Laparoscopic port site metastasis of an undetected primary tumor

A 50-year-old woman presented with an adenocarcinoma at a port site of a previous laparoscopic cholecystectomy. A thorough investigation and exploratory laparotomy with excision of the tumor failed to detect its origin.     

Port site recurrences after laparoscopic surgery. A review

The diagnosis of meningeal carcinomatosis hinges on the cytologic examination of cerebrospinal fluid (CSF), which has a known low sensitivity for the identification of malignant cells. Often only 'suspicious' or 'atypical' diagnoses can be rendered, and specimens are commonly unsatisfactory for evaluation due to poor morphologic preservation. Telomerase is widely expressed in most brain metastases, medulloblastomas, lymphomas, oligodendrogliomas, and is expressed focally in glioblastomas. Little is known about the level of telomerase expression in these tumors, except for brain metastases, where a four-fold variation in telomerase levels exists. In our laboratory, as few as ten carcinoma cells can be detected by a sensitive polymerase chain reaction-based assay, the telomeric repeat amplification protocol (TRAP), for telomerase, but it was unclear whether varying levels of telomerase expressed by different types of metastases would influence detection. Using the TRAP protocol, we studied 281 CSF samples from a wide variety of patients with neurologic and non-neurologic conditions for telomerase expression. An adjusted specificity of 90% and a sensitivity of 64% were achieved for detection of malignant cells in CSF by telomerase expression. The TRAP assay for telomerase detection may serve as an adjunct to the traditional examination of CSF. Neither previously documented four-fold variation in the levels of telomerase expression in brain metastases, high CSF protein levels nor high white blood cell counts precluded detection of malignant cells in CSF.     

A meta-analytic review of the preventive treatment of recurrences of febrile seizures

OBJECTIVE: To assess the efficacy of various medications in the prevention of recurrent febrile seizures. STUDY DESIGN: A meta-analysis of all published randomized, placebo-controlled trials of the preventive treatment of febrile seizures published in English; 45 articles were found, but only 9 trials were randomized and placebo-controlled--4 using phenobarbital; 3, diazepam; 1, pyridoxine; and 1, phenytoin. In one of the phenobarbital trials, valproate was also compared with placebo. RESULTS: The risk of recurrences was significantly lower in children receiving continuous phenobarbital therapy than placebo (odds ratio 0.54, 95% confidence intervals 0.33 to 0.90, p = 0.017). The odds ratio for recurrences in the valproate group was 0.09, 95% CI 0.01 to 0.78, p = 0.011. No difference in the risk was found for recurrences between children receiving intermittent diazepam and placebo (odds ratio 0.81, 95% CI 0.54 to 1.22, p = 0.31). The risk for recurrences in children receiving pyridoxine or phenytoin did not differ from the risk among children receiving placebo. Four children would have to be treated with valproate (95% CI 2 to 11) or eight children would have to be treated with phenobarbital (95% CI 5 to 27), continuously, to prevent one febrile seizure. CONCLUSIONS: Because both agents found to be effective in prevention of recurrent febrile seizures have known adverse effects, prophylaxis of febrile seizures cannot be recommended.     

Biopsy in rectal cancer recurrences

The design of a modified needle for trephine biopsy in rectal cancer recurrence in the perineal region is described. The needle design is simple and can be readily manufactured in a mechanic shop. The biopsy material obtained is large enough to type the tumor histologically. The technic of biopsy is not complicated and requires no special skill. Trephine-biopsy for rectal cancer recurrences may substitute completely knife biopsy, being a safe maneuvre in the complex diagnosis of rectal cancer recurrence.     

The relationship between stress and depression in first onsets versus recurrences: A meta-analytic review.

