Fear and Trembling While Working in a Pandemic: an Exploratory Meta-Analysis of Workers' COVID-19 Distress.

The global COVID-19 pandemic has disrupted the lives of workers and taken its toll on health and well-being. In line with recent calls for more inductive and abductive occupational health science research, we exploratorily meta-analyzed workers' COVID-19 distress, defined as psychological and psychosomatic strain contextualized to experiencing the virus and pandemic broadly. We identified many existing COVID-19 distress measures (e.g., Fear of COVID-19 Scale by Ahorsu et al., International Journal of Mental Health and Addiction, 2020; Coronavirus Anxiety Scale by Lee, Death Studies, 44(7), 393-401, 2020a) and correlates, including demographic variables (viz., gender, marital status, whether worker has children), positive well-being (e.g., quality of life, perceived social support, resilience), negative well-being (e.g., anxiety, depression, sleep problems), and work-related variables (e.g., job satisfaction, burnout, task performance). Additionally, we found preliminary evidence of subgroup differences by COVID-19 distress measure and country-level moderation moderators (viz., cultural values, pandemic-related government response) as well as COVID-19 distress's incremental validity over and above anxiety and depression. The findings-based on k = 135 independent samples totaling N = 61,470 workers-were abductively contextualized with existing theories and previous research. We also call for future research to address the grand challenge of working during the COVID-19 pandemic and ultimately develop a cumulative occupational health psychology of pandemics. Supplementary Information: The online version contains supplementary material available at 10.1007/s41542-022-00131-x.

[Quality of the Forensic Case Formulation in Mental Health]. / La calidad de la formulación del caso forense en salud mental.

OBJECTIVES: The "Guide to understand and assess the quality of the case formulation in forensic mental health - TECF" is tested in order to contribute to the development of the forensic reports. METHOD: Twelve mental health professionals of different Latin American traditions assessed with the TECF the quality of ten international forensic reports, both psychological and psychiatric. The guide includes the manual that describes the dimensions, criteria and guidelines to assess the quality of the forensic case formulation. RESULTS: Internal consistency indicators were in a rank of 0.34- 0.81 for the dimensions and 0.85 for the total TECF. The absolute agreement intraclass correlation coefficient among evaluators with similar tradition reached values of 0.72; 0.52; 0.76 and 0.77 for the dimensions and 0.84 for the total. The agreement among evaluators with different traditions was less. CONCLUSIONS: The TECF is a promising instrument to guide the assessment of quality and to stimulate improvement of the forensic reports. Caution is recommended in light of the traditional rating scale method due to the effect that can be produced by the different practices.

Effect of an ionic antineoplastic agent Cytoreg on blood chemistry in a Wistar rat model.

Cytoreg is an ionic therapeutic agent comprising a mixture of hydrochloric, sulfuric, phosphoric, hydrofluoric, oxalic, and citric acids. In diluted form, it has demonstrated efficacy against human cancers in vitro and in vivo. Although Cytoreg is well tolerated in mice, rats, rabbits, and dogs by oral and intravenous administration, its mechanism of action is not documented. The acidic nature of Cytoreg could potentially disrupt the pH and levels of ions and dissolved gases in the blood. Here, we report the effects of the intravenous administration of Cytoreg on the arterial pH, oxygen and carbon dioxide pressures, and bicarbonate, sodium, potassium, and chloride concentrations. Our results demonstrate that Cytoreg does not disturb the normal blood pH, ion levels, or carbon dioxide content, but increases oxygen levels in rats. These data are consistent with the excellent tolerability of intravenous Cytoreg observed in rabbits, and dogs. The study was approved by the Bioethics Committee of the University of the Andes, Venezuela (CEBIOULA) (approval No. 125) on November 3, 2019.

Evaluation of dermal corrosion and irritation by Cytoreg in rabbits.

