Mortality in cutaneous malignant melanoma and its association with Neutrophil-to-Lymphocyte ratio.

INTRODUCTION: Cutaneous malignant melanoma (CMM) incidence has risen rapidly in the last 50 years. Poor progression and high mortality characterize CMM, making a thorough understanding of progression and associated factors essential for optimizing care. AIMS: We assessed the association between the Neutrophil-to-Lymphocyte Ratio (NLR) and mortality in adults with CMM from an entirely mixed-race Hispanic population during 12 consecutive years of extensive follow-up. MATERIAL & METHODS: We performed a retrospective cohort study in a tertiary hospital in Peru. NLR was categorized with a cutoff value higher or equal than 3. We collected demographic variables, laboratory results and treatments at baseline of follow-up. Cox regression analysis was performed, and we calculated crude and adjusted hazard ratios (HR) and their 95% confidence interval (95%CI). RESULTS: The analysis was from 615 CMM cases, and there were 378 deaths. Most melanomas (63.6%) were acral lentiginous. The crude analysis showed that high NLR is a risk factor for mortality, HR = 2.52; 95%CI (2.03-3.14). High NRL ratio remains statistically significant after adjusting for confounding variables, aHR = 1.61; 95%CI (1.16-2.24). Other risk factors for mortality were clinical stages III and IV, older than 60 years, females and greater Breslow thickness. CONCLUSIONS: We concluded that high NRL ratio is a risk factor for mortality and should be monitored in every patient who is diagnosed with malignant melanoma during their first blood count. It should then be carried out in follow-up controls for patients of clinical stage III and IV only, or in patients who present a relapse.

[Relation of pre-operative ecography to laparoscopic cholecystectomy difficulty at the Central Military Hospital]. / Relación entre la ecografía pre-operatoria y la dificultad de la colecistectomía laparoscópica en el Hospital Militar Central.

This study included 62 patients diagnosed with known vesicular disease, who underwent laparoscopic cholecystectomy between August 1999 and March 2000, at the Central Military Hospital. Those patients showing alterations in the hepatic function tests and dilatation of the biliary tract in the pre-operative echography were excluded from the study. The patients selected were subjected to evaluation of the echographic parameters one day before the surgery in order to determine the vesicular volume and ejection fraction. The maximum ejection fraction was calculated as the difference between the fasting gastric volume and the residual volume, in the fasting volume percentage. We evaluated the above-mentioned operative parameters one day following the laparoscopic cholecystectomy, using a visual analog scale (VAS) for evaluation of the surgical difficulty and bleeding during surgery. The surgery duration was measured in minutes. Subsequently, the pre-operative echographic parameters, excluding the ballstone parameter in the main biliary tract, were related to the surgery parameters, obtaining the following results: -The pre-operative echographic parameters, thickness of the vesicular wall and vesicular ejection fraction, are the best indicators of surgical difficulty in laparoscopic cholecystectomy. -The pre-operative echographic parameter, vesicular ejection fraction <50% and vesicular wall thickness = 3 mm are indicators of larger bleeding during laparoscopic cholecystectomy. -The pre-operative echographic parameter, vesicular ejection fraction in gallbladder indicates prolongation of surgery duration in laparoscopic cholecystectomy. -Finally, our study supports the use of echography as a useful diagnosis mean in patients undergoing laparoscopic cholecystectomy, and which can predict, through some of its echographic parameters, cases with technical difficulty, bleeding during surgery and prolongation of surgery time in laparoscopic cholecystectomy.

Relación entre la ecografía pre-operatoria y la dificultad de la colecistectomía laparoscópica en el Hospital Militar Central / Relation of pre-operative ecography to laparoscopic cholecystectomy difficulty a the Central Militay Hospital

El presente estudio se realizó en 62 pacientes con enfermedad vesicular cronocida, quienes fueron operados mediante Colecistectomía Laparoscópica (CL), entre agosto de 1999 a marzo del 2000, en el Hospital Militar Central. Se excluyó del trabajo a aquellos pacientes que presentaron alteración de las pruebas de función hepática y aquellos pacientes que presentaron la vía biliar dilatada en la ecografía pre-operatoria. Los pacientes seleccionados, fueron sometidos un día antes de la cirugía a la evaluación de los parámetros ecográficos, determinando el volumen vesicular y la fracción de eyección. La máxima fracción de eyección vesicular se calculó como la diferencia entre el volumen de ayuno y el volumen residual, en porcentaje del volumen de ayuno. Al día siguiente, luego de concluirse la CL, se evaluaron los parámetros operatorios mencionados, tanto la dificultad operatoria y el sangrado durante la cirugía usando la escala análogo visual (VAS); la duración operatoria fue medida en minutos. Posteriormente, se relacionaron los parámetros ecográficos preoperatorios, exceptuando el parámetro cálculo en la vía biliar principal, con los parámetros operatorios los resultados fueron: Que los parámetros ecográficos preoperatorios, grosor de la pared vesicular y la fracción de eyección vesicular son los mejores indicadores de dificultad operatoria para la CL. Que el parámetro ecográfico preoperatorio, fracción de eyección vesicular <50 por ciento y grosor de pared vesicular> de 3mm son indicadores de mayor sangrado durante la CL. El parámetro ecográfico preoperatorio, fracción de eyección vesicular en la vesícula biliar es un indicador de prolongación de la duración operatoria de la CL. Finalmente, se apoya que la ecografía es un resultado por imágenes útil para los pacientes sometidos a CL y que puede predecir, mediante algunos de sus parámetros ecográficos, los casos de dificultad técnica, sangrado durante la cirugía prolongación del tiempo operatorio de la CL.