Carcinoma de tiroides: Descripción de 634 pacientes atendidos en el Hospital Universitario San Ignacio, Bogotá, D. C., Colombia / Thyroid carcinoma: Description of 634 patients treated at the Hospital Universitario San Ignacio, Bogotá, D. C., Colombia

Introducción. La incidencia del carcinoma de tiroides ha aumentado a nivel mundial, probablemente relacionado con el sobre diagnóstico de nódulos tiroideos asintomáticos. La alta sobrevida del carcinoma diferenciado de tiroides ha permitido posibilidades de manejo quirúrgico menos radicales, o inclusive, la vigilancia activa de tumores seleccionados. Existen reportes de características clínico-patológicas del carcinoma de tiroides de nuestro país distintas a las reportadas en la literatura internacional. Métodos. Estudio observacional descriptivo de una cohorte retrospectiva de pacientes con carcinoma de tiroides atendidos en un hospital universitario entre 2015 y 2020. Resultados. Se identificaron 634 pacientes, el 83,4 % de sexo femenino. La tiroidectomía total con vaciamiento central fue el procedimiento más realizado (86,7 %). De 613 carcinomas diferenciados de tiroides, el 94,2 % corresponden al tipo papilar, seguido por el carcinoma de células de Hürtle (1,6 %); el 26,2 % presentaron subtipos histológicos agresivos y el 28,4 % compromiso tumoral bilateral. En los vaciamientos centrales se encontró 58,7 % de enfermedad metastásica; que fue de 49 % en los pacientes con microcarcinomas papilares (19 %). De las 68 lesiones del nervio laríngeo recurrente, 47 % fueron por secciones oncológicas. Discusión. En nuestra serie, la proporción de pacientes con carcinoma papilar de tiroides y de sus variantes histológicas agresivas, así como el compromiso tumoral bilateral es mayor a lo reportado en la literatura científica. Conclusión. El comportamiento biológico del carcinoma de tiroides es variable y puede tener características diferentes entre regiones; el manejo en nuestro medio debería considerar las características propias de nuestra población.

Introduction. The incidence of thyroid carcinoma has increased worldwide, probably related to the overdiagnosis of asymptomatic thyroid nodules. The high survival of differentiated thyroid carcinoma has allowed less radical surgical resection or even active surveillance for selected tumors. There are reports of clinicopathological features of thyroid carcinoma in our country that are different from those reported in the international literature. Methods. Retrospective observational study of a cohort of patients with thyroid carcinoma treated at a university hospital between 2015 and 2020. Results. 634 patients were identified; 83.4% were female. Total thyroidectomy with central dissection was the most performed procedure (86.7%). Of the 613 differentiated thyroid carcinomas, 94.2% were papillary type, followed by Hürtle cell carcinoma with 1.6%; 26.2% presented aggressive histological subtypes and 28.4% had bilateral tumor involvement. Metastatic disease was found in 58.7% of the central dissections performed, which was 49% in patients with papillary microcarcinomas (19%). Of the 68 recurrent laryngeal nerve injuries, 47% were due to oncological involvement. Discussion. In our series, the rate of patients with papillary thyroid carcinoma and its aggressive histological subtypes as well as bilateral tumor involvement is higher than that reported in the scientific literature. Conclusion: The biological behavior of thyroid carcinoma is variable and may have different characteristics between regions; the management in our country should consider our population's characteristics.

Clinical Characteristics of Children With SARS-CoV-2 Infection in a Hospital in Latin America.

Objective: COVID-19 infections have shown a different behavior in children than in adults. The objective of this study was to describe the clinical characteristics and severity of SARS-CoV-2 infection in pediatric patients seen at a reference hospital in Colombia. Method: A descriptive, observational study in patients under the age of 18 years with a positive test for SARS-CoV-2 infection (RT-PCR or antigen) between April 2020 and March 2021. Multiple variables were studied, including demographic data, clinical characteristics, lab measurements, treatments administered, intensive care unit admission, and mortality. Results: A total of 361 patients were included of whom 196 (54%) were males. The median age was 3 years. Of all the patients, 65 (18%) were asymptomatic. The majority of patients had no comorbidities (n = 225, 76%). In those who were symptomatic (n = 296, 82%), the most frequent complaints were fever (n = 178, 60%), nasal congestion (n = 164, 55%) and cough (n = 149, 50%). Chest x-rays were normal in 73 patients (50%). When abnormalities were found, interstitial (29%) and alveolar (12%) patterns were the most prevalent. One hundred and fifty-seven children (53%) required general ward hospitalization, and 24 patients (8%) required pediatric intensive care admission. The global mortality was 0.8% (3 patients). Conclusions: The majority of cases were asymptomatic or mild. However, a significant percentage of patients required general ward admission, and some even required intensive care. The main symptom of COVID-19 infections in newborns was apnea. A second COVID-19 RT-PCR may be necessary to detect infections in critically ill patients with a high clinical suspicion of the disease if an initial test was negative.

Trasplante renal en paciente con pared abdominal compleja: síndrome de abdomen en ciruela pasa / Kidney transplant in a patient with a complex abdominal wall: Prune belly syndrome

Introducción. Se presenta un paciente con falla renal crónica secundaria a hidroureteronefrosis bilateral, con antecedente de síndrome de abdomen en ciruela pasa (prune belly), en quien se realiza trasplante renal. El objetivo de este reporte de caso es exponer una anomalía congénita, con baja incidencia mundial y en menor proporción asociado a trasplante renal, con énfasis en la dificultad para la técnica quirúrgica dada por la hipoplasia de los músculos de la pared abdominal. Métodos. Revisión de Historia clínica, Consentimiento Informado. Búsqueda de la literatura.Caso clínico. En cirugía se identifica ausencia de músculos de la pared abdominal y fibrosis de las venas Iliaca externa y común derecha. Se realiza abordaje bajo técnica de Gibson contralateral, con trasplante renal sin complicaciones. Presentó adecuada evolución en seguimiento ambulatorio. Discusión. El síndrome de abdomen en ciruela pasa (prune belly) es una anomalía congénita de baja incidencia, con pocos reportes asociados a trasplante renal. El reto quirúrgico está dado por la ausencia de músculos de la pared abdominal, que aumentan los riesgos por posibles complicaciones, como la lesión de los vasos epigástricos inferiores. Para el cierre de pared abdominal en trasplante renal, se describe en dos planos, que en este caso se realiza sobre fascia muscular y piel. Aun siendo un reto, el paciente presenta adecuada evolución postoperatoria

Introduction. We present a patient with chronic renal failure secondary to bilateral hydroureteronephrosis, with a history of prune belly syndrome, who underwent a kidney transplant. The objective of this case report is to expose a congenital anomaly, with a low worldwide incidence and to a lesser extent associated with kidney transplantation, with emphasis on the difficulty for the surgical technique due to the hypoplasia of the abdominal wall muscles.Methods. Review of clinical history, Informed Consent. Literature search.Clinical case. Absence of abdominal wall muscles and fibrosis of the external iliac veins and right common veins were identified intraoperatively. An approach was performed under the contralateral Gibson technique, with uncomplicated kidney transplantation. He presented adequate evolution in outpatient follow-up.Discussion. Prune belly syndrome is a low-incidence congenital anomaly, with few reports associated with kidney transplantation. The surgical challenge is given by the absence of abdominal wall muscles, which increases the risks due to possible complications, such as injury to the inferior epigastric vessels. For the closure of the abdominal wall in kidney transplantation, it is described in two planes, which in this case is performed on muscle fascia and skin. Despite being a challenge, the patient has adequate postoperative evolution