Neoplastic degeneration of chronic sacrococcygeal pilonidal sinus: report of seven cases and literature review.

INTRODUCTION: Neoplastic degeneration is an uncommon but extremely serious complication of pilonidal sinus (PS) disease. We pretend to determine the factors that influence in the prognosis of the neoplastic disease assessing clinical features and histological findings. MATERIALS AND METHODS: We retrospectively studied the patients diagnosed of malignization of PS in our institution from 2000 to 2019. RESULTS: Seven male patients with a mean age at diagnosis of 64.8 years old were collected. Average time between the initial symptoms of PS disease and the tumor diagnosis was 33.7 years. The patients presenting an ulcerative pattern in the primary tumor showed in all the cases perineural invasion, local deep structures infiltration, and neoplastic dissemination to the regional lymph nodes. All these patients died in an average time of 7 months. On the other hand, patients with exophytic patterns in the primary tumor did not present local invasion or regional nodes affectation. All the cases survive with an average follow-up of 70.5 months. CONCLUSIONS: Ulcerated lesions clearly show a worse prognosis than tumors with exophytic morphology. Factors as perineural infiltration, local deep structures infiltration, or regional lymph node involvement dramatically decrease survival rates.

OBJETIVO: La cancerificación es una complicación infrecuente pero grave de la enfermedad por sinus pilonidal. Intentaremos determinar los factores que influyen en el pronóstico de la enfermedad neoplásica basándonos en hallazgos clínicos e histopatológicos. MATERIAL Y MÉTODOS: retrospectivamente se revisan pacientes diagnosticados de malignización de sinus pilonidal en nuestra institución del 2000 a 2019. RESULTADOS: fueron recopilados los casos de siete varones con una media de edad al diagnóstico de 64.8 años. El promedio entre el inicio de los síntomas de sinus pilonidal y el diagnóstico del tumor fue de 33.7 años. Los pacientes con un patrón ulcerativo en el tumor primario presentaron todos invasión perineural, infiltración de estructuras profundas y diseminación a linfáticos regionales. Todos estos pacientes fallecieron en una media de 7 meses. Por el contrario, los pacientes que mostraban un patrón exofítico, no presentaron invasión local o afectación de los linfáticos regionales. Todos estos casos sobrevivieron, con una media de seguimiento de 70.5 meses. CONCLUSIONES: tumores primarios ulcerativos claramente presentan un peor pronóstico que los casos de morfología exofítica. Factores como la infiltración perineural, la invasión local de estructuras profundas o la afectación de los ganglios linfáticos regionales van ligados a una disminución dramática en la supervivencia.

Cyanoacrylate surgical glue for mesh fixation in laparoscopic total extraperitoneal hernia repair.

In an attempt to find the ideal surgical technique for mesh fixation during laparoscopic total extraperitoneal inguinal hernia repair, we evaluate the use of a synthetic surgical glue (N-butyl-cyanoacrylate-Glubran 2) in an effort to reduce postoperative pain and the complications associated with the use of staples. We have prospectively evaluated 61 consecutive patients (73 hernias) with a minimum follow-up period of 18 months and an average of 29.7 months, without any significant complications present. The majority (59%) only required low dosages of painkillers during the first 24 hours after surgery and have not experienced any cases of chronic pain or recurring hernias in the time period described. On the basis of this initial experience, the use of the surgical glue used to repair inguinal hernias with the laparoscopic total extraperitoneal technique has been proved to be a simple and effective surgical method for mesh fixation.

Respuesta de los autores: Cirugía laparoscópica del quiste hidatídico hepático / Authors’ reply: Laparoscopic surgery of hepatic hydatid cyst

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Tratamiento laparoscópico de los quistes hidatídicos hepáticos: técnicas y complicaciones postoperatorias / Laparoscopic treatment of hepatic hydatid cysts: techniques and post-operative complications

Introducción Análisis de nuestra experiencia en la intervención de quistes hidatídicos hepáticos mediante cirugía laparoscópica con criterios similares a los de la cirugía abierta. Material y métodos Estudio retrospectivo de 8 pacientes operados y de las complicaciones intraoperatorias y postoperatorias. Resultados En 7 pacientes se completó la intervención planificada por laparoscopia, en uno fue necesaria reconversión por hemorragia. Se realizaron 4 quistoperiquistectomías, 3 resecciones de cúpula saliente y 1 resección hepática. Dos pacientes sufrieron fístulas biliares: una de ellas (externa) necesitó una esfinterectomía endoscópica y la otra desarrolló un absceso que fue necesario reintervenir y drenar. En esta paciente se observó una trombosis de vena suprahepática derecha que se resolvió espontáneamente; 3 enfermos desarrollaron hipernatremia sin repercusión clínica. Conclusiones Muchas de las técnicas descritas en cirugía abierta son realizables por laparoscopia, sin necesidad de instrumentación específica para los quistes hidatídicos. Las complicaciones encontradas son similares a las de la cirugía abierta (AU)

