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Coppola A, La Vaccara V, Farolfi T, Asbun HJ, Boggi U, Conlon K, Edwin B, Ferrone C, Jonas E, Kokudo N, Perez EM, Satoi S, Sparrelid E, Stauffer J, Zerbi A, Takemura N, Lai Q, Almerey T, Bernon M, Cammarata R, Djoumi Y, Gallagher T, Ghorbani P, Ginesini M, Hashimoto D, Kauffmann EF, Kleive D, Lluís N, González RM, Napoli N, Nappo G, Nebbia M, Ricchitelli S, Sahakyan MA, Yamamoto T, Coppola R, Caputo D. Preoperative CA19.9 level predicts lymph node metastasis in resectable adenocarcinoma of the head of the pancreas: A further plea for biological resectability criteria. Int J Surg 2023:01279778-990000000-00664. [PMID: 37738016 DOI: 10.1097/js9.0000000000000773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/10/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Lymph-nodal involvement (N+) represents an adverse prognostic factor after pancreatoduodenectomy (PD) for pancreatic adenocarcinoma (PDAC). Preoperative diagnostic and staging modalities lack sensitivity for identifying N+. This study aimed to investigate preoperative CA19.9 in predicting the N+ stage in resectable-PDAC (R-PDAC). METHODS Patients included in a multi-institutional retrospective database of PDs performed for R-PDAC from January 2000 to June 2021 were analyzed. A preoperative laboratory value of CA19.9 >37 U/L was used in univariate and multivariate logistic regression analysis to determine a possible association with N+. Additionally, different cut-offs of CA19.9 related to the preoperative clinical T (cT) stage was assessed to evaluate the risk of N+. RESULTS A total of 2034 PDs from thirteen centers were included in the study. CA19.9>37 U/L was significantly associated with higher N+ at univariate and multivariate analysis (P<0.001). CA19.9 levels >37 U/L were associated with N+ in 75.9%, 81.3%, and 85.7% of patients, respectively, in cT1, cT2, and cT3 tumors and with higher cut-off values for all cT stages. CONCLUSION Lymph nodal involvement is strongly related to preoperative CA19.9 levels. Specially in patients staged as cT3 the CA 19.9 could represent a valid and easy tool to suspect nodal involvement. Due to these findings, R-PDAC patients with elevated CA19.9 values should be considered in a more biologically advanced stage.
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Affiliation(s)
| | - Vincenzo La Vaccara
- General Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Tommaso Farolfi
- General Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Horacio J Asbun
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, USA
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Kevin Conlon
- Department of HPB Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Bjørn Edwin
- The Intervention Center, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Department of Research; Development, Division of Emergencies and Critical Care, Oslo, University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
- Department of HPB Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Cristina Ferrone
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Eduard Jonas
- Department of Surgery, University of Cape Town Faculty of Health Sciences, Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town, South Africa
| | - Norihiro Kokudo
- Hepato-Biliary Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1,Toyama, Shinjyuku-ku, Tokyo, 162-8655, Japan
| | - Elena Martin Perez
- General Surgery Department, La Princesa Hospital, Health Research Institute Princesa (IIS-IP), Autónoma de Madrid University (UAM), Madrid, Spain
| | - Sohei Satoi
- Department of Surgery, Kansai Medical University, Hirakata City, Osaka, Japan
| | - Ernesto Sparrelid
- Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - John Stauffer
- Division of Surgical Oncology, Minimally Invasive and Hepatobiliary Surgery, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Alessandro Zerbi
- Pancreatic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Nobuyuki Takemura
- Hepato-Biliary Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1,Toyama, Shinjyuku-ku, Tokyo, 162-8655, Japan
| | - Quirino Lai
- General Surgery and Organ Transplantation Unit, Sapienza University of Rome, Umberto I Polyclinic of Rome, Rome, Italy
