David johnson, santader siglo xix

David Johnson, Santader Siglo XIX - Cambios Socioeconómicos(Bogotá 1985

¿Qué podemos esperar de las guías ATA 2014 en el manejo de cáncer temprano de tiroides?

El carcinoma papilar de tiroides es un tumor frecuente en mujeres y el número de casos nuevos viene en crecimiento. La mayoría de estos casos de novo son tumores menores de 2 centímetros. Parte de la responsabilidad de este aumento es explicable por un uso mayor de ayudas diagnósticas. Esto ha permitido detectar el cáncer de tiroides temprano o clínicamente silente. En esta población, el manejo ha sido típicamente agresivo, incluyendo cirugías extensas (tiroidectomía total) seguidas por terapia con yodo radiactivo y supresión de TSH. Las próximas guías plantearán cuatro grandes modificaciones: 1. Estadificación dinámica del riesgo (respuesta completa, respuesta bioquímica incompleta, respuesta estructural incompleta e indeterminada) 2. Disminución de las indicaciones y de la dosis de ablación con yodo radiactivo, específicamente el uso de esta terapia debe estar ajustado al riesgo basal de recurrencia (bajo, intermedio, alto) del paciente y debe tenerse en cuenta el número de ganglios linfáticos afectados, el tamaño de las metástasis ganglionares, la histología y el tamaño del tumor. Una dosis de 30 mCi de 131yodo es igual de eficaz para negativizar la tiroglobulina que una dosis de 100 mCi. 3. Extensión de la cirugía (cirugía parcial en tumores menores de 4 cm con histología favorable) y 4. Terapia de supresión con levotiroxina con metas más laxas de TSH, dado el riesgo de osteoporosis y arritmias con una supresión exagerada de TSH, especialmente en la población de edad avanzada. Abstract Papillary thyroid carcinoma is a frequent cancer in women. An increase in the number of new cases has been detected in the last years. However, tumors smaller than 2 cms represent the largest sample in those new detected cancers. The cause of this increment is partially responsibility of an increased use of diagnostic aids such as ultrasound, even in asymptomatic patients. The management of these clinically silent tumors has been quite aggressive with extensive surgery (total thyroidectomy) followed by radioactive iodine therapy and TSH suppression. The next papillary thyroid carcinoma guidelines will address 4 important modifications: 1. Dynamic approach to risk stratification (Complete response, incomplete biochemical response, incomplete structural response and indeterminate response) 2. Decrease in the indication and dose of radioactive iodine. The use of this therapy must be adjusted to the basal risk of recurrence with consideration of the number of lymph node metastases, the size of the lymph node metastases, the histopathologic variant and the size of the primary tumor. A dose of 30mCi of 131I is as effective as a dose of 100 mCi for thyroid ablation. 3. Extension of the thyroidectomy (partial surgery in tumors smaller than 4 cms without unfavorable histopathology and 4. Higher TSH goal with levothyroxine suppression therapy. A strict TSH suppression has been associated with increased risk of osteoporosis and cardiac arrhythmias, especially in older population

Determinación ecográfica del volumen normal de la glándula tiroides en una población pediátrica de Bogotá, Colombia.

