[Factors associated to death in patients hospitalized due to COVID-19]. / Factores asociados a defunción en pacientes hospitalizados por COVID-19.

BACKGROUND: SARS-CoV-2 virus was notified by the World Health Organization in January 2020 as a global emergency, due to its intense transmission, and clinical picture, that is aggravated in susceptible people. OBJECTIVE: To describe the factors associated with death in COVID-19 and pneumonia patients hospitalized in a thirdlevel center. MATERIAL AND METHODS: An undivided case-control study was carried out. It was conducted an interview to obtain general information; from the medical record were collected hospitalization data, radiological images, laboratory parameters, and treatments used. It was used descriptive statistics. Student's t, Mann-Whitney U, and chi-squared were used to identify variables associated with death, and models of adjusted binary logistic regression to propose which variables of the patient's history, clinical parameters and treatments explained the death. RESULTS: We treated 5339 patients with suspicion of COVID-19: 3117 positive (59%), 1029 hospitalized due to pneumonia, and 513 deaths (16.46%). For the analysis, 1110 patients were taken, 399 death cases were selected and 357 controls discharged due to improvement. The average age was 57.8 years; 59% were male. CONCLUSIONS: The variables associated with mortality were: patients older than 40 years, chest radiography image > 50% involvement, intubation, lactic dehydrogenase > 500, C-reactive protein > 10, and organ failure; variables associated with improvement were: stay in the intensive care unit, use of broad spectrum parenteral antibiotics, steroids, and use of the anticoagulant enoxyheparin. Sex, diabetes, and comorbidities did not show significant association.

INTRODUCCIÓN: el SARS-CoV-2 fue notificado por la Organización Mundial de la Salud en enero de 2020 como emergencia mundial debido a su intenso contagio y cuadro clínico, que se agrava en personas susceptibles. OBJETIVO: describir factores asociados a defunción en pacientes con COVID-19 y neumonía hospitalizados en tercer nivel. MATERIAL Y MÉTODOS: estudio de casos y controles no pareado. Se obtuvo información general mediante entrevista; del expediente se tomaron datos de hospitalización, imágenes radiológicas, parámetros de laboratorio y tratamientos. Se empleó estadística descriptiva, t de student, U de Mann-Whitney y chi cuadrada para identificar variables asociadas a defunción, y modelos de regresión logística binaria ajustada para proponer variables de antecedentes del paciente, parámetros clínicos y tratamientos que explicaran la defunción. RESULTADOS: atendimos 5339 pacientes sospechosos de COVID-19: 3117 positivos (59%), 1029 hospitalizados por neumonía y 513 defunciones (16.46%). Para el análisis, se tomaron 1110, se seleccionaron 399 casos de defunción y 357 controles egresados por mejoría. La edad promedio fue 57.8 años; 59% fueron hombres. CONCLUSIONES: las variables asociadas a mortalidad fueron: mayores de 40 años, radiografía de tórax > 50% de afectación, intubación, deshidrogenasa láctica > 500, proteína C reactiva > 10 e insuficiencia orgánica; las asociadas a mejoría: estancia en unidad de cuidados intensivos, uso de antibióticos parenterales de amplio espectro, esteroides y anticoagulante enoxiheparina. El sexo, la diabetes y las comorbilidades no mostraron asociación.

[Blood groups and SARS-CoV-2 in health professionals from a single center]. / Grupos sanguíneos y SARS-CoV-2 en personal de salud de un solo centro.

BACKGROUND: The possibility that the blood group (BG) predisposes to SARS-CoV-2 infection is controversial. OBJECTIVE: To compare the prevalence of BG, anti-IgG SARS-CoV-2, and more frequent symptoms in convalescent health personnel vs controls prior to vaccination. MATERIAL AND METHODS: Analytical cross-sectional design of cases and controls, which included health personnel, from March to June 2020, confirmed with (polymerase chain reaction) PCR-SARS-CoV-2 and negative controls with PCR and anti-IgG-SARS-CoV-2. Participants were questioned concerning symptoms and BG was determined. It was used descriptive statistics and comparative analysis with chi squared, Fisher's exact test, Student's t, and Mann Whitney's U tests. RESULTS: Of 218 workers, 102 (46.8%) were confirmed cases for SARS-CoV-2 (convalescent) and 116 controls. The distribution of BG was similar between cases and controls, being BG-O + the most frequent (52.9%). The risk of becoming infected by SARS-CoV-2 for BG-O compared to BGNo-O showed a lower trend (odds ratio [OR] 0.725, 95% confidence interval [95% CI] 0.416-1.261, p = ns). The BG-A (28.4%) compared with BG-No-A (71.6%) showed a trend of increased risk in BG-A (OR 1.523, 95% CI 0.818-2.837, p = ns). The presence of SARS-CoV-2 IgG antibodies was 85% in the convalescent group. CONCLUSIONS: The prevalence of infected was proportionally higher for BG-A and lower for BG-O. About 15% did not develop SARS-CoV-2 antibodies after overcoming COVID-19 disease.

