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Results of immunotherapy in childhood solid cancer have been so far, with the exception of neuroblastoma, quite disappointing. Lack of knowledge of the immune contexture of these tumors may have contributed to the failure of immunotherapies so far. Here, we systematically reviewed the literature regarding the immunology of Wilms tumor (WT), one of the most frequent pediatric solid tumors of the abdomen. In Wilms tumor patients the high cure rate of >90%, achieved by the combination of surgery and radio-chemotherapy, is at the expense of a high early and late toxicity. Moreover, treatment-resistant entities, such as diffuse anaplastic tumors or recurrent disease, still pose unsolved clinical problems. Successful immunotherapy could represent a novel and possibly less-toxic treatment option. Employing the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) method of literature search, we analyzed the current knowledge of the immunological landscape of Wilms tumors in terms of tumor microenvironment, prognostic implications of single biomarkers, and immunotherapy response., Graphical abstract, The corresponding author and colleagues address the role of immunotherapy in Wilms tumor, in the attempt to evaluate the issues at the basis of the so-far disappointing results of immunomodulation in childhood solid cancer. On the basis of the current knowledge, novel reasonable areas of research are highlighted.

The most advanced epithelial ovarian cancer develops recurrent disease despite maximal surgical cytoreduction and adjuvant platinum-based chemotherapy. Treatment with secondary cytoreductive surgery (SCS) combined with chemotherapy or with chemotherapy alone for patients with platinum-sensitive recurrent ovarian cancer (ROC) is currently under heated discussion. Encouragingly, the results of the AGO DESKTOP III Study and the SOC1/SGOG-OV2 trial, which have been published recently, showed a striking advantage in terms of overall survival (OS) and progression-free survival (PFS) of ROC patients undergoing SCS compared to chemotherapy alone; moreover, a benefit of SCS exclusively for patients with complete gross resection (CGR) was particularly highlighted. CGR is considered the ultimate goal of SCS, on condition that the balance between maximal survival gain and minimal operative morbidity is maintained. Several models have been proposed to predict the rate of CGR, such as the MSK criteria, the AGO score, and the Tian model, over the last 15 years. This summary is mainly about the several previously published prediction models for CGR in SCS of ROC patients and discusses the effectiveness and limitations of these prediction models.

Primary hyperoxaluria type 2 is a rare autosomal recessive genetic disease characterized by endogenous oxalate excess caused by deficiency of glyoxalate reductase/ hydroxypyruvate reductase. The optimal form of transplantation for primary hyperoxaluria type 2 remains controversial. Herein, we described a 26-year-old man with primary hyperoxaluria type 2 confirmed by genetic testing. The patient experienced rapid and severe recurrence of oxalate nephropathy after isolated kidney transplantation. Despite extensive fluid intake and the use of potassium citrate, the urine volume and estimated glomerular filtration rate decreased progressively. To avoid further accumulation of oxalate crystal in the graft and save the renal function, subsequent liver transplantation was performed. However, it failed to restore the function of the kidney allograft and the patient began hemodialysis afterwards. Subsequent liver transplantation after isolated kidney transplantation was not an optimal choice for patients with primary hyperoxaluria type 2. It seems combined liver-kidney transplantation or kidney transplantation after liver transplantation should be preferred.

There is a paucity of information regarding the demographic factors associated with the development of neck fibrosis in head and neck cancer (HNC) patients following radiotherapy. A retrospective review of all patients being treated for HNC at a tertiary care center between 2013 and 2017 was performed. Chi-squared and Mann-Whitney U tests were used to identify differences in incidence and grade of fibrosis, respectively, between populations. A total of 90 patients aged 19 to 99 years were included. Factors associated with an increased incidence of fibrosis included smoking during radiotherapy (p < 0.001), alcohol use (p = 0.026), recurrent disease (p = 0.042), and age less than 60 (p < 0.001) on univariate analysis. Factors associated with increased grade of fibrosis in HNC patients included recurrent HNC (p = 0.033), alcohol use (p = 0.013), patient age younger than 60 years (p = 0.018), smoking during radiotherapy (p < 0.001), and non-Caucasian race (p = 0.012). Identification and intervention directed at patients that possess risk factors associated with fibrosis prior to treatment has the potential to improve the long-term quality of life for HNC patients.

Background Patterns of failure after treatment of oral and squamous cell carcinomas (OSCC) are diversified, with recurrences being one of the common causes. A special group of patients are sometimes encountered in the outpatient clinic for improper or insufficient initial treatment with reports of positive margins, implying residual/persistent diseases. The question of whether these patients can be surgically salvaged remain unanswered. Methods A retrospective study was performed between January 2013 and December 2017 for patients with residual or rapid recurrent (within 3 months) OSCCs, who received salvage surgeries in our institution. The patients with residual/persistent OSCCs were those with microscopic or macroscopic positive surgical margins, while those with rapid recurrent OSCCs were those with close or negative margins, but unabated painful symptoms right after treatment. Both clinicopathological and prognostic variables were analyzed. The focus was also directed towards lessons for possible initial mistakes, resulting in these residual/persistent diseases. Results Of 103 patients, 68 (66%) were men, with mean age of 56.3 years. The overall survival reached 60.2%. Regarding the primary OSCC status, most of our patients (n = 75, 72.8%) were diagnosed with ycT2–3 stages. Besides, most patients were found with macroscopic residual diseases (52.4%) before our salvage surgery. The sizes of the residual/persistent OSCCs were generally under 4 cm (87.3%) with minimally residual in 21 (20.4%). Among all the variables, primary T stage (p = 0.003), and residual lesion size (p Conclusions Cases with residual/persistent OSCCs were mostly due to mistakes which could have been avoided under well-round treatment plans and careful surgical practice. Salvage surgery for cases with smaller residual/persistent OSCCs is still feasible with acceptable outcomes.

