Cirugia y cirujanos最新文献

Objective: Reviewing available literature regarding extranodal Rosai-Dorfman disease in the breast to explore the clinical characteristics of this disease, the described therapeutic options, and their outcomes.

Method: In January 2024, the PubMed, SpringerOpen, and Scopus databases were searched with the keywords "Rosai," "Dorfman," and "Breast." Forty-two studies were included in the final analysis, obtaining a total of 70 reported cases of extranodal Rosai-Dorfman disease affecting the breast. Patient characteristics, mammogram descriptions, therapeutic management, and outcomes were reviewed for statistical analysis.

Results: The main population consisted of females in their sixth decade of life (93%), presenting with a firm, non-tender nodule (65.7%), generally localized to one breast (72%). About 18.6% of patients had nodal or extranodal disease in other areas. Excisional biopsy was the main treatment strategy (63%) and surgical excision showed a lesser association with recurrence than incisional biopsy (p = 0.049). Most instances of disease recurrence or progression were diagnosed within the first 2 years.

Conclusions: This study revealed that surgical excision showed less association with disease recurrence or progression than expectant management. Follow-up can be conducted with a mammogram and physical examination since recurrence tends to occur locally within 2 years.

Objective: Correlate methods to analyze and identify the effectiveness of the objectives in actors with maps of strategic power.

Method: It is a conceptual study, analytical and with deductive reasoning, of explanatory scope in correlation of convergent and divergent strategic objectives to health processes.

Results: Understanding the importance of analyzing and understanding the prospective in the decision-making of the actors that impact their strategic, tactical and operational deployment of hospital medical care with the proposals of models with alignment in the health system and comprehensive practicality and analytical architecture modeling of how the hierarchical levels of actors can be concentrated according to the objectives with indicators and committed goals.

Conclusions: The prospective analysis of actors makes it easier to evaluate health leaders according to the effectiveness of their established objectives through the collection of information in matrices, MACTOR (Method, Actors, Objectives, Force Results) and mapping of health objectives. It is relevant in favor of ensuring strategic alignment in health institutions until reaching hospitals and giving continuity to the objectives and improving conflict management for the benefit of medical care.

In the context of cystic lesions of the pancreas and their paucisymptomatic symptoms, we present the case of a 33-year-old woman with epigastric pain and nonspecific abdominal discomfort. Computed tomography and magnetic resonance imaging were performed, with the finding of a lesion at the level of the head-uncinate process of the pancreas, compatible with a solid pseudopapillary neoplasm of the pancreas. The procedure was performed with a cephalic pancreaticoduodenectomy of Whipple, without incident. After 18 months of follow-up, the disease remains free. It is worth highlighting the importance of images prior to therapeutic planning, due to the proximity of the tumor to the celiac artery in the hepatic artery´s origin.

Objective: To evaluate if the comorbidity and coinfections presented by SARS-CoV-2 infection vs. COVID-19 impact our Mexican children.

Method: Prospective and observational study that included the 2020-2021 peak influenza season. All patients with a diagnosis of infection by SARS-CoV-2 vs. COVID-19 who were admitted to the Hospital Infantil de Mexico were analyzed. Real-time RT-PCR for SARS-CoV-2 was performed in all patients, determining E, RdRp and RP genes and protein N, as well as RT-PCR for detection of respiratory viruses.

Results: The inclusion criteria were met by 163 patients. The group with the highest risk of becoming ill was adolescents (40.4%), followed by schoolchildren and preschoolers (21.4% and 19.6% of the cases, respectively). There were three cases with viral coinfection: two (1.2%) with parvovirus B-19 and one (0.6%) with herpes type I; another two (1.2%) showed bacterial coinfection. The main comorbidity were obesity, acute lymphoblastic leukemia and arterial hypertension. Regarding mortality, we only had four cases (2.4%).

Conclusions: Obesity, cancer, hypertension, heart disease and diabetes are comorbidity present in our patients, as referred to in literature, but not coinfections. In our study, we did not have any associated mortality related to comorbidity.

