Secondary Dissemination Research Articles

Dissemination of CPR video self-instruction materials to secondary trainees: Results from a hospital-based CPR education trial

BackgroundCardiopulmonary resuscitation (CPR) video self-instruction (VSI) materials have been promoted as a scalable approach to increase the prevalence of CPR skills among the lay public, in part due to the opportunity for secondary training (i.e., sharing of training materials). However, the motivations for, and barriers to, disseminating VSI materials to secondary trainees is poorly understood. MethodsThis work represents an ancillary investigation of a prospective hospital-based CPR education trial in which family members of cardiac patients were trained using VSI. Mixed-methods surveys were administered to primary trainees six months after initial enrollment. Surveys were designed to capture motivations for, and barriers to, sharing VSI materials, the number of secondary trainees with whom materials were shared, and the settings, timing, and recipients of trainings. ResultsBetween 07/2012 and 05/2015, 653 study participants completed a six-month follow-up interview. Of those, 345 reported sharing VSI materials with 1455 secondary trainees. Materials were shared most commonly with family members. In a logistic regression analysis, participants in the oldest quartile (age >63 years) were less likely to share materials compared to those in the youngest quartile (age ≤44 years, OR 0.58, CI 0.37–0.90, p=0.02). Among the 308 participants who did not share their materials, time constraints was the most commonly cited barrier for not sharing. ConclusionsVSI materials represent a strategy for secondary dissemination of CPR training, yet older individuals have a lower likelihood of sharing relative to younger individuals. Further work is warranted to remedy perceived barriers to CPR dissemination among the lay public using VSI approaches.

Transabdominal–pelvic–perineal (TAPP) anterolateral thigh flap: A new reconstructive technique for complex defects following extended abdominoperineal resection

Abdominoperineal resection (APR) following radiotherapy is associated with a high rate of perineal wound complications. The anterolateral thigh (ALT) flap, combined with the vastus lateralis (VL) muscle, can cover complex perineal and pelvic anteroposterior defects. This is used for the first time transabdominally through the pelvis and the perineum (TAPP) in the infero-posterior directions; this technique has been described and illustrated in this study. Among over 90 patients who underwent perineal reconstruction between May 2004 and June 2011, six patients presented high-grade tumours invading perineum, pelvis and sacrum, thereby resulting in a continuous anteroposterior defect. ALT+VL TAPP reconstructions were performed after extended APR and, subsequently, sacrectomy. Patients were examined retrospectively to determine demographics, operative time, complications (general and flap-related), time to complete healing and length of hospital stay. Long-term flap coverage, flap volume stability and functional and aesthetic outcomes were assessed. Mean operating time of the reconstruction was 290min. No deaths occurred. One patient presented partial flap necrosis. Another patient presented a novel wound dehiscence after flap healing, due to secondary skin dissemination of the primary tumour. Following volumetric flap analysis on serial post-operative CT scans, no significant flap atrophy was observed. All flaps fully covered the defects. No late complications such as fistulas or perineal hernias occurred. Donor-site recovery was uneventful with no functional deficits. The use of the ALT+VL flap transabdominally is an innovative method to reconstruct exceptionally complex perineal and pelvic defects extending up to the lower back. This flap guarantees superior bulk, obliterating all pelvic dead space, with the fascia lata (FL) supporting the pelvic floor.

