tbuckley/cabot-search huggingface dataset:
PWE-276 High-frequency mini-probe ultrasound as a useful adjunct in surveillance of patients after excision of malignant colorectal polyps
Authors: A Emmanuel, S Papagrigoriadis, B Hayee, I Bjarnason, A Haji
Journal: Gut (2015)

<h3>Introduction</h3> Colorectal polyps with a focus of malignancy, identified postpolypectomy, pose a management challenge of whether endoscopic treatment is adequate or whether further surgical resection is required. This study assessed 12- and 20-MHz colonoscopic ultrasound to evaluate the presence of residual disease and local lymph nodes. <h3>Method</h3> Consecutive cases of all colorectal polyps with a focus of malignancy were included. Colonoscopic high-frequency ultrasound was performed (20-MHz mini-probes for residual polyps and 12-MHz ultrasound for local lymph nodes) in the region of previous polypectomy. Biopsies were taken of the polypectomy site if any abnormalities were seen. <h3>Results</h3> Fifty malignant polyps (sigmoid, n = 19; rectum, n = 25; descending colon, n = 1; transverse colon, n = 1; hepatic flexure, n = 2; ascending colon, n = 1; and caecum, n = 1) were identified. 3 were neuroendocrine tumours and 47 were invasive adenocarcinomas; 9 were intramucosal and 38 were submucosal (seven sm1 lesions in the upper third of the submucosa; 11 sm2 lesions in the middle third of the submucosa, seven sm3 lesions in the lower third of the submucosa, one Haggitt level 1, one Haggitt level 2, two Haggitt level 3 and 9 with an unspecified submucosa level). Two patients had T2 tumours extending into the muscularis propria. Excision was histologically complete in 31 patients, five had involved margins and histology was uncertain in fourteen owing to diathermy artefacts or piecemeal resections. High-frequency 12- and 20-MHz ultrasound imaging was normal in 40 patients and four had changes either subsequently proved to be scar related or due to minor benign polyp recurrence. At the time of writing, 39 (89%) of the 44 patients were disease free without further surgery. Five of the 21 patients underwent surgery, despite normal high-frequency ultrasound findings, because of submucosal invasion (sm1 or sm2) and uncertain completeness of resection. The specimens were free of cancer in all five patients. <h3>Conclusion</h3> High frequency mini probe ultrasound is feasible in the colon and rectum for the assessment of the polypectomy site post endoscopic resection of malignant polyps. Definitive management cannot be exclusively based on the ultrasound findings but this may act as a useful adjunct to histology in providing a more complete prediction of poorer prognosis. <h3>Disclosure of interest</h3> None Declared.
Temozolomide and radiation therapy in elderly patients affected by glioblastomas: A pooled analyses of three prospectic phase II trials.
Authors: A. Fiorentino, S. Chiesa, P. De Bonis, S. Manfrida, G. R. D'Agostino, A. Mangiola, A. G. Morganti, V. Frascino, C. Anile, M. Balducci
Journal: Journal of Clinical Oncology (2010)

