Long-term outcome of retroperitoneoscopic partial versus total adrenalectomy in patients with Cushing's syndrome.

BACKGROUND: We analyze the long-term outcome of surgery for Cushing's syndrome (CS) and the influence of the extent of surgical resection on the duration of postoperative cortisone substitution. METHODS: One-hundred forty-one patients (129 female, 12 males; mean age: 45.7 ± 12.8 years) operated between January 2000 to June 2020 were included in the analysis. Patients suffered from manifest (124) or subclinical (17) CS due to benign unilateral adrenal neoplasia. All tumors were removed by the posterior retroperitoneoscopic approach. 105 patients had total (TA) and 36 partial (PA) adrenalectomies. All patients were discharged with ongoing corticosteroid supplementation therapy. RESULTS: Follow-up data could be obtained for 83 patients. Twenty-four (1 male, 23 females; mean age 42.3 years) underwent PA and 59 TA (6 males, 53 females; mean age 44.6 years). Mean follow-up time was 107 ± 68 months (range: 6-243 months). The median duration of postoperative corticosteroid therapy was 9.5 months after PA and 11 months after TA (p = 0.1). Significantly, more patients after total adrenalectomy required corticosteroid therapy for more than 24 months (25% vs. 4%; p = 0.03). Recurrent ipsilateral disease occurred in one case after partial adrenalectomy and was treated by completion adrenalectomy. A case of contralateral recurrence associated with subclinical Cushing's syndrome was observed after total adrenalectomy. CONCLUSIONS: The risk of local recurrence after partial adrenalectomy in CS is low. Cortical-sparing surgery may shorten corticosteroid supplementation therapy after surgery.

Adult ocular adnexal xanthogranulomatous disease associated with immunoglobulin G4-related disease: an unusual association.

Adult-onset xanthogranuloma (AOX) and immunoglobulin G4-related disease (IgG4-RD) are uncommon fibrosing conditions that may exhibit localized ocular manifestations and occasionally systemic symptoms. These conditions exhibit overlapping clinical and histological features, suggesting a potential correlation between them, although their exact relationship remains unclear. This paper presents the case of a black male patient exhibiting typical histological indications of both AOX and IgG4-RD. The patient responded positively to corticosteroid treatment.

Quiste hidatídico de la glándula tiroides: Reporte de tres casos

Introducción: La enfermedad hidatídica puede desarrollarse en cualquier órgano del cuerpo, siendo las localizaciones más frecuentes el hígado y pulmón, pero ocasionalmente puede afectar a otros órganos como la glándula tiroides. En Chile existen escasas publicaciones previas. El objetivo de este reporte es presentar el diagnóstico, tratamiento y seguimiento de tres pacientes portadores de quiste hidatídico de la glándula tiroides. Casos Clínicos: Se refiere a dos mujeres de 9 y 56 años y un paciente de sexo masculino de 56 años, provenientes de la zona rural de la Región de Aysén en la Patagonia, todos enviados por aumento de volumen sintomático de la glándula tiroides. El diagnóstico presuntivo se realizó mediante los antecedentes anamnésticos e imágenes de ultrasonografía. Todos fueron sometidos a tiroidectomía subtotal y a quimioprofilaxis post operatoria con Albendazol por 30 días. La confirmación diagnóstica se realizó mediante el estudio histopatológico. Ninguno ha presentado recurrencia, llevando una de ellas 22 años de seguimiento. Conclusión: Aunque la glándula tiroides rara vez se ve afectada, la enfermedad hidatídica no debe pasarse por alto en el diagnóstico diferencial de lesiones quísticas de la glándula, especialmente en pacientes que viven en regiones donde la enfermedad es endémica.

Introduction: Hydatid disease can develop in any organ of the body, the most frequent locations being the liver and lung, but occasionally it can affect other organs such as the thyroid gland. In Chile there are few previous publications. Aim: The aim of this report is to present the diagnosis, treatment and follow-up of three patients with hydatid thyroid cysts. Clinical Cases: Two women, ages 9 and 56, and a 56 year old male patient, referred from Aysén in Patagonia, all of them due to a symptomatic increased volume in thyroid gland. The diagnosis was made through anamnestic history and ultrasound images. All underwent subtotal thyroidectomy and postoperative chemoprophylaxis with Albendazole for 30 days. Diagnostic confirmation was made by histopathological study. None had recurrence, one of them has been followed for 22 years. Conclusion: In conclusion, although the thyroid gland is rarely affected, hydatid disease should not be overlooked in the differential diagnosis of cystic lesions of the thyroid gland, especially in patients living in regions where the disease is endemic.

