Autonomic dysfunction in Hodgkin and non-Hodgkin lymphoma. A paraneoplastic syndrome?

We wanted to determine whether autonomic dysfunction in patients with lymphoma is related to chemotherapy or represent a paraneoplastic syndrome. 40 patients with current or cured Hodgkin or non-Hodgkin lymphoma and 40 healthy controls, matched for age, gender, hypertension and diabetes mellitus underwent autonomic evaluation (Deep Breath, Valsalva Maneuver, Hand Grip, Lying to Standing, Tilt Test). Current patients also suffering from diabetes or hypertension, or still on chemotherapy revealed autonomic changes, while cured or healthy subjects did not. Autonomic dysfunction in lymphoma is a transient manifestation of a paraneoplastic syndrome

Cancer initiation and progression: an unsimplifiable complexity

BACKGROUND: Cancer remains one of the most complex diseases affecting humans and, despite the impressive advances that have been made in molecular and cell biology, how cancer cells progress through carcinogenesis and acquire their metastatic ability is still widely debated. CONCLUSION: There is no doubt that human carcinogenesis is a dynamic process that depends on a large number of variables and is regulated at multiple spatial and temporal scales. Viewing cancer as a system that is dynamically complex in time and space will, however, probably reveal more about its underlying behavioural characteristics. It is encouraging that mathematicians, biologists and clinicians continue to contribute together towards a common quantitative understanding of cancer complexity. This way of thinking may further help to clarify concepts, interpret new and old experimental data, indicate alternative experiments and categorize the acquired knowledge on the basis of the similarities and/or shared behaviours of very different tumours

Classification of internal and external rectal prolapse

Physical examination has traditionally been, and continues to be, the mandatory initial step in the evaluation of patients with constipation or faecal incontinence. This is because the initial treatment decision and the necessity of further investigations of patients with pelvic floor dysfunction depend on primary clinical assessment of the patient [1]. Even if authors [2] found good correlation between clinical assessment and defecography in high-grade intussusceptions when studying subjects with defecatory difficulties, several reports in the nonradiologic literature have documented the relative insensitivity of the history and physical examination in diagnosing the cause of constipation and detecting pelvic organ prolapse [11, 3-6]. The common clinical physical examination tends to underestimate the degree of prolapse and may be able to diagnose only 30-40% of rectal prolapse [7]. Therefore, the precise preoperative diagnosis supplied by defecography can help in the selection of a rationale treatment programme, placing the patient into a treatment-defined group, determining the type of operation and giving objective evidence for the corrective scope and degree of operation

A gastric hiatal hernia may make abdominal pain disappear

Recurrent abdominal pain developed in a 74-year-old woman that chronically suffered from retrosternal pain and regurgitation. An erect abdominal plain film showed a fluid level in the ascending colon and an enlargement of the posterior lower mediastinum containing gas on the right. Unexpectedly, the patient reported that abdominal pain disappeared after meals. Double contrast enema and contemporaneous barium swallow showed herniation of the left colonic flexure into the left lower mediastinum and a gastric hernia within the right lower mediastinum, respectively. The hernias were in the same site of the enlargement of the mediastinum seen on the plain abdominal film. The colonic hernia partially reduced when the gastric hernia was filled with barium. We postulate that these findings could explain the disappearance of the colic obstruction and abdominal pain after meals

PET-CT Scanning in the Management of Differentiated Thyroid Carcinoma

Purpose: Differentiated thyroid carcinoma (DTC) has a good prognosis with a 10-year survival rate higher than 90%. However, 5-24% of patients experience persistent or recurrent disease. DTC management guidelines recommend PET for imaging patients with 131I negative whole body scans and increasing serum thyroglobulin levels. The aim of this study was to assess the impact of PET on the therapeutic management of patients with recurrent DTC. Methods and Materials: 100 DTC patients underwent surgery and postoperative thyroid remnant ablation with 131I and were studied using PET-CT because of rising basal or recombinant TSH-stimulated serum thyroglobulin levels. They were divided into 3 groups based on: diagnostic indications for 131I-negative scanning and increasing thyroglobulin level (group 1, 33 pts); surgical planning for recurrent disease (group 2, 45 pts); and effectiveness of systemic therapy (group 3, 22 pts). Results: PET-positive foci were found in 53/100 studies. PET located recurrent disease in 42% of group 1 patients, predicted curative resection in 58% of group 2 patients, and confirmed known metastatic disease in 59% of group 3 patients. PET results led to surgical treatment with radical intent in 19 patients (complete remission in 8 patients) and palliative in 6 cases. Moreover, PET results led to high-dose 131I radio-metabolic treatment for 11 patients and external beam radiotherapy for 3 patients. The remaining 14 patients underwent only clinical follow\u2011up. Conclusion: The study emphasises how PET indications are changing from a purely diagnostic role in localising 131I-negative DTC recurrences to designing appropriate DTC surgical or combined therapeutic strategies