INTRODUCCIÓN: la posibilidad de que el grupo sanguíneo (GS) predisponga a infección por SARS-CoV-2 es controversial. OBJETIVO: comparar prevalencia de GS, anti-IgG SARSCoV-2 y síntomas más frecuentes, en personal de salud convaleciente frente a controles previo a la vacunación. MATERIAL Y MÉTODOS: diseño transversal analítico de casos y controles, que incluyó personal de salud, de marzo a junio de 2020, confirmados con reaccion en cadena de la polimerasa (PCR-SARS-CoV-2) y controles negativos con PCR y anti-IgG-SARS-COV-2. Se les interrogó sobre los síntomas y se determinó el GS. Se empleó estadística descriptiva y análisis comparativo con chi cuadrada o prueba exacta de Fisher y t de Student o U de Mann-Whitney. RESULTADOS: de 218 trabajadores, 102 (46.8%) fueron casos confirmados para SARS-CoV-2 (convalecientes) y 116 controles. La distribución de GS fue similar entre los casos y los controles y el GS-O+ fue el más frecuente (52.9%). El riesgo de infectarse de SARS-CoV-2 para el GS-O, comparado con GS-No-O mostró menor tendencia: razón de momios [RM] 0.725 (intervalo de confianza del 95% [IC 95%] 0.416-1.261; p = ns). El GS-A (28.4%) comparado con GSNo-A (71.6%) mostró tendencia de incremento del riesgo en GS-A, RM 1.523 (IC 95% 0.818-2.837, p = ns). La presencia de anticuerpos IgG de SARS-CoV-2 fue del 85% en el grupo de convalecientes. CONCLUSIONES: la prevalencia de infectados fue proporcionalmente mayor para GS-A y menor para GS-O. Alrededor de 15% no desarrollaron anticuerpos de SARS-CoV-2 después de recuperarse de COVID-19.

Grupos sanguíneos y SARS-CoV-2 en personal de salud de un solo centro / Blood groups and SARS-CoV-2 in health professionals from a single center

Introducción: la posibilidad de que el grupo sanguíneo (GS) predisponga a infección por SARS-CoV-2 es controversial. Objetivo: comparar prevalencia de GS, anti-IgG SARS-CoV-2 y síntomas más frecuentes, en personal de salud convaleciente frente a controles previo a la vacunación. Material y métodos: diseño transversal analítico de casos y controles, que incluyó personal de salud, de marzo a junio de 2020, confirmados con reaccion en cadena de la polimerasa (PCR-SARS-CoV-2) y controles negativos con PCR y anti-IgG-SARS-COV-2. Se les interrogó sobre los síntomas y se determinó el GS. Se empleó estadística descriptiva y análisis comparativo con chi cuadrada o prueba exacta de Fisher y t de Student o U de Mann-Whitney. Resultados: de 218 trabajadores, 102 (46.8%) fueron casos confirmados para SARS-CoV-2 (convalecientes) y 116 controles. La distribución de GS fue similar entre los casos y los controles y el GS-O+ fue el más frecuente (52.9%). El riesgo de infectarse de SARS-CoV-2 para el GS-O, comparado con GS-No-O mostró menor tendencia: razón de momios [RM] 0.725 (intervalo de confianza del 95% [IC 95%] 0.416-1.261; p = ns). El GS-A (28.4%) comparado con GS-No-A (71.6%) mostró tendencia de incremento del riesgo en GS-A, RM 1.523 (IC 95% 0.818-2.837, p = ns). La presencia de anticuerpos IgG de SARS-CoV-2 fue del 85% en el grupo de convalecientes. Conclusiones: la prevalencia de infectados fue proporcionalmente mayor para GS-A y menor para GS-O. Alrededor de 15% no desarrollaron anticuerpos de SARS-CoV-2 después de recuperarse de COVID-19.

Background: The possibility that the blood group (BG) predisposes to SARS-CoV-2 infection is controversial. Objective: To compare the prevalence of BG, anti-IgG SARS-CoV-2, and more frequent symptoms in convalescent health personnel vs controls prior to vaccination. Material and methods: Analytical cross-sectional design of cases and controls, which included health personnel, from March to June 2020, confirmed with (polymerase chain reaction) PCR-SARS-CoV-2 and negative controls with PCR and anti-IgG-SARS-CoV-2. Participants were questioned concerning symptoms and BG was determined. It was used descriptive statistics and comparative analysis with chi squared, Fisher's exact test, Student's t, and Mann Whitney's U tests. Results: Of 218 workers, 102 (46.8%) were confirmed cases for SARS-CoV-2 (convalescent) and 116 controls. The distribution of BG was similar between cases and controls, being BG-O + the most frequent (52.9%). The risk of becoming infected by SARS-CoV-2 for BG-O compared to BG-No-O showed a lower trend (odds ratio [OR] 0.725, 95% confidence interval [95% CI] 0.416-1.261, p = ns). The BG-A (28.4%) compared with BG-No-A (71.6%) showed a trend of increased risk in BG-A (OR 1.523, 95% CI 0.818-2.837, p = ns). The presence of SARS-CoV-2 IgG antibodies was 85% in the convalescent group. Conclusions: The prevalence of infected was proportionally higher for BG-A and lower for BG-O. About 15% did not develop SARS-CoV-2 antibodies after overcoming COVID-19 disease.

