Papillary thyroid microcarcinoma with minimal extrathyroidal extension. Is its course so indolent that it requires a less aggressive treatment?

BACKGROUND: Although the incidence of papillary thyroid microcarcinoma (PTMC) has increased in recent decades, the role played by minimal extrathyroidal extension (mETE) in the prognosis of PTMC is still unclear. The aim of this study is to analyze the factors associated with PTMC with mETE and its long-term prognosis. MATERIAL AND METHODS: We conducted a retrospective study on patients with a histological diagnosis of PTMC. We excluded patients who had previously undergone thyroid surgery, those who had other synchronous malignancies, those with an ectopic location of the PTMC, and those lost to follow-up within two years. We compared group 1 (PTMC without extrathyroidal extension) to group 2 (PTMC with mETE) and performed a multivariate analysis. RESULTS: We observed PTMC with mETE in 11.2% (n = 18) of patients. On the multivariate analysis, mETE was associated with an age ≥45 years (OR: 4.383; 95% CI: 1.051-18.283, p = .043), tumor size ≥8 mm (OR: 5.913; 95% CI: 1.795-19.481; p = .003), bilaterality (OR: 4.430; 95% CI: 1.294-15.173; p = .018) and metastatic lymph nodes (OR: 12.588; 95% CI: 2.919-54.280; p = .001). Over the mean follow-up period of 119.8 ±â€¯65 months, one case of recurrence was detected in group 2 (0% vs. 5.6%; p = .112). No patients died of the disease. Disease-free survival was lower in group 2 (124.9 ±â€¯5.6 vs. 97.4 ±â€¯10.3 months; p = .034). CONCLUSIONS: The mETE of PTMC is a factor of worse prognosis associated with the presence of metastatic lymph nodes and a lower rate of disease-free survival.

Microcarcinoma papilar de tiroides con extensión extratiroidea mínima. ¿Tiene un curso tan indolente para precisar un tratamiento menos intensivo? / Papillary thyroid microcarcinoma with minimal extrathyroidal extension. Is its course so indolent that it requires a less aggressive treatment?

Introducción Aunque el microcarcinoma papilar de tiroides (MCPT) ha sufrido un incremento en la incidencia en las últimas décadas, todavía no está claro qué papel desempeña la extensión extratiroidea mínima (EETm) en su pronóstico. El objetivo de este estudio es analizar los factores asociados al MCPT con EETm y su pronóstico a largo plazo. Material y métodos Estudio retrospectivo cuya población a estudio la constituyen los pacientes con diagnóstico histológico de MCPT. Se excluye a los pacientes con: cirugía tiroidea previa, otras enfermedades malignas sincrónicas, localización ectópica del MCPT o pérdida durante el seguimiento antes de los 2 años. Se comparan 2grupos: grupo 1 (MCPT sin extensión extratiroidea) y grupo 2 (MCPT con EETm). Se realiza un análisis multivariante. Resultados El 11,2% (n = 18) de los pacientes presentaron MCPT con EETm. En el análisis multivariante, la EETm se asoció con la edad ≥ 45 años (OR: 4,383; IC del 95%: 1,051-18,283; p = 0,043), el tamaño tumoral ≥ 8mm (OR: 5,913; IC del 95%; 1,795-19,481; p = 0,003), la bilateralidad (OR: 4,430, IC del 95%; 1,294-15,173; p = 0,018) y las adenopatías metastásicas (OR: 12,588; IC del 95%; 2,919-54,280; p = 0,001). Durante un seguimiento medio de 119,8 ± 65 meses, una recurrencia fue detectada en el grupo 2 (0% vs. 5,6%; p = 0,112). Ningún paciente falleció debido a la enfermedad. La supervivencia libre de enfermedad fue menor en el grupo 2 (124,9 ± 5,6 vs. 97,4 ± 10,3 meses; p = 0,034). Conclusión La EETm del MCPT es un factor de peor pronóstico, asociada a la presencia de adenopatías metastásicas y a una menor supervivencia libre de enfermedad (AU)

