Doppler ultrasonography of the ophthalmic artery in perimenopausal and postmenopausal women: a new approach.

BACKGROUND: The vascular endothelium has specific estrogen receptors and the impact of hormone therapy (HT) on circulation is associated with cardiovascular protection in perimenopause and postmenopause. Blood vessels can be assessed by ultrasound Doppler velocimetry, and more specifically the study of the ophthalmic artery (OA) can be used for brain vessel assessment; more recently, it is a possible method for cardiovascular risk assessment. METHODS: A cross-sectional study involved perimenopausal and postmenopausal women divided into three groups: 60 non-HT users (control group), 23 users of estrogen therapy (ET group), and 23 users of estrogen-progesterone therapy (EPT group). Doppler velocimetry of the OA was performed with analysis of the resistance index (RI), pulsatility index (PI), systolic peak velocity (P1), second systolic peak velocity (P2), peak velocity ratio (PVR), final diastolic velocity (FDV), and ratio between means of systolic and diastolic velocity (SDR). RESULTS: There was no significant difference between the groups in Doppler velocimetry indices of the OA: RI (p = 0.94), PI (p = 0.85), P1 (p = 0.81), P2 (p = 0.53), PVR (p = 0.41), FDV (p = 0.76), and SDR (p = 0.84). We observed a positive correlation of the SDR with age only in the control group (r = 0.34, p = 0.01). CONCLUSIONS: There is a positive correlation between the SDR and age in the control group. Therefore, this new index is a promising instrument in the non-invasive assessment of cardiovascular risk.

Laparoscopic Liver Resection: A South American Experience with 2887 Cases.

BACKGROUND: Laparoscopic liver resections (LLR) have been increasingly performed in recent years. Most of the available evidence, however, comes from specialized centers in Asia, Europe and USA. Data from South America are limited and based on single-center experiences. To date, no multicenter studies evaluated the results of LLR in South America. The aim of this study was to evaluate the experience and results with LLR in South American centers. METHODS: From February to November 2019, a survey about LLR was conducted in 61 hepatobiliary centers in South America, composed by 20 questions concerning demographic characteristics, surgical data, and perioperative results. RESULTS: Fifty-one (83.6%) centers from seven different countries answered the survey. A total of 2887 LLR were performed, as follows: Argentina (928), Brazil (1326), Chile (322), Colombia (210), Paraguay (9), Peru (75), and Uruguay (8). The first program began in 1997; however, the majority (60.7%) started after 2010. The percentage of LLR over open resections was 28.4% (4.4-84%). Of the total, 76.5% were minor hepatectomies and 23.5% major, including 266 right hepatectomies and 343 left hepatectomies. The conversion rate was 9.7%, overall morbidity 13%, and mortality 0.7%. CONCLUSIONS: This is the largest study assessing the dissemination and results of LLR in South America. It showed an increasing number of centers performing LLR with the promising perioperative results, aligned with other worldwide excellence centers.

Extended preoperative chemotherapy, extent of liver resection and blood transfusion are predictive factors of liver failure following resection of colorectal liver metastasis.

AIM: The aim of this study was to determine the incidence and prognostic factors of postoperative liver failure in patients submitted to liver resection for colorectal metastases. METHOD: Patients with CLM who underwent hepatectomy from 1998 to 2009 were included in retrospective analysis. Postoperative liver failure was defined using either the 50-50 criteria or the peak of serum bilirubin level above 7 mg/dL independently. RESULTS: Two hundred and nine (209) procedures were performed in 170 patients. 120 surgeries were preceded by chemotherapy within six months. The overall morbidity rate was 53.1% and 90-day mortality was 2.3%. Postoperative liver failure occurred in 10% of all procedures, accounting for a mortality rate of 9.5% among this group of patients. In multivariate analysis, extent of liver resection, need of blood transfusion and more than eight preoperative chemotherapy cycles were independent prognostic factors of postoperative liver insufficiency. This complication was not related with the chemotherapy regimen used. CONCLUSION: We conclude that postoperative liver failure has a relatively low incidence (10%) after CLM resection, but a remarkable impact on postoperative mortality rate. The amount of liver resected, the need of blood transfusion and extended preoperative chemotherapy are independent predictors of its occurrence and this knowledge can be used to prevent postoperative liver failure in a multidisciplinary approach.

The interaction between N-category and N-ratio as a new tool to improve lymph node metastasis staging in gastric cancer: results of a single cancer center in Brazil.

