Extended preoperative chemotherapy, extent of liver resection and blood transfusion are predictive factors of liver failure following resection of colorectal liver metastasis.

AIM: The aim of this study was to determine the incidence and prognostic factors of postoperative liver failure in patients submitted to liver resection for colorectal metastases. METHOD: Patients with CLM who underwent hepatectomy from 1998 to 2009 were included in retrospective analysis. Postoperative liver failure was defined using either the 50-50 criteria or the peak of serum bilirubin level above 7 mg/dL independently. RESULTS: Two hundred and nine (209) procedures were performed in 170 patients. 120 surgeries were preceded by chemotherapy within six months. The overall morbidity rate was 53.1% and 90-day mortality was 2.3%. Postoperative liver failure occurred in 10% of all procedures, accounting for a mortality rate of 9.5% among this group of patients. In multivariate analysis, extent of liver resection, need of blood transfusion and more than eight preoperative chemotherapy cycles were independent prognostic factors of postoperative liver insufficiency. This complication was not related with the chemotherapy regimen used. CONCLUSION: We conclude that postoperative liver failure has a relatively low incidence (10%) after CLM resection, but a remarkable impact on postoperative mortality rate. The amount of liver resected, the need of blood transfusion and extended preoperative chemotherapy are independent predictors of its occurrence and this knowledge can be used to prevent postoperative liver failure in a multidisciplinary approach.

The interaction between N-category and N-ratio as a new tool to improve lymph node metastasis staging in gastric cancer: results of a single cancer center in Brazil.

BACKGROUND: Depth of tumor invasion (T-category) and the number of metastatic lymph nodes (N-category) are the most important prognostic factors in patients with gastric cancer. Recently, the ratio between metastatic and dissected lymph nodes (N-ratio) has been established as one. The aim of this study is to evaluate the impact of N-ratio and its interaction with N-category as a prognostic factor in gastric cancer. METHODS: This was a retrospective study in which we reviewed clinical and pathological data of 165 patients who had undergone curative surgery at our institution through a 9-year period. The exclusion criteria included metastases, gastric stump tumors and gastrectomy with less than 15 lymph nodes dissected. RESULTS: The median age of the patients was 63 years and most of them were male. Total gastrectomy was the most common procedure and 92.1% of the patients had a D2-lymphadenectomy. Their 5-year overall survival was 57.7%. T-category, N-category, extended gastrectomy, and N-ratio were prognostic factors in overall and disease-free survival in accordance with univariate analysis. In accordance with TNM staging, N1 patients who have had NR1 had 5-year survival in 75.5% whereas in the NR2 group only 33% of the cases had 5-year survival. In the multivariate analysis, the interaction between N-category and N-ratio was an independent prognostic factor. CONCLUSION: Our findings confirmed the role of N-ratio as prognostic factor of survival in patients with gastric cancer surgically treated with at least 15 lymph nodes dissected. The relationship between N-category and N-ratio is a better predictor than lymph node metastasis staging.

Modified pharyngogastrostomy by a stapler technique.

Pharyngolaryngoesophagectomy is the gold standard treatment for the majority of larynx, pharynx and cervical esophagus advanced tumours. Reconstruction of these pharyngoesophageal defects is complex, and implicates additional time, morbity and mortality to the procedure. Gastric pull up and pharyngogastrostomy with hand sewing technique is the commonest way of doing it. The authors describe a modified technique to execute it using a stapler device.

Masas de tumores testiculares del síndrome adrenogenital: presentación de un caso / Testicular masses of adrenogenital syndrome: report of a case

Se presenta el caso de un paciente masculino de 19 años de edad que consultó por tumefacción testicular bilateral. El estudio ecográfico reveló formaciones nodulares sólidas, bilaterales. Se efectuó una orquiectomía bilateral. Macroscópicamente se observaron sendas formaciones tumorales de 4,8 y 4 cm de diámetro, sólidas de color marrón claro y bordes lobulados que reemplazaban casi totalmente el parénquima testicular. Se observaban, además pequeños nódulos a nivel del epidímo. Histológicamente las masas testiculares estaban constituídas por células de citoplasma amplio, granular, eosinófilo, con pigmento lipofucsínico intracitoplasmático y ausencia de cristaloides de Reinke con un grado variable de fibrosis interpuesta entre las mismas. Los hallazgos observados correspondían a las masas tumorales del síndrome adrenogenital el que fue confirmado por los datos clínicos y de laboratorio del paciente. El diágnostico de esta rara entidad permite un tratamiento adecuado. Desde el punto de vista morfológico en ausencia de datos clínicos, como en nuestro caso, es necesario hacer el diágnostico diferencial, con tumores de células de Leydig

Masas de tumores testiculares del síndrome adrenogenital: presentación de un caso / Testicular masses of adrenogenital syndrome: report of a case

