Resultados con la utilización de prótesis en el cáncer de esófago y cardias

Introducción: El cáncer de esófago y cardias es una enfermedad grave, en el que más de tres cuartos de los enfermos que se tratan están en fase avanzada. En Cuba existe experiencia con las prótesis esofágicas originales o construidas en el país. Objetivo: Evaluar los resultados de la experiencia de los hospitales universitarios "Comandante Manuel Fajardo" y "Miguel Enríquez" con las prótesis transtumorales en el cáncer de esófago no resecable. Métodos: Se realizó un estudio observacional, descriptivo, retrospectivo, tipo serie de casos, con una muestra de 197 enfermos con cáncer avanzado del esófago en los Hospitales Universitarios "Comandante Manuel Fajardo" y "Miguel Enríquez" tratados con prótesis por presentar un cáncer avanzado del esófago en el período 1995-2020. Resultados: Predominó el sexo masculino, las edades más afectadas fueron la sexta y séptima década. La localización más frecuente del tumor fue en tercio inferior del esófago y cardias y el tipo histológico el carcinoma epidermoide. En el 71 por ciento se utilizaron prótesis rígidas de tubos endotraqueales; en el 20,8 por ciento prótesis de Heering y en el 8,2 por ciento prótesis autoexpansible. En el Hospital Manuel Fajardo la prótesis que más se utilizó fue la rígida de construcción artesanal y en el Hospital Miguel Enríquez la de Heering. La menos utilizada fue la autoexpansible. Se presentó un 10,1 por ciento de complicaciones, sin mortalidad quirúrgica. Conclusiones: Aunque las prótesis autoexpansible son de fácil colocación por endoscopia, es un método ideal pero costoso. La prótesis plástica rígida industrial o artesanal también puede ofrecer calidad de vida sin disfagia, evitan que el enfermo fallezca con una ostomía abdominal(AU)

Introduction: Esophageal and cardia cancer is a serious disease, in which more than three quarters of the treated patients are in advanced stage. In Cuba there is experience with original esophageal prostheses or others domestically built. Objective: To evaluate the results of the experience of the Comandante Manuel Fajardo and Miguel Enriquez university hospitals with transtumoral prostheses in unresectable esophageal cancer. Methods: An observational, descriptive, retrospective, case-series type study was carried out with a sample of 197 patients treated with prosthesis for advanced esophageal cancer in the university hospitals Comandante Manuel Fajardo and Miguel Enríquez in the period 1995-2020. Results: The male sex predominated, while the most affected ages were the sixth and seventh decades. The most frequent tumor location was the lower third of the esophagus and cardia, while squamous cell carcinoma was the most frequent histological type. Rigid prostheses of endotracheal tubes were used in 71 percent; Heering prostheses, in 20.8 percent; and self-expanding prostheses, in 8.2 percent. The most commonly used prostheses at Manuel Fajardo and Miguel Enriquez hospitals were the rigid prosthesis of handmade construction and the Heering prosthesis, respectively. The least used was the self-expanding prosthesis. There was a 10.1 percent of complications, with no surgical mortality. Conclusions: Although self-expanding prostheses are easy to place by endoscopy, it is an expensive method, even being ideal. The industrial or handmade rigid plastic prosthesis can also offer quality of life without dysphagia, avoiding the patient's death with an abdominal ostomy(AU)

Palliative surgery in gastrointestinal malignancy: experience from a regional cancer centre

Background: With so much burden of advanced incurable disease, the role of palliative surgery is paramount for gastrointestinal malignancies improving quality of life. Aim of the study was to study the indications, risks and outcome of palliative surgeries in gastrointestinal malignancies, the burden of disease requiring palliative surgery, and to describe strategies to improve end of life care.Methods: All the patients diagnosed with gastrointestinal malignancy and who underwent palliative surgery between January 2017 and December 2017 were analysed.Results: A total of 186 cases underwent palliative surgery. The most common age group affected was between 50-60 years and the mean age was 54.55 years. Stomach was the most common primary consisting of 58.60% followed by colorectal (23.66%), small intestine (9.68%), hepato-pacreatico-billiary (4.30%), and oesophageal (3.76%) primary. Major complications were seen in 4.84% of cases. Average symptomatic relief was observed for 5.5 months in cases of stomach and 7 months in case of colorectal malignancies. 35.48% cases were alive at the end of one year.Conclusions: Present study concludes that palliative surgery improves quality of life of the patient, provides them with time to accept death and live rest of the life in a dignified manner.

