Factores de riesgo asociados a evolución desfavorable en el tratamiento de las infecciones de partes blandas

Introducción: Las infecciones de piel y partes blandas (IPPB) son una consulta frecuente y los casos graves conllevan morbimortalidad, por lo que su identificación y manejo precoz es fundamental para mejorar el pronóstico. Objetivo: Identificar los factores de riesgo asociados a una evolución desfavorable y mortalidad en pacientes tratados por IPPB en nuestro centro. Materiales y Método: Se realizó un estudio de casos y controles de una serie consecutiva de 172 pacientes con diagnóstico de IPPB entre enero de 2018 y enero de 2019, se recolectaron variables clínicas, de laboratorio e imagenológicas. Se definió como casos aquellos que requirieron cirugía, ingresaron a una unidad de paciente crítico o fallecieron, y como controles a los pacientes con buena respuesta al tratamiento médico. Resultados: Al realizar el análisis estadístico: la leucocitosis > 12.000 cel/mm3 (OR 6,56; IC 95%; 3,21-13,42), y la PCR > 150 mg/dl (OR 7,79; IC 95%; 3,59-16,91), resultaron ser factores de riesgo para evolución desfavorable. El puntaje LRINEC elevado (25,5% vs. 15,1%, p = 0,1034) y la cirugía tardía al ingreso (31,3% vs. 16,2%, p = 0.2632) fueron más frecuente en los casos de evolución desfavorable, pero sin diferencia significativa. Discusión: El uso de parámetros clínicos, de laboratorio e imágenes es fundamental para un diagnóstico precoz y tratamiento oportuno. Conclusiones: La leucocitosis, la elevación de la PCR y la cirugía tardía son factores de mal pronóstico en IPPB. El puntaje LRINEC aún es controversial por su baja sensibilidad.

Introduction: Skin and soft tissue infections (SSTI) are a frequent consultation and severe cases carry morbidity and mortality, so their early identification and management is essential to improve prognosis. Aim: To identify the risk factors associated with an unfavorable evolution and mortality in patients treated for SSTI in our center. Materials and Method: A case-control study of a consecutive series of 172 patients diagnosed with SSTI between January 2018 and January 2019 was carried out, clinical, laboratory and imaging variables were collected. Cases were defined as those that required surgery, were admitted to a critical patient unit or died, and as controls were patients with a good response to medical treatment. Results: When performing the statistical analysis: leukocytosis > 12,000 cel/mm3 (OR 6.56; 95% CI; 3.21-13.42), and CRP > 150 mg/dl (OR 7.79; 95% CI; 3.59-16.91), turned out to be risk factors for unfavorable evolution. The high LRINEC score (25.5% vs. 15.1%, p = 0.1034) and late surgery on admission (31.3% vs. 16.2%, p = 0.2632) were more frequent in cases of evolution unfavorable but without significant difference. Discussion: The use of clinical, laboratory and imaging parameters is essential for an early diagnosis and timely treatment. Conclusions: Leukocytosis, elevated CRP, and late surgery are poor prognostic factors in SSTI. The LRINEC score is still controversial due to its low sensitivity.

Neumotórax espontáneo bilateral metastásico. Inusual manifestación de metástasis pulmonar / Spontaneous metastatic bilateral pneumothorax. Unusual manifestation of lung metastasis

Resumen Objetivo: Comunicar el caso de una paciente de 77 años tratada de un angiosarcoma de cuero cabelludo, que evoluciona con neumotórax bilateral, cuyo estudio histopatológico informa enfermedad metastásica. Materiales y Método: Revisión de ficha clínica electrónica, registro informático de imagenología e informes de biopsias. Seguimiento ambulatorio en policlínico de cirugía. Resultados: Se realiza manejo por videotoracoscopía bilateral, con bulectomía más pleurodesis. Discusión: El neumotórax secundario por enfermedad metastásica es poco frecuente, aproximadamente 1% a 2% de los casos. De los tumores que más frecuentemente metastizan al pulmón se encuentran los sarcomas. Conclusión: El neumotórax metastásico es poco frecuente y requiere un alto índice de sospecha. Su manejo va a depender del pronóstico y de las condiciones generales del paciente.

Aim: To report the case of a 77-year-old patient treated for angiosarcoma of the scalp, who evolves with bilateral pneumothorax, whose histopathological study reports metastatic disease. Materials and Method: Review of electronic clinical record, computerized imaging record and biopsy reports. Outpatient follow-up at the polyclinic of surgery. Results: Management was performed by bilateral videothoracoscopy, with bulectomy plus pleurodesis. Discussion: Secondary pneumothorax due to metastatic disease is rare, approximately 1 to 2% of cases. Sarcomas are among the tumors that most frequently metastasize to the lung. Conclusion: Metastatic pneumothorax is infrequent and requires a high index of suspicion. Its management will depend on the prognosis and the general conditions of the patient.

Hipoglicemiantes Orais Para Diabetes Mellitus Tipo 2: Comparação de Preços no Brasil e em Outros Sistemas Universais de Saúde.

