Unravelling the Encapsulation of DNA and Other Biomolecules in HAp Microcalcifications of Human Breast Cancer Tissues by Raman Imaging.

Microcalcifications are detected through mammography screening and, depending on their morphology and distribution (BI-RADS classification), they can be considered one of the first indicators of suspicious cancer lesions. However, the formation of hydroxyapatite (HAp) calcifications and their relationship with malignancy remains unknown. In this work, we report the most detailed three-dimensional biochemical analysis of breast cancer microcalcifications to date, combining 3D Raman spectroscopy imaging and advanced multivariate analysis in order to investigate in depth the molecular composition of HAp calcifications found in 26 breast cancer tissue biopsies. We demonstrate that DNA has been naturally adsorbed and encapsulated inside HAp microcalcifications. Furthermore, we also show the encapsulation of other relevant biomolecules in HAp calcifications, such as lipids, proteins, cytochrome C and polysaccharides. The demonstration of natural DNA biomineralization, particularly in the tumor microenvironment, represents an unprecedented advance in the field, as it can pave the way to understanding the role of HAp in malignant tissues.

Fluorescent cholangiography with direct injection of indocyanine green (ICG) into the gallbladder: a safety method to outline biliary anatomy.

PURPOSE: Near infrared cholangiography (NIRC) with indocyanine green (ICG) directly injected into the gallbladder is a novel technique to outline biliary anatomy. The purpose of this article is to analyze the usefulness and feasibility of NIRC as a safety method during laparoscopic cholecystectomies. MATERIAL AND METHODS: A case-controlled study comparing 20 patients undergoing laparoscopic cholecystectomies with NIRC with direct injection of ICG into the gallbladder to 20 consecutive standard cholecystectomies. Operative time, length of stay, complications, conversion rates, and biliary injury were analyzed. RESULTS: Both groups were comparable in epidemiological characteristics. In the ICG group fluorescent visualization of the junction of the Hartmann pouch and the whole cystic duct was achieved in 16 (80%) patients. Median surgical time was 65 (50-76) and 55 (45-71) min for the ICG and the control group, respectively (p = 0.113). There were no postoperative complications and no biliary duct injuries in any of the groups, and a patient from both groups underwent conversion to open surgery. CONCLUSION: NIRC with direct injection of ICG into the gallbladder is a feasible method that is not time-consuming; it does not require a different learning curve from standard laparoscopic cholecystectomies and has no major complications described so far.

Telemedicine to follow patients in a general surgery department. A randomized controlled trial.

BACKGROUND: Telemedicine is becoming more popular in many medical specialties but few studies have been conducted in General Surgery. This study aims to evaluate the feasibility of its introduction in this specialty. METHODS: A prospective randomized clinical trial (RCT) was conducted in 200 patients to compare conventional vs telemedicine follow-up in the outpatient clinics. The primary outcome was the feasibility of telemedicine follow-up and the secondary outcomes were its clinical impact and patient satisfaction. RESULTS: Patients were enrolled between March 2017 and April 2018 and there were no statistically significant differences between the groups' characteristics. The primary outcome was achieved in 90% of the conventional follow-up group and in 74% of the telemedicine group (P = 0.003). No differences were found in clinical outcomes (P = 0.832) or patient satisfaction (P = 0.099). CONCLUSION: Telemedicine is a good complementary service to facilitate follow-up management in selected patients from a General Surgery department.

Ganglio secundario como indicador de linfadenectomía axilar en pacientes afectas de cáncer de mama / Secondary node analysis as an indicator for axillary lymphadenectomy in breast cancer patients

Introducción: En la actualidad no existe consenso en cuanto a la necesidad de realizar linfadenectomía axilar (LA) en los casos en que se detectan macrometástasis en el ganglio centinela (GC). En este estudio se presenta la utilidad del ganglio secundario (GS), una nueva técnica diagnóstica, como factor predictor de afectación axilar. Métodos: Se diseñó un estudio observacional, retrospectivo y multicéntrico con el objetivo de validar la técnica del GS, entendido como tal el siguiente ganglio a nivel anatómico y de difusión linfogammagráfica tras el GC, como predictor de la afectación axilar. Sobre un total de 2.273 pacientes afectas de cáncer de mama se obtuvo una muestra válida de 283 pacientes a las que se había analizado el estado del GS de forma adicional. Las variables principales del estudio fueron el estado histológico del GC, del GS y del vaciamiento axilar y se valoró la sensibilidad, especificidad y exactitud de la prueba. Resultados: La prueba del GS, con GC positivo, presenta una sensibilidad del 61,1%, una especificidad del 78,7%, un valor predictivo positivo del 45,8% y un valor predictivo negativo del 87,3%, con una exactitud del 74,7%. Conclusión: El estudio del GS junto con la técnica del GC permite realizar una estadificación más precisa del estado axilar, en pacientes con cáncer de mama, en comparación con el estudio único del GC (AU)

