Unilateral caudate infarct following pituitary adenoma resection.

Cerebral ischemic complications after pituitary surgery are not frequently reported. Multiple mechanisms have been proposed, including vasospasm, and delayed cerebral ischemia resulting from postoperative subarachnoid bleeding. Given the unknown etiology of vasospasm following these situations, little is known about its prevention. Through a case report and bibliographic review, the authors warn about the importance of recognizing key signs postoperatively that could indicate increased risk for cerebral vasospasm and must be recognized in a timely manner, with appropriate treatment strategies implemented once these symptoms present.

Uncommon metastases to the brain: Frontal lobe myoepithelial carcinoma.

Background: Myoepithelial tumors have been widely described as a rare form of salivary gland neoplasm, although currently soft-tissue phenotypes have also been identified. These are tumors composed entirely of myoepithelial cells that exhibit a dual epithelial and smooth muscle phenotype. The occurrence of myoepithelial tumors within the central nervous system is also extremely rare, with only a few cases reported. Treatment options include surgical resection, chemotherapy, radiotherapy, or a combination of these approaches. Case Description: The authors present a case of soft-tissue myoepithelial carcinoma with an unusual brain metastasis, rarely described in the literature. The purpose of this article is to present an update on the diagnosis and treatment of this pathology when affecting the central nervous system, through the review of the current evidence. Conclusion: However, despite complete surgical resection, there is about a significative high rate of local recurrence and metastasis. Careful patient follow-up and staging is essential for better characterization and understanding of this tumor's behavior.

Cáncer de mama asociado a síndrome de Poland / Breast cancer associated with Poland syndrome

Introducción: El síndrome de Poland es una malformación congénita rara. Su incidencia varía de hasta un caso por cada 100.000 nacidos vivos. La etiología no está clara y se identifican varios factores relacionados con su etiopatogenia. Informes previos han demostrado la asociación con tumores malignos, como cáncer de pulmón, tumor de Wilms, leiomiosarcoma, leucemia, linfoma y cáncer de mama.Caso clínico: Paciente femenina de 56 años, de raza mestiza, con cuadro de un año de evolución caracterizado por tumoración de crecimiento progresivo en la mama izquierda. Al examen físico resaltaba una malformación anatómica del hemitórax y miembro superior izquierdo. El ultrasonido evidenció lesión nodular sólida hipoecoica e irregular (BIRADS IV), además de agenesia uterina y renal derecha. Se realizó mastectomía total izquierda con biopsia del ganglio centinela, cuya captación se presenció en la prolongación axilar contralateral. El reporte histopatológico reveló carcinoma ductal infiltrante grado histológico 2, ganglio centinela derecho positivo para carcinoma y ganglios axilares izquierdos sin metástasis.Conclusión: Los hallazgos clínicos se corresponden con los reportados para este síndrome; destaca el hallazgo de malignidad en la axila contralateral, lo cual plantea una duda diagnóstica y terapéutica. Todos los pacientes con síndrome de Poland deben ser cribados cuidadosamente para la detección temprana del cáncer.(AU)

Introduction: Poland syndrome is a rare congenital malformation. Its incidence ranges from 1 case per 100,000 live births. The aetiology is unclear, and several factors related to its etiopathogenesis have been identified. Previous reports have shown an association with malignant tumours such as lung cancer, Wilms tumour, leiomyosarcoma, leukaemia, lymphoma, and breast cancer.Case report: A 56-year-old mixed-race woman presented with a 1-year history of a progressively growing tumour in the left breast. Physical examination revealed an anatomical malformation of the left hemithorax and upper limb. Ultrasound showed a solid, nodular, hypoechoic and irregular lesion (BIRADS IV), as well as uterine and right renal agenesis. We decided to perform total left mastectomy and sentinel lymph node biopsy, which showed uptake in the contralateral axillary tail. The histopathology report revealed infiltrating ductal carcinoma, right sentinel lymph node positive for carcinoma, and left axillary lymph nodes without metastasis.Conclusion: The clinical findings correspond to those reported for this syndrome; a notable finding was the malignant tumour in the contralateral axilla, which raised a diagnostic and therapeutic dilemma. All patients with Poland syndrome should be carefully screened for early cancer detection.(AU)

Rosai-Dorfman-Destombes disease: isolated intracranial without nodal involvement presentation. Illustrative case.

