Carotid body tumorCarotid body tumors (paragangliomas) are very rare, highly vascularized and usually benign tumors, originated in the carotid body chemoreceptors. We present the cases of two asymptomatic patients referred for left cervical mass; preoperative study was CT and CT angiography, respectively, which are consistent with carotid body tumors. The tumors were completely removed by subadventitial disection without complications; the biopsy was compatible with paraganglioma. No evidence of recurrence could be found. ResumenLos tumores de cuerpo carotídeo (paragangliomas) son neoplasias altamente vascularizadas, muy poco frecuentes y generalmente benignas, originadas en los quimiorreceptores del cuerpo carotídeo. Se presentan los casos de dos pacientes derivados por aumento de volumen cervical izquierdo, asintomáticos, con estudio preoperatorio realizado por TAC y angiografía por TAC, respectivamente, que resultan compatibles con tumores de cuerpo carotídeo. Se resuelven quirúrgicamente, mediante disección subadventicial, informando la biopsia paraganglioma. Los tumores fueron completamente removidos, sin evidencia de recurrencia y sin mayores complicaciones.Palabras clave: Paraganglioma, cuerpo carotídeo, tumor.
RESUMENEl embarazo localizado dentro de una cicatriz de cesárea previa es el menos frecuente de los embarazos ectópicos y no existe un tratamiento estándar. Se presenta el caso clínico de una paciente con embarazo ectópico ístmico-cervical sobre una cicatriz de cesárea. Se hospitaliza por el riesgo de ruptura uterina, evolucionó con invasión trofoblástica de la histerorrafia culminando en muerte embrionaria. No hubo complicaciones maternas. Se trató con metotrexato para evitar la progresión de la invasión trofoblástica, con buen resultado materno.PALABRAS CLAVES: Cicatriz de cesárea, embarazo ectópico, tratamiento con metotrexato SUMMARYThe pregnancy within a cesarean scar is the most infrequent of ectopic pregnancy and there are no standard treatments. This is a case of a patient with ectopic pregnancy within the scar of a previous cesarean of isthmic-cervical location. She is admitted for risk of uterine rupture and with uterine scar trofoblastic invasion, ending in an embryonic death, without maternal complications. The treatment was methotrexate, avoiding trofoblastic invasion, with a favorable maternal outcome.KEY WORDS: Cesarean scar, ectopic pregnancy, methotrexate treatment Casos Clínicos INTRODUCCIÓNLa implantación del blastocisto en un sitio distinto al endometrio se denomina embarazo ectópi-co (1). Presenta una frecuencia cercana al 2% de los embarazos y es una importante causa de muerte materna (2,3). Presenta distintas localizaciones, la más frecuente es en la trompa uterina (95%) y sólo un pequeño porcentaje (<2%) se localiza dentro de una cicatriz de cesárea previa, habiéndose reportado escaso número de casos de esta ubicación en las últimas décadas (4). Las pacientes portadoras de un embarazo ectópico en cicatriz de cesárea previa tienen elevado riesgo de presentar complicaciones tales como placenta acreta, perforación y hemorragia uterina y pérdida de fertilidad, entre otras (4,5). Dado que presenta una baja frecuencia no existe consenso en cuanto al tratamiento, utilizándose actualmente medicamentos tales como metotrexato y KCl principalmente, además del manejo quirúrgico en casos específicos (5-7).El objetivo de la presente comunicación es presentar y discutir el caso clínico de una paciente con embarazo ectópico en cicatriz de cesárea de localización cérvico-ístmica.
