ABSTRACT
BACKGROUND: Transanal total mesorectal excision (TaTME) has been proposed as an approach in patients with mid and low rectal cancer. The TaTME procedure has been introduced in the Netherlands in a structured training pathway, including proctoring. This study evaluated the local recurrence rate during the implementation phase of TaTME. METHODS: Oncological outcomes of the first ten TaTME procedures in each of 12 participating centres were collected as part of an external audit of procedure implementation. Data collected from a cohort of patients treated over a prolonged period in four centres were also collected to analyse learning curve effects. The primary outcome was the presence of locoregional recurrence. RESULTS: The implementation cohort of 120 patients had a median follow up of 21·9 months. Short-term outcomes included a positive circumferential resection margin rate of 5·0 per cent and anastomotic leakage rate of 17 per cent. The overall local recurrence rate in the implementation cohort was 10·0 per cent (12 of 120), with a mean(s.d.) interval to recurrence of 15·2(7·0) months. Multifocal local recurrence was present in eight of 12 patients. In the prolonged cohort (266 patients), the overall recurrence rate was 5·6 per cent (4·0 per cent after excluding the first 10 procedures at each centre). CONCLUSION: TaTME was associated with a multifocal local recurrence rate that may be related to suboptimal execution rather than the technique itself. Prolonged proctoring, optimization of the technique to avoid spillage, and quality control is recommended.
ANTECEDENTES: La escisión total del mesorrecto por vía transanal (Transanal Total Mesorectal Excision, TaTME) se ha propuesto como abordaje quirúrgico en pacientes con cáncer de recto medio e inferior. La técnica TaTME se ha introducido en los Países Bajos mediante un proceso de formación estructurado que incluye la supervisión. Este estudio evaluó el porcentaje de recidiva local durante la fase de implementación de TaTME. MÉTODOS: Se recogieron los resultados oncológicos de los primeros 10 procedimientos realizados mediante TaTME en cada uno de los 12 centros participantes como parte de una auditoría externa de implementación del procedimiento. Se reunió una cohorte más amplia de pacientes procedentes de 4 centros para analizar los efectos de la curva de aprendizaje. El criterio de valoración principal fue la presencia de recidiva locorregional. RESULTADOS: La cohorte de implementación de 120 pacientes tuvo una mediana de seguimiento de 21,9 meses. Los resultados a corto plazo incluyeron una tasa del margen de resección circunferencial positivo del 5% y una tasa de fuga anastomótica del 17,4%. La tasa global de recidiva local en la cohorte de implementación fue del 10% (12/120) con un intervalo medio de recidiva de 15,2 (DE 7) meses. El patrón de recidiva local fue multifocal en 8 de 12 casos (67%). En la cohorte ampliada (n = 266), la tasa global de recidiva fue del 5,6% (4,0%, excluyendo a los primeros 10 pacientes). CONCLUSIÓN: TaTME se asoció con un porcentaje de recidiva local multifocal que puede relacionarse con una ejecución subóptima, más que con la técnica en sí. Se recomienda una supervisión prolongada, la optimización de la técnica para evitar la diseminación tumoral, así como un control de calidad.
Subject(s)
Neoplasm Recurrence, Local/epidemiology , Proctectomy/methods , Rectal Neoplasms/surgery , Rectum/surgery , Aged , Female , Humans , Learning Curve , Male , Neoplasm Recurrence, Local/pathology , Proctectomy/adverse effects , Proctectomy/education , Rectal Neoplasms/pathology , Rectum/pathology , Time Factors , Treatment OutcomeABSTRACT
INTRODUCTION: Next to locoregional control, good cosmetic outcome is one of the main goals of breast conserving treatment (BCT) for breast cancer surgery. Factors affecting cosmetic outcome are well known. The sentinel node (SN) procedure avoids lymphedema in the breast, which might influence cosmetic outcome. The aim of this study was to evaluate the cosmetic outcome of BCT after the SN procedure compared to that after axillary lymph node dissection (ALND). METHODS: The subjects were 20 patients who underwent ALND and 20 patients who underwent the SN procedure. After a minimum follow-up period of 43 months, we photographed each patient. Fifteen healthy women served as control subjects. We used the percentage breast retraction assessment index (pBRA=BRA/reference length x 100) to compare cosmetic outcome. RESULTS: The median pBRAs of the ALND group and SN group (14.3 and 6.71, respectively) significantly differed ( p=0.001). The pBRA of the SN group was comparable to the pBRA (6.1) of the control group ( p=0.317). CONCLUSION: Cosmetic outcome of BCT after the SN procedure was superior compared to the cosmetic outcome after ALND. This is an important additional reason to implement the SN procedure in routine daily practice.
Subject(s)
Breast Neoplasms/pathology , Breast Neoplasms/surgery , Esthetics , Lymph Node Excision , Mastectomy, Segmental , Sentinel Lymph Node Biopsy , Axilla , Case-Control Studies , Female , Follow-Up Studies , Humans , Linear Models , Middle Aged , Multivariate Analysis , Statistics, Nonparametric , Treatment OutcomeABSTRACT
This paper gives a brief historical overview of Fabry disease. First described in 1898 and called angiokeratoma corporis diffusum, a succession of observations and pioneering clinical research over the past 100 years has led to our present understanding of the disease. The major milestones during this time are described, as is the work that resulted in the successful introduction of enzyme replacement therapy.
