Tumor neuroendocrino Tipo 1: reporte de un caso y revisión de la literatura / Localized neuroendocrine tumor of the stomach: a case report and literature review

Resumen Introducción: Los tumores neuroendocrinos (TNE), son tumores compuestos por células productoras de péptidos y aminas. Los TNE gástricos, representan el 1% de todas las neoplasias, sin embargo su incidencia ha ido en aumento. Son generalmente asintomáticos y no funcionantes. El tratamiento es generalmente la resección local. Caso Clínico: paciente de 48 años con sospecha de cáncer gástrico; su estudio demuestra un TNE gástrico bien diferenciado tipo 1. Se realiza etapificación y se define en comité oncológico la vigilancia endoscópica. El hallazgo de un TNE, en el estudio de cáncer gástrico, es un hallazgo poco frecuente. Debido al aumento progresivo en la realización de endoscopías digestivas altas, secundario a la alta prevalencia de cáncer gástrico en nuestro país, se espera que aumenten hallazgos como un TNE. Es por esto que realizamos una revisión de la literatura y planteamos algunas conclusiones al respecto.

Introduction: Neuroendocrine tumors (NETs) are composed of cells that produce peptides and amines. Gastric NETs represent 1% of all neoplasms; however their incidence has been increasing. They are usually asymptomatic and non-functioning. The treatment is usually local resection. Case Report: We present the case of a 48-year-old patient who was suspected of gastric cancer; her study shows a well-differentiated type 1 gastric NET. Staging is performed and endoscopic surveillance is defined in the oncology board. The finding of a NET, in the study of gastric cancer, is a rare finding. Due to the progressive increase in the performance of upper gastrointestinal endoscopies, secondary to the high prevalence of gastric cancer in our country, it is expected to increase findings as a NET. That is why we conducted a review of the literature and made some conclusions about it.

Use of tongue flap as alternative for the closure of palatinal fistulas in patients with sequela of palatoplasty / Uso del colgajo de lengua como alternativa para el cierre de las fístulas palatinas en pacientes con secuela de palatoplastia

AIMS: A retrospective study was conducted in the Department of Oral and Maxillofacial Surgery Dr. Atilio Perdomo; Ángel Larralde Hospital, Carabobo- Venezuela, which describes the procedure and protocol of the postoperative period of patients operated on multiple occasions for the closure of palatal fistulas. MATERIAL AND METHODS: A total of 20 patients treated for palatal fistulas were included in this study, in the period between 2014-2018. Patients with presence of sequelae of palatal fistulas, large fistulas with inadequate local scars, presence of oronasal communication and hypernasal resonance were considered. Patients were evaluated during the first 24 hours, 21 days and 6 months. RESULTS: A total of 20 patients (12 men and 8 women) with palatal fistulas were treated with tongue flap, aged between 25 and 40 years. In the postoperative period, patients reported 58 % of cases, mild pain. The most frequent clinical signs during the postoperative period were presented in 60 % of the patients, showing headache, passive bleeding, severe pain. No significant changes in lingual motility. Acoustic analysis of the 6-month late postoperative control voice, presented favorable changes in the intonation line, showing its continuity. All remaining cases showed satisfactory cure, and donor site morbidity was minimal. CONCLUSIONS: The tongue flaps are an excellent alternative for closing large or recurrent palatal fistulas, due to their versatility and excellent vascularity of the area. However, the design and the delicate manipulation of the flap are also decisive

