ABSTRACT
PURPOSE: Surgery of primary thyroid lymphoma (PTL) has been mostly limited to diagnostic work-up. This study aimed to further study its potential role. METHODS: This was a retrospective study from a multi-institutional registry of PTL patients. Clinical, diagnostic work-up (fine needle aspiration, FNA; core needle biopsy, CoreNB), contribution of surgery (open surgical biopsy, OpenSB; thyroidectomy), histology subtype, and outcome data were evaluated. RESULTS: Some 54 patients were studied. Diagnostic work-up included FNA in 47 patients, CoreNB in 11, and OpenSB in 21. CoreNB yielded the best sensitivity (90.9%). Thyroidectomy was performed in 14 patients with other diagnosis (incidental PTL), in 4 for diagnosis and in 4 for elective treatment of PTL. Incidental PTL was associated with not performed FNA nor CoreNB (OR 52.5; P = 0.008), mucosa-associated lymphoid tissue (MALT) subtype (OR 24.3; P = 0.012), and Hashimoto's thyroiditis (OR 11.1; P = 0.032). Lymphoma-related death (10 cases) mostly occurred within the first year after diagnosis and was associated with diffuse large B-cell (DLBC) subtype (OR 10.3; P = 0.018) and older patients (OR 1.08 for every 1-year increase; P = 0.010). There was a trend towards lower mortality rate in patients receiving thyroidectomy (2/22 versus 8/32, P = 0.172). CONCLUSION: Incidental PTL accounts for most of thyroid surgery cases and are associated with incomplete diagnostic work-up, Hashimoto's thyroiditis and MALT subtype. CoreNB appears to be the best tool for diagnosis. Most of PTL deaths occurred during the first year after diagnosis and mostly related to systemic treatment. Age and DLBC subtype are poor prognostic factors.
Subject(s)
Lymphoma , Thyroid Neoplasms , Thyroiditis , Humans , Retrospective StudiesABSTRACT
Antes de planificar estrategias de mejora, es crucial conocer el grado de implementación de las medidas preventivas de infección postoperatoria. Se presentan los resultados agregados de 3encuestas realizadas por el Observatorio de Infección en Cirugía a miembros de 11 asociaciones de cirugía y de enfermería quirúrgica. Las preguntas fueron dirigidas a determinar el conocimiento de la evidencia científica, las creencias personales y el uso real de las principales medidas. De 2.295 encuestados, el 45,1% no recibe información de la tasa de infección de su unidad. Se observó un conocimiento insuficiente de algunas de las principales recomendaciones de prevención y unas tasas de utilización, en ocasiones, inquietante. Se indagó sobre las estrategias preferidas para mejorar el cumplimiento de las pautas preventivas y su grado de implementación. Se confirmó la brecha existente entre la evidencia científica y la práctica clínica en la prevención de infecciones en diferentes especialidades quirúrgicas (AU)
Before planning improvement strategies, it is crucial to know the degree of implementation of preventative measures for postoperative infection. The aggregated results of 3surveys carried out by the Observatory of Infection in Surgery to members of 11 associations of surgeons and perioperative nurses are presented. The questions were aimed to determine the knowledge of the scientific evidence, personal beliefs and the actual use of the main measures. Of 2295 respondents, 45.1% did not receive feedback on the infection rate of their unit. Insufficient knowledge of some of the main prevention recommendations and some disturbing rates of use were observed. The preferred strategies to improve compliance with preventive guidelines and their degree of implementation were investigated. A gap between scientific evidence and clinical practice in the prevention of infection in different surgical specialties was confirmed (AU)
Subject(s)
Humans , Health Care Surveys , Surgical Wound Infection/prevention & control , Practice Patterns, Physicians' , Surgeons , Nurses , Surveys and QuestionnairesABSTRACT
In humans, apocrine gland tumours encompass a heterogeneous group of uncommon neoplasms with varied and unpredictable biological behaviour. They can be slow-growing lesions, recur after excision, produce lymph node metastasis in up to 50% of cases or lead to tumour-related death. We document a malignant scent adenocarcinoma in a wedge-capped capuchin monkey (Cebus olivaceus). Immunohistochemical labelling revealed complete absence of myoepithelial cells, a finding usually considered a hallmark of malignancy in humans; however, after a 2-year follow-up, the neoplasm had not recurred. This is the first detailed report of the pathology of a spontaneous scent (apocrine) gland adenocarcinoma in a non-human primate.
