Bone chondrosarcomas: clinical features and surgical outcomes in five years / Condrosarcomas óseos: características clínicas y resultados quirúrgicos en cinco años

Background: Biological and clinical behavior of chondrosarcoma, and its prognosis, are broadly related to histological grade, location and treatment. Surgery plays the most important role in local control and preservation of the limb. Given its low incidence, there are few cancer surgical centers in our country that report their experience concerning the treatment of this pathology. Objective: To describe the management, clinical features, and outcomes of surgical treatment in patients diagnosed with bone chondrosarcoma. Methods: Descriptive study which included 25 patients diagnosed with bone chondrosarcoma who received surgical treatment. We assessed their clinical features, localization, stage, treatment and surgical outcomes. Results: Mean age was 43.4 ± 14.7 years and the most frequently affected site was the pelvis (44%). The most frequently performed surgery was wide resection and immediate reconstruction with implants in 10 patients (40%). Local recurrence was observed in six patients (24%). During follow up, two patients died from metastatic disease (8%). Conclusions: Due to the characteristics of chondrosarcoma, the treatment is multidisciplinary. Local surgery plays the most important role in control, limb preservation and function.

Introducción: La conducta biológica de los condrosarcomas, así como su comportamiento clínico y pronóstico están ampliamente relacionados con el grado histológico, la localización y el tratamiento. La cirugía juega el papel más importante en el control local y la preservación de las extremidades. Debido a su baja incidencia, en nuestro país existen pocos centros que informen acerca de su experiencia en el tratamiento de esta patología. Objetivo: Describir el manejo y los resultados del tratamiento quirúrgico de pacientes con diagnóstico de condrosarcoma óseo. Métodos: Estudio descriptivo en el que se incluyeron 25 pacientes con diagnóstico de condrosarcoma óseo que recibieron tratamiento quirúrgico. Se estudiaron variables sociodemográficas, así como localización, grado histológico, estadio clínico, cirugía realizada, complicaciones y mortalidad. Resultados: La edad media de los pacientes fue de 43.4 ± 14.7 años y el sitio anatómico más frecuentemente afectado fue la pelvis (44%). La resección amplia y la reconstrucción inmediata con prótesis se realizó en 10 pacientes (40%). Seis pacientes (24%) se registraron con recurrencia local y se presentaron dos muertes (8%). Conclusiones: Debido a las características del condrosarcoma, el tratamiento es multidisciplinario. La cirugía juega el papel más importante en el control local, la preservación de la extremidad y su función.

Reconstrucción mamaria postmastectomía. Análisis y resultados en un hospital de tercer nivel en México / Postmastectomy breast reconstruction. Analysis and outcome in a tertiary care hospital in Mexico

Introducción y Objetivo: El tratamiento de las neoplasias mamarias así como de ciertos padecimientos benignos requieren, en muchos casos, una mastectomía unilateral o bilateral con resección de la piel, glándula mamaria y complejo pezón-areola. La reconstrucción mamaria es una parte importante del tratamiento multidisciplinario para lograr la reintegración de las mujeres a una vida normal. El objetivo de nuestro estudio fue reportar los resultados de los diferentes tipos de reconstrucción mamaria en pacientes con cáncer de mama, así como otros padecimientos benignos, en un hospital de alta especialidad del Occidente de México. Material y Método: Serie de casos en la que incluimos pacientes sometidas a reconstrucción mamaria entre el 1 enero de 2006 y el 31 de diciembre de 2012 con diferentes procedimientos, evaluando el tipo de cirugía inicial, tipo de reconstrucción, procedimientos complementarios y morbilidad. El seguimiento de las pacientes fue de 24 meses. Resultados: Recogimos 170 pacientes con un promedio de edad de 46.12 ± 8.2 años. Las técnicas más utilizadas fueron: reconstrucción con implante expansor tipo Becker (48.8%), expansor tisular (11.2%), colgajo miocutáneo de recto abdominal transverso (8.8%), implantes definitivos (8.8%) y reconstrucción con dorsal ancho más implante o expansor (8.8%). Se presentaron complicaciones en 20 pacientes (11.8%). Conclusiones: Nuestros resultados son satisfactorios ya que la morbilidad temprana y tardía son aceptables, pero, perfectibles. Con el advenimiento de extensas campañas de detección oportuna esperamos aumentar los procedimientos conservadores por cirugía temprana y los procedimientos oncoplásticos durante la mastectomía sin necesidad de esperar periodos prolongados para la reconstrucción

