On August 20, Fernando died at home surrounded by his wife and lifetime mate, his children, and h... more On August 20, Fernando died at home surrounded by his wife and lifetime mate, his children, and his grandchildren. The ongoing pandemic prevented deeply shocked friends and colleagues from saying goodbye to him in the HI Chapel, as it should have been, and from accompanying his remains to his grave.
Objetivo: Buscar las variables mas intimamente relacionadas al desarrollo de recidivas locales (R... more Objetivo: Buscar las variables mas intimamente relacionadas al desarrollo de recidivas locales (RL) luego de resecciones por cancer del recto, para definir con mayor precision los grupos de pacientes que podrian beneficiarse con terapias adyuvantes. Material y metodos: Se estudiaron 292 pacientes operados entre 1980 y 1992 con resecciones potencialmente curativas, realizadas con la tecnica de la reseccion total del masorrecto y que fueron seguidos por un minimo de 36 meses. resecciones anteriores (RA): 232; operaciones de Miles: 54 y operaciones de Hartman: 6. Resultados: La incidencia global de RL fue 8,2 por ciento (24/292); 23 fueron pelvianas y 1 anastomotica. La incidencia por estadios TNM fue: T1-4, NO, MO: 6/191 (3,1 por ciento); T1-4, N1, MO: 4/49 (8,2 por ciento); T1-4 N2, MO: 9/36 (25,0 por ciento); T1-4, N3, MO: 5/16 (31,3 por ciento) p
PURPOSE: We updated an Uruguayan family with hereditary nonpolyposis colorectal cancer first desc... more PURPOSE: We updated an Uruguayan family with hereditary nonpolyposis colorectal cancer first described in 1977, incorporating knowledge of how thehMLH1 germline mutation has been established and shown to segregate in accord with the expected ...
This study was designed to assess the prognostic value of the lymph node ratio in patients with c... more This study was designed to assess the prognostic value of the lymph node ratio in patients with colon cancer treated by colorectal specialists.
A study of the fundamental principles upon which manipulation dexterity is based cannot help mixi... more A study of the fundamental principles upon which manipulation dexterity is based cannot help mixing robotic and neurophysiological concepts. A preliminary step in this study consists of trying to understand the complexity of manipulation dynamics. Though complexity shows itself in the massive number of elements of kinematic and dynamic equations, the fundamental simplicity of the underlying mechanical laws suggests to look for a structure, particularly from the computational point of view. Accordingly, a working computational model is proposed that organizes the massive computational load into a structure which is composed of a small number of computational units and lends itself to parallel computation.
A postoperative enterocutaneous fistula is one of the most complex medical problems. Its treatmen... more A postoperative enterocutaneous fistula is one of the most complex medical problems. Its treatment may become long-lasting, wearisome, and its outcome often is disappointing. Here, we describe the use of a novel device to treat a 67-year-old patient with a postoperative, high-output enterocutaneous fistula. A semipermeable barrier was created over the fistula by vacuum packing a synthetic, hydrophobic polymer covered with a self-adherent surgical sheet. To set up the system, we constructed a vacuum chamber equipped with precision instruments that supplied subatmospheric pressures between 350 and 450 mm Hg. The intestinal content was, thus, kept inside the lumen, restoring bowel transit and physiology. The fistula output was immediately reduced from a median of 800 ml/day (range, 400-1,600 ml/day), to a median of 10 ml/day (range, 0-250 ml/day), which was readily collected by the apparatus. Oral feeding was reinitiated while both parenteral nutrition and octreotide were withdrawn. No septic complications occurred, and the perifistular skin stayed protected from irritating intestinal effluents. Both the fistula orifice and the wound defect fully healed after 50 days of treatment. We believe this method may serve as a useful tool to treat selected cases of high-output enterocutaneous fistulas without the need for octreotide or parenteral nutrition.
... Autor: Vaccaro, Carlos A; Bonadeo, Fernando; Benati, Mario L; Ojea Quintana, Guillermo; Mulle... more ... Autor: Vaccaro, Carlos A; Bonadeo, Fernando; Benati, Mario L; Ojea Quintana, Guillermo; Mullen, Eduardo; Bono, Diego; Trinchero, Lady. ... De acuerdo a Gabriel-Dukes los grupos C1 y C2 tuvieron índices de sobrevidas del 60,2 por ciento y 45,1 por ciento respectivamente (p ...
