683 results on '"regional perfusion"'
Search Results
2. The impact of thoracoabdominal normothermic regional perfusion on early outcomes in donation after circulatory death lung transplantation.
- Author
-
Malas, Jad, Chen, Qiudong, Thomas, Jason, Emerson, Dominic, Megna, Dominick, Esmailian, Fardad, Bowdish, Michael E., Chikwe, Joanna, and Catarino, Pedro
- Subjects
- *
ISOLATION perfusion , *LUNG transplantation , *EXTRACORPOREAL membrane oxygenation , *ARTIFICIAL respiration , *DATABASES - Abstract
Thoracoabdominal normothermic regional perfusion has emerged as an alternative method to procure donation after circulatory death (DCD) hearts, but its impact on concomitantly procured lung allografts remains unclear. The United Network for Organ Sharing database identified 627 DCD donors whose hearts were procured (211 in situ perfused, 416 directly procured) between December 2019 to December 2022. Lung utilization rates were 14.9% (63/422) for in situ perfused donors and 13.8% (115/832) for directly procured donors (p = 0.80). Following transplantation, lung recipients from in situ perfused donors required numerically lower rates of extracorporeal membrane oxygenation (7.7% vs 17.0%, p = 0.26) and mechanical ventilation (34.6% vs 47.2%, p = 0.29) at 72 hours. Six-month post-transplant survival was similar between groups (85.7% vs 89.1%, p = 0.67). These results suggest that the use of thoracoabdominal normothermic regional perfusion in DCD heart procurement may not adversely impact recipients of concomitantly procured lung allografts. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
3. A novel preoperative risk score to optimize patient selection for performing concomitant liver resection with cytoreductive surgery/HIPEC
- Author
-
Lee, Rachel M, Gamboa, Adriana C, Turgeon, Michael K, Zaidi, Mohammad Y, Kimbrough, Charles, Leiting, Jennifer, Grotz, Travis, Lee, Andrew J, Fournier, Keith, Powers, Benjamin, Dineen, Sean, Baumgartner, Joel M, Veerapong, Jula, Mogal, Harveshp, Clarke, Callisia, Wilson, Gregory, Patel, Sameer, Hendrix, Ryan, Lambert, Laura, Pokrzywa, Courtney, Abbott, Daniel E, LaRocca, Christopher J, Raoof, Mustafa, Greer, Jonathan, Johnston, Fabian M, Staley, Charles A, Cloyd, Jordan M, Maithel, Shishir K, and Russell, Maria C
- Subjects
Clinical Research ,Digestive Diseases ,Liver Disease ,Patient Safety ,Colo-Rectal Cancer ,Cancer ,Evaluation of treatments and therapeutic interventions ,6.4 Surgery ,Appendiceal Neoplasms ,Chemotherapy ,Cancer ,Regional Perfusion ,Colorectal Neoplasms ,Combined Modality Therapy ,Cytoreduction Surgical Procedures ,Female ,Follow-Up Studies ,Hepatectomy ,Humans ,Hyperthermia ,Induced ,Male ,Middle Aged ,Patient Selection ,Peritoneal Neoplasms ,Preoperative Care ,Prognosis ,Risk Factors ,Survival Rate ,appendiceal adenocarcinoma ,colorectal cancer ,HIPEC ,liver resection ,risk score ,Oncology and Carcinogenesis ,Oncology & Carcinogenesis - Abstract
BackgroundWhile parenchymal hepatic metastases were previously considered a contraindication to cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC), liver resection (LR) is increasingly performed with CRS/HIPEC.MethodsPatients from the US HIPEC Collaborative (2000-2017) with invasive appendiceal or colorectal adenocarcinoma undergoing primary, curative intent CRS/HIPEC with CC0-1 resection were included. LR was defined as a formal parenchymal resection. Primary endpoints were postoperative complications and overall survival (OS).ResultsA total of 658 patients were included. About 83 (15%) underwent LR of colorectal (58%) or invasive appendiceal (42%) metastases. LR patients had more complications (81% vs. 60%; p = .001), greater number of complications (2.3 vs. 1.5; p
- Published
- 2021
4. Innovative Invasive Loco-Regional Techniques for the Treatment of Lung Cancer.
- Author
-
Claes, Erik, Wener, Reinier, Neyrinck, Arne P., Coppens, Axelle, Van Schil, Paul E., Janssens, Annelies, Lapperre, Thérèse S., Snoeckx, Annemiek, Wen, Wen, Voet, Hanne, Verleden, Stijn E., and Hendriks, Jeroen M. H.
- Subjects
- *
TREATMENT of lung tumors , *MEDICAL technology , *LUNG tumors , *TUMOR classification , *ENDOVASCULAR surgery , *COMBINED modality therapy , *DIFFUSION of innovations - Abstract
Simple Summary: Every year lung cancer takes the lives of many patients, making it the most common cause of cancer-related deaths. While surgery is the gold standard treatment for early-stage lung cancer, its share in treating more advanced disease stages is limited. Therefore, clinicians advise a multimodal treatment consisting of chemotherapy, radiotherapy and/or immunotherapy to treat advanced lung cancers. There has been a growing interest in loco-regional techniques as they are expected to have advantages over current therapies. In this article, we provide an overview of the established and promising innovative invasive loco-regional techniques ordered by their route of administration (endobronchial, endovascular and transthoracic route) and an overview of their implementation and effectiveness. Although the results of these techniques show improved local disease control and effect, there is a need for more clinical studies to guarantee their efficacy and safety before they can be used within the clinic. Surgical resection is still the standard treatment for early-stage lung cancer. A multimodal treatment consisting of chemotherapy, radiotherapy and/or immunotherapy is advised for more advanced disease stages (stages IIb, III and IV). The role of surgery in these stages is limited to very specific indications. Regional treatment techniques are being introduced at a high speed because of improved technology and their possible advantages over traditional surgery. This review includes an overview of established and promising innovative invasive loco-regional techniques stratified based on the route of administration, including endobronchial, endovascular and transthoracic routes, a discussion of the results for each method, and an overview of their implementation and effectiveness. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
5. Cirrhosis is not a contraindication to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in highly selected patients
- Author
-
Weiss, Anna, Ward, Erin P, Baumgartner, Joel M, Lowy, Andrew M, and Kelly, Kaitlyn J
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Cancer ,Patient Safety ,Digestive Diseases ,Chronic Liver Disease and Cirrhosis ,Clinical Research ,Liver Disease ,Adult ,Chemotherapy ,Adjuvant ,Chemotherapy ,Cancer ,Regional Perfusion ,Contraindications ,Cytoreduction Surgical Procedures ,Female ,Follow-Up Studies ,Humans ,Hyperthermia ,Induced ,Liver Cirrhosis ,Male ,Middle Aged ,Patient Selection ,Peritoneal Neoplasms ,Prognosis ,Prospective Studies ,Retrospective Studies ,Cytoreductive surgery ,Cytoreduction ,HIPEC ,Cirrhosis ,Oncology and Carcinogenesis ,Oncology & Carcinogenesis ,Clinical sciences ,Dentistry ,Oncology and carcinogenesis - Abstract
BackgroundPatient selection for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is critically important to optimizing outcomes. There is currently no literature regarding the safety of CRS/HIPEC in patients with cirrhosis. The aim of this case series is to report the outcomes of three patients with well-compensated cirrhosis who underwent CRS/HIPEC.MethodsPatients were identified from a prospectively maintained peritoneal surface malignancy database. Patient, tumor, and operative-related details were recorded as short-term postoperative outcomes. Results were analyzed using descriptive statistics.ResultsAll patients had well-compensated (Child-Pugh Class A) cirrhosis and Eastern Cooperative Oncology Group (ECOG) performance status of 0. One patient had preoperative evidence of portal hypertension. All safely underwent CRS/HIPEC with completeness of cytoreduction (CC) scores of 0. The postoperative morbidity profile was unique, but all complications were manageable and resulted in full recovery to preoperative baseline status.ConclusionsPatient selection for CRS/HIPEC is critical for optimization of short- and long-term outcomes. This small series suggests that well-compensated cirrhosis should not be an absolute contraindication to CRS/HIPEC.
