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Barat M, Milot L. Is robotic assistance the future of percutaneous interventional radiology? Diagn Interv Imaging 2024:S2211-5684(24)00019-6. [PMID: 38403506 DOI: 10.1016/j.diii.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 02/27/2024]
Affiliation(s)
- Maxime Barat
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; Génomique et Signalisation des Tumeurs Endocrines, Institut Cochin, INSERM U 1016, CNRS UMR8104, 75014 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France.
| | - Laurent Milot
- Department of Diagnostic and Interventional Radiology, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69005 Lyon, France; LabTAU, INSERM U1032, 69003 Lyon, France; Université Claude Bernard Lyon 1, 69003 Lyon, France
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Bonnet B, de Baère T, Beunon P, Feddal A, Tselikas L, Deschamps F. Robotic-assisted CT-guided percutaneous thermal ablation of abdominal tumors: An analysis of 41 patients. Diagn Interv Imaging 2024:S2211-5684(24)00017-2. [PMID: 38368177 DOI: 10.1016/j.diii.2024.01.005] [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: 11/22/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/19/2024]
Abstract
PURPOSE Robotic assistance is rapidly evolving and may help physicians optimize needle guidance during percutaneous interventions. The purpose of the study was to report feasibility, safety, accuracy, immediate clinical success and short-term local tumor control after robotic-assisted computed tomography (CT)-guided thermal ablation of abdominal tumors. MATERIALS AND METHODS Forty-one patients who underwent percutaneous thermal ablation of abdominal tumors using robotic-assisted CT-guided were included. All ablations were performed with robotic assistance, using an optically-monitored robotic system with a needle guide sent to preplanned trajectories defined on three-dimensional-volumetric CT acquisitions with respiration monitoring. Endpoints were technical success, safety, distance from needle tip to planned trajectory and number of needle adjustments, and complete ablation rate. RESULTS Forty-one patients (31 men; mean age, 66.7 ± 9.9 [standard deviation (SD)] years [age range: 41-84 years]) were treated for 48 abdominal tumors, with 79 planned needles. Lesions treated were located in the liver (23/41; 56%), kidney (14/41;34%), adrenal gland (3/41; 7%) or retroperitoneum (1/41; 2%). Technical success was achieved in 39/41 (95%) patients, and 76/79 (96%) needle insertions. The mean lateral distance between the needle tip and planned trajectory was 3.2 ± 4.5 (SD) mm (range: 0-20 mm) before adjustments, and the mean three-dimensional distance was 1.6 ± 2.6 (SD) mm (range: 0-13 mm) after 29 manual depth adjustments (29/78; 37%) and 33 lateral adjustments (33/78; 42%). Two (2/79; 3%) needles required complete manual reinsertion. One grade 3 complication was reported in one patient (1/41; 2%). The overall clinical success rate was 100%. The 3-month local tumor control rate (progression free survival) was 95% (38/41). CONCLUSION These results provide further evidence on the use of robotic-assisted needle insertion regarding feasibility, safety, and accuracy, resulting in effective percutaneous thermal ablation of abdominal tumors.
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Affiliation(s)
- Baptiste Bonnet
- Centre d'Investigation Clinique BIOTHERIS, INSERM CIC1428, Radiologie Interventionnelle; Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), INSERM U1015, 94805 Villejuif, France
| | - Thierry de Baère
- Centre d'Investigation Clinique BIOTHERIS, INSERM CIC1428, Radiologie Interventionnelle; Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), INSERM U1015, 94805 Villejuif, France; Gustave Roussy, Service d'Imagerie Thérapeutique, Département d'Anesthésie, Chirurgie et Interventionnel (DACI), 94805 Villejuif, France; Faculté de Médecine, Paris-Saclay Université, 94270 Le Kremlin Bicêtre, France.
