Two stage, hybrid endovascular and open surgical approach to treat difficult carotid body tumors.

OBJECTIVE: Present the feasibility, applicability, clinical effectiveness, and results of complicated Shamblin II or III carotid body tumors treated with a two-stage hybrid surgical approach. MATERIALS AND METHODS: Retrospective, observational, cross-sectional, descriptive study of the successful treatment of 16 cases of difficult Shamblin II or III carotid body tumors, consisting of a two-stage surgical approach. We conducted a retrospective, observational, cross-sectional, descriptive study of a series of patients with complicated Shamblin II or III carotid body tumors, which we treated with a two-stage hybrid surgical procedure, in which we first placed a carotid endoprosthesis and 45 days later performed surgical resection of the tumor, following our originally published technique. This study was conducted from February, 2007 to November, 2019, in a third level care centre. RESULTS: We treated 16 patients with a mean age of 50.5 years. All resided at more than 2000 meters above sea level. In all 16 a complete resection was performed. The average duration of surgery was 103.9 min, the average intraoperative bleeding was 69 ml. There were three cases of neuropraxia. The ansa cervicalis nerve had to be sectioned in three cases and there was permanent upper laryngeal nerve injury in two cases. There were no permanent cerebrovascular injuries from placement of the endoprostheses. One patient developed transient cerebral ischaemia (TIA) with no long-term sequelae. There were two cases of asymptomatic late occlusion of the endoprostheses. The average initial volume of the tumors was 54.4 cc. The average tumor volume 35 days after implant of the endoprosthesis was 30.9 cc. SYMPTOMS: Presence of tumors in the neck in all cases and two cases of dysphagia. CONCLUSION: This two-stage hybrid technique allowed for the complete resection of difficult Shamblin II or III carotid body tumors, with one case of TIA and two with permanent upper laryngeal nerve injuries and without mortality.

Assessment of diagnostic capacity and decision-making based on the 2015 American Thyroid Association ultrasound classification system.

BACKGROUND: This study evaluates the American Thyroid Association (ATA) ultrasound (US) classification system for the initial assessment of thyroid nodules to determine if it indeed facilitates clinical decision-making. AIM: To perform a systematic review and meta-analysis of the diagnostic value of the ATA US classification system for the initial assessment of thyroid nodules. METHODS: In accordance with the PRISMA statement for diagnostic test accuracy, we selected articles that evaluated the 2015 ATA US pattern guidelines using a diagnostic gold standard. We analyzed these cases using traditional diagnostic parameters, as well as the threshold approach to clinical decision-making and decision curve analysis. RESULTS: We reviewed 13 articles with 8445 thyroid nodules, which were classified according to 2015 ATA patterns. Of these, 46.62% were malignant. No cancer was found in any of the ATA benign pattern nodules. The Bayesian analysis post-test probability for cancer in each classification was: (1) Very-low suspicion, 0.85%; (2) Low, 2.6%; (3) Intermediate, 6.7%; and (4) High, 40.9%. The net benefit (NB), expressed as avoided interventions, indicated that the highest capacity to avoid unnecessary fine needle aspiration biopsy (FNAB) in the patterns that we studied was 42, 31, 35, and 43 of every 100 FNABs. The NB calculation for a probability threshold of 11% for each of the ATA suspicion patterns studied is less than that of performing FNAB on all nodules. CONCLUSION: These three types of analysis have shown that only the ATA high-suspicion diagnostic pattern is clinically useful, in which case, FNAB should be performed. However, the curve decision analysis has demonstrated that using the ATA US risk patterns to decide which patients need FNAB does not provide a greater benefit than performing FNAB on all thyroid nodules. Therefore, it is likely that a better way to approach the assessment of thyroid nodules would be to perform FNAB on all non-cystic nodules, as the present analysis has shown the ATA risk patterns do not provide an adequate clinical decision-making framework.

The Role of Tc-99 m-MIBI Scan in the Assessment of the Cystic Thyroid Nodule.

