Extensive Salvage Research Articles

Location of Recurrences after Trimodality Treatment for Glioblastoma with Respect to the Delivered Radiation Dose Distribution and Its Influence on Prognosis.

While prognosis of glioblastoma after trimodality treatment is well examined, recurrence pattern with respect to the delivered dose distribution is less well described. Therefore, here we examine the gain of additional margins around the resection cavity and gross-residual-tumor. All recurrent glioblastomas initially treated with radiochemotherapy after neurosurgery were included. The percentage overlap of the recurrence with the gross tumor volume (GTV) expanded by varying margins (10 mm to 20 mm) and with the 95% and 90% isodose was measured. Competing-risks analysis was performed in dependence on recurrence pattern. Expanding the margins from 10 mm to 15 mm, to 20 mm, to the 95%- and 90% isodose of the delivered dose distribution with a median margin of 27 mm did moderately increase the proportion of relative in-field recurrence volume from 64% to 68%, 70%, 88% and 88% (p < 0.0001). Overall survival of patients with in-and out-field recurrence was similar (p = 0.7053). The only prognostic factor significantly associated with out-field recurrence was multifocality of recurrence (p = 0.0037). Cumulative incidences of in-field recurrences at 24 months were 60%, 22% and 11% for recurrences located within a 10 mm margin, outside a 10 mm margin but within the 95% isodose, or outside the 95% isodose (p < 0.0001). Survival from recurrence was improved after complete resection (p = 0.0069). Integrating these data into a concurrent-risk model shows that extending margins beyond 10 mm has only small effects on survival hardly detectable by clinical trials. Two-thirds of recurrences were observed within a 10 mm margin around the GTV. Smaller margins reduce normal brain radiation exposure allowing for more extensive salvage radiation therapy options in case of recurrence. Prospective trials using margins smaller than 20 mm around the GTV are warranted.

Revision Surgeries at the Index Level After Cervical Disc Arthroplasty - A Systematic Review.

ObjectiveTo perform a systematic literature review on revision surgeries at the index level after cervical disc arthroplasty (CDA) failure. MethodsA systematic literature review was performed according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Prospective studies on patients who required a secondary surgery after CDA failure were included for analysis. The minimum follow-up for these studies was 5 years. ResultsOut of 864 studies in the original search group, a total of 20 studies were included. From a total of 4,087 patients, 161 patients required a reoperation at the index level. A total of 170 surgeries were performed, as some patients required multiple surgeries. The most common secondary procedures were anterior cervical discectomy and fusion (ACDF) (68%, N = 61) and posterior cervical fusion (15.5%, N = 14), followed by other reoperation (13.3%, N = 12). The associated outcomes for those who required a revision surgery were rarely mentioned in the included literature. ConclusionThe long-term revision rate at the index level of failed CDA surgery was 3.9%, with a minimum 5-year follow-up. ACDF was the most commonly performed procedure to salvage a failed CDA. Some patients who required a new surgery after CDA failure may require a more extensive salvage procedure and even subsequent surgeries.

Oral squamous cell carcinoma involving the maxillae: Factors affecting local recurrence and the value of salvage treatment for overall survival.

ObjectiveTo determine factors associated with local recurrence (LR) of oral squamous cell carcinoma involving the maxillae (MSCC) and overall survival (OS) after salvage treatment.Subjects and MethodsRetrospective study of MSCC operated between 2000 and 2015. Kaplan‐Meier survival and Cox regression were used for analysis of MSCC‐associated clinical and histopathological factors.ResultsNinety‐five patients were included. LR occurred in 24% of patients. Vascular invasion significantly increased the risk of LR (hazard ratio 4.595, P = .003). Local salvage surgery, in the area of the original tumor, significantly prolonged OS, compared to palliative treatment (P = .001) and extensive salvage surgery (P = .013). Extensive salvage surgery, requiring resection of adjacent facial structures, did not prolong OS compared to palliative treatment (P = .186).ConclusionsMSCC with vascular invasion has higher risk of LR. Salvage surgery may prolong OS in small recurrences but might have dubious value for larger recurrences infiltrating adjacent facial structures.