Background and Objective: Treatment of mammary neoplasms as well as certain benign conditions require, in many cases, a unilateral or bilateral mastectomy with resection of the skin, the mammary gland and the nippleareola complex. Breast reconstruction is an important part of the multidisciplinary treatment to achieve the reintegration of women into a normal life. The aim of our study was to report the results of the different types of breast reconstruction in patients with breast cancer as well as other benign conditions in a highly specialized hospital in Western Mexico. Methods: Case series of patients undergoing breast reconstruction from 1 January 2006 to 31 December 2012 were included with different procedures evaluating the type of initial surgery, type of reconstruction, complementary procedures and morbidity. The follow-up of the patients was 24 months. Results: One hundred and seventy patients were included. The average age was 46.12 ± 8.2 years. The most used techniques were: reconstruction with expander Becker type implant (48.8%), tissue expander (11.2%), transverse rectus abdominus mucocutaneous flap (8.8%), definitive implants (8.8%) and wide dorsal reconstruction plus implant or expander (8.8%). Complications occurred in 20 patients (11.8%). Conclusions: Our results are satisfactory, since early and late morbidity are acceptable, but, perfectible. With the advent of extensive early detection campaigns, we hope to increase conservative procedures for early and oncoplastic procedures during mastectomy, without the need to wait for long periods for reconstruction

[Findings of thyroid nodules in autopsies in Western Mexico]. / Hallazgo de nódulos tiroideos en autopsias en el occidente de México.

BACKGROUND: International literature reports a prevalence of 50% of thyroid nodules detected during autopsies of subjects without known thyroid disease. Currently there are no studies of this type in Mexico. The aim was to identify the prevalence of thyroid nodules in autopsied bodies without known thyroid pathology. METHODS: A series of cases of 300 cadavers without known thyroid pathology, from which we obtained their thyroid glands. It was analyzed the presence of thyroid nodules as well as their macroscopic and microscopic characteristics. RESULTS: 300 autopsies were included. 123 cadavers (41%) presented thyroid nodules; 69 were men (56%) and 54, women (44%). The mean age was 37 ± 14 years. A total of 149 nodules were found, out of which 94 were solid nodules (63%), and 55 were cystic (37%). Histopathological diagnosis of malignancy was found in 12 of the analyzed thyroid glands (4%). CONCLUSIONS: There was a greater prevalence of thyroid nodules in men and in subjects whose age at the time of dying was 45 years or less, unlike what is found in the international literature. We consider necessary to create screening programs for early diagnosis of thyroid nodules.

INTRODUCCIÓN: la literatura internacional reporta una prevalencia de nódulos tiroideos de 50% en autopsias de personas sin enfermedad tiroidea conocida. Hasta el momento no existen estudios de este tipo en México. El objetivo de este trabajo fue identificar la prevalencia de nódulos tiroideos en cadáveres humanos sin patología tiroidea conocida. MÉTODOS: serie de casos de 300 cadáveres sin patología tiroidea conocida, de los cuales se obtuvieron las glándulas tiroideas. Se analizó la presencia de nódulos tiroideos, así como sus características macroscópicas y microscópicas. RESULTADOS: se incluyeron 300 necropsias y se encontró una prevalencia de nódulos tiroideos en 123 de los cadáveres (41%), de los cuales 69 fueron hombres (56%) y 54 mujeres (44%). La edad promedio fue de 37 ± 14 años. Se encontraron 149 nódulos en total, de los cuales 94 fueron sólidos y 55 quísticos (37%); obtuvimos un diagnóstico histopatológico de malignidad en 12 de las glándulas analizadas (4%). CONCLUSIONES: se encontró una mayor prevalencia de nódulos tiroideos en cadáveres del sexo masculino y cuya edad al momento de morir fue de 45 años o menos, contrario a lo descrito en la literatura internacional. Consideramos necesaria la creación de programas de escrutinio para el diagnóstico oportuno de nódulos tiroideos.

