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1.
Stem Cell Res Ther ; 11(1): 19, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31915074

RESUMO

Stem cell-derived sheet engineering has been developed as the next-generation treatment for myocardial infarction (MI) and offers attractive advantages in comparison with direct stem cell transplantation and scaffold tissue engineering. Furthermore, induced pluripotent stem cell-derived cell sheets have been indicated to possess higher potential for MI therapy than other stem cell-derived sheets because of their capacity to form vascularized networks for fabricating thickened human cardiac tissue and their long-term therapeutic effects after transplantation in MI. To date, stem cell sheet transplantation has exhibited a dramatic role in attenuating cardiac dysfunction and improving clinical manifestations of heart failure in MI. In this review, we retrospectively summarized the current applications and strategy of stem cell-derived cell sheet technology for heart tissue repair in MI.

2.
Eur J Radiol ; 122: 108756, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31786505

RESUMO

PURPOSE: Intravenous contrast administration is crucial in many CT examinations but also poses a potential risk to the patient. Monoenergetic images (MonoE) of dual-energy CT systems can virtually increase iodine attenuation and might improve image quality (IQ) if contrast dose is reduced. In this study, we investigated the influence of MonoE on lymph node (LN) delineation and IQ in chest CT examinations with significantly reduced contrast dose (50 %) of a novel dual-layer CT (DLCT). METHOD: 30 patients with clinically indicated reduced contrast dose underwent venous-phase chest DLCT scans. Conventional polyenergetic (PolyE) and MonoE images at 40 keV were calculated. The contrast difference of hilar lymph nodes (LN-CD) to the adjacent right pulmonary artery, their signal-to-noise (SNR) and contrast-to-noise-ratio (CNR) were determined. Subjective IQ was evaluated by 2 readers with respect to LN delineation and overall contrast enhancement (CE) using a 5-point-Likert-scale. RESULTS: LN-CD, SNR and CNR were significantly higher in MonoE than in PolyE images (LN-CD 92.3 ±â€¯37.9 vs. 33.1 ±â€¯14.5 HU, SNR 8.4 ±â€¯3.4 vs. 4.0 ±â€¯1.2, CNR 9.2 ±â€¯6.3 vs. 2.6 ±â€¯1.5; all p < 0.01). The LN delineation (3.7 ±â€¯0.9 vs.1.8 ±â€¯0.7; p < 0.01) and the CE (3.9 ±â€¯0.7 vs. 2.3 ±â€¯0.7; p < 0.01) were rated significantly better for MonoE than for PolyE images. There was no MonoE examination classified as non-diagnostic. CONCLUSIONS: Subjective and objective IQ parameters can be significantly improved for venous-phase chest CT examinations with reduced contrast doses by utilization of low-keV MonoE reconstructions. All MonoE images provided sufficient overall CE and therefore reduced contrast doses might be considered in a wider range of DLCT examinations and patients.

3.
Innov Surg Sci ; 4(3): 85-90, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31709299

RESUMO

Objectives: Postoperative chylothorax is a serious complication after transthoracic esophagectomy, and is associated with major morbidity due to dehydration and malnutrition. For patients with high-output fistula, re-thoracotomy with ligation of the thoracic duct is the treatment of choice. Radiologic interventional management is an innovative procedure that has the potential to replace surgery in the treatment algorithm. Methods: Four patients with high-output chylous leaks following esophagectomy are presented. Ultrasound-guided lymphangiography with embolization of the thoracic duct and/or disruption of the cisterna chyli was performed to occlude the leakage site. Radiologic interventions and procedure-related outcomes are described in detail. Results: In all four patients, ultrasound-guided lymphangiography of the groin with injection of Lipiodol was able to detect and visualize the leakage site in the lower mediastinum. In three patients, the leak could be successfully occluded by Lipiodol embolization. In one patient, embolization failed and the disruption technique was successfully performed. No procedure-related complications were observed. Conclusions: In case of a postoperative chylothorax, radiologic intervention is feasible and safe. The procedure is indicated for high-output chylous fistulas after esophagectomy, and should be applied early after the diagnosis of this postoperative complication.

