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The article focuses on the medical treatment of hidradenitis suppurativa, a chronic, recurrent, suppurative cutaneous disease. It is stated that the disease affects the apocrine gland-bearing skin and the anogenital region of the human body. Based on histological findings, the treatment of hidradenitis must be individualized and needs an absolute cessation of smoking. Moreover, antibiotics and radical surgery can be efficient in the control and prevention of the disease.

Background: Matrix metalloproteinases (MMPs) have been reported to play an important role in tumour cell invasion and metastasis. The bioactivity of MMPs in liver metastasis from colorectal cancer was investigated and correlated with clinicopathological variables. Method: Thirty-two patients underwent resection of colorectal cancer liver metastases. Latent and active forms of MMP were measured in tissue extracts, by means of quantitative gelatin zymography and a fluorometric activity assay. Results: Broad-spectrum MMP activity, and levels of both active and latent forms of MMP-2 and MMP9, were higher in tissues containing metastatic tumour than in normal liver tissue. Median metastatic to normal tissue ratios were 15·0 and 17·6 for active and proMMP-2 respectively, and those for active and proMMP-9 were 6·2 and 2·9. The ratios of active to latent enzyme were higher in metastatic tissue than in normal tissue. Lowered MMP-2 activity was associated with large metastatic lesions and increased proMMP-9 levels with preoperative chemotherapy. Both MMP-2 and MMP-9 activity were linked unfavourably to early recurrent disease. Conclusion: These data suggest a role for MMPs in colorectal cancer liver metastasis, but indicate different roles for individual MMPs. [ABSTRACT FROM AUTHOR]

Delayed breast reconstruction following mastectomy for cancer is widely accepted because of a high satisfaction rate. Immediate breast reconstruction offers an even more satisfactory solution, especially related to recovery and self-esteem. In our study, immediate breast reconstruction was performed for three indications: breast cancer, high risk for development of breast cancer and chronic cystic breast disease. Forty-eight consecutive patients with a mean age of 48 years were evaluated. In 37 cases malignant disease, in eight patients prophylaxis, and in three patients benign disease were the reasons for mastectomy. In 42 patients, primary reconstruction was performed, using tissue expanders, followed by prosthetic replacement. Of the other six patients, three were reconstructed with a definitive prosthesis and three with a musculocutaneous flap. At the end of the follow-up period, 42 patients had a definitive prosthesis and two patients had their breasts reconstructed with autologous tissue only. Four patients stopped the procedure following infection and extrusion of their implants. These infections accounted for an overall complication rate of 24%. After starting perioperative antibiotic prophylaxis from the 20th patient onwards, the complication rate was reduced to 12%. Thirty-three patients could be interviewed to assess satisfaction: nine patients were very satisfied, 18 were satisfied and six were moderately satisfied with the end result. Thus, 82% of the patients were satisfied. [ABSTRACT FROM AUTHOR]

Background: There is a growing interest in assessing the impact of a disease and the effect of a treatment on a patient's life, expressed as health-related quality of life (HRQoL). HRQoL assessment can provide essential outcome information for cancer surgery. Methods: The core of this review is derived from a literature search of the Medline database. Results: Three types of HRQoL instrument can be distinguished: generic, disease specific and symptom specific. There are criteria against which HRQoL instruments may be evaluated. The instrument chosen must be reliable, valid and sensitive to change. Conclusion: HRQoL measurement may be useful in identifying the optimal surgical procedure. It may also be of help in deciding whether surgery in patients with limited life expectancy should still be considered. No HRQoL instrument fits all the recommended conditions or is suitable in all clinical situations. Using the appropriate instrument is essential to arrive at valid and clinically meaningful outcome measures. [ABSTRACT FROM AUTHOR]

