RESUMEN

PURPOSE: Pseudomyxoma peritonei (PMP) is a rare and poorly understood malignant condition characterized by the accumulation of intra-abdominal mucin produced from peritoneal metastases. Currently, cytoreductive surgery remains the mainstay of treatment but disease recurrence and death after relapse frequently occur in patients with PMP. New therapeutic strategies are therefore urgently needed for these patients. EXPERIMENTAL DESIGN: A total of 120 PMP samples from 50 patients were processed to generate a collection of 50 patient-derived organoid (PDO) and xenograft (PDX) models. Whole exome sequencing, immunohistochemistry analyses, and in vitro and in vivo drug efficacy studies were performed. RESULTS: In this study, we have generated a collection of PMP preclinical models and identified druggable targets, including BRAFV600E, KRASG12C, and KRASG12D, that could also be detected in intra-abdominal mucin biopsies of patients with PMP using droplet digital PCR. Preclinical models preserved the histopathological markers from the original patient sample. The BRAFV600E inhibitor encorafenib reduced cell viability of BRAFV600E PMP-PDO models. Proof-of-concept in vivo experiments showed that a systemic treatment with encorafenib significantly reduced tumor growth and prolonged survival in subcutaneous and orthotopic BRAFV600E-PMP-PDX mouse models. CONCLUSIONS: Our study demonstrates for the first time that systemic targeted therapies can effectively control PMP tumors. BRAF signaling pathway inhibition represents a new therapeutic opportunity for patients with BRAFV600E PMP who have a poor prognosis. Importantly, our present data and collection of preclinical models pave the way for evaluating the efficacy of other systemic targeted therapies toward extending the promise of precision oncology to patients with PMP.

Asunto(s)

Terapia Molecular Dirigida , Neoplasias Peritoneales , Medicina de Precisión , Seudomixoma Peritoneal , Ensayos Antitumor por Modelo de Xenoinjerto , Seudomixoma Peritoneal/patología , Seudomixoma Peritoneal/tratamiento farmacológico , Seudomixoma Peritoneal/genética , Humanos , Animales , Ratones , Medicina de Precisión/métodos , Terapia Molecular Dirigida/métodos , Neoplasias Peritoneales/tratamiento farmacológico , Neoplasias Peritoneales/secundario , Neoplasias Peritoneales/genética , Neoplasias Peritoneales/patología , Proteínas Proto-Oncogénicas B-raf/genética , Proteínas Proto-Oncogénicas B-raf/antagonistas & inhibidores , Femenino , Masculino , Proteínas Proto-Oncogénicas p21(ras)/genética , Secuenciación del Exoma , Mutación , Línea Celular Tumoral , Organoides/efectos de los fármacos , Organoides/patología , Biomarcadores de Tumor/genética , Biomarcadores de Tumor/metabolismo

RESUMEN

We present here a performance comparison of quantum-dash (Qdash) semiconductor amplifiers (SOAs) with three, five, eight, and twelve InAs dash layers grown on InP substrates. Other than the number of Qdash layers, the structures were identical. The eight-layer Qdash SOA gave the highest amplified spontaneous emission power (4.3 dBm) and chip gain (26.4 dB) at 1550 nm, with a 300 mA CW bias current and at 25 °C temperature, while SOAs with fewer Qdash layers (for example, three-layer Qdash SOA), had a wider ASE bandwidth (90 nm) and larger 3 dB gain saturated output power (18.2 dBm) in a shorter wavelength range. The noise figure (NF) of the SOAs increased nearly linearly with the number of Qdash layers. The longest gain peak wavelength of 1570 nm was observed for the 12-layer Qdash SOA. The most balanced performance was obtained with a five-layer Qdash SOA, with a 25.4 dB small-signal chip gain, 15.2 dBm 3 dB output saturated power, and 5.7 dB NF at 1532 nm, 300 mA and 25 °C. These results are better than those of quantum well SOAs reported in a recent review paper. The high performance of InAs/InP Qdash SOAs with different Qdash layers shown in this paper could be important for many applications with distinct requirements under uncooled scenarios.

