bluuebunny/crossref_metadata_2025 huggingface dataset:
Uneven development and displaced care in Sri Lanka
Authors: Withers Matt , Piper Nicola
Published: April 2018

Temporary labour migration has become a defining characteristic of Sri Lanka’s economy. The concentration of production and services in and around urban Colombo has produced a lopsided pattern of development that undermines traditional rural livelihoods and necessitates practices of ‘survival migration’. Such migration has been starkly gendered: export production has been explicitly feminised through the creation of garment factories operating in export processing zones, and through the displacement of care in the form of internal and international migrant domestic work. This article examines the displacement and commodification of care through the lens of domestic worker migration. It situates this at the intersection of gender, ethnicity and class, both geographically and historically, and analyses the Interrelationship between internal and international migration. This framework is then used to explore the changing dynamics of, and attitudes towards, domestic work. Migrant domestic work is explicitly bound up in uneven development, articulated through a continuum of gendered and ethnic subordination. There are many differentiated outcomes and experiences of constrained agency within this process.
Introduction: Towards a global sociology of care and care work
Authors: Aulenbacher Brigitte , Lutz Helma , Riegraf Birgit
Published: April 2018

Although care and care work have always formed a theme of fundamental social significance, neither has had much social recognition nor sociological attention commensurate with this importance. In this Current Sociology monograph we want to move the discussion forward towards a global sociology of care and care work. The contributions focus on both theoretical and empirical studies about care relations and their global interrelations. To shed light on the dynamics that characterise the social organisation of care and care work, the monograph has been structured around three significant tendencies in the international sociology of care: (a) the marketisation and the de-commodification of care and care work; (b) the transnationalisation of labour and policies; and (c) new forms of governance and social statehood. The articles in this monograph present state of the art research reflecting on the care-situation, -arrangements and -regimes all over the globe.
Since you left: United Nations peace support, private military and security companies, and Canada
Authors: Spearin Christopher
Published: April 2018

In the late 1990s when Canada was largely removing itself from United Nations peace support endeavours, private military and security companies were heralded as likely replacements. Canada has indicated its desire to reengage in a United Nations peace support milieu in which there is now a private military and security presence. It is not the type of presence initially envisioned, but it is one with multiple impacts regarding training and operations. This article emphasizes the interventions in the first decade of the twenty-first century and the corresponding, defensively minded regulations that came about in the private military and security industry. The article reveals that commercial logics are now insinuated in United Nations peace support operations and the private military and security presence therein is indicative of a larger shift in United Nations activities towards insularity and protection.
The Mulroney government and humanitarian intervention in the former Yugoslavia
Authors: Boutilier Misha
Published: April 2018

Based on primary and secondary sources, this article analyzes the policy of the Mulroney government on humanitarian intervention in the former Yugoslavia between 1991 and 1993. It finds that the Mulroney government chose to play a leading role in the international intervention in the former Yugoslavia, because doing so both allowed the government to implement its vision of a post-Cold War world order that aligned with its understanding of Canadian interests, and satisfied the demands and preferences of the Canadian public. At the same time, the Mulroney government stumbled into unanticipated situations in Yugoslavia, and failed to respond to them effectively. This led the government to reconsider the assumptions that had motivated its initial enthusiasm for intervention, and to commence a review of peacekeeping and intervention that it would not live to implement.
Experimental investigation and phenomenological modeling of hygrothermal effect on tensile fatigue behavior of carbon/epoxy plain weave laminates
Authors: Khay M , Ngo AD , Ganesan R
Published: April 2018

The purpose of this paper is to study the hygrothermal effect on fatigue behavior of quasi-isotropic carbon/epoxy plain weave aerospace laminates containing artificial flaw under axial tension–tension loading. Dry and wet specimens were tested at tensile load-controlled cyclic loading with a stress ratio R = 0.1 and a load frequency of 7 Hz at room temperature (RT) and at 82℃ under different stress levels. Allowable stiffness change as a failure criterion was used to determine the delamination propagation onset threshold under cyclic tensile loading at each environmental condition. The delamination propagation onset was verified using the ultrasonic imaging (C-Scan) technique. The experimental results show that (1) fatigue life of CFRP specimens was more individually affected by moisture than by temperature and (2) combined moisture and temperature cause a drastic decrease in fatigue life. Finally, an investigation of the effect of hygrothermal conditions on stiffness degradation and damage of composite laminates subjected to tensile fatigue loading has been also carried. On the basis of the residual stiffness degradation, a damage variable was presented and phenomenological damage models were proposed by employing fatigue modulus and secant modulus concepts as measure of material damage.
Accidental cut-throat injuries from the broken windshield of an auto rickshaw: Two unusual cases
Authors: Swain Rajanikanta , Dhaka Shivani , Sharma Munish , Bakshi Mantaran Singh , Murty OP , Sikary Asit Kumar
Published: April 2018