- Published
- 2018
6. ANA-12靶向抑制BDNF/TrkB信号缓解奥沙利铂诱导化疗 大鼠的痛觉行为.
- Author
-
赵佳佳, 万文军, 杨荷雨, 谢敏, and 刘玲
- Abstract
To investigate the effect and mechanism of ANA-12 on relieving oxaliplatin (OXA) induced neuropathic pain by targeting brain-derived neurotrophic factor (BDNF)/tyrosine kinase receptor B (TrkB) signaling in rats. Methods Eighteen male SD rats were randomly divided into 3 groups according to table of random number: the control group, the OXA treated group and the OXA + ANA-12 group (OXA+ANA-12), with 6 rats in each group. The OXA group and the OXA + ANA-12 group received an intraperitoneal injection of OXA (4 mg/kg for 5 days) to construct a chemotherapeutic pain model. After the model was successfully established, ANA-12 (20 g/L) was intrathecally administered in the OXA + ANA-12 group. After administration, pain behavior tests of rats in each group were performed, and changes in number of spontaneous flinches and mechanical pain threshold were recorded. The infiltration of spinal inflammatory cells and changes in expression level of interleukin (IL)-1β, tumor necrosis factor (TNF)-α, ionized calcium binding adapter molecule 1 (Iba1), BDNF, TrkB and nuclear factor kappa B (NF-κB) were detected by HE staining, immunofluorescence and Western blot assay. Results Compared with the control group, behavioral analysis showed that continuous injection of OXA significantly induced pain hyperalgesia and increased number of spontaneous flinches. Compared with the OXA group, intrathecal injection of ANA-12 significantly decreased the number of spontaneous flinches and increased mechanical pain threshold of rats. Morphological and protein expression analysis showed that OXA administration induced spinal inflammation, up-regulated BDNF/TrkB signaling and increased the expression levels of IL-1β, TNF-α, Iba1 and NF-κB compared with those of the control group. Compared with the OXA group, ANA-12 treatment significantly inhibited BDNF/ TrkB signaling and down-regulated the expression levels of IL-1β, TNF-α, Iba1 and NF-κB. Conclusion Intrathecal administration of ANA-12 inhibits spinal inflammation and relieves chemotherapy pain by blocking BDNF/TrkB signal. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
7. Basics of Electrical Impedance Tomography and Its Application
- Author
-
Putensen, Christian, Hentze, Benjamin, Muders, Thomas, Magder, Sheldon, editor, Malhotra, Atul, editor, Hibbert, Kathryn A., editor, and Hardin, Charles Corey, editor
- Published
- 2021
- Full Text
- View/download PDF
8. A Novel Tool for Predicting Major Complications After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy
- Author
-
Baumgartner, Joel M, Kwong, Thomas G, Ma, Grace L, Messer, Karen, Kelly, Kaitlyn J, and Lowy, Andrew M
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Clinical Research ,Cancer ,Adolescent ,Adult ,Aged ,Aged ,80 and over ,Antineoplastic Combined Chemotherapy Protocols ,Chemotherapy ,Adjuvant ,Chemotherapy ,Cancer ,Regional Perfusion ,Combined Modality Therapy ,Cytoreduction Surgical Procedures ,Female ,Follow-Up Studies ,Humans ,Hyperthermia ,Induced ,Male ,Middle Aged ,Neoplasm Recurrence ,Local ,Neoplasm Staging ,Neoplasms ,Peritoneal Neoplasms ,Postoperative Complications ,Prognosis ,Prospective Studies ,Retrospective Studies ,Severity of Illness Index ,Survival Rate ,Young Adult ,Oncology and Carcinogenesis ,Oncology & Carcinogenesis ,Oncology and carcinogenesis - Abstract
BackgroundCytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) has an emerging role in the treatment of peritoneal malignancies. The CRS-HIPEC approach has known treatment-related toxicities. This study sought to determine the predictors of major postoperative complications after CRS-HIPEC in a high-volume center.MethodsFrom a single-institution database, this study investigated complications experienced by patients undergoing CRS-HIPEC. Multiple preoperative and operative factors were analyzed for their ability to predict 60-day Clavien grade 3 and greater (major) complications by logistic regression. A predictive model was created from preoperative factors using multivariate logistic regression. The model was tested by Akaike's information criterion, the Hosmer and Lemeshow Goodness-of-Fit Test, the receiver operating characteristic, and the Youden Index.ResultsThe study evaluated 247 patients undergoing CRS-HIPEC. The primary tumor site was the appendix in 166 cases (67.2 %), the colorectal area in 51 cases (20.6 %), the peritoneum (mesothelioma) in 22 cases (8.9 %), the ovary in 5 cases (2 %), and the small bowel in 3 cases (1.2 %). The median peritoneal cancer index was 14 (range 0-29), and 235 patients (95.1 %) had a complete (CC-0/1) cytoreduction. Major complications occurred for 41 patients (16.6 %), classified as grade 3 in 33 cases (13.4 %), grade 4 in 5 cases (2 %), and grade 5 (deaths) in 3 cases (1.2 %). The factors predictive of major complications in the multivariate analysis were a Charlson Comorbidity Index (CCI) score higher than 0 [odds ratio (OR), 2.505; p = 0.035], presence of preoperative symptoms (OR 1.951; p = 0.064), and prior resection status [no resection or prior CRS-HIPEC (OR 2.087) vs. prior resection without CRS-HIPEC (OR 3.209); p = 0.046]. These variables were used to create a tool predictive of postoperative complications.ConclusionPresence of symptoms, CCI, and prior resection status predict major complications and define a low-risk population after CRS-HIPEC.
- Published
- 2016
9. Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC): The First Reported Case in Brazil Using Standardized Technique with the Capnopen® Nebulizer Device.
- Author
-
Hiroshi Akaishi, Eduardo, Greatti Vaz da Silva, Diego, Gadelha Lima, Helber Vidal, M. Grapperon-Mathis, Roberta Lages, de Souza Arakaki, Mariana, Andrade Galindo, Ivan Vinicius, Afonso Daia, Lucas, Ferreira Araruna, Gustavo, Torres Oliveira, André Luiz, Nasser Mancini, Caio, and Gehm Hoff, Paulo Marcelo
- Subjects
- *
MEDICAL care , *CANCER chemotherapy , *CANCER invasiveness , *DIAGNOSIS , *DRUGS , *PANCREATIC surgery , *PERITONEAL cancer , *CANCER pain - Abstract
Patient: Male, 67-year-old Final Diagnosis: Pancreatic moderately differentiated tubular metastatic adenocarcinoma Symptoms: Abdominal pain-ascites Medication: -- Clinical Procedure: Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) Specialty: Oncology Surgery Objective: Unusual setting of medical care Background: Peritoneal metastasis is a common progression of abdominal-pelvic cancers, and it is associated with poorer oncological prognosis when compared to other metastasis sites. Its treatment has limited results, mainly because of poor bioavailability of chemotherapy within the abdominal cavity after systemic administration. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) has been proposed as a novel method to deliver chemotherapy directly into the peritoneal surface; it combines the effectiveness and response of an intraperitoneal therapy with benefits of a minimally invasive approach. The laparoscopic capnoperitoneum is used to instill chemotherapy particles in a more efficient way for distribution and penetration when compared to peritoneal lavage. In the present study, we describe the first PIPAC performed in Brazil, according to the standard technique previously described with the Capnopen® nebulizer device, as well as technique details based on our literature review. Case Report: A 67-year-old man with pancreatic adenocarcinoma metastatic to the liver at first diagnosis underwent systemic treatment with the FOLFIRINOX protocol. After a major clinical response due to systemic treatment, pancreaticoduodenectomy was performed with resection and radiofrequency ablation of hepatic nodules. After 7 months of follow-up, the patient's condition evolved with symptomatic relapse in the peritoneum. Aiming at better control of this site, multiple PIPAC procedures were performed, showing excellent control of the peritoneal cavity disease. The patient had a sustained response in the peritoneal cavity and showed systemic disease progression 6 months after the first PIPAC procedure, which deceased at 20 months after the first PIPAC procedure and 42 months after the primary diagnosis. Conclusions: This report shows that the PIPAC procedure is reproducible elsewhere, with safety and good functional results. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
10. A systematic review and meta‐analyses of regional perfusion in donation after circulatory death solid organ transplantation.
- Author
-
De Beule, Julie, Vandendriessche, Katrien, Pengel, Liset H. M., Bellini, Maria Irene, Dark, John H., Hessheimer, Amelia J., Kimenai, Hendrikus J. A. N., Knight, Simon R., Neyrinck, Arne P., Paredes, David, Watson, Christopher J. E., Rega, Filip, and Jochmans, Ina
- Subjects
- *
ISOLATION perfusion , *TRANSPLANTATION of organs, tissues, etc. , *HEMORHEOLOGY , *BLOOD viscosity , *LUNG transplantation - Abstract
Summary: In donation after circulatory death (DCD), (thoraco)abdominal regional perfusion (RP) restores circulation to a region of the body following death declaration. We systematically reviewed outcomes of solid organ transplantation after RP by searching PubMed, Embase, and Cochrane libraries. Eighty‐eight articles reporting on outcomes of liver, kidney, pancreas, heart, and lung transplants or donor/organ utilization were identified. Meta‐analyses were conducted when possible. Methodological quality was assessed using National Institutes of Health (NIH)‐scoring tools. Case reports (13/88), case series (44/88), retrospective cohort studies (35/88), retrospective matched cohort studies (5/88), and case‐control studies (2/88) were identified, with overall fair quality. As blood viscosity and rheology change below 20 °C, studies were grouped as hypothermic (HRP, ≤20 °C) or normothermic (NRP, >20 °C) regional perfusion. Data demonstrate that RP is a safe alternative to in situ cold preservation (ISP) in uncontrolled and controlled DCDs. The scarce HRP data are from before 2005. NRP appears to reduce post‐transplant complications, especially biliary complications in controlled DCD livers, compared with ISP. Comparisons for kidney and pancreas with ISP are needed but there is no evidence that NRP is detrimental. Additional data on NRP in thoracic organs are needed. Whether RP increases donor or organ utilization needs further research. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
11. Neoadjuvantní užití izolované perfuze končetiny u objemného myxoidního liposarkomu stehna: kazuistika.
- Author
-
LESENSKÝ, J., VOČKA, M., ŠPAČEK, M., and HÓSOVÁ, M.
