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Ashraf S, Lone H, Wani ML, Francis W, Alkhulaifi AM, Carr CS. Radical sternectomy for osteomyelitis without reconstruction post-coronary artery bypass graft: 10 years on. J Wound Care 2024; 33:S22-S24. [PMID: 38573948 DOI: 10.12968/jowc.2024.33.sup4.s22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Radical sternectomy with sternal reconstruction using synthetic mesh or titanium plates has been described before with excellent results. However, radical removal of the sternum without reconstruction is a rare surgical treatment for complicated deep sternal wound infections (DSWI). The long-term outcome following this radical operation is not well-known due to the limited number of cases in the literature. We report on a patient 10 years after a radical sternectomy for DSWI who presented with shortness of breath. We highlight some of the anatomical and physiological changes the chest cavity may undergo and the fact that this patient had a near normal quality of life in the 10 years following the sternectomy.
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Affiliation(s)
- Shady Ashraf
- Department of Cardiothoracic Surgery, the Heart Hospital, HMC, Doha, Qatar
| | - Hafeez Lone
- Department of Cardiothoracic Surgery, the Heart Hospital, HMC, Doha, Qatar
| | - Mohd Lateef Wani
- Department of Cardiothoracic Surgery, the Heart Hospital, HMC, Doha, Qatar
| | | | | | - Cornelia S Carr
- Department of Cardiothoracic Surgery, the Heart Hospital, HMC, Doha, Qatar
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2
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Mehdinejadshani M, Fallah H, Kamali F, Alizadeh-Diz A, Eslami M, Golabchi A, Taherpour M, Shahabi J, Mollazadeh R, Madadi S, Azhari A, Sodagar A, Eftekharzadeh M, Oraii S, Fazelifar A, Kazemisaeed A, Ghorbanisharif A, Dalili M, Khorgami M, Heidari-Bakavoli A, Jorat M, Nikoo H, Kheirkhah J, Saravi M, Khodaparast M, Mirzaali M, Emkanjoo Z, Mirmasoumi M, Sadeghian S, Mokhtari M, Hedayati-Goudarzi M, Haghjoo M. Clinical outcomes of subcutaneous implantable cardiac defibrillator implantation - Iran SICD registry. Pacing Clin Electrophysiol 2023; 46:273-278. [PMID: 36751953 DOI: 10.1111/pace.14668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 12/29/2022] [Accepted: 01/15/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND The subcutaneous implantable-defibrillator (S-ICD) is a relatively new alternative to the transvenous ICD system to minimize intravascular lead-related complications. This paper presents outcome of SICD implantation in patients enrolled in Iran S-ICD registry. METHODS Between October 2015 and June 2022, this prospective multicenter national registry included 223 patients with a standard indication for an ICD, who neither required bradycardia pacing nor needed cardiac resynchronization to evaluate the early post-implant complications and long-term follow-up results of the S-ICD system. RESULTS The mean age of the patients was 45 ± 17 years. The majority (79.4%) were male. Ischemic cardiomyopathy (39.5%) was the most common underlying disorder among patients selected for S-ICD implant. Most study patients (68.6%) had ICD for primary prevention of sudden cardiac death. Seven patients (3.1%) were found to have suboptimal lead positions. Six patients (2.7%) developed a pocket hematoma; all were managed medically. During a mean follow-up of 2 years, the appropriate therapy was recorded in 13% of the patients and inappropriate ICD intervention mainly due to supraventricular tachycardia in 8.9%. Pocket infection was observed in four patients (1.8%) and five patients (2.2%) died mainly due to heart failure. CONCLUSION S-ICDs were effective at detecting and treating both induced and spontaneous ventricular arrhythmias. Major clinical complications were rare.