Introduction. The World Health Organization bases its reference standards for normal thyroid volume on values derived from measurements of European children. However, WHO recommends that normal values for each region be estimated separately, given the variability as a consequence of geographic, racial, and nutritional differences.Objective. A normal standard of thyroid volume was estimated for the pediatric population of Bogotá, Colombia.Materials And Methods. A cross-sectional study was carried-out in 591 children assessed at the Clínica Jorge Bejarano, Bogotá, Colombia, between January and August 2003. Children with maternal or personal history of thyroid disease and those with abnormal weight or height characteristics were excluded. Age, weight, and body surface index were recorded for each child. Thyroid volume was estimated by ultrasonography using the ellipse formula.Results. The mean estimated volume for each age group was as follows: 0.6 +/- 0.2 cm3 for neonates, 1.1 +/- 0.6 cubic centimeters for milk-fed babies, 2.2 +/- 1.3 cc for pre-school age children, 3.0 +/- 1.7 cc for school age children and 5.7 +/- 3.1 cc for adolescents. Thyroid volume increases with increasing body surface. A linear relationship between the natural logarithm of the thyroid volume and the square root of the body surface was found.Conclusions. The normal thyroid volume for Bogotá children was smaller than the World Health Organization reference value. Values described in the current study are recommended for local use as the normal parameter.Introducción. La Organización Mundial de la Salud utiliza como referencia para el tamaño normal de la glándula tiroides en niños valores obtenidos en poblaciones europeas. Sin embargo, por la variabilidad derivada de diferencias geográficas, raciales y nutricionales recomienda la obtención de valores normales para cada región. Objetivo. Estimar el volumen normal de la glándula tiroides en niños de Bogotá, Colombia. Materiales y métodos. Se realizó un estudio de corte transversal en niños que asistieron a la consulta de niño sano de la Clínica Jorge Bejarano de Bogotá, Colombia, entre enero y agosto de 2003. Se excluyeron los niños con antecedentes maternos o personales de enfermedad tiroidea o retardo en el desarrollo pondo-estatural. Para cada niño se registró edad, peso, talla e índice de superficie corporal. Además, se determinó el volumen de la gándula tiroides mediante ecografía, utilizando la fórmula de la elipse. Resultados. Se incluyeron 591 niños. El promedio de los volúmenes estimados en cada grupo de edad fue de 0,63±0,2 cm3 en recién nacidos; 1,1±0,61cm3 en lactantes; 2,2±1,3 cm3 en preescolares; 3±1,7 cm3 en escolares, y 5,7±3,15 cm3 en púberes. Se evidenció un aumento del volumen de la glándula tiroides con el incremento de la superficie corporal. Se encontró una relación lineal entre el logaritmo del volumen de la glándula tiroides y la raíz cuadrada de la superficie corporal. Conclusión. El volumen de la glándula tiroides normal en niños de Bogotá es inferior al utilizado como referencia por la Organización Mundial de la Salud. Recomendamos utilizar los valores descritos en este estudio como parámetro local de normalidad

Cost-effectiveness analysis regarding postoperative administration of vitamin-d and calcium after thyroidectomy to prevent hypocalcaemia

Objective Hypocalcaemia is a frequently arising complication following total thyroidectomy. Routine postoperative prophylactic administration of vitamin D or metabolites and calcium reduce the incidence of symptomatic hypocalcaemia; this article reports evaluating its cost-effectiveness in Colombia.Methods Meta-analysis was used for comparing the administration of vitamin D or metabolites to oral calcium or no treatment at all in patients following total thyroidectomy and a cost-effectiveness analysis was designed based on a decision-tree model with local costs.Results The OR value for the comparison between calcitriol and calcium compared to no treatment and to exclusive calcium treatment groups was 0.32 (0.13-0.79 95 %CI) and 0.31 (0.14-0.70 95 %CI), respectively. The most cost-effective strategy was vitamin D or metabolites and calcium administration, having a US $0.05 incremental costeffectiveness ratio.Conclusion Prophylactic treatment of hypocalcaemia with vitamin D or metabolites + calcium or calcium alone is a cost-effective strategy