[Evaluation of quality of life in patients with liver transplant]. / Evaluación de la calidad de vida en pacientes con trasplante hepático.

BACKGROUND: Complications in patients with liver transplant may occur in less than 10 % of cases. These appear in short and/or long term and are due to a vascular or biliary cause, rejection, recurrence of the disease or adverse effects of immunosuppression, among others, which may affect the quality of life. The aim of this article is to evaluate the quality of life in patients with deceased donor liver transplantation through the questionnaire SF-36. METHODS: A descriptive cross-sectional study. The quality of life of patients with deceased donor liver transplantation was assessed during the period from January 1, 2005 to December 31, 2012. The variables evaluated were: age, sex, time and main reason for transplantation and quality of life using the short form SF-36 version 1.1 for Mexican population. RESULTS: 37 patients were included. The mean age was 48.7 years. The most frequent cause was cirrhosis (n = 35). The highest average score corresponded to the mental health component, and the lowest score to the physical component. The average time of liver transplantation was 6.73 ± 3.53 years. CONCLUSIONS: Liver transplantation is still the most effective treatment for end-stage liver disease. It can increase the patient's life expectancy and their quality of life, assessed with the SF-36 questionnaire. The results were similar to those in other studies in both the physical and mental component.

Introducción: los pacientes con trasplante hepático pueden presentar complicaciones en menos del 10 % de los casos. Las complicaciones a corto y/o largo plazo son de origen vascular, biliar, de rechazo, recidiva de la enfermedad y efectos adversos de la inmunosupresión, entre otros, lo que puede repercutir en la calidad de vida. El objetivo de este artículo es evaluar la calidad de vida de los pacientes con trasplante hepático de donante fallecido mediante el cuestionario de salud formato corto-36 (SF-36). Métodos: estudio transversal analítico. Se evaluó la calidad de vida de los pacientes con trasplantes hepáticos de donante fallecido, realizados del 1 de enero de 2005 al 31 de diciembre de 2012. Variables de estudio: edad, sexo, tiempo de trasplante, motivo de trasplante y calidad de vida a través del formato corto SF-36 versión 1.1 para población mexicana. Resultados: se incluyeron 37 pacientes. Edad promedio, 48.7 años. Etiología más frecuente, cirrosis (n = 35). La calificación del SF-36 promedio más alta correspondió al componente de salud mental, y la más baja al componente de salud físico. El promedio de tiempo del postrasplante hepático fue de 6.73 ± 3.53 años. Conclusiones: el trasplante hepático es el único tratamiento eficaz para la enfermedad hepática terminal que logra incrementar la expectativa y calidad de vida. Los resultados del SF-36 fueron similares a otros estudios tanto en el componente físico y mental.

[Hepatic angiosarcoma and liver transplantation: case report and literature review]. / Angiosarcoma hepático y trasplante hepático: reporte de caso y revisión de bibliografía.

BACKGROUND: Hepatic angiosarcoma is a rare vascular malignancy that accounts for 2% of all hepatic primary tumours. The diagnosis is difficult, especially if the patient does not have history of exposure to carcinogens, which are considered as risk factors. The diagnosis is made by histopathology, but in a considerable percentage it can only be accomplished by autopsy. The performing of fine needle aspiration biopsy can lead to bleeding, with limitations in its use. CLINICAL CASE: A 41 year-old male, with no history of exposure to carcinogens, who developed abdominal pain secondary to a haemoperitoneum due to tumour rupture, was diagnosed by imaging methods with a giant cavernous hepatic haemangioma. He was initially treated with embolisation, and later with a liver transplant. After six months he developed haemoptysis secondary to lung metastasis. The autopsy reported metastatic hepatic angiosarcoma. DISCUSSION: This condition has been related to carcinogen exposure, with malignant transformation from a benign vascular neoplasia being proposed as a hypothesis. The differential diagnosis can be achieved with imaging studies such as CT scan, and the definitive diagnosis is made by histopathology with immunohistochemistry tests, with 35%-100% being made in the autopsy. CONCLUSION: Hepatic angiosarcoma is a malignant vascular neoplasia, the potential curative option is surgery with tumour free margins. Liver transplantation remains controversial because of its poor prognosis in the short term.

