Meta-analysis of risk factors and complications associated with atrial fibrillation after oesophagectomy.

BACKGROUND: Oesophagectomy is associated with high morbidity and mortality rates. New-onset atrial fibrillation (AF) is a frequent complication following oesophagectomy. Several studies have explored whether new-onset AF is associated with adverse events after oesophagectomy. METHODS: This review was performed according to PRISMA guidelines. Eligible studies were identified through a search of PubMed, Scopus and Cochrane CENTRAL databases up to 25 November 2018. A meta-analysis was conducted with the use of random-effects modelling. The I2 statistic was used to assess for heterogeneity. RESULTS: In total, 53 studies including 9087 patients were eligible for analysis. The overall incidence of postoperative AF was 16·5 per cent. Coronary artery disease and hypertension were associated with AF, whereas diabetes, smoking and chronic obstructive pulmonary disease were not. Patients with AF had a significantly higher risk of overall postoperative adverse events than those without fibrillation (odds ratio (OR) 5·50, 95 per cent c.i. 3·51 to 8·30), including 30-day mortality (OR 2·49, 1·70 to 3·64), anastomotic leak (OR 2·65, 1·53 to 4·59) and pneumonia (OR 3·42, 2·39 to 4·90). CONCLUSION: Postoperative AF is frequently observed in patients undergoing oesophagectomy for cancer. It is associated with an increased risk of death and postoperative complications.

Contribution of patient-advisors during rehabilitation for replantation of digits improves patient-reported functional outcomes: A presentation of concept.

Clinical approach to surgical patients has evolved to include previous patients as part of the treating team in the role of "patient-advisors". Knowing that compliance to rehabilitation protocols is significant for a successful functional hand replantation, we set out to quantify functional patient-reported outcomes in individuals enrolled in a Patient-Advisor Program (PAP). We performed a prospective cohort pilot study of all patients admitted for a finger replantation between July 2015 to January 2016. All patients were offered to partake in the PAP, or else they would constitute the control group. Primary endpoints were functional outcomes as reported by patients at 6-8weeks and 4-6months of follow-up. Secondary endpoints were patient-reported pain and quality of life questionnaires. In total, 62 patients were admitted for finger replantation in the studied period, in which 50 agreed to participate in the study, including 7 in the patient-advisors group and 43 in the control group. Patients from the patient-advisors group fared better on mean scores of the Disabilities of the Arm, Shoulder and Hand than controls (29.6 vs 34.8 respectively at 4-6months). Improvements in the McGill Pain Questionnaire were also greater in the studied group (19.9 vs 33.3 at 4-6months). Replantation patients benefiting from the PAP demonstrated superior functional outcomes on self-reported questionnaires, which could be explained by a better understanding of rehabilitation protocols and compliance when previous patients are active members of the treating team.

Prospective randomized comparison of vincristine, doxorubicin and dexamethasone (VAD) administered as intravenous bolus injection and VAD with liposomal doxorubicin as first-line treatment in multiple myeloma.

BACKGROUND: The combination of vincristine and doxorubicin administered as a continuous infusion via an indwelling catheter together with intermittent high-dose dexamethasone (VAD) is an effective primary treatment for patients with symptomatic multiple myeloma. In order to avoid the need for an indwelling catheter, which imposes logistic problems for outpatient administration, several phase II studies have explored the feasibility and efficacy of VAD-like outpatient regimens. We designed a prospective randomized study to compare the objective response rates of two VAD-like outpatient regimens as primary treatment for symptomatic patients with multiple myeloma. PATIENTS AND METHODS: Patients were entered in a randomized study regardless of age, performance status and renal function. One hundred and twenty-seven patients received VAD bolus, which consisted of vincristine 0.4 mg i.v., doxorubicin 9 mg/m(2) i.v. and dexamethasone 40 mg p.o. daily for four consecutive days and 132 patients received VAD doxil, which consisted of vincristine 2 mg i.v. and liposomal doxorubicin 40 mg/m(2) i.v. on day 1 and dexamethasone 40 mg p.o. daily for 4 days. The two regimens were administered every 28 days for four courses and in courses 1 and 3, in both arms, dexamethasone was also given on days 9-12 and 17-20. RESULTS: An objective response was documented in 61.4% and 61.3% of patients treated with VAD bolus and VAD doxil, respectively. Hematological and non-hematological toxicities were mild or moderate and equally distributed between the two treatment arms with the exception of alopecia, which was more common after VAD bolus, and of palmar-plantar erythrodysesthesia, which was more common after VAD doxil. CONCLUSIONS: Our multicenter trial, which included an unselected patient population, indicated that both VAD bolus and VAD doxil can be administered to outpatients and can provide an equal opportunity of rapid response in many patients with multiple myeloma.

