Carcinoma pulmonar de celulas pequeñas en paciente neumonectomizada no fumadora - primera criobiopsia por fibrobroncoscopia en bolivia, presentación de caso clínico / Small cell lung carcinoma in a non-smoking pneumonectomized patient - first cryobiopsy by fibrobronchoscopy in Bolivia, case report

El cáncer broncogénico tiene una base genética, que se expresa por factores externos relacionados a la exposición medioambiental y laboral, en los últimos años ha cambiado el perfil epidemiológico con incidencia creciente en mujeres sin hábito tabáquico en rangos de 50-70 años. Paciente femenino de 50 años con el antecedente de exposición a humo de leña y uso de pesticidas, con síndrome de atelectasia pulmonar masiva izquierda. Se realizó estudios fibrobroncoscopicos con toma de biopsia de masa tumoral endobronquial izquierda y se realizó la primera criobiopsia por fibrobroncoscopía en Bolivia, posteriormente paciente fue sometida a neumonectomia izquierda con estudio histopatológico concluyente de carcinoma indiferenciado de células pequeñas con primario pulmonar. Existe una fuerte asociación entre la exposición medio-ambiental y laboral y el cáncer broncogénico en pacientes no fumadores, incluso en variantes histopatológicas infrecuentes en este subgrupo como el cáncer de células pequeñas o microcítico.

Bronchogenic cancer has a genetic basis, which is expressed by external factors related to environmental and occupational exposure. In recent years, the epidemiological profile has changed with increasing incidence in women without tobacco habit in ranges of 50-70 years. A 50-year-old female patient with a history of exposure to wood smoke and pesticide use, with massive left lung atelectasis syndrome. Fibrobronchoscopy studies were performed with a biopsy of the left endobronchial tumor mass and the first cryobiopsy was performed by fibrobronchoscopy in Bolivia, later the patient underwent left pneumonectomy with a conclusive histopathological study of undifferentiated small cell carcinoma with a pulmonary primary. There is a strong association between environmental and occupational exposure and bronchogenic cancer in non-smokers, even in infrequent histopathological variants in this subgroup such as small cell or microcytic cancer.

Evaluation of the cytokines response in buffaloes focused on its milk as a newly emerging indicator tracing for toxocariasis.

This study aimed to evaluate the immune responses and oxidative stress provoked by Toxocara vitulorum infection in buffaloes with special reference to milk parameters as an emerging tool. The use of the milk tool was reported for the first time in tracing T. vitulorum infection in Egyptian buffaloes. Intestine, milk, serum, and liver samples were gathered from flocks in Cairo and Giza districts to evaluate buffalo immune responses provoked by T. vitulorum. The compositional items and somatic cells of milk were monitored. The intestine and milk were evaluated for interleukin IL-1ß, IL-6, and tumor necrosis factor-alpha (TNF-α) by quantitative real-time polymerase chain reaction protocol and the analysis of malondialdehyde (MDA) as an oxidative stress marker. The mean percentages for the total solids, fats, proteins, lactose, salts, pH, and somatic cell count/ml in positive samples were 11.23 ± 0.37, 5.1 ± 0.17, 4.44 ± 0.14, 3.9 ± 0.14, 0.81 ± 0.02, 6.8 ± 0.22, and 4.23 × 106± 1.41 × 105 cells/ml, respectively. A significant difference (p < 0.05) was observed in the mean values of compositional items except for the total protein %, salts %, and pH. For T. vitulorum-contaminated samples, the milk IL-1ß, IL-6, TNF-α, and MDA (nmol/ml) were 7 ± 0.23, 18 ± 0.6, 17 ± 0.56, and 3.7 ± 0.12, respectively (which were less than the values for intestinal cytokines). There is a statistical difference (p < 0.05) between positive and negative samples in the intestinal, milk cytokines, and MDA. This study is an initial investigation of the utilization of intestine and milk cytokines in the evaluation of buffalo toxocariasis.

Milk tumor necrosis factor alpha (TNF-α), interleukin-1 beta (IL-1ß), interferon (IFN-γ) and oxidative stress markers as new indicators for fascioliasis in dairy water buffaloes.

