RESUMO
Abstract Introduction: The purposes of our study were to describe the distribution of diagnoses in a series of 273 patients over 65 years of age who presented for neck masses and to identify semiological fea tures associated with malignancy. Methods: Neck masses were categorized as congenital lesions (n = 7, 3%, 95% CI: 1%- 5%), inflammatory masses (n = 67, 25%, 95% CI: 19%- 30%), benign neoplasms (n = 77, 28%, 95% CI: 23%- 34%), and malignant neoplasms (n = 87, 32%, 95% CI: 26%- 38%). Results: A group of patients had discontinued care and, consequently, a definitive diagnosis could not be reached (n = 35, 12%). Age (OR 1.06, 95% CI 1.00-1.12), male sex (OR 2.35, 95% CI 1.11-4.96), prior history of cancer (OR 2.66, 95% CI 1.02-6.92), mass fixation to skin or deep tissues (OR 4.87, 95% CI 2.20-10.76), and the involvement of multiple cervical lymph node levels (OR 4.15, 95% CI 1.64-10.51) were identified as semiological features associated with malignancy. Conclusion: In the case of a neck mass in an elderly patient, its neoplastic origin should be strongly suspected.
Resumen Introducción: El objetivo de nuestro estudio fue describir la distribución de diagnósticos en una serie de 273 pacientes mayores de 65 años que consultaron por masas cervicales e identificar características semiológicas asociadas a malignidad. Métodos: Las masas cervicales fueron categorizadas como lesiones congénitas (n = 7, 3%, 95% CI: 1%- 5%), masas de origen inflamatorio (n = 67, 25%, 95% CI: 19%-30%), neoplasias benignas (n = 77, 28%, 95% CI: 23%- 34%) y neoplasias malignas (n = 87, 32%, 95% CI: 26%-38%). Resultados: Un grupo de pacientes discontinuó el tratamiento y en consecuencia no fue posible alcanzar un diagnóstico defini tivo (n = 35, 12%). La edad (OR 1.06, 95% CI 1.00-1.12), el sexo masculino (OR 2.35, 95% CI 1.11-4.96), los antecedentes de cáncer (OR 2.66, 95% CI 1.02-6.92), la fijación de la masa a los planos profundos o a piel (OR 4.87, 95% CI 2.20-10.76) y la afectación de más de un nivel ganglionar del cuello (OR 4.15, 95% CI 1.64-10.51) fueron identificados como características semiológicas asociadas a malignidad. Conclusión: En presencia de una masa cervical en un paciente adulto mayor debe existir una fuerte sospecha de origen neoplásico.
RESUMO
INTRODUCTION: The purposes of our study were to describe the distribution of diagnoses in a series of 273 patients over 65 years of age who presented for neck masses and to identify semiological features associated with malignancy. METHODS: Neck masses were categorized as congenital lesions (n = 7, 3%, 95% CI: 1%- 5%), inflammatory masses (n = 67, 25%, 95% CI: 19%- 30%), benign neoplasms (n = 77, 28%, 95% CI: 23%- 34%), and malignant neoplasms (n = 87, 32%, 95% CI: 26%- 38%). RESULTS: A group of patients had discontinued care and, consequently, a definitive diagnosis could not be reached (n = 35, 12%). Age (OR 1.06, 95% CI 1.00-1.12), male sex (OR 2.35, 95% CI 1.11-4.96), prior history of cancer (OR 2.66, 95% CI 1.02-6.92), mass fixation to skin or deep tissues (OR 4.87, 95% CI 2.20-10.76), and the involvement of multiple cervical lymph node levels (OR 4.15, 95% CI 1.64-10.51) were identified as semiological features associated with malignancy. CONCLUSION: In the case of a neck mass in an elderly patient, its neoplastic origin should be strongly suspected.
