Resultados del tratamiento quirúrgico de las luxaciones acromioclaviculares tipo iii mediante técnica de Weaver-Dunn modificada / Results of surgical treatment of acromioclavicular dislocations type III using modified Weaver Dunn technique

Objetivo. Valorar los resultados clínicos y radiológicos del tratamiento quirúrgico de las luxaciones acromioclaviculares tipo iii mediante la técnica de Weaver-Dunn en fase diferida. Material y método. Estudio observacional retrospectivo controlado no aleatorizado de 38 pacientes intervenidos entre enero de 2006 y diciembre de 2014. Se excluyeron 10 pacientes por fallecimiento o no localización. Se recogieron datos demográficos, tiempo hasta la intervención y complicaciones, analizando la Escala visual analógica, DASH y Oxford Shoulder Score y el resultado radiológico actualizado. Resultados. Edad media de los pacientes de 35 años con hombro derecho-dominante afectado en un 71% de los casos predominantemente por caídas no a nivel. El 70% de los casos tenían percepción subjetiva tanto de recuperación de fuerza como de desaparición de deformidad. Se objetivó reducción completa radiológica en un 95% de los casos, con aparición de artrosis leve en un 44% y moderada en un 5,6%. Los resultados del DASH presentaron valores de 12,939 (±16,851) y el OSS de 42,736 (±7,794), indicando una función articular satisfactoria. Discusión. Los datos de este estudio muestran similitud en cuanto a resultados de estudios anteriores en lo que respecta a la recuperación subjetiva de la fuerza, mantenimiento de la reducción anatómica, resultados de test funcionales y eficacia de la técnica de Weaver-Dunn. Conclusiones. La técnica de Weaver-Dunn modificada aportó buenos resultados clínicos y radiológicos con reincorporación del paciente a sus actividades habituales y su mantenimiento a lo largo del tiempo (AU)

Objective. To evaluate the clinical and radiological results of the surgical treatment of type III acromioclavicular dislocations using the Weaver-Dunn technique in the delayed phase. Material and method. A non-randomised controlled retrospective observational study of 38 patients operated between January 2006 and December 2014. We excluded 10 patients due to death or non-localisation. We collected demographic data, time to intervention, complications, analysing the Visual Analog Scale, DASH and Oxford Shoulder Score and the updated radiological result. Results. mean age of patients with right-dominant shoulder affected in 71% of cases predominantly by non-level falls was 35. 70% of the cases had subjective perception of both recovery of strength and disappearance of deformity. Full radiological reduction was observed in 95% of the cases with the appearance of mild osteoarthritis in 44% and moderate osteoarthritis in 5.6%. The results of the DASH presented values of 12,939 (±16,851) and the OSS of 42,736 (±7,794), indicating satisfactory articular function. Discussion. The data from this study shows similar results to previous studies regarding subjective recovery of strength, maintenance of anatomical reduction, functional test results and efficacy of the Weaver-Dunn technique. Conclusions. The modified Weaver-Dunn technique provided good clinical and radiological results with patient reincorporation to their usual activities and maintenance over time (AU)

Results of surgical treatment of acromioclavicular dislocations type III using modified Weaver Dunn technique. / Resultados del tratamiento quirúrgico de las luxaciones acromioclaviculares tipo iii mediante técnica de Weaver-Dunn modificada.

OBJECTIVE: To evaluate the clinical and radiological results of the surgical treatment of type III acromioclavicular dislocations using the Weaver-Dunn technique in the delayed phase. MATERIAL AND METHOD: A non-randomised controlled retrospective observational study of 38 patients operated between January 2006 and December 2014. We excluded 10 patients due to death or non-localisation. We collected demographic data, time to intervention, complications, analysing the Visual Analog Scale, DASH and Oxford Shoulder Score and the updated radiological result. RESULTS: mean age of patients with right-dominant shoulder affected in 71% of cases predominantly by non-level falls was 35. 70% of the cases had subjective perception of both recovery of strength and disappearance of deformity. Full radiological reduction was observed in 95% of the cases with the appearance of mild osteoarthritis in 44% and moderate osteoarthritis in 5.6%. The results of the DASH presented values of 12,939 (±16,851) and the OSS of 42,736 (±7,794), indicating satisfactory articular function. DISCUSSION: The data from this study shows similar results to previous studies regarding subjective recovery of strength, maintenance of anatomical reduction, functional test results and efficacy of the Weaver-Dunn technique. CONCLUSIONS: The modified Weaver-Dunn technique provided good clinical and radiological results with patient reincorporation to their usual activities and maintenance over time.