| | - Paul Beunon
- Centre d'Investigation Clinique BIOTHERIS, INSERM CIC1428, Radiologie Interventionnelle; Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), INSERM U1015, 94805 Villejuif, France
| | - Adlane Feddal
- Centre d'Investigation Clinique BIOTHERIS, INSERM CIC1428, Radiologie Interventionnelle; Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), INSERM U1015, 94805 Villejuif, France
| | - Lambros Tselikas
- Centre d'Investigation Clinique BIOTHERIS, INSERM CIC1428, Radiologie Interventionnelle; Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), INSERM U1015, 94805 Villejuif, France; Gustave Roussy, Service d'Imagerie Thérapeutique, Département d'Anesthésie, Chirurgie et Interventionnel (DACI), 94805 Villejuif, France; Faculté de Médecine, Paris-Saclay Université, 94270 Le Kremlin Bicêtre, France
| | - Frédéric Deschamps
- Centre d'Investigation Clinique BIOTHERIS, INSERM CIC1428, Radiologie Interventionnelle; Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), INSERM U1015, 94805 Villejuif, France; Gustave Roussy, Service d'Imagerie Thérapeutique, Département d'Anesthésie, Chirurgie et Interventionnel (DACI), 94805 Villejuif, France
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Nassif YJ, Zanin ME, Martinez-Sobalvarro JV, de Barros CM, Pacheco-Neto M, Dos Reis TM, Cardoso-Podestá MHM, Torres LH. Effectiveness of epidural morphine for the treatment of cancer pain in patients with gastrointestinal neoplasm-a systematic review. Naunyn Schmiedebergs Arch Pharmacol 2024:10.1007/s00210-023-02925-4. [PMID: 38180558 DOI: 10.1007/s00210-023-02925-4] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/22/2023] [Indexed: 01/06/2024]
Abstract
One-third of cancer pain patients do not experience adequate pain relief using analgesic ladder by the World Health Organization. Interventional procedures, such as epidural morphine, have been considered. This study aimed to review the literature comparing the effects of epidural administration of morphine with the oral route. This systematic review included randomized controlled trials (RCTs) conducted with patients with gastrointestinal neoplasm. A search was conducted on PubMed, EMBASE, Web of Science, Scopus, Cochrane Library, and CINAHL databases to identify studies published up to May 2023. The retrieved study was evaluated using the Risk of Bias 2 (RoB 2) tool and qualitatively synthesized. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach (Prospero: CRD42021264728). Only one RCT, a crossover trial, was included in this systematic review. The study was conducted with ten participants (one withdrawal) and reported a statistically significant difference between both subcutaneous and epidural morphine solutions and oral morphine. The adverse events were not described. The included study presents some concerns of bias and low certainty of evidence on the effectiveness and security of epidural morphine administration. The available literature does not suffice to elucidate whether morphine administration via the epidural route is more effective than other routes. Further RCTs are necessary to improve the level of evidence on the effectiveness and risk-benefit of epidural morphine in the management of cancer pain in gastrointestinal neoplasm patients.
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Affiliation(s)
- Yasmim Jianjulio Nassif
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700, Centro-Alfenas, MG, CEP: 37130-001, Brazil
| | - Maria Elisa Zanin
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700, Centro-Alfenas, MG, CEP: 37130-001, Brazil
| | - Joselin Valeska Martinez-Sobalvarro
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700, Centro-Alfenas, MG, CEP: 37130-001, Brazil
- Department of Pharmacy, Health Sciences Sector, Federal University of Paraná, Curitiba, Brazil
| | - Carlos Marcelo de Barros
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700, Centro-Alfenas, MG, CEP: 37130-001, Brazil
- Department of Anesthesiology, Pain and Palliative Care, Santa Casa of Alfenas, Alfenas, Brazil
| | | | - Tiago Marques Dos Reis
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Brazil
| | - Márcia Helena Miranda Cardoso-Podestá
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700, Centro-Alfenas, MG, CEP: 37130-001, Brazil
| | - Larissa Helena Torres
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Rua Gabriel Monteiro da Silva, 700, Centro-Alfenas, MG, CEP: 37130-001, Brazil.
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Iwakura M, Kawagoshi A, Furukawa Y, Sugawara K, Wakabayashi T, Sato T, Wakasa M. Health literacy in older patients with abdominal tumours and its association with clinical characteristics: A cross-sectional study. Eur J Oncol Nurs 2023; 67:102461. [PMID: 37976753 DOI: 10.1016/j.ejon.2023.102461] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/05/2023] [Accepted: 10/29/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Health literacy (HL) is pivotal in managing patients with abdominal cancer and is associated with treatment outcomes and care experience. However, detailed characteristics of HL and their associations with clinical features remain uncertain in the population. Therefore, we aimed to comprehensively investigate HL and its associations with clinical characteristics in older patients with abdominal tumours. METHODS We analysed 103 older patients with abdominal tumours prescribed perioperative rehabilitation programs in an acute care hospital. The Japanese version of the European Health Literacy Survey Questionnaire was used to measure comprehensive HL. Multivariate ordinal or linear regression analyses were used to explore the associations between HL and the following clinical characteristics: physical status, physical function, cardiopulmonary function, levels of activities of daily living (ADL), physical activity level, and health-related quality of life (HR-QoL). All regression analyses included patient demographics as covariates. RESULTS Approximately 50%-70% of the participants had difficulty accessing and appraising health-related information, and 20%-45% thought it was difficult to understand and apply the information. The percentage of limited HL levels in general HL, three health-relevant domains, and four competencies ranged from 62% to 83%. Moreover, regression analyses revealed that lower HL was associated with worse physical status/function, lower ADL, and poorer HR-QoL. CONCLUSION Most older patients with abdominal tumours have limited HL, which may lead them to make treatment decisions without fully understanding what healthcare providers advise. Furthermore, patients with lower HL are at a higher risk of poor treatment outcomes because of their worse clinical characteristics.
