Online prediction tools for melanoma survival: A comparison.

BACKGROUND: Breslow thickness, patient age and ulceration are the three most valuable clinical and pathological predictors of melanoma survival. A readily available reliable online tool that accurately considers these and other predictors could be valuable for clinicians managing melanoma patients. OBJECTIVE: To compare online melanoma survival prediction tools that request user input on clinical and pathological features. METHODS: Search engines were used to identify available predictive nomograms. For each, clinical and pathological predictors were compared. RESULTS: Three tools were identified. The American Joint Committee on Cancer tool inappropriately rated thin tumours as higher risk than intermediate tumours. The University of Louisville tool was found to have six shortcomings: a requirement for sentinel node biopsy, unavailable input of thin melanoma or patients over 70 years of age and less reliable hazard ratio calculations for age, ulceration and tumour thickness. The LifeMath.net tool was found to appropriately consider tumour thickness, ulceration, age, sex, site and tumour subtype in predicting survival. LIMITATIONS: The authors did not have access to the base data used to compile various prediction tools. CONCLUSION: The LifeMath.net prediction tool is the most reliable for clinicians in counselling patients with newly diagnosed primary cutaneous melanoma regarding their survival prospects.

Iron oxide/hydroxide-nitrogen doped graphene-like visible-light active photocatalytic layers for antibiotics removal from wastewater.

Hybrid layers consisting of Fe oxide, Fe hydroxide, and nitrogen doped graphene-like platelets have been synthesized by an eco-friendly laser-based method for photocatalytic applications. The complex composite layers show high photodecomposition efficiency towards degradation of antibiotic molecules under visible light irradiation. The photodecomposition efficiency was investigated as a function of relative concentrations of base materials, Fe oxide nanoparticles and graphene oxide platelets used for the preparation of target dispersions submitted to laser irradiation. Although reference pure Fe oxide/Fe hydroxide layers have high absorption in the visible spectral region, their photodecomposition efficiency is negligible under the same irradiation conditions. The high photocatalytic decomposition efficiency of the nanohybrid layer, up to 80% of the initial antibiotic molecules was assigned to synergistic effects between the constituent materials, efficient separation of the electron-hole pairs generated by visible light irradiation on the surface of Fe oxide and Fe hydroxide nanoparticles, in the presence of conducting graphene-like platelets. Nitrogen doped graphene-like platelets contribute also to the generation of electron-hole pairs under visible light irradiation, as demonstrated by the photocatalytic activity of pure, reference nitrogen doped graphene-like layers. The results also showed that adsorption processes do not contribute significantly to the removal of antibiotic molecules from the test solutions. The decrease of the antibiotic concentration under visible light irradiation was assigned primarily to photocatalytic decomposition mechanisms.

Risk of hepatitis B virus reactivation in hepatitis B virus + hepatitis C virus-co-infected patients with compensated liver cirrhosis treated with ombitasvir, paritaprevir/r + dasabuvir + ribavirin.

Hepatitis B virus may reactivate in patients with chronic hepatitis C treated with direct-acting antivirals. The aim of this study was to investigate the risk of hepatitis B virus (HBV) reactivation in HBV + hepatitis C virus (HCV)-co-infected patients with compensated liver cirrhosis treated with paritaprevir/ombitasvir/ritonavir, dasabuvir with ribavirin. We reviewed prospectively gathered data from a national cohort of 2070 hepatitis C virus patients with compensated liver cirrhosis who received reimbursed paritaprevir/ombitasvir/r, dasabuvir with ribavirin for 12 weeks from the Romanian National Health Agency during 2015-2016. Twenty-five patients in this cohort were HBs antigen positive (1.2%); 15 untreated with nucleotide analogues agreed to enter the study. These patients were followed up: ALT monthly, serology for HBV and DNA viral load at baseline, EOT and SVR at 12 weeks. Hepatitis B virus (HBV)-co-infected patients were all genotype 1b and 52% females, with a median age of 60 years (51 ÷ 74); 76% were pretreated with peginterferon + ribavirin; 72% were with severe necroinflammatory activity on FibroMax assessment; 40% presented comorbidities; and all were HBe antigen negative. Hepatitis C virus (HCV) SVR response rate was 100%. Hepatitis B virus (HBV)-DNA viral load was undetectable in 7/15 (47%) before therapy, and for the other 8 patients, it varied between below 20 and 867 IU/mL. Five patients (33%) presented virological reactivation (>2 log increase in HBV-DNA levels) during therapy. One patient presented with hepatitis associated with HBV reactivation, and two started anti-HBV therapy with entecavir. Hepatitis B virus (HBV) virological reactivation was present in 33% in our patients. Generally, HBV-DNA elevations were mild (<20 000 IU/mL); however, we report one case of hepatitis associated with HBV reactivation.

