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Tirmarche M, Apostoaei I, Blanchardon E, Ellis ED, Gilbert E, Harrison JD, Laurier D, Marsh JW, Sokolnikov M, Wakeford R, Zhivin S. ICRP Publication 150: Cancer Risks from Plutonium and Uranium Exposure. Ann ICRP 2021; 50:1-143. [PMID: 34877884 DOI: 10.1177/01466453211028020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Fundamental estimates of radon-associated health risk have been provided by epidemiological studies of miners. In total, approximately 15 studies have been conducted worldwide since the 1960s. These results have contributed directly to radiological protection against radon. The present article summarises the main results, with a focus on analyses of miners exposed more recently, estimates of radon lifetime attributable risk, and interaction between radon and smoking. The potential for the upcoming Pooled Uranium Miner Analysis project to further improve our knowledge is discussed.
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Abstract
The International Commission on Radiological Protection (ICRP) publishes guidance on protection from radon in homes and workplaces, and dose coefficients for use in assessments of exposure for protection purposes. ICRP Publication 126 recommends an upper reference level for exposures in homes and workplaces of 300 Bq m-3. In general, protection can be optimised using measurements of air concentrations directly, without considering radiation doses. However, dose estimates are required for workers when radon is considered as an occupational exposure (e.g. in mines), and for higher exposures in other workplaces (e.g. offices) when the reference level is exceeded persistently. ICRP Publication 137 recommends a dose coefficient of 3 mSv per mJ h m-3 (approximately 10 mSv per working level month) for most circumstances of exposure in workplaces, equivalent to 6.7 nSv per Bq h m-3 using an equilibrium factor of 0.4. Using this dose coefficient, annual exposure of workers to 300 Bq m-3 corresponds to 4 mSv. For comparison, using the same coefficient for exposures in homes, 300 Bq m-3 corresponds to 14 mSv. If circumstances of occupational exposure warrant more detailed consideration and reliable alternative data are available, site-specific doses can be assessed using methodology provided in ICRP Publication 137.
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Birchall A, Marsh JW. The Mayak Worker Dosimetry System (MWDS-2013): How to Weight the Absorbed Dose to Different Lung Regions in the Calculation of Lung Dose. RADIATION PROTECTION DOSIMETRY 2017; 176:95-101. [PMID: 27986962 DOI: 10.1093/rpd/ncw245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 07/21/2016] [Accepted: 08/01/2016] [Indexed: 06/06/2023]
Abstract
In the Mayak Worker Dosimetry System-2013, lung dose is calculated as an average of the three absorbed doses to the bronchial, the bronchiolar and the alveolar regions. Previous epidemiological studies involving Mayak Workers have used a lung dose calculated as the total energy deposited in the lungs divided by the mass. These two definitions lead to very different estimates of lung dose, especially for radon dosimetry. This paper uses the results of recent epidemiological studies to justify the use of a regionally weighted lung dose (wi = 1/3, I = 1, 3) over the use of an 'average lung' dose.
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Etherington G, Bérard P, Blanchardon E, Breustedt B, Castellani CM, Challeton-de Vathaire C, Giussani A, Franck D, Lopez MA, Marsh JW, Nosske D. TECHNICAL RECOMMENDATIONS FOR MONITORING INDIVIDUALS FOR OCCUPATIONAL INTAKES OF RADIONUCLIDES. RADIATION PROTECTION DOSIMETRY 2016; 170:8-12. [PMID: 26464525 DOI: 10.1093/rpd/ncv395] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The TECHREC project, funded by the European Commission, will provide Technical Recommendations for Monitoring Individuals for Occupational Intakes of Radionuclides It is expected that the document will be published by the European Commission as a report in its Radiation Protection Series during 2016. The project is coordinated by the European Radiation Dosimetry Group (EURADOS) and is being carried out by members of EURADOS Working Group 7 (Internal Dosimetry). This paper describes the aims and purpose of the Technical Recommendations, and explains how the project is organised.
