Interleukin-2-based therapy following surgery for renal cell carcinoma metastatic to the chest wall.

Herein, thè authors report two cases of renai celi carcinoma with solitary metastasis to thè chest wall. lnterleukin-2-based therapy following nephrectomy and resection of thè metastatic lesion of thè chest wall resulted in improvement of quality of life and in prolonged diseasefree survival in ali patients. They believe that an aggressive surgical approach, in selected patients with metastatic renai celi carcinoma, may improve patients' response to immunotherap

Lymphectomy in the treatment of thyroid cancer in adults and children.

Thyroid carcinoma is thè most frequent endocrine malignancy in Italy and differs in naturai history according to histological type and age of patients. Lymph node metastases are more frequently seen in young patients with papillary carcinoma. However, many clinical series suggested that although thè incidence of lymph node invasion in high-risk patients (over-50s) is slightiy lower than in low-risk patients, thè locai recurrence rate is higher than in thè former. From thè results of our experience, confirmed by other authors, we retain total thyroidectomy with lymphectomy of thè centrai compartment as thè procedure of choice in thè treatment of well-differentiated thyroid carcinoma in thè under-50s. In thè over-50s, functional bilateral lymphectomy improves survival and should be considered mandatory, just as for medullary carcinoma. On thè contrary, thè prognosis of anaplastic carcinoma is not improved by lymphectomy

The biofragmentable anastomosis ring in elective colon resections.

Methods. Sixty-eight patients underwent elective colon resection and ìntraperitoneal anastomosis wìth thè biofragmentable anastomosis ring (BAR). Results. Anastomotic dehiscence occurred in 3 patients (4.4%). Two of them had an end-to-end ileocolostomy using a 31 mm BAR. The anastomosis failure was due to ischaemic lesion of thè small bowel dose to thè ileocolostomy, probably caused by a mismatch between thè size of small bowel and that of thè BAR. Another patient experienced anastomosis dehiscence probably due to a faecal impaction into thè BAR. Forty-eight patients (70.5%) experienced troublesome constipation and evacuated after thè sixth postoperative day. A bowel obstruction proximal to thè BAR was documented in 4 cases who have been treated conservatively. Condmions. The low rate of major complications justify thè use of thè BAR in elective colon surgery, but thè surgeon must be aware of tedious postoperative obstructive episodes frequently encountered in this series

Minor troponin T elevation and mortality in patients with atrial fibrillation presenting to the emergency department

Background There are limited data on the association of minor troponin elevation in unselected patients with atrial fibrillation (AF) presenting to the emergency department (ED) with adverse events. In this study, we sought to assess the early and mid-term mortality of these patients. Methods In this observational study, 2911 patients with AF were admitted to the ED. They were divided into 3 groups based on peak high-sensitivity troponin (TnT) levels: normal ( Results All-cause mortality was 6.7% (n = 196) at 30 days and 22.2% (n = 646) at 1 year. Mortality rate increased along with increasing levels of TnT irrespective of baseline covariates, primary discharge diagnosis and type of AF. A significant association between TnT levels and all-cause mortality was observed. The adjusted hazard ratio (HR) at 30 days was 6.02 (95% CI 2.62-13.83) for TnT 15-50 ng/L and 11.28 (95% CI 4.87-26.12) for TnT 51-100 ng/L (P Conclusions Among patients with AF admitted to the ED, increased TnT levels were associated with increased early and mid-term all-cause mortality irrespective of baseline covariates and type of AF.Peer reviewe

Is Inferior Mesenteric Artery Embolization Indicated Prior to Endovascular Repair of Abdominal Aortic Aneurysm?

Type II endoleak is a common condition occurring after endovascular repair of abdominal aortic aneurysms (EVAR), and may result in aneurysm sac growth and/or rupture in a small number of patients. A prophylactic strategy of inferior mesenteric artery (IMA) embolization before EVAR has been advocated, however, the benefits of this strategy are controversial. A clinical vignette allows the authors to summarize the available data about this issue and discuss the possible benefits and risks of prophylactic IMA embolization before EVAR. The authors performed a meta-analysis of available data which showed that the pooled rate of type II endoleak after IMA embolization was 19.9% (95% Cl 3.4-34.7%, I-2 93%) whereas it was 41.4% (95% Cl 30.4-52.3%, I-2 76%) in patients without IMA embolization (5 studies including 596 patients: p <.0001, OR 0.369, 95% Cl 0.22-0.61, I-2 27%). Since treatment for type II endoleaks is needed in less than 20% of cases and this complication can be treated successfully in 60-70% of cases resulting in an aneurysm rupture risk of 0.9%, these data indicate that embolization of patent IMA may be of no benefit in patients undergoing EVAR. (C) 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.Peer reviewe