In-transit melanoma: an individualized approach

The majority of locoregional recurrences in melanoma occur in the form of intradermal or subcutaneous local or in-transit metastasis. In-transit melanoma represents contamination of the lymphatic space that, if treated, can result in long-term cure in a subset of patients. The management of in-transit metastases is challenging, since the treatments and extent of disease vary greatly based on the number, depth, location, and distribution of lesions, and on their biological behavior. A number of different treatment options exist, but there is no level 1 evidence to guide clinical decision-making. Herein we present our institutional treatment algorithm, which allows for individualization based on the patient's presentation.     

Adjuvant therapy for locally advanced renal cell cancer: A systematic review with meta-analysis

Background  

Many adjuvant trials have been undertaken in an attempt to reduce the risk of recurrence among patients who undergo surgical resection for locally advanced renal cancer. However, no clear benefit has been identified to date. This systematic review was conducted to examine the exact role of adjuvant therapy in renal cancer setting.     

Vascular access calcification predicts mortality in hemodialysis patients

Vascular calcification is a recognized risk factor for cardiovascular mortality in patients with end-stage renal disease. The aim of this study was to identify risk factors for vascular access calcification and to determine if patients with this disorder are at increased risk of death. Vascular access calcification was found in 49 of 212 hemodialysis patients as measured by plain X-ray (arteriovenous fistula or synthetic graft) in two dimensions. Male gender, diabetes mellitus, and length of time on dialysis were independent predictors for access calcification determined by logistic regression multivariate analysis. Serum parameters were not independently related to access calcification. Kaplan-Meier analysis showed an increased mortality risk, and Cox regression analysis confirmed that vascular access calcification was an independent mortality predictor. Our study suggests that detection of vascular access calcification is a cost-effective method to identify patients at increased mortality risk.     

A higher radiotherapy dose is associated with more durable palliation and longer survival in patients with metastatic melanoma

BACKGROUND: Oncologists are often reluctant to recommend radiotherapy (RT) to palliate metastatic melanoma due to a perception that this tumor is "radioresistant." The Mayo Clinic experience was analyzed to determine the efficacy of palliative RT. METHODS: Eighty-four consecutive patients with 114 lesions that were not metastatic to the central nervous system (CNS) were evaluated for the response of the presenting symptom, the duration of response, and survival after RT. The median dose delivered was 30 grays (Gy) and the median biologic effective dose (BED) was 39.0 Gy(10). Performance status was not uniformly available for all patients. RESULTS: Complete resolution of the presenting symptom occurred in 10 lesions (9%). Of the lesions treated, there was partial improvement in 86 (75%), no change in 12 (11%), and worsening in 6 (5%) lesions. The median survival was 3.8 months and freedom from disease progression (FFP) for individual lesions was 6 months. Patients treated with >30 Gy had significantly longer FFP compared with patients given 30 Gy had a significantly longer survival than those given a lesser dose (median of 2 months vs 8 months; P < .0001). Similarly, patients receiving a BED >39.0 Gy(10) also were found to have longer FFP (P = .03) and survival (median of 2 months vs 8 months; P < .0001) compared with those receiving a BED 30 Gy and a BED >39.0 Gy(10) were found to be associated with longer palliation.     

Border line cases and diagnostic doubts in definition kidney parenchymal and collecting tract neoplasia

Aim of this work is to present cases of renal neoplasms where all available diagnostic modalities and control exams were applied, still explorative surgery was needed. Asymptomatic tissue mass with diagnostic findings of hypovascular renal cell carcinoma and renal pelvic carcinoma were inconclusive. While percutaneous CT guided biopsy is advisable in such cases, it was not performed due to central, hilar localization of the lesions and its small dimensions. In rare cases, such ours are diagnosis is achieved by surgery-histology examination.     

Endoanal ultrasonography in establishing the diagnosis of fecal incontinence

Visualisation of the rectum, rectoanal junction and adjacent structures is very demanding and challenging both with technical and medical side. Local staging of rectal and anal tumor and perianal neoplasm by conventional and sibgle slice CT or by barium enema study is not so valuable. These methods can not visualise fistulous communication in inflamatory bowel diseases and have not any role in evaluation of fecal incontinence. During last decade, endoscopic ultrasound and magnetic resonance imaging have been recognised as methods of choice in establishing diagnosis of rectal, perirectal, anal and perianal diseases. The aim of this article is to review the possibilities of endoanal ultrasound in evaluation of fecal incontinence.     

Body mass maximizes power output in human jumping: a strength-independent optimum loading behavior

It is well known that in vitro muscles maximize their power output when acting against a moderate resistance regarding their maximum strength. Similar behavior has been observed from in vivo muscular systems in both single-joint and most of the multi-joint maximum performance tasks. We refer to that phenomenon as a strength-dependent behavior, since the optimum external load that maximizes the mechanical power output of particular muscle(s) or neuro-musculoskeletal system corresponds to a certain percent of maximum strength. In this review paper, we present evidence that the optimum load in maximum vertical jumps is one’s own body mass, regardless of the strength of the lower limb muscles (i.e., the strength-independent behavior). Although the discussed phenomenon is still underexplored, we believe that several neuro-mechanical mechanisms are involved. Among these are a long-term adaptation of the muscular force–velocity relationship to the body weight and inertia, alteration of the jumping technique, load-specific muscle activation and jumping skills. Further exploration of the discussed strength-independent behavior of the lower limb muscles is of importance for refining various training and rehabilitation procedures, as well as for understanding the design and function of lower limb muscles.