Disease-Related Mortality within the First Year after Subtotal Esophagectomy for Cancer

Background

Esophageal carcinoma has poor prognosis. Surgery is still considered to be the mainstay of treatment. The mortality rate within the first year after surgery is unknown, but identifying risk factors for early mortality would increase our ability to predict the outcome of these patients and might improve patient selection.

Methods

All patients who had undergone subtotal esophagectomy for cancer between 2003 and 2008 were included in this retrospective series. Patients with less than 12 months follow-up, perioperative mortality, and death from unrelated causes were excluded. Patients were divided into two groups. Group A included all oncological mortality cases within 12 months of surgery. Group B included all patients who survived longer than 12 months following surgery.

Results

Of 81 patients who met the inclusion criteria, group A included 18 patients and group B included 63 (median survival 10 and 25 months, respectively). A higher proportion of patients were operated for pN1 disease in group A (72% versus 33%, p = 0.0004). R₀ esophagectomy rate was lower in group A (39% versus 76%, p = 0.03). Metastatic lymph node ratio (LNR) was higher in group A (mean: 46% versus 10%, p = 0.0003). Multivariate analysis identified LNR as an independent risk factor for first-year oncological mortality [odds ratio (OR) = 1.04, p = 0.0001; 95% confidence interval (CI): 1.02–1.06]. No differences were found in preoperative variables including age, gender, tumor histology, type of operation, and administration of or response to neoadjuvant therapy. Response to neoadjuvant therapy was associated with R₀ resection.

Conclusions

pN1 disease, resection margin involvement, and high LNR were found to be risk factors for first-year oncological mortality after esophagectomy for cancer.     

Different coping strategies influence the development of PTSD among first-time mothers

Objective: To evaluate the different coping strategies for post-traumatic stress disorder (PTSD), described in the non-obstetric trauma literature, with respect to first time postpartum women.

Study design: This was a prospective cohort study conducted between 2011 and 2013. Eligible women had a singleton pregnancy and delivered a healthy newborn at term. Five sets of relevant questionnaires were sent to the participants six weeks postpartum. Posttraumatic stress disorder was defined as per DSM-V criteria.

Results: One hundred and eighty eight completed questionnaires were considered for the final analysis. Two women (1.1%) had PTSD and nine women (4.8%) had partial PTSD. Coping by self-blame and/or rumination together with perception of resource loss emerged as independent variables that were significantly associated with post-traumatic symptomatology (PTS) severity. Objective birth factors such as participation in birth classes or the different modes of delivery seem to have no significant impact on postpartum PTS in our study.

Conclusions: Cognitive coping styles such as self-blame and rumination, as well as perception of resource loss, were all related to postpartum PTS. Redirecting resources to address postpartum negative coping mechanisms may reduce the overall incidence of full and partial postpartum PTSD.     

Natural autoantibodies in the serum of healthy women--a five-year follow-up.

Autoantibodies are often found among healthy individuals. The significance of these findings, regarding the potential development of overt autoimmune disease and the severity of such an eventuality, is as yet unclear. In order to elucidate these issues 506 healthy women were screened and 60 women of child-bearing age were found to posses high titres of various anti-nuclear antibodies. After a 5-year follow-up, 57 of these 60 women were found to have autoantibodies to a variety of autoantigens. Seven of the women had some symptoms that could be associated with the presence of the antibodies (i.e. arthritis, multiple abortions, Raynaud's phenomenon), however, none exhibited overt clinical signs of an autoimmune disease. Our study may point to the fact that in normal subjects (women aged 22-44 years) high titres of natural autoantibodies are not necessarily indicative of a high risk of developing an overt autoimmune condition, at least for a follow-up period of 5 years.     

Brain injuries caused by spherical bolts

OBJECT: Metallic particles contained in antihuman bombs increase the number of fatalities. The ballistics of these particles depends on the explosive that is used, the distance from the explosion, the shape of the particle projected, and the biomechanics of the injured tissue. The authors present their experience with penetrating spherical bolt injuries to the brain. METHODS: The authors retrospectively reviewed clinical and radiological data obtained in eight patients with penetrating spherical bolt injuries to the cranium: four had Glasgow Coma Scale (GCS) scores less than 8 (three died, one from an unrelated injury) and four had a GCS score of 15 (all survived). Two of the latter patients suffered unique anatomical injuries attributed to the distinctive ballistics of spherical bolts: in one patient the bolt penetrated the cavernous sinus causing minimal cranial nerve injury, and in the other patient the bolt lodged in the fourth ventricle causing acute hydrocephalus without other neurological deficits. CONCLUSIONS: Penetrating spherical bolts to the brain may be lethal. Nevertheless, they have unique ballistics that cause highly delineated anatomical damage and minor neurological deficits.     

The detection of anti-Sm-RNP activity in sera of patients with monoclonal gammopathies.

The sera of 141 patients with monoclonal gammopathies were examined for the presence of anti-RNP and anti-Sm activities. An enzyme-linked immunosorbent assay (ELISA) was employed. Thirty-two sera were found to bind RNP while 16 bound to Sm. The anti-Sm and anti-RNP antibodies were found in sera of patients with IgG, IgM and IgA gammopathies. The activity against RNP and/or Sm was confirmed further by using purified immunoglobulins, employing competition assays and immunoblotting. Anti-Sm antibodies are regarded as being highly specific for SLE, yet none of the patients whose serum was found to contain high titres of anti-Sm/anti-RNP antibodies presented with symptoms related to SLE or other rheumatic diseases. Our results of a high incidence of anti-ribonucleoproteins activity in the serum of patients with monoclonal gammopathies support previous reports of autoantibody properties characteristic of these immunoglobulins.