Accidental cut-throat injuries are extremely rare and usually involve a sharp-edged weapon. In this paper, two cases of a cut-throat wound to two auto-rickshaw drivers are presented where the broken windshield of the auto-rickshaws was responsible for the wounds. In both the cases, fatal incised wounds were present over the neck, cutting the soft tissue along with the major vessels. The death occurred due to exsanguination caused by neck-vessel injury in one case and trachea along with neck-vessel injury in the second case. Although the wounds on the neck initially suggested homicide, they were found to have occurred accidentally as a result of a road traffic accident involving a head-on collision of auto rickshaws. The injuries were inflicted by the shattered glass of the windshield.
Using Media While Interacting Face-to-Face Is Associated With Psychosocial Well-Being and Personality Traits
Authors: Lee Mindy , Murphy Karen , Andrews Glenda
Published: April 2018

Positive face-to-face human interactions are known to benefit well-being. Drawing upon previous work regarding the interference of media (via technological devices or print) in social interaction, the aim of this study was to identify whether using media during face-to-face interaction could potentially limit the positive effect of interaction on well-being. Participants were 437 university students who completed an online survey which assessed media multitasking behaviors, well-being (trait depression, trait anxiety, social anxiety, empathy, and psychological well-being), and personality traits (Big-5 and narcissism). Face-to-face interaction was positively associated with well-being. However, when media use during face-to-face interaction was considered, there was a negative relationship with well-being (more depression, more anxiety, and less psychological well-being). Those who used certain media types, such as phone or video chatting, listening to music, and gaming, while interacting with others, also had lower scores on measures of empathy. Regression analyses showed significant contributions by these media types to empathy levels, even after controlling for age, gender, and personality traits. Face-to-face media multitasking was related to higher levels of narcissism and neuroticism, and lower levels of agreeableness, conscientiousness, and openness. This study provides insight into the possible role of media multitasking during face-to-face interaction on psychosocial outcomes.
‘Deal or no deal?’ Governing urban infrastructure funding and financing in the UK City Deals
Authors: O’Brien Peter , Pike Andy
Published: April 2018

How urban infrastructure is funded, financed and governed is a central issue for states at the national, city-regional and city scales. Urban infrastructure is being financialised by financial and state actors and transformed into an asset in the international investment landscape. Local governments are being compelled by national state and financial institutions to be more entrepreneurial in their infrastructure funding and financing and to reorganise their governance arrangements. This article explains the socially and spatially uneven unfolding and implications of urban infrastructure financialisation and local government attempts to implement more entrepreneurial practices and governance forms. The empirical focus is the City Deals in the UK: a new form of urban governance and infrastructure investment based upon negotiated central–local government agreements on decentralised powers, responsibilities and resources. The continued authority of the highly centralised UK national state, its managerialist institutions and conservative/risk-averse administrative culture have constrained urban infrastructure financialisation and entrepreneurial urban governance in the UK City Deals. Situated in their particular spatial, temporal, political-economic and institutional settings, financialisation is understood as a socially and spatially variegated process and urban governance is interpreted as the articulation and mixing of new entrepreneurial and enduring managerialist forms.
Re-examining the early history of the Leiden jar: Stabilization and variation in transforming a phenomenon into a fact
Authors: Silva Cibelle Celestino , Heering Peter
Published: April 2018

In this paper, we examine the period that immediately followed the invention of the Leiden jar. Historians of science have developed narrations that emphasize the role of grounding during the process of charging the jar. In this respect, this episode shows significant aspects that can be used to characterize science, scientific knowledge production, and the nature of science. From our own experimentation, we learned that grounding was not necessary in order to produce the effect. These experiences inspired us to go back to primary sources. In doing so, we came to a new understanding of the early period after Kleist’s and Musschenbroek’s initial creation of the effect. From our analysis, we conclude that it is not the grounding which was perceived as a major innovation (as well as a challenge) during this early period of the discussion but the concept of an electrical circuit. This understanding was fundamental in characterizing the Leiden jar as a new device challenging the then current knowledge of experimental practices in the field of electricity.
Hematocrit and impact of transfusion in patients receiving extracorporeal life support
Authors: Swol Justyna , Marschall Christopher , Strauch Justus T. , Schildhauer Thomas A.
Published: April 2018

Introduction: Increasing the hematocrit is considered to increase oxygen delivery to the patient, especially when hypoxic conditions exist and the patient may become more stable. The aim of this study was to evaluate the relationship between hematocrit and hospital mortality via subgroup analyses of trauma and non-trauma patients. Methods: The hospital length of stay (LOS) and LOS in the intensive care unit (ICU) and hospital after extracorporeal life support (ECLS) treatment of 81 patients were analyzed and compared. In-hospital survival until extracorporeal membrane oxygen (ECMO) weaning and hospital discharge were defined as the clinical outcome. Results: Significantly increased mortality, with a relative risk of 1.73 with a 95% confidence interval of 1.134 to 2.639, was identified in the group with an hematocrit greater than 31%. However, no significant differences in relative risk (95% confidence interval) of death for each group were found among groups with an hematocrit less than or equal to 25%, 26-28% and 29-31%. Additionally, no significant relationship between survival and median hematocrit level was observed at a significance level of 0.413 and an Exp (B) of 1.089 at a 95% confidence interval of 0.878 to 1.373 in binary logistic regression analysis; a model was established with a -2 log likelihood of 40.687 for the entire group of patients. Moreover, a significant increase in mortality was observed as the average number of transfusions per day in the hospital increased (significance level 0.024, Exp (B) 4.378, 95% confidence interval for Exp (B) 1.212 to 15.810). Conclusion: Because a variety of factors influence therapy, the indication for transfusion should be re-evaluated and adapted repeatedly on a case-by-case basis. Further studies are needed to demonstrate whether an acceptable outcome from ECLS device therapy can also be achieved with a low hematocrit and a restrictive indication for transfusion.
Decision Making for Healthcare Resource Allocation: Joint v. Separate Decisions on Interacting Interventions
Authors: Dakin Helen , Gray Alastair
Published: April 2018