OBJECTIVES: To estimate the average price of oral hypoglycemic agents provided by the Brazilian health system (SUS) and to compare them to other public health systems. METHODS: Cross-sectional study about drug prices purchased by Belo Horizonte (municipal level), Minas Gerais (state level) and federal institutions in January and February of 2014. Average prices were calculated by defined daily dosage (DDD) and were compared to the management levels and the program "Aqui Tem Farmácia Popular" (ATFP). For international comparison, reimbursement values from Spain, Portugal, the United Kingdom and Canada (Province of Quebec) were used. RESULTS: Belo Horizonte had higher average prices than Minas Gerais. In general, essential oral hypoglycemic agents purchased by the SUS had lower prices than ATFP. For example, glibenclamide 5 mg was 1.023% more expensive. Metformin purchased by ATFP was more expensive than by SUS. Eight drugs purchased by SUS had average values above the respective Brazilian price ceiling. As an international comparison, SUS had lower average prices for glibenclamide and metformin. In ATFP, metformin was more expensive than in other countries, while glibenclamide was cheaper than Portugal only. CONCLUSION: The municipal management level had higher average prices than state level. Oral hypoglycemic agents purchased by SUS are predominantly cheaper than ATFP. Average prices paid by SUS are lower, while the prices paid by ATFP are higher than the reimbursed amounts from other countries.

Aplicación de tres modelos pronósticos en cáncer de mama precoz / Application of three prognostic models in T1N0M0 breast cancer

Resumen Objetivo Aplicar tres modelos pronósticos "online" (índice pronóstico de Nothingham (NPI), Adjuvantonline! (AO) y PREDICT utilizados en la práctica oncológica para estratificar a pacientes y definir el uso de terapias adyuvantes en pacientes con cáncer de mama (CM) precoz, para evaluar su correlación y predicción de sobrevida en nuestra población. Métodos Obtuvimos datos clínicos de pacientes con CM invasor T1N0M0, tratados en el Centro de Cáncer de la Pontificia Universidad Católica de Chile, Santiago, Chile, desde enero de 1997 hasta diciembre de 2003. Resultados Analizamos datos de 125 pacientes. Edad mediana fue 55 años (35-80). La mayoría de los tumores fueron carcinomas ductales infiltrantes (72,8%), receptor de estrógeno (RE) positivos (88,8%), 80% recibieron terapia endocrina (TE). El beneficio estimado de la TE y la quimioterapia (QT) en la sobrevida global (SG), determinadas según AO y PREDICT, no fueron significativamente diferentes (1,3% y 1% para QT, p = 0,13; 0,9% y 1% para TE, p = 0,8; respectivamente). El modelo NPI estimó una mediana de SG superior (96%) a la calculada por AO (90,9%) y PREDICT (92,5%). La mortalidad específica por CM fue de 3%, similar a lo observado (3,2%). La mediana de SG estimada por todos los modelos en el grupo de pacientes fallecidos no fue estadísticamente diferente al grupo de sobrevivientes (p = 0,85). Conclusión Los modelos pronósticos predicen apropiadamente la SG en pacientes con CM precoz; sin embargo, en esta serie, no discriminaron pacientes de mal pronóstico.

Objective Apply three prognostic models "online" (Nothingham index (NPI), Adjuvantonline! (AO) and PREDICT used in routine oncology practice in order to stratify patients and define the use of adjuvant therapies in patients with stage I breast cancer (BC) to evaluate its correlation and overall survival (OS) in our population. Methods We obtained patients' medical records data with invasive BC T1N0M0, treated at the Cancer Center of the Pontificia Universidad Católica de Chile, Santiago, Chile, from January 1997 to December 2003. Results We analyzed data from 125 patients. Median age was 55 years (35 80). Most tumors were infiltrating ductal carcinoma (72.8%), estrogen receptor positive (88.8%), 80% received endocrine therapy (ET). The estimated ET and chemotherapy benefit was not significantly different according to the AO and PREDICT models (1.3% and 1% for CT, p = 0.13, 0.9% and 1% for ET p = 0.8, respectively). The estimated median OS on NPI (96%) was higher than calculated by AO (90.9%) and PREDICT (92.5%). Interestingly disease specific mortality estimated was 3%, similar to that observed (3.2%). While the estimated median OS by all models in the group of deceased patients was lower than in surviving, this difference did not reach statistical significance (p = 0.85). Conclusion The prognostic models applied effectively predict OS in Chilean patients with T1N0M0 BC, but in this series, they do not sufficiently discriminate patients with poor prognosis. The addition of co -morbidities to AO does not alter the results.

Infection due to travel-related carbapenemase-producing Enterobacteriaceae, a largely underestimated phenomenon in Belgium.

BACKGROUND: Carbapenemase-producing Enterobacteriaceae (CPE) are emerging worldwide, representing a major threat for public health. Early CPE detection is crucial in order to prevent infections and the development of reservoirs/outbreaks in hospitals. In 2008, most of the CPE strains reported in Belgium were imported from patients repatriated from abroad. Actually, this is no longer the case. OBJECTIVES AND METHODS: A surveillance was set up in Belgian hospitals (2012) in order to explore the epidemiology and determinants of CPE, including the link with international travel/hospitalization. The present article describes travel-related CPE reported in Belgium. Different other potential sources for importation of CPE are discussed. RESULTS: Only 12% of all CPE cases reported in Belgium (2012-2013) were travel related (with/without hospitalization). This is undoubtedly an underestimation (missing travel data: 36%), considering the increasing tourism, the immigration from endemic countries, the growing number of foreign patients using scheduled medical care in Belgium, and the medical repatriations from foreign hospitals. The free movement of persons and services (European Union) contributes to an increase in foreign healthcare workers (HCW) in Belgian hospitals. Residents from nursing homes located at the country borders can be another potential source of dissemination of CPE between countries. Moreover, the high population density in Belgium can increase the risk for CPE-dissemination. Urban areas in Belgium may cumulate these potential risk factors for import/dissemination of CPE. CONCLUSIONS: Ideally, travel history data should be obtained from hospital hygiene teams, not from the microbiological laboratory. Patients who received medical care abroad (whatever the country) should be screened for CPE at admission.

