Diagnosis and treatment of primary thyroid lymphoma from a surgical perspective: a multi-institutional study.

PURPOSE: Surgery of primary thyroid lymphoma (PTL) has been mostly limited to diagnostic work-up. This study aimed to further study its potential role. METHODS: This was a retrospective study from a multi-institutional registry of PTL patients. Clinical, diagnostic work-up (fine needle aspiration, FNA; core needle biopsy, CoreNB), contribution of surgery (open surgical biopsy, OpenSB; thyroidectomy), histology subtype, and outcome data were evaluated. RESULTS: Some 54 patients were studied. Diagnostic work-up included FNA in 47 patients, CoreNB in 11, and OpenSB in 21. CoreNB yielded the best sensitivity (90.9%). Thyroidectomy was performed in 14 patients with other diagnosis (incidental PTL), in 4 for diagnosis and in 4 for elective treatment of PTL. Incidental PTL was associated with not performed FNA nor CoreNB (OR 52.5; P = 0.008), mucosa-associated lymphoid tissue (MALT) subtype (OR 24.3; P = 0.012), and Hashimoto's thyroiditis (OR 11.1; P = 0.032). Lymphoma-related death (10 cases) mostly occurred within the first year after diagnosis and was associated with diffuse large B-cell (DLBC) subtype (OR 10.3; P = 0.018) and older patients (OR 1.08 for every 1-year increase; P = 0.010). There was a trend towards lower mortality rate in patients receiving thyroidectomy (2/22 versus 8/32, P = 0.172). CONCLUSION: Incidental PTL accounts for most of thyroid surgery cases and are associated with incomplete diagnostic work-up, Hashimoto's thyroiditis and MALT subtype. CoreNB appears to be the best tool for diagnosis. Most of PTL deaths occurred during the first year after diagnosis and mostly related to systemic treatment. Age and DLBC subtype are poor prognostic factors.

Consideraciones en torno a la formación del residente en cirugía de pared abdominal en España / Training of residents in abdominal wall surgery in Spain

La formación del residente en cirugía de la pared abdominal constituye un aspecto fundamental en la formación quirúrgica, representando globalmente un 20% de su actividad. En el presente artículo, se analiza el estado actual de la formación del residente en este tipo de cirugía en España teniendo en cuenta el amplio espectro en el que se desarrolla: servicios generales, unidades funcionales específicas, programas de cirugía mayor ambulatoria. Para ello, partiendo de las especificaciones del programa de la especialidad, se han utilizado datos concretos obtenidos de diversas fuentes de información directas, así como una revisión de los resultados obtenidos por los residentes en cirugía herniaria. En general los residentes en nuestro país manifiestan su conformidad con la formación recibida, y los resultados objetivos registrados se adecuan a los planteados en el programa. Sin embargo, sería importante estructurar en sus itinerarios docentes, un periodo de rotación en alguna Unidad específica y su implicación en programas de cirugía mayor ambulatoria (AU)

The training of residents in abdominal wall surgery is a fundamental aspect of surgical training, representing globally 20% of its activity. In this paper, we analyze the current state of resident training in this kind of surgery in Spain, taking into account the broad spectrum it covers: general services, specific functional units, ambulatory surgery programs. To do this, based on the specifications of the specialty program, specific data were used from several different sources of direct information and a review of the results obtained by residents in hernia surgery. In general, our residents agree with their training and the recorded results are in line with objectives outlined in the program. However, it would be important to structure their teaching schedules, a rotation period in any specific unit and their involvement in outpatient surgery programs (AU)

[Training of residents in abdominal wall surgery in Spain]. / Consideraciones en torno a la formación del residente en cirugía de pared abdominal en España.

The training of residents in abdominal wall surgery is a fundamental aspect of surgical training, representing globally 20% of its activity. In this paper, we analyze the current state of resident training in this kind of surgery in Spain, taking into account the broad spectrum it covers: general services, specific functional units, ambulatory surgery programs. To do this, based on the specifications of the specialty program, specific data were used from several different sources of direct information and a review of the results obtained by residents in hernia surgery. In general, our residents agree with their training and the recorded results are in line with objectives outlined in the program. However, it would be important to structure their teaching schedules, a rotation period in any specific unit and their involvement in outpatient surgery programs.

Colecistectomía laparoscópica ambulatoria / No disponible

No disponible

Impactación de una sonda de Dormia en el coledoco tras colangiopancreatografía retrógrada endoscópica por coledocolitiasis / Dormia baskets impacted in the bile duct after endoscopic retrograde cholangio pancreatography

No disponible

Isquemia cólica simulando un carcinoma / Colic ischemia mimicking carcinoma

No disponible

[Epidermoid carcinoma on Zenker's diverticulum]. / Carcinoma epidermoide sobre un divertículo de Zenker.

Carcinoma is a rare but recognized complication of pharyngoesophageal diverticulum. We report the case of a 49-year-old man operated for a Zenker's diverticulum with an epidermoid carcinoma arising in the diverticulum. Since carcinoma is an uncommon complication of this pathology, we review the literature and discuss the therapeutic options.

