Retrospective Analysis Of Management Research Articles

Retrospective analysis of management and outcomes of patients with malignant biliary obstruction.

e16266 Background: Malignant biliary obstruction (MBO) is commonly associated with pancreaticobiliary cancers (PBCa). It increases the risk for cholangitis, hepatic failure, and deconditioning, which delays systemic therapy. This study aims to identify predictors associated with MBO outcomes after biliary decompression. Methods: This single-center, retrospective study analyzed patients with MBO from 2016-2020 who underwent biliary drainage. Patient demographics, cancer history, intervention type, and date of last follow up were obtained. Descriptive statistics were used to summarize relevant variables. Baseline characteristics were compared using Chi squared tests. Kruskal Wallis test was used to identify whether there were significant difference among multiple groups. Results: Of the 59 patients included, mean age was 62 years and 75% had PBCa. Baseline characteristics were presented in Table. The mean survival time from MBO diagnosis was 227 days (range: 16-1446). Overall, 39% survived at the end of 6 months follow up. Of the 29 patients who received chemotherapy after decompression, they were younger (57 vs 66 years old, p = 0.004). History of prior chemotherapy was significantly associated with increased 180-day mortality (OR 0.75, CI 0.58-0.97, p = 0.033). There were no differences based on sex, race, primary cancer, stage, intervention type or bilirubin levels in chemotherapy initiation or 6-month survival. In those with MBO as initial presentation of cancer, they were older, had pancreatic or biliary cancer, non-metastatic disease, unresected primary tumors, treatment-naïve, and no survival difference compared to later MBO presentation. Conclusions: Diagnosis of MBO is significantly associated with mortality (61% at 6-months) in our patient population, similar to historical controls of 40-60%. This data suggests that younger patients and those treatment naïve were associated with receipt of subsequent therapy and better 6-month survival, respectively.[Table: see text]

HEMORRHAGIC PROGRESSION OF CONTUSION IN PATIENTS WITH MILD TRAUMATIC BRAIN INJURY ON THE ROUTINE REPEAT HEAD COMPUTED TOMOGRAPHY

Computed tomography (CT) scan is a standard for the diagnosis of intracranial pathology after traumatic brain injury (TBI). Hemorrhagic progression of contusion (HPC) is frequently seen on repeat CT, but its clinical and radiological significance in case of mild TBI is not well define. The aim of the study: to evaluate the result of routine repeat head CT in patients with mild TBI and brain contusions. Materials and methods: retrospective analysis of management of patients with mild TBI (Glasgow Coma Scale (GCS) score – 13 to 15) and cerebral contusion. All patients were treated at the Kyiv City Clinical Emergency Hospital between 2016 and 2017. Results: within 202 patients with mild TBI, 87 (43.1 %) met the inclusion criteria and were selected for detailed analysis. There were 69 (79.3 %) men and 18 (20.7 %) women. The mean age of the patients was 43.8±12.7 years (17–82 years). The average time between trauma and CT was 3.3 hours. The average volume of contusion on the initial CT was 1.9±0.6 cm3 (0.2–9.6 cm3). The average time of routine CT was 6.8 hours (range 4–24 hours) after the initial scans. HPC was found in 24 (30.7 %) of 87 cases. The average volume of brain contusion on the repeat CT was 2.3±0.5 cm3 (0.2-17.1 cm3). In 3 (3.4 %) patients the size of the hematoma increased. Clinical deterioration occurred in 10 (11.5 %) patients. Six (6.9 %) patients were operated after a CT scan due to HPC with midline shift in 4 cases and increasing of subdural hematoma – 2 cases. Four of these patients had clinical deterioration, and 2 patients were neurological stable. Patients with HPC at admission had lower points of GCS, fractures of the skull (both p <0.001), subdural blood collection (p=0.002), a higher average duration of treatment 8.1±4.2 vs 14.3±5.2 days (p=0.0001), and mortality rate 0 vs. 3 (12.5 %) (p=0.02). Conclusions: Routine repeat CT in patients with mild TBI with brain contusions is aimed to find a patients with s high risk for clinical deterioration. One third of patients with mild TBI and brain contusion experienced HPC. Patients with HPC often have unfavorable clinical course with higher average duration of treatment, delay surgical treatment and mortality rate.

