Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 7.238
Filtrar
1.
Zhongguo Yi Liao Qi Xie Za Zhi ; 45(2): 176-182, 2021 Apr 08.
Artículo en Chino | MEDLINE | ID: mdl-33825378

RESUMEN

The methods of monitoring the thermal ablation of tumor are compared and analyzed in recent years. The principle method results and insufficient of ultrasound elastography and quantitative ultrasound imaging are discussed. The results show that ultrasonic tissue signature has great development space in the field of real-time monitoring of thermal ablation, but there are still some problems such as insufficient monitoring accuracy difficulty in whole-course monitoring and insufficient in vivo experiments, so it is impossible to realize clinical application. It is necessary to further study the monitoring method which can realize accurate and real-time detection of ablation zone and transition zone and can be easily combined with the existing ultrasonic equipment.


Asunto(s)
Ablación por Catéter , Diagnóstico por Imagen de Elasticidad , Hipertermia Inducida , Neoplasias , Humanos , Hígado/diagnóstico por imagen , Hígado/cirugía , Neoplasias/diagnóstico por imagen , Neoplasias/cirugía , Ultrasonografía
2.
Int J Nanomedicine ; 16: 2147-2171, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33746512

RESUMEN

The use of fluorescence imaging technique for visualization, resection and treatment of cancerous tissue, attained plenty of interest once the promise of whole body and deep tissue near-infrared (NIR) imaging emerged. Why is NIR so desired? Contrast agents with optical properties in the NIR spectral range offer an upgrade for the diagnosis and treatment of cancer, by dint of the deep tissue penetration of light in the NIR region of the electromagnetic spectrum, also known as the optical window in biological tissue. Thus, the development of a new generation of NIR emitting and absorbing contrast agents able to overcome the shortcomings of the basic free dye administration is absolutely essential. Several examples of nanoparticles (NPs) have been successfully implemented as carriers for NIR dye molecules to the tumour site owing to their prolonged blood circulation time and enhanced accumulation within the tumour, as well as their increased fluorescence signal relative to free fluorophore emission and active targeting of cancerous cells. Due to their versatile structure, good biocompatibility and capability to efficiently load dyes and bioconjugate with diverse cancer-targeting ligands, the research area of developing protein-based NPs encapsulated or conjugated with NIR dyes is highly promising but still in its infancy. The current review aims to provide an up-to-date overview on the biocompatibility, specific targeting and versatility offered by protein-based NPs loaded with different classes of NIR dyes as next-generation fluorescent agents. Moreover, this study brings to light the newest and most relevant advances involving the state-of-the-art NIR fluorescent agents for the real-time interventional NIR fluorescence imaging of cancer in clinical trials.


Asunto(s)
Colorantes/química , Retroalimentación , Rayos Infrarrojos , Nanopartículas/química , Neoplasias/diagnóstico por imagen , Neoplasias/cirugía , Proteínas/química , Animales , Fluorescencia , Humanos
3.
Orv Hetil ; 162(13): 504-513, 2021 03 28.
Artículo en Húngaro | MEDLINE | ID: mdl-33774601