Objective: This study aimed to investigate the limitations, barriers, and complications in the early transition from the microscopic transsphenoidal approach (MTA) to the endonasal endoscopic approach (EEA) to the skull base in our institution.

Methods: Technical challenges, as well as clinical features and complications, were compared between MTA, EEA, and mixed cases during the early surgical curve.

Results: The period from the early learning curve was 1 year until the EEA protocol was used routinely. A total of 34 patients registered a resection using a transsphenoidal approach. Eighteen patients underwent EEA, 11 underwent MTA, and five underwent a mixed endonasal and microscopic approach. Non-significant differences were found in endocrine outcomes between the three groups. Patients with unchanged or improved visual function were higher in the EEA group (p = 0.147). Non-significant differences were found in terms of the extent of resection (EOR) between groups (p = 0.369). Only 1 (2.9%) patient in the whole series developed a post-operative CSF leaking that resolved with medical management, belonging to the EEA group (5.5%).

Conclusions: The early phase of the learning curve did not affect our series significantly in terms of the EOR, endocrine status, and visual outcomes.

Objective: We present a solitary fibrous tumor (SFT) of the abdominal wall treated laparoscopically.

Method: We will discuss the clinicopathologic characteristics and will present a review of the literature.

Results: SFTs are rare neoplasms of mesenchymal origin. Its location in the abdominal wall is extremely rare. To the best of our knowledge, only 20 cases have currently been described in the literature.

Conclusions: Complete surgical resection is the main therapy for all cases. A laparoscopic approach is safe. Clinical-radiological follow-up must be carried out due to its uncertain behavior, and perioperative treatment may be necessary in high-risk patients.

Background: Robot-assisted radical prostatectomy has positioned itself as the approach of choice in the treatment of prostate cancer.

Objective: To compare the outcomes of robot-assisted radical prostatectomy using the Retzius-Sparing (RS) approach against the modified Frankfurt (MF) technique.

Method: To describe the perioperative, functional and oncological outcomes of 13 patients with prostate cancer who underwent RS robotic radical prostatectomy compared to MF, evaluating pathological results, urinary continence, sexual function and oncological control in 1 year of follow-up.

Results: The average age was 64 years in RS group vs. 61 years in MF group. The values of total prostate antigen were higher in the RS group (25 ng/dl) vs. MF group (11 ng/dl). The volume of gland in RS group was 40.62 ml vs. 63.33 ml in the RS group. All patients were bilaterally neuropreserved, being statistically significant in favor of MF group (p = 0.016). Positive surgical margins were higher in R-S group (38.4%) vs. MF group (33.3%).

Conclusions: With RS the same tendency to urinary continence is observed, with a significant difference in erectile function in favor of MF. This preliminary study shows better impact on erectile function.

Background: Colon leakage score (CLS) was developed for risk prediction of anastomotic leak (AL) in the left-sided colorectal surgery. Although the risk factors for leakage are well known and accepted by the surgical community, an accurate forecast of AL is still a difficult task.

Objective: The study aims to apply the CLS in patients undergoing left-sided colorectal surgery.

Methods: Retrospective study in patients with the left-sided colorectal surgery and primary anastomosis without diverting stoma. CLS was calculated in patients, who were classified in AL and NO-AL groups. Predictive value of CLS was evaluated by receiver operator characteristic. Correlation between CLS and AL was determined. 208 patients (55% male, mean age 59 years) were included in the study.

Results: Overall, AL was 7.2%. Mean CLS of all patients was 7.2 ± 3.2 (0-17). Patients with AL had a higher CLS (11.8 ± 2.3) than NO-AL patients (6.8 ± 3) (p = 0.0001). The area under the curve for the prediction of AL by CLS was 0.898 ([CI] 0.829-0.968, p = 0.0001). A CLS of 8.5 had 93% sensitivity and 72% specificity. There was a statistically significant odds ratio for CLS and AL (0.58: [CI] 0.46-0.73, p = 0.0001).

Conclusion: CLS is a useful tool to predict AL in the left-sided colorectal surgery.