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Castellani CM, Marsh JW, Hurtgen C, Blanchardon E, Bérard P, Giussani A, Lopez MA. EURADOS-IDEAS GUIDELINES (VERSION 2) FOR THE ESTIMATION OF COMMITTED DOSES FROM INCORPORATION MONITORING DATA. RADIATION PROTECTION DOSIMETRY 2016; 170:17-20. [PMID: 26541189 DOI: 10.1093/rpd/ncv457] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Dose assessment after intakes of radionuclides requires application of biokinetic and dosimetric models and assumptions about factors influencing the final result. In 2006, a document giving guidance for such assessment was published, commonly referred to as the IDEAS Guidelines. Following its publication, a working group within the European networks CONRAD and EURADOS was established to improve and update the IDEAS Guidelines. This work resulted in Version 2 of the IDEAS Guidelines, which was published in 2013 in the form of a EURADOS report. The general structure of the original document was maintained; however, new procedures were included, e.g. the direct dose assessment method for (3)H or special procedure for wound cases applying the NCRP wound model. In addition, information was updated and expanded, e.g. data on dietary excretion of U, Th, Ra and Po for urine and faeces or typical and achievable values for detection limits for different bioassay measurement techniques.
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Fontes P, Lopez R, van der Plaats A, Vodovotz Y, Minervini M, Scott V, Soltys K, Shiva S, Paranjpe S, Sadowsky D, Barclay D, Zamora R, Stolz D, Demetris A, Michalopoulos G, Marsh JW. Liver preservation with machine perfusion and a newly developed cell-free oxygen carrier solution under subnormothermic conditions. Am J Transplant 2015; 15:381-94. [PMID: 25612645 PMCID: PMC5024042 DOI: 10.1111/ajt.12991] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 07/28/2014] [Accepted: 08/23/2014] [Indexed: 01/25/2023]
Abstract
We describe a new preservation modality combining machine perfusion (MP) at subnormothermic conditions(21 °C) with a new hemoglobin-based oxygen carrier (HBOC) solution. MP (n=6) was compared to cold static preservation (CSP; n=6) in porcine orthotopic liver transplants after 9 h of cold ischemia and 5-day follow-up. Recipients' peripheral blood, serial liver biopsies, preservation solutions and bile specimens were collected before, during and after liver preservation. Clinical laboratorial and histological analyses were performed in addition to mitochondrial functional assays, transcriptomic, metabolomic and inflammatory inflammatory mediator analyses. Compared with CSP, MP animals had: (1) significantly higher survival (100%vs. 33%; p<0.05); (2) superior graft function (p<0.05);(3) eight times higher hepatic O2 delivery than O2 consumption (0.78 mL O2/g/h vs. 0.096 mL O2/g/h) during MP; and (4) significantly greater bile production (MP=378.5 ± 179.7; CS=151.6 ± 116.85). MP downregulated interferon (IFN)-α and IFN-γ in liver tissue. MP allografts cleared lactate, produced urea, sustained gluconeogenesis and produced hydrophilic bile after reperfusion. Enhanced oxygenation under subnormothermic conditions triggers regenerative and cell protective responses resulting in improved allograft function. MP at 21 °C with the HBOC solution significantly improves liver preservation compared to CSP.
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Kreuzer M, Dufey F, Laurier D, Nowak D, Marsh JW, Schnelzer M, Sogl M, Walsh L. Mortality from internal and external radiation exposure in a cohort of male German uranium millers, 1946–2008. Int Arch Occup Environ Health 2014; 88:431-41. [DOI: 10.1007/s00420-014-0973-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 08/11/2014] [Indexed: 11/30/2022]
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Gregoratto D, Marsh JW. Note on the autocorrelation coefficient as a test statistic for assessment of the goodness-of-fit of biokinetic models to multiple bioassay data sets. RADIATION PROTECTION DOSIMETRY 2013; 157:442-445. [PMID: 23813614 DOI: 10.1093/rpd/nct160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The European Commission project IDEAS has produced guidelines for internal dose assessments from monitoring data. A key stage in the guidelines requires assessment of the goodness-of-fit of biokinetic models to bioassay data. The present note extends the use of an autocorrelation coefficient to assess the fits of multiple types of bioassay quantity simultaneously.
