Znaczenie objętości przepływu w tętnicach dogłowowych dla postępowania klinicznego – wpływ rozwoju krążenia obocznego

Aim: An assessment of increased compensatory blood flow in the brain-supplying arteries in patients with significant carotid artery stenosis. Materials and methods: Doppler ultrasound was performed in 218 patients over 60 years of age to evaluate both the degree of brain-supplying artery stenosis as well as the blood flow volume balance in all vessels supplying the brain: the internal carotid artery, the external carotid artery and the vertebral artery. The control group included 94 patients with no stenosis in the extracranial segments and no neurological manifestations, in whom blood flow values were calculated (the internal carotid artery – 290 mL/min, the external carotid artery – 125 mL/min, the vertebral artery – 80 mL/min); the total mean blood flow in the brain-supplying arteries was 985 mL/min. A 33% increase in blood flow was considered compensatory. In addition to the control group, 30 patients with asymptomatic stenosis of less than 50% and 12 patients after endarterectomy with mean blood flow of 920 mL/min and 960 mL/min, as well as two groups of particular interest to us, i.e. 38 patients with no compensatory blood flow increase despite significant stenosis (>50%) with mean blood flow of 844 mL/ min and 44 patients with similar stenosis and with compensatory blood flow increase up to 1174 mL/min were included in the analysis. Results: Comparison of the two groups showed several significant differences: increased blood flow (118% vs. 86% of the norm) in patients with compensated stenosis, an increased number of asymptomatic patients (70% vs. 37%) and a threefold increase in the number of patients with occlusions (15 : 5) in the group of patients with increased blood supply to the brain. Conclusions: All potential blood-supplying vessels, including the external carotid artery, are involved in brain tissue perfusion in some of the patients with significant stenosis. Determining the degree of compensation may have an important impact on the indications for surgical treatment, which will make a valuable contribution to the current criteria (asymptomatic/ symptomatic patients).Cel pracy: Ocena wpływu kompensacyjnego wzrostu przepływu w naczyniach dogłowowych u chorych z istotnymi zwężeniami tętnic szyjnych. Materiał i metoda: U 218 chorych powyżej 60. roku życia wykonano rozszerzone badanie ultrasonograficzne z opcją dopplera w celu oceny zarówno stopnia zwężenia naczyń dogłowowych, jak i bilansu objętości przepływu we wszystkich głównych naczyniach doprowadzających krew do mózgu: tętnicy szyjnej wewnętrznej, tętnicy szyjnej zewnętrznej i tętnicy kręgowej. Grupę kontrolną stanowiło 94 pacjentów bez zwężeń naczyń w odcinkach przedczaszkowych oraz bez objawów neurologicznych, u których obliczono normy przepływu w naczyniach (tętnica szyjna wewnętrzna – 290 ml/min, tętnica szyjna zewnętrzna – 125 ml/min, tętnica kręgowa – 80 ml/min); całkowity przepływ w naczyniach dogłowowych wynosił u nich średnio 985 ml/min. Za kompensacyjny wzrost uznano zwiększenie przepływu o 33%. Poza grupą kontrolną analizie poddano 30 pacjentów z bezobjawowymi zwężeniami poniżej 50% i 12 osób po endarterektomii ze średnimi przepływami 920 ml/min i 960 ml/min, a także dwie szczególnie interesujące nas grupy: 38 pacjentów bez kompensacyjnego wzrostu przepływu pomimo istotnych (>50%) zwężeń ze średnim przepływem 844 ml/min oraz 44 chorych z kompensacyjnym wzrostem przepływu do 1174 ml/min przy podobnych zwężeniach. Wyniki: Porównanie dwóch grup wykazało kilka istotnych różnic: większy przepływ (118% vs 86% normy) u chorych ze skompensowanymi zwężeniami, większą liczbę chorych bezobjawowych (70% vs 37%) oraz trzykrotnie więcej chorych z niedrożnościami (15 : 5) w grupie pacjentów ze zwiększonymi przepływami domózgowymi. Wnioski: Wszystkie naczynia mogące doprowadzić krew do mózgu, w tym tętnica szyjna zewnętrzna, u części chorych z istotnymi zwężeniami biorą udział w zapewnieniu perfuzji tkanki mózgowej. Określenie stopnia kompensacji może w istotny sposób wpłynąć na wskazania do leczenia zabiegowego, co stanowi cenne uzupełnienie dotychczasowych kryteriów (pacjenci bezobjawowi/objawowi)

Is there a rationale for aggressive breast cancer liver metastases resections in Polish female patients? Analysis of overall survival following hepatic resection at a single centre in Poland

