Abstract The clivus corresponds to a posterior cranial fossa region formed by the union of the body of the sphenoid bone and the basilar portion of the occipital bone, being its pathology very rare. Among the clival lesions, the most frequent are chordomas (40%), chondrosarcomas, ectopic adenomas, lymphomas, among others. Primary bone non-Hodgkin lymphomas correspond to an extranodal presentation, which is very infrequent in adults, while the skull base presentation corresponds only to 1% to 2%. They present mainly with headache, B symptoms, diplopia, and trigeminal paresthesia. The primary clival origin is an even more infrequent manifestation, with headache being its main symptom. The clinical suspicious must be high, requiring neuroimaging, then an endoscopic or open surgery biopsy. Management is standardized with R-CHOP chemotherapy with a 67% of complete response, 16% stop of progression and 16% progression despite treatment.

Resumen El clivus corresponde a una región de la fosa craneal posterior conformada por la unión del cuerpo del hueso esfenoidal y la porción basilar del hueso occipital, siendo sus lesiones poco frecuentes. Dentro de las lesiones clivales las más frecuentes son los cordomas (40%), condrosarcomas, adenomas ectópicos, linfomas, entre otros. Los linfomas no Hodgkin primario de hueso corresponden a una presentación extranodal, muy infrecuente en adultos, constituyendo sólo un 1% a 2% de estos en la base de cráneo. Se presentan principalmente con cefalea, síntomas B, diplopia y parestesias trigeminales. El origen primario clival es una manifestación aún más infrecuente, siendo su principal síntoma la cefalea. La sospecha debe ser alta requiriendo neuroimágenes, luego biopsia ya sea endoscópica o abierta. El manejo es con quimioterapia R-CHOP con un 67% de respuesta completa, 16% de detención de la progresión y 16% de progresión pese a tratamiento.

Hypopituitarism after moderate or severe traumatic brain injury (TBI) is usually underdiagnosed and therefore undertreated. Its course can be divided in an acute phase during the first 14 days after TBI with 50 to 80% risk of hypopituitarism, and a chronic phase, beginning three months after the event, with a prevalence of hypopituitarism that ranges from 2 to 70%. Its pathophysiology has been addressed in several studies, suggesting that a vascular injury to the pituitary tissue is the most important mechanism during the acute phase, and an autoimmune one during chronic stages. In the acute phase, there are difficulties to correctly interpret pituitary axes. Hence, we propose a simple and cost-effective algorithm to detect and treat a potential hypothalamic-pituitary-adrenal axis impairment and alterations of sodium homeostasis, both of which can be life-threatening. In the chronic phase, post-concussion syndrome is the most important differential diagnosis. Given the high prevalence of hypopituitarism, we suggest that all pituitary axes should be assessed in all patients with moderate to severe TBI, between 3 to 6 months after the event, and then repeated at 12 months after trauma by a specialized team in pituitary disease.

Abstract Tumors of the parapharyngeal space are rare. Benign neoplasms are the most frequent and, among them, pleomorphic adenomas stand out. These tumors are usually asymptomatic until they reach a size large enough to produce symptoms due to mass effect. Despite its benign nature, it is necessary to perform a complete resection given its high recurrence rate and its potential for malignant transformation. We present the case of a 52-year-old man in whom a study of vertigo incidentally detected a mass in the parapharyngeal space measuring 45 mm × 32 mm in diameter, of unknown etiology. An endoscopic incisional biopsy was performed, showing a pleomorphic adenoma, which is currently under assessment to plan complete removal. In conclusion, as clinical and radiological findings are not always sufficient to determine the nature of parapharyngeal space lesions, it is important to obtain a histological diagnosis. Advances in endoscopic sinus surgery techniques have allowed access to this area with minimal morbidity and hospital stay. Due to the possibility of malignant transformation pleomorphic adenomas require active management.

