Intravascular leiomyomatosis with intracardiac extension: a toraco-abdominal approach.

Intravenous leiomyomatosis is a rare nonmalignant tumor, which originates from the uterine smooth muscle cells and is usually confined to the pelvic venous system. Sometimes it can extend from the pelvis through the veins into the right side of the heart; this condition is named intracardiac leiomyomatosis (ICLM). To date few cases of these conditions have been described, the treatment is surgical, often challenging and usually multidisciplinary. In this paper are described the clinical presentation, the full radiologic study and surgical treatment of a case of ICLM that authors treated at their institution with thoraco-abdominal approach. Surgical removal of the ICLM is strongly recommended, because no recurrence has been reported, in our case at 7 years we did not observe recurrence of the disease.

Sentinel Lymph Node Analysis in Colorectal Cancer Patients Using One-Step Nucleic Acid Amplification in Combination With Fluorescence and Indocyanine Green.

PURPOSE: Analysis of the sentinel lymph node (SLN) in colorectal cancer (CRC) patients was proposed for more accurate staging and tailored lymphadenectomy. The aim of this study was to assess the ability to predict lymph node (LN) involvement through analysis of the SLN with a one-step nucleic acid (OSNA) technique in combination with peritumoral injection of indocyanine green (ICG) and near-infrared (NIR) lymphangiography in CRC patients. METHODS: A total of 34 patients were enrolled. Overall, 51 LNs were analyzed with OSNA. LNs of 17 patients (50%) were examined simultaneously with hematoxylin and eosin (H&E) and OSNA. RESULTS: SLN analysis of 17 patients examined with H&E and OSNA revealed that OSNA had a higher sensitivity (1 vs. 0.55), higher negative predictive value (1 vs. 0.66) and higher accuracy (100% vs. 76.4%) in predicting LN involvement. Overall, OSNA showed a sensitivity of 0.69, specificity of 1, accuracy of 88.2%, and stage migration of 8.8%. Compared to those who were OSNA (-), OSNA (+) patients had a greater number of LN metastases (4.8 vs. 0.16, P = 0.04), higher G3 rate (44.4% vs. 4%, P = 0.01), more advanced stage of disease (stage III: 77.8% vs. 16%; P = 0.00) and were more rapidly subjected to adjuvant chemotherapy (39.1 days vs. 50.2 days, P = 0.01). CONCLUSION: SLN analysis with OSNA in combination with ICG-NIR lymphangiography is feasible and can detect LN involvement in CRC patients. Furthermore, it allows for more accurate staging reducing the delay between surgery and adjuvant chemotherapy.

How to prevent the postoperative pancreatic fistula with an ethylene vinyl alcohol copolymer (Onyx®): A proposal of a new technique.

BACKGROUNDS/AIMS: Despite the advances in identifying risk factors, improving operative technique, and postoperative patient care, pancreatic leakage after pancreatic resection remains a highly debated topic. The aim of this study is to describe our technique and our initial experience with the intraoperative embolization of the main pancreatic duct with an Ethylene Vinyl Alcohol Copolymer (Onyx®). METHODS: Two patients of 63 and 64 years underwent pancreaticoduodenectomy for a cholangiocarcinoma of the extrahepatic bile duct and a pancreatic adenocarcinoma, respectively. At the time of pancreatic parenchyma resection, a Wirsung duct was identified and catheterized. A wirsungography was done and then, embolization with Onyx® was carried out under fluoroscopic control. RESULTS: Neither of the patients developed a postoperative pancreatic fistula. They were discharged to home on the 17th and 18th postoperative day, respectively. At the last follow-up, no recurrence was found. The two patients became diabetics; both needed the support of supplementary pancreatic enzymes. CONCLUSIONS: To our knowledge, we are the first to describe this technique, which seems safe and reliable. Studies on this subject with more patients are needed to confirm the validity of this procedure.

Partial splenectomy: A case series and systematic review of the literature.

