Predictors Of Long-term Results Research Articles

P006 The Relationship of Histological Remission With the Duration of the Anamnesis Ulcerative Colitis.

The objectives of the treatment of patients with ulcerative colitis (UC) in accordance with the STRIDE-I provision, involves endoscopic healing of the colon mucosa. Histological remission is associated with endoscopic healing, which can be a predictor of long-term results. Biological and cellular therapy is most effective in the early stages of the disease. To assess the depth of histological remission with the duration of UC. The biopsy material of 75 patients with total or left-sided UC of moderate severity and severe severity aged from 22 to 56 years (average age 31 ± 2.5 years), who were divided into groups depending on the therapy, was studied. The first group of patients with UC aged 22 to 51 years (Me-32) (n = 29) received anti-inflammatory therapy using mesenchymal stromal cell culture (MSCs) 2 million/kg; the second group of patients with UC (n = 27) aged 24 to 56 years (Me-38) received vedolizumab (VDB) according to the recommended scheme, the third group of patients with UC (n = 19) aged 27 to 52 years (Me-31) received MSCs+VDB. The achievement of histological remission was assessed by the score of Geboes (SG). In 1st group, patients who achieved histological remission (SG1) with a disease duration of more than 5 years - 14 (48.3%) patients, less than 5 years - 5 (17.2%) (95% CI 1.256 - 19.293; x2-7.635; p = 0.006). In the 2nd group of patients who achieved histological remission (SG1) with a disease duration of more than 5 years - 15 (55.5%) patients, less than 5 years - 4 (14.9%) (95% CI 1.262 - 20.615; x2-7.026; p = 0.009). In the 3rd group of patients who achieved histological remission (SG1) with a disease duration of more than 5 years - 4 (21.1%) patients, less than 5 years - 7 (36.8%) (95% CI 1.080 - 138.995; x2-4.968; p = 0.026). A statistically significant majority of patients who achieved histological remission, regardless of the therapy, had a disease duration of less than 5 years.

ROLE OF COMPUTED TOMOGRAPHY WITH PNEUMOGASTROGRAPHY IN DETERMINING THE REGRESSION GRADE OF LOCALLY ADVANCED GASTRIC CANCER AFTER NEOADJUVANT CHEMOTHERAPY

Introduction. A multimodal approach to the treatment of locally advanced gastric cancer with the addition of systemic or local treatment methods, such as chemotherapy and radiation therapy, reduces the risk of cancer recurrence, thus improving survival of patients. Advances in anticancer therapy dictate the need to develop systems for assessing tumor response to new treatment modalities.Material and Methods. The study included 162 patients with locally advanced gastric cancer who received treatment at the N.N. Petrov National Medical Research Center of Oncology from 2015 to 2018. All patients underwent subtotal gastric resection or gastrectomy with lymph node dissection and previously received neoadjuvant polychemotherapy. Patients were in the age range 30 to 80 years old. The tumor pathomorphological response to chemotherapy was assessed in all patients using a pathomorphological response rate system according to the classification of the Japanese Gastric Cancer Association (JGCA, 3rd English edition). All patients underwent computed tomography with pneumogastrography before neoadjuvant chemotherapy and immediately before surgery. For each of 162 patients, 96 qualitative and quantitative biomarkers of tumor and paragastric lymph node imaging were analyzed.Results. The accuracy of determining the tumor response rate using computed tomography with pneumogastrography was 82.6 % for TRG-0/1, 90 % for TRG-1/2, and 88 % for TRG-2/3. Discussion. The tumor pathomorphological response to treatment is a predictor of long-term results; however, it can be assessed only after analyzing the surgical specimen, and this marker cannot be used in inoperable cases and for correction of palliative chemotherapy. The study of imaging biomarkers based on quantitative and qualitative data reflecting the histopathological features of the tumor and lymph nodes can help determine the tumor regression grade and optimize treatment.Conclusion. The proposed algorithm for assessing the response grade of locally advanced gastric cancer to chemotherapy using imaging biomarkers is a promising prognostic marker and requires further study.

