Long-Term Survival after High-Dose Chemotherapy Followed by Peripheral Stem Cell Rescue for High-Risk, Locally Advanced/Inflammatory, and Metastatic Breast Cancer

Patients with high-risk locally advanced/inflammatory and oligometastatic (≤3 sites) breast cancer frequently relapse or experience early progression. High-dose chemotherapy combined with peripheral stem cell rescue may prolong progression-free survival/relapse-free survival (PFS/RFS) and overall survival (OS). In this study, patients initiated high-dose chemotherapy with STAMP-V (carboplatin, thiotepa, and cyclophosphamide), ACT (doxorubicin, paclitaxel, and cyclophosphamide), or tandem melphalan and STAMP-V. Eighty-six patients were diagnosed with locally advanced/inflammatory (17 inflammatory) breast cancer, and 12 were diagnosed with oligometastatic breast cancer. Median follow-up was 84 months (range, 6-136 months) for patients with locally advanced cancer and 40 months (range, 24-62 months) for those with metastatic cancer. In the patients with locally advanced cancer, 5-year RFS and OS were 53% (95% CI, 41%-63%) and 71% (95% CI, 60%-80%), respectively, hormone receptors were positive in 74%, and HER2 overexpression was seen in 23%. In multivariate analysis, hormone receptor–positive disease and lower stage were associated with better 5-year RFS (60% for ER [estrogen receptor]/PR [progesterone receptor]-positive versus 30% for ER/PR-negative; P < .01) and OS (83% for ER/PR-positive versus 38% for ER/PR-negative; P < .001). In the patients with metastatic cancer, 3-year PFS and OS were 49% (95% CI, 19%-73%) and 73% (95% CI, 38%-91%), respectively. The favorable long-term RFS/PFS and OS for high-dose chemotherapy with peripheral stem cell rescue in this selected patient population reflect the relative safety of the procedure and warrant validation in defined subgroups through prospective, randomized, multi-institutional trials

Idiopathic Popliteal Artery Pseudoaneurysm: Emergency Diagnosis And Treatment [pseudoaneurisma Idiopático Da Artéria Poplítea: Abordagem Diagnóstico-terapêutica Na Urgência]

