SOX9 immunosuppression in primary colorectal cancer tumors with lymph node metastasis.

INTRODUCTION AND AIMS: Colorectal cancer is the most frequent malignant tumor of the digestive system. Its pathogeny is complex and involves the APC/ß-catenin sequence. Lymph node metastases are a significant indicator for determining treatment and are a prognostic factor. SOX9 overexpression is related to oncogenic qualities and the capacity for metastasis. Our aim was to analyze SOX9 immunoexpression in primary colorectal cancer and lymph node metastasis status. MATERIAL AND METHODS: Seventy-nine available cases were divided into the group with lymph node metastasis (n=38) and the group without lymph node metastasis (n=41), evaluating their SOX9 expression. The IBM SPSS version 27 program in Spanish was utilized to carry out the statistical analysis, obtaining measures of central tendency, the kappa index, standard deviation, Wilcoxon Mann-Whitney nonparametric measurements, Spearman's correlation coefficient, and chi-square test and Student's t test values. SOX9 immunoexpression was evaluated through the mean-based H-score, with high immunoexpression as a score ≥145 and low immunoexpression as a score ≤144. RESULTS: A p=0.73 was obtained that was not statistically significant, regarding the relation of SOX9 expression in primary colorectal cancer to lymph node metastasis. CONCLUSIONS: The absence or presence of lymph node metastasis was independent from SOX9 immunoexpression in primary colorectal cancer. However, due to the limited size of the population analyzed, further research is needed.

Ganglion impar block in chronic cancer-related pain - A review of the current literature.

Oncologic chronic pain is often difficult to control, especially in anatomical areas with multiple and complex innervation, such as the pelvic/perineal region. The ganglion impar block (GIB) is a procedure with growing interest and varied applicability. It has been used in several benign and malignant causes of pelvic and perineal pain refractory to pharmacological treatment. We conducted a review of all articles published in PUBMED® until the 30th of October 2022 regarding GIB in oncologic pain. 19 articles were identified with a total of 278 patients. Both chronic cancer pain and chronic postcancer treatment pain patients were included. We reviewed the various techniques, approaches, and therapeutic options that were employed. No serious adverse effects were reported. GIB appears to be an effective and safe procedure that should be considered in patients with intractable perineal cancer-related pain.

Radioterapia del grupo ganglionar retrofaríngeo y retroestiloídeo: ¿Cuándo y a quién? Una revisión de la literatura / Radiotherapy for retropharyngeal and retrostyloid lymph node groups: When and who? A review of the literature

La radioterapia de cabeza y cuello posee un rol central en el tratamiento de las neoplasias otorrinolaringológicas, ya sea como tratamiento adyuvante a la cirugía o como terapia definitiva. Dentro de este campo de estudio, un tópico aún poco explorado y motivo de debate, es la indicación de irradiación de los ganglios linfáticos retrofaríngeos, correspondientes a los niveles VIIa y VIIb de cuello. Hemos llevado a cabo una revisión sistemática con el objetivo de dilucidar criterios de irradiación electiva de estos grupos nodales y de emitir recomendaciones en cuanto a su inclusión en la práctica de la radio-oncología.

Radiation therapy has a central role in the management of head and neck malignancies, either as adjuvant treatment after surgery or as definitive therapy. Within this field of study, a still poorly explored and matter-of-debate topic is the indication for irradiation of retropahyngeal lymph nodes, corresponding to neck levels VIIa and VIIb. We have conducted a systematic review with the objective of elucidating elective irradiation criteria for these nodal groups and to issue recommendations about its inclusion in the practice of radiation oncology.

Persistencia de enfermedad metastásica ganglionar de cáncer colorrectal con resección en bloque y colocación de injerto aortoilíaco / Persistence of lymph node metastatic disease from colorectal cancer with bloc resection and biaortoiliac graft placement

Introducción: el pronóstico del cáncer de colon está relacionado con el grado de penetración del tumor a través de la pared intestinal y con la infiltración ganglionar en el momento de la cirugía. Se reporta poca experiencia en cuanto al tratamiento quirúrgico de persistencia o recidivas locorregionales a ganglios paraaórticos con afectación de la aorta abdominal. Caso clínico: mujer que presenta persistencia locorregional del cáncer colorrectal con afectación aortoilíaca. Se plantea una estrategia de tratamiento quirúrgico interdisciplinario con intención curativa, con la colocación de un injerto vascular bifurcado y conseguir la resección R0 con la supervivencia libre de enfermedad. Discusión: los pacientes con persistencia de la enfermedad metastásica requieren un abordaje quirúrgico abierto con el objetivo de lograr una resección R0. En el caso de presentarse infiltración local de estructuras a órganos adyacentes, se recomienda la resección radical en bloque. Estos procedimientos más complejos se asocian con una mayor morbilidad. Sin embargo, los beneficios asociados con la eliminación de la metástasis a ganglios paraaórticos deben considerarse frente al riesgo de morbilidad quirúrgica. (AU)

Introduction: the prognosis of colon cancer is related to the degree of tumor penetration through the intestinal wall and lymph node infiltration at the time of surgery. Little experience is reported regarding the surgical treatment of persistence or locoregional recurrences to para-aortic nodes with involvement of the abdominal aorta. Case report: woman presenting with locoregional persistence of colorectal cancer with aortoiliac involvement. An interdisciplinary surgical treatment strategy with curative intent is proposed, with the placement of a vascular graft bifurcated and achieving R0 resection with disease-free survival. Discussion: patients with persistent metastatic disease require an open surgical approach, with the goal of achieving an R0 resection. In the case of local infiltration of structures to adjacent organs, radical en bloc resection is recommended. These more complex procedures are associated with greater morbidity. However, the benefits associated with removal of para-aortic lymph node metastasis must be weighed against the risk of surgical morbidity. (AU)

