Effects of Oral Pirfenidone on Colon Anastomosis Healing and Adhesion Formation in Rats.

INTRODUCTION: Many experimental studies have examined multiple drugs or treatments to improve the healing of intestinal anastomoses. Synthetic prostacyclin analogs, immunosuppressants, erythropoietin, growth hormone, insulin-like growth factor type 1, synthetic metalloproteinases inhibitors, and hyperbaric oxygen therapy have produced promising results in low-risk models of anastomosis dehiscence. However, in high-risk models, only hyperbaric oxygen therapy has been shown to be useful. Pirfenidone (PFD), a commonly used antifibrosing drug, has not been shown to be effective for this purpose. Our objective was to evaluate the effects of PFD on anastomosis healing and adhesion genesis in a low-risk rat model of dehiscence of colonic anastomosis. METHODS: An experimental study was conducted on 40 healthy Wistar rats randomly assigned to the control group or PFD experimental group (20 rats in each group). Colon anastomosis was performed 3 cm above the peritoneal reflection using the same technique in all animals. Mechanical resistance was studied by measuring bursting pressure. Adhesions were evaluated macroscopic and histologically using common staining techniques. Animals received the first PFD dose 12 h after surgery at a dose of 500 mg/kg one a day (SID) for 5 consecutive days. On day 6, the animals were reoperated on to measure the bursting pressure in situ and to classify adhesions macroscopically, and the anastomosed colon was resected for histological analysis. RESULTS: There were no deaths, complications, or anastomosis dehiscence in either group. The mean bursting pressure was 120.8 ± 11 mm Hg and 135.5 ± 12.4 in the control and PFD groups, respectively (p < 0.001). The adhesions were less dense and had less inflammatory cell infiltration in the PFD group (p < 0.02 and 0.002, respectively). Collagen content was slightly higher in the PFD group (p = 0.04). CONCLUSIONS: Our results revealed favorable effects of PFD in this low-risk colon anastomosis model; for example, the bursting pressure was higher, and the macroscopic adhesions were soft and exhibited less inflammatory infiltration and higher collagen content in the PFD group than in the control group. The results showing that PFD treatment was associated with better healing of minor adhesions seem to be paradoxical because the therapeutic indications for this drug are directed at treating fibrosing diseases.

Differences in Postoperative Pain, Nausea, and Vomiting After Elective Laparoscopic Cholecystectomy in Premenopausal and Postmenopausal Mexican Women.

BACKGROUND: Postoperative symptoms and pain after laparoscopic cholecystectomy (LC) are common in women. However, there is no evidence of differences in incidence and severity among different age groups. We evaluated whether adverse postoperative symptoms were more common in younger than in older women after LC. METHODS: One hundred and fifty premenopausal (mean age 37.6 ± 3.6 y) and 145 postmenopausal women (59 ± 5.2 y) were included in this retrospective cohort study. Clinical and anthropometric parameters were analyzed. Study endpoints were the incidences of postoperative nausea and vomiting (PONV) and pain, and the additional analgesics and antiemetics needed after surgery. RESULTS: Body mass index was normal in 42.7% of patients in the younger group and 64.8% in the older group (P < 0.001). Reported pain was more frequent and intense in the younger group throughout the study period (P < 0.01). Additional narcotics were required in 18% of premenopausal versus 7.6% of postmenopausal women (P = 0.001), and the doses used to reduce pain were higher for premenopausal women (P = 0.02). PONV was more frequent in the younger group at 1 and 6 h after surgery (P < 0.005). Rescue antiemetics were required in 29 premenopausal and 13 postmenopausal women (P = 0.01). Hospital stay was shorter for the older patients (P = 0.01). Minor morbidity was observed in both groups (0.7% and 2.1%). There was no mortality. CONCLUSIONS: Early PONV and pain after LC were more frequent in premenopausal women, who also required more rescue analgesic and antiemetic medication.

Effects of Oral Zafirlukast, Sildenafil, or Pirfenidone on the Formation of Postsurgical Intra-Abdominal Adhesions in an Experimental Rat Model.