Acute anterior uveitis and other extra-articular manifestations of spondyloarthritis.

BACKGROUND: Spondyloarthritis (SpA) is associated with an array of peripheral manifestations. Our study aims to evaluate extra-articular manifestations of SpA in a Romanian academic clinical setting and to observe their associations with different disease measures. METHODS: The study was designed to note the extra-articular manifestations of SpA patients in a cross-sectional and retrospective manner. Records included demographics, inflammation markers, SpA clinical characteristics, treatment regimes, associated osteoporosis and cardiovascular morbidity. Data were assessed by using appropriate non-parametric tests. RESULTS: A total of 126 SpA patients were included. The most common extra-articular manifestations were skin involvement in the form of psoriasis (34.1%), eye involvement in the form of acute anterior uveitis (8.7%) and dactylitis (7.2%). Compared to patients with no record of uveitis, uveitis-affected cases were more frequently males, more frequently diagnosed with ankylosing spondylitis, but less frequently dyslipidemic and diagnosed with psoriasis. Psoriasis-affected patients were older and had a higher prevalence of peripheral SpA diagnosis, but a lower prevalence of radiographic sacroiliitis. CONCLUSIONS: Acute anterior uveitis in SpA predominantly affects males with AS. This is relevant both to clinical and fundamental science, since its management requires both ophthalmology and rheumatology clinical settings. Psoriasis was associated more frequently with peripheral SpA. ABBREVIATIONS: AHT = arterial hypertension, AS = ankylosing spondylitis, ASAS = Assessment in SpondyloArthritis international Society, aSpA = axial spondyloarthritis, BASFI = Bath Ankylosing Spondylitis Functional Index, BASDAI = Bath Ankylosing Spondylitis Disease Activity Index, CRP = C-reactive protein, ESR = erythrocyte sedimentation rate, DM2 = type 2 diabetes mellitus, HLA = human leukocyte antigen, IBD = inflammatory bowel disease, MRI = magnetic resonance imaging, mSpA = mixed (peripheral and axial) spondyloarthritis, NSAIDs = non-steroidal anti-inflammatory drugs, pSpA = peripheral spondyloarthritis, PsA = psoriatic arthritis, ReA = reactive arthritis, SD = standard deviation, SI = sacroiliitis, SpA = spondyloarthritis, UDSpA = undifferentiated spondyloarthritis.

No survival benefit for patients with melanoma undergoing sentinel lymph node biopsy: critical appraisal of the Multicenter Selective Lymphadenectomy Trial-I final report.

