An analysis of long-term survival after pneumonectomy for lung cancer: A retrospective study of 20 years.

INTRODUCTION: The incidence of pneumonectomy for lung cancer in the UK is continuing to decline in the era of minimally invasive thoracic surgery totalling approximately 3.5% of lung cancer resections annually. Literature is lacking for long-term survival of pneumonectomies. This study updates our previous results. Between 1998 and 2008, 206 patients underwent pneumonectomy compared to 98 patients between 2009 and 2018. METHODS: From January 1998 until December 2018, 304 patients underwent pneumonectomy. This was a retrospective study; data was analysed for age, gender, laterality, histology and time period. RESULTS: Operative mortality was 4.3% overall which was lower than the national average of 5.8%. In the last five years, there were no in-hospital, operative or 30-day mortality. During this period, 90-day mortality was 9.2%. Left-sided pneumonectomies had significantly better overall survival (3.00 vs. 2.03 years; p = 0.0015), squamous cell carcinoma (3.23 vs. 1.54 years; p = 0.00012) as well as those aged less than 70 (2.79 vs. 2.13 years; p = 0.011). There was no significant difference in survival between gender (p = 0.48). Intervention from 1998 to 2008 had significantly greater survival compared to the latter 10 years (2.68 vs. 2.46 years; p = 0.031). The Cox model shows that laterality, age, histology and time period remain significant with multivariate testing. No patient survived after 16 years. DISCUSSION: Our updated retrospective study has built on our previous results by reinforcing the success of pneumonectomies. The incidence of pneumonectomies is likely to decrease with the deployment of nation-wide lung cancer screening in the UK due to earlier detection.

Outcomes of Patients with FLT3 Positive Acute Myeloid Leukaemia; an Experience from a Tertiary Care Hospital in Karachi, Pakistan.

Introduction: Molecular genetic abnormalities in acute myeloid leukaemia (AML) are essential for disease diagnosis and determining prognosis and clinical course. Mutations in FLT3 and nucleophosmin (NPM) genes are the most frequent genetic abnormalities, which are also known to impact disease outcomes. FLT3 mutations have been identified in approximately 30% of de novo AML patients and are associated with poor prognoses. This study aimed to determine the response to induction chemotherapy, overall survival (OS) and relapse rate (RR) in patients with FLT3-positive AML. Materials and Methods: In this study, a retrospective analysis was performed of 75 newly diagnosed patients with AML registered between January 2015 and July 2022. Patient demographics and clinical-haematological parameters were noted and molecular analysis for FLT3 ITD/TKD and NPM mutations was performed. All the patients received standard induction chemotherapy and their response to treatment, OS and RR were assessed. Results: A total of 75 cases of AML were analysed. The mean age of the sample was 34.9 years, of which 65.3% were males and 34.7% were females. The patients were stratified into two groups: Those who were positive for FLT3 while negative for NPM (FLT3+/NPM-), representing 17.3% and those who were negative for both FLT3 and NPM (FLT3-/NPM-), representing 82.7% of cases. On day 28 post-induction, the complete remission rate was 69.2% in the FLT3 positive group and 77.4% in the FLT3 negative group. In the FLT3+/NPM- group, 55.6% of cases who were in remission at day 28 subsequently relapsed, compared to 50.0% of FLT3-/NPM- cases. The overall median survival time for the cohort and FLT3+ group was 1467 days, while that of the FLT3-group could not be estimated due to the very high survival rate. Conclusion: No significant differences in outcomes were observed in patients who were FLT3 positive compared to those who were FLT3 negative.

Redo aortic valve replacement versus valve-in-valve trans-catheter aortic valve implantation: a UK propensity-matched analysis.