Resumen Los tumores del espacio parafaríngeo son poco frecuentes. Dentro de ellos, las neoplasias benignas son las más frecuentes, destacando principalmente los adenomas pleomorfos. Estos tumores suelen permanecer asintomáticos hasta alcanzar el tamaño suficiente para producir alteraciones debido al efecto de masa. A pesar de su naturaleza benigna, es necesario realizar resección completa dada su alta tasa de recurrencia y potencial de transformación maligna. Presentamos el caso de un paciente de 52 años que en estudio de vértigo se detecta incidentalmente una masa tumoral del espacio parafaríngeo de 45 mm × 32 mm de diámetro, de etiología incierta. Se realizó una biopsia incisional endoscópica que evidenció un adenoma pleomórfico, que actualmente se encuentra en etapa de evaluación y planificación de escisión completa. En conclusión, dado que los hallazgos clínicos y radiológicos no siempre son suficientes para determinar la naturaleza de las lesiones del espacio parafaríngeo, es importante contar con un diagnóstico histológico. Los avances en las técnicas de cirugía endoscópica sinusal han permitido acceder a esta zona con una mínima morbilidad y estadía hospitalaria. Debido a la posibilidad de transformación maligna los adenomas pleomórficos requieren un manejo activo.

We report the case of a 13-year-old woman with a large tumor with osseous appearance in her right infratemporal fossa, which was biopsied through an endoscopic transpterygoid approach. The biopsy showed an osteocondroma. We described the case and discuss its relevant aspects.

Presentamos el caso de una mujer de 13 años con un gran tumor de características óseas en la fosa infratemporal derecha, el cual fue biopsiado mediante un abordaje endoscópico transeptal transpterigoídeo. La biospia mostró un osteocondroma. Describimos el caso y discutimos sus aspectos relevantes.

We report the case of a 56-year-old woman with diagnosis of esthesioneuroblastoma Kadish C/Hyams II treated with a purely endonasal endoscopic resection and adjuvant radiotherapy. We described the case and discuss its relevant aspects.

Presentamos el caso de una mujer de 56 años con diagnóstico de estesioneuroblastoma Kadish C/Hyams II tratado con resección quirúrgica mediante un abordaje endoscópico endonasal puro y radioterapia adyuvante. Describimos el caso y discutimos sus aspectos relevantes.

Purpose: To establish the prognostic value of the retinal nerve fiber layer thickness measured at Optical Coherence Tomography (OCT) as a predictor of visual function posterior to resection of sellar tumors. Material and Methods: Descriptive, retrospective study in patients undergoing microscopic transsphenoidal resection of sellar tumors with preoperative ophthalmologic evaluation (evaluation by specialist, 24-2 Sita Standard visual field (24-2 SS VF) and optic nerve head Stratus OCT) and postoperative (evaluation by specialist and 24-2 SS VF). Minimum follow-up was 3 months. For statistical analysis, Spearman and Pearson's Correlation Coefficient and linear regression was used. Results: A total of 18 patients were included. In the preoperative evaluation, patients had logMAR average Snellen visual acuity (VA) of 0.70 (0.15 logMAR, 0-4.0), an average mean deviation (MD) of -9.25 dB (0.4 to -30.4 dB) and a average retinal nerve fiber layer thickness of 83.7 microns (45.24 to 115.37). Postoperative evaluation of patients showed an Snellenaverage VA of 0.78 (0.1 logMAR, 0-1.3) and MD of 5.58 dB (2.31 -32.39 dB). A positive correlation (r = 0.51) between average retinal nerve fiber layer thickness and postoperative MD, less probably to improved in VF and VA with thicknesses below 80 microns. Conclusion: A nerve fiber layer thickness on optic nerve head Stratus OCT below 80 microns correlated with poorer visual function improvement in patients undergoing transsphenoidal resection surgery of sellar tumors.

