125I radioactive seed localization (RSL) in surgery of cervical metastasis of thyroid cancer. / Localización con semillas radioactivas 125I (RSL) en cirugía de metástasis cervical de cáncer de tiroides.

INTRODUCTION: The aim of this work is the evaluation of usefulness of radioactive seed localization (RSL) for the detection of cervical recurrence of thyroid cancer in order to improve the surgical outcome. MATERIAL AND METHOD: Ten patients with thyroid cancer and lymph node involvement (4 naive and 6 with cervical recurrence) evidenced by ultrasound, cytology/Tg-FNAB (reoperated group) were selected for this procedure. A 125I seed was placed in the metastatic lesion using a needle guided by ultrasound. During surgery, a handheld gamma probe/portable gammacamera were used for lesion localization and excision. After removing the target tissue, it was verified that the seed was included in the excised tissue. Surgical intervention duration, lesion location, seed activity, thyroglobulin level, effective radiation dose, complications and the degree of surgical resection were analyzed. RESULTS: All the marked nodes were positive in histology. The mean duration of the ultrasound procedure was 11.4±3.4minutes. Seed was kept inside the patient, in average, during 4days (1-7) and the average surgical time was 44.7±29.1minutes. We found 21 metastatic specimens with an average diameter 13.9±6.3mm. The mean activity of the implanted seed was 71.27±21.6MBq (42.8-105) In the reoperated group, thyroglobulin level was 2.08±1.56ng/dl and decreased after surgery to 0.13±0.12ng/dl, P<.01. Only one case of transient hypoparathyroidism was found in the total group. CONCLUSIONS: The introduction of RSL in our unit has shown benefits for the patient and medical team, being a safe and effective procedure that also improves surgical programming.

[Effects of dietary phosphorus restriction on the production of 1,25(OH)2D3 (calcitriol) in patients with moderated renal failure]. / Efectos de una restricción de fósforo dietético en la producción de 1,25(OH)2D3 (calcitriol) en pacientes con insuficiencia renal moderada.

UNLABELLED: Calcitriol deficiency and phosphate retention are two main factors in the pathogenesis of renal hyperparathyroidism. In spite of normal serum levels, phosphate may have an important role even in moderate RI. The aim of this study was to evaluate the effect of dietary phosphorus restriction on serum levels of calcitriol in patients with moderate RI. We studied 21 patients (7 F/14 M); mean age 61.7 +/- 15 years old; corrected creatinine clearance 51.4 +/- 14 ml/m. Serum PTH, calcitriol 25(OH)D3, calcium, phosphorus and urinary excretion of calcium and phosphorus were measured before and after 30 days on phosphorus restricted diet (700 mg/day). RESULTS: [table: see text] CONCLUSIONS: Our patients with moderate RI have elevated serum levels of PTH while calcitriol was in the lower normal range. Dietary phosphorus restriction resulted in a significant decrease in PTH levels and a significant increase in serum calcitriol concentrations. The levels of 25(OH)D3 did not change in this study.

[Early treatment of secondary hyperparathyroidism in moderate renal insufficiency: low-phosphorus diet versus calcium carbonate]. / Tratamiento precoz del hiperparatiroidismo secundario en insuficiencia renal moderada: dieta baja en fósforo frente a carbonato cálcico.

Calcitriol deficiency and phosphorus retention are mechanisms involved in the pathogenesis of renal hyperparathyroidism. The aim of this study was to evaluate the effect of dietary phosphorus restriction versus calcium carbonate treatment for one month on PTH and calcitriol levels in patients with mild renal failure. We studied two groups of patients: Group I: 21 patients (14M/7F); mean age 61 years old; mean glomerular filtration rate 51 ml/min. Their diet contained phosphorus 700 mg/day. Group II: 30 patients (21M/9F); mean age 58; mean glomerular rate 56 ml/min. They were divided in two subgroups: 18 patients treated with calcium carbonate 2.5 g/day and 12 patients with 5 g/day. Serum PTH, calcitriol, 25(OH)D3, calcium, phosphorus and urinary excretion of calcium and phosphorus were measured before and after a 30 day period. The low phosphorus diet (Group I) resulted in a significant decrease in PTH levels (81.3 +/- 35 vs 71 +/- 39 pg/ml, p < 0.05) and significant increase in calcitriol levels (22.4 +/- 4.4 vs 33.4 +/- 7.5 pg/ml, p < 0.05). In our study calcium carbonate treatment (Group II) had no effect on PTH and calcitriol levels.

[Bilateral vocal cords paresis following iodine therapy]. / Paresia bilateral de cuerdas vocales tras tratamiento con radioiodo.

We present a case of a 33 year old man who underwent a thyroidectomy due to papillary thyroid carcinoma, with a reversible paresis of both vocal cords after radioiodine therapy. The patient had no previous lesion in laryngeal nerves. Paralysis of the vocal cords is a rare complication of the 131I administration and generally occurs more frequently when there is already some type of lesion in the recurrent laryngeal nerves. The paper reviews the literature on this type of complications.

[I-131 uptake in renal cyst: a false positive result]. / Captación de I-131 en un quiste renal: un resultado falso positivo.

We present the case of a 60-year old male with a follicular pattern of multifocal invasive papillary thyroid carcinoma who had undergone total thyroidectomy. During post-surgical follow-up with I-131 scan, a I-131 deposit was observed in the upper left hemiabdomen. Due to suspicion that it could be a metastasis, an ultrasound and CT scan were performed, with the subsequent diagnosis of a left simple serous renal cyst. Once confirmed, drainage was performed under ultrasound control, obtaining I-131 in the analysis of its content.