Hemorrhagic shock secondary to ruptured hypogastric artery pseudoaneurysm. A rare complication of colorectal anastomotic leakage.

Massive bleeding due to rupture of hypogastric artery pseudoaneurysm is an exceptional complication of colorectal anastomotic leakage. A 41-year-old woman with history of rectal cancer surgery, who debuted with massive rectorrhagia and hypovolemic shock due to rupture of a hypogastric artery pseudoaneurysm as a late complication of a colorectal anastomosis leak. The ruptured hypogastric artery pseudoaneurysm should be taken into account in the differential diagnosis of patients with massive rectorrhagia and history of colorectal anastomosis leak. Endovascular embolization is considered the first-line treatment.

La hemorragia masiva por rotura de un pseudoaneurisma de la arteria hipogástrica es una complicación muy rara de la fuga anastomótica colorrectal. Mujer de 41 años con antecedentes de cirugía por cáncer de recto, que debutó con un cuadro de rectorragias masivo y shock hipovolémico secundario a la rotura de un pseudoaneurisma de la arteria hipogástrica como complicación tardía de una fuga de la anastomosis colorrectal. La rotura de un pseudoaneurisma de la arteria hipogástrica se debe tener presente en el diagnostico diferencial de pacientes con rectorragia masiva y antecedentes de dehiscencia de anastomosis colorrectal. La embolización endovascular es actualmente el tratamiento de elección.

Post-vaccination SARS-CoV-2 axillary adenopathy. Differences with axillary metastases from breast cancer.

The differential diagnosis of the metastatic axillary lymphadenopathies of breast cancer with which they occur secondary to the Pfizer-BioNTech vaccine against COVID-19, is imperative. In a series of cases, we analyzed the characteristics of unilateral axillary lymphadenopathy in patients after Pfizer-BioNTech vaccination. Axillary lymphadenopathy were observed ipsilateral to the vaccination arm. The axillary ultrasound defined these as reactive and that they disappeared in 3 weeks. The pathological findings were benign. The anamnesis, the place and date of vaccination and the radiological findings, play an essential role to carry out a correct differential diagnosis and follow-up of these adenopathies.

El diagnóstico diferencial de las adenopatías axilares metastásicas del cáncer de mama con las que se producen secundarias a la vacuna de Pfizer-BioNTech contra la COVID-19 es imperioso. Analizamos una serie de casos con las características de las adenopatías axilares unilaterales tras la administración de la vacuna de Pfizer-BioNTech. Se observaron adenopatías axilares homolaterales al brazo de vacunación. La ecografía axilar las definió como reactivas y que desaparecían en 3 semanas. Los hallazgos anatomopatológicos fueron de benignidad. La anamnesis, el lugar y la fecha de vacunación, así como los hallazgos radiológicos, desempeñan un papel esencial para realizar un correcto diagnóstico deferencial y el seguimiento de estas adenopatías.

Cytomegalovirus colitis: a cause of severe lower gastrointestinal bleeding.

Cytomegalovirus infection is an uncommon illness that mainly affects immunocompromised subjects being associated with high morbidity and mortality rates. Reactivation or reinfection of the virus causes various symptoms ranging from asymptomatic forms to severe organ-specific complications, such as severe lower gastrointestinal bleeding. Once diagnosed the infection it is important and necessary to establish an adequate treatment with antivirals, with the surgical option for those cases with gastrointestinal complications depending on the patients clinical situation. We report two cases of immunocompromised patients that after presenting rectal bleeding, were diagnosed of cytomegalovirus colitis, requiring urgent surgery.

La infección por citomegalovirus es poco frecuente, afecta sobre todo a sujetos inmunocomprometidos y los pacientes de este grupo tienen una alta morbilidad y mortalidad. La clínica de la reactivación o reinfección del virus puede variar desde formas asintomáticas hasta complicaciones graves específicas de órgano, como la hemorragia del tracto gastrointestinal masiva. Es de vital importancia un tratamiento adecuado con antivirales; la opción quirúrgica se reserva para las complicaciones gastrointestinales de acuerdo con la situación clínica del paciente. Se presentan los casos de dos pacientes inmunocomprometidas que luego presentar episodios de rectorragia se diagnostican con colitis por citomegalovirus que exige tratamiento quirúrgico.