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Marsh JW, Bailey MR. A review of lung-to-blood absorption rates for radon progeny. RADIATION PROTECTION DOSIMETRY 2013; 157:499-514. [PMID: 23887272 DOI: 10.1093/rpd/nct179] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The International Commission on Radiological Protection (ICRP) Publication 66 Human Respiratory Tract Model (HRTM) treats clearance of materials from the respiratory tract as a competitive process between absorption into blood and particle transport to the alimentary tract and lymphatics. The ICRP recommended default absorption rates for lead and polonium (Type M) in ICRP Publication 71 but stated that the values were not appropriate for short-lived radon progeny. This paper reviews and evaluates published data from volunteer and laboratory animal experiments to estimate the HRTM absorption parameter values for short-lived radon progeny. Animal studies showed that lead ions have two phases of absorption: ∼10 % absorbed with a half-time of ∼15 min, the rest with a half-time of ∼10 h. The studies also indicated that some of the lead ions were bound to respiratory tract components. Bound fractions, f(b), for lead were estimated from volunteer and animal studies and ranged from 0.2 to 0.8. Based on the evaluations of published data, the following HRTM absorption parameter values were derived for lead as a decay product of radon: f(r) = 0.1, s(r) = 100 d(-1), s(s) = 1.7 d(-1), f(b) = 0.5 and s(b) = 1.7 d(-1). Effective doses calculated assuming these absorption parameter values instead of a single absorption half-time of 10 h with no binding (as has generally been assumed) are only a few per cent higher. However, as there is some conflicting evidence on the absorption kinetics for radon progeny, dose calculations have been carried out for different sets of absorption parameter values derived from different studies. The results of these calculations are discussed.
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Cardinal JS, Reddy SK, Tsung A, Marsh JW, Geller DA. Laparoscopic major hepatectomy: pure laparoscopic approach versus hand-assisted technique. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 20:114-9. [PMID: 23053353 DOI: 10.1007/s00534-012-0553-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Laparoscopic liver resections are being performed with increasing frequency, with several groups having reported minimally invasive approaches for major anatomic hepatic resections. Some surgeons favor a pure laparoscopic approach, while others prefer a hand-assisted approach for major laparoscopic liver resections. There are clear advantages and disadvantages to a hand-assisted technique. The purpose of this study is to summarize the literature comparing pure laparoscopic and hand-assisted approaches for minimally invasive hepatic resection, and to describe our approach in 432 laparoscopic liver resections.
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Abstract
Currently, the International Commission on Radiological Protection (ICRP) uses the dose conversion convention to calculate effective dose per unit exposure to radon and its progeny. In a recent statement, ICRP indicated the intention that, in future, the same approach will be applied to intakes of radon and its progeny as is applied to all other radionuclides, calculating effective dose using reference biokinetic and dosimetric models, and radiation and tissue weighting factors. Effective dose coefficients will be given for reference conditions of exposure. In this paper, preliminary results of dose calculations for Rn-222 progeny are presented and compared with values obtained using the dose conversion convention. Implications for the setting of reference levels are also discussed.
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Marsh JW, Blanchardon E, Gregoratto D, Hofmann W, Karcher K, Nosske D, Tomásek L. Dosimetric calculations for uranium miners for epidemiological studies. RADIATION PROTECTION DOSIMETRY 2012; 149:371-383. [PMID: 21816722 DOI: 10.1093/rpd/ncr310] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Epidemiological studies on uranium miners are being carried out to quantify the risk of cancer based on organ dose calculations. Mathematical models have been applied to calculate the annual absorbed doses to regions of the lung, red bone marrow, liver, kidney and stomach for each individual miner arising from exposure to radon gas, radon progeny and long-lived radionuclides (LLR) present in the uranium ore dust and to external gamma radiation. The methodology and dosimetric models used to calculate these organ doses are described and the resulting doses for unit exposure to each source (radon gas, radon progeny and LLR) are presented. The results of dosimetric calculations for a typical German miner are also given. For this miner, the absorbed dose to the central regions of the lung is dominated by the dose arising from exposure to radon progeny, whereas the absorbed dose to the red bone marrow is dominated by the external gamma dose. The uncertainties in the absorbed dose to regions of the lung arising from unit exposure to radon progeny are also discussed. These dose estimates are being used in epidemiological studies of cancer in uranium miners.
