Javiera Torres M

Tumores del apéndice cecal: Análisis anatomoclínico y evaluación de la sobrevida alejada

Introduccion: Los tumores del apendice cecal corresponden al 0,5% de las neoplasias gastrointestinales y su pronostico depende del tipo de tumor. Objetivos: Analizar las caracteristicas de los tumores apendiculares y los factores que influyen en su sobrevida. Material y Metodos: Estudio retrospectivo de los pacientes con un tumor apendicular operados entre 1981 y 2006 en el Hospital de la P. Universidad Catolica. Se evaluaron las caracteristicas clinicas, anatomopatologicas (AP) y la sobrevida alejada. Se utilizo la prueba de Fisher, el test de Wilcoxon y curvas de Kaplan-Meier. Resultados: Se operaron 67 enfermos, 39 mujeres y 28 hombres con una edad de 45,3 + 19,6 anos. En 59 enfermos la operacion se realizo por sospecha de apendicitis aguda, la que se confirmo en el estudio AP en 37 de ellos. En 36 pacientes se demostro un carcinoma neuroendocrino, en 18 un tumor benigno, en 7 un adenocarcinoma, en 5 un adenocarcinoide y en uno un carcinoma neuroendocrino y un cistoadenoma mucinoso. Se realizo una hemicolectomia en un segundo tiempo operatorio a 9 enfermos: 4 con un carcinoide, 3 con un adenocarcinoma, 1 con un adenocarcinoide y uno con un pseudomixoma peritoneal. La sobrevida a 5 anos fue de 100% en los enfermos con un tumor benigno, 97% en los con un carcinoma neuroendocrino, 75% en los con un adenocarcinoide y 62% en los con un adenocarcinoma (p<0,05). Conclusiones: En la mayoria de los enfermos el diagnostico de tumor se obtuvo como un hallazgo del estudio anatomopatologico en apendicectomias indicadas por sospecha de apendicitis aguda. En la sobrevida influyo fundamentalmente el tipo histologico del tumor

Características de presentación del microcarcinoma papilar del tiroides: Experiencia retrospectiva de los últimos 12 años

BACKGROUND Thyroid microcarcinoma is a tumor of 10 mm or less, that should have a low risk of mortality. However, a subgroup of these carcinomas is as aggressive as bigger tumors. AIM To describe the pathological presentation of these tumors, and compare them with larger tumors. MATERIAL AND METHODS All pathological samples of thyroid carcinoma that were obtained between 1992 and 2003, were studied. In all biopsies, the pathological type, tumor size, the focal or multifocal character, the presence of lymph node involvement and the presence of lymphocytic thyroiditis or thyroid hyperplasia, were recorded. RESULTS One hundred eighteen microcarcinomas and 284 larger tumors were studied. The mean age of patients with microcarcinoma and larger tumors was 42.7+/-14 and 49.3+/-16 years respectively (p <0,001) and 83% were female, without gender differences between tumor types. Mean size of microcarcinomas was 8.6 mm and 116 (98%) were papillary carcinomas. Of these, 109 (94%) were well differentiated and seven (6%) were moderately differentiated. Thirty six (31%) were multifocal and in 10 (8,6%), there was lymph node involvement. The mean size of larger tumors was 23.8 mm and 241 (85%) were papillary carcinomas. Of these, 200 (83%) were well differentiated, and 41 (17%) were moderately differentiated. Eighty five (35%) were multifocal and in 44 (18%) there was lymph node involvement. The prevalence of thyroiditis and hyperplasia was significantly higher among microcarcinomas than in larger tumors (15 and 2.5%, respectively, p <0.001, for the former; 32.4 and 1.7%, respectively, p <0.001, for the latter). CONCLUSIONS In this series, one third of microcarcinomas were multifocal and 10% had lymph node involvement. Therefore, the aggressiveness of these tumors is higher than what is reported in the literature and they should be treated with total thyroidectomy.

Abscesos esplénicos: Comunicación de siete casos y revisión de la literatura

BACKGROUND Splenic abscesses are uncommon, appear in subjects with predisposing factors such as systemic infections and have high mortality rates. AIM To report seven patients with splenic abscesses. MATERIAL AND METHODS Retrospective review of medical records of patients with a splenic abscess treated between 1987 and 2005. RESULTS The records of four women and three males aged 20 to 74 years, were reviewed. The most common presenting symptoms were fever and abdominal pain and all had predisposing factors. Six patients had a leukocyte count of 19,500 x mm(3). Mean erythrocyte sedimentation rate and C reactive protein values were 75 mm/h and 13.5 mg/dl. Diagnosis was made with ultrasound in two patients and CT scan in five. Six patients had an unique abscess and one patient had multiple lesions. A splenectomy was done in three patients as the first choice treatment and in one, due to medical treatment failure. In two patients, a CT guided percutaneous drainage was performed and one patient was subjected to medical treatment only. Abscess cultures were positive in 50% of patients subjected to percutaneous drainage and in 50% of splenectomized patients. No patient died and no complications were observed in the early or late postoperative period. CONCLUSION Splenic abscesses are associated to predisposing conditions. The first choice is surgical treatment, but percutaneous drainage is also a therapeutic option.

