Histopathological evaluation of the subtotal laryngectomy specimen

AbstractBackgroundThe goal of conservative surgical treatment of laryngeal cancer is to obtain oncological control with preservation of laryngeal function. The concept of laryngeal function preservation should be understood as the preservation of the patient's ability to breathe normally with neither tracheostomy nor aspiration, and maintaining intelligible speech. This can be achieved by a balance between two fundamental aspects, proper patient selection (based on tumour extension and preoperative laryngeal function), and an adequate histopathological analysis of the surgical specimen. Supracricoid subtotal laryngectomy is the voice conservative surgical technique that offers the best possibility of control in patients with locally advanced laryngeal cancer. The proper histopathological analysis allows staging and selecting patients for adjuvant therapy, avoiding unnecessary ones as well as designing monitoring and surveillance programs based on risk factors.ObjectiveTo highlight key points in the histopathological evaluation of the surgical specimen of a subtotal laryngectomy.ConclusionThe proper communication between the surgeon and pathologist, offering complete information on preoperative clinical evaluation and the knowledge of the key points in the evaluation of the surgical specimen (sites of tumour leakage and surgical resection margins) are fundamental parameters to achieve a proper histopathological evaluation of the surgical specimen

Dermatoscopia en melanoma cutáneo

ResumenAntecedentesLa mortalidad del melanoma cutáneo no ha disminuido en los últimos 50 años. Las únicas medidas que permiten reducirla son la prevención primaria y el diagnóstico oportuno; la evaluación dermatoscópica es fundamental para lograrlo. Permite identificar características del melanoma que pasarían desapercibidas al ojo desnudo.El objetivo es reportar los hallazgos dermatoscópicos más frecuentes en pacientes con diagnóstico de melanoma in situ e invasivo.Material y métodosEstudio observacional, retrospectivo en el que se realizó dermatoscopia de contacto utilizando dermatoscopio LED DermliteMR, y cámara fotográfica DermliteMR. Se evaluó asimetría en 2 ejes, asociación de colores, falta de pigmento, puntos irregulares, red atípica, pseudópodos, velo azul, ulceración y anillo rosa perilesional, y se comparó el diagnóstico histológico con los hallazgos dermatoscópicos.ResultadosFueron 65 pacientes con melanoma cutáneo: 10 in situ y 55 invasivos. La media de Breslow en invasivos fue 3mm. La mayoría de los pacientes (35) tuvieron localización en extremidades. El hallazgo dermatoscópico más frecuente fue asimetría en 2 ejes, seguida de asociación de 2 o más colores; en melanoma in situ el hallazgo más habitual fue la asimetría en 2 ejes seguida de los puntos atípicos; en melanoma invasivo la asimetría en 2 ejes, la asociación de 2 colores o más y los pseudópodos fueron los hallazgos más frecuentes.ConclusiónLa asimetría en 2 ejes es el hallazgo dermatoscópico más frecuente en melanoma ya sea in situ o invasivo; la presencia de 2 colores o más en una lesión pigmentada debe hacer sospechar de un melanoma invasivo.AbstractBackgroundThe mortality of cutaneous melanoma has not declined over the past 50 years. The only interventions that can reduce mortality are primary prevention and early diagnosis, and the dermoscopic evaluation is essential to achieve this. Dermoscopy identifies characteristics of melanoma that would go unnoticed to the naked eye.The aim of this paper is to report the most frequent dermoscopic findings in patients diagnosed with in situ and invasive melanoma.Material and methodsAn observational and retrospective study of contact dermoscopy was performed using LED DermliteTM and camera DermliteTM dermoscope. The findings evaluated were: asymmetry in two axes, association of colours, lack of pigment, irregular points, atypical network, pseudopods, blue veil, ulceration, and peri-lesional pink ring. These dermoscopic findings were compared with the histological diagnosis.ResultsThe study included 65 patients with cutaneous melanoma; 10 in situ, and 55 invasive. The mean Breslow in invasive melanoma was 3 mm. Most patients (35) had localization in extremities. In all patients, the most frequent dermoscopic finding was asymmetry in two axes, followed by association of two or more colours; in melanoma in situ, asymmetry was the most frequent, followed by atypical-irregular points. In invasive melanoma asymmetry in two axes, the association of two or more colours, and pseudopods, were the most frequent findings.ConclusionAsymmetry in two axes is the most common dermoscopic finding in in situ and invasive melanoma. The presence of two or more colours in a pigmented lesion should be suspected in an invasive melanoma

