Post-radiation fibrosarcoma of the breast

We report the first case of fibrosarcoma of stromal breast tissue occurring 11 years after breast-conserving therapy for breast cancer. A review of six cases of stromal malignant fibrous histiocytoma is presented, developing between 5 years and 11 years after breast radiation. Since all cases developed in the area of boost irradiation, abandoning the booster dose might reduce the incidence of secondary sarcomas. Treatment of radiation-induced sarcoma should be surgical, with wide excisional margins. A lifelong follow-up is recommended for patients treated with breast-conserving therapy for primary cancer

Usefulness and applicability of femorofemoral crossover bypass grafting.

We examined the usefulness of femorofemoral crossover bypass grafting ( FFC) and factors influencing its outcome by retrospectively analyzing all FFCs performed in our hospital over a 5-year period, focusing on both patency rates and clinical efficacy. For 95 patients Kaplan- Meier patency rates were calculated ( follow- up 40.4 +/- 3.0 months). Clinical outcome was defined according to Rutherford's standardized categories. The influence of cardiovascular risk factors and technical characteristics on outcome was determined. Clinical status of the limb remained improved in 89%. One- and 5- year primary, primary assisted, and secondary patency rates were 88.2% and 57.3%, 90.6% and 62.4%, and 92.6% and 68.1%, respectively. Clinical outcome of the limb was better in patients with <50% stenosis in the femoral arteries preoperatively (p = 0.033). No predictors for patency rates were identified. FFCs are effective in the medium long term for patients in all age categories independently of cardiovascular risk factors. The best predictor of clinical outcome is the preoperative degree of stenosis, with a better outcome for patients affected by <50% stenosis. Success of FFC cannot be reliably measured by graft patency alone but should be assessed by combining patency rates and clinical outcome according to standardized categories

Alice Lane, Ettie Lane and one unidentified figure in orchard

BACKGROUND: Despite the increasing use of pre- and posthydration protocols and low-osmolar instead of high-osmolar iodine-containing contrast media, the incidence of contrast-induced nephropathy (CIN) is still significant. There is evidence that contrast media cause ischemia-reperfusion injury of the medulla. Remote ischemic preconditioning (RIPC) is a non-invasive, safe, and low-cost method to reduce ischemia-reperfusion injury. METHODS: The RIPCIN study is a multicenter, single-blinded, randomized controlled trial in which 76 patients at risk of CIN will receive standard hydration combined with RIPC or hydration with sham preconditioning. RIPC will be applied by four cycles of 5 min ischemia and 5 min reperfusion of the forearm by inflating a blood pressure cuff at 50 mmHg above the actual systolic pressure. The primary outcome measure will be the change in serum creatinine from baseline to 48 to 72 h after contrast administration. DISCUSSION: A recent pilot study reported that RIPC reduced the incidence of CIN after coronary angioplasty. The unusual high incidence of CIN in this study is of concern and limits its generalizability. Therefore, we propose a randomized controlled trial to study whether RIPC reduces contrast-induced kidney injury in patients at risk for CIN according to the Dutch guidelines. TRIAL REGISTRATION: Current Controlled Trials ISRCTN76496973

Remote Ischemic Preconditioning To Reduce Contrast-Induced Nephropathy: A Randomized Controlled Trial

Item does not contain fulltextBACKGROUND: Despite the increasing use of pre- and post-hydration protocols and low osmolar instead of high osmolar iodine containing contrast media, the incidence of contrast induced nephropathy (CIN) is still significant. There is evidence that contrast media cause ischemia reperfusion injury of the renal medulla. Remote ischemic preconditioning (RIPC) is a non-invasive, safe, and low cost method to reduce ischemia reperfusion injury. The aim of this study is to investigate whether RIPC, as an adjunct to standard preventive measures, reduces contrast induced acute kidney injury in patients at risk of CIN. METHODS: The RIPCIN study is a multicenter, single blinded, randomized controlled trial in which 76 patients at risk of CIN received standard hydration combined with RIPC or hydration with sham preconditioning. RIPC was applied by four cycles of 5 min ischemia and 5 min reperfusion of the forearm. The primary outcome measure was the change in serum creatinine from baseline to 48 to 72 hours after contrast administration. RESULTS: With regard to the primary endpoint, no significant effect of RIPC was found. CIN occurred in four patients (2 sham and 2 RIPC). A pre-defined subgroup analysis of patients with a Mehran risk score >/=11, showed a significantly reduced change in serum creatinine from baseline to 48 to 72 hours in patients allocated to the RIPC group (Delta creatinine -3.3 +/- 9.8 mumol/L) compared with the sham group (Delta creatinine +17.8 +/- 20.1 mumol/L). CONCLUSION: RIPC, as an adjunct to standard preventive measures, does not improve serum creatinine levels after contrast administration in patients at risk of CIN according to the Dutch guideline. However, the present data indicate that RIPC might have beneficial effects in patients at a high or very high risk of CIN (Mehran score >/= 11). The RIPCIN study is registered at: http://www.controlled-trials.com/ISRCTN76496973