BACKGROUND The concept of oligo-recurrence in non-small-cell lung cancer (NSCLC) has been suggested to describe the possibility of achieving long-term survival or even cure with local therapy for recurrence despite having recurrent disease. Oligo-recurrence involves a limited number of metachronous recurrences that can be treated with local therapy. However, the number of recurrences that constitutes an oligo-recurrence has varied among studies and remains to be defined. The aim of this study was to elucidate the number of recurrences that constitutes an oligo-recurrence in NSCLC. PATIENTS AND METHODS We retrospectively reviewed 577 patients with NSCLC who had underwent complete resection and developed recurrence between 1990 and 2009, and these patients were evaluated. Patients were categorized according to the number of recurrences, and postrecurrence survival (PRS) was compared between groups. RESULTS Altogether, 270 patients underwent local therapy for all recurrent lesions. In these patients, sex (female), histological type (adenocarcinoma), gene mutation status, recurrence-free interval

Despite a greater understanding of pathologic factors that increase the chance for treatment failure, initial therapy of diffuse large B cell lymphoma (DLBCL) has not evolved from R/CHOP. Although it was anticipated that the genetic underpinnings of the cell or origin would dramatically change treatment, thus far, this has not been realized. Similarly, contrary to the situation with Hodgkin lymphoma, meaningful early treatment response assessment with PET-CT has yet to be established in DLBCL. Nevertheless, there is tremendous enthusiasm that circulating tumor DNA, possibly in combination with PET- T may facilitate earlier recognition of treatment failure or relapse. And, in contrast to the situation with front-line treatment, therapy for recurrent disease appears to be on the cusp of dramatically improving. Thus, in addition to high dose therapy with autologous transplant, a treatment that is not feasible for many older patients, CAR-T cells, bispecific T-cell engagers (BiTEs), antibody-drug conjugates and new monoclonal antibodies are all offering the possibility of long-term disease control and possible cure. The success of the cell and immunotherapies even offer hope for a chemotherapy-free strategy, initially for recurrent disease. Herein, we review the landscape of the novel agents in resistant DLBCL and speculate about their appropriate sequencing and possible migration to earlier use.

Background and purpose Highergrade glial neoplasms undergo standard treatment with surgery, radiotherapy, and alkylating agents. There is often a clinical/neuroimaging dilemma in the post-treatment setting to differentiate disease recurrence from treatment-related changes. FET (fluoro-ethyl-tyrosine) PET has emerged as a molecular imaging modality for cases where MR imaging is inconclusive. This study aims to develop a cutoff on FET PET for differentiating true recurrence from post-treatment changes. Methods We retrospectively analyzed72 patientswith post-treatment grade 3 or 4 brain gliomas. Five to six mCi of 18 F-FET was injected and static imaging of the brain was performed at 20 min. A tumor-to-white matter (T/Wm) ratio was used as semiquantitative parameter. A T/Wm cutoff of 2.5 was used for image interpretation. Imaging findings were confirmed by either histopathologic diagnosis in a multidisciplinary joint clinic or based on follow-up of clinical and neuroimaging findings. Results Forty-one of 72 patients (57%) showed recurrent disease on FET PET. Thirty-five of them were confirmed to have tumor recurrence; six patients showed post-treatment changes. Thirty-one of 72 patients (43%) showed post-treatment changes on FET PET; 27 were confirmed as post-treatment change and four patients had tumor recurrence on subsequent MR imaging. An optimum T/Wm cutoff of 2.65 was derived based on receiver operating characteristic analysis with a sensitivity of 80% and specificity of 87.5%. Conclusion Static FET PET can be used as problem-solving imaging modality with a T/Wm cutoff of 2.65 to differentiate late recurrence from post-treatment changes in grade 3 or 4 brain gliomas with equivocal MR features.

Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is a low-grade adnexal malignant neoplasm. We report a 90-year-old man who had a hard, dome-shaped tumor approximately 9 mm in diameter on the left cheek. Dermoscopy showed an overall, non-uniformly light-pink tumor with crust. The diagnosis of EMPSGC is made histologically from excisional biopsy. No signs of recurrent disease were evident at 42 months postoperatively.

We aimed to evaluate, in a large Western cohort, perioperative and long-term oncological outcomes of salvage hepatectomy (SH) for recurrent hepatocellular carcinoma (rHCC) after primary hepatectomy (PH) or locoregional treatments.Data were collected from the Hepatocarcinoma Recurrence on the Liver Study Group (He.RC.O.Le.S.) Italian Registry. After 1:1 propensity score-matched analysis (PSM), two groups were compared: the PH group (patients submitted to resection for a first HCC) and the SH group (patients resected for intrahepatic rHCC after previous HCC-related treatments).2689 patients were enrolled. PH included 2339 patients, SH 350. After PSM, 263 patients were selected in each group with major resected nodule median size, intraoperative blood loss and minimally invasive approach significantly lower in the SH group. Long-term outcomes were compared, with no difference in OS and DFS. Univariate and multivariate analyses revealed only microvascular invasion as an independent prognostic factor for OS.SH proved to be equivalent to PH in terms of safety, feasibility and long-term outcomes, consistent with data gathered from East Asia. In the awaiting of reliable treatment-allocating algorithms for rHCC, SH appears to be a suitable alternative in patients fit for surgery, regardless of the previous therapeutic modality implemented.

Treatment of breast lesions has evolved toward the use of less-invasive or minimally invasive techniques. Minimally invasive treatments destroy focal groups of cells without surgery; hence, less anesthesia is required, better cosmetic outcomes are achieved because of minimal (if any) scarring, and recovery times are shorter. These techniques include cryoablation, radiofrequency ablation, microwave ablation, high-intensity focused US, laser therapy, vacuum-assisted excision, and irreversible electroporation. Each modality involves the use of different mechanisms and requires specific considerations for application. To date, only cryoablation and vacuum-assisted excision have received U.S. Food and Drug Administration approval for treatment of fibroadenomas and have been implemented as part of the treatment algorithm by the American Society of Breast Surgeons. Several clinical studies on this topic have been performed on outcomes in patients with breast cancer who were treated with these techniques. The results are promising, with more data for radiofrequency ablation and cryoablation available than for other minimally invasive methods for treatment of early-stage breast cancer. Clinical decisions should be made on a case-by-case basis, according to the availability of the technique. MRI is the most effective imaging modality for postprocedural follow-up, with the pattern of enhancement differentiating residual or recurrent disease from postprocedural changes. ©RSNA, 2021.