- Abstract
Large unresectable STS presents a therapeutic challenge. Several options are being explored to avoid amputation without compromising the oncological outcome. Neoadjuvant chemotherapy delivers inconsistent and rather unsatisfactory results, preoperative radiotherapy compromises healing, hence it can impede adjuvant systemic treatment. We present a case report of neoadjuvant use of isolated limb perfusion with TNF-alfa and Alkeran (Melphalan) in a patient with initially unresectable large myxoid liposarcoma of the thigh. We achieved 55% reduction in size of the tumor that allowed for wide resection with a safe margin. Pathology confirmed 99% tumor necrosis. The patient has a full function of his extremity and is disease-free at one year follow-up. ILP should be considered as a treatment option which, in selected cases, can contribute to limb sparing surgery. [ABSTRACT FROM AUTHOR]
- Published
- 2021
12. Perfusión aislada de extremidad: una opción terapéutica para metástasis en tránsito de melanoma nodular y lentiginoso acral.
- Author
-
Duarte, Carlos, Restrepo, Juliana, Gómez, Alden Pool, and Carreño, Alexander
- Abstract
Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2021
- Full Text
- View/download PDF
13. Surgical Outcomes of Hyperthermic Intraperitoneal Chemotherapy: Analysis of the American College of Surgeons National Surgical Quality Improvement Program
- Author
-
Jafari, Mehraneh D, Halabi, Wissam J, Stamos, Michael J, Nguyen, Vinh Q, Carmichael, Joseph C, Mills, Steven D, and Pigazzi, Alessio
- Subjects
Clinical Research ,Digestive Diseases ,Patient Safety ,Cancer ,7.3 Management and decision making ,6.4 Surgery ,Management of diseases and conditions ,Evaluation of treatments and therapeutic interventions ,Good Health and Well Being ,Chemotherapy ,Cancer ,Regional Perfusion ,Digestive System Surgical Procedures ,Female ,Follow-Up Studies ,Hospital Mortality ,Humans ,Hyperthermia ,Induced ,Kaplan-Meier Estimate ,Length of Stay ,Male ,Middle Aged ,Peritoneal Neoplasms ,Quality Improvement ,Retrospective Studies ,Survival Rate ,Treatment Outcome ,United States - Abstract
ImportanceHyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery have been shown to benefit selected patients with peritoneal carcinomatosis. However, these procedures are associated with high morbidity and mortality. Available data investigating the outcomes of HIPEC are mostly limited to single-center studies. To date, there have been few large-scale studies investigating the postoperative outcomes of HIPEC.ObjectiveTo determine the associated 30-day morbidity and mortality of cytoreductive surgery-HIPEC in the treatment of metastatic and primary peritoneal cancer in American College of Surgeons National Surgical Quality Improvement Program centers.Design, setting, and participantsA retrospective review of HIPEC cases performed for primary and metastatic peritoneal cancer diagnoses was conducted. The cytoreductive surgical procedures were sampled, and disease processes were identified. Patient demographics, intraoperative occurrences, and postoperative complications were reviewed from the American College of Surgeons National Surgical Quality Improvement Program from 2005-2011.Main outcomes and measuresThirty-day mortality and morbidity.ResultsOf the cancers identified among the 694 sampled cases, 14% of patients had appendiceal cancer, 11% had primary peritoneal cancer, and 8% had colorectal cancer. The American Society of Anesthesiologists classification was 3 for 70% of patients. The average operative time was 7.6 hours, with 15% of patients requiring intraoperative transfusions. Postoperative bleeding (17%), septic shock (16%), pulmonary complications (15%), and organ-space infections (9%) were the most prevalent postoperative complications. The average length of stay was 13 days, with a 30-day readmission rate of 11%. The rate of reoperation was 10%, with an overall mortality rate of 2%.Conclusions and relevanceAmerican College of Surgeons National Surgical Quality Improvement Program hospitals performing HIPEC have acceptable rates of morbidity and mortality.
- Published
- 2014
14. Haemodynamic monitoring by application of transpulmonary thermodilution in patients with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
- Author
-
Sakka, S. G., Grensemann, J., Harte, M., Defosse, J. M., Wappler, F., Heiss, M. M., and Ströhlein, M. A.
- Subjects
HEMODYNAMICS ,CYTOREDUCTIVE surgery ,HYPERTHERMIC intraperitoneal chemotherapy ,FLUID therapy ,ISOLATION perfusion - Abstract
Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2021
- Full Text
- View/download PDF
15. Carotid artery infusion via implantable catheters for squamous cell carcinoma of the tonsils
- Author
-
Karl Reinhard Aigner, Sabine Gailhofer, and Kornelia Aigner
- Subjects
Regional perfusion ,Intra-arterial infusion ,Squamous cell carcinoma of the tonsils ,Toxicity ,Port catheters ,Locally advanced cancers ,Surgery ,RD1-811 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background Chemoradiotherapy has a dominant role in therapy for head and neck cancers. However, impressive results are often disturbed by adverse events such as dysphagia, xerostomia, and functional speech and hearing loss. To avoid exceeding toxicity limits in patients with primary and recurrent cancers of the tonsils, chemotherapy was administered intra-arterially via implantable Jet-Port-Allround catheters. Methods We report on patients with primary and recurrent cancers of the tonsils. Eleven patients who refused chemoradiation were included in this trial. Of the seven patients without prior therapy, one was stage I, one was stage III, three were stage IVA, one was stage IVB, and one was stage IVC. The four patients who were in progression after prior chemoradiation were stage IVA. The median follow-up time was 47 months (20 to 125 months). After the implantation of a Jet-Port-Allround catheter into the carotid artery, the patients received intra-arterial infusion chemotherapy with venous chemofiltration for systemic detoxification. The stage I patient received lower-dose chemotherapy without chemofiltration. The stage IVC patient with lung metastases and a primary tumor that extended across the midline to the contralateral tonsil received additional isolated thoracic perfusion chemotherapy. Results All seven chemoradiation-naïve patients exhibited clinically complete responses and are still alive after 20 to 125 months. Among the four patients who had relapsed after prior chemoradiation, the intra-arterial therapy elicited only poor responses, and the median survival time was 7.5 months. After carotid artery infusion chemotherapy, none of the patients required tube feeding. No cases of dysphagia, xerostomia, or functional speech and hearing loss have been reported among the patients without prior chemoradiotherapy. Conclusion Despite the administration of low total dosages, intra-arterial infusion generates high concentrations of chemotherapeutics. In combination with chemofiltration, the systemic toxicity is kept within acceptable limits. Among the non-pretreated patients, better tumor responses and long-term tumor control were noted compared with those who had prior chemoradiation. Implantable Jet-Port-Allround carotid artery catheters facilitate the application of regional chemotherapy.
- Published
- 2018
- Full Text
- View/download PDF
16. Survival analysis of patients with medium and advanced hepatocellular carcinoma treated by TACE combined with Endostar.
- Author
-
Qi, Xiu-Heng, Wu, Zhen-Ming, Liu, Qi, Guo, Qian, Wang, Ling-Ling, and Wang, Shuai-Bing
- Subjects
- *
HEPATOCELLULAR carcinoma , *SURVIVAL analysis (Biometry) , *INFUSION therapy , *INTRAVENOUS therapy , *TREATMENT effectiveness - Abstract
To explore the effects of two different administration routes of Endostar on the survival of patients with medium and advanced hepatocellular carcinoma (HCC) and underwent trans-arterial chemoembolization (TACE). Seventy-two patients with medium and advanced HCC were enrolled. Among them, 42 patients underwent the hepatic arterial infusion of Endostar combined with TACE (infusion therapy group); and the remaining 30 patients underwent the hepatic treatment of TACE combined with the intravenous application of Endostar (intravenous therapy group). All patients underwent regular examinations of CT (or MRI) and DSA to observe the conditions of tumor recurrence or metastasis, and to determine the existence of tumor angiogenesis. The response rate of treatment in the Endostar hepatic arterial infusion group was higher than that in the control group, and the difference was statistically significant (31/42:14/30, X 2 = 5.501, p < 0.05). In addition, median progression free-survival time of the two groups were 8.67 months and 6.67 months, respectively (p = 0.046); and the difference was statistically significant. The hepatic arterial infusion of Endostar combined with TACE can significantly improve recent clinical efficacy and mPFS in the treatment of medium and advanced HCC. However, improvement on the overall survival of long-term efficacy is not significant. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
17. Donation after circulatory death liver transplantation: consensus statements from the Spanish Liver Transplantation Society.
