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Surgical Oncology Aug 2022Magnetic resonance imaging (MRI) has gained increasing importance in the management of rectal cancer over the last two decades. The role of MRI in patients with rectal... (Review)
Review
Magnetic resonance imaging (MRI) has gained increasing importance in the management of rectal cancer over the last two decades. The role of MRI in patients with rectal cancer has expanded beyond the tumor-node-metastasis (TNM) system in both staging and restaging scenarios and has contributed to identifying "high" and "low" risk features that can be used to tailor and personalize patient treatment; for instance, selecting the patients for neoadjuvant chemoradiation (NCRT) before the total mesorectal excision (TME) surgery based on risk of recurrence. Among those features, the status of the circumferential resection margin (CRM), extramural vascular invasion (EMVI), and tumor deposits (TD) have stood out. Moreover, MRI also has played a role in surgical planning, especially when the tumor is located in the low rectum, when the relationship between tumor and the anal canal is important to choose the best surgical approach, and in cases of locally advanced or recurrent tumors invading adjacent pelvic organs that may require more complex surgeries such as pelvic exenteration. As approaches using organ preservation emerge, including transanal local excision and "watch-and-wait", MRI may help in the patient selection for those treatments, follow up, and detection of tumor regrowth. Additionally, potential MRI-based prognostic and predictive biomarkers, such as quantitative and semi-quantitative metrics derived from functional sequences like diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE), and radiomics, are under investigation. This review provides an overview of the current role of MRI in rectal cancer in staging and restaging and highlights the main areas under investigation and future perspectives.
Topics: Humans; Magnetic Resonance Imaging; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Neoplasm Staging; Rectal Neoplasms; Rectum
PubMed: 35339339
DOI: 10.1016/j.suronc.2022.101739 -
Eye (London, England) Apr 2023Caruncle malignancy is rare, but signs of disease can be easily missed by both patients and clinicians. There is significant potential for significant morbidity and even... (Review)
Review
Caruncle malignancy is rare, but signs of disease can be easily missed by both patients and clinicians. There is significant potential for significant morbidity and even mortality from delayed diagnosis and treatment. Clinical features of primary malignant cancer include rapid growth, pigment deposition, ulcerated surface and bleeding. Malignant diagnoses include lymphoproliferative disease, basal cell carcinoma, squamous cell carcinoma, sebaceous carcinoma and malignant melanoma. Increased pigmentation is associated with melanoma, yellow coloured deposition with sebaceous carcinoma and a salmon-pink hue with lymphoproliferative disease. Treatment involves excision with margin control which may necessitate exenteration. Metastases to cervical and preauricular lymph nodes has been reported.
Topics: Humans; Skin Neoplasms; Adenocarcinoma, Sebaceous; Melanoma; Carcinoma, Basal Cell; Sebaceous Gland Neoplasms
PubMed: 35729271
DOI: 10.1038/s41433-022-02124-0 -
Obstetrics & Gynecology Science Sep 2021To describe the laterally extended parametrectomy (LEP) surgical technique, emphasizing the main challenges of the procedure.
OBJECTIVE
To describe the laterally extended parametrectomy (LEP) surgical technique, emphasizing the main challenges of the procedure.
METHODS
LEP was designed as a more radical surgical procedure aiming to remove the entire parametrial tissue from the pelvic sidewall. Its initial indications were for lymph node positive Stage Ib (current International Federation of Gynecology and Obstetrics 2018 Stage IIIc) and Stage IIb cervical cancer. Currently, with most guidelines recommending definitive radiochemotherapy for these cases, initial LEP indications have become debatable. LEP is now mainly indicated for removing tumors involving the soft structures of the pelvic sidewall during a pelvic exenteration, aiming to obtain lateral free margins. This expands the lateral borders of the dissection to not only the medial surface of internal iliac vessels, but also to the true limits of the pelvic sidewall.
