Ten-year Single Center Research Articles

Congenital central nervous system anomalies: Ten-year single center experience on a challenging issue in perinatal medicine

Objective:Our goal was to highlight the prenatal diagnosis and management of central nervous system (CNS) anomalies through sharing our clinic’s experience.Material and Methods:We evaluated prenatal findings and postnatal outcomes of neonates who had a CNS anomaly diagnosis in our clinic over a ten-year period. A total of 183 cases with various CNS anomalies were included in the study. Birth or termination preferences of mothers were recorded in all cases, and postnatal diagnosis concordance and prognosis after surgical procedures were evaluated in mothers who chose to continue the pregnancy.Results:The mean maternal age was 28.2±5.5 years, mean gravida was 2.2±1.3, and the mean gestational age at diagnosis was 30.5±5.5 weeks. Seventy-five out of 183 (41%) patients chose to terminate their pregnancy. Twenty babies (26.6%) in the termination of pregnancy group had additional anomalies. One hundred eight patients gave birth at our institution. The mean birth weight was 3060±647.5 g, the mean gestational week at delivery was 37.9±1.7 weeks, and mean APGAR score (5th minute) was 8.8±2.3. Four neonates died on the postpartum first day. The postnatal diagnosis of 60 of the 108 (55.5%) patients who gave birth was concordant with the prenatal diagnosis, and 32 of the 108 (29.6%) babies underwent surgical interventions.Conclusion:CNS anomalies have a broad spectrum and variable prognoses. This study highlights the limitations of prenatal diagnoses, and the need for parents to have this information in order to determine the course of their pregnancy and prepare themselves for the postnatal challenging treatment/rehabilitation process.

Usefulness of the Coronary Artery Calcium Score in Predicting Subsequent Coronary Interventions-A Ten-Year Single-Center Perspective.

There is no consensus as to whether the Coronary Artery Calcium Score (CACS) results can affect the therapeutic approach that is selected for coronary artery disease. The aim of this study was to follow patients’ management over a period of ten years after application of the CACS. Methods: The research was conducted as a prospective, single-center, long-distance study. In 174 asymptomatic patients (78M; aged 58.9 ± 7.86), a CACS examination using 64-slice computed tomography was performed between 2008 and 2009. The patients were divided into three subgroups according to the CACS results using Agatston Units (AU)—G1: CACS = 0 AU (52 pts); G2: CACS = 1–399 AU (64 pts) and G3: CACS ≥ 400 AU (58 pts). During the ten years of follow-up, the classical cardiovascular risk factors, drugs, diseases, and information about the therapeutic approach that was used (PCI—Percutaneous Coronary Intervention; CABG—Coronary Artery Bypass Graft) were also analyzed. Results: The average time until a percutaneous intervention (PCI) was 825.2 ± 1111.7 and for CABG, it was 529.0 ± 833.6. PCI was performed in 5.8% (G1), 4.7% (G2) and 32.6% (G3) of the cases, respectively; p = 0.0000. CABG was performed in 0% (G1), 1.6% (G2) and 18.9% (G3) of the cases, respectively; 0.0035 Yates. The area under the curve in PCI was 0.783 (95% CI: 0.714–0.841); in CABG, it was 0.825 (95% CI: 0.760–0.878) and the average for both groups was 0.838 (95% CI: 0.774–0.889). Conclusions: The coronary artery calcium score can potentially help to predict the best therapeutic approach for coronary artery disease in a ten-year perspective.

Ten-Year Single-Center Results of Abdominal Aortic Aneurysm Treatment: Endovascular versus Open Repair