4.
BMJ Open ; 9(10): e029618, 2019 10 11.
Artigo em Inglês | MEDLINE | ID: mdl-31604785

RESUMO

INTRODUCTION: Liver resection is the only curative treatment for primary and secondary hepatic tumours. Improvements in perioperative preparation of patients and new surgical developments have made complex liver resections possible. However, small for size and flow syndrome (SFSF) is still a challenging issue, rendering patients inoperable and causing postoperative morbidity and mortality. Although the role of transhepatic flow in the postoperative outcome has been shown in small partial liver transplantation and experimental studies of SFSF, this has never been studied in the clinical setting following liver resection. The aim of this study is to systematically evaluate transhepatic flow changes following major liver resection and its correlation with postoperative outcomes. METHODS AND ANALYSIS: The TransHEpatic FLOW (THEFLOW) study is a single-centre, non-interventional cohort study, and aims to enrol 50 patients undergoing major hepatectomy (defined as hemihepatectomy or extended hepatectomy based on the Brisbane classification) with or without prior chemotherapy. The portal venous flow, hepatic artery flow and portal venous pressure are measured before and after each resection. All patients are followed-up for 3 months after the operation. During each evaluation, standard clinical data, posthepatectomy liver failure and overall morbidity and mortality will be recorded. THEFLOW study was initiated on 25 March 2018 and is expected to progress for 2 years. ETHICS AND DISSEMINATION: This protocol study received approval from the Ethics Committee of the University of Heidelberg (registration number: S576/2017). The results of this study will be published in a peer-reviewed journal, and will also be presented at medical meetings. TRIAL REGISTRATION NUMBER: NCT03762876.

5.
J Clin Med ; 8(10)2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31618968

RESUMO

The major extended donor criteria (maEDC; steatosis >40%, age >65 years, and cold ischemia time >14 h) influence graft and patient outcomes after liver transplantation. Despite organ shortages, maEDC organs are often considered unsuitable for transplantation. We investigated the outcomes of maEDC organ liver transplantation in patients with hepatocellular carcinoma (HCC). Two hundred and sixty-four HCC liver transplant patients were eligible for analysis. Risk factor analysis was performed for early allograft dysfunction; primary nonfunction; 30-day and 90-day graft failure; and 30-day, 90-day, and 1-year patient mortality. One-year graft survival was higher in recipients of no-maEDC grafts. One-year patient survival did not differ between the recipients of no-maEDC and maEDC organs. The univariate and multivariate analyses revealed no association between maEDC grafts and one-year patient mortality. Graft survival differed between the recipients of no-maEDC and maEDC organs after correcting for a laboratory model of end-stage liver disease (labMELD) score with a cut-off value of 20, but patient survival did not. Patient survival did not differ between recipients who did and did not meet the Milan criteria and who received grafts with and without maEDC. Instead of being discarded, maEDC grafts may expand the organ pool for patients with HCC without impairing patient survival or recurrence-free survival.

6.
J Cancer Res Clin Oncol ; 145(11): 2761-2769, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31428932

RESUMO

PURPOSE: This study aims to examine the health-related quality of life in patients with hepatocellular carcinoma. METHODS: 181 patients attending a tertiary center outpatient clinic were interviewed and completed the short form 36 (SF36) questionnaire. The SF36 was used to assess health-related QoL. Cross-sectional analyses by group (age, gender, clinical scores, systemic, and local interventions) as well sequel questionnaires were conducted. RESULTS: Participants included were 79% (143/181) men [mean age at first SF36: 63.8 (± 12.3; 18.4-85.8) years]. Barcelona Clinic Liver Cancer (BCLC) stadium C was associated with significantly lower SF36 total scores, and elevated initial alpha-fetoprotein (AFP) concentrations were associated with lower SF36 functional and mental health sum scores throughout the course of the third questionnaire. Patients treated with sorafenib had within the sub-dimension scores a significantly lower result for role limitations due to physical health compared to patients without sorafenib treatment. Patients who underwent a transarterial chemoembolization (TACE) had within the sub-dimension scores a significantly higher result for control of pain compared to patients without TACE. Kaplan-Meier analysis revealed significant survival benefits for patients who underwent any intervention at the first SF36 (mean survival in years 4.3 vs. 1.6; P < 0.01) as well as for patients who underwent hepatic resection (mean survival in years 6.3 vs. 2.7; P < 0.0001). CONCLUSION: Advanced tumor stages marked by BCLC stadium C and elevated initial AFP concentrations were associated with lower SF36 total scores and functional sum scores, respectively. During the course of sorafenib treatment, the sub-dimensional score for role limitations due to physical health decreased significantly, whereas TACE performance was associated with a significant improvement of the control of body pain.


Assuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/mortalidade , Neoplasias Hepáticas/terapia , Qualidade de Vida , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/psicologia , Estudos Transversais , Intervenção Médica Precoce , Feminino , Seguimentos , Humanos , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/psicologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos , Inquéritos e Questionários , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
7.
Diabetes Metab Syndr Obes ; 12: 439-445, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31114274

RESUMO

Purpose: Retrospective evaluation and comparison of image quality generated by low-dose computed tomography (LDCT) from obese patients with urolithiasis using alternative reconstruction algorithms. Materials and methods: Twenty-five obese patients (body mass index [BMI]>25 kg/m2) underwent LDCT scans for suspected urolithiasis. The scans were recompiled using filtered-back projection (FBP), statistical iterative reconstruction (iDose) and iterative model-based reconstruction (IMR). Dose-length product (DLP) and patient details were obtained from the CT dose report and clinical charts, respectively. Objective image noise was assessed by measuring the SD of Hounsfield units (HUs) in defined locations. Additionally, subjective image evaluation was independently performed by two radiologists using a 3-point Likert scale. The inter-reviewer agreement of image quality was calculated. Results: Ureteral concretions were observed in all CT scans, two of which revealed bilateral stones. The assessed patients' mean BMI was 29.29±3.74 kg/m2, and the DLP of the CT scans was 100.04±10.00 mGy*cm. All scans were rated diagnostic with the iDose and iterative model-based reconstructions, whereas 41% of the scans performed with FBP reconstruction were nondiagnostic. With respect to image quality, IMR was superior to iDose and FBP, both in the objective (P<0.001) and overall subjective (P≤0.008) evaluation of the respective data sets. The inter-reviewer agreement for overall image quality was "almost perfect" for IMR, "substantial" for iDose and "moderate" for FBP (κ values of 1.0, 0.6 and 0.46, respectively). Conclusion: Using iterative image reconstruction algorithms, LDCT of urolithiasis is feasible in overweight patients with a BMI between 25 and 35 kg/m2. Due to higher image quality, IMR is the preferred algorithm for scan reconstruction as it may help to avoid repeated examinations due to initial nondiagnostic scans.

9.
World Neurosurg ; 123: e433-e439, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30500582

RESUMO

OBJECTIVE: Fast and secure access to intracranial vessel occlusion is essential for mechanical thrombectomy (MT) in the treatment of acute ischemic stroke. We compared 2 intermediate distal access catheters (DAC: Distal Access Catheter [C1] and SOFIA: Soft torquable catheter Optimized For Intracranial Access [C2]) for procedural speed and safety of MT as well as clinical outcome at discharge and after 90 days. METHODS: This is a retrospective study of all 398 consecutive patients receiving MT with C1 or C2 for the treatment of acute ischemic stroke between September 2010 and June 2016, using a propensity score matched cohort. Baseline characteristics, clinical outcome, and procedural factors such as the number of retrieval attempts or duration of procedure were analyzed. RESULTS: A total of 282 patients (70.9%) underwent MT with C1 and 116 patients (29.1%) with C2. MT with C2 was faster with an average duration of 69.8 ± 51 minutes (mean ± standard deviation) compared with 80.6 ± 54 minutes with C1 (P < 0.05). The average number of necessary stent-retriever maneuvers was significantly lower with C2 (1.8 ± 1.7 vs. 3.2 ± 2.5, P < 0.0001). Successful MT with aspiration only yielded higher modified Thrombolysis in Cerebral Infarction rates (mTIC 2b/3 69.9% vs. 31.5%, P < 0.0001) with C2. Modified Rankin Scale at discharge was significantly lower with C2 (3.5 ± 1.9) versus C1 (3.9 ± 1.7, P < 0.05). No significant differences of modified Rankin Scale 90 were observed. CONCLUSIONS: The use of C2 resulted in reduced procedural times with less stent-retriever maneuvers. Clinical outcome at discharge was better for C2 catheters, whereas no significant difference of outcome was apparent after 90 days.


