Association of socioeconomic factors with the receipt of neoadjuvant therapy for patients with non-small cell lung cancer.

BACKGROUND: Neoadjuvant therapy (NT) will be increasingly used for patients with non-small cell lung cancer (NSCLC), particularly given the recent approval of neoadjuvant chemoimmunotherapy. Several barriers may prevent the uptake of NT and should be identified and addressed. We queried the National Cancer Database (NCDB) to determine predictors of the use of NT. METHODS: Using the NCDB (2006-2019), we identified 80,707 patients who underwent surgery for clinical stage II and III NSCLC. Sociodemographic and clinical factors were reviewed, and univariable and multivariable analyses were performed to identify associations with the uptake of NT. In propensity score-matched groups, survival was determined using the Kaplan-Meier method. RESULTS: Among 80,707 eligible patients, 17,262 (21.4%) received NT. Clinical stage and node positivity were associated with receipt of NT. On multivariable analysis, factors associated with lower rates of NT included black race (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.67-0.90), Charlson Comorbidity Index ≥2 (OR, 0.75; 95% CI, 0.67-0.85), Medicaid/Medicare insurance (OR, 0.82; 95% CI, 0.75-0.90), lower income level (OR, 0.79; 95% CI, 0.71-0.87), and treatment at a community center (OR, 0.81; 95% CI, 0.67-0.96). In an exploratory analysis, those patients who received NT had longer 5-year overall survival compared with those who did not (48.3% vs 46.0%; P < .001). CONCLUSIONS: Rates of NT are relatively low for patients with clinical stage II/III NSCLC treated prior to recent chemoimmunotherapy trials. Socioeconomic barriers to the uptake of NT include race, insurance status, income, and area of residence. As NT becomes more widely offered, accessibility for vulnerable populations must be assured.

Conversion from laparoscopic to open cholecystectomy: Risk factor analysis based on clinical, laboratory, and ultrasound parameters.

INTRODUCTION AND AIMS: The standard of care for gallbladder disease is laparoscopic cholecystectomy. Difficult dissection of the hepatocytic triangle and bleeding can result in conversion to open cholecystectomy, which is associated with increased morbidity. Identifying risk factors for conversion in the context of acute cholecystitis will allow patient care to be individualized and improve outcomes. MATERIALS AND METHODS: A retrospective case-control study included all patients diagnosed with acute cholecystitis, according to the 2018 Tokyo Guidelines, admitted to a tertiary care academic center, from January 1991 to January 2012. Using logistic regression, we analyzed variables to identify risk factors for conversion. Variables that were found to be significant predictors of conversion in the univariate analysis were included in a multivariate model. We then performed an exploratory analysis to identify the risk factor summation pathway with the highest sensitivity for conversion. RESULTS: The study included 321 patients with acute cholecystitis. Their mean age was 49 years (±16.8 SD), 65% were females, and 35% were males. Thirty-nine cases (12.14%) were converted to open surgery. In the univariate analysis, older age, male sex, gallbladder wall thickness, and pericholecystic fluid were associated with a higher risk for conversion. In the multivariate analysis all of the variables, except pericholecystic fluid, were associated with conversion. Our risk factor summation model had a sensitivity of 84%. CONCLUSIONS: Preoperative clinical data can be utilized to identify patients with a higher risk of conversion to open cholecystectomy. Being aware of such risk factors can help improve perioperative planning and preparedness in challenging cases.

Conversion from laparoscopic to open cholecystectomy: Risk factor analysis based on clinical, laboratory, and ultrasound parameters. / Conversión de colecistectomía laparoscópica a abierta: análisis de factores de riesgo con base en parámetros clínicos, de laboratorio y de ultrasonido.