S. M. Monroe and K. L. Harkness (see record 2005-02750-005) reviewed the empirical evidence supporting R. M. Post's (see record 1992-43211-001) kindling model, which suggests the 1st episode of depression is more likely to be preceded by major stressors than are subsequent episodes. Their review highlighted the diverse interpretations of Post's premise in the current literature and the changes in research methods that have contributed to this interpretive shift. The authors conducted a meta-analysis (N=13 studies) to test Post's premise that integrated early and recent research and examined potential moderators. A proportion difference effect size was used. Results indicated that 1st onsets of depression were more likely than recurrences to be preceded by severe life events, supporting Post's premise. The moderator analyses suggested that support may be most evident in patient samples and may vary according to age and gender, with less support for Post's premise evidenced in younger samples and in women. Although these results are preliminary, as the analysis included a small number of studies, they suggest that future research should further examine factors that influence the stress-depression relationship with successive recurrences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parenteral nutrition in oncologic patients]

A B16 melanoma-specific CD8+ T cell line (AB1) was established from the spleen cells of C57BL/6 mice cured of B16 melanoma with interleukin (IL)-12 treatment. The AB1 line exclusively used T cell receptor Vbeta11. The AB1 cells exhibited a cytolytic activity against both syngeneic B16 melanoma and allogeneic P815 mastocytoma, whereas a cold inhibition assay revealed specificity of the AB1 cells against B16 melanoma. Their lostability to kill a class I loss variant of B16 melanoma was restored by the transfection of H-2Kb gene. In addition, their interferon (IFN)-gamma production was significantly suppressed by the addition of anti-H-2Kb monoclonal antibody, and RT-PCR analysis showed that the AB1 line expressed the mRNA encoding IFN-gamma, but not IL-4 or IL-10. The experiment using synthetic peptides of tyrosinase-related protein-2 (TRP-2) revealed that the AB1 cells could recognize TRP-2(181-188) peptide. Moreover, the AB1 cells showed an in vivo antitumor effect against established pulmonary metastases of B16 melanoma. Overall, these results indicate that the Tc1-type Vbeta11+ AB1 cells exert an antitumor activity against syngeneic B16 melanoma through recognition of TRP-2(181-188) peptide in an H-2Kb-restricted manner.     

Use of lasers in orthopedic surgery--a mutagenesis risk?

Since ten years different laser systems have been used in arthroscopic procedures and percutaneous laser disc decompression. A potential mutagenic risk has not been excluded yet. From photobiology it is known that light in the UV-range is the main source of mutations. Therefore the aim of our study was to determine the mutagenic risk of laser systems at UV-wavelengths. The BALB/3T3 cell line was irradiated at the Excimer wavelengths 248 nm and 308 nm. Transformation rates were compared with non-irradiated cells and the effect of 1 Gy-Roentgen irradiation. Pulse energy, frequency and irradiation time were varied over a broad range. The effect of double irradiation was also examined. For 308 nm no significant transformation rate was found (p < 0.18). In contrast 248 nm showed a highly significant transformation rate (p < 10(-9). Transformation rate after Roentgen irradiation exceeded that of the negative control about two orders. While a certain mutagenic risk exists for 248 nm application of the wavelength 308 nm seems harmless. Our data therefore represent an essential contribution to long term laser safety both for the physician and his patient.     

A review of 716 consecutive free flaps for oncologic surgical defects: refinement in donor-site selection and technique

