Peshāwar, Pakistan
Peshāwar, Pakistan

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Lombardi L.,Oncology Unit | Troiano M.,Radiation Therapy Unit | Silvestris N.,Italian National Cancer Institute | Nanni L.,Oncology Unit | And 6 more authors.
Expert Opinion on Therapeutic Targets | Year: 2012

Introduction: Of all the carcinomas, pancreatic carcinoma (PC) has the highest mortality rate, with a 1- and 5-year survival rate of 25% and less than 5% respectively. This is regardless of the stage at diagnosis. Areas covered: In this review relevant literature assessing the evidence regarding preoperative and adjuvant chemoradiotherapy (CRT) is discussed. Furthermore, new therapeutic approaches are summarized, while the future direction regarding the multimodality approach to PC is also discussed. Expert opinion: The role of combined-modality therapy for PC is continuously evolving. There have been several recent developments, as well as the completion of major, multi-institutional clinical trials. One of the challenges for the busy clinician is to appreciate the variation in staging, surgical expertise, and application of either definitive CRT or neo-adjuvant CRT for local and/or borderline disease. © Informa UK, Ltd.


PubMed | University of Rome La Sapienza, Surgical Unit and Pathology Unit
Type: | Journal: Diagnostic pathology | Year: 2015

Granular cell tumors (GCTs) were firstly described by Weber in 1854 and 70years later by Abrikossoff and classified as benign tumors. Originally considered muscle tumors, they have been identified as neural lesions, due to their close association with nerve and to their immunohystochemical characteristics. GCTs are uncommon tumors and they may arise in any part of the body; they have been mainly observed in tongue, chest wall and upper extremities; less frequent sites are larynx, gastrointestinal tract, breast, pituitary stalk and the female anogenital region. Here we report a case of GCT showing an uncommon localization such as the upper third of the right rectus muscle of the abdominal wall.A 45year-old woman of Caucasian origin presented to the surgeon with a 6-month history of light pain in the upper third of the abdominal wall. Radiological exams (Ultrasonography, Computed Tomography and Contrast magnetic resonance imaging) showed a localized in the right rectus abdominis muscle. After excision, histological and immunohystochemical analysis, with the support of electron microscopy, allowed making diagnosis of granular cell tumor.After fist description by Abrikosoff in 1926 of GCT like mesenchymal tumor of unknown origin, in recent years immunohystochemical techniques definitely demonstrated the histogenetic derivation of GCT from Schwann cells. Granular cell tumors are rare, small, slow-growing, solitary and painless subcutaneous nodules which behave in a benign fashion, but can have a tendency to recur; in rare cases they can metastasize, when they became malignant; there are some clinical and histological criteria to suspect the malignance of this tumor.It is important that clinicians, radiologists and pathologists are aware of the clinical presentation and histopathology of GCT for appropriate management, counselling and follow-up. In our case we had a complete radiological, morphological and immunohystochemical characterization of the lesion and a definitive diagnosis of benignity confirmed by electron microscopy.


La Greca M.,San Vincenzo Hospital | Grasso G.,San Vincenzo Hospital | Antonelli G.,San Vincenzo Hospital | Russo A.E.,San Vincenzo Hospital | And 4 more authors.
OncoTargets and Therapy | Year: 2014

Neoadjuvant chemotherapy has been successfully tested in several bulky solid tumors, but it has not been utilized in advanced cutaneous melanoma, primarily because effective medical treatments for this disease have been lacking. However, with the development of new immunotherapies (monoclonal antibodies specific for cytotoxic T lymphocyte-associated antigen 4 [anti-CTLA-4] and programmed death protein-1 [anti-PD1]) and small molecules interfering with intracellular pathways (anti-BRAF and mitogen-activated protein kinase kinase [anti-MEK]) the use of this approach is becoming a viable treatment strategy for locally advanced melanoma. The neoadjuvant setting provides a double opportunity for a better knowledge of these drugs: a short-term evaluation of their intrinsic activity, and a deeper analysis of their action and resistance-induction mechanisms. BRAF inhibitors seem to be ideal candidates for the neoadjuvant setting, because of their prompt, repeatedly confirmed response in V600E BRAF-mutant metastatic melanoma. In this report we summarize studies focused on the neo- adjuvant use of traditional medical treatments in advanced melanoma and anecdotal cases of this approach with the use of biologic therapies. Moreover, we discuss our experience with neoadjuvant targeted therapy as a priming for radical surgery in a patient with BRAF V600E mutation-positive advanced melanoma. © 2014 La Greca et al.