Introduction: Currently, there is no agreement regarding if it would be necessary to perform an axillary lymph node dissection (ALND) in patients who have macrometastases in the sentinel lymph node (SLN). We studied the utility of the secondary node analysis (SN), defined as the following node after the SLN in an anatomical and lymphatic pathway, as a sign of malignant axillary involvement. Methods: An observational, retrospective and multicentre study was designed to assess the utility of the SN as a sign of axillary involvement. Among 2273 patients with breast cancer, a valid sample of 283 was obtained representing those who had the SN studied. Main endpoints of our study were: the SLN, the SN and the ALND histological pattern. Sensitivity, specificity and precision of the test were also calculated. Results: SN test, in cases with positive SLN, has a sensitivity of 61.1%, a specificity of 78.7%, a positive predictive value of 45.8% and a negative predictive value of 87.3% with a precision of 74.7%. Conclusion: The study of the SN together with the technique of the SLN allows a more precise staging of the axillary involvement, in patients with breast cancer, than just the SLN technique (AU)

Secondary node analysis as an indicator for axillary lymphadenectomy in breast cancer patients. / Ganglio secundario como indicador de linfadenectomía axilar en pacientes afectas de cáncer de mama.

INTRODUCTION: Currently, there is no agreement regarding if it would be necessary to perform an axillary lymph node dissection (ALND) in patients who have macrometastases in the sentinel lymph node (SLN). We studied the utility of the secondary node analysis (SN), defined as the following node after the SLN in an anatomical and lymphatic pathway, as a sign of malignant axillary involvement. METHODS: An observational, retrospective and multicentre study was designed to assess the utility of the SN as a sign of axillary involvement. Among 2273 patients with breast cancer, a valid sample of 283 was obtained representing those who had the SN studied. Main endpoints of our study were: the SLN, the SN and the ALND histological pattern. Sensitivity, specificity and precision of the test were also calculated. RESULTS: SN test, in cases with positive SLN, has a sensitivity of 61.1%, a specificity of 78.7%, a positive predictive value of 45.8% and a negative predictive value of 87.3% with a precision of 74.7%. CONCLUSION: The study of the SN together with the technique of the SLN allows a more precise staging of the axillary involvement, in patients with breast cancer, than just the SLN technique.

Adenocarcinoma sobre colostomía terminal. Una entidad rara pero relevante / Adenocarcinoma at the site of a terminal colostomy. A rare but important entity

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Value of C-reactive protein in the assessment of organ-space surgical site infections after elective open and laparoscopic colorectal surgery.

BACKGROUND: Although C-reactive protein (CRP) has proved useful in the assessment of post-operative infections, its value at those time points useful to assess organ-space surgical site infection (OSI) after open and laparoscopic colorectal surgery has not been clarified. METHODS: We compared values of CRP on post-operative days two and five and percentage of change between those days (Δ%D2-5) in patients with and without OSI, after open (OPEN) and laparoscopic (LAP) colo-rectal surgery. Receiver-operating characteristic analysis was performed and indices of test performance of sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and likelihood ratios (LR+ and LR-) were assessed. RESULTS: The best CRP predictive values for OSI were D5 >120 mg/L (area under the curve [AUC] 0.959; 95% confidence interval [CI] 0.890-0.990) and Δ%D2-5 <40% (AUC 0.968; 95% CI 0.901-0.994; p=0.0001) in OPEN and D5 >66 mg/L (AUC 0.921; 95% CI 0.841-0.969) and Δ%D2-5 <48% (AUC 0.894-95% CI 0.806-0.952; p=0.0001) in LAP. The best measure was NPV (100%; CI 93.6%-100% for D5 and Δ%D2-5 in OPEN and 98.4%, CI 91.3%-99.7% for D5 and 100%, CI 93.4%-100% for Δ%D2-5 in LAP). CONCLUSIONS: In patients with CRP <120.66 mg/L on post-operative day 5 or a decay from post-operative day two to five of >40%-48% in OPEN and LAP, respectively, OSI may be ruled out and the patient discharged safely. Careful workup is needed in those patients with higher postoperative CRP concentrations or lower apparent decay values.

