Experience with radiofrequency ablation in the treatment of unresectable pelvic recurrence of rectal cancer

More than half of colorectal cancers are located in the rectum, and the number of such cancers is increasing. In Hungary colorectal cancers are diagnosed predominantly in advanced stages. In the last five years 736 patients with colorectal cancer were operated on at our Department, with the following stage distribution: Dukes A 10%, BI 10%, B2 31%, C 36% and D 13%. The local recurrence rate is decreasing since the introduction of total mesorectal excision and preoperative radiation. Effective treatment options are however poor for unresectable pelvic recurrences. Chemo- and radiotherapy have severe limitations in this advanced stage cancer. In recent years there are a few publications on the minimal-invasive radiofrequency tumour ablation (RFTA) technique, which is an effective treatment for primary and metastatic liver carcinomas and is a new palliative for the local treatment of pelvic recurrence. The aim of this study was to assess the response to treatment using ultrasound-guided radiofrequency ablation in two patients with unresectable pelvic recurrent rectal cancer.     

Rare complication of breast cancer irradiation: postirradiation osteosarcoma

Radiation-induced osteosarcoma is a rare complication of radiation therapy for breast cancer. The authors present a 60-year-old patient in whom osteosarcoma of the chest wall developed 5 years after modified radical mastectomy and radiation therapy for breast cancer. One year after resection of the chest osteosarcoma, metastasis to the contralateral axillary lymph nodes developed and these were removed. Radiation-induced osteosarcoma is difficult to treat and has a poor prognosis, thus early diagnosis is necessary for optimal treatment.     

Impact of childhood abuse and neglect on substance abuse and psychological distress in adulthood

Structural equation modeling was used to examine the relationship of childhood trauma, educational level, and the use of avoidant coping on substance abuse and psychological distress in a community sample of 285 women. Results indicated that self-reported childhood trauma was significantly related to greater substance abuse and psychological distress, through educational attainment and avoidant coping strategies. Lower level of education affected substance abuse through greater use of avoidant coping, but had no significant relationship with psychological distress. Greater use of avoidant coping was related to increased substance abuse and greater psychological distress. Findings indicate the need for supportive educational strategies and interventions to teach coping skills in preventing substance abuse and longer-term psychological distress in children exposed to trauma.     

Hepatitis C inflection in dialysis patients: a link to poor clinical outcome?

Among the 350,000 maintenance dialysis patients in the USA, the mortality rate is high (20–23% per year) as is the prevalence of hepatitis C virus (HCV) infection (5–15%). An additional same number of dialysis patients in the USA may be infected with HCV but have undetectable HCV antibodies. Almost half of all deaths in dialysis patients, including HCV-infected patients, are due to cardiovascular disease. Since over two-thirds of dialysis patients die within 5 years of initiating dialysis and because markers of malnutrition–inflammation complex syndrome (MICS), rather than traditional cardiovascular risk factors, are among the strongest predictors of early death in these patients, the impact of HCV infection on nutritional status and inflammation may be a main cause of poor survival in this population. Based on data from our cross-sectional and limited longitudinal studies, we hypothesize that HCV infection confounds the association between MICS and clinical outcomes in dialysis patients and, by doing so, leads to higher short-term cardiovascular events and death. Understanding the natural history of HCV and its association with inflammation, nutrition and outcomes in dialysis patients may lead to testing more effective anti-HCV management strategies in this and other similar patient populations, providing benefits not only for HCV infection but the detrimental consequences associated with this infection. In this article, we review the link between the HCV infection and mortality in dialysis patients and compare HCV antibody to molecular methods to detect HCV infection in these individuals. Funding source: Supported by a Young Investigator Award from the National Kidney Foundation; the National Institute of Diabetes, Digestive and Kidney Disease grant # DK61162; and a research grant from DaVita (for KKZ); and the National Institute of Allergy and Infectious Diseases grant # AI01831 (for LGM and HD41224 (for ESD)).     

