Decision making in the treatment of pancreatic cancer : a retrospective analysis

Pancreatic cancer is a major and often frustrating disease in clinical gastroenterology. Diagnosis and treatment are very difficult; 90% of all patients diagnosed with pancreatic cancer die within one year after diagnosis has been made. The incidence of pancreatic cancer has increased steadily in the past 60 years, beconting the fourth leading cause of death in Western Europe and the USA. The aetiology of pancreatic cancer remains unclear. Some studies have found some influence of cigarette smoking; others find coffee consumption as an aetiological factor. Diet, diabetes mellitus, chronic pancreatitis, industrial exposure and alcohol consumption are mentioned as aetiological factors, but no consensus has been reached so far. It is possible that different methods of obtaining data and its subsequent analysis are the main reasons that a definitive aetiological factor has not been found. Further investigations in experimental models and a better understanding of oncogenes might result in improved knowledge of the aetiology of pancreatic cancer. When cancer of the pancreas or periampullary region have been diagnosed, surgical excision continues to be the only possibility for cure. However, the overall resectability rate is low, and long-term survival after intentional curative resection is 0-15 % in cases of cancer of the head of the pancreas and up to 50% in cases of periarnpullary cancer. Although several types of adjuvant treatments have been proposed, none of these have proven to be effective. One of the major problems, however, remains to select those patients who will benefit from radical surgery, and as a consequence, how to palliate patients with irresectable cancer, aiming for maximal quality of life and low morbidity

Subchondral Bone Trabecular Integrity Predicts and Changes Concurrently with Radiographic and MRI Determined Knee Osteoarthritis Progression

OBJECTIVE: To evaluate subchondral bone trabecular integrity (BTI) on radiographs as a predictor of knee osteoarthritis (OA) progression. METHODS: Longitudinal (baseline, 12-month, and 24-month) knee radiographs were available for 60 female subjects with knee OA. OA progression was defined by 12- and 24-month changes in radiographic medial compartment minimal joint space width (JSW) and medial joint space area (JSA), and by medial tibial and femoral cartilage volume on magnetic resonance imaging. BTI of the medial tibial plateau was analyzed by fractal signature analysis using commercially available software. Receiver operating characteristic (ROC) curves for BTI were used to predict a 5% change in OA progression parameters. RESULTS: Individual terms (linear and quadratic) of baseline BTI of vertical trabeculae predicted knee OA progression based on 12- and 24-month changes in JSA (P < 0.01 for 24 months), 24-month change in tibial (P < 0.05), but not femoral, cartilage volume, and 24-month change in JSW (P = 0.05). ROC curves using both terms of baseline BTI predicted a 5% change in the following OA progression parameters over 24 months with high accuracy, as reflected by the area under the curve measures: JSW 81%, JSA 85%, tibial cartilage volume 75%, and femoral cartilage volume 85%. Change in BTI was also significantly associated (P < 0.05) with concurrent change in JSA over 12 and 24 months and with change in tibial cartilage volume over 24 months. CONCLUSION: BTI predicts structural OA progression as determined by radiographic and MRI outcomes. BTI may therefore be worthy of study as an outcome measure for OA studies and clinical trials. Copyright 2013 by the American College of Rheumatology

Residual disease after excision of non-palpable breast tumours: analysis of tumour characteristics.

Contains fulltext : 57513.pdf (publisher's version ) (Closed access)INTRODUCTION: A tumour-positive resection margin is a well-known prognostic factor for local recurrence. The aim of this study was to evaluate tumour characteristics that might be predictive for the presence of residual disease after excisional surgery. PATIENTS AND METHODS: Data of 295 patients, subjected to a wire-guided excisional breast biopsy were studied. Type and size of the primary tumour, the presence of DCIS and an extensive in situ component (EIC), multifocality of the tumour and nodal status were recorded. RESULTS: Residual disease was found in 51% of the patients undergoing a re-operation. 80% of the patients with positive margins were treated by mastectomy. Nodal status and the presence of an extensive in situ component were the only two variables that were statistically significant. CONCLUSION: In case of tumour positive margins axillary involvement and an extensive in situ component in the primary tumour were predictive for residual disease. No subgroups could be defined in whom additional surgery could be omitted. More 'aggressive' surgical therapy is justified in patients belonging to these risk groups

Surgical treatment of hidradenitis suppurativa with gentamicin sulfate: a prospective randomized study.

BACKGROUND AND METHOD: This article describes and discusses a prospective randomized study with gentamicin sulfate in the surgical treatment of hidradenitis suppurativa. The purpose of the study was to investigate whether enclosure of antibiotics after primary excision and closure reduces the number of postoperative infections. Therefore, the hidradenitis lesions were excised and closed with or without enclosure of a gentamicin-collagen sponge (GC). RESULTS: A total of 200 patients were included in the study. Seventy-six patients underwent surgical excision with primary closure (PC), and 124 PCs over a GC. After 1 week there were significantly fewer complications (infection, dehiscence, etc.) in the GC group, 35% versus 52%; after 3 months the complications in both groups were comparable, 12% versus 19% (Table 2). The mean period of wound healing was 21 days in the first group and 24 days in the second group. The recurrence rate after 3 months was comparable in both groups, 40% versus 42%. CONCLUSION: This study shows that enclosure of gentamicin after primary excision of hidradenitis suppurativa reduces the number of complications 1 week postoperatively. Furthermore, in 65% of the patients treated with gentamicin, the wound was completely healed within 2 months. There is no effect on the long term recurrence rate, as expected

Extranodal extension of axillary metastasis of invasive breast carcinoma as a possible predictor for the total number of positive lymph nodes.