Cytoreg is an experimental therapeutic platform consisting of an aqueous solution of six acids (hydrofluoric, hydrochloric, sulfuric, phosphoric, citric, and oxalic) with oncolytic, antiviral, immune modulatory and antibacterial activities. Cytoreg may be formulated for topical, oral, and parenteral administration. In the present study, a skin corrosion/irritation screen was conducted on three albino rabbits for the Cytoreg topical formulation at three dilutions; one animal each received a dilution of 100 %, 4 %, or 2 % in physiological saline solution. Three intact skin test sites per animal/concentration were evaluated. Each test site was treated with 0.5 mL of the appropriate test substance solution. Site one was dosed for 3 min, then observed. Dose site two was wrapped for 1 h, then both first and second test sites were observed. Dose site three was wrapped for 4 h. One hour after unwrapping the third site, all three test sites were observed for skin irritation and/or corrosion, and again at 24, 48 and 72 h after final unwrap. Based on the 4 -h dose scores through 72 h, the primary irritation index (PII) for Cytoreg is 0.00 at 2 % and 4 %, with a descriptive rating of non-irritating, and 0.25 PII with slightly irritating rating at 100 %.

Effective control of SARS-CoV-2 transmission between healthcare workers during a period of diminished community prevalence of COVID-19.

Previously, we showed that 3% (31/1032)of asymptomatic healthcare workers (HCWs) from a large teaching hospital in Cambridge, UK, tested positive for SARS-CoV-2 in April 2020. About 15% (26/169) HCWs with symptoms of coronavirus disease 2019 (COVID-19) also tested positive for SARS-CoV-2 (Rivett et al., 2020). Here, we show that the proportion of both asymptomatic and symptomatic HCWs testing positive for SARS-CoV-2 rapidly declined to near-zero between 25th April and 24th May 2020, corresponding to a decline in patient admissions with COVID-19 during the ongoing UK 'lockdown'. These data demonstrate how infection prevention and control measures including staff testing may help prevent hospitals from becoming independent 'hubs' of SARS-CoV-2 transmission, and illustrate how, with appropriate precautions, organizations in other sectors may be able to resume on-site work safely.

Neurophysics Assessment of the Muscle Bioenergy Generated by Transcranial Magnetic Stimulation.

The content of the rectified motor evoked potential (MEP) induced by transcranial magnetic stimulation (TMS) has ambiguously been assessed without the precision that energy calculation deserves. This fact has misled data interpretation and misguided biomedical interventions. To definitively fill the gap that exits in the neurophysics processing of these signals, we computed, in Walls ( W ^ ), the bioenergy within the rectified MEP recorded from the human first digitorum index (FDI) muscle at rest and under isometric contraction. We also gauged the biowork exerted by this muscle. Here we show that bioenergy and biowork can accurately and successfully be assessed, validated, and determined in W ^ from MEP signals induced by TMS, regardless of knowing the mathematical expression of the function of the signal. Our novel neurophysics approach represents a dramatic paradigm shift in analysis and interpretation of the content of the MEP and will give a true meaning to the content of rectified signals. Importantly, this innovative approach allowed unveiling that women exerted more bioenergy than men at the magnetic stimulations used in this study. Revisitation of conclusions drawn from studies published elsewhere assessing rectified EMG signals that have used ambiguous units is strongly recommended.

Fighting for time: Spillover and crossover effects of long work hours among dual-earner couples.

Drawing upon the spillover-crossover model, this study examined the extent to which one's work time demands spilled over to the family domain and crossed over to his or her spouse, utilizing data of 365 dual-earner couples from the 500 Family Study. The results of the distinguishable actor-partner interdependence model indicated that there was gender symmetry in the spillover processes such that the effects of work hours were identical between men and women. Further, although there was more bidirectional crossover between partners within couples, we observed some unidirectional crossover from husbands to wives. Specifically, husbands only increased their contribution to domestic work in response to wives' work fatigue, whereas wives increased their contribution to domestic work in response to husbands' work fatigue and high workloads. Finally, husbands' housework hours negatively related to wives' marital satisfaction and positively related to wives' depression, whereas wives' housework hours negatively related to husbands' marital satisfaction and depression. These findings have practical implications for improving the work-family balance, health, and well-being of dual-earner couples.