Propósito: Establecer el valor pronóstico del grosor peripapilar de la capa de fibras de las células ganglionares (CFCG) cuantificado a la Tomografía de Coherencia Óptica (OCT) como factor pronóstico visual posterior a la resección de tumores selares. Material y Método: Estudio descriptivo, retrospectivo en pacientes sometidos a resección transesfenoidal microscópica de tumores selares con evaluación oftalmológica preoperatoria (evaluación por especialista, campo visual 24 Sita Standard (CV 24-2 SS) y OCT Stratus de papila) y postoperatoria (evaluación por especialista y CV 24-2 SS). El seguimiento mínimo fue de 3 meses. Para el análisis estadístico se utilizó el coeficiente de correlación de Pearson y Spearman, y regresión lineal. Resultados principales: Se incluyó un total de 18 pacientes. En la evaluación prequirúrgica los pacientes presentaron agudeza visual (AV) promedio de 0,70 en Snellen (0,15 en logMAR, rango 0-4 logMAR), una desviación media (DM) promedio de -9,25 dB (0,4 a -30,4 dB) y un grosor de CFCG de 83.7 μm promedio (45,24 a 115,37 μm). En la evaluación postoperatoria los pacientes presentaron AVpromedio de 0,78 Snellen (0,1 logMAR, rango 0-1,3) y una DMpromedio de -5,58 dB (2,31, -32,39 dB). Se encontró una correlación positiva (r2 = 0,51) entre el grosor de CFCG y la DM postoperatoria, con tendencia a la menor mejoría del CV y AV con grosores bajo 80 μm. Conclusión: Una capa de fibras nerviosas bajo 80 μm al OCT Stratus se correlacionó con menor mejoría visual postoperatoria en pacientes sometidos a cirugia transesfenoidal de tumores selares.

Resumo Objetivo Determinar o efeito do trabalho tanatológico de enfermagem a través da relação interpessoal no nível de frustração da pessoa com diabetes mellitus tipo 2. Métodos Estudo de intervenção com avaliação pré e post, realizada em Yucatán, México. As variáveis foram: idade, gênero, escolaridade, ocupação, estado civil, tempo com a doença e nível de frustração. O programa de intervenção teve 6 módulos, implementado durante 4 meses. Para a prova de hipótese do estudo aplicou-se a estatística de Wilcoxon para amostras em pares. Resultados Observou-se que 87% das pessoas obteve um nível de frustração médio, prévio à intervenção de enfermagem e o 13% restante, um nível de frustração alto. Posterior à intervenção, observou-se que 69% obteve um nível de frustração baixo, o 26.1% um nível de frustração médio e só 4.3% um nível alto. Em referência à prova de hipótese, observou-se um valor p menor a 0.000, o qual indicou que existe diferença significativa entre os níveis de frustração antes e depois da intervenção. Conclusões O trabalho tanatológico de enfermagem a través da relação interpessoal diminui o nível de frustração da pessoa perante à diabetes mellitus tipo 2.

Abstract Objective To determine the effect of the nursing thanatological activity through interpersonal relationships on the levels of frustration in the person with type 2 diabetes mellitus. Methods Intervention study with pre and post assessment carried out in Yucatan, Mexico. Variables were age, gender, school level, occupation, civil status, time suffering the illness, and level of frustration. The intervention program consisted of 6 modules implemented during 4 months. A paired-samples Wilcoxon hypothesis test was performed. Results 87% of the participants showed a medium level of frustration prior to the intervention, and the remaining 13% showed a high one. After the intervention, it was observed that 69% showed a low level of frustration, 26.1% showed a medium one, and only 4.3% showed a high one. The hypothesis test returned p less than 0.000 indicating that there is a significant difference between the levels of frustration before and after the intervention. Conclusions Nursing thanatological activity through interpersonal relationships decreases the level of frustration of the person with type 2 diabetes mellitus.

