Impact of preoperative levels of hemoglobin and albumin on the survival of pancreatic carcinoma.

INTRODUCTION: Pancreatic cancer presents the worst survival rates of all neoplasms. Surgical resection is the only potentially curative treatment, but is associated with high complication rates and outcome is bad even in those resected cases. Therefore, candidates amenable for resection must be carefully selected. Identification of prognostic factors preoperatively may help to improve the treatment of these patients, focusing on individually management based on the expected response. PATIENTS AND METHODS: We perform a retrospective study of 59 patients with histological diagnosis of pancreatic carcinoma between 1999 and 2003, looking for possible prognostic factors. RESULTS: We analyze 59 patients, 32 males and 27 females with a mean age of 63.8 years. All the patients were operated, performing palliative surgery in 32% and tumoral resection in 68%, including pancreaticoduodenectomies in 51% and distal pancreatectomy in 17%. Median global survival was 14 months (Range 1-110).We observed that preoperative levels of hemoglobin under 12 g/dl (p = 0.0006) and serum albumina under 2.8 g/dl (p = 0.021) are associated with worse survival. CONCLUSION: Preoperative levels of hemoglobin and serum albumina may be prognostic indicators in pancreatic cancer.

Basal cell adenoma of the parotid gland. Case report and review of the literature.

Basal cell adenoma of the salivary glands is an uncommon type of monomorphous adenoma. Its most frequent location is the parotid gland. It usually appears as a firm and mobile slow-growing mass. Histologically, isomorphic cells in nests and interlaced trabecules with a prominent basal membrane are observed. It is also characterized by the presence of a slack and hyaline stroma and the absence of myxoid or condroid stroma. In contrast to pleomorphic adenoma, it tends to be multiple and its recurrence rate after surgical excision is high. Due to prognostic implications, differential diagnosis with basal cell adenocarcinoma, adenoid cystic carcinoma and basaloid squamous cell carcinoma is mandatory. We describe a case of basal cell adenoma of the parotid gland. We also review the literature and discuss the diagnosis and management of this rare entity.

Wall thickness of ventricular chambers in transposition of the great arteries: surgical implications.

One hundred four specimens of complete transposition of the great arteries (TGA) were studied. The free wall thickness of the left (LV-T) and right (RV-T) ventricular chambers and the left ventricular/right ventricular (LV/RV) thickness ratio for all hearts were analyzed. A control group of 63 normal hearts was also studied. Specimens of TGA were divided into four groups: (1) TGA with intact ventricular septum (TGA + IVS); (2) TGA with ventricular septal defect (TGA + VSD); (3) TGA with a large patent ductus arteriosus (TGA + PDA); (4) TGA with pulmonary stenosis (TGA + PS). In Group I, LV-T was under the 95% confidence limits for normality after 8 months of age, and in Group II, the same was true after 18 months of age. For all groups the RV-T was above the 95% confidence limits for normality from the first month of age. The LV/RV ratio was under 1 in every group. Group I showed a significant decrease in the LV/RV ratio after the neonatal period (p less than 0.005). The potential failure of the left ventricle after anatomic correction of TGA is explained by a multifactorial hypothesis. In view of the ventricular wall thickness findings, we do not recommend the anatomic correction after 8 months of age in Group I or after 18 months in Group II.

A new surgical technique for orthoterminal correction: experimental development.

A new technique is presented for surgical correction of tricuspid atresia, univentricular heart, pulmonary atresia with intact ventricular septum and hypoplastic ventricle, and hypoplastic left heart syndrome. The procedure consists of an angled right atriotomy, creation of an interatrial septal defect and a right neoatrium that is anastomosed to the pulmonary artery, and creation of a left neoatrium communicating with the left atrium through the interatrial septal defect. The technique was evaluated in 28 mongrel dogs. In 15 of these experimental procedures, the objective was to acquire skill in performing the technique. In the remaining 13, the procedure was executed with cardiopulmonary bypass. Hemodynamic studies were made at 30, 60, 120, and 180 minutes after operation. The results and advantages of the procedure are discussed. We consider it feasible for clinical application.

[The National Registry of Cardiac Tumors (the 1996-1997 report)]. / Registro Nacional de Tumores Cardíacos (memoria 1996-1997).

We presented the first report of the national database of heart tumors. We described the origin, development and goals reached during the years 1996 and 1997, the way the data was collected and the form used. The cases collected until 31st of December of 1997 include 165 tumors in 155 patients distributed all around the country. Age and gender distribution, way of diagnosis, morphologic classification, treatment and follow-up of this pathology is reported.

[New histopathologic data of prognostic value in extra-adrenal paragangliomas. Study of 9 cases]. / Nuevos factores histopatológicos de valor pronóstico en paragangliomas extraadrenales. Estudio de 9 casos.