Percutaneous tracheostomy in an intensive care unitBackground: Prolonged mechanical ventilation (PMV) is a main factor in a long stay at Intensive Care Units (ICU) in our country. The correct and prompt tracheostomy (TQT) indication has shown signifi cant reductions in ICU stay. The classic open technique has been progressively replaced by the percutaneous TQT. Aims: To describe the experience and the results of percutaneous TQT in a tertiary center ICU. Methods: Prospective study of patients in PMV who underwent a percutaneous tracheostomy in ICU at Hospital Dr. Sótero del Rio, since January 2009 to June 2010. We analyse patient characteristics, waiting time, duration of procedure and complications. Results: The series consist of 130 PMV patients, 101 men, median age 51 (17-22) years old, more frequent diagnoses were neurological disease, cerebrovascular disease and infectious disease. The mean waiting time for the procedure was 1 (0-3) day, the operative time was 11 (3-15) minutes, complications rate was 7.6%, and the most frequent was local hemorrhage. Discussion: Percutaneous TQT technique is a feasible and safe procedure in ICU at a Tertiary Hospital, with a short waiting time and a low complication rate.
Total laryngectomy in advanced laryngeal neoplasma T4aBackground: In Chile a signifi cant number of patients is presented with advanced laryngeal cancer at diagnosis with poor prognosis and less than 50% survival at 5 years. Nowadays choosing the organ sparing treatment, but in selected cases total laryngectomy is a valid treatment option. Aim: To present the results obtained with the extended total laryngectomy in patients with advanced laryngeal carcinoma. Patients and Methods: Retrospective analysis of all patients with advanced laryngeal carcinoma T4a underwent total extended laryngectomy at our center between 2007-2010. Results: 18 patients, a woman, a median age 64 years (range, 50-82), they were studied and etapifi ed with Rhino-Laryngo-Fibrescope Olympus© and CT. Seven patients underwent emergency tracheostomy. All patients underwent total extended laryngectomy with primary pharyngeal closure. The median tumor size was 4.3cm. In 17 patients R0 was achieved. Postoperative complication was presented in one patient with a pharyngocutaneous fi stula. Thirteen patients were sent to radiotherapy. After a follow-up of 17 months (range, 2-55): one, two and three years of survival was 88.8%, 50% and 50% respectively. Conclusion: In the serie, extended total laryngectomy is a good therapeutic alternative in patients with advanced laryngeal carcinoma, with low surgical morbidity, short hospital stay and favorable survival.
Mesenteric lymphangioma causing volvulus. Report of one caseLymphangiomas are rare benign lesions, most commonly seen in children and adolescents. Their intra-abdominal presentation is uncommon. We report a 19 years old male, presenting to the emergency room with abdominal pain associated with fever, vomiting and abdominal distension. There was a history of multiple previous consultations for abdominal pain. A plain abdominal X-ray examination suggested a bowel obstruction. At surgery a volvulus and dilation of the small bowel in relation to a vascular malformation was found, excising 40 cm of jejunum with an end-to-end intestinal anastomosis. The pathology report showed a Mesenteric Multicystic Lymphangioma. Presently, the patient is in good conditions. Key words: Volvulus, bowel obstruction, lymphangioma. ResumenLos linfangiomas son lesiones benignas, de baja incidencia, más comunes en niños y adolescentes. Con muy baja frecuencia son intraabdominales y poseen presentación clínica variable, yendo desde el hallazgo clínico hasta pacientes con riesgo vital por abdomen agudo. Presentamos el caso de un paciente de 19 años, sin antecedentes mórbidos que acude a urgencias por dolor abdominal asociado a fiebre, vómitos y distensión abdominal; la radiografía simple es sugerente de obstrucción intestinal. En laparotomía exploradora se encuentra un vólvulo y dilatación del intestino delgado en relación a una malformación vascular y lesiones multilobuladas en mesenterio. Se resecan 40 cm de yeyuno y realiza anastomosis término-terminal. La histología reveló un Linfangioma Multiquístico Mesentérico. El paciente evoluciona en buenas condiciones generales y se mantiene control clínico e imagenológico seriado. Aunque infrecuente, es uno de los diagnósticos diferenciales de abdomen agudo. A pesar de su naturaleza benigna puede llegar a comprometer el pronóstico vital del paciente.Palabras clave: Linfangioma, mesenterio, linfangioma quístico, vólvulo.
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