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1.
J Radiat Res ; 2020 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-32030408

RESUMO

The aim of this study was to assess the impact of fractional dose and the number of arcs on interplay effects when volumetric modulated arc therapy (VMAT) is used to treat lung tumors with large respiratory motions. A three (fractional dose of 4, 7.5 or 12.5 Gy) by two (number of arcs, one or two) VMAT plan was created for 10 lung cancer cases. The median 3D tumor motion was 17.9 mm (range: 8.2-27.2 mm). Ten phase-specific subplans were generated by calculating the dose on each respiratory phase computed tomography (CT) scan using temporally assigned VMAT arcs. We performed temporal assignment of VMAT arcs using respiratory information obtained from infrared markers placed on the abdomens of the patients during CT simulations. Each phase-specific dose distribution was deformed onto exhale phase CT scans using contour-based deformable image registration, and a 4D plan was created by dose accumulation. The gross tumor volume dose of each 4D plan (4D GTV dose) was compared with the internal target volume dose of the original plan (3D ITV dose). The near-minimum 4D GTV dose (D99%) was higher than the near-minimum 3D internal target volume (ITV) dose, whereas the near-maximum 4D GTV dose (D1%) was lower than the near-maximum 3D ITV dose. However, the difference was negligible, and thus the 4D GTV dose corresponded well with the 3D ITV dose, regardless of the fractional dose and number of arcs. Therefore, interplay effects were negligible in VMAT-based stereotactic body radiation therapy for lung tumors with large respiratory motions.

2.
Phys Med ; 69: 176-182, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31918370

RESUMO

PURPOSE: To compare radiomic features extracted from diagnostic computed tomography (CT) images with and without contrast enhancement in delayed phase for non-small cell lung cancer (NSCLC) patients. METHODS: Diagnostic CT images from 269 tumors [non-contrast CT, 188 (dataset NE); contrast-enhanced CT, 81 (dataset CE)] were enrolled in this study. Eighteen first-order and seventy-five texture features were extracted by setting five bin width levels for CT values. Reproducible features were selected by the intraclass correlation coefficient (ICC). Radiomic features were compared between datasets NE and CE. Subgroup analyses were performed based on the CT acquisition period, exposure value, and patient characteristics. RESULTS: Eighty features were considered reproducible (0.5 ≤ ICC). Twelve of the sixteen first-order features, independent of the bin width levels, were statistically different between datasets NE and CE (p < 0.05), and the p-values of two first-order features depending on the bin width levels were reduced with narrower bin widths. Sixteen out of sixty-two features showed a significant difference, regardless of the bin width (p < 0.05). There were significant differences between datasets NE and CE with older age, lighter body weight, better performance status, being a smoker, larger gross tumor volume, and tumor location at central region. CONCLUSIONS: Contrast enhancement in the delayed phase of CT images for NSCLC patients affected some of the radiomic features and the variability of radiomic features due to contrast uptake may depend largely on the patient characteristics.

3.
Anticancer Res ; 40(1): 393-399, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892592

RESUMO

AIM: This study was performed to confirm the superior overall survival (OS) after pulmonary oligo-recurrence compared to pulmonary sync-oligometastases in a large nationwide study. PATIENTS AND METHODS: Patients that met the following criteria were included: 1 to 5 lung-only metastases at the beginning of stereotactic body radiation therapy (SBRT) was performed between January 2004 and June 2015, and the biological effective dose (BED) of SBRT was 75 Gy or more. The parameters included in the analyses were age, gender, ECOG PS, primary lesion, pathology, oligoetastatic state, SBRT date, chemotherapy before SBRT, chemotherapy concurrent SBRT, chemotherapy after SBRT, maximum tumor diameter, number of metastases, field coplanarity, dose prescription, BED10, OTT of SBRT. RESULTS: In total, 1,378 patients with 1,547 tumors were enrolled. Oligo-recurrence occurred in 1,016 patients, sync-oligometastases in 118, and unclassified oligometastases in 121. The three-year OS was 64.0% for oligo-recurrence and 47.5% for sync-oligometastasis (p<0.001). In the multivariate analysis, the hazard ratio (HR) for sync-oligometastases versus oligo-recurrence was 1.601 (p=0.014). Adverse events of Grade 5 were occurred in 3 patients. CONCLUSION: This is the first nationwide to indicate that the OS of patients with pulmonary oligo-recurrence is better than that of patients with sync-oligometastases.


