Aryl hydrocarbon receptor interacting protein (AIP) significantly influences prognosis of pancreatic carcinoma.

INTRODUCTION: Aryl hydrocarbon receptor (AHR) is a ligand-activated transcription factor. Aryl hydrocarbon receptor interacting protein (AIP) in one of AHR ligands. The aim of this study is to analyze the prognostic influence of AIP in pancreatic carcinoma. MATERIAL AND METHODS: Retrospective case series with immunohistochemical analysis of AIP. We have estimated a multivariate Cox's model for the outcome (progression free and overall survival). RESULTS: 204 patients were included in the study. As expected prognosis was poor and 67.8% died of disease. As for AIP 9.8% of the cases showed nuclear staining of the epithelial tumor cells and 59.4% a cytoplasmic one. Stroma was stained in 53.1% of the cases. Univariate survival analysis revealed a significantly worse prognosis of patients with cytoplasmic AIP expression (stroma and epithelium), but nuclear expression was associated to a better prognosis. In the multivariate analysis stromal AIP expression was an independent prognosticator of progression free survival, together with pT stage, histological grade and history of diabetes. DISCUSSION: AIP Is a conserved cochaperone protein binding to many proteins. AIP has been proposed as a potential tumor suppressor gene. To date, no study has analyzed the immunohistochemical expression of AIP in pancreatic carcinoma. Our results indicate that both epithelial and stromal cytoplasmic expression of AIP is associated to bad prognosis, while nuclear translocation seems to improve prognosis. CONCLUSION: Although we must deepen into the complex signaling pathways underlying this potential association, our results open a way to inhibiting AHR as a potential target against pancreatic carcinoma.

Splenic volume as a biomarker of hepatic damage after chemotherapy in patients with resected colorectal liver metastases (CRLM).

BACKGROUND: Chemotherapy-associated liver injury (CALI) is a matter of concern for hepatobiliary surgeons as it can entail postoperative liver failure after an extensive hepatectomy. Recent studies have taken special interest in liver function parameters which can correlate with CALI to decrease this adverse event. Therefore, the current study investigates the usefulness of splenic volume as a biomarker of CALI through a portal hypertension mechanism, in patients with colorectal liver metastases (CRLM). STUDY DESIGN: We carried out a study in patients with CRLM operated on between 2009 and 2014 in our center. All samples of healthy liver were graded for non-alcoholic fatty liver disease (NAFLD) and sinusoidal obstructive syndrome. Computarized tomography scans for spleen volumetry were analyzed for each patient at CRLM diagnosis, after neoadjuvant chemotherapy, 1 and 6 months after resection. RESULTS: A group of 65 consecutive patients with CRLM of large bowel adenocarcinoma submitted to liver resection were included. Patients receiving neoadjuvant chemotherapy had a greater spleen volume increase than those who did not receive treatment (p = 0.053), finding a statistically significant spleen growth in patients with NAFLD (p = 0.036). There was no correlation between spleen enlargement and postoperative complications or average stay. However, survival was decreased in patients with spleen growth and CALI. CONCLUSIONS: Patients who receive neoadjuvant chemotherapy for liver metastasis surgery have a greater splenic volume increase, which correlates with NAFLD and a lower survival.

Still a place for conventional histopathological analysis in the era of molecular medicine: predicting prognosis of resectable ductal pancreatic adenocarcinoma.

INTRODUCTION: Our aim is to find features that define prognosis in surgically resected ductal pancreatic adenocarcinoma readily accessible in everyday practice. MATERIALS AND METHODS: Longitudinal retrospective case series of pancreatic adenocarcinoma operated with a curative intent in a large tertiary hospital in Madrid between 2009 and 2015. RESULTS: 162 were enrolled. 40.8% survived less than 1 year. Multivariate Cox's regression model revealed that gender, presence of symptoms, T and N stage independently influenced progression-free survival, while overall survival was determined by gender, smoking, presence of symptoms and N stage. Logistic regression analysis revealed that only symptoms at diagnosis could predict death, while gender, symptoms, histopathological type, vessel invasion, T stage and necrosis could independently predict recurrence. DISCUSSION: Our series show that patients with symptomatic disease at the time of diagnosis and females showed a shorter progression-free and overall survival. We herein propose a regression model to predict outcome.