RESUMEN

Chip-scale optical frequency comb sources are ideal compact solutions to generate high speed optical pulses for applications in wavelength division multiplexing (WDM) and high-speed optical signal processing. Our previous studies have concentrated on the use of quantum dash based lasers, but here we present results from an InAs/InP quantum dot (QDot) C-band passively mode-locked laser (MLL) for frequency comb generation. By using this single-section QDot-MLL we demonstrate an aggregate line rate of 12.544 Tbit/s 16QAM data transmission capacity for both back-to-back (B2B) and over 100-km of standard single mode fiber (SSMF). This finding highlights the viability for InAs/InP QDot lasers to be used as a low-cost optical source for large-scale networks.

RESUMEN

We have developed and experimentally demonstrated a highly coherent and low noise InP-based InAs quantum dash (QDash) buried heterostructure (BH) C-band passively mode-locked laser (MLL) with a pulse repetition rate of 25 GHz for fiber-wireless integrated fronthaul 5G new radio (NR) systems. The device features a broadband spectrum providing over 46 equally spaced highly coherent and low noise optical channels with an optical phase noise and integrated relative intensity noise (RIN) over a frequency range of 10 MHz to 20 GHz for each individual channel typically less than 466.5 kHz and -130 dB/Hz, respectively, and an average total output power of ∼50 mW per facet. Moreover, the device exhibits low RF phase noise with measured RF beat-note linewidth down to 3 kHz and estimated timing jitter between any two adjacent channels of 5.5 fs. By using this QDash BH MLL device, we have successfully demonstrated broadband optical heterodyne based radio-over-fiber (RoF) fronthaul wireless links at 5G NR in the underutilized spectrum of around 25 GHz with a total bit rate of 16-Gb/s. The device performance is experimentally evaluated in an end-to-end fiber-wireless system in real-time in terms of error vector magnitude (EVM) and bit error rate (BER) by generating, transmitting and detecting 4-Gbaud 16-QAM RF signals over 0.5-m to 2-m free-space indoor wireless channel through a total length of 25.22 km standard single mode fiber (SSMF) with EVM and BER under 8.4% and 2.9 × 10-5, respectively. The intrinsic characteristics of the device in conjunction with its system transmission performance indicate that QDash BH MLLs can be readily used in fiber-wireless integrated systems of 5G and beyond wireless communication networks.

RESUMEN

BACKGROUND: Gastrointestinal complications, predominantly anastomotic leak (AL), are the most frequent source of severe morbidity after cytoreductive surgery (CRS). OBJECTIVE: The aim of this study was to present the technical standards for colorectal anastomoses developed and systematically applied to all patients undergoing CRS in a high-volume tertiary center, and the associated AL rates. METHODS: This was a descriptive study reporting the technical characteristics of a standardized protocol for three types of colorectal anastomoses (colorectal, ileorectal, and ileocolic) in CRS with heated intraperitoneal chemotherapy (HIPEC), and a retrospective analysis of prospectively collected data on anastomotic outcomes. All patients (1172) undergoing CRS with HIPEC from September 2006 to September 2020 were included. The anastomotic complications were classified according to the International Study Group of Rectal Cancer Surgery (ISGRCS) classification. RESULTS: Overall, 1172 patients underwent 1300 procedures and 1359 gastrointestinal anastomoses. An ileocolic anastomosis was performed in 408 patients, colorectal anastomosis in 469 patients, and ileorectal anastomosis in 16 patients, none with diverting ileostomy; 345 other gastrointestinal reconstructions and 82 urinary reconstructions were performed in these patients. The AL rate was 1% (4/408) for the ileocolic anastomosis, 0.85% (4/469) for the colorectal anastomosis, and 0% (0/16) for the ileorectal anastomosis. One patient died postoperatively due to AL. CONCLUSIONS: Systematic application of standardized techniques adapted to ensure optimal tissue healing (stapled anastomoses avoiding overlap, accurate staple deployment, and hand-sewn reinforcement) are associated with a very high level of anastomotic safety in a large cohort of patients undergoing CRS and HIPEC.

