Vitamin D Deficiency Reduces Postthyroidectomy Protracted Hypoparathyroidism Risk. Is Gland Preconditioning Possible?

Context: Hypoparathyroidism is the most frequent complication after total thyroidectomy (PT-hypoPTH). After 1 year, most patients recover parathyroid function; however, the implicated physiologic dynamics remain unknown. Vitamin D deficiency (VDD) is the main cause of secondary hyperparathyroidism. Whether this compensatory hyperparathyroidism could influence parathyroid function recovery (PFR) in the setting of PT-hypoPTH has not been studied. Objective: This work aimed to evaluate the effect of preoperative VDD on PFR. Methods: A retrospective study was conducted with a prospectively maintained database including patients undergoing a total thyroidectomy between May 2014 and June 2019. Preoperative vitamin D (25(OH)D) less than 20 mg/mL was defined as VDD. Intact PTH less than 14 pg/mL on postoperative day 1 was defined as PT-hypoPTH. Transient PT-hypoPTH displayed PFR within the first year (early recovery: < 30 days; protracted recovery: > 30 days) whereas definite PT-hypoPTH did not. Survival analysis evaluated the effect of preoperative VDD on PFR, and a binary logistic regression model identified associated factors. Results: A total of 397 patients were identified. The observed rates of transient, protracted, and definite PT-hypoPTH were 32.9%, 15.1%, and 5.2%, respectively. Rates of VDD were higher in the early-recovery PT-hypoPTH group (55.2% vs 31.5%; P = .01). Preoperative VDD was associated with faster PFR (19 vs 35 days; P = .03) and behaved as a protective factor for protracted PT-hypoPTH (odds ratio 0.47; 95% CI, 0.25-0.881; P = .016) in the multivariable analysis. Conclusion: Preoperative VDD could act as a preconditioning factor of the parathyroid glands prior to the surgical aggression exerted against them during surgery aiding PFR. Basic research studies and prospective clinical trials are needed to explain the underlying physiological mechanisms and to provide further evidence to improve clinical management.

Digital melanoma in Caucasians: a descriptive and survival study according to sublocation.

BACKGROUND AND OBJECTIVES: Digital melanoma is an uncommon form of acral melanoma that is anatomically restricted to the finger. The aim of this study is to provide specific epidemiological and clinical information about this subtype of melanoma, as well as to identify differences in recurrence and survival depending on the anatomical sublocation. PATIENTS AND METHODS: We describe a group of 45 Caucasian patients with digital melanoma divided into three groups: nail unit melanoma (group A), finger skin melanoma (group B), and those melanomas that involve both nail and adjacent skin (group C). RESULTS: The mean tumor thickness was 4.66 mm, and the most common histological subtype is acral lentiginous melanoma. Group C was more frequent in older men and was thicker and more frequently ulcerated (P < 0.05). In addition, patients in group C developed distant metastases more frequently and had a significantly lower median disease-free survival (26.60 months) compared with group A (69.47 months) and group B (89.81 months) (P < 0.05). CONCLUSIONS: According to our results, digital melanoma limited to nail apparatus or finger skin was associated with a better prognosis, while those affecting both nail apparatus and skin showed lower melanoma-specific survival.

Scarless neck thyroidectomy using bilateral axillo-breast approach: Initial impressions after introduction in a specialized unit and a review of the literature. / Tiroidectomía sin incisión cervical por abordaje endoscópico biaxilo-biareolar. Primeras impresiones tras su introducción en una unidad especializada. Revisión de la literatura.