BACKGROUND: Rosai-Dorfman-Destombes disease is a rare and heterogeneous entity that has been associated with autoimmune, hereditary, and malignant diseases. There is controversy about its etiopathogenesis, clinical course, and therapeutic management. OBSERVATIONS: The authors report a case of a 61-year-old man with a history of progressive headache without any other symptoms. Magnetic resonance imaging of the brain revealed multiple irregular lesions with an initial diagnostic impression of meningiomatosis. An excisional biopsy was performed, and the pathology report stated the finding was Rosai-Dorfman-Destombes disease. LESSONS: The uniqueness of this case is its rarity. The isolated intracranial location presents many diagnostic and therapeutic challenges, with radiological and clinical characteristics similar to those of other central nervous system tumors. There is currently no clear evidence of the pathogenesis and therapeutic management of this condition. Follow-up of these patients will help elucidate the natural history of this condition and the benefits of various treatment modalities.

Ganglio centinela en el cáncer de mama masculino: reporte de caso y revisión de la literatura / Sentinel lymph node in male breast cancer: case report and review of the literature

INTRODUCCIÓN: El cáncer de mama masculino representa <1% de todas las neoplasias malignas en hombres, y aunque comparte muchas similitudes con el cáncer de mama en las mujeres, tiene diferencias importantes. CASO CLÍNICO: Paciente masculino de 68años, de raza mestiza, que acude con cuadro clínico de 5meses de evolución caracterizado por lesión nodular en la región areolar de la mama izquierda acompañada de dolor ocasional y crecimiento progresivo. El ultrasonido evidenció lesión heterogénea de bordes irregulares con calcificaciones, BIRADSV. Se decidió hacer mastectomía más biopsia de ganglio centinela, con positividad en el transoperatorio, por lo que se completó la linfadenectomía axilar. El reporte de histopatología confirmó carcinoma ductal infiltrante, ganglio centinela y satélite positivo para carcinoma metastásico. CONCLUSIÓN: Varias incógnitas permanecen sobre el cáncer de mama en hombres. Es de importancia comprender mejor la biología de la enfermedad para lograr identificar las diferencias entre ambos géneros y así determinar si estas tienen implicaciones terapéuticas

INTRODUCTION: Male breast cancer accounts for <1% of all malignancies in men, and although it shares many similarities with breast cancer in women, it has important differences. CASE REPORT: A 68-year-old male patient presented with a 5-month history of a nodular lesion in the areolar region of the left breast accompanied by occasional pain and progressive growth. An ultrasound scan showed a heterogeneous lesion with irregular edges and calcifications, BIRADSV. It was decided to perform a mastectomy and sentinel lymph node biopsy, with positivity in the transoperative period, and axillary lymphadenectomy was completed. The histopathology report confirmed infiltrating ductal carcinoma, sentinel lymph node- and satellite-positive for metastatic carcinoma. CONCLUSION: Several questions remain unanswered about breast cancer in men. It is important to enhance understanding of the biology of the disease to identify the differences between the two sexes and thus determine if they have therapeutic implications

Carcinoma adenoneuroendocrino mixto de la ampolla de Vater: reporte de caso / Mixed adenoneuroendocrine carcinoma of the ampulla of Vater: case report

INTRODUCCIÓN: Los carcinomas adenoneuroendocrinos mixtos (MANEC) son tipos de tumores bifásicos, reconocidos morfológicamente ante la presencia de una formación neoplásica constituida de manera simultánea por epitelio glandular y células neuroendocrinas. Dentro del tracto gastrointestinal, estas neoplasias predominan en el estómago o el colon. Solo 19 casos localizados en la ampolla de Vater han sido reportados por la literatura. OBJETIVO: Reportar un caso de MANEC; revisar la epidemiología, pronóstico y tratamiento de estos tumores. MATERIALES Y MÉTODO: Presentación de caso clínico de una paciente con diagnóstico de adenocarcinoma neuroendocrino mixto de la región ampular. DISCUSIÓN: La presentación clínica, el manejo y el pronóstico son similares al del adenocarcinoma ampular. Se diagnostican con el examen histopatológico de la muestra resecada. Ambos componentes deben ser histológicamente malignos, y cada uno de ellos debe representar al menos el 30% de la lesión. CONCLUSIÓN: Los MANEC ampulares son tumores poco comunes a nivel mundial, siendo éste el primer caso reportado en nuestro instituto.

