 8th Edition staging was adapted. Median follow-up for surviving patients was 40 months. On multivariate analysis for all-comers, comparing Cisplatin and Cetuximab, 3-year locoregional recurrence (LRR): 6% vs. 16% (p = 0.07), 3-year distant metastasis (DM): 8% vs. 21% (p = 0.04), 3-year overall recurrence rate (ORR): 11% vs. 29% (p = 0.01), and 3-year cause-specific survival (CSS): 94% vs. 79% (p = 0.06), respectively. On stage-based subgroup analysis, for stage I-II disease, 3-year LRR: 5% vs. 10% (p = 0.51), 3-year DM: 7% vs. 16% (p = 0.32), 3-year ORR: 10% vs. 23% (p = 0.15), and 3-year CSS: 95% vs. 82% (p = 0.38). For stage III disease, 3-year LRR: 10% vs. 40% (p = 0.07), 3-year DM: 9% vs. 43% (p = 0.07), 3-year ORR: 15% vs. 55% (p = 0.04), and 3-year CSS: 94% vs. 57% (p = 0.048). When given concurrently with radiotherapy, Cetuximab and triweekly Cisplatin demonstrated comparable efficacy for AJCC 8th Edition stage I-II p16-positive OPSCC. However, Cetuximab appeared to be associated with higher rates of treatment failure and cancer-related deaths in stage III disease. Upon availability of the RTOG 1016 trial results, analysis based on the revised HPV-based staging should be performed to confirm these findings.

Venous sinus stenting for idiopathic intracranial hypertension: a systematic review and meta-analysis

BackgroundStenting of the intracranial venous sinuses is used as a treatment in certain cases of idiopathic intracranial hypertension (IIH). Interest in, and experience of, this technique is growing, particularly in...

Clinical Outcome after Doppler-Guided Hemorrhoidal Artery Ligation and Rubber Band Ligation for Treatment of Primary Symptomatic Hemorrhoids

To compare the efficacy and clinical outcome after rubber band ligation (RBL) and Doppler-guided hemorrhoidal artery ligation (DG-HAL) for primary symptomatic (grades II and III) hemorrhoids. Fifty patients with symptomatic grades II and III uncomplicated internal hemorrhoids were randomly assigned to treatment with RBL or DG-HAL. Patients were assessed clinically for postoperative complications and recurrence through 6 months after surgery. Preoperative characteristics were similar between both groups. The main preoperative complaint was protrusion of piles followed by bleeding. The overall rate of complications was 16% after RBL (9.1% of grade II and 21.4% of grade III) and 4% after DG-HAL (6.7% of grade II and 0% of grade III). The overall rate of recurrence was 12% after RBL (9.1% of grade II and 14.3% of grade III) and 4% after DG-HAL (0% of grade II and 10% of grade III). All complications were conservatively controlled with no need for reintervention. At the end of 6 months of follow-up, the overall freedom of symptoms was 88% after RBL (90.9% of grade II and 85.7% of grade III) and 96% after DG-HAL (100% of grade II and 90% of grade III). With respect to grade of hemorrhoids (II or III), there were statistically insignificant differences between both procedures in terms of recurrence and complications. DG-HAL is safer and effective than RBL for treatment of grade III hemorrhoids, however in grade II patients, both procedures had nearly equal rate of complications despite no recurrence with DG-HAL.

Combination of Metformin and Chemotherapy Decreases the Recurrence Rates of Epithelial Ovarian Cancers: A Randomized Clinical Trial

