The Histopathological Growth Pattern of Colorectal Liver Metastases Impacts Local Recurrence Risk and the Adequate Width of the Surgical Margin.

BACKGROUND: The histopathological growth pattern (HGP) of colorectal liver metastases (CLM) has been associated with prognosis. This study was designed to elucidate if the HGP is associated with local recurrence risk and impacts the adequate width of surgical margin. METHODS: All consecutive patients resected for CLM in 2018-2019 were considered. HGP was prospectively classified as follows: desmoplastic, pushing, and replacement. Surgical margin was classified as follows: R0 (margin ≥ 1 mm), R1vasc (0-mm margin, tumor detachment from intrahepatic vessels), and R1par (tumor exposure along transection plane). R0 resections were further distinguished in R0min (1-mm margin) and R0wide (> 1-mm margin). RESULTS: A total of 340 resection areas in 136 patients were analyzed (70 R0min, 143 R0wide, 31 R1vasc, 96 R1par). HGP was desmoplastic in 26 cases, pushing in 221, and replacement in 93. Thirty-six local recurrences occurred (11%, median follow-up 21 months): 1 after R0wide, 4 after R0min, 3 after R1vasc, and 28 after R1par resection. In R1par group, local recurrence rate was high independently of HGP (29%). In R1vasc and R0min groups, local recurrence risk was higher in the replacement group (R1vasc: 29% vs. 4% if pushing/desmoplastic; R0min: 11% vs. 4%). In R0wide group, local recurrence risk was low for all HGP ( < 1%). Independent predictors of local recurrence were replacement HGP (odds ratio = 1.654, P = 0.036), and R1par resection (odds ratio = 57.209, P < 0.001 vs. R0). CONCLUSIONS: Replacement HGP is associated with an increased risk of local recurrence. In these patients, a wide surgical margin should be pursued, because R1vasc and R0min resections could be insufficient. R1par resection is inadequate, independently of the HGP.

Organ targeted mini-invasive approach in the treatment of colorectal cancer liver metastases: role of intraoperative ultrasonography as guidance in liver resection.

Surgery is still considered the gold standard therapy for patient carries of colorectal liver metastases (CLM) because related to more chance of long-term survival. The major limitation of surgical approach is its technical feasibility because of the inability to completely clear the metastatic disease in a single operation while preserving enough future liver remnant. Thus, the two-stage hepatectomy is generally recommended for these patients. We have shown how with an extensive use of intraoperative ultrasonography based on strict criteria is possible performing curative resection in a single stage despite complex tumor presentation as in multifocal and bilateral spread. This strategy aims to keep the liver skeleton although allowing the radical tumor clearance: as consequence it is minimized the need for a multistep surgical strategy, and is enhanced the feasibility of repeated hepatectomies in the event of recurrent disease.

Intraoperative ultrasonographic detection of communicating veins between adjacent hepatic veins during hepatectomy for tumours at the hepatocaval confluence.

BACKGROUND: The presence of communicating veins between adjacent hepatic veins may allow parenchyma-sparing hepatectomy. Taking advantage of improvements in ultrasound technology, such as e-flow modality, a study of the presence of communicating veins was conducted in patients with hepatic tumours at the caval confluence. METHODS: Consecutive patients undergoing surgery between October 2007 and December 2009 for hepatic tumours in contact with or invading a hepatic vein at its caval confluence were included. Communicating vein mapping by means of e-flow intraoperative ultrasonography (EF-IOUS) was carried out. RESULTS: A total of 20 patients were enrolled. Communicating veins between adjacent hepatic veins or with the inferior vena cava were detected in 16 patients. The median number of communicating veins was 1 (range 0-5). The total number of lesions removed was 126 (range 1-46). In 11 of 12 patients requiring resection of a hepatic vein, communicating veins enabled a parenchyma-sparing procedure to be performed. No patient had a formal major hepatectomy. There was no postoperative mortality or major morbidity. CONCLUSION: EF-IOUS estimation of the frequency of communicating veins between adjacent hepatic veins suggests that such veins are common. This may facilitate parenchyma-sparing procedures in patients with hepatic tumours encroaching on major hepatic veins.

Isolated hemihyperplasia (hemihypertrophy): report of a prospective multicenter study of the incidence of neoplasia and review.

