DNA content by flow cytometry in gastric carcinoma: pathology, ploidy and prognosis.

BACKGROUND/AIMS: The prognostic relevance of histopathologic findings in gastric carcinoma is well established. Studies on DNA-ploidy are still scanty and contradictory. METHODOLOGY: Histopathologic parameters, DNA ploidy and S-phase were evaluated in 78 cancer patients curatively resected, using formalin-fixed paraffin-embedded tissue. RESULTS: Thirty-nine tumors (50%) were aneuploid. No significant correlation was found between histologic data and ploidy, but tumors with nodal involvement were more frequently aneuploid. In univariate analysis, tumor location (p=0.05), tumor size (p=0.01), differentiation grade (p=0.02), Lauren classification (p=0.01), deeper infiltration of gastric wall (p=0.001), nodal affectation (p=0.0000) and number of lymph nodes (p=0.01), TNM stage (p=0.0000), type of gastrectomy performed (p=0.04), and DNA ploidy (p=0.04) significantly influenced survival. S-phase values had no effect on prognosis. In the multiple regression model, factors independently associated with survival were TNM stage (p=0.0009), nodal affectation (p=0.01) and, marginally, ploidy (p=0.08). CONCLUSIONS: In gastric carcinoma curatively resected, the more relevant prognostic factors were stage and nodal involvement. Fifty percent of the tumors were aneuploid. Aneuploidy was significantly associated with poorer prognosis.

Acid-base balance alterations in laparoscopic cholecystectomy.

BACKGROUND: The purpose of this study is to determine alterations of acid-base balance originated by pneumoperitoneum with CO2. Influence of other factors such as anesthetic technique, duration of procedure, and volume of CO2 insufflated has also been analyzed. METHODS: Some 132 patients were divided in three groups according to anesthetic technique used. Arterial blood gases were determined before pneumoperitoneum, at 20 min after it, and every 30 min, until procedure's end, and in postoperative period up to a total of four samples. RESULTS: Pneumoperitoneum originated a fall of pH (p << 0. 001), ion bicarbonate (p << 0.001), and base excess (p << 0.001) and an elevation of PaCO2 (p << 0.001). No correlation was found between these changes and duration of pneumoperitoneum or amount of CO2 insufflated. Changes were fundamentally of a metabolic type. There were no statistically significant differences among anesthetic techniques. CONCLUSIONS: In conclusion, pneumoperitoneum with CO2 originates alterations of the acid-base balance, mostly of a metabolic type. This could mean that besides CO2 absorption, there is a tissular hypoperfusion due to the increase of abdominal pressure.

[Respiratory changes during laparoscopic cholecystectomy. A comparative study of three techniques]. / Alteraciones respiratorias durante la colecistectomía laparoscópica. Estudio comparativo de tres técnicas anestésicas.

OBJECTIVES: To analyze the repercussions of CO2 pneumoperitoneum on the ventilation of healthy patients undergoing laparoscopic cholecystectomy; to assess the influence of anesthetic technique and determine whether duration of procedure or CO2 volume are relevant factors. PATIENTS AND METHOD: Prospective study of 132 patients undergoing laparoscopic cholecystectomy. The patients were selected based on disease and level of anesthetic risk and then randomly assigned to three groups to receive anesthesia with oxygen/nitrous oxide (group I), isoflurane in O2 and air (FIO2 0.4) (group II) or propofol in continuous infusion with O2 and air (FIO2 0.4) (group III). Analgesia and muscle relaxation were the same in all groups. Monitoring included blood pressure (BP), heart rate (HR), electrocardiography (ECG), central venous pressure (CVP), capnography (PETco2), pulse oximetry (SaO2), peak airways pressure (PAP), FIO2, intra-abdominal pressure (IAP), volume in insufflated CO2 and serial gasometry. Readings were taken before pneumoperitoneum after 20 minutes and every 30 minutes until end of surgery. After surgery parameters were recorded four more times at intervals of 30 minutes. RESULTS: The groups were homogeneous. pneumoperitoneum caused a decrease in PaO2 (p < 0.001) and SaO2 and increases in PaCO2, PETco2 and CVP, although levels later stabilized. No relation was found between duration of pneumoperitoneum or CO2 volumen and any of the changes observed. Group I had the lowest mean PaO2 before pneumoperitoneum and 60 minutes later (p < 0.05). Group II had the smallest increase in PaCO2, although the difference was non significant. CONCLUSIONS: CO2 pneumoperitoneum caused ventilatory changes dependent on uptake and increased abdominal pressure. The duration and volume of CO2 used did not influence the parameters studied. The clinical significance of these changes is slight in the healthy patient. The anesthetic agents used did not have substantial effects.

[Hydatid cyst of the diaphragm. Apropos of a case]. / Kyste hydatique du diaphragme. A propos d'un cas.

We report a case of hydatid cyst of diaphragma in a 70 year-old male, who was admitted to hospital in emergency for right basithoracic pain, aggravated by cough and deep breathing. Laboratory tests were normal. Standard roentgenographs showed a right-sided subpulmonic opacity. Pleural aspiration fluid revealed hemorrhagic pleural effusion. Lung scintigraphy showed and hypoperfused area at the base. Abdominal echography evidenced an hepatic cyst referred to the diaphragma. Thoracoabdominal CT-scans indicated a calcium-loaded mass on the postero-lateral aspect of the right lobe of liver. Surgical exploration revealed an independent hepatic cyst localized in the latero-costal bundles of the diaphragma which was removed en masse.