Videolaryngoscopy vs. direct Macintosh laryngoscopy in tracheal intubation in adults: a ranking systematic review and network meta-analysis.

Videolaryngoscopes are thought to improve glottic view and facilitate tracheal intubation compared with the Macintosh direct laryngoscope. However, we currently do not know which one would be the best choice in most patients undergoing anaesthesia. We designed this systematic review with network meta-analyses to rank the different videolaryngoscopes and the Macintosh direct laryngoscope. We conducted searches in PubMed and a further five databases on 11 January 2021. We included randomised clinical trials with patients aged ≥16 years, comparing different videolaryngoscopes, or videolaryngoscopes with the Macintosh direct laryngoscope for the outcomes: failed intubation; failed first intubation attempt; failed intubation within two attempts; difficult intubation; percentage of glottic opening seen; difficult laryngoscopy; and time needed for intubation. We assessed the quality of evidence according to GRADE recommendations and included 179 studies in the meta-analyses. The C-MAC and C-MAC D-Blade were top ranked for avoiding failed intubation, but we did not find statistically significant differences between any two distinct videolaryngoscopes for this outcome. Further, the C-MAC D-Blade performed significantly better than the C-MAC Macintosh blade for difficult laryngoscopy. We found statistically significant differences between the laryngoscopes for time to intubation, but these differences were not considered clinically relevant. The evidence was judged as of low or very low quality overall. In conclusion, different videolaryngoscopes have differential intubation performance and some may be currently preferred among the available devices. Furthermore, videolaryngoscopes and the Macintosh direct laryngoscope may be considered clinically equivalent for the time taken for tracheal intubation. However, despite the rankings from our analyses, the current available evidence is not sufficient to ensure significant superiority of one device or a small set of them over the others for our intubation-related outcomes.

Manejo quirúrgico de la hidatidosis hepática en esta última década: ¿qué hemos aprendido? / Surgical management of liver hydatidosis in the last decade: what have we learned?

Resumen El manejo clínico de la hidatidosis hepática es complejo y se basa fundamentalmente en tres pilares: quirúrgico, percutáneo y farmacológico; los cuales en ocasiones pueden ser complementarios. La terapia debe definirse en función de las características, ubicación y tipo de quiste; a lo cual debe sumarse la experiencia del equipo médico, recursos disponibles y la adherencia de los pacientes al monitoreo a largo plazo. La cirugía es el tratamiento más utilizado, las técnicas percutáneas posiblemente puedan reemplazar a la cirugía en casos específicos. Sin embargo, a pesar de los avances en las técnicas quirúrgicas, en el uso de la quimioterapia y otros tratamientos, el manejo de hidatidosis hepática sigue siendo un problema importante, debido principalmente a la falta de consenso sobre qué procedimiento a utilizar es mejor. El objetivo de esta presentación es dar a conocer el amplio abanico de terapias existentes en el actual manejo de la hidatidosis hepática, así como indicar algunas sugerencias en la utilización de cada una de ellas.

The clinical management of hepatic hydatidosis is complex and is fundamentally based on three pillars: surgical, percutaneous and pharmacological; which can sometimes be complementary. Therapy should be defined based on the characteristics, location and type of cyst; to which must be added the experience of the medical team, available resources and the adherence of patients to long-term monitoring. Surgery is the most used treatment, percutaneous techniques can possibly replace surgery in specific cases. However, despite advances in surgical techniques, in the use of chemotherapy and other treatments, the management of liver hydatidosis continues to be a major problem; mainly due to the lack of consensus on which procedure to use is better. The objective of this presentation is to present the wide range of existing therapies in the current management of hepatic hydatidosis and some suggestions in the use of each one of them.

