Prevalence of Cyclomodulin-Positive E. coli and Klebsiella spp. Strains in Mexican Patients with Colon Diseases and Antimicrobial Resistance.

Colon diseases, such as colorectal cancer (CRC), are multifactor diseases that affect more than one million people per year; recently, the microbiota has been associated with an etiologic factor, specifically bacterial cyclomodulin positivity (CM+). Unfortunately, there are no studies from Mexico that detail the presence of bacterial CM+ in patients with colon diseases. We therefore performed a comprehensive study to investigate the associations and prevalence of cyclomodulin-positive Diarrheagenic E. coli (DEC), non-DEC, and Klebsiella spp. strains isolated from Mexican subjects with colon diseases. In this work, we analyzed 43 biopsies, 87 different bacteria were isolated, and E. coli was the most frequently noted, followed by Klebsiella spp., and Enterococcus spp. E. coli, non-DEC, and EPEC belonging to phylogroup B2 were the most prevalent. More than 80% of E. coli and Klebsiella were CM+. pks, cdt, cnf, and cif were identified. cdt was associated with non-DEC, cif and its combinations with EPEC, as well as cdt and psk with Klebsiella. Lastly, all the CM+ bacteria were resistant to at least one antibiotic (34% were MDR, and 48% XDR). In conclusion, the high prevalence of bacterial CM+ in colon disease patients suggests that these bacteria play an important role in the genesis of these diseases.

[The first Mexican consensus of endometrial cancer. Grupo de Investigación en Cáncer de Ovario y Tumores Ginecológicos de México]. / Primer consenso Mexicano de cancer de endometrio.

INTRODUCTION: Endometrial cancer (EC) is the second most common gynecologic malignancy worldwide in the peri and postmenopausal period. Most often for the endometrioid variety. In early clinical stages long-term survival is greater than 80%, while in advanced stages it is less than 50%. In our country there is not a standard management between institutions. GICOM collaborative group under the auspice of different institutions have made the following consensus in order to make recommendations for the management of patients with this type of neoplasm. MATERIAL AND METHODS: The following recommendations were made by independent professionals in the field of Gynecologic Oncology, questions and statements were based on a comprehensive and systematic review of literature. It took place in the context of a meeting of four days in which a debate was held. These statements are the conclusions reached by agreement of the participant members. RESULTS: Screening should be performed women at high risk (diabetics, family history of inherited colon cancer, Lynch S. type II). Endometrial thickness in postmenopausal patients is best evaluated by transvaginal US, a thickness greater than or equal to 5 mm must be evaluated. Women taking tamoxifen should be monitored using this method. Abnormal bleeding in the usual main symptom, all post menopausal women with vaginal bleeding should be evaluated. Diagnosis is made by histerescopy-guided biopsy. Magnetic resonance is the best image method as preoperative evaluation. Frozen section evaluates histologic grade, myometrial invasion, cervical and adnexal involvement. Total abdominal hysterectomy, bilateral salpingo oophorectomy, pelvic and para-aortic lymphadenectomy should be performed except in endometrial histology grades 1 and 2, less than 50% invasion of the myometrium without evidence of disease out of the uterus. Omentectomy should be done in histologies other than endometriod. Surgery should be always performed by a Gynecologic Oncologist or Surgical Oncologist, laparoscopy is an alternative, especially in patients with hypertension and diabetes for being less morbid. Adjuvant treatment after surgery includes radiation therapy to the pelvis, brachytherapy, and chemotherapy. Patients with Stages III and IV should have surgery with intention to achieve optimal cytoreduction because of the impact on survival (51 m vs. 14 m), the treatment of recurrence can be with surgery depending on the pattern of relapse, systemic chemotherapy or hormonal therapy. Follow-up of patients is basically clinical in a regular basis. CONCLUSIONS: Screening programme is only for high risk patients. Multidisciplinary treatment impacts on survival and local control of the disease, including surgery, radiation therapy and chemotherapy, hormonal treatment is reserved to selected cases of recurrence. This is the first attempt of a Mexican Collaborative Group in Gynecology to give recommendations is a special type of neoplasm.

Mature cystic teratoma of suprahepatic localization, presentation of case and literature review.

We present the case of a suprahepatic tumor related to mature cystic teratoma, extragonadal germ cell tumors are rare and represent from 1.6 to 5% of all germ cell tumors, the most common site and the extragonadal presentation is the mediastinum (50-70%), retroperitoneum (30-40%), other rare locations pineal gland, sacrococcal region, prostate and bladder; however, the supra-hepatic location is not so common and is not documented in the literature.

El tumor suprahepático se relaciona con el teratoma quístico maduro. Los tumores de células germinales extragonadales son raros y representan del 1,6 al 5% de todos los tumores de células germinales. El sitio más común y la presentación extragonadal es el mediastino (50-70%), seguido del retroperitoneo (30-40%) Otras localizaciones raras son la glándula pineal, la región sacrococcígea, la próstata y la vejiga; sin embargo, la localización suprahepática no es tan común y no está documentada en la literatura.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal carcinomatosis: initial experience in Oaxaca, Mexico.

