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INTRODUCTION: Cancers of unknown primary origin (CUP) pose a significant clinical challenge, representing a small percentage (1 to 5 %) of overall cancer cases. The patient is a 31-year-old male who has been diagnosed with poorly differentiated infiltrating squamous cell carcinoma, which has been classified as CUP. The exceptional perineal presentation and diagnostic process serve as a reminder of the diverse nature of CUPs and the crucial role played by advanced imaging methods and a multidisciplinary approach. The inclusion of this case, the seventh one in the literature, deepens our understanding of CUPs. PRESENTATION OF CASE: A 31-year-old man came in with a gradual onset of perineal pain that had been worsening for the past six months. A nodular lesion in the urogenital triangle, infiltrating the bulbo spongiosus muscle, was surgically removed. The histopathology results confirmed a poorly differentiated squamous cell carcinoma. Despite conducting extensive examinations, the multidisciplinary team was unable to determine the source of the tumour, classifying it as CUP. One year post-surgery, the patient remains in complete remission. DISCUSSION: The management of CUPs can be challenging because of the variety of their origins and presentations. The importance of advanced imaging, pathological and biological techniques, as well as meticulous surgical intervention, is emphasized in this case, as it helps in avoiding unnecessary adjuvant therapies. CONCLUSION: This case highlights the significance of a customized and interdisciplinary approach in effectively managing CUPs, especially when they present in unusual ways. Timely surgical intervention, backed by comprehensive imaging and pathological analysis, can result in positive results.
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Urothelial carcinoma (UC) could be observed in urinary bladder (UBUC) and upper urinary tracts (UTUC). In the National Comprehensive Cancer Network guidelines for bladder cancer, extirpative surgery is indicated in certain cases. However, some extreme cases might also need the extirpation of the majority of the urinary tract, which is called complete urinary tract extirpation (CUTE). We present a patient diagnosed with high-grade UBUC and UTUC. He underwent dialysis for end-stage renal disease (ESRD) at the same time. Considering his non-functional kidneys and removing his high-risk urothelium at the same time, we performed robot-assisted CUTE to extirpate both his upper urinary tracts, urinary bladder, and prostate. In our experience, the console time was not significantly elongated, and the perioperative course was uneventful. To our knowledge, this is the first case report adopting a robotic system in such an extreme case. We conclude that robot-assisted CUTE is worth further study regarding its oncological survival outcomes and perioperative safety in patients with ESRD on dialysis.
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Carcinoma de Células Transicionales , Fallo Renal Crónico , Robótica , Neoplasias de la Vejiga Urinaria , Sistema Urinario , Masculino , Humanos , Neoplasias de la Vejiga Urinaria/complicaciones , Neoplasias de la Vejiga Urinaria/cirugía , Carcinoma de Células Transicionales/patología , Diálisis Renal , Sistema Urinario/patología , Fallo Renal Crónico/patología , Fallo Renal Crónico/cirugíaRESUMEN
Abstract Introduction Selective neck dissection inclinically node-negative neckisconsidered the standard of care for oral squamous cell carcinomas (SCCs). Controversy still prevailsinnode-positive disease regarding the extent of neck dissection. In our part of the world, comprehensive neck dissection is mostly considered to be the minimal optimal treatment for palpable neck disease. Objective To compare regional control and disease-specific survival between clinically node-positive and node-negative patients undergoing selective neck dissection for oral SCC. Methods This was a retrospective cohort study conducted in the department of ENT, Head and Neck surgery at a tertiary care hospital. All patients with biopsy-proven oral and lip SCC, with or without nodal disease, who underwent selective neck dissection between April 2006 and July 2015 were included in the study. Results During the study period, 111 patients with oral SCC underwent selective neck dissection, of whom 71 (62%) were clinically node-negative and 40 (38%) patients had clinically positive nodes in the neck. The mean follow-up was 16.62 months (standard deviation [SD]: 17.03). The overall regional control rates were 95 versus 96% for clinical negative versus positive nodes, respectively (p = 0.589). The disease-specific survival was 84.5% in the node negative group versus 82.5% in the node-positive group (p = 0.703). Conclusion Selective neck dissection in node-positive neck oral SCC has similar regional control rates when compared with node-negative neck SCC. The difference in disease-specific survival between the two groups is also not significant.
