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Therapeutic effects and prognostic factors of 125I brachytherapy for pelvic recurrence after early cervical cancer surgery.
Wang, R, Zhu, J, Yang, S, Chen, X, Gu, C, Liang, T, Li, L, Liu, D, Cao, Y
Scientific reports. 2021;(1):11356
Abstract
To investigate the efficacy of 125I seed implantation in the treatment regimen of pelvic recurrence after early cervical cancer surgery and to analyse prognostic factors. To evaluate efficacy and analyse prognostic factors of 125I seed implantation for pelvic recurrence after early cervical cancer surgery. A prospective study was conducted on 62 patients who experienced pelvic recurrence after early cervical cancer surgery between August 2005 and September 2015. The 62 patients were treated and assessed in 2 groups (n = 30). All 62 patients were randomized into two groups that received two different treatment regimens: the treatment group (n = 30), which received 125I particle implantation therapy, and the control group (n = 32), which received whole-pelvic irradiation using the anteroposterior/posteroanterior field and cisplatin-based concurrent chemoradiation therapy. The efficacy/efficiency of 125I seed implantation and prognostic factors were analysed by logistic regression. Overall survival was determined by Kaplan-Meier analysis. Multivariate analysis results were obtained by the Cox proportional hazards regression model. The effective control rates at 1, 3, 6 and 12 months were 76.7%, 80.0%, 83.3%, and 86.7% in the 125I particle implantation group. The total effective control rates at 1, 3, 6 and 12 months were 65.6%, 65.5%, 62.5%, and 71.9% in the chemoradiotherapy group. Significant differences were observed between the two groups. The overall survival rates at 1, 2, 3, 4, and 5 years and the median overall were 96.7%, 93.3%, 86.7%, 71.9%, 65.6% and 4.34 years, respectively, in the 125I seed implantation group and 81.3%, 71.9%, 62.5%, 56.3%, 53.1% and 3.59 years, respectively, in the control group. There were statistically significant differences in survival rates depending on the diameter of the largest recurrent pelvic tumour (χ2 = 6.611, P = 0.010). The multivariate analysis showed that the survival rates were related to the diameter of the largest recurrent pelvic tumour (χ2 = 4.538, P = 0.033). 125I implantation is an effective, safe, and promising method for the treatment of pelvic recurrence after early cervical cancer surgery. The diameter of the recurrent pelvic tumour was identified as a significant independent prognostic factor in patients who received 125I implantation.
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Pharmacokinetics of Ferumoxytol in the Abdomen and Pelvis: A Dosing Study with 1.5- and 3.0-T MRI Relaxometry.
Wells, SA, Schubert, T, Motosugi, U, Sharma, SD, Campo, CA, Kinner, S, Woo, KM, Hernando, D, Reeder, SB
Radiology. 2020;(1):108-116
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Abstract
Background The off-label use of ferumoxytol (FE), an intravenous iron preparation for iron deficiency anemia, as a contrast agent for MRI is increasing; therefore, it is critical to understand its pharmacokinetics. Purpose To evaluate the pharmacokinetics of FE in the abdomen and pelvis, as assessed with quantitative 1.5- and 3.0-T MRI relaxometry. Materials and Methods R2*, an MRI technique used to estimate tissue iron content in the abdomen and pelvis, was performed at 1.5 and 3.0 T in 12 healthy volunteers between April 2015 and January 2016. Volunteers were randomly assigned to receive an FE dose of 2 mg per kilogram of body weight (FE2mg) or 4 mg/kg (FE4mg). MRI was repeated at 1.5 and 3.0 T for each volunteer at five time points: days 1, 2, 4, 7, and 30. A radiologist experienced in MRI relaxometry measured R2* in organs of the mononuclear phagocyte system (MPS) (ie, liver, spleen, and bone marrow), non-MPS anatomy (kidney, pancreas, and muscle), inguinal lymph nodes (LNs), and blood pool. A paired Student t test was used to compare changes in tissue R2*. Results Volunteers (six female; mean age, 44.3 years ± 12.2 [standard deviation]) received either FE2 mg (n = 5) or FE4 mg (n = 6). Overall R2* trend analysis was temporally significant (P < .001). Time to peak R2* in the MPS occurred on day 1 for FE2mg and between days 1 and 4 for FE4mg (P < .001 to P < .002). Time to peak R2* in non-MPS anatomy, LNs, and blood pool occurred on day 1 for both doses (P < .001 to P < .09). Except for the spleen (at 1.5 T) and liver, MPS R2* remained elevated through day 30 for both doses (P = .02 to P = .03). Except for the kidney and pancreas, non-MPS, LN, and blood pool R2* returned to baseline levels between days 2 and 4 at FE2mg (P = .06 to P = .49) and between days 4 and 7 at FE4mg (P = .06 to P = .63). There was no difference in R2* change between non-MPS and LN R2* at any time (range, 1-71 sec-1 vs 0-50 sec-1; P = .06 to P = .97). Conclusion The pharmacokinetics of ferumoxytol in lymph nodes are distinct from those in mononuclear phagocyte system (MPS) organs, parallel non-MPS anatomy, and the blood pool. © RSNA, 2019 Online supplemental material is available for this article.