RESULTS
During LEP, the parietal and visceral branches of the hypogastric vessels are divided at the entry and exit level of the pelvis. Consequently, the entire internal iliac system is excised, and no connective or lymphatic tissue remain on the pelvic sidewall. The main technical challenges of LEP are caused by the difficulty in ligating large caliber vessels (internal iliac artery and vein) and the variable anatomic distribution of pelvic sidewall veins.
CONCLUSION
LEP is a feasible technique for removing pelvic sidewall recurrences, aiming to obtain surgical free margins.
PubMed: 34030221
DOI: 10.5468/ogs.21103 -
Microorganisms Dec 2022: Gram-negative bacteria are causative agents of endogenous endophthalmitis (EBE). We aim to systematically review the current literature to assess the aetiologies, risk... (Review)
Review
: Gram-negative bacteria are causative agents of endogenous endophthalmitis (EBE). We aim to systematically review the current literature to assess the aetiologies, risk factors, and early ocular lesions in cases of Gram-negative EBE. : All peer-reviewed articles between January 2002 and August 2022 regarding Gram-negative EBE were included. We conducted a literature search on PubMed and Cochrane Controlled Trials. : A total of 115 studies and 591 patients were included, prevalently Asian (98; 81.7%) and male (302; 62.9%). The most common comorbidity was diabetes (231; 55%). The main aetiologies were (510; 66.1%), (111; 14.4%), and (60; 7.8%). Liver abscesses (266; 54.5%) were the predominant source of infection. The most frequent ocular lesions were vitreal opacity (134; 49.6%) and hypopyon (95; 35.2%). Ceftriaxone (76; 30.9%), fluoroquinolones (14; 14.4%), and ceftazidime (213; 78.0%) were the most widely used as systemic, topical, and intravitreal anti-Gram-negative agents, respectively. The most reported surgical approaches were vitrectomy (130; 24.1%) and evisceration/exenteration (60; 11.1%). Frequently, visual acuity at discharge was no light perception (301; 55.2%). : Gram-negative EBEs are associated with poor outcomes. Our systematic review is mainly based on case reports and case series with significant heterogeneity. The main strength is the large sample spanning over 20 years. Our findings underscore the importance of considering ocular involvement in Gram-negative infections.
PubMed: 36677371
DOI: 10.3390/microorganisms11010080 -
Eplasty 2022The COVID-19 pandemic has affected the entire world tremendously. Particularly during the second wave in India, a dangerous complication followed in the form of... (Review)
Review
BACKGROUND
The COVID-19 pandemic has affected the entire world tremendously. Particularly during the second wave in India, a dangerous complication followed in the form of COVID-19-associated mucormycosis. On June 7th, 2021, the Indian Union Health Minister stated that 28,252 cases of mucormycosis were reported from 28 states/Union territories in the country.
METHODS
A PubMed search was conducted for English-language studies published from 1988 through May 22, 2021 using the terms "reconstruction AND mucormycosis."
RESULTS
The search yielded 102 results. After excluding the articles not describing reconstruction in mucormycosis, 53 abstracts were screened. Then 34 articles dealing with reconstruction in non-ROC regions were excluded. The full text of 16 articles was reviewed. Additionally, 3 articles were identified from the reference search. Due to the aggressive debridements, rhino-orbito-cerebral mucormycosis survivors may be left with complex tissue defects with significant functional and aesthetic impairments. It is essential to offer reconstructive solutions that improve their quality of life. As far as the timing of reconstruction is concerned, the consensus is in favor of delayed reconstruction after ensuring that the infection has been eliminated/controlled and that there are no recurrences. The most common defects encountered were the ones that resulted from orbital exenteration and excision of a varying extent of the involved contiguous bony and soft tissue structures. Reconstruction with pedicled flaps was preferred rather than free flaps, especially in the cases where the infection was not eliminated completely. Adjuvant antifungal therapy was used in most of the cases. Long-term follow-up was considered essential to detect and treat recurrences.
