e16134 Background: Although surgical excision remains the gold standard treatment for renal cell carcinoma ( RCC ), active surveillance and thermal ablation provide alternative options for patients at higher surgical risk.The purpose of our study is to investigate the effectiveness of image guided thermal ablation for pathologically proven T1a RCC in patients with other non-renal primary malignancies. Methods: We performed a retrospective review of our renal tumor ablation registry for the period of January 2005 to December 2013. We included patients with T1a renal tumors (< 4 cm). We excluded patients without histologically proven RCC, those with Von Hippel Lindau syndrome, and those with prior history of RCC. Two groups were created; (A) patients with RCC and history of other non-renal primary malignancy (in remission or active), (B) Patients with RCC only. Statistical analysis was performed to compare the two groups using Fisher’s exact and Kruskal-Wallis test for demographics (age, sex) and clinical characteristics (prior or current cancer history, renal tumor Size, and complications). Overall survival (OS) was estimated using the Kaplan-Meier product-limit estimator and we conducted a log-rank test to compare the two groups. OS was measured from the procedure date to the date of last contact or death. Results: Seventy four patients were included in the study, 37 patients (50%) has other non-renal primary. The average age at procedure was 68.8 years. There was no difference in age (68.6 vs. 68.9; p = 0.842), sex (15 women and 22 men vs. 13 men and 24 women; p = 0.811), or tumor size (2.3 vs. 2.5; p = 0.107).Complication rates did not differ between the groups (2.9 vs. 5.9; p = 0.614). Median survival time for the entire population was 8.39 years. The probability of 5-yr (10-yr) survival was 0.74 (0.48). There was no difference in survival between the two groups (p = 0.384). Conclusions: Minimally invasive therapy with image guided thermal ablation provides safe and effective treatment for T1a RCC in patients with other non-renal malignancies. In our study, Primary malignancies or their therapy did not have discernible impact on the thermal ablation effectiveness, complications, or overall survival rates.
OBJECTIVE. The purpose of this article is to project the effects of radiation exposure on life expectancy (LE) in patients who opt for CT-guided radiofrequency ablation (RFA) instead of surgery for renal cell carcinoma (RCC). MATERIALS AND METHODS. We developed a decision-analytic Markov model to compare LE losses attributable to radiation exposure in hypothetical 65-year-old patients who undergo CT-guided RFA versus surgery for small (≤ 4 cm) RCC. We incorporated mortality risks from RCC, radiation-induced cancers (for procedural and follow-up CT scans), and all other causes; institutional data informed the RFA procedural effective dose. Radiation-induced cancer risks were generated using an organ-specific approach. Effects of varying model parameters and of dose-reduction strategies were evaluated in sensitivity analysis. RESULTS. Cumulative RFA exposures (up to 305.2 mSv for one session plus surveillance) exceeded those from surgery (up to 87.2 mSv). In 65-year-old men, excess LE loss from radiation-induced cancers, comparing RFA to surgery, was 11.7 days (14.6 days for RFA vs 2.9 days for surgery). Results varied with sex and age; this difference increased to 14.6 days in 65-year-old women and to 21.5 days in 55-year-old men. Dose-reduction strategies that addressed follow-up rather than procedural exposure had a greater impact. In 65-year-old men, this difference decreased to 3.8 days if post-RFA follow-up scans were restricted to a single phase; even elimination of RFA procedural exposure could not achieve equivalent benefits. CONCLUSION. CT-guided RFA remains a safe alternative to surgery, but with decreasing age, the higher burden of radiation exposure merits explicit consideration. Dose-reduction strategies that target follow-up rather than procedural exposure will have a greater impact.
To determine the response to i.v. anti-D and its comparison with splenectomy as second line therapy in refractory and relapsed cases of ITP, in the Aga Khan University Hospital, Karachi.A total of 23 patients with chronic ITP were treated with either anti-D or splenectomy as second line treatment. The patients were assessed for time to achieve a response to second line treatment, duration of response and adverse events.There were 12 patients in the anti-D group and 11 in the splenectomy group. The mean platelet count at presentation was 9,000/cumm. The mean age was 8.9 years and 13.0 years and the male to female ratio was 1:1 and 1:1.2 in anti-D and splenectomy group respectively. 54.5% of the patient in the anti-D group responded compared to 81.8% in the splenectomy group. Median time to achieve a response was 7 days in the anti-D group and 1 day in the splenectomy group. Mean time to relapse was 87.8 days in the anti-D group and 55.4 days in the splenectomy group. No adverse events were recorded for any of the infusions of anti-D and none of the patients had more than 0.5 gm/dl fall in the hemoglobin level following anti-D infusion.It was thus concluded that Anti-D is a relatively safe, convenient and effective therapy for chronic ITP and can be used as a splenectomy sparing agent when treatment is clinically indicated.
Diffusion tensor imaging (DTI) was performed in 39 right-handed children to examine structural hemispheric differences and the impact of age, socioeconomic status, and sex on these differences. Apparent diffusion coefficient (ADC) values were smaller in the left than in the right temporal, prefrontal, anterior internal capsular and the thalamic regions, and fractional anisotropy (FA) values were larger in the left than in the right internal capsule, thalamus, and cingulate. Significant region-by-sex interactions disclosed that the relation of DTI asymmetries to performance depended on sex including the relation of temporal lobes to reading comprehension and the relation of frontal lobes to solving applied mathematical problems.
