Carbon and zeolite-based composites for radionuclide and heavy metal sorption.

Zeolites have been investigated as sorbents of heavy metals from water. Since graphene oxide was already reported as promising radionuclide sorbent, we developed composite materials containing both a synthetic zeolite (type A, P or Y) and graphene oxide to be multifunctional sorbents. The extension of multifunctionality of sorbents was done by presence of third component, exfoliated graphite, to have additional properties as conductivity. The changing sorption activities of a composite was studied depending on its composition and functional modification. The composites, characterized by X-ray powder diffraction, Raman, FTIR spectroscopy and scanning electron microscopy, were tested for sorption of selected radionuclides (134Cs+, 85Sr2+) and heavy metals (Pb2+, Cd2+). The dependency on composition was found in connection with a high sorption of Pb2+ and Cd2+. Finally, optimized multifunctional sorbents (Gr-GO-COOH-A in ratio 40:40:20 and Gr:GO:A in ratio 25:25:50) were found to keep interesting high sorption activities for heavy metals and radionuclides with good conductivity properties.

Aggressive multimodal therapy may prolong disease-free survival in recurrent primary retroperitoneal embryonal carcinoma.

INTRODUCTION: Primary retroperitoneal extragonadal tumours relapsing after initial chemotherapy have a poor prognosis. PRESENTATION OF THE CASE: We report a case of primary retroperitoneal embryonal carcinoma in a patient with negative open testes biopsy. After the first line of chemotherapy (4 cycles BEP) secondary surgery with extirpation of a retroperitoneal residual mass was performed. The residuum proved histologically to be a mature teratoma, and no adjuvant treatment was given according to current recommendations. The patient had regular follow-up. 3.5 years later, patient developed recurrence in the ipsilateral adrenal gland, which was treated with surgery and 4 cycles of salvage VeIP chemotherapy. Seven months after the second surgical intervention the patient underwent multivisceral "desperation surgery" for early metastatic disease progression followed by 2 cycles of salvage TIP chemotherapy. The patient is currently disease-free at 34 months. CONCLUSION: Initial postchemotherapy retroperitoneal lymph node dissection is crucial for local retroperitoneal disease control. Aggressively treated metastatic recurrent disease does not preclude prolonged survival. Despite a generally poor prognosis, repeated complex oncosurgical therapy for retroperitoneal extragonadal tumours may be worthwhile.

Pancreatic paraganglioma - a rare and dangerous entity. Vascular anatomy and impact on management.

Pancreatic paragangliomas are extremely rare with less than 20 cases ever described in the world literature. There is no detailed report of the vascular anatomy in this entity and its possible impact on patient management. We present a case of large pancreatic head paraganlioma in a 53-year-old woman. The tumour had a predominant arterial blood supply via both the hepatic artery and the superior mesenteric artery. Complex inflow was complemented by supplementary branches from the right renal artery. The arteriovenous communications within the lesion represented the most dangerous aspect of excision and the tumour removal was accompanied with a considerable blood loss. After pancreaticoduodenectomy, patient experienced transient elevation of liver function tests with no other identifiable cause than a change in portal haemodynamics. It is advisable that the precise knowledge of vascular anatomy in pancreatic head paraganglioma should be obtained prior to any intervention.

Giant adrenocortical carcinoma with 27-month disease-free survival by surgical resection alone: a case report.

BACKGROUND: Adrenocortical cancer (ACC) is a rare disease with an estimated incidence of 1-2/million/year. The tumour stage and completeness of surgical resection have the biggest impact on survival. Whereas stage I-II patients survive in 55-64% of cases, only 0-5% of patients with stage IV disease are still alive at 5 years. A median survival of 33 months can be expected after curative surgery. Incomplete surgery leads to a significant drop in survival. METHOD: We present a 40-year-old man who underwent a technically demanding complete surgical excision of a giant (26 cm, 2372 g) ACC and experienced a 27-month disease-free survival without any systemic treatment. Detailed description of the surgical anatomy in relation to tumour size and patient body constitution is provided. The surgical strategy and exposure pitfalls under such extreme circumstances are discussed. CONCLUSION: To achieve R0 resection in locally advanced disease, en bloc resection with neighbouring organs is widely recommended. Giant tumours may however pose a technical challenge due to space constraints.