- Author
-
Hessheimer, Amelia J., Gastaca, Mikel, Miñambres, Eduardo, Colmenero, Jordi, Fondevila, Constantino, Briceño, Javier, Caralt, Mireia, de la Rosa, Gloria, Fernández Aguilar, José Luis, Fundora, Yiliam, García‐Gil, F. Agustín, González‐Pinto, Ignacio, Lladó, Laura, López‐Andújar, Rafael, López Guerra, Diego, López Santamaría, Manuel, Manrique, Alejandro, Marín Gómez, Luis Miguel, Moneva, Enrique, and Nuño, Javier
- Subjects
- *
LIVER transplantation , *ISOLATION perfusion , *STANDARDS - Abstract
Summary: Livers from donation after circulatory death (DCD) donors are an increasingly more common source of organs for transplantation. While there are few high‐level studies in the field of DCD liver transplantation, clinical practice has undergone progressive changes during the past decade, in particular due to mounting use of postmortem normothermic regional perfusion (NRP). In Spain, uncontrolled DCD has been performed since the late 1980s/early 1990s, while controlled DCD was implemented nationally in 2012. Since 2012, the rise in DCD liver transplant activity in Spain has been considerable, and the great majority of DCD livers transplanted in Spain today are recovered with NRP. A panel of the Spanish Liver Transplantation Society was convened in 2018 to evaluate current evidence and accumulated experience in DCD liver transplantation, in particular addressing issues related to DCD liver evaluation, acceptance criteria, and recovery as well as recipient selection and postoperative management. This panel has created a series of consensus statements for the standard of practice in Spain and has published these statements with the hope they might help guide other groups interested in implementing new forms of DCD liver transplantation and/or introducing NRP into their clinical practices. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
18. Norwood Operation/Damus-Stansel-Kaye
- Author
-
Mavroudis, Constantine, Mavroudis, Constantine, editor, and Backer, Carl Lewis, editor
- Published
- 2015
- Full Text
- View/download PDF
19. Thoracoabdominal Normothermic Perfusion in Donation After Circulatory Death
- Author
-
Shaheed Merani, Marian Urban, John Y. Um, Aleem Siddique, Kim F. Duncan, Lance Fristoe, Anthony W. Castleberry, Nicholas W. Markin, M. Megan Chacon, and Ryan Robertson
- Subjects
Pulmonary and Respiratory Medicine ,Tissue and Organ Procurement ,business.industry ,medicine.medical_treatment ,Regional perfusion ,Organ Preservation ,Circulatory death ,Tissue Donors ,Donation after brain death ,Death ,Perfusion ,Normothermic perfusion ,Donation ,Anesthesia ,Extracorporeal membrane oxygenation ,Heart Transplantation ,Humans ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Donation after circulatory death (DCD) is emerging as an alternative pathway to donation after brain death (DBD) to expand the cardiac organ donor pool.1 We describe the surgical technique and circuit configuration for in-situ organ reperfusion with thoracoabdominal normothermic regional perfusion (TA-NRP) using portable venoarterial extracorporeal membrane oxygenation (VA-ECMO).
- Published
- 2022
20. The future of organ perfusion and re‐conditioning.
- Author
-
Weissenbacher, Annemarie, Vrakas, Georgios, Nasralla, David, and Ceresa, Carlo D. L.
- Subjects
- *
PERFUSION , *PANCREAS transplantation , *ISOLATION perfusion , *INTESTINE transplantation , *TRANSPLANTATION of organs, tissues, etc. - Abstract
Summary: Organ preservation and re‐conditioning using machine perfusion technologies continue to generate promising results in terms of viability assessment, organ utilization and improved initial graft function. Here, we summarize the latest findings and study the results of ex‐vivo/ex‐situ hypothermic (HMP) and normothermic machine perfusion (NMP) in the area of abdominal organ transplantation (kidney, liver, pancreas and intestine). We also consider the potential role of normothermic regional perfusion (NRP) to re‐condition donors after circulatory death organs before retrieval. The findings from clinical studies reported to date suggest that machine perfusion will offer real benefits when compared with conventional cold preservation. Several randomized trials are expected to report their findings within the next 2 years which may shed light on the relative merits of different perfusion methods and could indicate which perfusion parameters may be most useful to predict organ quality and viability. Further work is needed to identify composite endpoints that are relevant for transplanted organs that have undergone machine preservation. Multi‐centre trials to compare and analyse the combinations of NRP followed by HMP and/or NMP, either directly after organ retrieval using transportable devices or when back‐to‐base, are needed. The potential applications of machine preservation technology beyond the field of solid organ transplantation are also considered. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
21. Abdominal normothermic regional perfusion in controlled donation after circulatory determination of death liver transplantation: Outcomes and risk factors for graft loss
- Author
-
Andrea Boscá, Amelia J. Hessheimer, Luis Miguel Marín, Bárbara Vidal, Juan Carlos Rodríguez-Sanjuan, Enrique Velasco Sánchez, Carlos Jiménez, Laura Lladó, Elisabeth Coll, Manuel Barrera, Mireia Caralt, Carolina González-Abos, Belinda Sánchez, Patricia Ruiz, Javier Nuño, Josefina Lopez-Dominguez, Javier Briceño, Beatriz Domínguez-Gil, Gloria de la Rosa, Gerardo Blanco, Fernando Rotellar, Evaristo Varo, Felipe Alconchel, Julio Santoyo Santoyo, Rafael López-Andújar, Fernando Mosteiro, Lander Atutxa, Diego R. Lopez, Constantino Fondevila, G. Rodriguez-Laiz, Manuel Gómez, Alejandra Otero, Pablo Ramírez, Ramón Charco, José Ángel López-Baena, José Manuel Granadino Roldán, V. Sánchez-Turrión, Jesus Maria Villar del Moral, Miguel Ángel Gómez-Bravo, Mario Royo-Villanova, Iago Justo, Javier López-Monclús, Mikel Gastaca, Santiago Tomé, Pablo Martí-Cruchaga, David Pacheco, María Aranzazu Varona, and María Trinidad Villegas Herrera
- Subjects
Tissue and Organ Procurement ,medicine.medical_treatment ,organ procurement and allocation ,Regional perfusion ,Liver transplantation ,clinical research/practice ,Graft loss ,Cold Ischemia Time ,Donor age ,Risk Factors ,Interquartile range ,extracorporeal membrane oxygenation (ECMO) ,Humans ,Immunology and Allergy ,Medicine ,Pharmacology (medical) ,donation after circulatory determination of death (DCD) [donors and donation] ,Aged ,Retrospective Studies ,Transplantation ,business.industry ,Graft Survival ,surgical/technical [complication] ,Organ Preservation ,Middle Aged ,Tissue Donors ,Liver Transplantation ,Death ,Perfusion ,ischemia reperfusion injury (IRI) ,Anesthesia ,Circulatory system ,business ,liver transplantation/hepatology - Abstract
Postmortem normothermic regional perfusion (NRP) is a rising preservation strategy in controlled donation after circulatory determination of death (cDCD). Herein, we present results for cDCD liver transplants performed in Spain 2012-2019, with outcomes evaluated through December 31, 2020. Results were analyzed retrospectively and according to recovery technique (abdominal NRP [A-NRP] or standard rapid recovery [SRR]). During the study period, 545 cDCD liver transplants were performed with A-NRP and 258 with SRR. Median donor age was 59 years (interquartile range 49-67 years). Adjusted risk estimates were improved with A-NRP for overall biliary complications (OR 0.300, 95% CI 0.197-0.459, p
- Published
- 2022
22. The Anatomy Features and Variations of the Point Where Right Gastroepiploic Vein Flows into Superior Mesenteric Vein/Portal Vein: Anatomical Study of Catheterization of Portal Vein Infusion Chemotherapy.
- Author
-
Liu, Xingxing, Yang, Jian, Li, Xia-Xi, Xiang, Nan, Zeng, Ning, Fan, Ying-Fang, and Fang, Chi-Hua
- Subjects
- *
GASTROEPIPLOIC artery , *LIVER tumors , *COMPUTED tomography , *PORTAL vein , *CANCER chemotherapy , *SURGICAL complications , *CATHETERIZATION , *THREE-dimensional imaging , *RETROSPECTIVE studies , *MESENTERIC veins , *ANATOMY ,TUMOR surgery - Abstract
Introduction: To study the anatomical features and classification of the angle between the right gastroepiploic vein (RGEV) and superior mesenteric vein/portal vein (SMV/PV) and to guide the catheterization of intraportal infusion chemotherapy through RGEV and reduce surgical complications.Patients and Methods: A retrospective three-dimensional (3D) computed tomography study was undertaken on 200 consecutive subjects with or without hepatic malignant tumors with a dedicated workstation 3D-MIA (the improved MI-3DVS workstation) developed by ourselves to determine the prevalence of surgically significant angle between RGEV and SMV/PV anatomic variations and its classification.Results: The mean value of the angles between the end of RGEV and SMV/PV (AERS/P) (200 cases) was 84.2° ± 23.8 (31.4°-151.5°): 40.6° ± 92.3 (-177.9° to 178.0°) (sagittal angle), 81.7° ± 29.8 (-79.3° to 160.7°) (coronal angle), and 10.5° ± 94.3 (-178.7° to 175.8°) (horizontal angle). The mean value of the angles between the right bend of RGEV and SMV/PV (ARRS/P) (168 cases) was 104.8° ± 26.1 (20.5°-159.7°):49.3° ± 117.8 (-175.3° to 179.5°) (sagittal angle), 103.5° ± 37.7 (-178.8° to 168.9°) (coronal angle), and 12.6° ± 102.8 (-179.9° to 179.2°) (horizontal angle). The AERS/P were classified into large angle group (32 cases, 16%), middle angle group (113 cases, 56.5%), and small angle group (55 cases, 27.5%) based on angle variations and risks of catheterization.Conclusions: Precognition of the variations of AERS/P and ARRS/P before surgery is useful during chemotherapy pump catheterizing through RGEV in reduction of surgical complications by modulating the angle and direction of RGEV running into SMV/PV properly. [ABSTRACT FROM AUTHOR]- Published
- 2018
- Full Text
- View/download PDF
23. 欧洲癌症研究与治疗组织评分系统对非肌层 浸润性尿路上皮癌患者经尿道膀胱肿瘤电切 术后吡柔比星即刻灌注化疗的效果评价
- Author
-
丁祥黎, 杨德林, 颜汝平, 李志鹏, 叶春伟, 何进, 禹路, 和术臣, and 李海丹
- Abstract
Objective To assess value of immediate postoperative intravesical instillation of pirarubicin after transurethral resection (TURBT)of non-muscle invasive bladder cancer. Methods 484 patients diagnosed with non-muscle-invasive bladder cancer admitted to the Second Affiliated Hospital of Kunming Medical University were divided into two groups after transurethral resection of bladder tumor. 285 patients received postoperative intravesical instillation of pirarubicin within 6 hours after the surgery, 199 patients received first instillation of pirarubicin at 10 days after the surgery, after that, all the patients received routine bladder perfusion chemotherapy. Patients who received intravesical instillation of pirarubicin within 6 hours were defined as immediate intravesical instillation group and the other patients as the control group. Based on the European Organisation for Research and Treatment of Cancer risk tables, scores of recurrence and progression of patients were calculated and then stratified into risk groups accordingly. Recurrence and progression rates of the immediate intravesical instillation group were analyzed and then compared with the corresponding reference of the risk tables. Results The 1-year and 5-year recurrence rate of patients with EORTC table scoring 0 in the immediate intravesical instillation group were significantly lower than that of the EORTC reference group (5.3% and 14.0% vs 15.0% and 31.0%, P<0.05). 1-year recurrence free rate between the immediate intravesical instillation group and the control group in patients scoring 1-4 was significantly different (81.3% vs 76.7%, P=0.014). However, 1-year recurrence free rate of the immediate intravesical instillation group was comparable with that of the control group in patients scoring 5-9, 10-17(P>0.05), which is quite close to the EORTC reference. The probability rates of 1-year and 5-year progression of the 285 patients who received immediate intravesical instillation group did not show significant difference with the EORTC reference. On multivariate analysis, previous recurrence, tumor grade G2-3, tumor multiplicity, delay of immediate intravesical instillation were independent risk factors of recurrence(P<0.05). Conclusions With the help of EORTC recurrence risk table stratifying the patients into different risk groups, our study showed that delay of immediate postoperative intravesical instillation of chemotherapy after TURBT was an independent risk factor of post-surgery recurrence of tumor. Moreover, patients with EORTC scoring 1-4 might obtain greatest benefits. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
