Successful outcome of the transitional process of inflammatory bowel disease from pediatric to adult age: A five years experience

Introduction and aim

The transitional process of young patients affected by inflammatory bowel disease from pediatric to adult care is a crucial step. Our study aimed to investigate the 1-year success outcome of this transitional process.

About a case of squamous cell carcinoma of the scalp. Management and aesthetic results

We present a case of squamous cell carcinoma of the scalp, treated with local excision and flap reconstruction. We discuss the treatment modalities of this pathology with particular attention to the role of surgery and adjuvant radiotherapy. The authors suggest the systematic use of subgaleal drainage to avoid the hematoma and/or seroma occurrence.     

Long-Term Outcome of Laparoscopic Nissen Procedure in Pediatric Patients with Gastroesophageal Reflux Disease Measured Using the Modified QPSG Roma III European Society for Pediatric Gastroenterology Hepatology and Nutrition's Questionnaire

Abstract Background/Purpose: Laparoscopic fundoplication (LF) represents the gold standard for surgical treatment for pediatric patients with gastroesophageal reflux disease (GERD). Methods: We report the results of long-term outcome of 36 patients who had undergone LF from January to December 1998, with a follow-up longer than 10 years (range, 11-12 years). The patients were invited, by phone, to undergo a clinical follow-up. All patients underwent the modified European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN)'s Roma III questionnaire; however, only 22 out of 36 patients accepted to be controlled in a day hospital setting, and 10 out of 36 accepted to undergo a telephonic questionnaire. Our study is focused on the data of these 32 patients. Results: Twenty-eight out of 32 (87.5%) patients had completely recovered; 4 out of 32 patients (12.5%) had a mild persistent GER; 9 out of 32 patients (28%) referred a mild dysphagia; 21 out of 32 (66%) patients could burp; and only 9 out of 32 (28%) patients could vomit. The cosmetic result was good in 30 out of 32 (94%) patients. The weight/height ratio was satisfactory in 28 out of 32 (87.5%) patients. The quality of life was good in 28 out of 32 (87.5%) patients. Conclusions: Our experience shows that the long-term follow-up after LF produces a good clinical result and a good quality of life. The modified ESPGHAN's Roma III questionnaire seems an effective way to check the long-term results, because it avoids submitting patients to long and not well tolerated instrumental exams.     

Fish oil supplement alters markers of inflammatory and nutritional status in colorectal cancer patients

Inflammation is a common feature in cancer. The presence and magnitude of the chronic systemic inflammatory responses may produce progressive nutritional decline. This study aims at investigating whether there are changes in inflammation markers and/or in nutritional status of patients with colorectal cancer undergoing chemotherapy who were supplemented with fish oil. The clinical trial was conducted with 23 patients randomly distributed in 2 groups. The supplemented group (SG) consumed 2 g of fish oil containing 600 milligrams of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) for 9 wk. Nutritional and inflammatory markers status was available, both at a baseline (M0), and after 9 wk of chemotherapy (M9) in the SG and in the nonsupplemented group (NSG). Statistical analysis was conducted with STATA 11.0 software. SG and NSG presented the same baseline characteristics (P > 0.05). Nutritional status indicators such as body mass index and body weight were modified only in the NSG when comparing baseline and M9, P = 0.03 and P = 0.01 respectively, whereas in SG these indicators did not vary. Patients supplemented with fish oil (SG) showed a clinically relevant decrease in the C-reactive protein/albumin relation (P = 0.005). Low doses of fish oil supplement can positively modulate the nutritional status and the C-reative protein/albumin ratio.     

Efficacy of curettage before excision in clearing surgical margins of nonmelanoma skin cancer

OBJECTIVE: To determine whether curettage before excision of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) improves margin clearance rates. DESIGN: A retrospective, nonrandomized, case-control series of nonmelanoma skin cancers treated with preexcisional curettage followed by simple excision was identified using a computerized search of the database of a dermatopathology service. A validation cohort was established by manually identifying nonmelanoma skin cancers treated with wide excision on a given day. SETTING: All analyzed specimens were derived from the Dermatopathology Service at the University of California, San Francisco, a university-based laboratory that provides interpretation of skin biopsy specimens received directly from community (90%) and academic (10%) practices. PATIENTS: Our retrospective cohort consisted of all nonrecurrent nonmelanoma skin cancers diagnosed by biopsy and treated by simple excision between April 1, 1997, and April 30, 1999. There were 1983 BCCs and 849 SCCs included in our study. The validation cohort included skin cancers diagnosed by biopsy treated with simple excision on the 16th day of each month during the same period. INTERVENTION: Preexcisional curettage. MAIN OUTCOME MEASURE: We compared the frequency of tumor margin involvement of curetted vs noncuretted lesions. Margin involvement was considered surgical failure. RESULTS: Forty-two pecent of BCCs and 34% of SCCs were curetted before excision. In BCC, risks for surgical failure included head and neck lesions (P<.001), lesions treated by physicians performing fewer than 51 procedures (P<.001), and invasive subtypes (P<.01). Factors associated with surgical failure in SCC included in situ disease (P=.01) and an older (77 vs 74 years) patient population (P=.05). In univariate analysis, curettage before excision decreased the surgical failure rate for BCC by 24% (P=.03) but did not decrease the rate for SCC (P=.8). In multivariate analysis, curettage of BCC reduced surgical failure rates by 26% when the physician performed 50 skin cancer excisions or less during the study (odds ratio, 0.74; 95% confidence interval, 0.57-0.95;P=.02). CONCLUSION: Preoperative curettage decreases the frequency of positive margins in the management of BCC but not of SCC.