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La neuralgia del trigémino es un trastorno neuropático craneofacial que sigue una o más de las ramas del nervio craneal V y ocasiona ataques paroxísticos de alta intensidad, produce discapacidad y es más prevalente en el sexo femenino. El tratamiento de primera línea es el farmacológico, con el objetivo de aliviar los síntomas, evitar recidivas y complicaciones. Sin embargo, presenta un alto índice de refractariedad, por lo que se han desarrollado otros procedimientos no invasivos como la radiocirugía estereotáctica. Este tratamiento ofrece un alivio de los síntomas durante un periodo más prolongado que permite al paciente puntuar entre el rango I-III en la escala del Instituto Neurológico Barrow; sin embargo, también puede reaparecer. Con el objetivo de determinar la recurrencia de neuralgia del trigémino refractaria en pacientes tratados con radiocirugía estereotáctica, se realizó una revisión narrativa de artículos originales de revistas científicas en inglés y español, publicados de 2019 a 2024. La recurrencia posterior a la radiocirugía puede estar determinada por características propias de la enfermedad, así como por el plan de tratamiento. A pesar de ello, debido a la seguridad y eficacia que ofrece, es posible realizar múltiples intervenciones sin presentar complicaciones graves y obteniendo baja incidencia de casos de hipoestesia y una escasa prevalencia de aneurismas.

Trigeminal neuralgia is a neuropathic disease with a craniofacial trajectory following one or all the branches of the V cranial nerve. It is characterized by paroxysmal pain of high intensity that may cause disability, with higher prevalence in females. The first line of treatment is pharmacological seeking to alleviate the symptoms, diminishing the odds of recurrence and complications. Nonetheless, this therapy has a high rate of refractoriness. As a result, other non-invasive procedures have been developed such as stereotactic surgery. This treatment offers symptom relief for a longer period allowing the patient to score between I-III range in the Barrow Neurological Institute scale; however, it can also present refractoriness. This paper was written with the objective of determining the recurrence of trigeminal neuralgia in patients that have been treated with stereotactic surgery. The current review was done using original articles from journals in English and Spanish from 2019 to 2024. Post-radiosurgery recurrence may be determined by characteristics of the disease as well as the treatment plan. Despite this, due to the safety and effectiveness, multiple interventions can be performed, with low cases of hypoesthesia and aneurysms

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Introducción. La herniorrafia inguinal es una cirugía ampliamente realizada a nivel mundial, con casi 20 millones de procedimientos anuales. En la literatura no se describen diferencias significativas en las tasas de recurrencia entre las técnicas laparoscópicas, pero estos resultados difieren en cuanto a la fijación de la malla. Métodos. Estudio retrospectivo observacional en el que se incluyeron los pacientes sometidos a herniorrafia inguinal por laparoscopia en una institución de cuarto nivel en Medellín, Colombia, entre enero de 2019 y junio de 2023. Se registraron los datos demográficos, como edad, género y comorbilidades, y los datos del procedimiento, como técnica utilizada, tipo de hernia, tipo de malla y fijación o no de la malla. Los desenlaces posoperatorios evaluados fueron dolor agudo y crónico, recurrencia y otras complicaciones. Resultados. De un grupo de 1106 pacientes sometidos a herniorrafia inguinal por vía laparoscópica, 69,0 % fueron sometidos a la técnica transabdominal preperitoneal, 23,1 % a la técnica totalmente extraperitoneal y 7,9 % a totalmente extraperitoneal extendida. La malla macroporosa de baja densidad fue la más utilizada (56,3 %). A 784 (70,9 %) se les fijó la malla y a 322 (29,1 %) no. La tasa de complicaciones fue menor al 8 %. Al final, 77 (7,0 %) pacientes experimentaron dolor agudo y 26 crónico (2,3 %). Hubo recurrencia de la hernia en 20 pacientes (1,8 %). Conclusión. El uso de prótesis sin fijación en la herniorrafia inguinal por laparoscopia pareciera ser un procedimiento seguro, con una tasa de recidivas equiparables a los procedimientos con fijación y con una leve tendencia a un menor dolor posquirúrgico agudo y crónico.

Introduction. Inguinal herniorrhaphy is a widely performed surgery worldwide, with almost 20 million procedures annually. The literature does not describe significant differences in recurrence rates between laparoscopic techniques, but these outcomes differ in terms of mesh fixation. Methods. Retrospective observational study that included patients undergoing laparoscopic inguinal herniorrhaphy at a fourth-level institution in Medellin, Colombia, between January 2019 and June 2023. Demographic data, including age, gender, and comorbidities were recorded, along with data related to the procedure details, such as technique used, type of hernia, type of mesh, and mesh fixation or not. Postoperative outcomes evaluated were acute and chronic pain, recurrences, and other complications. Results. Of a group of 1106 patients undergoing laparoscopic inguinal herniorrhaphy, 69.0% underwent the preperitoneal transabdominal technique, 23.1% underwent the totally extraperitoneal tecnhique, and 7.9% underwent the extended totally extraperitoneal tecnique. Low-density macroporous mesh was the most used (56.3%); 784 (70.9%) had the mesh fixed and 322 (29.1%) did not. The complication rate was less than 8%. In the end, 77 (7.0%) patients experienced acute pain and 26 (2.3%) developed chronic pain. There was hernia recurrence in 20 patients (1.8%). Conclusion. The use of prostheses without fixation in laparoscopic inguinal herniorrhaphy seems to be a safe procedure, with a recurrence rate comparable to procedures with fixation and with slight tendency towards less acute and chronic postsurgical pain.

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Antineutrophil cytoplasmic antibody-associated vasculitis is a group of disorders characterized by inflammation and destruction of small blood vessels. Cardiac involvement as the initial manifestation is rare. We present the case of a patient with acute myopericarditis as the initial manifestation of ANCA-associated vasculitis.

La vasculitis asociada a anticuerpos anticitoplasma de neutrófilos (ANCA) es un grupo de trastornos caracterizados por la inflamación y destrucción de vasos sanguíneos de tamaño pequeño. El compromiso cardíaco como manifestación inicial es poco frecuente. Se presenta el caso de un paciente con miopericarditis aguda como manifestación inicial de vasculitis asociada a ANCA.

