RESUMEN
Laparoscopic cholecystectomy has become the standard treatment for gallbladder diseases. However, there are still some patients for whom conversion to open surgery is required. This surgery can produce significant post-operative pain. Opioids drugs have traditionally been used to treat this pain, but side effects have led to seeking alternatives (plexus, nerve or fascia blocks or wound). The cases are presented of 4 patients subjected to ultrasound-guided intercostal branches blocks in the mid-axillary line from T6 to T12 with levobupivacaine as an analgesic alternative in open surgery of gallbladder, with satisfactory results.
Asunto(s)
Anestésicos Locales/administración & dosificación , Bupivacaína/análogos & derivados , Colecistectomía/métodos , Nervios Intercostales/efectos de los fármacos , Bloqueo Nervioso/métodos , Dolor Postoperatorio/prevención & control , Ultrasonografía Intervencional , Anciano , Anciano de 80 o más Años , Anestésicos Locales/uso terapéutico , Bupivacaína/administración & dosificación , Bupivacaína/uso terapéutico , Colecistitis/cirugía , Urgencias Médicas , Femenino , Humanos , Levobupivacaína , Masculino , Manejo del DolorRESUMEN
To determine the relationship between p53 altered expression and p53 mutations in hepatocellular carcinoma (HCC), we analysed p53 protein immunohistochemically and assessed the presence of mutations in exons 4-8 of the p53 gene using SSCP assay in 117 HCCs corresponding to 78 patients. We also determined the relationship of p53 expression with cellular proliferation by immunostaining with monoclonal antibodies to Ki-67. We found significant levels of p53 protein expression in 23.1% of the 117 cases studied, but identified mutations in only 12 cases (10.3%). Only four of the p53-positive cases had mutations in the regions analysed. Six of the cases that displayed mutations at p53 gene were negative for immunohistochemical analysis (IHC) and two cases showed positive immunoreactivity in the cytoplasm of the cell. In conclusion, strong IHC reactivity for p53 protein is not an indicator of the presence of p53 gene mutations at exons 4-8 in HCC. Thus, p53 loss of function in HCC should be evaluated both by p53 mutation analysis and p53 protein expression, as both give complementary information about p53 status.
Asunto(s)
Carcinoma Hepatocelular/genética , Genes p53 , Neoplasias Hepáticas/genética , Mutación , Proteína p53 Supresora de Tumor/metabolismo , Regulación hacia Arriba , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Hepatocelular/metabolismo , Carcinoma Hepatocelular/fisiopatología , Femenino , Humanos , Inmunohistoquímica , Neoplasias Hepáticas/metabolismo , Neoplasias Hepáticas/fisiopatología , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Polimorfismo Conformacional Retorcido-Simple , Pronóstico , Proteína p53 Supresora de Tumor/genéticaRESUMEN
BACKGROUND: Hepatocellular carcinoma often displays multiple tumor nodules, thus posing a problem for differential diagnosis between cancers of both multifocal and metastatic origin. Conventionally, pathological criteria have been used for this purpose, but these are largely subjective. In order to facilitate a more objective differential diagnosis of multiple HCCs, we used the patterns of methylation of p16INK4a, p14ARF, and GSTP1 genes as markers for each tumor nodule. METHODS: Sixty-seven nodules from 30 cases of multiple or recurrent HCCs were examined using methylation-specific PCR (MSP) analysis for the detection of methylation profiles. RESULTS: Hypermethylation was detected in 56.7%, 43.3% and 17.9% of the cases for p16INK4a, p14ARF, and GSTP1 genes, respectively. At the genetic level the inter-nodule methylation profiles were heterogeneous in 23 of the cases and homogeneous in another 7, enabling a multifocal origin to be diagnosed in the former and metastatic origin in the latter. CONCLUSIONS: Methylation profiling seems to be useful in differentiating the clonal origins of multiple cancers, as the information yielded by this method is essentially objective.
