Myxedema Psychosis: Systematic Review and Pooled Analysis.

BACKGROUND AND OBJECTIVE: The term myxedema psychosis (MP) was introduced to describe the occurrence of psychotic symptoms in patients with untreated hypothyroidism, but the optimal assessment and treatment of this condition are unclear. We aimed to synthesize data from the literature to characterize the clinical presentation and management of MP. METHODS: We performed a systematic review according to the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines in PubMed (Medline), Embase, Google Scholar, and Cochrane databases, including observational studies, case series, and case reports published from 1/1/1980 to 31/12/2019 in the English language. Descriptive statistics along with univariate and multivariate analysis were used for data synthesis. RESULTS: Out of 1583 articles screened, 71 case reports met our inclusion criteria providing data on 75 MP cases. The median age at diagnosis was 42 years [32-56]. About 53% had no prior hypothyroidism diagnosis. Delusions occurred in 91%, with a predominance of persecutory ideas (84%), while hallucinations occurred in 78%. Physical symptoms and signs of hypothyroidism were absent in 37% and 26%, respectively. If symptoms occurred, nonspecific fatigue was seen most frequently (63%). The median thyroid-stimulating hormone value was 93 mIU/L [60-139]. Thyroid peroxidase antibodies were found positive in 75% (23/33) of reported cases. Creatinine kinase was reported abnormal in seven cases. Cranial imaging (CT or MRI) and electroencephalogram were normal in 89%, 75%, and 73% of the cases reported. The majority of patients were treated orally with thyroxine in combination with short-term antipsychotics. More than 90% of them showed complete recovery. Univariate analysis revealed a trend towards a shorter duration of psychosis with IV thyroid hormone therapy (p= 0.0502), but the effect was not consistent in a multivariate analysis. CONCLUSION: While we identified a substantial lack of published research on MP, our pooled analysis of case observations suggests that the condition presents a broad spectrum of psychiatric and physical symptoms lending support to the value of screening for thyroid dysfunction in patients with first-ever psychosis. PROSPERO REGISTRATION NUMBER: CRD42020160310.

Phyllodes tumor of the breast. Experience and clinical-pathological characteristics of patients treated in a third level oncologic referral center / Tumor phyllodes de la mama. Experiencia y características clínico-patológicas de los pacientes tratados en un centro oncológico de referencia de tercer nivel

Introduction: Phyllodes tumors are rare fibroepithelial lesions, with an incidence of 2.1 cases per million. They represent 0.2-2% of all breast tumors. The breast tumor department treats the largest number of patients per year at the Oncology Hospital, National Medical Center Siglo XXI, Mexican Social Security Institute, representing 17.4% of all patients treated in this centre. Material and methods: Retrospective, descriptive study. We assessed clinical and pathological characteristics, recurrences and overall survival at 5 years in patients with phyllodes tumor of the breast treated at the Oncology Hospital, Siglo XXI National Medical Center, from January 2000 to December 2017. Results: Thirty-two patients were included in the analysis. Mean age was 43.5 years, presentation was in the right breast in 66% of the patients and pain was present in 19%. 66% presented in the right breast, presented pain 19%. A total of 41% were benign phyllodes tumors, 41% were borderline and 18% malignant. In all, 18% of the cases were treated with wide resection, 65% with simple total mastectomy and 15% with modified radical mastectomy. Recurrence at 5 years was observed in 12%. Overall survival at 5 years was 94%, 100% for patients with benign histology, 100% for patients with borderline histology, and 66% for those with malignant histology (p=0.09). Conclusions: In our population, phyllodes tumors show a tendency towards size greater than 5cm, which is reflected in the greater number of mastectomies in contrast to other reports

Introducción: Los tumores phyllodes son lesiones fibroepiteliales raras, con una incidencia de 2,1 casos por millón, representando del 0,2 al 2% de todos los tumores de mama. El departamento de tumores de mama del Hospital de Oncología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, ocupa el primer lugar en la atención, por el número de pacientes al año, lo que representa el 17,4% de todos los pacientes tratados en este centro. Material y métodos: Estudio retrospectivo, descriptivo. Se analizaron las características clínico-patológicas, la recurrencia y la supervivencia general a los 5 años en pacientes con tumor phyllodes de la mama, tratados en el Hospital de Oncología, Centro Médico Nacional Siglo XXI, desde enero de 2000 hasta diciembre de 2017. Resultados: Incluimos 32 pacientes. La edad media fue 43,5 años. El 66% se localizó en la mama derecha y el 19% presentó dolor. El 41% correspondió a tumor phyllodes benigno, 41% límítrofe y el 18% maligno. El 18% se trató con resección amplia, 65% con mastectomía total simple y 15% con mastectomía radical modificada. La recurrencia a 5 años se observó en el 12%. La supervivencia global a 5 años fue del 94%; para la histología benigna del 100%, limítrofe 100% y maligna 66% (p = 0,09). Conclusiones: En nuestra población el tumor phyllodes presentó una tendencia hacia un tamaño mayor a 5 cm, lo cual se refleja en el mayor número de mastectomías que contrasta con otros estudios