Resumen Objetivo Determinar el efecto de la labor tanatológica de enfermería a través de la relación interpersonal en el nivel de frustración de la persona con diabetes mellitus tipo 2. Métodos Estudio de intervención con evaluación pre y post, realizada en Yucatán, México. Las variables fueron: edad, género, escolaridad, ocupación, estado civil, tiempo con la enfermedad y nivel de frustración. El programa de intervención constó de 6 módulos, implementado durante 4 meses. Para la prueba de hipótesis del estudio se aplicó la estadística de Wilcoxon para muestras pareadas. Resultados Se observó que el 87% de las personas obtuvo un nivel de frustración medio previo a la intervención de enfermería, y el 13% restante un nivel de frustración alto. Posterior a la intervención, se observó que el 69.6% obtuvo un nivel de frustración bajo, el 26.1% un nivel de frustración medio y solo el 4.3% un nivel alto. De acuerdo a la prueba de hipótesis, se observó un valor de p menor a 0.000, lo cual indicó que existe diferencia significativa entre los niveles de frustración antes y después de la intervención. Conclusiones La labor tanatológica de enfermería a través de la relación interpersonal disminuye el nivel de frustración de la persona frente a la diabetes mellitus tipo 2.

An exceptional case of bilateral Krukenberg tumor of the ovary associated with mature teratoma presented in a 54 years old patient is reported. The ultrasound showed a 55 mm solid right ovarian tumor and a 125 mm left cystic ovarian tumor. Hysterectomy and bilateral salpingoophorectomy was performed including omental resection and peritoneal biopsies. Massive pulmonary embolism was detected in the third day after the surgery. Even anticoagulant therapy was established the patient died in the fifth postoperative day. The histological study revealed massive infiltration of signet ring cell carcinoma with positive expression for cytokeratin in both ovaries. The right ovary showed the classical solid form of the tumor. The left ovary was a dermoid cyst with signet ring cell carcinoma infiltrating the cystic wall.

Se reporta un caso excepcional de tumor de Krukenberg ovárico bilateral asociado a teratoma maduro encontrado en una mujer de 54 años. La ecografía mostró al lado derecho tumor ovárico sólido de 55 mm y al lado izquierdo tumor quístico de 125 mm. Se realizó histerectomía total, salpingooforectomía bilateral, resección del epiplón mayor y muestras peritoneales. Al tercer día postcirugía, la paciente presentó signos de tromboembolismo pulmonar masivo y aunque recibió terapia anticoagulante falleció al quinto día postoperatorio. El estudio histológico mostró infiltración masiva de carcinoma de células en anillo positivas para citoqueratina en ambos ovarios. El ovario derecho mostró la forma sólida clásica del tumor de Krukenberg mientras que el ovario izquierdo correspondió a un quiste dermoide con infiltración tumoral de carcinoma de células en anillo en la pared.

Background: There is consensus in promoting the selective use of glucocorticoids (GC) in the peri-operative period of transsphenoidal surgery (TE) for pituitary adenomas (PA). Aim: To evaluate the safety of a selective glucocorticoid administration protocol and the usefulness of immediate postoperative cortisol levels as a predictor of final eucortisolism. Patients and Methods: Clinical and biochemical data from 40 patients aged 27 to 78 years (65% males) were prospectively collected. Exclusion criteria were previous use of GC, apoplexy and Cushing disease. Patients with pre-operative short synthetic ACTH test (SST) > 18 µg/dl or basal cortisol > 15 µg/dl did not receive GC. A morning serum cortisol (SC) threshold of 10 µg/dl in postoperative days one to three was used to decide a discharge without GC. Hypotension, dizziness or nausea, requirement of increased dose of corticosteroids, hospitalizations and emergency service visits were investigated, as well as surgical and endocrinological complications. Corticotropic status was evaluated three months after surgery. Results: Macroadenomas were present in 87% of patients. Median hospital stay was 4 days and follow up lasted 9 months. No differences were found in gender, age or tumor size between patients who received or not GC (35 and 65% respectively). Eighty five percent of patients were discharged without GC and all of them had normal corticotropic function three months after surgery. A SC ≥ 15 µg/dl had 100% specificity to predict eucortisolism. Conclusions: Selective glucocorticoid administration is safe. A normal corticotropic function before surgery and in the immediate postoperative period are useful to identify patients who do not need GC.