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RESUMEN El insulinoma es un tumor poco frecuente de las células de los islotes pancreáticos, caracterizado por la proliferación de las células betas. Son tumores neuroendocrinos pancreáticos, generalmente benignos y de pequeño tamaño, caracterizados por el síndrome de hipersecreción de insulina con el desarrollo de hipoglucemia. La mayoría de estos tumores son esporádicos, solo alrededor de 15-30 % es hereditario; está asociado a enfermedades como la neoplasia endocrina múltiple tipo 1, o el síndrome de Von Hippel-Lindau. La incidencia de dicho tumor es de 3-10 casos por cada millón de habitantes. La edad media de aparición es entre 40-50 años de edad y es más frecuente en mujeres. El reconocimiento temprano y el diagnóstico adecuado de este tumor pancreático raro, son aspectos importantes pues es potencialmente curable con un tratamiento quirúrgico oportuno.
ABSTRACT Insulinoma is a rare pancreatic islet cell tumor characterized by proliferation of beta cells. They are pancreatic neuroendocrine tumors, generally benign and small in size, characterized by insulin hypersecretion syndrome with the development of hypoglycemia. Most of these tumors are sporadic, only about 15-30% are hereditary; it is associated with diseases such as multiple endocrine neoplasia type 1, or Von Hippel-Lindau syndrome. The incidence of this tumor is 3-10 cases per million inhabitants. The average age of onset is between 40-50 years of age and it is more frequent in women. Early recognition and proper diagnosis of this rare pancreatic tumor are important aspects, as it is potentially curable with timely surgical treatment.
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Adenoma de Células de los Islotes Pancreáticos/cirugía , Procedimientos Quirúrgicos OperativosRESUMEN
Introduction Selective neck dissection in clinically node-negative neck is considered the standard of care for oral squamous cell carcinomas (SCCs). Controversy still prevails in node-positive disease regarding the extent of neck dissection. In our part of the world, comprehensive neck dissection is mostly considered to be the minimal optimal treatment for palpable neck disease. Objective To compare regional control and disease-specific survival between clinically node-positive and node-negative patients undergoing selective neck dissection for oral SCC. Methods This was a retrospective cohort study conducted in the department of ENT, Head and Neck surgery at a tertiary care hospital. All patients with biopsy-proven oral and lip SCC, with or without nodal disease, who underwent selective neck dissection between April 2006 and July 2015 were included in the study. Results During the study period, 111 patients with oral SCC underwent selective neck dissection, of whom 71 (62%) were clinically node-negative and 40 (38%) patients had clinically positive nodes in the neck. The mean follow-up was 16.62 months (standard deviation [SD]: 17.03). The overall regional control rates were 95 versus 96% for clinical negative versus positive nodes, respectively ( p = 0.589). The disease-specific survival was 84.5% in the node negative group versus 82.5% in the node-positive group ( p = 0.703). Conclusion Selective neck dissection in node-positive neck oral SCC has similar regional control rates when compared with node-negative neck SCC. The difference in disease-specific survival between the two groups is also not significant.
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Microsurgery and biopsies on individual cells in a cellular microenvironment are of great importance to better understand the fundamental cellular processes at subcellular and even single-molecular levels. However, it is still a big challenge for in situ surgery without interfering with neighboring living cells. Here, we report a thermoplasmonics combined optical trapping (TOT) technique for in situ single-cell surgery and intracellular organelle manipulation, without interfering with neighboring cells. A selective single-cell perforation was demonstrated via a localized thermoplasmonic effect, which facilitated further targeted gene delivery. Such a perforation was reversible, and the damaged membrane was capable of being repaired. Remarkably, a targeted extraction and precise manipulation of intracellular organelles were realized via the optical trapping. This TOT technique represents a new way for single-cell microsurgery, gene delivery, and intracellular organelle manipulation, and it provides a new insight for a deeper understanding of cellular processes as well as to reveal underlying causes of diseases associated with organelle malfunctions at a subcellular level.
