Disección submucosa endoscópica en cáncer gástrico incipiente / Endoscopic submucosal dissection for early gastric cancer

Introduction: Endoscopic submucosal dissection (ESD) is nowadays the standard treatment for a subgroup of early gastric cancer with low risk of lymph node metastasis. This procedure has the advantage of achieving a higher percentage of negative margins and of allowing resections of larger tumors compared with the endoscopic mucosal resection (EMR) method, being less invasive compared with surgery. Aim: To analyze the postoperative outcomes, histology and overall survival of patients undergoing ESD in our center. Methods: Descriptive study. Data were collected from clinical records of patients undergoing ESD from January 2008 to June 2012. Results: 15 patients (8 males and 7 females, median age 70 years (45-88)) were included. The tumor was located at upper, middle and lower third in 2, 5 and 8 patients, respectively. Median tumor size was 13.5 mm (6-21). Most tumors were classified as type IIc. Among postoperative complications, there was 1 gastric bleeding and 3 gastric perforations. Hospital stay was 3 days (1-23). There was no mortality. There was one case of submucosal invasion. Negative margins were achieved in 86.7 percent. There was one deep and one lateral positive margin, managed by surgery and re-ESD, respectively. At 16 months (7-61) of median follow-up, overall survival was 100 percent. Tumor recurrence was observed in one patient at 51 months, was treated by surgery. Conclusion: ESD is a feasible technique in the minimally invasive management of early gastric cancer, allowing a high percentage of negative margins.

Introducción: La disección endoscópica de la submucosa (DES) es actualmente el tratamiento estándar en pacientes con cáncer gástrico incipiente y bajo riesgo de metástasis ganglionares, con la ventaja de obtener un mayor porcentaje de márgenes negativos que en la mucosectomía y ser menos invasivo que la cirugía. Objetivo: Analizar los resultados inmediatos, anatomía patológica y sobrevida alejada de los pacientes sometidos a DES en nuestro centro. Métodos: Estudio descriptivo. Revisión de los registros clínicos de pacientes con lesiones gástricas incipientes sometidos a DES entre enero de 2008 y junio de 2012. Resultados: Serie compuesta por 15 pacientes, 8 de sexo masculino. Mediana de edad 70 años (45-88). Ubicación tumoral: tercio superior en 2, tercio medio en 5 y tercio inferior en 8. La mediana de tamaño tumoral fue 13,5 mm (6-21). La mayoría fueron lesiones IIc. Dentro de las complicaciones postoperatorias, hubo 1 hemorragia digestiva tratada por endoscopia y 3 perforaciones gástricas tratadas quirúrgicamente (gastrorrafia). Mediana de hospitalización, 3 días (1-23). No se registró mortalidad post-procedimiento. Se obtuvieron bordes negativos en un 86,7 por ciento de los casos. Un paciente presentó margen profundo positivo, tratado mediante gastrectomía subtotal y otro presentó positividad en un margen lateral, manejado con una nueva DES. Mediana de seguimiento 16 meses (7-61), sin fallecidos por patología tumoral. Hubo 1 recurrencia tumoral (51 meses), tratada quirúrgicamente. Conclusión: La DES representa una alternativa en el manejo de las lesiones gástricas incipientes, permitiendo un alto porcentaje de márgenes negativos.

Genotipos de virus papiloma humano (VPH) en pacientes con cáncer cervico-uterino en un hospital público y una clínica privada de Santiago, Chile / Human papillomavirus (HPV) genotypes in cervix uterine cancer patients in a public hospital and private clinic from Santiago, Chile

We compared HPV genotypes among squamous cervical cancer samples from a public hospital (n = 55) and a private clinic (n = 35 cases) of Santiago. Paraffin-embedded specimens were analyzed by PCR followed by an immunoenzimatic assay. Reverse line blotting was used for the identification of 36 HPV genotypes. We found HPVDNAm 94.4 percent of all cancers. Single mfections: HPV16: 40.0 percent, (clinic 37.1 percent, hospital 41.8 percent) VPH18:7.8 percent (clinic 2.9 percent, hospital 10.9 percent); single+multiple mfections: VPH16: 61.1 percent (clinic 53.1 percent, hospital 71.7 percent), VPH18: 34.4 percent (clinic 21.9 percent, hospital 45.2 percent). HPV16 orHPV18 occurredin 75.6 percent of cases, higher inthe hospital than the clinic (87.3 percent-95 percent CI: 84.9-96.3 - and 57. l percent-95 percent CI: 46.6-66 - respectively, p = 0.002). Other genotypes in single mfections: HPV 26, 31, 33, 45, 58, 67; in co-mfections: HPV 35,52,56,59 and 66. HPV16 but specially HPV 18 were significantly more frequent in the public hospital; 75.6 percent of squamous cervical cancer were associated to the vaccine preventable HPV16/18.

