Pancreatic Resection in the Octogenarian Blansfield, Joseph A; Shabahang, Mohsen M; Woll, Nicole L ...
Gastroenterology (New York, N.Y. 1943),
2011, Letnik:
140, Številka:
5
Journal Article
Background The mainstay of treatment for pancreatic cancer is surgical resection; however, positive surgical margins remain commonplace. We identified hospitals with higher than predicted rates of ...positive margins and isolated factors that caused this discordance. Methods This is a retrospective review of patients with head of the pancreas adenocarcinoma in the National Cancer Database between 2004 and 2015. A nomogram was used to calculate the observed to expected positive margin rates (O/E) for facilities. If the O/E differed significantly (P < .05), it was considered an outlier. Results Among a total of 19 968 patients, 24.3% had positive margins. Among hospitals with lower than expected positive margin rates, 73.6% were academic or research programs, 17% were comprehensive community cancer programs, and none were community cancer programs (P = .0002). Within the group with higher than expected positive margin rates, 47% were comprehensive community cancer programs and 38.6% were academic or research programs (P = .0002). The mean hospital volume was higher in the low positive margin group (110.4 vs 48.8, P < .0001). Conclusions Facility type and hospital volume can predict improvement in the O/E ratio for margin positivity in pancreatic adenocarcinoma resection. Surgeons should consider referral to academic or research facilities with higher case volumes for improved surgical resection.
We explored the functioning of the slowly activating anion conductance, S-type or SLAC, and of the quickly activating anion conductance, R-type or QUAC, in whole guard cells of Vicia faba L.; details ...of QUAC activity had not previously been demonstrated in guard cells possessing their walls. The discontinuous single-electrode voltage-clamp method was used to record current responses to voltage pulses and voltage ramps as well as the free-running membrane voltage. At all voltages tested between -200 and 60 mV, SLAC activated with two components, one had a time constant similar to 7 s, the other similar to 40 s. The current-voltage relationship resembled that obtained by patch-clamp experiments. In pulse experiments and 1-s ramps, QUAC activity appeared with half-maximum activation near -50 mV and full activation above -10 mV; it inactivated with a half-time of approximately 10 s. Inactivation of QUAC at -40 mV led to the appearance of SLAC. After deactivation of SLAC at -200 mV, QUAC could be activated again. We concluded that voltage-dependent interchanges between SLAC and QUAC had occurred. Frequently, SLAC and QUAC were active simultaneously in the same cell. Abscisic acid (ABA, 20 microM) activated SLAC as well as QUAC. External Ca2+ was not required, but enhanced the activation of QUAC. Rises in the partial pressure of CO2, in the range between 0 and 700 microbar, caused rapid and reversible increases in the activity of SLAC (and outward currents of K+). QUAC also responded to CO2, however in an unpredictable manner (either by increased or by decreased activity). Oscillations in the free-running membrane voltage arose either spontaneously or after changes in CO2. They were correlated with periodic activations and inactivations of QUAC and required the simultaneous activity of an electrogenic pump.
Abstract Introduction The purpose of this systematic review was to compare the clinical and radiographic outcomes of nonsurgical retreatment with those of endodontic surgery to determine which ...modality offers more favorable outcomes. Methods The study began with targeted electronic searches of MEDLINE, PubMed, and Cochrane databases, followed with exhaustive hand searching and citation mining for all articles reporting clinical and/or radiographic outcomes for at least a mean follow-up of 2 years for these procedures. Pooled and weighted success rates were determined from a meta-analysis of the data abstracted from the articles. Results A significantly higher success rate was found for endodontic surgery at 2–4 years (77.8%) compared with nonsurgical retreatment for the same follow-up period (70.9%; P < .05). At 4–6 years, however, this relationship was reversed, with nonsurgical retreatment showing a higher success rate of 83.0% compared with 71.8% for endodontic surgery ( P < .05). Insufficient numbers of articles were available to make comparisons after 6 years of follow-up period. Endodontic surgery studies showed a statistically significant decrease in success with each increasing follow-up interval ( P < .05). The weighted success for 2–4 years was 77.8%, which declined at 4–6 years to 71.8% and further declined at 6+ years to 62.9% ( P < .05). Conversely, the nonsurgical retreatment success rates demonstrated a statistically significant increase in weighted success from 2-4 years (70.9%) to 4–6 years (83.0%; P < .05). Conclusions On the basis of these results it appears that endodontic surgery offers more favorable initial success, but nonsurgical retreatment offers a more favorable long-term outcome.
