Prognostic determinants in patients with stage I uterine papillary serous carcinoma: a 15-year multi-institutional review.

OBJECTIVE: The aim of this retrospective, multi-institutional study was to evaluate the importance of surgical staging for stage I uterine papillary serous carcinomas (UPSCs) to determine optimal management of this rare tumor. METHODS: With institutional review board approval from both participating institutions, all patients with 2009 International Federation of Gynecology and Obstetrics stage I mixed serous and UPSC diagnosed between January 1, 1992, and December 31, 2007, were identified at the 2 institutions. Clinical factors were correlated using Spearman correlation coefficients, Kaplan-Meier survival estimates and a Cox proportional hazards model. RESULTS: Of the 204 UPSC patients treated during this period, 84 were classified as stage I, with substages as follows: stage IA, n = 71; stage IB, n = 13. Thirty-seven patients (44%) had a history of a second cancer (22 breast tumors, 9 synchronous müllerian cancers). Surgical staging with at least hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and bilateral pelvic lymph node dissection was performed in 60 (71%) of 84 patients. The median survival for all patients was 10 years. Univariate analysis revealed surgical staging (P < 0.001), normal preoperative CA-125 (P < 0.001), and absence of additional cancers (P < 0.01) to be associated with improved survival. Age-adjusted multivariate analysis incorporating these factors revealed that advancing substage (hazard ratio, 4.59; P < 0.05), a second malignancy (hazard ratio, 2.75; P < 0.04), and surgical staging (hazard ratio, 0.18; P < 0.001) were independent factors associated with overall survival. In a subset analysis excluding patients with a second malignancy, substage (hazard ratio, 3.52; P < 0.05), and surgical staging (hazard ratio, 0.16; P < 0.001) were independent factors affecting overall survival. CONCLUSIONS: Independent of adjuvant chemotherapy or radiation, stage of disease, comprehensive surgical staging, and the presence of a second malignancy were predictors of overall survival.

Derrame pleural paraneumónico: casuística de un hospital de segundo nivel / ârapneumonic pleural effusion: the application of general ethical principles in a paediatric hospital in Barcelona

Introducción. En los últimos años, en nuestro medio se ha podido constatar un aumento en el diagnóstico de pleuroneumonía bacteriana en la infancia. Embassament pleural parapneumònic: casuística d’un hospital pediàtric a Barcelona Alvaro Díaz-Conradi 1, Ramon Clapes 1, Orencio Urraca 1, Adriana Cordon 2, Nora Ruggieri 3, Jorge Canals 4, José Luis Peiró 4, Carmen Muñoz-Almagro 5 1 Servei de Pediatria. 2 Servei de Radiologia. 3 Servei de Pneumologia. 4 Servei de Cirurgia. Hospital de Nens de Barcelona. 5 Servei de Microbiologia. Hospital Sant Joan de Déu. Barcelona Objetivo. Evaluar las características clínicas, radiológicas y microbiológicas, así como el tratamiento y la evolución de los pacientes que han requerido ingreso en un hospital pediátrico de 35 camas con el diagnóstico de neumonía complicada con derrame y que requirieron drenaje pleural. Método. Durante 4 años, desde enero de 2005 hasta diciembre de 2008, ingresaron 33 pacientes diagnosticados de pleuroneumonía complicada que requirieron drenaje pleural y fibrinolíticos endopleurales. Resultados. Se distinguieron 2 períodos: 2005-2006 y 2007- 2008. Se demuestra un aumento de las neumonías ingresadas durante el período 2007-2008 del 2,4% (OIC 95%: 2,1-2,8%), así como un aumento de las pleuroneumonías diagnosticadas del 3,9% en el segundo período en relación con el número de neumonías ingresadas. La ecografía ha constituido una buena herramienta para el diagnóstico y seguimiento sin irradiar al paciente. La etiología ha sido predominantemente neumocócica, determinada sobre todo por Real-Time-PCR en líquido pleural, y el tratamiento estándar, la cefotaxima. Durante el período 2007-2008 se observa que la instilación precoz de urocinasa antes de la aparición de septos endopleurales disminuye el tiempo de estancia hospitalaria en 1,8 días (p = 0,04) respecto al período anterior. Conclusiones. El drenaje pleural con aspiración continuada e instilación de urocinasa endopleural sigue siendo un método eficaz en el tratamiento del empiema en un hospital pediátrico(AU)

Background. In recent years, we have seen an increase in the diagnosis of bacterial pleuropneumonia in children around us. Objective. To evaluate the clinical, radiological, and microbiological characteristics, as well as the treatment and evolution of patients hospitalised in a 35-bed paediatric hospital with the diagnosis of pneumonia complicated with effusion, and who required pleural drainage. Method. For four years, from January of 2005 until December of 2008, 33 patients entered the hospital diagnosed with complicated pleuropneumonia requiring pleural fluid drainage and endopleural fibrinolytics. Results. Two periods were distinguished: 2005-2006 and 2007- 2008. There was an increase of 2.4% (OIC 95%: 2.1- 2.8%) in hospitalisation for pneumonia during the period 2007-2008, as well as an increase of 3.9% in the pleuropneumonia diagnosed in the second period, with respect to hospitalised pneumonia. Ultrasound scanning has been a useful tool for diagnosis and follow-up without radiating the patient. The cause was mainly pneumococcal, determined especially by Real-Time-PCR (Real-Time Polymerase Chain Reaction) in pleural liquid. The most frequently used treatment was cefotaxime. During the 2007-2008 period it was shown that instillation of urokinase before the appearance of endopleural septums decreases the length of hospitalisation by 1.8 days (p = 0.04) with respect to the period 2005-2006. Conclusions. Pleural drainage under continuous aspiration and endopleural instillation of urokinase continue to be an effective method in the treatment of empyemas in a paediatric hospital(AU)