Multifocal hepatic cystic mass as first manifestation of metastatic spinal hemangiopericytoma.

INTRODUCTION: Hemangiopericytomas (HPCs) are rare vascular tumors with a high malignant potential. Hepatic metastases from HPC are very infrequent and usually show a distinctive solid aspect with a surrounding pseudocapsule. PRESENTATION OF CASE: A 37-year-old man with a previous medical history of recurrent spinal hemangiopericytoma with a 9cm×7cm cystic hepatic mass detected on follow-up. Contrast enhanced US and MRI confirmed the presence the lesion showing mixed (solid and cystic) content. Parasitic and viral serology plus serum tumoral markers (CEA, ca 19.9, ca 125, AFP) tests, upper and lower endoscopy and general laboratory tests were normal and extended left lobectomy was performed. Histopathologic study confirmed the diagnosis of multifocal metastasic hemangiopericytoma with moderate CD-34, CD-99 and Bcl-2 positivity after immunohistochemical staining. After 1-year follow-up the patient does not present any evidence of abdominal recurrence but a skull base recurrence has been detected. DISCUSSION: Liver metastasis from spinal HPC are uncommon and do not have cystic appearance so radiologic diagnosis can be challenging. In spite of the presence of previously diagnosed HPC context, the presence of a liver cystic mass in a young patient makes necessary to discard a number much more frequent benign and malignant diagnosis before metastatic disease can be confirmed. CONCLUSION: The presence of a cystic hepatic mass makes it mandatory to rule out a number neoplasms other than metastasic HPC before a definitive diagnosis is made. In addition to local radiotherapy and antiangiogenic agents, surgery can be useful to treat liver dissemination.

Reconstruccion de la mama con gel de plaquetas en la cirugia conservadora del cancer / Use of platelet gel in breast reconstruction after breast-conserving cancer surgery

Introducción: Con la finalidad de disminuir las deformidades de la mama después de la cirugía conservadora del cáncer, presentamos una nueva técnica de reconstrucción mamaria mediante la restitución del volumen mamario con gel de plaquetas. Pacientes y métodos Estudio piloto de 20 pacientes con cáncer de mama sometidas a tumorectomía a las que se aplicó en el espacio residual el gel obtenido por plaquetoaféresis de donante alogénico sano. A las pacientes se les realizó un seguimiento clínico, iconográfico e histológico, así como una valoración del resultado estético. Resultados La edad media fue de 50,5±8,65 años (rango 42-70 años) y la mediana del índice de comorbilidad de Charlson fue de 1,15±1,27 (rango 0-5). El volumen medio de la tumorectomía fue de 63,1±31,1ml (rango 30-160ml) y el volumen de restitución con el gel de plaquetas fue de 111,5±60,9ml (rango 40-250ml). Después de una mediana de seguimiento de medio de 17 meses, el 80% de las pacientes preservaron el volumen mamario y no fueron necesarias reintervenciones por afectación de los márgenes quirúrgicos ni se observaron recidivas. Conclusiones El gel de plaquetas permite restituir el volumen mamario ajustado al volumen de la tumorectomía, minimizando las retracciones y deformidades habituales de la cirugía conservadora, lo que permite realizar resecciones amplias con márgenes oncológicos de seguridad (AU)