Background: The mainstay of treatment for ovarian cancers is surgical resection and post-operative chemotherapy to minimize the chance for recurrence. Metformin has been evidenced to increase the cytotoxic effects of chemotherapy in malignant cells and tissues by altering several gene expression pathways. Objectives: This study evaluated clinical efficacy of adding metformin to chemotherapy regimen for patients with ovarian cancers. Methods: The patients were divided in two groups; the study group received 500 mg metformin 3 times a day in addition to standard chemotherapy sessions after surgical resection of the primary ovarian cancer. The control group received only the standard chemotherapeutic agents after surgery. The patients were followed for up to 4 years and recurrence rate and their disease free survival after surgical resection statistically were compared between two groups. Results: The recurrence of the primary malignancy occurred in 13.3% of the study cases versus 67.5% in control group. Disease free survival was 48 months in the study group, which was significantly longer than the control group (25.7 months). Conclusions: The results of this study demonstrate that adding metformin to the chemotherapy regimen of patients undergoing surgery for ovarian cancer can clinically improve the outcome of treatment by decreasing the overall rate of recurrence and prolonging the disease free survival in these patients.

Abstract LB-243: Precision medicine: Lung biomarkers

Abstract More than half of all new lung cancer diagnoses are made in patients with locally advanced or metastatic disease, at which point therapeutic options are scarce. It is anticipated, however, that the widespread use of Low-Dose Computed Tomography (LDCT) screening, will lead to a greater proportion of lung cancers being diagnosed at an early, operable, stage. Still, the overall rate of recurrence for surgically treated Stage I lung cancer patients is up to 30% within 5 years of diagnosis. Thus, the identification and clinical application of biomarkers of early stage lung cancer are a pressing medical need. The integrative analysis of "omic," clinical and epidemiological data for single patients is a core principle of precision medicine. Through rigorous bioinformatics and statistical analyses we have identified biomarkers of early-stage lung cancer based on DNA methylation, expression of mRNA and miRNA, inflammatory cytokines, and urinary metabolites. Beyond a more comprehensive understanding of the molecular taxonomy of lung cancer, these biomarkers can have very practical implications in the context of unmet clinical needs of early stage lung cancer patients: First, current guidelines for LDCT screening broadly include individuals based on age and history of heavy smoking. Tumor-derived circulating biomarkers in the blood and urine associated with lung cancer risk could narrow and prioritize individuals for LDCT screening. Second, a high number of nodules are identified by LDCT, of which fewer than 5% are finally diagnosed as lung cancer. Biomarkers may help discriminate malignant nodules from benign or indolent lesions. Third, the expected rise in the numbers of lung cancer patients diagnosed at an early stage will necessitate new treatment options. Circulating, urinary and tissue-based biomarkers that molecularly categorize Stage I patients after tumor resection can help identify high-risk patients who may benefit from adjuvant chemotherapy or innovative immunotherapy regimens.

Distinctions in Breast Tumor Recurrence Patterns Post-Therapy among Racially Distinct Populations.

BackgroundClinical studies have revealed a higher risk of breast tumor recurrence in African-American (AA) patients compared to European-American (EA) patients, contributing to the alarming inequality in clinical outcomes among the ethnic groups. However, distinctions in recurrence patterns upon receiving hormone, radiation, and/or chemotherapy between the races remain poorly characterized.MethodsWe compared patterns and rates (per 1000 cancer patients per 1 year) of recurrence following each form of treatment between AA (n = 1850) and EA breast cancer patients (n = 7931) from a cohort of patients (n = 10504) treated between 2005–2015 at Northside Hospital in Atlanta, GA.ResultsAmong patients who received any combination of adjuvant therapy, AA displayed higher overall rates of recurrence than EA (p = 0.015; HR: 1.699; CI: 1.108–2.606). Furthermore, recurrence rates were higher in AA than EA among stage I (p = 0.031; HR: 1.736; CI: 1.052–2.864) and T1 classified patients (p = 0.003; HR: 2.009; CI: 1.263–3.197). Interestingly, among patients who received neoadjuvant chemotherapy, AA displayed higher rates of local recurrence than EA (p = 0.024; HR: 7.134; CI: 1.295–39.313).ConclusionOur analysis revealed higher incidence rates of recurrence in AA compared to EA among patients that received any combination of adjuvant therapy. Moreover, our data demonstrates an increased risk of tumor recurrence in AA than EA among patients diagnosed with minimally invasive disease. This is the first clinical study to suggest that neoadjuvant chemotherapy improves breast cancer recurrence rates and patterns in AA.