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Introducción. Los pacientes octogenarios y nonagenarios conforman un grupo etario en progresivo crecimiento. La hernia inguinal es una patología que aumenta progresivamente con la edad. Este trabajo tuvo como objetivo conocer los resultados quirúrgicos de los pacientes mayores de 80 años a quienes se les realizó herniorrafía inguinal. Métodos. De acuerdo con las guías PRISMA, se realizó una revisión sistemática de PubMed, Embase y Google Scholar. Se incluyeron estudios que reportaron la incidencia de complicaciones y mortalidad después de una herniorrafía inguinal en los pacientes octogenarios y nonagenarios. Se calculó la proporción de pacientes con complicaciones después de una herniorrafía inguinal según los datos presentados, con su respectivo intervalo de confianza del 95 %. Resultados. Catorce estudios reportaron un total de 19.290 pacientes, entre quienes se encontró una incidencia acumulada de infección del sitio operatorio de 0,5 % (IC95% 0,460 - 0,678), seroma de 8,7 % (IC95% 6,212 - 11,842), hematoma de 2,6 % (IC95% 2,397 - 2,893), dolor crónico de 2,1 % (IC95% 0,778 - 4,090) y recidiva de 1,2 % (IC95%0,425 - 2,284), para una morbilidad de 14,7 % (IC95% 9,525 - 20,833). Conclusión. Las complicaciones de la herida quirúrgica, el dolor crónico y la recidiva en los pacientes mayores de 80 años a quienes se les realiza herniorrafia inguinal son comparables con las de la población general.

Introduction. Octogenarian and nonagenarian patients constitute a progressively growing age group. Inguinal hernia is a pathology that increases with age. This study aims to understand the surgical outcomes of inguinal herniorrhaphy in patients over 80 years of age. Methods. A systematic review of PubMed, Embase, and Google Scholar was conducted following PRISMA guidelines. Studies reporting the incidence of complications and mortality after inguinal herniorrhaphy in octogenarian and nonagenarian patients were included. The proportion of patients with complications after inguinal herniorrhaphy was calculated based on the data presented, with its respective 95% confidence interval. Results. Fourteen studies reported a total of 19,290 patients, among whom a cumulative incidence of surgical site infection of 0.5 (95% CI 0.460 ­ 0.678), seroma of 8.7% (95% CI 6.212 ­ 11.842), hematoma of 2.6% (95% CI 2.397 ­ 2.893), chronic pain 2.1% (95% CI 0.778 ­ 4.090), recurrence 1.2% (95% CI 0.425 ­ 2.284), and morbidity 14.7% (95% CI 9.525 ­ 20.833) were found. Conclusion. Surgical wound complications, chronic pain, and recurrence in patients over 80 years of age undergoing inguinal herniorrhaphy are comparable to those in the general population.

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O carcinoma papilífero de tireoide (CPT) é a neoplasia maligna mais comum na glândula tireoide. Embora essas lesões geralmente tenham um excelente prognóstico, há casos que apresentam características clínico-patológicas agressivas, com alto índice de metástase linfonodal e recorrência. Diante disso, novos biomarcadores moleculares têm sido pesquisados com a finalidade de esclarecer melhor os processos biológicos e moleculares envolvidos no desenvolvimento e progressão desta neoplasia. Dentre eles destaca-se as proteínas YAP, LATS2 e TEAD, constituintes da Via Hippo (VH), a qual é essencial em diversos processos biológicos, além de participar no processo da carcinogênese quando a via está desregulada. Dessa forma, esta pesquisa teve como objetivo avaliar as proteínas relacionadas YAP, LATS2 e TEAD, nos CPTs, com o intuito de verificar se estas moléculas podem influenciar o comportamento biológico destas lesões. A amostra foi composta por 31 casos de CPTs e 5 de adenomas foliculares (grupo controle). As informações clínico-patológicas foram coletadas e correlacionadas à imunoexpressão das proteínas YAP1, LATS-2 e TEAD nestas lesões. A avaliação da marcação foi realizada no núcleo e citoplasma, onde foram considerados como positivos os casos com mais de 20% dos núcleos marcados para cada um das moléculas. Quanto ao citoplasma, foi avaliado a intensidade para YAP1 e LATS2. Nesse compartimento os casos foram classificados em negativo (sem coloração), fraco (coloração marrom claro) e forte (cor marrom escuro). Os dados foram submetidos à análise estatística por meio dos testes Qui-quadrado de Pearson e Exato de Fisher, com o nível de significância estabelecido em 5% (p < 0,05). Na análise da imunoexpressão, observou-se que, para YAP, todos os casos (n=31;100%) de CPTs apresentaram positividade nuclear. Houve também, uma associação significativa da forte expressão da YAP no citoplasma com casos de CPTs, quando comparado ao grupo controle (p=0,001). Para a LATS2 houve uma baixa expressão citoplasmática na maioria dos casos dos CPTs (58,1%). Já para o TEAD, houve uma maior positividade nuclear para TEAD (p=0,029) nos CPTs. Em relação às associações com os dados clínico-patológicos não houve dados estatisticamente significativos relevantes. A menor expressão citoplasmática de LATS2 nos CPTs sugere que essa proteína pode não estar regulando a YAP, o que resulta em sua translocação para o núcleo. Já a elevada expressão nuclear de YAP e TEAD sugere que essas moléculas podem estar interagindo no núcleo. Com base nisso, propõe-se que a subregulação citoplasmática da LATS 2 e a interação nuclear YAPTEAD podem influenciar o processo de tumorigênese dos CPTs (AU).

Papillary thyroid carcinoma (PTC) is the most common malignant neoplasm of the thyroid gland. Although these lesions generally have an excellent prognosis, there are cases that present aggressive clinicopathological characteristics, with a high rate of lymph node metastasis and recurrence. Given this, new molecular biomarkers have been researched with the aim of better clarifying the biological and molecular processes involved in the development and progression of this neoplasm. Among them, the YAP, LATS2, and TEAD proteins, components of the Hippo Pathway (HP), stand out, which is essential in various biological processes and also participates in the carcinogenesis process when the pathway is deregulated. Therefore, this research aimed to evaluate the related proteins YAP, LATS2, and TEAD in PTCs, to verify whether these molecules can influence the biological behavior of these lesions. The sample consisted of 31 cases of PTCs and 5 follicular adenomas (control group). Clinicopathological information was collected and correlated with the immunoexpression of the YAP, LATS2, and TEAD proteins in these lesions. The evaluation of the staining was performed in the nucleus and cytoplasm, where cases with more than 20% of the nuclei stained for each of the molecules were considered positive. Regarding the cytoplasm, the intensity for YAP1 and LATS2 was evaluated. In this compartment, cases were classified as negative (no staining), weak (light brown staining), and strong (dark brown staining). Data were subjected to statistical analysis using Pearson's Chi-square and Fisher's Exact tests, with a significance level set at 5% (p < 0.05). The immunoexpression analysis showed that all PTC cases (100%) exhibited nuclear positivity for YAP. A significant association was also found between strong cytoplasmic YAP expression and PTC cases compared to the control group (p = 0.001). For LATS2, low cytoplasmic expression was observed in most PTC cases (58.1%). TEAD showed higher nuclear positivity (p = 0.029) in PTC cases. No statistically significant associations with clinicopathological data were found. The lower cytoplasmic expression of LATS2 in PTCs suggests that this protein may not regulate YAP, leading to its nuclear translocation. The elevated nuclear expression of YAP and TEAD indicates possible nuclear interaction. Therefore, the cytoplasmic subregulation of LATS2 and the nuclear YAP-TEAD interaction may influence PTC tumorigenesis (AU).

