Transarterial radioembolization: a systematic review on gaining control over the parameters that influence microsphere distribution.

[Purpose] Transarterial radioembolization (TARE) is an established treatment modality for patients with unresectable liver cancer. However, a better understanding of treatment parameters that influence microsphere distribution could further improve the therapy. This systematic review examines and summarizes the available evidence on intraprocedural parameters that influence the microsphere distribution during TARE as investigated by in vivo, ex vivo, in vitro and in silico studies. [Methods] A standardized search was performed in Medline, Embase and Web of Science to identify all published articles investigating microsphere distribution or dynamics during TARE. Studies presenting original research on parameters influencing the microsphere distribution during TARE were included. [Results] A total of 42 studies reporting a total of 11 different parameters were included for narrative analysis. The investigated studies suggest that flow distribution is not a perfect predictor of microsphere distribution. Increasing the injection velocity may help increase the similarity between flow and microsphere distributions. Furthermore, the microsphere distributions are very sensitive to the radial and axial catheter position. [Conclusion] The most promising parameters for future research which can be controlled in the clinic appear to be microsphere injection velocity as well as the axial catheter position. Up to now, many of the included studies do not take clinical feasibility into account, limiting the translation of results to clinical settings. Future research should therefore focus on the applicability of in vivo, in vitro, or in silico research to patient specific scenarios to improve the efficacy of radioembolization as treatment for liver cancer.

PSMA radioligand therapy for solid tumors other than prostate cancer: background, opportunities, challenges, and first clinical reports.

In the past decade, a growing body of literature has reported promising results for prostate-specific membrane antigen (PSMA)-targeted radionuclide imaging and therapy in prostate cancer. First clinical studies evaluating the efficacy of [177Lu]Lu-PSMA radioligand therapy (PSMA-RLT) demonstrated favorable results in prostate cancer patients. [177Lu]Lu-PSMA is generally well tolerated due to its limited side effects. While PSMA is highly overexpressed in prostate cancer cells, varying degrees of PSMA expression have been reported in other malignancies as well, particularly in the tumor-associated neovasculature. Hence, it is anticipated that PSMA-RLT could be explored for other solid cancers. Here, we describe the current knowledge of PSMA expression in other solid cancers and define a perspective towards broader clinical implementation of PSMA-RLT. This review focuses specifically on salivary gland cancer, glioblastoma, thyroid cancer, renal cell carcinoma, hepatocellular carcinoma, lung cancer, and breast cancer. An overview of the (pre)clinical data on PSMA immunohistochemistry and PSMA PET/CT imaging is provided and summarized. Furthermore, the first clinical reports of non-prostate cancer patients treated with PSMA-RLT are described.

Balancing the risk of dioxins and polychlorinated biphenyls (PCBs) and the benefit of long-chain polyunsaturated fatty acids of the n-3 variety for French fish consumers in western coastal areas.

A study of 401 fish-eating adults living in a coastal region of France was undertaken to establish exposure to dioxins/polychlorinated biphenyls and the intake of long-chain polyunsaturated fatty acids of the n-3 variety. Fish consumption was estimated using food frequency diaries and the dioxin/polychlorinated biphenyl data collected by the French control authorities was used to calculate dietary exposure. The results showed that for a group of adult subjects selected because of their consumption of fish, 60% achieved the nutritional recommendation for long-chain n-3 polyunsaturated fatty acids and 79% were exposed to total dioxins below the toxicological threshold of 14 pg kg(-1) body weight week(-1). Nevertheless, only 41% of these subjects had an optimal balance between the risk and benefit of eating fish, because 19% were meeting the nutritional recommendation but exceeding the toxicological threshold, whereas 38% were exposed below the toxicological threshold but failed to reach the recommended intake of long-chain n-3 polyunsaturated fatty acids. Similar results were found regarding the balance between long-chain n-3 polyunsaturated fatty acids and polychlorinated biphenyls even if a toxicological threshold was not established for these compounds. The results show that meeting the nutritional requirements of 0.5 mg day(-1) of long-chain n-3 polyunsaturated fatty acids is compatible with respect to toxicological thresholds, while an intake higher than 1.5 g day(-1) is likely to lead to a dietary exposure above the provisional tolerable weekly intake for dioxins.