[Nesidioblastosis in the adult: a case report]. / Nesidioblastosis en el adulto: reporte de un caso.

BACKGROUND: Nesidioblastosis is a rare cause of endocrine disease which represents between 0.5% - 5% of cases. This has been associated with other conditions, such as in patients previously treated with insulin or sulfonylurea, in anti-tumour activity in pancreatic tissue of patients with insulinoma, and in patients with other tumours of the Langerhans islet cells. In adults it is presented as a diffuse dysfunction of ß cells of unknown cause. CLINICAL CASE: The case concerns 46 year-old female, with a history of Sheehan syndrome of fifteen years of onset, and with repeated events characterized with hypoglycaemia in the last three years. Body scan was performed with octreotide, revealing an insulinoma in the pancreatic region. A distal pancreatectomy was performed on the patient. The study reported a pancreatic fragment 8.5 × 3 × 1.5 cm with abnormal proliferation of pancreatic islets in groups of varying size, some of them in relation to the ductal epithelium. Histopathology study was showed positive for chromogranin, confirmed by positive synaptophysin, insulin and glucagon, revealing islet hyperplasia with diffuse nesidioblastosis with negative malignancy. The patient is currently under metabolic control and with no remission of hypoglycaemic events. CONCLUSIONS: Nesidioblastosis is a disease of difficult diagnosis should be considered in all cases of failure to locate an insulinoma, as this may be presented in up to 4% of persistent hyperinsulinaemic hypoglycaemia.

[Allogeneic parathyroid: 2-year follow-up]. / Alotrasplante de paratiroides: seguimiento a 2 años.

BACKGROUND: Hypoparathyroidism is one of the most frequent complications of neck surgery. The treatment is currently medical; however this involves several complications secondary to high doses of calcium and vitamin D, thus making parathyroid allotransplantation a good management option. MATERIAL AND METHODS: Patients with hypoparathyroidism were selected in the April-December period of 2011 in the general surgical clinic. They were between 16 and 65 years, and ingested high doses of calcium. The donors were patients with primary and secondary hyperparathyroidism, and the transplants were performed in relation to blood group and human leucocyte antigen. RESULTS: Five parathyroid allografts were performed. All the patients had iatrogenic hypoparathyroidism, all women with a mean age of 49.8 years. The graft was implanted under local anaesthesia in the non-dominant forearm. Four of the patients are so far considered functional due to the increase in paratohormone, and demonstrating its function by scintigraphy with sestamibi. One of the patients showed no increase in paratohormone or imaging studies that demonstrate its functionality. After a two year follow up the graft remains functional but with with oral calcium intake at a lower dose than before transplantation. None of the patients had immunosuppression side effects. CONCLUSIONS: In this study, allogeneic unrelated living parathyroid transplant with an immunosuppressive regimen of six months has proven to be a safe alternative treatment to improve quality of life by decreasing the excessive calcium intake and improving physical activity with adequate graft survival at 24 months follow up.

[Gastric perforation by MALT lymphoma. Case report]. / Perforación gástrica por linfoma MALT. Reporte de caso.

BACKGROUND: Gastric non-Hodgkin lymphoma is a rare tumour that represents approximately 7% of all stomach cancers and 2% of all lymphomas. The most frequent location of gastric MALT (mucosa associated lymphoid tissue) lymphomas is in the antrum in 41% of the cases, and 33% can be multifocal. The risk of spontaneous perforation of a gastric MALT lymphoma is 4-10%. CLINICAL CASE: 24 year old male patient carrying the Human Immunodeficiency Virus, who began with signs and symptoms of acute abdomen and fever 72 hours before arriving in the emergency room. A computed tomography was performed that showed free fluid in the cavity, and gastric wall thickening. The patient underwent a laparotomy, finding absence of the anterior wall of the stomach, sealed with the left lobe of the liver, colon and omentum. Total gastrectomy, with oesophagosty and jejunostomy tube, was performed. CONCLUSIONS: Gastric perforation secondary to a MALT lymphoma is rare, with high mortality. There is limited information reported of this complication and should be highly suspected in order to provide appropriate treatment for a complication of this type.

