The circumferential resection margins status: A comparison of robotic, laparoscopic and open total mesorectal excision for mid and low rectal cancer.

INTRODUCTION: Minimally invasive surgery for rectal cancer (RC) is now widely performed via the laparoscopic approach, but robotic-assisted surgery may overcome some limitations of laparoscopy in RC treatment. We compared the rate of positive circumferential margins between robotic, laparoscopic and open total mesorectal excision (TME) for RC in our institution. METHODS: Mid and low rectal adenocarcinoma patients consecutively submitted to robotic surgery were compared to laparoscopic and open approach. From our prospective database, 59 patients underwent robotic-assisted rectal surgery from 2012 to 2015 (RTME group) were compared to our historical control group comprising 200 open TME (OTME group) and 41 laparoscopic TME (LTME group) approaches from July 2008 to February 2012. Primary endpoint was to compare the rate of involved circumferential resection margins (CRM) and the mean CRM between the three groups. Secondary endpoint was to compare the mean number of resected lymph nodes between the three groups. RESULTS: CRM involvement was demonstrated in 20 patients (15.5%) in OTME, 4 (16%) in LTME and 9 (16.4%) in the RTME (p = 0.988). The mean CRM in OTME, LTME and RTME were respectively 0.6 cm (0-2.7), 0.7 cm (0-2.0) and 0.6 cm (0-2.0) (p = 0.960). Overall mean LN harvest was 14 (0-56); 16 (0-52) in OTME, 13 (1-56) in LTME and 10 (0-45) in RTME (p = 0.156). CONCLUSION: Our results suggest that robotic TME has the same oncological short-term results when compared to the open and laparoscopic technique, and it could be safely offered for the treatment of mid and low rectal cancer.

Nonoperative management of rectal cancer after chemoradiation opposed to resection after complete clinical response. A comparative study.

INTRODUCTION: Surgery is the standard treatment of rectal cancer after neoadjuvant therapy. Some authors advocate a nonoperative management (NOM) after complete clinical response (cCR) following chemoradiotherapy (CRT). We compare our results with NOM to standard resection in a retrospective analysis. METHODS: Rectal adenocarcinomas submitted to NOM after CRT between September 2002 and December 2013 were compared to surgical patients that had pathological complete response (pCR) during the same period. Endpoints were Overall Survival (OS), Disease Free Survival (DFS), Local Relapse (LR) and Distant Relapse (DR). RESULTS: Forty-two NOM patients compared to 69 pCR patients operated after a median interval of 35 weeks after CRT. NOM tumors were distal (83.3% vs 59.4%, p = 0.011), less obstructive (26.2% vs 54.4%, p = 0.005) and had a lower digital rectal score (p = 0.024). Twelve (28.0%) recurrences in NOM group and eight (11.5%) in the surgical group occurred after a follow-up of 47.7 and 46.7 months respectively. Isolated LR occurred in five (11%) NOM patients and one (1.4%) in the surgical group. Four (80%) LR were surgically salvaged in NOM group. No difference in OS was found (71.6% vs 89.9%, p = 0.316) but there was a higher DFS favoring surgical group (60.9% vs 82.8%, p = 0.011). Distal tumors had worse OS compared to proximal tumors in surgical group (5-year OS of 85.5% vs 96.2%, p = 0.038). CONCLUSION: The NOM achieved OS comparable to surgical treatment and spared patients from surgical morbidity but it resulted in more recurrences. This approach cannot be advocated routinely and controlled trials are warranted.

Spinal cord compression in young children with type VI mucopolysaccharidosis.

Spinal cord compression (SCC) is a known complication of mucopolysaccharidosis type VI (MPS VI) secondary to atlantoaxial subluxation, craniovertebral stenosis, posterior longitudinal ligament hypertrophy, or dural thickening. SCC is expected to occur in the natural history of the disease, regardless of enzyme replacement therapy (ERT), as intravenous enzyme does not cross the blood-brain barrier. We describe six MPS VI children with SCC, all diagnosed before 7years of age. Within this group, four of the children were diagnosed with SCC after the introduction of ERT. We hypothesize that these patients may illustrate the previously undetected risk of increased joint mobility caused by ERT which may have contributed to increased cervical instability by loosening the neck joint, thus leading to or unmasking SCC. We reinforce the need for close follow-up of SCC, periodic neurological assessment, spine imaging, and neurophysiology in all MPS VI patients before and during ERT. Neurophysiological abnormalities may precede changes in MRI images (as shown in patients 4 and 5 from this sample) and should, therefore, be accessed in MPS VI patient evaluations, allowing for timely intervention and better prognosis. We recognize the limitations of these data due to the small sample size and recommend further investigation into this patient population.

Recorrência de adenocarcinoma em coto gástrico: qual o papel da cirurgia? / Recurrence of remnant gastric adenocarcinoma: what is the importance of surgery?

