Upper urinary tract urothelial carcinoma (UTUC) is a rare malignancy with a poor prognosis in advanced disease. With the advent of novel systemic therapies, including enfortumab vedotin (EV) and immune checkpoint inhibitors (ICIs), deep and durable responses can now be achieved, potentially enabling consolidative surgery with curative intent. However, evidence supporting this approach in advanced UTUC remains scarce. We report a case series of five patients with advanced UTUC who underwent consolidative surgery after EV and/or ICI therapy. All patients achieved sufficient disease control with systemic therapy to allow surgical consolidation, including cases in which the primary tumor showed regrowth and metastatic lesions had nearly or completely resolved during systemic therapy. Consolidative surgery was successfully performed with negative surgical margins in all cases. At a median follow-up of 12 (6-30) mo after surgery, all five patients remained alive, with no evidence of disease, and three patients achieved complete discontinuation of systemic therapy. These findings suggest that consolidative surgery after modern systemic therapy, including EV and/or ICIs, may provide durable disease control and treatment-free survival in selected patients with advanced UTUC.
BACKGROUND:Contributing factors to cardiac tamponade after contemporary thermal ablation remain poorly defined, especially in relation to ablation strategies. We aimed to clarify the incidence and identify the risk factors associated with cardiac tamponade following thermal atrial fibrillation (AF) ablation. METHODS:Data from consecutive AF ablation procedures at 20 cardiovascular centers between 2022 and 2024 were analyzed. RESULTS:Among 12 820 AF ablation procedures (mean age 68 ± 11 years; 8877 men; 6,963 paroxysmal AF; 9824 index procedures), radiofrequency and cryoballoon ablation were performed in 10 083 (78.6%) and 5884 (45.9%) procedures. Peri-procedural anticoagulant was a direct thrombin inhibitor (DTI) in 6051 (49.2%) procedures. Cavo-tricuspid isthmus, superior vena cava, mitral isthmus linear ablation, Vein of Marshall (VoM) ethanol infusion, and non-pulmonary vein AF trigger ablation were performed in 6590 (51.4%), 2834 (22.1%), 1138 (8.9%), 733 (5.7%), and 729 (5.7%) procedures, respectively. Cardiac tamponade occurred in 84 (0.64%) (0.59% after index and 0.80% after re-do) procedures. Among them, 61 (0.48%) procedures required pericardiocentesis with a median of 300 [167-500] mL of drainage, and 4 (0.03%) required surgical intervention. All patients recovered without sequelae. In the multivariable analysis, mitral isthmus linear ablation (Odds ratio [OR] = 4.230, 95% confidence interval [CI] = 2.525-7.059; p < 0.001) and paroxysmal AF (OR = 2.095, 95% CI = 1.265-3.470; p = 0.004) significantly increased the incidence of cardiac tamponade. In contrast, DTI use (OR = 0.415, 95% CI = 0.250-0.691; p = 0.001) significantly decreased the incidence. CONCLUSIONS:The real-world incidence of cardiac tamponade during contemporary thermal AF ablation was 0.64%, with surgical intervention required in 0.03%. Lateral mitral isthmus ablation, paroxysmal AF, and lack of direct thrombin inhibitor use were independent predictors, with lateral mitral isthmus ablation being the strongest predictor.
Among acute osteoporotic vertebral fractures with poor prognostic MRI findings, early balloon kyphoplasty did not improve 12-week pain compared with bracing after propensity score matching. However, kyphoplasty better preserved vertebral body height, suggesting that its main early benefit in this subgroup may be structural rather than analgesic. The optimal management for acute osteoporotic vertebral fractures (OVFs) with radiological signs suggesting a poor prognosis remains controversial. This study aimed to compare 12-week clinical and radiographic outcomes of early balloon kyphoplasty (BKP) versus brace treatment in acute OVFs with poor prognostic magnetic resonance imaging (MRI) findings. We compared a prospective BKP cohort (n = 82) with historical brace-treated controls (n = 62) from a prior randomized trial. Eligible patients were aged ≥ 65 years, had acute OVFs with fluid or diffuse low-intensity signal on T2-weighted MRI, and had back pain visual analog scale (VAS) scores ≥ 4/10. The primary outcome was 12-week back pain VAS; the secondary outcome was anterior vertebral body compression percentage (AVBCP). The primary analysis involved a direct comparison of these 12-week post-treatment measurements between the BKP and brace groups. One-to-one propensity score matching was performed using age, sex, and the anatomical location of the fracture (thoracic, thoracolumbar junction, or lumbar). Back pain improved significantly from baseline to 12 weeks within both the BKP group (from 73.6 ± 27.3 to 21.8 ± 19.5, p < 0.0001) and the brace group (from 74.9 ± 23.9 to 30.2 ± 23.3, p < 0.0001). In the crude analysis, BKP was associated with lower VAS scores (21.8 ± 19.5 vs. 30.2 ± 23.3, p = 0.047) and higher AVBCP (67.4 ± 12.3
Carcinoma cuniculatum (CC) is a subtype of squamous cell carcinoma characterized by distinctive histopathological features. Histopathologically, CC exhibits branching and keratin-filled crypts resembling rabbit burrows. Although CC shows minimal or no cytologic atypia, it demonstrates local invasion. The most common site of CC is the skin, especially the sole of the foot, while oral lesions (oral CC; OCC) remain rare. In this study, we aimed to describe the clinicopathological features of CC and analyze clinical outcomes according to the treatment modality. Three cases of OCC are presented, and the current literature is comprehensively reviewed. The patients' ages ranged from 60 to 88 years, and all were male. The tumors were located in the tongue (n = 2) and lower gingiva (n = 1). All patients presented with enlarged cervical lymph nodes, showing fluorodeoxyglucose accumulation on positron emission tomography-computed tomography, and underwent en bloc resection associated with neck dissection. Histopathologically, the tumors formed characteristic burrowing crypts filled with keratin and were diagnosed as CC with negative margins. In all cases, no metastases were identified in the dissected cervical lymph nodes; only follicular and/or paracortical hyperplasia was observed. No postoperative locoregional recurrence or metastasis was detected. Although OCC is a locally aggressive tumor, cervical lymph node metastases are rare. Therefore, achieving local control of the primary site is crucial for OCC treatment.