[Pedicled gastric lipoma. Case report]. / Lipoma gástrico pediculado. Reporte de caso.

BACKGROUND: The gastrointestinal tract lipomas are a rare, benign, slow-growth condition and can be a diagnostic challenge, they are more frequent in the colon. The gastric lipoma occurs in fewer than 5% of cases, and represents less than 1% of all gastric tumors, usually their finding is incidental and the initial presentation may be obstruction, bleeding and intussusception. The purpose of presenting this case for its rarity, the few symptoms that the patient present and collect the most current information about the diagnosis and treatment. CLINICAL CASE: We report the case of a 59 years-old male patient who after having suffered acute pancreatitis a tomography control was made looking for complications it found a pylorus-duodenal intussusception, an endoscopy was performed and a tumor about 6 cm was found and biopsies without confirm diagnosis, so it was decided to perform a partial gastrectomy, histopathology study confirmed the diagnosis of gastric lipoma as well as disease free margins. Was maintained with adequate postoperative evolution currently asymptomatic. CONCLUSIONS: The gastric lipoma is a rare benign entity that can mimic a malignancy, in our case an incidental finding which was managed by partial gastrectomy with satisfactory postoperative results.

[Adenocarcinoma mucoproductor in Meckel's diverticulum. Case report and review]. / Adenocarcinoma mucoproductor en un divertículo de Meckel. Reporte de caso y revisión del tema.

BACKGROUND: Meckel's diverticulum is the most common congenital anomaly in the small intestine, which results from incomplete obliteration omphalomesenteric duct, usually the diagnosis is incidental, rarely reaching with bleeding, obstruction, diverticulitis or in rare cases a neoplasm. Clinic case: 67 year old woman that started her condition with urinary symptoms (dysuria, frequency, bladder tenesmus and pushing), within the study protocol a cystogram was performed and demonstrated a defect in the bladder dome edges with compression effect, the computed tomography reported a bladder infiltrating hypodense lesion, which is decided to resect finding Meckel's diverticulum with a tumor that infiltrates the bladder dome, the histopathological confirmed the diagnosis shown free edges but insufficient, which need a reintervention to increase margins; all the extension studies shown without tumor activity. CONCLUSIONS: Mucoproductor adenocarcinoma derived from a Meckel's diverticulum is a clinical entity that because of its nonspecific symptomatology and variability of presentation, is diagnosed incidentally on radiological images. The disease has a high mortality rate and a low prevalence.

Antecedentes: el divertículo de Meckel es la anomalía congénita más frecuente en el intestino delgado, que resulta de la obliteración incompleta del conducto onfalomesentérico; su diagnóstico suele ser incidental, pocas veces con sangrado, obstrucción, diverticulitis o en casos raros una neoplasia. Caso clínico: paciente femenina de 67 años de edad, que inició su padecimiento con síntomas urinarios (disuria, polaquiuria, pujo y tenesmo vesical). El cistograma demostró: defecto en el domo de la vejiga, bordes irregulares y efecto de compresión. La tomografía computada reportó: vejiga con lesión hipodensa infiltrante en el domo vesical, al resecarla se encontró un divertículo de Meckel con un tumor infiltrante; el estudio histopatológico confirmó el diagnóstico y demostró los bordes libres; todos los estudios de extensión resultaron sin actividad tumoral. Conclusiones: el adenocarcinoma mucoproductor derivado de un divertículo de Meckel es una entidad clínica que debido a sus síntomas inespecíficos y variabilidad de presentación sólo se diagnostica por lo que se aprecia en las imágenes radiológicas. Este adenocarcinoma tiene un alto índice de mortalidad pero baja prevalencia.

Fractura crónica de hueso hioides / Chronic hyoid fracture

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