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Diagnostic Approach to Benign and Malignant Calcifications in the Abdomen and Pelvis.
Zulfiqar, M, Shetty, A, Tsai, R, Gagnon, MH, Balfe, DM, Mellnick, VM
Radiographics : a review publication of the Radiological Society of North America, Inc. 2020;(3):731-753
Abstract
Intra-abdominal calcifications are common. Multiple pathologic processes manifest within the abdomen and pelvis in association with calcifications, which can be benign, premalignant, or malignant. Although calcium deposition in the abdomen can occur secondary to various mechanisms, the most common cau se is cellular injury that leads to dystrophic calcifications. The authors provide a summary of various common and uncommon calcifications in the abdomen and pelvis, primarily using location to illuminate diagnostic significance. Six broad categories of calcifications in the abdomen and pelvis are recognized: mesenteric, peritoneal, retroperitoneal, organ-based, vascular, and musculoskeletal. In addition to site, the various patterns and morphology of calcifications encountered in various conditions can be helpful for diagnosis, especially those depicted on radiographs. For example, some patterns diagnostic for various conditions include round or oval stones in the biliary or urothelial tracts, curvilinear calcifications associated with cysts or neoplasms, and sheetlike calcifications along peritoneal surfaces in the setting of chronic peritoneal dialysis or metastatic disease. Organ encrustation with calcium may be a premalignant finding (eg, porcelain gallbladder). In addition, the development of calcium after initiation of treatment can be used as an indicator of response in conditions such as tuberculosis, lymphoma, and hydatid disease. As calcifications are almost invariably detected at imaging, it is imperative for radiologists to be aware of their diagnostic implications and use the presence of calcification in an organ, mass, or other anatomic location for problem solving. ©RSNA, 2020.
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[Nutritional factors associated with complications in major abdominopelvic surgery].
Verdú-Fernández, MÁ, Soria Aledo, V, Campillo-Soto, Á, Pérez-Guarinos, CV, Carrillo-Alcaraz, A, Aguayo-Albasini, JL
Nutricion hospitalaria. 2018;(4):942-947
Abstract
INTRODUCTION major abdomino-pelvic surgery includes a series of procedures that carry a high percentage of postoperative complications. Our objective is to identify the factors related to post-surgical complications, classified according to Clavien-Dindo classification, with special attention to nutritional factors in patients who undergo major abdomino-pelvic surgery. MATERIAL AND METHOD retrospective observational study between July 2012 and December 2013. A total of 255 patients undergoing major abdomino-pelvic surgery (colorectal, gastric, obesity or total cystectomy) were selected on a scheduled basis. Four types of variables were collected: sociodemographic, baseline, diagnostic and outcome variables, including perioperative complications that were classified in 5 grades according to the Clavien-Dindo scale, and for the analysis of results, two groups of patients were separated: The group with complications grade 0 and I and group 2 with complications III to V. The statistical analysis was performed using IBM SPSS version 22.0. RESULTS patients had a mean age of 65 years. Twenty patients (7.8%) returned in the first 30 days after surgery and 8 patients (3.1%) died. 152 cases (59.6%) were classified in group 1 and 103 cases (40.4%) in group 2. When analyzing both groups, we found significant differences in the operative variables: type of surgery and laparoscopic or open approach. Regarding the physiological and nutritional parameters, we observed significant differences in the following factors: preoperative BMI, preoperative albumin, preoperative hemoglobin and day of onset of postoperative tolerance. CONCLUSION in our study we have identified modifiable factors, such as hemoglobin and preoperative albumin, BMI and early onset of oral tolerance, related to postoperative morbidity. Preoperative nutritional status is related to postoperative complications in major abdomino-pelvic surgery.
