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51.
Arnoldo Piccardo Matteo Puntoni Egesta Lopci Massimo Conte Luca Foppiani Stefania Sorrentino Giovanni Morana Mehrdad Naseri Angelina Cistaro Giampiero Villavecchia Stefano Fanti Alberto Garaventa 《European journal of nuclear medicine and molecular imaging》2014,41(6):1046-1056
Purpose
The aim of this study was to investigate the relationship between 123I-metaiodobenzylguanidine (MIBG) scan semi-quantification and a new 18F-DOPA positron emission tomography (PET)/CT score in patients with suspected or documented neuroblastoma (NB) relapse and to assess the association between these two parameters and progression-free survival (PFS)/overall survival (OS).Methods
We analysed 24 NB patients who had undergone 123I-MIBG and 18F-DOPA PET/CT scans at the time of suspected relapse, after applying a proper scoring system for each scan. In time-to-event analyses, the score distributions were regarded as continuous and were categorized in tertiles and medians. We used Kaplan-Meier curves and Cox proportional hazard models for PFS and OS in order to estimate the independent prognostic impact of 123I-MIBG and 18F-DOPA PET/CT scans.Results
The 123I-MIBG and 18F-DOPA scores were highly and positively correlated (Spearman’s rho?=?0.8, p?<?0.001). Over a median follow-up of 14 months (range 6–82), 12 cases of disease progression and 6 deaths occurred. Multivariate Cox models showed a higher risk of disease progression [hazard ratio (HR) 17.0, 95 % confidence interval (CI) 2.7–109] in NB patients with 123I-MIBG score?>?3 (3rd tertile) and an even higher risk (HR:37.2, 95 % CI 2.4–574) in those with 18F-DOPA whole-body metabolic burden (WBMB) >7.5 (median), after adjustment for all main clinical/pathological factors considered. Kaplan-Meier analyses showed a significant association with OS (log-rank p?=?0.01 and p?=?0.03 for 123I-MIBG and 18F-DOPA WBMB, respectively).Conclusion
Our results confirm the good agreement between 18F-DOPA PET/CT and 123I-MIBG scan in patients affected by NB relapse. In time-to-event analyses, 123I-MIBG scan and 18F-DOPA PET/CT scores were independently and significantly associated with disease progression. 相似文献52.
Endovascular repair for concomitant multilevel aortic disease. 总被引:2,自引:0,他引:2
Patrizio Castelli Roberto Caronno Gabriele Piffaretti Matteo Tozzi Chiara Lomazzi Domenico Laganà Gianpaolo Carrafiello Salvatore Cuffari 《European journal of cardio-thoracic surgery》2005,28(3):478-482
OBJECTIVE: Patients with multilevel aortic disease represent a small subgroup with the need for extensive surgical treatment at considerable risk. We present our experience of endovascular exclusion for simultaneous thoracic and abdominal aortic disease in four patients. METHODS: Between January 2002 and January 2005, four patients underwent endovascular repair for simultaneous thoracic and abdominal aortic disease. Mean age was 69+/-10 years (range, 60-81). Thoracic lesions included penetrating aortic ulcer (n=2, ruptured=1), atherosclerotic aneurysm (n=1), and chronic type B dissection (n=1). Abdominal aortic disease included atherosclerotic infrarenal (n=3) and juxtarenal (n=1) aortic aneurysms. Thoracic aortic stent-grafts had been the following: Excluder/TAG (n=3) or Talent (n=1) straight tube devices. Abdominal aortic stent-grafts used were as following: Excluder (n=3) or Zenith (n=1). All patients were followed-up with CT-angiography and chest X-rays 1, 4, 12 months after the procedure, and once per year thereafter. RESULTS: Stent-graft deployment was technically successful in all cases. Intraoperative mortality was not observed. Mean procedure time was 94+/-34 min (range, 70-145). Early postoperative complications occurred in one patient that developed acute renal failure but dialysis was not required. Mean hospitalisation was 8+/-5 days (range, 4-15). Late death occurred in one patient for an undetected ruptured thoracic type 1 endoleak. All three survivors are currently well 16.5 months (range, 3-36) after surgery. No neurological complications developed. CONCLUSION: Simultaneous abdominal and thoracic endovascular repair for multilevel aortic disease is feasible and could be a viable alternative in high-risk patients, who otherwise may not be suitable candidates for conventional repair. 相似文献
53.