INTRODUCTION AND AIMS: The standard of care for gallbladder disease is laparoscopic cholecystectomy. Difficult dissection of the hepatocytic triangle and bleeding can result in conversion to open cholecystectomy, which is associated with increased morbidity. Identifying risk factors for conversion in the context of acute cholecystitis will allow patient care to be individualized and improve outcomes. MATERIALS AND METHODS: A retrospective case-control study included all patients diagnosed with acute cholecystitis, according to the 2018 Tokyo Guidelines, admitted to a tertiary care academic center, from January 1991 to January 2012. Using logistic regression, we analyzed variables to identify risk factors for conversion. Variables that were found to be significant predictors of conversion in the univariate analysis were included in a multivariate model. We then performed an exploratory analysis to identify the risk factor summation pathway with the highest sensitivity for conversion. RESULTS: The study included 321 patients with acute cholecystitis. Their mean age was 49 years (±16.8 SD), 65% were females, and 35% were males. Thirty-nine cases (12.14%) were converted to open surgery. In the univariate analysis, older age, male sex, gallbladder wall thickness, and pericholecystic fluid were associated with a higher risk for conversion. In the multivariate analysis all of the variables, except pericholecystic fluid, were associated with conversion. Our risk factor summation model had a sensitivity of 84%. CONCLUSIONS: Preoperative clinical data can be utilized to identify patients with a higher risk of conversion to open cholecystectomy. Being aware of such risk factors can help improve perioperative planning and preparedness in challenging cases.

Laparoscopic Roux-en-Y gastric bypass in the treatment of obesity: evidence based update through randomized clinical trials and meta-analyses.

Bariatric surgery was introduced in 1953, but during the last 20 years its popularity has increased after the development of significant Romaevidenced based breakthroughs in the field. Currently, approximately 150 long-term randomized clinical trials and 40 meta-analyses support and give credibility to the surgical approaches for the treatment of obesity and its related metabolic disturbances. Bariatric surgery has demonstrated improved outcomes compared to medical treatment, conduct therapy, and endoscopic procedures. Roux-en-Y gastrojejunostomy (RYGB) and Sleeve gastrectomy (SG) are the surgical procedures most frequently performed, due to their satisfactory results and security profile. There is sufficient evidence in medical literature to perform these procedures when indicated; however, there are still several controversies regarding technical aspects that need to be further explored.

Contrast-enhanced swallow study sensitivity for detecting esophagojejunostomy leakage. / Sensibilidad del trago de contraste hidrosoluble para la detección de fugas de anastomosis esofagoyeyunal.

INTRODUCTION AND AIM: Sixty percent of the patients with gastric carcinomas are candidates for surgical resection through total gastrectomy and esophagojejunostomy, the latter of which is associated with leaks in up to 12.3% of cases. There is no standardized procedure for diagnosing anastomotic leaks. The aim of the present study was to establish the diagnostic sensitivity of the contrast-enhanced swallow study for detecting esophagojejunostomy leakage after total gastrectomy. MATERIALS AND METHODS: A retrospective analysis was conducted on patients that underwent total gastrectomy due to gastric adenocarcinoma, within the time frame of 2002 and 2017. Demographic, clinical, and laboratory factors were identified, emphasizing the clinical and radiologic detection of anastomotic leaks. Descriptive statistics were carried out and the sensitivity of the contrast-enhanced swallow study for diagnosing leakage was calculated. RESULTS: Fifty-eight patients were included in the study. Their mean age was 61.5 years. A total of 55.2% of the patients were men and 44.8% were women. Gastric adenocarcinoma was the indication for gastrectomy in 100% of the cases. Anastomotic leak presented in 31.01% of the patients. Diagnostic sensitivity of the contrast-enhanced swallow study for detecting leaks was 66%. CONCLUSIONS: According to our analysis, the contrast-enhanced swallow study had limited diagnostic efficiency for detecting anastomotic leaks, with a sensitivity of 66%. We suggest maintaining high diagnostic suspicion in patients with studies that are initially negative and basing decisions on a more extensive approach.

Percutaneous cholecystostomy as treatment for acute cholecystitis: What has happened over the last five years? A literature review. / Colecistostomía percutánea como tratamiento de colecistitis aguda: ¿qué ha pasado en los últimos 5 años? Revisión de la literatura.