RESUMEN

Összefoglaló. Bevezetés: A tumorsebészetben a malnutritio független rizikófaktor. A kockázatcsökkentés egyik fontos eleme a perioperatív tápláltsági állapot felmérésén alapuló klinikai táplálás. Az irodalomban jól dokumentált az idoben végzett rizikószurés fontossága, de ennek módja, különösen hazai környezetben, kidolgozatlanabb. Célkituzés: A malnutritio szempontjából esendobb csoportot alkotó onkológiai sebészeti betegek azonosíthatóságának igazolása, a szurési metódus vizsgálata. Módszer: 2016. október és 2018. november között öt kórcsoportban (emlo, máj, pancreas, mellkas, gyomor-bél rendszer) az igazolt vagy gyanított malignitás, illetve gyulladásos bélbetegség miatt mutétre váró betegeket telemedicina-módszerrel kerestük fel. A rizikócsoportokat (nincs rizikó - alultápláltság valószínusítheto - súlyos alultápláltság) a sebész és dietetikus által közösen vezetett 'Nutritional Risk Score 2002' (NRS 2002) szuro pontrendszerrel állapítottuk meg. Az NRS 2002 pontértékeket a posztoperatív lefolyással vetettük össze (kórházi tartózkodás, 30 napon belüli szövodmények Clavien-Dindo szerinti osztályozása). Prospektív vizsgálatunkban 1556 beteg szerepel. Eredmények: Az emlosebészeti betegek (n = 314) 95,2%-a rizikómentes. A májreszekcióra várók (n = 79) 43%-a valószínuleg vagy biztosan alultáplált. A hasnyálmirigymutétre elojegyzett betegek (n = 122) 81,2%-a emelt rizikójú. A kuratív célú pancreasreszekción átesett betegek pontértéke alacsonyabb, mint a palliatív mutétben részesüloké (p>0,05). A tüdoreszekcióra váró (n = 219) betegeknél 40,7% került emelt rizikócsoportba. Az emelkedett NRS 2002 érték magasabb szövodményaránnyal járt (p<0,05). Béltraktust érinto mutétek (n = 822) esetén a betegek 71,2%-a valószínuleg vagy biztosan súlyosan alultáplált. Az elorehaladott tumorok és a szövodmények egyaránt eros összefüggést mutattak az NRS 2002 értékkel (p<0,01). Következtetés: Az NRS 2002 szuromódszer prediktív értékkel bír mind a tumorstádium, mind a szövodmények tekintetében. Módszerünkkel idoben felismerheto a fokozott rizikót jelento betegcsoport, így a pontérték alapján célzott mesterséges táplálás tervezheto. Orv Hetil. 2021; 162(13): 504-513. INTRODUCTION: Malnutrition is an independent risk factor in oncologic surgery. Perioperative screening and aimed clinical nutrition are key elements in risk reduction. The importance of timely screening has been well published, but its method is underdeveloped, especially in Hungary. OBJECTIVE: Evaluation of a malnutrition screening method to identify patients at risk in oncologic surgery. METHOD: Patients were enrolled from October 2016 to November 2018 in five groups (breast, liver, pancreas, thoracic and gastrointestinal surgery). All patients awaiting surgery for suspected or proven malignancy or for inflammatory bowel disease were screened preoperatively via telephone (telemedicine). Probability for malnutrition (no risk - suspicion for malnutrition - severe malnutrition) was jointly assessed by surgeon and dietitian using Nutritional Risk Score 2002 (NRS 2002). Screening results were compared to the postoperative course (including length of stay and 30-day morbidity/mortality using Clavien-Dindo classification). A total of 1556 patients were identified prospectively. RESULTS: 95.2% of breast surgery patients (n = 314) were not at risk. Malnutrition was suspected or detected in 43% of patients awaiting liver resection (n = 79). Increased risk is present in 81.2% of pancreatic surgery cases (n = 122). Pancreas resections with curative intent were associated with lower scores than in palliative operations (p>0.05). 40.7% of the 219 patients scheduled for lung resection had increased malnutrition risk. Higher NRS 2002 resulted in increased morbidity rate (p<0.05). Surgery on the intestines was performed on 822 cases. 71.2% of them had suspected or severe malnutrition. Presence of advanced cancer and complication rate showed strong relations with increased NRS 2002 (p<0.01). CONCLUSION: Screening with NRS 2002 has predictive value on both tumor stage and complications. Our method is sound to identify patients at malnutrition risk in time, and thus an aimed clinical nutrition therapy can be planned. Orv Hetil. 2021; 162(13): 504-513.


Asunto(s)
Desnutrición , Tamizaje Masivo , Neoplasias , Atención Perioperativa , Femenino , Humanos , Hungría , Desnutrición/diagnóstico , Tamizaje Masivo/métodos , Neoplasias/cirugía , Valor Predictivo de las Pruebas , Factores de Riesgo
5.
Int J Mol Sci ; 22(4)2021 Feb 17.
Artículo en Inglés | MEDLINE | ID: mdl-33671198

RESUMEN

Near-infrared (NIR) fluorescence-guided surgery is an innovative technique for the real-time visualization of resection margins. The aim of this study was to develop a head and neck multicellular tumor spheroid model and to explore the possibilities offered by it for the evaluation of cameras for NIR fluorescence-guided surgery protocols. FaDu spheroids were incubated with indocyanine green (ICG) and then included in a tissue-like phantom. To assess the capability of Fluobeam® NIR camera to detect ICG in tissues, FaDu spheroids exposed to ICG were embedded in 2, 5 or 8 mm of tissue-like phantom. The fluorescence signal was significantly higher between 2, 5 and 8 mm of depth for spheroids treated with more than 5 µg/mL ICG (p < 0.05). The fluorescence intensity positively correlated with the size of spheroids (p < 0.01), while the correlation with depth in the tissue-like phantom was strongly negative (p < 0.001). This multicellular spheroid model embedded in a tissue-like phantom seems to be a simple and reproducible in vitro tumor model, allowing a comparison of NIR cameras. The ideal configuration seems to be 450 µm FaDu spheroids incubated for 24 hours with 0.05 mg/ml of ICG, ensuring the best stability, toxicity, incorporation and signal intensity.