Assuntos
Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/secundário , Radiocirurgia , Inquéritos e Questionários , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Adulto Jovem
4.
Ann Vasc Dis ; 12(2): 216-221, 2019 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-31275477

RESUMO

Objective: To present a new and easy technique for performing endarterectomy in patients with peripheral arterial occlusive disease (PAD) having dollop calcification at the common femoral artery (CFA). Materials and Methods: We developed a procedure for angioplasty for PAD using a supersonic surgical suction device, based on the new concept of "to create a new lumen to dig tunnel in calcification." Ultrasonic surgical aspiration device was inserted into the intravascular space from outside the area of the target lesion and only internal calcification was removed. Results: We performed this technique in three patients who had PAD with dollop calcification at CFA. We succeeded in performing endarterectomy easily and safely. This method does not require vascular wall closure suture at calcified lesion or intimal fixation suture of dollop calcification. Conclusion: We address the technical difficulty in treating highly calcified lesions that could not be dealt with conventional endarterectomy. Our new method is one of the options for revascularization of heavily calcified lesions.

5.
J Geriatr Oncol ; 9(6): 589-593, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29779799

RESUMO

PURPOSE: The purpose of the present study was to retrospectively evaluate impact of pre-treatment skeletal muscle mass (SMM) on overall survival and non-lung cancer mortality after stereotactic body radiotherapy (SBRT) for patients with stage I non-small cell lung cancer (NSCLC). METHODS AND MATERIALS: One-hundred and eighty-six patients whose abdominal CT before the treatment was available were enrolled into this study. The patients were divided into two groups of SMM according to gender-specific thresholds for unilateral psoas area. Operability was judged by the treating physician or thoracic surgeon after discussion in a multi-disciplinary tumor board. RESULTS: Patients with low SMM tended to be elderly and underweight in body mass index compared with the high SMM. Overall survival in patients with the low SMM tended to be worse than that in the high SMM (41.1% and 55.9% at 5 years, P = 0.115). Cumulative incidence of non-lung cancer death was significantly worse in the low SMM (31.3% at 5 years compared with 9.7% in the high SMM, P = 0.006). Multivariate analysis identified SMM and operability as significant factors for non-lung cancer mortality. Impact of SMM on lung cancer death was not significant. No difference in rate of severe treatment-related toxicity was observed between the SMM groups. CONCLUSION: Low SMM is a significant risk factor for non-lung cancer death, which might lead to worse overall survival, after SBRT for stage I NSCLC. However, the low SMM does not increase lung cancer death or severe treatment-related toxicity.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/mortalidade , Neoplasias Pulmonares/mortalidade , Músculo Esquelético/patologia , Sarcopenia/mortalidade , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Estudos de Casos e Controles , Feminino , Humanos , Neoplasias Pulmonares/radioterapia , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Radiocirurgia/métodos , Estudos Retrospectivos , Sarcopenia/complicações , Tomografia Computadorizada por Raios X
6.
Int J Radiat Oncol Biol Phys ; 100(5): 1228-1236, 2018 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-29722662

