Comprehensive pouch clinic concept for follow-up of patients after ileal pouch anal anastomosis: Report of 3 yearsʼ experience in a tertiary referral center

2008 ◽  
Vol 14 (8) ◽  
pp. 1125-1132 ◽  
Author(s):  
Hagit Tulchinsky ◽  
Iris Dotan ◽  
Arik Alper ◽  
Eli Brazowski ◽  
Joseph M. Klausner ◽  
...  
Keyword(s):  
Ileal Pouch ◽  
Ileal Pouch Anal Anastomosis ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Referral Center ◽  
Anal Anastomosis

Primary focal cryosurgery of the prostate: Long-term clinical and biochemical outcomes in a large cohort at a tertiary referral center.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 114-114
Author(s):  
Jamie Sungmin Pak ◽  
Philippa J. Cheetham ◽  
Aaron Katz ◽  
Sven Wenske
Keyword(s):  
Cancer Control ◽  
Median Number ◽  
Primary Treatment ◽  
Consecutive Series ◽  
Primary Therapy ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Referral Center ◽  
Psa Nadir

114 Background: Modern primary focal cryosurgery (PFC) has emerged as a primary therapy option for localized and minimal low-risk prostate cancer (PCa), achieving good local cancer control and survival outcome. The aim of this analysis was to report on the experience of PFC in our tertiary referral center in the management of localized PCa. Methods: We identified a consecutive series of patients that underwent PFC for localized PCa at our institution between 8/2000 and 1/2014. Demographics, PSA levels and Gleason scores before primary treatment and at time of recurrence were assessed; BDFS, OS, and DSS were assessed. BCR was defined by the Phoenix (PD) and Stuttgart Definitions (SD). Results: A total of 126 patients were included in the analysis, with a median follow-up of 40.3 (0.8-116, IQR 41) months. Median age was 73.5 (range 45-92, IQR 9) years. Median initial serum PSA level was 6.0 (1-44.5, IQR 3) ng/ml. Median primary and secondary Gleason score on initial biopsy was 3 (3-5, IQR 1) with a median sum of 6 (6-10, 1), and 15% (2-95%, IQR 0) of biopsy tissue involved with cancer. Median number of biopsy cores was 12 (2-32), with a median of 1 (1-12, IQR 1) core affected by cancer. Median PSA nadir post-treatment was 1.3 (0.1-13.1, IQR 2) ng/ml. According to PD and SD, 24 and 37 patients had BCR after a median of 14.9 (3.4-91.3, IQR 17) and 13.0 (2.9-90.3, IQR 11) months. Overall 4-year-BDFS was 83% and 73% by PD and SD, respectively. 5-year OS and DSS was 95%, and 99.2%. Of patients that met BCR criteria, almost 25% were proven to be negative on biopsy, confirming over-estimation of failures. Patients that recurred had significantly higher initial median PSA levels (8.5 vs. 5.8 ng/ml; p<0.01) and PSA-nadir (2.1 vs. 1.0 ng/ml; p<0.05). Conclusions: Our analysis confirms PFC being a good option with low rate of morbidities for patients with localized PCa, with excellent BDFS and DSS at a long follow-up of 40 months. Controversy exists regarding criteria of BCR-definitions after focal therapies. More stringent definitions, such as the SD, especially in a focal cryosurgery setting, significantly over-estimate failure rates, and prostate biopsy seems to be the only reliable means to assess for recurrence at this point.

Postnatal outcomes of infants with gastroschisis: a 5-year follow-up in a tertiary referral center in Brazil

2015 ◽  
Vol 29 (3) ◽  
pp. 418-422 ◽  
Author(s):  
Natália Silva Carvalho ◽  
Talita Micheletti Helfer ◽  
Priscila de Oliveira Serni ◽  
Ohanna Ana Terasaka ◽  
Tatiane Boute ◽  
...  
Keyword(s):  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Referral Center

Clinical features and management of presumed ocular tuberculosis: A long-term follow-up cohort study in a tertiary referral center in Brazil