The uterine metastatic involving of extragenital carcinomas is rare, especially the signetring cell type. Three of such a cases were found in 240 cases of adenocarcinomas of uterine cervix (1.25%) diagnosed between 1979-2012. Two of these cases occurred in patients aged 48 and 56 years with infiltrating lobular carcinomas arising in the breast previously diagnosed. The first patient is alive at 19 months after diagnosis and the second is deceased at 14 months after diagnosis. In both cases, the metastasis to the cervix was an incidental histological finding in surgeries performed by benign gynecological pathology. The third case was identified in a 43-years old patient who debuted with metrorrhagia and cervical tumor which was originated in a diffuse infiltrating gastric carcinoma that was found synchronously and she is dead at 2 months after diagnosis. The diagnostic criteria between metastases and primary cervix carcinoma of signet ring cells and the contribution to the diagnosis of conventional histology, immunohistochemistry and molecular typing of HPV are reviewed. The metastasis of signet ring cell carcinoma to the uterine cervix is rare and the survival is poor. Conclusion: The role of cytoreduction and chemotherapy for selected cases of metastasis from breast carcinomas should be considered and in such a case the gynecological involvement should not be considered a preterminal event.

Las metástasis de carcinomas extragenitales al útero es rara y el compromiso al cuello uterino es excepcional, especialmente del tipo histológico de carcinoma de células en anillo de sello. Se presentan tres casos encontrados en 240 adenocarcinomas cervicales (1,25%) diagnosticados entre 1979-2012. Dos casos se presentaron en pacientes de 48 y 56 años originados en carcinomas lobulillares infiltrantes de la mama diagnosticados previamente. La primera paciente está viva a 19 meses del diagnóstico ginecológico y la segunda falleció a los 14 meses, siendo en ambas un hallazgo histológico incidental en cirugías realizadas por patología ginecológica benigna. El tercer caso se presentó en una paciente de 43 años que debutó por metrorragia y tumor cervical y fue originado en un carcinoma gástrico infiltrante difuso, encontrado en forma sincrónica y fallece a los 2 meses del diagnóstico. Se revisan los criterios diagnósticos entre metástasis y carcinoma primario de células en anillo de sello del cuello uterino y el aporte al diagnóstico de la histología convencional, la inmunohistoquímica y la tipificación molecular de HPV. Conclusión: Se concluye que la metástasis de carcinoma de células en anillo al cuello uterino es rara y el pronóstico es malo. La citoreducción y la quimioterapia podría tener un rol para casos seleccionados de carcinomas metastásicos de origen mamario y que estos casos no deberían ser considerados un evento preterminal.

Schinus molle L., also known as pepper tree, has been reported to have antimicrobial, antifungal, anti-inflammatory, antispasmodic, antipyretic, antitumoural and cicatrizing properties. This work studies supercritical fluid extraction (SFE) to obtain volatile and non-volatile compounds from the aerial parts of Schinus molle L. and the influence of the process on the composition of the extracts. Experiments were performed in a pilot-scale extractor with a capacity of 1 L at pressures of 9, 10, 12, 15 and 20 MPa at 323.15 K. The volatile compounds were obtained by CO2 supercritical extraction with moderate pressure (9 MPa), whereas the non-volatile compounds were extracted at higher pressure (12 to 20 MPa). The analysis of the essential oil was carried out by GC-MS and the main compounds identified were sabinene, limonene, D-germacrene, bicyclogermacrene, and spathulenol. For the non-volatile extracts, the total phenolic content was determined by the Folin-Ciocalteau method. Moreover, one of the goals of this study was to compare the experimental data with the simulated yields predicted by a mathematical model based on mass transfer. The model used requires three adjustable parameters to predict the experimental extraction yield curves.

