Endoscopic incision and selective cutting for primary treatment of benign esophageal anastomotic stricture: outcomes of 5 cases with a minimum follow-up of 12 months

Background.Retinoblastoma (RB) is a life threatening cancer disease. A breakthrough in the treatment of children with RB is associated with the improvement of conservative treatment that was administered in at least one of the two tumor-affected eyes in most bilateral cases, that was chemotherapy both systemic and local (selective intra-arterial and intravitreal) in most cases combined with laser therapy, cryotherapy, or brachytherapy. The development of such techniques as local chemotherapy is focused on preservation of visual functions, reducing the number of enucleations and radiotherapy (RT) course. The success of the healing of RB is closely associated with a multidisciplinary approach to diagnosis and treatment, as well as specialized longterm follow-up clinical examination.Objective.eye and vision preservation against large intraocular tumors with different growth types and localization without the course of remote radiation therapy was the main purpose.Methods.In the period from September 2012 to January 2016, the study enrolled 45 patients with RB when at least one eye had intraocular tumor spread corresponding to the group C or D. According to the ABC international classification, patients have a relatively good prognosis for organ-preserving treatment. 4 of 18 children with bilateral RB had undergone primary enucleation of worse eye the worst eye, group E; 49 (77.8%) of the 63 affected eyes had features for groups C and D. In this study, no patient received local chemotherapy initially, only after prior systemic chemotherapy. Selective intra-arterial chemotherapy (SIAC) was applied to 41 patients (45 eyes; mean course number was 2), and 32 patients (34 eyes) had undergone intravitreal chemo therapy (IViC) (mean course number was 2). Focal therapy and local chemotherapy were the main methods of treatment for progression (new lesions on the retina) in 8 (16.3%) of 49 eyes with tumors of group C (n=1) and D (n=7); the relapse in 14 of 49 (new lesions on the retina) in eyes with tumors of group C (n=5) and D (n=6) and (new lesions on the retina and the vitreous) in eyes with tumors of group D (n=3) (28.5%), and stabilization of disease n=23 (46.9%). We should note that 2 patients underwent repeated course of in case of systemic chemotherapy, 1 patient — a Gamma Knife procedure due to registered disease stabilization, progression or relapse.Results.10 (20.4%) of 49 eyes saved due to the combined chemotherapy. In 45 patients diseasefree survival rate was 56.1±8.9 % (with mean follow-up period 26.9±2.5 months). 1 of 45 patients died from leukemia. 44 of 45 patients are alive without metastasis. The mean follow-up was 20 months (3 to 43 months). Eye salvage rate in group C — 14 (93.3%) of 15, in group D — 31 (91.2%) of 34.Conclusion.These methods: second line of systemic chemotherapy, RT, and a Gamma Knife procedure should be considered as a failure of primary treatment. Our study demonstrated a high efficacy of local chemotherapy with promissing techniques of conservation therapy, which safety increases due to experience.

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Endoscopic transsphenoidal pituitary surgery: a good and safe primary treatment option for Cushing's disease, even in case of macroadenomas or invasive adenomas

Acta Endocrinologica ◽

10.1530/eje-13-0325 ◽

2013 ◽

Vol 169 (3) ◽

pp. 329-337 ◽

Cited By ~ 48

Author(s):

M A E M Wagenmakers ◽

H D Boogaarts ◽

S H P P Roerink ◽

H J L M Timmers ◽

N M M L Stikkelbroeck ◽

...

Keyword(s):

Treatment Option ◽

Cushing’S Disease ◽

Remission Rate ◽

Pituitary Surgery ◽

Primary Treatment ◽

Endoscopic Technique ◽

Cushing's Disease ◽

Recurrence Rates ◽

Transsphenoidal Pituitary Surgery

ContextAlthough the endoscopic technique of transsphenoidal pituitary surgery (TS) has been widely adopted, reports on its results in Cushing's disease (CD) are still scarce and no studies have investigated long-term recurrence rates. This is the largest endoscopic series published till now.ObjectiveTo gain insight into the role of endoscopic TS as a primary treatment option for CD, especially in patients with magnetic resonance imaging (MRI)-negative CD and (invasive) macroadenomas.DesignRetrospective cohort study.Patients and methodsThe medical records of 86 patients with CD who underwent endoscopic TS were examined. Data on preoperative and postoperative evaluation, perioperative complications, and follow-up were collected. Remission was defined as disappearance of clinical symptoms with a fasting plasma cortisol level ≤50 nmol/l either basal or after 1 mg dexamethasone.ResultsThe remission rate in different adenoma subclasses varied significantly: 60% in MRI-negative CD (n=20), 83% in microadenomas (n=35), 94% in noninvasive macroadenomas (n=16), and 40% in macroadenomas that invaded the cavernous sinus (n=15). The recurrence rate was 16% after 71±39 months of follow-up (mean±s.d., range 10–165 months).ConclusionsEndoscopic TS is a safe and effective treatment for all patients with CD. Recurrence rates after endoscopic TS are comparable with those reported for microscopic TS. Our data suggest that in patients with noninvasive and invasive macroadenomas, the endoscopic technique of TS should be the treatment of choice as remission rates seem to be higher than those reported for microscopic TS, although no comparative study has been performed.

