Biomedical subjects

Luis Mauricio Hurtado-López

Publications and source records attributed to Luis Mauricio Hurtado-López.

7 recordsLinked to original sources

PubMed2004

Combined use of fine-needle aspiration biopsy, MIBI scans and frozen section biopsy offers the best diagnostic accuracy in the assessment of the hypofunctioning solitary thyroid nodule.

PURPOSE: The probability of malignancy is increased in hypofunctioning solitary thyroid nodules (HFNs). Fine-needle aspiration biopsy (FNA), (99m)Tc-methoxyisobutylisonitrile (MIBI) and frozen section biopsy (FS) have limited independent diagnostic accuracy for the differential diagnosis of HFNs. The goal of this study was to assess the accuracy of the three independent diagnostic methods in distinguishing between benign and malignant disease. METHODS: A total of 130 patients with an HFN on the (99m)Tc-pertechnetate scan were included in this study. FNA, MIBI scans, FS, thyroidectomy and histological analysis of surgical specimens for final diagnosis were performed in all patients. RESULTS: Of the 130 patients, 80 (61.54%) had benign lesions and 50 (38.46%), malignant lesions. FNA was diagnostic in 78/130 (60%) patients and non-diagnostic in 52/130 (40%) patients. None of the patients with a negative MIBI scan had a final histological diagnosis of malignancy, and MIBI scans were negative in 38.46% of patients with non-diagnostic FNA results. FS was diagnostic in 104/130 (80%) patients and non-diagnostic in 26/130 (20%) patients. Sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios were 81.3%, 97.8%, 96%, 88%, 36.95 and 0.19 respectively for FNA; 100%, 61.3%, 61.7%, 100%, 2.58 and 0 respectively for MIBI; and 80.5%, 100%, 100%, 89%, 0 and 0.2 respectively for FS. Use of both MIBI scans and FS in patients with non-diagnostic FNA rendered a specificity and sensitivity of 100%. CONCLUSION: MIBI scans exclude malignancy in a significant proportion of patients with non-diagnostic FNAs (38% in this study). Cystic nodules with a positive MIBI scan should be further investigated even when the FNA result indicates a benign lesion. Combined use of FNA, MIBI and FS offers the best diagnostic accuracy.

Adaptor Proteins, Signal Transducing↗

PubMed2004

Clinical course of insular thyroid carcinoma.

BACKGROUND: To present the clinical picture and outcome of poorly differentiated insular-type thyroid carcinoma (ITC) compared with papillary thyroid carcinoma (PTC) in a Mexican population in order to demonstrate their different biological behavior. MATERIAL/METHODS: Retrospective, transversal study comparing ITC (G1) with PTC (G2). Assessed variables were: age, gender, size of tumor, previous history of thyroid disease, and outcome. The recurrence/death risk was established according to the MACIS, De GROOT, and AMES classifications. Statistical analysis was made by means of central tendency measures, the Kaplan-Meier method, Cox-Mantel's log-rank, Student's t, and chi-square tests. RESULTS: Both groups were classified based on a high or low risk for thyroid neoplasms. G1 had 13 patients, tumor volume was 78 cm3, 7 cases presented metastases at the time of admittance, five had antecedents of goiter. Average follow-up time was 23 months. G2 had seventy-one patients, tumor volume was 42 cm3, and follow-up time of 44 months. Kaplan-Meier revealed a lower survival in Group 1 than Group 2, statistically significant by the Cox-Mantel log-rank test. A significant statistical difference existed regarding survival and the presence of metastases: G1 (61%) and G2 (53.8%). No statistical difference was found between tumor size. CONCLUSIONS: ITC is more aggressive than PTC. It occurs in the 6th decade of life, with antecedents of long-standing goiter, and has a high recurrence, metastasis and mortality frequency.

Adult↗

PubMed2002

Causes for early reintervention after thyroidectomy.

BACKGROUND: The purpose of our study was to ascertain the causes for early reintervention after thyroidectomy performed by a surgical team using a systematized surgical technique. MATERIAL/METHODS: We analyzed 1131 patients, 939 (83.1%) women and 192 (16.9%) men, average age 38.7 years (range 12 to 79). Of these patients, there were 675 hemithyroidectomies with isthmusectomy (59.74%), 189 subtotal thyroidectomies (16.71%), and 267 total thyroidectomies, alone or with regional lymphatic dissection at levels VI and VII (23.55%). Statistical analysis was performed by main tendency measures and chi square (chi-squared) for comparison of two independent samples; the dependent variable was the rate of early reintervention, while the independent variables included causes, time of presentation, hormonal functional state and extent of surgery. RESULTS: Early reintervention was necessary in 11 cases (0.97%). 9 were due to hematoma (0.79%) resolved with drainage and hemostasis, and two (0.18%) due to acute respiratory failure (ARF) caused by laryngeal edema, resolved by tracheostomy. Analysis based on diagnosis, extent of surgery and functional state failed to reveal statistically significant differences. The maximum time presentation of complications was 6 hours. CONCLUSIONS: The most intense postoperative monitoring is necessary during the first six hours. The low frequency of early reintervention and the appearance of complications in less than 8 hours enable thyroid surgery to be performed on a short-stay basis with adequate safety margins.

Adolescent↗

PubMedDate not supplied

Cytologic criteria of cystic papillary carcinoma of the thyroid.