INTRODUCTION: Mixed adenoneuroendocrine carcinomas (MANEC) are types of biphasic tumors, morphologically recognized in the presence of a neoplastic formation constituted simultaneously by glandular epithelium and neuroendocrine cells. Only 19 cases located in the ampulla of Vater have been reported in the literature. Within the gastrointestinal tract, these neoplasms predominate in the stomach or colon. AIM: Report a case of MANEC; review of the epidemiology, prognosis and treatment of these tumors. MATERIALS AND METHOD: Case presentation of a patient diagnosed with mixed adeno-neuroendocrine carcinoma of the ampullary region. DISCUSSION: The clinical presentation, management and prognosis are similar to ampullary adenocarcinoma. These tumors are diagnosed with a histopathological examination of the resected specimen. Both components must be histologically malignant, and each of them must represent at least 30% of the lesion. CONCLUSION: MANEC of the ampulla are rare tumors worldwide, being this case the first reported in our institute.

Relation between serum uric acid levels with the degree of coronary artery disease: A prospective study from Ecuador / Relación entre los niveles séricos de ácido úrico y el grado de enfermedad arterial coronaria: un estudio prospectivo en Ecuador

To analyze the relationship between serum levels of uric acid and the severity of coronary disease. Methods: This observational, descriptive and cross-sectional study included 77 patients previously selected using inclusion criteria, from September 2014 to May 2015. It was conducted in a third level regional hospital from Guayaquil, Ecuador. Patients enrolled in this study were older than 30 years with coronary disease undergoing coronary angiography, without prior diagnosis of any other condition that could influence in serum uric acid values. Results: (1) Direct relation between serum uric acid levels and the severity of coronary disease, with a 0.600 Spearman correlation coefficient (p < 0.001); (2) other variables such as hypertension and medical history did not have an influence on the study's results; (3) serum uric acid levels didn't show difference among the different groups (p>0.05). Conclusions: Based on the results, it was possible to conclude that there is a relation between serum uric acid level and the severity of coronary artery disease; this relation was independent of clinical diagnosis and hypertension. According to this, serum uric acid levels can be taken as a practical and inexpensive parameter related to the severity of coronary artery disease. As a primary preventive intervention, we recommend maintaining levels within normal parameters in patients with cardiovascular risk

Objetivo: Analizar la relación entre los niveles séricos de ácido úrico y la severidad de la enfermedad coronaria. Métodos: Este estudio observacional, descriptivo y transversal incluyó 77 pacientes previamente seleccionados mediante criterios de inclusión, desde septiembre de 2014 a mayo de 2015. Se realizó en un hospital regional de tercer nivel de Guayaquil, Ecuador. Los pacientes incluidos en este estudio eran mayores de treinta años, con enfermedad coronaria sometidos a angiografía coronaria, sin diagnóstico previo de ninguna otra condición que pudiera influir en los valores de ácido úrico sérico. Resultados: 1) Relación directa entre los niveles séricos de ácido úrico y la gravedad de la enfermedad coronaria, con un coeficiente de correlación de Spearman de 0.600 (p < 0.001); 2) Otras variables como la hipertensión y el historial médico no influyeron en los resultados del estudio; 3) Los niveles séricos de ácido úrico no mostraron variabilidad entre los diferentes grupos (p > 0.05). Conclusiones: de acuerdo con los resultados, fue posible concluir que existe una relación entre el nivel sérico de ácido úrico y la severidad de la enfermedad coronaria; esta relación fue independiente del diagnóstico clínico y la hipertensión. De acuerdo con esto, los niveles séricos de ácido úrico se pueden tomar como un parámetro práctico y económico relacionado con la gravedad de la enfermedad arterial coronaria. Como intervención preventiva primaria, recomendamos mantener los niveles dentro de los parámetros normales en pacientes con riesgo cardiovascular

Relation between serum uric acid levels with the degree of coronary artery disease: A prospective study from Ecuador.