Temporal changes in the climate sensitivity of Norway spruce and European beech along an elevation gradient in Central Europe

Norway spruce has experienced unprecedented forest declines in recent decades, leading to extensive salvage logging. Currently, because of the conversion of conifer forests into more natural mixed forests in Central Europe, spruce has begun to be replaced, mainly by European beech. The frequently discussed changing climate has a crucial effect on the vitality of both species. To improve our understanding of spruce and beech responses to climate change, including more frequent temperature and drought extremes, we investigated the impact of temporal climate variability on the growth of these species along an elevation gradient. In total, 79 spruce and 90 beech trees were used to build species-specific tree-ring width chronologies representing the altitudinal range in which both species grow (450, 650, 800, and 950m asl) under the conditions of the Czech Republic. The climate–growth relationship indicates strong dependence of spruce and beech tree-ring growth on spring temperature (Mar–May) at all sites and summer (Jun–Aug) water availability at lower altitudes. Significant temporal shifts in the climate–growth relationships of both species indicate an increasing negative effect of summer temperature and positive effect of water availability in summer. The increasing drought and temperature sensitivity of both species suggest a significant impact of the predicted climate change on such forest ecosystems. Discussion emphasizes the current importance of adaptive forest management strategies.

The Newport Medieval Ship, Wales, United Kingdom

The Newport Ship is the most substantial late medieval vessel excavated and recovered in Britain in recent years. It was abandoned after extensive salvage, possibly following attempts at repairs to the hull. More than 23 m of the clinker-built ship were recovered, along with significant artefact and environmental assemblages. Finds point to strong Iberian connections during the active life of the ship, which arrived in Newport in the Severn Estuary, after the spring of AD 1468. The dismantling and recovery of the ship has enabled detailed recording using innovative 3D digital techniques and approaches to hypothetical reconstruction. Publication includes a digital archive hosted by the Archaeological Data Service, a substantial report and this article.

Black and White

On Being a DoctorAugust 20, 2013Black and WhiteDaniel E. Epner, MDDaniel E. Epner, MDFrom MD Anderson Cancer Center, Houston, Texas.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-159-4-201308200-00015 Audio Reading - “Black and White” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Black and White," by D.E. Epner. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Mrs. Connor was a 51-year-old woman with stage IV colon cancer who was referred to our clinical trials unit after receiving extensive salvage chemotherapy. She was hospitalized for hyperbilirubinemia and possible biliary decompression in preparation for trial enrollment. Within seconds of meeting her, I knew that she would not be a candidate for experimental therapy.She was severely cachectic and debilitated, barely able to sit up in bed. Her belly was tensely swollen. An abdominal CT scan revealed extensive ascites and hepatic metastases nearly replacing the liver. I knew that I was about to embark on the heart-wrenching task of ... Author, Article, and Disclosure InformationAffiliations: From MD Anderson Cancer Center, Houston, Texas.Corresponding Author: Daniel E. Epner, MD, Department of Palliative Care and Rehabilitation Medicine, Unit 1414, MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030; e-mail, [email protected]. PreviousarticleNextarticle Advertisement Audio Reading - “Black and White” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Black and White," by D.E. Epner. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics August 20, 2013Volume 159, Issue 4Page: 304-305KeywordsAscitesBreathingChemotherapyClinical trialsColorectal cancerComputed axial tomographyEnd of life careInflammationLiverMultiple sclerosisQuality of lifeStent implantation ePublished: 20 August 2013 Issue Published: August 20, 2013 Copyright & PermissionsCopyright © 2013 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Utility of [11C]choline PET/CT in guiding lesion-targeted salvage therapies in patients with prostate cancer recurrence localized to a single lymph node at imaging: Results from a pathologically validated series

