[High-risk biliary surgery. Study of 108 patients operated using the tradition method]. / Cirugía biliar de alto riesgo. Estudio de 108 pacientes operados por el método tradicional.

This study is to inform the patients outcomes from biliary tract surgery, with surgical risk higher than normal, in a general hospital. It was observational, retrospective, longitudinal and descriptive study. Among 1989-1992 were studied 108 patients with a 30 days follow up, operated from one or more risk surgical factors, 63 cases were included because had one high risk factor, 31 had two factors, 11 with three and three with four or more. 88 patients (81%) had good outcomes, while 20 (19%) had bad outcomes, 18 were women and two men, with two deaths and two reoperations. The good outcomes were in majority of patients with one high risk factor (57/63 = 90.5%); there were statistic difference with the two, three or four high risk factors cases.

[The local complications of appendicitis]. / Complicaciones locales de la apendicitis.

In order to find out the predisposing factors of local complications after appendectomy in two general hospitals, 268 charts of patients with acute appendicitis confirmed by surgery were reviewed. There were 142 males and 126 females. All wounds were closed and prophylactic antibiotics were not used. Sixty patients (22 per cent) developed local complications; 49 (81.7 per cent) surgical wound infection and 11 (18.3 per cent) with intra-abdominal abscess. In the wound infection group 25 per cent had complicated acute appendicitis and only one per cent non-complicated acute appendicitis. The correlation between the preoperative period and wound sepsis showed, the longer period the higher incidence of wound infection, 1.7 per cent with less than 24 hr. 11 per cent with less than 72 hr. and 78.9 per cent with more than 96 hr.

[Sensitivity, specificity, and predictive values of fine-needle biopsy in thyroid cancer]. / Sensibilidad, especificidad y valores predictivos de la biopsia con aguja fina en cáncer de tiroides.

One-hundred and eleven patients were studied with the objective of exploring the diagnostic usefulness of the fine needle aspiration (FNA) biopsy in cases with cancer of the thyroid gland. The mean age of the total sample was 42.4 years, with 89 percent females. A thyroid gland FNA was done in all cases as well as a surgical intervention for the establishment of a definitive diagnosis (i.e., gold standard). The cytologic diagnosis was done by the same expert pathologist in all cases. The diagnostic accuracy was obtained using a 2 x 2 table. Sensitivity was found to be 72 percent and specificity 91 percent, with 85.5 percent of diagnostic accuracy. Taking into account a 30 percent prevalence in our sample, predictive values were found to be 81 percent for positive and 87 percent for negative. It is concluded that FNA is better than the gold standard in the following points: it is easy to do, it has lower risk, and it has lower discomfort and financial cost. FNA showed a better utility to identify the absence of cancer. This is a procedure which is recommended for use in hospitals similar to the General Hospital of Mexico S.S. as part of the presurgical diagnosis in cases with clinical suspicion of thyroid gland malignancy.

[Reoperations in appendicitis]. / Reoperaciones en apendicitis.

We present our experience in reoperations after appendectomy. From 276 patients were operated for acute appendicitis, we found 70 who presented appendicular abscess, only 13 needed reoperation because of residual abscess, (three cases), evisceration (four cases), and cecum perforation (two cases). All had history of more than four days of preoperative evolution (range 4-45 days) in those eleven patients (six men, and five women) were done 13 reoperations. We had no mortality after successful recovery in all of theme. Our experience in reported from the surgical services of Hospital General de México an Hospital Juárez, both located in México City.