Medullary thyroid carcinoma: 20 years experience Background: Medullary thyroid carcinoma (MTC) is a rare malignant tumor that arise from C cells. Surgical treatment and its results are controversial, so we decided to study it. Aim: To describe clinically MTC, treatment and outcomes in the long term. Material and Method: We retrospectively reviewed medical records of patients with MTC operated in our hospital between the years 1987 and 2007. We analyzed the clinical characteristics, treatment, morbidity and long-term follow up. Results: There were 24 patients operated with a mean age of 46.1 ± 16.6 years. The main form of presentation was painless increased cervical volume (56.2%). In 15% this pathology was part of a MEN 2b. All of them have had a total thyroidectomy, which was extended in 50% of cases. The 35.2% were multifocal, 29.4% bilateral and 62.5% had metastatic lymph node involvement. Five patients remained higher calcitonin levels in the postoperative period and 9 patients recurred clinically on average 4.5 years after surgery. The presence of persistent disease was significantly associated with hereditary MTC (p = 0.0088) and the clinical recurrence was significantly determined by the presence of not expanded total thyroidectomy (p = 0.0196). The probability of surviving more than 19 years was 66.6% (95% CI = 0.24 to 0.89). Conclusions: The MTC is a rare tumour and treatment of choice is surgery. The persistent disease is associated with hereditary MTC form, and the clinical recurrence is associated with not expanded total thyroidectomy. We recommend total thyroidectomy with central voiding and radical modified jugular dissection.
Efecto del bypass gástrico a largo plazo (7 a 10 años) en pacientes con obesidad severa y mórbida sobre el peso corporal, diabetes, dislipidemia y desarrollo de anemiaResults of gastric bypass for morbid obesity after a follow up of seven to 10 years (Rev Med Chile 2011; 139: 1414-1420.
Tumor location in the stomach, macroscopic type, pathological type, lymph node involvement and long term survival were analyzed. results: Three hundred four patients with a mean age of 62 years (170 males) were analyzed. Tumors were intramucosal and submucosal in 136 (45%) and 168 (55%) patients, respectively. Among group III proximal tumors and diffuse pathological types were more common. Five and 15 years survival were 88 and 72%, respectively. conclusions: During the study period, tumor location and pathological types changed. Patients had high survival rates.
Hiperobesity v/s morbid obesity: a comparative studyIntroduction: Bariatric surgery is effective and safe in treating obese patients with BMI > 40, however, higher preoperative weight could increases morbidity and mortality. Aim: To describe and compare the perioperative and mid term outcomes between hiperobese and morbidly obese patients submitted to gastric bypass. Material and Method: A prospective study of hiperobese patients submitted to gastric bypass over the past 10 years. We analyzed clinical characteristics, perioperative morbimortality and resolution of comorbidities. The results were compared with a group of morbidly obese patients matched by age and sex. Results: 146 hiperobese were operated and compared with 165 morbidly obese patients. 66.8% were female and the average age of the total group was 39.9 ± 12.4 years, with no signifi cant differences between groups by sex and age. The average BMI was 53 and 44.4 respectively. 21.5% had diabetes mellitus 2, 39.5% hypertension, 31% dislipidemia and 8.4% osteoarthritis, with no signifi cant differences between groups except for a higher prevalence of dyslipidemia in the morbidly obeses (p = 0.001). 10.4% had surgical complications during the postoperative period, with no differences between both groups (p = 0.24). One year later all patients had a signifi cant decrease in weight, however, hiperobeses showed a more pronounced decrease (p = 0.001). The fasting glucose, cholesterol and triglycerides levels also showed a signifi cant decrease without reaching differences between the groups. Conclusions: The gastric bypass is effective in achieving weight loss and resolution of comorbidities in morbidly obese as well as hiperobese patients, with no signifi cant differences in surgical complications and mortality.
RESUMENIntroducción: El cáncer de vesícula biliar es una enfermedad muy frecuente en la actualidad, sobre todo en Chile, la India y Japón. La displasia de vesícula biliar es considerada como una lesión que precede la aparición de carcinoma vesicular. Objetivos: El objetivo de este estudio es determinar la prevalencia de la displasia de vesícula biliar en nuestro centro hospitalario y conocer sus características histológicas y clínicas. Material y Método: Los datos obtenidos de 1.237 informes de biopsias de colecistectomías realizadas en el hospital durante el año 2003 fueron procesados y analizados. Resultados: La prevalencia de la displasia de vesícula biliar fue de 2,5 %. Del total de displasias (31 casos), 12 pertenecen a grado I (38,7 %), 14 a grado II (45,16 %) y 5 a grado III-CIS ( carcinoma in situ 16%). La edad promedio en que se detectó la displasia de vesícula biliar fue de 54.7 años, siendo predominante en el sexo femenino con un 74,2 %. Discusión: La displasia de vesícula biliar es una patología prevalente que sólo es posible diagnosticar mediante la histología realizada a los pacientes sometidos a colecistectomías.PALABRAS CLAVE: Vesícula biliar, histología, displasia. ABSTRACTIntroduction: Gallbladder dysplasia is considered a premalignant stage, preceding the appearance of carcinoma. Aim: To assess the prevalence of gallbladder dysplasia in gallbladder biopsies. Material and methods: Review of pathology reports of 1237 gallbladders obtained during cholecystectomies, during 2003. Results: Thirty one reports informed the presence of dysplasia (2.5 %). Of these, 12 were in stage 1 (39 %), 14 were in stage 2 (45 %) and 5 in stage 3-ISC (in-situ carcinoma, 16 %). The mean age of patients with gallbladder dysplasia was 54 years. Discussion: Gallbladder dysplasia is common. The pathological study of the excised gallbladders is the only way to make the diagnosis.
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