Absceso de psoas y adenocarcinoma mucinoso de apéndice / Psoas abscess abd mucinous appendiceal cancer

No disponible

Carcinoma epidermoide sobre un divertículo de Zenker / Spontaneous epidermoid carcinoma arising in Zenker´s diverticulum

El carcinoma es una complicación rara, pero posible, de los divertículos faringoesofágicos. Se presenta el caso de un paciente de 49 años intervenido quirúrgicamente por un divertículo de Zenker en cuyo interior se descubrió la presencia de un carcinoma epidermoide. Dado que se trata de una complicación muy poco frecuente de esta patología, se revisa la literatura y se discuten las opciones terapéuticas (AU)

Hamartoma quístico retrorrectal / Retrorectal cystic hamartoma

Se presenta el caso de un paciente de 38 años con historia de dolor perineal y con pruebas de diagnóstico preoperatorio sugestivas de tumoración quística retrorrectal. El paciente fue intervenido quirúrgicamente y el diagnóstico anatomopatológico fue de hamartoma quístico retrorrectal. Se discuten el diagnóstico y el tratamiento (AU)

Resultado del tratamiento quirúrgico de los divertículos faringoesofágicos / Outcome of surgical treatment of pharyngoesophageal diverticula

Introducción. El divertículo de Zenker es una entidad relativamente frecuente relacionada con alteraciones de la musculatura faringoesofágica. Su tratamiento es siempre intervencionista. Revisamos nuestra serie y analizamos el resultado del tratamiento quirúrgico. Pacientes y métodos. Realizamos una revisión retrospectiva de 20 pacientes afectados de divertículo faringoesofágico, centrándonos en los síntomas, hallazgos clínicos, tipo de cirugía y sus resultados. Resultados. La disfagia es el síntoma más frecuente. El método diagnóstico más exacto es el tránsito esofágico y destacamos la relación con la hernia de hiato. La miotomía del cricofaríngeo no aumenta las complicaciones. Conclusiones. El divertículo de Zenker es susceptible de tratamiento quirúrgico o endoscópico en todos los casos, y está indicada la miotomía del cricofaríngeo (AU)

[Evaluation of a nosocomial infection surveillance program]. / Validación de un programa de vigilancia de infecciones nosocomiales.

OBJECTIVE: To validate the nosocomial infections surveillance system, establish its impact in morbi-mortality. MATERIAL AND METHODS: Surveillance of every single patient admitted during a one month period was done by one of us (DMG). Each possible case was discussed with two other hospital epidemiologists (SPLR, MSRF). This intensive surveillance was compared against the routinely surveillance performed by the nurses. We included all hospitalized patients between 11th July and 12th of August according to CDC (Atlanta, GA) nosocomial infections definitions. Patients were followed everyday and information about age, gender, underlying diagnosis, microorganisms responsible for nosocomial infections, hospital length of stay and mortality. RESULTS: During the study period 429 were admitted, 45 developed a nosocomial infection (cases) and 384 did not (controls). The incidence of nosocomial infections was 10.48 cases/100 discharges. The sensitivity and specificity of the surveillance system was 95.3 and 98.7%, respectively. Mortality in infected was 11.11% and in non infected was 2.4%. The average length of stay was 20 and 11 days for cases and non infected respectively (p < 0.01). Urinary tract infections were the most common NI (42%), secondary bacteremia (14 < or = %), pneumonia (11.11%) and deep surgical site infection (9.25%). The surgical wound infection rates were: 1.3%, 1.9% and 1.9% for clean, clean-contaminated and contaminated wounds. Patients with rapidly fatal diseases had an increased frequency of infections. The microorganisms most commonly isolated were Escherichia coli (28%), Staphylococcus aureus (11.11%), and Pseudomonas aeruginosa (8.6%). The level of antibiotic resistance was in average of 43% for those antibiotics tested. CONCLUSIONS: The sensitivity and specificity of the surveillance system was excellent. Patients with nosocomial infections had an increased length of stay and a higher mortality compared to those without NI. The validation of the surveillance system allows the production of trustable conclusions about nosocomial infections.

[Survival in colorectal adenocarcinoma in Cantabria. A population-based study (1989)]. / Supervivencia del adenocarcinoma colorrectal en Cantabria. Estudio de base poblacionol (1989).

PURPOSE: To analyse a population-based study of postoperative mortality and five-year survival in patients with colorectal adenocarcinoma and to compare the results to those of a previous survival study of 1970-1978 period. METHODS: Using the Register of Colorectal Cancer of Cantabria, with a population of 531.654 inhabitants according to the 1989 census, we studied 187 patients with primary colorectal adenocarcinoma. Patients with recurrence after previous excision and who were not residents of Cantabria were excluded. Postoperative mortality included 30-days postoperative period. Survival was calculated using the Kaplan-Meier method and the log-rank test was used to compare curves of probability. RESULTS: Postoperative mortality was 7.7%. Overall five-year survival was 42.4%. Specific-cancer survival was 46%. Type of surgical procedure (curative or palliative) and TNM classification showed significant differences (p < 0.05). CONCLUSION: In Cantabria the five-years survival rate in patients with colorectal adenocarcinoma is similar to published data from other population-based studies but the survival rate did not change over the last decade.