Integrated Therapy for Invasive Pulmonary Aspergillosis in a Patient with Asthma and Chronic Obstructive Pulmonary Disease Overlap Syndrome

Integrated Therapy for Invasive Pulmonary Aspergillosis in a Patient with Asthma and Chronic Obstructive Pulmonary Disease Overlap Syndrome

Surgical Risk Factors of Patients with Operable Gist

Abstract Introduction: Gastrointestinal stromal tumors (GIST) are the most frequently mezenchimale tumors of the gastrointestinal tract. This study aims to analyze the results after surgical treatment of GIST and identify key risk factors influencing postoperative course of these patients in order to discover the most effective therapeutic methods to significantly improve postoperative course of these patients. Methods: We retrospectively reviewed the medical records of all patients who underwent surgical removal of GISTs from 2004-2014. Patient demographics, criterion for admission, surgery, complications, secondary dissemination, histopathological data and clinical course were analized following patient survival at 12, 24, 36 and to 60 months postoperatively. Statistical analysis was performed using the MedCalc software program, and survival analysis was done by Kaplan Meyer. Results: During this period we analyzed a total of 28 cases, including 13 males and 15 females with age from 33 to 80 years (median, 61). The tumor was located in the stomach (15 cases; 53%), small intestine in ten cases (36%) and other sites in three patients (11%). Multivariate analysis revealed that tumor size (P <0,05), criterion for admission (P<0,05) and secondary dissemination (P<0,05) are independed prognostic factors. Conclusions: Factors like: age and sex of patients, size and tumor site, presence or absence of metastasis, are prognostic risk factors with significant differences in the evolution of patients with operable GIST. The small number of patients and retrospective nature of the study have created difficulties in the estimation where we concluded the need of a prospective multicentric study.

Promising Results of Ibrutinib in Three Patients with Secondary Central Nervous System Mantle Cell Lymphoma

Introduction. Risk of CNS dissemination in mantle cell lymphoma (MCL) is a rare and secondary event that occurs during the course of the disease. Prognosis from time of CNS involvement diagnosis is poor despite high-dose metabolite chemotherapy. New drugs are emerging in MCL treatment. The oral inhibitor of Bruton’s tyrosine kinase (BTK), Ibrutinib (Pharmacylics, Sunnyvale, CA), has demonstrated unprecedented single agent overall response rate in relapsed or refractory MCL. Efficacy of Ibrutinib in CNS relapse is not known.Patients and methods. In 2014, three patients with MCL presented with a refractory secondary CNS dissemination at our institution. Patient 1, a 61 years old man, was first diagnosed in November 2009 with MCL, stage IV with a nodal, bone marrow and colon dissemination. MIPI score was evaluated as 5.5 (low risk). Patient received R-DHAX (rituximab, dexamethasone, aracytine, oxaliplatine) x 4 cycles followed by a high-dose R-BEAM therapy plus autologous stem cell transplantation (ASCT) (LYMA trial). First CNS relapse occurred in November 2012 as a right retro-ocular nodule and optic nerve infiltration. Patient was treated with R-IVAM, (rituximab, aracytine, ifosfamide, vepeside, high-dose methotrexate) x 6 cycles, with a complete response. He relapsed in December 2013 during rituximab maintenance, and was treated with CHOP-procarbazine x 3 cycles with a progression of the retro-ocular nodule and a peripheral nodal dissemination. Ibrutinib single agent was started in April 2014 at standard dose (560 mg/day). Patient 2, a 77 years old woman, was first diagnosed in February 2013 with MCL, stage IV disease with a nodal, splenic, blood, and bone marrow dissemination. MIPI score was 7.67 (high risk). Six cycles of R-CHOP followed by Rituximab maintenance was given. Relapse occurred during the Rituximab maintenance as an isolated meningeal dissemination. Patient received 6 cycles of R-DHA with a complete response. One month later, she presented an early relapse with meningeal dissemination and a left retro-orbital nodule. Ibrutinib single agent was started in May 2014 at standard dose. Patient 3, a 62 years old man, was first diagnosed in January 2011 with MCL stage IV with a splenic, blood and nodal dissemination. MIPI score was evaluated at 5.8 (intermediate risk). The patient had a splenectomy in March 2011. He relapsed in July 2013 with a blood, liver and nodal infiltration. The patient was treated with R-DHAX x 4 cycles followed by a high-dose R-BEAM therapy plus ASCT. He relapsed in July 2014 with a transverse myelitis. Ibrutinib single agent was started at standard dose. In parallel we studied plasmatic and CSF pharmacokinetic of Ibrutinib in one patient.Results. All patients were alive, respectively at 4 and 3 months and two weeks. CNS response of patient 1 by CT showed a tumor reduction of 81% with a complete CNS response on TEP at 4 months (Fig 2A and 2B). A complete response of peripheral nodal involvement was also observed. Patient 2 was evaluated with CSF study and CNS MRI. We observed an important decrease of CSF involvement (from 900 cells/mL to 100 cells/mL) as early as day 15 (Fig 1), and a response of the retro-orbital lesion (-23%). However an increase of lymphoma cells in CSF was observed at day 64 and was associated with 88 % decrease in Ibrutinib plasma exposure. At the same time, Ibrutinib CSF concentration measured at Tmax remained stable from day 8 to day 36, ranging from 1 to 3 ng/mL, with a CSF concentration/plasmatic concentration ratio of 0,019. Patient 3 rapidly improve his clinical exam with a recuperation of motor deficit and sensitive level at day 8. MRI was evaluated at day 8 of Ibrutinib and showed a spectacular response with a 69% decrease of myelitis trasverse and a regression of contrast enhancement (Fig 2C).Conclusion. This is the first report of efficacy of Ibrutinib in CNS lymphoma dissemination. We observed in these 3 cases an objective response and a pharmacodynamy proof of Ibrutinb CSF diffusion. Hypotheses for progression in patient 2 are 1/ a variability of Ibrutinib exposure; or 2/ the apparition of a C481S mutation of BTK. This observation is pivotal as CNS dissemination of other lymphoma subtypes, such as diffuse large B-cell lymphoma, or indolent lymphomas (follicular or marginal zone lymphoma) are all associated with poor prognosis. Given Ibrutinib upfront may eradicate this risk of dissemination and has to be prospectively evaluated. [Display omitted] [Display omitted] DisclosuresAmorim:Oncoethix SA: Research Funding. Brice:Seattle Genetics, Inc.: Research Funding; Takeda Pharmaceuticals International Co.: Honoraria, Research Funding; Roche: Honoraria. Thieblemont:Oncoethix SA: Research Funding.

