RESUMO
A group of 79 patients with non-resectable lung carcinomas (T1, 1; T2, 13; T3, 34; T4, 19; recurrence, 12) underwent endobronchial iridium-192 high-dose rate afterloading therapy (5 Gy/session total dose: 5-25 Gy, mean 11.6 Gy). In 39 cases the fair general condition and absence of metastases allowed external-beam irradiation (EBR) to be administered (50-70 Gy total dose; 2gy/day), starting 1 week after the brachytherapy session. In nine cases with superior vena cava syndrome, EBR (30 Gy total dose; 3 Gy/day) was administered concomitantly. Improvement in symptoms of respiratory obstruction was noted in 87% of our patients. The mean duration of palliation was 17.1 weeks in the group without and 34.7 weeks in that with additional EBR. The median survival time was 6 months without and 13 months with additional EBR. In T4 cases EBR had no impact on the 1-year survival (30.8% vs 24.4%, P > 0.05). The rate of severe complications was 7%, without significant differences between cases with or without EBR.
Assuntos
Obstrução das Vias Respiratórias/radioterapia , Braquiterapia , Neoplasias Brônquicas/radioterapia , Carcinoma/radioterapia , Neoplasias da Traqueia/radioterapia , Obstrução das Vias Respiratórias/etiologia , Braquiterapia/efeitos adversos , Braquiterapia/métodos , Neoplasias Brônquicas/complicações , Neoplasias Brônquicas/secundário , Carcinoma/complicações , Carcinoma/secundário , Humanos , Radioisótopos de Irídio/uso terapêutico , Terapia a Laser/métodos , Neoplasias Pulmonares/patologia , Estadiamento de Neoplasias , Dosagem Radioterapêutica , Análise de Sobrevida , Neoplasias da Traqueia/complicações , Neoplasias da Traqueia/secundário , Resultado do TratamentoRESUMO
Forty-eight patients with non-resectable cancer of the oesophagus and oesophagogastric junction (Group A: Stage I/II, 32; Group B: Stage III/IV, 16) underwent intraluminal Iridium-192 high dose-rate afterloading therapy (5-7 Gy/session, total dose: 5-21 Gy, mean: 12.4 Gy) and external beam irradiation (Karnofsky > or = 80% 50-60 Gy/2 Gy per day; Karnofsky 60-79%: 30 Gy/3 Gy per day). Durable satisfactory palliation (intake of at least semi-solid food) was demonstrated in 96% of patients. The mean survival for group A was 19.1 months and that for group B, 6.9 months, with a 12-month survival rate of 66% (group A) and 0% (group B) (P < 0.001). Local tumour response and complication rate were significantly dose-related with a predicted response rate of 70.5%, and a complication rate of 50% at ERD 129.3 Gy.
Assuntos
Neoplasias Esofágicas/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Braquiterapia/efeitos adversos , Relação Dose-Resposta à Radiação , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Feminino , Humanos , Radioisótopos de Irídio , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Dosagem Radioterapêutica , Taxa de SobrevidaRESUMO
This trial was designed to study the correlation between peri-operative mortality in patients undergoing elective surgery and the physical status classification of the American Society of Anesthesiologists, the Goldman multifactorial cardiac risk index or the two indices combined. All patients scheduled for elective surgery over a 5-year period were evaluated pre-operatively and were scored according to both indices. Of 16,227 patients studied, 215 died within 4 weeks of operation. Both indices correlated significantly with peri-operative mortality, the ASA grade showing a closer correlation. A regression tree analysis divided the combination groups into five subgroups where the mortality was lowest (0.4%) in ASA grade < or = 2 and cardiac risk index group I (score 0-5 points) and increased up to 7.3% in ASA grade = 4 and cardiac risk index group > or = 3 (score > 13 points). We conclude that for this large number of patients peri-operative mortality can be predicted with the ASA grade and, to a lesser degree, with the cardiac risk index. Applied in the correct way, the combination of the two scores can increase the accuracy of prediction of peri-operative mortality.
Assuntos
Procedimentos Cirúrgicos Eletivos/mortalidade , Indicadores Básicos de Saúde , Cuidados Pré-Operatórios/métodos , Adulto , Cardiopatias/etiologia , Humanos , Valor Preditivo dos Testes , Estudos Prospectivos , Medição de RiscoRESUMO
BACKGROUND: Polytetrafluoroethylene (PTFE), dacron, and, more recently, collagen prostheses are finding increasing use for femoropopliteal reconstruction when a suitable vein is not available. The main factors to be considered when choosing a prosthesis are patency, susceptibility to infection and formation of aneurysms. METHODS: Sheep collagen prostheses were implanted on 274 occasions in the femoropopliteal or crural regions. RESULTS: The patency rate for supragenual bypass after 3 years was 61.9% with good vascular periphery and 44% with poor vascular periphery. If the prosthesis extended below the knee, the patency rate was 55.4% with good and 35.3% with unfavourable vascular periphery. Patency for the femorocrural bypass was 28.7% after 2 years. The rate of infection was 0% and an aneurysm occurred in three patients (1.1%). CONCLUSIONS: With this low infection rate and very slight danger of aneurysm, the long-term results suggest that the ovine collagen prosthesis can be recommended for use when no suitable vein is available.