The purpose of the present study was to compare the long-term survival in matched cohorts of patients with infrarenal abdominal aortic aneurysm (AAA) undergoing an elective open repair (OR) or an endovascular aneurysm repair (EVAR). Patients with a primary elective repair of an infrarenal aortic aneurysm between 1998 and 2006 were identified in a retrospective review of our single-center database. EVAR and OR patients were matched with respect to age, gender, renal disease, tobacco use, hypertension, chronic obstructive pulmonary disease, and coronary artery disease. The primary end points were the early mortality and all-cause mortality during follow-up. A total of 465 patients with elective infrarenal aortic aneurysm repair were identified in the database. The EVAR and OR patients were matched according to the above-mentioned characteristics, and finally, 108 patients were included in each group. The early mortality encountered was only one death in the open group (P=0.316). The Kaplan-Meier survival analysis by the log-rank test showed no difference in cumulative survival between OR group and EVAR group (P=0.458). Seventeen reinterventions (16.7%) in the EVAR group vs. 7 (6.5%) in the OR group (P=0.018) were necessary during follow-up. OR and EVAR can be performed safely for elective treatment of AAA. The reintervention rate is, as expected, significantly higher in the EVAR group, but the long-term survival remains equal in both groups.

Ten-year Single Center Experience of Pulmonary Carcinoid Tumors and Diagnostic Yield of Bronchoscopic Biopsy.

Bronchoscopic biopsy of pulmonary carcinoid tumors has been controversial, and no study to date is dedicated to investigate diagnostic yield or safety. We reviewed our single center experience with pulmonary carcinoid tumors over a 10-year time period and assessed the diagnostic yield and safety of bronchoscopic biopsy of these tumors. A retrospective analysis was conducted of all bronchopulmonary carcinoid tumors from January 2003 through January 2014 for patients treated at or referred to our tertiary care facility, including patient and tumor characteristics, diagnostic yield, and complications of bronchoscopy. Forty-nine patients with bronchopulmonary carcinoid tumors were identified. 75.5% of our patients were female, and the median age was 60.7years. 85.7% patients were white, and 53.1% were smokers. 83.7% had typical carcinoid tumors or tumorlets, and 85.7% had centrally located tumors. The median tumor size was 2.0cm. Thirty patients underwent bronchoscopy for diagnostic evaluation. 76.7% were diagnosed via bronchoscopic biopsy. Bronchoscopic yield was calculated at 65.7% yield, and two complications of moderate to severe bleeding occurred with no emergent thoracotomies, transfusions, or deaths. No other complications occurred from bronchoscopy. The diagnosis of pulmonary carcinoid tumors via bronchoscopic biopsy is safe and effective, and bronchoscopy is recommended as the initial diagnostic modality for these tumors.

Long-term Results after Bidirectional Glenn Anastomosis in Patients with Hypoplastic Right Heart Syndrome: A Ten-year Single Center Experience

Long-term Results after Bidirectional Glenn Anastomosis in Patients with Hypoplastic Right Heart Syndrome: A Ten-year Single Center Experience

Targeted Oral Busulfan (BU)/Cyclophosphamide (CY)/VP-16 and Autologous Stem Cell Transplant (ASCT) for Hodgkin's (HL) and Non-Hodgkin's Lymphoma (NHL) Results in Excellent 5-Year Survival and Low Treatment-Related Mortality: Ten-Year Single Center Experience of 246 Consecutively Treated Patients

