scholarly journals Small-Diameter PTFE Portosystemic Shunts: Portocaval vs Mesocaval

HPB Surgery ◽  
1998 ◽  
Vol 10 (6) ◽  
pp. 413-414 ◽  
Author(s):  
Robert Shields
Keyword(s):  
Liver Volume ◽  
Small Diameter ◽  
Actuarial Survival ◽  
Shunt Thrombosis ◽  
Portosystemic Shunts ◽  
Portal Decompression ◽  
Actuarial Survival Rate ◽  
Second Year ◽  
Low Incidence

Fifty-seven patients with failed sclerotherapy received a mesocaval interposition shunt with an externally supported, ringed polytetrafluoroethylene prosthesis of either 10 or 12 mm diameter. Thirty-one patients had Child-Pugh gradeA disease and 26 grade B; all had a liver volume of 1000– 2500 ml. Follow-up ranged from 16 months to 6 years 3 months. Three patients (5 per cent) died in the postoperative period. There were two postoperative recurrences of variceal haemorrhage and one recurrent bleed in the second year after surgery. The cumulative shunt patency rate was 95 per cent and the incidence of encephalopathy 9 per cent; the latter was successfully managed by protein restriction and/or lactulose therapy. The actuarial survival rate for the whole group at 6 years was 78 per cent, for those with Child-Pugh grade A 88 per cent and for grade B 67 per cent. Small-lumen mesocaval interposition shunting achieves portal decompression, preserves hepatopetal flow, has a low incidence of shunt thrombosis, prevents recurrent variceal bleeding and is not associated with significant postoperative encephalopathy.

scholarly journals Photodynamic Therapy of Malignant Brain Tumours

1990 ◽  
Vol 17 (2) ◽  
pp. 193-198 ◽  
Author(s):  
Paul J. Muller ◽  
Brian C. Wilson
Keyword(s):  
Photodynamic Therapy ◽  
Median Survival ◽  
Brain Tumours ◽  
Complete Response ◽  
Tumour Resection ◽  
Malignant Tumours ◽  
Actuarial Survival ◽  
Malignant Brain Tumours ◽  
Actuarial Survival Rate

ABSTRACT:Fifty patients with malignant supratentorial tumours were treated with intra-operative photodynamic therapy (PDT); in 33 cases the tumour was recurrent. In 45 patients the tumour was a cerebral glioma and in 5 cases a solitary cerebral metastasis. All patients received a porphyrin photosensitizer 18-24 hours pre-operatively. Photoillumination was carried out at 630 nm to a tumour cavity created by radical tumour resection and/or tumour cyst drainage. The light energy density ranged from 8 to 175 J/cm2. In 8 patients additional interstitial light was administered. The operative mortality was 4%. Follow up has ranged from 1 to 30 months. The median survival for the 45 primary malignant tumours was 8.6 months with a 1 and 2 year actuarial survival rate of 32% and 18%, respectively. In 12 patients a complete or near complete CT scan response was identified post PDT. These patients tended to have a tumour geometry (eg. cystic) that allowed complete or near complete light distribution to the tumour. The median survival for this group was 17.1 months with a 1 and 2 year actuarial survival of 62% and 38%, respectively. In the 33 cases who did not have a complete response the median survival was 6.5 months with a 1 and 2 year actuarial survival of 22% and 11%, respectively. Photodynamic therapy of malignant brain tumours can be carried out with acceptable risk. Good responses appear to be related to adequate light delivery to the tumour.