INTRODUCTION: The extracervical approach for thyroidectomy remains widely unknown in our country. Its main aim is to avoid a cervical scar while maintaining the same safety profile of conventional thyroidectomy. The objective is to communicate our experience after the first 15 cases using the endoscopic bilateral axillo-breast approach (BABA) and to review critical points described in literature. METHODS: Between June 2017 and June 2018, 15 endoscopic thyroidectomies were performed using the BABA extracervical approach, locating incisions in axillary folds and areolar borders. Indications were benign goiter and suspicious nodule (Bethesda 3 and 4). RESULTS: All 15 cases (12 patients) were treated using the extracervical endoscopic technique. We performed 5 total thyroidectomies, 7 hemithyroidectomies and 3 completion thyroidectomies. Mean surgical time for total thyroidectomy was 285minutes and 210minutes for hemithyroidectomy. The average hospital stay was 1.67days. With a mean follow-up of 7.73months, rates of transient and definitive hypoparathyroidism were 37% and 0%, and transient recurrent nerve palsy occurred in one case. Anterior chest paraesthesia rate was 80%, which were mild and resolved within the first month. The degree of cosmetic satisfaction is very high. CONCLUSION: Our experience with endoscopic bilateral axillo-breast approach thyroidectomy is short but satisfactory. It is a reproducible procedure that requires extensive experience in endocrine and endoscopic surgery. Extracervical approaches are an alternative for selected patients who are especially concerned about cervical scarring and are not intended to displace conventional thyroidectomy, which is the current gold standard. Our Scientific Society should explore these approaches to establish coherent indications and limitations.

Epidemiología de infecciones nosocomiales en el Instituto Jalisciense de Cancerología / Epidemiology of nosocomial infections in Instituto Jalisciense de Cancerología

Introducción: las intervenciones durante el tratamiento en el paciente oncológico, aumentan los riesgos para sufrir una infección nosocomial. En el Instituto Jalisciense de Cancerología, la prevención, identificación y seguimiento de las infecciones nosocomiales se realiza a través del programa de epidemiologia y por el Comité de Vigilancia Epidemiológica. Objetivos: determinar la incidencia de infecciones nosocomiales en pacientes oncológicos atendidos en el citado instituto. Métodos: se trata de un estudio descriptivo retrospectivo. Se tomaron en cuenta 5 056 egresos de abril de 2008 a diciembre de 2010, de los cuales 140 pacientes presentaron 178 infecciones nosocomiales. Resultados: la tasa global de infecciones por 100 egresos, fue variable (2008: 5,8; en 2009: 3,5 y en 2010: 2,2). La infección de herida quirúrgica se mantuvo con las tasas más altas (2,9; 1,5; 1,1). El germen más frecuentemente aislado fue Escherichia coli (55 %, 34 %, 20 %), el hongo más frecuente fue la Candida albicans (6 %, 7 %, 6 %). El promedio días estancia en el momento de la captación de la infección, fue de 3,3 días y en el momento del egreso fue de 17 días. La tasa de letalidad, fue de 19 por cada 100 casos, y la tasa de mortalidad 27 por cada 100 casos. Conclusiones: se observa una disminución en la tasa de infección nosocomial en los últimos años. La intervención del Servicio de Epidemiología con sus acciones dirigidas de manera específica, al manejo de las heridas quirúrgicas, es fundamental.

Background: the treatments in cancer patients increase the risk of catching nosocomial infection. In the Instituto Jalisciense de Cancerología, the prevention, identification and monitoring of nosocomial infections is carried out by the Epidemiological Surveillance Committee through an epidemiological program. Objectives: To determine the incidence of nosocomial infections in cancer patients seen at the Instituto Jalisciense de Cancerología Methods: A retrospective and descriptive study, which included 5056 patients discharged from April 2008 to December 2010, of whom 140 had nosocomial infections. Results: The overall rate of infections per 100 discharges was variable (5.8 in 2008; 3.5 in 2009 and 2.2 in 2010). The surgical wound infection kept the highest rates (2.9, 1.5, 1.1 respectively). The most common isolated bacteria was Escherichia coli (55 %, 34 %, 20 %); the most frequent fungus was Candida albicans (6 %, 7 %, 6 %). The average length of stay at the time of catching the infection was 3.3 days, and at the time of hospital discharge was 17 days. The fatality rate was 19 per 100 cases whereas the mortality rate was 27 per 100 cases. Conclusions: a decrease in the rate of nosocomial infection was observed in recent years; where the epidemiology service was the key to implementing epidemiological actions, in particular the management of surgical wounds.

[Splenic aneurism associated with a hilar arteriovenous fistula]. / Aneurisma esplénico asociado a una fístula arteriovenosa hiliar.

Splenic aneurisms are the most frequent visceral aneurisms. These aneurisms are usually asymptomatic and are diagnosed incidentally by imaging studies performed for other diseases. The clinical importance of these entities lies in the possibility of rupture, leading to high mortality. Most aneurisms are single and small-sized. The presence of an associated hilar or intrasplenic arteriovenous fistula is exceptional and is usually related to trauma, prior surgery, or infections; a congenital origin may also be involved. We present a case of intrasplenic aneurism associated with a hilar arteriovenous fistula, which was satisfactorily treated through the laparoscopic approach.