Short-term outcomes and prognosis of palliative surgery for malignant bowel obstruction caused by peritoneal metastasis of colorectal cancer / 中华胃肠外科杂志

Objective@#To explore the short-term efficacy and prognosis of palliative surgical treatment for malignant bowel obstruction (MBO) caused by peritoneal metastasis of colorectal cancer (mCRC).@*Methods@#A retrospective cohort study was conducted. The inclusion criteria for patients were as follows: (1) primary colorectal cancer; (2) massive peritoneal metastasis; (3)obstructive site located below Treitz ligament by imaging; (4) obstruction refractory to conservative treatment; (5) estimated rese survival time more than 2 months; (6) patients and their families had strong willingness for operation; (7) surgical treatment included stoma/bypass and debulking surgery. In accordance with the above criteria, clinicopathological data of 46 patients undergoing palliative surgery at Peking University Gastrointestinal Cancer Center, Unit III from January 2016 to October 2018 were retrospectively collected. Postoperative symptomatic relief rate, morbidity of complication within 30 days, complication classification (Clavien-Dindo classification), mortality and survival after operation were analyzed. Kaplan-Meier method was used to evaluate survival and Cox regression analysis was used to identify prognostic factors.@*Results@#Among 46 patients, 30 were male and 16 were female with median age of 63 (19-87) years; 23 patients received stoma/bypass surgery (stoma/bypass group), and 23 cases received tumor debulking surgery (debulking group). The overall symptom relief rate was 76.1% (35/46), while symptom relief rate in the debulking group was 91.3% (21/23), which was significantly higher than 60.9% (14/23) in the stoma/bypass group (χ2=4.301, P=0.038). Postoperative complications occurred in 25 patients. The complication rate was 52.2% (12/23) in the debulking group and 56.5% (13/23) in the stoma/bypass group, without statistically significant difference (χ2=0.088, P=0.767). Morbidity of complication beyond grade III was 8.7% (2/23) and 13.0% (3/23) in the debulking group and stoma/bypass group respectively, without statistically significant difference (χ2=0.224, P=0.636). Four patients died within 30 days after operation, 2 (8.7%) in each group. Twenty-four patients underwent 1-8 cycles of chemotherapy ± targeting therapy (regimens: CapeOX ± Bevacizumab, FOLFOX/FOLFIRI ± Bevacizumab/Cetuximab), including 10 cases in the stoma/bypass group and 14 cases in the debulking group. Two patients of debulking group received postoperative radiotherapy and chemotherapy (50.6 Gy/22 f, with concurrent oral capecitabine). Till the last follow up of April 2019, 34 patients died (34/46, 73.9%) with a median overall survival time of 6.4 months, and the 6-month and 1-year survival rate was 54.5% and 29.2% respectively. The median survival time in the debulking group was significantly longer than that in the stoma/bypass group (11.5 months vs. 5.2 months, χ2=5.117, P=0.024). The median survival time of the 35 patients with symptomatic relief after operation was significant longer than that of 11 patients without relief (7.1 months vs 5.1 months, χ2=3.844, P=0.050). Multivariate analysis showed stoma/bypass surgery (HR=2.917, 95%CI:1.357-6.269, P=0.006) and greater omental metastasis (HR=4.060, 95%CI:1.419-11.617, P=0.009) were independent risk factors associated with prognosis of patients with MBO caused by peritoneal mCRC.@*Conclusions@#For patients of MBO caused by peritoneal mCRC, tumor debulking surgery may achieve higher symptom relief rate and prolong survival. Greater omental metastasis indicates poor prognosis.

Palliative Posterior Instrumentation versus Corpectomy with Cage Reconstruction Treatment for Thoracolumbar Pathological Fracture

