Radioguided surgery in primary hyperparathyroidism: a review of the different available techniques. / Cirugía radioguiada en el hiperparatiroidismo primario: revisión de las diferentes técnicas disponibles.

Parathyroidectomy has evolved over the years from bilateral neck exploration to a single gland approach using minimally invasive surgery. The precise presurgical localization of the problem gland, using functional techniques, such as double-phase scintigraphy with [99mTc] Tc-MIBI including SPECT-CT and PET-CT with [18F]-Choline and morphological ones, such as ultrasound have played a crucial role in this paradigm's shift. Radioguided surgery techniques have also adapted and grown with new contributions known for their indication in other fields. Thus, we currently have a wide range of techniques that have been added to the minimally invasive radioguided parathyroidectomy with [99mTc] Tc-MIBI, which was the first on the stage and for which more experience exists. Among them, in this update, we will discuss parathyroidectomy using ultrasound-guided ROLL technique as well as with the use of 125I seeds and finally, hybrid techniques that use radiotracer and fluorescence.

[Intussusception in the adult: a rare cause of mechanical obstruction]. / Invaginación intestinal en el adulto. Una causa infrecuente de obstrucción mecánica.

Intussusception is an infrequent cause of mechanical intestinal obstruction in the adult. We present herein two clinical cases of intussusception with different etiologies. In the first case, the underlying cause was a lipoma, and in the second, it was metastasis from melanoma. In both cases the intussusception was identified through computed tomography and treatment was intestinal resection. Pathologic anatomy provided the definitive diagnosis. Etiology is diverse and it is more common for obstruction to be due to organic lesions that are malignant at the level of the colon and benign at the level of the small bowel. Currently there are more preoperative diagnoses thanks to the advances made in imaging study techniques. Intestinal resection continues to be the treatment of choice in the majority of cases, because of the high percentage of malignant lesions as the underlying cause.

Functional outcome and quality of life in victims of terrorist explosions as compared to conventional trauma.

BACKGROUND: Following trauma, the number of preventable deaths is low. Outcome should also be measured in terms of quality of life (QoL). Studies analyzing QoL in trauma patients have been published, but little is known about the long term QoL of victims of terrorist attacks. METHODS: This is a case-control study of casualties of the March 11, 2004 attacks in Madrid. Patients treated for other trauma with similar age and Injury Severity Score (ISS), served as controls. Patients were assessed using the POLO-Chart (VAS, SF-36 and TOP). RESULTS: Fifty-eight patients were included, 32 casualties admitted following the March 11, 2004 attacks and 26 controls. Both groups were comparable in age (average = 37), ISS (average = 23) and time from trauma (average = 1,770 days). Subjects demonstrated lower scores for the VAS, and the SF-36 clusters social functioning, role emotional and mental health. There was a tendency towards higher prevalence of symptoms associated to posttraumatic stress disorder (PTSD) in subjects (p = 0.056). Subjects suffered from higher residual pain in the head region (p = 0.032). Strong association was found between the presence of symptoms associated to depression, anxiety and PTSD and worse QoL (p < 0.001). CONCLUSION: Subjects present more emotional distortions, residual pain in the head region and a tendency towards a worsened perception of their own health and wellness. They also present symptoms associated to PTSD more frequently. The presence of symptoms associated to PTSD, depression or anxiety was an independent variable related to lower QoL in both groups.

Fournier's gangrene: analysis of prognostic variables in 34 patients.

INTRODUCTION: Fournier's gangrene (FG) is the necrotizing fasciitis of the perineum and genital area. The objective of this study was to assess risk factors for mortality. MATERIALS AND METHODS: We conducted an analytic and retrospective study of the patients with FG treated at our institution between 1998 and 2008. Statistical analysis was performed with the Statistical Package for Social Science for Windows, version 15.0, using the Mann-Whitney test for quantitative variables, and the chi-square and Fisher exact tests for qualitative variables, in univariate analyses. RESULTS: Of the 34 patients treated, 25 survived (74%) and 9 died (26%) with a median timing of 29 days (13, 60). Statistically significant differences were not found in age, sex and predisposing factors, except heart disease (p = 0.034). Admission laboratory parameters and severity criteria showed significant differences in serum urea (p = 0.007), potassium (p = 0.008), alkaline phosphatase (p = 0.014) and Fournier's gangrene severity index score (FGSIS) (p = 0.008). Others factors such as duration of symptoms before hospital admission, extent of body surface area, number of surgical debridements, additional surgical manoeuvers (supra-pubic catheterization or colostomy), microbiological cultures and ICU stay did not show significant differences. CONCLUSIONS: FG is a life-threatening necrotizing fasciitis with a high mortality rate. In our study, prognostic variables were heart disease, admission serum urea, potassium, alkaline phosphatase, and FGSIS. More studies are needed to validate these findings.

[Lower gastrointestinal bleeding secondary to rectal gastrointestinal stromal tumor]. / Hemorragia digestiva baja secundaria a tumor del estroma gastrointestinal rectal.

Gastrointestinal stromal tumors are the most frequent mesenchymal digestive tract neoplasms, but represent only 1 to3% of all GI tract neoplasms. We report an uncommon case of stromal rectal tumor because of its atypical location.

[Local resection and radiofrequency hepatic epithelioid hemangioendothelioma]. / Resección local y radiofrecuencia en hemangioendotelioma epitelioide hepático.

Epithelioid hemangioendothelioma is an uncommon tumor of vascular endothelial cell origin with a clinical course between hemangioma and angiosarcoma. Clinical manifestations and radiological findings are nonspecific, and histopathologic examination is required to establish a definitive diagnosis. Currently, hepatic resection or liver transplantation is the best therapeutic options. Because of its unknown biological behavior, local resection and radio-frequency ablation, although an uncommon treatment method, can be performed in the absence of extrahepatic or diffuse involvement.

Shewanella putrefaciens in a fuel-in-water emulsion from the Prestige oil spill.

Microorganisms that colonize the fuel-in-water emulsion from the Prestige spill have been compared with those from Exxon-Valdez. Both emulsions contained non-fermentative gram-negative rods but unlike Exxon-Valdez's, the Prestige's spill contained anaerobic bacteria and no fungi. Our main finding has been the identification of Shewanella putrefaciens , a bacterium promising for bioremediation.