La biopsia del ganglio centinela de la cadena mamaria interna en el manejo del cáncer infiltrante de mama / No disponible

El estado de los ganglios axilares es un elemento pronóstico importante en el cáncer infiltrante de mama. La linfadenectomía axilar ha sido sustituida por la biopsia selectiva del ganglio centinela para la estadificación del cáncer de mama. La cadena mamaria interna es la segunda estación de drenaje de la mama y su afectación metastásica influye negativamente en el pronóstico. La biopsia selectiva del ganglio centinela de la mamaria interna es un procedimiento controvertido en el cáncer de mama. La controversia se relaciona con la técnica de medicina nuclear empleada, la seguridad del procedimiento quirúrgico y las consecuencias derivadas para las pacientes. Pensamos que dicha biopsia se debe considerar en la práctica clínica de las unidades especializadas en el tratamiento del cáncer de mama, para una correcta estadificación. Nos permite además seleccionar a las pacientes con metástasis en la cadena mamaria interna y adaptar el tratamiento adyuvante de un modo más eficaz. Es un procedimiento multidisciplinar, asequible después de un periodo de aprendizaje, con escasa morbilidad y de poca relevancia. Son fundamentales el buen juicio clínico y la individualización de los pacientes para establecer una adecuada relación riesgo/beneficio del procedimiento. Se necesitan estudios prospectivos y multicéntricos para poder aclarar los aspectos de controversia(AU)

The axillary lymph node status is still considered an important prognosis factor in infiltrating breast cancer. The sentinel lymph node biopsy proves to be an efficient option to the axillary lymphadenectomy for the purpose of staging, having less morbidity and a similar diagnostic precision. The internal mammary chain represents a second regional basin of lymph drainage from the breast and its metastatic involvement is associated with a less favourable prognosis. Sentinel node biopsy of the internal mammary chain is a controversial procedure and most centers do not perform it. Controversial points are the lymphoscintigraphy technique, security of the surgical procedure and the practical consequences derived to the patients. We believe that we should consider the sentinel node biopsy of the internal mammary on a clinical practice in units specialized on breast cancer for a correct staging. It is a feasible technique after a learning period and has a low rate of complications. It allows us to select positive internal mammary patients and to adjust the adjuvant treatments more effectively. A good clinical judgement and the individualization of the risk-benefit relation should be a priority. Prospective multicenter studies are necessary if we want to resolve the controversial aspects(AU)

Sentinel lymph node biopsy in selected cases of ductal carcinoma in situ

INTRODUCTION: Axillary lymphadenectomy is nowadays not recommended to treat ductal carcinoma in situ (DCIS), but there is controversy surrounding the indication for sentinel lymph node biopsy (SLNB). MATERIALS AND METHODS: A prospective study of a selected group of patients diagnosed preoperatively with DCIS was performed between 2004 and 2009. Indications for SLNB were histologically determined high-grade tumours, tumour size >2 cm and patients scheduled to undergo a mastectomy. RESULTS: Sixty-five patients were analysed. Surgical technique was mastectomy in 39 patients (60%) and conservative breast surgery in 26 (40%). Definitive histological study of the resected breast tumour revealed 43 cases (66.2%) of DCIS, 15 (23.1%) of ductal invasive carcinoma and seven (10.7%) microinvasive tumours. In confirmed DCIS, only 6.9% of sentinel lymph nodes were positive, in microinvasive carcinoma 28.5% and in invasive carcinoma 40% were positive. Total number of patients with positive sentinel lymph nodes was 11 (16.9%). Of 39 mastectomies, 12 corresponded to microinvasive or invasive carcinoma and six (50%) showed a positive SLNB. CONCLUSIONS: Performing SLNB avoids an unnecessary second surgery to study axillary lymph nodes in invasive carcinoma diagnosed after definitive histological study. In patients undergoing a mastectomy, this study requires an axillary lymphadenectomy that is not useful in up to 50% of cases. We think that in a selected group of patients with DCIS, SLNB improves tumour staging, adapts the treatment and avoids second surgery in this group of patients (AU)