Laparoscopic abdominoperineal resection with intraoperative radiotherapy for locally advanced low rectal cancer.

AIMS: Intraoperative radiotherapy (IORT) for locally advanced rectal cancer as an integral part of multimodal treatment, may lead to reduced local recurrence but it is not routinely used. The aim of this paper is to describe our experience with IORT in the treatment of patients with locally advanced adenocarcinoma of the lower third of the rectum. MATERIAL AND METHODS: Laparoscopic abdominoperineal amputation of the rectum with intraoperative radiotherapy was performed on 17 patients, 13 men and 4 women, median age 64 years (49-75 years) between 2010-2011. All patients underwent complete therapy according to the treatment protocol. RESULTS: In one patient, the laparoscopic procedure had to be converted to an open resection. The duration of the surgical procedure with IORT was 185 to 345 min (median 285 min). In 14 cases, the intraoperative dose was 10 Gy and in two patients a dose of 12 Gy was used. There were no severe intraoperative complications. Blood loss ranged from 30 to 500 mL (median 100 mL). There were postoperative complications in 4 patients (23.5%); 2 necessitated surgical reintervention (11.8%). The duration of postoperative hospitalization was 6 to 35 days (median 7 days). In the follow-up of 2 to 16 months (median 12 months), no local recurrence or disease generalization have been found to date. CONCLUSIONS: The results show the technical feasibility of laparoscopically assisted abdominoperineal amputation of the rectum in combination with IORT in the treatment of locally advanced rectal carcinoma with an acceptable risk of postperative complications.

Endoscopic ultrasound-guided fine needle aspiration of pancreatic masses: the utility and impact on management of patients.

OBJECTIVE: It is controversial whether endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is beneficial in all patients with suspected pancreatic cancer. The aim of this study was to assess diagnostic yield, safety and impact of EUS-FNA on management of patients with solid pancreatic mass. MATERIAL AND METHODS: Consecutive patients undergoing EUS-FNA of solid pancreatic mass were enrolled. Gold standard for final diagnosis included histology from surgical resection. In patients without surgery, clinical evaluation methods and repeated imaging studies were used for the comparison of initial cytology and final diagnosis. Patients were followed-up prospectively focusing on subsequent treatment. RESULTS: Among 207 enrolled patients, final diagnosis was malignant in 163 (78.6%) and benign in 44 (21.4%). The sensitivity, specificity and accuracy of EUS-FNA in diagnosing pancreatic cancer were 92.6% (95% CI: 87.20-95.96), 88.6% (95% CI: 74.64-95.64) and 91.8% (95% CI: 87.24-94.81), respectively. No major and five (2.4%) minor complications occurred. Of 151 true-positive patients by EUS-FNA, 57 (37.7%) were surgically explored, of whom 28 (49.1%) underwent resection. Ten of 12 patients with false-negative cytology were explored based on detection of mass on EUS, of whom two had a delay due to false-negative cytology without curative treatment. From the whole study cohort, EUS-FNA had positive and negative impacts on subsequent management in 136 (65.7%) and 2 (0.9%) patients, respectively. CONCLUSIONS: EUS-FNA provides accurate diagnosis in 92% and has positive therapeutic impact in two-thirds of patients with solid pancreatic mass. Despite negative cytology, surgical exploration is recommended in clinical suspicion for pancreatic cancer and solid mass on EUS.

First molecular detection of Anaplasma phagocytophilum in European brown bear (Ursus arctos).

In Europe, Anaplasma phagocytophilum circulates in natural foci in a tick-host cycle. Up to now, antibodies against A. phagocytophilum as well as pathogen's DNA were recorded in several domestic and wild animals. Nevertheless, the reservoir host range is still under investigation. Tissue samples from European brown bears (Ursus arctos) were tested for the presence of A. phagocytophilum DNA by a PCR amplification of 16S rRNA gene. The results of our study provides the evidence, that the range of animals involved in the circulation and maintenance of A. phagocytophilum in natural foci, is extended of another ursine carnivore, European brown bear (Ursus arctos).