Cancer by Sfakianakis Alexandros

Σάββατο 15 Απριλίου 2017

Pneumoperitoneum without Intestinal Perforation in a Neonate: Case Report and Literature Review

Pneumoperitoneum in a preterm neonate usually indicates perforation of the intestine and is considered a surgical emergency. However, there are cases of pneumoperitoneum with no evidence of rupture of the intestine reported in the literature. We report a case of pneumoperitoneum with no intestinal perforation in a preterm neonate with respiratory distress syndrome who was on high frequency oscillatory ventilation (HFOV). He developed bilateral pulmonary interstitial emphysema with localized cystic lesion, likely localized pulmonary interstitial emphysema, and recurrent pneumothoraces. He was treated with dexamethasone to wean from the ventilator. Pneumoperitoneum developed in association with left sided pneumothorax following mechanical ventilation and cardiopulmonary resuscitation. Pneumoperitoneum resolved after the pneumothorax was resolved with chest tube drainage. He died from acute cardiorespiratory failure. At autopsy, there was no evidence of intestinal perforation. This case highlights the fact that pneumoperitoneum can develop secondary to pneumothorax and does not always indicate intestinal perforation or require exploratory laparotomy.

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Does exclusion of cancers registered only from death-certificate information diminish socio-demographic disparities in recorded survival?

Publication date: June 2017
Source:Cancer Epidemiology, Volume 48
Author(s): Hanna E. Tervonen, David Roder, Stephen Morrell, Hui You, David C. Currow
BackgroundDeath Certificate Only (DCO) cancer cases are commonly excluded from survival analyses due to unknown survival time. This study examines whether socio-demographic factors are associated with DCO diagnosis, and the potential effects of excluding DCO cases on socio-demographic cancer survival disparities in NSW, Australia.MethodsNSW Cancer Registry data for cases diagnosed in 2000–2008 were used in this study. Logistic regression was used to estimate the odds of DCO registration by socio-demographic sub-group (socio-economic disadvantage, residential remoteness, country of birth, age at diagnosis). Cox proportional hazard regression was used to estimate the probability of death from cancer by socio-demographic subgroup when DCO cases were included and excluded from analyses.ResultsDCO cases consisted of 1.5% (n=4336) of all cases (n=299,651). DCO diagnosis was associated with living in socio-economically disadvantaged areas (most disadvantaged compared with least disadvantaged quintile: odds ratio OR 1.25, 95%CI 1.12–1.40), living in inner regional (OR 1.16, 95%CI 1.08–1.25) or remote areas (OR 1.48, 95%CI 1.01–2.19), having an unknown country of birth (OR 1.63, 95%CI 1.47–1.81) and older age. Including or excluding DCO cases had no significant impact on hazard ratios for cancer death by socio-economic disadvantage quintile or remoteness category, and only a minor impact on hazard ratios by age.ConclusionSocio-demographic factors were associated with DCO diagnosis in NSW. However, socio-demographic cancer survival disparities remained unchanged or varied only slightly irrespective of including/excluding DCO cases. Further research could examine the upper limits of DCO proportions that significantly alter estimated cancer survival differentials if DCOs are excluded.

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Does exclusion of cancers registered only from death-certificate information diminish socio-demographic disparities in recorded survival?

Complications pulmonaires de la radiothérapie après cancer du sein : penser à la BOOP

Publication date: Available online 4 April 2017
Source:Cancer/Radiothérapie
Author(s): J. Ducray, S. Vignot, A. Lacout, I. Pougnet, P.-Y. Marcy, C. Chapellier, N. Foray, A. Creisson, J. Thariat
La bronchiolite oblitérante avec organisation pneumonique est une réaction inflammatoire pouvant survenir dans les suites de diverses agressions pulmonaires. L'imputabilité de la radiothérapie dans la survenue d'une pneumopathie survenant en cours ou au décours d'une irradiation n'est pas systématique. La bronchiolite oblitérante avec organisation pneumonique ne doit pas être confondue avec la fibrose pulmonaire post-radique dose-dépendante, qui est inflammatoire, non immunologique, et localisée dans la zone d'irradiation. Le rôle de l'immunité, de l'inflammation locale et de la radiosensibilité individuelle, doit probablement être mieux défini dans cet effet secondaire qui représente 1 % des patientes irradiées pour un cancer du sein, soit près de 400 patientes par an en France. Elle se traduit par une fièvre (syndrome pseudogrippal), une toux plutôt sèche et une dyspnée. En contexte post-radique, une bronchiolite oblitérante avec organisation pneumonique peut être diagnostiquée plusieurs mois, voire jusqu'à un an, après la fin d'une irradiation mammaire. Le traitement est une corticothérapie de longue durée ou des immunosuppresseurs, qui n'éviteraient pas le passage à la chronicité pour 15 % des patients et le décès dans 5 % des observations dans certaines séries, les 80 % des patients restants guérissant sans séquelle.Bronchiolitis obliterans with organizing pneumonia is an inflammatory reaction that can occur as a consequence of various pulmonary affections. Radiotherapy is not the sole and systematic cause of bronchiolitis obliterans with organizing pneumonia. Radiation-induced should not be confused with post-radiation, dose-dependent, inflammatory pulmonary fibrosis, which is non-immunological and located within the irradiation field. The role of immunity, local inflammation and individual radiosensitivity in bronchiolitis obliterans with organizing pneumonia is not well defined. Bronchiolitis obliterans with organizing pneumonia represents 1% of irradiated patients with breast cancer. It results in fever (flu-like symptoms), a rather dry cough and dyspnea. In the post-radiation context, bronchiolitis obliterans with organizing pneumonia may be diagnosed several months and up to a year after breast irradiation. The treatment consists of prolonged steroids or immunosuppressants, which do not prevent chronicity in 15% of patients and death in up to 5% of cases, the remaining 80% of patients healing without sequelae.

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Complications pulmonaires de la radiothérapie après cancer du sein : penser à la BOOP

Impact of major vascular resection on outcomes and survival in patients with intrahepatic cholangiocarcinoma: A multi-institutional analysis

Background

Major vascular involvement (IVC or portal vein) for intrahepatic cholangiocarcinoma (ICC) has traditionally been considered a contraindication to resection. We sought to define perioperative outcomes and survival of ICC patients undergoing hepatectomy with major vascular resection in a large international multi-institutional database.

Methods

A total of 1087 ICC patients who underwent curative-intent hepatectomy between 1990 and 2016 were identified from 13 institutions. Multivariable logistic and cox regressions were used to determine the impact of major vascular resection on perioperative and survival outcomes.

Results

Of 1087 patients who underwent resection, 128 (11.8%) also underwent major vascular resection (21 [16.4%] IVC resections, 98 [76.6%] PV resections, 9 [7.0%] combined resections). Despite more advanced disease, major vascular resection was not associated with the risk of any complication (OR = 0.68, 95%CI 0.32-1.45) or major complications (OR = 0.95, 95%CI 0.49-2.00). Post-operative mortality was also comparable between groups (OR = 1.05, 95%CI 0.32-3.47). In addition, median recurrence-free (14.0 vs 14.7 months, HR = 0.737, 95%CI 0.49-1.10) and overall (33.4 vs 40.2 months, HR = 0.71, 95%CI 0.359-1.40) survival were similar among patients who did and did not undergo major vascular resection (both P > 0.05).

Conclusion

Among patients with ICC, major vascular resection was not associated with worse perioperative or oncologic outcomes. Concurrent major vascular resection should be considered in appropriately selected patients with ICC undergoing hepatectomy.

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