Intrapelvic Retroperitoneal Synovial Sarcoma in a 15-Year-Old Adolescent Girl: A Case Report and Review of the Literature.

Synovial sarcomas are a rare subtype of soft tissue sarcomas mostly located in the lower extremities. The authors report a case of synovial sarcoma in a 15-year-old adolescent girl with several unusual features including age, intrapelvic retroperitoneal location of the primary tumor, and presentation with right abdominal tenderness and compression of the iliac vessels with thrombosis of the right iliac and femoral vein.

Production of High-Yield Adeno Associated Vector Batches Using HEK293 Suspension Cells.

Adeno-associated viral vectors (AAVs) are a remarkable tool for investigating the central nervous system (CNS). Innovative capsids, such as AAV.PHP.eB, demonstrate extensive transduction of the CNS by intravenous injection in mice. To achieve comparable transduction, a 100-fold higher titer (minimally 1 x 1011 genome copies/mouse) is needed compared to direct injection in the CNS parenchyma. In our group, AAV production, including AAV.PHP.eB relies on adherent HEK293T cells and the triple transfection method. Achieving high yields of AAV with adherent cells entails a labor- and material-intensive process. This constraint prompted the development of a protocol for suspension-based cell culture in conical tubes. AAVs generated in adherent cells were compared to the suspension production method. Culture in suspension using transfection reagents Polyethylenimine or TransIt were compared. AAV vectors were purified by iodixanol gradient ultracentrifugation followed by buffer exchange and concentration using a centrifugal filter. With the adherent method, we achieved an average of 2.6 x 1012 genome copies (GC) total, whereas the suspension method and Polyethylenimine yielded 7.7 x 1012 GC in total, and TransIt yielded 2.4 x 1013 GC in total. There is no difference in in vivo transduction efficiency between vectors produced with adherent compared to the suspension cell system. In summary, a suspension HEK293 cell based AAV production protocol is introduced, resulting in a reduced amount of time and labor needed for vector production while achieving 3 to 9 times higher yields using components available from commercial vendors for research purposes.

Evaluation of a New Elastic Ostomy Appliance to Decrease Skin Complications: Results of a Pilot Study.

Peristomal skin complications due to appliance leakage frequently occur in all types of ostomies, resulting in great emotional, social, and financial impact for patients. PURPOSE: This pilot study was conducted to evaluate the safety and use of a new, reusable, nonadherent, elastic device. METHOD: A convenience sample of nonhospitalized patients with ileostomies and colostomies was recruited through the Dutch ostomy patient association. Participant inclusion criteria stipulated the presence of ileostomy or colostomy, a body mass index (BMI) between 18 and 30, and presence of an osto-my for at least 1 month. Patients with existing prolapse or necrosis of the ostomy, inability to give consent, or concurrent usage of other aids to prevent leakage or skin problems were excluded. Participants were fitted with and asked to wear the appliance continuously for 4 weeks and report experiences in a structured diary. Patient charts were reviewed for baseline demographic characteristics that included age, gender, American Society of Anaesthesiologists classification, and BMI. Study nurses performed structured weekly interviews and inspections of the ostomies and peristomal skin. The primary outcome measure was occurrence of serious adverse events such as ostomy necrosis or perforation. Secondary outcome measures were patient reported incidents of leakage and satisfaction during wear and changing of the appli-ance. Peristomal skin complications also were recorded. Descriptive statistics were used to analyze results. In addition, subgroup analysis of patients with a parastomal hernia was performed because of the potential benefits of the device design in these cases. RESULTS: Participants included 23 patients (16 with colostomies, 7 with ileostomies); 13 participants (57%) were female. Mean age and BMI were 64 years and 28.3, respectively. Six (6) patients had a parastomal hernia. Due to shifting or discomfort while wearing the appliance, 16 participants discontinued use before the end of the study and were excluded from analysis from the point they left the study. Mean duration of participation was 12.8 days. No adverse events occurred. Mean number of incidents of leakage/week decreased from 3.5 ± 4.9 at start of the study to 1.8 ± 1.3 at week 4. The mean number of pouches used/week decreased from 10.5 ± 5.4 to 8 ± 2.6. Peristomal skin reactions present in 15 patients at start of the study decreased to 1 patient at the end of the study. Patient satisfaction did not change over the course of the study. Patients with parastomal hernias had similar results. CONCLUSION: No serious adverse events were reported and leakage and skin irritation were found to improve, but participant dropout rate was high and average usage time was only 12.8 days, which limited interpretation of the results. The data suggest that the appliance may offer an (intermittent) alternative to existing ostomy materials for patients experiencing troublesome leakages, peristomal skin problems, or parastomal hernias, but further research is needed to explore these outcomes.