División ganglionar posquirúrgica y su efecto en el recuento ganglionar y la estadificación en pacientes con cáncer gástrico / Postoperative lymph node division and its effect on lymph node count and staging in patients with gastric cancer

Introducción. La gastrectomía y disección ganglionar es el estándar de manejo para los pacientes con cáncer gástrico. Factores como la identificación de ganglios por el patólogo, pueden tener un impacto negativo en la estadificación y el tratamiento. El objetivo de este estudio fue comparar el recuento ganglionar de un espécimen quirúrgico después de una gastrectomía completa (grupo A) y de un espécimen con un fraccionamiento por grupos ganglionares (grupo B). Métodos. Estudio de una base de datos retrospectiva de pacientes sometidos a gastrectomía D2 en el Servicio de Cirugía gastrointestinal de la Liga Contra el Cáncer seccional Risaralda, Pereira, Colombia. Se comparó el recuento ganglionar en especímenes quirúrgicos con y sin división ganglionar por regiones anatómicas previo a su envío a patología. Resultados. De los 94 pacientes intervenidos, 65 pertenecían al grupo A y 29 pacientes al grupo B. El promedio de ganglios fue de 24,4±8,6 y 32,4±14,4 respectivamente (p=0,004). El porcentaje de pacientes con más de 15 y de 25 ganglios fue menor en el grupo A que en el grupo B (27 vs 57, p=0,432 y 19 vs 24, p=0,014). El promedio de pacientes con una relación ganglionar menor 0,2 fue mayor en el grupo B (72,4 % vs 55,4 %, p=0,119). Conclusiones. Los resultados de nuestro estudio mostraron que una división por grupos ganglionares previo a la valoración del espécimen por el servicio de patología incrementa el recuento ganglionar y permite establecer de manera certera el pronóstico de los pacientes, teniendo un impacto positivo en su estadificación, para evitar el sobretratamiento

Introduction. A gastrectomy and lymph node dissection is the standard of management for patients with gastric cancer. Factors such as the identification of nodes by the pathologist can have a negative impact on staging and treatment. The objective of this study was to compare the lymph node count of a surgical specimen after a complete gastrectomy (group A) and of a specimen with lymph node by groups (group B). Methods. Study of a retrospective database of patients undergoing D2 gastrectomy in the Risaralda section of the Liga Contra el Cancer Gastrointestinal surgical service, Pereira, Colombia. The lymph node count was compared in surgical specimens with and without lymph node division by anatomical regions, prior to sending them to pathology. Results. Of the 94 patients who underwent surgery, 65 were from group A and 29 patients were from group B. The average number of nodes was 24.4±8.6 and 32.4±14.4, respectively (p=0.004). The percentage of patients with more than 15 and 25 nodes was lower in group A than in group B (27 vs 57, p=0.432 and 19 vs 24, p=0.014). The average number of patients with a nodal ratio less than 0.2 was higher in group B (72.4% vs 55.4%, p=0.119). Conclusions. The results of our study showed that a division by lymph node groups prior to the evaluation of the specimen by the pathology service increases the lymph node count and allows the prognosis of patients to be accurately established, having a positive impact on their staging, to avoid overtreatment.

Enfermedad de Fahr. A propósito de un caso

El síndrome de Fahr, o ferrocalcinosis cerebrovascular, o calcinosis de los núcleos del cerebro, se caracteriza por un depósito anómalo del calcio sin anomalía en el metabolismo del calcio. Se acumula, principalmente, en los ganglios basales, núcleos dentados cerebelosos y sustancia blanca. Es un trastorno neurológico degenerativo asociado a síntomas tales como trastornos del movimiento y síntomas neuropsiquiátricos. Se presenta el caso de un paciente masculino de 65 años de edad, de procedencia rural, viudo, con antecedentes personales de hipertensión arterial, diabetes mellitus tipo 1 y adenoma de próstata, para lo cual lleva tratamiento con Cardicor, Lasix, Plaunac, DuoPlavin y Adenuric. Es llevado a emergencias por la ambulancia presentando convulsiones tónico-clónicas generalizadas sin relajación de esfínter, que respondieron a la administración de diazepam 10 mg endovenoso. Se diagnosticó enfermedad de Fahr. El paciente evolucionó satisfactoriamente y egresó a los cinco días de su ingreso.

Fahr's syndrome, or cerebrovascular ferro-calcinosis, or calcinosis of the nuclei of the brain, is characterized by abnormal calcium deposition without abnormality in calcium metabolism. It accumulates mainly in the basal ganglia, cerebellar dentate nuclei and white matter. It is a degenerative neurological disorder associated with symptoms such as movement disorders and neuropsychiatric symptoms. The case of a 65-year-old male patient, from rural origin, widower, with a personal history of high blood pressure, type 1 diabetes mellitus, and prostate adenoma is presented. For this, he is treated with Cardicor, Lasix, Plaunac, DuoPlavin and Adenuric. He was taken to the emergency room by ambulance presenting generalized tonic-clonic seizures without sphincter relaxation, which responded to the administration of intravenous diazepam 10 mg. Fahr's syndrome was diagnosed, the patient progressed satisfactorily and was discharged 5 days after admission.