2070 Background: This analysis evaluated the impact of age and comorbidities on compliance and outcomes in patients with glioblastoma multiforme (GBM) treated according to three chemoradiation prospective phase II trials. Methods: Patients (≥ 18 yrs) with an histologic diagnosis of GBM were enrolled in 3 phase II studies using temozolomide (TMZ: 75 mg/mq x 5 days) concurrent (the first and the last week of RT until December 2003 and five days/week successively) and sequential to RT (6 cycles or until progression disease at the EORTC-NCIC study dose). Conformal radiotherapy (CRT) was performed delivering 5960 cGy on tumor bed and residual mass, if present, while patients enrolled in trial using fractionated stereotactic conformal RT received a dose of 6,940 cGy. Charlson Comorbidity Index (CCI) was used to assess comorbidities; toxicity was evaluated according to RTOG; survival analisys was calculated with Kaplan-Meier method. Results: From October 2001 to December 2008, 146 patients were observed: 56 (38.4%) were over 65 yrs (median age 69, range 65-80 yrs) and a CC1≥ 1 in 41% while 90 pts (61.6%) were under 65 yrs (median age 52, range 21-64 yrs) and a CC1 ≥ 1 in 22%. Ederly and young group were different only for RT dose (p = 0.006). Compliance to treatment was 97.9% and toxicity was mild (G3-4 neutropenia: 3.42%). With a median follow-up of 46 months (range 3-94), median progression-free survival of elderly and younger group was 11 and 15 months respectively (p = 0.03). Median overall survival (OS) was 14 and 21 months in the pts ≥ 65 and < 65 yrs respectively. In older patients 2-yrs OS was 26.9%, whitout any patient alive at 5 years. In < 65 group 2-5-yrs OS was 44.4% and 7.9% (p = 0.01). A stratification of elderly (two groups: under or over 70 yrs; three groups under 70, between 70 and 74, over 75 yrs) didn't show any difference on OS. CCI ≤ 2 did not impact on OS. Only complete surgery vs. partial (p = 0.04) and radiation dose of 70 vs. 60 Gy (p = 0.03) improved OS in ≥ 65 group. Conclusions: Chemoradiation is well tollerated in older patients with an improved OS for higher doses of RT; older than age 65 remains a negative prognostic factors; CCI ≤ 2 doesn't impact on compliance and outcomes. No significant financial relationships to disclose.
SAT0613 Sonoelastography is a Novel Imaging Biomarker in Spondyloarthropathy: A Pilot Study
Authors: I. Sahbudin, A. Peall, A. Filer
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Sono-elastography (SE) is a novel ultrasound application that quantifies the tissue elasticity (ie the degree of tissue stiffness) within an anatomical structure. It provides a different aspect of biomechanical tissue information that can complement Grey-Scale Ultrasound (GSUS) and Power Doppler Ultrasound (PDUS) findings. At present, the value of SE in the detection of clinical enthesitis in Spondyloarthropathy (SpA) is yet to be assessed. <h3>Objectives</h3> The aim of this pilot study was to explore the diagnostic ability of SE compared to GSUS and PDUS in the detection of clinical enthesitis in SpA <h3>Methods</h3> A total of 40 enthesial sites of patients with physician-diagnosed SpA were included in the analysis. Bilateral proximal plantar fascia, distal Achilles tendon, distal and proximal patellar tendon insertion and distal quadriceps tendon were systematically scanned with the same <i>Aplio-400</i>™ Diagnostic Ultrasound System (Toshiba Medical Systems Corporation; multi-frequency transducer 7-18Hz) in GSUS, PDUS and real-time sonoelastography imaging mode. SE grading was based on differential tissue stiffness; blue-green (hard) =0, green-yellow (intermediate) =1, yellow-red (soft) =2, red (very soft) =3. GSUS and PDUS were graded based on the validated Madrid Sonographic Enthesis Index (MASEI) scoring system [i.e. calcification, power Doppler enhancement, erosions, tendon structure, tendon thickness and bursa was scored on a semi-quantitative scale of 0-3]. <h3>Results</h3> SE grading strongly correlated with PDUS grading (r<sub>S</sub>=0.852, p&lt;0.01), and combined GSUS/PDUS gradings (r<sub>S</sub>=0.716, p&lt;0.01). <h3>Conclusions</h3> This is the first study to compare the diagnostic ability of SE with conventional US for the detection clinical enthesitis in SpA. SE is a promising new imaging biomarker in SpA; further work is required to standardise the grading system, image acquisition and reliability of this novel US application. <h3>Disclosure of Interest</h3> None declared
Why a burden of disease study?
Authors: Z Jakab
Journal: Eurosurveillance (2007)

From the time I was appointed as Director of the European Centre for Disease Prevention and Control (ECDC) in 2005, I and the ECDC Governing and Advisory Bodies faced the task of tackling the 46 diseases under mandatory notification in the European Union (EU), as well as severe acute respiratory syndrome (SARS), avian influenza and West Nile virus.
PTH-341 Initial experience with lateral pelvic lymph node dissection in rectal cancer-a pilot study
Authors: S Sinukumar, A Saklani
Journal: Gut (2015)