OBJETIVOS: Se realizó un estudio retrospectivo en el Departamento de Cirugía Oral y Maxilofacial Dr. Atilio Perdomo, Hospital Ángel Larralde, Carabobo- Venezuela, que describe el procedimiento y protocolo del postoperatorio de pacientes operados en múltiples oportunidades para el cierre de fístulas palatales. MATERIAL Y MÉTODOS: Se incluyeron en este estudio un total de 20 pacientes tratados por fístulas palatinas, en el periodo comprendido entre 2014 y 2018. Se consideraron secuelas de fístulas palatinas, las fístulas grandes con cicatrices locales inadecuadas, la presencia de comunicación oronasal y resonancia hipernasales. Los pacientes fueron evaluados durante las primeras 24 horas, 21 días y 6 meses. RESULTADOS: Un total de 20 pacientes (12 hombres y 8 mujeres) con fístulas palatales fueron tratados con colgajo de lengua, con edades entre 25 y 40 años. En el postoperatorio, los pacientes informaron el 60 % de los casos, dolor leve. Los signos clínicos más frecuentes durante el postoperatorio se presentaron en el 60 % de los pacientes, con cefalea, sangrado pasivo y dolor intenso. No hay cambios significativos en la motilidad lingual. El análisis acústico de la voz de control postoperatorio tardío de 6 meses presentó cambios favorables en la línea de entonación mostrando su continuidad. Todos los casos restantes mostraron una cura satisfactoria, y la morbilidad del sitio donante fue mínima. CONCLUSIONES: Los colgajos de lengua son una excelente alternativa para el cierre de fístulas palatinas grandes o recurrentes debido a su versatilidad y excelente vascularización del área, lo que brinda una gran seguridad al cirujano en el éxito del tratamiento, sin embargo, el diseño y la delicada manipulación del colgajo también son determinantes

Administración de radioyodo en cáncer diferenciado de tiroides bajo régimen hospitalario: a propósito de la implementación del aislamiento de radioyodoterapia en un hospital regional / Administration of radioiodine in differentiated thyroid cancer under a hospital regime: about the implementation of radioiodotherapy isolation in a regional hospital

Resumen Introducción El cáncer diferenciado de tiroides (CDT) presenta un aumento a nivel mundial. El uso selectivo de terapia con radioyodo (RAI) es un pilar de su tratamiento. Su efecto terapéutico se debe a la radiación beta, mientras que la gamma hace que sea necesaria la hospitalización para limitar la exposición de terceros. Objetivo Describir la seguridad de la administración de altas dosis de RAI en pacientes con CDT. Materiales y Método Estudio retrospectivo descriptivo. Se incluyó a todos los pacientes con diagnóstico de CDT que requirieron hospitalización para administración de RAI ≥ 30 mCi en el Hospital Regional de Talca (HRT) entre agosto-diciembre de 2018. Resultados Durante el período descrito 10 pacientes recibieron RAI bajo régimen hospitalario. La mediana de dosis de RAI administrada fue de 100 mCi (rango: 50-150 mCi). Todos los pacientes fueron manejados con asilamiento estricto. El promedio de hospitalización fue 28 horas, siendo dados de alta al reportar una tasa de dosis absorbida < 70 µSv/h a 1 metro. Se entregaron instrucciones al alta para minimizar el riesgo de irradiación o contaminación a terceras personas. Conclusiones Nuestro protocolo de administración de RAI permite tratar de manera segura a pacientes con CDT disminuyendo la exposición a radiación de terceros. Las salas de asilamiento de radioyodoterapia, podrían dar cobertura al 100% de la demanda de terapia con RAI en CDT a nivel local.

Introduction Differentiated thyroid cancer (CDT) presents an increase in global levels. The selective use of radioiodine therapy (RAI) is a pillar of its treatment. Its therapeutic effect is due to beta radiation, while gamma makes hospitalization necessary to limit exposure. Aim To describe the safety treated with RAI inpatients and the functioning of the radioactive isolation rooms of our center. Materials and Method Retrospective descriptive study. All patients diagnosed with CDT who required RAI therapy under a hospital regimen at the Regional Hospital of Talca (HRT) between August-December 2018 were included. Results During the period described, 10 patients were treated. The median dose of RAI administered was 100 mCi (range: 50-150 mCi). The average of hospitalization was 28 hours, being discharged when reporting an absorbed dose rate < 70 μSv/h at 1 meter, giving the patient instructions, so that they follow to minimize the risk of irradiation or contamination of people in their environment. Conclusions Our RAI administration protocol allows patients with CDT to be treated safely. The radioactive isolation rooms could cover 100% of the demand for RAI therapy in CDT at the local level.

[Mortality within 30 days of receiving systemic chemotherapy at a regional oncology unit]. / Mortalidad a 30 días posterior a la administración de quimioterapia sistémica en una unidad oncológica regional.