У роботі наведені результати амбулаторного малоінвазивного лікування пацієнтів із варикозною хворобою нижніх кінцівок, ускладненою тромбофлебітом. Встановлено, що радіочастотна абляція в поєднанні з мініфлебектомією є ефективним методом лікування за рахунок радикального видалення патологічного вогнища, одночасної ліквідації загрози рецидивуючого плину захворювання, прискорення термінів реабілітації, має гарний косметичний ефект та може бути альтернативою відкритих хірургічних втручань.Ключові слова: варикозна хвороба, тромбофлебіт, радіочастотна абляція, флебектомія.

The biliary system is an uncommon location for neuroendocrine tumours (NETs), and within this system, the common hepatic duct is an even more rare site for NETs. Clinical and radiological presentations are challenging because these tumours may be preoperatively confused with Klatskin-like lesions. Here we report a well-differentiated grade 2 NET arising from the common hepatic duct in a 64-year-old female. Curative surgery was performed, and no evidence of recurrent disease was observed at the 2-months follow-up.

Hydatid cyst remains a global health problem. Intraperitoneal hydatid cyst rupture is a life-threatening complication because it causes serious hemodynamic instability and allergic reactions. No clearly defined guidelines exist for dealing with ruptured cysts or intraperitoneal spillage, though emergency exploration remains the standard approach. We present here a case of a 35 -year- old woman who developed spontaneous rupture of a Giant hepatic hydatid cyst. However, patient could not be taken up for emergency surgery in view of very poor chest condition. She was managed by placement of an intra peritoneal drain and lavage with hypertonic saline. Subsequently, patient underwent two surgeries for definitive treatment of the giant hydatid cyst. At one year of follow- up, patient has no evidence of any recurrent disease. Intraperitoneal drain placement and lavage with hypertonic saline may be considered an option to contain peritoneal implantations while patient is being optimised for exploration.

Simple Summary Up to 85% of patients with colorectal liver metastases develop distant intrahepatic recurrence after curative intent local treatment. (Inter)national guidelines and scientific societies consider repeat local treatment, comprising repeat thermal ablation and/or repeat resection, the standard of care to treat recurrent new colorectal liver metastases. This systematic review and meta-analysis assessed the potential additive value of neoadjuvant chemotherapy before repeat local treatment. The addition of neoadjuvant chemotherapy prior to repeat local treatment was suggested by merely all authors, though supporting evidence is lacking. The results do not substantiate the routine use of neoadjuvant chemotherapy. We are currently constructing a phase III randomized controlled trial directly comparing upfront repeat local treatment with neoadjuvant chemotherapy followed by repeat local treatment (COLLISION RELAPSE trial). Abstract The additive value of neoadjuvant chemotherapy (NAC) prior to repeat local treatment of patients with recurrent colorectal liver metastases (CRLM) is unclear. A systematic search was performed in PubMed, Embase, Web of Science, and an additional search in Google Scholar to find articles comparing repeat local treatment by partial hepatectomy and/or thermal ablation with versus without NAC. The search included randomized trials and comparative observational studies with univariate/multivariate analysis and/or matching as well as (inter)national guidelines assessed using the AGREE II instrument. The search identified 21,832 records; 172 were selected for full-text review; 20 were included: 20 comparative observational studies were evaluated. Literature to evaluate the additive value of NAC prior to repeat local treatment was limited. Outcomes of NAC were often reported as subgroup analyses and reporting of results was frequently unclear. Assessment of the seven studies that qualified for inclusion in the meta-analysis showed conflicting results. Only one study reported a significant difference in overall survival (OS) favoring NAC prior to repeat local treatment. However, further analysis revealed a high risk for residual bias, because only a selected group of chemo-responders qualified for repeat local treatment, disregarding the non-responders who did not qualify. All guidelines that specifically mention recurrent disease (3/3) recommend repeat local treatment; none provide recommendations about the role of NAC. The inconclusive findings of this meta-analysis do not support recommendations to routinely favor NAC prior to repeat local treatment. This emphasizes the need to investigate the additive value of NAC prior to repeat local treatment of patients with recurrent CRLM in a future phase 3 randomized controlled trial (RCT).

Aim: The aim of this study was to compare the results of patients who underwent primary excision of the pilonidal sinus with open excision (GE), wide excision primary closure (PC) and flap application (F). Materials and Methods: The data of 249 patients were evaluated retrospectively. Twelve of these patients were excluded because of recurrent disease. 101 patients had GE, 68 had PK and 68 had F. Demographic characteristics, duration of symptoms, characteristics of gluteal cleft, perioperative complications, duration of surgery and hospital stay, drain use and dressing status, pathological volume, distance to anus, and recurrence of the disease were recorded. Results: Mean operative time was 32.62 ± 9.65 in the GE group; 53.23 ± 15.40 in the PK group; In the F group, it was 76.69 ± 17.00 minutes (p

Background/aim Ovarian cancer presents an aggressive tumor biology, a significant number of patients experiencing recurrent disease. The aim of this study was to examine the feasibility and effectiveness of secondary debulking surgery for relapsed ovarian cancer. Patients and methods Between 2014 and 2018, debulking surgery for relapsed ovarian cancer was performed in 40 cases. Results Debulking surgery to no residual disease was achieved in 31 cases; among the remaining cases, an R1 resection was feasible in six cases, while in the remaining three cases an R2 resection was performed. The most commonly performed visceral resections were represented by rectosigmoidian resection, right colon resection, total or partial cystectomy and unilateral or bilateral ureteral resection. The early postoperative morbidity rate was 32.5% while the postoperative mortality rate was 2.5%. Conclusion Extended pelvic resections are feasible in patients with relapsed ovarian cancer and might be performed with acceptable rates of postoperative complications.

