Pancreatoblastoma (PB), a neoplasm derived from pancreatic follicular cells, primarily affects the pediatric population. Although infrequent in adults, it is associated with a considerably worse ...prognosis. Approximately one-third of patients are diagnosed with metastatic disease, with liver metastases being the most prevalent. Diagnosis relies on histopathological alterations including squamous vesicles, positive staining for CK8/CK18/CK19, and nuclear displacement of β-catenin. Additionally, liver metastases demonstrate substantial enhancement during the arterial phase of a contrast-enhanced computed tomography (CT) scan. Surgical resection serves as the principal therapeutic approach for addressing primary lesions and liver metastatic PB. In instances where surgical intervention is not viable, patients may derive benefits from systemic therapy and radiotherapy. This particular case report presents the clinical details of a 27-year-old female patient diagnosed with PB, who subsequently developed multiple liver metastases following a pancreaticoduodenectomy. Genomic examinations revealed the presence of ERBB2 amplification, RAD54L deletion, low TMB-L, and MSS in the patient. Despite the patient undergoing chemotherapy and Her-2 targeted therapy in conjunction with immunotherapy, no reduction in lesion size was observed until the administration of surufatinib. Subsequently, a notable outcome ensued, where the metastatic lesions were effectively excised via surgical intervention. Surufatinib has demonstrated a progression-free survival (PFS) of no less than 14 months, and the patient’s survival has endured for a duration of 33 months. This indicates the potential efficacy of surufatinib as a viable therapeutic alternative for adult patients afflicted with PB.
Cystic lymphangioma (CL) is a rare benign tumour that arises from the lymphatic vessels. The most common site of presentation is the posterior triangle of the neck. 90% of the lesions are diagnosed ...before the age of two years old and only a small number is reported in adults. In this paper, we describe the diagnostic and treatment approach of a cervical CL in an adult male.
Background It is unclear whether hepatectomy, which ranges in invasiveness from partial to major hepatectomy, is safe and feasible for older adult patients. Therefore, we compared its postoperative ...complications and long-term outcomes between younger and older adult patients. Methods Patients who underwent hepatectomies for hepatocellular carcinoma (N = 883) were evaluated. Patients were divided into two groups: aged < 75 years (N = 593) and greater than or equal to 75 years (N = 290). Short-term outcomes and prognoses were compared between the groups in the entire cohort. The same analyses were performed for the major hepatectomy cohort. Results In the entire cohort, no significant differences were found in complications between patients aged < 75 and greater than or equal to 75 years, and the multivariate analysis did not reveal age as a prognostic factor for postoperative complications. However, overall survival was significantly worse in older patients, although no significant differences were noted in time to recurrence or cancer-specific survival. In the multivariate analyses of time to recurrence, overall survival, and cancer-specific survival, although older age was an independent poor prognostic factor for overall survival, it was not a prognostic factor for time to recurrence and cancer-specific survival. In the major hepatectomy subgroup, short- and long-term outcomes, including time to recurrence, overall survival, and cancer-specific survival, did not differ significantly between the age groups. In the multivariate analysis, age was not a significant prognostic factor for complications, time to recurrence, overall survival, or cancer-specific survival. Conclusion Hepatectomy, including minor and major hepatectomy, may be safe and oncologically feasible options for selected older adult patients with hepatocellular carcinoma. Keywords: Hepatocellular carcinoma, Hepatectomy, Older adult patient, Postoperative complication, Prognosis
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The insertion of peripheral intravenous catheters (PIVCs) is common for treatment among hospitalized patients. However, this procedure usually fails before the end of therapy because of several ...complications, including phlebitis. Therefore, this study aimed to determine the incidence and associated factors of phlebitis among patients with PIVC. A prospective cohort study was conducted in one of the hospitals located in East Coast Malaysia. The presence of phlebitis was assessed using the visual infusion phlebitis score checklist. The patients were followed until PIVC removal. A total of 321 data were collected among patients who received a new PIVC in the medical, gynecology, and orthopedic wards. The incidence of phlebitis was 36.1% (n= 116), and 96.6% of which were grade II. Patients aged 60 years (51.5%), men (42.2%), no known phlebitis history (47.4%), and with chronic disease record (46.8%) were determined as the highest percentage with phlebitis. This study demonstrated that age, gender, and chronic diseases were risk factors of developing phlebitis. Abstrak Karakteristik Pasien yang Berhubungan dengan Flebitis di Rumah Sakit Pantai Timur Semenanjung Malayía. Di antara