Surgical Resection of an Intravascular Lipoma of the Superior Vena Cava.

Intravascular lipomas (IVL) located in the superior vena cava (SVS) are rare benign primary venous tumors with less than 15 cases reported in the literature. We report a case of a 64-year-old woman with IVL of the SVC extending to the right brachiocephalic vein. She was treated successfully using a hybrid procedure which involved endovascular control of the right subclavian vein and surgical approach via median sternotomy followed by mass resection and use of pericardial patch for vein defect closure.

Hybrid Procedure for Coexistence of Coarctation of the Aorta and Aberrant Right Subclavian Artery: A Case Report and Review of the Literature.

Background: Coarctation of the aorta (CoA) can either present alone as an isolated condition or in association with other aortic arch or cardiac anomalies. One percent of patients with CoA have concomitant an aberrant right subclavian artery (ARSA). Purpose: We report the case of a 35-year-old woman with uncontrolled hypertension who was found to have CoA and ARSA. Results: The patient was treated successfully using a hybrid procedure comprising ARSA ligation and subclavian to carotid transposition, followed by thoracic endovascular aortic repair. Conclusions: Patients with CoA should be carefully studied, considering the possible coexistence of other congenital aortic arch defects, such as ARSA. Hybrid repair is a safe and effective approach for this condition.

Hybrid Treatment of Aberrant Right Subclavian Artery Causing Dysphagia Lusoria by Subclavian to Carotid Transposition and Endovascular Plug.

Differences in the common aortic arch branching pattern arise from abnormal embryological development. Aberrant origin of the right subclavian artery is the most common of these anomalies. We report the case of a 47-year-old female with progressive dysphagia, found to have an aberrant right subclavian artery (ARSA) running posterior to the esophagus on computed tomography angiography. She was managed successfully with a hybrid procedure involving a right supraclavicular incision for ARSA ligation and subclavian to carotid transposition followed by endovascular closure of the ARSA origin.

[Role of transoperative frozen section in the surgical management of thyroid nodules]. / Utilidad de la biopsia transoperatoria en el manejo quirúrgico del nódulo tiroideo.

BACKGROUND: Thyroid nodules (TN) are a common problem occurring in 4-7% of the general population. The final objective of a TN study is to determine whether the nodule is benign or malignant. Fine needle aspiration biopsy (FNAB) is accepted as the most appropriate preoperative procedure, but some authors have described undetermined results in 30% (follicular or suspicious lesion). Our objective is to determine whether transoperative frozen section (TOFS) plays a significant role in diagnosis and treatment of TN. METHODS: This was a retrospective study and included patients who underwent thyroid surgery between January 2000 and December 2003 at the ABC Medical Center in Mexico City. RESULTS: We included 142 patients: 14.8% were males and 85% were females. Median age was 43 years. In women, 30% had cancer and in men 76%. Sensitivity and specificity for TOFS were 94% and 93%, respectively. FNAB and the TOFS together detected 89% of the cancers. TOFS detected 39% of the cancers that the FNAB failed to detect and changed the surgical procedure in 13.4% of the patients. CONCLUSIONS: Males face a higher risk of thyroid cancer. TOFS should be done as a routine procedure in the ABC Medical Center. In cases where FNAB is inconclusive or in the absence of one, TOFS is useful and can avoid a significant number of reoperations.

Utilidad de la biopsia transoperatoria en el manejo quirúrgico del nódulo tiroideo / Role of transoperative frozen section in the surgical management of thyroid nodules

Introducción: Los nódulos tiroideos son un problema común (4 a 7 % en la población general). El objetivo final del estudio de un nódulo tiroideo es saber si es benigno o maligno. La biopsia por aspiración con aguja fina (BAAF) es aceptada como el procedimiento preoperatorio más apropiado para su estudio, pero se ha descrito hasta 30 % de resultados indeterminados (“tumor folicular” o “sospechoso”). Nuestro objetivo es definir si el examen transoperatorio (ETO) tiene utilidad en el manejo de los nódulos tiroideos. Material y métodos: Estudio retrospectivo de pacientes sometidos a cirugía tiroidea entre enero de 2000 y diciembre de 2003 en el Centro Médico ABC de la ciudad de México. Resultados: Se incluyeron 142 pacientes, 14.8 % hombres y 85.2 % mujeres, edad mediana de 43 años. El 30 % (37/121) de las mujeres tuvo cáncer y 76 % (16/21) de los hombres. La sensibilidad del ETO fue de 94 % y la especificidad de 93 %. La BAAF y el ETO juntos identificaron 89 % de los cánceres; el ETO detectó 39 % que la BAAF no evidenció y modificó la conducta quirúrgica en 13.4 %. Conclusiones: El sexo masculino representa un factor de riesgo para cáncer. Cuando no se dispone de BAAF o los resultados de ésta indican sospecha, el ETO es útil y puede evitar un número importante de reoperaciones.

BACKGROUND: Thyroid nodules (TN) are a common problem occurring in 4-7% of the general population. The final objective of a TN study is to determine whether the nodule is benign or malignant. Fine needle aspiration biopsy (FNAB) is accepted as the most appropriate preoperative procedure, but some authors have described undetermined results in 30% (follicular or suspicious lesion). Our objective is to determine whether transoperative frozen section (TOFS) plays a significant role in diagnosis and treatment of TN. METHODS: This was a retrospective study and included patients who underwent thyroid surgery between January 2000 and December 2003 at the ABC Medical Center in Mexico City. RESULTS: We included 142 patients: 14.8% were males and 85% were females. Median age was 43 years. In women, 30% had cancer and in men 76%. Sensitivity and specificity for TOFS were 94% and 93%, respectively. FNAB and the TOFS together detected 89% of the cancers. TOFS detected 39% of the cancers that the FNAB failed to detect and changed the surgical procedure in 13.4% of the patients. CONCLUSIONS: Males face a higher risk of thyroid cancer. TOFS should be done as a routine procedure in the ABC Medical Center. In cases where FNAB is inconclusive or in the absence of one, TOFS is useful and can avoid a significant number of reoperations.

[Sclerosing mesenteritis. Presentation of three cases and review of the literature]. / Mesenteritis esclerosante. Presentación de tres casos y revisión de la literatura.

Sclerosing mesenteritis or panniculitis is a rare condition characterized by inflammation of the mesentery ranging from an acute to a chronic fibrotic process that can resemble an intestinal malignant neoplasm even though it is benign. Its etiology is unknown, although it is thought to be the result of a nonspecific inflammatory response of the mesentery to an allergic, chemical, thermal, infectious, autoimmune or surgical stimulus. Its natural history is benign and in most cases is self-limited. Surgery is reserved only for those cases where there is intestinal obstruction. We report three cases of sclerosing mesenteritis that occurred after abdominal surgery and we present a review of the literature.

Mesenteritis esclerosante: presentación de tres casos y revisión de la literatura / Sclerosing mesenteritis: presentation of three cases and review of the literature

Sclerosing mesenteritis or panniculitis is a rare condition characterized by inflammation of the mesentery ranging from an acute to a chronic fibrotic process that can resemble an intestinal malignant neoplasm even though it is benign. Its etiology is unknown, although it is thought to be the result of a nonspecific inflammatory response of the mesentery to an allergic, chemical, thermal, infectious, autoimmune or surgical stimulus. Its natural history is benign and in most cases is self-limited. Surgery is reserved only for those cases where there is intestinal obstruction. We report three cases of sclerosing mesenteritis that occurred after abdominal surgery and we present a review of the literature.