Utilidad de la clasificación TNM para el cáncer de mama en la toma de decisiones quirúrgicas / No disponible

La clasificación TNM (UICC) pretende agrupar en sus diferentesapartados a tumores de características similares enlos que el pronóstico sea parecido y el tratamiento pueda serhomogéneo.En la medida en que los conocimientos sobre el cáncer demama han ido progresando, la clasificación TNM ha sufridodistintas modificaciones y adaptaciones a los mismos. La últimaedición, la sexta, se produce en el año 2002.Sus diferentes modificaciones no han podido dar una respuestasatisfactoria y estable a las distintas situaciones clínicas.Nos preguntamos en qué medida la vigente clasificaciónTNM contribuye a facilitar la planificación quirúrgica en elcáncer de mama, que es uno de sus objetivos, y analizamoscon sentido crítico aquellas circunstancias que puedan tenerun mayor impacto, o planteen más dudas para el cirujano.Reconociendo la extraordinaria aportación de la clasificaciónTNM, debemos aceptar que hoy desempeña un papelmenor en la práctica quirúrgica diaria.La dirección de las investigaciones y del tratamiento seorientan claramente hacia factores biológicos y no en variablesanatómicas e histológicas, que son la base del sistemaTNM.Debe diseñarse un sistema de clasificación más adecuado,que contemple otras variables y que nos ayude mejor en lasdecisiones de tratamiento.Mientras ese nuevo sistema llega, debemos seguir elTNM, complementado por otros factores de los que ya disponemoshoy día (receptores hormonales, grado histológico,P53, índice de proliferación, HER2, perfil genético, etc.).La necesidad de un nuevo sistema de clasificación para elcáncer de mama parece evidente, también para una mejorplanificación quirúrgica(AU)

The TNM staging system (UICC) is used to determine theanatomical extent of malignant disease on the basis of clinicaland pathological criteria. It pretends to group tumors with similarprognosis and therefore treatment would be homogeneous.The TNM system in breast cancer is periodically revisedwith advances in biology, diagnosis and treatment. Significantmodifications were made to the breast cancer staging systemin the sixth edition, published in 2002, with the aim of providingmore reliable prognostic information.The TNM classification system was also designed with theaims of assisting treatment planning, surgical treatment included,providing prognostic guidance and improving understandingof the neoplastic process.How the current TNM staging help to the surgical treatmentdecision? We analyse some confused and polemical surgicalaspects of the breast cancer.We conclude that in current surgical practice, the TNM systemplays a minor part in the management of breast cancerand there are many confusing points.The TNM staging system has failed to fulfil its objectives,and an alternative staging approach that would more suitableto assist treatment decisions should be devised. The limitationsare a reflection of the biological heterogeneity of the breastcancer and new prognostic factors may help improve and adjusttreatments.While the new staging system comes, the TNM is the bestone for the breast cancer, complemented with other prognosticfactors currently in use (hormonal receptors, P53,HER2/neu, etc.).The future for the TNM classification seems brief and surgeonsneed also a new staging system for the best breast cancertreatment choice(AU)

Chyle fistula in right cervical area after thyroid surgery

Thoracic duct injury is an infrequent (1-2.5%) but severe complication after neck surgery, leading to nutritional, metabolic and immunologic deficiencies. We report a case of a 34-year-old woman with a right thoracic duct injury after surgery of a thyroid medullar cancer effectively treated with conservative management (parenteral nutrition and intravenous somatostatin). Optimal treatment of these patients is unclear, without a clear limit between conservative and surgical treatment (AU)

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Papillary serous carcinoma of peritoneum: presentation of 2 cases

Papillar serous carcinoma of peritoneum (PSPC) is an unfrequent neoplasm, histologically similar to papillar serous carcinoma of ovarium. It presents as peritoneal carcinomatosis without evident tumoral focus. Management of PSPC is similar to ovaric neoplasms, although prognosis should be worse. Long-term survival has been described with cytoreductive surgery and adjuvant chemotherapy with platinum. We present hereby 2 cases of PSPC (AU)

20 years experience in the management of Zenker's diverticulum in a third-level hospital.