Clinical characteristics of malignant tumours originating in the external ear

AbstractBackgroundSkin tumours that originate in the external ear are common in individuals with type 1 skin and phenotype 1 and 2. The skin cancer is associated with chronic or intermittent, but intense sunlight. The most common malignant tumour is basal cell carcinoma, followed by squamous cell carcinoma and melanoma. The diagnosis of squamous cell skin cancer in head and neck area is usually made in the advanced stages and has a poor prognosis.Material and methodsA cross-sectional, retrospective analysis was performed on the database of patients with skin cancer of the external ear treated between 2011 and 2014. Histology type, stage, rate of clinical and occult metastases, and rate of loco-regional recurrence were evaluated.ResultsOf the 42 patients included there were, 25 squamous cell carcinomas, 11 basal cell carcinomas, and 6 invasive melanomas. The rate of lymph node metastases in patients with squamous cell carcinoma was 32%, mostly in the parotid and peri-parotid region, 7% of them with capsular rupture, 2/17 were staged as cN0, and 11.7% had occult metastases. All patients with nodal metastasis were classified as T2 with ulceration.None of the patients with basal cell carcinoma had lymph node metastases.All melanomas were superficial extension type with mean level of Breslow of 3mm. All underwent lymphatic mapping and sentinel node biopsy, with only one having metastases in the sentinel node.ConclusionThe most frequent tumour in the external ear in this series was squamous cell carcinoma. The possibility of lymph node metastases is associated with tumour size (T). Node dissection should be systematic in patients with T2 or greater

Resección guiada por fluorescencia en pacientes con cáncer de lengua

ResumenIntroducciónLa fluorescencia ha sido utilizada exitosamente como pesquisa del cáncer oral, adicional al examen oral convencional, identifica áreas con cambios histológicos que son desapercibidas con luz blanca.ObjetivoSaber si la resección guiada por fluorescencia se asocia a márgenes quirúrgicos negativos en pacientes con cáncer de lengua.Material y métodosSe incluyó a pacientes con carcinoma invasivo de lengua candidatos a resección. Se evaluaron con examen oral convencional y con fluorescencia determinándose si el límite de la lesión coincidía en ambos exámenes, se marcaron los límites quirúrgicos analizándose histológicamente.ResultadosFueron 30 pacientes con carcinoma epidermoide invasivo; 10 T1, 15 T2 y 5 T3; 18 mujeres y 12 hombres. El borde de la lesión neoplásica evaluado con el examen oral convencional coincidió con la evaluación con fluorescencia en 17 (56%) y en 13 (44%) la lesión fue mayor. Los márgenes de quirúrgicos fueron negativos en 27 (90%) y positivos en 3 (10%), los positivos lo fueron en el espesor lingual, todos fueron cT3.ConclusionesLa fluorescencia identifica lesiones mayores a las diagnosticadas con el examen oral convencional en el 44% de los pacientes, favorece resección quirúrgica con márgenes negativos en el 90%, la infiltración submucosa y muscular no puede ser detectada por este método.AbstractBackgroundFluorescence has been successfully used as screening method of oral cavity cancer. In addition to the conventional oral examination, it identifies areas with histological changes that are not identified with conventional white light.ObjectiveTo determine whether fluorescence facilitates resection with negative margins in patients diagnosed with squamous cell carcinoma of the tongue.Material and methodsPatients diagnosed with invasive tongue squamous cell carcinoma were evaluated with a conventional oral examination and fluorescence. To determine whether the threshold of injury coincided in both tests, the limits of section were identified and histologically evaluated.ResultsThe study included 30 patients, 18 women and 12 men; 10 T1, 15 T2, and 5 patients with T3. The neoplastic margin evaluated with conventional light coincided with fluorescence in 17 patients (56%), and in 13 (44%) fluorescence identified a larger tumour. Surgical margins were negative in 27 (90%), and 3 (10%) positives that were all in the tongue thickness and with bulky tumours (T3).ConclusionsFluorescence identifies larger tumours than those identified with conventional oral examination in 44% of patients, and ensures a longer surgical resection with free surgical margins in 90% of cases. Submucosal and muscular invasion is not detected by this method

Dispositivo de medición discreta por reflectancia de NIR multibanda del índice glucoacídico en uva para vinificación

