Osteolytic bone destruction resulting from relapse of a testicular tumour 23 years after inguinal orchiectomy and adjuvant chemotherapy: a case report

<p>Abstract</p> <p>Introduction</p> <p>Late relapse of a testicular germ cell tumour is an uncommon occurrence. We report a case of osteolytic bone metastasis appearing 23 years after the initial treatment of a metastatic testicular mixed tumour (choriocarcinoma and embryonal carcinoma). This is one of the longest periods of recurrence reported for testicular germ cell tumours.</p> <p>Case presentation</p> <p>A 52-year-old Caucasian man who underwent a right inguinal orchiectomy due to testicular tumour in 1984 presented to our outpatient clinic in a generally bad condition of health and with severe pain of his right hip joint and os ischii caused by osteolytic metastasis.</p> <p>Conclusions</p> <p>This case emphasizes the need for a life-long follow-up of patients with primary metastatic testicular cancer.</p

A Case Report of Urinary Bladder Carcinosarcoma and Review of the Literature

Carcinosarcoma of the bladder is an unusual tumour characterized by a combination of malignant epithelial and soft tissue elements. Most of the reported cases have been case reports or small series. Optimal treatment is uncertain. We herein report our experience in such a case treated with transurethral resection followed by radiotherapy with adverse final outcome. Treatment of bladder carcinosarcomas should be aggressive and multimodal but optional treatment is still unknown. Radiotherapy alone is insufficient as a treatment option of these aggressive tumors

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Clinical usage of the squamous cell carcinoma antigen in patients with penile cancer

Background: We present our initial experience with the use of the squamous cell carcinoma (SCC) antigen (SCCAg) in 16 men with penile SCC (SCC group), in four men with condyloma acuminatum (benign group), and in 32 blood donors (control group). Methods: The SCCAg levels were measured at presentation and every 6 months (upper limit was 2 ng/mL). The mean follow-up time was 4 years. Results: All non-SCC patients had normal SSCAg serum levels in contrast with the SCC patients. The presence of nodal and/or distant metastases resulted in statistically significant higher SCCAg levels, both at presentation and during the follow-up. In patients undergoing lymph node dissection with elevated SCCAg levels prior to the procedure, there was a statistically significant decrease of the SCCAg levels after the operation. Conclusion: The SCCAg level could be a serum marker that holds promise for clinical use in penile SCC. Sequential monitoring of SCCAg level might indicate developing of nodal and/or distant metastases and could be useful in following the response to treatment

A theory-based educational intervention to pediatricians in order to improve identification and referral of maternal depression: a quasi-experimental study

Background: Maternal depression has a negative impact on both the mother and child’s physical and mental health, as well as impairs parenting skills and pediatric health care utilization. The pediatricians’ role in identification and management of maternal depression is well established. Although it can be successfully and easily treated, maternal depression remains under-recognized and under-treated. Despite the heightened emphasis, there is lack of interventions to pediatricians in order to improve detection and management of maternal depression. Methods: To address this gap, an educational intervention based on the ‘Health Belief Model’ was developed, implemented, and evaluated. The present quasi-experimental study, aimed to assess the pediatricians’ knowledge, self-efficacy, beliefs, and attitudes toward maternal depression at baseline and post-intervention measurements. A total of 43 randomly selected primary care pediatricians residing in Athens completed a 59-item survey by mail in 2011. Pediatricians in the intervention group received a toolkit about the recognition and management of maternal depression, while pediatricians in the control group received a leaflet about mental health. Descriptive statistics, t test, chi-square, Fisher’s exact test, and analysis of variance were used for the statistical analysis. Results: Post-intervention measurement revealed differences at a statistical significance level between the two groups, in the following variables: beliefs, attitudes, self-efficacy, perceived barriers, and management practices of maternal depression. Furthermore, at post-measurement, pediatricians in the intervention group demonstrated increased perceived responsibility and increased self-efficacy for detection and referral of maternal depression. Conclusions: Educational interventions to pediatricians seem to be beneficial for the improvement of the pediatricians’ knowledge, self-efficacy, and attitudes regarding maternal depression. Studies using large, representative population samples are needed to provide evidence if the training interventions to pediatricians for maternal depression are translated to changes in their clinical practice and improved the patients’ health outcomes

