ABSTRACT
BACKGROUND: Single-session intraoperative radiation therapy (IORT) minimizes treatment demands associated with traditional whole breast radiation therapy (WBRT) but outcomes on local disease control and morbidity among the elderly is limited. METHODS: A multi-institutional retrospective registry was established from 19 centers utilizing IORT from 2007 to 2013. Patient, tumor, and treatment variables were analyzed for ages <70 and ≥70. RESULTS: We evaluated 686 patients (<70 = 424; ≥70 = 262) who were margin and lymph node negative. Patients <70 were more likely to have longer operative time, oncoplastic closure, higher rates of IORT used as planned boost, and receive chemotherapy and post-operative WBRT. Wound complication rates were low and not significantly different between age groups. Median follow-up was 1.06 (range 0.51-1.9) years for < 70 and 1.01 (range 0.5-1.68) years for ≥ 70. There were 5 (0.73%) breast recurrences (4 in <70 and 1 ≥ 70, p = 0.65) and no axillary recurrences during follow-up. CONCLUSIONS: IORT was associated with a low rate of wound complication and local recurrence on short-term follow-up in this cohort.
Subject(s)
Breast Neoplasms/radiotherapy , Intraoperative Care , Age Factors , Aged , Aged, 80 and over , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Combined Modality Therapy , Female , Humans , Mastectomy, Segmental , Middle Aged , North America , Operative Time , Postoperative Complications/epidemiology , Retrospective Studies , Treatment OutcomeSubject(s)
Burn Units , Burns/psychology , Burns/therapy , Cadaver , Humans , Internship and Residency , Los Angeles , Tissue DonorsABSTRACT
Cutaneous blood flow may be an indirect measure of circulatory function estimated by continuous, noninvasive laser Doppler velocimetry (LDV). It has been postulated that LDV may be a useful monitor of cardiac output changes. To test this hypothesis, LDV was evaluated in 67 critically ill adult patients with simultaneous measurements of cardiac index (CI) and other physiologic variables. Heated and unheated laser probes were utilized. The results indicate that LDV reflects acute directional changes of CI. Further, with the heated laser probe, the magnitude of acute CI change is reflected. However, there are gradual changes over time of LDV which may occur independently of CI or other monitored variables. Hence, absolute LDV values are not predictive of absolute CI values.
Subject(s)
Cardiac Output , Critical Care , Monitoring, Physiologic/methods , Rheology , Adult , Aged , Blood Flow Velocity , Hot Temperature , Humans , Middle Aged , Skin/blood supplyABSTRACT
Cutaneous blood flow may be measured utilizing a continuous, noninvasive technique, laser Doppler velocimetry (LDV). Monitoring of cutaneous blood flow by LDV might be a useful method to monitor cardiac output. To test this hypothesis, sequential measurements of cardiac output, LDV, and transcutaneous oxygen (PtcO2) were made on 10 anesthetized dogs during experimental shock. There was significant correlation between LDV and cardiac output, while PtcO2 reflected cardiac output only at low flow states. These results show that, in the animal model, cutaneous LDV is a sensitive and specific method for monitoring cardiac output changes.
Subject(s)
Cardiac Output , Skin/blood supply , Animals , Dogs , Lasers , Monitoring, Physiologic/instrumentation , Oxygen/blood , Positive-Pressure Respiration , Regional Blood Flow , Shock, Hemorrhagic/physiopathologyABSTRACT
Fluosol-DA 20% (Fluosol), a perfluorochemical emulsion capable of improving oxygen transport, was used to treat three patients with life-threatening hemorrhage. In each case a decreased partial pressure of oxygen, an increased alveolar-arterial oxygen gradient, fever, an increased white blood cell count, and chest x-ray abnormalities occurred at similar time intervals after treatment with Fluosol. In one patient, pulmonary complications were fatal. Similar adverse reactions to treatment with Fluosol have not been previously reported. Possible explanations for these pulmonary complications are the adult respiratory distress syndrome, oxygen toxicity, or direct toxic effects of Fluosol.
Subject(s)
Blood Substitutes/adverse effects , Fluorocarbons/adverse effects , Hemorrhage/therapy , Lung/drug effects , Adult , Aged , Christianity , Drug Combinations/adverse effects , Female , Hemorrhage/complications , Humans , Hydroxyethyl Starch Derivatives , Lung/physiopathology , Male , Oxygen/physiology , Respiratory Distress Syndrome/chemically inducedABSTRACT
Whether bile reflux through a common channel into the pancreatic duct is a causative factor in the development of gallstone pancreatitis is controversial. To address this issue, we have reviewed a consecutive series of cholecystectomies performed with intraoperative cholangiograms. The cholangiograms and the patients' charts were reviewed independently to determine the incidence of a common channel in patients both with and without pancreatitis and to analyze their clinical courses. The group of patients who had pancreatitis showed a common channel in 19 (90%) of 20 cases, while those patients who did not have pancreatitis showed a common channel in 23 (35%) of 66 cases. The patients who had pancreatitis were less likely to have choledocholithiasis than were those patients who did not have pancreatitis, and these patients were less likely to require exploration of the common bile duct.