RESUMO

PURPOSE: To assess the local recurrence (LR) rate and timing after stereotactic body radiation therapy (SBRT) for non-small cell lung cancer using long-term follow-up data from a single institution. METHODS AND MATERIALS: Patients with primary or recurrent non-small cell lung cancer with or without pathologic verification, with tumors <3 cm, treated with SBRT (isocenter prescription of 48 Gy in 4 fractions) between April 1998 and August 2014, and with >6 months' follow-up were eligible. The LR rate was calculated by the cumulative incidence function, accounting for death as a competing risk. Univariate and multivariate analyses were performed to identify prognostic factors for LR. RESULTS: A total of 216 patients and 230 tumors were analyzed. The median follow-up time of tumors without LR was 3.9 years, and the crude number of LR cases was 49 (21%). The actuarial rate of LR was 19% (95% confidence interval, 14%-25%) at 5 years. The number of LR cases in each period was 10 in year 1, 17 in year 2, 9 in year 3, 3 in year 4, 3 in year 5, and 7 after 5 years. Among 73 tumors with >5 years' follow-up, we observed 7 late LRs. The tumor histology of these late LRs was adenocarcinoma in 3, squamous cell carcinoma in 2, and unknown in 2 (1 of the unknown cases was confirmed as adenocarcinoma following salvage surgery). The median time to LR was 2.1 years (interquartile range, 1.5-4.2 years) for adenocarcinoma compared with 1.3 years (interquartile range, 1.0-2.3 years) for squamous cell carcinoma. Multivariate analysis revealed that larger tumor size, squamous cell histology compared with adenocarcinoma, and use of abdominal compression for respiratory motion management were independent negative prognostic factors for LR. CONCLUSIONS: Long-term follow-up data demonstrated that late LR was not uncommon and that careful follow-up after SBRT is needed, especially in patients with adenocarcinoma.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/epidemiologia , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/radioterapia , Recidiva Local de Neoplasia/epidemiologia , Radiocirurgia , Adenocarcinoma/epidemiologia , Adenocarcinoma/patologia , Adenocarcinoma/radioterapia , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/radioterapia , Intervalos de Confiança , Feminino , Seguimentos , Humanos , Incidência , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Terapia de Salvação , Fatores de Tempo , Carga Tumoral
7.
J Radiat Res ; 59(1): 50-57, 2018 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-29182777

RESUMO

Systemic inflammation and poor nutritional status have a negative effect on the outcomes of cancer. Here, we analyzed the effects of the pretreatment inflammatory and nutritional status on clinical outcomes of locally advanced non-small-cell lung cancer (NSCLC) patients treated with chemoradiotherapy. We retrospectively reviewed 89 patients with locally advanced NSCLC treated with chemoradiotherapy between July 2006 and June 2013. Serum C-reactive protein (CRP) was assessed as an inflammatory marker, and serum albumin, body mass index (BMI) and skeletal mass index were assessed as nutritional status markers. The relationships between these markers and overall survival (OS) were assessed. The median OS was 24.6 months [95% confidence interval (CI): 19.4-39.3 months]. During follow-up, 58 patients (65%) had disease recurrence and 52 patients (58%) died. In multivariate Cox hazard analysis, CRP levels and BMI approached but did not achieve a significant association with OS (P = 0.062 and 0.094, respectively). Recursive partitioning analysis identified three prognostic groups based on hazard similarity (CRP-BMI scores): 0 = CRP < 0.3 mg/dl, 1 = CRP ≥ 0.3 mg/dl and BMI ≥ 18.5 kg/m2, and 2 = CRP ≥ 0.3 mg/dl and BMI < 18.5 kg/m2. The CRP-BMI score was significantly associated with OS (P = 0.023). Patients with scores of 0, 1 and 2 had median OS of 39.3, 24.5 and 14.5 months, respectively, and the scores also predicted the probability of receiving salvage treatment after recurrence. The CRP-BMI score is thus a simple and useful prognostic marker of clinical outcome for patients with locally advanced NSCLC treated with chemoradiotherapy.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/terapia , Quimiorradioterapia , Inflamação/patologia , Neoplasias Pulmonares/terapia , Estado Nutricional , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Proteína C-Reativa/metabolismo , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/patologia , Feminino , Humanos , Inflamação/complicações , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Prognóstico
8.
Clin Lung Cancer ; 19(3): e287-e296, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29277565