Peritoneal carcinomatosis (PC) has been traditionally considered a terminal disease with median survivals reported in the literature of 6 to 12 months. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) are playing an ever increasing role in the treatment of these patients. Excellent results have been achieved in well-selected patients but there is a very steep learning curve when starting a new program. A program for peritoneal surface malignancies in which patients with PC of gastrointestinal or gynecological origin were treated using multimodality therapy with combinations of systemic therapy, cytoreductive surgery (CRS), and HIPEC was initiated in December 2007 at "Hospital Regional de Alta Especialidad de Oaxaca," Mexico. We present the results of our initial experience. From December 2007 to February 2011, 26 patients were treated with CRS and HIPEC. There were 21 female patients. Most common indication (46%) was recurrent ovarian cancer. Mean duration of surgery was 260 minutes. Mean Peritoneal Cancer Index was 9. Twenty-three (88.5%) patients had a complete cytoreduction. Major morbidity and mortality rates were 19.5 and 3.8 per cent, respectively. Mean hospital stay was 8 days. At a mean follow-up of 20 months, median survival has not been reached. Rigorous preoperative workup, strict selection criteria, and mentoring from an experienced cytoreductive surgeon are mandatory and extremely important when starting a center for PC.

Evaluación de la morbilidad por disección del compartimiento central en cáncer papilar de tiroides / Assessment of morbidity of central neck compartment dissection in papillary thyroid cancer

Objetivo: Evaluar la hipocalcemia y lesión del nervio laríngeo recurrente secundaria a tiroidectomía total acompañada de disección del compartimiento central en cáncer papilar de tiroides. Sede: Instituto Nacional de Cancerología, México. Diseño: Estudio clínico descriptivo, observacional, prospectivo, longitudinal. Análisis estadístico: Porcentajes como medida de resumen para variables cualitativas. Pacientes y métodos: Veinte y cuatro pacientes con diagnóstico de cáncer papilar de tiroides (CPT) establecido mediante citología y/o histopatología, que se llevaron a disección central del cuello como parte del tratamiento quirúrgico inicial con seguimiento mínimo de 6 meses. Variables estudiadas: Tiempo quirúrgico, sangrado transoperatorio, movilidad cordal evaluadas por laringoscopia directa pre y postoperatoriamente, hipocalcemia e hipoparatiroidismo, reintervención y número de ganglios resecados. Resultados: De los 24 pacientes, 16 con enfermedad confinada al tiroides y 8 con afección al cuello, el tiempo quirúrgico medio de 2 a 4.30 horas con una media de 2.2, sangrado de 100 a 400 ml con media de 196 ml. Un paciente con hipocalcemia transitoria, cero pacientes con hipocalcemia permanente corroborado con paratohormona, cero lesiones del nervio laríngeo recurrente (NLRL), cero reintervenciones, el número de ganglios resecados fue de 7 a 16. Conclusiones: La morbilidad de la tiroidectomía total más disección del compartimiento central fue de hipocalcemia transitoria de 4.1%. No existió lesión de nervio laríngeo recurrente ni hipoparatiroidismo.

Objective: To assess hypocalcemia and injury to the recurrent laryngeal nerve secondary to total thyroidectomy plus central compartment dissection in papillary thyroid cancer. Setting: National Institute of Cancerology, Mexico Design: Descriptive, observational, retrospective, prospective, longitudinal clinical study. Statistical analysis: Percentages as summary measure for qualitative variables. Patients and methods: Twenty-four patients with diagnosis of papillary thyroid cancer (PTC), established by cytology and histopathology, subjected to central dissection of the neck as part of the initial surgical treatment with a follow-up of at least 6 months. Assessed variables were: surgical time, trans-operative bleeding, vocal cords mobility, assessed through direct laryngoscopy pre- and postoperatively, hypocalcemia and hypothyroidism, re-intervention, and number of dissected ganglia. Results: Twenty four patients, 16 with thyroid-confined disease, and 8 with neck involvement. Average surgical time of 2 to 4.30 hours, mean of 2.2, bleeding of 100 to 400 ml, mean of 196 ml. One patient with transient hypocalcemia, nill patients with permanent hypocalcemia confirmed with PHT testing, nill Recurrent laryngeal nerve (NLRL) injuries, nill re-interventions; the number of dissected ganglia was 7 to 16. Conclusions: Morbidity of total thyroidectomy plus dissection of the central compartment consisted of transient hypocalcemia (4.1%). Neither recurrent laryngeal nerve injury nor hypoparathyroidism occurred.

Derivación biliointestinal en lesiones de la vía biliar extrahepática / Hepatic-jejunostomy in biliary tract injury

Se revisa la morbilidad y mortalidad de las técnicas de derivación biliointestinal para lesiones benignas y malignas de la vía biliar extrahepática. La hepaticoyeyunostomía en Y de Roux es la técnica más frecuentemente empleada y se hacen comentarios basados en la experiencia personal de 30 casos de obstrucción biliar