[Effect of intramedullary reaming and nailing on the production of growth factors in the femur fracture callus in rats]. / Efecto del fresado y enclavado endomedular sobre la producción de factores de crecimiento en el callo de fractura de fémur en ratas.

INTRODUCTION: Many studies have been conducted to determine the different effects that reaming or intramedullary nailing have on fracture healing, but there is no evidence in the literature of the effect of intramedullary reaming on osteogenesis. We performed a prospective study to analyse the effect of intramedullary reaming and nailing on the production of growth factors during the process of fracture healing in the femur of rats. MATERIAL AND METHODS: A transverse mid-shaft non-comminuted femur fracture was produced in 64 rats; 34 rats did not receive any treatment, and a standardized surgical procedure was performed on 30 rats, by exposing the left knee, reaming the medullary canal from distal to proximal, and then fixing the fracture with a steel pin. The rats were sacrificed at the 24th hour, 4th, 7th and 15th days after the fracture. The amount of growth factors that appeared in the callus fracture was measured using histopathology studies. The primary categorical variables analysed were PDGFA, TGF2 and TGFß-R2. These variables were analysed in each group at the different sacrifice times. RESULTS: The results of the primary variables of the study, stratified by the time until sacrifice, showed no statistically significant differences. DISCUSSION: Even if the presence of an intramedullary wire facilitates the fracture repair and the stabilising the bridge of bone between both edges of the fracture site, no evidence was found that reaming changes the expression of the growth factors studied (PDGFA, TGFß-R2 and TGFß2) during the callus formation in rats.

[Neurilemmoma of the larynx: a case report]. / Neurinoma laríngeo: a propósito de un caso.

Neuromas or Schwannomas are extremely rare among tumors of the larynx. They are Schwann cell tumors that can be difficult to distinguish from neurofibromas. They present usually as supraglottic masses, since they may arise from the internal branch of the superior laryngeal nerve. Nuclear magnetic resonance imaging is the best diagnostic technique, conferring a high degree of suspicion. We present an exceptional case of a laryngeal neuroma, with a very long evolution, a large tumor volume, dyspnea and vocal cord fixation, with complete resolution through an external approach following surgical removal. The difficulties encountered with its pathological and clinical diagnosis are discussed as well as a review of the literature.

[Spread channels of anterior commissure cancer: clinico-pathological study and surgical implications]. / Vías de diseminación del cáncer de comisura anterior: estudio clínico-patológico e implicaciones quirúrgicas.

UNLABELLED: The aim of the present study is to describe the spread channels of the anterior commisure cancer, its clinical significance and its surgical implications. PATIENTS AND METHODS: A prospective study was performed at the ENT Department of the Complutense University in about 31 patients with anterior commisure carcinoma wo underwent surgery between 1994/97. Specimens were processes with Whole-Organ Serial Sections. RESULTS: Patients were differenciated into two groups: 1) Patients with glottic tumors, with a good cord mobility and no invasive tumor in commisure region (18 patients); In these patients, conservative surgery was possible; 2) Another group (13 patients) with aggressive lesions (80% with cartilage involvement), vocal cord fixation and transglottic lesions. In these group, conservative surgery was contraindicated. CONCLUSIONS: This report emphasizes the importance of laryngoscopy in surgical technique of anterior commisure cancer.

Protective effect of vagotomy on the gastric mucosa in a stress model in rats.

