ABSTRACT
Background Chile has one of the highest mortality rates by gastric cancer (GC) worldwide. Primary prevention of GC and detection of pre-neoplastic and early neoplastic lesions should be a national priority. Aim To assess the impact of the protocolization of endoscopy referral and the use of H. pylori stool antigen test (HPSA) in the management of dyspepsia to decrease the waiting list for endoscopy and increase the detection of gastric pre-neoplastic and early neoplastic lesions. Material and Methods We included all patients referred to the Endoscopy Unit of a regional hospital, from January 2015 to December 2017. We also included patients with known pre-neoplastic lesions and all those with first degree relatives with GC. We implemented protocols for referral of patients with dyspepsia considering the use of HPSA test, prioritizing to endoscopy those with a higher risk of GC. Results A total of 4,641 endoscopies and 2,631 HPSA tests were carried out. After the adoption of these protocols, we observed a 52% decrease in the waiting time for endoscopy. The GC detection rate in this period was 1.8 to 3.1 cases per 100 endoscopies. After the adoption of the protocols, we observed a significant increase in early GC detection rate (from none in 2015 to 13% in 2017, p = 0.03). Conclusions The protocolization of the referral for endoscopy associated with widespread use of HPSA test in the management of patients with dyspepsia, are successful strategies to decrease waiting lists for endoscopy and optimize the detection rate of pre-neoplastic lesions and early GC.
Subject(s)
Humans , Precancerous Conditions/diagnosis , Waiting Lists , Helicobacter pylori/isolation & purification , Helicobacter Infections/diagnosis , Dyspepsia/diagnosis , Feces/microbiology , Antigens, Bacterial/analysis , Precancerous Conditions/microbiology , Primary Health Care , Referral and Consultation , Helicobacter Infections/complications , Helicobacter Infections/microbiology , Sensitivity and Specificity , Early Diagnosis , Dyspepsia/microbiology , Endoscopy/statistics & numerical dataABSTRACT
La neoplasia papilar intracolecística (NPIC), es un tumor compuesto por células neoplásicas preinvasivas, que forman masas de hasta 1,0 cm, clínicamente detectables. El objetivo de este estudio fue reportar un caso de NPIC y revisar la evidencia existente. Se trata de un paciente sexo masculino, de 33 años de edad, asintomático, que en el curso de un examen de salud, se realiza una ecotomografía abdominal, en la que se verifica una lesión polipoide vesicular de 32 x 19 mm de diámetro. Se programa para colecistectomía electiva, la que se realizó por vía laparoscópica, cirugía que se pudo realizar sin inconvenientes. Una vez extirpado el espécimen, se fue a estudio histopatológico en el que tras un mapeo vesicular se concluye NPIC, colecistitis crónica inespecífica, colesterolosis y pólipos colesterínicos. El paciente ha evolucionado sin inconvenientes. Presentamos un caso de NPIC en un paciente joven, cuyo diagnóstico fue confirmado por anatomía patológica tras una colecistectomía electiva, descartándose la presencia de carcinoma invasivo y displasia de alto grado, por lo que el pronóstico es favorable.
Intracholecystic papillary neoplasm (ICPN) is a tumor composed of pre-invasive neoplastic cells, with up to 1.0 cm clinically detectable masses. The objective of this study was to report a case of NPIC and review the evidence in the literature. A 33-year-old asymptomatic male patient had an abdominal ultrasonography during a health examination, in which a vesicular polyp lesion of 32 x 19 mm in diameter was verified. Thepatient was subsequently scheduled for elective cholecystectomy, which was performed laparoscopically and the surgery was uneventful. Once removed, the specimen was studied histopathologically and after performing vesicular mapping, we determined an ICPN, chronic non-specific cholecystitis, cholesteroliasis and cholesteric polyps. The patient has evolved without reported problems. We present a case of ICPN in a young patient, whose diagnosis was confirmed by pathological anatomy after an elective cholecystectomy, ruling out the presence of invasive carcinoma and high-grade dysplasia, with a favorable prognosis.
