Evaluación del desempeño diagnóstico del Índice de Riesgo de Malignidad II en mujeres con diagnóstico de masa anexial en un hospital de tercer nivel.

OBJETIVO: Evaluar la exactitud diagnóstica del Índice de Riesgo de Malignidad II (IRM II) en 100 pacientes con diagnóstico de masa anexial. MÉTODO: En una muestra de 100 pacientes con diagnóstico de masa anexial se cuantificaron variables demográficas y se aplicó el IRM II. Mediante una tabla 2 × 2 se obtuvieron la sensibilidad, la especificidad, el valor predictivo positivo, el valor predictivo negativo y la exactitud diagnóstica, y se compararon con el resultado histopatológico. RESULTADOS: El IRM II con resultado positivo se presentó en el 73.1% (52 pacientes) de los casos con resultado histopatológico maligno y en el 26.9% de aquellos con resultado histopatológico benigno. Presenta una sensibilidad en la prueba del 73.1%, una especificidad del 70.8%, un valor predictivo positivo del 73.2% y un valor predictivo negativo del 70.8%. La exactitud diagnóstica es del 72%. CONCLUSIONES: El IRM II es una herramienta de cribaje con aceptable desempeño diagnóstico para normar la conducta, como referir a un centro especializado o solicitar estudios más específicos en pacientes con diagnóstico de masa anexial por sospecha de malignidad. OBJECTIVE: Evaluate the usefulness of the Malignancy Risk Index II (MRI II) using diagnostic accuracy variables in 100 patients diagnosed with adnexal mass. METHOD: In a sample of 100 patients with a diagnosis of adnexal mass, demographic variables were quantified and MRI II was applied. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were obtained using a 2 × 2 table and compared with the histopathological result. RESULTS: MRI II with positive result was presented in 73.1% (52 patients) with malignant histopathological result and in 26.9% of patients with benign histopathological result. It presents a sensitivity in the test of 73.1%, a specificity of 70.8%, positive and negative predictive value of 73.2 and 70.8%, respectively. Diagnostic accuracy of 72%. CONCLUSIONS: MRI II is a screening tool with acceptable diagnostic performance to regulate behavior, such as referring to a specialized center or requesting more specific studies in patients diagnosed with adnexal mass due to suspected malignancy.

Primary leiomyosarcoma of kidney with metastasis to contralateral kidney. Case report.

INTRODUCTION: Renal leiomyosarcoma is a rare entity in the world and its understanding is based on reports and various cases; however, the prognosis is bleak for its malignant potential and an average survival of 18 months. CLINICAL CASE: A 54-year-old woman with a clinical picture of 6 months of pain in the right flank and a tomographic image of a bilateral renal lesion underwent right radical nephrectomy and left conservative surgery. The definitive histopathological study reported right primary renal leiomyosarcoma with left metastasis. CONCLUSION: Renal leiomyosarcoma is an entity of low incidence and high mortality; however, our case represents the minority of patients with contralateral kidney metastasis reported in the literature.

[Initial experience in the laparoscopic treatment of benign and malignant gynaecological diseases in the Hospital Regional de Alta Especialidad in Oaxaca]. / Experiencia inicial en el tratamiento de enfermedad ginecológica benigna y maligna por laparoscopia en el Hospital Regional de Alta Especialidad de Oaxaca.

BACKGROUND: The history of laparoscopic surgery in gynaecological diseases progressed with the advances of Semm, as well as with the development of tools, equipment, and energy that led to its development in all surgical areas, including oncology. OBJECTIVE: To present the initial experience in the laparoscopic treatment of benign and malignant gynaecological disease in the Hospital Regional de Alta Especialidad in Oaxaca. MATERIAL AND METHODS: An analysis was performed on a total of 44 cases, distributed into: type III radical hysterectomy for invasive cervical cancer, hysterectomy type I cervical cancer in situ, extrafascial hysterectomy for benign disease, routine endometrium, ovary and routine salpingo-oophorectomy. The variables included age, BMI, surgical time, bleeding, intraoperative and postoperative complications, conversion, hospital stay, and pathology report. RESULTS: Hysterectomy type III; age 40.2 years, BMI 25.8kg/m2, 238ml bleeding, operative time 228min, 2.6-day hospital stay, intraoperative or postoperative complications, tumour size 1.1cm, 14 lymph nodes dissected, vaginal and negative parametrical edge. Type I hysterectomy cervical cancer in situ: 51 years, BMI 23.8kg/m2, 80ml bleeding, operative time 127minutes, uterus of 9cm, length of stay of 2 days, a conversion by external iliac artery injury, with bleeding of 1500ml. Routine endometrium: 50.3 years, BMI 30.3kg/m2, 83ml bleeding, operative time 180minutes, uterus 12.6cm, length of stay 2.3 days, no complications. CONCLUSION: The management of benign and malignant pelvic diseases using laparoscopy is feasible and safe, with shorter hospital stays and a prompt recovery to daily activities.

