TEM in the treatment of recurrent rectal cancer in the elderly

Articolo presente su PubMed Central. Surcerecord id Scopus 28558 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3194378/ Introduction.Transanal endoscopic microsurgery is a useful technique of minimally invasive surgery that allows the realization of complex interventions, from transanal excisions to full thickness resections with anastomotic reconstructions. TEM can have a diagnostic and therapeutic value in the elderly for the treatment of primary rectal cancer as well as for recurrences. Materials and methods.During the period between January 2002 and December 2009 six patients, average age of 66 years, four men and two women, with early diagnosed rectal cancer recurrence were selected to undergo this palliative surgical procedure. 3 men and 1 woman underwent "ultra-low anterior resection”, followed by chemo / radio therapy (T3N1M0); in one woman a TEM (T1NxM0) and in one old man the local escission was performed after neoadiuvant chemo/radio therapy (T2NxM0). The selection of the patients was made by: rigid sigmoidoscope, transrectal us, colonoscopy, abdominal us to rule out liver metastases, CT and MRI abdomen and pelvis with and without contrast agents, PET CT. In all patients the lesions were superficial, smaller than 2 cm and located at the posterior wall of the rectum. Results.Follow-up was approximately 12-28 months; the pathologic staging confirmed the complete excision of recurrences. Patients were then referred for more complementary therapies. Only one patient presented a retro rectal abscess treated with conservative techniques, too. Conclusions.The alternative to conservative surgery is an abdomino-perineal resection sec. Miles, but also this really invasive procedure can be considered palliative in the most part of recurrences. So, based on equal oncological results, the reduction of surgical trauma and preservation of anatomical integrity are really important goals

Laparoscopy in bilio-pancreatic surgery in elderly

Articolo presente su PubMed Central. Sourcerecord id Scopus 28558 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3194374/ Background.More minimally invasive techniques are currently available for the surgical oncologist in the optimal staging of biliopancreatic cancer. With the increased age of population we can see an increase of age-related diseases, such a cardiovascular disease, hypertension, arthritis and other malignancies. With the development of endoscopy, laparoscopy, ultrasonography and biopsy equipment, more minimally invasive techniques are currently available for the surgical oncologist to provide a better optimal diagnosis and strategy, followed by an appropriate surgical treatment of biliopancreatic cancer. Improvement in the diagnostic and surgical care of elderly cancer patients will have a final impact on disease and overall survival rates of the different types of cancer treatment. Materials and methods.We retrospectively reviewed the records of patients between January 2001 and December 2008 who had either a mass in the biliopancreatic area classified as clinically resectable. Tumours were considered to be resectable when there was no evidence of distant extra pancreatic disease or involvement of lymphnodes outside the classic margins of resections. Occlusion or encasement of the superior mesenteric artery or vein, celiac artery or portal vein were used as a criteria for unresectability. Twenty-eight patients over 65 and under 75 years (middle age 69) with primary biliopancreatic cancer were submitted to operations for potentially operative resection. In all cases staging laparoscopy was performed just prior to planned open exploration and resection. Results.Twenty seven patients underwent laparoscopy exploration for potential resection. Two of five patients (40%) with distal cholangiocarcinoma survived at 5 years after DCP. Eighteen patients (66.6%) had unresectable disease identified at laparoscopy and fourteen were able to convert to laparotomy palliative surgery while for the others laparoscopy spared an unnecessary laparotomy. In four patients it was possible to perform a laparoscopy palliative surgery. Conclusions.Laparoscopy may have a role in the staging of patients with biliopancreatic malignancies, in particular, for reduction of unnecessary exploratory laparotomy. Moreover, even in old age, duodenocephalopancreasectomy, properly planned and executed, resulted in reduction of operative mortality and morbility and a clear long-term survival

Sentinel node biopsy and radical lymph node dissection for advanced melanoma in the elderly

Articolo presente su PubMed Central. Sourcerecord Id Scopus: 28558 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3194399/ Background.The majority of indications for surgery in melanoma are for the treatment of primary tumor and lymph node metastases. During the last decade, the Sentinel Node Biopsy (SNB), from a research procedure, has become standard of care in most institutions. SNB is normally considered for patients with melanoma > 1 mm and generally about 20% are positive; however, the risk of a positive SNB in a melanoma < 1 mm is still 5%. Usually when SNB is positive a complete lymphadenectomy is performed. Materials and methods.In the period 2004-2009, 18 elderly patients (median age 68 years) affected by cutaneous melanoma (mean Breslow’s thickness = 3.77 mm), after SNB histologically confirmed regional lymph node involvement, underwent complete lymph node dissection (CLND). We treated 11 of them with groin dissection, in 3 cases bilateral; 4 patients underwent axillar dissection, in one case bilateral; 2 patients underwent neck dissection and another patient underwent groin-axillar dissection. We treated bilateral groin involvement with laparoscopic access for dissection of lumbar-aortic, iliac and obturator lymph nodes. Results.Disagreeing with literature, 12/18 (67%) of these patients had positive lymph nodes, a high percentage if compared with younger patients’ data. Currently the average follow-up is 25 months. In our sample CLND has a crucial prognostic role (16% vs 41% of deceased in CLND – and CLND + patients respectively). Conclusions.Elderly melanoma patients are characterized by a higher tumor stage and, in patients with nodal metastases, the prognosis is independently affected by older age. In case of positive SNB the CLND plays a notable prognostic role and a presumable therapeutic role