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Affiliation(s)
- Mahdiye Mehdinejadshani
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Fallah
- Department of Cardiology, Faculty of Medicine, Ayatollah Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Farzad Kamali
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfath Alizadeh-Diz
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Eslami
- Department of Cardiology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Allahyar Golabchi
- The Advocate Center for Clinical Research, Ayatollah Yasrebi Hospital, Kashan, Iran
| | | | - Javad Shahabi
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Mollazadeh
- Department of Cardiology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Shabnam Madadi
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Azhari
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | | | | | - Amirfarjam Fazelifar
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Kazemisaeed
- Cardiology Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Dalili
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadrafie Khorgami
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Alireaza Heidari-Bakavoli
- Department of Cardiovascular Disease, Faculty of Medcine, Mashhad University of Medical Sciences, Mashahd, Iran
| | | | - Hossein Nikoo
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jalal Kheirkhah
- Department of Cardiology, School of Medicine, Heshmat Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mehrdad Saravi
- Department of Cardiology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Morteza Khodaparast
- Zavareh Atherosclerosis Research Center, Baqyitallah University of Medical Sciences, Tehran, Iran
| | - Mansour Mirzaali
- Shafa Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Zahra Emkanjoo
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Saeed Sadeghian
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Meisam Mokhtari
- Cardiac Electrophysiology Department, Shahid Chamran Cardiovascular Medical and Research Center, Isfahan University of Medical Science, Isfahan, Iran
| | | | - Majid Haghjoo
- Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Santos JM, Casabé JH, Fava C, Godoy Armando CL, Perandones CE, Segura M, Raffaelli H, Favaloro RR. [Takayasu arteritis. Therapeutic alternatives and long term outcomes]. Medicina (B Aires) 2022; 82:74-80. [PMID: 35037864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
The aim of this study was to describe the long term prognosis of 34 patients with Takayasu arteritis and the results of surgical and endovascular treatment. A total of 5 central surgeries and 53 endovascular procedures were performed including 18 bypass surgeries (33.8%) and 35 angioplasties (66.2%). The median follow-up was 7.5 years, interquartile range [IQR] 2.6-12.5. Among the 18 bypass surgeries 6 (33.3%) had events, while in the 35 patients with endovascular treatment there were 16 events (45.7%). The overall 1-, 3-, 5-, and 10-year death and arterial complication-free survival rates were 80% (95% CI between 74 and 89%), 68% (95% CI between 58 and 79%), 65% (95% CI between 54 and 76%) and 47% (95% CI between 41 and 62%). Both revascularization techniques were initially successful. In long term follow-up there was a high restenosis recurrence rate with endovascular treatment requiring repeated revascularization to the same vessel in 41% of the cases. Surgery had higher mortality in patients with aortic and ascending aortic valve disease, combined coronary artery disease and carotid disease. In long term follow up Takayasu arteritis frequently requires revascularization and restenosis or new lesions are common. Surgical treatment had better results with less restenosis than angioplasty.
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Affiliation(s)
- José M Santos
- Servicio de Cardiología, Instituto de Cardiología y Cirugía Cardiovascular (ICYCC), Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina. E-mail:
| | - J Horacio Casabé
- Servicio de Cardiología, Instituto de Cardiología y Cirugía Cardiovascular (ICYCC), Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina
| | - Carlos Fava
- Servicio de Hemodinamia, Instituto de Cardiología y Cirugía Cardiovascular (ICYCC), Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina
| | - Casandra L Godoy Armando
- Servicio de Cardiología, Instituto de Cardiología y Cirugía Cardiovascular (ICYCC), Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina
| | - Carlos E Perandones