The goal of the present study was to further knowledge on gender and role (i.e. patient versus partner) differences in psychological distress and quality of life as a consequence of dealing with cancer. There is some evidence that being the patient or the caregiver makes more difference for men than for women. In total, 173 couples facing various forms of cancer (two samples) and a control group of 80 couples completed the CES-D and Cantril's Ladder. Analyses of variance revealed that both female patients and female partners of patients perceived more psychological distress and a lower quality of life than women in healthy couples. In contrast, role did have an effect on men. Specifically, male patients scored as high on psychological distress and as low on quality of life as female patients and female partners, but psychological distress and quality of life did not differ between male partners of patients and their healthy controls. However, this effect was found in only one patient sample. The finding that female partners perceived more psychological distress and a lower quality of life than male partners could not be accounted for by differences in the physical condition of the patient or the partner. [ABSTRACT FROM AUTHOR]

Background Results from a previous study suggested that advanced age does not affect early repair of experimental intestinal anastomoses. The present study aimed to establish whether anastomotic healing is impaired more easily in old animals by immediate postoperative chemotherapy. Methods Young adult (2–3 months) and old (27–30 months) rats underwent resection and anastomosis of both ileum and colon. Within each age group, subgroups received intraperitoneal saline or 5-fluorouracil in a dose of 15 or 20 mg per kg per day from the day of operation onwards. After 7 days, anastomotic healing was assessed by wound strength and collagen deposition in the wound area. Results No differences were found between young and old control groups. The higher dose of fluorouracil induced severe loss of strength with concomitant reduction of wound collagen, which was similar in both age groups (ileum: from 52(13) to 24(8) volume per cent in young animals and from 56(10) to 20(9) volume per cent in old animals; colon: from 58(10) to 37(18) volume per cent in young animals and from 65(5) to 30(17) volume per cent in old animals). The lower dose of fluorouracil induced a significantly greater loss of strength, measured as the bursting pressure, in the old animals (150(49) versus 201(59) mmHg in colon of young rats). Conclusion In this model early anastomotic repair in older animals proceeds normally under optimal conditions, but it is more easily disturbed in the presence of fluorouracil. [ABSTRACT FROM AUTHOR]

Early post-operative local or systemic administration of 5-fluorouracil (5-FU) is under investigation as a means to improve outcome after resection of intestinal malignancies. It is therefore quite important to delineate accurately its potentially negative effects on anastomotic repair. Five groups (n = 24) of rats underwent resection and anastomosis of both ileum and colon: a control group and four experimental groups receiving daily 5-FU, starting immediately after operation or after 1, 2 or 3 days. Within each group, the drug (or saline) was delivered either intraperitoneally (n = 12) or intravenously (n = 12). Animals were killed 7 days after operation and healing was assessed by measurement of anastomotic bursting pressure, breaking strength and hydroxyproline content. In all cases, 5-FU treatment from the day of operation or from day 1 significantly (P < 0.025) and severely suppressed wound strength; concomitantly, the anastomotic hydroxyproline content was reduced. Depending on the location of the anastomosis and the route of 5-FU administration, even a period of 3 days between operation and first dosage seemed insufficient to prevent weakening of the anastomosis. The effects of intravenous administration, though qualitatively similar, were quantitatively less dramatic than those observed after intraperitoneal delivery. Post-operative treatment with 5-FU, if started within the first 3 days after operation, is detrimental to anastomotic strength and may compromise anastomotic integrity. [ABSTRACT FROM AUTHOR]