Asunto(s)

Fuga Anastomótica , Procedimientos Quirúrgicos de Citorreducción , Anastomosis Quirúrgica , Fuga Anastomótica/etiología , Procedimientos Quirúrgicos de Citorreducción/efectos adversos , Humanos , Ileostomía , Estudios Retrospectivos

RESUMEN

Gastrointestinal complications are the main source of severe morbidity after cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC), mainly in the form of anastomotic leak. Reducing the rate of anastomotic leaks is of paramount importance and should be approached both through risk factor understanding and reduction, as well as optimization of surgical team performance. We performed a study that describes the details of a technical protocol for the creation of anastomoses after colorectal resections in CRS and HIPEC and the anastomotic outcomes associated with its systematic application in a high-volume peritoneal surface malignancy center. An extremely low, near-zero anastomotic leak rate (0.85% in colorectal anastomoses, 1% in ileo-colic anastomoses, and 0% in ileo-rectal anastomoses) was observed among 1172 patients. Extremely low, near-zero rates of anastomotic leak after colorectal resections in CRS and HIPEC could be achievable in high-volume peritoneal malignancy centers. The described techniques could be adopted and validated in other high-volume peritoneal malignancy centers.

Asunto(s)

Hipertermia Inducida , Neoplasias Peritoneales , Fuga Anastomótica/etiología , Terapia Combinada , Procedimientos Quirúrgicos de Citorreducción/efectos adversos , Humanos , Neoplasias Peritoneales/terapia , Estudios Retrospectivos

RESUMEN

Importance: Studies on the prognostic role of hyperthermic intraperitoneal chemotherapy (HIPEC) in pseudomyxoma peritonei (PMP) are currently not available. Objectives: To evaluate outcomes after cytoreductive surgery (CRS) and HIPEC compared with CRS alone in patients with PMP. Design, Setting, and Participants: This cohort study analyzed data from the Peritoneal Surface Oncology Group International (PSOGI) registry, including 1924 patients with histologically confirmed PMP due to an appendiceal mucinous neoplasm. Eligible patients were treated with CRS with or without HIPEC from February 1, 1993, to December 31, 2017, and had complete information on the main prognostic factors and intraperitoneal treatments. Inverse probability treatment weights based on the propensity score for HIPEC treatment containing the main prognostic factors were applied to all models to balance comparisons between the CRS-HIPEC vs CRS-alone groups in the entire series and in the following subsets: optimal cytoreduction, suboptimal cytoreduction, high- and low-grade histologic findings, and different HIPEC drug regimens. Data were analyzed from March 1 to June 1, 2018. Interventions: HIPEC including oxaliplatin plus combined fluorouracil-leucovorin, cisplatin plus mitomycin, mitomycin, and other oxaliplatin-based regimens. Main Outcomes and Measures: Overall survival, severe morbidity (determined using the National Cancer Institute Common Terminology for Adverse Events, version 3.0), return to operating room, and 30- and 90-day mortality. Differences in overall survival were compared using weighted Kaplan-Meier curves, log-rank tests, and Cox proportional hazards multivariable models. A sensitivity analysis was based on the E-value from the results of the main Cox proportional hazards model. Differences in surgical outcomes were compared using weighted multivariable logistic models. Results: Of the 1924 patients included in the analysis (997 [51.8%] men; median age, 56 [interquartile range extremes (IQRE), 45-65] years), 376 were in the CRS-alone group and 1548 in the CRS-HIPEC group. Patients with CRS alone were older (median age, 60 [IQRE, 48-70] vs 54 [IQRE, 44-63] years), had less lymph node involvement (14 [3.7%] vs 119 [7.7%]), received more preoperative systemic chemotherapy (198 [52.7%] vs 529 [34.2%]), and had higher proportions of high-grade disease (179 [47.6%] vs 492 [31.8%]) and suboptimal cytoreduction residual disease (grade 3, 175 [46.5%] vs 117 [7.6%]). HIPEC was not associated with a higher risk of worse surgical outcomes except with mitomycin, with higher odds of morbidity (1.99; 95% CI, 1.25-3.19; P = .004). HIPEC was associated with a significantly better overall survival in all subsets (adjusted hazard ratios [HRs], 0.60-0.68, with 95% CIs not crossing 1.00). The weighted 5-year overall survival was 57.8% (95% CI, 50.8%-65.7%) vs 46.2% (95% CI, 40.3%-52.8%) for CRS-HIPEC and CRS alone, respectively (weighted HR, 0.65; 95% CI, 0.50-0.83; P < .001; E-value, 2.03). Such prognostic advantage was associated with oxaliplatin plus fluorouracil-leucovorin (HR, 0.42; 95% CI, 0.19-0.93; P = .03) and cisplatin plus mitomycin (HR, 0.57; 95% CI, 0.42-0.78; P = .001) schedules. Conclusions and Relevance: In this cohort study, HIPEC was associated with better overall survival when performed after CRS in PMP, generally without adverse effects on surgical outcomes.

