Starting a peritoneal carcinomatosis treatment program in a developing country: A prospective analysis.

BACKGROUND: Cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) has become a valuable treatment strategy for selected patients with peritoneal carcinomatosis (PC). In Chile, it is an emerging technique. The aim of this study is to describe our protocol and report our perioperative results. METHODS: A prospectively maintained database for patients undergoing exploratory surgery for PC was reviewed. Eligible patients were selected using the peritoneal cancer index in correlation with the primary tumor. Patients underwent HIPEC using mitomycin C. Clinical data and postoperative results were analyzed. RESULTS: Seventy-six patients underwent exploratory surgery. Most patients were female (55%) with a median age of 62 years (range, 25-83). Complete CRS and HIPEC were achieved in 53 patients. The most frequent primary tumor site was colon-rectum (49%). The median number of resected organs was 4 (range, 1-13). Overall 90-day incidence of major complications was 26%. After a median follow-up of 26 months, 44 patients (83%) in the resected group were alive with no evidence of disease. CONCLUSIONS: The PC treatment program at our institution has been established in a safe manner, with acceptable morbidity comparable to high-volume centers. A comprehensive preoperative evaluation, careful patient selection, and a cohesive team are necessary for successful results.

[Gastric intramural pseudocyst in a heterotopic pancreas causing gastric outlet obstruction. Report of one case]. / Pseudoquiste pancreático intramural gástrico en páncreas heterotópico, una causa infrecuente de retención gástrica. Caso clínico.

Heterotopic pancreas is a silent gastrointestinal malformation that may become clinically evident when complicated by inflammation and pseudocyst formation. We report a 26 year-old male presenting with vomiting, pain and abdominal distention. An abdominal CT scan showed an important gastric distention secondary to a 4-cm cystic lesion located in the antrum wall. An endosonography showed that the lesion obstructed the gastric outlet and was compatible with a pseudocyst. A cysto-gastrostomy was performed draining the cyst. Its high lipase and amylase content confirmed that it was a pancreatic pseudocyst. Six months later, the lesion appeared again and a subtotal gastrectomy was performed Histopathology confirmed ectopic pancreatic tissue.

[Spontaneous splenic rupture secondary to infectious mononucleosis]. / Rotura esplénica espontánea secundaria a mononucleosis infecciosa.

Splenic rupture is a rare but potentially fatal complication of infectious mononucleosis. We report the case of an 18-year-old woman, who presented a 7-day history of abdominal pain, sudden temporary loss of consciousness and fever. Admission blood tests showed anemia, and lymphocytosis. Computed tomography of the abdomen and pelvis demonstrated extensive hemoperitoneum and numerous cervical, mesenteric and inguinal enlarged lymph nodes. Laparoscopy was performed and abundant hemoperitoneum with blood clots along the left parietocolic gutter were observed. The spleen was completely decapsulated and surrounded by a hematoma and the subcapsular tissue was bleeding. Total splenectomy was performed without complications. Splenic histology demonstrated white pulp attenuation and expansion of the red pulp with focal hemorrhage and necrosis. IgM anti-viral capsid antigen of Epstein Barr virus was positive. The patient had a satisfactory recovery.

Total neoadjuvant chemotherapy with FLOT scheme in resectable adenocarcinoma of the gastro-oesophageal junction or gastric adenocarcinoma: impact on pathological complete response and safety.