Frequency of vacA, cagA and babA2 virulence markers in Helicobacter pylori strains isolated from Mexican patients with chronic gastritis.

BACKGROUND: Helicobacter pylori has been strongly associated with chronic gastritis, peptic and duodenal ulcers, and it is a risk factor for gastric cancer. Three major virulence factors of H. pylori have been described: the vacuolating toxin (VacA), the cytotoxin-associated gene product (CagA) and the adhesion protein BabA2. Since considerable geographic diversity in the prevalence of H. pylori virulence factors has been reported, the aim of this work was to establish the H. pylori and vacA, cagA and babA2 gene status in 238 adult patients, from a marginal urban area of Mexico, with chronic gastritis. METHODS: H. pylori was identified in cultures of gastric biopsies by nested PCR. vacA and cagA genes were detected by multiplex PCR, whereas babA2 gene was identified by conventional PCR. RESULTS: H. pylori-positive biopsies were 143 (60.1%). All H. pylori strains were vacA+; 39.2% were cagA+; 13.3% were cagA+ babA2+ and 8.4% were babA2+. Mexican strains examined possessed the vacA s1, m1 (43.4%), s1, m2 (24.5%), s2, m1 (20.3%) and s2, m2 (11.9%) genotypes. CONCLUSION: These results show that the Mexican patients suffering chronic gastritis we have studied had a high incidence of infection by H. pylori. Forty four percent (63/143) of the H. pylori strains analyzed in this work may be considered as highly virulent since they possessed two or three of the virulence markers analyzed: vacA s1 cagA babA2 (9.8%, 14/143), vacA s1 babA2 (4.9%, 7/143), and vacA s1 cagA (29.4%, 42/143). However, a statistically significant correlation was not observed between vacAs1, cagA and babA2 virulence markers (chi2 test; P > 0.05).

Evaluation of a laser technique to isolate the inner cell mass of murine blastocysts.

hESCs (human embryonic stem cells) are pluripotent cells derived from the ICM (inner cell mass) of blastocysts that can be used to derive several kinds of cells of the human body for the treatment of some previously untreated diseases. In considering the future use of hESCs in regenerative medicine and cell-therapy programmes, several research centres have begun projects involving the derivation of hESC lines using spare human embryos from IVF (in vitro fertilization) cycles. In some stem-cell banks, such as ours, the law also permits us to obtain these cell lines. The low availability of spare IVF human embryos, and the low rate of success in the derivation of hESC lines, give these embryos a great research value that limits experiments with new techniques. The use of murine embryos would be a good model with which to do research to discover the best methodologies to use in order to derive new hESC lines. The aim of the present study was to evaluate a new method of isolation of the ICM and derivation of ESC lines in a murine blastocyst model using laser drilling to eliminate the trophectoderm cells and compare it with the usual control method consisting of culturing the whole murine blastocyst. We also tested the adhesion and growth of primary colonies of mESCs (murine ESCs) over two different growth surfaces, namely an MEF (inactive murine fibroblastic feeder layer) or gelatin-coated dishes, in order to achieve the best culture conditions for future derivation of human stem-cell lines for application in human transplantation.

Reacción fisiológica de la hemodilución isovolémica aguda en pacientes en edad escolar / Physiological reaction to acute isovolemic hemodilution in school-age children

La hemodilución isovolémica aguda (HIA) es un procedimiento utilizado para el ahorro de sangre homóloga en cirugía electiva. Al disminuir el hematocrito, disminuyen las resistencias periféricas totales y se incrementa el gasto cardíaco (Qt). Objetivo: El objetivo principal fue conocer la reacción fisiológica de la HIA aplicada a cirugía electiva de niños en edad escolar. Material y método: Se realizó un estudio descriptivo, longitudinal y prospectivo en niños en edad escolar que cubrían los criterios de inclusión. Se analizó el Qt y la oxigenación sistémica en cuatro fases mediante ANOVA de medidas repetidas y T pareada con una p < 0.05. Se utilizó como solución de reemplazo polimerizado de gelatina al 3.5 por ciento en una proporción de 1.5 ml/1 ml de sangre. Resultados: Se evaluaron 15 pacientes (n = 15), todos considerados como ASA I, de edad x = 11 años ± 1.25. Se realizó una flebotomía de x = 1116.67 ml ± 95.74. Se comprobó un incremento del Qt, de la PVC y de la O2ER, y una caída de las RPT, RVS y del hematocrito, observándose diferencias estadísticamente significativas durante las fases 2 y 3. La FC y PAM se mantuvieron uniformes durante todo el procedimiento. Se obtuvo un ahorro de sangre homóloga del 100 por ciento. Conclusiones: Se obtuvo una adecuada respuesta fisiológica a la HIA en los pacientes en edad escolar estudiados, por lo que se puede proponer a la HIA como una técnica alternativa de ahorro de sangre homóloga.

