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Journal of Cystic Fibrosis : Official... May 2019Mortality risk stratification is essential in lung transplantation (LTx) to allow listing, prioritization and mitigating strategies. In cystic fibrosis (CF) patients,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Mortality risk stratification is essential in lung transplantation (LTx) to allow listing, prioritization and mitigating strategies. In cystic fibrosis (CF) patients, predictors of post-LTx mortality are not established.
METHODS
For this systematic review and meta-analysis, seven databases were searched until January 3, 2018 to identify predictors of post-LTx mortality in CF. We excluded studies of multi-organ transplantation, re-transplantation and graft survival. For multiple studies assessing the same population during overlapping time-periods, the largest one was analyzed. Risk of bias was assessed with the Newcastle-Ottawa scale (NOS). Pooled hazard ratios were calculated using random-effects models.
RESULTS
Fifty-four studies were included in the systematic review and 11 studies in the meta-analyses (low-to-moderate bias risk, NOS score ≥ 5). Among 10 factors assessed in the meta-analysis, B. cepacia complex (BCC) (N = 1451, unadjusted HR = 2.35, 95%CI:1.80-3.06; I = 20.4% and adjusted HR = 2.49, 95%CI:1.74-3.57; I = 46.2%) and ascending chronological year of LTx (N = 4207, unadjusted HR = 0.98, 95%CI:0.97-0.98, I = 4.8%) were predictors of post-LTx mortality. Male gender (N = 2903, adjusted HR = 1.12, 95%CI:1.0-1.26, I = 0%) and age in adults (N = 3677, unadjusted HR = 0.99, 95%CI:0.97-1.00; I = 64.1% and N = 2605, adjusted HR = 0.98, 95%CI:0.97-0.99; I = 34.3%) had borderline significant associations with post-LTx mortality. P. aeruginosa colonization, forced expiratory volume in one second (FEV), pulmonary hypertension, body mass index (BMI), pancreatic insufficiency and CF-related diabetes (CFRD) were not predictors of mortality.
CONCLUSIONS
BCC was associated with a higher post-LTx mortality whereas FEV, pulmonary hypertension, BMI, CFRD and female gender were not associated with post-LTx mortality. These findings indicate that CF-specific risk estimates of post-LTx mortality should be considered.
Topics: Cystic Fibrosis; Humans; Lung Transplantation; Postoperative Complications; Prognosis; Risk Assessment
PubMed: 30482682
DOI: 10.1016/j.jcf.2018.10.013 -
Danish Medical Journal Aug 2020With the increasing use of cross-sectional imaging, the incidence of non-symptomatic pancreatic cystic neoplasms is increasing. Surgical management of pancreatic cystic...
INTRODUCTION
With the increasing use of cross-sectional imaging, the incidence of non-symptomatic pancreatic cystic neoplasms is increasing. Surgical management of pancreatic cystic neoplasms possess significant risks of perioperative morbidity and mortality. Our aim was to evaluate endoscopic ultrasound (EUS)-guided ablation as a non-operative treatment of pancreatic cystic neoplasms.
METHODS
We performed a literature search in MEDLINE, Embase and Scopus. All clinical studies examining the safety and efficacy of EUS-guided pancreatic cyst ablation with radiofrequency, sclerosants, ethanol, chemotherapeutics or a combination hereof were included.
RESULTS
A total of 17 studies were included. We found that EUS-guided pancreatic cyst ablation was feasible with complete resolution in up to 86% of cases after 3-12 months. The modality with the most promising results after 3-12 months was chemoablation with complete resolution rates ranging from 46 to 79% (median 64%). The most appropriate follow-up period was estimated to be 12 months. The risk of serious adverse events including pancreatitis was approximately 16%. Very few cyst recurrences have been documented following complete resolution after cyst ablation.
CONCLUSIONS
EUS-guided cyst ablation of pancreatic cystic lesions seems effective and safe as an alternative to surgical resection in patients who are unfit for surgery or who have low-risk pancreatic cystic neoplasms.
