RESUMEN
High productivity and specificity in anaerobic digesters arise because complex microbiomes organize into a metabolic cascade to maximize energy recovery and to utilize the advantage that the gaseous end product methane freely bubbles out of the system. These lessons were applied to ascertain whether a reactor microbiome could be shaped to produce a different end product. The liquid product n-caproic acid was chosen, which is a 6-carbon-chain carboxylic acid that is valuable and that has a relatively low maximum solubility concentration for product recovery. Acetoclastic methanogenesis was inhibited by pH control and a route was provided for n-caproic acid extraction by implementing selective, in-line recovery. Next, ethanol was supplemented to promote chain elongation, which is a pathway in which short-chain carboxylic acids are elongated sequentially into medium-chain carboxylic acids with two-carbon units derived from ethanol. The reactor microbiome developed accordingly with the terminal process catalyzed by chain-elongating bacteria. As a result, n-caproic acid production rates increased to levels comparable to anaerobic digestion systems for solid waste treatment.
Asunto(s)
Reactores Biológicos/microbiología , Caproatos/metabolismo , Anaerobiosis , Eliminación de Residuos/métodosRESUMEN
AIM OF THE STUDY: The impact of lymphadenectomy in therapeutic strategy of ovarian carcinomas is strongly debated. The aim of this retrospective study was to report a series of 86 patients with ovarian carcinoma who underwent pelvic and paraaortic lymphadenectomy. PATIENTS AND METHOD: From 1993 to 1998, a retroperitoneal lymphadenectomy was performed in 86 patients (median age: 54 years) during the first laparotomy (n = 52) or later (n = 34) for ovarian carcinoma stade I and II (n = 33), stade III and IV (n = 53). Sixty patients underwent pelvic and paraaortic lymphadenectomy with separate study of the different groups of nodes. RESULTS: There was a lymph node involvement in 48.8% of all cases and in 36% of stade I and II carcinomas. Lymph node involvement was observed for all histological types. It was present in both pelvic and paraaortic nodes in 52.3% of the patients N+. Its incidence was 46.1% in patients before chemotherapy and 52.9% in patients after chemotherapy. It may concern all anatomical location with a 5 to 31% frequency. There was no postoperative death and a low morbidity rate (13.9%). CONCLUSIONS: Retroperitoneal lymphadenectomy is feasible; it is a contribution to the tumoral cytoreduction and to a better classification of ovarian carcinomas. According to this series and to the other reported series, an initial, complete, pelvic and paraaortic lymphadenectomy should be recommended for all cases of ovarian carcinomas but prospective randomised trials are necessary to appreciate the impact of this lymphadenectomy on survival.
Asunto(s)
Carcinoma/cirugía , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Neoplasias Ováricas/cirugía , Adolescente , Adulto , Anciano , Carcinoma/patología , Femenino , Humanos , Laparotomía , Metástasis Linfática , Persona de Mediana Edad , Estadificación de Neoplasias/métodos , Neoplasias Ováricas/patología , Pronóstico , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
STUDY AIM: To evaluate the effect of intraoperative lymph node mapping and sentinel lymph node dissection (SLND) on the axillary staging of patients with N0 breast carcinoma. Two techniques were used: blue dye alone (Evans Blue and Patent Blue) and combined technique (blue dye and isotope). METHODS: The incidence of axillary node metastasis in axillary lymph node dissection (ALND) and SLND was compared prospectively. Multiple sections of each SLN were examined by HPS staining and immunohistochemical techniques. Two sections of each non sentinel node in ALND specimens were examined by routine HPS staining. RESULTS: 243 patients underwent ALND after SLN biopsy. The SLN detection rate was 225/243 cases (92.59%): 89.94% with blue dye alone and 100% with the combined technique. The false-negative rate was less than 2%. CONCLUSION: SN biopsy is an accurate staging technique for N0 breast cancer. SLN biopsy with multiple sections and immunohistochemical staining of the SLN can identify significantly more patients with lymph node metastases than ALND with routine HPS staining.
