Background
Liver and peritoneum are two of the most common sites of colorectal metastases.
Methods
We searched for articles comparing outcomes of surgical management for metastatic colorectal cancer ...to the liver and peritoneum.
Conclusion
Cytoreductive surgery/heated intraperitoneal chemotherapy has a similar safety profile and survival outcomes as hepatectomy for colorectal metastases after stratifying by resection status and should be incorporated earlier in the management algorithm for colorectal cancer patients with peritoneal metastases
Methods
We performed a wide search on PubMed, EMBASE, and Google Scholar for articles comparing outcomes of surgical management for metastatic colorectal cancer to the liver and peritoneum. We focused on studies comparing their perioperative clinical outcomes as well as their oncological outcomes. The following words were included in the search: comparison, outcomes, metastasectomy, colorectal cancer, liver, peritoneal surface disease, hepatectomy, and cytoreduction.
Results
One hundred and twenty studies were evaluated. Six of these studies met the criteria for this review.
•Despite achieving a plantigrade foot, external fixation does not restore the articular relationships of the foot.•The correction of neglected clubfoot with external fixation presents complications ...inherent to the treatment, such as osteitis, edema, and pain.•The Ponseti method, the primary treatment for idiopathic clubfoot in children under five years old, presents less risk of overcorrection than posterior internal extended-release.•Using the Ponseti method to correct neglected clubfoot decreases the costs of clubfoot treatment compared to external fixation.•The Ponseti method produces a gait pattern similar to that obtained with external fixator correction.•Ponseti correction is effective even in skeletally mature patients and is more tolerable than external fixation.
Congenital clubfoot is the most common foot deformity. It affects 1 - 7/1000 live births. Clubfoot is considered neglected when it has not been treated before the child walks. The treatment of choice in these patients is usually the correction of the deformity with external fixation. However, this treatment is not exempt from complications and does not restore the anatomy.
Sixteen years-old female with neglected bilateral clubfoot underwent extended posterior internal release and gradual correction with an external fixator on her right foot. Due to the poor results and tolerance to the surgical treatment of the right foot, she underwent the Ponseti Method on her left foot. Gait analysis was performed six months after the treatment was completed. The joint relations were closer to normal in the limb treated with the Ponseti method, and the gait pattern was similar in both feet.
The Ponseti method is a treatment option for neglected clubfoot even in skeletally mature patients. This technique has not only been shown to restore foot anatomy and reduce the risk of overcorrection. It is also better tolerated by the patient and brings lower costs to the health insurance system.
To compare the mid-long-term clinical and radiological outcomes between a combination of cortico-cancellous iliac bone graft with vascularized greater trochanter flap (Group A) and isolate iliac bone ...graft (Group B) in the treatment of Osteonecrosis of the Femoral Head (ONFH).
From January 2006 to December 2012, 123 patients (135 hips) who underwent abovementioned hip-preserving surgeries were included for analysis. Clinical outcomes were assessed based on Harris Hip Score (HHS) System and The Western Ontario and McMaster University Index (WOMAC) scores between the preoperative and the last follow-up. A series of postoperative X-rays were compared to preoperative images for radiological evaluation.
The HHS in Group A and B were enhanced from 50.57 ± 3.39 to 87.60 ± 4.15 and from 50.24 ± 3.30 to 85.18 ± 6.45, respectively, which both showed significance between preoperative and postoperative latest follow-up (p < 0.001). Group A revealed better improvement in terms of HHS (p = 0.017). The WOMAC total, postoperative stiffness, difficulty subscale scores in Group A showed better outcomes when compared to Group B (p < 0.01), while pain improvement between these two groups revealed no significance (p = 0.402). Besides, Group A suggested better necrotic region repair (p = 0.020), but no femoral head collapse difference in terms of Association Research Circulation Osseous classification change was found (p > 0.05).
A combination of cortico-cancellous iliac bone graft and concurrent vascularized greater trochanter flap with the lateral femoral circumflex transverse branch has been proved can obtain better functional and radiological results than isolate iliac bone grafting, which is attributed to blood reconstruction of the femoral head.
To estimate differences in treatment costs and health outcomes between non-myeloablative hematopoietic stem cell transplantation (HSCT) and disease-modifying therapies (DMTs) for the treatment of ...relapsing-remitting multiple sclerosis (RRMS).
We collected data on costs and reimbursements for patients who underwent HSCT for RRMS at Northwestern Memorial Hospital in Chicago (USA) between January 2017 and January 2019. The costs of HSCT were compared against those for DMTs in the United States, obtained from the literature. We also conducted a literature review to interpret the cost comparisons in terms of disease control and patients’ wellbeing defined as no evidence of disease activity (NEDA), neurologic disability by the Expanded Disability Status Scale (EDSS), and quality of life by the short form SF-36, respectively.
Outside of the data, herein, no other studies on cost of HSCT for RRMS were found in the literature. HSCT mean total costs, based on our own hospital, were $85,184 (range $70,635 to $120,260). Mean revenue collected was $95,268 (range $16,544 to $173,204). In comparison, according to the literature, 2019 DMT costs in the USA ranged from $80,000 to $100,000 per year per patient. Compared to DMTs, studies of HSCT reported greater improvement in no evidence of disease activity, disability, and quality of life.