Clinicopathologic subtypes and compromise of lymph nodes in patients with breast cancer.

UNLABELLED: Breast cancer (BC) is currently a heterogeneous disease with variations in clinical behaviour. Classification according to subtypes has allowed progress in the individualisation of treatment. The objective of this study is to evaluate the risk of axillary node compromise in patients with BC, according to clinicopathologic subtypes. Materials and methods are a retrospective, descriptive-analytical study. All patients that had undergone surgery for invasive BC were included, with the study of sentinel lymph nodes (SLNs) at Hospital Clínico de la Pontificia Universidad Católica, between May 1999 and December 2012. The results showed 632 patients fulfilled the inclusion criteria, with the median age being 55 years (range: 28-95), and 559 (88.4%) patients presented with estrogen receptor and/or progesterone receptor positive tumours. Luminal A: 246 patients (38.9%), luminal B: 243 (38.4%), luminal not otherwise specified: 70 (11.1%) triple negative (TN): 60 (9.5%) and over expression of epidermal growth factor type 2 receptor (HER2 positive): 13 (2.1%). Luminal tumours displayed a greater risk of metastasis in the SLNs, but this difference was not statistically significant (p = 0.67). TN and HER2 positive tumours presented the greatest proportion of metastatic compromise in non-sentinel lymph nodes (non-SLNs) (57.1% and 50%, respectively). The presence of macrometastasis (MAM) in the SLN was associated with a greater risk of compromise of the non-SLN. CONCLUSIONS: Luminal tumours are the most frequent and present a greater proportion of axillary lymph node compromise, without being statistically significant. TN and HER2 positive tumours tend to have a higher axillary compromise; however, this was not statistically significant in either. Only the presence of MAM in SLNs displayed a statistically significantly association in the compromise of non-SLNs.

Hiperparatiroidismo primario: manejo quirúrgico / Primary hyperparathyroidism: surgical treatment

Background: Primary hyperparathyroidism (HPTP) is the most common cause of hypercalcaemia in the ambulatory setting. This condition affects between 0.1 -2 percent of the population. Surgery is the only curative treatment. Objective: The aim of the study is to present our 10-year surgical experience. Methods: Analytical-descriptive study. We included all patients diagnosed with HPTP treated with surgery in our hospital between June 2003 and June 2013. Results: 173 patients underwent surgery for HPTP. The mean age was 57.5 +/- 13.5 years. Asymptomatic in 98 cases (56.6 percent). Resection the abnormal parathyroid glands was performed in all cases with intraoperative PTH monitoring. In 167 patients (96.5 percent) intraoperative PTH declined ≥ 50 percent. The median follow-up was 61 months (1-117 months). Cure was achieved in 169 patients (97.7 percent). Four cases (2.3 percent) had recurrence. Conclusions: Surgery is effective and safe for the treatment of HPTP. A decline in intraoperative PTH > 50 percent predicts cure in 97.7 percent of cases.

Introducción: El hiperparatiroidismo primario (HPTP), es una entidad frecuente que afecta entre el 0,1 y 2 por ciento de la población. La cirugía es el único tratamiento curativo. Objetivo: Evaluar la eficacia y riesgos del tratamiento quirúrgico del HPTP. Material y Métodos: Estudio analítico-descriptivo. Se incluyó a todos los pacientes con diagnóstico de HPTP referidos para cirugía al Hospital Clínico de la Pontificia Universidad Católica de Chile entre junio de 2003 y junio de 2013. Resultados: 173 pacientes fueron operados en nuestra institución por HPTP. El promedio de edad de los pacientes fue de 57,5 +/- 13,5 años. La forma de presentación fue asintomática en 98 casos (56,6 por ciento) y sintomática en 75 casos (43,4 por ciento). Todos los pacientes fueron tratados con resección de la o las glándulas hiperfuncionantes con medición de PTH intraoperatoria. En 167 pacientes (96,5 por ciento) se logró caída de PTH intraoperatoria > 50 por ciento. Catorce pacientes (8,1 por ciento) presentaron complicaciones post operatorias. La mediana de hospitalización fue de 2 días (1 a 23 días). La mediana de seguimiento fue de 61 meses (6 a 117 meses). Se logró curación en 169 pacientes (97,7 por ciento). Cuatro casos (2,3 por ciento) presentaron recidiva. Conclusiones: La cirugía es eficaz y segura para el tratamiento del hiperparatiroidismo primario. Una caída de PTH intraoperatoria > 50 por ciento del valor basal predice curación en 97,7 por ciento de los casos.

