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Medicina (Kaunas, Lithuania) Oct 2023Total laryngectomy with partial pharyngectomy is traditionally the principal curative treatment for hypopharyngeal cancer; however, conservative surgical approaches... (Review)
Review
Total laryngectomy with partial pharyngectomy is traditionally the principal curative treatment for hypopharyngeal cancer; however, conservative surgical approaches that minimize functional disability are attracting increasing interest. Thus, we evaluated the appropriateness and oncological outcomes of open conservation surgery for such patients. We reviewed the medical records of 49 patients who underwent vertical hemipharyngolaryngectomy from 1998 to 2018 at a single institution. Locoregional recurrences developed in 19 patients (38.8%) and distant metastases in 6 (12.2%). Histopathologically, paraglottic space invasion was apparent in 13 patients (26.5%), pre-epiglottic space invasion in 4 (8.2%), thyroid cartilage invasion in 9 (18.4%), thyroid gland invasion in 2, perineural invasion in 11 (22.4%), and lymphovascular invasion in 35 (71.4%). The 5-year overall survival of patients who underwent open conservation surgery was comparable to that of patients who underwent total laryngectomy with partial pharyngectomy (68.7% vs. 48.4%, = 0.14). Pre-epiglottic space invasion significantly decreased the 5-year disease-free survival rate after open conservation surgery (69.7% vs. 17.9%, = 0.01). We found that pre-epiglottic space invasion negatively impacted disease control after open conservation surgery, emphasizing the crucial role played by a preoperative evaluation during patient selection.
Topics: Humans; Hypopharyngeal Neoplasms; Carcinoma, Squamous Cell; Neoplasm Recurrence, Local; Thyroid Gland; Minimally Invasive Surgical Procedures; Retrospective Studies
PubMed: 37893591
DOI: 10.3390/medicina59101873 -
Cancers Sep 2023Advanced penile carcinoma is characterized by poor prognosis. Most data on prognostic factors are based on small study cohorts, and even meta-analyses are limited in...
BACKGROUND
Advanced penile carcinoma is characterized by poor prognosis. Most data on prognostic factors are based on small study cohorts, and even meta-analyses are limited in patient numbers. Therefore, there is still a lack of evidence for clinical decisions. In addition, the most recent TNM classification is questionable; in line with previous studies, we found that it has not improved prognosis estimation.
METHODS
We evaluated 297 patients from Germany, Russia, and Portugal. Tissue samples from 233 patients were re-analyzed by two experienced pathologists. HPV status, p16, and histopathological parameters were evaluated for all patients.
RESULTS
Advanced lymph node metastases (N2, N3) were highly significantly associated with reductions in metastasis-free (MFS), cancer-specific (CS), and overall survival (OS) rates ( = <0.001), while lymphovascular invasion was a significant parameter for reduced CS and OS ( = 0.005; = 0.007). Concerning the primary tumor stage, a significant difference in MFS was found only between pT1b and pT1a ( = 0.017), whereas CS and OS did not significantly differ between T categories. In patients without lymph node metastasis at the time of primary diagnosis, lymphovascular invasion was a significant prognostic parameter for lower MFS ( = 0.032). Histological subtypes differed in prognosis, with the worst outcome in basaloid carcinomas, but without statistical significance. HPV status was not associated with prognosis, either in the total cohort or in the usual type alone.
CONCLUSION
Lymphatic involvement has the highest impact on prognosis in penile cancer, whereas HPV status alone is not suitable as a prognostic parameter. The pT1b stage, which includes grading, as well as lymphovascular and perineural invasion in the T stage, seems questionable; a revision of the TNM classification is therefore required.
PubMed: 37835442
DOI: 10.3390/cancers15194748 -
Ideggyogyaszati Szemle Mar 2024
We aimed to investigate the difference of clinical and electrophysiological improvement between perineural corticosteroid injection therapy (PCIT) and perineural 5%...
BACKGROUND AND PURPOSE
We aimed to investigate the difference of clinical and electrophysiological improvement between perineural corticosteroid injection therapy (PCIT) and perineural 5% dextrose injection therapy (5%PDIT) in carpal tunnel syndrome (CTS).
.METHODS
Total of 92 wrists that were diagnosed as mild-to-moderate idiopathic CTS and completed their follow-up were included in our study. The severity of pain, symptom severity and functional status were assessed by visual analog scale (VAS) and the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) scores for treatment effectiveness. Randomized wrists were administered PCIT or 5%PDIT accompanied by ultrasound guidance. VAS, BCTQ scores and the electrophysiological study repeated before and after treatment at the 1st and 6th months after perineural injection therapies (PITs) were recorded.
