Treatment of Bone Tumors

In this article, the authors summarize the state of the art and future potential in the management of Osteosarcoma, Ewing's sarcoma, and Chondrosarcoma. They cover systemic therapy, surgical therapy, and radiotherapy, along with targeted therapies to inhibit signal transduction pathways. They discuss staging and the role of imaging evaluation to provide an overview of bone tumor treatment. Images presenting pathologic-radiologic correlations are included.     

Autocystectomy following extensive genitourinary tuberculosis: Presentation and management

Genitourinary tuberculosis is an important cause of morbidity in developing and developed countries. We describe a case of extensive genitourinary tuberculosis in which there was complete destruction of the right kidney, stricture of the entire left ureter and an autocystectomized bladder. He presented in azotemia with urinary incontinence and was managed by right nephroureterectomy, ileal replacement of left ureter and ileal neobladder after a preliminary nephrostomy and antituberculous chemotherapy.     

Periprocedural complications by Child-Pugh class in patients undergoing transcatheter arterial embolization or chemoembolization to treat unresectable hepatocellular carcinoma at a VA medical center

Background

For patients with compensated cirrhosis, transcatheter arterial embolization with and without additive chemotherapy has been shown to improve survival. The aim of this study was to compare periprocedural complications in a population with hepatitis C virus-related hepatocellular carcinoma to evaluate for differences in complications by severity of liver disease.

Methods

Patients with unresectable hepatocellular carcinoma treated by transcatheter arterial embolization with or without additive chemotherapy procedures from 2003 to 2006 were retrospectively reviewed and compared by Child-Pugh (CP) class. A total of 141 embolizations were done in 76 patients.

Results

Complication rates were seen in 27% of CP class A and 17% of CP class B patients. There was no significant difference in the grade of complications between the 2 groups or between procedure types. Survival rate was dependent on the degree of liver dysfunction (3-year CP class A, 49%; CP class B, 13%; P = .0048).

Conclusion

Embolization procedures to treat hepatitis C virus-related hepatocellular carcinoma can be performed safely with low morbidity and mortality rates, even in patients with a compromised hepatic reserve.     

Comparative Evaluation of Thoracoscopy Versus Thoracotomy in the Management of Lung Hydatid Disease

Background  

Lung hydatid disease is an endemic problem in Mediterranean countries, and the ideal surgical management for it is still debated. In this prospective study, we aimed to evaluate the feasibility and safety of thoracoscopy in patients with lung hydatid disease. We studied the advantages of thoracoscopic procedure over posterolateral thoracotomy.     

Outcomes of brachial artery-basilic vein fistula

Increasing the creation of arteriovenous fistulas in the maintenance of hemodialysis patients is of great importance to the nephrology community. The creation of the brachial artery-basilic vein fistula is an important option in patients with unsuccessful or failing forearm accesses for hemodialysis. The aim of this study is to review reported outcomes of brachial artery-basilic vein fistulas regarding patency and primary failure rates in comparison with other types of fistulas and grafts in the published literature. We have also described the variations in the surgical technique during creation and the potential influence on outcomes. Based on our review of the literature, the rate of primary failure is approximately 15-20% with a range of 0-40%. The mean 1-year primary patency rate is approximately 72% with a range of 23-90%, and the 2-year primary patency rate is approximately 62% with a range from 11% to 86%. The number of required interventions to maintain patency is lower with brachial artery-basilic vein fistula compared to arteriovenous grafts.     

Interdialytic hypertension-an update

The reference standard for diagnosing hypertension among hemodialysis patients is 44-hour interdialytic ambulatory blood pressure (BP) recording. However, a more practical way to diagnose and manage hypertension is to measure home BP over the interdialytic interval. In contrast to pre- and postdialysis BP recordings, measurements of BP performed outside the dialysis unit correlate with the presence of left ventricular hypertrophy and directly and strongly with all-cause mortality. Hypervolemia that is not clinically obvious is the most common treatable cause of hypertension among patients with end-stage renal disease; thus, volume control should be the initial therapy to treat hypertension in most hemodialysis patients. To diagnose hypervolemia, continuous blood volume monitoring is emerging as an effective and simple technique. Reducing dietary and dialysate sodium is an often overlooked strategy to improve BP control. Although definitive randomized trials that show cardiovascular benefits of BP lowering among hypertensive hemodialysis have not been performed, emerging evidence suggests that lowering BP might reduce cardiovascular events. The treatment should be guided by BP obtained outside the dialysis unit because predialysis and postdialysis BP are quite variable and agree poorly with measurements obtained outside the dialysis unit. Although the appropriate level to which BP should be lowered remains elusive, current data suggest that interdialytic ambulatory systolic BP should be lowered to <130 mm Hg and averaged home systolic BP to <140 mm Hg. Antihypertensive drugs will be required by most patients receiving thrice weekly dialysis for 4 hours. Beta blockers, dihydropyridine calcium blockers, and agents that block the renin-angiotensin system appear to be effective in lowering BP in these patients.     

Comparison of the 6th and 7th Editions of the UICC TNM Staging System for Gastric Cancer: Results of a Chinese Single-Institution Study of 1,503 Patients

Aim

To evaluate the prognostic efficacy of the 7th edition tumor–node–metastasis (TNM) classification compared with the 6th edition in gastric cancer patients.

Methods

A total of 1,503 gastric cancer patients undergoing surgical resection were staged using the 6th and 7th edition staging systems. Homogeneity, discriminatory ability, and monotonicity of gradients of the two systems were compared using linear trend χ², likelihood ratio χ² statistics, and Akaike information criterion (AIC) calculations.

Results

Significant differences in 5-year survival rates were observed for the T, N, and M subgroups using the 7th edition system, except for stage N2 and N3 patients in the 6th edition system. There were no significant differences in survival between IB and IIA in the 7th edition system. Patients with stage IV disease due to T4/N3 in the 6th edition system who were downstaged to stage III in the 7th edition system had significantly better survival than those who remained at stage IV. The 7th edition system had higher linear trend and likelihood ratio χ² scores, and smaller AIC values compared with those for the 6th edition, which represented the optimum prognostic stratification.

Conclusions

Our study suggests that the 7th edition system performs better than the 6th edition in several aspects.