La recuperación posoperatoria acelerada (fast track) disminuye la estancia hospitalaria en cirugía gastrointestinal alta: revisión sistemática de la literatura / Fast track surgery protocols diminish hospital length of stay in upper gastrointestinal surgery: systematic review of literature

Introducción. Los protocolos de la cirugía con recuperación acelerada (fast-track surgery) han demostrado disminución de la estancia hospitalaria y los costos médicos en cirugía colorrectal. La evidencia sobre su aplicación en cirugía general es escasa si se compara con otras especialidades quirúrgicas. En este estudio se revisa la evidencia científica sobre la estrategia fast-track en cirugía gastrointestinal alta. Métodos. Se revisaron PubMed y Medline con el término "fast track surgery" y "ERAS surgery". Se incluyeron estudios clínicos controlados de asignación aleatoria que contaran con un grupo de control de pacientes con cuidado convencional. Se excluyeron trabajos no relacionados con cirugía gastrointestinal alta. Se analizaron las diferencias de medias sopesadas, tomando como puntos finales la estancia hospitalaria, la morbilidad, la mortalidad y la rehospitalización. Resultados. Cinco estudios clínicos de asignación aleatoria cumplieron con los criterios de inclusión. Cuatro estudios de gastrectomías y uno de perforación de úlcera duodenal. De un total de 385 pacientes, se compararon 197 (51 %) en el grupo con cuidado convencional y 188 (49 %) en grupo con fast-track. Al comparar el cuidado convencional con el fast-track, la estancia hospitalaria fue de 7,5 Vs. 5,7 días, (p=0,019), y la morbilidad, de 22 % Vs. 14 % (p=0,017), respectivamente. No se obtuvieron diferencias significativas en la mortalidad (p=0.347) ni en las rehospitalizaciones (p=0.954) entre los dos grupos. Conclusión. La estrategia fast-track disminuye la estancia hospitalaria, y puede implementarse en forma segura en pacientes que requieren cirugía gastrointestinal alta, sin incrementar la morbilidad, la mortalidad ni las rehospitalizaciones.

Introduction: Fast-track surgery protocols (FT) have demonstrated reduction in hospital length of stay (LOS) and medical costs in colorectal surgery. The evidence on FT applied to general surgery is sparse. This study reviews the scientific evidence of FT strategy in upper gastrointestinal surgery (UGIS). Methods: PubMed and Medline databases were reviewed with the term "Fast Track surgery" and "ERAS surgery". Randomized clinical trials (RCT) regarding FT strategies in UGIS were included only if a control group with conventional care (CC) was compared. Studies not related to UGIS were excluded. The differences in weighted means were analyzed using as end points the LOS, morbility, mortality, and hospital readmission. Results: Five RCT met the inclusion criteria: four randomized clinical studies on gastrectomies, and one on perforated duodenal ulcer From a total of 385 patients, 197 (51%) included the CC group and 188 (49%) in FT group were compared. The LOS of CC vs. FT groups was 7.5 and 5.7 days, respectively (p=0.019), and morbidity of 22% vs. 14%. Respectively (p=0.019). No significance differences were obtained on mortality (p=0.347) or hospital readmission (p=0.954) between the two groups. Conclusion: Fast-Track strategy decreases length of hospital stay, and could be safely implemented in patients undergoing upper gastrointestinal surgery, without increasing morbidity, mortality or readmission rates.

Auditory and Lower Limb Tactile Prepulse Inhibition in Primary Restless Legs Syndrome: Clues to Its Pathophysiology.

The resting sensory discomfort transiently relieved upon movement of the affected area in restless legs syndrome suggests that sensorimotor integration mechanisms, specifically gating, may be altered in the disease. The authors sought to determine the effects of prepulse auditory and tactile stimulation applied to lower limbs on the blink reflex of patients with restless legs syndrome and healthy subjects. Seventeen patients with restless legs syndrome and 17 age- and sex-matched healthy controls were investigated. Auditory stimuli and tactile lower limb stimulation were applied as prepulses. The R2 response of the blink reflex induced by electrical stimulation applied to the right supraorbital nerve was selected as the test stimulus. Time intervals between prepulses and response-eliciting stimuli were 40, 70, 90, 110, and 200 milliseconds. There were no differences in either the auditory or tactile prepulse conditions between patients and controls and no differences between these measures within subject groups. We concluded that the tactile lower limb and the auditory prepulse effects on the brainstem interneurons mediating the blink reflex share common neural pathways. Because forebrain interneurons mediate these prepulse effects, they are likely not involved in the disordered sensorimotor interaction of restless legs syndrome.

