Molecular subtypes in early colorectal cancer associated with clinical features and patient prognosis.

PURPOSE: After surgical resection, an ample prognosis variability among stages is observed. Multiple prognostic factors are individually studied and some CRC classifiers have been proposed. Not one have been implemented into clinical practice. METHODS/PATIENTS: We classified 105 patients with resected CRC (stage I-III) into five molecular subtypes using BRAFV600E and RAS (KRAS; NRAS) status, and the expression of DNA mismatch repair (MMR) proteins (MLH1 and MSH2). Clinicopathological features and DFS) of distincts groups were evaluated. RESULTS AND CONCLUSIONS: RAS and BRAFV600E mutations were detected in 43.8 and 11.4% of patients, respectively. 19% of tumours had lack of expression of any MMR proteins reflecting a system deficiency (dMMR). Patients with any RAS mutation had lower DFS that patients with RAS wild type (wt) (40.23 vs 45.26 months; p value = 0.035). Of a total of five molecular subtypes, three were MMR proficient (pMMR): RAS mutated (39%), BRAFV600E mutated (6.7%) and RAS/BRAFV600E wt (35.2%); and two were dMMR: BRAFV600E mutated (4.8%) and BRAFV600E wt (14.3%). Left side tumours were more frequently observed in pMMR/RAS and BRAFV600E wt subtype, and right side tumours in dMMR subtypes. Among the three pMMR subtypes, a benefit survival was observed for patients without any mutation in BRAFv600E or RAS oncogenes (median of DFS = 45.5 vs 40.98 months in RAS mutated group; p = 0.084 and vs 34.13 in BRAFv600E mutated group; p = 0.031). Molecular classification using these biomarkers can be useful to identify groups with differences in prognosis.

Comparative effects of growth hormone in large and small bowel resection in the rat.

Our aim was to assess the proliferative effect of human growth hormone on ileal mucosa after two different adaptation models of massive small and massive large bowel resection. Male Wistar rats were assigned to control-laparotomy, 90% small bowel resection, or 75% large bowel resection and were treated with either saline or human growth hormone daily for 7 days (total six groups; n = 8/group). Ileal proliferative status was assessed by means of histomorphometry and proliferating cell nuclear antigen. Plasma somatostatin was quantitated. Growth hormone increased (P < 0.01) mucosal height in all groups with a more marked effect on the crypt than on villus height. Proliferating cell nuclear antigen-labeled cells increased similarly (P < 0.01). Small bowel resection appears to favor a more marked increment in villus height than large bowel resection. Compared to control saline-treated group, the remaining groups showed decreases in plasma somatostatin (P < 0.01). Human growth hormone has a marked trophic effect on intestinal mucosa, even in hyperproliferative states. Decreased plasma somatostatin associated with intestinal hyperplastic mucosa suggests a possible relationship with the adaptive process.

[Somatostatin and growth hormone in post-colectomy intestinal hyperplasia in rats]. / Somatostatina y hormona de crecimiento en la hiperplasia intestinal post-colectomía en la rata.

AIM: Somatostatin exerts significant effects on gastrointestinal function that may include mucosal growth regulation, probably through its action on growth hormone release. The aim of this work was to correlate somatostatin and growth hormone plasma levels and the hyperproliferative status of intestinal mucosa after colectomy. EXPERIMENTAL DESIGN: Adult Wistar rats were divided into two groups: control sham operated (n = 8) and large bowel resection (n = 8). Seven days post-colectomy, the animals were killed. Ileal mucosal samples were assayed for proliferative status (morphometry, and proliferating cell nuclear antigen labeling) and blood samples for plasmatic somatostatin and growth hormone measurement. RESULTS: A hyperproliferative status was observed with significant increases in villous length and crypt proliferating cell nuclear antigen labeling. Plasma somatostatin showed a 95% significant decrease while growth hormone levels increased significantly. CONCLUSION: The intestinal adaptation seen after colectomy is associated with lower somatostatin and higher growth hormone plasma level, possibly by regulating the intestinal adaptative process.

