Volumen plaquetario medio e índice de plaquetas-linfocitos como factores de pronóstico en cáncer papilar de tiroides.

BACKGROUND: Papillary thyroid cancer is the most common endocrine neoplasia. There are prognostic factors that establish risk of recurrence and mortality; however, patients considered low risk may have a less favorable evolution and hence the importance of finding new markers. OBJECTIVE: To assess whether the mean platelet volume (MPV) and the platelet-lymphocyte index (PLI) show a relationship with the clinical staging in papillary thyroid cancer. METHOD: Retrospective, observational and analytical study. Preoperative MPV and PLI were recorded, its relationship with TNM and MACIS systems was sought, as well as locally advanced invasion and tumor focality. RESULTS: 107 cases treated from November 2017 to February 2020. No statistically significant difference was observed in these two preoperative parameters with advanced and initial stages, risk groups or tumor focality. The statistical analysis used was one-way ANOVA with SPSS 25, a 95% confidence interval and p < 0.05. CONCLUSIONS: Despite the logical reasoning of tumor pathophysiology, our study did not find a relationship between papillary thyroid carcinoma with MPV and PLI, and should be complemented with more extensive studies.

ANTECEDENTES: El cáncer papilar de tiroides es la neoplasia endocrina más frecuente. Existen factores pronósticos que establecen el riesgo de recurrencia y mortalidad; sin embargo, los pacientes considerados de bajo riesgo pueden llegar a presentar una evolución menos favorable, y de ahí la importancia de encontrar nuevos marcadores. OBJETIVO: Evaluar si el volumen plaquetario medio (VPM) y el índice plaquetas-linfocitos (IPL) presentan una relación con la etapificación clínica en el cáncer papilar de tiroides. MÉTODO: Estudio retrospectivo, observacional y analítico. Se registraron el VPM y el IPL preoperatorios, y se buscó su relación con los sistemas TNM y MACIS, así como con la invasión localmente avanzada y la focalidad del tumor. RESULTADOS: Se trataron 107 casos de noviembre de 2017 a febrero de 2020. No se observó diferencia estadísticamente significativa en estos dos parámetros preoperatorios o en estadios avanzados e iniciales, grupos de riesgo ni focalidad del tumor. El análisis estadístico utilizado fue ANOVA de una vía, con SPSS 25, con intervalo de confianza del 95% y p < 0.05. CONCLUSIONES: Pese al razonamiento lógico de la fisiopatología tumoral, en nuestro estudio no se encontró relación entre el carcinoma papilar de tiroides, el VPM y el IPL, y debiera complementarse con estudios más extensos.

International Validation of a Methicillin-Resistant Staphylococcus aureus Risk Assessment Tool for Skin and Soft Tissue Infections.

INTRODUCTION: To promote judicious prescribing of methicillin-resistant Staphylococcus aureus (MRSA)-active therapy for skin and soft tissue infections (SSTI), we previously developed an MRSA risk assessment tool. The objective of this study was to validate this risk assessment tool internationally. METHODS: A multicenter, prospective cohort study of adults with purulent SSTI was performed at seven international sites from July 2016 to March 2018. Patient MRSA risk scores were computed as follows: MRSA infection/colonization history (2 points); previous hospitalization, previous antibiotics, chronic kidney disease, intravenous drug use, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), diabetes with obesity (1 point each). Predictive performance of MRSA surveillance percentage, MRSA risk score, and estimated MRSA probability (surveillance percentage adjusted by risk score) were quantified using the area under the receiver operating characteristic curves (aROC) and compared. Performance characteristics of different risk score thresholds across varying baseline MRSA prevalence were examined. RESULTS: Two hundred three patients were included. Common SSTI were wounds (28.6%), abscess (25.1%), and cellulitis with abscess (20.7%). Patients with higher risk scores were more likely to have MRSA (P < 0.001). The MRSA risk score aROC (95%CI) [0.748 (0.678-0.819)] was significantly greater than MRSA surveillance percentage [0.646 (0.569-0.722)] (P = 0.016). Estimated MRSA probability aROC [0.781 (0.716-0.845)] was significantly greater than surveillance percentage (P < 0.001) but not the risk score (P = 0.192). The estimated negative predictive value (NPV) of an MRSA score ≥ 1 (i.e., a score of 0) was greater than 90% when MRSA prevalence was 30% or less. CONCLUSION: The MRSA risk score and estimated MRSA probability were significantly more predictive of MRSA compared with surveillance percentage. An MRSA risk score of zero had high predictive value and could help avoid unnecessary empiric MRSA coverage in low-acuity patients. Further study, including impact of such risk assessment tools on prescribing patterns and outcomes are required before implementation.