RESUMO

BACKGROUND: This pilot study aimed to evaluate the safety and efficacy of a dose escalation method for the treatment of peripheral lung tumors by administrating steep dose gradients in the target volumes via stereotactic body radiotherapy (SBRT). PATIENTS AND METHODS: Patients with peripheral lung tumors were enrolled onto this study and treated with SBRT using a total dose of 70 Gy in 4 fractions at target isocenter, covering the planning target volume surface with 70% of the isodose. The primary end point was the rate of grade 2 or higher radiation pneumonitis (RP) within 1 year. RESULTS: A total of 35 patients were enrolled onto this study between September 2014 and January 2016. Thirty-two patients with primary lung cancers and 3 patients with lung metastases were treated with SBRT. Grade 2 RP was observed in 4 patients within 1 year. No severe RP (grade 3 or higher) was observed within the follow-up period. The median follow-up period was 21.2 months (range, 4.2-31.7 months). Local recurrence was observed in a single patient with lung metastasis. No local recurrence was observed within the follow-up period in the 32 patients with primary lung cancer. The local control and overall survival rates at 2 years were 95.7% (95% confidence interval, 72.9-99.4) and 85.2% (95% confidence interval, 67.8-93.6), respectively. CONCLUSION: This dose escalation method with steep dose gradients using SBRT for peripheral lung tumors was safe in the subacute phases. These results also suggest that this method can obtain excellent local control rates.


Assuntos
Neoplasias Pulmonares/radioterapia , Pneumonite por Radiação/epidemiologia , Radiocirurgia/efeitos adversos , Radiocirurgia/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Dosagem Radioterapêutica
9.
Anticancer Res ; 37(9): 5161-5167, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28870949

RESUMO

BACKGROUND/AIM: To examine the prognostic significance of serum carcinoembryonic antigen (CEA) for stage I non-small cell lung cancer (NSCLC) treated with stereotactic body radiotherapy (SBRT). PATIENTS AND METHODS: In total, 129 stage I NSCLC patients were analyzed and divided into two groups: CEA-High (CEA>5 ng/ml) and CEA-Low (CEA≤5 ng/ml). RESULTS: Median follow-up time was 38 months. Overall survival was not significantly different between CEA-High (n=47) and CEA-Low (n=82) patients (57% vs. 63% at 3 years; p=0.39), although progression-free survival (PFS) was significantly worse in CEA-High patients (31% vs. 51% at 3 years; p=0.01). Larger tumor size and high CEA level were independent prognostic factors for worse PFS. Failure pattern analysis showed that regional node or distant recurrence was more common in CEA-High patients (47%) than in CEA-Low patients (29%). CONCLUSION: Patients with CEA-High stage I NSCLC have a higher risk of regional or systemic relapse and should be followed-up carefully.


Assuntos
Antígeno Carcinoembrionário/sangue , Carcinoma Pulmonar de Células não Pequenas/sangue , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Neoplasias Pulmonares/sangue , Neoplasias Pulmonares/radioterapia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/patologia , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Radiocirurgia , Carga Tumoral
10.
Eur J Radiol ; 92: 58-63, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28624021

RESUMO

BACKGROUND AND PURPOSE: There is no early predictor of treatment response after lung stereotactic body radiotherapy (SBRT). We conducted this pilot study to evaluate whether serial diffusion weighted magnetic resonance imaging (DW-MRI) or positron emission tomography (PET) could predict response after SBRT. MATERIAL AND METHODS: Early stage non-small cell lung cancer patients who received SBRT were eligible. DW-MRI and PET were undertaken pretreatment and every 3 months after SBRT in the first year. Patients with <1year of follow-up were excluded from the analysis. The apparent diffusion coefficient (ADC) value and maximum standardized uptake value (SUVmax) of tumors were measured and compared between groups with or without local recurrence (LR). RESULTS: Fifteen patients were enrolled and the data of 14 patients were analyzed. The median ADC value was significantly lower in patients with LR (n=3) than in those without LR (n=11) at 3 and 6 months (1.11 vs. 1.54 and 0.98 vs. 1.69 [×10-3mm2/s]; p=0.039 and 0.012, respectively) while there was no significant difference pretreatment and at 9 and 12 months after treatment. No significant difference was observed in the SUVmax at any time point. CONCLUSIONS: DW-MRI could be an early predictor of treatment response after lung SBRT.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética/métodos , Fluordesoxiglucose F18/química , Neoplasias Pulmonares/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/métodos , Radiocirurgia/métodos , Carcinoma Pulmonar de Células não Pequenas/patologia , Humanos , Neoplasias Pulmonares/patologia , Recidiva Local de Neoplasia , Projetos Piloto
11.
Oncol Lett ; 9(5): 2068-2072, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-26137014