24. Avulsão parcial de casco em equino com crescimento laminar em aparente fluxo ascendente.
- Author
-
de Siqueira Almeida Reis, Luiza, de Cássia Campebell, Rita, Lopes Câmara, Antônio Carlos, Teixeira Neto, Antônio Raphael, de Castro, Márcio Botelho, Meziara Wilson, Tais, and Louzada Moreira, Igor
- Abstract
Copyright of Revista Acadêmica: Ciência Animal is the property of Revista Academica: Ciencia Animal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2018
- Full Text
- View/download PDF
25. Investigation of arterial claudication with transcutaneous oxygen pressure at exercise: Interests and limits
- Author
-
Pierre Ramondou, Pierre Abraham, Samir Henni, Wendsendate Yves Sempore, Jeanne Hersant, and Mathieu Feuilloy
- Subjects
medicine.medical_specialty ,Partial Pressure ,Regional perfusion ,030204 cardiovascular system & hematology ,Hypoxemia ,Peripheral Arterial Disease ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Oxygen pressure ,Skin ,integumentary system ,business.industry ,Reproducibility of Results ,Blood flow ,Intermittent Claudication ,Lower extremity artery ,Oxygen ,Lower Extremity ,Regional Blood Flow ,Exercise Test ,Cardiology ,medicine.symptom ,Transcutaneous oxygen ,Cardiology and Cardiovascular Medicine ,Claudication ,business ,Blood Gas Monitoring, Transcutaneous ,Biomarkers - Abstract
Transcutaneous oxygen pressure (TcpO2) measurement has been used for years at rest in patients with lower extremity artery disease. It was proposed for exercise testing (Ex-TcpO2) in the 80ies to evaluate regional blood flow impairment (RBFI) at the proximal and distal levels simultaneously and on both sides, in case of claudication. It was suggested that the use of a chest electrode was mandatory to show that decreases in TcpO2 at the limb level result from limb RBFI and not from a systemic pO2 decrease of cardiopulmonary origin (exercise-induced hypoxemia). Unfortunately, a major pitfall of Ex-TcpO2 was the low absolute reliability of the regional perfusion index (RPI: ratio of limb to chest values) and the technique was almost abandoned until 2003, when the DROP index (Decrease from rest of oxygen pressure: limb changes minus chest changes from rest) was proposed. The DROP mathematical formula makes Tcpo2 results independent from the absolute pO2 starting values, improving reliability of Ex-TcpO2 as compared to the RPI. Since then, Ex-TcpO2 has been of renewed interest. The present paper addresses the physiology of Ex-TcpO2, interpretation of its results, and common misunderstandings about its use.
- Published
- 2021
26. Regional Therapy of Rectal Cancer
- Author
-
Guadagni, Stefano, Schietroma, Mario, Fiorentini, Giammaria, Cantore, Maurizio, Lely, Claudio, Ruscitti, Cristina, Clementi, Marco, Kanavos, Evangelos, Amicucci, Gianfranco, Teicher, Beverly A., editor, Schlag, Peter M., editor, Stein, Ulrike, editor, and Eggermont, Alexander M. M., editor
- Published
- 2007
- Full Text
- View/download PDF
27. Innovative Invasive Loco-Regional Techniques for the Treatment of Lung Cancer
- Author
-
Erik Claes, Reinier Wener, Arne P. Neyrinck, Axelle Coppens, Paul E. Van Schil, Annelies Janssens, Thérèse S. Lapperre, Annemiek Snoeckx, Wen Wen, Hanne Voet, Stijn E. Verleden, and Jeroen M. H. Hendriks
- Subjects
inhalation ,CELL-CARCINOMA ,Cancer Research ,Science & Technology ,PERCUTANEOUS MICROWAVE ABLATION ,RISK PREDICTION ,transthoracic ,ENDOBRONCHIAL ULTRASOUND ,PULMONARY-ARTERY PERFUSION ,CLINICAL-TRIAL ,lung cancer ,PHOTODYNAMIC THERAPY ,PHASE-I ,INTRATUMORAL INJECTION ,Oncology ,endovascular ,Human medicine ,endobronchial ,RADIOFREQUENCY ABLATION ,Life Sciences & Biomedicine ,regional perfusion - Abstract
Surgical resection is still the standard treatment for early-stage lung cancer. A multimodal treatment consisting of chemotherapy, radiotherapy and/or immunotherapy is advised for more advanced disease stages (stages IIb, III and IV). The role of surgery in these stages is limited to very specific indications. Regional treatment techniques are being introduced at a high speed because of improved technology and their possible advantages over traditional surgery. This review includes an overview of established and promising innovative invasive loco-regional techniques stratified based on the route of administration, including endobronchial, endovascular and transthoracic routes, a discussion of the results for each method, and an overview of their implementation and effectiveness. ispartof: CANCERS vol:15 issue:8 ispartof: location:Switzerland status: published
- Published
- 2023
28. Lung
- Author
-
Isawa, Toyoharu, Feinendegen, Ludwig E., editor, Shreeve, Walton W., editor, Eckelman, William C., editor, Bahk, Yong-Whee, editor, and Wagner, Henry N., Jr., editor
- Published
- 2003
- Full Text
- View/download PDF
29. Regional Effects of Catecholamines
- Author
-
Meier-Hellmann, Andreas, Vincent, Jean-Louis, editor, Carlet, Jean, editor, and Opal, Steven M., editor
- Published
- 2002
- Full Text
- View/download PDF
30. Katecholamintherapie in der Sepsis
- Author
-
Meier-Hellmann, Andreas, Bardenheuer, Hubert J., editor, Forst, Helmuth, editor, Rossaint, Rolf, editor, and Spahn, Donat R., editor
- Published
- 2001
- Full Text
- View/download PDF
31. INTRAVENOUS REGIONAL ANTIBIOTIC PERFUSION THERAPY AS AN ADJUNCTIVE TREATMENT FOR DIGITAL LESIONS IN SEABIRDS.
- Author
-
Fiorello, Christine V.