| | - Tariq Almerey
- Division of Surgical Oncology, Minimally Invasive and Hepatobiliary Surgery, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Marc Bernon
- Department of Surgery, University of Cape Town Faculty of Health Sciences, Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town, South Africa
| | - Roberto Cammarata
- General Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Yasmine Djoumi
- Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Tom Gallagher
- Department of HPB Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Poya Ghorbani
- Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Michael Ginesini
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Daisuke Hashimoto
- Department of Surgery, Kansai Medical University, Hirakata City, Osaka, Japan
| | | | - Dyre Kleive
- Department of HPB Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Núria Lluís
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, USA
| | - Rocio Maqueda González
- General Surgery Department, La Princesa Hospital, Health Research Institute Princesa (IIS-IP), Autónoma de Madrid University (UAM), Madrid, Spain
| | - Niccolò Napoli
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Gennaro Nappo
- Pancreatic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Martina Nebbia
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Simone Ricchitelli
- Pancreatic Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Mushegh A Sahakyan
- The Intervention Center, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Department of Research; Development, Division of Emergencies and Critical Care, Oslo, University Hospital, Oslo, Norway
- Department of Surgery N1, Yerevan State Medical University, Yerevan, Armenia
| | - Tomohisa Yamamoto
- Department of Surgery, Kansai Medical University, Hirakata City, Osaka, Japan
| | - Roberto Coppola
- General Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Damiano Caputo
- General Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Sánchez-Santos R, Morales-Conde S, Ramos Rodriguez JL, Alvarez Peña E, Aranda Narváez JM, Alvarez Gallego M, Badía JM, Balibrea del Castillo JM, Garcia-Botella A, Guirao Garriga X, Espin Basany E, Martin-Antona E, Martin Perez E, Martinez Cortijo S, Pascual Miguelañez I, Perez Diaz L, Rubio Perez I, Soria Aledo V. Analysis of the broadcasting and perceived utility through the implementation of a virtual training platform during the pandemic. Cir Esp 2023; 101:29-34. [PMID: 35809787 PMCID: PMC9259185 DOI: 10.1016/j.cireng.2021.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/12/2021] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The SARS-CoV-2 pandemic has affected training opportunities for healthcare professionals partly because face to face courses were cancelled. This study analyzes the results of participation and satisfaction of the AEC Virtual Classroom sessions during the first year. METHODS The AEC Virtual Classroom includes a combined format of weekly Webinar broadcast live that can be viewed on a delayed basis in a virtual platform. In this study, the results in its first year are evaluated considering the number of live participants, the delayed views and the global reach; as well as the results of the satisfaction survey in each of the sessions (0-10). RESULTS From 16/04/2020 to 15/04/2021, 50 sessions of the Virtual Classroom AEC were held. The average scope of the sessions was 509 ± 288 views with a range between 196 and 149. At the times of highest incidence of cases during the pandemic, a decrease in live participants was observed 275 ± 135 vs. 391 ± 233 (P = 0.032). The mean score on the format was 8.46 ± 0.31/10. The best-scored sessions were those of the subject related to coloproctology with a statistically significant difference in the mean score 8.79 ± 0.42 vs. 8.39 ± 0.27 (P = 0.035). 90% of users considered the sessions useful. 97.2% of respondents believe that the sessions should be maintained after the pandemic. CONCLUSIONS The AEC Virtual Classroom has had very good results in the first year, proving to be a useful surgical teaching tool that will foreseeably survive once the pandemic is over.
