Hospital Maciel

Abstract Background Morbidly obese people have lower quality of life (QoL) scores than the general population, which improve significantly after surgery. Objective Evaluate the perceived changes in QoL of OMBSP patients, after surgery, according to changes in self-esteem, physical activity, social activity, labor and sexual interest. Design Retrospective observational study of a cohort of patients after one year of bariatric surgery. Material and method Patients belonging to the OBSP were included from January 2016 to January 2022. A computer survey was conducted using the BAROS (Bariatric Analysis and Reporting Outcome System) questionnaire, assessing changes in self-esteem, physical activity, social activity, work and sexual interest. For statistical analysis, the RStudio software was used. Results 114 patients were included, 87.8% women, average age 48 years. 61 sleeve gastrectomies were performed (53.5%) and 53 RYGB (46.5%). 7% postoperative complications. The average BMI changed from 55.8(SD +-14.7) preoperatively to 36(SD+-11) postoperatively. From the results of the BAROS questionnaire, the vast majority have improved their QoL in the five aspects evaluated. 95.6% improved their self-esteem, 95.6% their physical activity, 80.7% improved social life, 78.1% showed improvement in work activity and 61.4% their sexual activity. The average score was 5.31 +/- 2.06. Conclusions Bariatric and metabolic surgery have been shown to be an effective procedure for the treatment of morbid obesity and to determine improvement in QoL. The BAROS score corresponds to a good response to bariatric surgery.

Small (<5 mm) intracranial aneurysms present a therapeutic challenge due to their low annual rupture risk and uncertainties regarding procedure-related morbidity. Evidence from Latin America remains limited. We conducted a retrospective multicenter observational study including 1,519 patients treated between 2017 and 2023 in eight referral centers across five Latin American countries. Demographic, clinical, morphological, and treatment-related variables were analyzed. Logistic regression was used to identify independent predictors of treatment-related complications. The overall complication rate was 6%. Surgical treatment showed higher crude complication rates (11%) compared with endovascular therapy (6%), largely reflecting a greater proportion of ruptured aneurysms. Independent predictors of treatment-related complications were a history of aneurysmal subarachnoid hemorrhage (odds ratio [OR] = 5.03), intraparenchymal hematoma before treatment (OR = 3.56), and ruptured aneurysm status (OR = 2.13). Complications were associated with higher mortality (31% vs. 7%; P < 0.001) and worse 1-year outcomes (Modified Rankin Scale 3-6: 41% vs. 12%; P < 0.001). In this first regional multicenter series, treatment of small intracranial aneurysms in Latin America demonstrated low complication rates and favorable safety profiles for both surgical and endovascular techniques. The predictors identified may support clinical decision-making and improve prognostic assessment.

Introducción: El prolapso rectal es una patología infrecuente, aunque invalidante para los pacientes, que afecta generalmente a personas de edad avanzada, predominantemente mujeres con una marcada debilidad del piso pélvico.1 Trastornos funcionales, como constipación y/o incontinencia anal, suelen asociarse a esta condición. El tratamiento quirúrgico del prolapso rectal admite varios enfoques, con abordajes abdominales2 y perineales y diversas opciones tácticas (resección, fijación con suturas o mallas y combinación de ambas). Entre los abordajes perineales, la proctosigmoidectomía perineal - también denominada procedimiento de Altemeier - con levatorplastia anterior (plastia anterior del músculo elevador del ano), se destaca por su simplicidad y rápida ejecución. Tiene la ventaja de poder utilizarse en pacientes añosos y frágiles, así como en aquellos portadores de un prolapso recurrente, incluso cuando existe una incarceración.3,4 Descripción de contenido: Se presenta el caso de una paciente de sexo femenino de 83 años de edad, con antecedentes de 2 laparotomías (colecistectomía e histerectomía), portadora de un prolapso rectal completo, reductible e incoercible de 1 año de evolución, acompañado de incontinencia fecal. El tacto rectal reveló una gran hipotonía esfintérica asociada y se descartó prolapso vaginal. La colonoscopía no informó patología colónica sincrónica. Se realiza un abordaje inicialmente laparoscópico con el objetivo de efectuar una rectopexia, debiendo abandonar esta vía debido a la presencia de múltiples e importantes adherencias viscerales, lo que prolongaría y dificultaría el procedimiento en una paciente añosa y frágil. Se pasa a posición de litotomía para realizar una proctosigmoidectomía perineal (Altemeier), comenzando por la sección circunferencial del recto a 1 cm de la línea pectínea hasta abrir el fondo de saco de Douglas. Se tracciona el recto y el colon sigmoides hasta lograr una exteriorización máxima y se secciona el mesosigmoides con sellador. Se efectúa una plastia anterior del elevador del ano con puntos separados de material irreabsorbible y una anastomosis coloanal a puntos separados con polidioxanona 3-0. La paciente presentó una buena evolución postoperatoria, siendo dada de alta al 6º día posoperatorio. Con 3 meses de seguimiento, aún no es posible evaluar resultados como la recurrencia a mediano y largo plazo. No obstante, desde el punto de vista funcional presenta evacuaciones diarias de características normales y una buena continencia anal. Conclusiones: Si bien la cirugía mínimamente invasiva ha hecho resurgir el abordaje abdominal, en los pacientes añosos, frágiles y/o portadores de múltiples adherencias viscerales como en el caso que se presenta, el procedimiento de Altemeier continúa siendo una buena opción. Permite abreviar el tiempo operatorio y proporciona resultados alejados aceptables en términos de recurrencia, similares a los de otros procedimientos. Asociar la levatorplastia puede mitigar las secuelas funcionales (incontinencia), así como evitar complicaciones precoces (evisceración perineal).

Introduction: DLBCL has heterogeneous clinical outcomes, and prognosis depends on patient´s and biological variables. Nevertheless, treatment for the last decades has relied on RCHOP schema for all patients fit for it. Results of the POLARIX study have challenged the paradigm of RCHOP treatment for every patient showing increased Progression Free Survival (PFS) in the experimental arm. Due to the high cost of Polatuzumab, there has been a great effort to identify patients most likely to benefit from this approach. Activated-B cell derived DLBCL, elderly and high risk patients by IPI seemin the study cohort to benefit the most. In limited resource countries, a careful selection of patients in whom to invest on more expensive therapies is extremely important. Furthermore, availability of effective second line treatment for the30% of patients expected to relapse are scarce, making this selection even more important. Objectives: Analyze the clinical characteristics and outcomes of patients with DLBCL treated in our country, trying to identify those who have the worst outcomes with conventional treatments and should be considered for novel therapies. Methods: Retrospective, observational study of patients with confirmed diagnosis of DLBCL treated with RCHOPor R-miniCHOP form 8 public and private institutions in Montevideo-Uruguay from 2008 to 2024. Primary mediastinal, primary SNC lymphoma and transformed DLBCL were excluded. COO was evaluated by Hans algorithm due to lack of access to GEP. Results: 294 patients included, 71.4% from private centers, 51.4% female. Median age 68 (19–90) 191 (65%) IPI 0–2, 103 (35%) 3–5. By Hans algorithm 44.2% GCB, 37.1% nonGCB, 18.7% unclassified. 91% received RCHOP, 9% RminiCHOP. Median of 6 cycles (0–7) CR achieved in 71%. 99 (33.7%) relapsed/refractory (R/R). Median follow up was 28.3 months (0.39–178) PFS and OS at 5 years were 48% and 58% respectively with a significant difference in IPI 0–2 versus 3–5 (59% vs. 29%) at 5 years for PFS p < 0.001 and 73% versus 23% for OS p < 0.001. In patients > 60 with IPI 3–5 OS at 5 years was 20% No difference in OS or PFS observed according to COO by IHQAmong R/R, OS at 5 years 23%. 25% received autoSCT. Conclusions: Our data show that with conventional RCHOP, the subset of patients with IPI 3–5 irrespective of stage or age alone have a dismal prognosis with a significantly shorter PFS and OS compared to IPI0–2, worse than what has been reported in international studies. COO did not correlate with outcomes which we attribute to quality of the reported IHQ. RR patients in our country have limited effective therapies available, mostly platinum-based chemotherapy and autoSCT in fit patients and very recently PolaBR in unfit patients. Lack of access to new agents like CART or bispecific antibodies in 2L compels us to make the most out of 1L therapy specially for those with the worst reported outcomes (IPI 3–5) in whom more expensive and effective therapies is justified. Research funding declaration: none Keywords: other; aggressive B-cell non-Hodgkin lymphoma; cancer health disparities No potential sources of conflict of interest.

Abstract .Disease registries are essential for real-world epidemiology and clinical practice for rare diseases like pulmonary arterial hypertension (PAH) and chronic thromboembolic PH (CTEPH). We analyze the epidemiological profile, therapy approach, and survival of PAH and CTEPH patients treated in a reference center in PH (Uruguay). Methods: PAH and CTEPH patients diagnosed within the past 6 months from entry into the registry (incident) and who were diagnosed more than 6 months before (prevalent) (ESC-ERS 2015) with at least two clinical controls between 2006-2024 were included. Demographic, clinical, echocardiographic, and hemodynamic data, the treatment approach, and survival at 1, 3, and 5 years were analyzed. We estimated the individual global risk of PAH patients using a model of 4 variables (NYHA/WHO FC, 6MWD, right atrial pressure, cardiac index) at the time of diagnosis. The individual average risk was calculated by assigning a score of 1, 2, and 3 for each variable (1=low -LR-, 2=intermediate -IR-, and 3=high-risk -HR-) and rounding the average value to the nearest integer. Pulmonary thromboendarterectomy (PTE) program began in 2011. PTE patient selection was performed considering clinical history, severity of PH and RV dysfunction, surgical accessibility, and experience of the cardiac surgeon. Results: One hundred twenty patients were included. The table shows the study cohort data. Females significantly predominated in the PAH cohort. 65% corresponded to typical PAH; 42% were idiopathic PAH (12% vasoreactive), 31% were PH associated with congenital heart disease, and 23% corresponded to PH associated with connective tissue disease, presenting the highest mortality rate. 60% were incident PAH patients with significantly higher mortality than prevalent. 21, 72, and 7% of PAH patients had LR, IR, and HR, respectively, with one-year mortality of 0, 3, and 14%. For PAH patients, one-, three- and five-year survival were 97, 93, and 83%. Sixteen PTEs were performed, presenting echocardiographic (TAPSE/sPAP 0.22±0.08 mm/mmHg) and hemodynamic (PVR 10±4 WU) severity which significantly improved in the early postoperative period. In-hospital mortality was 19%. All deceased patients had significantly more severe preoperative hemodynamics. 54% of survivors had residual PH, only three needed specific vasodilator therapy. One-, three- and five-year survival was 81, 81, and 74% for operated CTEPH patients. Conclusions: The PAH survival rate could be explained by the low age, a high proportion of CHD-PH, LR/IR patients, and use of combined therapy. The low rate of PTEs/year and the presence of severe distal vasculopathy could explain the high perioperative mortality in CTEPH patients.

