Gestación gemelar con feto acárdico: Presentación de un caso

Normal 0 21 false false false ES X-NONE X-NONE Introducción: la secuencia de perfusión arterial reversa (secuencia TRAP) o transfusión feto-fetal; se encuentra entre las numerosas peculiaridades de la gestación monocoriónica (univitelina) gemelar. En ella, el gemelo afectado es perfundido de forma reversa mediante anastomosis arterio-arterial y veno-venosa por el otro gemelo; resultando un feto acardio y otro normal, con consecuencias hemodinámicas en este último, debidas a la misma. Objetivo: caso de embarazo gemelar monocigótico con feto acardio-acéfalo diagnosticado por ultrasonido preparto; dada su baja frecuencia. Presentación del caso: gestante de 17 años de edad, primigrávida, con embarazo gemelar de 36.3 semanas, diagnosticado por Ultrasonido (US); con 4 controles prenatales. La misma consultó en trabajo de parto. Se le realizó un US evolutivo que encontró un feto vivo, en presentación cefálica, acompañado de una masa amorfa, que se concluyó como feto malformado en un embarazo gemelar. Se remitió la gestante al Hospital Nacional Regional de Escuintla (HNRE); donde se le practicó una cesárea; se obtuvo un recién nacido femenino de 2.37 kilogramos y una masa deforme (feto malformado). La placenta resultó ser monocoriónica, univitelina, con perfusión sanguínea feto-fetal (de normal a malformado); lo cual permitió la supervivencia del feto amorfo hasta entonces, seguido de muerte fetal intraparto. El gemelo malformado se envió al servicio de anatomía patológica para su estudio; cuyos resultados se presentan en este trabajo. Se revisa la bibliografía hasta el 2013. Conclusiones: el feto acardio-acéfalo por transfusión feto-fetal inversa es poco frecuente en nuestro país, debido al temprano y avanzado control prenatal. El diagnóstico prenatal temprano es un método valioso para evitar el desenlace fatal e incremento de la mortalidad infantil. Palabras clave: Feto acardio-acéfalo, mielocéfato, embarazo gemelar. Acardius, gestación múltiple, síndrome de transfusión feto-fetal. <!--[endif] --

Carcinoma de células escamosas de la piel infiltrando hueso. Presentación de un caso

Introduction: the squamous or epidermoid cell carcinoma is the second most common ¨non- melanoma¨ tumor in the skin areas exposed to sunlight, and it is more common in older people. Its incidence is higher in men, but it can be seen in both sexes. Case presentation: a 57-year-old female patient, native, with a clinical antecedent of a "removed" lesion in her right leg about 30 years ago in a private hospital, without specifying its anatomopathological result. She went to the Emergency Service at the National Regional Hospital in Escuintla, Guatemala, because four months ago she began with a small ulcerated injure in the same leg, and as she reported, in the "same place", which was initially treated with "home remedies", without specifying which ones, but the injure did not get better, otherwise it began to grow in an exophytic way and became secondarily infected. It was decided then to hospitalize the patient in the Surgery Service of Women for the study and later treatment. It was performed a skin biopsy to obtain an accurate diagnosis, the anatomopathological diagnosis confirmed the existence of a squamous cell carcinoma, well differentiated and infiltrating of the skin. It was decided then to consult and send the case to Roosevelt Hospital in Guatemala to be consulted with a surgeon specialist in oncology.Discussion: the epidermoid carcinoma, also known as spinocellular carcinoma is the second most common "non-melanoma" skin cancer, preceded by basal cell carcinoma; it is derived from alterations in the epidermis, specifically of keratinocytes.Conclusion: the squamous (epidermoid) cell carcinoma arises from alterations in epidermal keratinocytes and it can infiltrate bone structures.Introducción: el carcinoma de células escamosas o “epidermoide” como también se le denomina, es el segundo tumor “no melanoma” más frecuente de la piel de las zonas expuestas a los rayos solares y es más común en las personas mayores. Tiene mayor incidencia en los hombres, aunque pueden ser vistos en ambos sexos.Presentación de caso: paciente de sexo femenino, 57 años de edad, raza indígena, con antecedentes de habérsele “removido” hace aproximadamente 30 años una lesión en la pierna derecha, en un Sanatorio Privado no precisando el resultado anatomopatológico de la misma. Acude a emergencias del Hospital Nacional Regional de Escuintla, (HNRE), Guatemala, porque desde hace aproximadamente 4 meses comenzó con una lesión, ulcerada, pequeña en la misma pierna y según refiere la paciente en el “mismo lugar”, que se trató inicialmente con “remedios caseros”, sin precisar cuáles, pero que no mejoró, al contrario comenzó a crecer de forma exofítica y a infectarse secundariamente. Se decide ingresar en el Servicio de Cirugía de Mujeres para estudio y posterior tratamiento. Se realiza biopsia de piel para un diagnóstico certero, el diagnóstico anatomopatológico confirma la existencia de un carcinoma de células escamosas bien diferenciado e infiltrante de piel, se toma la conducta de consultar y remitir el caso para el Hospital Roosevelt de Ciudad de Guatemala para ser interconsultado con un especialista cirujano oncólogo.Discusión: el carcinoma epidermoide o también conocido como carcinoma espinocelular, es el segundo cáncer de piel “no melanoma” más frecuente, siendo precedido por el carcinoma de células basales, el mismo se deriva de alteraciones a nivel de la epidermis específicamente de los queratinocitos.Conclusión: el carcinoma de células escamosas (epidermoide) surge por alteraciones de queratinocitos de la epidermis y es capaz de infiltrar estructuras óseas.

