ABSTRACT
Graft versus host disease is a serious complication that occurs following bone marrow transplant with significant morbidity and mortality. The gold standard to diagnose gastrointestinal graft versus host disease is upper and lower gastrointestinal endoscopy with histological validation. The development of intramural duodenal hematoma is a rare complication associated with this procedure. We present two cases of intramural duodenal haematoma after duodenal biopsies in bone marrow transplant patients that presented clinically with severe abdominal pain and intestinal bleeding. In both cases, CT scans confirmed the diagnosis and they were treated conservatively with favorable outcomes. Final diagnosis of gastrointestinal graft versus host disease was based on the colonic samples with normal duodenal histoarchitecture, which could lead to avoiding duodenal samples in future patients in order to prevent this serious complication and thus diminish morbidity.
La enfermedad de injerto contra huésped es una complicación grave que se presenta después del trasplante de médula ósea, con morbilidad y mortalidad elevadas. El patrón de oro para evaluar su compromiso gastrointestinal es la endoscopia digestiva alta y baja con toma de biopsia. El desarrollo de hematoma duodenal intramural es una complicación poco frecuente asociada con este procedimiento. Se presentan dos casos de hematoma duodenal intramural posendoscopia en pacientes con trasplante y sospecha de enfermedad injerto contra huésped que presentaron un cuadro agudo de dolor abdominal y sangrado intestinal. El diagnóstico se realizó por tomografía y recibieron tratamiento conservador, con un resultado favorable. En ambos casos, el diagnóstico de enfermedad injerto contra huésped gastrointestinal se hizo a través de las biopsias colónicas con histología duodenal normal, lo que sugiere evitar la toma de muestras duodenales para prevenir esta grave complicación en pacientes de alto riesgo y, de este modo, disminuir la morbilidad.
Subject(s)
Duodenal Diseases , Graft vs Host Disease , Child , Duodenal Diseases/diagnosis , Duodenal Diseases/etiology , Endoscopy, Gastrointestinal , Gastrointestinal Hemorrhage , Graft vs Host Disease/diagnosis , Graft vs Host Disease/etiology , Hematoma/diagnosis , Hematoma/etiology , HumansABSTRACT
PURPOSE: To analyze the initial impact of the SARS-CoV-2 pandemic on surgical skills training and performance of Pediatric Surgery Residents. METHODS: Retrospective study considering the modifications on the Pediatric Surgery Residency training from March 1st-May 31st, 2020. Exposure to OR learning opportunities was compared to the same 2018-2019 trimesters. An anonymous survey about self-perception on surgical skills development was also performed. RESULTS: Residents performed 209 procedures as leading surgeons during the 2020 trimester with a mean number of surgeries per resident of 20.9, representing a reduction of 46% and 56.8% compared to the 2018-2019 averages, respectively. Reduction in both the number and the percentage of total procedures (n: 209, 56.8%) compared to both 2019 (n: 354, 68.7%, p: 0.000272) and 2018 (n: 420, 76.1%, p < 0,00,001) showed statistical correlation with no changes in their complexity pattern. From the survey (response rate: 100%), hours dedicated to simulation-based training were highly increased. More time was spent studying, but only 60% achieved better preparation for surgery and 70% perceived a decrease in surgical confidence. CONCLUSIONS: Even though the pandemic promoted new teaching strategies and the use of simulation-based training, it drastically reduced "on-the-job" learning opportunities with potential effects on residents' performance and self-confidence during surgery.
Subject(s)
COVID-19/prevention & control , General Surgery/education , Internship and Residency/organization & administration , Pandemics , COVID-19/epidemiology , COVID-19/psychology , Child , Clinical Competence , Humans , Pandemics/prevention & control , Retrospective Studies , SARS-CoV-2 , Surveys and QuestionnairesABSTRACT
La enfermedad de injerto contra huésped es una complicación grave que se presenta después del trasplante de médula ósea, con morbilidad y mortalidad elevadas. El patrón de oro para evaluar su compromiso gastrointestinal es la endoscopia digestiva alta y baja con toma de biopsia. El desarrollo de hematoma duodenal intramural es una complicación poco frecuente asociada con este procedimiento .Se presentan dos casos de hematoma duodenal intramural posendoscopia en pacientes con trasplante y sospecha de enfermedad injerto contra huésped que presentaron un cuadro agudo de dolor abdominal y sangrado intestinal. El diagnóstico se realizó por tomografía y recibieron tratamiento conservador, con un resultado favorable. En ambos casos, el diagnóstico de enfermedad injerto contra huésped gastrointestinal se hizo a través de las biopsias colónicas con histología duodenal normal, lo que sugiere evitar la toma de muestras duodenales para prevenir esta grave complicación en pacientes de alto riesgo y, de este modo, disminuir la morbilidad.