BACKGROUND: Sentinel lymph node biopsy (SLNB) was developed in the hope that it would improve outcomes for patients with melanoma. SLNB is an area of discussion and controversy in melanoma medicine. The final trial results of the Multicenter Selective Lymphadenectomy Trial (MSLT-I) have now been published and the authors suggest their long-term results 'clearly validate the use of sentinel-node biopsy in patients with intermediate-thickness or thick primary melanomas'. An accompanying editorial states that MSLT-I is a practice-changing trial. CONCLUSIONS: However, critical appraisal of MSLT-I data does not support the claims of the final report. On the contrary, MSLT-I failed to demonstrate that there is a significant treatment-related difference in the 10-year melanoma-specific survival rate in the overall study population. Furthermore, there was no improvement in overall or melanoma-specific survival of the intermediate-thickness group (1·2-3·5 mm). Completion lymphadenectomy can result in complications in about a third of patients, with a rate of clinically significant lymphoedema following axillary or groin dissection of 5-10%. Unnecessary lymphadenectomy can therefore have a major effect on patient quality of life. The evidence provided by Morton et al. does not support the claim that sentinel lymph node biopsy followed by lymphadenectomy in patients with positive sentinel nodes should be the standard of care in patients with melanoma. Readers are encouraged to check with registration sites to make sure declared primary outcomes are fairly reported. Post-hoc analyses are at best exploratory and cannot be used to form the principal conclusions of a trial.

Melatonin and cancer.

Melatonin plays an important role in cancer (tumor growth and metastasis) through different pathways and may have therapeutic significance.

Enzymatic aspects in ENT cancer-Matrix metalloproteinases.

The study of ENT cancer allows the implementation of molecular biology methods in diagnosis, predicting the evolution of the disease and suggesting a certain treatment. MMPs are proteolytic enzymes, zinc dependent endopeptidases, secreted by tissues and proinflammatory cells that play a role in the clearance of cell surface receptors. They are expressed as zymogens (inactive forms). Proteolytic enzymes cleave zymogens generating active forms. They are involved in cell proliferation, adhesion, differentiation, migration, angiogenesis, apoptosis and host defense.

Rare complication of the cervical spine trauma--traumatic esophageal fistula: case report and review of the literature.

BACKGROUND AND STUDY AIMS: Esophageal fistula due to cervical spine trauma is a rare, potentially fatal complication, which changes significantly the treatment and the prognosis of the trauma patient. There is scarce data regarding this associated pathology of cervical trauma and it consists only of isolated cases, most of them being reported as a complication of the surgical treatment. We present the case of a female patient who suffered a fall from a wagon and who was diagnosed at presentation with cervical fracture and esophageal fistula. Patient: A 65 years old female who suffered a fall from a train wagon presented for intense neck pain and bilateral brachial paresis. The MRI exam showed a C6-C7 fracture with bilateral facet dislocation in the context of a degenerative, spondylotic cervical spine. It also showed an anterior fragment from the C7 body, in contact with esophageal adventitia. The patient underwent surgery. RESULTS: A C6 corpectomy was performed, with arthrodesis with bone graft and cervical plate fixation. 24 hours after the procedure, the clinical signs of an esophageal fistula appeared and a CT-scan revealed the typical aspects of that complication. The patient underwent a second surgery in collaboration with the general surgeon with a good outcome and complete neurological recovery. CONCLUSION: In the case of cervical spine trauma the imaging exploration has to look for potential signs of lesions to the neighboring vital structures. Although a rare complication of cervical trauma, esophageal fistula represents a formidable complication and requires immediate surgical sanction, the only factor decisive for a good prognosis.

Case reports - common and external carotid artery resection in head and neck cancer patients.

Most head and neck cancer patients are first referred to an E.N.T. specialist thus the need for that surgeon to be the leader of the multidisciplinary team. Oncological surgical interventions need to ensure clear resection margins; this means that whatever anatomic structures are involved in the tumor spread, need to be resected. The carotid artery is a vascular vessel system that provides blood supply for the head and neck region, the most important structure being the brain and its organs. The ligation or the resection of the common carotid artery leads to an abrupt decrease of blood flow towards the brain, which can cause single sided paralysis, decreased cognitive functions, shock and even death. Common or internal carotid arteries ligatures or resections can be performed in patients with malignant tumors of the head and neck. This is a synopsis of 2 successful cases of patients who underwent common and external carotid artery resection.

Anti-cyclic citrullinated peptide antibodies in psoriatic arthritis--cross-sectional study and literature review.

