ABSTRACT
BACKGROUND: Endovascular treatment of autogenous arteriovenous haemodialysis fistula stenosis has high reintervention rates. We investigate the effect of drug-eluting balloons in the treatment of recurrent haemodialysis fistula stenosis. METHODS: This is a randomised, controlled, investigator-initiated and run, prospective, blinded, multicentre trial. Patients with recurrent autogenous arteriovenous haemodialysis fistula stenosis received standard endovascular treatment plus drug-eluting balloon or standard endovascular treatment plus uncoated balloon (Sham). Primary endpoint was late lumen loss in trial area on ultrasound at 6 weeks, 3, 6 and 12 months. Secondary endpoints were freedom from reintervention to the Index Trial Area and decline in fistula flow (Qa). Interim analysis was performed at 6 months (unblinded due to timeliness). RESULTS: Patients with 132 recurrent stenoses (48% in bare Nitinol stents) were randomised with 70 receiving drug-eluting balloon and 62 Sham. At 6 months, decline in late lumen loss was 0.23 ± 0.03 mm/month for Sham and 0.045 ± 0.03 mm/month for drug-eluting balloon arm, a significant difference (0.18 mm, p = 0.0002). At 12 months, this difference persisted at 0.12 mm (p = 0.0003). At 6 months, significant difference in late lumen loss for instent restenoses (p = 0.0004) was observed, with non-significant difference for unstented restenoses (p = 0.065). Mean time for freedom from reintervention was 10.14 months for Sham versus 42.39 months for drug-eluting balloon (p = 0.001). The same was shown for instent (p = 0.014) and unstented (p = 0.029) restenoses. Qa decline rate at 6 months was 36.89 mL/min/month (Sham) and 0.41 mL/min (drug-eluting balloon). The difference was significant (36.48 mL/min; p = 0.02) and persisted to 12 months (p = 0.44). CONCLUSION: Paclitaxel drug-eluting balloon significantly delays restenosis after angioplasty for recurrent autogenous arteriovenous haemodialysis fistula stenosis, persisting to 12 months. Drug-eluting balloon significantly increases freedom from reintervention at 12 months with these effects true in stented and unstented fistulas.
Subject(s)
Angioplasty, Balloon/instrumentation , Arteriovenous Shunt, Surgical/adverse effects , Cardiovascular Agents/administration & dosage , Coated Materials, Biocompatible , Graft Occlusion, Vascular/therapy , Paclitaxel/administration & dosage , Renal Dialysis , Vascular Access Devices , Aged , Angioplasty, Balloon/adverse effects , Equipment Design , Female , Graft Occlusion, Vascular/diagnostic imaging , Graft Occlusion, Vascular/etiology , Graft Occlusion, Vascular/physiopathology , Humans , Male , Middle Aged , New South Wales , Recurrence , Time Factors , Treatment Outcome , Ultrasonography, Interventional , Vascular PatencyABSTRACT
AIMS: BRCA1 has a role in maintaining normal nuclear DNA content during cell division and its inactivation may result in DNA aneuploidy and cancer progression. BRCA1-linked breast cancers are more aneuploid and have a worse prognosis, but this has not been elucidated in ovarian cancers. This study explores the potential difference in ploidy status between BRCA1-mutated and sporadic ovarian carcinomas. It also explores the potential association between BRCA1 mutation site and DNA ploidy status. METHODS: This study compared DNA ploidy status of tumor blocks from 23 BRCA1-mutated ovarian carcinomas with that of 23 sporadic ovarian carcinomas matched for histologic subtype, patient age, stage and grade. DNA content of the nuclei was measured by Feulgen-Schiff staining followed by image cytometry and compared. RESULTS: BRCA1-linked tumors with a stop codon closer to the N-terminal (between 1 and 500 aa; 6/6, 100%) had a significantly higher frequency of nondiploidy compared with those with stop codon above 500 aa (7/12, 58%) (P = 0.033). A diploid peak was detected in 28% of BRCA1-mutated ovarian cancers and in 33% of sporadic ovarian cancers. CONCLUSIONS: The present study concluded that ovarian tumors with mutations closer to the N-terminal of BRCA1 may have a higher risk of DNA aneuploidy. There is no significant difference between BRCA1-mutated and sporadic ovarian carcinomas with respect to the DNA content.
Subject(s)
DNA, Neoplasm/genetics , Genes, BRCA1/physiology , Mutation , Ovarian Neoplasms/genetics , Ploidies , Aneuploidy , Female , Humans , Middle AgedSubject(s)
Amides/therapeutic use , Anesthetics, Local/therapeutic use , Cholecystectomy, Laparoscopic , Cholelithiasis/surgery , Intraoperative Care/methods , Pain, Postoperative/prevention & control , Shoulder Pain/prevention & control , Adult , Aged , Aged, 80 and over , Diaphragm , Double-Blind Method , Female , Humans , Incidence , Male , Middle Aged , Pain Measurement , Pain, Postoperative/epidemiology , Prospective Studies , Ropivacaine , Shoulder Pain/epidemiology , Shoulder Pain/etiology , Therapeutic Irrigation , Treatment OutcomeABSTRACT
Chest X-ray and CT examinations often find pulmonary nodules that could be malignant or benign. A case is presented and discussed here in order to improve diagnosis and management of pulmonary nodules. A 62-year-old lady was found to have multiple pulmonary nodules by X-ray when she complained of a cough and fever. This was confirmed by a CT scan. Fine needle aspiration (FNA) of one of the lung lesions reported scant atypical epithelial cells that stained positive for TTF-1 and cytokeratin 7, but negative for cytokeratin 20. Thus, it was suspicious for large cell carcinoma. A videothoracoscopic lung biopsy and histopathology were applied and showed a necrotic nodule with surrounding chronic inflammation and macrophage response, with no evidence of malignant cells. Atypical reactive pneumocytes at the periphery of the lesion (an old infarct) were probably equivalent to the atypical cells seen on cytology. This result changed the diagnosis of our patient from a malignant condition to a benign process. Thus, CT and FNA may give a false positive. A second pathological opinion is very useful for the right diagnosis and management, as shown in our case.