STUDY DESIGN: Single-center, retrospective cohort study. PURPOSE: We aimed to evaluate and compare the clinical outcomes in patients who underwent palliative posterior instrumentation (PPI) versus those who underwent corpectomy with cage reconstruction (CCR) for thoracolumbar pathological fracture. OVERVIEW OF LITERATURE: The requirement for anterior support after corpectomy has been emphasized in the treatment of pathological fractures of the vertebrae. However, for patients with a relatively short life expectancy, anterior reconstruction may not be required and posterior instrumentation alone may provide adequate stabilization. METHODS: A total of 43 patients with metastases of the thoracolumbar spine underwent surgery in the department of orthopaedic and traumatology of Istanbul University Faculty of Medicine from 2003 to 2016. Surgical outcomes were assessed on the basis of survival status, pre- and postoperative pain, complication rate, and operation time. RESULTS: PPI was performed for 22 patients and CCR was performed for 21 patients. In the PPI group, the follow-up period of the five surviving patients was 32 months. The remaining 17 patients died with a mean survival duration of 12.3 months postoperatively. In the CCR group, the five surviving patients were followed up for an average of 14.1 months. The remaining 16 patients died with a mean survival duration of 18.7 months postoperatively. No statistically significant difference (p=0.812) was noted in the survival duration. The Visual Analog Scale scores of the patients were significantly reduced after both procedures, with no significant difference noted on the basis of the type of surgical intervention (p>0.05). The complication rate in the CCR group (33.3%) was higher compared with that in the PPI group (22.7%); however, this difference was not noted to be statistically significant (p=0.379). The average operation time in the PPI group (149 minutes) was significantly shorter (p=0.04) than that in the CCR group (192 minutes). CONCLUSIONS: The PPI technique can decompress the tumor for functional improvement and can stabilize the spinal structure to provide pain relief.

Outcome of neonatal palliative procedure for pulmonary atresia with ventricular septal defect or tetralogy of Fallot with severe pulmonary stenosis: experience in a single tertiary center / 소아과

PURPOSE: The present study aimed to evaluate progression and prognosis according to the palliation method used in neonates and early infants aged 3 months or younger who were diagnosed with pulmonary atresia with ventricular septal defect (PA VSD) or tetralogy of Fallot (TOF) with severe pulmonary stenosis (PS) in a single tertiary hospital over a period of 12 years. METHODS: Twenty with PA VSD and 9 with TOF and severe PS needed initial palliation. Reintervention after initial palliation, complete repair, and progress were reviewed retrospectively. RESULTS: Among 29 patients, 14 patients underwent right ventricle to pulmonary artery (RV-PA) connection, 11 palliative BT shunt, 2 central shunt, and 2 ductal stent insertion. Median age at the initial palliation was 13 days (1–98 days). Additional procedure for pulmonary blood flow was required in 5 patients; 4 additional BT shunt operations and 1 RV-PA connection. There were 2 early deaths among patients with RV-PA connection, one from RV failure and the other from severe infection. Finally, 25 patients (86%) had a complete repair. Median age of total correction was 12 months (range, 2–31 months). At last follow-up, 2 patients had required reintervention after total correction; 1 conduit replacement and 1 right ventricular outflow tract (RVOT) patch enlargements. CONCLUSION: For initial palliation of patients with PA VSD or TOF with severe PS, not only shunt operation but also RV-PA connection approach can provide an acceptable outcome. To select the most proper surgical strategy, we recommend thorough evaluation of cardiac anomalies such as RVOT and PA morphologies and consideration of the patient's condition.

Effect of life quality and survival rate of palliative surgery combined with FOLFOX adjuvant chemotherapy on treatment of advanced rectal cancer in elderly patients / 中国生化药物杂志

Objective To investigate the survival rate and effects of life quality of palliative surgery combined with FOLFOX adjuvant chemotherapy on advanced rectal cancer treatment in elderly patients. Methods 100 elderly patients with advanced rectal cancer from May 2015 to May 2017, were randomly divided into the control group and the experimental group, 50 patients for each group. The control group was treated with palliative surgery. Patients in the experimental group were given palliative surgery and FOLFOX adjuvant chemotherapy. The survival rate and quality of life score were compared between the experimental and control groups. Results One year survival rate was 76% in the experimental group. One year survival rate was 52% in the control group. The survival rate of the experimental group was significantly higher than that of the control group, with statistical difference (P<0.05). After treatment, the total score of quality of life in the experimental group was (75.2 ± 11.2) points, and the total score of QOL in the control group was (64.2±9.3) points. The quality of life score of the control group was lower than that of the experimental group, with statistical difference (P<0.05). Conclusion Palliative surgery combined with FOLFOX adjuvant chemotherapy could significantly improve the survival rate of elderly patients with advanced rectal cancer and the quality of life.