Sixty Bubaline milk samples with corresponding blood samples were obtained from flocks at random in Cairo and Giza Governorates. The aerobic bacteria & somatic cells were counted and evaluated the physicochemical parameters of milk. Both milk and serum of buffaloes' were evaluated for tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1ß), and interferon (IFN-ɤ) by quantitative real-time PCR protocol, and oxidative stress markers were measured spectrophotometrically. There was a significant difference (p < 0.05) between the mean values of whole milk physicochemical aspects except the moisture % & pH values were recorded for infested and non-infested animals. For F. gigantica infested animals, the milk TNF-α, IL-1ß, interferon IFN-γ, malondialdehyde (MDA), and total antioxidant capacity (TAC) values were 17.5 ± 0.67, 18.5 ± 0.71, 19.25 ± 0.74, 7.75 ± 0.29, and 1.1 ± 0.04, respectively (lesser than serum values) with a significant difference (p < 0.05) between positive and negative samples for both examined serum and milk samples. There was also a significant (p < 0.05) negative relationship between MSCC & fat% and protein%, while a significant (p < 0.05) positive relationship between MSCC and the investigated milk cytokines in F. gigantica infested animals. This study is considered one of the fewest investigations of milk cytokines and oxidative stress markers in buffaloes fascioliasis diagnosis. Meanwhile, monitoring these genes modification that is active in the milk-producing gland is significant to typify the act technicality of the inherited immunity that helps the progress of schemes to retain the udder health.

Dysregulation of mitochondrial function and biogenesis modulators in adipose tissue of obese children.

BACKGROUND/OBJECTIVES: We aimed to evaluate mitochondrial biogenesis (MB), structure, metabolism and dysfunction in abdominal adipose tissue from male pediatric patients with obesity. SUBJECTS/METHODS: Samples were collected from five children with obesity (percentile ⩾95) and five eutrophic boys (percentile ⩾5/⩽85) (8-12 years old) following parental informed consent. We analyzed the expression of key genes involved in MB (sirtuin-1 (SIRT1), peroxisome proliferator-activated receptor-γ (PPARγ), PPARγ coactivator-1α (PGC1α), nuclear respiratory factors 1 and 2 (NRF1, NRF2) and mitochondrial transcription factor A (TFAM) and surrogates for mitochondrial function/structure/metabolism (porin, TOMM20, complex I and V, UCP1, UCP2, SIRT3, SOD2) by western blot. Citrate synthase (CS), complex I (CI) activity, adenosine triphosphate (ATP) levels, mitochondrial DNA (mtDNA) content and oxidative stress end points were also determined. RESULTS: Most MB proteins were significantly decreased in samples from children with obesity except complex I, V and superoxide dismutase-2 (SOD2). Similarly, CS and CI activity showed a significant reduction, as well as ATP levels and mtDNA content. PPARγ, PGC1α, complex I and V and SOD2 were hyperacetylated compared with lean samples. Concurrently, in samples from children with obesity, we found decreased SOD2 activity and redox state imbalance highlighted by decreased reduced glutathione/oxidized glutathione (GSH/GSSG) ratio and significant increases in protein carbonylation. CONCLUSIONS: Adipose tissue from children with obesity demonstrates a dysregulation of key modulators of MB and organelle structure, and displays hyperacetylation of key proteins and altered expression of upstream regulators of cell metabolism.

Pesticide residue analyses and biomarker responses of native Costa Rican fish of the Poeciliidae and Cichlidae families to assess environmental impacts of pesticides in Palo Verde National Park.

Pesticide chemical residues in water samples and biomarker responses in transplanted fish were used to monitor environmental hazards of pesticides in Palo Verde National Park (Costa Rica). The Costarican fish, Parachromis dovii (Ciclhidae) and Poecilia gillii (Poecillidae), were selected as sentinel species. Contaminant analyses detected up to 15 different pesticide residues in water with hexachlobenzene (2261 ng l(-1)), phorate (473 ng l(-1)), epoxiconazole (314) and bromacil (117 ng l(-1)) being the compounds found in higher concentrations. Biomarker responses evidenced impacts on cholinesterase activities in transplanted fish at Barbudal site probably due to the presence of organophosphate insecticides such as phorate. High enzyme activities of glutathione S-transferase and catalase and elevated levels of lipid peroxides were also observed at a site impacted by rice fields (Cabuyo); those effects could be associated with the presence of hexachloro benzene and triazole fungicides. In general, P. dovii biomarkers were affected to a greater extent than those of P. gillii in fish transplanted to sites associated with agriculture, which suggests the former species is a good candidate for future surveys.