[Complete anorectal stenosis due to paracetamol and salicylamide suppositories]. / Estenosis ano-rectal completa por supositorios de paracetamol y salicilamida.

A female patient previously diagnosed of psychiatric disease used a compound of paracetamol-salicilamide-codeine in suppositories, daily, for more than one year, for migraine. She developed a complete recto-anal stenosis and bowel obstruction requiring permanent colostomy. Ulceration and recto-anal stenosis have been described in association with the use of suppositories, mainly ergotamine. However, this is the first case of total recto-anal stenosis.

[Administration of growth hormone enhances the intestinal adaptive response after resection of small intestine in rats]. / La administración de hormona de crecimiento incrementa la respuesta adaptativa intestinal posterior a una resección de intestino delgado en la rata.

The aim of this study was to assess the proliferative effect of growth hormone (GH) on the remnant intestinal mucosa after small bowel resection in the rat. Three groups (n = 8/group) of adult Wistar rats were established as follows: 1) control, 2) 90% small bowel resection (SBR) and 3) 90% small bowel resection + GH 1 mg/kg-day (SBR+GH) during 7 days. Ileal samples were taken prior to resection (basal), and at sacrifice, for assessment of intestinal mucosal growth by means of morphometric (crypt and villous length) and proliferative (proliferating cell nuclear antigen, PCNA) techniques. GH administered to resected rats (SBR+GH) significantly increased the number of proliferating cells and crypt and villous length when compared to resected non-treated animals (SBR). In conclusion, in the rat, GH markedly increases the trophic action of intestinal mucosa in hyperproliferative states like massive bowel resection, enhancing remnant bowel morphologic and proliferative adaptation.

Foreign minorities from developing countries in Madrid.

"Spain, which has always been a land of emigrants, is currently a centre of attraction for immigrants, as are other countries in Mediterranean Europe. The proportion is not as high as in other countries with a longer tradition of immigration. In this survey we selected the six nationalities which provide the highest numbers of immigrants from the developing world, and which have the greatest racial or cultural contrast to the native population. We analyse their structural features, whether or not immigrants from the same country...collect in the Madrid Metropolitan Area, the recent mobility of the immigrant population, and the evolution of immigration since the Administration carried out a regularization process, as well as Spaniards' opinion of foreign immigrants."

[Cerebral infarct secondary to an intraoral injury from a spoon. A case report]. / Infarto cerebral secundario a traumatismo intrabucal con una cuchara. Informe de un caso.

We report the case of a 4-year-old female who developed an extensive cerebral infarction after trauma to the right peritonsillar area with a spoon. Blunt injury to the intima of the interna carotid artery promotes thrombus formation or clot embolization which results in an ischemic cerebrovascular event. We emphasize the need to prevent this rare complication of intraoral trauma in childhood.

Importance of criminal behaviour related variables in criminal prognosis: a study of 156 subjects.

The task of assessing and predicting whether an individual does, or will in future, constitute a danger to society is one of the most important facing the Forensic psychiatrist. The various factors that should be taken into account in assessing and predicting 'dangerousness' are discussed.

[Congenital hepatic fibrosis associated with choledochal cyst]. / Fibrosis hepática congénita asociada a quiste del colédoco.

The purpose of this work is to report the case of a one-year and eleven-month-old female child who presented with an asymptomatic hepatic mass; on x-ray examination a well limited round tumor was seen as well as renal cysts. A choledochal cyst was found upon laparotomy; the liver biopsy exhibited congenital hepatic fibrosis. This association is not clearly defined in the literature review made, making this perhaps the first well-documented case with this combination. We analyze the pathogenic mechanisms of both disorders and conclude that choledochal cyst is probably not related to hepatorenal fibropolycystic disease; this could be a casual association in our patient.