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Primary lymphoma of the colon is a rare tumor of the gastrointestinal (GI) tract and comprises only 0.2-1.2% of all colonic malignancies. The most common variety of colonic lymphoma is non-Hodgkin's lymphoma (NHL). The GI tract is the most frequently involved site, accounting for 30-40% of all extra nodal lymphomas, approximately 4-20% of which are NHL. The stomach is the most common location of GI lymphomas, followed by the small intestine. Early diagnosis may prevent intestinal perforation; however, the diagnosis is often delayed in most cases. Therapeutic approaches described in two subsets include: Radical tumor resection (hemicolectomy) plus multi-agent chemotherapy (polychemotherapy) in early stage patients, biopsy plus multidrug chemotherapy in advanced stage patients. Radiotherapy is reserved for specific cases; surgery alone can be considered as an adequate treatment for patients with low-grade NHL disease that does not infiltrate beyond the sub mucosa. Although resection plays an important role in the local control of the disease and in preventing bleeding and/or perforation, it rarely eradicates the lymphoma by itself. Those with limited stage disease may enjoy prolonged survival when treated with aggressive chemotherapy.
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PMID:Primary lymphoma of the colon. 1979 80

The widespread availability of novel primary treatment approaches against oropharyngeal cancers has provided several potentially curative surgical and nonsurgical treatment options for patients, generating both hope and controversy. As treatment is usually curative in intent, management considerations must include consideration of primary tumor and nodal disease control as well as long-term toxicities and functional outcomes. Anatomical and functional organ preservation (speech and deglutition) remains of paramount importance to patients with oropharyngeal cancer and the physicians involved in their care, accounting for the growing popularity of chemoradiotherapy and transoral surgical techniques for this indication. These novel approaches have greatly diminished the role of open surgery as initial therapy for oropharyngeal cancers. Open surgery which is often reserved for salvage on relapse, may still be an appropriate therapy for certain early stage primary lesions. The growing treatment armamentarium requires careful consideration for optimal individualized care. The identification of oncogenic human papillomavirus as a predictive and prognostic marker in patients with oropharyngeal cancer has great potential to further optimize the choice of treatment. In this review, novel primary therapies against oropharyngeal squamous cell carcinoma are presented in the context of anatomical, quality of life, and emerging biological considerations.
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PMID:Current trends in initial management of oropharyngeal cancer: the declining use of open surgery. 1986 22

Completion operations after thyroid surgery due to incidental postoperative diagnosis of thyroid cancer are indicated in differentiated thyroid cancer with tumor size > 1 cm, extrathyroidal invasion, multifocality, angioinvasion or metastases. By thorough preoperative clinical work-up of nodular goiter (ultrasonography, fine needle aspiration cytology the frequency of completion thyroidectomies are aimed to be less than 10% of all thyroid cancer operations. To facilitate postoperative radioiodine ablation prophylactic completion operations can be postponed to 3 months postoperatively to minimize surgical morbidity, if not performed during the early postoperative period. Prophylactic central node dissection as part of the completion operation is reserved for papillary (PTC) and medullary carcinomas (MTC) but not for follicular cancer. Lateral node dissection is recommended in nodal-positive MTC and in PTC with more than 5 lymph node metastases in the central compartment.
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PMID:[Thyroid carcinoma found incidentally after thyroidectomy: postoperative strategy]. 1994 Dec 36

Locally advanced non-small-cell lung cancer is a heterogeneous group of diseases encompassing both stage IIIA and IIIB disease. The treatment options vary, including surgery, chemotherapy, neoadjuvant concurrent chemoradiation, definitive chemoradiation, radiation, and various combinations of the above. Optimal therapy for each patient group is controversial; however, previous trials have shown efficacy of various treatments for different stages. Surgery as initial therapy is beneficial for patients with stage T3, N1 or T3-4, N0-1 disease due to satellite lesions within the same lung. Chemotherapy should be used for diseases minimally involving the mediastinal lymph nodes, whereas concurrent induction chemoradiation is a good option for bulky nodal disease prior to planning a resection. Concurrent definitive chemoradiation or definitive radiation should be reserved for patients who are not candidates for a surgical resection. Most importantly, the treatment strategy for stage IIIA/IIIB disease should involve a multimodality approach individualized to the patient's disease stage, age, underlying medical conditions, and performance status.
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PMID:Managing the patient with borderline resectable lung cancer. 2039 37

