Laparoscopic ventral hernia repair: does IPOM plus allow to increase the indications in larger defects?

PURPOSE: The laparoscopic ventral hernia repair (LVHR) may have a limit of effectiveness, especially in defects greater than 80 cm2, with a higher recurrence rate which contraindicates this technique. The purpose of this study is to analyze the indication of LVHR determining and comparing the recurrence rate according to defect size in two series. METHODS: We analyzed all patients who underwent LVHR between 2007 and 2017. Patients were divided according to the ring size: < o ≥ 80 cm2 into group one (G1) and group two (G2) respectively. In both groups, all three techniques were used: intraperitoneal onlay mesh (IPOM), IPOM with closure of the defect (IPOM plus), and IPOM plus + anterior videoscopic component separation (AVCS). RESULTS: A total of 258 patients underwent LVHR. Mean recurrence rate was 13% in G1 and 24% in G2. A statistically significant difference was found when comparing the IPOM technique among both groups, with a higher recurrence rate when ring size was ≥ 80 cm2 (p < 0.5). However, when comparing recurrence rate in IPOM plus and IPOM plus + AVCS between both groups, no significant differences were observed, yielding a p of 0.51 and 0.63, respectively. CONCLUSION: The IPOM technique has shown a limit of effectiveness in large ventral hernia defects. The combination of techniques (ring closure and AVCS) may be useful to expand the indication for this surgery to larger defects and to reduce the recurrence rate. Prospective randomized studies are required to confirm this trend.

Glositis romboidal media: revisión a propósito de un caso clínico / glossitis Rhomboid average: review of a clinical case

La glositis romboidal media (GRM) es una alteración benigna, poco frecuente, que afecta ligeramente más a los varones. Suele localizarse en la línea media del dorso de la lengua por delante de la “V” lingual, en forma de área rojiza, romboidal, de superficie plana, como una mácula o a veces exofítica, mamelonada, que puede sobresalir de 2 a 5 mm y en la que no se observan papilas filiformes. Se presenta el caso clínico de un varón de 50 años de edad que consulta por presentar una lesión en dorso de lengua, situada en la línea media.

Median rhomboid glossitis (MRG) is an uncommon benign abnormality of the tongue, most frequently affecting men. It is typically located around the midline of the dorsum of the tongue, anterior to the lingual “V”, appearing as a reddish, rhomboid area, depapillated, flat maculate or mamillated and raised by2- 5 mm. This paper reports a case of rhomboid glossitis in a 50-year-old man who consulted for a lesion on the dorsum of the tongue, in a medial location.

MGMT methylation in diffuse large B-cell lymphoma: validation of quantitative methylation-specific PCR and comparison with MGMT protein expression.

AIMS: (1) To validate a quantitative real time methylation specific PCR assay (MethyLight) for the detection of O6-methylguanine-DNA methyltransferase (MGMT) gene methylation status (MS) in diffuse large B-cell lymphoma (DLBCL). (2) To determine the immunohistochemical (IHC) expression of the MGMT protein and correlate it with MS. Both IHC and MethyLight results were compared with patient's outcome. METHODS: 71 patients with primary nodal DLBCL were studied. MGMT immunoreactivity was detected using a specific monoclonal antibody. The MS of MGMT gene was analysed in 52/71 DLBCL using MethyLight. A selected subset of 40 DLBCL was also analysed using qualitative methylation-specific PCR (MSP). Statistical analysis of overall survival (OS), lymphoma-specific survival (LSS) and progression free survival (PFS) was performed according to IHC and MS results. RESULTS: 19/71 DLBCLs (27%) were MGMT-negative at IHC; all were analysed, together with 33/52 MGMT-positive DLBCLs. MethyLight showed a better performance than MSP. There was a good correlation between the presence of MGMT expression and the unmethylated status; the absence of IHC expression was poorly correlated with the presence of methylation. Better OS, LSS and PFS was found in DLBCLs with MGMT gene methylation. DLBCLs not expressing MGMT at IHC showed a longer PFS. CONCLUSIONS: The quantitative real-time methylation-specific PCR assay for the detection of MGMT gene hypermethylation has been validated for the first time in DLBCL. Immunohistochemistry seems to represent an useful preliminary test to identify unmethylated cases; MS analysis may be performed in non-immunoreactive cases to identify truly methylated DLBCLs, which bear a better prognosis.