PURPOSE: A non-surgical therapeutic option requires assurance that a cystic thyroid nodule with non-diagnostic cytology is benign. This work was undertaken to determine whether Tc-99 m-MIBI scan (MIBI) findings can guide the best therapeutic option with confidence. MATERIAL AND METHODS: We studied 81 cystic non-functioning thyroid nodules with non-diagnostic fine-needle aspiration biopsy (FNAB) report classified according to ATA 2015 ultrasonography (US) patterns for suspicion of malignancy. All had a MIBI to assess metabolic activity within the nodule as well as histopathological diagnosis. Diagnostic value analysis of MIBI as compared to the US pattern was determined. RESULTS: None of the 11 patients with US pattern of benign showed positive MIBI, and all had a histopathological report of benign. Diagnostic value of MIBI on US pattern of very low suspicion showed sensitivity, specificity, PPV, and NPV of 100%, 78.9%, 42.9%, and 100%, respectively. CONCLUSION: Our data shows that the only approach to a safe non-surgical treatment option in a cystic nodule with non-diagnostic FNAB is when no metabolic activity is seen on MIBI.

Endoscopic transoral parathyroidectomy: Initial experience.

BACKGROUND: We evaluate our initial experience of transoral vestibular approach parathyroidectomy (TOEPVA) for the treatment of primary hyperparathyroidism. METHODS: We conducted a prospective study of patients with single parathyroid adenoma, using TOEPVA to perform the parathyroidectomy. The variables we analyzed were size, volume, and location of the adenoma, bleeding, identification, and preservation of the recurrent laryngeal nerve, injury to the mental nerve, and the effective cure rate, using measures of central tendency. RESULTS: Our study included 21 women, with an average age of 43 years. The recurrent laryngeal nerve and mental nerve suffered no permanent damage, the average size of the adenoma was 26.6 mm, and a volume of 3.95 mL. We were able to identify the adenoma and cure the hyperparathyroidism in 20 of the patients (95.2%). CONCLUSIONS: TOEPVA is viable and safe in who wish to avoid the cervical scar resulting for the patient with primary hyperparathyroidism.

Regional Node Distribution in Papillary Thyroid Cancer with Microscopic Metastasis.

BACKGROUND: Optimal neck lymphadenectomy in patients with papillary thyroid cancer (PTC) and microscopic lymph node metastasis needs to be defined in order to aid surgeons in their decision about the best way to proceed in these cases. METHODS: Patients who underwent total thyroidectomy and lymphadenectomy at levels IIa to VI were divided into two groups: Group 1 (G1) with macroscopic metastasis detected before surgery and Group 2 (G2) with microscopic metastasis detected in sentinel node during surgery. Odds ratio (OR) was computed for age, sex, tumor size, multicentricity, capsular invasion, vascular/lymphatic permeation, and nodes with metastasis. RESULTS: Primary tumor size was (G1 versus G2, respectively) 3.8 cm versus 1.98 cm (P<0.001); only lymphatic permeation was correlated to an increase in metastasis in lymph nodes 65.4% versus 25% (OR=5.6, p<0.001); metastatic frequency by region was IIa 18.5% versus 1.5%, III 24.3% versus 9.9%, IV 17.4% versus 18.1%, and VI 25.9% versus 71,2%. Metastasis to level V was found only in G1. CONCLUSION: Selective lymphadenectomy at levels III, IV, and VI is optimal for PTC patients without preoperative evidence of lymph node disease, but who present with lymph node microscopic metastasis in an intraoperative assessment.

Management of acute bacterial skin and skin structure infections with a focus on patients at high risk of treatment failure.

Over the last 25 years, the terminology of skin and soft tissue infections, as well as their classification for optimal management of patients, has changed. The so-called and recently introduced term 'acute bacterial skin and skin structure infections' (ABSSSIs), a cluster of fairly common types of infection, including abscesses, cellulitis, and wound infections, require an immediate effective antibacterial treatment as part of a timely and cautious management. The extreme level of resistance globally to many antibiotic drugs in the prevalent causative pathogens, the presence of risk factors of treatment failure, and the high epidemic of comorbidities (e.g. diabetes and obesity) make the appropriate selection of the antibiotic for physicians highly challenging. The selection of antibiotics is primarily empirical for ABSSSI patients which subsequently can be adjusted based on culture results, although rarely available in outpatient management. There is substantial evidence suggesting that inappropriate antibiotic treatment is given to approximately 20-25% of patients, potentially prolonging their hospital stay and increasing the risk of morbidity and mortality. The current review paper discusses the concerns related to the management of ABSSSI and the patient types who are most vulnerable to poor outcomes. It also highlights the key management time-points that treating physicians and surgeons must be aware of in order to achieve clinical success and to discharge patients from the hospital as early as possible.

