Surgical treatment in bone metastases in the appendicular skeleton. / Tratamiento quirúrgico de las metástasis óseas en el esqueleto apendicular.

INTRODUCTION: Metastatic bone disease is the most common neoplastic process that affects the skeletal system. Eighty percent of bone metastases come from carcinomas of the breast, lung, kidney, thyroid and prostate. The Katagiri scale enables an estimation of the survival of patients based on the presence or absence of visceral metastases, multiple bone metastases and functional status according to the ECOG scale. MATERIAL AND METHODS: A retrospective, descriptive and observational study conducted between March 1, 2013 and June 30, 2015. Thirty-two patients were studied with a diagnosis of metastatic bone disease and who had undergone some type of orthopaedic surgical treatment for pathological fracture or impending fracture. RESULTS: 28 cases (87.5%) presented pathological fracture and 4 cases (12.5%) impending fracture according to the Mirels score. Fifteen cases (46.875%) were treated by placing a central medullary nail + spacer in the long bone diaphysis, 15 cases (46.875%) with modular arthroplasties and 2 patients (6.25%) with forequarter amputation. Eleven patients (34.375%) died during the course of this study, all with a Katagiri greater than or equal to 4. DISCUSSION: The presence of a fracture in previously damaged territory is a catastrophic complication for most cancer patients. A clear understanding of the life expectancy of patients with bone metastases is of great help to prevent errors and failures in treatment.

Metástasis cerebrales en pacientes con cáncer de tiroides / Brain metastases in patients with thyroid cancer

Resumen: ANTECEDENTES: el cáncer es una de las primeras causas de morbilidad y mortalidad en el mundo; la neoplasia endocrinológica más frecuente es el cáncer de tiroides. A pesar que la mayoría de los pacientes con cáncer de tiroides tienen buen pronóstico, 10 a 15% de los pacientes muestra recurrencia de la enfermedad e incluso 5% padece metástasis a distancia. Las metástasis cerebrales del cáncer de tiroides son raras y habitualmente conllevan mal pronóstico. OBJETIVO: describir las características demográficas y radiológicas, así como el pronóstico clínico de pacientes con cáncer de tiroides que requirieron consulta neurológica. MATERIAL Y MÉTODO: estudio prospectivo observacional en el que se incluyeron pacientes atendidos en un centro de referencia de tercer nivel con cáncer de tiroides que requirieron consulta neurológica entre enero de 2010 y enero de 2016. Se estudiaron las concentraciones séricas de tiroglobulina, TSH y anticuerpos anti-tiroglobulina, como se ha sugerido previamente. RESULTADOS: encontramos siete pacientes con metástasis cerebrales por cáncer de tiroides y las comparamos con registros encontrados en la bibliografía. El género masculino, la edad avanzada y las concentraciones elevadas de tiroglobulina se asociaron con mayor frecuencia de metástasis a distancia de cáncer de tiroides. CONCLUSIONES: las metástasis cerebrales de cáncer de tiroides son complicaciones poco frecuentes con pronóstico adverso. La tiroglobulina es un marcador tumoral muy útil para el seguimiento de pacientes con cáncer de tiroides ya que está elevada en pacientes con actividad sistémica y muy elevada en sujetos con metástasis cerebrales.

Abstract: BACKGROUND: Cancer is one of the first causes of both mortality and morbidity in the world. Thyroid cancer is the most common endocrine neoplasm. Although most TC patients have a good prognosis, 10 to 15% present recurrent disease and up to 5% show distant metastases. Brain metastases are unusual and are associated with a worse prognosis. OBJECTIVE: To describe the demographic and radiological characteristics, as well as clinical prognosis of patients with thyroid cancer who required neurological consultation. MATERIAL AND METHOD: A prospective observational study in which patients with thyroid cancer who required neurological consultation, attended in a tertiary referral cancer center, was done from January 2010 to January 2016. Serum levels of thyroglobulin, TSH and anti-thyroglobulin antibodies were studied, as suggested previously. RESULTS: We followed around 400 patients with TC and we found seven patients with brain metastases by thyroid cancer and compared them with records found in literature. Male gender, older age and high levels of thyroglobulin were associated with higher incidence of distant metastases of thyroid cancer. CONCLUSIONS: Brain metastases of thyroid cancer are little frequent complications with adverse prognosis. Thyroglobulin is a very useful tumoral marker for the following of patients with thyroid cancer, because it is high in patients with systemic activity and very high in patients with brain metastases.