[Uso de los valores de hormona paratiroidea intranodular obtenidos por punción con aguja fina como factor predictivo de hipoparatiroidismo posoperatorio]. / Use of intranodular parathyroid hormone values obtained by fine needle aspiration as a predictive factor of postoperative hypoparathyroidism.

OBJETIVO: Análisis de los valores de hormona paratiroidea (PTH) intranodular obtenidos por punción con aguja fina como factor predictivo de hipoparatiroidismo posoperatorio. MÉTODO: De los 157 pacientes a los que se realizó la medición de la PTH intranodular, se estudiaron 37 que fueron intervenidos quirúrgicamente, estableciendo 15 variables para analizar: edad, sexo, tiempo de evolución, tamaño, cirugía de tiroides asociada, tratamiento preoperatorio con calcimiméticos, litiasis renal, densitometría ósea, aclaramiento de creatinina, calcio y PTH preoperatorios, PTH determinada tras punción con aguja fina, descenso de la PTH intraoperatoria, calcio posoperatorio y malignidad de la tumoración. Estas se compararon con la prueba de ji al cuadrado o el test exacto de Fisher, siendo significativa una p < 0.05, construyéndose así un análisis de regresión logística. RESULTADOS: El uso de calcimiméticos previo a la cirugía, la PTH preoperatoria > 88 pg/dl, el calcio preoperatorio > 12 mg/dl, los valores de PTH intranodular > 2700 pg/dl, el descenso de la PTH intraoperatoria a < 15 pg/dl y el calcio posoperatorio < 8,5 mg/dl fueron variables independientes significativas en el análisis univariante (p < 0.05) para la predicción del hipoparatiroidismo posoperatorio. CONCLUSIONES: Los valores de PTH intranodular pueden predecir qué pacientes tienen mayor riesgo de sufrir un hipoparatiroidismo posoperatorio. Este factor debe tenerse en cuenta durante el estudio y el seguimiento de los pacientes para identificar precozmente posibles complicaciones. OBJECTIVE: To analize if parathyroid hormone (PTH) washout levels can be considered a predictive factor of postoperative hypoparathyroidism and determine its importance relative to other features already known as intraoperative PTH, Ca and PTH preoperative, and others. METHOD: Of the 157 patients to whom a fine needle aspiration (FNA) biopsy with intranodular parathyroid hormone level measurement was performed (washout PTH) 37 who underwent surgery were studied. 15 variables were taken into account when selecting patients for this study: age, gender, evolution length, size, associated thyroid surgery, preoperative treatment with calcimimetics, presence of renal lithiasis, bone densitometry alterations, creatine clearance, preoperative calcium and PTH levels, PTH scores obtained by fine needle aspiration, intraoperative PTH decrease, postoperative calcium levels and tumour malignancy. We compare the nominal values, using the Chi squared or the exact Fisher test, where p < 0.05 was considered statistically significant and perform a logistic regression analysis. RESULTS: The use of calcimimetics prior to surgery, the preoperative PTH level above 88 pg/dl, the preoperative calcium above 12 mg/dl, washout PTH above 2700 pg/dl, intraoperative PTH level decrease below 15 pg/dl, and postoperative calcium levels under 8.5 mg/dl were all independently significant variables in the univariant analysis (p < 0.05) in order to establish an early postoperative hypoparathyroidism. The rest of the variables were not statistically significative. CONCLUSION: The PTH washout levels can predict the appearance of postoperative hypoparathyroidism. This factor must be taken into account during the study and follow-up to identify possible complications and establish an adequate treatment on time.

The value of thyroperoxidase as a prognostic factor for differentiated thyroid cancer -- a long-term follow-up study.