El estado nutricio no influye en el desarrollo de dehiscencia de anastomosis en una población mexicana / The nutritional state does not influence development of anastomotic dehiscence in a Mexican population

Objetivo: Describir los factores de riesgo asociados al desarrollo de dehiscencia anastomótica en pacientes sometidos a cirugía intestinal en una población mexicana, con énfasis en el estado nutricional del paciente. Sede: Servicio de Cirugía, Hospital Regional de Alta Especialidad de Oaxaca, Secretaría de Salud. Diseño: Estudio clínico, ambispectivo, ambilectivo de casos y controles. Análisis estadístico: Análisis univariado con χ², regresión logística binomial simple y regresión logística multivariada. Pacientes y métodos: Se analizaron 144 pacientes sometidos a 214 resecciones y/o derivaciones intestinales con anastomosis. Se consideraron distintos factores clínicos, demográficos y de laboratorio asociados a dehiscencia de anastomosis. Los principales factores de riesgo considerados fueron: número de anastomosis, tipo de anastomosis, IMC, antecedente de cáncer, creatinina, tabaquismo, tipo de cirugía, nivel de hemoglobina, cuenta de leucocitos y linfocitos, tiempos de coagulación, biometría hemática, género, hipotensión intraoperatoria, diabetes mellitus, enfermedad cardiovascular, puntuación de ASA, hiperbilirrubinemia, BUN y sangrado quirúrgico. Se valoró la asociación de estas variables a la dehiscencia anastomótica y a la mortalidad de la población. Resultados: Se analizaron 144 pacientes sometidos a 214 anastomosis. En el análisis univariado, las variables que mostraron significancia estadística para dehiscencia fueron edad (p < 0.001), sangrado (p = 0.01) y la necesidad de transfusiones (p = 0.03). La presencia de hipoalbuminemia o un IMC < 15 no fueron significativos tanto en el análisis univariado como en el multivariado. El sangrado quirúrgico y la necesidad de transfusiones mostraron ser los predictores más significativos de desarrollo de dehiscencia anastomótica en el análisis multivariado (p < 0.01). Conclusiones: La presencia de hipoalbuminemia y un bajo índice de masa corporal no aumenta el riesgo de dehiscencia anastomótica en la población de estudio. Los principales factores de riesgo asociados a la fuga anastomótica son el sangrado transoperatorio y la administración de hemoderivados en el perioperatorio.

Objective: To describe the risk factors associated to the development of an anastomotic dehiscence in patients subjected to intestinal surgery in a Mexican population, emphasizing the nutritional state of the patient. Setting: Surgery Service, Regional High Specialty Hospital of Oaxaca, Mexico. Ministry of Health (Third Level Health Care Center). Design: Clinical, ambispective, ambilective study of cases and controls. Statistical analysis: Univariate analysis with χ2, simple binomial logistic regression, and multivariate logistic regression. Patients and methods: We analyzed 144 patients subjected to 214 resections and/or intestinal shunts with anastomoses. We considered different clinical, demographic, and laboratory factors associated to dehiscence of anastomoses. The main risk factors considered were: number of anastomoses, type of anastomoses, IMC, antecedents of cancer, creatinine, smoking, type of surgery, hemoglobin level, leukocytes and lymphocyte counts, clotting time, blood biometrics, gender, intraoperative hypotension, diabetes mellitus, cardiovascular disease, ASA score, hyperbilirubinemia, BUN, surgical bleeding. We assessed the association of these variables with anastomotic dehiscence and mortality in the studied population. Results: We analyzed 144 patients subjected to 214 anastomoses. The univariate analysis revealed that the variables with statistical significance for dehiscence were age (p < 0.001), bleeding (p = 0.01), and need of transfusions (p = 0.03). The presence of hypoalbuminemia or a BMI < 15 was not significant in either the univariate and multivariate analyses. Surgical bleeding and the need of transfusions were the most significant predictors for the development of anastomotic dehiscence in the multivariate analysis (p < 0.01). Conclusions: The presence of hypoalbuminemia and a low BMI does not increase the risk of anastomotic dehiscence in the studied population. The main risk factors associated to anastomotic leakage are transoperative bleeding and administration of hemoderivates during the perioperative time.