This study sought to compare the morbidity and mortality of redo aortic valve replacement (redo-AVR) versus valve-in-valve trans-catheter aortic valve implantation (valve-in-valve TAVI) for patients with a failing bioprosthetic valve. A multicenter UK retrospective study of redo-AVR or valve-in-valve TAVI for patients referred for redo aortic valve intervention due to a degenerated aortic bioprosthesis. Propensity score matching was performed for confounding factors. From July 2005 to April 2021, 911 patients underwent redo-AVR and 411 patients underwent valve-in-valve TAVI. There were 125 pairs for analysis after propensity score matching. The mean age was 75.2±8.5 years. In-hospital mortality was 7.2% (n=9) for redo-AVR versus 0 for valve-in-valve TAVI, p=0.002. Surgical patients suffered more post-operative complications, including intra-aortic balloon pump support (p=0.02), early re-operation (p<0.001), arrhythmias (p<0.001), respiratory and neurological complications (p=0.02 and p=0.03) and multi-organ failure (p=0.01). The valve-in-valve TAVI group had a shorter intensive care unit and hospital stay (p<0.001 for both). However, moderate aortic regurgitation at discharge and higher post-procedural gradients were more common after valve-in-valve TAVI (p<0.001 for both). Survival probabilities in patients who were successfully discharged from the hospital were similar after valve-in-valve TAVI and redo-AVR over the 6-year follow-up (log-rank p=0.26). In elderly patients with a degenerated aortic bioprosthesis, valve-in-valve TAVI provides better early outcomes as opposed to redo-AVR, although there was no difference in mid-term survival in patients successfully discharged from the hospital.

Intraductal Papillary Mucinous Neoplasm of the Pancreas Arising in a Patient With Limited Cutaneous Systemic Sclerosis.

Systemic sclerosis (SS) is a heterogenous autoimmune disease that manifests itself with skin and internal organ involvement. The association of SS and malignancy is an emerging field of study with limited data in the literature. This report highlights the unique case of a patient with limited cutaneous SS (lcSS) found to have an intraductal papillary mucinous neoplasm (IPMN) of the pancreas. In this report, we review the clinical manifestations, serologic findings, and phenotypes of SS. Furthermore, an evaluation of the risk of pancreatic neoplasms in patients with SS will be discussed, as well as the correlation of cancers among SS phenotypes and auto-antibodies. As part of our research, a PubMed search of the following terms was performed: "systemic sclerosis, scleroderma, limited cutaneous systemic sclerosis, CREST syndrome, Raynaud syndrome, cancer, malignancy, pancreas, and intraductal papillary mucinous neoplasm".

Preferences in Learning Styles and Modes of Information Delivery in Patients Receiving First-Day Education for Radiation Therapy.

PURPOSE: The primary objective of this study was to determine levels of patient satisfaction with current first-day teaching practices at a large, academic Canadian Radiation Therapy Department. A secondary objective was to investigate patient preferences in learning styles and modes of information delivery. METHODS: A literature review was conducted on learning styles, modes of information delivery, and patient education in radiation therapy. Based on this review, a quantitative survey was designed to evaluate patient preferences. Inclusion and exclusion criteria were generated to select participants. The study population included 21 patients with prostate cancer and 24 patients with breast cancer. The surveys were distributed for a 2-week period. The Sign Test and Kruskal-Wallis Test were used to analyze the data. RESULTS: The results revealed that patients significantly disagreed with the use of group sessions and strongly agreed with sit-down, one-on-one sessions and the use of supporting print material. Patients agreed with the use of a combination of teaching methods. Male participants more frequently strongly agreed with the use of videos to support educational practices. Significant results were found on preference for visual and kinesthetic learning. Overall, participants agreed that teaching sessions reduced anxiety. CONCLUSIONS: Radiation therapists are encouraged to continue with current teaching practices since patients reported high levels of satisfaction. The results of this study indicate that a combination of teaching methods including visual aids and videos for male patients may be of benefit. Therefore, to further strengthen teaching sessions, the use of a multimedia tool can be investigated in the future.

A Qualitative Comparison to Understand the Differences between Perceptions and Reality of Errors in Radiation Therapy: An Understanding Based on Principles of Perception Psychology.