Carcinoembryonic antigen (CEA) is not normally produced in significant quantities after birth but is elevated in colorectal cancer. The aim of this review was to define the current role of CEA and how best to investigate patients with elevated CEA levels. A systematic review of CEA was performed, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were identified from PubMed, Cochrane library, and controlled trials registers. We identified 2,712 papers of which 34 were relevant. Analysis of these papers found higher preoperative CEA levels were associated with advanced or metastatic disease and thus poorer prognosis. Postoperatively, failure of CEA to return to normal was found to be indicative of residual or recurrent disease. However, measurement of CEA levels alone was not sufficient to improve survival rates. Two algorithms are proposed to guide investigation of patients with elevated CEA: one for patients with elevated CEA after CRC resection, and another for patients with de novo elevated CEA. CEA measurement has an important role in the investigation, management and follow-up of patients with colorectal cancer.

Medical treatment remains the mainstay of perianal disease management for CD; however, aggressive surgical management should be considered for severe or recurrent disease. In all cases of perianal CD, medical and surgical treatments should be used in tandem by a multidisciplinary team. Significant development has been made in the treatment of Crohn's-related fistulas, particularly minimally invasive options with recent clinical trials showing success with mesenchymal stem cell applications. Inevitably, some patients with severe refractory disease may require fecal diversion or proctectomy. When considering reversal of a diverting or end ileostomy, cessation of proctitis is the most important factor.

Background: Contrast Enhanced Spectral Mammography (CESM) is an advanced technique to detect the tumor neoan-giogenesis by using the dual energy technique with acquisition of a pair of low and high-energy images only after contrast medium injection. The potential clinical applications are the clarification of mammographically equivocal lesions, the detection of occult lesions on standard mammography, partic-ularly in dense breast, the determination of the extent of disease, the assessment of recurrent disease and the monitoring of the response to chemotherapy. Aim of Study: To assess the potential of Contrast Enhanced Spectral Mammography (CESM) to upstage/downdstage the BIRADS category of equivocal and suspicious breast lesions. Patients and Methods: Thirty female patients with 44 equivocal and suspicious breast lesions, were enrolled in the study, age ranged from 20 to 76 years. All patients underwent conventional mammography and ultrasound then CESM. Results: Mammography + Ultrasound categorized 40/44 lesions (90.9%) lesions to be malignant (BIRADS 4,5) and 4/44 lesions (9.1%) to be benign (BIRADS 1,3). CESM cate-gorized 35/44 lesions (79.5%) to be malignant (BIRADS 4,5) and 9/44 lesions (20.5%) to be benign (BIRADS1,3). Disa-greement about BIRADS category was observed in 25% of the examined lesions including upgraded and downgraded lesions in 11.36% and 13.6% respectively. 100% of up/down graded lesions also proved CESM to be correct in reference to the final diagnosis. Conclusion: CESM has better diagnostic performance than mammography plus Ultrasound and provides a valuable tool to accurately evaluate equivocal and suspicious breast lesions.

Introduction: Urolithiasis is a common, highly recurrent disease with increasing prevalence worldwide. There are many dietary and pharmacological measures to prevent kidney stones.Areas cov...

AIM To investigate the diagnostic performance of 18F-fluciclovine positron-emission tomography (PET) or combined PET and computed tomography (PET/CT) for diagnosis of primary cancer, preoperative lymph node (LN) staging, and detection of recurrent disease of prostate cancer (PCa) through a systematic review and meta-analysis. MATERIALS AND METHODS The PubMed and EMBASE databases were searched from the earliest available date of indexing through 31 December 2018, for studies evaluating the diagnostic performance of 18F-fluciclovine PET or PET/CT for the management of PCa patients. The sensitivities, specificities, and positive and negative likelihood ratios (LR+ and LR-) across the studies were calculated and summary receiver operating characteristic curves were constructed. RESULTS Across 13 studies (563 patients), the pooled sensitivity for 18F-fluciclovine PET or PET/CT for diagnosis of primary PCa was 0.87 (95% confidence interval [CI]: 0.77–0.93) and a pooled specificity of 0.84 (95% CI: 0.68–0.93). For LN staging, the pooled sensitivity was 0.56 (95% CI: 0.37–0.74) and a pooled specificity of 0.98 (95% CI: 0.88–1.00). For detection of recurrent disease, the pooled sensitivity was 0.79 (95% CI: 0.60–0.91) and a pooled specificity of 0.69 (95% CI: 0.59–0.77). In meta-regression analysis, no definite variable was the source of the study heterogeneity. CONCLUSION The current meta-analysis showed the moderate sensitivity and specificity of 18F-fluciclovine PET or PET/CT for the diagnosis of primary cancer, preoperative LN staging, and detection of recurrent PCa. Further large multicentre studies will be necessary to substantiate the diagnostic accuracy of 18F-fluciclovine PET/CT for management of PCa patients.

Purpose: This study aimed to investigate the cost-effectiveness of adjuvant treatments in resected pancreatic cancer.Methods: A Markov model was developed to mimic the disease process of postoperative pancreatic cancer, encompassing three health states (relapse-free survival, recurrent disease, and death). Health outcomes and utility scores were derived from the phase III trial and available literature. Cost data were calculated using standard fee data from the West China Hospital for 2017. One-way sensitivity analyses and probabilistic sensitivity analyses were developed to explore model uncertainty.Results: Treatment with S-1 was estimated to yield 1.61 quality-adjusted life-years (QALYs) at a cost of $25,696, whereas treatment with gemcitabine yielded 1.27 QALYs at a cost of $28,930. The incremental cost-effectiveness ratio of S-1 versus gemcitabine was $-9,490 per QALY. Based on the willingness-to-pay threshold of $25,841 per QALY, the net monetary benefit (NMB) was $15,786 for S-1 and $3,727 for gemcitabine, generating the incremental NMB of $12,059. A probabilistic sensitivity analysis revealed that the probabilities of S-1 and gemcitabine being cost-effective were 92% and 8%, respectively. Results were robust to changes in parameters.Conclusion: Adjuvant therapy using S-1 is a cost-effective alternative compared to gemcitabine in patients with postoperative pancreatic cancer from the Chinese societal perspective.

