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Patients Older (patient + older)
Selected AbstractsFixed Implant-Supported Prostheses in Elderly Patients: A 5-Year Retrospective Study of 133 Edentulous Patients Older than 79 YearsCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 4 2004Ingela Engfors DDS ABSTRACT Background: An increasing number of elderly patients are treated with implants, but results for the elderly patient in terms of implant success and adaptation to implant prostheses are contradictory. Objective: To retrospectively study the 5-year clinical and radiologic performances of fixed implant-supported prostheses placed in edentulous elderly patients and to compare those results with the results of using similar prostheses in a control group of younger patients. Materials and Methods: The study group comprised 133 edentulous patients who were 80 or more years of age and who were consecutively treated with fixed implant-supported prostheses between January 1986 and August 1998. Altogether 761 Brånemark System® implants (Nobel Biocare AB, Göteborg, Sweden) were placed in 139 edentulous jaws. The control group comprised 115 edentulous patients who were younger than 80 years and who were treated consecutively from March 1996 to November 1997 with similar prostheses. In this group 670 implants were placed in 118 edentulous jaws. Information was collected from all postinsertion visits, including the fifth annual checkup, and changes of marginal bone levels were analyzed from intraoral radiographs. Results: The 5-year cumulative survival rate (CSR) for implants in the maxilla was 93.0% in the study group and 92.6% in the control group; the corresponding CSRs for implants in the mandible were 99.5% and 99.7%. The most common complications for patients in the study group were soft tissue inflammation (mucositis) and cheek and lip biting (p < .05) whereas resin veneer fractures were the most common complications for the control group. Overall 5-year marginal bone loss for the study group was 0.7 mm (standard deviation [SD], 0.45) in the upper jaw and 0.6 mm (SD, 0.50) in the lower jaw. Differences in bone levels and bone loss between the two groups did not reach significant levels (p > .05). Conclusions: Implant treatment in the elderly patients showed treatment results comparable to those observed in younger age groups. However, indications of more problems with adaptation could be observed and were reflected in more postinsertion problems. Cleaning problems and associated soft tissue inflammation (mucositis) as well as tongue, lip, and cheek biting were significantly more often observed among the elderly patients (p < .05). [source] Surgical outcomes of partial nephrectomy for renal cell carcinoma: A joint study by the Japanese Society of Renal CancerINTERNATIONAL JOURNAL OF UROLOGY, Issue 4 2007Yutaka Senga Objective: A joint study was undertaken by the Japanese Society of Renal Cancer to investigate the present status of partial nephrectomy in Japan and to speculate about what may be the indications for partial nephrectomy in patients with renal cell carcinoma. Methods: Data were tabulated for 469 patients from participating medical institutions and various clinical factors were investigated with regard to disease progression (local recurrence and distant metastasis). Results: Disease progression was observed in 21 patients (4.5%). No significant relation to disease progression was observed for sex, laterality, tumor histology, grade and tumor size. Although patients with solitary tumors displayed excellent prognosis irrespective of tumor diameter, patients with multiple tumors displayed a high likelihood of disease progression. Patients older than 77 years old and patients with imperative indication were found to have a poorer prognosis. Conclusion: In patients with solitary tumors, partial nephrectomy can be actively performed, even if the patient displays elective indications and the tumor is >4 cm in diameter. In patients displaying multiple tumors with imperative indications, the decision whether to perform partial nephrectomy should be made by the patients and their physicians after considering the impact on curability and the quality of life. [source] Outcome following surgical closure of secundum atrial septal defectJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 3 2001DA Jones Objective: To assess the current outcome of surgical closure of secundum atrial septal defects (ASD) in an Australian paediatric population. Methodology: A retrospective chart review of 87 children, aged 2 months to 15 years, was performed for surgery between August 1995 and March 1999. Results: There were no deaths in the patients studied. Approximately one in four patients (24.1%) experienced complications requiring further management. Complication rates were similar to those published previously. However, one in nine patients (11.5%) required surgical drainage of a pericardial effusion. A total of five of 87 (5.7%) patients developed post-pericardiotomy syndrome (PPS), of whom four required pericardiocentesis. The risk for developing a pericardial effusion requiring drainage or PPS was more than twice in children older than 5 years of age at the time of surgery compared to those aged under 5 years, although there was an insufficient number of subjects in the study to prove this statistically (Odds ratio 2.31). Conclusions: Most patients have an uncomplicated postoperative course following surgical closure of secundum ASD. However, a significant minority (24.1%) do develop complications requiring further management and have a correspondingly longer period of hospitalization. Patients older than 5 years of age were identified as being potentially at greater risk for the development of PPS or a pericardial effusion requiring drainage. Further research needs to be performed to clarify this. [source] Outcome of patients with hepatocellular carcinoma listed for liver transplantation within the Eurotransplant allocation system,LIVER TRANSPLANTATION, Issue 4 2008Michael Adler Although hepatocellular carcinoma (HCC) has become a recognized indication for liver transplantation, the rules governing priority and access to the waiting list are not well defined. Patient- and tumor-related variables were evaluated in 226 patients listed primarily for HCC in Belgium, a region where the allocation system is patient-driven, priority being given to sicker patients, based on the Child-Turcotte-Pugh (CTP) score. Intention-to-treat and posttransplantation survival rates at 4 years were 56.5 and 66%, respectively, and overall HCC recurrence rate was 10%. The most significant predictors of failure to receive a transplant in due time were baseline CTP score equal to or above 9 (relative risk [RR] 4.1; confidence interval [CI]: 1.7,9.9) and , fetoprotein above 100 ng/mL (RR 3.0; CI: 1.2,7.1). Independent predictors of posttransplantation mortality