Factores asociados a defunción en pacientes hospitalizados por COVID-19 / Factors associated to death in patients hospitalized due to COVID-19

Introducción: el SARS-CoV-2 fue notificado por la Organización Mundial de la Salud en enero de 2020 como emergencia mundial debido a su intenso contagio y cuadro clínico, que se agrava en personas susceptibles. Objetivo: describir factores asociados a defunción en pacientes con COVID-19 y neumonía hospitalizados en tercer nivel.Material y métodos: estudio de casos y controles no pareado. Se obtuvo información general mediante entrevista; del expediente se tomaron datos de hospitalización, imágenes radiológicas, parámetros de laboratorio y tratamientos. Se empleó estadística descriptiva, t de student, U de Mann-Whitney y chi cuadrada para identificar variables asociadas a defunción, y modelos de regresión logística binaria ajustada para proponer variables de antecedentes del paciente, parámetros clínicos y tratamientos que explicaran la defunción.Resultados: atendimos 5339 pacientes sospechosos de COVID-19: 3117 positivos (59%), 1029 hospitalizados por neumonía y 513 defunciones (16.46%). Para el análisis, se tomaron 1110, se seleccionaron 399 casos de defunción y 357 controles egresados por mejoría. La edad promedio fue 57.8 años; 59% fueron hombres. La estancia hospitalaria en casos fue 9.8 (DE 10.9) y en controles 12.5 (DE 10.2).Conclusiones: las variables asociadas a mortalidad fueron: mayores de 40 años, radiografía de tórax > 50% de afectación, intubación, deshidrogenasa láctica > 500, proteína C reactiva > 10 e insuficiencia orgánica; las asociadas a mejoría: estancia en unidad de cuidados intensivos, uso de antibióticos parenterales de amplio espectro, esteroides y anticoagulante enoxiheparina. El sexo, la diabetes y las comorbilidades no mostraron asociación.

Background: SARS-CoV-2 virus was notified by the World Health Organization in January 2020 as a global emergency, due to its intense transmission, and the clinical picture, that is aggravated in susceptible people.Objective: To describe the factors associated with death in COVID-19 and pneumonia patients hospitalized in a third-level center. Material and methods: An undivided case-control study was conducted. It was conducted an interview to obtain general information; from the medical record were collected hospitalization data, radiological images, laboratory parameters, and treatments used. It was used descriptive statistics. Student's t, Mann-Whitney U, and chi-squared were used to identify variables associated with death, and models of adjusted binary logistic regression to propose which variables of the patient's history, clinical parameters and treatments explained the death. Results: We treated 5339 patients with suspicion of COVID-19: 3117 positive (59%), 1029 hospitalized due to pneumonia, and 513 deaths (16.46%). For the analysis, 1110 patients were taken, 399 death cases were selected and 357 controls discharged due to improvement. The average age was 57.8 years; 59% were male. The hospital stay in cases was 9.8 (SD 10.9), and in controls 12.5 (SD 10.2). Conclusions: The variables associated with mortality were: patients older than 40 years, chest radiography image > 50% involvement, intubation, lactic dehydrogenase > 500, C-reactive protein > 10, and organ failure; variables associated with improvement were: stay in the intensive care unit, use of broad spectrum parenteral antibiotics, steroids, and use of the anticoagulant enoxyheparin. Sex, diabetes, and comorbidities did not show significant association.

Association of depression and anxiety with characteristics related to the training of medical residents / Asociación de depresión y ansiedad con características relacionadas con el adiestramiento de médicos residentes

Abstract Introduction Higher rates of depression and anxiety have been reported in resident physicians compared to the general population. The association with characteristics related to training has been poorly studied. Objective To know the association of depression and anxiety with characteristics related to training in a group in medical residents. Method 542 resident physicians of different grade and specialty were included. They answered the Mini International Neuropsychiatric Interview to identify depression and anxiety. The training characteristics evaluated were: work performance; use of tobacco, alcohol, and drugs; grade of residence; frequency of guards; type of specialty; and emotional exhaustion. Other factors assessed by their possible association were: personal antecedent of depression and/or anxiety and presence of any medical illness. Results 277 women and 265 men with an average age of 28 were evaluated. The prevalence of depression and anxiety found was 12.2% and 47.1%, respectively, and was associated with work fatigue, decreased socio-labor performance, emotional exhaustion, harmful alcohol consumption, and personal history of depression and/or anxiety. Discussion and conclusion There are training-related characteristics that could promote depression and anxiety in physicians vulnerable to depression and/or anxiety.