Reconstrucción vulvoperineal en cáncer vulvar / Vulvoperineal reconstruction in vulvar cancer

Resumen ANTECEDENTES: Los estadios clínicos avanzados del cáncer vulvar representan un reto quirúrgico y un abordaje que requiere ser multidisciplinario, con cirugía plástica que provea márgenes quirúrgicos adecuados, con menor tasa de complicaciones, cierre primario de la herida e inicio temprano de la terapia oncológica coadyuvante. OBJETIVOS: Describir y exponer las alternativas de reconstrucción vulvoperineal para pacientes con cáncer vulvar, atendidas en el Instituto Nacional de Cancerología de México. MATERIALES Y MÉTODOS: Análisis descriptivo y retrospectivo de casos de pacientes a quienes se hizo reconstrucción vulvoperineal en el Instituto Nacional de Cancerología, México, entre enero y diciembre de 2015, por el mismo cirujano plástico. Se muestra el algoritmo basado en su experiencia. RESULTADOS: Se analizaron 11 casos de pacientes operadas con diferentes técnicas de reconstrucción vulvoperineal, por defectos quirúrgicos del cáncer vulvar y se expuso el algoritmo utilizado y la experiencia del cirujano. CONCLUSIONES: Se revisaron las diferentes alternativas de reconstrucción para subsanar defectos quirúrgicos en pacientes con cáncer vulvar. Los algoritmos de tratamiento quirúrgico previamente publicados son confusos y complejos, quizá por la baja incidencia del cáncer vulvar y las diversas opciones de procedimientos de reconstrucción.

Abstract BACKGROUND: Vulvar cancer is a relatively infrequent disease, that constitutes 1-5% of all gynecological cancers. Surgery is the mainstay treatment is adequate resection, and lymph node evaluation, often have a high risk of relapse that may reach 65%. ADVANCED: Stages are a surgical challenge and multidisciplinary ap proach with plastic surgery will provide adequate surgical margins, less complications, adequate wound closure, and early adjuvant treat ment starting; as well as excellent cosmetic results, with functional, psychological and sexual morbidity decreased. OBJECTIVES: To describe and present the alternatives of vulvoperineal reconstruction in vulvar cancer at Instituto Nacional de Cancerología, Mexico. METHODS: A retrospective descriptive analysis of eleven cases of vulvoperineal reconstruction in vulvar cancer was performed from January 2015 to December 2015, at Instituto Nacional de Cancerología, Mexico; for one plastic surgeon; and demonstrated the algorithm base don their experience. RESULTS: We performed 11 patients of vulvar reconstruction with different reconstructive techniques, such as gracilis flapping, pudend, with a high success rate. as well as, to propose an algorithm based in our experience with vulvar cancer reconstruction at Instituto Nacional de Cancerología, Mexico. CONCLUSION: The present article aims to review the reconstructive alternatives in Vulvar Cancer, several algorithms for surgical treatment have been published before; but they tend to be complex, in part be cause of the low incidence of Vulvar Cancer and the several options of reconstructive procedures.

Comparing the effects of endogenous and synthetic cannabinoid receptor agonists on survival of gastric cancer cells.

AIMS: Anti-neoplastic activity induced by cannabinoids has been extensively documented for a number of cancer cell types; however, this topic has been explored in gastric cancer cells only in a limited number of approaches. Thus, the need of integrative and comparative studies still persists. MATERIALS AND METHODS: In this study we tested and compared the effects of three different cannabinoid receptor agonists-anandamide (AEA), (R)-(+)-methanandamide (Meth-AEA) and CP 55,940 (CP)- on gastric cancer cell morphology, viability and death events in order to provide new insights to the use of these agents for therapeutic purposes. KEY FINDINGS: The three agents tested exhibited similar concentration-dependent effects in the induction of changes in cell morphology and cell loss, as well as in the decrease of cell viability and DNA laddering in the human gastric adenocarcinoma cell line (AGS). Differences among the cannabinoids tested were mostly observed in the density of cells found in early and late apoptosis and necrosis, favoring AEA and CP as the more effective inducers of apoptotic mechanisms, and Meth-AEA as a more effective inducer of necrosis through transient and rapid apoptosis. SIGNIFICANCE: Through a comparative approach, our results support and confirm the therapeutic potential that cannabinoid receptor agonists exert in gastric cancer cells and open possibilities to use cannabinoids as part of a new gastric cancer therapy.