INTRODUCTION: Intra-abdominal adhesions' main etiology is surgical procedures that commonly require reintervention. Oral treatments with sildenafil, zafirlukast, and pirfenidone have yielded decreased severity of fibrotic phenomena secondary to the introduction of foreign material. This study aimed to evaluate the efficacy of oral zafirlukast, sildenafil, or pirfenidone treatment on reducing or preventing intra-abdominal adhesions in an experimental rat model. METHODS: Four groups, each of 10 male Wistar rats weighing 250-300 g, were used. A midline laparotomy was used to excise an area of 1.5 × 1.5 cm and reconstructed with polypropylene mesh fixed to the abdominal wall. After 12 h, oral doses of zafirlukast (1.25 mg/kg, group B), sildenafil (15 mg/kg, group C), or pirfenidone (500 mg/kg, group D) were given every day for 8 days. The control group, A, received no treatment. At day 9, animals were reoperated. The implant was resected after ethically approved euthanasia, and specimens were fixed in 10% formaldehyde for histopathology. RESULTS: Control group A yielded adhesions with greater fibrovascular density and neighboring organ involvement than the other groups (p = 0.001), as well as intense inflammatory infiltrates and numerous granulomas (p = 0.04). Adhesions in group C had less fibrovascular density (p = 0.03) with decreased serosal injuries (p = 0.001) and less organ involvement. Group D had reduced adhesions without organ involvement (p < 0.01) and less inflammatory infiltrates, collagen fibers, and foreign body granulomas than group B or C (p < 0.01). CONCLUSIONS: Oral administration of these agents did not prevent adhesions but ameliorated them. Oral pirfenidone offered the best performance and could be recommended for human use.

Effect of a preoperative single-dose steroid on pulmonary function and postoperative symptoms after modified radical mastectomy: results of a randomized clinical trial.

BACKGROUND: Evidence suggests that a preoperative single-dose steroid improves lung function and decreases the incidence of postoperative symptoms; however, this has not been sufficiently proved in modified radical mastectomy for cancer. This study aimed to evaluate the efficacy of preoperative single-dose steroid administration for postoperative lung function and postoperative symptoms in women undergoing modified radical mastectomy for breast cancer. METHODS: In this controlled clinical trial, conducted between June 2014 and October 2018, we examined 81 patients. Patients received a preoperative single dose of 8 mg dexamethasone (n=41; treatment group) or placebo (sterile injectable water; n=40; control group). We obtained data on postoperative nausea and vomiting and pain intensity and performed spirometry 1 h before and 1, 6, 12, and 24 h after surgery. The use of additional analgesic or antiemetic drugs was recorded. We followed up patients 30 days after discharge and recorded any surgical or medical complications. RESULTS: The age distribution and anthropometric variables of the two groups were similar. Almost 50% of the patients in each group also underwent breast reconstruction. In the treatment group, pain intensity was always lower, the incidence of postoperative nausea and vomiting was lower at 6, 12, and 24 h, and additional analgesics or antiemetics were required less frequently (P<0.05 for all). Both treatment and control groups demonstrated a restrictive ventilatory pattern immediately after surgery, which in the treatment group was reversed after 24 h. However, the reconstructed patients had a more intense and prolonged restrictive pattern (P<0.05). Surgical morbidity included one seroma observed in the control group. No infections occurred at the surgical site or at any other level, and no patient developed any metabolic disorder. No mortality was observed in either group. CONCLUSIONS: This study establishes that a single preoperative dose of dexamethasone markedly decreased the incidence of postoperative nausea and vomiting and pain, improved respiratory parameters, and decreased the need for additional postoperative analgesic or antiemetic drugs. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov (ID NCT02305173).

Sexuality Among Women Treated for Breast Cancer: A Survey of Three Surgical Procedures.