were age equal to or above 50 years (RR 2.5; CI: 1.0,3.7) and United Network for Organ Sharing pathological tumor nodule metastasis above the Milan criteria (RR 2.1; CI: 1.0,5.9). Predictors of recurrence (10%) were , fetoprotein above 100 ng/mL (RR 3.2; CI:1.1,10) and vascular involvement of the tumor on the explant (RR 3.6; CI: 1.1,11.3). Assessing the value of the pretransplantation staging by imaging compared to explant pathology revealed 34% accuracy, absence of carcinoma in 8.3%, overstaging in 36.2%, and understaging in 10.4%. Allocation rules for HCC should consider not only tumor characteristics but also the degree of liver impairment. Patients older than 50 years with a stage above the Milan criteria at transplantation have a poorer prognosis after transplantation. Liver Transpl 14:526,533, 2008. © 2008 AASLD. [source] Older age and liver transplantation: A reviewLIVER TRANSPLANTATION, Issue 8 2004Rajesh N. Keswani Patients older than 60 are undergoing transplantation with increasing frequency. Reports from several transplant centers document that overall short-term patient survival rates in seniors undergoing liver transplantation are comparable to survival rates of younger adults. However, specific subgroups of older patients may not fare as well. Seniors with far-advanced end-stage liver disease are high-risk for liver transplantation and have poor survival rates. In addition, seniors older than 65 have worse outcomes than those who are 60 to 65, and studies have shown increased mortality with increasing age as a continuous variable. On the other hand, the majority of seniors who survive liver transplantation have full or only minimally limited functional status. Preoperative evaluation of older patients for transplantation requires careful screening to exclude cardiopulmonary disease, malignancy, and other diseases of the aged. Paradoxically, seniors may benefit from a senescent immune system, which results in decreased requirements for immunosuppressive drugs, and possibly a lower rate of acute allograft rejection. Despite good overall short-term survival in the elderly, long-term survival may be worse because of an increased rate of long-term complications, such as malignancy and heart disease. In conclusion, although advanced age is a negative risk factor, advanced age alone should not exclude a patient from liver transplantation; however, it mandates thorough pretransplant evaluation and careful long-term follow-up with attention to usual health maintenance issues in the elderly. (Liver Transpl 2004;10:957,967.) [source] Cholelithiasis in infant and pediatric heart transplant patientsPEDIATRIC TRANSPLANTATION, Issue 3 2002Andreas G. Sakopoulos Abstract: There have been numerous studies which demonstrate a relatively high incidence of gallstones in adult solid-organ transplant recipients receiving cyclosporin A (CsA) immunosuppression. The purpose of the present study was to investigate our experience with cholelithiasis in babies and children undergoing heart transplant (HTx). From May 1985 to December 1998, 311 neonatal and pediatric cardiac transplants were performed at our institution. Routine abdominal ultrasound was performed at 3 months, 1 yr, and bi-annually thereafter on all transplant recipients. Asymptomatic or symptomatic gallstone development was detected during abdominal ultrasound in 10 of 311 patients (3.2%). Eight of these 10 patients (80%) were transplanted when younger than 3 months of age. Eight per cent of all infants transplanted at < 3 months of age developed cholelithiasis (p < 0.05 compared to older age at HTx). Fifty per cent of gallstones were detected and treated within 6 months post-HTx, while the remaining 50% of patients with gallstones underwent cholecystectomy 3,6 yr later. Only 20% (two of 10) had symptoms of cholelithiasis/cholecystitis. Five patients (50%) underwent laparoscopic cholecystectomy. Only one patient older than 1 yr of age, who was symptomatic, underwent open cholecystectomy. There were no complications from surgery. There were no differences in liver function tests or cholesterol levels in transplant recipients with or without gallstones, and all mean values were within normal limits. Hence, although the incidence of pediatric post-transplant cholelithiasis in infant and pediatric heart transplant recipients is low, almost all occurrences are associated with HTx during early infancy and, because of this, patients in this group should be routinely screened. Laparoscopic or open cholecystectomy are extremely well tolerated and we recommend that surgery be performed when cholelithiasis is found in pediatric heart treatment patients. [source] Preoperative breast magnetic resonance imaging in early breast cancer,CANCER, Issue 8 2009Implications for partial breast irradiation Abstract BACKGROUND: Accelerated partial breast irradiation (APBI) of patients with early breast cancer is being investigated on a multi-institutional protocol National Surgical Adjuvant Breast and Bowel Project (NSABP) B-39/RTOG 0413. Breast magnetic resonance imaging (MRI) is more sensitive than mammography (MG) and may aid in selection of patients appropriate for PBI. METHODS: Patients with newly diagnosed breast cancer or ductal carcinoma in situ (DCIS) routinely undergo contrast-enhanced, bilateral breast MRI at the Cleveland Clinic. We retrospectively reviewed the medical records of all early-stage breast cancer patients who had a breast MRI, MG, and surgical pathology data at our institution between June of 2005 and December of 2006. Any suspicious lesions identified on MRI were further evaluated by targeted ultrasound ± biopsy. RESULTS: A total of 260 patients met eligibility criteria for NSABP B-39/RTOG 0413 by MG, physical exam, and surgical pathology. The median age was 57 years. DCIS was present in 63 patients, and invasive breast cancer was found in 197 patients. MRI identified suspicious lesions in 35 ipsilateral breasts (13%) and in 16 contralateral breasts (6%). Mammographically occult, synchronous ipsilateral foci were found by MRI in 11 patients (4.2%), and in the contralateral breast in 4 patients (1.5%). By univariate analysis, lobular histology (infiltrating lobular carcinoma [ILC]), pathologic T2, and American Joint Committee on Cancer stage II were significantly associated with additional ipsilateral disease. Of patients with ILC histology, 18% had ipsilateral secondary cancers or DCIS, compared with 3% in the remainder of histologic subtypes (P = .004). No patient older than 70 years had synchronous cancers or DCIS detected by MRI. CONCLUSIONS: Breast MRI identified synchronous mammographically occult foci in 5.8% of early breast cancer patients who would otherwise be candidates for APBI. Cancer 2009. © 2009 American Cancer Society. [source] Mitral Valve Prolapse in Marfan Syndrome: An Old Topic RevisitedECHOCARDIOGRAPHY, Issue 4 2009Cynthia C. Taub M.D. Background: The echocardiographic