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Affiliation(s)
- Masahiro Iwakura
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, 1-1 Hondo 1-chome, Akita City, Akita, 010-8543, Japan.
| | - Atsuyoshi Kawagoshi
- Department of Rehabilitation, Akita City Hospital, 4-30 Kawamoto Matsuoka-Cho, Akita City, Akita, 010-0933, Japan
| | - Yutaka Furukawa
- Department of Rehabilitation, Akita City Hospital, 4-30 Kawamoto Matsuoka-Cho, Akita City, Akita, 010-0933, Japan
| | - Keiyu Sugawara
- Department of Rehabilitation, Akita City Hospital, 4-30 Kawamoto Matsuoka-Cho, Akita City, Akita, 010-0933, Japan
| | - Toshiki Wakabayashi
- Department of Gastrointestinal Surgery, Akita City Hospital, 4-30 Kawamoto Matsuoka-Cho, Akita City, Akita, 010-0933, Japan
| | - Tsutomu Sato
- Department of Gastrointestinal Surgery, Akita City Hospital, 4-30 Kawamoto Matsuoka-Cho, Akita City, Akita, 010-0933, Japan
| | - Masahiko Wakasa
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, 1-1 Hondo 1-chome, Akita City, Akita, 010-8543, Japan
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Ye X, Cai Y, You Z. Abdominal lymph node tuberculosis mimicking malignant obstructive jaundice in a young woman. Asian J Surg 2023; 46:5067-5069. [PMID: 37419815 DOI: 10.1016/j.asjsur.2023.06.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 06/15/2023] [Indexed: 07/09/2023] Open
Affiliation(s)
- Xiwen Ye
- Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Yulong Cai
- Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Zhen You
- Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, China.
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Pacheco-Feijoó GM, Amado-Tineo JP, Plancarte-Sánchez R, Valdivia CC, López-Millán JM. Efficacy and Safety of Celiac Plexus Neurolysis in the Treatment of Chronic Pain Secondary to Oncological Pathology of the Upper Hemiabdomen: A Systematic Review and Meta-Analysis. Indian J Palliat Care 2023; 29:394-406. [PMID: 38058484 PMCID: PMC10696325 DOI: 10.25259/ijpc_203_2022] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 08/29/2023] [Indexed: 12/08/2023] Open
Abstract
Objectives The management of chronic pain among patients with abdominal cancer is complex; against that, the neurolysis of the celiac plexus (CPN) is the best technique at the moment to determine the efficacy and safety in the treatment of chronic pain secondary to oncological pathology of the upper abdomen. Material and Methods This was a systematic review of controlled clinical trials between 2000 and 2021, in the sources MEDLINE/PubMed, Cochrane, Scopus, Web of Science, and Google Scholar. Three independent evaluators analysed the results of the bibliographical research. The quality of the studies was assessed with the Jadad scale and the mean difference (95% confidence interval) and heterogeneity of the studies (I2) were calculated with Review Manager 5.3. Results Seven hundred and forty-four publications were identified, including 13 studies in the qualitative synthesis and three studies in the quantitative synthesis. No difference was found in the decrease in pain intensity between 1 and 12 weeks after the intervention, comparing the experimental group with the control (P > 0.05). The adverse effects related to neurolysis were not serious and transitory, mentioning the most frequent adverse effects and reporting a percentage between 21% and 67% (with 17% for echoendoscopic neurolysis and 49% for percutaneous neurolysis). Conclusion Celiac plexus neurolysis for the treatment of severe chronic pain secondary to oncological pathology in the upper hemiabdomen produces similar pain relief as conventional pharmacological analgesic treatment. It is a safe analgesic technique since the complications are mild and transitory.