- Servicio de Reumatología, Instituto de Cardiología y Cirugía Cardiovascular (ICYCC), Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina
| | - Mónica Segura
- Servicio de Cardiología, Instituto de Cardiología y Cirugía Cardiovascular (ICYCC), Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina
| | - Héctor Raffaelli
- Servicio de Cirugía Cardiovascular, Instituto de Cardiología y Cirugía Cardiovascular (ICYCC), Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina
| | - Roberto R Favaloro
- Servicio de Cirugía Cardiovascular, Instituto de Cardiología y Cirugía Cardiovascular (ICYCC), Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina
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4
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Zheng Z, Yang L, Zhang Z, Wang D, Zong J, Zhang L, Wang X. Early and late outcomes of non-total aortic arch replacement for repair of acute Stanford Type A aortic dissection. Am J Transl Res 2021; 13:7047-7052. [PMID: 34306462 PMCID: PMC8290664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/29/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study evaluated the early and late outcomes of non-total aortic arch replacement for acute Stanford A aortic dissection. METHODS 131 cases of acute Stanford Type A aortic dissection with no rupture admitted to our hospital from January 2016 to December 2019 were selected for non-total aortic arch replacement. According to different surgical methods, 51 patients with tear-oriented ascending/hemiarch replacement were included in Group A, and 80 patients who underwent total arch replacement surgery were enrolled in Group B. The perioperative indicators, 30-day mortality rate, and the incidence of postoperative complications were compared between the two groups, and the survival rate of patients were compared by follow-up after discharge. RESULTS The cardiopulmonary bypass time, cardiac perfusion time, invasive ventilation and ICU hospitalization in Group A were critically shorter than those in Group B (P<0.05). The incidence of transient cerebral dysfunction in Group A was substantially lower than that in Group B (P<0.05). The difference of comparison in perioperative mortality, incidence of permanent neurological dysfunction, and incidence of acute kidney and liver damage between the two groups was statistically insignificant (P>0.05). In addition, the two groups had statistically insignificant difference in survival during postoperative follow-up (P>0.05). CONCLUSION For acute Stanford type A aortic dissection without rupture in aortic arch, the non-total aortic arch replacement has simple surgical method with high perioperative safety and long-term efficacy that similar to total arch replacement.
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Affiliation(s)
- Zhifa Zheng
- Department of Cardiovascular Surgery, Shanxi Bethune Hospital (Shanxi Academy of Medical Sciences) Taiyuan 030032, Shanxi, China
| | - Lingbo Yang
- Department of Cardiovascular Surgery, Shanxi Bethune Hospital (Shanxi Academy of Medical Sciences) Taiyuan 030032, Shanxi, China
| | - Zhongjie Zhang
- Department of Cardiovascular Surgery, Shanxi Bethune Hospital (Shanxi Academy of Medical Sciences) Taiyuan 030032, Shanxi, China
| | - Dong Wang
- Department of Cardiovascular Surgery, Shanxi Bethune Hospital (Shanxi Academy of Medical Sciences) Taiyuan 030032, Shanxi, China
| | - Junqing Zong
- Department of Cardiovascular Surgery, Shanxi Bethune Hospital (Shanxi Academy of Medical Sciences) Taiyuan 030032, Shanxi, China
| | - Likui Zhang
- Department of Cardiovascular Surgery, Shanxi Bethune Hospital (Shanxi Academy of Medical Sciences) Taiyuan 030032, Shanxi, China
| | - Xuening Wang
- Department of Cardiovascular Surgery, Shanxi Bethune Hospital (Shanxi Academy of Medical Sciences) Taiyuan 030032, Shanxi, China
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Kuroda S, Nakayama N, Yamamoto S, Kashiwazaki D, Uchino H, Saito H, Hori E, Akioka N, Kuwayama N, Houkin K. Late (5-20 years) outcomes after STA-MCA anastomosis and encephalo-duro-myo-arterio-pericranial synangiosis in patients with moyamoya disease. J Neurosurg 2020; 134:909-916. [PMID: 32168480 DOI: 10.3171/2019.12.jns192938] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 12/17/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgical revascularization is known to reduce the incidence of further ischemic and hemorrhagic events in patients with moyamoya disease, but the majority of previous studies report only short-term (< 5 years) outcomes. Therefore, in this study the authors aimed to evaluate