Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) delivered via a modified perfusion system for peritoneal carcinomatosis of colorectal origin.

BACKGROUND AND PURPOSE: The long-term survival of patients with peritoneal carcinomatosis of colorectal origin has been achieved with cytoreductive surgery, which removes all macroscopic implants, combined with hyperthermic intraperitoneal chemotherapy (HIPEC). The current technology for administering intraperitoneal heated chemotherapy is expensive and, for some institutions, unaffordable. We conducted this study to assess the temperature stability provided by a modified, inexpensive system, to offer a simple and low cost alternative to the standard HIPEC delivery equipment. METHODS: Ten patients with histologically diagnosed peritoneal metastases of adenocarcinoma or pseudomyxoma peritonei underwent cytoreductive surgery and received HIPEC with 5-fluorouracil for 90 min, delivered via our modified system. The temperature was recorded from two probes: one in the inflow catheter and one in the outflow catheter. The intra-abdominal temperature was monitored meticulously to maintain it at between 41 and 42 °C. RESULTS: All patients underwent cytoreductive surgery and HIPEC using our modified delivery system. Temperature stability was achieved in all patients, with a mean of 41.4°. There were no thermal injuries associated with any of the ten perfusions. The mean hospital stay was 15 days and the median survival was 30 months. CONCLUSION: Analysis of this data demonstrates that the uniform delivery of HIPEC at 41° with this modified system is feasible and safe. The outcome of the patients treated with cytoreductive surgery and HIPEC with this modified system compares favorably to other published series. Its low cost and simple design will give more patients with peritoneal carcinomatosis access to this treatment.

Thrombocytosis as a predictor of distant recurrence in patients with rectal cancer.

BACKGROUND AND AIMS: Thrombocytosis is frequently observed in patients with malignancy. We undertook this study to determine the prognostic value of thrombocytosis in patients with rectal cancer. METHODS: We performed a retrospective study of patients undergoing low anterior resection for rectal cancer between January 2000 and March 2007. Preoperative platelet count was measured before surgery. Postoperative platelets were determined 1 month after surgery. Two-tailed p values <0.05 were considered statistically significant. RESULTS: One hundred sixty three patients with rectal cancer were included in the study. Preoperative platelet count >350,000 was found in 8% of patients. Postoperative platelet count >350,000 was found in 6% of patients. Distant metastases were found in 17 patients (10.4%). Significant variables in the multivariate analyses were preoperative platelets >350,000 (p = 0.001), postoperative platelets >350,000 (p = 0.002), carcinoembryonic antigen >13 ng/dL (p = 0.003). Patients with preoperative platelet count <350,000 showed a 5-year survival rate of 81%, whereas patients with platelet count >350,000 had a 25-month survival [95% confidence interval (CI): 20-26]; p <0.001. Patients with postoperative platelets <350,000 showed a 5-year survival rate of 80%, whereas patients with platelets >350,000 showed a 3-year survival rate of 37.5% (p <0.05). CONCLUSIONS: Pre- or postoperative platelet count >350,000 is associated with poor survival in patients with rectal cancer. The measurement of platelets is a clinical marker useful to define the prognosis for patients with rectal cancer.

Quiste de duplicación gástrica. Informe de un caso / Gastric duplication cyst. A case report

Los quistes de duplicación gástricos son hallazgos poco comunes en adultos porque habitualmente son detectados durante los primeros años de vida. Son el resultado de una alteración entre el ectodermo, la notocorda y el endodermo durante la embriogénesis temprana. Otra teoría está relacionada con el desarrollo del divertículo respiratorio, cuando la pared del quiste está revestida por epitelio de tipo respiratorio. Se informa el caso de una mujer de 52 años, previamente sana, asintomática, con una lesión quística abdominal de 4×2,7×2cm, localizada en la curvatura mayor del estómago y detectada por estudio de tomografía computarizada. Microscópicamente la pared del quiste estaba revestida por epitelio gástrico con túnica muscular completa y sin datos de malignidad. Se discute el origen embriológico de estas lesiones poco frecuentes(AU)

Gastric duplication cysts are usually discovered early in life and are therefore uncommon findings in adults. They are thought to result from a disturbance in the interrelations between the ectoderm, the notochord and the endoderm during early embryogenesis. Another hypothesis is related to the development of the respiratory diverticulum when the cyst wall is lined by pseudostratified respiratory epithelium with ciliated cells. We report a case of an asymptomatic 52-year-old woman with an 4×2.7×2cm abdominal cystic mass located in the greater curvature of the stomach and detected by CT scan. Microscopically, the cyst wall was lined by gastric mucosa with complete smooth muscle bundles. No sign of malignancy was found. The embryogenesis of this uncommon entity is discussed(AU)

[Parathyroid glands radio-guided surgery]. / Cirugía radioguiada de las glándulas paratiroides.

INTRODUCTION: Several advances have been made in the management of hyperparathyroidism. The preoperative sestamibi scan appears to have revolutionized the entire approach to parathyroid surgery including minimally invasive parathyroidectomy. Gamma probe is a useful tool that complements a well performed localization of parathyroid adenomas. METHODS: We conducted a retrospective analysis of the patients submitted to radio-guided parathyroidectomy between January and December 2003 at a Oncology tertiary hospital in Mexico City, for evaluate the results and shows the feasibility of this approach. RESULTS: Six patients was included, all of them referred to the hospital with the diagnosis of bone tumors or with bone disease suggest malignancy. Median serum level of preoperative calcium was 13.18 mg/dl. In all cases the transoperative localization of the affected gland was possible using gamma probe and according with Tc 99m sestamibi scintigraphy imaging. None perioperative deaths reported and there were no recurrent laryngeal nerve injuries neither recurrent hypercalcemia. Median serum level of postoperative calcium was 9.39 mg/dl. There were at histopathological analysis five adenomas and one hyperplasia. CONCLUSIONS: Radio-guided parathyroidectomy is a useful approach for transopertaive localization of the affected gland, we obtained a 100% success rate, according with the histopathologic analysis and the normal postoperative serum calcium level.