ABSTRACT
BACKGROUNDS/AIMS: The bile duct injuries are the most severe complications that occur after the surgical manipulation of the bile duct. The hepaticojejunostomy remained as the best treatment. Several factors identified that affect the result. This study aimed to analyze and identify risk factors that affected the evolution of these patients. METHODS: A retrospective, observational study was conducted from February 1998 to June 2017. We included all patients with bile duct injuries who required surgical treatment. RESULTS: We found 79 patients. The majority had a Bismuth type III in 35.4% (n=28). The morbidity of the Hepaticojejunostomy was 19% (n=15). In short-term follow-up, the main complications were cholangitis 11.4% (n=9) and bile leak 10% (n=8). In the long-term follow-up, in 2.5% (n=2) stricture was presented. On the comparison between postoperative and preoperative parameters, biliary peritonitis after a cholecystectomy (p=0.02) was an independent predictor of postoperative morbidity (p<0.05). CONCLUSIONS: In the treatment of bile duct injuries, different factors affect their outcomes. Our results show that infectious complications continue to affect the results of the treatment of bile duct lesions.
ABSTRACT
Background: Male breast cancer is a rare entity, with an approximate rate of 1.1 / 100 000 in the US, with an average age of 67 years. In all cases a genetic study must be performed, in order to find mutations in known genes, and after the resolution of the disease, based on the results, a contralateral prophylactic mastectomy should be considered. Clinical case: 53 -year-old male diagnosed with right breast cancer, infiltrating ductal adenocarcinoma type, clinical stage IIB, breast cancer on 2 immediate family history, mutations of the BRCA1 gene and positive hormone receptors and Her2/Neu. He was treated with modified radical mastectomy in diseased side with subsequent neoadjuvant chemotherapy/radiotherapy. After a year of follow-up and a free behavior of disease, contralateral prophylactic mastectomy was performed. The patient progressed satisfactorily, following up to 18 months since the beginning, with no tumor activity data. Conclusions: Breast cancer in male patient has a worse prognosis than female patients, due to lower amount of tissue in breast exposed to an earlier chest spread and a different biological behavior, also a higher risk of prostate and pancreatic cancer is associated. Studies of adequate methodological quality are scarce, so that decisions are based on guidelines for breast cancer in women.
Introducción: el cáncer de mama en varones es una entidad poco frecuente, con una tasa aproximada de 1.1/100 000 habitantes en los Estados Unidos de América, con una edad media de presentación de 67 años. En todos los casos se aconseja realizar un estudio genético al paciente en búsqueda de mutaciones conocidas y después de la resolución de la enfermedad, con base en los resultados, considerar realizar una mastectomía profiláctica contralateral. Caso clínico: paciente masculino de 53 años de edad, con diagnóstico de cáncer de mama derecha, tipo adenocarcinoma canalicular infiltrante, estadio clínico IIB, con antecedentes de cáncer de mama en 2 familiares directos, mutaciones del gen BRCA1 y positivo tanto a receptores hormonales como para el gen Her2/Neu. Fue tratado con mastectomía radical modificada en lado enfermo con neoadyuvancia subsecuente a base de quimio/radioterapia, tras un año de seguimiento y con un comportamiento libre de enfermedad se realizó mastectomía profiláctica contralateral. El paciente evolucionó satisfactoriamente, en seguimiento a 18 meses sin datos de actividad tumoral. Conclusiones: el cáncer de mama en el paciente varón tiene un pronóstico peor respecto al paciente de sexo femenino, esto por la menor cantidad de tejido en mama que lo expone a una diseminación torácica más temprana y por su comportamiento más agresivo, además de asociarse a un mayor riesgo de desarrollar cáncer de próstata y páncreas, respecto a la población general. Los estudios de adecuada calidad metodológica son escasos, por lo que la toma decisiones se fundamenta en las directrices para el cáncer de mama en mujeres.
