ABSTRACT
PURPOSE: Perineal hernias are infrequent complications of abdominoperineal operations with estimated historic prevalences (from the era where the perineal wound was left open) ranging from 0.6 to 7 percent. The purpose of this study was to identify the modern prevalence of postoperative perineal hernias, factors that may contribute to their development, and examine the methods of repair. METHODS: The Mayo Clinic patient database (1990-2000) was interrogated for the following data identifiers: incisional hernia, perineal hernia, abdominoperineal resection, proctocolectomy, and partial or total pelvic exenteration. All surviving patients were followed up to December 2005. The retrieved patient data was retrospectively analyzed. RESULTS: Of a total of 3,761 patients who underwent abdominoperineal resection (including nonrestorative proctocolectomy and pelvic exenteration) during the study period, 8 developed a perineal hernia (5 females). The median age at hernia presentation was 76 (range, 69-84) years, representing a median interval of 22 (range, 1-60) months from the original operation. All were smokers (> or =15 pack years) and five had received chemoradiotherapy for their original diagnosis. The commonest prevalence was found in patients who had undergone abdominoperineal resection (5/1,266) or pelvic exenteration (2/1,334). Only 1 of 1,161 patients developed a perineal hernia after proctocolectomy despite most being on perioperative immunosuppression for inflammatory bowel disease. Abdominal exploration and repair was performed in four patients whereas four underwent perineal repair (2 of each with mesh). None have recurred with a median follow-up of 36 (range, 6-60) months. CONCLUSIONS: Perineal hernias are rare complications of abdominoperineal surgery with a more common prevalence after cancer operations. Smoking and chemoradiotherapy, but not corticosteroid immunosuppression, may be factors. The abdominal approach has advantages over the perineal approach, but both are suitable with good medium-term results.
Subject(s)
Abdomen/surgery , Hernia/epidemiology , Pelvic Floor/surgery , Postoperative Complications/epidemiology , Aged , Aged, 80 and over , Databases, Factual , Female , Herniorrhaphy , Humans , Male , Pelvic Exenteration/adverse effects , Postoperative Complications/surgery , Prevalence , Recurrence , Retrospective Studies , Risk FactorsABSTRACT
BACKGROUND: Lung cancer is the most common cause of cancer death in women in the USA. Lung cancer arising during pregnancy is rare and has been reported only 15 times since the 1950s. However, the use of chemotherapy for lung cancer during pregnancy has not previously been reported. METHODS: The history, treatment and outcome of a patient with stage IV non-small-cell lung carcinoma (NSCLC) diagnosed during pregnancy is presented. Previous published reports on lung cancer were retrieved by a literature search of Medline and Cancerlit. RESULTS: A 31-year-old woman was diagnosed as having stage IV NSCLC with bilateral pulmonary involvement when 26 weeks pregnant. Her shortness of breath progressed to dyspnea at rest on 100% inspired oxygen. Therefore, she was treated with systemic chemotherapy using cisplatin and vinorelbine. Despite this treatment, her oxygenation declined further over the next 4 days and thus the baby was delivered via cesarean section after 27 weeks of gestation. Four cycles of vinorelbine and cisplatin have now been administered. Following this treatment, the patient has experienced a significant clinical improvement and no longer requires supplemental oxygen. No chemotherapy-related adverse effects have been noted in the baby. In the 15 previously reported patients with concurrent lung cancer and pregnancy, chemotherapy administration during pregnancy has not been described. CONCLUSIONS: Treatment of lung cancer with chemotherapy during pregnancy should be considered on an individual basis with regard to the stage of the cancer and the maturity of the fetus. To our knowledge, the case presented here is the first report of a woman receiving chemotherapy for lung cancer while pregnant.
Subject(s)
Adenocarcinoma/drug therapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Non-Small-Cell Lung/drug therapy , Lung Neoplasms/drug therapy , Pregnancy Complications, Neoplastic/drug therapy , Vinblastine/analogs & derivatives , Adenocarcinoma/diagnosis , Adenocarcinoma/pathology , Adult , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Carcinoma, Non-Small-Cell Lung/diagnosis , Carcinoma, Non-Small-Cell Lung/pathology , Cesarean Section , Cisplatin/administration & dosage , Cisplatin/adverse effects , Diagnostic Errors , Dyspnea/etiology , Female , Fetus/drug effects , Gestational Age , Humans , Infant, Newborn , Lung Neoplasms/diagnosis , Lung Neoplasms/pathology , Male , Oxygen/therapeutic use , Pneumonia/diagnosis , Pregnancy , Pregnancy Complications, Neoplastic/diagnosis , Pregnancy Complications, Neoplastic/pathology , Pregnancy Outcome , Smoking , Vinblastine/administration & dosage , Vinblastine/adverse effects , VinorelbineABSTRACT
Gamma-interferon (IFN-gamma) seems to be required for resistance to Listeria monocytogenes in vivo, but acts early in infection, before apparent T cell involvement. The early role of IFN-gamma is unknown, but might include enhancing antigen presentation, inducing secretion of tumor necrosis factor alpha and helping early precursor macrophages to express nonspecific listericidal activity.
Subject(s)
Interferon-gamma/physiology , Listeriosis/immunology , Animals , Histocompatibility Antigens Class I/metabolism , Histocompatibility Antigens Class II/metabolism , Humans , Immunity, Innate , Listeriosis/metabolism , Tumor Necrosis Factor-alpha/metabolismABSTRACT
An important component of the cell-mediated immune response often is the migration of macrophages to the site of immune activity. Although much evidence suggests that macrophage migration is regulated by antigen-specific T cells, the influence of T cell-derived cytokines on macrophage chemotaxis has not been well studied. Here we present evidence that interleukin-4 (IL-4), a cytokine derived from T helper 2 (Th 2) cells, is chemotactic for mouse peritoneal macrophages. In an in vitro chemotaxis assay using Boyden chambers, recombinant IL-4 was chemotactic for mouse peritoneal exudate macrophages. This response was inhibited in a dose-dependent manner by the anti-IL-4 antibody, 11B11. As shown here and previously, interleukin-2 (IL-2) and interferon-gamma (IFN-gamma), cytokines derived from T helper 1 cells, are not chemotactic for mouse macrophages.
Subject(s)
Chemotaxis, Leukocyte/drug effects , Interleukin-4/pharmacology , Macrophages/physiology , Animals , Cells, Cultured , In Vitro Techniques , Interleukin-2/pharmacology , Mice , Peritoneal Cavity/cytology , Recombinant Proteins , T-Lymphocytes, Helper-Inducer/physiologyABSTRACT
A dose table that provides the dose as a function of fractions of peripheral volume for 125I implants is presented. The table is based on seed distributions from 50 actual patient implants. Computer dosimetry was used to determine peripheral doses and dose ranges within implant volumes. The effects of seed distribution were also examined. The patient data and a study of computer-generated randomized seed coordinates within a given volume suggest that matched doses do not depend strongly on the exact position of each seed. The table provides the means for planning an implant to obtain a desired peripheral dose that can be directly compared with the postimplant computer dose calculation.