features of mitral valve prolapse (MVP) in Marfan syndrome have been well described, and the incidence of MVP in Marfan syndrome is reported to be 40,80%. However, most of the original research was performed in the late 1980s and early 1990s, when the diagnostic criteria for MVP were less specific. Our goal was to investigate the characteristics of MVP associated with Marfan syndrome using currently accepted diagnostic criteria for MVP. Methods: Between January 1990 and March 2004, 90 patients with definitive diagnosis of Marfan syndrome (based on standardized criteria with or without genetic testing) were referred to Massachusetts General Hospital for transthoracic echocardiography. Patients' gender, age, weight, height, and body surface area at initial examination were recorded. Mitral valve thickness and motion, the degree of mitral regurgitation and aortic regurgitation, and aortic dimensions were quantified blinded to patients' clinical information. Results: There were 25 patients (28%) with MVP, among whom 80% had symmetrical bileaflet MVP. Patients with MVP had thicker mitral leaflets (5.0 ± 1.0 mm vs. 1.8 ± 0.5 mm, P < 0.001), more mitral regurgitation (using a scale of 1,4, 2.2 ± 1.0 vs. 0.90 ± 0.60, P < 0.0001), larger LVEDD, and larger dimensions of sinus of Valsalva, sinotubular junction, aortic arch, and descending aorta indexed to square root body surface area, when compared with those without MVP. When echocardiographic features of patients younger than 18 years of age and those of patients older than 18 were compared, adult Marfan patients had larger LA dimension (indexed to square root body surface area), larger sinotubular junction (indexed to square root body surface area), and more mitral regurgitation and aortic regurgitation. Conclusions: The prevalence of MVP in Marfan syndrome is lower than previously reported. The large majority of patients with MVP have bileaflet involvement, and those with MVP have significantly larger aortic root diameters, suggesting a diffuse disease process. [source] Routine Transesophageal Echocardiography for the Evaluation of Cerebral Emboli in Elderly PatientsECHOCARDIOGRAPHY, Issue 9 2005Sergey Vitebskiy M.D. Background: Approximately 20% of cerebral infarctions are cardioembolic in nature. Transesophageal echocardiography (TEE) is widely regarded as the initial study of choice for evaluating cardiac source of embolism. Although the majority of cerebrovascular accidents occur in elderly patients, the value of TEE in this population is poorly defined. Methods: We compared 491 patients older than 65 years with suspected embolic stroke or transient ischemic attack (TIA) who had undergone TEE evaluation between April 2000 and February 2004 to an age-, sex-, and time-matched control group that consisted of 252 patients. Studies were reviewed for abnormalities associated with thromboembolic disease. Results: The overall incidence of stroke risk factors was significantly higher in the study than in the control group. However, the four patients with left atrial thrombi had a history of atrial fibrillation. Although ascending and aortic arch sessile atheromata were observed more frequently in the study than control group, there were no significant differences in the incidence of either complex or mobile aortic atheromata. The incidence of atrial septal aneurysm was higher in the stroke/TIA group, but not in association with patent foramen ovale. Finally, there were also no differences in the incidence of spontaneous echocontrast, and/or patent foramen ovale between study and control groups. Conclusions: We conclude: (1) There is a higher incidence of abnormalities implicated as sources of thromboembolic disease on TEE in elderly patients with cerebral infarctions, but (2) this incidence is driven by the presence of sessile aortic atheroma and atrial septal aneurysm. Until the benefits of specific therapies for these conditions are known, routine TEE in elderly patients with suspected embolic neurological events appears to be unwarranted. [source] Seizure Semiology in the Elderly: A Video AnalysisEPILEPSIA, Issue 3 2004Christoph Kellinghaus Summary: Purpose: To describe the seizure semiology of patients older than 60 years and to compare it with that of a control group of younger adults matched according to the epilepsy diagnosis. Methods: Available videotapes of all patients aged 60 years and older who underwent long-term video-EEG evaluation at the Cleveland Clinic Foundation (CCF) between January 1994 and March 2002 were analyzed by two observers blinded to the clinical data. A younger adult control group was matched according to the epilepsy diagnosis, and their seizures also were analyzed. Results: Fifty-four (3.3%) of the 1,633 patients were 60 years or older at the time of admission. For 21 of them, at least one epileptic seizure was recorded. Nineteen patients had focal epilepsy (nine temporal lobe, two frontal lobe, two parietal lobe, eight nonlocalized), and two patients had generalized epilepsy. Seventy-three seizures of the elderly patients and 85 seizures of the 21 control patients were analyzed. In nine elderly patients and 14 control patients, at least one of their seizures started with an aura. Eleven elderly patients and 19 control patients lost responsiveness during their seizures. Approximately two thirds of the patients in both groups had automatisms during the seizures. Both focal and generalized motor seizures (e.g., clonic or tonic seizures) were seen less frequently in the elderly. Conclusions: Only a small percentage of the patients admitted to a tertiary epilepsy referral center for long-term video-EEG monitoring are older than 60 years. All seizure types observed in the elderly also were seen in the younger control group, and vice versa. Simple motor seizures were seen less frequently in the elderly. [source] Acute ischemic stroke and transient ischemic attack in the very old , risk factor profile and stroke subtype between patients older than 80 years and patients aged less than 80 yearsEUROPEAN JOURNAL OF NEUROLOGY, Issue 8 2007J. I. Rojas Old age groups have different risk profile and stroke features compared to younger groups. Our aim was to examine the risk factor profile and stroke subtype in patients older than 80 years with ischemic stroke. Data of 535 patients with ischemic stroke or transient ischemic attack (TIA) were prospectively recorded. Cardiovascular risk factors and stroke subtype in individuals aged 80 years or older were compared with patients under 80. Of 535 patients a total of 179 were over 80 years (33.5%). The mean age was 84.4 ± 4.4 years (61.8%; 111 women). The most common risk factors included hypertension (82.7%) and hyperlipidemia (40.2%). Lacunar stroke was the most frequent subtype of stroke (41.7%). When the groups were compared, we observed the following risk factors more frequently in the group older than 80: female patients (P = <0.001), hypertension (OR = 1.62), atrial fibrillation (OR = 2.64); whereas diabetes (OR = 0.54), hyperlipidemia (OR = 0.57), smoking (OR = 0.17) and obesity (OR = 0.58) were more frequent in the group younger than 80. In the old group we found a high incidence of ischemic stroke in women. We also found a higher frequency of hypertension and atrial fibrillation. The available and future epidemiological data will provide a better knowledge about the effect of typical risk factors in old people. [source] Oral primary angiosarcoma of the lower lip mucosa: Report of a case in a 15-year-old boyHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2008Ignacio Arribas-Garcia MD Abstract Background. Angiosarcomas are rare soft tissue malignant tumors with dismal prognosis. Head and neck involvement is uncommon (5%) and usually affects the scalp or facial skin. Methods and Results. We present the case of an inferior lip mucosal low-grade angiosarcoma in a 15-year-old boy treated exclusively with surgery. One and a half years after treatment, the patient was free of signs of recurrence. Prompt and accurate diagnosis with adequate imaging modalities and multidisciplinary treatment are crucial for optimal management of these neoplasms. Conclusion. Lip mucosal involvement is exceptional with only a few cases described in the literature, all in patients older than 60 years To our knowledge, this is the youngest patient ever reported. © 2008 Wiley Periodicals, Inc. Head Neck, 2008 [source] Safety and Efficacy of Arterial Switch Operation in Previously Inoperable PatientsJOURNAL OF CARDIAC SURGERY, Issue 4 2010Liu Ying-long M.D. This study aimed to evaluate the safety and efficacy of ASO in these selected subset patients. Methods: The records of 86 patients older than six months with complete transposition of the great arteries and ventricular septal defect or Taussig-Bing anomaly and severe PAH who underwent ASO at our institution from May 2000 to October 2008 were reviewed retrospectively. Eighty survivors were followed-up. Results: There were six hospital deaths (7.0%, 95% confidence limit 1.6 to 12.4%). From January 2006 to October 2008, 46 consecutive ASOs were performed with no death. Operative mortality and mobility decreased significantly (p = 0.008 and p = 0.046, respectively). The median duration of follow-up was 42.1 ± 28.8 months (range, 2.0 to 99.5). Two late deaths occurred. Latest follow-up data showed that 2.8% of survivors were in New York Heart Association (NYHA) class II and 97.2% were in NYHA class I. Conclusions: Excellent early and mid-term results of ASO are obtained from patients older than six months with complete transposition of the great arteries and ventricular septal defect or Taussig-Bing anomaly and severe PAH in current era, and ASO is safe and effective in these selected subset patients. (J Card Surg 2010;25:400-405) [source] Incidence and odds ratio of appendicitis as first manifestation of colon cancer: A retrospective analysis of 1873 patientsJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 11 2006Hung-Wen Lai Abstract Background and Aim:, Obstruction of the lumen of the appendix is the major cause of appendicitis. Tumors could obstruct this lumen and cause appendicitis in the elderly. The association between appendicitis and colon cancer has not been sufficiently investigated, and this study was designed to clarify this association. Methods:, This was a retrospective study. Patients diagnosed with acute appendicitis from January 1998 to December 2003 at the Taipei Veterans General Hospital were surveyed. Patients found to have colon cancers immediately or subsequently after appendectomy were included and analyzed. Results:, A total of 1873 patients were diagnosed as having appendicitis of whom 16 were found to have colon cancer. The incidence of appendicitis associated with colon cancer was 0.85%. The time from appendectomy to the recognition of colonic cancer was at a median delay of 5.8 months. From the Taiwan Cancer Research Annual Report, the incidence of colon cancer was 31.91/100 000 in the year 2000. The odds ratio of colon cancer incidence had a 38.5-fold increase among patients older than 40 with acute appendicitis. Conclusions:, In patients over 40 years who present with symptoms of acute appendicitis the possibility of a coexistent colonic neoplasm should always be kept in mind. These patients should undergo colonoscopy 6 weeks after surgery to exclude the possibility of a coexistent colorectal cancer. [source] High D-dimer levels increase the likelihood of pulmonary embolismJOURNAL OF INTERNAL MEDICINE, Issue 2 2008L. W. Tick Abstract. Objective., To determine the utility of high quantitative D-dimer levels in the diagnosis of pulmonary embolism. Methods., D-dimer testing was performed in consecutive patients with suspected pulmonary embolism. We included patients with suspected pulmonary embolism with a high risk for venous thromboembolism, i.e. hospitalized patients, patients older than 80 years, with malignancy or previous surgery. Presence of pulmonary embolism was based on a diagnostic management strategy using a clinical decision rule (CDR), D-dimer testing and computed tomography. Results., A total of 1515 patients were included with an overall pulmonary embolism prevalence of 21%. The pulmonary embolism prevalence was strongly associated with the height of the D-dimer level, and increased fourfold with D-dimer levels greater than 4000 ng mL,1 compared to levels between 500 and 1000 ng mL,1. Patients with D-dimer levels higher than 2000 ng mL,1 and an unlikely CDR had a pulmonary embolism prevalence of 36%. This prevalence is comparable to the pulmonary embolism likely CDR group. When D-dimer levels were above 4000 ng mL,1, the observed pulmonary embolism prevalence was very high, independent of CDR score. Conclusion., Strongly elevated D-dimer levels substantially increase the likelihood of pulmonary embolism. Whether this should translate into more intensive diagnostic and therapeutic measures in patients with high D-dimer levels irrespective of CDR remains to be studied. [source] Surgery after neoadjuvant chemotherapy for colorectal liver metastases is safe and feasible in elderly patientsJOURNAL OF SURGICAL ONCOLOGY, Issue 5 2009Dietmar Tamandl MD Abstract Background Surgery for colorectal liver metastases is part of the endeavor to cure metastatic colorectal cancer (mCRC). Neoadjuvant chemotherapy increases progression free survival in resectable patients. The safety and feasibility of this concept has not been investigated in elderly patients. Methods We performed a comparative analysis of data from 244 patients who were resected for colorectal liver metastases between 1999 and 2004 at our institution. Seventy patients were aged 70 or older; they form the basis of this analysis. Results Twenty-nine patients received neoadjuvant chemotherapy (oxaliplatin-based chemotherapy (XELOX), 19; 5-fluorouracil (5-FU), 10) prior to surgery. XELOX was associated with higher response rates to chemotherapy (CR,+,PR: XELOX 68% vs. 5-FU 0%, P,=,0.001), and responding patients had a better overall (OS, P,<,0.001) and recurrence free survival (RFS, P,<,0.001) compared to others. Response to neoadjuvant chemotherapy was the only factor on multivariate analysis predicting longer OS and RFS (P,=,0.01 and P,=,0.001). Conclusion Neoadjuvant chemotherapy can be administered safely in patients older than 70 years and appears to be effective in prolonging long-term outcome. Patients responding to neoadjuvant treatment have a significantly better prognosis after liver resection. J. Surg. Oncol. 