Topics: Ablation Techniques; Adult; Clinical Trials as Topic; Endosonography; Female; Humans; Male; Middle Aged; Pancreatic Cyst; Pancreatic Neoplasms; Prospective Studies; Retrospective Studies; Treatment Outcome; Ultrasonography, Interventional
PubMed: 32741440
DOI: No ID Found -
Gastroenterology Research and Practice 2016Background. Researchers have evaluated various molecular tests for improving the differential diagnosis of cystic lesions of the pancreas. Methods. Six electronic...
Background. Researchers have evaluated various molecular tests for improving the differential diagnosis of cystic lesions of the pancreas. Methods. Six electronic databases were searched for articles on molecular tests for the diagnosis of pancreatic cysts. Measures of accuracy were extracted from selected articles and pooled by the random-effects model. Summary receiver operating characteristic curves were used to analyze the overall accuracy of the molecular tests. Pooled sensitivity and specificity values [95% confidence intervals] are reported. Results. The systematic review included eight studies of 428 patients in total. We determined the sensitivities and specificities of tests for KRAS mutations (0.47 [0.39-0.54], 0.98 [0.93-0.99]) and loss of heterozygosity (0.63 [0.54-0.71], 0.76 [0.63-0.87]) for distinguishing mucinous from nonmucinous cysts, as well as the sensitivities and specificities of tests for KRAS mutations (0.59 [0.46-0.71], 0.78 [0.71-0.85]) and loss of heterozygosity (0.89 [0.78-0.96], 0.69 [0.60-0.76]) for differentiating malignant from benign cysts. Conclusion. Tests of KRAS mutations could confirm but not exclude a diagnosis of a mucinous or malignant pancreatic cyst.
PubMed: 26819604
DOI: 10.1155/2016/3546085 -
Annals of Medicine and Surgery (2012) Feb 2021Hydatid disease is a major health problem worldwide. The liver is the most frequent location of hydatid disease. Acute pancreatitis secondary to liver hydatid cyst...
Hydatid disease is a major health problem worldwide. The liver is the most frequent location of hydatid disease. Acute pancreatitis secondary to liver hydatid cyst ruptured in the biliary tract is scarce and fewly described in literature. The management of this pancreatic complication of liver hydatid disease is challenging and includes a combination of surgical and endoscopic approaches. We report herein a rare case of hydatid cyst of the liver with cysto-biliary communication revealed by acute pancreatitis. A systematic literature review of similar cases reported was provided to compare surgical and endoscopic techniques. A thirty-year-old woman was referred to our emergency unit for acute pancreatitis. The CT-scan findings revealed a liver hydatid cyst ruptured in the biliary tract and daughter vesicles within were found, responsible for C-grade acute pancreatitis. We decided then to perform an emergency surgery through a bisoucostal incision. We performed a cholecystectomy and a peroperative cholangiogram that showed the communication between the cyst and left biliary tracts and the presence of daughter vesicle within the common bile duct. We conducted an exploration of the common bile duct with extraction of vesicle daughters. We left behind a T-tube in the common bile duct and we sutured the cysto-biliary fistula. Drainage was left in the remnant cavity after unroofing the cyst. Postoperative course was uneventful. Six months follow-up showed no recurrence. Cysto-biliary communication of liver hydatid disease revealed by acute pancreatitis is uncommon. We chose to perform emergency open surgery. However, through a systematic literature review, we noticed that endoscopic treatment is an efficient therapeutic and diagnostic tool to delay a morbid surgery of the liver and the common bile duct.
PubMed: 33552493
DOI: 10.1016/j.amsu.2021.01.079 -
Virchows Archiv : An International... Jul 2021Cystic lesions of the pancreas may range from benign to precursors of pancreatic cancer. Simple mucinous cyst (SMC) is larger than 1 cm, has a gastric-type flat mucinous...