Uberto Fumagalli Riccardo Rosati Stefano De Pascale Matteo Porta Elisa Carlani Alessandra Pestalozza Alessandro Repici 《Journal of gastrointestinal surgery》2016,20(3):494-499
Aim
Surgical myotomy of the lower esophageal sphincter has a 5-year success rate of approximately 91 %. Peroral endoscopic myotomy can provide similar results for controlling dysphagia. Some patients experience either persistent or recurrent dysphagia after myotomy. We present here a retrospective analysis of our experience with redo myotomy for recurrent dysphagia in patients with achalasia.Methods
From March 1996 to February 2015, 234 myotomies for primary or recurrent achalasia were performed in our center. Fifteen patients (6.4 %) had had a previous myotomy and were undergoing surgical redo myotomy (n?=?9) or endoscopic redo myotomy (n?=?6) for recurrent symptoms.Results
Patients presented at a median of 10.4 months after previous myotomy. Median preoperative Eckardt score was 6. Among the nine patients undergoing surgical myotomy, three esophageal perforations occurred intraoperatively (all repaired immediately). Surgery lasted 111 and 62 min on average (median) in the surgical and peroral endoscopic myotomy (POEM) groups, respectively. No postoperative complications occurred in either group. Median postoperative stay was 3 and 2.5 days in the surgical and POEM groups, respectively. In the surgical group, Eckardt score was <3 for seven out of nine patients after a mean follow-up of 19 months; it was <3 for all six patients in the POEM group after a mean follow-up of 5 months.Conclusions
A redo myotomy should be considered in patients who underwent myotomy for achalasia and presenting with recurrent dysphagia. Preliminary results using POEM indicate that the technique can be safely used in patients who have undergone previous surgical myotomy.54.
Effect of Balloon‐Expandable Transcatheter Aortic Valve Replacement Positioning: A Patient‐Specific Numerical Model 下载免费PDF全文
Matteo Bianchi Gil Marom Ram P. Ghosh Harold A. Fernandez James R. Taylor Jr. Marvin J. Slepian Danny Bluestein 《Artificial organs》2016,40(12):E292-E304
Transcatheter aortic valve replacement (TAVR) has emerged as a life‐saving and effective alternative to surgical valve replacement in high‐risk, elderly patients with severe calcific aortic stenosis. Despite its early promise, certain limitations and adverse events, such as suboptimal placement and valve migration, have been reported. In the present study, it was aimed to evaluate the effect of various TAVR deployment locations on the procedural outcome by assessing the risk for valve migration. The deployment of a balloon‐expandable Edwards SAPIEN valve was simulated via finite element analysis in a patient‐specific calcified aortic root, which was reconstructed from CT scans of a retrospective case of valve migration. The deployment location was parametrized in three configurations and the anchorage was quantitatively assessed based on the contact between the stent and the native valve during the deployment and recoil phases. The proximal deployment led to lower contact area between the native leaflets and the stent which poses higher risk for valve migration. The distal and midway positions resulted in comparable outcomes, with the former providing a slightly better anchorage. The approach presented might be used as a predictive tool for procedural planning in order to prevent prosthesis migration and achieve better clinical outcomes. 相似文献
55.
56.
Percutaneous implantation of a catheter with subcutaneous reservoir for intraarterial regional chemotherapy: Technique and preliminary results 总被引:5,自引:0,他引:5
Grosso M Zanon C Mancini A Garruso M Gazzera C Anselmetti GC Veglia S Gandini G 《Cardiovascular and interventional radiology》2000,23(3):202-210
Purpose: We present the technique and the preliminary results of percutaneous implantation of intraarterial catheters connected to
a subcutaneous infusion reservoir for prolonged regional chemotherapy of hepatic and extrahepatic tumors.
Methods: Two hundred patients with primary or secondary hepatic neoplasms, pelvic, pancreatic, renal, lingual, and breast cancer underwent
the procedure. The access was the left axillary artery (188 patients) and the femoral artery (12 patients). The catheter tip
was placed in the hepatic (170 patients), hypogastric (18), splenic (4), internal thoracic (2), gastroduodenal (3), renal
(2) or the external carotid artery (1). The catheter was connected to a subcutaneous reservoir and filled with heparin; chemotherapeutic
infusion was subsequently started.
Results: One hundred percent immediate technical success was obtained. Forty-three of 200 (21.5%) patients had a complication: 29
patients had a catheter dislodgment, nine had arterial thrombosis, three had a pseudoaneurysm of the left axillary artery
and two had a port pocket hematoma. Most complications (37/43, 86%) were treated percutaneously without interruption of chemotherapy.
In only six cases (3% of the total population) was chemotherapy discontinued due to the complication itself. The mean duration
of catheter patency was 7.2 months.
Conclusion: Percutaneous placement of an intraarterial catheter is feasible and causes less discomfort to the patient than the surgical
approach. The technique has an acceptable complication rate (21.5%), similar to that for surgical implantation (17.8%), with
the advantage that in most cases the complications can be resolved percutaneously. This technique represents an alternative
to surgical implantation in the treatment of liver metastases from colorectal cancer and opens new therapeutic possibilities
for the local prolonged treatment of other kinds of tumor, though its clinical efficacy must be assessed in selected trials. 相似文献
57.