Atomic force acoustic microscopy: Influence of the lateral contact stiffness on the elastic measurements.

Atomic force acoustic microscopy is a dynamic technique where the resonances of a cantilever, that has its tip in contact with the sample, are used to quantify local elastic properties of surfaces. Since the contact resonance frequencies (CRFs) monotonically increase with the tip-sample contact stiffness, they are used to evaluate the local elastic properties of the surfaces through a suitable contact mechanical model. The CRFs depends on both, normal and lateral contact stiffness, kN and kS respectively, where the last one is taken either as constant (kS<1), or as zero, leading to uncertainty in the estimation of the elastic properties of composite materials. In this work, resonance spectra for free and contact vibration were used in a finite element analysis of cantilevers to show the influence of kS in the resonance curves due to changes in the kS/kN ratio. These curves have regions for the different vibrational modes that are both, strongly and weakly dependent on kS, and they can be used in a selective manner to obtain a precise mapping of elastic properties.

[Neurological manifestations in patients with cancer: more than 17,000 reasons for consultation]. / Manifestaciones neurologicas en pacientes con cancer: mas de 17.000 motivos de consulta.

INTRODUCTION: Cancer is one of the leading causes of death in our population; neurologic manifestations are frequent and are associated with higher rates of morbidity and mortality. AIM: To describe the neurological manifestations in patients with cancer. PATIENTS AND METHODS: From January 2010 to December 2014 a database was created from patients with cancer, required a neuro-oncological assessment at a referral cancer center. RESULTS: 17,092 reasons for neuro-oncological consultation are described. Neoplasms most frequently associated with neurological manifestations were: breast cancer, hematologic malignancies, primary central nervous system tumors, lung cancer and gynecological malignancies. The most frequent neurological manifestations were: neuromuscular disease (including neuropathy), central nervous system metastasis, primary headaches, seizures, stroke and primary neurological tumors. CONCLUSION: It is important that neurologists, physicians and those involved in the management of patients with cancer recognize and get to know the neurological complications.

TITLE: Manifestaciones neurologicas en pacientes con cancer: mas de 17.000 motivos de consulta.Introduccion. El cancer es una de las primeras causas de muerte en nuestra poblacion. Las complicaciones neurologicas asociadas son frecuentes e incrementan significativamente la morbilidad y la mortalidad de estos pacientes. Objetivo. Describir las manifestaciones neurologicas en pacientes con cancer. Pacientes y metodos. Desde enero de 2010 hasta diciembre de 2014 se creo una base de datos de pacientes con cancer que merecian una valoracion por neurooncologia en un centro de referencia. Resultados. Se describen 17.092 motivos de consulta de neurooncologia. Las neoplasias que mas se relacionaron con manifestaciones neurologicas fueron: cancer de mama, neoplasias hematologicas, tumores primarios del sistema nervioso central, cancer de pulmon y neoplasias ginecologicas. Las manifestaciones neurologicas mas frecuentes fueron: afeccion neuromuscular, actividad tumoral en el sistema nervioso central, cefalea primaria, crisis convulsivas, enfermedad vascular cerebral y tumores neurologicos primarios. Conclusiones. Es importante que los neurologos, medicos de distintas areas de la medicina y personal paramedico, involucrados en el manejo de estos pacientes, reconozcan las complicaciones neurologicas de manera temprana.

On the effects of CP 55-940 and other cannabinoid receptor agonists in C6 and U373 cell lines.