Eventroplastia convencional vs eventroplastia laparoscópica: análisis de recidiva y morbilidad postoperatoria / Open and laparoscopic incisional hernia repair: recurrence and morbidity rates

Antecedentes: el tratamiento de las eventraciones es todavía motivo de controversia y ha originado nuevas alternativas terapéuticas en la búsqueda de un menor índice de recidiva y morbilidad postoperatoria. Objetivo: comparar el índice de recidiva y morbilidad postoperatoria en una serie de eventroplastías laparoscópicas y convencionales. Lugar de aplicación: Hospital Privado de Comunidad. Diseño: estudio comparativo no randomizado de una base prospectiva de datos. Población: entre junio 1997 y diciembre de 2002 se incluyeron 62 eventroplastías laparoscópicas y 65 eventroplastías convencionales. Criterios de inclusión: cirugía programada, colocación de malla, anillo eventrógeno entre 10 y 150 cm cuadrados, eventroplastía como única cirugía. Método: análisis comparativo entre grupos con distinta vía de abordaje (laparoscópico vs convencional). Se utilizaron test de Student, Z-Test y Chi-cuadrado. Una p < 0,05 se consideró significativa. Resultados: ambos grupos fueron homogéneos en cuanto a características demográficas y del defecto eventrógeno. El tiempo operatorio y de internación fue significativamente mayor en el grupo operado por vía abierta. El índice de morbilidad fue significativamente menor en el grupo abordado por vía laparoscópica. El índice de recidiva fue menor en el grupo laparoscópico, sin presentar diferencias significativas. Conclusión: la eventroplastía laparoscópica demostró ser, en nuestra serie, una técnica efectiva, con un menor índice de morbilidad y un índice de recidiva aceptable en comparación con la técnica convencional

Chromosome 6 abnormalities in ovarian surface epithelial tumors of borderline malignancy suggest a genetic continuum in the progression model of ovarian neoplasms.

PURPOSE: We used conventional cytogenetics, molecular cytogenetics, and molecular genetic analyses to study the pattern of allelic loss on chromosome 6q in a cohort of borderline epithelial ovarian tumors. EXPERIMENTAL DESIGN: Fifteen tumor samples were collected from patients undergoing surgery for ovarian tumors. The tumors of borderline malignancy, classified according to the standard criteria, included 4 mucinous and 11 serous tumors. Cytogenetic and molecular cytogenetic (with yeast artificial chromosome clones from 6q26-27) studies were performed on tumor areas contiguous to those used for histological examination ensuring the appropriate sampling. Moreover loss of heterozygosity analysis was performed using PCR amplification of eight microsatellite markers mapping on 6q27 (D6S193, D6S297), 6q26 (D6S305, D6S415, D6S441), 6q21 (D6S287), 6q16 (D6S311), and 6q14 (D6S300). RESULTS: Deletions of this chromosome arm, in particular of 6q24-27, were the most frequent lesions found in this set of tumors. In a tumor with a normal karyotype the only detectable alteration was a deletion of approximately 300 kb within the D6S149-D6S193 interval at band 6q27. This is, to date, the smallest deletion described for borderline tumors. CONCLUSION: Alterations in the above-mentioned interval are a common finding in advanced ovarian carcinomas but also in benign ovarian cysts, implying that some tumors of borderline malignancy may arise from benign tumors and that malignant ones may evolve from tumors of borderline malignancy. Genes located in 6q27 seem to be crucial for this mechanism of early events in ovarian tumorigenesis.

