Search

The article discusses the aggressive fibromatosis of the abdominal wall, limbs and limb girdles. Background on the subject to be examined; Methods used in the study; Results on the study conducted.

Background Gastrointestinal stromal tumours ( GISTs) of the rectum often require radical surgery to achieve complete resection. This study investigated the management and outcome of surgery for rectal GISTs and the role of imatinib. Methods A cohort study was undertaken of patients identified from a database at one tertiary sarcoma referral centre over a continuous period, from January 2001 to January 2013. Results Over 12 years, 19 patients presented with a primary rectal GIST. Median age was 57 (range 30-77) years. Neoadjuvant imatinib was used in 15 patients, significantly reducing mean tumour size from 7·6 (95 per cent c.i. 6·1 to 9·0) to 4·1 (2·8 to 5·3) cm ( P < 0·001). Nine of these patients underwent surgical resection. Imatinib therapy enabled sphincter-preserving surgery to be undertaken in seven patients who would otherwise have required abdominoperineal resection or pelvic exenteration for tumour clearance. Neoadjuvant imatinib treatment also led to a significant reduction in mean(s.d.) tumour mitotic count from 16(16) to 4(9) per 50 high-power fields ( P = 0·015). Imatinib was used only as adjuvant treatment in two patients. There were three deaths, all from unrelated causes. Eleven of the 13 patients who underwent resection were alive without evidence of recurrence at latest follow-up, with a median disease-free survival of 38 (range 20-129) months and overall survival of 62 (39-162) months. Conclusion The use of neoadjuvant imatinib for rectal GISTs significantly decreased both tumour size and mitotic activity, which permitted less radical sphincter-preserving surgery. [ABSTRACT FROM AUTHOR]

The article presents a study which analyzes the predictors of local recurrence as well as the survival of patients with primary retroperitoneal sarcoma (RPS) after surgical resection. It says that the recurrence and the survival of patients who have undergone resection for primary RPS between March 1990-March 2009 were correlated with their operative outcomes, demographics, and tumour variables. Results show that tumour grade and complete RPS resection are the most important predictors.

Presents a study on the role of surgery in the initial and subsequent treatment of retroperitoneal liposarcoma. Identification of the low-grade tumor and macroscopic clearance of tumor; Importance of palliative resection to treat troublesome symptoms of recurrence; Characterization of the retroperitoneal liposarcoma.

Focuses on the management of in-transit metastases from cutaneous malignant melanoma. Prognosis of in-transit metastases; Recommendation for the creation of a treatment tailored to the extent of cutaneous disease; Importance of carbon dioxide laser therapy.

Objectives: To determine the incidence of and risk factors for perioperative myocardial infarction with noncardiac surgery and to test the accuracy of a risk stratification system.Design: Prospective cohort study.Setting: A large urban Veterans Affairs hospital.Participants: A total of 1487 men older than 40 years undergoing major, nonemergent, noncardiac operations.Measurements: Infarction was established by at least two of the following: development of new Q waves, typical change in creatine kinase MB, and positive technetium pyrophosphate scintigraphy. Patients were stratified preoperatively into high-, intermediate-, low-, and negligible-risk strata based on clinical markers corresponding to different levels of coronary artery disease prevalence.Main Results: Patients with coronary disease (high-risk stratum) had a 4.1% incidence of infarction (13 of 319; 95% CI, 1.8% to 6.4%); patients with peripheral vascular disease but no evidence of coronary disease (intermediate-risk stratum) had a 0.8% incidence (2 of 260, upper bound of CI, 2.0%); patients with high atherogenic risk factor profiles but no clinical atherosclerosis (low-risk stratum) had a 0% incidence (0 of 256, upper bound of CI, 1.2%). No cardiac deaths occurred in 652 men who had no atherosclerosis and low atherogenic risk factor profiles (the negligible-risk stratum). Factors independently associated with infarction included age more than 75 years (adjusted odds ratio, 4.77; CI, 1.17 to 19.41), signs of heart failure on the preoperative examination (adjusted odds ratio, 3.31; CI, 0.96 to 11.38), coronary disease (adjusted odds ratio, 10.39; CI, 2.27 to 47.46), and a planned vascular operation (adjusted odds ratio, 3.72; CI, 1.12 to 12.37).Conclusions: Coronary artery disease is the major risk factor for perioperative infarction. The stratification scheme identifies subsets of patients with different risks, and finer within-stratum distinctions can be made using additional variables. [ABSTRACT FROM AUTHOR]