PURPOSE: The first Argentine experience with epidemiologic, molecular, and genetic counseling dat... more PURPOSE: The first Argentine experience with epidemiologic, molecular, and genetic counseling data is reported. METHODS: We analyzed 43 families fulfilling Amsterdam criteria identified from a prospective database with data from 779 relatives. RESULTS: Eleven families (25.6 percent) presented as Lynch I, 29 (67.4 percent) as Lynch II, and 3 (7 percent) as Muir-Torre syndrome. Among the 306 affected members, 197 cases of colorectal cancer were identified (mean age at diagnosis, 52.1 (range, 21-90) years). The most frequent extracolonic tumors were gastric adenocarcinoma in males and endometrium adenocarcinoma in females. A high incidence of breast cancer was observed (16 cases among 155 females, crude rate: 11,594.20/100,000). Twenty-seven patients (8.8 percent) developed more than one tumor. These patients were younger than those with only one tumor (45 vs. 51 years; P=0.001). In 5 of 11 patients who underwent molecular sequencing, a pathologic mutation was found. A novel C deletion at 1910 nucleotide, codon 637, exon 12 of MSH2 gene was identified in a family with a strong aggregation of breast cancer with lack of MSH2 immunohistochemical staining. For 78.2 percent of counseled individuals, this session represented the first time they received information, and 73.9 percent stated that their physicians were unaware of their family background. CONCLUSIONS: Argentine families presented a high incidence of stomach cancer. The elevated incidence of breast cancer and its association with a novel hMSH2 mutation bring to consideration the inclusion of this malignancy as part of the syndrome. A lack of awareness by both physicians and persons at risk was observed. [
Resumo: Objetivo: Analizar los resultados de las resecciones simultáneas colónicas y hepáticas po... more Resumo: Objetivo: Analizar los resultados de las resecciones simultáneas colónicas y hepáticas por cáncer colorrectal. Diseño: Entre junio 1982 y julio de 2003, en 750 pacientes se realizaron resecciones hepáticas de las cuales 138 fueron simultáneas con ...
Resumo: Objetivo: Analizar los resultados post-operatorios ya largo plazo con la resección local ... more Resumo: Objetivo: Analizar los resultados post-operatorios ya largo plazo con la resección local transanal como tratamiento curativo del cáncer de recto. Material y Métodos: Entre enero de 1981 y enero de 2002, excluyendo los casos con pólipos sésiles o pediculados ...
Current American Joint Committee on Cancer and the Union Internationale Contre le Cancer TNM clas... more Current American Joint Committee on Cancer and the Union Internationale Contre le Cancer TNM classification disregards location of positive nodes, discontinuing N3 category, which constitutes a major modification to 1987 version. This study was designed to assess the impact of the recategorization of former N3 cases and the reliability of the current N1-N2 subcategorization of Stage III patients. Prospectively collected data from 1,391 patients (55.8 percent males; median age, 64 (range, 21-97) years), operated on with curative intent between 1980 and 1999, were analyzed. The median follow-up was 60 (interquartile range, 27-97) months with 129 cases lost to follow-up. Of positive node cases, 25.3 percent were former N3. Among them, 30.5 percent migrated to the N1 group and 69.5 percent to the N2 group. The proportions of former N3 cases in N1 and N2 groups were 12.5 percent and 46.1 percent, respectively (P<0.001). Node-positive patients had an actuarial five-year survival rate of 56.7 percent (95 percent confidence interval, 53-59), with a significant difference between N1/N2 categories (63.6 vs. 44.1 percent, respectively; P<0.001). Although apical node involvement and more than three positive nodes were associated with poorer outcomes in univariate analysis, only the number of positive nodes had independent association (hazard ratio, 1.6 (range, 1.2-2.2); P<0.001). Integration of former N3 cases did not modify outcomes. The recategorization of former N3 involved a high proportion of positive node cases. Current N1/N2 categories clearly defined different outcomes and were not modified by the integration of former N3.
... Diagnosis and Management for Nurses Emma L. Kurnat-Thoma, MS, RN ... I will use the term HNPC... more ... Diagnosis and Management for Nurses Emma L. Kurnat-Thoma, MS, RN ... I will use the term HNPCC in this article because of its widespread clinical acceptance. However, using the term Lynch syndrome may be less misleading (Umar, Boland, et al., 2004). ...
BACKGROUND: Our goal was to analyze the results of resection of colorectal cancer and liver metas... more BACKGROUND: Our goal was to analyze the results of resection of colorectal cancer and liver metastases in one procedure. STUDY DESIGN: Between June 1982 and July 1998, 522 patients underwent liver resection for colorectal metastases. Liver resection was performed simultaneously with colorectal resection in 71 cases, representing the population in this study. Morbidity, mortality, overall survival, and disease-free survival times were analyzed. Median followup time was 29 months (range 6 to 162 months). Prognostic factors and their influence on outcomes were analyzed.