Resumen Introducción Se han reportado más altas tasas de depresión y ansiedad en médicos residentes que en la población en general. La asociación con características relacionadas con el adiestramiento ha sido poco estudiada. Objetivo Conocer la asociación de depresión y ansiedad con características relacionadas con el adiestramiento en un grupo de médicos residentes. Método Se incluyeron 542 médicos residentes de diferente grado y especialidad. Se les aplicó la Mini Entrevista Neuropsiquiátrica Internacional para identificar depresión y ansiedad. Las características relacionadas con el adiestramiento que se evaluaron fueron: fatiga laboral y reducción del desempeño laboral por sueño insatisfactorio; consumo de tabaco, alcohol y drogas; año de residencia; frecuencia de guardias; tipo de especialidad y agotamiento emocional. Otros factores evaluados por su posible asociación fueron: antecedente personal de depresión y/o ansiedad y presencia de cualquier enfermedad médica. Resultados Se evaluaron 277 mujeres y 265 hombres con edad media de 28 años; la prevalencia de depresión y ansiedad encontrada fue de 12.2% y 47.1%, respectivamente, y se asoció con fatiga laboral, disminución del desempeño socio laboral, agotamiento emocional, consumo perjudicial de alcohol y antecedente personal de depresión y/o ansiedad. Discusión y conclusión Existen características relacionadas con el adiestramiento que pudieran favorecer la presencia de depresión y ansiedad en médicos residentes vulnerables por el antecedente de depresión y/o ansiedad.

Laparoscopic resection of a gastric schwannoma: A case report.

INTRODUCTION: Mesenchymal tumors of the gastrointestinal tract are a group spindle cell tumors which include gastrointestinal stromal tumors, leiomyomas, leiomyosarcomas and schwannomas (Nishida and Hirota, 2000). Schwannomas generally present as a slow and asymptomatic growing mass in the gastrointestinal tract typically arising in the gastric submucosa accounting for up to 0.2% of gastric tumors (Melvin and Wilkinson, 1993; Sarlomo-Rikala M, Miettinen, 1995). TREATMENT: with negative surgical margin resection (as approached in this case) is considered the standard treatment. PRESENTATION OF CASE: A 60-year-old woman was referred to our general surgery service for dyspepsia. During her evaluation a gastric mass was incidentally found on upper GI endoscopy which showed a submucosal exophytic neoplasm at the gastric antrum. The patient was discharged following an uneventful recovery from a successful surgical laparoscopic tumor resection. DISCUSSION: Schwannomas are benign neurogenic tumors that originate from Schwann cells. They commonly occur in the head and neck but are rare in the GI tract (Menno et al., 2010). The differential diagnosis between gastric schwannomas and GISTs can be difficult in the preoperative assessment. With the advent of immunohistochemical staining techniques it is now possible to make a differential diagnosis based on their distinctive immunophenotypes. Gastric schwannomas are consistently positive for S-100 protein and negative for c-kit; conversely, 95% of GISTs are positive for c-kit and negative for S-100 protein in up to 98 to 99% of the cases. CONCLUSION: Gastric schwannomas should be included in the differential diagnosis of any gastric submucosal mass. Negative margin resection as seen with this patient is the standard surgical treatment as there is low malignant transformation potential.

[Risk factors related to surgical site infection in elective surgery]. / Factores de riesgo relacionados con infección del sitio quirúrgico en cirugía electiva.

BACKGROUND: The risk factors for surgical site infections in surgery should be measured and monitored from admission to 30 days after the surgical procedure, because 30% of Surgical Site Infection is detected when the patient was discharged. AIM: Calculate the Relative Risk of associated factors to surgical site infections in adult with elective surgery. METHODS: Patients were classified according to the surgery contamination degree; patient with surgery clean was defined as no exposed and patient with clean-contaminated or contaminated surgery was defined exposed. Risk factors for infection were classified as: inherent to the patient, pre-operative, intra-operative and post-operative. Statistical analysis; we realized Student t or Mann-Whitney U, chi square for Relative Risk (RR) and multivariate analysis by Cox proportional hazards. RESULTS: Were monitored up to 30 days after surgery 403 patients (59.8% women), 35 (8.7%) developed surgical site infections. The factors associated in multivariate analysis were: smoking, RR of 3.21, underweight 3.4 hand washing unsuitable techniques 4.61, transfusion during the procedure 3.22, contaminated surgery 60, and intensive care stay 8 to 14 days 11.64, permanence of 1 to 3 days 2.4 and use of catheter 1 to 3 days 2.27. CONCLUSION: To avoid all risk factors is almost impossible; therefore close monitoring of elective surgery patients can prevent infectious complications.