Vulvovaginal candidiasis (VVC) is one of the most common vaginal infections, representing 40% to 50% of all cases of infectious vulvovaginitis. Between 70-75% of sexually active women experience at least one episode of VVC in their lifetime, and 8-10% of adult women have recurrent VVC. The treatment of VVC remains as one of the most pressing challenges of gynecology. The share of recurrent disease event rates remains high, despite the modern medicines used to treat various forms of VVC.

A peptic ulcer is a chronic and recurrent disease, massively effect on the morbidity and mortality and almost 20% of the world human population experiences from this illness. The main factors lead to peptic ulcer is the infection of Helicobacter pylori bacteria and regular intake of non-steroidal anti-inflammatory drugs (NSAIDs). Huge development has been accomplished in deciding the pathogenesis of this disease and finding the right biomarkers are mandatory with understanding the current scenario. The existence and form of ulcers cannot be anticipated precisely from the signs and the differential diagnosis is comprehensive. Ultimately, diagnostics on H. pylori have been in front of the beneficial health of human and a special focus in the future. On the other hand, nanoencapsulation is an advanced methodology, can be applied in peptic ulcer treatment from the natural sources. Indeed, nanocellulose particles have been proposed and studied as novel formulations to enhance the stability and solubility of phytochemicals, improve their absorption, protect them from untimely degradation in the body and lengthen their circulation time. Merging the current prospects of diagnostics and nanotechnological approaches are necessary for the remedy from peptic ulcer.

Purpose: To report the outcomes of sinonasal tumors treated with proton beam therapy (PBT) on the Proton Collaborative Group registry study. Methods and Materials: Sixty-nine patients with sinonasal tumors underwent curative intent PBT between 2010 and 2016. Patients who received de novo irradiation (42 patients) were analyzed separately from those who received reirradiation (27 patients) (re-RT). Median age was 53.1 years (range, 15.7-82.1; de novo) and 57.4 years (range, 31.3-88.0; re-RT). The most common histology was squamous cell carcinoma in both groups. Median PBT dose was 58.5 Gy (RBE) (range, 12-78.3; de novo) and 60.0 Gy (RBE) (range 18.2-72.3; re-RT), and median dose per fraction was 2.0 Gy (RBE) for both cohorts. Survival estimates for patients who received de novo irradiation and those who received re-RT were calculated using the Kaplan-Meier method. Results: Median follow-up for surviving patients was 26.4 months (range, 3.5-220.5). The 3-year overall survival (OS), freedom from distant metastasis, freedom from disease progression, and freedom from locoregional recurrence (FFLR) for de novo irradiation were 100%, 84.0%, 77.3%, and 92.9%, respectively. With re-RT, the 3-year OS, freedom from distant metastasis, FFDP, and FFLR were 76.2%, 47.4%, 32.1%, and 33.8%, respectively. In addition, 12 patients (17.4%) experienced recurrent disease. Re-RT was associated with inferior FFLR (P = .04). On univariate analysis, squamous cell carcinoma was associated with inferior OS (P

BACKGROUND: We wished to compare the efficacy of ultrasound versus intravenous contrast-enhanced computed tomography (CT) for detecting recurrent renal cell carcinoma (RCC) by identifying patients presenting with such tumor burden and to evaluate the utility of these imaging modalities in these circumstances. METHODS: Patients who developed local and/or distant recurrences following surgical intervention for RCC were identified. The imaging regimen utilized during post-operative surveillance was analyzed to determine whether recurrent disease was identifiable on ultrasound or CT or both. RESULTS: Of the 22 patients with recurrent RCC, 16 had previously undergone radical nephrectomy and 6 had undergone partial nephrectomy. Median duration to RCC recurrence was 28.5 months (range 2-66 months). Fourteen patients (64%) underwent ultrasound during their follow-up surveillance protocol and 1 case of disease recurrence was detected by ultrasound before subsequent con-frmation with CT. All 22 patients underwent CT as a routine component of their follow-up surveillance protocol and all recurrences were detected by this modality. Six patients had recurrence in their ipsilateral kidney after partial nephrec-tomy - five had undergone ultrasound in their surveillance protocol and this modality failed to detect a recurrence in four of these patients. CONCLUSION: Ultrasound is inferior to CT for detecting recurrent RCC. CT should be recognized as the standard diagnostic modality during post-operative surveillance, in contradiction to what is recommended in many guidelines.

Purpose Role of diffusion-weighted (DW) MR imaging in differentiating residual or recurrent neck malignancies from postoperative/post-radiation changes with histopathological correlation and comparison with PET-CT. Methods and materials Prospective observational study for a period of 1 year in 62 post-radiation/post-operative patients suspected to have residual/recurrent tumors of neck with lesion diameter more than 5 mm measured on MRI. Results Mean ADC for recurrent/residual tumors: 1.008 ± 0.220 × 10−3 mm2/s - significantly lower than mean ADC value for post-treatment changes of 1.69 ± 0.40 × 10−3 mm2/s (p Conclusion DW MRI is a promising non-invasive MRI technique used to differentiate recurrent/residual head and neck malignancies from posttreatment changes based on ADC values. DWI offers advantage as it has a short scanning time and can be safely added to standard MRI protocol with minimum patient discomfort. Complementary use of DWI and PET/CT imaging may increase diagnostic confidence for differentiating recurrent disease from radiation therapy-induced changes after 6–12 months in posttreatment cases.

Introduction Pilonidal disease is a common condition that is often treated with morbid and painful surgeries. A minimally invasive, endoscopic approach has been described as an alternative to traditional open procedures. It allows the full visualization of the sinus tracks, leaves minimal scarring and results in less pain and a quicker recovery. Methods Patients who underwent minimally invasive endoscopic surgery for pilonidal disease at a major metropolitan hospital in Australia were retrospectively identified. Their operative reports and medical records were assessed to determine analgesic requirements, lengths of hospital stay, recurrence rates of pilonidal disease, and wound complications. Results Nine patients had endoscopic sinus surgery (six male, three female). All patients received treatment from the same surgeon. No patients required opiate analgesia for pain and only one stayed post-operatively in hospital overnight. There were no recorded wound complications. The median follow-up period was 28 months (range, 8-36 months). Eight patients had satisfactory healing recorded during their post-operative consultations. Three patients suffered recurrent disease. Conclusion Minimally invasive surgery is safe and well tolerated when employed to treat pilonidal disease. It could be considered as a first-line treatment for the obliteration of symptomatic pilonidal sinuses.

