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31.
Ioannis T. Konstantinidis Pedro Mastrodomenico Constantinos T. Sofocleous Karen T. Brown George I. Getrajdman Mithat Gönen Peter J. Allen T. Peter Kingham Ronald P. DeMatteo Yuman Fong William R. Jarnagin Michael I. D’Angelica 《Journal of gastrointestinal surgery》2016,20(4):748-756
Background
Improvements in liver surgery have led to decreased mortality rates. Symptomatic perihepatic collections (SPHCs) requiring percutaneous drainage remain a significant source of morbidity.Study Design
A single institution’s prospectively maintained hepatic resection database was reviewed to identify patients who underwent hepatectomy between January 2004 and February 2012.Results
Data from 2173 hepatectomies performed in 2040 patients were reviewed. Overall, 200 (9 %) patients developed an SPHC, the majority non-bilious (75.5 %) and infected (54 %). Major hepatic resections, larger than median blood loss (≥360 ml), use of surgical drains, and simultaneous performance of a colorectal procedure were associated with an SPHC on multivariate analysis. Non-bilious, non-infected (NBNI) collections were associated with lower white blood cell (WBC) counts, absence of a bilio-enteric anastomosis, use of hepatic arterial infusion pump (HAIP), and presence of metastatic disease, and resolved more frequently with a single interventional radiology (IR) procedure (85 vs 46.5 %, p?<?0.001) more quickly (15 vs 30 days, p?=?0.001).Conclusions
SPHCs developed in 9 % of patients in a modern series of hepatic resections, and in one third were non-bilious and non-infected. In the era of modern interventional radiology, the need for re-operation for SPHC is exceedingly rare. A significant proportion of minimally symptomatic SPHC patients may not require drainage, and strategies to avoid unnecessary drainage are warranted.32.
Ayhan Karak?se Mehmet B. Yüksel ?zgü Aydo?du Bilal Gümü? Yusuf Z. Ate??i Zafer Akan 《Current Urology》2014,7(4):181-184
Objective
To evaluate the potential effect of bisphosphonates on bone mineral density (BMD) in patients who are treated with anti-androgen drugs and radiotherapy for metastatic prostate cancer.Materials and Methods
The data of 31 patients with metastatic prostate cancer who were treated with anti-androgen drugs and radiotherapy during a 1-year period were retrospectively reviewed. Patients were divided in 2 groups, in which 17 patients in group 1 were treated with zoledronic acid (4 mg/month, intravenous) and 14 patients in group 2 who did not receive zoledronic acid. BMD was measured before the treatment and at the end of the 1st year by dual energy X-ray absorptiometry. Statistical analyses were performed with the T test.Results
Mean age of the patients was 71.42 ± 6.7(range 59-85) years. A significant increase was noted for pelvic bone, femoral neck, and lumbar vertebrae t scores when pretreatment and 1st year measurements were compared in group 1 (p < 0.05). In group 2 a significant decrease was noted for pelvic bone and femoral neck t scores at the end of the 1st year (p < 0.05). A significant increase was noted for pelvic bone and femoral neck follow-up in BMD values at the end of the 1st year compared to initial measurements in group 1. A significant decrease was noted for lumbar vertebrae follow-up in BMD values at the end of the 1st year when compared to initial values in group 2.Conclusion
Zoledronic acid significantly increases BMD and delays unfavorable outcomes for bones in men who are treated with anti-androgen drugs and radiotherapy for metastatic prostate cancer.Key Words: Metastatic prostate cancer, Osteoporosis, Radiotherapy, Bisphosphonate therapy 相似文献33.