OBJECTIVE: To establish differential cytologic criteria between benign and malignant thyroid cysts. STUDY DESIGN: The study was a retrospective, transverse, analytic, comparative one of 3 groups of patients with nonfunctional thyroid nodules subjected to fine needle aspiration biopsy (FNAB) and surgical resection of the lesions, with histologic study as the diagnostic gold standard. Fifteen cases of cystic papillary carcinomas (group 1) with initial false negative diagnoses, 42 goiters accompanied by cystic degeneration (group 2) and 15 noncystic papillary carcinomas (group 3) were studied. Independent variables were age and sex; dependent variables were the presence of tridimensional fragments, papillae, anisonucleosis, nuclear bars, pseudoinclusions, powdery chromatin, cytoplasmic vacuoles, metaplastic cytoplasm, psammoma bodies, autolysis, multinucleated giant cells, spindle cells, colloid, monolayered laminae and macrophages in FNAB specimens. Statistical analysis was performed by central tendency measures and the chi 2 test. RESULTS: The chi 2 test revealed a statistically significant difference between group 2 and the groups with papillary carcinoma based on the presence of tridimensional fragments, anisonucleosis, nuclear bars, pseudoinclusions, powdery chromatin, cytoplasmic vacuoles, metaplastic cytoplasm and autolysis. CONCLUSION: The above cytologic characteristics must be searched for systematically in the FNAB of every cystic lesion of the thyroid to rule out the presence of cystic papillary thyroid carcinoma and to decrease the rate of false negative results.

Adult↗

PubMedDate not supplied

[Superior mesenteric artery syndrome as a cause of chronic partial intolerance to oral feeding. Report of a case and review of the subject].

INTRODUCTION: Superior mesenteric artery syndrome (SMAS) is the obstruction of the duodenum in the third portion due to this artery. We present a case of chronic oral feeding intolerance due to this problem. CLINICAL CASE: A 24 year-old woman, with a time of evolution of 1 year and a half of postprandial epigastric pain with nausea, vomiting, and loss of 30 kg managed as acid-peptic disease. The patient was studied with gastrointestinal contrast study and endoscopy without conclusive results. The patient was admitted for unstoppable vomiting, malnutrition, and severe dehydration. A laparotomy was performed and SMAS was identified. We performed Treitz's ligament section and gastrojejunoanastomosis. Her clinical outcome was satisfactory and the patient was discharged without complications. DISCUSSION: SMAS is also called Wilkie's syndrome. SMAS is more frequent in women between the 10 and 39 years. The disease due to the decrease of the angle between the superior mesenteric artery and the aorta, to the anomalous origin of this artery, or to the shortening of Treitz's ligament. SMAS may appear as a sudden weight loss. Food intolerance is a predominant symptom. Diagnosis can be made with x-ray studies. Treatment is medical or surgical, with Treitz's ligament section, duodenojejunoanastomosis, and in some cases gastrojejunoanastomosis. CONCLUSIONS: SMAS should be considered as no the differential diagnosis of chronic oral feeding intolerance.

Adult↗

PubMedDate not supplied

[Etiology on determining the severity of acute pancreatitis].

INTRODUCTION: There exist contradictory results regarding the role of etiology in severity and mortality of acute pancreatitis. In the population of "Hospital General de México" we stablished their importance. MATERIAL AND METHODS: We carried out a retrospective, comparative, longitudinal, and observational study. We determined sex, age, time of evolution, and subjective nutritional state of patients with diagnosis of acute pancreatitis from January 1, of 1996 to December 31, 2000. We compared days of hospitalization, severity, and mortality according to etiology. RESULTS: Ninety five patients were studied, 54% with biliarY and 41% with alcoholic etiology. Differences did not exist in ages and times of symptom evolution, but did in distribution by sex and nutritional state. There were no differences in days of hospitalization but there were differences in severity and mortality when comparing groups of different etiologies. DISCUSSION: In acute pancreatitis, etiology is the decisive factor of severity and mortality, although this can be conditioned by sex of patient and nutritional state.

Acute Disease↗

PubMedDate not supplied

[Dyspareunia after total abdominal hysterectomy. Anatomical relation].

BACKGROUND: We undertook this study to determine whether anatomic changes after total abdominal hysterectomy are a cause of dyspareunia in premenopausal women. METHODS: This is a comparative, prospective and longitudinal study in 50 premenopausal women with benign uterine disease without dyspareunia treated with total abdominal hysterectomy. Primary variable was presence of postsurgical dyspareunia. Secondary variables are presurgical and assessment 3 months after surgery of left, right, anterior and posterior vaginal longitude (VLL, VRL, VAL and VPL, respectively) expressed in centimeters, as well as of the vaginal volume (VV). Statistical analysis for mean, central tendency and t-test. Group 1 (G1) is comprised of patients with postsurgical dyspareunia and Group 2 (G2) is comprised of patients without dyspareunia. RESULTS: In G1, three patients (mean age: 42 years) had dyspareunia, pre- and postsurgical mean values were VV 146.6 and 100, VLL 8 and 7.3, VPL 9.16 and 7.3, VLL 8 and 7.3, VRL 8 and 7.3. In G2, 47 patients (mean age: 40.36 years) were without dyspareunia, pre- and postsurgical values were VV 150.6 and 121.57, VLL 8.81 and 8.12, VPL 9.7 and 8.69, VLL 9.24 and 8.3, VRL 9.28 and 8.33. We did not find significant differences between the groups. Two of the three patients with dyspareunia had a vaginal granuloma, but the third case did not show an anatomical cause. CONCLUSIONS: There is no relationship between total abdominal hysterectomy in premenopausal women and anatomical vaginal changes after surgery as assessed by vaginal volume and longitude. Presence of vaginal granuloma was responsible for dyspareunia in 4% of cases. Dyspareunia was found in 2% of premenopausal women without posthysterectomy anatomical cause.

Adult↗