Impact of a risk-benefit advisory on fish consumption and dietary exposure to methylmercury in France.

We designed the CORAI (COnsumer Risk Advisory Inquiry) study to observe consumer reactions' after an advisory revealing risk of methylmercury contamination together with benefits of Long-Chain Poly Unsaturated Fatty Acids of the n-3 variety (LC n-3 PUFA). The message was very close to the ones commonly delivered by national food agencies and included recommendations for women of childbearing age and children below 15 years old. Two groups of subjects including consumers at risk were selected. Participants recorded the frequency of their fish consumption detailed by species for them and their family over a one-month period one month before, a month immediately after and 3 month after the advisory. Results were compared between consumers receiving the advisory and controls. Results show that the message revelation led to a significant decrease in total fish consumption which is greater for children below 6 years old than for the children between 6 and 15 years old and women. The consumption of the most contaminated fish quoted in the advisory, rarely consumed and poorly known by French consumers did not decrease in any group despite the advice to avoid their consumption. The consumption of other fish products quoted in the advisory but frequently consumed and better known, as canned tuna, did decrease and was a major contributor to the overall reduction of exposure for the advised group. Before the information, about 3% of women of childbearing age are exceeding the PTWI for MeHg and both the average and the high percentiles of the exposure to MeHg are decreasing significantly in the advised group. Regarding the number of subjects of the advised group exceeding the PTWI, they were 6, 3 and 2, respectively, in May, June and September. Accompanying questionnaires show that consumers imperfectly memorize most of the fish species quoted in the recommendation. This paper concludes that consumer advisory, which is a major tool for risk management, has a minimal effect under our experimental conditions to reduce the exposure of groups at risk. Messages to be carried to consumers should be carefully tested for long term memorization in order to become more effective.

Economic evaluation for conservation of farm animal genetic resources.

The decline in biodiversity of farm animal genetic resources (AnGR) has come to the forefront of concern in the discussion of animal conservation and breeding programmes. To improve decision-making regarding conservation and breeding programmes, a number of evaluation techniques of farm AnGR are available. This paper presents an overview of the different values associated to AnGR and of the techniques for their measurement being employed in the economic literature. Those include linear programming and farm simulation models, dynamic models estimating the value of research and development and econometric models estimating the demand for breed characteristics. While farm programming and simulation models are fairly well developed, they do have large data requirements. Alternatively, contingent valuation methods are available, in particular when the goal is to capture non-market values embedded in breeds.

Comparison of premortem clinical diagnoses in critically iII patients and subsequent autopsy findings.

OBJECTIVE: To determine whether our practice of requesting an autopsy for patients who die in the medical intensive care unit (MICU) continues to be a valid approach to obtain clinically and educationally relevant findings. METHODS: In this retrospective study conducted in an adult MICU population of a university hospital, the clinical diagnoses and postmortem major diagnoses of 100 patients who died in 1996 (autopsy rate of 93%) were compared. RESULTS: Eighty-one percent of the clinical diagnoses were confirmed at autopsy. In 16%, autopsy findings revealed a major diagnosis that, if known before death, might have led to a change in therapy and prolonged survival (class I missed major diagnoses). The most frequent class I missed major diagnoses were fungal infection, cardiac tamponade, abdominal hemorrhage, and myocardial infarction. Another 10% of autopsies revealed a diagnosis that, if known before death, would probably not have led to a change in therapy (class II error). CONCLUSIONS: Autopsy remains an important tool for education and quality control. In contrast with historical series of 1 to 2 decades ago, there is a clear shift in the type of class I missed major diagnoses toward opportunistic infections. Bedside-applicable techniques such as electrocardiography with supplemental posterior leads, echocardiography, and meticulous abdominal ultrasonography might improve the outcome in selected MICU patients.

[Use of prostate specific antigen. A review]. / Anvendelse af prostataspecifikt antigen. En oversigt.

