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The existence of two nontrivial solutions for a class of fully nonlinear problems at critical growth with perturbations of lower order is proved. The first solution is obtained via a local minimization argument while the second solution follows by a non-smooth mountain pass theorem.

Objective: First, to assess the impact of the number of examined lymph nodes (ELNs) on staging and survival after distal pancreatectomy (DP) for pancreatic adenocarcinoma (PDAC). Second, to identify the minimum number of ELNs (MNELNs) ensuring an accurate detection of nodal involvement. Third, to reappraise the role of lymph node (LN) parameters, including N-status and lymph node ratio (LNR). Background: In contrast with pancreatoduodenectomy, information on LN staging and the MNELN required in DP is lacking. Methods: Patients undergoing DP for PDAC at 2 academic hospitals from 2000 through 2013 were retrospectively analyzed. The eighth edition of the American Joint Committee on Cancer staging system was used. The MNELN was estimated using the binomial probability law. Survival analyses were performed separately for node-negative and node-positive patients using univariable and multivariable models. Results: The study population consisted of 240 patients. The median number of ELN was 21, significantly lower in node-negative patients as compared with node-positive patients (18.5 vs 24.0; P = 0.001). The proportion of node-positive patients increased with increasing numbers of ELNs, whereas LNR showed an inverse trend. The estimated MNELN was 20. The number of ELN (≥ or <20) was an independent prognostic factor only in node-negative patients [odds ratio (OR) 3.23 for ELN <20), suggesting a stage migration effect. In node-positive patients, N2-class, but not LNR, was a significant predictor of survival at multivariable analysis (OR 1.68). Conclusion: The number of ELN affects nodal staging in body/tail PDAC. At least 20 LNs are required for correct staging. N-status is superior to LNR in predicting survival of node-positive patients.

de Quervain's disease (dQD) is a stenosing tenosynovitis of the first extensor compartment of the wrist which is formed by the tendons of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB).1,–,3 Thirty-three consecutive patients with a clinical diagnosis of dQD underwent ultrasound (US). The inclusion criteria were (1) a history of pain over the radial aspect of the wrist aggravated by excessive use of the thumb; (2) an orthopaedic diagnosis of dQD; and (3) a positive Finkelstein test. The control group consisted of 24 healthy subjects and was matched for age and sex. All studies were performed using a Vivid 7 machine (General Electric, Milwaukee, Wisconsin, USA) with a 12 MHz matrix linear array transducer. The sonographer was not blinded to the identity of the control subjects. Statistical analysis was performed using the Student …

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The toxicity and efficacy of intrathecal liposomal cytarabine (LC) were evaluated in children with central nervous system (CNS) relapsed/refractory acute leukemia/lymphoma. Thirty patients (male:female ratio 21:9; median age 9.4 years) with CNS relapsed/resistant disease were treated with intrathecal LC at dosages adjusted for age. Twenty-seven (90%) patients simultaneously received systemic chemotherapy, including concurrent high-dose cytarabine or methotrexate in 21 (70%) cases. Of 28 patients evaluable for response, 25 patients (89%) achieved CNS complete remission and three (11%) partial remission. The median number of intrathecal LC administrations per patient was 4. The cerebrospinal fluid was cleared after a median of 3 intrathecal LC administrations. Neurological toxicity ≥ grade 3 occurred in four (13%) patients. No permanent sequelae were observed. The median overall survival was 20.9 months and the 5-year probability of survival was 46%. These encouraging data suggest that intrathecal LC is well tolerated and effective in children with relapsed/refractory CNS leukemia/lymphoma.