2009;100:364,371. © 2009 Wiley-Liss, Inc. [source] Survival in patients with papillary thyroid cancer is not affected by the use of radioactive isotopeJOURNAL OF SURGICAL ONCOLOGY, Issue 1 2007Yale D. Podnos MD Abstract Introduction Papillary cancer is the most common neoplasm of the thyroid. The mainstay of treatment is thyroidectomy, but most patients are additionally treated with radioactive iodine (RAI). Its utility is controversial. This study seeks to determine whether RAI use affects patient outcome and to identify specific cohorts of patients that benefit from its use. Methods The Surveillance, Epidemiology, and End Results (SEER) database is a large-scale sample of approximately 14% of the US population. It was used to identify patients with papillary carcinoma of the thyroid. Statistical analyses were used to compare prognostic factors such as lymph node status, age, tumor size, and treatment with RAI. Results A total of 14,545 patients were identified in SEER as having papillary cancer of the thyroid. Multivariate analysis showed significantly worse outcome in patients with age>45 years, tumor size >2 cm, lymph node disease, and distant metastases. Multivariate analysis failed to show RAI significantly affecting mortality. Survival between those not treated with RAI was similar to those whose treatment included it (P,=,0.9176). Subgroup analysis identified patients older than 45 years with primary tumors >2 cm and disease in the lymph nodes with distant metastatic disease as the only group positively affected by RAI. Conclusions Despite its widespread use in the treatment of well-differentiated papillary cancer of the thyroid, RAI only affects a survival advantage in older patients with large primary tumors involving the lymph nodes and with distant spread. Treating other patient groups is costly and offers no improvement in outcome. J. Surg. Oncol. 2007; 96:3,7. © 2007 Wiley-Liss, Inc. [source] Multicentre trial evaluating alveolar NO fraction as a marker of asthma control and severityALLERGY, Issue 5 2010B. Mahut To cite this article: Mahut B, Trinquart L, Le Bourgeois M, Becquemin M-H, Beydon N, Aubourg F, Jala M, Bidaud-Chevalier B, Dinh-Xuan A-T, Randrianarivelo O, Denjean A, de Blic J, Delclaux C. Multicentre trial evaluating alveolar NO fraction as a marker of asthma control and severity. Allergy 2010; 65: 636,644. Abstract Background:, Exhaled NO can be partitioned in its bronchial and alveolar sources, and the latter may increase in the presence of recent asthmatic symptoms and in refractory asthma. The aim of this multicentre prospective study was to assess whether alveolar NO fraction and FENO could be associated with the level of asthma control and severity both at the time of measurement and in the subsequent 3 months. Methods:, Asthma patients older than 10 years, nonsmokers, without recent exacerbation and under regular treatment, underwent exhaled NO measurement at multiple constant flows allowing its partition in alveolar (with correction for back-diffusion) and bronchial origins based on a two-compartment model of NO exchange; exhaled NO fraction at 50 ml/s (FENO,0.05) was also recorded. On inclusion, severity was assessed using the four Global initiative for asthma (GINA) classes and control using Asthma Control Questionnaire (ACQ). Participants were followed-up for 12 weeks, control being assessed by short-ACQ on 1st, 4th, 8th and 12th week. Results:, Two-hundred patients [107 children and 93 adults, median age (25th; 75th percentile) 16 years (12; 38)], 165 receiving inhaled corticosteroid, were included in five centres. The two-compartment model was valid in 175/200 patients (87.5%). Alveolar NO and FENO,0.05 did not correlate to control on inclusion or follow-up (either with ACQ /short-ACQ values or their changes), nor was influenced by severity classes. Alveolar NO negatively correlated to MEF25,75% (rho = ,0.22, P < 0.01). Conclusion:, Alveolar and exhaled NO fractions are not indexes of control or severity in asthmatic children and adults under treatment. [source] Long-term follow-up of 386 consecutive patients with essential thrombocythemia: Safety of cytoreductive therapy,AMERICAN JOURNAL OF HEMATOLOGY, Issue 4 2009Francesca Palandri Cytotoxic agents like Hydroxyurea, Busulfan and Interferon-alpha are to date the most commonly used therapeutic approaches in Essential Thrombocythemia (ET). However, few data on the efficacy and safety of these agents in the long-term are currently available. We report a retrospective analysis of the long-term outcome of 386 consecutive ET patients, followed at single Institution for a median follow-up of 9.5 years (range, 3,28.5). Cytoreductive therapy was administered to 338 patients (88%), obtaining a response in 86% of cases. Forty-five patients (12%) experienced a thrombosis. Among baseline characteristics, only history of vascular events prior to ET diagnosis predicted a higher incidence of thrombosis. Evolution in acute leukemia/myelofibrosis occurred in 6 (1,5%) and 20 (5%) patients, and was significantly higher in patients receiving sequential cytotoxic agents. Overall survival was 38% at 19 years and was poorer for patients older than 60 years, with higher leukocytes count (>15 × 109/L), hypertension and mellitus diabetes at ET diagnosis and for patients experiencing a thrombotic event during follow-up. Cytoreductive therapy was effective in decreasing platelet number with negligible toxicity; however, thrombocytosis control did not reduce the incidence of thrombosis and, for patients who received sequential therapies, the probability of disease evolution was higher and survival was poorer. Am. J. Hematol. 