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Pinzas Ópticas , OrgánulosRESUMEN
OBJECTIVES: To compare functional and surgical outcomes of robot-assisted partial nephrectomy for complex tumors with RENAL scores ≥10 and non-complex tumors at a single academic institution. METHODS: We retrospectively analyzed the data of all patients who underwent robot-assisted partial nephrectomy at Kobe University Hospital (Kobe, Hyogo, Japan) from 2011 to 2020. Functional and surgical outcomes for complex tumors (RENAL score ≥10) were compared with those of patients with non-complex tumors (RENAL <10). Outcomes analyzed included blood loss, warm ischemia time, console time, perioperative complications, and preoperative and postoperative renal function. RESULTS: A total of 348 patients were included in our present study, with a median follow-up time of 35.1 months. Of these, 299 patients (85.9%) had non-complex tumors and 49 patients (14.1%) had complex tumors. Warm ischemia time and console time were significantly longer in the complex tumors group. Major perioperative complications (Clavien-Dindo classification system ≥3) were significantly more frequent in the complex tumors group than the non-complex tumor group (16.3% vs 5.7%, P = 0.018). Postoperative preservation of estimated glomerular filtration rate and percentage of chronic kidney disease upstage by 1 year were significantly inferior in the complex tumors group. The positive surgical margin rate was 0% and 0.3% in the complex and non-complex tumor groups, respectively. There were no significant differences in recurrence-free survival between the two groups (P = 0.11). CONCLUSIONS: Robot-assisted partial nephrectomy for complex renal tumors is safe, with no difference in oncological outcomes, although more postoperative complications and decreased renal function can be observed than non-complex tumors.
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Neoplasias Renales , Procedimientos Quirúrgicos Robotizados , Robótica , Tasa de Filtración Glomerular , Humanos , Riñón/fisiología , Riñón/cirugía , Neoplasias Renales/cirugía , Nefrectomía/efectos adversos , Estudios Retrospectivos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Resultado del TratamientoRESUMEN
BACKGROUND: Glaucomatous optic neuropathy (GON) is an anatomofunctional impairment of the optic nerve triggered by glaucoma. Recently, growth factors (GFs) have been shown to produce retinal neuroenhancement. The suprachoroidal autograft of mesenchymal stem cells (MSCs) by the Limoli retinal restoration technique (LRRT) has proven to achieve retinal neuroenhancement by producing GF directly into the choroidal space. This retrospectively registered clinical study investigated the visual function changes in patients with GON treated with LRRT. METHODS: Twenty-five patients (35 eyes) with GON in progressive disease conditions were included in the study. Each patient underwent a comprehensive ocular examination, including the analysis of best corrected visual acuity (BCVA) for far and near visus, sensitivity by Maia microperimetry, and the study of the spectral domain-optical coherence tomography (SD-OCT). The patients were divided into two groups: a control group, consisting of 21 eyes (average age 72.2 years, range 50-83), and an LRRT group, consisting of 14 eyes (average age 67.4, range 50-84). RESULTS: After 6 months, the BCVA, close-up visus, and microperimetric sensitivity significantly improved in the LRRT-treated group (p<0.05), whereas the mean increases were not statistically significant in controls (p>0.5). CONCLUSIONS: Patients with GON treated with LRRT showed a significant increase in visual performance (VP) both in BCVA and sensitivity and an improvement of residual close-up visus, in the comparison between the LRRT results and the control group. Further studies will be needed to establish the actual significance of the reported findings.
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Glaucoma , Enfermedades del Nervio Óptico , Anciano , Anciano de 80 o más Años , Humanos , Persona de Mediana Edad , Nervio Óptico , Enfermedades del Nervio Óptico/terapia , Retina , Tomografía de Coherencia ÓpticaRESUMEN
Light can be employed as a tool to alter and manipulate matter in many ways. An example has been the implementation of optical trapping, the so called optical tweezers, in which light can hold and move small objects with 3D control. Of interest for the Life Sciences and Biotechnology is the fact that biological objects in the size range from tens of nanometers to hundreds of microns can be precisely manipulated through this technology. In particular, it has been shown possible to optically trap and move genetic material (DNA and chromatin) using optical tweezers. Also, these biological entities can be severed, rearranged and reconstructed by the combined use of laser scissors and optical tweezers. In this review, the background, current state and future possibilities of optical tweezers and laser scissors to manipulate, rearrange and alter genetic material (DNA, chromatin and chromosomes) will be presented. Sources of undesirable effects by the optical procedure and measures to avoid them will be discussed. In addition, first tentative approaches at cellular-level genetic and organelle surgery, in which genetic material or DNA-carrying organelles are extracted out or introduced into cells, will be presented.
