Prognostic value of nuclear morphometry in colorectal cancer.

PURPOSE: In many types of cancer, certain morphometric characteristic of tumor cells correlate with patient survival. Our observations suggested that the survival of patients with colorectal carcinomas is negatively correlated with tumor-cell nucleus size. METHODS: We investigated relationships between postsurgery survival and nucleus morphometrics in 90 patients who had undergone resection for a colorectal tumor. The nucleus-size variables considered were maximum diameter, minimum diameter, perimeter, area, and form factor (means for 100 nuclei from each patient were used in all cases). RESULTS: Our results confirmed that patients with large maximum nucleus diameter (where large = greater than the first quartile) have significantly worse survival than patients with smaller maximum nucleus diameter (mean survival, 28 vs. 43 months). Similar results were obtained for the other nucleus-size variables. Stepwise Cox regression analysis was then performed, with postsurgery survival time as the dependent variable and the following candidate independent variables: age, gender, Dukes class, degree of histologic differentiation, the various nucleus-size variables, and relative frequencies of different nucleus shapes (spherical, oval, cylindrical, fusiform, and irregular). The variables selected for the prognostic model were Dukes class, relative frequency of irregular nuclei, and maximum nucleus diameter. CONCLUSIONS: These findings indicated that nucleus size and shape are useful predictors of survival. Even if Dukes class is known, consideration of nucleus size and shape significantly improves prediction of survival.

[Prognosis of acute pancreatitis: Ranson or APACHE II?]. / Pronóstico de la pancreatitis aguda: Ranson o Apache II?

OBJECTIVE: The aim of this paper is to determine which is the best early prognostic score in acute pancreatitis among those we have studied. DESIGN: Prospective study of acute pancreatitis cases during a 5 year period. PATIENTS: 113 patients, biliary etiology in 93 cases, (average age: 63 years) and 66% females. The diagnostic accuracy of Ranson, Imrie, Osborne and apache II scores was analyzed. RESULTS: There were complications in 12%, and mortality was 8%. Among all the systems analyzed the Ranson criteria achieved the highest sensitivity (79%), although sensitivity was improved with Apache II at admission to the hospital (86%). We have obtained the best specificity with the Apache II (89%) and with the Osborne criteria (88%). The modification of Ranson's criteria for biliary etiology didn't improve the sensitivity (56%) to detect severe cases of acute pancreatitis. CONCLUSIONS: The Apache II system was the best for the early detection of severe acute pancreatitis. Its diagnostic sensitivity was higher than the multiple laboratory criteria analyzed.

[Laparoscopic cholecystectomy in Spain: multicentric study of 2,432 patients]. / La colecistectomía laparoscópica en España: estudio multicéntrico de 2.432 enfermos.

OBJECTIVES: To evaluate the efficiency of laparoscopic cholecystectomy for the treatment of gallstones. DESIGN: Retrospective/prospective multicentric study undertaken by the Department of Surgical Endoscopy of the Spanish Association of Surgeons. Data were introduced into a computerized protocol. Statistical analysis with SPSS 4.0 applying the Student's T test and Pearson's chi square. PARTICIPANTS: 69 surgeons from 40 Hospitals who have performed laparoscopic cholecystectomies in 2432 patients, diagnosed of gallstones, with an average age of 49 years (9-91) and 80% in women. RESULTS: The operation was completed in 94% of the cases and lasted on an average of 75 minutes (20-120). Surgical findings were 2380 non complicated gallstones, 185 acute cholecystitis (7.6%) and 265 scleroatrophic gallbladders (11%). Intraoperative cholangiography was performed in 9% and gallstones in the common bile duct were diagnosed in 2%, of which 0.3% were treated by laparoscopy and 1% by post-operative endoscopic sphinterotomy Five per cent were converted to laparotomy, of which 29% (1.5% of total patients) were obligatory conversions. Among postoperative complications there were 0.4% lesions due to abdominal puncture, 0.4% lesions of the common bile duct and 2.5% hemorrhages. Post-operative complications were seen in 7.5% of patients. The most frequent complications affected the surgical wounds (3%), whereas bile duct complications represented 0.6% and were most frequent in the series of less than 50 patients. Mortality was 0.12%. Average post-operative hospital stay was 2.5 days (0.5-5). CONCLUSIONS: In Spain, laparoscopic cholecystectomy is an effective and safe procedure with results which are comparable to other multicentric studies published in other countries, with a morbidity-morbility index similar to open cholecystectomy and the great added advantage is the avoidance of laparotomy and its inconveniences (pain, longer hospital stay...) and complications.

[Hepatic cystadenoma: report of a case]. / Cistoadenoma hepático: presentación de un caso.

A case is presented of bilobar hepatic cystadenoma. This is a rare benign tumor in which an adequate preoperative diagnosis is important for correct treatment. A review is made of the literature and controversial aspects of this infrequent lesion are discussed.