BACKGROUNDS/AIMS: Partial splenectomy (PS) is a surgical option for splenic mass, in order to reduce postoperative complications and preserve the splenic function. Despite this, data in literature is still scarce. The present study aimed to reveal our recent experience and provide a comprehensive overview of the feasibility and complications related to various surgical approaches. METHODS: Data of patients who underwent PS, between 2014 and 2017 were retrospectively reviewed. Literature was searched for studies reporting all types of PS in adult or adolescent patients. RESULTS: Five PS were performed in our department: two (40%) by laparoscopy and three (60%) by laparotomy. Two (40%) postoperative complications were detected, and in one of them, total splenectomy (TS) by laparotomy was finally required. There were no deaths or complications at last follow-up. Twenty studies including 213 patients were identified in the literature search. The rate of conversion from laparoscopic to open surgery was 3% (range, 5-50%) and in 3% of cases (range, 7-10%) PS was converted into total TS and the overall morbidity rate was 8% (range, 5-25%). In comparison to laparotomy, the conversion rate of laparoscopic approach to TS was 3.5% (vs. 1.4%) and a morbidity rate of 9.8% (vs. 4.3%). CONCLUSIONS: The present review shows that PS is a viable procedure in selected cases. The mini-invasive approach seemed to be feasible despite the presence of higher rate of complications than the open technique. In future, further studies on this topic are needed by involving more patients. Furthermore, it is proposed that the development of robotic surgery could make this approach the new gold-standard technique for spleen-preserving surgery.

Merkel cell carcinoma: extended lymphadenectomy and reconstruction with biosynthetic prosthesis.

INTRODUCTION: Merkel cell carcinomas (MCC) is an aggressive neuroendocrine carcinoma originating from the Merkel cell in the dermo-epidermal junction. Only 10% of MCC occur on the skin of the trunk. CASE REPORT: We report a case of Merkel's abdominal carcinomas treated with extensive inguinal lymphadenectomy and reconstruction of the abdominal wall and inguinal canal using prosthesis GORE® BIO-A®. DISCUSSION: Immunohistochemical analysis by tumor-specific markers is crucial for diagnosis and permits differentiation from other tumors of the skin. MCC is an aggressive tumor with poor prognosis. CONCLUSIONS: For primary tumors without indications of the presence of organ metastases complete surgical excision is the gold standard. Gore BIO-A is a biosynthetic prosthesis with manageable structure that allows it to be positioned and shaped according to needs, its strength provides for excellent support for the reconstruction of the inguinal canal wall.

High dose rate brachytherapy for prostate cancer: A prospective toxicity evaluation of a one day schedule including two 13.5 Gy fractions.

BACKGROUND AND PURPOSE: High dose-rate (HDR) brachytherapy (BT) provides a highly conformal method of dose delivery to the prostate. The purpose of this study is to prospectively determine the toxicity of the treatment protocol of 13.5 Gy × 2 fractions. MATERIALS AND METHODS: From 2010 through 2017, 119 patients with low (71%) or intermediate-risk prostate cancer were prospectively treated in a single institute with HDR-BT at 13.5 Gy × 2 fractions within one day. Median follow-up time was 4.4 years. RESULTS: Actuarial rates of no biochemical evidence of disease, overall survival and metastasis-free survival for all patients were 96%,98% and 98%, respectively. The cumulative incidence of acute grade 2 and 3 genitourinary (GU) toxicity was 9% and 2%, respectively. The corresponding incidences of late GU toxicity were 18% and 1%. No grade ≥4 of either type of toxicity was detected. Multivariate analysis showed that having higher international prostate symptom score (IPSS; P = 0.041) or higher V200 (P = 0.013) was associated with a higher risk of experiencing any grade of acute GU toxicity. In addition, patients having a higher IPSS (P = 0.019) or a higher V150 (P = 0.033) were associated with a higher grade >1 acute GU toxicity. CONCLUSIONS: The findings of this study show that HDR-BT 13.5 Gy × 2 as monotherapy was safe and effective for prostate cancer patients with low-intermediate risk.