ABSTRACT
Resumen Introducción: Los primeros reportes de histerectomía se remontan al año 120 a. C. con Sorano de Efeso; sin embargo, fue hasta 1988 que H. Reich realizó la primera histerectomía laparoscópica. Las indicaciones para esta cirugía son: endometriosis, hemorragia uterina anormal, masas anexiales benignas, dolor pélvico crónico en relación con adherencias, secundarias a enfermedad inflamatoria pélvica o cirugía previa, cáncer de endometrio, de ovario y de cérvix estadio l. Caso clínico: Paciente de 44 años de edad, que 4 meses antes de la intervención quirúrgica inició su padecimiento con sangrado intermitente abundante con uso de 6 toallas sanitarias al día con ciclo menstrual de 15 × 15, acompañado de dolor tipo cólico, que remitía con tratamiento hormonal inyectable y antiinflamatorios no esteroideos. Se le realizó ultrasonido pélvico con reporte de miomatosis uterina. Pasó a quirófano y se encontró: útero de 10 × 7 × 7 cm con miomatosis de grandes elementos subserosos, el mayor de 7 × 7 × 7 cm en la pared posterior del útero. Egresó al tercer día de estancia hospitalaria sin datos de sangrado activo, tolerando la vía oral, canalizando gases. Justificación: La histerectomía por vía laparoscópica permite una mejor visualización gracias a la magnificación de la anatomía y la patología existente, mejor acceso al fondo del saco de Douglas y las fosas ováricas, mejor control hemostático, así como disminución del dolor de la incisión abdominal. Conclusión: Con esta técnica se ha demostrado una disminución de la estancia intrahospitalaria, un más rápido retorno a las actividades normales, así como reducción en el riesgo de infección en el sitio de la herida quirúrgica.
Abstract Introduction: The first reports of hysterectomy were in the year 120 BC. The first indications for surgery were: Endometriosis, Abnormal uterine bleeding, Benign adnexal masses, Chronic pelvic pain in relation to adhesions, secondary to inflammatory disease, but it was not until 1988 that the first laparoscopic hysterectomy was performed by H. Reich. Pelvic or prior surgery; Cancer of the endometrium, ovary and cervix stage l. Clinical case: a 44-year-old female patient who started her illness four months prior to surgery with intermittent heavy bleeding with the use of 6 sanitary towels per day with a 15 x 15 menstrual cycle accompanied by colic type pain, which referred with hormonal Injectable and non-steroidal anti-inflammatory drugs, pelvic ultrasound was performed with a report of uterine myomatosis, passed to the operating room where it was found as uterus of 10x7x7cm with myomatosis of large subserosal elements, the largest of 7x7x7cm in the posterior wall of the uterus, being graduated To the third day of hospital stay without data of active bleeding, tolerating the oral route, channeling gases. Justification: A laparoscopic hysterectomy allows better visualization by magnifying anatomy and existing pathology, better access to Douglas fundus and ovarian fossae, better hemostatic control as well as diminishing abdominal incision pain. Conclusion: decreased hospital stay, greater return to activities, shorter hospital stay, reduced infection at the surgical wound site.
ABSTRACT
BACKGROUND: There are only a few reports regarding the quality of life of patients who underwent a complicated cholecystectomy with an iatrogenic bile duct injury (IBDI); the results have been heterogeneous and realized with unspecific measures. METHODS: The objective was to determine whether the quality of life of the subjects with a history of IBDI repaired with bilioenteric derivation is modified in the long term with respect to a control group, for which a group of patients with a history of IBDI (group A) was compared with a group of patients with a history of uncomplicated cholecystectomy (group B). Two different measures were used: on the one hand, the SF-12 questionnaire and on the other hand, a questionnaire was implemented where the patient could determine by himself which variables define his quality of life. RESULTS: A total of 46 patients were included in group A and 51 in group B. The analysis of the SF-12 questionnaire showed a statistical significant reduction in 4 of 8 of the evaluated parameters (general health, physical functioning, physical role and social functioning) in group A in comparison with group B. If a more specific questionnaire is used, the results are similar, with a statistically significant reduction in the quality of life within the group A (0.03). CONCLUSIONS: We conclude that the quality of life of patients with a history of bilioenteric derivation due to an IBDI decreases significantly compared to patients with uncomplicated cholecystectomy.