Se presenta el caso de un paciente masculino de 19 años de edad que consultó por tumefacción testicular bilateral. El estudio ecográfico reveló formaciones nodulares sólidas, bilaterales. Se efectuó una orquiectomía bilateral. Macroscópicamente se observaron sendas formaciones tumorales de 4,8 y 4 cm de diámetro, sólidas de color marrón claro y bordes lobulados que reemplazaban casi totalmente el parénquima testicular. Se observaban, además pequeños nódulos a nivel del epidímo. Histológicamente las masas testiculares estaban constituídas por células de citoplasma amplio, granular, eosinófilo, con pigmento lipofucsínico intracitoplasmático y ausencia de cristaloides de Reinke con un grado variable de fibrosis interpuesta entre las mismas. Los hallazgos observados correspondían a las masas tumorales del síndrome adrenogenital el que fue confirmado por los datos clínicos y de laboratorio del paciente. El diágnostico de esta rara entidad permite un tratamiento adecuado. Desde el punto de vista morfológico en ausencia de datos clínicos, como en nuestro caso, es necesario hacer el diágnostico diferencial, con tumores de células de Leydig(AU)

[Correlation between specific prostatic antigen and findings with total body bone scintigraphy]. / Correlación entre el antígeno prostático específico (P.S.A.) y los hallazgos del centellograma óseo corporal total (COCT).

OBJECTIVES: To analyze the correlation between PSA values, bony symptoms and total body bone scintiscanning in order to determine the utility of the latter technique in patients with adenocarcinoma of the prostate. METHODS: We analyzed the correlation between the PSA values, bony symptoms and total body bone scintiscan findings of 191 patients with adenocarcinoma of the prostate; of these, 129 patients met the criteria for inclusion into the study. RESULTS: Of the 128 patients, 32 (25%) had PSA value < 20 ng/ml, 48 (37.5%) had values ranging from 20-50 ng/ml and 48 (37.5%) had values > 50 ng/ml. The bone scintiscan was positive in only one of the 32 patients with PSA < 20 ng/ml, 45.8% of those with PSA values between 20-50 ng/ml and 70.8% of those with PSA values > 50 ng/ml. All of the patients with PSA < 20 ng/ml and no bony symptoms had a negative bone scintiscan. All patients with PSA > 20 ng/ml and bony symptoms had a positive bone scintiscan. CONCLUSIONS: PSA is a biological marker that can effectively predict the scintiscan findings. The bone scintiscan was negative in 96.9% of the patients with PSA < 20 ng/ml. Total body bone scintiscanning can therefore be obviated in patients with PSA < 20 ng/ml and no bony symptoms, thereby reducing health costs without altering the benefits.

Dental noxious input reaches the subnucleus caudalis of the trigeminal complex in the rat, as shown by c-fos expression upon thermal or mechanical stimulation.

The first upper molar tooth was subject to noxious thermal or mechanical stimulation in anaesthetised rats. In some animals, the red-heated metal end of a dental filling instrument was placed upright, briefly, on the occlusal surface. In other rats, a fine explorer was introduced three times into the pulp through a drilling cavity. Brainstem and cervical cord of treated and control animals were immunoreacted for the Fos protein. Numerous Fos cells occurred in the dorsomedial part of the ipsilateral trigeminal subnucleus caudalis including the transition zone with the subnucleus interpolaris, and in lamina I at spinal segments C1-C2, but were lacking in more rostral trigeminal subdivisions. Findings support the exclusive processing of nociceptive dental input in the medullary and upper cervical dorsal horn.

Detection of lung abnormalities by auscultatory percussion: a comparative study with conventional percussion.

Auscultatory percussion is a new method of physical examination developed by Guarino [Lancet i: 1332-1334, 1980]. It consists in tapping lightly the manubrium sterni with the distal phalanx of the middle finger while listening over the chest wall posteriorly with a stethoscope; a decrease in sound intensity is usually attributed to lung abnormalities. The aim of our study was to assess the validity of the method as compared to classical percussion, a point not entirely clear in the original study. Two observers independently examined 281 unselected patients (170 men; 111 women) referred for chest X-ray studies. Roentgenographic analysis, carried out by a third observer, revealed 12 categories of abnormalities in 96 patients. The validity of auscultatory and conventional percussion was calculated by taking the product of sensitivity and specificity of each method. For both observers and both methods, the values of this index were always found to be below 0.25, indicating that the results can be explained entirely by chance. When the roentgenographic category was taken into account, both methods of percussion were valid only to detect large pleural effusions. Auscultatory percussion failed completely to detect many other abnormalities including solitary nodules less than 6 cm in diameter. There is no single hypothesis to explain these results. Various possibilities are discussed.

The treatment of uncomplicated urinary tract infections with mezlocillin.

Fourteen adult patients with uncomplicated urinary tract infections (UTI) caused by gram-negative and gram-positive bacteria were treated with 2 g mezlocillin daily by i. m. injection for an average of eight days. Clinical examinations were performed daily; bacteriological and laboratory controls (blood and urine) were made before and after treatment. The clinical results were very good in twelve patients, good in one and moderate in one. Bacteriological cure was obtained in twelve cases and a failure occurred in two. The local and general tolerance were excellent.