Morbidity of the abdominal wall resection and reconstruction after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC).

BACKGROUND: CRS/HIPEC has evolved as a therapeutic option for selected patients with peritoneal surface malignancies. To achieve complete cytoreduction (CC), some patients require extensive abdominal-wall resection (AWR) and subsequent complex reconstructions, which may be associated with wound complications (WC) and delay of postoperative cancer therapy. METHODS: Review of a prospective database of 350 patients revealed 213 patients with peritoneal carcinomatosis who underwent AWR due to suspected or proven wound/port site metastases during CRS/HIPEC. Tumor origin included: appendix, colon, ovarian, peritoneal mesothelioma, primary peritoneal, and others. WC were related to peritoneal carcinomatosis index (PCI), CC score, length of surgery, type of AWR and closure, blood transfusion, and albumin levels using binary logistic regression (odds ratios (OR) and 95 % CIs) analysis. RESULTS: PCI ≥ 20 was found in 151 (71 %), CC was achieved in 178 (84 %). Mean length of surgery was 613 min. Postoperative WC were detected in 49 of 213 (23 %) patients, 13 (6 %) had Grade III (according to Clavien-Dindo's classification) WC, and led to delay of postoperative chemotherapy. WC occurred in 21 of 64 (32.8 %) patients with excision of port sites (odds ratio [OR] = 2.11, confidence interval [CI] = 1.09-4.10, p = 0.026). Primary fascial closure was performed in 191 of 213 (89.7 %) patients, 40 (21 %) of whom had WC. Mesh-assisted abdominal wall reconstruction was required in 22 of 213 (10.3 %) patients, of whom 9 (40.9 %) had WC (OR = 2.61, CI = 1.04-6.55, p = 0.035). CONCLUSIONS: Port-site excision and mesh-assisted abdominal wall reconstruction were associated with higher incidence of postoperative WC following CRS/HIPEC. The implications of these preliminary findings may need to be considered during surgical planning for these patients.

Port-site metastases is an independent prognostic factor in patients with peritoneal carcinomatosis.

INTRODUCTION: Port-site metastases (PSMs) have been reported after laparoscopy in patients with peritoneal carcinomatosis (PC). We hypothesize that PSM is an independent negative predicting factor of survival in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). METHODS: A retrospective review of a prospective database was conducted to search patients who underwent laparoscopy prior to CRS/HIPEC. Most of the tumors were of appendiceal origin. All previous laparoscopy port sites were excised regardless of macroscopic tumor involvement. Patients were divided into two groups: patients with PSM [PSM (+)] and patients without PSM [PSM (-)]. Overall survival (OS) was estimated by Kaplan-Meier curves and the log-rank test. Cox regression [hazard ratios (HRs) and 95 % confidence intervals (CIs)] was used to test for independent effects of the PSM (+) and the associated clinicopathological variables. RESULTS: Sixty-five patients had laparoscopy before CRS/HIPEC. One hundred and forty-four port-sites were resected; 41 (29 %) ports were positive for malignancy in a total of 22 (34 %) patients. Mean OS at 1, 3, and 5 years was 88, 66, and 63 %, respectively. Survival in patients with PSM was 73, 35, and 23 %, respectively, compared with 95, 82, and 82 %, respectively, in patients without PSM (p ≤ 0.001). Positive lymph nodes (LNs) were detected in 13/22 patients with PSM and 11/43 patients without PSM. Independent effects on survival shows an HR of 3.136, 95 % CI 1.150-8.549 (p = 0.026) for LN metastases, and an HR of 3.462, 95 % CI 1.198-10.006 (p = 0.022) in patients with positive PSM. CONCLUSION: PSMs are common in patients with PC undergoing CRS/HIPEC and are independently associated with a worse prognosis. Resection of previous laparoscopy port sites is advocated in patients with PC to ensure complete cytoreduction.

Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Mesothelioma: Experience of a Peritoneal Surface Malignancy Center.