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Affiliation(s)
- Raquel Sánchez-Santos
- Servicio de Cirugía General y Digestiva, Complejo Hospitalario Universitario de Vigo, Instituto de Investigación Biomédica Galicia Sur, Spain,Corresponding author
| | | | | | | | | | - Mario Alvarez Gallego
- Servicio de Cirugía General y Digestiva, Hospital Universitario la Paz, Madrid, Spain
| | - Josep María Badía
- Servicio de Cirugía General y Digestiva, Hospital de Granollers, Universitat Internacional de Catalunya, Spain
| | | | | | - Xavier Guirao Garriga
- Servicio de Cirugía General y Digestiva, Parc Taulí, Hospital Universitario Sabadell, Sabadell, Spain
| | - Eloy Espin Basany
- Servicio de Cirugía General y Digestiva, Hospital Valle de Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Esteban Martin-Antona
- Servicio de Cirugía General y Digestiva, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Elena Martin Perez
- Servicio de Cirugía General y Digestiva, Hospital Universitario la Princesa, Madrid, Spain
| | | | | | - Lola Perez Diaz
- Servicio de Cirugía General y Digestiva, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ines Rubio Perez
- Servicio de Cirugía General y Digestiva, Hospital Universitario la Paz, Madrid, Spain
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Sánchez-Santos R, Morales-Conde S, Ramos Rodriguez JL, Alvarez Peña E, Aranda Narváez JM, Alvarez Gallego M, Badía JM, Balibrea Del Castillo JM, Garcia-Botella A, Guirao Garriga X, Espin Basany E, Martin-Antona E, Martin Perez E, Martinez Cortijo S, Pascual Miguelañez I, Perez Diaz L, Rubio Perez I, Soria Aledo V. [Analysis of the broadcasting and perceived utility through the implementation of a virtual training platform during the pandemic]. Cir Esp 2023; 101:29-34. [PMID: 34720121 PMCID: PMC8542455 DOI: 10.1016/j.ciresp.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/12/2021] [Indexed: 01/04/2023]
Abstract
Introduction The SARS-CoV-2 pandemic has affected training opportunities for healthcare professionals partly because face to face courses were cancelled. This study analyzes the results of participation and satisfaction of the AEC Virtual Classroom sessions during the first year. Methods The AEC Virtual Classroom includes a combined format of weekly Webinar broadcast live that can be viewed on a delayed basis in a virtual platform. In this study, the results in its first year are evaluated considering the number of live participants, the delayed views and the global reach; as well as the results of the satisfaction survey in each of the sessions (0-10). Results From 16/04/2020 to 15/04/2021, 50 sessions of the Virtual Classroom AEC were held. The average scope of the sessions was 509 ± 288 views with a range between 196 and 149. At the times of highest incidence of cases during the pandemic, a decrease in live participants was observed 275 ± 135 vs. 391 ± 233 (p = 0.032). The mean score on the format was 8.46 ± 0.31/10. The best-scored sessions were those of the subject related to coloproctology with a statistically significant difference in the mean score 8.79 ± 0.42 vs. 8.39 ± 0.27 (p = 0.035). 90% of users considered the sessions useful. 97.2% of respondents believe that the sessions should be maintained after the pandemic. Conclusions The AEC Virtual Classroom has a very good results in the first year, proving to be a useful surgical teaching tool that will foreseeably survive once the pandemic is over.
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Affiliation(s)
- Raquel Sánchez-Santos
- Servicio de Cirugía General y Digestiva, Complejo Hospitalario Universitario de Vigo, Instituto de Investigación Biomédica Galicia Sur, España
| | | | | | | | | | - Mario Alvarez Gallego
- Servicio de Cirugía General y Digestiva, Hospital Universitario la Paz, Madrid, España
| | - Josep María Badía
- Servicio de Cirugía General y Digestiva, Hospital de Granollers, Universitat Internacional de Catalunya, España
| | | | | | - Xavier Guirao Garriga
- Servicio de Cirugía General y Digestiva, Parc Tauli, Hospital Universitario Sabadell, Sabadell, España
| | - Eloy Espin Basany
- Servicio de Cirugía General y Digestiva, Hospital Valle de Hebron, Universitat Autónoma de Barcelona, Barcelona, España
| | - Esteban Martin-Antona
- Servicio de Cirugía General y Digestiva, Hospital Clinico Universitario San Carlos, Madrid, España
| | - Elena Martin Perez
- Servicio de Cirugía General y Digestiva, Hospital Universitario la Princesa, Madrid, España
| | - Sagrario Martinez Cortijo
- Servicio de Cirugía General y Digestiva, Hospital Universitario Fundación Alcorcon, Alcorcon, España
| | | | - Lola Perez Diaz
- Servicio de Cirugía General y Digestiva, Hospital General Universitario Gregorio Marañon, Madrid, España
| | - Ines Rubio Perez
- Servicio de Cirugía General y Digestiva, Hospital Universitario La Paz, Madrid, España
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Lindemann WR, Philiph RL, Chan DWW, Ayers CT, Perez EM, Beckman SP, Strzalka J, Chaudhary S, Vaknin D. Oriented polyvinylidene fluoride-trifluoroethylene (P(VDF-TrFE)) films by Langmuir-Blodgett deposition: a synchrotron X-ray diffraction study. Phys Chem Chem Phys 2015; 17:29335-9. [PMID: 26473177 DOI: 10.1039/c5cp04307g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Langmuir-Blodgett films of polyvinylidene fluoride trifluoroethylene - P(VDF-TrFE)-copolymers possess substantially improved electrocaloric and pyroelectric properties, when compared with conventionally spin-cast films. In order to rationalize this, we prepared single-layered films of P(VDF-TrFE) (70 : 30) using both deposition techniques. Grazing incidence wide-angle X-ray scattering (GIWAXS), reveals that Langmuir-Blodgett deposited films have a higher concentration of the ferroelectric β-phase crystals, and that these films are highly oriented with respect to the substrate. Based on these observations, we suggest alternative means of deposition, which may substantially enhance the electrocaloric effect in P(VDF-TrFE) films. This development has significant implications for the potential use of P(VDF-TrFE) in solid-state refrigeration.