Designing for Dissemination: Lessons in Message Design From “1-2-3 Pap”

Despite a large number of evidence-based health communication interventions tested in private, public, and community health settings, there is a dearth of research on successful secondary dissemination of these interventions to other audiences. This article presents the case study of “1-2-3 Pap,” a health communication intervention to improve human papillomavirus (HPV) vaccination uptake and Pap testing outcomes in Eastern Kentucky, and explores strategies used to disseminate this intervention to other populations in Kentucky, North Carolina, and West Virginia. Through this dissemination project, we identified several health communication intervention design considerations that facilitated our successful dissemination to these other audiences; these intervention design considerations include (a) developing strategies for reaching other potential audiences, (b) identifying intervention message adaptations that might be needed, and (c) determining the most appropriate means or channels by which to reach these potential future audiences. Using “1-2-3 Pap” as an illustrative case study, we describe how careful planning and partnership development early in the intervention development process can improve the potential success of enhancing the reach and effectiveness of an intervention to other audiences beyond the audience for whom the intervention messages were originally designed.

Twitter-Based Dissemination of Corporate Disclosure and the Intervening Effects of Firms' Visibility: Evidence from Australian-Listed Companies

ABSTRACT This paper investigates the effect of dissemination of corporate disclosure via Twitter. In particular, the study is focused on listed companies in Australia that employed Twitter as a secondary dissemination channel for corporate announcements in 2008–2013. Based on a sample of 3,516 announcements at the Australian Stock Exchange (ASX) related to 109 listed companies, the research employs the Investor Recognition Hypothesis to investigate the effect of Twitter activity on the information asymmetry proxied by abnormal spread (SpreadAbn). The findings show that there is a negative association between SpreadAbn and tweets posted by a firm during the announcement period. Further analysis shows that this association is stronger for firms less visible through business press or financial analyst coverage. The study concludes that while corporate announcements are publicly available through the ASX platform, dissemination of corporate announcements through Twitter allows companies to attract investors' attention and decrease information asymmetry.