INTRODUCTION: The use of vagotomy is classically based on its inhibiting effects on acid secretion. Vagotomy induces both cellular and endocrine changes that may be involved in protective actions. Our aim was to study morphologic changes induced by vagotomy on the gastric mucosa and their relation to stress protection in the short, medium and long term. MATERIAL AND METHODS: An immobilization and cold stress model was used with 80 Wistar rats divided into two groups--control (with and without stress) and vagotomy (at 7, 30 and 120 days). Changes induced in the gastric mucosa by stress were studied with and without vagotomy, as well as relationship between these changes and the intended protective action. RESULTS: Bleeding showed a very significant relation to stress (p < 0.0001). Bleeding incidence exhibited a significant difference between vagotomised and non-vagotomised rats (p < 0.0001) in the short, medium and long term (vagotomy was protective against stress). Regeneration signs related significantly to vagotomy (p < 0.0001) but not stress (p = 0.208). However, no significant relationship was found between the protective action and the presence of regeneration signs (p = 1). CONCLUSIONS: Vagotomy has tropic effects on the gastric mucosa and is protective against stress. This protective action is maintained in the short, medium and long term. However, these changes are not sufficient to explain protection. An adaptation phenomenon mediated by hormonal and peptidic factors may be involved in this action.

[Early glottic carcinoma: a clinico-pathological study]. / Cáncer glótico precoz: estudio clínico-patológico.

UNLABELLED: The aim of the present study is to evaluate histopathological features of malignization of laryngeal dysplasia and recurrence of early glottic carcinoma. PATIENTS AND METHODS: A prospective study was perform in a cohort of 134 patients who underwent surgery between 1992/99 at the ENT department of the Complutense University of Madrid. Tumor localization, malignization rate and recurrence rate were studied in 68 cases of laryngeal dysplasia, 11 of in situ-carcinoma and 55 of microinvasive carcinoma. RESULTS: Nine laryngeal dysplasias experienced invasive carcinoma (13%) and six patients with invasive glottic carcinoma had laryngeal recurrence (11%), all of them with anterior commisure involvement. Eight patients underwent total laryngectomy for recurrence (6%) and three patients died of laryngeal cancer. CONCLUSIONS: Anterior commisure involvement was the most important risk factor in early glottic carcinoma.

[Extracapsular spread in advanced laryngeal cancer]. / Rotura capsular en el cáncer avanzado de laringe.

UNLABELLED: The aim of the present study is to evaluate histopathological features of extracapsular spread detected in patients with laryngeal cancer. PATIENTS AND METHODS: Specimens of 47 patients with laryngeal cancer were processed as Whole-Organ Serial Sections at the ENT Department of the Complutense University of Madrid between 1994/97. RESULTS: Extracapsular metastases were found in 21 patients. The risk for extracapsular spread was higher in those patients with: supraglottic or piriform sinus cancer, more than 2-3 neck metastatic nodes, tumor diameter of more than 2 cm and N2 stage.

Colonic carcinogenesis in vagotomyzed rats.

INTRODUCTION: An increased incidence of colorectal cancer (CRC) has been reported in patients with peptic ulcer disease treated with truncal vagotomy. Inhibition of gastric acid output and its hormonal consequence, hypergastrinemia, have been considered risk factors for the development of CRC. The aim of the present study was to determine whether truncal vagotomy increases, in the short (7 days) and long term (120 days), the incidence of CRC in a model of carcinogenesis. MATERIAL AND METHOD: We used 86 Wistar rats distributed in 7 groups to which DMH (1,2-dimethylhydrazine dihydrochloride) was administered for the induction of colon tumors, at doses of 5 and 20 mg/kg of weight. The first three groups were used as control groups; the rats of the four other groups underwent a truncal vagotomy with pyloroplasty and Heller myotomy prior to the administration of DMH. Finally, we compared the incidence of colonic tumors in vagotomized vs non-vagotomized groups receiving the same dose of DMH. RESULTS: In the non-vagotomized rats that received low doses of DMH (5 mg/kg of weight), mortality was 0% and 0% developed cancer as compared to 40% and 0%, respectively, of rats vagotomized 7 days before the administration of DMH and 20% and 0%, respectively, of rats vagotomized 120 days before the administration of DMH. After the administration of high doses of DMH, mortality was 50% and 80% developed cancer as compared to 100% and 0%, respectively, of rats vagotomized 7 days before the administration of DMH and 61.11% and 42.8%, respectively, of rats vagotomized 120 days before the administration of DMH. CONCLUSION: Truncal vagotomy does not increase the incidence of CRC induced by DMH in the rat.