Background Although the incidence of papillary thyroid microcarcinoma (PTMC) has increased in recent decades, the role played by minimal extrathyroidal extension (mETE) in the prognosis of PTMC is still unclear. The aim of this study is to analyze the factors associated with PTMC with mETE and its long-term prognosis. Material and methods We conducted a retrospective study on patients with a histological diagnosis of PTMC. We excluded patients who had previously undergone thyroid surgery, those who had other synchronous malignancies, those with an ectopic location of the PTMC, and those lost to follow-up within 2years. We compared group 1 (PTMC without extrathyroidal extension) to group 2 (PTMC with mETE) and performed a multivariate analysis. Results We observed PTMC with mETE in 11.2% (n=18) of patients. On the multivariate analysis, mETE was associated with age ≥45 years (OR: 4.383; 95% CI: 1.051-18.283, p = .043), tumor size ≥8mm (OR: 5.913; 95% CL: 1.795-19.481; p = .003), bilaterality (OR: 4.430; 95% CI: 1.294-15.173; p = .018) and metastatic lymph nodes (OR: 12.588; 95% CI: 2.919-54.280; p = .001). During a mean follow-up of 119.8±65 months, one recurrence was detected in group 2 (0% vs. 5.6%; p = .112). No patients died of the disease. Disease-free survival was lower in group 2 (124.9±5.6 vs. 97.4±10.3 months; p = .034). Conclusions The mETE of PTMC is a factor of worse prognosis associated with the presence of metastatic lymph nodes and a lower rate of disease-free survival (AU)

Papillary thyroid microcarcinoma with minimal extrathyroidal extension. Has it so indolent course to require a less aggressive treatment? / Microcarcinoma papilar de tiroides con extensión extratiroidea mínima. ¿Tiene un curso tan indolente para precisar un tratamiento menos intensivo?

BACKGROUND: Although the incidence of papillary thyroid microcarcinoma (PTMC) has increased in recent decades, the role played by minimal extrathyroidal extension (mETE) in the prognosis of PTMC is still unclear. The aim of this study is to analyse the factors associated with PTMC and mETE and the long-term prognosis of PTMC. MATERIAL AND METHODS: We conducted a retrospective study with a population consisting of patients with a histological diagnosis of PTMC. We excluded patients who had previously undergone thyroid surgery, those who had other synchronous malignancies, those with an ectopic location of the PTMC and those lost to follow-up within 2years. We compared group 1 (PTMC without extrathyroidal extension) versus group 2 (PTMC with mETE) and performed a multivariate analysis. RESULTS: We observed PTMC with mETE in 11.2% (n=18) of the patients. In the multivariate analysis, mETE was associated with an age ≥45 years (OR, 4.383; 95% CI 1.051-18.283, p=.043), a tumour size ≥8mm (OR, 5.913; 95% CI 1.795-19.481; p=.003), bilaterality (OR, 4.430; 95% CI 1.294-15.173; p=.018) and metastatic lymph nodes (OR, 12.588; 95% CI 2.919-54.280; p=.001). During a mean follow-up of 119.8±65 months, one recurrence was detected in group 2 (0% vs. 5.6%; p=.112), but none of the patients died due to the disease. Disease-free survival was lower in group 2 (124.9±5.6 vs. 97.4±10.3 months; p=.034). CONCLUSIONS: The mETE of MCPT is a factor of worse prognosis, associated with the presence of metastatic lymph nodes and lower disease-free survival.

Establishing the Number of Procedures for Optimal Renal Transplantation Training With the Use of a Canine Model.

BACKGROUND: The training of surgeons that perform renal transplantations can be diverse. For example, the training profile can vary greatly, involving urologists to general surgeons. The efficacy of training programs directed at transplantation surgeons is influenced by numerous factors, including the specialist profile who is trained, the number of procedures available to trainees in a given teaching hospital, and the duration of training. Here we determine the number of procedures necessary to consolidate and contribute to proficiency in renal transplantation technique. METHODS: We used a canine model, comparing 32 renal transplantations performed by a urologist and by a general surgeon who had completed their respective training in renal transplantation. RESULTS: Our results demonstrated that with 12 surgical procedures, surgeons were able to consolidate their skills in renal transplantation, regardless of their educational background. CONCLUSIONS: This is an initial effort in the establishment of a system for targeted training of transplantation surgeons directed specifically at correcting deficiencies and consolidating skills acquired during training programs. These efforts should contribute to the improvement of patient safety in public and private health systems.

Neumomediastino y enfisema subcutáneo como manifestación de una perforación duodenal / Pneumomediastinum and subcutaneous emphysema like manifestation of duodenal ulcer perforation

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Embolización por radiología intervencionista de un angioma yeyunal recidivado / Embolization by interventional radiology of relapsed jejunal haemangioma

No disponible

Insuficiencia respiratoria tardía por restricción tras herniorrafia inguinal / Late respiratory insufficiency by restriction after inguinal hernioplasty

No disponible

[Clinical recurrence of multinodular goiter after surgery. A multivariate study on the risk factors]. / Recidiva clínica del bocio multinodular tras la cirugía. Estudio multivariante de los factores de riesgo.