Value and Quality of Care in Head and Neck Oncology

Purpose of ReviewThe concept of value-based health care (VBHC) was articulated more than a decade ago. However, its clinical implementation remains an on-going process and a particularly demanding one for the domain of head and neck cancer (HNC). These cancers often present with fast growing tumors in functionally and cosmetically sensitive sites and afflict patients with differing circumstances and comorbidity. Moreover, the various treatment modalities and protocols have different effects on functional outcomes. Hence, the interpretation of what constitutes VBHC in head and neck oncology remains challenging.Recent FindingsThis monograph reviews developments in specific aspects of VBHC for HNC patients, including establishment of registries and quality indices (such as infrastructure, process, and outcome indicators). It emphasizes the importance of the multidisciplinary team, "time to treatment intervals," and adherence to guidelines. The discussion addresses major indicators including survival, quality of life and functional outcomes, and adverse events. Also, strengths and weaknesses of nomograms, prognostic and decision models, and variation of care warrant attention.SummaryHealth care professionals, together with patients, must properly define quality and relevant outcomes, both for the individual patient as well as the HNC population. It is essential to capture and organize the relevant data so that they can be analyzed and the results used to improve both outcomes and value.Peer reviewe

Prototipo para levantamiento arquitectónico: Desarrollo y evaluación caso de estudio del Hospital Metropolitano de Tunja

This article describes the development and implementation of a compact and portable prototype for the survey of a point cloud of the Metropolitan Hospital of Tunja, Colombia, as a result of the SENNOVA project called “Development of preliminary diagnoses in existing buildings from the merger of 4 remote sensing technologies: laser scanner, photogrammetry, thermography and ground penetrating radar, through information models (BIM)”, developed by the collaboration of the Industrial Center for Maintenance and Manufacturing (Sena Regional Boyacá). Key components of this solution include a Hesai lidar, a 9-axis inertial unit (IMU), and a UP4000 computer. The construction of the point cloud was carried out through the implementation of LIO-SAM, which is developed in the ROS framework.Data acquisition was performed in three different configurations of the LIDAR and the IMU. This approach sought to determine the most effective orientation to achieve a complete and accurate representation. Simultaneously, tests were carried out by modifying the closed loop parameter in LIO-SAM and running the software on both the UP4000 and an external computer.The results revealed that the configuration that minimizes the error is achieved by positioning the LIDAR and IMU horizontally, with the Z axis oriented vertically. However, the need for additional tests to comprehensively evaluate the influence of the closed-loop parameter was highlighted. In addition, it was observed that the UP4000 has sufficient processing capacity to execute LIO-SAM, although the simultaneous execution of more processes could affect the results obtained.El presente articulo describe la construcción e´ implementación de un prototipo compacto y portátil para el levantamiento de una nube de puntos del Hospital Metropolitano de Tunja, Colombia, como resultado del proyecto SENNOVA denominado “Desarrollo de diagnósticos preliminares en edificaciones existentes a partir de la fusión de 4 tecnologías de sensoramiento remoto: escáner láser, fotogrametría, termografía y radar de penetración de terrenos, a través de modelos de información (BIM)”, desarrollado en conjunto con el Centro Industrial de Mantenimiento y Manufactura (Sena Regional Boyacá). Los componentes clave de esta solución  incluyen un LIDAR Hesai, una unidad inercial de 9 ejes (IMU) y una computadora UP4000. La construcción de la nube de puntos´ se llevó a cabo mediante la implementación de LIO-SAM, el cual se encuentra desarrollado en el marco de ROS. La adquisición de datos fue realizada en tres configuraciones distintas del LIDAR y la IMU. Este enfoque buscaba determinar la orientación  más efectiva para lograr una representación completa y precisa. Simultáneamente, se llevaron a cabo pruebas´ modificando el parámetro de lazo cerrado en LIO-SAM y ejecutando el software tanto en la UP4000 como en un computador externo. Los resultados revelaron que la configuración que minimiza el error se logra al posicionar el LIDAR y la IMU horizontalmente, con el eje Z orientado verticalmente. No obstante, se destacó la necesidad de realizar pruebas adicionales para evaluar exhaustivamente la influencia del parámetro de lazo cerrado. Además, se observó o que la UP4000 posee suficiente capacidad de procesamiento para ejecutar LIO-SAM, aunque la ejecución simultanea de más procesos podría afectar los resultados obtenidos

Pharyngeal Reconstruction Methods to Reduce the Risk of Pharyngocutaneous Fistula After Primary Total Laryngectomy: A Scoping Review

