ABSTRACT
Resumen Introducción: La esofagectomía presenta una alta morbilidad postoperatoria. Sin embargo, las definiciones de las complicaciones son variables. Un grupo multinacional (esophagectomy complications consensus group; ECCG) propuso definiciones estandarizadas. Objetivo: Evaluar las complicaciones postoperatorias en esofagectomía según las definiciones propuestas por el ECCG. Materiales y Método: Realizamos un estudio de cohorte retrospectivo, a partir de una base de datos prospectiva. Se incluyeron pacientes sometidos a una esofagectomía por cáncer entre 1996 y 2018 en un centro. Se aplicaron las definiciones de las complicaciones postoperatorias según el ECCG. Resultados: Se incluyeron 215 pacientes (Hombres 64%; edad 67 [31-82] años). Un 64% presentaban alguna comorbilidad. Existió un predominio de carcinoma escamoso con un 68%. La ubicación tumoral más frecuente fue el tercio inferior del esófago (48%). Se utilizó un abordaje abierto en 74% y mínimamente invasivo en 26%. La morbilidad postoperatoria total fue de 67%. Las complicaciones más frecuentes fueron las respiratorias alcanzando un 27%. En total, un 25% de los pacientes presentó una filtración de la anastomosis esofagogástrica, de las cuales un 24% fueron tipo II (no requirieron una reintervención quirúrgica). Se produjo una paresia de cuerda vocal en 7%, todas tipo I (no requirieron terapia específica). Se presentó una fístula quilosa en 2%, en 1% se trataron con nutrición parenteral (tipo II) y en 1% se realizó una reintervención (tipo III). Conclusión: La esofagectomía se asocia a una alta morbilidad. Las principales complicaciones son las respiratorias y las gastrointestinales. La utilización de las definiciones de consenso permite una estandarización y graduación de las complicaciones.
Introduction: Esophagectomy presents a high postoperative morbidity. However, the definitions used are variable. A multinational group (esophagectomy complications consensus group; ECCG) proposed standardized definitions. Aim: To evaluate postoperative complications in esophagectomy according to the definitions proposed by the ECCG. Materials and Method: We conducted a retrospective cohort study, based on a prospective database. Patients undergoing esophagectomy for cancer between 1996 and 2018 at one center were included. The definitions of postoperative complications according to the ECCG were applied. Results: We included 215 patients (64% men, age 67 [31-82] years). Sixty-four percent had some comorbidity. There was a predominance of squamous carcinoma with 68%. The most frequent tumor location was the lower third of the esophagus (48%). An open approach was used in 74% and minimally invasive in 26%. Total postoperative morbidity was 67%. The most frequent complications were respiratory complications, which reached 27%. The leakage of the esophagogastric anastomosis reached 25%, 24% were type II (did not require surgical reoperation). There was a vocal cord paresis in 7%, all were classified as type I (did not require specific therapy). A chylous fistula was presented in 2%, in 1% they were treated with parenteral nutrition (type II) and in 1% a reoperation was performed (type III). Conclusion: Esophagectomy is associated with a high morbidity. The main complications are respiratory and gastrointestinal. The use of consensus definitions allows standardization and grading of complications.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Postoperative Complications , Esophageal Neoplasms/epidemiology , Esophagectomy/adverse effects , Retrospective Studies , Cohort Studies , MorbiditySubject(s)
Humans , Adult , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Indomethacin/therapeutic use , Pancreatitis/prevention & control , Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Administration, Rectal , Double-Blind Method , Length of Stay , Patient Selection , Pancreatitis/etiology , Risk Factors , SuppositoriesABSTRACT
Serum thyroglobulin and cervical ultrasonography are the milestones of the follow up of patients with differentiated thyroid carcinoma. When levels of thyroglobulin, stimulated either by discontinuing thyroid hormone supplementation or by using human recombinant TSH are undetectable and cervical ultrasonography is negative for relapse, there is a 99 percent probability that the patient is free of disease. Twenty percent of patients with undetectable thyroglobulin levels under thyroid hormone supplementation, will have levels above 2 ng/ml when treatment is discontinued and in one third of them, a relapse will be detected. Pre ablative thyroglobulin levels below 27.5 ng/mg have a positive predictive value of 98 percent for a disease free survival in low risk patients. Anti thyroglobulin antibodies must be measured along with thyroglobulin value, rendering false negative results. Thyroglobolin determination in the needle washout is useful, when a suspicious cervical lymphadenopathy is aspirated. If this value is twice or highr than that of a simultaneous serum determination, it is suggestive of metastases even with a negative cytology.
Subject(s)
Humans , Thyroid Neoplasms/blood , Thyroglobulin/blood , Neck , Disease Progression , Biomarkers, Tumor/blood , Thyroid Neoplasms/surgery , Thyroid Neoplasms/radiotherapy , Thyroid Neoplasms , Prognosis , ThyroglobulinABSTRACT
Background: The treatment of choice for acromegaly is surgery that, according to the literature, is curative in 91 percent of pituitary microadenomas and 73 percent of macroadenomas. Aim: To report the results of surgical treatment in 53 patients with acromegaly. Material and methods: Retrospective review of medical records of all patients with acromegaly, operated between 1984 and 2004. When necessary, patients were contacted by telephone to complete information or to perform biochemical or imaging studies. A normal value of insulin like growth factor I (IGF-1) for age and sex, a growth hormone (GH) nadir of less than 1 ng/ml during a glucose tolerance test or a basal GH of less than 2.5 ng/ml, all assessed three months after surgery, were considered as criteria for cure. Results: Biochemical cure was achieved in 67 percent of patients with pituitary microadenomas and 21 percent of patients with macroadenomas. In 47 percent of patients with neuro-ophtalmological involvement, a partial or total recovery in the visual field defect was achieved. The most common surgical complications were transient diabetes insipidus in 19 percent, persistent diabetes insipidus in 4 percent and cerebrospinal fluid fistula in 4 percent. A lower size of the tumor and lower preoperative growth hormone levels were associated with a better chance of cure. Conclusions: The cure rates obtained in this group of patients are clearly lower than those reported abroad. These results stress the importance of having a national registry of acromegaly and the need to train neurosurgeons in the treatment of pituitary tumors.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Acromegaly/surgery , Adenoma/surgery , Pituitary Neoplasms/surgery , Adenoma/diagnosis , Follow-Up Studies , Growth Hormone/blood , Pituitary Neoplasms/diagnosis , Preoperative Care , Retrospective Studies , Treatment OutcomeABSTRACT
La lesión traumática cerrada de los cuerpos cavernoso o fractura de pene o fractura de cujerpoas cavernosos, es una patología urológica de urgencia y poco frecuente. Presentamos nuestra experiencia en el diagnóstico, tratamiento quirúrgico y evaluación alejada de 6 pacientes intervenidos en el hospital de Clínicas "José de San Martín". El tiempo entre la Lesión y la consulta varió entre 2 y 10 horas. Todos los pacientes fueron intervenidos quirúrgicamente y se realizó evacuación del hematoma, control de la hemostasis y reparación de la lesión. En ningún caso se presentó lesión de uretra. El seguimiento se realizó durante 6 a 46 meses. Los resultados a largo plazo fueron satisfactorios ya que todos los pacientes mostraron una restituición anatómica y funcional completa