Asunto(s)

Antineoplásicos/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias del Apéndice/terapia , Procedimientos Quirúrgicos de Citorreducción , Quimioterapia Intraperitoneal Hipertérmica , Seudomixoma Peritoneal/terapia , Adulto , Anciano , Neoplasias del Apéndice/mortalidad , Estudios de Cohortes , Esquema de Medicación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Seudomixoma Peritoneal/mortalidad , Tasa de Supervivencia , Resultado del Tratamiento

RESUMEN

BACKGROUND: Endometrial cancer is the most common malignancy of the female genital tract. For cancers detected at an advanced stage or intraperitoneal relapse, the prognosis is poor. Optimal cytoreductive surgery (CRS) is the most accepted treatment; however, patients with advanced intraperitoneal disease might benefit from hyperthermic intraoperative peritoneal chemotherapy (HIPEC). The aim of this study was to analyze recurrence-free survival (RFS) after CRS and HIPEC in a large series of patients with peritoneal metastases from endometrial cancer. METHODS: Patients with a diagnosis of endometrial cancer with primary or recurrent peritoneal dissemination were included. All patients underwent CRS plus HIPEC. Data were prospectively collected in the Spanish Group of Peritoneal Oncological Surgery (GECOP) database. RESULTS: Forty-three patients with endometrial cancer and peritoneal metastasis were included. Fifteen patients (35%) were diagnosed with G3 endometrioid carcinomas and 28 (65%) with other non-endometroid histologies. A completeness of cytoreduction score of CC-0 was achieved in 41 patients (95%). RFS at 5 years was 23%, being factors related to worse RFS: treatment with preoperative chemotherapy (p = 0.027), resection of more than three peritoneal areas (p = 0.010), cytoreduction of the upper abdominal space (p = 0.023), HIPEC treatment with paclitaxel (p = 0.013), and the presence of metastatic lymph nodes (p = 0.029). CONCLUSIONS: Better RFS rates after CRS and HIPEC were observed for patients with the following characteristics: cytoreductive surgery without preoperative chemotherapy, complete surgery performed with limited surgical maneuvers, treated with cisplatin, and no lymph node metastases. SYNOPSIS: Endometrial cancer has a poor prognosis when diagnosed at advance stage. Patients with intraperitoneal metastases from endometrial cancer may benefit from CRS plus HIPEC with improvement in the recurrence-free survival results.

Asunto(s)

Antineoplásicos/administración & dosificación , Carcinoma Endometrioide/terapia , Cisplatino/administración & dosificación , Procedimientos Quirúrgicos de Citorreducción , Neoplasias Endometriales/terapia , Quimioterapia Intraperitoneal Hipertérmica , Neoplasias Quísticas, Mucinosas y Serosas/terapia , Neoplasias Peritoneales/terapia , Anciano , Carcinoma Endometrioide/secundario , Supervivencia sin Enfermedad , Neoplasias Endometriales/patología , Femenino , Humanos , Escisión del Ganglio Linfático , Persona de Mediana Edad , Neoplasias Quísticas, Mucinosas y Serosas/secundario , Neoplasias Peritoneales/secundario

RESUMEN

This paper presents an InAs/InP quantum dash (QD) C-band passively mode-locked laser (MLL) with a channel spacing of 34.224 GHz. By using this QD-MLL we demonstrate an aggregate 5.376 Tbit/s PAM-4 data transmission capacity both for back-to-back (B2B) and over 25-km of standard single mode fiber (SSMF). This represents the first demonstration of QD-MLL acting as error-free operation at an aggregate data transmission capacity of 5.376 Tbit/s for some filtered individual channels. This finding highlights the viability for InAs/InP QD lasers to be used as a low-cost optical source for data center networks.

