What's Current and What's New in Mesothelioma?

Malignant mesothelioma is a rare disease with limited treatment options. In malignant pleural mesothelioma (MPM), radical trimodality approaches, including surgery, radiotherapy and systemic chemo- and immunotherapy, have been delivered in some countries but remain controversial due to a lack of randomised evidence. Even in the unresectable scenario, surgery and radiotherapy play an important role in managing pleural effusions and pain, which may optimise wellbeing and maintain performance status. From the systemic treatment point of view, the recent incorporation of anti-angiogenics and, more importantly, immunotherapy has changed the standard of care in a space where chemotherapy with platinum and pemetrexed was the only therapeutic intervention with demonstrated benefits in overall survival. Histology is essential in determining an initial treatment plan as non-epithelioid MPMs may have a higher substantial survival improvement with dual immunotherapy compared with chemotherapy, whereas chemotherapy remains an option for epithelioid MPM; however, predictive biomarkers for systemic therapy are not entirely validated to guide the selection, as a subgroup of MPM patients might not benefit from immunotherapy. This overview approaches how the overall management of mesothelioma is evolving to incorporate the recent changes in the standards of care.

Burnout syndrome in oral and maxillofacial surgeons: a critical analysis.

The aim of this study was to determine the prevalence of burnout syndrome among Brazilian oral and maxillofacial surgeons and its relationship with socio-demographic, clinical, and habit variables. The sample of this study comprised 116 surgeons. The syndrome was quantified using the Maslach Burnout Inventory (General Survey), which defines burnout as the triad of high emotional exhaustion, high depersonalization, and low personal accomplishment. The criteria of Grunfeld et al. were used to evaluate the presence of the syndrome (17.2%). No significant differences between the surgeons diagnosed with and without the syndrome were observed according to age (P=0.804), sex (P=0.197), marital status (P=0.238), number of children (P=0.336), years of professional experience (P=0.102), patients attended per day (P=0.735), hours worked per week (P=0.350), use of alcohol (P=0.148), sports practice (P=0.243), hobbies (P=0.161), or vacation period per year (P=0.215). Significant differences occurred in the variables sex in the emotional exhaustion subscale (P=0.002) and use or not of alcohol in the personal accomplishment subscale (P=0.035). Burnout syndrome among Brazilian surgeons is average, showing a low personal accomplishment.

[Long-term results of end-to-end urethroplasty]. / Resultado a largo plazo de la uretroplastia término-terminal.

OBJECTIVE: We evaluated long term results of end-to-end urethroplasty. MATERIAL AND METHODS: We reviewed 40 patients with bulbar urethral stricture of diverse origin: iatrogenic 40%, traumatic 15%, infectious 2% and unknown 40%. In 17 cases internal urethrotomy was made previously. The radiological study with retrograde and voiding cystogram revealed a bulbar location in all cases and a length inferior to 1 cm in 13 cases, between 1-2 cm in 26 cases and 2-3 cm in 1 case. The maximum flow rate varied between 3-13 ml/s. The absence of bacteriuria was valued by means of preoperating culture. The average time of pursuit was 45 months (12-142 months). The stricture was considered resolute when not appear compatible radiological or functional finds of failure. RESULTS: In 37 cases (92%) the results were satisfactory, without secondary surgical procedure. After surgery maximum flow-rate varied between 18-45 ml/s. In two patients with failure, internal urethrotomy was decisive. In this case the stricture origin was traumatic. The third patient with failure was finally chosen to make new end-to-end urethroplasty, with good later result. CONCLUSIONS: End-to-end urethroplasty is a highly decisive technique for bulbar urethral stricture. The preoperating diagnosis is based on the radiological study (retrograde and voiding cystogram). The postoperating control must be based on clinic and uroflow study. Traumatic stricture repair showed worse results. In cases of failure, internal urethrotomy allows to complement successful results of end-to-end urethroplasty.

[Survival prognostic factors valuation on a series of 202 patients with surgical treatment of renal cell carcinoma]. / Valoración de factores pronósticos de la supervivencia en una serie de 202 pacientes intervenidos por carcinoma de células renales.

OBJECTIVES: To describe renal cell carcinoma prognostic factors and set up the relationship with survival rates in this neoplasm. Likewise we show epidemiologic, clinical, diagnosis and therapeutic facts. MATERIAL AND METHOD: We review 202 patients underwent surgical treatment for renal cell carcinoma and the following features were recorded: gender, age and presenting symptoms, especially incidentally discovered tumors; tumor-related factors like TNM tumor stage, tumor grade and venous involvement: therapy-related recorded were surgical techniques and cytokine-based therapy. RESULTS: 60% of the patients showed organ-confined disease, 10% of patients with renal cell carcinoma presented with nodal positive disease and 7% with systemic metastases. 42% of patients presenting incidental tumor, with survival rates substantially better than that for symptomatic patients. 42% of patients with nodal positive disease presented systemic metastases at diagnosis, and 30% at surveillance. Systemic metastases presented a particularly poor prognosis for patients with renal cell carcinoma, with 12-months survival rates that 0%. Patients with cytokine-related therapy for metastatic disease presented 24-months survival rates that 20%. CONCLUSIONS: Renal cell carcinoma remains a major source of mortality, basically at advanced disease (nodal positive disease or systemic disease), without a clear improvement of survival rates despite the newer therapy modalities.

Evaluation of kallikrein in human parotid and submandibular saliva.

Saliva was collected from 10 subjects using a universal-design parotid collector and individually-adapted submandibular collectors. The enzymic activity of kallikrein was measured using D-leucylvalylarginine-p-nitroanilide as the substrate. Mean kallikrein activity was much higher in parotid saliva than in submandibular saliva; the difference was statistically significant. Protein concentrations were not significantly different, whereas alpha-amylase was, as expected, much higher in parotid saliva.