BACKGROUND: The use of systemic chemotherapy has survival and palliation benefits in oncological patients. Mortality at 30 days after the administration of systemic chemotherapy is considered as a quality and safety indicator of oncological patient care. The international mortality threshold is 5%, which is the figure used to compare institutions. AIM: To assess mortality at 30 days after the administration of ambulatory systemic chemotherapy in a regional referral center in adult cancer patients. MATERIAL AND METHODS: Retrospective observational study of patients receiving ambulatory systemic chemotherapy in the oncology service of a regional public hospital during 2018. The 30-day mortality rate was calculated. Demographic characteristics, baseline disease and the treatment received were recorded. RESULTS: During the study period, 690 patients received ambulatory systemic chemotherapy. Chemotherapy was palliative in 76% of patients and 53% received a first line treatment. Seventeen (2.5%) died within 30 days of treatment administration. Nine deaths (52.9%) were definitely related to treatment and sepsis was the most frequent cause. CONCLUSIONS: Our mortality rates are similar to international data. This type of audit reviews local outcomes and identifies factors contributing to mortality aiming to improve standards of care.

Mortalidad a 30 días posterior a la administración de quimioterapia sistémica en una unidad oncológica regional / Mortality within 30 days of receiving systemic chemotherapy at a regional oncology unit

Background: The use of systemic chemotherapy has survival and palliation benefits in oncological patients. Mortality at 30 days after the administration of systemic chemotherapy is considered as a quality and safety indicator of oncological patient care. The international mortality threshold is 5%, which is the figure used to compare institutions. Aim: To assess mortality at 30 days after the administration of ambulatory systemic chemotherapy in a regional referral center in adult cancer patients. Material and Methods: Retrospective observational study of patients receiving ambulatory systemic chemotherapy in the oncology service of a regional public hospital during 2018. The 30-day mortality rate was calculated. Demographic characteristics, baseline disease and the treatment received were recorded. Results: During the study period, 690 patients received ambulatory systemic chemotherapy. Chemotherapy was palliative in 76% of patients and 53% received a first line treatment. Seventeen (2.5%) died within 30 days of treatment administration. Nine deaths (52.9%) were definitely related to treatment and sepsis was the most frequent cause. Conclusions: Our mortality rates are similar to international data. This type of audit reviews local outcomes and identifies factors contributing to mortality aiming to improve standards of care.

Resultados funcionales de pacientes tratados con faringolaringectomía y reconstrucción faríngea con colgajo pediculado / Functional Outcomes using pedicle flap reconstruction approach after pharyngolaryngectomy in laryngeal carcinoma patients

INTRODUCCIÓN: La laringectomía total es el tratamiento de elección del cáncer de laringe avanzado, requiriendo en ocasiones asociar una resección parcial o total de la faringe para su manejo. El defecto faríngeo, puede repararse con colgajos libres o pediculados, teniendo estos últimos la ventaja de ser simples, confiables y resistentes a la radioterapia. OBJETIVO: Presentar los resultados funcionales de una serie de pacientes tratados con faringolaringectomía y reconstrucción faríngea con colgajo pediculado. MATERIAL Y MÉTODO: Se revisaron registros de pacientes con laringectomía total más faringectomía parcial y reconstrucción con colgajo pediculado en el Hospital Regional de Talca entre 2009 y 2017, encontrando 6 casos de los cuales 4 se encontraron vivos al momento de iniciar el estudio. Se realizó videofluoroscopía para evaluar deglución, presencia de estenosis y/o fístulas, además, de evaluación nutricional y encuesta de calidad de vida. RESULTADOS: En el estudio de la deglución por fluoroscopía, todos los pacientes presentaron escasa retención del material de contraste en la hipofaringe y esófago cervical, lo cual está en relación con cambios morfológicos posquirúrgicos, sin afectar significativamente el mecanismo deglutorio. Todos los pacientes se encontraron eutróficos en su evaluación nutricional y sin evidencias de alteración de su calidad de vida secundaria a la deglución. CONCLUSIONES: La reconstrucción faríngea parcial con colgajo pediculado en pacientes con laringectomías totales asociadas a faringectomía parcial permite una deglución adecuada y sin disfagia, con un estado nutricional eutrófico.