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PURPOSE: To assess whether treatment with the Limoli Retinal Restoration Technique (LRRT) can be performed in patients with retinitis pigmentosa (RP), grafting the autologous cells in a deep scleral pocket above the choroid of each eye to exert their beneficial effect on the residual retinal cells. METHODS: The patients were subjected to a complete ophthalmological examination, including best corrected visual acuity (BCVA), close-up visus measurements, spectral domain-optical coherence tomography (SD-OCT), microperimetry (MY), and electroretinography (ERG). Furthermore, the complete ophthalmological examination was carried out at baseline (T0) and at 6 months (T180) after surgery. The Shapiro-Wilk test was used to assess the normality of distribution of the investigated parameters. A mixed linear regression model was used to analyse the difference in all the studied parameters at T0 and T180, and to compare the mean change between the two groups. All statistical analyses were performed with STATA 14.0 (Collage Station, Texas, USA). RESULTS: LRRT treatment was performed in 34 eyes of 25 RP patients recruited for the study. The eyes were classified in two groups on the basis of foveal thickness (FT) assessed by SD-OCT: 14 eyes in Group A (FT≤190µm) and the remaining 20 ones in Group B (FTâ>â190µm). Although it had not reached the statistical significance, Group B showed a better improvement in BCVA, residual close-up visus and sensitivity than Group A. CONCLUSIONS: Previous studies have described the role of LRRT in slowing down retinal degenerative diseases. Consequently, this surgical procedure could improve the clinical and rehabilitative prognostic parameters in RP patients. On the other hand, further clinical research and studies with longer follow-up will be needed to evaluate its efficacy.
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Células Madre Mesenquimatosas , Regeneración/fisiología , Retina/fisiopatología , Retinitis Pigmentosa/cirugía , Adulto , Electrorretinografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Retina/diagnóstico por imagen , Retinitis Pigmentosa/diagnóstico por imagen , Retinitis Pigmentosa/fisiopatología , Retinitis Pigmentosa/rehabilitación , Tomografía de Coherencia Óptica , Resultado del Tratamiento , Agudeza VisualRESUMEN
RESUMEN Fundamento: el carcinoma basocelular es el cáncer cutáneo más frecuente. El tratamiento de elección es quirúrgico, existen otras terapéuticas. El HeberFERON es una formulación farmacéutica que contiene una mezcla de interferones alfa2b y Y en proporciones sinérgicas de actividad anti-tumoral. Objetivo: caracterizar los pacientes con carcinoma basocelular tratados con HeberFERON. Métodos: se realizó un estudio observacional descriptivo transversal. El universo lo constituyeron 22 pacientes con diagnóstico clínico e histológico de carcinoma basocelular, que asistieron a consulta de Dermatología del Hospital Universitario Manuel Ascunce Domenech de la provincia Camagüey, durante el periodo de estudio se administró 3,5 millones UI de HeberFERON, perilesional, tres veces por semana en días alternos, durante tres semanas, seguidos cada 15 días durante 13 semanas, con evaluación final a la semana 16. Las variables estudiadas fueron: sexo, foto tipo cutáneo, localización, tamaño de las lesiones, subtipo clínico, ocupación laboral, respuesta clínica, efecto cosmético y reacciones adversas. La información obtenida fue procesada mediante el paquete estadístico SPSS v21.Los métodos empleados fueron estadística descriptiva con distribución de frecuencias absolutas y relativas. Los resultados se expusieron en tablas y gráficos. Resultados: predominó el sexo masculino, foto tipo cutáneo III en más de la mitad de los enfermos. Las lesiones en cara predominaron en más de las cuatro quintas partes de ellos, casi las dos terceras medían menos de dos centímetros. Prevaleció el subtipo clínico nodular en la mitad de estos, igual que los trabajadores expuestos al sol. Todos tuvieron respuesta clínica favorable, con respuesta completa en los dos tercios, y parcial en un tercio, igual que el efecto cosmético aceptable. La mayoría presentó escalofríos como reacción adversa, seguida de fiebre. Conclusiones: el HeberFERON resultó un medicamento eficaz y seguro para tratar el carcinoma basocelular; ofrece una alternativa en enfermos que no pueden ser sometidos a cirugía.