Cannabinoid receptor (CBs) agonists affect the growth of tumor cells via activation of deadly cascades. The spectrum of action of these agents and the precise role of the endocannabinoid system (ECS) on oncogenic processes remain elusive. Herein we compared the effects of synthetic (CP 55-940 and WIN 55,212-2) and endogenous (anandamide or AEA) CBs agonists (10-20 µM) on morphological changes, cell viability, and induction of apoptosis in primary astrocytes and in two glioblastoma cell lines (C6 and U373 cells) in order to characterize their possible differential actions on brain tumor cells. None of the CBs agonist tested induced changes in cell viability or morphology in primary astrocytes. In contrast, CP 55-940 significantly decreased cell viability in C6 and U373 cells at 5 days of treatment, whereas AEA and WIN 55,212-2 moderately decreased cell viability in both cell lines. Treatment of U373 and C6 for 3 and 5 days with AEA or WIN 55,212-2 produced discrete morphological changes in cell bodies, whereas the exposure to CP 55-940 induced soma degradation. CP 55-940 also induced apoptosis in both C6 and U373 cell lines. Our results support a more effective action of CP 55-940 to produce cell death of both cell lines through apoptotic mechanisms. Comparative aspects between cannabinoids with different profiles are necessary for the design of potential treatments against glial tumors.

Retrospective study of the association between epidural analgesia during labour and complications for the newborn.

OBJECTIVE: our objective was to determine the association between epidural analgesia and different variables. BACKGROUND: the effect on newborns of epidural analgesia administered to the mother during labour remains under debate. METHOD: this association was retrospectively investigated in a cohort of 2399 children born in a Spanish public hospital. Only full-term (>37 weeks of gestation) deliveries were included. Other exclusion criteria were: induced delivery (medical or obstetric indication), elective caesarean section, or the presence of an important pregnancy risk factors (hypertension, diabetes, severe disease, toxaemia, retarded intrauterine growth, chronologically prolonged pregnancy, prolonged membrane rupture (>24 hours), oligoamnios, or polyhydramnios). The Mann-Whitney U test and Fisher׳s exact test were applied to determine the relationship between variables. KEY CONCLUSIONS: Apgar index values at one minute and five minutes were slightly but significantly lower in neonates whose mothers had received epidural analgesia. Neonatal intensive care unit admission was significantly more frequent in the epidural versus non-epidural group. Resuscitation was significantly more frequent in the epidural versus non-epidural group. Early breast feeding onset was more frequent in the non-epidural group. The adverse effect of epidural analgesia on early lactation remained significant after adjusting for NICU admission and the need for resuscitation in a logistic regression analysis. Epidural analgesia may have adverse effects on newborns, although the risks are low, and further research is required to elucidate the causal nature of this relationship.

[Colorectal surgery in patients over 65 years of age]. / Cirugía colorrectal en pacientes mayores de 65 años.

BACKGROUND: There is a limited functional reserve in patients over 65 years of age which is conducive to more frequent postoperative complications. Disease extension at the time of diagnosis (clinical stage) and complete tumor resection are two independent risk factors that have a direct influence on survival. AIMS: To describe the factors that influence morbidity and mortality in patients over 65 years of age after colorectal surgery. MATERIAL AND METHODS: A retrospective, observational, descriptive study was carried out within the time frame of January 2004 and December 2009 on 105 colon cancer patients after colorectal surgery. They were divided into two groups, one under 65 years of age and the other over 65 years of age, in order to compare preoperative comorbidity, as well as morbidity and mortality 30 days after surgery. RESULTS: Of the 105 patient total (53,3%), 56 were ≤ 65 years of age. There were complications in 42,8% of the patients, and those of early and less severe presentation were the most frequent; late complications were more frequent in patients ≤ 65 vs > 65 years of age (16,0% vs 10,2%). Overweight (BMI > 25 kg/m(2)) was observed in 35,0% of the study population. Patients > 65 years of age had fewer comorbidities. The most common causes of reintervention were anastomosis dehiscence and postoperative hemorrhage. Mortality in the group was 6,6% and sepsis was the most frequent cause of death. CONCLUSIONS: Colorectal surgery in patients over 65 years of age has an acceptable complication frequency and a low mortality rate. Our results suggest that patients older than 65 years of age be treated with the same prospects for cure as younger patients.

