Αρχειοθήκη ιστολογίου

Κυριακή 22 Ιουλίου 2018

Geriatrische Onkologie

Zusammenfassung

Aufgrund der demografischen Entwicklung mit einer zunehmenden Zahl alter Menschen und des altersabhängigen Anstiegs der Inzidenzrate der Krebserkrankungen wird die Zahl alter Menschen mit Krebserkrankungen in den kommenden Jahrzehnten erheblich ansteigen. In der Geriatrie wurde ein strukturiertes systematisches Assessment etabliert, um Defizite und Ressourcen des einzelnen Patienten zu erkennen und individuelle Therapieplanungen vornehmen zu können. Die Forschung in der geriatrischen Onkologie hat bisher gezeigt, dass die Übertragung des Assessments von der Geriatrie zur Onkologie hilft, unabhängig vom chronologischen Alter, Patienten mit altersabhängigen Einschränkungen besser zu erkennen. Solche Einschränkungen sind zudem prädiktiv für ein höheres Risiko der Therapieunverträglichkeit und für geringeres Überleben. Geriatrisches Assessment hilft dabei, eine onkologische Therapie besser zu stratifizieren und somit Über- und Untertherapie zu vermeiden. In aktuellen Studien wird untersucht, ob auf den Ergebnissen des Assessments aufbauende Interventionen zu einer Verbesserung von für die Patienten relevanten Endpunkten beitragen. Für alte Patienten relevante Endpunkte, wie der Erhalt der Fähigkeit zur Selbstversorgung, sind bisher unzureichend in onkologische Therapiestudien integriert worden.



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Endoscopic DCR: A 10 Years Personal Experience

Abstract

Endoscopic DCR is an endonasal minimally invasive procedure to bypass an obstructed nasolacrimal duct by creating a direct fistula between the lacrimal sac and the nasal cavity. This is a retrospective case series review of the author's experience in endoscopic DCR in the period from 2007 to 2017. This series included 193 adult patients with a mean age of 47 years who underwent endoscopic DCR surgery. In this study, both primary and revision cases were reviewed including non-stented primary cases and bilateral simultaneous surgeries at the same session. Causes of failure in primary surgeries were stated, and indications of secondary cases were also reviewed. As a conclusion, endoscopic DCR remains the standard procedure in treating nasolacrimal duct obstruction with its consequent symptoms of epiphora, recurrent or chronic dacryocystitis.



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Cortical Auditory Evoked Potentials in Children with Auditory Neuropathy/Dys-Synchrony

Abstract

Auditory neuropathy/spectrum disorder (ANSD), also referred to as auditory neuropathy/dys-synchrony (AN/AD) is a recently described form of hearing impairment. Many studies have shown that changing the pattern of afferent input to the cortex significantly affects cortical organization and there is little studies about cortical neuromaturation and plasticity in children with ANSD. Study of P1 component of cortical auditory evoked potentials (CAEPs) in children with ANSD. This survey was descriptive cross-sectional. During that 97 hearing impairment children were under hearing screening tests. Of these, 14 selected subjects (ear = 28) diagnosed with ANSD (an average age of 8.5 years) and evaluated by P1 component of CAEPs. Based on latency results of p1 wave, the ears of the subjects fell into two seperate groups: Control (normal: n = 10) and case {total: n = 18 (delayed: n = 12) + (absent: n = 6)}. The averages of mean latency of P1 components of the case group in the right and the left ears compared to the control group had significant differences (p < 0.05). Abnormal latency of p1 component in ANSD children shows the possibility of different scales of disturbances in cortical auditory maturation and grow.



https://ift.tt/2A29HJx

Endoscopic DCR: A 10 Years Personal Experience

Abstract

Endoscopic DCR is an endonasal minimally invasive procedure to bypass an obstructed nasolacrimal duct by creating a direct fistula between the lacrimal sac and the nasal cavity. This is a retrospective case series review of the author's experience in endoscopic DCR in the period from 2007 to 2017. This series included 193 adult patients with a mean age of 47 years who underwent endoscopic DCR surgery. In this study, both primary and revision cases were reviewed including non-stented primary cases and bilateral simultaneous surgeries at the same session. Causes of failure in primary surgeries were stated, and indications of secondary cases were also reviewed. As a conclusion, endoscopic DCR remains the standard procedure in treating nasolacrimal duct obstruction with its consequent symptoms of epiphora, recurrent or chronic dacryocystitis.



https://ift.tt/2uGIQ0o

Cortical Auditory Evoked Potentials in Children with Auditory Neuropathy/Dys-Synchrony

