Results of the treatment of pancreatic cephalic tumours hospitalised through an emergency

Scop. Analiza rezultatelor tratamentului chirurgical (paliativ și rezecțional) la pacienții cu tumori pancreatice (TP) cefalice spitalizați în urgență. Materiale şi metode. Studiu retrospectiv-prospectiv, 2016-2021, 185 pacienţi cu TP, B:F/1:1, vârsta medie 62,8±12,7 ani. Adresarea a fost determinată de icter în 121 (65,5%) cazuri, formaţiune intraabdominală – 41 (22,2%), abdomen acut – 23 (12,4%). Diagnosticul s-a stabilit: la 147 (79,5%) − prin TC; la 14 (7,6%) – prin RMN şi la 102 (55,1%) – la CPGRE. În 163 (88,1%) cazuri TP era localizată cefalic, în 22 (11,9%) − corporeo-caudal (excluși din studiu). În 14,7% cazuri (24 pacienți cu tumora cefalică) s-a refuzat orice procedura terapeutică. Pacienţii s-au repartizat în trei loturi: lot.I – stentare biliară la CPGRE sau transparietohepatică (87), lot. II – derivație biliodigestivă (25), lot. III – rezecţie pancreatoduodenală (27). Rezultate. Lotul I − 87 (62,6%) cazuri, vârsta m=65,6±11,7 ani, bilirubinemia m=222±122 mmol/l, durata spitalizării m=10,7±6,4 zile, mortalitatea p/op – 9 (10,3%). Lotul II – 25 (18%) cazuri, vârsta m=61,2±10,9 ani, bilirubinemia m=86,0±17,0 mmol/l, durata spitalizării m=21,2±10 zile, mortalitatea p/op – 4 (16%). Lotul III – 27 (19,4%) pacienți, vârsta m=57,9±8,1ani, bilirubinemia m=127±53 mmol/l, 8 (29,6%) cazuri au fost stentați preoperator (bilirubinemia m=218,8±65,7 mmol/l), durata spitalizării m=30,2±13,8 zile, mortalitatea p/ op – 4 (14,8%). Concluzii. Examenul imagistic (TC cu angiografie și/sau RMN) este de prima intenție în diagnosticul și stabilirea tacticii chirurgicale pentru TP. Stentarea căilor biliare este o soluție frecvent aplicată pentru rezolvarea icterului în TP cefalice. Rata operațiilor rezecționale cu viza de radicalitate rămâne sub limitată mondială raportată din cauza diagnosticului tardiv și simptomatologiei nespecifice.Aim of study. To analyze the outcomes of surgical treatment (palliative and radical) in patients with cephalic pancreatic tumors (PTs) admitted to hospital through an emergency. Materials and methods. Retrospective-prospective study, 2016-2021, 185 patients with PT, gender ratio 1:1, mean age 62,8±12,7 years. Cause of admission: jaundice 121 (65,5%) cases, intraabdominal mass 41 (22,2%), and acute abdomen 23 (12,4%). Diagnosis was established by CT in 147 (79,5%), MRI 14 (7,6%), and ERCP 102 (55,1%). In 163 (88,1%) cases PT was localized cephalic, in 22 (11,9%) - corporeal-caudal (excluded from the study). In 14,7% cases (24 patients with cephalic tumor) any therapeutic procedure was refused. Patients were divided into three groups: group I – minimally invasive decompression (87), group II – biliodigestive bypass (25), group III – pancreaticoduodenal resection (27). Results. Group I – 87 (62,6%) cases, age m=65,6±11,7 years, bilirubin level m=222±122 mmol/l, hospital stay m=10,7±6,4 days, mortality – 9 (10,3%). Group II – 25 (18%) cases, age m=61,2±10,9 years, bilirubin level m=86±17 mmol/l, hospital stay m=21,2±10 days, mortality – 4 (16%). Group III – 27 (19,4%) patients, age m=57,9±8,1 years, bilirubin level m=127±53 mmol/l, in 8 (29,6%) cases preoperative stenting was performed (bilirubin level m=218,8±65,7 mmol/l), hospital stay m=30,2±13,8 days, mortality – 4 (14,8%). Conclusions. Imaging examinations (CT with angiography and/or MRI) are the first option in diagnosis and determining surgical tactics for PTs. Bile ducts stenting is commonly applied in patients with jaundice. The rate of radical surgery remains below the reported world rate because of late diagnosis and non-specific symptoms

A double-blind, delayed-start trial of rasagiline in Parkinson's disease.

BACKGROUND: A therapy that slows disease progression is the major unmet need in Parkinson's disease. METHODS: In this double-blind trial, we examined the possibility that rasagiline has disease-modifying effects in Parkinson's disease. A total of 1176 subjects with untreated Parkinson's disease were randomly assigned to receive rasagiline (at a dose of either 1 mg or 2 mg per day) for 72 weeks (the early-start group) or placebo for 36 weeks followed by rasagiline (at a dose of either 1 mg or 2 mg per day) for 36 weeks (the delayed-start group). To determine a positive result with either dose, the early-start treatment group had to meet each of three hierarchical end points of the primary analysis based on the Unified Parkinson's Disease Rating Scale (UPDRS, a 176-point scale, with higher numbers indicating more severe disease): superiority to placebo in the rate of change in the UPDRS score between weeks 12 and 36, superiority to delayed-start treatment in the change in the score between baseline and week 72, and noninferiority to delayed-start treatment in the rate of change in the score between weeks 48 and 72. RESULTS:Early-start treatment with rasagiline at a dose of 1 mg per day met all end points in the primary analysis: a smaller mean (+/-SE) increase (rate of worsening) in the UPDRS score between weeks 12 and 36 (0.09+/-0.02 points per week in the early-start group vs. 0.14+/-0.01 points per week in the placebo group, P=0.01), less worsening in the score between baseline and week 72 (2.82+/-0.53 points in the early-start group vs. 4.52+/-0.56 points in the delayed-start group, P=0.02), and noninferiority between the two groups with respect to the rate of change in the UPDRS score between weeks 48 and 72 (0.085+/-0.02 points per week in the early-start group vs. 0.085+/-0.02 points per week in the delayed-start group, P<0.001). All three end points were not met with rasagiline at a dose of 2 mg per day, since the change in the UPDRS score between baseline and week 72 was not significantly different in the two groups (3.47+/-0.50 points in the early-start group and 3.11+/-0.50 points in the delayed-start group, P=0.60). CONCLUSIONS: Early treatment with rasagiline at a dose of 1 mg per day provided benefits that were consistent with a possible disease-modifying effect, but early treatment with rasagiline at a dose of 2 mg per day did not. Because the two doses were associated with different outcomes, the study results must be interpreted with caution