RESUMEN

We have developed and experimentally demonstrated a novel monolithic InAs/InP quantum-dash dual-wavelength distributed feedback (QD DW-DFB) C-band laser as a compact optical beat source to generate millimeter-wave (MMW) signals. The device uses a common gain medium in a single cavity structure for simultaneous correlated and stable dual-mode lasing in the 1550-nm wavelength range. A record narrow optical linewidth down to 15.83 kHz and average relative intensity noise (RIN) as low as -158.3 dB/Hz from 10 MHz to 20 GHz are experimentally demonstrated for the two optical modes generated by the laser. As a result, the beat note between these two lasing modes generates spectrally pure MMW signals between 46 GHz and 48 GHz. Such an efficient, coherent, and compact optical source is extremely attractive for applications in MMW systems, such as Radar and fiber-wireless integrated fronthaul for 5G and beyond.

RESUMEN

INTRODUCCIÓN: La edad avanzada y la presencia de comorbilidades repercuten en la morbimortalidad postoperatoria del paciente quirúrgico frágil. El objetivo de este estudio es valorar los resultados de morbimortalidad tras cirugía por cáncer colorrectal en el paciente quirúrgico frágil tras la implementación de un Área de Atención al paciente Quirúrgico Complejo (AAPQC). MÉTODOS: Estudio retrospectivo con recogida prospectiva de datos. Un total de 91 pacientes consecutivos considerados como frágiles (ASAIV o ASAIII con Barthel < 80 i/o Pfeiffer>3) fueron intervenidos entre 2013 y 2015 con diagnóstico de cáncer colorrectal con intención curativa. Grupo I (AAPQC): 35 pacientes incluidos en AAPQC durante 2015. Grupo II (No AAPQC): 56 pacientes intervenidos entre 2013 y 2014 previa implementación del AAPQC. Se analizó homogeneidad de grupos, complicaciones, estancia media, mortalidad, reintervenciones, reingresos y costes en función del GRD. RESULTADOS: No se encontraron diferencias significativas en edad, sexo, ASA, índex de masa corporal, estadio tumoral y tipo de intervención quirúrgica entre los dos grupos. Las complicaciones mayores (Clavien-DindoIII-IV) (11,4% vs. 28,5%, p = 0,041), la estancia media (12,6 ± 6 días vs. 15,2 ± 6 días, p = 0,043), los reingresos (11,4% vs. 28,3%, p = 0,041) y el peso específico del episodio (3,29 ± 1 vs 4,3 ± 1, p = 0,008) fueron significativamente menores en el grupo AAPQC. No hubo diferencias en re intervenciones (6,2% vs. 5,3%) ni mortalidad (6,2% vs 7,1%). El 96,9% de pacientes del grupo I manifestó una atención y calidad de vida satisfactoria. CONCLUSIONES: La implementación de una AAPQC en pacientes frágiles que deben ser intervenidos de cáncer colorrectal comporta una reducción de las complicaciones, estancia y reingresos, y es una medida coste-efectiva

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INTRODUCTION: Advanced age and comorbidity impact on post-operative morbi-mortality in the frail surgical patient. The aim of this study is to assess the impact of a comprehensive, multidisciplinary and individualized care delivered to the frail patient by implementation of a Work Area focused on the Complex Surgical Patient (CSPA). METHODS: Retrospective study with prospective data collection. Ninety one consecutive patients, classified as frail (ASAIII or IV, Barthel<80 and/or Pfeiffer>3) underwent curative radical surgery for colorectal carcinoma between 2013 and 2015. GroupI: 35 patients optimized by the CSPA during 2015. Group II: 56 No-CSPA patients, treated prior to CSPA implementation, during 2014-2015. Group homogeneity, complication rate, length of stay, reoperations, readmissions, costs and overall mortality were analyzed and adjusted by Diagnosis-Related Group (DRG). RESULTS: There were no statistically significant differences in term of age, gender, ASA classification, body mass index, tumor staging and type of surgical intervention between the two groups. Major complications (Clavien-DindoIII-IV) (12.5% vs. 28.5%, P = .04), hospital stay (12.6 ± 6 days vs. 15.2 ± 6 days, P = 0.041), readmissions (12.5% vs. 28.3%, P < 0.041), and patient episode cost weighted according to DRG (3.29 ± 1 vs. 4.3 ± 1, P = 0.008) were statistically inferior in Group CSPA. There were no differrences in reoperations (6.2% vs. 5.3%) or mortality (6.2% vs. 7.1%). 96.9% of patients of Group I manifested having received a satisfactory attention and quality of life. CONCLUSIONS: Implementation of a CSPA, delivering surgical care to frail colorectal cancer patients, involves a reduction of complications, length of stay and readmissions, and is a cost-effective arrangement