INTRODUCTION: Total laryngectomy is the treatment of choice for advanced laryngeal cancer and after radiotherapy failure. In patients with pharyngeal invasion, it is associated with total or partial pharyngectomy, wich defect can be repaired with free or pedicle flaps. AIM: To present a brief series of pedicle flap reconstruction approach after pharyngolaryngectomy in laryngeal carcinoma patients and functional outcomes MATERIALS AND METHOD: We looked at laryngeal cancer patient records who were treated with total laryngectomy with partial pharyngectomy and pharyngeal reconstruction with pedicle flap at "Hospital Regional de Talca" between the years 2009 and 2017, finding 6 cases, 4 of which were alive at the beginning of the study. We analized videoflourocopy swallow studies to assess mechanisms of deglutition, and presence of stenosis or fistulas. We also performed a nutritional state assessment and a quality of life questionnaire. RESULTS: During videodeglutition study, the 4 patients showed minimal contrast swallow delay at hypopharynx and cervical esophagus. All the patients were found eutrophic in their nutritional assessment and with no significant evidence of quality of life disturbances secondary to deglutition state. CONCLUSIONS: Partial pharyngeal reconstruction using pedicle flaps in patients who underwent total laryngectomy with partial pharyngectomy allows to maintain an adequate deglutition without dysphagia, as well as a good nutritional state.

Efecto del uso intraoperatorio de corticoides en dosis bajas en pacientes sometidos a resección hepática mayor con maniobra de Pringle / Effects of low dose corticosteroids in patients undergoing major hepatic resection with Pringle maneuver

Introducción: Las resecciones hepáticas mayores pueden presentar una alta morbimortalidad en relación al sangrado intraoperatorio. La utilización de la maniobra de Pringle permite disminuir esta complicación a costa de un daño por isquemia-reperfusión. Una estrategia para minimizarla es el uso de corticoides perioperatorios. Objetivo: Evaluar el uso de metilprednisolona en dosis bajas (< 500 mg) en pacientes sometidos a resección hepática mayor con maniobra de Pringle en la incidencia de daño por isquemiareperfusión, morbilidad y mortalidad perioperatoria. Material y Métodos: Estudio retrospectivo utilizando la base de datos de hepatectomías entre los años 2000 y 2015. De un total de 171 resecciones hepáticas mayores, 62 utilizaron clampeo vascular. Se establecieron dos grupos: (A) aquellos que recibieron metilprednisolona inmediatamente previo al clampeo (n = 27) y (B) pacientes sin metilprednisolona (n = 35). Se evaluó el daño por isquemia-reperfusión por alteración de las pruebas hepáticas en los días 1, 3 y 5. Resultados: Los pacientes del grupo A tuvieron mayor tiempo de isquemia (43 + 3,3 vs 27 + 2,1 min, p < 0,05) que el grupo B, con una significativamente menor elevación de las fosfatasas alcalinas y bilirrubina en los días 1 y 5 poshepatectomía. No se observó diferencias en la magnitud del sangrado y no hubo diferencias en morbimortalidad. Conclusiones: La utilización de dosis bajas de metilprednisolona parece disminuir el impacto del DIR relacionado a la resección hepática bajo clampeo vascular, evitando los efectos adversos de la administración de esteroides en dosis altas.

Introduction: Liver resections may be associated with high morbidity and mortality due to intraoperative bleeding. Pringle maneuver reduces this complication at the expense of ischemia-reperfusion injury. Current strategies to minimize reperfusion injury include the use of perioperative corticosteroids. Objective: To assess the use of methylprednisolone in low doses (< 500 mg) in patients submitted to major hepatic resection under Pringle maneuver in the incidence of ischemia-reperfusion injury, peri-operative morbidity, and mortality. Material and Methods: Retrospective study from the liver resections database undertaken between the years 2000-2015 in our center. One hundred and seventy-one major liver resections were done, in 62 under Pringle maneuver. Two groups were established: (A) Patients administered methylprednisolone immediately before Pringle maneuver (n = 27) and (B) those without steroid (n = 35). We assessed ischemia-reperfusion injury by measuring liver tests on days 1, 3 and 5. Results: Patients in group A had longer ischemia time (43 ± 3.3 vs. 27 ± 2.1 min, p < 0.05) than those of group B, and significantly lower elevation of serum phosphatase alkaline and bilirubin on days 1 and five post-hepatectomy. We did not observe any difference in bleeding magnitude, and there were no differences in morbidity or mortality. Conclusions: The use of low doses of methylprednisolone seems to diminish the impact of ischemia-reperfusion injury related to major hepatic resection under Pringle maneuver avoiding the adverse side effects of high dose steroid.