Impacto de las metástasis del linfonodo centinela y su tamaño, en el tratamiento del cáncer de mama / Impact of sentinel lymph node metastases in the treatment of breast cancer

Introducción: La importancia de las metástasis encontradas en linfonodos centinelas (LC) de pacientes con cáncer de mama ha sido cuestionada, por lo que frente al hallazgo de éstas, la observación sin disección axilar (DA), asociada a terapias adyuvantes, ha sido considerada como una alternativa en los últimos años. Objetivo: Evaluar las macro (MA), micro (MI) y submicrometástasis (SM) de cáncer de mama en LC, y su impacto en la DA posterior. Materiales y Métodos: Se revisaron los resultados de las biopsias de pacientes con cáncer de mama invasor con MA, MI y SM encontradas en el LC operadas en nuestra institución, entre mayo de 1999 y diciembre de 2011. Resultados: Se encontraron 134 pacientes con MA, 33 pacientes con MI y 30 SM, dentro de 632 pacientes con cáncer de mama invasor a los que se les realizó LC. De estos se operaron 130, 24 y 17 pacientes, respectivamente. La frecuencia de Linfonodos No Centinelas (LNC) con metástasis encontradas en la DA fue de 46,9 por ciento (61/130) para MA, 33,3 por ciento (8/24) para MI y 23,5 por ciento (4/17) para SM. Las metástasis del LNC provenientes de MA modificaron el TNM en 26,9 por ciento (35/130), las provenientes de MI en 20,8 por ciento (5/24) pacientes, mientras que las SM sólo lo modificaron en un paciente (5,9 por ciento). Conclusiones: La frecuencia del compromiso linfonodal en la DA es significativamente mayor en las pacientes con MA. El número de DA sin claro aporte terapéutico es alto y aumenta al disminuir el tamaño de las metástasis en el LC. Los resultados apoyan no realizar la DA en pacientes con MI y SM en el LC, que hayan recibido tratamiento quirúrgico conservador y vayan a recibir adyuvancia sistémica.

Introduction: The importance of sentinel lymph nodes (SL) metastasis at breast cancer patients has been questioned and observation without axillary dissection (AD) associated with adjuvant therapies has been the recommendation in recent years. Objective: To evaluate the macro (MA), micro (MI) and submicrometastasis (SM) of breast cancer in SL, and their impact on the posterior AD. Methods: We reviewed results of biopsies from patients with invasive breast cancer with MA, MI and SM found in the SL operated at our institution between May 1999 and December 2011. Results: We found 134 patients with MA, 33 patients with MI and 30 patients with SM, in a total of 632 patients with invasive breast cancer in those who underwent SL. These were operated 130, 24 and 17 patients respectively. The frequency of no sentinels lymph nodes (NSL) with metastases found on AD was 46.9% (61/130) for MA, 33.3% (8/24) for MI and 23.5% (4/17) for SM. The NSL metastasis from MA modified the TNM in 26.9% (35/130), those from MI in 20.8% (5/24) patients, while the SM only modified in one patient (5.9%). Conclusions: The frequency of lymph nodal involvement in AD is significantly higher in patients with MA. The number of AD without clear therapeutic input is high and increases with decreasing size of SL metastases. The results support to not perform AD in patients with MI and SM in the SL, who received conservative surgery and adjuvant therapy.

Cáncer medular de tiroides: Experiencia quirúrgica en 10 años / Medullary thyroid cancer: Review of 28 patients

Background: Medullary thyroid cancer (MTC) represents approximately 5% of all thyroid cancers. Surgery is the only curative treatment, which includes total thyroidectomy and in most cases, neck dissection. Aim: To report our 10-year experience with surgical treatment of MTC. Material and Methods: Review of medical records and pathology reports of a university hospital. We retrieved data from 28 patients aged 47.2 ± 16 years (21 women) operated for a MTC treated between June 2002 and June 2012. Results: In 20 patients, MTC was diagnosed in the preoperative period. Total thyroidectomy was performed in all cases and included a neck dissection in 24 patients. Median follow-up was 48 (2-120) months. Twenty-five patients (89.2%) achieved complete remission of the disease and three had disease recurrence. There were no deaths during the follow up. Conclusions: The diagnosis of MTC is mainly based on cytology. Total thyroidectomy with neck dissection is the treatment of choice. An early-stage diagnosis is associated with low rates of recurrence and absence of mortality.

Development and assessment of national performance indicators for infection prevention and control and antimicrobial stewardship in European long-term care facilities.

BACKGROUND: Healthcare-associated infections in long-term care facilities (LTCFs) are of increasing importance. AIM: To develop consensus national performance indicators (NPIs) for infection control (ICPI) and antimicrobial stewardship (ASPI) in LTCFs, and assess the performance of 32 European countries against these NPIs. METHODS: Previously established European standards were the basis for consensus and the same iterative approach with national representatives from the 32 countries. A World Health Organization scoring system recorded how close each country was to implementing each standard. FINDINGS: The 42 agreed component indicators were grouped into six NPI categories: 'national programme', 'guidelines', 'expert advice', 'IC structure' (not present in the ASPI), 'surveillance' and 'composite'. 'Guidelines' scored the highest mean total possible score (60%, range 20-100%), followed by 'composite' (53%, range 30-100%), 'expert advice' (48%, range 20-100%), 'surveillance' (47%, range 20-83%), 'national programme' (42%, range 20-100%) and 'IC structure' (39%, range 20-100%). Although several scores were low, some countries were able to implement all NPIs, indicating that this was feasible. Most NPIs were very significantly related, indicating that they were considered to be important by the countries. 'Guidelines' and 'IC structure' were significantly related to European region (P ≤ 0.05). Accreditation/inspection was not evident in seven (22%) countries, nine (28%) countries had accreditation/inspection that included IC assessments, and seven (22%) countries had accreditation/inspection that included IC and antimicrobial stewardship assessments. Multi-variable analysis found that only the NPI and the ICPI 'expert advice' were associated with accreditation/inspection which included IC and antimicrobial stewardship. CONCLUSION: The identified gaps represent significant potential patient safety issues. The NPIs should serve as a basis for monitoring improvements over the coming years.

