Incidence of fibroblastic sleeve and of catheter-related venous thrombosis in peripherally inserted central catheters: A prospective study on oncological and hematological patients.

BACKGROUND: Insertion of peripherally inserted central catheters in oncological patients is potentially associated with catheter-related thrombosis and fibroblastic sleeve; the actual incidence and interactions between these two non-infective complications have never been investigated in a prospective clinical study on peripherally inserted central catheters. METHODS: In a cohort of oncological/hematological patients with peripherally inserted central catheter, we evaluated the occurrence of catheter-related thrombosis and/or fibroblastic sleeve, examining all patients by ultrasound scan at days 7, 14, 21, and 28 after insertion. We correlated our findings with the type of disease. RESULTS: We enrolled 254 patients with power injectable polyurethane 4Fr peripherally inserted central catheters. Ultrasound scan of the veins of the arm showed fibroblastic sleeve in 76 patients (29.9%); the fibroblastic sleeve was first detected on day 7 in 45 cases (17.7%), on day 14 in 26 cases (10.2%), on day 21 in 3 cases (1.2%), and on day 28 in 2 cases (0.79%). There was no correlation between the type of disease and the development of fibroblastic sleeve. The incidence of asymptomatic catheter-related thrombosis was 5.12%: all catheter-related thromboses were detected before day 14. There was only one case of symptomatic catheter-related thrombosis (0.39%) in a leukemia patient. Fibroblastic sleeve and catheter-related thrombosis were associated only in two cases (0.78%). CONCLUSION: Fibroblastic sleeve is a frequent (29.9%) but asymptomatic finding in oncological and hematological patients with peripherally inserted central catheter, and-in the vast majority of cases-it occurs within 2 weeks after insertion. If compared to fibroblastic sleeve, asymptomatic catheter-related thrombosis is less frequent (5.51%); symptomatic catheter-related thrombosis is rare (<1%).

Irreversible electroporation of locally advanced solid pseudopapillary carcinoma of the pancreas: A case report.

INTRODUCTION: Solid pseudopapillary Carcinoma (SPC) is a rare pancreatic Tumor with variable, usually low, malignancy potential. Howewer, several SPC are associated with aggressive behavior, local vascular infiltration, organ invasion, distant metastasis, and can be unresectable. Irreversible Electroporation (IRE) is an emerging non-thermal ablation technique for the treatment of locally advanced pancreatic carcinoma. We report the results of four year disease-free follow-up in a case of locally advanced unresectable SPC treated with IRE. PRESENTATION OF CASE: A 24-year female patient with SPC of the pancreas underwent IRE during laparotomy under general anesthesia with intubation. Computed Tomography (CT) showed complete tumor thrombosis of splenic vein, encasement of celiac artery and mesenteric vein. Six insertions of 3-4 electrodes per insertion were performed. One month-CT-control showed shrinkage of the tumor. 6 months-post-treatment imaging showed complete regression of the mass, patent Splenic/mesenteric veins, absence of local recurrence or distant metastasis. Post treatment CTs at 12-18-24-30-36-42-48 months follow-up confirmed absence of local or distant recurrence. DISCUSSION: Surgery is the first choice curative treatment of SPC. Howewer aggressive surgery (duodeno-pancreasectomy) in unresectable cases, may have a high risk of recurrences, morbidities and death, and bring concerns about endocrine and exocrine insufficiency in a young patient. In these cases, IRE could be a safe and effective alternative treatment and could realize, in selected cases, the condition for a radical surgery, and a bridge to R-0 resection. CONCLUSIONS: IRE could represent an effective alternative therapy to surgery in local advanced, unresectable SPC.