Introduction: The most common early postoperative complication after total laryngectomy (TL) is pharyngocutaneous fistula (PCF). Rates of PCF are higher in patients who undergo salvage TL compared with primary TL. Published meta-analyses include heterogeneous studies making the conclusions difficult to interpret. The objectives of this scoping review were to explore the reconstructive techniques potentially available for primary TL and to clarify which could be the best technique for each clinical scenario. Methods: A list of available reconstructive techniques for primary TL was built and the potential comparisons between techniques were identified. A PubMed literature search was performed from inception to August 2022. Only case-control, comparative cohort, or randomized controlled trial (RCT) studies were included. Results: A meta-analysis of seven original studies showed a PCF risk difference (RD) of 14% (95% CI 8-20%) favoring stapler closure over manual suture. In a meta-analysis of 12 studies, we could not find statistically significant differences in PCF risk between primary vertical suture and T-shaped suture. Evidence for other pharyngeal closure alternatives is scarce. Conclusion: We could not identify differences in the rate of PCF between continuous and T-shape suture configuration. Stapler closure seems to be followed by a lower rate of PCF than manual suture in those patients that are good candidates for this technique

Sacrocoxigeal teratoma

Introducción: la palabra teratoma fue utilizada por primera vez por Virchow en 1869 para referirse a los crecimientos sacrococcígeos y es el tumor más frecuente en el período perinatal y presentan baja mortalidad en el período neonatal se revisa la literatura en lo concerniente a teratoma coccígeo. Presentación del caso: se realiza la presentación de un caso en neonato masculino, con peso de 3000 g, nacido por vía vaginal en villa Pongui, distrito Kimongo, extrahospitalario, en un puesto médico rural. Ingresa a los 5 días de nacido por tumor en región sacro-coccígea. La clínica y los complementarios permitieron el diagnóstico de teratoma sacrococcígeo benigno. Conclusiones: se realizó por primera vez en el Hospital de Dolisie, República del Congo la exéresis del tumor en dos tiempos, dado su gran tamaño. La evolución del niño fue favorable y no existió recidiva a los 12 meses.Introduction: the term teratoma was first time used in 1869 by Virchow to refer to sacrococcygeal growths. It is the most frequent tumor in perinatal period; however it presents a low mortality rate at birth, medical literature is reviewed concerning coccygeal teratoma. Case report: the bibliography concerning coxigeal teratoma is revised. A case is presented of a male neonate, weight 3000 g, natural birth, in Pongui Village, Kimongo District, extrahospitalary, at a rural medical post. He is admitted after six days of been born, due to a tumor in the sacrocoxigeal region. The clinical study and the complementary tests allowed diagnosing a benign sacrocoxigeal teratoma. Conclusions: it was for the first time performed in the Congo Republic Dolisie Hospital, the removal of a tumor in two periods, due to its big size. The child´s evolution was favorable and it did not exist redisive after 12 months

Prognostic and predictive factors in recurrent and/or metastatic head and neck squamous cell carcinoma : A review of the literature

The pattern of clinical behaviour and response to treatment of recurrent and/or metastatic head and neck squamous cell carcinoma is heterogeneous. Treatment strategies that can be employed vary from potentially curative salvage surgery and re-irradiation to palliative systemic therapies and best supportive care. The advent of new therapeutic options, in terms of more sophisticated surgical approaches and techniques, highly conformal and precise radiation techniques and immunotherapy may offer improved control of disease and longer survival. Moreover, the epidemiological changes during the last decades, including the increase of human papilloma virus-related oropharyngeal primary tumors, are also reflected in the recurrent and metastatic setting. In this complex context the identification of predictive and prognostic factors is urgently needed to tailor treatment, to increase its efficacy, and to avoid unnecessary toxicities. A better knowledge of prognosis may also help the patients and caregivers in decision making on the optimal choice of care. The purpose of our review is to highlight the current evidence and shortcomings in this field.Peer reviewe