Asunto(s)

Humanos , Anciano , Neoplasias Colorrectales/cirugía , Atención Integral de Salud/organización & administración , Indicadores de Morbimortalidad , Anciano Frágil/estadística & datos numéricos , Servicio de Cirugía en Hospital/estadística & datos numéricos , Estudios Retrospectivos , Negativa al Tratamiento/estadística & datos numéricos , Complicaciones Posoperatorias/prevención & control

RESUMEN

INTRODUCTION: Advanced age and comorbidity impact on post-operative morbi-mortality in the frail surgical patient. The aim of this study is to assess the impact of a comprehensive, multidisciplinary and individualized care delivered to the frail patient by implementation of a Work Area focused on the Complex Surgical Patient (CSPA). METHODS: Retrospective study with prospective data collection. Ninety one consecutive patients, classified as frail (ASAIII or IV, Barthel<80 and/or Pfeiffer>3) underwent curative radical surgery for colorectal carcinoma between 2013 and 2015. GroupI: 35 patients optimized by the CSPA during 2015. GroupII: 56 No-CSPA patients, treated prior to CSPA implementation, during 2014-2015. Group homogeneity, complication rate, length of stay, reoperations, readmissions, costs and overall mortality were analyzed and adjusted by Diagnosis-Related Group (DRG). RESULTS: There were no statistically significant differences in term of age, gender, ASA classification, body mass index, tumor staging and type of surgical intervention between the two groups. Major complications (Clavien-DindoIII-IV) (12.5% vs. 28.5%, P=.04), hospital stay (12.6±6days vs. 15.2±6days, P=0.041), readmissions (12.5% vs. 28.3%, P<0.041), and patient episode cost weighted according to DRG (3.29±1 vs. 4.3±1, P=0.008) were statistically inferior in Group CSPA. There were no differrences in reoperations (6.2% vs. 5.3%) or mortality (6.2% vs. 7.1%). 96.9% of patients of GroupI manifested having received a satisfactory attention and quality of life. CONCLUSIONS: Implementation of a CSPA, delivering surgical care to frail colorectal cancer patients, involves a reduction of complications, length of stay and readmissions, and is a cost-effective arrangement.

Asunto(s)

Neoplasias Colorrectales/cirugía , Fragilidad , Medicina de Precisión/normas , Anciano , Estudios de Casos y Controles , Procedimientos Quirúrgicos del Sistema Digestivo , Femenino , Humanos , Masculino , Complicaciones Posoperatorias/prevención & control , Estudios Retrospectivos , Resultado del Tratamiento

RESUMEN

INTRODUCTION: Radical Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC), has been proposed as the current standard of treatment for metastatic peritoneal disease by several tumors. Despite its widely utilization, there seems to be a great variability in their organization, clinical practice, and safety among centers. AIM OF THE STUDY: To obtain updated information on clinical practice in different perioperative areas of the CRS-HIPEC. PATIENTS AND METHODS: All 25 members of the Spanish Surface Peritoneal Malignancy (GECOP), were invited to answer an online survey, to describe their usual practice in different perioperative areas of the CRS-HIPEC. RESULTS: Survey was responded by 100% of centers. This study represents more than 800 patients treated annually. Seventy per cent of respondents perform CRS-HIPEC for more than 5 years. The most frequent technique was Coliseum (88%). Routinely non-invasive monitoring of cardiac output is used by 92% of centers. More than 50% of centers administer oxaliplatin (74%), or mitomycin-C (65%) in colorectal cancer; cisplatin in gastric cancer (73%) and mesothelioma (74%). Ovarian cancer is treated with cisplatin and various combinations, in 64% or paclitaxel in 54.5%. Spillage protocol was available in 100% centers. CONCLUSIONS: Data showed an important variability in volume of patients per center, selection of cytostatic agents, professional training and safety measures applied. The standardization of CRS/HIPEC procedures based on the best available evidence, the individualization of patients and the consensus among professionals, constitute an important part of the basis that will allow us to improve results of this complex procedure.