To analyze the relationship between serum levels of uric acid and the severity of coronary disease. METHODS: This observational, descriptive and cross-sectional study included 77 patients previously selected using inclusion criteria, from September 2014 to May 2015. It was conducted in a third level regional hospital from Guayaquil, Ecuador. Patients enrolled in this study were older than 30 years with coronary disease undergoing coronary angiography, without prior diagnosis of any other condition that could influence in serum uric acid values. RESULTS: (1) Direct relation between serum uric acid levels and the severity of coronary disease, with a 0.600 Spearman correlation coefficient (p<0.001); (2) other variables such as hypertension and medical history did not have an influence on the study's results; (3) serum uric acid levels didn't show difference among the different groups (p˃0.05). CONCLUSIONS: Based on the results, it was possible to conclude that there is a relation between serum uric acid level and the severity of coronary artery disease; this relation was independent of clinical diagnosis and hypertension. According to this, serum uric acid levels can be taken as a practical and inexpensive parameter related to the severity of coronary artery disease. As a primary preventive intervention, we recommend maintaining levels within normal parameters in patients with cardiovascular risk.

Manejo del Cáncer de Vejiga mediante cirugía convencional en Solca, experiencia 2012-2017 / Bladder Cancer Management through conventional surgery in Solca, experience 2012-2017

Introducción: El cáncer de vejiga es la más común de las patologías del tracto urinario. La importancia del estudio radica en el manejo quirúrgico de los pacientes con este tipo de neoplasias vesicales que en ciertos casos con diagnóstico temprano suelen ser curativo. La técnica quirúrgica empleada de acuerdo al tipo histológico de los pacientes con cáncer de vejiga de este reporte fue el objetivo principal de este estudio. Métodos: El presente es un estudio retrospectivo, fue realizado desde enero 2012 a julio 2017 en el que se revisaron las historias clínicas de los pacientes con diagnóstico de cáncer de vejiga atendidos en el Servicio de Urología Oncológica del Instituto Oncológico Nacional "Dr. Juan Tanca Marengo", Solca-Guayaquil. Se incluyeron pacientes operados dentro de la institución, con diagnóstico de cáncer de vejiga a quienes se les realizó Cistectomía radical más Bricker o Neovejiga. Se excluyeron pacientes con cáncer de vejiga oncológicamente no operables, casos clínicos con falta de información completa en la historia clínica, con exámenes diagnósticos incompletos. Se realizó un análisis estadístico descriptivo con porcentajes. Resultados: Ingresaron al estudio 89 casos, 53 (59.6 %) fueron hombres, 16 pacientes (18 %) con Cáncer de Vejiga de Bajo Grado Infiltrante a Lámina Propia (CABILAPRO), 1 paciente (1.1 %) con Cáncer de Vejiga de Bajo Grado Infiltrante a Muscular (CABIMUS), 5 pacientes (5.6 %) con Cáncer de Vejiga de Alto Grado Infiltrante a Lamina Propia (CALAPRO) y 63 pacientes (70.8 %) con Cáncer de Vejiga de Alto Grado Infiltrante a Muscular (CALMUS), Cáncer de Vejiga de Alto Grado Infiltrante a Grasa Perivesical 3 (3.4 %), de los cuales presentaron recidiva local pos tratamiento por CALMUS 13 (14.6 %), 1 rabdosarcoma. Tratamiento quirúrgico del CALMUS 18 cirugías con derivación Bricker y 7 Neo-vejigas orto tópicas. Se realizaron RTUv en 50 pacientes (56.2 %). Conclusión: La cirugía de cistectomía más derivación Bricker se realizó en menos de un cuarto de la población estudiada, la cirugía RTUv fue la más prevalente.

Introduction: Bladder cancer is the most common of the pathologies of the urinary tract. The importance of the study lies in the surgical management of patients with this type of bladder neoplasms that in certain cases with early diagnosis are usually curative. The surgical technique used according to the histological type of patients with bladder cancer in this report was the main objective of this study. Methods: This is a retrospective study, carried out from January 2012 to July 2017, in which the clinical histories of patients diagnosed with bladder cancer treated at the Oncology Urology Service of the National Oncological Institute "Dr. Juan Tanca Marengo ", Solca-Guayaquil. Patients operated on within the institution were included, with diagnosis of bladder cancer who underwent radical cystectomy plus Bricker or Neovejiga. Patients with oncologically inoperable bladder cancer were excluded, clinical cases with lack of complete information in the clinical history, with incomplete diagnostic tests. A descriptive statistical analysis was performed with percentages. Results: 89 cases were included in the study, 53 (59.6%) were men, 16 patients (18%) with Low-Grade Infiltrating Bladder Cancer (CABILAPRO), 1 patient (1.1%) with Low-grade Bladder Cancer Infiltrant to Muscular (CABIMUS), 5 patients (5.6%) with High-Grade Infiltrating Bladder Laminal Cancer (CALAPRO) and 63 patients (70.8%) with High-Grade Infiltrating Muscle Bladder Cancer (CALMUS), Cancer High Grade Infiltrant to Perivesical Fat Bladder 3 (3.4%), of which local recurrence after treatment by CALMUS 13 (14.6%), 1 rhabdosarcoma. Surgical treatment of CALMUS 18 surgeries Bricker and 7 Neo-bladders orthotopic. TURb was performed in 50 patients (56.2%). Conclusion: Bricker surgery was performed in less than a quarter of the study population, TURb surgery was the most prevalent.

