Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , COVID-19 , Humanos , Fígado , México , SARS-CoV-2RESUMO
Pseudomyxoma extraperitonei is rare lesion resulting from the rupture of an appendiceal mucocele into the extraperitoneal tissues. We report a case of an 80-year-old woman with a medical history for a left hemicolectomy and a laparoscopic cholecystectomy 11 and 6 years, respectively, referred to our hospital for abdominal pain of increasing severity localised to the right hemiabdomen. The abdominal examination revealed a mobile mass a multidetector CT was performed; the patient was taken to surgery which was performed with no complications. Histopathological analysis of the tumour reported a pseudomyxoma associated to a moderately differentiated adenocarcinoma. The patient remains asymptomatic at a 1-year follow-up.
Assuntos
Adenocarcinoma/complicações , Neoplasias Císticas, Mucinosas e Serosas/complicações , Neoplasias de Tecidos Moles/complicações , Parede Abdominal , Idoso de 80 Anos ou mais , Feminino , HumanosRESUMO
Glomus tumours are a rare type of subepithelial mesenchymal tumours that present in deep visceral organs such as the stomach, which are difficult to diagnose. We report a case of a 44-year-old woman with diabetes who presented with anaemia, abdominal pain and melena diagnosed preoperatively with a gastric glomus tumour initially misdiagnosed as a gastric ulcer located at the lesser curvature. Upon referral to our centre a repeat endoscopy and biopsy were performed. A partial gastrectomy was performed with no complications. Histopathological analysis of the tumour reported clear margins and immunostaining was positive for smooth muscle actin and collagen IV. The patient remains asymptomatic at 3-month follow-up.
Assuntos
Hemorragia Gastrointestinal/etiologia , Tumor Glômico/complicações , Neoplasias Gástricas/complicações , Adulto , Feminino , HumanosRESUMO
INTRODUCTION/AIM: Dengue fever is a common disease in tropical and subtropical regions and is characterized by fever, headache, and joint and muscle pain. Occasionally, patients develop abdominal and gastrointestinal symptoms but information about the real frequency of these manifestations is lacking. The aim of this study was to determine the frequency of abdominal and gastrointestinal symptoms in a cohort of patients with Dengue fever. PATIENTS AND METHODS: We performed a retrospective review of 8559 patients with a diagnosis of Dengue fever during the 2006 epidemic to determine the frequency of abdominal and gastrointestinal symptoms. RESULTS: Abdominal and gastrointestinal symptoms were present in 67% of patients. The most frequent symptom was nausea (n=4453, 52%), followed by abdominal pain (n=3058, 36%), vomiting (n=2477, 29%), diarrhea (n=1471, 17%), hepatomegaly, (n=144, 2%), gastrointestinal bleeding (n=34, 0.3%) and ascites (n=8, 0.1%). Hospitalization was required in 1640 patients (19%), of which 1210 (74%, p=0.0001) had some abdominal and gastrointestinal symptoms. In this group, the most frequent symptoms were nausea (n=972, 59%), abdominal pain (n=692, 42%), vomiting (n=668, 41%) and diarrhea (n=393, 24%). Among patients admitted to our hospital for Dengue, 70% showed alterations in liver function tests. CONCLUSIONS: Our findings suggest that close to 67% of patients with Dengue fever have abdominal and gastrointestinal symptoms or abnormalities in liver function tests. Abdominal and gastrointestinal symptoms were significantly more frequent in patients who were hospitalized. The differential diagnosis of an acute febrile syndrome with abdominal pain or gastrointestinal symptoms in patients living in endemic areas or who have recently travelled to certain regions should include Dengue fever.