Microbiological control in stem cell banks: approaches to standardisation.

The transplant of cells of human origin is an increasingly complex sector of medicine which entails great opportunities for the treatment of a range of diseases. Stem cell banks should assure the quality, traceability and safety of cultures for transplantation and must implement an effective programme to prevent contamination of the final product. In donors, the presence of infectious micro-organisms, like human immunodeficiency virus, hepatitis B virus, hepatitis C virus and human T cell lymphotrophic virus, should be evaluated in addition to the possibility of other new infectious agents (e.g. transmissible spongiform encephalopathies and severe acute respiratory syndrome). The introduction of the nucleic acid amplification can avoid the window period of these viral infections. Contamination from the laboratory environment can be achieved by routine screening for bacteria, fungi, yeast and mycoplasma by European pharmacopoeia tests. Fastidious micro-organisms, and an adventitious or endogenous virus, is a well-known fact that will also have to be considered for processes involving in vitro culture of stem cells. It is also a standard part of current good practice in stem cell banks to carry out routine environmental microbiological monitoring of the cleanrooms where the cell cultures and their products are prepared. The risk of viral contamination from products of animal origin, like bovine serum and mouse fibroblasts as a "feeder layer" for the development of embryonic cell lines, should also be considered. Stem cell lines should be tested for prion particles and a virus of animal origin that assure an acceptable quality.

Mediciones hemodinámicas de la preeclampsia severa/eclampsia: ¿Es determinante su aportación para aplicar maniobras terapéuticas? / Severe pre-eclampsia/eclampsia. Hemodynamic measuring: is its contribution a determinant to apply therapeutic maneuvers?

La preeclampsia severa/eclampsia presenta cambios en el gasto cardíaco y en la oxigenación sistémica. Estas pacientes pueden cursar con fase hipodinámica o hiperdinámica, por lo que es determinante conocer objetivamente cual de estas etapas está presente. Objetivo: Utilizando el principio de Fick, determinar el estado hemodinámico, las variables del gasto cardíaco y del equilibrio del oxígeno, y realizar la estabilización prealumbramiento. Materiales y métodos: Se realizó un estudio descriptivo, prospectivo y longitudinal en pacientes portadoras de preeclampsia severa/eclampsia. Se analizaron el gasto cardíaco (Qt), la disponibilidad de O2 (DO2), el consumo de oxígeno (VO2), la tasa de extracción de O2 (O2ER) y las resistencias periféricas totales (RPT), y los valores de la presión venosa central (PVC), TAS, TAD, PAM y FC durante las tres fases siguientes: basal, la estabilización prealumbramiento y final. La terapia de estabilización se efectuó con administración de soluciones cristaloides, coloides, vasodilatadoras y sulfato de magnesio. Estas variables se analizaron mediante la prueba de ANOVA con una p< 0.05. Resultados: todas las pacientes cursaron con fase hipodinámica. Durante la terapia de prealumbramiento se observó un incremento en el Qt, DO2, VO2 y PVC en la fase de estabilización, y una disminución de las RPT estadísticamente significativa. En las variables de TAS, TAD y PAMd existió disminución, siendo más acentuada en la fase final. Los volúmenes urinarios fueron mayores de 1 ml/ka/h en la fase final. Discusión y conclusiones: Las pacientes estudiadas cursaron con fase hipodinámica con una evolución satisfactoria. Concluimos que es indispensable el conocimiento de la oxigenación sistémica para definir una terapéutica dirigida y favorecer el pronóstico en el postoperatorio inmediato.