.RESULTS
Compared with baseline data, within groups there was significant improvement in VAS, BCTQ severity and function scores at 1st and 6th months follow-up (all p < 0.001). Considerable advance were detected in the median sensory nerve conduction velocity (SNCV) when pretreatment values were compared with posttreatment first month in both groups (p = 0.01; p < 0.001, respectively). No significant change occurred in median distal motor latency (DML) values between the 1st and 6th months in the groups (p = 0.095; p = 0.113, respectively). No significant difference was observed between 5%PDIT and PCIT groups.
.CONCLUSION
Clinical and electrophysiologic improvement in CTS began from 1st month after PCIT and 5%PDIT. At the 6th month follow-up of the patients, 5%PDIT and PCIT had similar therapeutic effects. As a result, we can consider the replacement of PCIT with 5%PDIT in mild-to-moderate CTS patients especially in those who are hesitant because of the corticosteroid’s adverse effects.
.Topics: Humans; Carpal Tunnel Syndrome; Wrist; Adrenal Cortex Hormones; Treatment Outcome; Glucose
PubMed: 38591925
DOI: 10.18071/isz.77.0121 -
Przeglad Gastroenterologiczny 2024Pancreaticoduodenectomy is a major procedure. Delayed gastric emptying (DGE) is a frequent postoperative complication that is attributed to several factors.
Association between perineural infiltrations and delayed gastric emptying after Whipple procedure for periampullary tumours, and the relationship with other clinicopathological factors and overall survival.
INTRODUCTION
Pancreaticoduodenectomy is a major procedure. Delayed gastric emptying (DGE) is a frequent postoperative complication that is attributed to several factors.
AIM
To investigate the probable association between perineural infiltrations and DGE, and the effects on overall survival.
MATERIAL AND METHODS
A total of 123 patients who underwent pancreaticoduodenectomy were enrolled in the study. Factors like the presence of perineural infiltrations and post-operative DGE along with age, gender, presence of postoperative fistula, and grade of fistula and postoperative haemorrhage were analysed, and survival analyses were conducted.
RESULTS
The presence of perineural infiltrations is statistically associated with DGE occurrence ( = 0.01). Moreover, the occurrence of DGE is statistically associated with male gender ( = 0.001), worse grade of postoperative fistula ( < 0.01), and the presence of postoperative haemorrhage ( = 0.03). There was no statistical association between the presence of perineural infiltrations and the other factors. Cox regression and Kaplan-Meier survival analyses showed that increased overall survival is associated with low age ( = 0.018 and = 0.028, respectively), absence of perineural infiltrations ( = 0.005 and = 0.003, respectively), better grade of postoperative fistula ( < 0.001), and absence of postoperative haemorrhage ( < 0.001). Multivariate analysis showed that independent prognostic factors for survival prognosis are perineural infiltrations, age, the presence of postoperative pancreatic fistula, and the presence of postoperative haemorrhage.
CONCLUSIONS
This is the first study that proves a statistically significant association between the presence of perineural infiltrations and the occurrence of DGE. Moreover, perineural infiltrations are an important independent prognostic factor for overall survival, along with other clinical factors.
PubMed: 38571537
DOI: 10.5114/pg.2023.129464 -
Biomedicines Dec 2023(1) Background: The human MutS homolog, hMSH2, is known to be involved in DNA mismatch repair and is responsible for maintaining the stability of the genome. When DNA...
Correlations between MSH2 and MSH6 Concentrations in Different Biological Fluids and Clinicopathological Features in Colorectal Adenocarcinoma Patients and Their Contribution to Fast and Early Diagnosis of Colorectal Adenocarcinoma.
(1) Background: The human MutS homolog, hMSH2, is known to be involved in DNA mismatch repair and is responsible for maintaining the stability of the genome. When DNA damage occurs, MSH2 promotes cell apoptosis via the regulation of ATR/Chk2/p53 signal transduction, and MSH2 deficiency is also related to accelerated telomere shortening in humans. MSH2 missense mutations are involved in a defective DNA reparation process, and it can be implied in carcinogenesis, as it is already involved in well-known cancer-related syndromes such as Lynch syndrome. Human MSH6, which stands for mutS homolog 6, is a member of the MMR family that is responsible for the repair of post-replicative mismatched DNA bases. It is also one of the proteins with gene mutations that are associated with a high risk of developing Lynch syndrome, leading to a large series of tumors. (2) Methods: Patients and their clinical and pathological features were selected from the database of the project GRAPHSENSGASTROINTES and used accordingly, with ethics committee approval no. 32647/2018 awarded by the County Emergency Hospital from Targu-Mures. Analyses were conducted on whole blood, saliva, urine, and tumoral tissue samples using a stochastic method with stochastic microsensors. (3) Results: The results obtained using stochastic sensors were correlated with a series of macroscopic and microscopic pathological features for each sample type. Criteria or relationships were established for tumor location, vascular and perineural invasions, lymph node metastases, the presence of tumor deposits, and the presence of a mucus compound in the tumor mass. (4) Conclusions: The correlation between the concentrations of MSH2 in the four types of samples and the pathological features allowed for the fast characterization of a tumor, which can help surgeons and oncologists choose personalized treatments. Also, the colorectal tumor location was correlated with the concentration of MSH2 in whole blood, urine, and saliva. MSH6, which stands for mutS homolog 6, is not only useful in immunohistochemistry but in pathology practice as well. In this paper, the relationships between MSH6 levels in four biological fluids-whole blood, saliva, urine, and tissues-and tumor locations among the colorectal area, gross features, presence of a mucinous compound, molecular subtype, stroma features, and vascular invasions are presented.