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Kreuzer M, Straif K, Marsh JW, Dufey F, Grosche B, Nosske D, Sogl M. Occupational dust and radiation exposure and mortality from stomach cancer among German uranium miners, 1946-2003. Occup Environ Med 2011; 69:217-23. [PMID: 22172952 DOI: 10.1136/oemed-2011-100051] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES 'Dusty occupations' and exposure to low-dose radiation have been suggested as potential risk factors for stomach cancer. Data from the German uranium miner cohort study are used to further evaluate this topic. METHODS The cohort includes 58 677 miners with complete information on occupational exposure to dust, arsenic and radiation dose based on a detailed job-exposure matrix. A total of 592 stomach cancer deaths occurred in the follow-up period from 1946 to 2003. A Poisson regression model stratified by age and calendar year was used to calculate the excess relative risk (ERR) per unit of cumulative exposure to fine dust or from cumulative absorbed dose to stomach from α or low-LET (low linear energy transfer) radiation. For arsenic exposure, a binary quadratic model was applied. RESULTS After adjustment for each of the three other variables, a statistically non-significant linear relationship was observed for absorbed dose from low-LET radiation (ERR/Gy=0.30, 95% CI -1.26 to 1.87), α radiation (ERR/Gy=22.5, 95% CI -26.5 to 71.5) and fine dust (ERR/dust-year=0.0012, 95% CI -0.0020 to 0.0043). The relationship between stomach cancer and arsenic exposure was non-linear with a 2.1-fold higher RR (95% CI 0.9 to 3.3) in the exposure category above 500 compared with 0 dust-years. CONCLUSION Positive statistically non-significant relationships between stomach cancer and arsenic dust, fine dust and absorbed dose from α and low-LET radiation were found. Overall, low statistical power due to low doses from radiation and dust are of concern.
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Lopez MA, Balásházy I, Bérard P, Blanchardon E, Breustedt B, Broggio D, Castellani CM, Franck D, Giussani A, Hurtgen C, James AC, Klein W, Kramer GH, Li WB, Marsh JW, Malatova I, Nosske D, Oeh U, Pan G, Puncher M, Peixoto Telles P, Schimmelpfeng J, Vrba T. EURADOS coordinated action on research, quality assurance and training of internal dose assessments. RADIATION PROTECTION DOSIMETRY 2011; 144:349-352. [PMID: 21156780 DOI: 10.1093/rpd/ncq435] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
EURADOS working group on 'Internal Dosimetry (WG7)' represents a frame to develop activities in the field of internal exposures as coordinated actions on quality assurance (QA), research and training. The main tasks to carry out are the update of the IDEAS Guidelines as a reference document for the internal dosimetry community, the implementation and QA of new ICRP biokinetic models, the assessment of uncertainties related to internal dosimetry models and their application, the development of physiology-based models for biokinetics of radionuclides, stable isotope studies, biokinetic modelling of diethylene triamine pentaacetic acid decorporation therapy and Monte-Carlo applications to in vivo assessment of intakes. The working group is entirely supported by EURADOS; links are established with institutions such as IAEA, US Transuranium and Uranium Registries (USA) and CEA (France) for joint collaboration actions.
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Castellani CM, Lopez MA, Luciani A, Marsh JW, Vrba T, Cruz-Suarez R. Results of an internal dose assessment intercomparison exercise after a EURADOS/IAEA training course. RADIATION PROTECTION DOSIMETRY 2011; 144:592-595. [PMID: 21051435 DOI: 10.1093/rpd/ncq344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A training course named 'European Radiation Dosimetry Group/International Atomic Energy Agency Advanced Training Course on Internal Dose Assessment' was held in Czech Technical University in Prague from 2 to 6 February 2009. The course, jointly organised by the two organisations, had the aim of providing guidance on the application of IDEAS guidelines and of disseminating the results of EC CONRAD Project in relation to internal dosimetry (Work Package 5). At the end of the course a dose assessment exercise was proposed to participants. Four artificial cases, named exercises left to participants, were used to check the capabilities of application of the IDEAS guidelines, gained by participants during the event. The participants had to use both hand calculations and dedicated software, in limited time (7 h). Forty per cent of participants had solved all four cases in the allotted time. The results of the dose assessment were analysed to gain experience in types of errors assessors may make during the evaluations. The result of this intercomparison exercise was promising: half of the results in each case were equal to the 'reference evaluation estimate', which was obtained by applying the guidelines correctly.
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Gregoratto D, Bailey MR, Marsh JW. Particle clearance in the alveolar-interstitial region of the human lungs: model validation. RADIATION PROTECTION DOSIMETRY 2011; 144:353-356. [PMID: 21036808 DOI: 10.1093/rpd/ncq314] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
New information on particle retention of inhaled insoluble material indicates that the ICRP Human Respiratory Tract Model (HRTM) significantly underestimates long-term retention in the lungs. In a previous paper, the information from three studies was reviewed, and a model developed to predict particle retention in the lungs of coal miners was adapted in order to obtain parameter values for general use to predict particle retention in the alveolar-interstitial (AI) region. The model is physiologically based and simpler than the HRTM, requiring two instead of three compartments to model the AI region. The main difference from the HRTM AI model is that a significant fraction, about 35 %, of the AI deposit of insoluble material remains sequestered in the interstitium. The new model is here applied to the analysis of two well-known contamination cases with several years of follow-up data.
