The purpose of the study was to retrospectively reassess in our institutional series at a longer follow-up the value of a systematic attempt to carry out wide resections in retroperitoneal soft ...tissue sarcoma.
Three hundred and thirty-one consecutive patients surgically treated were analyzed. Since a shift toward a systematic more extended surgical approach took place starting from 2002, patients were divided in two groups according to the time of surgery. Overall survival (OS), crude cumulative incidence of local recurrence (LR) and distant metastases (DMs) were estimated. Cox model multivariate analysis was carried out.
Five-year OS of patients operated in the recent period was 66%, compared with 48% for those operated in the previous period. This was associated with less LR (28% versus 49%), while the number of DMs was higher in the recent group (25% versus 12%). Beside the treatment period, the only independent determinant for survival was histological grade.
The adoption of a policy of more liberal visceral en bloc resections was associated with a higher local control and OS. This benefit was evident in patients with grade I–II tumors, while DMs were a limiting factor in high-grade ones. New therapies are needed to control systemic disease as local surgery may improve local control.
Children and adolescents with haematological malignancies (PedHM) are characterized by a severe loss of exercise ability during cancer treatment, lasting throughout their lives once healed and ...impacting their social inclusion prospects. The investigation of the effect of a precision-based exercise program on the connections between systems of the body in PedHM patients is the new frontier in clinical exercise physiology. This study is aimed at evaluating the effects of 11 weeks (3 times weekly) of combined training (cardiorespiratory, resistance, balance and flexibility) on the exercise intolerance in PedHM patients. Two-hundred twenty-six PedHM patients were recruited (47% F). High or medium frequency participation (HAd and MAd) was considered when a participant joined; > 65% or between 30% and < 64% of training sessions, respectively. The "up and down stairs'' test (TUDS), "6 min walking" test (6MWT), the "5 Repetition Maximum strength" leg extension and arm lateral raise test (5RM-LE and 5RM-ALR), flexibility (stand and reach), and balance (stabilometry), were performed and evaluated before and after training. The TUDS, the 5RM-LE and 5RM-ALR, and the flexibility exercises showed an increase in HAd and MAd groups (P < 0.05), while the 6MWT and balance tests showed improvement only in HAd group (P < 0.0001). These results support the ever-growing theory that, in the case of the treatment of PedHM, 'exercise is medicine' and it has the potential to increase the patient's chances of social inclusion.
Head and neck soft tissue sarcomas (STS) represent a rare disease.
One hundred and sixty-seven patients underwent surgery at our institution with an eradicating intent between 1990 and 2010. Local ...recurrence (LR), distant metastasis (DM) and disease-specific mortality (DSM) incidence were studied along with clinicopathological prognostic factors.
Ten-year crude cumulative incidence (CCI) of LR, DM and DSM were 19%, 11% and 26%, respectively (median follow-up 66 months). Independent prognostic factors for DSM were tumor size (P < 0.001) and grade (P = 0.032), while surgical margins obtained a border-line significance (0.070); LR was affected by the tumor size (P = 0.001), while DM only by grade (P = 0.047). The median survival after LR and DM were 14 months and 7 months, respectively. Tumors sited in the paranasal sinus and supraclavicular region had the worst survival.
Head and neck represent a very critical anatomical site for STS. Achievement of local disease control appears to be crucial, since even LR could be a life-threatening event.
Purpose
To explore the potential of superb microvascular imaging (SMI) in visualizing brain microvessels in preterm neonates of different gestational ages (GA).
Methods
In this retrospective, ...observational pilot study, 15 preterm newborns were equally divided into GA groups: extremely (GA < 28 weeks), very (28–31 weeks), and moderate to late (32–37 weeks) preterm. All patients underwent conventional transcranial ultrasounds during the first day of life following the American Institute of Ultrasound in Medicine practice guidelines. SMI was then performed; based on their SMI morphology and location, brain microvessels were classified as extrastriatal (cortical and medullary), striatal, or thalamic. Two examiners independently classified vessels as visible or invisible. To assess the association between vessel visibility and GA, binomial logistic regression analysis (separate for each microvessel group) was performed, taking visibility as a dependent variable and both examiners and GA as predictor variables.
Results
A statistically significant difference among GA groups was found in sex (
P
= 0.030), birth weight (
P
= 0.007), and Apgar score within 1 min after birth (
P
= 0.024). Microvascular visibility increased with GA for superficial vessels (
P
< 0.05 for both cortical and medullary), while striatal and thalamic vessels were visible in all neonates irrespective of their GA.
Conclusions
SMI technology shows promise to assess brain microvasculature in preterm neonates, even potentially providing data on early brain development.
Purpose
The aim of this study is to describe and validate a simple and reliable method to pre-operatively predict the size of the ACL graft in the double strand technique with autologous ...semitendinosus–gracilis tendons on the same MRI used for ACL rupture diagnosis.
Methods
The study included 92 patients, with a median age of 31 years (IQR 26–41 years), 73/92 (79%) of whom were males. All patients that underwent an ACL reconstruction with doubled ST + GT between 2017 and 2022 were counted in the study.
Results
Overall, the median predicted graft diameter from MR imaging was similar to the actual graft diameter with no significant differences (n.s.). Regarding the comparison between predicted and actual graft size, concordance was 78/92 (85%, 95% CI 76–91%), with
κ
= 0.797 which corresponds to a level of agreement defined as “Strong”. Tendon sizes calculated on pre-operative MRI were evaluated both with intra-observer and inter-observer reliability demonstrating a statistically reproducible method. The predicted graft was then compared to the reported one with a statistically significant reliability found.