Asunto(s)
Cabeza/diagnóstico por imagen , Imagenología Tridimensional , Modelos Biológicos , Cuello/diagnóstico por imagen , Neoplasias/cirugía , Fotograbar/instrumentación , Espectroscopía Infrarroja Corta , Esferoides Celulares/citología , Muerte Celular/efectos de los fármacos , Línea Celular Tumoral , Proliferación Celular , Fluorescencia , Humanos , Verde de Indocianina/toxicidad , Cinética , Fantasmas de Imagen
7.
J Surg Oncol ; 123(5): 1246-1252, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33523470

RESUMEN

PURPOSE: The aims of the study were to estimate the frequency of epiphora and to identify factors associated with epiphora after orbital-sparing maxillectomy via modified Weber-Ferguson incision with lower blepharoplasty (OSOSM-MWFILB). METHODS: We performed a retrospective cohort study enrolling a sample derived from the patient population undergoing OSM-MWFILB over a 7-year period. The predictor variables were grouped into demographic, related health status, anatomic, tumor-specific, and therapeutic categories. The primary outcome variable was the presence of postmaxillectomy epiphora (PME). Descriptive, univariate, and multivariate regression mixed-effect models were computed. RESULTS: The study sample was composed of 134 patients (46.3% females; 71.6% squamous cell carcinomas) with a mean age of 64.7 ± 12.2 years. There were 23 (17.2%) PME events, which were significantly associated with eight variables: male gender, poor general health (ASA III-IV), large vertical defect (Brown and Shaw's class III-IV), squamous cell carcinoma tumor type, big tumor size (T3-4), cervical lymph node metastasis (N1-2), long operating time > 3 h, and adjuvant radio(chemo)therapy in both univariate mixed regression and multivariate Cox hazards analyses. Healing of PME in irradiated patients was significantly delayed. CONCLUSIONS: Ophthalmologic consequences in patients undergoing OSM-MWFILB require particular attention, especially in case of advanced tumors, multiple comorbidities, or long surgery with postoperative radio(chemo)therapy. This emphasizes the importance of appropriate cooperation between the surgeons and ophthalmic colleagues.


Asunto(s)
Blefaroplastia/métodos , Carcinoma de Células Escamosas/cirugía , Enfermedades del Aparato Lagrimal/cirugía , Maxilar/cirugía , Neoplasias/cirugía , Órbita/cirugía , Tratamientos Conservadores del Órgano/métodos , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/patología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/patología , Pronóstico , Estudios Retrospectivos
8.
J Surg Oncol ; 123(5): 1353-1360, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33523484

RESUMEN

BACKGROUND AND OBJECTIVES: Patient engagement software is a ubiquitous and expensive commercially available tool designed to improve transitions of care. There are currently no high-quality patient and provider-level data about the usability of these products for surgical oncology patients. This study aims to better understand patient and provider attitudes and perceptions about the implementation of such technology. METHODS: Focused interviews were conducted following the demonstration of a provider-built mobile technology platform. Interviews were audio-recorded, transcribed, and analyzed. Data were consensus coded inductively and categorized into themes regarding patient and provider perspectives on the usability and implementation of MobiMD. RESULTS: Our interviews revealed four consistent themes: (1) patients feel there is a lack of reliable resources for patient education; (2) both patients and providers are supportive of using a mobile application; (3) providers perceive patient onboarding as an added burden on current workflows; and (4) after onboarding, providers express that such an application would optimize current workflows. CONCLUSIONS: Patients perceive a need for improved perioperative education. Providers and patients agree that a mobile technology platform would be an effective solution in addressing this need. Effective implementation of such an intervention may improve patient education and engagement, leading to improved patient outcomes.