Asunto(s)

Antineoplásicos/uso terapéutico , Carcinoma/terapia , Procedimientos Quirúrgicos de Citorreducción/métodos , Hipertermia Inducida/métodos , Mesotelioma/terapia , Neoplasias Peritoneales/terapia , Pautas de la Práctica en Medicina , Carcinoma/secundario , Gasto Cardíaco , Cisplatino/uso terapéutico , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/terapia , Femenino , Humanos , Infusiones Parenterales , Masculino , Mesotelioma/secundario , Mitomicina/uso terapéutico , Monitoreo Intraoperatorio/métodos , Compuestos Organoplatinos/uso terapéutico , Neoplasias Ováricas/patología , Neoplasias Ováricas/terapia , Oxaliplatino , Paclitaxel/uso terapéutico , Neoplasias Peritoneales/secundario , España , Neoplasias Gástricas/patología , Neoplasias Gástricas/terapia , Encuestas y Cuestionarios

RESUMEN

Paciente mujer de 60 años, en seguimiento por historia familiar de cáncer de mama y ovario, en la que se detectaron implantes tumorales peritoneales y depósitos de mucina en serosa apendicular. Los implantes peritoneales fueron diagnosticados de carcinoma seroso tipo ovárico/peritoneal con inmunofenotipo característico, siendo la mucina acelular. Se realizaron estudios de mutación de KRAS y BRAF mediante PCR que demostró la presencia de mutación GD12 únicamente en el componente mucinoso, lo que permitió mostrar la existencia de una doble neoplasia. La cirugía posterior confirmó la existencia sincrónica de un adenocarcinoma mucinoso apendicular y un carcinoma seroso peritoneal. Creemos que este caso permite ilustrar que la incorporación de los estudios moleculares en la actividad asistencial del patólogo puede aportarnos información adicional con valor diagnóstico (AU)

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A 60 year old female with a family history of ovarian and breast cancer underwent a follow-up laparoscopic exploration which revealed peritoneal implants and mucinous deposits on the appendicular surface. The peritoneal implants were diagnosed as serous carcinoma with a characteristic immunophenotype, while the mucinous material was acellular. KRAS and BRAF mutation studies with PCR showed a GD12 mutation in the mucinous component only, suggesting the presence of a synchronous carcinoma. Subsequent cytorreductive surgery confirmed the presence of an infiltrating appendicular mucinous adenocarcinoma, synchronous with the peritoneal infiltrating serous carcinoma. We believe that this case, where the different immunohistochemical and molecular profiles allowed a correct diagnosis of two independent neoplasms, emphasizes the value of molecular studies in routine diagnostic procedure (AU)

Asunto(s)

Humanos , Femenino , Persona de Mediana Edad , Adenocarcinoma Mucinoso/patología , Cistadenocarcinoma Seroso/patología , Biopsia , Cistadenocarcinoma Seroso/tratamiento farmacológico , Neoplasias/patología , Inmunohistoquímica/métodos , Patología/métodos , Terapia Neoadyuvante/métodos

RESUMEN

No disponible

Asunto(s)

Humanos , Masculino , Persona de Mediana Edad , Seudoobstrucción Colónica/complicaciones , Seudoobstrucción Colónica/cirugía , Seudoobstrucción Colónica , Anastomosis Quirúrgica/métodos , Anastomosis Quirúrgica/tendencias , Anastomosis Quirúrgica , Insuficiencia Respiratoria/complicaciones , Insuficiencia Respiratoria/cirugía , Insuficiencia Respiratoria , Megacolon/complicaciones , Megacolon , Colonoscopía/métodos , Colonoscopía

Asunto(s)

Seudoobstrucción Colónica/complicaciones , Enfermedades Intestinales/etiología , Enfermedades del Sistema Nervioso/etiología , Enfermedad Crónica , Humanos , Masculino , Persona de Mediana Edad