Objective: To analyze the distribution according to stage and age of women with histological cervical carcinoma confirmed diagnosis. Method: A cross sectional study of 1,131 women of the Hospital Guillermo Grant B with FIGO's classification, in the period 1999-2005. Results: From the 1,131 cases, 522 (46.1%) women correspond to Stage 0, the average age was 34.9 years; 9% were younger than 25 years of age; 40.6% were between 25-34 years old. Invasive cancer had 609 women (53.9%), average age was 51.2 years, corresponding 223 (36.6%) Stage I, 194 (31.8%) Stage II, 159 (26.1%) Stage III, and 8 (1.3%) Stage IV. The range of age in invasive stages was between 19-95 years. From the group of women with cancer, 117 (19.2%) were older than 65 years, and 4 women (0.6%) were younger than 25. Conclusion: The implementation of the National Program of early detection for cervical cancer caused that 46.1% of cases correspond to early diagnosis, contributing to the national trend of decreasing rate of mortality for this disease. There is a progressive decrease in the incidence of invasive cancer as it progresses in stages, coincidentally there is an increase in the age of these women, so that 19.2% were older than 65 years. Based on these results it is necessary to analyze the cost benefit of including women younger than 25 years and older than 65 in the screening.

Objetivo: Analizar la distribución de mujeres con diagnóstico histológico de cáncer cérvico-uterino de acuerdo a la etapa clínica y edad. Método: Estudio de corte transversal de 1.131 mujeres clasificadas de acuerdo a la etapa FIGO en el Hospital Guillermo Grant (1999-2005). Resultados: 522 casos (46,1 %) corresponden a Etapa 0, con edad promedio de 34,9 años; el 9% eran menores de 25 años; el 40,6% se concentró en el grupo entre 25 y 34 años. A cáncer invasor corresponden 609 mujeres (53,9%), con edad promedio de 51,2 años, en Etapa I el 36,6%, Etapa II el 31,8%, Etapa III el 26,1% y Etapa IV el 1,3%. Del grupo de mujeres con cáncer invasor, 117 (19,2%) eran mayores de 65 años y 4 (0,6%) menores de 25 años. Conclusión: La aplicación del Programa Nacional de pesquisa precoz del cáncer cérvico-uterino hizo que el 46,1% de los casos correspondan a diagnóstico precoz, contribuyendo a la tendencia nacional de disminución de la tasa de mortalidad por esta patología. Hay una disminución progresiva del número de casos de cáncer invasor a medida que se avanza en las etapas, coincidentemente hay un aumento en la edad de estas mujeres, es así que el 19,2% eran mayores de 65 años. De acuerdo con estos resultados es necesario analizar el costo-beneficio de incluir mujeres menores de 25 años y mayores de 65 en el programa de pesquisa precoz.

Objective: To analyze the results of 1,141 cervical excisions. Method: Descriptive and retrospective study of the clinical charts and biopsies of 1,141 cases with surgical resection of the uterine cérvix performed from 1999 to 2005. Only patients with a mínimum of 18 months of follow up were included. Results: From 3,004 patients with a positive Papanicolaou smear for neoplastic cells and/or condyloma, 1,113 (97.5%) were trea-ted with loop electrosurgical excisional procedure (LEEP) and 28 (2.5%) with cold-knife conization. The most frequent lesión (66.7%) found was high grade squamous intraepithelial lesions (SIL), follow by low grade SIL (7.8%); 74 patients (6.5%) presented with early stage of squamous cell carcinoma and 377 (33%) of the histological specimens revealed positive margins; 210 (18.4%) of the cases showed no histological lesión. There were a 26.2% of témales that were considered to receive over treatment. After 18 months follow up 85.5% of patient were free of high grade SIL. A second surgical treatment was done in 194 patients (17%) including 110 cases (9.6%) with persistent or recurrence of the lesión. Conclusions: The results are satisfac-tory related to treatment of high grade SIL and it contributes to the early diagnosis of cervical cáncer. The results are similar to other national and international series previously published.