Conclusion
This study can help the surgeons to perform a fast pre-operative planning of an ACL reconstruction for graft selection. If the planned graft with ST and GT is smaller than 8 mm, the clinician can decide to switch to a different type of graft or plan a different graft preparing technique and, therefore, reduce the risk of post-operative ligament re-rupture. The method proposed is reliable and reproducible. The major strength of the planning technique proposed is that it relies on data that are already available for the clinician before surgery, without the need of further analysis.
Level of evidence
IV.
Background
More than 60 per cent of patients treated surgically for primary retroperitoneal sarcoma survive for at least 5 years. Extended surgical resection has been proposed for primary disease, ...but long‐term morbidity data are lacking. A cross‐sectional study was conducted to assess the long‐term morbidity of patients undergoing surgery for retroperitoneal sarcoma.
Methods
Patients operated on between January 2002 and December 2011 were eligible for the study. Long‐term morbidity was evaluated based on a semistructured clinical interview. Lower limb function was assessed by means of the Lower Extremity Functional Scale (LEFS), a self‐report questionnaire with a total score ranging from 0 (low functioning) to 80 (high functioning). Pain was investigated by means of the Brief Pain Inventory – Short Form, with pain intensity scores reported on a scale from 0 (no pain) to 10 (worst pain).
Results
Some 243 patients underwent surgery, and 101 of 160 patients who were alive at the time of the investigation responded to the study invitation letter. Finally, 95 patients were enrolled in the study. Sensory impairment of the limbs was reported in 72 patients (76 per cent). The median LEFS score was 60 (i.q.r. 43–73). Mean scores for the pain intensity items varied from 1·23 to 2·68. In multivariable analysis, there was no difference in median levels of creatinine at survey between patients who did or did not undergo nephrectomy (difference between median values 13 (95 per cent c.i. −4 to 30) µmol/l; P = 0·170).
Conclusion
Severe chronic pain and lower limb motor impairment after multivisceral resection for retroperitoneal sarcomas are rare. Long‐term renal function is not significantly impaired when nephrectomy is performed.
Severe impairment was uncommon
Rubinstein-Taybi syndrome (RSTS) is an autosomal dominant disorder, caused by variants in
or
. Affected individuals present with distinctive craniofacial features, broad thumbs and/or halluces, ...intellectual disability and immunodeficiency. Here we report on one RSTS patient who experienced hemophagocytic lymphohystiocytosis (HLH) and disseminated herpes virus 1 ( HSV-1) disease. The clinical picture of RSTS is expanding to include autoinflammatory, autoimmune, and infectious complications. Prompt treatment of HLH and disseminated HSV-1 can lower the mortality rate of these life-threatening conditions.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Abstract Objectives Aim of study was to assess the correlation between computed tomography scan (CT) findings and histopathology. Material and methods Data were collected on consecutive patients with ...suspected retroperitoneal sarcoma (RPS) referred to a tertiary sarcoma center. Patients underwent contrast enhanced multi-detector CT scans. Radiological features of lesions were classified according to the presence of a fatty (Group A) mass, or non-fatty (Group B) mass, both subdivided according to homogeneity and intralesional high-contrasted appearance. Radiological classification was compared with histopathological diagnosis. Sensitivity, specificity, positive/negative predictive value (PPV, NPV) were analyzed. Results Of 291 patients, 103/291 (35.4%) masses were classified in Group A and 188/291 (64.6%) in Group B. Diagnosis of mesenchymal tumor was obtained in 231/291 cases (79%) and non-mesenchymal tumor in 60/291 (21%). Sensitivity and specificity of Group A for liposarcoma were 76.7% and 92.0%; PPV and NPV were 86.4% and 85.6%. Sensitivity of Group B for a mesenchymal tumor was 55.4% and specificity was 0%; PPV and NPV were 68.1% and 0%. Conclusions None of radiological criteria were sufficient to anticipate a specific diagnosis, with the only exception of well differentiated liposarcoma and angiomyolipoma. In a series of suspected RPS, 21% of the lesions were finally non-mesenchymal tumors.
Abstract Purpose The purpose of the study is to quantify, by means of pain-related Somatosensory Evoked Potentials, the pain experience in subjects with Alzheimer's disease and to compare their ...psychophysiological response with that of persons without dementia. Subjects Twenty-seven subjects of both sexes, aged over 65 years and residing at the nursing home of Padua, participated: 10 subjects with probable mild to moderate Alzheimer's disease and 17 without dementia. Methods We measured the threshold values of thermal, mechanical and electrical pain and then we recorded the Somatosensory Evoked Potentials elicited by painful and non-painful electrical stimuli. Three components evoked by pain were analyzed: P100 and N150, which reflect discriminative/sensory processing, and P260, which reflects cognitive and emotional processing. Results There were no significant differences between the two groups with regard to three pain thresholds, as well as to P100 and N150 amplitudes. Although present in the Alzheimer's disease group, P260 was significantly lower even respect to that in subjects without dementia. Discussion Alzheimer's disease patients retain a stimuli perception and detection capacity comparable to that in similarly aged subjects without dementia while, although present, the cognitive and emotional response to pain seems to be reduced. Conclusion The difficulties in the cognitive and affective elaboration of pain and the patients’ inability to communicate, prevent people/persons with AD to be adequately treated at a pharmacological level. Therefore, the priority is to identify all the nonverbal behaviour through which people with dementia communicate to the outside their pain, so you can act quickly.
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