Room temperature pulsatile perfusion of renal allografts with Lifor compared with hypothermic machine pump solution.

This pilot study compared the use of the Lifor Organ Preservation Medium (RTLF) at room temperature with hypothermic Belzer machine preservation solution (CMPS) and room in vitro temperature Belzer machine preservation solution (RTMPS) in a porcine model of uncontrolled donation after cardiac death (DCD). In this study, 5 porcine kidneys for each perfusate group were recovered under a DCD protocol. The kidneys were recovered, flushed, and placed onto a renal preservation system following standard perfusion procedures. The average flow rate for CMPS was 36.2 +/- 7.2549 mL/min, RTMPS was 90.2 +/- 9.7159 mL/min, and RTLF was 103.1 +/- 5.1108 mL/min. The average intrarenal resistance for CMPS was 1.33 +/- 0.1709 mm Hg/mL per minute, RTMPS was 0.84 +/- 0.3586 and RTLF was 0.39 +/- 0.04. All perfusion parameters were statistically significant (P < .05) at all time points for the CMPS when compared with both RTMPS and RTLF. All perfusion parameters for RTMPS and RTLF were equivalent for the first 12 hours; thereafter, RTLF became significantly better than RTMPS at 18 and 24 hours. It appears that both RTMPS and RTLF have equivalent perfusion characteristic for the initial 12 hours of perfusion, but LF continues to maintain a low resistance and high flow up to 24 hours. The results of this pilot study indicate that RTLF may represent a better alternative to pulsatile perfusion with CMPS and requires validation in an in vivo large animal transplant model.

Histological, CT, and intraoperative ultrasound appearance of hepatic tumors previously treated by laparoscopic radiofrequency ablation.

PURPOSE: The purpose of this paper is to compare intraoperative biopsy results of previously ablated liver tumors with their preoperative computed tomography (CT) and intraoperative laparoscopic ultrasound (LUS) appearances in patients undergoing repeat radiofrequency ablation (RFA). METHODS: Seventy repeat RFA procedures were performed in 59 (13%) patients. Laparoscopically, suspected recurrent and stable appearing foci were biopsied using an 18 G biopsy gun. Preoperative CT and LUS appearances of the previously ablated lesions were compared with core biopsy results. RESULTS: There were 33 patients with colorectal cancer, 11 with hepatocellular cancer, 8 with neuroendocrine tumors, and 7 with other tumor types. Two hundred lesions were treated by RFA in these 70 repeat ablations. Suspected recurrent tumor foci were enhanced on CT and produced a more finely stippled echo pattern on LUS. Biopsy confirmed recurrent tumor in 72 of 84 such lesions. Previously ablated foci had a CT appearance of a hypodense, nonenhancing lesion without evidence of adjacent enhancing foci. Laparoscopic ultrasound appearance was of a hypoechoic lesion with a coarse internal pattern with the tracks of the ablation catheter probes often still visible. Biopsy found necrotic tissue in 21 of 22 such lesions appearing radiologically to be without recurrence. Biopsy of an ablated focus adjacent to an area of suspected recurrence showed necrotic tissue in 17 of 22 lesions and viable cancer in 5. CONCLUSION: CT and LUS appearance of previously ablated foci showed good correlation with core biopsies. CT scan is reliable in following RFA lesions, without the need for routine biopsy. LUS reliably distinguished recurrent from ablated lesions in patients undergoing repeat ablation.

Omission of axillary lymph node dissection in early-stage breast cancer: effect on treatment outcome.

PURPOSE: To determine the effect omission of axillary lymph node dissection has on outcome in patients treated with breast-conserving therapy for early-stage invasive breast cancer. MATERIALS AND METHODS: The authors evaluated 492 patients with breast cancer treated with (n = 32) and without (n = 456) axillary lymph node dissection. The primary tumor characteristics of the two groups were similar, though the median age was different. All patients received whole-breast radiation (mean dose, 50 Gy); additional tumor bed boosts and nodal irradiation were used more often in patients without dissection. RESULTS: Median follow-up in patients without and with dissection was 60 and 52 months, respectively. The 5-year survival was 88% and 93%, respectively. There were no regional failures in the group treated without dissection. Crude rates of local and distant failure were similar for both groups. CONCLUSION: Omission of axillary lymph node dissection should be considered in patients whose pathologic nodal status will not influence decisions regarding adjuvant therapy.