Searching the optimal options for reoperations in overweight patients has the same lengthy and difficult history as all bariatric surgery. The key issues of this aspect of obesity surgery are inefficiency (inadequate weight reduction or it regain) and the unavoidable complications of conservative methods and the negative effects of primary surgery. Weight regain after bariatric surgery is a multicomponent problem. The main reason for the unsatisfactory results of surgical (and conservative) treatment of obesity in some patients is the nature of obesity – the lifelong chronic recurrent disease. A certain role in the return of excess weight is played by the imperfection of the currently existing surgical procedures for the correction of overweight, as well as the wrong choice of options for surgical interventions and technical errors in their implementation. Increase the number of worldwide operations for obesity and its associated diseases translates the problem of revision bariatric surgery from the category of narrow questions in this field of medicine into a serious problem. The article describes modern approaches to the surgical treatment of re-gaining weight after bariatric operations. It considered options for audit procedures, depending on the previously performed surgery. Original techniques of repeated operations for effective correction of the relapse of overweight are described in article.

Canine otitis externa is a common and recurrent disease in domestic dogs. Although not being life threatening, it can result in the overuse of antibiotics, increased bacterial resistance and reduction of options for treatment. This study aimed to determine: the principal characteristics (age, race, and gender) of dogs affected by otitis externa; the most frequently bacteria identified as being associated with it and their antimicrobial resistance profiles. A total of 221 bacterial isolates were identified by morphological staining and biochemical processes and tested against eleven antibiotics. Among the 148 dogs diagnosed with otitis externa, 51.4% (76/148) were males and 48.6% (72/148) females. The cases were detected mainly in dogs with age above 7 years (54.7%; 81/148. Among the races examined, poodles were the most numerous (14.84%; 22/148). The most common bacteria found were: coagulase-negative Staphylococcus (StCN), 33.9% (75/221); coagulase-positive Staphylococcus (StCP), 19% (42/221); Proteus spp., 17.2% (38/221) and Pseudomonas aeruginosa, 9.5% (21/221). Simultaneous resistance to more than three classes of antimicrobials were most frequently detected in P. aeruginosa (61.9%; 13/21) and Proteus spp (39.47%; 15/38). According to data obtained from this study, two veterinary medications found to be most effective for topical treatment were tobramycin and ciprofloxacin. Resumo A otite externa canina é uma doença comum e recorrente em cães domésticos. Embora não seja uma ameaça à vida, pode resultar no uso excessivo de antibióticos, aumento da resistência bacteriana e redução das opções de tratamento. Este estudo teve como objetivo determinar: as principais características (idade, raça e gênero) de cães afetados por otite externa; as bactérias mais frequentemente identificadas como associadas a enfermidade e seus perfis de resistência. Um total de 221 isolados bacterianos foram identificados por características morfo-tintoriais e testes bioquímicos, e posteriormente testados contra onze antibióticos. Entre os 148 cães com diagnóstico de otite externa, 51,4% (76/148) eram machos e 48,6% (72/148) fêmeas. Os casos foram detectados principalmente em cães com idade acima de 7 anos (54,7%; 81/148). Entre as raças examinadas, poodles foram os mais acometidos (14,84%; 22/148). As bactérias mais encontradas foram: Staphylococcus coagulase-negativo. (StCN), 33,9% (75/221), Staphylococcus coagulase-positiva (StCP), 19% (42/221), Proteus spp., 17,2% (38/221) e Pseudomonas aeruginosa, 9,5% (21/221) Resistência simultânea a mais de três classes de antimicrobianos foi mais frequentemente detectada em P. aeruginosa (61,9%; 13/21) e Proteus spp (39,47%; 15/38). Segundo os dados obtidos neste estudo, os antibióticos com maior capacidade de inibição do crescimento bacteriano in vitro foram tobramicina e ciprofloxacina.

This article summarizes the surgical management of tumors associated with multiple endocrine neoplasia 1 (MEN1) and multiple endocrine neoplasia 2 (MEN2) and includes discussion of the preoperative planning, the goals, and extent of surgery, as well as the intraoperative considerations and the management of recurrent disease.

Cervical lymph node metastases are present in a considerable number of patients with differentiated and medullary thyroid cancer. The completeness of surgical resection, including clinically significant lymph node metastases, is an important determinant of outcome, because cervical lymph nodes represent the most common site of persistent and recurrent disease. This article delineates the management of nodal disease in thyroid cancer, focusing on the preoperative evaluation, operative management, and postoperative assessment of cervical lymph nodes.

Background/Aims The role of [18F]-f luorodeoxyglucose positron emission tomography-computed tomography (PET/CT) in patients with diffuse large B-cell lymphoma (DLBCL) in first remission is unclear. Methods Medical costs within the first 3 years of treatment completion and clinical outcomes of 118 patients with DLBCL in first remission with and without surveillance PET/CT (PET/CT [+] group [n = 76] and PET/CT [–] group [n = 42], respectively) were retrospectively analyzed. Results In a propensity matched cohort with adjustment for International Prognostic Index risk and relapse, the PET/CT (+) group was shown to have similar medical costs as the PET/CT (–) group. Relapse-free survival (RFS) and overall survival (OS) were comparable between the two groups (median RFS not reached [NR] for both groups, p = 0.133; median OS NR, p = 0.542). Among 76 patients with surveillance PET/CT, 31 (40.8%) had findings suggestive of recurrence and 16 of these (51.6%) were later confirmed to have recurrent disease. Fifteen patients (48.4%) were confirmed to not have recurrence after follow-up CT or PET/CT evaluation (n = 10) and biopsy (n = 4). None of the patients with negative PET/CT findings had disease recurrence. Sensitivity, specificity, positive predictive value, and negative predictive value of PET/CT for detection of recurrence were 1, 0.75, 0.52, and 1, respectively. Conclusions Surveillance PET/CT resulted in similar clinical outcomes and medical costs compared to no surveillance PET/CT. Approximately half of patients with PET/CT findings of recurrence had no recurrence after follow-up imaging and biopsy, which would not have been carried out if PET/CT had not been performed in the first place.