CONCLUSIONS
A multitude of options are available for reconstruction in rhino-orbito-cerebral mucormycosis including skin grafts, pedicled flaps, free flaps and in some cases implants and prosthetics. These can be utilized to give as much as functional and aesthetic restoration as possible to the patient.
PubMed: 35873068
DOI: No ID Found -
American Journal of Ophthalmology Case... Dec 2020To describe the details of a unique case of cannibalistic orbital trauma and the oculoplastic reconstruction approach.
PURPOSE
To describe the details of a unique case of cannibalistic orbital trauma and the oculoplastic reconstruction approach.
OBSERVATIONS
A 65-year-old homeless man survived a disfiguring cannibalistic facial and bilateral orbital injury that included bilateral loss of all adnexal structures, partial exenteration of the left orbit, and severe damage to the right globe and anterior orbital structures. The patient's extensive facial and orbital tissue damage required emergent surgery, which included left exenteration and right eyelid reconstruction.
CONCLUSIONS
This is the first report of cannibalistic evisceration in a live victim who survived the attack, posing a unique reconstructive challenge. Bilateral globe removal was avoided to provide time for the patient's emotional recovery. Although this was an exceptional surgical scenario, traditional oculoplastic principles remained crucial to achieving a successful outcome. The patient survived and was pleased with his surgical outcome, refusing further reconstruction or prosthesis fitting.
PubMed: 33163692
DOI: 10.1016/j.ajoc.2020.100983 -
Clinics in Colon and Rectal Surgery Sep 2020Pelvic exenteration involves radical multivisceral resection for locally advanced and recurrent pelvic tumors. Advances in tumor staging, oncological therapies,... (Review)
Review
Pelvic exenteration involves radical multivisceral resection for locally advanced and recurrent pelvic tumors. Advances in tumor staging, oncological therapies, preoperative patient optimization, surgical techniques, and critical care medicine have permitted the safe expansion of pelvic exenterative surgery at specialist units. It is now understood that in carefully selected patients, 5-year survival can exceed 60% following pelvic exenteration, and that very low mortality figures and an optimum postexenteration quality of life are possible. In the present review, we provide a contemporary summary of the current state of the art in pelvic exenterative surgery following all key phases of the treatment pipeline from patient staging and tumor assessment, to treatment planning and surgery.
PubMed: 32968362
DOI: 10.1055/s-0040-1713744 -
Journal of Ophthalmic & Vision Research 2022The management of conjunctival melanoma is challenging due to the more frequent local recurrence and metastasis compared to other conjunctival neoplasms. Locally... (Review)
Review
The management of conjunctival melanoma is challenging due to the more frequent local recurrence and metastasis compared to other conjunctival neoplasms. Locally advanced conjunctival melanoma may require an orbital exenteration, and treatment options for metastatic conjunctival melanoma have been limited until recently. This review aims to provide comprehensive updates on immunotherapy for conjunctival melanoma, focusing on immune checkpoint inhibitors. We reviewed the available literature on the use of immunotherapy for the treatment of conjunctival melanoma. Systemic immunotherapy, particularly with checkpoint inhibitors, has recently been reported to have improved outcomes for patients with conjunctival melanoma. Immune checkpoint inhibitors that are currently approved by the US Food and Drug Administration for melanoma include anti-PD-1 (nivolumab and pembrolizumab), anti-PDL-1 (avelumab and atezolizumab), and anti-CTLA-4 inhibitors (ipilimumab). Most recent reports described using immune checkpoint inhibitors in patients with locally advanced conjunctival melanoma in an attempt to avoid orbital exenteration or in patients with metastatic conjunctival melanoma.Although the current data are limited to case reports and small case series, eye care providers should be aware of the potential role of immunotherapy for patients with locally advanced, recurrent, or metastatic conjunctival melanoma.
PubMed: 36160103
DOI: 10.18502/jovr.v17i3.11579