International Society of University Colon and Rectal Surgeons survey of surgeons’ preference on rectal cancer treatment

Purpose@#Rectal cancer treatment has a wide range of possible approaches from radical extirpative surgery to nonoperative watchful waiting following chemoradiotherapy, with or without, additional chemotherapy. Our goal was to assess the personal opinion of active practicing surgeons on rectal cancer treatment if he/she was the patient. @*Methods@#A panel of the International Society of University Colon and Rectal Surgeons (ISUCRS) selected 10 questions that were included in a questionnaire that included other items including demographics. The questionnaire was distributed electronically to ISUCRS fellows and other surgeons included in our database and remained open from April 16 to 28, 2020. @*Results@#One hundred sixty-three specialists completed the survey. The majority of surgeons (n=65, 39.9%) chose the minimally invasive (laparoscopic) surgery for their personal treatment of rectal cancer. For low-lying rectal cancer T1 and T2, the treatment choice was standard chemoradiation+local excision (n=60, 36.8%) followed by local excision±chemoradiotherapy if needed (n=55, 33.7%). In regards to locally advanced low rectal cancer T3 or greater, the preference of the responders was for laparoscopic surgery (n=65, 39.9%). We found a statistically significant relationship between surgeons’ age and their preference for minimally invasive techniques demonstrating an age-based bias on senior surgeons’ inclination toward open approach. @*Conclusion@#Our survey reveals an age-based preference by surgeons for minimally invasive surgical techniques as well as organ-preserving techniques for personal treatment of treating rectal cancer. Only 1/4 of specialists do adhere to the international guidelines for treating early rectal cancer.

Pediatric Heart Failure: Current State and Future Possibilities

Heart failure is a complex pathophysiological syndrome that can occur in children from a variety of diseases, including cardiomyopathies, myocarditis, and congenital heart disease. The condition is associated with a high rate of morbidity and mortality and places a significant burden on families of affected children and to society as a whole. Current medical therapy is taken largely from the management of heart failure in adults, though clear survival benefit of these medications are lacking. Ventricular assist devices (VADs) have taken an increasingly important role in the management of advanced heart failure in children. The predominant role of these devices has been as a bridge to heart transplantation, and excellent results are currently achieved for most children with cardiomyopathies. There is an ongoing investigation to improve outcomes in high-risk populations, such as small infants and those with complex congenital heart disease, including patients with functionally univentricular hearts. Additionally, there is an active investigation and interest in expansion of VADs beyond the predominant utilization as a bridge to a heart transplant into ventricular recovery, device explant without a heart transplantation (bridge to recovery), and placement of devices without the expectation of recovery or transplantation (destination therapy).

The Importance of the RAS Interacting with the HGF/C-Met Receptor System in Hypertensive Type 2 Diabetes Mellitus.

The classic renin-angiotensin system (RAS) is described as a circulating hormone system with primary roles in the regulation of blood pressure, body water balance and thirst and control over vasopressin and aldosterone release. Recently local tissue RASs have been identified with regulatory physiological functions and also with pathophysiological processes including fibrosis, inflammation and dysfunctional cell proliferation. There is a strong correlation between organs vulnerable to diabetic–induced hyperglycemic injury (eg. kidney and retina) and the over activation of local RASs. Increased angiotensin II concentrations in these tissues promotes hypertension and end-organ damage in at least two ways: 1) By activating AT1 receptor proteins thus inducing changes in local blood flow and tissue hydration and 2) Exacerbating hyperglycemic-induced oxidative stress, elevated polyol and hexosamine pathway variability and facilitating glycation end-products. Thus, inhibition of the RAS has become an important treatment approach to control diabetic related hypertension, nephropathy and to a lesser extent retinopathy. The present review emphasizes the recently established importance of the hepatocyte growth factor (HGF)/c-Met receptor system interacting with the RAS in Type 2 diabetes and their likely contribution to end-organ damage. A hypothesis is offered concerning how the pancreatic RAS may affect dimerization of HGF and in turn activation of the c-Met receptor to promote β cell proliferation and insulin synthesis. We conclude with details concerning the development of an AngIV-based small molecule HGF mimetic designed to act as an insulinotropic factor.

