Cytoreduction and HIPEC in The Netherlands: Nationwide Long-term Outcome Following the Dutch Protocol

Purpose

This nationwide study evaluated results of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal metastasis of colorectal origin in the Netherlands following a national protocol.

Methods

In a multi-institutional study prospective databases of patients with peritoneal carcinomatosis (PC) from colorectal cancer and pseudomyxoma peritonei (PMP) treated according to the Dutch HIPEC protocol, a uniform approach for the CRS and HIPEC treatment, were reviewed. Primary end point was overall survival and secondary end points were surgical outcome and progression-free survival.

Results

Nine-hundred sixty patients were included; 660 patients (69 %) were affected by PC of colorectal carcinoma and the remaining suffered from PMP (31 %). In 767 procedures (80 %), macroscopic complete cytoreduction was achieved. Three-hundred and thirty one patients had grade III–V complications (34 %). Thirty-two patients died perioperatively (3 %). Median length of hospital stay was 16 days (range 0–166 days). Median follow-up period was 41 months (95 % confidence interval (CI), 36–46 months). Median progression-free survival was 15 months (95 % CI 13–17 months) for CRC patients and 53 months (95 % CI 40–66 months) for PMP patients. Overall median survival was 33 (95 % CI 28–38 months) months for CRC patients and 130 months (95 % CI 98–162 months) for PMP patients. Three- and five-year survival rates were 46 and 31 % respectively in case of CRC patients and 77 and 65 % respectively in case of PMP patients.

Conclusions

The results underline the safety and efficacy of cytoreduction and HIPEC for PC from CRC and PMP. It is assumed the uniform Dutch HIPEC protocol was beneficial.     

Influence of body size and age on maximal systolic velocity of mitral annulus motion.

The maximal systolic velocity of the mitral annulus motion (or maximal systolic long-axis contraction velocity of the ventricle, MLACV) has been suggested as a means to assess left ventricular function. However, reference values for a wide range of age and body size are lacking. The maximal systolic velocity was studied with M-mode echocardiography using the apical four- and two-chamber views. Data are reported as the average of the measurements of four sites of the mitral annulus. Fifty-seven healthy subjects aged 6 months to 72 years were studied. In children and adolescents up to age 18, MLACV had a significant positive correlation with age, height, body surface area, weight and mitral annulus motion amplitude and a significant negative correlation with heart rate. In adults, there was a significant positive correlation between MLACV and height, mitral annulus motion amplitude and body surface area and a significant negative correlation with age and heart rate. Multiple stepwise analysis showed that the maximal systolic velocity is highly dependent on height and age in children and adolescents up to age 18, and on height in adults. The maximal long-axis contraction velocity (MLACV) can be described by the following equations: MLACV (mm s-1) = 24.0 + 0.34 x height (cm) (Standard Error of the Estimate (SEE)=10.5) in children and adolescents, and MLACV (mm s-1) = -50.5 + 0.75 x height (cm) (SEE=9.8) in adults over 18. There were significant differences between the four sites, with the highest velocity at the lateral site and the lowest velocity at the septal site. No significant difference was found between inspiratory and expiratory beats.     

Ectopic eruption: presentation of a case with 90 percent rotation of an upper primary second molar

Ectopic eruption of the first permanent molar is a plaguing problem in pedriatric dentistry. This paper reviews the characteristics of ectopic eruption and in the last part reports a case with a 90% rotation of a second primary maxillary molar.     

Frontotemporal clear cell meningioma. Report of 3 cases

Clear cell meningioma (CCM) is an uncommon meningioma. Some cases have been reported, and the localization of most of them is the spinal region. We present 3 cases of CCMs in the frontotemporal lobes. All cases were postmenopausal women with a history of arterial hypertension and uterine leiomyomatosis. The radiologic appearance in 2 cases was similar to that of dural hematomas, and in 1 case, the imaging study was consistent with the diagnosis of meningioma. On histologic examination, there were sheets of glycogenated polygonal cells with abundant clear cytoplasm and round, uniform, bland appearing nuclei. Numerous hyalinized blood vessels and collagenous stroma with fibrillary appearance were present in 2 cases. They were immunoreactive to epithelial membrane antigen, epithelial cell adhesion molecule, and progesterone receptors. However, 2 cases showed weak and focal reaction to Her-2/neu. In our knowledge, some cases of CCMs have been reported and no immunoexpression has been noted with those markers used. These cases illustrate a rare variant of meningioma in the frontotemporal lobes and their immunohistochemical profiles. Differential diagnosis is discussed.     

Recent Sedimentary History of Organic Matter and Nutrient Accumulation in the Ohuira Lagoon,Northwestern Mexico

²¹⁰Pb-derived sediment accumulation rates, as well as a suite of geochemical proxies (Al, Fe, δ¹³C, δ¹⁵N), were used to assess the time-dependent variations of C, N, and P fluxes recorded in two sediment cores collected at Ohuira Lagoon, in the Gulf of California, Mexico, during the last 100 years. Sedimentary C, N, and P concentrations increased with time and were related to land clearing, water impoundment, and agriculture practices, such as fertilization. C:N:P ratios and δ¹³C suggested an estuarine system that is responsive to increased C loading from a N-limited phytoplankton community, whereas δ¹⁵N values showed the transition between an estuarine-terrestrial to an estuarine-more marine environment, as a consequence of the declining freshwater supply into the estuary due to the channeling and impoundment of El Fuerte River between 1900 and 1956. The recent increases in nutrient fluxes (2- to 9-fold the pre-anthropogenic fluxes of C and N, and 2 to 13 times for P) taking place in the mainland from the 1940s, were related to the expansion of the intensive agriculture fields and to the more recent development of shrimp farming activities.