Assuntos
Dengue/complicações , Surtos de Doenças , Gastroenteropatias/etiologia , Dor Abdominal/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ascite/etiologia , Criança , Pré-Escolar , Estudos de Coortes , Dengue/diagnóstico , Dengue/epidemiologia , Doenças Endêmicas , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Hipertrofia/etiologia , Lactente , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Náusea/etiologia , Pancreatite/etiologia , Estudos Retrospectivos , Viagem , Adulto JovemRESUMO
BACKGROUND: Gastric cancer has a tendency to present at early age in the Mexican population, and it is frequently associated with a family history. A polymorphism at position -160 at the CDH1 promoter region has been reported to lead to transcriptional downregulation of the gene in vitro, with possible increase in the risk of gastric cancer. We evaluated the role of the -160A allele in the risk of gastric cancer in a young Mexican population. METHODS: Peripheral blood sample of Mexican patients younger than 45 years old with diagnosis of diffuse gastric cancer were obtained. We performed DNA extraction and analyzed the frequencies of -160 promoter polymorphism of E-cadherin gene by polymerase chain reaction-single strand conformational polymorphism. These frequencies were compared with those of healthy controls. The chi2 test for association was used to test differences of the genotype frequencies between normal controls and patients with gastric cancer. Findings were considered significant at P < .05. RESULTS: The frequency of the -160 A allele was significantly higher (P = .002) in 39 patients with diffuse gastric cancer compared with 78 matched controls. The odds ratio associated with the A-allele was 1.98 for C/A heterozygotes (95% CI 1.01-3.98) and 6.5 for A/A homozygotes (95% CI 2.1-19.6). We found an increased risk of diffuse gastric cancer according to family history, independent of the expression of the polymorphism. CONCLUSIONS: The -160 C/A polymorphism of the E-cadherin has a direct effect on the risk of diffuse gastric cancer at young age in Mexican population.
Assuntos
Caderinas/genética , Polimorfismo de Nucleotídeo Único , Regiões Promotoras Genéticas , Neoplasias Gástricas/genética , Adulto , Alelos , Estudos de Casos e Controles , Feminino , Frequência do Gene , Heterozigoto , Homozigoto , Humanos , Masculino , México/epidemiologia , Razão de Chances , Reação em Cadeia da Polimerase , Fatores de Risco , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patologiaRESUMO
BACKGROUND: There are very few studies that analyze surgical morbidity and mortality in the general population and the factors associated with those events. OBJECTIVE: To determine factors associated to mortality in surgical procedures performed in a tertiary referral center in Mexico City. METHODS: We retrospectively analyze surgical mortality in 4,157 consecutive surgical procedures performed in a one-year period from 1/1/2000 through 12/31/2000. Categorical variables were analyzed with the chi-square test and continuous variables with the t-Student test. Significance was defined as p < 0.05. RESULTS: During the study period there were 76 postoperative deaths, representing a mortality rate of 1.82%. Mean patient's age in the entire cohort was 48.7 +/- 17.6 years and for the patients who died in the postoperative period 57.8 +/- 17.8 years (p < 0.05). Sixty-six percent of deaths were attributed to the primary or surgical disease. In 33.8% of postoperative deaths an adverse event was identified as responsible for the outcome. In 23% of cases there was a potentially preventable event, representing 0.3% of surgical procedures. Most patients (96.9%) had at least one comorbid condition and 61.5% had two or more. Almost 80% of surgical deaths occurred in patients with ASA score III of IV and albumin levels below 3.5 g/dL. Most common cause of death was sepsis, reported in 35% of patients who died in the postoperative period. CONCLUSION: Surgical mortality in our series is low. In 0.3% of procedures it was detected a potentially preventable event. Postoperative deaths occurred in older patients with low albumin levels.
