Variations in preterm stabilisation practices and caffeine therapy between two European tertiary level neonatal units.

AIM: To investigate interinstitutional differences in preterm infant stabilisation between two European tertiary neonatal centres with particular focus on intubation timing, surfactant administration, caffeine therapy and neonatal morbidity and mortality. METHODS: Retrospective (2012-2014) study of very low birth weight (VLBW) preterm infants admitted to John Radcliffe Hospital (UK centre) and Charité Medical Centre (German centre). Timing of intubation, surfactant and caffeine administration and respiratory outcomes were examined. RESULTS: Gestational age, birth weight and five-minute Apgar scores of VLBW infants from the UK centre (n = 86) were comparable to those from the German centre (n = 96). Significant differences in antenatal steroid therapy, intubation timing and surfactant therapy were noted. Timing of caffeine initiation differed significantly between centres (median 0 [0-2.5] UK vs. 2 [1.5-4] days German centre); however, caffeine was discontinued at a similar corrected gestational age of 34.7 weeks. Mechanical ventilation was significantly longer at the UK centre, but there was no difference in bronchopulmonary dysplasia (BPD) (44% UK vs. 36% German centre) or mortality (15% UK vs. 13% German centre). CONCLUSION: Timing of primary intubation and caffeine therapy differed significantly between centres. However, earlier intubation and caffeine administration in the UK centre were not associated with a changed incidence of BPD.

Well-differentiated bronchial neuroendocrine tumors: Clinical management and outcomes in 105 patients.

INTRODUCTION: Bronchial neuroendocrine tumors (NETs) are rare tumors representing approximately 20%-30% of all neuroendocrine tumors and 2%-3% of all adult lung cancers. Here, they present a large case series of well-differentiated bronchial NETs with the aim of investigating the behavior of these tumors and long-term outcomes. METHODS: A retrospective review was performed of 105 patients with bronchial NETs managed in a tertiary referral center in the period between January 1998 and January 2012. RESULTS: Bronchial NETs are commoner in females and the commonest presenting symptoms were cough (13.9%) and dyspnoea (11.6%). OctreoscanTM and Gallium-68 DOTATATE PET were found to have similar diagnostic sensitivity and FDG PET was more sensitive for higher-grade tumors. Over a median follow-up period of 35.5 months mortality rate was 5.7%. The 5-year survival was 76% and the 10-year survival was 62%. Female patients survived longer but this difference was not statistically significant (P = .59). Older age greater than 50 years (P = .027), higher levels of Chromogranin A (CgA) (P = .034), first-line treatment with surgery (P = .005), ki67 over 10% (P = .037), and tumor stage (P = .036) but not tumor grade (P = .22), were significantly associated with survival. DISCUSSION: Several factors have been identified which are independently associated with survival including CgA levels greater than 100 pmol/L, tumor stage, age greater than 50, ki67 over 10% and having surgery as first-line treatment. There was no difference in survival between typical and atypical carcinoids.

Appendiceal goblet cell carcinoid tumour: a case of unexpected lung metastasis.

Goblet cell carcinoid tumours are often considered a subset of appendiceal neuroendocrine tumours which behave more aggressively. They usually metastasize through transcoelomic/peritoneal invasion and common sites include the ovaries, peritoneum, and liver. Metastases may have goblet cell carcinoid, signet ring cell carcinoma or classic carcinoid histology. We report the first case in the literature of a patient with a goblet cell carcinoid with lung metastasis, which was associated with unfavourable outcome.

Gastric mixed adenoneuroendocrine carcinoma with a trilineage cell differentiation: case report and review of the literature.

Most gastric neuroendocrine tumours are well differentiated and considered as neuroendocrine neoplasms, whilst poorly differentiated lesions are considered as neuroendocrine carcinomas and account for only 6-16% of gastric neuroendocrine tumours. Gastric mixed adenoneuroendocrine carcinomas are rare malignancies usually composed of a neuroendocrine carcinoma and an adenocarcinoma with a variable grade of differentiation. Here, we report an unusual and rare gastric mixed adenoneuroendocrine carcinoma with a trilineage cell differentiation including a neuroendocrine carcinoma, an adenocarcinoma and a squamous cell carcinoma. A brief discussion of the histopathological features, biological behaviour and treatment of this rare tumour type is presented.

Vascular access for hemodialysis in the elderly.

OBJECTIVE: The number of elderly patients needing hemodialysis is constantly increasing year by year. Elderly patients with end-stage renal failure represent a challenge for the surgeons who create vascular accesses. The aim of this study was to analyze the outcome of conduit creation in the elderly in our institution and to compare it with the outcome of a cohort of patients aged <65 years. METHODS: The study was performed retrospectively on prospectively collected data. The study period was between January 1, 2000, and December 31, 2006. We identified first attempts at conduit creations, including arteriovenous fistulas (AVFs) and grafts, in elderly patients (aged ≥65 years) who were allocated to group A, and in nonelderly patients (<65 years) who were allocated to group B. Subsequent attempts at conduit creations in the same patient were omitted from the data set. RESULTS: There were 246 first AVFs in group A and 89 in group B. At a mean follow-up of 25.46 months (SD, 18.93 months), the primary patency (PP) rate of all AVFs was 70% in group A and 68% in group B (P = .75). The assisted PP rate was 73% in group A and 77% in group B (P = .4). The secondary patency (SP) rate was 73% in group A and 79% in group B (P = .9). Also, the differences in the 12-month cumulative patency rates (including PP, assisted PP, and SP) in the two groups (65% vs 60%) were not significant. At a mean follow-up of 25 months, death with a functioning conduit occurred at the same rate in both groups (56% and 54%), and mean conduit survival did not differ according to age (516 and 511 days). The incidence of failure to mature was higher in group A (6.1% vs 1.1%, P = .03). Patency rates for different types of conduits were similar between the two groups, although polytetrafluoroethylene grafts had a higher cumulative patency in group A (94% vs 69%; P = .05). The rate of procedures to salvage conduits was 2.5% in group A vs 10.1% in group B. Mean hospital stay for group A and group B was 3.2 days. CONCLUSIONS: In our experience, the creation of permanent hemodialysis access in the elderly with AVF is not only possible but also proved to have a short hospital stay, high patency rates, and an acceptable rate of further intervention.