BACKGROUND:Endoscopic palliation in malignant hilar biliary obstruction requires endoscopic retrograde cholangiopancreatography (ERCP),whereas contrast injection leads to cholangitis.Contrast-free metal stenting with ...BACKGROUND:Endoscopic palliation in malignant hilar biliary obstruction requires endoscopic retrograde cholangiopancreatography (ERCP),whereas contrast injection leads to cholangitis.Contrast-free metal stenting with or without magnetic resonance cholangiopancreatography (MRCP) has shown encouraging results,but MRCP and metal stents are costly.There have been no reports on the use of air cholangiography.METHODS:We prospectively evaluated the role of air cholangiography-assisted unilateral plastic stenting in 10 patients with type Ⅱ malignant hilar biliary obstruction.A retrospectively analysed group of 10 patients treated with contrast-free unilateral metal stenting served as historical controls.RESULTS:Ten patients with unresectable type Ⅱ malignant hilar biliary obstruction were studied.Air cholangiography detected type Ⅱ obstruction in all patients,similar to MRCP.The patients underwent unilateral stenting.Successful endoscopic drainage was achieved in all patients.The mean patency of the stent was 95.8±17.5 days in the study group and 143.9±115.1 days in the control group (P=0.20).The mean survival was 121.8±41.6 days in the study group and 154.9±122.5 days in the control group (P=0.42).KaplanMeier analysis showed an estimated median survival of 100:95% CI (65.9,134.1) days in the study group and 98:95% CI (84.1,111.9) days in the control group (P=0.62).Cholangitis occurred in none of the patients and there were no 30-day deaths nor major complications.Air cholangiographyassisted unilateral plastic stenting was cheaper than contrastfree unilateral metal stenting.CONCLUSION:Air cholangiography-assisted unilateral plastic stenting is as safe and effective as contrast-free unilateral metal stenting in type Ⅱ malignant hilar biliary obstruction for palliating patients,but it is cheaper.展开更多
Objective:Conservative approaches in muscle-invasive bladder cancer(MIBC)have been evolved to avoid aggressive surgery,but are limited to elderly,frail,and patients medically unfit for surgery.Our study aimed to asses...Objective:Conservative approaches in muscle-invasive bladder cancer(MIBC)have been evolved to avoid aggressive surgery,but are limited to elderly,frail,and patients medically unfit for surgery.Our study aimed to assess the response rate of neoadjuvant chemotherapy(NACT)before radiotherapy(RT)in MIBC patients.Methods:Forty patients with urothelial carcinoma of stage T2-T4a,N0,M0 were enrolled between November 2013 and November 2015,and treated with three cycles of NACT with gemcitabine-cisplatin.Post-NACT response was assessed using Response Evaluation Criteria in Solid Tumors(RECIST)criteria.Patients who achieved complete response(CR)and partial response(PR)>50%were treated with radical RT,and those who had PR<50%,stable disease(SD),and progressive disease(PD)underwent radical cystectomy(RC).Survival analysis was done with Kaplan-Meier method and point-to-time events were analyzed with Cox-proportional hazards regression model.Results:After NACT,35(87.5%)patients achieved either PR>50%or CR,and were treated with RT.Five(12.5%)patients who had PR<50%,SD,or PD underwent RC.All patients who received radiation showed CR after 6 weeks.Median follow-up was 43 months(range:10-66 months)and median overall survival(OS)was not reached.Three-year OS,local control,and disease-free survival were 70.1%,60.9%,50.6%,respectively,and 50%of patients preserved their functioning bladder.Three-year OS rate was 88.9%in patients who achieved CR to NACT,73.1%in patients with PR≥50%and 40%in patients with PR<50%.Conclusion:NACT followed by RT provides a high probability of local response with bladder preservation in CR patients.Appropriate use of this treatment regimen in carefully selected patients may omit the need for morbid surgery.展开更多
Objective:Despite conflicting evidence,it is common practice to use continuous antibiotic prophylaxis(CAP)in patients with indwelling double-J(DJ)stents.Cranberry extracts and d-mannose have been shown to prevent colo...Objective:Despite conflicting evidence,it is common practice to use continuous antibiotic prophylaxis(CAP)in patients with indwelling double-J(DJ)stents.Cranberry extracts and d-mannose have been shown to prevent colonization of the urinary tract.We evaluated their role in this setting.Methods:We conducted a prospective randomized study to evaluate patients with indwelling DJ stents following urological procedures.They were randomized into three groups.Group A(n=46)received CAP(nitrofurantoin 100 mg once daily[OD]).Group B(n=48)received cranberry extract 300 mg and d-mannose 600 mg twice daily(BD).Group C(n=40)received no prophylaxis.The stents were removed between 