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Long-Term Outcomes and Prognostic Factors in Patients with Indications for Particle Therapy in Sarcomas
Published in Manjit Dosanjh, Jacques Bernier, Advances in Particle Therapy, 2018
Beate Timmermann, Stephanie E. Combs
Chemotherapy is administered according to risk stratification. Local control (LC) is typically achieved by a combination of resection with or without RT. The goal of surgical resection is complete tumour removal while preserving organs and functional tissue. However, surgical approach depends highly on tumour site and feasibility of complete surgery. In parameningeal sites, LC is usually managed by CTx (chemotherapy) and RT alone [15].
Polymer Implants for Intratumoral Drug Delivery and Cancer Therapy
Published in Severian Dumitriu, Valentin Popa, Polymeric Biomaterials, 2020
Brent D. Weinberg, Jinming Gao
Image-guided, minimally invasive techniques for therapeutic interventions use regional tumor destruction as an alternative to surgical resection. In each of these techniques, a conduit for administering the therapy, such as a needle or electrode, is inserted with image guidance into the desired treatment region and its position is confirmed. Image guidance can be provided using ultrasound, computed tomography, or magnetic resonance imaging (Clasen and Pereira 2008). Many options for local tumor ablation involve using a localized energy source, such as radio-frequency (RF) (Goldberg 2001), microwave (Martin et al. 2010), laser (Lindner et al. 2010), or ultrasound (Fischer et al. 2010) to heat the tumor to lethal temperatures. Alternative strategies for tumor destruction include cryoablation (Dale et al. 1998; Han and Belldegrun 2004) and chemical injection (Livraghi et al. 1998; Shah et al. 2004). Since they can be applied percutaneously, these minimally invasive treatments typically are viable alternatives to surgery that can be used in patients with poor overall health who might not be able to tolerate a surgical procedure. Additionally, local administration of the treatment maximizes destruction to the tumor target while limiting damage to the surrounding normal tissue. Ablation has been recently described for cancers in a wide variety of organ systems, including the esophagus (Gan and Watson 2010), lung (Nguyen et al. 2006), liver (Shiina 2009), kidney (Joniau et al. 2010), pancreas (Varshney et al. 2006), and prostate (Lindner et al. 2010). The role of local treatment will is different in each of these organ systems and is not likely to immediately supplant well-established treatments. However, focused ablation will provide new options for a subset of patients, and some authors suggest that the impact will be substantial (Bradley 2009).
Admission scheduling of inpatients by considering two inter-related resources: beds and operating rooms
Published in Optimization, 2020
Ting Zhu, Li Luo, Wenwu Shen, Xueru Xu, Ran Kou
Patients' medical care usually involves multi-unit (upstream and downstream) in a single hospital, such as an emergency/outpatient care unit, a medical examination unit, an admission service unit, an operating room (OR), a central transportation unit, a postoperative anaesthesia care unit (PACU), an inpatient unit, an intensive care unit (ICU), a rehabilitation unit [1]. These units require a variety of medical resources (e.g. doctor, nurse, anaesthetist, technician, CT/MRI facility, bed, OR). Some surgeries like a brain tumour resection or cardiothoracic surgery procedures often imply a stay in the ICU post-surgery. It is now widely recognized that the integration of downstream resources such as beds or nursing care in ICUs leads to a better overall performance for surgeries [2]. More and more works address the admission scheduling problem of surgical patients considering the objective of jointly optimizing the utilization of several resources such as ORs, beds and nursing care [3]. By studying in isolation, the complexity and uncertainty that are inherent in healthcare systems may seem to be more manageable, but suboptimal conclusions may be drawn when the influences of other services are ignored or the impact of a change on the overall care chain is overlooked [4]. Failure to balance the use of capacity at consecutive stages to ensure smooth patient flow through the system often leads to blocking, cancellation, and inefficient use of capacity.
Surgical planning for living donor liver transplant using 4D flow MRI, computational fluid dynamics and in vitro experiments
Published in Computer Methods in Biomechanics and Biomedical Engineering: Imaging & Visualization, 2018
David R. Rutkowski, Scott B. Reeder, Luis A. Fernandez, Alejandro Roldán-Alzate
It is important to note that although the velocity trend across all four case 3 simulation models was consistent with that seen in cases 1 and 2, the post-surgery pressure and stress trends were not consistent. As seen in Table 4, the post-surgery model of case 3 has the lowest maximum branch pressure, average venous pressure, and average wall shear stress, even lower than the values of the corresponding pre-surgery model. This difference may be due to the fact that case 3 involved a left lateral resection, instead of a right lobectomy as in cases 1 and 2. If this is the true, it may indicate that a left lateral resection leads to a noticeably different hemodynamic alteration after surgery than in a right lobe resection. Further study is needed to determine the cause of this difference.
Predicting and managing complications following colonoscopy: risk factors and management of advanced interventional endoscopy with a focus on colorectal ESD
Published in Expert Review of Medical Devices, 2020
Hiroyuki Takamaru, Rina Goto, Masayoshi Yamada, Taku Sakamoto, Takahisa Matsuda, Yutaka Saito
It is well known that endoscopic resection of early colorectal neoplasm could reduce the incidence of colorectal cancer mortality [1]. Indications for colorectal endoscopic submucosal dissection (ESD) includes lesions suspected for early colorectal cancer with large size or non-polypoid morphology in which en-bloc EMR would be challenging [2,3]. Colorectal ESD is a minimally invasive procedure and an effective treatment for early colorectal neoplasms. Nowadays, colorectal ESD has been introduced widely in many countries as one of the techniques for en-bloc endoscopic resection, especially for lesions suspected submucosal invasion in Western countries [4–8]. However, when colorectal ESD is introduced, complications such as perforations should be considered [2,9–11].