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De Gregorio MÁ, Yamamoto-Ramos M, Fredes A, Serrano-Casorran C, Sierre S, Ciampi-Dopazo JJ, Méndez S, Abadal JM, Urtiaga I, Bonastre C, Rodríguez J, Urbano J, Guirola JA. A Comparative Study of a Small Series of Patients (50 Patients) with Pelvic Varicose Veins Treated with Plugs Alone or Plugs and Polidocanol. J Clin Med 2023; 12:5408. [PMID: 37629450 PMCID: PMC10455180 DOI: 10.3390/jcm12165408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
LEVEL OF EVIDENCE Level 2. PURPOSE To compare the safety and efficacy of vascular plug (VP) and vascular plug and polidocanol foam (VPPF) treatments for embolization in pelvic congestion syndrome (PCS). MATERIALS AND METHODS A comparative, prospective, two-center study enrolled 50 women with PCS from January 2019 to January 2020. The patients were divided into two groups, and embolization was performed with VP (n = 25) and VPPF (n = 25) treatments. The mean age of the patients was 45.6 years ± 6.9. Three clinical parameters were assessed: abdominal pain, dyspareunia, and lower limb pain. The primary outcome (clinical success at 1 yr using a VAS), number of devices, procedure and fluoroscopy times, radiation doses, costs, and complications were compared. The participants were followed-up at 1, 3, 6, and 12 months. RESULTS At the 1-year follow-up, clinical success did not significantly differ between the two groups (VP vs. VPPF) regarding the improvement of the symptoms analyzed (pelvic pain, dyspareunia, lower extremity pain, and other symptoms (p < 0.05)). The mean number of devices per case was 4 ± 1.1 for the VP group and 2 ± 0.31 for the VPPF group (p < 0.001). No major complications were recorded in either group. The VPPF group had a significantly longer fluoroscopy time (42.8 min ± 14.2 vs. 25.4 min ± 7) and longer radiation dose (VPPF air kerma 839.4 ± 513 vs. VP air kerma 658.4 mGy ± 355 (all p < 0.001)). CONCLUSIONS Embolization for PCS resulted in pain relief in 90% of patients; the use of polidocanol did not demonstrate changes in the clinical outcome. The use of a VP alone was associated with decreased fluoroscopy time and radiation dose.
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Affiliation(s)
- Miguel Ángel De Gregorio
- Minimally Invasive Techniques Research Group—GITMI, University of Zaragoza, Clínica Quirón, 50013 Zaragoza, Spain
| | - Masao Yamamoto-Ramos
- Interventional Radiology, Minimally Invasive Techniques Research Group—GITMI, Clínica Quirón, 50013 Zaragoza, Spain;
| | - Arturo Fredes
- Interventional Radiology, Clinica Quiron Salud Zaragoza, 50006 Zaragoza, Spain;
| | - Carolina Serrano-Casorran
- Minimally Invasive Techniques Research Group (GITMI), University of Zaragoza, 50013 Zaragoza, Spain; (C.S.-C.); (C.B.); (J.R.)
| | - Sergio Sierre
- Interventional Radiology, Hospital Universitario Austral, Buenos Aires B1629, Argentina;
| | | | - Santiago Méndez
- Interventional Radiology, Hospital Universitario Puerta de Hierro, 28222 Madrid, Spain
| | - Jose Maria Abadal
- EBIR Intereventional Radiology, Hospital Universitario Severo Ochoa, 28914 Madrid, Spain;
| | - Ignacio Urtiaga
- Vascular Surgery, Minimally Invasive Techniques Research Group (GITMI), 50013 Zaragoza, Spain;
| | - Cristina Bonastre
- Minimally Invasive Techniques Research Group (GITMI), University of Zaragoza, 50013 Zaragoza, Spain; (C.S.-C.); (C.B.); (J.R.)
| | - Jose Rodríguez
- Minimally Invasive Techniques Research Group (GITMI), University of Zaragoza, 50013 Zaragoza, Spain; (C.S.-C.); (C.B.); (J.R.)