Subject(s)
Fabry Disease/history , Fabry Disease/diagnosis , Fabry Disease/therapy , History, 19th Century , History, 20th Century , HumansABSTRACT
BACKGROUND: Biliopancreatic diversion (BPD) according to Scopinaro's method is a safe and effective technique for treatment of morbid obesity. In this operation a side-to-side enteroenterostomy is created 60 cm proximal to the ileocecal valve. Malabsorption of fat and starch is one of the main goals of the BPD. Ingestion of an excess of fat leads to steatorrhea. As a side-effect, malabsorption of iron, calcium and other elements can occur causing anemia and hypocalcemia. The blind loop syndrome gives the same symptoms. METHODS: A lady was admitted with a long history of steatorrhea, anemia and hypocalcemia due to a blind loop syndrome after a BPD. The diagnostic problem in this patient is illustrated. RESULTS: The diagnosis was only made at exploratory laparotomy. CONCLUSION: The blind loop syndrome was then treated with resection of the blind loop and antibiotics.
Subject(s)
Biliopancreatic Diversion , Blind Loop Syndrome/diagnosis , Obesity, Morbid/surgery , Postoperative Complications/diagnosis , Adult , Blind Loop Syndrome/etiology , Diagnosis, Differential , Female , Humans , Postoperative Complications/etiologySubject(s)
Fabry Disease/history , Heterozygote , Disease Progression , England , Eponyms , Fabry Disease/genetics , Fabry Disease/pathology , Female , Germany , History, 19th Century , Humans , Longevity , MaleABSTRACT
Cryosurgery is considered an alternative method in the treatment of basal cell carcinomas of the face and usually leads to excellent functional and cosmetic results. This technique can be modified depending on the number of freeze-thaw cycles. According to our experiences (220 cases), a single freeze-thaw cycle is indicated for those basal cell carcinomas which do not go beyond the middle dermis; these cases were characterized by fast wound healing and a very satisfying cosmetic outcome. Invasion of the lower dermis as well as basal cell carcinomas in skin folds require repeated freeze-thaw cycles. The specific mode of cryosurgical treatment, therefore, has to be differentiated depending on the site of the tumor and its depth of invasion.
Subject(s)
Carcinoma, Basal Cell/surgery , Cryosurgery , Neoplasm Recurrence, Local/pathology , Postoperative Complications/pathology , Skin Neoplasms/surgery , Wound Healing , Carcinoma, Basal Cell/pathology , Follow-Up Studies , Humans , Retrospective Studies , Skin/pathology , Skin Neoplasms/pathologyABSTRACT
The case of a 14-year-old boy who had oral ulcers with histologic proof of granulomatous disease nine months before the diagnosis of intestinal Crohn's disease is presented. Additional extraintestinal manifestations of this case were cheilitis, anal fissures, and "metastatic" disease to the umbilicus. The diagnosis was established after the onset of abdominal symptoms. All manifestations responded rapidly to systemic prednisone, sulfasalazine, and metronidazole.
Subject(s)
Crohn Disease/diagnosis , Stomatitis, Aphthous/complications , Adolescent , Anal Canal/pathology , Cheilitis/complications , Cheilitis/pathology , Crohn Disease/complications , Crohn Disease/pathology , Diagnosis, Differential , Humans , Intestinal Mucosa/pathology , Langerhans Cells/pathology , Male , Skin Diseases/complications , Skin Diseases/pathology , Stomatitis, Aphthous/pathology , UmbilicusABSTRACT
Hallux valgus leads to lateral deviation of the big toe's longitudinal axis. In consequence, the forces working on the tip of the toe during unrolling of the foot are shifted in medial direction. As a result, subungual clavi, unguis incarnatus, unguis convolutus, or laterally turning onychogryposis like a cork-screw develop.
Subject(s)
Foot Dermatoses/pathology , Hallux Valgus/pathology , Nail Diseases/pathology , Humans , Nails/pathology , Skin/pathology , Toes/pathologyABSTRACT
A multicentre, between-patient, comparative trial was carried out by nine dermatologists in the Federal Republic of Germany to compare the efficacy and tolerability of 0.05 halometasone ointment with those of an ointment, containing 0.25% fluocortolone + 0.25% fluocortolone caproate, in patients with psoriasis vulgaris. The evaluable trial population consisted of 182 patients, 115 males and sixty-seven females. Halometasone ointment yielded a higher success rate ('good' to 'very good' results), namely 56.4% than that obtained with the comparative ointment (45.4%). Halometasone ointment also produced a higher cure rate, namely 26.6%, than that reported with the comparative preparation (19.3%). An improvement of one score over the pre-treatment clinical status of the psoriatic lesions reported at the Day 10 visit was significantly higher (p = 0.04), namely 48.9%, with halometasone ointment than that with the comparative preparation (35.2%). The percentages of patients obtaining an early cure, i.e. in less than 30 days, and onset of action were practically identical in both treatment groups. No adverse effects were reported in any of the ninety-four patients treated with halometasone ointment, while unwanted reactions were observed in three of the eighty-eight patients treated with the comparative preparation.
Subject(s)
Anti-Inflammatory Agents/administration & dosage , Betamethasone/analogs & derivatives , Fluocortolone/administration & dosage , Psoriasis/drug therapy , Administration, Topical , Adolescent , Adult , Aged , Anti-Inflammatory Agents/adverse effects , Betamethasone/administration & dosage , Betamethasone/adverse effects , Clinical Trials as Topic , Female , Humans , Male , Middle Aged , OintmentsABSTRACT
A ring Y chromosome was found in a male showing growth retardation and aspermia but normally developed external genitalia. The ring does not display either the characteristic brilliant Y fluorescence or the typical late-replicating heterochromatin.
