Soft tissue sacrococcygeal chordoma with intracytoplasmic filamentous inclusions

Extraskeletal chordoma arising within soft tissue is a rare occurrence. We report a case of chordoma that is unusual both for its location within the subcutaneous soft tissue of the sacrococcygeal region without involvement of adjacent bones and for the presence of eosinophilic roundish inclusion bodies within the cytoplasm of tumor cells. These bodies revealed immunoreactivity for cytokeratin and a fibrillar, partly whorled structure on the electron microscopic examination, consistent with an intermediate filament-based composition. To our knowledge, this is the first report of chordoma featuring this cellular change although we do not know the significance of these bodies.     

Attentional load of the primary task influences the frontal but not the temporal generators of mismatch negativity

According to the model hypothesized by N??t?nen and Michie, the generation of the mismatch negativity (MMN) requires a mismatch detection, taking place in temporal areas, followed by the activation of frontal generators, underlying attention switching toward the deviant stimulus. We aimed at verifying whether the activation of temporal and frontal regions is dependent on the amount of attentional resources allocable toward the deviant stimulus. We recorded event-related potentials (ERPs) in nine healthy subjects while reading and during a demanding visual task (Multiple Features Target Cancellation, MFTC). Raw data were further evaluated by Brain Electrical Source Analysis (BESA). During the Reading condition, distraction toward the unattended auditory stimuli was reflected by the enhancement of the N1 response to frequent stimuli and by the elicitation of a P3a response to deviant ones. The MMN distribution was explained by bilateral temporal dipoles. During the MFTC condition, no P3a was detected, while source analysis showed the activation of a right frontal generator. Temporal dipoles showed no change between the two conditions: we thus conclude that the earlier mismatch detection is independent on the attentional load. By contrast, the activation of a right frontal subcomponent occurred only during the high-load task, independently on any actual attention shift reflected by the P3a component. We thus discuss the hypothesis whether the right frontal MMN generator, rather than subserving a simple attention switching toward the deviant stimulus, plays a role in modulating the auditory change detection system ("contrast enhancement" model).     

Three-dimensional virtual cholangioscopy: a reliable tool for the diagnosis of common bile duct stones

OBJECTIVE: Our goal was to evaluate the clinical reliability of a new software system employing 3-dimensional (3D) virtual anatomic reconstruction and intraluminal virtual exploration for detection of choledocholithiasis and preoperative visualization of the biliary anatomy. SUMMARY BACKGROUND DATA: Virtual reality systems have been proposed for gastroscopy, bronchoscopy, and colonoscopy, as well as for the 3D reconstruction of liver anatomy and hepatic lesions. The impact of these systems in preoperative diagnostics has not been established due to the lack of large clinical series evaluating their reliability. METHODS: From November 2000 to July 2002, all patients presenting to our Institute with suspected choledocholithiasis were prospectively included in the study. All patients underwent conventional magnetic resonance cholangiopancreatography (MRCP) and either intraoperative cholangiogram (IOC) or endoscopic retrograde cholangiopancreatography (ERCP). The digital data from MRCP were incorporated into an original virtual reality software system to generate a 3D reconstruction. All 3D reconstructions were evaluated by a surgeon and a computer software engineer who were blind to the results of the IOC or ERCP. Sensitivity and specificity were then calculated based on the results of either the IOC or ERCP. RESULTS: Sixty-five patients were enrolled in the study. The average time required to reconstruct the images into navigable virtual reality was 7.5 minutes (range, 4-13.5). The 3D virtual cholangioscopy had sensitivity and specificity rates of 71% and 91%, respectively, compared with 61% and 86% of the standard MRCP. CONCLUSION:: The 3D virtual cholangioscopy provides detailed preoperative reconstruction of biliary anatomy and reliable identification of choledocholithiasis with acceptable sensitivity and specificity in a clinical setting. Newer software developments may further enhance its accuracy, so that virtual cholangioscopy might challenge or replace more invasive diagnostic measures in the near future.     

Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes

Background: Total mesorectal excision (TME) offers the lowest reported rates of local recurrence and the best survival results in patients with rectal cancer. However, the laparoscopic approach to resection for colorectal cancer remains controversial due to fears that oncologic principles will be compromised. We assessed the feasibility, safety and long-term outcome of laparoscopic rectal cancer resections following the principles of TME. The aim of this study was to evaluate the perioperative outcome and long-term results of laparoscopic TME. Methods: We reviewed the prospective database of 102 consecutive unselected patients undergoing laparoscopic TME for rectal cancer between November 1991 and December 2000. Follow-up was done through office charts or direct patient contact. Recurrence and survival curves were generated by the Kaplan-Meier method. Results: Laparoscopic TME was completed successfully in 99 patients, whereas conversion to an open approach was required in three cases (3%). The overall morbidity and mortality rates were 27% and 2%, respectively, with an overall anastomotic leak rate of 17%. Of the 102 patients, four were excluded from the oncologic evaluation because final pathology was not confirmatory (two had anal canal squamous cell carcinoma and two had villous adenoma with dysplasia). In 90 of the 98 remaining patients (91.8%), the resection was considered curative. The remainder had a palliative resection due to synchronous metastatic disease or locally advanced disease. Mean follow-up was 36 months (range, 6–96). There were no trocar site recurrences. The local recurrence rate was 6%, and the cancer-specific survival of all curatively resected patients was 75% at 5 years. The overall survival rate of all curatively resected patients was 65% at 5 years; mean survival time was 6.23 years (95% confidence interval [CI], 5.39–7.07). Conclusion: Laparoscopic TME is feasible and safe. The laparoscopic approach to the surgical treatment of operable rectal cancer does not seem to entail any oncologic disadvantages. Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), New York, NY, USA, 13–16 March 2002     

Work, cardiopathy, and sports

BACKGROUND: Heart disease is the main cause of early disability and premature death in Europe. Regular physical activity may prevent heart disease, diabetes, ictus, and obesity. Nevertheless, a certain resistance to a dynamic lifestyle, lack of free time, lack of motivation and other factors are frequently encountered. OBJECTIVES: To stress the importance of physical activity in the prevention of cardiovascular disease. METHODS: A literature review of the main risk factors for cardiovascular disease was carried out. RESULTS AND CONCLUSION: It has been shown that physical exercise is beneficial to the cardiovascular apparatus and to the bones and joints, by improving some metabolic parameters. Recent studies have shown that a personalized, moderate physical activity should be suggested for primary and secondary prevention, in particular for subjects with coronary artery disease and left ventricular dysfunction. An increase in sports activity and physical exercise at work and at school is recommended so as to improve quality of life and promote home rehabilitation. Some promising experience has already been made among workers and their families with excellent results, as shown by a follow-up period of three years.     

Radiation dose, chemotherapy and risk of soft tissue sarcoma after solid tumours during childhood

Soft tissue sarcoma (STS) is one of the most frequent second primary cancer that occurs during the first 20 years following treatment for a solid cancer in childhood. Our aim was to quantify the risk of STS as a second malignant neoplasm and to investigate its relationship with radiotherapy and chemotherapy. A cohort study of 4,400 3-year survivors of a first solid cancer diagnosed during childhood in France or the United Kingdom, between 1942 and 1985, was followed 15 years on average. In a partially nested case-control study, we matched 25 cases of STS and 121 controls for sex, type of first cancer, age at first cancer and duration of follow-up. Sixteen STS occurred in the cohort, as compared to 0.3 expected from the general population (Standardized Incidence Radio, SIR = 54 (95%CI: 34-89)). The SIR was 113 (95% CI: 62-185) after chemotherapy plus radiotherapy (13 STS), whereas it was 28 (95%CI: 2-125) after chemotherapy alone (1 STS) and 19 (95%CI: 3-60) after radiotherapy alone (2 STS). After adjustment for treatment, there was no evidence of variation in the annual excess of incidence or in the SIR with either age at first cancer or time since 1st cancer. In the case-control study, the risk of a STS was increased with the square of the dose of radiation to the site of STS development and with the administration of Procarbazine. The increased risk of soft tissue sarcoma that occurred after childhood cancer is independently related to exposure to radiotherapy and Procarbazine. A closer surveillance of children treated with this treatment combination is strongly recommended.