| | - Jose Urbano
- Interventional Radiology, Minimally Invasive Techniques Research Group (GITMI), Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain;
| | - José Andrés Guirola
- Minimally Invasive Techniques Research Group (GITMI), Hospital Clínico Universitario Lozano Blesa, University of Zaragoza, 50009 Zaragoza, Spain;
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Arrieta O, Hernández-Pedro N, Maldonado F, Ramos-Ramírez M, Yamamoto-Ramos M, López-Macías D, Lozano F, Zatarain-Barrón ZL, Turcott JG, Barrios-Bernal P, Orozco-Morales M, Flores-Estrada D, Cardona AF, Rolfo C, Cacho-Díaz B. Nitroglycerin Plus Whole Intracranial Radiation Therapy for Brain Metastases in Patients With Non-Small Cell Lung Cancer: A Randomized, Open-Label, Phase 2 Clinical Trial. Int J Radiat Oncol Biol Phys 2023; 115:592-607. [PMID: 35157994 DOI: 10.1016/j.ijrobp.2022.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 02/03/2022] [Accepted: 02/06/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE Hypoxia has been associated with chemoradioresistance secondary to vascular endothelial growth factor receptor induced by hypoxia-induced factor (HIF). Nitroglycerin (NTG) can reduce HIF-1 in tissues, and this may have antiangiogenic, proapoptotic, and antiefflux effects. Particularly, epidermal growth factor-mutated (EGFRm) tumor cell lines have been shown to overexpress both vascular endothelial growth factor and HIF. In this phase 2 study, we evaluated the effect of transdermal NTG plus whole brain radiation therapy (WBRT) in patients with non-small cell lung cancer (NSCLC) with brain metastases (BM). METHODS This was an open-label, phase 2 clinical trial with 96 patients with NSCLC and BM. Patients were randomized 1:1 to receive NTG plus WBRT (30 Gy in 10 fractions) or WBRT alone. The primary endpoint was intracranial objective response rate (iORR) evaluated 3 months posttreatment. NTG was administered using a transdermal 36-mg patch from Monday through Friday throughout WBRT administration (10 days). The protocol was retrospectively registered at ClinicalTrials.gov (NCT04338867). RESULTS Fifty patients were allocated to the control group, and 46 were allocated to the experimental group (NTG); among these, 26 (52%) had EGFRm in the control group and 21 (45.7%) had EGFRm in the NTG arm. In terms of the iORR, patients in the NTG group had a significantly higher response compared with controls (56.5% [n = 26/46 evaluable patients] vs 32.7% [n = 16/49 evaluable patients]; relative risk, 1.73; 95% confidence interval [CI], 1.08-2.78; P = .024). Additionally, patients who received NTG + WBRT had an independently prolonged intracranial progression-free survival (ICPFS) compared with those who received WBRT alone (27.7 vs 9.6; hazard ratio [HR], 0.5; 95% CI, 0.2-0.9; P = .020); this positively affected overall progression-free survival among patients who received systemic therapy (n = 88; HR, 0.5; 95% CI, 0.2-0.9; P = .043). The benefit of ICPFS (HR, 0.4; 95% CI, 0.2-0.9; P = .030) was significant in the EGFRm patient subgroup. No differences were observed in overall survival. A significantly higher rate of vomiting presented in the NTG arm of the study (P = .016). CONCLUSIONS The concurrent administration of NTG and radiation therapy improves iORR and ICPFS among patients with NSCLC with BM. The benefit in ICPFS is significant in the EGFRm patient subgroup.
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Affiliation(s)
- Oscar Arrieta
- Thoracic Oncology Unit and Laboratory of Personalized Medicine.
| | - Norma Hernández-Pedro
- Thoracic Oncology Unit and Laboratory of Personalized Medicine; Personalized Medicine Laboratory
| | - Federico Maldonado
- Department of Radio-Oncology, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | | | | | - Francisco Lozano
- Department of Radio-Oncology, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | - Jenny G Turcott
- Thoracic Oncology Unit and Laboratory of Personalized Medicine
| | | | | | | | - Andrés F Cardona
- Clinical and Translational Oncology Group, Fundación Santa Fe de Bogotá, Bogotá, Colombia; Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia
| | - Christian Rolfo
- Marlene and Stewart Greenbaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland
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Arrieta Rodriguez OG, Hernández-Pedro N, Maldonado F, Ramos M, Yamamoto-Ramos M, López D, Lozano F, Zatarain-Barron ZL, Cruz-Rico G, Barrios-Bernal P, Orozco-Morales M, Cacho B, Flores-Estrada D, Cardona Zorrilla AF, Rolfo CD. Nitroglycerin (NTG) plus whole intracranial radiotherapy for brain metastases (BM) in non-small cell cancer patient (NSCLC): A randomized open label, phase II clinical trial. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.9114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9114 Background: Hypoxia has been associated with chemo-radioresistance secondary to Vascular Endothelial Growth Factor Receptor induced by Hypoxia Induced Factor (HIF). Nitroglycerin (NTG) can reduce HIF-1 in cell lines, and this may have anti-angiogenic, pro-apoptotic, and anti-efflux effects. Particularly, EGFR mutated (EGFRm) tumor cell lines have been shown to overexpress both VEGF and HIF. In this phase II study, we evaluated the effect of transdermal NTG on intracranial objective response rate (iORR), intracranial progression-free survival (ICPFS), and overall survival (OS) of NSCLC patients with BM. Methods: We performed an open-label, phase II clinical trial among ninety-six histologically confirmed NSCLC patients with BM. Patients were randomized 1:1 to receive NTG plus WBRT (30 Gy in 10 fractions) or WBRT alone. iORR and ICPFS were evaluated by MRI by two independent, blinded radiologists. Nitroglycerin was administered using a transdermal 36 mg patch, which released 10 mg in 24 hours with a rest interval of 12 hours from Monday-Friday throughout WBRT administration (10 days). Results: Fifty patients were allocated to the control group, while 46 were allocated to the experimental group (NTG); among these 26 (55.3%) had EGFRm in the control group and 21 (44.7%) had EGFRm in the NTG arm. In terms of the iORR, patients in the NTG group had a significantly higher response when compared to controls (56.6% vs. 43.5%; p = 0.024). Additionally, patients who received NTG in addition to WBRT had an independently prolonged ICPFS compared with those who received WBRT alone (27.7 vs. 9.6; HR: 0.470 [95%CI: 0.24-0.89]; p = 0.021). PFS was also positively impacted (HR: 0.519 [95%CI: 0.27-0.98]; p = 0.043). The benefit in terms of iORR and ICPFS (HR: 0.38 [95%CI: 0.16-0.91]; p = 0.030) was particularly important in the EGFRm patient subgroup. No differences were observed in OS. A significantly higher rate of vomiting presented in the NTG arm of the study ( p= 0.016). Conclusions: The concurrent administration of NTG and chemo-radiotherapy improves iORR and ICPFS among NSCLC patients with BM. The benefit is particularly significant in the EGFRm patient subgroup. Clinical trial information: NCT04338867.
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Affiliation(s)
| | | | | | | | | | - Diego López
- Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | | | | | | | | | | | | | | | - Christian Diego Rolfo
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD
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Hernandez-Trejo AF, Cuellar-Calderon KP, Treviño-Gonzalez JL, Yamamoto-Ramos M, Campos-Coy MA, Quiroga-Garza A, Guzman-Avilan K, Elizondo-Riojas G, Elizondo-Omaña RE, Guzman-Lopez S. Prevalence of facial canal dehiscence and other bone defects by computed tomography. Eur Arch Otorhinolaryngol 2020; 277:2681-2686. [PMID: 32383094 DOI: 10.1007/s00405-020-06013-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/25/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The facial nerve is the most vulnerable structure during otological surgeries. Facial canal dehiscence (FCD) is the main risk factor for iatrogenic injuries. Its prevalence in clinical studies ranges between 6 and 33.3%, while anatomical studies report 25-57%. The objective was to determine the prevalence of FCD stratified by age and gender in a healthy population. MATERIALS AND METHODS Temporal bones from high-resolution computed tomography (CT) were analyzed. Patients with a history of trauma or tumors of the temporal bone, cholesteatomas, chronic middle ear disease, and any pathology that could modify the bone's anatomy, were excluded. RESULTS A total of 184 temporal bones were included. FCD was observed in 94 (51.2%) of the analyzed bones. The tympanic portion was the most frequently affected site with 91 (49.5%), followed by the mastoid segment with 3 (1.6%). No dehiscence was found in the labyrinth portion. We observed 30 (31.9%) of the FCD involved the oval window. Other bone defects identified with the FCD included: 11 (11.7%) with a lateral semicircular canal fistula and 7 (7.4%) with tegmen tympani erosions. CONCLUSION FCD has a high prevalence among healthy patients. A pre-surgical otological evaluation using high-resolution CT should be indicated to properly assess the patient and reduce the risk of injury.
