Our study highlights that simple clinical variables, long procedures, and operative complications have a negative impact on procedural outcomes. Based on this, it may be possible to predict cases requiring collaboration with experienced surgeons in order to minimize perioperative morbidity.
The purpose of this study was to analyze our experience with surgically treated isolated adrenal metastases in order to find those factors which can significantly affect survival. This method includes a retrospective single-center chart review. We evaluated how overall survival and disease-free survival (DFS) were influenced by demographic, tumor, and procedure-related variables. Thirty-seven adrenalectomies were performed in 34 patients. Procedures included 25 laparoscopic and 12 open adrenalectomies. Median follow-up was 49 months. Median overall survival was 63 months. Patients submitted to laparoscopic approach had a median survival of 57 months while it was 65 months for those who underwent open procedure (p = 0.67). DFS was 30 months, and these were 35 and 25 months after laparoscopic approach and open approach, respectively (p = 0.59). The concurrent resection of the adrenal metastasis with the primary tumor was the only factor influencing DFS (HR 6.8 95 % CI 1.2-37.3, p = 0.02). Patients with non-small cell lung cancer (n = 15) had a median survival of 63 months and DFS of 35 months. Our experience confirms that adrenalectomy, regardless of the surgical approach, can offer durable disease-free and overall survival outcomes for surgical candidates with isolated adrenal metastases.
Background: Actinomycosis is a rare, insidious, infectious disease. Cervicofacial, thoracic and abdominopelvic districts are most commonly involved. Its tendency to involve surrounding structures may mimic a tumor on imaging studies. Early diagnosis, obtained with mini-invasive methods or surgical biopsy, is fundamental to optimize therapeutic approach and to reduce morbidity due to aggressive surgery. Antibiotic therapy is the cornerstone of the treatment of actinomycosis, but the combination with a surgical resection can be necessary in patients who do not respond to medical treatment. Methods: A 66-years old female presented at our attention with an abdominal, retroperitoneal mass found during clinical tests for a vertiginous syndrome. Patient presented with asthenia, anorexia, weight loss, and sacral pain. A retroperitoneal mass, studied with Computed tomography (CT) and Positron emission tomography (PET), was found. No inflammatory signs were found in laboratory tests. Previous core biopsies did not provide the expected results. Cause of that, the patient was prepared for a surgical laparoscopic biopsy and ureteral stenting. After frozen biopsies, histological findings have identified filaments of Actinomyces. No apparent cause of this infection has been identified at first exploration. Results: The patient was treated with antibiotic therapy for three months (Amoxicillin: 1g three times daily). At three months first follow-up, the CT shows the reduction of the retroperitoneal mass and the presence of diverticulosis of the sigma near the mass, in absence of signs of fistulisation. Conclusion: Abdominopelvic actinomycosis should be considered in patients with unusual abdominal mass on abdominal CT or PET. Early diagnosis is necessary to avoid aggressive surgery and its morbidities. Open/laparoscopic surgical biopsy is often necessary to identify the infection. Antibiotic therapy is the standard treatment but surgery can help to optimize medical approach removing necrotic tissue and persistent sinuses.
The use of advanced sealing devices was associated with reduced operative time, particularly with left adrenalectomy.
Background The catabolism of the essential amino acid tryptophan to kynurenine is emerging as a potential key pathway involved in post-cardiac arrest brain injury. The aim of this study was to evaluate the effects of the modulation of kynurenine pathway on cardiac arrest outcome, through genetic deletion of the rate-limiting enzyme of the pathway, indoleamine-2,3-dyoxygenase(IDO). Methods Wild-type (WT) and IDO-deleted (IDO -/-) mice were subjected to 8 min cardiac arrest. Survival, neurological outcome, and locomotor activity were evaluated following resuscitation. Brain magnetic resonance imaging with diffusion tensor and diffusion-weighted imaging sequences was performed, together with microglia/macrophage activation and neurofilament light chain measurements. Results IDO-/- mice showed higher survival compared to WT mice (IDO-/- 11/16, WT 6/16, log-rank p=0.036). Neurological function was higher in IDO-/- mice than in WT mice following cardiac arrest (IDO-/- 9±1, WT 7±1, p=0.012, n=16). IDO-deletion preserved locomotor function while maintaining physiologic circadian rhythm after cardiac arrest. Brain magnetic resonance imaging with diffusion tensor imaging showed an increase in mean fractional anisotropy in the corpus callosum (IDO-/- 0.68±0.01, WT 0.65±0.01, p=0.010, n=5-4) and in the external capsule (IDO -/- 0.47±0.01, WT 0.45±0.01, p=0.006, n=5-4) in IDO-/- mice compared to WT ones. Increased release of neurofilament light chain was observed in WT mice compared to IDO-/- (median concentrations (IQR), pg/mL: WT 1138 (678–1384), IDO-/- 267 (157–550), p<0.001, n=3-4). Brain magnetic resonance imaging with diffusion-weighted imaging revealed restriction of water diffusivity 24 hours after cardiac arrest in WT mice, IDO-deletion prevented water diffusion abnormalities, which was reverted in IDO-/- mice receiving L-kynurenine (Apparent Diffusion Coefficient, μm2/ms: WT 0.48±0.07, IDO-/- 0.59±0.02, IDO-/- +L-Kynurenine 0.47±0.08, p=0.007, n=6). Conclusions Kynurenine pathway represents a novel target to prevent post-cardiac arrest brain injury. The neuroprotective effects of IDO-deletion were associated with preservation of brain white matter microintegrity and with reduction of cerebral cytotoxic edema.
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