Retrospective analysis of pathological response in colorectal cancer liver metastases following treatment with bevacizumab

AIMS: Pathological response has been shown to be a predictor for survival after preoperative chemotherapy and surgical resection of colorectal cancer liver metastases. This retrospective analysis evaluated the effect on pathological response of adding bevacizumab to standard neoadjuvant chemotherapy in patients with metastatic colorectal cancer (mCRC) and liver metastases. METHODS: Patient records from two Spanish centres were retrospectively examined for this analysis. Patients were included if they had stage IV mCRC with liver metastases, were unresectable or marginally resectable tumour before chemotherapy, and had oxaliplatin- or irinotecan-based chemotherapy, with or without bevacizumab, before resection. Tumour response was evaluated using response evaluation criteria in solid tumours (RECIST). Pathological response was assessed by pathologists blinded to treatment. RESULTS: Ninety-five patients were included. Good pathological responses (PR0/PR1) were observed in 37 patients (39 %). The RECIST response rate was 51 %. Only 42 % of patients with a good pathological response had a complete or partial response according to RECIST, while 57 % of those with a poor pathological response had a complete or partial response according to RECIST. RECIST response rates were similar with and without bevacizumab, although 49 % of bevacizumab-treated patients had a good pathological response versus 27 % of those receiving chemotherapy alone (χ (2) P = 0.0302). CONCLUSION: Pathological response may be a better indicator of treatment efficacy than RECIST for patients with mCRC receiving bevacizumab in the neoadjuvant setting. Adding bevacizumab to chemotherapy has the potential to increase pathological response rates. Well-designed prospective clinical studies are required to establish the efficacy and tolerability of this approach (AU)

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Retrospective analysis of pathological response in colorectal cancer liver metastases following treatment with bevacizumab.

AIMS: Pathological response has been shown to be a predictor for survival after preoperative chemotherapy and surgical resection of colorectal cancer liver metastases. This retrospective analysis evaluated the effect on pathological response of adding bevacizumab to standard neoadjuvant chemotherapy in patients with metastatic colorectal cancer (mCRC) and liver metastases. METHODS: Patient records from two Spanish centres were retrospectively examined for this analysis. Patients were included if they had stage IV mCRC with liver metastases, were unresectable or marginally resectable tumour before chemotherapy, and had oxaliplatin- or irinotecan-based chemotherapy, with or without bevacizumab, before resection. Tumour response was evaluated using response evaluation criteria in solid tumours (RECIST). Pathological response was assessed by pathologists blinded to treatment. RESULTS: Ninety-five patients were included. Good pathological responses (PR0/PR1) were observed in 37 patients (39 %). The RECIST response rate was 51 %. Only 42 % of patients with a good pathological response had a complete or partial response according to RECIST, while 57 % of those with a poor pathological response had a complete or partial response according to RECIST. RECIST response rates were similar with and without bevacizumab, although 49 % of bevacizumab-treated patients had a good pathological response versus 27 % of those receiving chemotherapy alone (χ (2) P = 0.0302). CONCLUSION: Pathological response may be a better indicator of treatment efficacy than RECIST for patients with mCRC receiving bevacizumab in the neoadjuvant setting. Adding bevacizumab to chemotherapy has the potential to increase pathological response rates. Well-designed prospective clinical studies are required to establish the efficacy and tolerability of this approach.

Contasure-Needleless compared with transobturator-TVT for the treatment of stress urinary incontinence.

INTRODUCTION: Single-incision devices for the treatment of stress urinary incontinence (SUI) have been introduced in the last few years. We report a comparison between Obturator Tension-free vaginal tape (TVT-O) and Contasure-Needleless (C-NDL). METHODS: One hundred and fifty-eight women with primary SUI were scheduled to receive TVT-O or C-NDL and follow-up during the first year. Epidemiological information, complications, blood loss, and pain level were recorded. We also analyze stress test and quality of life. RESULTS: Sixty-three (87.5%) C-NDL presented a negative stress test, compared with 54 (90%) of TVT-O (p value 0.015 for non-inferiority test). Sandvik Severity Index was 0 in 75.4% in the C-NDL group and 87.3% in the TVT-O (p < 0.015). Complication rate and degree of satisfaction were similar in both groups. Statistically, there were differences (p = 0.012) in postoperative pain in the TVT-O group. CONCLUSIONS: C-NDL provides similar outcomes as TVT-O after 1-year follow-up. It is necessary that long-term data confirm our results.