Graft versus host disease is a serious complication that occurs following bone marrow transplant with significant morbidity and mortality. The gold standard to diagnose gastrointestinal graft versus host disease is upper and lower gastrointestinal endoscopy with histological validation. The development of intramural duodenal hematoma is a rare complication associated with this procedure. We present two cases of intramural duodenal haematoma after duodenal biopsies in bone marrow transplant patients that presented clinically with severe abdominal pain and intestinal bleeding. In both cases, CT scans confirmed the diagnosis and they were treated conservatively with favorable outcomes.Final diagnosis of gastrointestinal graft versus host disease was based on the colonic samples with normal duodenal histoarchitecture, which could lead to avoiding duodenal samples in future patients in order to prevent this serious complication and thus diminish morbidity.
Subject(s)
Humans , Male , Infant , Child , Duodenal Diseases/diagnosis , Duodenal Diseases/etiology , Graft vs Host Disease/diagnosis , Graft vs Host Disease/etiology , Endoscopy, Gastrointestinal , Hematoma/diagnosis , Hematoma/etiology , Gastrointestinal HemorrhageABSTRACT
PURPOSE: Although surgical therapy for testicular tumors (TT) is often radical orchidectomy, tumor resection with preservation of healthy testicular parenchyma has been proposed. This study herein reports a 20 year single center experience applying testicular sparing surgery (TSS) as a primary operative strategy in pediatric patients. A systematic literature review summarizes the utility and outcomes of TSS in appropriately selected patients. METHODS: Pediatric patients with TT who underwent TSS between 1997 and 2018 were studied. TSS was indicated if patients presented evidence of adequately spared healthy testicular parenchyma on preoperative ultrasound and negative serum tumor markers. A systematic review of the literature was also performed. RESULTS: 12 cases met full inclusion criteria with 10 of 12 subjects in the prepubertal age group. Follow-up was 73 months (range 18-278 months). Only a single male patient (GSCCT) presented with early recurrence and orchidectomy was then performed. No cases of postoperative testicular atrophy were identified. Sexual maturation (Tanner stage) expected for age in each patient was documented. Review of the literature identified 34 published studies including 269 patients (94% prepubertal). Pathologic lesions here were mainly mature teratoma(s)-(62%) with a follow-up period of 4 years. Recurrent tumors were observed in only three patients (1.1%) notably two Leydig Cell Tumors and one Teratoma. Testicular atrophy reportedly occurred in only one single case (0.37%). DISCUSSION: TSS is a feasible alternative to radical orchidectomy in pediatric male patients with localized TT and negative tumor markers. Long term follow-up is essential to monitor testicular growth, puberty with sexual development and psychological male health.
Subject(s)
Leydig Cell Tumor/surgery , Testicular Neoplasms/surgery , Adolescent , Biomarkers, Tumor , Child , Child, Preschool , Humans , Infant , Leydig Cell Tumor/pathology , Male , Neoplasm Recurrence, Local/surgery , Orchiectomy , Teratoma/surgery , UltrasonographyABSTRACT
Juvenile polyposis syndrome is a rare autosomal dominant condition characterized by multiple hamartomatous polyps throughout the gastrointestinal tract. Juvenile polyposis of infancy is a generalized severe form of juvenile polyposis syndrome associated with a poor prognosis. A 47-month-old female infant presented initially with gastrointestinal bleeding and protein-losing enteropathy at 4 months of age. At the age of 12 months, the condition worsened, requiring albumin infusions every 24 to 48 hours and red blood cell transfusions every 15 days. Upper gastrointestinal endoscopy, colonoscopy, and small-bowel enteroscopy revealed diffuse polyposis that was treated with multiple endoscopic polypectomies. Despite subtotal colectomy with ileorectal anastomosis, protein-losing enteropathy and bleeding persisted, requiring continued blood transfusions and albumin infusions. A chromosomal microarray revealed a single allele deletion in chromosome 10q23, involving both the PTEN and BMPR1A genes. Loss of PTEN function is associated with an increased activation of the protein kinase B (AKT)/mammalian target of rapamycin (mTOR) pathway involved in cell proliferation. Treatment with sirolimus, an mTOR inhibitor, was initiated with the aim of inhibiting polyp growth. Soon after initiation of treatment with sirolimus, blood and albumin infusions were no longer needed and resulted in improved patient growth and quality of life. This case represents the first detailed report of successful drug therapy for life-threatening juvenile polyposis of infancy.
