Solitary diverticulum of the cecum is a benign condition uncommon in the Western world, and with a higher incidence in Asian population. They are usually asymptomatic, and manifest clinically only with complications such as inflammation, perforation, or bleeding. They are a rare cause of acute abdominal pain, clinically similar to acute appendicitis, with tenderness in the right lower quadrant, fever, and leukocytosis. In spite of the information provided by ultrasonography or CT scans, a correct preoperative diagnosis is still difficult to reach, and is usually arrived at in the operating theater; differentiation from a neoplasm may be also sometimes complicated, and a wide surgical resection is usually required for such cases. We report on 5 cases of inflammation and perforation of a solitary cecal diverticulum, and perform a literature review.
The great heterogeneity of breast cancer makes it impossible to firmly predict which patients with early-stage tumours will or will not need systemic treatments according to the conventional prognostic factors currently employed. In fact, a substantial percentage of patients receive medical treatment for a disease that will not relapse, while another proportion of patients regarded as having good prognostic factors according to the classic criteria do not receive treatment and suffer disease relapse. Considering that most oncological treatments have short- and long-term toxic effects, new methods capable of offering a more precise prognosis need to be developed. The individualisation of the diagnosis of patients with breast cancer based on molecular and gene expression studies is bringing about a veritable revolution in our understanding of the biology of the disease. The new molecular classification of breast cancer, based on these profiles, allows us to establish a prognosis according to the genetic characteristics of each tumour. Such individualisation of the diagnosis of patients with breast cancer will lead to the application of more specific treatments, thereby improving patient survival with lesser toxicity and increased economic savings. Of the different genetic analytical tests available, MammaPrint has been shown to be the option offering the most information on the behaviour of early breast cancer; as a result, it is the most useful technique in deciding the need for oncological treatment as a complement to surgery.
Antecedentes: Los aneurismas del segmento comunicante posterior representan aproximadamente 25% de todos los aneurismas intracraneales, y el 50% de los aneurismas de la arteria carótida interna. El objetivo fue evaluar la eficacia del tratamiento quirúrgico y endovascular en el manejo de aneurismas de esta localización. Métodos: Estudio comparativo retrospectivo. Se revisó las historias clínicas de pacientes con aneurisma del segmento comunicante posterior que ingresaron al departamento de Neurocirugía del Hospital Nacional Guillermo Almenara durante el periodo 2010–2017. Se comparó estancia hospitalaria, complicaciones, mortalidad y estado funcional a los 12 meses, en relación al tratamiento recibido, microquirúrgico o endovascular. Resultados: Se evaluaron 256 pacientes, 111 (43.36%) recibieron tratamiento quirúrgico, y 145 (56.64%) endovascular. En el caso de aneurismas rotos, el estado de independencia funcional fue alcanzado por 68 (66.7%) y 69 (70.4%) pacientes que recibieron tratamiento quirúrgico y endovascular, respectivamente (OR: 0.84, IC 95%: 0.46–1.53; P = 0.505). Se presentaron complicaciones neurológicas en 37 (36,3%) y 34 (34.7%) pacientes sometidos a tratamiento microquirúrgico y endovascular, respectivamente (OR: 1.07, IC 95%: 0.60–1.91; P = 0.912). La estancia hospitalaria promedio fue 19.55 ± 13.85 y 14.06 ± 14.97 días, para pacientes con tratamiento quirúrgico y endovascular, respectivamente (P < 0.008). La mortalidad fue 11.8% y 11.2%, con ligera predominancia en el grupo tratado quirúrgicamente (OR: 1.05, IC 95%: 0.44–2.52; P = 0.904). Conclusión: No existe diferencia significativa respecto al resultado funcional a los 12 meses, complicaciones y mortalidad entre ambos tipos de tratamiento en el caso de aneurismas rotos. Los pacientes sometidos a terapia endovascular tuvieron de forma significativa menor estancia hospitalaria.
Introduction: The most frequent brain tumors in adults are high-grade gliomas and meningiomas. Having a discouraging prognosis of high-grade gliomas and knowing that the prognosis improves depending on the degree of tumor resection, is that new therapeutic strategies are sought, one of them is the use of 5-aminolevulinic acid (5-ALA) thanks to the fluorescence it produce in the tumor it allows to improve the rate of tumor resection, finally improving the prognosis of the patients. We presented the first experience in Almenara Hospital of the use of 5-ALA in a patient with a diagnosis of high-grade glioma. Clinical Case: Presents itself the case of a 48-year-old male patient with clinical evidence of motor and sensory deficit contralateral to the lesion, without alteration of the state of consciousness. The magnetic resonance of the encephalon with contrast, a right frontal lesion is evidenced compatible with high-grade glioma. Therefore, it is programmed for guided surgery with fluorescence, where 5-ALA is used, and a total resection of the tumor is performed, obtaining an anaplastic ependymoma as pathological anatomy. The patient presented an increase in the motor deficit, which he later recovered. In the tomographic control with contrast at 4 months, complete tumor resection is evident. Conclusion: 5-aminolevulinic acid is a drug that helps to properly delimit the edges of a high-grade glioma, by using a modified microscope, and thus increases the degree of tumor resection, ultimately improving the prognosis of the disease. Keywords: Glioma, Aminolevulinic acid, Ependymoma, Fluorecense, Prognosis. (source: MeSH NLM)
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