PubMed | Surgical Unit and San Vincenzo Hospital
Type: | Journal: OncoTargets and therapy | Year: 2014

Neoadjuvant chemotherapy has been successfully tested in several bulky solid tumors, but it has not been utilized in advanced cutaneous melanoma, primarily because effective medical treatments for this disease have been lacking. However, with the development of new immunotherapies (monoclonal antibodies specific for cytotoxic T lymphocyte-associated antigen 4 [anti-CTLA-4] and programmed death protein-1 [anti-PD1]) and small molecules interfering with intracellular pathways (anti-BRAF and mitogen-activated protein kinase kinase [anti- MEK]) the use of this approach is becoming a viable treatment strategy for locally advanced melanoma. The neoadjuvant setting provides a double opportunity for a better knowledge of these drugs: a short-term evaluation of their intrinsic activity, and a deeper analysis of their action and resistance-induction mechanisms. BRAF inhibitors seem to be ideal candidates for the neoadjuvant setting, because of their prompt, repeatedly confirmed response in V600E BRAF-mutant metastatic melanoma. In this report we summarize studies focused on the neoadjuvant use of traditional medical treatments in advanced melanoma and anecdotal cases of this approach with the use of biologic therapies. Moreover, we discuss our experience with neoadjuvant targeted therapy as a priming for radical surgery in a patient with BRAF V600E mutation-positive advanced melanoma.


Naseer A.,Postgraduate Medical Institute | Ahmad S.,Surgical Unit | Naeem M.,Lady Reading Hospital | Safirullah,Lady Reading Hospital
Journal of the College of Physicians and Surgeons Pakistan | Year: 2010

Objective: To evaluate the safety of single stage resection and primary anastomosis (RPA) in cases of viable sigmoid volvulus, in terms of anastomotic healing and complications. Study Design: Observational study. Place and Duration of Study: Surgical Unit, Hayatabad Medical Complex (HMC), Postgraduate Medical Institute, Peshawar, from November 2006 to October 2008. Methodology: Study included all patients presented and admitted in Surgical Unit, HMC, with sigmoid volvulus during the above mentioned period. Resection and primary anastomosis was done without defunctioning stoma formation or on-table colonic lavage. Manual decompression was carried out pre-operatively. Patients excluded, had serious co-morbid conditions in whom colostomy was done instead of primary anastomosis. Patients were followed-up for one month after surgery. Results: A total of 30 patients were admitted during the study of 2 years duration, out of which there were 21 male and 09 female patients, with male to female ratio of 2.4:1. Only 1 patient had anastomotic leak while 4 patients had superficial wound infection. One patient died due to comorbid condition. Abdominal wound dehiscence or postoperative abdominal abscess was not observed in any case. Conclusion: Single stage resection and primary anastomosis is a reliable current treatment modality for the emergency surgical management of sigmoid volvulus and has low morbidity and mortality. On-table colonic lavage and proximal defunctioning colostomies are unnecessary with this technique.


PubMed | University of Padua and Surgical Unit
Type: | Journal: Aging clinical and experimental research | Year: 2016

Chronic mesenteric ischaemia (CMI) has a long asymptomatic period, but little is known about the clinical implications of this phase of the disease, particularly in the elderly, who are most exposed to the condition.The aim of the present observational study was to survey the in-hospital clinical course of elderly patients during the non-specific phase of the disease due to occlusion of at least one splanchnic artery.For a median of 29months, we followed up 85 patients aged 65 and over who, for various clinical reasons, had undergone computed tomographic and magnetic resonance angiography during 2010 at Padua Teaching Hospital, assessing economic impact and reasons for admission.Thirty-four of these patients had at least one occluded artery, and 68% of them had at least one hospital admission. Elderly CMI patients were characterised by a higher number of admissions (median 2 vs 1 p=0.05) and a higher cost (6044 vs 1733 Euros p=0.04), but did not present typical gastrointestinal symptoms. The higher number of hospital admissions was not due to specific clinical risks (admitting wards: general medicine: 32 vs 29%, p=0.77; general surgery 8 vs 14%, p=0.73; vascular surgery: 26.5 vs 20%, p=0.46).In the asymptomatic phase of CMI, hospitalised elderly patients with at least one occluded splanchnic artery can be subject to a more challenging in-hospital clinical course.