Introducción: El objetivo de nuestro estudio fue describir la distribución de diagnósticos en una serie de 273 pacientes mayores de 65 años que consultaron por masas cervicales e identificar características semiológicas asociadas a malignidad. Métodos: Las masas cervicales fueron categorizadas como lesiones congénitas (n = 7, 3%, 95% CI: 1%- 5%), masas de origen inflamatorio (n = 67, 25%, 95% CI: 19%-30%), neoplasias benignas (n = 77, 28%, 95% CI: 23%- 34%) y neoplasias malignas (n = 87, 32%, 95% CI: 26%-38%). Resultados: Un grupo de pacientes discontinuó el tratamiento y en consecuencia no fue posible alcanzar un diagnóstico definitivo (n = 35, 12%). La edad (OR 1.06, 95% CI 1.00-1.12), el sexo masculino (OR 2.35, 95% CI 1.11-4.96), los antecedentes de cáncer (OR 2.66, 95% CI 1.02-6.92), la fijación de la masa a los planos profundos o a piel (OR 4.87, 95% CI 2.20-10.76) y la afectación de más de un nivel ganglionar del cuello (OR 4.15, 95% CI 1.64-10.51) fueron identificados como características semiológicas asociadas a malignidad. Conclusión: En presencia de una masa cervical en un paciente adulto mayor debe existir una fuerte sospecha de origen neoplásico.
Assuntos
Neoplasias de Cabeça e Pescoço , Idoso , Humanos , Masculino , Neoplasias de Cabeça e Pescoço/etiologia , Linfonodos/patologia , Diagnóstico Diferencial , Estudos RetrospectivosRESUMO
La suspensión de antirresortivos en el contexto de cuadros de osteonecrosis asociada a medicamentos (ONAM) es controversial. Aunque la evidencia de ca-lidad al respecto es insuficiente, múltiples socieda-des profesionales y grupos de trabajo han sugerido emplear este recurso. Recientemente la Sociedad Americana de Cirujanos Orales y Maxilofaciales ha puesto en duda sus beneficios. En el presente estudio abordamos esta temática en dos situaciones clínicas diferentes. Por un lado, analizamos la suspensión de los antirresortivos en pacientes asintomáticos an-tes de llevar a cabo procedimientos invasivos en los maxilares para disminuir el riesgo de desarrollo de ONAM. Por otro lado, evaluamos la suspensión de los antirresortivos en pacientes con ONAM establecida para mejorar el pronóstico de la enfermedad (AU)
The suspension of antiresorptive drugs in the context of medication-related osteonecrosis of the jaws (MRONJ) is controversial. Despite the lack of quality evidence, several professional associations and working groups have made suggestions in using this resource. Recently the American Association of Oral and Maxillofacial Surgeons has questioned its benefits. In the present study we address this issue in two different clinical situations. On the one hand, we analyzed the suspension of antiresorptive agents in asymptomatic patients before carrying out invasive procedures in the jaws to reduce the risk of developing MRONJ. On the other hand, we evaluated the suspension of antiresorptive drugs in patients actually presenting MRONJ to improve the prognosis of the disease (AU)
Assuntos
Humanos , Conservadores da Densidade Óssea/efeitos adversos , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/complicações , Prognóstico , Sociedades Odontológicas/normas , Duração da TerapiaRESUMO
BACKGROUND: Esophagojejunal anastomotic leakage (EJAL) is among the most feared complications after gastric cancer surgery; they entail an uncertain prognosis and relate with increased morbidity and mortality. Factors associated with their development are not well determined, and their diagnosis and treatment vary between institutions. MATERIAL AND METHODS: Retrospective case-control study of patients operated of total gastrectomy with Roux-en-Y esophagojejunostomy from January 2002 to December 2018. We divided our sample into two groups based on the presence of EJAL, and compared demographic, clinical, and histologic variables. We performed a logistic regression model to search risk factors associated with EJAL and described the management offered in our center. RESULTS: We included 58 patients of which 8 (13.7%) presented clinically relevant EJAL. On the comparative analysis, albumin levels and diffuse histology presented a statistically significant difference between groups and presented association with EJAL in the logistic regression model. Regarding treatment of EJAL, ten patients (55.5%) required only conservative measures, whereas eight patients (44.4%) warranted an endoscopic or surgical intervention. CONCLUSION: Our retrospective analysis identified some factors that may be associated with the development of EJAL after gastric cancer surgery. High suspicion and prompt identification of this complication is essential to improve postoperative outcomes in this group.