Since it was first introduced, measurement of prostate specific antigen has gained increasing interest, and prostate specific antigen is regarded as being the best tumour marker available. The antigen lacks cancer specificity, limiting the usefulness in early diagnosis, The use of prostate specific antigen in early diagnosis, staging, and in monitoring patients with prostate cancer is reviewed.

Invasive, high grade transitional cell carcinoma of the bladder treated with transurethral resection. A survival analysis focusing on TUR as monotherapy.

Two hundred and fifteen consecutive patients admitted to our department between 1978 and 1988 were included in a retrospective study. Entrance criteria were transitional cell carcinoma of the bladder T1-4, Grade III-IV. Status of nodes and metastases were not recorded. Initially all patients had a macroscopically radical transurethral resection (TUR). Patients were followed with cystoscopies. Recurrent tumours were treated with repeated TUR (RE-TUR). In cases of progression to a higher T-stage or recurrences with multiple papillomas (> 10), adjuvant therapy was recommended. The patients were retrospectively allocated to three different groups. Group 1 had TUR only, Group 2 had TUR + adjuvant irradiation, and Group 3 had TUR and various adjuvant therapies (Table I). Median crude actuarial overall survival was 29 months. In Groups 1, 2 and 3, median crude survival was 37, 13 and 32 months, respectively. In the analysis, most emphasis was put on Group 1. For stages T1-4 in this group, the median survivals was 67, 19, 9 and 2 months, respectively. Differences were statistically significant (p < 0.05). T1 tumour stage seemed to predict a reduced risk of progression compared with the higher tumour stages (p = 0.05, Fisher's test). There was a tendency for females to progress less often than men, but the difference was not statistically significant. In conclusion, macroscopically radical TUR does not seem to offer the same cure rates as radical cystectomy. However, in a selected group of patients with a troublesome medical history, or for patients wishing minimal risk treatment, TUR might be a reasonable treatment modality.

Renal cell carcinoma: prognostic factors.

OBJECTIVE: To establish the prognostic value of a series of pre-operative, per-operative and histopathological parameters in relation to renal cell carcinoma (RCC). PATIENTS AND METHODS: This retrospective study involved a consecutive series of 76 patients (46 men and 30 women with a mean age of 65.3 years [range 44-91]) with a histologically confirmed diagnosis of RCC. Patients who were admitted over the period 1980-1984 were included. Data such as erythrocyte sedimentation rate (ESR), alkaline phosphatase level, histological tumour grade, degree of necrosis and presence of tumour vessels were evaluated in relation to actuarial survival. RESULTS: The ESR and alkaline phosphatase level at the time of diagnosis of RCC, the histological tumour grade, degree of necrosis and presence of tumour vessels on angiography were all found to affect the actuarial length of survival significantly (P < or = 0.05 log-rank test). Macroscopic tumour demarcation estimated per-operatively by the surgeon or after surgery by the pathologist, microscopic demarcation, vascular density on histological examination, tumour diameter and vascular density on angiography were found not to affect actuarial survival significantly. CONCLUSION: The value of establishing simple and reliable diagnostic indicators for patients with RCC is stressed.

[Endothelial cyst in the adrenal gland]. / Endotelcyste i binyren.

Suprarenal cysts are rare. A case of a 3.5 l cyst incidentally discovered in a 30 year old woman is described. Operative treatment is recommended in order to avoid spontaneous rupture and to exclude malignancy. Endothelial origin can be established by a specific immunohistochemical staining, factor VIII antibody.

Self-catheterization after urethrotomy. Prevention of urethral stricture recurrence using clean intermittent self-catheterization.

Following urethrotomy approximately 50% develop recurrence within 6 months. Twenty-nine consecutive patients were offered clean intermittent self-catheterization (CISC) as a preventive measure against urethral stricture recurrence following internal urethrotomy. Ten patients dropped out during the scheduled 6-month regimen. Of the 19 patients left, a significantly improved flow was maintained over the period of observation. No reoperations were required. Prior to the trial, 14 of the 19 patients had a history of recurrent urethral stricture; 92% of these recurrences were diagnosed within 6 months following urethrotomy. It is concluded that CISC seems to be a promising preventive measure against recurrence of urethral stricture.

