bluuebunny/crossref_metadata_2025 huggingface dataset:
A Prospective Observational Study to Assess the Impact of Operator Seniority on outcome following Arteriovenous Fistula Formation
Authors: Barnes Rachel , Smith George E. , Chetter Ian C.
Published: July 2015

Purpose

Arteriovenous fistula (AVF) surgery affords an excellent opportunity for junior surgeons to learn key vascular techniques. However, implementation of the European Working Time Directive has reduced trainee surgeon's working hours, leading to concerns regarding a possible effect on patient outcomes. Given high early postoperative failure rates and limited AVF sites, it has been proposed that AVF surgery should be performed by Consultants and senior trainees only. This prospective observational study aimed to establish how seniority impacts upon AVF surgery outcomes.

Methods

All patients referred for AVF formation were considered for inclusion. Demographic data, comorbidities, medications and previous access history were recorded. Surgery was performed by a Consultant Vascular Surgeon or a junior surgeon. Clinical review was undertaken 30 days postoperatively to assess patency and record any complications.

Results

Seventy-seven patients underwent AVF formation. About 63.6% procedures were carried out by a junior surgeon. The groups were well matched for demographics, comorbidities and medications. There was no difference in anatomical site of formation between groups operated on by consultant versus juniors (p = 0.373). More general anaesthetic procedures were undertaken by Consultant surgeons, for example basilic vein transposition when compared with juniors (p = 0.039). There was no significant difference in terms of early AVF failure (p = 0.710), complication rates (p = 0.139) or requirement for re-intervention (p = 0.256) between the groups. Patency rates were also equivocal between the groups.

Conclusions

The seniority of the operating surgeon does not appear to impact on outcomes following AVF formation. A greater proportion of general anaesthetic cases were undertaken by a Consultant, which may introduce bias. Junior surgeons with appropriate training and modest experience can perform access surgery without detriment to patients patient detriment.
Percutaneous versus Surgical Insertion of PD Catheters in Dialysis Patients: A Meta-Analysis
Authors: Boujelbane Lamya , Fu Ning , Chapla Kevin , Melnick David , Redfield Robert R. , Waheed Sana , Yevzlin Alexander S. , Shin Jung-Im , Astor Brad C. , Chan Micah R.
Published: July 2015

Purpose

Several small studies have suggested that the percutaneous method of peritoneal dialysis (PD) catheter insertion is effective and has a lower complication rate than surgical techniques (open, laparoscopic or peritoneoscopic), although no randomized, controlled study has compared these methods. Our objective was to compare percutaneous PD catheter insertion vs surgical placement in terms of 1-year catheter survival, catheter dysfunction, fluid leak and incidence of peritonitis.

Methods

We searched Medline for English-language literature from 1966 through June 2014, along with national conference proceedings and reference lists of all included publications to identify relevant studies. Inclusion criteria were having a measure of catheter survival at 1 year, catheter dysfunction, peritonitis rate per patient-month or fluid leak as outcomes. Studies were excluded if they were not in English or if they included pediatric patients. Random effects models were used to derive the pooled risk ratios, differences in patency and their variations.

Results

Thirteen studies with a total of 2,681 subjects met the inclusion criteria. There was no significant difference in 1-year catheter survival in percutaneous vs surgical PD catheter placement (relative risk [RR] = 0.81; 95% confidence interval [CI]: 0.59-1.11, p = 0.19). Catheter dysfunction also did not differ significantly between the groups (pooled odds ratio [OR] = 0.86; 95% CI: 0.57-1.29, p = 0.46). The prevalence of peritoneal fluid leak also was similar for percutaneous and surgical groups (OR = 1.10; 95% CI: 0.58-2.09, p = 0.77). However, there was a significant lower incidence of peritonitis among those with percutaneous placement (incidence rate ratio [IRR] = 0.77; 95% CI: 0.62-0.96, p = 0.02). Significant heterogeneity was detected across studies ( I2 = 78.4%, p<0.0001).

Conclusions

Our results suggest that there is no significant difference in catheter survival between percutaneous and surgical placement of PD catheters. Whether there are significant benefits from percutaneous placement in terms of peritonitis rates requires further robust studies. These findings have significant implications for future design of clinical trials in the placement of PD catheters and the delivery of dialysis-related services.
Echographic Landmark of Cephalic and Collateral Accessory vein at Forearm in Preoperative Evaluation for Hemodialysis Angioaccess
Authors: Pirozzi Nicola , Giuliani Anna , Scrivano Jacopo , Pettorini Laura , Fazzari Loredana , Punzo Giorgio , Menè Paolo
Published: July 2015

Introduction

Superficial veins in the upper arm differ according to their relationship to the superficial fascia. We investigated the echographic landmark of the cephalic vein (CV) to correctly distinguish it from the collateral accessory vein (CAV) before hemodialysis angioaccess creation.

Materials and Method

Twenty consecutive patients were evaluated by ultrasonographic scan. The echographic features of CV and CAV together with their relationship were described.

Results

Ninety-five percent of patients presented both CV and CAV (75% CAV laterally located, 25% medially located). CV and CAV diameters were 2.9 (±0.65) and 2.0 (±0.70), respectively.