INTRODUCCIÓN: Las fugas de la anastomosis esófago-yeyunal se encuentran entre las más temidas complicaciones de la cirugía para cáncer gástrico. Estas conllevan un mal pronóstico con una alta mortalidad y morbilidad. Los factores asociados a su desarrollo no están bien determinados y su diagnóstico, y tratamiento varían ampliamente entre instituciones. MATERIAL Y MÉTODOS: Estudio retrospectivo de casos y controles en pacientes operados de gastrectomía total con esófago-yeyuno anastomosis en Y de Roux en el periodo de enero 2002 a diciembre 2018. Nuestra muestra fue dividida en dos grupos con base al desarrollo de fuga de anastomosis en el postoperatorio. Se realizó un análisis comparativo de características demográficas, clínicas y histológicas. Se realizó además una regresión logística para identificar factores de riesgo asociados al desarrollo de fuga de anastomosis en nuestra serie. RESULTADOS: Incluimos a 58 pacientes de los cuales 8 (13.7%) presentaron fuga de anastomosis clínicamente relevante. En el estudio comparativo: Niveles disminuidos de albúmina e histología difusa fueron significativamente mayores en el grupo de fuga y se asociaron en el modelo de regresión logística. En cuanto al tratamiento, diez pacientes (55%) requirieron únicamente tratamiento conservador, mientras que ocho pacientes (44.4%) fueron sometidos a maniobras endoscópicas o quirúrgicas. CONCLUSIÓN: Nuestro análisis retrospectivo identifico factores asociados al desarrollo de fuga de anastomosis posterior a cirugía de cáncer gástrico. Una alta sospecha diagnóstica es esencial para mejorar el pronóstico de estos pacientes.
Assuntos
Adenocarcinoma , Fístula Anastomótica , Adenocarcinoma/complicações , Adenocarcinoma/cirurgia , Fístula Anastomótica/epidemiologia , Fístula Anastomótica/etiologia , Estudos de Casos e Controles , Gastrectomia/efeitos adversos , Humanos , Estudos RetrospectivosRESUMO
OBJETIVO: El objetivo de este trabajo fue analizar los resultados perioperatorios y a largo plazo de los pacientes sometidos a exenteración pélvica para cáncer de recto en un centro de referencia en la Ciudad de México. MÉTODO: Se incluyeron todos los pacientes que se sometieron a exenteración pélvica por cáncer de recto entre 1995 y 2019. Se analizaron variables demográficas, clínicas, quirúrgicas y patológicas. RESULTADOS: Se incluyeron 18 pacientes operados por cáncer de recto (16 localmente avanzados y 2 recurrentes). La relación hombre: mujer fue de 1:3.5. La morbilidad mayor fue del 27.7%. El sangrado intraoperatorio ≥ 1000 ml se asoció con morbilidad (80 vs. 20%; p = 0,029) y mortalidad posoperatoria (100 vs. 0; p = 0.043). La mediana de sobrevida global fue 102 meses. Las sobrevidas global y libre de enfermedad a los 5 años fueron del 44.4% y el 38.8%, respectivamente. La invasión linfovascular fue un factor de mal pronóstico para sobrevida libre de enfermedad (p = 0.017). CONCLUSIONES: La exenteración pélvica para el cáncer de recto es un procedimiento quirúrgico con altas morbilidad y mortalidad. La invasión linfovascular es un factor de mal pronóstico para la sobrevida libre de enfermedad. INTRODUCTION: Pelvic exenteration is a radical treatment for locally advanced and recurrent pelvic tumors. The aim of this study was to analyze the perioperative and long-term outcomes of patients undergoing pelvic exenteration for rectal cancer at a referral center in Mexico City. METHOD: We included all patients who underwent pelvic exenteration due to rectal cancer between 1995 and 2019. Demographic, clinical, surgical and pathological variables were analyzed. RESULTS: 18 patients were included (16 locally advanced and 2 recurrent). The male-female ratio was 1:3.5. The highest morbidity was 27.7%. Intraoperative bleeding ≥ 1000 ml was associated with postoperative morbidity (80 vs. 20%; p = 0.029) and mortality (100 vs. 0; p = 0.043). The median overall survival was 102 months. Overall survival and disease free survival at 5 years after exenteration were 44.4% and 38.8%, respectively. Lymphovascular invasion of the tumor was a poor prognostic factor for disease free survival (p = 0.017). CONCLUSIONS: Pelvic exenteration for rectal cancer is a surgical procedure with high morbidity and mortality. Lymphovascular invasion is a poor prognostic factor for disease-free survival.
