Investigations on the Genus Rhizoecus (Hemiptera: Rhizoecidae) with Description of Two New Species from South America.

Neotropical species of the scale insect genus Rhizoecus Künckel d'Herculais (Hemiptera: Coccomorpha: Rhizoecidae) found in soil sample material of the Hungarian Natural History Museum were studied. Two new Rhizoecus species, Rhizoecus kontschani Kaydan and Konczné Benedicty sp. n., and Rhizoecus granaradewillinkae Kaydan and Szita sp. n., are described and illustrated based on the adult females. Also, the adult females of Rhizoecus keysensis Hambleton and Rhizoecus pseudocacticans Hambleton are illustrated. An identification key and new additional locality records for the currently known Rhizoecus species are provided.

Correction to: The Genus Coccidella Hambleton (Hemiptera: Rhizoecidae) with Description of Two New Species.

Due to an unfortunate turn of events, the initials of the third author appeared incorrectly in the original publication as the name should have read T Kondo.

The Genus Coccidella Hambleton (Hemiptera: Rhizoecidae) with Description of Two New Species.

A study was conducted on the Neotropical scale insect genus Coccidella Hambleton (Hemiptera: Coccomorpha: Rhizoecidae) based on soil sample material deposited at the Hungarian Natural History Museum. Descriptions of the adult females of two new Coccidella species, i.e., Coccidella hexapora Kaydan & Konczné Benedicty, sp. n. and Coccidella kozari Kaydan & Szita, sp. n., are provided, plus a redescription and illustration of adult female of Coccidella kissbalazsi Konczné Benedicty & Kozár. An identification key and new additional locality records for the currently known Coccidella species are provided and the affinities of the new species are discussed.

Trends in the use and cost of human and analogue insulins in a Colombian population, 2011-2015.

OBJECTIVES: Diabetes mellitus is a common disease among the general population and imposes considerable costs on health care systems. Insulin is used to treat type 1 diabetes mellitus and as an adjuvant to oral agents in advanced stages of type 2 diabetes mellitus. The objective was to describe the trends in use and cost of human and analogue insulins for Colombian patients. STUDY DESIGN: Descriptive retrospective analysis of prescriptions of human and analogue insulins on a monthly basis for the period from July 1, 2011 to February 2, 2015. METHODS: Information was collected for the database population of two insurance companies. Frequencies and proportions were calculated; estimated economic impact was expressed as net cost and cost per thousand inhabitants per day. RESULTS: During the observation period, there was continuous growth in use of insulin, mainly in analogue forms (34.0% growth). At the start of the study, 10.4% of subjects were using an analogue insulin; this figure was 62.6% at the end of the study. In 2012, the average cost per 1000 inhabitants/day was US$1.7 for analogue and US$0.8 for human insulins. At the end of the observation period these costs had risen to US$9.2 for analogue (441.1% increase) and fallen to US$0.5 for human insulin (58.3% decrease). CONCLUSIONS: There has been an increase in the unit cost and frequency of use of insulin analogues for anti-diabetic therapy in Colombian patients. Moreover, there is controversy over whether insulin analogues are a more cost-effective treatment than human insulins for the general diabetic population.

Growing teratoma syndrome: an unusual evolution of treated ovarian immature teratoma - a case report.

Growing teratoma syndrome (GTS) is a rare condition among germ cell tumor (GCT) patients during treatment with systemic chemotherapy. It is characterized by the development of enlarging masses, the normalization of tumor markers, and the presence of only mature teratoma in the pathological specimen. The authors present the unusual case of a 15-year-old girl with an immature teratoma treated with conventional surgery and systemic chemotherapy. On her follow up, although tumor markers returned to normal, there was an enlargement of abdomino-pelvic masses confirmed by a PET/TC study. With the diagnosis of a GTS, the patient underwent a com- plete cytoreduction. Histologically, all the specimens contained mature teratoma tissue. The patient remains clear with no signs of recurrence with no further treatment. The knowledge and awareness of this syndrome are highlighted in order to prevent further unnecessary chemotherapy and allow an optimal cytoreduction, which seems to be the most effective therapy so far.