Fractionation and characterization of Dunaliella microalgal biomass and extraction of carotenoids

This paper presents findings on the application of two fractionation protocols of Dunaliella microalgal biomass with the aim to separate and recover the lipid, pigment and protein fraction, leaving as “residue” the fraction that contains carbohydrates. The first protocol (LPC) is based on the initial extraction of lipids, followed by extraction of proteins, while in the second protocol (CLP), the pigments are first extracted followed by lipids extraction. With the LPC protocol the recovered lipid fraction was 34 and 32 wt%, while the recovered proteinic fraction was 46 and 50 wt% for the two samples under study, i.e. 1120 (D. granulata) and 1220 (D. minutissima). The CLP protocol led to the initial extraction of the pigment fraction with a percentage of 10–15 wt% while the subsequently recovered lipidic fraction was 16–24 wt%. The initial biomass was characterized for its moisture (<0.7 wt% for both samples), ash (approx. 45 wt% for both samples), organic matter, elemental composition and higher heating value (HHV) which was 23 and 30 MJ/kg (organic matter based-OMB). The composition of the lipid fraction was analyzed via esterification and gas chromatography (GC-FID) showing C16 and C18 as the predominant acids in the samples. The residue/carbohydrate fraction was analyzed via acid hydrolysis and analysis by high pressure liquid chromatography (HPLC) showing about 20 wt% (-OMB) content of carbohydrates. The high ash content of the biomass was found to be co-extracted during the fractionation protocols at a percentage of ≈49 % in the lipidic fraction and 45 % in the proteinic fraction. Furthermore, emphasis was given on pigment extraction and recovery using various solvents and quantification methods. Measurements of β-carotene, carotenoids, and chlorophyll content through UV and HPLC analyses is presented with chlorophyl and carotenoid content being ≈12 wt% and ≈9 wt% for samples 1120 and 1220 (-OMB). Additionally, a comparison between three solvents (THF, dichloromethane, acetone) was performed regarding their ability to extract the pigments from the microalgal biomass showing that acetone is capable of extracting pigments when concentration of the pigments is not high. The comparison of the HPLC with the UV method, suggested that UV spectroscopy is a reliable and rapid alternative for pigments determination, while HPLC enables identification and quantitative determination of specific pigments and chlorophyll species. The study provides insights for different fractionation protocols applied in two not yet fully studied Dunaliella species as well as the chlorophyl and carotenoid content

Numerical Imbalances of Chromosome 7 in Oral Squamous Cell Carcinoma

Background: Oral squamous cell carcinoma (OSCC) is an aggressive neoplasm. Many chromosomal and gene alterations have been identified in OSCC, including structural and numerical changes. In this study, we implemented a molecular assay of chromosome 7 (Chr7) in order to investigate the level of its numerical instability in OSCC. Materials and Methods: Using tissue microarray technology, 30 primary OSCCs were cored and re-embedded into one recipient block. Chromogenic in situ hybridization assay was performed based on Chr7 centromeric probedetection. Results: Chr 7 numerical analysis detected polysomy (trisomy/tetrasomy) in 4/30 (13.3%) of the examined tissue OSCC cores. Statistical significance was assessed correlating Chr7 numerical aberrations with stage (p= 0.015), especially detected in cases not related to human papillomavirus (HPV) (p= 0.01). Conclusion: Although Chr7 polysomy is a relatively rare gross genetic event in OSSC, it affects their biological behavior leading toa progressively aggressive phenotype (advanced stage). Furthermore, Chr7 polysomy is observed more frequently in non-viral (HPV) cases