ABSTRACT
PURPOSE: To assess the feasibility and performance of radical cystectomy with urinary diversion using exclusively regional anesthesia (i.e. combined spinal thoracic epidural anesthesia, CSTEA). MATERIALS AND METHODS: In 2011 radical cystectomy with extended pelvic and iliac lymphadenectomy was performed on 14 patients using urinary diversion without applying general anesthesia. Under maintained spontaneous breathing, the patients were awake and responsive during the entire procedure. Postoperatively, pain management took three days with the remaining epidural catheter before oral analgesics were administered. Mobilization and diet restoration were carried out according to the fast-track concept. Outcome measurements included operative time, blood loss, beginning of oral nutrition, beginning of mobilization, postoperative pain levels using numerical and visual analog scales (NAS/VAS), length of hospital stay. RESULTS: All surgical procedures were performed without any complications. The absence of general anesthesia did not result in any relevant disadvantages. The postoperative progress was normal in all patients. Particularly, cardiopulmonary complications and enteroparesis did not occur. The provided palliative care proved sufficient (NAS max. 3-4). Discharge followed 10 to 22 days after surgery. At the time of discharge, the patients described the procedure to be relatively positive. CONCLUSIONS: Our data show that CSTEA is an effective technique for radical cystectomy, whereby spontaneous breathing and reduced interference with the cardiopulmonary system potentially lower the perioperative risks especially for high-risk patients. We recommend practice of CSTEA for radical cystectomy to further evaluate and monitor the safety, efficacy, outcomes, and complications of CSTEA.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Anesthesia, Conduction/methods , Cystectomy/methods , Urinary Bladder Neoplasms/surgery , Urinary Diversion/methods , Anesthesia, Conduction/adverse effects , Feasibility Studies , Pain Measurement , Reproducibility of Results , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
Apoptotic protease activating factor 1 (APAF-1) has a critical role in the regulation of apoptosis. In the present study, the mRNA expression analysis of different APAF-1 transcripts (APAF-1S, APAF-1LC, APAF-1LN, and APAF-1XL) was analyzed in bone marrow samples from 37 patients with acute myeloid leukemia (newly diagnosed, with no previous treatment). APAF-1XL and APAF-1LN transcripts (with and without an extra WD-40 repeat region, respectively) were detected in all samples, although the major form expressed was APAF-1XL in 65 percent of the samples (group 1), while 35 percent of the samples expressed primarily APAF-1LN (group 2). Only 46 percent of the patients presented complete remission in response to remission induction therapy (represented by less than 5 percent marrow blasts and hematological recovery), all but 2 cases being from group 1, 21.6 percent did not attain complete remission (only 1 case from group 1), and 32.4 percent of the patients died early. Lower expression of APAF-1XL (APAF-1XL/APAF-1LN ratio <1.2) was associated with a poor response to therapy (P = 0.0005, Fisher exact test). Both groups showed similar characteristics regarding white blood cell counts, cytogenetic data or presence of gene rearrangements associated with good prognosis as AML1-ETO, CBFB-MYH11 and PML/RARA. Since it has been shown that only the isoforms with the extra WD-40 repeat region activate procaspase-9, we suggest that low procaspase-9 activation may also be involved in the deregulation of apoptosis and chemotherapy resistance in acute myeloid leukemia.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Apoptotic Protease-Activating Factor 1/genetics , Leukemia, Myeloid, Acute/genetics , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bone Marrow Cells/chemistry , Case-Control Studies , Densitometry , DNA, Complementary/genetics , Gene Expression Regulation, Neoplastic , Leukemia, Myeloid, Acute/drug therapy , Reverse Transcriptase Polymerase Chain Reaction , RNA, Messenger/genetics , Transcription Factors , Treatment Failure , Transcription, Genetic/genetics , Biomarkers, Tumor/genetics , Young AdultABSTRACT
Se analiza un grupo de 25 pacientes sometidos a trasplante renal, con una edad media de 11=3 años, 9 niñas y 16 varones. Se utilizaron 22 injertos de dador vivo y 3 de cadaver. El peso corporal era menor de 25 kg. En el 60 por ciento de la poblacion y todos tenian deficit pondoestatural. Las uropatias (12/25) y las glomerulopatias (9/25), fueron las enfermedades de base mas frecuentes que llevaron a estos pacientes a la insuficiencia renal. La tasa de mortalidad fue del 12 por ciento (3 casos). Las complicaciones postoperatorias y la tasa de mortalidad fueron mayores para los injertos cadavericos, pero sin significancia estadistica por el numero de casos. Los reimplantes ureterales se realizaron con tecnica de Politano-Leadbetter en 22 y con tecnica de Gregoire en 3. Las complicaciones precoces mas frecuentes fueron la discracia sanguinea (4/25) y el rechazo agudo (5/25). Las tardias fueron la infeccion urinaria (4/25) y el rechazo cronico (3/25). Catorce injertos presentan un clearence > de 80 ml/min y 2 entre 40-45 ml/min. La sobrevida actuarial del injerto fue de 64 por ciento, siendo el rechazo la principal causa de fracaso. Cuatro pacientes tenian reconstrucciones del tracto urinario a traves de un reservorio continente y mecanismo de cateterismo limpio por la tecnica de Mitrofanoff. Se concluye que el trasplante renal es una opcion terapeutica para niños con enfermedades renales, que tiene baja mortalidad y complicaciones locales del facil manejo