Rendimiento diagnóstico del marcador tumoral CA 19-9 en la diferenciación entre patología bilio-pancreática benigna y maligna / Accuracy of the tumor marker CA 19-9 in the differentiation of benign and malignant bilio-pancreatic diseases

Introduction: CA 19-9 has been identified as a derivative of sialic Lewis blood group A and is expressed in 95 percent of the population. Several studies have documented an overproduction of CA 19-9 in malignant pancreatic and biliary tree diseases. The objective of this study is to determine the accuracy of the tumor marker CA 19-9 differentiating benign and malignant bilio-pancreatic diseases. Material and Methods: diagnostic test study. We reviewed the records of all patients with malignant bilio-pancreatic diseases and benign biliary calculous diseases evaluated in Hospital Base Osorno between august 2007 and december 2011, with CA 19-9 as part of their study. Results: 71 patients met the inclusion criteria, 17 men and 54 women, with a mean age of 60.7 +/- 15.3 years old. Twenty nine (40.8 percent) cases were benign and 42 (59.2 percent) cases malignant. For a cutoff level of 37 U/ml the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) to differentiate benign from malignant disease was 81 percent, 72.4 percent, 81 percent and 72.4 percent, respectively. For a cut off level of 130 U/ml specificity and PPV increased to 96.6 percent and 96.4 percent, respectively. Conclusions: the use of CA 19-9 is useful in the diagnosis of patients with suspected bilio-pancreatic malignant disease. The optimization of the normal published value can help to improve accuracy.

Introducción: El CA 19-9 se ha identificado como un derivado siálico del grupo sanguíneo Lewis A y se expresa en el 95 por ciento de la población. Numerosos estudios han documentado una sobreproducción de CA 19-9 en tumores malignos del árbol biliar y páncreas. El objetivo de este estudio es determinar la utilidad del marcador tumoral CA 19-9 en la diferenciación de patología bilio-pancreática benigna y maligna. Material y Métodos: estudio de pruebas diagnósticas. Se revisaron los antecedentes de todos los pacientes con patología bilio-pancreática maligna y enfermedad litiásica biliar benigna, evaluados en el Hospital Base de Osorno entre agosto de 2007 y diciembre de 2011, a los que se les haya solicitado CA 19-9 como parte de su estudio. Resultados: 71 pacientes cumplieron los criterios de inclusión, 17 hombres y 54 mujeres, con una media de 60,7 +/- 15,3 años de edad. Veintinueve (40,8 por ciento) casos correspondieron patología benigna y 42 (59,2 por ciento) casos a patología maligna. Para un valor de corte de 37 U/ml la sensibilidad, especificidad, valor predictivo positivo (VPP) y valor predictivo negativo (VPN) para diferenciar enfermedad benigna de maligna fue de 81 por ciento, 72,4 por ciento, 81 por ciento y 72,4 por ciento, respectivamente. Para un valor de corte de 130 U/ ml la especificidad y el VPP aumentaron a 96,6 por ciento y 96,4 por ciento, respectivamente. Conclusiones: el uso del Ca 19-9 es útil en el proceso diagnóstico de pacientes con sospecha de patología bilio-pancreática maligna. La optimización de los valores sobre el valor de normalidad publicado puede ayudar a mejorar su rendimiento.

Abordaje transtorácico para la hidatidosis pulmonar derecha y hepática concomitante / Transthoracic approach for concurrent right lung and liver hydatid cysts

Introduction: Pulmonary and hepatic hydatid disease occurs concomitantly in 4 to 33 percent of cases. When the condition is localized in the right lung and liver dome surgical resolution in one time is possible. Objective: To describe the transthoracic-transfrenic approach and review the available literature. Material and Methods: We report two cases operated at our institution through a right posterolateral thoracotomy and frenotomy in one stage, with uneventful postoperative evolution. A systematic review of the literature was conducted in the PubMed database period 1990-2011. Five studies met the inclusion criteria. Conclusions: Transthoracic-transfrenic approach is feasible and safe, allowing the surgical resolution in one time through a single incision, without another anesthetic procedure or subsequent laparotomy, with low morbidity and mortality.

Introducción: La hidatidosis pulmonar y hepática concomitante se presenta en el 4 a 33 porciento de los casos. Cuando la afección está localizada en el pulmón derecho y el domo hepático la resolución quirúrgica en un tiempo es posible. Objetivo: Describir el abordaje transtorácico-transfrénico y revisar la literatura disponible. Material y Métodos: Se presentan dos casos clínicos resueltos quirúrgicamente en nuestro centro a través de toracotomía posterolateral derecha y frenotomía en un tiempo, con evolución satisfactoria sin complicaciones. Se realizó una revisión sistemática de la literatura en la base de datos PubMed, período 1990-2011. Cinco estudios cumplieron los criterios de inclusión. Conclusiones: El abordaje transtorácico-transfrénico es factible y seguro, permitiendo la resolución en un tiempo quirúrgico a través de una sola incisión, sin necesidad de otro evento anestésico ni de una laparotomía posterior, con baja morbilidad y mortalidad.