Subject(s)
Adenocarcinoma/veterinary , Apocrine Glands/pathology , Cebus , Monkey Diseases/pathology , Sweat Gland Neoplasms/veterinary , Animals , MaleABSTRACT
BACKGROUND: Stratification of the severity of infection is currently based on the Sequential Organ Failure Assessment (SOFA) score, which is difficult to calculate outside the ICU. Biomarkers could help to stratify the severity of infection in surgical patients. METHODS: Levels of ten biomarkers indicating endothelial dysfunction, 22 indicating emergency granulopoiesis, and six denoting neutrophil degranulation were compared in three groups of patients in the first 12 h after diagnosis at three Spanish hospitals. RESULTS: There were 100 patients with infection, 95 with sepsis and 57 with septic shock. Seven biomarkers indicating endothelial dysfunction (mid-regional proadrenomedullin (MR-ProADM), syndecan 1, thrombomodulin, angiopoietin 2, endothelial cell-specific molecule 1, vascular cell adhesion molecule 1 and E-selectin) had stronger associations with sepsis than infection alone. MR-ProADM had the highest odds ratio (OR) in multivariable analysis (OR 11·53, 95 per cent c.i. 4·15 to 32·08; P = 0·006) and the best area under the curve (AUC) for detecting sepsis (0·86, 95 per cent c.i. 0·80 to 0·91; P < 0·001). In a comparison of sepsis with septic shock, two biomarkers of neutrophil degranulation, proteinase 3 (OR 8·09, 1·34 to 48·91; P = 0·028) and lipocalin 2 (OR 6·62, 2·47 to 17·77; P = 0·002), had the strongest association with septic shock, but lipocalin 2 exhibited the highest AUC (0·81, 0·73 to 0·90; P < 0·001). CONCLUSION: MR-ProADM and lipocalin 2 could be alternatives to the SOFA score in the detection of sepsis and septic shock respectively in surgical patients with infection.
ANTECEDENTES: La estratificación de la gravedad de una infección se basa actualmente en la puntuación SOFA (Sequential Organ Failure Assessment), que es difícil de calcular fuera de la unidad de cuidados intensivos. Los biomarcadores podrían ayudar a estratificar la gravedad de la infección en pacientes quirúrgicos. MÉTODOS: Se compararon las concentraciones de 10 biomarcadores que denotan disfunción endotelial, 22 que indican granulopoyesis de emergencia y 6 que expresan la degranulación de neutrófilos en tres grupos de pacientes de tres hospitales españoles (100 con infección, 95 con sepsis y 57 con shock séptico) en las primeras doce horas después del diagnóstico. RESULTADOS: Siete biomarcadores que expresan disfunción endotelial (proadrenomedulina, sindecan-1, trombomodulina, angiopoyetina-2, endocan-1, molécula de adhesión endotelial 1 y E-selectina) mostraron una fuerte asociación con la sepsis en comparación con la infección aislada. La proadrenomedulina presentó el valor más alto de la razón de oportunidades (odds ratio, OR) en el análisis multivariable (OR 11,53, i.c. del 95% 4,15-32,08, P = 0,006) y la mejor área bajo la curva para detectar sepsis (AUC 0,86, i.c. del 95% 0,80-0,91, P < 0,001). En la comparación entre sepsis y shock séptico, los biomarcadores que mostraron la asociación más estrecha con el shock séptico fueron dos biomarcadores de degranulación de neutrófilos (proteinasa-3 y lipocalina-2) (OR 8,09, i.c. del 9% 1,34-48,91, P = 0,028; OR 6.62, i.c. del 95% 2,47-17,77, P = 0,002), pero la lipocalina-2 presentó la mejor AUC (0,81, i.c. del 95% 0,73-0,90, P < 0,001). CONCLUSIÓN: la proadrenomedulina y la lipocalina-2 podrían representar alternativas a la puntuación SOFA para detectar sepsis y shock séptico en pacientes quirúrgicos con infección.
Subject(s)
Adrenomedullin/blood , Lipocalin-2/blood , Neutrophils/pathology , Protein Precursors/blood , Sepsis/blood , Shock, Septic/blood , Adult , Aged , Angiopoietin-2/blood , Area Under Curve , Biomarkers/blood , Female , Hospital Mortality , Humans , Intensive Care Units , Male , Middle Aged , Multivariate Analysis , Organ Dysfunction Scores , Prognosis , ROC Curve , Sepsis/diagnosis , Shock, Septic/diagnosis , Spain , Thrombomodulin/blood , Vascular Cell Adhesion Molecule-1/bloodABSTRACT
INTRODUCTION AND OBJECTIVE: Atrophy and intestinal metaplasia are early phenotypic markers in gastric carcinogenesis. White light endoscopy does not allow direct biopsy of intestinal metaplasia due to a lack of contrast of the mucosa. Narrow-band imaging is known to enhance the visibility of intestinal metaplasia, to reduce sampling error, and to increase the diagnostic yield of endoscopy for intestinal metaplasia in Asian patients. The aim of our study was to validate the diagnostic performance of narrow-band imaging using 1.5× electronic zoom endoscopy (with no high magnification) to diagnose intestinal metaplasia in Mexican patients. MATERIALS AND METHODS: A retrospective cohort study was conducted on consecutive patients with dyspeptic symptoms at a private endoscopy center within the time frame of January 2015 to December 2016. RESULTS: A total of 338 patients (63±8.4 years of age, 40% women) were enrolled. The prevalence of H. pylori infection was 10.9% and the incidence of intestinal metaplasia in the gastric antrum and corpus was 23.9 and 5.9%, respectively. Among the patients with intestinal metaplasia, 65.3% had the incomplete type, 42.7% had multifocal disease, and one third had extension to the gastric corpus. Two patients had low-grade dysplasia. The sensitivity of white light endoscopy was 71.2%, with a false negative rate of 9.9%. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of narrow-band imaging (with a positive light blue crest) were 85, 98, 86.8, 97.7, and 87.2%, respectively. CONCLUSION: The prevalence of H. pylori infection and intestinal metaplasia in dyspeptic Mexican patients was not high. Through the assessment of the microsurface structure and light blue crest sign, non-optical zoom narrow-band imaging had high predictive values for detecting intestinal metaplasia in patients from a general Western setting.