Tumor maligno de la vaina nerviosa periférica del epiplón mayor como causa de abdomen agudo quirúrgico

Se trata de una paciente femenina, de la raza negroide, de 57 años de edad, con antecedentes de salud, que acude al Servicio de Urgencias del Hospital Clinicoquirúrgico Docente "Dr. Salvador Allende", por un cuadro de abdomen agudo. La paciente refirió que notaba un aumento de volumen del abdomen superior de 1 mes de evolución que resultó asintomático hasta unos días antes de su admisión en este centro, se acompañaba de dolor de moderada intensidad. El dolor referido previamente se hace más intenso y aparecen vómitos así como detención del tránsito intestinal (no expulsión de heces ni gases), niega otros síntomas. Al examen físico se constató un tumor abdominal que ocupaba epigastrio, ambos hipocondrios y flanco izquierdo respectivamente, de consistencia firme y con áreas renitentes. El diagnóstico preoperatorio fue una oclusión intestinal mecánica, probablemente de causa tumoral. En la laparotomía se encontró un tumor gigante con áreas quísticas y sólidas que ocupaba los espacios referidos en el examen físico, con unos 1 500 mL de sangre libre en cavidad, procedente de las áreas quísticas antes mencionadas. Se pudo realizar exéresis total de dicho tumor, que histológicamente fue informado como tumor maligno de la vaina nerviosa periférica del epiplón mayor.A black female patient aged 57 with past history is seen at the Emergency Department of "Dr. Salvador Allende" Clinical and Surgical Teaching Hospital due to a clinical picture of acute abdomen. The patient referred to a volume increase of the upper abdomen of a month of evolution that was asymptomatic until a few days before her admission in this center. It was accompanied of a moderate pain, which got stronger later on. Vomits and obstruction of the contents of the intestine appeared (no expulsion of faeces or gases). She denied having other symptoms. An abdominal tumor that occupied the epigastrium, both hypochondria and the left flank, respectively, of firm consistency and with remittent areas, was found on the physical examination. The preoperative diagnosis was a mechanical intestinal obstruction, probably of tumoral origin. In the laparotomy, it was observed a giant tumor with cystic and solid areas that occupied the spaces referred to on the physical examination, with some 1 500 mL of free blood in cavity, from the above mentioned cystic areas. It was possible to perform exeresis of this tumor, which was histologically reported as a malignant tumor of the perypheral nerve sheath of the greater omentum

Hamartoma de la mama Breast hamartoma

El hamartoma de la mama o fibroadenolipoma de la mama es una lesión nodular que puede simular un fibroadenoma o un tumor phyllodes . Aparece en las mujeres en la edad media de la vida y se presenta clínicamente como un nódulo bien definido e indoloro. El diagnóstico imagenológico es el que hace pensar en éste, ya que es un tumor poco frecuente. Histológicamente cumple los requisitos generales de un hamartoma: mezcla desordenada de tejidos maduros y especializados. En la mama se puede apreciar estructura ductal y lobulillar con estroma fibroso, tejido adiposo y en ocasiones, tejido muscular liso. En este trabajo se presenta un caso de una paciente de 40 años con un hamartoma de la mama derecha que histológicamente mostraba además, tejido óseo y cartilaginosoBreast hamartoma or breast fibroadenolipoma is a nodular lesion that may resemble a fibroadenoma or phyllodes tumor. It appears in middle-aged women and it clinically presents as a well defined and painless nodule. The imaging diagnosis makes to think about it, since it is an uncommon tumor. From the histological point of view, it fulfills the general requirements of a hamartoma: disarranged combination of mature and specialized tissues. Ductal and lobular structure with fibrous stroma, fat tissue and, on occasions, smooth muscular tissue, may be observed in the breast. A case of a 40-year-old female patient with a hamartoma of the right mamma that histologically showed osteal and cartilaginous tissue is reporte

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline