Archiv für chirurgische Onkologie

Monocyte/macrophages are shown to be altered in monoclonal gammopathy of undetermined significance (MGUS), smouldering (SMM) and active myeloma (MM), with an impression on the disruption of the homeostasis of the traditional bone marrow (BM) microenvironment. We investigated the distribution of various subsets of monocytes (Mo) in blood and BM of newlydiagnosed untreated MGUS (n=23), SMM (n=14) and MM (n=99) patients vs. healthy donors (HD; n=107), in parallel to an outsized panel of cytokines and bone-associated serum biomarkers. Our results showed normal production of monocyte precursors and classical Mo (cMo) in MGUS, while decreased in SMM and MM (p≤0.02), in association with lower blood counts of recently-produced CD62L+ cMo in SMM (p=0.004) and of all subsets of (CD62L+, CD62L− and FcεRI+) cMo in MM (p≤0.02). In contrast, intermediate and end-stage nonclassical Mo were increased in BM of MGUS (p≤0.03), SMM (p≤0.03) and MM (p≤0.002), while normal (MGUS and SMM) or decreased (MM; p=0.01) in blood. In parallel, increased serum levels of interleukin (IL)1β were observed in MGUS (p=0.007) and SMM (p=0.01), higher concentrations of serum IL8 were found in SMM (p=0.01) and MM (p=0.002), and better serum IL6 (p=0.002), RANKL (p=0.01) and bone alkaline phosphatase (BALP) levels (p=0.01) with decreased counts of FcεRI+ cMo, were restricted to MM presenting with osteolytic lesions. This translated into three distinct immune/bone profiles: (1) normal (typical of HD and most MGUS cases); (2) senescent-like (increased IL1β and/or IL8, found during a minority of MGUS, most SMM and few MM cases with no bone lesions); and (3) pro-inflammatory-high serum IL6, RANKL and BALP with significantly (p=0.01) decreased blood counts of immunomodulatory FcεRI+ cMo-, typical of MM presenting with bone lesions. These results provide new insight into the pathogenesis of plasmacyte neoplasms and therefore the potential role of FcεRI+ cMo in normal bone homeostasis

Mammography because the best method of diagnosing carcinoma in its early stages has been accepted in many countries. Digital mammography is in development and is employed in carcinoma screening in countries like the us, however, cost-effectiveness of digital mammography screening (DMS) compared to film mammography screening (FMS) is debatable. This study is meant to systematically review the available evidence during this regard. Methods: This study is meant as a scientific review using PRISMA guidelines. The search was conducted on October 2019 on the PubMed, Web of Science core collection, Embase, Scopus, Cochrane library and ProQuest databases. All full economic evaluation studies (cost-effectiveness analysis (CEA), cost-utility analysis (CUA), and analysis (CBA)) that assessed DMS compared to FMS are included. the standard of ultimate articles was evaluated by CHEERS checklist and data was collected employing a data extraction form. Finally, the info was analysed by a meta-synthesis method. Results: Five studies were included. Three of them were conducted within the U.S., one within the Australia, and one the Brazil. Studies show that despite the slight difference within the effectiveness of DMS, its costs increased more. Three studies concluded that age-targeted DMS and FMS could be cost-effective and two concluded biennial DMS could be cost-effective digital strategy, however one study concluded that biennial FMS remains cost-effective. Conclusion: there's currently little evidence on the cost-effectiveness of DMS over FMS and more evidence is required, especially in developing countries. While the cost-effectiveness of DMS has not been fully confirmed, manufacturers are developing digital mammography and film mammography are getting obsolete. Therefore, the move towards digital mammography, especially in developing countries, should be gradual and targeted.

In recent years there has been a growing interest in the use of tumor antigenspecific CAR T cells as an effector mechanism to develop immunotherapy of malignant diseases. The impressive clinical results obtained with CAR T cells with some hematological malignancies have resulted in the FDA approval of some products. On the other hand, tumor antigen-specific CAR T cells have not been so effective with solid tumors thus far. The latter results are believed to be caused at least in part by the escape mechanism utilized by malignant cells to avoid recognition and destruction by immune effector cells. In this presentation I will describe some of the strategies that we are testing in order to counteract the escape mechanisms utilized by malignant cells

One the of the most difficult steps when operating mid and low rectal cancer is performing a neat transection of the distal segment while attaining negative margins both longitudinally as well as circumferentially. This technical difficulty is aggravated further in patients with a narrow pelvis and/or bulky tumors. Since the space in the pelvis may be restricted and with large tumors, vision is impaired and accessibility to the distal transection margin is hampered. Using the principles of transanal microsurgery, the TA-TME procedure is an extrapolation intended to assist surgeons to perform a complete TME under vision while maintaining comfortable ergonomics. The essence of the procedure is that the TME performed transabdominally can be completed through a transanal route. This procedure, no doubt, requires additional equipment such as a transanal gel port system and a separate laparoscopic tower is also desirable. This procedure also obviates the need for stapler transection of the distal end. The anastomosis can be performed either with a circular stapler or by a hand-sewn technique. This video takes us through the TA-TME procedure is a step-wise fashion with an easy-to-learn description

Incidence of breast cancer ranges from 89.7 per 100,000 women in Western Europe, about 40 per 100,000 in developing countries and to 19.3 per 100,000 women in Eastern Africa (1). The 5-year relative survival rate for breast cancer in the US was 91% from 2009-2015 (2). Treatment of breast cancer typically requires a potent combination of surgery, radiation and chemotherapy, and in a hormonal type of breast cancer also a hormonal therapy (3). Rehabilitation of patients after breast cancer surgery is important and its aim is to return to all presurgery activities of daily living with no pain (3,4). Rehabilitation should be induvidually Physical therapy is helpful in reducing swelling, improving range of motion and strength, increasing energy and returning to presurgery lifestyle (3,4) After a mastectomy, double mastectomy or lymphadenectomy woman are expected to rest and limit arm movements in the first week or more after surgery (3). In case of lymphedema lympdrainage and compression orthosis can be helpful (4). Later gentle exercises can be started, deep breathing and walking short distances (3,4). Being more active helps with prognosis (3,4). Studies show that patients after breast cancer surgery have considerable impairments in cardiorespiratory fitness, because of the toxic effects of anticancer therapy and deconditioning (3,4). This can lead to functional dependence, cardiovascular morbidity and mortality (3,4). On the other side women, who exercise for three to five hours per week (e.g walking on a treadmill) improved their survival rate as much as 40 percent over less active breast cancer patients (4). Induvidualized rehabilitation of patients after breast cancer surgery is important and can help in returning to all presurgery activities of daily living with no pain