Risk Factors for Recurrent Pedatric Community Associated Clostridium difficile Infection

BackgroundAs rates of pediatric community-associated (CA) Clostridium difficile infection (CDI) increase, additional research is needed to address the paucity of data in this cohort. Studies in pediatrics suggest concurrent antibiotics, CA CDI, malignancy, recent surgery, the number of antibiotic exposures by class and tracheostomy as independent risk factors for recurrent CDI (rCDI).MethodsThis study was a retrospective review of the electronic health records of all children 1- 17 years with stool specimens sent for C difficile from January 1st 2012 – December 31st2016 at Kaiser Permanente Northern California. Children with clinical symptoms consistent with CDI, confirmatory laboratory testing, no other identified causes of diarrhea, and community associated disease were defined as cases.ResultsOf the 961 positive C. difficile cases from 2012 to 2016, 744 were community-associated. There were 558 total cases of CA CDI fitting case definition. Of these 507 were primary, 43 recurrence and 8 recurrence following recurrence. The incident rate of CDI was 17 per 100,000 children.The overall rate of recurrence in our cohort was 8.5%. Race and having a diagnosis of inflammatory bowel disease (IBD) were statistically significant risk factors for rCDI. Compared with other races, we observed increased rates of rCDI in multi-racial and “other/unknown” children. Though not statistically significant, there appeared to be a correlation between the age subset of 2–5 years of age and developing rCDI. (Table)Table:Demographics and comorbidities in rCDITotal PrimaryRecurrence <8wk N = 507(%) N = 43(%)p-valueAge (years)0.09 1131(25.8)6(4.6) 2–5131(25.8)22(16.8) 6–1187(17.2)6(6.9) 12–17158(31.2)20(12.7)Sex0.99 Female247(48.7)21(8.5) Male260(51.3)22(8.5)Race0.02 Caucasian244(48.1)21(8.6) Hispanic133(26.2)8(6.0) Asian67(13.2)4(6.0) African American31(6.1)2(6.5) Multi-Racial23(4.5)6(26.1) Other/Unknown9(1.8)2(22.2)IBD0.02 No340(67.1)22(6.5) Yes167(32.9)21(12.6)Malignancy0.33 No477(94.1)39(8.2) Yes30(5.9)4(13.3)ConclusionHigh suspicion for recurrence must be maintained in multi-racial or non-Caucasian, Hispanic, Asian, or African American children and those with underlying IBD for rCDI in children.Disclosures All authors: No reported disclosures.

Maxillary Ameloblastoma with Orbital Involvement: An Institutional Experience and Literature Review.

To describe 8 patients with orbital involvement by ameloblastoma and to review the literature on this topic. The electronic medical records and pathology databases of the Hospital of the University of Pennsylvania were searched to identify all patients with histopathologically confirmed ameloblastoma diagnosed between 1990 and 2015. PubMed database was searched for all well-documented cases of maxillary ameloblastoma and ameloblastic carcinoma ex-ameloblastoma with orbital involvement published in the English literature. The information collected on the compiled 23 patients included age, sex, clinical presentation, imaging findings, management, tumor histopathologic features, and follow up. Review of medical records identified 8 patients with orbital involvement by ameloblastoma. Literature search yielded 15 patients with well-documented orbital involvement by ameloblastoma. Most tumors occurred in men (19 of 23, M:F = 4-5:1) with an average age of 56 years. The overall rates of recurrence, visual compromise, death, and confirmed disease-related mortality were 70% (16/23), 26% (6/23), 39% (9/23), and 22% (5/23), respectively. The initial surgical approach correlated with prognosis. The rates of recurrence, orbital exenteration, and mortality in the cohort managed with conservative surgery or partial maxillectomy were 57% (8/14), 29% (4/14), and 50% (7/14), respectively. In contrast, the patients initially managed with a radical resection had substantially lower frequencies of tumor recurrence (2/7, 29%), exenteration (1/7, 14%), and death (1/7, 14%). Malignant transformation to ameloblastic carcinoma occurred in the setting of recurrent disease in 3 patients and in 1 patient with prolonged duration of symptoms, suggestive of a long-standing tumor. Maxillary ameloblastoma can rarely involve the orbit, leading to significant ocular morbidity and occasional mortality. Prompt radical resection of the tumor has the potential to decrease the likelihood of recurrence and visual compromise, and can improve survival.