Zenker s diverticulum arises in the posterior wall of the pharynx, above the cricopharyngeal muscle, secondary to a functional cricopharyngeal disorder. We describe our experience with the management of Zenker s diverticulum from 1985 to this day in a third-level hospital. We review clinical data from 27 patients (78% males) with a mean age of 60.4 years. The most common clinical manifestations were dysphagia, regurgitation, syalorrhea, cough, and weight loss. All cases were diagnosed using an esophagogram. A diverticulectomy with cricopharingeal myotomy was performed in 74% of patients. Complications developed in 5 cases (21%), and the recurrence rate was 4% (1 of 3 cases, where myotomy was not performed).

Conservative treatment for infiltrating breast cancer. Ten years follow-up experience

INTRODUCTION: We retrospectively analyze our experience in conservative treatment for infiltrating advanced breast cancer before implementation of selective sentinel node biopsy, specially focusing on characteristics, incidence, treatment and evolution of local-regional recurrences, disease-free survival time, overall survival and patient's satisfaction. MATERIAL AND METHODS: From January 1984 to 31st December 1998, 739 female patients were operated in our institution, diagnosed as having infiltrating breast cancer. One hundred and eighty-eight patients (25.43%) received conservative treatment and they were followed up until December 2003. RESULTS: Average age when diagnosed was 50.42 years old (24-87 years). 53.19% of the patients were premenopausal. After a median follow-up of 129 months (60-198 months), 13 women (6.91%) presented local -regional recurrence and the disease-free time was 48.4 months (8-108 months). Global survival rate was 83.5% and disease free survival rate was 80.85%. CONCLUSIONS: The management of choice for early stage (I and II) infiltrating breast cancer is nowadays conservative, with a low local-regional recurrence rate and survival rate that are comparable to radical mastectomy, according to the literature. It's a safe and efficient method that let us preserve the breast with a good esthetical result. In selected cases, when a regional recurrence occurs, a second conservative management is possible with a good control of the disease, although the most widely accepted treatment in these cases is total mastectomy (AU)

Mammary hamartoma.

INTRODUCTION: Mammary hamartomas are rare benign breast lumps. They are usually painless, wellcircumscribed, mobile and with no adherence to skin or muscle, composed of varying amounts of fat, glandular and fibrous tissue. Mammary hamartoma has been classically considered as an underdiagnosed pathology, but with the increasing use of diagnostic procedures in breast tumours, the number of hamartomas has increased in the last years. Because there is no distinct pathological feature, a correlation with the clinical findings and image techniques is necessary in order to achieve a correct diagnosis of the pathology. MATERIALS AND METHODS: The clinicopathological features of 8 mammary hamartomas are reported here. RESULTS: The patients are ranged in age from 34 to 67 years. The initial manifestation was in all cases a well-circumscribed, soft, palpable breast lump. Mammography was performed in all patients. Other diagnostic procedures used in the diagnosis were Ultrasound, Fine Needle Aspiration Cytology and Needle Core Biopsy. Treatment was tumorectomy. We describe a case of recurrence after excision of the lump in a more aggressive histological form and one patient who presented the coexistence of a mammary hamartoma and an invasive ductal carcinoma. CONCLUSION: Mammary hamartoma is an uncommon breast tumour. It is necessary the correlation between pathology and clinical and radiological findings. We express our management plan for these lesions.

Mammary hamartoma

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Introduction. Mammary hamartomas are rare benignbreast lumps. They are usually painless, wellcircumscribed,mobile and with no adherence toskin or muscle, composed of varying amounts offat, glandular and fibrous tissue. Mammary hamartomahas been classically considered as an underdiagnosedpathology, but with the increasing use ofdiagnostic procedures in breast tumours, the numberof hamartomas has increased in the last years.Because there is no distinct pathological feature, acorrelation with the clinical findings and imagetechniques is necessary in order to achieve a correctdiagnosis of the pathology.Materials and methods. The clinicopathologicalfeatures of 8 mammary hamartomas are reportedhere.Results. The patients are ranged in age from 34 to67 years. The initial manifestation was in all cases awell-circumscribed, soft, palpable breast lump.Mammography was performed in all patients. Otherdiagnostic procedures used in the diagnosis wereUltrasound, Fine Needle Aspiration Cytology andNeedle Core Biopsy. Treatment was tumourectomy.We describe a case of recurrence after excision ofthe lump in a more aggressive histological formand one patient who presented the coexistence of amammary hamartoma and an invasive ductal carcinoma.Conclusion. Mammary hamartoma is an uncommonbreast tumour. It is necessary the correlationbetween pathology and clinical and radiologicalfindings. We express our management plan forthese lesions

Posthemipelvectomy hernia.