Asunto(s)
Prestación de Atención de Salud/normas , Aplicaciones Móviles/estadística & datos numéricos , Neoplasias/cirugía , Atención al Paciente/normas , Medición de Resultados Informados por el Paciente , Pautas de la Práctica en Medicina/normas , Telemedicina/métodos , Humanos , Neoplasias/patología , Neoplasias/psicología , Percepción , Resultado del Tratamiento
9.
J Surg Oncol ; 123(5): 1316-1327, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33523514

RESUMEN

Symptomatic peri-acetabular metastatic lesions are often treated with open surgery such as modified Harrington procedures. In an effort to avoid surgical complications inherently associated with open surgical approaches, we developed and recently reported a novel Tripod percutaneous screw technique. The tripod technique is minimally invasive and was found to yield excellent outcomes regarding both pain control and functionality. The procedure is performed in a standard operative theater using fluoroscopic guided percutaneous screws. Despite the simplicity of intraoperative set-up and instrumentation, it is technically demanding. Obtaining the correct fluoroscopic views and troubleshooting intraoperative hurdles can be challenging for even an experienced orthopedic surgeon. The technique and bony conduits were previously described in the trauma literature, however, there are key points of difference in the setting of metastatic disease. Here we provide a compilation of a stepwise graphic guide for the tripod model in the setting of metastatic peri-acetabular lesions, as well as the tips and tricks based on our own experience. These encompass preoperative preparation, operating room settings, intraoperative fluoroscopic guidance, postoperative care, and subsequent conversion to a cemented total hip arthroplasty, if needed.


Asunto(s)
Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/métodos , Neoplasias Óseas/cirugía , Tornillos Óseos , Fijación Interna de Fracturas/métodos , Neoplasias/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos , Neoplasias Óseas/secundario , Fluoroscopía , Humanos , Neoplasias/patología , Pronóstico
10.
J Surg Oncol ; 123(5): 1345-1352, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33621378

RESUMEN

BACKGROUND AND OBJECTIVES: Post-discharge oncologic surgical complications are costly for patients, families, and healthcare systems. The capacity to predict complications and early intervention can improve postoperative outcomes. In this proof-of-concept study, we used a machine learning approach to explore the potential added value of patient-reported outcomes (PROs) and patient-generated health data (PGHD) in predicting post-discharge complications for gastrointestinal (GI) and lung cancer surgery patients. METHODS: We formulated post-discharge complication prediction as a binary classification task. Features were extracted from clinical variables, PROs (MD Anderson Symptom Inventory [MDASI]), and PGHD (VivoFit) from a cohort of 52 patients with 134 temporal observation points pre- and post-discharge that were collected from two pilot studies. We trained and evaluated supervised learning classifiers via nested cross-validation. RESULTS: A logistic regression model with L2 regularization trained with clinical data, PROs and PGHD from wearable pedometers achieved an area under the receiver operating characteristic of 0.74. CONCLUSIONS: PROs and PGHDs captured through remote patient telemonitoring approaches have the potential to improve prediction performance for postoperative complications.


Asunto(s)
Cuidados Posteriores/normas , Neoplasias/cirugía , Alta del Paciente , Evaluación del Resultado de la Atención al Paciente , Medición de Resultados Informados por el Paciente , Complicaciones Posoperatorias/fisiopatología , Tecnología Inalámbrica/instrumentación , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Aprendizaje Automático , Masculino , Persona de Mediana Edad , Neoplasias/patología , Valor Predictivo de las Pruebas , Recuperación de la Función , Adulto Joven
11.
Br J Surg ; 108(1): 88-96, 2021 01 27.
Artículo en Inglés | MEDLINE | ID: mdl-33640908

RESUMEN

BACKGROUND: Surgical services are preparing to scale up in areas affected by COVID-19. This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery. METHODS: This international cohort study included adult patients undergoing elective surgery for cancer in areas affected by SARS-CoV-2 up to 19 April 2020. Patients suspected of SARS-CoV-2 infection before operation were excluded. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery. Preoperative testing strategies were adjusted for confounding using mixed-effects models. RESULTS: Of 8784 patients (432 hospitals, 53 countries), 2303 patients (26.2 per cent) underwent preoperative testing: 1458 (16.6 per cent) had a swab test, 521 (5.9 per cent) CT only, and 324 (3.7 per cent) swab and CT. Pulmonary complications occurred in 3.9 per cent, whereas SARS-CoV-2 infection was confirmed in 2.6 per cent. After risk adjustment, having at least one negative preoperative nasopharyngeal swab test (adjusted odds ratio 0.68, 95 per cent confidence interval 0.68 to 0.98; P = 0.040) was associated with a lower rate of pulmonary complications. Swab testing was beneficial before major surgery and in areas with a high 14-day SARS-CoV-2 case notification rate, but not before minor surgery or in low-risk areas. To prevent one pulmonary complication, the number needed to swab test before major or minor surgery was 18 and 48 respectively in high-risk areas, and 73 and 387 in low-risk areas. CONCLUSION: Preoperative nasopharyngeal swab testing was beneficial before major surgery and in high SARS-CoV-2 risk areas. There was no proven benefit of swab testing before minor surgery in low-risk areas.