Development of quantitative RNA biomarkers for detecting dioxin-like and estrogenic pollutants in Costa Rican native fish species.

Monitoring the environmental impact on native species is crucial for the correct management of tropical ecosystems. The Costa Rican fish Parachromis dovii (Cichlidae) and Poecilia gillii (Poecillidae) were used as sentinel species for freshwater bodies under considerable pressure by intensive agriculture Cichlidae development. Suitable qRT-PCR probes for the quantification of hepatic mRNA levels of two stress-related genes--vitellogen in (estrogenic effects) and cytochrome P4501A(CYP1A, dioxin-like compounds)--for both species were designed and validated in experimental treatments with model effectors (17beta-estradiol and beta-naphtoflavone, respectively), demonstrating their usefulness as markers of exposure to these two kinds of pollutants. Analysis of fish transplanted across pesticide contaminated sites near Palo Verde National Park, Pacific Coast of Costa Rica did show significant changes on hepatic Cyp1A in both species. In P. dovii, Cyp1A levels were enhanced in Barbubal and in the impacted Cabuyo sites in the rainy season whereas in P. gillii fish Cyp1A transcripts were down-regulated differently across rainy and dry seasons. Vitellogen in mRNA levels in P. gillii varied between males and females with males showing always low values which indicated no estrogenic effects. Within females, vitellogenin levels varied over 100,000 fold depending on their maturation stage, further demonstrating the ability of the method to monitor changes (natural or induced) in the reproductive system of the fish.

Prolactin fractions from lactating rats elicit effects upon sensory spinal cord cells of male rats.

Recently it has been suggested that the neurohormone prolactin (PRL) could act on the afferent nociceptive neurons. Indeed, PRL sensitizes transient receptor potential vanilloid 1 (TRPV1) channels present in nociceptive C-fibers and consequently reduces the pain threshold in a model of inflammatory pain. Accordingly, high plasma PRL levels in non-lactating females have been associated with several painful conditions (e.g. migraine). Paradoxically, an increase of PRL secretion during lactation induced a reduction in pain sensitivity. This difference could be attributed to the fact that PRL secreted from the adenopituitary (AP) is transformed into several molecular variants by the suckling stimulation. In order to test this hypothesis, the present study set out to investigate whether PRL from AP of suckled (S) or non-suckled (NS) lactating rats affects the activity of the male Wistar wide dynamic range (WDR) neurons. The WDR neurons are located in the dorsal horn of the spinal cord and receive input from the first-order neurons (Ab-, Ad- and C-fibers). Spinal administration of prolactin variant from NS rats (NS-PRL) or prolactin variant from S rats (S-PRL) had no effect on the neuronal activity of non-nociceptive Ab-fibers. However, the activities of nociceptive Ad-fibers and C-fibers were: (i) increased by NS-PRL and (ii) diminished by S-PRL. Either NS-PRL or S-PRL enhanced the post-discharge activity. Taken together, these results suggest that PRL from S or NS lactating rats could either facilitate or depress the nociceptive responses of spinal dorsal horn cells, depending on the physiological state of the rats.

Environmental hazards of pesticides from pineapple crop production in the Río Jiménez watershed (Caribbean Coast, Costa Rica).