ObjectivePositron emission tomography (PET)/computed tomography (CT) has been shown to be a valid tool in detecting lymph node (LN) metastases in men with biochemical recurrence after radical prostatectomy. We assessed its validity in detecting a single positive LN at pathologic examination in regard to an increasing interest in lesion-targeted salvage therapies. Methods and materialsWe included 46 patients with biochemical recurrence after radical prostatectomy and a single positive spot at [11C]choline PET/CT who underwent pelvic or pelvic and retroperitoneal LN dissection. The ability of [11C]choline PET/CT in identifying the exact positive LN was assessed with the positive predictive value (PPV) in the overall population and according to androgen deprivation therapy, prostate-specific antigen value, and site of PET/CT positivity. ResultsOverall, 30 patients (65%) had positive LNs at pathologic examination. Of these, only 16 (35%) had pathologically confirmed metastases in the same lymphatic region and 11 (24%) had involvement of 1 single LN. Conversely, 28 patients had positive LNs in other areas and 8 had no evidence of metastases. The overall PPV of PET/CT was 34.8% and 23.9% when exact concordance was defined according to the lymphatic landing site and single positive LN, respectively. The PPV ranged from 33.3% to 44.4% and from 17.9% to 28.6%, in men with and without androgen deprivation therapy, respectively. ConclusionsThe PPV [11C]choline of PET/CT in correctly identifying patients with a single positive LN at salvage LN dissection is poor (24%). Therefore, extensive salvage treatment approaches are needed to maximize the chance of cure.

Functional Gait Analysis Before and After Delayed Military Trauma-Related Amputation: A Report of Three Cases.

The current conflicts in Iraq and Afghanistan have produced a large number of service members with severe combat-related injuries. Eighty-two percent of service members with combat-related injuries have sustained extremity trauma, which accounts for 54% of wounds overall1. Of all the lower-extremity amputations performed at military treatment facilities, approximately 13% (125 of 975) were the result of delayed or “elective” procedures2. Recent studies have shown that the outcomes of extensive salvage procedures for severely injured limbs are not necessarily definitive in a nonmilitary population3 and that early amputation can be preferable to limb salvage in many such instances3-12. Some military and nonmilitary population studies have considered a delayed amputation as occurring within as little as twenty-four hours postinjury, while other studies have cited a range over years4,13,14. Up to 15% of combat-related amputations have occurred later than twelve weeks postinjury, and the military medical community has adopted this as a reasonable timeframe during which initial operative efforts at limb salvage can be attempted2,14. Given the incidence of trauma-related amputation in the active duty military population, as well as the likely underreported frequency of similar scenarios in civilian trauma settings3,8,15-17, the goal of this report is to provide an analysis of gait in combat-injured patients before and after delayed amputation. Our institutional review board approved the retrospective review of the data presented in this manuscript. The three patients included in this case series were informed that data would be submitted for publication, and they all gave consent. Case 1. A forty-one-year-old male U.S. Navy navigator was involved in a midair collision and was ejected from his aircraft. Upon landing, he sustained a Gustilo …

Historique de la recherche

This chapter introduces the ensemble of the archaeological harbour site of Parc Saint-Georges, Lyon (Rhône region) that lies at the level of the ancient right bank of the Saône River. Commencing with the location and circumstances of this extensive salvage excavation (2004-2006), the principal characteristics of this land dig within a caisson of moulded concrete walls are then presented. After a description of the technical conditions of the dig and the complexity of the means employed, the principal results are mentioned begin-ning with the topographie évolution of this arm of the Saône River and its associated harbour vestiges. Then, the evolution of the port itself, in relation to the shipwrecks and the developments of the river bank, is described following a chronological progression. The modestly equipped Gallo-Roman river port of Lugdunum was followed by the development of a riverside quarter during the Middle Ages and by the creation of the port du Sablet in the 14th century, and then its enlargement throughout the following centuries (16th &amp; 17th centuries). The evolution of the harbour structure in the 18th century was expressed in important architectural developments of the river bank (access stairs to the water, quays) that were striking within the urban fabric of Lyon and in terms of the economie significance of the port. Finally, the restructuring of the quays and the port district of Saint-Georges during the 19th and 20th centuries isolated the former port zone, whether ancient, medieval or modem, from the Saône River. The last stage of this reshaping of the river bank involved the digging of the underground parking area that would lead to the salvage excavation of the site and to the discovery of the 16 ships. The museographie future of those chosen as architectural exemplars is discussed.