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Basal cell carcinoma (BCC) is the most common skin cancer, but oral involvement is extremely rare. Here, we showed a case of a 71-year-old Caucasian male patient presenting an asymptomatic submucosal nodule in the left buccal mucosa on the same side of a previous BCC skin lesion. Intraoral examination revealed a circumscribed sessile and fibrous mass covered by normal mucosa. An incisional biopsy was performed. Microscopically, the lesion showed uniform, ovoid, dark-staining basaloid cells with medium-sized nuclei and little cytoplasm arranged in islands and strands, invading the underlying connective tissue. These islands demonstrated palisading of the peripheral cells and occasionally central areas with epidermoid differentiation. The final diagnosis was nodular basal cell carcinoma. Although uncommon, recurrent BCC may occur in the oral cavity. (AU)

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Objetivo: Investigar a associação entre Diabetes Mellitus e obesidade quanto ao risco de recorrência e mortalidade do câncer. Métodos: Estudo de caso controle com população composta por pacientes com neoplasias malignas. A amostra foi de 171 prontuários, 69 do grupo caso e 102 do grupo controle. Resultados: Houve nos dois grupos um predomínio do estadiamento IV. A quimioterapia foi o tratamento mais utilizado no grupo caso, no grupo controle não foi possível observar essa variável. Observou-se que no grupo caso os pacientes que tiveram câncer digestivo apresentaram o menor tempo de sobrevida, com mediana de 2 meses e que ter Diabetes Mellitus e obesidade aumenta em dez vezes (OR= 10,29) a chance de recorrência e mortalidade para os tumores em estadiamento I. Conclusão: Este estudo sugere que existe associação entre os cânceres digestivo e de próstata e a Diabetes Mellitus e obesidade no que concerne à incidência; que pacientes com câncer digestivo e que tem Diabetes Mellitus e/ou obesidade vivem menos; que mesmo que o diagnóstico seja precoce, se o paciente tiver Diabetes Mellitus e/ou obesidade, há uma maior chance dos desfechos recorrência e óbito. (AU)

Objective: To investigate the association between Diabetes Mellitus and obesity with the risk of cancer recurrence and mortality. Methods: Study of case control which the populations is composed by patients with malignant neoplasm. The sample was 171 medical records, 69 of the case group and 102 of the control group. Results: In both groups occurred a predominance of staging IV. The chemotherapy was the treatment more used in the group case, in the group control was not possible to observe this variant. It was observed that in the group case, the patients who had digestive cancer presented a lesser time of survival, with median of 2 months and that having Diabetes Mellitus and obesity raises ten times (OR= 10,29) the odds of recurrence and mortality for tumors in stage I. Conclusion: This study suggests that there is an association between digestive and prostate cancer, Diabetes Mellitus and obesity in terms of incidence; patients with digestive cancer and DM and/or obesity liv less; even if there is an early diagnostic ,if the patient has Diabetes Mellitus and/or obesity, there is a bigger chance of recurrence and death prognosis. (AU)

Objetivo: Investigar la asociación entre la Diabetes Mellitus y la obesidad con el riesgo de mortalidad y de cáncer. Métodos: Estudio de caso-control con población compuesta por pacientes con neoplasias malignas. El tamaño de la muestra fue de 171 historias clínicas, 69 del grupo de casos y 102 del grupo de control. Resultados: Hubo em los dos grupos un predominio de estadificación IV. La quimioterapia fue el tratamiento más utilizado en el grupo caso, en el grupo controle no fue posible observar esta variable. Se observa que en el grupo caso los pacientes que tuvieran cáncer digestivo presentaran el menor tempo de sobrevida, con mediana de 2 meses e que presentar Diabetes Mellitus e obesidad aumenta en diez veces (OR= 10,29) la probabilidad de recurrencia e mortalidad para los tumores en estadificación I. Conclusión: Este estudio sugiere que existe asociación entre los cánceres digestivo e de próstata e la Diabetes Mellitus e obesidad en lo que concierne a la incidencia; que pacientes con cáncer digestivo e que tienen Diabetes Mellitus y/o obesidad viven menos; mismo que o diagnóstico sea precoz, si el paciente tiene Diabetes Mellitus y/o obesidad, existe una mayor chance de los pronósticos de recurrencia e óbito. (AU)

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INTRODUCCIÓN: En la diarrea asociada a Clostridioides dfficile (DACD) leve-moderada se recomienda tratar con vancomicina por sobre metronidazol, a pesar de su difícil acceso y poca evidencia en el medio ambulatorio. OBJETIVO: Comparar la tasa de cura clínica y recurrencia entre vancomicina y metronidazol en adultos chilenos con primer episodio leve-moderado de DACD de manejo ambulatorio. MÉTODOS: Cohorte retrospectiva entre enero 2015 y diciembre 2020 en centros de una red de salud universitaria de pacientes de ≥ 18 años con DACD tratados ambulatoriamente. RESULTADOS: Se obtuvieron 161 pacientes, 59% mujeres, edad promedio de 53 años (entre 18 y 94 años). De ellos, 109 (67,7%) usaron metronidazol y 52 (32,3%) vancomicina. En el análisis multivariado ajustado por edad y comorbilidades se obtuvo un OR 3,00 (IC 95% 1,12-9,59) para cura clínica y 0,27 (IC 95% 0,06-0,88) para recurrencia a ocho semanas, ambos a favor de vancomicina, sin diferencias en recurrencia a 12 meses, necesidad de hospitalización o mortalidad. CONCLUSIÓN: La terapia con vancomicina comparada contra metronidazol en el tratamiento ambulatorio de la infección leve-moderada por C. dfficile se asocia a mayor cura clínica y menor tasa de recurrencia a corto plazo, sin diferencias en desenlaces a largo plazo.