Early in vivo infection dynamics in non-human primates infected with Mycobacterium tuberculosis (MPF3P.813)

Abstract Tuberculosis (TB) continues to pose a significant health risk to morbidity and mortality worldwide. The vast majority of individuals infected with M. tuberculosis, the causative agent of TB, contain the infection as clinically asymptomatic latent TB. A small minority of people do not and either present with primary active disease or reactivate over their lifetime. By examining early events in infection at the local lesion level, we aim to uncover some of the basis for the observed spectrum of TB disease and host outcome. Using genetically barcoded M. tuberculosis, serial PET/CT lesion imaging, and tools to analyze each granuloma at the microbial and immunological level, we are tracking local lesion development and dissemination at various stages of infection in cynomolgus macaques. Background studies have revealed that granulomas are dynamic entities that largely arise from single bacteria. We hypothesize that early interactions between M. tuberculosis and host immune components contribute to lesion heterogeneity and that these initial events influence infection outcome. We performed a small reinfection experiment with M. tuberculosis barcoded strains. Our data suggests that primary infection limits secondary infection lesion development and dissemination. Further analysis of this study is ongoing. Probing the mechanisms that underlie the human TB spectrum will reveal crucial stages of infection that can be exploited for novel therapeutic design.

Re: First isolation of dengue virus from the 2010 epidemic in Nepal.

We compliment the team of investigators from Kathmandu, Nepal for their meticulous serologic and molecular investigations of patients suspected with dengue virus (DENV) infection during the large 2010 epidemic in Nepal [1]. Several measures are needed to address the rapid emergence of DENV infection in different regions of Nepal. Recently, DENV infection was reported in Chitwan with a large number of patients presenting in the Chitwan Medical College Teaching Hospital and other privately-run clinics and nursing homes in Bharatpur [2]. Furthermore, in Jhapa district, 17 people, including 13 from Mechinagar Municipality alone, were found to be infected with the disease. Dengue cases were found in Kakadvitta and its adjoining areas, while 12 patients were receiving treatment in various hospitals in Parsa district and 13 had returned home after treatment [3]. In Nepal, diagnosis of DENV infections was based on serologic testing for IgM antibody at different centres in Kathmandu and Mahendranagar, Kanchanpur and Kuhsibu employing IgM-capture ELISA [4]. Molecular investigations were performed at the National Institute of Infectious Diseases, Tokyo, Japan [1]. Rather than relying on a multi-step capture ELISA, it would be convenient to opt for point-of-care, rapid diagnostics in different heath care centres across Nepal. Such assay formats involve 1–2 steps, are user friendly and require minimum equipment. Neither sophisticated laboratory facilities nor highly trained technologists are needed. A concurrent testing for NS1, IgM and IgG is ideal since it would address even cases with atypical presentations. During the 2006–2007 outbreak of DENV in Malaysia, the molecular and serologic response in in ten adults with a fatal outcome was remarkable. DENV infection was confirmed in all ten cases by serological tests. Seven were both IgM and IgG positive while three were IgM negative and IgG positive. Eight of the patients (two were unavailable) tested positive for dengue NS1 while DENV-1 was isolated from one case. Consequently, the presence of anti-dengue IG anybody with dengue NS1 antigen confirmed the secondary infection in all eight patients [5]. Screening for DENV antigenemia among international travellers at different ports of entry could be introduced to detect persons infected with the virus who could be bitten by DENV vectors during their stay in different regions of Nepal. After viral amplification in mosquitoes, a secondary dissemination of the disease could occur. Furthermore, even prospective international travellers from Nepal to DENV endemic areas should be asked to protect themselves against the mosquito bites while away on any business or pleasure trip. It is important to educate the community about otherwise ignored basic facts about of the mosquito and protection from bites. The mosquitoes of Aedes genus, A. aegypti and A. albopictus are responsible for multiplication and dissemination of dengue Virus, chikungunya virus and yellow fever virus. Both A. aegypti and A. albopictus are day-biters but will bite at night if there is sufficient artificial lighting. A. aegypti is particularly fond of ankles when searching for a good spot to bite a human being [6]. A. albopictus is a very aggressive day-time biter, with peaks occurring during early morning and late afternoon. Both are container-inhabiting species that lay eggs in domestic and peri-domestic clean water-containing receptacles. Anti-mosquito measures are practiced universally at night when insecticides and mosquito repellents and mosquito nets are used. In spite of such meticulous night-time care taking, one could still be exposed to bites from mosquitoes of the genus Aedes as they are mostly day-biters [6]. The public should be advised to wear full-length clothes to cover their arms and legs during day-time as well as in the evenings if they go outdoors. As a final suggestion, fashion designers in Nepal and elsewhere should be urged to create attractive formal and informal clothing for both sexes that would not protect against mosquito bites but also is attractive and suited to the local customs each region. Prominent public personalities like film stars, actors, athletes should wear such clothes during their appearance in public. School children should avoid use of skirts or shorts while in school. local governments should declare an exemption of such garments from sales local taxes.