2009. © 2008 Wiley-Liss, Inc. [source] Broad-band ultraviolet B phototherapy in zoster patients may reduce the incidence and severity of postherpetic neuralgiaPHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE, Issue 5 2006Mir Hadi Aziz Jalali Background: Postherpetic neuralgia (PHN) is one of the common complications of herpes zoster infection, particularly in the elderly. Current therapeutic measures are only partially effective in the affected patients. As inflammatory mediators released by different cells play an important role in the pathogenesis of this neuropathic pain and with regard to the immunomodulatory effects of ultraviolet B (UVB) spectrum, we presumed that UVB phototherapy might be effective in the prevention of PHN. Method: This study was performed in two phases. Phase I was a prospective open controlled trial. Twenty-five patients with severe pain in the first 7 days of zoster rash were divided into two groups: the prevention group (n=12) received oral acyclovir (800 mg five times a day for 10 days) plus broad-band UVB to the affected dermatomes, starting with 20 mJ/cm2 and gradually increasing the dose by 10 mJ/cm2 each session to a maximum dose of 100 mJ/cm2. Treatment sessions were repeated three times a week until pain relief or to a maximum of 15 sessions. The control group (n=13), who had disease characteristics similar to the prevention group, received only oral acyclovir with the same dose. All patients reported their severity of pain on a verbal rating scale (VRS, score 0,4) before treatment and at 1 and 3 months' follow-up. In phase II of the study, five patients with established PHN (more than 3 months after rash onset) received UVB with the above-mentioned protocol. Results: A total of 17 patients older than 40 (10 females, seven males; mean age, 65.5 years; range: 47,82 years) who had intractable pain due to zoster infection received UVB in two phases of the study. In patients who received phototherapy in the first 7 days of rash, 58.33% and 83.33% were completely pain free at 1-and 3-month follow-up, respectively. The corresponding figure in the control group was significantly lower (38.46% at 1 month and 53.85% at 3 months). The severity of pain was also lower in the phototherapy group than the control group (mean VRS 2.50 vs. 3.28 at 3 months). None of the patients who were treated more than 3 months after rash onset (established PHN) experienced significant (more than 50%) pain relief. Conclusion: UVB phototherapy in the acute stage of zoster rash might reduce the incidence and severity of PHN. Treatment after 3 months does not seem to have a significant beneficial effect. [source] Predictors of Toxicity and Toxicity Profile of Adjuvant Chemotherapy in Elderly Breast Cancer PatientsTHE BREAST JOURNAL, Issue 4 2009Praveen Garg MD Abstract:, Women older than 70 years have been underrepresented in breast cancer adjuvant chemotherapy trials due to concerns about toxicity, safety and tolerance of chemotherapy. The aim of our study was to assess the tolerance of chemotherapy in older women with breast cancer and determine patterns of toxicity including the impact of age, chemotherapy regimen, functional status and comorbid conditions on this toxicity. We retrospectively reviewed the charts of early stage (stages 1 and 2) breast cancer patients older than 70 years from 1998 to 2004. A total of 62 patients, with mean age of 74.3 years, were identified. Chemotherapy was completed in 89% patients. Overall 79% completed chemotherapy without any significant side-effects, dose reductions, or breaks during chemotherapy. Using logistic regression model increasing age was not associated with early termination of chemotherapy (p = 0.19, OR: 0.868, 95% CI: 0.7,1.076). However, increasing age, lower functional status, and higher comorbidity index scores were associated with reduction in dose and breaks in chemotherapy. None of the patients who received pegfilgrastim prophylactically developed high-grade neutropenia. Our study suggests that adjuvant chemotherapy is safe in elderly patients. Older patients with good functional status and low comorbidity index scores tolerate chemotherapy as well as the younger patients. Prophylactic use of pegfilgrastim may reduce occurrence of severe neutropenia and related toxicity such as febrile neutropenia in the elderly patient. [source] Role of Albumin Coating of Tympanostomy Tubes: Long-Term Clinical EvaluationTHE LARYNGOSCOPE, Issue 12 2007Teemu J. Kinnari MD Abstract Objective: Our previous work has shown that albumin coating of tympanostomy tubes prevented adhesion of proteins or bacteria on the tube surface in vitro and in a 9-month prospective follow-up study. This study was continued until all tubes were extruded. Study Design: A prospective, clinical trial. Methods: The randomized, double-blind clinical trial had 149 patients. The randomization was revealed after the follow-up period of 9 months. The number of tube sequelae in ears with human serum albumin (HSA)-coated titanium tympanostomy tubes was compared with the contralateral ears with uncoated, otherwise identical titanium tubes. The follow-up continued until all tubes were extruded, followed by evaluation of each tympanostomized patient. Results: No significant difference between the two tube types emerged after the 9-month follow-up. Among the patients younger than 2 years, one of the three typical bacteria causing acute otitis media (AOM), Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis, was found in 45% of all bacterial cultures taken during AOM. However, among patients older than 2, one of these bacteria appeared in 17% of all the bacterial cultures and in 8% of cultures taken during the summer. Conclusions: After the first 9 follow-up months, no difference was found in the sequelae related to uncoated and HSA-coated tubes. The typical bacteria causing AOM were found less frequently among patients older than 2 years. A profile of tympanostomy patients in Finland will be given. [source] Measurement of Angle and Length of the Eustachian Tube on Computed Tomography Using the Multiplanar Reconstruction TechniqueTHE LARYNGOSCOPE, Issue 7 2007Kenji Takasaki MD Abstract Objective: To compare the anatomic features of the eustachian tube (ET) between children with and without otitis media with effusion (OME) and with adults. Methods: The angle and length of the ET in children with OME (54 ears, OME children) and without OME (50 ears, normal children), as well as those of normal adults (90 ears), were measured on computed tomography using the multiplanar reconstruction technique. Results: The angles of ET in the OME children group, the normal children group, and the normal adult group were 20.4 ± 3.5° and 21.2 ± 4.8°, 19.9 ± 3.4° and 20.0 ± 3.6°, and 27.3 ± 2.7° and 27.3 ± 2.8° on the right and the left sides, respectively. There was no significant difference between the right and the left side in any group (P = .541, P = .952, P = .978). The lengths of ET in the OME children group, the normal children group, and the normal adult group were 37.2 ± 3.0 mm (mean ± SD) and 37.6 ± 3.2 mm, 37.5 ± 3.3 mm and 38.0 ± 3.2 mm, and 42.5 ± 2.8 mm and 42.9 ± 2.9 mm on the right and the left sides, respectively. There was no significant difference between the right and left sides in any group (P = .670, P = .597, and P = .545). Both the angles and lengths were significantly greater in the normal adult group than in either the OME children group or the normal children group (one-way