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Randomized clinical trial of ultrasonic versus electrocautery dissection of the gallbladder in laparoscopic cholecystectomy.

BACKGROUND: Laparoscopic cholecystectomy is frequently complicated by gallbladder perforation and loss of bile or stones into the peritoneal cavity. The aim of this study was to compare the use of ultrasonic dissection and electrocautery with respect to the incidence of gallbladder perforation and intraoperative consequences. METHODS: Between January 1998 and January 2000, 200 patients undergoing elective laparoscopic cholecystectomy were randomized to electrocautery or ultrasonic dissection of the gallbladder. The main outcome measures were gallbladder perforation, operating time and the number of times the lens was cleaned. Univariate and multivariate analyses were performed. RESULTS: The perforation rate differed significantly: 16 per cent for ultrasonic dissection (n = 96) and 50 per cent for electrocautery (n = 103) (P < 0.001). The operating time of the least experienced surgeons, who had performed fewer than ten laparoscopic cholecystectomies, was significantly shorter when ultrasonic dissection was used, compared with electrocautery. The number of times the lens needed to be cleaned was significantly lower when ultrasonic dissection was used in complicated gallbladders (P < 0.035). At logistic regression analysis, the risk of perforation in the electrocautery group was about four times higher (odds ratio 0.26, P < 0.001) than that in the ultrasonic group. When the groups were matched for prognostic factors, including body mass index and surgical experience, the results were similar to those obtained with univariate and multivariate analysis. CONCLUSION: The use of ultrasonic dissection in laparoscopic cholecystectomy reduces the incidence of gallbladder perforation and helps the operation to progress. Less experienced surgeons benefit most from ultrasonic dissection, particularly in complicated intraoperative circumstances

The clinical efficacy and cost effectiveness of the vacuum-assisted closure technique in the management of acute and chronic wounds: a randomized controlled trial.

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Small but significant survival benefit in patients who undergo routine follow-up after colorectal cancer surgery.

Contains fulltext : 57914.pdf (publisher's version ) (Closed access)BACKGROUND: The benefit of follow-up for patients after resection of primary colorectal cancer is unproven. The aim of this study was to evaluate the value of a standardised follow-up program considering detection of recurrent disease, eligibility for surgical treatment and survival. METHODS: Five hundred and sixty-four patients' records were evaluated. Detection of recurrent disease was distinguished in routine follow up (RF), interval visit (IV) or accidental finding (AF). RESULTS: One hundred and forty-nine patients (26%) had recurrent disease of which 68 were detected by routine follow-up. In 42 patients a resection was performed with curative intent (RF 18, IV 14, AF 10). In 26 patients radical resection (R(0)) was possible (RF 13, IV 5, AF 8), seven of them were long-term survivors. Routine follow-up itself had no significant influence on overall survival (P=0.08), although increased survival was observed if recurrent disease was detected by routine follow-up and resection was performed with curative intent (P=0.006). Median survival after resection was 4.2 years if recurrent disease was detected during routine follow-up and 0.5 years if detected during interval visits. CONCLUSIONS: Patients undergoing resection with curative intent for recurrent disease survive significantly longer if the disease is detected by routine follow-up. Routine follow-up itself did not improve overall survival

Preoperative functional status is not associated with postoperative surgical complications in low risk patients undergoing esophagectomy

Preoperative functional status is a risk factor for developing postoperative complications (POC) in major abdominal and thoracic surgery, but this has hardly been evaluated in esophageal cancer patients undergoing esophagectomy. The aim of this prospective cohort study was to determine if preoperative functional status in esophageal cancer patients is associated with POC. From March 2012 to October 2014, esophageal cancer patients scheduled for esophagectomy at the outpatient clinic of a large tertiary referral center were eligible for the study. We measured inspiratory muscle strength, hand grip strength, physical activities, and health related quality of life as indicators of functional status one day before surgery. POC were scored according to the Clavien-Dindo Classification. We used univariate and multivariate backward regression analysis to determine the association between functional status and POC. We included 94 patients in the study and esophagectomy was performed in 90 patients from which 55 developed POC (61.1%). After multivariate analysis, none of the indicators of preoperative functional status were independently associated with POC (inspiratory muscle strength [OR 1.00; P = 0.779], hand grip strength [OR 0.99; P = 0.250], physical activities [OR 1.00; P = 0.174], and health related quality of life [OR 1.02; P = 0.222]). We concluded that preoperative functional status in our study cohort is not associated with POC after esophagectomy