Overall lymph node harvest, in this unit, varied according to the reporting pathologist but not operating surgeon. As lymph node harvest increased to 15 per patient, the probability of identifying a metastatic node increased.
In psoriasis, the earliest observable electron microscopic changes are in the dermal papillary vasculature. The flashlamp-pumped pulsed tunable dye laser can achieve selective photothermolysis of the dermal vasculature. This laser was used to treat eight patients with chronic plaque psoriasis, as it was hypothesized that the ablation of dermal papillary vasculature would arrest the early events leading to the evolution of psoriasis, and produce resolution of the plaques. At the final assessment, performed 10 weeks after three fortnightly laser treatments, five of the eight patients recorded an improvement of > or = 50%, and one showed complete resolution of the treated plaques of psoriasis. Although not practicable in the treatment of widespread psoriasis, we conclude that selective photothermolysis of the dermal vasculature by pulsed tunable dye laser offers an alternative new therapy for chronic plaque psoriasis, and also demonstrates the pivotal role of the vasculature in the pathogenesis of psoriasis.
Introduction: Detection of lymph node (LN) metastasis is important for the optimal management of rectal cancer patients. Ultrasmall-particle superparamagnetic iron oxide (USPIO) contrast enhanced magnetic resonance imaging (MRI) has emerged as an effective method of assessing nodal involvement in various malignancies. We have investigated the correlation between nodes seen on specimen MRI and those found at histopathology and the optimum time interval between contrast injection and surgery in USPIO mesorectal lymphography.Method: Thirteen rectal cancer patients underwent MRI before and 24 h after intravenous infusion of USPIO contrast (SineremÒ, Advanced Magnetics Inc, Cambridge, MA, USA). Total Mesorectal Excision (TME) surgery was followed by fixed specimen MRI. Lymph nodes seen on specimen MRI and those found at pathology were compared for studies performed <5 days and ‡5 days prior to surgery.Results: Histopathological LNs found correlated well with those seen on specimen MRI (all patients, r = 0.73; P = 0.005, figure). Correlation was better for the <5 day group (r = 0.84; P = 0.01) than for the ‡5 day group (r = 0.54; P = 0.35).Discussion: USPIO specimen MRI is useful in mesorectal LN assessment. We demonstrate good correlation between specimen MRI and histopathology and show that fewer errors occur in assessment when the time interval between contrast injection and surgery is <5 days.Factors influencing lymph node retrieval in colorectal cancer and its effect on survival Introduction: NICE has set standards for lymph node (LN) harvest in surgery for colorectal cancer (CRC). We report the effect of the operating surgeon and reporting pathologist on lymph node yield and the role of LN yield on survival.
Background
Contemporary management of patients with synchronous colorectal cancer and liver metastases is complex. The aim of this project was to provide a practical framework for care of patients with synchronous colorectal cancer and liver metastases, with a focus on terminology, diagnosis, and management.
Methods
This project was a multiorganizational, multidisciplinary consensus. The consensus group produced statements which focused on terminology, diagnosis, and management. Statements were refined during an online Delphi process, and those with 70 per cent agreement or above were reviewed at a final meeting. Iterations of the report were shared by electronic mail to arrive at a final agreed document comprising 12 key statements.
Results
Synchronous liver metastases are those detected at the time of presentation of the primary tumour. The term ‘early metachronous metastases' applies to those absent at presentation but detected within 12 months of diagnosis of the primary tumour, the term ‘late metachronous metastases’ applies to those detected after 12 months. ‘Disappearing metastases’ applies to lesions that are no longer detectable on MRI after systemic chemotherapy. Guidance was provided on the recommended composition of tumour boards, and clinical assessment in emergency and elective settings. The consensus focused on treatment pathways, including systemic chemotherapy, synchronous surgery, and the staged approach with either colorectal or liver-directed surgery as first step. Management of pulmonary metastases and the role of minimally invasive surgery was discussed.
Conclusion
The recommendations of this contemporary consensus provide information of practical value to clinicians managing patients with synchronous colorectal cancer and liver metastases.
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