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Management of spinal dural arteriovenous malformations

Journal of Neurosurgery ◽

10.3171/jns.1989.70.6.0832 ◽

1989 ◽

Vol 70 (6) ◽

pp. 832-836 ◽

Cited By ~ 100

Author(s):

Michael K. Morgan ◽

W. Richard Marsh

Keyword(s):

Arteriovenous Malformations ◽

Primary Treatment ◽

Endovascular Embolization ◽

Content Type ◽

Early Improvement ◽

Time To Treatment Failure ◽

Spinal Arteriovenous Malformations ◽

Progressive Paraparesis ◽

Dural Avm

✓ Dura-based spinal arteriovenous malformations (AVM's) are being diagnosed with increasing frequency. The optimal management of such lesions remains a topic of discussion. In an effort to guide this discussion, the authors review their experience with 17 cases of spinal dural AVM treated between January, 1984, and July, 1987. All patients presented with a slowly progressive paraparesis. The abnormalities were initially identified on myelography and confirmed by selective spinal angiography. Fourteen patients underwent endovascular embolization as a primary treatment, and a total of 18 embolization procedures were performed. After all but two of these, obliteration was confirmed at angiography. Patients' symptoms improved following 15 or these procedures but early improvement was not sustained in 10 instances; patients were unchanged after two procedures and worse after one. Follow-up angiography was performed at varying intervals after 15 of the 18 procedures, and recanalization of the previously obliterated spinal dural AVM was demonstrated in 13 instances. Eight patients ultimately underwent surgical treatment of their dura-based spinal AVM. No patient suffered deterioration of symptoms following operation. While embolization may allow angiographic obliteration of a spinal dural AVM and early clinical improvement, for the majority of patients these are not sustained. The average time to treatment failure was 5 months. Newer embolization materials will be necessary to effect permanent treatment in many of these patients.

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Development of a prognostic model for grading chronic graft-versus-host disease

Blood ◽

10.1182/blood.v97.5.1219 ◽

2001 ◽

Vol 97 (5) ◽

pp. 1219-1226 ◽

Cited By ~ 138

Author(s):

Görgün Akpek ◽

Marianna L. Zahurak ◽

Steven Piantadosi ◽

Jeffrey Margolis ◽

Jon Doherty ◽

...

Keyword(s):

Graft Versus Host Disease ◽

Risk Groups ◽

Primary Treatment ◽

Prognostic Models ◽

Karnofsky Performance Score ◽

Primary Therapy ◽

Host Disease ◽

Graft Versus Host ◽

Progressive Type

The disease-specific survival (DSS) of 151 patients with chronic graft-versus-host disease (cGVHD) was studied in an attempt to stratify patients into risk groups and to form a basis for a new grading of cGVHD. The data included the outcome and 23 variables at the diagnosis of cGVHD and at the primary treatment failure (PTF). Eighty-nine patients (58%) failed primary therapy for cGVHD. Nonrelapse mortality was 44% after a median follow-up of 7.8 years. The probability of DSS at 10 years after diagnosis of cGVHD (DSS1) and after PTF (DSS2) was 51% (95% confidence interval [CI] = 39%, 60%) and 38% (95% CI = 28%, 49%), respectively. According to multivariate analysis, extensive skin involvement (ESI) more than 50% of body surface area; hazard ratio (HR) of 7.0 (95% CI = 3.6-13.4), thrombocytopenia (TP) (< 100 000/μL; HR, 3.6; 95% CI = 1.9-6.8), and progressive-type onset (PTO) (HR, 1.7; 95% CI = 0.9-3.0) significantly influenced DSS1. These 3 factors and Karnofsky Performance Score of less than 50% at PTF were significant predictors for DSS2. The DSS1 at 10 years for patients with prognostic factor score (PFS) at diagnosis of 0 (none), less than 2 (ESI only or TP and/or PTO), 2 to 3.5 (ESI plus either TP or PTO), and more than 3.5 (all 3 factors) was 82%, 68%, 34%, and 3% (P = .05, < .001, < .001), respectively. The DSS2 at 5 years for patients with PFS at PTF of 0, 2 or less, 2 to 3.5, and more than 3.5 were 91%, 71%, 22%, and 4% (P = .2, .005, and < .001), respectively. It was concluded that these prognostic models might be useful in grouping the patients with similar outcome.