Se comparan los genotipos de VPH en casos de cáncer cérvico-uterino escamocelular de una clínica privada (n: 35) y de un hospital público (n: 55) atendidos entre 1996 y 2006 en Santiago, Chile. Se analizaron por RPC y ensayo inmunoenzimático muestras tumorales en bloques de parafina, genotipificándose con reverse Une blotting para 36 genotipos de VPH. Se detectó VPH en 94,4 por ciento de los casos: infecciones únicas por: VPH 16: 40,0 por ciento>, (clínica 37,1 por ciento, hospital 41,8 por ciento) VPH 18: 7,8 por ciento (clínica 2,9 por ciento, hospital 10,9 por ciento); total de infecciones por VPH 16 61,1 por ciento (clínica 53,1 por ciento, hospital 71,7 por ciento), por VPH 18 34,4 por ciento (clínica 21,9 por ciento, hospital 45,2 por ciento). Co-infección: VPH 16/18 75,6 por ciento (clínica 57,1 por ciento; IC95 por ciento = 46,6-66,0 hospital 87,3 por ciento; IC95 por ciento = 84,9-96,3, p = 0,002). Se identificó otros 11 genotipos oncogénicos en infecciones únicas (VPH: 26, 31, 33, 45, 58, 67) o en co-infección con VPH 16/18 (VPH: 35, 52, 56, 59, 66). VPH 16 y VPH 18 fueron significativamente más frecuentes en el hospital público, particularmente VPH18; 75,6 por ciento> de los cánceres se asociaron a los genotipos VPH 16/18, tipos prevenibles por vacuna.

Apendicectomía en la embarazada: Experiencia en un hospital público chileno / Appendectomies for suspected acute appendicitis during pregnancy: Experience at a Chilean public hospital

Background: Acute appendicitis is the most common non obstetric surgical emergency during pregnancy. Aim: To asses our experience in the diagnosis and management of acute appendicitis occurring during pregnancy. Patients and methods: Data from all pregnant patients who were subjected to an appendectomy for a suspected acute appendicitis from January 1998 to December 2002, were retrospectively analyzed. All pathological, surgical, clinical records and the delivery outcome registry of each patient were reviewed. Results: Among 47,322 deliveries, 46 pregnant women aged 29±9 years and with a gestational age of 21±7 weeks, were operated because of a presumptive acute appendicitis. Forty (87%) had a histopathologically proven appendicitis; ten (25%) cases had a perforated appendix and 30 (75%) had a non-perforated appendicitis. Five (10.9%) patients had a negative laparotomy and one had a necrotic ovarian tumor. Patients with perforated and non perforated appendices had a similar lapse from the onset of symptoms to operation (69±45 and 50±34 hours respectively, NS) and a similar white cell count (15,667±3,707 and 13,006±5,206 cells/mm3, respectively, NS). Wound infection was the most common surgical complication in 15%. Seven (15%) patients had a premature delivery and there was one fetal death (2.2%). There were no pregnancy complications on negative appendectomy cases. Conclusions: Acute appendicitis continues to be a challenge in diagnosis and treatment during pregnancy. Maternal and fetal outcome was better than previously reported.

Pesquisa poblacional de cáncer gástrico en pacientes sintomáticos digestivos período 1996-2000 / Frequency of gastric cancer in endoscopies performed in symptomatic patients period 1996-2000

Background: Gastric cancer is the first cause of death due to malignant tumors in Chile. Its mortality rates have stabilized in the last two decades and its prognosis is closely associated to the degree of tumor invasion at the moment of surgery. Aim: To study the frequency of gastric cancer among symptomatic patients subjected to an upper gastrointestinal endoscopy at a secondary care health center. Patients and methods: All upper gastrointestinal endoscopies performed to patients derived from public primary care clinics were recorded. Results: In the study period, 4,145 endoscopies were done to 818 men and 2,128 women. Seventy one percent of patients were aged over 40 years of age. Fifty one carcinomas and one lymphoma were detected. Of these, 10 tumors were incipient. Thirty one patients were operated on and in 22 a total gastrectomy was performed. One patient, that required an esophageal resection, died. Conclusions: Gastric cancer was detected in 1.2 percent of symptomatic adult patients subjected to an upper gastrointestinal endoscopy

Estudio cromosómico y citometría de flujo en cáncer de vesícula biliar / Chromosomic study and cytometric flow in gallbladder cancer

A través de un proyecto Fondecyt, realizamos el estudio cromosómico y del contenido de DNA (o ploidía) en citómetro de flujo, en 23 muestras de adenocarcinoma de vesícula biliar, provenientes de pacientes operados en estados clínicos avanzados, con el fin de determinar la presencia de aberraciones cromosómicas que sena específicas de este cáncer, que puedan tener algún valor en el pronóstico o diagnóstico de la enfermedad, o bien que puedan ayudar en la búsqueda de un gen responsable de su desarrollo. También buscamos alteraciones del contenido de DNA (ploidía) en las mismas muestras, para determinar su validez en el pronóstico o diagnóstico clínico como seha establecido para otros tumores malignos. Todos los casos mostraron dos poblaciones celulares y otra con múltiples aberraciones cromosómicas, tales como deleciones, traslocaciones e inversiones

Cistitis intersticial: diagnóstico y tratamiento de casos severos / Interstitial cystitis: diagnosis and treatment of severe cases

Se presentan 11 pacientes con estudio clínico, endoscópico y urológico compatible con vejiga inestable sensitiva. El estudio histológico mostró pancistitis. Este grupo se selecciona por la importante retracción vesical. Demuestra el fracaso de la cistolisis y el éxito de la enterocistoplastía