Carcinoma sieroso papillare del peritoneo in paziente già operata di carcinoma mammario. Caso clinico

Il carcinoma sieroso papillare del peritoneo (PPSC) è un tumore raro che si riscontra più frequentemente nel sesso femminile. L?età media al momento della diagnosi è di 56 anni. Si diffonde coinvolgendo il peritoneo, la superficie delle ovaie e la pelvi. L?istologia è indistinguibile dall?analogo tumore ovarico, cioè il carcinoma sieroso papillare (PSCO). L?istogenesi del PPSC è probabilmente correlata all?epitelio celomatico embrionale. Sintomi e segni clinici tipici sono distensione addominale, costipazione, nausea, vomito, riduzione dell?appetito, malessere generale e perdita di peso. La chirurgia citoriduttiva, in aggiunta alla chemioterapia con cisplatino e ad altre terapie come l?immunoterapia e la radioterapia, aumenta la sopravvivenza dei pazienti affetti da PPSC. Viene descritto il caso di una paziente di 51 anni, già operata di carcinoma mammario, nella quale si manifestavano alcuni dei segni e sintomi descritti. L?intervento chirurgico dimostrò le localizzazioni sierose caratteristiche. Si fece una larga exeresi ma la malata morì 14 mesi dopo per la fatale progressione della malattia. English version The peritoneal papillary serous carcinoma (PPSC) is a rare tumor more frequently revealed in female. The onset mean age is 56 years. It implicate peritoneum, ovary?s surface and pelvis. The histology of this disease is similar to papillary serous carcinoma ovary (PSCO). The PPSC histogenesis is probably correlated to coelomatic embryonal epithelium. Clinical characteristics are abdominal swelling, constipation, nausea, emesis, inappetence, feel unwell, lose weight. The cytoreductive surgery and the cisplatinum chemotherapy, and other treatments like immunotherapy and radiotherapy, increase the PSCP patient survival. A case of a 51 years old patient with previous surgery for breast cancer is here described. She show some of the yet described clinical findings. At the surgery we found the typically serous peritoneal localizations. We performed a debulking, and the patient died 14 months after the operation due to the disease progression

Ematoma intestinale spontaneo come complicanza del trattamento anticoagulante

L’emoperitoneo e l’ematoma intestinale sono rare complicanze del trattamento con anticoagulanti orali. Dolori addominali in paziente in trattamento anticoagulante pongono un problema diagnostico; oltre a un addome acuto di altro tipo, bisogna considerare possibili lesioni emorragiche rare in un paziente senza difetti di coagulazione. L’importanza di riconoscere queste complicanze è legata alla possibilità di tentare un trattamento conservativo e risolutivo, evitando l’intervento chirurgico in pazienti che abitualmente presentano gravi patologie associate. Presentiamo il caso di un malato con emoperitoneo ed ematoma intramurale intestinale le cui alterazioni degli esami ematochimici e l’instabilità emodinamica hanno reso necessario il trattamento chirurgico d’urgenza

Influencia de la temperatura del agua y el estrés calórico sobre el consumo de agua de bebida en vacas lecheras