El dispositivo de medición discreta por reflectancia de NIR multibanda del índice glucoacídico en uva para vinificación tiene por objeto detectar y medir el índice glucoacídico en uva para vinificación. A partir de este índice el dispositivo identificará las etapas de madurez de la uva. Esto se hará de forma automática utilizando medidas de reflectancia en determinadas longitudes de onda del infrarrojo cercano. Tras la calibración del dispositivo, la medida se realiza de manera puntual sobre la superficie del fruto, que es colocado en el interior del sistema. Este sistema es aplicable al control de calidad en la industria alimentaria, en la agricultura y en áreas afines dedicadas a la investigación y desarrollo.Españ

Cirugía conservadora de laringe en pacientes candidatos a tratamiento combinado con quimio-radiación por cáncer laríngeo

ResumenAntecedentesEl tratamiento de referencia de tipo conservador no quirúrgico para el cáncer de laringe en etapa avanzada es combinado (quimio-radioterapia). Sin embargo, las complicaciones que se presentan con dicho tratamiento no son pocas, principalmente en lo que se refiere a la deglución. La cirugía conservadora de laringe sigue siendo una alternativa eficaz para el control oncológico sin las complicaciones asociadas a la quimio-radioterapia.Material y métodosEstudio retrospectivo que incluyó a pacientes con cáncer laríngeo cT3, cN0 con infiltración paraglótica, fijación cordal, pero movilidad aritenoidea normal y sin infiltración subglótica que fueron tratados con laringectomía subtotal supracricoidea. Se evaluaron complicaciones, secuelas del tratamiento y recurrencia. La aspiración bronquial fue estudiada con gammagrafía de tránsito esofágico.ResultadosFueron intervenidos 25 pacientes; los márgenes de sección fueron negativos en 22; en uno, los márgenes mostraron contacto con el tumor, y en dos resultaron positivos. Dos pacientes recibieron radioterapia posoperatoria. La media del tiempo hasta la decanulación fue de 15 días, en tanto que para el retiro de la sonda nasogástrica fue de 25 días. La media del seguimiento fue de 26 meses. Ninguno de los pacientes ha presentado recurrencia tumoral, ni conversión a laringectomía total. Todos los pacientes presentan deglución normal y ninguno ha requerido traqueotomía permanente, en tanto que la voz es considerada inteligible en todos ellos. Los estudios de gammagrafía del tránsito esofágico mostraron aspiración en 15/25 pacientes, ninguno con repercusión clínica. Cinco pacientes experimentaron complicaciones posoperatorias, cuatro requirieron re-intervención, pero ninguno requirió conversión a laringectomía total.ConclusiónLa cirugía conservadora es una alternativa eficaz a la asociación quimio-radioterapéutica, que ofrece un control oncológico con complicaciones aceptables y secuelas mínimas. Aunque la mayoría de los pacientes experimenta aspiración, ésta no repercute en el estado funcional.AbstractBackgroundThe non-surgical organ-preserving standard of care for advanced-stage laryngeal cancer is combined treatment (chemo-radiotherapy). However, complications occurring with this treatment are not few, and mainly with regards to swallowing. Conservative laryngeal surgery remains an effective alternative for cancer control without the complications associated with chemo-radiotherapy.Material and methodsRetrospective study that included patients with cT3, cN0 laryngeal cancer with paraglottic infiltration, vocal cord fixation, but with normal arytenoid mobility, and without subglottic infiltration, who were treated with supracricoid subtotal laryngectomy. Complications, treatment sequels, and recurrence were assessed. Bronchial aspiration was studied with swallowing scintigraphy.ResultsTwenty-five patients underwent the intervention. Surgical margins were negative in 22, and in one, they were in contact with the tumour, and in 2 they were positive. Two patients received post-operative radiotherapy. Mean time to de-cannulation was 15 days, and 25 days to nasogastric tube removal. Mean follow-up was 26 months. None of the patients has had tumour recurrence or has required conversion to total laryngectomy. In all patients, swallowing has been normal and no one has required permanent tracheotomy. The voice is considered to be intelligible in all patients. Swallowing scintigraphy showed aspiration in 15/25 patients, which was not clinically relevant. Five patients had post-operative complications, with 4 patients requiring re-intervention, but no one required conversion to total laryngectomy.ConclusionConservative surgery is an effective alternative to chemo-radiotherapy that offers cancer control with acceptable complications and minimal sequels. Although most patients experience aspiration, this does not affect the functional status

Acceptance of living liver donation among medical students: A multicenter stratified study from Spain

