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Factor V is an early marker for EAD and is a continuous predictor of short-term graft loss after LT.

The 30-year experience in improving detection of breast cancer in the Breast Unit of the Hospital de Clínicas, Federal University of Rio Grande do Sul, Brazil (1972-2002) is reported. We retrospectively analyzed the behavior of surrogate parameters of early breast cancer detection, such as the mean tumor diameter at diagnosis, clinical staging, as well as the percentage of breast conservative surgery along this period of three decades. From 2,103 identified women, 1,607 women met our criteria for study entry and had follow-up information, constituting our study cohort. Statistical tests were two-sided and considered significant at p < 0.05. There was a decrease of about 0.8 cm in the median tumor diameter over this 30-year period. The incidence of early-stage tumors increased progressively over time, and the percentage of patients presenting with stage I breast cancer doubled in 30 years. The Halsted procedure that represented 11.5% of surgeries in the 1970s is a very rare procedure nowadays (<1% of cases). Modified radical mastectomy was the procedure applied in about 50% of women with invasive breast cancer during these 30 years of observation. Notably, breast conservative surgery increased from 17.3% in the 1970s to 43.2% in the 2000s, while the decrease in tumor size and clinical staging was accompanied by an increased number of breast conservative surgical procedures. In geographic areas where coordinated preventive efforts are not thoroughly available, analysis of subsets of the patient population using tumor size as a surrogate represents an indirect way to observe long-term effects of prevention. The present study shows that tumor size is a surrogate for populations from developing countries too and gives scientific support for the design of continuous comprehensive programs of breast cancer prevention in this setting.

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PURPOSE:To evaluate the influence of the anesthetic regimen on anesthetic recovery, survival, and blood glucose levels following a 90% partial hepatectomy in rats. METHODS:Thirty adult male Wistar rats were divided into two groups according to their anesthetic regimens: intraperitoneal ketamine and xylazine or inhaled isoflurane. In order to prevent hypoglycemia, glucose was administered intraperitoneally and glucose (20%) was added to the drinking water. RESULTS:Anesthetic recovery time was longer in the ketamine and xylazine group. The survival rate after 72 hours was lower (log rank=0.0001) in the ketamine and xylazine group (0.0%) than in the isoflurane group (26.7%). The blood glucose after six hours was lower (p=0.017) in the ketamine and xylazine group (63±31.7 mg/dL) than in the isoflurane group (98±21.2 mg/dL). The prolonged anesthesia recovery time associated with ketamine and xylazine decreased the survival rate and blood glucose levels after 90% hepatectomy. CONCLUSION:Isoflurane anesthesia reduced the recovery time and incidence of hypoglycemia and increased the survival rate in the early hours, providing a therapeutic window that is suitable for experimental studies.Key words: Liver Failure, Acute. Hepatectomy. Isoflurane. Ketamine. Xylazine. Ratos. RESUMO OBJETIVO:Avaliar a influência do regime anestésico sobre a recuperação anestésica, a sobrevida em 72 horas e a glicemia após hepatectomia parcial de 90% em ratos. MÉTODOS:Trinta ratos Wistar machos adultos foram distribuídos em dois grupos conforme o regime anestésico: combinação de ketamina e xilazina intraperitoneal ou isoflurano inalatório. Para prevenção de hipoglicemia foi administrada glicose intraperitoneal e adicionado glicose (20%) na água de beber. RESULTADOS:A recuperação anestésica no grupo ketamina e xilazina foi mais prolongada. Durante primeira hora após hepatectomia, nenhum rato anestesiado com ketamina e xilazina despertou. Todos do grupo isoflurano estavam ativos minutos após final da cirurgia. The effects of anesthetic regimen in 90% hepatectomy in ratsActa Cirúrgica Brasileira -Vol. 27 (10) 2012 -703 A sobrevida em 72 horas foi menor (Log rank=0,0001) no grupo ketamina e xilazina (0,0%) que no grupo isoflurano (26,7%). Glicemia em 6 horas do grupo ketamina e xilazina (63±31,7 mg/dL) foi menor (p=0,017) que no grupo isoflurano (98 ±21,2 mg/dL). Prolongado tempo de recuperação anestésica com ketamina e xilazina diminuiu sobrevida e glicemia após hepatectomia 90%.CONCLUSÃO: Anestesia com isoflurano reduziu tempo de recuperação e hipoglicemia, além de aumentar a sobrevida nas primeiras horas, possibilitando uma janela terapêutica adequada para estudos experimentais.