Targeted Oral Busulfan (BU)/Cyclophosphamide (CY)/VP-16 and Autologous Stem Cell Transplant (ASCT) for Hodgkin's (HL) and Non-Hodgkin's Lymphoma (NHL) Results in Excellent 5-Year Survival and Low Treatment-Related Mortality: Ten-Year Single Center Experience of 246 Consecutively Treated Patients.High-dose chemotherapy with ASCT has been a standard component of therapy for patients with HL and NHL for decades, however there are no randomized data supporting the superiority of any specific high-dose regimen. A recent retrospective CIBMTR analysis has suggested a potential benefit of BCNU-based regimens in patients with HL (Chen et al. Biol Blood Marrow Transplant 2015; 21:1046-1053). We present long-term outcome data for 246 consecutive HL and NHL patients receiving ASCT at a single institution between July 2004 and December 2014. All patients received a preparative regimen consisting of targeted oral BU (days -8 to -4, AUC targeted to 1200 µmol/L), CY (60mg/kg/d x 2 days, day -3, -2) and VP-16 (10mg/kg/d x 3 days, days -4, -3, -2). All treatment and post-transplant care was planned to be delivered in the outpatient setting, and patients were admitted only for complications more safely managed in the inpatient setting. The treatment cohort included 80 HL and 166 NHL (including 77 diffuse large B cell [DLBCL], 28 follicular [FL], 29 mantle cell [MCL], 27 T cell [TCL] lymphoma) patients, median age 50 [19, 71] (HL 33 [19, 67], NHL 54 [20, 71]). CIBMTR risk group was low (CR1), intermediate (chemosensitive relapsed or resistant disease), or high (chemorefractory) in 62 (25%), 158 (64%), and 26 (11%) respectively (8%, 70%, 22% for HL; 34%, 61%, 5% for NHL). Median follow-up for surviving patients was 64 months [6, 132]. Non-relapse mortality (NRM) by 100 days post-transplant occurred in one patient (0.4%) and one-year NRM was 0% and 3% for HL and NHL respectively. In NHL patients, 5-year OS for low, intermediate, and high CIBMTR disease risk patients was 86%, 74%, and 25%; corresponding 5-year DFS was 68%, 52%, and 25% respectively (figure 1). Five-year OS, DFS, and relapse was 77%, 59%, and 34% for DLBCL; 83%, 71%, and 20% for MCL; 76%, 48%, and 52% for FL; 70%, 48%, and 45% for TCL patients. In HL patients, 5-year OS for low, intermediate, and high CIBMTR disease risk patients was 100%, 82%, and 72%; corresponding 5-year DFS was 67%, 58%, and 17%; and relapse was 33%, 40%, and 83% respectively. Multivariate analysis demonstrated two factors that predicted inferior overall survival: age ≥55 years [HR 2.16, p=0.003], CIBMTR risk group (high vs intermediate/low) [HR 2.31, p=0.017]. High CIBMTR risk status was also a risk factor for DFS [HR 3.49, p<0.001] and relapse [3.65, p<0.001]. In summary, targeted oral Bu/Cy/VP-16 and ASCT results in low NRM and excellent long-term survival in patients with NHL and HL. Although CIBMTR high risk patients, defined by chemoresistance prior to ASCT, do not appear to benefit significantly from this approach, high-risk HL patients maintain a favorable outcome despite a high incidence of post-transplant relapse. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Ten-Year Single-Center Experience of the Ketogenic Diet: Factors Influencing Efficacy, Tolerability, and Compliance

To evaluate the efficacy, tolerability, and compliance of 3 ketogenic diets, the classical ketogenic diet, medium-chain triglyceride (MCT), and modified Atkins diet. A single-center, retrospective study of 48 children with intractable epilepsy receiving ketogenic diets from 2003 to 2012. Patient demographics, epilepsy history, nutritional management, and side effects were collated. Compliance and tolerability were assessed by recording reasons for diet modification and cessation. The value of potassium citrate supplementation for preventing nephrolithiasis was reviewed. Median age at ketogenic diet initiation was 3.8 years (IQR: 2.3-7 years). The majority had intractable epilepsy, and 33 of the 48 children (69%) had epileptic encephalopathies. Three (6%) patients became seizure free, 35 (73%) reported <50%-90% reduction, and 10 (21%) had 0%-50% reduction during a 2-year period. Diet duration or ketogenic diet type did not predict reduction in seizures (P = .381; P = .272). Constipation (n = 31, 65%) was very common. Food refusal (n = 3, 6%) and poor parental compliance (n = 5, 10%) were common reasons cited for cessation. There were lower rates of side effects for modified Atkins diet. Diet cessation was greatest for MCT; however, 3 patients on MCT ceased therapy because adequate seizure control was achieved. Nephrolithiasis was reported in 1 patient before potassium citrate was used and 2 patients noncompliant with potassium citrate supplementation developed hypercalciuria. The 3 ketogenic diets were comparably effective in seizure control and generally well-tolerated. Potassium citrate supplementation is an effective prophylactic supplement for the prevention of nephrolithiasis.