Asunto(s)
/diagnóstico , Procedimientos Quirúrgicos Electivos/efectos adversos , Enfermedades Pulmonares/etiología , Nasofaringe/virología , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/cirugía , Pandemias , Complicaciones Posoperatorias , Medición de Riesgo
12.
JCO Glob Oncol ; 7: 311-323, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33617304

RESUMEN

PURPOSE: There has been noteworthy concern about the impact of COVID-19 pandemic on health services including the management of cancer. In addition to being considered at higher risk for worse outcomes from COVID-19, people with cancer may also experience disruptions or delays in health services. This systematic review aimed to identify the delays and disruptions to cancer services globally. METHODS: This is a systematic review with a comprehensive search including specific and general databases. We considered any observational longitudinal and cross-sectional study design. The selection, data extraction, and methodological assessment were performed by two independent reviewers. The methodological quality of the studies was assessed by specific tools. The delays and disruptions identified were categorized, and their frequency was presented. RESULTS: Among the 62 studies identified, none exhibited high methodological quality. The most frequent determinants for disruptions were provider- or system-related, mainly because of the reduction in service availability. The studies identified 38 different categories of delays and disruptions with impact on treatment, diagnosis, or general health service. Delays or disruptions most investigated included reduction in routine activity of cancer services and number of cancer surgeries; delay in radiotherapy; and delay, reschedule, or cancellation of outpatient visits. Interruptions and disruptions largely affected facilities (up to 77.5%), supply chain (up to 79%), and personnel availability (up to 60%). CONCLUSION: The remarkable frequency of delays and disruptions in health care mostly related to the reduction of the COVID-19 burden unintentionally posed a major risk on cancer care worldwide. Strategies can be proposed not only to mitigate the main delays and disruptions but also to standardize their measurement and reporting. As a high number of publications continuously are being published, it is critical to harmonize the upcoming reports and constantly update this review.


Asunto(s)
Prestación de Atención de Salud/métodos , Neoplasias/terapia , Atención Ambulatoria , Estudios Transversales , Prestación de Atención de Salud/organización & administración , Prestación de Atención de Salud/estadística & datos numéricos , Humanos , Neoplasias/radioterapia , Neoplasias/cirugía
14.
J Surg Oncol ; 123(5): 1177-1187, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33567139

RESUMEN

BACKGROUND: The novel coronavirus pandemic (COVID-19) hinders the treatment of non-COVID illnesses like cancer, which may be pronounced in lower-middle-income countries. METHODS: This retrospective cohort study audited the performance of a tertiary care surgical oncology department at an academic hospital in India during the first six months of the pandemic. Difficulties faced by patients, COVID-19-related incidents (preventable cases of hospital transmission), and modifications in practice were recorded. RESULTS: From April to September 2020, outpatient consultations, inpatient admissions, and chemotherapy unit functioning reduced by 62%, 58%, and 56%, respectively, compared to the same period the previous year. Major surgeries dropped by 31% with a decrease across all sites, but an increase in head and neck cancers (p = .012, absolute difference 8%, 95% confidence interval [CI]: 1.75% - 14.12%). Postoperative complications were similar (p = .593, 95% CI: -2.61% - 4.87%). Inability to keep a surgical appointment was primarily due to apprehension of infection (52%) or arranging finances (49%). Two COVID-19-related incidents resulted in infecting 27 persons. Fifteen instances of possible COVID-19-related mishaps were averted. CONCLUSIONS: We observed a decrease in the operations of the department without any adverse impact in postoperative outcomes. While challenging, treating cancer adequately during COVID-19 can be accomplished by adequate screening and testing, and religiously following the prevention guidelines.