Costs of HSCT would be expected to vary by conditioning regimen utilized, patient selection, center experience, and regional variation. No cost data on other HSCT regimens or on the three most recently licensed DMTs, alemtuzumab, ocrelizumab, and cladribine, are available. Randomized trials for cost comparisons are missing and variations in HSCT designs, populations, and methodology preclude more precise cost estimates.
Costs of non-myeloablative HSCT after which DMTs are indefinitely discontinued, are approximately the same cost as those for one year of prescription DMTs. Since DMTs assessed in this analysis are given on an ongoing basis, whilst HSCT is not, HSCT is expected to produce long-term cost-savings. When considered alongside the available clinical evidence, which suggests that HSCT may generate more health gains than DMTs, HSCT is likely to represent a cost-effective use of resources. Model-based health economic analyses are required to substantiate this conclusion.
Male breast cancer (bc) is a rare disease, and the availability of information on treatment outcomes is limited compared with that for female bc. The objective of the present study was to compare ...disease-free (dfs) and overall survival (os) for men compared with women having early-stage bc.
This retrospective case-control study compared men and women treated for stage 0-iiib bc at a single institution between 1981 and 2009. Matching was based on age at diagnosis, year of diagnosis, and stage. Treatment, recurrence, and survival data were collected. Kaplan-Meier analysis was used to calculate os and dfs.
For the 144 eligible patients (72 men, 72 women), median age at diagnosis was 66.5 years. Treatments included mastectomy (72 men, 38 women), radiation (29 men, 44 women), chemotherapy (23 men, 20 women), and endocrine therapy (57 men, 57 women). Mean dfs was 127 months for women compared with 93 months for men (p = 0.62). Mean os was 117 months for women compared with 124 months for men (p = 0.35). In multivariate analysis, the only parameter that affected both dfs and os was stage at diagnosis.
This case-control study is one of the largest to report treatment outcomes in early-stage male bc patients treated in a non-trial setting. Male patients received systemic therapy that was comparable to that received by their female counterparts, and they had similar os and dfs. These results add to current evidence from population studies that male sex is not a poor prognostic factor in early-stage breast cancer.
Abstract Background/Purpose Preterm infants needing patent ductus arteriosus (PDA) ligation are transferred to a pediatric cardiac center (CC) unless the operation can be done locally by a pediatric ...surgeon at a non-cardiac center (NCC). We compared infant outcomes after PDA ligation at CC and NCC. Methods We analyzed 990 preterm infants who had PDA ligation between 2005 and 2009 using the Canadian Neonatal Network database. In-hospital mortality and major morbidities were compared between CC ( n = 18) and NCC ( n = 9). Results SNAP-II-adjusted mortality rates were similar (CC = 8.7% vs NCC = 10.7%, P = .32). Significant cranial ultrasound abnormalities (CC = 24.1% vs NCC = 32.1%, P < .01) and culture-proven sepsis (CC = 39.7% vs NCC = 54.8%, P < .01) were more frequent in infants treated at NCC. Infants transferred to CC had higher rates of cranial ultrasound abnormalities (transferred 31.6% vs non-transferred 20.4%, P < .01). NSAIDs prior to PDA ligation were used more often at NCC (CC 36.6% vs NCC 75.6%, P < .001). Conclusions Mortality rates after PDA ligation were similar at CC and NCC, but cranial ultrasound abnormalities and sepsis rates were higher at NCC. Higher morbidity may be associated with different PDA management strategies, including NSAID use or infant transfer. Further studies are needed to investigate the reasons for these differences in morbidity.
The ability to plan a training path fulfilling working needs plays a key role, when it comes to finding the desired job. Nonetheless, in a dynamic scenario characterized by frequent technological ...innovations and economic changes, as the present one, getting a clear picture of the requirements of the world of work could become difficult, as it would imply performing a deep periodic evaluation of available job offers, and matching them with own previous experience. Intelligent systems able to automatically match résumés with job offers already exist, but they are mostly targeted to recruiters, instead of learners. This work aims at filling this gap, by presenting a system for comparing learners' acquirements - expressed in terms of learning outcomes - with companies requirements. The proposed system relies on semantics for processing natural language texts and exploits bar charts to visualize learning outcomes and their levels in order to quickly depict similarities and differences between résumés and job offers. An evaluation, on 50 volunteers, underlined the added value of the system.
Burst and 10 kHz spinal cord stimulation (SCS) demonstrated improvement for failed back surgery syndrome (FBSS) with predominant, refractory back pain. Here, we report the long-term follow-up of a ...previously published study comparing the safety and efficacy of burst vs. 10 kHz SCS for predominant back pain (70% of global pain) of FBSS patients.
This comparative, observational study extended the follow-up period up to 20 months evaluating both SCS modalities. Pain intensity (visual analog scale VAS
, VAS
), functional capacity (Pittsburgh Sleep Quality Index PSQI; depression (Beck Depression Inventory BDI), stimulation parameters and hardware and/or stimulation associated adverse events were recorded and analyzed over time.