BACKGROUND: The biological behavior of paragangliomas is difficult to evaluate by classic histological criteria thus justifying the use of immunohistochemical markers as prognostic factors. METHODS: Nine extra-adrenal paragangliomas (three jugulo-tympanic, four carotid-body tumors, and two retroperitoneal) were studied by conventional histological criteria, and also by chromogranin A and neuron-specific enolase (NSE) immunohistochemical staining for the study of chief cells, and S-100 as a marker of sustentacular cells. The rate of cell proliferation was studied by the proliferating cell nuclear antigen (PCNA). The correlation between these parameters and the clinical evolution of the neoplasms, which were classified as benign, locally aggressive, and malignant (with metastasis), were also analyzed. RESULTS: The atypia and the mitotic rate did not correlate with the behavior of the tumor. Less immunostaining with the anti-S-100 and anti-chromogranin A antibodies was observed in the malignant paragangliomas and in those which were locally aggressive. In the benign tumors the proliferative rate (PCNA) oscillated between 0.7% and 3.7%, and 40 or less PCNA positive cells were counted in 10 high-power field (HPF) (40x). In malignant and locally aggressive tumors the proliferative rate was 5% or more, with 60 or more cells that were positive for PCNA being found in 10 HPF. CONCLUSIONS: The histopathologic signs implying worse prognosis in extra-adrenal paragangliomas are a decrease in chromogranin A and S-100 immunoreactivity and a rate of cell proliferation of 5% or greater, or a number of cells stained for proliferating cell nuclear antigen greater than 50 in 10 high-power field.

[Histiocytic necrotizing lymphadenitis: Kikuchi-Fujimoto disease. Apropos of 6 cases]. / Linfadenitis necrotizante histiocitaria: enfermedad de Kikuchi-Fujimoto. A propósito de 6 casos.

Necrotizing Histiocytic Lymphadenitis or Kikuchi-Fujimoto disease is a benign process of lymphatic system that consists of lymphadenopathy which may be accompanied by fever, rash and some haematological alterations as anaemia. It affects usually young people, mostly women. Although it is more frequent in Oriental countries, there have been some notices about this disease in Europe recently. We present six patients that have been diagnosed in our Hospital between 1986 and 1996. All presented as cervical masses and fever. The diagnostic procedure was the lymph node biopsy, which showed the typical pathology of this disease: some foci of necrosis which contained plasmocytoides cells and atypical lymphocytes. It is also suggestive of this entity the absence of polymorphonuclear cells. Then, the diagnosis of the Necrotizing Histiocytic Lymphadenitis is made by the histology. The treatment is symptomatic. In all cases the evolution is the whole remission of symptoms. In our patients the illness was self-limited and none presented any other symptom. Our proposal with this article is to remind the clinicians of this entity when people ask for cervical masses and fever.

Cystic adenomatoid tumor of the uterus.

We describe a case of cystic adenomatoid tumor of the uterus in a 38-year-old woman. The tumor was a subserosal cystic mass with a maximum diameter of 8 cm and located at the posterior wall of the right cornual region. Histologically, the tumor was composed of multiple cavities lined by flattened cells, lying among thin septa of connective tissue. The neoplasm showed small solid areas with a more typical histologic pattern of adenomatoid tumor. Immunohistochemical techniques showed the cells to be positive for keratins. They showed desmosomes, abundant intracytoplasmic filaments, and microvilli on ultrastructural study. The histologic, immunohistochemical, and ultrastructural characteristics of the present case closely resemble those of benign cystic mesothelioma and strongly support the mesothelial origin of the adenomatoid tumor of the uterus.

Complete atrioventricular canal. Anatomic study and presentation of a new technique for total correction.

A new surgical technique for total correction of complete common atrioventricular canal was evolved from study of 34 specimens from affected infants who had died in the first year of life. An interventricular patch was fashioned to reconstruct the interventricular septum and the atrioventricular valves. The patch had two distinct components, one superior or atrial and the other inferior or ventricular. The division was made by inserting a lateral support at different levels on either face of the patch, to which the anterior and posterior atrioventricular cusps were sutured. The interatrial defect was closed with a patch that, together with the atrial component of the interventricular patch, produced a foramen ovale type closure mechanism. The authors present the pathologic observations which served as a basis for development of the surgical technique.

Extraatrial interatrial duct and reestablishment of aortopulmonary communication by enlarging the aortic arch. Experimental development of two surgical techniques for hypoplastic left heart syndrome palliation without extracorporeal circulation.

A new surgical procedure is presented for palliation of hypoplastic left heart syndrome. The first palliative technique consists of creation of an extraatrial interatrial duct and the second, reestablishment of the aortopulmonary communication by enlarging the aortic arch with a "conduit patch". Both procedures avoid having to clamp small systemic vessels and pulmonary veins and extracorporeal circulation is not needed. Extraatrial interatrial ducts were created in 10 dogs and the effectiveness of the procedure was evaluated. Reestablishment of the aorto-pulmonary communication and enlargement of the aortic arch was done in 7 specimens from patients with hypoplastic left heart syndrome who had died in the first hours of life and in 8 dogs. The surgical procedures, their advantages and the results obtained are described.

A new physiologic correction technique for re-establishment of pulmonary circulation. Experimental surgical development.

A new physiologic technique is presented for surgical correction of truncus arteriosus, pseudotruncus, transposition of the great arteries, double right ventricular outflow tract with subpulmonary ventricular septal defect and certain cases of Fallot's tetralogy. The basis of the technique are creation of a neo-right atrium, neo-pulmonary trunk, neo-right atrioventricular valve and a neo-pulmonary valve by right angular atriotomy and insertion of a homologous pericardial patch with a monocuspid valve. The pulmonary circulation is re-established by anastomosis of the neo-pulmonary trunk to the pulmonary tree. The technique was used on 26 mongrel dogs. In 14 the experiments were preliminary, to evaluate the technique's validity, and in the other 12 it was performed with extracorporeal circulation and the hemodynamic status was studied at 30 and 180 min postoperatively. The technique and its results and potential advantages are described. Clinical application is considered to be feasible.