Use of additional treatment for prostate cancer after radical prostatectomy, radiation therapy, androgen deprivation, or watchful waiting

OBJECTIVE. To examine how the use of additional treatment for prostate cancer differs as a function of the initial therapy (radical prostatectomy [RP], radiation therapy [RT], androgen deprivation therapy [ADT], or watchful waiting [WW]) for men with non-metastatic prostate cancer. MATERIAL AND METHODS. A dataset was created that combined information from the Surveillance, Epidemiology, and End Results program and Medicare claims for hospital and physician services. To identify patients receiving additional cancer treatment, we searched the claims for the presence of RP, RT (palliative radiation not included), or ADT. RESULTS. The study population consisted of 12 711 patients: as initial treatment, 3940 (31.0%) had RP, 3950 (31.1%) RT, 1209 (9.5%) ADT, and 3612 (28.4%) WW. The RP group had a less favorable distribution of tumor differentiation than the RT group. Only 54.6% of men who had initial RP had localized cancer. In men who had initial RP, 8.1% had RT and 12.4% ADT during the follow-up period, which was 6-66 months after the initial therapy ended. Among patients who had initial RT or WW, 22.8% and 22.1%, respectively had ADT during the follow-up period. CONCLUSION. Older American men with prostate cancer who are initially treated with RT or simply observed (WW) are more likely than men who undergo RP to receive ADT as a follow-up treatment.     

T cell memory,anergy and immunotherapy in breast cancer

T cell immunity in breast cancer is suggested to play a role in tumor dormancy, a period of stability which can correspond to the time interval between primary treatment and tumor recurrence. Bone marrow in breast cancer patients seems to be particularly important because it is highly enriched with cancer specific memory T cells. Similar cells can be found in peripheral blood, but these appear to be functionally anergic. The immune system of primary operated breast cancer patients does not seem to be completely anergized. Bone marrow derived memory T cells can be reactivated ex vivo and show functional reactivity, including tumor rejection in NOD/SCID mice. Promising results were obtained from a postoperative phase-II active specific immunotherapy study. In this study, 32 patients treated with an optimal formulation of a virus-modified autologous tumor vaccine (ATV-NDV) appeared to have a significant 5-year survival benefit. Our results suggest that cancer reactive memory T cells which are enriched in the bone marrow of breast cancer patients, can be activated ex vivo via autologous dendritic cells pulsed with breast cancer tumor antigens, or they can be activated in situ via a tumor vaccine, which combines tumor antigens with virus infection. The findings should encourage further studies in breast cancer on active specific immunotherapy with tumor vaccines or adoptive immunotherapy with activated memory T cells.     

Short-term Changes in Insulin Resistance following Weight Loss Surgery for Morbid Obesity: Laparoscopic Adjustable Gastric Banding versus Laparoscopic Roux-en-Y Gastric Bypass

Background: Laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGBP) both effectively treat the insulin resistance associated with type 2 diabetes mellitus (T2DM). Restriction of caloric consumption, alterations in the entero-insular axis or weight loss may contribute to lowering insulin resistance after these procedures. The relative importance of these mechanisms, however, following LAGB and LRYGBP remain unclear. The aim of this study was to compare directly the short-term changes in insulin resistance following LAGB and LRYGBP in similar populations of patients. Methods: Patient preference determined operation type. The Homeostasis Model Assessment for Insulin Resistance (HOMA IR) was used to measure insulin resistance. Preoperative values were compared to postoperative levels obtained within 90 days of surgery. Significant differences between groups were tested by ANOVA. Results: There were no significant preoperative differences between groups. The 56 LAGB patients had a mean age of 42.5 years (25.7-63), BMI of 45.5 kg/m² (35-66) and preoperative HOMA IR of 4.1 (1.4-39.2). 75% of LAGB patients were female and 43% had T2DM. The 61 LRYGBP patients had a median age of 39.9 years (22.1-64.3), BMI of 45.0 kg/m² (36-62), and preoperative HOMA IR of 5.0 (0.6-56.5). 79% of LRYGBP patients were women and 44.3% had T2DM. Median follow-up for LAGB patients was 45 days (18-90) and for LRYGBP patients 46 days (8-88 days). LAGB patients had a median of 14.8% excess weight loss (6.9%-37.0%) and LRYGB patients 24.2% (9.8%-51.4%). Postoperative HOMA IR was significantly less after LRYGBP, 2.2 (0.7-12.2), than LAGB, 2.6 (0.8-29.6), although change in HOMA IR was not significantly different. Change in HOMA IR for both groups did not vary with length of follow-up or weight loss but correlated best with preoperative HOMA IR (LAGB r=0.8264; LRYGBP r=0.9711). Conclusions: Both LAGB and LRYGBP significantly improved insulin resistance during the first 3 months following surgery. Both operations generated similar changes in HOMA IR, although postoperative HOMA IR levels were significantly lower after LRYGBP. These findings suggest that caloric restriction plays a significant role in improving insulin resistance after both LAGB and LRYGBP.     