A large 6q deletion is a common cytogenetic alteration in fibroadenomas, pre-malignant lesions, and carcinomas of the breast.

To assess whether early breast lesions are the precursors of invasive carcinomas, three classes of breast lesions, namely benign tumors (including fibroadenomas), putative premalignant lesions (including cases of atypical hyperplasia), and invasive carcinomas, were compared at the cytogenetic and molecular cytogenetic levels. Genetic relatedness was clearly demonstrated by the sharing of several anomalies, among which 6q deletions outnumbered all of the other alterations detected. Indeed, deletions of the long arm of chromosome 6, most likely occurring in epithelial cells, were present in 83.9% of benign breast tumors, 64% of putative premalignant lesions, and 77.4% of analyzable carcinomas. Furthermore, the interval between 6q24 and qter appeared to be the common region of deletion in all three classes of breast lesions, whereas the minimal common region of deletion was 6q27-qter. Interestingly, the latter region was reported previously to be deleted in benign ovarian tumors and recently found to harbor a gene (SEN6) that is important for SV40-mediated immortalization of human cells.

Microsatellite instability in gastric MALT lymphomas and other associated neoplasms.

BACKGROUND: Microsatellite instability (MSI), caused by a reduced efficacy of the DNA mismatch repair (MMR) machinery, represents a type of genomic instability frequently detected in HNPCC spectrum cancers and in a subset of sporadic carcinomas. The involvement of MSI in the pathogenesis of gastric lymphoma of mucosa-associated lymphoid tissue (MALT) has never been conclusively investigated. In this study, we tested the presence of MSI in tumor samples of patients harboring both MALT lymphomas and other types of malignancies. MATERIALS AND METHODS: We examined 10 microsatellite loci (D3S11, D3S1261, D3S1265, D6S262, D6S193, BAT-26, BAT-25, D17S250, APC, D2S123) out of a total of 34 primary tumors from 14 patients with MALT lymphomas and one or more additional neoplasms. The patients' MSI results were also tested for an association with a positive family history of cancer. RESULTS: MSI, defined by the presence of microsatellite alterations in more than 40% of the examined loci, was scored negative in all tumors studied, and pedigree analysis failed to identify any condition of familial cancer among the patients examined. CONCLUSIONS: The present study suggests that defects in DNA mismatch repair do not contribute significantly to the molecular pathogenesis of MALT lymphomas and associated neoplasms.

Mesalamine in the treatment of mild to moderate active Crohn's ileitis: results of a randomized, multicenter trial.

BACKGROUND & AIMS: The efficacy of 5-aminosalicylic acid (mesalamine) in the treatment of flare-ups of Crohn's disease is controversial. In previous studies, different locations and pathological behavior of Crohn's disease could have obscured the efficacy of these drugs that deliver their substance in different intestinal sites. The present study tested two different mesalamine formulations with 6-methylprednisolone in mild to moderate active Crohn's ileitis. METHODS: Ninety-four patients with Crohn's ileitis (Crohn's Disease Activity Index [CDAI], 180-350) were randomly assigned to receive for 12 weeks mesalamine tablets, 4 g (35 patients); mesalamine microgranular preparation, 4 g (28 patients); and 6-methylprednisolone, 40 mg (31 patients). Mesalamine microgranular preparation was a gelatin capsule containing 400 mg of mesalamine microgranules coated with Eudragit S, which has been shown to deliver the drug in the terminal ileum. RESULTS: Patients taking mesalamine tablets experienced a decrease of CDAI median score value of 113.5 (95% confidence interval [CI], 33-149) compared with 123 (95% CI, 77-155) in the mesalamine microgranular group and 154 (95% CI, 99-197) in the 6-methylprednisolone group (P = 0.07 [NS]). Remission at the final visit occurred in 19 of 31 (61%) patients taking steroids compared with 21 of 35 (60%) patients taking mesalamine tablets and 22 of 28 (79%) patients taking microgranular mesalamine (NS). Five patients on steroids were withdrawn because of side effects, and a case of pancreatitis was related to microgranular mesalamine. CONCLUSIONS: Mesalamine in microgranular formulation seems to be equally as effective as a standard dosage of steroids in the treatment of the mild to moderate form of Crohn's ileitis.