BACKGROUND: Recommended treatment against mild cases of Clostridioides difficile associated diarrhea is vancomycin despite the difficulties of access compared to metronidazole. AIM: To compare the effectiveness of vancomycin and metronidazole in Chilean adults with first mild-moderate episode of Clostridiodes difficile infection (CDI). METHODS: Retrospective cohort of patients with CDI between January 2015 and December 2020 treated in centers of a university health network. The patients were adults treated for C. difficile infection on an outpatient basis. Recurrent and severe cases were excluded. Outcomes included clinical cure and recurrence rate. RESULTS: Data from 161 patients was recovered. Fifty-nine percent were women and average age was 53 (18-94). One hundred and nine patients were treated with metronidazole (67.7%) and 52 (32.3%) used vancomycin. Multivariate analysis adjusted by age and comorbidities showed an Odds Ratio of 3.00 (IC 95% 1.12-9.59) for clinical cure and 0.27 (IC 95% 0.06-0.88) for 8-week recurrence rate, both in favor of vancomycin, without differences in 12-month recurrence rate, hospitalization rate nor mortality. CONCLUSIONS: Vancomycin is associated with better short-term outcomes in the treatment of outpatient mild-moderate first episode C. difficile infection, without differences in long term recurrence or mortality when compared with metronidazole.

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Introducción: El prolapso de órganos pélvicos (POP) o distopia genital, es el descenso o desplazamiento de los órganos del suelo pélvico a través del canal vaginal o fuera de este. Objetivo: Evaluar los resultados de la histeropexia vaginal en la corrección quirúrgica del prolapso genital apical grado III o IV, usando prótesis de polipropileno; además describir la tasa de éxito, recurrencias y complicaciones. Método: Estudio de cohorte, en 42 mujeres sometidas a histeropexia vaginal (histero-cistopexia ortotópica) mediante prótesis de polipropileno (Splentis®), entre 2016 y 2021. Se realizaron tres evaluaciones postoperatorias (tres, seis y 12 meses). Se hizo muestreo no probabilístico. Se utilizó estadística descriptiva. Resultados: La edad media fue de 56,19 ± 9,27 años. El tiempo quirúrgico de 58,95 ± 13,74 minutos, el sangrado quirúrgico de 119,85 ± 68,73 ml. La tasa de éxito a los 12 meses fue del 90,47%. La recurrencia del prolapso apical fue del 4,76% a los seis meses y del 9,52% a los 12 meses; el de compartimento anterior a los seis meses arrojó un 7,14%, frente al 11,9% a los 12 meses. El 14,28% de las pacientes presentaron complicaciones menores. La incidencia de incontinencia urinaria de esfuerzo a los 12 meses fue del 16,66%. Conclusiones: la histeropexia vaginal es un procedimiento efectivo y seguro, con bajas tasas de recurrencias o complicaciones. Es importante que se sigan haciendo estudios con mejores diseños estadísticos.

Introduction: Pelvic organ prolapse (POP), or genital dystopia, is the descent or displacement of pelvic floor organs through the vaginal canal or outside of it. Objective: To evaluate the results of vaginal hysteropexy in the surgical correction of grade III or IV apical genital prolapse, using polypropylene prosthesis; also describe the success rate, recurrences and complications. Method: Cohort study in 42 women undergoing vaginal hysteropexy (orthotopic hystero-cystopexy) using a polypropylene prosthesis (Splentis®); between 2016 and 2021. Three postoperative evaluations were carried out (three, six and twelve months). Non-probabilistic sampling was done. Descriptive statistics were used. Results: The mean age was 56.19 ± 9.27 years. Surgical time of 58.95 ± 13.74 minutes, surgical bleeding of 119.85 ± 68.73 ml. The success rate after twelve months was 90.47%. Apical prolapse recurrence was 4.76% at six months and 9.52% at twelve months; that of the previous compartment, after six months it showed 7.14%, compared to 11.9% after twelve months; 14.28% of the patients presented minor complications. The incidence of stress urinary incontinence, at twelve months, was 16.66%. Conclusions: Vaginal hysteropexy is an effective and safe procedure, with low rates of recurrence or complications. It is important that studies continue to be carried out with better statistical designs.

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Objective: To synthesize evidence involving pathophysiological and clinical-epidemiological linking mechanisms in women with breast cancer and metabolic syndrome. Method: This is a structured scoping review according to the Joanna Briggs Institute and was conducted in the PubMed, BDENF, LILACS, IBECS, CUMED, WPRIM, BINACIS, and Embase databases. This review is registered in the Open Science Framework. Result: Regarding the level of evidence of the included studies, moderate and strong evidence levels were predominant. There were no weak evidence findings in this research. The chronic inflammatory state of breast adipose tissue in patients with obesity can worsen the negative impact on cancer cells, directly affecting survival and recurrence. Unexplained weight gain or loss is associated with shorter survival in women with breast cancer, highlighting the need for specific guidance during treatment. Conclusion: Metabolic syndrome is associated with the risk of breast cancer; however, massive weight loss during active disease can be associated with a worse prognosis and should therefore be prevented. Patients should be advised to maintain a stable weight during chemotherapy and to receive guidance on adequate nutrition and physical activity to increase muscle mass

Objetivo: Sintetizar as principais evidências envolvendo os mecanismos de ligação fisiopatológico e clínico-epidemiológico em mulheres com câncer de mama e a síndrome metabólica. Método: Trata-se de uma revisão de escopo estruturada conforme o Instituto Joanna Briggs, realizado nas bases de dados PubMed, BDENF, LILACS, IBECS, CUMED, WPRIM, BINACIS e Embase. Esta revisão encontra-se protocolada no Open Science Framework. Resultado: Com relação ao nível de evidência dos estudos inclusos, houve predominância para níveis fortes de evidência. Não houve achados de evidência fraca nesta pesquisa. O estado inflamatório crônico do tecido adiposo mamário em casos de obesidade pode agravar o impacto negativo nas células cancerígenas, afetando diretamente a sobrevida e recorrência. Ganho ou perda de peso inexplicável estão associados a uma menor sobrevida em mulheres com câncer de mama, sublinhando a necessidade de orientações específicas durante o tratamento. Conclusão: A síndrome metabólica esta associada ao risco de câncer de mama, entretanto, a perda maciça de peso durante a doença ativa pode ser um fator de pior prognóstico, devendo assim, ser realizada de forma preventiva. Os pacientes devem ser orientados a manter um peso estável durante a quimioterapia e receber orientações sobre alimentação adequada e atividade física em busca de aumento de massa muscular