We report the case of a white male who underwent a classic hemipelvectomy due to a femur fibrosarcoma with inguinal metastases, which 33 years later, developed into a posthemipelvectomy hernia in the amputation stump that impaired the use of his Canadian prosthesis. The hernia was repaired with a polypropylene mesh in a subaponeurotic position. A seroma was drained in the postoperative and it was only 2 months after the operation that he could use his prosthesis with any difficulty. A year after the operation, the hernia had not recurred. Only seven similar cases have been published, and there are only four cases with details of their correction, two with a mesh as was our case, and the rest with a primary suture of the aponeurotic borders. A brief review of the bibliography is given on this subject.

Breast metastasis of primary colon cancer.

Metastatic tumors to the breast from colon adenocarcinoma are very rare. They are usually indicative of disseminated disease, and the prognosis is poor. Generally, radical operation should be avoided unless needed for palliation. This case report described a patient with breast metastasis from colon adenocarcinoma treated by simple mastectomy.

Metástasis en mama de carcinoma primario de colon / Breast metastasis of primary colon cancer

La metástasis en la mama de tumores de colon es una entidad muy poco frecuente. El pronóstico a largo plazo es infausto, pues esta lesión es expresión de enfermedad sistémica. El tratamiento quirúrgico debe ser lo más conservador posible, ya que es un tratamiento paliativo. Presentamos un caso de esta rara entidad, tratada mediante mastectomía. (AU)

[Prevalence of Chlamydia trachomatis infection in registered prostitutes in the city of Durango, Mexico]. / Prevalencia de infección por Chlamydia trachomatis en prostitutas registradas de la ciudad de Durango, México.

OBJECTIVE: To determine the prevalence of Chlamydia trachomatis infection among registered prostitutes of Durango City and to establish whether there is a correlation between epidemiological factors and infection. MATERIAL AND METHODS: Two-hundred-and-forty-seven registered prostitutes of Durango city were studied. Endocervical samples and epidemiological data were obtained. C.trachomatis antigen was detected with the Chlamydiazyme test (Abbott Laboratories, USA.) RESULTS: Forty-one (16.6%) out of 247 prostitutes were positive to C. trachomatis. Thirty-seven out of the 41 positive women had had sexual activity on several States of Mexico (95.1%), as compared to only 109 out of 206 negative women (53.0%) (p < .0001). Prostitutes positive to C. trachomatis (39/41, 95.1%) were more likely to belong to low socioeconomic level than negatives (171/206, 83%) (p = 0.05). CONCLUSIONS: The prevalence of C. trachomatis infection was 16.6%. C. trachomatis infection was associated with sexual activity in multiple States of Mexico, and had a tendency to be associated with low socioeconomic level.

Isolated primary aldosteronism in a patient with adrenal carcinoma and XY/XXY mosaic Klinefelter's syndrome.

Although breast cancer, germ cell tumors and other neoplasms are known to occur in patients with Klinefelter's syndrome, adrenal carcinoma has not yet been reported in such patients. We describe a rare case of severe primary aldosteronism as the unique manifestation of a large adrenocortical carcinoma in a patient with Klinefelter's syndrome. Complete biological and hormonal evaluation was performed. Surgical treatment was successful and the patient remained asymptomatic with normal biological and hormonal values after 1 year of followup.

[Intraparenchymal non-neoplastic residual masses after treatment of large-cell non-Hodgkin's lymphoma with intensive chemotherapy]. / Masas residuales no tumorales intraparenquimatosas después del tratamiento de linfomas no hodgkinianos de célula grande con quimioterapia intensiva.

We report two patients with large-cell non-Hodgkin's lymphomas who were treated with intensive chemotherapy (MACOP-B), and in whom large isolated intraparenchymal masses (splenic in one case, renal in the other) were found with computed tomography after clinical remission. It was found at surgery that both masses were constituted by acellular necrotic material, without tumoral infiltration and limited by fibrous tissue. The finding of these residual masses in patients in remission raises problems of approach, as they may be nontumoral and not require new therapy. At present, until new radiological or biochemical markers are available, a judicious clinical attitude should be taken, with radiological control of the evolution of the masses and reserving surgery only for those cases with progression, diagnostic doubts, or patient's decision to know his real status.