Diffuse malignant peritoneal mesothelioma (DMPM) is an uncommon malignancy, which can be difficult to treat. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have evolved as the treatment of choice when complete cytoreduction is to be achieved. This study reports the outcomes of CRS/HIPEC for peritoneal mesothelioma performed in a center for peritoneal surface malignancy. A retrospective analysis of a prospective database of 389 CRS/HIPEC procedures identified 23 patients who underwent CRS/HIPEC for DMPM from 1999 to 2014. Gender, age at diagnosis, age at surgery, previous surgeries, follow-up time, peritoneal cancer index (PCI) score, completeness of cytoreduction (CC), pathology, and overall survival (OS) were analyzed. The univariate analysis was used to determine the prognostic value of age, gender, neoadjuvant chemotherapy, histopathology of the tumor, PCI, CC, and lymph node status on survival. Mean follow-up time from surgery was 31 months (range = 0.5-124). The median PCI score was 28, and 77 per cent had PCI ≥20. CC 0-1 was achieved in 65 per cent of cases. One- and 5-year actuarial OS rates from diagnosis were 86 per cent and 60 per cent, respectively. One- and 5-year actuarial OS from HIPEC was 70 per cent and 64 per cent, respectively. The univariate analysis showed that the CC was the only significant prognostic factor. Patients with DMPM may achieve long-term survival when treated with CRS/HIPEC. The CC is the most significant prognostic factor for long-term survival.

Progression of peritoneal adenomucinosis to the scrotum: a rare occurrence treated with cytoreductive surgery and hyperthermic chemoperfusion of the scrotum in two patients.

INTRODUCTION: Disseminated Peritoneal Adenomucinosis (DPAM) is an infrequent presentation of appendiceal cancer. Infrequently, umbilical or inguinal hernias could be the first clinical manifestation of this condition; DPAM extension to the scrotum may be anatomically viable. Treatment with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is the standard of treatment for DPAM. We hypothesize that these same treatment principles, consisting of CRS with hyperthermic chemoperfusion of the scrotum (HCS), could be applied to the scrotal dissemination of DPAM. METHODS: We reviewed our Institution's prospective cancer database and identified two cases of DPAM with extension to the scrotum. Their medical records were examined, and close follow-up was performed. Tumor histopathology and cytoreduction scores were evaluated. Tumor progression was monitored on follow-up by physical examination, tumor markers (CEA, CA 125, CA 19.9) and abdomino-pelvic CT scan. RESULTS: Two patients who previously had CRS/ HIPEC for DPAM were successfully treated with HSC. Both patients are alive and free of disease at 88 and 57 months following initial CRS/HIPEC, and 50 and 32 months following CRS/HCS, respectively. CONCLUSION: Increased awareness by surgeons to the coexistence of inguinal hernia with peritoneal neoplasm and the need for a surgical repair is raised. CRS/HCS may be employed to treat patients with DPAM extension to the scrotum. Successful outcome is dependent on complete cytoreduction of metastatic tumor.

INTRODUCCIÓN: La Adenomucinosis Peritoneal Diseminada (DPAM, por el término en inglés) es una presentación no frecuente del cáncer de apéndice. Infrecuentemente, las hernias umbilicales o inguinales pueden ser la primera manifestación clínica de esta condición; la extensión al escroto puede ser anatómicamente viable. La cirugía citoreductiva (CRS, por el término en inglés) con quimioterapia hipertérmica intraperitoneal (HIPEC, por el término en inglés) es el tratamiento estándar para DPAM. Nuestra hipótesis es que los mismos principios terapéuticos, consistentes en CRS con quimioterapia hipertérmica del escroto (HCS), pueden ser aplicados para DPAM con extensión al escroto. MÉTODOS: Revisamos una base de datos prospectiva en nuestra Institución donde se identificaron dos casos de DPAM con extensión al escroto. Se examinaron sus historias clínicas, y se realizaron controles cercanos. La histopatología tumoral y la citoreducción fueron evaluados. La progresión tumoral fue monitorizada en los controles mediante examen físico, marcadores tumorales (CEA, CA 125, CA 19.9) y TAC abdomino-pélvico. RESULTADOS: Dos pacientes a quienes se les practicó previamente CRS/HIPEC por DPAM fueron exitosamente tratados con CRS/HSC. Ambos pacientes se encuentran vivos y sin evidencia de enfermedad 88 y 57 meses después de la CRS/HIPEC inicial y a 50 y 32 meses post CRS/HCS, respectivamente. CONCLUSIÓN: La precaución de los cirujanos sobre la coexistencia de hernias inguinales con neoplasias peritoneales y la necesidad de reparo quirúrgico debe ser incrementada. La CRS/HCS puede ser empleada en el tratamiento a pacientes con DPAM con extensión al escroto. Los resultados clínicos son dependientes de una citoreducción completa del tumor metastásico.