analysis of variance and Fisher's protected least significant difference tests, P < .05), but there was no significant difference in either the angle or length of the ET between the OME and normal children groups (P > .05). In the OME and normal children groups, the angle was observed to constantly increase with age, and the values were found to be within the range of the adult size in all the patients older than 7.5 years and 7.7 years in the OME children group and the normal children group, respectively. As well as the angle, the lengths were observed to constantly increase with age, but the increase appeared to be greater at a younger age (until approximately 3 to 4 years) than at an older age, and the values were found to be within the range of the adult size in all the patients older than 6.8 years and 7.7 years in the OME children group and the normal children group, respectively. Conclusion: The angle and length of the ET are more horizontal and shorter in infants than in adults. However, there is no statistical difference between the angle and length of the ET in infants with and without OME. These results lead us to believe that a short and horizontal ET may not be a main etiologic factor related to high susceptibility to OME in infants and children. [source] Incidence of Unsuspected Metastases in Lateral Cervical Cysts,THE LARYNGOSCOPE, Issue 10 2000Christine G. Gourin MD Abstract Objective Solitary cystic squamous cell carcinoma metastases may be difficult to distinguish clinically from a benign cervical cyst. We sought to identify the incidence of solitary cystic squamous cell carcinoma metastasis in patients presenting with apparently benign cervical cysts. Study Design Retrospective review. Methods The records of all patients who presented with isolated lateral cervical cysts between 1983 and 1999 were reviewed. Patients with a clinically apparent primary malignancy, a history of head and neck cancer, a history of irradiation, or age less than 18 years were excluded from analysis, as were patients with a histological diagnosis of nonsquamous cell malignancy or those without a final histological diagnosis. Results One hundred twenty-one adult patients presented with an initial diagnosis of lateral cervical cyst. Metastatic squamous cell carcinoma was demonstrated histologically after surgical excision in 12 patients (9.9%). The incidence of malignancy was significantly greater in patients greater than 40 years of age (23.5%, P < .0001). Results of preoperative fine-needle aspiration (FNA) were negative for malignancy in five cases of metastatic squamous cell carcinoma. Panendoscopy with directed biopsies revealed an occult primary in the base of tongue in three patients, tonsil in one patient, and nasopharynx in one. No primary was found in six patients, despite repeated examinations and close follow-up. Conclusions Solitary cervical cysts in patients older than 40 years of age should be presumed to be carcinoma until proven otherwise. A negative FNA result may be misleading, because of hypocellularity of the cyst fluid. Excisional biopsy should be undertaken with provisions made for frozen-section analysis of the specimen and contingency panendoscopy with directed biopsies of Waldeyer's ring if frozen-section histological examination reveals malignancy. [source] MOSHER AWARD HONORABLE MENTION,THE LARYNGOSCOPE, Issue 4 2000Natural History of Acoustic Neuromas Abstract Objectives/Hypothesis 1) Develop a computerized technique to accurately compare acoustic neuroma size on routine computed tomography and magnetic resonance imaging (MRI) scans; 2) use this technique to determine the growth pattern in a large series of patients with acoustic neuroma who were conservatively managed; 3) describe the natural history of patients with acoustic neuromas who did not receive surgical intervention and those who underwent subtotal resection; 4) correlate the size and growth rate of acoustic neuromas to clinical presentation and auditory and vestibular testing; and 5) recommend guidelines for the management of patients with acoustic neuromas. Study Design A retrospective study from 1974 to 1999 of patients with unilateral acoustic neuromas who had conservative treatment by serial imaging studies (80 patients) or subtotal resection (49 patients). Methods All patient charts were evaluated for presenting symptoms, reasons for the type of management given, and clinical outcome. Charts were also reviewed with respect to serial audiological assessment, electronystagmography, and brainstem auditory evoked response. Imaging studies were analyzed using a computer technique so that serial studies could be compared to determine growth rates. Results Rigorous computer analysis of tumor size and growth rate was statistically the same as the radiologist's description of the tumor size and growth rate. Of 70 patients who were older than 65 years of age old at the time their tumor was discovered, 4 (5.7%) required intervention and 18 (26%) were dead of unrelated causes. These patients had a mean follow-up of 4.8 years (range, 0.01,17.2 y). Overall, growth rate for nonsurgical patients was 0.91 mm per year. Nonsurgical tumors did not grow or regressed in 42.3%. Overall postoperative growth rate for surgical subtotal resection patients was 0.35 mm per year. Surgical tumors did not grow or regressed after subtotal resection of acoustic neuroma in 68.5% of patients. Three patients (6.1%) required revision surgery because of tumor growth or the development of symptoms. Neither auditory nor vestibular testing was a reliable measure for determining tumor growth. Conclusion Measurement of the maximal tumor diameter on MRI scans is a reliable method for following acoustic neuroma growth. There is no need to perform a rigorous analysis of tumor size to determine whether the tumor is growing significantly. The vast majority of patients older than 65 years with acoustic neuromas do not require intervention. The indications for intervention should be based on a combination of rapid tumor growth with the development of symptoms. [source] Age as only predictive factor for successful sperm recovery in patients with Klinefelter's syndromeANDROLOGIA, Issue 2 2009K. Ferhi Summary The study was performed to determine factors affecting successful sperm retrieval by testicular sperm extraction in patients with nonmosaic Klinefelter's syndrome (KS). From May 2001 to February 2007, 27 azoospermic patients were diagnosed as having nonmosaic KS. All patients underwent sperm testicular extraction. Patient's age, testicular volume, serum follicle-stimulating hormone (FSH) and inhibin B were assessed as predictive factors for successful sperm recovery. Of the 27 Klinefelter's patients examined, eight (29.6%) had successful sperm recovery. The comparisons of serum FSH, inhibin B and testicular volume between patients with and without successful sperm retrieval did not show any