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Affiliation(s)
| | - Jose Percy Amado-Tineo
- Department of Medicine, School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | | | - José M. López-Millán
- Department of Anesthesiology-Critical Care and Pain Medicine, Virgen Macarena University Hospital, Seville, Spain
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Hayati F, Mohd Zuki A, Lim MC, Chandran PC, Azizan N, Hameed Sultan MA, Muhamad Zin MH, Abdul Karim K. A peculiar case of intususception in a pregnant woman: A diagnostic challenge. Radiol Case Rep 2023; 18:2836-2839. [PMID: 37388266 PMCID: PMC10300483 DOI: 10.1016/j.radcr.2023.05.048] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/22/2023] [Indexed: 07/01/2023] Open
Abstract
Adult intussusception presents a diagnostic challenge given its non-specific symptoms. It is not as common as in infants and young children. Traditionally, diagnostic steps are invariably fit for normal adults, but not in pregnancy which faces certain limitations. A 40-year-old pregnant mother, gravida 9 para 8 at 34-week gestation, complained of intermittent epigastric pain for 2 days, requiring hospitalization. She soon developed minimal per rectal bleeding that was ruled out as hemorrhoid. Imaging was limited due to her pregnancy status. She later developed spontaneous delivery to a premature baby. Computed tomography (CT) revealed an ileocolic intussusception, which was confirmed via exploratory laparotomy. Histology was consistent with inflammatory fibroid polyp. Acute abdomen in pregnancy can be due to various causes, thus a high index of suspicion and early CT abdomen might help in early diagnosis and treatment. The benefit of doing CT on the mother and the risk of CT on the fetus is to be weighed as the timely diagnosis can prevent bowel ischemia and reduce maternal morbidity and mortality. Surgery remains the definite management in adult intussusception and an exact diagnosis can be made during the operation.
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Affiliation(s)
- Firdaus Hayati
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Jalan UMS, Kota Kinabalu, Sabah, 88450, Malaysia
| | - Asyraf Mohd Zuki
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ming Chin Lim
- Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Pradeep Chand Chandran
- Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Nornazirah Azizan
- Department of Pathology and Microbiology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Mohamed Arif Hameed Sultan
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Jalan UMS, Kota Kinabalu, Sabah, 88450, Malaysia
| | - Muhamad Hud Muhamad Zin
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Jalan UMS, Kota Kinabalu, Sabah, 88450, Malaysia
| | - Khasnizal Abdul Karim
- Department of Surgery, Teluk Intan Hospital, Ministry of Health Malaysia, Teluk Intan, Perak, Malaysia
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Iwakura M, Kawagoshi A, Furukawa Y, Sugawara K, Wakabayashi T, Sato T, Wakasa M. Association of health literacy with short-term postoperative outcomes in older adult patients with abdominal tumors undergoing surgery and perioperative rehabilitation program: A prospective cohort study. J Geriatr Oncol 2023; 14:101422. [PMID: 36657247 DOI: 10.1016/j.jgo.2022.101422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/13/2022] [Accepted: 12/21/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Low health literacy (HL) is associated with poor surgical outcomes in patients with abdominal tumors, despite enhanced recovery programs. However, the relationship between HL and postoperative outcomes, including health-related quality of life (HRQOL) and physical functions, has been unclear in patients with abdominal tumors receiving perioperative rehabilitation programs (PRPs). Our objective was to identify associations of HL with postoperative functional and general outcomes in patients with abdominal tumors undergoing surgery and PRPs, controlling for critical covariates. MATERIALS AND METHODS The prospective cohort study was conducted from April 2020 to December 2021 in a single acute care hospital in Akita City, Japan. Out of 112 consecutive older adults with abdominal tumors referred to PRPs before surgery for tumors, 101 participated. Three patients declined undergoing follow-up assessment, and thus 97 were analyzed. Demographic data, comorbidities, education, surgical procedure, frailty status, cognitive functions, physical activity, nutritional status, tumor sites, types, and stages were collected as covariates at baseline. All participants underwent PRPs. HL was measured using the Japanese version of the European Health Literacy Survey Questionnaire, a comprehensive HL measurement. Primary endpoints were changes in HRQOL, measured using the EuroQol 5-dimension 5-level (EQ-5D-5L) index and EuroQol-visual analog scale (EQ-VAS), and physical functions (chair-stand ability, usual gait speed, and grip strength) from before surgery to discharge. Secondary endpoints were 90-day readmissions, postoperative complications, and length of hospital stay. Multivariate regression with inverse probability weighting, using propensity scores, estimeted associations of HL with the outcomes. RESULTS Of the 97 patients (36 [37.1%] women, mean [standard deviation] age 74.4 [6.3] years), 42 (43.3%) reported low HL. At baseline, patients with low HL exhibited worse EQ-5D-5L scores (P = .001), EQ-VAS values (P = .03), chair-stand ability (P = .001), and gait speed (P = .03) than controls. Low HL was associated with a low risk of grip strength declines (risk ratio, 0.13; 95% confidence interval, 0.12-0.99) but not with any other outcome. DISCUSSION There appeared to be no apparent associations of HL with surgical outcomes in patients with abdominal tumors receiving PRPs. Thus, HL might not be a crucial predictor of surgical outcomes when combined with PRPs.