This study aimed to characterize environmental hazards of pesticides from pineapple production in riparian communities along the Jiménez River watershed. To achieve our objectives riparian ecological quality indices on riparian habitat and macroinvertebrate assemblages were combined with toxicity assays, fish biomarkers, physico-chemical water analysis and pesticide environmental hazards. During two consecutive years and two periods (July and October), three reference and four impacted sites were monitored. The ecological quality of benthic macroinvertebrates and of riparian habitats deteriorated from the reference sites downstream to the polluted reaches along the Jiménez River area affected by pineapple plantations. The toxicity of water to Daphnia magna also increased towards downstream reaches. Biomarkers of fish of the species Poecilia gillii and Bryconamericus scleroparius transplanted across the studied sites evidenced a clear anticholinergic effect towards downstream sites as well as increased levels of lipid peroxidation. Different pesticide residues were frequently detected in water samples collected across the Jiménez River watershed with herbicides (ametryn, bromacil, diuron), organophosphorus insecticides (diazinon and ethoprophos) and triazole fungicides being the greatest reaching levels above 1 µg L(-1) in downstream sites. Principal component and environmental hazard analysis of physico-chemical and biological responses established clear relationships among habitat deterioration and the ecological quality of macroinvertebrate communities, high levels of herbicides and poor plant growth, high levels of organophosphorus insecticides in water and anticholinesterase effects on fish, D. magna mortality and deterioration of macroinvertebrate communities. Fungicide and herbicide residue levels were also related with high levels of lipid peroxidation and high activities of glutathione S transferase in fish liver, respectively. These results indicated, thus, that riparian habitat deterioration due to deforestation and land use for agriculture and pesticide contamination are affecting river ecosystems.

Effect of KRAS oncogene substitutions on protein behavior: implications for signaling and clinical outcome.

BACKGROUND: Mutations in the v-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (KRAS) play a critical role in cancer cell growth and resistance to therapy. Most mutations occur at codons 12 and 13. In colorectal cancer, the presence of any mutant KRas amino acid substitution is a negative predictor of patient response to targeted therapy. However, in non-small cell lung cancer (NSCLC), the evidence that KRAS mutation is a predictive factor is conflicting. METHODS: We used data from a molecularly targeted clinical trial for 215 patients with tissues available out of 268 evaluable patients with refractory NSCLC to examine associations between specific mutant KRas proteins and progression-free survival and tumor gene expression. Transcriptome microarray studies of patient tumor samples and reverse-phase protein array studies of a panel of 67 NSCLC cell lines with known substitutions in KRas and in immortalized human bronchial epithelial cells stably expressing different mutant KRas proteins were used to investigate signaling pathway activation. Molecular modeling was used to study the conformations of wild-type and mutant KRas proteins. Kaplan-Meier curves and Cox regression were used to analyze survival data. All statistical tests were two-sided. RESULTS: Patients whose tumors had either mutant KRas-Gly12Cys or mutant KRas-Gly12Val had worse progression-free survival compared with patients whose tumors had other mutant KRas proteins or wild-type KRas (P = .046, median survival = 1.84 months) compared with all other mutant KRas (median survival = 3.35 months) or wild-type KRas (median survival = 1.95 months). NSCLC cell lines with mutant KRas-Gly12Asp had activated phosphatidylinositol 3-kinase (PI-3-K) and mitogen-activated protein/extracellular signal-regulated kinase kinase (MEK) signaling, whereas those with mutant KRas-Gly12Cys or mutant KRas-Gly12Val had activated Ral signaling and decreased growth factor-dependent Akt activation. Molecular modeling studies showed that different conformations imposed by mutant KRas may lead to altered association with downstream signaling transducers. CONCLUSIONS: Not all mutant KRas proteins affect patient survival or downstream signaling in a similar way. The heterogeneous behavior of mutant KRas proteins implies that therapeutic interventions may need to take into account the specific mutant KRas expressed by the tumor.

Long-term outcomes of laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass in the United States.