Socioeconomic and Racial Disparities in the Presentation of Advanced Colon Cancer in a Veterans Affairs Population: A Ten-Year Single Center Experience: Presidential Poster

Purpose: Colorectal cancer (CRC) is the third leading cause of cancer death in the United States. We sought to study trend of CRC location over time and roles of race and SES in determining stage and location of CRC in a veteran population. Methods: Records were reviewed for patients diagnosed with CRC at VA Loma Linda during 1999-2009. Variables included age at diagnosis, sex, anatomic location, stage at diagnosis, race/ethnicity, SES quintiles (low, medium, high; using 2011 census block groups based on method described by Yost et al). Analysis was performed using SAS version 9.2. Results: A total of 600 patients (mean age at diagnosis 77.4 years), grouped as 580 males (97.1%), 17 females (2.9%); 126 blacks (21%), 388 whites (64.7%), 69 Hispanics (11.5%), 16 others (2.7%); 125 low SES (20.8%), 286 middle SES (64.3%), 89 high SES (14.8%), were included. At time of diagnosis, 109 (18.1%) patients were at stage I, 168 (28%) at stage II, 135 (22.5%) at stage III, and 188 (31.3%) at stage IV. Ten years were divided in three categories (t1=1999-2002, t2=2003-2005, t3=2006-2009) to study trends. During 10 years, there were 226 right-sided and 374 left-sided CRC. Controlling for time and race, right side was at non-significant higher risk of stage IV CRC (odds ratio [OR] 1.147; 95% confidence interval [CI] 0.805-1.635). Number of right-sided CRC during different time periods t1 (45) to t2 (58) and t3 (123) increased significantly (p for trend t2-t1=0.1753; t3-t2=0.0039; t3-t1=<0.0001). Number of stage IV CRC during different time periods 72 (t1), 55 (t2), and 61 (t3) decreased significantly (p for trend t2-t1=0.0346; t3-t2=0.0583; t3-t1<0.0001). Sorted by race, number of right-sided CRC increased in both blacks (p for trend t2-t1=0.0784; t3-t2=0.0135; t3-t1<0.0001) and whites (p for trend t2-t1=0.7484; t3-t2=0.0075; t3-t1=0.0239; p overall=0.0121). There was a significant decrease in stage IV CRC for blacks (p for trend t2-t1=0.1453; t3-t2=0.0764; t3-t1=0.0004; p overall=0.0003) and whites (p for trend t2-t1=0.1957; t3-t2=0.2883; t3-t1=0.1753; p overall=0. 0129). Low SES was more closely associated with black race and right side. With SES as a constant, poor blacks were at a higher risk of developing right-sided CRC compared to poor whites (OR 2.62; 95% CI=1.03-6.67). Also, poor blacks were more likely to have stage IV CRC compared to poor whites, but association was non-significant (OR=1.14; 95% CI=0.47-2.72). Conclusion: At our VA, there is a significant trend for diagnosis of more right-sided and less stage IV CRC over a 10-year time period. Low SES is associated with stage IV and right-sided CRC, but it is not as strong a predictor of location and stage as race is.Table 1: Trend of colorectal cancer location and cancer stage with timeTable 2: Trend of colorectal cancer stage with time period and stage IV with race

The Effect of Socioeconomic, Racial Disparities and a Prior EGD on Outcomes of Gastric Adenocarcinoma in a Veteran Population: A Ten-Year Single-Center VA Experience

The Effect of Socioeconomic, Racial Disparities and a Prior EGD on Outcomes of Gastric Adenocarcinoma in a Veteran Population: A Ten-Year Single-Center VA Experience

Perfusing chemotherapy by percutaneous lung puncture "holing" for pulmonary tuberculoma-a ten-year single center experience.