Evaluation of C-reactive protein, procalcitonin and the PCR/PCT index as indicators of mortality in abdominal sepsis.

BACKGROUND: Biomarker combinations can improve timely diagnosis and survival. OBJECTIVE: To determine the usefulness of serum procalcitonin concentration (PCT), C-reactive protein (PCR) and the PCR / PCT index as predictors of mortality. METHOD: Retrospective study of patients diagnosed with abdominal sepsis during the period from April 2017 to February 2018. RESULTS: We included 182 cases. In the survivors, the mean PCR was 170 and procalcitonin (PCT) 10.5. In the deceased, the mean of C-reactive protein (CRP) was 328 and that of PCT was 17.6. When applying the student's t-test for independent samples, it was found that these differences were significant for PCR (p = 0.001); however, for PCT it was not significant (p = 0.460). Afterwards, the PCR/PCT index was studied, as a predictor of mortality, in the deceased cases a PCR/PCT score of 7534 (standard deviation [SD]: 19,303) and for survivors of 538 (SD:805) (p = 0.001) was obtained. CONCLUSION: CRP is associated with mortality, serum PCT does not correlate with mortality. The PCR/PCT index seems to be a better indicator to predict mortality in patients with abdominal sepsis due to secondary peritonitis.

ANTECEDENTES: Las combinaciones de biomarcadores pueden mejorar el diagnóstico oportuno y la supervivencia. OBJETIVO: Determinar la utilidad de la concentración sérica de procalcitonina (PCT), la proteína C reactiva (PCR) y el índice PCR/PCT como predictores de mortalidad. MÉTODO: Estudio retrospectivo de pacientes con diagnóstico de sepsis abdominal durante el periodo de abril de 2017 a febrero de 2018. RESULTADOS: Se incluyeron 182 casos. En los sobrevivientes, la media de los valores de PCR fue de 170 y la de PCT fue de 10.5. En los fallecidos, la media de los valores de PCR fue de 328 y la de PCT fue de 17.6. Al aplicar el estadístico t de Student para muestras independientes se obtuvo que estas diferencias resultaron significativas para la PCR (p = 0.001), pero no para la PCT (p = 0.460). Posteriormente se estudió el índice PCR/PCT como predictor de mortalidad: en los fallecidos se obtuvo un valor de 7534 (desviación estándar [DE]:± 19,303) y en los sobrevivientes de 538 (DE± 805) (p = 0.001). CONCLUSIÓN: La PCR se asocia con la mortalidad, mientras que la PCT no guarda relación con la mortalidad. El índice PCR/PCT parece ser un mejor indicador para predecir la mortalidad en los pacientes con sepsis abdominal por peritonitis secundaria.

Hyperparathyroidism during pregnancy. Is it a diagnostic and therapeutic challenge?

BACKGROUND: Primary hyperparathyroidism (PHPT) is characterized by an increase in parathyroid hormone (PTH) and hypercalcemia, which, when present during pregnancy, increases both maternal and fetal morbidity and mortality. OBJECTIVE: Emphasize the importance of surgical intervention in primary hyperparathyroidism during pregnancy. CLINICAL CASE: A 27-year-old female with a pregnancy of 27.2 weeks of gestation, with a diagnosis of symptomatic primary hyperparathyroidism secondary to parathyroid adenoma, a history of nephrolithiasis and severe acute pancreatitis, surgery was decided upon finding intrathyroid right parathyroid adenoma, post-surgical course with adequate evolution and remission of hyperparathyroidism. CONCLUSIONS: Parathyroidectomy in primary hyperparathyroidism during pregnancy is safe.

