Goiter surgery recommendations in sub-Saharan Africa in humanitarian cooperation.

Background: The standard treatment for endemic goiter is usually total thyroidectomy. In low- and middle-income countries, the management of thyroid disease, which is commonplace in fully developed countries, is not always possible. The purpose of this study is to establish a treatment algorithm to calculate the extent of thyroidectomy based on the risk factors of each patient. Methods: This is a retrospective observational study conducted during the period between 2017 and 2019. A total of 287 patients with thyroid pathology were treated in Maragua Hospital (Kenya). The results of surgical treatment were analyzed after the implementation of an individualized treatment protocol. Results: One hundred and sixty patients with different types of goiter underwent surgery: solitary nodule (54.4%), multi-nodular goiter (30.6%), diffuse goiter (10.6%), and intrathoracic goiter (3.8%). The techniques used were hemithyroidectomy (78.8%), Dunhill thyroidectomy (9.4%), bilateral subtotal thyroidectomy (6.9%), and total thyroidectomy (3.1%). There was no mortality. The surgical morbidity rate was 16% (only one major complication (3b)). Two cases of dysphonia were resolved in the first week. There were three cases of symptomatic hypocalcaemia, two of which resolved in the first week and the other of which was definitive. The follow-up at 6 months was 67%. The cancer rate found in the resection specimens was 5%. Discussion: The implementation of individualized surgical protocols for thyroid surgery in sub-Saharan Africa can improve outcomes. The cooperation projects can increase access to complex surgical treatment for patients with limited resources in low- and middle-income countries.

Cirugía del tracto urinario en pacientes con carcinomatosis peritoneal ovárica tratadas con citorreducción y quimioterapia intraperitoneal intraoperatoria hipertérmica / Urinary tract surgery in patients with ovarian peritoneal carcinomatosis treated with cytoreduction and hyperthermic intraoperative intraperitoneal chemotherapy

Introducción El objetivo del presente trabajo es describir nuestra experiencia en la cirugía del uréter y la vejiga en pacientes con carcinoma de ovario primario y recurrente sometidas a procedimientos de peritonectomía y administración de quimioterapia intraperitoneal intraoperatoria hipertérmica (HIPEC).Pacientes y método Sobre una base de datos prospectiva construida al comienzo del programa de carcinomatosis peritoneal en nuestro centro, se seleccionaron aquellas pacientes en las que fue preciso realizar maniobras quirúrgicas sobre uréter distal o la vejiga. Siete pacientes cumplían este requisito y fueron incluidas en el estudio. Desde diciembre de 2007 hasta abril de 2011 fueron incluidas para la realización de citorredución de máximo esfuerzo y HIPEC 81 pacientes diagnosticadas de carcinoma de ovario primario o recurrente. Resultados En siete pacientes, con una mediana de edad de 46 años (40-71), fue necesaria la realización de algún gesto quirúrgico sobre el uréter o la vejiga. Cuatro pacientes fueron intervenidas por recurrencia de la enfermedad ovárica y en otras 3 pacientes la indicación fue el rescate quirúrgico, tras cirugía no óptima en otro centro. En 4 de ellas existía afectación tumoral directa del tracto urinario inferior. Tres pacientes (42%) de la serie desarrollaron al menos una complicación postoperatoria. Conclusión La realización de procedimientos de peritonectomía que incluye la eventual resección del uréter o la vejiga y la posterior aplicación de HIPEC en un grupo seleccionado de pacientes con diseminación peritoneal por carcinoma de ovario puede realizarse con cifras razonables de morbilidad postoperatoria. Estos gestos quirúrgicos pueden ser necesarios para la consecución de una cirugía óptima (AU)

Introduction The objective of the present work is to describe our experience in the surgery of the ureter and bladder in patients with primary and recurrent ovarian cancer subjected to peritonectomy procedures and the administration of hyperthermic intraoperative intraperitoneal chemotherapy (HIIC).Patients and method Those patients who required surgical procedures on the distal ureter or bladder, were selected from a prospective data base constructed at the beginning of the peritoneal carcinomatosis program in our centre. Seven patients fulfilled this requirement and were included in the study. A total of 81 patients diagnosed with primary or recurrent ovarian cancer from December 2007 to April 2011 were included for maximum effort cytoreduction and HIIC. ResultsIt was necessary to perform some surgical manoeuvre on the ureter or bladder in seven patients, with a median age of 46 years (40-71). Four patients were operated on due to recurrence of the ovarian disease and in the other 3 patients the indication was surgical rescue after non-optimal surgery in another centre. There was direct tumour involvement of the lower urinary tract in 4 of them. Three patients (42%) in the series developed at least one postoperative complication. Conclusion The performing of peritonectomy procedures that include the eventual resection of the ureter or bladder, and the subsequent application of HIIC in a selected group of patients with peritoneal dissemination due to an ovarian carcinoma can be done with reasonable rates of postoperative morbidity. These surgical procedures may be necessary to achieve optimal surgery (AU)

[Urinary tract surgery in patients with ovarian peritoneal carcinomatosis treated with cytoreduction and hyperthermic intraoperative intraperitoneal chemotherapy]. / Cirugía del tracto urinario en pacientes con carcinomatosis peritoneal ovárica tratadas con citorreducción y quimioterapia intraperitoneal intraoperatoria hipertérmica.