Effect of life quality and survival rate of palliative surgery combined with FOLFOX adjuvant chemotherapy on treatment of advanced rectal cancer in elderly patients / 中国生化药物杂志

Objective To investigate the survival rate and effects of life quality of palliative surgery combined with FOLFOX adjuvant chemotherapy on advanced rectal cancer treatment in elderly patients. Methods 100 elderly patients with advanced rectal cancer from May 2015 to May 2017, were randomly divided into the control group and the experimental group, 50 patients for each group. The control group was treated with palliative surgery. Patients in the experimental group were given palliative surgery and FOLFOX adjuvant chemotherapy. The survival rate and quality of life score were compared between the experimental and control groups. Results One year survival rate was 76% in the experimental group. One year survival rate was 52% in the control group. The survival rate of the experimental group was significantly higher than that of the control group, with statistical difference (P<0.05). After treatment, the total score of quality of life in the experimental group was (75.2 ± 11.2) points, and the total score of QOL in the control group was (64.2±9.3) points. The quality of life score of the control group was lower than that of the experimental group, with statistical difference (P<0.05). Conclusion Palliative surgery combined with FOLFOX adjuvant chemotherapy could significantly improve the survival rate of elderly patients with advanced rectal cancer and the quality of life.

Comparison of the therapeutic efficacy of combined intracavitary therapy with palliative surgery in patients with extrahepatic ductal cholangiocarcinoma / 中华肝胆外科杂志

Objective To compare the therapeutic efficacy of combined biliary stent and 125I seed intracavity irradiation with palliative surgery in the treatment of extrahepatic ductal cholangiocarcinoma.Methods A prospective analysis was conducted on 142 patients with cholangiocarcinoma who were treated in The First Affiliated Hospital of Bengbu Medical College from January 2012 to December 2015.There were 80 patients who underwent percutaneous biliary metal stenting combined with 125I particles implantation (the stenting-particle group) and 62 patients who were treated by palliative biliary drainage (the surgical group).The surgical group included R1 resection in 17 patients,R2 resection in 26 patients and biliary enteric drainage in 19 patients).The levels of jaundice,liver function,survival time,hospitalization time and hospitalization cost before and after therapy were analyzed.Results Jaundice was effectively alleviated in the two groups after a short period.The liver function in the 2 groups improved significantly at 1,3 and 6 months when compared with that before operation,(P ＜ 0.05).The average hospitalization time of the stenting-particle group and the surgery group were (16.5 ± 5.0) days and (25.5 ± 10.5) days,respectively,(P ＜ 0.01).The average hospitalization cost of the stenting-particle group and the surgery group were (39 622.0 ± 7 666.4) yuan and (59 562.0 ± 24 218.2) yuan,respectively,(P ＜ 0.05).The average survival time of the stenting-particle group and the surgery group were (12.2 ± 5.1) months and (12.69 ± 7.46) months,respectively,and the difference was not significantly different (P ＞ 0.05).Conclusions For patients with extrahepatic ductal cholangiocarcinoma who were not suitable for radical surgery,percutaneous biliary stenting combined with 125I seed brachytherapy effectively reduced jaundice,improved liver function,shortened average length of hospital stay and reduced average cost of hospitalization.When compared with palliative surgery,it was a minimally invasive,easy,safe and efficacious treatment,especially for elderly patients with poor physical conditions.

Short and Long Term Efficacy and Safety of Pancreaticoduodenectomy for Pancreatic Head Carcinoma and Periampullary Carcinoma / 现代生物医学进展

Objective:To investigate the recent and long-term efficacy and safety of pancreaticoduodenectomy for pancreatic head carcinoma and periampullary carcinoma.Methods:82 cases of pancreatic cancer combined with periampullary carcinoma patients admit ted in our hospital from August 2009 to June 2013 were selected and randomly divided into the control group and the observation group With 41 patients in each group.The control group received palliative surgical treatment,while the observation group underwent pancreatoduodenectomy.The operation time,hospitalization time,intraoperative bleeding volume and the incidence of complications,1,2,3-year survival rate and the recurrence rate at 1 year after operation and tumor eradication rate were compared between twp groups.Results:The amount of bleeding,operation time of observation group were significantly higher than those of the control group(P＜0.01),no signif icant difference was found in the hospitalization time between the two groups(P＞0.05);the incidence of complications in the observation group (41.46％) was significantly higher than the control group (22.96％)(P=0.03);the 2-year and 3-year survival rate of observation group were significantly higher than those of the control group (P＜0.05),the recurrence rate at 1 year after operation of observation group was significantly lower than that of the control group (P=0.04),the tumor eradication rate was significantly higher in the observation group than that of the control group (P=0.04).Conclusion:Though pancreaticoduodenectomy could prolong the operation time,increase the risk of bleeding and complications for pancreatic head carcinoma and periampullary carcinoma,but it could effectively reduce the possibility of recurrence after operation,significantly improve the long-term survival rate.