Safety and Cost-Effectiveness in Thyroidectomy Using the HARMONIC Scalpel Compared to Traditional Hemostasis: A Controlled Clinical Assay.

INTRODUCTION: The aim of this clinical control trial is to analyze the cost-effectiveness and to understand the efficacy of the HARMONIC FOCUS®+ (Ethicon Inc., Somerville, New Jersey) scalpel as the only system to cut and coagulate in thyroidectomy. MATERIALS AND METHODS: One hundered patients of the thyroid clinic of the Mexico City General Hospital were included. All patients underwent surgery and were divided into two randomized groups. In Group 1, the HARMONIC scalpel was the only device used for cut and coagulate (50 patients), and in Group 2 clamp, tie, and electrocautery (50 patients) were used. Surgical bleeding, operative time, complications, diagnosis, thyroid size, and hospital stay were evaluated in both groups. The statistical analysis was done using central trend measurements, Student's t-, chi-squared, and Fisher's exact test, with a significance level of p < 0.05. The cost-effectiveness analysis was completed by determining the total cost of the surgical procedure per hour in US dollars, and the evolution to compare efficacy will be the number of re-interventions due to postoperative bleeding. RESULTS: The use of the HARMONIC scalpel in thyroid surgery had the same results as the traditional method when comparing complications, reoperation, hospital stay, and hypoparathyroidism. In total thyroidectomy patients, the bleeding in Group 1 was 55.16ml ( ± 32.97) and 85.4ml ( ± 69.41) in Group 2 , p=0.034. Operative time in Group 1 was 74.6 minutes (± 23.39) and 104.09 minutes (± 34.66) in Group 2, p= 0.0001. In both groups, there were no statistical differences in lobectomy. Cost-effectiveness analysis implies an adequate hemostasis if we are using a hemostatic device, and above all, the avoidance of a re-intervention due to hematoma, and the cost-effectiveness with regard to the re-intervention as a result of a hematoma implies that $161 US more is spent for each re-intervention. CONCLUSION: The utilization of the HARMONIC scalpel device is similar to the traditional technique of ligature and knots as far as cost-effectiveness is concerned, due to the fact that the greater expense of the device is compensated by the lower expense in time and surgical re-intervention.

[Gallstone ileus, experience in the Dr. Eduardo Liceaga General Hospital of Mexico]. / Íleo biliar, experiencia en el Hospital General de México Dr. Eduardo Liceaga.

BACKGROUND: Gallstone ileus is a rare cause of intestinal obstruction (1-4%). It results from the migration of a gallstone through a bilio-enteric fistula. Treatment begins with fluid therapy, followed by enterolithotomy, fistula closure, and cholecystectomy. OBJECTIVES: To determine the clinical presentation in patients with gallstone ileus and subsequent medical -surgical management outcomes. MATERIAL AND METHODS: A retrospective, observational, descriptive and transversal study was conducted on patients diagnosed with intestinal obstruction secondary to a gallstone ileus from May 2013 to October 2014. The following variables were recorded: age, sex, comorbidities, mean time of onset of symptoms, length of preoperative and postoperative stay, imaging studies, biochemical tests, type of surgical management, stone location and size, complications, mortality, and postoperative follow-up. RESULTS: The study included 10 patients (male: female ratio 1:4), with a mean age of 61.9 years. The mean time of onset symptoms 15.4 days, and preoperative stay was 2days. On admission, 80% of patients had leukocytosis and neutrophilia, and 70% with renal failure. The most common surgical management was enterolithotomy with primary closure (50%), finding 80% of the stones in the terminal ileum. Recurrence was found in 2 cases. Mean postoperative hospital stay was 6.3 days. Mortality was 20%. CONCLUSIONS: Gallstone ileus most commonly presented in women in the seventh decade of life, with intermittent bowel obstruction. On hospital admission, they presented with systemic inflammatory response, electrolyte imbalance and abnormal liver function tests. Initial treatment must include fluid-electrolyte replacement, and tomography scans must be made in all cases. In our experience, the best procedure is enterolithotomy and primary closure, which presented lower morbidity and mortality.