ABSTRACT Background: basal cell carcinoma is the most frequent skin cancer. The treatment of choice is surgical, but there are other therapies. HeberFERON is a pharmaceutical formulation containing a mixture of interpheron alpha2b and IFN-Y in synergistic proportions of anti-tumor activity. Objective: to characterize patients with basal cell carcinoma treated with HeberFeron. Methods: a transversal, observational, descriptive study was carried out in which 22 patients were clinically and histologically diagnosed with basal cell carcinoma, who attended a Dermatology consultation at the University Hospital Manuel Ascunce Domenech, Camagüey, Cuba. 3.5 million IU of HeberFeron, was administered, near the lesion, three times a week on alternate days for three weeks, followed biweekly for 13 weeks, with final evaluation at week 16. The variables studied were: sex, skin photo-type, tumor site, size of lesions, clinical subtype, occupation, clinical response, cosmetic effect and adverse reactions. The information obtained was processed using the statistical package SPSS v21. The methods used were descriptive statistics with distribution of absolute and relative frequencies. The results were presented in tables and graphs. Results: male sex, cutaneous photo-type III, predominated in more than half of the patients. Face lesions predominated in more than four fifths of them, and almost two thirds measured less than two centimeters. The nodular clinical subtype prevailed in half of these, just like workers exposed to the sun. All had a favorable clinical response, with a complete response in two thirds, and partial in a third, as well as an acceptable cosmetic effect. Most presented chills as an adverse reaction, followed by fever. Conclusions: the HeberFERON was an effective and safe medicine to treat basal cell carcinoma, and offer an alternative in patients who cannot be operated on.
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Cell manipulation plays a vital role in the success rate and efficiency of the cell microsurgical operations, including biopsy of cell internal organelles such as the embryo biopsy, in which the embryo is manipulated and reoriented safely to a predefined desired position and orientation. In this paper, a simplified approach for the blastocyst embryo reorientation is proposed. It utilizes conventional tools and techniques currently in use in manual approaches in research labs and In Vitro Fertilization clinics, and controls the process using a vision feedback system. An experimental setup is developed to verify the dynamic behavior of the proposed approach, in which a stationary holding micropipette is used to hold the embryo, which is then rotated in two coordinate directions through friction contact with a moving substrate, in our case a glass microscope slide. The embryo rotates on the holding micropipette tip, due to the relatively low friction of this contact. A computer vision algorithm is used to estimate the embryo orientation coordinates, and use this information as a feedback signal to a simple proportional controller to control the embryo rotation angle. Experimental results demonstrate that the system is capable of cell rotation in two independent coordinates, suitable for embryo microsurgical task execution.
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Blastocisto , Embrión de Mamíferos , Micromanipulación/métodos , Animales , Ratones , Modelos Teóricos , RotaciónRESUMEN
We propose an innovative design of millirobot, which can achieve donor cell suction, delivery, and injection in a mammalian oocyte on a microfluidic chip. The millirobot body contains a hollow space that produces suction and ejection forces for the injection of cell nuclei using a nozzle at the tip of the robot. Specifically, a controller changes the hollow volume by balancing the magnetic and elastic forces of a membrane along with the motion of stages in the XY plane. A glass capillary attached to the tip of the robot contains a nozzle that is able to absorb and inject cell nuclei. The millirobot provides three degrees of freedom and generates micronewton forces. We demonstrate the effectiveness of the proposed millirobot through an experiment of the absorption and ejection of 20-µm particles from the nozzle using magnetic control in a microfluidic chip.