Conservative Treatment for T2-T4 Bladder Cancer with Primary Chemotherapy and Radiotherapy: A Pilot Study

1993 ◽  
Vol 79 (1) ◽  
pp. 53-57 ◽  
Author(s):  
Giorgio Cruciani ◽  
Claudio Dazzi ◽  
Francesco Montanari ◽  
Salvatore Voce ◽  
Vincenzo Salerno ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Conservative Treatment ◽  
Transitional Cell ◽  
Distant Metastases ◽  
Phase Iii ◽  
Severe Toxicity ◽  
Pelvic Radiotherapy ◽  
Actuarial Survival ◽  
Actuarial Survival Rate

Aims and Background After radical cystectomy, with or without pelvic radiotherapy, more than 50 % of patients affected by infiltrating bladder cancer died of distant metastases. Polychemotherapy yields 25 % complete remissions (CR) in patients with invasive transitional cell bladder carcinoma; although many concerns exist about the duration of such CR. This study was undertaken with the aim of evaluating the efficacy and safety of an integrated chemo-radio-therapeutic treatment, in order to broaden indications to a conservative surgical therapy. Methods Thirty-three consecutive patients with bladder urothelial cancer T2-T4, N0, M0, have been treated. Patients received neoadjuvant chemotherapy (rescue-M-VEC) consisted of methotrexate 30 mg/sqm plus folinic acid 15 mg after 24 h on days 1, 15, 22; vinblastine 3 mg/sqm on days 1, 15 and 22; epidoxorubicin 30 mg/sqm on day 1; cisplatin 70 mg/sqm on day 1. This cycle was repeated on day 29. After 2 cycles of rescue-M-VEC, patients underwent pelvic cobalt teletherapy 40 Gy combined with low dose cisplatin 25 mg/sqm/week. After restaging, responding patients underwent further radiation therapy (24 Gy) as booster consolidation. Results After 2 cycles of chemotherapy and pelvic radiotherapy 14/31 evaluable patients (45.2 %) achieved CR and 11/31 (35.4 %) partial remission, with an overall response rate of 80.6 % (25/31). With a median follow up of 21 months the actuarial survival rate at 24 months was equal to 79.8 %. Eleven radical cystectomies were performed, 6 of which at restaging in non responding patients and 5 during the follow up due to relapse. Of the 25 patients selected for bladder conservation, 12 (48 %) have not yet shown relapses. Three out of 31 (9.7 %) patients died of distant metastases. No severe toxicity has been observed: moreover no patient developed stomatitis after chemotherapy. Conclusions Our results seem encouraging but longer follow-up and further phase III studies need to be carried out to demonstrate the feasibility of conservative treatment in muscle infiltrating bladder cancer.

Detection of relapse in early-stage Hodgkin's disease: role of routine follow-up studies.

1997 ◽  
Vol 15 (3) ◽  
pp. 1123-1130 ◽  
Author(s):  
M J Torrey ◽  
J C Poen ◽  
R T Hoppe
Keyword(s):  
Salvage Therapy ◽  
Hodgkin's Disease ◽  
Early Stage ◽  
Hodgkin’S Disease ◽  
Actuarial Survival ◽  
X Ray ◽  
Actuarial Survival Rate ◽  
Chest X Ray ◽  
The Impact

PURPOSE To examine the costs and benefits of routine follow-up evaluation in patients treated with radiation therapy for early-stage Hodgkin's disease. PATIENTS AND METHODS We retrospectively examined patterns of follow-up evaluation and methods of relapse detection among 709 patients with stage I and II Hodgkin's disease treated with primary radiotherapy between 1969 and 1994. We determined the probability of relapse detection for seven routine follow-up procedures, compared their relative costs, and determined the impact of each procedure on the likelihood of survival following salvage therapy. RESULTS Relapse has occurred in 157 patients (22%) at a median 1.9 years (range, 0 to 13 years) posttreatment. Relapse was suspected primarily by history (Hx) in 55% of patients, physical examination (PE) in 14%, chest x-ray (CXR) in 23%, and abdominal x-ray (KUB) in 7%. Only one relapse (1%) was identified by a routine laboratory study. The rate of relapse detection was highest for a combination of Hx and PE (78 of 10,000 examinations) followed by CXR (26 of 10,000 examinations). The projected charges (1995 dollars) per relapse detected by routine follow-up Hx and PE were $11,000 compared with $68,000 for CXR and $142,000 for KUB. The 10-year actuarial survival rate following salvage therapy was 65% overall, 65% for patients in whom relapse was detected by Hx or PE, and 69% for patients in whom relapse was detected by radiographs (P = not significant). CONCLUSION The majority of relapses occurred within 5 years of treatment and were identified by Hx and PE. CXR was useful during the first 3 years of follow-up evaluation. KUB, CBC, and laboratory studies accounted for nearly half of all follow-up charges and rarely led to the detection of relapse. Their routine use as a method of relapse detection is questionable. In general, the method of relapse detection did not have a significant impact on the likelihood of successful salvage therapy.