Radiofrequency catheter ablation (RFA) is an effective treatment of arrhythmias. However, patients often remain symptomatic after the procedure. We aimed to assess the arrhythmia recurrence after successful RFA in relation to patients' symptoms using transtelephonic loop recorders. Thirty-six consecutive patients (age 50 +/- 14 years, 17 males/19 females) were enrolled after successful RFA for atrioventricular (AV) nodal reentrant tachycardia (n = 21), AV reentrant tachycardia (n = 8), atrial tachycardia (n = 2), atrial fibrillation/flutter (n = 4), and ventricular tachycardia (n = 1). During 23 +/- 6 days of follow-up, 679 events were recorded, 246 of which were true arrhythmic events, mostly (56%) asymptomatic. The vast majority of these true arrhythmic events were due to trivial arrhythmias (extrasystoles or sinus tachycardia), equally distributed among symptomatic and asymptomatic episodes. Arrhythmia relapse was shown in four patients, who had a total of nine episodes, eight of which were symptomatic. No high degree AV block was detected. Overall, symptom recurrence had low sensitivity (44%) and high specificity (95%) for the detection of any arrhythmia, and high sensitivity (89%) but low specificity (58%) for the detection of relapse. In conclusion, transtelephonic monitoring was a useful tool for the assessment of symptoms after RFA and its use may be reserved for the most symptomatic patients to detect a relapse or to reassure them for the benign nature of their symptoms.
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PMID:The use of transtelephonic loop recorders for the assessment of symptoms and arrhythmia recurrence after radiofrequency catheter ablation. 2081 46

The diagnosis of Wolff-Parkinson-White syndrome is typically reserved for patients who experience ventricular pre-excitation and symptoms that are related to paroxysmal supraventricular tachycardia, such as chest pain, dyspnea, dizziness, palpitations, or syncope. Herein, we report the case of a 38-year-old woman who presented at our outpatient department because of exercise intolerance. Cardiac auscultation revealed a grade 2/6 pansystolic murmur over the left lower sternal border. Twelve-lead electrocardiography showed sinus rhythm at a rate of 76 beats/min, with a significant delta wave. Transthoracic echocardiography revealed abnormal left ventricular systolic function. The results of a thallium stress test were also abnormal. Coronary artery disease was suspected; however, coronary angiography yielded normal results. Electrophysiologic study revealed a para-Hisian Kent bundle and a dual atrioventricular nodal pathway. After radiofrequency catheter ablation was performed, the patient's left ventricular function improved and her symptoms disappeared. In Wolff-Parkinson-White syndrome, left ventricular systolic dyssynchrony can yield abnormal findings on echocardiography and thallium scanning--even in persons who have no cardiovascular risk factors. Physicians who are armed with this knowledge can avoid performing coronary angiography unnecessarily. Catheter ablation can reverse the dyssynchrony of the ventricle and improve the patient's symptoms.
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PMID:Reversion of left ventricular systolic dysfunction and abnormal stress test: by catheter ablation, in a patient with Wolff-Parkinson-White syndrome from Para-Hisian Kent bundle. 2084 29

