The value of 18F-FDG-PET/CT imaging for sinonasal malignant melanoma

The aim this study was to evaluate imaging findings using position emission tomography (PET) in combination with computed tomography (CT) and 18F-fluorodeoxyglucose (18F-FDG) in sinonasal malignant melanoma (SNMM) of the head and neck in a retrospective analysis of a consecutive cohort of patients. 18F-FDG-PET/CT examinations were performed for initial staging and compared with CT or magnetic resonance tomography (MRI), and 18F-FDG-PET alone. Medical records were reviewed retrospectively with regard to the location and the size of the tumor. Furthermore, locoregional and distant metastases with a consecutive change in therapy detected by 18F-FDG-PET/CT were assessed. Ten patients suffering from sinonasal malignant melanoma were staged and followed by 18F-FDG-PET/CT imaging. A total of 34 examinations were obtained. 18F-FDG-PET/CT depicted all primary tumors adequately. Aside from one cerebral metastasis all regional and distant metastases were truly identified by using this method. In summary, if available, 18F-FDG-PET/CT is a valuable imaging modality for staging and re-staging sinonasal malignant melanoma to evaluate expansion of the primary tumor, locoregional disease, and distant metastase

Dupuytren contracture recurrence project: reaching consensus on a definition of recurrence

The aim of this study was to determine a definition of recurrence of Dupuytren disease that could be utilized for the comparison of the results independently from the treatment used. 24 hand surgeons from 17 countries met in an international consensus conference. The participants used the Delphi method to evaluate a series of statements: (1) the need for defining recurrence, (2) the concept of recurrence applied to the Tubiana staging system, (3) the concept of recurrence applied to each single treated joint, and (4) the concept of recurrence applied to the finger ray. For each item, the possible answer was given on a scale of 1-5: 1=maximum disagreement; 2=disagreement; 3=agreement; 4=strong agreement; 5=absolute agreement. There was consensus on disagreement if 1 and 2 comprised at least 66% of the recorded answers and consensus on agreement if 3, 4 and 5 comprised at least 66% of the recorded answers. If a threshold of 66% was not reached, the related statement was considered not defined. A need for a definition of recurrence was established. The presence of nodules or cords without finger contracture was not considered an indication of recurrence. The Tubiana staging system was considered inappropriate for reporting recurrence. Recurrence was best determined by the measurement of a specific joint, rather than a total ray. Time 0 occurred between 6 weeks and 3 months. Recurrence was defined as a PED of more than 20\ub0 for at least one of treated joint, in the presence of a palpable cord, compared to the result obtained at time 0. This study determined the need for a standard definition of recurrence and reached consensus on that definition, which we should become the standard for the reporting of recurrence. If utilized in subsequent publications, this will allow surgeons to compare different techniques and make is easier to help patients make an informed choice.usammenfassung Ziel der Konsensuskonferenz in Rom war es, eine Definition des Rezidivs bei Morbus Dupuytren festzulegen, die fur einen Vergleich der Ergebnisse unabhangig von der gewahlten Behandlung einsetzbar ist. 24 Handchirurgen aus 17 Landern kamen im Rahmen einer internationalen Konsensuskonferenz zusammen. Die Teilnehmer wendeten die Delphi-Methode an, um folgende Thesen zu bewerten: (1) die Notwendigkeit einer Definition des Rezidivs bei Morbus Dupuytren, das Rezidiv soll (2) auf die Stadieneinteilung nach Tubiana, (3) fur jedes einzelne behandelte Gelenk, oder (4) auf den Fingerstrahl angewandt werden. Jede These konnte auf einer Skala von 1 bis 5 bewertet werden: 1=stimme gar nicht zu; 2=stimme nicht zu; 3=stimme zu; 4=stimme sehr zu; 5=stimme vollstandig zu. Keine Zustimmung lag vor, wenn mindestens 66% der erfassten Antworten auf 1 und 2 entfielen und Zustimmung lag vor, falls mindestens 66 % der erfassten Antworten auf 3, 4 und 5 entfielen. Falls der Schwellenwert von 66% nicht erreicht wurde, wurde die jeweilige Aussage als "nicht definiert betrachtet. Die Notwendigkeit einer Definition des Rezidivs bei Morbus Dupuytren wurde mit dieser Methode festgestellt. Das Vorliegen von Knoten oder Sehnen ohne Kontraktur der Finger wurde nicht als Anzeichen eines Rezidivs gewertet. Die Stadieneinteilung nach Tubiana stellte sich als ungeeignet zur Beschreibung eines Rezidivs heraus. Ein Rezidiv bei Morbus Dupuytren ist besser durch die Messung eines spezifischen Gelenks als durch eine Messung der Beugekontraktur des gesamten Fingerstrahls bestimmt. Der Ausgangspunkt Null wurde definiert als Zeitraum zwischen 6 Wochen und 3 Monaten nach der primaren Behandlung. Ein Rezidiv wird dann definiert als eine passive Beugekontraktur von mehr als 20 degrees fur jedes behandelte Gelenk bei Vorliegen eines tastbaren Stranges, verglichen mit dem Ergebnis zum Zeitpunkt Null. Die Konferenz zeigte die Notwendigkeit einer Definition des Rezidivs bei Morbus Dupuytren und fuhrte zu einem Konsens in Bezug auf diese Definition. Bei Verwendung in nachfolgenden Publikationen wird sie es ermoglichen, verschiedene Techniken zu vergleichen und die Patienten beim Treffen einer informierten Entscheidung zu unterstutzen

Down regulation of E-Cadherin (ECAD) - a predictor for occult metastatic disease in sentinel node biopsy of early squamous cell carcinomas of the oral cavity and oropharynx

<p>Abstract</p> <p>Background</p> <p>Prognostic factors in predicting occult lymph node metastasis in patients with head and neck squamous-cell carcinoma (HNSCC) are necessary to improve the results of the sentinel lymph node procedure in this tumour type. The E-Cadherin glycoprotein is an intercellular adhesion molecule in epithelial cells, which plays an important role in establishing and maintaining intercellular connections.</p> <p>Objectives</p> <p>To determine the value of the molecular marker E-Cadherin in predicting regional metastatic disease.</p> <p>Methods</p> <p>E-Cadherin expression in tumour tissue of 120 patients with HNSCC of the oral cavity and oropharynx were evaluated using the tissue microarray technique. 110 tumours were located in the oral cavity (91.7%; mostly tongue), 10 tumours in the oropharynx (8.3%). Intensity of E-Cadherin expression was quantified by the Intensity Reactivity Score (IRS). These results were correlated with the lymph node status of biopsied sentinel lymph nodes. Univariate and multivariate analysis was used to determine statistical significance.</p> <p>Results</p> <p>pT-stage, gender, tumour side and location did not correlate with lymph node metastasis. Differentiation grade (<it>p </it>= 0.018) and down regulation of E-Cadherin expression significantly correlate with positive lymph node status (<it>p </it>= 0.005) in univariate and multivariate analysis.</p> <p>Conclusion</p> <p>These data suggest that loss of E-cadherin expression is associated with increased lymhogeneous metastasis of HNSCC. E-cadherin immunohistochemistry may be used as a predictor for lymph node metastasis in squamous cell carcinoma of the oral cavity and oropharynx.</p> <p><b>Level of evidence: 2b</b></p

Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

OBJECTIVES The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p <0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to assess physiological significance. In deferred patients presenting with ACS, the event rate was significantly increased compared with SAP at 1 year. (C) 2018 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.Peer reviewe

ICAR: endoscopic skull‐base surgery

n/