Cisplatin and 5-Fluorouracil in Advanced and Recurrent Cervical Cancer

1988 ◽  
Vol 74 (4) ◽  
pp. 471-474 ◽  
Author(s):  
Silvana Chiara ◽  
Rita Consoli ◽  
Alfredo Falcone ◽  
Milena Bruzzone ◽  
Giovanni Foglia ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Tumor Regression ◽  
Objective Response ◽  
Outpatient Basis ◽  
Actuarial Survival ◽  
Recurrent Cervical Cancer ◽  
Actuarial Survival Rate ◽  
Duration Of Response ◽  
Previously Treated

Nineteen consecutive patients with advanced or recurrent cervical cancer were treated with cisplatin 20 mg/m1 plus 5-fluorouracil 200 mg/m2 on days 1–5 every 3 weeks. Toxicity was acceptable and manageable, with most patients treated on an outpatient basis. The most important side effect was dose-cumulative neurotoxicity. In 18 evaluable patients a 61 % objective response rate (1 complete and 10 partial) was achieved. In recurrent disease the regimen was effective both in irradiated lesions and in non-irradiated ones. Two out of five patients not previously treated with radiotherapy and/or chemotherapy responded to the treatment but tumor regression was insufficient for the disease to be controlled radically by subsequent surgery or radiotherapy. The median duration of response was 11 months (3–23) and the actuarial survival rate after 36 months follow-up was 43.3 %.

scholarly journals Small-head metal on metal total hip arthroplasty is associated with a high rate of complication and reoperation at mid-term follow-up

2021 ◽  
Vol 9 ◽  
pp. 205031212110147
Author(s):  
Nobuhiko Sumiyoshi ◽  
Kazuhiro Oinuma ◽  
Yoko Miura
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Adverse Reactions ◽  
Small Diameter ◽  
High Rate ◽  
Metal Debris ◽  
Total Hip ◽  
Metal On Metal ◽  
Small Head

Background: Adverse reactions to metal debris are significant complications after metal-on-metal total hip arthroplasty. Recently, late appearances of adverse reactions to metal debris and subsequent need for reoperations have been reported with small-diameter head metal-on-metal devices. We retrospectively investigated mid-term clinical outcomes of small-head metal-on-metal total hip arthroplasty. Methods: We reviewed 159 hips in 139 patients who had a small-head metal-on-metal total hip arthroplasty (M2a Taper; Biomet, Warsaw, IN) with a minimum 5-year follow-up and documented postoperative complications. Results: Focal osteolysis in either the femur or acetabulum was observed in 12 hips (7.5%, 44 months after surgery on average), with pseudotumor observed in 8 hips (5%, 120 months after surgery on average). Four hips (2.5%) had dislocations (84 months after surgery on average) and six hips (3.8%, 122 months after surgery on average) underwent reoperation. Conclusion: Small-head metal-on-metal total hip arthroplasty is associated with a high degree of complications at mid-term follow-up period. Considering this, we discourage the use of metal-on-metal total hip arthroplasty regardless of head size.

Experience With Unfavorable Iliac Access When Performing Fenestrated/Branched Endovascular Aneurysm Repair

2021 ◽  
pp. 152660282199112
Author(s):  
Adrien Hertault ◽  
Aurélia Bianchini ◽  
Guillaume Daniel ◽  
Teresa Martin-Gonzalez ◽  
Birgit Sweet ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Endovascular Repair ◽  
Clinical Success ◽  
Multiorgan Failure ◽  
Endovascular Aneurysm Repair ◽  
Small Diameter ◽  
Early Postoperative Period ◽  
Single Center Experience ◽  
Aneurysm Repair

