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BACKGROUND: Palliative care (PC) is integrated into standard oncology care. However, its clinical impact at the end of life remains unclear in pancreatic adenocarcinoma (PA). We aimed to describe the end-of-life care pathway and to assess whether PC referral influences survival after chemotherapy discontinuation (CD) among advanced PA patients. METHODS: This retrospective single-centre observational study was conducted among deceased patients with advanced PA who had received chemotherapy between January 1, 2016, and December 31, 2021. Baseline characteristics, the timing of PC referral and events after CD were collected. The primary outcome was time from CD to death. RESULTS: Among the 148 included patients, 53.4% (n = 79) received PC, mostly late after the CD (n = 133, 89.9%), 16.9% (n = 25) received chemotherapy in the last 14 days of life and 75.6% died at the hospital. None received PC in the 8 weeks following the diagnosis. PC referral significantly increased PC department admissions (p < 0.001) and decreased medical unit admissions (p < 0.001). The median survival after the CD was 35 days (IQR: 19-64.5). PC referral was associated with increased survival after CD (HR: 0.65 [0.47-0.90], p = 0.010, Cox) and after adjusting (HR: 0.65 [0.42-0.99], p = 0.045, Cox). CONCLUSION: The study suggests that PC may be associated with longer survival after CD in advanced PA patients. However, PC is underused, and patients are referred late in their care pathway.
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Adenocarcinoma , Neoplasias , Neoplasias Pancreáticas , Humanos , Cuidados Paliativos , Neoplasias Pancreáticas/tratamiento farmacológico , Estudios Retrospectivos , Adenocarcinoma/tratamiento farmacológico , Neoplasias PancreáticasRESUMEN
BACKGROUND: The reperfused human cadaver is a validated simulator for surgery. We aimed to use it as a colonoscopy simulator. METHODS: Novices, intermediates and skilled participants in gastrointestinal endoscopy were included. They performed one colonoscopy on a reperfused human cadaver and reaching rates, time, and length needed to reach anatomical landmarks were reported for construct validity analysis. We also assessed our model realism (SRS survey), educational content (CVS survey) and task load (NASA-TLX index). Score items were collected and defined as "favorable" when items were rated ≥ 5/7 with an inter-quartile range (IQR) overlapping four, and "very favorable" when rated ≥ 5/7 with an IQR excluding four (neutral). Primary endpoints were the rectosigmoid junction (RSJ) reaching rate and the descending colon (DC) reaching time. Secondary objectives were SRS, CVS and NASA-TLX questionnaire results. RESULTS: A total of 11 skilled participants, 5 intermediates and 8 novices were included. Skilled participants reached RSJ more often than novice and intermediary groups, respectively, 100%, 80% and 75% without differing significantly. They reached DC more frequently (100% for skilled, 80% for intermediates and 50% for novices, p = 0.018). The median time to reach RSJ (59, 272 and 686 s for skilled, intermediates and novices group, respectively) and DC (90, 534 and 1360 s for skilled, intermediates and novices) was significantly shorter for skilled participants (both p < .01). Nineteen out of the 22 items composing the realism survey obtained "very favorable" and "favorable" scores. Educational content was designated as "very favorable". Mental, physical, and technical demands were gradually higher the lower the initial level of experience. CONCLUSIONS: Reperfused human cadaver model has the potential to be valid simulation tool for diagnostic colonoscopy training.
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Colonoscopía , Entrenamiento Simulado , Humanos , Proyectos Piloto , Escolaridad , Cadáver , Simulación por Computador , Competencia ClínicaRESUMEN
BACKGROUND: Previous studies have observed an increased incidence of Cetuximab-induced hypersensitivity infusion reactions (CI-IRs) in the southeastern states of the USA. Tick's bites were suspected of generating cross-reactions between cetuximab and alpha-gal. This study aims was to describe the incidence and associated risk factors of CI-IRs, in the French areas chosen according to their Lyme disease incidence. PATIENTS AND METHODS: A retrospective chart review was conducted on patients that received cetuximab infusion from January 2010 to June 2019 in 4 French areas with different Lyme disease incidence rates. RESULTS: Of 1392 patients, 117 (8.4%) experienced a CI-IR, including 68 severe (grade 3 or 4) reactions (4.9%). This CI-IR incidence was significantly higher in the Lyme disease high-risk area than in the other areas (13.2% versus 7.1%, 8.1% and 6.4%; P = 0.016). Sex (P = 0.53), premedication (P = 0.91), primary cancer location (P = 0.46) and chemotherapy regimen type (P = 0.78) had no impact on CI-IR incidence in the overall population. In the head and neck squamous cell carcinoma (HNSCC) patient subgroup, CI-IRs were significantly more frequent in the high-risk area (16.4% versus 6.7%, 7.1% and 7.0%; P = 0.0015). CONCLUSION: This study suggests that patients treated in the French area with the highest incidence of Lyme disease are at a higher risk of CI-IRs.