Antecedentes: desde el ingreso del paciente hasta 30 días después del procedimiento quirúrgico es necesario identificar y vigilar los factores de riesgo de infección del sitio quirúrgico, debido a que 30% de esas infecciones se detectan cuando el paciente sale del hospital. Objetivo: calcular el riesgo relativo de los factores asociados con las infecciones del sitio quirúrgico en adultos con cirugía programada. Material y métodos: estudio de cohorte prospectiva de pacientes quirúrgicos clasificados según el grado de contaminación de la cirugía; expuesto si fue limpia-contaminada o contaminada, no expuesto si fue limpia. Los factores de riesgo estudiados fueron: los inherentes al paciente, pre-quirúrgicos, intraquirúrgicos y posquirúrgicos. El análisis bivariado se realizó con t de Student o U de Mann-Withney, ?2 para riesgo multivariado de riesgos proporcionales de Cox. Resultados: se estudiaron 403 pacientes durante 30 días después de operados (59.8% mujeres); 8.7% resultaron con infección del sitio quirúrgico. Los factores asociados con el análisis multivariado fueron: índice tabáquico con un riesgo relativo de 3.21, índice de masa corporal en bajo peso 3.4, técnica inadecuada de lavado de manos 4.61, transfusión durante la cirugía 3.22, cirugía contaminada 60, estancia de 8 a 14 días en terapia intensiva 11.64, permanencia 1 a 3 días con venoclisis 2.4 y con sonda vesical 1 a 3 días 2.27. Conclusión: es imposible evitar todos los factores de riesgo para infecciones del sitio quirúrgico; sin embargo, la vigilancia formal de los pacientes puede prevenir complicaciones.

[Thyroglossal cyst and papillary carcinoma. Management proposals]. / Quiste tirogloso con carcinoma papilar de tiroides. Propuestas de manejo.

The thyroid descends through the foramen cecum leaving the thyroglossal duct, which disappears between the fifth and the tenth week of pregnancy. The lack of involution of any part of this duct results in thyroglossal cyst formation. Its diagnostic approach is made by cervical ultrasound, computed tomography and magnetic resonance imaging. Approximately 1 % of the thyroglossal cyst formation contains malignant elements, and the most reported primary tumor has been papillary carcinoma. The recommended treatment for these carcinomas is controversial and it has evolved as time goes by. From Sistrunk procedure to neck dissection with total thyroidectomy and complementary therapies, such as iodine ablation and thyroid supplements, yet there is still no consensus as to the type of surgery and postoperative management it should be used to treat this carcinoma. Therapy should be applied according to each specific case, and it should be based on histological diagnosis, the invasive character of the tumor, and the lymph node affectation. In this paper we review the literature published so far with regards to the treatment of this carcinoma.

La tiroides hace su descenso a través del foramen cecum y deja el conducto tirogloso, el cual desaparece entre la quinta y la décima semana de gestación. La falta de involución de cualquier parte de este conducto da lugar a la formación de quistes tiroglosos. Su evaluación se realiza por medio de ecografía cervical, tomografía computada y resonancia magnética. Aproximadamente el 1 % de los quistes tiroglosos contiene elementos malignos y el tumor primario que se ha documentado más ha sido el carcinoma papilar. El tratamiento recomendado para estos carcinomas es objeto de discusión; se ha usado desde la operación de Sistrunk hasta la disección cervical con tiroidectomía total y terapias complementarias como la ablación con yodo y los suplementos tiroideos; sin embargo, todavía no existe un consenso dominante en cuanto al tipo de intervención quirúrgica y su manejo postoperatorio. La terapia debe ser adaptada a cada caso, sobre el diagnóstico histológico, el carácter invasivo del tumor y la afectación de los ganglios linfáticos. En el presente escrito hemos realizado una revisión de la literatura respecto al tratamiento.

Quiste tirogloso como foco primario de carcinoma papilar de tiroides metastásico a cadena ganglionar yugular / Thyroglossal cyst as primary site of papillary thyroid carcinoma metastatic to jugular lymph node chain

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[Surgical complications of gallbladder and the biliary tree in the elderly patients]. / Complicaciones quirúrgicas de la vesícula y la vía biliar en el paciente geriátrico.

BACKGROUND: the morbidity and mortality in surgery of gallbladder and biliary tract (SGBT) in the geriatric patient define the prognostic. The aim was to describe the perioperative and immediate post-operative complications of the geriatric patient undergoing SGBT. METHODS: A cross-sectional study with control group in patients older than 60 years was done. The patients were divided into two groups by age (I: 60-69 years and II: > 70 years). The variables analyzed were morbidity, anesthetic risk, type of surgery, perioperative and post-operative complications, conversion rate and length of hospital stay. RESULTS: a total of 236 patients were included: 65.2 % were females with a mean age 68.5 years. Chronic cholelithiasis accounted for 83 % and laparoscopic cholecystectomy was the procedure most commonly performed (72.8 %). Surgery was scheduled in 92 % cases and urgently in 8 %. In both groups, ASA rank was I-II in 76.2 % vs. 70.1 %; the conversion rate was 2.5 %. Complications were 13.5 %, of which 9.3 % were postoperative and 4.2 % of perioperative. Complications were higher in emergency surgery than elective surgery (36.8 % vs. 11.8 %). The average hospital stay was 4.2 days and there was no mortality. CONCLUSIONS: the age does not represent an increase in complications. The laparoscopic cholecystectomy is safe and applicable in elderly. Complications presented were related to the urgent nature of the surgery.