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Affiliation(s)
- W R Lindemann
- Department of Materials Engineering, Iowa State University, Ames, IA 50011, USA and Ames National Laboratory, Ames, IA 50011, USA.
| | - R L Philiph
- Department of Materials Engineering, Iowa State University, Ames, IA 50011, USA and Department Bioengineering, University of Washington, Seattle, WA 98105, USA
| | - D W W Chan
- Department of Electrical & Computer Engineering, Iowa State University, Ames, IA 50011, USA
| | - C T Ayers
- Department of Electrical & Computer Engineering, Iowa State University, Ames, IA 50011, USA
| | - E M Perez
- Department of Materials Engineering, Iowa State University, Ames, IA 50011, USA
| | - S P Beckman
- Department of Materials Engineering, Iowa State University, Ames, IA 50011, USA and School of Mechanical and Materials Engineering, Washington State University, Pullman, WA 99164, USA
| | - J Strzalka
- X-Ray Science Division, Argonne National Laboratory, Argonne, Illinois, USA
| | - S Chaudhary
- Department of Electrical & Computer Engineering, Iowa State University, Ames, IA 50011, USA
| | - D Vaknin
- Ames National Laboratory, Ames, IA 50011, USA. and Department of Physics and Astronomy, Iowa State University, Ames, IA 50011, USA
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5
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Perez EM, Carrara H, Bourne L, Berg A, Swanevelder S, Hendricks MK. Massage therapy improves the development of HIV-exposed infants living in a low socio-economic, peri-urban community of South Africa. Infant Behav Dev 2015; 38:135-46. [PMID: 25645599 DOI: 10.1016/j.infbeh.2014.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 10/24/2014] [Accepted: 12/14/2014] [Indexed: 11/29/2022]
Abstract
The aim of this study was to assess the effect of massage therapy on the growth and development of infants of HIV-infected mothers in a low socio-economic community in Cape Town. It was a prospective, randomised, controlled intervention trial that included massage therapy and control groups of HIV-infected mothers and their normal birth weight infants who were enrolled in the prevention of mother-to-child transmission (PMTCT) programme. Participants were recruited at the 6-week clinic visit and followed up every 2 weeks until their infants were 9 months of age. Mother-infant pairs in the massage therapy and control groups included 73 and 88 at 6 weeks and 55 and 58 at 9 months, respectively. Mothers in the intervention group were trained to massage their infants for 15 min daily. The socioeconomic status, immunity, relationship with the partner and mental pain of mothers; the infants' dietary intake, anthropometry and development (Griffiths Mental Development Scales); and haematological and iron status of mothers and infants were assessed at baseline and follow-up. Nine infants (5.3%) were HIV-infected on the HIV DNA PCR test at 6 weeks. Despite significantly higher levels of maternal mental pain, infants in the massage therapy compared to control group scored higher in all five of the Griffiths Scales of Mental Development and significantly higher in the mean quotient (p=0.002) and mean percentile (p=0.004) for the hearing and speech scale at 9 months. Based on the mean difference in scores, the massage therapy group showed greater improvement for all five scales compared to the control group. The mean difference in scores was significantly greater for the hearing and speech quotient (21.9 vs. 11.2) (p<0.03) and the general quotient percentile (19.3 vs. 7.7) (p=0.03) in the massage therapy compared to the control group. These scales remained significant when adjusting for the relationship with the partner and maternal mental pain. Both groups had lower scores in the performance scale at 9 months although this was significantly worse in the control compared to the massage therapy group when adjusting for maternal CD4 count, anaemia, relationship with the partner and mental pain. There were no significant differences in the anthropometric measurements between the two groups. In conclusion, based on the Griffiths Scales, massage therapy improved the overall development and had a significant effect on the hearing and speech and general quotient of HIV-exposed infants in this study.