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Objective@#This study described the clinical profile and outcomes of patients with ocular dermoid cysts at a subspecialty Ophthalmology clinic of the Philippine General Hospital (PGH). @*Methods@#Medical records of 38 patients seen at the External Disease & Cornea Clinic from January 2012 to June 2023 were reviewed. Demographics, best-corrected visual acuity (BCVA), refraction, other associated malformations, and dermoid characteristics were collected. For those that underwent surgery, the procedures performed and histopathology reports were reviewed. Most recent refraction, BCVA, presence of amblyopia, recurrence, and complications were recorded. @*Results@#Mean age at presentation was 8.33 years old with equal male:female distribution (52% vs 48%). Thirtyfour (34) participants (89.5%) had unilateral dermoids and 4 participants (10.5%) had bilateral dermoids, for a total of 42 eyes. Thirty-five (35) or 83.3% of the dermoids were located at the inferotemporal quadrant of the cornea. There were 42.1% participants who had associated congenital anomalies, with dermolipoma and preauricular tags being the most common ocular and craniofacial findings, respectively. Twenty-seven (27) eyes (64.2%) underwent surgery and the most common procedure was excision with limbal conjunctival autograft (55.6%). In the 8 eyes that underwent simple excision, recurrence of the dermoid was seen in 1 patient and development of pseudopterygium in 5 patients. Dermoid was the histopathological diagnosis in 96.3% of the excised tissues. Twenty-four (24) patients (63.2%) presented with ambylopia with BCVA <20/30, and regardless of type of intervention done, only 7 participants (23.3%) had a visual acuity better than 20/30 during their latest consult.@*Conclusion@#Ocular dermoid is a common congential anomaly usually presenting as an isolated, unilateral mass at the inferotemporal limbal area. Aside from the obvious effect on the cosmetic appearance of the eye, a more pressing concern is the high incidence of amblyopia. Timely excision with limbal conjunctival autograft is highly recommended coupled with aggressive amblyopia therapy.

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Chimeric antigen receptor (CAR)-modified T-cell therapy has achieved remarkable success in the treatment of acute lymphoblastic leukemia (ALL). Measurable/minimal residual disease (MRD) monitoring plays a significant role in the prognostication and management of patients undergoing CAR-T-cell therapy. Common MRD detection methods include flow cytometry (FCM), polymerase chain reaction (PCR), and next-generation sequencing (NGS), and each method has advantages and limitations. It has been well documented that MRD positivity predicts a poor prognosis and even disease relapse. Thus, how to perform prognostic evaluations, stratify risk based on MRD status, and apply MRD monitoring to guide individual therapeutic decisions have important implications in clinical practice. This review assesses the common and novel MRD assessment methods. In addition, we emphasize the critical role of MRD as a prognostic biomarker and summarize the latest studies regarding MRD-directed combination therapy with CAR-T-cell therapy and allogeneic hematopoietic stem cell transplantation (allo-HSCT), as well as other therapeutic strategies to improve treatment effect. Furthermore, this review discusses current challenges and strategies for MRD detection in the setting of disease relapse after targeted therapy.

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Objective: To analyze the clinical characteristics and prognosis of patients with infant acute lymphoblastic leukemia (IALL). Methods: A retrospective cohort study.Clinical data, treatment and prognosis of 28 cases of IALL who have been treated at Beijing Children's Hospital, Capital Medical University and Baoding Children's Hospital from October 2013 to May 2023 were analyzed retrospectively. Based on the results of fluorescence in situ hybridization (FISH), all patients were divided into KMT2A gene rearrangement (KMT2A-R) positive group and KMT2A-R negative group. The prognosis of two groups were compared. Kaplan-Meier method and Log-Rank test were used to analyze the survival of the patients. Results: Among 28 cases of IALL, there were 10 males and 18 females, with the onset age of 10.9 (9.4,11.8) months. In terms of immune classification, 25 cases were B-ALL (89%), while the remaining 3 cases were T-ALL (11%). Most infant B-ALL showed pro-B lymphocyte phenotype (16/25,64%). A total of 22 cases (79%) obtained chromosome karyotype results, of which 7 were normal karyotypes, no complex karyotypes and 15 were abnormal karyotypes were found. Among abnormal karyotypes, there were 4 cases of t (9; 11), 2 cases of t (4; 11), 2 cases of t (11; 19), 1 case of t (1; 11) and 6 cases of other abnormal karyotypes. A total of 19 cases (68%) were positive for KMT2A-R detected by FISH. The KMT2A fusion gene was detected by real-time PCR in 16 cases (57%). A total of 24 patients completed standardized induction chemotherapy and were able to undergo efficacy evaluation, 23 cases (96%) achieved complete remission through induction chemotherapy, 4 cases (17%) died of relapse. The 5-year event free survival rate (EFS) was (46±13)%, and the 5-year overall survival rate (OS) was (73±10)%.The survival time was 31.3 (3.3, 62.5) months. There was no significant statistical difference in 5-year EFS ((46±14)% vs. (61±18)%) and 5-year OS ((64±13)% vs. (86±13)%) between the KMT2A-R positive group (15 cases) and the KMT2A-R negative group (9 cases) (χ2=1.88, 1.47, P=0.170, 0.224). Conclusions: Most IALL patients were accompanied by KMT2A-R. They had poor tolerance to traditional chemotherapy, the relapse rate during treatment was high and the prognosis was poor.