Neonatal Gastrointestinal Emergencies in a Tertiary Care Center in Bhopal, India: A Prospective Study.

Background: In emergency neonatal surgery is challenging and difficult, causing high morbidity and mortality. In our country, only few reports are there about the results and consequences of acute surgical abdominal emergencies in newborns. Objective: The aim of present study was to determine the etiology and clinical results in neonates with acute abdomen requiring surgical intervention. Materials and Methods: This was a 3 years prospective hospital-based study of all neonates who underwent surgery for acute gastrointestinal emergencies at Chirayu Medical College and hospital Bhopal from January 2012 to January 2015. Patient’s profile, symptoms, causes of acute surgical abdomen, clinical outcomes were analyzed. Results: A total of 25 neonates were studied, males were the majority being 18 (72.0%) Neonatal intestinal obstruction was the main abdominal surgical emergency. Anorectal malformation was seen in 12 (48%) cases. Abdominal distension was seen in 15 cases and failure to pass meconium was seen in 15 (19.2%) cases. Palliative surgery was done in 16 cases and definitive surgery was done in 9 cases. The mortality was seen in 5 neonates (20%). Conclusion: In present study, Intestinal obstruction was the major cause of acute surgical abdominal emergency. There is a need to increase care at all levels of referral in our country for the early management of sick newborns. Facilities such as neonatal ventilators, specialized neonatal surgeon, and operative facilities will result in better outcome.

Sobrevida de pacientes con cáncer gástrico etapas IIIC y IV sometidos a cirugía: parte II de estudio prospectivo 2004-2012 / Survival of patients with advanced gastric cancer subjected to palliative surgery

Background: Most patients with gastric cancer consult when the tumor is an advanced stage. Aim: To assess the survival of patients with gastric cancer in stage IIIc or IV subjected to surgery. Patients and Methods: Prospective study of patients with gastric cancer in stages IIIc (spreading to nearby organs or serosa) or IV (spreading to distant organs), who consulted between 2004 and 2012. A surgical exploration was carried out in all patients performing a palliative total or subtotal gastrectomy, a gastrojejunal anastomosis or only an exploration. Twenty five patients received adjuvant chemotherapy. All were followed until their death. Results: A surgical resection was performed in 61 patients (64 percent) with an operative mortality of 5 and 0 percent for total and subtotal gastrectomy, respectively. The mortality of non-resected patients was 6.4 percent with a maximal survival of 15 months after surgery. No significant differences in survival were observed between patients with hepatic or peritoneal metastases. Adjuvant chemotherapy significantly improved survival among patients subjected to gastric resection. Conclusions: Among patients with gastric cancer, palliative gastrectomy may improve quality of life and adjuvant chemotherapy apparently improves survival.

Introducción: El cáncer gástrico constituye un problema de salud pública por su alta incidencia. Muchos pacientes consultan en etapas muy avanzadas. Objetivo: Evaluar la sobrevida de pacientes con cáncer gástrico etapa IIIc y IV sometidos a cirugía. Material y Método: Estudio prospectivo y descriptivo de pacientes en dichas etapas, que consultaron entre mayo de 2004 y diciembre de 2012, divididos en 4 grupos según ubicación de metástasis. Todos sometidos a exploración quirúrgica realizando una gastrectomía total o subtotal paliativa, gastroyeyuno-anastomosis o sólo laparotomía. Quimioterapia adyuvante se realizó en 25 pacientes. Se realizó un seguimiento hasta la fecha de fallecimiento en un 100 por ciento de los casos. Resultados: La resección quirúrgica se realizó en 61 pacientes (64,3 por ciento), con una mortalidad operatoria de 4,6 por ciento para la gastrectomía total y 0 por ciento para la gastrectomía subtotal. La mortalidad de los pacientes no resecados fue de 6,4 por ciento, con sobrevida máxima de 15 meses después de operado. Entre los casos con resección gástrica, se observó una mayor pero no significativa sobrevida en pacientes con metástasis hepáticas comparadas con las peritoneales. La quimioterapia adyuvante mostró una sobrevida significativamente mayor en los resecados comparado a los pacientes en los que no se la empleó. Conclusión: La gastrectomía paliativa para mejorar la calidad de vida en pacientes con cáncer gástrico metastásico es factible, en grupos entrenados. El efecto beneficioso de la quimioterapia adyuvante debe ser evaluado en futuros estudios randomizados.