AIM: To analyze the attitude of Spanish medical students toward living liver donation (LLD) and to establish which factors have an influence on this attitude. METHODS: STUDY TYPE: A sociological, interdisciplinary, multicenter and observational study. STUDY POPULATION: Medical students enrolled in Spain (n = 34000) in the university academic year 2010-2011. SAMPLE SIZE: A sample of 9598 students stratified by geographical area and academic year. Instrument used to measure attitude: A validated questionnaire (PCID-DVH RIOS) was self-administered and completed anonymously. Data collection procedure: Randomly selected medical schools. The questionnaire was applied to each academic year at compulsory sessions. STATISTICAL ANALYSIS: Student´s t test, ?(2) test and logistic regression analysis. RESULTS: The completion rate was 95.7% (n = 9275). 89% (n = 8258) were in favor of related LLD, and 32% (n = 2937) supported unrelated LLD. The following variables were associated with having a more favorable attitude: (1) age (P = 0.008); (2) sex (P < 0.001); (3) academic year (P < 0.001); (4) geographical area (P = 0.013); (5) believing in the possibility of needing a transplant oneself in the future (P < 0.001); (6) attitude toward deceased donation (P < 0.001); (7) attitude toward living kidney donation (P < 0.001); (8) acceptance of a donated liver segment from a family member if one were needed (P < 0.001); (9) having discussed the subject with one's family (P < 0.001) and friends (P < 0.001); (10) a partner's opinion about the subject (P < 0.001); (11) carrying out activities of an altruistic nature; and (12) fear of the possible mutilation of the body after donation (P < 0.001). CONCLUSION: Spanish medical students have a favorable attitude toward LLD

Diagnóstico rápido y efectivo de brucelosis bovina en sangre, mediante una reacción en cadena de la polimerasa doble

Brucellosis is a major infectious disease of cattle. It is also an international trade barrier for the import and export of dairy and beef products. In Mexico, bovine brucellosis is diagnosed using the card, rivanol, and complement fixation serological tests. Molecular methods such as polymerase chain reaction (PCR) are rapid, specific diagnostic tools for brucellosis. This research developed a duplex PCR assay for the diagnosis of brucellosis in cattle blood samples, using the omp2 and BSCP31 genes. Fifty three (53) blood samples with rivanol titers of 1:400, and 60 serologically-negative samples were used. The optimum concentrations of both primers and magnesium chloride for specific fragment amplifications were 100 nM and 0.5 mM, respectively. The analytical sensitivity of duplex PCR was 100 fg/μ,,,,l DNA, while the optimum amplification concentration was 1 ng/μ,,,,l DNA. Analytical specificity was 100%. Diagnostic sensitivity and specificity were 96.3% and 100%, respectively. The results of this study provide evidence for the routine use of duplex PCR in the diagnosis of bovine brucellosis directly on blood samples, as a highly safe, sensitive, specific method.La brucelosis es una de las enfermedades infecciosas más importantes del ganado y representa una barrera para la importación y exportación de productos lácteos y cárnicos. En México, el diagnóstico se realiza mediante las pruebas serológicas de tarjeta, rivanol y fijación del complemento. Los métodos moleculares, como la reacción en cadena de la polimerasa (PCR), son herramientas rápidas y especí­ficas para el diagnóstico de la enfermedad. En el presente trabajo se desarrolló el diagnóstico de brucelosis por PCR doble, a partir de muestras de sangre, utilizando los genes omp2 y BSCP31. Para este estudio se utilizaron 53 muestras de sangre con tí­tulos de rivanol de 1:400 y 60 muestras con resultados negativos a las pruebas serológicas. Las concentraciones óptimas de iniciadores y cloruro de magnesio para lograr la amplificación especí­fica de los dos fragmentos, fueron de 100 nM y 0.5 mM respectivamente. La sensibilidad analí­tica alcanzada para la PCR doble fue de 100 fg/μ,,,,l de ADN, mientras que la concentración óptima de amplificación fue de 1 ng/μ,,,,l de ADN. La especificidad analí­tica obtenida fue del 100 %, mientras que la sensibilidad y la especificidad diagnóstica fueron del 96.3 % y 100 % respectivamente. Los resultados de este estudio aportan evidencia para el uso rutinario de la PCR doble para el diagnóstico de la brucelosis bovina directamente de muestras de sangre, ya que es un método altamente seguro, sensible y especí­fico

Oral fosfomycin for the treatment of lower urinary tract infections among kidney transplant recipients—Results of a Spanish multicenter cohort