Carcinomatosis peritoneal secundaria a carcinoma mucoepidermoide de glándula salival / Peritoneal carcinomatosis secondary to mucoepidermoid carcinoma of the salivary gland

Resumen: Introducción: Los tumores de glándulas salivales son neoplasias poco frecuentes y representan menos del 5% de todos los tumores de cabeza y cuello. El carcinoma mucoepidermoide representa un 10-15% de todas las neoplasias de las glándulas salivales y aproximadamente un 30% de los tumores malignos salivales. El comportamiento biológico y las manifestaciones clínicas de este tipo de tumores son variables y se correlacionan con el estadio y grado histológico, siendo la presencia de metástasis a distancia un hallazgo inhabitual (en especial, en tumores de grado bajo o intermedio). Caso clínico: Paciente de 65 anos de edad con antecedentes de tabaquismo, a quien se diag nostica carcinoma mucoepidermoide de grado intermedio de glándula submandibular izquierda tratado con cirugía más radioterapia adyuvante, y que presenta progresión metastásica hepática y carcinomatosis peritoneal a los 26 meses de seguimiento.

Abstract: Introduction: Tumors of salivary glands are uncommon and comprise of about 5% of all head and neck tumors. Although constituting less than 15% of all salivary gland tumors, mucoepidermoid carcinoma account for approximately 30% of all malignant salivary gland neoplasms. Commonly these tumours are metastatic to local lymph nodes and distant metastases are rare (especially, in low and intermediate grade tumors). Case report: We report a case of 65 years old man who developed peritoneal carcinomatosis secondary to metastatic dissemination of mucoepidermoid carcinoma of the major salivary glands, which is an uncommon occurrence with intermediate grade tumors.

[Surgical treatment of renal hyperparathyroidism. Experience in 71 patients]. / Tratamiento quirúrgico del hiperparatiroidismo asociado a insuficiencia renal crónica.

BACKGROUND: Surgery is an effective method for the management of renal hyperparathyroidism. AIM: To report the clinical presentation and results of surgical treatment of renal hyperparathyroidism. MATERIAL AND METHODS: Retrospective analysis of 58 patients aged 46 ± 11 years with secondary hyperparathyroidism (HPT2) and 13 patients aged 53 ± 11 years with tertiary hyperparathyroidism (HPT3), operated at a clinical hospital. RESULTS: In 55 cases (77.4%) the indications for surgery were complications of excess parathyroid hormone (PTH) and in 16 patients (22.6%) a failure of medical treatment. Total parathyroidectomy with intraoperative measurement of PTH (PTHop) plus a forearm parathyroid autograft was performed in 54 (93.1%) patients with HPT2 and in all patients with HPT3. PTHop decreased ≥ 75% in 51 patients (88%) with HPT2 and in 9 patients (69.2%) with HPT3, respectively. Cure of the disease was achieved in 52 (89.7%) and 11 (84.6%) patients with HPT2 and 3, respectively. Median follow-up was 41 months. Five (9.6%) patients with HPT2 and two patients (18.2%) with HPT3 had a recurrence of the disease. CONCLUSIONS: In patients with renal hyperparathyroidism, the primary indication for surgery was the presence of complications of PTH excess. A drop in PTHop ≥ 75% from baseline predicts healing in 98% and 100% of cases with secondary or tertiary HPT respectively. Surgery was a safe and effective treatment in both groups.