Transüretral Mesane Tümörü Rezeksiyonunda Addüktör Spazmını Önlemek İçin Levobupivakain ile Obturator Blok Uygulaması

Objective: Adductor spasm can occur during transurethral resection of bladder tumour (TUR-BT) due to the stimulation of obturator nerve and can cause involuntary movement of legs, incomplete resection, bladder perforation and secondary extravesical dissemination of neoplastic cells. In this study we aimed to prevent adductor spasm and associated complications by obturator block with levobupivacain in patients with spinal anesthesia during TUR-BT for lateral wall tumors of the bladder. Material and Methods: Sixty 18-80 year-old patients, graded as ASA (American Society of Anestesiologists) I-III and scheduled for transuretral resection for lateral wall tumor of the bladder, were recruited for this study. Thirty patients, randomized as group S, received only spinal anesthesia and 30 patients randomized as group SOB, received spinal anesthesia and obturator block. Using a 22 G 50 mm insulated needle, 2 Hz, 0.5 mA electrical stimulation, with a pulse duration of 0.1 ms was applied, until the adductor muscle contractions were evoked. The local anesthetic solution 5 mL 7.5% levobupivacaine (37.5 mg) plus 5 mL 0.9% NaCl (Levobupivacaine 3.75%) was injected. Surgery was allowed after the spinal sensory block reached the T10 dermatome for all patients. Any adductor spasm occurring during surgery was recorded. Occurence of adductor muscle spasm and patient and surgeon satsifaction was evaluated. Results: Surgeon satisfaction was significantly higher in Group OBS (p<0.001) compared to Group S. Adductor spasm incidence was higher in Group S [25/30 (83%)] patients than in Group OBS [2/30 (6.7%)] patients (p<0.001). Conclusion: Obturator nerve block using levobupivacaine is effective in preventing adductor spasm in transurethral resection of lateral wall bladder tumours.

Cutaneous fistula of liver echinococcal cyst previously misdiagnosed as fistulizated rib osteomyelitis

External fistulization or subcutaneous rupture of liver echinococcal cyst (EC) is found occasionally with total of 15 cases reported in the literature. We report a case of 60-year-old female previously misdiagnosed as fistulizated osteomyelitis of the 11th rib. At computed tomography scan, non-vital EC was noted in the third liver segment. Under suspicion of external fistulization of perforated EC the patient underwent one-stage operation-pericystectomy and complete fistula excision. A retrospective analysis of the reported cases in the literature was performed with special references to classifying this rare entity. The main purpose of this report is to highlight the possibility of such a diagnosis when cutaneous fistula occurs in a same anatomic area with hydatid EC, even that cyst is proven to be calcified. We emphasize the role of a swift and radical surgical procedure including complete fistula excision to prevent secondary dissemination and post-operative complications.