Standard guidance for allocating healthcare resources based on cost-effectiveness recommends using different decision rules for independent and mutually exclusive alternatives, although there is some confusion around the definition of “mutually exclusive.” This paper reviews the definitions used in the literature and shows that interactions (i.e., non-additive effects, whereby the effect of giving 2 interventions simultaneously does not equal the sum of their individual effects) are the defining feature of mutually exclusive alternatives: treatments cannot be considered independent if the costs and/or benefits of one treatment are affected by the other treatment. The paper then identifies and categorizes the situations in which interventions are likely to have non-additive effects, including interventions targeting the same goal or clinical event, or life-saving interventions given to overlapping populations. We demonstrate that making separate decisions on interventions that have non-additive effects can prevent us from maximizing health gained from the healthcare budget. In contrast, treating combinations of independent options as though they were “mutually exclusive” makes the analysis more complicated but does not affect the conclusions. Although interactions are considered by the World Health Organization, other decision makers, such as the National Institute for Health and Care Excellence (NICE), currently make independent decisions on treatments likely to have non-additive effects. We propose a framework by which interactions could be considered when selecting, prioritizing, and appraising healthcare technologies to ensure efficient, evidence-based decision making.
Evaluation of the Prognostic Accuracy of Astler-coller's and Jass’ Classifications of Colorectal Cancer
Authors: Li Destri Giovanni , Rinzivillo Calogero , Vasquez Enrico , Di Cataldo Antonio , Puleo Stefano , Licata Antonio
Published: April 2018

Aim

The study aim was to determine whether the Jass classification is superior to that of Astler-Coller (modification of Dukes’ stage) in determining prognosis of patients treated for colorectal carcinoma.

Study Design

The authors used Jass’ classification to restage 263 patients who had undergone radical colorectal surgery and classified according to Astler-Coller.

Results

The results revealed that: 1) Astler-Coller's classification enables more accurate selection of patient groups where life expectancy can be predicted; 2) Jass’ classification enables statistically significant (P <0.05) improved prognostic discrimination of Astler-Coller's B2 patients, for which the probability of nonrecurrence of the disease is around 60%.

Conclusions

Although Astler-Coller's classification is still valid, Jass’ classification is useful for the prognostic discrimination of Astler-Coller's B2 patients.
On the Delineation of the Gross Tumor Volume and Clinical Target Volume for Head and Neck Squamous Cell Carcinomas
Authors: Sanguineti Giuseppe , Foppiano Franca , Marcenaro Michela , Roncallo Federico , Corvò Renzo , Ameli Franco , Vitale Vito
Published: April 2018

Gross tumor volume (GTV) and clinical target volume (CTV) delineation on planning computed tomography (pICT) for head and neck squamous cell carcinomas can be troublesome. We highlight the factors which can be crucial for the radiation oncologist in delineating GTV and CTV on pICT and provide some pratical solutions. Regarding GTV, uncertainties are correlated with transfer of information collected by physical examination and diagnostic radiology to pICT. Moreover, reproducibility of delineation can also be highly variable, particularly when diagnostic imaging quality and pICT quality are poor. Once the prescription has been made, clinical target volume identification on pICT is rarely straightforward. Whereas there are some data about the location of major lymph node stations of the neck, there are no reported guidelines on how to draw subclinical extention of primary head and neck tumors on pICT. Such volumes can be derived from those currently included in simulator films or from those addressed by the surgeon. Some examples are provided. A particular situation is represented by the adjuvant setting, when the primary tumor is removed (by surgery) or reduced (by chemotherapy). In conclusion, this paper shows some major problems associated with identification of GTV and CTV on pICT. Apart from selected cases, the use of pICT for target volume delineation (and thus for field shaping) for head and neck squamous cell carcinoma is still to be considered investigational.
An Experience of Stereotactic Radiation Therapy for Primary Intracranial Choriocarcinoma
Authors: Kohyama Shinya , Uematsu Minoru , Ishihara Shoichiro , Shima Katsuji , Tamai Seiichi , Kusano Shoichi
Published: April 2018

We report on a patient with choriocarcinoma in the pineal region who was successfully treated with stereotactic radiation therapy (SRT). The increased level of serum human chorionic gonadotropin (HCG) was lowered during chemotherapy with etoposide, cisplatin, and ifosfamide. However, HCG was not normalized and magnetic resonance images still showed an enhanced tumor mass with gadolinium. The patient underwent SRT of 40 Gy at an 80% isodose line per 10 fractions over'two weeks, followed by conventional craniospinal irradiation of 32.4 Gy. The level of HCG dropped below the detection limit. The patient has been in good condition for more than four years after the completion of treatment, without any signs of recurrence. We propose SRT as a valid treatment option for malignant germ cell tumors in the pineal region.
Cadherins and Integrins in Renal Cell Carcinoma an Immunohistochemical Study
Authors: Markovic-Lipkovski Jasmina , Brasanac Dimitrije , Müller Gerhard A , Müller Claudia A
Published: April 2018

Aims and Background

The aim of this study was to determine the expression of cadherins and integrins in renal cell carcinoma (RCC) and their relationship with tumor morphology and TNM status.