INTRODUCCIÓN: El hiperparatiroidismo primario (HPTP) se caracteriza por un aumento de la hormona paratiroidea (PTH) e hipercalcemia, que aumenta la morbimortalidad materna y fetal cuando se presenta durante el embarazo. OBJETIVO: Enfatizar la importancia de la intervención quirúrgica en el hiperparatiroidismo primario durante el embarazo. CASO CLÍNICO: Paciente femenino de 27 años de edad con embarazo de 27.2 semanas de gestación, con diagnóstico de hiperparatiroidismo primario sintomático secundario a adenoma paratiroideo, antecedentes de nefrolitiasis y pancreatitis aguda grave; al decidir realizar un procedimiento quirúrgico se identificó un adenoma paratiroideo derecho intratiroideo; el curso posquirúrgico mostró adecuada evolución y remisión del hiperparatiroidismo. CONCLUSIÓN: La paratiroidectomía en el hiperparatiroidismo primario durante el embarazo es segura.

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.

[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.

Hallazgos de anatomía patológica en una serie clínica de colecistectomía electiva: ¿Es frecuente el cáncer in situ ? / Pathologic anatomy findings in a clinical series of elective cholecystectomy: Is in situ cancer frequent?

Objetivo: Conocer la frecuencia de las lesiones de la vesícula biliar, incluyendo al cáncer in situ , mediante el estudio definitivo de anatomía patológica en una serie clínica de pacientes con diagnóstico preoperatorio benigno crónico. Sede: Hospital General de México. Diseño: Estudio retrospectivo, descriptivo, observacional y transversal. Análisis estadístico: Porcentajes como medida de resumen para variables cualitativas. Pacientes y métodos: Se realizó un estudio retrospectivo y observacional que incluyó a 200 pacientes sometidos a colecistectomía, tanto por vía abierta como laparoscópica, en el Servicio de Cirugía General del Hospital General de México, en el periodo de junio de 1991 a junio de 1995. Todos los pacientes fueron intervenidos por el mismo grupo de cirujanos. Se analizó la distribución por sexo, edad, antecedentes heredofamiliares, antecedentes personales, evolución de la sintomatología, datos clínicos, estudios ultrasonográficos, tipo de cirugía, y hallazgos de anatomía patológica. Resultados: En nuestra serie clínica de 200 pacientes, de acuerdo a los resultados del estudio histopatológico, se encontró a dos pacientes con diagnóstico de carcinoma de vesícula in situ más colelitiasis, ambas fueron mujeres. Conclusión: La frecuencia del carcinoma in situ de vesícula biliar en esta serie fue del 1%.

Objective: To know the frequency of gallbladder injuries, including in situ cancer, by means of a definitive pathological anatomy study, in a clinical series of patients with a benign chronic preoperative diagnosis. Setting: General Hospital of Mexico (Third Level Health Care Center). Design: Retrospective, descriptive, observational and cross-sectional study. Statistical analysis: Percentages as summary measure for qualitative variables. Patients and methods: A retrospective and observational study was perfomed that included 200 patients subjected to cholecystectomy, through open surgery or laparoscopically, at the General Surgery Unit of the General Hospital of Mexico from June 1991 to June 1995. All patients were operated by the same surgical team. We analyzed the distribution according to gender, age, familial antecedents, personal antecedents, evolution of symptomatology, clinical data, ultrasound studies, type of surgery, and pathological anatomy findings. Results: In our clinical series of 200 patients, according to the histopathological results there were two patients with diagnosis of in situ gallbladder carcinoma plus cholelithiasis; both were women. Conclusion: Frequency of in situ gallbladder carcinoma in this series was of 1%.

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.

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.

Prevalence of thyroid nodules in the Valley of Mexico.