Hiperplasia de cóndilo mandibular: reporte de doce casos / Hyperplasia of the mandibular condyle: considerations in a series of 12 patients

Introducción: La hiperplasia condilar (HC) se define como un crecimiento patológico no neoplásico que afecta tanto al tamaño como a la morfología del cóndilo mandibular. Objetivo: Evaluar la eficacia y riesgos del tratamiento quirúrgico de la HC. Material y método: Estudio descriptivo, serie de casos. Se incluyó a todos los pacientes con diagnóstico de HC tratados en el Hospital Clínico de la Pontificia Universidad Católica de Chile entre enero de 2010 y febrero de 2014. Resultados: Doce pacientes fueron operados en nuestra institución por HC. El promedio de edad fue 19,3 ± 3,4 años. La forma de presentación más frecuente fue presencia de asimetría facial. Todos los pacientes fueron estudiados con SPECT que evidenció diferencia de captación mayor a 50% ± 3,1% entre ambos cóndilos. Todos los pacientes fueron tratados con condilectomía mandibular alta del lado afectado y en 3 casos, se realizó además cirugía ortognática en el mismo tiempo para corrección de maloclusión dental. La mediana de seguimiento fue de meses 16 (5 a 54 meses). En todos los pacientes se evidenció una mejora en la oclusión dental y simetría facial, con desaparición de la disfunción articular previa. Conclusiones: La HC es una entidad de poca frecuencia. La cirugía es eficaz y segura para el tratamiento de la HC.

Introduction: Condylar hiperplasia is defined as a pathological non neoplastic growth which compromises both size and shape of the mandibular condyle and is characterized by progressive facial asymmetry. Aim: To evaluate the efficacy and risks of surgical treatment of HC. Material and method: Descriptive study, cohort of cases. All patients between 2010 and February 2014 with diagnosis of condylar hyperplasia at Hospital Clínico P. Universidad Católica de Chile were included. Results: Twelve patients were operated at our institution because of condylar hyperplasia. Age average was 19.3 ± 3.4 years. The most frequent presentation was facial asymmetry. All patients were studied with single photon emission computed tomography (SPECT) with differential intake more than 50 ± 3.1% between both condyles. All patients were treated with mandibular condylectomy of the affected site and in 3 cases orthognatic surgery was performed at the same time of the condylectomy to correct dental malocclusion. Average follow up was 16 months (5 to 54 months). All patients recovered facial symmetry and occlusion with absence of the previous joint dysfunction. Conclusions: Condylar hyperplasia is an unfrequent condition and surgery is efficient and safe for the treatment of the deformity.

Manejo de disfonía post cirugía tiroidea con laringoplastía por inyección con ácido hialurónico / Hyaluronic acid in the management of post-thyroidectomy vocal cord paralysis

Introduction: Thyroid surgery rates have tripled over the past 3 decades. Currently, the main postoperative complications of this surgery are vocal fold paralysis because of recurrent laryngeal nerve dysfunction and hypocalcemia. Case report: We report the case of a 58 years old woman who presented with persistent dysphonia post total thyroidectomy. Laryngeal videostroboscopy evidenced unilateral vocal fold paralysis. We performed a percutaneous injection laryngoplasty with hyaluronic acid achieving significant improvement in voice. Conclusions: Percutaneous injection laryngoplasty with hyaluronic acid is a safe and effective procedure in the management of post thyroidectomy vocal cord paralysis.

Introducción: La tasa de cirugía tiroidea se ha triplicado en las últimas 3 décadas. Dentro de sus complicaciones se encuentra la parálisis de cuerda vocal unilateral secundaria a lesión transitoria o permanente del nervio laríngeo recurrente, lo que se presenta clínicamente como disfonía. Caso clínico: Paciente de 58 años, post tiroidectomía total evoluciona con disfonía persistente. Videoestroboscopia evidencia parálisis cuerda vocal izquierda en posición paramediana, con hiato fonatorio longitudinal amplio. Se maneja con laringoplastía por inyección con ácido hialurónico a cuerda vocal paralítica, logrando mejora significativa de voz. En videoestroboscopia de control al 7º día se evidencia cuerda vocal izquierda en línea media, con borde libre recto, sin presencia de hiato al fonar. Conclusiones: La laringoplastía por inyección percutánea con ácido hialurónico es un procedimiento seguro y eficaz para el tratamiento de la disfonía secundaria a parálisis cordal unilateral post cirugía tiroidea.