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BACKGROUND@#Immunoglobulin G4-related disease (IgG4-RD) is a recently recognized immune-mediated disorder that can affect almost any organ in the human body. IgG4-RD can be categorized into proliferative and fibrotic subtypes based on patients' clinicopathological characteristics. This study aimed to compare the clinical manifestations, laboratory findings, and treatment outcomes of IgG4-RD among different subtypes.@*METHODS@#We prospectively enrolled 622 patients with newly diagnosed IgG4-RD at Peking Union Medical College Hospital from March 2011 to August 2021. The patients were divided into three groups according to their clinicopathological characteristics: proliferative, fibrotic, and mixed subtypes. We compared demographic features, clinical manifestations, organ involvement, laboratory tests, and treatment agents across three subtypes. We then assessed the differences in treatment outcomes among 448 patients receiving glucocorticoids alone or in combination with immunosuppressants. Moreover, risk factors of relapse were revealed by applying the univariate and multivariate Cox regression analysis.@*RESULTS@#We classified the 622 patients into three groups consisting of 470 proliferative patients, 55 fibrotic patients, and 97 mixed patients, respectively. We found that gender distribution, age, disease duration, and frequency of allergy history were significantly different among subgroups. In terms of organ involvement, submandibular and lacrimal glands were frequently involved in the proliferative subtype, while retroperitoneum was the most commonly involved site in both fibrotic subtype and mixed subtype. The comparison of laboratory tests revealed that eosinophils ( P = 0.010), total IgE ( P = 0.006), high-sensitivity C-reactive protein ( P <0.001), erythrocyte sedimentation rate ( P <0.001), complement C4 ( P <0.001), IgG ( P = 0.001), IgG1 (P <0.001), IgG4 (P <0.001), and IgA ( P <0.001), at baseline were significantly different among three subtypes. Compared with proliferative and mixed subtypes, the fibrotic subtype showed the lowest rate of relapse (log-rank P = 0.014).@*CONCLUSIONS@#Our study revealed the differences in demographic characteristics, clinical manifestations, organ involvement, laboratory tests, treatment agents, and outcomes across proliferative, fibrotic, and mixed subtypes in the retrospective cohort study. Given significant differences in relapse-free survival among the three subtypes, treatment regimens, and follow-up frequency should be considered separately according to different subtypes.

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Objetivo principal: Conocer la epidemiologia de las fracturas del cuarto distal del radio en el esqueleto en crecimiento y el tratamiento realizado en el CHPR en los años 2017 y 2018. Objetivos específicos: Valorar re-desplazamiento, necesidad de re manipulación, complicaciones, re-fractura. Metodología: Estudio observacional descriptivo retrospectivo. Criterios de inclusión: pacientes de 0 a 14 años con fractura de radio distal (fisaria, metafisaria y suprametafisaria) valorados en el CHPR entre 1 enero del 2017 y 31 diciembre del 2018. Criterios de exclusión: pacientes con radiografía normal, fracturas en miembros con malformaciones, infecciones óseas, patología tumoral maligna o benigna. Obtención de datos: Valoración de radiografías de puño y antebrazo realizadas en el CHPR en 2017 y 18, iniciales y evolutivas. Se analizaron: edad, sexo, fecha fractura, topografía de la fractura, desplazamiento inicial, tratamiento, evolución radiográfica y complicaciones. Resultados: se incluyeron 662 pacientes. Siendo en su mayoría de género masculino (65%), con una media de 9 años, miembro derecho (61%), en los meses de verano (36%). En cuanto a la topografía se evidenció una frecuencia mayor en fracturas tipo rodete y metafisarias (31.72% y 31.57%), seguido por suprametafisaria (18.43%) y fisaria (18.28%). El tratamiento realizado fue ortopédico en el 86.56% de los casos, mientras que quirúrgico fue el 12.84%, en su gran mayoría con alambres de Kirschner (11,2%). El tiempo de inmovilización promedio fue de 6 semanas, con un porcentaje de complicaciones del 14.05% del total de las fracturas. Conclusiones: Se valoraron las características de los pacientes y fracturas de radio distal en el CHPR en los años 2017 y 18, siendo un total de 662 fracturas, en las que su mayoría se realizó tratamiento ortopédico con un índice de complicaciones que ronda el 14%, siendo mayor cuanto mayor es el desplazamiento inicial de la fractura.

Objetivo principal: Conhecer a epidemiologia das fraturas do quarto distal do rádio no esqueleto em crescimento e o tratamento realizado no CHPR nos anos de 2017 e 2018. Objetivos específicos: Avaliar re-deslocamento, necessidade de remanipulação, complicações, refratura. Metodologia: Estudo observacional descritivo retrospectivo. Critérios de inclusão: pacientes de 0 a 14 anos com fratura do rádio distal (fisário, metafisário e suprametafisário) avaliados no CHPR entre 1º de janeiro de 2017 e 31 de dezembro de 2018. Critérios de exclusão: pacientes com radiografias normais, fraturas em membros com malformações, osso infecções, patologia tumoral maligna ou benigna. Coleta de dados: Avaliação das radiografias de punho e antebraço realizadas no CHPR em 2017 e 18, inicial e evolutiva. Foram analisados: idade, sexo, data da fratura, topografia da fratura, deslocamento inicial, tratamento, evolução radiográfica e complicações. Resultados: 662 pacientes foram incluídos. Sendo maioritariamente do sexo masculino (65%), com média de 9 anos, membro direito (61%), nos meses de verão (36%). Em relação à topografia, foi evidenciada maior frequência nas fraturas da borda e metafisárias (31,72% e 31,57%), seguidas das suprametafisárias (18.43%) e fisárias (18.28%). O tratamento realizado foi ortopédico em 86.56% dos casos, enquanto cirúrgico em 12.84%, sendo a maioria com fios de Kirschner (11,2%). O tempo médio de imobilização foi de 6 semanas, com percentual de complicações de 14.05%. Conclusões: Foram avaliadas as características dos pacientes e fraturas do rádio distal no CHPR nos anos de 2017 e 18, com um total de 662 fraturas (0,9 por dia), em que a maioria foi submetida a tratamento ortopédico com índice de complicações que fica em torno de 14%, sendo maior quanto maior for o deslocamento inicial da fratura.

Title: Fractures of the distal end of the radius in the immature skeleton. Epidemiological study at the Pereira Rossell Hospital Center. Main objective: To know the epidemiology of fractures of the distal fourth of the radius in the growing skeleton and the treatment carried out in the CHPR in the years 2017 and 2018. Specific objectives: To assess re-displacement, need for re-manipulation, complications, re- fracture. Methodology: Retrospective descriptive observational study. Inclusion criteria: patients aged 0 to 14 years with distal radius fracture (physeal, metaphyseal and suprametaphyseal) evaluated at the CHPR between January 1, 2017 and December 31, 2018. Exclusion criteria: patients with normal radiographs, fractures in limbs with malformations, bone infections, malignant or benign tumor pathology. Data collection: Assessment of fist and forearm X-rays performed at the CHPR in 2017 and 18, initial and evolutionary. The following were analyzed: age, sex, fracture date, fracture topography, initial displacement, treatment, radiographic evolution and complications. Results: 662 patients were included. Being mostly male (65%), with an average of 9 years, right limb (61%), in the summer months (36%). Regarding the topography, a higher frequency was evidenced in rim and metaphyseal fractures (31.72% and 31.57%), followed by suprametaphyseal (18.43%) and physeal (18.28%). The treatment performed was orthopedic in 86.56% of the cases, while surgical was 12.84%, mostly with Kirschner wires (11.2%). The average immobilization time was 6 weeks, with a percentage of complications of 14.05%. Conclusions: The characteristics of the patients and fractures of the distal radius in the CHPR in the years 2017 and 18 were evaluated, with a total of 662 fractures (0.9 per day), in which the majority underwent orthopedic treatment with an index of complications that is around 14%, being greater the greater the initial displacement of the fracture.