Lung cancer is a fairly common malignancy. An early diagnosis and a reliable staging and re-staging with the aim to detect both local and distant relapse are of utmost importance in planning the therapeutic management. The imaging diagnostic work-up of patients with lung cancer usually includes conventional imaging (chest X-ray, contrast-enhanced CT, bone scan) and more recently 18F-FDG PET/CT. Great advances in the management of lung cancer are based on the information provided by 18F-FDG PET/CT, as it supplies both metabolic and anatomic information (better localisation). There is vast evidence in the literature demonstrating its utility in (a) characterising benign versus malignant solitary nodules, (b) staging and re-staging lung cancer, (c) guiding the type of therapy, (d) monitoring treatment response and (e) predicting outcome. In particular, given its specificity in differentiating 18F-FDG-avid relapse from post-surgical changes or post-radiation fibrosis (which do not take up 18F-FDG), PET/CT can detect recurrent disease after initial treatment and (being a whole-body technique) has demonstrated high accuracy in the detection of distant metastases or secondary tumours. In conclusion, 18F-FDG PET/CT can be considered a highly accurate and reliable method for staging and re-staging lung cancer, and is highly effective in guiding personalised therapies.

The solitary fibrous tumour (SFT) is a rare tumour, which usually occurs in the pleura. Patients with an advanced SFT have a poor prognosis. The treatment options for recurrent disease are especially limited. We present the case of a 55-year-old female patient with a malignant SFT of the pleura, who received conventional chemotherapy and targeted therapy. This paper focuses on systemic therapy in the treatment of metastatic SFT.

Statistics of the last years indicates the significant incidence of vascular neoplasms, the most of which are located at the maxillofacial area – 68–80 %, multi sites simultaneously – 20%. According to histological signs the capillary tumors are 51%, cavernous – 42%, combined – 4%, mixed – 3% of cases. Currently, in surgical dentistry, the problematic choice of new technical means and technologies that can increase the effectiveness of surgical treatment for the most common types of pathologies remains relevant. Despite numerous methods of treatment for benign vascular tumors (surgical, radiation, cryosurgical, electrosurgical, laser, sclerotherapy), the results leave much to be desired, as many authors note a significant percentage of tumor recurrence, as well as complications during the operation. As a rule, they are characterized by multiple procedures and are not accompanied by a more radical removal of hemangiomatous tissues, in this connection constant seek for new methods of hemangiomas treatment for children and adults is provided. At the same time, the expediency and effectiveness of radio wave coagulation remains an open question, as one of the latest among the high-tech methods of tissue dissection. This publication presents the results of cavernous hemangiomas treatment for the maxillofacial area by radio-wave coagulation. In all clinical cases, operations were performed practically with noninvasive technique. In the early postoperative period, there was a slight swelling of the tissues without the infiltration in the area of the wound. Healing process of the wound in all patients occurred below the crust, which persisted on average 7-10 days after the procedure, with the formation of the hardly noticeable scar, the shape, size and elasticity of which did not change during the first year of observation. The state of the scar in 52 cases (91%) was estimated as good (7-9 points according to the scale), in 5 (9%) – satisfactory (10-11 points according to the scale). A review in dynamics after 6 months allowed detecting recurrent disease in 4 patients (7%) with localization of hemangiomas in the scalp area, upper and lower lip. Recurrence cases of hemangiomas were noticed as small-spotted hemangiomatous lesions of the skin at the border of the tumor or in the area of the postoperative scarring, which were re-operated with a needle-shaped electrode of 0.02 mm in diameter. The application of radiosurgical technique allows us to conclude that this is a tool to minimize the risk of intra- and postoperative complications and reduce the period of rehabilitation of patients. Thus, the application of radio-wave coagulation for the treatment of maxillofacial hemangiomas is promising and allows us to discover the following advantages: greatly facilitates the work of the surgeon, reduces the traumatism and duration of surgical intervention; minimizes blood loss; reduces the percentage of postoperative complications; contributes to the formation of aesthetic scar. The obtained data indicate the expediency of using the method of radio-wave coagulation in the treatment of cavernous hemangiomas of the maxillofacial area.

Background Ocular toxoplasmosis (OT) is the most common cause of posterior uveitis, leading to visual impairment in a high proportion of patients. Antibiotics and corticosteroids lower the risk of permanent visual impairment by reducing the size of the retinochoroidal scar, the risk of recurrence, and the severity and duration of acute symptoms. Although OT is a very common cause of infectious posterior uveitis, its treatment remains controversial. Through our systematic review and meta-analysis, we aim to provide the best possible evidence-based information on the safety and effectiveness of the different antibiotic regimes for OT. Methods This systematic review protocol has been developed based on PRISMA-P guidelines for reporting systematic reviews evaluating health care interventions. We will include all published and unpublished randomized controlled trials (RCTs) comparing different antibiotics used for the treatment of OT. We will consider changes in visual acuity, number of recurrences, improvement or worsening of ocular inflammation, size of lesion, and adverse effects as our outcomes. Screening, data extraction, and quality assessment will be undertaken by two reviewers with disagreements resolved through discussion. Studies that compared antibiotics with placebo will be excluded. The reviews will be assessed for quality and relevance. We will assess the risk of bias in five domains according to Cochrane group’s tool. The type of data will dictate measures of treatment effect. We will use a random-effects model to calculate our meta-analysis, as eligible studies represent clinically varied populations of participants. Discussion The strength of our study will lie in the exhaustive and systematic nature of the literature search, as well as in its methods for assessing quality and analyzing RCT data. Considering the controversial efficacy of the treatment for OT, our study will contribute to improving the existing evidence on the effectiveness of different antibiotics. Future studies may be conducted to increase physicians’ awareness of antibiotic therapies, improving the health of patients with OT. Systematic review registration PROSPERO CRD42018085468. Electronic supplementary material The online version of this article (10.1186/s13643-019-1067-8) contains supplementary material, which is available to authorized users.