Clinical features and survival outcome of locally advanced extrahepatic cholangiocarcinoma

BACKGROUNDS/AIMS: Little is known about clinical features and survival outcome in locally advanced unresectable extrahepatic cholangiocarcinoma (EHC). The aim was to investigate the clinical features and the survival outcome in these patients, and to evaluate the role of palliative resections in locally advanced unresectable EHC. METHODS: Between 1995 and 2007, 280 patients with locally advanced unresectable EHC were identified. Clinical, pathologic, and survival data were investigated. A comparative analysis was done between those who received palliative resection (PR) and those who were not operated on (NR). RESULTS: The overall median survival of the study population was 10+/-1 months, and the 3- and 5-year survival rates (YSR) were 8.5% and 2.5%, respectively. The median survival, 3- and 5-YSR of PR were 23 months, 32.1% and 13.1%, respectively. For NR, they were 9 months, 3.9% and 0%, which were significantly worse than PR (p<0.001). In univariate analysis, T classification, N classification, tumor location, palliative resection, adjuvant treatment, chemotherapy, and radiation therapy were factors that showed survival difference between PR and NR. Regional lymph node metastasis (RR, 2.084; 95% CI, 1.491-2.914; p<0.001), non-resections (RR, 2.270; 95% CI, 1.497-3.443; p<0.001), and no chemotherapy (RR, 1.604; 95% CI, 1.095-2.349; p=0.015) were identified as risk factors for poor outcome on multivariate analysis. CONCLUSIONS: Without evidence of systemic disease, palliative resection may provide some survival benefit in selected locally advanced unresectable EHCs and adjuvant treatment may further improve survival outcome.

Prognostic Implications of Primary Tumor Resection in Stage IVB Colorectal Cancer in Elderly Patients

PURPOSE: The aim of this study was to identify prognostic factors in stage IVB colorectal cancer in elderly patients, focusing on the influence of treatment modalities, including palliative chemotherapy and primary tumor resection. METHODS: A cohort of 64 patients aged over 65 years who presented with stage IVB colorectal cancer at the Gangneung Asan Hospital between July 1, 2001, and December 31, 2009, was analyzed. Demographics, tumor location, tumor grade, performance status, levels of carcinoembryonic antigen (CEA), level of aspartate aminotransferase (AST), and distant metastatic site at diagnosis were analyzed. Using the treatment histories, we analyzed the prognostic implications of palliative chemotherapy and surgical resection of the primary tumor retrospectively. RESULTS: The cohort consisted of 30 male (46.9%) and 34 female patients (53.1%); the median age was 76.5 years. Primary tumor resection was done on 28 patients (43.8%); 36 patients (56.2%) were categorized in the nonresection group. The median survival times were 12.43 months in the resection group and 3.58 months in the nonresection group (P < 0.001). Gender, level of CEA, level of AST, Eastern Cooperative Oncology Group performance status, tumor location, and presence of liver metastasis also showed significant differences in overall survival. On multivariate analysis, male gender, higher level of CEA, higher AST level, and no primary tumor resection were independent poor prognostic factors. In particular, nonresection of the primary tumor was the most potent/poor prognostic factor in the elderly-patient study group (P = 0.001; 95% confidence interval, 2.33 to 21.99; hazard ratio, 7.16). CONCLUSION: In stage IVB colorectal cancer in elderly patients, resection of the primary tumor may enhance survival.

Non-invasive Fdlow-up of Pulmonary artey by EBT Other Palliatrve Shunt Operatin / 대한흉부외과학회지