PubMed: 38137434
DOI: 10.3390/biomedicines11123213 -
Acta Cirurgica Brasileira 2023To evaluate the neuroprotective effects of Rilmenidine on diabetic peripheral neuropathy (DPN) in a rat model of diabetes induced by streptozotocin (STZ).
PURPOSE
To evaluate the neuroprotective effects of Rilmenidine on diabetic peripheral neuropathy (DPN) in a rat model of diabetes induced by streptozotocin (STZ).
METHODS
STZ (60 mg/kg) was administered to adult Sprague-Dawley rats to induce diabetes. On the 30th day after STZ administration, electromyography (EMG) and motor function tests confirmed the presence of DPN. Group 1: Control (n = 10), Group 2: DM + 0.1 mg/kg Rilmenidine (n = 10), and Group 3: DM + 0.2 mg/kg Rilmenidine (n = 10) were administered via oral lavage for four weeks. EMG, motor function test, biochemical analysis, and histological and immunohistochemical analysis of sciatic nerves were then performed.
RESULTS
The administration of Rilmenidine to diabetic rats substantially reduced sciatic nerve inflammation and fibrosis and prevented electrophysiological alterations. Immunohistochemistry of sciatic nerves from saline-treated rats revealed increased perineural thickness, HMGB-1, tumor necrosis factor-α, and a decrease in nerve growth factor (NGF), LC-3. In contrast, Rilmendine significantly inhibited inflammation markers and prevented the reduction in NGF expression. In addition, Rilmenidine significantly decreased malondialdehyde and increased diabetic rats' total antioxidative capacity.
CONCLUSIONS
The findings of this study suggest that Rilmenidine may have therapeutic effects on DNP by modulating antioxidant and autophagic pathways.
Topics: Rats; Animals; Diabetic Neuropathies; Rats, Sprague-Dawley; Diabetes Mellitus, Experimental; Rilmenidine; Nerve Growth Factor; Sciatic Nerve; Antioxidants; Inflammation
PubMed: 38055406
DOI: 10.1590/acb387823 -
World Journal of Surgical Oncology Nov 2023Perineural invasion (PNI) is regarded as a prognostic factor for patients with GC. However, the significance of PNI in patients with stage II GC remains unclear. This...
BACKGROUND
Perineural invasion (PNI) is regarded as a prognostic factor for patients with GC. However, the significance of PNI in patients with stage II GC remains unclear. This study aimed to investigate the clinical implication of PNI in patients with stage II GC undergoing curative resection.
METHODS
Patients with stage II GC who underwent curative resection were retrospectively evaluated from January 2010 to July 2019. According to PNI status, all patients were divided into two groups: with or without PNI. The prognostic value of PNI was analyzed by univariate and multivariate Cox proportional hazards regression models.
RESULTS
A total of 233 patients were included in this study. There were 100 patients with PNI (42.92%) and 133 patients without PNI (57.08%). The overall survival (OS) and disease-free survival (DFS) rates for patients with PNI were significantly lower than that for patients without PNI (p = 0.019 and p = 0.032, respectively). Multivariate analysis indicated that the presence of PNI was an independent risk factor for OS (hazard ratio (HR): 1.76, 95% confidence interval (CI) 1.02-3.06, p = 0.044) and DFS (HR: 1.70, 95% CI 1.04-2.80, p = 0.035), while adjuvant chemotherapy (AC) was an independent protective factor for OS (HR: 0.51, 95% CI 0.30-0.88, p = 0.016) and DFS (HR: 0.52, 95% CI 0.31-0.86, p = 0.011). Furthermore, among patients with PNI, those who received AC had better OS (p = 0.022) and DFS (p = 0.027) than their counterparts. When patients with PNI received AC, the OS (p = 0.603) and DFS (p = 0.745) appeared to be similar to those without PNI and no AC.
