Pelvic exenteration: a retrospective study in a tertiary referral cancer center in the UK.

BACKGROUND: Pelvic exenteration (PE) is an extensive surgery that is indicated in cases of recurrent advanced gynecological cancer with curative and sometimes palliative intent. The procedure is associated with both high morbidity and mortality and as such is considered a highly specialist procedure. The aim of the study was to analyze surgical outcomes in women who underwent PE for advanced gynecological malignancy in a tertiary cancer referral center over 11 years. METHODS: This is an observational retrospective single-center study. There were 17 patients included who underwent PE in Hull Royal Infirmary Hospital (Hull, UK) between 2010 and 2021. The main outcome measures were the perioperative complications, overall survival (OS), and recurrence free survival (RFS). Cumulative survival rates were reported at 1, 3 and 5 years. Univariate Cox regression analysis was undertaken to analyze factors that are prognostic for OS and RFS. Hazard Ratios (HR) with 95% confidence intervals (95% CI) were computed from the results of the Cox regression analyses. Kaplan-Meier survival curves were generated to visually display estimates of OS and RFS over the follow-up period. RESULTS: The median age at the time of surgery was 63.0 (IQR: 48.0-71.0). All patients received surgery with curative intent and complete tumor resection (R0) was achieved in 94.1% of cases. An overall 5-year survival was achieved in 63.7% of patients. Mean overall survival (OS) was 8.4 years (95% CI: 7.78-9.02). The RFS was 5.0 years (95% CI: 4.13-5.87). Both OS and RFS were significantly negatively affected by the hospital stay (P=0.020 and P=0.035, respectively), but not by the type of surgery (P=0.263 and P=0.826, respectively). CONCLUSIONS: The results of the study demonstrated stable and comparable outcomes in patients undergoing pelvic exenteration.

Ultra-radical surgery for advanced ovarian cancer: a retrospective cohort study in a tertiary referral cancer center in the UK.

BACKGROUND: Ovarian cancer is the leading cause of death from gynecological cancer in the UK. The standard of care is a combination of surgery and chemotherapy. The aim of the treatment is the resection of all macroscopic disease. In selected cases of advanced ovarian cancer this is achieved with ultra-radical surgery. However, NICE encourages further research due to low quality evidence on the safety and efficacy of this extensive surgery. The aim of this study was to examine the morbidity and survival rates of ultra-radical surgery for advanced ovarian cancer performed in our unit and compare our findings with the current literature. METHODS: This is a retrospective study of 39 patients diagnosed with stage IIIA-IV ovarian and primary peritoneal cancer who underwent surgery in our unit between 2012 and 2020. The main outcome measures were the perioperative complications, the disease-free survival, the overall survival rate and the recurrence rate. RESULTS: The study enrolled 39 patients with stages IIIA-IV who were treated in our unit between 2012 and 2020. 21 patients were at stage III (53.8%) whereas 18 (46.1%) at stage IV. 14 patients underwent primary and 25 secondary debulking surgery. Major and minor complications occurred 17.9% and 56.4% of the patients, respectively. Complete cytoreduction following surgery was achieved in 24 cases (61.5%). The mean and the median survival time were 4.8 years and 5 years, respectively. The mean disease-free survival time was 2.9 years while median disease-free survival time was 2 years. Age (P=0.028) and complete cytoreduction (p=0.048) were found to be significantly associated with survival. Primary debulking surgery was significantly associated with lower probability of recurrence (P=0.049). CONCLUSIONS: Although the number of patients is relatively small, our study indicates that ultra-radical surgery in centers with high expertise may result in excellent survival rates with an acceptable rate of major complications. All patients in our cohort were operated by an accredited gynecological oncologist and a hepatobiliary general surgeon with a special interest in ovarian cancer. A few cases required input from a colorectal and a thoracic surgeon. We believe that the careful selection of the patients that can benefit from ultra-radical surgery and our model of joint surgery can explain our excellent results. Further research is essential to establish that ultra- radical surgery has an acceptable rate of morbidity for patients with advanced ovarian cancer.

MR imaging of gynecologic diseases at 3T.

MR imaging using anatomic, chemical, and functional information offers huge potential for the management of the gynecologic patient. By differentiating benign from malignant disease with very high specificity, it can aid the selection of patients requiring further treatment and determine the level of urgency. Staging accuracy, which equals that obtained at laparotomy, allows appropriate clinical expertise to be organized before surgery or the deferment of surgery until later in the treatment pathway and is a cost-effective use of resources. This article compares and contrasts MR imaging of gynecologic conditions at 1.5 and 3T and defines a role for high field imaging for these clinical conditions.

Comparison of two rapid influenza A/B test kits with reference methods showing high specificity and sensitivity for influenza A infection.

