Desmoid Tumors of the Foot: A Retrospective Study of Four Patients.

BACKGROUND: Desmoid-type fibromatosis (DF) is an aggressive (myo)fibroblastic neoplasm with an infiltrative growth pattern and a tendency for local recurrence. It is rarely seen at the foot. The aim of this retrospective study was to analyze clinical presentation, therapy, and outcomes in a consecutive series of four patients with DF at the foot. METHODS: From 1994 to 2014, four patients had been surgically treated. The resection margin was marginal or even intralesional in all. One patient already had local recurrence at first presentation. The end point was either local recurrence or progression of residual disease. RESULTS: The mean patient age was 27 years. In one patient, marginal excision healed the disease. In another patient, local recurrence after marginal resection necessitated distal phalanx amputation. Two other patients showed stable disease after either adjuvant radiotherapy or treatment with nonsteroidal anti-inflammatory drugs and tamoxifen. CONCLUSIONS: If surgery is necessary, operative margins are less important than keeping function for the patient. Radiotherapy might be an option to avoid major amputation. The role of adjuvant radiotherapy is controversially discussed. A watchful wait-and-see policy seems to be justified by the published data but may be difficult for DF at the foot.

Desmoid Tumours of the extremity and trunk. A retrospective study of 44 patients.

BACKGROUND: Desmoid-type fibromatosis (DF) is a aggressive (myo)fibroblastic neoplasm with an infiltrative growth and a tendency to local recurrence. Resection of the tumour and/or radiation were proposed as principal treatment. The aim of this retrospective study was to analyze the local control rates focusing on the effect of surgical margins and radiotherapy. METHODS: From 1981 to 2014, 44 patients had been treated. Fifty four therapies had been applied, in 50 cases surgery +/- radiation therapy, NSAIDs or chemotherapy. In 4 cases a conservative approach was chosen. Thirty seven patients had primary, 17 recurrent disease. Endpoint was either local recurrence (LR), progression of residual disease or rare non-metastatic secondary lesions at the same extremity. RESULTS: The mean age was 39,4 years. In 17 cases a R0, in 27 a R1 and in 6 cases a R2 resection was achieved. Four patients were treated conservatively. All together in 21 cases radiotherapy, in 5 NSAIDs, in 3 imatinib and in 2 cases each tamoxifen or chemotherapy had been applied. The median follow-up was 119 months. 5-year recurrence free survival after resection was 78%. 10 (20.4%) patients developed LR between 5 and 42 months after therapy. Recurrent disease was a negative factor on LR. Margins, radiotherapy, sex, or size of the tumour had no significant impact on LR. Patients younger than 40 years had a significant higher risk of LR. CONCLUSIONS: Surgical margins are less important than keeping function. Radiotherapy might be an option in unresectable lesions, the role of adjuvant radiotherapy is controversially discussed.

Reduced sensitivity of the renal vasculature to angiotensin II in young rats: the role of the angiotensin type 2 receptor.

BACKGROUND: The angiotensin type-2 receptor (AT2R) opposes the vasoconstrictor actions of angiotensin II (AngII) mediated through the angiotensin type-1 receptor (AT1R). Renal AT2R levels are high during fetal life, but decrease significantly during postnatal maturation. To provide insight into the functional role of the AT2R in the kidney during postnatal development, we investigated the effects of AT2R antagonism on cardiovascular responses to AngII in young and adult male rats. METHODS: In anesthetized 3- and 6-wk-old male Sprague-Dawley rats, mean arterial pressure (MAP) and renal blood flow (RBF) were measured in response to AngII in the presence of vehicle treatment or AT2R blockade with PD123319. RESULTS: The pressor effect of AngII and associated reduction in RBF were significantly less in 3-wk- than 6-wk-old rats. AT2R blockade potentiated the reduction in RBF in response to AngII in 3-wk-old rats only. CONCLUSION: In young rats, the AT2R modulates the response to AngII, blunting renal vasoconstriction. This effect is attenuated with age in association with a developmental reduction in renal AT2R expression. These findings may have implications for the development of novel therapies that target the renin-angiotensin system for the improvement of renal function in term and, in particular, preterm infants.