Introducción: en el anciano, la morbilidad posoperatoria en la cirugía de vesícula y vía biliar se relaciona con el pronóstico. Se describen las complicaciones trans y posoperatorias en el anciano sometido a esa cirugía. Métodos: estudio transversal descriptivo en pacientes mayores de 60 años. Se integraron dos grupos: I, pacientes de 60 a 69 años; II, mayores de 70 años. Se registraron comorbilidad, riesgo quirúrgico, tipo de cirugía, complicaciones trans y posoperatorias inmediatas, conversión y estancia hospitalaria. Resultados: se incluyeron 236 pacientes (65.2 % mujeres) con edad media de 68.5 años. La colecistitis crónica litiásica representó 83 % y la colecistectomía laparoscópica se utilizó en 72.8 %. La cirugía fue programada en 92 %. Se identificó ASA I-II en 76.2 y 70.1 % de los grupos I y II, respectivamente; la conversión fue de 2.5 %. Hubo complicaciones en 13.5 % (9.3 % en el posoperatorio y 4.2 % en el transoperatorio) y su proporción fue mayor en las cirugías urgentes (36.8 %) que en las programadas (11.8 %). La estancia hospitalaria fue de 4.2 días. No hubo mortalidad. Conclusiones: las complicaciones no se incrementaron con la edad pero sí con la urgencia de la cirugía. La colecistectomía laparoscópica es segura en geriatría.

Experiencia quirúrgica en el hiperparatiroidismo primario en el Hospital de Especialidades del Centro Médico Nacional ''La Raza'' / Surgical experience in primary hyperparathyroidism at the Specialty Hospital of the National Medical Center ''La Raza''

Objetivo: Presentar la experiencia quirúrgica en el tratamiento del hiperparatiroidismo primario. Sede: Hospital de Especialidades del Centro Médico Nacional ''La Raza''. Diseño: Ambispectivo, observacional, longitudinal, descriptivo. Análisis estadístico: Porcentajes como medida de resumen para variables cualitativas. Pacientes y métodos: Se realizó un estudio en el periodo comprendido de enero del 2006 a diciembre del 2010 en el Servicio de Cirugía General del Hospital de Especialidades del Centro Médico Nacional ''La Raza''. Con seguimiento mínimo de un año, se revisó el expediente y su evolución a través del tiempo, enumerando morbilidad, mortalidad, así como recurrencia o éxito quirúrgico. Resultados: Se incluyeron 119 pacientes con una edad promedio de 51.8 años, 22 hombres y 97 mujeres. La mayor frecuencia de hiperparatiroidismo primario se observó entre los pacientes de 40 y 69 años de edad. El calcio sérico promedio fue de 11.6 mg/dl al momento del diagnóstico y la media de hormona paratiroidea fue de 274 pg/ml. El hallazgo histopatológico fue de 106 adenomas (89%) y 13 hiperplasias (10.9%). Se obtuvo la curación con la primera intervención en 113 pacientes (95%), de ellos dos presentaron complicaciones agudas (1.6%) y tres crónicas (2.5%), sin mortalidad. Conclusiones: Al determinar la recurrencia del hiperparatiroidismo primario dentro de la experiencia quirúrgica en este centro hospitalario de tercer nivel y comparándolo con lo reportado en la literatura mundial, éste se encuentra dentro del promedio. La utilidad del estudio al determinar la recurrencia nos sirve para detectar factores condicionantes de la misma, además de llevar a cabo un adecuado estudio preoperatorio y selección de los pacientes.

Objective: To present the surgical experience in the treatment of primary hyperparathyroidism. Setting: Third level health care center (Specialty Hospital of the National Medical Center ''La Raza''). Design: Ambispective, observational, longitudinal, descriptive study. Statistical analysis: Percentages as summary measure for qualitative variables. Patients and Methods: The study was performed from January 2006 to December 2010 in the General Surgery Service of the Specialty Hospital of the Centro Médico Nacional ''La Raza'', with a minimum follow up of one year. The clinical records were revised as well as evolution along time, assessing morbidity, mortality, recurrence or surgical success. Results: A total of 119 patients were included with an average age of 51.8 years; 22 men and 97 women. The highest frequency of primary hyperparathyroidism was observed among patients aged from 40 to 69 years. Average serum calcium was 11.6 mg/dl at the time of diagnosis, and the mean parathyroid hormone value was of 274 pg/ml. Histopathological findings included 106 adenomas (89%) and 13 hyperplasias (10.9%). Cure was obtained with the first surgery in 113 (95%) patients with two acute complications (1.6%) and three chronic ones (2.5%); no mortality was recorded. Conclusions: When determining recurrence of primary hyperparathyroidism according to surgical experience in this third level healthy care center and comparing with that reported in the worldwide literature, our result lie within the average. Determining recurrence is useful to detect its conditioning factors, aside from performing adequate preoperative study and patient selection.

