La determinación peroperatoria de PTHi como factor predictivo de curación en el hiperparatiroidismo / Intraoperative intact parathyroid hormone determination as a predictive factor of hyperparathyroidism resolution

Introducción. Nuestros objetivos son valorar la eficacia de la determinación peroperatoria de la hormona paratiroidea intacta (PTHi) como marcador de curación del hiperparatiroidismo (HPT), establecer el número mínimo de muestras sanguíneas necesarias y comprobar si la manipulación cervical eleva la PTHi basal. Pacientes y método. Estudio prospectivo realizado con 45 pacientes. Peroperatoriamente se hicieron 3 determinaciones sanguíneas de PTHi: basal y a los 10 y 25 min de extirpar la lesión. Para analizar los efectos de la manipulación cervical, en 19 pacientes, se hicieron otras 2 determinaciones tras 2 min de masaje en ambos lados del cuello. Se aceptó como criterio diagnóstico y terapéutico el descenso > 50% del valor de PTHi entre las muestras postexeréticas y la basal (gradiente > 50) y como criterio de curación la normalización de la calcemia. Resultados. Siempre que se extirpó la causa del HPT hubo descensos de PTHi a los 10 y 25 min de la exéresis. Este descenso tuvo valor predictivo de curación cuando el gradiente fue > 50. La manipulación cervical (masaje) no produjo elevación de la cifra de PTHi. En los casos curados, también se normalizaron las cifras de la calcemia. Conclusiones. La determinación intraoperatoria de PTHi, con gradiente > 50, es un excelente indicador de curación. Sólo se precisan 2 muestras de PTHi: la basal y la extraída a los 10 min de la exéresis. La manipulación cervical preoperatoria no produjo elevación de los valores de PTHi (AU)

Introduction. The objectives of this study were: a) to evaluate the effectiveness of intraoperative intact parathyroid hormone (PTHi) determination as a marker of hyperparathyroidism resolution; b) to establish the minimum number of blood samples required; and c) to determine whether cervical manipulation increases baseline PTHi levels. Patients and method. We performed a prospective study in 45 patients. Three intraoperative blood PTHi determinations were performed: at baseline and at 10 and 25 minutes after excising the lesion. To analyze the effects of cervical manipulation, in 19 patients, 2 further determinations were made after 2 minutes of massage on both sides of the neck. A decrease of > 50% in PTHi values between postexeresis samples and the baseline sample (gradient > 50%) was used as diagnostic and therapeutic criteria and normalization of calcemia was used as a criteria for complete resolution. Results. Whenever the lesion causing hyperparathyroidism was extirpated, PTHi levels decreased at 10 and 25 minutes after exeresis. This decrease was predictive of complete resolution when the gradient was > 50. Cervical manipulation (massage) did not increase PTHi values. In patients with complete resolution, blood calcium levels also returned to normal. Conclusions. 1. Intraoperative PTHi determination with a gradient > 50 is an excellent prognostic marker of resolution. 2. Only 2 PTHi samples are required: one at baseline and another at 10 minutes after exeresis. 3. Preoperative cervical manipulation does not increase PTHi values (AU)

Mild temperature hyperthermia combined with carbogen breathing increases tumor partial pressure of oxygen (pO2) and radiosensitivity.

The partial pressure of oxygen (pO2) of FSaII tumors grown in the leg of C3H mice significantly improved when the tumors were heated by immersing the tumor-bearing legs in a water bath at 41.5 degrees C for 60 min. The tumor pO2 also substantially increased when the tumor-bearing mice breathed carbogen (95% O2:5% CO2). Additionally, mild hyperthermia followed by carbogen breathing further increased the tumor pO2 and increased radiation cytotoxicity as assessed by the in vivo/in vitro excision assay for surviving FSaII cells. It was concluded that mild hyperthermia in combination with carbogen breathing is potentially useful to reoxygenate radioresistant hypoxic cells and improve the radiotherapy of human tumors.

Graded imagination and relaxation as components of experimental desensitization: a psychophysiological evaluation.

Studied the effects of aversive imagery gradation and muscular relaxation as procedural variables within desensitization by using (pre-vs. posttreatment) peripherally cued electrodermal responsivity as the dependent-variable measure of fear. There was no evidence that experimental desensitization or any of its procedural components yielded attenuated electrodermal responsivity to the peripheral fear cue. Because this result derives from a relatively well-done study, it poses a challenge to widespread notions about the vehicle of therapeutic effects from desensitization.