Fathi K.,Tolna County Teaching Hospital | Harangi F.,Tolna County Teaching Hospital | Kravjak A.,Tolna County Teaching Hospital | Pinter A.,Surgical Unit
Pediatric Dermatology | Year: 2014

Granuloma annulare (GA) is an uncommon benign inflammatory skin condition, most often found on the extremities of young females. The subcutaneous variant of GA involving the penis is very rare. We report a case of subcutaneous GA associated with a urethral anomaly in a 15-year-old boy that persisted for a year. Treatment options are discussed with a review of the current literature. © 2014 Wiley Periodicals, Inc.


Alenezi A.N.,Surgical Unit | Mansour E.A.,King Saud University
Bahrain Medical Bulletin | Year: 2016

Objective: To evaluate a structured patient education program on minimizing skin complications in ostomy patients. Design: A Randomized Controlled Trial. Setting: Surgical Ward and Outpatient Clinic, Prince Sultan Military Medical City, Kingdom of Saudi Arabia. Method: One hundred adult stoma patients, divided into two groups (study and control, fifty each) were included in the study from October 2014 and completed in April 2015. A designed stoma care educational program was given to study group before discharge. Peristomal skin area was assessed after hospital discharge one week, three weeks and six weeks, for the study and control group. Result: The study found a significant decrease in peristomal skin complications in the study group (P-value. 028) and significant increase of stoma skin complications in the control group (P-value. 000). Highly statistically significant difference between the study and control group of skin assessment around the stoma of patients six weeks postoperatively (P-value. 028). Conclusion: Complications of stoma could be due to the lack of knowledge of stoma-care. Patients with stoma who attended the structured patient education program have less peristomal skin complications compared to those who did not attend. Educational program aimed to increase the knowledge of stoma-care is recommended. © 2016, Bahrain Medical Bulletin. All rights reserved.


Zorcolo L.,University of Cagliari | Restivo A.,University of Cagliari | Capra F.,University of Cagliari | Capra F.,Surgical Unit | And 3 more authors.
Colorectal Disease | Year: 2011

Aim The aim of the study was to define risk factors for perineal wound complications after abdominoperineal resection (APR), with particular reference to preoperative radiotherapy. Method Patients undergoing APR at our institution between 1985 and 2009 were reviewed. Wound complications were classified according to the Center for Disease Control and Prevention classification of surgical site infection (SSI). Perineal complications were identified in patients who had preoperative long-course radiotherapy (Group 1) and those who had surgery alone (Group 2). Results One hundred and fifty-seven patients met the inclusion criteria. Preoperative radiotherapy was performed in 68 (44.7%) patients (Group 1), and 89 (65.3%) patients (Group 2) underwent surgery alone. The overall rate of perineal wound complications was 14.8%. The wound infection rate was similar in each group (Group 1, 10/68, 14.7%; Group 2, 13/89, 14.9%; P=0.9). An elevated BMI (>30) was the only factor correlated with perineal morbidity on univariate analysis (P=0.01). Conclusion Preoperative radiotherapy does not influence perineal healing other than in patients with obesity. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.


PubMed | Surgical Unit and Papworth Hospital
Type: Journal Article | Journal: Nursing standard (Royal College of Nursing (Great Britain) : 1987) | Year: 2016

Papworth Hospital is the cardiothoracic centre for East Anglia and also one of the I designated supra-regional centres for cardiac and cardiopulmonary transplantation. It was the first hospital in the UK to commission a cardiac transplant programme within the National Health Service, in 1979.

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