Subject(s)
Immunosuppressive Agents/therapeutic use , Intestinal Polyposis/congenital , Neoplastic Syndromes, Hereditary/diagnosis , Neoplastic Syndromes, Hereditary/drug therapy , Sirolimus/therapeutic use , Child, Preschool , Female , Follow-Up Studies , Humans , Intestinal Polyposis/diagnosis , Intestinal Polyposis/drug therapy , Intestinal Polyposis/surgery , Neoplastic Syndromes, Hereditary/surgery , Treatment OutcomeABSTRACT
La supervivencia global a 5 años de los pacientes conosteosarcoma no-metastásico es del 60-70%, mientrasque la misma se reduce a 10-30% en los pacientes con enfermedad diseminada. El objetivo de nuestro estudiofue determinar supervivencia y factores pronósticos enun grupo de pacientes con metástasis pulmonares porosteosarcoma tratados quirúrgicamente. Se realizó unabúsqueda retrospectiva en nuestra base de datos oncológicaentre 1992-2006, y 38 pacientes fueron incluidos enel estudio. La edad media al momento del diagnóstico fuede 18 ± 9.4 años (3-45) y el seguimiento promedio de 57± 53.8 meses (12-231). Todos fueron tratados con quimioterapia, resección oncológica del tumor primario y de lasmetástasis pulmonares. Se analizó la supervivencia a 5 y10 años de la serie y los siguientes factores pronósticos: edad, sexo, localización del tumor primario, metástasis de inicio, recidiva local, número de metástasis extirpadasy la respuesta al tratamiento de quimioterapia (necrosistumoral). La supervivencia global fue de 29% a los 5 años(IC95%:14.5-43.5) y de 26% a los 10 años (IC95%:12-40).Se encontró una diferencia estadísticamente significativa entre los buenos y malos respondedores a la quimioterapia:53% (IC95%: 28-78) vs. 8% (IC95%: 0-20) (p = 0.0008). Nose observó relación estadísticamente significativa entre losdemás factores pronósticos analizados. La supervivenciaa 5 y 10 años de los pacientes con osteosarcoma y metástasis pulmonares tratados con quimioterapia y resección quirúrgica continúa siendo pobre. Los pacientes con buena respuesta a la quimioterapia neoadyuvante presentan un mejor pronóstico oncológico.
Five years overall survival in osteosarcoma patients isaround 70%, although in patients with metastatic diseaseit is only 10-30%. The objective of this study was to analyzeoverall survival and prognostic factors in a group of patientswith metastatic osteosarcoma treated with surgical removal of the lung metastases. A retrospective review from ouroncology data base revealed 38 patients treated between1992 and 2006. The mean age at diagnosis was 18 ± 9.4years (3-45) and mean follow-up was 57 ± 53.8 months(12-231). All patients were treated with chemotherapy and oncologic resection of the primary tumor and surgicalremoval of the lung metastases. We analyzed overallsurvival and prognostic factors: age, gender, site, time ofmetastasis, local recurrences, number of lung metastasisand chemotherapy response (necrosis). Overall survival of the entire series was 29% at 5 years (CI95%: 14.5-43.5)and 26% at 10 years (CI95%: 12-40). Significant differencein 5 year overall survival was found between good and badresponders to chemotherapy, 53% (IC95%: 28-78) vs. 8%(IC95%: 0-20) (p = 0.0008). No statistically significantrelationship between other prognostic factors analyzedwas observed. Five and ten years overall survival ratesin osteosarcoma patients with lung metastasis treatedwith chemotherapy and surgically resection is poor. Patientswith good response to chemotherapy have betterprognosis.
