Patterns of relapse in stage I–II uterine papillary serous carcinoma treated with adjuvant intravaginal radiation (IVRT) with or without chemotherapy

Objective

To evaluate patterns of relapse in early stage uterine papillary carcinoma (UPSC) patients receiving adjuvant intravaginal radiotherapy (IVRT) with or without chemotherapy.

Methods

From 1/1996 to 12/2010, 77 women with stage I–II UPSC underwent surgery followed by IVRT (median 21 Gy). Stage IA patients without residual disease at surgery were excluded. IVRT and chemotherapy (carboplatin/taxane) was given to 61 (79%) patients and IVRT alone to 16 (21%). The median follow-up was 62 months for surviving patients.

Results

Of the 77 patients, 11 (14%) relapsed as follows: vaginal 2 (3%), pelvic 5 (6%), para-aortic 5 (6%), peritoneal 6 (8%), and other distant sites 8 (10%). Of the 5 pelvic relapses, 2 were isolated and were salvaged. In those treated without chemotherapy, only 1/16 developed recurrence (mediastinal). The 5-year vaginal, pelvic, para-aortic, peritoneal, and distant recurrence rates were 2.7% (C.I. 0–6.2%), 5.8% (C.I. 0.6–11.0%), 5.4% (C.I. 0.6–10.1%), 5.3% (C.I. 0.5–10.1%) and 6.6% (C.I. 1.4–11.8%), respectively. The 5-year disease-free survival (DFS), and overall survival (OS) were 88% (C.I. 81–95%), and 91% (C.I. 84–97%), respectively. The only predictor of worse 5-year pelvic control was stage (96.2% stage IA vs 87.7% for stage IB-II, p = 0.043).

Conclusions

In stage I–II UPSC patients who predominantly receive adjuvant chemotherapy, IVRT as the sole form of adjuvant RT provides excellent locoregional control. The risk of isolated pelvic recurrence is too low to warrant routine use of external pelvic RT.     

Proximal Roux-en-y Gastrojejunal Anastomosis with Pyloric Ring Resection Improves Gastric Emptying After Pancreaticoduodenectomy

Background

Delayed gastric emptying (DGE) is a common complication of pancreaticoduodenectomy. We determined the efficiency of a new reconstruction technique, designed to preserve motilin-secreting cells and maximize the utility of their receptors, in reducing the incidence of DGE after pancreaticoduodenectomy.

Methods

From April 2005 to September 2014, 217 consecutive patients underwent pancreaticoduodenectomy at our institution. Nine patients who underwent total pancreatectomy were excluded. We compared outcomes between patients who underwent pancreaticoduodenectomy with resection of the pyloric ring followed by proximal Roux-en-y gastrojejunal anastomosis (group I, n?=?90) and patients who underwent standard pancreaticoduodenectomy with the orthotopic reconstruction technique (group II, n?=?118).

Results

Overall and clinically relevant rates of DGE were significantly lower in group I than in group II (10 and 2.2 % vs. 57 and 24 %, respectively; p?<?0.05). Length of hospital stay as a result of DGE was shorter in group I than in group II. In univariate analysis, older age, comorbidities, ASA grade 4, operative time, preoperative diabetes, standard reconstruction technique, and postoperative complications were significant risk factors for DGE. In multivariate analysis, older age, standard technique, and postoperative complications were independent risk factors for DGE.

Conclusion

Our new reconstruction technique reduces the occurrence of DGE after pancreaticoduodenectomy.

     

Lunate chondromalacia: evaluation of routine MRI sequences

OBJECTIVE: Chondromalacia is a commonly encountered abnormality at arthroscopy and may be responsible for significant clinical symptoms and disability. In the wrist, the most common location for chondromalacia is the lunate bone. Consequently, we sought to study the accuracy of clinical MRI in the assessment of lunate articular cartilage. MATERIALS AND METHODS: MR images of 34 patients who underwent arthroscopy and had an MRI examination within 1 month of surgery were evaluated by two reviewers for the presence and location of lunate cartilage defects and subchondral edema. RESULTS: Lunate cartilage defects were seen on MRI in 10 of the 13 patients with chondromalacia, but these defects were also incorrectly noted in three of 21 of patients without chondromalacia. The visible locations for cartilage defects were the ulnar aspect of the proximal lunate bone (n = 3), radial aspect of the proximal lunate bone (n = 4), ulnar aspect of the distal lunate bone (n = 2), and radial aspect of the distal lunate bone (n = 1). Subchondral marrow edema was observed in six of the 10 patients with chondromalacia seen on MRI; in all six patients, the edema was seen in the same quadrant as the cartilage defect. Marrow edema was detected in one patient without chondromalacia. CONCLUSION: We conclude that lunate chondromalacia can be accurately assessed using routine MRI sequences, although there are occasional false-positive interpretations.     