Manejo complicaciones biliares de la cirugía del quiste hidatídico hepático / Management of biliary complications of liver hydatid cyst surgery

Resumen La complicación más frecuente del quiste hidatídico hepático es la fístula biliar externa. El diagnóstico pre e intraoperatorio es esencial en el tratamiento. En dicha evaluación se describen factores predictivos que hacen sospechar las comunicaciones cistobiliares. En presencia de estas, es posible realizar estudios adicionales para su diagnóstico. La filtración y la fístula biliar son las complicaciones postoperatorias más frecuentes y las principales causas de morbimortalidad. Sus tasas pueden disminuirse siguiendo con acuciosidad los factores predictivos y el adecuado manejo de la fístula biliar postoperatoria.

The most frequent complication of hepatic hydatid cyst is the external biliary fistula. Pre and intraoperative diagnosis is essential in treatment. This evaluation describes predictive factors that make cystobiliary communications suspicious. In the presence of these it is possible to carry out additional studies for its diagnosis. Filtration and biliary fistula are the most frequent postoperative complications and the main causes of morbidity and mortality. Their rates can be decreased by acutely following the predictive factors and proper management of postoperative biliary fistula.

Change in renal function post-nephrectomy for renal cell carcinoma in patients with and without hypertension and/or diabetes.

BACKGROUND: The standard of care for surgically resectable disease renal cell carcinoma (RCC) is a nephrectomy. Post-nephrectomy, these patients are at risk for the development of new onset chronic kidney disease or the progression of pre-existing chronic kidney disease. We aimed to report the changes in renal function in patients who had a nephrectomy for RCC. METHODS: This retrospective, descriptive, cross-sectional study identified 137 patients who had a nephrectomy for RCC from 1 January 2009 to 31 December 2017. The pre-nephrectomy and post-nephrectomy estimated glomerular filtration rate (eGFR) and the histological subtype of RCC on histopathological analysis of the resected specimen were recorded from the National Health Laboratory Services online results platform. All analyses were conducted using SPSS (Version 25) and the significance level was set at p < 0.05. RESULTS: After a mean follow-up period of 26.5 ± 22 months (median = 19 months), the patients' eGFR dropped by a mean of 4.82 ± 8.67 ml/min/1.73 m2 (95% CI 3.23-6.41) post-nephrectomy. The mean eGFR fall in patients' who had hypertension and/or diabetes (n = 63) was significantly larger compared to patients who had neither of these comorbidities (n = 54; p < .001; mean = 7.30 ± 8.40 ml/min/1.73 m2 (95% CI 5.19-9.42) and 1.93 ± 8.14 ml/min/1.73 m2 (95% CI 0.30-4.15) respectively. CONCLUSIONS: The decline in renal function in patients with hypertension and/or diabetes mellitus is more pronounced than in patients with neither of these comorbidities. In these high-risk patients, measures must be taken to prevent the development and limit the progression of chronic kidney disease.

Encuesta de Percepción en Capacidad Instalada para la Formación de Médicos Residentes en Ortopedia (Traumatología) y Necesidades de la Atención en Patología Musculoesquelética Aguda y Crónica en México. Primera Parte / Installed Capacity Perception Survey for the Training of Resident's Program in Orthopedics and Care Needs in Acute and Chronic Musculoskeletal Pathology in Mexico

resumen está disponible en el texto completo

Abstract: Introduction: It is essential that orthopaedic resident physicians be highly proficient in all aspects, considering the balance between supply, demand, need and context. Fundamental to identify the capacity and quality installed for their training in Mexico. Material and methods: Observational Study, transverse, non-probabilistic sampling-conglomerates, in two phases. The instrument has 8 domains, 57 variables and 4,867 items. 60 graduate professors of 20 states, 50 hospital sites, 22 university programs. Results: 1,038 years of experience (collective intelligence), 17 years of experience/teacher (01 to 50 years). Identified: acute pathology 30 (2 to 90%), chronic pathology 30 (5 to 96%), patients ˂ 15 years, 10 (3 to 30%), patients between 15 and 65 years, 47 (2 to 78%), patients ˃ 65 years, 20 (2 to 60%), number of beds/seat 20 (2 to 510), number of clinics 3 (1 to 48), number of surgical procedures/headquarters per year at the national level, was 960 (50 to 24,650). The national average per resident doctor is 362 surgeries/year with 1,450 surgical times/year. Conclusions: The needs and resources for the training of physicians specializing in orthopedics/traumatology are highly heterogeneous, so it should be adapted to the epidemiological needs of the region of influence, in an area of epidemiological transition. 62.2% expressed not having or have bad academic and scientific infrastructure at its headquarters, more than 50% without rotation overseas and ˃ 90% without regular scientific production.

