The influence of hepatic function on prostate cancer outcomes after radical prostatectomy.

Prostate growth is dependent on circulating androgens, which can be influenced by hepatic function. Liver disease has been suggested to influence prostate cancer (CaP) incidence. However, the effect of hepatic function on CaP outcomes has not been investigated. A total of 1181 patients who underwent radical prostatectomy (RP) between 1988 and 2008 at four Veterans Affairs hospitals that comprise the Shared Equal Access Regional Cancer Hospital database and had available liver function test (LFT) data were included in the study. Independent associations of LFTs with unfavorable pathological features and biochemical recurrence were determined using logistic and Cox regression analyses. Serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) levels were elevated in 8.2 and 4.4% of patients, respectively. After controlling for CaP features, logistic regression revealed a significant association between SGOT levels and pathological Gleason sum > or =7(4+3) cancer (odds ratio=2.12; 95% confidence interval=1.11-4.05; P=0.02). Mild hepatic dysfunction was significantly associated with adverse CaP grade, but was not significantly associated with other adverse pathological features or biochemical recurrence in a cohort of men undergoing RP. The effect of moderate-to-severe liver disease on disease outcomes in CaP patients managed non-surgically remains to be investigated.

Adjuvant portal-vein infusion of fluorouracil and heparin in colorectal cancer: A randomised trial

Background. There is conflicting evidence on the efficacy of regional adjuvant chemotherapy, via portal-vein infusion (PVI), after resection of colorectal cancer. We undertook a randomised controlled multicentre trial to investigate the efficacy of PVI (500 mg/m2 fluorouracil plus 5000 IU heparin daily for 7 days). Methods. 1235 of about 1500 potentially eligible patients were randomly assigned surgery plus PVI or surgery alone (control). The patients were followed up for a median of 63 months, with yearly screening for recurrent disease. The primary endpoint was survival; analyses were by intention to treat. Findings. 619 patients in the control group and 616 in the PVI group met eligibility criteria. 164 (26%) control-group patients and 173 (28%) PVI-group patients died. 5-year survival did not differ significantly between the groups (73 vs 72%; 95% CI for difference -6 to 4). The control and PVI groups were also similar in terms of disease-free survival at 5 years (67 vs 65%) and the number of patients with liver metastases (79 vs 77%). Interpretation. PVI of fluorouracil, at a dose of 500 mg/m2 for 7 days, cannot be recommended as the sole adjuvant treatment for high-risk colorectal cancer after complete surgical excision. However, these results cannot eliminate a small benefit when PVI is used at a higher dosage or in combination with mitomycin.

Laparoscopic Appendectomy in Italy: An Appraisal of 26,863 Cases

Objective: To evaluate the practice of laparoscopic appendectomy (LA) in Italy. Methods: On behalf of the Italian Society of Young Surgeons (SPIGC), an audit of LA was carried out through a written questionnaire sent to 800 institutions in Italy. The questions concerned the diffusion of laparoscopic surgery and LA over the period 1990 through 2001, surgery-related morbidity and mortality rates, indications for LA, the diagnostic algorithm adopted prior to surgery, and use of LA among young surgeons (<40 years). Results: A total of 182 institutions (22.7%) participated in the current audit, and accounted for a total number of 26863 LA. Laparoscopic surgery is performed in 173 (95%) institutions, with 144 (83.2%) routinely performing LA. The mean interval from introduction of laparoscopic surgery to inception of LA was 3.4 ± 2.5 years. There was an emergent basis for 8809 (32.8%) LA procedures (<6 hours of admission); 10314 (38.4%) procedures were performed on an urgent basis (<24 hours of admission); while 7740 (28.8%) procedures were elective. The conversion rate was 2.1% (561 cases) and was due to intraoperative complications in 197 cases (35.1%). Intraoperative complications ranged as high as 0.32%, while postoperative complications were reported in 1.2% of successfully completed LA. The mean hospital stay for successfully completed LA was 2.5 ± 1.05 days. The highest rate of intraoperative complications was reported as occurring during the learning curve phase of their experience (in their first 10 procedures) by 39.7% of the surgeons. LA was indicated for every case of suspected acute appendiceal disease by 51.8% of surgeons, and 44.8% order abdominal ultrasound (US) prior to surgery. A gynecologic counseling is deemed necessary only by 34.5% surgeons, while an abdominal CT scan is required only by 1.5%. The procedure is completed laparoscopically in the absence of gross appendiceal inflammation by 83%; 79.8% try to complete the procedure laparoscopically in the presence of concomitant disease; while 10.4% convert to open surgery in cases of suspected malignancy. Of responding surgeons aged under 40, 76.3% can perform LA, compared to 47.3% surgeons of all age categories. Conclusions: The low response rate of the present survey does not allow us to assess the diffusion of LA in Italy, but rather to appraise its practice in centers routinely performing laparoscopic surgery. In the hands of experienced surgeons, LA has morbidity rates comparable to those of international series. The higher diagnostic yield of laparoscopy makes it an invaluable tool in the management algorithm of women of childbearing age; its advantages in the presence of severe peritonitis are less clear-cut. Surgeons remain the main limiting factor preventing a wider diffusion of LA in our country, since only 47.3% of surgeons from the audited institutions can perform LA on a routine basis.

