Iodine-125 seed brachytherapy for early stage prostate cancer: a single-institution review.

Purpose: We are reporting the five-year biochemical control, toxicity profile and dosimetric parameters using iodine-125 low dose rate brachytherapy (BT) as monotherapy for early stage prostate cancer at a single institution.

Material And Methods: Between April 2006 and December 2010, 169 men with early stage prostate cancer were treated with BT. Biochemical failure was defined using the Phoenix definition (nadir + 2 ng/mL).

Fabry disease mimicking multiple sclerosis: Lessons from two case reports.

Fabry disease is an X-linked lysosomal storage disorder that can mimic multiple sclerosis. We present two cases of heterozygous adult women where clinical and radiological features initially suggested a diagnosis of multiple sclerosis. This led us to review the early clinical course and neurological features of Fabry disease and highlight the importance of assessing non-neurologic (systemic) symptoms when considering a diagnosis of multiple sclerosis and the need for specialist interpretation of neuroradiological findings.

Emergency open incarcerated hernia repair with a biological mesh in a patient with colorectal liver metastasis receiving chemotherapy and bevacizumab uncomplicated wound healing.

Bevacizumab is a humanized monoclonal antibody targeting vascular endothelial growth factor (VEGF), often used in combinational chemotherapy regimens for the treatment of patients with colorectal liver metastases. However adverse events have been attributed to the use of bevacizumab including gastrointestinal perforations, thrombotic events, hypertension, bleeding, and wound healing complications. 53-year-old male, with a history of colorectal cancer with liver metastasis, receiving a combination of cytotoxic chemotherapy (FOLFIRI, irinotecan with fluorouracil and folinic acid) with bevacizumab presented as an emergency with an incarcerated incisional hernia.

Neutrophil to lymphocyte ratio predicts pattern of recurrence in patients undergoing liver resection for colorectal liver metastasis and thus the overall survival.

Objective: We investigate the neutrophil to lymphocyte ratio (NLR) as a potential prognostic factor for patients undergoing curative liver resection for colorectal liver metastasis (CRLM).

Methods: We identified patients who underwent liver resection, via our prospectively accumulated surgical database at the Royal Marsden Hospital and The London Clinic, by two liver surgeons (SM and AZK) between January 2005 and December 2012 and patients included had liver resection for CRLM and received preoperative chemotherapy with an NLR > 2.5 considered elevated.

Image-guided tumor ablation: standardization of terminology and reporting criteria--a 10-year update.

Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The breadth of options available in this growing field increases the need for standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison among treatments that use different technologies, such as chemical (eg, ethanol or acetic acid) ablation, thermal therapies (eg, radiofrequency, laser, microwave, focused ultrasound, and cryoablation) and newer ablative modalities such as irreversible electroporation. This updated consensus document provides a framework that will facilitate the clearest communication among investigators regarding ablative technologies.

An Update of the International Society of Sexual Medicine's Guidelines for the Diagnosis and Treatment of Premature Ejaculation (PE).

Introduction: In 2009, the International Society for Sexual Medicine (ISSM) convened a select panel of experts to develop an evidence-based set of guidelines for patients suffering from lifelong premature ejaculation (PE). That document reviewed definitions, etiology, impact on the patient and partner, assessment, and pharmacological, psychological, and combined treatments. It concluded by recognizing the continually evolving nature of clinical research and recommended a subsequent guideline review and revision every fourth year.

An evidence-based unified definition of lifelong and acquired premature ejaculation: report of the second international society for sexual medicine ad hoc committee for the definition of premature ejaculation.

Introduction: The International Society for Sexual Medicine (ISSM) Ad Hoc Committee for the Definition of Premature Ejaculation developed the first evidence-based definition for lifelong premature ejaculation (PE) in 2007 and concluded that there were insufficient published objective data at that time to develop a definition for acquired PE.

Aim: The aim of this article is to review and critique the current literature and develop a contemporary, evidence-based definition for acquired PE and/or a unified definition for both lifelong and acquired PE.

Methods: In April 2013, the ISSM convened a second Ad Hoc Committee for the Definition of Premature Ejaculation in Bangalore, India.

Tumour Microenvironment: Overview with an Emphasis on the Colorectal Liver Metastasis Pathway.

The tumour microenvironment (TME) represents a dynamic network that plays an important role in tumour initiation, proliferation, growth, and metastasis. Cell behaviour may be regulated by interplay of molecular interactions involving positive and negative reinforcement as well as a high level of cross-talk, which determines this system. Additionally, cancer involves cell proliferation, its malignancy defined by the tumour's ability to break down normal tissue architecture and by a dynamic process of invasion and metastasis.

Addition of bevacizumab to preoperative chemotherapy for colorectal liver metastases does not increase perioperative morbidity and mortality.

Aim: Patients with colorectal liver metastases (CRLM) benefit from liver resection. Bevacizumab is commonly used in these patients resulting in a greater number of patients receiving an operation for a potentially curative liver resection, with initially unresectable liver metastases. Our purpose was to evaluate the effect of preoperative bevacizumab administration on perioperative complications in patients undergoing hepatic resection for CRLM.

Improving ostomates' confidence with a discharge-solidifying agent.

Not every person with a stoma will develop problems or even feel that he or she is unable to manage a stoma independently. However, for the individual who does experience problems and struggles to cope, the stoma nurse is pivotal in providing resources and product experience. He or she can enable the ostomate to adapt to the stoma and maintain their quality of life.

Emergency Pancreatoduodenectomy with Preservation of Gastroduodenal Artery for Massive Gastrointestinal Bleeding due to Duodenal Metastasis by Clear Cell Renal Cell Carcinoma in a Patient with Celiac Artery Stenosis.