Predictive and prognostic survival factors in peritoneal carcinomatosis from appendiceal cancer after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.

BACKGROUND: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has survival benefit in the treatment of selected patients with peritoneal carcinomatosis (PC) from appendiceal cancer (AC). We evaluated factors affecting the survival of patients with PC from AC after CRS/HIPEC. METHODS: A retrospective analysis of 387 CRS/HIPEC procedures performed between February 1998 and February 2013 identified 202 patients with PC from AC. Tumor histopathology, complete cytoreduction (CC 0-1), Peritoneal Cancer Index (PCI), and lymph node (LN) status were related to overall survival (OS) and progression-free survival (PFS) using the Kaplan-Meier method. RESULTS: Overall, 129 women (64 %) and 73 men (36 %), mean age 54 years (range 25-81), with a mean follow-up of 36 months were included in the study. Seventy-seven low-grade tumors (disseminated peritoneal adenomucinosis [DPAM]; 38 %) and 125 high-grade tumors (peritoneal mucinous carcinomatosis [PMCA]; 62 %) were identified. Five- and 10-year OS was 56 % and 47 %, respectively, with PFS of 44 % at 5 and 10 years. Five-year OS in DPAM patients was 83 %, with a 5-year OS significant difference related to CC 0-1 versus CC 2-3 (incomplete cytoreduction) [p = 0.021]. Five-year OS in PMCA patients was 41 %, with a 5-year OS significant difference related to CC 0-1 versus CC 2-3 (p < 0.001), PCI <20 versus PCI ≥20 (p = 0.002), and (-)LN versus (+)LN (p < 0.001). Grade III/IV complications were 16 %. No perioperative mortality was reported. CONCLUSION: Positive LN, PMCA histopathology, and PCI ≥20 are negative prognostic factors, while CC 0-1 is a positive survival predictor in PC from AC treated with CRS/HIPEC. However, in patients with PMCA and PCI ≥20 in whom CC 0-1 was a potential outcome should not be denied CRS/HIPEC.

The activation of representative emotional verbal contexts interacts with vertical spatial axis.

Several experimental studies have shown that there exists an association between emotion words and the vertical spatial axis. However, the specific conditions under which this conceptual-physical interaction emerges are still unknown, and no study has been devised to test whether longer linguistic units than words can lead to a mapping of emotions on vertical space. In Experiment 1, Spanish and Colombian participants performed a representative verbal emotional contexts production task (RVEC task) requiring participants to produce RVEC for the emotions of joy, sadness, surprise, anger, fear, and disgust. The results showed gender and cultural differences regarding the average number of RVEC produced. The most representative contexts of joy and sadness obtained in Experiment 1 were used in Experiment 2 in a novel spatial-emotional congruency verification task (SECV task). After reading a sentence, the participants had to judge whether a probe word, displayed in either a high or low position on the screen, was congruent or incongruent with the previous sentence. The question was whether the emotion induced by the sentence could modulate the responses to the probes as a function of their position in a vertical axis by means of a metaphorical conceptual-spatial association. Overall, the results indicate that a mapping of emotions on vertical space can occur for linguistic units larger than words, but only when the task demands an explicit affective evaluation of the target.