RATIONALE: Anti-CCP antibodies are detectable not only in rheumatoid arthritis (RA), but also in psoriatic arthritis (PsA). It is possible those anti-CCP antibodies are associated with features of PsA and that these auto-antibodies are useful in distinguishing PsA from RA. OBJECTIVE: to evaluate the prevalence and the associations of anti-CCP antibodies in PsA patients; to evaluate the usefulness of anti-CCP antibodies in distinguishing PsA from RA. METHODS AND RESULTS: The inquiry was designed as a cross-sectional study of 41 PsA patients, 139 RA patients and 147 normal subjects, which recorded demographic data, disease activity and serology: rheumatoid factor (RF), anti-CCP antibodies. Five PsA patients (12.2%) were anti-CCP positive. Compared to anti-CCP negative PsA patients, anti-CCP positive PsA patients had a more frequently a polyarticular disease pattern (p = 0.005), they were more frequently treated with biologics (p = 0.015) and less frequently with classic disease-modifying drugs (p < 0.001). An optimal positive cutoff value for anti-CCP titer was determined (11.6 U/mL), over which it is highly probable that a known PsA patient actually has RA and psoriasis. DISCUSSION: The more aggressive the disease of anti-CCP positive PsA patients indicates the need of a more intensive management regarding anti-rheumatic treatment and follow-up. Anti-CCP antibodies can be a useful tool in differentiating PsA from RA, especially in RA-like forms of PsA, which present no elements pertaining to spondyloarthropathies.

Intestinal perforated malignant melanoma: diagnostic and therapeutic difficulties.

The intestinal malignant melanoma is a rare occurrence in the daily surgical practice, with difficult diagnosis (even on usual pathologic examination) and therapeutic attitude. Most of the lesions are secondary to a cutaneous primary melanoma, but there are cases in which the original site may not be discovered, and are considered as primitive intestinal melanomas. This paper presents the case of a 50 year old male patient, diagnosed and operated as emergency with acute abdomen caused by a tumoral perforation of the small bowel; several tumors, in different stages of local evolution, were discovered during laparotomy. A triple enterectomy with end-to-end entero-enteral anastomosis was performed, with uneventful postoperative recovery. The later postoperative evolution was marked by the occurrence of multiple subcutaneous recurrences and a bulky metastasis in the mediastinum; 18 month after the initial surgery, the patient died due to the melanoma recurrence. Diagnostic and therapeutic difficulties are discussed in this paper, related especially to the differential diagnosis of the origin of the intestinal lesion (a metastatic melanoma with unknown primary site or a primary malignant melanoma of the small bowel), since no other sites of origin were discovered after a thorough examination.

Anatomo-surgical correlations in larynx cancer.

OBJECTIVE: Cancer remains a crucial problem of contemporary medicine and the principle is perfectly true regarding the laryngeal cancer. Laryngologists are constantly searching for laryngeal cancer to provide functional and oncological surgical techniques. Conservative surgery in laryngeal cancer tries to keep enough laryngeal lumen and maintain the main laryngeal functions: breath, phonation, swallowing, by using open surgical techniques. METHODS: 412 patients with larynx neoplasms were operated by open surgical techniques between 1.01.2006 and 31.12. 2008 in the ENT Clinic of "Coltea" Clinical Hospital. We selected 21 cases divided into three groups, each with 7 patients, to whom we have changed the type of surgery based on anatomical data. Careful preoperative selection is of outmost importance for the clinical outcome of the patients. Postoperative follow up was between 3 and 5 years. RESULTS: All the patients are alive, decannulated; they feed orally and are fully socially integrated. CONCLUSIONS: In the light of anatomical structures analysis, indications of partial laryngeal surgery may be extended from where it is now, to accepting only total laryngectomy.

Morphology and morphopathology of hypopharyngo-esophageal cancer.