CONCLUSION
In patients with stage II GC undergoing curative resection, the presence of PNI was associated with worse survival, which appeared to improve with the treatment of AC, indicating a potential need for more intensive AC.
Topics: Humans; Stomach Neoplasms; Retrospective Studies; Peripheral Nerves; Prognosis; Disease-Free Survival; Neoplasm Invasiveness
PubMed: 38031044
DOI: 10.1186/s12957-023-03236-x -
Frontiers in Cellular Neuroscience 2024
PubMed: 38293293
DOI: 10.3389/fncel.2024.1365755 -
Endoscopy International Open Jul 2023Undifferentiated early gastric cancer (UD-EGC) represents an extended indication for endoscopic submucosal dissection (ESD) based on the existing guidelines. This study...
Undifferentiated early gastric cancer (UD-EGC) represents an extended indication for endoscopic submucosal dissection (ESD) based on the existing guidelines. This study evaluated the prevalence of UD-EGC recurrence after ESD, and potentially implicated risk factors. Data from 17 centers were collected retrospectively including demographics, endoscopic and pathological findings, and follow-up data from UD-EGC cases treated by ESD. Patients with incomplete resection or advanced disease were excluded. Descriptive statistics quantified variables and calculated the incidence of recurrence. Chi-square test was applied to assess any link between independent variables and relapse; significantly associated variables were inserted to a multivariable regression model. Seventy-one patients were eligible, with 2:1 female to male ratio and age of 65.8 ± 11.8 years. Mean lesion size was 33.5 ± 18.8 mm and the most frequent histological subtype was signet ring-cells UGC (2:1). Patients were followed-up every 5.6 ± 3.7 months with a mean surveillance period of 29.3 ± 15.3 months until data collection. Four patients (5.6%) developed local recurrence 8.8 ± 6.5 months post-ESD, with no lymph node or distal metastases been reported. Lesion size was not associated with recurrence ( = 0.32), in contrast to lymphovascular and perineural invasion which were independently associated with local recurrence ( = 0.006 and < 0.001, respectively). ESD could be considered as the initial step to manage UD-EGC, providing at least an "entire-lesion" biopsy to guide therapeutic strategy. When histology confirms absence of lymphovascular and perineural invasion, this modality could be therapeutic, providing low recurrence rates.
PubMed: 37744471
DOI: 10.1055/a-2105-1934 -
Cureus Feb 2024Background Oral cancer is found to be the thirteenth most common cancer as stated by the WHO (World Health Organization 2023). Oral squamous cell carcinoma (OSCC) is...
Background Oral cancer is found to be the thirteenth most common cancer as stated by the WHO (World Health Organization 2023). Oral squamous cell carcinoma (OSCC) is associated with deleterious oral habits such as smoking, chewing tobacco and betel quid, alcohol consumption, low socioeconomic status, sharp teeth, and various causative factors. Materials and methods A three-year retrospective analysis (March 2020-September 2023) was carried out with the available patient records in the Dental Information Archival Software (DIAS) used in a private dental college in Chennai. The demographic data such as age, gender, and habit duration and clinicopathological data such as the anatomical site; tumor, node, and metastasis (TNM) staging; perineural invasion (PNI); lymphovascular invasion (LVI); and oral health-related quality of life were retrieved. Statistical analysis was done using IBM SPSS Statistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, New York, United States). Results Males (78.35%) more commonly reported OSCC than females (21.62%), and the majority of them were in the age category of fifth to seventh decades of life. The most affected region was the buccal mucosa with 33.3%, followed by the lower alveolus with 30.63%. The duration of harmful habits varied from one year to more than 40 years, and the majority of the patients had T4a staging (40.54%), followed by T2 staging (29.73%) with a habit duration of more than five years. Approximately 22.52% and 0.9% had PNI and LVI, respectively. The correlation between the two variables was evaluated using the Pearson correlation test and was found to be statistically significant (p < 0.05), i.e., habit to gender and staging with gender were p = 0.027 and p = 0.028, respectively. Conclusion The majority of cases reported were found to be at T4a tumor staging with a habitual duration of more than five years, and more than half of the study population had severe compromise in their quality of life. The presence of perineural invasion and lymphovascular invasion has an impact on nodal metastasis, treatment choices, recurrence, and oral health-related quality of life. To address this challenge, oral health programs can implement comprehensive antitobacco counseling strategies, oral cancer public awareness programs to tackle the rising incidence of OSCC, and early oral precancer screening measures to enhance the prevention and overall quality of life of individuals with oral cancer.
PubMed: 38476798
DOI: 10.7759/cureus.54001