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Aim: This study was interested in extremity leiomyosarcoma with focus on clinical outcome after surgery with or without adjuvant therapy. Patients and Methods: A retrospective case series of all patients with leiomyosarcoma, surgically treated between 2000 and 2015 and a minimum follow-up of 2 years, was drawn from institutional databases in Belgium and the Netherlands. Postoperative complications were reported with the Radiation Therapy Oncology Group (RTOG) and the Henderson classification. Results: Seventy-five patients were operated on, of whom 47 underwent (neo)adjuvant therapy. Infection was observed in 11 patients, seven associated with (neo)adjuvant radiotherapy. Dermatological complaints vvere observed in 26 patients, 10 associated with (neo)adjuvant radiotherapy. Overall survival was 60%. Local recurrence occurred in 11 (15%) patients. Conclusion: This study describes favourable clinical outcome following (neo)adjuvant radiotherapy. In the future, larger databases on leiomyosarcoma should enhance the power of these findings and define the benefits of adjuvant therapy in leiomyosarcoma.

Objective In this study, we investigated the roles of presepsin (PSP) and midregional proadrenomedullin (mr-proADM) in children with febrile neutropenia (FN) due to chemotherapy. Methods We assessed 36 FN episodes in 26 children. Patients were classified into bacteremia (B) and fever of unknown origin (FUO) groups. We evaluated PSP and mr-proADM at admission (T0), after 24/48 h (T1), and after 5 days (T2). Results PSP and mr-proADM levels were elevated at T0 and significantly decreased at T2. mr-proADM levels did not significantly differ between the B and FUO groups. PSP levels significantly differed between the B and FUO groups only at T1. Both PSP and mr-proADM levels at T0 were a predictor of length of hospital stay but not of the duration of fever. Finally, receiver operating characteristic curve analysis showed that PSP and mr-proADM had low diagnostic accuracy for blood culture positivity. Conclusion PSP and mr-proADM display poor clinical usefulness for FN in oncologic children.

Laura Vollono1, Arianna Piccolo1, Caterina Lanna1, Maria Esposito2, Mauro Bavetta1, Elena Campione1, Luca Bianchi1, Laura Diluvio1 1Dermatology Department, University of Rome, Tor Vergata, Italy; 2Dermatology Department, University of L’Aquila, L’Aquila, ItalyCorrespondence: Laura VollonoDermatology Department, University of Rome Tor Vergata, Viale Oxford 81, Rome 00133, ItalyTel +39 06 2090 0252Email laura.vollono@gmail.comIntroduction: Omalizumab is a recombinant humanized anti-IgE monoclonal antibody, approved for patients affected by chronic spontaneous urticaria resistant to antihistamines. Although the clinical benefit of omalizumab has been established in several clinical trials, there are very little data about long-term treatment with this drug and real-life reports regarding its use in patients affected by comorbidities other than urticaria are lacking.Objectives: To assess omalizumab efficacy and safety in a heterogeneous population of patients affected by chronic spontaneous urticaria and several comorbidities in a real-world setting.Materials and methods: Patients affected by chronic spontaneous urticaria with weekly urticaria activity score >16 resistant to antihistamines were treated with omalizumab 300 mg injection as add-on to H1-antihistamines administered every 4 weeks for 6 months. Clinical assessment of weekly urticaria activity score, dermatology life quality index and blood tests were performed at baseline, 12, 24 and 52 weeks of treatment. Response was assessed based on reduction weekly urticaria activity score.Results: Thirty-two patients (22F; 10M) with a mean age of 52.4 years (range 27–72) affected by chronic spontaneous urticaria were enrolled. Comorbidities affecting our study population were divided into 6 categories: cardio-metabolic (77%), oncologic (19%), infectious (16%), allergic (45%) immunologic (41%) and others (18%). Omalizumab determined a satisfactory reduction of symptoms of chronic spontaneous urticaria and an amelioration of quality of life within our population. No relevant alterations regarding patients’ underlying conditions were encountered. This is the first study regarding the use of omalizumab for chronic spontaneous urticaria in a population of adult patients affected by several comorbidities, eg, cardio-metabolic, oncologic, infectious, allergic, immunologic and psychiatric diseases. Real-life data represent a valuable source of information about a drug’s safety and efficacy profile, especially in patients affected by different comorbidities that are widely diffused in Western countries.Keywords: chronic spontaneous urticaria, omalizumab, oncologic, cardiovascular, allergic and immunologic conditions, comorbidities