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Nutrition for cystectomy with pelvic lymph nodes dissection: perioperative considerations.
Mir, MC, Izquierdo, L
Minerva urologica e nefrologica = The Italian journal of urology and nephrology. 2016;(2):150-60
Abstract
Assessment of nutritional status by an objective measure such as NRS-2002 or sarcopenia in the preoperative workup of major abdominal surgeries helps identify patients at risk for increased surgical morbidity and mortality. Preoperative and immediate postoperative nutritional supplements have demonstrated to decrease risk of complications and length of stay. Enhancing the immune system with immunonutrition has also been suggested as major player in this setting. In this review on nutritional considerations in the perioperative setting of radical cystectomy, we will describe several tools available to improve the complications rates and mortality surrounding this procedure.
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Nutrition in pelvic radiation disease and inflammatory bowel disease: similarities and differences.
DeWitt, T, Hegazi, R
BioMed research international. 2014;:716579
Abstract
Due to the intestinal inflammation, tissue damage, and painful abdominal symptoms restricting dietary intake associated with both diseases, patients with intestinal pelvic radiation disease (PRD) or inflammatory bowel disease (IBD) are at increased risk to develop protein calorie malnutrition and micronutrient deficiencies. In the current paper, we review the nutritional management of both diseases, listing the similar approaches of nutritional management and the nutritional implications of intestinal dysfunction of both diseases. Malnutrition is prevalent in patients with either disease and nutritional risk screening and assessment of nutritional status are required for designing the proper nutritional intervention plan. This plan may include dietary management, oral nutritional supplementation, and enteral and/or parenteral nutrition. In addition to managing malnutrition, nutrients exert immune modulating effects during periods of intestinal inflammation and can play a role in mitigating the risks associated with the disease activity. Consistently, exclusive enteral feeding is recommended for inducing remission in pediatric patients with active Crohn's disease, with less clear guidelines on use in patients with ulcerative colitis. The field of immune modulating nutrition is an evolving science that takes into consideration the specific mechanism of action of nutrients, nutrient-nutrient interaction, and preexisting nutritional status of the patients.
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Thromboprophylaxis in patients with pelvic and acetabular fractures: A short review and recommendations.
El-Daly, I, Reidy, J, Culpan, P, Bates, P
Injury. 2013;(12):1710-20
Abstract
The management of thromboprophylaxis in patients with pelvic and acetabular fractures remains a highly controversial topic within the trauma community. Despite anticoagulation, venous thromboembolism (VTE) remains the most common cause of surgical morbidity and mortality in this high-risk patient group. Although various thromboprophylactic regimes are employed, evidence relating to the most effective method remains unclear. Controversies surrounding screening, the use of prophylactic inferior vena cava filters (IVCF) and chemothromboprophylaxis in polytraumatised patients, particularly those with pelvic and acetabular fractures, form the basis of considerable debate. With the absence of a well-designed clinical trial and the presence of ongoing controversies within the literature, this review will explore current treatment options available to trauma surgeons and highlight differing scientific opinions, providing an update on the role of screening and current available preventative measures. We cover existing as well as recent advances in chemical thromboprophylactic agents and discuss external mechanical compression devices, the usefulness of serial duplex ultrasonography and the role of extended chemothromboprophylaxis on discharge. The evidence behind prophylactic IVCF is also considered, along with reported complication profiles. We conclude with a proposed protocol for use in major trauma centres, which can form the basis of local policy for the prevention of VTE in trauma patients with pelvic and acetabular fractures.