BACKGROUND: The quality of life of Mexican patients with breast cancer has been studied, but female sexual function has only been explored superficially. The Female Sexual Function Index (FSFI) questionnaire has been validated as a tool to measure sexual function among women with cancer. However, no study in Mexico has been published. PURPOSE: To evaluate and compare female sexuality of breast cancer survivors treated with three surgical procedures. MATERIALS AND METHODS: This is a cross-sectional questionnaire survey applied in patients without active disease and free of any oncologic treatment who underwent conservative mastectomy, and mastectomy with and without reconstruction. Patients included in this study had no evidence of active disease after at least 2 years of postoperative follow-up and agreed to complete the FSFI questionnaire during a surveillance visit. RESULTS: Seventy-four patients were included: 37.8% had undergone conservative mastectomy, 29.7% radical mastectomy, and 32.4% radical mastectomy plus reconstruction. Patients in the radical mastectomy group were older than those in the other groups (p = 0.002). Female sexual dysfunction was observed in 34% of patients, but in patients who underwent radical mastectomy, it was 63% by contrast with 14 and 29% in women treated with conservative mastectomy and radical mastectomy with reconstruction (p = 0.001). CONCLUSIONS: We found a lower prevalence of female sexual dysfunction in patients treated with conservative mastectomy or reconstruction after radical mastectomy. Alternatively, radical mastectomy was offered to older patients, a condition that could contribute together with a loss of female perception to a higher prevalence of sexual dysfunction. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Long-term outcome after percutaneous endoscopic gastrostomy in geriatric Mexican patients.

AIM: To evaluate long-term survival and prognostic factors in elderly Mexican patients who have undergone percutaneous endoscopic gastrostomy (PEG). METHODS: The present study was a retrospective cohort analysis of 110 patients aged older than 70 years without head and neck malignancy who underwent PEG between January 2005 and December 2012. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for demographic and clinical variables, and survival was determined by the Kaplan-Meier method. RESULTS: Medium age and follow up were 82.45 ± 6.6 years and 688.3 ± 394.6 days, respectively. The patients who died in the early postoperative period (n = 6) were older than those who survived. The Karnofsky performance status and lymphocyte count were non-significantly lower in non-survivors. The body mass index and serum albumin level were lower in non-survivors (P = 0.03 and 0.01, respectively) and Charlson's Comorbidity Index (CCI) was higher. A total of 32 (29%) patients died later in the postoperative period with a mean follow up of 436.2 ± 267.4 days. Risk factors for mortality included Karnofsky Performance Status (odds ratio [OR] 9.76, 95% CI: 3.26-29.3), CCI (OR 7.04, 95% CI: 2.31-21.41) and postoperative hypoalbuminemia (OR 3.45, 95% CI: 1.71-6.67). Postgastrostomy pneumonia occurred in 36.8% of the patients who died during follow-up (OR 0.28, 95% CI: 0.6-1.26). CONCLUSIONS: Karnofsky performance status, Charlson's comorbidity index and postoperative hypoalbuminemia, were independent risk factors for mortality. Modifiable factors are related to nutritional support. Early PEG may help prevent malnutrition and infection.

2-octyl cyanoacrylate versus reintervention for closure of urethrocutaneous fistulae after urethroplasty for hypospadias: a randomized controlled trial.

BACKGROUND: Urethrocutaneous fistulae (UCFs) represent one of the most frequent causes of morbidity after urethroplasty. Hypospadias can be repaired using different surgical techniques, but-regardless of technique-the incidence of UCF ranges between 10% and 40%. Surgical repair of UCF remains the treatment of choice, even if some patients need further surgery because of recurrences. Cyanoacrylates have been used as skin suture substitutes, and some evidence suggests a beneficial effect when these adhesives are used as an adjuvant in the management of UCF. Here we describe the results of management of UCF using 2-octyl cyanoacrylate (OCA) compared with surgical repair. METHODS: A randomized clinical trial conducted from January 2008 to December 2012 included 42 children with UCF complications after urethroplasty for hypospadias. Twenty-one children were assigned to receive OCA as ambulatory patients and 21 were treated surgically. The main outcome variable was closure of the UCF. The estimated costs of both treatments were also calculated, as were absolute risk reduction (ARR), relative risk reduction (RRR) and number needed to treat (NNT) to prevent a surgical intervention. RESULTS: The mean numbers of UCF were 1.3 in the OCA group (n = 28) and 1.1 in the surgical group (n = 25) with no statistically significant difference. The external orifices measured were 2.96 ± 1.0 mm and 3.8 ± 0.89 mm, respectively (NS). Sixty per cent of the UCFs treated with cyanoacrylate were completely closed and 68% of the surgical group healed completely (NS). More than one reoperation to improve complications was needed in the surgical group (3.5 ± 1.2). The clinical significance of the therapeutic usefulness of OCA was demonstrated by an ARR of 0.08, RRR of 0.25 and NNT of 12 to avoid further surgical treatment. The total costs of adhesive applications and reoperations were $US 14,809.00 and $US 158,538.50, respectively. CONCLUSIONS: The results showed a similar success rate for both treatments. However, sealant use should be considered before surgical treatment because this is a simple outpatient procedure with a reasonable success rate. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02115191. Date: April 13, 2014.