Asunto(s)
Aciltransferasas/metabolismo , Carcinoma Hepatocelular/diagnóstico , Metilación de ADN , Genes p16/fisiología , Neoplasias Hepáticas/diagnóstico , Proteína p14ARF Supresora de Tumor/metabolismo , Carcinoma Hepatocelular/genética , Carcinoma Hepatocelular/metabolismo , Femenino , Perfilación de la Expresión Génica , Humanos , Neoplasias Hepáticas/genética , Neoplasias Hepáticas/metabolismo , Masculino , Reacción en Cadena de la PolimerasaRESUMEN
OBJECTIVES: A study is made of the main clinicopathological factors in squamous cell carcinoma (SCC) of the tongue and floor of the mouth in the province of Vizcaya (Biscay) (The Basque Country, Spain), and their relation to patient prognosis. DESIGN: A retrospective study was made of 40 patients with early (clinical stage I/II) SCC of the tongue and floor of the mouth. A previously designed protocol was used to record the clinical and histopathological data, which were subjected to descriptive and comparative bi- and multivariate statistical and survival analyses. RESULTS: There were 34 males and 6 females, with a mean age of 55.7 years (range 33-81). In 23 cases the SCC was located in the tongue, and in 17 cases in the floor of the mouth. The average tumor diameter was 2.6 cm; 65% of the neoplasms were ulcerated. The mean clinical course was 3.4 months, with an average tumor growth rate or velocity of 268 (Evans formula). Thirty-four patients were smokers and 33 consumed alcohol. All SCC of the floor of the mouth, and all regional recurrences, were diagnosed in smokers and drinkers. Survival at 5 years was 65%. Well differentiated SCC were diagnosed in 52.5% of cases. The average histological malignancy grade was 1.96, and was higher in males, tongue malignancies, T2 lesions, tumors with growth velocities above 200, and in recurrent neoplasms. CONCLUSIONS: Early SCC of the tongue and floor of the mouth in Vizcaya affects mainly male smokers and drinkers of alcohol under the age of 60 years. A relationship is observed between the histopathological findings (particularly invasion mode and stage) and patient prognosis.
Asunto(s)
Carcinoma de Células Escamosas/patología , Suelo de la Boca/patología , Neoplasias de la Boca/patología , Neoplasias de la Lengua/patología , Adulto , Anciano , Anciano de 80 o más Años , Consumo de Bebidas Alcohólicas , Análisis de Varianza , Carcinoma de Células Escamosas/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Suelo de la Boca/cirugía , Neoplasias de la Boca/cirugía , Análisis Multivariante , Invasividad Neoplásica , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Úlceras Bucales/patología , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Estudios Retrospectivos , Factores Sexuales , Fumar , España , Análisis de Supervivencia , Tasa de Supervivencia , Neoplasias de la Lengua/cirugíaRESUMEN
OBJECTIVE: Warthin tumor is the second most common benign parenchymal salivary neoplasm. The purpose of this study was to evaluate the histopathologic features of Warthin tumor to determine whether a developmental pattern could be identified. STUDY DESIGN: Seventy-nine Warthin tumors in 63 patients (62 male and 1 female; average age, 58.62 years) were examined. All cases were histopathologically classified and morphometrically analyzed with an Optomax system to measure the proportions of lymphoid tissue and cystic cavities. RESULTS: The predominantly epithelial type (21% of all cases) of Warthin tumor was associated with a mean patient age at diagnosis of 53 years, a mean evolution time of 2.8 months, an average size of 1 cm, and a mean lymphoid component of 10%. In the case of the classical type (61% of all cases), the mean patient age at diagnosis was 58 years, the mean evolution time 9 months, the average size 2.4 cm, and the mean lymphoid component 40%. For the predominantly lymphoid type (18% of all cases), these values were, respectively, 62 years, 11 months, 2.8 cm, and 74%. The mean size of the classical and lymphoid tumors (79% of the Warthin tumors) was significantly greater (p < 0.0001) than the mean size of the epithelial type (21% of the Warthin tumors). A positive correlation between tumor size and evolution time was found. CONCLUSION: Our results suggest that the Warthin tumor initially develops as an adenomatous epithelial proliferation followed by lymphocytic infiltration.
Asunto(s)
Adenolinfoma/patología , Neoplasias de la Parótida/patología , Progresión de la Enfermedad , Femenino , Humanos , Subgrupos Linfocitarios , Linfocitos Infiltrantes de Tumor , Masculino , Persona de Mediana Edad , Análisis de RegresiónRESUMEN
El objetivo del trabajo ha sido disponer de evaluaciones sobre la capacidad de almacenaje de agua en suelos áridos y semiáridos y de sus constantes hidrológicas y además lograr valores de almacenajes mínimos que pueden alcanzarse en esos ambientes climáticos