Predictive Factors for Local Control and Survival in Patients with Cancer of Unknown Primary (CUP) Irradiated for Cerebral Metastases

Background/Aim: To identify predictors of local control and survival after whole-brain irradiation (WBI) for cerebral metastases from cancer of unknown primary (CUP). Patients and Methods: In 140 patients receiving WBI alone or following resection, seven factors were investigated including treatment approach, WBI-regimen, age, gender, Eastern Cooperative Oncology Group (ECOG) performance score, number of cerebral lesions and extra-cerebral metastases. Results: On univariate analysis, resection plus WBI and boost (p=0.002), ECOG 0-1 (p<0.001) and a single lesion (p<0.001) were positively associated with local control. On Cox regression, ECOG-score remained significant (p=0.002). On univariate analysis of survival, surgery plus WBI and boost (p=0.009), ECOG 0-1 (p<0.001), a single lesion (p=0.024) and no extra-cerebral metastases (p<0.001) were associated with better outcomes. On Cox regression, ECOG-score (p<0.001) and extra-cerebral lesions (p<0.001) were significant. Conclusion: Significant predictors of local control and survival were identified that contribute to treatment personalization and design of prospective trials in patients with cerebral metastases from CUP.

https://ift.tt/2pQJiWG

Interventions to Reduce Neurological Symptoms in Patients with GBM Receiving Radiotherapy: From Theory to Clinical Practice

Background: Patients affected by glioblastoma often develop cerebral oedema as a life-threatening complication. Although there is no approved pharmacological intervention, such cerebral oedema is usually treated with dexamethasone. Dexamethasone has been shown in experimental studies to reduce cerebral oedema with only few mineralocorticoid side-effects. The goal of our study was to examine its efficacy in reducing the emergence of neurological deficits during the Stupp protocol. Patients and Methods: We studied a retrospective cohort of 459 patients, assigned in controlled groups: in group A, patients received radiochemotherapy followed by adjuvant chemotherapy; in group B, patients received an equivalent combined treatment with dexamethasone. Results: The frequency of neurological symptoms was significantly lower in dexamethasone-treated patients. Conclusion: Early diagnosis and prevention of cerebral oedema are important because functional consequences can be anticipated with an appropriate medical treatment. Thus, our study reveals that dexamethasone acts to prevent the appearance of neurological symptoms in patients with brain tumour.

https://ift.tt/2J435Lo

Metformin-associated Chemopreventive Effects on Recurrence After Hepatic Resection of Hepatocellular Carcinoma: From In Vitro to a Clinical Study

Background/Aim: We investigated metformin-induced cytotoxic effects in vitro and assessed the chemopreventive effects of metformin in patients undergoing hepatic resection (HR) for hepatocellular carcinoma (HCC). Materials and Methods: This study consisted of laboratory and clinical studies. Results: In vitro study using HCC cell lines revealed noticeable cytotoxic effects of metformin, that were largely weaker than those of sorafenib. In the clinical study, no statistical differences were found in tumor recurrence or overall survival between metformin and control groups. In contrast, there was a non-significant difference in tumor recurrence between metformin and propensity score-matched control groups, but there was a significant difference in overall patient survival. Metformin administration was an independent risk factor for patient survival. Conclusion: In conclusion, our in vitro laboratory study demonstrated the presence of cytotoxic effects of metformin. Metformin administration was associated with reduced tumor recurrence and helped induce significant improvements in overall patient survival in patients who underwent HR for HCC.

https://ift.tt/2pQ6Pan

Cost-effectiveness of Multiparametric MRI in 800 Men Submitted to Repeat Prostate Biopsy: Results of a Public Health Model

Background/Aim: To evaluate the cost-effectiveness of multiparametric magnetic imaging resonance (mpMRI) in men submitted to repeat saturation prostate biopsy (SPBx). Materials and Methods: From January 2011 to June 2017, 800 men underwent repeat SPBx; the cost-effectiveness of mpMRI if used as a 'triage test' to avoid unnecessary repeat prostate biopsy was retrospectively calculated using the Italian Public National Health System Day Service. Results: SPBx vs. MRI fusion targeted biopsy diagnosed 215 (89.5%) vs. 184 (76.6%) out of 240, respectively. The overall cost of the 800 prostate biopsies was 138,221 ; the use of mpMRI as triage test would have spared 364/800 procedures, equivalent to 60,905 (44% of the entire cost), whilst missing 15/205 (7.3%) cases of clinically significant cancer. Conclusion: mpMRI used as a triage test could reduce the need for prostate biopsies by about 45%, thereby improving cost-effectiveness, however, patients should be informed of the false-negative rate associated with mpMRI.