Quality of life among women treated for breast cancer: a survey of three procedures in Mexico.

BACKGROUND: This study aimed to determine the quality of life among patients treated with one of three different types of surgery for breast cancer. METHODS: This cross-sectional study used a questionnaire survey completed by Mexican patients without active disease 1 year after breast cancer surgery. RESULTS: The 139 patients enrolled in the study included 44 (31.6 %) who had undergone mastectomy with reconstruction, 41 (29.5 %) who had undergone a quadrantectomy, and 54 (38.9 %) who had undergone radical mastectomy without reconstruction. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, core version 30 (EORTC QLQ-C30) and EORTC Breast Quality-of-Life Questionnaire (QLQ-BR23) questionnaires were used. These instruments had a reliability greater than 0.82. Global health status (94.30 ± 12.04; p = 0.028) and role functioning (85.16 ± 17.23; p = 0.138) were highest in the quadrantectomy group. The pain score was highest in the group that had received mastectomy with reconstruction (26.13 ± 30.15; p = 0.042). The breast symptom score (22.56 ± 22.30; p = 0.009) and body image perception (85.56 ± 19.72; p = 0.025) were highest in the group that had conservative treatment. The overall health of the patients who had undergone mastectomy without reconstruction was lower (72.61 ± 20.89; p = 0.014) among the women older than 50 years than among the younger women. CONCLUSIONS: The quadrantectomy procedure had better acceptance, but the overall health status did not differ between the groups. The overall health status was lower among the women older than 50 years who had received a mastectomy without reconstruction.

Serum albumin level as a risk factor for mortality in burn patients

OBJECTIVE: Hypoalbuminemia is a common clinical deficiency in burn patients and is associated with complications related to increased extravascular fluid, including edema, abnormal healing, and susceptibility to sepsis. Some prognostic scales do not include biochemical parameters, whereas others consider them together with comorbidities. The purpose of this study was to determine whether serum albumin can predict mortality in burn patients. METHODS: We studied burn patients ≥16 years of age who had complete clinical documentation, including the Abbreviated Burn Severity Index, serum albumin, globulin, and lipids. Sensitivity and specificity analyses were performed to determine the cut-off level of albumin that predicts mortality. RESULTS: In our analysis of 486 patients, we found that mortality was higher for burns caused by flame (p = 0.000), full-thickness burns (p = 0.004), inhalation injuries (p = 0.000), burns affecting >30% of the body surface area (p = 0.001), and burns associated with infection (p = 0.008). Protein and lipid levels were lower in the patients who died (p<0.05). Albumin levels showed the highest sensitivity and specificity (84% and 83%, respectively), and the area under the receiver-operating characteristic curve (0.869) had a cut-off of 1.95 g/dL for mortality. CONCLUSION: Patients with albumin levels <2 g/dL had a mortality risk of >80%, with 84% sensitivity and 83% specificity. At admission, the albumin level could be used as a sensitive and specific marker of burn severity and an indicator of mortality. .

[Totally implantable central venous access devices in patients with cancer. Experience at a private oncology center]. / Dispositivos de acceso venoso central totalmente implantables en pacientes con cáncer. Experienciaen un Centro Oncológico Privado.