BACKGROUND: Although laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the most common bariatric procedures performed in the past decade, little is known about their long-term (>5 years) outcomes. METHODS: A retrospective outcome study investigated 148 consecutive patients from a single practice who underwent LAGB from November 2000 to March 2002. The group was matched with 175 consecutive patients who underwent LRYGB from June 2000 to March 2005. Follow-up data for 5 years or longer was available for 127 LAGB patients (86%) and 105 LRYGB patients (60%). RESULTS: After an initial 4 years of progressive weight loss, body mass index (BMI) loss stabilized at 5-7 years at approximately 15 kg/m(2) for the LRYGB patients and at about 9 kg/m(2) for the LAGB patients with band in place (P < 0.01). At 7 years, the excess weight loss (EWL) was 58.6% for LRYGB and 46.3% for LAGB with band in place (P < 0.01). By 7 years, 19 LAGB patients (15%) had had their bands removed, bringing the failure rate for LAGB (including patients with less than 25% EWL) to 48.3% versus 10.7% for LRYGB (P < 0.01). By 10 years, 29 (22.8%) of the bands had been removed, bringing the total LAGB failure rate to 51.1%. In 10 years, 67 LAGB (52.8%) and 43 LRYGB (41%) adverse events had occurred. However, over time, the LRYGB group experienced 9 (8.6%) serious, potentially life-threatening complications, whereas the LAGB group had none (P < 0.001). One procedure-related death occurred in the LRYGB group. CONCLUSIONS: Over the long term, LRYGB had an approximate reduction of 15 kg/m(2) BMI and 60% EWL, a significantly better outcome than LAGB patients experienced with band intact. The main issue with LAGB was its 50% failure rate in the long term, as defined by poor weight loss and percentage of band removal. Nevertheless, LAGB had a remarkably safe course, and it may therefore be considered for motivated and informed patients.

A genetic fusion GDNF-C fragment of tetanus toxin prolongs survival in a symptomatic mouse ALS model.

PURPOSE: Amyotrophic Lateral Sclerosis (ALS) is a paralyzing disorder that kills individuals within three to five years of onset without any possibility for effective treatment. One proposed therapy has been the use of neurotrophic factors to inhibit the apoptosis of motorneurones. At the present, one way to deliver neurotrophic factors after intramuscular injection to the motor neurones is through the use of adenoviral vectors. An alternative strategy is the use of the atoxic C fragment of tetanus toxin (TTC) as a neurotrophic factor carrier for motorneurones. METHODS: We have produced the recombinant protein fusion Glial Derived Neurotrophic Factor and C fragment of tetanus toxin (GDNF-TTC) and we have tested its antiapoptotic activity in degeneration culture cells and in the symptomatic SOD;{G93A} transgenic animal model for ALS. RESULTS: We demonstrated that GDNF-TTC induces the neuronal survival Akt kinase pathway in mouse cortical culture neurons and~maintains its antiapoptotic neuronal activity in Neuro2A cells. Moreover, we have found that genetic fusion is able to increase survival by 9 days and improves life quality in symptomatic ALS animal models. CONCLUSION: These results suggest that recombinant GDNF-TTC fusion protein intramuscular injections provide a potential therapy for ALS treatment.

Isolation and development of haematopoietic progenitor cells from peripheral blood of adult and newborn pigs.

Pluripotent stem cells (PSCs), already described in human beings, are fibroblast-like cells that exhibit a CD34 marker specific for haematopoietic stem cells. In this work we have demonstrated the presence of PSCs in the peripheral blood of pigs, a species frequently used in transplantation studies as an animal model for human diseases. Differentiation into haematopoietic colonies (granulomacrophagic colonies, erythroid colonies and mixed colonies) has been carried out with the peripheral blood of adult and newborn pigs, using solely human commercial media. Peripheral blood mononuclear cells (PBMNCs) were cultured in semisolid methylcellulose based media enriched with recombinant human cytokines, achieving granulomacrophagic-colony forming unit (GM-CFU) and mixed-colony forming unit (Mix-CFU) growth with erythroblastic lineage proliferation in the presence of erythropoietin (Epo). In all the samples CFU growth was associated with the presence of recombinant human cytokine. No evidence of proliferation in control plates without cytokines was found. From liquid medium culture, a population of macrophages and CD34+ fibroblast like cells were retrieved 21 days after sowing. These findings allow us to think about the direct application of this simple and standardised method in several work fields such as the study of pharmacological effects of many drugs over the haematopoietic line and in the study of new strategies in cellular therapy for some human diseases.

Study and culture of haematopoietic progenitor cells from peripheral blood in rats, hamsters and mice.

The aim of this work was to isolate and cultivate a subpopulation of pluripotent stem cells present in peripheral blood of different animal species, frequently used in laboratory studies (mice, rats and hamsters). Pluripotent stem cells (PSCs), already described in human beings, are fibroblast-like cells that exhibit a CD34 marker, specific for haematopoietic stem cells. Commonly used human commercial media were investigated for culturing animal PSCs. These findings suggest that this simple and standardized methodology may be applicable in several fields such as the study of the pharmacological effects of drugs on the haematopoietic line and the study of new strategies in cellular therapy for some human diseases.