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STEREOTACTIC RADIOSURGERY FOR CAVERNOUS SINUS OR ORBITAL HEMANGIOMAS

Neurosurgery ◽

10.1227/01.neu.0000356987.98197.71 ◽

2009 ◽

Vol 65 (5) ◽

pp. 914-918 ◽

Cited By ~ 28

Author(s):

Aftab A. Khan ◽

Ajay Niranjan ◽

Hideyuki Kano ◽

Douglas Kondziolka ◽

John C. Flickinger ◽

...

Keyword(s):

Stereotactic Radiosurgery ◽

Cavernous Sinus ◽

Tumor Regression ◽

Target Volume ◽

Symptomatic Improvement ◽

Primary Treatment ◽

Vascular Tumors ◽

Presenting Symptoms ◽

Primary Treatment Modality

Abstract OBJECTIVE Hemangiomas are rare but highly vascular tumors that may develop in the cavernous sinus or orbit. These tumors pose diagnostic as well as therapeutic challenges to neurosurgeons during attempted removal. We analyzed our increasing experience using stereotactic radiosurgery (SRS). METHODS Eight symptomatic patients with hemangiomas underwent SRS between 1988 and 2007. The presenting symptoms included headache, orbital pain, diplopia, ptosis, proptosis and impaired visual acuity. The hemangiomas were located in either the cavernous sinus (7 patients) or the orbit (1 patient). Four patients underwent SRS as primary treatment modality based on clinical and imaging criteria. Four patients had previous microsurgical partial excision or biopsy. The median target volume was 6.8 mL (range, 2.5–18 mL). The median prescription dose delivered to the margin was 14.5 Gy (range, 12.5–19 Gy). The dose to the optic nerve in all patients was less than 9 Gy (range, 4.5–9 Gy). RESULTS The median follow-up period after SRS was 80 months (range, 40–127 months). Six patients had symptomatic improvement; 2 patients reported persistent diplopia. Follow-up imaging revealed tumor regression in 7 patients and no change in tumor volume in 1 patient. All the patients improved after SRS. CONCLUSION Our extended experience confirms that SRS is an effective management strategy for symptomatic intracavernous and intraorbital hemangiomas. Our study is the first long-term report on the safety and efficacy of SRS.

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116 PROGNOSTIC IMPACT OF THE SHORT-AXIS DIAMETER FOR THE NODAL ASSESSMENT BEFORE PREOPERATIVE CHEMOTHERAPY IN ESOPHAGEAL CANCER

Diseases of the Esophagus ◽

10.1093/dote/doab052.116 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Hiroshi Ichikawa ◽

Natsuru Sudo ◽

Takeo Bamba ◽

Takaaki Hanyu ◽

Yosuke Kano ◽

...

Keyword(s):

Lymph Node ◽

Preoperative Chemotherapy ◽

Primary Treatment ◽

Prognostic Impact ◽

Short Axis ◽

Metastatic Node ◽

Nodal Diameter ◽

Number Of Patients ◽

Group 5

Abstract Clinical N category (cN) is generally assessed by measuring the nodal diameter by CT before the initiation of primary treatment in esophageal squamous cell carcinoma (ESCC). The short-axis diameter is recommended for evaluating treatment response in solid tumors by RECIST. This study aimed to elucidate the prognostic implication of the maximum short-axis diameter of lymph node (cN-size) before preoperative chemotherapy for ESCC. Methods We enrolled a total of 152 patients who underwent preoperative cisplatin/5-fluorouracil therapy (CF) followed by esophagectomy from 2005 to 2011. There were 127 men and 25 women with a median age of 65 years (range: 47–79 years). Clinically metastatic node was defined as follows; the node with cN-size ≥10 mm or that with 5 mm ≤ cN-size <10 mm and contrast enhancement, round shape and/or central necrosis in CT before starting CF. The association between the maximum cN-size and the overall survival (OS) after surgery was statistically investigated. The median follow-up period was 87 months (range: 36–145 months). Results The number of patients with cN0 and cN1–3 was 60 and 92, respectively. Twenty-seven and 65 patients with cN1–3 were classified into cN-size <10 mm and cN-size ≥10 mm group, respectively. The 5-year OS rates in cN0, cN-size <10 mm and cN-size ≥10 mm groups were 70%, 51% and 45%, respectively (P = 0.006). Among Ut-Mt tumors, the OS in the cN-size <10 mm group was significantly worse than that in the cN0 group (5-year OS rate: 45% vs. 74%, P = 0.048). However, there were no significant differences in the OS between these two groups in Lt tumors (67% vs. 64%, P = 0.789). Conclusion The maximum short-axis diameter of lymph node before preoperative chemotherapy is significantly associated with OS in patients with ESCC. Lymph node with 5 mm ≤ cN-size <10 mm in the short axis should be treated as a metastatic node especially in Ut or Mt tumors, considering the poor prognosis.