Asunto(s)
/epidemiología , Hospitales Universitarios/estadística & datos numéricos , Neoplasias/cirugía , Oncología Quirúrgica/estadística & datos numéricos , Estudios de Cohortes , Humanos , India/epidemiología , Control de Infecciones/métodos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Pandemias , Pobreza , Estudios Retrospectivos , Oncología Quirúrgica/métodos
15.
J Surg Oncol ; 123(5): 1188-1198, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33592128

RESUMEN

BACKGROUND: Coronavirus disease 2019 (COVID-19) has impacted cancer care globally. The aim of this study is to analyze the impact of COVID-19 on cancer healthcare from the perspective of patients with cancer. METHODS: A cross-sectional survey was conducted between June 19, 2020, to August 7, 2020, using a questionnaire designed by patients awaiting cancer surgery. We examined the impact of COVID-19 on five domains (financial status, healthcare access, stress, anxiety, and depression) and their relationship with various patient-related variables. Factors likely to determine the influence of COVID-19 on patient care were analyzed. RESULTS: A significant adverse impact was noted in all five domains (p = < 0.05), with the maximal impact felt in the domain of financial status followed by healthcare access. Patients with income levels of INR < 35 K (adjusted odds ratio [AOR] = 1.61, p < 0.05), and 35K- 100 K (AOR = 1.96, p < 0.05), married patients (AOR = 3.30, p < 0.05), and rural patients (AOR = 2.82, p < 0.05) experienced the most adverse COVID-19-related impact. CONCLUSION: Delivering quality cancer care in low to middle-income countries is a challenge even in normal times. During this pandemic, deficiencies in this fragile healthcare delivery system were exacerbated. Identification of vulnerable groups of patients and strategic utilization of available resources becomes even more important during global catastrophes, such as the current COVID-19 pandemic. Further work is required in these avenues to not only address the current pandemic but also any potential future crises.


Asunto(s)
/epidemiología , Neoplasias/cirugía , Adolescente , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , India/epidemiología , Masculino , Persona de Mediana Edad , Neoplasias/psicología , Pobreza , Oncología Quirúrgica/normas , Encuestas y Cuestionarios , Adulto Joven
16.
Br J Radiol ; 94(1121): 20201329, 2021 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-33571010

RESUMEN

OBJECTIVES: To evaluate image quality and lesion detection capabilities of low-dose (LD) portal venous phase whole-body computed tomography (CT) using deep learning image reconstruction (DLIR). METHODS: The study cohort of 59 consecutive patients (mean age, 67.2 years) who underwent whole-body LD CT and a prior standard-dose (SD) CT reconstructed with hybrid iterative reconstruction (SD-IR) within one year for surveillance of malignancy were assessed. The LD CT images were reconstructed with hybrid iterative reconstruction of 40% (LD-IR) and DLIR (LD-DLIR). The radiologists independently evaluated image quality (5-point scale) and lesion detection. Attenuation values in Hounsfield units (HU) of the liver, pancreas, spleen, abdominal aorta, and portal vein; the background noise and signal-to-noise ratio (SNR) of the liver, pancreas, and spleen were calculated. Qualitative and quantitative parameters were compared between the SD-IR, LD-IR, and LD-DLIR images. The CT dose-index volumes (CTDIvol) and dose-length product (DLP) were compared between SD and LD scans. RESULTS: The image quality and lesion detection rate of the LD-DLIR was comparable to the SD-IR. The image quality was significantly better in SD-IR than in LD-IR (p < 0.017). The attenuation values of all anatomical structures were comparable between the SD-IR and LD-DLIR (p = 0.28-0.96). However, background noise was significantly lower in the LD-DLIR (p < 0.001) and resulted in improved SNRs (p < 0.001) compared to the SD-IR and LD-IR images. The mean CTDIvol and DLP were significantly lower in the LD (2.9 mGy and 216.2 mGy•cm) than in the SD (13.5 mGy and 1011.6 mGy•cm) (p < 0.0001). CONCLUSION: LD CT images reconstructed with DLIR enable radiation dose reduction of >75% while maintaining image quality and lesion detection rate and superior SNR in comparison to SD-IR. ADVANCES IN KNOWLEDGE: Deep learning image reconstruction algorithm enables around 80% reduction in radiation dose while maintaining the image quality and lesion detection compared to standard-dose whole-body CT.