Assuntos
Academias e Institutos/estatística & dados numéricos , Mortalidade Hospitalar , Procedimentos Cirúrgicos Operatórios/mortalidade , Adulto , Fatores Etários , Idoso , Causas de Morte , Estudos de Coortes , Comorbidade , Feminino , Humanos , Hipoalbuminemia/epidemiologia , Complicações Intraoperatórias/mortalidade , Falência Hepática/mortalidade , Masculino , Erros Médicos/mortalidade , México/epidemiologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Encaminhamento e Consulta , Estudos Retrospectivos , Fatores de Risco , Sepse/mortalidade , Índice de Gravidade de Doença , Choque Cardiogênico/mortalidadeRESUMO
Background. There are very few studies that analyze surgical morbidity and mortality in the general population and the factors associated with those events. Objective. To determine factors associated to mortality in surgical procedures performed in a tertiary referral center in Mexico City. Methods. We retrospectively analyze surgical mortality in 4,157 consecutive surgical procedures performed in a one-year period from 1/1/2000 through 12/31/2000. Categorical variables were analyzed with the chi-square test and continuous variables with the t-Student test. Significance was defined as p < O.OB. Results. During the study period there were 76 postoperative deaths, representing a mortality rate of 1.82%. Mean patient's age in the entire cohort was 48.7 ± 17.6 years and for the patients who died in the postoperative period 57.8 ± 17.8 years (p < 0.05). Sixty-six percent of deaths were attributed to the primary or surgical disease. In 33.8% of postoperative deaths an adverse event was identified as responsible for the outcome. In 23% of cases there was a potentially preventable event, representing 0.3% of surgical procedures. Most patients (96.9%) had at least one co-morbid condition and 61.5% had two or more. Almost 80% of surgical deaths occurred in patients with ASA score III of TV and albumin levels below 3.5 g/dL. Most common cause of death was sepsis, reported in 35% of patients who died in the postoperative period. Conclusion. Surgical mortality in our series is low. In 0.3% of procedures it was detected a potentially preventable event. Postoperative deaths occurred in older patients with low albumin levels.
Introducción. Existen pocos estudios que analicen la mortalidad quirúrgica general y los factores asociados a la misma. Objetivo. Estudiar las causas y factores asociados a mortalidad quirúrgica en las intervenciones quirúrgicas realizadas en el INCMNSZ. Métodos. Se analizó en forma retrospectiva la mortalidad quirúrgica asociada a 4,157 procedimientos consecutivos realizados del 1/1/2000 al 31/12/2000. Los factores asociados a mortalidad fueron analizados mediante la prueba de chi-cuadrada para variables categóricas y t de Student para variables continuas. Se estableció como significativa a p < 0.05. Resultados. Durante ese periodo ocurrieron 76 muertes postoperatorias, lo que representa una mortalidad global de 1.82% para todos los procedimientos. El promedio de edad para los 4,157 procedimientos fue de 48.7 ± 17.6 años y para las muertes postoperatorias fue de 57.8 ± 17.8 años (p < 0.05). El 66.2% de las muertes se atribuyeron a la enfermedad de base o a la patología que motivó la cirugía. En 33.8% de las muertes se identificó algún evento diferente a la enfermedad primaria como responsable de la muerte. En 23% se identificó algún evento potencialmente prevenible, lo que representa 0.3% del total de eventos quirúrgicos. El 96.9% de los pacientes tenía al menos una comorbilidad y 61.5% cursaba con dos o más. El 78.5% de las muertes sucedió en pacientes ASA III-IV. El 80% de las muertes se asoció a niveles preoperatorios de albúmina por debajo de 3.5 g/dL. La causa de muerte más frecuentemente reportada fue sepsis en 35% de los eventos. Conclusión. La mortalidad postoperatoria en nuestra serie es baja. En 0.3% de los pacientes sometidos a cirugía se detectó algún evento potencialmente prevenible. Las muertes postoperatorias ocurrieron en pacientes más viejos y con niveles bajos de albúmina.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Academias e Institutos/estatística & dados numéricos , Mortalidade Hospitalar , Procedimentos Cirúrgicos Operatórios/mortalidade , Fatores Etários , Causas de Morte , Estudos de Coortes , Comorbidade , Hipoalbuminemia/epidemiologia , Complicações Intraoperatórias/mortalidade , Falência Hepática/mortalidade , Erros Médicos/mortalidade , México/epidemiologia , Complicações Pós-Operatórias/mortalidade , Encaminhamento e Consulta , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Sepse/mortalidade , Choque Cardiogênico/mortalidadeRESUMO