Proteomic Comparison of MCF-7 Tumoursphere and Monolayer Cultures

Breast cancer is a heterogenous disease, composed of tumour cells with differing gene expressions and phenotypes. Very few antigens have been identified and a better understanding of tumour initiating-cells as targets for therapy is critically needed. Recently, a rare subpopulation of cells within tumours has been described with the ability to: (i) initiate and sustain tumour growth; (ii) resist traditional therapies and allow for secondary tumour dissemination; and (iii) display some of the characteristics of stem cells such as self-renewal. These cells are termed tumour-initiating cells or cancer stem cells, or alternatively, in the case of breast cancer, breast cancer stem cells. Previous studies have demonstrated that breast cancer stem cells can be enriched for in “tumoursphere” culture. Proteomics represents a novel way to investigate protein expression between cells. We hypothesise that characterisation of the proteome of the breast cancer line MCF-7 tumourspheres compared to adherent/differentiated cells identifies proteins of novel interest for further isolating or targeting breast cancer stem cells. We present evidence that: (i) the proteome of adherent cells is different to the proteome of cells grown in sphere medium from either early passage (passage 2) or late passage (passage 5) spheres; (ii) that spheres are enriched in expression of a variety of tumour-relevant proteins (including MUC1 and Galectin-3); and (iii) that targeting of one of these identified proteins (galectin-3) using an inhibitor (N-acetyllactosamine) decreases sphere formation/self-renewal of MCF-7 cancer stem cells in vitro and tumourigenicity in vivo. Hence, proteomic analysis of tumourspheres may find use in identifying novel targets for future therapy. The therapeutic targeting of breast cancer stem cells, a highly clinically relevant sub-population of tumour cells, has the potential to eliminate residual disease and may become an important component of a multi-modality treatment of cancer.

Alcohol and young people: What the legislation says about access and secondary supply

The rationale and potential impact of Australia's recent legislative changes regulating secondary supply of alcohol to minors, particularly on private premises. An examination of similarities and differences between state and territory liquor licensing legislation regulating secondary supply of alcohol to minors was undertaken. The Northern Territory, New South Wales, Queensland, Tasmania and Victoria prohibit supply of alcohol to minors on private premises, except by parents/guardians/authorised persons. Northern Territory, Queensland and Tasmanian legislation also prescribes that supply must occur responsibly and under supervision. Elsewhere, alcohol supply to minors on private premises is unregulated. These legislative changes reflect the 'familialisation' of adolescent drinking. Recent legislative amendments regulating secondary supply on private premises may indicate growing awareness of adolescent alcohol-related harms and signal a shift in community norms. However, sociocultural factors, misunderstanding and challenges in enforcing the legislation may limit compliance. Changes in secondary supply legislation need effective dissemination as divergence between states and territories may result in confusion about legal responsibilities. A national approach may be warranted to help set community boundaries for young people's drinking.

887 Two Cases of Gigantic Juvenile Cystic Echinococcosis

Background and AimsCystic Echinococcosis (CE) is a serious multi-organ disease, caused by cestode infection with Echinococcus granulosus. Simultaneous hepatopulmonary or isolated pulmonary hydatidosis in children are rare and demand an...