Progression of peritoneal adenomucinosis to the scrotum: a rare occurrence treated with cytoreductive surgery and hyperthermic chemoperfusion of the scrotum in two patients / Progresión de adenomucinosis peritoneal en el escroto de dos pacientes y tratamiento con cirugía citorreductora y quimioperfusión hipertérmica

Introduction: Disseminated Peritoneal Adenomucinosis (DPAM) is an infrequent presentation of appendiceal cancer. Infrequently, umbilical or inguinal hernias could be the first clinical manifestation of this condition; DPAM extension to the scrotum may be anatomically viable. Treatment with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is the standard of treatment for DPAM. We hypothesize that these same treatment principles, consisting of CRS with hyperthermic chemoperfusion of the scrotum (HCS), could be applied to the scrotal dissemination of DPAM. Methods: We reviewed our Institution's prospective cancer database and identified two cases of DPAM with extension to the scrotum. Their medical records were examined, and close follow-up was performed. Tumor histopathology and cytoreduction scores were evaluated. Tumor progression was monitored on follow-up by physical examination, tumor markers (CEA, CA 125, CA 19.9) and abdomino-pelvic CT scan. Results: Two patients who previously had CRS/ HIPEC for DPAM were successfully treated with HSC. Both patients are alive and free of disease at 88 and 57 months following initial CRS/HIPEC, and 50 and 32 months following CRS/HCS, respectively. Conclusion: Increased awareness by surgeons to the coexistence of inguinal hernia with peritoneal neoplasm and the need for a surgical repair is raised. CRS/HCS may be employed to treat patients with DPAM extension to the scrotum. Successful outcome is dependent on complete cytoreduction of metastatic tumor.

Introducción: La Adenomucinosis Peritoneal Diseminada (DPAM, por el término en inglés) es una presentación no frecuente del cáncer de apéndice. Infrecuentemente, las hernias umbilicales o inguinales pueden ser la primera manifestación clínica de esta condición; la extensión al escroto puede ser anatómicamente viable. La cirugía citoreductiva (CRS, por el término en inglés) con quimioterapia hipertérmica intraperitoneal (HIPEC, por el término en inglés) es el tratamiento estándar para DPAM. Nuestra hipótesis es que los mismos principios terapéuticos, consistentes en CRS con quimioterapia hipertérmica del escroto (HCS, por el término en inglés), pueden ser aplicados para DPAM con extensión al escroto. Métodos: Revisamos una base de datos prospectiva en nuestra Institución donde se identificaron dos casos de DPAM con extensión al escroto. Se examinaron sus historias clínicas, y se realizaron controles cercanos. La histopatología tumoral y la citoreducción fueron evaluados. La progresión tumoral fue monitorizada en los controles mediante examen físico, marcadores tumorales (CEA, CA 125, CA 19.9) y TAC abdomino-pélvico. Resultados: Dos pacientes a quienes se les practicó previamente CRS/HIPEC por DPAM fueron exitosamente tratados con CRS/HSC. Ambos pacientes se encuentran vivos y sin evidencia de enfermedad 88 y 57 meses después de la CRS/HIPEC inicial y a 50 y 32 meses post CRS/HCS, respectivamente. Conclusión: La precaución de los cirujanos sobre la coexistencia de hernias inguinales con neoplasias peritoneales y la necesidad de reparo quirúrgico debe ser incrementada. La CRS/HCS puede ser empleada en el tratamiento a pacientes con DPAM con extensión al escroto. Los resultados clínicos son dependientes de una citoreducción completa del tumor metastásico.

Melphalan: a promising agent in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