[Merkel cell carcinoma. On one case]. / Carcinoma de células de Merkel. A propósito de un caso.

We present the case of an 86 year old woman who was sent for consultation at General Surgery due to asymptomatic tumouration on the back face of the left thigh whose size had increased during the 2 previous months. Physical exploration revealed tumouration that was painless, excrescent, indurated, mobile and well delimited, with a diameter of 5 cm, a reddish colour and a rough surface. Tumoural extirpation was carried out with broad margins, with a hystopathological result of primary cutaneous neuro-endocrynal carcinoma or Merkel cell carcinoma. Computerised tomography was carried out, observing tumoural adenopathies in the para-aortic spaces, iliac chains and left femorals, as well as edema in the lower left extremity. The patient was sent to the Oncology service for treatment, without presenting a satisfactory evolution and with a progressive deterioration of her general state, dying within the first year after diagnosis.

Carcinoma de células de Merkel. A propósito de un caso / Merkel cell carcinoma. On one case

Presentamos el caso de una mujer de 86 años que fue remitida a consulta de Cirugía General por presentar tumoración asintomática en la cara posterior del muslo izquierdo cuyo tamaño había aumentado durante los 2 últimos meses. Se apreciaba en la exploración física una tumoración indolora, excrecente, indurada, móvil y bien delimitada, de 5 cm de diámetro, de coloración rojiza y superficie rugosa. Se realizó la extirpación tumoral con márgenes amplios, con resultado histopatológico de carcinoma neuroendocrino primario cutáneo o carcinoma de células de Merkel. Se realizó tomografía computarizada, observando adenopatías tumorales en los espacios para aórtico, cadenas ilíacas y femorales izquierdas, así como edema en la extremidad inferior izquierda. Se remitió a la paciente al servicio de Oncología para continuar tratamiento pertinente, sin presentar evolución satisfactoria y con progresivo deterioro del estado general, falleciendo dentro del primer año tras el diagnóstico (AU)

We present the case of an 86 year old woman who was sent for consultation at General Surgery due to asymptomatic tumouration on the back face of the left thigh whose size had increased during the 2 previous months. Physical exploration revealed tumouration that was painless, excrescent, indurated, mobile and well delimited, with a diameter of 5 cm, a reddish colour and a rough surface. Tumoural extirpation was carried out with broad margins, with a hystopathological result of primary cutaneous neuro-endocrynal carcinoma or Merkel cell carcinoma. Computerised tomography was carried out, observing tumoural adenopathies in the para-aortic spaces, iliac chains and left femorals, as well as edema in the lower left extremity. The patient was sent to the Oncology service for treatment, without presenting a satisfactory evolution and with a progressive deterioration of her general state, dying within the first year after diagnosis (AU)

Usefulness of acr expression for monitoring latent Mycobacterium tuberculosis bacilli in 'in vitro' and 'in vivo' experimental models.

Real-time RT-PCR was used to quantify the expression of genes possibly involved in Mycobacterium tuberculosis latency in in vitro and murine models. Exponential and stationary phase (EP and SP) bacilli were exposed to decreasing pH levels (from 6.5 to 4.5) in an unstirred culture, and mRNA levels for 16S rRNA, sigma factors sigA,B,E,F,G,H and M, Rv0834c, icl, nirA, narG, fpbB, acr, rpoA, recA and cysH were quantified. The expression of acr was the one that best correlated with the CFU decrease observed in SP bacilli. In the murine model, the expressions of icl, acr and sigF tended to decrease when bacillary counts increased and vice versa. Values from immunodepressed mice (e.g. alpha/beta T cells, TNF, IFN-gamma and iNOs knock out strains), with accelerated bacillary growth rate, confirmed this fact. Finally, the expression of acr was maintained in mice following long-term treatment with antibiotics. The quantification of acr expression could be useful for monitoring the presence of latent bacilli in some murine models of tuberculosis.

[Origin and development of RUTI, a new therapeutic vaccine against Mycobacterium tuberculosis infection]. / Origen y desarrollo de RUTI, una nueva vacuna terapéutica contra la infección por Mycobacterium tuberculosis.

