Modified kraske procedure with mid-sacrectomy and coccygectomy for en bloc excision of sacral giant cell tumors.

Sacral giant cell tumors are rare neoplasms, histologically benign but potentially very aggressive due to the difficulty in achieving a complete resection, their high recurrence rate, and metastization capability. Although many treatment options have been proposed, en bloc excision with tumor-free margins seems to be the most effective, being associated with long term tumor control, improved outcome, and potential cure. An exemplifying case of a 29-year-old female with progressive complaints of pain and paresthesias in the sacral and perianal regions, constipation, and weight loss for 6 months is presented. The surgical technique for en bloc excision of a large sacral giant cell tumor through a modified Kraske procedure with mid-sacrectomy and coccygectomy is described. Complete resection with wide tumor-free margins was achieved. At 5 years of follow-up the patient is neurologically intact, without evidence of local recurrence on imaging studies. A multidisciplinary surgical procedure is mandatory to completely remove sacral tumors. In the particular case of giant cell tumors, it allows minimizing local recurrence preserving neurovascular function, through a single dorsal and definitive approach

COMPARAÇÃO DA CIRURGIA CONVENCIONAL COM A LAPAROSCÓPICA NO CANCRO DO RETO: RESULTADOS DO REGISTO PORTUGUÊS

Introduction: This study aimed to compare the 3-year rates of local recurrence (LR) and overall survival (OS) for open (OPEN) and laparoscopic (LAP) surgeries in a Portuguese registry. Material and Methods: This observational study included patients who underwent rectal cancer resection performed in 16 hospitals between July 2014 and December 2019. The radiologic staging and the specimen images of the first three cases of any hospital were uploaded and audited by the scientific committee. Clinical and pathological characteristics and short and long-term outcomes of OPEN and LAP surgeries were analyzed. Results: The registry included 640 patients who underwent rectal cancer surgery: 562 (87.8%) underwent curative resection and 78 (12.2%) underwent palliative resection. In the curative cohort, OPEN surgery was performed in 269 cases whereas LAP surgery, which had a conversion rate of 17.5%, was performed in 266 cases. The pN staging showed that the LAP group had less advanced disease than the OPEN group. Anterior resection was performed in 57.8% of the cases whereas abdominoperineal resection was performed in 16.5%. Patients who underwent LAP surgery had shorter hospital stays. The 3-year LR rate was 3.0% (95% CI, 1.4%-6.3%) for LAP surgery and 8.3% (95% CI, 5.1%-13.1%) for OPEN surgery (P=0.02). The 3-year OS was 88.2% (95% CI, 83.1%-92.0%) for LAP surgery and 76.5% (95% CI, 69.1%-82.6%) for OPEN surgery (P=0.0061). Discussion: LAP surgery for patients with rectal cancer is associated with a decreased LR rate and improved OS, although in those with less advanced pN staging. Conclusion: The data support the view that the LAP approach is justified for rectal cancer when performed by surgeons with appropriate laparoscopic experience.Introdução: O objetivo do estudo consistiu na avaliação da recidiva local (RL) e da sobrevivência global (SG) aos 3 anos, comparando cirurgia convencional (CONV) e laparoscópica (LAP) no registo Português do cancro do reto. Material e Métodos: Neste estudo observacional incluíram-se doentes com cirurgia por cancro do reto realizada em 16 hospitais, entre Julho 2014 e Dezembro 2019. O estadiamento imagiológico e as imagens anatomopatológicas foram registadas e auditadas pela comissão científica. Analisaram-se as características clinico-patológicas e os resultados pós-operatórios e à distância na cirurgia CONV e LAP. Resultados: O registo inclui 640 doentes que realizaram cirurgia por cancro do reto: 562 (87.8%) resseções curativas e 78 (12.2%) resseções paliativas. No grupo curativo foram realizadas 269 resseções CONV e 266 resseções LAP, que tiveram conversão em 17,5% dos casos. O grupo LAP tinha estadiamento pN menos avançado que o grupo CONV. A resseção anterior foi realizada em 57,8% dos casos e a amputação abdominoperineal em 16,5%. Os doentes com cirurgia LAP tiveram estadia pós-operatória mais curta. A taxa de RL aos 3 anos foi de 3,0% (95% CI, 1,4%-6,3%) na cirurgia LAP e 8,3% (95% CI, 5.1%-13,1%) na cirurgia CONV (P=0.02). A SG aos 3 anos foi 88,2% (95% CI, 83,1%-92,0%) na cirurgia LAP e 76,5% (95% CI, 69,1%-82,6%) na cirurgia CONV (P=0.0061). Discussão: Nos doentes com cancro do reto a cirurgia LAP associou-se a menor taxa de RL e melhor SG, embora em doentes com estadiamento pN menos avançado. Conclusão: Estes resultados confirmam que no cancro do reto a abordagem LAP é segura se for realizada por cirurgiões com adequada experiência laparoscópica

Genome-wide evolutionary dynamics of influenza B viruses on a global scale

The global-scale epidemiology and genome-wide evolutionary dynamics of influenza B remain poorly understood compared with influenza A viruses. We compiled a spatio-temporally comprehensive dataset of influenza B viruses, comprising over 2,500 genomes sampled worldwide between 1987 and 2015, including 382 newly-sequenced genomes that fill substantial gaps in previous molecular surveillance studies. Our contributed data increase the number of available influenza B virus genomes in Europe, Africa and Central Asia, improving the global context to study influenza B viruses. We reveal Yamagata-lineage diversity results from co-circulation of two antigenically-distinct groups that also segregate genetically across the entire genome, without evidence of intra-lineage reassortment. In contrast, Victoria-lineage diversity stems from geographic segregation of different genetic clades, with variability in the degree of geographic spread among clades. Differences between the lineages are reflected in their antigenic dynamics, as Yamagata-lineage viruses show alternating dominance between antigenic groups, while Victoria-lineage viruses show antigenic drift of a single lineage. Structural mapping of amino acid substitutions on trunk branches of influenza B gene phylogenies further supports these antigenic differences and highlights two potential mechanisms of adaptation for polymerase activity. Our study provides new insights into the epidemiological and molecular processes shaping influenza B virus evolution globally

Intestinal Obstruction. The Experience of the Emergency Service of S. José Hospital 1981-1991

Os Autores descrevem a experiência, em oclusão intestinal, da Unidade de Urgência Cirúrgica dos Hospitais Civis de Lisboa (UUC-HCL), no período de 10 anos, decorrido entre Novembro de 1981 e Novembro de 1991, estimando que esta entidade patológica tenha constituído cerca de 15% da casuística de cirurgia geral daquele Serviço. Os dados referentes aos 3679 doentes, operados de urgência por oclusão intestinal, foram reunidos num ficheiro informatizado e a sua análise global é descrita recorrendo à representação gráfica dos elementos mais relevantes. Foi semelhante a distribuição por sexos : feminino (49%) e masculino (5 1%). A forma mecânica de oclusão (94%)teve como patologias mais frequentes: a hérnia estrangulada (1604 casos), a brida (568 casos) e o cancro (713 casos); e a forma dinâmica ou funcional (6%) teve, como principal ocorrência, a isquémia intestinal (143 casos). A terapêutica cirúrgica foi avaliada de forma geral. No entanto, comenta-se, brevemente, a evolução registada no tratamento primário do cancro colorrectal em oclusão (625 casos). A taxa de mortalidade global foi de 10,8% (adulto). Em termos relativos, teve como principais expressões: (39%) na isquémia intestinal, (23%) no cancro e (22%) no volvo intestinal