Conclusions

CV differs from CAV for its anatomic location at forearm. Such a difference is clearly evident under ultrasound examination, despite any recommendation in ultrasound guidelines. Whether the exclusive use of CV for angioaccess creation can lead to a better outcome will be ascertained by further studies.
Thickness and Diameter in Melanoma: Is There a Relation?
Authors: Crocetti Emanuele , Fancelli Laura , Caldarella Adele , Buzzoni Carlotta
Published: July 2015

Objective

To evaluate the relationship between diameter and Breslow's thickness in skin melanoma.

Methods

2,071 skin melanomas incident in the area of activity of the Tuscany Cancer Registry (central Italy) were analyzed. Pearson's linear correlation coefficient r was computed between diameter and Breslow's thickness.

Results

There was a statistically significant, but rather small, correlation between diameter and Breslow (r = 0.39). The same was true for men and women, for older and younger patients, and for skin subsites. 22.3% of the examined skin melanomas had a diameter ≤6 mm.

Conclusions

There was a statistically significant, but small, correlation between Breslow's thickness and diameter in skin melanomas. Moreover, a non-negligible proportion of small lesions were thick and/or nodular.
Cutaneous and Bone Metastasis of Follicular Thyroid Carcinoma: A Case Report
Authors: Bansal Anju , Kaur Manveen , Narula Varsha
Published: July 2015

Follicular thyroid carcinoma (FTC) is the second most common type of thyroid cancer after papillary carcinoma. Based on the extent of invasion, it has been classified into minimally and widely invasive subtypes. The minimally invasive type usually grows slowly and is clinically indolent but in rare cases has an aggressive behavior with distant metastases. The lungs and bones are the most common sites of metastasis. The literature mentions very few cases of scalp metastases. We report an unusual case of minimally invasive FTC with multiple scalp and bone metastases as the initial presenting complaint. In conclusion, awareness of the histopathological characteristics and variations in the metastatic behavior of thyroid carcinomas can help us overcome the difficulty in the diagnosis of such lesions.
Nasal Cavity Reirradiation: A Challenging Case for Comparison between Proton Therapy and Volumetric Modulated arc Therapy
Authors: Ruggieri Ruggero , Dionisi Francesco , Mazzola Rosario , Fellin Francesco , Fiorentino Alba , Schwarz Marco , Ricchetti Francesco , Amichetti Maurizio , Alongi Filippo
Published: July 2015

Background

The aim of this case report is to report on a dosimetric comparison between volumetric modulated arc therapy (RapidArc technique and active scanning proton therapy (single-field (SFO) and multifield (MFO) techniques) in a case of nasal cavity cancer recurrence.

Case Report

A 72-year-old man, who received adjuvant radiotherapy for a carcinoma of the nasal cavity, experienced an unresectable local recurrence in the previous surgical bed. Hence, the patient was evaluated for reirradiation by comparing different modalities, with a total prescribed dose of 50 Gy in standard fractionation. RA plan was revealed to be equivalent to the MFO plan in terms of target dose coverage and conformity index. SFO plan was not able to respect a maximum dose of 9 Gy to nervous structures, in contrast to RA and MFO plans.

Conclusions

In this challenging scenario, although a clear preference would be given to the MFO proton plan, the RA plan was revealed to be adequate for the clinical goal of target coverage and sparing of organs at risk.
Metastatic Choriocarcinoma as Initial Presentation of Small Bowel Perforation in Absence of Primary Uterine Lesion: A Case Report
Authors: Cho En Bee , Byun Jung Mi , Jeong Dae Hoon , Yoon Hye Kyoung , Kim Young Nam , Sung Moon Su , Lee Kyung Bok , Kim Ki Tae
Published: July 2015

Background

Choriocarcinoma is a highly malignant tumor of gestational trophoblastic neoplasia that characteristically spreads via the bloodstream. Small bowel metastasis is very rare, and a small number of cases of choriocarcinoma metastasis to small bowel have been reported.

Methods

We report a case of a 40-year-old woman presenting with acute abdominal pain and vaginal bleeding due to small bowel perforation secondary to jejunal metastasis. In our case, metastatic choriocarcinoma was present in the small bowel, lung, and liver, but no primary lesion was apparent.

Results

After resection and anastomosis of the perforated small bowel, chemotherapy was performed. The patient began chemotherapy with etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMA-CO) for 9 cycles. When the 4th cycle of chemotherapy was finished, β-human chorionic gonadotropin (hCG) level was normalized and follow-up computed tomography scans showed regression of the liver metastasis and small bowel lesion and significantly decreased lung metastasis. After 9 cycles of chemotherapy were completed, the patient showed complete response.

