Canadian guidelines on the management of colorectal peritoneal metastases.

Modern management of colorectal cancer (crc) with peritoneal metastasis (pm) is based on a combination of cytoreductive surgery (crs), systemic chemotherapy, and hyperthermic intraperitoneal chemotherapy (hipec). Although the role of hipec has recently been questioned with respect to results from the prodige 7 trial, the role and benefit of a complete crs were confirmed, as observed with a 41-month gain in median survival in that study, and 15% of patients remaining disease-free at 5 years. Still, crc with pm is associated with a poor prognosis, and good patient selection is essential. Many questions about the optimal management approach for such patients remain, but all patients with pm from crc should be referred to, or discussed with, a pm surgical oncologist, because cure is possible. The objective of the present guideline is to offer a practical approach to the management of pm from crc and to reflect on the new practice standards set by recent publications on the topic.

Reconstruction after ureteral resection during HIPEC surgery: Re-implantation with uretero-neocystostomy seems safer than end-to-end anastomosis.

INTRODUCTION: Resection of the pelvic ureter may be necessary in cytoreductive surgery for peritoneal carcinomatosis in combination with hyperthermic intraperitoneal chemotherapy (HIPEC). As the morbidity for cytoreductive surgery with HIPEC has decreased, expert teams have begun to perform increasingly complex surgical procedures associated with HIPEC, including pelvic reconstructions. After ureteral resection, two types of reconstruction are possible: uretero-ureteral end-to-end anastomosis and uretero-vesical re-implantation or uretero-neocystostomy (the so-called psoas hitch technique). By compiling the experience of three surgical teams that perform HIPEC surgeries, we have tried to compare the effectiveness of these two techniques. METHODOLOGY: A retrospective comparative case-matched multicenter study was conducted for patients undergoing operation between 2005 and 2014. Patients included had undergone resection of the pelvic ureter during cytoreductive surgery with HIPEC for peritoneal carcinomatomosis; ureteral reconstruction was by either end-to-end anastomosis (EEA group) or re-implantation uretero-neocystostomy (RUC group). The primary endpoint was the occurrence of urinary fistula in postoperative follow-up. RESULTS: There were 14 patients in the EEA group and 14 in the RUC group. The groups were comparable for age, extent of carcinomatosis (PCI index) and operative duration. Four urinary fistulas occurred in the EEA group (28.5%) versus zero fistulas in the RUC group (0%) (P=0.0308). CONCLUSION: Re-implantation with uretero-neocystostomy during cytoreductive surgery with HIPEC is the preferred technique for reconstruction after ureteral resection in case of renal conservation.

Benefits of exercise training in Spanish prison inmates.

Prison populations are growing in Western countries. Imprisoned people usually have a poor health status and an increased risk to suffer chronic debilitating conditions as coinfection with the HIV and hepatitis C virus (HCV) and/or opioid dependency. We studied the effects of a 4-month concurrent cardiorespiratory and resistance training program on the cardiorespiratory fitness, lower and upper body dynamic strength endurance (6-RM test for bench press and knee-extensor exercise, respectively), muscle mass and quality of life (QOL) of adult prison inmates who are HIV/HVC co-infected and enrolled in a methadone maintenance program (n = 9; mean [SD] age: 37 [3] yrs). We also evaluated a control group (n = 10; 37 [2] yrs). A significant combined effect of group and time was found for peak completed workload (W) (p < 0.01), peak heart rate (HR (peak)) (p < 0.05) and rate of HR decrease at 1-min postexercise compared to HR (peak) (p < 0.05), respectively, in a gradual cycle ergometer test. A significant combined effect of group and time was also found for both bench press and knee-extensor 6-RM tests, respectively (p < 0.05). Supervised exercise training can improve the overall physical fitness of incarcerated people. Our results suggest that this type of intervention could be applied in prisons of Western societies.

Light-emitting diode 415 nm in the treatment of inflammatory acne: an open-label, multicentric, pilot investigation.

BACKGROUND: The management of acne remains a challenge, with current therapies linked to significant side effects and patient non-compliance. Phototherapy using blue light has been proven in the treatment of acne vulgaris and offers the clinician an effective alternative. OBJECTIVE: To determine the effect of narrowband light-emitting diode (LED) blue light in the reduction of inflammatory and non-inflammatory lesions in patients with mild to moderate acne and to evaluate patient tolerance of the therapy. METHODS: Forty-five patients were treated with high-intensity pure blue light, 415 nm and 48 J/cm2, receiving two treatments of 20 minutes per week for a period of 4-8 weeks. Clinical assessment was performed at baseline, and 2, 4 and 8 weeks after treatment. A patient's therapeutic response was measured using a global improvement scoring system. RESULTS: The mean improvement score was 3.14 at 4 weeks and 2.90 at 8 weeks. Nine patients experienced complete clearing at 8 weeks. The treatment was well tolerated, with 50% of patients highly satisfied with the treatment. CONCLUSION: This open-label study suggests the therapeutic efficacy of high-intensity LED pure blue light in the treatment of acne vulgaris with no reported side effects.

Atrophic facial scars secondary to discoid lupus erythematous: treatment using the Erbium:YAG laser.

BACKGROUND: Discoid lupus erythematosus (DLE) is a chronic inflammatory skin condition notorious for causing disfiguring scars and alopecia. We describe the case of a 66-year-old woman with a 25-year history of relapsing DLE who developed extensive cribriform scarring on her face. OBJECTIVE: To assess the safety and efficacy of laser resurfacing in the treatment of facial scars in DLE. METHODS: One patient was treated with an Er:YAG laser and followed for more than 2 years. RESULTS: The patient showed remarkable cosmetic improvement with no hypertrophic scarring and no reactivation of her disease. CONCLUSION: Er:YAG laser resurfacing may be safe and effective in the treatment of patients with DLE-induced atrophic scars.

Melanoma in situ of the oral mucosa in an adolescent with dysplastic nevus syndrome.

We describe a case of melanoma in situ occurring on the oral mucosa in an adolescent male patient who has dysplastic nevus syndrome. This association has not been previously reported and is of interest both because of the rarity of melanoma involving the oral mucosa, particularly in childhood, and because of the lack of any previous reports of oral mucosal melanoma in association with the dysplastic nevus syndrome.

Attention deficit hyperactivity disorder: an evolutionary perspective.

Attention deficit hyperactivity disorder (ADHD) affects a significant portion of the population--some 5% of all school-aged children--and approximately half of these individuals continue to show the full disorder in adulthood. Recent studies point to a strong genetic component in the etiology of this disorder. Questions have been raised as to the relatively high prevalence of this condition in the population, given its apparent maladaptive nature in present-day society. In this article, we review and discuss three theories regarding the possible adaptive function of ADHD: the hunter, fighter, and wader theories. Although no theory entirely explains the occurrence of ADHD, it is worthwhile to note that, at least historically, ADHD may have served an adaptive function and may have been selected by the environment for survival.