The Tragedy of the Ehime Maru and the Role of Baseball in the Healing Process

The Tragedy of the Ehime Maru and the Role of Baseball in the Healing Process Frank Ardolino (bio) The tragedy of the Ehime Maru and its aftermath illustrates an important aspect of human reaction to calamities. Official apologies, culturally sensitive recovery and treatment of the dead, financial settlements, and time all played essential parts in the healing process, but what aided the final reconciliation was young boys from both countries playing baseball. The games played in Japan and Hawaii helped those affected by the tragedy to move beyond it and to forge new ties of friendship and cooperation. On February 9, 2001, at 1:43 p.m., nine miles south of Diamond Head, the famous Honolulu landmark, a terrible naval accident occurred.1 A Japanese fishing trawler, the Ehime Maru, was struck and sunk by a surfacing nuclear submarine, the USS Greeneville. The Ehime Maru was a training boat for future fishermen from the Ehime Prefectural Uwajima Fisheries High School. On board were twenty crew members, two teachers, and twelve second-year students, who were spending a semester on the ship. When the ship was struck by the Greeneville, the sub's rudder hit the hull at the stern where the engine room was located and tore a hole in the five-hundred-ton ship. The crew heard a loud thump, like banging a fifty-five-gallon drum with a baseball bat, and felt the ship shudder; power was lost almost immediately, and water poured into the ship, causing it to sink within ten minutes. Three Coast Guard boats arrived at 2:45, and within fifteen minutes they had rescued twenty-six survivors, who were sick from swallowing diesel oil and were suffering from shock. However, nine people were missing: four seventeen-year-old students, two teachers, and three crew members. Christened on September 17, 1994, the Greeneville, a 360-foot super sub, had a crew of sixteen officers and 126 sailors who served under Commander Scott Waddle, a 1981 Annapolis graduate and the son of a retired Air Force colonel. Waddle seemed destined to become an admiral, but at the age of forty-one his nineteen-year career came to a tragic end when his sub, in executing a test [End Page 80] procedure, hit and sank the Ehime Maru. The major question raised was, in the words of an irate Honolulu resident, how a super sub was "not even capable of locating a ship floating peacefully above it." Japan demanded an immediate inquiry into the causes of the accident, an apology from the United States and Waddle, and an extensive salvage operation to recover the nine bodies. Waddle was immediately relieved of duty, and the Navy ordered that a court of inquiry be established to investigate the causes of the tragedy. Waddle was found guilty of violating articles 92 and 110 of the Uniform Code of Military Justice—dereliction in performance of his duties and negligent hazarding of a vessel. However, the court did not find him criminally negligent, and he was allowed to retire at full rank and pension, further angering Japan. The navy also conducted a $60 million salvage operation, which lasted twenty-one days and recovered eight bodies. The families of the crew members received a settlement of $16.5 million, and the navy paid $11.5 million to Ehime Prefecture for the rebuilding of the Ehime Maru, memorial services, and indemnities for the surviving crew members. Despite the financial settlements and the official apologies, there was a nagging sense that something else needed to be done to provide a more humane denouement to the tragedy. It was decided to hold a four-year home-and-home baseball series between teams from the Hawaiian Babe Ruth Leagues and Ehime Prefecture, ages 11–12 and 13–15. The Ehime-Hawaii Goodwill Baseball Association of Japan made the initial offer to Seiji Naya, director of the Hawaii Department of Business, Economic Development, and Tourism, who underscored the importance of the series: "Officials in Ehime are hoping to heal emotional wounds and promote positive relations through the common bond of youth baseball. What's important in this exchange is the healing that person-to-person contact will provide...

Exploratory analysis of forest harvest and regeneration pattern among multiple landowners

A land cover map (1993) was combined with an updated forest change detection map (1991–2000) to examine forest harvest activity, mostly on private commercial forest lands. Landsat change detection methods indicated that industrial forest owners harvested a higher percentage of forest than non-industrial owners in a northern Maine study area. In the 1980s, the percentage of forest harvested across all ownership classes (five) was higher, the mean harvest patch size was larger, patches were more compact, and the mean perimeter to area ratios were smaller compared to data from the 1990s. For all patch metrics, there was a significant time period effect but there was no effect among landowners. Larger harvest patch size in the 1980s may be partially explained by extensive salvage logging that occurred in the wake of a massive spruce budworm infestation in the 1970s. Softwood types were dominant (&gt; 80%) in regeneration stands approximately 15–25 years old on all ownerships. Medium spatial resolution Landsat imagery shows promise as a landscape level tool to monitor forest change patterns and trends across multiple ownerships. Key words: remote sensing, Landsat, change detection, harvest intensity, forest regeneration, forest landowners

Analgesic benefit, functional outcome, and patient satisfaction after partial wrist denervation.