Determinación de la certeza diagnóstica de la gammagrafía tiroidea con tecnecio 99 sestamibi en pacientes con nódulo tiroideo y resultado histopatológico definitivo / Determination of the diagnostic accuracy of 99mTc sestamibi scanning in patients with thyroid nodule and a definitive histopathological report

Antecedentes La gammagrafía con tecnecio 99 (Tc99) sestamibi y la biopsia por aspiración permiten predecir de forma relativamente segura el resultado histopatológico de un nódulo tiroideo. Objetivo Determinar la utilidad diagnóstica de la gammagrafía tiroidea con tecnecio 99 sestamibi para detección de malignidad en pacientes con nódulo tiroideo, confirmado por resultado histopatológico definitivo posterior a tiroidectomía. Material y métodos Se estudió un total de 69 pacientes con diagnóstico de nódulo tiroideo solitario que contaban con punción por aspiración con aguja fina y que fueron sometidos a tiroidectomía total ante sospecha de cáncer con análisis patológico posterior en todos. Cincuenta y cuatro pacientes con gammagrafía tiroidea positiva para malignidad; 25 pacientes con un histopatológico final de cáncer y 29 con un histopatológico negativo al mismo. Quince pacientes con gammagrafía tiroidea negativa para neoplasia tiroidea, con 3 presentando un diagnóstico de cáncer confirmado por patología y 12 confirmados con ausencia de malignidad. Resultados En el presente estudio se realizó un análisis estadístico para determinar la certeza diagnostica del Tc99 sestamibi para detectar malignidad en los nódulos tiroideos. El estudio con gammagrafía tiroidea con Tc99 sestamibi para cáncer de tiroides, tuvo una sensibilidad de 89,28%, con una especificidad de 29,25%. El Tc99 sestamibi mostró un valor predictor positivo de 46,29% y un valor predictor negativo de 80%.ConclusionesConsideramos que la práctica de la gammagrafía tiroidea con Tc99 sestamibi debe ser una técnica diagnóstica que se utilice de forma rutinaria en todo aquel paciente con un nódulo tiroideo que presente una punción aspiración con citología tiroidea indeterminada; siendo su mayor utilidad para descartar malignidad en aquellos que presentan captación baja en el estudio de medicina nuclear (AU)

Background 99m Tc sestamibi scanning and aspiration biopsy can predict the histopathological result of a thyroid nodule fairly accurately. Objective To determine the accuracy of 99mTc sestamibi scanning in detecting malignancy in patients with thyroid nodule confirmed by definitive histopathological report after thyroidectomy. Material and methods A total of 69 patients with a solitary thyroid nodule were studied. In all patients, fine needle aspiration, total thyroidectomy for suspected thyroid cancer, and histological analysis of the surgical specimen were performed. There were 54 patients with a positive 99mTc sestamibi scan; of these, malignancy was confirmed by histological analysis in 25 and excluded in 29. There were 15 patients with a negative 99mTc sestamibi scan; of these, three had a final diagnosis of cancer and 12 were confirmed as cancer-free. Results The diagnostic accuracy of 99mTc sestamibi scanning in detecting malignancy in thyroid nodules was determined through a statistical analysis. 99mTc sestamibi scan for thyroid cancer had a sensitivity of 89.28% and a specificity of 29.25%. The positive predictive value was 46.29% and the negative predictive value was 80%.ConclusionsWe believe that 99mTc sestamibi scan should be routinely used in all patients with a thyroid nodule and an indeterminate result on fine needle aspiration. This procedure is most useful in excluding malignancy in patients with a negative 99mTc sestamibi scan (AU)

[Determination of the diagnostic accuracy of 99mTc sestamibi scanning in patients with thyroid nodule and a definitive histopathological report]. / Determinación de la certeza diagnóstica de la gammagrafía tiroidea con tecnecio 99 sestamibi en pacientes con nódulo tiroideo y resultado histopatológico definitivo.

BACKGROUND: 99mTc sestamibi scanning and aspiration biopsy can predict the histopathological result of a thyroid nodule fairly accurately. OBJECTIVE: To determine the accuracy of 99mTc sestamibi scanning in detecting malignancy in patients with thyroid nodule confirmed by definitive histopathological report after thyroidectomy. MATERIAL AND METHODS: A total of 69 patients with a solitary thyroid nodule were studied. In all patients, fine needle aspiration, total thyroidectomy for suspected thyroid cancer, and histological analysis of the surgical specimen were performed. There were 54 patients with a positive 99mTc sestamibi scan; of these, malignancy was confirmed by histological analysis in 25 and excluded in 29. There were 15 patients with a negative 99mTc sestamibi scan; of these, three had a final diagnosis of cancer and 12 were confirmed as cancer-free. RESULTS: The diagnostic accuracy of 99mTc sestamibi scanning in detecting malignancy in thyroid nodules was determined through a statistical analysis. 99mTc sestamibi scan for thyroid cancer had a sensitivity of 89.28% and a specificity of 29.25%. The positive predictive value was 46.29% and the negative predictive value was 80%. CONCLUSIONS: We believe that 99mTc sestamibi scan should be routinely used in all patients with a thyroid nodule and an indeterminate result on fine needle aspiration. This procedure is most useful in excluding malignancy in patients with a negative 99mTc sestamibi scan.