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Introduction: Almost 25% of colorectal cancer (CRC) patients have synchronous colorectal liver metastasis (SCLM) coinciding with the disease diagnosis. Liver-first approach for the treatment of SCLM involves neoadjuvant chemotherapy, subsequent liver resection, and then primary tumor resection. This strategy is adopted as the prognosis of the disease depends mainly on the metastases, not the primary tumor. This study aims to evaluate the feasibility of the liver-first approach and clinical prognosis in managing SCLM. Materials and Methods: This retrospective study included 25 patients with SCLM from July 2015 to July 2020. All patients were subjected to a liver-first approach with an "intention-to-treat" approach. Follow-up was planned for at least 3 years. Data were collected from the hospital records and included survival rates and univariate analyses of the prognostic factors, such as gender, age, and number of chemotherapy cycles to evaluate their effect on the survival probability. Results: Nineteen patients completed the treatment paradigm. Long-term outcomes reported a median overall survival (OS) of 32 months. One-year and 3-year survival probabilities were 89.5% and 42.1%, respectively. The median disease-free survival was 13 months. The number of metastatic lesions, unilobar versus bilobar disease, and the frequency of administered chemotherapy cycles significantly affected survival (p < 0.05). Seven patients (36.84%) remained disease free (no recurrence) while 2 patients (10.53%) survived with recurrence. The overall mortality included 10 deaths (52.63%) due to recurrence. Conclusion: Synchronous colorectal liver metastasis treated with the liver-first approach achieved a notable overall advantage. However, the recurrence rate remained relatively high. (AU)

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O ameloblastoma é uma neoplasia odontogênica benigna originada de remanescentes do epitélio odontogênico com padrão de crescimento lento, porém infiltrativo nos tecidos adjacentes. Apresenta três variantes clínicas: convencional, unicística e periférica, as quais diferem em seu comportamento biológico e consequentemente na resposta às modalidades terapêuticas disponíveis. Essas modalidades são classificadas como conservadoras (enucleação e excisão cirúrgicas) e radicais (ressecção marginal e segmentar). As técnicas conservadoras são empregadas para o tratamento do ameloblastoma unicístico, devido ao seu aspecto encapsulado, e para o periférico, por se tratar de uma lesão restrita aos tecidos moles. Já as técnicas radicais são mais indicadas para o manejo do ameloblastoma convencional, o qual apresenta um comportamento mais infiltrativo. Os protocolos terapêuticos para o manejo da lesão disponíveis variam de acordo com os autores dos trabalhos e seu emprego sofre influência de fatores clínicos e imaginológicos (localização e extensão da lesão, envolvimento de dentes adjacentes, idade e escolha do paciente, histórico de recidivas, preferência do cirurgião) e histológicos (subtipo histológico). Por esse motivo o presente estudo visou analisar, de forma retrospectiva, casos de ameloblastoma tratados por um mesmo cirurgião entre os anos de 2002 e 2023. A amostra foi constituída por 12 casos de ameloblastoma unicístico e 24 de ameloblastoma convencional. Os dois grupos foram avaliados separadamente. Houve predileção pelo sexo feminino em ambos, e a média de idade foi de 27,25 e 40,2 anos, respectivamente. As lesões foram predominantemente encontradas em mandíbula posterior nos dois grupos. Radiograficamente, houve predominância do aspecto unilocular, nos casos de ameloblastoma unicístico (91,7%), e do padrão multilocular, para o ameloblastoma convencional (83%). A extensão média das lesões foi de 46,14mm e 41,06mm, respectivamente. Reabsorção radicular, deslocamento dentário e perfuração de corticais foram observados em ambos os grupos. O subtipo histológico mural correspondeu a 75% dos casos de ameloblastoma unicístico, enquanto o subtipo folicular respondeu por 79% dos casos do tipo convencional. A análise microscópica de margens quanto à infiltração tumoral foi realizada nas amostras de ameloblastoma convencional e revelou margens infiltradas em 4 casos (16%) e livres de doença em 20 casos (83%). Quanto à terapia cirúrgica adotada, todos os casos unicísticos (n=12, 100%) foram tratados conservadoramente (enucleação + ostectomia periférica + cauterização com solução de Carnoy), enquanto todos os casos de ameloblastoma convencional (n=24; 100%) foram submetidos à ressecção (marginal ou segmentar). Nenhuma abordagem adicional foi empregada nos casos de ameloblastoma convencional que apresentaram as margens infiltradas. As taxas de recidiva observadas foram de 8,33% em ambos os grupos, correspondentes a uma lesão unicística mural e a dois casos de ameloblastoma convencional do subtipo folicular cujas margens encontravam-se livres de doença, o que não exclui a possibilidade de recidivas. O período médio de follow-up foi de 62 e 79 meses, respectivamente. Nossos achados sugerem que uma abordagem conservadora deve ser a primeira opção para o tratamento do ameloblastoma unicístico, mesmo para aqueles com proliferação mural e que o ameloblastoma convencional deve ser tratado preferencialmente através de ressecçã marginal/segmentar por se considerar seu caráter mais infiltrativo nos tecidos adjacentes.