Grazing animals are exposed to heat stress and there should be conditions to facilitate water intake. Three experiments were carried out to determine the relationship between water intake, water temperature, and heat stress for Holstein pastured dairy cows. Experiment 1: Drinking behavior of 13 cows was evaluated (for 3 consecutive days) and four time periods were established according to the temperature humidity index (TI-11): (H1:05:00 to 10:59 h, H2: 11:00 to 16:59 h, H3:17:00 to 22:59 h, and H4:23:00 to 04:59 h). The highest mean percentage of drinking bouts (53.2%) was registered in H2 (THI: 74.91 to 83.95). Drinking bout means among time periods were different (p < 0.05), thus showing that heat stress conditions influence drinking behavior. Experiment 2: Three water troughs were placed in the sun (S) and three under a 2.2 m high structure covered with shade cloth (MS). Water temperature was registered at 10:00, 13:30, and 17:00 h, twice a week for 6 weeks. Mean water temperatures at 17:00 h were 33.2 ± 1.6ºC (S) and 25.3 ± 1.9ºC (MS) and showed significant differences (p < 0.05), thus supporting the shade cloth effect. Experiment 3: Five cows were offered water simultaneously at 18 and 31 ºC (Tl and T2), for 10 min, twice a day for 5 d. There were no significant differences among treatments (p > 0.05). Recorded water intake in Tl (18 L) was lower than in T2 (35.9 L), although body heat dissipation was higher (Tl = 672.64 kJ d -1 , T2 = 620.76 kJ d -1 ).Los animales en pastoreo están expuestos al estrés calórico, siendo fundamental proveer agua en condiciones que faciliten su consumo. Se desarrollaron tres experimentos para determinar las relaciones entre el consumo del agua de bebida con la temperatura del agua y el estrés calórico, en vacas lecheras en pastoreo. Experimento 1: Se evaluó el comportamiento de abrevado en 13 vacas (3 días consecutivos), estableciéndose cuatro franjas horarias según índice de temperatura y humedad (THI): (H1:05:00-10:59 h, H2:11:00-16:59 h, H3:17:00- 22:59 h y H4:23:00-04:59 h). En H2 (THI: 74,91-83,95) se registró el mayor porcentaje medio de accesos al bebedero (53,2%). Las medianas de los eventos “beber” por franjas horarias resultaron diferentes (p < 0,05), demostrándose que las condiciones de estrés calórico influyen sobre el comportamiento de bebida. Experimento 2: Tres bebederos con agua fueron colocados al sol (S) y tres bajo estructura de red 80% sombra (MS), a 2,2 m de altura, registrándose la temperatura del agua a las 10:00, 13:30 y 17:00 h, dos veces por semana (6 semanas). A las 17:00 h la temperatura media del agua, 33,2 ± 1,6 ºC (S) y 25,3 ± 1,9 ºC (MS) presentó diferencias significativas (p < 0,05), mostrando el efecto de MS. Experimento 3: Se ofreció agua a 18 y 31 ºC (T1 y T2) durante 10 min dos veces al día (5 d) a cinco vacas. No hubo diferencias significativas entre las proporciones de respuesta a los tratamientos (p > 0,05). Se registró menor consumo con T1 (18 L) respecto a T2 (35,9 L), pero mayor disipación de calor corporal (T1 = 672,64 kJ d-1 , T2 = 620,76 kJ d-1 )

What is the role of nodal ratio as a prognostic factor for gastric cancer nowadays? Comparison with new TNM staging system and analysis according to the number of resected nodes

Nodal ratio (NR) has been demonstrated to be an important prognostic factor in patients with gastric cancer. The aim of this study is to evaluate the prognostic role of nodal ratio comparing it with the new TNM (2010) classification. One hundred forty-two patients were submitted to potentially curative gastrectomy for cancer. Patients with low performance status underwent D1.5 lymphadenectomy, whereas the other patients underwent D2-D2.5 lymphadenectomy. Nodal staging was classified according to 2010 International Union Against Cancer/American Joint Committee on Cancer classification. Kaplan-Meier method was used to evaluate survival, stratified for nodal classes and nodal status. Total gastrectomy was performed in 39 per cent of cases and distal gastrectomy in 61 per cent. Mean number of resected nodes was 25.5. Whereas N status was strictly related to the number of resected nodes, the NR was independent from the extension of the lymphadenectomy. Overall five-year survival was 81 per cent for N0 patients, 72 per cent for N1, and 26 and 23 per cent for N2 and N3, respectively. Patients with NR0 had 81 per cent five-year survival, whereas NR1 67 per cent, NR2 51 per cent, and NR3 22 per cent. NR seems to be a simple method to predict the prognosis of patients with gastric cancer; unlike N status, it is independent from the number of resected nodes, and therefore it is particularly useful in case of inadequate lymphadenectomy. Copyright Southeastern Surgical Congress. All rights reserved