[Tumor invasion in gallbladder cancer. Importance of blood vascular tumor infiltration diagnosis]
Roa I. Guzman P. Araya JC. Villaseca M. Roa JC. Ibacache G. de Aretxabala X. Garcia M.
Hospital Temuco, Facultad de Medicina, Universidad de la Frontera, Temuco, Chile.
BACKGROUND: The infiltration of venous blood vessels in gallbladder carcinoma and its importance as a prognostic factor has not been well studied. Victoria blue stain has been used to identify vascular involvement in gastric and thyroidal carcinomas. AIM: To assess blood vessel infiltration using Victoria blue stain in gallbladder carcinomas. MATERIAL AND METHODS: One hundred forty eight samples of gallbladder carcinomas, coming from 24 men and 123 women aged 60.4 +/- 12.2 years old, were studied. They were stained with Victoria blue stain to quantify blood vessel invasion. RESULTS: Twenty nine percent of tumors had blood vessel infiltration, 61% had lymph vessel and 20% had perineural infiltration. Lymph vessel or perineural involvement was found in 81% and 31% of those tumors with blood vessel infiltration, respectively. Perineural infiltration was associated with lymph or vascular involvement in 93 and 40% of tumors, respectively. None of the early carcinomas had blood vessel infiltration, whereas 33% of advanced tumors had this type of infiltration (p < 0.001). No differences in vascular infiltration were observed according to the differentiation of the tumor. CONCLUSIONS: Blood vessel infiltration was observed only in advanced gallbladder carcinomas and was tightly related to the degree of gallbladder wall infiltration. The presence of perineural infiltration was the best marker of lymph or blood vessel infiltration.
[Negative appendectomy: experience at a university hospital]
Espinoza R. Ohmke J. Garcia-Huidobro I. Guzman S. Azocar M.
Departamento de Cirugia Digestiva, Hospital Clinico, P Universidad Catolica, Santiago, Chile.
BACKGROUND: Acute appendicitis still constitutes a difficult diagnostic problem. AIM: To assess the experience of an University Hospital in the diagnosis of acute appendicitis and to determine the rates of negative appendectomies. PATIENTS AND METHODS: The charts of 1,075 patients operated with the diagnosis of acute appendicitis, between 1993 and 1995, were retrospectively reviewed. All resected appendices were pathologically examined. Those cases in whom pathology did not confirm the clinical diagnosis were considered as a negative appendectomy. RESULTS: There was a 12.2% rate of negative appendectomies (18.9% in women and 6.2% in men). The difference between sexes disappears in patients over 40 years old. In 49% of patients, no abnormality was detected during the laparotomy. The most frequent differential diagnosis were gynecological illnesses or diseases of the colon. DISCUSSION: The rate of negative appendectomies can be reduced with a close clinical observation of patients during their hospitalization and the judicious use of diagnostic laparoscopy.
[Neuroradiological findings in 2 cases of Wilson disease with neurological involvement]
Troncoso M. Badilla L. Bravo E. Miranda M. Gajewski C. Barrios A. Villagra R.
Servicio de Neurologia Infantil, Hospital Clinico San Borja Arriaran, Santiago-Chile.
Wilson disease is an inborn error of copper metabolism that has neurological and hepatic manifestations. We report a 13 years old girl and a 12 years old boy with Wilson disease. In both patient, brain computed tomography and magnetic resonance imaging showed marked involvement of basal ganglia and other deep gray nuclei. Considering that this is a treatable disease, it should be included in the differential diagnosis of the so called "striatal necrosis of childhood".