Retrospective analysis of management and outcome of advanced soft tissue sarcomas (STS) with rare histology.

e23564Background: There is sparse data for the management and outcome of rare histology advanced STS Methods: Retrospective database from 2015-January 2018 was analyzed, rare advanced STS (15%) wer...

Retrospective analysis of management for primary leiomyosarcoma of inferior vena cava

To study the treatment strategy and survival of patients with primary leiomyosarcoma of inferior vena cava (PIVCLMS). Clinical data of 12 cases with PIVCLMS admitted in Peking University People's Hospital from January 2006 to September 2014 were reviewed retrospectively. All cases were confirmed by pathology examination. Among them, there were 4 male and 8 female patients with a mean age of (54 ± 9) years old. Tumors arose from the inferior vena cava (IVC) upper segment in 5 patients, from the middle in other 7 patients. Cardiac extension was observed in 4 cases. Tumor resection was undertaken in 8 patients, the other 4 patients were inoperable. The series was analyzed to identify clinical outcome of surgical strategy and protective factors for patient survival. In tumor resection group, 6 patients had radical resection and 2 underwent palliative resection. As for IVC reconstruction, caval wall resection with a direct suture was carried out in 6 patients or with prosthetic patch in 1 patient. The other 1 patient underwent a segment caval resection and prosthetic graft replacement in situ. In 4 cases of suprahepatic PIVCLMS cardiopulmonary bypass or perfusion by right atrial intubation was performed to assist bleeding control and maintain circulation stabilization, among them 1 patient survived for more than 101 months with no tumor recurrence or metastasis. Among the patients submitted to tumor resection 2 early postoperative deaths occurred, and another 2 patients had complications. All 4 patients submitted to non-resective operation (only neoplasm biopsy) died of PIVCLMS within 8 months. Except for 2 cases of early death, mean survival after tumor resection was (54 ± 40) months. Two patients presented local recurrence and hepatic metastasis at follow-up of 16 months and 68 months. Tumor resection is the only therapy for PIVCLMS with an expectation for long-term survival. The applicant of cardiopulmonary bypass makes some inoperable indicated to tumor resection.

Anorectal malignant melanoma: retrospective analysis of management and outcome in a single Portuguese Institution.

Anorectal melanoma is an uncommon cancer with a poor prognosis. We aim to describe the clinical presentation, treatment and outcome of patients with anorectal melanoma in our center. Retrospective study of patients withanorectal melanomatreated between 2000 and 2011 at a cancer center in Lisbon. Ten patients were identified, eight females and two males, with median age 70.5years (32-79). Symptoms at presentation were rectal bleeding (8), anal pain (4) and discomfort (3). Tumor location was anal (6), rectal (3) and anorectal transition (2). Seven patients had surgery: abdomino-pelvic resection (5) and local resection (2). Among the two patients who underwent local resection, one was an incidental finding in a hemorrhoidectomy specimen. This patient had further adjuvant chemotherapy (dacarbazine). Three patients had distant metastasis at diagnosis, one had chemotherapy and two had best supportive care. Six of the sevenoperated patients relapsed in a median time of 5.4months: distant metastasis (4), local recurrence (1), both (1). The two local relapse patients had surgical widening of resection margins (1) and radiotherapy (2). One-year survival was 30%; 3-year survival was 20%. Anorectal melanoma has a poor prognosis due to advanced disease at presentation and aggressive course, with relapse in almost all operated patients. Treatment guidelines have not been established due to the lack of randomized studies. However, recent studies show that sphincter-sparing surgical procedures along with low dose intensity radiotherapy seem to achieve a local control similar to abdomino-pelvic resection. No systemic therapy is considered standard of care for advanced disease, and regimens are extrapolated from cutaneous melanoma experience.