15 days and 45 days after surgery.Three groups were compared in terms of colonization of stent and urine,stent related symptoms and febrile urinary tract infections(UTIs)during the period of indwelling stent and until 1 week after removal.Results:In Group A,9(19.5%)patients had significant bacterial growth on the stents.This was 8(16.7%)in the Group B and 5(12.5%)in Group C(p-value:0.743).However,the culture positivity rate of urine specimens showed a significant difference(p-value:0.023)with Group B showing least colonization of urine compared to groups A and C.There was no statistically significant difference in the frequency of stent related symptoms(p-value:0.242)or febrile UTIs(p-value:0.399)among the groups.Conclusion:Prophylactic agents have no role in altering bacterial growth on temporary indwelling DJ stent,stent related symptoms or febrile UTIs.Cranberry extract may reduce the colonization of urinary tract,but its clinical significance needs further evaluation.展开更多
Small bowel adenocarcinoma(SBA)is a rare malignancy of the gastrointestinal tract.However,these tumors are among those with worst prognosis.Vague clinical signs and symptoms and radiological diagnostic challenges ofte...Small bowel adenocarcinoma(SBA)is a rare malignancy of the gastrointestinal tract.However,these tumors are among those with worst prognosis.Vague clinical signs and symptoms and radiological diagnostic challenges often delay treatment,which negatively impacts the prognosis of the patients.However,recent advances in imaging technology,like multidetector computed tomography,magnetic resonance imaging,and capsule endoscopy,have made earlier and accurate diagnosis possible.Surgery is the treatment of choice followed by adjuvant therapy.However,there are no strict treatment guidelines available for the management of SBA.Most of the available evidence from colorectal and gastric carcinoma has been extrapolated to adequately manage SBA.Prognosis for SBA is better than gastric carcinoma but worse than colorectal carcinoma.Currently,there is not enough information on the molecular characteristics and tumor pathogenesis.Because the incidence of SBA is very low,there is a need for further studies to evaluate the possible application of newer investigative agents and strategies to obtain a better outcome within the framework of international collaborations.展开更多
Surgery is the only curative treatment for cholangiocarcinoma. However, mostpatients present with advanced disease, and hence are unresectable. Thus, theintent of treatment shifts from curative to palliative in the ma...Surgery is the only curative treatment for cholangiocarcinoma. However, mostpatients present with advanced disease, and hence are unresectable. Thus, theintent of treatment shifts from curative to palliative in the majority of cases.Biliary drainage with intraluminal brachytherapy is an effective means ofrelieving the malignant biliary obstruction. In this review, we discuss the role ofbrachytherapy in the palliation of obstructive symptoms in extrahepatic cholangiocarcinoma.展开更多
文摘BACKGROUND:Endoscopic palliation in malignant hilar biliary obstruction requires endoscopic retrograde cholangiopancreatography (ERCP),whereas contrast injection leads to cholangitis.Contrast-free metal stenting with or without magnetic resonance cholangiopancreatography (MRCP) has shown encouraging results,but MRCP and metal stents are costly.There have been no reports on the use of air cholangiography.METHODS:We prospectively evaluated the role of air cholangiography-assisted unilateral plastic stenting in 10 patients with type Ⅱ malignant hilar biliary obstruction.A retrospectively analysed group of 10 patients treated with contrast-free unilateral metal stenting served as historical controls.RESULTS:Ten patients with unresectable type Ⅱ malignant hilar biliary obstruction were studied.Air cholangiography detected type Ⅱ obstruction in all patients,similar to MRCP.The patients underwent unilateral stenting.Successful endoscopic drainage was achieved in all patients.The mean patency of the stent was 95.8±17.5 days in the study group and 143.9±115.1 days in the control group (P=0.20).The mean survival was 121.8±41.6 days in the study group and 154.9±122.5 days in the control group (P=0.42).KaplanMeier analysis showed an estimated median survival of 100:95% CI (65.9,134.1) days in the study group and 98:95% CI (84.1,111.9) days in the control group (P=0.62).Cholangitis occurred in none of the patients and there were no 30-day deaths nor major complications.Air cholangiographyassisted unilateral plastic stenting was cheaper than contrastfree unilateral metal stenting.CONCLUSION:Air cholangiography-assisted unilateral plastic stenting is as safe and effective as contrast-free unilateral metal stenting in type Ⅱ malignant hilar biliary obstruction for palliating patients,but it is cheaper.