RESUMO

In the present study, a 79-year-old male was referred to Kobe City Medical Center General Hospital due to an abnormal shadow that was revealed on a chest X-ray. The patient possessed a five-year history of consolidation in the right lower lobe, which was diagnosed as chronic aspiration pneumonia and followed up. However, the abnormal shadow adjacent to the pleura gradually increased in size and a novel mass appeared in the right lower lobe that rapidly increased in size. A repeat biopsy revealed a combination of large cell neuroendocrine carcinoma with a clinical tumor-node-metastasis (cTNM) stage of cT2bN2M0 (stage 3A) and mucosa-associated lymphoid tissue lymphoma at Ann Arbor stage 1E. Chemoradiotherapy markedly affected the lesion and the size of the mass was significantly reduced subsequent to four cycles of chemotherapy, which was considered to be a near complete response. The present study reports an extremely rare combination of tumors. The disease course was followed over a period of six years, which included the onset of disease, and the present case may therefore be valuable in clarifying the mechanism of lung cancer development.

12.
Clin Lung Cancer ; 16(5): e91-6, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25659504

RESUMO

BACKGROUND: Previous reports have shown that curative surgical approaches for synchronous primary lung cancer (SPLC) yielded excellent treatment outcomes. However, patients with SPLC are often unsuitable for such surgery as a result of poor general condition or other medical comorbidities. The effectiveness and feasibility of stereotactic body radiotherapy (SBRT) as a definitive treatment for SPLC are not well understood. PATIENTS AND METHODS: We retrospectively reviewed the records of the patients who received lung SBRT between July 2007 and December 2012 at our institution and identified patients with SPLC. The clinical outcome was analyzed for each patient. The first progression site was classified as local, regional, distant, or new primary lung cancer. RESULTS: A total of 18 patients were eligible. Fifteen patients received SBRT for both lesions, and 3 patients received surgery for one tumor and SBRT for the other. The median follow-up time was 34.3 months (range, 12.2-64.7 months). The median overall and progression-free survival was 45.6 months (95% confidence interval [CI] 21.0-60.6) and 25.3 months (95% CI, 13.1-50.6 months), respectively. The 3-year overall survival and progression-free survival rates were 69.1% (95% CI, 40.7-85.9) and 43.2% (95% CI, 20.2-64.4), respectively. Eleven patients (61%) experienced disease progression. The first progression site was local in 4 (22%), regional in 5 (28%), distant in 3 (17%), and new primary lung cancer in 2 patients (11%). Grade 3 radiation pneumonitis was observed in 2 patients (11%). CONCLUSION: SBRT for SPLC is a highly effective local treatment with limited toxicity, although the progression rate seems relatively high.


Assuntos
Neoplasias Pulmonares/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Radiocirurgia/métodos , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Intervalo Livre de Doença , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/patologia , Masculino , Neoplasias Primárias Múltiplas/patologia , Radiocirurgia/efeitos adversos , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
13.
Mol Clin Oncol ; 2(3): 454-460, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24772317

RESUMO

Elderly patients with stage III non-small-cell lung cancer (NSCLC) are frequently underrepresented in clinical trials that evaluate chemoradiotherapy, due to their poor functional status, coexisting illnesses and limited life expectancy. The Japan Clinical Oncology Group 0301 trial (JCOG0301) was the first study to demonstrate that thoracic radiation therapy (TRT) with daily low-dose carboplatin may improve the outcome of elderly patients with stage III NSCLC. However, the efficacy and safety profiles of chemoradiotherapy, including platinum doublets, have not been clearly determined in this patient population. We retrospectively assessed the efficacy and toxicity of weekly paclitaxel in combination with carboplatin and concurrent TRT in patients aged ≥75 years with previously untreated locally advanced NSCLC. Between February, 2004 and July, 2013, we collected the data of 20 patients treated with weekly paclitaxel and carboplatin for 6 weeks and concurrent TRT. The objective response rate was 90%, the disease control rate was 95%, the median progression-free survival was 8.63 months [95% confidence interval (CI): 5.7-16.7] and the median overall survival (OS) was 16.1 months (95% CI: 10.7-41.6). There were no grade 4 hematological or non-hematological toxicities and no reported treatment-related deaths. Therefore, platinum doublet therapy in combination with TRT did not provide a clinically significant survival benefit in our population of elderly patients with locally advanced NSCLC. However, the present study demonstrated the good feasibility and safety of this regimen. Further prospective clinical trials are required to evaluate the efficacy and safety of platinum doublet with TRT in elderly patients.