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Murakami T, Shimizu H, Yamazaki K, Nojima H, Usui A, Kosugi C, Shuto K, Obi S, Sato T, Yamazaki M, Koda K. Intra-abdominal ectopic bronchogenic cyst with a mucinous neoplasm harboring a GNAS mutation: A case report. World J Clin Cases 2022; 10:8709-8717. [PMID: 36157792 PMCID: PMC9453374 DOI: 10.12998/wjcc.v10.i24.8709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/23/2022] [Accepted: 07/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Bronchogenic cysts are congenital cysts caused by abnormal sprouting from the ventral foregut during fetal life. They usually occur in the mediastinum or lung, but there are very rare cases of ectopic bronchogenic cysts that develop in the abdominal cavity. A unique intra-abdominal ectopic bronchogenic cyst with a mucinous neoplasm that was producing carcinoembryonic antigen (CEA), harboring a GNAS mutation, is reported. The present case may contribute to clarifying the mechanism of tumorigenesis and malignant transformation of ectopic bronchogenic cysts.
CASE SUMMARY In 2007, a man in his 50s was incidentally found to have an intra-abdominal cystic mass, 8 cm in diameter. Surgical resection was recommended, but he preferred to remain under observation. In 2020, his serum CEA level increased to 26.7 ng/mL, and abdominal computed tomography showed a 15 cm × 12 cm, multifocal, cystic mass located predominantly on the lesser curvature of the stomach. Since malignancy could not be ruled out, he finally underwent surgical resection. Histologically, the cystic wall was lined by ciliated columnar epithelium, accompanied by bronchial gland-like tissue, bronchial cartilage, and smooth muscle. Part of the cyst consisted of atypical columnar epithelium with an MIB-1 index of 5% and positive for CEA. Moreover, a GNAS mutation (p.R201C) was detected in the atypical epithelium, leading to a diagnosis of an ectopic bronchogenic cyst with a low-grade mucinous neoplasm. The patient is currently undergoing outpatient follow-up without recurrence.
CONCLUSION An extremely rare case of an abdominal bronchogenic cyst with a low-grade mucinous neoplasm harboring a GNAS mutation was reported.
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Affiliation(s)
- Takashi Murakami
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara 299-0111, Chiba, Japan
| | - Hiroaki Shimizu
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara 299-0111, Chiba, Japan
| | - Kazuto Yamazaki
- Department of Pathology, Teikyo University Chiba Medical Center, Ichihara 299-0111, Chiba, Japan
| | - Hiroyuki Nojima
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara 299-0111, Chiba, Japan
| | - Akihiro Usui
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara 299-0111, Chiba, Japan
| | - Chihiro Kosugi
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara 299-0111, Chiba, Japan
| | - Kiyohiko Shuto
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara 299-0111, Chiba, Japan
| | - Shuntaro Obi
- Department of Internal Medicine, Teikyo University Chiba Medical Center, Ichihara 299-0111, Chiba, Japan
| | - Takahisa Sato
- Department of Internal Medicine, Teikyo University Chiba Medical Center, Ichihara 299-0111, Chiba, Japan
| | - Masato Yamazaki
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara 299-0111, Chiba, Japan
| | - Keiji Koda
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara 299-0111, Chiba, Japan
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Kim S, Marcus R, Wells ML, Sheedy SP, Hansel SL, Bruining DH, Barlow JM, Carter RE, Lee YS, Johnson MP, Fidler JL, Goenka AH, McCollough CH, Fletcher JG. The evolving role of imaging for small bowel neuroendocrine neoplasms: estimated impact of imaging and disease-free survival in a retrospective observational study. Abdom Radiol (NY) 2020; 45:623-631. [PMID: 31980866 DOI: 10.1007/s00261-020-02410-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To determine how small bowel neuroendocrine neoplasms (SBNEN's) are diagnosed and examine the effect of CT enterography (CTE) on diagnosis and rates of disease-free survival. METHODS Histopathologically-confirmed SBNEN's diagnosed at our institution between 1996 and 2016 were identified. Clinical presentation, radiology, endoscopy, surgery, and pathology reports were reviewed and