Methods

Cadherin and integrin expression was investigated using an indirect immunoperoxidase technique, applying antibodies to E-, N-, P- and VE-cadherin and to α1, α2, α3, α4, α5, α6 and αv integrin subunits. Correlation of semiquantitatively scored adhesion molecule levels with histopathological parameters (cytology, growth pattern, nuclear grade) and TNM status was performed for 24 RCCs (17 clear cell, 3 granular, 3 spindle cell and 1 chromophobe cell type according to the WHO classification).

Results

E-cadherin and N-cadherin were present in most cases (88% and 67%, respectively) and were usually coex-pressed. T3 RCCs displayed higher E-cadherin and N-cadherin levels than T1/T2 tumors regardless of tumor grade, suggesting that impairment of their function might exist without actual loss from tumor cells. P-cadherin was found focally in two RCCs only, while VE-cadherin was present on stromal vessel endothelium in five tumors, showing no differences with regard to cell type, growth pattern, tumor grade or TNM status. All integrins were present in the studied RCCs (ranging from 12% for α5 to 79% for α3), including those that are normally absent from adult kidney tissue (α4 and α5). Tumors of higher grade showed increased αv and decreased α6 levels, while RCCs with metastases less often showed diffuse α3 presence and never expressed α5 integrin.

Conclusions

Our results suggest that the level of expression of N-cadherin and some integrins (most notably α3, α6, and α5) is associated with the capacity of RCC for local and distant spread, regardless of tumor grade.
Deep Venous Thrombosis of the Extremity Diagnosed by Color Doppler Ultrasonography after Isolated Limb Perfusion
Authors: Eroğrlu Aydan , Özcan Hasan , Eryavuz Yavuz , Kocaoğlu Hilmi , Demirci Salim , Aytac Suat K
Published: April 2018

Aim

Isolated limb perfusion (ILP) is used to treat locally advanced sarcoma and melanoma of the extremities. ILP is associated with a 1.7% to 10% incidence of deep venous thrombosis (DVT). The aim of the study was to examine the effect of ILP on the peripheral venous system and to evaluate the diagnostic accuracy of color Doppler ultrasonography (US).

Methods

A total of 26 patients with locally advanced sarcoma or melanoma of the extremities received a total of 38 ILP. The patients were evaluated preoperatively and postoperatively by color Doppler US as a noninvasive venous measurement. We used a color Doppler US system (SSA-270A, Toshiba) with a 7.5-MHz linear transducer for gray-scale imaging and a 5-MHz vascular transducer for color Doppler imaging.

Results

Seventeen patients underwent single ILP while the others were treated with multiple ILPs. Color Doppler US showed a reflux flow in three (7.9%) patients and DVT occurred subsequently in these patients.

Conclusions

Color Doppler US is a noninvasive and clinically useful diagnostic technique in the diagnosis of extremity DVT. We recommend anticoagulant therapy in patients with reflux on ultrasonographic examination.
High-grade Cervical Squamous Intraepithelial Lesion during Pregnancy
Authors: Candido Murta Eddie Fernando , De Souza Flávio Henrique Caetano , De Souza Maria Azniv Hazarabedian , Adad Sheila Jorge
Published: April 2018

Aims and Background

An increasing incidence of high-grade squamous intraepithelial lesion (HSIL) has been observed among young women. Consequently, an increased number of cases are being discovered during pregnancy. We analyzed the clinical and therapeutic management of HSIL during pregnancy.

Methods

A retrospective study was conducted from 1979 to 1998, and 58 registries of women with a cytological or histological diagnosis of HSIL during the pregnant-puerperal period were reviewed. Information obtained from medical records included age, gestational age at diagnosis, parity, age of first intercourse, number of sexual partners before pregnancy, tobacco use, cytologic and colposcopic findings, route of delivery, postpartum follow-up, and treatment. This information was compared with a non-pregnant control group with HSIL.

Results

The average age of pregnant women with HSIL was 27.9 ± 5.2 years. The cytologic or histologic diagnosis of HSIL was made in the first trimester in 12 (20.7%) women and in the second trimester in 30 (51.7%) women. Average parity was 2.8 ± 2 deliveries. Age of first intercourse ranged from 13 to 29 years (16.1 ± 3.3). Thirty-two women (55.1%) had more than one sexual partner before pregnancy. Thirty-seven (63.8%) refereed tobacco use. According to the aforementioned aspects, no statistical difference was found in relation to control, except to cervical ectopia, which was more frequent in pregnant women (56.9% versus 42.6%). From the total of 58 pregnant women with cytologic or biopsy HSIL diagnosis, 53 had HSIL diagnosis made on cervical biopsy directed by colposcopy performed during the pregnancy; 44 (83%) of them were submitted to conservative management. HSIL was diagnosed by cervical biopsy in postpartum evaluation in 76% pregnant women with vaginal delivery and 78.6% women who underwent cesarean section.