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Affiliation(s)
| | - Karla Paola Cuellar-Calderon
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina, Human Anatomy Department, Monterrey, Nuevo Leon, Mexico
| | - Jose Luis Treviño-Gonzalez
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Otorhinolaryngology Department, Monterrey, Nuevo Leon, Mexico.
| | - Masao Yamamoto-Ramos
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Radiology and Imaging Department, Monterrey, Nuevo Leon, Mexico
| | - Mario Alberto Campos-Coy
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Radiology and Imaging Department, Monterrey, Nuevo Leon, Mexico
| | - Alejandro Quiroga-Garza
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina, Human Anatomy Department, Monterrey, Nuevo Leon, Mexico
| | - Katia Guzman-Avilan
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina, Human Anatomy Department, Monterrey, Nuevo Leon, Mexico
| | - Guillermo Elizondo-Riojas
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Radiology and Imaging Department, Monterrey, Nuevo Leon, Mexico
| | | | - Santos Guzman-Lopez
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina, Human Anatomy Department, Monterrey, Nuevo Leon, Mexico
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Treviño-González JL, Campos-Coy MA, Villegas-González MJ, Morales-Del Ángel JA, Soto-Galindo GA, Yamamoto-Ramos M, Moreno-Sales R, Montemayor-Alatorre A, Méndez-Sáenz MA, González-Cantú A. Impact of bilateral nasal polyposis on the interoptic and interzygomatic distance. Eur Arch Otorhinolaryngol 2019; 276:1701-1705. [PMID: 30895433 DOI: 10.1007/s00405-019-05390-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/13/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To identify and determine variations on eye distance in patients with bilateral nasal polyposis (BNP) compared to a healthy control group. METHODS This is a case-control study that included 20 BNP patients and 40 healthy controls. We included all patients with BNP confirmed by pathology and a computed tomography scan. A healthy control group was admitted, filtered by the exclusion criteria of nasal polyposis, craniofacial malformations, and encephalocele. Paranasal sinus CT scans were performed in all participants, and two measures were evaluated, the interoptic (soft tissue) and the interzygomatic (bone structure) distances. RESULTS A total of 20 BNP subjects, 13 (65%) male and 7 (35%) female, with a mean age of 38.8 years, and 40 healthy controls, 16 (40%) male and 24 (60%) female with a mean age of 43.2 years, were included. The mean interoptic distance was 69.7 mm (71.9 mm men, 66.4 mm women) and interzygomatic distance was 103.1 mm (104.5 mm men, 100.6 mm women). A significant increase of the interoptic (p < 0.001) and interzygomatic (p < 0.002) measurements was found in patients with polyposis compared to the controls. In the receptor operative curve analysis, the interoptic distance had an area under a curve of 96% and the threshold that maximizes the sensitivity and specificity was 59.85 mm (sensitivity 90%, specificity 95%, PPV 90%, NPV 95%). CONCLUSIONS An increase in ocular and orbital distances was identified in patients with BNP. Polyposis may be identified by measuring eye separation. The established cut point distance identifies patients that may benefit from follow-up. Further research in this study line is suggested.
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Affiliation(s)
- José Luis Treviño-González
- Department of Otolaryngology-Head and Neck Surgery, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Av. Madero y Gonzalitos Colonia Mitras Centro, CP 64460, Monterrey, NL, Mexico.
| | - Mario Alberto Campos-Coy
- Department of Radiology and Imaging, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - Mario Jesús Villegas-González
- Department of Otolaryngology-Head and Neck Surgery, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Av. Madero y Gonzalitos Colonia Mitras Centro, CP 64460, Monterrey, NL, Mexico
| | - Josefina Alejandra Morales-Del Ángel
- Department of Otolaryngology-Head and Neck Surgery, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Av. Madero y Gonzalitos Colonia Mitras Centro, CP 64460, Monterrey, NL, Mexico
| | - German A Soto-Galindo
- Department of Otolaryngology-Head and Neck Surgery, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Av. Madero y Gonzalitos Colonia Mitras Centro, CP 64460, Monterrey, NL, Mexico
| | - Masao Yamamoto-Ramos
- Department of Radiology and Imaging, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - Rafael Moreno-Sales
- Department of Otolaryngology-Head and Neck Surgery, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Av. Madero y Gonzalitos Colonia Mitras Centro, CP 64460, Monterrey, NL, Mexico
| | - Adolfo Montemayor-Alatorre
- Department of Otolaryngology-Head and Neck Surgery, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Av. Madero y Gonzalitos Colonia Mitras Centro, CP 64460, Monterrey, NL, Mexico
| | - Marco Antonio Méndez-Sáenz
- Department of Otolaryngology-Head and Neck Surgery, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Av. Madero y Gonzalitos Colonia Mitras Centro, CP 64460, Monterrey, NL, Mexico
| | - Arnulfo González-Cantú
- Mathematical Investigation Center (CIMAT), National Council of Science and Technology (CONACYT), Mexico City, Mexico
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