14.
Ann Vasc Dis ; 6(3): 573-7, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24130611

RESUMO

In this study, we retrospectively reviewed 36 cases that required surgical treatment in the femoropopliteal regions (46 regions) because of the development of obstructions after stent placement in these patients. Of the 46, stents were placed in 37 involved regions (80.4%) that included the common femoral and popliteal arteries; such as the common femoral, entire length of superficial femoral, or popliteal arteries, and the anastomosis site created during femoropopliteal (prosthetic graft) bypass surgeries (Group A). In contrast, 9 involved regions (19.6%) did not include the common femoral or popliteal arteries; the stents were primarily localized in the superficial femoral artery (Group B). Symptoms of stent occlusion were more severe in the former group of patients, who subsequently required peripheral artery bypass surgery. These results indicate that placement of stents in the common femoral artery and popliteal arteries should be avoided. (English translation of J Jpn Coll Angiol 2012; 52: 19-23).

15.
Gen Thorac Cardiovasc Surg ; 58(11): 592-4, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21069501

RESUMO

We present a new, less-invasive technique for a re-do for perivalvular leakage after aortic mechanical valve replacement. Only the carbon ring of the previously implanted St. Jude prosthesis was excised, the sewing cuff being preserved. The locations of the perivalvular defects were clearly identified by pulling the sewing cuff inward. They were securely closed by placing pledgeted sutures at the preserved cuff through the full thickness of the aortic wall or through the annulus by a deep bite from the left ventricular side. A new mechanical prosthesis was then sewn onto the preserved sewing cuff.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Falha de Prótese , Técnicas de Sutura , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Reoperação , Resultado do Tratamento
16.
Ann Vasc Surg ; 24(2): 255.e13-6, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19879731

RESUMO

This case report concerns a 62-year-old woman with spontaneous infrarenal abdominal aortic dissection, which developed into claudication and rest pain in the lower extremity. Multi-row detector computed tomography showed the entry site of the abdominal aortic dissection at the second lumbar artery, while the reentry site was found intraoperatively at the median sacral artery, indicating that the false lumen had progressed and compressed the true lumen. A direct approach involving grafting appears to be an effective procedure for resolving mesenteric and lower extremity hypoperfusion due to aortic dissection with a dilated false channel, even during the acute period.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Extremidade Inferior/irrigação sanguínea , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/fisiopatologia , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/fisiopatologia , Aortografia/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Dor/etiologia , Fluxo Sanguíneo Regional , Tomografia Computadorizada por Raios X , Resultado do Tratamento
17.
Org Biomol Chem ; 6(6): 1015-9, 2008 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-18327326

RESUMO

Unmodified [60]fullerenes (C60) were solubilised with high stability using various type of poly(ethylene glycol) (PEG) based block copolymer micelles. Block copolymer micelle-incorporated C60 fullerenes were studied in cultures for biological activities using human cervical cancer HeLa cells. As a result, the cationic block copolymer micelles delivered C60 into the cells depending on their surface densities and showed cytotoxicity under photoirradiation.


Assuntos
Fulerenos/química , Micelas , Fármacos Fotossensibilizantes/química , Polietilenoglicóis/química , Polímeros/química , Neoplasias do Colo do Útero/tratamento farmacológico , Apoptose/efeitos dos fármacos , Cátions , Linhagem Celular Tumoral , Ensaios de Seleção de Medicamentos Antitumorais , Feminino , Fulerenos/farmacologia , Células HeLa , Humanos , Luz , Estrutura Molecular , Fármacos Fotossensibilizantes/farmacologia , Polímeros/síntese química , Polímeros/farmacocinética , Solubilidade , Neoplasias do Colo do Útero/metabolismo
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