Abstract

Auditory neuropathy/spectrum disorder (ANSD), also referred to as auditory neuropathy/dys-synchrony (AN/AD) is a recently described form of hearing impairment. Many studies have shown that changing the pattern of afferent input to the cortex significantly affects cortical organization and there is little studies about cortical neuromaturation and plasticity in children with ANSD. Study of P1 component of cortical auditory evoked potentials (CAEPs) in children with ANSD. This survey was descriptive cross-sectional. During that 97 hearing impairment children were under hearing screening tests. Of these, 14 selected subjects (ear = 28) diagnosed with ANSD (an average age of 8.5 years) and evaluated by P1 component of CAEPs. Based on latency results of p1 wave, the ears of the subjects fell into two seperate groups: Control (normal: n = 10) and case {total: n = 18 (delayed: n = 12) + (absent: n = 6)}. The averages of mean latency of P1 components of the case group in the right and the left ears compared to the control group had significant differences (p < 0.05). Abnormal latency of p1 component in ANSD children shows the possibility of different scales of disturbances in cortical auditory maturation and grow.



https://ift.tt/2A29HJx

Triple-negative and HER2 positive ductal carcinoma in situ of the breast: characteristics, behavior, and biomarker profile

Abstract

We compared the characteristics, clinical behavior, and biomarker profile between HER2 positive (HER2+) and triple-negative (TN) ductal carcinoma in situ (DCIS) which are considered more aggressive than other DCIS subtypes. In addition, we explored the impact of these features on its potential of progression to invasive breast carcinomas. Cases of DCIS diagnosed at the Department of Pathology, Singapore General Hospital from 1994 to 2010 were identified. TN and HER2+ DCIS cases formed the study cohort. Immunohistochemistry (IHC) was performed for ER, PR, HER2, CK14, EGFR, and p53. Comparisons of clinicopathological features, IHC results, and clinical outcomes were performed between the two groups. We evaluated 145 HER2+ and 85 TN DCIS cases. HER2 positive DCIS had significantly higher nuclear grade (p < 0.001) and more frequent necrosis (p < 0.001) than TN DCIS. HER2 positive DCIS also harbored significantly higher rates of nuclear p53 immunoreactivity (p = 0.002) than TN DCIS. Younger patients (age < 40) with HER2+ and TN DCIS demonstrated statistically significant worse invasive DFS than older women (p < 0.001). Multivariate cox regression analysis (HR 15.08, 95% CI 12.79–81.45, p = 0.002) also confirmed these findings. In addition, younger patients (age < 40) with HER2+ DCIS experienced significantly poorer prognosis when p53 was also positive (p = 0.033). HER2+ DCIS had more aggressive pathological characteristics compared to TN DCIS; accumulation of mutant p53 could possibly be contributory. Age was an independent predictor of aggressive biological behavior of HER2+ and TN DCIS. We demonstrated that younger patients with p53 positive HER2+ DCIS had significantly adverse clinical outcome.



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Revisiting the 2015 American Thyroid Association Guidelines With Respect to Indeterminate Thyroid Nodules in the Era of Noninvasive Follicular Thyroid Neoplasm With Papillary-like Nuclear Features.

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Revisiting the 2015 American Thyroid Association Guidelines With Respect to Indeterminate Thyroid Nodules in the Era of Noninvasive Follicular Thyroid Neoplasm With Papillary-like Nuclear Features.

JAMA Otolaryngol Head Neck Surg. 2018 Jul 19;:

Authors: Underwood HJ, Patel KN

PMID: 30027291 [PubMed - as supplied by publisher]



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Incidence and Risk of Second Primary Malignant Neoplasm After a First Head and Neck Squamous Cell Carcinoma.

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Incidence and Risk of Second Primary Malignant Neoplasm After a First Head and Neck Squamous Cell Carcinoma.

JAMA Otolaryngol Head Neck Surg. 2018 Jul 19;:

Authors: Adjei Boakye E, Buchanan P, Hinyard L, Osazuwa-Peters N, Schootman M, Piccirillo JF