BACKGROUND: Use of totally implantable central venous access ports in cancer patients is a common practice for chemotherapy not excluding early and late morbidity. OBJECTIVE: To report the experience using these devices in a private cancer center. METHODS: A consecutive series of 156 cases of patients using these devices placed by the same surgical team to enhance chemotherapy. They were evaluated over a period of 44 months. Prevalence of early and late complications and days-risk for patient infection was determined. RESULTS: In 140 cases (89.8%) patients underwent placement of totally implantable devices by surgical cut down through the external jugular vein. One case was done (0.6%) through the internal jugular, and another one (0.6%) through the cephalic vein (0.6%). In the remaining 13 cases (8.4%) devices were placed by percutaneous puncture of the subclavian vein. In one case it was impossible to place it by any of the two access ways (0.6%). The prevalence of early complications was 3.22% and of late complications 1.93%. The average days-risk for the development of infection was 473.8/patient. One case had fracture of the catheter during follow up. There was no mortality. DISCUSSION: Overall complication rate was 5.15%, similar to that reported by reference centers, without infection during follow-up. Access through the external jugular vein facilitates correct positioning of the catheter and has fewer complications. CONCLUSIONS: The combination of a trained surgical team and careful monitoring reduces morbidity and prevents infections. Access through the external jugular is recommended for its accessibility and low morbidity.

Follicular neoplasms of the thyroid: importance of clinical and cytological correlation.

BACKGROUND: Thyroid cancer presents as nodules. Thyroid nodules are frequent, but only 5-30% are malignant. Fine needle aspiration biopsy (FNAB) is useful for initial evaluation; nevertheless, malignancy is uncertain when follicular neoplasm is reported. Some factors can be associated with malignancy. Therefore, we analyzed our follicular neoplasms in order to identify those factors associated with a higher risk of malignancy. METHODS: We analyzed the clinical files of consecutive patients with cytological diagnoses of follicular neoplasm. RESULTS: From 1,005 cases of thyroid nodules, 121 were follicular neoplasms according to cytology. Of these, 75 were surgically treated. Definitive report showed 45 benign (60%) and 30 malignant (40%) cases. Benign cases included 29 goiters, 11 follicular adenomas, and 5 cases of thyroiditis. Malignant cases were comprised of 12 papillary carcinomas, 4 follicular carcinomas, 3 papillary carcinomas-follicular variant, 1 lymphoma, 1 teratoma, 5 medullary carcinomas, 2 insular carcinomas, 1 anaplastic carcinoma and 1 metastatic breast carcinoma. Tumor size of benign lesions was 3.43 ± 2.04 cm, and 4.67 ± 2.78 (p = 0.049) for malignant lesions. Age was 46.95 ± 15.39 years for benign lesions and 48.67 ± 17.28 for malignant lesions (p = 0.66). Fifty percent of males showed malignancy vs. 37.7% of females (p < 0.005). CONCLUSIONS: Our results suggest that size and gender, but not age, are associated with cytological pattern. Ultrasonographic characteristics may be useful discriminating patients with a higher risk of malignancy. FNAB is a useful tool for initial evaluation of thyroid nodules, but clinical evaluation can enhance predictive value.

[Malignant neoplasm in burn scar: Marjolin's ulcer. Report of two cases and review of the literature]. / Neoplasia maligna en cicatriz de quemadura: úlcera de Marjolin. Informe de dos casos y revisión de la literatura.

BACKGROUND: Marjolin's ulcer forms part of a group of neoplasms that originate in a burn scar, a phenomenon associated with superficial tissue trauma. The frequency of Marjolin's ulcer is low and represents between 2 and 5% of all squamous cell carcinomas of the skin. This condition is found three times more frequently in men than in women and is thought to be more aggressive than conventional squamous cell carcinoma of the skin. CLINICAL CASES: We present two cases of squamous cell carcinoma that originated on a burn scar. 41 year old woman with gasoline burn on the left foot, 3 months old, in whom an exofitic ulcerated lesion on the right calcaneum region has evolved since she was 32 years old. Left transtibial amputation was decided. Another woman who started its suffering 9 years after a thorax burn with a progressive fungus lesion on the scar area. For its size and as it was a high degree neoplasia, surgical resection and radiotherapy to the zone of the primary with 50 Gy in 25 fractions was decided. CONCLUSIONS: Marjolin's ulcer usually occurs in old burn sites that were not skin grafted and were left to heal secondarily. Although it is believed that there is a latency period of 25-40 years after burn injury before the occurrence of malignancy, this may occur in a period as short as 3 months. Recurrence after radical surgery is 14.7%. Nonetheless, because of the aggressive behavior of this type of cancer, appropriate radical treatment allows an adequate control of the disease. Early grafting of the burn site can prevent the formation a malignant neoplasm. This condition should be suspected in a non-healing chronic ulcer on a burn scar.