Introduction. The problem of organ-specific metastasis still captivates researchers. Elucidation of the patterns of this phenomenon is important not only for theoretical oncology but also for practice, since modern clinical oncology tends to individualize patient treatment tactics. Hundreds of genes are involved in the metastatic cascade, and their identification is a cumbersome study that is ineffective in a clinical setting. Therefore, the clinic needs a simple, fast, and cheap technique for determining the high and low probability of organ-specific metastasis. The technique should have sufficiently high diagnostic specificity and sensitivity. The study’s aim is to create an in vitro model that can show the condition of a specific patient in real time and then test the model on patients who already have metastases. This will allow the risk of metastasis to be predicted and reference indicators to be found. Materials and methods. We isolated leukocytes from 8–10 ml of the patient’s blood and brought them to a concentration of 2 million/ml. We used water-salt extracts of metastatic tumors from organs with possible tumor progression as antigens. In each paired well of the plate, 50 μl of culture medium, 100 μl of primary tumor extract or allogeneic metastatic tumors, and 100 μl of leukocyte suspension were added. 50 μl of serum IV (AB) were added to odd wells, and 50 μl of the subject’s autoserum were added to even wells. 50 μl of culture medium were added to control wells instead of tumor extract. We covered the plates with a lid and incubated them for 1.5 h at 37 °C. We then turned the plates upside down and incubated them for 30 min, allowing us to separate adherent cells from non-adherent ones. We removed the fluid containing non-adherent cells, fixed the adherent fraction with 96% ethanol, stained it with methylene blue, washed it three times with saline, and added dimexide. We estimated the amount of dye using spectrophotometric analysis or a color scale. Results and discussion. We assessed the proposed method’s ability to predict metastases in 189 breast cancer patients with known metastases treated at the Donetsk Regional Antitumor Center from 1989 to 2002. The control group consisted of twenty donors. Fifty-one women had metastases in their bones, twenty-one to their lymph nodes, one to their skin, forty-five to their lungs, twenty-five to their pleurisy, eight to a pleurisy and lung parenchyma metastasis together, twenty-two to their liver, and sixteen to their ovaries. The diagnostic sensitivity was 94.12% for the bone antigen test on donor serum, 80.95% for lymph node antigens, 92.50% for lung parenchyma antigens, 84.0% for metastatic pleurisy antigens, 71.43% for combined lung lesions (parenchyma and metastatic pleurisy), 94.44% for liver metastasis antigens, and 93.75% for ovarian antigens. The combined diagnostic sensitivity on donor serum was 89.94%. The addition of donor serum to the test system allows for an assessment of the contribution of blood cells and large vesicles to the metastasis process. The diagnostic sensitivity was 82.35% for the bone antigen test on autoserum, 66.67% for lymph node antigen, 71.11% for lung parenchyma antigens, 82.61% for metastatic pleurisy antigens, 87.50% for combined lung lesion (parenchyma and metastatic pleurisy), 90.91% for liver metastasis antigens, and 78.72% for ovarian antigens. The combined diagnostic sensitivity on autoserum was 78.72%. Autoserum has a lower combined diagnostic sensitivity than donor serum. The reason for this remains unknown. Normal body cells, particularly those in the blood system, played a crucial role in realizing the metastatic cascade. Because they release lytic enzymes and NETosis, neutrophils help metastatic cells get past the tissue-hematological and hemato-tissue barriers. Platelets keep tumor cells moving; macrophages and lymphocytes help create a microenvironment; and neutrophils and lymphocytes wake up dormant metastases. Conclusions. 1. The model we proposed for predicting organ-specific metastasis in patients with breast cancer demonstrates a relatively high diagnostic sensitivity and specificity. On donor serum, the diagnostic sensitivity is 89.94%, and on autoserum, it is 78.72%. The specificity level was 80%. The test allows us to determine the number and optimal timing of chemotherapy courses for a specific patient. We think that the goal of adjuvant chemotherapy is to affect both dormant micrometastases and normal cells in the blood system. These cells help the metastatic cascade and wake up dormant metastases.