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Affiliation(s)
- E M Perez
- School of Child and Adolescent Health, Health Sciences Faculty, University of Cape Town, South Africa
| | - H Carrara
- School of Child and Adolescent Health, Health Sciences Faculty, University of Cape Town, South Africa
| | - L Bourne
- Medical Research Council, Parow, Cape Town, South Africa
| | - A Berg
- School of Child and Adolescent Health, Health Sciences Faculty, University of Cape Town, South Africa
| | - S Swanevelder
- Medical Research Council, Parow, Cape Town, South Africa
| | - M K Hendricks
- School of Child and Adolescent Health, Health Sciences Faculty, University of Cape Town, South Africa.
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Quiroga MA, Lozada MI, Madariaga G, Cappucio JA, Machuca MA, Barrales H, Perez EM, Perfumo CJ. Ileal ganglioneuromatosis in a piglet: histopathological and immunohistochemical studies. J Comp Pathol 2014; 151:380-3. [PMID: 25443431 DOI: 10.1016/j.jcpa.2014.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 08/08/2014] [Accepted: 09/01/2014] [Indexed: 11/27/2022]
Abstract
Ganglioneuromatosis (GNM) is a rare condition characterized by the benign proliferation of ganglion cells, nerve fibres and supporting cells of the enteric nervous system. Necropsy examination of a female piglet weighing 4 kg revealed a well-demarcated 20 cm segment of terminal ileum with thickening of the wall. Microscopically, the lamina propria was infiltrated by enteric glial cells and large ganglion cells. Within the submucosal and muscular layers, aggregates of neurons were interlaced by Schwann cells and enteric glial cells arranged in concentric rings. Immunohistochemically, the neurons were weakly labelled for S-100 and neuron-specific enolase, Schwann cells expressed S-100 and vimentin and enteric glial cells expressed glial fibrillary acidic protein and S-100. Pathological and immunohistochemical findings supported the diagnosis of ileal GNM.
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Affiliation(s)
- M A Quiroga
- Department of Veterinary Pathology, Faculty of Veterinary Science, La Plata National University, cc 296, B1900AVW, La Plata, Buenos Aires, Argentina
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Abstract
BACKGROUND Choroidal nevi are fairly common lesions of the posterior pole that can sometimes transform into melanoma, and it is thought that most choroidal melanomas arise from preexisting nevi. Occasionally, these lesions present as nonpigmented or amelanotic variations of their pigmented counterparts. Recent studies suggest a relationship between tumor pigmentation and risk of growth and metastasis, with a better prognosis for lightly pigmented or amelanotic lesions. CASE REPORTS A case of an amelanotic choroidal nevus and melanoma are presented. In Case 1, a 26-year-old white female was found to have a large amelanotic nevus in the right eye. After 7 years of periodic observation, the lesion has not changed. In Case 2, a 51-year-old white male was diagnosed with a large amelanotic melanoma in the left eye. Due to extensive involvement of the optic nerve, the patient underwent enucleation. Histological evaluation confirmed the lesion as a mixed-cell type malignant amelanotic melanoma. CONCLUSION Management of choroidal nevi generally consists of periodic observation, and the most widely accepted management of choroidal melanoma is observation, radiotherapy, and transpupillary thermotherapy or enucleation. The therapeutic modality of choice for melanoma will vary depending on the size, growth, and location of the lesion. In addition, recent studies suggest an association between heavy tumor pigmentation, tumor size, cell type, and risk of metastasis. Although many variables will influence the final treatment option, pigmentation of the lesion should also be considered.