Efectos de tratamientos de presiembra sobre el comportamiento a campo de semillas de zanahoria y pimiento

p.173-181

Determinación por computadora del tamaño de muestra y potencia estadística en ensayos agropecuarios

p.173-191

Eficiencia de selección en planteles ovinos

p.165-173

Potasio en algunos suelos argentinos : II- extractantes y ensayo de Neubauer

p.173-179

Prácticas cooperativas en campesinos formoseños : problemas y alternativas

p.173-186

Estimación de actitudes hacia el riesgo

p.173-180

Dinámica de la vegetación en áreas pastoreadas del extremo austral de la provincia fitogeográfica del monte

p.173

Razonamiento inductivo de 12 alumnos de secundaria en la resolución de un problema matemático

En este trabajo se presenta el resultado obtenido del análisis de un proceso de razonamiento inductivo desarrollado por 12 estudiantes de secundaria en un contexto de resolución de problemas. Se plantea un problema, en el transcurso de una entrevista, que consiste en determinar el número máximo de regiones que se obtienen al trazar rectas sobre un plano. Durante la resolución del problema los estudiantes, y a través del dialogo con el entrevistador, han de explicar y justificar sus decisiones. Centrándonos en el trabajo de Pólya y en otras investigaciones previas relacionadas sobre este tema, se define un sistema de categorías mediante las cuales se organizan los datos para su análisis.

Influencia de la estructura y del contexto en las dificultades de los problemas de probabilidad condicional de nivel N0. Un estudio exploratorio con estudiantes sin enseñanza previa

Partiendo de las resoluciones de 165 estudiantes de 4º de las ESO (15-16 años), hablamos sobre las dificultades de un tipo particular de problemas (problemas de nivel N0) y las relacionamos con su estructura y con el contexto en el que están formulados. Mostramos como, en efecto, es posible hablar de la influencia del contexto, principalmente sobre la dificultad de la solución del problema, y de una influencia significativa de la estructura sobre otras dos de las dificultades consideradas en este estudio: la dificultad apreciada del problema y la dificultad del problema.

Esquemas lógico-matemáticos en juicios bajo incerteza

Los esquemas lógico-matemáticos desarrollados durante el crecimiento y formación dentro de un sistema educativo podrían influir y marcar cierta evolución sobre los sesgos del pensamiento probabilístico de los estudiantes, aun cuando éstos no reciban instrucción formal en probabilidades. Esta investigación ha sido realizada con 152 estudiantes de nivel medio entre 13 y 17 años. Los objetivos de la misma han sido: (a) identificar y analizar la influencia de esquemas lógico-matemáticos sobre sesgos intuitivos en juicios bajo incerteza cuando no existe conocimiento probabilístico formal y (b) analizar la evolución etaria de estos procesos. La metodología utilizada es mixta. Los instrumentos han sido cuestionarios con preguntas orientadas a la detección de algunos sesgos intuitivos y los esquemas actuantes.

A multi-scale numerical modelling of crack propagation in a 2D metallic plate

A new multi-scale model of brittle fracture growth in an Ag plate with macroscopic dimensions is proposed in which the crack propagation is identified with the stochastic drift-diffusion motion of the crack-tip atom through the material. The model couples molecular dynamics simulations, based on many-body interatomic potentials, with the continuum-based theories of fracture mechanics. The Ito stochastic differential equation is used to advance the tip position on a macroscopic scale before each nano-scale simulation is performed. Well-known crack characteristics, such as the roughening transitions of the crack surfaces, as well as the macroscopic crack trajectories are obtained.