Asunto(s)
Neoplasias de la Mama/patología , Cuidados Intraoperatorios/métodos , Estadificación de Neoplasias/métodos , Biopsia del Ganglio Linfático Centinela/métodos , Biopsia , Neoplasias de la Mama/cirugía , Colorantes , Azul de Evans , Reacciones Falso Negativas , Femenino , Francia , Humanos , Inmunohistoquímica , Cuidados Intraoperatorios/normas , Mastectomía , Estadificación de Neoplasias/normas , Estudios Prospectivos , Colorantes de Rosanilina , Biopsia del Ganglio Linfático Centinela/normasRESUMEN
The Authors analyse a series of 149 consecutive patients with carcinoma of the pancreas or the periampullary region. Curative surgical treatment was achievable in 55 patients, palliative procedures included surgery in 68 patients; biliary decompression with endoscopic or percutaneous procedure in 25 patients and chemotherapy in one patient with lymphoma. Perioperative complications consisted in gastroplegia (33%), pancreatic fistula (22%), biliary fistula (7.3%), abdominal abscess (5.5%) and hemoperitoneum (1.8%). Five patients died within 30 days after surgery (9%). The overall median postoperative survival was 37, 29 and 21 months in papillary, choledochal and pancreatic cancer, respectively.
Asunto(s)
Adenocarcinoma/cirugía , Ampolla Hepatopancreática , Neoplasias del Conducto Colédoco/cirugía , Neoplasias Pancreáticas/cirugía , Adenocarcinoma/mortalidad , Anciano , Anciano de 80 o más Años , Ampolla Hepatopancreática/cirugía , Neoplasias del Conducto Colédoco/mortalidad , Femenino , Humanos , Complicaciones Intraoperatorias , Metástasis Linfática , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Pancreatectomía , Neoplasias Pancreáticas/mortalidad , Pancreaticoduodenectomía , Factores de TiempoRESUMEN
The influence of the timing of surgery in relation to the menstrual cycle on the survival of breast cancer patients has been both advocated and disputed. The records of 165 premenopausal M- breast cancer women consecutively operated from 1977 to 1991 were reviewed. All patients underwent modified radical mastectomies or quadrantectomies plus postoperative radiotherapy. Node-positive patients received adjuvant chemotherapy. Cox regression analysis was used to estimate the relative risk (RR) of death in three models including timing of surgery, age, histology, pT and pN. In each model, patients were divided into two groups according to the criteria proposed by Badwe, Hrushesky, and Senie. Multivariate analysis showed a significant association between pT and pN and survival, whereas no association with survival was observed for the timing of surgery according to either Badwe or Hrushesky or Senie (RR = 1.26, RR = 0.91 and RR = 0.88 respectively). Consensus on the menstrual phase related to the expected best prognosis is still required.
Asunto(s)
Neoplasias de la Mama/fisiopatología , Neoplasias de la Mama/cirugía , Ciclo Menstrual/fisiología , Premenopausia/fisiología , Adulto , Neoplasias de la Mama/patología , Femenino , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Factores de TiempoRESUMEN
The influence of timing of surgery in relation to menstrual period on survival of breast cancer patients has been both advanced advocated and disputed. A meta-analysis on published series showed a statistically significant overall odds reduction when surgery is performed in the luteal phase. The records of 165 premenopausal M- breast cancer women, not on hormonal therapies, consecutively operated on from 1977 to 1991 were reviewed. All patients underwent modified radical mastectomies or quadrantectomies plus operative radiotherapy, Node-positive patients received standard adjuvant chemotherapy. Cox regression analysis was used to estimate the relative risk (RR) of death in three models including timing of surgery, age, histology, pathological T and N. In each model, patients were divided into two groups according to the criteria proposed by Badwe, Hrushesky, and Senie. Multivariate analysis showed a significant association between pT and pN and survival, whereas no association with survival was observed for timing of surgery according to Badwe or Hrushesky or Senie criteria (RR = 1.26, RR = 0.91, and RR = 0.88 respectively). Up-to-date agreement on the menstrual phase and relative expected better prognosis is still lacking.
