RESUMEN
When patients lack suitable superficial veins in the upper extremity to create an arteriovenous fistula, surgeons are faced with a decision between a synthetic graft or autologous fistula using deep veins, such as a brachial artery to brachial vein arteriovenous fistula. In patients with a high radial artery origin (or brachioradial artery) and inadequate superficial veins, arteriovenous fistula creation will be even more challenging. In the present report, we describe a technique used in three such patients who underwent successful staged brachioradial artery to brachioradial vein arteriovenous fistula creation.
RESUMEN
OBJECTIVE: Mycotic aneurysms of the infrapopliteal vessels are rare, with few cases reported in the literature. Management strategies are diverse and should be tailored to the patient's presentation. METHODS: We describe the case of a 40-year-old male who presented with a painful left leg mass in the setting of bacteremia and infective endocarditis. Imaging revealed an aneurysm of the anterior tibial artery. RESULTS: The patient was treated with antibiotics and open surgical repair with excision of the aneurysmal sac, ligation of the anterior tibial artery, and primary repair of the popliteal artery and tibioperoneal trunk. CONCLUSION: The epidemiology, pathophysiology, and clinical management of infrapopliteal aneurysms are briefly reviewed in this case study.
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Aneurisma Infectado/microbiología , Cardiobacterium/aislamiento & purificación , Endocarditis Bacteriana/microbiología , Infecciones por Bacterias Gramnegativas/microbiología , Arterias Tibiales/microbiología , Adulto , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/terapia , Antibacterianos/uso terapéutico , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Humanos , Ligadura , Masculino , Resultado del Tratamiento , Procedimientos Quirúrgicos VascularesRESUMEN
The superficial radial artery is an anatomic variant in which the radial artery passes superficial to the tendons of the anatomic snuffbox. Cadaver studies have shown its incidence to be 0.5% to 1%. Four patients with this anatomic variation were encountered in our practice, and their clinical courses and anatomy are described. One patient presented with digital ischemia after catheter placement in the anomalous radial artery. Three patients with end-stage renal disease were found to have a superficial radial artery incidentally, and this was used for inflow in the creation of hemodialysis fistulas.
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Derivación Arteriovenosa Quirúrgica/efectos adversos , Bacterias Anaerobias/aislamiento & purificación , Contaminación de Equipos , Infecciones por Bacterias Gramnegativas/etiología , Anciano de 80 o más Años , Bacteroides fragilis/aislamiento & purificación , Enterobacter cloacae/aislamiento & purificación , Enterococcus faecalis/aislamiento & purificación , Femenino , Humanos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Klebsiella oxytoca/aislamiento & purificación , Masculino , Persona de Mediana Edad , Diálisis RenalRESUMEN
BACKGROUND: Surgical intervention after chemoradiation for locoregionally advanced non-small cell lung cancer (NSCLC) is controversial. This study evaluated patient survival after neoadjuvant chemoradiation and anatomic pulmonary resections for locoregionally advanced NSCLC. METHODS: Clinicopathologic data were retrospectively collected for 233 patients (110 women, 123 men) with NSCLC who underwent chemoradiation therapy, followed by pneumonectomy, sleeve lobectomy, bilobectomy, and standard lobectomy, from 1989 to 2008. Univariate log-rank analysis of Kaplan-Meier survival curves and multivariate Cox regression analysis was performed. RESULTS: Final pathologic stages were complete responders, 52 (22%); I, 56 (24%); II, 39 (17%); and III, 86 (37%). Final pathologic lymph node status was N0, 130 (56%); N1, 28 (12%); and N2, 75 (32%). Overall 5-year survival for the cohort was 43%. The 90-day mortality was 8% (18 of 233). The 5-year survival was 33% for pneumectomy vs 51% for lobectomy (p=0.002). Survival rates at 5 years by stage were complete responders, 58%; I, 50%; II, 41%; and III, 32%; by primary tumor status, T0, 50%; T2, 38%; T3, 29%; and T4, 28%; and by final pathologic nodal status, N0, 51%; N1, 40%; N2, 32% (N0 vs N1, p=0.236; N1 vs N2, p=0.704; N0 vs N2, p=0.019; N0 vs N1+N2, p=0.020). Multivariate analysis demonstrated pneumonectomy was associated with decreased 5-year survival (hazard risk, 1.5162; 95% confidence interval, 10.05028 to 2.189, p=0.0263). CONCLUSIONS: Respectable survival can be achieved after neoadjuvant chemoradiation, followed by anatomic resection, in selected patients with clinically advanced NSCLC. A T0 primary tumor or N0 lymph node status individually, or together as a complete response (T0 N0) status, is associated with the best long-term survival. Survival is most favorable for lobectomies vs pneumonectomies after neoadjuvant chemoradiation therapy.