Overall VAS
(t
= 66.76, p < 0.001) and VAS
(t
= 4.763, p < 0.049; p < 0.001) declined over time. Burst significantly decreased VAS
by 87.5% (±17.7) (mean 8 ± 0.76 to 1 ± 1.41; t
=12.3, p < 0.001), and 10 kHz significant decreased VAS
by 54.9% (±44) (mean 8 ± 0.63 to 3.5 ± 3.27; t
=3.09, p = 0.027). No significant differences for between SCS types were revealed (t
=1.75, p = 0.13). VAS
was significantly suppressed for burst (burst: 3.6 ± 1.59 to 1.5 ± 1.06; t
= 3.32, p = 0.013). A significant effect of time was found for functional outcome with no significant differences between SCS types (PSQI: t
= 8.8, p = 0.012; and BDI: t
= 53.3, p < 0.001). No stimulation/hardware-related complications occurred.
Long-term data of this comparative study suggests that burst responsiveness was superior to 10 kHz in our small-scale cohort, thus a larger, randomized-controlled comparative study design is highly recommended.
The COVID-19 pandemic has emerged as a global health problem, associated with high morbidity and mortality rates. The aim of this study was to compare the outcomes of hospitalized patients with ...COVID-19 or with seasonal influenza in a teaching hospital in Belgium.
In this retrospective, single-center cohort study, 1384 patients with COVID-19 and 226 patients with influenza were matched using a propensity score with a ratio of 3:1. Primary outcomes included admission to intensive care unit (ICU), intubation rates, hospital length of stay, readmissions within 30 days and in-hospital mortality. Secondary outcomes included pulmonary bacterial superinfection, cardiovascular complications and ECMO.
Based on the analysis of the matched sample, patients with influenza had an increased risk of readmission within 30 days (Risk Difference (RD): 0.07, 95% CI: 0.03 to 0.11) and admission to intensive care unit (RD: 0.09, 95% CI: 0.03 to 0.15) compared with those with COVID-19. Patients with influenza had also more pulmonary bacterial superinfections (46.2% vs 7.4%) and more cardiovascular complications (32% vs 3.9%) than patients with COVID-19.However, a two-fold increased risk of mortality (RD: −0.10, 95% CI: 0.15 to −0.05) was observed in COVID-19 compared to influenza. ECMO was also more required among the COVID-19 patients who died than among influenza patients (5% vs 0%).
COVID-19 is associated with a higher in-hospital mortality compared to influenza infection, despite a high rate of ICU admission in the influenza group. These findings highlighted that the severity of hospitalized patients with influenza should not be underestimated.
•Our study found that compared to UK and Europe, severe TBI patients in Victoria, Australia were younger and a higher proportion had early hypotension.•In Australia, a higher proportion were ...discharged to a specialized rehabilitation centre, rather than another hospital or home.•Compared to Europe, a higher proportion of patients in Australia and UK had intensive therapies including invasive arterial and ICP monitoring.•Six months after injury, patient mortality and “favourable” independent living at 6 months were similar in all regions.•Mortality was better than predicted, but fully independent living at 6 months was not.
The aim of this manuscript is to compare characteristics, management, and outcomes of patients with severe Traumatic Brain Injury (TBI) between Australia, the United Kingdom (UK) and Europe.
We enrolled patients with severe TBI in Victoria, Australia (OzENTER-TBI), in the UK and Europe (CENTER-TBI) from 2015 to 2017. Main outcome measures were mortality and unfavourable outcome (Glasgow Outcome Scale Extended <5) 6 months after injury. Expected outcomes were compared according to the IMPACT-CT prognostic model, with observed to expected (O/E) ratios and 95% confidence intervals.
We included 107 patients from Australia, 171 from UK, and 596 from Europe. Compared to the UK and Europe, patients in Australia were younger (median 32 vs 44 vs 44 years), a larger proportion had secondary brain insults including hypotension (30% vs 17% vs 21%) and a larger proportion received ICP monitoring (75% vs 74% vs 58%). Hospital length of stay was shorter in Australia than in the UK (median: 17 vs 23 vs 16 days), and a higher proportion of patients were discharged to a rehabilitation unit in Australia than in the UK and Europe (64% vs 26% vs 28%). Mortality overall was lower than expected (27% vs 35%, O/E ratio 0.77 95% CI: 0.64 – 0.87. O/E ratios were comparable between regions for mortality in Australia 0.86 95% CI: 0.49–1.23 vs UK 0.82 0.51–1.15 vs Europe 0.76 0.60–0.87). Unfavourable outcome rates overall were in line with historic expectations (O/E ratio 1.32 0.96-1.68 vs 1.13 0.84-1.42 vs 0.96 0.85-1.09).
There are major differences in case-mix between Australia, UK, and Europe; Australian patients are younger and have a higher rate of secondary brain insults. Despite some differences in management and discharge policies, mortality was less than expected overall, and did not differ between regions. Functional outcomes were similar between regions, but worse than expected, emphasizing the need to improve treatment for patients with severe TBI.
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