Enfermedad relacionada con IgG4 en paciente con antecedente de linfoma MALT gástrico: un gran reto diagnóstico y terapéutico / IgG4 related disease in a patient with a history of gastric MALT lymphoma: a great diagnostic and treatment challenge

We describe a case of a 57-year-old woman with a history of gastric MALT lymphoma and interstitial nephritis attributed to chemotherapy. In the study of chronic diarrhea, we found an atrophic pancreas, with elastase deficiency. Autoimmune pancreatitis is suspected. A significant elevation of serum IgG4 was observed. With these data, a review of the renal biopsy performed 10 months earlier was carried out. Immunohistochemistry reveals a significant number of IgG4-producing plasma cells. In the lungs, the patient has nodules, adenopaties and infiltrates. The diagnosis we arrived at is IgG4-related disease. (AU)

Se presenta el caso de una mujer de 57 años con antecedentes de linfoma MALT gástrico y nefritis intersticial atribuida a la quimioterapia. En el estudio de diarrea crónica encontramos un páncreas atrófico, con deficiencia de elastasa. Se sospecha pancreatitis autoinmune. Se comprueba una elevación importante de IgG4 sérica. Con estos datos, se procede a la revisión de la biopsia renal realizada 10 meses antes. La inmunohistoquímica revela un número significativo de células plasmáticas productoras de IgG4. En los pulmones, la paciente tiene nódulos, adenopatías e infiltrados. El diagnóstico al que llegamos es Enfermedad relacionada con IgG4. (AU)

Enfermedad de Castleman. Reporte de un caso

Fundamento: La enfermedad de Castleman es un proceso poco común y se caracteriza por la proliferación de linfocitos no clonales. Objetivo: Describir la presentación clínica, diagnóstico y tratamiento de un paciente con enfermedad de Castleman. Presentación del caso: Paciente masculino de 53 años de edad, color de la piel blanca, que acudió al servicio de cirugía por presentar una masa en región abdominal. Con la administración de anestesia general se realizó exéresis de la lesión y se diagnosticó por el departamento de Anatomía Patológica una enfermedad de Castleman unicéntrica variedad hialino vascular. Conclusiones: La enfermedad de Castleman es poco frecuente, su sintomatología y tratamiento varían según la presentación clínica; y el diagnóstico definitivo se obtiene del análisis de la biopsia de un ganglio afectado.

Background: Castleman disease is an uncommon process and is characterized by the non-clonal lymphocyte proliferation. Objective: To describe the clinical presentation, diagnosis and treatment in a patient with Castleman disease. Case presentation: 53 years old male patient, fair skin color, who attended to the surgery service for presenting a mass in the abdominal region. With the general anesthesia administration, the lesion was excised and an unicentric Castleman disease was diagnosed by the Pathological Anatomy department, hyaline vascular variety. Conclusions: Castleman disease is not frequent, its symptomatology and treatment vary according to the clinical presentation; and the definitive diagnosis is obtained by a biopsy analysis of an affected ganglion.

Lumbar safety triangle: comparative study of coronal and coronal oblique planes in 3.0-T magnetic resonance imaging / Triângulo de segurança lombar: estudo comparativo dos planos coronal e coronal oblíquo em ressonância magnética 3.0-T

Abstract Objective: To compare the measurements of the lumbar safety triangle (Kambin's triangle) and the invasion of the dorsal root ganglion in the triangle in coronal and coronal oblique planes. Materials and Methods: A cross-sectional study, in which 210 3.0-T magnetic resonance images of L2-L5 were analyzed in coronal and coronal oblique planes. Exams with lumbar spine anomalies were excluded. Demographic (sex and age) and radiological variables were recorded by a single evaluator. Results: Most sample was female (57.1%), mean age 45.5 ± 13.3 (18-98 years). The measurements average, as well as the areas, gradually increased from L2 to L5. The dorsal root ganglion invaded the triangle in all images. The safety triangle average area was smaller in the coronal oblique plane than in the coronal plane. Of the seven dimensions of safety triangle obtained for each level of the lumbar spine, six were significantly smaller in the coronal oblique plane than in the coronal plane. The only dimension that showed no difference was the smallest ganglion dimension. Conclusion: The dimensions and areas investigated were smaller in coronal oblique plane, especially the area (difference > 1 mm). The analysis of the triangular zone in this plane becomes important in the preoperative assessment of minimally invasive procedures.

Resumo Objetivo: Comparar as medidas do triângulo de segurança lombar (triângulo de Kambin) e invasão do gânglio da raiz dorsal no triângulo nas incidências coronal e coronal oblíqua. Materiais e Métodos: Estudo transversal, em que foram analisadas 210 imagens de ressonância magnética 3.0-T de L2-L5 nos planos coronal e coronal oblíquo. Foram excluídos exames com anomalias da coluna lombar. Variáveis demográficas (sexo e idade) e radiológicas foram registradas por um único avaliador. Resultados: A maioria da amostra era do sexo feminino (57,1%), com idade média de 45,5 ± 13,3 (18-98 anos). A média das medidas, assim como as áreas, aumentaram gradativamente de L2 a L5. O gânglio da raiz dorsal invadiu o triângulo em todas as imagens. A área média do triângulo de segurança foi menor na incidência coronal oblíqua do que na incidência coronal. Das sete dimensões do triângulo de segurança obtidas para cada nível da coluna lombar, seis foram significativamente menores no plano coronal oblíquo do que no plano coronal. Única dimensão que não apresentou diferença foi a menor dimensão do gânglio. Conclusão: As dimensões e áreas investigadas foram menores na incidência coronal oblíqua, especialmente a área (diferença > 1 mm). A análise da zona triangular nesta incidência torna-se importante na avaliação pré-operatória de procedimentos minimamente invasivos.