Assuntos
Infarto Encefálico/terapia , Trombólise Mecânica/métodos , Acidente Vascular Cerebral/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo Periférico/instrumentação , Cateterismo Periférico/normas , Remoção de Dispositivo , Procedimentos Endovasculares/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Resultado do Tratamento , Dispositivos de Acesso Vascular/normas , Adulto Jovem
10.
World J Surg ; 43(3): 862-869, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30377723

RESUMO

BACKGROUND: Esophageal anastomotic leakages after Ivor Lewis esophagectomy are severe and life-threatening complications. We analyzed the outcome of using self-expanding metal stents (SEMS) in the treatment of postoperative leakage after esophagogastrostomy. METHODS: Seventy patients with esophageal anastomotic leakage after Ivor Lewis esophagectomy for esophageal cancer who had received SEMS treatment between January 2006 and December 2015 at our clinic were identified in this retrospective study. The patients were analyzed according to demographic characteristics, risk factors, leakage characteristics, stent characteristics, stent-related complications, sealing success rate and mortality. RESULTS: Over a 10-year period, 70 patients received SEMS as treatment for postoperative anastomotic leakage after esophagectomy. Technical success of esophageal stenting in anastomotic leakage was achieved in 50 out of 70 cases (71.4%). Sealing success rate was 70% (n = 49) with a median treatment of 28 days (range 7-87). In 20 patients (28.6%), stent-related complications, such as stenosis, dislocation, leakage persistence, perforation or esophagotracheal fistula occurred after the SEMS treatment. Sixty-one patients (87.1%) survived SEMS treatment of esophagogastric anastomotic leakage. Mean follow-up for all patients was 38 months (IQR 10-76), and no significant difference was found in a comparison of the long-term survival rate between patients with successful and unsuccessful SEMS treatment. CONCLUSIONS: The management of esophageal anastomotic leaks after Ivor Lewis esophagectomy with SEMS is effective, safe and technically feasible. Aggressive non-surgical management should be considered when developing a treatment plan for stenting.


Assuntos
Fístula Anastomótica/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Stents Metálicos Autoexpansíveis , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/etiologia , Doenças do Esôfago/cirurgia , Esofagectomia/métodos , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fístula Traqueoesofágica/etiologia
11.
Magn Reson Imaging ; 53: 52-62, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30008436

RESUMO

PURPOSE: This study aims to assess the feasibility of 4D flow MRI measurements in complex vascular territories; namely, the celiac artery (CA) and superior mesenteric artery (SMA). MATERIALS AND METHODS: In this prospective study, 22 healthy volunteers and 10 patients were scanned at 3 T. Blood flow parameters were compared between healthy volunteers and patients with stenosis of the CA and/or SMA as a function of stenosis grade characterized by prior contrast-enhanced computed tomography (CE-CT). The 4D flow MRI acquisition covered the CA, SMA and adjusting parts of the abdominal aorta (AO). Measurements of velocity- (peak velocity [PV], average velocity [AV]) and volume-related parameters (peak flow [PF], stroke volume [SV]) were conducted. Further, stenosis grade and wall shear stress in the CA, SMA and AO were evaluated. RESULTS: In patients, prior evaluation by CE-CT revealed 11 low- and 5 mid-grade stenoses of the CA and/or SMA. PV and AV were significantly higher in patients than in healthy volunteers [PV: p < 0.0001; AV: p = 0.03, p < 0.001]. PF and SV did not differ significantly between healthy volunteers and patients; however, a trend towards lower PF and SV could be detected in patients with mid-grade stenoses. Comparison of 4D flow MRI with CE-CT revealed a strong positive correlation in estimated degree of stenosis (CA: r = 0.86, SMA: r = 0.98). Patients with mid-grade stenoses had a significantly higher average WSS magnitude (AWM) than healthy volunteers (p = 0.02). CONCLUSION: This feasibility study suggests that 4D flow MRI is a viable technique for the evaluation of complex flow characteristics in small vessels such as the CA and SMA. 4D flow MRI approves comparable to the morphologic assessment of complex vascular territories using CE-CT but, in addition, offers the functional evaluation of flow parameters that goes beyond the morphology.