[Cervical lymphangioma in the adult. A report of 2 cases]. / Linfangioma de cuello en el adulto. Reporte de 2 casos.

BACKGROUND: Cervical lymphangiomas are uncommon benign congenital malformations usually present in children, and are rare in adults. Currently, complete resection is still the standard care. Two cases are presented of a cervical lymphangioma in an adult. The diagnosis and surgical approach is also discussed. CLINICAL CASE: Case 1. The first case is a 23 year old male with chief complaint of a tumour in the posterior triangle of the neck, which showed a substantial increase in size in the last 9 months. No associated signs or symptoms, or any trauma history was reported. CT scan of the neck showed images suggestive of a posterior cervical lymphangioma. Exploratory cervical surgery was performed, with complete resection of a cystic tumour located in the posterior triangle of the neck. Surgery was performed without complications and postoperative care was unremarkable. CASE 2: The second case is a 28 woman with a cystic tumour in submandibular space. She had history of a previous incomplete operation in another institution 2 years ago, with recurrence of the tumour. A second surgery was performed with complete resection without complications, and with a good outcome. CONCLUSIONS: Cervical lymphangioma is a very rare benign disease, surgical treatment is preferred, but sclerotherapy can be used as alternative treatment.

Efficacy of Intraoperative Neuro-Monitoring to Localize the External Branch of the Superior Laryngeal Nerve.

BACKGROUND: This study investigated whether visual localization of the external branch of the superior laryngeal nerve (EBSLN) coincides with its localization via intraoperative neuro-monitoring (IONM) during thyroidectomy and whether its use influences the frequency of injuries. METHODS: A prospective, comparative, cross-sectional, observational study was performed in 240 superior thyroid poles. The metrics were visual identification of the EBSLN and its corroboration with IONM. The frequency of EBSLN injuries was also determined. Statistical analysis was achieved via kappa and chi-square tests, as well as odds ratios (OR). RESULTS: Of the 240 superior thyroid poles, IONM identified 234 (97.5%) EBSLN, whereas 190 (79.1%) were identified visually: OR = 10.35 [CI 4.37-24.65] p < 0.0001. Of the 190 EBSLN identified visually, 150 were confirmed through IONM. Indeed, their structure corresponded to an EBSLN to yield a kappa with a linear weighting value of 0.362. The standard error was 0.0467 [CI 0.2686-0.4554], indicating a fair agreement between the visual and IONM classification. CONCLUSION: IONM identified 97.5% of EBSLN cases. It was higher than the visual identification. There were no injuries to EBSLN identified through IONM.

Molecular Analysis by Gene Expression of Mitochondrial ATPase Subunits in Papillary Thyroid Cancer: Is ATP5E Transcript a Possible Early Tumor Marker?

BACKGROUND: Cancer development involves an "injury" to the respiratory machinery (Warburg effect) due to decreased or impaired mitochondrial function. This circumstance results in a down regulation of some of the ATPase subunits of the malignant tissue. The objective of this work was to assess and compare the relative expression of mRNA of mitochondrial ATPase subunits between samples of thyroid cancer and benign nodules. MATERIAL AND METHODS: Samples from 31 patients who had an operation for PTC at the General Hospital of Mexico were snap-frozen and stored at -70°C. Thirty-five patients who had an operation for benign tumors were also included in the study. mRNA expression levels of alpha, beta, gamma, and epsilon subunits of F1 and "c12" of subunit Fo were determined by real-time RT-PCR (by duplicate), in order to determine if abnormal expression of these genes could partially explain the Warburg effect in papillary thyroid cancer (PTC). RESULTS: ATP5E transcript alteration (down-expression) was highly associated to PTC diagnosis OR=11.76 (95% confidence interval, 1.245-237.98; p=0.04). CONCLUSIONS: Relative down-expression of ATP5E transcript was highly associated with PTC diagnosis. This transcript alteration may be used as a tumoral marker in papillary thyroid cancer.