The extent of cutaneous lesions predicts outcome in extranodal nasal-type natural killer/T-cell lymphoma of the upper aerodigestive tract with secondary cutaneous involvement

This study determined the clinical characteristics and prognosis for patients with extranodal nasal-type natural killer/T-cell lymphoma (NKTCL) with secondary cutaneous involvement. Twenty-eight patients with NKTCL of the upper aerodigestive tract with secondary cutaneous involvement were reviewed. The median overall survival (OS) was 21.5 months from the first diagnosis, and 12.3 months from the presentation of a cutaneous lesion. The 5-year OS rate was 43.1% (median, 28 months) for patients with localized cutaneous disease compared with 0% (median, 3.6 months) for generalized cutaneous disease (p = 0.017). The 2-year OS rates were 67.5% for patients who achieved a complete response (CR) compared with 19.4% (median, 5.2 months) for patients who did not (p = 0.003). Patients with NKTCL with secondary cutaneous dissemination overall have a poor prognosis, but a relatively favorable prognosis was identified for the small subgroup of patients who had localized cutaneous lesions and achieved a CR.

Primary cutaneous aspergillosis due to Aspergillus flavus in a neutropenic patient

Summary Cutaneous aspergillosis is a rare disease that generally affects immunosuppressed patients. We report a case of primary cutaneous aspergillosis developed at the site of cervical lymphadenectomy in a 32-year-old man with underlying anaplastic large T-cell lymphoma. The lymphadenectomy was performed to confirm relapse of the malignancy. Wound infection developed during the second week of post-chemotherapy neutropenia. Histopathologic examination of a skin biopsy specimen showed abundant hyphae, cultures yielded Aspergillus flavus and galactomannan antigenemia was positive. Treatment consisted of combination of voriconazole and surgical debridement. Patient died of multiorgan failure caused by bacterial sepsis without secondary dissemination of the Aspergillus infection. Conclusion Aspergillus infection should always be considered in the differential diagnosis of wound infections, especially in neutropenic patients.

Incidence of Cancer in Kidney Transplantation Waiting List Patients: A Single Center Experience

Introduction It is widely accepted that the risk of malignancies is significantly increased among patients with end-stage kidney disease (ESKD) and after kidney transplantation compared with the general population. Only a few data are available on kidney transplantation waiting list patients. The aim of this study was to investigate solid organ cancer incidence among subjects on the waiting list at a single center. Materials and Methods We retrospectively reviewed the records of all patients enrolled on our kidney transplantation waiting list between August 1, 2008 and July 31, 2010, seeking to evaluate the causes of withdrawal from the list, incidence of cancer, type of neoplasm, and its correlation with clinical features. We estimated the ratio of observed to expected numbers of cancers, the standardized incidence ratio (SIR). Results Among 1184 patients, we excluded 569 patients from the waiting list including 26 (4.56%) who displayed malignancies. The overall incidence of cancer was 0.11 events/person-months and the overall prevalence of cancer was 2.2%. In 97% of patients, the malignant disease was confined to the primitive organ of origin without secondary dissemination. We observed a prevalence of cancers related to ESKD (17; 65.38%). The SIR for all cancer types in our population compared with the general population was 2.22. The SIR for native kidney and thyroid cancers among our population compared with the general population was >10. Conclusion The incidence of cancer was significantly increased among kidney transplantation waiting list patients compared with the general population. Our study highlighted the importance of a careful, targeted neoplastic screening. It could be particularly important for ESKD-related malignancies like native kidney tumors or thyroid cancers.

Prognostic Factors Affecting the Outcome of Salvage Radiotherapy for Isolated Locoregional Recurrence After Mastectomy

