Gallbladder carcinoma: intraoperative imprint cytology, a helpful and valuable screening procedure.

BACKGROUND/PURPOSE: A major problem arises when a tumor is not readily recognized at the time of cholecystectomy. A carcinoma at early stages or one hidden by acute or chronic inflammation can be overlooked during surgery, and the diagnosis would then be made only after microscopic examination of paraffin-embedded tissue. The purpose of the present report is to communicate the results of 10 years' experience with the use of imprint cytology for the intraoperative diagnosis of gallbladder carcinoma. METHODS: During the period June 1994 to June 2004, 525 imprint cytologies of gallbladder mucosa were performed after 160 open cholecystectomies and 365 laparoscopic cholecystectomies. The patients had been operated on for acute or chronic cholecystitis due to lithiasis. Only 18 patients had a preoperative diagnosis of gallbladder carcinoma. The sensitivity, specificity, predictive values, accuracy, and their confidence intervals (95% CIs), of intraoperative imprint cytology for the diagnosis of carcinoma were analyzed. RESULTS: The average time employed for each procedure was 10 min. Patients' mean age was 69.2 years with a range of 24 to 92 years. Three hundred and forty-two patients (65.1%) were women and 183 (34.9%) were men. The imprint cytology method was positive in 44 of 58 gallbladder carcinomas diagnosed, with a sensitivity of 75.9% (44/58 patients) and a specificity of 99.8% (466/467). Only 1 case (1/525; 0.2%) was a false-positive; this was due to reactive changes. The positive predictive value was 97.8% (44/45; 95% CI = 86.8-99.9), negative predictive value was 97.1% (466/480; 95% CI = 95.0-98.3), and accuracy was 97.1% ([44 + 466]/525; 95% CI = 95.2-98.3). There was insufficient or inadequate material in 4 cases. CONCLUSIONS: Imprint cytology of the gallbladder mucosa is an easy, rapid, and high-quality method for detecting gallbladder carcinoma.

Gallbladder cancer: surgical results after cholecystectomy in 25 patients with lamina propria invasion and 26 patients with muscular layer invasion.

BACKGROUND/PURPOSE: It has been stated that simple cholecystectomy is sufficient treatment for all patients with pT1 gallbladder cancer. However, other authors note the necessity of carrying out extended surgery when there is muscular-layer involvement. METHODS: A consecutive series of gallbladder carcinomas with lamina propria or muscular layer invasion were analyzed. Between July 1982 and December 2000, 51 patients with pT1 gallbladder carcinomas were treated with simple cholecystectomy (group A, 25 patients with lamina propria-invasion; group B, 26 patients with muscular-layer invasion). Patients with intraepithelial carcinomas were excluded from the study. RESULTS: There were no differences between the groups in average age, sex ratios, association with other tumors, histologic type, malignancy grade, cholecystitis type, macroscopic aspects, lymph node status, or treatment applied. After an average of 6 years' follow-up, no patients in group A and nine patients (34.6%) in group B died due to gallbladder carcinoma. Cystic lymph nodes could be studied in five of these nine patients who relapsed, and the results were negative for metastasis. Lymphatic or venous invasion was observed in five of these nine patients. CONCLUSIONS: According to these results, cholecystectomy is not sufficient treatment for gallbladder carcinoma with muscular-layer invasion.

Resultados y experiencias de la vigilancia nacionalde meningitis bacteriana en Cuba / Resultados y experiencias de la vigilancia nacional

Objetivos: Desde 1998 se implementó en Cuba un nuevo sistema de vigilancia nacional de meningitis bacteriana (VNMB) con el objetivo de lograr información en correspondencia con el desarrollo científico actual y las exigencias del programa nacional de prevención y control de estas infecciones. Resultados: Este sistema permitió medir el impacto de la vacuna contra H. influenzae tipo b (Hib) en 1999 sin necesidad de un proyecto y gastos adicionales, demostrando la reducción inmediata de la incidencia (52por ciento). Hasta el 2002 fueron reportados 82 niños < 5 años de los cuales 61(74,4por ciento) no estaban vacunados. Entre los vacunados hubo 14 (66,7por ciento) con una sola dosis aplicada.A partir de esta intervención S. pneumoniae resultó el principal agente causal de meningitis. Los serogrupos/ serotipos más frecuentes han sido 19, 6, 14, 18, 1, 7 y 23, mostrando un 40por ciento de susceptibilidad disminuida a la penicilina. Por primera vez identificamos: - fuerte asociación (RR > 20) de los estudiantes internos de primaria con la enfermedad, - incidencia elevada entre amas de casa (> 2/100 000) y jubilados (> 8/100 000), - fuerte asociación (Razón de disparidad > 20) de la muerte con jubilados y amas de casa en el análisis multivariado. Los resultados microbiológicos posibilitaron la caracterización de agentes y la política antibiótica más adecuada. La letalidad general de la meningitis neumocócica fue > 32 por ciento y fundamentalmente en ancianos. Conclusiones: LaVNMB aportó novedosa información clínico - epidemiológica y microbiológica, permitiendo ampliar el marco integral de los conocimientos y garantizando acciones más efectivas y eficientes en un proyecto multidisciplinario e intersectorial generalizado (AU)