BACKGROUND: Thyroperoxidase (TPO) is a membrane-bound protein essential for the production of thyroid hormones; because of this, TPO expression may be impaired in selected thyroid diseases. The goal of this study is to analyze TPO immune expression in differentiated thyroid cancer, and to determine whether TPO has any prognostic value. METHODS: A total of 139 patients who required surgery due to a thyroid nodule with signs or symptoms suspicious for malignancy during their physical, ultrasound and/or cytology examination were consecutively selected for the study. A study of TPO immunohistochemical expression was carried out on these patients using the MoAb47 monoclonal antibody. In addition, cell proliferation marker Ki67 and tumor suppressor p53 were also measured for comparison. RESULTS: A total of 139 cases, 43 benign tumors, 42 papillary carcinomas, 38 follicular carcinomas, 8 undifferentiated carcinomas, and 8 sporadic medullary carcinomas were analyzed. The relationship between TPO expression and disease was statistically significant (p <0.001), and decreased with tumor dedifferentiation extent. Increased TPO expression in benign lesions as compared to decreased expression in papillary carcinomas and undifferentiated tumors is outstanding. Differences in TPO expression were observed in minimally invasive follicular carcinoma (MIFC) compared to widely invasive follicular carcinoma (WIFC). TPO expression decreases in undifferentiated malignancies in contrast with p53 and Ki67 expression, which increases in that setting. TPO, p53 and Ki67 expression was significantly related to TNM stage (p <0.001). Survival rate was 72 % after a 20-year follow-up, and 100 % for subjects with higher TPO expression. CONCLUSIONS: TPO may be useful in confirming or ruling out benign diseases from differentiated thyroid carcinoma, with the exception of low-risk carcinoma such as MIFC. It could be used as a prognostic factor for differentiated thyroid cancer and patient follow-up, together with other markers.

Remission of female sexual dysfunction in morbidly obese female patients with the Scopinaro procedure.

BACKGROUND: The prevalence of obesity has increased in Spain in recent years. Obese women are at increased risk for sexual dysfunction, and important remission of this condition has been previously reported with bariatric surgery. OBJECTIVES: The major aim of this study was to assess the effects of the Scopinaro biliopancreatic diversion on female sexual dysfunction (FSD) using a validated Female Sexual Function Index (FSFI). METHODS: Eighty sexually active women with morbid obesity and with FSD underwent surgery. All patients completed the FSFI before surgery, as well as 6 and 12 months after surgery. The FSFI evaluates the sexual function using 6 items: desire, arousal, lubrication, orgasm, satisfaction, and pain. We used a<26.5 cut-point to assess the presence of FSD. This cut-point is used as a standard for the investigation. RESULTS: Before surgery, all patients had FSD (mean 19.9±1.6). Six months after surgery, the FSD improved (mean 25.4±4.1; P<.001), and 12 months after surgery FSD resolved in most of the patients (mean 30.4±3.5; P<.001). All of the parameters evaluated by the FSFI (P<.001) improved significantly in all patients. CONCLUSION: FSD improved significantly 6 months after biliopancreatic diversion among obese women with preoperative sexual dysfunction and continued improving up to 12 months later.

Radioterapia en sarcoma de Kaposi / Radiotherapy in Kaposi's sarcoma

Se revisó la experiencia en el tratamiento de pacientes con sarcoma de Kaposi atendidos de 1991 a 1993 en el Departamento de Radioterapia del Hospital de Oncología del Centro Médico Nacional Siglo XXI, IMSS. Fueron tratadas 30 lesiones de sarcoma de Kaposi en 23 pacientes, 18 de ellos con síndrome de inmunodeficiencia adquirida (SIDA) y los cinco restantes con sarcoma de kaposi clásico. La técnica de tratamiento se llevó a cabo utilizando campos localizados que cubren con sarcoma de kaposi clásico. La técnica de tratamiento se llevó a cabo utilizando campos localizados que cubren con margen de dos cm la lesión tumoral. La dosis utilizada fue en promedio de 8 Gray (Gy) en una sesión, hasta 36Gy en 18 sesiones, la localización más frecuente fue en miembros inferiores y cavidad oral. El porcentaje de respuestas objetivas fue de 96 por ciento y las respuestas completas se obtuvieron en 93 por ciento de las lesiones tratadas. La radioterapia para el manejo de pacientes con Sarcoma de Kaposi, clásico y epidémico asociado a SIDA, logra altos índices de control local y es una alternativa para el manejo de pacientes que tienen SIDA con esta entidad, para inducir excelentes aplicaciones