Subject(s)
Dyspepsia/diagnostic imaging , Dyspepsia/etiology , Intestines/diagnostic imaging , Intestines/pathology , Narrow Band Imaging/methods , Aged , Cohort Studies , Dyspepsia/pathology , False Negative Reactions , Female , Humans , Male , Metaplasia/diagnostic imaging , Middle Aged , Narrow Band Imaging/instrumentation , Predictive Value of Tests , Retrospective StudiesSubject(s)
Esophageal Neoplasms/diagnosis , Granular Cell Tumor/diagnosis , Humans , Male , Young AdultABSTRACT
BACKGROUND: With the introduction of high resolution manometry (HRM) and esophageal topography a novel classification (Chicago Classification) has been proposed for the diagnosis of esophageal motor disorders (EMD). Clinical differences with the traditional classification are currently under evaluation. AIM: To investigate differences between the Chicago (CC) and traditional (TC) classifications in the diagnosis of EMD. METHODS: Consecutive patients with indication for esophageal manometry were studied. HRM was performed with a 36 sensors solid-state catheter and Manoview software (V2.0).Conventional manometric tracings were analyzed by an investigator blinded to the results of HRM. Diagnosis by CC and CT were compared. RESULTS: Two hundred patients were studied, 106 (53%) of them women (53%) with a mean patient age of 43.4 (range 16 - 84) years. Preoperative evaluation for GERD 152 (76%) was the most frequent indication. Achalasia (8), scleroderma (2) and peristaltic dysfunction (60 vs. 59) were similarly diagnosed by CC and CT. Spastic disorders were more frequently identified by CC: nutcracker esophagus (NC) in 3, spastic NC in3 and segmental NC in 11 patients versus TC: NC 5. Three patients had spasm with CC and 1 with TC. Non specific motor disorder was diagnosed by TC and 2 patients had functional obstruction with CC. Hypotensive lower esophageal sphincter was identified in 63 patients with CC vs.57 with TC. CONCLUSIONS: Spastic disorders and functional obstruction were the EMD better identified by HRM and CC.
Subject(s)
Esophageal Motility Disorders/classification , Esophageal Motility Disorders/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Esophageal Motility Disorders/physiopathology , Female , Humans , Male , Manometry/methods , Middle Aged , Pressure , Young AdultABSTRACT
OBJECTIVES: To find out whether the system for issuing prescriptions is linked to the therapeutic compliance and control of the blood pressure of a group of hypertense patients, and to quantify compliance with hypertension treatment through an indirect measurement method (counting pills). DESIGN: Crossover, descriptive study. SETTING: Torrelodones Health District (Madrid). PATIENTS: 54 patients known to be hypertense, of which 27 collected their prescriptions over the counter with no need for a doctor's appointment and 27 received them at a consultation with their doctor. MEASUREMENTS AND MAIN RESULTS: To measure the therapeutic compliance, first a phone call and then a surprise visit to the patient's home were made. At this visit, all the hypertension drugs prescribed were counted. It was specified that patients would be considered compliant if they had a compliance rate of 80-110%. 53.7% of the patients were considered good compliers and 46.3% bad compliers (of whom 37% were under-compliers and 9.3% over-compliers). The statistical analysis found that 59.3% of the patients who collected their prescriptions over the counter were good compliers, whereas 48.1% of those who did so at a medical consultation were (p = 0.41). 7.4% of patients who collected their prescriptions over the counter controlled their blood pressure well, whereas 22% of those who collected them at a consultation did so (p = 0.12). CONCLUSIONS: No statistically significant association was found between compliance and blood pressure figures, and systems of issuing prescriptions. The percentage of good compliers is high in comparison with other studies, but still insufficient.