late (5-20 years) outcomes of moyamoya patients after superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis and indirect bypass (encephalo-duro-myo-arterio-pericranial synangiosis [EDMAPS]). METHODS Cumulative incidences of late morbidity/mortality and disease progression were evaluated among 93 patients who underwent STA-MCA anastomosis and EDMAPS. All of the patients were prospectively followed up for longer than 5 years postsurgery (10.5 ± 4.4 years). There were 35 pediatric and 58 adult patients. Initial presentation included transient ischemic attack/ischemic stroke in 80 patients and hemorrhagic stroke in 10 patients, and 3 patients were asymptomatic. Surgery was performed in a total of 141 hemispheres. Follow-up MRI/MRA was performed within a 6- or 12-month interval during the follow-up periods. RESULTS During the follow-up periods, 92/93 patients were free from any stroke or death, but 1 patient had a recurrence of hemorrhagic stroke (0.10% per patient-year). Disease progression occurred in the territory of the contralateral carotid or posterior cerebral artery (PCA) in 19 hemispheres of 15 patients (1.5% per patient-year). The interval between initial surgery and disease progression varied widely, from 0.5 to 15 years. Repeat bypass surgery for the anterior and posterior circulation resolved ischemic attacks in all 10 patients. CONCLUSIONS The study results indicate that STA-MCA anastomosis and EDMAPS would be the best choice to prevent further ischemic and hemorrhagic stroke for longer than 10 years on the basis of the demonstrated widespread improvement in cerebral hemodynamics in both the MCA and ACA territories in the study patients. However, after 10 years postsurgery regular follow-up is essential to detect disease progression in the territory of the contralateral carotid artery and PCA and prevent late cerebrovascular events.
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Affiliation(s)
- Satoshi Kuroda
- 1Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama; and.,2Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Naoki Nakayama
- 2Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Shusuke Yamamoto
- 1Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama; and
| | - Daina Kashiwazaki
- 1Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama; and
| | - Haruto Uchino
- 1Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama; and.,2Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hisayasu Saito
- 1Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama; and.,2Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Emiko Hori
- 1Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama; and
| | - Naoki Akioka
- 1Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama; and
| | - Naoya Kuwayama
- 1Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama; and
| | - Kiyohiro Houkin
- 2Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Abstract
Massive blood transfusion (MBT) increased mortality and morbidity after cardiac surgery. However, a mid-term follow-up study on repair surgery of acute type A aortic dissection (AAAD) with MBT was lacking. This study aimed to assess the impact of perioperative MBT on late outcomes of surgical repair for AAAD.There were 3209 adult patients firstly received repair surgery for AAAD between 2005 and 2013, were identified using Taiwan National Health Insurance Research Database. Primary interest variable was MBT, defined as transfused red blood cell (RBC) ≥10 units.The outcomes contained in-hospital mortality, surgical-related complications, all-cause mortality, respiratory failure, and chronic kidney disease (CKD) during follow-up period. Higher in-hospital mortality (37.7% vs 11.6%; odds ratio, 4.00; 95% confidence interval [CI], 3.30-4.85), all-cause mortality (26.1% vs 13.0%; hazard ratio [HR], 1.66; 95% CI, 1.36-2.04), and perioperative complications were noted in the MBT group. A subdistribution hazard model revealed higher cumulative incidence of CKD (13.9% vs 6.5%; HR, 1.95; 95% CI, 1.47-2.60) and respiratory failure (7.1% vs 2.7%; HR, 2.34; 95% CI, 1.52-3.61) for the MBT cohort. A dose-dependent relationship between amount of transfused RBC (classified as tertiles) and cumulative incidence of all-cause mortality, incident CKD, and respiratory failure was found (P of trend test <.001).Patients with MBT had worse late outcomes following surgical repair of AAAD. The cumulative incidence of all-cause mortality, incident CKD, and respiratory failure increased with the amount of transfused RBC in a dose-dependent manner.