Background: The surgical approach to colorectal liver metastases is becoming increasingly aggressive. The aim of this prospective study was to evaluate the impact of surgery on health-related quality of life (HRQoL) of patients with colorectal liver metastases. Methods: HRQoL data front 97 patients with colorectal liver metastases were analysed. Sixty patients (group 1) had surgical treatment of the liver metastases. Seventeen patients (group 2) were shown to have inoperable disease at laparotomy. Twenty outpatients with inoperable disease were included as a control group (group 3). Two validated HRQoL instruments, the European Organization for Research and Treatment of Cancer Core questionnaire (QLQ C-30) and the EuroQol-SD, were applied. Results: By 2 weeks after operation patients in group 1 showed a clear overall deterioration in HRQoL, but after 3 months most HRQoL scores had returned to baseline levels. At 2 weeks after surgery there was clear deterioration in almost all HRQoL domains in group 2, and several symptoms were still being reported at 3 months. Patients in group 3 showed hardly any deterioration in HRQoL over the 3 months. Conclusion: The fast recovery of HRQoL, generally within 3 months, justifies an aggressive surgical approach to colorectal liver metastases. However, careful preoperative evaluation is crucial to avoid needless laparotomy, considering the ongoing deteriorated HRQoL of group 2. [ABSTRACT FROM AUTHOR]

The article discusses a study that assessed the impact of fluorodeoxyglucose positron emission tomography (FDG-PET) on the treatment of melanoma in three Dutch university medical centers. The study concluded that FDG-PET is most valuable in patients with stage III melanoma for detection of distant metastases and identification of candidates for surgery and/or systemic treatment. Unexpected FDG-PET findings should not be disregarded, as malignant, clinically relevant tumors may be identified.

Background: In 50-60 per cent of patients who undergo hepatic resection for metastasis of colorectal cancer the first site of turnout recurrence is extrahepatic, indicating the presence of more extensive disease at the time of resection. The aim of this study was to evaluate whether the presence of disseminated tumour cells in blood and bone marrow could predict extrahepatic tumour recurrence. Methods: Cytokeratin 20 (CK20) reverse transcriptase-polymerase chain reaction was used to study the presence of tumour cells in preoperative peripheral blood and bone marrow samples from 41 patients with liver metastasis scheduled for surgical resection. Results: CK20 expression was detected in six of 41 peripheral blood samples and in eight of 32 bone marrow samples. There was no correlation between CK20-positive samples and subsequent extrahepatic recurrence. Positive blood samples did, however, correlate with high serum carcinoembryonic antigen level and large turnout volume. None of the 14 patients previously treated with chemotherapy had CK20-positive samples, whereas six of 27 blood and eight of 20 bone marrow samples were positive in the chemotherapy-naive group. Conclusion: Although the number of patients in this study is limited, the presence of disseminated tumour cells did not predict subsequent extrahepatic recurrence. The results strongly suggest that the presence of circulating tumour cells in peripheral blood may reflect transient shedding of tumour cells related to large tumour volume. [ABSTRACT FROM AUTHOR]

Since the early 1970s, substantial progress in dealing with musculoskeletal tumours has been made, with improvements in surgical skills, radiology, chemotherapy, pathology, and radiotherapy. Nowadays, 70-85% of all malignant tumours are treated by limb salvage, without compromising the oncological result. After many years, the functional result that may be achieved with a limb-saving procedure is becoming clear. Limb salvage has cosmetic advantages, but whether the quality of life of these patients is superior to that of those who undergo amputation is unclear. The non-oncological complication rate is much higher after limb salvage than after amputation, and consequently additional surgery is necessary. In the future, the co-operating disciplines should strive for better survival of these patients, for which the development of new chemotherapeutic drugs is especially needed. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to determine the long-term efficacy of cryosurgery as an adjunct to hepatic resection in patients with colorectal liver metastases not amenable to resection alone. Methods: Thirty patients met the following inclusion criteria: metastases confined to the liver and judged irresectable, ten or fewer metastases, cryosurgery alone or in combination with hepatic resection allowed tumour clearance. Results: Median follow-up was 26 (range 9–73) months. Overall 1- and 2-year survival rates were 76 and 61 per cent respectively. Median survival was 32 months. Disease-free survival at 1 year was 35 per cent, at 2 years 7 per cent. Six patients developed recurrence at the site of cryosurgery; given that the total number of cryosurgery-treated lesions was 69 the local recurrence rate was 9 per cent. Conclusion: In patients with colorectal liver metastases, local ablative techniques can be used as an effective adjunct to hepatic resection to obtain tumour clearance. [ABSTRACT FROM AUTHOR]