The rapid detection of influenza viruses is important for forming preventative strategies, directing initiation of anti-viral therapy, detecting potential avian influenza viruses, and excluding influenza-like pathogens, such as SARS. The ImmunoCard STAT! Flu A and B Plus test (Meridian Bioscience, Cincinnati, OH) is a new point of care (POC) test utilizing influenza-specific monoclonal antibodies for rapid diagnosis. The performance of this assay was compared to the established POC Binax NowFlu A and NowFlu B test, and the reference diagnostic standards of viral culture, indirect immunofluorescence (IFA), and RT-PCR where appropriate. Testing of nasopharyngeal aspirates (NPA) from children, throat swabs, and nasal swabs from adults indicated ImmunoCard STAT! specificity of 98% and 100% for influenza A and B, respectively in 224 specimens. The Binax test showed specificity of 99% and 100%, respectively for influenza A and B. Sensitivity results were identical for both rapid detection kits (80% and 47% for Flu A and B, respectively). Overall results were very similar for both testing devices with the advantage of ImmunoCard STAT! Flu A and B Plus test detecting influenza A and B with sharp and easy to read results.

Initial experience of the use of photodynamic therapy (PDT) in recurrent malignant and pre-malignant lesions of the vulva.

OBJECTIVES: To assess the suitability and effectiveness of photodynamic therapy (PDT) in the treatment and symptom relief of vulval intraepithelial neoplasia (VIN), other pre-malignant and early neoplastic conditions of the vulva in an out patient setting. METHODS: Patients were selected from the vulvoscopy clinic whilst being investigated or under long-term follow-up. PDT was offered to patients in whom other treatments had failed or were unsuitable. 5-Aminoleuvinic acid (5-ALA) was used as a topical pro-drug, inducing the photosensitiser protoporphyrin IX. This was applied 4-6h before treatment. Laser light (630nm) generated by a Diode laser and Light Emitting Diode (LED) non-laser light of 630nm wavelength was also used. Initially, PDT was carried out with no analgesia, followed by oral analgesia, inhaled nitrous oxide and oral anxiolytic. Patients were seen and examined 2-3 weeks following treatment to assess clinical and symptomatic improvement. Further review was arranged as required. RESULTS: All those who had been symptomatic described improvement of their symptoms and all improved clinically. However, pain was a significant side effect during treatment and for 24h post treatment in most cases. CONCLUSION: The use of PDT for pre-malignant and early malignant vulval conditions, particularly VIN appears to be effective in the control of symptoms and can be carried out in an outpatient setting. However, a further long-term study, combined with biopsy, is needed to assess the pathological response. Pain is a significant side effect.

The significance of paired MEFV mutations in individuals without symptoms of familial Mediterranean fever.

The majority of patients with familial Mediterranean fever (FMF) have identifiable mutations in both alleles of the MEFV gene, while some individuals with paired MEFV mutations do not have clinical symptoms of the disease. During family studies we identified nine such individuals from six kindreds, most of whom either subsequently developed FMF or had other clinically significant inflammatory disease; one case benefiting substantially from colchicine therapy. Four individuals remained asymptomatic. Two further asymptomatic subjects with paired MEFV mutations were identified among 49 healthy controls from western Turkey, of whom a further 18.4 per cent were simple heterozygotes. This carrier rate was higher than would be expected from prevalence of FMF in this region, suggesting that penetrance of paired recognised pathogenic MEFV mutations may frequently be incomplete. MEFV genotyping results must be interpreted with due caution, and follow-up of apparently asymptomatic subjects with paired mutations is advisable.

Misdiagnosis of hereditary amyloidosis as AL (primary) amyloidosis.

BACKGROUND: Hereditary, autosomal dominant amyloidosis, caused by mutations in the genes encoding transthyretin, fibrinogen A alpha-chain, lysozyme, or apolipoprotein A-I, is thought to be extremely rare and is not routinely included in the differential diagnosis of systemic amyloidosis unless there is a family history. METHODS: We studied 350 patients with systemic amyloidosis, in whom a diagnosis of the light-chain (AL) type of the disorder had been suggested by clinical and laboratory findings and by the absence of a family history, to assess whether they had amyloidogenic mutations. RESULTS: Amyloidogenic mutations were present in 34 of the 350 patients (9.7 percent), most often in the genes encoding fibrinogen A alpha-chain (18 patients) and transthyretin (13 patients). In all 34 of these patients, the diagnosis of hereditary amyloidosis was confirmed by additional investigations. A low-grade monoclonal gammopathy was detected in 8 of the 34 patients (24 percent). CONCLUSIONS: A genetic cause should be sought in all patients with amyloidosis that is not the reactive systemic amyloid A type and in whom confirmation of the AL type cannot be obtained.