BACKGROUND: Depth of tumor invasion (T-category) and the number of metastatic lymph nodes (N-category) are the most important prognostic factors in patients with gastric cancer. Recently, the ratio between metastatic and dissected lymph nodes (N-ratio) has been established as one. The aim of this study is to evaluate the impact of N-ratio and its interaction with N-category as a prognostic factor in gastric cancer. METHODS: This was a retrospective study in which we reviewed clinical and pathological data of 165 patients who had undergone curative surgery at our institution through a 9-year period. The exclusion criteria included metastases, gastric stump tumors and gastrectomy with less than 15 lymph nodes dissected. RESULTS: The median age of the patients was 63 years and most of them were male. Total gastrectomy was the most common procedure and 92.1% of the patients had a D2-lymphadenectomy. Their 5-year overall survival was 57.7%. T-category, N-category, extended gastrectomy, and N-ratio were prognostic factors in overall and disease-free survival in accordance with univariate analysis. In accordance with TNM staging, N1 patients who have had NR1 had 5-year survival in 75.5% whereas in the NR2 group only 33% of the cases had 5-year survival. In the multivariate analysis, the interaction between N-category and N-ratio was an independent prognostic factor. CONCLUSION: Our findings confirmed the role of N-ratio as prognostic factor of survival in patients with gastric cancer surgically treated with at least 15 lymph nodes dissected. The relationship between N-category and N-ratio is a better predictor than lymph node metastasis staging.

Ophthalmic artery Doppler as a measure of severe pre-eclampsia.

OBJECTIVE: To identify differences in orbital flow behavior in mild and severe pre-eclamptic women compared with healthy pregnant women, demonstrated by ophthalmic artery Doppler indexes. METHODS: Ophthalmic artery Doppler indexes of 20 mild and 20 severe pre-eclamptic women were compared with 51 healthy pregnant women. Right and left eye Doppler index means were evaluated and the resistance index (RI), pulsatility index (PI), peak systolic velocity (PSV), end diastolic velocity (EDV), and peak ratio (PR) were calculated. RESULTS: Statistically significant differences were observed between PR, PSV, and EDV (P=0.0009, P=0.0020, P=0.0001) ophthalmic artery Doppler in a comparison of women with mild and severe pre-eclampsia. Statistically significant differences were seen between all Doppler indexes of the study group and healthy pregnant women. Ophthalmic PR, PSV, and EDV were significantly higher in severe pre-eclamptic cases but other index parameters did not show any difference. An elevation of diastolic and systolic flow occurred when pre-eclampsia became severe. CONCLUSION: Orbital vascular impedance reduction with orbital hyperperfusion was present in severe pre-eclamptic women compared with mild pre-eclamptic and healthy pregnant women. Ophthalmic Doppler is a novel parameter that may be useful in the diagnosis of severe pre-eclampsia.

Cervical gland area as an ultrasonographic marker for preterm delivery.

OBJECTIVE: To assess the association between spontaneous preterm delivery (SPTD) in the general population and the measurement of the cervix length, cervical funneling, and absence of the cervical gland area (CGA). METHOD: A prospective cohort of 338 women carrying uncomplicated pregnancies was evaluated by transvaginal sonography between 21 and 24 weeks' gestation. RESULTS: Measurement of cervical length with less than 20 mm and the presence of cervical funneling presented a statistically significant association with SPTD before 35 weeks. The non-detection of CGA demonstrated a strong association with SPTD before 37 weeks' (p < 0.001; OR = 194.5) and before 35 weeks' gestation (p < 0.001; OR = 129.6). The multiple logistic regression analysis suggested the non-detection of CGA as the only variable to reveal statistically significance association with SPTD. CONCLUSION: The results seem to indicate that the absence of CGA can be a new and important ultrasound marker for SPTD, to be confirmed by future multicenter investigations.

True hermaphroditism-the importance of ultrasonic assessment.

Intersex states are associated with rare syndromes within a wide clinical spectrum, true hermaphroditism being the rarest of them all. It is a condition that is characterized by ovotestis, i.e. the presence of ovarian and testicular tissues in the same individual, either in separate gonads or in the same gonad. Diagnostic investigation of hermaphroditism involves ultrasound examination of the gonads, karyotype analysis and histological studies. We report the case of a 21-year-old individual with true hermaphroditism, in whom ovotestis was diagnosed on ultrasonography and which was later confirmed by anatomopathological study of the gonads. The role of ultrasound in the initial diagnostic investigation of intersex states, especially true hermaphroditism, is discussed.