Assuntos
Exenteração Pélvica , Neoplasias Retais , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Recidiva Local de Neoplasia , Neoplasias Retais/cirurgia , Estudos RetrospectivosRESUMO
BACKGROUND: The implementation of quality-of-care indicators aiming to improve colorectal cancer (CRC) outcomes has been previously described by Cancer Care Ontario. The aim of this study was to assess the quality-of-care indicators in CRC at a referral centre in a developing country and to determine whether improvement occurred over time. METHODS: We performed a retrospective study of our prospectively collected database of patients after CRC surgery from 2001 to 2016. We excluded patients who underwent local transanal excision, pelvic exenteration or palliative procedures. We evaluated trends over time using the Cochran-Armitage test for trend. RESULTS: A total of 343 patients underwent surgical resection of CRC over the study period. There was improvement of the following indicators over time: the proportion of patients detected by screening (p = 0.03), the proportion of patients with preoperative liver imaging (p = 0.001), the proportion of patients with stage II or III rectal cancer who received neoadjuvant chemotherapy (p = 0.03), the proportion of patients with pathology reports that indicated the number of lymph nodes examined and the number of positive nodes (p = 0.001), and the proportion of patients with pathology reports describing the details on margin status (p = 0.001). CONCLUSION: This study showed the feasibility of applying the Cancer Care Ontario indicators for evaluating outcomes in CRC treatment at a single centre in a developing country. Although there was an improvement of some of the quality-of-care indicators over time, policies and interventions must be implemented to improve the fulfillment of all indicators.
CONTEXTE: Action Cancer Ontario a déjà décrit l'application d'indicateurs de la qualité des soins dans le but d'améliorer l'issue du cancer colorectal (CCR). Le but de cette étude était d'évaluer les indicateurs de la qualité de soins pour le CCR dans un centre de référence d'un pays en voie de développement et de déterminer si des améliorations ont pu être observées avec le temps. MÉTHODES: Nous avons procédé à une étude rétrospective de notre base de données recueillies prospectivement auprès de patients ayant subi une chirurgie pour CCR entre 2001 et 2016. Nous avons exclu les patients qui ont subi une exérèse transanale locale, une exentération pelvienne ou des traitements palliatifs. Nous avons évalué les tendances au fil du temps à l'aide du test CochranArmitage pour dégager les tendances. RÉSULTATS: En tout, 343 patients ont subi une résection chirurgicale de CCR au cours de la période de l'étude. On a noté une amélioration des indicateurs suivants au fil du temps : proportion de patients ayant subi un dépistage (p = 0,03), proportion de patients ayant subi des épreuves d'imagerie hépatique préopératoires (p = 0,001), proportion de patients atteints d'un cancer rectal de stade II ou III ayant reçu une chimiothérapie néoadjuvante (p = 0,03), proportion de patients dont les rapports d'anatomopathologie indiquaient le nombre de ganglions lymphatiques examinés et le nombre de ganglions positifs (p = 0,001) et proportion de patients dont les rapports d'anatomopathologie décrivaient le statut des marges (p = 0,001). CONCLUSION: Cette étude a démontré l'applicabilité des indicateurs d'Action Cancer Ontario pour évaluer les résultats du traitement pour CCR dans un seul centre d'un pays en voie de développement. Même si certains des indicateurs de la qualité des soins se sont améliorés au fil du temps, il faut appliquer des politiques et des interventions pour améliorer tous les indicateurs.
