The impact of obesity on surgery in gynecological oncology: a review.

Surgery represents a mainstay in the treatment of gynecological cancers. It is a common belief that operating on obese patients causes more peri- and postoperative complications than operating on nonobese patients. The surgical outcome in gynecological oncology can be evaluated by comparing intra- and postoperative complications, extent of lymphadenectomy, negativity of the specimens' margins, and percentage of optimal debulking between obese and nonobese patients affected by malignancies at the same stage. In this review, we analyze how obesity affects the feasibility of a correct oncologic procedure in case of cervical, endometrial, and ovarian cancer. We also describe the techniques that have been suggested in the literature to improve the surgical outcome on obese patients.

Differential expression and cellular localization of ERKs during organogenic nodule formation from internodes of Humulus lupulus var. Nugget.

The expression and subcellular localization of extracellular signal-regulated kinase 1 or 2 (ERK1/2) homologues (HLERK1/2) during the process of organogenic nodule formation in Humulus lupulus var. Nugget was studied using antibodies specific for ERK1 and ERK2, and for phosphorylated mitogen-activated protein kinases (MAPKs). The increase in HLERK levels, detected by Western blotting 12 hours after wounding suggests their involvement in response to the wounding treatment applied for morphogenesis induction. In dividing cambial cells, occurring in between 4 and 7 days after morphogenesis induction, as well as in dividing prenodular cells (15 days after induction) HLERK1 and/or 2 were localized in the nucleus. However, as soon as nodular cells start proliferating to form shoot meristems, HLERK1 and 2 were detected in the cytoplasm and not in the nucleus. The data reported account for a differential expression and activation of HLERK1 and HLERK2 throughout the process of nodule formation and plantlet regeneration. HLERK1 appears to be expressed in the stages of nodule formation and plantlet regeneration, playing a possible role in controlling cell proliferation and differentiation. HLERK2 may be induced as a response to reactive oxygen species (ROS) generated by wounding of internodes as its expression is reduced in liquid medium with less oxygen availability compared to solid medium. However, addition of a ROS inhibitor to the liquid medium does not result in a further decrease in the HLERK2 level.

Radical hysterectomy for cervical cancer: hysterectomy before pelvic lymphadenectomy or vice versa?

The technique for radical abdominal hysterectomy (RAH) and lymphadenectomy (LND) for patients with cervical cancer has been well described. Whether RAH should be performed before or after pelvic lymph node dissection (PLND) is a controversial issue. This study compared the two procedures performed at the same institution. Patients treated with type III RAH for cervical cancer stage IB-IIA at our institution between 1987 and 1995 were included in this study. Only patients who underwent para-aortic lymph node dissection (PALND) first, followed by PLND and then RAH (Group A) or RAH and then PLND (Group B) were included. Clinical and surgical information including intraoperative and postoperative complications was collected. Operative reports were used to identify the patients who had RAH performed before PLND or vice versa. Data analysis was obtained using unpaired t-test with significance set at P < 0.05. Complete information was obtained for 314 patients. The results of Group A (157 patients) and Group B (157 patients) were as follows: mean age = 45.3 and 44.8 (P = 0.73); mean weight = 149 and 149 lb.; mean length of stay = 10 and 8 days (P < 0.0001); mean operative time = 230 and 172 mins (P = 0.004); mean estimated blood loss (EBL) = 1,238 and 1098 cc (P = 0.21); mean number of PALN removed = 7 and 6 (P = 0.06); mean number of PLN removed = 28 and 26 (P = 0.24). No statistical difference in major intraoperative and postoperative complications was observed. The most common complication was postoperative fever (53/157 in Group A and 49/157 in Group B). Radical hysterectomy can be safely performed either before or after PLND. The number of pelvic lymph nodes removed, as well as the EBL and the intraoperative complications are similar and are not affected by the operative time. The surgeon should decide the sequence of the procedures accordingly to his/her personal preference.

Revisión retrospectiva de la prevalencia del virus de la hepatitis B (VHB) en varios grupos de población / Retrospective review of prevalence of hepatitis B virus in several groups of individuals

Nine different groups of individuals studied from 1969 to 1985 were tested for Hepatitis B Virus (HBV) markers. In 8 groups only HBsAg in serum was tested, in another group: tissular HBsAg, and in two of those groups: serum HBsAg, anti-HBs and anti-HBc. Mean HBsAg prevalence in groups similar to general population was 0.64%; 5% in cirrhotics; HBV prevalence in haemophiliacs was 18.87% by testing serum for HBsAg and anti-HBs; serum HBsAg prevalence in Viral Chronic Active Hepatitis was 43.24%; and Hepatocellular Cancer (HCC) group had a prevalence for HBV of 13.04% when only tissular HBsAg was tested, and 54.29% when serum HBsAg, anti-HBs and anti-HBc were tested in all patients. Costa Rica has a low HBV markers prevalence only similar to what is found in industrial developed countries

Descripción epidemiológica de las hepatitis virales en Costa Rica entre 1979 y 1983 / Description of the viral hepatitis in Costa Rica, since 1979 to 1983

Entre enero de 1979 y diciembre de 1983 hubo 14.167 hepatitis virales (HV) en Costa Rica, reportadas al Departamento de Vigilancia Epidemiológica del Ministerio de Salud. Se distribuyeron similarmente entre hombres (1,08) y mujeres (1). El 72,6 por ciento se presentó en menores de 15 años y en los meses de vacaciones escolares hubo menos casos, para aumentar al inicio de las lecciones en marzo y continuar haciéndolo hasta el mes de agosto. La Región Brunca es donde porcentualmente hubo más HV en adultos y por ende, probablemente más hepatitis por virus B (HVB). La tasa de incidencia x/100.000 h (Ti x/100.000 h) para el quinquenio estudiando fue de 113,39 y el cantón con mayor Ti/100.000 h=360,72, fue Coto Brus. La mayoría de los cantones de alta incidencia tienen mala calidad del agua potable y se localizan en la falda sur de la Cordillera Central, al norte y noroeste del Cantón Central de Heredia. A nivel nacional, la enfermedad ha hecho picos epidémicos cada 5 años desde 1971. El de 1982 ha sido el de mayor magnitud, quizá en relación con el deterioro económico del país a partir de 1980. (Rev. Cost. Cienc. Méd. 1989; 10(1): 11-21)

Cirrosis biliar primaria (colangitis crónica destructiva no supurativa) / Primary biliar cirrosis (non-suppurative destructive chronic cholangitis)

Se presenta cuatro casos de pacientes con evidencia clinica, bioquimica e histologica de Cirrosis biliar primaria. Dos de los casos se asociaron con el sindrome de CREST, uno con el sindrome de sjogren y el cuarto tenia una historia de ingesta de anticonceptivos orales. Tres de los casos tuvieron un titulo de anticuerpos antimitocondria mayor o igual a 1: 40 diluciones y los niveles de lgM son normales en todos los casos. Tres pacientes tienen una edad superior a la del caso de mayor edad reportado en la literatura, apesar de que la biopsia hepatica mostro estadios iniciales de la enfermedad en todos ellos