Epithelial ovarian cancer has a very high rate of relapse after primary therapy; historically approximately 70% of patients with a complete clinical response to surgery and adjuvant chemotherapy will relapse and die of the disease. Although this number has slowly improved, cure rates remain less than 50%. As such, maintenance therapy with the aim of preventing or delaying disease relapse and the goal of improving overall survival has been the subject of intense study. Numerous earlier studies with agents ranging from radioactive phosphorus to extended frontline therapy or to monthly taxol administration demonstrated encouraging improvements in progression-free survival (PFS) only to find, disappointingly, no benefit in overall survival. In addition, the PFS advantage of maintenance therapy was associated with disconcerting side effects such that maintenance therapy was not adapted as standard of care. Studies with bevacizumab and PARP inhibitors have demonstrated a PFS advantage with a manageable side-effect profile. However, an overall survival advantage remains unclear, and the use of these approaches thus remains controversial. Furthermore, in recurrent disease, the length of chemotherapy and benefits of extended chemotherapy is unclear. Thus, additional trials assessing maintenance strategies in ovarian and other gynecologic malignancies are needed.

Background The aim of this feasibility study was to assess the diagnostic performance of an electronic nose (e‐nose) as a noninvasive diagnostic tool in detecting locoregional recurrent and/or second (or third) primary head and neck squamous cell carcinoma (HNSCC) after curative treatment. Methods Using an e‐nose (Aeonose, The eNose Company, Zutphen, The Netherlands), breath samples were collected from patients after curative treatment of an HNSCC with a locoregional recurrence or second (or third) primary tumor (N = 20) and from patients without evidence of recurrent disease (N = 20). Analyses were performed utilizing artificial neural networking based on patterns of volatile organic compounds. Results A diagnostic accuracy of 83% was observed in differentiating follow‐up patients with locoregional recurrent or second (or third) primary HNSCC from those without evidence of disease. Conclusion This study has demonstrated the feasibility of using an e‐nose to detect locoregional recurrent and/or second (or third) primary HNSCC.

ObjectiveHead and neck cancer follow-up length, interval and content are controversial. Therefore, this study aimed to evaluate the efficacy of the follow-up protocol after curative treatment in head and neck cancer patients.MethodClinical data of 456 patients with new malignancy of the head and neck from a tertiary care centre district from 1999 to 2008 were analysed. Time from treatment, symptoms and second-line treatment outcomes of patients with recurrent disease were evaluated.ResultsA total of 94 (22 per cent) patients relapsed during the 5-year follow-up period; 90 per cent of recurrences were found within 3 years. Fifty-six per cent of the patients had subjective symptoms indicating a recurrence of the tumour. All recurrent tumours found during routine follow-up visits without symptoms were found within 34 months after completion of treatment.ConclusionRoutine follow up after three years is questionable; recurrent disease beyond this point was detected in only 2 per cent of patients. In this study, all late tumour recurrences had symptoms of the disease. Easy access to extra follow-up visits when symptoms occur could cover the need for late follow up.

Liver transplantation (LT) has been proposed as a curative treatment in hereditary hemorrhagic telangiectasia (HHT) with severe hepatic involvement. We provide a long-term evaluation of graft status after LT for HHT, with a focus on the risk of recurrence. The present study included all patients prospectively followed up after LT for HHT in the Lyon Liver Transplant Unit from 1993 to 2010, with a survival of more than 1 year. Protocol clinical, radiological, and histological examinations were performed at regular intervals. Fourteen patients were included (13 women and one man). Median age at LT was 52.5 years (range: 33.1-66.7). In eight patients (seven female), disease recurrence was diagnosed by abnormal radiological features, suggestive of microcirculatory disturbances. Typical vascular lesions, including telangiectasia, were demonstrated by liver biopsy in five of these patients. The median interval between LT and diagnosis of recurrence was 127 months (range: 74-184). The risk of recurrence increased over time; estimated cumulative risk was 47.9% at 15 years. Liver tissue analysis found the coexistence of an angiogenic process combined with endothelial microchimerism, as shown by the presence of vascular lining cells of recipient origin. Conclusion: The present data show that disease recurrence occurs, usually after a long delay, in a significant number of patients treated by LT for liver complications of HHT. This strongly supports the necessity of a lifelong follow-up and suggests that therapeutic strategy needs discussion and evaluation, especially of the role of potential adjuvant treatments to LT, such as antiangiogenic medications, when recurrent disease appears.

Background and Objective: Although accounting for a relatively small proportion of all lung cancers, small cell lung cancer (SCLC) remains to be a global health concern with grim prognosis. Radiotherapy (RT) plays a central role in SCLC management either as a curative or palliative therapeutic strategy. There has been considerable progress in RT of SCLC, thanks to improved imaging techniques leading to accurate target localization for precise delivery of RT. Positron emission tomography (PET) is increasingly used in oncology practice as a non-invasive molecular imaging modality. Methods: Herein, we review the utility of molecular imaging with 2-deoxy-2-[fluorine-18] fluoro-Dglucose PET (18F-FDG PET) for SCLC from a radiation oncology perspective. Results: There has been extensive research on the utility of PET for SCLC in terms of improved staging, restaging, treatment designation, patient selection for curative/palliative intent, target localization, response assessment, detection of residual/recurrent disease, and prediction of treatment outcomes. Conclusion: PET provides useful functional information as a non-invasive molecular imaging modality and may be exploited to improve the management of patients with SCLC. Incorporation of PET/CT in staging of patients with SCLC may aid in optimal treatment allocation for an improved therapeutic ratio. From a radiation oncology perspective, combination of functional and anatomical data provided by integrated PET/CT improves discrimination between atelectasis and tumor, and assists in the designation of RT portals with its high accuracy to detect intrathoracic tumor and nodal disease. Utility of molecular imaging for SCLC should be further investigated in prospective randomized trials to acquire a higher level of evidence for future potential applications of PET.