Assuntos
Artéria Celíaca/diagnóstico por imagem , Constrição Patológica/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Artéria Mesentérica Superior/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Aorta Abdominal/diagnóstico por imagem , Velocidade do Fluxo Sanguíneo , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resistência ao Cisalhamento , Estresse Mecânico , Volume Sistólico , Tomografia Computadorizada por Raios X , Adulto Jovem
12.
Ther Clin Risk Manag ; 14: 721-727, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29713180

RESUMO

Purpose: Anastomotic leakage is a major surgical complication following esophagectomy and gastric pull-up. Specific risk factors such as celiac trunk (TC) stenosis and high calcification score of the aorta have been identified, but no data are available on their relative prognostic values. This retrospective study aimed to compare and evaluate calcification score versus stenosis quantification with regards to prognostic impact on anastomotic leakage. Patients and methods: Preoperative contrast-enhanced computed tomography scans of 164 consecutive patients with primary esophageal cancer were evaluated by two radiologists to apply a calcification score (0-3 scale) assessing the aorta, the celiac axis and the right and left postceliac arteries. Concurrently, the presence and degree of stenosis of TC and superior mesenteric artery were recorded for stenosis quantification. Results: Anastomotic leakage was noted in 14/164 patients and 12/14 showed stenosis of TC (n=11). The presence of TC stenosis was found to have a significant impact on anastomotic healing (p=0.004). The odds ratio for the prediction of anastomotic leakage by the degree of stenosis was 1.04 (95% CI, 1.02-1.07). Ten of 14 patients had aortic calcification scores of 1 or 2, but calcification scores of the aorta, the celiac axis and the right and left postceliac arteries did not correlate with the corresponding TC stenosis values and showed no influence on patient outcome as defined by the occurrence of anastomotic insufficiency (p=0.565, 0.855, 0.518 and 1.000, respectively). Inter-reader reliability of computed tomography analysis and absolute agreement on calcium scoring was mostly over 90%. No significant differences in preoperative comorbidities and patient characteristics were found between those with and without anastomotic leakage. Conclusion: Measurement of TC stenosis in preoperative contrast-enhanced computed tomography scans proved to be more reliable than calcification scores in predicting anastomotic leakage and should, therefore, be used in the risk assessment of patients undergoing esophagectomy and gastric pull-up.

13.
Case Rep Gastroenterol ; 12(1): 137-142, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29805356

RESUMO

Phlebosclerotic colitis (PC) is a rare, potentially life-threatening disease of unclear pathogenesis almost exclusively reported in Asian patients of both genders. A fibrous degeneration of venous walls leads to threadlike calcifications along mesenteric vessels and colonic wall thickening, detectable by CT. This causes disturbed blood drainage and hemorrhagic infarction of the right-sided colonic wall. This is a report of PC in a Caucasian woman in Europe without Asian background and no history of herbal medications, a suspected cause in Asian patients. CT revealed no calcification of the mesenteric vein or its tributaries. Instead, submucosal veins of the left-sided colonic wall were calcified, leading to subsequent transmural necrosis. Clinically, the patient developed a paralytic ileus and sigmoidal perforation during a 2-week hospitalization due to a bleeding cerebral vascular aneurysm. This case of a European woman with PC is unique in its course as well as its radiologic, clinical, and pathologic presentation.