Recommendations in the management of epithelial appendiceal neoplasms and peritoneal dissemination from mucinous tumours (pseudomyxoma peritonei).

The epithelial appendiceal neoplasms are uncommon and are usually detected as an unexpected surgical finding. The general surgeon should be aware of the diversity of its clinical manifestations and biological behaviors along with the significance of the surgical treatment on the progression of the illness and the prognosis of the patients. The operative findings and, especially, tumor histology, determine the type of surgery. Intestinal histologic subtype behaves and should be treated similarly to the right colon neoplasms; while mucinous tumors, often discordant between histology and its aggressiveness, can be treated with a simple appendectomy or require complex oncological surgeries. Mucinous tumors are often associated with the presence of mucin or tumor implants in the abdominal cavity, being the clinical syndrome known as pseudomyxoma peritonei (PMP). PMP tends to present an indolent but deadly evolution and requires a multimodal approach as a single treatment with curative potential: complete cytoreductive surgery plus hyperthermic Intra-peritoneal chemotherapy (CCRS + HIPEC) now considered the standard of care in this pathology. The general surgeon should be aware of the governing principles of the treatment of appendiceal neoplasms with or without peritoneal dissemination, know the therapeutic frontiers in every situation (avoiding unnecessary or counterproductive surgeries) and sending early these patients to specialised centres in the radical management of malignant diseases of the peritoneum in the conditions and with the necessary information to facilitate a possible radical treatment.

Accuracy and clinical relevance of computed tomography scan interpretation of peritoneal cancer index in colorectal cancer peritoneal carcinomatosis: a multi-institutional study.

BACKGROUND: Evaluation of peritoneal metastases by computed tomography (CT) scans is challenging and has been reported to be inaccurate. METHODS: A multi-institutional prospective observational registry study of patients with peritoneal carcinomatosis from colorectal cancer was conducted and a subset analysis was performed to examine peritoneal cancer index (PCI) based on CT and intraoperative exploration. RESULTS: Fifty-two patients (mean age 52.6 ± 12.4 years) from 16 institutions were included in this study. Inaccuracies of CT-based assessment of lesion sizes were observed in the RUQ (P = 0.004), LLQ (P < 0.0005), RLQ (P = 0.003), distal jejunum (P = 0.004), and distal ileum (P < 0.0005). When CT-PCI was classified based on the extent of carcinomatosis, 17 cases (33%) were underestimations, of which, 11 cases (21%) were upstaged from low to moderate, 4 cases (8%) were upstaged from low to severe, and 2 cases (4%) were upstaged from moderate to severe. Relevant clinical discordance where an upstage occurred to severe carcinomatosis constituted a true inaccuracy and was observed in six cases (12%). CONCLUSIONS: The actual clinical impact of inaccuracies of CT-PCI was modest. CT-PCI will remain as a mandatory imaging tool and may be supplemented with other tools including positron emission tomography scan or diagnostic laparoscopy, in the patient selection for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

Giant perineal hernia: laparoscopic mesh repair complemented by a perineal cutaneous approach.

Symptomatic perineal herniation after abdominoperineal resection is a rare complication and its management remains challenging. Perineal laparoscopic mesh repair is safe and effective and can be performed with minimal complications. We report a giant perineal hernia treated by a combined laparoscopic mesh repair approach and plastic resection of the cutaneous perineal wound. To the best of our knowledge, this is the first report with this technical approach that we could find in the English literature.

Recurrent postoperative perineal hernia: laparoscopic redo mesh repair.

Symptomatic perineal herniation after abdominoperineal resection is a rare complication and its management remains challenging. Recurrent symptomatic perineal hernia after a previous laparoscopic mesh repair is exceptional and no standardized procedure has been deemed the "gold standard of care." To date, this redo laparoscopic mesh repair is only the second report that we could find in the English literature.

The European contribution to "Sugarbaker's protocol" for the treatment of colorectal peritoneal carcinomatosis.