Abstract
Importance: Second primary malignant neoplasms (SPMNs) are the leading cause of death in survivors of head and neck squamous cell carcinoma (HNSCC). Recently, human papillomavirus (HPV) has emerged as a risk factor for oropharyngeal squamous cell carcinoma and has different prognosis from classic tobacco/alcohol-associated HNSCC. This suggests that there also may be different risks and burden of SPMNs among patients who's HNSCC were from HPV or tobacco and/or alcohol.
Objective: To assess SPMN risks and burden in a large US cohort of patients with a first potentially HPV-associated HNSCC vs non-HPV-associated HNSCC.
Design, Setting, and Participants: In this population-based retrospective cohort study, 109 512 adult patients diagnosed with HNSCC between 2000 and 2014 were identified from the Surveillance, Epidemiology, and End Results registry.
Exposures: HPV-relatedness based on whether patients' first HNSCC was potentially associated with HPV. Patients were grouped into 2 cohorts: potentially HPV-associated HNSCC, and non-HPV-associated HNSCC.
Main Outcomes and Measures: The primary outcome was incidence of SPMN (defined as the first subsequent primary cancer occurring at least 2 months after first cancer diagnosis). Excess SPMN risk was calculated using relative (standardized incidence ratios [SIRs]) and absolute (excess absolute risk [EAR] per 10 000 person-years at risk [PYR]).
Results: A total of 109 512 patients with HNSCC (mean [SD] age, 61.9 [12.1] years; 83 305 [76.1%] men) were identified. The overall SIR was 2.18 (95% CI, 2.14-2.22) corresponding to 160 excess cases per 10 000 PYR. The risk among patients with first potentially HPV-associated HNSCC (SIR, 1.98; EAR, 114 excess cases per 10 000 PYR) was lower than those with first non-HPV-associated HNSCC (SIR, 2.28; EAR, 188 excess cases per 10 000 PYR). Overall, the largest SIRs and EARs were observed for cancers of the head and neck, lung, and esophagus. However, the risks of SPMN were lower among potentially HPV-associated HNSCC patients.
Conclusions and Relevance: Patients diagnosed with HNSCC experience excess risk of SPMN, which was higher among those with non-HPV-associated HNSCC than from potentially HPV-associated HNSCC. Clinicians should implement strategies that prevent or detect SPMN early in patients with HNSCC.

PMID: 30027284 [PubMed - as supplied by publisher]



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JAMA Otolaryngology-Head & Neck Surgery.

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JAMA Otolaryngology-Head & Neck Surgery.

JAMA Otolaryngol Head Neck Surg. 2018 Jul 01;144(7):552

Authors:

PMID: 30027260 [PubMed - in process]



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Association of Tumor Size With Histologic and Clinical Outcomes Among Patients With Cytologically Indeterminate Thyroid Nodules.

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Association of Tumor Size With Histologic and Clinical Outcomes Among Patients With Cytologically Indeterminate Thyroid Nodules.

JAMA Otolaryngol Head Neck Surg. 2018 Jul 19;:

Authors: Valderrabano P, Khazai L, Thompson ZJ, Otto KJ, Hallanger-Johnson JE, Chung CH, Centeno BA, McIver B

Abstract
Importance: Tens of thousands of unnecessary operations are performed each year for diagnostic purposes among patients with cytologically indeterminate thyroid nodules. Whereas a diagnostic lobectomy is recommended for most patients with solitary indeterminate thyroid nodules, a total thyroidectomy is preferred for nodules larger than 4 cm.
Objective: To determine whether histologic or clinical outcomes of indeterminate thyroid nodules 4 cm or larger are worse than those for nodules smaller than 4 cm, thus justifying a more aggressive initial surgical approach.
Design, Setting, and Participants: In this retrospective cohort study, 652 indeterminate thyroid nodules (546 nodules <4 cm and 106 nodules ≥4 cm) with surgical follow-up were consecutively evaluated at an academic cancer center from October 1, 2008, through April 30, 2016.
Exposure: Tumor size.
Main Outcomes and Measures: Differences in cancer rates, rates of invasive features, cancer aggressiveness, and response to therapy between indeterminate thyroid nodules smaller than 4 cm and 4 cm or larger.
Results: A total of 652 indeterminate thyroid nodules (546 nodules <4 cm and 106 nodules ≥4 cm) from 589 patients (mean [SD] age, 53.1 [13.8] years; 453 [76.9%] female) were studied. No differences were found in the baseline characteristics of patients or nodules between the 2 size groups. Tumor size was not associated with the cancer rate as a categorical (140 of 546 [25.6%] for nodules <4 cm and 33 of 106 [31.1%] for nodules ≥4 cm; effect size, 0.05; 95% CI, 0.002-0.12) or continuous (odds ratio [OR], 1.03; 95% CI, 0.92-1.15) variable. No association was found between nodule size and prevalence of extrathyroidal extension, positive margins, lymphovascular invasion, lymph node metastasis, or distant metastasis. Most malignant tumors were low risk in both size groups (70% in the nodules <4 cm and 72% in the nodules ≥4 cm), and tumor size was not associated with tumor aggressiveness as a categorical (effect size, 0.10; 95% CI, 0.03-0.31) or continuous variable (OR for intermediate-risk cancer, 0.91; 95% CI, 0.72-1.14; OR for high-risk cancer, 1.43; 95% CI, 0.96-2.15). At the last follow-up visit, 88 of 105 patients (83.8%) with malignant tumors in the smaller than 4 cm group and 21 of 25 (84.0%) in the 4 cm or greater group had no evidence of disease, and tumor size was not associated with response to therapy (effect size, 0.13; 95% CI, 0.07-0.33).
Conclusions and Relevance: Most indeterminate thyroid nodules are benign or low-risk malignant tumors regardless of tumor size. In the absence of other indications for total thyroidectomy, this study suggests that a thyroid lobectomy is sufficient initial treatment for most solitary cytologically indeterminate thyroid nodules independent of the tumor size.