Retrospective analysis of management of patients with hyperhidrosis in a general dermatology clinic over a 6-year period

Retrospective analysis of management of patients with hyperhidrosis in a general dermatology clinic over a 6-year period

Retrospective analysis of management of inpatient adults with community-acquired pneumonia (findings of medical reports)

A retrospective comparative trial was performed to analyze management of adult patients with community-acquired pneumonia (CAP) hospitalized to a large clinical hospital of Moscow from January, 2006, to December, 2006. The study involved 42 in-patients with CAP (21 of them were discharged and 21 died). Time period from the onset of the disease to the hospital admission was 9.5 (95 % CI 6.4–12.6) days without a significant difference between the groups. Death occurred in 6.7 (95 % CI 2.7–10.7) days in average after presentation. Factors influencing the course of CAP in inpatient adults were inadequate and / or delayed antibacterial treatment before the admission, underestimation of severity of the disease in presentation to the hospital, uncommon use of computed tomography of the lungs to diagnose complications of CAP, poor adherence to current guidelines for management of patients with CAP

Cervical myelopathy and rheumatoid arthritis: a retrospective analysis of management.

Although a number of recent studies have described the outcome of surgical treatment of patients with rheumatoid cervical myelopathy, few have reported outcome in those unable to have surgery. We sought to examine the outcome in this group of patients regardless of surgical intervention. Retrospective and descriptive. Department of Rheumatology, Freeman Hospital, Newcastle upon Tyne, UK. Retrospective review of case notes of 40 patients (31 females, 9 males) with rheumatoid cervical myelopathy diagnosed 1988-1997. The mean age was 64 years (range 36-80 years). The mean duration of rheumatoid arthritis (RA) before the development of myelopathy was 21 years (range 5-44 years). The common impairments were paraesthesia in the arms, neck pain and weakness. Twenty-five patients (60%) were deemed fit for surgery (group I). Twenty-two patients successfully had operative treatment and the others refused. Twelve of the 15 patients who reported pain preoperatively obtained pain relief. Six of the 11 patients who were nonambulant (Ranawat class IIIB) were able to walk postoperatively. There were two deaths within six months (9% mortality) after primary surgery due to pneumonia and sepsis. Seven of the 15 patients managed conservatively (group II) because of coexisting medical complications died within six months of presentation (47% mortality). The study confirms the overall benefit of surgical intervention in those who are medically stable. Following surgery some functional improvement may occur even in patients with severe myelopathy.

Prise en charge du cancer du sein à Madagascar

Purpose. – Retrospective analysis of management and outcome of breast cancer in Madagascar. Patients and methods. – From January 1996 to December 1998, 259 women with breast cancer were seen in the only department of oncology of the island, located in Antananarivo. It is equipped with a cobalt unit (unavailable in 1996). There was no uniform policy on surgery. Chemotherapy and hormonotherapy were not available for all patients. Reduced equipment enabled a minimal pre-therapeutic workshop. Results. – Mean age was 48.5 years. One hundred and fifty-six women were premenopausal. The majority (69%) lived less than 50 km from the department. Tumours were at an advanced stage in 67% of the cases; the mean delay for diagnosis was 9.4 months. Treatments were done with curative intent in 118 cases and with palliative intent in 64 cases. Partial surgery (89) was adequate in 40.5% of the cases; total mastectomy concerned 94 women. Axillary lymph node dissection was done in 94 cases and was positive in 76 cases. The number of involved nodes was noticed in 47 cases. Curative radiotherapy concerned 106 patients, 41 after total mastectomy and 44 after lumpectomy, and was exclusive in 21 cases. Palliative irradiation was done locally with hypofractionation for 35 patients. Chemotherapy was performed in 86 women. The 4-year survival of the 136 assessable patients was 73%. Conclusion. Improvement in breast cancer treatment outcome in Madagascar is the result of earlier diagnosis of the disease. Information and education of the population together with caregivers are necessary, because updating and improving technical equipment is not currently possible due to the economic problems that the country has to face.