Hemihyperplasia is characterized by asymmetric growth of cranium, face, trunk, limbs, and/or digits, with or without visceral involvement. It may be an isolated finding in an otherwise normal individual, or it may occur in several syndromes. Although isolated hemihyperplasia (IHH) is of unknown cause, it may represent one end of the clinical spectrum of the Wiedemann-Beckwith syndrome (WBS). Uniparental paternal disomy of 11p15.5 or altered expression of insulin-like growth factor 2 (IGF2) from the normally silent maternal allele have been implicated as causes of some cases of WBS. IHH and other mild manifestations of WBS may represent patchy overexpression of the IGF2 gene following defective imprinting in a mosaic fashion. The natural history of IHH varies markedly. An association among many overgrowth syndromes and a predisposition to neoplasia is well recognized. Heretofore the risk for tumor development in children with IHH was unknown. We report on the results of a prospective multicenter clinical study of the incidence and nature of neoplasia in children evaluated because of IHH. One hundred sixty-eight patients were ascertained. A total of 10 tumors developed in nine patients, for an overall incidence of 5.9%. Tumors were of embryonal origin (similar to those noted in other overgrowth disorders), including Wilms tumor, hepatoblastoma, adrenal cell carcinoma, and leiomyosarcoma of the small bowel in one case. These data support a tumor surveillance protocol for children with IHH similar to that performed in other syndromes associated with overgrowth.

Fatigue effects in daily life activities of kidney transplant recipients.

After undergoing kidney transplantation, some patients still face one symptom that continues after the dialysis sessions: fatigue (physical and mental tiredness that does not get better after resting). Fatigue effects in the everyday lives of kidney transplant patients can be beneficially modified early by changing this scenario. This is a quantitative study about the intensity and impacts of fatigue in kidney transplant patients admitted to the Hypertension and Kidney Hospital from October 2011 to March 2012. The fatigue pictogram was used to evaluate the level of fatigue interference in the daily life activities of kidney transplant patients. The sample consists of 39 patients, and was developed in 2 phases: data collection and attendance after and before the transplantation until hospital discharge. Descriptive statistical analyses were used. In the group at issue, we have noticed the following profile of the sample: 84.3% of transplantations with live donors, most were men, average age 36.5 years old, average hospitalization time 11.1 days, average time of renal failure 66.4 months, systemic arterial hypertension prevalence 66.7%, and the prevalence of at least 1.8 diseases in each individual. The self-referred causes of chronic renal failure were uncontrolled systemic arterial hypertension, glomerulonephritis, and overuse of anti-inflammatory drugs, among others. The study shows that fatigue is directly related to the level of activities of daily living, causing less ability to perform activities in the higher level of fatigue, which is in the immediate postoperative period and only settling fully on the 9th postoperative day.

Effects of combining extracts (from propolis or Zingiber officinale) with clarithromycin on Helicobacter pylori.

Propolis and Zingiber officinale have been shown to be specifically targeted against Helicobacter pylori strains, to possess antiinflammatory, antioxidant and antitumoral activity and to be used in traditional medicine for the treatment of gastrointestinal ailments. Considering that these natural products could potentially serve as novel therapeutic tools also in combination with an antibiotic, the aim of this work was to evaluate their effect when combined with clarithromycin on clinical H. pylori isolates (n = 25), characterized in respect to both clarithromycin susceptibility and the presence of the cagA gene. The results showed that the combinations of propolis extract + clarithromycin and Z. officinale extract + clarithromycin exhibited improved inhibition of H. pylori with synergistic or additive activity. Interestingly, the susceptibility to combinations was significantly independent of the microbial clarithromycin susceptibility status. Only one H. pylori strain showed antagonism towards the Z. officinale extract + clarithromycin combination. The data demonstrate that combinations of propolis extract + clarithromycin and Z. officinale extract + clarithromycin have the potential to help control H. pylori-associated gastroduodenal disease.

MHC immunoevasins: protecting the pathogen reservoir in infection.

Alteration of antigen recognition by T cells as result of insufficient major histocompatibility complex (MHC)-dependent antigen-presenting function has been observed in many cases of infections, particularly in in vitro systems. To hide themselves from an efficient immune response, pathogens may act on MHC-related functions at three levels: (i) by limiting the number of potential antigens that can be presented to naïve T cells; (ii) by synthesizing proteins which directly affect MHC cell-surface expression; and (iii) by altering the normal intracellular pathway of peptide loading on MHC. Here, we review examples of pathogens' action on each single step of MHC function and we suggest that the result of these often synergistic actions is both a limitation of the priming of naïve T cells and, more importantly, a protection of the pathogen's reservoir from the attack of primed T cells. The above mechanisms may also generate a skewing effect on immune effector mechanisms, which helps preserving the reservoir of infection from sterilization by the immune system.

