BACKGROUND Liver metastases secondary to breast cancer are associated with unfavourable prognosis.Radioembolization with ytrrium-90 is an emerging option for management of liver metastases of breast cancer when other ...BACKGROUND Liver metastases secondary to breast cancer are associated with unfavourable prognosis.Radioembolization with ytrrium-90 is an emerging option for management of liver metastases of breast cancer when other systemic therapies have failed to achieve disease control.However,unlike the case of other liver tumours(colorectal/melanoma metastases/cholangiocarcinoma),its role in the management of breast liver metastases is yet to be elucidated.AIM The aims of this systematic review were to(1)assess the effect of radioembolization with yttrium-90 on tumour response;and(2)to estimate patient survival post radioembolization.METHODS The review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.A systematic literature search was performed using the PubMed and EMBASE databases from January 2007 to December 2018.The initial search yielded 265 reports which were potentially suitable for inclusion in this review.Studies published in English reporting at least one outcome of interest were considered to be suitable for inclusion.Conference abstracts;case reports,animal studies and reports not published in English were excluded from this review.Data was retrieved from each individual report on the name of primary author,year of publication,patient demographics,type of microspheres used,radiation dose delivered to tumour,duration of follow-up,disease control rate(%),tumour response,and overall patient survival.RESULTS The final number of studies which met the inclusion criteria was 12 involving 452 patients.There were no randomized controlled trials identified after the literature search.The age of the patients included in this review ranged from 52 to 61 years.The duration of the follow up period post-radioembolization ranged from 6 to 15.7 mo.The total number of patients with breast metastases not confined to the liver was 236(52.2%).Cumulative analysis revealed that radioembolization with yttrium-90 conferred tumour control rate in 81%of patients.Overall survival post-radioembolization ranged from 3.6 to 20.9 mo with an estimated mean survival of 11.3 mo.CONCLUSION Radioembolization with ytrrium-90 appears to confer control of tumour growth rate in most patients,however its effect on patient survival need to be elucidated further.Furthermore,quality evidence in the form of randomized trials is needed in order to assess the effect of radioembolization in more depth.展开更多
Non-alcoholic fatty liver disease(NAFLD)is currently the most common chronic liver disease in developed countries because of the obesity epidemic.The disease increases liverrelated morbidity and mortality,and often in...Non-alcoholic fatty liver disease(NAFLD)is currently the most common chronic liver disease in developed countries because of the obesity epidemic.The disease increases liverrelated morbidity and mortality,and often increases the risk for other comorbidities,such as type 2 diabetes and cardiovascular disease.Insulin resistance related to metabolic syndrome is the main pathogenic trigger that,in association with adverse genetic,humoral,hormonal and lifestyle factors,precipitates development of NAFLD.Biochemical markers and radiological imaging,along with liver biopsy in selected cases,help in diagnosis and prognostication.Intense lifestyle changes aiming at weight loss are the main therapeutic intervention to manage cases.Insulin sensitizers,antioxidants,lipid lowering agents,incretin-based drugs,weight loss medications,bariatric surgery and liver transplantation may be necessary for management in some cases along with lifestyle measures.This review summarizes the latest evidence on the epidemiology,natural history,pathogenesis,diagnosis and management of NAFLD.展开更多
Tibial plateau and distal femoral fractures are common injuries presenting a significant operative challenge.Complexity of the fracture often needs multi-planar surgical access.A combined two-staged procedure is frequ...Tibial plateau and distal femoral fractures are common injuries presenting a significant operative challenge.Complexity of the fracture often needs multi-planar surgical access.A combined two-staged procedure is frequently suggested both in supine and prone position to address this issue.However,this will significantly increase the operative time and eventually impact the outcome,in addition to the complications associated with prone positioning.In this study we used a standard orthopaedic table to position these patients in order to grant access to the postro-medial and a postro-lateral structures while the patient stays in supine setup,at the same time,giving the flexibility to change the alignment from valgus to varus and vice versa.This facilitates fracture reduction while addressing the anatomical structure of the knee.A further advantage is the unobstructed imaging access throughout the surgical fixation.This facilitates the reduction in operative time hence leading to a better outcome in these difficult fractures.We tested this positioning technique in more than 40 patients over a 4-year period at two different centres in the United Kingdome.We found that this approach is safe,reproducible and relatively easy to set up in the two centres.展开更多