INTRODUCTION: In multinodular goiter there is no consensus on which is the most adequate surgical technique, since although the techniques with partial resection show lower risk of complications they are associated with a higher risk of recurrences. The objective of this study is to define the risk factors for recurrence of multinodular goiters after surgery in a series with a mean postoperative follow-up higher than 12 years. PATIENTS AND METHOD: 231 multinodular goiters with partial thyroid surgery are analyzed. The recurrence is assessed through clinical exploration, and is confirmed with echography. The variables analyzed are age, sex, family history of thyroid pathology, residence in goitrogenic areas, asymptomatic hyperthyroidism, compression syndromes, intrathoracic extension of goiter, surgeon experience with endocrine surgery, weight of the thyroid, and surgical technique, chi2 test, Student's t test and a logistic regression test are applied. RESULTS: After a mean postoperative follow-up of 152 +/- 71 months 67 goiters (29%) showed recurrence with a mean time for recurrence of 85 +/- 67 months. Risk factors detected in the multivariate study were youngest age, surgeon's lack of experience in endocrine surgery, and the surgical technique. Forty-six patients (69%) were operated because of recurrence, most of them by surgeons experienced in endocrine surgery. Thyroidectomy was completed in all cases, and two definitive postoperative complications occurred. CONCLUSIONS: The index of clinical recurrences is high and increases with the progression; primary risk factors are age, surgeon's experience, and surgical technique. The implication is that partial resection techniques should be carried out by surgeons with experience and there should be avoided in young patients.

Recidiva clínica del bocio multinodular tras la cirugía. Estudio multivariante de los factores de riesgo / Clinical recurrence of multinodular goiter after surgery. A multivariate study on the risk factors

Introducción. En el bocio multinodular no existe consenso sobre cuál es la técnica quirúrgica más adecuada, pues, aunque las técnicas resectivas parciales presentan menor riesgo de complicaciones, conllevan un alto riesgo de recidivas. El objetivo es determinar los factores de riesgo de recidiva del bocio multinodular tras la cirugía en una serie con un seguimiento medio postquirúrgico superior a los 12 años. Pacientes y método. Se analizan 231 bocios multinodulares con cirugía tiroidea parcial. La recidiva se valora mediante exploración clínica y se confirma mediante ecografía. Las variables analizadas son edad, sexo, antecedentes familiares de patología tiroidea, residir en áreas bociógenas, asintomático, hipertiroidismo, síndromes compresivos, prolongación intratorácica del bocio, experiencia en cirugía endocrina del cirujano, peso del tiroides y técnica quirúrgica. Se aplica la prueba de χ2, la de la «t» de Student y una prueba de regresión logística. Resultados. Con un seguimiento medio de 152 ± 71 meses recidivaron 67 bocios (29%) con un tiempo medio de recidiva de 85 ± 67 meses. Los factores de riesgo detectados en el estudio multivariante fueron la edad más joven, la no experiencia en cirugía endocrina del cirujano y la técnica quirúrgica. Cuarenta y seis pacientes (69%) fueron intervenidos de la recidiva, la mayoría por cirujanos con experiencia en cirugía endocrina. En todos los casos se completó la tiroidectomía y se presentaron dos complicaciones postoperatorias definitivas. Conclusiones. El índice de recidivas clínicas es alto y aumenta con la evolución, siendo los principales factores de riesgo la juventud, la experiencia del cirujano y la técnica quirúrgica. Por lo que que estas técnicas resectivas parciales deben realizarse por cirujanos con experiencia y evitarse en pacientes jóvenes

