Concomitant Radiotherapy with Protracted 5-fluorouracil Infusion in Locally Advanced Carcinoma of the Pancreas: A Phase Ii Study
Mattia Falchetto OstiA CostaFederico BianciardiMarco De NicolòVittorio DonatoGianfranço SilecchiaRiccardo Maurizi Enrici
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Aims and Background To evaluate the efficacy of combined radiation therapy and continuous infusion of 5-fluorouracil in patients with locally advanced carcinoma of the pancreas. Methods Between January 1992 and June 1999, 31 patients with locally advanced adenocarcinoma of the pancreas were treated in our Institute. In 20 patients, the tumor (65%) was located in the head of the pancreas and in 11 (35%) in the body or tail; 13 cases also showed involved nodes. Radiation therapy consisted in a median dose of 63 Gy in 33-36 fractions applied to the tumor and regional lymph nodes. Chemotherapy with 5-fluorouracil in continuous infusion, 250 mg/m 2 daily, was administered in the first and fifth week of the radiation therapy. Thereafter, 22 patients received 3-10 cycles of adjuvant chemotherapy with same doses. Median follow-up of the series was 20 months. The toxicity of the treatment was scored according to WHO criteria. All patients underwent nutritional assessment at the time of radiochemotherapy. Results The median overall survival was 15.2 months (range, 4-42). At restaging, 17 cases (55%) showed no change and 14 (45%) a partial remission. At the end of radiochemotherapy in 8 (26%) of the cases there was indication for pancreatectomy, which was executed in 4 patients. At the time of the study, 2 patients (6.4%) were surgically proven disease free. Eleven of the 13 cases (85%) presenting involved nodes showed that the enlarged lymph nodes had disappeared. Nineteen patients (61%) are alive with clinical evidence of disease and 2 cases are alive with liver metastases; 8 patients (26%) died for disease. In 74% of cases there was complete pain control. Tolerance to the regimen was good. Nutritional assistance was evaluated and was found to be correlated to survival. Conclusions The results of the series confirm a good tolerance with low acute toxicity. Tumor down-staging and resectability rates were high, together with prolonged survival and a good quality of life.Keywords:
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Objective To evaluate the efficacy of the perioperative management of concomitant cerebrovascular and/ar cardiovascular diseases in elderly patients with endometrial carcinoma.Methods The materials of 60 patients with endometrial carcinoma between 1980 and 2000 were retrospectively analyzed.The patients were divided into two groups according to the dividing point of concomitant cerebrovascular and/or cardiovascular diseases.Thirty six of them were identified to have concomitant cerebrovascular cerebr and/or cardiovascular diseases and the other 24 cases had no complicated diseases.Results Mean length of hospital stay of two groups was 29 days and 19 days,respectively(P 0.05 ),and intra operative and postoperative complications occurred in 14 cases and 6cases,respectively,(P0.05).Three and five year survival rates showed no significant difference.Conclusions The elderly patients with endometrial carcinoma and concomitant cerebrovascular and/or cardiovascular diseases can tolerate complicated gynecologic surgery in condition of controlling the perioperative concomitant diseases.
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Conventional resection of the body and tail of the pancreas usually involves splenectomy. There are evidence that spleen removal can lead to septic and hematological complications and should, therefore, be avoided when possible. Distal pancreatectomy with spleen conservation has been described by specialized centers with good results. This report describes our experience in 8 cases with conservation of the spleen during the resection of the body and tail of the pancreas. The technique has been applied in patients with pancreatic neuroendocrine tumors (n = 4), cystic tumors (n = 3) and cystic-papillary tumor (n = 1) with no complications and good late results in all cases.
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Nephrology
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ve To provide hand surgery with the regularity of concomitant relationship between the arteries and veins of the hand. Method Concomitant relationship between the arteries and veins of the hand were observed in 10 sides decicolor cast specimens and stuffing specimens perfused with hyperchlororinylacetic ether or emulsoid respectively. Results Compactly concomitant relationship was observed in the superficialand the deep arcus vasculosi, the palmal metacarpal vessels and the common palmal digital vessels. In the palm and the opisthenar, the superficial vessels were not concomitant or not compactly concomitant, so were the vessels of the maniphalanx. Conclusions The distribution regularity between the arteries and veins of the hand are showed as follows: Like a network, vessels are not concomitant in the superficial laminae of the hand. However, deeper to the partes profunda of the hand, more compactly concomitant relationship between the arteries and veins. The vessels of the maniphalanx are not concomitant or not compactly concomitant
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For a period of six years, concomitant disorders were registered at annual routine examinations of 226 residents of a central institution for mentally retarded. Only in six patients were no concomitant disorders found. 19.5% displayed concomitant disorders from one type of disease, 30.5% displayed two or more concomitant disorders from two types of disease, and as many as 47.3% displayed concomitant disorders from three or more types of disease. The residents examined showed particularly high occurrences of various deformities, mental disorders, and diseases of the nervous system, sense organs and musculo-skeletal system. The most frequent singular disorders were epilepsy, cerebral palsy and deformities of the back and foot.