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Gruttadauria S, Saint Georges Chaumet M, Pagano D, Marsh JW, Bartoccelli C, Gridelli BG. Effect of blood transfusion on early outcome of liver resection for colorectal hepatic metastases. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
314 Background: The useof intraoperative blood transfusions (IBT) has been associated with worse surgical outcome in patients undergoing liver resection for malignancy. However, detailed analyses are required to define clinical findings impacting short-term outcome in this scenario.The aim of this study is to evaluate whether IBT are associated with a worse short-term outcome of liver resection in patients with colorectal hepatic metastases, and to assess whether certain patient characteristics and/or surgical variables affect the need for IBT. Methods: In a series of 127 consecutive patients who underwent partial liver resection for colorectal metastases, between July 1999 and March 2010, we studied postoperative 90 days surgical outcome relative to IBT, and the effect of a variety of factors, including type of resection, surgical technique used, concomitant colo-rectal resection, non-tumoral hepatic histological findings, site of primary tumor, and comorbidities, on the incidence of IBT. Results: Patients who received IBT during their liver resection were more likely to have a longer postoperative length of stay (p = 0.02), to experience complications (p = 0.0003), and to experience a Clavien Grade IIIa or worse complication (p = 0.003). Furthermore, undergoing a major resection, and the presence of portal fibrosis in the non-tumoral liver were both correlated with an increase in IBT (respectively, p = 0.003 and p = 0.049), while the surgical technique used (Kellyclasia or TissueLink), the presence of steatosis, undergoing a concomitant major colonic or rectal resection, and having a major comorbidity had no effect on the incidence of IBT (p ≥ 0.05). Conclusions: This study confirmed that receiving IBT during partial liver resection for colorectal hepatic metastases is associated with a worse short-term surgical outcome. These clinical findings suggest that although several significant factors (surgical technique chosen, comorbidities present, etc.) do not seem to influence the short-term outcome of surgery, it is important to be aware of the deleterious effects of the type of resection performed and the presence of portal fibrosis on blood loss during partial liver resection. No significant financial relationships to disclose.
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Cho SW, Steel J, Tsung A, Marsh JW, Geller DA, Gamblin TC. Safety of liver resection in the elderly: how important is age? Ann Surg Oncol 2010; 18:1088-95. [PMID: 21046265 DOI: 10.1245/s10434-010-1404-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Indexed: 12/15/2022]
Abstract
BACKGROUND With the aging population, more elderly patients are being considered for hepatic resection. We investigated whether advanced age was associated with higher rate and severity of postoperative complications. METHODS A total of 75 patients aged ≥70 years (group E) were matched with 75 patients aged <70 years (group Y) by the extent of liver resection and by operative indications. Primary outcome measures were rates and severity of complications. Secondary outcome measures were length of hospital stay and discharge destination. Univariate analysis was also performed to identify variables associated with higher surgical risk. RESULTS Male-to-female ratio was 43:32 in both groups. Overall complication rates were 44 and 33.3% in group E and Y, respectively (P = 0.241; odds ratio = 1.57; 95% confidence interval [95% CI], 0.81-3.05). There was no mortality in both groups. The only postoperative age-related morbidity was confusion in the elderly. There was no difference in the rates of severe complications (grade ≥3) between group E and group Y (16 vs. 14.7%; P = 0.744; odds ratio = 1.11; 95% CI, 0.46-2.70). Median length of hospital stay were 7 and 6 days, respectively (P = 0.01). Nineteen percent and 1% of patients in group E and group Y were discharge to rehabilitation facilities, respectively (P = 0.001). Univariate analysis showed that preoperative systemic chemotherapy and longer operative time were associated with higher morbidity in the elderly. CONCLUSIONS Liver resection can be performed in patients aged ≥70 years as safely as in younger patients. Duration and timing of systemic chemotherapy before liver resection should be optimized to minimize postoperative morbidity.