Contains fulltext : 245653.pdf (Publisher’s version ) (Open Access) Immunocompromised patients are a heterogeneous and diffuse category frequently presenting to the emergency department with acute surgical diseases. Diagnosis and treatment in immunocompromised patients are often complex and must be multidisciplinary. Misdiagnosis of an acute surgical disease may be followed by increased morbidity and mortality. Delayed diagnosis and treatment of surgical disease occur; these patients may seek medical assistance late because their symptoms are often ambiguous. Also, they develop unique surgical problems that do not affect the general population. Management of this population must be multidisciplinary.This paper presents the World Society of Emergency Surgery (WSES), Surgical Infection Society Europe (SIS-E), World Surgical Infection Society (WSIS), American Association for the Surgery of Trauma (AAST), and Global Alliance for Infection in Surgery (GAIS) joined guidelines about the management of acute abdomen in immunocompromised patients.

The precision medicine era has helped to better manage patients with immunological and oncological diseases, improving the quality of life of this class of patients. Regarding the management of these patients and positivity to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), currently, limited data are available and information is evolving. In this quick review, we have analyzed the mechanisms of action and related infective risk of drugs used for the treatment of immune-mediated and oncologic skin conditions during the daily clinical practice. In general, immunosuppressant and antineoplastic agents for dermatologic treatments do not require suspension and do not require special measures, if not those commonly observed. In the case of a coronavirus disease (COVID-19) patient with complications (such as pneumonia, respiratory failure), treatment suspension should always be considered after taking into account the general condition of the patient, the risk-benefit ratio, and the pathophysiology of COVID-19 infection. The COVID-19 emergency pandemic does not imply undertreatment of existing skin conditions, which together with the SARS-CoV-2 infection may jeopardize the patient's life.

Objective: To evaluate and compare laparoscopic and conventional open rectum amputation procedures using clinical, intraoperative, postoperative, and oncological criteria. Methods: Fifty-nine patients with lower rectal and anorectal cancer were included in a retrospective study, conducted between 2014 and 2017. Patients underwent open or laparoscopic rectum amputation surgery and were divided into two groups: group 1 – laparoscopic amputation group (LAG) and group 2 – open amputation group (OAG). The clinical, intraoperative, and postoperative outcomes and oncological results were compared between the two groups. Results: We found a significantly smaller intraoperative blood loss (325 mL vs. 538.29 mL, p = 0.0002), earlier return of bowel motility (2.41 days vs. 3.10 days, p = 0.036), shorter hospital stays (10.08 days vs. 12.66 days, p = 0.03), and a higher number of lymph nodes removed during surgery (12.33 nodes for LAG vs. 9.98 nodes for OAG, p = 0.049). In the open surgery group we found shorter durations of surgery (199.58 minutes for LAG vs. 157.87 minutes for OAG, p = 0.0046). Conclusion: Laparoscopic rectum amputation is a technically demanding procedure. The present study demonstrates the benefits and disadvantages of this surgery, with comparable clinical, intraoperative, postoperative, and oncological results compared to the conventional open rectum amputation procedure.

Gastrointestinal stromal tumors (GISTs) are rare tumors of the GI tract. Surgical resection remains the mainstay of non-metastatic disease. However, the ability to provide an adequate oncologic resection using laparoscopic surgery is still an area of debate. This is a thorough review of the current literature, looking particularly at the use of laparoscopic surgery for larger GISTs and the long-term oncologic outcomes compared to the results of open surgery. Laparoscopic resections provide an adequate oncologic result for GISTs of all sizes, including those greater than 5 cm in size.