Outcomes of corticosteroid prophylaxis for hypersensitivity reactions to low osmolar contrast media in high-risk patients

BackgroundCorticosteroid prophylaxis has been widely adopted for the prevention of acute allergic-like reactions to iodinated contrast media, but its use is still controversial because there is no strong evidence supporting its efficacy before administration of nonionic low osmolar contrast media (LOCM). ObjectiveTo assess the outcomes of premedication in patients with previous acute allergic-like reactions to LOCM in clinical practice. MethodsA retrospective study was performed on 322 high-risk patients who were reexposed to LOCM after premedication composed of antihistamines and/or systemic corticosteroids because of a previous history of acute allergic-like reactions to LOCM. ResultsAfter premedication, 275 patients (85.4%) did not experience any reaction, but 47 patients (14.6%) still experienced a breakthrough reaction. The premedication rate and amount of corticosteroid administered were significantly higher in the nonrecurrence group than in the recurrence group (P = .04 and P = .04, respectively), and a linear trend was observed in the use of corticosteroid premedication and the efficacy of prevention (P for trend = .02). Multivariate binary logistic regression revealed that corticosteroid premedication was effective in preventing recurrence (odds ratio, 0.284; 95% confidence interval, 0.103–0.784). Nonetheless, despite corticosteroid premedication, 3.4% of high-risk patients still experienced moderate to severe reactions, and 14.3% of patients with a severe index reaction again had a severe reaction. ConclusionPremedication with corticosteroids seems to be helpful in reducing the overall rate of recurrence of acute allergic-like reactions to LOCM in high-risk patients, but patients with severe index reactions are still at risk of developing severe reactions despite corticosteroid premedication.

Patient outcomes following surgical management of multinodular goiter: Does multinodularity increase the risk of thyroid malignancy?

Background:the difference in the risk of thyroid malignancy for patients with multinodular goiter (MNG) and solitary nodular goiter (SNG) remains controversial. Although total thyroidectomy (TT) is the current preferred surgical option for MNG, permanent hypothyroidism in these patients may be a concern. Therefore, we discuss whether nontotal thyroidectomy is a reasonable alternative surgical option.Methods:A retrospective cohort study was performed for 1598 consecutive patients who underwent thyroid surgery for nodular goiter between January 2007 and December 2012. Numerous clinical parameters were collected and analyzed.Results:We reviewed 795 patients with MNG and 803 patients with SNG. The prevalence of malignancy on final pathology was significantly higher in the patients with MNG than in the patients with SNG (15.6% vs 10.1%, P = 0.001). However, a multivariate analysis revealed that this difference was insignificant (P = 0.50). Papillary carcinoma was the predominant type in both groups, but papillary microcarcinoma was more frequently found (41.1%) in the patients with MNG. The only multifocal cancers were of the papillary carcinoma histologic type, and the incidence of multifocal papillary carcinoma was significantly higher in the patients with MNG (23.4% vs 7.4%, P = 0.005). Reoperation was not required for the patients who underwent TT for goiter recurrence or incidental carcinoma. The overall rate of recurrence following nontotal thyroidectomy was 12.2%. Among the patients who underwent reoperation for goiter recurrence, 2 (20.0%) were complicated with permanent hypoparathyroidism. Among the patients who underwent a nontotal bilateral thyroidectomy, an average of 56.5% had permanent hypothyroidism.Conclusions:Multinodularity does not increase the risk of thyroid malignancy. However, patients with MNG who develop papillary carcinoma are at an increased risk of cancer multifocality. If a patient can tolerate lifelong thyroid hormone replacement, TT is the preferred surgical option because it helps avoid reoperation and the associated complications. Nontotal bilateral thyroidectomy does not ensure the preservation of thyroid hormone function.