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Gregoratto D, Bailey MR, Marsh JW. Modelling particle retention in the alveolar-interstitial region of the human lungs. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2010; 30:491-512. [PMID: 20826887 DOI: 10.1088/0952-4746/30/3/005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Better information is available now on long-term particle retention in the human lungs than there was in 1994, when the human respiratory tract model (HRTM) was adopted by the International Commission on Radiological Protection (ICRP). Three recent studies are especially useful because they provide such information for groups of people who inhaled very similar aerosols. For all three the HRTM significantly underestimates lung retention of insoluble material. The purpose of this work was to improve the modelling of long-term retention in the deep lung. A simple physiologically based model developed to predict lung and lymph node particle retention in coal miners was found to represent lung retention in these studies adequately. Instead of the three alveolar-interstitial (AI) compartments in the HRTM, it has an alveolar compartment which clears to the bronchial tree and to a second compartment, representing the interstitium, which clears only to lymph nodes. The main difference from the HRTM AI model is that a significant fraction of the AI deposit is sequestered in the interstitium. To obtain default parameter values for general use, the model was fitted to data from the three recent studies, and also the experimental data used in development of the HRTM to define particle transport from the AI region for the first year after intake. The result of the analysis is that about 40% of the AI deposit of insoluble particles is sequestered in the interstitium and the remaining fraction is cleared to the ciliated airways with a half-time of about 300 days. For some long-lived radionuclides in relatively insoluble form (type S), this increased retention increases the lung dose per unit intake by 50-100% compared to the HRTM value.
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Gruttadauria S, di Francesco F, Li Petri S, Dominioni T, Lorenzin D, Cintorino D, Spada M, Marsh JW, Marcos A, Gridelli B. Technical aspects of living-related liver donation: single-center experience. Transplant Proc 2009; 41:1273-4. [PMID: 19460536 DOI: 10.1016/j.transproceed.2009.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Living-related donor liver transplantation is the newest and both technically and ethically most challenging evolution in liver transplantation and has contributed to reduction in donor shortage. We briefly report the technical aspects of surgical procedures performed to achieve a partial graft from a live donor. Eighty-four adult and two pediatric recipients underwent living-related donor liver transplantation at our center. There were no donor deaths, and all patients returned to their normal activities after the perioperative period. This single-center experience may contribute to refinement of the surgical technique required to improve the outcome of these complex operations.
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de Vera ME, Lopez-Solis R, Dvorchik I, Campos S, Morris W, Demetris AJ, Fontes P, Marsh JW. Liver transplantation using donation after cardiac death donors: long-term follow-up from a single center. Am J Transplant 2009; 9:773-81. [PMID: 19344466 DOI: 10.1111/j.1600-6143.2009.02560.x] [Citation(s) in RCA: 235] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
There is a lack of universally accepted clinical parameters to guide the utilization of donation after cardiac death (DCD) donor livers and it is unclear as to which patients would benefit most from these organs. We reviewed our experience in 141 patients who underwent liver transplantation using DCD allografts from 1993 to 2007. Patient outcomes were analyzed in comparison to a matched cohort of 282 patients who received livers from donation after brain death (DBD) donors. Patient survival was similar, but 1-, 5- and 10-year graft survival was significantly lower in DCD (69%, 56%, 44%) versus DBD (82%, 73%, 63%) subjects (p < 0.0001). Primary nonfunction and biliary complications were more common in DCD patients, accounting for 67% of early graft failures. A donor warm ischemia time >20 min, cold ischemia time >8 h and donor age >60 were associated with poorer DCD outcomes. There was a lack of survival benefit in DCD livers utilized in patients with model for end-stage liver disease (MELD) < or =30 or those not on organ-perfusion support, as graft survival was significantly lower compared to DBD patients. However, DCD and DBD subjects transplanted with MELD >30 or on organ-perfusion support had similar graft survival, suggesting a potentially greater benefit of DCD livers in critically ill patients.
