Role of surgery in the treatment of radiation-induced sarcomas of the head and neck

Introduction: Radiation-induced sarcoma (RIS) is a well-known complication of radiotherapy. It is an aggressive tumour and the prognosis is often poor, despite radical treatment. We aim to investigate the role of surgery in the treatment of patients with RIS of the head and neck region. Method: We conducted a retrospective review of records of patients whom were treated for radiation-induced sarcoma at Queen Mary Hospital, Hong Kong, between the period 1999 to 2010. Data collected included patient age, gender, latency period for the development of RIS, site of RIS, symptoms, treatment given, pathology and survival. Results: Nineteen patients were included, (M=11, F=8). Eighteen received radiotherapy for treatment of primary nasopharyngeal carcinoma. One received radiotherapy for carcinoma of the parotid. The medial latency period for the development of sarcoma was 11.1 years (range 5.3-25.1). The most common site for development of RIS was the neck (n=8), followed by the oropharynx/oral cavity (n=4), nasopharynx (n=3) nasal cavity (n=2), maxilla (n=1) and mandible (n=1). The most common histology was undifferentiated sarcoma (n=6). Nine patients underwent surgical resection of the RIS with curative intent, three and six patients achieved R0 and R1 resection respectively. Chemotherapy was used in eleven instances after surgery. Radiotherapy was used in seven instances, three through brachytherapy, four through external beam irradiation. Overall medial survival from diagnosis of RIS was 1.74 years (95% CI 0.60-2.87), which improves to 2.47 years (95% CI 0.97-3.97) when only calculating those whom surgery was performed. Conclusions: Patients suffering from radiation-induced sarcomas have a poor prognosis, in keeping with existing literature. Treatment is mainly by surgery aiming at resection with a curative intent. If curative resection is impossible, surgery may still have a role in palliating the patients’ symptoms such as bleeding, fungation, or painpublished_or_final_versio

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Initial experience of real-time capsule endoscopy in monitoring progress of the videocapsule through the upper GI tract

Background: Wireless capsule endoscopy (WCE) is one of the most important investigations for small bowel examination. Although newer-generation WCE is equipped with a real-time viewer, the role of this advancement in daily practice remains unknown. Objective: Our purpose was to determine the role of the real-time viewer for monitoring of the videoendoscope passage through the upper GI tract. Design: Case-control comparison. Setting: Single tertiary referral center. Patients: Forty-five consecutive patients who underwent capsule endoscopy in a 12-month period were studied. Twenty-seven patients received conventional WCE, whereas 18 patients were examined by real-time WCE. Passage into the small bowel was monitored with the real-time viewer in the second group of patients. Gastric transit time and the rate of complete small bowel examination were compared. Interventions: On-demand polyethylene glycol and erythromycin were prescribed according to the progress as viewed by the real-time monitor. Main Outcome Measurements: Small bowel examination completion rate and gastric transit time. Results: Small bowel examination was completed in 19 (70.4%) and 17 (94.4%) patients undergoing conventional and real-time WCE, respectively (P = .048). With the real-time monitoring and on-demand preparations, gastric passage time was significantly reduced (100 vs 59 minutes, P = .02). Limitations: Nonrandomized study. Conclusions: The use of the real-time viewer may help to secure the passage of the capsule endoscope into the small bowel and hence result in a higher rate of complete small bowel examination. © 2007 American Society for Gastrointestinal Endoscopy.link_to_subscribed_fulltex

Prolonged esophageal transit during wireless capsule endoscopy: A series of five cases and analysis of risk factors [1]

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Long-term follow-up of patients with obscure gastrointestinal bleeding after negative capsule endoscopy

BACKGROUND AND AIMS: Capsule endoscopy (CE) is one of the widely accepted investigations for obscure gastrointestinal bleeding (OGIB), but little is known about the impact of CE on the long-term outcome of patients with OGIB. We studied the long-term outcome of patients with OGIB after CE examination. PATIENTS AND METHODS: Forty-nine consecutive patients (45% men, mean age 58.3 yr) who underwent CE for OGIB were studied. The most clinically relevant finding that was related to bleeding was identified by CE. All patients were followed up for at least 12 months for clinical overt and occult bleeding. RESULTS: The median follow-up was 19 months (range 12 to 31). Possible bleeding lesions were detected by CE in 31 (63.3%) patients, and 15 (30.6%) patients, underwent further interventions including laparotomy and push enteroscopy. The overall long-term rebleeding rate in this cohort was 32.7%. The cumulative rebleeding rate was significantly lower in patients with a negative CE (5.6%) than in patients with a positive CE (48.4%, p = 0.03 log-rank test). The sensitivity and negative predictive value of CE in predicting rebleeding were 93.8% and 94.4%, respectively. CONCLUSIONS: Patients with OGIB and negative CE had a very low rebleeding rate, and further invasive investigations can be deferred. © 2006 by Am. Coll. of Gastroenterology Published by Blackwell Publishing.link_to_subscribed_fulltex

Inter-observer variations on interpretation of capsule endoscopies

Objective: Capsule endoscopy is a novel investigation for diagnosing small bowel diseases. However, its interpretation is highly subjective and the potential variability may compromise its accuracy and reliability. Here we studied the potential inter-observer variations on the interpretation of capsule endoscopy. Method: Two residents and one specialist in gastroenterology independently reviewed 58 capsule endoscopy studies in the same sequential order. The gastric transit time, small bowel transit time, and the most significant small bowel lesion were independently recorded. The consensus transit time was determined by the joint review of the three gastroenterologists. The 'gold standard' for small bowel diagnoses was based on final surgical, endoscopic findings or consensus diagnosis. Results: Clinically significant and relevant small bowel lesions were found in 32 (55%) cases by consensus review. The overall mean accuracy in determining gastric emptying time, small bowel transit time and small bowel lesion was 89%, 76% and 80%, respectively. There was a significant difference in the accuracy between the residents and specialist on small bowel transit time (P<0.05) and small bowel diagnosis (P<0.05). The mean kappa values on small bowel diagnosis among the three viewers was 0.56 (range, 0.52-0.59). Among various small bowel diagnoses, small bowel bleeding was more accurately identified than other pathology. Conclusions: Our results show that there is moderate degree of inter-observer discrepancies on the interpretation of capsule endoscopy. A second reading by an experienced viewer might improve the diagnostic accuracy of this investigation. © 2006 Lippincott Williams & Wilkins.link_to_subscribed_fulltex

一种可收纳袖子的运动文胸

Inventor name used in this publication: 张俊Inventor name used in this publication: 张诗晨Inventor name used in this publication: 刘民龙Inventor name used in this publication: 余咏文Inventor name used in this publication: 叶晓云Inventor name used in this publication: 易洁伦Inventor name used in this publication: 何绮雯Inventor name used in this publication:Title in Traditional Chinese: 一種可收納袖子的運動文胸China202006 bcrcVersion of Recor