<h3>Introduction</h3> Surgery plays a pivotal role in the treatment of rectal cancer and the role of Total mesorectal excision (TME) cannot be overemphasised. This is because TME ensures removal of the locoregional nodes and has been shown to aid in reducing locoregional recurrences. However in 15% &gt;25% of patients, the lateral pelvic lymph nodes (LPN) are known to be involved especially with rectal tumour lying below the peritoneal reflection. This is important because of the increased risk of local recurrences and poor survival associated with involvement of the lateral pelvic nodes and the fact that TME does not address removal of these nodes. Although there is no robust evidence to support Lateral pelvic lymph node dissection (LPND), LPND is being performed by selected surgeons for persistent LPLN after administration of neoadjuvant CRT. The aim of our study was to share our initial experience with LPND in patients with persistent pelvic nodes after neoadjuvant chemoradiotherapy (NACTRT) in advanced rectal cancers. <h3>Method</h3> From October 2013 to Nov 2014, 144 locally advanced rectal cancer patients (LARC) were operated with curative intent after receiving NACTRT. Of these 144 patients, 8 patients underwent TME with LPLND after NACTRT. LPND was performed when pelvic node metastasis was suspected on preoperative magnetic resonance imaging (MRI) and persisted despite preoperative NACTRT. Clinicopathological and perioperative details were recorded for these 8 patients. <h3>Results</h3> Out of the 144 patients operated with curative intent for rectal LARC, eight (5%) patients had persistent lateral pelvic nodes despite NACTRT. The median age of the patients was 42 years. An Abdominoperineal resection was the most common procedure performed. The median operative time for surgery was 240 min and the median blood loss was 800ml. Bilateral LPND was performed in three patients. The median total number of lymph nodes harvested was 8, and the total number of LPLNs was 5. Despite NACTRT 2/8 patients showed residual disease in the lateral pelvic nodes (i.e.25%). Of these two patients one also had residual disease in the mesorectal nodes. The median length of hospital stay was 6 days. Most patients were given soft diet orally on the second postoperative day. One patient had a superficial abdominal wound surgical site infection which was managed conservatively. There were no anastomotic leaks. There was no mortality within 30 days. <h3>Conclusion</h3> LPND can be performed with acceptable perioperative outcomes in carefully selected patients. <h3>Disclosure of interest</h3> None Declared.
FRI0088 Prevalence and Characteristics of Traditional Cardiovascular Risk Factors in Rheumatoid Arthrtis in a Black African Population
Authors: M. Doualla, F. Kemta
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Traditional cardiovascular (CV) risk factors are more prevalent in rheumatoid arthritis (RA) patients and are associated with increase morbidity and mortality <h3>Objectives</h3> To determine the prevalence of traditional CV risk factors in RA patients in a Sub Saharan black population <h3>Methods</h3> Cross sectional hospital based study, including RA patients fufilling ACR /EULAR 2010 classification criteria recruted in a tertiary health care Rheumatology clinic in Douala Cameroon. Disease activity (DAS) was assessed using the 28 joints count score. Traditional cardiovascular risk factors included arterial hypertension, obesity, diabetis, dyslipidemia, smoking. CV risk was estimated using Framingham Score <h3>Results</h3> 125 patients (101 female) were included; mean age was 47,86±2,28 (21-82) years and mean RA duration 4.1 (0.8 – 12) years; DAS was low in 1.6%, moderate in 16.8%, and high in 81.6%. 81 (64.8%) patients presented at least one CV risk factors: HTN in 43 (34.4%), obesity in 31 (24.8%), diabetis in 15 (12%), dyslipidemia in 10 (8%) and smoking in 8 (6.4%). High LDL cholesterol was found in 3 (8.1%) and low HDL cholesterol in 2 (5.4%). Mean Framingham score was 10,7±2,1 (0-21); mean estimated cardiovascular risk at ten years was 8,8±2,1% (0-21), among these, 17 (35,4%) patients had a CV risk ≥10%. There was a significant association between HTN and age (OR =0,06; IC 95% =0,01-0,22; p=0,00) but no association was found with disease activity, duration, and type of treatment <h3>Conclusions</h3> CV risk factors are frequent in RA patients in Cameroon <h3>Disclosure of Interest</h3> None declared
Clinical and Dosimetric Variables Related to Outcome After Treatment of Graves’ Disease With 550 and 1110 MBq of 131I
Authors: Marcelo Tatit Sapienza, George Barberio Coura-Filho, José Willegaignon, Tomoco Watanabe, Paulo Schiavom Duarte, Carlos Alberto Buchpiguel
Journal: Clinical Nuclear Medicine (2015)