Introduction Omalizumab is a recombinant humanized anti-IgE monoclonal antibody, approved for patients affected by chronic spontaneous urticaria resistant to antihistamines. Although the clinical benefit of omalizumab has been established in several clinical trials, there are very little data about long-term treatment with this drug and real-life reports regarding its use in patients affected by comorbidities other than urticaria are lacking. Objectives To assess omalizumab efficacy and safety in a heterogeneous population of patients affected by chronic spontaneous urticaria and several comorbidities in a real-world setting. Materials and methods Patients affected by chronic spontaneous urticaria with weekly urticaria activity score >16 resistant to antihistamines were treated with omalizumab 300 mg injection as add-on to H1-antihistamines administered every 4 weeks for 6 months. Clinical assessment of weekly urticaria activity score, dermatology life quality index and blood tests were performed at baseline, 12, 24 and 52 weeks of treatment. Response was assessed based on reduction weekly urticaria activity score. Results Thirty-two patients (22F; 10M) with a mean age of 52.4 years (range 27–72) affected by chronic spontaneous urticaria were enrolled. Comorbidities affecting our study population were divided into 6 categories: cardio-metabolic (77%), oncologic (19%), infectious (16%), allergic (45%) immunologic (41%) and others (18%). Omalizumab determined a satisfactory reduction of symptoms of chronic spontaneous urticaria and an amelioration of quality of life within our population. No relevant alterations regarding patients’ underlying conditions were encountered. This is the first study regarding the use of omalizumab for chronic spontaneous urticaria in a population of adult patients affected by several comorbidities, eg, cardio-metabolic, oncologic, infectious, allergic, immunologic and psychiatric diseases. Real-life data represent a valuable source of information about a drug’s safety and efficacy profile, especially in patients affected by different comorbidities that are widely diffused in Western countries.

Le but de l'étude est de comparer la performance clinique de deux techniques d'imagerie PET-CT en terme de détectabilité de lésions oncologiques. Nous comparons l'imagerie semi-quantitative SUV et l'imagerie quantitative Ki. 18 patients ont été inclus. Nous concluons à une détectabilité équivalente et à une réduction des faux-positifs en faveur des images Ki.

Imaging is critical for the diagnosis and staging of veterinary oncology patients. Although cytology or biopsy is generally required for diagnosis, imaging characteristics inform the likelihood of a cancer diagnosis, can result in a prioritized list of differentials that guide further staging tests, and assist in the planning of surgery, radiation, and chemotherapy options. Advanced imaging, such as CT and MRI, can better define the extent of disease for surgical and radiation planning for head and neck cancer cases in particular. Additionally, new imaging technologies are continually being translated into veterinary fields, and they may provide more options for cancer patients as they become more widely available.