Clinical characteristics and outcomes of critically ill cancer patients with septic shock.

OBJECTIVE: To evaluate the clinical characteristics and outcomes of critically ill cancer patients with septic shock. DESIGN: Prospective, observational cohort study. METHODS: Medical-surgical intensive care unit (ICU) at the Instituto Nacional de Cancerología located in Mexico City from January 2008 to February 2010. There were no interventions. Eighty-two consecutive cancer patients with septic shock aged over 18 years were prospectively included and evaluated. RESULTS: During the study period, 620 critically ill cancer patients were admitted to ICU. Ninety-four patients were evaluated for septic shock at the request of ward onco-hematologists or surgeon oncologist responsible for the patient. After being evaluated by the intensivists, 82 patients were admitted to the ICU. Of the 82 patients, 56 (68.3%) had solid tumours and 26 (31.7%) had hematological malignancy. The most frequent sites of infection were: abdominal (57.3%) and respiratory (35.8%). Cultures were positive in 41 (50%) patients. The 63.4% of the patients had three or more organ dysfunctions on the day of their admission to the ICU. Cox multivariate analysis identified the Sequential Organ Failure Assessment (SOFA) score [hazard ratio (HR): 1.11; 95% confidence interval (95% CI): 1.02-1.19, P=0.008) and performance status (PS)≥2 (HR: 1.84; 95% CI: 1.03-3.29, P=0.040) as independent predictors of death to 3 months. The ICU mortality rate was 41.5% (95% CI: 31-52%). CONCLUSION: The variables associated with increased mortality were the degree of organ dysfunction determined by SOFA score at ICU admission and PS≥2.

Prognostic factors in critically ill patients with solid tumours admitted to an oncological intensive care unit.

The mortality and prognostic factors for patients admitted to the intensive care unit (ICU) with solid tumours are unclear The aim of this study was to describe demographic, clinical and survival data and to identify factors associated with mortality in critically ill patients with solid tumours. A prospective observational cohort study of 177 critically ill patients with solid tumours admitted to a medical-surgical oncological ICU was undertaken. There were no interventions. Among the admissions, 66% were surgical, 79.7% required mechanical ventilation during their stay in the ICU and 31.6% presented with severe sepsis or septic shock. In a multivariate analysis, independent prognostic factors for in-ICU death were the need for vasopressors (OR: 22.66, 95% confidence interval: 6.09 to 82.22, P < 0.001) and the acute physiology and chronic health evaluation (APACHE) II score (OR: 1.92, 95% confidence interval: 1.43 to 2.58, P < 0.001). Cox multivariate analysis identified the length of stay in the ICU, Charlson comorbidity index score greater than 2, and the need for vasopressors as independent predictors of death after ICU discharge. The mortality rate in the ICU was 21.4%. Improved outcomes in critically ill cancer patients extended to the subgroup of patients with solid tumours. Independent prognostic factors for in-ICU death were the need for vasopressors and the APACHE IL score, while the length of stay in the ICU, Charlson comorbidity index score >2, and the need for vasopressors were independent predictors of death after ICU discharge.

Testing of a scanning adiabatic calorimeter with Joule effect heating of the sample.

We evaluated a scanning adiabatic resistive calorimeter (SARC) developed to measure the specific enthalpy of viscous and gel-type materials. The sample is heated employing the Joule effect. The cell is constituted by a cylindrical jacket and two pistons, and the sample is contained inside the jacket between the two pistons. The upper piston can slide to allow for thermal expansion and to keep the pressure constant. The pistons also function as electrodes for the sample. While the sample is heated through the Joule effect, the electrodes and the jacket are independently heated to the same temperature of the sample using automatic control. This minimizes the heat transport between the sample and its surroundings. The energy to the sample is supplied by applying to the electrodes an ac voltage in the kilohertz range, establishing a current in the sample and inducing electric dissipation. This energy can be measured with enough exactitude to determine the heat capacity. This apparatus also allows for the quantification of the thermal conductivity by reproducing the evolution of the temperature as heat is introduced only to one of the pistons. To this end, the system was modeled using finite element calculations. This dual capability proved to be very valuable for correction in the determination of the specific enthalpy. The performance of the SARC was evaluated by comparing the heat capacity results to those obtained by differential scanning calorimetry measurements using a commercial apparatus. The analyzed samples were zeolite, bauxite, hematite, bentonite, rice flour, corn flour, and potato starch.