- Abstract
Foot infections are a common problem among seabirds in wildlife rehabilitation. Pododermatitis and digital infections are often challenging to treat because of the presence of suboptimal substrates, abnormal weight-bearing due to injuries, and suboptimal nutritional or health status. Seabirds represent the majority of animals requiring rehabilitation after oil spills, and foot problems are a common reason for euthanasia among these birds. Antibiotic intravenous regional perfusion therapy is frequently used in humans and other species to treat infections of the distal extremities, but it has not been evaluated in seabirds. During the 2015 Refugio oil spill response, four birds with foot lesions (pododermatitis, osteomyelitis, or both) were treated with ampicillin/sulbactam administered intravenously to the affected limb(s) in addition to systemic antibiotics and anti-inflammatories. Three of the birds, all brown pelicans ( Pelecanus occidentalis) recovered rapidly and were released. Two of these birds had acute pododermatitis and were treated once with intravenous regional perfusion. They were released approximately 3 wk after the perfusion therapy. The third pelican had osteomyelitis of a digit. It was treated twice with intravenous regional perfusion and was released about 1 mo after the initial perfusion therapy. The fourth bird, a Pacific loon ( Gavia pacifica), was treated once with perfusion therapy but did not respond to treatment and was euthanatized. No serious adverse effects were observed. This technique should be explored further in avian species. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
32. 华蟾素注射液经肝动脉灌注联合碘油栓塞治疗巴塞罗那C期原发性肝癌的效果和安全性
- Author
-
于 童, 翟笑枫, 刘 群, 孟永斌, 陆检英, and 陈喆
- Abstract
Objective To investigate the clinical effect and safety of hepatic arterial infusion of cinobufotalin injection combined with lipiodol chemoembolization ( TACE) in the treatment of Barcelona Clinic Liver Cancer( BCLC) stage C primary liver cancer.Methods A retrospective analysis was performed for the clinical data of 82 patients with BCLC stage C primary liver cancer who were admitted to Department of TCM Oncology in Changhai Hospital from December 2010 to October 2014. According to intraoperative medication, the patients were divided into two groups.The 40 patients in the cinobufotalin group were treated with hepatic arterial infusion with cinobufotalin combined with lipiodol embolism, and the 42 patients in the control group underwent TACE with epirubicin. The objective response rate, time to progression, median survival time, and acute adverse events were compared between the two groups after a single treatment. The t- test was used for comparison of continuous data between groups, the chi- square test was used for comparison of categorical data between groups, and the Kaplan- Meier method was used for the analysis of cumulative survival rate.Results At 1.5 months after surgery, the cinobufotalin group had a significantly higher objective response rate than the control group( 27.5% vs 9.52%, χ~2= 4.429, P = 0.035). The time to progression was 2.4 months( 95% CI:1.978- 2.822) in the cinobufotalin group and 3.0 months( 95% CI:2.260- 3.740) in the control group, and there was no significant difference between the two groups( P = 0.344). The median survival time was 6.6 months( 95% CI:4.131-9.069) in the cinobufotalin group and 10.3 months( 95% CI:0.089- 20.511) in the control group, and there was no significant difference between the two groups( P = 0.132).At 5 days after surgery, the cinobufotalin group had significantly lower incidence rates of abnormal alanine aminotransferase level, white blood cell count, and platelet count, as well as adverse events including hepatalgia, abdominal distension, and nausea/vomiting than the control group( χ~2= 6.193, 5.311, 6.096, 5.909, 4.761, and 4.173, all P < 0.05).Conclusion As for patients with BCLC stage C primary liver cancer, hepatic arterial infusion of cinobufotalin injection combined with lipiodol chemoembolization has a better short- term therapeutic effect, milder adverse effects, and a similar long- term therapeutic effect compared with TACE with conventional chemotherapeutic agents. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
33. Effects of Catecholamine Therapy on Regional Perfusion in Septic Shock
- Author
-
Treggiari-Venzi, M. M., Suter, P. M., Romand, J. A., and Vincent, Jean-Louis, editor
- Published
- 2000
- Full Text
- View/download PDF
34. Liver Transplantation From Controlled Donors After Circulatory Death Using Normothermic Regional Perfusion: An Initial French Experience
- Author
-
Eric Savier, C. Jasseron, Corinne Antoine, and Federica Dondero
- Subjects
medicine.medical_treatment ,Regional perfusion ,030230 surgery ,Liver transplantation ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Liver damage ,Transplantation ,Hepatology ,business.industry ,Graft Survival ,Organ Preservation ,medicine.disease ,Circulatory death ,Tissue Donors ,Confidence interval ,Liver Transplantation ,Perfusion ,Anesthesia ,030211 gastroenterology & hepatology ,Surgery ,Graft survival ,France ,Neoplasm Recurrence, Local ,Liver cancer ,business - Abstract
A national program of controlled donation after circulatory death (cDCD) began in France in 2014 involving the use of a standardized national protocol that involves the systematic use of normothermic regional perfusion (NRP). In this article, we describe in detail the French cDCD program. Between January 1, 2015, and December 31, 2018, 225 livers were offered for donation, resulting in 123 cDCD liver transplantations (LTs). The overall 90-day graft survival rate was 93.1% (95% confidence interval [CI], 85.9%-96.6%). A total of 21 of 123 LTs (17%) did not adhere strictly to the national protocol. The 1-year graft survival was significantly lower in the group deviating from the national protocol compared with those patients following the national protocol: 68.4% (95% CI, 42.8%-84.4%) versus 94.8% (95% CI, 86.5%-98.0%; P < 0.01). There were 14 patients who died, including 2 after primary 2 after primary non function, and 10 related to liver cancer recurrence. Only 1 case of ischemic cholangiopathy was observed at month 18 in this series, and the patient underwent a successful retransplant. During the first 4 years, excellent LT results were observed where the national protocol was followed. Systematic use of NRP limits liver damage induced by warm ischemia and provides excellent cDCD organs for transplant.
- Published
- 2020
35. Maintaining the permanence principle for death during in situ normothermic regional perfusion for donation after circulatory death organ recovery: A United Kingdom and Canadian proposal
- Author
-
John H. Dark, Janet MacLean, Jeanne Teitelbaum, Prosanto Chaudhury, Andrew Healey, Andrew J Baker, Christopher J.E. Watson, Mitesh V. Badiwala, Lindsay C. Wilson, Gabriel C. Oniscu, Dale Gardiner, Christy Simpson, Marius Berman, Laura Hornby, Simon Messer, Alex Manara, Dan Harvey, Stephen R. Large, John Forsythe, Darren H. Freed, Sam D. Shemie, Andrew J. Butler, and Sylvia Torrance
- Subjects
Aortic arch ,Canada ,medicine.medical_specialty ,Tissue and Organ Procurement ,Personal Viewpoints ,organ procurement and allocation ,Regional perfusion ,Perfusion scanning ,030230 surgery ,03 medical and health sciences ,0302 clinical medicine ,editorial/personal viewpoint ,extracorporeal membrane oxygenation (ECMO) ,medicine.artery ,Internal medicine ,Ascending aorta ,Occlusion ,medicine ,Humans ,Immunology and Allergy ,Pharmacology (medical) ,organ procurement ,Personal Viewpoint ,Transplantation ,organ perfusion and preservation ,business.industry ,Organ Preservation ,donors and donation: donation after circulatory death (DCD) ,ethics ,Cannula ,Tissue Donors ,United Kingdom ,Death ,Perfusion ,Descending aorta ,Donation ,Cardiology ,business - Abstract
There is international variability in the determination of death. Death in donation after circulatory death (DCD) can be defined by the permanent cessation of brain circulation. Post‐mortem interventions that restore brain perfusion should be prohibited as they invalidate the diagnosis of death. Retrieval teams should develop protocols that ensure the continued absence of brain perfusion during DCD organ recovery. In situ normothermic regional perfusion (NRP) or restarting the heart in the donor's body may interrupt the permanent cessation of brain perfusion because, theoretically, collateral circulations may restore it. We propose refinements to current protocols to monitor and exclude brain reperfusion during in situ NRP. In abdominal NRP, complete occlusion of the descending aorta prevents brain perfusion in most cases. Inserting a cannula in the ascending aorta identifies inadequate occlusion of the descending aorta or any collateral flow and diverts flow away from the brain. In thoracoabdominal NRP opening the aortic arch vessels to atmosphere allows collateral flow to be diverted away from the brain, maintaining the permanence standard for death and respecting the dead donor rule. We propose that these hypotheses are correct when using techniques that simultaneously occlude the descending aorta and open the aortic arch vessels to atmosphere., The authors present techniques to prevent the restoration of brain perfusion during in situ normothermic regional perfusion by ensuring the diversion of any possible collateral supply.
- Published
- 2020
36. Mobile Extracorporeal Membrane Oxygenation Teams for Organ Donation After Circulatory Death
- Author
-
Maria Adele Figini, Eva Oliver Juan, Davide Alberto Chiumello, and David Paredes-Zapata
- Subjects
Extracorporeal Circulation ,medicine.medical_specialty ,Tissue and Organ Procurement ,medicine.medical_treatment ,Regional perfusion ,Economic shortage ,Cardiovascular System ,Secondary care ,Extracorporeal Membrane Oxygenation ,Intensive care ,Extracorporeal membrane oxygenation ,Humans ,Medicine ,Organ donation ,Intensive care medicine ,Transplantation ,business.industry ,Organ Preservation ,Organ Transplantation ,Circulatory death ,Tissue Donors ,Death ,Perfusion ,Intensive Care Units ,Italy ,Tissue and Organ Harvesting ,Surgery ,Emergency Service, Hospital ,business ,Mobile Health Units - Abstract
The shortage of available organ donors is a significant problem worldwide, and various efforts have been carried out to avoid the loss of potential organ donors. Among them, organ donation from cardiocirculatory deceased donors (DCD), in which withdrawal of life-sustaining therapies is ongoing (Maastricht type III donors), is one emerging strategy. Thanks to the latest advances in transplantation and organ preservation, such as normothermic regional perfusion (NRP), ex vivo perfusion techniques, and good organization and communication among prehospital care providers, emergency departments, intensive care units, and transplantation units, DCD is rapidly increasing; it’s estimated that it will increase the number of donations of lungs and splanchnic organs by more than 40%. Although Maastricht type II DCD requires a 24/7 available experienced extra corporeal membrane oxygenation (ECMO) team in the institution, Maastricht DCD type III could be organized in secondary care and spoke hospitals without in loco ECMO facilities for NRP. This article analyses a potential mobile team organization based on the hub-and-spoke model, which already exists and functions in Italy, by estimating the dimension of the controlled DCD phenomenon in Italy, coordination requirements, costs, personnel training, and education, and reporting a single center experience in Milan, Italy.