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Neoplasias de la Mama/cirugía , Carcinoma Ductal de Mama/cirugía , Ciclo Menstrual , Adulto , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/radioterapia , Carcinoma Ductal de Mama/mortalidad , Carcinoma Ductal de Mama/radioterapia , Fenómenos Cronobiológicos , Terapia Combinada , Femenino , Humanos , Mastectomía Radical Modificada , Mastectomía Segmentaria , Persona de Mediana Edad , Análisis Multivariante , Cuidados Posoperatorios , Premenopausia , Pronóstico , Análisis de RegresiónRESUMEN
Hyperthermic Antiblastic Perfusion (HAP) is a widely used method for the treatment of recurrent limb melanoma. In terms of tumor response, locoregional control and survival HAP has led to better results than those achieved with any other treatment. The aim of this report is to analyze our own experience with HAP in locally advanced limb melanoma. Thirty-two patients were submitted to HAP. HAP lasted 60 minutes, with maximal local temperature of 40.5-42 degrees C using melphalan 10 mg/L limb volume as antiblastic agent. Twenty patients had in-transit metastases and 12 local recurrence. Regional nodes were involved in 12 patients. Systemic leakage monitored with 125I or 99Tc ranged between 5-30% (mean 14%). No operative mortality nor major complications occurred. Local toxicity scored Wieberdink grade I in 8 patients, grade II in 17, grade III in 6 and grade IV in 1 case. Response rate (UICC) in the 16 patients treated with unexcised lesions was 94% (56% complete responses). With a median follow-up of 29 months (2-126) 14 patients relapsed after a median time of 10 months, and 17 patients are currently disease free, 3 of these are being reexcised and 3 re-perfused. Actuarial 5 years survival was 64%, with 39% disease free to the first relapse. Our results are consistent with the literature indicating HAP as a safe procedure with a high evidence of clinical responses.
Asunto(s)
Antineoplásicos Alquilantes/uso terapéutico , Hipertermia Inducida , Melanoma/terapia , Melfalán/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos Alquilantes/administración & dosificación , Terapia Combinada , Supervivencia sin Enfermedad , Circulación Extracorporea , Femenino , Humanos , Hipertermia Inducida/efectos adversos , Hipertermia Inducida/métodos , Hipertermia Inducida/mortalidad , Pierna , Masculino , Melanoma/mortalidad , Melanoma/patología , Melfalán/administración & dosificación , Persona de Mediana Edad , Metástasis de la Neoplasia , Recurrencia , Tasa de Supervivencia , Factores de TiempoRESUMEN
Twenty-two patients with recurrent melanoma of the limbs, underwent Hyperthermic Antiblastic Perfusion (HAP). HAP lasted 60 min, with maximal local temperature of 40.5-42 degrees C and melphalan 10 mg/L limb volume as antiblastic agent. Fourteen patients had in-transit metastases and 8 local recurrences. Regional nodes were involved in 6 patients. Systemic leakage monitored with 125I or 99Tc ranged between 5 and 30% (mean 19%). No operative mortality nor major complications occurred. Local toxicity scored Wieberdink grade I in 6 patients, grade II in 11 and III in 5. Response rate (UICC) in the 9 patients treated with unexcised lesions was 88% (55% complete responses). After a median follow-up of 27 months (1-92) 9 patients relapsed after a median time of 17 months, and 15 patients are currently disease free, 4 of them being re-excised and one reperfused. Actuarial 5 year survival is 67%, with 45% disease free to the first relapse. Our results are consistent with the literature indicating HAP as a safe procedure with a high evidence of clinical responses.