The use of intraoperative ultrasound for diagnosis and stadiation in pancreatic head neoformations

The intraoperative staging of the pancreatic cancer is important to make a proper treatment. For this reason the intraoperative echography is playing an important role in the right treatment choice. The intraoperative echography, that can be performed with an open or laparoscopic probe, is used to confirm the preoperative diagnosis and assess the pancreatic cancer resecability. The intraoperative echography (IOUS) or laparoscopic intraoperative echography (LIOUS) are useful to identify the patients with a non resecable cancer and perform a faster neoadjuvant treatment. The LIOUS can also avoid an useless laparotomy. The aim of this study is to assess, both in our experience and in the cited literature, the concordance rate between the pancreatic cancer preoperative staging, performed with TC and MRI (when it is available), and intraoperative staging, performed with intraoperative laparotomic or laparoscopic echography. Material and methods: We have analyzed the treatment management of 34 patients, who were candidate to major surgery for suspected pancreatic head cancer and who underwent to intraoperative LIOUS or IOUS staging from 2001 to 2012. Results: LIOUS and IOUS have allowed to detect cases in which preoperative diagnosis, proved by CT and MRI, was not agreeing with intraoperative diagnosis (22 patients on 34, 64% discordance rate), avoiding the execution of a demolitive and uneseful surgery in order to guarantee the surveillance and life's quality of patients. Conclusion: We suggest to perform in every patients undergone to pancreatic surgery an intraoperative ultrasound exam, to detect unresecable and unpredicted lesions

Image sensors for wave monitoring in shore protection: Characterization through a machine learning algorithm

Waves propagating on the water surface can be considered as propagating in a dispersive medium, where gravity and surface tension at the air–water interface act as restoring forces. The velocity at which energy is transported in water waves is defined by the group velocity. The paper reports the use of video‐camera observations to study the impact of water waves on an urban shore. The video‐monitoring system consists of two separate cameras equipped with progressive RGB CMOS sensors that allow 1080p HDTV video recording. The sensing system delivers video signals that are processed by a machine learning technique. The scope of the research is to identify features of water waves that cannot be normally observed. First, a conventional modelling was performed using data delivered by image sensors together with additional data such as temperature, and wind speed, measured with dedicated sensors. Stealth waves are detected, as are the inverting phenomena encompassed in waves. This latter phenomenon can be detected only through machine learning. This double approach allows us to prevent extreme events that can take place in offshore and onshore areas

A water-filled garment to protect astronauts during interplanetary missions tested on board the ISS

Abstract As manned spaceflights beyond low Earth orbit are in the agenda of Space Agencies, the concerns related to space radiation exposure of the crew are still without conclusive solutions. The risk of long-term detrimental health effects needs to be kept below acceptable limits, and emergency countermeasures must be planned to avoid the short-term consequences of exposure to high particle fluxes during hardly predictable solar events. Space habitat shielding cannot be the ultimate solution: the increasing complexity of future missions will require astronauts to protect themselves in low-shielded areas, e.g. during emergency operations. Personal radiation shielding is promising, particularly if using available resources for multi-functional shielding devices. In this work we report on all steps from the conception, design, manufacturing, to the final test on board the International Space Station (ISS) of the first prototype of a water-filled garment for emergency radiation shielding against solar particle events. The garment has a good shielding potential and comfort level. On-board water is used for filling and then recycled without waste. The successful outcome of this experiment represents an important breakthrough in space radiation shielding, opening to the development of similarly conceived devices and their use in interplanetary missions as the one to Mars

Impact of Tumor Grade on Prognosis in Pancreatic Cancer: Should We Include Grade in AJCC Staging?

AJCC staging of pancreatic cancer (PAC) is used to determine prognosis, yet survival within each stage shows wide variation and remains unpredictable. We hypothesized that tumor grade might be responsible for some of this variation and that the addition of grade to current AJCC staging would provide improved prognostication. The Surveillance, Epidemiology, and End Results (SEER) database (1991–2005) was used to identify 8082 patients with resected PAC. The impact of grade on overall and stage-specific survival was assessed using Cox regression analysis. Variables in the model were age, sex, tumor size, lymph node status, and tumor grade. For each AJCC stage, survival was significantly worse for high-grade versus low-grade tumors. On multivariate analysis, high tumor grade was an independent predictor of survival for the entire cohort (hazard ratio [HR] 1.40, 95% confidence interval [95% CI] 1.31–1.48) as well as for stage I (HR 1.28, 95% CI 1.07–1.54), stage IIA (HR 1.43, 95% CI 1.26–1.61), stage IIB (HR 1.38, 95% CI 1.27–1.50), stage III (HR 1.28, 95% CI 1.02–1.59), and stage IV (HR 1.58, 95% CI 1.21–2.05) patients. The addition of grade to staging results in a statistically significant survival discrimination between all stages. Tumor grade is an important prognostic variable of survival in PAC. We propose a novel staging system incorporating grade into current AJCC staging for pancreas cancer. The improved prognostication is more reflective of tumor biology and may impact therapy decisions and stratification of future clinical trials

Multi-institutional analysis of pancreatic adenocarcinoma demonstrating the effect of diabetes status on survival after resection

The effect of diabetes on survival after resection pancreatic ductal carcinoma (PDAC) is unclear. The present study was undertaken to determine whether pre-operative diabetes has any predictive value for survival