Lamivudine prophylaxis for prevention of chemotherapy-induced hepatitis B virus reactivation in hepatitis B virus carriers with malignancies 总被引:5,自引:0,他引:5
Idilman R Arat M Soydan E Törüner M Soykan I Akbulut H Arslan O Ozcan M Türkyilmaz AR Bozdayi M Karayalçin S Van Thiel DH Ozden A Beksaç M Akan H 《Journal of viral hepatitis》2004,11(2):141-147
Summary. Although hepatitis B virus (HBV) reactivation in HBV carriers undergoing immunosuppressive therapy is clearly documented, the role of antiviral prophylaxis in such individuals is still controversial. The aim of this study was to determine the efficacy of lamivudine prophylaxis in HBV carriers with haemato/oncological malignancies, who receive chemotherapy. Eighteen HBV carriers with malignancy, who were candidates for chemotherapy, were enrolled. Eight subjects (three with leukaemia, four with lymphoma and one with multiple myeloma) were enrolled for prophylactic lamivudine therapy. The remaining 10 patients (six with leukaemia, three with lymphoma and one with breast cancer) were not treated with lamivudine and were used as a control. Lamivudine was administered beginning on the same day as the chemotherapy and was maintained for a year after chemotherapy was discontinued. No HBV-related mortality was observed in either group. In the lamivudine-treated group, none of the subjects had clinical, biochemical or serological evidence of HBV reactivation during the time they were receiving chemotherapy and after their chemotherapy was discontinued. In contrast, five of the 10 HBV carriers not receiving lamivudine therapy experienced a reactivation of HBV infection. This reactivation of HBV was observed during the chemotherapy in four with one individual experiencing a HBV activation 12 months after chemotherapy was discontinued. No lamivudine-related major adverse effects were observed. Hence prophylactic lamivudine treatment in HBV carriers with haemato/oncological malignancy receiving chemotherapy prevents chemotherapy-induced HBV reactivation. 相似文献
34.
Lauren S. Tufts Emma D. Jarnagin Jessica R. Flynn Mithat Gonen Jose G. Guillem Philip B. Paty Garrett M. Nash Joshua J. Smith Iris H. Wei Emmanouil Pappou Michael I. DAngelica Peter J. Allen T. Peter Kingham Vinod P. Balachandran Jeffrey A. Drebin Julio Garcia-Aguilar William R. Jarnagin Martin R. Weiser 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(2):181-186
Background
Surgical site infections (SSIs) are a major cause of morbidity, mortality, and healthcare costs, and patients undergoing simultaneous colorectal/liver resections are at an especially high SSI risk.Methods
Data were collected on all patients undergoing synchronous colorectal/liver resection from 2011 to 2016 (n = 424). The intervention, implemented in 2013, included 13 multidisciplinary perioperative components. The primary endpoints were superficial/deep and organ space SSIs. Secondary endpoints were hospital length of stay (LOS) and 30-day readmission rate. To control for changes in SSI rates independent of the intervention, interrupted time series analysis was conducted.Results
Overall, superficial/deep, and organ space SSIs decreased by 60.5% (p < 0.001), 80.6% (p < 0.001), and 47.6% (p = 0.008), respectively. In the pre-intervention cohort (n = 231), there were 79 (34.2%), 31 (13.4%), and 48 (20.8%) total, superficial/deep, and organs space SSIs, respectively. In the post-intervention cohort (n = 193), there were 26 (13.5%), 5 (2.6%), and 21 (10.9%) total, superficial/deep, and organs space SSIs, respectively. Median LOS decreased from 9 to 8 days (p < 0.001). Readmission rates did not change (p = 0.6). Interrupted time series analysis found no significant trends in SSI rate within the pre-intervention (p = 0.35) and post-intervention (p = 0.55) periods.Conclusion
In combined colorectal/liver resection patients, implementation of a multidisciplinary care bundle was associated with a 61% reduction in SSIs, with the greatest impact on superficial/deep SSI, and modest reduction in LOS. The absence of trends within each time period indicated that the intervention was likely responsible for SSI reduction. Future efforts should target further reduction in organ space SSI. 相似文献35.
36.
Evaluation of Different Thickness,Die Color,and Resin Cement Shade for Veneers of Multilayered CAD/CAM Blocks 下载免费PDF全文
37.
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39.
Quah HM Chou JF Gonen M Shia J Schrag D Landmann RG Guillem JG Paty PB Temple LK Wong WD Weiser MR 《Diseases of the colon and rectum》2008,51(5):503-507
Purpose Adjuvant therapy for Stage II colon cancer remains controversial but may be considered for patients with high-risk features.
