Try a new search

Format these results:

Searched for:

person:raccuj02

Total Results:

14


Prognostic factors and survival in patients treated surgically for recurrent metastatic uterine leiomyosarcoma

Hoang, Han L T; Ensor, Kelsey; Rosen, Gerald; Leon Pachter, H; Raccuia, Joseph S
Background. Uterine leiomyosarcoma (LMS) is a rare diagnosis, which is seldom cured when it recurs with metastatic disease. We evaluated patients who present with first time recurrence treated surgically to determine prognostic factors associated with long-term survival. Methods. Over a 16-year period, 41 patients were operated on for recurrent uterine sarcoma. Data examined included patient age, date of initial diagnosis, tumor histology, grade at the initial diagnosis, cytopathology changes in tumor activity from the initial diagnosis, residual tumor after all operations, use of adjuvant therapy, dates and sites of all recurrences, and disease status at last followup. Results. 24 patients were operated for first recurrence of metastatic uterine LMS. Complete tumor resection with histologic negative margins was achieved in 16 (67%) patients. Overall survival was significantly affected by the FIGO stage at the time of the initial diagnosis, the ability to obtain complete tumor resection at the time of surgery for first time recurrent disease, single tumor recurrence, and recurrence greater than 12 months from the time of the initial diagnosis. Median disease-free survival was 14 months and overall survival was 27 months. Conclusion. Our findings suggest that stage 1 at the time of initial diagnosis, recurrence greater than 12 months, isolated tumor recurrence, and the ability to remove ability to perform complete tumor resection at the time of the first recurrence can afford improved survival in selected patientsat the time of the first recurrence can afford improved survival in selected patients.
PMCID:4090477
PMID: 25045534
ISSN: 2090-1402
CID: 1075772

Primary rhabdomyosarcoma of the diaphragm: case report and review of the literature

Melis, Marcovalerio; Rosen, Gerald; Hajdu, Cristina H; Pachter, H Leon; Raccuia, Joseph S
BACKGROUND: Diaphragmatic sarcomas are extremely rare and mostly described in children. We present the case of an adult with rhabdomyosarcoma of the diaphragm. METHODS: We performed a literature review, highlighted possible diagnostic pitfalls, and discussed multidisciplinary treatment options.
PMID: 23397333
ISSN: 1091-255x
CID: 248182

Surgical treatment for primary and locally advanced/metastatic soft-tissue sarcoma involving the pancreas and liver [Meeting Abstract]

Sabbaghian, M; Rosen, G; Pachter, H; Raccuia, J
Purpose: Primary and metastatic sarcoma involving the hepatopancreaticobiliary structures is rare. Surgical resection is examined for its role in cure or palliation. Methods: From 1997 to 2011, 151 patients were treated surgically for sarcoma involving the retroperitoneum, abdomen and pelvis. Sixty-four (42%) had primary or locally advanced/metastatic sarcoma involving the pancreas and/or liver. Results: Fifty-two of 64 (81%) patients underwent en bloc pancreas and/or liver resection. 34/52 (65%) had recurrent disease. Pancreatectomy was performed in 23 (44%), hepatectomy in 17 (33%), and combined resection in 12 (23%). The average lesion size was 12.2 +/- 8.9 cm. The average number of tumors resected at once was 4.8 +/- 7.9. Intraoperative blood loss averaged 2200 +/- 2600 cc with a mean number of blood transfusions 3.0 +/- 3.3 units. There were 4 operative deaths and 18 non-lethal perioperative complications. Pathology included gastrointestinal stromal tumor in 18 (34%), leiomyosarcoma in 16 (30%), liposarcoma in 11 (21%), and various other soft tissue sarcomas in 7 (13%). Mean follow-up was 35 +/- 41 months. 33/52 patients had tumor recurrence at a mean 15 +/- 18 months (range 2-71) after surgery. Recurrence occurred in the liver (n = 11), retroperitoneum (7), abdomen (6), pancreas (3), lung (3) and other multiple sites (3). Sixteen patients remain alive: 5 with and 11 without evidence of disease. The median survival has been 27 +/- 7 months with overall survival at 5 and 10 years 36% and 19%, respectively. Conclusions: En bloc pancreas/liver resection for sarcoma is feasible, and complete resection seems to provide worthwhile palliation or long-term survival
EMBASE:70682860
ISSN: 1365-182x
CID: 161214

