Background: Aberrant immunophenotype, characterized by the expression of lineage-inappropriate antigens on leukemic blasts, is associated with early relapse and a poor survival rate in Acute Lymphoblastic Leukemia (ALL). Early relapse gives a bad prognosis for ALL. This study evaluated the association between aberrant immunophenotype and Overall Survival (OS) and Disease-Free Survival (DFS) up to 18 months following the diagnosis of ALL. Materials and Methods: A retrospective cohort study was conducted to identify aberrant immunophenotype in 156 patients under 18 years of age with ALL. In this study, done at a tertiary level hospital, OS and DFS were analyzed using the Kaplan-Meier method, the Breslow test and a Cox regression model, with hazard ratios to determine the variables associated with mortality and relapse over an 18-month follow-up period. Results: The mean age at diagnosis was 6.5 years, and 57% of the patients were male. Aberrant immunophenotype was expressed in 87 patients. After 18 months of follow-up, 41 patients had died. The CD123 antigen was mostly associated with relapses (p=0.010). CD66c and CD123 co-expression decreased OS (p=0.040) and DFS (p=0.003). The univariate analysis demonstrated that CD66c and CD123 co-expression (p=0.005), single CD123 expression (p=0.001), and positive Measurable Residual Disease (MRD) (p=0.001) increased the risk of relapse. In a multivariable analysis, only risk stratification and MRD remained as independent predictors of OS and DFS. Conclusion: CD66c and CD123 co-expression was associated with decreased OS and DFS and a higher risk of relapse. However, this association did not remain significant in the multivariate model, indicating that it is not an independent prognostic factor. Nonetheless, isolated CD123 expression was linked to positive MRD and an increased risk of relapse. These observations provide clinically relevant preliminary insights, particularly in settings with survival disparities. These require confirmation in larger cohorts with extended follow-up and integrated molecular data.
Introduction:Retroperitoneal leiomyosarcoma is a rare malignant neoplasm with insidious growth and delayed clinical presentation. Giant tumors pose major surgical challenges because of their anatomical relationships and the frequent need for multivisceral resection to achieve oncological control. Case presentation:We report the case of a 47-year-old male who presented with progressive abdominal distension and nonspecific symptoms. Imaging revealed a massive retroperitoneal tumor occupying nearly the entire abdominal cavity, with marked displacement of adjacent structures. The patient underwent exploratory laparotomy, and a complete macroscopic resection was achieved without multivisceral resection. The tumor encased a long segment of the right ureter, requiring segmental ureteral resection and urinary diversion with nephrostomy. The specimen measured 55 × 31.6 × 18 cm and weighed 19.5 kg. Histopathology confirmed a grade II retroperitoneal leiomyosarcoma with tumor at the inked peripheral surgical margins, consistent with R1 resection. Early postoperative imaging showed no macroscopic residual disease. During follow-up, recurrent tumor burden was identified approximately 3 months after surgery. The patient continued ifosfamide-based chemotherapy and subsequently showed an estimated 60% reduction in tumor size, with preserved renal function. Discussion:This case illustrates that complete macroscopic resection with organ preservation may be feasible in selected patients with giant retroperitoneal leiomyosarcoma. However, this approach is patient-specific and does not replace multivisceral resection when required for oncological clearance. Conclusion:Tumor size alone should not preclude surgical intervention. Surgical strategy should be individualized according to tumor biology, anatomical relationships, resectability, and expected functional consequences.
Trauma remains a leading global cause of morbidity and mortality, demanding an integrated understanding of biomechanics, physiological responses, surgical stabilization, and long-term functional outcomes. This review analyzes the complex continuum of trauma care by synthesizing evidence from mechanobiological models, stabilization strategies, and functional recovery data, incorporating perspectives from Mexico, Colombia, and Ecuador. Results demonstrate that injury patterns are predominantly characterized by long bone fractures and traumatic brain injury, reflecting global epidemiological trends. Early definitive fixation is more common in resource-available settings, while staged approaches are increasingly utilized where physiological instability or systemic barriers exist. Complication rates rise significantly when definitive fixation is delayed beyond 72 hours, supporting established trauma physiology frameworks such as the systemic inflammatory response and the two-hit model. Despite successful stabilization, long-term outcomes remain heterogeneous: while nearly half of patients achieve full recovery, a substantial proportion experiences persistent limitations or permanent disability. These findings emphasize that trauma care is inherently multidimensional, requiring coordinated biomechanical, surgical, physiological, and rehabilitative strategies. Strengthening trauma systems—especially rehabilitation access and physiologically guided surgical decision-making—is essential for improving outcomes across Latin America
Introduction: Death has always been, and continues to be, a subject of profound reflection and contemplation for humankind—from philosophical and religious perspectives to, more recently, scientific ones. However, in advanced industrial societies, it is increasingly difficult to live with or accept even the idea of death. Objective: To determine the attitude of family members of critically ill patients toward the risk of death in the intensive care unit of a high-specialty medical facility. Materials and Methods: A descriptive cross-sectional study was conducted in the Intensive Care Unit, including, by convenience sampling, family members of critically ill patients who agreed to participate. A structured Likert-type questionnaire was administered, assessing attitudes toward death, and sociodemographic data were collected. The results were analyzed using frequencies, proportions, measures of central tendency, and dispersion. Results: A total of 44 family members of critically ill patients participated; 15,9% were men and 84,1% women, with a mean age of 42,7 ± 15,9 years. Approach acceptance was rated as completely favorable; death avoidance, escape acceptance, and neutral acceptance were all favorable; and fear of death was completely favorable. Overall, the attitude was classified as completely favorable. Conclusions: The attitude of family members of critically ill patients toward the risk of death is favorable. The most strongly endorsed dimensions were approach acceptance, fear of death, and neutral acceptance.
Rhinoplasty is a complex and versatile surgical procedure aimed at reshaping the nose for aesthetic and functional purposes. It employs diverse techniques, primarily categorized into open and closed approaches. Open rhinoplasty, characterized by a transcolumellar incision, allows superior visualization and precise modifications, making it suitable for complex cases and revisions but carries risks such as extended nasal tip edema and scarring. Closed rhinoplasty, devoid of external incisions, offers reduced recovery times and minimal visible scarring, albeit with limited access and visibility. Minimally invasive approaches, leveraging endoscopic visualization and piezoelectric instruments, are gaining traction for their ability to minimize tissue trauma and enhance recovery. Specific grafting techniques, such as lateral crural strut grafts and tongue-in-groove modifications, optimize structural support and nasal tip aesthetics while addressing demographic and ethnic variations. Despite advancements, rhinoplasty is associated with complications, including graft resorption, scarring, nasal obstruction, and residual deformities, underscoring the need for meticulous planning and patient-specific strategies. This review highlights the significance of tailored approaches in rhinoplasty to achieve optimal functional and aesthetic outcomes while minimizing complications.