A Comparative Analysis of Outcomes of Pterygium Surgery with or without Collagen Matrix Implantation

Background: Pterygium is a common disorder in many parts of the world, with reported prevalence rates ranging from 0.3 to 29%. Epidemiological studies have proposed an association with chronic exposure to sunlight and an increased geographical prevalence within a peri-equatorial ‘pterygium belt’ region (1). Pterygium excision is often combined with various adjunctive measures to prevent its recurrence, however recurrenece is still the most common post-surgical complication. Numerous techniques have been attempted to reduce localized fibrovascular activity and the overall rate of recurrence; these include, β-irradiation, conjunctival and limbal auto-grafting, antimitotic drugs and amniotic membrane transplantation (2). In recent years, a novel bioengineered product has been advocated for preventing recurrence and has shown promising outcomes in animal models This study was conducted to compare the effect of collagen matrix implant with conjunctival autograft following pterygium surgery (treatment group) with only conjunctival autograft following pterygium surgery (control group). Methods: Following informed consent, sixty eyes of 60 patients (females = 23, males =37, aged 23–67 years) were randomly allocated into two equal groups. Pterygia of all patients were excised and conjunctival autograft was done. However, for patients in the treatment group a 1×3 mm collagen matrix graft (Ologen) was implanted subconjunctivally under the graft. Patients were followed up for six months. The parameters studied were patient comfort, foreign body sensation, dellen formation, pterygium recurrence and time for absorption of the collagen matrix. Results: Results revealed that no eyes in the control group and one eye in the intervention group developed recurrence; dellen formation not was observed in any patient in both groups. Patient comfort and foreign body sensation did not differ significantly in both groups. Three eyes in treatment group developed a tenon’s cyst. In 12 out of 30 eyes, the collagen matrix was not absorbed at six months post surgery. Conclusion: In conclusion, the use of biodegradable collagen matrix implants (Ologen) following pterygium excision did not seem to be associated with a lower risk of recurrence. Moreover, tenon’s cyst formation and persistence of the matrix subconjunctivally was observed. Further studies with adequate sample size are recommended for more comprehensive conclusion.

Integration of multiple “OMIC” biomarkers: A precision medicine strategy for lung cancer

More than half of all new lung cancer diagnoses are made in patients with locally advanced or metastatic disease, at which point therapeutic options are scarce. It is anticipated, however, that the widespread use of Low-Dose Computed Tomography (LDCT) screening, will lead to a greater proportion of lung cancers being diagnosed at an early, operable, stage. Still, the overall rate of recurrence for surgically treated Stage I lung cancer patients is up to 30% within 5 years of diagnosis. Thus, the identification and clinical application of biomarkers of early stage lung cancer are a pressing medical need. The integrative analysis of “omic,” clinical and epidemiological data for single patients is a core principle of precision medicine. Through rigorous bioinformatics and statistical analyses we have identified biomarkers of early-stage lung cancer based on DNA methylation, expression of mRNA and miRNA, inflammatory cytokines, and urinary metabolites. Beyond a more comprehensive understanding of the molecular taxonomy of lung cancer, these biomarkers can have very practical implications in the context of unmet clinical needs of early stage lung cancer patients: First, current guidelines for LDCT screening broadly include individuals based on age and history of heavy smoking. Tumor-derived circulating biomarkers in the blood and urine associated with lung cancer risk could narrow and prioritize individuals for LDCT screening. Second, a high number of nodules are identified by LDCT, of which fewer than 5% are finally diagnosed as lung cancer. Biomarkers may help discriminate malignant nodules from benign or indolent lesions. Third, the expected rise in the numbers of lung cancer patients diagnosed at an early stage will necessitate new treatment options. Circulating, urinary and tissue-based biomarkers that molecularly categorize Stage I patients after tumor resection can help identify high-risk patients who may benefit from adjuvant chemotherapy or innovative immunotherapy regimens.