Cirugía de corta estancia en sábados, domingos y días festivos, experiencia en el Servicio de Cirugía General del Hospital General de México, O.D / Short stay surgery on weekends and holidays, experience at the General Surgery Service of the General Hospital of Mexico, O.D

Objetivo: Demostrar las bondades del impacto, tiempo y costo-eficacia de la cirugía de corta estancia en sábados, domingos y días festivos. Sede: Hospital General de México. Diseño: Estudio prospectivo, transversal, observacional, comparativo. Análisis estadístico: Prueba t de Student, chi cuadrada y análisis costo-eficacia. Material y método: Durante 4 años se realizaron 1,200 cirugías dentro de este programa piloto, utilizando la capacidad hospitalaria instalada y al mismo personal contratado para la atención médica de dichos días, sin contar con una unidad de cirugía de corta estancia como tal. Los procedimientos realizados fueron: plastía inguinal, resección de enfermedad pilonidal, plastía umbilical, resección de tumor benigno de partes blandas, plastía de pared, mastectomía subcutánea, hemorroidectomía, fistulectomía y excisión de tumores benignos mamarios y se comparó con los mismos procedimientos, pero realizados en forma de cirugía programada, evaluando y comparando las siguientes variables: edad, género, procedimiento realizado, tiempo de estancia hospitalaria y costo-beneficio del procedimiento. También se evaluó necesidad de hospitalización, reingreso en menos de 24 h, morbilidad y mortalidad. Resultados: Los diagnósticos incluyeron: hernias inguinales con 486 casos, tumores de partes blandas en 359 casos, hernia umbilical en 185 casos, eventración en 88 casos, enfermedad anorrectal en 27 casos, enfermedad pilonidal en 17 casos, ginecomastia en 17 casos, fimosis en 10 y otros en 11. Se realizaron plastía inguinal, resección de enfermedad pilonidal, plastía umbilical, excisión de tumor benigno de partes blandas, plastía de pared, mastectomía subcutánea, hemorroidectomía y/o fistulectomía, circuncisión y otros. El tiempo empleado para el manejo quirúrgico se redujo de 36 horas en promedio a doce horas (p < 0.05). El costo-eficacia fue del 40% menor en comparación con los pacientes que se operaron con el método tradicional. El promedio de tiempo quirúrgico y anestésico no fue diferente entre cirugía ambulatoria y el método tradicional. Conclusión: Se puede realizar con gran eficiencia cirugía de corta estancia en sábados domingos y días festivos con un ahorro de 40%.

Objective: To demonstrate the benefits of the impact, time, and cost-effectiveness of short stay surgery performed on weekends and holidays. Setting: General Hospital of Mexico (Third level health care hospital). Design: Prospective, cross-sectional, observational, and comparative study. Statistical analysis: Student's t test, chi square, and cost-effectiveness analysis. Material and method: During 4 years, 1,200 surgeries were performed within this pilot program, using the installed hospital infrastructure and the same personnel employed for medical care in those days, without having a special short stay surgery unit as such. Performed procedures were: inguinal plasty, resection of pilonidal disease, umbilical plasty, resection of benign soft tissue tumor, wall plasty, subcutaneous mastectomy, hemorrhoidectomy, fistulectomy, and excision of benign breast tumors, these were compared with the same procedures but performed as programmed surgeries. We assessed and compared the following variables: age, gender, performed procedure, time of hospital stay, and cost-benefit of the procedure. We also evaluated the need of hospitalization, re-admittance in less than 24 h, morbidity and mortality. Results: Diagnoses included: inguinal hernias with 486 cases, 359 cases of soft tissue tumors, 185 cases of umbilical hernia, 88 cases of eventration, 22 cases of anorectal disease, 17 cases of pilonidal disease, 17 cases of gynecomastia, 10 cases of phimosis, and 11 other diagnoses. We performed inguinal plasties, resection of pilonidal disease, umbilical plasty, excision of soft tissue tumor, wall plasty, subcutaneous mastectomy, hemorrhoidectomy and/or fistulectomy, circumcision and other procedures. The time used for surgical management was reduced from an average of 36 to 12 hours (p < 0.05). Cost-effectiveness was 40% lower as compared with the traditional method. Surgical and anesthetic times were not different between ambulatory and traditional surgeries. Conclusion: Short stay surgery can be performed efficiently on the weekends and holydays with a 40% savings.