Cystic lesions of the pancreas may range from benign to precursors of pancreatic cancer. Simple mucinous cyst (SMC) is larger than 1 cm, has a gastric-type flat mucinous lining, and minimal atypia without ovarian-type stroma. We report a new case of pancreatic SMC, coupling a systematic review of the English literature mainly focused on their clinic-pathological features. We reviewed 103 cases of SMC in adults (73 women), averaging 57 (range, 26-70) years. The SMCs were located in the body-tail region of the pancreas in 60 (58%) cases, presenting as single cystic lesions in 94% of cases; 43% of patients were asymptomatic. A preoperative fine-needle aspiration of the cyst fluid detected amylase and carcinoembryonic antigen positivity in 71% and 76% of cases, respectively. Patients underwent surgery mostly for suspected malignancy; in 83% of cases, a standard pancreatic resection was performed. Mean SMC size was 4.9 (range, 1.5-12.0) cm. Mucins MUC5AC and MUC6 resulted positive in 77% and 81% of cases performed, respectively, whereas MUC2 was negative in all but one patient. The SMC from our institution was characterized by a KRAS somatic mutation. The diagnosis of SMC should be considered when a solitary pancreatic cyst larger than 1 cm is detected in asymptomatic patients. To establish a correct diagnosis, an extensive histologic/immunohistochemical analysis is essential. The presence of a KRAS mutation highlights that SMC may represent another potential pancreatic cancer precursor.
Topics: Adult; Aged; Amylases; Biomarkers, Tumor; Carcinoembryonic Antigen; Cystadenoma, Mucinous; Female; Humans; Male; Middle Aged; Mucin 5AC; Mucin-6; Mutation; Pancreatectomy; Pancreatic Cyst; Pancreatic Intraductal Neoplasms; Pancreatic Neoplasms; Precancerous Conditions; Proto-Oncogene Proteins p21(ras)
PubMed: 33511431
DOI: 10.1007/s00428-021-03029-1 -
World Journal of Gastroenterology Jul 2011To determine whether the outcomes of laparoscopic fenestration (LF) were superior to open fenestration (OF) for congenital liver cysts. (Meta-Analysis)
Meta-Analysis
AIM
To determine whether the outcomes of laparoscopic fenestration (LF) were superior to open fenestration (OF) for congenital liver cysts.
METHODS
Comparative studies published between January 1991 and May 2010 on Medline (Ovid), Emsco, PubMed, Science Direct; Cochrane Reviews; CNKI; Chinese Biomedical Database, VIP and other electronic databases were searched. Randomized controlled trials (RCTs) and retrospective case-control studies on the management of congenital hepatic cysts were collected according to the pre-determined eligibility criteria to establish a literature database. Retrieval was ended in May 2010. Meta-analysis was performed using RevMan 5.0 software (Cochrane library).
RESULTS
Nine retrospective case-control studies involving 657 patients, comparing LF with OF were included for the final pooled analysis. The meta-analysis results showed less operative time [mean difference (MD): -28.76, 95% CI: -31.03 to 26.49, P < 0.00001]; shorter hospital stay (MD: -3.35, 95% CI: -4.46 to -2.24, P < 0.00001); less intraoperative blood loss (MD: -40.18, 95% CI: -52.54 to -27.82, P < 0.00001); earlier return to regular diet (MD: -29.19, 95% CI: -30.65 to -27.72, P < 0.00001) and activities after operation (MD: -21.85, 95% CI: -31.18 to -12.51, P < 0.0001) in LF group; there was no significant difference between the two groups in postoperative complications (odds ratio: 0.99, 95% CI: 0.41 to 2.38, P = 0.98) and cysts recurrence rates.
CONCLUSION
The short-term outcomes of LF for patients with congenital hepatic cysts were superior to open approach, but its long-term outcomes should be verified by further RCTs and extended follow-up.
Topics: Adult; Aged; Aged, 80 and over; Cysts; Databases, Factual; Female; Humans; Laparoscopy; Liver; Male; Middle Aged; Randomized Controlled Trials as Topic; Young Adult
PubMed: 21876626
DOI: 10.3748/wjg.v17.i28.3359