Four cancer cases after esophageal atresia repair: Time to start screening the upper gastrointestinal tract

Esophageal atresia(EA) is one of the most common congenital digestive malformations and requires surgical correction early in life. Dedicated centers have reported survival rates up to 95%. The most frequent comorbidities after EA repair are dysphagia(72%) and gastroesophageal reflux(GER)(67%). Chronic GER after EA repair might lead to mucosal damage, esophageal stricturing, Barrett's esophagus and eventually esophageal adenocarcinoma. Several long-term follow-up studies found an increased risk of Barrett's esophagus and esophageal carcinoma in EA patients, both at a relatively young age. Given these findings, the recent ESPGHAN-NASPGHAN guideline recommends routine endoscopy in adults born with EA. We report a series of four EA patients who developed a carcinoma of the gastrointestinal tract: three esophageal carcinoma and one colorectal carcinoma in a colonic interposition. These cases emphasize the importance of lifelong screening of the upper gastrointestinal tract in EA patients.     

Surgical management of hepatocellular carcinoma

Hepatocellular carcinoma(HCC) is the second most common cause of death from cancer worldwide. Standard potentially curative treatments are either resection or transplantation. The aim of this paper is to provide an overview of the surgical management of HCC, as well as highlight current issues in hepatic resection and transplantation. In summary, due to the relationship between HCC and chronic liver disease, the management of HCC depends both on tumourrelated and hepatic function-related considerations. As such, HCC is currently managed largely through nonsurgical means as the criteria, in relation to the above considerations, for surgical management is still largelyrestrictive. For early stage tumours, both resection and transplantation offer fairly good survival outcomes(5 years overall survival of around 50%). Selection therefore would depend on the level of hepatic function derangement, organ availability and local expertise. Patients with intermediate stage cancers have limited options, with resection being the only potential for cure. Otherwise, locoregional therapy with transarterial chemoembolization or radiofrequency ablation are viable options. Current issues in resection and transplantation are also briefly discussed such as laparoscopic resection, ablation vs resection, anatomical vs non-anatomical resection, transplantation vs resection, living donor liver transplantation and salvage liver transplantation.     

Limited Margins Using Modern Radiotherapy Techniques Does Not Increase Marginal Failure Rate of Glioblastoma

PURPOSE: We investigate the patterns of failure in the treatment of glioblastoma(GBM) based on clinical target volume(CTV) margin size,dose delivered to the site of initial failure,and the use of temozolomide and intensity-modulated radiotherapy(IMRT).METHODS: Between August 2000 and May 2010,161 patients with GBM were treated with radiotherapy with or without concurrent temozolomide.Patients were treated with CTV expansions that ranged from 5 to 20 mm using a shrinking field technique.Patterns of failure and time to progression and overall survival were compared based on CTV margin,use of temozolomide,and use of IMRT.Kaplan Meier analysis was used to estimate survival times,and χ test was used for comparison of cohorts.RESULTS: For patients treated with 5-,10-,and 15-to 20-mm CTV,79%,77%,and 86% experienced failures in the 60 Gy volume,respectively.Forty-eight percent,55%,and 66% of patients with 5-,10-,and 15-to 20-mm CTV experienced failures in the 46 Gy volume,respectively.There was no statistical difference between patients treated with 5-,10-,15-to 20-mm margins with regard to 60 Gy failure(P=0.76),46 Gy failure(P=0.51),or marginal failure(P=0.73).Eighty percent of patients receiving temozolomide experienced failures in the 60 Gy volume.There was no increased likelihood of marginal failures in patients receiving IMRT(P =0.97).CONCLUSIONS: Modern treatment techniques including use of concurrent temozolmide,limited CTV margin size,and IMRT have not greatly changed the patterns of failure of GBM.     

Social adjustment among Chinese women following breast cancer surgery

Background: How breast cancer surgery affects social adjustment among Chinese women is unknown, as are factors predicting such adjustment. Methods: 405 Chinese women receiving surgery for localized breast cancer completed Social Adjustment Scales (Ch‐SAS) at 1‐, 4‐ and 8‐months post‐operatively. Subscale scores were regressed on baseline (days 3–12 post‐operatively) measures of treatment decision‐making difficulty (TDMD), self‐efficacy (GSeS), consultation satisfaction (C‐MISS‐R), psychological (CHQ‐12) and physical distress (PD), and 1‐month follow‐up optimism (C‐LOT‐R), and disappointment (E‐OI), fully adjusted for demographic and clinical factors. Results: All Ch‐SAS subscales except appearance & sexuality changed significantly over 8‐months follow‐up: Enjoyment of social activities (F=27.38, df 2, p<0.001) and self‐image (F=3.63, df 2, p=0.027) improved slightly. Family interaction (F=26.63, df 2, p<0.001) and interaction with friends (F=3.37, df 2, p=0.035) declined slightly. Family and friends interaction subscales were predominantly predicted by high self‐efficacy and optimism, whereas self‐image and appearance & sexuality subscales were predominantly predicted by low treatment outcome disappointment, TDM difficulties, baseline psychological morbidity and high self‐efficacy. Enjoyment of social activities was predicted by low baseline psychological distress and concurrent physical symptom distress. Conclusion: High self‐efficacy and optimism predicted women who have better social relationships with friends and family. Higher self‐efficacy, low TDM difficulties, less disappointment with treatment outcome and low psychological and physical distress predicted better adjustment to self‐image and body image. Copyright © 2009 John Wiley & Sons, Ltd.     

