Hemangioma cavernoso intraóseo costal

It is presented a 31 year old white housewif, with 35.4 weeks of pregnancy and who for two months had been experiencing chest tightness and slight dyspnea side tip, repeatedly she came to her health area and symptomatology as normal changes that occur in pregnancy. The symptoms  increased and incorporated dry cough, dyspnea, skin pale mucosa, insomnia, back pain, fever and difficulty wander. A chest radiograph showed large amount of pleural effusion and tumor-like deformity of the 6th left rib. By their stage of pregnancy and symptoms present at issue in the PAMI and decide to perform cesarean section, which was performed without complications and is then transferred to “Arnaldo Milián” University Hospital to continue the study of the lesion in the chest where the computed tomography checks the persistence pleural effusion despite thoracentesis performed and tumor-like lesion of the posterior arch of left 6th rib. Scan of the chest was performed where pleural effusion large amount of clear, transparent color and thick tumor mass posterior arch of the 6th rib dark reddish- gray color without invasion of the rest of the chest wall or lung and practiced wide excision of the lesion. The pathology report referred intraosseous cavernous hemangioma. The patient is currently asymptomatic.Se presenta una paciente de 31 años de edad, raza blanca y ama de casa, con 35.4 semanas de embarazo, que desde hacía dos meses sentía opresión torácica y disnea ligera en punta de costado; acudió varias veces a su área de salud y se interpretaron sus síntomas como cambios normales que ocurren en el embarazo. Los síntomas aumentaron y se incorporaron tos seca, disnea, palidez cutáneo mucosa, insomnio, dorsalgia, dificultad para deambular y fiebre; una radiografía de tórax anteroposterior mostró un derrame pleural de gran cuantía y una deformidad de aspecto tumoral en la sexta costilla izquierda. Por su estado de gestación y los síntomas presentes se discutió en el Programa de Atención Materno Infantil y se decidió realizar la operación cesárea, que se efectuó sin complicaciones en el Hospital Ginecoobstétrico “Mariana Grajales”; posteriormente fue trasladada al Hospital Clínico Quirúrgico “Arnaldo Milián Castro” para continuar el estudio de la lesión en el tórax. En una tomografía axial computadorizada se comprobó la persistencia del derrame pleural a pesar de las toracocentesis efectuadas y de la lesión de aspecto tumoral del arco posterior de la sexta costilla izquierda. Se realizó la exploración del tórax y se encontró un derrame pleural de gran cuantía de color claro y transparente y una gruesa masa tumoral del arco posterior de la sexta costilla de color gris-rojizo oscuro sin invasión al resto de la pared costal ni a pulmón y se practicó la exéresis amplia de la lesión; el informe anatomopatológico refirió hemangioma cavernoso intraóseo costal. La paciente actualmente se encuentra asintomática

Quiste tímico multilocular. A propósito de un caso

Introduction: thymic cyst is a condition that sits in the thymus gland. It can be congenital or acquired.Case report: It is presented a male patient who started about a year ago with a wet cough, accompanied by mucous expectoration. In the study performed, a mediastinal cystic lesion was detected and interpreted radiologically as a pleuropericardial cyst; he was operated and the lesion was completely resected by right thoracotomy. The anatomopathological diagnosis reported multilocular thymic cyst. The patient evolved satisfactorily and was discharged on the third post-operative day.Conclusions: cystic lesions of the anterior mediastinum are many times a finding because there are no symptoms until they reach great size. They must be treated surgically, with total resection, to avoid complications inherent to growth and compression and to arrive at a histopathological diagnosis.Introducción: el quiste tímico es una afección que se asienta en la glándula timo, puede ser congénito o adquirido.Presentación del caso: se presenta un paciente masculino que comenzó hace más o menos un año con tos húmeda, acompañada de expectoración mucosa. En el estudio realizado se detectó una lesión quística mediastinal que se interpretó radiológicamente como quiste pleuropericárdico; fue intervenido quirúrgicamente y se resecó la lesión completamente por toracotomía derecha. El diagnóstico anatomopatológico informó quiste tímico multilocular. El paciente evolucionó de forma satisfactoria y fue egresado al tercer día del postoperatorio.Conclusiones: las lesiones quísticas del mediastino anterior son muchas veces un hallazgo porque no hay síntomas hasta que no alcanzan gran tamaño. Deben ser tratadas quirúrgicamente, con resección total, para evitar las complicaciones inherentes al crecimiento y la compresión y para arribar al diagnóstico histopatológico

Pseudotumor inflamatorio de pulmón, informe de un paciente

Inflammatory pseudotumor or pulmonary fibroxanthoma is a less frequent tumor. Endobronchial lesion is an unusual event characterized by being a mesenchymatous tumor lack of typical clinical expression, with common symptoms in other diseases without pathognomonic clinical signs that describe it; diagnosis is usually histological and histochemical analysis of biopsy. The fibroxanthoma should be considered as a differential diagnosis in mesenchymal tumors; they are needed a complete analytical and radiological clinical studies before defining the therapeutic behavior.El pseudotumor inflamatorio o fibroxantoma pulmonar es una neoplasia poco frecuente. La lesión endobronquial constituye una eventualidad inusual caracterizada por ser un tumor mesenquimatoso carente de expresión clínica típica, con síntomas habituales en otras enfermedades y sin signos clínicos patognomónicos que la describan; generalmente su diagnóstico resulta del análisis histológico e histoquímico de la biopsia. El fibroxantoma debe ser considerado como diagnóstico diferencial en los tumores mesenquimales; son necesarios unos completos estudios clínico analítico y radiológico antes de definir la conducta terapéutica

Problemáticas psicosociales en el ámbito universitario y programas de prevención

el texto que se presenta aquí sistematiza las experiencias del proyecto “Diplomatura virtual en prevención de problemáticas psicosociales en el ámbito universitario con énfasis en adicciones”, auspiciado por el Centro Coordinador de la Investigación de la Federación Internacional de Universidades Católicas –FIUC-, en el que participaron las Universidades: Universidad Católica Luis Amigó (Colombia) a partir del reconocimiento como universidad que otorgó el Ministerio de Educación Nacional a la institución, el 10 de noviembre de 2016; Católica de Honduras Nuestra Señora Reina de la Paz; Católica de Costa Rica y Católica de Chile Cardenal Silva Henríquez. En la primera parte del texto se da cuenta del proyecto, sus antecedentes, objetivos, metodología y actividades; una reseña sobre las instituciones participantes y una reflexión sobre los problemas psicosociales de los universitarios hoy. En la segunda parte, se presentan los resultados de las pesquisas desarrolladas por cada una de la Universidades participantes, para dar cuenta de las problemáticas psicosociales que más afectan a sus propias comunidades educativas y del programa de prevención diseñado para intervenir dichos problemas

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research