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Biomedical subjects

Heriberto Medina-Franco

Publications and source records attributed to Heriberto Medina-Franco.

At least 19 recordsLinked to original sources
PubMed2006

Molgramostim (GM-CSF) associated with antibiotic treatment in nontraumatic abdominal sepsis: a randomized, double-blind, placebo-controlled clinical trial.

HYPOTHESIS: The addition of molgramostim (recombinant human granulocyte-macrophage colony-stimulating factor) to antibiotic therapy for nontraumatic and generalized abdominal sepsis is effective and has a significant impact on length of hospitalization, direct medical costs, and mortality. DESIGN: Randomized, double-blind, placebo-controlled clinical trial. SETTING: Tertiary referral center. PATIENTS: Fifty-eight patients with abdominal sepsis. INTERVENTIONS: Patients were allocated to receive, in addition to ceftriaxone sodium, amikacin sulfate, and metronidazole, molgramostim in a daily dosage of 3 microg/kg for 4 days (group 1) or placebo (group 2). Antibiotics were administered for at least 5 days and discontinued after clinical improvement had occurred and white blood cell count had been normal for 48 hours. MAIN OUTCOME MEASURES: Time to improvement, duration of antibiotic therapy, hospital stay, complications, mortality, and adverse reactions to drugs. RESULTS: Median time to improvement was 2 days in group 1 and 4 days in group 2 (P<.005). Median length of hospitalization was 9 and 13 days, respectively (P<.001), and median duration of antibiotic therapy was 9 and 13 days, respectively (P<.001). Numbers of infectious complications in the 2 groups were, respectively, 6 and 16 (P = .02); of residual abscesses, 3 and 5; and of deaths, 2 and 2. Costs per patient were 12,333 dollars and 16,081 dollars (US dollars), respectively. CONCLUSION: Addition of molgramostim to antibiotic therapy reduces the rate of infectious complications, the length of hospitalization, and costs in patients with nontraumatic abdominal sepsis.

Adolescent↗
PubMed2006

[Gastric cancer].

Explore the source record for details and available documents.

Clinical Trials as Topic↗
PubMed2005

Adrenocortical carcinoma: a single institution experience.

Adrenocortical carcinoma (ADCC) ranks among the least common malignant endocrine tumors. Surgical resection is considered the most important treatment for this neoplasm. Medical records of patients with the diagnosis of ADCC between 1990 and 2000 were reviewed. Patient and pathologic factors were analyzed with overall survival as the primary endpoint. Statistical analysis was performed by the method of Kaplan-Meier. There were a total of 17 patients, with a mean age of 56 years. Twelve per cent presented as an asymptomatic mass, 41 per cent as a functional tumor, and 47 per cent as a nonfunctioning tumor. Primary treatment was surgical resection in 71 per cent. There was no operative mortality and one complication. Seven patients presented with stage II, five with stage III, four with stage IV, and in one could not be determined. Median follow-up was 12.8 months, median survival 67, 13, and 3 months for stages II, III, and IV, respectively. Older age, distant metastasis, nonoperative management, positive margins, advanced tumor stage, and venous invasion were significantly associated with worse overall actuarial survival. Survival for ADCC is poor. Factors associated with a worse prognosis were stage of disease, nonoperative management, positive surgical margins, vascular invasion, and older age.

Adrenal Cortex Neoplasms↗
PubMed2004

Surgery for stage IV gastric cancer.

BACKGROUND: Surgical treatment for stage IV gastric cancer is controversial. METHODS: We analyzed the surgical experience with advanced gastric carcinoma in a tertiary referral center in Mexico City from 1995 through 2000. We analyzed surgical morbidity, mortality, and factors associated with prognosis. Survival was analyzed with the Kaplan-Meier method, and the curves were compared with the log-rank test. Significance was assigned at P <0.05. RESULTS: Seventy-six cases were identified. Mean patient age was 56 +/- 14.5 years. Thirty-nine patients (51.3%) were women. Patients were grouped according to surgical procedure: group 1 underwent resection (40 patients), group 2 underwent bypass procedures (10 patients), and group 3 underwent either celiotomy and biopsy alone or jejunostomy placement (26 patients). Twenty patients (26%) developed operative complications, but most were minor. There was no difference in morbidity between surgical groups and no difference according to patient's age. Operative mortality was 2.6%. Good palliation of symptoms was significantly more common in group 1 patients (82%) than in group 2 patients (60%) (P = 0.0001). Median survival was 8 months (95% confidence interval 4 to 12) for the entire cohort and 13, 5, and 3 months for groups 1, 2, and 3, respectively (P = 0.00001 for group 1 vs groups 2 and 3). CONCLUSIONS: Surgical resection for stage IV gastric cancer can be done with low operative mortality and acceptable morbidity rates, and it provides patients with good symptomatic relief. Advanced patient age is not a contraindication for surgical treatment.

