A role for surgery in the treatment of relapsed Hodgkin lymphoma.

Treatment of Hodgkin lymphoma (HL) has advanced over time, rendering a fatal disease now largely curable. Multiagent chemotherapy regimens, hematopoietic stem cell transplantation, and radiotherapy are the mainstays of care. Surgical intervention is rarely indicated other than for biopsy at diagnosis. However, for patients with recurrent relapsed HL isolated to one anatomical location, refractory to all other therapy, there may be a beneficial role for surgical excision. Herein, we report the surgical management of three relapsed patients with stage IVB HL who were refractory to multiple other therapeutic approaches, who all achieved good event-free survival after operative management.

Comparison between laparoscopic and open radical nephrectomy for the treatment of primary renal tumors in children: single-center experience over a 5-year period.

OBJECTIVES: To compare the outcomes of laparoscopic nephrectomy (LN) with open radical nephrectomy (ORN) in the management of consecutive pediatric neoplasms. PATIENTS AND METHODS: Retrospective cohort study of consecutive children treated for primary renal tumors between 2006 and 2011, segregated based on surgical modality (LN/ORN). Pre-, intra- and postoperative data and outcomes were collected. RESULTS: Demographics from the 45 patients (13 LN, 32 ORN) were similar, and tumors in the LN group were smaller [6.59 ± 1.8 cm vs. 10.99 ± 2.99 cm ORN (p < 0.05)]. Six patients had preoperative chemotherapy (two LN, four ORN). No tumor ruptures occurred with either technique. Wilms tumor (seven LN, 24 ORN) was the most common diagnosis, followed by renal cell carcinoma (four LN, four ORN). Procedure length was similar between groups (282 ± 79 LN, 263 ± 81 min ORN). Mean length of stay was significantly shorter for LN (2.9 vs. 5.9 days; p = 0.002). Postoperative narcotic requirements and use of nasogastric tube were higher in the ORN group. After a median follow-up of 18 (LN) and 33 months (ORN), 1 and 4 recurrences occurred, respectively. CONCLUSIONS: LN is an attractive alternative to open surgery in carefully selected cases of pediatric renal tumors. Procedure length and incidence of intra-operative rupture were not increased, while post-operative recovery and hospital stay were shorter for LN. Longer follow-up is mandatory to confirm comparable oncological outcomes to ORN.

Small-bowel intussusception around a gastrojejunostomy tube resulting in ischemic necrosis of the intestine.

Gastrojejunostomy (GJ) tube feeding has made a significant difference in the lives of children with oropharyngeal motor problems and severe gastroesophageal reflux disease. It may, however, also lead to small-bowel intussusception. Previously, these intussusceptions have been reported as intermittent, self limiting, and innocuous. We report a case of a GJ-tube-related small-bowel intussusception that resulted in ischemic necrosis of the bowel. This case suggests that close monitoring and confirmation of successful reduction is necessary in the treatment of GJ-tube-related small-bowel intussusception.

Is laparoscopic subtotal colectomy better than open subtotal colectomy in children?

PURPOSE: The role of laparoscopic colectomy is not defined clearly. The aim of this study was to compare clinical outcomes of laparoscopic versus open subtotal colectomy in children with inflammatory bowel disease. METHODS: Eight consecutive patients undergoing laparoscopic subtotal colectomy were compared with 10 consecutive patients undergoing open subtotal colectomy. All patients were refractory to medical management on immunosuppressive regimens. Operating time, length of postoperative stay and intravenous narcotic use, time to return of intestinal function, and perioperative complications were compared between the groups. RESULTS: Operating times were significantly longer in the laparoscopic group (mean laparoscopic, 4 hours 40 minutes v mean open 2 hours 25 minutes; P <.01). There was no difference between the 2 groups in length of postoperative intravenous narcotics or hospital stay. Ileostomy output occurred earlier (mean laparoscopic, 2.5 days v mean open 3.8 days; P =.01), and there was a trend toward earlier oral intake in the laparoscopic group. A total of 6 complications occurred in 4 patients in the laparoscopic group compared with 5 complications in 5 patients in the open group. CONCLUSIONS: Perioperative clinical outcomes, including complication rates, are similar with laparoscopic and open subtotal colectomy. Laparoscopic subtotal colectomy can be performed safely in children with improved cosmesis.

The incidence, management, and outcome of patients with gastrointestinal carcinoids and second primary malignancies.