[Installed Capacity Perception Survey for the Training of Residents Program in Orthopedics and Care Needs in Acute and Chronic Musculoskeletal Pathology in Mexico]. / Encuesta de Percepción en Capacidad Instalada para la Formación de Médicos Residentes en Ortopedia (Traumatología) y Necesidades de la Atención en Patología Musculoesquelética Aguda y Crónica en México. Primera Parte.

INTRODUCTION: It is essential that orthopaedic resident physicians be highly proficient in all aspects, considering the balance between supply, demand, need and context. Fundamental to identify the capacity and quality installed for their training in Mexico. MATERIAL AND METHODS: Observational Study, transverse, non-probabilistic sampling-conglomerates, in two phases. The instrument has 8 domains, 57 variables and 4,867 items. 60 graduate professors of 20 states, 50 hospital sites, 22 university programs. RESULTS: 1,038 years of experience (collective intelligence), 17 years of experience/teacher (01 to 50 years). Identified: acute pathology 30 (2 to 90%), chronic pathology 30 (5 to 96%), patients 15 years, 10 (3 to 30%), patients between 15 and 65 years, 47 (2 to 78%), patients 65 years, 20 (2 to 60%), number of beds/seat 20 (2 to 510), number of clinics 3 (1 to 48), number of surgical procedures/headquarters per year at the national level, was 960 (50 to 24,650). The national average per resident doctor is 362 surgeries/year with 1,450 surgical times/year. CONCLUSIONS: The needs and resources for the training of physicians specializing in orthopedics/traumatology are highly heterogeneous, so it should be adapted to the epidemiological needs of the region of influence, in an area of epidemiological transition. 62.2% expressed not having or have bad academic and scientific infrastructure at its headquarters, more than 50% without rotation overseas and 90% without regular scientific production.

INTRODUCCIÓN: Es fundamental que los médicos residentes de ortopedia (traumatología) sean altamente competentes en todos los aspectos, considerando el equilibrio entre la oferta, demanda, necesidad y contexto. Es primordial identificar la capacidad y calidad instalada para su formación en México. MATERIAL Y MÉTODOS: Estudio observacional, transversal, muestreo no probabilístico-conglomerados, en dos fases. El instrumento tiene ocho dominios, 57 variables y 4,867 ítems. Sesenta profesores de postgrado de 20 estados, 50 sedes hospitalarias, 22 programas universitarios. RESULTADOS: 1,038 años de experiencia (inteligencia colectiva), 17 años de experiencia/profesor (01 a 50 años). Se identificó: patología aguda 30 (2 a 90%), patología crónica 30 (5 a 96%), pacientes 15 años, 10 (3 a 30%), pacientes entre 15 y 65 años, 47 (2 a 78%), pacientes 65 años, 20 (2 a 60%), número de camas/sede 20 (2 a 510), número de consultorios 3 (1 a 48), el número de procedimientos quirúrgicos/sede al año a nivel nacional fue de 960 (50 a 24,650). La media nacional por médico residente es de 362 cirugías/año con 1,450 momentos quirúrgicos/año. CONCLUSIONES: Las necesidades y recursos para la formación de médicos especialistas en ortopedia/traumatología son en alto grado heterogéneos, por lo cual se debería adaptar a las necesidades epidemiológicas de la región de influencia, en un ámbito de transición epidemiológica. Sesenta y dos punto dos por ciento expresó no tener o tener deficiente infraestructura académica y científica en su sede, más de 50% sin rotación al extranjero y 90% sin producción científica regular.

Outcomes of outpatient ureteral stenting without fluoroscopy at Groote Schuur Hospital, Cape Town, South Africa.