Conclusions

A conservative management of HSIL in pregnancy is proposed, with colposcopic evaluation during gestation and postpartum, regardless of route of delivery.
Reactivation of Pulmonary Tuberculosis in Malignancy
Authors: Karnak Demet , Kayacan Oya , Beder Sumru
Published: April 2018

Aims and Background

Deterioration of immunity due to local or systemic effects of the tumor itself and/or administered chemotherapeutics or radiotherapy may play roles in the reactivation of tuberculosis, increasing the mortality in patients with various malignancies. In a country with a high prevalence of tuberculosis such as Turkey, most people have inactive tuberculous lesions and tuberculin test positivity. Therefore, a prospective study was carried out to investigate the frequency of tuberculosis reactivation in patients with a malignancy.

Methods

Seventy-three patients with a malignancy and undergoing diagnostic fiberoptic bronchoscopy were enrolled in the study during a 2-year period (1993-1995). Bronchoscopic biopsies and cytologic materials were obtained. Bronchoalveolar lavage fluids, bronchial washings, and pre- and post-bronchoscopic sputum specimens were also evaluated for acid-fast bacilli. A diagnosis of tuberculosis was based on smear and/or culture positivity for acid-fast bacilli.

Results

The mean age of the patients was 56.2 ± 13.6 years, with a male/female ratio of 69/4. The biopsy proven malignancies were as follows: primary lung carcinoma (n = 66, 90.4%), lymphoma (n = 5, 6.8%), metastatic breast adenocarcinoma (n = 1, 1.4%), and acute myelocytic leukemia (n = 1, 1.4%). Thirty-one of all patients had findings compatible with tuberculosis on radiology. The sputa and bronchial washing specimens were smear negative in all patients. Acid-fast bacilli were grown on culture in 6 patients (8%) (primary lung cancer, n = 5; non-Hodgkin lymphoma, n = 1). Four of these 6 patients had positive radiology for tuberculosis. These subjects were treated with a three- or four-drug anti-tuberculosis regimen. Two months later, smears remained acid-fast bacilli negative, or no bacilli were grown on culture.

Conclusions

The possibility of coexisting tuberculosis should be kept in mind in patients with a malignancy, especially those with lung carcinoma in countries with a high prevalence of tuberculosis. Pulmonary infections encountered in such patients should raise the suspicion of tuberculosis reactivation, and in addition to direct microscopic evaluation, sputum specimens and materials obtained by fiberoptic bronchoscopy should be cultivated for tuberculosis. Three-four-drug anti-tuberculosis regimens should be given, especially in countries with high drug-resistance rates for eradicating tuberculosis.
Sentinel Node Biopsy in the Evaluation of the Internal Mammary Node Chain in Patients with Breast Cancer
Authors: Carcoforo P , Basaglia E , Soliani G , Bergossi L , Corcione S , Pozza E , Feggi L
Published: April 2018

Aims and Background

In patients with breast cancer the presence of internal mammary chain (IMC) metastases changes tumor staging, and the occurrence of IMC drainage is quite common in breast cancer. Nevertheless, IMC dissection is not a routine procedure in modern surgical approaches towards breast cancer. We therefore need minimally invasive techniques for accurate assessment of the IMC nodal basin. The aim of this study was to investigate whether sentinel node biopsy (SLNB) could offer a solution.

Methods and Study Design

From November 1997 to June 2001 143 female patients who were eligible for breast cancer surgery were included in the study. All patients had T1 breast cancer and clinically negative axillae. Patients were submitted to preoperative lymphoscintigraphy with subsequent SLNB. We used a 99m-technetium nanocolloid tracer (Nanocoll®) that was injected peritumorally so as to have about 10 MBq of radioactivity at the time of surgery. Scintigraphy was performed about 17 hours after tracer administration. During surgery, lymphoscintigraphic imaging and a gamma ray detection probe were used to locate the sentinel node. Histological examination after embedding in paraffin was usually requested and multilevel sectioning of the sentinel node (SLN) was performed, with hematoxylin and eosin staining and immunohistochemistry.

Results

Preoperative lymphoscintigraphy localized SLNs in the IMC basin in 27 of 143 patients (18.9%). Harvesting of IMC-SLNs based on lymphoscintigraphy results was successful in 20 of 27 patients (74.1 %). Histological examination revealed micrometastases in four of the 20 harvested nodes. One of these patients showed no axillary drainage and no axillary lymph node dissection was therefore performed. In the remaining three patients also axillary SLNs were harvested, which turned out be free from metastatic involvement.