Follow-up after surgical treatment in older patients with colorectal cancer: The evaluation of emerging health problems and quality of life after implementation of a standardized shared-care model.

INTRODUCTION: One-year mortality after hospital discharge is higher among older patients with colorectal cancer who underwent surgery compared to younger patients. Taking care of older adults with multi-morbidity is often fragmented with lack of coordination and information exchange between healthcare professionals. The aim of this study was to evaluate emerging health problems and quality of life after implementing a standardized shared-care model. MATERIAL AND METHODS: 141 patients aged ≥70 years who underwent surgery for colorectal carcinoma in two hospitals were included. A standardized transmission from hospital to primary care was set up. Patients' health status and quality of life was evaluated during subsequent follow-up moments. RESULTS: A reduction in one-year mortality rate from 10.9% to 9.2% was observed after implementation of the standardized shared-care model. Almost all health status domains improved to 'good' during follow-up moments, still the general condition remained poor in 26% of patients at week fourteen. Although quality of life improved during subsequent follow-up moments, fatigue, dyspnoea and insomnia were the most prominent persisting problems at the end of follow-up. DISCUSSION: The implementation of a standardized shared-care model for older patients after surgery for colorectal cancer resulted in a reduction in the one year mortality rate. Although most aspects of both health status and quality of life improved during subsequent follow-up moments, especially the general condition remained poor for a long time after surgery. This means that, besides a good preoperative counseling of patients, future research should focus on possible interventions to improve general condition.

Normocalcemia but still elevated parathyroid hormone levels after parathyroidectomy.

Even when laboratory results at first match with clinical assessment, assay interference should still be on a clinician's mind when later results no longer fit with the patient.

Improvable quality of diagnostic assessment of colorectal cancer in southern Netherlands.

OBJECTIVE: To determine the extent of guideline implementation of the diagnostic approach in patients with colorectal cancer (CRC) in southern Netherlands in 2005, with special focus on colonoscopy. METHODS: Data were extracted from the medical records for a random sample of 257 colon and 251 rectal cancer patients newly diagnosed in 2005 and recorded from the Eindhoven Cancer Registry. Adherence to guidelines was determined for diagnostic assessment. Multivariable logistic regression analysis was conducted to assess determinants of complete colonoscopy. RESULTS: Diagnostic assessment was carried out mainly by internists (50%) and gastroenterologists (36%). Colonoscopy was performed in 83% of patients with proximal/transverse colon cancer, 55% of those with distal colon cancer, and 65% of those with rectal cancer. A tumour biopsy was taken for 84% of colon and 93% of rectal tumours. Colonoscopy completeness was lower for patients with comorbidity, obstructing tumours, and patients with poor bowel preparation. Abdominal ultrasound was performed for 72% of colon and 52% of rectal cancer patients and a thoracic radiography of over 80% of CRC patients. Computed tomography (CT) of the abdomen was performed in over half of the colon cancer patients and a pelvic CT scan or magnetic resonance imaging in 36% of rectal cancer patients. CONCLUSION: Improvements in adherence to diagnostic guidelines for CRC appear possible, especially in the performance of imaging procedures. Among patients where complete visualization of the colon was not feasible with colonoscopy, imaging techniques such as virtual CT might be of added value in the near future.