BACKGROUND: Gastric cancer is the fifth cause of cancer incidence worldwide. Multidisciplinary approaches that improve the survival are needed. Perioperative chemotherapies show improvement in pathological complete remission (pCR) and overall survival (OS), but less than 50% of the patients completed the chemotherapeutic regimen. The recent 5-fluorouracil, leucovorin, oxaliplatin, docetaxel-4 (FLOT4) study shows OS 50 months and pCR 16.6%, but only 46% of the patients completed pre- and postoperative treatment. This case series report evaluated pCR and safety in patients that received complete preoperative chemotherapeutic with FLOT. METHODS: Patients received eight cycles FLOT regimen before surgery. Each cycle comprised 50 mg/m2 docetaxel intravenous (iv) on day 1, 85 mg/m2 oxaliplatin iv on day 1, 200 mg/m2 leucovorin iv on day 1 and 2,600 mg/m2 5-fluorouracil iv in a 24-hour infusion on day 1, every 2 weeks. RESULTS: Fifty-nine patients were evaluated, 58 patients received preoperative cycles. Thirty-one patients received all eight cycles of preoperative therapy. 65.5% patients presented any major adverse event. Thirty-nine patients underwent surgery. Thirty-three biopsy reports were obtained. Six patients (18.2%) presented pCR, 13 patients (39.4%) had no lymph node involvement. OS was 21.32 months. Patients with histology of signet ring carcinoma cells had a shorter survival than other histologies. CONCLUSION: Total neoadjuvant with FLOT chemotherapy presents an adequate safety profile, a similar pathologic regression rate, and a slightly higher rate of completing treatment to report in perioperative FLOT regimen studies. A prospective clinical study with suitable diagnostic, staging tools and an adequate follow-up may prove total neoadjuvant chemotherapy's efficacy.

The Impact of COVID-19 Management Policies Tailored to Airborne SARS-CoV-2 Transmission: Policy Analysis.

BACKGROUND: Daily new COVID-19 cases from January to April 2020 demonstrate varying patterns of SARS-CoV-2 transmission across different geographical regions. Constant infection rates were observed in some countries, whereas China and South Korea had a very low number of daily new cases. In fact, China and South Korea successfully and quickly flattened their COVID-19 curve. To understand why this was the case, this paper investigated possible aerosol-forming patterns in the atmosphere and their relationship to the policy measures adopted by select countries. OBJECTIVE: The main research objective was to compare the outcomes of policies adopted by countries between January and April 2020. Policies included physical distancing measures that in some cases were associated with mask use and city disinfection. We investigated whether the type of social distancing framework adopted by some countries (ie, without mask use and city disinfection) led to the continual dissemination of SARS-CoV-2 (daily new cases) in the community during the study period. METHODS: We examined the policies used as a preventive framework for virus community transmission in some countries and compared them to the policies adopted by China and South Korea. Countries that used a policy of social distancing by 1-2 m were divided into two groups. The first group consisted of countries that implemented social distancing (1-2 m) only, and the second comprised China and South Korea, which implemented distancing with additional transmission/isolation measures using masks and city disinfection. Global daily case maps from Johns Hopkins University were used to provide time-series data for the analysis. RESULTS: The results showed that virus transmission was reduced due to policies affecting SARS-CoV-2 propagation over time. Remarkably, China and South Korea obtained substantially better results than other countries at the beginning of the epidemic due to their adoption of social distancing (1-2 m) with the additional use of masks and sanitization (city disinfection). These measures proved to be effective due to the atmosphere carrier potential of SARS-CoV-2 transmission. CONCLUSIONS: Our findings confirm that social distancing by 1-2 m with mask use and city disinfection yields positive outcomes. These strategies should be incorporated into prevention and control policies and be adopted both globally and by individuals as a method to fight the COVID-19 pandemic.

Correction: The Impact of COVID-19 Management Policies Tailored to Airborne SARS-CoV-2 Transmission: Policy Analysis.

[This corrects the article DOI: 10.2196/20699.].

Clinical pharmacology and therapeutic use of antioxidant vitamins.

The clinical use of antioxidants has gained considerable interest during the last decade. It was suggested from epidemiological studies that diets high in fruits and vegetables might help decrease the risk of cardiovascular disease. Therefore, supplements of vitamins C and E were applied through protocols aimed to prevent diseases such as atherosclerosis, preeclampsia or hypertension, thought to be mediated by oxidative stress. Despite the biological properties of these vitamins could account for an effective protection, as shown by several clinical and experimental studies, their efficacy remains controversial in the light of some recent clinical trials and meta-analyses. However, the methodology of these studies, criteria for selection of patients, the uncertain extent of progression of the disease when initiating supplementation, the lack of mechanistic studies containing basic scientific aspects, such as the bioavailability, pharmacokinetic properties, and the nature of the antioxidant sources of vitamins, could account for the inconsistency of the various clinical trials and meta-analyses assessing the efficacy of these vitamins to prevent human diseases. This review presents a survey of the clinical use of antioxidant vitamins E and C, proposing study models based on the biological effects of these compounds likely to counteract the pathophysiological mechanisms able to explain the structural and functional organ damage.