BACKGROUND: Ureteral stenting is generally a theatre-based procedure that requires a multidisciplinary team and on-table imaging. Limited hospital bed numbers and theatre time in our centre in Cape Town, South Africa, have led us to explore an alternative approach. OBJECTIVES: To see whether outpatient insertion of ureteric stents under local anaesthesia without fluoroscopy was a possible and acceptable alternative to theatre-based ureteral stenting. METHODS: Ureteral stenting (double-J stents and ureteric catheters) was performed with flexible cystoscopy under local anaesthesia and chemoprophylaxis, but without fluoroscopic guidance, in an outpatient setting. Every patient had an abdominal radiograph and an ultrasound scan of the kidney after the procedure to confirm stent position. RESULTS: Three hundred and sixteen procedures (276 double-J stents and 40 ureteric catheters) were performed in 161 men and 155 women. The overall success rate for the procedures was 85.4%, independent of gender (p=0.87), age (p=0.13), type of device inserted (p=0.81) or unilateral/bilateral nature of the procedure (p=1.0). Procedures with a successful outcome were performed in a significantly (p<0.0001) shorter median time (10 minutes (interquartile range (IQR) 5 - 15)) than failed procedures (20 minutes (IQR 10 - 30)). Patients with a pain score of >5 experienced a significantly (p=0.02) greater proportion of failure (27.3%) than patients with a pain score of ≤5 (12.5%). Difficulties were encountered in 23.7% of procedures, with a significantly higher proportion being registered in failed interventions compared with successful ones (82.6% v. 13.7%; p<0.0001). CONCLUSIONS: The procedure was easily mastered and technically simple, and represents savings in cost, time and human resources in our setting.

Laparoscopic sleeve gastrectomy for morbid obesity: role of intraluminal and intraperitoneal postoperative drainage.

BACKGROUND AND AIMS: Bleeding and staple line leak are the most common postoperative complications of LSG. To prevent and/or to promptly identify such complications, conventional peri-operative protocols imply post-operative gastric decompression (NGT) and staple line drain (IAD). Our aim was to evaluate the role of naso-gastric tube (NGT) and intra-abdominal drain (IAD) in preventing and/or facilitating identification and treatment of post-operative complications after sleeve gastrectomy. PATIENTS AND METHODS: A retrospective observational study on two consecutive series has been undertaken to evaluate the real utility of routine placement of NGT and IAD at the end of a LSG to prevent (primary end-point), promptly identify (secondary end-point) and manage (tertiary end-point) bleeding and staple line leakage. Collected outcome data of all consecutive cases, which underwent primary LSG at our Department, were analyzed. The first 100 consecutive patients (group A) received the standard perioperative protocol and the other consecutive 100 (group B) received a fast track protocol (no NGT neither IAD). RESULTS: The two groups were not different in their outcome. Two bleeding occurred in Group A and were conservatively treated. One abscess developed in group B soon after surgery. It was diagnosed by an abdominal CT performed because patients presented fever, leucocitosis and tachycardia. It was successfully treated by percutaneous ultrasound-guided drainage. One fistula occurred in group B after discharge on 30th post-operative day. Fistula was suspected based on fever and tachycardia in absence of any abdominal discomfort and was confirmed by an abdominal CT. The patient was successfully treated in 40 days by endoscopic positioning of a gastric tube-prosthesis and percutaneous ultrasound-guided drainage of abdominal collection. A third patient in group B experienced bleeding suspected due to hemoglobin drop and confirmed by abdominal CT. He also was conservatively treated. CONCLUSIONS: In conclusion, placement of drains does not facilitate detection of leak, abscess, or bleeding after primary LSG.

Diagnóstico, tratamiento y seguimiento de la hidatidosis / Diagnosis, treatment and monitoring of hydatid disease

En el año 2003 el grupo de trabajo de la OMS sobre la equinococosis (WHO-IWGE) publicó una clasificación ecotomográfica que monitorea su historia natural. Esta se traduce en el paso de un quiste simple a una etapa de transición, la cual finaliza con su inactivación. Basándose en esta clasificación y ante la carencia de criterios uniformes en el manejo de esta enfermedad en el país, el grupo de trabajo de la región de Aysén decidió proponer un manejo integral de esta zoonosis, la cual fue aceptada y publicada como normas por el Ministerio de Salud en enero del 2016. El objetivo de este documento es dar a conocer las normas en el diagnóstico, tratamiento y seguimiento de los pacientes portadores de hidatidosis basado en las normas ministeriales.