Modest evidence for linkage and possible confirmation of association between NOTCH4 and schizophrenia in a large Veterans Affairs Cooperative Study sample.

Wei and Hemmings [2000: Nat Genet 25:376-377], using 80 British parent-offspring trios, identified a number of NOTCH4 variants and haplotypes that showed statistically significant evidence of association to schizophrenia. Specifically, the 10 repeat allele of a (CTG)(n) marker and the 8 repeat allele of a (TAA)(n) marker demonstrated excess transmission to affected individuals; SNP21 and haplotypes SNP2-(CTG)(n) and SNP12-SNP2-(CTG)(n) also showed significant associations. In an attempt to replicate these findings, we tested for linkage and association between the same five markers used by Wei and Hemmings in 166 families collected from a multi-center study conducted by the Department of Veterans Affairs (DVA) Cooperative Study Program (CSP). The families include 392 affected subjects (schizophrenia or schizoaffective disorder, depressed) and 216 affected sibling pairs. The families represent a mix of European Americans (n = 62, 37%), African Americans (n = 60, 36%), and racially mixed or other races (n = 44, 27%). We identified moderate evidence for linkage in the pooled race sample (LOD = 1.25) and found excess transmission of the 8 (P = 0.06) and 13 (P = 0.04) repeat alleles of the (TAA)(n) marker to African American schizophrenic subjects. The 8 and 13 repeat alleles were previously identified to be positively associated with schizophrenia by Wei and Hemmings [2000: Nat Genet 25:376-377] and Sklar et al. [2001: Nat Genet 28:126-128], respectively.

[Bladder cancer]. / Cáncer vesical.

OBJECTIVE: For optimum treatment planning and to establish the prognosis, the main objectives of diagnostic imaging techniques after detecting a tumor in the urinary bladder are to determine 1) its nature and histological structure, 2) depth of bladder wall invasion, 3) tumor localization and involvement of the ureter and trigone, 4) involvement of bladder wall lymphatics, and (5) to determine if there is or no regional and/or distant mestatasis. The capabilities of the diagnostic imaging techniques in regard to achieving the foregoing objectives are analyzed. METHODS: This study comprised 160 patients with a suspected or confirmed bladder tumor. The imaging methods utilized were: conventional radiology including IVP, retrograde and double contrast cystography, ultrasound, CT and MRI. RESULTS: Analysis of the images allowed assessment of 18 morphological parameters, of which the following were among the most relevant: presence of ureterohydronephrosis, filling defect(s), tumor localization, tumor base, tumor-mucosa angle, wall stiffness, total wall thickness, changes observed in the perivesical space and degree of pelvic lymph node involvement. Visualization of a bladder filling defect confirms a bladder tumor. The predictors of the biological behaviour of bladder tumors, such as wall stiffness and lumen asymmetry, characteristically express tumor invasiveness. The tumor-mucosa angles in relation to tumor base and peritumoral edema express a higher grade of infiltration for the obtuse angles and a lower grade for the acute angles. Determining tumor stage with accuracy is the essential challenge of the imaging methods in the assessment of bladder cancer. Both CT and MRI are used to analyze four basic aspects prior to treatment: 1) tumor appearance, 2) presence or absence of perivesical invasion, 3) presence or absence of invasion of the adjacent organs, and 4) presence or absence of lymphadenopathies. The accuracy of CT for tumor staging is estimated to be 88%-92% for stage D1 and 80%-85% for stages C and B2, respectively, while MRI has an accuracy of 95% for stage B2 and 85% for tumor stages that compromise adjacent organs such as the prostate, uterus or vagina. CONCLUSIONS: Conventional radiological methods, together with transabdominal or transrectal ultrasound, have a high rate of accuracy for tumor detection. Determination of the stage of tumor invasion requires analysis of wall thickness, width of tumor base, tumor-mucosa angles and perivesical space. CT and MRI provide highly reliable diagnostic information on the foregoing. CT may present some difficulty in determining the stage of bladder wall invasion. With contrast enhancement, MRI has shown a greater capability to differentiate tumor stages B2 and C and is very similar to CT in detecting pelvic or retroperitoneal lymph node involvement.