Rendimiento de la biopsia intraoperatoria por congelación en el estudio del linfonodo centinela en cáncer de mama / Intraoperative frozen section of the sentinel lymph nodes in breast cancer

Introduction: The sentinel lymph node (SN) biopsy has become the standard technique for staging the axillary involvement in breast cancer. The intraoperative diagnosis of lymph node metastatic involvement can immediately decide the need for axillary dissection. The main objective of this study was to determine the accuracy of intraoperative frozen section in the investigation of metastases in the SN, in patients with breast cancer, between 1999 and 2011. Materials and Methods: A retrospective study of patients operated for invasive breast cancer, in which the SN was studied with intraoperative frozen section. Results: 503 patients biopsy was performed with intraoperative frozen section. One hundred fifty-four (30.6 percent) patients had metastases in the SN, of these 103 (66.9 percent) were detected on frozen section. No significant difference in the ability to detect metastases for tumors up to 2 cm and tumors more than 2 cm was observed (p = 0.86). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of frozen section for detection of metastases in the SN was 66.9 percent, 99.7 percent, 99 percent and 87 percent, respectively. Conclusions: The accuracy of intraoperative biopsy for detection of metastases in the SN in our center is comparable to that described in the literature, being effective only for the investigation of macrometastases (MA). Given the low frequency of metastases in the SN in tumors up to 2 cm, associated with a relatively high number of micro (MI) and submicrometastasis (SM) and false negatives, it seems that in these tumors intraoperative biopsy is unnecessary.

Introducción: La biopsia del linfonodo centinela (LC) se ha convertido en la técnica estándar para estadificar el compromiso axilar en el cáncer de mama. El diagnóstico intraoperatorio del compromiso metas-tásico del linfonodo permite decidir en forma inmediata la necesidad de disección axilar. El objetivo general de este estudio fue determinar el rendimiento de la biopsia intraoperatoria por congelación en la pesquisa de metástasis en el LC, en pacientes con cáncer de mama, entre 1999 y 2011. Material y Métodos: Estudio retrospectivo de las pacientes operadas por cáncer de mama invasor, en que se realizó biopsia del LC, con estudio intraoperatorio por congelación. Resultados: 503 pacientes con biopsia del LC con estudio intrao-peratorio. Ciento cincuenta y cuatro (30,6 por ciento) pacientes tuvieron metástasis en el LC, de estos 103 (66,9 por ciento) fueron detectadas en la biopsia rápida. No hubo diferencias significativas en la capacidad de detección para los tumores de hasta 2 cm y los tumores mayores de 2 cm (p = 0,86). La sensibilidad, especificidad, valor predictivo positivo (VPP) y valor predictivo negativo (VPN) de la biopsia intraoperatoria para la detección de metástasis en el LC fue de 66,9 por ciento, 99,7 por ciento, 99 por ciento y 87 por ciento, respectivamente. Conclusiones: El rendimiento obtenido es comparable al descrito en la literatura, siendo efectiva sólo para la pesquisa de macrometástasis (MA). Dada la baja frecuencia de metástasis en el LC en tumores de hasta 2 cm, asociado a un número relativamente alto de micro (MI) y submicrometástasis (SM) y de falsos negativos, nos parece que, en estos casos, la utilización de la biopsia intraoperatoria del LC es innecesaria.

Resultados de la cirugía torácica mínimamente invasiva (vídeo-asistida) en el tratamiento de la Miastenia Gravis / Results of minimally invasive thoracic surgery (video-assisted) in the treatment of Myasthenia Gravis

Introduction: Myasthenia Gravis (MG) is the most common primary disorder of neuromuscular transmission. Treatment is multidisciplinary medical and surgical. Thymectomy is now part of standard treatment with clinical improvement in approximately 85 percent of cases. The best approach has not yet been defined. Objective: To evaluate the results of thymectomy for minimally invasive surgery (video-assisted) in patients with MG, with or without thymoma, analyzing the results in the literature to date. Material and Methods: We conducted a systematic review of literature in the PubMed database. Results: We found 66 publications related to the search, 20 studies were selected for review. We included those that evaluated the results of thymectomy in MG patients with or without thymoma. Discussion: Minimally invasive surgery (video-assisted) is a safe way, with low morbidity, shorter hospitalization, better cosmetic result and complete remission rates or improvement at least equivalent to conventional surgical approaches. These results should be evaluated with caution because there isn't enough evidence to ensure that minimally invasive surgery is the best approach.

Introducción: La Miastenia Gravis (MG) es el desorden primario más común de la transmisión neuro-muscular. Su tratamiento es multidisciplinario, médico y quirúrgico. La timectomía es en la actualidad parte del estándar de tratamiento con mejorías clínicas en aproximadamente el 85 por ciento de los casos. El mejor abordaje aún no se ha definido. Objetivo: Evaluar los resultados de la timectomía por cirugía mínimamente invasiva (video-asistida) en pacientes con MG, con o sin timoma, analizando los resultados en la literatura disponible hasta la actualidad. Material y Métodos: Se realizó una revisión sistemática de la literatura en la base de datos PubMed. Resultados: Se encontró 66 publicaciones relacionadas con la búsqueda, de los cuales se seleccionó 20 estudios para revisión. Se incluyó aquellos en los que se evaluó los resultados de la timectomía en pacientes con MG, con o sin timoma. Discusión: La cirugía mínimamente invasiva (video-asistida) es una vía segura, con tasas de morbilidad bajas, menor tiempo de hospitalización, buen resultado estético y tasas de remisión completa o de mejoría al parecer equivalentes a las vías de abordaje clásicas. Estos resultados deben evaluarse con cautela ya que no existe suficiente evidencia para asegurar que la cirugía mínimamente invasiva es el mejor abordaje.