On August 20, Fernando died at home surrounded by his wife and lifetime mate, his children, and h... more On August 20, Fernando died at home surrounded by his wife and lifetime mate, his children, and his grandchildren. The ongoing pandemic prevented deeply shocked friends and colleagues from saying goodbye to him in the HI Chapel, as it should have been, and from accompanying his remains to his grave.
Objetivo: Buscar las variables mas intimamente relacionadas al desarrollo de recidivas locales (R... more Objetivo: Buscar las variables mas intimamente relacionadas al desarrollo de recidivas locales (RL) luego de resecciones por cancer del recto, para definir con mayor precision los grupos de pacientes que podrian beneficiarse con terapias adyuvantes. Material y metodos: Se estudiaron 292 pacientes operados entre 1980 y 1992 con resecciones potencialmente curativas, realizadas con la tecnica de la reseccion total del masorrecto y que fueron seguidos por un minimo de 36 meses. resecciones anteriores (RA): 232; operaciones de Miles: 54 y operaciones de Hartman: 6. Resultados: La incidencia global de RL fue 8,2 por ciento (24/292); 23 fueron pelvianas y 1 anastomotica. La incidencia por estadios TNM fue: T1-4, NO, MO: 6/191 (3,1 por ciento); T1-4, N1, MO: 4/49 (8,2 por ciento); T1-4 N2, MO: 9/36 (25,0 por ciento); T1-4, N3, MO: 5/16 (31,3 por ciento) p
PURPOSE: We updated an Uruguayan family with hereditary nonpolyposis colorectal cancer first desc... more PURPOSE: We updated an Uruguayan family with hereditary nonpolyposis colorectal cancer first described in 1977, incorporating knowledge of how thehMLH1 germline mutation has been established and shown to segregate in accord with the expected ...
This study was designed to assess the prognostic value of the lymph node ratio in patients with c... more This study was designed to assess the prognostic value of the lymph node ratio in patients with colon cancer treated by colorectal specialists.
A study of the fundamental principles upon which manipulation dexterity is based cannot help mixi... more A study of the fundamental principles upon which manipulation dexterity is based cannot help mixing robotic and neurophysiological concepts. A preliminary step in this study consists of trying to understand the complexity of manipulation dynamics. Though complexity shows itself in the massive number of elements of kinematic and dynamic equations, the fundamental simplicity of the underlying mechanical laws suggests to look for a structure, particularly from the computational point of view. Accordingly, a working computational model is proposed that organizes the massive computational load into a structure which is composed of a small number of computational units and lends itself to parallel computation.
A postoperative enterocutaneous fistula is one of the most complex medical problems. Its treatmen... more A postoperative enterocutaneous fistula is one of the most complex medical problems. Its treatment may become long-lasting, wearisome, and its outcome often is disappointing. Here, we describe the use of a novel device to treat a 67-year-old patient with a postoperative, high-output enterocutaneous fistula. A semipermeable barrier was created over the fistula by vacuum packing a synthetic, hydrophobic polymer covered with a self-adherent surgical sheet. To set up the system, we constructed a vacuum chamber equipped with precision instruments that supplied subatmospheric pressures between 350 and 450 mm Hg. The intestinal content was, thus, kept inside the lumen, restoring bowel transit and physiology. The fistula output was immediately reduced from a median of 800 ml/day (range, 400-1,600 ml/day), to a median of 10 ml/day (range, 0-250 ml/day), which was readily collected by the apparatus. Oral feeding was reinitiated while both parenteral nutrition and octreotide were withdrawn. No septic complications occurred, and the perifistular skin stayed protected from irritating intestinal effluents. Both the fistula orifice and the wound defect fully healed after 50 days of treatment. We believe this method may serve as a useful tool to treat selected cases of high-output enterocutaneous fistulas without the need for octreotide or parenteral nutrition.
... Autor: Vaccaro, Carlos A; Bonadeo, Fernando; Benati, Mario L; Ojea Quintana, Guillermo; Mulle... more ... Autor: Vaccaro, Carlos A; Bonadeo, Fernando; Benati, Mario L; Ojea Quintana, Guillermo; Mullen, Eduardo; Bono, Diego; Trinchero, Lady. ... De acuerdo a Gabriel-Dukes los grupos C1 y C2 tuvieron índices de sobrevidas del 60,2 por ciento y 45,1 por ciento respectivamente (p ...