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Cho SW, Marsh JW, Geller DA, Holtzman M, Zeh H, Bartlett DL, Gamblin TC. Surgical management of leiomyosarcoma of the inferior vena cava. J Gastrointest Surg 2008; 12:2141-8. [PMID: 18841423 DOI: 10.1007/s11605-008-0700-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2008] [Accepted: 09/08/2008] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Leiomyosarcoma of the inferior vena cava (IVC) is a rare tumor for which en bloc resection offers the only chance of cure. Due to its rarity, however, optimal strategies for the management of the primary tumor and subsequent recurrences are not well defined. METHODS We performed a retrospective review of patients who underwent surgical resection of IVC leiomyosarcoma. We evaluated clinical presentations, operative techniques, patterns of recurrence and survival. RESULTS From 1990 to 2008, nine patients (four females) were identified. Median age was 55 years (40-76). Presentations included abdominal pain (n = 5), back pain (n = 2), leg swelling (n = 4) and abdominal mass (n = 2). Pre-operative imaging studies showed tumor location to be from the right atrium to renal veins (n = 1), retrohepatic (n = 5), and from hepatic veins to the iliac bifurcations (n = 3). En bloc resection included right nephrectomy (n = 5), right adrenalectomy (n = 4), pancreaticoduodenectomy (n = 1), right hepatic trisectionectomy (n = 1) and right hemicolectomy (n = 1). The IVC was ligated in six patients, and a prosthetic graft was used for IVC reconstruction in three patients. Resection margins were negative in seven cases. Median length of stay was 12 days (range, 6-22 days). Major morbidity included renal failure (n = 1) and there was one post-operative mortality. Five patients had leg edema post-operatively, four of whom had IVC ligation. Median survival was 47 months (range, 1-181 months). Four patients had recurrence and the median time to recurrence was 14 months (range, 3-25 months). Two patients underwent successful resection of recurrence. CONCLUSIONS Curative resection of IVC leiomyosarcoma can lead to long-term survival. However, recurrence is common, and effective adjuvant treatments are needed. In selected cases, aggressive surgical treatment of recurrence should be considered.
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Lopez MA, Etherington G, Castellani CM, Franck D, Hurtgen C, Marsh JW, Nosske D, Breustedt B, Blanchardon E, Andrasi A, Bailey MR, Balashazy I, Battisti P, Bérard P, Birchall A, Broggio D, Challeton-de-Vathaire C, Cruz-Suarez R, Doerfel H, Giussani A, Hodgson A, Koukouliou V, Kramer GH, Le Guen B, Luciani A, Malatova I, Molokanov A, Moraleda M, Muikku M, Oeh U, Puncher M, Rahola T, Stradling N, Vrba T. Internal dosimetry: towards harmonisation and coordination of research. RADIATION PROTECTION DOSIMETRY 2008; 131:28-33. [PMID: 18757895 DOI: 10.1093/rpd/ncn217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The CONRAD Project is a Coordinated Network for Radiation Dosimetry funded by the European Commission 6th Framework Programme. The activities developed within CONRAD Work Package 5 ('Coordination of Research on Internal Dosimetry') have contributed to improve the harmonisation and reliability in the assessment of internal doses. The tasks carried out included a study of uncertainties and the refinement of the IDEAS Guidelines associated with the evaluation of doses after intakes of radionuclides. The implementation and quality assurance of new biokinetic models for dose assessment and the first attempt to develop a generic dosimetric model for DTPA therapy are important WP5 achievements. Applications of voxel phantoms and Monte Carlo simulations for the assessment of intakes from in vivo measurements were also considered. A Nuclear Emergency Monitoring Network (EUREMON) has been established for the interpretation of monitoring data after accidental or deliberate releases of radionuclides. Finally, WP5 group has worked on the update of the existing IDEAS bibliographic, internal contamination and case evaluation databases. A summary of CONRAD WP5 objectives and results is presented here.
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Marsh JW, Castellani CM, Hurtgen C, Lopez MA, Andrasi A, Bailey MR, Birchall A, Blanchardon E, Desai AD, Dorrian MD, Doerfel H, Koukouliou V, Luciani A, Malatova I, Molokanov A, Puncher M, Vrba T. Internal dose assessments: uncertainty studies and update of ideas guidelines and databases within CONRAD project. RADIATION PROTECTION DOSIMETRY 2008; 131:34-39. [PMID: 18718961 DOI: 10.1093/rpd/ncn218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The work of Task Group 5.1 (uncertainty studies and revision of IDEAS guidelines) and Task Group 5.5 (update of IDEAS databases) of the CONRAD project is described. Scattering factor (SF) values (i.e. measurement uncertainties) have been calculated for different radionuclides and types of monitoring data using real data contained in the IDEAS Internal Contamination Database. Based upon this work and other published values, default SF values are suggested. Uncertainty studies have been carried out using both a Bayesian approach as well as a frequentist (classical) approach. The IDEAS guidelines have been revised in areas relating to the evaluation of an effective AMAD, guidance is given on evaluating wound cases with the NCRP wound model and suggestions made on the number and type of measurements required for dose assessment.
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