Management of the hemophilic pseudotumor of the abdomen: A rare pathological entity.

INTRODUCTION: Hemophilic pseudotumor is a rare complication that occurs in patients with severe hemophilia. Results from multiple episodes of bleeding into the bones and soft tissues. PRESENTATION OF CASE: A 31 years old male patient, with severe hemophilia A. Diagnosed with an abdominal tumor 10 years ago during routine screening, that progressively grew to encompass the entire abdominal area, with symptoms of intestinal obstruction. DISCUSSION: Hemophilic pseudotumor appears as a painless tumor of slow growth that can compress vital organs producing bone destruction, muscle and skin necrosis. The tumor may have fistulas or break spontaneously. CONCLUSION: The abdominal hemophilic pseudotumor is a rare pathological entity, with few reports worldwide, but must be considered in hemophilic patients with a well documented abdominal tumor.

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.

[Splenectomy in autoimmune hematological diseases. Comparative study between laparoscopic and open technique]. / Esplenectomía en pacientes con enfermedades hematológicas autoinmunes. Estudio comparativo entre técnicas laparoscópica y abierta.

BACKGROUND: We undertook this study to compare the outcome of laparoscopic and open splenectomy in the treatment of hematological diseases. METHODS: This was a comparative study of two groups of patients. The study sample consisted of 37 patients divided into two groups: group I, open splenectomy (OS) and group II, laparoscopic splenectomy (LS). Twenty one consecutive patients with LS were compared to 16 randomized patients selected from clinical records of OS patients. General and specific variables were collected in Microsoft Access database and analyzed in SPSS for Windows statistical program. Statistical analysis was done. RESULTS: Of 25 women and 12 men (37.2 +/- 16.9 years old), 6 had autoimmune hemolytic anemia, 29 idiopathic thrombocytopenic purpura (ITP), and two had Evans syndrome. Patients with ITP had preoperative platelet count of 74.6 +/- 64.1/mm(3) and patients with autoimmune hemolytic anemia had a preoperative hemoglobin of 10.6 +/- 2.9 g/dl. Ten patients had co-morbidity. There were 16 OS and 21 LS. Size of spleen was 13.1 +/- 3.7 cm and weight was 178 +/- 115 g. Surgical time for OS was 69.3 +/- 21.7 min and for LS was 152.8 +/- 61.1 min (p <0.05). Operative bleeding for OS was 300 +/- 265 ml and for LS it was 265 +/- 198 ml (p >0.05). One patient in LS group had red cell transfusion and two in the same group had to be converted to OS to reassure hemostasis. Reoperations had to be done in the OS group, two to control bleeding and one with a left lobe hepatic hematoma. There was no mortality. Postoperative platelet count in patients with ITP increased to 246 +/- 159 and hemoglobin in patients with hemolytic anemia increased to 12.1 +/- 3.6 g (p <0.05). Hospital stay in OS was 5.06 +/- 3.6 days vs. 2.06 +/- 0.26 in LS (p <0.05). Patients in OS had 30.6 +/- 10.5 lost work days vs. 15.5 +/- 4.6 in LS group (p <0.05). CONCLUSIONS: It is possible to treat patients with hematological diseases with LS. LS is time-consuming compared to OS. Morbidity in LS may be less than in OS. Mortality may be zero. Hospital stay and postoperative lost work days are less in LS than with OS. LS may be the gold standard in treatment of patients with hematological diseases.