(18)F-FDG PET/CT for discrimination between tumor extension and blood thrombus in pancreatic adenocarcinoma associated with portal vein thrombosis.

Pancreatic cancer is a malignancy with an extremely poor prognosis. Less than 3 % of patients are alive 5 years after diagnosis. Pancreatic neoplasms represent a possible but uncommon etiology of portal venous invasion. It is important to differentiate the nature of the thrombus, if it is a bland thrombus or is a direct tumor extension. Intense uptake of 18F-fluorodeoxyglucose ((18)F-FDG) has been reported in portal vein tumor thrombus. We present a case of pancreatic adenocarcinoma and clinical findings of portal hypertension due to portal vein thrombosis. (18)F-FDG positron emission tomography (PET)/computed tomography (CT) evaluation discarded a tumor thrombus; imaging findings of the pancreatic tumor and the bland thrombus are presented.

Craniofacial resection for sinunasal tumors.

INTRODUCTION: Malignant sinonasal tumors are very rare in Mexico. They ussually present as advanced disease because it is extremely difficult to make an early diagnosis; in addition, its treatment is complicated by a variety of lesions. Surgical resection remains the mainstay of treatment, but its relative therapeutic value compared with alternative treatments is controversial. OBJECTIVE: We undertook a retrospective analysis in order to evaluate results of craniofacial resections for sinonasal tumors. MATERIALS AND METHODS: A total of 20 patients, 11 men and 9 women were considered, median age was 49 years (18-74). Eleven had received previous treatment elsewhere. In 13 patients tumor was limited to maxillo-ethmoid complex, but in 6 cases tumor involved anteroinferior aspect of sphenoid sinus, in 7 extended to the orbit, in 3 to dura and two to the brain. One had cervical metastases. Median tumoral size was 5.8 cm (1-10). RESULTS: Overall complication rate was 50%. Major surgical complications occurred in 4 patients (20%): one patient developed isolated cerebrospinal fluid leakage (CEFL), 1 developed deterioration of mental status, and two developed meningitis associated with CEFL. Late complications occurred in 30% of the patients. There was not any operative death. Eleven patients received postoperative radiotherapy. Fifteen patients recurred. There were 11 local relapses, although one associated with a regional relapse, and another with regional and distant relapse. There were four isolated regional fails and six isolated distant failures. Three year overall survival was 65%, and 3-year disease free survival was 50%. Patients without previous treatment median survival was 28.3 months, meanwhile with previous treatment was 18.2 months. CONCLUSIONS: Craniofacial resection is a safe and valuable tool in the treatment of advanced sinonasal tumors involving cranial base.

Phase II trial of gemcitabine concurrent with radiation for locally advanced squamous cell carcinoma of the head and neck.

BACKGROUND: Concurrent chemoradiation is the current standard of treatment for patients with advanced unresectable head and neck squamous cell carcinoma (HNSCC). Due to the potent radiosensitizing properties of gemcitabine, we decided to assess its efficacy and toxicity with concurrent radiation in patients with advanced HNSCC. PATIENTS AND METHODS: From January 1997 to December 2001, 27 patients with locally advanced HNSCC (stage III, 37%; stage IV, 63%) were enrolled. All received a course of radiotherapy (70 Gy over 7 weeks) concurrent with weekly infusions of gemcitabine at 100 mg/m2 or 50 mg/m2. RESULTS: All patients were assessable for toxicity and 26 for response. Severe mucositis (grade 3-4) was observed in 74% of patients (grade 4, 41%). Severe hematological toxicity was uncommon. Mild and moderate xerostomy was the most common late toxicity in 23 patients (85%). The median radiation dose delivered was 70 Gy (40-80 Gy), 25 patients (93%) received > or = 80% of the intended dose. Gemcitabine dose intensity was > or = 80% in only 13 (48%) patients. The rate of complete and partial responses were 61% and 27%, respectively, for an overall response rate of 88%. At a median follow-up of 13 months (range 6-62), the actuarial 3-year progression-free survival (PFS) and overall survival (OS) were 37% and 33%, respectively. The only variable associated with prolonged survival (P = 0.0001) was the degree of response. No difference was observed in response or toxicity with either gemcitabine 50 or 100 mg/m2. CONCLUSIONS: The concurrent use of radiotherapy and gemcitabine is effective but produces manageable severe mucositis in a high percentage of patients.