Pseudoaneurysms or false aneurysms of the popliteal artery are uncommon arterial disorders. These disorders most commonly result from trauma and iatrogenic lesions following orthopedic procedures. The authors report a rare case of popliteal artery pseudoaneurysm in which etiology was unknown. The authors also demonstrate that Doppler ultrasonography may be sufficient for planning vascular surgical procedures and that the open surgical approach is the treatment of choice for cases in which the symptomatic lesion causes local compression.133244248Tedesco, M.M., Dalman, R.L., Arterial aneurysms (2010) Rutherford's Vascular Surgery, pp. 559-615. , In: Cronenwett JL, Johnston KW, editors, 7th ed. Philadelphia: ElsevierMiyamotto, M., Moreira, R.C.R., Erzinger, F.L., França, G.J., Cunha, A.G.P., Pseudo-aneurisma idiopático da artéria poplítea (2004) J Vasc Bras, 3 (2), pp. 169-171Gillespie, D.L., Cantelmo, N.L., Traumatic popliteal artery pseudoaneurysms: Case report and review of the literature (1991) J Trauma, 31 (3), pp. 412-415. , http://dx.doi.org/10.1097/00005373-199103000-00019, PMid: 2002532Bel Haj Salah, R., Triki, W., Gherib, S.B., Ben Moussa, M., Zaouche, A., Traumatic popliteal artery pseudo aneurysm (2011) Tunis Med, 89 (8-9), pp. 721-722. , PMid: 21948669Szyber, P., Jr., Skóra, J., Rybak, W., Pupka, A., Iatrogenic pseudoaneurysm of the popliteal artery following corrective tibial osteotomy (2011) Vasa, 40 (5), pp. 414-417. , http://dx.doi.org/10.1024/0301-1526/a000140, PMid: 21948786Tsuji, Y., Kitano, I., Iida, O., Kajita, S., Sawada, K., Nanto, S., Popliteal pseudoaneurysm caused by stent fracture (2011) Ann Vasc Surg, 25 (6), pp. 840.e5-840.e8. , http://dx.doi.org/10.1016/j.avsg.2010.12.039, PMid: 21620667Kao, C.L., Chang, J.P., Pseudoaneurysm of the popliteal artery: A rare sequela of acupuncture (2002) Tex Heart Inst J, 29 (2), pp. 126-129. , PMid: 12075870Pavić, P., Vergles, D., Sarlija, M., Ajduk, M., Cupurdija, K., Pseudoaneurysm of the popliteal artery in a patient with multiple hereditary exostoses (2011) Ann Vasc Surg, 25 (2), pp. 268.e1-268.e2. , http://dx.doi.org/10.1016/j.avsg.2010.07.027, PMid: 20926234Pellenc, Q., Capdevila, C., Julia, P., Fabiani, J.N., Ruptured popliteal artery pseudoaneurysm complicating a femoral osteochondroma in a young patient (2012) J Vasc Surg, 55 (4), pp. 1164-1165. , http://dx.doi.org/10.1016/j.jvs.2011.01.060, PMid: 21459549Ge, P.S., Ishaque, B.M., Bonilla, J., de Virgilio, C., Popliteal artery pseudoaneurysm after isolated hyperextension of the knee (2010) Ann Vasc Surg, 24 (7), pp. 950.e7-950.e11. , http://dx.doi.org/10.1016/j.avsg.2010.01.014, PMid: 20471789Koksoy, C., Gyedu, A., Alacayir, I., Bengisun, U., Uncu, H., Anadol, E., Surgical treatment of peripheral aneurysms in patients with Behcet's disease (2011) Eur J Vasc Endovasc Surg, 42 (4), pp. 525-530. , http://dx.doi.org/10.1016/j.ejvs.2011.05.010, PMid: 21641238Ghassani, A., Delva, J.C., Berard, X., Deglise, S., Ducasse, E., Midy, D., Stent graft exclusion of a ruptured mycotic popliteal pseudoaneurysm complicating sternoclavicular joint infection (2012) Ann Vasc Surg, 26 (5), pp. 730.e13-730.e15. , http://dx.doi.org/10.1016/j.avsg.2011.09.015, PMid: 22664287Erler, K., Ozdemir, M.T., Oguz, E., Basbozkurt, M., Does false aneurysm behave like a sarcoma? Distal femoral arterial false aneurysm simulated a malign mesenchymal tumor. A case report and review of the literature (2004) Arch Orthop Trauma Surg, 124 (1), pp. 60-63. , http://dx.doi.org/10.1007/s00402-003-0595-8, PMid: 14576956Kim, Y.J., Baek, W.K., Kim, J.Y., Pseudoaneurysm of the popliteal artery mimicking tumorous condition (2011) J Korean Surg Soc, 80, pp. S71-S74. , http://dx.doi.org/10.4174/jkss.2011.80.Suppl1.S71, PMid: 2206609Fitzgerald, E.J., Bowsher, W.G., Ruttley, M.S., False aneurysm of the femoral artery: Computed tomographic and ultrasound appearances (1986) Clin Radiol, 37 (6), pp. 585-588. , http://dx.doi.org/10.1016/S0009-9260(86)80033-2, PMid: 3539457Callcut, R.A., Acher, C.W., Hoch, J., Tefera, G., Turnipseed, W., Mell, M.W., Impact of intraoperative arteriography on limb salvage for traumatic popliteal artery injury (2009) J Trauma, 67 (2), pp. 252-257. , http://dx.doi.org/10.1097/TA.0b013e31819ea796, PMid: 19667876, discussion 257-8Proia, R.R., Walsh, D.B., Nelson, P.R., Early results of infragenicular revascularization based solely on duplex arteriography (2001) J Vasc Surg, 33 (6), pp. 1165-1170. , http://dx.doi.org/10.1067/mva.2001.115376, PMid: 11389413Ascher, E., Hingorani, A., Markevich, N., Costa, T., Kallakuri, S., Khanimoy, Y., Lower extremity revascularization without preoperative contrast arteriography: Experience with duplex ultrasound arterial mapping in 485 cases (2002) Ann Vasc Surg, 16 (1), pp. 108-114. , http://dx.doi.org/10.1007/s10016-001-0130-8, PMid: 11904814Pulli, R., Dorigo, W., Castelli, P., A multicentric experience with open surgical repair and endovascular exclusion of popliteal artery aneurysms (2013) Eur J Vasc Endovasc Surg, 45 (4), pp. 357-363. , http://dx.doi.org/10.1016/j.ejvs.2013.01.012, PMid: 23391602Trinidad-Hernandez, M., Ricotta, J.J., II, Gloviczki, P., Results of elective and emergency endovascular repairs of popliteal artery aneurysms (2013) J Vasc Surg, 57 (5), pp. 1299-1305. , http://dx.doi.org/10.1016/j.jvs.2012.10.112, PMid: 23375609Zaraca, F., Ponzoni, A., Stringari, C., Ebner, J.A., Giovannetti, R., Ebner, H., The posterior approach in the treatment of popliteal artery aneurysm: Feasibility and analysis of outcome (2010) Ann Vasc Surg, 24 (7), pp. 863-870. , http://dx.doi.org/10.1016/j.avsg.2010.04.005, PMid: 2083198

Prediction of long-term outcomes of HIV-infected patients developing non-AIDS events using a multistate approach

Outcomes of people living with HIV (PLWH) developing non-AIDS events (NAEs) remain poorly defined. We aimed to classify NAEs according to severity, and to describe clinical outcomes and prognostic factors after NAE occurrence using data from CoRIS, a large Spanish HIV cohort from 2004 to 2013. Prospective multicenter cohort study. Using a multistate approach we estimated 3 transition probabilities: from alive and NAE-free to alive and NAE-experienced ("NAE development"); from alive and NAE-experienced to death ("Death after NAE"); and from alive and NAE-free to death ("Death without NAE"). We analyzed the effect of different covariates, including demographic, immunologic and virologic data, on death or NAE development, based on estimates of hazard ratios (HR). We focused on the transition "Death after NAE". 8,789 PLWH were followed-up until death, cohort censoring or loss to follow-up. 792 first incident NAEs occurred in 9.01% PLWH (incidence rate 28.76; 95% confidence interval [CI], 26.80-30.84, per 1000 patient-years). 112 (14.14%) NAE-experienced PLWH and 240 (2.73%) NAE-free PLWH died. Adjusted HR for the transition "Death after NAE" was 12.1 (95%CI, 4.90-29.89). There was a graded increase in the adjusted HRs for mortality according to NAE severity category: HR (95%CI), 4.02 (2.45-6.57) for intermediate-severity; and 9.85 (5.45-17.81) for serious NAEs compared to low-severity NAEs. Male sex (HR 2.04; 95% CI, 1.11-3.84), ag