Introduction: With the aim of decreasing breast defects after conservative cancer surgery, we present a new breast reconstruction technique using breast volume restitution with platelet gel. Patients and method: A pilot study was conducted on 20 breast cancer patients undergoing tumorectomy with placement a gel obtained by platelet pheresis of a healthy allogeneic donor in the surgical cavity. Patients had a clinical, photographic and histological follow-up, as well as an assessment of the aesthetic outcome. Results: The mean age was 50.5 8.6 years (range 42-70 years) and with a mean Charlson comorbidity index of 1.1 1.2 (range 0-5). The mean tumour volume was 63.1 31.1 ml(range 30-160 ml) and the mean restitution volume with platelet gel was 111.5 60.9 ml (range40-250 ml). After a mean follow-up of 17 months, 80% of the patients maintained the breast volume and no further operations were needed due to surgical margin involvement. No recurrences were observed in any patient. Conclusions: Platelet gel allows restitution of the breast volume adjusted to the tumorectomy volume, minimising the usual retractions and deformities after conservative surgery. It enables wide resections and safety margins (AU)

[Use of platelet gel in breast reconstruction after breast-conserving cancer surgery]. / Reconstrucción de la mama con gel de plaquetas en la cirugía conservadora del cáncer.

INTRODUCTION: With the aim of decreasing breast defects after conservative cancer surgery, we present a new breast reconstruction technique using breast volume restitution with platelet gel. PATIENTS AND METHOD: A pilot study was conducted on 20 breast cancer patients undergoing tumorectomy with placement a gel obtained by plateletpheresis of a healthy allogeneic donor in the surgical cavity. Patients had a clinical, photographic and histological follow-up, as well as an assessment of the aesthetic outcome. RESULTS: The mean age was 50.5±8.6 years (range 42-70 years) and with a mean Charlson comorbidity index of 1.1±1.2 (range 0-5). The mean tumour volume was 63.1±31.1 ml (range 30-160 ml) and the mean restitution volume with platelet gel was 111.5±60.9 ml (range 40-250 ml). After a mean follow-up of 17 months, 80% of the patients maintained the breast volume and no further operations were needed due to surgical margin involvement. No recurrences were observed in any patient. CONCLUSIONS: Platelet gel allows restitution of the breast volume adjusted to the tumorectomy volume, minimising the usual retractions and deformities after conservative surgery. It enables wide resections and safety margins.

Laparoscopic resection of clinically suspected gastric stromal tumors.

Gastrointestinal stromal tumors (GISTs) account for 5% of all gastric tumors. Preoperative diagnosis is relatively difficult because biopsy samples are rarely obtained during fibergastroscopy. Surgical radical resection is the gold standard treatment, allowing pathologic study for both diagnosis and prognosis. Laparoscopic resection has become an alternative to the open approach, but long-term results are not well known. The aim of this study is to report experience with laparoscopic resection, placing special emphasis on preoperative diagnosis and describing long-term results. A retrospective analysis was made of all patients undergoing a laparoscopic resection for clinically suspected gastrointestinal stromal tumors between November 1998 and August 2006 at 2 tertiary hospitals. The medical records of all participants were reviewed regarding surgical technique, clinicopathologic features, and postoperative long-term outcome. Laparoscopic gastric resection was attempted in 22 patients (13 women and 9 men) with a mean age of 66.7 years (range, 29-84 years). One patient had 2 gastric tumors. Tumor localization was upper gastric third in 6 patients, mid-gastric third in 7, and distal third in 10. Surgical techniques were transgastric submucosal excision (n = 1), wedge resection (n = 13), partial gastrectomy with Y-en-Roux reconstruction (n = 6), and total gastrectomy with Y-en-Roux reconstruction (n = 2). Two patients (9.1%) required conversion to the open procedure because of tumor size. Postoperative morbidity was delayed gastric emptying in 3 patients. Median postoperative stay was 6 days (range, 4-32 days). Pathologic and immunohistochemical study confirmed gastrointestinal stromal tumors in 18 cases. The other 4 cases were adenomyoma, hamartoma, plasmocytoma, and parasitic tumor (anisakis). Median tumor size was 5.6 cm (range, 2.5-12.5 cm) in cases of gastrointestinal stromal tumors. Malignant risk of gastrointestinal stromal tumors assessed according to mitotic index and size was low (n = 8), intermediate (n = 6), or high (n = 4). After a median follow-up of 32 months (range, 1-72 months), there was 1 case of recurrence of GIST. Definitive preoperative diagnosis of gastric submucosal tumors is frequently difficult. The laparoscopic approach to surgical treatment of these tumors seems safe and is associated with acceptable intermediate-term results, especially in cases of gastrointestinal stromal tumors.