[Clinical and histological indicators predictive of cervical metastases in laryngeal cancer]. / Indicadores predictivos (IP) clinicopatológicos de metástasis cervicales en cáncer de laringe.

INTRODUCTION: A study was made of possible clinical and pathological indicators associated with cervical lymph node involvement in laryngeal cancer. PATIENTS AND METHODS: Between 1994 and 1997, 85 patients with laryngeal cancer underwent surgery in the ENT department of the Complutense University of Madrid (Spain). A statistical analysis was made to identify clinical and pathological indicators of lymph node metastases. RESULTS: Predictive indicators (PI) of cervical metastatic disease in our study were: 1) tumor location; 2) low degree of differentiation; 3) invasion > 5 mm deep; 4) perineural invasion; and 5) invasion of the pre-epiglottic space.

[Elective dissection in cancer of the larynx]. / Vaciamiento electivo en cáncer de laringe.

OBJECTIVE: 1) To determine if elective neck dissection (END) is more effective than surgery without END in patients with cancer and a clinically negative neck (N0). 2) To determine if selective posterolateral neck dissection is effective in these patients. PATIENTS AND METHODS: The study included 74 patients with laryngeal cancer and no palpable nodes who were treated surgically at the ENT Department of the Universidad Complutense de Madrid between 1994 and 1997. Thirty-seven patients underwent surgery alone (Group A) and 37 patients underwent laryngeal surgery and elective neck dissection (Group B). No patient underwent irradiation. Minimum follow-up was 24 months. RESULTS: Cervical recurrence was observed in 4 (11%) patients who underwent laryngeal surgery alone and in 2 (5%) patients who underwent laryngeal surgery and elective neck dissection. CONCLUSIONS: Laryngeal surgery with elective neck dissection was more effective than laryngeal surgery without END in patients with laryngeal cancer and a clinically negative neck. Selective lateral neck dissection was effective for the elective treatment of these patients.

[Stomal recurrence after laryngectomy. An inevitable late complication]. / Recidiva estomal tras laringuectomía. Una complicación tardía inevitable?

Postlaryngectomy tumoral recurrence on the stoma is a terrible late complication that has a fatal outcome. In spite of advances in laryngeal surgery and modern reconstructive techniques, it is still a major cause of death in patients with laryngeal cancer. In a review of 500 patients who underwent surgery for laryngeal cancer in 1981-86 and 1995-97, we found no changes in the frequency of stomal recurrence between periods (4% in both periods). Stomal recurrence was associated in our study with subglottic extension and with transglottic lesions. Previous tracheotomy was not a decisive factor in the appearance of stomal recurrence in our patients.

[Essential bone cyst of the calcaneus in children. Report of three cases]. / Quiste óseo esencial de calcáneo en el niño. Presentación de tres casos.

OBJECTIVE: The purpose of this study was to analyze the properties of essential bone cyst of the calcaneus in childhood, as well as its evolution, and differences with regard to adults. PATIENTS AND METHODS: The cases of children with a diagnosis of essential bone cyst of calcaneus in last sixteen years in the pediatric orthopedic unit of San Carlos Clinic have been reviewed. We evaluated the information regarding the clinical history and the radiological and histological date as well as the therapy result with esteroid intracavity therapy and curettage and bone grafting. The radiologic score was done following Södergard criteria and the posttreatment follow-up with Neer's score. RESULTS: The mean age of the patients was 10.3 years. Two of the patients had recurrent heel pain for more than six months. Treatment consisted in intracavitary esteroid in two cases and curettage and bone grafting in all three cases, in two of the cases because of failure of esteroid therapy and in the other because of an atypical X-ray image. In all cases the histological stady identified the existence of a characteristic membrane conective tissue. The postsurgery follow-up a period of half four years has been satisfactory. CONCLUSIONS: The essential bone cyst of the calcaneous is exceptional localization in children, frequently symptomatic and resistant to the esteroid intracavitaria contrary to what happens with the essential bone cyst of other localizations and with the essential bone cyst of the calcaneus in the adults. The recurrent heel pain and atipical X-ray image are surgery indications.