To evaluate the prognostic factors affecting the outcome of salvage radiotherapy for isolated locoregional recurrence after mastectomy. Between May 1988 and April 2002, 65 breast cancer patients underwent radiotherapy as a component of salvage treatment for isolated locoregional recurrence after mastectomy. The sites of failure were as follows: chest wall in 37 patients, regional lymph nodes (LNs) in 23 patients, and combined chest wall and LNs in 5 patients. None of the patients had previously been treated with radiation. Thirty-nine patients had surgical resection, and 55 patients received systemic chemotherapy and/or hormonal therapy for recurrent disease. In 51 cases (78.5%), the chest wall and ipsilateral regional lymphatics including supraclavicular, axillary, and internal mammary LNs were irradiated. Median dose was 50.4 Gy (range: 50-71.5). Median duration of follow-up was 52 months (range: 2-206). The 5-year overall survival rate was 48.1%. On multivariate analysis, patients without initial nodal involvement had better overall survival (P = 0.0118). The 5-year locoregional progression-free survival rate was 69.8%, and time to recurrence (>36 months vs. < or =36 months) had an influence on the outcome with borderline significance (P = 0.0775). The 5-year distant metastasis-free survival rate was 42.1%. Lack of systemic therapy after recurrence (P = 0.0089) and age <50 years at recurrence (P = 0.0145) were significant prognostic factors predicting poor distant metastasis-free survival. Radiotherapy for isolated locoregional relapse after mastectomy achieved locoregional control in about two-thirds of patients. Major pattern of failure was distant relapse, and systemic therapy is warranted to prevent secondary dissemination.

Surgical management of pelvic primary bone tumors involving the sacroiliac joint

Pelvic primary malignant bone tumours, especially when involving the sacroiliac joint are difficult to treat. Abdominoperineal amputations are today used, only in life-threatening situations. A precisely planed surgical technique can save the affected extremity without compromising the resection quality and subsequent patient survival. To assess the procedures used for resection and reconstruction of bone tumours invading the sacroiliac joint as well as their effects on cancer outcome and functional results. This is a continuous and retrospective analysis of 24 patients treated between 1986 and 2003. Six tumours affected the sacral body and 18 tumours involved the wing of the ilium. The joint articular surface was invaded in only six cases. Seventeen patients received neoadjuvant chemotherapy. The procedure was performed through an enlarged iliac crest incision, giving access to two sections of the pelvic ring. Six cases required neurological sacrifice. Initial tumour grading was based on the Enneking classification, and the functional results, on the Musculoskeletal Tumour Society (MSTS) scoring system. The average operation lasted 5.27 hours. Reconstruction was performed with bone autograft and instrumentation. Resection was large with adequate margins 11 times, marginal 12 times, and contaminated once. Average follow-up was 4.77 years. The 5-year survival rate was 50%. Twelve patients either died from their disease or were in the metastatic stage at final follow-up. Survival was linked to the quality of resection and initial tumour staging. Hemisacrectomy did not affect patient survival. Local recurrences had a poor prognosis with eight cases of secondary metastases out of 11. Bone healing occurred in 13 patients, 10 of whom survived. Of the 12 patients who survived and were in complete remission at final follow-up, the average MSTS score was 61%. The score was at 38.6% in cases involving neurological sacrifice, and at 77.1% for the rest of the group. It was at 64% in healed cases and 13% in nonunion cases. The survival of patients presenting with a sacroiliac joint tumour is substantially related to both tumour histology and resection quality. Local recurrences carry a poor prognosis with a high rate of secondary metastatic dissemination. In situations where disease control can be achieved, the proposed method of reconstruction allows, satisfactory bone healing and fair functional recovery, provided no major neurological sacrifice has taken place. level IV: Retrospective Therapeutic Study.

CutaneousFusarium solaniinfection in childhood acute lymphoblastic leukaemia

Cutaneous involvement is often an initial presentation of infection with Fusarium species, which occurs more commonly in immunocompromised hosts and may be either localized or widespread. Skin lesions typically appear as red or grey macules, which may develop central ulceration and black eschar. Secondary dissemination to extracutaneous organs may occur in immunocompromised hosts, especially those with prolonged and severe neutropenia. We describe a case of widespread cutaneous involvement after infection with Fusarium solani in childhood acute lymphoblastic leukaemia that responded successfully to treatment with prolonged liposomal amphotericin B.