Renal genetic mechanisms of essential hypertension.

Human essential hypertension is a polygenic disease whose phenotypic expression is modulated by the environment. Though the kidney could play a major role in the initiation and maintainment of hypertension, many questions remain open. Rat models of primary hypertension provided the substantial information with experiments on kidney cross-transplantation showing that at least a portion of hypertension could be transplanted with the kidney in all strains where such experiment has been carried out. Data consistent with those of rats have also been obtained in humans. Many abnormalities in kidney function and cell membrane on transport have been described in hypertensive rats and humans but the logical sequence of events going from a genetic-molecular abnormality to a cellular abnormality which causes hypertension via a modification of kidney function is difficult to prove. We established this sequence in Milan hypertensive rats using a variety of experimental techniques such as the study of isolated kidney and renal cell function, cell membrane ion transport, cross-immunisation with membrane proteins, molecular biology, genetic crosses and manipulation. Such study led to the identification of a polymorphism in the cytoskeletal protein adducin and to the demonstration of its role in blood pressure control. Recently, alpha-adducin variants have been associated to both human primary hypertension and salt sensitive hypertension. Finally, recent findings strongly support the hypothesis that adducin variants may affect kidney function by modulating the overall capacity of the tubular epithelial cells to transport ions through both a modification in the assembly of actin cytoskeleton, and a modulation of sodium pump activity.

Reduction in urinary prostaglandin excretion in the premenstrual syndrome.

The purpose of the present work was to study some factors involved in renal handling of salt and water in the premenstrual syndrome (PMS), in which salt and water retention is frequently observed. In 18 women with PMS and in 18 healthy women we studied the levels of cyclic adenosine monophosphate, aldosterone, prostaglandin E2, prostaglandin F2 alpha and kallikrein in urinary samples collected during the luteal phase. There was no difference between the two groups regarding sodium, aldosterone and kallikrein urinary excretion. In the PMS group there was a significant reduction in urinary excretion of cyclic adenosine monophosphate, prostaglandin E2 and prostaglandin F2 alpha with respect to the control group. At multivariate analysis sodium urinary excretion proved not to be the same as the model validated in healthy women. There may be different renal handling of water and electrolytes during the luteal phase of the menstrual cycle in women with PMS.

Flora bacteriana heterotrófica em ostras (Crassostrea rhizophorae) e águas da Baía Norte, Ilha de Santa Catarina, Brasil / Heterotrophic bacteria in oysters and waters of North Bay, Santa Catarina, Brazil

A população bacteriana das águas da Baía Norte da Ilha de Santa Catarina foi estudada utilizando-se a ostra Crassostrea rhizophorae como biondicador. Foram realizadas avaliações quali-quantitativas de bactérias heterotróphicas originárias da água do mar e de ostras de três locais da Baía. Nas ostras, analisou-se a massa digestiva e o corpo inteiro do animal. Os resultados mostram altas concentrações de bactérias na água e nos bivalves. A maior acumulação de microrganismos foi detectada no trato digestivo das ostras. Enterobactérias predominam na água enquanto as Pseudomonadaceae são mais frequentes nos bivalves.

Incision subcostal en cirugia biliar.Evaluacion en 100 casos consecutivos. / Subcostal incision in biliary surgery. Evaluation in 100 consecutive cases

Se evaluo la incision subcostal de Kocher en sus aspectos tecnicos y su morbilidad postoperatoria, estudiando restrospectivamente 100 operados consecutivos por patologia biliar. Se encontro que con la tecnica empleada no se prolonga en forma apreciable la intervencion y que los pacientes presentaron una rapida recuperacion postoperatoria con un bajo indice de complicaciones de la herida