Daniele Focosi Matteo Pelosini Piero Palla Sara Galimberti Francesco Caracciolo Edoardo Benedetti Federico Papineschi Mario Petrini 《Transplant immunology》2009,21(4):240-243
We report here a 50-years old female with multiple myeloma-associated chronic renal failure who underwent high-dose chemotherapy supported by autologous hematopoietic stem cell transplantation. She developed progressive encephalopathy on day 5 progressing to coma despite hemodialysis and no obvious organ failure. She finally recovered after a single 1-liter plasma exchange. The final diagnosis was metabolic encephalopathy due to hypercytokinemia, particularly high serum TNF levels. We discuss here the pathogenesis and raise an alert for monitoring cytokine levels in patients with renal failure undergoing high-dose chemotherapy. 相似文献
58.
Alessandro Cucchetti MD Fabio Piscaglia MD Eugenio Caturelli MD Luisa Benvegnù MD Marco Vivarelli MD Giorgio Ercolani MD Matteo Cescon MD Matteo Ravaioli MD Gian Luca Grazi MD Luigi Bolondi MD Antonio Daniele Pinna MD 《Annals of surgical oncology》2009,16(2):413-422
The presence of cirrhosis is the only risk factor that is advocated for recurrence of hepatocellular carcinoma (HCC) 2 years
after hepatic resection compared with noncirrhotic control subjects; however, data for cohorts of exclusively patients with
cirrhosis are lacking. This study was designed to assess risk factors and annual incidence of early (<2 years) and late (>2 years)
recurrence after resection of cirrhosis and to compare these findings with those of patients with cirrhosis enrolled in HCC
surveillance programs (HCC occurrence). Data from 204 patients with cirrhosis resected for HCC and 150 surveilled for cirrhosis
were retrospectively collected and compared using propensity score matching to overcome biases of nonrandomized study. Risk
factors for early recurrence (incidence = 21.8%/year) were higher serum alpha-fetoprotein (AFP) levels, poorly differentiated
tumor, and presence of microvascular invasion (P < 0.05). Risk factors for both late recurrence (18.4%/year) and HCC occurrence (3.3%/year) were male gender, older age, and
higher serum transaminase levels; multiple primary tumors and higher AFP were additional risk factors for late recurrence
and HCC occurrence respectively (P < 0.05). After propensity adjustment, resected patients with less than two risk factors for late recurrence showed an annual
incidence of HCC (6.2%/year) similar to that of surveilled patients with ≥2 risk factors (5.8%/year; P = 0.898). Early and late recurrence of HCC for patients with cirrhosis after resection have distinct risk factors. Annual
incidence of HCC 2 years or more after resection may be similar to that of general patients because the same risk factors
are involved; assessment of these characteristics could be useful in tailoring clinical management. 相似文献
59.
"Radical but conservative" is the main goal for ultrasonography-guided liver resection: prospective validation of this approach 总被引:3,自引:0,他引:3
Torzilli G Montorsi M Donadon M Palmisano A Del Fabbro D Gambetti A Olivari N Makuuchi M 《Journal of the American College of Surgeons》2005,201(4):517-528
BACKGROUND: Despite higher blood loss, morbidity, and mortality, rate of major resection is still high in most surgical institutions because of fear of incomplete tumor removal. To verify whether intraoperative ultrasonography (IOUS) minimizes the rate of major hepatectomies while maintaining treatment radicality, we have prospectively validated our policy, based on extensive use of IOUS resection guidance. STUDY DESIGN: Ninety-three consecutive patients with liver tumors were prospectively enrolled. There were 61 men and 32 women with a mean age of 65.6 years. Fifty-nine patients had hepatocellular carcinoma and 34 had colorectal cancer liver metastases. Surgical strategy was based on the relationship between the tumor and intrahepatic vascular structures at IOUS. Rates of major and minor resection, mortality, morbidity, and rate of local recurrences were evaluated. RESULTS: There was no hospital mortality; major morbidity occurred in 2.2% of patients and minor complications in 17%. Six (6.5%) patients required blood transfusion. Major resections (two or more segments) were accomplished in 14 patients (15%), and 5 (5.4%) patients had more than three segments removed. Major vascular invasion was present in 16 patients (17%), and contact without infiltration with major vessels was present in another 16; part of the wall of the inferior vena cava was resected in 1 patient. Surgical clearance was achieved in all patients without local recurrence at a mean followup of 18 months (median 13, range 6 to 52 months). CONCLUSIONS: This study shows that liver operations performed under IOUS guidance are safe and radical and reduce need for major hepatectomies. 相似文献
60.
Roberto Santambrogio MD Enrico Opocher MD Massimo Zuin MD Carlo Selmi MD PhD Emanuela Bertolini MD Mara Costa MD Matteo Conti MD Marco Montorsi MD 《Annals of surgical oncology》2009,16(12):3289-3298