Introduction. In multinodular goiter there is no consensus on which is the most adequate surgical technique, since although the techniques with partial resection show lower risk of complications they are associated with a higher risk of recurrences. The objective of this study is to define the risk factors for recurrence of multinodular goiters after surgery in a series with a mean postoperative follow-up higher than 12 years. Patients and method. 231 multinodular goiters with partial thyroid surgery are analyzed. The recurrence is assessed through clinical exploration, and is confirmed with echography. The variables analyzed are age, sex, family history of thyroid pathology, residence in goitrogenic areas, asymptomatic hyperthyroidism, compression syndromes, intrathoracic extension of goiter, surgeon experience with endocrine surgery, weight of the thyroid, and surgical technique, χ2 test, Student’s «t» test and a logistic regression test are applied. Results. After a mean postoperative follow-up of 152±71 months 67 goiters (29%) showed recurrence with a mean time for recurrence of 85 ± 67 months. Risk factors detected in the multivariate study were youngest age, surgeon's lack of experience in endocrine surgery, and the surgical technique. Forty-six patients (69%) were operated because of recurrence, most of them by surgeons experienced in endocrine surgery. Thyroidectomy was completed in all cases, and two definitive postoperative complications occurred. Conclusions. The index of clinical recurrences is high and increases with the progression; primary risk factors are age, surgeon's experience, and surgical technique. The implication is that partial resection techniques should be carried out by surgeons with experience and there should be avoided in young patients

[Importance of primary health-care professionals in the sanitary education about organ donation]. / Importancia de los profesionales de atención primaria en la educación sanitaria de la donación de órganos.

AIM: To determine the influence of the information on donation generated from primary health-care on the attitude towards organ donation. DESIGN: Descriptive transversal study. SETTING: 45 municipalities of Murcia Region, Spain. PARTICIPANTS: The population in this study was randomly selected and stratified according to age, sex, and geographic localization among people over > or =15 years of age (n=1887). INTERVENTIONS AND MEASURES: The attitude was evaluated according to a questionnaire psychosocial aspects of donation. There is valued the information transmitted on donation to the population from primary care (group A) or other informative sources (group B), and if this information was to favour or in opposition to the same one. STATISTICS: chi2 test, t Student, and logistic regression analysis. RESULTS: Of 1887 surveys, 129 cases (group A) (7%) had received information from primary care. In this group, the 89% is in favour of the donation. In 120 cases the received information was favourable, presenting an attitude in favour of the donation of 93%, whereas in all 9 remaining cases the information was in against, decreasing the attitude to favour up to 44% (P<.05). In the group B (n=1758) the attitude in favour of the donation was of 65% (P<.05, with regard to the group A). The 62% (n=1083) received favourable information, improving in them the favourable attitude towards the donation up to 74%. The rest (38%; n=675) had received also unfavourable information, decreasing his attitude to favour up to 51% (P<.05). CONCLUSIONS: Little information about organ donation is transmitted from primary care, but when it is realized a very positive impact has if it is favourable and very negative if it is unfavourable.

Importancia de los profesionales de atención primaria en la educación sanitaria de la donación de órganos / Importance of Primary Health-Care Professionals in the Sanitary Education About Organ Donation

Objetivo. Determinar la influencia de la información sobre donación generada desde atención primaria (AP) en la actitud poblacional. Diseño. Estudio descriptivo, transversal. Emplazamiento. Un total de 45 municipios de la Comunidad Autónoma de Murcia. Participantes. Muestra aleatoria y estratificada por edad, sexo y localización geográfica entre la población >= 15 años (n = 1.887). Mediciones principales. Encuesta psicosocial sobre donación y trasplante de órganos. Se valora la información transmitida desde AP (grupo A) u otras fuentes informativas (grupo B), y su impacto en la actitud hacia la donación. Se analizan diversas variables psicosociales. Se aplicaron los tests de la * 2 y de la t de Student y un análisis de regresión logística. Resultados. De los 1.887 encuestados, 129 del grupo A (7%) habían recibido información desde AP. En este grupo, el 89% está a favor de la donación. En 120 casos la información recibida fue favorable, con una actitud a favor del tema del 93%, mientras que en los 9 casos restantes la información fue en contra, con lo que dicha actitud favorable descendió al 44% (p < 0,05). En el grupo B (n = 1.758), la actitud a favor de la donación fue del 65% (p < 0,05, respecto al grupo A). El 62% (n = 1.083) recibió una información favorable, con una actitud a favor del 74%. El resto (38%; n = 675) había recibido también información desfavorable, por lo que su actitud favorable disminuyó hasta el 51% (p < 0,05). Conclusiones. Se transmite poca información sobre donación desde AP. Sin embargo, cuando se realiza, tiene un impacto muy positivo si es favorable y muy negativo si es desfavorable (AU)