Objetivo: Analizar los resultados de la escisión de la zona de transformación del cérvix efectuadas en la Unidad de Patología Cervical del Hospital Guillermo Grant de Concepción. Método: Estudio descriptivo, retrospectivo, de los antecedentes clínicos e histológicos de 1.141 casos de escisión electro quirúrgica efectuados entre 1999 a 2005, con seguimiento mínimo de 18 meses. Resultados: De las 3.004 mujeres derivadas por citología positiva para neoplasia y/o HPV, a 1.141 (37,9%) se les realizó escisión de la zona de transformación; 1.113 con asa electroquirúrgica (97,5%) y 28 (2,5%) cono frío con bisturí. Las lesiones intraepiteliales (LIE) de alto grado fueron las más frecuentes (66,7%), seguidas por las LIE de bajo grado (7,8%); el 6,5% de las pacientes presentan etapas iniciales de carcinoma invasor; 33% de las piezas histológicas presentaron bordes comprometidos; 18,4% no presentaron lesión histológica, que sumadas a 7,8% de LIE de bajo grado representan un 26,2% de mujeres consideradas como sobretratadas. El porcentaje a 18 meses de seguimiento en mujeres con LIE de alto grado fue de 85,5%. Necesitaron de una segunda intervención 194 pacientes (17%), 110 (9,6%) por persistencia y recidivas de la lesión. Conclusión: Los resultados presentados son satisfactorios en el porcentaje de curación de las LIE de alto grado como en el aporte al diagnóstico precoz de carcinomas del cérvix y similares a estudios publicados tanto nacionales como extranjeros.

Pancoast tumors represent a rare presentation of lung cancer. Their particular location delays diagnosis and makes resection difficult. Nevertheless recent advances in surgical techniques and multi-modality therapy (chemo-radiation followed by surgery) had increased resection rates and achieved long term survival. We present the case of a 62-year-old woman with an extensive Pancoast tumor and a synchronous hypofisiary lesion. We carried out an exhaustive staging workout determining that the infratentorial lesion was a hypofisiary adenoma. She underwent induction chemo-radiotherapy and posterior surgery. A complete resection was possible with prolonged survival and minimal functional disability. We present the evolution in management of Pancoast tumors and our approach to patients with suspicious metastases in potentially resectable tumors

Los tumores de Pancoast representan una presentación poco frecuente de los cánceres pulmonares. Su particular localización retrasa el diagnóstico y dificulta su resección. En los últimos años se han realizado importantes avances en las técnicas quirúrgicas y se ha consolidado la terapia tri-modal en el manejo de estos pacientes mejorando su sobrevida. Presentamos el caso de una mujer de 62 años con un extenso tumor de Pancoast y una lesión sincrónica hipofísiaria. Un exhaustivo estudio de diseminación permitió determinar que esta lesión era un adenoma hipofisiario. Se realizó quimio y radioterapia de inducción y posteriormente una resección completa del tumor, con una sobrevida prolongada sin secuelas funcionales. Se presenta la evolución del manejo de estos tumores y nuestra conducta en el enfrentamiento de posibles metástasis en tumores potencialmente curables

Background: Brain metastases are the most common cerebral tumors, have a poor prognosis and their incidence is five times higher than primary brain tumors. Aim: To analyze the survival of patients with the diagnosis of brain metastases, operated in our institution. Patients and methods: We retrospectively reviewed all patients operated from January 1989 to December 2001, whose pathological diagnosis confirmed the presence of cerebral metastases. The death date of each patient was obtained from the analysis of death certificates, obtained from the computerized National Registry. Results: In 46 operated patients, the date of death was determined. In 23 of them, information about primary site of malignancy, type of surgery performed and adjunctive treatment with Holocerebral Radiotherapy (Rt) was obtained. The overall median survival time of the 46 patients was 29 weeks (range 4207). Thirty percent of patients were alive one year after surgery. Among those patients with complete clinical information, the median survival of 16 patients who received postoperative Rt was 41 weeks (range 12207), compared to a survival of 18 weeks (range 872), among those that did not receive Rt (p = 0.04). Conclusions: The median survival for patients operated for cerebral metastases in our institution is 29 weeks. Those who are operated and receive Rt, have a longer survival, than those who did not receive Rt (Rev Méd Chile 2005; 133: 190-4)