The aim of this study was to analyze the clinicopathologic characteristics of young patients with gastric cancer with special attention to hereditary gastric cancer in a tertiary referral university hospital. Charts from all patients 40 years of age or younger at the time of diagnosis, during the period from January 1, 1987 to December 31, 2001, were retrospectively reviewed. Demographic variables, family history of gastric cancer, clinicopathologic characteristics, and treatment-related variables were analyzed. Overall survival was the main outcome variable. Survival curves were constructed by means of the Kaplan-Meier method, univariate analysis was performed with the log-rank test, and multivariate analysis with Cox regression. Significance was considered at P<0.05. During the study period, 558 cases of gastric cancer were seen at our institution, 83 (14.8%) were in patients 40 years of age or younger. Mean patient age was 33.2 years. Forty-five patients (54.2%) were male. Fourteen patients (16.9%) had a family history of gastric cancer. Five patients (6%) fulfilled the criteria of hereditary gastric cancer. Surgery was performed in 88% of patients, but only 35% of the operations had a curative intent. Operative mortality was 2.4%. On univariate analysis, advanced tumor stage, hypoalbuminemia, low performance status, diffuse type, pangastric tumor location, noncurative surgery, and lack of adjuvant chemotherapy had a significant negative impact on survival. On multivariate analysis, advanced tumor stage, pangastric tumor location, and absence of adjuvant chemotherapy were significantly associated with poor prognosis. Family history of gastric cancer or hereditary gastric cancer did not have any impact on prognosis. There is a high frequency of gastric cancer in young patients at our institution. Most patients present in advanced stages, which favors a poor overall survival. Family history of gastric cancer or hereditary gastric cancer did not have a significant impact on survival. Complete resection and adjuvant chemotherapy appeared to confer the only chance of prolonged survival.
Assuntos
Adenocarcinoma/genética , Síndromes Neoplásicas Hereditárias/diagnóstico , Neoplasias Gástricas/genética , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adulto , Caderinas/genética , Feminino , Humanos , Masculino , México/epidemiologia , Análise Multivariada , Estadiamento de Neoplasias , Síndromes Neoplásicas Hereditárias/mortalidade , Estudos Retrospectivos , Estômago/patologia , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/patologia , Taxa de SobrevidaRESUMO
BACKGROUND: Surgical treatment for stage IV gastric cancer is controversial. METHODS: We analyzed the surgical experience with advanced gastric carcinoma in a tertiary referral center in Mexico City from 1995 through 2000. We analyzed surgical morbidity, mortality, and factors associated with prognosis. Survival was analyzed with the Kaplan-Meier method, and the curves were compared with the log-rank test. Significance was assigned at P <0.05. RESULTS: Seventy-six cases were identified. Mean patient age was 56 +/- 14.5 years. Thirty-nine patients (51.3%) were women. Patients were grouped according to surgical procedure: group 1 underwent resection (40 patients), group 2 underwent bypass procedures (10 patients), and group 3 underwent either celiotomy and biopsy alone or jejunostomy placement (26 patients). Twenty patients (26%) developed operative complications, but most were minor. There was no difference in morbidity between surgical groups and no difference according to patient's age. Operative mortality was 2.6%. Good palliation of symptoms was significantly more common in group 1 patients (82%) than in group 2 patients (60%) (P = 0.0001). Median survival was 8 months (95% confidence interval 4 to 12) for the entire cohort and 13, 5, and 3 months for groups 1, 2, and 3, respectively (P = 0.00001 for group 1 vs groups 2 and 3). CONCLUSIONS: Surgical resection for stage IV gastric cancer can be done with low operative mortality and acceptable morbidity rates, and it provides patients with good symptomatic relief. Advanced patient age is not a contraindication for surgical treatment.