Acute cholecystitis is one of the most frequent diseases faced by the general surgeon. In recent decades, different prognostic factors have been observed, and effective treatments described, to improve the results in patients with said pathology (lower morbidity and mortality, shorter hospital stay, and minimum conversion of laparoscopic to open procedures). In general, laparoscopic cholecystectomy is the standard treatment for acute cholecystitis, but it is not exempt from complications, especially in patients with numerous comorbidities or those that are critically ill. Percutaneous cholecystostomy emerged as a less invasive alternative for the treatment of acute cholecystitis in patients with organ failure or a prohibitive surgical risk. Even though it is an effective procedure, its usefulness and precise indications are subjects of debate. In addition, there is little evidence on cholecystostomy catheter management. We carried out a review of the literature covering the main aspects physicians involved in the management of acute cholecystitis should be familiar with.

Myths and realities in the management of the open abdomen with negative pressure systems. A case report and literature review.

INTRODUCTION: The open abdomen is a useful resource for treating patients with abdominal hypertension and abdominal compartment syndrome. Currently, early closure assisted with negative pressure devices is considered standard of treatment, and its use has demonstrated favorable outcomes and a decreased rate of complications. PRESENTATION OF A CASE: We present a case of a 32-year-old male patient with diagnosis of non-seminomatous germinal testicular tumor (Stage IIIB (T3-N3-M1), which was summited to surgery, as a complication he presented massive bleeding, that culminated in acute compartment syndrome. With the aforementioned findings the patient re entered the operating room and was managed with open abdomen combined with a medial retraction technique of the abdominal fascia. Currently, the patient has not presented recurrence or late complications after a year. DISCUSSION: The use of negative pressure techniques for open abdomen management began to be generalized in 1995. Subsequently, this technique evolved to V.A.C therapy (Vacuum-assisted closure therapy). Currently, these negative pressure techniques have become the most used method for the temporary closure and management of open abdomen. Controversies continue to limit its widespread use and effectiveness. CONCLUSION: Adequate application of negative pressure therapy in combination with techniques of medial retraction of the abdominal fascia, have proved to be useful in management for patients with open abdomen.

Strong Running Coupling from the Gauge Sector of Domain Wall Lattice QCD with Physical Quark Masses.

We report on the first computation of the strong running coupling at the physical point (physical pion mass) from the ghost-gluon vertex, computed from lattice simulations with three flavors of domain wall fermions. We find α_{MS[over ¯]}(m_{Z}^{2})=0.1172(11), in remarkably good agreement with the world-wide average. Our computational bridge to this value is the Taylor-scheme strong coupling, which has been revealed of great interest by itself because it can be directly related to the quark-gluon interaction kernel in continuum approaches to the QCD bound-state problem.

Recurrent giant Brunner's gland adenoma.

Benign duodenal tumours are extremely rare, with an incidence of 0.008% among general population; those originating from Brunner's Gland represent 11% of this neoplasms. Most cases remain asymptomatic and are often diagnosed during routine endoscopic procedures, however their clinical presentation may be variable making resection treatment of choice in order to prevent complications. Recurrence has not been reported previously on literature. 59-year-old male presented to the emergency department nine months following endoscopic resection of a 2x1.5cm Brunner's gland adenoma complaining of bloating, weight loss and gastro intestinal bleeding, diagnostic approach revealed a 10x4cm mass occupying the duodenum. Tumour size did not allow for endoscopic resection and surgical removal was performed with excellent outcome and no further recurrence at 30 months.

Strong running coupling at τ and Z(0) mass scales from lattice QCD.

This Letter reports on the first computation, from data obtained in lattice QCD with u, d, s, and c quarks in the sea, of the running strong coupling via the ghost-gluon coupling renormalized in the momentum-subtraction Taylor scheme. We provide readers with estimates of α(MS[over ¯])(m(τ)(2)) and α(MS[over ¯])(m(Z)(2)) in very good agreement with experimental results. Including a dynamical c quark makes the needed running of α(MS[over ¯]) safer.