We know that screening for breast cancer leads to detection of smaller tumours with less lymph node metastases. Could it be possible that the decrease in mortality after screening is not only caused by this earlier stage, but also by a different mitotic activity index (MAI) of the tumours that are detected by screening? Is MAI a prognostic factor for recurrence-free survival? A retrospective study was carried out of 387 patients with breast cancer, treated at the University Hospital Nijmegen between January 1992 and September 1997. Ninety patients had screen-detected breast cancer, 297 patients had breast cancers detected outside the screening programme. The MAI, other prognostic factors and recurrence-free survival were determined. In non-screen-detected tumours the MAI is twice as high as in screen-detected tumours, even after correction for age took place. The MAI correlated well with other tumour characteristics. The MAI in itself is a prognostic factor for recurrence-free survival. Favourable outcome in screen detected breast cancer is not entirely caused by detecting cancer in early stages: quantitative features such as the MAI indicate a less malignant character of screen detected breast cancer. The MAI is an independent prognostic factor for recurrence-free survival. [ABSTRACT FROM AUTHOR]

In recent years, large discrepancies were described in the success rate of the tyrosinase reverse transcription polymerase chain reaction (RT-PCR) for detecting melanoma cells in the peripheral blood of melanoma patients. We present a quality control study in which we analysed the reproducibility of detection of tyrosinase and MART-1 transcripts in 106 blood samples from 68 melanoma patients (mainly stages III and IV). With this study, we aimed to improve insight in the reproducibility of a RT-PCR for the detection of (minimal) amounts of circulating melanoma cells. We performed two reverse transcriptions on each mRNA sample and performed tyrosinase and MART-1 nested PCRs in duplicate per cDNA sample. Thus, four tyrosinase and four MART-1 measurements were performed per blood sample. In our study, the majority of blood samples was negative for tyrosinase (80%) or MART-1 (66%). Only four samples were positive in all four determinations for tyrosinase and seven for MART-1. Variable results (1-3 times positive results) were obtained for tyrosinase and MART-1 in 16% and 27% respectively. MART-1 PCR had a better performance than tyrosinase PCR. Sensitivity increased when both markers were used. We reasoned that the low number of melanoma marker PCR-positive blood samples can be explained by differences in mRNA quality. By using real-time quantitative PCR, we found that this was not the case: amplification of porphobilinogen deaminase (PBGD), a low copy household gene, was not different in blood samples in which a melanoma marker was not detected from groups in which this marker was detected more or less consistently (1-4 times). When applying real-time quantitative PCR for tyrosinase and MART-1, we found that a low amount of SK-MEL-28 cell equivalents was present in the blood of melanoma patients, with a higher number of equivalents in the group with a consistently positive result. We conclude that low reproducibility of a repeated assay for the detection of... [ABSTRACT FROM AUTHOR]

This article focuses on a study which shows that circulating matrix metalloproteinase-9 is transiently elevated in response to surgical stress. Matrix Metalloproteinases are enzymes capable of degrading and remodeling essentially all components of the extracellular matrix and these enzymes are thought to be crucial for typical malignant properties such as infiltrative growth and outgrowth of metastases. The present data show that proMMP-9 activity in plasma is temporarily increased in response to surgical stress while activity of proMMP-2 is not affected. This finding may have important consequences for the possible use of circulating MMPs as markers for the progression of various malignancies.

Presents the case of a teenager who died from testicular cancer which had metastasized. Involvement of the teenager in a car accident; Abdominal ultrasonography which revealed retroperitoneal hematoma; Effectiveness of treating testicular carcinoma; Delay in diagnosis which may be caused by lack of knowledge, embarrassment, or fear of cancer.