This article reviews the pathophysiology of the latent form of Mycobacterium tuberculosis along with its natural history and progression in infected tissues. The proposed hypotheses regarding the relationship between M tuberculosis and the associated immune response, the cause of granuloma necrosis, the tolerance of a certain concentration of the bacillus in host tissues, the constant turnover of cells in the lung, and the effect of chemotherapy form the basis for the design of the therapeutic vaccine RUTI against latent M tuberculosis infection. This vaccine is generated from detoxified M tuberculosis cell fragments that facilitate a balanced T helper (Th) 1/Th2/Th3 response to a wide range of antigens along with intense antibody production. Treatment with RUTI following chemotherapy has been demonstrated to be effective in experimental models in mice and guinea pigs and does not exhibit toxicity.

Origen y desarrollo de RUTI, una nueva vacuna terapéutica contra la infección por Mycobacterium tuberculosis / Origin and development of RUTI a new therapeutic vaccine against Mycobacterium tuberculosis Infection

En este artículo se revisan la fisiopatología de la forma latente de Mycobacterium tuberculosis, su naturaleza y su evolución en los tejidos infectados. Las hipótesis planteadas entre la relación de este bacilo con la respuesta inmunitaria generada, el origen de la necrosis intragranulomatosa, la tolerancia hacia cierta concentración bacilar en los tejidos del hospedador, el constante recambio celular en los pulmonares y el efecto inducido por el tratamiento quimioterápico permiten conocer las bases para el diseño de la vacuna terapéutica RUTI contra la infección latente por M. tuberculosis. Se trata de una vacuna generada a partir de fragmentos celulares de M. tuberculosis biotransformados que permiten generar una respuesta equilibrada de tipo Th1/Th2/Th3 ante un amplio abanico de antígenos, además de una intensa producción de anticuerpos. El tratamiento con RUTI, posterior a la quimioterapia, ya ha demostrado su eficacia en modelos experimentales en ratones y cobayas, sin generar ninguna respuesta tóxica

This article reviews the pathophysiology of the latent form of Mycobacterium tuberculosis along with its natural history and progression in infected tissues. The proposed hypotheses regarding the relationship between M tuberculosis and the associated immune response, the cause of granuloma necrosis, the tolerance of a certain concentration of the bacillus in host tissues, the constant turnover of cells in the lung, and the effect of chemotherapy form the basis for the design of the therapeutic vaccine RUTI against latent M tuberculosis infection. This vaccine is generated from detoxified M tuberculosis cell fragments that facilitate a balanced T helper (Th) 1/Th2/Th3 response to a wide range of antigens along with intense antibody production. Treatment with RUTI following chemotherapy has been demonstrated to be effective in experimental models in mice and guinea pigs and does not exhibit toxicity

[Sentinel node in breast cancer. Histological study of 67 cases]. / Ganglio centinela en cáncer de mama. Estudio histológico de 67 casos.

BACKGROUND: The extirpation of the sentinel node is a widespread surgical technique whose aim is to avoid axillary resection in patients with breast cancer at early stages. Determination of tumoral infiltration can be evident in the case of macrometastasis (>2mm), or difficult to detect in micrometastasis (<2mm). For this reason we use a protocol of serialized sections, to increase our capacity for detecting micrometastasis. Realisation of this protocol is highly laborious and represents a high cost, thus its effectiveness and efficacy must be studied. MATERIAL AND METHODS: We reviewed 67 sentinel nodes corresponding to 48 patients with breast cancer treated at our hospital in the last three years. All the samples received at the Pathology Unit were included. Serialized sections of three microns were made on each node and with a depth of 40 microns between them. A total of fourteen cuts were made. Every five cuts there was an alternation of immunostaining with a cocktail of queratines (AE1/AE3) and with haemotoxylin-eosin. RESULTS: Sixty-seven sentinel nodes were extirpated from 48 patients. Fourteen positive (20%) were detected. Of these metastases, 6 were macrometastases >2mm, 5 were micrometastases <2mm and 3 were isolated cellular groups (between 0.2 and 2mm). In 6 cases (43%), the metastases only became evident with queratine staining in serialized cuts. Axillary resection was carried out in 44 cases. CONCLUSIONS: The histological study of the sentinel nodes makes it possible to evaluate the status of tumoral infiltration of the axillary ganglions and to greatly reduce axillary lymphadenectomies. The conventional study of the sentinel node (with a single section) is insufficient for the diagnosis of tumoral infiltration. In our series, histological study using a protocol of serialized sections has enabled us to detect some 43% of metastases in the sentinel node that were not evident in the initial section.