Adenocarcinoma↗
PubMed2004

Anorectal melanoma: report of three cases with extended follow-up.

Primary anorectal melanoma is rare. There is controversy regarding the best surgical treatment because of its poor prognosis. Three cases with extended follow-up are reported in this article. A 53-year-old woman with rectal bleeding was diagnosed with a melanoma of the rectum and underwent an abdominoperineal resection. The patient died with distant metastases 8 months later. An 80-year-old woman with rectal bleeding was diagnosed with a melanoma of the rectum and underwent a transanal local excision. She remains alive 4 years later but with locally recurrent disease. A 78-year-old man with rectal bleeding was diagnosed with a melanoma of the rectum and underwent an abdominoperineal resection. He died with local and metastatic disease 25 months later. Recent trends favor local excision when technically feasible, although some patients may require an abdominoperineal resection of the rectum, especially for larger tumors.

Aged↗
PubMed2004

[Intestinal occlusion in cancer].

OBJECTIVE: To perform a review of the literature about the management of bowel obstruction in advanced cancer. BACKGROUND: Bowel obstruction is a common problem, mainly in patients with advanced colorectal or ovarian cancer. The management of this group of patients is complex and controversial. METHODS: A review of the English and Spanish literature about the clinical picture, diagnosis and management of bowel obstruction in advanced cancer was performed. RESULTS: Bowel obstruction is a common and distressing outcome in patients with abdominal or pelvic cancer. Patients may develop bowel obstruction at any time in their clinical history, with a prevalence ranking from 5.5 to 51% in those with ovarian cancer and from 10% to 28% in those with colorectal cancer. The causes of the obstruction may be benign postoperative adhesions, a focal malignant or benign deposit, or relapse or diffuse carcinomatosis. The symptoms, which are almost always present, are intestinal colic, continuous abdominal pain, nausea or vomiting. Although surgery should be the primary treatment for malignant obstruction, it is now recognized that some patients with advanced disease or in generally poor condition are unfit for surgery and require alternative management to relieve distressing symptoms. A number of treatment options are now available for the patient with advanced cancer who develops intestinal obstruction. CONCLUSIONS: Bowel obstruction in cancer patients is a common and difficult problem. Patients must be selected for surgery or palliative treatment of their symptoms based on their clinical status.

Humans↗
PubMed2003

Primitive neuroectodermal tumor of the vagina.

OBJECTIVES: Primitive neuroectodermal tumor is grouped together with Ewing sarcoma of the bone, but its presentation includes a wider age range and more central locations than its osseous counterpart. Presentation in vagina is exceedingly rare. CASE: A 34-year-old woman with personal history of kidney transplant presented with a painless vaginal mass. After surgical excision, pathology results demonstrated a primitive neuroectodermal tumor. Chemotherapy was given, followed by external beam and vaginal intracavitary brachytherapy. After 20 months postexcision, there is no clinical nor radiographic evidence of recurrence. CONCLUSIONS: This is the second case of primitive neuroectodermal tumor located in the vagina reported in the literature.

Adult↗
PubMed2003

Expression of p53 and proliferation index as prognostic factors in gastrointestinal sarcomas.

BACKGROUND: Sarcomas arising in the gastrointestinal (GI) tract are rare tumors. Molecular markers could be associated with prognosis in these types of tumors. METHODS: We performed a retrospective analysis of adult patients with sarcomas arising in the GI tract at the National Institute of Medical Sciences in Mexico City and the University of Alabama at Birmingham Hospital. All histological types were included. Patient, tumor, and treatment factors were analyzed, with overall survival as the main outcome variable. Expression of p53 and cellular proliferation antigen Ki-67 was also analyzed. Statistical analysis was performed by log-rank test and Cox regression. Significance was defined as P <.05. RESULTS: Forty-seven patients were analyzed. The median patient age was 53 years (range, 16-82 years). Twenty-five patients (53%) were women. The stomach was the most common site of presentation. The mean tumor size was 14 cm (2-45 cm). A complete resection was achieved in 40 patients. With a median follow-up of 30 months, the actuarial 3-year survival was 68%. Univariate analysis identified overexpression of p53 and Ki-67, high tumor grade, tumor size >10 cm, and incomplete resection as significant negative prognostic factors. Hispanic race and good performance status were significantly associated with prolonged survival. On multivariate analysis, overexpression of p53 was the only independent negative prognostic factor. CONCLUSIONS: Overexpression of p53 is the strongest predictor of poor prognosis in patients with sarcomas of the GI tract.