Prospective evaluation of circulating hepatocytes by alpha-fetoprotein mRNA in humans during liver surgery

Lemoine, A; Le Bricon, T; Salvucci, M; Azoulay, D; Pham, P; Raccuia, J; Bismuth, H; Debuire, B
OBJECTIVE: The objective of this study was to analyze the specificity of detecting liver tumor cell dissemination by alpha-fetoprotein (AFP) mRNA in peripheral blood. SUMMARY BACKGROUND DATA: Alpha-fetoprotein mRNA has been used for the detection of circulating micrometastatic tumor foci of hepatocellular carcinoma (HCC); however, the interpretation of the results has been equivocal. METHODS: Sixty-four consecutive patients with malignant HCC (n = 20), liver metastases (n = 27), or nonmalignant (n = 17) liver diseases undergoing partial or total hepatectomy and orthotopic liver transplantation were included in this prospective study from January to July 1995. Peripheral blood samples were obtained before surgery, during surgery, and after surgery (range, 6-15 months). Total mRNA was extracted from nucleated cells, and cDNA synthesis and polymerase chain reaction amplification (nested polymerase chain reaction in one tube) were performed with specific AFP primers. RESULTS: Preoperative AFP mRNA was detected in 20 patients (17%), of which 5 of 20 had HCC. Intraoperative assessment showed positive AFP mRNA values in a total of 34 patients (53%) with various causes, of which 8 of 20 (40%) had HCC, 17 of 27 (63%) had other malignancies, and 9 of 17 (53%) had nonmalignant diseases. Recurrent tumor in patients with HCC occurred in four cases after surgery (range, 6-15 months) and did not correlate with AFP mRNA positivity before surgery, during surgery, or after surgery. CONCLUSIONS: Alpha-fetoprotein mRNA in peripheral blood is not a specific marker of circulating micrometastases from HCC, especially in the context of surgical treatment of HCC.
PMCID:1190905
PMID: 9242336
ISSN: 0003-4932
CID: 719092

"Protected" double needle biopsy technique for hepatic tumors

Azoulay, D; Johann, M; Raccuia, J S; Castaing, D; Bismuth, H
PMID: 8696549
ISSN: 1072-7515
CID: 692882

Beneficial effects of Eurocollins as aortic flush for the procurement of human livers

Adam, R; Astarcioglu, I; Raccuia, J S; Ducot, B; Reynes, M; Bismuth, H
A review of 550 consecutively transplanted liver grafts stored in University of Wisconsin solution (UW) was performed during a 4-year period to ascertain whether graft function was impaired by flushing the aorta with Eurocollins (EC) rather than UW during the harvesting. The outcome of 255 liver grafts flushed with UW in both the aorta and portal vein (group UW/UW) was compared with 295 liver grafts flushed with EC through the aorta and UW through the portal vein (group ECUW). Liver grafts in both groups were flushed with 1 L of UW during the back table procedure and subsequently stored in UW at 4 degrees C before transport. Donor and recipient characteristics, cold and warm ischemia times, and methods of transplantation were similar in both groups, except that the recipient prothrombin time (PT) before liver transplantation (LT) was lower in the UW/UW group. There was no significant difference between the groups with peak transaminases aspartate aminotransferase (AST) and alanine aminotransferase, maximum value of serum bilirubin within 10 days following LT, incidence of primary nonfunction, need for retransplantation, and patient and graft survival at 1 month. Results were improved, however, in the EC/UW group in regard to PT after LT, operative bleeding and proportion of grafts with histologic lesions at the reperfusion biopsy (P<0.001). These better results in the EC/UW group were confirmed when grafts transplanted in urgent situations were excluded from analysis and by multivariate analysis assessing the effects of pretransplant PT and AST values of the recipients combined with the method of liver cooling with each of the aforementioned criteria. In conclusion, the method of using EC for the aortic flush during liver procurement reduces the amount of UW solution by 50% with improved graft function. This method seems justified in that it is less expensive while affording improved graft function.
PMID: 8607171
ISSN: 0041-1337
CID: 692892