A comparison of aspiration, antazoline sclerotherapy and surgery in the treatment of hydrocele.

Of 98 hydroceles (mean volume 125 ml) in a consecutive series of 92 patients, treated initially by aspiration, 14% (mean volume 70 ml) were cured. The 76 recurring hydroceles (mean volume 146 ml) were then randomised to either antazoline sclerotherapy on an out-patient basis or surgery. Cure rates were 89 and 100%, respectively, at follow-up 6 months later. Operated patients were admitted for a mean duration of 2.5 days. The results indicated that aspiration alone was inadequate, and sclerotherapy is advocated as the first choice of treatment for hydrocele.

[A case of perforation of a blind loop secondary to ileocolic side-to-side anastomosis]. / Et tilfaelde af perforation af blind loop sekundaert til ileocolisk side-til-side anastomose.

A rare late complication of side-to-side anastomosis; perforation of a blind loop with subsequent localized inflammation of the abdominal wall is presented. Operative intervention with resection of the blind loop and the establishment of an end-to-end anastomosis is recommended.

Urate calculi complicating orchidectomy in a patient with advanced prostatic cancer. Case report.

A patient passed 11 urate calculi after palliative orchidectomy for advanced prostatic cancer, and there was a simultaneous rise in urinary urate excretion. We believe that this rise could be the result of increased purine metabolism from lysis of tumour cells. To our knowledge this has not previously been reported.

[Prostatic cancer and growth factors]. / Prostatacancer og vaekstfaktorer.

Advanced prostatic cancer (PC) involves a serious prognosis. PC cells form growth factors, which affect growth in autocrine or paracrine manner. PC cell lines, hormone dependency, and growth modalities are mentioned. Interference with these model systems by TGF-alpha, TGF-beta and EGF is described. The presence of less characterized growth factors in homogenates and conditioned media from PC cells is mentioned. An abundance of EGF and EGF-receptors has been found in PC compared to BPH samples. New strategies for treatment are outlined.

[Results of treatment of anal cancer]. / Ergebnisse der Behandlung des Analkarzinoms.

Symptoms, results of therapy as well as prognosis of carcinoma of the anal canal and anal margin are analyzed in 37 own patients, treated within 1977 and 1988. Most of the patients were between 55 and 75 years old. Women (n = 24) were twice as often afflicted as men. Bleedings and pain were the most frequent symptoms. At the end of this study 25 (71%) of the registered patients were still alive, 12 (34%) of them for more than 5 years. Different therapeutical procedures had been applied. Because of the own results the value of radical abdomino-perineal rectum amputation is stressed for invasive cancers, relapses and rest cancer after preceding adjuvant therapy. Multimodal treatment strategy with combined radiation-chemotherapy and individually adapted surgery is performed according to the literature. Valid results of the value of this procedure in our own patients however can not be given at the present time.

Anal cancer: current concepts and treatment results.

37 patients were treated upon carcinoma of the anal canal or anal margin between 1977 and 1989. Although combined radiochemotherapy is of increasing interest as the treatment of choice our patients who underwent radical surgery in form of abdominoperineal rectum resection only had a very good outcome. Combined multimodal therapy by radiation and chemotherapy may possibly be able to reduce the rate of necessary resections. Difficulties in finding out a relapse of disease after such treatments are discussed. The own experience with combined radio-chemotherapy is not large enough at the present time to make significant statements. Long term results have to be expected yet. Abdominoperineal rectum resection as a means of radical surgery still has its place in the spectrum therapeutic modalities of treating anal carcinoma.

Acute traumatic dislocations of the patella.

Twenty-three consecutive patients with acute traumatic dislocation of the patella were followed up for a mean period of 39 months. All patients had a medial capsulorrhaphy and in eight cases a supplementary lateral capsulotomy. Dislocation recurred in two cases, one of whom had had a supplementary lateral capsulotomy. Chondromalacia was demonstrated at followup in eight patients, six of whom belonged to the lateral capsulotomy group. We conclude that lateral capsulotomy confers no advantage in the operative repair of acute dislocation of the patella.