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INTRODUCTION: Inferior vena cava tumor thrombectomy in renal cell carcinoma patients is a challenging procedure, frequently requiring the vascular bypass technique for high-level thrombi with additional complications. Adopting a technique such as intrapericardial control in selected cases will circumvent these problems. Here, we present the results of our intrapericardial control technique during supradiaphragmatic inferior vena caval tumor thrombectomy. CASE PRESENTATION: The records of six patients with supradiaphragmatic tumor thrombi, who underwent radical nephrectomy and thrombectomy at our center with intrapericardial control between the years 2008 and 2015, were retrospectively reviewed. The patients' characteristics, intra- and postoperative data, histology, and follow-up records were gathered and compared. There were no immediate or 30-day postoperative deaths. The mean age of the patients was 61.3 years (range 46 - 75). The total mean duration of surgery was 315 minutes and the mean amount of transfused red blood cells was 4.33 units during surgery and 0.8 units in the postoperative period. The average hospitalization duration was 8 days (range 5 - 17). Tumor stage was T3 in four patients and T4 in two, due to ipsilateral adrenal involvement. The mean duration of follow-up was 33.5 months. Only one of the patients developed recurrences, first in the tumor bed and then at the site of the skin incision; these were excised with no apparent complications. CONCLUSIONS: Radical nephrectomy and tumor thrombectomy by intrapericardial control without cardiopulmonary bypass and hypothermic circulatory arrest is a safe and effective procedure that can avoid serious intra- and postoperative complications while providing acceptable cancer-control and mortality results.
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INTRODUCTION: A renal parenchymal clamp has been used at our centre since March 2012. It is used in position over the kidney to achieve optimal vascular control of a tumour while minimising parenchymal ischaemia. This study aimed to report the feasibility, surgical outcome, and oncological control of a kidney clamp in partial nephrectomy. METHODS: This study was conducted at a teaching hospital in Hong Kong. Partial nephrectomies performed from January 2009 to March 2015 were reviewed. The tumour characteristics and surgical outcomes of kidney clamp were studied and compared with traditional hilar clamping. RESULTS: A total of 92 patients were identified during the study period. Kidney clamps were used in 20 patients and hilar clamping in 72, with a mean follow-up of 27 and 37 months, respectively. For patients in whom a kidney clamp was applied, all tumours were exophytic to a different extent and the majority (90%) were located at the polar region. The PADUA (preoperative aspects and dimensions used for an anatomical) classification nephrometry score was also lower than those in whom hilar clamping was used (7.07 vs 8.34; P=0.002). The clamp was used in open, laparoscopic, and robot-assisted surgery. Operating time was shorter (207 ± 72 mins vs 306 ± 80 mins; P<0.001) and estimated blood loss was lower (205 ± 191 mL vs 331 ± 275 mL; P=0.045) with kidney clamp. No acute kidney injury occurred. Postoperative renal function was comparable between the two groups. CONCLUSIONS: Partial nephrectomy using parenchymal clamping is safe and feasible in selected cases. The postoperative renal function and oncological control were satisfactory.
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Carcinoma de Células Renales/cirugía , Constricción , Isquemia/prevención & control , Neoplasias Renales/cirugía , Riñón/irrigación sanguínea , Nefrectomía/métodos , Femenino , Tasa de Filtración Glomerular , Hong Kong , Humanos , Laparoscopía , Masculino , Persona de Mediana Edad , Nefrectomía/efectos adversos , Tempo Operativo , Estudios Retrospectivos , Centros de Atención Terciaria , Resultado del TratamientoRESUMEN
BACKGROUND: The contemporary treatment of oropharyngeal squamous cell carcinoma (SCC) is an area of debate. We report outcomes of a minimally invasive approach involving transoral laser microsurgery (TLM). METHODS: A consecutive series of patients (n = 153) undergoing primary TLM for oropharyngeal SCC from 2006 to 2013 was studied. Human papillomavirus (HPV) status was determined by p16 immunohistochemistry and high-risk HPV DNA in situ hybridization. Survival analyses were evaluated using Kaplan-Meier statistics. RESULTS: Tumor subsites included tonsil (n = 94; 61.5%), tongue base (n = 38; 24.8%), and soft palate (n = 21; 13.7%), with the majority being American Joint Committee on Cancer (AJCC) stage III/IVa (n = 124; 81.0%) and HPV-positive (n = 101; 66.0%). Three-year overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were 84.5%, 91.7%, and 78.2%, respectively. HPV-positivity portended favorable oncologic outcomes. One-year gastrostomy tube (G-tube) dependency was 1.3%. CONCLUSION: To the best of our knowledge, this is the largest single-center TLM oropharyngeal SCC series to date. Our data suggest that TLM +/- postoperative radiotherapy (PORT) results in at least as good oncologic outcomes as chemoradiotherapy (CRT), while conferring swallowing function advantages. © 2016 Wiley Periodicals, Inc. Head Neck , 2016 © 2016 Wiley Periodicals, Inc. Head Neck 38:1263-1270, 2016.