Introduction Breast cancer (BC) makes up nearly 26% of malignant tumours worldwide and is the leading cause of cancer-related deaths in European women. With approximately 18,000 new cases of BC diagnosed in Polish women annually, breast cancer liver metastasis (BCLM) is respectively an increasing issue. Recent data found in literature indicates improved survival following liver resection with systemic therapy. Objective The aim of study was to evaluate surgical treatment in patients with isolated BCLM. Material and Methods During 2009–2013, a retrospective study was undertaken and 30 cases analysed. From nearly 2,000 liver resections performed, 11 female patients at the mean age of 59.18 years with BCLM were qualified for surgery. Results The median time between primary and secondary treatment was 3.5 years (1–7). One patient (9.1%) presented an extrahepatic lesion – bone metastasis. The left lobe, right lobe and both lobes of the liver were affected, respectively, in 3 (27.3%), 4 (36.4%) and 4 (36.4%) patients. 5 patients (45.5%) presented single hepatic lesion, in contrast to the maximum number of lesions which equalled 6 in the right lobe. Average hospitalisation period was 13.27 days and discharge on the 11.3 postoperative day. One-year survival was 72.7% (8 patients); therefore, three-year survival was 36.4% (4 patients). Conclusions Oncological centres should assess BCLM patients more openly and qualify them for hepatic resection along with adjuvant systemic treatment in order to improve overall survival. This, however, needs to be studied in a multicentre randomized trial

Is there a rationale for aggressive breast cancer liver metastases resections in Polish female patients? Analysis of overall survival following hepatic resection at a single centre in Poland

Introduction Breast cancer (BC) makes up nearly 26% of malignant tumours worldwide and is the leading cause of cancer-related deaths in European women. With approximately 18,000 new cases of BC diagnosed in Polish women annually, breast cancer liver metastasis (BCLM) is respectively an increasing issue. Recent data found in literature indicates improved survival following liver resection with systemic therapy. Objective The aim of study was to evaluate surgical treatment in patients with isolated BCLM. Material and Methods During 2009–2013, a retrospective study was undertaken and 30 cases analysed. From nearly 2,000 liver resections performed, 11 female patients at the mean age of 59.18 years with BCLM were qualified for surgery. Results The median time between primary and secondary treatment was 3.5 years (1–7). One patient (9.1%) presented an extrahepatic lesion – bone metastasis. The left lobe, right lobe and both lobes of the liver were affected, respectively, in 3 (27.3%), 4 (36.4%) and 4 (36.4%) patients. 5 patients (45.5%) presented single hepatic lesion, in contrast to the maximum number of lesions which equalled 6 in the right lobe. Average hospitalisation period was 13.27 days and discharge on the 11.3 postoperative day. One-year survival was 72.7% (8 patients); therefore, three-year survival was 36.4% (4 patients). Conclusions Oncological centres should assess BCLM patients more openly and qualify them for hepatic resection along with adjuvant systemic treatment in order to improve overall survival. This, however, needs to be studied in a multicentre randomized trial

Can Color Doppler Ultrasound Be Effectively Used as the Follow-Up Modality in Patients Undergoing Splenic Artery Aneurysm Embolization? A Correlational Study between Doppler Ultrasound, Magnetic Resonance Angiography and Digital Subtraction Angiography

Splenic artery aneurysm (SAAs) rupture is associated with a high mortality rate. Regular surveillance with imaging before and after intervention is crucial to guide best evidence treatment. The following study aimed to determine the efficacy of color Doppler ultrasound imaging (DUS) compared to digital subtraction angiography (DSA) and magnetic resonance angiography (MRA) as a follow-up modality after selective coil embolization of true SAAs. We analyzed data from 20 patients, 15 females (48.1 ± 16.1 years) undergoing selective SAA coil embolization using detachable fibered embolization coils. Imaging using DUS, MRA, and DSA was performed 3 months after the initial embolization or the consequent re-embolization procedure. Primary clinical success, defined as Class I aneurysm occlusion, on 3-month follow-up was seen in 16 (80.0%) patients. DUS had a sensitivity of 94.4% and a specificity of 42.9% when compared to DSA and 92.3% and 30%, respectively, when compared to MRA in identifying Class I aneurysm occlusion. The positive predictive value (PPV) of DUS in identifying the need for re-embolization was 75.0%, while the NPV of DUS in these terms was 90.5%. DUS showed a high sensitivity in detecting aneurysm occlusion and clinical success, simultaneously exhibiting poor specificity. Still, with caution, this follow-up modality could be used for monitoring select low-risk patients after selective embolization of SAAs. DUS could provide a higher cost-to-benefit ratio, enabling more systematic post-procedural follow-up, as it is far more commonly used compared to MRA and non-invasive compared to DSA