Adolescent↗
PubMed2002

Factors associated with local recurrence after skin-sparing mastectomy and immediate breast reconstruction for invasive breast cancer.

OBJECTIVE: To examine the incidence of local recurrence (LR) and factors associated with it in a population of patients who underwent skin-sparing mastectomy (SSM) and immediate reconstruction for invasive carcinoma. SUMMARY BACKGROUND DATA: The efficacy of SSM has been challenged by concerns about increased risks of LR. METHODS: A consecutive series of 173 patients (176 cancers) with invasive carcinoma underwent SSM and immediate breast reconstruction (June 1986 to December 1997). Data were analyzed by the Kaplan-Meier method, the log-rank statistic test, and the Cox proportional hazards model. RESULTS: Mean patient age was 47 +/- 9 years (27% were 40 or younger). The AJCC stages were 1 = 43%, 2 = 52%, and 3 = 5%. Thirty percent of tumors were poorly differentiated. With a median follow-up of 73 months, the LR rate was 4.5%. The mean local relapse-free interval was 26 months. Seventy-five percent of patients who presented with LR developed distant metastases and died of disease within a mean of 21 months. On univariate analysis, factors associated with higher LR rate were tumor stage 2 or 3, tumor size larger than 2 cm, node-positive disease, and poor tumor differentiation. Actuarial 1-, 3-, and 5-year overall survival rates were 98%, 94%, and 88%, respectively. On multivariate analysis, factors associated with decreased survival were advanced stage, presence of LR, and absence of hormone therapy. LR was a highly significant predictor of tumor-related death. CONCLUSIONS: There is a low incidence of LR after SSM, and it is associated with advanced disease at presentation. LR is an independent risk factor for tumor-related death.

Adult↗
PubMedDate not supplied

Clinicopathologic characteristics of gastric cancer in a young patient population.

The aim of this study was to analyze the clinicopathologic characteristics of young patients with gastric cancer with special attention to hereditary gastric cancer in a tertiary referral university hospital. Charts from all patients 40 years of age or younger at the time of diagnosis, during the period from January 1, 1987 to December 31, 2001, were retrospectively reviewed. Demographic variables, family history of gastric cancer, clinicopathologic characteristics, and treatment-related variables were analyzed. Overall survival was the main outcome variable. Survival curves were constructed by means of the Kaplan-Meier method, univariate analysis was performed with the log-rank test, and multivariate analysis with Cox regression. Significance was considered at P<0.05. During the study period, 558 cases of gastric cancer were seen at our institution, 83 (14.8%) were in patients 40 years of age or younger. Mean patient age was 33.2 years. Forty-five patients (54.2%) were male. Fourteen patients (16.9%) had a family history of gastric cancer. Five patients (6%) fulfilled the criteria of hereditary gastric cancer. Surgery was performed in 88% of patients, but only 35% of the operations had a curative intent. Operative mortality was 2.4%. On univariate analysis, advanced tumor stage, hypoalbuminemia, low performance status, diffuse type, pangastric tumor location, noncurative surgery, and lack of adjuvant chemotherapy had a significant negative impact on survival. On multivariate analysis, advanced tumor stage, pangastric tumor location, and absence of adjuvant chemotherapy were significantly associated with poor prognosis. Family history of gastric cancer or hereditary gastric cancer did not have any impact on prognosis. There is a high frequency of gastric cancer in young patients at our institution. Most patients present in advanced stages, which favors a poor overall survival. Family history of gastric cancer or hereditary gastric cancer did not have a significant impact on survival. Complete resection and adjuvant chemotherapy appeared to confer the only chance of prolonged survival.

Adenocarcinoma↗
PubMedDate not supplied

Occult breast carcinoma presenting with axillary lymph node metastases.

BACKGROUND AND OBJECTIVES: Occult primary breast carcinoma is uncommon. Most reported series encompass a large periods of time with great variability in diagnostic and treatment approaches. The objective of the present study was to review the recent experience with this type of presentation of breast cancer in the University of Alabama at Birmingham. METHODS: Retrospective review of clinicopathological data of female patients presenting with axillary metastasis of adenocarcinoma with unknown primary and normal clinical and mammographic breast exam seen at UAB between 1985 and 1998. RESULTS: Ten patients were identified. Mean age was 56 years. Sixty per cent were white and postmenopausal. All patients had biopsy proven adenocarcinoma consistent with breast primary. All but one patient underwent an axillary dissection. Nine out of ten patients received some type of local treatment to the breast. Three of them underwent mastectomy and no invasive carcinoma was demonstrated in the surgical specimens. Six patients received radiation therapy to the breast. All patients received chemotherapy. With mean follow-up time of 48 months, two patients developed local recurrence to the axilla and four developed distant metastasis and eventually died. At last follow-up six patients are alive with no evidence of disease. CONCLUSIONS: In presence of axillary metastasis from an unknown breast primary, an extensive work-up evaluation is not necessary. An axillary dissection is recommended to provide prognostic indicators as well as local control. A breast conservation approach seems to be feasible without affect the local control and survival.

