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.

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 (AU)

Supervivencia del paciente trasplantado de hígado por hepatocarcinoma y riesgo de recurrencia tumoral / Survival of patients receiving a liver transplant for hepatocellular carcinoma, and risk of tumor recurrence

Objetivo: el objetivo de este estudio ha sido evaluar la supervivencia a corto y largo plazo del paciente trasplantado de hígado por hepatocarcinoma (CHC), el riesgo de recidiva tumoral postrasplante y los factores asociados a esta complicación. Diseño: estudio restrospectivo de una serie consecutiva de pacientes trasplantados de hígado por hepatocarcinoma. Pacientes y métodos: enfermos trasplantados por hepatocarcinoma desde el año 1989 hasta noviembre de 2003. Los pacientes fueron seleccionados con unos límites generales de tamaño y número de nódulos que fueron posteriormente publicados como criterios de Milán. En su diagnóstico pretrasplante se siguieron asimismo criterios consensuados en la Conferencia de Barcelona. Resultados: la supervivencia de este grupo de 81 pacientes trasplantados por hepatocarcinoma fue del 80, 61 y 52%, a los 1, 5 y 10 años respectivamente. En el 32% de los casos el CHC fue un hallazgo incidental en el explante. En el 12,3% se constató recidiva tumoral. El estudio multivariante identificó como factores de riesgo de recidiva el tamaño del nódulo (OR = 1,7944) (IC 95% = 1,1332-2,8413) y la invasión vascular (OR = 6,6346) (IC 95% = 1,4624-30,1003). Conclusiones: el trasplante de hígado en pacientes seleccionados con CHC obtiene buenos resultados a medio y largo plazo. El riesgo de recidiva tumoral postrasplante se ha reducido notablemente y está asociado con el tamaño del nódulo y con la invasión vascular microscópica

Objective: the goal of this research has been to evaluate the survival, in long and short term, of the patient receiving liver transplant for hepatocellular carcinoma (HCC), the risk of posttransplant tumor relapse and factors related to this complication. Design: retrospective study of a consecutive series of patients having had liver transplant for HCC. Patients and methodology: transplant patients for HCC from 1989 to November 2003. Patients were selected due to general limitations of nodule size and quantity, which were subsequently published as Milan criteria. Also, criteria agreed in the Conference of Barcelona were followed in the pre-transplant diagnosis. Results: the survival of this 81 patients group was of the 80, 61 and 52% for 1, 5 and 10 years respectively. In the 32% of the cases the HCC was an incidental finding in the explant. In the 12.3%, the tumor relapse was verified. The multivariate research identified the size of the nodule (OR = 1,7944) (IC 95% = 1,1332-2,8413) and the vascular invasion (OR = 6,6346) (IC 95% = 1,4624-30,1003) as risk factors of relapse. Conclusions: the liver transplant in selected patients with HCC has good results in medium and long term. The risk of post-transplant tumor relapse becomes notably reduced and is associated with the size of the nodule and the microscopic vascular invasion

Survival of patients receiving a liver transplant for hepatocellular carcinoma, and risk of tumor recurrence.

OBJECTIVE: The goal of this research has been to evaluate the survival, in long and short term, of the patient receiving liver transplant for hepatocellular carcinoma (HCC), the risk of post-transplant tumor relapse and factors related to this complication. DESIGN: Retrospective study of a consecutive series of patients having had liver transplant for HCC. PATIENTS AND METHODOLOGY: Transplant patients for HCC from 1989 to November 2003. Patients were selected due to general limitations of nodule size and quantity, which were subsequently published as Milan criteria. Also, criteria agreed in the Conference of Barcelona were followed in the pre-transplant diagnosis. RESULTS: The survival of this 81 patients group was of the 80, 61 and 52% for 1, 5 and 10 years respectively. In the 32% of the cases the HCC was an incidental finding in the explant. In the 12.3%, the tumor relapse was verified. The multivariate research identified the size of the nodule (OR=1,7944) (IC 95%=1,1332-2,8413) and the vascular invasion (OR=6,6346) (IC 95%=1,4624-30,1003) as risk factors of relapse. CONCLUSIONS: The liver transplant in selected patients with HCC has good results in medium and long term. The risk of post-transplant tumor relapse becomes notably reduced and is associated with the size of the nodule and the microscopic vascular invasion.

[Cytological diagnosis of malignant melanoma of the esophagus]. / Diagnóstico citológico de melanoma maligno de esófago.

Malignant melanoma of the esophagus is an extremely rare neoplasm. We presented a case of this neoplasm diagnosed on a cytologic smear from a 84 year-old women. The smear was characterized by scattered dissociated cells with hyperchromatic irregular nuclei, prominent nucleoli and occasional cytoplasmic brown pigment. The immunohistochemical study revealed positivity for HMB-45 and S-100 protein.

[Iatrogenic perforation of the intrathoracic colon after a late traumatic diaphragmatic hernia]. / Perforación iatrogénica de colon intratorácico tras hernia diafragmática traumática tardia.

A case of delayed presentation of traumatic diaphragmatic hernia and colonic injury leading to a review of the literature. Relative diagnostic difficulty in this type of lesions and its acute presentation make managements by mistake, as this one. In a patient with very important acute respiratory embarrassment and chest pain, an Argyle tube was placed because pneumothorax was suspected; the patient improved, but a fluid bowel content was obtained through the drainage tube; TAC and barium enema film showed the colon into the thorax. The patient underwent thoracotomy and laparotomy. In her history, she suffered from a stab wound on the left abdominal flank four years ago; it did not require surgical treatment but it caused the start of the colon movement into the thorax. The ways of presentation and its development are reviewed with the aim of remembering that it must be borne in mind if a patient present a penetrating trauma in the lower chest or upper abdomen, especially if surgical operation was not required, as it happened in this case. A careful history, examination, and review of follow up chest X-ray appears to be the easiest mechanism to avoid delays in diagnosis and reduce the morbi-mortality of this important disease.