Yu-Ching Wei,1,2 Sheau-Fang Yang,2,3 Shih-Lun Chang,4,5 Tzu-Ju Chen,5,6 Sung-Wei Lee,7 Hung-Sung Chen,1 Li-Ching Lin,8 Chien-Feng Li6,9,10 1Department of Pathology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan; 2Department of Pathology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 3Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 4Department of Otolaryngology, Chi Mei Medical Center, Tainan, Taiwan; 5Department of Optometry, Chung Hwa University of Medical Technology, Tainan, Taiwan; 6Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan; 7Department of Radiation Oncology, Chi Mei Medical Center, Liouying, Tainan, Taiwan; 8Department of Radiation Oncology, Chi Mei Medical Center, Tainan, Taiwan; 9National Institute of Cancer Research, National Health Research Institute, Tainan, Taiwan; 10Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan Purpose: Nasopharyngeal carcinoma (NPC) is a heterogeneous disease. We searched for genes that function in cell adhesion in GSE12452, a published transcriptomic database. We found that POSTN, which encodes periostin (POSTN), was significantly upregulated in NPC tumorigenesis. Herein, we sought to analyze the expression of POSTN and its prognostic significances in patients with NPC. Materials and methods: In this single-institution retrospective study, we determined and analyzed POSTN expression by immunohistochemistry and H-score method, respectively, in 124 patients with NPC. The results indicated that POSTN expression was correlated with the clinicopathologic features, disease-specific survival (DSS), distant metastasis-free survival (DMFS), and local recurrence-free survival (LRFS) of NPC. We performed univariate and multivariate analyses to determinate the statistical significance. Results: High POSTN expression was significantly associated with lymph node metastasis (p=0.004) and advanced American Joint Committee on Cancer (AJCC) stage (p=0.006). In univariate analysis, high POSTN expression served as a significant prognostic factor for worse DSS (p=0.0002), DMFS (p=0.0138), and LRFS (p=0.0028). In multivariate Cox regression analyses, which was adjusted for AJCC stages, POSTN expression was independently associated with cancer-related death (HR: 2.311; 95% CI: 1.327–4.027; p=0.003) and local tumor recurrence (HR: 3.187; 95% CI: 1.108–4.408; p=0.024). Conclusion: High POSTN expression is associated with tumor aggressiveness and worse clinical outcomes in NPC, indicating that it may be a potential prognostic biomarker and a therapeutic target. Keywords: nasopharyngeal cancer, periostin, oncologic, outcomes

Представлений аналіз пошкоджень сечоводів під час видалення пухлин черевної порожнини у 19 хворих. Обговорені клініко-анатомічні передумови пошкоджень та методи реконструкцій. Шов сечовода або його пересадка в товсту кишку були методами вибору., Представлен анализ повреждений мочеточников у 19 больных. Обсуждены клинико-анатомические факторы, способствующие повреждениям и методы реконструкций. Шов мочеточника или его пересадка в толстый кишечник были методами выбора., Analysis of 19 ureter injuries in patients is presented. Clinical and anatomical factors promoting injury and the methods of reconstructions are discussed. Suture of the ureter or its transplantation into the large intestine were suggested as methods of choice.

Nuo onkologinių susirgimų pasaulyje miršta apie 10 mln. žmonių per metus (Onkologija šeimos gydytojui, 2008). Dėl to kenčia šalių ekonomika: prarandama darbo jėga, gydymas reikalauja nemažai lėšų. Tačiau onkologines ligas galima ir išgydyti, jei jos bus pasatebėtos ankstyvoje stadijoje. Anot mokslininkų, ankstyva vėžio diagnostika lemia sėkmingą gydymą. Dėl tos priežasties Baltijos šalyse pradėtos įgyvendinti onkologinių ligų profilaktikos prevencinės programos. Minėtos programos yra kol kas vienintelė priemonė, padedanti anksti pastebėti ligą ir apsaugoti visuomenę nuo mirties. Tačiau, įgyvendinant šias programas, susiduriama su ne viena problema. Šiame darbe gilinamasi, kaip Baltijos šalyse įgyvendinama viena iš sveikatos politikos sričių – iš Privalomojo sveikatos draudimo fondo finansuojamos profilaktinės gyventojų onkologinių ligų kontrolės programos, kurių pagrindinis tikslas – organizuoti ir vykdyti vėžio profilaktiką, užtikrinti geros kokybės ankstyvąją diagnostiką, gydymą ir mažinti mirtingumą nuo šių ligų Darbo tikslas – ištirti onkologinių susirgimų prevencinių programų įgyvendindinimo problemas., The Baltic States began implementation of the oncologic disease prevention programs aimed at reducing the oncologic disease-related mortality. Several problems were encountered in the course of implementation of the prevention programs. Aim of the Thesis: to make an analysis of the problems encountered in the course of implementation of the oncologic disease prevention programs. Objectives of the Thesis: to reveal the meaning and effectiveness of the oncologic disease prevention programs and to describe the disease control measures in the context of the public health policy; to make an analysis of the current situation in the field of implementation of the oncologic disease prevention programs; to discover the problems encountered in the course of implementation of the oncologic disease prevention programs in Kaunas, Vilnius, Kėdainiai and Raseiniai Cities. In the first part of the Thesis, the health care policy concept was analysed and the fact that the treatment of the specific diseases was getting more attention in the sector of health care than the public health measures, i.e. prevention, allowing early detection of the diseases or removal of their causes. Many problems, such as the high rates of morbidity, mortality, expensive treatment, and etc. were encountered due this fact. We found out that the main problem impeding implementation of the oncologic disease prevention programs was low funding of the oncologic disease prevention programs. However, the finances needed for the treatment of the diseases not always were sufficient; therefore, not every patient was receiving the high quality, innovative and timely services. Other important problems were arising due to the low funding as well, for example: scarce information about the prevention programs, low rate of participation in the prevention programs, and overemphasis on the treatment over prevention. In the second part of the Thesis, the current situation in the field of administration of the oncologic disease prevention programs in the Baltic States was analysed. The effectiveness of the prevention programs differed in the states of Lithuania and Latvia. Aim of the Thesis: to make an analysis of the problems encountered in the course of implementation of the oncologic disease prevention programs