Inguinodinia en postoperados de plastía inguinal con técnica de Lichtenstein con resección versus preservación del nervio ilioinguinal ipsilateral / Inguinodynia in patients after inguinal hernioplasty with the Lichtenstein technique with resection versus preservation of the ipsilateral ilioinguinal nerve

Objetivo: Evaluar la inguinodinia en pacientes postoperados de plastía inguinal tipo Lichtenstein, comparando la sección contra la preservación de nervio ilioinguinal. Sede: Clínica de Hernias del Servicio de Cirugía General del Hospital General de México. Diseño: Ensayo clínico controlado, doble ciego. Análisis estadístico: Prueba de Wilcoxon y U de Mann-Whitney. Material y métodos: A 40 pacientes se les realizó plastía tipo Lichtenstein; aleatoriamente, en 18 se seccionó el nervio ilioinguinal y en 22 se preservó. Se evaluó la sensibilidad cutánea pre y postoperatoria, con escala visual análoga para la intensidad del dolor, con el fin de determinar si la sección del nervio ilioinguinal disminuye o no la intensidad del dolor y la presentación de inguinodinia postoperatoria. Resultados: Hubo diferencia significativa en cuanto a reducción del dolor a favor de los pacientes en que se seccionó el nervio a partir de 24 horas del postoperatorio (p < 0.001) y a los 60 días del postoperatorio (p < 0.0001), sin presentarse inguinodinia, alodinia, ni molestias por la hipoestesia o anestesia. Conclusión: La sección del nervio ilioinguinal durante la reparación de la hernia inguinal con la técnica de Lichtenstein disminuye el dolor postoperatorio en forma óptima, sin alterar en forma importante la sensibilidad superficial y además evita la inguinodinia.

Medición del conocimiento de bioética en residentes y médicos de base de cirugía general del Hospital General de México / Assessment of the bioethical knowledge in residents and tenure physicians of General Surgery at the General Hospital of Mexico

Objetivo: Medir el conocimiento bioético de los médicos de base y residentes de cirugía general. Sede: Hospital General de México. Diseño: Estudio prospectivo, transversal, comparativo y observacional. Análisis estadístico: Prueba t de Student y Kruskal-Wallis. Metodología: Se evaluaron 22 médicos de base y 61 residentes de los cuatro años de la especialidad de cirugía general, a los cuales se les aplicó un cuestionario basado en cuatro casos clínicos, elaborado por la Universidad de Toronto, para evaluar la capacidad de reconocer problemas bioéticos. Resultados: Se recabaron un total de 52 cuestionarios contestados (62%), 15 médicos de base con una edad promedio de 48.6 años y 37 residentes con una edad promedio de 26.5 años. Se reconoció el 12% de los problemas bioéticos presentes en los cuatro casos clínicos. El 53% de problemas relacionados a justicia, el 30% en autonomía y el 28% en beneficencia. El grupo que presentó mayor promedio total de conocimiento bioético fueron los residentes de cuarto año, seguidos de los de segundo y primer año y en último lugar los médicos de base y los residentes de tercer año. Los médicos con formación bioética previa a la respuesta de los casos clínicos reconocieron un mayor número de problemas. Conclusión: El bajo puntaje obtenido en el cuestionario se traduce en una deficiente capacidad para reconocer problemas bioéticos, tanto por médicos de base como por residentes de cirugía general.

Objective: To measure the bioethical knowledge in tenure physicians and general surgery residents. Setting: General Hospital of Mexico. Design: Prospective, cross-sectional, comparative, and observational study. Statistical analysis: Student's t and Kruskal-Wallis tests. Methodology: We evaluated 22 physicians and 61 residents of the four years of the General Surgery speciality, to whom a questionnaire based on four clinical cases, elaborated by the University of Toronto, was applied to assess their ability to recognize bioethical conflicts. Results: We obtained a total of 52 answered questionnaires (62%), 15 graduated surgeons with an age average of 48,6 years and 37 surgical residents with an age average of 26,5 years. Only 12% of the bioethics problem in the four clinical cases was clear. 53% of problems related to justice, 30% in autonomy and 28% in charity. The fourth year resident group has the major average of bioethics knowledge, followed of those of second and first year and last was the graduated surgeons and the residents of third year. The surgeons with bioethics formation recognized a greater number of problems. Conclusion: The low score obtained in the questionnaire is translated in a deficient capacity to recognize bioethics problems, as much by graduated surgeons as by residents of general surgery.

