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81.
Surgical treatment strategies and outcome in patients with breast cancer metastatic to the spine: a review of 87 patients 总被引:3,自引:0,他引:3
Joseph A. Shehadi Daniel M. Sciubba Ian Suk Dima Suki Marcos V. C. Maldaun Ian E. McCutcheon Remi Nader Richard Theriault Laurence D. Rhines Ziya L. Gokaslan 《European spine journal》2007,16(8):1179-1192
Aggressive surgical management of spinal metastatic disease can provide improvement of neurological function and significant
pain relief. However, there is limited literature analyzing such management as is pertains to individual histopathology of
the primary tumor, which may be linked to overall prognosis for the patient. In this study, clinical outcomes were reviewed
for patients undergoing spinal surgery for metastatic breast cancer. Respective review was done to identify all patients with
breast cancer over an eight-year period at a major cancer center and then to select those with symptomatic spinal metastatic
disease who underwent spinal surgery. Pre- and postoperative pain levels (visual analog scale [VAS]), analgesic medication
usage, and modifed Frankel grade scores were compared on all patients who underwent surgery. Univariate and multivariate analyses
were used to assess risks for complications. A total of 16,977 patients were diagnosed with breast cancer, and 479 patients
(2.8%) were diagnosed with spinal metastases from breast cancer. Of these patients, 87 patients (18%) underwent 125 spinal
surgeries. Of the 76 patients (87%) who were ambulatory preoperatively, the majority (98%) were still ambulatory. Of the 11
patients (13%) who were nonambulatory preoperatively, four patients were alive at 3 months postoperatively, three of which
(75%) regained ambulation. The preoperative median VAS of six was significantly reduced to a median score of two at the time
of discharge and at 3, 6, and 12 months postoperatively (P < 0.001 for all time points). A total of 39% of patients experienced complications; 87% were early (within 30 days of surgery),
and 13% were late. Early major surgical complications were significantly greater when five or more levels were instrumented.
In patients with spinal metastases specifically from breast cancer, aggressive surgical management provides significant pain
relief and preservation or improvement of neurological function with an acceptably low rate of complications. 相似文献
82.
Jessica N. McAlpine MD Derek S. Chiu MSc Remi A. Nout MD David N. Church MD Pascal Schmidt BSc Stephanie Lam BSc Samuel Leung MSc Stefania Bellone PhD Adele Wong MD Sara Y. Brucker MD Cheng Han Lee MD Blaise A. Clarke MD David G. Huntsman MD Marcus Q. Bernardini MD Joanne Ngeow MD Alessandro D. Santin MD Paul Goodfellow PhD Douglas A. Levine MD Martin Köbel MD Stefan Kommoss MD Tjalling Bosse MD C. Blake Gilks MD Aline Talhouk PhD 《Cancer》2021,127(14):2409-2422
83.
Thomas Neri Pierre Dalcol Fabien Palpacuer Florian Bergandi Jean Michel Prades Frederic Farizon Remi Philippot Michel Peoch 《The Knee》2018,25(3):360-366
Background
The aim was to determine whether the anterolateral ligament (ALL) had a histological structure that defined it as a real ligament.Methods
Histological examination of 30 ALL samples taken from fresh-frozen knees were performed. The ALL femoral insertion and its relationship with the lateral collateral ligament (LCL) were studied and the tibial insertion and its relationship with articular cartilage of the tibial joint surface were analyzed. For the ligamentous part, its histological structure and its differences with the articular capsule were studied.Results
This connective tissue is composed of a dense fibrous core constituted by a network of oriented collagenous fibers. The periphery of this dense connective center is made up of loose fibrocollagenous tissue with vascular structures and focal deposits of adipose tissue. This part was in contact but different to the joint capsule.With a perpendicular orientation of the collagen fibers relative to the bone, a fibrocartilaginous zone with an unmineralized hyalinized aspect, a mineralization front, its bone insertions presented a typical ligamentous insertion.With a cleavage plane between ALL and LCL femoral insertion, the ALL appeared to have a femoral insertion distinct from the LCL. ALL tibial insertion was less characteristic with less organized connective tissue and was at a distance from the articular cartilage.Conclusion
From its bony insertion to its tissue composition and organization, the ALL has all the histological characteristics of a ligamentous structure. Our study confirms that ALL can be considered a real and distinct ligament. 相似文献84.