Glomerular filtration rate in transplantation patients: estimation of renal function using Tc-99m DTPA

The clinical assessment of a transplanted kidney is often difficult, especially in the immediate postoperative period. The biochemical parameters used to monitor renal function change slowly and can take several days to reflect the actual renal status. We have modified a technique for determining the glomerular filtration rate (GFR) from a Tc-99m DTPA renal scan and have found that it correlates with the actual GFR throughout the postoperative course. In addition, we describe a method for changing dose calibrator measurements into administered counts. This technique for determining the GFR provides a quick and accurate assessment of renal function and is useful to guide therapeutic decisions.     

Spontaneous intramural haematoma of the oesophagus: CT and MRI appearances

A 64-year-old man with history of ischaemic heart disease and coronary artery bypass graft surgery, but no history of peptic ulcer or liver disease, presented with retrosternal pain and coffee-ground vomitus. Endoscopy revealed a long column of bluish discolouration with normal mucosa interpreted as a grade IV oesophageal varix. Computed tomography showed a non-enhancing low-density submucosal columnar lesion in the mid- and lower oesophagus consistent with a submucosal haematoma. This resolved on follow-up at 10 days. The magnetic resonance features of intermediate signal intensity on T1 -weighted images and hyperintense signal on T2-weighted images of this lesion are also highlighted.     

Value of CT in the preoperative assessment of lung cancer: a survey of thoracic surgeons

Practicing thoracic surgeons were randomly surveyed to evaluate how computed tomography (CT) has influenced the preoperative evaluation of bronchogenic carcinoma. Thirty-six percent of the 529 respondents routinely requested CT and 62% did so selectively. Approximately 40% indicated that CT provided useful information in most cases. Nearly all surgeons (98.7%) do not rely on the identification of enlarged lymph nodes with CT to spare the patient surgical staging; however, 77.5% are influenced by CT results in their staging procedures. Fifty-seven percent reported that a negative CT study eliminates surgical staging entirely unless the patient has a "coin lesion," in which case 75% are willing to proceed directly to thoracotomy. For surgeons who use CT selectively, an abnormal mediastinal contour on the radiograph was the most frequent radiologic abnormality to prompt CT (85%). Thirty-seven percent are influenced by tumor histology in their decision to request CT. There was little difference in the pattern of CT use between university and community hospital surgeons.     

Pigmented eccrine poromas: expression of melanocyte-stimulating cytokines by tumour cells does not always result in melanocyte colonization

Background Although eccrine poroma (EP) occurs preferentially in palmoplantar areas, pigmented variants of EP have not been documented on the palms and soles. Objectives We seek to confirm the notion regarding lack of pigmented EP on palmoplantar areas and determine whether the absence of pigmentation in palmoplantar EPs is due to lack of expression of melanocyte‐stimulating cytokines by tumour cells. Methods We searched the PubMed and Web of Science databases (1966–2006) for reports of pigmented EPs. In addition, a total of 17 EPs were collected from our pathology department. The presence of melanin was examined with haematoxylin‐eosin sections, and melanocyte colonization was shown by immunohistochemical stains for tyrosinase. In addition, immunohistochemical staining with antibodies to melanocyte‐stimulating cytokines, including endothelin‐1, stem cell factor, and nerve growth factor, was done on these tumours. Results A review of the literature revealed 15 pigmented EP reports, none of which were located in palmoplantar areas. Among 17 EPs collected from our pathology department, 7 occurred in palmoplantar areas and 10 in non‐palmoplantar areas. Three of the palmoplantar EPs and three of the non‐palmoplantar EPs showed positive staining with melanocyte‐stimulating cytokines. However, none of the palmoplantar EPs contained melanocytes or melanin pigment, wheras the three non‐palmoplantar EPs that stained positively with melanocyte‐stimulating cytokines were colonized with melanocytes and showed pigmentation clinically. Conclusions The expression of melanocyte‐stimulating factors by tumour cells is associated with melanocyte colonization in non‐palmoplantar EPs but not palmoplantar EPs. Therefore, the presence of melanocyte‐stimulating cytokines per se is not sufficient by itself to induce melanocyte colonization. Certain characteristics of palmoplantar skin, such as the dermal components of these anatomical sites, may play a role in inhibiting melanocyte colonization of EPs.