Miocardiopatía dilatada secundaria a enfermedad celíaca: Caso clínico

There is an increased incidence of celiac disease in patients with idiopathic dilated cardiomyopathy. We report a 4 7 year-old female presenting with heart failure secondary to dilated cardiomyopathy of unknown etiology. During the five months following the first hospitalization the patient had multiple hospital admissions due to decompensate heart failure. Due to a history of intermittent diarrhea and weight loss, a celiac disease was suspected. Antiendomysial antibodies were positive and there was a villous atrophy in duodenal mucosa. A gluten free diet was started with a concomitant recovery of her functional capacity. After one month of gluten free diet a new echocardiogram showed a normal left ventricle and systolic function.

Ameloblastoma mandibular maligno con metástasis hepática y pulmonar: Caso clínico

Malignant mandibular ameloblastoma with hepatic and lung metastases: a case report Ameloblastoma is a benign rare tumor, originated in the odontogenic epithelium, is locally invasive and with high tendency to local recurrence, a variety less common is the malignant or metastasizing ameloblastoma, where more frequent sites of deployment are the lung and cervical lymph nodes, being much less frequent sites the liver and skull among others. The surgical treatment is mainly the aggressive surgery of the primary tumor and metastases. We present a case of a patient with malignant mandibular ameloblastoma with metastases in liver and lung, which was subjected to a subtotal mandibulectomy, local radiotherapy and lung and liver metastasectomy in a second time, with late recurrence of the lesion.

Hepatectomía derecha extendida por colangiocarcinoma intrahepático en un paciente con síndrome de Dubin-Johnson*

Hepatectomy for cholangiocarcinoma in one patient with Dubin Johnson syndrome Dubin-Johnson syndrome (SDJ) is a rare benign autosomal recessive congenital disease that causes jaundice. We report a 71 years old male with a Dubin Jonson syndrome diagnosed at the age of 40. On a ultrasound examination and magnetic resonance imaging, a liver tumor was found, that was excised. The pathology report showed a cholangiocarcinoma. During the postoperative period, the patient had a hyperbilirubinemia that subsided slowly. There are reports of hyperbilirubinemia of difficult management after hepatectomy in patients with Dubin-Johnson syndrome.

Pancreatectomía distal: indicaciones y resultados quirúrgicos inmediatos

Introduccion: Se denomina pancreatectomia distal a la reseccion pancreatica a la izquierda del eje mesenterico portal. Los objetivos del trabajo son analizar las indicaciones y los resultados quirurgicos de esta operacion en enfermos con un tumor pancreatico. Material y metodos: Estudio retrospectivo de 38 pacientes operados entre 1990 y 2005. Se analizaron las caracteristicas clinicas, quirurgicas y el estudio anatomopatologico. Resultados: Se operaron 29 mujeres y 9 hombres, de 52,9 + 5 anos. El motivo de consulta mas frecuente fue dolor abdominal en 26 enfermos. El diagnostico se realizo con una ecografia en 7 pacientes y en 31 con una tomografia o una resonancia de abdomen. La indicacion quirurgica fue la presencia de un tumor pancreatico en los 38 enfermos, quistico en 24 y solido en 14. A 25 pacientes se les realizo una esplenectomia. Diez enfermos presentaron complicaciones postoperatorias; las mas frecuentes fueron: fistula pancreatica en 5, sepsis en 3 e infeccion del cateter central en 3. No hubo diferencias en la frecuencia de complicaciones ni en el desarrollo de una fistula pancreatica entre los enfermos con y sin esplenectomia. Un enfermo fallecio por sepsis abdominal. El estudio anatomopatologico mostro 28 tumores benignos y 10 tumores malignos, siendo los mas frecuentes el cistoadenoma mucinoso y el adenocarcinoma, respectivamente. Conclusiones: Las pancreatectomias distales se realizaron principalmente por un tumor quistico benigno. La complicacion mas frecuente fue la fistula pancreatica, la que llevo a la muerte a un paciente. Los enfermos esplenectomizados no presentaron mas complicaciones postoperatorias que los sin esplenectomia