Evaluación de la morbilidad y mortalidad de la colecistectomía laparoscópica con técnica de tres puertos en el Hospital Regional de Alta Especialidad de Oaxaca / Assessment of morbidity and mortality due to laparoscopic cholecystectomy with three ports technique at the Regional High Specialty Hospital of Oaxaca

Objetivo: Evaluar la morbilidad y mortalidad de la colecistectomía laparoscópica (CL) en el Hospital regional de Alta Especialidad de Oaxaca (HRAEO), y compararlo con lo reportado en la literatura. Sede: Hospital Regional de Alta Especialidad de Oaxaca. Diseño: Estudio retrospectivo, transversal, descriptivo y comparativo. Análisis estadístico: Análisis estadístico bivariado con medidas de tendencia central y χ². Pacientes y métodos: Pacientes sometidos a CL de enero del 2010 a diciembre del 2011. Se evaluó el tiempo quirúrgico, sangrado transoperatorio, porcentaje de conversión, días de estancia intrahospitalaria, complicaciones transoperatorias y postoperatorias. Resultados: Se incluyeron 386 pacientes, 68 (17.6%) hombres, edad de 43.51 ± 16.8 años. Se identificó un paciente con lesión de vía biliar (0.3%), un paciente con fuga biliar (0.3%), dos pacientes con bilomas residuales (0.5%) y un porcentaje de conversión del 2.8% (11 casos). Un paciente falleció en el grupo de tres puertos (mortalidad global = 0.3%) por colangitis aguda. El porcentaje de complicaciones fue del 4.9%; en 355 (92%) pacientes se usaron tres puertos y cuatro puertos en 31 (8%). Al comparar ambas técnicas, la estancia intrahospitalaria fue menor en el grupo de tres puertos, 1.92 ± 1.22 días versus 2.87 ± 2.84 días (p = 0.0001), el sangrado fue menor 55.23 ± 123.48 ml versus 114.52 ± 193.04 ml (p = 0.0001), así como el tiempo operatorio 71.05 ± 41.87 min versus 110.26 ± 61.25 min (p = 0.0001). Sin diferencia en la morbilidad (frecuencia de fístulas y lesiones de vía biliar). Conclusiones: La morbilidad y mortalidad de la CL en el HRAEO es similar a la reportada en la literatura mundial. El uso de tres puertos sobre cuatro puertos demostró un menor tiempo quirúrgico, estancia hospitalaria y sangrado.

Objective: To assess morbidity and mortality of laparoscopic cholecystectomy (LC) at the Regional Hospital of High Specialty (HRAEO, for its initials in Spanish). Setting: Regional Hospital of High Specialty of Oaxaca (third level health care center). Design: Retrospective, cross-sectional, descriptive, comparative study. Statistical analysis: Bivariate statistical analysis with central tendency measures and chi square. Patients and methods: Patients subjected to LC from January 2010 to December 2011. We assessed surgical time, transoperative bleeding, percentage of conversion, days of in-hospital stay, transoperative and postoperative complications. Results: A total of 386 patients were included, 68 (17.6%) were men of 43.51 ± 16.8 years of age. We identified: one patient with biliary tract lesion (0.3%), one patient with biliary leakage (0.3%), two patients with residual bilomas (0.5%), and a conversion percentage of 2.8% (11 cases). One patient died in the group of three ports due to acute cholangitis (global mortality = 0.3%). Percentage of complications was 4.9%; three ports were used in 355 (92%) patients and four ports in 31 (8%). When comparing both techniques, in-hospital stay was lower in the three ports group, 1.92 ± 1.22 days versus 2.87 ± 2.84 days (p = 0.0001); bleeding was lower, 55.23 + 123.48 ml versus 114.52 ± 193.04 ml (p = 0.0001); as well as surgical time, 71.05 ± 41.87 min versus 110.26 ± 61.25 min (p = 0.0001). There were no differences in morbidity (frequency of fistulae and injuries to the biliary tract). Conclusions: Morbidity and mortality of LC at the HRAEO is similar to that reported in the world literature. The use of three ports, as compared to four ports, demonstrated a lower surgical time, in-hospital stay, and bleeding.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal carcinomatosis: initial experience in Oaxaca, Mexico.