PMID: 30027226 [PubMed - as supplied by publisher]



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Development of Multimodal Analgesia Pathways in Outpatient Thyroid and Parathyroid Surgery and Association With Postoperative Opioid Prescription Patterns.

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Development of Multimodal Analgesia Pathways in Outpatient Thyroid and Parathyroid Surgery and Association With Postoperative Opioid Prescription Patterns.

JAMA Otolaryngol Head Neck Surg. 2018 Jul 19;:

Authors: Militsakh O, Lydiatt W, Lydiatt D, Interval E, Lindau R, Coughlin A, Panwar A

Abstract
Importance: Prescription opioid use contributes to drug-related adverse effects and risk for dependence and abuse. Multimodal analgesia (MMA) has been shown to be useful in reducing opioid use following orthopedic, gynecologic, and colorectal surgery, but adoption in head and neck surgery has lagged. Recently, we published findings related to the feasibility of MMA protocols in same-day thyroid, parathyroid, and parotid surgery. However, whether such strategies lead to effective and durable reduction in frequency of opioid prescriptions, and affect physician prescribing practices, remains unclear.
Objective: To observe trends in adoption and adherence to institutional MMA protocols following thyroid and parathyroid surgery, and to assess the association of institutional multimodal (nonopioid) analgesia protocols with opioid use and physician prescribing patterns following outpatient thyroid and parathyroid surgery.
Design, Setting, and Participants: Cohort study at a head and neck surgery service at a tertiary care hospital of prescription patterns and retrospective review of patient medical records following implementation of an optional institutional MMA protocol in 2015, based on preoperative administration of acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and gabapentin, and postoperative use of acetaminophen and ibuprofen for analgesia after thyroid and parathyroid surgery. There were 528 adult patients who underwent thyroid and parathyroid surgery between January 1, 2015, and June 30, 2017.
Main Outcomes and Measures: We report on adherence to the MMA protocol over the study period as measure of physician buy-in and adoption of the technique. The frequency of opioid use and physician prescription patterns following thyroid and parathyroid surgery is reported over the study period to study the association of the available MMA pathway with these variables.
Results: A total of 528 patients (mean [SD] age, 53.1 [15.7] years; 80.3% female) underwent outpatient thyroid and parathyroid surgery. The frequency of postoperative opioid prescriptions decreased during the study period (16 of 122 [13.1%] in 2015, 22 of 244 [9.0%] in 2016, 3 of 162 [1.9%] in 2017). Adherence to the MMA protocol increased (0 of 122 cases in 2015, 106 of 244 [43.4%] cases in 2016, 142 of 162 [87.7%] cases in 2017), with reduced likelihood of opioid prescription on discharge (2017 vs 2015 odds ratio, 0.13; 95% CI, 0.04-0.44). Only 1 postoperative hematoma was recorded in the study cohort, and 352 (66.7%) patients achieved same-day discharge, whereas 176 (33.3%) maintained outpatient status but received overnight observation prior to discharge.
Conclusions and Relevance: Adoption and adherence to the MMA protocol increased substantially over the study period for patients undergoing thyroid and parathyroid surgery and was associated with a simultaneous significant decline in prescription of postoperative opioid analgesics. Use of nonopioid multimodal agents, incorporating NSAIDs, was safe and did not lead to increased incidence of bleeding. Availability of effective nonopioid MMA pathways may favorably influence physician prescribing practices and avoid unnecessary opioid prescriptions.

PMID: 30027221 [PubMed - as supplied by publisher]



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Bilateral Painless Cervical Lymphadenopathy in a Child.

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Bilateral Painless Cervical Lymphadenopathy in a Child.

JAMA Otolaryngol Head Neck Surg. 2018 Jul 19;:

Authors: Amin S, Sybenga A, Pleitz J

PMID: 30027203 [PubMed - as supplied by publisher]



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