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Nongynecologic findings on pelvic ultrasound: focus on gastrointestinal diseases.
Baltarowich, OH, Scoutt, LM, Hamper, UM
Ultrasound quarterly. 2012;(2):65-85
Abstract
Ultrasound (US) is considered the first-line imaging modality of choice in women presenting with pelvic complaints. Although imaging is focused on detecting abnormalities of the uterus and adnexa, occasionally nongynecologic findings are detected, which may or may not explain the patient's symptoms. Many of these findings are related to the gastrointestinal (GI) tract. Although most of these GI abnormalities are better diagnosed with computed tomography (CT), symptoms are often nonspecific and US may be the first imaging modality requested by referring clinicians. Sonographers should be aware of the possibility of nongynecologic diseases in patients with pelvic symptoms, particularly if US evaluation of the female reproductive tract does not provide an answer to the clinical question. Careful attention to the bowel when performing a pelvic US may allow the sonographer to diagnose GI pelvic diseases such as appendicitis, diverticulitis, colitis, bowel obstruction, mesenteric adenitis, epiploic appendagitis, Crohn disease, and even GI malignancy. As concerns grow regarding the radiation dose of pelvic CT, the use of iodinated contrast material, and imaging costs, US examination may be increasingly requested as an initial imaging study in patients in whom GI diseases is primarily suspected in the pelvis, and familiarity with the various sonographic manifestations will aid considerably in establishing the correct diagnosis.
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Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations.
Nygren, J, Thacker, J, Carli, F, Fearon, KC, Norderval, S, Lobo, DN, Ljungqvist, O, Soop, M, Ramirez, J, ,
Clinical nutrition (Edinburgh, Scotland). 2012;(6):801-16
Abstract
BACKGROUND This review aims to present a consensus for optimal perioperative care in rectal/pelvic surgery, and to provide graded recommendations for items for an evidenced-based enhanced recovery protocol. METHODS Studies were selected with particular attention paid to meta-analyses, randomized controlled trials and large prospective cohorts. For each item of the perioperative treatment pathway, available English-language literature was examined, reviewed and graded. A consensus recommendation was reached after critical appraisal of the literature by the group. RESULTS For most of the protocol items, recommendations are based on good-quality trials or meta-analyses of good-quality trials (evidence grade: high or moderate). CONCLUSIONS Based on the evidence available for each item of the multimodal perioperative care pathway, the Enhanced Recovery After Surgery (ERAS) Society, European Society for Clinical Nutrition and Metabolism (ESPEN) and International Association for Surgical Metabolism and Nutrition (IASMEN) present a comprehensive evidence-based consensus review of perioperative care for rectal surgery.
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Biomarkers of normal tissue toxicity after pelvic radiotherapy.
Henson, CC, Ang, YS
Current opinion in supportive and palliative care. 2012;(1):33-40
Abstract
PURPOSE OF REVIEW To review the evidence for candidate biomarkers of gastrointestinal toxicity following pelvic radiotherapy to highlight recent findings of potential interest to those involved in the treatment of pelvic malignancies or the management of gastrointestinal consequences of cancer treatments. RECENT FINDINGS Multiple serum and faecal biomarkers have been studied for use in the detection of gastrointestinal toxicity following pelvic radiotherapy. There is no single biomarker that has been shown to be useful and studies have been hampered by the lack of a 'gold standard' test to confirm the presence of toxicity. Given the complex effects of pelvic radiotherapy on the gastrointestinal tract, it is likely that a panel of biomarkers would be necessary in clinical practice. SUMMARY Biomarkers for gastrointestinal toxicity have a potential role in determining the outcomes of current and evolving radiotherapy techniques, identifying those patients at risk of greater degrees of toxicity to facilitate individualized treatment and determining whether symptoms that develop following treatment are related to the previous radiotherapy. Outcome measurement of pelvic radiotherapy has been plagued by inaccurate terminology and crude outcome measures. An accurate and acceptable biomarker or panel of biomarkers has the potential to revolutionize cancer management from treatment planning to posttreatment care. Several candidate biomarkers show promising results, but further robust research is required to clearly identify reliable biomarkers that can be translated into clinical practice.