Ameloblastoma is a benign odontogenic neoplasm originating from remnants of odontogenic epithelium which grows slowly but infiltrating the surrounding tissues. It has three clinical variants: conventional, unicystic and peripheral, according to which differ in their biological behavior and consequently in their response to the available therapeutic modalities. These modalities are classified as conservative (enucleation and surgical excision) and radical (marginal and segmental resection) ones. Conservative techniques are used for the treatment of unicystic ameloblastoma, due to its encapsulated aspect, and for the peripheral subtype. Radical techniques are advised for the management of conventional ameloblastoma. The available treatment protocols vary between surgeons and their use is influenced by clinicoradiographic aspects (location and size of the lesion, involvement of adjacent teeth, age, history of recurrences, surgeon preference), histological subtype and literary (lack of standardization of data relating to the issue). For this reason, the present study will retrospectively analyze cases of ameloblastoma treated uniformly by the same surgeon from 2002 to 2023. The sample was formed by 12 cases of unicystic and 24 cases of conventional ameloblastomas. These groups were analyzed separately. There was a female predilection, and the mean age of patients were 27,25 and 40,2 years respectively. Almost all lesions affected the posterior mandible in both groups. Radiographically, we observed a predominant unilocular pattern for unicystic ameloblastoma (91,7%) and a multilocular pattern for conventional ones (83%). Lesions measured, on average, 46,14mm and 41,06mm respectively. Root resorption, tooth displacement and cortical perforation were also observed. The mural histological subtype corresponded to 75% of the unicystic cases, while follicular pattern (79%) was predominant in conventional samples. Microscopic analysis of margins for tumour infiltration was performed in conventional ameloblastoma samples and revealed 4 positive margins (16%) and 20 margins free of disease (83%). Regarding the surgical therapy adopted, all unicystic cases (n=12, 100%) were treated conservatively (enucleation + peripheral ostectomy + cauterization with Carnoy's solution) and all cases of conventional ameloblastoma (n=24; 100%) underwent marginal/segmental resection. No additional approach was used in cases of conventional ameloblastoma that presented infiltrated margins. Recurrence occurred in 8,33% of both groups, corresponded to one mural and two follicular ameloblastomas whose margins were free of disease, which does not exclude the possibility of recurrence. The mean follow up period was 62 and 79 months, respectively. Our findings suggest that a conservative approach should be the first option for the treatment of unicystic ameloblastoma, even for those with mural proliferation. Conventional ameloblastomas, on the other hand, should be managed through a radical approach due to its infiltrative behavior.

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La uretroplastía se ha convertido en el estándar de manejo de la estrechez uretral, dependiendo de la localización y etiología de esta. Los datos de los resultados a largo plazo varían dependiendo de la definición que se utilice como éxito (subjetiva u objetiva). El objetivo de esta revisión integrativa es mostrar la información disponible sobre los resultados funcionales de pacientes con estrechez uretral manejados quirúrgicamente. El estudio es una revisión integrativa que se realizó mediante una búsqueda de la literatura en PubMed. Incluimos artículos que describían resultados de pacientes sometidos a reconstrucción uretral con uretroplastia, solo hombres, en inglés o español, publicados entre 1999-2022. Incluimos 34 artículos, los cuales mostraron que, según el tipo de procedimiento realizado, las características de la estrechez uretral y las variables definidas como éxito y fracaso, los factores de riesgo asociados a la recurrencia posterior a la reconstrucción con uretroplastia en uretra fueron la presencia de comorbilidades, obesidad y etiología infecciosa. Concluimos entonces que la uretroplastia es un procedimiento que ha aumentado en los últimos años, con pocos estudios que nos comparan resultados dependiendo del tipo de procedimiento utilizado. Nuestra revisión encontró que hay mayor literatura sobre el uso de injertos de mucosa oral comparado con escición primaria y anastomosis (EPA), con unos resultados anatómicos y funcionales comparables entre ambos procedimientos. Los cuestionarios PROMS (Patient Reported Outcome Measures) son herramientas útiles para el seguimiento postoperatorio de estos pacientes.

Urethroplasty has become the standard for managing urethral stricture, depending on its location and etiology. Long-term outcome data varies depending on the definition of success used (subjective or objective). The objective of this integrative review is to show the available information on the functional results of patients with surgically managed urethral stricture. The study is an integrative review that was carried out through a literature search in PubMed, we included articles that described the results of patients undergoing urethral reconstruction with urethroplasty, only men, in English or Spanish, published between 1999-2022. The study included 34 articles, which showed that, depending on the type of procedure performed, the characteristics of the urethral stricture and the variables defined as success and failure, the risk factors associated with recurrence after reconstruction with urethroplasty in the urethra were the presence of comorbidities, obesity, and infectious etiology. In conclusion, urethroplasty is a procedure that has increased in recent years, with few studies that compare results depending on the type of procedure used. Our review found that there is more literature on the use of buccal mucosa graft (BMG) compared to excision and primary anastomotic urethroplasy (EPA), with comparable anatomical and functional results between both procedures.

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Introducción: La luxación de la hemiartroplastia tras una fractura de cadera es una complicación difícil de tratar debido la comorbilidad asociada en este tipo de pacientes, la pobre calidad del hueso y las partes blandas. Materiales y Métodos: Se evaluaron 28 casos de luxación tras una hemiartroplastia. Se comparó la mortalidad con la de 56 controles, en un seguimiento mínimo de un año. En todos los casos, se intentó una reducción cerrada bajo anestesia general, que fue exitosa en 26 pacientes. Se analizaron los episodios de recurrencia de la luxación, considerando los diferentes factores que pueden influir en ella. Resultados: La tasa de mortalidad global de los 28 pacientes con luxación fue del 42% en los primeros 12 meses frente al 21% en el grupo de control (p <0,001). Hubo 12 casos (42%) de recurrencia tras la reducción cerrada inicial. El riesgo de recurrencia es menor cuando las luxaciones se producen por un traumatismo que si ocurren espontáneamente o con traumatismos menores. Asimismo, el riesgo de recurrencia de las luxaciones en pacientes con deterioro cognitivo moderado o severo es más alto. Conclusiones: La luxación tras una hemiartroplastia se asocia con un incremento significativo de la mortalidad. Aunque la reducción cerrada bajo anestesia general se considera de elección en la mayoría de los casos, la tasa de fracaso es alta, sobre todo en pacientes con deterioro cognitivo moderado o severo o tras luxaciones atraumáticas. Nivel de Evidencia: III

Introduction: The hip hemiarthroplasty dislocation is a challenging complication due to patient frailty, associated comorbidities, poor bone and soft tissue quality. Materials and Methods: We have studied 28 cases of dislocation after hemiarthroplasty and compared with 56 control patients with one year follow-up. Closed reduction under general anesthesia were made in 26 cases. The study analyzed recurrence episodes of dislocation, considering various factors influencing instability recurrence. Results: Among the 28 patients with dislocation post-hemiarthroplasty, there was an overall mortality 42% within the first 12 months, compared to 21% in the group of patients who did not experience a dislocation episode (p<0.001.) Recurrence following the initial reduction occurred in 12 cases (42%). Cases resulting from trauma had a lower recurrence risk than those occurring spontaneously or with minor with a OR of 11. Similarly, dislocations in patients with moderate to severe cognitive decline had a higher recurrence risk compared to those without cognitive decline, with an OR of 5.5 Conclusions: Hemiarthroplasty dislocation is associated with a significantly increased mortality rate. While closed reduction under general anesthesia is often considered the preferred management, it is associated with a high failure rate, especially in patients with moderate to severe cognitive decline or with spontaneous dislocations. Level of Evidence: III