RESUMEN

PURPOSE: Pseudomyxoma peritonei (PMP) originating from an appendiceal mucinous neoplasm remains a biologically heterogeneous disease. The purpose of our study was to evaluate outcome and long-term survival after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) consolidated through an international registry study. PATIENTS AND METHODS: A retrospective multi-institutional registry was established through collaborative efforts of participating units affiliated with the Peritoneal Surface Oncology Group International. RESULTS: Two thousand two hundred ninety-eight patients from 16 specialized units underwent CRS for PMP. Treatment-related mortality was 2% and major operative complications occurred in 24% of patients. The median survival rate was 196 months (16.3 years) and the median progression-free survival rate was 98 months (8.2 years), with 10- and 15-year survival rates of 63% and 59%, respectively. Multivariate analysis identified prior chemotherapy treatment (P < .001), peritoneal mucinous carcinomatosis (PMCA) histopathologic subtype (P < .001), major postoperative complications (P = .008), high peritoneal cancer index (P = .013), debulking surgery (completeness of cytoreduction [CCR], 2 or 3; P < .001), and not using HIPEC (P = .030) as independent predictors for a poorer progression-free survival. Older age (P = .006), major postoperative complications (P < .001), debulking surgery (CCR 2 or 3; P < .001), prior chemotherapy treatment (P = .001), and PMCA histopathologic subtype (P < .001) were independent predictors of a poorer overall survival. CONCLUSION: The combined modality strategy for PMP may be performed safely with acceptable morbidity and mortality in a specialized unit setting with 63% of patients surviving beyond 10 years. Minimizing nondefinitive operative and systemic chemotherapy treatments before definitive cytoreduction may facilitate the feasibility and improve the outcome of this therapy to achieve long-term survival. Optimal cytoreduction achieves the best outcomes.

Asunto(s)

Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias del Apéndice/patología , Hipertermia Inducida/métodos , Neoplasias Peritoneales/secundario , Neoplasias Peritoneales/terapia , Seudomixoma Peritoneal/tratamiento farmacológico , Seudomixoma Peritoneal/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Terapia Combinada , Supervivencia sin Enfermedad , Femenino , Humanos , Inyecciones Intraperitoneales , Masculino , Persona de Mediana Edad , Neoplasias Peritoneales/tratamiento farmacológico , Neoplasias Peritoneales/mortalidad , Neoplasias Peritoneales/cirugía , Seudomixoma Peritoneal/mortalidad , Tasa de Supervivencia , Adulto Joven

RESUMEN

We report on the characterization of the ultrafast gain and refractive index dynamics of an InAs/InGaAsP self-assembled quantum dot semiconductor optical amplifier (SOA) operating at 1.55 mum through heterodyne pump-probe measurements with 150 fs resolution. The measurements show a 15 ps gain recovery time at a wavelength of 1560 nm, promising for ultrafast switching at >40 GHz in the important telecommunications wavelength bands. Ultrafast dynamics with 0.2-1.5 ps lifetimes were also found consistent with carrier heating and spectral hole burning. Comparing with previous reports on quantum dot SOAs at 1.1-1.3 mum wavelengths, we conclude that the carrier heating is caused by a combination of free-carrier absorption and stimulated transition processes.

RESUMEN

Neurotrauma is one of the three causes of mortality. We are showing our initial experience, with neurosurgical support and specifically all of the patients were admited to the Critical Care Unit of the Hospital Regional of Copiapó; at the 3rd region of the country. We described the head trauma and spine trauma cases, and the neurointensive management; now with neurotrauma surgery at all. The goal of this article is to show our initial experience and our capabilities and the proyection in the development of neurointensivism in our center.

Asunto(s)

Humanos , Cuidados Críticos , Hipertensión Intracraneal/terapia , Laminectomía , Traumatismos Craneocerebrales/mortalidad , Traumatismos Craneocerebrales/terapia , Traumatismos de la Médula Espinal/mortalidad , Traumatismos de la Médula Espinal/terapia , Chile

RESUMEN

Se revisan 100 casos de atrapamiento de nervio mediano al nivel de canal carpiano operados entre 1997 y 1999, en el Hospital Regional de Talca. Se describe relación etaria y predominancia por sexo, además del perfil laboral. Además se describe la técnica quirúrgica, lo mismo que las complicaciones y evolución post quirúrgica. Se correlacionan datos clínicos con resultados electrofisiológicos. Se hace hincapié en lo frecuente de ésta patología y además de su presentación atípica

Asunto(s)

Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/métodos , Síndrome del Túnel Carpiano/cirugía , Distribución por Edad , Evolución Clínica , Hospitales Provinciales , Nervio Mediano , Ocupaciones , Complicaciones Posoperatorias , Procedimientos Quirúrgicos Ambulatorios/métodos , Distribución por Sexo , Síndrome del Túnel Carpiano/epidemiología