INTRODUCTION: In 1981, Dr. PH Sugarbaker, challenging oncological orthodoxy, considered carcinomatosis to be a locoregional stage of the disease that was still susceptible to treatment with curative intent. To this end he developed a new therapeutic alternative based on the combined treatment. The macroscopic disease treated by maximum radical oncological cytoreductive surgery (through the peritonectomies described by him), followed by treatment of the residual microscopic disease with the direct intra-abdominal application of intraoperative chemotherapy with locoregional intensification, modulated by hyperthermia and early normothermic postoperative intra-abdominal chemotherapy. Using this new therapeutic regimen, known as "Sugarbaker s Protocol", his group has reported 45% survival rates in carcinomatosis of colorectal origin at 5 years, and, in selected groups of patients, 50% survival rates at 5 years. The scientific community, however, has criticized these results considering that: it is a personal experience, with a not homogenous treatment protocol with developmental modifications over time, that it is a retrospective non-randomized study, and finally that the cytostatics used in his protocol are obsolete. Various European groups have replied to these main criticisms confirming the good results that this new therapeutic alternative offers for patients with carcinomatosis of colorectal origin. The purpose of this article is to present these contributions. MATERIAL AND METHODS: All the articles published in the English language by European groups in the world s medical literature have been reviewed using the Pubmed-MEDLINE database to identify the relevant articles related to the treatment of carcinomatosis of colorectal origin using cytoreduction and intraperitoneal chemotherapy from January 1980 to January 2008. RESULTS: The European contribution during these 25 years in favour of the "Sugarbaker s Protocol" has consisted fundamentally in: a) one multicenter retrospective study; b) two randomized prospective phase III studies; and c) the use of oxaliplatin and irinotecan as new cytostatic agents in the protocols for intraperitoneal chemotherapy. At the same time, two new transcendental European contributions have been made in which the possibility has been considered of combined simultaneous treatment for patients with hepatic metastases and carcinomatosis, and the introduction, as a selection factor, of patients responsive to intravenous induction chemotherapy within the regimen of sandwich treatment (with systemic neoadjuvant and adjuvant chemotherapy) complementary to intraperitoneal chemotherapy. CONCLUSIONS: The results obtained by European groups using "Sugarbaker s protocol" and "Elias protocol" with oxaliplatin compel us to request that these treatments be considered by all professionals involved in the treatment of patients with colorectal carcinomatosis as the best treatment currently available for this condition. Furthermore a randomized, prospective, multicenter study should be carried out to clarify its value and the degree of scientific evidence. A validation of this treatment will change, in the future, the dogmatic consideration of carcinomatosis as an incurable disease stage.

The intraoperative staging systems in the management of peritoneal surface malignancy.

The establishment of a rationale guideline for intraoperative staging system the extent of carcinomatosis is warranted. The quantitation of tumor found at the time of surgical exploration of the abdomen has proven to be of value in assessment of prognosis and treatment planning in patients with peritoneal carcinomatosis. Four different assessments systems have been employed more frequently, thus far. The advantages and disadvantages of each classification systems are described and discussed. The results of the Consensus of the last 5th International Workshop on Peritoneal Surface malignancy of Milan, December 2006 are presented.

[Prevalence and treatment of oncologic disease in the elderly --an impeding challenge]. / Prevalencia y tratamiento de la patología oncológica en el anciano. El reto que se avecina.

