Factors associated with adjuvant treatment delays in patients treated surgically for head and neck cancer.

OBJECTIVE: To determine the patient and treatment characteristics associated with delay in post-operative radiation therapy (PORT) for patients treated surgically for head and neck squamous cell cancer (HNSCC) at our institution. DESIGN: Single institution retrospective review. SETTING: Tertiary care academic medical centre. PARTICIPANTS: Patients treated surgically for HNSCC who underwent PORT between 2013 and 2016. MAIN OUTCOME MEASURES AND RESULTS: One hundred forty patients met inclusion criteria. A majority did not start radiotherapy within 6 weeks. Factors associated with a delayed initiation of PORT included length of stay >8 days, 30-day readmission, no adjuvant chemotherapy, post-operative complications and fragmented care. CONCLUSIONS: A majority of patients did not initiate PORT within the guideline-recommended 6 weeks. Modifiable risks factors that delay initiation of PORT were identified.

Fluid Flow Patterns Through Drainage Catheters: Clinical Observations in 99 Patients.

PURPOSE: To describe patterns of fluid flow through locking pigtail and biliary catheters in patients that underwent biliary and abdominopelvic fluid drainage. METHODS: Contrast movement through catheter sideholes in pigtail and biliary catheters was evaluated retrospectively using sinograms and cholangiograms at 7-10 days post insertion. Dilute contrast injected through the catheter was evaluated by following flow through the catheter shaft and exit from side holes within the body cavity. Exit of contrast through side holes was appreciated and recorded. Included patients underwent biliary and abdominopelvic fluid drainage using 10.2-F catheters. Exclusion criteria included masking of contrast flow through sideholes by catheter angulation, contrast pooling or other imaging artifacts. RESULTS: A total of 99 patients meeting inclusion criteria underwent evaluation of contrast flow through pigtail (n = 81) and biliary (n = 18) catheters. For pigtail and biliary catheters, 91/99 cases (91.9%) showed contrast exiting the catheter from only the sidehole located most proximally to the catheter hub. In 6/99 cases (6.1%) contrast exited no further than the second most proximal sidehole. In 2/99 cases (2.0%) contrast exited no further than the third most proximal sidehole. In no cases was contrast observed exiting from distal sideholes beyond the third most proximal sidehole. CONCLUSION: Retrograde contrast injection through catheters suggests that the majority of the contribution to total output in drainage catheters comes from the most proximal side hole. Contribution of distal side holes to total drainage is negligible or non-existent, therefore the distal segment of the catheter may be considered non-functional.

Ethanol ablation in postbiopsy liver hemorrhage following two failed embolizations.

A 42-year-old male presented with intraperitoneal hemorrhage 5days following percutaneous liver biopsy for suspected hepatocellular carcinoma. Diagnostic angiogram localized the bleeding to segment VI hepatic artery branches. Two consecutive arterial embolizations with microspheres and platinum coils failed to control the bleeding. The patient was a poor surgical candidate, so ultrasound-guided ethanol ablation of the bleeding source and surrounding liver segment was employed as salvage therapy. The patient stabilized clinically and was discharged home to begin palliative therapy.