- Published
- 2020
37. Does Normothermic Regional Perfusion Improve the Results of Donation After Circulatory Death Liver Transplantation?
- Author
-
Jose Aguilar, María Pitarch Martínez, Jose Antonio Pérez Daga, Daniel Cabañó Muñoz, Francisco Javier León Díaz, Belinda Sánchez Pérez, and Julio Santoyo Santoyo
- Subjects
Male ,Brain Death ,medicine.medical_specialty ,medicine.medical_treatment ,Regional perfusion ,030230 surgery ,Liver transplantation ,Liver transplants ,Extended criteria ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Transplantation, Homologous ,Prospective Studies ,Warm Ischemia ,Risk factor ,Prospective cohort study ,Transplantation ,business.industry ,Cold Ischemia ,Graft Survival ,Middle Aged ,Circulatory death ,Tissue Donors ,Liver Transplantation ,Perfusion ,Donation ,Tissue and Organ Harvesting ,Cardiology ,Female ,030211 gastroenterology & hepatology ,Surgery ,business - Abstract
The so-called grafts or donors with extended criteria are a risk factor for the development of liver transplant activity. One source comes from controlled donation after circulatory death (cDCD). The hypothesis was to verify the improvement in results by comparing DCD liver transplants performed with postmortem normothermic regional perfusion (NRP) vs super-rapid recovery (SRR), the current standard for cDCD. A prospective study comparing both techniques was carried out.A total of 42 transplants were performed with cDCD, 22 of which were with SRR and 23 with NRP from April 2014 to September 2019.Differences were found in early allograft dysfunction (68.1% in the SRR group vs 25% in the NRP group; P .01) and biliary complications (22.7% vs 5%, respectively; P = .04). Differences were also found, although not statistically significant, in ischemic cholangiopathy (13.6% in the SRR group vs 5% in the NRP group; P = .09), and retransplant rate (9.1% vs 0%, respectively; P = .3).With the use of NRP machines, results are similar to the standard donation with donors in brain death in terms of rate of early allograft dysfunction and survival of the patient and graft attempted, reducing the rate of ischemic cholangiopathy compared with SRR.
- Published
- 2020
38. Assessment of Myocardial Perfusion and Metabolism: Promises and Limitations
- Author
-
Vosberg, H. R., Klein, Michael, editor, Schulte, H. D., editor, and Gams, E., editor
- Published
- 1998
- Full Text
- View/download PDF
39. Use of ex vivo normothermic machine perfusion after normothermic regional perfusion to salvage a poorly perfused DCD kidney
- Author
-
Fanourios Georgiades, Michael L. Nicholson, Sarah A. Hosgood, Andrew J. Butler, Georgiades, Fanourios [0000-0003-0440-2720], and Apollo - University of Cambridge Repository
- Subjects
Male ,Extracorporeal Circulation ,medicine.medical_specialty ,Tissue and Organ Procurement ,medicine.medical_treatment ,Urology ,organ procurement and allocation ,Regional perfusion ,kidney transplantation/nephrology ,030230 surgery ,clinical research/practice ,Kidney ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Immunology and Allergy ,organ transplantation in general ,Pharmacology (medical) ,organ procurement ,Dialysis ,Aged ,Tissue Survival ,Transplantation ,Machine perfusion ,Red Cell ,organ perfusion and preservation ,business.industry ,Organ Preservation ,donors and donation: donation after circulatory death (DCD) ,Tissue Donors ,Death ,Perfusion ,medicine.anatomical_structure ,Renal blood flow ,business ,Ex vivo - Abstract
Normothermic regional perfusion (NRP) and normothermic machine perfusion (NMP) have both been used in the procurement and conditioning of abdominal organs from donation after circulatory death donors with reported improved outcomes for the recipients. Here, we describe an unusual case of a kidney that underwent NMP after NRP. After 2 hours of abdominal NRP, the intra-abdominal organs were cold flushed in situ. The liver and right kidney were well flushed, but the left kidney was poorly flushed. Further attempts to clear the left kidney by flushing on the backtable were unsuccessful, and the kidney was thought to be unsuitable for transplant. The left kidney then underwent a 1-hour period of NMP using a red cell-based perfusate. During NMP, the kidney met previously described quality assurance criteria for transplant with good global perfusion and adequate renal blood flow and urine production. The kidney was transplanted into a suitable recipient who had slow early graft function but did not require dialysis posttransplant. The recipient was discharged 6 days posttransplant, and the serum creatinine level was 160 μmol/L (1.8 mg/dL) at 2 months posttransplant.
- Published
- 2019
40. Development of a method to measure regional perfusion of the lung in anesthetized ponies using computed tomography angiography and the maximum slope model
- Author
-
Gaetano Perchiazzi, Peter Lord, Görel Nyman, Adam Auckburally, Maja Wiklund, Alessandro Beda, Charles J. Ley, and Anna K. Straube
- Subjects
Mechanical ventilation ,Maximum slope ,Lung ,General Veterinary ,medicine.diagnostic_test ,business.industry ,Computed Tomography Angiography ,medicine.medical_treatment ,Respiration ,Regional perfusion ,General Medicine ,Perfusion ,medicine.anatomical_structure ,Angiography ,Breathing ,Medicine ,Animals ,Horses ,business ,Nuclear medicine ,Tomography, X-Ray Computed ,Computed tomography angiography - Abstract
OBJECTIVE To develop a method based on CT angiography and the maximum slope model (MSM) to measure regional lung perfusion in anesthetized ponies. ANIMALS 6 ponies. PROCEDURES Anesthetized ponies were positioned in dorsal recumbency in the CT gantry. Contrast was injected, and the lungs were imaged while ponies were breathing spontaneously and while they were mechanically ventilated. Two observers delineated regions of interest in aerated and atelectatic lung, and perfusion in those regions was calculated with the MSM. Measurements obtained with a computerized method were compared with manual measurements, and computerized measurements were compared with previously reported measurements obtained with microspheres. RESULTS Perfusion measurements obtained with the MSM were similar to previously reported values obtained with the microsphere method. While ponies were spontaneously breathing, mean ± SD perfusion for aerated and atelectatic lung regions were 4.0 ± 1.9 and 5.0 ± 1.2 mL/min/g of lung tissue, respectively. During mechanical ventilation, values were 4.6 ± 1.2 and 2.7 ± 0.7 mL/min/g of lung tissue at end expiration and 4.1 ± 0.5 and 2.7 ± 0.6 mL/min/g of lung tissue at peak inspiration. Intraobserver agreement was acceptable, but interobserver agreement was lower. Computerized measurements compared well with manual measurements. CLINICAL RELEVANCE Findings showed that CT angiography and the MSM could be used to measure regional lung perfusion in dorsally recumbent anesthetized ponies. Measurements are repeatable, suggesting that the method could be used to determine efficacy of therapeutic interventions to improve ventilation-perfusion matching and for other studies for which measurement of regional lung perfusion is necessary.
- Published
- 2021
41. A systematic review and meta-analyses of regional perfusion in donation after circulatory death solid organ transplantation
- Author
-
John H. Dark, Hendrikus J. A. N. Kimenai, Christopher J.E. Watson, Julie De Beule, Amelia J. Hessheimer, Filip Rega, Liset H. M. Pengel, Maria Irene Bellini, Ina Jochmans, Simon R. Knight, Katrien Vandendriessche, David Paredes, Arne Neyrinck, and Surgery
- Subjects
Transplantation ,Kidney ,Tissue and Organ Procurement ,business.industry ,Blood viscosity ,Graft Survival ,Regional perfusion ,Retrospective cohort study ,Organ Preservation ,Organ Transplantation ,Tissue Donors ,Death ,Perfusion ,medicine.anatomical_structure ,Anesthesia ,Meta-analysis ,Donation ,Donation after circulatory death ,meta-analysis ,regional perfusion ,solid organ transplantation ,systematic review ,Medicine ,Humans ,business ,Pancreas ,Solid organ transplantation ,Retrospective Studies - Abstract
In donation after circulatory death (DCD), (thoraco)abdominal regional perfusion (RP) restores circulation to a region of the body following death declaration. We systematically reviewed outcomes of solid organ transplantation after RP by searching PubMed, Embase, and Cochrane libraries. Eighty-eight articles reporting on outcomes of liver, kidney, pancreas, heart, and lung transplants or donor/organ utilization were identified. Meta-analyses were conducted when possible. Methodological quality was assessed using National Institutes of Health (NIH)-scoring tools. Case reports (13/88), case series (44/88), retrospective cohort studies (35/88), retrospective matched cohort studies (5/88), and case-control studies (2/88) were identified, with overall fair quality. As blood viscosity and rheology change below 20 °C, studies were grouped as hypothermic (HRP, ≤20 °C) or normothermic (NRP, >20 °C) regional perfusion. Data demonstrate that RP is a safe alternative to in situ cold preservation (ISP) in uncontrolled and controlled DCDs. The scarce HRP data are from before 2005. NRP appears to reduce post-transplant complications, especially biliary complications in controlled DCD livers, compared with ISP. Comparisons for kidney and pancreas with ISP are needed but there is no evidence that NRP is detrimental. Additional data on NRP in thoracic organs are needed. Whether RP increases donor or organ utilization needs further research.