PURPOSE: The first Argentine experience with epidemiologic, molecular, and genetic counseling dat... more PURPOSE: The first Argentine experience with epidemiologic, molecular, and genetic counseling data is reported. METHODS: We analyzed 43 families fulfilling Amsterdam criteria identified from a prospective database with data from 779 relatives. RESULTS: Eleven families (25.6 percent) presented as Lynch I, 29 (67.4 percent) as Lynch II, and 3 (7 percent) as Muir-Torre syndrome. Among the 306 affected members, 197 cases of colorectal cancer were identified (mean age at diagnosis, 52.1 (range, 21-90) years). The most frequent extracolonic tumors were gastric adenocarcinoma in males and endometrium adenocarcinoma in females. A high incidence of breast cancer was observed (16 cases among 155 females, crude rate: 11,594.20/100,000). Twenty-seven patients (8.8 percent) developed more than one tumor. These patients were younger than those with only one tumor (45 vs. 51 years; P=0.001). In 5 of 11 patients who underwent molecular sequencing, a pathologic mutation was found. A novel C deletion at 1910 nucleotide, codon 637, exon 12 of MSH2 gene was identified in a family with a strong aggregation of breast cancer with lack of MSH2 immunohistochemical staining. For 78.2 percent of counseled individuals, this session represented the first time they received information, and 73.9 percent stated that their physicians were unaware of their family background. CONCLUSIONS: Argentine families presented a high incidence of stomach cancer. The elevated incidence of breast cancer and its association with a novel hMSH2 mutation bring to consideration the inclusion of this malignancy as part of the syndrome. A lack of awareness by both physicians and persons at risk was observed. [
Resumo: Objetivo: Analizar los resultados de las resecciones simultáneas colónicas y hepáticas po... more Resumo: Objetivo: Analizar los resultados de las resecciones simultáneas colónicas y hepáticas por cáncer colorrectal. Diseño: Entre junio 1982 y julio de 2003, en 750 pacientes se realizaron resecciones hepáticas de las cuales 138 fueron simultáneas con ...
Resumo: Objetivo: Analizar los resultados post-operatorios ya largo plazo con la resección local ... more Resumo: Objetivo: Analizar los resultados post-operatorios ya largo plazo con la resección local transanal como tratamiento curativo del cáncer de recto. Material y Métodos: Entre enero de 1981 y enero de 2002, excluyendo los casos con pólipos sésiles o pediculados ...
Current American Joint Committee on Cancer and the Union Internationale Contre le Cancer TNM clas... more Current American Joint Committee on Cancer and the Union Internationale Contre le Cancer TNM classification disregards location of positive nodes, discontinuing N3 category, which constitutes a major modification to 1987 version. This study was designed to assess the impact of the recategorization of former N3 cases and the reliability of the current N1-N2 subcategorization of Stage III patients. Prospectively collected data from 1,391 patients (55.8 percent males; median age, 64 (range, 21-97) years), operated on with curative intent between 1980 and 1999, were analyzed. The median follow-up was 60 (interquartile range, 27-97) months with 129 cases lost to follow-up. Of positive node cases, 25.3 percent were former N3. Among them, 30.5 percent migrated to the N1 group and 69.5 percent to the N2 group. The proportions of former N3 cases in N1 and N2 groups were 12.5 percent and 46.1 percent, respectively (P<0.001). Node-positive patients had an actuarial five-year survival rate of 56.7 percent (95 percent confidence interval, 53-59), with a significant difference between N1/N2 categories (63.6 vs. 44.1 percent, respectively; P<0.001). Although apical node involvement and more than three positive nodes were associated with poorer outcomes in univariate analysis, only the number of positive nodes had independent association (hazard ratio, 1.6 (range, 1.2-2.2); P<0.001). Integration of former N3 cases did not modify outcomes. The recategorization of former N3 involved a high proportion of positive node cases. Current N1/N2 categories clearly defined different outcomes and were not modified by the integration of former N3.
... Diagnosis and Management for Nurses Emma L. Kurnat-Thoma, MS, RN ... I will use the term HNPC... more ... Diagnosis and Management for Nurses Emma L. Kurnat-Thoma, MS, RN ... I will use the term HNPCC in this article because of its widespread clinical acceptance. However, using the term Lynch syndrome may be less misleading (Umar, Boland, et al., 2004). ...
BACKGROUND: Our goal was to analyze the results of resection of colorectal cancer and liver metas... more BACKGROUND: Our goal was to analyze the results of resection of colorectal cancer and liver metastases in one procedure. STUDY DESIGN: Between June 1982 and July 1998, 522 patients underwent liver resection for colorectal metastases. Liver resection was performed simultaneously with colorectal resection in 71 cases, representing the population in this study. Morbidity, mortality, overall survival, and disease-free survival times were analyzed. Median followup time was 29 months (range 6 to 162 months). Prognostic factors and their influence on outcomes were analyzed.
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