Prognostic significance of microvascular counts in rectal carcinoma.

Numerous studies of many tumor types have demonstrated that microvessel quantitation as a measure of angiogenesis is a powerful prognostic tool. Vascular enumeration has been claimed to be an independent prognosticator for several human tumors, including breast carcinoma, melanoma or bladder carcinoma; however, the studies of colorectal cancer have rendered variable results. To test the prognostic influence of this factor in our patients, we selected 39 patients with rectal carcinoma Dukes' stages A to C treated only with curative surgery, with no further adjuvant therapy. The minimal follow-up time was 5 years (60 months). After immunostaining with CD34, we performed a manual count of the vessels following Gasparini's criteria. In our series, vascular enumeration has been a prognosticator for OS (overall survival) but not for RFS (relapse-free-survival) at all Dukes' stages in the univariate analysis. This prognostic influence was lost in the multivariate analysis, in which only stage as well as vascular and neural invasion behaved as significant independent prognosticators. The presence of hypervascularization did not show any significant association with histologic grade, tumor staging, and vascular or neural invasion.

Análisis de la problemática social en un centro sanitario de media y larga estancia: estudio de costes / Analysis of the social problem in a middle and long term health care center: cost study

Objetivo: analizar cómo repercute la problemática social de nuestros pacientes sobre el gasto y producción asistencial. Métodos: estudio descriptivo preliminar para determinar la problemática social interna y la demanda social externa. Análisis de coste/actividad del año 1998 sobre el total de altas realizadas (1.269) evaluando producción de nuestras seis Unidades Asistenciales y coste mediante Contabilidad Analítica. La Unidad Sociosanitaria (USS) acogió a pacientes que no pudieron abandonar el Centro al alta por algún problema social que exigió la tramitación de recursos en la comunidad. Resultados: estudio preliminar: 100 por ciento de los pacientes tenían evaluación por Trabajo Social al ingreso y 50,2 por ciento de ellos presentaban problemática social con necesidad de tramitación de algún recurso. Respecto a la demanda externa, durante 1998 solicitaron ingreso 2.473 pacientes y se denegaron 377 (15,24 por ciento), de las cuales 81 (21,48 por ciento) fueron causas puramente sociales. Coste/actividad: de las 53.526 estancias realizadas en el período, el 3,9 por ciento correspondieron a la USS (2.085) con una estancia media de 148,9 días; esta unidad dio el alta a 14 'residentes' agrupados en el GRD 467: Otros factores que influyen en el estado de salud; cuyo coste fue de 51.953.030 ptas. con un coste unitario de 3.710.931 ptas. por paciente y de 24.918 ptas. por estancia. Conclusiones: sin la actividad de la USS, nuestro centro habría reducido su coste total un 3,8 por ciento, mejorado su actividad al reducir la estancia media un 2,8 por ciento. Con los recursos de la USS se hubieran podido tratar 51 pacientes (a 40,98 días de estancia media) en lugar de 14 'residentes' por problemática social (AU)

Prognostic influence of tumor-associated eosinophilic infiltrate in colorectal carcinoma.

BACKGROUND: In 1983, Pretlow et al. reported one classical study of the prognostic influence of eosinophil infiltration in human colon carcinoma. Since then, very few reports have analyzed this supposed prognostic influence in this type of tumor, although there have been several reports of other types of tumors with different results. Eosinophils seem to play a central role in the immunologic defense against tumors; their activity can be induced through immunotherapy with interleukin in cases that are unresponsive to conventional therapies. METHODS: To analyze the prognostic influence of eosinophils in colorectal carcinoma, the authors selected 126 patients with this type of tumor treated only with curative surgery and followed for a minimal period of 5 years. They divided these patients into 4 categories according to the number of eosinophils per high-power field (400x): 0 (Grade 1), 1-9 (Grade 2), 10-50 (Grade 3), and more than 50 (Grade 4). RESULTS: The results of this series confirm that high eosinophil counts are associated with a significantly better prognosis. In multivariate analysis, this factor was independent from staging, vascularization, p53 expression, and histologic grade. CONCLUSIONS: Eosinophil count served as a significant independent favorable prognosticator in colorectal carcinoma patients.

Vascular enumeration as a prognosticator for colorectal carcinoma.

Vascular enumeration is thought to be an independent prognosticator for several human tumours, including breast, bladder and colorectal carcinomas. There have been 12 reports on the prognostic influence of vascular enumeration in colorectal carcinoma with different results. To test the prognostic influence of this factor in our patients, we have selected 126 patients with colorectal carcinoma Dukes' stages A to C treated only with curative surgery with no further adjuvant therapy. The minimal follow-up time was 5 years (60 months). After immunostaining with CD34, we performed a manual count of the vessels following Gasparini's criteria. In our series vascular enumeration showed significant association with the histological grade (P = 0.03) with a cut-off point at 77 vessels/200x, but not with tumour staging and vascular and neural invasion (P > 0.05). Vascular enumeration was a prognosticator for RFS (relapse-free survival) (P = 0.009) and OS (overall survival) (P = 0.01) in all Dukes' stages in the univariate analysis, but this prognostic influence was lost in the multivariate analysis, in which only stage, histological differentiation, location and vascular and neural invasion behaved as significant independent prognosticators.

[The diagnostic value of echography in appendicitis in children]. / Valor diagnóstico de la ecografía en la apendicitis del niño.

