[Utility of topical vancomycin application in the prevention of surgical site infection of the lumbosacral spine]. / Utilidad de la aplicación de vancomicina tópica en la prevención de infección de sitio quirúrgico de la columna lumbosacra.

INTRODUCTION: surgical site infections (SSI) remain a significant cause of morbidity and mortality and one of the most representative causes of nosocomial infections. The use of intrawound vancomycin in lumbar spine surgery is a potential prophylactic measure against SSI; however, evidence regarding its efficacy is contradictory. Our study was designed to research if intrawound vancomycin significantly prevents SSI in lumbar spine surgery. MATERIAL AND METHODS: this is a randomized, double-blinded, controlled clinical trial; 233 patients who underwent lumbar spine surgery, were randomly assigned to a group in which intrawound vancomycin was instilled in the incision before closure (109), or to a control group (114). The main outcome is the presence of SSI; we determined its prevalence and searched for difference between groups for association between SSI and independent variables. RESULTS: global SSI prevalence was 1.8%, in the experimental group was 0.9%, in the control group was 2.6%. There was no significant difference between these values, p = 0.622. The relative risk of SSI in the experimental group was 0.35 (95% CI 0.037-3.30), that of the control group was 2.87 (95% CI 0.30-27.16). The number needed to treat is 58.3. We did not find a significant association between the independent variables studied and the appearance of SSI. CONCLUSIONS: we did not find a significant difference in the prevalence of SSI between groups nor a significant association between SSI and independent variables.

INTRODUCCIÓN: las infecciones postoperatorias del sitio quirúrgico son una importante causa de morbimortalidad y una de las formas más comunes de infecciones nosocomiales. La aplicación de vancomicina al terminar una intervención de columna lumbar es una potencial práctica profiláctica de infecciones del sitio quirúrgico (ISQ). La evidencia que sostiene su uso es controversial. Nuestro estudio investiga si la aplicación de vancomicina disminuye en forma significativa la prevalencia de ISQ. MATERIAL Y MÉTODOS: ensayo clínico aleatorizado, controlado, cegado; 223 pacientes intervenidos de la columna lumbar fueron aleatoriamente asignados a un grupo experimental de 109 pacientes en quienes se colocó vancomicina y a un grupo control de 114 pacientes que no recibió vancomicina. El principal desenlace del estudio es la aparición de ISQ; se estudió la prevalencia de ISQ en ambos grupos y se buscó si existe diferencia significativa. Se analizó la existencia de factores predictores de ISQ. RESULTADOS: la prevalencia global de infección fue 1.8%; en el grupo experimenta 0.09% y en el grupo control 2.6%. No hubo diferencia significativa entre estas cifras, p = 0.622. El riesgo relativo de ISQ en el grupo experimental fue 0.35 (IC95% 0.037-3.30), el del grupo control fue 2.87 (IC95% 0.30-27.16). El número necesario para tratar es 58.3. No encontramos asociación significativa entre las variables independientes estudiadas y la aparición de ISQ. CONCLUSIONES: no encontramos evidencia suficiente de que la aplicación de vancomicina disminuya significativamente la prevalencia de ISQ ni asociación significativa de ISQ con las variables independientes estudiadas.

Gastric perforation and subarachnoid hemorrhage secondary to intragastric balloon device.

Obesity is a major health problem worldwide that leads to high morbidity and mortality rates. Medical options for obesity treatment are multiple and invasive therapy may be classified as surgical and non-surgical. Intragastric balloon device placement is an invasive non-surgical option that may benefit some obese patients. Potential complications related to intragastric balloon placement are multiple and perforations at the esophagus or stomach are the most hazardous. Prompt surgical management is mandatory upon the diagnosis of gastric perforation secondary to intragastric balloon to avoid further complications and mortality. Here we report an unusual case of patient that suffered both a subarachnoid hemorrhage as well as a gastric perforation related to intragastric balloon in which early diagnosis and prompt surgical treatment lead to a successful outcome.

[Haemorrhagic brain metastasis from prostatic adenocarcinoma]. / Metastasis cerebral hemorragica de adenocarcinoma prostatico.

