The 51.7% incidence of strictures after BDI repair in this study was higher than reported in the literature, probably because of selection bias secondary to the referral pattern. The timing of repair and the surgeon's expertise are significant risk factors of failure.
Background: Prognosis of patients following resection of CRC metastases to the liver has traditionally been predicted by clinical risk factors. In the era of neoadjuvant chemotherapy, determination of new prognostic indicators of outcome are necessary. Methods: This retrospective study includes patients with CRC liver metastases, who received oxaliplatin or irinotecan based neoadjuvant chemotherapy and underwent R0 resection. Patients were followed by CT and PET-CT, before, during and after chemotherapy and surgery. The predictive value of the Memorial Sloan-Kettering Cancer Center Clinical Score (MSKCC-CS) and degree of response to chemotherapy (measured by CT and PET-CT), were analyzed by univariate and multivariate COX regression. Results: Included are 54 patients. Overall 1-, 2-, 3-year survival rates 88%, 70%, and 39%. Response to chemotherapy on CT was a significant predictor of survival on univariate (P ¼ 0.03) and multivariate analysis (P ¼ 0.03), whereas MSKCC-CS and response to chemotherapy on PET-CT were not. Multivariate analysis demonstrated response to chemotherapy as a predictor of time to recurrence on CT (P ¼ 0.02) and PET-CT (P ¼ 0.03), while the MSKCC-CS (P ¼ 0.64) was not. Conclusions: In this cohort of patients treated by neoadjuvant chemotherapy, the outcome was not predicted by the traditional clinical scoring system, but rather by response to chemotherapy as evaluated by CT and PET-CT.
The diagnosis of late acute graft pancreatitis is clinical, with confirmatory computed tomography or ultrasound imaging. Conservative treatment yields excellent graft and patient survival.
His abdominal examination was significant for an exquisitely tender right upperquadrant but without signs of peritoneal inflammation. He had a scarlitiniform rash on his face, trunk, and extremities, but no Pastia lines. Ocular and oropharyngeal examination were unremarkable, and neither extremity changes nor cervical adenopathy were present. His laboratory tests were remarkable for a sodium of 132 mmol/L
PREVIOUSLY HEALTHY 6-YEAR-OLD BOY PREsented to the emergency department (ED) with 2 weeks of progressive right leg pain and a limp. He reported pain only when bearing weight or with extension of his right knee, although his parents noted he had been waking from sleep in pain. He denied a history of trauma and had not experienced joint swelling or erythema. He had not had fever, weight loss, or recent infections and confirmed normal voiding patterns. Our patient saw his pediatrician for this same concern 3 days before our evaluation and was found to have a minimally elevated
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