Relation between the bowel electromyogram and the intestinal pressure wave. An experimental study in dogs.

OBJECTIVE: A linear regression study is made of the parameters identifying the electrical activity of the small bowel, with the aim of determining those variables most closely related to the type I pressure waves. PATIENTS AND METHODS: A computer system was used for the simultaneous and real time acquisition of the manometric activity (using microballoons implanted in the bowel mucosa) and electromyogram of the intestine (employing bipolar electrodes implanted in the intestinal serosa) in dogs. RESULTS: Of the electromyogram intestinal parameters studied, those determining signal energy (root mean square voltage and energy) yielded the highest correlation coefficients (0.71 +/- 0.08 in the jejunum and 0.78 +/- 0.06 in the duodenum) to bowel pressure. Peak-to-peak voltage also shows good correlation, though to a lesser degree. The rest of the parameters studied, such as those that measure the duration of the action potential or its number of peaks, yielded poor correlations to pressure. CONCLUSIONS: It is concluded that the energy of the intestinal electromyogram represents the mechanical activity of the small bowel, reflecting intestinal motility, and that the recording of this parameter is not subjected to subjective cutoff values or threshold levels. On the other hand, and unlike in the case of manometric recordings, the signal obtained is free of background interference and noise.

[Unusual metastasis of differentiated thyroid carcinoma]. / Metástasis poco habituales del carcinoma diferenciado de tiroides.

Distant metastases of differentiated thyroid cancer are usually localised in the lung and bone; less common sites of metastases are the brain, liver, and skin. To find it in other sites it is exceptional. This work shows the clinical, histological and therapeutical characteristic of primary tumour in three cases of non-typical distant metastases of differentiated thyroid cancer. Follicular thyroid carcinoma was displayed in two cases, the first presented one metastases in right adrenal gland and the second in left kidney. Both cases were initially treated only with hemithyroidectomy, without posterior radioiodine. In one case, elevated serum thyroglobulin did not receive radioiodine treatment because Whole-Body Scintigraphy was negative. The thirst case was a papillary thyroid carcinoma treated with total thyroidectomy, ablative radioiodine and suppressor therapy with levothyroxine. However, posterior evolution was unfavourable and tumour presented metastases in common and less common sites like choroid. Histological study showed tall cell variant of papillary thyroid carcinoma. In summary, when the initial treatment of well-differentiated thyroid carcinoma it is inaccurate, it is possible to find common and less common sites metastases. Some variants of papillary thyroid carcinoma, like tall cell, have a worse prognosis and they can present metastases in less common sites.

The optimal age for performing surgery on patients with MEN 2B syndrome.

Multiple endocrine neoplasia (MEN) syndromes are characterized by the association of various endocrine neoplasias. Prophylactic thyroidectomy is the treatment of choice for patients with RET gene mutations. The age at which patients undergo prophylactic thyroidectomy may vary depending on the position of the RET gene codon. In cases of MEN 2B, when the mutation is carried in codons 883, 918 or 922, prophylactic thyroidectomy is performed prior to 6 months of age, due to the increased aggressiveness of these heterozygosities, which are capable of determining the onset of medullary cancer during the first months of life. We present two heterozygous twin patients with MEN 2B syndrome who were born 32 weeks premature, and who underwent prophylactic thyroidectomy at 7 months of age. The patients were carriers of the mutation at codon 918. We suggested the early surgery at 7 months as, due to their prematurity, the patients were required to gain weight to improve their condition prior to surgery. The two patients had medullary thyroid carcinoma without lymph node involvement. In conclusion, for a truly prophylactic thyroidectomy, such patients should undergo surgery within the first month of life, particularly if these patients are carriers of the mutation in codons 883, 918 or 922.