compared between consecutive 5-year periods. RESULTS Of the 178 SBNEN initially diagnosed at our institution, the incidence increased 12-fold from 9 (during 1996-2000) to 114 (during 2011-2016). Comparing the first 5 to the last 5 years, GI bleeding and abdominal pain increased significantly as indications (with both increasing from 0 to > 25%, p ≤ 0.023). Initial diagnosis by radiology increased 2-fold [from 33% (n = 3) to 66% (n = 75); p = 0.263]. Detection of a small bowel mass and the suggestion that SBNEN was present varied significantly between imaging modalities (p < 0.0001; CTE - 95% (52/55) and 91% (50/55) vs. abdominal CT 45% (37/85) and 35% (29/85), respectively). Recurrence rates increased with SBNEN size (p = 0.012; e.g., of SBNEN diagnosed by endoscopy, 18% of SBNEN measuring 0.6 ± 0.3 cm recurred vs. 75% measuring 3.7 ± 1.0 cm). Rates of disease-free survival, and the incidence of local and liver metastases were decreased when tumors were first identified by CTE rather than other CT/MR imaging modalities (p = 0.0034, 0.0475, and 0.0032, respectively). CONCLUSION There has been a dramatic increase in SBNENs detected by CTE and endoscopy over the last 20 years. SBNEN's detected by CTE and small tumors detected at endoscopy have longer disease-free survival after surgical resection.
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Abstract
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are therapeutic options for the treatment of intra-abdominal neoplasms. Following the resection of all visible tumor areas by CRS, microscopic tumor areas are treated with HIPEC. This procedure increases the quality of life and survival. The CRS with HIPEC is a complex surgical procedure in which the mainly younger and often otherwise healthy patients undergo several pathophysiological changes during the operation. The main concern of the anesthesiologist is the massive volume loss, volume shift and metabolic alterations. Patients with a high comorbidity should undergo preoperative optimization to reduce the perioperative morbidity and mortality especially by protracted interventions.
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Affiliation(s)
- D Bleiler
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - S Bleiler
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | - B Sinner
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
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Golzarri MF, Silva-Sánchez J, Cornejo-Juárez P, Barrios-Camacho H, Chora-Hernández LD, Velázquez-Acosta C, Vilar-Compte D. Colonization by fecal extended-spectrum β-lactamase-producing Enterobacteriaceae and surgical site infections in patients with cancer undergoing gastrointestinal and gynecologic surgery. Am J Infect Control 2019; 47:916-21. [PMID: 30850249 DOI: 10.1016/j.ajic.2019.01.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/27/2019] [Accepted: 01/27/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cancer patients are at increased risk of infection. Fecal carriage of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) may increase this risk. There are few studies on the prevalence of ESBL-PE colonization and surgical site infections (SSIs). METHODS This prospective cohort study included patients with gastrointestinal and gynecological malignancies who were admitted to the hospital for elective surgery. Rectal swab cultures were obtained on the day of admission and during the postoperative period every 5 days. Prevalence of ESBL-PE fecal colonization and risk factors for the development of SSI were assessed. RESULTS We included 171 patients, 30 (17.5%) of whom were colonized with ESBL-PE at admission. This proportion increased to 21% (37 of 171) of the samples during the hospital stay. Incidence of SSI was 14.6% (n = 25). Ten of 37 (27%) patients colonized by ESBL-PE developed SSI versus 15 of 134 (11%) of the non-ESBL-PE (relative risk [RR], 2.163; 95% confidence interval [CI], 1.201-3.897; P = .016). Five patients developed a bloodstream infection, and 4 patients were colonized with ESBL-PE (RR = 4.02; 95% CI, 1.2-3.89; P = .008). CONCLUSIONS The rate of ESBL-PE fecal colonization in surgical patients was 17.5%. Colonization of ESBL-PE duplicated the risk of SSI by the same strain and, by a factor of 4, the risk of bloodstream infections.