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To describe the clinical characteristics in classical trigeminal neuralgia (TN) with concomitant persistent pain and to investigate whether TN with concomitant persistent pain represents a distinct phenotype.There has been much debate about the possible pathophysiological and clinical importance of concomitant persistent pain in TN. This has led to subgrouping of TN into forms with and without concomitant persistent pain in the recent 3rd International Classification of Headache Disorders beta classification.In this cross-sectional study, data on the clinical characteristics were systematically and prospectively collected from consecutive TN patients.A total of 158 consecutive TN patients were included. Concomitant persistent pain was present in 78 patients (49%). The average intensity of concomitant persistent pain was 4.6 (verbal numerical rating scale). The concomitant persistent pain was present at onset or early in the disease course. Patients with concomitant persistent pain were on average 6.2 (P = .008) years younger at onset, but the 2 groups had the same duration of disease (P = .174). There was a preponderance of women in TN with (P < .001) but not in TN without concomitant persistent pain (P = .820). Right-sided pain was more prevalent than left-sided in TN without (P = .007) but not in TN with concomitant persistent pain (P = .907). TN with concomitant persistent pain more frequently had sensory abnormalities (P < .001) and less frequently responded to sodium channel blockers (P = .001). There were no significant differences in other clinical characteristics.Concomitant persistent pain is very prevalent in TN and is not a consequence of paroxysmal pain. Findings support that the 3rd International Classification of Headache Disorders beta division of TN with and without concomitant persistent pain is clinically and scientifically important.
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Cystic neoplasms comprise 1-10% of all pancreatic neoplasms. Most authors recommend resection due to the difficulties in differentiating benign from malignant tumors prior to operation. We performed an analysis on the radical surgical handling of patients with cystic neoplasms of the pancreas.We analyzed data of all patients with pancreatic neoplasms who were treated by potentially curative surgical treatment by a single surgeon (A.D.C.). Postoperative survival and complications were recorded.Between August 1983 and November 2003, the aforementioned surgeon performed 77 pancreatic resections for pancreatic tumors. Nine of those operations were performed for cystic neoplasms of the pancreas. All patients submitted to partial pancreatic resections were discharged in good health. The patient that underwent a total pancreatectomy died nine days after the procedure. At a mean follow up of 44 months, there has been one local recurrence with death.Cystic tumors of the pancreas accounted for 11.7 % of the neoplasms studied in our series. Resection of those neoplasms attained by distal pancreatectomy is a safe procedure. PD is a risky procedure and should be viewed cautiously. Total pancreatectomy remains as a high-risk procedure and should be avoided.
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Cystic neoplasms of the pancreas are an uncommon entity comprising fewer than 1 per cent of all pancreatic neoplasms. The guidelines for management of these tumors, specifically, the extent of resection, are unclear. Formerly, a distal pancreatectomy including the spleen was performed for tumors in the tail of the pancreas. The importance of preserving the spleen has been well documented; however, there are few reports of spleen-preserving pancreatectomy for cystic neoplasms of the distal pancreas. We report two patients who underwent spleen-preserving pancreatectomy for mucinous cystic neoplasms in the tail of the pancreas. Both patients were female, ages 39 and 65 years. Preoperative preparation included administration of vaccinations and subcutaneous somatostatin. Operative technique emphasized division of the splenic artery and vein beyond the tip of the distal pancreas without mobilization of the spleen. The pancreas was transected with a vascular stapler. Fibrin glue was applied to the margin of the pancreas. The operative blood loss, duration of operation, and postoperative hospital stay were 150 and 250 mL, 150 and 180 minutes, and 7 and 9 days, respectively. The pathology revealed both lesions to be mucinous cystic neoplasms. The patients recovered and at 6-month follow-up were without complaints and in good health. Spleen-preserving pancreatectomy is rapid and associated with minimal morbidity. This procedure should be considered in the surgical management of cystic neoplasms in the tail of the pancreas.
Splenic vein
Distal pancreatectomy
Nesidioblastosis
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In dealing with a lethal disease such as cancer of the pancreas, an all out attack is necessary for an early lesion. The general trend seems to be toward radical en bloc resections, usually, but not always, with a total pancreatectomy. A digestive supplement with a higher proportion of lipase provides better nutrition. Diabetes can be controlled in patients with no pancreas. Reports of long-term survivors should be better documented as to details of previous reporting, care, procedure and pathology.
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