Impacto de la superación profesional en la meteoro labilidad de la enfermedad cerebrovascular / Climate change and cardiovascular disease: impact of professional development

Introducción: La enfermedad cerebrovascular (ECV) es una urgencia neurológica que en ocasiones se encuentra influenciada por los cambios del tiempo. La ECV isquémica es una emergencia médica con una ventana estrecha para su diagnóstico y tratamiento. El daño generado por esta enfermedad se estima mediante de la mortalidad, discapacidad e impacto social. Objetivo: Proponer un programa de capacitación basado en los efectos fisiopatológicos que provocan en los pacientes, cambios de tiempo y ritmo circadiano en el contexto de la adaptación al cambio climático. Método: Se desarrolló un estudio multietápico prospectivo en el Hospital Universitario Mártires del 9 de Abril del municipio Sagua la Grande entre los años 1993 a 2017. En la primera etapa se seleccionó un universo de 52 profesionales de la salud que atendieron a estos pacientes; en la segunda, 48 y en la tercera, 61. Resultados: El nivel de conocimiento del personal de salud en una primera etapa era inadecuado (78,85 %); en la tercera, este porcentaje disminuyó (14,75 %). Como resultado de la capacitación mejoraron los tiempos de atención a los pacientes con ECV a su llegada al hospital, y en la tercera, más del 50 % de los enfermos fueron atendidos antes de las seis horas de inicio de los síntomas. Conclusiones: La capacitación sobre ECV basada en los efectos fisiopatológicos que provocan en los pacientes el cambio climático y el ritmo circadiano disminuyó el tiempo de espera, y se asoció con una reducción de la morbilidad y la mortalidad, después de aplicar este programa.

Introduction: cerebrovascular disease (CVD) is a neurological emergency that is sometimes influenced by climate changes. Ischemic CVD is a medical emergency with a narrow window for diagnosis and treatment. The damage generated by this disease is estimated through mortality, disability and social impact. Objective: to propose a training program based on the pathophysiological effects in patients caused by changes in time and circadian rhythm in the context of adaptation to climate change. Methods: a multistage prospective study was conducted at "Mártires del 9 de Abril" University Hospital in Sagua la Grande municipality between 1993 and 2017. A universe of health professionals who cared for these patients was selected as follows: 52 in the first stage; 48 in the second stage, and 61 in the third ones. Results: the level of knowledge of health personnel in the first stage was inadequate (78.85%); this percentage decreased in the third stage (14.75%). Care times for CVD patients improved upon arrival at the hospital as a result of the training, as well as in the third ones, more than 50% of the patients were seen within six hours of the onset of symptoms. Conclusions: CVD training based on the pathophysiological effects of climate change and circadian rhythm on patients decreased waiting time, and was associated with reduced morbidity and mortality, after applying this program.

Treatment planning evaluation for bilateral breast cancer using volumetric modulated arc therapy (VMAT) / Evaluación de la planificación del tratamiento para el cáncer de mama bilateral mediante la arcoterapia volumétrica de intensidad modulada (VMAT)

Objective: To evaluate plans using volumetric modulated arc therapy techniques specifically for synchronous bilateral breast cancer patients undergoing right-sided lumpectomy, left-sided mastectomy and regional lymph node dissection (level I & II axillary lymph nodes). Methods: Eleven bilateral breast cancer patients underwent right-side lumpectomy, left-sided mastectomy, and regional lymph node dissection. The patients underwent CT simulation and 3D contouring had been done by Focalsim soft wear from Elekta and Monaco 5.1 treatment planning system by Elekta was used for planning, then the treated with either 6 or 10 MV photon beam energy using a Synergy lineal accelerator. Results: VMAT provided sufficient dose coverage and a high dose conformity index for all right breast, left chest wall and lymph node (level III axilla & IX lymph node) targets. The dose distribution was almost homogenous. The correlation between the monitor units and the conformity indices was significant for both the right and the left breast but not significant for the regional nodal volume target. There was no significant correlation between the monitor units and homogeneity indices for right or left targets, but there was a significant correlation for the nodal volumes. Conclusion: VMAT is an effective treatment technique for bilateral breast cancer patients, providing a highly conformal dose and a good dose distribution. The correlation between the MU and the dose conformity serves as a useful evaluation tool for this technique. (AU)

Objetivo: Evaluar una estrategia de tratamiento para pacientes con cáncer de mama bilateral sincrónico sometidas a tumorectomía del lado derecho, mastectomía del lado izquierdo y linfadenectomía. Métodos: Once pacientes con cáncer de mama bilateral se sometieron a tumorectomía del lado derecho, mastectomía del lado izquierdo y linfadenectomía de los niveles I y II axilares. La delimitación de volúmenes se realizó mediante Focalsim, la planificación se realizó con Monaco 5.1 de Elekta y se trataron con energía de haz de fotones de 6 o 10 MV utilizando un acelerador lineal Synergy. Resultados: VMAT proporcionó una cobertura de dosis suficiente y un alto índice de conformidad para todos los volúmenes de mama izquierda, mama derecha y ganglios linfáticos. La distribución de dosis fue casi homogénea. La correlación entre las unidades de monitor y los índices de conformidad fue significativa para ambas mamas, pero no llegó a la significación en volumen supraclavicular. No hubo una correlación significativa entre las unidades de monitor y los índices de homogeneidad para ambas mamas, pero hubo una correlación significativa para los ganglios linfáticos. Conclusión: VMAT es una técnica de tratamiento eficaz para pacientes con cáncer de mama bilateral, que proporciona una cobertura de dosis suficiente con un alto índice de conformidad. La correlación entre el número de unidades de monitor y el índice de conformidad sirve como una herramienta de evaluación útil para esta técnica. (AU)

Lesiones metabólicas bilaterales en núcleos basales: Serie de casos y Revisión de literatura

Introducción: Los núcleos basales son sustancias de materia gris, involucradas en la regulación de distintas funciones metabólicas y son vulnerables a situaciones de hipoxia y distintas situaciones patológicas. Los hallazgos imagenológicos no son específicos en la mayoría de los casos. Reporte de caso: Se reportan los casos de diez pacientes con lesiones metabólicas bilaterales en núcleos basales atendidos en un hospital de referencia nacional de Perú y se realiza una revisión de la literatura: 3 casos de Hipoparatiroidismo postquirúrgico, 2 de encefalopatía de Wernicke, 1 con degeneración hepatolenticular, 1 con mielinólisis extrapontina, 1 Intoxicación por metanol y 2 con encefalopatía Hipóxico-isquémica. Conclusión: Las lesiones bilaterales de núcleos basales producto de lesiones metabólicas son en gran parte inespecíficas, por lo que el contexto clínico es de vital importancia, así como las particularidades de los hallazgos imagenológicos, para el adecuado reconocimiento de las entidades etiológicas y su manejo oportuno.