Neoplasia maligna en cicatriz de quemadura: úlcera de Marjolin: informe de dos casos y revisión de la literatura / Malignant neoplasm in burn scar: Marjolin's ulcer: report of two cases and review of the literature

BACKGROUND: Marjolin's ulcer forms part of a group of neoplasms that originate in a burn scar, a phenomenon associated with superficial tissue trauma. The frequency of Marjolin's ulcer is low and represents between 2 and 5% of all squamous cell carcinomas of the skin. This condition is found three times more frequently in men than in women and is thought to be more aggressive than conventional squamous cell carcinoma of the skin. CLINICAL CASES: We present two cases of squamous cell carcinoma that originated on a burn scar. 41 year old woman with gasoline burn on the left foot, 3 months old, in whom an exofitic ulcerated lesion on the right calcaneum region has evolved since she was 32 years old. Left transtibial amputation was decided. Another woman who started its suffering 9 years after a thorax burn with a progressive fungus lesion on the scar area. For its size and as it was a high degree neoplasia, surgical resection and radiotherapy to the zone of the primary with 50 Gy in 25 fractions was decided. CONCLUSIONS: Marjolin's ulcer usually occurs in old burn sites that were not skin grafted and were left to heal secondarily. Although it is believed that there is a latency period of 25-40 years after burn injury before the occurrence of malignancy, this may occur in a period as short as 3 months. Recurrence after radical surgery is 14.7%. Nonetheless, because of the aggressive behavior of this type of cancer, appropriate radical treatment allows an adequate control of the disease. Early grafting of the burn site can prevent the formation a malignant neoplasm. This condition should be suspected in a non-healing chronic ulcer on a burn scar.

[Neoadjuvant treatment for locally advanced breast cancer. Comparison of two schemes based on docetaxel-epirubicin vs. 5-fluorouracil-epirubicin-cyclophosphamide]. / Tratamiento neoadyuvante del cáncer de mama localmente avanzado. Comparación de dos esquemas a base de docetaxel-epirrubicina versus 5-fluoraciloepirrubicina-ciclofosfamida.

BACKGROUND: Breast cancer is the most common type of cancer in women worldwide. In Mexico, >34% of patients are in locally advanced stages at the time of diagnosis. Neoadjuvant chemotherapy is administered to control local disease, make surgical resection possible and increase the possibility of breast tissue conservation. METHODS: We performed a double-blind, randomized clinical trial in patients with locally advanced breast cancer (stages IIB and IIIA) with two therapy schemes; 5-fluorouracil-epirubicin-cyclophosphamide (control group) vs. docetaxel-epirubicin (study group). Both were indicated in three preoperative cycles, and patients were submitted afterwards to surgery. Pathological response was measured. RESULTS: Forty one patients were included in our study. They were distributed in two homogeneous groups: 21 in the control group and 20 in the study group. Dimensional pathological response was higher in the study group than in the control one (p <0.05). Five patients in the control group and ten patients of the study group experienced complete pathological response (p <0.05). The most common secondary events were leucopenia, neutropenia and fever. Morbidity, number of lymph nodes, disease-free survival and general survival did not show significant differences between groups. No mortality was reported during a minimum follow-up of 28 months. CONCLUSIONS: Our results confirm the effectiveness of docetaxel-epirubicin to obtain complete pathological response. Neoadjuvant therapy has been shown to increase the pathological response when a taxane is added to an anthracycline. This combination presented more secondary events, but they can be effectively managed medically. Neoadjuvant docetaxel-epirubicin followed by surgery is an appropriate regimen for patients with locally advanced breast cancer.