The management of regional lymphatics in patients with melanoma has evolved over the past several decades from delayed lymphadenectomy, to elective resection, to the current approach which utilizes sentinel lymph node mapping to accomplish a selective approach to performing lymphadenectomy. Sentinel lymphatic mapping allows for an opportunity to demonstrate regional lymphatic disease prior to the development of lymphadenopathy. Complete resection of a nodal basin can be reserved for patients with documented disease in a sentinel node while patients with a negative sentinel node can avoid an unnecessary and potentially morbid surgery. The preliminary results of sentinel node mapping at Ochsner Medical Institutions reflect an outstanding ability to demonstrate the sentinel node in patients with trunk and extremity melanoma when radioactive colloid is used in combination with a vital blue dye. The results of sentinel node mapping in patients with head and neck melanoma have not been as reliable and require additional refinements of technique.
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PMID:A selective approach to regional lymphatics in melanoma. 2184 20

Neuroendocrine neoplasms are a rare and heterogeneous group of diseases that account for only 2% of all gynecologic malignancies. The most common types are ovarian carcinoid tumor and small cell neuroendocrine carcinoma of the cervix. The tumors are staged according to FIGO clinical staging system. The diagnosis is usually made retrospectively after obtaining the results of histopathological evaluation of the primary tumor They rarely cause syndromes related to hormone overexpression. Neuroendocrine neoplasms are characterized by aggressive behaviour Even at an early stage there is high incidence of nodal and distant metastases. Survival is poor regardless of stage at diagnosis. The most important is to diagnose the neuroendocrine tumor accurately and treat it in multimodal, aggressive approach to control the disease better and reduce the incidence of reccurences. Apart from typical therapeutic approach, treatment may encompass isotope therapy using radiolabeled somatostatin analogs. This method should be reserved for patients with expression of somatostatin receptors detected by the somatostatin receptor scyntygraphy. Data concerning the management of neuroendocrin tumors are based mainly on retrospective studies and clinical case series. Lack of randomized trials makes it impossible to select the best treatment option. Better understanding of the biology of neuroendocrine tumors, especially the molecular genetics, will in the future help to determine the optimal treatment strategies for these tumors.
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PMID:[Contemporary management of neuroendocrine neoplasms of the female genital organs]. 2237 29

This article reviews the changes in management of the axilla in patients with breast cancer in the last decade. It discusses the recent advances, existing controversies and provides evidence-based guidelines for use in clinical practice.Sentinel lymph node (SLN) biopsy has replaced the more morbid axillary lymph node dissection (ALND) and four node sampling for axillary nodal staging. Blue dye guided four node sampling is an acceptable alternative when radioisotope facilities are not available. ALND is reserved for patients with proven axillary lymph node involvement.Preoperative axillary ultrasound and fine-needle aspiration cytology or core biopsy of suspicious lymph nodes reliably identifies around 30% of node positive patients. Intraoperative assessment of the SLN using frozen section or real time molecular assays enables surgeons to perform one stage ALND in node positive patients. For those patients in whom intra-operative SLN assessment is negative, but whose final pathology reveals SLN metastasis, standard treatment has been to perform a completion ALND. Predictive models can be used to identify a lowrisk group of SLN-positive patients in whom routine ALND may not be necessary. In the future, completion ALND for microscopic disease will not be the standard of care but axillary radiotherapy may be an alternative with equal control and less morbidity.
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PMID:Management of the axilla in patients with breast cancer. 2313 86

Neurotropic melanoma is a rare subtype of cutaneous malignant melanoma. Compared with conventional melanoma, it is more locally aggressive with an increased tendency for local recurrence but less likely for nodal or distant metastases. These tumours can be a diagnostic dilemma with a variety of morphological, histopathological, and immunophenotypical expressions. The often amelanotic, benign appearance may lead to treatment issues such as late presentation, diagnostic delay, misdiagnosis, insufficient surgical margins, and recurrence with resulting poor outcome. The neurotropic nature of the disease and prevalence in the head and neck region can result in perineural and neural invasion along named large nerves into the brain with resulting neuropathies. Wide local excision with adjuvant radiotherapy where indicated remains the current practice for treatment with chemotherapy predominately being reserved as a salvage treatment for patients with disseminated disease.
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PMID:Neurotropic melanoma: the management of localised disease. 2313 58


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