Purpose: To review a single-center experience with fenestrated and branched endovascular aneurysm repair (f/bEVAR) in patients with challenging iliac anatomies. Materials and Methods: A retrospective review of the department’s database identified 398 consecutive patients who underwent complex endovascular repair f/bEVAR between January 2010 and June 2018; of these, 67 had challenging accesses. The strategies implemented to overcome access issues were reviewed, using a dedicated scoring system to evaluate the access (integrating diameter, tortuosity, calcification, and previous open or endovascular repair). Results: In this subgroup of patients, the most common graft design was a 4-vessel fenestrated endograft (27, 40.3%). Hostile access was due to small diameter (<7 mm) in 25 patients (37.3%) and/or concentric calcifications in 19 patients (26.9%). Mean iliac diameter was 5.5±2.6 mm on the right side and 6.0±2.5 mm on the left side. Previous open or endovascular aortoiliac repair had been performed in 15 patients (22.4%), and 20 patients (29.9%) had a stent previously implanted in at least 1 iliac artery, resulting in the inability to perform standard fenestrated repair with access from both sides. Five patients (7.5%) had a single patent iliac access. Eight distinctive strategies were identified to overcome these access issues, including the use of preloaded renal catheters in the endograft delivery system, angioplasty, graft modification (branches instead of fenestrations or 4 preloaded fenestrations), a conduit via a retroperitoneal approach, iliac artery recanalization, and/or the multiple puncture technique. Technical success was achieved in 62 cases (92.5%). Four patients had access complications and 1 died in the early postoperative period of multiorgan failure. Median follow-up was 24.6 months (IQR 7.2, 41.3). Clinical success at the end of follow-up was achieved in 57 patients (85.1%). During follow-up, 14 patients died, including 4 from an aorta-related cause. Conclusion: Dedicated strategies can be implemented to overcome hostile iliac access in patients with complex aneurysms when f/bEVAR is required. Typically, these maneuvers are associated with favorable outcomes.

Surgical resection of locally recurrent cervical cancer: a single institutional 70 patient series

2004 ◽  
Vol 14 (5) ◽  
pp. 846-851 ◽  
Author(s):  
V. Moutardier ◽  
G. Houvenaeghel ◽  
M. Martino ◽  
B. Lelong ◽  
V. J. Bardou ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Local Control ◽  
Cancer Recurrence ◽  
Palliative Surgery ◽  
Morbidity Rate ◽  
Actuarial Survival ◽  
Recurrent Cervical Cancer ◽  
Actuarial Survival Rate ◽  
Life Threatening ◽  
Threatening Situation

Pelvic recurrence of cervical cancer is a life-threatening situation and only local control can provide hope for remission. The aim of this study was to evaluate the role of surgery in the treatment of cervical cancer recurrence. This retrospective study analyzed a series of 70 patients who underwent resection of cervix locoregional recurrence. Thirteen patients had palliative salvage surgery for pelvic complications. Twenty-nine resections were considered as curative. Fifty recurrences required pelvic exenterations. The hospital mortality rate was 9% and the morbidity rate was 44%. Overall 5-year actuarial survival rate was 23%. Survival was significantly higher: (a) after curative resection and (b) after centropelvic recurrence resection. Local control was obtained in 48% of the cases and 13 patients are alive with a median follow-up of 75 months. In conclusion, the results of this small and heterogen series seem to justify an attempt to resection for centropelvic recurrences whenever possible. Palliative surgery should be reserved to salvage therapy and highly selected patients.