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Renz DM, Mentzel HJ. [Imaging of abdominal tumors in childhood and adolescence : Part II: relevant intra-abdominal and retroperitoneal tumor entities]. Radiologe 2018; 58:673-86. [PMID: 29947934 DOI: 10.1007/s00117-018-0410-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Abdominal and pelvic tumors in children and adolescents can be manifested intra-abdominally and also often in the retroperitoneum. The most important pediatric primary retroperitoneal space-occupying lesions are nephroblastoma (Wilms' tumor) and neuroblastoma, whereby imaging plays a decisive role in the diagnostics and differentiation of the two entities. Benign tumors of the mesentery and gastrointestinal tract occur more frequently in children than malignant lesions. The benign entities include lipoma, polyps and vascular tumors, such as lymphatic malformations. Of the malignant sarcomas, abdominal rhabdomyosarcomas (RMS) occur relatively often in childhood and adolescence. The most frequent pediatric abdominal lymphoma is Burkitt's lymphoma, an aggressive subtype of non-Hodgkin's lymphoma. Relevant tumor entities in childhood are also germ cell tumors, which originate from the genitals (gonadal) or can be extragonadally manifested. The benignancy or malignancy of germ cell tumors ranges from benign teratomas to highly malignant entities, such as yolk sac tumors. The germ cell tumors, just as all pediatric abdominal mass lesions, show a broad spectrum of tumor aggressiveness, malignancy and therefore also prognosis and mortality for the affected children and adolescents.
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Abstract
In comparison to adult patients, other specific entities of abdominal tumors occur in childhood and adolescence. These include malignant tumors originating from embryonic tissue, such as hepatoblastoma. Some of the abdominal tumors are already diagnosed prenatally or in neonates. Sonography functions as the primary radiological basic diagnostics of pediatric abdominal space-occupying lesions, if necessary supplemented by administration of ultrasound contrast medium or the implementation of novel techniques (e.g. innovative Doppler and elastography procedures). Magnetic resonance imaging (MRI) is used for a comprehensive and detailed depiction of the tumors including the question of resectability and vascular supply. Various weighting and different MRI sequences are used in order to be able to assess the signal behavior of the tumor and therefore the possible presence of calcification, necrosis or hemorrhage, the behavior of dynamic contrast enhancement, and the presence and extent of diffusion disorders. This information is decisive in order to be able to assess the entity and malignancy of the abdominal space-occupying lesion. Rare but relevant tumors with respect to the entity occur in childhood and adolescence in the abdominal organs liver, spleen and pancreas.
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Affiliation(s)
- D M Renz
- Sektion Pädiatrische Radiologie, Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - H-J Mentzel
- Sektion Pädiatrische Radiologie, Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
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15
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Bleiler D, Bleiler S, Sinner B. [Perioperative management for CRS and HIPEC : Anesthesiological aspects]. Chirurg 2018; 89:687-692. [PMID: 29971459 DOI: 10.1007/s00104-018-0677-3] [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] [Indexed: 11/29/2022]
Abstract
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are therapeutic options for the treatment of intra-abdominal neoplasms. Following the resection of all visible tumor areas by CRS, microscopic tumor areas are treated with HIPEC. This procedure increases the quality of life and survival. The CRS with HIPEC is a complex surgical procedure in which the mainly younger and often otherwise healthy patients undergo several pathophysiological changes during the operation. The main concern of the anesthesiologist is the massive volume loss, volume shift and metabolic alterations. Patients with a high comorbidity should undergo preoperative optimization to reduce the perioperative morbidity and mortality especially by protracted interventions.