Rotura esplénica espontánea secundaria a mononucleosis infecciosa / Spontaneous splenic rupture secondary to infectious mononucleosis

Resumen La rotura esplénica es una complicación rara pero potencialmente fatal de la mononucleosis infecciosa. Presentamos el caso de una mujer de 18 años que consultó por dolor abdominal de siete días de evolución, asociado a fiebre y pérdida de conciencia brusca y transitoria. En el hemograma presentaba una anemia y linfocitosis. Se realizó una tomografía computada de abdomen y pelvis que mostró un extenso hemoperitoneo, con el bazo rodeado por un hematoma, y numerosas adenopatías cervicales, mesentéricas e inguinales. Se efectuó una laparoscopía que demostró abundante hemoperitoneo con coágulos a lo largo de la gotera parietocólica izquierda. El bazo estaba completamente decapsulado y rodeado por una colección hemática con sangrado en napa. Se realizó una esplenectomía total sin complicaciones. El estudio histopatológico esplénico mostró una atenuación de la pulpa blanca y expansión de la pulpa roja con áreas de hemorragia y necrosis. La IgM anti-cápside para virus de Epstein Barr fue positiva. La paciente evolucionó de manera favorable.

Abstract Splenic rupture is a rare but potentially fatal complication of infectious mononucleosis. We report the case of an 18-year-old woman, who presented a 7-day history of abdominal pain, sudden temporary loss of consciousness and fever. Admission blood tests showed anemia, and lymphocytosis. Computed tomography of the abdomen and pelvis demonstrated extensive hemoperitoneum and numerous cervical, mesenteric and inguinal enlarged lymph nodes. Laparoscopy was performed and abundant hemoperitoneum with blood clots along the left parietocolic gutter were observed. The spleen was completely decapsulated and surrounded by a hematoma and the subcapsular tissue was bleeding. Total splenectomy was performed without complications. Splenic histology demonstrated white pulp attenuation and expansion of the red pulp with focal hemorrhage and necrosis. IgM anti-viral capsid antigen of Epstein Barr virus was positive. The patient had a satisfactory recovery.

Pseudoquiste pancreático intramural gástrico en páncreas heterotópico, una causa infrecuente de retención gástrica: caso clínico / Gastric intramural pseudocyst in a heterotopic pancreas causing gastric outlet obstruction: report of one case

Heterotopic pancreas is a silent gastrointestinal malformation that may become clinically evident when complicated by inflammation and pseudocyst formation. We report a 26 year-old male presenting with vomiting, pain and abdominal distention. An abdominal CT scan showed an important gastric distention secondary to a 4-cm cystic lesion located in the antrum wall. An endosonography showed that the lesion obstructed the gastric outlet and was compatible with a pseudocyst. A cysto-gastrostomy was performed draining the cyst. Its high lipase and amylase content confirmed that it was a pancreatic pseudocyst. Six months later, the lesion appeared again and a subtotal gastrectomy was performed Histopathology confirmed ectopic pancreatic tissue.

Os limbos felizes da não-identidade: tensões e implicações / The happy limbo of non-identity: tensions and implications / El limbo feliz de la no-identidad: tensiones y consecuencias / Les limbes heureux de non-identité: tensions et implications

Esse artigo compõe-se de reflexões a respeito de conceitos, teorias, epistemologias e políticas identitárias. O objetivo é o de tencionar em tais políticas o uso da concepção de identidade, partindo de nossas inserções/implicações acadêmicas, políticas e afetivas. Para tanto, servimo-nos de narrativas e cenas analisadoras que experienciamos em alguns pontos de nossos per-cursos acadêmicos, profissionais e militantes dentro do movimento de lésbicas, gays, bissexuais e transgêneros (LGBT) bem como na luta antimanicomial. Nesses espaços, a concepção de identidade costuma ser usada como possuindo o que se pode denominar de "produtividade polí-tica". Para nós, é importante por em análise o primado da identidade enquanto ferramenta de pensamento, de produção de conhecimento e de luta política. Quando essa palavra é utilizada, quais enunciados a fazem possível? Quando se opera com o conceito de identidade, ou mesmo o de identificação, quais limites se impõem, quais engessamentos, quais capturas se produzem? Perguntamo-nos se as identidades culturais/sexuais/raciais fazem mesmo frente à globalização e homogeneização dos territórios existenciais e culturais ou se as ondas de reivindicação identitária das chamadas "minorias" seriam uma resposta mal colocada, apostando que é a própria referência identitária que deveria ser discutida/problematizada. Tentamos esboçar caminhos para uma nova política: assinalamos com que política queremos compor e apontamos a política de que queremos diferir...