CONTEXT: Hirschsprung disease is a developmental disorder of the enteric nervous system that is characterized by absence of ganglion cells in the distal intestine, and it occurs in approximately 1 in every 500,000 live births. Hepatoblastoma is a malignant liver neoplasm that usually occurs in children aged 6 months to 3 years, with a prevalence of 0.54 cases per 100,000. CASE REPORT: A boy diagnosed with intestinal atresia in the first week of life progressed to a diagnosis of comorbid Hirschsprung disease. Congenital cataracts and sensorineural deafness were diagnosed. A liver mass developed and was subsequently confirmed to be a hepatoblastoma, which was treated by means of surgical resection of 70% of the liver volume and neoadjuvant chemotherapy (ifosfamide, cisplatin and doxorubicin). CONCLUSION: It is known that Hirschsprung disease may be associated with syndromes predisposing towards cancer, and that hepatoblastoma may also be associated with certain congenital syndromes. However, co-occurrence of hepatoblastoma and Hirschsprung disease has not been previously described. We have reported a case of a male patient born with ileal atresia, Hirschsprung disease and bilateral congenital cataract who was later diagnosed with hepatoblastoma.

calcifications and the enhancement pattern on computed tomography (CT) imaging, correlates with clinicopathologic features and outcomes of patients with gastroenteropancreatic neuroendocrine tumors. We sought to investigate whether these radiographic characteristics were prognostic among patients with neuroendocrine liver metastases (NELM) undergoing surgical resection. Methods: The preoperative contrast-enhanced CT scans of all patients who underwent resection of NELM at a single institution between 2000e2015 were retrospectively reviewed. The presence of calcifications was determined on non-contrast phase imaging. Enhancement on the arterial phase scan was categorized as hyperenhancing, hypoenhancing, or mixed. Relevant clinicopathologic characteristics as well as recurrence-free (RFS) and overall-survival (OS) were compared between groups. Results: Among 82 patients who underwent resection of NELM, 56 had available data on calcifications while 50 had data available on arterial enhancement patterns. Among all patients, median age was 58 (IQR 47-63) and the majority were female (N = 48, 58%). The most common primary tumor locations were pancreas (N = 25, 30%) and small bowel (N = 27, 33%). The most commonly performed procedures were right hepatectomy (N = 21, 28%) and bisegmentectomy (N = 14, 19%). Median tumor number was 3 (IQR 1e5), median Ki-67 was 5% (IQR 2%e10%), and median size of the largest liver metastases was 4.5 cm (IQR 2.8e7.7). Twelve (21%) patients had tumor calcifications. Among patients with and without calcifications there were no differences in demographics, clinicopathologic characteristics, RFS (p = 0.917) or OS (p=0.104). Arterial enhancement was hypoenhancing in 23 (47%), hyperenhancing in 9 (19%), and mixed in 16 (34%). Similarly, there were no differences between arterial enhancement groups in demographics, clinicopathologic characteristics, RFS (p = 0.303) or OS (p = 0.258). Conclusion: Radiographic characteristics on contrastenhanced CT are not associated with the outcomes of patients undergoing resection of NELM. Future investigations should evaluate the prognostic impact of functional neuroendocrine imaging.Background: Although MELD score is a reliable tool for estimating mortality in the waiting list, criteria for preoperative prediction of survival after liver transplantation (LT) are lacking. ALBI score was validated as a prognostic marker for hepatocellular carcinoma (HCC) patients undergoing transarterial chemoembolization, hepatic resection and sorafenib treatment but not for LT outcomes yet. This study aimed to evaluate ALBI score as a prognostic factor in LT. Methods: Single center analysis of patients undergoing LT between October 2001 and June 2017. Primary endpoint was overall post-LT mortality. Secondary endpoint was 90th day mortality. Results: Of all 301 patients included in this study, 185 (61.5%) were males. The mean age was 54.1 AE 11.3 years. Univariate and multivariate analyses revealed that ALBI grade 3 (HR = 1.836, 95%CI [IQR=1.154e2.921], p = 0.010), low serum al...