Combination Chemotherapy with Cyclophosphamide, Adriamycin, Vincristine and Prednisone (CHOP) for Non-Hodgkin's Lymphomas with Unfavorable Histology: Preliminary Results

1980 ◽  
Vol 66 (6) ◽  
pp. 749-756 ◽  
Author(s):  
Pasquale Cornelia ◽  
Giuseppe Abate ◽  
Giuseppe Cornelia ◽  
Giovanni S. Bruni ◽  
Donato Zarrilli ◽  
...  
Keyword(s):  
Complete Remission ◽  
Combination Chemotherapy ◽  
Remission Rate ◽  
Early Stage ◽  
Stage I ◽  
Bone Marrow Toxicity ◽  
Actuarial Survival ◽  
Actuarial Survival Rate ◽  
Moderate Nausea ◽  
Hodgkin's Lymphomas

From January 1978 to June 1979, 29 selected, previously untreated patients with unfavorable histology of non-Hodgkin's lymphomas (12 DPDL, 7 DM, 9 DH and 1 DU) were submitted to the combination chemotherapy CHOP (cyclophosphamide, 750 mg/m2 i.v. on day 1; adriamycin, 50 mg/m2 i.v. on day 1; vincristine, 1.4 mg/m2 i.v. on day 1, and prednisone, 100 mg p.o. on day 1 through 5) every 21 days. Eighteen patients were in early stage (I or II) and 11 of them were also submitted to involved field radiotherapy (60Co), immediately before (stage I) or during (stage II) the chemotherapy, with a mean dosage of 4,500 rad. The remaining 11 patients were in advanced stage (III or IV) of disease and were treated with chemotherapy alone. We obtained 20 complete remissions (68%), 8 partial remissions (28 %) and 1 no response (4 %) to therapy. Sixteen of 18 patients (89 %) in early stages and 4 of 11 patients (36 %) in advanced stages achieved a complete remission. The bone marrow toxicity of the chemotherapy was moderate. Nausea, vomiting and diarrhea were frequent but well controlled by the support therapy. The actuarial survival rate of patients, after 18 months of follow-up, is 41 % (40 % in complete remission). The patients who achieved a complete remission are all alive and 65 % of them still relapse free. We believe that the combination chemotherapy CHOP improves the complete remission rate as well as the survival of patients with unfavorable histology of non-Hodgkin's lymphomas.

Healing of Carotid Stents: A Prospective Duplex Ultrasound Study

2003 ◽  
Vol 10 (3) ◽  
pp. 636-642 ◽  
Author(s):  
Andrea Willfort-Ehringer ◽  
Ramazanali Ahmadi ◽  
Michael E. Gschwandtner ◽  
Angelika Haumer ◽  
Gottfried Heinz ◽  
...  
Keyword(s):  
Carotid Arteries ◽  
Duplex Ultrasound ◽  
Stable Phase ◽  
Carotid Stent ◽  
Time Intervals ◽  
Unstable Phase ◽  
Ultrasound Study ◽  
Maximal Thickness ◽  
Second Year

Purpose: To study the dynamics of carotid stent healing over a 2-year period using duplex ultrasound imaging. Methods: One hundred twelve patients with 121 successfully stented carotid arteries were examined with color-coded duplex ultrasound the day after the stent procedure and at 1, 3, 6, 12, and 24 months in follow-up. The maximal thickness and echogenicity of the layer between the stent and the perfused lumen (SPL) were evaluated. Echogenicity was classified as echogenic if the SPL layer was clearly detected in B mode and echolucent if the SPL layer was barely visible in B mode, its border defined by assistance of color-coded flow. Results: At day 1, an echolucent SPL layer with a median thickness of 0.7 mm was interpreted as a thrombotic layer, which decreased at 1 month to practically zero (i.e., not detectable). In follow-up, increases in thickness (mainly up to 6 months) and echogenicity (up to 12 months) of the SPL layer were interpreted as neointimal ingrowth. At 3, 6, and 12 months, the median maximal thickness of the SPL layer was 0.5 mm, 0.9 mm, and 1.0 mm, respectively, whereas the percentage of patients with an echogenic SPL layer was 27% (32/119), 56% (66/117), and 95% (105/110), respectively, at the same time intervals. No further change was observed at the 24-month examination. Conclusions: Three phases of carotid stent incorporation are defined: (1) an early unstable period soon after stent placement with an echolucent (thrombotic) SPL layer, (2) a moderately unstable phase with ingrowing neointima (1–12 months), and (3) a stable phase from the second year on. These data may indicate the need for different intensities of therapy and surveillance intervals.

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