Os autores apresentam sua experiência com recorrência de adenocarcinoma em coto gástrico, perfazendo um total de cinco casos no período de 1981 a 1989, dos quais somente um caso foi passível de cirurgia com ressecçäo de intençäo curativa, com sobrevida de quatro meses. Fica-nos a impressäo de que o screening pós-operatório pode levar a aumento de taxas de re-ressecabilidade e sobrevida em casos precoces

Growth, bone maturation, and biochemical changes in Brazilian children from two different socioeconomic groups.

A study of blood biochemistry related to skeletal growth in 900 Brazilian children aged 7 to 17 yr is reported. Two groups were studied, a privileged and underprivileged sample. Anthropometry and measures of bone maturation in the control group were comparable with American and British standards. Underprivileged children showed growth impairment and delay in bone maturation. No signs of rickets were found in either group. Plasma calcium, magnesium, vitamin D, and total protein did not differ in the two groups of Brazilian children. Plasma alkaline phosphatase and inorganic phosphorus were abnormal in the underprivileged children. Alkaline-phosphatase activity and phosphorus levels did not fall towards adult levels after the predicted age of the adolescent spurt for underprivileged children. Menarche was delayed in the underprivileged girls.

Effect of nutrition on vitamin D status: studies on healthy and poorly nourished Brazilian children.

A cross-sectional study was carried out of 412 healthy and 226 chronically malnourished children in Recife, Brazil. Anthropometric measurements, x-rays of hands and wrists, and biochemical data related to skeletal growth were obtained. Levels of plasma 25 hydroxyvitamin D were measured in both groups of children and both showed higher concentrations than those reported for normal European children. The high levels of 25 hydroxyvitamin D found in these two groups of Brazilian children are probably the result of the intense solar radiation in this part of Brazil and argue against the diet being an important source of vitamin D in poorly nourished children. Some bone abnormalities were seen in the underprivileged group of children but in view of our findings these were more likely to be a result of protein-energy malnutrition than rickets.

Dosagens (RIA) de prolactina e progesterona na esterilidade feminina. / Dosages (RIA) of prolactin and progesterone in female sterility

Foram estudados 36 casos de esterilidade feminina com dosagens (RIA) de prolactina e de progesterona na segunda fase do ciclo menstrual (entre 21o. e 23o. dias do ciclo) de mulheres com menstruacoes normais. Para comparacao foram realizadas as mesmas dosagens no mesmo periodo em 16 mulheres com antecedentes de partos normais. A galactorreia foi encontrada em quatro mulheres sem esterilidade (25%) e em cinco casos com esterilidade (13%). Excluindo-se em cada grupo os casos de galactorreia com hiperprolactinemia, o valor medio da prolactina e significativamente superior na esterilidade primaria (15 casos).Os valores de progesterona apresentam, todavia, uma dispersao dentro da faixa de normalidade do metodo, sem exibir qualquer tendencia nos dois grupos. Na discussao do mecanismo do hipogonadismo dependente da taxa de prolactina, os presentes achados permitem supor que o aumento da prolactina nao causa a anovulacao; e uma consequencia, igualmente, de um disturbio hipotalamico previo como causa primaria

Contribuicao dos metodos radiomarcados na avaliacao da funcao testicular. / Radioimmunoassay contribution to the evaluation of testicular function

A funcao androgenica no homem depende da sindrome da testosterona nas celulas de Leydig do testiculo, sob a influencia ganodotrofica do LH hipofisario, melhor denominado no homem ICSH (interstitial cell stimulating hormone).Entretanto, existe uma importante contribuicao da cortex supra-renal, atraves de esteroides C-19 oriundos da camada reticular e eliminados na urina - a semelhanca da testosterona - sob a forma de 17-cetosteroides neutros. A oportunidade de estudar maridos de casais estereis, selecionados pela normalidade do espermograma, permitiu-se reunir 50 observacoes de homens adultos, de idade conhecida, com dosagens de 17-cetosteroides urinarios (metodo quimico) e FSH, LH e testosterona plasmaticos (metodo RIA) na faixa de normalidade dos metodos respectivos. Foram avaliadas as principais correlacoes, concluindo-se pela existencia de significancia, em determinados limites, apenas da relacao LH/testosterona, o que seria de se esperar no quadro fisiologico conhecido. A fixacao de padroes de normalidade e logicamente o substrato basico para ulterior aplicacao propedeutica

Medicina nuclear em obstetricia. / Nuclear medicine in obstetrics

A introducao da metodologia relativa a area da medicina nuclear propiciou aquisicoes relevantes para o diagnostico e o tratamento de diversas doencas. No campo da obstetricia, a existencia do ovo, desde a primeira semana de desenvolvimento ate o feto maduro, criou novos problemas com relacao aos possiveis efeitos deleterios da exposicao a radiacao. O principal aspecto destes problemas e considerado, com alguma extensao, sob o titulo de protecao radiologica