pasien yang dirawat di rumah sakit, penyisipan kateter intravena perifer (PIVC) umum untuk pengobatan. Namun, prosedur ini seringkali gagal sebelum terapi selesai karena beberapa komplikasi. Salah satu komplikasi yang terjadi adalah flebitis. Oleh karena itu, penelitian ini bertujuan untuk menentukan kejadian dan faktor-faktor terkait flebitis di antara pasien dengan PIVC. Sebuah studi kohort prospektif dilakukan di salah satu rumah sakit yang berlokasi di Pantai Timur Malaysia. Kejadian flebitis dinilai menggunakan daftar periksa skor Visual Infusion Phlebitis (VIP). Para pasien ditindaklanjuti sampai pengangkatan PIVC. Terdapat 321 data yang dikumpulkan di antara pasien yang menerima PIVC baru di bangsal medis, ginekologi, dan ortopedi. Insiden flebitis ditemukan 36,1% (n= 116), 96,6% di antaranya adalah grade II. Pasien berusia 60 tahun (51,5%), pria (42,2%), pasien tidak memiliki riwayat flebitis (47,4%) dan pasien dengan catatan penyakit kronis (46,8%) tercatat sebagai persentase tertinggi dengan flebitis. Studi ini menunjukkan bahwa usia, jenis kelamin, dan pasien dengan penyakit kronis kemungkinan besar mengalami flebitis. Kata Kunci: flebitis, kateter intravena peripheral, pasien dewasa
AIM: To investigate the status of stereoscopic reconstruction in adults with intermittent exotropia after surgery, and analyze related influencing factors.METHODS: A retrospective study was conducted ...among 196 adults with intermittent exotropia who were admitted to our hospital from January 2019 to January 2021. All patients underwent strabismus surgery, and their preoperative and postoperative data were collected.RESULTS: Near and distal stereo visual function was not found in all the included 196 patients before surgery. The reconstruction rates of near stereo visual function and distal stereo visual function were 52.6%(103/196)and 50.5%(99/196), respectively. There were significant differences in surgical age, age of onset, course of disease, and postoperative level of horizontal strabismus between patients with near stereoscopic reconstruction(103 cases)and those without reconstruction(93 cases; P<0.001). Multivariate Logistic regression analysis showed that age of onset, course of disease, and postoperative level of horizontal strabismus were factors influencing near stereo visual function reconstruction(P<0.05). The receiver operating characteristic(ROC)curve showed that the area under the curve(AUC)values of age of onset, course of disease and postoperative level of horizontal strabismus to predict near stereo visual function reconstruction were 0.757, 0.737 and 0.727, respectively(P<0.001). There were significant differences in surgical age, age of onset, course of disease, and postoperative level of horizontal strabismus between patients with distal stereoscopic reconstruction(99 cases)and those without reconstruction(97 cases; P<0.001). Multivariate Logistic regression analysis showed that age of onset and course of disease were factors influencing distal stereo visual function reconstruction(P<0.05). ROC curve showed that the AUC values of age of onset and course of disease to predict distal stereo visual function reconstruction were 0.672 and 0.821, respectively(P<0.001).CONCLUSION: Stereoscopic reconstruction in adults with intermittent exotropia after surgery is affected by many factors, such as age of onset and course of disease. The influencing factors of near stereo visual function reconstruction and distal stereo visual function reconstruction are different, which deserves attention.
Though frailty is associated with mortality, its impact on long-term survival after an ICU admission with COVID-19 is unclear. We aimed to investigate the association between frailty and long-term ...survival in patients after an ICU admission with COVID-19.
This registry-based multicentre, retrospective, cohort study included all patients ≥16 years discharged alive from the hospital following an ICU admission with COVID-19 and documented clinical frailty scale (CFS). Data from 118 ICUs between 01/01/2020 through 31/12/2020 in New Zealand and 31/12/2021 in Australia were reported in the Australian and New Zealand Intensive Care Society Adult Patient Database. The patients were categorised as ‘not frail’ (CFS 1-3), ‘mildly frail’ (CFS 4-5) and ‘moderately-to-severely frail’ (CFS 6-8).
The primary outcome was survival time up to two years, which we analysed using Cox regression models.
We included 4028 patients with COVID-19 in the final analysis. ‘Moderately-to-severely frail’ patients were older (66.6 56.3–75.8 vs. 69.9 60.3–78.1; p < 0.001) than those without frailty (median interquartile range 53.0 40.1–64.6), had higher sequential organ failure assessment scores (p < 0.001), and less likely to receive mechanical ventilation (p < 0.001) than patients without frailty or mild frailty. After adjusting for confounders, patients with mild frailty (adjusted hazards ratio: 2.31, 95%-CI: 1.75–3.05) and moderate-to-severe frailty (adjusted hazards ratio: 2.54, 95%-CI: 1.89–3.42) had higher mortality rates than those without frailty.
Frailty was independently associated with shorter survival times to two years in patients with severe COVID-19 in ANZ following hospital discharge. Recognising frailty provides individualised patient intervention in those with frailty admitted to ICUs with severe COVID-19.
Not applicable.