[Renal cancer]. / Cáncer renal.

OBJECTIVES: This study was carried out 1) to analyze the growth and clinical manifestations of renal adenocarcinoma; 2) to determine the presence of tumor, its malignant nature, size, local extent or distant spread and route of dissemination according to the imaging methods utilized, and 3) to determine the accuracy of the different imaging procedures, such as IVP, US, CT, and MRI, in staging renal adenocarcinoma. These objectives attempted to provide answers to the following questions: a) Are there currently substantial changes in the biological behavior of renal adenocarcinoma?, b) Does the route of tumor dissemination (direct infiltration through the capsule, lymphohematogenous, cancer embolus carried by the bloodstream to a distant location) affect the rate of progression to stages III and IV?, and c) What are the most relevant findings of the imaging methods that aid in determining the extent of the renal tumor? METHODS: 106 renal masses were evaluated; of these, 93 were renal adenocarcinomas. The diagnosis, clinical evaluation and preoperative staging were based on the clinical history, physical examination, symptoms and imaging methods (IVP, US, CT, and MRI) to assess renal morphological changes, presence of calcifications, mass effect, tumor mass ultrasound characteristics, densitometry or MR signal pattern, perinephric fat involvement, venous vasculature, involvement of renal fascia, locoregional lymph nodes or metastasis and distant neoplastic changes. RESULTS: A third of the tumors had a size greater than 10 cms and practically half were 5-10 cms in size. Calcifications were found in 47%; 85% were punctiform and showed a central location. 88% of the tumors showed areas of necrosis. Due to the presence, in most of the cases, of a viable tumor, necrosis, calcification or cystic degeneration, the adenocarcinomas showed a very inhomogeneous ultrasound pattern and with varying degrees of vascularization on CT volumetric assessment. Invasion of perinephric fat and tumor fibrous septae were found in 65% on CT evaluation, although MRI was particularly sensitive in detecting fat infiltration in the early stages of perinephric involvement, venous thrombosis, involvement of adjacent and distant organs and tumor hemorrhagic changes. CONCLUSIONS: In determining the biological behaviour of renal adenocarcinoma, preoperative staging of infiltration and prognosis, US, volumetric CT and MRI are currently the diagnostic methods with the highest accuracy, specificity and sensitivity. These diagnostic methods allow early detection of tumors thereby making them potentially curable. Lymphatic drainage of the tumor may be determinant in its more or less rapid progression from Robson stage II to IIIa and IIIb, and thereafter to stage IV. CT and MRI showed a higher accuracy for tumor detection, localization, determining local extent, tumor characterization and staging. Detection of a tumor pseudocapsule comprised of reactive fibrous tissue and compact renal parenchyma by CT or MRI allows determination of the borders of the renal tumor. Lymph node involvement radically changes the prognosis and survival in renal adenocarcinoma.

Carcinoma of the extrahepatic biliary tree: analysis of 15 cases.

AIM: to analyze the epidemiology, prognosis and treatment of those diagnosed as having cholangiocarcinoma of the extrahepatic biliary tree. METHODS: a prospective study including all cases diagnosed over a period of 26 months. Fifteen patients with primary bile duct carcinoma were included. RESULTS: the incidence rate was 3.23 cases/10(4). The tumor locations were: 40% proximal bile duct, 33% distal bile duct, and 27% mid-duct. The treatments used were: curative resection in 1 case (7%); palliative surgery in 3 cases (20%); internal drainage through a prosthetic biliary stent by endoscopic retrograde cholangiopancreatography in 6 cases (40%) and by percutaneous transhepatic cholangiography in 2 cases (13%); external bile drainage in case (7%), and in the remaining 2 patients (13%) no treatment was possible. The 1-month, 6-month and 10-month survival rates were 67%, 40% and 33% respectively. Factors associated with a worse survival in this study were age over 70 years and female sex. The worst prognostic location was the mid-duct compared to the distal and proximal thirds. CONCLUSIONS: the incidence of the primary bile duct carcinoma is high in our population. The commonest location is the proximal bile duct. Curative surgical resection is possible in only a few cases, and thus the overall prognosis is very bad.