OBJECTIVE: The purpose of this study was to analyze the possible usefulness of ultrasonography for the diagnosis of acute appendicitis in children and to compare this technique with the clinical signs classically employed in the evaluation of pain in the right lower quadrant (RLQ) in the emergency ward. PATIENTS AND METHODS: We prospectively analyzed 112 patients younger than 14 years with suspected appendicitis. After a careful clinical record and physical and complementary studies were performed, we performed a ultrasonography of the RLQ on all patients a tubular, non-mobile, non-compressible image with a target image measuring 6 mm or more on the cut section was considered suggestive of appendicitis. After the initial clinical-radiological evaluation, the patients were either operated or included in a follow-up group. None of them were dismissed. The confirmation of the diagnosis of appendicitis was histological. RESULTS: Only 4 of the 14 factors analyzed showed a significant association with acute appendicitis (leukocytosis, left shift, abdominal RX film suggesting inflammation in the RLQ and ultrasonography positive for appendicitis), with ultrasonography being the technique with the highest diagnostic reliability (77.7% sensitivity and 94.8% specificity). The age of the patients with appendicitis was significantly lower than that of the patients without appendicitis. Nevertheless, we did not find any relationship between advanced appendicitis and factors such as age or time of evolution. CONCLUSIONS: After a clinical-ultrasonography evaluation, our negative appendectomy rate was 7% and the perforation/gangrenous appendicitis rate was 29%. We conclude that ultrasonography performed by trained professionals is a useful tool in the differential diagnosis of appendicitis in children.

Evaluation of ultrasonography and clinical diagnostic scoring in suspected appendicitis.

BACKGROUND: Several diagnostic aids have been developed to improve diagnosis in suspected appendicitis including ultrasonography and clinical diagnostic scoring. The aim of this study was to elaborate a new scoring system and to measure its accuracy in the preoperative diagnosis of appendicitis, comparing it with the available scoring systems. METHODS: The clinical, radiological and ultrasonographic data of 192 patients with suspected appendicitis were collected prospectively. RESULTS: Only six of the 12 variables analysed were shown to have prognostic significance. Using Bayesian methodology, a weight was given to each criterion and two overall scores were calculated (ultrasonographic and classical scores). A cut-off point was identified to separate patients who needed surgery and those for observation. The ultrasonographic score showed an 81 per cent sensitivity and a 96 per cent specificity, compared with 60 and 73 per cent respectively for the classical score. CONCLUSION: Ultrasonography increases the diagnostic accuracy in patients with suspected acute appendicitis.

Inflammatory pseudotumor of spleen. Report of two cases and literature review.

OBJECTIVE: We report two new cases of inflammatory pseudotumor of the spleen and review the cases reported to date. We discuss the diagnostic value of the clinical manifestations, the modern image technics and the laboratory data and conclude that only pathological and immunohistochemical studies allow a reliable diagnosis of this disease. DATA SOURCES: We have obtained the cases for the review through a computer search with the system SilverPlatter 3.11 (SilverPlatter Software Copyright NU 1992). The new cases have been obtained from our files. DATA SYNTHESIS: 53% were random findings (47% in the workup of another disease and 5% at autopsy). In the remaining cases, the clinical signs were not specific and none of the image technics could establish diagnosis. Neither fine needle aspiration nor laboratory data rendered conclusive results. Only pathological and immunohistochemical study after splenectomy allowed diagnosis. The clinical signs disappeared in all the cases following splenectomy and none of the patients have had recurrences. CONCLUSIONS: Inflammatory pseudotumor is a benign disease of unknown etiology and pathogenesis. It consists of solitary or multiple tumors that can affect virtually any organ. Clinical signs are non-specific. This lesion can render diagnostic problems with neoplasms of the lymphoreticular system. Splenectomy is diagnostic and curative.

Atypical metastasis from prostatic carcinoma. Report of a case of renal metastasis and literature review.

Occult prostatic carcinoma (carcinoma diagnosed because of the presence of metastasis) is commoner and commoner; the sites for metastatic disease are progressively more diverse. This is partially due to the longer life of the general population and to the better expectative of life for oncologic patients with modern treatments. We report the first case to our knowledge, of occult prostatic carcinoma diagnosed in a patient with a parenchymatous acute renal failure secondary to diffuse metastatic infiltration. We also review other atypical locations of metastasis from prostatic carcinoma reported in the literature and discuss the ways of spread in these cases.

Traumatic rupture of the pericardium. Case report and literature review.

Rupture of the pericardium due to blunt thoracic trauma is a rare pathology with a range of mortality between 30 and 64% according to different authors. We review 40 cases which have been reported in the literature in the last decade and report a case of our own. We have found that 82% of the patients with traumatic rupture of the pericardium were men with a mean age of 45 years. In 80% of the cases the cause was a motor vehicle accident, 17% were due to falls and only 1 case was associated with a crush. The commonest location of the tear was the left pleuropericardium (62%) followed by the diaphragmatic portion of the pericardium (22%). In 80% of the cases the diagnosis was achieved in the course of a surgery performed for associated lesions. None of the cases was diagnosed in a post-mortem study. The traumatic rupture of the pericardium is a disease which often remains undiagnosed, especially when one does not have a high index of suspicion. Nevertheless, this is a disease which can threaten the life of the patient and we should keep it in mind to diagnose and treat it as soon as possible. It is known that an early and aggressive management of these patients implies a much better prognosis with a significant reduction of the mortality. In this article we want to give useful clues to allow a preoperative diagnosis and an early and adequate management.