Ganglio centinela en cáncer de mama. Estudio histológico de 67 casos / Sentinel node in breast cancer. Histological study of 67 cases

Fundamento. La extirpación del ganglio centinela es una técnica quirúrgica muy extendida cuyo objetivo es evitar el vaciamiento axilar en pacientes con cáncer de mama en estadios iniciales. La determinación de la infiltración tumoral puede ser evidente en caso de macrometástasis (>2mm), o difícil de detectar en las micrometástasis (2mm, 5 fueron micrometástasis <2 mm y 3 grupo celular aislado (entre 0,2 y 2 mm) . En 6 casos (43 por ciento), las metástasis sólo se hicieron patentes con la tinción de queratina en los cortes seriados. Se realizó resección axilar en 44 casos. Conclusiones. El estudio histológico del ganglio centinela permite evaluar el estatus de infiltración tumoral de los ganglios axilares y reducir en gran medida las linfadenectomías axilares. El estudio convencional del ganglio centinela (con un único corte) resulta insuficiente para el diagnóstico de la infiltración tumoral. En nuestra serie el estudio histológico mediante un protocolo de cortes seriados nos ha permitido detectar un 43 por ciento de metástasis en ganglio centinela que no eran evidentes en el corte inicial (AU)

Resultados comparativos de la disección ganglionar en cáncer de recto con y sin tratamiento previo del tejido adiposo / Comparative results of ganglion dissection in cancer of the rectum with and without prior treatment with adipose tissue

Fundamento. El propósito de este estudio es describir los resultados obtenidos mediante dos técnicas de aislamiento de ganglios linfáticos en piezas quirúrgicas de resección anterior por adenocarcinoma de recto. Material y métodos. En una serie de 30 casos consecutivos de pacientes intervenidos por adenocarcinoma de recto hemos realizado una búsqueda de ganglios de forma manual convencional y una segunda tras 24 horas en una solución desengrasante a temperatura ambiente. Resultados. En la primera búsqueda se han aislado 335 ganglios linfáticos con una media que oscila entre 6,46 y 17,58, correspondiendo los valores más bajos a los grupos que habían recibido tratamiento adyuvante previo. En la segunda inclusión, tras la acción de la solución de aclaramiento hemos encontrado nuevos ganglios (85) en un 70 por ciento de los casos, en número y tamaño sensiblemente inferior al inicial. Conclusiones. La disección ganglionar manual del tejido adiposo es un método fiable para el aislamiento de ganglios linfáticos en las piezas de resección por adenocarcinoma de recto. La búsqueda de ganglios linfáticos tras la acción de una solución de aclaramiento debe reservarse para los casos en los que no se alcanza el mínimo aconsejado en el estadiaje TNM (AU)

[Comparative results of ganglion dissection in cancer of the rectum with and without prior treatment of the adipose tissue]. / Resultados comparativos de la disección ganglionar en cáncer de recto con y sin tratamiento previo del tejido adiposo.

BACKGROUND: The aim of this study is to describe the result obtained through two techniques of isolation of lymphatic lymph nodes in surgical pieces of anterior resection due to adenocarcinoma of the rectum. MATERIAL AND METHODS: We carried out a search in a series of 30 consecutive cases of patients operated on for adenocarcinoma of the rectum for lymph nodes first in a manual conventional way and second after 24 hours in a degreasing solution at room temperature. RESULTS: In the first search 335 lymph nodes were lymph nodes isolated, with an average that oscillated between 6.46 and 17.58, with the lower values corresponding to the groups that had received prior adjuvant treatment. In the second inclusion, following the action of the clearing solution, we found new lymph nodes (85) in some 75% of the cases, appreciably lower in number and smaller in size than the initial search. CONCLUSIONS: Manual lymph nodes dissection of the adipose tissue is a reliable method for the isolation of lymphatic lymph nodes in pieces of resection due to adenocarcinoma of the rectum. The search for lymphatic ganglions following the action of a clearing solution should be reserved for cases in which the minimum recommended in the TNM staging is not reached

Hemorragia digestiva recurrente en relación con divertículo yeyunal. Una rara asociación / Recurrent digestive haemorrhage in relation to jejunum diverticulosis. A rare association

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[Standard versus decreasing weight loss. Better tolerance and comfort in hemodialysis]. / Pérdida standard vs. pérdida decreciente. Mejor tolerancia y confort en hemodiálisis.

The usual procedure to eliminate an overweight in hemodialysis consist in eliminating the whole amount of water distributed in an equitable way during the four hours hemodialysis session. This approach has tried to establish in what way the comfort of patients under dialysis improved, varying this loss in a decreasing way from the beginning to the end of the session.