https://ift.tt/2J433Dg

Phase I-II Study of Short-course Accelerated Radiotherapy (SHARON) for Palliation in Head and Neck Cancer

Aim: To determine the maximum tolerated dose (MTD) of a short-course accelerated radiotherapy and its feasibility for symptomatic palliation of advanced head and neck cancer or head and neck metastases from any primary site. Patients and Methods: A phase I trial in four dose-escalation steps was planned: total dose ranged between 14 and 20 Gy in a total of four fractions administered twice a day. The dose-limiting toxicity (DLT) was determined as grade 3 or more toxicity occurring during treatment. The MTD obtained was used to plan a phase II trial. Results: A total of 48 patients were treated. In the phase I trial, the 20 Gy dose level was determined to be the MTD. In the phase II trial, the palliative response rate was 82.7%, with a median duration of palliation of 3 months. Conclusion: Short-course accelerated radiotherapy was well tolerated and effective for palliation. These findings may help design future prospective randomized studies.

https://ift.tt/2pP2vIw

Feasibility Study of Sequentially Alternating EGFR-TKIs and Chemotherapy for Patients with Non-small Cell Lung Cancer

Background/Aim: The purpose of this trial was to evaluate the feasibility and efficacy of alternating platinum-based doublet chemotherapy with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in patients with EGFR-mutant non-small cell lung cancer (NSCLC). Patients and Methods: Chemotherapy-naive patients with advanced NSCLC harboring an EGFR mutation were enrolled. All patients underwent induction chemotherapy by sequentially alternating pemetrexed/cisplatin/bevacizumab and EGFR-TKIs followed by maintenance therapy with pemetrexed/bevacizumab and EGFR-TKIs. The primary outcome was the completion rate of the induction therapy. Results: Eighteen eligible patients were enrolled between May 2011 and March 2016. The completion rate of induction therapy was 72.2% (13/18). Unfortunately, one patient developed grade 4 acute renal injury, but no other serious complications concerning this protocol were observed. Furthermore, diarrhea, rashes, and hematological adverse effects were mild. Conclusion: The completion rate of induction therapy was promising. Alternating chemotherapy and EGFR-TKIs should be further investigated regarding feasibility and efficacy.

https://ift.tt/2IZ7HSV

Tumor Enhancement on Dynamic CT: A Predictive Factor for Recurrence After Nephrectomy in Localized T1 Clear Cell Renal Cell Carcinoma

Aim: To investigate whether radiological parameters obtained on dynamic computed tomography (CT), especially those related to tumor enhancement, are predictive factors for recurrence after nephrectomy in localized stage T1 clear cell renal cell carcinoma (ccRCC). Materials and Methods: We retrospectively studied 88 patients with localized stage T1 ccRCC who underwent dynamic CT preoperatively. Seven patients had recurrent disease after surgery. Tumor attenuations were measured by placing a region of interest in the solid region. TA_pre and TA_neph were defined as the tumor attenuation values of the pre-contrast and nephrographic phase, respectively. The correlations between disease-free survival and clinicopathological factors, including the radiological parameter TA_neph – TA_pre (TA_neph), were analyzed by Cox proportional hazards model or Kaplan–Meier method with the log-rank test. Results: Only TA_neph was significantly and positively correlated with disease-free survival (p<0.05). Tumor size also tended to be negatively correlated with disease-free survival (p<0.1). The 5- and 10-year disease-free survival rates of the group with high TA_neph (≥86 HU) were 97.4% and 97.4%, while those of the group with low TA_neph (<86 HU) were 89.6% and 71.6%, respectively. Conclusion: Tumor enhancement in the nephrographic phase of CT was a predictive factor for recurrence after nephrectomy in patients with localized stage T1 ccRCC.

https://ift.tt/2pP2unW

Performance Status and Number of Metastatic Extra-cerebral Sites Predict Survival After Radiotherapy of Brain Metastases from Thyroid Cancer