The insertion of peripheral intravenous catheters (PIVCs) is common for treatment among hospitalized patients. However, this procedure usually fails before the end of therapy because of several ...complications, including phlebitis. Therefore, this study aimed to determine the incidence and associated factors of phlebitis among patients with PIVC. A prospective cohort study was conducted in one of the hospitals located in East Coast Malaysia. The presence of phlebitis was assessed using the visual infusion phlebitis score checklist. The patients were followed until PIVC removal. A total of 321 data were collected among patients who received a new PIVC in the medical, gynecology, and orthopedic wards. The incidence of phlebitis was 36.1% (n= 116), and 96.6% of which were grade II. Patients aged 60 years (51.5%), men (42.2%), no known phlebitis history (47.4%), and with chronic disease record (46.8%) were determined as the highest percentage with phlebitis. This study demonstrated that age, gender, and chronic diseases were risk factors of developing phlebitis. Abstrak Karakteristik Pasien yang Berhubungan dengan Flebitis di Rumah Sakit Pantai Timur Semenanjung Malayía. Di antara pasien yang dirawat di rumah sakit, penyisipan kateter intravena perifer (PIVC) umum untuk pengobatan. Namun, prosedur ini seringkali gagal sebelum terapi selesai karena beberapa komplikasi. Salah satu komplikasi yang terjadi adalah flebitis. Oleh karena itu, penelitian ini bertujuan untuk menentukan kejadian dan faktor-faktor terkait flebitis di antara pasien dengan PIVC. Sebuah studi kohort prospektif dilakukan di salah satu rumah sakit yang berlokasi di Pantai Timur Malaysia. Kejadian flebitis dinilai menggunakan daftar periksa skor Visual Infusion Phlebitis (VIP). Para pasien ditindaklanjuti sampai pengangkatan PIVC. Terdapat 321 data yang dikumpulkan di antara pasien yang menerima PIVC baru di bangsal medis, ginekologi, dan ortopedi. Insiden flebitis ditemukan 36,1% (n= 116), 96,6% di antaranya adalah grade II. Pasien berusia 60 tahun (51,5%), pria (42,2%), pasien tidak memiliki riwayat flebitis (47,4%) dan pasien dengan catatan penyakit kronis (46,8%) tercatat sebagai persentase tertinggi dengan flebitis. Studi ini menunjukkan bahwa usia, jenis kelamin, dan pasien dengan penyakit kronis kemungkinan besar mengalami flebitis. Kata Kunci: flebitis, kateter intravena peripheral, pasien dewasa
The impact of obesity on long-term survival after intensive care unit (ICU) admission with severe COVID-19 is unclear.
To quantify the impact of obesity on time to death up to two years in patients ...admitted to Australian and New Zealand ICUs.
This is a retrospective multicentre registry-based study of 92 ICUs between 01/01/2020 and 31/03/2022 with COVID-19, reported in the ANZICS adult patient database. All patients with documented height and weight to estimate the body mass index (BMI) were included. Obesity was classified patients according to the WHO recommendations. The primary outcome was survival time up to two years after ICU admission, assessed using the Cox proportional hazards model. Confounders were illness severity, sex, frailty, hospital type and jurisdiction.
We examined 2,931 patients; the median BMI was 30.2 (IQR 25.6-36.0) kg/m2. Patients with a BMI ≥30kg/m2 were younger (median IQR age 57.7 46.2-69.0 vs. 63.0 50.0-73.6; p<0.001) than those with a BMI <30kg/m2. Most patients (76.6%; 2,244/2,931) were discharged alive after ICU admission. The mortality at two years was highest for BMI categories <18.5kg/m2 (35.4%) and 18.5-24.9kg/m2 (31.1%), while lowest for BMI ≥40kg/m2 (14.5%). After adjusting for confounders and referencing for BMI 18.5-24.9kg/m2, only the BMI ≥40kg/m2 category patients had improved survival up to 2 years (hazard ratio=0.51; 95%CI: 0.34-0.76).
The obesity paradox appears to exist beyond hospital discharge in critically ill patients with COVID-19 admitted in Australian and New Zealand ICUs. A BMI ≥40kg/m2 was associated with a higher survival time of up to two years.
Not applicable
A meta‐analysis was implemented to appraise the effect of hydrocolloid dressings (HCDs) in the management of different grades of pressure wound ulcers (PWUs) in critically ill adult subjects (CIUSs). ...Inclusive literature research until April 2023 was done, and 969 interconnected researches were revised. The 8 picked researches, enclosed 679 critically ill adult persons at the utilized researchers' starting point; 355 of them were utilizing HCDs, and 324 were controls. Odds ratio (OR) and 95% confidence intervals (CIs) were utilized to appraise the consequences of HCDs in treating CIUSs by the dichotomous approach and a fixed or random model. HCDs had significantly higher PWU complete healing (OR, 2.15; 95% CI, 1.54–3.02, p < 0.001), PWU stage II ulcers complete healing (OR, 2.82; 95% CI, 1.40–5.69, p = 0.004), and PWU stage III ulcers complete healing (OR, 3.73; 95% CI, 1.23–11.35, p = 0.02) compared to control in critically ill adult persons. HCDs had significantly higher PWU complete healing, PWU stage II ulcers complete healing, and PWU stage III ulcers complete healing compared with control in critically ill adult persons. However, caution needs to be taken when interacting with its values since there was a low sample size of most of the chosen research found for the comparisons in the meta‐analysis.
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