Seroprevalence of and risk factors for Toxoplasma gondii antibodies among asymptomatic blood donors in Egypt

A cross-sectional study was conducted to evaluate the seroprevalence of and risk factors for Toxoplasma gondii antibodies in 260 blood donors seen at blood banks in Mansoura University Hospital, Egypt. Blood donors were interviewed about sociodemographic characteristics and risk factors for T. gondii infection. A blood sample was taken to document their T. gondii antibody status using enzyme-linked immunosorbent assay. Overall, 155 (59.6%) of 260 blood donors were positive for anti-T. gondii IgG antibodies. Multivariate logistic regression analysis showed a significant association between T. gondii seropositivity and eating meat by-products (luncheon/shawerma) (adjusted odds ratio [OR] 80.82 [95% CI 18.62–350.81], P < 0.0001) or being non-educated (adjusted OR 32.25 [95% CI 7.46–139.44], P < 0.0001). These findings highlight that T. gondii is prevalent among blood donors in Egypt.     

Familial mediterranean fever (recurrent hereditary polyserositis) in children: analysis of 88 cases

The clinical profile, course and complications of familial Mediterranean fever (recurrent hereditary polyserositis) seen in 88 children over a period of 11 years are presented. Forty eight children (55%) started their illness below the age of 5 years, and the mean age of onset was 4.9 years. Peritonitis occurred in 85% of children, arthritis in 50%, pleuritis in 33% and erysipelas-like lesions in 16%. Two children developed renal amyloidosis, and one third of the children were subjected to unnecessary operative surgery, reflecting the diagnostic difficulties. The arthritis was mono-articular in 80% and polyarticular in 20% of children with arthritis, and was seronegative (rheumatoid factor and antinuclear antibodies). Human leucocyte antigen (HLA) typing for the B-27 antigen carried out in ten children with arthritis was negative. The synovial attack showed a wide variation in the clinical presentation, course and duration of arthritis, causing diagnostic difficulties. The difficulties in the differentiation of recurrent hereditary polyserositis (familial Mediterranean fever) arthritis from the common causes of acute and chronic juvenile arthritis and the seronegative spondyloarthropathies are discussed. Of 45 children treated with colchicine, 42 children (93%) achieved a therapeutic response.Abbreviations FMF familial Mediterranean fever - HLA human leucocyte antigen - RHP recurrent hereditary polyserositis     

Renal tubular insufficiency, cholestatic jaundice, and multiple congenital anomalies--a new multisystem syndrome

We are describing two male siblings with proximal renal tubular insufficiency, cholestatic jaundice, predisposition to infection, and multiple congenital anomalies. These patients presented in the early neonatal period with micrognathia, low set ears, high arched palate, barrel shaped chest, bilateral simian creases, club feet, congenital hip dislocation, hypotonia, conjugated hyperbilirubinemia, repeated infections, and severe failure to thrive. They died at the age of 2 and of 4 months despite medical therapy. Findings of renal tubular insufficiency included persistent renal tubular acidosis, glucosuria, phosphaturia, aminoaciduria, and mild proteinuria. Kidney biopsy, liver biopsy, and a comprehensive immunologic investigation were performed on the first sibling. Kidney histology was normal except for calcification of some distal tubules. Liver biopsy revealed paucity of bile ducts, bile stasis, and some inflammatory cell infiltration. Immunologic investigation suggested a defect in polymorphonuclear cell migration and intracellular killing. Review of the literature revealed remarkably similar findings in two previously reported male siblings. These four cases probably represent a previously unrecognized familial syndrome. The possible etiology and mode of inheritance of this syndrome are discussed, and the association of hepatic and renal tubular dysfunction is reviewed.     

Treatment of tracheobronchomegaly with an Ultraflex prosthesis. A case report

Tracheobronchomegaly is defined as a dilatation of the trachea and the large bronchi. It may occur as a familial condition or in association with a connective tissue disease, e.g. Ehlers-Danlos syndrome. Tracheobronchomegaly occurs late in adults. The predominant symptoms are bronchial irritation and recurrent bronchopulmonary infections (because of ineffective cough). Diagnosis is provided by thoracic imaging, particularly computed tomography that enables measuring the precise diameter of the trachea. We report the case of one patient with tracheobronchomegaly who was greatly improved after implantation of Ultraflex tracheobronchial prostheses.     

Portal vein pulsatility and spectral width changes in patients with portal hypertension: relation to the severity of liver disease

Using Doppler ultrasound in patients with chronic liver disease (CLD) and portal hypertension, portal vein pulsatility pattern and spectral width changes were assessed and evaluated in relation to the severity of liver disease as determined according to the Child-Pugh score. The pulsatility index (PI) was significantly lower in CLD patients (mean+/-SD: 0.23+/-0.08) compared with healthy subjects (0.39+/-0.1) (p<0.001) and lower in Child-Pugh class C compared with Child-Pugh class A patients (0.21+/-0.07 vs 0.25+/-0.08, respectively) (p<0.05). The spectral width index was significantly higher in CLD patients vs healthy subjects (0.91+/-0.16 vs 0.60+/-0.12, respectively) (p<0.001). The difference was also noted in the early stage (Child-Pugh A patients) when compared with healthy subjects (0.88+/-0.17). In conclusion, portal vein pulsatility and spectral width indices can reflect the early haemodynamic changes in CLD patients. These changes become more pronounced with the progression of liver disease.