El estado nutricio no influye en el desarrollo de dehiscencia de anastomosis en una población mexicana / The nutritional state does not influence development of anastomotic dehiscence in a Mexican population

Objetivo: Describir los factores de riesgo asociados al desarrollo de dehiscencia anastomótica en pacientes sometidos a cirugía intestinal en una población mexicana, con énfasis en el estado nutricional del paciente. Sede: Servicio de Cirugía, Hospital Regional de Alta Especialidad de Oaxaca, Secretaría de Salud. Diseño: Estudio clínico, ambispectivo, ambilectivo de casos y controles. Análisis estadístico: Análisis univariado con χ², regresión logística binomial simple y regresión logística multivariada. Pacientes y métodos: Se analizaron 144 pacientes sometidos a 214 resecciones y/o derivaciones intestinales con anastomosis. Se consideraron distintos factores clínicos, demográficos y de laboratorio asociados a dehiscencia de anastomosis. Los principales factores de riesgo considerados fueron: número de anastomosis, tipo de anastomosis, IMC, antecedente de cáncer, creatinina, tabaquismo, tipo de cirugía, nivel de hemoglobina, cuenta de leucocitos y linfocitos, tiempos de coagulación, biometría hemática, género, hipotensión intraoperatoria, diabetes mellitus, enfermedad cardiovascular, puntuación de ASA, hiperbilirrubinemia, BUN y sangrado quirúrgico. Se valoró la asociación de estas variables a la dehiscencia anastomótica y a la mortalidad de la población. Resultados: Se analizaron 144 pacientes sometidos a 214 anastomosis. En el análisis univariado, las variables que mostraron significancia estadística para dehiscencia fueron edad (p < 0.001), sangrado (p = 0.01) y la necesidad de transfusiones (p = 0.03). La presencia de hipoalbuminemia o un IMC < 15 no fueron significativos tanto en el análisis univariado como en el multivariado. El sangrado quirúrgico y la necesidad de transfusiones mostraron ser los predictores más significativos de desarrollo de dehiscencia anastomótica en el análisis multivariado (p < 0.01). Conclusiones: La presencia de hipoalbuminemia y un bajo índice de masa corporal no aumenta el riesgo de dehiscencia anastomótica en la población de estudio. Los principales factores de riesgo asociados a la fuga anastomótica son el sangrado transoperatorio y la administración de hemoderivados en el perioperatorio.

Objective: To describe the risk factors associated to the development of an anastomotic dehiscence in patients subjected to intestinal surgery in a Mexican population, emphasizing the nutritional state of the patient. Setting: Surgery Service, Regional High Specialty Hospital of Oaxaca, Mexico. Ministry of Health (Third Level Health Care Center). Design: Clinical, ambispective, ambilective study of cases and controls. Statistical analysis: Univariate analysis with χ2, simple binomial logistic regression, and multivariate logistic regression. Patients and methods: We analyzed 144 patients subjected to 214 resections and/or intestinal shunts with anastomoses. We considered different clinical, demographic, and laboratory factors associated to dehiscence of anastomoses. The main risk factors considered were: number of anastomoses, type of anastomoses, IMC, antecedents of cancer, creatinine, smoking, type of surgery, hemoglobin level, leukocytes and lymphocyte counts, clotting time, blood biometrics, gender, intraoperative hypotension, diabetes mellitus, cardiovascular disease, ASA score, hyperbilirubinemia, BUN, surgical bleeding. We assessed the association of these variables with anastomotic dehiscence and mortality in the studied population. Results: We analyzed 144 patients subjected to 214 anastomoses. The univariate analysis revealed that the variables with statistical significance for dehiscence were age (p < 0.001), bleeding (p = 0.01), and need of transfusions (p = 0.03). The presence of hypoalbuminemia or a BMI < 15 was not significant in either the univariate and multivariate analyses. Surgical bleeding and the need of transfusions were the most significant predictors for the development of anastomotic dehiscence in the multivariate analysis (p < 0.01). Conclusions: The presence of hypoalbuminemia and a low BMI does not increase the risk of anastomotic dehiscence in the studied population. The main risk factors associated to anastomotic leakage are transoperative bleeding and administration of hemoderivates during the perioperative time.