Infección del sitio quirúrgico en neurocirugía / Surgical site infection in neurosurgery

Se define como infección del sitio quirúrgico a toda aquella que ocurre en la incisión quirúrgica o cerca de la misma, pudiendo extenderse hacia estructuras adyacentes más profundas. Por lo general tienen baja incidencia y están asociadas con altas tasas de morbimortalidad, hospitalización prolongada, reintervención y mayores costos. Representan del 20 al 31% de todas las infecciones adquiridas en el hospital. Se identifican elementos de riesgo específicos del paciente y del entorno quirúrgico, los mismos que por lo general se superponen y coadyuvan. La etiología es multifactorial siendo la fuente más común de contaminación la flora endógena de la piel del paciente. Debido a que son varios los factores contribuyentes al desarrollo de infección del sitio quirúrgico, la prevención es compleja y requiere de la integración de medidas antes, durante y después de la cirugía. El objetivo de este trabajo es presentar un repaso actual de la epidemiología, incidencia y factores de riesgo asociados a infección del sitio quirúrgico posterior a procedimientos neuroquirúrgicos. Además, ofrecer recomendaciones basadas en la evidencia sobre estrategias y protocolos para el manejo y prevención de esta condición que con relativa frecuencia es vista en centros hospitalarios.

Surgical-site infections are infections that occur either in, or in close proximity to a surgical incision, and can spread to deeper, adjacent structures. Their incidence is considerable, and they are associated with high morbidity and mortality rates, prolonged hospitalization, the increased need for re-intervention, and higher costs. They represent 20% to 31% of all infections acquired in hospitals. Several risk factors specific to the patient and surgical environment have been identified, and these often overlap. The etiology of surgical-site infections is multi-factorial, the most common source of contamination being the endogenous flora of the patient's skin. Since several factors contribute to the development of surgical site infections, prevention is complex and requires integrating measures before, during and after surgery. The main objective of the current paper is to review the epidemiology, including the incidence of and risk factors for surgical-site infections after neurosurgical procedures. In addition, we provide evidence-based recommendations on strategies and protocols for the management and prevention of frequently-observed complications in hospital settings.

Cognitive Impairment in Rural Elderly Population in Ecuador.

INTRODUCTION: The Mini-Cog is a simple and short test that identifies cognitive impairment. Its detection helps provide an early dementia diagnosis, rapid access to treatments, and even delay or reversion. MATERIALS AND METHODS: This multicenter, observational, descriptive, and cross-sectional study included 214 patients. Patients enrolled in this study were community dwellers aged ≥55-year-old, without prior diagnosis of cognitive impairment or dementia, with adequate hearing and vision functions. It was conducted in primary care health centers localized in rural communities of Ecuador. RESULTS: Ages ranged from 50 to 98 years and there was predominance of female gender: 66% versus 33%. The percentage of illiteracy was 26.4% (CI: 25.32-27.48), and 63% (CI: 62.1-63.94) of patients had complete primary educational level. The overall prevalence of cognitive impairment was 50.9% (95% CI: 48.5-53.3) and 47.2% (95% CI: 45.2-49.2) in patients with risk factors. We found several established risk factors associated with cognitive impairment onset, including social factors, physiological factors, and comorbidities. CONCLUSION: This is the first epidemiological research of CI in rural populations in this country using the Mini-Cog as a screening tool. Adopting public health measures for the prevention and control of those modifiable risk factors could reduce the prevalence of cognitive impairment and even its progression to dementia.