[Medullary thyroid cancer: review of 28 patients]. / Cáncer medular de tiroides: experiencia quirúrgica en 10 años.

BACKGROUND: Medullary thyroid cancer (MTC) represents approximately 5% of all thyroid cancers. Surgery is the only curative treatment, which includes total thyroidectomy and in most cases, neck dissection. AIM: To report our 10-year experience with surgical treatment of MTC. MATERIAL AND METHODS: Review of medical records and pathology reports of a university hospital. We retrieved data from 28 patients aged 47.2 ± 16 years (21 women) operated for a MTC treated between June 2002 and June 2012. RESULTS: In 20 patients, MTC was diagnosed in the preoperative period. Total thyroidectomy was performed in all cases and included a neck dissection in 24 patients. Median follow-up was 48 (2-120) months. Twenty-five patients (89.2%) achieved complete remission of the disease and three had disease recurrence. There were no deaths during the follow up. CONCLUSIONS: The diagnosis of MTC is mainly based on cytology. Total thyroidectomy with neck dissection is the treatment of choice. An early-stage diagnosis is associated with low rates of recurrence and absence of mortality.

Resultados del tratamiento de la hidatidosis pulmonar complicada y no complicada / Treatment results of complicated and uncomplicated pulmonary hydatidosis

Introduction: Hydatidosis is an endemic disease in our country caused by the cestode Echinococcus granulosus. The lung is the second most affected organ in humans. Objective: To review the results of surgical treatment of pulmonary hydatidosis in Hospital Base Osorno and analyze its presentation, surgical treatment and results of complicated and uncomplicated forms. Material and Methods: Retrospective case series of patients with pulmonary hydatidosis operated at the Surgery Department of Hospital Base Osorno between January 2001 and may 2011. Results: We reviewed data from 27 patients (21 men and 6 women) with 39 pulmonary hydatid cysts in total. The average age was 35 +/- 16.2. The average number of cysts per patient was 1.4 +/- 0.6. Four patients (15 percent) had bilateral disease. Fifteen patients (55.5 percent) had complicated cysts and 12 (44.5 percent) had uncomplicated cysts. Fever and cough were significantly more frequent in patients with complicated cysts (p < 0.05). Twenty nine pericystectomies with capitonaje were performed, 9 without capitonaje and one right lower lobectomy. There were no significant differences in morbidity and mortality between groups. Discussion: Pulmonary hydatidosis has a low frequency of occurrence, debuting mainly in young patients. Their complicated forms differ in some aspects of their presentation with uncomplicated cysts; however, in our series there were no differences in postoperative results.

Introducción: La hidatidosis es una enfermedad endémica en nuestro país, producida por el céstodo Echinococcus granulosus. El pulmón es el segundo órgano más afectado en el humano. Objetivo: Revisar los resultados del tratamiento quirúrgico de la hidatidosis pulmonar en el Hospital Base Osorno y analizar su presentación, tratamiento quirúrgico y resultados de sus formas complicada y no complicada. Material y Métodos: Serie de casos retrospectiva de pacientes con hidatidosis pulmonar intervenidos en el Servicio de Cirugía del Hospital Base Osorno entre enero de 2001 y mayo de 2011. Resultados: Se revisaron los datos de 27 pacientes (21 hombres y 6 mujeres) con 39 quistes hidatídicos pulmonares en total. El promedio de edad fue 35 +/- 16,2 años. El promedio de quistes por paciente fue de 1,4 +/- 0,6. Cuatro pacientes (15 por ciento) presentaron enfermedad bilateral. Quince pacientes (55,5 por ciento) presentaron quistes complicados y 12 (44,5 por ciento) no complicados. La fiebre y la tos fueron significativamente más frecuentes en los pacientes con quistes complicados (p < 0,05). Se realizaron 29 periquistectomías asociadas a capitonaje, 9 sin capitonaje y una lobectomía inferior derecha. No hubo diferencias significativas en cuanto a morbilidad ni mortalidad entre los grupos. Discusión: La hidatidosis pulmonar tiene una baja frecuencia de presentación, debutando principalmente en pacientes jóvenes. Sus formas complicadas difieren en algunos aspectos de su presentación con los quistes no complicados, sin embargo, en nuestra serie no se encontraron diferencias en los resultados postoperatorios.

Hiperobesidad y obesidad mórbida: estudio comparativo / Hiperobesity v/s morbid obesity: a comparative study

Introduction: Bariatric surgery is effective and safe in treating obese patients with BMI > 40, however, higher preoperative weight could increases morbidity and mortality. Aim: To describe and compare the perioperative and mid term outcomes between hiperobese and morbidly obese patients submitted to gastric bypass. Material and Method: A prospective study of hiperobese patients submitted to gastric bypass over the past 10 years. We analyzed clinical characteristics, perioperative morbimortality and resolution of comor-bidities. The results were compared with a group of morbidly obese patients matched by age and sex. Results: 146 hiperobese were operated and compared with 165 morbidly obese patients. 66.8 percent were female and the average age of the total group was 39.9 +/- 12.4 years, with no significant differences between groups by sex and age. The average BMI was 53 and 44.4 respectively. 21.5 percent had diabetes mellitus 2, 39.5 percent hypertension, 31 percent dislipidemia and 8.4 percent osteoarthritis, with no significant differences between groups except for a higher prevalence of dyslipidemia in the morbidly obeses (p = 0.001). 10.4 percent had surgical complications during the postoperative period, with no differences between both groups (p = 0.24). One year later all patients had a significant decrease in weight, however, hiperobeses showed a more pronounced decrease (p = 0.001). The fasting glucose, cholesterol and triglycerides levels also showed a significant decrease without reaching differences between the groups. Conclusions: The gastric bypass is effective in achieving weight loss and resolution of comorbidities in morbidly obese as well as hiperobese patients, with no significant differences in surgical complications and mortality.

