Definitive Success Rate Research Articles

Motherhood after breast cancer: can we balance fertility preservation and cancer treatment? A narrative review of the literature.

Breast cancer may affect young women who have not yet completed childbearing. Assisted reproductive technology (ART) provides alternatives for fertility preservation such as oocyte, embryo or ovarian tissue cryopreservation. We reviewed the published literature on fertility-preserving management in breast cancer, aiming at finding evidence to answer the following questions: (1) What are the fertility sparing options available?; (2) How do these women respond to IVF? and (3) Can pregnancy influence breast cancer recurrence? There is a paucity of publications describing clinical experience and outcome data which limits accessibility to fertility preservation in this setting. Presently, oocyte or embryo cryopreservation are the main options for fertility preservation. IVF success rates are comparable to the ones of non-oncological populations according to the woman's age but current published studies lack data on definitive success rates following embryo banking for cancer patients. The perception that IVF and pregnancy may worsen cancer prognosis remains, despite the lack of scientific evidence to support this notion. Published studies show reassuring results for pregnancies occurring >2 years after breast cancer diagnosis. The best published evidence suggests pregnancy after breast cancer does not increase the risk of disease recurrence, thus pregnancy should not be forbidden once treatment is completed. Decision making for women diagnosed with cancer requires up-to-date knowledge of the efficacy and safety of available options. Providing consultation with a reproductive specialist and appropriate information on fertility preservation for these women should be an essential aspect of their supportive care.

Effectiveness of chemical pleurodesis in spontaneous pneumothorax recurrence prevention: a systematic review

ObjectivesSpontaneous pneumothorax is a common pathology. International guidelines suggest pleurodesis for non-resolving air leak or recurrence prevention at second occurrence. This study comprehensively reviews the existing literature regarding chemical pleurodesis...

Acute Dacryocystitis with Empyema of the Lacrimal Sac: Is Immediate Endoscopic Dacryocystorhinostomy Justified?

To evaluate the efficacy of endoscopic dacryocystorhinostomy (Endo-DCR) in the treatment of acute dacryocystitis with lacrimal sac empyema (ADLSE). Case series with chart review. Academic tertiary center. The study included 26 consecutive patients who underwent Endo-DCR for ADLSE between August 2005 and December 2013. The success of the procedure was defined as complete complaint relief and DCR patency. Data on the time from referral to surgery, postoperative complications, and revision surgery are also reported. The present patient series included 4 males (15.4%) and 22 females (84.6%) (mean age, 66 years). The mean time between referral and surgery was 0.88 days and the mean follow-up time was 29 months. All patients showed immediate relief from symptoms, with no ADLSE recurrences. Complete success was achieved in 25 (96.2%) cases; the only failure was in a patient who had previously undergone radioiodine treatment. In this case, revision Endo-DCR was not successful. The only perioperative complication (3.8%) was epistaxis in a patient who required revision surgery under general anesthesia. The definitive success rate was 96.2% after primary and revision surgery. Endo-DCR enables rapid resolution of ADLSE with a very high success rate. Immediate surgery may reduce the risk of skin fistulization and/or orbital complications. DCR shrinkage and lacrimal obstruction are unlikely with Endo-DCR since the procedure is performed on an enlarged sac. The main advantage of Endo-DCR, compared with external DCR, is the absence of a skin incision in an inflamed and infected field.

Acute Dacryocystitis with Empyema of the Lacrimal Sac: Is Immediate Endoscopic Dacryocystorhinostomy Justified?

Objectives: To evaluate the efficacy of endoscopic dacryocystorhinostomy (endoDCR) in the treatment of acute dacryocystitis with lacrimal sac empyema (ADLSE). Methods: Design: Single center cohort study. Setting: Academic tertiary center. Patients: Twenty-one consecutive patients who underwent endoDCR for ADLSE between August 2005 and December 2012 were included. Main outcome measures: The success of the procedure was defined as complete complaint relief and DCR patency. Time from referral to surgery, post-operative complications, and revision surgery data were also reported. Results: The present cohort of patients included 3 males (14.3%) and 18 females (85.7%) (median age: 66 years). Median time between referral and surgery was 0 days (mean: 0.86 days). Median follow-up was 12 months. All patients showed immediate relief from symptoms, with no recurrences of ADSLE. Complete success was achieved in 20 of 21 (95.2%) cases; the only failure was recorded in a patient who had previously undergone radio-iodine treatment. In this case also revision endoDCR was not successful. The only perioperative complication was an epistaxis requiring revision surgery under general anesthesia. The definitive success rate was 95.2% after primary and revision surgery. Conclusions: EndoDCR enables rapid solution of ADSLE with a very high success rate. Immediate surgery minimizes the risk of skin fistulization and/or orbital complications; DCR shrinkage and lacrimal obstruction are unlikely since the procedure is performed on an enlarged sac. In comparison with external DCR, the absence of skin incision in an inflamed and infected field is the main advantage.

What future for vascular neurosurgery?

What future for vascular neurosurgery?

