1,720,964 research outputs found
Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy as salvage treatment for a late wound recurrence of endometrial cancer.
No full textEndometrial cancer (EC) is usually diagnosed at an early stage, when surgery alone may be curative, but 20-25% of patients with EC have higher-risk early-stage disease requiring radiation therapy alone or in combination with chemotherapy, in addition to surgery. Most EC relapses are either pelvic or distant metastases and occur within the first three years after hysterectomy. Laparotomy wound recurrences of EC are extremely rare, and only a few cases have been previously reported. We describe the unusual case of a late wound recurrence from an EC surgically removed 10 years previously which was successfully treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) after response to a hormonal therapy. Ten years after abdominal hysterectomy and bilateral salpingo-oophorectomy, on computed tomographic (CT) scan, a 70-year-old woman exhibited an abdominal mass of 3.5 cm, strictly adherent to the abdominal rectal muscle. CT-guided biopsy revealed estrogen- and progesterone receptor-positive metastasis from EC and the patient was treated with megestrole acetate. The whole body 18F-fluoro-2-deoxyglucose (FDG)-positron emission tomography (PET)/CT showed a marked metabolic response at the single metastatic site, with no further metastases, and the patient underwent surgical resection of the mass followed by immediate HIPEC perfusion with cisplatin. No residual macroscopic disease was present at the end of surgery and no complications occurred during the hospital stay. At 12-month follow-up, the patient is alive without evidence of disease. Although this approach is still being investigational for peritoneal recurrence of EC, our report confirms its feasibility and its promising results in highly selected patients
PET/CT in patients with peritoneal carcinomatosis undergoing hypertemic intraperitoneal chemotherapy (HIPEC) following cytoreductive surgery.
No full textBackground: The peritoneum is the preferred site of metastasis from several primary malignancies, and peritoneal carcinomatosis (PC) is one of the most significant negative prognostic indicators in patients with metastatic disease. A survival benefit has been observed for patients with PC from colorectal, ovarian, and gastric carcinomas treated by cytoreductive surgery (CRS) followed by intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC). In patients undergoing this treatment modality, the strongest determinant of outcome is the residual tumor extension after CRS. Unfortunately, PC can be difficult to diagnose preoperatively by imaging studies. The aim of our study was to evaluate the role of computed tomography (CT) and 18F-2-deoxy-fluoro-D-glucose positron emission tomography/CT (PET/CT) scanning in detecting the presence and the extent of PC in patients with various advanced malignancies.
Patients and Methods: A group of 47 patients (median age 61.4±11.5 years) with advanced or recurrent cancers (colorectal=26, ovarian=21, gastric=8, pseudomyxoma peritonei=3) scheduled for CRS and HIPEC underwent preoperative CT and PET/CT. The results were expressed as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. The negative (NLR) and positive (PLR) likelihood ratio were also obtained. The receiver operator characteristic (ROC) curves were drawn, and areas under the curve (AUC) were measured. The 95% confidence interval (95%CI) was also calculated, when appropriate. The results of CT scan and PET/CT were compared with the final surgical findings.
Results: The sensitivity, specificity, PPV, NPV, accuracy were 91%, 33%, 93%, 29% and 69% for CT, and 82%, 67%, 95%, 33% and 71% for PET/CT, respectively. NLR and PLR were 0.27 (95%CI 0.07-1.09) and 1.37 (95%CI 0.76-2.44), while the AUC was 62 and 74 for CT and PET/CT, respectively (p=NS).
Conclusions: In patients with PC undergoing surgery both PET/CT and CT showed low sensitivity, and thus they seem not to be a reliable tool in view of treatment planning. Our study demonstrates that PET/CT does not add substantially to CT scanning in the detection of this disease
Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy as salvage treatment for a late wound recurrence of endometrial cancer
No full textEndometrial cancer (EC) is usually diagnosed at an early stage, when surgery-alone may be curative, but 20-25% of patients with EC have higher-risk early-stage disease requiring radiation therapy alone or in combination with chemotherapy, in addition to surgery. Most EC relapses are either pelvic or distant metastases and occur within the first three years after hysterectomy. Laparotomy wound recurrences of EC are extremely rare, and only a few cases have been previously reported. We describe the unusual case of a late wound recurrence from an EC surgically removed 10 years previously which was successfully treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) after response to a hormonal therapy. Ten years after abdominal hysterectomy and bilateral salpingo-oophorectomy, on computed tomographic (CT) scan, a 70-year-old woman exhibited an abdominal mass of 3.5 cm, strictly adherent to the abdominal rectal muscle. CT-guided biopsy revealed estrogen- and progesterone receptor-positive metastasis from EC and the patient was treated with megestrole acetate. The whole body F-18-fluoro-2-deoxyglucose (FDG)-positron emission tomography (PET)/CT showed a marked metabolic response at the single metastatic site, with no further metastases, and the patient underwent surgical resection of the mass followed by immediate HIPEC perfusion with cisplatin. No residual macroscopic disease was present at the end of surgery and no complications occurred during the hospital stay. At 12-month follow-up, the patient is alive without evidence of disease. Although this approach is still being investigational for peritoneal recurrence of EC, our report confirms its feasibility and its promising results in highly selected patients
Fattori di controllo della angiogenesi: modificazioni dei valori ematici di VEGF, FGFB ed Endostatina nel post- operatorio
No full textPreoperative assessment of peritoneal carcinomatosis in patients undergoing hyperthermic intraperitoneal chemotherapy following cytoreductive surgery.
No full textThe present study evaluates the accuracy of computed tomographic (CT) scan and positron emission tomography with F-18-fluorodeoxyglucose (FDG-PET)/CT for the quantification of peritoneal carcinomatosis (PC) in patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Data were retrospectively collected for 58 patients, who were considered for CRS and HIPEC. The predictability, sensitivity, specificity and accuracy values of FDG-PET/CT and CT were tested. Preoperative CT and FDG-PET/CT failed to detect PC in 9% and 17% of cases, respectively, with a sensitivity of 91% and 82%, a specificity of 33% and 67%, an area under the curve (AUC) of 62% and 74% and a negative likelihood ratio of 027 (CI.95 0.07-1.09) and 027 (CI.95 0.11-0.62), respectively (p=0.469). Both techniques showed a high prevalence of PC extent underestimation (CT 47% and FDG-PET/CT 43% of cases). Small bowel involvement and optimal CRS had a prevalence of 60% and 76%, respectively, and both the CT and FDG-PET/CT imaging techniques were inaccurate at predicting them (AUC 53% and 52% for small bowel involvement, and 63% and 58% for optimal CRS, respectively). In conclusion both CT and FDG-PET/CT had low preoperative staging reliability for PC, and this can strongly influence the ability to implement the correct treatment strategy for patients with PC
Controllo del leakage in per fusioni locoregionali con sonda intraoperatoria per radiazioni gamma: l’esperienza preliminare di Udine
No full text
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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