Pulmonary tuberculoma is a special form of secondary pulmonary tuberculosis, with a poor response to drug treatment. We used the method of drug administration via percutaneous lung puncture "holing" to treat pulmonary tuberculoma and observe its short- and long-term efficacy, summing up our 10-year clinical experience. A total of 54 patients with pulmonary tuberculoma were included in this study. They themselves were taken as the control group. Three to six months of conventional anti-tuberculosis treatment was conducted firstly. Then those patients with no changes of sizes in tuberculoma were recommended to receive drug administration via percutaneous lung puncture. Isoniazid (INH, 0.1 g) and amikacin (AMK, 0.2 g) were injected into tuberculoma (once or twice per week, 10 times as a course of treatment). After two months of drug treatment by lung puncture, the sputum smear test showed the negative conversion rate of tubercle bacillus was 87% (13/15), and the positive conversion rate was 8% (3/39). The tuberculosis bacillus culture indicated that the negative conversion rate was 100% (7/7). The reexamination after one year showed the negative conversion rate of tubercle bacillus in the sputum smear test was 80% (4/5). About 58% (31/54) of tuberculoma disappeared or significantly reduced, in which, 40% (21/54) of tuberculoma disappeared. The tuberculoma diameter reduced from 3.6 cm × 2.8 cm to 1.7 cm × 1.1 cm on average. Side-effects included postoperative pneumothorax 9% (5/54), hemoptysis 7% (4/54) and fever 11% (6/54). A total of 34 patients were followed up for five years, and the disappearance rate of tuberculoma was up to 47% (16/34), with no recurrence. The drug administration via percutaneous lung puncture-"holing" in pulmonary tuberculoma takes a significant effect obviously, good short- and long-term effects and less side effects.

The Dynamics of Oral Lichen Planus: A Retrospective Clinicopathological Study

To evaluate disease dynamics, treatment results, and frequency of malignant transformation. Ten-year single center retrospective study. The study included 171 patients, 28-99 years old. Follow-up was 1-16 years. 49.5% exhibited changes in clinical presentation, with 19% yearly increase of probability for type shift. Index of extent (number of oral locations) showed a mean 40% decrease and 94.1% reported improvement. There were significant differences between treated and untreated patients (P=0.012). Patients with or without systemic diseases had identical treatment requirements for oral lesions. The prevalence of SCC was 5.8%. Oral lichen planus constantly changes presentation and extent of involvement. The effect of systemic diseases was insignificant in the present study. There is a clear value for treatment to reduce the extent of lesions. The results indicate that all clinical forms of the disease need to be equally followed since the clinical presentation typically changes over time, while malignant transformation can occur in all forms.

Ursodeoxycholic acid with vitamin E in patients with nonalcoholic steatohepatitis: Long-term results

The combination of ursodeoxycholic acid (UDCA) and vitamin E is a therapeutic option for nonalcoholic steatohepatitis (NASH) but randomized controlled studies have produced inconsistent results. The objective of this study was to report the long-term tolerability and efficacy of this combination in our ten-year single center experience. The study group included 101 adult patients with persistent elevation of serum aminotransferases (AST and ALT) and/or γ glutamyl-transferase (GGT), in whom a histological diagnosis of NASH was made from January 1998 to January 2009, and who were treated with a combination of UDCA with vitamin E. Median body mass index (30 kg/m(2)) remained unchanged during the study. UDCA and vitamin E were well tolerated (5% withdrawal for side effects). Mean serum AST, ALT and GGT levels (expressed as times of Upper Normal Limit) diminished significantly (1.39 ± 0.74 to 0.78 ± 0.34 for AST, 1.72 ± 0.92 to 0.91 ± 0.69 for AST and 3.25 ± 2.85 to 1.30 ± 1.30 for GGT). AST, ALT and GGT reached normal range in 80%, 70% and 65% of the patients, respectively. From the ten patients who had a second liver biopsy during follow-up, NAS score improved in seven, and worsened in one. The combination of UDCA with vitamin E significantly improves liver function tests in long-term and is very well tolerated.

Contemporary Outcomes of Vertebral Artery Injury: A Ten-Year Single-Center Experience

Contemporary Outcomes of Vertebral Artery Injury: A Ten-Year Single-Center Experience

Minimally Invasive Heart-Port Assisted Technique as Standard First Choice Approach for Left Ventricle Endoplasty: A Ten-Year Single-Center Experience