[Compensatory reaction of the ascending colon following jejuno-ileal bypass. Experimental study]. / Reacción compensadora del colon ascendente tras el by-pass yeyuno-íleal. Estudio experimental.

The series of physiopathologic consequences and the adaptive response that appears in the residual intestine following intestinal by-pass surgery has been widely studied. The same is not true for the ascending colon. Having demonstrated the adaptive changes this organ undergoes after a massive enterectomy, we carried out the present study to evaluate the compensatory reaction after an intestinal by-pass. A total of 115 Wistar rats weighing 350-550 g were used. Twenty animals made up group 0 (control), 30 underwent intestinal section (group II) and 65 received a jejuno-ileal by-pass (group III), with latero-lateral anastomosis. After weight control was performed the animals were sacrificed at 15, 30, 45 and 60 days, and samples were taken from the ascending colon for optical microscopy (OM), scanning electronic microscopy (SEM) and transmission electronic microscopy (TEM). All objective data were quantified and statistical studies carried out. The by-pass animals showed statistically significant ponderal drops (p less than 0.001), an expression of the malabsorption disorder the by-pass produced. Groups 0 (control) and I (IS) showed no macroscopic, microscopic or ultrastructural changes. The by-pass animals, however, manifested colic dilatation with a significant increase in thickness, to the detriment of the muscularis and mucosa, and greater crypt depth with a relative decrease in the number of goblet cells. Enterocytes increased in number and size. These changes were statistically significant in relation to groups 0 and I. The above findings were confirmed ultrastructurally. In the scanning electronic microscopy after 30 days, the colic mucosa had an irregular appearance, with elevations but no foliated appearance.(ABSTRACT TRUNCATED AT 250 WORDS)

[Carcinoma of the gastric stump after resection of benign disease (32 cases)]. / Carcinomas del muñón gástrico tras resección por enfermedad benigna (32 casos).

Gastric stump carcinomas have a poor prognosis; the etiology, diagnosis and treatment are not well-defined. The authors analyze their experience with 32 patients with carcinoma of the gastric stump after gastric resection for peptic ulcer; the age of the patients was 44-72 years. The period of latency, since the previous resection, was 28 years. At the time of diagnosis, all patients were symptomatic. The radiological study was positive in 69% of cases and endoscopic exploration and biopsy in 100%. 47% of patients could be resected but the surgery was considered radical only in 4. The tumors were always adenocarcinomas; the muscular layer was infiltrated in 86% of cases and to adjacent organs in 52%. 76% of cases presented lymph node metastases and 31% distant metastases. There were 8 postoperative deaths (28%). The five years survival was 4.2%. The poor prognosis of this lesion emphasizes the importance of early diagnosis and treatment as well as that of periodic follow-up of gastrectomized patients older than 50.

Surgical management of malignant tumors of the esophagogastric junction: a retrospective review of 188 patients.

A series of 188 patients with cancer of the esophagogastric junction were operated from 1960 to 1985. Their age range was 18-79 years old and 73% were males. Mean duration of symptomatology was five months and 93% were affected by dysphagia. Surgery was limited to exploratory laparotomy in 17 patients (9%), feeding gastrostomy in 14 (7.5%), Celestin endoluminal tube in 31 (16.5%), jejunal by-pass in one and tumoral resection in 125 (66.5%). The predominant procedures of resection were total (64%) and proximal gastrectomy (28%). To restore digestive continuity, the stomach was used in 40 (32%) cases, jejunum in 67 (53.6%) and colon in 18 (14.4%). Eighty-eight per cent of tumors were adenocarcinomas. Seventeen per cent of patients died in the post-operative period: 18.4% following resection (17.5% following partial gastrectomy and 18.8% following total gastrectomy) and 14% following palliative measures. Five-year survival rates were 11.8% for resected cases, 8.7% for total gastrectomized patients and 18.2% for partial gastrectomized tumors.

[Extrahepatic biliodigestive anastomoses. Analysis of 227 cases]. / Anastomosis biliodigestivas extrahepáticas. Análisis de 227 casos.

The authors analyze their experience with 227 biliodigestive anastomoses to compare the early and late results. Choledocholithiasis (49%) and cancer of the pancreas (25%) were the most common processes. Choledochoduodenostomy (48%), cholecystojejunostomy (22%), sphincteroplasty (18%) and hepaticojejunostomy (9%) were the techniques most often used. In 61% of cases (90% of the malignant tumors) there was an emergency indication. Twenty-one percent of the patients presented serious complications in the postoperative period (14% of the benign tumors), half of which depended on the bypass. Postoperative peritonitis (2%), external biliary fistula (4%) and acute pancreatitis (2%) were the most significant surgical complications. Hepaticojejunostomy induced the largest number of bypass-dependent complications. There were 12 deaths due to medical causes (5%), these being most numerous in subjects with neoplasms and cholecystojejunostomy, and 8 of surgical origin (4%), half of them in carriers of a hepaticojejunostomy. There was a clear decline in the morbidity of patients operated on in recent years. In the long term, 91% of the patients remained free of discomfort or had minimal symptoms. Choledochoduodenostomy or sphincteroplasty produced the best results. It is concluded that biliodigestive anastomoses yield the best early and late results with minimal secondary effects.