Subject(s)
Drug Therapy , Neoplasm Metastasis , Osteosarcoma , General Surgery , Prognosis , SurvivalABSTRACT
Five years overall survival in osteosarcoma patients is around 70%, although in patients with metastatic disease it is only 10-30%. The objective of this study was to analyze overall survival and prognostic factors in a group of patients with metastatic osteosarcoma treated with surgical removal of the lung metastases. A retrospective review from our oncology data base revealed 38 patients treated between 1992 and 2006. The mean age at diagnosis was 18 ± 9.4 years (3-45) and mean follow-up was 57 ± 53.8 months (12-231). All patients were treated with chemotherapy and oncologic resection of the primary tumor and surgical removal of the lung metastases. We analyzed overall survival and prognostic factors: age, gender, site, time of metastasis, local recurrences, number of lung metastasis and chemotherapy response (necrosis). Overall survival of the entire series was 29% at 5 years (CI 95%: 14.5-43.5) and 26% at 10 years (CI 95%: 12-40). Significant difference in 5 year overall survival was found between good and bad responders to chemotherapy, 53% (IC 95%: 28-78) vs. 8% (IC 95%: 0-20) (p = 0.0008). No statistically significant relationship between other prognostic factors analyzed was observed. Five and ten years overall survival rates in osteosarcoma patients with lung metastasis treated with chemotherapy and surgically resection is poor. Patients with good response to chemotherapy have better prognosis.
Subject(s)
Bone Neoplasms/pathology , Lung Neoplasms/mortality , Lung Neoplasms/secondary , Osteosarcoma/mortality , Osteosarcoma/secondary , Adolescent , Adult , Bone Neoplasms/drug therapy , Bone Neoplasms/surgery , Child , Child, Preschool , Female , Humans , Kaplan-Meier Estimate , Lung Neoplasms/surgery , Male , Middle Aged , Necrosis , Osteosarcoma/drug therapy , Osteosarcoma/surgery , Prognosis , Retrospective Studies , Young AdultABSTRACT
La supervivencia global a 5 años de los pacientes con osteosarcoma no-metastásico es del 60-70%, mientras que la misma se reduce a 10-30% en los pacientes con enfermedad diseminada. El objetivo de nuestro estudio fue determinar supervivencia y factores pronósticos en un grupo de pacientes con metástasis pulmonares por osteosarcoma tratados quirúrgicamente. Se realizó una búsqueda retrospectiva en nuestra base de datos oncológica entre 1992-2006, y 38 pacientes fueron incluidos en el estudio. La edad media al momento del diagnóstico fue de 18 ± 9.4 años (3-45) y el seguimiento promedio de 57 ± 53.8 meses (12-231). Todos fueron tratados con quimioterapia, resección oncológica del tumor primario y de las metástasis pulmonares. Se analizó la supervivencia a 5 y 10 años de la serie y los siguientes factores pronósticos: edad, sexo, localización del tumor primario, metástasis de inicio, recidiva local, número de metástasis extirpadas y la respuesta al tratamiento de quimioterapia (necrosis tumoral). La supervivencia global fue de 29% a los 5 años (IC95%:14.5-43.5) y de 26% a los 10 años (IC95%:12-40). Se encontró una diferencia estadísticamente significativa entre los buenos y malos respondedores a la quimioterapia: 53% (IC95%: 28-78) vs. 8% (IC95%: 0-20) (p = 0.0008). No se observó relación estadísticamente significativa entre los demás factores pronósticos analizados. La supervivencia a 5 y 10 años de los pacientes con osteosarcoma y metástasis pulmonares tratados con quimioterapia y resección quirúrgica continúa siendo pobre. Los pacientes con buena respuesta a la quimioterapia neoadyuvante presentan un mejor pronóstico oncológico.(AU)