Tratamiento neoadyuvante del cáncer de mama localmente avanzado: comparación de dos esquemas a base de docetaxel-epirrubicina versus 5-fluoraciloepirrubicina-ciclofosfamida / Neoadjuvant treatment for locally advanced breast cancer: comparison of two schemes based on docetaxel-epirubicin vs. 5-fluorouracil-epirubicin-cyclophosphamide

BACKGROUND: Breast cancer is the most common type of cancer in women worldwide. In Mexico, >34% of patients are in locally advanced stages at the time of diagnosis. Neoadjuvant chemotherapy is administered to control local disease, make surgical resection possible and increase the possibility of breast tissue conservation. METHODS: We performed a double-blind, randomized clinical trial in patients with locally advanced breast cancer (stages IIB and IIIA) with two therapy schemes; 5-fluorouracil-epirubicin-cyclophosphamide (control group) vs. docetaxel-epirubicin (study group). Both were indicated in three preoperative cycles, and patients were submitted afterwards to surgery. Pathological response was measured. RESULTS: Forty one patients were included in our study. They were distributed in two homogeneous groups: 21 in the control group and 20 in the study group. Dimensional pathological response was higher in the study group than in the control one (p <0.05). Five patients in the control group and ten patients of the study group experienced complete pathological response (p <0.05). The most common secondary events were leucopenia, neutropenia and fever. Morbidity, number of lymph nodes, disease-free survival and general survival did not show significant differences between groups. No mortality was reported during a minimum follow-up of 28 months. CONCLUSIONS: Our results confirm the effectiveness of docetaxel-epirubicin to obtain complete pathological response. Neoadjuvant therapy has been shown to increase the pathological response when a taxane is added to an anthracycline. This combination presented more secondary events, but they can be effectively managed medically. Neoadjuvant docetaxel-epirubicin followed by surgery is an appropriate regimen for patients with locally advanced breast cancer.

[Frequency of heart tumors and their histopathological correlation]. / Frecuencia de tumores cardiacos y su correlación histopatológica.

BACKGROUND: The presentation of heart tumors is very uncommon. Eighty percent of primary heart neoplasias are benign, and myxomas represent the first cause in frequency among adult populations. Due to the frequency of presentation of these tumors, it is common to make the clinical/surgical diagnosis without obtaining histopathologic confirmation. Our objective was to determine the frequency of presentation of heart tumors and its correlation between the surgical/clinical and histopathologic diagnosis in our Institute. METHODS: This is a case series with 16 patients with cardiac tumors treated surgically at the Department of Cardiothoracic Surgery during a 4-year period. We used descriptive statistics, and quantitative variables are expressed as mean, range and standard deviation whereas qualitative variables were described as proportions. RESULTS: We included 3 men (19%) and 13 women (81%) with a mean age of 41.4 +/- 16.2 years. Clinical presentation was predominantly of congestive heart failure. Clinical diagnosis was determined in 15 patients (94%) and just one case of intracardiac thrombus (6%), whereas the histopathologic diagnosis reported myxoma in only 11 cases (68.8%), three patients with intra-cardiac thrombus (18.7%) and two patients with sarcomas (12.5%), leiomiosarcoma and angiosarcoma, respectively. We found a positive correlation between the clinical diagnosis and the histopathology results. There was no mortality. CONCLUSIONS: Even though myxomas represent the most frequent proportion of presentation in heart tumors, histopathological confirmation is necessary for diagnosis. Clinical and histopathologic correlation represents the basis for the choice of adequate management strategies and prognosis for the patient.

[Reduction of lymphatic drainage posterior to modified radical mastectomy with the application of fibrin glue]. / Reducción del drenaje linfático posterior a mastectomía radical modificada con la aplicación de gel de fibrina.