Free-tissue transfer has become an important method for reconstructing complex oncologic surgical defects. This study is a retrospective review of a 10-year experience with 716 consecutive free flaps in 698 patients. Regional applications included the head and neck (69 percent), trunk and breast (14 percent), lower extremity (12 percent), and upper extremity (5 percent). Donor sites included the rectus abdominis (195), fibula (193), forearm (133), latissimus dorsi (69),jejunum (55), gluteus (28), scapula (26), and seven others (17). Microvascular anastomoses were performed to large-caliber recipient vessels using a continuous suture technique; end-to-end anastomoses were preferred (75 percent). Flaps were designed to avoid the need for vein grafts. Conventional postoperative flap monitoring methods were used. These included clinical observation supplemented by Doppler ultrasonography, surface temperature probes, and pin prick testing. Buried flaps were either evaluated with Doppler ultrasonography or not monitored. The overall success rate for free-flap reconstruction of oncologic surgical defects was 98 percent. Fifty-seven flaps (8 percent) were reexplored for either anastomotic or infectious problems. Reexplored flaps were salvaged in 40 cases (70 percent). Surviving flaps resulted in a healed wound and did not delay postoperative radiation or chemotherapy. The incidence of major and minor postoperative complications was 34 percent. The mean duration of hospitalization was 20 days, and the average cost was $40,224. The results of this study support the need for only seven donor sites to solve the majority (98 percent) of oncologic problems requiring microsurgical expertise. The evolution of preferred donor sites for specific regional applications is illustrated in this 10-year experience. Technical refinements have simplified performing the microsurgical anastomoses and essentially eliminated the need for vein grafts. Conventional monitoring has led to the rapid identification of vascular compromise and subsequent flap salvage in the majority of non-buried free flaps.     

Late sequelae of oncologic treatment in children

The risk of late effects of cancer treatment in children is higher than that after treatment during adulthood. The late effects of chemotherapy are proportional to the dosage and those of irradiation to the size of the radiation field, fractionation and dose. Irradiation may lead to impaired growth of bone and soft tissues, cranial irradiation to pituitary deficiencies, alopecia and impaired cognitive function, irradiation of the neck to altered thyroid function, thoracic irradiation to diminished pulmonary function and cardiovascular morbidity, radiation therapy of the abdomen to infertility in females, impaired renal function and chronic enteritis. Chemotherapy-induced damage is more organ-specific. Well-known cardiotoxic agents are the anthracycline derivatives. Restricted pulmonary function is seen after treatment with bleomycin and nitrourea derivatives. Several antineoplastic agents are gonadotoxic in men. Nephrotoxic agents are cisplatin and ifosfamide. The cumulative relative risk of developing a second primary neoplasm is 3,8-6,9 after a follow-up period of 25 years. Alkylating agents and the topoisomerase inhibitors are known to increase the risk of haematologic malignancy, while radiation therapy is associated with bone, soft tissue, thyroid, breast, brain and gastrointestinal malignancies.     

Laparoscopic approach in acute small bowel obstruction. A review of 68 patients

BACKGROUND/AIMS: Laparoscopic management of acute small bowel obstruction has potential advantages over classical laparotomy. The aims of this study were to assess the feasibility and the safety of this technique, as well as to find any predictive success factors. METHODOLOGY: A laparoscopic approach was undertaken in 68 out of 150 patients admitted between 1991 and 1997 for acute small bowel obstruction. RESULTS: The cause of obstruction was bands or adhesions in 80% of the patients. A correct laparoscopic diagnosis was established in 66% of the cases. A laparoscopic treatment was performed successfully in 31 patients (46%), and was assisted by minilaparotomy in 4 patients (6%), and by open herniorraphy in 2 patients (3%). Thirty-one patients (46%) needed a conversion to laparotomy. There were 6 bowel injuries (9%), all recognized during laparoscopy. There were 2 deaths in converted patients and 2 early reoperations for persisting ileus in patients treated by laparoscopy alone or by assisted laparoscopy. CONCLUSION: Acute small bowel obstruction can be treated by laparoscopy alone, or assisted by minilaparotomy or open herniorraphy with advantages for the patient and few complications despite a high rate of conversion. There were no pre-operative predictive factors for successful laparoscopy, except for an isolated previous scar from an appendectomy. Pre-operative predictive success factors were parietal intestinal adhesions, as the only cause of obstruction. Multiple adhesions will mostly require conversion to laparotomy.     

