Use of a gamma probe to identify and guide resection of recurrent parathyroid carcinoma: report of a case.

Parathyroid carcinoma (PC) accounts for less than 0.005% of all cancers and less than 5% of causes of hyperparathyroidism. This tumor is difficult to identify during surgery, which is detrimental to the oncologic results. Surgery is still the main treatment for the primary tumor and to control parathyroid hormone levels after recurrence. We report a case of recurrent parathyroid carcinoma in a 30-year-old man, identified and managed with the use of a gamma probe during surgery. To our knowledge, this is only the second report of a gamma probe being used to guide resection of a recurrent PC. We discuss the diagnosis and treatment, analyzing the current evidence-based literature.

Predictors of outcome in children and adolescents with overactive bladder treated with parasacral transcutaneous electrical nerve stimulation.

BACKGROUND: Parasacral transcutaneous electrical nerve stimulation (TENS) has emerged as an effective treatment for overactive bladder (OAB) in view of its high success rates in improving lower urinary tract symptoms and constipation, with no direct side effects. However, the clinical characteristics associated with the outcomes remain to be established. OBJECTIVE: The aim of this study was to evaluate potential predictors of outcome in children with OAB treated using parasacral TENS. STUDY DESIGN: This was a prospective study of children with symptoms of isolated OAB, enrolled consecutively to the study and treated with parasacral TENS (figure). Isolated OAB was defined as the presence of urinary urgency with no signs of dysfunctional voiding. The symptoms were considered completely resolved when a patient's parents/guardians or the patients themselves reported a 100% improvement. Parasacral TENS was performed twice weekly for a total of 20 sessions of 20 min each at 10 Hz. The potential predictive factors evaluated were: sex, age, daytime incontinence, nocturia, a prior history of urinary tract infection, the presence of nocturnal enuresis, constipation and holding maneuvers. RESULTS: Eighty-three patients with a mean age of 7.8 ± 2.8 years were included in the study. Complete resolution of symptoms was achieved in 47 (56.6%). Following parasacral TENS treatment, a significant response was reported in 96.4% of cases. Of the 55 patients with nocturnal enuresis, partial resolution was achieved in 30 cases (54.5%), with a statistically significant association between nocturnal enuresis and the patient's response to treatment (p < 0.004; OR = 4.4, 95% CI 1.5-12.5). No other factor was associated with response to treatment. DISCUSSION: To the best of our knowledge, this association between nocturnal enuresis and failure to respond to parasacral TENS treatment for lower urinary tract dysfunction has not previously been reported. The identification of factors capable of predicting therapeutic failure may allow professionals to select those specific patients who would benefit from a multimodal approach in the treatment of this pathology, which has such a significant impact on the quality of life of affected patients. CONCLUSIONS: Nocturnal enuresis was the only symptom associated with a poor outcome following parasacral TENS treatment in children with OAB.

Decreased hyperlocomotion induced by MK-801, but not amphetamine and caffeine in mice lacking cellular prion protein (PrP(C)).

The cellular prion protein (PrP(C)) has been involved in several neurodegenerative disorders however it has been proposed that it is also be implicated in psychotic disorders. We investigated the effect of three psychotropic drugs in locomotor activity of PrP(C) knockout (Prnp(O/O)) and wild-type mice. The NMDA receptor channel blocker MK-801 (0.25 mg/kg), the indirect dopamine agonist amphetamine (1 mg/kg) and the adenosine receptor antagonist caffeine (10 mg/kg) were administered i.p. after 60 min of habituation and locomotion was monitored for 3 h. Prnp(O/O) mice presented a diminished hyperlocomotor response to MK-801 treatment but normal response to amphetamine and caffeine compared to wild type mice. These results suggest that lack of PrP(C) leads to a functional alteration in the glutamatergic system, whereas the regulation of both dopaminergic and adenosinergic systems are preserved. Finally, lack of PrP(C) seems not to exacerbate the response to these psychotropic drugs, which modulate neurotransmitter systems possibly involved in schizophrenia and psychotic disorders.

Chronic treatment with caffeine blunts the hyperlocomotor but not cognitive effects of the N-methyl-D-aspartate receptor antagonist MK-801 in mice.

RATIONALE: Administration of N-methyl- d-aspartate (NMDA) receptor antagonists produce hyperlocomotion and cognitive deficits in rodents. Activation of NMDA receptors promotes adenosine release, and adenosine agonists prevent central effects of NMDA receptor antagonists. We hypothesized that if NMDA receptor antagonists require adenosine to produce behavioral effects, mice tolerant to the adenosine receptor antagonist caffeine would have a diminished response to NMDA receptor antagonists. OBJECTIVES: To evaluate MK-801-induced hyperlocomotion and cognitive deficits after chronic caffeine treatment in mice. METHODS: Locomotor activity was analyzed in a computerized system, spontaneous alternation was assessed in the Y-maze and long-term memory was assessed with the inhibitory avoidance task in mice. RESULTS: Mice chronically treated with caffeine in drinking solution (1 mg/ml for 7 days) presented normal habituation and substantial tolerance to acute caffeine (30 mg/kg, i.p.) locomotor effects. MK-801 (0.25 mg/kg, i.p.) produced pronounced hyperlocomotion in water-treated mice, but this effect was abolished in caffeine-drinking mice. Chronic caffeine treatment had no influence on either normal or MK-801-induced deficits in spontaneous alternation and inhibitory avoidance tasks. CONCLUSION: Hyperlocomotion induced by MK-801 may be mediated by reduced adenosinergic activity. These results also suggest that locomotor and cognitive effects of MK-801 can be dissociated and are distinctly modulated. Finally, these findings agree with the adenosine hypofunction model of schizophrenia, since NMDA receptor antagonists are a pharmacological model for this disorder.