Conclusions

In our experience lymphoscintigraphy with SLNB was an accurate method to detect IMC metastases in patients with breast cancer. We recommend peritumoral tracer injection and a reasonable interval between injection and scintigraphy. IMC-SLN biopsy did not result in any serious additional complications or morbidity. In our study this approach led to improved cancer staging: four of 20 harvested IMC-SLNs proved to be micrometastatic. None of these four patients had metastatic axillary SLNs. Exclusive drainage to the IMC is present in only a small number of breast cancer patients, and our results suggest that it is possible to avoid unnecessary axillary node dissection in such cases.
Radioguided Surgery for Gastrinoma: A Case Report
Authors: Albertario S , Forti P , Bianchi C , Morone G , Tinozzi FP , Moglia P , Abelli M , Benedetti M , Aprile C
Published: April 2018

Aims and Background

Gastrinomas are the most common neuroendocrine tumors of the duodenopancreatic region. Surgical resection is the primary type of radical treatment.

Methods and Study Design

At the Institute of General, Gastrointestinal and Breast Surgery we treated a patient with a duodenal gastrinoma that was diagnosed and localized by means of selective celiacmesenteric angiography and labeled octreotide scintigraphy. Surgery was performed using a radioguided technique; in this way we easily detected the small tumor and discovered another tracer-uptaking lesion that turned out to be a metastatic lymph node.

Results

Surgical resection is the ideal treatment for sporadic gastrinoma: it improves quality of life, prolongs survival, and reduces the incidence of metastases, with a modest percentage of complications and practically zero mortality. Meanwhile, medical treatment is being revaluated, particulary in the case of metastatic disease or polyendocrine MEN1 syndrome. A fundamental aspect in the management of gastrinomas is tumor localization. Endoscopic ultrasonography and labeled octreotide scintigraphy (Octreoscan) proved to be more effective than the usual imaging modalities. Intraoperative ultrasonography, gastroscopy for duodenal transillumination and repeated measurement of blood gastrin levels should be performed intraoperatively in the surgical treatment of gastrinomas.

Conclusions

The clinical application of radioguided surgery for tracer-uptaking endocrine tumors is still controversial. In our case the decision to use this method was influenced by the fear that the patient's obesity and the effects of previous surgery could hamper the identification of the small tumor.
Sentinel Lymphadenectomy in Cutaneous Melanoma
Authors: Buonomo O , Felici A , Granai AV , Piccirillo R , De Liguori Carino N , Guadagni F , Mariotti S , Orlandi A , Tipaldi G , Cipriani C , Chimenti S , Cervelli V , Casciani CU , Roselli M
Published: April 2018

Aims and Background

In the last ten years validation of the sentinel lymph node (SLN) concept has led to modification of the surgical approach for patients with intermediate-risk cutaneous melanoma.

Methods and Study Design

Forty-eight patients affected by cutaneous melanoma with a Breslow thickness between 0.65 and 4 mm were enrolled in the study. Approximately 2 mCi of radiotracer and 1 mL of vital blue dye were injected in each patient around the site of the primary lesion. Lymphoscintigraphy was performed until the lymphatic basin and the respective SLN were localized. The whole surgical procedure consisted of enlargement of the surgical margins followed by localization and excision of the SLN(s) by using both radiotracer and vital dye. Whenever the SLN proved to be histologically positive for metastasis, complete regional lymphadenectomy was performed.

Results

Within 15 minutes of radiotracer administration the lymphatic basin was localized in all 48 patients by lymphoscintigraphy. Vital dye and radiotracer successfully allowed SLN localization and excision in 46 of 48 patients (97%); in one case the SLN was detected by radiotracer alone. The SLN proved to be metastatic in six (13%) of 46 evaluable patients; interestingly, in three of them the presence of metastatic cells was revealed only by immunohistochemistry. All patients with tumor-positive SLNs had primary lesions with a Breslow thickness = 2 mm.

Conclusions

Sentinel lymphadenectomy is able to identify lymph node involvement in patients with cutaneous melanoma with a Breslow thickness >1 mm, thus avoiding the risks associated with radical regional lymphadenectomy. Lymphoscintigraphy proved to be an important tool to obtain correct preoperative localization of the drainage basin, especially for melanomas located on the face and trunk.
99MTc-mibi Radio-guided Surgery in Primary Hyperparathyroidism: A Prospective Study of 128 Patients
Authors: Rubello D , Casara D , Saladini G , Piotto A , Pagetta C , Pelizzo MR
Published: April 2018

Aims and study design

We investigated the role of an intraoperative gamma probe (IGP) technique in 128 patients with primary hyperparathyroidism (HPT). The patients were evaluated before surgery by 99mTcO4/MIBI scintigraphy and neck ultrasound and then operated on by the same surgical team. The IGP technique consisted of the injection of a low dose (37 MBq) of 99mTc-MIBI in the operating room shortly before the start of surgery. Quick parathyroid hormone (QPTH) was routinely measured during the operation.