This article consists of reflections about concepts, theories, epistemologies and identity politics. The goal is to discuss how the concept of identity is being used in such polices, from our inser-tions/implications academic, political and affective. For that, we used narratives and scenes ana-lyzers that we have experienced in some areas of our academic, professional and militant action within the lesbian, gay, bisexual and transgender movement (LGBT), as well as in the antima-nicomial movement. In these spaces, the concept of identity is often used as having what can be called a "political productivity". For us, it is important to analyze the primacy of identity as an in-strument for thinking, production of knowledge and political struggle. When this word is used, which enunciations make it possible? When one operates with the concept of identity, or even of identification, which limits are imposed, which rigidities and which capture of senses occur? We wonder if the cultural/sexual/racial identities do really face the globalization and the homogeniza-tion of the cultural and existential territories, or if the waves of identity claims of the so called "minorities" would be poorly placed as a response, indicating that is exactly the identity reference that should be discussed...

Este trabajo consiste en reflexiones sobre conceptos, teorías, la epistemología y la política de la identidad. El objetivo es poner en duda el concepto de la identidad de estas políticas, partir de nuestras inserciones y las implicaciones académicas, políticas y afectivas. Para ello, utilizamos las narraciones y escenas de los analizadores que se han experimentado en algunas partes de nuestros cursos académicos, profesionales y activistas dentro del movimiento de lesbianas, gays, bisexuales y transgénero (LGBT), así como en la lucha anti-asilos. En estos espacios, el concepto de identidad se utiliza a menudo como poseedor de lo que podríamos llamar "política de la productividad". Para nosotros, es importante para el análisis en la primacía de la identidad como una herramienta de producción de conocimiento pensamiento, y la lucha política. i Cuando se usa esta palabra, que se creó para que esto sea posible? iCuando se opera con el concepto de identidad o de identificación, incluso, que se imponen límites, que capturas se producen? Nos preguntamos si las identidades culturales o sexuales / raciales que aun frente a la globalización y la homogeneización de los territorios culturales y existenciales o las olas de las reivindicaciones de identidad de las llamadas "minorías" sería una respuesta fuera de lugar, está apostando a que la referencia de identidad debe se discutirá / tela de juicio...

Ce document se compose de réflexions sur les concepts, théories, l'épistémologie et la politique identitaire. L'objectif est de contester l'utilisation de la conception de l'identité par ces politiques à partir de nos inserts et implications académique, politique et affectif. Pour ce faire, nous servir avec des histoires et des scènes analyseurs ont connu dans certaines parties de nos voyages, des universitaires et des militants professionnels au sein du mouvement pour les lesbiennes, gays, bisexuels et transgenres (LGBT), ainsi que des anti-asiles. Dans ces espaces, la notion d'identité est souvent utilisé comme possédant ce qu'on pourrait appeler ®la politique de la productivité¼. Pour nous, il est important pour l'analyse de la primauté de l'identité comme un outil de production de connaissances pensée, et la lutte politique. Quand ce mot est utilisé, qui visait à rendre cela possible? Lorsque vous travaillezavec la notion d'identité, ou même d'identification, quels sont les limites imposées, quelles plâtreries, quelles les captures sont produites? Nous nous demandons si les identités culturelles ou sexuelles / raciale de même le visage de la mondialisation et l'homogénéisation des territoires culturels et existentiels ou des vagues pour revendiquer une identité des minorités serait une réponse mal placée, fait le pari que la référence identitaire très qui devrait être discutée / problématique. Nous avons essayé d'exposer les moyens d'une nouvelle politique: nous l'avons souligné que l'écriture politique et a souligné la politique que nous différons...