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Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/cirugía , Neoplasias de Cabeza y Cuello/mortalidad , Neoplasias de Cabeza y Cuello/cirugía , Terapia por Láser/métodos , Microcirugia/métodos , Neoplasias Orofaríngeas/mortalidad , Neoplasias Orofaríngeas/cirugía , Adulto , Anciano , Carcinoma de Células Escamosas/patología , Quimioradioterapia Adyuvante , Estudios de Cohortes , Supervivencia sin Enfermedad , Femenino , Neoplasias de Cabeza y Cuello/patología , Humanos , Estimación de Kaplan-Meier , Terapia por Láser/mortalidad , Masculino , Microcirugia/mortalidad , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Cirugía Endoscópica por Orificios Naturales/métodos , Recurrencia Local de Neoplasia/epidemiología , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/fisiopatología , Neoplasias Orofaríngeas/patología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/fisiopatología , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Medición de Riesgo , Carcinoma de Células Escamosas de Cabeza y Cuello , Análisis de Supervivencia , Resultado del Tratamiento , Reino UnidoRESUMEN
Systemic embolization from a primary cardiac tumor is a relatively frequent presentation. However, an acute myocardial infarction due to coronary embolization is rarely seen. We offer an unusual case of a 50-year-old man who presented with severe angina and was diagnosed with an inferolateral ST-segment-elevation myocardial infarction. Aside from otherwise healthy coronary arteries, his coronary angiogram revealed an acute occlusion of the first obtuse marginal branch, which was treated with balloon angioplasty. Because no residual plaque or dissection was found after the angioplasty, an embolic source was suspected. An echocardiogram then revealed a large mobile left atrial myxoma prolapsing into the left ventricle, so the patient underwent minimally invasive resection. Detailed pathologic examination of the myxoma revealed a concomitant high-grade B-cell lymphoma.
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Embolia/etiología , Neoplasias Cardíacas/complicaciones , Infarto de la Pared Inferior del Miocardio/etiología , Linfoma/complicaciones , Mixoma/complicaciones , Neoplasias Primarias Múltiples , Células Neoplásicas Circulantes/patología , Angioplastia Coronaria con Balón , Biomarcadores de Tumor/análisis , Biopsia , Angiografía Coronaria , Electrocardiografía , Embolia/diagnóstico , Embolia/terapia , Atrios Cardíacos/patología , Neoplasias Cardíacas/química , Neoplasias Cardíacas/patología , Neoplasias Cardíacas/cirugía , Humanos , Inmunohistoquímica , Infarto de la Pared Inferior del Miocardio/diagnóstico , Infarto de la Pared Inferior del Miocardio/terapia , Linfoma/química , Linfoma/patología , Linfoma/cirugía , Masculino , Persona de Mediana Edad , Mixoma/química , Mixoma/patología , Mixoma/cirugía , Células Neoplásicas Circulantes/química , Resultado del TratamientoRESUMEN
The association between neutrophil:lymphocyte ratio (NLR) and poor long-term outcomes in patients with non-small-cell lung cancer (NSCLC) has been demonstrated in numerous studies. The benefit of perioperative administration of anti-inflammatory drugs on these outcomes has not been well established. Our aim in this retrospective study was to investigate the effects of postoperative nonsteroidal anti-inflammatory drug (NSAID) administration and NLR on tumor recurrence and survival in patients' undergoing surgical resection for NSCLC. This retrospective study included perioperative data from 1139 patients who underwent surgical resection for stages I-III NSCLC. Perioperative data such as baseline characteristics, adjuvant or neoadjuvant therapy, pre- and postoperative NLR, and NSAID use (ketorolac, ibuprofen, celecoxib, or in combination) were included. We evaluated the association between preoperative NLR and NSAID use on recurrence-free (RFS) and overall survival (OS). In all, 563 patients received an NSAID as a part of their postoperative management. The majority of patients received ketorolac (n = 374, 67.16%). Ketorolac administration was marginally associated with better OS (P = 0.05) but not with RFS (P = 0.38). Multivariate analysis (n = 1139) showed that preoperative NLR >5 was associated with a reduction in RFS (hazard ratio [HR] = 1.37; 95% confidence interval [CI] = 1.05-1.78; P = 0.02) and OS (HR = 1.69; 95% CI = 1.27-2.23; P = 0.0003). However, after accounting for tumor stage, NLR ≥ 5 was a predictor of RFS and OS only in patients with stage I NSCLC. To conclude, preoperative NLR was demonstrated to be an independent predictor of RFS and OS in a subset of patients with early stage NSCLC. Ketorolac administration was not found to be an independent predictor of survival.