Introducción: La cirugía bariátrica es efectiva y segura en el tratamiento de obesos con IMC > 40, sin embargo, a mayor peso preoperatorio podría aumentar la morbimortalidad. Objetivo: Describir y comparar los resultados perioperatorios y a mediano plazo entre hiperobesos y obesos mórbidos sometidos a bypass gástrico. Material y Método: Estudio prospectivo de pacientes hiperobesos operados de bypass gástrico los últimos 10 años. Se analizaron características clínicas, morbimortalidad perioperatoria y resolución de comorbilidades. Se compararon los resultados con un grupo de obesos mórbidos pareados por edad y sexo. Resultados: Se operaron 146 hiperobesos, que fueron comparados con 165 obesos mórbidos. El 66,8 por ciento fueron mujeres y el promedio de edad fue 39,9 +/- 12,4 años, no encontramos diferencias significativas entre ambos grupos por sexo y edad. El IMC promedio fue 53 y 44,4 respectivamente. El 21,5 por ciento tenía diabetes mellitus 2, el 39,5 por ciento hipertensión arterial, el 31 por ciento dislipidemia y el 8,4 por ciento artrosis, sin encontrar diferencias significativas, a excepción de una mayor prevalencia de dislipidemia en los obesos mórbidos (p = 0,001). Un 10,4 por ciento presentó complicaciones quirúrgicas durante el postoperatorio, no existiendo diferencias entre ambos grupos (p = 0,24). Al año todos los pacientes presentaban un descenso significativo del peso, sin embargo, los hiperobesos presentaban un descenso más acentuado (p = 0,001). Los niveles de glicemia en ayunas, colesterol y triglicéridos también presentaron un descenso significativo sin lograr diferencias entre ambos grupos. Conclusiones: El bypass gástrico es efectivo en la baja de peso y resolución de comorbilidades tanto en obesos mórbidos como hiperobesos, sin presentar diferencias significativas en las complicaciones quirúrgicas y mortalidad.

Previous healthcare exposure is the main antecedent for methicillin-resistant Staphylococcus aureus carriage on hospital admission in Belgium.

This study aimed to estimate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) carriage upon hospital admission and to study the molecular epidemiology of MRSA in order to assess the proportion of Panton-Valentine leukocidin (PVL)-positive community-associated (CA) and livestock-associated (LA) MRSA strains. Epidemiological data on MRSA carriage upon hospital admission (2006-2009) were collected in a compulsory, continuous, national MRSA surveillance in Belgian acute-care hospitals. Additionally, 328 MRSA strains in 2005 and 314 strains in 2008 were collected in a separate, multicenter microbiological survey. Spa-typing, SCCmec-typing and MLST were performed; toxin genes were detected by PCR. The overall prevalence of MRSA carriage upon hospital admission was 8.9 cases/1,000 admissions between 2006 and 2009. Of MRSA carriers, 37.5% had a known MRSA history, 39.4% had stayed in a care facility, 12.2% reported no contact with healthcare. Over 90% of MRSA belonged to five healthcare-associated clones. Of these, MRSA spa-CC038-ST45-IV was in decline, mainly in favor of spa-CC008-ST8-IV. MRSA spa-CC002-ST5-IV, spa-CC002-ST5-II and spa-CC032-ST22-IV remained relatively stable. The proportion of PVL-positive CA-MRSA and LA-MRSA ST398 was below 2% of all MRSA. The extra-hospital MRSA reservoir in Belgium mainly consists of persons with previous healthcare exposure. PVL-positive CA-MRSA and LA-MRSA strains remained infrequent among hospitalized patients.

2-Acetylpyridine- and 2-benzoylpyridine-derived hydrazones and their gallium(III) complexes are highly cytotoxic to glioma cells.

2-Acetylpyridine-phenylhydrazone (H2AcPh), its para-chlorophenylhydrazone (H2AcpClPh) and para-nitrophenylhydrazone (H2AcpNO(2)Ph) analogues, the corresponding 2-benzoylpyridine-derived hydrazones (H2BzPh, H2BzpClPh and H2BzpNO(2)Ph) and their gallium(III) complexes were assayed for their cytotoxic activity against U87 (expressing wild-type p53 protein) and T98 (expressing mutant p53 protein) glioma cells. IC(50) values against both glioma cells and against the MRC5 (human fetal lung fibroblast) lineage were obtained for the hydrazones, but not for their gallium(III) complexes, due to their low solubility. Hydrazones were highly cytotoxic at nanomolar doses against U87 and T98 cells. The therapeutic indexes (TI = IC(50MRC5)/IC(50glioma)) were 2-660 for T98 cells and 28-5000 for U87 cells, indicating that the studied hydrazones could be good antitumor drug candidates to treat brain tumors.