Prevención de quejas y demandas al aplicar las metas de seguridad en el paciente quirúrgico / Prevention of complaints and claims by applying the Safety Guidelines to the surgical patient

Objetivo: Demostrar si el cumplimiento de las ''metas internacionales de seguridad en el paciente'' pueden disminuir la frecuencia de quejas y/o demandas. Sede: Hospital General de México. Diseño: Observacional, descriptivo, retrospectivo, transversal. Análisis estadístico: Porcentaje como medida de resumen para variables cualitativas. Material y métodos: Se evaluaron las quejas y demandas relacionadas al Servicio de Cirugía General y manejada por el Departamento Jurídico de enero de 2008 a octubre de 2009, al requerir peritaje por tercero en discordia, previo a instrumentar la aplicación del programa de metas internacionales de seguridad en el paciente. Se evalúo la causa específica de la queja y si ésta hubiera sido o no prevenida al aplicar las metas internacionales de seguridad del paciente. Resultados: Durante el periodo de estudio se requirió de ocho peritajes relacionados a cirugía general, si se hubieran aplicado las metas internacionales de seguridad del paciente, el 50% de la quejas hubieran sido prevenidas. La cuarta meta internacional que garantiza cirugía en el lugar correcto, con el procedimiento correcto y al paciente correcto destaca sobre las demás en casos relacionados a cirugía general para prevenir quejas. Conclusión: La aplicación correcta de las metas internacionales de seguridad del paciente logra detectar fallas en la atención médica y, en consecuencia, previene en un 50% la frecuencia de quejas o demandas relacionadas con la atención médica.

Objective: To demonstrate whether complying with the ''International Safety Guidelines for the Patient'' can decrease the frequency of complaints and/or claims. Setting: General Hospital of Mexico. Design: Observational, descriptive, retrospective, cross-sectional study. Statistical analysis: Percentages as summary measure for qualitative variables. Material and methods: We evaluated the complaints and claims related to the general surgery service and handled by the legal department from January 2008 to October 2009 that required expert advice from a third arbitrator, and which occurred before applying the International Safety Guidelines for the Patient. We assessed the specific cause of the complaints and whether these could have or not been prevented by applying the Safety Guidelines. Results: During the studied period, eight third arbitrator revisions were required related to general surgery. If the Safety Guidelines had been applied, 50% of the complaints could have been avoided. The fourth guideline that warrants that surgery be performed in the right place, use of the correct procedure, and the correct patient stands out above the other guidelines in cases related to general surgery to avoid complaints. Conclusion: Adequate application of the International Safety Guidelines for the Patient is instrumental in detecting failures related to medical care.

Low-risk papillary thyroid cancer recurrence in patients treated with total thyroidectomy and adjuvant therapy vs. patients treated with partial thyroidectomy.

BACKGROUND: Surgical extension for treatment of patients with low-risk papillary thyroid carcinoma is still controversial. We undertook this study to assess if there is a difference in recurrence between patients undergoing total thyroidectomy plus adjuvant therapy and patients treated with only partial thyroidectomy. METHODS: We conducted a longitudinal, observational, analytical study in patients with histopathological diagnosis of low-risk papillary thyroid carcinoma followed for at least 10 years. Patients were divided into two groups: Group 1: Patients treated with total thyroidectomy plus adjuvant therapy (TT) and Group 2: Patients treated with only partial thyroidectomy without adjuvant therapy (HT). Descriptive and inferential statistical methods were used. RESULTS: AMES: 184 patients, recurrence in 5/23 HT and 7/161 TT (p = 0.0016); MACIS: 170 patients, recurrence in 5/24 HT and 5/146 TT (p = 0.0008); DeGroot: 92 patients, recurrence in 3/19 HT and 2/73 TT (p = 0.0254); TNM: 150 patients, recurrence in 5/22 HT and 7/128 TT (p = 0.0058). The time interval for local recurrences was higher in comparison to regional recurrences (p <0.05). In all classifications, recurrences occur mainly with regional metastatic disease (60%). Multifocality, bilateral disease and extracapsular disease showed no statistical difference. There was one incidental injury to a recurrent laryngeal nerve and this was repaired during the same surgical procedure. There was no morbidity due to hypoparathyroidism. CONCLUSIONS: Patients classified as low risk according to any of the studied classifications have a higher risk for recurrence when treated with hemithyroidectomy than when treated with total thyroidectomy plus adjuvant therapy.