文摘Objective:Conservative approaches in muscle-invasive bladder cancer(MIBC)have been evolved to avoid aggressive surgery,but are limited to elderly,frail,and patients medically unfit for surgery.Our study aimed to assess the response rate of neoadjuvant chemotherapy(NACT)before radiotherapy(RT)in MIBC patients.Methods:Forty patients with urothelial carcinoma of stage T2-T4a,N0,M0 were enrolled between November 2013 and November 2015,and treated with three cycles of NACT with gemcitabine-cisplatin.Post-NACT response was assessed using Response Evaluation Criteria in Solid Tumors(RECIST)criteria.Patients who achieved complete response(CR)and partial response(PR)>50%were treated with radical RT,and those who had PR<50%,stable disease(SD),and progressive disease(PD)underwent radical cystectomy(RC).Survival analysis was done with Kaplan-Meier method and point-to-time events were analyzed with Cox-proportional hazards regression model.Results:After NACT,35(87.5%)patients achieved either PR>50%or CR,and were treated with RT.Five(12.5%)patients who had PR<50%,SD,or PD underwent RC.All patients who received radiation showed CR after 6 weeks.Median follow-up was 43 months(range:10-66 months)and median overall survival(OS)was not reached.Three-year OS,local control,and disease-free survival were 70.1%,60.9%,50.6%,respectively,and 50%of patients preserved their functioning bladder.Three-year OS rate was 88.9%in patients who achieved CR to NACT,73.1%in patients with PR≥50%and 40%in patients with PR<50%.Conclusion:NACT followed by RT provides a high probability of local response with bladder preservation in CR patients.Appropriate use of this treatment regimen in carefully selected patients may omit the need for morbid surgery.
文摘Objective:Despite conflicting evidence,it is common practice to use continuous antibiotic prophylaxis(CAP)in patients with indwelling double-J(DJ)stents.Cranberry extracts and d-mannose have been shown to prevent colonization of the urinary tract.We evaluated their role in this setting.Methods:We conducted a prospective randomized study to evaluate patients with indwelling DJ stents following urological procedures.They were randomized into three groups.Group A(n=46)received CAP(nitrofurantoin 100 mg once daily[OD]).Group B(n=48)received cranberry extract 300 mg and d-mannose 600 mg twice daily(BD).Group C(n=40)received no prophylaxis.The stents were removed between 15 days and 45 days after surgery.Three groups were compared in terms of colonization of stent and urine,stent related symptoms and febrile urinary tract infections(UTIs)during the period of indwelling stent and until 1 week after removal.Results:In Group A,9(19.5%)patients had significant bacterial growth on the stents.This was 8(16.7%)in the Group B and 5(12.5%)in Group C(p-value:0.743).However,the culture positivity rate of urine specimens showed a significant difference(p-value:0.023)with Group B showing least colonization of urine compared to groups A and C.There was no statistically significant difference in the frequency of stent related symptoms(p-value:0.242)or febrile UTIs(p-value:0.399)among the groups.Conclusion:Prophylactic agents have no role in altering bacterial growth on temporary indwelling DJ stent,stent related symptoms or febrile UTIs.Cranberry extract may reduce the colonization of urinary tract,but its clinical significance needs further evaluation.
文摘Small bowel adenocarcinoma(SBA)is a rare malignancy of the gastrointestinal tract.However,these tumors are among those with worst prognosis.Vague clinical signs and symptoms and radiological diagnostic challenges often delay treatment,which negatively impacts the prognosis of the patients.However,recent advances in imaging technology,like multidetector computed tomography,magnetic resonance imaging,and capsule endoscopy,have made earlier and accurate diagnosis possible.Surgery is the treatment of choice followed by adjuvant therapy.However,there are no strict treatment guidelines available for the management of SBA.Most of the available evidence from colorectal and gastric carcinoma has been extrapolated to adequately manage SBA.Prognosis for SBA is better than gastric carcinoma but worse than colorectal carcinoma.Currently,there is not enough information on the molecular characteristics and tumor pathogenesis.Because the incidence of SBA is very low,there is a need for further studies to evaluate the possible application of newer investigative agents and strategies to obtain a better outcome within the framework of international collaborations.
文摘Surgery is the only curative treatment for cholangiocarcinoma. However, mostpatients present with advanced disease, and hence are unresectable. Thus, theintent of treatment shifts from curative to palliative in the majority of cases.Biliary drainage with intraluminal brachytherapy is an effective means ofrelieving the malignant biliary obstruction. In this review, we discuss the role ofbrachytherapy in the palliation of obstructive symptoms in extrahepatic cholangiocarcinoma.