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Hipersensibilidad a las Drogas , Neoplasias de Cabeza y Cuello , Enfermedad de Lyme , Humanos , Cetuximab/efectos adversos , Incidencia , Estudios Retrospectivos , Hipersensibilidad a las Drogas/epidemiología , Hipersensibilidad a las Drogas/etiología , Infusiones Intravenosas , Neoplasias de Cabeza y Cuello/complicaciones , Enfermedad de Lyme/tratamiento farmacológico , Enfermedad de Lyme/epidemiología , Enfermedad de Lyme/complicacionesRESUMEN
BACKGROUND: This study evaluated the impact of time to surgery (TTS) on overall survival (OS), disease free survival (DFS) and postoperative complication rate in patients with upfront resected pancreatic adenocarcinoma (PA). METHODS: We retrospectively included patients who underwent upfront surgery for PA between January 1, 2004 and December 31, 2014 from four French centers. TTS was defined as the number of days between the date of the first consultation in specialist care and the date of surgery. DFS for a 14-day TTS was the primary endpoint. We also analyzed survival depending on different delay cut-offs (7, 14, 28, 60 and 75 days). RESULTS: A total of 168 patients were included. 59 patients (35%) underwent an upfront surgery within 14 days. Patients in the higher delay group (> 14 days) had significantly more vein resections and endoscopic biliary drainage. Adjusted OS (p = 0.44), DFS (p = 0.99), fistulas (p = 0.41), hemorrhage (p = 0.59) and severe post-operative complications (p = 0.82) were not different according to TTS (> 14 days). Other delay cut-offs had no impact on OS or DFS. DISCUSSION: TTS seems to have no impact on OS, DFS and 90-day postoperative morbidity.
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Adenocarcinoma , Neoplasias Pancreáticas , Adenocarcinoma/cirugía , Supervivencia sin Enfermedad , Drenaje , Humanos , Neoplasias Pancreáticas/cirugía , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
BACKGROUND: The effect of treatment delay on survival in pancreatic ductal adenocarcinoma (PDAC) remains unclear. AIMS: This study aimed to assess the prognostic impact of time to diagnosis and chemotherapy in advanced PDAC and factors influencing the time intervals. METHODS: advanced PDAC patients receiving chemotherapy in five centers in the decade 2007-2016 were included. Key time points during care pathway from clinical presentation to beginning of chemotherapy were retrospectively collected. Multivariate Cox proportional hazard model was performed. RESULTS: A total of 409 patients were included (mean age 66.1 ± 10.3 years; 250 metastatic (61%); 139 received FOLFIRINOX chemotherapy (34%). The median overall survival (OS) was 7.2 months. The median times from first symptoms and from first specialist visit to the beginning of chemotherapy were respectively 100 days and 47 days. None of time intervals was significantly associated with OS. Significant prognostic factors were FOLFIRINOX chemotherapy (HR 0.6 [0.5-0.8]; P < 0.001), metastasis (HR 1.6 [1.3-2.0]; Pâ¯=â¯0.001), WHO PS ≥ 2 (HR 1.6 [1.2-2.1]; P < 0.001) and acute pancreatitis as first symptom (HR 2.9 [1.7-4.9]; P < 0.001). Jaundice shortened time to diagnosis (P < 0.001). Acute pancreatitis (P < 0.001) and diabetes (Pâ¯=â¯0.01) increased time to treatment. CONCLUSION: Wait times from clinical presentation to beginning of chemotherapy do not influence survival in advanced PDAC.
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Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/mortalidad , Neoplasias Pancreáticas/tratamiento farmacológico , Neoplasias Pancreáticas/mortalidad , Tiempo de Tratamiento , Adenocarcinoma/patología , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Diabetes Mellitus/fisiopatología , Femenino , Fluorouracilo/uso terapéutico , Francia/epidemiología , Humanos , Irinotecán/uso terapéutico , Leucovorina/uso terapéutico , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oxaliplatino/uso terapéutico , Neoplasias Pancreáticas/patología , Pancreatitis/fisiopatología , Pronóstico , Modelos de Riesgos Proporcionales , Estudios RetrospectivosRESUMEN
The glenoid labrum is an important stabilizer of the glenohumeral joint. Labral injuries affect the stability of the shoulder joint to varying degrees depending on the localization, the extension and the structures involved. Because of the complex anatomy and the high variability of the glenoid labrum, in-depth knowledge concerning normal variations and labral injury patterns is required as well as high-resolution imaging with intra-articular contrast in order to discriminate anatomical variants from pathological findings. Therefore, magnetic resonance (MR) and alternatively computed tomography (CT) arthrography have become established as the imaging methods of choice. In this review MR arthrographic findings of normal labral variants and different labral injury patterns are portrayed.
