Accuracy of sentinel lymph node in papillary thyroid carcinoma.

BACKGROUND: The sentinel lymph node has been used in several tumors. The aim of this study was to analyze the accuracy of the sentinel node in papillary thyroid carcinoma. METHODS: A series of 22 patients with papillary thyroid carcinoma were included. Approximately 0.5 cc of isosulfan blue dye was injected at operation to trace the sentinel node. Lymph node dissection of the ipsilateral central compartment and extensive sampling of the jugular compartment were performed in addition to sentinel node resection. Surgical specimens were stained with hematoxylin-eosin, and negative sentinel nodes were subsequently stained with immunohistochemistry for cytokeratin-7. RESULTS: Mean age was 37 +/- 14 years. Twenty patients were women, and 2 were men. Mean tumor size was 2.5 +/- 1 cm. A sentinel lymph node was found in 20 patients. With use of hematoxylin-eosin, metastases were identified in 12/20 sentinel nodes (60%). Eleven patients with positive sentinel nodes presented additional lymph node metastases: 9 in the central compartment, 1 in the jugular compartment, and 1 in both compartments. Two patients with negative sentinel nodes had lymph node metastases elsewhere. When sentinel nodes were processed by immunohistochemistry, accuracy increased to 100%. CONCLUSIONS: Sentinel node is highly accurate for diagnosing metastases in papillary thyroid carcinoma.

[Surgical treatment of colorectal cancer. 10-year experience at the INCMNSZ]. / Tratamiento quirúrgico del cáncer colorrectal. Experiencia de 10 años en el INCMNSZ.

OBJECTIVE: To analyze the short- and long-term outcomes of the surgical treatment for colorectal cancer at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ) in Mexico City. BACKGROUND: Colorectal cancer is the second most frequent malignant tumor of the digestive tract in Mexico. Its incidence is rising, and its identification in early stages is important to offer a curative surgical treatment. METHODS: Retrospective, descriptive observational trial. We studied 165 patients who underwent colorectal surgery for treatment of cancer between 1985 and 1994 at the INCMNSZ. We compared the variables of patients and the surgical procedures and their relationship with morbidity and mortality with 5-year survival. RESULTS: Survival was greater in curative-attempting procedures of the colon than of the rectum (p < 0.05). Survival rate was also greater in earlier stages of the disease at the moment of diagnosis. Surgical morbidity occurred in 30% due to wound infections in most cases. Mortality rate was 3.6%, while the main cause was sepsis. Patients > 65 years of age had a higher mortality rate. Rectal surgery had higher morbidity than colonic surgery. CONCLUSIONS: Detecting patients at earlier stages of the disease is required to offer them a curative-attempting surgery procedure. Stage at moment of diagnosis correlates with survival rates. Age was a risk factor for surgical mortality, and rectal surgery, a risk factor for morbidity.

[Quality of the presentation of free research papers in the National Congress of Gastroenterology: Morelia-1997]. / Calidad de presentación de los trabajos libres de investigación en el Congreso Nacional de Gastroenterología: Morelia-1997.

BACKGROUND: The quality of the presentation of a free paper in a medical congress is not necessarily related to the quality of the methodology. OBJECTIVE: To analyze the quality of the presentation of the free papers in the National Congress of Gastroenterology in Mexico (Morelia-1997). METHODS: A prospective study was designed to evaluate the following aspects: Limitation to time assigned, adequate use and design of slides, and mentioning of the main methodologic characteristics. RESULTS: There was a high quality of presentation in the majority of papers. The most frequent problems identified, amenable to improvement, were non-limitation to assigned time (24%), as well as problems in the design of slides (too many lines/columns in 32% and excessive number in 23%). CONCLUSIONS: The knowledge of the results may help to improve the presentations of the free papers in the national congresses of gastroenterology.

[Total proctocolectomy with ileo-anal reservoir in "J". Experience at the Salvador Zubirán National Institute of Nutrition]. / Proctocolectomía total con anastomosis ileo-anal de reservorio en "J". Experiencia en el Instituto Nacional de la Nutrición Salvador Zubirán.

BACKGROUND: Total proctocolectomy with ileal pouch-anal anastomosis (TPCIAA) is the procedure of choice for patients with Ulcerative Colitis and Familial Adenomatous Polyposis. The frequency of presentation of both diseases is low in Mexico, therefore the experience with the surgical procedure is limited. OBJECTIVE: To analyze the operative morbidity and mortality and long-term functional results in a series of patients operated upon with the TPCIAA in a referral center in Mexico. MATERIAL AND METHODS: Retrospective analysis of 44 consecutive patients operated upon from 1987 through 1997. The operation included resection of the anal transitional zone, handsewn anastomosis of a "J" pouch, and diverting ileostomy in all cases. Operative morbidity and mortality, and long-term functional results and complications were determined. RESULTS: Mean age was 33 +/- 15 years. There were 52% women and 48% men. Diagnoses were ulcerative colitis in 59% and familial polyposis in 36%. Global morbidity was 39%, and mortality 2%. With a mean follow-up of 24 months, mean number of bowel movements was 4, 10% of patients had diurnal spotting, 30% nocturnal spotting, and no patient had gross incontinence. Three patients presented pouchitis with adequate response to antibiotics. Two patients presented long-term pouch fistulas that did not require pouch excision. CONCLUSIONS: The TPCIAA is a feasible operation with acceptable rates of morbidity and mortality and satisfactory functional results.

[Surgical treatment of colonic volvulus. 10-year experience at the Instituto Nacional de la Nutrición Salvador Zubirán]. / Tratamiento quirúrgico del vólvulus colónico. Experiencia de 10 años en el Instituto Nacional de la Nutrición Salvador Zubirán.

OBJECTIVES: To analyze morbidity-mortality and results of surgical treatment for colonic volvulus. METHODS: Retrospective review of 33 patients who underwent surgical treatment for colonic volvulus from 1986 through 1996. RESULTS: Mean age was 62 +/- 20 years (SD) with predominance of female sex (2:1). There were 25 cases of sigmoid volvulus (76%), 7 in the cecum (21%) and 1 in the transverse colon (3%). Colonic necrosis and/or perforation were most frequently seen in the right and transverse colon (50%) than in the sigmoid (4%) (P < 0.002). Operative morbidity was 45% with mortality of 21%. Age was the only variable statistically significant for operative morbidity (52 +/- 23 years in patients without morbidity vs 71 +/- 17 years in patients with morbidity, P = 0.02). Surgical procedures for sigmoid volvulus were resection in 13 and fixation in 12. Recurrence after fixation was 38% to 12 months and 69% to 24 months (Kaplan-Meier), with associated mortality of 50%. There was no recurrence after resections. Treatment for cecal volvulus was cecopexy in 4 cases, with one recurrence; and right hemicolectomy without recurrence. CONCLUSIONS: The results should encourage resective procedures in sigmoid volvulus because the risk of recurrence after fixation is high and the morbidity-mortality is similar. Elderly patients are more susceptible to complications.