GECOP-MMC: phase IV randomized clinical trial to evaluate the efficacy of hyperthermic intraperitoneal chemotherapy (HIPEC) with mytomicin-C after complete surgical cytoreduction in patients with colon cancer peritoneal metastases.

BACKGROUND: The French PRODIGE 7 trial, published on January 2021, has raised doubts about the specific survival benefit provided by HIPEC with oxaliplatin 460 mg/m2 (30 minutes) for the treatment of peritoneal metastases from colorectal cancer. However, several methodological flaws have been identified in PRODIGE 7, specially the HIPEC protocol or the choice of overall survival as the main endpoint, so its results have not been assumed as definitive, emphasizing the need for further research on HIPEC. It seems that the HIPEC protocol with high-dose mytomicin-C (35 mg/m2) is the preferred regime to evaluate in future clinical studies. METHODS: GECOP-MMC is a prospective, open-label, randomized, multicenter phase IV clinical trial that aims to evaluate the effectiveness of HIPEC with high-dose mytomicin-C in preventing the development of peritoneal recurrence in patients with limited peritoneal metastasis from colon cancer (not rectal), after complete surgical cytoreduction. This study will be performed in 31 Spanish HIPEC centres, starting in March 2022. Additional international recruiting centres are under consideration. Two hundred sixteen patients with PCI ≤ 20, in which complete cytoreduction (CCS 0) has been obtained, will be randomized intraoperatively to arm 1 (with HIPEC) or arm 2 (without HIPEC). We will stratified randomization by surgical PCI (1-10; 11-15; 16-20). Patients in both arms will be treated with personalized systemic chemotherapy. Primary endpoint is peritoneal recurrence-free survival at 3 years. An ancillary study will evaluate the correlation between surgical and pathological PCI, comparing their respective prognostic values. DISCUSSION: HIPEC with high-dose mytomicin-C, in patients with limited (PCI ≤ 20) and completely resected (CCS 0) peritoneal metastases, is assumed to reduce the expected risk of peritoneal recurrence from 50 to 30% at 3 years. TRIAL REGISTRATION: EudraCT number: 2019-004679-37; Clinicaltrials.gov: NCT05250648 (registration date 02/22/2022, ).

Negative pressure therapy as palliative treatment for a colonic fistula.

Colonic fistulas in an open wound are always a challenge for colorectal surgeons, and this report provides a technique for the appropriate management of these cases. We communicate the use of a negative pressure dressing therapy as part of the palliative care for a patient following the development of an enterocutaneous fistula. The use of this therapy allowed us to keep the patient clean and comfortable during the last few days of his life.

Teorías subjetivas de profesionales de escuelas de lenguaje en chile sobre el trastorno específico del lenguaje / Subjective theories of professionals of language schools in Chile about Specific Language Impairment

OBJETIVO: comprender y reconstruir las teorías subjetivas de profesionales de escuelas de lenguaje en Chile, sobre las causas y el tratamiento del trastorno específico del lenguaje. MÉTODO: se utilizó métodos cualitativos para recolectar datos en profundidad. Se realizó entrevistas individuales semi-estructuradas con una muestra de cuatro fonoaudiólogas (logopedas) y cuatro educadoras diferenciales de cuatro escuelas de lenguaje. Se grabó y transcribió las entrevistas, las que fueron analizadas con el programa informático Atlas.ti 5.0. Los resultados del análisis relacional se sintetizaron en tres modelos. RESULTADOS: para las fonoaudiólogas y educadoras diferenciales las causas principales del trastorno específico del lenguaje son factores sociales, originados en la familia de los niños afectados. Con respeto a la superación de este trastorno las entrevistadas destacaron con alta importancia el apoyo familiar para un tratamiento eficaz. CONCLUSIONES: entre las explicaciones subjetivas de las profesionales entrevistadas y las explicaciones científicas acerca las causas del trastorno específico del lenguaje, existen diferencias. Mientras las entrevistadas hablan de causas sociales, los enfoques científicos explican este trastorno por causas biológicas. Esta diferencia debería ser investigada en estudios posteriores. Las fonoaudiólogas y educadoras diferenciales ven la familia del niño como una de las causas principales del trastorno específico del lenguaje y al mismo tiempo consideran el apoyo familiar como un requisito crucial en el tratamiento. En la opinión de los profesionales de las escuelas de lenguaje el trastorno específico del lenguaje es un trastorno superable, si escuela y familia trabajan en conjunto.

PURPOSE: understand and reconstruct the Subjective Theories from professionals in language schools in Chile about causes and treatment of Specific Language Impairment. METHOD: qualitative methods were used to recollect data in depth. The sample included four speech therapists and four psychopedagogists from four different language schools. Every participant was interviewed based on an individual, semi-structured interview. The interviews were recorded, transcribed and analyzed with the computer program Atlas.ti 5.0. The results were visualized in three models. RESULTS: according to the speech therapists and the psychopedagogists, social factors within the families of the affected children are the main causes of specific language impairment. With regard to efficient therapy and the overcoming of this impairment, participants emphasized the importance of family support. CONCLUSIONS: the subjective explanations from the interviewed professionals regarding the cause of specific language impairment differ from the scientific explanations: While the participants of this study attribute social causes to specific language impairment, the scientific explanations focus on biological factors. This inconsistency should be investigated in future studies. The speech therapists and psychopedagogists indicate that certain circumstances in families as one of the main causes of the impairment. But at the same time they talk about the family support as a pivotal element in the treatment. As a result, they claim that if school and family work together SLI becomes a superable impairment.

[Solid organ transection. Open and laparoscopic surgery]. / Transección de órganos sólidos. Cirugía abierta y laparoscópica.

Recent advances in liver surgery have reduced post-hepatectomy mortality to less than 5% in most units specialized in hepato-pancreatic-biliary surgery. Possibly, the single most important factor contributing to these improved results has been the reduction in intraoperative bleeding during liver parenchymal transection. Liver transection is the most risky part of the intervention due to the risk of massive hemorrhage. Some technological advances and refinements to the surgical technique have contributed to making this critical phase of liver surgery safer. Among these advances, the most notable are detailed knowledge of the surgical anatomy of the liver, vascular control techniques and methods of liver parenchymal transection. The present review describes current transection techniques, as well as their advantages and disadvantages. Until there is solid evidence on the best method, the choice of technique and instrument for liver transection depends mainly on the surgeon's personal preference. Nevertheless, some factors can influence the choice of method, such as the surgeon's experience, anesthetic management, type of hepatectomy (central, peripheral), type of approach (open, laparoscopic), quality of the liver (normal, cirrhotic, steatotic) and the availability of the instruments in the center.