Age as a Predictor of Long-Term Results in Patients with Brachial Plexus Palsies Undergoing Surgical Repair.

Among other factors, like the time from trauma to surgery or the number of axons that reach the muscle target, a patient's age might also impact the final results of brachial plexus surgery. To identify (1) any correlations between age and the 2 outcomes: elbow flexion strength and shoulder abduction range; (2) whether childhood vs adulthood influences outcomes; and (3) other baseline variables associated with surgical outcomes. Twenty pediatric patients (under age 20 yr) who had sustained a traumatic brachial plexus injury were compared against 20 patients, 20 to 29 yr old, and 20 patients, 30 yr old or older. Univariate, univariate trend, and correlation analyses were conducted with patient age, time to surgery, type of injury, and number of injured roots included as independent variables. A statistically significant trend toward decreasing mean strength in elbow flexion, progressing from the youngest to oldest age group, was observed. This linear trend persisted when subjects were subdivided into 4 age groups (<20, 20-29, 30-39, ≥40). There were no differences by age group in final shoulder abduction range or the percentage achieving a good shoulder outcome. Our data suggest that age is somehow linked to the outcomes of brachial plexus surgery with respect to elbow flexion, but not shoulder abduction strength. Increasing age is associated with steadily worsening elbow flexion outcomes, perhaps indicating the need for earlier surgery and/or more aggressive repairs in older patients.

Predictors of long-term results after treatment of iliac artery obliteration by transluminal angioplasty and stent deployment.

To investigate initial and long-term success rate after percutaneous treatment of iliac artery occlusion with angioplasty and stent deployment. To investigate the influence of vascular comorbidity, lesion length, stent placement and lesion coverage as possible predictors of outcome. Between January 1994 and December 1999, 80 iliac recanalizations were performed on 78 patients, median age 61.1 +/- 11.5 (SD) years. All patients were followed up by clinical examinations, duplex ultrasound and intravenous digital subtraction angiography. Mean follow-up time was 2.0 +/- 1.53 (SD) years. Multivariate Cox regression analysis was used to determine the influence of cofactors on patency. One, 2 and 4 years after recanalization, primary patency was 78.1%, 74.5% and 64.0%; secondary patency was 88.8%, 88.8% and 77.9%, respectively. Patients with shorter occlusions, complete lesion coverage and patent ipsilateral femoral arteries had significantly longer patency rates. Complications included inguinal hematoma (n=1), technical failure (n=3) aortic dissection (n=1), embolic occlusions (n=7), gluteal claudication (n=1) and genital necrosis after subsequent urethral surgery in one patient with contralateral occlusion and ipsilateral overstenting of the internal iliac artery with subsequent stenosis. Complications were of permanent clinical significance in seven of 78 (9%) of the patients. In 17 (22%) cases, percutaneous reintervention was performed with angioplasty in the stent (n=16) or deployment of a new stent (n=1). Endoluminal stent placement has its place in an interdisciplinary therapeutic approach as a viable therapeutic alternative to major transabdominal bypass surgery and can be performed with comparable complication rates. Patients with short occlusions, patent femoral arteries, and stents covering the entire occlusion have significant longer patency.

Surgery for duodenal ulcer: A study relating indications to the results of surgery

The present study correlates the indications for operation in 215 patients with duodenal ulcer disease with the results of operative management. The majority of patients had conservative surgery utilizing truncal vagotomy and pyloroplasty or gastrojejunostomy. None of the 194 patients operated on electively died and four patients died after emergency operations, for an overall operative mortality in the entire series of 1.8 per cent. The incidence of recurrent ulcer symptoms in all patients was 10 per cent. We could demonstrate only a modest correlation between indications for operation and long-term results of conservative surgical management; the indication for surgery, whether that of chronic (intractability, stenosis) or more acute (hemorrhage, perforation) ulcer disease is only moderately reliable as a predictor of long-term results. In this series of patients, those with obstructing duodenal ulcers (pyloric stenosis) had the best long-term results after conservative surgical management.