Edmée C. M. Sikkens Djuna L. Cahen Casper van Eijck Ernst J. Kuipers Marco J. Bruno 《Journal of gastrointestinal surgery》2012,16(8):1487-1492
Introduction
After pancreatic surgery, up to 80?% of patients will develop exocrine insufficiency. For enzyme supplementation to be effective, prescribing an adequate dose of pancreatic enzymes is mandatory but challenging because the required dose varies. Data on the practice of enzyme replacement therapy after surgery are lacking, and therefore, we conducted this analysis.Methods
An anonymous survey was distributed to members of the Dutch and German patient associations for pancreatic disorders. The target population consisted of patients with chronic pancreatitis or pancreatic cancer who had undergone pancreatic surgery and were using enzymes to treat exocrine insufficiency. Results were compared to a similar group of non-operated patients.Results
Ninety-one cases were analyzed (84?% underwent a resection procedure). The median daily enzyme dose was 6, and 25?% took three or less capsules. Despite treatment, 68?% of patients reported steatorrhea-related symptoms, 48?% adhered to a non-indicated dietary fat restriction, and only 33?% had visited a dietician. The outcome was equally poor for the 91 non-operated patients.Conclusion
Most patients suffering from exocrine insufficiency after pancreatic surgery are undertreated. To improve efficacy, physicians should be more focused on treating exocrine insufficiency and educate patients to adjust the dose according to symptoms and their diet. 相似文献85.
86.
Jérome Larche Steve Lancel Sidi Mohamed Hassoun Raphael Favory Brigitte Decoster Philippe Marchetti Claude Chopin Remi Neviere 《Journal of the American College of Cardiology》2006,48(2):377-385
OBJECTIVES: The purpose of this study was to test whether mitochondrial dysfunction is causative of sepsis sequelae, a mouse model of peritonitis sepsis induced by cecal ligation and perforation. Inhibition of mitochondrial permeability transition was achieved by means of pharmacological drugs and overexpression of the antiapoptotic protein B-cell leukemia (Bcl)-2. BACKGROUND: Sepsis is the leading cause of death in critically ill patients and the predominant cause of multiple organ failure. Although precise mechanisms by which sepsis leads to multiple organ dysfunction are unknown, growing evidence suggests that perturbations of key mitochondrial functions, including adenosine triphosphate production, Ca2+ homeostasis, oxygen-derived free radical production, and permeability transition, might be involved in sepsis pathophysiology. METHODS: Heart and lung functions were evaluated respectively by means of isolated heart preparation, bronchoalveolar lavage fluid protein concentration, lung wet/dry weight ratio, lung homogenate myeloperoxidase activity, and histopathologic grading. Respiratory fluxes, calcium uptake, and membrane potential were evaluated in isolated heart mitochondria. RESULTS: Peritonitis sepsis induced multiple organ dysfunction, mitochondrial abnormalities, and increased mortality rate, which were reduced by pharmacological inhibition of mitochondrial transition by cyclosporine derivatives and mitochondrial Bcl-2 overexpression. CONCLUSIONS: Our study provides strong evidence that mitochondrial permeability transition plays a critical role in septic organ dysfunction. These studies demonstrate that mitochondrial dysfunction in sepsis is causative rather than epiphenomenal and relevant in terms of vital organ function and outcome. Regarding the critical role of heart failure in the pathophysiology of septic shock, our study also indicates a potentially new therapeutic approach for treatment of sepsis syndrome. 相似文献
87.
Fregonese D Naspetti R Ferrer S Gallego J Costamagna G Dumas R Campaioli M Morante AL Mambrini P Meisner S Repici A Andreo L Masci E Mingo A Barcenilla J Petruzziello L 《Gastrointestinal endoscopy》2008,67(1):68-73
BACKGROUND: Emergency surgery for malignant colon obstruction entails relatively high morbidity and mortality rates and typically necessitates a 2-step resection. These problems might be potentially mitigated by placement of a self-expanding metal stent (SEMS) as a bridge to surgery. A nitinol colorectal SEMS may offer several advantages, but available evidence on the utility of this SEMS type remains highly limited. OBJECTIVE: Our purpose was to evaluate the effectiveness and safety as a bridge to surgery of a nitinol SEMS designed for colorectal use. DESIGN: Prospective and retrospective multicenter clinical study. SETTING: Sixteen European study centers. PATIENTS: Thirty-six patients with malignant colonic obstruction. INTERVENTIONS: Nitinol colorectal SEMS placement. MAIN OUTCOME MEASURES: Technical success in accurate SEMS placement with coverage of the entire stricture length, clinical success in alleviating colonic obstructive symptoms, and bridging to elective surgery. RESULTS: Technical success was achieved in 97% of patients with a 95% CI of 85% to 100% and clinical success in 81% (95% CI, 64%-92%). Elective surgery was performed in 94% (95% CI, 81%-99%) of patients at a median of 11 days (95% CI, 7-15 days) after SEMS placement. SEMS-related perforation occurred in 3 patients. LIMITATIONS: No control group was included in this nonrandomized cohort study. CONCLUSIONS: In this first comparatively large clinical study of a nitinol colorectal SEMS as a bridge to surgery, a high proportion of patients successfully proceeded to elective surgery after prior decompression by SEMS placement. 相似文献
88.