Introduction We evaluate our experience in the surgical laparoscopic treatment of hepatic hydatid cysts with the same criteria that we use in open surgery. Material and methods A retrospective study of 8 operated patients and their intra- and postoperative complications. Results We performed the scheduled surgery on 7 patients; bleeding was the reason for conversion to open surgery in the remaining one. We made 4 complete peri-cystectomies, 3 de-roofing and 1 hepatic resection. Two patients had postoperative bile leaks: the first one had an external leak that needed an endoscopic sphincterotomy and the other developed an abscess that needed reintervention for drainage. This patient also had a right hepatic vein thrombosis that disappeared spontaneously. Finally, 3 patients had hypernatremia without clinical symptoms. Conclusions Many of the open surgery techniques for hepatic hydatid cysts can be performed laparoscopically, without any specific instruments. Our complications with laparoscopic treatment of hepatic hydatid cysts were similar to those of open surgery(AU)

[Laparoscopic treatment of hepatic hydatid cysts: techniques and post-operative complications]. / Tratamiento laparoscópico de los quistes hidatídicos hepáticos: técnicas y complicaciones postoperatorias.

INTRODUCTION: We evaluate our experience in the surgical laparoscopic treatment of hepatic hydatid cysts with the same criteria that we use in open surgery. MATERIAL AND METHODS: A retrospective study of 8 operated patients and their intra- and postoperative complications. RESULTS: We performed the scheduled surgery on 7 patients; bleeding was the reason for conversion to open surgery in the remaining one. We made 4 complete peri-cystectomies, 3 de-roofing and 1 hepatic resection. Two patients had postoperative bile leaks: the first one had an external leak that needed an endoscopic sphincterotomy and the other developed an abscess that needed reintervention for drainage. This patient also had a right hepatic vein thrombosis that disappeared spontaneously. Finally, 3 patients had hypernatremia without clinical symptoms. CONCLUSIONS: Many of the open surgery techniques for hepatic hydatid cysts can be performed laparoscopically, without any specific instruments. Our complications with laparoscopic treatment of hepatic hydatid cysts were similar to those of open surgery.

Effects of nefazodone on the development of experimentally induced tumors in stressed rodents.

RATIONALE: Anxiety and depression are commonly encountered in patients with cancer and constitute risk and prognostic factors for the disease. Although previous findings do not support an overall association between the use of antidepressants and higher prevalence of cancer, results for serotonin uptake inhibitors are not entirely reassuring. OBJECTIVES: We evaluated the effects of nefazodone, a serotonin and norepinephrine (NE) reuptake inhibitor and 5-HT(2A) receptor antagonist antidepressant, on the appearance of breast cancer induced by mammary tumor virus (MTV) in mice, and on the development of lung metastases in rats injected intravenously with Walker 256 (W-256) carcinosarcoma cells. METHODS: Female C3H/He mice carrying the MTV were monitored for mammary tumor incidence and latent periods while being treated with a daily intraperitoneal injection with placebo or nefazodone. Rats were administered 10(4) W-256 cells, exposed to a chronic auditory stressor for 8 days, and then killed to evaluate metastatic nodules in the lungs. RESULTS: Although all of the mice were potential candidates for MTV-induced breast cancer, those treated with nefazodone were partially protected against adverse effects of stress induced by the daily administration of placebo on both parameters. Relative to placebo, nefazodone reduced the stress-induced increase in the number and percentage area of metastases in the frontal section through pulmonary hilus and increased the survival periods of rats given W-256 cells and exposed to a chronic auditory stressor. CONCLUSIONS: Our results provide evidence of the beneficial effects of nefazodone against the adverse effects of stress on tumor development and metastaticity in rodents, but did not show significant effects in unstressed rodents.

Administration of the 5-hydroxytryptamine(1A) receptor antagonist WAY100635 suppresses acute experimental allergic encephalomyelitis in Lewis rats.

Experimental allergic encephalomyelitis (EAE) is a T-cell inflammatory disease of the central nervous system (CNS) widely considered as an animal model of multiple sclerosis. In Lewis rats, myelin basic protein-complete Freund's adjuvant (MBP-CFA)-induced EAE is an acute monophasic disease from which animals recover fully. In our experiments, daily treatment (since day 1 after MBP-CFA inoculation) with the 5-hydroxytryptamine((1A)) (5-HT(1A)) receptor agonist (R)-(+)-8-hydroxy-2-(Dipropylamino)-tetralin (R(+)-8-OH-DPAT) resulted in a dose-related enhancement of neurological and histological signs in EAE-induced rats. This effect of R(+)-8-OH-DPAT was reduced by the co-administration of the 5-HT(1A) receptor antagonist (N-[2-(4-[2-mehoxyphenil]-1-piperazinyl)-ethyl]-N-2-pyridinylcyclohexanecarboxamide (WAY100635) at the peak of the acute disease. Moreover, treatment with WAY100635 since inoculation resulted in a delayed onset of the first clinical signs, milder disease and earlier regression of neurological signs along with a decrease in inflammation in the CNS.