In 2003 the Working Group on Echinococcosis WHO (WHO-IWGE) published a classification ecotomographic monitors its natural history. This results in the passage from a simple cyst to a transitional stage which ends with its inactivation. Based on this classification and in the absence of uniform criteria in the management of this disease in the country, it is that the working group of the Aysen Region decided to propose an integrated management of this zoonosis, which was accepted and published as Standards for the Ministry of Health in January 2016. The purpose of this paper is to present standards in the diagnosis, treatment and monitoring of patients with hydatid disease based on ministerial standards.

N-acetyl Glucosamine Distribution and Mitochondrial Activity of Tumor Cell Exposed to Photodynamic Therapy.

The use of lectins can play an important role for tracking modification on cell surface components, since lectins can be easily complexed with radioisotopes, biotin or fluorescein, facilitating the evaluation of carbohydrates distribution in the cell and mitochondrial activity. The aim of this study was to evaluate photodynamic therapy effects on indirect distribution of N-acetyl-glucosamine terminal glycoproteins, in human laryngeal carcinoma HEp-2 cell line surface, using lectin wheat germ agglutinin (WGA) and on mitochondrial activity, for the same cell line, using MitoTracker. The photosensitizer Aluminum Phthalocyanine Tetrasulfonate (AlPcS4) was administrated at 10 µM/mL, followed by an incubation period for its accumulation in the tumor cells, which were irradiated with laser diode λ = 685 nm and energy density of 4.5 J/cm2. Our results indicated that, after Photodynamic Therapy (PDT), it was observed N-acetyl glucosamine terminal glycoprotein expression and mitochondrial O2 production, compared to the control group. Based on these results, we suggest that PDT influences the O2 mitochondrial production and the presence of surface glycoproteins N-acetyl glucosamine terminals.

Expression of Mcl-1 and Ki-67 in Papillary Thyroid Carcinomas.

UNLABELLED: Studying molecules that are differentially expressed in cancers as well as benign and normal tissues is crucial for identifying novel biomarkers for cancer immunotherapy. This study aimed to investigate the clinical utility of the immunochemical expression of the proliferative cell marker Ki-67 and the apoptotic blocker Mcl-1 in papillary thyroid carcinoma (PTC). METHODS: We built a tissue microarray with 282 thyroid specimens. There were 59 PTCs including 35 classic (CPTC), 3 tall cell (TCPTC) and 21 follicular variants (FVPTC); 79 benign thyroid diseases (22 follicular adenomas; 57 adenomatoid hyperplasia); 33 Hashimoto's thyroiditis (HT) specimens; and 111 normal thyroid tissues. Clinical history and ultrasound data were retrospectively obtained by chart review. RESULTS: Mcl-1 overexpression was evident in 66.7% of the PTC tissues compared to 32% of the benign thyroid diseases. Mcl-1 strong staining distinguished benign from malignant thyroid lesions (sensitivity=61.3%; specificity=72.8%; negative predictive value, NPV=68%; positive predictive value, PPV=66.7% and 67.5% accuracy). Positive nuclear Ki-67 staining was observed in 34% of PTCs vs. 19% of thyroid adenomas (P=0.031). Strong Mcl-1 and Ki-67 co-expression was identified in 57.5% of PTCs with a higher PPV (75.8%). Mcl-1 and Ki-67 expression was not associated with any clinicopathological feature of malignancy. No deaths occurred during the follow-up. CONCLUSIONS: Mcl-1 immunochemical overexpression allowed differentiating low-risk PTC from the benign thyroid lesions. We suggest that Mcl-1 expression may help differentiate follicular patterned thyroid lesions. The influence of the Mcl-1 expression on several features of tumor aggressiveness has to be studied in large series of high-risk thyroid carcinomas.

[A CMO achievement, new legislature about developmental dysplasia of the hip]. / La ley de detección de la DDC en niños, un logro del CMO.

No Abstract available.