The value of early transjugular liver biopsy after liver transplantation

Azoulay, D; Raccuia, J S; Roche, B; Reynes, M; Bismuth, H
Conventional percutaneous liver biopsy in the early postoperative period, within 30 days, following liver transplantation may be impossible due to coagulopathy and/or ascites. The use of transjugular liver graft biopsy (TJLB) in this setting is an attractive alternative in that a tissue diagnosis can be obtained despite the relative contraindications for percutaneous biopsy during this period. During the early posttransplant period, 124 TJLBs were performed in 105 liver patients, the majority (89%) of whom had standard liver transplantation without preservation of the native inferior vena cava; the others (11%) had the native inferior vena cava intact. The technical success rate was 87%, with adequate specimen for definitive diagnosis in most instances (86%), which included both rejection (61%) and nonrejection (39%) diagnoses on final histopathology. The biopsy diagnosis influenced clinical management in the majority of cases (65%), with decisions made to perform retransplantation (3%), to influence initiation of antirejection therapy (59%), and to institute antiviral therapy (3%). There was no morbidity or mortality associated with TJLB and it is feasible, safe, and effective in the early period after liver transplantation.
PMID: 8610351
ISSN: 0041-1337
CID: 692902

Right portal vein embolization in preparation for major hepatic resection

Azoulay, D; Raccuia, J S; Castaing, D; Bismuth, H
PMID: 7670687
ISSN: 1072-7515
CID: 692912

[Liver transplantation in the treatment strategy of portal hypertension]

Bismuth, H; Adam, R; Raccuia, J S
We reviewed 1000 consecutive liver transplants over a 10 year period with special attention to a pre-transplant history of portal hypertension revealed by variceal hemorrhage. Of 730 primary transplanted patients with chronic liver disease 186 (26%) experienced variceal bleeding prior to transplantation of which 130 (70%) required interventional therapy to palliate the bleeding. Sclerotherapy was performed in 93 (50%), surgical portal diversion in 27 (15%) and TIPSS in 10 (5%) patients. Moderate to severe liver dysfunction accounted for 91% of the patients with bleeding complications. The impact of both bleeding and treatment modality utilized in the pre-transplant period was analyzed in a way to integrate liver transplantation into the multimodality treatment of portal hypertension. The overall survival for all patients was 76% at five years. Previous history of variceal bleeding did not affect the outcome of patients following liver transplantation. The patients treated by initial sclerotherapy demonstrated no difference with either graft or patient survival. The patients who had TIPSS to control hemorrhage had lower, but insignificant, graft and patient survival. The group of patients with variceal hemorrhage who had prior surgical shunt did, however, demonstrate a significant increased survival of 96% when compared to the non-shunted group which had a 73% survival (p < 0.007). The strategy in treating these potential transplant patients is critical to the success of the subsequent transplant.
PMID: 7664586
ISSN: 0009-4722
CID: 692922

Comparative efficacy of topical hemostatic agents in a rat kidney model

Raccuia, J S; Simonian, G; Dardik, M; Hallac, D; Raccuia, S V; Stahl, R; Dardik, H
The efficacies of four topical hemostatic agents were compared in a rat model employing a standardized renal injury. The materials used to effect hemostasis were oxidized cellulose, microfibrillar collagen powder, positively charged modified collagen, and single donor heterologous fibrin glue. Animals that were treated only with surgical gauze served as controls. Hemostasis was achieved by application of one of the topical hemostatic agents plus moderate digital pressure. The time necessary to achieve complete hemostasis was recorded for each animal. Control animals bled profusely and suffered an increased postoperative mortality rate compared with the experimental animals. Microscopic studies demonstrated progressive healing of the injuries with varying degrees of inflammation and scar formation. Fibrin glue was by far the most effective agent in controlling hemostasis. The collagen materials, though effective, required a longer time to control bleeding and did not differ statistically in their activity from one another.
PMID: 1739179
ISSN: 0002-9610
CID: 692932