OBJECTIVE: Our objective was to investigate the effectiveness of fibrin glue to reduce hemato-lymphatic fluid production after modified radical mastectomy (MRM) in women with breast cancer. MATERIAL AND METHODS: A total of 43 women treated surgically were randomly assigned to receive 10 ml of fibrin glue at the end of the breast resection plus closed suction drains (n = 22), or drain system only as a control group (n = 23). Outcome variables were fluid collected in the drainage system measured each 24 h. Drains were removed when a 50 ml output per day was obtained. Seroma formation and flap complications were also investigated. RESULTS: The average age was 48.36 +/- 8.9 years for the study group and 52.87 +/- 9.74 years for the control group (p = 0.11). Body mass index (BMI) ranged between 22 and 35 kg/m2: 28.1 +/- 2.7 vs. 29.92 +/- 4.0 kg/m2 (p = 0.27). A reduction of the fluid drained was observed from the first postoperative day in the study group in contrast with the control (174.55 +/- 64.69 vs. 281.22 +/- 116.91, p = 0.001). A correlation between the BMI and the exposed surgical area was also statistically significant (p < 0.002), as well as the day the drains were extracted (p < 0.05). The incidence of seroma formation was 9% in the study group and 34.78% in the control, a statistically significant finding (p < 0.05). CONCLUSIONS: Fibrin glue locally applied to the surgical wound under the flap and axilla significantly reduced the amount and duration of lymphatic fluid produced after MRM with axillary dissection. Also, a significant reduction in the incidence of seromas was observed.

[Sensitivity, specificity, and predictive values of the level of hemoglobin, hematocrit and platelet count as an activity index in ulcerative colitis]. / Sensibilidad, espedificidad y valores predictivos del nivel de hemoglobina, hematócrito y cuenta plaquetaria como índices de actividad en colitis ulcerativa.

INTRODUCTION: Ulcerative colitis (UC) is a disease characterized by relapsing and remitting non-infectious inflammation of the colorectal mucosa. Its heterogeneity makes assessment of the disease's activity a prerequisite for a rational choice of therapy. We aimed to determine sensitivity, specificity, positive and negative predictive values of hemoglobin, hematocrit, and platelets to develop a simplified activity index of UC. MATERIAL AND METHODS: Sixty patients with UC were included and submitted to measurements of hemoglobin, hematocrit, and platelets, as well as sigmoidoscopy and biopsy. Sensitivity and specificity, positive and negative predictive values were correlated with the reported degree of activity in the biopsy. Kruskal-Wallis test was used to determine differences between groups, and Pearson and Spearman rank tests were used to correlate each parameter with the degree of activity. A p value < 0.05 was considered statistically significant. RESULTS: The patients had moderate (n = 15), severe (n = 15), and normal histology as a control group (n = 15). Thirty-four (57%) were female and 26 (43%) were male. Average age was 26 +/- 12.8 years. Sensitivity and specificity for hemoglobin level was 51% and 100% for hematocrit, respectively, 51% and 100% for hematocrit, and 84% and 100% for platelet counts. Spearman's correlation for hemoglobin was r = -0.866 (p < 0.001), for hematocrit r = -0.864 (p < 0.001) and for platelets r = 0.928 (p < 0.001). CONCLUSIONS: Hemoglobin and hematocrit are useful to catalog the degree of activity of UC when it is severe. Platelet count may be a marker of severity at any time, due to its high sensitivity and specificity as a diagnostic test.

[Academic medicine and gender: women in surgical specialities]. / Medicina académica y género. La mujer en especialidades quirúrgicas.

Scientific advances have always been used as a measure to place societies in the context of developed and developing countries. This circumstance has directly influenced the division among the sexes and among social strata. Traditionally women have been relegated to an inferior status and in some instances their role as active participants in social and economic development has been annulled. In professional spheres, women have reached positions that previously seemed unattainable due to social and cultural limitations imposed by men and sometimes by women themselves. Medical school is currently no longer an obstacle for women to gain entry to, approximately 50% of medical students are women. On the other hand, surgical residences constitute a more complex situation. In order for women to decide to apply to a surgical residence, they have to take into account a variety of factors, among them, the difficulty of joining a male dominated environment where women have to demonstrate they are able and capable of performing sometimes at the expense of having to carry an additional work load. Women admitted to surgical residences will have to face gender discrimination, pregnancy and family responsibilities as well as salary inequities and sometimes even sexual harassment. We aimed to show the circumstances and obstacles that women are confronted with during surgical training and the influence these have in their personal and professional development.