The purpose of this study was to assess the prognostic significance of commonly reported clinicopathologic features of Stage
II colon cancer to identify high-risk patients.
Methods We analyzed a prospectively maintained database of patients with colon cancer who underwent surgical treatment from 1990 to
2001 at a single specialty center. We identified 448 patients with Stage II colon cancer who had been treated by curative
resection alone, without postoperative chemotherapy.
Results With median follow-up of 53 months, 5-year disease-specific survival for this cohort was 91 percent. Univariate and multivariate
analyses identified three independent features that significantly affected disease-specific survival: tumor Stage T4 (hazard
ratio (HR), 2.7; 95 percent confidence interval (CI), 1.1–6.2; P = 0.02), preoperative carcinoembryonic antigen >5 ng/ml (HR, 2.1; 95 percent CI, 1.1–4.1; P = 0.02), and presence of lymphovascular or perineural invasion (HR, 2.1; 95 percent CI, 1–4.4; P = 0.04). Five-year disease-specific survival for patients without any of the above poor prognostic features was 95 percent;
five-year disease-specific survival for patients with one of these poor prognostic features was 85 percent; and five-year
disease-specific survival for patients with ≥2 poor prognostic features was 57 percent.
Conclusions Patients with Stage II colon cancer generally have an excellent prognosis. However, the presence of multiple adverse prognostic
factors identifies a high-risk subgroup. Use of commonly reported clinicopathologic features accurately stratifies Stage II
colon cancer by disease-specific survival. Those identified as high-risk patients can be considered for adjuvant chemotherapy
and/or enrollment in investigational trials.
Read at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, June 2 to 6, 2007.
Reprints are not avaliable. 相似文献
40.
Heiko Sch?der Diane L Carlson Dennis H Kraus Hilda E Stambuk Mithat G?nen Yusuf E Erdi Henry W D Yeung Andrew G Huvos Jatin P Shah Steven M Larson Richard J Wong 《Journal of nuclear medicine》2006,47(5):755-762
(18)F-FDG PET has a high accuracy in staging head and neck cancer, but its role in patients with clinically and radiographically negative necks (N0) is less clear. In particular, the value of combined PET/CT has not been determined in this group of patients. METHODS: In a prospective study, 31 patients with oral cancer and no evidence of lymph node metastases by clinical examination or CT/MRI underwent (18)F-FDG PET/CT before elective neck dissection. PET/CT findings were recorded by neck side (left or right) and lymph node level. PET/CT findings were compared with histopathology of dissected nodes, which was the standard of reference. RESULTS: Elective neck dissections (26 unilateral, 5 bilateral; a total of 36 neck sides), involving 142 nodal levels, were performed. Only 13 of 765 dissected lymph nodes harbored metastases. Histopathology revealed nodal metastases in 9 of 36 neck sides and 9 of 142 nodal levels. PET was TP in 6 nodal levels (6 neck sides), false-negative in 3 levels (3 neck sides), true-negative in 127 levels (23 neck sides), and false-positive in 6 levels (4 neck sides). The 3 false-negative findings occurred in metastases smaller than 3 mm or because of inability to distinguish between primary tumor and adjacent metastasis. TP and false-positive nodes exhibited similar standardized uptakes (4.8 +/- 1.1 vs. 4.2 +/- 1.0; P = not significant). Sensitivity and specificity were 67% and 85% on the basis of neck sides and 67% and 95% on the basis of number of nodal levels, respectively. If a decision regarding the need for neck dissection had been based solely on PET/CT, 3 false-negative necks would have been undertreated, and 4 false-positive necks would have been overtreated. CONCLUSION: (18)F-FDG PET/CT can identify lymph node metastases in a segment of patients with oral cancer and N0 neck. A negative test can exclude metastatic deposits with high specificity. Despite reasonably high overall accuracy, however, the clinical application of PET/CT in the N0 neck may be limited by the combination of limited sensitivity for small metastatic deposits and a relatively high number of false-positive findings. The surgical management of the N0 neck should therefore not be based on PET/CT findings alone. 相似文献