Introduction: Basal nuclei are gray matter substances, involved in the regulation of different metabolic functions and are vulnerable to situations of hypoxia and different pathological situations. Imaging findings are not specific in most cases. Case of report: The cases of ten patients with bilateral metabolic lesions in the basal nuclei treated at a national reference hospital in Peru are reported, and a review of the literature is carried out: 3 cases of postoperative hypoparathyroidism, 2 of Wernicke's encephalopathy, 1 with hepatolenticular degeneration, 1 with extrapontine myelinolysis, 1 methanol intoxication and 2 with hypoxic-ischemic encephalopathy. Conclusion: Bilateral lesions of the basal nuclei as a result of metabolic lesions are nonspecific, so the clinical context is of vital importance, as well as the particularities of the imaging findings, for the adequate recognition of the etiological entities and their timely management.

Basal Ganglia Traumatic Hematoma: Case Series and Literature Review / Hematoma traumático em gânglios da base: Série de casos e revisão da literatura

Introduction Basal ganglia traumatic hematoma (BGTH) is rare, occurring in 3% of closed traumatic brain injuries, and it is associated with a poor prognosis. In the present paper, the authors present a series of 16 BGTH cases, describing their causes, treatment, and results. Patients and Methods Thisis a retrospective study of 16 patients diagnosed with BGTH, associated with a literature review in the PubMed, ScienceDirect, and Google Scholar databases, using the terms craniocerebral trauma AND basal ganglia and basal ganglia AND hematoma AND trauma. Articles published in the period from 1986 to 2019 were selected, resulting in a total of 19 articles that met the inclusion criteria taking into account their citations and their respective impacts. Results Sixteen patients were studied. They were all male, with an average age of 21 years and 5 months. The main cause of BGTH was traffic accident (12). The mean score in the Glasgow coma scale at admission was 8. All patients underwent a computed tomography (CT) scan of the skull. The putamen was the most affected structure (5). Thirteen patients underwent conservative treatment, and three drained the associated intracranial hematoma. Nine patients died, and seven, and four had neurological sequel. Conclusions The neurosurgeon's knowledge of GBTH, including diagnosis and clinical surgical management, is extremely important, as this type of lesion is associated with a poor prognosis.

Introdução O hematoma traumático dos gânglios da base (HTGB) é raro, ocorrendo em 3% dos traumatismos cranioencefálicos fechados, estando associado a mau prognóstico. Neste artigo, os autores apresentam uma série de 16 casos de HTGB, descrevendo suas causas, tratamento e resultados. Pacientes e métodos Estudo retrospectivo de 16 pacientes com diagnóstico de HTGB, associado a uma revisão de literatura nas bases de dados PubMed, ScienceDirect e Google Scholar, utilizando os termos: "Craniocerebral Trauma" AND "Basal Ganglia" and "Basal Ganglia"AND "Hematoma"AND "Trauma." Foram selecionados artigos com período de 1986 a 2019, resultando em um total de 19 artigos que atenderam aos critérios de inclusão levando em consideração suas citações e seus respectivos impactos. Resultados Dos 16 pacientes foram estudados, todos do sexo masculino e com idade média de 21 anos e 5 meses. A principal causa de HTGB foi acidente de trânsito (12). A pontuação média na escala de coma de Glasgow na admissão foi de 8. Todos foram submetidos a uma tomografia computadorizada do crânio. Putamen foi o mais afetado (5). Treze pacientes foram submetidos a tratamento conservador e três apresentaram o hematoma intracraniano associado. Nove pacientes morreram e sete, e quatro tiveram sequelas neurológicas. Conclusões O conhecimento dos neurocirurgiões sobre HTGB, diagnóstico e manejo clínico cirúrgico é de extrema importância, pois está associado a um mau prognóstico.

Factores asociados con la recidiva de cáncer de mama en pacientes con cirugía conservadora / Factors associated with breast cancer recurrence in patients with conservative surgery

Resumen OBJETIVO: Identificar los factores asociados con la recidiva de cáncer de mama en pacientes con cirugía conservadora. MATERIALES Y MÉTODOS: Estudio observacional, de cohorte retrospectiva, efectuado a partir de expedientes de pacientes con cáncer de mama en estadios tempranos e intervenidas con cirugía conservadora. Parámetros de estudio: estadio, subtipo histológico, perfil de expresión de receptores hormonales, tiempo de seguimiento, recidiva y periodo libre de enfermedad. La tasa de recidiva, el periodo libre de enfermedad y la identificación de los factores asociados con recidiva se hicieron con análisis estadístico. RESULTADOS: Se estudiaron 53 pacientes con edad media de 51.0 ± 9.4 años. El subtipo histopatológico más frecuente fue el ductal en 49 de las 53 pacientes; en 48 de ellas los tumores fueron positivos para receptores de progesterona, en 7 de 53 para Her-2 y en 3 de 53 triple negativo. La tasa de recidiva de cáncer de mama fue de 13.2% (es decir: 7 de 53 pacientes). El tiempo libre de enfermedad en quienes recayeron fue de 30.6 ± 24.8 meses. En el análisis bivariado se asociaron significativamente con recidiva: los ganglios linfáticos positivos, la expresión de receptores de progesterona y de estrógenos, los tumores triple negativo y el tratamiento complementario con quimioterapia. En el análisis multivariado solo se asociaron con recidiva: tener un tumor triple negativo (OR = 51.8; IC95%: 4.9- 548.4; p = 0.001) y recibir quimioterapia (OR = 8.0; IC95%: 1.4-46.1; p = 0.020). CONCLUSION: Los factores asociados con la recidiva fueron los ganglios linfáticos positivos, la expresión de receptores de progesterona y de estrógenos, tumores triple negativo y recibir quimioterapia.