The diagnostic value of fine needle aspiration cytology in Waldeyer's ring lymphomas.

Fine needle aspiration cytology (FNAC) is a well-established diagnostic technique for tumours in the head and neck area. In recent years FNAC has been established as an accurate and useful method for the diagnosis of nodal malignant lymphoproliferative disease. The purpose of the present study was to determine and evaluate the accuracy of FNAC in the diagnosis of primary malignant lymphoma of Waldeyer's ring. The cases of 29 patients suffering from tumours of the oro- and nasopharynx, in which the diagnosis of lymphoma was established by FNAC during the years 1991-1998, were collected and analysed. Twelve of the patients had a previous history of lymphoma, and FNAC was used to establish the diagnosis of recurrent disease. In 17 patients with no previous history of malignancy FNAC was used to diagnose primary extranodal non-Hodgkin's lymphomas (NHLs). In two patients FNAC failed to diagnose NHL. In all patients cytological findings were complemented and compared with those of a histopathological examination after open biopsy. In two cases a difference in the specific histological type of the lymphoma was noted. The findings from the present study (sensitivity 93.10% and positive predictive value 100%) indicated that FNAC is a useful and accurate method in establishing diagnosis of Waldeyer's ring lymphomas.

An unusual cytogenetic abnormality involving chromosomes 1 and 7 in a case of chronic myelomonocytic leukemia.

We report a case of chronic myelomonocytic leukemia in which cytogenetic analysis revealed a 47,XY, +1, +der(7)del(7)(q32q36)ins(7;1)(q32;p36.3p22) chromosomal constitution. This abnormal karyotype, which as a whole is new to any myeloid malignancy, points to a possible pathogenetic role for the oncogenes MET and FGR on the derivative chromosome 7, and for the CSF1 and JUN genes flanking the breakpoint on chromosome 1.

Mixed lineage leukemia with cytogenetically unrelated abnormal clones.

We present a case of acute leukemia with morphologic, cytochemical, and immunophenotypic markers indicating that the population of blasts have characteristics of lymphoid and myelomonocytic origin. The cytogenetic study revealed the following mosaic abnormal karyotype: 46XX,dup(1)(q21----32)/46,XX,dup(11)(q13----25)/47,XX,trip(11) (q13----25),+der(17)t(17;?) (q24;?). The two clones involving #11 are obviously related. It is reasonable to assume that the third clone is an evolutionary result of the second one. Because no cytogenetic similarities were found among the first clone and the other two, we suggest that this mixed leukemia was of biclonal origin. To our knowledge, acute leukemia with mixed lineage characteristics and with the simultaneous presence of cytogenetically unrelated clones has not previously been reported.

Poly(A)-polymerase activity in chronic lymphocytic leukemia of the B cell type.

Poly(A)-polymerase enzymic activity was biochemically determined in lymphocytic extracts from 40 patients with chronic lymphocytic leukemia of the B cell type. The enzymic activities of patients with stage A, B and C disease were (U/mg of protein): 4.9 +/- 5.5, 12.5 +/- 7.5 and 20.9 +/- 18.9, respectively. The difference in the enzyme level between stage A and C patients was statistically significant (p less than 0.05). Comparison of the enzyme activity level in relation to the pattern of bone marrow involvement revealed that patients with a diffuse pattern of infiltration had a significantly higher enzyme level (17.9 +/- 15.5 U/mg of protein) than patients with interstitial or mixed infiltration patterns (5.9 +/- 6.6 and 7.9 +/- 7.0 U/mg of protein; p less than 0.025). Finally, patients who required treatment for their disease also had a significantly higher poly(A)-polymerase activity level (14.5 +/- 13.9 U/mg of protein) than patients with stable disease (4.9 +/- 5.5 U/mg of protein; p less than 0.05). Our results indicate that the enzyme poly(A)-polymerase may be used as a biological marker in patients with chronic lymphocytic leukemia.