14.
Ther Clin Risk Manag ; 14: 849-859, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29765226

RESUMO

Background: The study was conducted to compare examination time and artifact vulnerability of whole-body computed tomographies (wbCTs) for trauma patients using conventional or optimized patient positioning. Patients and methods: Examination time was measured in 100 patients scanned with conventional protocol (Group A: arms positioned alongside the body for head and neck imaging and over the head for trunk imaging) and 100 patients scanned with optimized protocol (Group B: arms flexed on a chest pillow without repositioning). Additionally, influence of two different scanning protocols on image quality in the most relevant body regions was assessed by two blinded readers. Results: Total wbCT duration was about 35% or 3:46 min shorter in B than in A. Artifacts in aorta (27 vs 6%), liver (40 vs 8%) and spleen (27 vs 5%) occurred significantly more often in B than in A. No incident of non-diagnostic image quality was reported, and no significant differences for lungs and spine were found. Conclusion: An optimized wbCT positioning protocol for trauma patients allows a significant reduction of examination time while still maintaining diagnostic image quality.

16.
Radiol Case Rep ; 13(1): 65-67, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29552244

RESUMO

Bleeding of an aberrant right subclavian artery following transthoracic en bloc esophagectomy and intrathoracic gastric reconstruction is a rare but severe complication in esophageal surgery. Preoperative diagnosis can be achieved by computed tomography or magnetic resonance angiography (MRA). Various treatment options are available; thus, the treatment can be challenging and should be adjusted to the severity of the symptoms. Bleeding of an aberrant right subclavian artery can result from perioperative vascular injury or various postoperative complications. We report about a case of a patient with esophageal cancer and an asymptomatic, simultaneously existing aberrant right subclavian artery. The patient underwent a successful conventional Ivor-Lewis esophageal resection without any life-threatening bleeding. Early detection and intraoperative identification was of major importance for successful surgery.

17.
Mycoses ; 61(1): 48-52, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28872711

RESUMO

Invasive Candida infection is the fourth most common bloodstream infection. Blood cultures are the current gold standard diagnostic method, however, false negatives remain a clinical challenge. We developed a new technique measuring Candida-reactive T cells as diagnostic read-out for invasive Candida infection. In a pilot study, we followed the treatment course of a patient with an invasive Candida infection of the lumbar vertebral spine. We present the case of a 56-year-old patient with HIV-associated Burkitt lymphoma who developed septic shock during chemotherapy-induced neutropenia. For the first time, we provide flow cytometry-based diagnostics with Candida-reactive T cells for invasive candidiasis with comprehensive MRI imaging. The Candida-reactive T cell assay has potential to complement current diagnostic assays for invasive Candida infection and thus to support targeted treatment.


Assuntos
Candida/imunologia , Candidíase Invasiva/diagnóstico , Candidíase Invasiva/imunologia , Vértebras Lombares/microbiologia , Linfócitos T/imunologia , Linfoma de Burkitt/complicações , Linfoma de Burkitt/virologia , Proteína C-Reativa/análise , Ligante de CD40/análise , Ligante de CD40/imunologia , Candidíase Invasiva/sangue , Discite/microbiologia , Citometria de Fluxo/métodos , Infecções por HIV/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Neutropenia/complicações , Neutropenia/microbiologia , Osteomielite/diagnóstico , Osteomielite/microbiologia , Projetos Piloto
18.
Strahlenther Onkol ; 194(2): 91-97, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28812120