Five years overall survival in osteosarcoma patients is around 70%, although in patients with metastatic disease it is only 10-30%. The objective of this study was to analyze overall survival and prognostic factors in a group of patients with metastatic osteosarcoma treated with surgical removal of the lung metastases. A retrospective review from our oncology data base revealed 38 patients treated between 1992 and 2006. The mean age at diagnosis was 18 ± 9.4 years (3-45) and mean follow-up was 57 ± 53.8 months (12-231). All patients were treated with chemotherapy and oncologic resection of the primary tumor and surgical removal of the lung metastases. We analyzed overall survival and prognostic factors: age, gender, site, time of metastasis, local recurrences, number of lung metastasis and chemotherapy response (necrosis). Overall survival of the entire series was 29% at 5 years (CI95%: 14.5-43.5) and 26% at 10 years (CI95%: 12-40). Significant difference in 5 year overall survival was found between good and bad responders to chemotherapy, 53% (IC95%: 28-78) vs. 8% (IC95%: 0-20) (p = 0.0008). No statistically significant relationship between other prognostic factors analyzed was observed. Five and ten years overall survival rates in osteosarcoma patients with lung metastasis treated with chemotherapy and surgically resection is poor. Patients with good response to chemotherapy have better prognosis.(AU)
ABSTRACT
La supervivencia global a 5 años de los pacientes con osteosarcoma no-metastásico es del 60-70%, mientras que la misma se reduce a 10-30% en los pacientes con enfermedad diseminada. El objetivo de nuestro estudio fue determinar supervivencia y factores pronósticos en un grupo de pacientes con metástasis pulmonares por osteosarcoma tratados quirúrgicamente. Se realizó una búsqueda retrospectiva en nuestra base de datos oncológica entre 1992-2006, y 38 pacientes fueron incluidos en el estudio. La edad media al momento del diagnóstico fue de 18 ± 9.4 años (3-45) y el seguimiento promedio de 57 ± 53.8 meses (12-231). Todos fueron tratados con quimioterapia, resección oncológica del tumor primario y de las metástasis pulmonares. Se analizó la supervivencia a 5 y 10 años de la serie y los siguientes factores pronósticos: edad, sexo, localización del tumor primario, metástasis de inicio, recidiva local, número de metástasis extirpadas y la respuesta al tratamiento de quimioterapia (necrosis tumoral). La supervivencia global fue de 29% a los 5 años (IC95%:14.5-43.5) y de 26% a los 10 años (IC95%:12-40). Se encontró una diferencia estadísticamente significativa entre los buenos y malos respondedores a la quimioterapia: 53% (IC95%: 28-78) vs. 8% (IC95%: 0-20) (p = 0.0008). No se observó relación estadísticamente significativa entre los demás factores pronósticos analizados. La supervivencia a 5 y 10 años de los pacientes con osteosarcoma y metástasis pulmonares tratados con quimioterapia y resección quirúrgica continúa siendo pobre. Los pacientes con buena respuesta a la quimioterapia neoadyuvante presentan un mejor pronóstico oncológico.
Five years overall survival in osteosarcoma patients is around 70%, although in patients with metastatic disease it is only 10-30%. The objective of this study was to analyze overall survival and prognostic factors in a group of patients with metastatic osteosarcoma treated with surgical removal of the lung metastases. A retrospective review from our oncology data base revealed 38 patients treated between 1992 and 2006. The mean age at diagnosis was 18 ± 9.4 years (3-45) and mean follow-up was 57 ± 53.8 months (12-231). All patients were treated with chemotherapy and oncologic resection of the primary tumor and surgical removal of the lung metastases. We analyzed overall survival and prognostic factors: age, gender, site, time of metastasis, local recurrences, number of lung metastasis and chemotherapy response (necrosis). Overall survival of the entire series was 29% at 5 years (CI95%: 14.5-43.5) and 26% at 10 years (CI95%: 12-40). Significant difference in 5 year overall survival was found between good and bad responders to chemotherapy, 53% (IC95%: 28-78) vs. 8% (IC95%: 0-20) (p = 0.0008). No statistically significant relationship between other prognostic factors analyzed was observed. Five and ten years overall survival rates in osteosarcoma patients with lung metastasis treated with chemotherapy and surgically resection is poor. Patients with good response to chemotherapy have better prognosis.