Peritoneal carcinomatosis (PC) has been traditionally considered a terminal disease with median survivals reported in the literature of 6 to 12 months. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) are playing an ever increasing role in the treatment of these patients. Excellent results have been achieved in well-selected patients but there is a very steep learning curve when starting a new program. A program for peritoneal surface malignancies in which patients with PC of gastrointestinal or gynecological origin were treated using multimodality therapy with combinations of systemic therapy, cytoreductive surgery (CRS), and HIPEC was initiated in December 2007 at "Hospital Regional de Alta Especialidad de Oaxaca," Mexico. We present the results of our initial experience. From December 2007 to February 2011, 26 patients were treated with CRS and HIPEC. There were 21 female patients. Most common indication (46%) was recurrent ovarian cancer. Mean duration of surgery was 260 minutes. Mean Peritoneal Cancer Index was 9. Twenty-three (88.5%) patients had a complete cytoreduction. Major morbidity and mortality rates were 19.5 and 3.8 per cent, respectively. Mean hospital stay was 8 days. At a mean follow-up of 20 months, median survival has not been reached. Rigorous preoperative workup, strict selection criteria, and mentoring from an experienced cytoreductive surgeon are mandatory and extremely important when starting a center for PC.

Evaluación de la morbilidad por disección del compartimiento central en cáncer papilar de tiroides / Assessment of morbidity of central neck compartment dissection in papillary thyroid cancer

Objetivo: Evaluar la hipocalcemia y lesión del nervio laríngeo recurrente secundaria a tiroidectomía total acompañada de disección del compartimiento central en cáncer papilar de tiroides. Sede: Instituto Nacional de Cancerología, México. Diseño: Estudio clínico descriptivo, observacional, prospectivo, longitudinal. Análisis estadístico: Porcentajes como medida de resumen para variables cualitativas. Pacientes y métodos: Veinte y cuatro pacientes con diagnóstico de cáncer papilar de tiroides (CPT) establecido mediante citología y/o histopatología, que se llevaron a disección central del cuello como parte del tratamiento quirúrgico inicial con seguimiento mínimo de 6 meses. Variables estudiadas: Tiempo quirúrgico, sangrado transoperatorio, movilidad cordal evaluadas por laringoscopia directa pre y postoperatoriamente, hipocalcemia e hipoparatiroidismo, reintervención y número de ganglios resecados. Resultados: De los 24 pacientes, 16 con enfermedad confinada al tiroides y 8 con afección al cuello, el tiempo quirúrgico medio de 2 a 4.30 horas con una media de 2.2, sangrado de 100 a 400 ml con media de 196 ml. Un paciente con hipocalcemia transitoria, cero pacientes con hipocalcemia permanente corroborado con paratohormona, cero lesiones del nervio laríngeo recurrente (NLRL), cero reintervenciones, el número de ganglios resecados fue de 7 a 16. Conclusiones: La morbilidad de la tiroidectomía total más disección del compartimiento central fue de hipocalcemia transitoria de 4.1%. No existió lesión de nervio laríngeo recurrente ni hipoparatiroidismo.

Objective: To assess hypocalcemia and injury to the recurrent laryngeal nerve secondary to total thyroidectomy plus central compartment dissection in papillary thyroid cancer. Setting: National Institute of Cancerology, Mexico Design: Descriptive, observational, retrospective, prospective, longitudinal clinical study. Statistical analysis: Percentages as summary measure for qualitative variables. Patients and methods: Twenty-four patients with diagnosis of papillary thyroid cancer (PTC), established by cytology and histopathology, subjected to central dissection of the neck as part of the initial surgical treatment with a follow-up of at least 6 months. Assessed variables were: surgical time, trans-operative bleeding, vocal cords mobility, assessed through direct laryngoscopy pre- and postoperatively, hypocalcemia and hypothyroidism, re-intervention, and number of dissected ganglia. Results: Twenty four patients, 16 with thyroid-confined disease, and 8 with neck involvement. Average surgical time of 2 to 4.30 hours, mean of 2.2, bleeding of 100 to 400 ml, mean of 196 ml. One patient with transient hypocalcemia, nill patients with permanent hypocalcemia confirmed with PHT testing, nill Recurrent laryngeal nerve (NLRL) injuries, nill re-interventions; the number of dissected ganglia was 7 to 16. Conclusions: Morbidity of total thyroidectomy plus dissection of the central compartment consisted of transient hypocalcemia (4.1%). Neither recurrent laryngeal nerve injury nor hypoparathyroidism occurred.