Abstract OBJECTIVE: To identify factors associated with breast cancer recurrence in patients undergoing conservative surgery. MATERIALS AND METHODS: Observational, retrospective cohort study conducted on the records of patients with early-stage breast cancer who underwent conservative surgery. Study parameters: stage, histologic subtype, hormone receptor expression profile, follow-up time, recurrence and disease-free period. Statistical analysis was performed to estimate recurrence rate and disease-free period and to identify factors associated with recurrence. RESULTS: Fifty-three patients with a mean age of 51.0 ± 9.4 years were evaluated. The most common histopathologic subtype was ductal in 49 of 53 patients; tumors were progesterone receptor positive in 48, Her-2 positive in 7 of 53, and triple negative in 3 of 53. The breast cancer recurrence rate was 13.2% (i.e., 7 of 53 patients). Disease-free time in those who relapsed was 30.6 ± 24.8 months. In bivariate analysis, positive lymph nodes, progesterone and estrogen receptor expression, triple-negative tumors, and adjuvant chemotherapy were significantly associated with recurrence. In multivariate analysis, only having a triple-negative tumor (OR = 51.8; 95%CI: 4.9-548.4; p = 0.001) and receiving chemotherapy (OR = 8.0; 95%CI: 1.4-58.4; p = 0.001) were associated with recurrence. CONCLUSION: Factors associated with recurrence were positive lymph nodes, expression of progesterone and estrogen receptors, triple-negative tumors, and receipt of chemotherapy.

Tumor de células granulares de vulva: un raro tumor genital benigno / Granular cell tumor of vulva: a rare benign genital tumor

Resumen ANTECEDENTES: El tumor de células granulares de la vulva es poco común y de origen neurogénico. Afecta, principalmente, a mujeres entre 60 y 70 años y es más frecuente en la raza negra. CASO CLÍNICO: Paciente de 63 años, con una lesión vulvar indolora y no pruriginosa, en crecimiento. En la exploración se observó una lesión excrecente de 2.5 cm en la región superior del labio mayor izquierdo, dura, vascularizada y con infiltración a 2 cm de profundidad. No se palparon adenopatías sospechosas. Luego del reporte de la biopsia, sugerente de tumor de células granulares, se practicó una escisión completa, con márgenes libres. El estudio inmunohistoquímico se reportó positivo para CD68, S100 y TFE3 lo que confirmó el diagnóstico. Puesto que el índice proliferativo (Ki67) fue inferior al 5% y los márgenes quirúrgicos estaban libres, no se requirió tratamiento adyuvante. La paciente permanece en seguimiento y sin signos de recidiva. CONCLUSIÓN: Si bien los tumores de células granulares de la vulva son poco comunes y casi siempre benignos, deben incluirse en el diagnóstico diferencial de una tumoración vulvar. La inmunohistoquímica es la herramienta más útil para el diagnóstico preciso y su tratamiento de elección es la escisión local amplia, por su tendencia a la recurrencia local.

Abstract BACKGROUND: Granular cell tumor of the vulva is rare and neurogenic in origin. It mainly affects women between 60 and 70 years of age and is more frequent in black women. CLINICAL CASE: A 63-year-old woman with a painless, non-pruritic, growing vulvar lesion. Examination revealed a 2.5 cm excrescent lesion in the upper region of the left labium majus, hard, vascularized and infiltrated to a depth of 2 cm. No suspicious lymph nodes were palpated. After the biopsy report, suggestive of granular cell tumor, complete excision was performed, with free margins. The immunohistochemical study was positive for CD68, S100 and TFE3 which confirming the diagnosis. Since the proliferative index (Ki67) was less than 5% and the surgical margins were clear, adjuvant treatment was not required. The patient remains in follow-up with no signs of recurrence. CONCLUSION: Although granular cell tumors of the vulva are rare and almost always benign, they should be included in the differential diagnosis of a vulvar tumor. Immunohistochemistry is the most useful tool for accurate diagnosis and their treatment of choice is wide local excision because of their tendency for local recurrence.

Hypoparathyroidism and Fahr's syndrome: case series / Hipoparatireoidismo e síndrome de Fahr: série de casos

Abstract Hypoparathyroidism (HP) is a rare metabolic disorder and causes hypocalcemia because parathyroid hormone secretion is inadequate to mobilize calcium from bone and reabsorb calcium from kidney and gut. Anterior neck surgery is the most common cause of acquired HP and autoimmune HP is the next most common form in adults. The duration, severity, and rate of development of hypocalcemia determine the clinical presentation. A variety of organs can be affected by calcification, more frequently kidneys, but also joints, eyes, skin, vasculature, and other organ systems and, although rarely seen, intracerebral calcifications. We report four cases of bilateral basal ganglia calcifications (BGC) also known as Fahr's syndrome related to hypoparathyroidism. Fahr's syndrome is characterized by bilateral symmetrical calcification of areas of the brain that control movements including basal ganglia, thalamus, and others; it is a rare inherited or sporadic neurological disorder with a prevalence of less than 1/1.000.000. Main symptoms related to bilateral BGC include extra-pyramidal and cerebellar disorders, cognitive impairment, epileptic seizures, and psychiatric changes. BGC has been established as a possible outcome of HP. Its prevalence, demonstrated in the HP cohorts, varied significantly from 12 up to 74%. Currently, computed tomography (CT) is the most valuable method for diagnosis. The treatment include symptomatic support and identification of causes, but there is no specific treatment limiting the progression of calcification in the basal ganglia. Especially in HP, an early treatment can prevent calcification and neurophysiological disorders.