statistical significance. The patients with successful sperm recovery were significantly younger (28.6 ± 3.11 years) than those with failed attempts (33.9 ± 4.5 years, P = 0.002). The rate of positive sperm retrieval was significantly higher in patients younger than 32 years compared with patients older than 32 years (P = 0.01, chi-squared test). The study showed that clinical parameters such as FSH, inhibin B and testicular volume do not have predictive value for sperm recovery in patients with KS. The mean age of our patients with successful sperm recovery was significantly lower than that of men with unsuccessful results. Testicular sperm extraction or testicular sperm aspiration should be performed before the critical age of 32 years. [source] How safe is open abdominal aortic aneurysm surgery for octogenarians in New Zealand?ANZ JOURNAL OF SURGERY, Issue 5 2009Ian A. Thomson Abstract Background:, Abdominal aortic aneurysm (AAA) is an important cause of mortality for the aged, a group that has been denied surgery in the past for fear of peri-operative mortality. Is this attitude still justified? Methods:, Analysis of prospectively gathered data from a vascular database. Results:, 10.9% of all open AAA operations were in patients older than 79 years with an 8% mortality cate compared to 3% for younger patients. For fit elderly patients with ASA scores less than 3, mortality was just under 4%. Renal failure and wound dehiscence were more common in the elderly. Conclusion:, When endovascular repair is not possible in a fit elderly patient, open surgery can be performed with acceptable results. [source] Mortality in Behçet's diseaseARTHRITIS & RHEUMATISM, Issue 9 2010D. Saadoun Objective To report the long-term mortality in patients with Behçet's disease (BD). Methods A cohort of 817 patients fulfilling the international criteria for BD from a single center in France were analyzed for causes of death, the standardized mortality ratio (SMR), and the factors associated with mortality. Results Among the 817 patients with BD, 41 (5%) died after a median followup of 7.7 years, of whom 95.1% were male. The mean ± SD age at death was 34.8 ± 11.9 years. Main causes of death included major vessel disease (mainly, arterial aneurysm and Budd-Chiari syndrome) (43.9%), cancer and malignant hemopathy (14.6%), central nervous system involvement (12.2%), and sepsis (12.2%). The mortality rate at 1 year and 5 years was 1.2% and 3.3%, respectively. There was an increased mortality among patients ages 15,24 years (SMR 2.99, 95% confidence interval [95% CI] 1.54,5.39) and those ages 25,34 years (SMR 2.90, 95% CI 1.80,4.49) as compared with age-and sex-matched healthy controls. The mortality decreased in patients older than age 35 years (SMR 1.23, 95% CI 0.75,1.92). In multivariate analyses, male sex (hazard ratio [HR] 4.94, 95% CI 1.53,16.43), arterial involvement (HR 2.51, 95% CI 1.07,5.90), and a high number of BD flares (HR 2.37, 95% CI 1.09,5.14) were independently associated with the risk of mortality. Conclusion The overall mortality in our BD cohort was 5% after a median followup of 7.7 years. Male sex, arterial involvement, and the number of flares were associated with mortality in BD. [source] Clinical score for nonbacterial osteitis in children and adultsARTHRITIS & RHEUMATISM, Issue 4 2009Annette F. Jansson Objective To accurately differentiate nonbacterial osteitis (NBO) from other bone lesions by applying a clinical score through the use of validated diagnostic criteria. Methods A retrospective study was conducted to assess data on patients from a pediatric clinic and an orthopedic tertiary care clinic, using administrative International Classification of Diseases codes as well as laboratory and department records from 1996 to 2006. Two hundred twenty-four patients older than age 3 years who had either NBO (n = 102), proven bacterial osteomyelitis (n = 22), malignant bone tumors (n = 48), or benign bone tumors (n = 52) were identified by chart review. Univariate logistic regression was used to determine associations of single risk factors with a diagnosis of NBO, and multivariable logistic regression was used to assess simultaneous risk factor associations with NBO. Results NBO was best predicted by a normal blood cell count (odds ratio [OR] 81.5), symmetric bone lesions (OR 30.0), lesions with marginal sclerosis (OR 26.8), normal body temperature (OR 20.3) a vertebral, clavicular, or sternal location of lesions (OR 13.9), presence of >1 radiologically proven lesion (OR 10.9), and C-reactive protein level ,1 mg/dl (OR 6.9). The clinical score for a diagnosis of NBO based on these predictors ranged from 0 to 63. A score for NBO of ,39 had a positive predictive value of 97% and a sensitivity of 68%. Conclusion The proposed scoring system helps to facilitate the diagnostic process in patients with suspected NBO. Use of this system might spare unnecessary invasive diagnostic and therapeutic procedures. [source] The capacity of dental therapists to provide direct restorative care to adultsAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 5 2009Hanny Calache Abstract Introduction: In Victoria, dental therapists are restricted to treating patients under the age of 26 years. Removing this age restriction from dental therapists' scope of practice may assist significantly in addressing workforce shortages, particularly in rural Victoria. Objectives: This study aims to assess the capacity of dental therapists to provide direct coronal restorations (dental fillings) to patients older than 25 years, on the prescription of a dentist. Its objectives include determining the success rate of restorations placed by dental therapists six months post placement; and patients' and dental therapists' satisfaction with the services provided. Methods: The project was carried out in 2007 at the Royal Dental Hospital of Melbourne. Seven dental therapists participated in the study, placed 356 restorations (115 patients) with the support of a dentist. These restorations were reviewed six-months post placement by dentists blinded as to which restorations were placed by the dental therapists. Patients' age ranged from 26 to 82 years (82% were >40 years). Results: At six months post-treatment, 258 restorations (80 patients) were reviewed. At review, 94.6% of the restorations were successful. Patients and dental therapists were satisfied with the experience. Conclusions: The standard of restorations provided by dental therapists was considered to be at least similar to that expected of a newly graduated dentist. Implications: Broadening the dental therapists scope of practice would create opportunities to design more flexible ,oral health' clinical teams enabling dentists to provide more complex procedures for patients most in need. This is significant in the public sector and rural areas where workforce shortages are most acute. [source] | |||||||||||||||||||||||||||||||