INTRODUCTION: Prostatic adenocarcinomas have a marked tendency to spread to lymph nodes and bones, with occasional internal organ metastases. Brain metastases from prostatic carcinomas are rare. CASE REPORT: We report the case of a patient with haemorrhagic brain metastasis from prostatic adenocarcinoma, which was initially considered to be a parenchymatous brain haemorrhage. The possible ways by which it can spread, the difficulty involved in interpreting the images and the role played by a biopsy with immunostaining in reaching a final diagnosis are also discussed. CONCLUSIONS: Perhaps the most significant aspect of this case was the 13 year period that elapsed between diagnosis of the primary tumour and brain metastasis, the absence of spreading to lymph nodes and the localised, intrapelvic, aspect of the bone lesion that was detected.

[Paraganglioma of the cauda equina with papillary pattern and cytokeratin expression: 2 potential sources of diagnostic error. Report of a case and review of the literature]. / Paraganglioma de la cola de caballo con patrón papilar y expresión de citoqueratina: dos causas potenciales de error diagnóstico. Reporte de un caso y revisión de la literatura.

UNLABELLED: Paragangliomas are unusual neuroendocrine tumours, rare in the cauda equina and filum terminale. Due to their low frequency, no classical patterns and dual immunophenotype, may be misinterpreted as others neoplasms more frequent in this site. It is our aim to report a case of paraganglioma of the cauda equina and filum terminale (PGCCFT), standing out it's histological-immunohistochemical pattern, differential diagnosis, prognostic and treatment. We reviewed the clinical presentation, NMR features and morphological aspect of one PGCCFT, diagnosed in the ABC Medical Center's Surgical Pathology Department of Mexico City. Report of the case: 26 years old man, who had been suffering a low lumbar pain for one year before he came to our hospital. The NRM showed heterointense lesion in the level of first and second vertebra, suggesting ependymoma. The tumor was totally resected. Histologically it was papillary, the chief cells have stained with chromogranin, synaptophysin, and cytokeratin. The few sustentaculars cells were S100 positive. The patient have haven a favorable course. CONCLUSIONS: The certainty and differential diagnosis of paragangliomas of the cauda equina and filum terminale needs correlation between histological pattern and immunophenotype, the last must be considered in the peculiar context of this anatomic region.

Metástasis cerebral hemorrágica de adenocarcinoma prostático / Haemorrhagic brain metastasis from prostatic adenocarcinoma

Introducción. Los adenocarcinomas prostáticos se diseminan preferentemente a ganglios linfáticos y huesos, con ocasionales metástasis viscerales. Las metástasis encefálicas de carcinomas prostáticos son raras. Caso clínico. Informamos el caso de un paciente con metástasis cerebral hemorrágica de adenocarcinoma prostático, considerada inicialmente como hemorragia cerebral parenquimatosa. Discutimos las posibles vías de diseminación, la dificultad en la interpretación de las imágenes y la contribución de la biopsia con inmunomarcación para el diagnóstico definitivo. Conclusiones. El caso resultó relevante por los 13 años transcurridos entre el diagnóstico del tumor primario y la metástasis cerebral, la ausencia de diseminación ganglionar linfática y el aspecto localizado, intrapélvico, de la lesión ósea detectada (AU)

Introduction. Prostatic adenocarcinomas have a marked tendency to spread to lymph nodes and bones, with occasional internal organ metastases. Brain metastases from prostatic carcinomas are rare. Case report. We report the case of a patient with haemorrhagic brain metastasis from prostatic adenocarcinoma, which was initially considered to be a parenchymatous brain haemorrhage. The possible ways by which it can spread, the difficulty involved in interpreting the images and the role played by a biopsy with immunostaining in reaching a final diagnosis are also discussed. Conclusions. Perhaps the most significant aspect of this case was the 13-year period that elapsed between diagnosis of the primary tumour and brain metastasis, the absence of spreading to lymph nodes and the localised, intrapelvic, aspect of the bone lesion that was detected (AU)