Ehrlichiosis infection in a 5-year-old boy with neutropenia, anemia, thrombocytopenia, and hepatosplenomegaly.

Ehrlichiosis should be considered in the differential diagnosis of any patient with recent fever, pancytopenia, hepatosplenomegaly, and history of tick exposure. We present a previously healthy 5-year-old boy who was referred to the Hematology-Oncology Clinic to consider a bone marrow etiologic process after his pediatrician discovered progressive neutropenia, anemia, thrombocytopenia, and hepatosplenomegaly accompanied by 2 days of fever. Bone marrow aspirate and biopsy were nonrevealing. Because of the history of a recent tick bite, a diagnosis of ehrlichiosis infection was considered and ultimately confirmed by IgG-specific serum testing. The patient's fever was treated symptomatically with acetaminophen, and symptoms resolved on their own without intervention. Ehrlichiosis is a tick-borne infection that occurs throughout the spring and summer, often causing findings that mimic a malignancy or serious hematologic disorder. The diagnosis should be considered in any person living in tick-infested areas and can be confirmed by polymerase chain reaction or serum antibody titers. Treatment with doxycycline can lead to rapid clinical improvement if the diagnosis is made early.

Modifications of hydrophobicity, in vitro adherence and cellular aggregation of Streptococcus mutans by Helichrysum italicum extract.

AIMS: The purpose of the present study was to examine whether sublethal concentrations of Helichrysum italicum extract could affect some of the cariogenic properties of Streptococcus mutans. METHODS AND RESULTS: We studied the antibacterial activity of H. italicum (ethanolic extract) against oral streptococci (Strep. mutans ATCC 35668, Strep. salivarius ATCC 13419 and Strep. sanguis ATCC 10556) and its influence on cell-surface hydrophobicity, in vitro sucrose-dependent adherence to glass surface and cellular aggregation of Strep. mutans. The results indicate that all streptococci were susceptible to ethanolic extract with minimum inhibitory concentration (MIC) values of 31.25-62.50 microg x ml(-1). Sub-MIC concentrations of H. italicum (7.81-31.25 microg x ml(-1)) reduced the hydrophobicity and the adherence (almost 90%) to glass surface of Strep. mutans. The aggregation in the presence of dextran T2000 was also affected. CONCLUSION: The inhibitory activity of H. italicum extract on Strep. mutans is worthy of further study. SIGNIFICANCE AND IMPACT OF THE STUDY: There is considerable interest in the use of natural compounds as alternative methods to control undesirable micro-organisms.

Helichrysum italicum extract interferes with the production of enterotoxins by Staphylococcus aureus.

AIMS: The purpose of this work was to evaluate the effect of Helichrysum italicum extract on enterotoxin (A-D) production by Staphylococcus aureus strains. METHODS AND RESULTS: The production of enterotoxins A-D in the presence or absence of H.italicum diethyl ether extract was estimated in microtiter plates using a reversed passive latex agglutination (SET-RPLA) kit (Oxoid, Basingstoke, UK). The results indicate that, in culture medium, inhibition of staphylococcal growth and enterotoxins appeared with 250-125 microg ml(-1) of the extract. Lower concentrations of the extract (62.5-31.25 microg ml(-1)) did not affect the final viable count of Staph. aureus but reduced the production of enterotoxins B and C. CONCLUSIONS: H. italicum interferes with growth and production of enterotoxins by Staph. aureus. SIGNIFICANCE AND IMPACT OF THE STUDY: There is considerable interest in the use of natural compounds as alternative methods to control undesirable pathogenic micro-organisms.

Capitulo 6. Reflexões acerca do mundo cultural e do comportamento reprodutivo dos Kamaiurá ontem e hoje / Reflections concerning the cultural world and of the reproductive behavior of the Kamaiurá yesterday and today

Este capítulo encontra-se estruturado em duas partes. Na primeira está reproduzido o texto original de Camargo e Junqueira. Optou-se por mantê-lo na forma concebida à época em que foi escrito, inclusive no tocante à bibliografia utilizada. Na segunda parte, são apresentadas por Junqueira e Pagliaro breves análises com base em dados coletados em uma viagem recente (2003). Menos do que produzir uma análise detalhada, o intuito dessa revisita aos Kamaiurá foi o de fornecer um retrato recente, três décadas depois, de algumas mudanças culturais e demográficas.