- Published
- 2021
42. Coronary Artery Disease (CAD): ROC-Analysis of Tc-99m-MIBI-SPECT Versus Rb-82-PET
- Author
-
Glatting, G., Heß, M., Weller, R., Kotzerke, J., Reske, S. N., Bergmann, H., editor, Kroiss, A., editor, and Sinzinger, H., editor
- Published
- 1997
- Full Text
- View/download PDF
43. Regional Perfusion and Metabolism before Revascularization Compared with Functional Outcome
- Author
-
Bax, J. J., Cornel, J. H., Visser, F. C., Fioretti, P. M., van Lingen, A., Lengauer, R. A., Visser, C. A., Bergmann, H., editor, Kroiss, A., editor, and Sinzinger, H., editor
- Published
- 1997
- Full Text
- View/download PDF
44. Clinical Practice of Hyperthermic Extremity Perfusion In Combination with Radiotherapy and Chemotherapy
- Author
-
Cavaliere, R., Di Filippo, F., Cavaliere, F., Carlini, S., Schiratti, M., Anzà, M., Garinei, R., Callopoli, A., Capua, A., Impiombato, F. Ambesi, Perri, P., Psaila, A., Seegenschmiedt, M. Heinrich, Fessenden, Peter, and Vernon, Clare C.
- Published
- 1996
- Full Text
- View/download PDF
45. Impact of the duration of normothermic regional perfusion on the results of liver transplant from controlled circulatory death donors: A retrospective, multicentric study
- Author
-
Laurent Sulpice, Mickael Lesurtel, Eric Savier, Louise Barbier, Anne-Gaëlle Si Larbi, Claire Goumard, Marc Laffon, Fabien Robin, Marc-Antoine Allard, Olivier Soubrane, Gabriella Pittau, Petru Bucur, Ephrem Salamé, Xavier Muller, Olivier Scatton, Thomas Guillem, Federica Dondero, Emmanuelle Mercier, Jean-Christophe Venhard, CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Foch [Suresnes], CHU Pontchaillou [Rennes], Centre Hépato-Biliaire [Hôpital Paul Brousse] (CHB), Hôpital Paul Brousse-Assistance Publique - Hôpitaux de Paris, Centre d’Investigation Clinique [Tours] CIC 1415 (CIC ), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), None, Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Hôpital Paul Brousse, Université Paris-Saclay, Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris Diderot - Paris 7 (UPD7), and Jonchère, Laurent
- Subjects
[SDV]Life Sciences [q-bio] ,medicine.medical_treatment ,ischemia-reperfusion injury ,Regional perfusion ,030230 surgery ,Liver transplantation ,normothermic regional perfusion ,Graft function ,03 medical and health sciences ,delayed graft function ,0302 clinical medicine ,Clinical endpoint ,Medicine ,Humans ,In patient ,Retrospective Studies ,Transplantation ,business.industry ,Graft Survival ,Organ Preservation ,Time optimal ,Circulatory death ,Tissue Donors ,controlled circulatory deceased donors ,3. Good health ,Liver Transplantation ,[SDV] Life Sciences [q-bio] ,Death ,Perfusion ,Anesthesia ,030211 gastroenterology & hepatology ,business - Abstract
International audience; In France, the program of controlled donation after circulatory death (cDCD) was established with routine use of in situ normothermic regional perfusion (NRP). There is currently no consensus on its optimal duration. The purpose was to assess the impact of NRP duration on liver graft function and biliary outcomes. One-hundred and fifty-six liver recipients from NRP-cDCD donors from six French centers between 2015 and 2019 were included. Primary endpoint was graft function assessed by early allograft dysfunction (EAD, according to Olthoff's criteria) and MEAF (model for early allograft function) score. Overall, three (1.9%) patients had primary non-function, 30 (19.2%) patients experienced EAD, and MEAF score was 7.3 (+/- 1.7). Mean NRP duration was 179 (+/- 43) min. There was no impact of NRP duration on EAD (170 +/- 44 min in patients with EAD vs. 181 +/- 42 min in patients without, P = .286). There was no significant association between NRP duration and MEAF score (P = .347). NRP duration did neither impact on overall biliary complications nor on non-anastomotic biliary strictures (overall rates of 16.7% and 3.9%, respectively). In conclusion, duration of NRP in cDCD donors does not seem to impact liver graft function and biliary outcomes after liver transplantation. A 1 to 4-h perfusion represents an optimal time window.
- Published
- 2021
46. A North American single-center experience with liver transplantation using thoracoabdominal normothermic regional perfusion for donation after circulatory death
- Author
-
Wendy J. Grant, Alexander Maskin, Shaheed Merani, John Y. Um, Luciano M. Vargas, Marian Urban, Alan Norman Langnas, Anthony W. Castleberry, and David F. Mercer
- Subjects
Transplantation ,medicine.medical_specialty ,Tissue and Organ Procurement ,business.industry ,medicine.medical_treatment ,Regional perfusion ,Organ Preservation ,Liver transplantation ,Single Center ,Circulatory death ,Tissue Donors ,Liver Transplantation ,Death ,Perfusion ,Donation ,Internal medicine ,North America ,Cardiology ,medicine ,Immunology and Allergy ,Humans ,Pharmacology (medical) ,business - Published
- 2021
47. Which classification system defines best prognosis of mucinous neoplasms of the appendix with peritoneal dissemination: TNM vs PSOGI?
- Author
-
Martín-Román L, Lozano P, Gómez Y, Fernández-Aceñero MJ, Vasquez W, Palencia N, and González-Bayón L
- Subjects
- Humans, Prognosis, Retrospective Studies, Survival Rate, Appendix pathology, Peritoneal Neoplasms therapy, Peritoneal Neoplasms pathology, Appendiceal Neoplasms therapy, Appendiceal Neoplasms pathology, Pseudomyxoma Peritonei therapy, Neoplasms, Cystic, Mucinous, and Serous
- Abstract
Aims: Several classification systems are used for pseudomyxoma peritonei. The four-tiered classification system proposed by Peritoneal Surface Oncology Group International (PSOGI) and the two-tiered proposed by the eighth edition of the American Joint Committee on Cancer (AJCC) result from evolution in terminology and pathological insight. The aim is to evaluate the impact of PSOGI and eighth edition of the AJCC classifications on survival., Methods: Pathological slides were reviewed from a prospectively maintained database including patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for an appendiceal mucinous neoplasm with peritoneal dissemination between January 2009 and December 2019. Patients were reclassified according to PSOGI and AJCC eighth edition criteria. Survival analysis evaluated the impact of each classification system on overall survival (OS) and disease-free survival (DFS) while the concordance-index evaluated their predictive power., Results: 95 patients were identified; 21.1% were reclassified as acellular mucin, 55.8% as low-grade mucinous carcinoma peritonei, 8.4% as high-grade MCP (HGMCP) and 14 as HGMCP with signet ring cells. Median OS was not reached, 5-year OS and DFS were 86.1% and 51.5%, respectively. Multivariate analysis revealed significant associations with OS (PSOGI: HR 10.2, p=0.039; AJCC: HR 7.7, p=0.002) and DFS (PSOGI: HR 12.7, p=0.001; AJCC: HR 3.7, p<0.001). The predictive capacity of both classification systems was unacceptable for OS and DFS (concordance-index values <0.7)., Conclusions: Both classification systems behaved similarly when stratifying our series into prognostic groups. The PSOGI classification provides better histopathological description, but histology alone is insufficient for adequate patient prognostication., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2023
- Full Text
- View/download PDF
48. Graft utilization after normothermic regional perfusion in controlled donation after circulatory death - 5-year experience from France
- Author
-
E. Morelon, A. Grégoire, M. Lesurtel, J.-Y. Mabrut, S. Damotte, Xavier Muller, Kayvan Mohkam, G. Rossignol, and L. Badet
- Subjects
Hepatology ,business.industry ,Donation ,Anesthesia ,Gastroenterology ,Medicine ,Regional perfusion ,business ,Circulatory death - Published
- 2021
49. Alternatives for arterial inflow in open surgical descending and thoracoabdominal aortic repair.
- Author
-
Blohmé, Linus and Olsson, Christian
- Subjects
- *
VASCULAR surgery , *CARDIOPULMONARY bypass , *CATHETERIZATION , *EXTRACORPOREAL membrane oxygenation , *FEMORAL artery , *ILIAC artery , *PERFUSION , *THORACOTOMY ,ABDOMINAL aorta surgery - Abstract
Surgical repair of the descending and thoracoabdominal aorta is regularly performed with the support of extracorporeal circulation. Femoral artery cannulation is the standard for arterial inflow, but presents, along with extremity hypoperfusion, the risk of embolization and malperfusion with retrograde aortic perfusion. There are alternatives for arterial inflow to avoid the drawbacks of the standard approach while accommodating different perfusion strategies. Ideally, with a broadened perfusion armamentarium, the choice of arterial inflow could be individualized to provide safe and efficient extracorporeal circulation. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
50. Effects of Mechanical Ventilation and Cardiac Output upon Perfusion in Hypoxic Lung Areas
- Author
-
Burchardi, H. and Rügheimer, Erich, editor
- Published
- 1992
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.