Results

In 94/97 patients (96.9%) with a preoperative diagnosis of solitary parathyroid adenoma (PA) minimally invasive radioguided surgery (MIRS) was successfully performed; in the other 3/97 patients (3.1%) conversion to bilateral neck exploration (BNE) was required because of the intraoperative diagnosis of parathyroid carcinoma in two cases and multiglandular disease (MGD) in one. MIRS was successfully performed also in 23 patients who had undergone previous thyroid or parathyroid surgery. In 31 patients with a preoperative diagnosis of MGD (n = 5) or concomitant nodular goiter (n = 26) the IGP technique was used during a bilateral neck exploration. Among these patients IGP was useful in localizing an ectopic parathyroid gland in the thymus in one case of MGD and a PA located deep in the neck (n = 2) or ectopic at the carotid bifurcation (n = 1) in three cases with nodular goiter. However, in several other patients with nodular goiter it was difficult for the probe to distinguish intraoperatively between thyroid nodules and PA located close to the thyroid gland.

Conclusions

It can be concluded that a) in primary HPT patients with a high likelihood (according to scintigraphic and ultrasound findings) of being affected by a single PA and with a normal thyroid gland, the IGP technique appears useful in MIRS; b) a 99mTc-MIBI dose as low as 37 MBq appears to be adequate to perform MIRS; c) the measurement of QPTH is strongly recommended in HPT patients selected for MIRS to confirm the radicality of parathyroidectomy; d) MIRS can be useful also in HPT patients who underwent previous parathyroid or thyroid surgery to limit the surgical trauma of reoperation and minimize complications; e) with the exception of PAs located at ectopic sites or deep in the neck, the IGP technique does not seem to be recommendable in HPT patients with concomitant nodular goiter.
Late Visual and Auditory Toxicity of Radiotherapy for Nasopharyngeal Carcinoma
Authors: Rosenblatt Edward , Brook Olga R , Erlich Nurit , Miller Benjamin , Joachims Henry Z , Kuten Abraham
Published: April 2018

Aims and Background

Classical irradiation of carcinoma of the nasopharynx involves large fields and high doses; therefore, significant late toxicity and late side effects are to be expected. Given the fact that nasopharyngeal carcinoma (NPC) is a relatively radiosensitive disease and a significant proportion of patients are long-term survivors, late visual and auditory complications of treatment are of utmost concern for patients and radiation oncologists. The aim of this study was to evaluate the long-term visual and auditory toxicity in patients treated with radiotherapy for NPC.

Methods and Study Design

Forty-three long-term survivors (including 11 children), following definitive radiotherapy for NPC, underwent a thorough visual and auditory evaluation 2–22 years after their treatment. Ophthalmological examination consisted of anamnesis of dry eye syndrome and visual acuity, visual acuity testing, slit-lamp examination, Schirmer test, fundus examination, and intraocular pressure measurement, as well as fluorescein angiography in patients with pathological vascular findings in the fundus examination. Audiological evaluation included anamnesis of hearing loss, tinnitus or vertigo, examination of the ears and nasopharynx, audiogram, and tympanogram.

Results

Radiation retinopathy was found in 16% of patients by fundus examination, with one patient (2.3%) developing blindness. Severe dry eye syndrome was present in 26%. Fifty-six percent had some degree of hearing impairment, with 74% showing severe sensorineural hearing loss. Fifty-eight percent of patients reported tinnitus and 26% reported suffering from dizziness. Radiation retinopathy as well as all manifestations of auditory toxicity were found to bear a direct correlation with dose per fraction.

Conclusions

Unless there is tumor involvement, the orbital contents should be completely excluded from the target volume. Auditory toxicity is significant when treating NPC with two-dimensional techniques.
A Study of the Clinical Features and the Treatment of Breast Cancer in 374 Patients in Iran
Authors: Salsali Morteza , Tazejani Dehghan , Javadi Amir , Mahmud Babak , Sali Hamid-Reza , Hirani Ali , Baghbanian Mohamed , Hajipour Rambod
Published: April 2018

For evaluation of clinical features and state of the art in the treatment of breast cancer in Iran, we studied 347 consecutive patients among 1123 hospital admissions (in 14 hospitals in three cities) who had undergone surgery for a mass in their breasts during a 2-year period, 1991 to 1992. Thirty-nine additional patients with breast cancer had been treated in the second year of the study, an increment of 8.9%. The relative frequency of positive biopsies for breast cancer was 31% for the entire series. In Teheran, Babol and Yazd, it was 35%, 24.2% and 18.1%, respectively. The mean age for the entire series was 48 ± 1 years. The mean age for patients from Yazd was 51 ± 9, which was higher than the mean age (41.5 ± 16) of patients from Babol. The pathologic diameter was >2.1 cm (pT2 and pT3) in 59.36% of the tumors. In 15.56% of the patients, the exact size of the tumor was not available. In 83.45% of the patients, the tumors were reported as infiltrating ductal carcinoma. Of 173 patients in whom regional nodes had been histologically examined, 80% had metastatic involvement (stage II disease). Modified radical mastectomy had been used more than radical mastectomy in this series, but the choice of the operation was not related to the size of tumor.
Ethics Committees in Italy: A Survey on a Sample of Oncologists
Authors: Mosconi Paola , Apolone Giovanni , Cattaneo Giovanna , Pomodoro Livia , Garattini Silvio
Published: April 2018

Aims and background

The mission of physicians and the purpose of clinical research may give rise to a conflict between medical ethics and human rights. All the recommendations, directives and laws regarding experimental interventions require a formal protocol, approval from an ethics committee (EC), and written informed consent from potential participants. In Italy new guidelines on handling submissions to EC were published in 1998. One year later, there was a feeling among people involved in EC activities that the immediate impact of the new rules (ie, decentralization and emphasis on pharmacological aspects of the studies) was negative. A prospective study was launched to evaluate oncologists’ opinions on Italian EC functioning.