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Inestabilidad de la Articulación/diagnóstico , Imagen por Resonancia Magnética/métodos , Lesiones del Hombro , Articulación del Hombro/patología , Tomografía Computarizada por Rayos X/métodos , Artrografía/métodos , Humanos , Articulación del Hombro/diagnóstico por imagenRESUMEN
PURPOSE: The use of 4D-[(18)F]fluorodeoxyglucose (FDG) PET/CT in combination with respiratory gated magnet resonance imaging (MRI) in target volume definition for stereotactic radiation of liver metastases was investigated. METHODS AND MATERIALS: A total of 18 patients received respiration gated FDG-PET/CT and MRI. Data were fused using a rigid co-registration algorithm. The quality of the co-registration was rated on a scale from 1 (excellent) to 5 (poor) for co-registration of MRI with gated PET and ungated PET. Gross tumor volume (GTV) was delineated in CT (GTV (CT)), MRI (GTV(MRI)), and PET (GTV(PET)). MRI- and PET-based GTVs were defined by three observers each. Interobserver variability was calculated for all patients as well as for subgroups with and without previous treatment of liver metastases. All GTVs were compared for all patients and separately for patients with previous local therapy. In addition, a semiautomatic segmentation algorithm was applied on the PET images. RESULTS: Co-registration between MR and PET images was rated with 3.3 in average when non-gated PET was used and improved significantly (p < 0.01) to 2.1 using gated PET. The average GTV(CT) was 51.5 ml, GTV(MRI) 51.8 ml, and the average GTV(PET) 48.1 ml. Volumes delineated in MRI were 9.9% larger compared to those delineated in CT. Volumes delineated in PET were 13.8% larger than in MRI. The differences between the GTVs were more pronounced in patients with previous treatment. The GTVs defined in MRI showed an interobserver variability of 47.9% (84.1% with previous treatment and 26.2% without previous treatment). The PET-defined GTVs showed an interobserver variability of 21% regardless of previous treatment. Semiautomatic segmentation did not provide satisfying results. CONCLUSION: FDG-PET can distinguish vital tumor tissue and scar tissue, and therefore alters the GTV especially in patients with previous local treatment. In addition, it reduces the interobserver variability significantly compared to MRI. However, respiratory gated PET is necessary for good co-registration of PET and MRI.
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Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Tomografía de Emisión de Positrones/métodos , Radiocirugia/métodos , Radioterapia Guiada por Imagen/métodos , Técnicas de Imagen Sincronizada Respiratorias/métodos , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Femenino , Fluorodesoxiglucosa F18 , Humanos , Imagenología Tridimensional/métodos , Neoplasias Hepáticas/diagnóstico , Masculino , Persona de Mediana Edad , Radiofármacos , Técnica de Sustracción , Resultado del TratamientoRESUMEN
PURPOSE: To evaluate ultrasound guidance for intraarticular contrast injection via an anterolateral approach in comparison with fluoroscopic guidance. MATERIALS AND METHODS: Contrast agent injection was performed in 40 consecutive patients, 20 under sonographic guidance and 20 under fluoroscopic guidance. None of the patients had previous shoulder surgery. The procedure time was measured and the efficiency of joint distension, incidence of extravasation and intraarticular air on the consecutive MR arthrograms were assessed by three blinded radiologists with musculoskeletal radiology experience. Statistical analysis was performed using the Kruskal-Wallis test. RESULTS: Intraarticular contrast injection was successfully accomplished in all 40 patients. Subsequent MR arthrograms did not show any significant difference between sonographic and fluoroscopic guidance with respect to diagnostic quality, joint distension (p=0.6665), intraarticular air bubbles (p=0.1567) and occurrence of contrast extravasation (p=0.8565). The mean duration of ultrasound-guided injection was 7:30 min compared to a shorter procedure time of 4:15 min for fluoroscopic guidance. In both groups, no procedural complications were observed. CONCLUSION: Ultrasound-guided injection for MR arthrography of the shoulder via an anterolateral approach represents a simple, safe, and effective technique which yields comparable results to those of injection under fluoroscopic guidance, but is slightly more time-consuming.