RESUMO

PURPOSE: To evaluate efficacy and toxicity of stereotactic body radiation therapy (SBRT) with CyberKnife® (Accuray, Sunnyvale, CA, USA) in a selected cohort of primary, medically inoperable early-stage non-small cell lung cancer (NSCLC) patients. METHODS: From 2012 to 2016, 106 patients (median age 74 years, range 50-94 years) with primary NSCLC were treated with SBRT using CyberKnife®. Histologic confirmation was available in 87 patients (82%). For mediastinal staging, 92 patients (87%) underwent 18F-fluorodeoxyglucose positron-emission tomography (18-FDG-PET) and/or endobronchial ultrasound (EBUS)-guided lymph node biopsy or mediastinoscopy. Tumor stage (UICC8, 2017) was IA/B (T1a-c, 1-3 cm) in 86 patients (81%) and IIA (T2a/b, 3-5 cm) in 20 patients (19%). Depending on tumor localization, three different fractionation schedules were used: 3 fractions of 17Gy, 5 fractions of 11Gy, or 8 fractions of 7.5 Gy. Tracking was based on fiducial implants in 13 patients (12%) and on image guidance without markers in 88%. RESULTS: Median follow-up was 15 months (range 0.5-46 months). Acute side effects were mild (fatigue grade 1-2 in 20% and dyspnea grade 1-2 in 17%). Late effects were observed in 4 patients (4%): 3 patients developed pneumonitis requiring therapy (grade 2) and 1 patient suffered a rib fracture (grade 3). In total, 9/106 patients (8%) experienced a local recurrence, actuarial local control rates were 88% (95% confidence interval, CI, 80-96%) at 2 years and 77% (95%CI 56-98%) at 3 years. The median disease-free survival time was 27 months (95%CI 23-31 months). Overall survival was 77% (95%CI 65-85%) at 2 years and 56% (95%CI 39-73%) at 3 years. CONCLUSION: CyberKnife® lung SBRT which allows for real-time tumor tracking and risk-adapted fractionation achieves satisfactory local control and low toxicity rates in inoperable early-stage primary lung cancer patients.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Radiocirurgia/métodos , Risco Ajustado , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Estudos de Coortes , Fracionamento da Dose de Radiação , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Radiocirurgia/efeitos adversos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Resultado do Tratamento
19.
Case Rep Oncol ; 10(2): 627-633, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28868022

RESUMO

Prostate cancer is the most common solid tumor malignancy worldwide with an estimated 180,000 new cases of prostate cancer and 26,000 deaths in the USA in 2016. Although significant advances in the treatment of prostate cancer have recently been made, the treatment of metastatic disease remains a challenge. With visceral metastases marking more advanced tumor stages, liver involvement is associated with the worst prognosis. So far, no locoregional treatment regimens for the management of liver metastases of prostatic cancer exist. Herein, we report for the first time a successful treatment of hepatic metastases of prostatic cancer using radioembolization with selective intra-arterial administration of Yttrium-90 resin microspheres.

20.
J Int Med Res ; 45(6): 2101-2109, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28587537

RESUMO

Objective To evaluate the use of ultra-low-dose computed tomography (ULDCT) for CT-guided lung biopsy versus standard-dose CT (SDCT). Methods CT-guided lung biopsies from 115 patients (50 ULDCT, 65 SDCT) were analyzed retrospectively. SDCT settings were 120 kVp with automatic mAs modulation. ULDCT settings were 80 kVp with fixed exposure (20 mAs). Two radiologists evaluated image quality (i.e., needle artifacts, lesion contouring, vessel recognition, visibility of interlobar fissures). Complications and histological results were also evaluated. Results ULDCT was considered feasible for all lung interventions, showing the same diagnostic accuracy as SDCT. Its mean total radiation dose (dose-length product) was significantly reduced to 34 mGy-cm (SDCT 426 mGy-cm). Image quality and complication rates ( P = 0.469) were consistent. Conclusions ULDCT for CT-guided lung biopsies appears safe and accurate, with a significantly reduced radiation dose. We therefore recommend routine clinical use of ULDCT for the benefit of patients and interventionalists.


Assuntos
Pulmão/diagnóstico por imagem , Pulmão/patologia , Tomografia Computadorizada por Raios X , Idoso , Artefatos , Biópsia , Demografia , Relação Dose-Resposta à Radiação , Estudos de Viabilidade , Humanos , Masculino , Intensificação de Imagem Radiográfica
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