Tratamiento quirúrgico del hiperparatiroidismo asociado a insuficiencia renal crónica: Experience in 71 patients / Surgical treatment of renal hyperparathyroidism

Background: Surgery is an effective method for the management of renal hyperparathyroidism. Aim: To report the clinical presentation and results of surgical treatment of renal hyperparathyroidism. Material and Methods: Retrospective analysis of 58 patients aged 46 ± 11 years with secondary hyperparathyroidism (HPT2) and 13 patients aged 53 ± 11 years with tertiary hyperparathyroidism (HPT3), operated at a clinical hospital. Results: In 55 cases (77.4%) the indications for surgery were complications of excess parathyroid hormone (PTH) and in 16 patients (22.6%) a failure of medical treatment. Total parathyroidectomy with intraoperative measurement of PTH (PTHop) plus a forearm parathyroid autograft was performed in 54 (93.1%) patients with HPT2 and in all patients with HPT3. PTHop decreased ≥ 75% in 51 patients (88%) with HPT2 and in 9 patients (69.2%) with HPT3, respectively. Cure of the disease was achieved in 52 (89.7%) and 11 (84.6%) patients with HPT2 and 3, respectively. Median follow-up was 41 months. Five (9.6%) patients with HPT2 and two patients (18.2%) with HPT3 had a recurrence of the disease. Conclusions: In patients with renal hyperparathyroidism, the primary indication for surgery was the presence of complications of PTH excess. A drop in PTHop ≥ 75% from baseline predicts healing in 98% and 100% of cases with secondary or tertiary HPT respectively. Surgery was a safe and effective treatment in both groups.

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.

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.

[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.

Exactitud de la endosonografía rectal en la estadificación tumoral en pacientes con cáncer de recto sin quimio-radioterapia preoperatoria / Accuracy of endoscopic ultrasound in tumor staging of rectal cancer patients not treated with preoperative chemo-radiation

Introduction: Preoperative T staging of rectal cancer is essential for an adequate treatment strategy. Endoscopic ultrasonography (EUS) is one of the available modalities. The reported accuracy of this technique for T staging is variable. This inconsistency might be due to neoadyuvancy, and its downstaging properties. Aim: Determine the accuracy of rectal EUS for T staging of middle and lower rectal tumors in patients not treated with neoadyuvant chemo-radiotherapy. Materials and Methods: Clinical records of all consecutive patients evaluated by rectal EUS between years 2001-2009 in the Catholic University Clinical Hospital were accessed. Of 2.120 patients, 294 had the exam performed for middle or lower rectal cancer. Those who did not receive neoadyuvant chemo-radiation and whose histopathology was available were analyzed. Result: Data was obtained for 69 patients. The overall accuracy of EUS for T staging was 85 percent. For T1 tumors, the sensibility, specificity and accuracy were 82 percent, 96 percent and 94 percent respectively. For T2 tumors the sensibility, specificity and accuracy were 72 percent, 83 percent and 78 respectively. For T3 tumors the sensibility, specificity and accuracy were 82 percent, 83 percent and 83 percent respectively. Conclusion: Rectal EUS continues to be a valuable staging procedure for tumor depth invasion, with an overall accuracy of 85 percent.

Introducción: La estadificación tumoral (T) preoperatoria es esencial para el tratamiento del cáncer de recto. La endosonografía rectal (ER) es una de las modalidades disponibles. La exactitud de esta técnica para la estadificación tumoral es variable en la literatura, y se sospecha que esta inconsistencia se debe a la neoadyuvancia, por el descenso de estadio que esta produce. Objetivo: Analizar la exactitud de la endosonografía rectal para la estadificación tumoral en pacientes con cáncer de recto medio o inferior que no hayan recibido neoadyuvancia. Material y Método: Se estudió a los pacientes sometidos a endosonografía rectal entre los años 2001-2009 en el Hospital Clínico de la Pontificia Universidad Católica de Chile. De un total de 2.120 pacientes, 294 fueron evaluados por cáncer de recto en tercio medio o inferior. Se analizó el examen de aquellos que no recibieron quimio-radioterapia preoperatoria y se encontraba disponible la anatomía patológica para su comparación. Resultados: Se obtuvo información de 69 pacientes. La exactitud global del examen para la determinación del T fue 85 por ciento. Para la determinación de T1 los valores de sensibilidad, especificidad y exactitud fueron 82 por ciento, 96 por ciento y 94 por ciento respectivamente. Para T2 los valores de sensibilidad, especificad y exactitud fueron 72 por ciento, 83 por ciento y 78 por ciento respectivamente. Para T3 los valores de sensibilidad, especificidad y exactitud fueron 82 por ciento, 83 por ciento y 83 por ciento respectivamente. Conclusión: La endosonografía rectal sigue siendo un valioso examen para la determinación de la profundidad de invasión tumoral en cáncer de recto con una exactitud global de 85 por ciento.

