The possibility of preoperative prediction of pathologic complete response in rectal cancer has been studied in order to identify patients who would respond to neoadjuvant therapy and to individualize therapeutic strategies. Endoscopic ultrasound of the rectum is an accurate method for the evaluation of local tumor and lymph node invasion. Objective: To evaluate the potential of endoscopic ultrasound as a predictor of complete pathological response to neoadjuvant treatment in patients with locally advanced rectal cancer. Material and methods: Retrospective study of patients with rectal cancer from January 2014 to December 2016. Results: We obtained a statistical association between T stage by endoscopic ultrasound and complete pathological response (p = 0.015). It is not so for N, sphincter involvement, circumferential involvement and maximum tumor thickness (p = 0.723, p = 0.510, p = 0.233 and p = 0.114, respectively). When multivariate logistic regression analysis was applied to assess the degree of influence of the predictor variables on pathologic response, none of these variables was associated with complete pathologic response. Conclusion: Prediction of pathologic complete response in rectal cancer has been considered as the crucial point upon which treatments for rectal cancer could be individualized. So far, no imaging method has been able to demonstrate efficacy in predicting complete pathologic response, and in turn there is no direct association between any endosonographic finding that can accurately predict it.
Introduction: Chest trauma has a high incidence and pneumothorax is the most frequent finding. The literature is scarce on what to do with asymptomatic patients with pneumothorax due to penetrating chest trauma. The aim of this study was to evaluate what are the findings of the control radiography of patients with penetrating chest trauma who are not initially taken to surgery, and their usefulness in determining the need for further treatment. Methods: A retrospective cohort study was performed, including patients older than 15 years who were admitted for penetrating chest trauma between January 2015 and December 2017 and who did not require initial surgical management. We analyzed the results of chest radiography, the time of its acquisition, and the behavior decided according to the findings in patients initially left under observation. Results: A total of 1,554 patients were included, whose average age was 30 years, 92.5% were male and 97% had a sharp weapon wound. Of these, 186 (51.5%) had no alterations in their initial X-ray, 142 had pneumothorax less than 30% and 33 had pneumothorax greater than 30 %, hemopneumothorax or hemothorax. Closed thoracostomy was required as the final procedure in 78 cases, sternotomy or thoracotomy in 2 cases and discharged in 281. Conclusion: In asymptomatic patients with small or moderate pneumothorax and no other significant lesions, longer observation times, radiographs and closed thoracostomy may be unnecessary.
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