5 páginas A study with the aim to compare the bioavailability of two 400 mg imatinib formulations, test product Zeite® from Laboratorio Synthesis S.A.S., Colombia, and reference product Glivec® from Novartis Pharma, and determine if bioequivalence can be declared, was runned. It was an open, four periods and two pre-randomized sequences, crossed study, with a 400mg single dose in fastened and fed conditions, in 30 healthy Colombian volunteers; wash time was 7 days in between periods, with sampling between 0 and 72 hours after drug administration, which was randomly administered in each period. The analytical method used was high performance liquid chromatography with ultraviolet detector, HPLC UV for plasma identification and quantification of imatinib. The confidence interval of 90% of parameters Cmax, AUCall and AUC0-Inf, were taken to statistical analysis and were found, according to the european guidelines for research, which allowed to declare bioequivalence and interchangeability between the products from Laboratorios Synthesis S.A.S. and the reference product from Laboratory Novartis Pharma

Background 18F-FDG PET/CT imaging is widely utilized in the clinical evaluation of patients with suspected or documented lymphoma. The aim was to describe our cumulative experience with a multimodal 18F-FDG-directed lymph node surgical excisional biopsy approach in patients with suspected lymphoma. Methods Thirteen patients (mean age 51 (±16;22–76) years), with suspected new or suspected recurrent lymphoma suggested by 18F-FDG-avid lesions seen on prior diagnostic whole-body PET/CT imaging, were injected IV with 18F-FDG prior to undergoing same-day diagnostic lymph node surgical excisional biopsy in the operating room. Various 18F-FDG detection strategies were used on the day of surgery, including, (1) same-day pre-resection patient PET/CT; (2) intraoperative gamma probe assessment; (3) clinical scanner specimen PET/CT imaging of whole surgically excised tissue specimens; (4) specimen gamma well counts; and/or (5) same-day post-resection patient PET/CT. Results Same-day 18F-FDG injection dose was 14.8 (±2.4;12.5-20.6) millicuries or 548 (±89;463–762) megabecquerels. Sites of 18F-FDG-avid lesions were 4 inguinal, 3 cervical, 3 abdominal/retroperitoneal, 2 axillary, and 1 gluteal region subcutaneous tissue. Same-day pre-resection patient PET/CT was performed on 6 patients. Intraoperative gamma probe assessment was performed on 13 patients. Clinical scanner PET/CT imaging of whole surgically excised tissue specimens was performed in 10 cases. Specimen gamma well counts were performed in 6 cases. Same-day post-resection patient PET/CT imaging was performed on 8 patients. Time from 18F-FDG injection to same-day pre-resection patient PET/CT, intraoperative gamma probe assessment, and same-day post-resection patient PET/CT were 76 (±8;64–84), 240 (±63;168–304), and 487 (±104;331–599) minutes, respectively. Time from 18F-FDG injection to clinical scanner PET/CT of whole surgically excised tissue specimens was 363 (±60;272–446) minutes. Time from 18F-FDG injection to specimen gamma well counts was 591 (±96;420–689) minutes. Intraoperative gamma probe assessment successfully identified 18F-FDG-avid lesions in 12/13 patients. Histopathologic evaluation confirmed lymphoma in 12/13 patients and benign disease in 1/13 patients. Conclusions A multimodal approach to 18F-FDG-directed lymph node surgical excisional biopsy for suspected lymphoma is technically feasible for guiding appropriate diagnostic tissue sampling of lymph nodes seen as 18F-FDG-avid lesions on diagnostic 18F-FDG PET/CT imaging.