Methods and study design

A questionnaire was administered twice to 110 oncologists involved in two multicenter trials. Nine questions were included regarding the following aspects: presence of an EC at hospital level, personal experience with an EC, average time required for the evaluation of proposals submitted, and level of satisfaction with important functions of the EC.

Results

Responses were received from 93 (first survey) and 69 (second survey) clinicians. In both surveys clinicians reported they were satisfied with the scientific and ethical aspects of EC functioning but dissatisfied with educational activities and training as well as bureaucratic and clerical requirements. At the second survey, the mean time required for evaluation after the submission of a study protocol was about 2.4 months and the level of dissatisfaction was still high for some critical aspects such as bureaucracy (44%) and educational activities and training (64%). Analysis of the change over time documented small differences (from -8% to +7%) in all aspects evaluated.

Conclusions

Despite the limitations of the present study, ie, the small sample size and the intrinsic characteristics of the Italian setting, the findings add empirical evidence regarding the functioning of local EC and clinical researchers’ opinions. This experience confirms that empirical studies on medical ethics are feasible and may produce useful information to facilitate the implementation of EC in the medical and lay community.
Rare Case of Neuroendocrine Small Cell Carcinoma of the Endometrium with Paraneoplastic Membranous Glomerulonephritis
Authors: Meydanli M Mutlu , Erguvan Rezzan , Altinok M Tayfun , Ataoglu Omur , Kafkasli Ayse
Published: April 2018

Small cell carcinomas are well-recognized tumors known to occur predominantly in the lung. These neoplasms are occasionally associated with a variety of paraneoplastic syndromes. Four cases of paraneoplastic glomerulopathy associated with small cell lung carcinoma have been reported. However, there have been no reports in the literature indicating an association between endometrial small cell carcinoma and paraneoplastic glomerulopathy. We report a case of neuroendocrine small cell carcinoma of the endometrium associated with membranous glomerulonephritis (MGN), which appeared to be a component of an unusual paraneoplastic syndrome. A 33-year-old multiparous woman presented with abnormal vaginal bleeding and abdominal bloating. Endometrial biopsy revealed neuroendocrine small-cell carcinoma of the endometrium. On the eighth day of hospitalization the patient suddenly developed renal failure. Renal biopsy revealed MGN, probably due to tumor-antigen-related immune complex deposition. Small cell carcinoma of the endometrium may be associated with paraneoplastic MGN. Medical staff should take into account the possibility of a preexisting glomerular injury when managing a patient with small cell carcinoma of the endometrium.
Assessment of Cytogenetic Aberrations and Comet Assay in Colorectal Adenocarcinomas
Authors: Baltaci Volkan , Sardas Semra , Aytac Bulent , Cakar Sami , Karakaya Ali Esat
Published: April 2018

Aims, Background and Study Design

Few studies have investigated the karyotypes of colorectal carcinomas with emphasis on the correlation between cytogenetic findings and clinicopathologic features. The aim of our study involving 20 colorectal adenocarcinomas was to determine their genomic alterations at the chromosomal level by correlating the cytogenetic findings with the extent of DNA damage and clinicopathologic parameters and to compare the results with those of healthy controls.

Results

Cytogenetic evaluation of patients and controls revealed 10 abnormal karyotypes in patients with adenocarcinomas located in the rectum, sigmoid and rectosigmoid regions. Four had numerical and six had structural abnormalities.

Conclusions

Statistical analysis revealed a significant difference compared with controls (P <0.01). The karyotypes and the extent of DNA damage assessed by the comet assay were also significantly correlated with tumor stage (P <0.01) using the Kruskal-Wallis non-parametric test, while no statistical significance was observed in relation to patient age and smoking.
Synchronous Presentation of an Askin Tumor and a Plasmacytoma in an Adult Patient
Authors: Fresco Rodrigo , Saldombide Lyber , Suárez Lilians
Published: April 2018

Askin tumor, or malignant small round cell tumor of the thoracopulmonary region, is an extremely infrequent entity occurring primarily in children and adolescents. Its histopathologic and cytogenetic features suggest that it belongs to the family of Ewing's sarcoma and primitive neuroectodermal tumors.

We report the case of a 43-year-old woman affected by an Askin tumor with bone metastases at diagnosis, presenting synchronously with a plasmacytoma. This is the first reported case of the simultaneous occurrence of an Askin tumor and a malignant hemopathy. The progression of the former and the remission of the plasmacytoma during chemotherapy were remarkable, since Askin tumor treatment shares drugs used for the treatment of plasma cell tumors. Given the infrequent presentation of these diseases in a young adult and the coexistence of two neoplasias characterized by typical chromosomal abnormalities, we consider the possibility of a genetic cancer susceptibility in our patient.