Background/Aim: Patients with brain metastases from thyroid cancer are extremely rare. This study evaluated clinical factors for survival following whole-brain radiotherapy (WBRT) alone. Patients and Methods: In six patients, the following factors were analyzed for survival: Regimen of WBRT (5x4 Gy vs. 10x3 Gy), gender, age (≤55 vs. ≥56 years), Karnofsky performance score (KPS) (60% vs. 70-80%), number of brain lesions (2-3 vs. ≥4) and number of extra-cranial metastatic sites (one vs. more than one). Results: KPS 70-80% (p=0.036) and involvement of only one extra-cranial site (p=0.018) were associated with better survival on univariate analysis. On Cox regression analysis, KPS (p=0.14) and number of extra-cranial sites (p=0.14) showed trends for association with survival. In patients with KPS 70-80% and only one extra-cranial site, 6-month survival was 100%, no patient with KPS 60% and more than one extra-cranial site survived to 6 months. Conclusion: KPS and number of involved extra-cranial metastatic sites were associated with survival and may be helpful for individualizing therapy in patients with brain metastases from thyroid cancer.

https://ift.tt/2J1wZ2E

Curative Gastrectomy with Perioperative Chemotherapy Improves the Survival for Unresectable Gastric Cancer

Background/Aim: Although there are a few reports recommending gastrectomy for unresectable gastric cancer (UGC) to improve survival, the advantage of gastrectomy remains unclear. The objective of this study was to assess the meanings of the surgical intervention. Patients and Methods: Therapeutic outcomes were retrospectively evaluated in 127 patients with UGC. All patients had chemotherapy and 47 patients underwent gastrectomy. Patients were classified to three groups according to the treatment. Results: Multivariate analysis showed that gastrectomy was in independent favorable prognosis factor (p<0.001) as well as performance status 0/1, differentiated type, absence of distant organ metastasis, and second line chemotherapy for UGC. Among the patients with gastrectomy, R0 resection was an independent prognostic factor (p=0.011). R0 resection was mainly achieved when there was a single non-curable factor and no distant organ metastasis (p=0.007 and p=0.024, respectively). Conclusion: Gastrectomy has an advantage in improving the survival in selected cases among UGC. If chemotherapy enables to control the non-curable factors, gastrectomy should be considered.

https://ift.tt/2pQtIup

The Clinical Usefulness of the LigaSure™ Small Jaw in Axillary Lymph Node Dissection in Patients with Breast Cancer

Background: The LigaSure™ small jaw (LS-SJ) multifunctional tissue sealing system is mainly used in cervical operations. We aimed to evaluate the clinical efficacy of the LS-SJ in axillary lymph node dissection (ALND) in comparison to the conventional method. Patients and Methods: Ninety-two patients with breast cancer who underwent total mastectomy and ALND were included in this study. The patients were divided into the LS-SJ group (n=43) and the conventional-ALND (c-ALND) group (n=49). Results: Patients with high body mass index values had a greater drainage volume and longer time to drain removal. The drainage volume was in the LS-SJ group was significantly lower than that in the c-ALND group. The time to drain removal and the hospitalization period were also significantly shorter in the LS-SJ group. The LS-SJ was more effective for ALND in obese patients. Conclusion: The results suggest the clinical usefulness of LS-SJ in ALND in patients with breast cancer, especially in obese patients.

https://ift.tt/2J0UAjU

Effects of {omega}-3 Fatty Acid Supplementation in Patients with Bile Duct or Pancreatic Cancer Undergoing Chemotherapy

Background/Aim: Omega-3 fatty acids may improve cancer cachexia, but only in patients with pancreatic and bile duct cancer. Patients with pancreatic cancer commonly suffer from exocrine pancreatic insufficiency, and the ingestion of digestive enzyme supplements may improve absorption. Patients and Methods: Racol®, an enteral nutrient formulated with omega-3 fatty acids, was administered to patients with unresectable pancreatic and bile duct cancer. The skeletal muscle mass and blood test data were taken pre-administration and at 4 and 8 weeks after. Patients with pancreatic cancer were given the digestive enzyme supplement LipaCreon® from the fifth week after the start of administration. Results: In all 27 patients, skeletal muscle mass was significantly increased at both 4 and 8 weeks after the start of administration versus pre-administration (p=0.006, p=0.002, respectively). Conclusion: Omega-3 fatty acid supplementation in patients with unresectable pancreatic and bile duct cancer may improve cancer cachexia.