Resumo O hipoparatireoidismo (HP) é um distúrbio metabólico raro e causa hipocalcemia, pois a secreção do paratormônio é inadequada para mobilizar o cálcio dos ossos e reabsorver o cálcio dos rins e intestino. A cirurgia cervical anterior é a causa mais comum de HP adquirido. O HP autoimune é a segunda causa mais comum em adultos. A duração, gravidade e taxa de desenvolvimento da hipocalcemia determinam a apresentação clínica. Diversos órgãos podem ser afetados pela calcificação, mais frequentemente os rins, mas também articulações, olhos, pele, vasculatura e outros órgãos e, embora raramente vista, calcificações intracerebrais. Relatamos quatro casos de calcificações dos gânglios da base (CGB) bilaterais, também conhecidas como síndrome de Fahr relacionadas ao hipoparatireoidismo. A síndrome de Fahr é caracterizada pela calcificação bilateral simétrica de áreas do cérebro que controlam os movimentos incluindo os gânglios da base, tálamo e outros; é um distúrbio neurológico raro, hereditário ou esporádico, com uma prevalência 1/1.000.000. Os principais sintomas relacionados à CGB bilateral incluem distúrbios extrapiramidais e cerebelares, comprometimento cognitivo, convulsões e alterações psiquiátricas. A CGB foi estabelecida como uma possível consequência do HP. Sua prevalência, demonstrada nas coortes de HP, variou significativamente de 12 a 74%. Atualmente, a tomografia computadorizada (TC) é o método mais valioso para o diagnóstico. O tratamento inclui suporte sintomático e identificação de causas, mas não há tratamento específico limitando a progressão da calcificação nos gânglios da base. Especialmente no HP, um tratamento precoce pode prevenir calcificações e distúrbios neurofisiológicos.

Guía de uso e indicaciones de la fluorescencia con verde de indocianina (ICG) en cirugía general: recomendaciones basadas en la revisión descriptiva de la literatura y el análisis de la experiencia / Indocyanine green (ICG) fluorescence guide for the use and indications in general surgery: Recommendations based on the descriptive review of the literature and the analysis of experience

El verde de indocianina es una tinción fluorescente visible con luz cercana al infrarrojo. Es útil para la identificación de las estructuras anatómicas (tracto biliar, uréteres, paratiroides, conducto torácico), la vascularización de tejidos (en anastomosis en cirugía colorrectal, esofágica, gástrica, bariátrica, para plastias y colgajos en cirugía de pared abdominal, hepática, en hernias estranguladas en la isquemia intestinal), para la identificación de tumores (hígado, páncreas, suprarrenal, implantes en la carcinomatosis peritoneal, tumores retroperitoneales y linfomas) y para la identificación del ganglio centinela y del mapeo linfático de tumores malignos (cáncer de estómago, mama, colon, recto, esófago y piel). Las evidencias son muy alentadoras, aunque se necesita la estandarización de su uso y más estudios prospectivos y aleatorizados con mayor número de pacientes para obtener conclusiones definitivas sobre su uso. El objetivo de esta revisión de la literatura es proveer una guía para el uso de la fluorescencia con verde de indocianina en procedimientos de cirugía general (AU)

Indocyanine Green is a fluorescent substance visible in near-infrared light. It is useful for the identification of anatomical structures (biliary tract, ureters, parathyroid, thoracic duct), the tissues vascularization (anastomosis in colorectal, esophageal, gastric, bariatric surgery, for plasties and flaps in abdominal wall surgery, liver resection, in strangulated hernias and in intestinal ischemia), for tumor identification (liver, pancreas, adrenal glands, implants of peritoneal carcinomatosis, retroperitoneal tumors and lymphomas) and sentinel node identification and lymphatic mapping in malignant tumors (stomach, breast, colon, rectum, esophagus and skin cancer). The evidence is very encouraging, although standardization of its use and randomized studies with higher number of patients are required to obtain definitive conclusions on its use in general surgery. The aim of this literature review is to provide a guide for the use of ICG fluorescence in general surgery procedures (AU)

Aplicación de la neurocirugía endoscópica en el tratamiento de las hemorragias hipertensivas en los ganglios basales / Application of neuroendoscopic surgery in treatment of hypertensive basal ganglia hemorrhage

Introducción: La relevancia de la neurocirugía endoscópica en el tratamiento de las hemorragias hipertensivas de los ganglios basales no se conoce en buena medida. Objetivo: Comparar la eficacia clínica de la neurocirugía endoscópica mínimamente invasiva con la de la microcirugía con craneotomía de ventana pequeña (SBWC) en el tratamiento de las hemorragias hipertensivas de los ganglios basales. Pacientes y métodos: Análisis retrospectivo de los datos clínicos de 174 pacientes con hemorragia hipertensiva de los ganglios basales tratados en nuestro hospital desde enero de 2018 hasta septiembre de 2020. Los pacientes se dividieron en dos grupos: uno sometido a neurocirugía endoscópica mínimamente invasiva (n = 90) y otro a microcirugía con SBWC (n = 84). Se compararon la duración de la operación, la tasa de eliminación del hematoma, la recidiva hemorrágica y el pronóstico. Resultados: En el grupo sometido a la endoscopia mínimamente invasiva, tanto la duración de la intervención como el tiempo de hemostasia fueron significativamente más breves, y la pérdida de sangre durante la intervención fue significativamente menor que en el grupo de microcirugía con SBWC (p < 0,001). La puntuación preoperatoria de la escala de coma de Glasgow (GCS) era de 8,64 ± 1,04 puntos en el grupo de la endoscopia y de 8,68 ± 1,02 puntos en el de la microcirugía (p > 0,05). A las 24 horas de la intervención, la puntuación de la GCS en los sometidos a la neuroendoscopia aumentó hasta 12,89 ± 1,56, con una diferencia significativa respecto al grupo de la microcirugía, que presentaba 11,18 ± 1,14 puntos (p < 0,001). El volumen del edema cerebral fue de 11,82 ± 3,25 mL en el grupo de la neuroendoscopia mínimamente invasiva y de 18,89 ± 3,15 mL en el de la microcirugía (p < 0,001). En comparación con el grupo sometido a esta última, en el grupo de la endoscopia, la eliminación del hematoma fue más extensa y el pronóstico resultó más favorable.(AU)