Evaluación de la morbilidad y mortalidad de la colecistectomía laparoscópica con técnica de tres puertos en el Hospital Regional de Alta Especialidad de Oaxaca / Assessment of morbidity and mortality due to laparoscopic cholecystectomy with three ports technique at the Regional High Specialty Hospital of Oaxaca

Objetivo: Evaluar la morbilidad y mortalidad de la colecistectomía laparoscópica (CL) en el Hospital regional de Alta Especialidad de Oaxaca (HRAEO), y compararlo con lo reportado en la literatura. Sede: Hospital Regional de Alta Especialidad de Oaxaca. Diseño: Estudio retrospectivo, transversal, descriptivo y comparativo. Análisis estadístico: Análisis estadístico bivariado con medidas de tendencia central y χ². Pacientes y métodos: Pacientes sometidos a CL de enero del 2010 a diciembre del 2011. Se evaluó el tiempo quirúrgico, sangrado transoperatorio, porcentaje de conversión, días de estancia intrahospitalaria, complicaciones transoperatorias y postoperatorias. Resultados: Se incluyeron 386 pacientes, 68 (17.6%) hombres, edad de 43.51 ± 16.8 años. Se identificó un paciente con lesión de vía biliar (0.3%), un paciente con fuga biliar (0.3%), dos pacientes con bilomas residuales (0.5%) y un porcentaje de conversión del 2.8% (11 casos). Un paciente falleció en el grupo de tres puertos (mortalidad global = 0.3%) por colangitis aguda. El porcentaje de complicaciones fue del 4.9%; en 355 (92%) pacientes se usaron tres puertos y cuatro puertos en 31 (8%). Al comparar ambas técnicas, la estancia intrahospitalaria fue menor en el grupo de tres puertos, 1.92 ± 1.22 días versus 2.87 ± 2.84 días (p = 0.0001), el sangrado fue menor 55.23 ± 123.48 ml versus 114.52 ± 193.04 ml (p = 0.0001), así como el tiempo operatorio 71.05 ± 41.87 min versus 110.26 ± 61.25 min (p = 0.0001). Sin diferencia en la morbilidad (frecuencia de fístulas y lesiones de vía biliar). Conclusiones: La morbilidad y mortalidad de la CL en el HRAEO es similar a la reportada en la literatura mundial. El uso de tres puertos sobre cuatro puertos demostró un menor tiempo quirúrgico, estancia hospitalaria y sangrado.

Objective: To assess morbidity and mortality of laparoscopic cholecystectomy (LC) at the Regional Hospital of High Specialty (HRAEO, for its initials in Spanish). Setting: Regional Hospital of High Specialty of Oaxaca (third level health care center). Design: Retrospective, cross-sectional, descriptive, comparative study. Statistical analysis: Bivariate statistical analysis with central tendency measures and chi square. Patients and methods: Patients subjected to LC from January 2010 to December 2011. We assessed surgical time, transoperative bleeding, percentage of conversion, days of in-hospital stay, transoperative and postoperative complications. Results: A total of 386 patients were included, 68 (17.6%) were men of 43.51 ± 16.8 years of age. We identified: one patient with biliary tract lesion (0.3%), one patient with biliary leakage (0.3%), two patients with residual bilomas (0.5%), and a conversion percentage of 2.8% (11 cases). One patient died in the group of three ports due to acute cholangitis (global mortality = 0.3%). Percentage of complications was 4.9%; three ports were used in 355 (92%) patients and four ports in 31 (8%). When comparing both techniques, in-hospital stay was lower in the three ports group, 1.92 ± 1.22 days versus 2.87 ± 2.84 days (p = 0.0001); bleeding was lower, 55.23 + 123.48 ml versus 114.52 ± 193.04 ml (p = 0.0001); as well as surgical time, 71.05 ± 41.87 min versus 110.26 ± 61.25 min (p = 0.0001). There were no differences in morbidity (frequency of fistulae and injuries to the biliary tract). Conclusions: Morbidity and mortality of LC at the HRAEO is similar to that reported in the world literature. The use of three ports, as compared to four ports, demonstrated a lower surgical time, in-hospital stay, and bleeding.

Importance of the preoperative evaluation of multifocal and multicentric breast cancer with magnetic resonance imaging in women with dense parenchyma.

BACKGROUND: The presence and detection of multifocal and multicentric disease significantly increases the risk of recurrence and changes the best therapeutic approach in patients with breast cancer. Mammography has low sensitivity to detect multiple malignant foci in patients with dense breast parenchyma. We prospectively evaluated Magnetic Resonance Imaging (MRI) as part of preoperative assessment. MATERIAL AND METHODS: Women with clinical and radiological suspicion of breast cancer and dense breast parenchyma (> 75% dense tissue) were included. All patients underwent mammography, ultrasonogram and MRI prior to surgery. Surgical specimens were used for the detection of multifocal and multicentric disease. Patients who required neoadjuvant chemotherapy or radiotherapy were excluded. RESULTS: Nineteen patients were evaluated. Histological diagnosis was confirmed in 14 patients, multifocal and multicentric disease was found in five and two patients, respectively. Sensitivity and accuracy to detect multiple malignant foci were 42 and 64%, respectively, for mammography plus ultrasound and 100 and 92% for MRI (p<0.05). CONCLUSIONS: MRI is more sensible and has a better accuracy than mammography plus ultrasound to detect both multicentric and multifocal breast cancer in women with dense breast parenchyma. MRI can improve preoperative assessment of breast cancer in this group of patients.