1,720,968 research outputs found
Hepatic arterial infusion for unresectable liver metastases from colorectal carcinoma.
No full textI.F.: 0.40
Carcinoma dell’ovaio: studio pilota sulla perfusione ipertermico-antiblastica intraperitoneale intraoperatoria.
No full textOptimized procedure of real-time systemic leakage monitoring during isolated limb perfusion using a hand held gamma probe and 99mTc-HSA.
No full textIsolated limb perfusion (ILP) therapy using a combination of tumour necrosis factor alpha (TNF) and cytostatic agents in hyperthermic conditions has proven to be effective in treating cancers limited to limbs or to a single organ such as the liver. A critical step for ILP is the accurate and real-time monitoring of systemic leakage with the aim of avoiding severe systemic TNF mediated toxicity. It has been established that TNF toxic effects become relevant when overcoming the 10% limit of the 'effective' therapeutic dose administered during ILP. The most diffuse procedure for systemic leakage monitoring is based on the utilization of human soluble serum albumin (HSA) labelled with I-131 and an external scintillation detector. In order to overcome some drawbacks connected with the properties of I-131, we developed a new procedure based on the utilization of HSA labelled with Tc-99m in combination with a hand held gamma probe used as a detector. Our procedure consists of the following steps: (1) a Tc-99m-HSA dose standardized as 0.5 MBq(.)kg(-1) body weight is injected into the ILP circuit before TNF administration; (2) a hand held gamma probe is placed over the pre-cordial area in a zone pre-marked on the patient's skin during a simulation test; (3) 48-72 h before ILP, a simulation test is obtained using a Tc-99m-HSA dose corresponding to 10% of the dose calculated for ILP (i.e., 0.05 MBq(.)kg(-1) body weight); (4) during the simulation test the maximum count-rate zone detected on the pre-cordial area is marked on patient's skin; (5) a 60 min time-activity curve corresponding to the circulating Tc-99m-HSA radioactivity effective decay is calculated and fitted; and (6) this time-activity curve is used to compensate for the leakage systemic counting observed during ILP. In order to compare the external, probe counting with the circulating radioactivity, in the first 10 patients from a total series of 43 treated patients, the results of external, probe monitoring were compared with the results of patient blood and perfusion circuit samples taken simultaneously every 5 min and measured by a laboratory gamma counter placed in the operating theatre. A good correlation was found between the two methods (R-2 = 0.965, P < 0.01). It is concluded that the proposed procedure, based on the combination of Tc-99m-HSA as the radiotracer and a hand held gamma probe as the detector, appears to be technically simple and accurate enough in the real-time monitoring of perfusion leakage in ILP cancer therapy. Moreover, using Tc-99m-HSA as the radiotracer, the risk of radioactive contamination is significantly lower in comparison with I-131-HSA
Prognostic factors affecting long term outcome after iver resection for hepatocellular carcinoma. Results in a series of 100 italian patients
No full text
Patterns of recurrence after resection of colorectal liver metastases: prediction by models of outcome analysis
No full text
Prognostic factors affecting long term outcome after liver resection for hepatocellular carcinoma.
No full textI.F. 3,632
Abstract: BACKGROUND. Long term results after liver resection for hepatocellular carcinoma (HCC) are disappointing because the disease tends to recur. In this study, the authors assessed prognostic factors affecting long term outcome, in the hope that these factors might be used in selecting HCC patients for surgery.
METHODS. During the period 1977-1995, 100 consecutive patients underwent curative liver resection; 78 of 100 had HCC arising on preexisting cirrhosis (53 Child's Class A and 25 Child's Class B). Thirty-five prognostic factors were evaluated for their association with overall survival (OS) and disease free survival (DFS) in univariate and multivariate analysis (Cox proportional hazards model).
RESULTS. There were four postoperative deaths. Seven patients died in hospital of hepatorenal failure: six had Child's Class B cirrhosis and had undergone preoperative chemoembolization. Of the remaining 89 patients, 50 developed recurrence. All surviving Child's Class B patients had recurrence. Five-year OS, postoperative deaths included, was 38% (median, 36 months). Five-year DFS, postoperative deaths excluded, was 26% (median, 21 months). Independent prognostic factors for DFS were Child's class, glutamic-oxaloacetic transaminase, gamma-glutamyltransferase, alpha-fetoprotein, number of tumor nodules, width of resection margins, preoperative chemoembolization, and experience of the team that performed the surgery. Factors with an independent effect on OS were Child's class and width of resection margins.
CONCLUSIONS. Liver resection can provide long term DFS in HCC patients with normal liver function, In patients with liver function impairment or an inadequate resection margin, recurrences are almost certain to occur. Preoperative chemoembolization significantly prolongs DFS but may increase the risk of postoperative liver failure in patients with Liver function impairment. (C) 1998 American Cancer Society
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