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Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/terapia , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/terapia , Terapia Neoadyuvante/métodos , Neumonectomía/métodos , Adulto , Anciano , Análisis de Varianza , Carcinoma de Pulmón de Células no Pequeñas/patología , Quimioterapia Adyuvante , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estadificación de Neoplasias , Neumonectomía/mortalidad , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/fisiopatología , Modelos de Riesgos Proporcionales , Radioterapia Adyuvante , Estudios Retrospectivos , Medición de Riesgo , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
We recently reported the development of a multianalyte serum algorithm to identify nodal status in non-small cell lung cancer (NSCLC) patients facing an anatomic resection with curative intent. This study aims to enhance the overall performance characteristics of this test by adding autoantibody biomarkers identified through immunoproteomic discovery. More specifically, we used sera from 20 NSCLC patients to probe 2-D immunoblots of HCC827 lysates for tumor-associated autoantigens. Relevant differences in immunoreactivity associated with pathological nodal status were then identified via tandem mass spectrometry. Identified autoantigens were then developed into Luminex immunobead assays alongside a series of autoantigen targets relevant to early-disease detection. These assays were then used to measure circulating autoantibody levels in the identical cohort of NSCLC patients used in our original study. This strategy identified 11 autoantigens found primarily in patients with disease progression to the locoregional lymph nodes. Custom Luminex-based "direct-capture" assays (25 total; including autoantibody targets relevant to early-disease detection) were assembled to measure autoantibody levels in sera from 107 NSCLC patients. Multivariate classification algorithms were then used to identify the optimal combination of biomarkers when considered collectively with our original 6-analyte serum panel. The new algorithm resulting from this analysis consists of TNF-α, TNF-RI, MIP-1α and autoantibodies against Ubiquilin-1, hydroxysteroid-(17-ß)-dehydrogenase, and triosephosphate isomerase. The inclusion of autoantibody biomarkers provided a dramatic improvement in the overall test performance characteristics, relative to the original test panel, including an 11% improvement in the classification efficiency.
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Autoanticuerpos/sangre , Biomarcadores de Tumor/sangre , Carcinoma de Pulmón de Células no Pequeñas/sangre , Neoplasias Pulmonares/sangre , Metástasis Linfática , Adulto , Anciano , Algoritmos , Carcinoma de Pulmón de Células no Pequeñas/inmunología , Carcinoma de Pulmón de Células no Pequeñas/patología , Estudios de Cohortes , Electroforesis en Gel Bidimensional , Femenino , Humanos , Neoplasias Pulmonares/inmunología , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Espectrometría de Masas en TándemRESUMEN
PURPOSE: Non-small cell lung cancer (NSCLC) has an overall 5-year survival of <15%; however, the 5-year survival for stage I disease is over 50%. Unfortunately, 75% of NSCLC is diagnosed at an advanced stage not amenable to surgery. A convenient serum assay capable of unambiguously identifying patients with NSCLC may provide an ideal diagnostic measure to complement computed tomography-based screening protocols. EXPERIMENTAL DESIGN: Standard immunoproteomic method was used to assess differences in circulating autoantibodies among lung adenocarcinoma patients relative to cancer-free controls. Candidate autoantibodies identified by these discovery phase studies were translated into Luminex-based "direct-capture" immunobead assays along with 10 autoantigens with previously reported diagnostic value. These assays were then used to evaluate a second patient cohort composed of four discrete populations, including: 117 NSCLC (81 T(1-2)N(0)M(0) and 36 T(1-2)N(1-2)M(0)), 30 chronic obstructive pulmonary disorder (COPD)/asthma, 13 nonmalignant lung nodule, and 31 "normal" controls. Multivariate statistical methods were then used to identify the optimal combination of biomarkers for classifying patient disease status and develop a convenient algorithm for this purpose. RESULTS: Our immunoproteomic-based biomarker discovery efforts yielded 16 autoantibodies differentially expressed in NSCLC versus control serum. Thirteen of the 25 analytes tested showed statistical significance (Mann-Whitney P < 0.05 and a receiver operator characteristic "area under the curve" over 0.65) when evaluated against a second patient cohort. Multivariate statistical analyses identified a six-biomarker panel with only a 7% misclassification rate. CONCLUSIONS: We developed a six-autoantibody algorithm for detecting cases of NSCLC among several high-risk populations. Population-based validation studies are now required to assign the true value of this tool for identifying early-stage NSCLC.
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Autoanticuerpos/sangre , Carcinoma de Pulmón de Células no Pequeñas/sangre , Pruebas Hematológicas , Neoplasias Pulmonares/sangre , Análisis por Matrices de Proteínas , Adenocarcinoma/sangre , Algoritmos , Anticuerpos Antineoplásicos/análisis , Antígenos de Neoplasias/inmunología , Carcinoma de Pulmón de Células no Pequeñas/inmunología , Línea Celular Tumoral , Detección Precoz del Cáncer , Humanos , Neoplasias Pulmonares/inmunología , ProteómicaRESUMEN
Despite development of novel chemotherapy for gastrointestinal stromal tumors (GISTs), complete resection remains the gold standard treatment. Because of the small number of reported esophageal gastrointestinal stromal tumors, the optimal extent of resection is not well defined. We present a case of an 82-year-old man with an 11-cm esophageal gastrointestinal stromal tumor who was successfully treated with enucleation.