Pancreatitis aguda grave, manejo quirúrgico en un hospital de tercer nivel / Severe acute pancreatitis: surgical management in a third-level hospital

Introducción: La pancreatitis aguda grave está asociada a una mortalidad de 10 a 30 % en centros hospitalarios especializados y representa 20 % de los diagnósticos de pancreatitis. Las indicaciones para tratamiento quirúrgico son necrosis infectada, necrosis persistente, pancreatitis fulminante o complicaciones agudas de la pancreatitis como hemorragia o perforación intestinal. Métodos: Estudio que incluyó pacientes intervenidos quirúrgicamente con el diagnóstico de pancreatitis aguda grave del 1 de enero de 2000 al 31 de diciembre de 2007. Resultados: Se analizaron los expedientes de 82 pacientes, 63.4 % fue del sexo masculino; la etiología más frecuente de pancreatitis fue la biliar, en 63.4 %. La morbilidad fue de 62.19 %; 35.36 % presentó complicaciones pulmonares, 15.85 % fístula enterocutánea y 10.9 % hemorragia. La mortalidad fue de 20.73 %. Todos los pacientes con pancreatitis aguda grave fueron tratados en la unidad de cuidados intensivos; la nutrición parenteral se indicó en pacientes con intolerancia a la vía oral e imposibilidad de colocar una sonda nasoyeyunal; como terapia antibiótica profiláctica se utilizó un carbapenémico. Las indicaciones quirúrgicas se limitaron a necrosis pancreática infectada, necrosis pancreática estéril persistente, pancreatitis aguda fulminante e hipertensión intraabdominal y complicaciones como perforación intestinal y sangrado. Conclusiones: En los pacientes con pancreatitis aguda grave se recomienda manejo por un equipo multidisciplinario en una unidad de cuidados intensivos; la nutrición parenteral y los antibióticos deben ser bien valorados y no utilizarlos en forma rutinaria, y una vez diagnosticada la pancreatitis grave su uso debe ser sistemático.

BACKGROUND: Severe acute pancreatitis has a reported mortality of 10-30% in specialized hospitals, representing 20% of patients diagnosed with acute pancreatitis. Indications for surgery are infected necrosis, necrosis persistent, fulminant pancreatitis or acute pancreatitis complications such as bleeding or intestinal perforation. METHODS: We studied patients diagnosed with pancreatitis from January 1, 2000 to December 31, 2007. RESULTS: We analyzed records of 82 patients, 63.4% were male and the most common etiology of pancreatitis was biliary in 63.4% of patients. Morbidity was 62.19%; 35.36% had pulmonary complications. In 15.85% of patients there was enterocutaneous fistula and 10.9% had bleeding. Mortality was 20.73%. In our hospital, all patients with severe acute pancreatitis are managed in the intensive care unit. Parenteral nutrition is only indicated in patients intolerant to oral feeding or with inability to place a nasojejunal tube. Use of antibiotics is based on carbapenem, and surgical indications are infected pancreatic necrosis, persistent sterile pancreatic necrosis, fulminant acute pancreatitis and abdominal hypertension, and complications such as intestinal perforation and bleeding. CONCLUSIONS: It is recommended that patients with severe acute pancreatitis are managed by a multidisciplinary team in an intensive care unit. The role of parenteral nutrition and antibiotics should be individualized.

Severe acute pancreatitis: surgical management in a third-level hospital.

BACKGROUND: Severe acute pancreatitis has a reported mortality of 10-30% in specialized hospitals, representing 20% of patients diagnosed with acute pancreatitis. Indications for surgery are infected necrosis, necrosis persistent, fulminant pancreatitis or acute pancreatitis complications such as bleeding or intestinal perforation. METHODS: We studied patients diagnosed with pancreatitis from January 1, 2000 to December 31, 2007. RESULTS: We analyzed records of 82 patients, 63.4% were male and the most common etiology of pancreatitis was biliary in 63.4% of patients. Morbidity was 62.19%; 35.36% had pulmonary complications. In 15.85% of patients there was enterocutaneous fistula and 10.9% had bleeding. Mortality was 20.73%. In our hospital, all patients with severe acute pancreatitis are managed in the intensive care unit. Parenteral nutrition is only indicated in patients intolerant to oral feeding or with inability to place a nasojejunal tube. Use of antibiotics is based on carbapenem, and surgical indications are infected pancreatic necrosis, persistent sterile pancreatic necrosis, fulminant acute pancreatitis and abdominal hypertension, and complications such as intestinal perforation and bleeding. CONCLUSIONS: It is recommended that patients with severe acute pancreatitis are managed by a multidisciplinary team in an intensive care unit. The role of parenteral nutrition and antibiotics should be individualized.