[Extramedullary intradural tuberculosis: a case report and review of the literature]. / Tuberculoma intradural extramedular: descripcion de un caso clinico y revision de la bibliografia.

INTRODUCTION: Central nervous system tuberculosis is a common chronic infection in developing countries, being the most frequent forms: tuberculous meningitis and intracranial tuberculosis. Extramedullary intradural tuberculosis is a rare entity with few cases described in the world literature, and is usually associated with a history of tuberculous meningitis or during antituberculosis treatment. CASE REPORT: A 17 years-old male patient, without history of tuberculosis, with subacute onset and progressive course of compressive myelopathy. Spinal magnetic resonance imaging revealed an intradural extramedullary mass lesion between the C4 and T8 spinal levels. Surgical resection of tuberculoma was realized, followed by chemotherapy. The histopathological study confirmed the diagnostic. CONCLUSIONS: Tuberculosis of the central nervous system is an entity of high incidence in developing countries, and intradural extramedullary tuberculoma should be included in the differential diagnosis of expansive spinal cord injuries, especially if the patient is young and there is a history of pulmonary tuberculosis or tuberculous meningitis. It is also important to take it into account as part of a paradoxical reaction after the initiation of specific treatment. Although surgical resection improves compressive medullary symptoms, medical therapy remains the mainstay in the treatment of tuberculomas.

TITLE: Tuberculoma intradural extramedular: descripcion de un caso clinico y revision de la bibliografia.Introduccion. La tuberculosis del sistema nervioso central es una infeccion cronica comun en paises en vias de desarrollo, y la meningitis tuberculosa y los tuberculomas intracraneales son las formas mas frecuentes. El tuberculoma intradural extramedular es una entidad poco frecuente, con pocos casos descritos en la bibliografia mundial, y por lo general se asocia a un antecedente de meningitis tuberculosa o durante el tratamiento antituberculoso. Caso clinico. Varon de 17 años, sin antecedente de tuberculosis, con cuadro clinico de una mielopatia compresiva de aparicion subaguda y curso progresivo, cuya neuroimagen evidencio una lesion extensa intradural extramedular. Se le realizo cura quirurgica mas laminectomia descompresiva en D4-D8 seguido de quimioterapia. El estudio histopatologico confirmo el diagnostico. Conclusiones. La tuberculosis del sistema nervioso central es una entidad de alta incidencia en nuestro medio, y el tuberculoma intradural extramedular deberia incluirse en el diagnostico diferencial de lesiones expansivas de la medula espinal, mas aun si el paciente es joven y existe el antecedente de tuberculosis pulmonar o meningitis tuberculosa. Asimismo, es importante tenerla en cuenta como parte de una reaccion paradojica despues del inicio del tratamiento especifico. Aunque la reseccion quirurgica mejora los sintomas compresivos medulares, la terapia medica continua siendo el pilar en el tratamiento de los tuberculomas.

[Gastric cancer invading the muscularis propia]. / Cáncer Gástrico con invasión hasta la muscular propia.

OBJECTIVE: Determine the clinical features and the survival of patients with gastric cancer invading the muscularis propia. MATERIAL AND METHODS: We reviewed the clinical records of the patients with gastric cancer invading the muscularis propia, that had undergone surgical treatment at the National Cancer Institute (INEN) between 1950 and 1999. We considered age, sex, location of the tumor, regional lymph node metastases (N), distant metastases (M), TNM stage and survival. RESULTS: 202 patients had gastric cancer invading the muscularis propia, the mean age was 60.03 years, 105 (52%) were females, in 69% the neoplasm was in the antrum and in 22% in the body. We found regional lymph node metastases in 48% and distant metastases in 1%; 52.1% was in the IB TNM stage and 3.1% in the IV. The five year survival rate using Kaplan Meier was 66%, patients with N0, N1, N2 and N3 had 78%, 70%, 25% and 0% respectively.

[Total gastrectomy for gastric cancer in patients over 70 years old]. / Gastrectomía total por cáncer gástrico en pacientes mayores de 70 años.

OBJECTIVE: To determine if the morbidity and postoperative mortality after a full gastrectomy for gastric cancer performed on patients of more than 70 years of age were different from those of younger patients. MATERIAL AND METHODS: Between 1980 and 1999, a total of 411 gastrectomies for gastric adenocarcinoma were performed at the Institute of Cancer Diseases (INEN). Of these, 87 were inpatients older than 70 years of age (elderly group) and 92 were inpatients between 50 and 59 years of age (young group). The clinical record of both groups were studied and the clinical-pathological features, morbidity and postoperative mortality, staying time in hospital and survival rate were compared. RESULTS: There was no significant difference between the two groups regarding clinical-pathological features except in the TNM stage. In the elderly group 23.0% had stage IV and 43.5% in the young group (p=0.007). The average operating time in the elderly group was shorter than in the young group (5.5 hours versus 6.0 hours, p=0.015). The morbidity for the elderly group was 29.9% and that of the young group was 34.8%, whereas the postoperative mortality for the elderly and young groups was 4.6% and 2.2%, respectively. Pneumonia was the most frequent postoperative complication (14.8%) and the primary cause of postoperative death in the elderly group. Time in hospital and survival were similar between both groups. CONCLUSIONS: The morbidity and postoperative mortality after a full gastrectomy for cancer of the stomach in the elderly is no different from those found in younger patients.