Mesotelioma pleural difuso maligno.Presentacion de un caso: hallazgo necrosico. / Malignant diffuse pleural mesothelioma. Report of a case: necrotic findings

El mesotelioma pleural difuso es generalmente maligno, siendo rara esta enfermedad Se ha informado en nuestro pais el mesotelioma pleural fibroso localizado. Se considera que debe tener presente esta enfermedad en el diagnostico diferencial de un derrame pleural

Mesotelioma pleural difuso maligno.Presentacion de un caso: hallazgo necrosico. / Malignant diffuse pleural mesothelioma. Report of a case: necrotic findings

El mesotelioma pleural difuso es generalmente maligno, siendo rara esta enfermedad Se ha informado en nuestro pais el mesotelioma pleural fibroso localizado. Se considera que debe tener presente esta enfermedad en el diagnostico diferencial de un derrame pleural (AU)

Granuloma plasmocitario pulmonar:presentacion de un caso. / Pulmonary plasmocyte granuloma: report of a case

Se presenta el caso de un adulto joven que presentaba una sombra pulmonar en lobulo superior derecho y a quien la tecnica quirurgica se le determino el diagnostico de un granuloma de celulas plasmocitarias.Este seudotumor es de causa desconocida y no tiene relacion con el mieloma multiple. El tratamiento debe ser quirurgico o por radiaciones. La evolucion del enfermo ha sido favorable durante un periodo de cuatro anos

Granuloma plasmocitario pulmonar:presentacion de un caso. / Pulonary plasmocyte granuloma: report of a case

Se presenta el caso de un adulto joven que presentaba una sombra pulmonar en lobulo superior derecho y a quien la tecnica quirurgica se le determino el diagnostico de un granuloma de celulas plasmocitarias.Este seudotumor es de causa desconocida y no tiene relacion con el mieloma multiple. El tratamiento debe ser quirurgico o por radiaciones. La evolucion del enfermo ha sido favorable durante un periodo de cuatro anos

Mioblastoma de células granulosas. Presentación de un caso / Granular cell myoblastoma. A one-case report

Se expone el caso de un tumor de la tráquea que provocó un síndrome asmatiforme de evolución sorpresiva y fatal, cuyo diagnóstico definitio se hizo por broncoscopía de urgencia. La paciente falleció durante esta crisis como consecuencia de un paro cardíaco irreversible. En el examen anatómico se observó un tumor que obstruía la tráquea en su tercio medio, y cuya estructura hística fue la de un mioblastoma de células granulosas. Se hacen consideraciones referentes a las dificultades del diagnóstico de estos casos y se revisa la literatura a propósito de éste. Los estudios hísticos son motivos de diversas interpretaciones(AU)

Secuestro pulmonar. Presentación de dos casos / Pulmonary sequestration. Report of two cases

Se estudian dos casos (en adultos) de secuestro pulmonar, intrapulmonar, derecho e izquierdo, con manifestaciones respiratorias de larga evolución, que presentaban imágenes basales de bronquiectasias. Al diagnóstico definitivo se llegó mediante varias investigaciones, entre las cuales, fue la aortografía el examen de más valor(AU)

Alveolitis alérgica extrínseca causada por bagazosis / Extrinsic allergic alveolitis caused by bagassosis

Se realiza el estudio de 5 pacientes, obreros de la industria del bagazo, que presentan síntomas respiratorios y generales con alteraciones radiográficas y de la función ventilatoria de tipo obstructivo, así como cambios hísticos en 3 de los mismos, con predominio en 2, de obstrucción bronquiolar y en sólo 1 de éstos alteración granulomatosa. No se comprobó, en ningún paciente, alteraciones bacterianas ni micóticas de la pieza de biopsia. Por la referencia que se recoge en la literatura, se trata de una enfermedad provocada por bacterias y adquirida por el ejercicio de la actividad laboral señalada. Se trata de granulomatosis pulmonar(AU)