Adenocarcinoma↗
PubMedDate not supplied

[Intussusception in adults. Case report with uncommon etiology and review of the literature].

OBJECTIVE: To present a case of adult intussusception with uncommon etiology. BACKGROUND: Intussusception is a relatively common cause of intestinal obstruction in children, but is a rare clinical entity in adults, representing less than one per cent of intestinal obstruction in this patient population. METHOD: We report on 72-year old female patient with intestinal obstruction due to ileocolic intussusception related to leiomyosarcoma of the terminal ileum. A synchronic adenocarcinoma in the cecum was identified. The patient underwent right hemicolectomy and terminal ileum resection with primary anastomosis. Her postoperative course was uneventful. The patient is free of all evidence of disease at 2 year of follow-up. A thorough review of the literature of adult intussusception was carried out. CONCLUSION: From this review, the recommendation is to resect all cases of adult intussusception, different from the recommended approach in pediatric population.

Adenocarcinoma↗
PubMedDate not supplied

[Biliary-colonic fistulas. Analysis of 2 cases and literature review].

BACKGROUND: Bilioenteric fistulas are entities whose etiology can be diverse. OBJECTIVE: The aim of this paper was to present two cases of biliary-colonic fistulas with different presentations and to review existing literature regarding etiology, diagnosis, and management of these patients. METHODS: Two cases of biliary-colonic fistulas were reviewed. RESULTS: Case 1. A 48-year-old woman presented with lower gastrointestinal bleeding secondary to cholecystocolonic fistula in context of cholelithiasis. Case 2. A 60-year-old woman with multiple hepatic abscess associated with biliary-colonic fistula secondary to adenocarcinoma of gallbladder. CONCLUSIONS: Biliary-colonic fistulas are recognized complications of cholelithiasis. Association with neoplasia is less frequent. Preoperative diagnosis is difficult and management must be surgical.

Biliary Fistula↗
PubMedDate not supplied

[Hereditary gastric cancer. Genetics and clinical management].

Recently, germline mutations in the E-cadherin/CDH1 gene have been identified in families with an autosomal-dominant inherited predisposition to gastric cancer of the diffuse type. Criteria to define familial gastric cancer syndromes have been proposed and include review of the histopathology and pedigree analysis of any family with an aggregation of gastric cancer cases. Of families with two or more cases of diffuse gastric cancer in first- or second-degree relatives < 50 years of age or three or more cases at any age, up to half may be attributable to inherited germline mutations in the E-cadherin/CDH1 gene. Cumulative lifetime risk of developing gastric cancer in CDH1 mutation carriers is 70%, women from these families also have increased risk for developing lobular breast cancer. Prophylactic gastrectomies have been performed in several unaffected CDH1 mutation carriers; despite normal endoscopic examinations and negative gastric biopsy specimens, pathologic foci of early gastric cancer were found in all surgical specimens. Based on these results, guidelines for genetic testing, counseling and management of individuals with hereditary diffuse gastric cancer have been proposed. Raised awareness among the physician community regarding this syndrome may allow for increased detection and prevention of gastric and breast cancers in these high-risk individuals.

Humans↗
PubMedDate not supplied

Resection of an esophageal metastasis from a renal cell carcinoma.

Surgery for patients with isolated metastases from renal cell carcinoma has been shown to improve survival. Isolated esophageal metastases are very uncommon among patients with renal cell carcinoma and there are no reports addressing the outcome of their resection. A 60-year-old woman who had previous history of renal cell carcinoma was admitted to the hospital with progressive dysphagia. Esophagography and endoscopy showed an esophageal tumor and biopsies were consistent with adenocarcinoma. No other site with tumor was identified on CT-scan. Resected specimen showed metastasis from renal cell carcinoma and the patient survived for an 11-month period. Although resection of metastatic renal cell carcinoma has been shown to improve long-term survival, the presence of esophageal metastases can be considered an adverse prognostic factor.

Carcinoma, Renal Cell↗