Duodenal metastasis from renal cell carcinoma is rare, and even rarer is a massive gastrointestinal bleeding from such tumours. Coeliac occlusive disease, although rarely symptomatic, can lead to ischaemic changes with anastomotic dehiscence and leaks when a patient undergoes pancreatoduodenectomy. A 41-year-old man with known metastasis to the adrenal glands and the second part of the duodenum close to the ampulla of Vater from clear cell renal cell carcinoma was admitted to our department due to massive gastrointestinal bleeding from the duodenal metastasis.

Ciliated foregut cyst of the gallbladder. A diagnostic challenge and management quandary.

Ciliated foregut cysts are rare anomalies due to aberrant embryological development. Only a small number of gallbladder ciliated foregut cysts have been reported. We report the case of a 29-year-old woman presenting with epigastric pain associated with diarrhoea and vomiting, who was found to have raised serum bilirubin levels and abnormal liver function tests.

Jean Decima Jacomb (1894-1988), matron of The London Clinic, 20 Devonshire Place, London W1 from 1938 to 1949.

Miss Jean Jacomb born into a wealthy family, was at the age of 22 a student nurse at St Bartholomew's Hospital, London in 1917 where she nursed convalescent soldiers from World War I. Her midwifery training was in the slums around Whitechapel where a nurses uniform and medical bag provided a safe passage in the East End of London. For a while she worked in South Africa and India and returning to UK in 1923 she progressed to appointment as matron at the now re-named Royal Marsden Hospital in Chelsea.

Image-guided tumor ablation: standardization of terminology and reporting criteria--a 10-year update.

Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The breadth of options available in this growing field increases the need for standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison among treatments that use different technologies, such as chemical (eg, ethanol or acetic acid) ablation, thermal therapies (eg, radiofrequency, laser, microwave, focused ultrasound, and cryoablation) and newer ablative modalities such as irreversible electroporation. This updated consensus document provides a framework that will facilitate the clearest communication among investigators regarding ablative technologies.

Urticaria and angioedema in pregnancy and lactation.

Urticaria is part of the management of pregnancy, labor, delivery, and the puerperium in some women. The urticaria can be acute, chronic, or physical, presenting with whealing, angioedema, or both. Contact urticaria can occur.

Unusual presentation of Epstein-Barr virus hepatitis treated successfully with valganciclovir.

Described is the case of a 21-year-old male patient who presented with a severe Epstein-Barr virus (EBV) hepatitis. The initial diagnosis was challenging, as the patient did not have the typical features of the mononucleosis syndrome and despite the severity of the hepatitis, the initial serology was negative. In addition the liver biopsy did not show the mononuclear cell infiltration typically seen in EBV hepatitis.

Reducing the recurrence of pilonidal sinus disease.

Pilonidal sinus disease is a painful disorder of the natal cleft between the buttocks. Primary treatment is by surgery but there is a high recurrence rate. Laser hair removal reduces the rate of recurrence by diminishing the number and thickness of hairs.

Survival after radiofrequency ablation in 122 patients with inoperable colorectal lung metastases.

Purpose: To analyze the factors associated with favorable survival in patients with inoperable colorectal lung metastases treated with percutaneous image-guided radiofrequency ablation.

Methods: Between 2002 and 2011, a total of 398 metastases were ablated in 122 patients (87 male, median age 68 years, range 29-90 years) at 256 procedures. Percutaneous CT-guided cool-tip radiofrequency ablation was performed under sedation/general anesthesia.

Forces driving change in medical diagnostics.

This article reviews the external forces that affect and shape the future of medical diagnostics. A PESTELI model is retrospectively used to highlight the factors that drive change at an operational and management level. The author describes the future picture of clinical laboratory diagnostics and proposes ways to overcome current and pending challenges on clinical laboratories and university curriculum.

Congenital microgastria with limb defect combined with megaduodenum: case report and review of literature.

Congenital microgastria is a rare developmental disorder with only 59 previously reported cases. Most of the patients undergoing reconstructive surgery are in early infancy, providing gastric augmentation to achieve optimal thrive. The Hunt-Lawrence pouch is the standard surgical treatment in infancy, but late surgery in early adulthood requires different approach.

Management of procedural pain in adult patients.

Procedural pain in adults is not well documented in the literature. This article provides practical advice for healthcare professionals on how to assess and manage pain in these patients. Pain management strategies for common procedures, such as removing a chest drain and redressing a leg ulcer, are detailed.

The Sydney System for classification of gastritis 20 years ago.

The roots of research into gastritis go back into the early decades of the 20th century. Modern aspects of its classification and knowledge of its biological course and consequences were relatively well known even at the time that Helicobcter pylori was discovered by Robin Warren and Barry Marshall in 1982. This discovery, however, significantly changed the field, establishing that the commonest form of gastritis is simply an infectious disease, a finding that raised enormous interest in the subject amongst gastroenterologists, microbiologists, pathologists and basic researchers.

Dissecting the stress activating signaling pathways in acute pancreatitis.

Background/aims: Acute pancreatitis is a severe and frequently a life-threatening disease which can lead to pancreatic necrosis, acute lung injury, SIRS and MODS. The pathophysiologic pattern of acute pancreatitis is being investigated, when guidelines for treatment are being modified often and novel therapeutic strategies have failed to show real benefit in clinical practice.

Methodology: The present paper reviews the role of nuclear factors NF-kappaB and AP-1, TNFalpha, and TLR-4 in acute pancreatitis.