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A rare challenging case of co-existent craniopharyngioma, acromegaly and squamous cell lung cancer

Summary

Co-existence of craniopharyngioma and acromegaly has been very rarely reported. A 65-year-old man presented with visual deterioration, fatigue and frontal headaches. Magnetic resonance imaging revealed a suprasellar heterogeneous, mainly cystic, 1.9 × 2 × 1.9 cm mass compressing the optic chiasm and expanding to the third ventricle; the findings were consistent with a craniopharyngioma. Pituitary hormone profile showed hypogonadotropic hypogonadism, mildly elevated prolactin, increased insulin-like growth factor 1 (IGF-1) and normal thyroid function and cortisol reserve. The patient had transsphenoidal surgery and pathology of the specimen was diagnostic of adamantinomatous craniopharyngioma. Post-operatively, he had diabetes insipidus, hypogonadotropic hypogonadism and adrenocorticotropic hormone and thyroid-stimulating hormone deficiency. Despite the hypopituitarism, his IGF-1 levels remained elevated and subsequent oral glucose tolerance test did not show complete growth hormone (GH) suppression. Further review of the pre-operative imaging revealed a 12 × 4 mm pituitary adenoma close to the right carotid artery and no signs of pituitary hyperplasia. At that time, he was also diagnosed with squamous cell carcinoma of the left upper lung lobe finally managed with radical radiotherapy. Treatment with long-acting somatostatin analogue was initiated leading to biochemical control of the acromegaly. Latest imaging has shown no evidence of craniopharyngioma regrowth and stable adenoma. This is a unique case report of co-existence of craniopharyngioma, acromegaly and squamous lung cell carcinoma that highlights diagnostic and management challenges. Potential effects of the GH hypersecretion on the co-existent tumours of this patient are also briefly discussed.

Learning points:

Although an extremely rare clinical scenario, craniopharyngioma and acromegaly can co-exist; aetiopathogenic link between these two conditions is unlikely.

Meticulous review of unexpected biochemical findings is vital for correct diagnosis of dual pituitary pathology.

The potential adverse impact of GH excess due to acromegaly in a patient with craniopharyngioma (and other neoplasm) mandates adequate biochemical control of the GH hypersecretion.

https://ift.tt/2IcYDIS

Scholar : Obstructive sleep apnea - νέα αποτελέσματα

Patients with chronic rhinosinusitis and obstructive sleep apnea have increased paroxysmal limb movement

M Mahdavinia, JW Hui, M Zitun, A Lastra, JJ Herdegen… - American Journal of …, 2018

Background: Patients with chronic rhinosinusitis (CRS) frequently experience sleep
disruption and are at a higher than normal risk for obstructive sleep apnea (OSA).
The purpose of this study was to determine how CRS affects polysomnography …

Detection on pharyngeal wall floppiness in patients with nonstructural factor-induced obstructive sleep apnea-hypopnea syndrome: Difference in position detection.

Z Lin, K Jiang, L Zhao, S Li, S Shao, W Qian, Z Tao - The Laryngoscope, 2018

Abstract To evaluate changes in pharyngeal wall floppiness (PWF) between patients
with obstructive sleep apnea-hypopnea syndrome induced by non-upper-airway
structural factors and normal subjects, as well as the clinical significance using …

[HTML] Optimizing Treatment Success in Sleep Apnea

CE Elias, TL Davis, L Burgess, MD Burk, R John - 2018

… Abstract. Abstract. Purpose: Obstructive Sleep Apnea (OSA) is an exceedingly common
disorder in America with estimates of disease prevalence ranging from 3-7% of the entire
population, and it is likely that this is a gross underestimation …

[PDF] Intravenous acetaminophen: A study of effectiveness of practice of intraoperative administration in children undergoing adenotonsillectomy

K Sadacharam, BR Brenn - 2018

… Perioperative pain management in this surgical population is challenging due to obstructive
sleep apnea and other comorbidities … Recurrent hypoxemia in young chil- dren with
obstructive sleep apnea is associated with reduced opioid requirement for analgesia …

Peripheral Nerve Stimulation

M Ahmed, MA Huntoon - Essentials of Pain Medicine (Fourth Edition), 2018

… 7 ; 8 PNS has been also tried in functional conditions such as, but not limited
to, vagus nerve stimulation for obesity treatment; carotid sinus stimulation
for resistant hypertension and heart failure; hypoglossal nerve stimulation …

[HTML] Ambulatory blood pressure in relation to oxygen desaturation index as simultaneously assessed by nighttime finger pulse oximetry at home

Q Chen, YB Cheng, CY Liu, QH Guo, SK Xu, QF Huang… - The Journal of Clinical …, 2018

… by overnight finger pulse oximetry in 2342 participants on the day of
ambulatory BP monitoring, and calculated as the number of desaturation
episodes per sleeping hour … Obstructive sleep apnea and hypopnea …