Conclusions

If patients have high β-hCG of unknown origin and suspected panperitonitis, which are suspicious of choriocarcinoma metastasis to small bowel, the pathologic findings are important. It is essential to confirm the histopathologic diagnosis postoperatively. Choriocarcinoma can spread to various organs and show aggressive manifestations. Therefore, we should be aware of possible metastatic sites and remain alert to its diagnosis.
Management of Patients with Castration-Resistant Prostate Cancer (CRPC): Results of an Italian Survey Using the Delphi Method
Authors: Terrone Carlo , Berruti Alfredo , Papotti Mauro , Vavassori Vittorio , Sciarra Alessandro
Published: July 2015

Purpose

To assess the opinions of urologists, oncologists and radiation oncologists on the indication for androgen deprivation therapy (ADT) and the definition and management of castration-resistant prostate cancer (CRPC).

Methods

In this study using the Delphi method, a list of 15 statements (66 items overall) addressing key issues in ADT and CRPC was sent to 255 participants (urologists, oncologists and radiation oncologists). Responses were rated on a 5-point Likert scale (1=strong disagreement; 5=strong agreement). Disagreement was defined as ≥66% responses with scores 1-2 and agreement as ≥66% responses with scores 3-5. No consensus was absence of agreement/disagreement.

Results

Overall, there was agreement and disagreement in 50% and 15% of the items, respectively. In 71.2% of the items the panelists agreed with each other. The highest concordance rate was observed between urologists and oncologists (87.8%). There were no items with 3 different opinions between the specialists. All panelists agreed on the definition of CRPC. Urologists and oncologists agreed on the recommendation to continue ADT in CRPC. In both nonmetastatic and metastatic asymptomatic CRPC patients with biochemical progression, treatment should be based on PSA kinetics. The panelists agreed on the use of chemotherapy in symptomatic and asymptomatic metastatic CRPC patients but not in those with nonmetastatic CRPC. There was agreement on the timing of initiation of abiraterone and enzalutamide either before or after chemotherapy.

Conclusions

With few exceptions there was agreement among urologists, oncologists and radiation oncologists about the management of CRPC, although the indications were not always in line with international guidelines.
Preliminary Study on the Expression of Toll-Like Receptors 7 and 8 in Bladder Urothelial Tumors
Authors: Garau Gianmarco , Rocca Paolo Cossu , Manca Alessandra , Madonia Massimo , Siracusa Giuseppe , Sotgiu Giovanni , Corbu Carlo
Published: July 2015

The aim of the study was to demonstrate the expression of Toll-like receptor (TLR)-8 and to confirm the expression of TLR-7 on bladder transitional cell carcinomas (TCCs) analyzing the changes in expression between low-grade (LG) and high-grade (HG) and between non-muscle invasive (NMIBC) and muscle-invasive (MIBC) bladder cancers. In our study, 25 patients who underwent transurethral resection (TURB) for bladder TCC have been selected. Thirteen of those had an LG form, while the other cases were classified as HG; the lesions were NMIBC in 18 patients and MIBC in the others seven. The analysis of TLRs expression has been performed by immuno histochemistry.

TRL-8 expression seems to be higher in MIBC (85%) than in NMIBC (78%), but it is associated with a reduced percentage of immuno reactive cells and with a lower intensity. The expression had a large nuclear localization in NMIBC (80%), althoughit was mainly cytoplasmic in MIBC (72%).

TLR-7 was expressed in all NMIBC samples (where the localization was mainly nucleo-cytoplasmic) and in the 71% of MIBC samples (mainly in the nucleus). A higher expression of TRL-8 in HG TCC had been observed, while TRL-7 seems to be more expressed in LG forms.

Our study allowed to document the immunohistochemical expression of TLR-8 in TCCs, confirm the immunohistochemical expression of TLR-7, and suggest an increased expression of TLR-7 in LG TCC and NMIBC, and a prevalent expression of TLR-8 in HG TCC and MIBC.
Pulmonary Hypertension in the Course of Diffuse Parenchymal Lung Diseases—State of Art and Future Considerations
Authors: Szturmowicz Monika , Kacprzak Aneta , Błasińska-Przerwa Katarzyna , Kuś Jan
Published: July 2015

Lung diseases are one of the most frequent causes of pulmonary hypertension (PH). The development of PH influences the course of lung disease, worsening the clinical symptoms and prognosis. According to the most recent publications, PH in the course of lung diseases develops as a result of both “parenchymal” and vascular pathology, in the patients with genetic predisposition. Prolonged infection (especially viral one) may be an additional promoting factor. Right heart catheterization (RHC), which is an invasive procedure, is the only objective method of diagnosing PH. According to the latest recommendations, the management algorithm of PH and coexisting interstitial lung disease is based on RHC and the results of pulmonary function tests. Majority of the patients develop mild PH in the course of advanced lung disease. Best treatment of underlying lung pathology combined with long term oxygen treatment is recommended in this group. In case of severe PH (mean resting pulmonary artery pressure (mPAP) ≥ 35 mm Hg) the alternate cause of PH has to be sought. PAH-specific drugs use should be limited to patients with severe PH participating in clinical trials. In this review, the value of various non-invasive methods (echocardiography, radiological examination, exercise capacity and brain natriuretic peptides assessment) in the process of screening for PH is presented, and the results of recent randomized clinical trials with PAH-specific drugs in patients with diffuse parenchymal lung diseases are discussed.