: Therapy of Graves' hyperthyroidism (HTG) with I is still mostly performed on an empirical basis. The present study was carried out to evaluate clinical and dosimetric variables associated with outcome in HTG therapy, which could contribute to planning and defining the most appropriate activity to be administered.Patients with HTG were randomly assigned to therapy with 555 MBq (15mci) or 1110 MBq (30 mCi) of I. Estimation of thyroid radiation absorbed dose was made according to MIRD methodology. Success was defined as clinical/laboratory euthyroidism or hypothyroidism one year after therapy. The association between clinical, laboratory, and dosimetric variables with 1-year outcome was measured using bivariate analysis, followed by logistic regression.Ninety-one patients included completed the follow-up. Therapeutic success was observed in 77 (84.6%) of them, in a greater proportion when 1110 MBq of I was administered as compared with 550 MBq (94.8% vs 77.4%, P = 0.02). Besides administered activity, multivariate analysis indicated that outcome was related to patient age and gland mass. A higher therapeutic success rate was achieved with doses greater than 300 Gy as compared with doses less than 300 Gy (89% vs 60%, P = 0.01).Administered activity, age, and gland mass were related to the outcome. Radiation absorbed dose, although not significant according to multivariate analysis, may be used as a quantitative parameter in therapy planning, with a target dose of 300 Gy. In cases where a rapid and efficient response to radioiodine treatment is required, adoption of a simplified protocol employing high activities is justified.
An Anachronism: Free Care for Merchant Seamen
Authors: M A ISLAM, T SREEDHARAN
Journal: JAMA (1965)

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Turkish National Gastric Cancer Registry.
Authors: Suleyman Buyukberber, Esra Dumanli, Dogan Uncu, Metin Ozkan, Ruchan Uslu, Gamze Gokoz Dogu, Oguz Kara, Huseyin Abali, Hande Turna, Banu Ozturk, Alper Sevinc, Mukremin Uysal, Bulent Yalcin, Faysal Dane, Mehmet Aliustaoglu, Irfan Cicin, Salim Basol Tekin, Mahmut Gumus, Saadettin Kilickap, Mustafa Benekli
Journal: Journal of Clinical Oncology (2015)

e12645 Background: Gastric cancer (GC) remains a common malignancy in Turkey despite its decreasing incidence in recent years. Studies investigating the clinical and biologic features of gastric cancer in Turkey are small retrospective case series providing limited information. We initiated a Turkish National GC Registry program in October 2012 to define clinical and pathological variables of GC in Turkish pts. Methods: 2785 pts presenting to medical oncology clinics were prospectively registered in 28 centers nationwide. Patient demographics, and clinicopathological characteristics were recorded. Results: Of 2785 pts, 68.8% were males and 31.2% females with a median age of 59 (21-91). Median ages of males were higher compared to females (median 59 vs 57.4 yrs, p = 0.004). Family history of orher cancers were present in 18.6 pts and 1.2% had a second malignancy. Initial stages at diagnosis: I (7.8%), II (16%), III (31.5%) and IV (31.8%). Disease was localized at antrum (47.7%), gastroesophagial junction (31.4%) and other. Of metastatic pts, 56.5% had liver involvement followed by lung (17.5%), peritoneum (10%) and others. Most pts had single organ metastasis (83%). Of 2785 pts, 2290 (82%) were diagnosed after 2011. Of 2290 pts, Her2 was tested in 315 pts and 88 (27.9%) were found positive by IHC and/or FISH. Among metastatic pts, 162 (20%) pts were analyzed for Her2 and 54 pts (33%) were found Her2+. Of 54 Her2+ metastatic pts, only 26 received trastuzumab in the first-line treatment. Curative/palliative surgery was done in 70.7% of the pts (total gastrectomy 51.5%). T staging: T1 (6.1%), T2 (9.6%), T3 (25.3%), T4 (26.7%), unknown (32%). Median numbers of resected and positive lymph nodes were 13 and 4, respectively. Of all pts, 1.5% received neoadjuvant, 38.8% adjuvant and 32.4% palliative chemo. Second-line palliative chemo was given to 25% of the pts. Conclusions: This study is the first comprehensive GC registry performed in Turkey. Her2 testing has only been performed upon request in metastatic pts. High incidence of Her2+ disease might be related to selection bias of metastatic pts and small numbers of pts tested. Additionally, physicians’ lack of preference of trastuzumab treatment in Her2+ GC should be explored.
Cerebrospinal fluid norepinephrine in affective illness
Authors: R M Post, C R Lake, D C Jimerson, W E Bunney, J H Wood, M G Ziegler, F K Goodwin
Journal: American Journal of Psychiatry (1978)