Partial wrist denervation is a useful palliative procedure for chronic wrist pain when reconstructive procedures are not feasible or desirable. We reviewed 19 patients who had 20 isolated anterior and posterior interosseous neurectomies with no previous or concurrent wrist surgery in a 5-year period at our institution. At an average of 2.5 years postoperatively, 80% of patients reported a decrease in pain, 45% reported normal or increased grip strength, and 73% of employed patients had returned to work. Three patients required additional procedures for pain relief (2 arthrodesis, 1 radial styloidectomies). Failure tended to occur in the first postoperative year. Poor preoperative range of motion and workers' compensation status were predictive of failure. Failure also occurred in the single patient with rheumatoid arthropathy. Two patients had subsequent arthrodeses. There were no complications related to the surgery. Overall, 85% of patients reported satisfaction with this procedure; 90% retrospectively would choose the same treatment for their chronic wrist pain. Partial denervation of the wrist via the anterior and posterior interosseous nerves is a technically easy procedure and may provide pain relief sufficient to markedly delay the need for more extensive salvage procedures in patients with wrist arthritis.

Kinetics ofS-Adenosylmethionine Cellular Transport and Protein Methylation inTrypanosoma brucei bruceiandTrypanosoma brucei rhodesiense

African trypanosomes of theTrypanosoma bruceigroup are agents of disease in man and animals. They present unique biochemical characteristics such as the need for preformed purines and have extensive salvage mechanisms for nucleoside recovery. In this regard we have shown that trypanosomes have a dedicated transporter forS-adenosylmethionine (AdoMet), a key metabolite in transmethylation reactions and polyamine synthesis. In this study we compared the apparent kinetics of AdoMet transport, cytosolic AdoMet pool formation, and utilization of AdoMet in protein methylation reactions using two isolates:Trypanosoma brucei brucei,a veterinary parasite, andTrypanosoma brucei rhodesiense,a human pathogen that is highly refractory and has greatly reduced susceptibility to standard trypanocidal agents active againstT. b. brucei.The apparentKmvalues for [methyl-3H]AdoMet transport, derived by Hanes–Woolf analysis, forT. b. bruceiwas 4.2 and 10 mM forT. b. rhodesiense,and theVmaxvalues were 124 and 400 μmol/liter/min, respectively. Both strains formed substantial cytosolic pools of AdoMet, 1600 nmol/109T. b. bruceiand 3500 nmol/109T. b. rhodesienseafter 10 min incubation with 25 mM exogenous AdoMet. Data obtained from washed trichloroacetic acid precipitates of cells incubated with [methyl-3H]AdoMet indicated that the rate of protein methylation inT. b. bruceiwas fourfold greater than inT. b. rhodesiense.These results demonstrate that the unique rapid uptake and utilization of AdoMet by African trypanosomes is an important consideration in the design and development of new agents of potential use in chemotherapy.

THE RIO ORINOCO AND THE HAVEN—TWO MAJOR CASES FROM A LEGAL POINT OF VIEW

ABSTRACT The International Oil Pollution Compensation Fund (IOPC Fund), an inter-governmental organization with 49 member states, has recently been involved in two major oil spills of great interest from both a legal and a technical point of view. The Rio Orinoco incident occurred in Canada and the Haven incident took place in Italy. The Rio Orinoco was carrying asphalt when it grounded in the Gulf of St Lawrence. The grounding led to extensive salvage and cleanup operations carried out on behalf of the Canadian authorities. The claims for compensation, totalling 15 million Canadian dollars (12.5 million U.S. dollars), were settled out of court. This paper discusses the main legal problems that arose, for example, the reasonableness of certain operations and the relationship between pollution prevention and salvage. The Haven exploded off Genoa with 144,000 metric tons of crude oil on board. A large quantity of oil escaped, necessitating extensive cleanup operations in Italy, France, and Monaco. Over 1,300 claims for compensation have been submitted totalling US$1.4 billion. This paper deals with some of the main legal problems that have arisen as a result of this incident, for example, the admissibility of claims relating to non-economic damage to the marine environment and the method to be applied for the conversion of the maximum amount payable by the IOPC Fund into Italian lire.