Abdominal aortic aneurysm characteristics and outcomes: a single-center retrospective cross-sectional study.

OBJECTIVE: The objective of the study is to evaluate the characteristics and outcomes of patients with abdominal aortic aneurysm (AAA) and its correlation with mortality in the first 30 days after the procedure was performed. METHODS: Demographic information, clinical and radiological characteristics, as well as outcomes 30 days after the procedure was performed were assessed and compared. Continuous variables were analyzed with Student's t-test and categorical with Chi-square and Fisher's exact test. RESULTS: Duration of the procedure (p = 0.001), blood loss (p < 0.001), age > 75 years (p = 0.027), aneurysm size > 65 mm (p = 0.01), open surgery (p = 0.001), presence of pain (p = 0.005), chronic kidney disease (p = 0.03), and rupture of the aneurysm (p < 0.001) were the factors significantly associated with mortality. CONCLUSION: It is essential that patient characteristics and comorbidities are assessed, as well as factors that may affect the outcomes to predict the prognosis in patients with AAA. At present, no mortality predictive model is universally applicable and highly variable performance across different populations might need a model that adapts to the population of interest.

OBJETIVO: Evaluar las características y resultados de los pacientes con aneurisma de aorta abdominal y su correlación con la mortalidad en los primeros 30 días después de realizado el procedimiento. MÉTODOS: Se evaluó y comparó la información demográfica, las características clínicas y radiológicas, así como los resultados a los 30 días de realizado el procedimiento. Las variables continuas se analizan con la prueba de t de Student y las categóricas con Chi-cuadrado y la prueba exacta de Fisher. RESULTADOS: La duración del procedimiento (p = 0.001), pérdida de sangre (p < 0.001), edad > 75 años (p = 0.027), tamaño del aneurisma > 65 mm (p = 0.01), cirugía abierta (p = 0.001), presencia de dolor (p = 0.005), enfermedad renal crónica (p = 0.03) y rotura del aneurisma (p < 0.001) fueron los factores asociados significativamente a la mortalidad. CONCLUSIÓN: Es fundamental evaluar las características de los pacientes y las comorbilidades, así como los factores que pueden afectar los resultados para predecir el pronóstico en pacientes con aneurisma de aorta abdominal. En la actualidad, ningún modelo predictivo de mortalidad es universalmente aplicable y la alta variabilidad de resultados entre diferentes poblaciones podría necesitar un modelo que se adapte a la población de interés.

Intestinal perforation associated with chlorine dioxide ingestion: an adult chronic consumer during COVID-19 pandemic.

COVID-19 pandemic is one of the most devastating worldwide crises in recent years. During this pandemic, people have been exposed to products that have not been proven to be safe and effective against COVID-19. We present an adult chronic consumer of chlorine dioxide, in which a fatal outcome is described. This case demonstrates that for people searching products to protect themselves from COVID-19, unregulated access to industrial disinfectants represents a dangerous alternative. To date, there is no scientific evidence to uphold the use of chlorine dioxide or chlorine derivatives as preventive or therapeutic agents against COVID-19. Researchers and general population must take into consideration the fatal possible consequences of not following communications and warnings from health authorities and government institutions.

Primary extra-gastrointestinal stromal tumor (EGIST) of the mesentery: Case report and review of literature.

INTRODUCTION: Gastrointestinal stromal tumors (GISTs) represent <1% of all gastrointestinal (GI) tumors. Extra-gastrointestinal stromal tumors (EGISTs) are mesenchymal tissue neoplasm arising outside the GI tract. This rare group comprises only 5% of all GISTs. This case demonstrates a rare entity in a patient with non-specific symptoms, a large tumor size and unremarkable past personal and family history. PRESENTATION OF CASE: We present a 45-year old man with non-specific symptoms who was diagnosed with a primary EGIST arising in the small bowel mesentery after surgery. The tumor was not compromising the GI tract and it was completely resected. The tumor was sent for pathological examination that confirmed the diagnosis. Histological examination revealed a 15 cm in diameter mass, comprised of spindle cells and high mitotic activity. Treatment with imatinib mesylate was initiated. DISCUSSION: There have been only a few previous reports of EGISTs arising from the small bowel mesentery. It is believed that EGISTs originate from cells with similar pathological characteristics and biological behaviour as the intestinal cells of Cajal. Such tumors are associated with poorer prognosis, lager tumor size and younger presentation than their GI counterparts. The preferred treatment is complete surgical resection. The addition of specific tyrosine kinase inhibitors such as imatinib mesylate is recommended for high risk patients. Even though morphological and immunohistochemical similarities between GISTs and EGISTs are described, their pathogenesis, incidence, genetic background, complications and prognosis are not completely known because they are extremely rare. CONCLUSION: EGISTs are very rare tumors which originate from cells outside the GI tract and are associated with a more aggressive biological behavior than their GI counterparts. These tumors may grow without any clinical implications and should be kept in mind in the differential diagnosis for patients presenting with an abdominal mass. Further studies are needed due to lack of large patient cohort studies and long-term follow-up regarding the prognosis and management of this rare pathology.

Preoperative and Postoperative Risk Stratification of Thyroid Papillary Microcarcinoma: A Comparative Study Between Kuma Criteria and 2015 American Thyroid Association Guidelines Risk Stratification.

Background: The incidence of micropapillary thyroid carcinoma (mPTC) has increased in the last decade. Active surveillance (AS) has been proposed as an alternative management for low-risk mPTC based on preoperative Kuma criteria. Controversy still exists on how to appropriately manage this group of patients, as some low-risk mPTC may harbor some postoperative features associated with disease recurrence as described in the 2015 American Thyroid Association (ATA) guidelines. Methods: We retrospectively reviewed 108 patients with histopathologic diagnosis of mPTC after surgery at a third level hospital in Mexico City from 2000 to 2018. Demographic and clinicopathologic data were analyzed as predictors for disease recurrence and/or metastatic disease (lymph node or distant). Comparison between group stratification based on preoperative Kuma criteria and postoperative 2015 ATA guidelines risk criteria for disease recurrence was performed. Measures of diagnostic accuracy were obtained for preoperative risk features according to the Kuma criteria. Results: Of 108 patients, 79 (73%) were classified as preoperative high-risk mPTC and 29 (27%) as low risk based on the Kuma criteria. Of these 79 high-risk patients, 38 (48%) were reclassified as low risk for disease recurrence, 12 (15%) as intermediate risk, and 29 (37%) remained as high risk based on the 2015 ATA risk criteria. Of the 29 preoperative low-risk patients, 19 (65.5%) remained as postoperative low risk for disease recurrence, 2 (7%) as intermediate risk, and 8 (27.5%) as high risk. Higher accuracy of preoperative risk features was obtained for lymph node and distant metastases, 84.2% and 97.2%, respectively. After multivariate analysis, age <40 years and microscopic extrathyroidal extension (ETE) were associated with higher risk for metastatic disease (lymph node or distant) in our cohort. Conclusions: Patients with mPTC under 40 years old and microscopic ETE are more prone to develop metastatic disease (lymph node or distant). One-third of our patients stratified as low-risk mPTC according to the Kuma criteria for AS had histopathologic features associated with a more aggressive clinical behavior or structural recurrence. In addition, lymph node and distant metastases are the preoperative risk features with the highest diagnostic accuracy for preoperative risk stratification.