Ergonomics of novices and experts during simulated endotracheal intubation.

Endotracheal Intubation (ETI) is an airway procedure commonly used to secure the airway for a variety of medical conditions. Proficiency in ETI procedures requires significant clinical experience and insufficient data currently exists describing the physical ergonomics of successful direct laryngoscopy. The research objectives of this study were to examine how ETI time, error and practitioner biomechanics varied among clinical experience levels and hospital bed heights. The participant population included novice and expert personnel, differentiated by their exposure to ETI procedures. Participants used a standard laryngoscope and blade to perform ETI trials on an airway manikin trainer at predesigned hospital bed heights. Participants were evaluated based on ETI time and accuracy, as well as wrist postures and muscle utilization. Hospital bed height did not affect task completion time, error rates or muscle utilization. Expert participants exhibited less ulnar deviation and forearm supination during task trials, as well as a higher utilization of the bicep brachii and anterior deltoid muscles. Expert grasped instrumentation differently, requiring less wrist manipulation required to achieve ideal instrument positions. By encouraging ergonomic best-practices in hand and arm postures during ETI training, the opportunity exists to improve patient safety and reduce the learning curve associated with ETI procedures.

Ergonomic evaluation of laparoendoscopic single-site surgery ports in a validated laparoscopic training model.

Although laparoendoscopic single-site surgery (LESS) is feasible among expert laparoscopic surgeons, it poses many technical challenges not seen in conventional laparoscopy (CL). Recent technological advancements in single-incision instrumentation have created more interest and widespread usage of LESS. However, neither LESS nor its novel instrumentation have been thoroughly studied or evaluated using human factors and ergonomics techniques. Consequently, the aim of this study was to compare the physical performance of LESS to CL using a standardized task. Wrist and elbow angular movements, range of motion and physical discomfort were assessed for 24 novice participants. There were no significant differences for physical comfort/discomfort ratings or elbow and wrist flexion/extension range of motion between CL and LESS. However, wrist radial/ulnar range of motion was significantly greater in LESS compared to CL (p < 0.05). Additionally, wrist radial/ ulnar range of motion was significantly greater using the SILS Port compared to the GelPOINT (p < 0.05). Although further investigation is needed, LESS resulted in greater wrist deviation and range of motion due to the close proximity of the instruments, restrictive nature of the single-port devices, and the need to achieve adequate instrument triangulation and visualization.

Laparoendoscopic single-site (LESS) surgery versus conventional laparoscopic surgery: comparison of surgical port performance in a surgical simulator with novices.

BACKGROUND: Although laparoendoscopic single-site (LESS) surgery is feasible, it poses many technical challenges not seen in conventional laparoscopy. Recent interest and widespread implementation of LESS stems from advancements in commercially available access port technology. Consequently, this study objectively compared the technical performance between conventional laparoscopic and LESS surgical ports in a modified Fundamentals of Laparoscopic Surgery (FLS) simulator. METHODS: The 24 novice participants in this study performed the FLS peg transfer task using two conventional laparoscopic 12-mm working ports, the SILS port, the TriPort access system, and the GelPOINT system with two standard length 5-mm graspers. Each participant completed the task using conventional laparoscopy first for familiarization, followed by each of the three LESS surgical ports in random order. Task completion time, errors, and subjective questionnaire ratings were used to compare conventional laparoscopy and the single-port devices. Congruent with FLS scoring procedures, task completion time and errors were used to compute a standardized task score for each port. RESULTS: The task score did not differ significantly between conventional laparoscopy and the single-port devices. Additionally, there were no task score differences between trials for either the SILS port or the GelPOINT system. There was a significant performance decrement starting with the TriPort versus starting with either the SILS port or the GelPOINT, which resulted in the lowest overall trial task score (p<0.05). Task completion difficulty and instrument maneuverability resulted in no significant differences between ports. Ease of use and overall rank were significant, with conventional laparoscopy rated as the easiest to use and the highest overall followed by the GelPOINT system. CONCLUSIONS: Overall, the TriPort may be more challenging for novices to use in learning the LESS procedure than either the SILS port or the GelPOINT system. The GelPOINT system may offer the most consistent platform for LESS performance and novice skill acquisition.