2021 ◽  
pp. 112067212110446
Author(s):  
Yuslay Fernández Zamora ◽  
Luciana Peixoto Finamor ◽  
Luci Meire P Silva ◽  
Denise S Rodrigues ◽  
Ricardo P Casaroli-Marano ◽  
...  
Keyword(s):  
Clinical Features ◽  
Oral Prednisone ◽  
Interferon Gamma Release Assay ◽  
Tertiary Referral ◽  
Ocular Tuberculosis ◽  
Tertiary Referral Center ◽  
Referral Center ◽  
Significant Difference ◽  
Presumed Ocular Tuberculosis

Purpose: To evaluate the clinical features and management of presumed ocular tuberculosis (OTB). Method: A prospective 3-year follow-up study of patients with ocular inflammation that performed Interferon-gamma release assay (IGRA) and tuberculin skin test (TST) was conducted in a tertiary referral center in Brazil. Patients with clinical signs highly suspect of OTB with a positive TST and/or IGRA with other causes ruled out were prescribed anti-tuberculosis therapy (ATT) during 9 months. Clinical features and treatment outcomes were recorded. Results: Seventy-two patients (mean age 48.3 ± 15.7 years) were included in the study, and most were female (65.3%, n = 47). Posterior uveitis (43.1%, n = 31) was the main clinical feature. Multifocal choroiditis (25%, n = 18) was the most common choroidal involvement. Concomitant oral prednisone (45.8%, n = 33) during ATT was associated with more recurrences ( p = 0.04). A significant difference ( p < 0.001) between initial and final best-corrected visual acuity after ATT conclusion was observed. Cure or remission was observed in 58 (85.3%) patients that completed follow-up ( n = 68). Conclusion: In our cohort some variation in demographics and ocular phenotypes of presumed OTB was observed. The high rates of cure or remission of our patients strongly support the ATT in presumed OTB. Oral corticosteroids during ATT were associated with higher recurrences rates.

Role of perioperative dynamic sentinel node biopsy for cN0 penile cancer management: experience from an Italian tertiary referral center

2018 ◽  
Vol 104 (1) ◽  
pp. 66-70
Author(s):  
Omidreza Sedigh ◽  
Mirko Preto ◽  
Farzin Soleimanzadeh ◽  
Giancarlo Marra ◽  
Marco Falcone ◽  
...  
Keyword(s):  
Sentinel Node ◽  
Predictive Value ◽  
Penile Cancer ◽  
Detection Rate ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Referral Center ◽  
Node Biopsy ◽  
Dynamic Sentinel Node Biopsy

Purpose: Inguinal lymphadenectomy (iLAD) reduces mortality in patients with cN0 penile cancer but yields high complication rates. Thus, its prophylactic role has been questioned and dynamic sentinel node biopsy (DSNB) was introduced to select men who should undergo the procedure. Our aim was to investigate the accuracy of a contemporary DSNB cohort. Methods: We performed a retrospective analysis of ≥T1 or ≥G2 cN0 penile cancer undergoing perioperative DSNB from June 2009 to June 2015 at a tertiary referral center. We excluded men with <18 months follow-up or with local recurrence after primary curative treatment. Complications were graded according to the Clavien-Dindo classification. Results: Thirty-five men underwent DSNB; 85.71% had ≤T2 penile cancer with ≤G2a histology. Per groin detection rate was 80% (scintigraphy being positive bilaterally in 60% and unilaterally in 20.0%). In no cases did DSNB prolong the postoperative course compared to primary surgery. Nine men (n = 15/109 nodes removed) had positive results, 8 of whom underwent iLAD. Among negative DSNB patients, 2 developed nodal penile cancer recurrence; none of them had node biopsy due to inconclusive scintigraphy. At a median follow-up of 42 months (interquartile range 30-78 months), if considering only men with scintigraphy detected inguinal nodes, per-patient sensitivity and specificity were 50% and 80% whereas positive predictive value and negative predictive value were 25% and 92.3%, respectively. Conclusions: Perioperative DSNB is a safe procedure, yielding promising results when performed at a tertiary referral center. Future prospective large studies are needed to investigate how to optimize detection rate and reduce false-negative rates.

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