Scielo RSS <![CDATA[Revista médica del Hospital General de México]]> vol. 84 num. 3 lang. en <![CDATA[SciELO Logo]]> <![CDATA[Pharmacovigilance in the vaccination program against coronavirus disease 19]]> <![CDATA[Outcome in valve surgery at the General Hospital of Mexico: A retrospective review]]> Abstract Introduction: In cardiac surgery, valvular procedures rank second place in Europe and North America and first place in Mexico. The objective was to identify the clinical and surgical results of patients undergoing valvular surgery. Methods: An observational, cross-sectional, descriptive, retrospective, and retrolective study was performed. Records of patients undergoing valvular surgery in the Cardiothoracic Surgery Unit of the General Hospital of Mexico Dr. Eduardo Liceaga were included, during the period from January 1, 2014, to December 31, 2018. The patient records used included demographic characteristics, diagnosis, functional class, death, cardiovascular risk factors, post-operative complications, and survival. Results: A total of 163 patient records with valvular surgery were found, with an average age of 54 years ± 14, 54.6% were male. The main risk factors were obesity and systemic arterial hypertension. The most affected valve was the aortic and degenerative etiology. After valve replacement, 90% of patients remained in functional Class I and II. Complications such as respiratory infections, postsurgical bleeding, and sepsis were identified. The average hospital stay was 21 days ± 14 with a survival of 70% at 5 years, where the determinants were the functional class (p = 0.0001), the post-operative complications (p = 0.0001), and the post-operative follow-up (p = 0.0001). Conclusions: The survival of the patients improved significantly after the resolution of valvulopathy, with a favorable impact on the functional class and its post-surgical follow-up. <![CDATA[Maxillary osteosarcoma: Morphological variants, clinicopathological picture, and literary revision]]> Abstract Objective: Jaw osteosarcoma shows a variety of histomorphological clinical conditions. Despite the advances in molecular pathogenesis and biological markers, clinicopathological correlation is considered the most important criterion in diagnosis. Material and methods: The database of the Surgical Pathological Department of the General Hospital of Mexico was reviewed to obtain cases of osteosarcoma during the period from 2002 to 2019. The cases were evaluated on the Enneking scale, which has prognostic considerations. Results: Regarding the 11 cases found, 54.5% are women. The average age was 36 years old, the primary location was the jaw. The average size was 8 cm. Clinicopathological concordance was 27.3%. The most frequent histologic variant was chondroblastic. The predominant histological grade was high and 83% of the cases had surgical margins involved. Conclusion: The patients were in the fourth decade of their life, the tumors were large in size with a high histological grade of malignity and the majority of cases had affected surgical margins. All data had a bad prognostic. <![CDATA[Analysis of lung function in a Colombian military with a medical history of thoracic trauma]]> Abstract Introduction: Pulmonary function can be affected months after blunt thoracic trauma. However, the data reported are scarce. Objective: The objective of the study was to evaluate pulmonary function at 3 and 6 months in subjects with thoracic injuries suffered in combat. Materials and methods: Study of cases and controls evaluating subjects with chest trauma at 3 and 6 months after it, the controls were healthy soldiers with combat experience. Spirometric variables, lung volumes, Cooper test, 6 min walking test, and cardiopulmonary exercise test were evaluated between 2011 and 2016. Results: Forty-five male subjects entered the study, 25 cases evaluated 3 months and 11 at 6 months after the trauma, compared with 20 controls. After 3 months of evaluation, the subjects wounded in combat walked 43.63 m (p = 0.007) less when compared to the control group in the 6 min walk and the post-vital capacity was 0.88 l (p &lt; 0.001) lower at 6 months than in the control group. When comparing the subjects with chest trauma evaluated, the only variables that showed a statistically significant recovery were the pre-forced expiratory flow (p = 0.005) and 6 min walking test (p = 0.002). Conclusion: Subjects with chest trauma in combat show a decrease in lung volumes and a cardiopulmonary exercise test at 3 and 6 months of evaluation. <![CDATA[Endoscopy anesthesia, team perspective]]> Abstract Sedation, at the endoscopy room, is a very important step of the procedure. It helps to perform complex therapeutical procedures with better results for patients and helps reduce related adverse effects. A specific team of doctors, such as endoscopists-anesthesiologists, has allowed to perform more and complex advanced therapeutic procedures. However, in most endoscopy centers, anesthesiologists in training (residents) are often not familiarized with sedation in endoscopic procedures that allow the passage of the equipment through the cricopharyngeal muscle, without also causing respiratory depression, and the limitation that they do not have absolute control of the airways. Various drugs are used for endoscopic procedures. However, the patient's comorbidities must be known, as well as close communication with the endoscopist doctor by the anesthesiologist to use the appropriate drug according to the endoscopic procedure. When anesthesia is not possible in patients, the endoscopist doctor must know techniques to perform high-demand procedures in high-volume centers such as upper endoscopy and colonoscopy with favorable results for the diagnosis and timely treatment of patients. <![CDATA[Intestinal histoplasmosis in immunocompetent patient: An unusual cause of massive small intestine bleeding]]> Abstract Small bowel bleeding (SBB) accounts for 5-10% of patients with gastrointestinal bleeding and its association is unusual in patients with histoplasmosis. The incidence of gastrointestinal histoplasmosis is unknown since only 3-12% present symptoms, predominantly in immunocompromised patients. However, in immunocompetent hosts, it is reported only in 0.05% of cases. A clinical case of an immunocompetent patient with massive SBB, Grade IV hypovolemic shock associated with systemic histoplasmosis and treated with intestinal resection and amphotericin B is hereby discussed. <![CDATA[Miller Fisher variant Guillain-Barre syndrome: A case review]]> Abstract Female patient presents respiratory infection 1 month before the appearance of following triad: ophthalmoplegia, ataxia, and hyporeflexia. Diagnosed as Miller Fisher syndrome, associated with cytomegalovirus infection, that showed an aggressive pattern in anti-GQ1b antibodies as well as albuminocytological dissociation in cerebrospinal fluid and demyelination in electromyography, without therapeutic response to intravenous immunoglobulin and plasmapheresis. The progression of the disorder leads to overlap with a classic Guillain-Barré syndrome, presented by the persistence of quadriparesis and dysphagia for solids/liquids, reflecting a poor prognosis, confirming that the etiologic agent has impact on the aggressiveness. This is also indicated in up-to-date literature, which justifies the importance of report. <![CDATA[Neuroblastoma in adults: Differential diagnosis of giant retroperitoneal mass]]> Abstract Neuroblastoma develops from the cells of the primitive neural crest, although being the fourth most frequent cancer in childhood, it is seldom seen in adults, and when found in them, symptoms are usually nonspecific such as abdominal and lumbar pain, therefore, diagnosis is rarely suspected and often delayed. Imaging studies, such as abdominal computed tomography, identify laterality and size of the adrenal mass, which commonly has calcifications; blood work usually does not show abnormalities, excluding functional adrenal tumor. Definitive diagnosis requires histopathological examination. Surgical resection, when feasible, is the treatment of choice. We briefly reviewed diagnostic work-up, histopathological findings, and post-treatment outcome. <![CDATA[Ernesto “Che” Guevara, time and life in Hospital General de México]]> Abstract Ernesto Guevara is a well-known character. Before he participated in various revolutions throughout Latin America, he dedicated his early life and daily work to medicine, his profession, some of which he performed in Hospital General de México.