Cervical esophageal cancer and hypopharyngeal cancer represent a major diagnostic issue in early stages, considering the fact that the implication of both cervical esophageal and hypopharyngeal cancers shows a poor prognostic from the very beginning. Positive diagnosis can only be made after histopathological analysis and immunohistochemical analysis in addition. The bioptic material is sampled by rigid endoscopy this being the only viable method of assessing data on the tumor prior to the surgery. As much as 95% of tumors located at this site are epidermoid carcinomas with different staging and characteristics, other types of tumors being adenocarcinomas, lymphomas, etc. Several risk factors influence the biology of this site thus inflicting both cellular and molecular modifications that are the origin of cancer development.

Pharyngoesophageal junction neoplasia--therapeutic management.

Not only the anatomy but the treatment and the prognosis of these tumors are intermediate between hypopharyngeal and esophageal tumors. After a portion of the esophagus is removed or complete esophagectomy, a conduit must be established. The authors reviewed the experience of Prof. Cristian Popescu in total pharyngo-laryngectomy and his technique of pharyngoesophageal reconstruction with synthetic esophageal prosthesis. We have some 21 patients who underwent an esophageal reconstruction with Montgomery esophageal tube. This is a very important new, modem, interdisciplinary approach bewteen the head and neck surgeon and the general/thoracic surgeon to treat the pharyngo-laryngo-esofageal neoplasia with one stage reconstruction. The follow up for these patients shows that this reconstruction method is a good, reliable choice with low costs and considerable advantages for the quality of life. Surgery for these patients should be considered primarily palliative and the optimal reconstruction should preserve the quality of life for the duration of survival.

Functional implications of radical neck dissection and the impact on the quality of life for patients with head and neck neoplasia.

Radical neck dissection is a concept that was presented in 1906 by GW Crile and suffered constant improvement ever since. The surgical oncology procedure included the resection of the internal jugular vein, the sternocleidomastoid muscle, and the submandibular gland and the spinal accessory nerve. Deformities and impairment in the functionality of different regions of the neck and scapular regions have great implications on the quality of life of the patients who undergo such a procedure. Modifications to the radical neck dissection were made in the attempt to maintain the efficacy of the surgical oncology therapy. The authors try to assess the functional implications of radical neck dissection and the impact on the quality of life for patients with head and neck neoplasia.

Endoprosthetic reconstructive surgery with medical grade long term implantable silicone in facial asymmetry.

The authors present their experience over a period of 13 years (1998-2011) regarding a cohort of 54 patients. In an extensive loss of tissues resulted from congenital malformations (maxillary and mandibular malformations, micro stoma), collagenosis (scleroderma, Romberg Syndrome), traffic and work accidents, post surgical (cancer and facial nerve paralyze), when usual surgical procedures fail to establish the normal look of the patient medical grade long-term implantable silicone endoprosthetic reconstruction (rehabilitation) intervenes. Using a specific technique and materials like long-term implantable silicone grade, the resulted endoprostheses replace and create the aesthetic and a normal anatomy of the specified region, very well tolerated, elastic and non-allergic and with a perfect acceptation from the body all the life.

Reconstructive surgery of the nasal pyramid.

The authors present their personal experience regarding the reconstruction of the nasal pyramid on 150 cases, encompassing both children and adults during the period 2000-2011. Reconstruction of the nasal pyramid, regardless of age, was performed in cases of dysmorphias due to congenital malformations, accidents and surgical treatments with great loss of substance (benign or malignant tumors). There were used the classical methods of reconstruction meaning rhino correction and rhinoplasty. However we mainly focused on the use of heterografts (implantable silicone implants - endoprostheses), or on the reconstruction of the nasal pyramid entirely with elastomeric silicone (epitheses), fixed with adhesive, implants and titanium magnets. Silicone, as a synthetic material, is very well tolerated by the body, having been demonstrated that it is a good oxygen carrier. Moreover, both nasal silicone and titanium implants are well tolerated as well and, in addition, they have good aesthetic, functional and psychological results. Patients regain an almost normal appearance, having good family and social integration and improved quality life.