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Affiliation(s)
- Fang-Ting Chen
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City
| | - An-Hsun Chou
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City
- Department of Medicine, Chang Gung University, Linkou,Taipei
- Department of Anesthesiology, Xiamen Chang Gung Hospital, Taoyuan
| | - Victor Chien-Chia Wu
- Department of Cardiology, Chang Gung Memorial Hospital, Keelung Branch and Linkou Medical Center, Taoyuan City
| | - Chia-Hung Yang
- Department of Cardiology, Chang Gung Memorial Hospital, Keelung Branch and Linkou Medical Center, Taoyuan City
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital, Keelung Branch and Linkou Medical Center, Taoyuan City
| | - Pei-Chi Ting
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City
| | - Shao-Wei Chen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
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7
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Dieci MV, Tsvetkova V, Griguolo G, Miglietta F, Mantiero M, Tasca G, Cumerlato E, Giorgi CA, Giarratano T, Faggioni G, Falci C, Vernaci G, Menichetti A, Mioranza E, Di Liso E, Frezzini S, Saibene T, Orvieto E, Guarneri V. Androgen Receptor Expression and Association With Distant Disease-Free Survival in Triple Negative Breast Cancer: Analysis of 263 Patients Treated With Standard Therapy for Stage I-III Disease. Front Oncol 2019; 9:452. [PMID: 31245286 PMCID: PMC6563384 DOI: 10.3389/fonc.2019.00452] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/13/2019] [Indexed: 12/18/2022] Open
Abstract
Background: We evaluated immunohistochemical AR expression and correlation with prognosis in a large series of homogeneously treated patients with primary TNBC. Material and Methods: Patients diagnosed with stage I-III TNBC between 2000 and 2015 at Istituto Oncologico Veneto who received treatment with surgery and neoadjuvant and/or adjuvant chemotherapy were included. Whole tissue slides were stained for AR. AR-positive expression was defined as >1% of positively stained tumor cells. Distant-disease-free survival (DDFS) was calculated from diagnosis to distant relapse or death. Late-DDFS was calculated from the landmark of 3 years after diagnosis until distant relapse or death. Results: We included 263 primary TNBC patients. Mean AR expression was 14% (range 0–100%), and 29.7% (n = 78) of patients were AR+. AR+ vs. AR- cases presented more frequently older age (p < 0.001), non-ductal histology (p < 0.001), G1-G2 (p = 0.003), lower Ki67 (p < 0.001) and lower TILs (p = 0.008). At a median follow up of 81 months, 23.6% of patients experienced a DDFS event: 33.3% of AR+ and 19.5% of AR- patients (p = 0.015). 5 years DDFS rates were 67.2% and 80.6% for AR+ and AR- patients (HR = 1.82 95%CI 1.10–3.02, p = 0.020). AR maintained an independent prognostic role beyond stage, but when TILs were added to the model only stage and TILs were independent prognostic factors. AR was the only factor significantly associated with late-DDFS: 16.4% of AR+ and 3.4% of AR- patients experienced a DDFS after the landmark of 3 years after diagnosis (p = 0.001). Late-DDFS rates at 5 years from the 3-year landmark were 75.8% for AR+ and 95.2% for AR- patients (log-rank p < 0.001; HR = 5.67, 95%CI 1.90–16.94, p = 0.002). Conclusions: AR expression is associated with worse outcome for patients with TNBC. In particular, AR+ TNBC patients are at increased risk of late DDFS events. These results reinforce the rationale of AR targeting in AR+ TNBC.
