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INTRODUCTION: A retrospective study of 28 patients with obstetric combined vesicovaginal fistula (VVF) and rectovaginal fistula (RVF) treated at our centre throughout the last two decades (2002 to 2022) has been conducted. MATERIAL AND METHOD: In 12 patients, a preoperative diverting colostomy was performed. Six patients had single-stage surgery (both VVF and RVF repair in the same operation) of which two cases required transabdominal repair and four required transvaginal repair. RESULT: All single-stage repairs (n=6) were successful in curing urine and faecal incontinence. In 22 patients, VVF was corrected initially via the transvaginal method with Martius flap interposition, followed by RVF repair three months later. In 2/22 patients, there was a leak after RVF repair; therefore, proximal diverting colostomy was performed, and RVF repair was repeated after six months. CONCLUSION: All cases had effective VVF and RVF repairs, and both urine and faecal incontinence were completely cured. This study suggests the collaborative engagement of a urologist and a surgical gastroenterologist results in an advantageous outcome for the surgical treatment of these intricate obstetric fistulas.
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Background The behavior of metastatic renal cell carcinoma (mRCC) is unpredictable and elusive. International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) scores, histological subtypes, and targeted therapy predict survival and prognosis. However, there is a paucity of literature from the Indian subcontinent on mRCC outcomes. Therefore, this prospective study reports overall survival outcomes and complications due to targeted therapy of mRCC from a single tertiary care center. Methodology Between 2015 and 2020, 110 patients were included in the study. The treatment was based on the IMDC. Cytoreductive nephrectomy was done in 30 patients, and renal mass biopsy was done in 80 patients. Six were lost to follow-up after histopathological diagnosis, and targeted therapy was administered to 104 patients (sunitinib in 41, sorafenib in 33, and pazopanib in 30). During targeted therapy, six died within 30 days of treatment. The overall survival outcomes and complications due to targeted therapy were analyzed. Results The mean overall survival was 21.52 months with a 95% confidence interval of 17.04-25.98 months. Six variables significantly correlated with inferior survival in univariable Cox regression analysis. Weight loss, hemoglobin, platelet count, lung metastasis, and ≥2 visceral metastases were associated with poor outcomes. Performance status >2 and lung metastasis predicted poor outcomes in multivariate analysis. Overall survival was 24.52 months in clear cell carcinoma versus 21.39 months (13.32-29.45 months) in papillary cell carcinoma, which was not significant. Conclusions IMDC groups show significant differences in overall survival. The histological subtypes and types of targeted therapy did not differ in overall survival, and the presence of sarcomatoid differentiation correlated with poor prognosis concerning IMDC.
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Cancer is often caused by the immune system's inability to deal with malignant cells and allows them to progress and proliferate. Emerging cancerous cells constantly evade the immune system, and as a result, these cancerous cells acquire more mutations and exhibit the deadliest characteristics among malignant tumors. The importance of understanding tumor immunology, particularly the functions of tumor antigens and the immunosuppressive tumor microenvironment, is highlighted by the effectiveness of cancer immunotherapy therapies. Many innovative immunotherapy drugs that effectively battle cancer have been produced since the 1980s. At present, in cancer treatment, immunotherapy appears as a paradigm that targets immune checkpoints of tumor cells such as CTLA-4, PD-1, and monoclonal antibodies (MABs), although the treatment of cancer is classified into non-specific and specific types. Specific types define the antibody targeting cell receptors as a new cancer treatment modality. For a number of malignancies, checkpoint inhibitors, MABs, and their derivatives have become standard-of-care therapy. Other immunotherapy techniques, such as most cancer vaccines and cell-based therapies, are still in the experimental stage. Many new immunotherapy techniques and agents are being explored and evaluated in clinical trials, which is a good thing. Thus, this review discusses the role of checkpoint inhibitors and MABs in the treatment of tumor cells. Moreover, these findings help us to understand the mechanism of action of this class of therapeutics and provide support for the management of cancer treatment.