Radical cystectomy (RC) with pelvic lymph node dissection remains the gold-standard treatment for muscle-invasive bladder cancer (MIBC). Growing evidence suggests that bladder-sparing treatments may lead to acceptable oncologic outcomes in carefully selected patients and can offer improved quality of life through preservation of a functioning bladder. We summarize our clinical experience of bladder-sparing treatments for MIBC and review articles. MIBC patients with cT2 stage, unifocal tumor, absence of CIS or hydronephrosis are eligible for selective bladder preservation if they refuse or unfit for RC.

Background Intraoperative in situ identification of 18F-FDG-avid tissue sites during radioguided oncologic surgery remains a significant challenge for surgeons. The purpose of our study was to evaluate the 1.5-to-1 ratiometric threshold criteria method versus the three-sigma statistical threshold criteria method for determination of gamma detection probe positivity for intraoperative in situ identification of presumed abnormal 18F-FDG-avid tissue sites in a manner that was independent of the specific type of gamma detection probe used. Methods From among 52 patients undergoing appropriate in situ evaluation of presumed abnormal 18F-FDG-avid tissue sites during 18F-FDG-directed surgery using 6 available gamma detection probe systems, a total of 401 intraoperative gamma detection probe measurement sets of in situ counts per second measurements were cumulatively taken. Results For the 401 intraoperative gamma detection probe measurement sets, probe positivity was successfully met by the 1.5-to-1 ratiometric threshold criteria method in 150/401 instances (37.4%) and by the three-sigma statistical threshold criteria method in 259/401 instances (64.6%) (P

Introducción: El uso de catéter venoso central permanente (CVC) en pacientes oncológicos aporta un acceso venoso seguro y expedito. Sin embargo, la infección es una de las principales complicaciones asociadas a su uso. La "lock terapia" es una técnica que consiste en la aplicación en el lumen del catéter de una solución con alta concentración de antibiótico, con el objetivo de erradicar las bacterias presentes en el endolumen. Objetivo: Describir el uso de "lock terapia" asociada a antibióticos sistémicos en infecciones relacionadas a CVC en pacientes pediátricos oncológicos. Métodos: Estudio descriptivo, retrospectivo, donde se analizaron las infecciones asociadas a CVC que fueron tratadas con lock terapia y antibióticos sistémicos en la Unidad de Oncología del Hospital de Niños Roberto del Río entre los años 2005 y 2007. Los parámetros estudiados fueron: cultivo y antibiograma; retiro del CVC y mortalidad. Resultados: Se estudiaron 11 episodios de infección asociada a CVC en 8 pacientes. El microorganismo aislado con mayor frecuencia fue Staphylococcus coagulasa negativo. Se logró conservar el CVC en 7 pacientes. No hubo mortalidad asociada a infección. Conclusiones: En el grupo estudiado, el uso asociado de lock terapia y antibióticos sistémicos permitió conservar el CVC en la mayoría de los casos. Se requieren estudios prospectivos randomizados con un mayor número de pacientes que permitan corroborar estos hallazgos. Introduction: The use of a permanent Central Venous Catheter (CL) in oncologic patients allows a secure and rapid access. Infection is an important risk. "Lock therapy" (LT) consists of the application of a high concentration of antibiotics in the lumen of the catheter, for the purpose of eradicating bacteria. Objective: To describe the use of LT associated with the systemic use of antibiotics in CL infections occurring among pediatric oncological patients. Methods: A descriptive, restrospective review of charts of children seen at the Oncology Unit, Roberto del Rio Children's Hospital, 2005 to 2007. Evaluated parameters included culture and sentitivity studies, removal of CL and mortality. Results: There were 11 episodes of infection associated to CL in 8 patients, most frequently associated to Staphylococcus coagulase-negative. The CL was preserved in 7 patients. There was no mortality associated to infection. Conclusion: For this group, LT and systemic antibiotics preserved the CL in most patients. Randomized prospective studies are needed in a larger population to support these findings.