Life expectancy in Spain has more than duplicated during the last 20th Century, and is currently 75 years for men and 83 years for women. Predictions on the evolution of the National and global population anticipate a demographic shock in Spain when individuals older than 65 years eventually make up more than 33.5% of the Spanish population by year 2050. It is known that cancer is directly related with age, and that it is a disease of older people -at least 60% of all cancers are diagnosed in patients older than 65 years. The older people group is the most important group of patients in oncologic practice today. Predictions on the aging of the Spanish population show that cancer in the aging patient and its treatment must be considered a first-line health problem. The diagnosis of cancer is not associated with death in the majority of patients. Sixty percent of cancers are globally cured or chronified. This advanced prognosis has its toll not only in the expectancy of treatment but also in subsequent follow-up and post-treatment adverse effects that can be generated. A greater and better knowledge and understanding of the aging process will allow to identify and select those old patients that can benefit from prevention and treatment options, and more importantly will identify those other patients that are not candidates to treatments with curative intention because of their frail status. Progress in surgery, mainly in minimally invasive surgery, and its application to the field of oncologic surgery allows to forecast that a greater number of aging patients will benefit from treatment with curative intent. Age will not be a barrier for adequate treatment in healthy elderly patients, especially in those with long life expectancy and functional reserves. Fighting this healthcare discrimination is one of the main priorities in the strategy of improved health in the elderly. We present in this study and analyze the foreseen changes in the world s population, particularly in Spain; the association between cancer and age with its peculiar specificities; the general criteria for frailty in older patients, the limitations that aging generate for adjuvant treatments, and the new alternatives of treatment to be used in elderly oncologic patients for the most frequent tumors.

Treatment of peritoneal carcinomatosis from ovarian cancer. Present, future directions and proposals.

Peritoneal carcinomatosis, considered years ago as a final stage of unresectable cancer, can now be managed with curative intention by means of a radical cytoreductive surgical procedure with associated peritonectomy and intraperitoneal chemotherapy, as described by Sugarbaker. Malignant neoplasms such as mesothelioma and pseudomyxoma peritonei, ovarian and colon cancer nowadays are experiencing some new therapeutical approaches. Higher survival rates can be reached in ovarian cancer, which is commonly diagnosed in the presence of peritoneal carcinomatosis, using an optimal cytoreductive radical surgery with intraperitoneal chemotherapy. An actualised review of the treatment of advanced ovarian cancer and a proposal of a national multicentre protocol for the treatment of peritoneal carcinomatosis from ovarian cancer has been performed by a group of Spanish surgeons and oncologists dedicated to a therapeutical approach to this pathology.

Management of peritoneal surface malignancy with cytoreductive surgery and perioperative intraperitoneal chemotherapy.

AIMS: A new treatment strategy combining maximal cytoreductive surgery for treatment of macroscopic disease and maximal perioperative intraperitoneal chemotherapy for residual microscopic disease, suggests that in a selected group of patients benefit is possible. The purpose of this study was to report our experience with this combined treatment and to identify the principal prognostic factors. METHODS: The study included 266 patients from 9 institutions operated on between July 1990 and July 2004. The median age was 55 years. RESULTS: The mortality rate was 7.8% and the morbidity rate 37.5%. The overall median survival was 13.7 months. Positive independent prognostic factors by multivariate analysis were gender, perioperative intraperitoneal chemotherapy and treatment by the second-look procedure. CONCLUSIONS: The therapeutic approach combining cytoreductive surgery with perioperative intraperitoneal chemotherapy achieved long-term survival in a selected group of patients with an acceptable morbidity and mortality.

Peritoneal carcinomatosis of colorectal origin. Current treatment. Review and update.

Colorectal cancer is the most frequent tumor of the digestive tract. The high incidence of abdominal dissemination; the poor prognosis of these patients, with median survival consistently ranging from 5 to 9 months in all studies of peritoneal carcinomatosis from colorectal cancer; the failure of adjuvant systemic chemotherapy treatment with a maximal survival of 18 months despite the development of new cytostatic drugs, and new combinations of use, make it crucial to search for and develop new treatment strategies. We review the principles of Sugarbaker s treatment protocol, which involves the combination of maximum cytoreductive radical oncological surgery for the treatment of all macroscopically disseminated disease with maximum perioperative intraperitoneal intensification chemotherapy to treat residual microscopic disease. We present the results of several scientific papers, all of them phase II studies with more than 10 patients treated, published in the medical literature by the main groups working in this line of treatment, together with the only phase III study reported and published so far, and finally the results of a recently reported retrospective international multicenter study. With this new alternative therapeutic approach, overall mean survival is 40% at 36 months, and 20% at 5 years. Based on these results, this new therapeutic approach is proposed as the treatment of choice for these unfortunate patients.