Experimental study of the effect of intra-abdominal pressure during laparoscopy on tumour growth and port site metastasis

BACKGROUND: The influence of raised intraperitoneal pressure during laparoscopy on tumour growth and port site metastasis is still unknown. METHODS: Tumour growth of colonic adenocarcinoma DHD/K12/TRb was measured after laparoscopy with carbon dioxide at different pressures (0, 5, 10 and 15 mmHg) in a rat model. Cell kinetics were determined after incubation with carbon dioxide (0, 5, 10 and 15 mmHg) in vitro (n=60). Additionally, tumour growth was measured subcutaneously and intraperitoneally 4 weeks after laparoscopy at different intraperitoneal pressures (5, 10 and 15 mmHg) (n=100). RESULTS: In vitro tumour growth decreased significantly after incubation with carbon dioxide at 10 and 15 mmHg compared with a pressure of 0 or 5 mmHg. In vivo, mean(s.d.) intraperitoneal tumour weight was significantly increased after laparoscopy at 5 mmHg (919(1085) mg) and at 10 mmHg (1274(1523) mg) (P< 0.05), but decreased again after laparoscopy with an intraperitoneal pressure of 15 mmHg (731(929) mg) compared with the control group (365(353) mg) (P=0.3). Mean(s.d.) subcutaneous tumour growth was promoted after laparoscopy at 5 mmHg (172(234) mg), at 10 mmHg (190(253) mg) and at 15 mmHg (178(194) mg) compared with controls (48(33) mg) (P < 0.05). CONCLUSION: In vitro, raised intraperitoneal pressure leads to suppression of tumour growth. In vivo, intraperitoneal tumour growth is suppressed only by higher pressure (15 mmHg). Subcutaneous tumour growth is stimulated by carbon dioxide independently of the intraperitoneal pressure.     

Use of anorganic bone in periapical defects following apical surgery--a prospective trial

Clinical and statistical analyses of the patients with attack-like schizophrenia admitted to Moscow mental hospitals provided evidence for prognostic evaluation of the frequency of the patients' hospitalization in the initial 10 years. The number of hospitalizations was clearly correlated with social and occupational adaptation of the patients. Maintenance therapy produced no effect on the number of the patients' hospitalizations.     

Myth and reality in minimal access oncologic surgical management

A case of a woman affected by an unusual association of rare diseases, is presented. The patient was referred to our department for acute anaemia. Preoperative investigations revealed that the patient was affected by fibrous polyostotic dysplasia, so called Jaffè-Lichtenstein syndrome. The presence of skin brown spot and endocrine disorders requiring pill administration, allows to classify the patient as carrier of Albright syndrome. Moreover, the angiography pointed out a celiac trunc stenosis (Dunbar syndrome). The long-standing administration of the pill could be the cause of bleeding adenoma. The patient underwent hepatic resection. We did not treat the Dunbar syndrome because of poor symptoms. From literature, we review some opinions on the fibrous dysplasia of the bone.     

Effectiveness of autologous blood replacement in rheumatoid arthritis surgery--a report of 10 years experience

The use of a wood stick (meswak or chewing stick) for brushing the teeth continues to be an important tool for oral hygiene care in many Afro-Asian communities. It is inexpensive, customary and used for religious reasons as well. Despite the wide use of meswak, information on its chemical and pharmaceutical contents are scant, particularly in regard to an anticaries effect. In the present study, sticks from Salvadora persica, the most common source for meswak, were analyzed for their soluble and total content of fluoride, calcium, phosphorus and silica. Results showed that the fluoride released from meswak soaked in water was negligible (< 0.07 microgram/ml). Approximately 39% of the total fluoride in the sticks was in a form that could be leached out. The leached calcium and phosphorus averaged 582 micrograms/ml and 34 g/ml, respectively, representing 19.6% and 26.4% of their total content in the sticks. There was a substantial amount of silica in the ashes of meswak. It appears that meswak is probably not particularly active against caries through its fluoride content, but it does act as a brush for removing dental plaque and polishing the teeth.