Preliminary results of this study were presented at the 29th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), held in Amsterdam, The Netherlands, from 13 to 16 April, 2019 (oral communication O‐0699).Oral fosfomycin may constitute an alternative for the treatment of lower urinary tract infections (UTIs) in kidney transplant recipients (KTRs), particularly in view of recent safety concerns with fluroquinolones. Specific data on the efficacy and safety of fosfomycin in KTR are scarce. We performed a retrospective study in 14 Spanish hospitals including KTRs treated with oral fosfomycin (calcium and trometamol salts) for posttransplant cystitis between January 2005 and December 2017. A total of 133 KTRs developed 143 episodes of cystitis. Most episodes (131 [91.6%]) were produced by gram‐negative bacilli (GNB), and 78 (54.5%) were categorized as multidrug resistant (including extended‐spectrum β‐lactamase‐producing Enterobacteriaceae [14%] or carbapenem‐resistant GNB [3.5%]). A median daily dose of 1.5 g of fosfomycin (interquartile range [IQR]: 1.5‐2) was administered for a median of 7 days (IQR: 3‐10). Clinical cure (remission of UTI‐attributable symptoms at the end of therapy) was achieved in 83.9% (120/143) episodes. Among those episodes with follow‐up urine culture, microbiological cure at month 1 was achieved in 70.2% (59/84) episodes. Percutaneous nephrostomy was associated with a lower probability of clinical cure (adjusted odds ratio: 10.50; 95% confidence interval: 0.98‐112.29; P = 0.052). In conclusion, fosfomycin is an effective orally available alternative for treating cystitis among KTRs.This study was supported by Plan Nacional de I+D+i 2013‐2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016)—cofinanced by the European Development Regional Fund “A way to achieve Europe”; the Group for Study of Infection in Transplantation and the Immunocompromised Host (GESITRA‐IC) of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC); and the Spanish Network for Research in Renal Diseases (REDInREN RD16/0009). MFR holds a research contract “Miguel Servet” (CP 18/00073) from the Spanish Ministry of Science, Innovation and Universities, Instituto de Salud Carlos III

Efficacy and Safety of Oral Fosfomycin for Asymptomatic Bacteriuria in Kidney Transplant Recipients: Results from a Spanish Multicenter Cohort

Current guidelines recommend against systematic screening for or treating asymptomatic bacteriuria (AB) among kidney transplant (KT) recipients, although the evidence regarding episodes occurring early after transplantation or in the presence of anatomical abnormalities is inconclusive. Oral fosfomycin may constitute a good option for the treatment of posttransplant AB, particularly due to the emergence of multidrug-resistant (MDR) uropathogens. Available clinical evidence supporting its use in this specific setting, however, remains scarce. We performed a retrospective study in 14 Spanish institutions from January 2005 to December 2017. Overall, 137 episodes of AB diagnosed in 133 KT recipients treated with oral fosfomycin (calcium and trometamol salts) with a test-of-cure urine culture within the first 30 days were included. Median time from transplantation to diagnosis was 3.1 months (interquartile range [IQR], 1.1 to 10.5). Most episodes (96.4% [132/137]) were caused by Gram-negative bacteria (GNB), and 56.9% (78/137) were categorized as MDR (extended‐spectrum β‐lactamase‐producing Enterobacterales [20.4%] and carbapenem‐resistant GNB [2.9%]). Rate of microbiological failure at month 1 was 40.1% (95% confidence interval [CI], 31.9% to 48.9%) for the whole cohort and 42.3% (95% CI, 31.2% to 54.0%) for episodes due to MDR pathogens. Previous urinary tract infection (odds ratio [OR], 2.42; 95% CI, 1.11 to 5.29; P value = 0.027) and use of fosfomycin as salvage therapy (OR, 8.31; 95% CI, 1.67 to 41.35; P value = 0.010) were predictors of microbiological failure. No severe treatment-related adverse events were detected. Oral fosfomycin appears to be a suitable and safe alternative for the treatment (if indicated) of AB after KT, including those episodes due to MDR uropathogens.This study was supported by Plan Nacional de I+D+i 2013‐2016 and Instituto de Salud Carlos III (ISCIII), Subdirección General de Redes y Centros de Investigación Cooperativa, Ministry of Science and Innovation, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016), and Spanish Network for Research in Renal Diseases (REDInREN RD16/0009) and cofinanced by the European Development Regional Fund entitled A way to achieve Europe. M.F.-R. holds a research contract (Miguel Servet, CP18/00073), from the Spanish Ministry of Science and Innovation, ISCIII.Peer reviewe