Subject(s)
Humans , Male , Adult , Adenocarcinoma, Papillary/pathology , Gallbladder Neoplasms/pathology , Polyps/pathology , Adenocarcinoma, Papillary/surgery , Cholecystectomy, Laparoscopic , Gallbladder Neoplasms/surgeryABSTRACT
El poroma ecrino (PE) corresponde a una neoplasia anexial benigna originada de la porción intraepidérmica del conducto de las glándulas sudoríparas. Habitualmente se describe como nódulos eritematosos o color piel ubicados en región palmoplantar, pero sus características clínicas son muy variables. Se decriben los hallazgos clínicos y dermatoscópicos de una serie de casos de pacientes con PE. La dermatoscopia puede facilitar significativamente el diagnóstico clínico de la mayoría de los tumores de la piel, sin embargo el PE se caracteriza por un alto grado de variabilidad a la dermatoscopía. Habitualmente se describe un patrón vascula polimorfo con vasos glomerulares, en horquilla, y lineales irregulares con terminaciones semicirculares rodeados de un halo blanco a rosa en forma de caliz o flor de cerezo asociado a áreas rosadas blanquecinas sin estructuras similares a lo observado en melanoma amelanótico, carcinoma espinocelular entre otros tumores benignos y malignos. El PE puede exhibir características clínicas y dermatoscópicas polimórficas que pueden hacer difícil el diagnóstico y su diferenciación de otras neoplasias cutáneas.
Eccrine poroma (PE) is a benign adnexal neoplasm of the intraepidermal portion of the sweat gland duct. PE typically present as erythematous or flesh-colored nodules on the palms and soles, but the clinical features of PE are highly variable. Dermatoscopic and clinical findings of patients with EP are described. Dermoscopy may significantly improves the clinical diagnosis of most skin tumours, but PE is characterised by a high degree of dermoscopic variability. The main dermoscopic features described are polymorphous vascular pattern, whiteto- pink halo surrounding the vessels, pink-white structureless areas, vascular structures of glomerular, hairpin vessels, and linear irregular vessels, mimicking amelanotic melanoma, keratinising tumours and several benign and malignant tumors. Eccrine poroma may exhibit polymorphic clinical and dermoscopic features making it difficult to diagnosis and differentiate from other skin cancers.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Skin Neoplasms/pathology , Sweat Gland Neoplasms/pathology , Poroma/pathology , Skin Neoplasms/diagnosis , Sweat Gland Neoplasms/diagnosis , Dermoscopy , Diagnosis, Differential , Poroma/diagnosisABSTRACT
Background: To validate the BIRADS in mammography, the calculation of its predictive value in each center is required, as recommended by the American College of Radiology. Aim: To determine the predictive value of the BIRADS system in our center. Material and Methods: All ultrasound guided needle percutaneous biopsies, performed at our center between 2006 and 2010 were reviewed. Predictive value, sensitivity, specificity and diagnostic accuracy of BIRADS were calculated, with a confidence interval of 95%. Results: Of 1,313 biopsies available, 1,058 met the inclusion criteria. Fifty eight percent of biopsies were performed to women with mammographies classified as BIRADS 4 or 5. The presence of cancer in mammographies classified as BIRADS 0 was 4%. The prevalence of cancer for mammographies BIRADS 1, 2, 3, 4 and 5 were 0, 3, 2.7, 17.7 and 72.4% respectively. The positive and negative predictive values of BIRADS classification were 55 and 92 % respectively. Conclusions: In our institution BIRADS classification 4 and 5 has a high positive predictive value for detecting cancer as in developed countries.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Middle Aged , Young Adult , Breast Neoplasms/pathology , Breast Neoplasms , Biopsy, Needle , Cross-Sectional Studies , Image-Guided Biopsy , Mammography , Predictive Value of Tests , Sensitivity and SpecificityABSTRACT
Background: We report a 35-year-old female patient with a one year history of a pustular and painful erythematous dermatitis, located in great folds, pubis and abdomen. She was evaluated in primary health care, receiving antifungal treatment, antimicrobials, topical and systemic non-steroidal anti-inflammatory drugs, with no response. A skin biopsy was compatible with subcorneal pustular dermatosis. She was initially treated with prednisone (0.8 mg/kg), observing a partial response. Therefore clotrimoxazole was initiated, obtaining an excellent response after 30 days of treatment.