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Nonoperative Treatment (nonoperative + treatment)
Selected AbstractsNonoperative treatment of four esophageal perforations with hemostatic clipsDISEASES OF THE ESOPHAGUS, Issue 5 2007A. Fischer SUMMARY., Spontaneous or iatrogenic esophageal perforations are despite advances of modern surgery and intensive care medicine still potentially life-threatening events with a considerable mortality rate. Recently, encouraging results on the sealing of esophageal perforations by placement of endoluminal prostheses were reported. However, if the perforation is very proximal (close to the larynx) or very distal (involving the cardia), the situation is to our experience unsuitable for stent therapy. In these special cases non-operative treatment is still possible by application of hemostatic metal clips. We present four cases unsuitable for stent therapy where the perforation was sealed by endoscopic clip application. All patients had an uneventful recovery. Non-operative treatment of esophageal perforations with hemostatic metal clips is feasible and safe in cases not treatable with self-expanding metal stents. [source] The Effect of treatment on survival in patients with advanced laryngeal carcinoma,THE LARYNGOSCOPE, Issue 7 2009Christine G. Gourin MD Abstract Objectives/Hypothesis: Over the last 2 decades, survival from laryngeal cancer has decreased. We sought to identify factors associated with decreased survival in laryngeal cancer. Methods: Patients diagnosed with laryngeal squamous cell carcinoma from 1985 to 2002 were retrospectively reviewed. Results: A total of 451 patients met study criteria. Five-year survival rates were 85% for stage I, 77% for stage II, 51% for stage III, and 35% for stage IV disease. Survival for patients with stage I,III disease was similar for patients treated operatively or nonoperatively (P = .4). However, patients with stage III disease treated nonoperatively had worse survival with radiation alone (XRT) compared to chemoradiation (CR) (P = .006). Patients with stage IV disease had significantly better survival with surgery (49%) than CR (21%) or XRT alone (14%) (P < .0001). Analysis by primary tumor stage demonstrated that survival for T1,T3 disease was independent of treatment modality (P = .2); however, for T4 patients, operative treatment was associated with significantly better survival (55%) than CR (25%) or XRT (0%) (P < .0001). Proportional hazards models confirmed significantly worse survival for stage IV, T4, N2 or N3 disease, and nonoperative treatment. For T4 disease, after controlling for nodal status, nonoperative treatment was the only significant predictor of worse survival. Conclusions: Primary surgical treatment is associated with improved survival for patients with stage IV disease and specifically T4 primary tumors. These data suggest that the observed national decrease in survival from laryngeal cancer may be due to a shift toward nonoperative treatment in that subset of patients with advanced primary disease. Laryngoscope, 2009 [source] Prognostic factors in nonoperative therapy for chronic symptomatic calcific tendinitis of the shoulderARTHRITIS & RHEUMATISM, Issue 10 2009P. Ogon Objective To define prognostic factors in chronically symptomatic patients with calcific tendinitis of the shoulder. Methods We evaluated 420 patients (488 shoulders) in the context of a prospective cohort study. Epidemiologic data were assessed. The radiographic and sonographic appearance of the calcific deposits was classified. The mean period of nonoperative therapy was 4.4 years (range 0.5,13.7 years). After referral to our institution, standardized nonoperative therapy was continued for a minimum of 3 months. Failure of nonoperative therapy was defined as the persistence of symptomatic calcific tendinitis of the shoulder after a minimum of 6 months. Prognostic factors (determined at P < 0.05 by chi-square test) were analyzed by logistic regression. Results Of the 420 patients, 269 (64%) were women, 151 (36%) were men. The mean age of the patients was 51.3 years (range 28,84 years). Occurrence of calcific tendinitis of the shoulder was unilateral in 84% and bilateral in 16%. Gärtner type I calcific deposits were found in 37%, type II in 32%, and type III in 31%. Failure of nonoperative therapy was observed in 114 patients (27%). Negative prognostic factors were bilateral occurrence of calcific tendinitis of the shoulder, localization to the anterior portion of the acromion, medial (subacromial) extension, and high volume of the calcific deposit. Positive prognostic factors were a Gärtner type III deposit and a lack of sonographic sound extinction of the calcific deposit. Conclusion Our findings demonstrate the existence of prognostic factors in the nonoperative treatment of chronic symptomatic calcific tendinitis of the shoulder. Guidelines for optimal treatment can be implemented according to these factors to avoid a long-term symptomatic disease course. [source] Neoadjuvant chemo-radiotherapy and rectal cancer: can the UK watch and wait with Brazil?COLORECTAL DISEASE, Issue 1 2010S. M. Nyasavajjala Abstract Objecive, It has recently been reported that up to one-third of patients with nonmetastatic distal rectal cancer managed with neoadjuvant chemoradiation therapy (CRT) had a complete clinical response (cCR) to treatment. In the selected cases, this has been used as the sole treatment. The aim of this study was to determine the frequency of complete pathological response for patients receiving CRT in one centre in the UK. Method, Patients receiving 6 weeks of neoadjuvant CRT were identified using the two cancer audit databases in two different tertiary hospitals from January 2002 to November 2007. Pathology was reviewed and the histopathological response of the resected specimen to CRT was evaluated using the Mandard classification (1 = complete response, 5 = no response) Results, One hundred and thirty-two consecutive patients [median age 61 (range 44,86) years, 90 men] with nonmetastatic locally advanced rectal cancer received neoadjuvant chemo radiotherapy between 2002 and 2007 followed by resection of the tumour. Data were available from 129 patients. Mandard classification Number of patients 1 13 2 14 3 31 4 47 5 24 Conclusion, Only 13 out of 132 (10%) of patients had a complete pathological response. This is one-third of the cCR previously reported. Nonsurgical therapy for rectal cancer using the Habr-Gama treatment algorithm may only be effective in a very small proportion of patients with rectal cancer in the UK and nonoperative treatment would not be recommended. [source] | ||||||||||