Assuntos
Neoplasias Colorretais/cirurgia , Países em Desenvolvimento , Recidiva Local de Neoplasia/epidemiologia , Avaliação de Resultados em Cuidados de Saúde/métodos , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/mortalidade , Estudos de Viabilidade , Feminino , Seguimentos , Implementação de Plano de Saúde/organização & administração , Implementação de Plano de Saúde/estatística & dados numéricos , Humanos , Estimativa de Kaplan-Meier , Masculino , México , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/prevenção & controle , Avaliação de Programas e Projetos de Saúde , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/estatística & dados numéricos , Adulto JovemRESUMO
BACKGROUND: It is unknown whether surgically treated achalasia cases regain or surpass their usual weight into obesity or overweight in the long-term post-operative period. Here, we aimed to assess the incidence of overweight/obesity (Ob/Ow) and the risk for reoccurrence up to 48 months post-laparoscopic Heller myotomy (LHM). METHODS: We performed a cohort of 114 achalasia cases undergoing LHM. All patients had a confirmed diagnosis of achalasia and had no added comorbidities. We followed up the body mass index (BMI) at the immediate post-operative period, and at one-, six-, 12-, 24-, and 48 months after LHM. We measured the incidence of Ob/Ow and its reoccurrence risk with Cox regression. KEY RESULTS AND CONCLUSIONS: In the immediate post-operative period, the incidence of Ob/Ow was significantly less than the usual BMI (before the onset of symptoms) (28.2% vs 66.3%). From the sixth to the 48th month, there was a progressive increase in the incidence of Ob/Ow and at this timepoint the percent of Ob/Ow was not statistically different from the usual BMI. The most significant hazard for Ob/Ow reoccurrence in the long term following LHM is a usual BMI with obesity grade I or III and males lacking pre-surgical weight loss. INFERENCES: Achalasia cases undergoing surgical treatment should be monitored closely in the post-operative period for weight regain, regardless of their pre-operative BMI. Notably, males who before the onset of symptoms were obese or overweight are at significantly increased risk of regaining or surpassing their weight, despite most having lost weight pre-surgically.
Assuntos
Trajetória do Peso do Corpo , Acalasia Esofágica/fisiopatologia , Acalasia Esofágica/cirurgia , Miotomia de Heller/tendências , Sobrepeso/fisiopatologia , Cuidados Pós-Operatórios/tendências , Adulto , Estudos de Coortes , Acalasia Esofágica/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/fisiopatologia , Sobrepeso/diagnóstico , Fatores de Risco , Fatores de TempoRESUMO
BACKGROUND: Gastrointestinal schwannomas are slow-growing benign mesenchymal neoplasms that originate from Schwann cells of the nerve sheath of Auerbach´s plexus or less frequently from Meissner´s plexus. The main differential diagnosis of gastric schwannomas are the gastrointestinal stromal tumors (GISTs), which are classified by their immunohistochemistry. The treatment of choice for gastric schwannomas is surgery where laparoscopy plays an important role. Wedge resection, subtotal or total gastrectomy can be done. In its counterpart, esophageal schwannomas are benign tumors of the esophagus that are very uncommon since they comprise less than 2% of all esophageal tumors. The main differential diagnosis is the leiomyoma which corresponds to the most common benign esophageal tumor, followed by GIST. The treatment consists on tumoral enucleation or esophagectomy. AIM: To review the available literature about gastrointestinal schwannomas; especially lesions from de stomach and esophagus, including diagnosis, treatment, and follow up, as well as, reporting our institutional experience. METHODS: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guidelines. The following databases were used for reviewing process: PubMed, Ovid, MEDLINE, and Scopus. Only English language manuscripts were included. All gastrointestinal schwannomas specifically located in the esophagus and stomach were included. Cases that did not report long-term follow-up were excluded. RESULTS: Gastric localization showed a higher prevalence in both, the literature review and our institution: 94.95% (n = 317) and 83% (n = 5) respectively. With a follow-up with disease-free survival greater than 36 mo in most cases: 62.01% (n = 80) vs 66.66% (n = 4). In both groups, the median size was > 4.1 cm. Surgical treatment is curative in most cases. CONCLUSION: Schwannoma must be taken into account in the differential diagnosis of gastrointestinal mesenchymal tumors. It has a good prognosis, and most are benign. A disease-free survival of more than 36 mo can be achieved by surgery.
RESUMO
Hemophilia is an inherited coagulation disorder characterized by deficiency of the coagulation factor VIII or IX. When the management of hemostasis is inadequate, these patients are at high risk of experiencing intra and postoperative bleedings after tooth extractions. Coagulation factor replacement therapy allows performing most surgical procedures safely, although the factor levels and length of treatment have not been clearly determined. In this study, we present our experience in a retrospective series of 112 ambulatory tooth extractions under local anesthesia in 23 patients with hemophilia using a coagulation factor replacement therapy in combination with tranexamic acid. The results obtained with this protocol were satisfactory and only one episode of mild postoperative bleeding occurred after seven days in a patient who did not have good treatment compliance. Key words:Hemophilia, factor replacement therapy, tooth extractions, postoperative complications.