BACKGROUND: A higher than expected incidence of second primary malignancies in patients with gastrointestinal carcinoids has been reported. How patients with such concurrent neoplasms should be managed and whether or not the discovery of an incidental carcinoid at the time of operation for another malignancy affects patient management or outcome, has never been previously addressed. STUDY DESIGN: We retrospectively reviewed our 20-year experience with gastrointestinal carcinoid tumors with the purpose of determining the appropriate management and eventual outcome of patients with these multiple malignancies. RESULTS: Sixty-nine patients with carcinoids of the gastrointestinal tract were discovered, of whom 29 (42 percent) had second synchronous tumors and three (4 percent) had metachronous tumors. The gastrointestinal tract accounted for 42.9 percent of the tumors, and carcinoma of the colon and rectum was found in seven (21.9 percent) of 32 patients. None of the 29 patients with a second synchronous tumor presented with symptoms referable to their carcinoid, each of which was incidentally discovered: nine at autopsy and 20 at laparotomy for the treatment of other tumors. All of the 20 surgical patients had the gastrointestinal carcinoids resected for cure, although three had histopathologic criteria for invasion. None of the 29 patients died as a result of, had recurrence of, or had their postoperative therapy altered by the carcinoid diagnosis. CONCLUSIONS: Gastrointestinal carcinoid is associated with a high incidence of second primary malignancy, 46 percent in this study. The most common site for the second primary malignancy in these patients is the gastrointestinal tract, suggesting a site specific predisposition to malignant degeneration. Most gastrointestinal carcinoids are incidentally discovered at laparotomy or autopsy. The discovery of an asymptomatic gastrointestinal carcinoid during the operative treatment of another malignancy will usually only require resection without additional treatment and will have little affect on the prognosis of the individual.

The association between PGE2 activity and mucosal permeability in proximal small bowel.

Little is known about the ontogeny of cyclooxygenase activity and synthesis of prostaglandins in the developing gastrointestinal tract. We tested the hypothesis that an age-related increase in cyclooxygenase as reflected in production of PGE2 in the proximal small bowel (PSB) is associated with the maturation of the mucosal barrier as determined by 51Cr-EDTA permeability. Cyclooxygenase activity in PSB of rats at 10, 22, 36, and 63 (adult) days of age was determined by the generation of PGE2 using specific radioimmunoassay. Systemic 51Cr-EDTA clearance into the lumen was used to assess mucosal barrier function in PSB in 10- to 12-day-old and adult rats. Prostaglandin E2 generation rose significantly from 24.8 +/- 0.4 pg/mg/min in 10-day-old rats to 125.0 +/- 7.8 in adult rats. The 51Cr-EDTA clearance decreased significantly from 5.08 +/- 0.90 ml/min/100 g in 10- to 12-day-old rats to 0.43 +/- 0.18 ml/min/100 g in adult rats. To assess the possible role of endogenous PGE2 in directly mediating these observed changes in the mucosal permeability, a group of adult rats chronically received indomethacin (2.5 mg/kg/day) over a 3-day period, while another group of vehicle-treated rats served as controls. The 51Cr-EDTA clearance of the indomethacin-treated rats was significantly higher than the control rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Measurement of binding kinetics using the gel electrophoresis mobility shift assay.

The gel electrophoresis mobility shift assay is a technique for the qualitative and quantitative analysis of protein-DNA complexes. The ability to resolve reactants, reaction intermediates and products makes this method particularly well-suited for the measurement of the assembly and dissociation rates of protein-nucleic acid complexes. Here we identify conditions that must be met and variations of the technique that are useful for the measurement of reaction rates.

The effect of glucose infusion on survival after acute mesenteric ischemia/reperfusion.

Perfusion of ischemic tissue with glucose has been shown to be deleterious to heart, spinal cord, and kidney. Observations that glucagon improves survival after acute mesenteric ischemia, however, suggest that hyperglycemia may not be deleterious during bowel ischemia. This experiment examined the effect of glucose infusion on survival in an established rat model of acute mesenteric ischemia. The superior (cranial) mesenteric artery (SMA) was occluded for 85 min in 36 anesthetized Sprague-Dawley rats. Animals were randomized to receive 5% glucose in normal saline (n = 15; 16.5 mL/kg.min iv), normal saline alone (n = 13; 16.4 mL/kg.min iv), or no intravenous fluid (n = 8). Ninety-minute intravenous infusions were initiated 10 min after SMA occlusion. Survival to 48 h was 47% in glucose-saline-treated rats, 31% in saline-only-treated rats, and 12.5% in control rats. These results demonstrate no deleterious effect of glucose infusion on mortality after acute mesenteric ischemia in this model.