Trapeze-flap plasty: Effective method for postburn neck contracture elimination

The new method for postburn neck contracture management is presented. The method is found to be most effective when using the local flap procedures on patients who cannot undergo complex and long surgical procedures that are aimed at both contracture elimination and neck skin restoration (children, elderly patients, patients with inadequate donor sites, and patients with cosmetically acceptable scar appearance). The method consists of the opposite transposition of trapezoid scar-fascial flaps which are prepared one on each antero-lateral neck surface. Both flaps include scars, fat, platysma and deep cervical fascia. As a result of the trapeze-flap plasty, the anterior surface of the neck is lengthened approximately by 100–200%, the contracture is eliminated and mentocervical angle and head movement are restored. The flaps have reliable blood circulation through the superficial cervical artery perforators, therefore flap loss is rare. The functional results were good in 24 out of 26 patients. The flaps surface does not decrease; therefore, the mild contracture becomes an exception.     

Prospective randomised comparison of organ-preserving pancreatic head resection with pylorus-preserving pancreaticoduodenectomy

Background and aims In a prospective, randomised, control trial organ-preserving pancreatic head resection (OPPHR) was compared with pylorus-preserving pancreaticoduodenectomy (PPPD) to assess the advantages and disadvantages of each type of operation.Patients and methods Forty patients were allocated randomly to either the OPPHR (n=20) or the PPPD (n=20) group. The surgical data, postoperative complications, induction of diabetes mellitus, postoperative pain and quality of life 1 year, postoperatively, were considered.Results The two study groups of 20 patients were well balanced with regard to sex, age, chronic pancreatitis history and indication for surgery. The duration of the operation for OPPHR and PPPD was 142.5±4.9 and 278±6.9 min, respectively (P<0.05). The postoperative mortality in each group was zero. After OPPHR and PPPD, the morbidity was 0 and 40%, respectively (P<0.05). The duration of hospital stay was also significantly different: 8.05±0.9 vs 13.8±3.9 days (P<0.05). After 1 year the pain relief was effective in both groups, but three patients acquired diabetes mellitus after PPPD; the body weight had increased by 7.8±0.9 and 3.2±0.3 kg after OPPHR and PPPD, respectively (P<0.05).Conclusion The two procedures are equally safe and effective with regard to pain relief, but OPPHR is superior to PPPD not only in the operation data and morbidity, but also in the quality of life 1 year postoperatively. OPPHR should be regarded as a recommended procedure in the treatment of chronic pancreatitis.Presented at the 6th Congress of the European Hepato–Pancreato–Biliary Association, 25–28 May 2005, Heidelberg, Germany and published in abstract form as HPB (2005) 7(Suppl. No. 1):73.     

Pavlik’s method: a retrospective study

This retrospective study of the early work of Arnold Pavlik in the treatment of developmental dysplasia of the hip proves the success of his method in eradicating avascular necrosis (AVN) resulting from other modes of treatment. Authors analyzed some 100 charts of children treated for CDH, as it was known at that time, between 1969 and 1981, and assessed the influence of gender, clinical stability, severity of X-ray pathology and age at which treatment was started, according to duration, outcome of treatment and rate of AVN. Of the 100 children with 134 treated pathological hips, 62 children with 86 pathological hips were treated exclusively by Pavlik’s method. Length of treatment for the 86 hips successfully treated by Pavlik’s method only was an average of 6 months. No AVN was found for any hip treated by Pavlik’s method only, including dislocated hips. The 65% of failure rate was for dislocated hips only. Late onset and prolonged duration of treatment using Pavlik’s method contributed to relative high failure rate followed by AVN. This leads to the conclusion that Pavlik’s method is safe and accurate for all dysplastic and subluxated hips, along with the vast majority of dislocated hips.