Tumores estromales de potencial maligno incierto (STUMP): descripción epidemiológica y manejo durante el período 2004-2013 / Stromal tumors of an uncertain malignant potential (STUMP): epidemiological description and handling during the 2004-2013 period

Los tumores estromales de potencial maligno incierto (STUMP) se enmarcan dentro de las lesiones de células fusadas de la próstata, entidades de relativa infrecuencia en la práctica urológica habitual, contabilizándose entre 0,1-0,2 por ciento 1 de todas los tumores malignos prostáticos. Corresponden a una proliferación no epitelial mesenquimática de células fusadas estromales, que pueden adquirir la capacidad de infiltrar el epitelio glandular prostático. Representan un desafío tanto para el patólogo, por la dificultad diagnóstica, como para el clínico, pues no existe consenso respecto a su manejo. Materiales y métodos: estudio retrospectivo descriptivo. Se filtró la base de datos del servicio de Anatomía Patología del Hospital San Borja Arriarán con los términos clave “STUMP”, “Tumor estromal próstata”, tanto de biopsias transrrectales como de piezas operatorias. De los pacientes con diagnóstico histológico e inmunohistoquímico compatible, se registraron características epidemiológicas, estudio, manejo y sobrevida global. Resultados: se encontraron 3(tres) pacientes con diagnóstico histológico de STUMP. Edad promedio al diagnóstico 66años. Dos de los casos (66,6 ´po0r ciento) correspondieron a hallazgo en biopsia diferida por cirugía benigna prostática, (una por Adenomectomía transvesical y otra por RTU-P). El tercer caso correspondió a un hallazgo en biopsia por punción transrrectal ecodirigida, en contexto de PSA elevado (100ng/mL) y 4 biopsias previas: 3 normales, y una con informe de posible sarcoma prostático. La terapia de elección en 2 casos fue seguimiento y en uno se indicó cirugía radical. En los casos descritos no se registra mortalidad, con seguimiento promedio de 32 meses. Conclusión: Los tumores estromales de potencial maligno incierto son un diagnóstico histológico infrecuente, descrito como hallazgo tanto en la biopsia transrrectal como de pieza quirúrgica. No existen consensos internacionales ni guías de manejo. En nuestra experiencia...

Stromal tumors of uncertain malignant potential (STUMP) are included in the spindle cell lesions of the adult prostate, a very rare diagnostic entity in the clinical practice, accounting no more than 0,1-0,2 percent of all prostate malignancies. STUMP is defined as a non epithelial proliferation of spindle cells, which can acquire the ability of infiltrate the prostate glands. This lesions represent a challenge for both clinical and pathology physician. Material and methods: retrospective cohort study. A research was performed at the San Borja Hospital Pathology Service’s database, using keywords “STUMP”, “Stromal prostate tumor”. From eligible patients we took epidemiology and clinical data. Results: a total of three patients were included. Average age was 66 years. STUMP was founded in two patients in the pathology report after benign prostatic surgery (Simple prostatectomy and TUR-P). A third patient was diagnosed by a needle biopsy (TRUS Biopsy). This patient had an elevated PSA (>100 ng/mL), 4 previous biopsies, three normal and a fourth suspicious of prostate sarcoma. Surveillance was the therapy chosen for those patients diagnosed with STUMP after benign surgery. Radical prostatectomy was offered to the third patient. Average follow up was 32 month Conclusion: STUMP is a rare diagnostic, and is a challenge for both clinical and pathology physician. There are no guidelines for the management. In our series we confirmed the low frequency of this condition, and the management in our service is similar as other series described in literature...