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Affiliation(s)
- D Bleiler
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - S Bleiler
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - B Sinner
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
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16
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Stera S, Balermpas P, Chan MKH, Huttenlocher S, Wurster S, Keller C, Imhoff D, Rades D, Dunst J, Rödel C, Hildebrandt G, Blanck O. Breathing-motion-compensated robotic guided stereotactic body radiation therapy : Patterns of failure analysis. Strahlenther Onkol 2017; 194:143-155. [PMID: 28875297 DOI: 10.1007/s00066-017-1204-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 05/24/2017] [Accepted: 08/16/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE We retrospectively evaluated the patterns of failure for robotic guided real-time breathing-motion-compensated (BMC) stereotactic body radiation therapy (SBRT) in the treatment of tumors in moving organs. PATIENTS AND METHODS Between 2011 and 2016, a total of 198 patients with 280 lung, liver, and abdominal tumors were treated with BMC-SBRT. The median gross tumor volume (GTV) was 12.3 cc (0.1-372.0 cc). Medians of mean GTV BEDα/β =10 Gy (BED = biological effective dose) was 148.5 Gy10 (31.5-233.3 Gy10) and prescribed planning target volume (PTV) BEDα/β =10 Gy was 89.7 Gy10 (28.8-151.2 Gy10), respectively. We analyzed overall survival (OS) and local control (LC) based on various factors, including BEDs with α/β ratios of 15 Gy (lung metastases), 21 Gy (primary lung tumors), and 27 Gy (liver metastases). RESULTS Median follow-up was 10.4 months (2.0-59.0 months). The 2‑year actuarial LC was 100 and 86.4% for primary early and advanced stage lung tumors, respectively, 100% for lung metastases, 82.2% for liver metastases, and 90% for extrapulmonary extrahepatic metastases. The 2‑year OS rate was 47.9% for all patients. In uni- and multivariate analysis, comparatively lower PTV prescription dose (equivalence of 3 × 12-13 Gy) and higher average GTV dose (equivalence of 3 × 18 Gy) to current practice were significantly associated with LC. For OS, Karnofsky performance score (100%), gender (female), and SBRT without simultaneous chemotherapy were significant prognostic factors. Grade 3 side effects were rare (0.5%). CONCLUSIONS Robotic guided BMC-SBRT can be considered a safe and effective treatment for solid tumors in moving organs. To reach sufficient local control rates, high average GTV doses are necessary. Further prospective studies are warranted to evaluate these points.
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Affiliation(s)
- Susanne Stera
- Department of Radiation Oncology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Panagiotis Balermpas
- Department of Radiation Oncology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.,Saphir Radiosurgery Center, Frankfurt, Germany
| | - Mark K H Chan
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | | | - Stefan Wurster
- Saphir Radiosurgery Center, Güstrow, Germany.,Department of Radiation Oncology, University Medicine Greifswald, Greifswald, Germany
| | - Christian Keller
- Department of Radiation Oncology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.,Saphir Radiosurgery Center, Frankfurt, Germany
| | - Detlef Imhoff
- Department of Radiation Oncology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Dirk Rades
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Jürgen Dunst
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany.,Department of Radiation Oncology, University Hospital Copenhagen, Copenhagen, Denmark
| | - Claus Rödel
- Department of Radiation Oncology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Guido Hildebrandt
- Department of Radiation Oncology, University Medicine Rostock, Rostock, Germany
| | - Oliver Blanck
- Saphir Radiosurgery Center, Frankfurt, Germany.,Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany.,Saphir Radiosurgery Center, Güstrow, Germany
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Pavan H, Rihl MF, Oliveira de Freitas SL. Mesenteric Leiomyoma in Infancy. J Indian Assoc Pediatr Surg 2017; 22:173-175. [PMID: 28694578 PMCID: PMC5473307 DOI: 10.4103/jiaps.jiaps_143_16] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 10-year-old female presented with a palpable mass occupying the entire abdomen. Computerized tomography scan showed a large expansive lesion measuring 22 cm × 20 cm × 13 cm. The mass was resected and the diagnosis of leiomyoma was made from immunehistochemical findings. Mesenteric leiomyoma is an uncommon tumor among gastrointestinal stromal tumors.
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Affiliation(s)
- Henrique Pavan
- Department of Pediatric Surgery, University of Caxias do Sul, Caxias do Sul, Brazil
| | - Marcos Frata Rihl
- Department of Pediatric Surgery, University of Caxias do Sul, Caxias do Sul, Brazil
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Abstract
Diffusion-weighted magnetic resonance imaging (DWI) provides image contrast that is different from that obtained by conventional magnetic resonance techniques. Although previously, DWI has been used to evaluate various diseases of the central nervous system, several technical advances have expanded the clinical applications of DWI beyond the central nervous system. As a result, many reports have been published on the use of DWI in abdominal diseases. Particularly, abdominal DWI has now being focused on evaluation of patients with abdominal cancer. DWI can be used for pretreatment tumor detection, characterization including predicting tumor response to therapy, monitoring tumor response during therapy, and follow-up study after treatment to detect possible tumor recurrence.
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Abstract
We present a rare case of a 45-year-old woman who presented with epigastric pain associated with early satiety and weight loss. Imaging revealed a large intra-abdominal mass in the epigastrium. Despite intensive investigations, including ultrasound scanning, computed tomography, upper gastrointestinal endoscopy, and percutaneous biopsy, a diagnosis could not be obtained. A histological diagnosis of cavernous hemangioma arising from the gastro-splenic ligament was confirmed after laparoscopic excision and histological examination of the intra-abdominal epigastric mass.
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