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Kasai Procedure in Patients Older Than 90 Days: Worth a Cut

European Journal of Pediatric Surgery ◽

10.1055/s-0041-1740556 ◽

2021 ◽

Author(s):

Marie Uecker ◽

Joachim F. Kuebler ◽

Nagoud Schukfeh ◽

Eva-Doreen Pfister ◽

Ulrich Baumann ◽

...

Keyword(s):

Treatment Option ◽

Chart Review ◽

Retrospective Chart Review ◽

Primary Treatment ◽

Inclusion Criteria ◽

Bridge To Transplant ◽

Kasai Procedure ◽

Native Liver ◽

Native Liver Survival

Abstract Introduction Age at Kasai portoenterostomy (KPE) has been identified as a predictive factor for native-liver survival in patients with biliary atresia (BA). Outcomes of pediatric liver transplantation (LT) have improved over recent years. It has been proposed to consider primary LT as a treatment option for late-presenting BA infants instead of attempting KPE. We present our experience with patients older than 90 days undergoing KPE. Materials and Methods A retrospective chart review of patients with BA undergoing KPE at our institution between January 2010 and December 2020 was performed. Patients 90 days and older at the time of surgery were included. Patients' characteristics, perioperative data, and follow-up results were collected. Eleven patients matched the inclusion criteria. Mean age at KPE was 108 days (range: 90–133 days). Results Postoperative jaundice clearance (bilirubin < 2 mg/dL) at 2-year follow-up was achieved in three patients (27%). Eight patients (73%) received a liver transplant at a mean of 626 days (range: 57–2,109 days) after KPE. Four patients (36%) were transplanted within 12 months post-KPE. Two patients died 237 and 139 days after KPE due to disease-related complications. One patient is still alive with his native liver, currently 10 years old. Conclusion Even when performed at an advanced age, KPE can help prolong native-liver survival in BA patients and offers an important bridge to transplant. In our opinion, it continues to represent a viable primary treatment option for late-presenting infants with BA.

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OP12. Results of an economic evaluation of a RCT of routine follow-up after primary treatment for breast cancer: A comparison of primary care vs specialist care

European Journal of Cancer ◽

10.1016/s0959-8049(97)85893-5 ◽

1997 ◽

Vol 33 ◽

pp. S5

Author(s):

E Grunfeld ◽

A Gray ◽

D Mant ◽

D Coyle ◽

P Yudkin ◽

...

Keyword(s):

Breast Cancer ◽

Primary Care ◽

Economic Evaluation ◽

Primary Treatment ◽

Specialist Care

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Study of management of diaphyseal fracture shaft femur by intramedullary interlocking nail

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20192109 ◽

2019 ◽

Vol 5 (4) ◽

pp. 588

Author(s):

Ayush Tiwari ◽

Sarabjeet Singh Kohli ◽

Manish Kokne

Keyword(s):

Primary Treatment ◽

Rotational Stability ◽

Diaphyseal Fracture ◽

Flexion Deformity ◽

Interlocking Nail ◽

Medical College ◽

Diaphyseal Fractures ◽

Free Function ◽

Femur Shaft

Background: Aim of this study was to analyze the effectiveness of interlocking nail in management of femoral diaphyseal fractures with special reference to fracture anatomy, pattern and status of stability.Methods: This hospital based prospective study was done in the department of Orthopedics, MGM Medical College Navi Mumbai. A total of 41 patients who were admitted in our institute was included to evaluate management of diaphyseal fracture shaft femur by intramedullary interlocking nail from July 2015 to July 2017. They were asked to follow up at 6 weeks, 3 months and 6 months.Results: Most of the fractures (70.7%) were united in 16-20 weeks while 10 (24.4%) fractures were united in 10-15 weeks and 2 (4.9%) fractures were united in 21-25 weeks. The mean time to union was 16.87±3.09 weeks. In the present study, 26 out of 41 patients had excellent results (63.4%) with full, pain free, function of the extremity. 13 patients with good result (31.8%), 9 patients had flexion deformity 1200, 3 patients had shortening 2 cm, 2 patients had shortening 1 cm. Two patients with fair result (4.8%), both had flexion deformity and none had with poor result. So overall, we had 95.2% excellent to good and 4.8% fair results.Conclusions: Interlocking intramedullary nailing is the most effective ad successful method of definitive primary treatment, in most types of fractures of femur shaft. It provides strong fixation, rotational stability and earliest return to functional status, as rate of healing is good with nailing.

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