Tumor buding y el cáncer colorrectal / Budding tumour and colorectal cancer

Introduction: Tumour budding (TB) is defined as the presence of clusters of tumoural cells detaching from invasive margin of main tumor. It is an independent adverse prognostic factor in colorectal cancer. The aim of this study is to determinate if severity of tumor budding is associated with others prognostic factors in colorectal cancer. Materials and Methods: The study group is composed by 43 patients (27 males and 16 females; average age 73.4 years, (27-91) with colorectal cancer who underwent curative surgery. The histologic method of tumour budding used in this study was described by Nakamura. The applied statistical software was G-Stat 2.0. Statistical significance is accepted at p < 0.05. Results: High grade of TB was significantly associated with lymph node metastasis (p = 0.027), infiltrative tumour-border configuration (p = 0.016), lymphvessels invasion (p = 0.02), perineural invasion (p = 0.009) and tumor deposits (p = 0.018). There was a significant association with low grade of TB and peritumoural lymphocytic infiltration (p = 0.004). Conclusions: High grade of TB is significantly associated with other adverse prognostic factors as lymph node metastasis, infiltrative tumour-border configuration, lymphvessels invasion, venous invasion, perineural invasion and tumor deposits; and low grade of TB with favorable prognostic factor as peritumoural lymphocytic infiltration in colorectal cancer. Tumour budding can help to identify hig-risk patients with colorectal cancer.

Introducción: El tumor budding (TB) es la presencia de células tumorales aisladas o en pequeños grupos situadas en el frente infiltrante del tumor. Su hallazgo en alto grado es un factor de mal pronóstico independiente del cáncer colorrectal. El objetivo de este trabajo es determinar si el grado de TB está asociado con otros factores pronósticos del cáncer colorrectal. Materiales y Métodos: Se analizaron retrospectivamente 43 pacientes (27 varones y 16 mujeres) con una edad media de 73,4 años (27-91) intervenidos por cáncer colorrectal. El método histológico utilizado para determinar la presencia de TB fue el descrito por Nakamura en 2005. El análisis estadístico se realizó con el programa G-Stat2.0. Las diferencias se consideraron significativas si p < 0,05. Resultados: La presencia de TB de alto grado se asocia significativamente con la presencia de metástasis a ganglios linfáticos (p = 0,027), patrón de crecimiento infiltrativo (p = 0,016), invasión linfática (p = 0,02), perineural (p = 0,009) y depósitos tumorales discontinuos (p = 0,018). El TB de bajo grado se relaciona con la presencia de reacción linfocitaria peritumoral (p = 0,004). Conclusiones: El tumor budding alto grado se asocia con otros factores de mal pronóstico, como metástasis a ganglios linfáticos, crecimiento infiltrativo, invasión linfática, perineural y depósitos tu-morales discontinuos; y el tumor budding bajo grado con factores de buen pronóstico del cáncer colorrectal como reacción linfocitaria peritumoral. El análisis del grado de tumor budding podría ayudar a identificar a pacientes de peor pronóstico con cáncer colorrectal.

Study of polymorphic variants of the serotonin 2A receptor gene (5-HT2A) and its possible effects on smoking habits of a population from northeastern Brazil.

Previous studies have revealed a genetic component, including genetic polymorphisms in the serotonergic pathway, particularly in the serotonin receptor gene (5-HT2A). The aim of this study was to investigate associations of the T102C (rs6313) and A-1438G (rs6311) polymorphisms with tobacco use in a population from northeastern Brazil. We evaluated these polymorphisms in 135 nonsmokers and 135 smokers using polymerase chain reaction-restricted fragment length polymorphism. The distribution of allele and genotype frequencies and associations of polymorphisms with smoking were assessed with the chi-squared (χ(2)) test, the Fisher exact test, and odds ratio (OR) with a 95% confidence interval (CI). There were no differences in the distribution of genotype and allele frequencies between nonsmokers and smokers for A-1438G (P = 0.80) and T102C (P = 0.35). However, these polymorphisms were significantly associated with habit frequency (A/G: P = 0.02, OR = 6.87, 95%CI = 1.23-38.31, P = 0.04; A/G+G/G: P = 0.04, OR = 3.67, 95%CI = 1.06-12.75, P = 0.07), age of onset (C/C: P = 0.02, OR = 3.26, 95%CI = 1.17-9.07, P = 0.03, and nicotine dependence level (A/G: P = 0.02, OR = 3.28, 95%CI = 1.17-9.18, P = 0.04; A/G+G/G: P = 0.04, OR = 2.81, 95%CI = 1.13-6.99, P = 0.04; T/C: P = 0.03, OR = 3.12, 95%CI = 1.13-8.57, P = 0.04; T/C+C/C: P = 0.02, OR = 3.06, 95%CI = 1.22-7.70, P = 0.02). Therefore, these polymorphisms may not contribute significantly to smoking initiation, they do appear to be associated with habit maintenance.