Introduction: The influence of Application of neuroendoscopic surgery in treatment of hypertensive basal ganglia hemorrhage remains largely unknown. Aim: To compare the clinical efficacy of minimally invasive neuroendoscopic surgery (NES) and small bone window craniotomy (SBWC) microsurgery on the treatment of patients with hypertensive basal ganglia hemorrhage (HBGH). Patients and methods: The clinical data of 174 HBGH patients treated in our hospital from January 2018 to September 2020 were retrospectively analyzed. They were divided into minimally invasive NES group (n = 90) and SBWC microsurgery group (n = 84). Their operation time, hematoma clearance rate, rebleeding and prognosis were compared. Results: In minimally invasive NES group, the operation time and intraoperative hemostasis time were significantly shorter, and the intraoperative blood loss was significantly less than those in SBWC microsurgery group (p < 0.001). The preoperative Glasgow coma scale (GCS) score was 8.64 ± 1.04 points and 8.68 ± 1.02 points respectively in minimally invasive NES group and SBWC microsurgery group (p > 0.05). At 24 h after operation, the GCS score in minimally invasive NES group rose to 12.89 ± 1.56 points, and it had a significant difference from that in SBWC microsurgery group (11.18 ± 1.14 points, p < 0.001). The volume of brain edema was 11.82 ± 3.25 mL in minimally invasive NES group and 18.89 ± 3.15 mL in SBWC microsurgery group (p < 0.001). In minimally invasive NES group, the clearance of hematoma was superior to that in SBWC microsurgery group, and the prognosis was also better than that in SBWC microsurgery group. Conclusions: Minimally invasive NES has better efficacy than SBWC microsurgery in the treatment of HBGH.(AU)

Comparación del rendimiento de pruebas cognitivas en pacientes con Enfermedad de Parkinson con y sin estimulación cerebral profunda / Comparison of the performance of cognitive tests in Parkinson Disease patients with and without Deep Brain Stimulation

Resumen Los pacientes diagnosticados con Enfermedad de Parkinson (EP) presentan alteraciones motoras concomitantes a otras alteraciones de tipo cognitivo, conductual o emocional. Una de las alternativas al tratamiento farmacológico es la estimulación cerebral profunda (ECP). Existen reportes de alteraciones en el rendimiento de tareas cognitivas tras procedimiento de ECP, lo que podría sugerir que el procedimiento es responsable de estos cambios cognitivos. El objetivo del estudio fue comparar los resultados del rendimiento en pruebas cognitivas de pacientes con EP de dos grupos (con ECP y sin ECP). Se recolectaron los resultados de 47 pacientes (n = 16 ECP; n = 31 sin ECP) durante los años de 2011 hasta 2015. Dentro de las funciones y variables evaluadas se encuentran: categorización visual, flexibilidad cognitiva, solución de problemas, atención selectiva, velocidad de procesamiento, inhibición conductual y calidad de vida. En general, no se encontraron diferencias significativas entre los grupos en las funciones evaluadas. En el grupo de participantes con ECP, se encontró mayor cantidad de correlaciones entre las pruebas de semejanzas y las de dígitos inversos, listas de palabras, búsqueda de símbolos y las subpruebas del Wisconsin Card Sorting Test. Así mismo, en los pacientes con ECP se presentó una percepción menor de calidad de vida asociada al tiempo de la enfermedad en comparación con el grupo sin ECP. En conclusión, estos resultados son congruentes con estudios similares de evaluación neuropsicológica y se discute el papel del tratamiento de estimulación en los pacientes, los cuales no siempre tienen un impacto positivo sobre la calidad de vida percibida.

Abstract Patients diagnosed with Parkinson's disease show motor alterations together to cognitive, behavioral, and emotional disturbances. An alternative treatment to the exclusive pharmacological medication is the Deep Brain Stimulation procedure (DBS). Some studies have shown altered behavioral patterns after DBS device implantation, suggesting a relationship between a particular performance in cognitive tests derived from the DBS procedure. Our study aimed to compare the performance of cognitive tests in Parkinson's disease patients with and without DBS. Results were analyzed from 47 patients (n = 16 DBS; n = 31 without DBS) in a range since 2011 to 2015. Functions tested were visual categorization, cognitive flexibility, problem solutions, selective attention, cognitive processing speed, behavioral inhibition, and quality of life. In general, there are non-significative differences between groups in functions tested. However, correlations were found depending on the group (DBS or without DBS patients), with more positive correlations inside the DBS group between the similarity test and inversed digits, list of words, symbol search and the sub-test of the Wisconsin Card Sorting Test. In addition, the DBS group showed a low perception of the quality of life associated with the disorder´s time compared to the without DBS group. In conclusion, these results are congruent with similar studies of neuropsychological evaluation, and the role of treatment is discussed below the perception of the quality of life.