To investigate superb microvascular imaging (SMI), a novel Doppler ultrasound technique that can visualize low-velocity microvascular flow, for assessing pediatric focal nodular hyperplasia (FNH).
There is no reliable fluoroscopic criteria for failed intussusception reduction during air enema technique.This retrospective case-control study included 373 episodes of ileocolic intussusceptions who had undergone air enema under fluoroscopy. All procedures were initially classified by conventional fluoroscopic criteria: presumptive successful procedures (PSP) vs. presumptive failed procedures (PFP). PFP were divided into true failure, false failure, and undetermined groups. The configuration and size of the residual mass were evaluated on fluoroscopic images. Statistical analyses included Mann-Whitney U-test, Fisher's exact test, receiver operating characteristic (ROC) analysis, logistic regression analyses, and Kruskal-Wallis rank sum test with a post hoc Tukey test.PSP was 264 episodes (71%) and PFP was 109 episodes (29%). The true failure was 40 (37%) and false failure was 48 (44%). The true failure group commonly showed a larger size and round configuration for the residual mass than false failure (P<0.001). Multivariable analysis revealed configuration (P=0.004) and transverse diameter (P=0.007) as significant parameters that differentiated true and false failure. The optimal cut-off value of the transverse diameter of the residual mass was 2.3 cm. The sensitivity and specificity of conventional fluoroscopic criteria for failed reduction was 100% and 85%, respectively. The combination of new fluoroscopic findings and conventional criteria increased the specificity to 100%.Fluoroscopic finding of round-shape and larger size residual mass combined with conventional criteria may be useful for differentiating false failure from truly failed enema reduction in children with intussusception.
BackgroundMetastatic basal cell carcinoma (mBCC) is a rare condition with no effective second-line treatment options. Cemiplimab is an immune checkpoint inhibitor that blocks binding of programmed cell death-1 (PD-1) to its ligands, PD-L1 and PD-L2. Here, we present the final analysis of cemiplimab in patients with mBCC after first-line hedgehog pathway inhibitors (HHIs) (NCT03132636).Patients and methodsIn this open-label, single-arm, phase II study, adults with mBCC and Eastern Cooperative Oncology Group performance status ≤1, post-HHI treatment, received cemiplimab 350 mg intravenously every 3 weeks for ≤93 weeks or until disease progression or unacceptable toxicity. The primary endpoint was objective response rate (ORR) by independent central review (ICR). Duration of response (DOR) was a key secondary endpoint. Other secondary endpoints included ORR per investigator assessment (INV), progression-free survival (PFS), overall survival (OS), complete response (CR) rate, safety and tolerability.ResultsFifty-four patients were enrolled (70% male, median age 64 years [interquartile range (IQR) 57.0–73.0]). Median duration of follow-up was 8 months (IQR 4–21). ORR per ICR was 22% (95% confidence interval [CI] 12–36), with two CRs and 10 partial responses. Among responders, median time to response per ICR was 3 months (IQR 2–7). Estimated median DOR per ICR was not reached (95% CI 10 months–not evaluable [NE]). Disease control rate was 63% (95% CI 49–76) per ICR and 70% (95% CI 56–82) per INV. Median PFS per ICR was 10 months (95% CI 4–16); median OS was 50 months (95% CI 28–NE). The most common treatment-emergent adverse events were fatigue (23 [43%]) and diarrhoea (20 [37%]). There were no treatment-related deaths.ConclusionsCemiplimab demonstrated clinically meaningful antitumour activity, including durable responses, and an acceptable safety profile in patients with mBCC who had disease progression on or intolerance to HHI therapy.
Colorectal Obstruction: Use of Covered and Uncovered StentsObjective: We wanted to evaluate usefulness of uncovered stent in comparison with covered stent for the palliative treatment of malignant colorectal obstruction.Materials and Methods: Covered (n = 52, type 1 and type 2) and uncovered (n = 22, type 3) stents were placed in 74 patients with malignant colorectal obstruction.Stent insertion was performed for palliative treatment in 37 patients (covered stent: n = 23 and uncovered stent: n = 14).In the palliative group, the data on the success of the procedure, the stent patency and the complications between the two groups (covered versus uncovered stents) were compared. Results:The technical success rate was 89% (33/37).Symptomatic improvement was achieved in 86% (18/21) of the covered stent group and in 92% (11/12) of the uncovered stent group patients.The period of follow-up ranged from three to 319 days (mean period: 116 85 days).The mean period of stent patency was 157 33 days in the covered stent group and 165 25 days in the uncovered stent group.In the covered stent group, stent migration (n = 11), stent fracture (n = 2) and poor expansion of the stent (n = 2) were noted.In the uncovered stent group, tumor ingrowth into the stents (n = 3) was noted. Conclusion:Self-expanding metallic stents are effective for relieving malignant colorectal obstruction.The rate of complications is lower in the uncovered stent group than in the covered stent group.alliative treatment of malignant colorectal obstruction should be considered for the patients suffering with primary disseminated or recurrent cancer.The treatment options depend on the patient's condition, the site of obstruction, the extent of disease and the life expectancy.In many cases and particularly for palliative surgery, creation of colostomy is inevitable, and it may result in increased patient discomfort (1).Various non-surgical treatment procedures such as balloon dilatation, laser photoablation and electrocoagulation have been performed (2 4).However, their effectiveness is limited by the need for repeated treatments that are time-consuming and they increase the patient's discomfort and the medical costs, and these repeated treatments are associated with complications.Metallic stents have been used for the palliative treatment of malignant obstruction of the biliary and gastrointestinal tracts (5 7).Application of metallic stents for the treatment of acute malignant colonic obstruction was first reported by Dohmoto in 1991, and it has become a promising treatment option (8), although the number of reported cases is only 600 throughout the world (9, 10).According to the reports, stent implantation is the best final palliative treatment for some cases that are in an advanced stage of disease.
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