BACKGROUND: There are no open population epidemiological studies to determine the true prevalence of thyroid nodules in the Valley of Mexico. The aim of this investigation was to determine prevalence. METHODS: We carried out a cross-sectional, observational, descriptive study in 2401 open population subjects in the Valley of Mexico. All subjects were at least 18 years of age with no clinical history of thyroid disease. Variables analyzed were age, gender, thyroid nodule identified by neck palpation or neck ultrasound, TSH levels, cytological diagnosis and histopathological diagnosis in case of clinical thyroid nodule detection. Percentages as a summary measure for qualitative variables and proportions and chi-square for independent variables were used for statistical analysis. RESULTS: Included were 2401 subjects with a mean age of 39 years (82.4% female, 17.6% male). Thirty-four (1.4%) thyroid nodules were detected by palpation and 471 (19.6%) by ultrasound. The 34 palpable thyroid nodules corresponded to 16 (47.2%) colloid goiters, 8 (23.5%) follicular adenomas, 7 (20.5%) Hashimoto's thyroiditis, 2 (5.9%) papillary carcinomas and 1 (2.9%) oxiphilic cell adenoma. Nonpalpable thyroid nodules detected by ultrasound did not develop illness at 2-year follow-up. TSH was normal in 1620 (67.4%), high in 515 (21.5%) and low in 266 (11.1%) patients. There was no relationship between TSH levels and final diagnosis of the 34 palpable nodules (p >0.05). CONCLUSIONS: Prevalence of palpable thyroid nodule in the Valley of Mexico is 1.4%; 5.9% of these are due to papillary thyroid cancer. TSH levels do not correlate with the presence or cause of the thyroid nodule.

Causes for early reintervention after thyroidectomy.

BACKGROUND: The purpose of our study was to ascertain the causes for early reintervention after thyroidectomy performed by a surgical team using a systematized surgical technique. MATERIAL/METHODS: We analyzed 1131 patients, 939 (83.1%) women and 192 (16.9%) men, average age 38.7 years (range 12 to 79). Of these patients, there were 675 hemithyroidectomies with isthmusectomy (59.74%), 189 subtotal thyroidectomies (16.71%), and 267 total thyroidectomies, alone or with regional lymphatic dissection at levels VI and VII (23.55%). Statistical analysis was performed by main tendency measures and chi square (chi-squared) for comparison of two independent samples; the dependent variable was the rate of early reintervention, while the independent variables included causes, time of presentation, hormonal functional state and extent of surgery. RESULTS: Early reintervention was necessary in 11 cases (0.97%). 9 were due to hematoma (0.79%) resolved with drainage and hemostasis, and two (0.18%) due to acute respiratory failure (ARF) caused by laryngeal edema, resolved by tracheostomy. Analysis based on diagnosis, extent of surgery and functional state failed to reveal statistically significant differences. The maximum time presentation of complications was 6 hours. CONCLUSIONS: The most intense postoperative monitoring is necessary during the first six hours. The low frequency of early reintervention and the appearance of complications in less than 8 hours enable thyroid surgery to be performed on a short-stay basis with adequate safety margins.

Bases para realizar tiroidectomía en la enfermedad de Graves-Basedow / Basis to realize thyroidectomy in Graves-Basedow disease

El objetivo de este estudio fue analizar los datos más relevantes de 161 pacientes con enfermedad de Graves-Basedow, entre 713 casos de pacientes sometidos a cirugía de tiroides en la Unidad 307 de Cirugía General del Hospital General de México de la Secretaría de Salud. Estos datos nos revelan los problemas y retos fundamentales en el manejo de la enfermedad de Graves-Basedow. Se explican las bases para someter a los pacientes a cirugía y se compara ésta con otros métodos de tratamiento. Las conclusiones son que la cirugía en manos experimentadas presenta una morbilidad baja y sigue teniendo un papel preponderante en el tratamiento de este padecimiento, y finalmente que las complicaciones, la mayoría de las veces esperadas (como es la hipocalcemia), son leves y transitorias