文摘BACKGROUND Liver metastases secondary to breast cancer are associated with unfavourable prognosis.Radioembolization with ytrrium-90 is an emerging option for management of liver metastases of breast cancer when other systemic therapies have failed to achieve disease control.However,unlike the case of other liver tumours(colorectal/melanoma metastases/cholangiocarcinoma),its role in the management of breast liver metastases is yet to be elucidated.AIM The aims of this systematic review were to(1)assess the effect of radioembolization with yttrium-90 on tumour response;and(2)to estimate patient survival post radioembolization.METHODS The review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.A systematic literature search was performed using the PubMed and EMBASE databases from January 2007 to December 2018.The initial search yielded 265 reports which were potentially suitable for inclusion in this review.Studies published in English reporting at least one outcome of interest were considered to be suitable for inclusion.Conference abstracts;case reports,animal studies and reports not published in English were excluded from this review.Data was retrieved from each individual report on the name of primary author,year of publication,patient demographics,type of microspheres used,radiation dose delivered to tumour,duration of follow-up,disease control rate(%),tumour response,and overall patient survival.RESULTS The final number of studies which met the inclusion criteria was 12 involving 452 patients.There were no randomized controlled trials identified after the literature search.The age of the patients included in this review ranged from 52 to 61 years.The duration of the follow up period post-radioembolization ranged from 6 to 15.7 mo.The total number of patients with breast metastases not confined to the liver was 236(52.2%).Cumulative analysis revealed that radioembolization with yttrium-90 conferred tumour control rate in 81%of patients.Overall survival post-radioembolization ranged from 3.6 to 20.9 mo with an estimated mean survival of 11.3 mo.CONCLUSION Radioembolization with ytrrium-90 appears to confer control of tumour growth rate in most patients,however its effect on patient survival need to be elucidated further.Furthermore,quality evidence in the form of randomized trials is needed in order to assess the effect of radioembolization in more depth.
文摘Non-alcoholic fatty liver disease(NAFLD)is currently the most common chronic liver disease in developed countries because of the obesity epidemic.The disease increases liverrelated morbidity and mortality,and often increases the risk for other comorbidities,such as type 2 diabetes and cardiovascular disease.Insulin resistance related to metabolic syndrome is the main pathogenic trigger that,in association with adverse genetic,humoral,hormonal and lifestyle factors,precipitates development of NAFLD.Biochemical markers and radiological imaging,along with liver biopsy in selected cases,help in diagnosis and prognostication.Intense lifestyle changes aiming at weight loss are the main therapeutic intervention to manage cases.Insulin sensitizers,antioxidants,lipid lowering agents,incretin-based drugs,weight loss medications,bariatric surgery and liver transplantation may be necessary for management in some cases along with lifestyle measures.This review summarizes the latest evidence on the epidemiology,natural history,pathogenesis,diagnosis and management of NAFLD.
文摘Tibial plateau and distal femoral fractures are common injuries presenting a significant operative challenge.Complexity of the fracture often needs multi-planar surgical access.A combined two-staged procedure is frequently suggested both in supine and prone position to address this issue.However,this will significantly increase the operative time and eventually impact the outcome,in addition to the complications associated with prone positioning.In this study we used a standard orthopaedic table to position these patients in order to grant access to the postro-medial and a postro-lateral structures while the patient stays in supine setup,at the same time,giving the flexibility to change the alignment from valgus to varus and vice versa.This facilitates fracture reduction while addressing the anatomical structure of the knee.A further advantage is the unobstructed imaging access throughout the surgical fixation.This facilitates the reduction in operative time hence leading to a better outcome in these difficult fractures.We tested this positioning technique in more than 40 patients over a 4-year period at two different centres in the United Kingdome.We found that this approach is safe,reproducible and relatively easy to set up in the two centres.