PURPOSE: The purpose of this study was to qualitatively, compare, and understand why perceptions of errors in radiation therapy differ from actual reported errors. METHODS: The qualitative study consisted of one-on-one semi-structured interviews that were conducted with three radiation therapists and two medical physicists. Eight interview questions were based on the discrepancies that existed between perceptions and actual error reports from a survey administered in 2010. Interviews were voice recorded and transcribed followed by three independent thematic analyses. Saturated themes were those that were shared across all respondents. Interpretation of these results was based on the literature of perception psychology in an attempt to understand why such perceptions existed or differed from actual reports. RESULTS: The thematic analyses revealed that workload, documentation, motives, continuing education, and expectations were recurring themes. The effects of workload were attributed to the psychology of attention and an overburdened filtration process. It is common to find irrelevant distracters or stressors functioning as noise, which make it more difficult to identify and attend to important information. Many forms of stress such as workload, personal, or environmental can function as noise hindering the filtration process, which has been positively associated with therapist burnout. Respondents shared views on redundancy and consistency of documentation. In the literature, adaptation has been shown to play a major role in the formation and alteration of perceptions. Habituation is a form of adaptation that refers to a lessened degree of sensitivity to any one continuous stimulus. Adapting to an environment with a persistent stimulus can result in a passive frame of mind effectively dismissing the redundant stimulus. It is apparent that with redundant documentation, staff members may find themselves habituated with the process of continually transcribing from one document to the next and therefore, making documentation more prone to error. Motives were found as a common theme when respondents were asked to explain why treatment delivery was the area perceived to be where most errors occur, when in reality this was not true. Respondents expressed the onus of responsibility on therapists at the treatment delivery level. The driving force for this perception is the psychological effect of an individual's motives and the physical consequences of errors at the treatment delivery level. Bolus was perceived to be a greater error than it actually is. From the perspective of the "self-fulfilling prophecy" theory by Robert K. Merton, it would state that radiation therapy staff perceived bolus to be a common error because they expected it to be a common error. Expectations of bolus indicated were its subjectivity of placement, the uncertainty of its error, and its lack of an active interlock system. CONCLUSIONS: Emergent themes from this study have shown the implications and value of a qualitative approach in providing detail rich information and insight for further research of radiation therapy error analysis. Specifically, referencing the literature of perception psychology, we were able to theorize why therapists perceive certain errors to be more common than others and what factors may influence these perceptions. Future large scale studies in radiation therapy of this nature would benefit the field in helping to create reflective policies and procedures to ultimately minimize human errors and broaden our approach to error analysis.

Frequency and severity of neutropenia in diffuse large B-cell non Hodgkin's lymphoma after first cycle of chemotherapy comprising cyclophosphamide, doxorubicin, vincristine with prednisolone.

BACKGROUND: Chemotherapy used for malignant diseases may produce severe neutropenia in first cycle which may compel for dose modification and early termination of therapy. This descriptive cross sectional study was planned to see the frequency and severity of neutropenia after first cycle of chemotherapy comprising cyclophosphamide, doxorubicin, vincristine with prednisolon in patients of diffuse large B-cell non Hodgkin's lymphoma presenting at Oncology Department Combined Military Hospital Rawalpindi from August 2009 to July 2010. METHODS: Thirty patients of diffuse large B-cell non Hodgkin's lymphoma diagnosed on lymph node biopsy presenting for the first time at Oncology Department Combined Military Hospital Rawalpindi were included. They were admitted in the ward and evaluated with history, physical examination and staging investigations. Patients were then planned for first cycle of chemotherapy comprising cyclophosphamide, doxorubicin, and vincristine with prednisolon. After the first cycle of chemotherapy they were monitored for expected neutropenia in the ward. The neutrophil counts were repeated on days 7 and 10 following chemotherapy. Neutropenia was graded as defined in the operational definition and all the data was entered on a specially designed data card. RESULTS: As much as 3.3% of patients suffered from grade IV neutropenia (absolute neutrophil count of <0.5x10(9)/L), 3.3% had grade III neutropenia (absolute neutrophil count of 0.5x10(9)/L-0.9x10(9)/L), 6.6% had Grade II neutropenia (absolute neutrophil count 1.0x10(9)/L-1.4x10(9)/L and 10% had Grade I neutropenia (absolute neutrophil count 1.5x10(9)/L-1.9x10(9)/L. CONCLUSION: Overall 23.2% suffered from neutropenia of all grades post 1st cycle of chemotherapy comprising cyclophosphamide, doxorubicin, vincristine with prednisolon in diffuse large B-cell non Hodgkin's lymphoma. Further studies are required to find the risk factors to predict this complication in our population.