Endocrine Hypertensive Emergencies

G Eisenhofer, A Januszewicz, C Pamporaki… - Endocrine and Metabolic …, 2018

Patient-Controlled Analgesia

EM Soffin, SS Liu - Essentials of Pain Medicine (Fourth Edition), 2018

… levels and improve analgesia. 32 However, other investigators found that addition
of a basal infusion rate did not reduce pain, fatigue, or anxiety, 31 ; 36 and failed
to improve quality of sleep. The number of patient demands …

Intrathecal Opioids for Postoperative Pain

N Conlin, MC Grant, CL Wu - Essentials of Pain Medicine (Fourth Edition), 2018

… Supplemental oxygen may prevent hypoxemia but may not correct the
underlying etiology or even worsen hypoventilation and hypercarbia due
to the elimination of hypoxic respiratory drive, especially when obstruction …

Pulmonary Function in the Geriatric Patient

NL Werner, LM Napolitano - Geriatric Trauma and Acute Care Surgery, 2018

… disease General health status Asthma Obesity Interstitial lung disease
Obstructive sleep apnea Upper respiratory … or fully dependent 7 functional
status History of chronic 6 obstructive pulmonary disease … The airway should …

 

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Scholar : CPAP - νέα αποτελέσματα

A Retrospective Study of Neonatal Outcome in Preeclampsia at the University Hospital of the West Indies: A Resource-limited Setting

KA McKenzie, H Trotman - Journal of Tropical Pediatrics, 2018

… In total, 9 (13%) of the neonates born to women with preeclampsia received
mechanical ventilation, 7 (10%) received bubble continuous positive airway pressure
(CPAP) ventilation and 17 (25%) received oxygen via a headbox …

脑心通治疗阻塞性睡眠呼吸暂停低通气综合征的疗效研究

刘娟， 陆晓玲， 俞列群 - 中国慢性病预防与控制, 2018

… OSAHS)的疗效,为临床治疗提供依据。方法选择2016年4月至2017年3月浙江医院呼吸
科收治的96例OSAHS患者为研究对象,随机分为联合治疗组和对照组,每组48例。
对照组采用持续正压通气(CPAP)治疗。联合治疗组在对照组的基础上,采用脑心通胶囊治疗 …

机械通气治疗新生儿肺透明膜病的肺保护性临床分析

詹志义， 刘宁 - 当代医学, 2018

… 摘要】：目的分析机械通气治疗新生儿肺透明膜病的肺保护性效果。方法选择
48例新生儿肺透明膜病患儿根据随机数字表分组,对照组采用药物加CPAP治疗,
治疗组采用药物加无创机械通气治疗。比较两组肺透明膜病治疗成功率; …

[HTML] Ambulatory blood pressure in relation to oxygen desaturation index as simultaneously assessed by nighttime finger pulse oximetry at home

Q Chen, YB Cheng, CY Liu, QH Guo, SK Xu, QF Huang… - The Journal of Clinical …, 2018

… subjects were consecutive patients who were referred for ambulatory blood
pressure monitoring in the specialized hypertension outpatient clinic, Ruijin
Hospital, Shanghai, China; they were not aware of OSAHS nor on continuous …

Pediatric Emergencies

CM Horvat, MF Hamilton, C Dezfulian - Rapid Response System: A Practical Guide, 2018

2.1 Medikamentöse Prämedikation–18

W Wilhelm - Praxis der Anästhesiologie: konkret-kompakt …, 2018

5-HIAA βHBA A1C AACE ABCDE

A II - Endocrine and Metabolic Medical Emergencies: A …, 2018

Noninvasive positive airway pressure therapy of the obesity hypoventilation syndrome

TJ Martin

… Approximately 90 percent of patients with OHS have coexisting obstructive
sleep apnea (OSA), in which case continuous positive airway pressure
(CPAP) is the initial mode of choice … Patients with OHS and OSA who fail …

Patient-Controlled Analgesia

EM Soffin, SS Liu - Essentials of Pain Medicine (Fourth Edition), 2018

Patient-controlled analgesia (PCA) is a common, effective method for achieving
postoperative pain control. Classically, opioids are self-administered intravenou.

Compound heterozygosity for loss-of-function FARSB variants in a patient with classic features of recessive aminoacyl-tRNA synthetase-related disease

A Antonellis, SN Oprescu, LB Griffin, A Heider… - Ann Arbor, 2018

… chronic problem during and after this hospitalization). After extubation, he was placed
on CPAP and then weaned to high flow nasal cannula and then room air over the
course of a week. He remained intermittently tachypneic …

 

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