Gigantomastia juvenil. Hipertrofia virginal. Presentación de caso clínico / Juvenile macromastia. Virginal mammary hypertrophy. Case report

La gigantomastia juvenil es una afección médica benigna poco frecuente que causa el crecimiento excesivo y discapacitante de las mamas, provocando importantes trastornos físicos y psíquicos a pacientes púberes o adolescentes. Presentamos el caso en una paciente de 23 años, la cual se encontraba en la última etapa de su patología con una importante signosintomatología. Al no existir un tratamiento específico para ella, la mastoplastia reductiva es el procedimiento más efectivo con el que se cuenta. Se realizó una reducción de 9000 g de tejido mamario mediante la técnica de Torek, obteniendo mamas de volumen medio, simétricas, con cicatrices aceptables. La complejidad de esta patología hace que debamos manejarnos con un equipo multidisciplinario, tanto durante su estudio como en su tratamiento, y consideramos muy importante realizar un seguimiento estricto a largo plazo ya que es posible que, después del tratamiento quirúrgico, se presenten recurrencias.

Juvenile gigantomastia is a rare benign medical condition that causes excessive and disabling growth of the breasts and provokes considerable physical and psychological discomfort in patients in their puberty and adolescence. We introduce the case of a 23-year-old patient in the last stage of her condition with considerable signs and symptoms. There is no specific treatment for juvenile gigatomastia; hence breast reduction is the most effective procedure available. A reduction of 9,000 grams of breast tissue was performed using Torek's technique, resulting in medium volume, symmetrical breasts with acceptable scars. The complexity of this disorder requires a multidisciplinary team during the study and therapy stages. A strict long-term follow-up is recommended as relapses are possible after surgery.

Gigantomastia juvenil. Hipertrofia virginal. Presentación de caso clínico / Juvenile gigantomastia. Virginal hypertrophy. Clinical case presentation

La gigantomastia juvenil es una afección médica benigna poco frecuente que causa el crecimiento excesivo y discapacitante de las mamas provocando importantes trastornos físicos y psíquicos a pacientes púberes o adolescentes. Presentamos el caso en una paciente de 23 años de edad, la cual se encontraba en la última etapa de su patología con una importante signosintomatología. No existe un tratamiento especifi co para ella, por lo cual la mastoplastia reductiva es el procedimiento más efectivo con el que contamos. Se realizó una reducción de 9000 g de tejido mamario mediante la técnica de Torek, obteniendo mamas de volumen medio, simétricas, con cicatrices aceptables. La complejidad de esta patología hace que debamos manejarnos con un equipo multidisciplinario, tanto durante su estudio como en su tratamiento, y consideramos muy importante realizar un seguimiento estricto a largo plazo ya que es posible que, después del tratamiento quirúrgico, se presenten recurrencias

Juvenile Gigantomastia is a rare benign medical condition that causes excessive and disabling growth of the breasts and provokes considerable physical and psychological discomfort in patients in their puberty and adolescence. We introduce the case of a 23-year-old patient in the last stage of her condition with considerable signs and symptoms. There is no specifi c treatment for Juvenile Gigatomastia; hence breast reduction is the most eff ective procedure available. A reduction of 9,000 grams of breast tissue was performed using Torek's technique, resulting in medium volume, symmetrical breasts with acceptable scars. The complexity of this disorder requires a multidisciplinary team during the study and therapy stages. A strict long-term follow-up is recommended as relapses are possible after surgery

Optimizando el bolsillo subglandular en implantes mamarios: utilización del plano subfascial / Optimizing the subglandular pocket in breast implants: experience with the subfascial plane

Desde hace 6 años colocamos los implantes mamarios en un plano subfascial (subaponeurótico) reemplazando el plano subglandular(SG). Este artículo considera 150 pacientes implantados en este plano.

Rol de la albuminemia en el resultado de las anastomosis colónicas / Role of albuminemia in the result of colonic anastomosis

Con el objeto de evaluar el resultado de las anastomosis primarias de colon en ratas con hipoalbuminemia, se realizó un estudio comparativo de 60 ratas Sprague Dawley en condiciones de normonutrición y desnutrición severa. Se realizaron mediciones seriadas de peso, hematocrito y albúmina. Se practicó resección de un segmento colónico con anastomosis primaria. Después del décimo día postoperatorio se las sometió al estudio contrastado de colon por enema, medición de la presión de ruptura colónica y observación microscópica de los depósitos de colágeno. A pesar del aumento de la morbimortalidad hallada en las ratas hipoalbuminémicas, no encontramos diferencias estadísticamente significativas en la presión de ruptura de las anastomosis ni en la estimación del colágeno entre ambos grupos