BACKGROUND:To assess the accuracy of Electron-Beam Tomography(EBT) in following evaluation of the pulmonary vascular system after a shunt operation in the cyanotic congenital heart disease with pulmonary stenosis or pulmonary atresia. MATERIAL AND METHOD: Sixteen patients(M:F=11:5) who received Blalock-Taussig(n=8) bidirectional cavo-pulmonary shunt(n=10) and unifocalization (n=2) were ncluded in the study. We evaluated the patency of the shunt the morphology of intrapericardial and hilar pulmonary arteries(PA) peripheral pulmonary vascularity by background lung attenuation and the abundance of arterial & venous collateral. Angiography(n=12) and echocardiography(n=20) were used as the gold standard for the comparison of EBT results. RESULT: EBT was consistent with angiogram/ echo in 100% of the evaluation for the patency of the shunt and in 12(by angiogram 100%) and 19(by echo 95%) for the detection the hypoplasia stenosis or interruption of central PA In measuring of PA EBT and angiogram corrlated(r=0.91) better than EBT-echo(r=0.88) or echo-angiogram(r=0.72) Abundant systemic arterial collateral were noted in 4 and venous collateral in 3 cases. In evaluating the peripheral pulmonary vascularity the homogenous and normal-ranged lung attenuation(m=6) decreased but homogenous attenuation(n=1) segment-by-sgment heterogeneous attenuation(n=3) homogenous but asymmetrical attenuation(n=3) segment-by-segment heterogeneous attenuation(n=3) homogenous but asymmetrical attenuation(n=3) and venous congestion(n=2) were observed nd 12 of them were compatible with the blood flow pattern revealed by cardiac catheterization. CONCLUSIONS: EBT was accurate in the integrated evaluation of the pulmonary vascular system after the shunt including the patency of the shunt operaion the morphology and dimension of the central and hilar PAs and the loco-regional pulmonary flow in the lung parenchyma. It suggests the useful information about the need of secondary shunt operation the proper timing time for total repair and the need of interventional procedure prior to total repair.

Non-invasive Fdlow-up of Pulmonary artey by EBT Other Palliatrve Shunt Operatin / 대한흉부외과학회지

BACKGROUND:To assess the accuracy of Electron-Beam Tomography(EBT) in following evaluation of the pulmonary vascular system after a shunt operation in the cyanotic congenital heart disease with pulmonary stenosis or pulmonary atresia. MATERIAL AND METHOD: Sixteen patients(M:F=11:5) who received Blalock-Taussig(n=8) bidirectional cavo-pulmonary shunt(n=10) and unifocalization (n=2) were ncluded in the study. We evaluated the patency of the shunt the morphology of intrapericardial and hilar pulmonary arteries(PA) peripheral pulmonary vascularity by background lung attenuation and the abundance of arterial & venous collateral. Angiography(n=12) and echocardiography(n=20) were used as the gold standard for the comparison of EBT results. RESULT: EBT was consistent with angiogram/ echo in 100% of the evaluation for the patency of the shunt and in 12(by angiogram 100%) and 19(by echo 95%) for the detection the hypoplasia stenosis or interruption of central PA In measuring of PA EBT and angiogram corrlated(r=0.91) better than EBT-echo(r=0.88) or echo-angiogram(r=0.72) Abundant systemic arterial collateral were noted in 4 and venous collateral in 3 cases. In evaluating the peripheral pulmonary vascularity the homogenous and normal-ranged lung attenuation(m=6) decreased but homogenous attenuation(n=1) segment-by-sgment heterogeneous attenuation(n=3) homogenous but asymmetrical attenuation(n=3) segment-by-segment heterogeneous attenuation(n=3) homogenous but asymmetrical attenuation(n=3) and venous congestion(n=2) were observed nd 12 of them were compatible with the blood flow pattern revealed by cardiac catheterization. CONCLUSIONS: EBT was accurate in the integrated evaluation of the pulmonary vascular system after the shunt including the patency of the shunt operaion the morphology and dimension of the central and hilar PAs and the loco-regional pulmonary flow in the lung parenchyma. It suggests the useful information about the need of secondary shunt operation the proper timing time for total repair and the need of interventional procedure prior to total repair.

Orbital Metastasis of Hepatocellular Carcinoma

Recently elongation of life in cancer patients by modern treatment modalities is thought to be attributed to the increase in the frequency of metastatic tumors in the orbit. The characteristic feature of metastatic orbital tumors is rapid progression associated with motor and sensory symptoms. The authors experienced orbital metastais of hepatocellular carcinoma in a 45-year-old male patient, proven histopathologically. As far as we know, only three histologically proven cases been reported in the literature. Besides, no orbital metastasis of hepatoma has been reproted in Korea, where heaptitis and hepatoma are highly prevalent. Because metastatic hepatoma has highly developed vasculature, surgeons should be aware that intractable bleeding may obstruct the further progression of the palliative surgery, as in our case.