Phase II Study of Docetaxel with Radiation Therapy for Post Prostatectomy Rising PSA.

Aims: To determine the tolerability of adding docetaxel to radiation therapy in patients with a rising PSA post prostatectomy for prostate cancer. Study design: Phase II study of the combination of docetaxel and radiation therapy. Place and duration of study: University and Veterans Association Hospital from 2007- 2009. Methodology: Patients eligible to receive “salvage” radiation therapy were enrolled in a prospective study to receive concomitant weekly docetaxel (20 mg/m2) and then 4 cycles of full dose (75 mg/m2) docetaxel. Results: All 19 patients were able to complete the concomitant therapy, with just one patient not receiving all 7 cycles of weekly chemotherapy (missing one). Sixteen of 19 completed all four cycles, 2 completed 3 cycles and 1 completed 1 cycle of full dose docetaxel. During combined treatment, there were 3 transient grade 3 toxicities (diarrhea, hemoglobin decline, and hyperglycemia). There was no grade 4 toxicity. During full dose docetaxel, 3 patients suffered a grade 3 decline in WBC count and 2 went on to grade 4. Other single incidents of grade 3 toxicity were anxiety, fatigue, hyperglycemia, diarrhea, febrile neutropenia, port infection and abscess. All the toxicities were transient. By the end of treatment, 89% had a decline in PSA. Conclusion: This is the first report of combined docetaxel and radiation in the post prostatectomy setting. Patients tolerated the combined treatment very well. Toxicities of the full dose docetaxel are consistent with what’s reported in the literature and appear tolerable.

Brucella isolated from bone marrow.

A 40 year patient presented with pyrexia of one month duration. Routine work up for fever of unknown origin (FUO) was negative. Bone marrow aspiration and culture done yielded Brucella. Bone marrow cultures are recommended for patients for FUO for whom the routine workup turns out to be negative. Serological tests for brucellosis can be false-negative in some cases of brucellosis due to prozone phenomena.

Surgical management of ureteropelvic junction obstruction in adults

Ureteropelvic junction (UPJ) obstruction is a well-recognized entity that may present at any time - in fetal life, infancy, childhood, or early or late adulthood. As the most common site of obstruction in the upper urinary tract, the UPJ is an area with which urologists should be well familiar. There has been an improved understanding of the pathophysiology of primary congenital UPJ obstruction that has been reflected in the evolution of surgical options, from open surgical repair to minimally invasive surgery. Although the primary scope of this review is the surgical management of this condition, we will briefly review the pathogenesis, clinical presentation, and diagnosis of UPJ obstruction

Current evaluation and management of renal and ureteral stones

A systematic clinical approach is required for the diagnosis and management of renal and ureteral stones. The presenting symptoms, past medical history, medications, and physical examination all provide clues to the diagnosis of urinary stones. In the acute setting, noncontrast helical computerized tomography has emerged as the first line imaging test for renal colic. More traditional imaging tests are also important in the management of stone disease. After making the diagnosis of a urinary stone, the urologist should discuss the advantages and disadvantages of all treatment options with the patient. For most stone patients today, many equally effective treatment approaches can exist for the same problem. To help direct surgical management, guidelines for stone management have been devised. With technologic advances, stone treatment has improved and complications have decreased. While patient care has been significantly impacted by use of effective endourologic techniques, patients should complete imaging tests following surgery to assure a stone-free state. In addition, recurrent stone formers should complete a medical stone evaluation to identify treatable causes of their stones

La montaña del condor: metafora y ritual en un ayllu andino / sss

Sobre todo, doy gracias a los kállawayas, especialmente a Marcelino, Carmen, Dámaso, Elsa y Sarao, que me enseñaron la extensión de sus conocimientos y los límites de los míos. Compartieron conmigo, tal como yo intento hacer con el lector, su religión, que no enfatiza las ideas y dogmas, sino que, en vez de ello, considera a la tierra y a la naturaleza por su comprensión de la vida, y que está todavía embellecida con mitología, misterio y rito...