The bladder is partially involved in 1 to 4% of all inguinal hernias. However, few cases of massive inguinoscrotal herniation of the bladder have been described, all of which have involved unilateral ...hydronephrosis. We report on a 45-year-old man with incomplete voiding and massively enlarged right scrotum along with elevated creatinine who was found to have massive inguinoscrotal herniation. Preoperative computerized tomography showed bilateral hydronephrosis. Herniorrhaphy was successfully done through an inguinal incision. The left kidney regained normal function with a decrease in creatinine levels. This case is atypical because of the presence of massive inguinoscrotal herniation with bilateral hydronephrosis. Computerized tomography has proved to be a valuable tool in diagnosing such cases. Surgical repair and reduction of hernia can be accomplished through an inguinal incision.
Abstract Background Oncotype DX (ODX) is a multi-gene tumor assay for breast cancer patients. Our objective is to assess whether eligible ODX patients received the test and whether recommendations ...were followed based on respective risk. Methods We retrospectively analyzed testing in patients deemed eligible for ODX using the National Cancer Data Base. Results A total of 158,235 patients met ODX eligibility criteria. Sixty-four percent of eligible patients did not receive the test. Non-testing rose with age. White patients were more likely to be tested (56%) versus black patients (46%, p < 0.0001). Testing was highest at academic facilities (40%). Privately insured patients were more likely to get the test compared to uninsured (45 versus 34%, p < 0.0001). Those in the highest income quartile were more likely to be tested (p < 0.001). Conclusions ODX is under-utilized, with racial and socio-economic factors influencing testing. Further studies are necessary to identify ways to remove disparities and increase testing when appropriate. Summary This study uses the National Cancer Data Base to analyze compliance with the NCCN guidelines for Oncotype DX. Compliance with testing was thirty-six percent. Several factors influenced testing in our study, including facility type, racial and socio-economic factors.
Abstract Introduction Traditional pulp regeneration procedures that use a blood clot as a scaffold have produced histologic evidence of bone, cementum, and connective tissue growth within the root. ...Platelet-rich plasma (PRP) is a bioactive scaffold containing growth factors that enhance wound healing. Aim The aim of this study was to histologically compare the tissues generated when PRP or a blood clot is placed into teeth with preexisting necrotic pulps and periapical lesions. Methods Twenty-four canine teeth from 6 immature ferrets were used. Two ferrets served as positive controls. Sixteen experimental canine teeth from 4 ferrets were infected, debrided, treated with a triple antibiotic paste, and randomly distributed to the following groups: group 1 (blood clot/Gelfoam), group 2 (PRP), and group 3 (no scaffold). At 3 months, the ferrets were sacrificed, and the tissues were evaluated histologically. Data were analyzed by using the Fisher exact test ( P < .05). Results In 3 of 6 teeth in the PRP group, 2 of 6 teeth in the blood clot group, and 1 of 4 teeth in the no scaffold group, an ingrowth of hard tissues was observed in the apical third of the roots. When using PRP or a blood clot as a scaffold, we found significantly more apical narrowing and hard tissue deposition in comparison to not using a scaffold ( P < .05). Conclusions The use of PRP or blood clots as scaffolds results in the ingrowth of bone-like, cementum-like, and connective tissue in the apical third of the roots at inconsistent rates.
Abstract This article will describe requirements for case selection and review the procedures for apexogenesis and apexification in immature permanent teeth. Nonclinical and clinical data will be ...presented to support the recommendations, and outcomes will be presented from clinical studies. The dental pulp is an ectomesenchymally derived connective tissue with certain unique properties such as being encased in hard tissues, which limits its collateral circulation. The pulp provides a matrix for binding of its cells and provides support allowing communication between the cells. In addition to immune cells, the dental pulp contains odontoblasts, which are specialized cells capable of producing dentin. In the absence of a vital pulp, dentin deposition is arrested. When an immature tooth is affected by caries or trauma, the pulp requires proper management according to the degree of inflammation and its vitality. Maintenance of pulp vitality will allow continued root development along the entire root length. If the pulp is irreversibly inflamed or necrotic, root-end closure procedures are required when the apex has not fully formed.
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