The authors measured cerebrospinal fluid norepinephrine concentrations in manic, depressive, and neurological control patients with and without probenecid administration. Baseline and probenecid norepinephrine values were significantly higher in manic than in depressed patients, who did not differ significantly from the neurological patients. Depressed patients with high levels of anxiety had higher levels of norepinephrine than those with low anxiety. These data suggest that alterations in mood or motor activity may be associated with changes in central norepinephrine metabolism in man.
PTH-041 Large (&lt;4 cm) and giant (≥4 cm) colorectal polyps: comparison of piecemeal resection outcomes
Authors: ZP Tsiamoulos, T Elliott, R Rameshshanker, N Suzuki, S Peake, L Bourikas, BP Saunders
Journal: Gut (2015)

<h3>Introduction</h3> Piecemeal Endoscopic Mucosal Resection (p-EMR) is a standard and safe endoscopic technique for resection of large colorectal polyps (&gt;2 cm). Limited data are available regarding p-EMR of giant polyps (&gt;4 cm). <h3>Method</h3> A prospective study recording short and long-term outcomes after p-EMR for colorectal polyps &gt; 2 cm between Jan 2010 and August 2012 was conducted. We compared two cohorts of patients: group-A with large polyps (2 to &lt;4 cm) vs group-B with giant (≥4 cm) polyps. Chi-square/Fischer’s tests were performed between categorical variables including patient demographics/polyp features/techniques applied {p-EMR with spiral snare and hybrid p-EMR). Our primary outcome was to compare the safety, efficacy and complication rate between the two groups. <h3>Results</h3> Group-B patients were older than group-A patients (mean 70.6 vs. 67.8 yrs, p = 0.01) and were more likely to have come from a tertiary referral source (p = 0.05). Large polyp referrals were almost twice as frequent as giant polyp referrals (218 vs. 123, p &lt; 0.001). Median polyp size was 2.5cm in group-A and 5cm in group-B. Giant polyps were most commonly found in the recto-sigmoid segment (26% rectum and 28% sigmoid, p &lt; 0.001), whilst large polyps were more evenly distributed throughout the colon. No significant difference in cancer prevalence was recorded between the groups. Endoscopic excision was complete in 89% in large (median time 18min) and in 70% in giant groups (median time 38min). All large polyps were excised in one session, whilst 4% of giant polyps required more than one session. Incomplete submucosal lift (46% vs 63%, p = 0.002) and difficult polyp position (45% vs 63%, p &lt; 0.001) were more common in giant polyps. Spiral snare EMR (6% vs 28%, p &lt; 0.001) and hybrid (0% vs 7%, p &lt; 0.001) techniques were more commonly used in giant than in large polyps. Procedural bleeding occurred more frequently in giant polyps (5% vs 17%, p &lt; 0.001). Delayed bleeding was also significantly higher in giant polyps (15% vs 34%, p &lt; 0.001), but hospitalisation or further intervention did not vary significantly by polyp size. The overall long-term recurrence at 24 months was 17% (11% vs 28%, p = 0.02). The follow up occurrence was more frequent for giant polyps at 3 month (43% vs 72%, p &lt; 0.001) and 9 month (14% vs 26%, p = 0.007) intervals. Benign recurrence requiring surgery and the cancer prevalence did not vary between polyp size group. <h3>Conclusion</h3> Piecemeal resection is a safe and efficacious modality for the resection of colorectal polyps &gt;4 cm. However, these giant polyps more often require spiral snare or hybrid resection techniques and their higher adenoma recurrence rate post p-EMR may dictate shorter surveillance intervals. <h3>Disclosure of interest</h3> None Declared.