Aim. To determine the influence of the information on donation generated from primary health-care on the attitude towards organ donation. Design. Descriptive transversal study. Setting. 45 municipalities of Murcia Region, Spain. Participants. The population in this study was randomly selected and stratified according to age, sex, and geographic localization among people over >=15 years of age (n=1887). Interventions and measures. The attitude was evaluated according to a questionnaire psychosocial aspects of donation. There is valued the information transmitted on donation to the population from primary care (group A) or other informative sources (group B), and if this information was to favour or in opposition to the same one. Statistics: * 2 test, t Student, and logistic regression analysis. Results. Of 1887 surveys, 129 cases (group A) (7%) had received information from primary care. In this group, the 89% is in favour of the donation. In 120 cases the received information was favourable, presenting an attitude in favour of the donation of 93%, whereas in all 9 remaining cases the information was in against, decreasing the attitude to favour up to 44% (P<.05). In the group B (n=1758) the attitude in favour of the donation was of 65% (P<.05, with regard to the group A). The 62% (n=1083) received favourable information, improving in them the favourable attitude towards the donation up to 74%. The rest (38%; n=675) had received also unfavourable information, decreasing his attitude to favour up to 51% (P<.05). Conclusions. Little information about organ donation is transmitted from primary care, but when it is realized a very positive impact has if it is favourable and very negative if it is unfavourable (AU)

Research training during medical residency (MIR). Satisfaction questionnaire.

INTRODUCTION: It is during Medical Residency Training (MIR) that knowledge, abilities and habits are acquired, which will shape professional activity in the future. It is therefore very likely that residents who do not acquire the necessary habits and knowledge for research activities will eventually not carry out these activities in the future. The aim of this study was to analyze the level of satisfaction of residents with his or her scientific and research training, and to determine any deficiencies with respect to this training. MATERIALS AND METHODS: The aim of the questionnaire used was to determine the level of satisfaction of residents regarding their scientific and research training during their residency period. Questionnaires were usually distributed via internal mail to all residents (MIR physicians) registered at a third level teaching hospital, with a completion rate of 78% (n = 178). RESULTS: As far as the evaluation of scientific training is concerned, 68% of residents were dissatisfied or very dissatisfied. With respect to scientific studies carried out, 49% of residents had not taken part in any, but the number of studies carried out increases as the residency progresses. On the other hand, 22% of residents reported not having started their doctoral thesis, 50% having attended doctorate courses, 24% having a title for their thesis, and only 4% having written a thesis. Doctorate courses, thesis topics, and written theses increase with the year of residency, and a greater activity may be seen in this respect in surgical departments. If we analyze help available to residents for their carrying out scientific activities, 55% reported that only selected assistant doctors would offer help, and 21% reported that no doctors would offer help. Dissatisfaction with research training increases with the year of residency. With regard to main specialist fields, it can be seen that residents in surgical fields carry out more theses, whereas central fields report less facilities. Finally, if we evaluate the influence that these variables may have on the general satisfaction of residents with his or her residency, these variables are seen to be significant factors of dissatisfaction. CONCLUSIONS: Most residents are dissatisfied with their scientific training and have relatively few facilities for developing such skills, which in turn results in a scarce number of scientific studies and doctoral theses.

Influence of different sources of information on attitude toward organ donation: a factor analysis.

OBJECTIVES: To determine media through which the population receives information on donation; to analyze the association between the sources of information and the psychosocial variables with respect to the opinion on donation; and to determine how each source of information influences this opinion. MATERIALS AND METHODS: A questionnaire on donation was administered to a random sample of 2000 persons stratified by age, gender, and geographical location, of whom 1143 respondents claimed to have no experience with donation and/or transplantation. A statistical analysis was done between the sources of information or the psychosocial variables or their co-variation to determine their specific impact on the population. RESULTS: The medium with the greatest impact on the population is television; the second factor is the press and radio; the third is magazines and talks with friends/family; the fourth is hoardings and posters, and campaigns about organ donation; and the last factor is information given by health professionals. In the factor analysis between sources of information and psychosocial variables, an association was observed between press, radio, and information given by health professionals and a higher education level; and between information provided by discussions in schools, by age, and a higher level of education. Sources of Information sources as that have a favorable effect on donation include discussions, (P = .0079), and information by health professionals (P < .0005) and by friends (P = .0132) and by family (P = .0044). CONCLUSIONS: Opinion on donation is more favorable among subjects who have received information on an individual basis and at specialized meetings. The only psychosocial variable associated with some sources of information is the level of education.

Fibrohistiocitoma maligno de pulmón variedad estoriforme / Storiform-type malignant histiocytoma of the lung

No disponible