[Preliminary experience with the Miami type ileocolonic urinary reservoir in the practice of oncologic gynecology]. / Experiencia preliminar con el reservorio urinario ileocolónico tipo Miami en la práctica de Ginecología Oncológica.

OBJECTIVES: For many years we have used both ileal or colon conduits for urinary diversion during pelvic exenteration. Continent urinary reservoirs have replaced ileal and colon conduits as a method of urinary diversion at our institution. The aim of this study was to review the results and complications associated with continent urinary diversion in patients with gynecologic malignancies. METHODS: We reviewed the records of 26 patients who underwent construction of a continent urinary reservoir (Miami pouch) from February 1991 to June 1994 at the Department of Gynecologic Oncology of the National Cancer Institute of Mexico (Instituto Nacional de Cancerología). Twenty-four of these patients had received radiotherapy for gynecologic malignancies. RESULTS: An ileocolonic continent urinary reservoir (Miami pouch) was created in 26 patients, aged 38-81 years, as part of a concurrent anterior or total pelvic exenteration for primary or recurrent gynecologic malignancies (19 pts.), for the relief of a vesicovaginal fistula (3 pts.), hemorrhagic cystitis (2 pts.), or in substitution of an ileal conduit (2 pts.), with follow-up ranging from 2-54 months. Additional procedures performed concurrently with the Miami pouch and pelvic exenteration included low rectal anastomosis (11 pts.), pelvic floor reconstruction (8 pts.), and vaginal reconstruction (4 pts.). The complications associated with the reservoir included incontinence (1 pt.), ureteral strictures (3 pts.), pouch leakage (1 pt.), difficult self-catheterization (4 pts.), and urosepsis and pyelonephritis (6 pts.). One patient developed pouch stones. In this series, 95.6% of the patients were completely continent. No obstruction or reflux was noted in 92.3% of the cases. Nonsurgical management strategies used for reservoir-related complications included percutaneous nephrostomy, intravenous antibiotics, and percutaneous pouch decompression. Reoperation was required in 5 patients: one patient (early) due to a fistula, another patient required reimplantation due to obstruction, one patient with a nonfunctioning kidney underwent nephrectomy, and two patients with stoma stenosis. CONCLUSIONS: The Miami pouch is a low-pressure continent form of urinary diversion. The continence mechanism is easy to construct and the procedure can successfully be accomplished at the time of pelvic exenteration in patients with gynecologic malignancies. The rate of major complications of the Miami pouch is small and the continent urinary diversion can be undertaken with concurrent low rectal anastomosis or vaginal reconstruction.

Matrix metalloproteinases expressed in squamous cell carcinoma of the oral cavity: correlation with clinicopathologic features and neo-adjuvant chemotherapy response.

Secretion of gelatinases A (MMP-2) and B (MMP-9) from 21 tumoral explants of squamous cell carcinoma (SCC) and five samples of normal mucosa of the oral cavity is demonstrated here. The explants were cultured into fetal bovine serum- and phenol red-deprived medium for 48 hours. The gelatinases secreted into the medium were revealed and quantified by zymography and densitometry, respectively. The results showed high medians of the 66 kDa forms of gelatinase A in tumoral explants, in comparison to normal explants: 31.0 vs 5.9 densitometric units (DU) (p <0.01). There was also a relatioship between clinical response to neo-adjuvant chemotherapy and low activity of 66 kDa form of gelatinase A, as well as 84 kDa and 92 kDa forms of gelatinase B. The median of gelatinolysis of the inactive form of gelatinase A (72 kDa form) was higher in those patients who exhibited a complete response to neo-adjuvant chemotherapy. We conclude that gelatinase A is a useful and objective tool to evaluate the response to chemotherapy and the aggressiveness of carcinomas of the oral cavity.