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Affiliation(s)
- Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.,Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Vassilena Tsvetkova
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.,Anatomy and Histology Unit, Padova Hospital, Padova, Italy
| | - Gaia Griguolo
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Federica Miglietta
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Mara Mantiero
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Giulia Tasca
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.,Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Enrico Cumerlato
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | | | | | - Giovanni Faggioni
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Cristina Falci
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Grazia Vernaci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Alice Menichetti
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Eleonora Mioranza
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | | | - Simona Frezzini
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Tania Saibene
- Breast Surgery, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | | | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.,Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
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Perek B, Sławek S, Malińska A, Katyńska I, Puślecki M, Szymak-Pawełczyk B, Nowicki M, Jemielity M. Late subclinical hemolysis and long-term outcomes after aortic valve replacement with On-X mechanical prostheses - a preliminary single-center report. Kardiochir Torakochirurgia Pol 2017; 14:175-9. [PMID: 29181045 DOI: 10.5114/kitp.2017.70531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 09/03/2017] [Indexed: 11/17/2022]
Abstract
Introduction Aortic valve replacement (AVR) with a mechanical prosthesis is not free from late complications. Aim To evaluate the prevalence of subclinical hemolysis after AVR with On-X prostheses and assess its impact on long-term outcomes. Material and methods The prospective study included 84 consecutive patients aged 58.3 ±10.3 years who underwent AVR. They were retrospectively split into group H (n = 12; 14.3%) with prosthesis-related subclinical hemolysis and a control group (C; n = 72; 85.7%). All operations were performed via median sternotomy using cardio-pulmonary bypass. At the end of follow-up, echocardiography was carried out and blood samples for morphology and biochemistry (lactate dehydrogenase (LDH), bilirubin, haptoglobin) were taken. Results The rate of subclinical hemolysis in patients with properly working prostheses was 14.3% and it was the highest (33.3%) for the smallest valves. Although an improvement in functional status was noted in both groups, it was less evident in group H than in group C (p = 0.007). At the end of follow-up, 97.2% in group C and 75.0% in group H were found in NYHA classes I and II. Patients in group H had significantly lower hemoglobin, hematocrit, and haptoglobin and higher LDH activity than group C subjects. In group H, systolic gradients of On-X valves were higher whereas effective orifice area was smaller than in group C. Conclusions Our study proved that prosthesis-induced subclinical hemolysis is seen even after implantation of the latest generation mechanical prostheses, particularly of small diameter, and its degree may impact late outcome.
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Rodrigues JN, Zhang W, Scammell BE, Chakrabarti I, Russell PG, Fullilove S, Davidson D, Davis TRC. Functional outcome and complications following surgery for Dupuytren's disease: a multi-centre cross-sectional study. J Hand Surg Eur Vol 2017; 42:7-17. [PMID: 27474501 DOI: 10.1177/1753193416660045] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED Variables associated with recurrent Dupuytren's disease, or a 'diathesis', have been investigated, but those associated with functional outcome and complications are less well studied. Outcomes 1 or 5 years after an aponeurotomy, fasciectomy or dermofasciectomy were assessed by patient interview and examination at five UK centres. A total of 432 procedures were studied. The reoperation rate did not differ at 1 year ( p = 0.396, Chi-square test with Monte Carlo simulation), but was higher after aponeurotomy in the 5-year group (30%, versus 6% after fasciectomy and 0% after dermofasciectomy, p = 0.003, Chi square test with Monte Carlo simulation). Loss of function (DASH>15) did not differ between procedures at 5 years, even when reoperation and other variables were controlled. Diabetes, female gender and previous ipsilateral surgery were associated with poorer function in logistic regression analysis. The variables associated with poor function after treatments differ from diathesis variables. Aponeurotomy had lower complication rates than fasciectomy and dermofasciectomy. This may counterbalance the former's higher recurrence rate and explain why aponeurotomy demonstrated similar long-term functional outcome compared with excisional surgery in this study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- J N Rodrigues
- 1 Nuffield Department of Orthopaedics, University of Oxford, Oxford, UK
| | - W Zhang
- 2 Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham & Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - B E Scammell
- 2 Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham & Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - P G Russell
- 4 Pulvertaft Hand Centre, Royal Derby Hospital, Derby, UK
| | | | - D Davidson
- 6 St John's Hospital at Howden, Livingston, UK
| | - T R C Davis
- 2 Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham & Nottingham University Hospitals NHS Trust, Nottingham, UK
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