Aim of the study – to evaluate patients attitudes towards barriers for control of oncologic pain. Objectives: to evaluate characteristics of oncologic patients: attitudes towards pain and its control, perception of pain intensity; communication with physician about pain control and pain intensity; adherence of analgesics use related with pain intensity; analgesics side effects impact on pain control; emotional conditions and influence on pain intensity. Methods. The study was quantitative analytical, including anonymous survey. The questionnaire comprised 6 subscales (all of them except HAD not used in Lithuania this far) and demographic set. Subscales included Brief Pain Inventory (BPI; short form), the Barriers Questionnaire-II, Modified Version of the Patients’ Perceived Involvement in Care Scale, Medication Adherence Report (MAR), and Hospital Anxiety and Depression Scale (HAD). For evaluation of sensoric disorders the questionnaire was constructed that consisted of questions concerning patient's refusal to get analgesic due to its side effects. The questionnaires were adapted and translated from English to Lithuanian. The survey was conducted during April 31, 2007 and February 1, 2008 at Pain Treatment division and Department of Family Medicine, Kaunas University Hospital. The permission for study was obtained from University Bioethics Center and head of Kaunas University Hospital. Inclusion criteria: patient with oncologic disease, treated on out-patient basis, having chronic pain, using opioid analgesics, able to speak and understand Lithuanian, aged 18 or older. Results. The sample comprised 30 responders (15 men and 15 women) aged 29–77 year old. Average score for maximal pain was 5.50 pts, for minimal pain 2.33 pts. The pain was significantly more expressed in men (p = 0,03). More barriers for pain control were perceived by low educated patients (p = 0,04). The pain intensity was mostly related with the attitude that medication can alleviate oncologic pain. No significant differences regarding patients' age, gender, residence or education were observed. However, urban residents are more compliant concerning medication use than other subjects (p = 0,03). Additionally, patients with negative attitudes about physiologic mechanisms of analgesics show poorer adherence. The responders having more expressed pain are more prone to follow analgesics dosages and regimen. Main side effects for refusal of opioid analgesics: considerable fatigue (16,70 %), drowsiness (20 %), nausea (20 %), dry mouth (20 %), loss of appetite (20 %), sweating (23,33 %), pruritus (16,70 %), and mood disorders (16,70 %). Altogether, 30 % of oncologic patients are likely to have anxiety and 27 % depression. Moreover, depression score is significantly (p = 0,01) higher among low educated responders. Conclusions: Oncologic patients think that analgesics are effective for oncologic pain control. The main barriers for pain control are concern about toleration, fear of addiction and negative impact of analgesics on immune system, as well as patient's reluctance to talk about pain. Older age and lower education are associated with higher barriers for pain control. One third of oncologic patients strictly follow instructions for analgesics use, while about half of patients adjust the usage pattern individually. Only one sixth of oncologic patients don't change usage pattern after pain alleviation. Every third patient stops to use analgesics due to side effects. There are no associations between pain intensity and analgesics use. One third of oncologic patients are likely to have mental disorders such as anxiety or depression. The latter is more expressed among patients suffering stronger pain. Oncologic patients are passive recipient of information about pain control from physician. Oncologic patients don‘t subjected to seek other treatment or give opinion about treatmen that physician recommended. There are no associations between pain intensity and communication with physician about pain control. Practical recommendations are set for nurses who care about oncologic patients suffering pain. Recommendations are formulated according to scientific literature analysis and study findings.