Assuntos
Adenocarcinoma/cirurgia , Neoplasias Gástricas/cirurgia , Adenocarcinoma/patologia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Gástricas/patologiaRESUMO
BACKGROUND: Sarcomas arising in the gastrointestinal (GI) tract are rare tumors. Molecular markers could be associated with prognosis in these types of tumors. METHODS: We performed a retrospective analysis of adult patients with sarcomas arising in the GI tract at the National Institute of Medical Sciences in Mexico City and the University of Alabama at Birmingham Hospital. All histological types were included. Patient, tumor, and treatment factors were analyzed, with overall survival as the main outcome variable. Expression of p53 and cellular proliferation antigen Ki-67 was also analyzed. Statistical analysis was performed by log-rank test and Cox regression. Significance was defined as P <.05. RESULTS: Forty-seven patients were analyzed. The median patient age was 53 years (range, 16-82 years). Twenty-five patients (53%) were women. The stomach was the most common site of presentation. The mean tumor size was 14 cm (2-45 cm). A complete resection was achieved in 40 patients. With a median follow-up of 30 months, the actuarial 3-year survival was 68%. Univariate analysis identified overexpression of p53 and Ki-67, high tumor grade, tumor size >10 cm, and incomplete resection as significant negative prognostic factors. Hispanic race and good performance status were significantly associated with prolonged survival. On multivariate analysis, overexpression of p53 was the only independent negative prognostic factor. CONCLUSIONS: Overexpression of p53 is the strongest predictor of poor prognosis in patients with sarcomas of the GI tract.
Assuntos
Neoplasias Gastrointestinais/metabolismo , Antígeno Ki-67/metabolismo , Sarcoma/metabolismo , Proteína Supressora de Tumor p53/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/metabolismo , Feminino , Neoplasias Gastrointestinais/patologia , Neoplasias Gastrointestinais/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Sarcoma/patologia , Sarcoma/terapia , Análise de SobrevidaRESUMO
OBJECTIVE: To present a case of adult intussusception with uncommon etiology. BACKGROUND: Intussusception is a relatively common cause of intestinal obstruction in children, but is a rare clinical entity in adults, representing less than one per cent of intestinal obstruction in this patient population. METHOD: We report on 72-year old female patient with intestinal obstruction due to ileocolic intussusception related to leiomyosarcoma of the terminal ileum. A synchronic adenocarcinoma in the cecum was identified. The patient underwent right hemicolectomy and terminal ileum resection with primary anastomosis. Her postoperative course was uneventful. The patient is free of all evidence of disease at 2 year of follow-up. A thorough review of the literature of adult intussusception was carried out. CONCLUSION: From this review, the recommendation is to resect all cases of adult intussusception, different from the recommended approach in pediatric population.
Assuntos
Adenocarcinoma/complicações , Neoplasias do Ceco/complicações , Neoplasias do Íleo/complicações , Intussuscepção/etiologia , Leiomiossarcoma/complicações , Neoplasias Primárias Múltiplas , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Idoso , Neoplasias do Ceco/patologia , Neoplasias do Ceco/cirurgia , Ceco/patologia , Colectomia , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Neoplasias do Íleo/patologia , Neoplasias do Íleo/cirurgia , Íleo/patologia , Intussuscepção/diagnóstico por imagem , Intussuscepção/cirurgia , Leiomiossarcoma/patologia , Leiomiossarcoma/cirurgia , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/cirurgia , Radiografia , Fatores de TempoRESUMO
BACKGROUND: Bilioenteric fistulas are entities whose etiology can be diverse. OBJECTIVE: The aim of this paper was to present two cases of biliary-colonic fistulas with different presentations and to review existing literature regarding etiology, diagnosis, and management of these patients. METHODS: Two cases of biliary-colonic fistulas were reviewed. RESULTS: Case 1. A 48-year-old woman presented with lower gastrointestinal bleeding secondary to cholecystocolonic fistula in context of cholelithiasis. Case 2. A 60-year-old woman with multiple hepatic abscess associated with biliary-colonic fistula secondary to adenocarcinoma of gallbladder. CONCLUSIONS: Biliary-colonic fistulas are recognized complications of cholelithiasis. Association with neoplasia is less frequent. Preoperative diagnosis is difficult and management must be surgical.