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Antiinflamatorios no Esteroideos/uso terapéutico , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Neoplasias Pulmonares/mortalidad , Linfocitos/fisiología , Neutrófilos/fisiología , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Supervivencia sin Enfermedad , Femenino , Humanos , Cuidados Intraoperatorios/métodos , Cuidados Intraoperatorios/mortalidad , Recuento de Leucocitos , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/mortalidad , Estudios Retrospectivos , Microambiente TumoralRESUMEN
To transfer large cargo into mammalian cells, we recently provided a new approach called a photothermal nanoblade. Micron-sized membrane pores generated by the nanoblade are surprisingly well repaired with little cell death, suggesting rapid membrane-resealing dynamics. Here, we report the resealing time of photothermal porated mammalian cell plasma membranes using an electrical impedance sensor. Cell membrane pores were generated by high-speed cavitation bubbles induced by laser pulsing of metallic microdisks on a pair of transparent indium tin oxide electrodes. Electrical responses from the sensor electrodes were obtained with a signal voltage of 500 mV and a frequency at 500 kHz. Real-time impedance measurements show that membrane resealing and impedance recovery take a surprisingly long 1 to 2 min after laser pulsing. A nonrecovering impedance shift is also detected for cells after high-energy laser pulsing. This impedance response is also confirmed by a separate experiment in which thin-film gold electrodes are used to trigger cavitation bubbles for opening transient membrane pores on cells cultured on electrodes. Overall, our study platform provides new insight for micron-sized membrane defect repair dynamics to maintain cell viability.
Asunto(s)
Membrana Celular/fisiología , Membrana Celular/efectos de la radiación , Impedancia Eléctrica , Células Epiteliales/fisiología , Células Epiteliales/efectos de la radiación , Células HeLa , Calor , Humanos , Rayos LáserRESUMEN
Tracheobronchial-angle tumors involve the right main bronchus, the right upper lobar bronchus, and the lateral wall of the lower trachea. Resecting these tumors is one of the most complex procedures in thoracic surgery. In cases of high-caliber mismatch, the selection of a suitable anastomotic technique can be challenging. We found that our use of a one-stoma carinoplasty technique overcame high-caliber mismatch after the resection of these tumors. From 2009 through 2012, 8 men (mean age, 59 ± 6.2 yr; range, 46-66 yr) underwent complete resection of non-small-cell right-tracheobronchial-angle tumors at our institution. In every case, right upper sleeve lobectomy, wedge carinal resection, and one-stoma carinoplasty were applied. After tumor resection, one patient with hemoptysis and bronchopleural fistula underwent a completion pneumonectomy and died 10 days postoperatively. Bronchoscopy was necessary in 2 patients who had atelectasis in the contralateral lung. At a mean follow-up duration of 19.43 ± 8.4 months (range, 0.2-27.1 mo), 6 patients were alive and free of disease. We conclude that our one-stoma carinoplasty technique enables the resection of tumors at the right tracheobronchial angle, with acceptable morbidity and mortality rates. This method saves the unaffected part of the ipsilateral lung and can overcome high-caliber mismatch. Because of these and other advantages, we suggest that using our method first might preclude having to perform a right carinal sleeve pneumonectomy or using Barclay's method.