[Serial transverse enteroplasty for short bowel syndrome. Case report]. / Enteroplastía transversa seriada como alternativa en el tratamiento del síndrome de intestino corto. Caso clínico.

Among patients with short bowel syndrome, surgical small intestine lengthening techniques are employed to increase the absorptive surface. Among these, serial transverse enteroplasty involves transecting the bowel transversally, preserving the blood supply of the small intestine and creating a longer segment of bowel. We report a 51-year-old woman with a short bowel syndrome and multiple hospital admissions for complications. She was subjected to a serial transverse enteroplasty, increasing small intestinal length from 140 to 180 cm. During the postoperative period, she presented intra abdominal blood collections and a septic episode with bacterial endocarditis. One month after the operation, total parenteral nutrition was discontinued and nutritional and fluid balances were achieved using exclusively the oral route. During the ambulatory follow up, the patient continues with exclusive oral feeding and five bowel movements per day.

Enteroplastía transversa seriada como alternativa en el tratamiento del síndrome de intestino corto: caso clínico / Serial transverse enteroplasty for short bowel syndrome: case report

Among patients with short bowel syndrome, surgical small intestine lengthening techniques are employed to increase the absorptive surface. Among these, serial transverse enteroplasty involves transecting the bowel transversally, preserving the blood supply of the small intestine and creating a longer segment of bowel. We report a 51-year-old woman with a short bowel syndrome and multiple hospital admissions for complications. She was subjected to a serial transverse enteroplasty, increasing small intestinal length from 140 to 180 cm. During the postoperative period, she presented intra abdominal blood collections and a septic episode with bacterial endocarditis. One month after the operation, total parenteral nutrition was discontinued and nutritional and fuid balances were achieved using exclusively the oral route. During the ambulatory follow up, the patient continues with exclusive oral feeding and fve bowel movements per day.

Factores pronósticos, evolución y mortalidad en el adulto inmunocompetente hospitalizado por neumonía neumocócica adquirida en la comunidad / Prognostic factors and mortality in immunocompetent adult patients hospitalized with community-acquired pneumococcal pneumonia

Background: Streptococcus pneumoniae is the main cause of community-acquired pneumonia in adults. Aim: To describe baseline characteristics, risk factors and clinical outcomes of adult patients hospitalized with pneumococcal pneumonia. Material and methods: Prospective study of adult patients admitted for a community acquired pneumonia in a clinical hospital. Immune deficient patients and those with a history of a recent hospitalization were excluded. Results: One hundred fifty one immuno-competent patients, aged 16 to 92 years, 58 percent males, were studied. Seventy-five percent had other diseases, 26 percent were admitted to the intensive care unit and 9 percent needed mechanical ventilation. There were no differences in clinical features, ICU admission or hospital length of stay among bacteremic and non-bacteremic patients. Thirty days lethality for bacteremic and non-bacteremic patients was 10.9 percent and 11.5 percent, respectively. The predictive values for lethality of Fine pneumonia severity index and CURB-65 (Confusion, Urea nitrogen, Respiratory rate, Blood pressure, 65 years of age and older) had an area under the ROC curve of 0.8 and 0.69, respectively. Multivariate analysis disclosed blood urea nitrogen over 30 mg/ dL (odds ratio (OR), 6.8), need for mechanical ventilation (OR, 7.4) and diastolic blood pressure below 50 mmHg (OR, 3.9), as significant independent predictors of death. Conclusions: Pneumococcal pneumonia was associated with a substantial rate of complications and mortality. Clinical presentation and outcome did not differ significantly among patients with and without bacteremia.