18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) is a well-established imaging modality for a wide variety of solid malignancies. Currently, only limited data exists regarding the utility of PET/CT imaging at very extended injection-to-scan acquisition times. The current retrospective data analysis assessed the feasibility and quantification of diagnostic (18)F-FDG PET/CT oncologic imaging at extended injection-to-scan acquisition time intervals.(18)F-FDG-avid lesions (not surgically manipulated or altered during (18)F-FDG-directed surgery, and visualized both on preoperative and postoperative (18)F-FDG PET/CT imaging) and corresponding background tissues were assessed for (18)F-FDG accumulation on same-day preoperative and postoperative (18)F-FDG PET/CT imaging. Multiple patient variables and (18)F-FDG-avid lesion variables were examined.For the 32 (18)F-FDG-avid lesions making up the final (18)F-FDG-avid lesion data set (from among 7 patients), the mean injection-to-scan times of the preoperative and postoperative (18)F-FDG PET/CT scans were 73 (± 3, 70-78) and 530 (± 79, 413-739) minutes, respectively (P0.001). The preoperative and postoperative mean (18)F-FDG-avid lesion SUV(max) values were 7.7 (± 4.0, 3.6-19.5) and 11.3 (± 6.0, 4.1-29.2), respectively (P0.001). The preoperative and postoperative mean background SUV(max) values were 2.3 (± 0.6, 1.0-3.2) and 2.1 (± 0.6, 1.0-3.3), respectively (P = 0.017). The preoperative and postoperative mean lesion-to-background SUV(max) ratios were 3.7 (± 2.3, 1.5-9.8) and 5.8 (± 3.6, 1.6-16.2), respectively, (P0.001).(18)F-FDG PET/CT oncologic imaging can be successfully performed at extended injection-to-scan acquisition time intervals of up to approximately 5 half-lives for (18)F-FDG while maintaining good/adequate diagnostic image quality. The resultant increase in the (18)F-FDG-avid lesion SUV(max) values, decreased background SUV(max) values, and increased lesion-to-background SUV(max) ratios seen from preoperative to postoperative (18)F-FDG PET/CT imaging have great potential for allowing for the integrated, real-time use of (18)F-FDG PET/CT imaging in conjunction with (18)F-FDG-directed interventional radiology biopsy and ablation procedures and (18)F-FDG-directed surgical procedures, as well as have far-reaching impact on potentially re-shaping future thinking regarding the "most optimal" injection-to-scan acquisition time interval for all routine diagnostic (18)F-FDG PET/CT oncologic imaging.

Sarcopenia, or loss of skeletal muscle mass and quality, has been studied as part of aging and adverse health outcomes in elderly patients but has only recently been evaluated as a separate condition in cancer patients and important indicator of adverse outcomes. Currently, its definition and method of assessment are still being debated. Sarcopenia within an increasingly obese population has led to a subgroup with sarcopenic obesity, at even higher risk of adverse outcomes. Yet, sarcopenia often goes undiagnosed in these patients, hidden beneath higher body mass index. Identifying sarcopenic and sarcopenic obese subpopulations would allow for more effective treatment plans and potential avoidance of suboptimal outcomes, as well as the chance to intervene and combat these modifiable risk factors. This review will examine available literature on the definition and methods of evaluating sarcopenia and sarcopenic obesity, summarize the effectiveness of sarcopenia and sarcopenic obesity as predictors of outcomes after gastrointestinal cancer surgery, including colorectal cancer resection, liver resection, and pancreatic resection, and outline strategies to minimize the impact of sarcopenia. It is clear that untreated sarcopenia and sarcopenic obesity can be associated with suboptimal post-operative outcomes, especially infections and disease-free or overall survival.