Although the port-access technique has been shown to be an effective and safe approach for cardiac surgery procedures it has never become routine practice, and it is still limited to few and selected centers. Furthermore, such technique has rarely been applied to treat left ventricle disease. In 1999 we introduced left ventricle aneurysm repair through a left minithoracotomy using the port-access technique. Here we present the results in terms of early and medium-term follow-up using such technique as a routine first choice approach for left ventricle endoplasty. From 1999 to date, out of 38 patients undergoing left ventricle endoplasty (+/-associate procedures), mini-left thoracotomy and port-access techniques have been used in 32 patients (84%). All patients underwent endoventricular patch-repair with ventricular reshaping and associated procedures were performed in 8 patients. All patients survived the operation and were discharged from the hospital (30 days mortality 0%). Two patients (6.2%) experienced prolonged mechanical ventilations and 3 patients (9.3%) prolonged intensive care unit stay. Mean follow-up was 40+/-34 months (range, 2 to 105). One patient died during follow-up (cumulative mortality 3.3%). Follow-up revealed an improvement of hemodynamic performances (left ventricular ejection fraction 0.44+/-0.09 compared with 0.34+/-0.09 preoperatively, p=0.004) and improved clinical conditions (New York Heart Association class 1.4+/-0.5 compared with 2.3+/-1 preoperatively, p=0.003). The port-access technique can be safely applied to perform left ventricle endoplasty through a left minithoracotomy. Such approach allows optimal surgical view and therefore optimal surgical correction. Based on our satisfactory experience we support left minithoracotomy as a valuable alternative approach for left ventricle endoplasty in view of an extended use of minimally invasive techniques.

Liver transplantation: a 10-year single center experience in Pernambuco- northeastern Brazil

Purpose: The aim of this study is to analyze a ten-year single center experience in liver transplantation in Pernambuco - Northeastern region of Brazil. Methods: Data were retrospectively collected from medical records of 302 patients who underwent Orthotopic Liver Transplantation (OLT) between 1998 and 2008 at Oswaldo Cruz University Hospital, Pernambuco – Brazil. We analyzed just the outcomes and survival curve of 195 adult liver transplantation recipients from deceased donor. Results: Data concern liver donor, surgery technical aspects and liver transplantation recipients’ postoperative evolution are presented and discussed. This center has a significant experience in liver transplantation using conventional technique with no venovenous bypass. Efficient management of liver transplantation practice has made it feasible to keep the cold ischemia time within 6-7 hours. Because of the organ shortage, we have used a large amount of extended criteria liver donor. The survival 1-year rata was 76.4%. Conclusion: It is possible to provide a high-quality public medical assistance in an efficient and continuous manner in less developed areas of Brazil.

TCT-311: Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction In Octogenarians. Trends and Outcomes From a Ten-Year Single Center Experience

TCT-311: Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction In Octogenarians. Trends and Outcomes From a Ten-Year Single Center Experience

In-Center Intermittent Peritoneal Dialysis: Retrospective Ten-Year Single-Center Experience with Thirty Consecutive Patients

In-center intermittent peritoneal dialysis (IPD) is sometimes performed in elderly and multimorbid patients that have failed hemodialysis and that are unable to perform peritoneal dialysis (PD) at home. Complications, frequency of hospital admission, and survival are often claimed to be dismal although current data are lacking. We performed a retrospective cohort study of patients that underwent IPD at Hannover Medical School, Germany, between 1997 and 2007. Underlying renal disorders, comorbidity, and circumstances that precluded hemodialysis and home PD were recorded. Survival, cause of death, episodes of hospitalization, and episodes of peritonitis were calculated. Laboratory values at baseline and after 3 months of IPD were also retrieved. We identified 30 patients with severe comorbidity (median Charlson Comorbidity Index of 6; n = 30) who underwent IPD for 439 months in total. The majority of patients had vascular/hypertensive nephropathy (n = 12; 40%); congestive heart failure was the leading cause for choosing PD (n = 13; 43.3%); 73.3% of our patients had either no partner or at least one disease that precluded home therapy. Hospitalization rate was 1.39 admissions per patient-year and there was 1 episode of peritonitis per 48.8 IPD-months. Mean survival was 26.6 months (median 17 months; n = 30); sepsis was the leading cause of death (n = 13; 59.1%). IPD is associated with fewer episodes of peritonitis, fewer admissions, and longer survival than is often believed. Suitable patients in whom palliative care alone seems inappropriate should not be denied a trial of IPD if they so choose.