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Affiliation(s)
- D S Lee
- Veterans Affairs Greater Los Angeles Healthcare System, Sepulveda Ambulatory Care Center & Nursing Home, Sepulveeda, California 91343, USA
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Perez EM, Cooper TR, Moise AA, Ferry GD, Weisman LE. Treatment of obstructive jaundice in erythroblastosis fetalis with ursodeoxycholic acid (UDCA): a case report. J Perinatol 1998; 18:317-9. [PMID: 9730206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To report a significant improvement of direct hyperbilirubinemia values, in an infant with cholestasis secondary to erythroblastosis fetalis, after treatment with ursodeoxycholic acid (UDCA). STUDY DESIGN Case report. RESULTS A full term infant, with total and direct bilirubin values of 26 mg/dl (445 micromol/l) and 24.5 mg/dl (419 micromol/l), respectively, on the third day of life, had total and direct bilirubin values of 8.2 mg/dl (140 micromol/l) and 6.9 mg/dl (118 micromol/l), respectively, after 2 days of treatment with UDCA. Because the natural course of this cholestasis takes several weeks to resolve, the observed improvement is highly suggestive of a direct effect of UDCA on the disease course. CONCLUSION This treatment may add a new therapeutic option to the limited measures available for this condition, although further studies regarding safety and its mechanism of action are needed before it can be routinely recommended.
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Affiliation(s)
- E M Perez
- Department of Pediatrics, Baylor College of Medicine, Houston, Tex 77030, USA
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Perez EM, Weisman LE. Novel approaches to the prevention and therapy of neonatal bacterial sepsis. Clin Perinatol 1997; 24:213-29. [PMID: 9099511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A variety of adjunctive treatments have been shown to offer potential benefits for neonates with sepsis. Most are not available clinically and those that are available still should be considered experimental or limited in their use; however, these efforts are far from complete and should continue to evolve in the coming years. Efforts toward the rapid diagnosis of bacterial infections are a necessary component in the eventual implementation of these potential novel strategies. As a better understanding of the intricate mechanisms of neonatal sepsis is developed, it will be possible to provide patients with an increasingly effective array of treatment and prevention strategies.
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Affiliation(s)
- E M Perez
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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Hendricks MK, Perez EM, Burger PJ, Mouton PA. Brucellosis in childhood in the Western Cape. S Afr Med J 1995; 85:176-8. [PMID: 7777972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Human brucellosis, a multisystem disease which may mimic other conditions, has a low incidence in childhood and the diagnosis may easily be missed. Over a 7-month period 9 children with brucellosis presented to the Department of Paediatrics and Child Health, Tygerberg Hospital. Six of the children had consumed unpasteurized milk. The main presenting symptoms were fever, fatigue, headache, myalgia and haematuria. Clinical signs included lymphadenopathy (3), nasopharyngitis (2), features of lower respiratory tract infection (2), splenomegaly (2) and pyrexia (1). The diagnosis was made on the basis of a positive serological titre (> 1:160) for Brucella abortus. The prozone phenomenon was encountered in 6 cases; however, the Coombs test confirmed the diagnosis in these cases. Children under 7 years were treated with co-trimoxazole and rifampicin and those over 7 years with tetracycline and rifampicin, for at least 6 weeks. No relapses were detected on follow-up.
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Affiliation(s)
- M K Hendricks
- Department of Paediatrics, Tygerberg Hospital, University of Stellenbosch, Tygerberg, W. Cape
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Affiliation(s)
- E Benedetti
- University of Minnesota Department of Surgery, Minneapolis 55455, USA
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12
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Johnson ES, Eng RK, Perez EM, Smith LG. Aztreonam: early clinical studies in New Jersey. N J Med 1986; Spec No:26-9. [PMID: 3513061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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