Beta-amyloid treatment sensitizes mice to amphetamine-induced locomotion but reduces response to caffeine.

BACKGROUND: Psychosis frequently occurs in Alzheimer's disease (AD), being associated with more severe cognitive decline, but the underlying mechanisms are unknown. OBJECTIVE: To investigate the effect of centrally administered beta-amyloid peptide, a model for AD, in the locomotor response to amphetamine, caffeine and MK-801, which are psychoactive drugs related to neurochemical changes occurring in psychosis. METHODS: Mice were intracerebroventricularly injected with beta-amyloid (25-35), and after 1 week they were tested in the passive avoidance, spontaneous alternation and locomotor tasks. RESULTS: Besides impaired performance in inhibitory avoidance and spontaneous alternation tasks, beta-amyloid-treated mice showed increased spontaneous locomotion, augmented response to amphetamine (1.5 mg/kg), blunted response to caffeine (30 mg/kg) and no difference in MK-801 (0.25 mg/kg)-induced locomotor activation when compared to its respective control. CONCLUSION: These results are compatible with the hypothesis that beta-amyloid peptide may predispose to psychotic symptoms of AD by increasing sensitivity of the dopaminergic system, possibly related to a decreased adenosinergic inhibitory tone.

Effect of riluzole on MK-801 and amphetamine-induced hyperlocomotion.

N-methyl-D aspartate (NMDA) antagonists, such as MK-801, and the dopamine indirect agonist amphetamine are pharmacological models used for the evaluation of putative new treatments for schizophrenia. Since the psychotomimetic effects of NMDA antagonists have recently been linked to their ability to increase glutamate release and since the glutamate release inhibitor riluzole prevented NMDA antagonist neurotoxicity, we evaluated the effect of riluzole on hyperlocomotion induced by MK-801 (0.25 mg/kg) and amphetamine (2.5 mg/kg). Mice pretreated with riluzole (3 mg/kg) did not influence baseline or MK-801-induced behavior, but 10 mg/kg produced moderate hypolocomotion alone and somewhat prolonged MK-801-induced hyperlocomotion. Pretreatment with riluzole 10 mg/kg, but not 3 mg/kg, had a moderately depressant effect both on spontaneous and amphetamine-induced locomotion. Taken together, these results suggest that riluzole would not be particularly effective as a treatment for schizophrenia and the neurotoxic and behavioral effect of NMDA antagonists do not clearly correlate.

Linfadenectomia ampliada (D2) no tratamento do carcinoma gástrico: análise das complicações pós-operatórias / Extended lymphadenectomy (D2) in the treatment for gastric cancer: analysis of postoperative complications

OBJETIVO: Descrever e analisar as principais complicações pós-operatórias e mortalidade dos pacientes submetidos à ressecção gástrica por câncer gástrico com linfadenectomia D2. MÉTODO: Foi realizada uma coorte histórica onde as principais variáveis em estudo foram: idade, localização do tumor, estadiamento, complicações do procedimento cirúrgico, padrão de recidiva tumoral, análise da sobrevida livre de doença e sobrevida total. RESULTADOS: Foram avaliados 35 pacientes submetidos à dissecção linfonodal D2 no período de Janeiro de 2000 a Dezembro de 2004. A média de idade foi 57 anos. Apenas um (2,9 por cento) paciente apresentava tumor precoce e o local mais comum do tumor foi no terço médio do estômago. O número de linfonodos ressecados por paciente variou de 15 a 80 linfonodos (média 28,8). Vinte e seis (74,3 por cento) pacientes apresentaram linfonodos metastáticos, sendo a média de 13,4 (±11,8) linfonodos comprometidos por paciente. Seis (17,1 por cento) pacientes apresentaram complicações no período pós-operatório, sendo duas pneumonias, uma fístula pancreática, uma fístula do coto duodenal e duas deiscências da anastomose esôfago-jejunal. Apenas um (2,86 por cento) paciente morreu devido a complicações operatórias. O tempo de seguimento médio foi de 26 meses. Vinte e dois pacientes apresentavam-se vivos no fechamento do estudo, com uma sobrevida atuarial de 62,9 por cento. CONCLUSÃO: Os resultados deste estudo sugerem que, em centros especializados, a linfadenectomia D2 é um procedimento com nível de complicações aceitável e pode ser realizada sem aumento da mortalidade operatória.

BACKGROUND: The aim of this study was to describe and analyze the postoperative complications and the survival of patients submitted to gastric resection with extended lymphadenectomy. METHODS: In a historical cohort, data of patients with gastric carcinoma submitted to D2 lymphadenectomy were studied. The main variables analyzed were: age, tumor location, stage, surgical procedure complications, pattern of tumor recurrence and overall survival. RESULTS: Thirty-five patients were studied during the period between January 2000 and December 2004. Mean age of the patients was 57 years. Only one (2.9 percent) patient had early gastric cancer. The most common site was in the middle-third of the stomach. The number of resected nodes per patient ranged from 15 to 80 (mean of 28.8). Twenty-six (74.3 percent) patients had metastatic lymph nodes, with mean of 13.4 (±11.8) positive nodes per patient. Six (17.1 percent) patients had complications in the postoperative period, including two pneumonias, one pancreatic fistula, one duodenal stump fistula, and two esophagojejunal leakage. Only one (2.86 percent) patient died of operative complications. The meantime of follow-up was 26 months. Twenty-two patients were alive at the conclusion of the study, with a current actuarial survival of 62.9 percent. CONCLUSION: The results of this study suggest that, in specialized centers, gastrectomy with D2 lymphadenectomy is a procedure with acceptable levels of complications, and can be performed without increasing the postoperative mortality.