Asunto(s)
Aprendizaje Profundo , Neoplasias/diagnóstico por imagen , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Tomografía Computarizada por Rayos X/métodos , Imagen de Cuerpo Entero/métodos , Adulto , Anciano , Anciano de 80 o más Años , Algoritmos , Medios de Contraste/administración & dosificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/tratamiento farmacológico , Neoplasias/cirugía , Periodo Posoperatorio , Estudios Prospectivos , Control de Calidad , Dosis de Radiación , Relación Señal-Ruido , Tomografía Computarizada por Rayos X/normas
19.
Ann R Coll Surg Engl ; 103(3): 173-179, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33557703

RESUMEN

INTRODUCTION: With the emergence of the COVID-19 pandemic, all elective surgery was temporarily suspended in the UK, allowing for diversion of resource to manage the anticipated surge of critically unwell patients. Continuing to deliver time-critical surgical care is important to avoid excess morbidity and mortality from pathologies unrelated to COVID-19. We describe the implementation and short-term surgical outcomes from a system to deliver time-critical elective surgical care to patients during the COVID-19 pandemic. MATERIALS AND METHODS: A protocol for the prioritisation and safe delivery of time-critical surgery at a COVID-19 'clean' site was implemented at the Nuffield Health Exeter Hospital, an independent sector hospital in the southwest of England. Outcomes to 30 days postoperatively were recorded, including unplanned admissions after daycase surgery, readmissions and complications, as well as the incidence of perioperative COVID-19 infection in patients and staff. RESULTS: A total of 128 surgical procedures were performed during a 31-day period by a range of specialties including breast, plastics, urology, gynaecology, vascular and cardiology. There was one unplanned admission and and two readmissions. Six complications were identified, and all were Clavien-Dindo grade 1 or 2. All 128 patients had preoperative COVID-19 swabs, one of which was positive and the patient had their surgery delayed. Ten patients were tested for COVID-19 postoperatively, with none testing positive. CONCLUSION: This study has demonstrated the implementation of a safe system for delivery of time-critical elective surgical care at a COVID-19 clean site. Other healthcare providers may benefit from implementation of similar methodology as hospitals plan to restart elective surgery.


Asunto(s)
Procedimientos Quirúrgicos Electivos/métodos , Neoplasias/cirugía , Procedimientos Quirúrgicos Operativos/métodos , Tiempo de Tratamiento , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Procedimientos Quirúrgicos Ambulatorios/métodos , Derivación Arteriovenosa Quirúrgica , Cateterismo Cardíaco , Prestación de Atención de Salud/organización & administración , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Histerectomía , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Reino Unido/epidemiología , Procedimientos Quirúrgicos Urológicos , Adulto Joven
20.
J Surg Oncol ; 123(4): 815-822, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33524172

RESUMEN

BACKGROUND AND OBJECTIVES: During the worldwide pandemic of coronavirus disease 2019 (COVID-19), oncological procedures considered to be urgent could not be delayed, and a specific procedure was required to continue surgical activity. The objective was to assess the efficacy of our preoperative screening algorithm. METHODS: This observational retrospective study was performed between the 25th of March and the 12th of May 2020 in a comprehensive cancer center in France. Patients undergoing elective oncologic surgery were tested by preoperative nasopharyngeal reverse-transcription polymerase chain reaction (RT-PCR) that could be associated with a chest computerized tomography (CT) scan. RESULTS: Of the 510 screening tests (in 477 patients), only 5% (15/477) were positive for COVID-19 in 24 patients (18 RT-PCR+ and 7 CT scan+/RT-PCR-). Four patients were ultimately false positives based on the CT scan. In total, only 4.2% (20/477) of the patients were COVID-19+. The positivity rate decreased with time after the containment measures were implemented (from 7.4% to 0.8%). In the COVID-19+ group, 20% of the patients had postoperative pulmonary complications, whereas this was the case for 5% of the patients in the COVID-19 group. CONCLUSIONS: Maintaining secure surgical activity is achievable and paramount in oncology care, even during the COVID-19 pandemic, with appropriate screening based on preoperative RT-PCR.


Asunto(s)
/diagnóstico , Control de Infecciones/organización & administración , Neoplasias/cirugía , Complicaciones Posoperatorias/epidemiología , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Adulto , Anciano , Anciano de 80 o más Años , Algoritmos , Instituciones Oncológicas , Femenino , Francia , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Neoplasias/patología , Valor Predictivo de las Pruebas , Cuidados Preoperatorios , Reproducibilidad de los Resultados , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Adulto Joven
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...