Ana Luisa Calich Eduardo Ferreira Borba Michelle Remião Ugolini-Lopes Luiza Fuoco da Rocha Eloisa Bonfá Ricardo Fuller 《Clinical rheumatology》2018,37(5):1223-1228
Uric acid has been recognised as a potential marker of endothelial dysfunction and kidney disease but there are scarce data about its importance in systemic lupus erythematosus (SLE) nephritis. This study aimed to evaluate serum uric acid (UA) levels in lupus nephritis (LN), by comparing SLE patients with normal renal function, with and without nephritis. Forty-six female SLE patients were consecutively selected and divided in two groups according to renal activity at the evaluation: presence of a recently diagnosed lupus nephritis (LN+, n?=?18) and absence of lupus nephritis (LN?, n?=?28). Age-matched healthy women were selected (CONTROL, n?=?28). Patients with gout, creatinine clearance lower than 80 ml/min and use of drugs that interfere in UA were excluded. Laboratory and clinical data were analysed by appropriate tests. A multivariate analysis was performed, and a receiver operating characteristic (ROC) curve was plotted, and the area under the curve was calculated to assess the diagnostic strength of UA in LN. The mean age was similar among LN+, LN? and CONTROL groups (32.44?±?6.09 vs. 30.68?±?5.36 vs. 30.86?±?5.00 years, p?=?0.52). UA was significantly higher in LN+ compared to LN? (5.54?±?1.67 vs. 3.65?±?1.090 mg/dL, p?<?0.001) and CONTROL (5.54?±?1.67 vs. 3.92?±?0.95 mg/dL p?<?0.001). Multivariate analysis confirmed that high UA was an independent variable related to LN (p?<?0.001). The cut-off value for UA using the ROC curve was 4.47 mg/dL (AUC 0.86, p?=?0.00004, CI 95% 0.75–0.96). Lupus nephritis was associated with higher UA. Hyperuricemia as a predictor of renal damage in SLE needs to be evaluated in further studies. 相似文献
89.
Yoshiro Horai Oka Satoru Samuel Lapalme-Remis Remi Sumiyoshi Yoshikazu Nakashima Takahisa Suzuki Akitomo Okada Shin-ya Kawashiri Kunihiro Ichinose Mami Tamai Satoshi Yamasaki Hideki Nakamura Fuminao Takeshima Tomoki Origuchi Atsushi Kawakami 《Modern rheumatology / the Japan Rheumatism Association》2013,23(3):572-576
A 22-year-old female with ulcerative colitis that was successfully treated with infliximab (IFX), and remained stable following tapered discontinuation of prednisolone, developed anterior neck pain and elevation of C-reactive protein following her fourth administration of IFX. She was diagnosed with Takayasu arteritis (TA) based on neck ultrasound and computed tomography angiography. This is the first report describing the development of TA during treatment of UC with IFX. 相似文献
90.
Luciana Grazziotin Rossato Vera Marisa Costa Vânia Vilas-Boas Maria de Lourdes Bastos Anabela Rolo Carlos Palmeira Fernando Remião 《Cardiovascular toxicology》2013,13(4):413-425
Mitoxantrone (MTX) is a chemotherapeutic agent that emerged as an alternative to anthracycline therapy. However, MTX also causes late cardiotoxicity, being oxidative stress and mitochondrial-impaired function proposed as possible mechanisms. This work aimed to investigate the relevance of these mechanisms to the MTX toxicity in H9c2 cells, using therapeutic concentrations. The observed cytotoxicity of MTX was time and concentration dependent in both lactate dehydrogenase leakage assay and MTT reduction assay. Two therapeutic concentrations (100 nM and 1 μM) and three time points were selected (24, 48, and 96 h) for further studies. Both MTX concentrations caused a significant increase in caspase-3 activity, which was not prevented by inhibiting MTX CYP450-metabolism. Significant decreases were observed in the total and reduced glutathione levels only in MTX 100 nM at 96 h; however, neither alterations in oxidized glutathione nor increases in the malondialdehyde levels were observed at any time or concentrations tested. On the other hand, changes in the intracellular ATP levels, mitochondrial membrane potential, and intracellular calcium levels were observed in both concentrations and all time tested. Noteworthy, decreased levels of ATP-synthase expression and activity and increases in the reactive species generation were observed at 96 h in both working concentrations. However, the radical scavenger N-acetylcysteine or the mitochondrial function enhancer L-carnitine did not prevent MTX cytotoxicity. Thus, this work evidenced the early MTX-induced energetic crisis as a possible key factor in the cell injury. 相似文献