Microcarcinoma tiroideo de evolución agresiva: Report of one case

The treatment of papillary thyroid carcinoma of less than 10 mm diameter is a matter of controversy. The incidental finding of papillary microcarcinomas in autopsies is frequent and some authors postulate that these tumors are biologically inactive and should only be observed. We report a 21 years old woman with a papillary thyroid cancer of 6x5x5 mm and bilateral paratracheal metastases, that was subjected to a total thyroidectomy. She received 200 mCi of radioiodine. Two years after surgery, a new nodule of 9.6 mm diameter was detected by ultrasound, that was treated with a new dose of 200 mCi of radioiodine. One year later a suprasternal mass of 2 cm diameter and 3 enlarged lymph nodes were detected. She was subjected to a surgical lymph node dissection of the neck and the biopsy confirmed the presence of cancer. She received a new dose of 300 mCi of radioiodine. The mother of the patient had a 7 mm thyroid nodule that was also a papillary carcinoma (Rev Med Chile 2005; 133: 323-6)The treatment of papillary thyroid carcinoma of less than 10 mm diameter is a matter of controversy. The incidental finding of papillary microcarcinomas in autopsies is frequent and some authors postulate that these tumors are biologically inactive and should only be observed. We report a 21 years old woman with a papillary thyroid cancer of 6 x 5 x 5 mm and bilateral paratracheal metastases, that was subjected to a total thyroidectomy. She received 200 mCi of radioiodine. Two years after surgery, a new nodule of 9.6 mm diameter was detected by ultrasound, that was treated with a new dose of 200 mCi of radioiodine. One year later a suprasternal mass of 2 cm diameter and 3 enlarged lymph nodes were detected. She was subjected to a surgical lymph node dissection of the neck and the biopsy confirmed the presence of cancer. She received a new dose of 300 mCi of radioiodine. The mother of the patient had a 7 mm thyroid nodule that was also a papillary carcinoma.

Colitis de Crohn: Resultados del tratamiento quirúrgico y evolución alejada.

BACKGROUND Exclusive involvement of the colon or rectum in Crohns disease, called Crohns colitis, (CC) occurs in about 25% of these patients. AIM To analyze early surgical results and long-term outcomes of patients undergoing surgery for CC. MATERIAL AND METHODS Review of a prospective database, identifying patients with Crohns disease operated between 2003 and 2015 and excluding those with ileocecal disease. We analyzed demographic data, pre and postoperative pharmacological treatment, operations, morbidity and the need for a second bowel resection at follow-up. RESULTS We reviewed data from 28 patients aged 17 to 72 years (15 men). Twenty-seven (96.4%) had previous pharmacological treatment, 11 received monoclonal antibodies. The most common indications for surgical treatment were failure of medical treatment in 15 cases, acute severe colitis in 12 and anemia/malnutrition in eight. Total colectomy was performed in 17 (61%) patients, proctocolectomy in 8 (29%) and segmental colectomies in 3 (11%). Sixteen (57%) were operated laparoscopically. Major postoperative complications were observed in 5 (18%). Four needed a reintervention. There was no operative mortality. During a 55 months median follow-up of 27 patients, seven (26%) required a second bowel resection, one of them for recurrence. Nineteen (70%) patients had an ostomy, which was permanent in 11. Fifteen patients are without medical treatment. CONCLUSIONS Most of the reviewed patients required total colectomy for the control of the disease with a low surgical morbidity. Two-thirds required an ileostomy, which became permanent in half of them.

Tumores neuroendocrinos del páncreas: Resultados quirúrgicos y sobrevida alejada

Introduccion: Los tumores neuroendocrinos del pancreas (TNEP) representan el 1-2% de las neoplasias pancreaticas. Su incidencia ha aumentado en los ultimos anos debido probablemente a la mayor capacidad diagnostica de los estudios por imagenes. Objetivos: Analizar las caracteristicas clinicas, resultados quirurgicos y sobrevida alejada de los pacientes con TNEP operados en nuestro centro. Material y Metodos: Estudio descriptivo de una serie de casos. Analisis de base de datos y registros clinicos de los pacientes con diagnostico histologico de TNEP sometidos a cirugia resectiva en nuestro centro entre junio de 2005 y junio de 2012. Resultados: Serie compuesta por 20 pacientes (10,6% de las resecciones pancreaticas), 12 de sexo femenino, con una mediana de edad de 44 (20-77) anos. El dolor abdominal fue el sintoma de presentacion mas frecuente. Dos pacientes eran portadores del sindrome de neoplasia endocrina multiple tipo 1 (NEM-1). La evaluacion diagnostica se realizo con CT, RM y/o PET/CT. Los tumores fueron funcionantes en 5 enfermos. Se realizaron 5 pancreatoduodenectomias (PD), 14 pancreatectomias corporocaudales (PC) y 1 enucleacion. Entre las complicaciones postoperatorias, hubo 5 fistulas pancreaticas tipo B y una tipo C. No hubo mortalidad. En el seguimiento (mediana de 31 [5-90] meses), ningun paciente fallecio por progresion de la enfermedad. Conclusion: Los TNEP representan una patologia en aumento en nuestro centro. La cirugia resectiva con margenes microscopicos negativos es la alternativa terapeutica de eleccion.