INTRODUCTION: The objective of the present work is to describe our experience in the surgery of the ureter and bladder in patients with primary and recurrent ovarian cancer subjected to peritonectomy procedures and the administration of hyperthermic intraoperative intraperitoneal chemotherapy (HIIC). PATIENTS AND METHOD: Those patients who required surgical procedures on the distal ureter or bladder, were selected from a prospective data base constructed at the beginning of the peritoneal carcinomatosis program in our centre. Seven patients fulfilled this requirement and were included in the study. A total of 81 patients diagnosed with primary or recurrent ovarian cancer from December 2007 to April 2011 were included for maximum effort cytoreduction and HIIC. RESULTS: It was necessary to perform some surgical manoeuvre on the ureter or bladder in seven patients, with a median age of 46 years (40-71). Four patients were operated on due to recurrence of the ovarian disease and in the other 3 patients the indication was surgical rescue after non-optimal surgery in another centre. There was direct tumour involvement of the lower urinary tract in 4 of them. Three patients (42%) in the series developed at least one postoperative complication. CONCLUSION: The performing of peritonectomy procedures that include the eventual resection of the ureter or bladder, and the subsequent application of HIIC in a selected group of patients with peritoneal dissemination due to an ovarian carcinoma can be done with reasonable rates of postoperative morbidity. These surgical procedures may be necessary to achieve optimal surgery.

Tolerancia inmunológica en el trasplante hepático / No disponible

No disponible

[Spirometric evaluation of respiratory involvement in asymptomatic multinodular goiter with an intrathoracic component]. / Valoración espirométrica de la afectación respiratoria en el bocio multinodular asintomático con componente intratorácico.

Respiratory tract obstruction is underestimated in asymptomatic intrathoracic goiter. Our aim was to evaluate the involvement of the upper airway of asymptomatic patients with intrathoracic multinodular goiter, assessing the effect on respiratory function by means of spirometry. We selected 21 patients with asymptomatic intrathoracic goiter on whom a thyroidectomy had been performed. Spirometry was done in supine decubitus and in standing position before and 3 months after surgery. The preoperative study in decubitus showed mild obstruction in 4 cases (20%). In 2 of these cases this condition was also present in standing position (10%). Spirometry became normal after surgery in the 4 patients with obstruction. To conclude, spirometry in asymptomatic intrathoracic goiter shows mild obstruction of respiratory function in 10% to 20% of cases, depending on position. Surgery was associated with normalization of the abnormal parameters and an improvement in the remaining parameters. These data support the need to schedule surgery as soon as possible.

Valoración espirométrica de la afectación respiratoria en el bocio multinodular asintomático con componente intratorácico / Spirometric evaluation of respiratory involvement in asymptomatic multinodular goiter with an intrathoracic component

La obstrucción de la vía aérea se infravalora en el bocio intratorácico asintomático. Nuestro objetivo ha sido valorar mediante espirometría la afectación de la vía aérea superior y la repercusión en la función respiratoria de pacientes asintomáticos con bocio multinodular intratorácico. Para ello se seleccionó prospectivamente a 21 pacientes con bocio intratorácico asintomático a quienes se había practicado una tiroidectomía. Se realizó la espirometría en decúbito supino y en bipedestación antes y a los 3 meses de la cirugía. El estudio preoperatorio mostró en decúbito una afectación obstructiva leve en 4 casos (20%), en 2 de los cuales persistía en bipedestación (10%). Tras la cirugía se normalizó la alteración en los 4 casos. En conclusión, la espirometría en el bocio intratorácico asintomático muestra una afectación obstructiva leve de la función respiratoria en el 10-20% de los casos, en función de la postura. La cirugía se acompaña de la normalización de los parámetros alterados y de la mejoría del resto. Estos datos apoyan la necesidad de indicar la cirugía lo antes posible (AU)

Respiratory tract obstruction is underestimated in asymptomatic intrathoracic goiter. Our aim was to evaluate the involvement of the upper airway of asymptomatic patients with intrathoracic multinodular goiter, assessing the effect on respiratory function by means of spirometry. We selected 21 patients with asymptomatic intrathoracic goiter on whom a thyroidectomy had been performed. Spirometry was done in supine decubitus and in standing position before and 3 months after surgery. The preoperative study in decubitus showed mild obstruction in 4 cases (20%). In 2 of these cases this condition was also present in standing position (10%). Spirometry became normal after surgery in the 4 patients with obstruction. To conclude, spirometry in asymptomatic intrathoracic goiter shows mild obstruction of respiratory function in 10% to 20% of cases, depending on position. Surgery was associated with normalization of the abnormal parameters and an improvement in the remaining parameters. These data support the need to schedule surgery as soon as possible (AU)