BACKGROUND: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has become an option for peritoneal carcinomatosis (PC). Frequently, these patients have failed systemic chemotherapies and surgeries, including CRS/HIPEC with traditional regimens (mitomycin-C or platinum based). An alternative agent for failed or repeated CRS/HIPEC is unknown. We hypothesize that melphalan is an alternative agent in patients with PC from aggressive primaries, including recurrences following failed regional therapies. METHODS: A retrospective review of a prospective database of 247 patients revealed 25 patients (9 male and 16 female) who received intraperitoneal melphalan (50 mg/m(2)) in 31 CRS/HIPEC procedures, of which 19 were repeated. Primary malignancies included 17 appendiceal, one colorectal, two ovarian, two uterine sarcomas, two primary peritoneal and one mesentery sarcoma. RESULTS: PC index (PCI) was ≥20 in 76 % of patients (19/25). 88 % of patients (22/25) had complete cytoreduction. Seventeen patients were alive, with mean survival of 63.6 months, and eight patients are deceased. Overall survival (OS) for the entire group since diagnosis was 95.8, 84.5, 50.9, and 38.2 % at 1, 3, 5, and 10 years, respectively; OS since melphalan HIPEC was 89.4, 45, and 30 % at 1, 3, and 5 years, respectively; and OS in patients with appendiceal malignancies was 91.7, 48.1 and 32.1 % at 1, 3 and 5 years, respectively. There was no postoperative mortality. Grade III-IV morbidity was 23 % (7/31). Nine patents had neutropenia, controlled with filgrastim. CONCLUSIONS: Melphalan is an efficacious alternative agent in patients undergoing CRS/HIPEC for aggressive and recurrent peritoneal surface malignancies. Its postoperative significant myelosuppression effect should be addressed.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of recurrent high-grade uterine sarcoma with peritoneal dissemination.

OBJECTIVE: Peritoneal sarcomatosis from primary uterine sarcoma (US) is a rare condition. Conventional therapeutic modalities have failed to improve survival and outcomes among patients with high-grade US with extrapelvic spread. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has shown improved outcomes for peritoneal carcinomatosis from other epithelial primaries with similar clinical presentation. We report our experience applying this treatment in 3 patients with recurrent high-grade US with peritoneal dissemination. STUDY DESIGN: This retrospective review of a prospective database of 378 patients with peritoneal dissemination of cancer treated with CRS/HIPEC identified 3 patients with recurrent high-grade US. Follow-up for disease progression was carried out by physical examination and computed tomography scan of the chest, abdomen, and pelvis. RESULTS: Two leiomyosarcomas and 1 adenosarcoma with sarcomatous overgrowth were identified. Two of the 3 had failed standard treatment with surgery and systemic chemotherapy before CRS/HIPEC was performed. Follow-up ranged from 34 to 140 months. All 3 patients are alive, 2 with no evidence of disease (NED), and 1 alive with disease. Adramycin/cisplatin was used for HIPEC in 1 case (140 months with NED), whereas melphalan was used in the other 2 cases (53 months alive with disease, 34 months with NED). Two patients underwent 1 CRS/HIPEC, whereas 1 required 3 CRS/HIPEC due to disease recurrence. CONCLUSION: CRS/HIPEC shows promise as a treatment modality for the management of selected patients with recurrent high-grade US with peritoneal dissemination. Further studies are warranted.

Novel mechanisms underlying inhibitory and facilitatory transcranial magnetic stimulation abnormalities in Parkinson's disease.

BACKGROUND AND AIMS: The motor-evoked potential (MEP) induced by transcranial magnetic stimulation (TMS), its recruitment and the conditioning effects of weak stimuli in Parkinson's disease (PD) have shown contradictory results. The aim of this study is to definitively establish the influences of PD on the TMS-evoked MEP. METHODS: We investigated resting and active motor thresholds, resting and active recruitment curves, and short interval intracortical inhibition (ICI) and facilitation (ICF) in 39 PD patients and 40 age-matched healthy controls. The Unified Parkinson's Disease Rating Scale (UPDRS) motor score was used as a clinical measure. RESULTS: MEPs to single pulses were slightly, but significantly, larger in the PD patients at rest, but increased much less than controls with voluntary muscle activation. PD patients also showed clearly and consistently less ICI and ICF by the conditioning pulse. Both ICI and ICF correlated with MEP threshold in healthy subjects, but not in PD patients. None of the TMS measures correlated with the UPDRS. CONCLUSIONS: This study strongly supports the view that PD-related MEPs reflect a disturbed signal-noise ratio of pyramidal neuron responses. Such disturbance may be due to a complex combination of altered presynaptic and surround inhibition that results in unbalanced excitatory/inhibitory input at the brain motor cortex level.

WITHDRAWN: Mechanisms Underlying Inhibitory and Facilitatory Transcranial Magnetic Stimulation Abnormalities in a Large Sample of Patients with Parkinson's Disease.

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