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Artrografía/métodos , Medios de Contraste/administración & dosificación , Gadolinio DTPA/administración & dosificación , Aumento de la Imagen/métodos , Procesamiento de Imagen Asistido por Computador/métodos , Inyecciones Intraarticulares , Imagen por Resonancia Magnética/métodos , Lesiones del Manguito de los Rotadores , Articulación del Hombro , Traumatismos de los Tendones/diagnóstico , Ultrasonografía Intervencional/métodos , Adolescente , Adulto , Anciano , Femenino , Fluoroscopía , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Manguito de los Rotadores/patología , Sensibilidad y Especificidad , Articulación del Hombro/patología , Adulto JovenRESUMEN
BACKGROUND: C-reactive protein (CRP) levels are modulated by endogenous and exogenous factors independently of inflammation. The present study investigated the impact of oral contraceptives, endogenous oestrogens, age, gender, smoking, body mass index (BMI) and lipid levels on CRP concentrations in a healthy collective. METHODS: Highly sensitive CRP, total cholesterol, HDL-cholesterol and LDL-cholesterol levels were measured in 850 blood donors (438 M, 412 F); 227 women in this group used oral contraceptive formulations (OC). Additionally, serum samples from 58 women undergoing in vitro fertilization cycles (IVF) were tested for CRP. Results. The 97.5th percentile of CRP levels of the blood donors was 4.91 mg/L in men, 7.52 mg/L in OC non-users and 11.95 mg/L in OC users. Overweight gives a 2-fold increase of median CRP levels in men and women. The combination of overweight and OC use in women resulted in 6-fold median CRP levels. Age, smoking and lipid levels were influencing factors of lower significance. In IVF patients the elevated oestradiol levels had no influence on CRP concentrations in multivariance analysis. CONCLUSION: The diagnostic and predictive value of CRP levels is most affected by BMI and oral contraceptive use, which suggests the need for further investigations into the role of CRP modulating factors in monitoring infectious diseases.
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Peso Corporal , Proteína C-Reactiva/metabolismo , Anticonceptivos Hormonales Orales/farmacología , Adolescente , Adulto , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The evaluation of resectability in patients with pancreatic cancer remains a diagnostic challenge, especially regarding the preoperative assessment of vascular invasion. Thin-slice multiplanar reconstructions obtained with multislice helical computed tomography provide an exact depiction of the spatial relation between the tumor and the potentially invaded vessels and thus have the capability to improve the assessment of local resectability.
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Adenocarcinoma/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador/métodos , Neovascularización Patológica/diagnóstico por imagen , Neoplasias Pancreáticas/diagnóstico por imagen , Tomografía Computarizada Espiral , Anciano , Medios de Contraste , Femenino , Humanos , Imagenología Tridimensional , Masculino , Persona de Mediana Edad , Estadificación de NeoplasiasRESUMEN
MRI plays an important role in the diagnostic workup of skeletal metastases. In principle two different applications of MRI can be distinguished: apart from the well known indications of clarifying uncertain lesions seen with other imaging modalities or demonstrating known osseous lesions with high resolution imaging for therapeutic planing, MRI can also be used as a primary screening modality for skeletal metastases. Besides the higher lesion detection rate the major advantage of MRI compared to bone scintigraphy lies in the demonstration of morphology which on the one hand exactly shows the extension of tumorous lesions and on the other hand clearly distinguishes between malign and benign processes. As unclear findings on bone scintigraphy often require additional imaging studies, especially in patients with clinical findings or lab results suggestive for metastatic disease, we think that whole-body-skeletal-MRI is not only an accurate but also a cost effective diagnostic modality in the detection and screening for skeletal metastases, if the indication for the examination is closely related to clinical findings and the therapeutic relevance of the imaging results.
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Neoplasias de la Médula Ósea/diagnóstico , Neoplasias de la Médula Ósea/secundario , Imagen por Resonancia Magnética , Médula Ósea/diagnóstico por imagen , Médula Ósea/patología , Hemangioma/diagnóstico , Humanos , Imagen por Resonancia Magnética/métodos , Cintigrafía , Sensibilidad y EspecificidadRESUMEN
In a 14-years period (1970-1984) eight-three patients were operated on for primary hyperparathyroidism (pHPT) at the University Hospital of Erlangen. Special attention was paid to associated diseases, symptoms, preoperative diagnostic parameters were serum calcium, parathyroid hormone in venous blood, cyclic AMP in 24 h-urine. In 15.7% only borderline increased serum calcium values were measured. Ulcer incidence in pHPT was 19% as compared with approx. 7% in the general population. There was no increased incidence of pancreatitis in pHPT. The possibility of an association of pHPT with the Multiple Endocrine Neoplasia (MEN) syndrome was emphasized and measures of early diagnosis proposed.