Radiofrequency Cauterization: An Alternative to Reduce Post-biopsy Hemorrhage

As recently described in animals [1], we applied radiofrequency ablation (RFA) to clinical practice as a technique to reduce the risk of bleeding after biopsy of a highly vascular tumor. A 26-year-old man was admitted for renal core biopsy. Prior fine-needle biopsy of a left kidney mass and a supraclavicular lymph node showed renal cell carcinoma of unknown subtype. Repeat biopsy was performed to diagnose histologic subtype, which can affect experimental treatment options. The patient had first presented 6 months previously with a 6 cm palpable cervical lymph node, weight loss of 9 kg, and fatigue with no hematuria. The CT scan revealed extensive lymphadenopathy throughout his mediastinum and left periaortic region, and a 6 cm left kidney mass with three liver metastases. Laboratory values were normal. A bone scan did not show evidence of metastatic disease. Prior to biopsy, color Doppler ultrasound revealed a very vascular tumor with many large and small vessels throughout the tumor, suggesting increased risk of biopsy-related bleeding [3]. The patient underwent an ultrasound-guided coaxial core biopsy with a 17 gauge 10 cm outer needle and an 18 gauge 15 cm inner needle. Brisk bright red pulsatile blood was seen in the outer needle following removal of the inner core biopsy gun. The stylet was replaced as soon as the pulsatile bleeding was seen. Two grounding pads were rapidly applied to the patient’s thighs and the tissue ablation system was set up. Just prior to removal of the outer biopsy needle, a Radionics (Valleylab, Boulder, CO) RFA probe (20 cm with a 3 cm uninsulated tip) was placed, using tandem technique, immediately adjacent to the biopsy needle and to the same insertion depth, under direct ultrasound guidance. The outer needle was then removed from the patient and the RFA Cool Tip generator (Valleylab, Boulder, CO) was turned on. Tissue was heated to 95°C for about 90 sec during slow withdrawal of the RFA probe, without chilled saline perfusion. The generator was stopped as the uninsulated portion of the needle was withdrawn from the tumor capsule, but prior to crossing dermis. No sign of bleeding was evident by ultrasound 15 min following the procedure or by clinical criteria the day following the procedure. The patient remained clinically stable during and after the application of this technique. The patient did not complain of pain after the procedure. The pathology results showed clear cell carcinoma with papillary features. Five days later an excisional biopsy of a right arm tumor was performed. Results showed leiomyoma. Given the patient’s extensive family history of malignancy (the father had a rare eye adenocarcinoma; 5 of 9 of the father’s siblings had cancer, 2 of them renal cell carcinoma; and the mother’s siblings had renal cell carcinoma, uterine, and esophageal cancers) the diagnosis of hereditary leiomyomatosis renal cell carcinoma syndrome (HLRCC) was made. RFA may be a helpful therapeutic option to avoid the bleeding that may be seen in up to 90% of patients by CT [5] after a percutaneous renal biopsy, depending upon how one defines bleeding. Less than 3% of renal biopsies require transfusion or an intervention to stop the bleeding [6]. Other therapeutic options available are transarterial embolization with polyvinyl alcohol or acrylic particles, collagen pledgets, autologous blood, or metal coils [3]. These techniques, however, do not address the possibility of needle tract seeding with tumor cells, in contrast to RFA in which the tract is treated [4]. Also, treatment with embolization may result in an undesirable infarct in a patient with already compromised renal function. While RFA has been emerging as a viable therapeutic option for certain renal cell carcinomas and has a definitive success rate over 90% with few complications in selected patients [2, 4], it may be a low-risk, nephron-sparing method to facilitate hemostasis in the post-biopsy setting, especially when there is brisk pulsatile flow. A modified biopsy device could easily be manufactured to facilitate use of post-biopsy cauterization to minimize risk of bleeding and needle-tract seeding for high-risk patients. Such a simple maneuver could be performed following any biopsy where needle tract seeding or bleeding were thought to be a higher risk, as might occur when brisk backbleeding is seen from the outer needle, or with uncorrectable coagulopathies, anticoagulation, hypervascular tumors, vascular organ biopsies (i.e., spleen), or with the larger core samples often required for genomic or proteomic analysis. Such a biopsy might be a safer alternative to transjugular liver biopsy as well, although this remains speculative.

Prehospital resuscitation - outcome in an urban area

All prehospital resuscitations performed by emergency physicians in the city of Bochum, Germany, were recorded and evaluated prospectively from 1 August 1989 to 30 September 1990. Initially successful cardiopulmonary resuscitation (CPR) was achieved in 33.8% (alive at admission), and definitive success in 10.4% (discharged alive). Of the patients who presented with cardiac arrest before the arrival of the emergency physician, 28.4% could be resuscitated initially and 7.6% survived definitively. In patients who suffered circulatory arrest on or after the arrival of the emergency physician, the initial success rate of CPR was 51.7%, and the definitive success rate 11.1%. Although the initial success rate was significantly more favourable, the definitive outcome did not differ statistically between these two groups. Two time periods were compared. During the first period of 5 months only one base with two ambulances staffed with emergency physicians was available. During the second period of 9 months an additional base with a physician-staffed ambulance was established. This reorganization resulted in the reduced call to arrival time falling from 8.5 +/- 2.4 min to 7.6 +/- 2.4 min (univariate variance analysis: f = 8.89, d.f. = 1.31, p < 0.01). This decrease, however did not improve either the initial or the definitive success of CPR. From these results we conclude that further improvement of prehospital resuscitation can only be achieved to a small extent by reducing the call to arrival time of ambulances staffed with emergency physicians. Improvement is more likely to be seen when immediate resuscitation is performed by bystanders present at the scene.