What happens to the bone structure after normocalcemic primary hyperparathyroidism surgery?

BACKGROUND: Bone disease in primary hyperparathyroidism is a clear indication for surgical treatment. However, it is not known whether surgery benefits hypercalcemic primary hyperparathyroidism and normocalcemic primary hyperparathyroidism equally. The aim of our study was to evaluate the bone changes in patients undergoing parathyroidectomy based on the biochemical profile 1 and 2 years after surgery. METHODS: This prospective study included 87 consecutive patients diagnosed with primary hyperparathyroidism who underwent surgery between 2016 and 2018. Bone densitometry (1/3 distal radius, lumbar, and femur) and bone remodeling markers (osteocalcin, type 1 procollagen [P1NP], ß-cross-linked telopeptide of type I collagen [BCTX]) were performed preoperatively and postoperatively. Postoperative changes in bone mineral density and bone markers were compared and evaluated according to the clinical characteristics and the individual biochemical profile. RESULTS: One year after surgery, all patients showed an increase in bone mineral density at the lumbar site (mean, 0.029 g/cm2; range, 0.017-0.04; P < .001) and femur neck (mean, 0.025 g/cm2; range, 0.002-0.05; P < .001); however, there were no changes in the distal third of the radius (mean, -0.003 g/cm2; range, -0.008 to 0.002; P = NS). There were no significant differences when comparing normocalcemic primary hyperparathyroidism and hypercalcemic primary hyperparathyroidism. Serum osteocalcin (37 ± 17.41), P1NP (67.53 ± 31.81) and BCTX (0.64 ± 0.37) levels were elevated before surgery. One year after the surgery, we observed a significant decrease in P1NP (33.05 ± 13.16, P = .001), osteocalcin (15.80 ± 6.19, P = .001), and BCTX (0.26 ± 0.32, P < .001) levels. CONCLUSION: Our findings indicate that parathyroidectomy has similar benefits for normocalcemic primary hyperparathyroidism and hypercalcemic primary hyperparathyroidism in terms of bone improvement. Although the most substantial improvement occurred during the first postoperative year in both groups, we consider that studies with longer follow-up are warranted.

Appendicular pseudodiverticula and acute appendicitis. Our 12-year experience.

INTRODUCTION: the presence of diverticula and their complications in the cecal appendix is an uncommon disease. We present a series of 13 patients with this condition, and perform a review of the literature. PATIENTS AND METHOD: we carried out a retrospective study of patients undergoing appendectomy for acute appendicitis in the last twelve years in our department. The pathological examination of these episodes revealed 13 cases with a diagnosis of diverticular disease, all of them consisting of pseudodiverticula. Their clinical manifestations, laboratory results, imaging tests, and histology were analyzed, and findings were compared to those in the previous literature. RESULTS: the incidence of diverticular disease in our setting was 13 cases (0.8%) among 1634 appendectomies for acute appendicitis. Diverticulitis was found in 8 patients (61.5%), and diverticulosis (38.5%) in 5. Appendicular perforation was more common in patients with diverticular disease (53.8%) as compared to those without this condition (31.1%). CONCLUSIONS: complicated diverticular disease in the vermiform appendix of adult patients may result in insidious, recurrent manifestations that may confound preoperative diagnosis. A higher risk for appendicular perforation renders appendectomy the therapy of choice, even prophylactically when the condition is incidentally identified preoperatively.

Histopathology features of the lung in COVID-19 patients.

COVID-19 is the infectious disease caused by the recently discovered coronavirus, SARS-CoV-2, unknown before the outbreak in Wuhan, China, in December 2019. COVID-19 is a pandemic, infectious disease that has simultaneously affected many countries globally. The leading cause of dead in patients with COVID-19 is hypoxic respiratory failure from acute respiratory distress syndrome (ARDS). Diffuse alveolar damage (DAD) is the histopathological pattern commonly described in all the postmortem series up to date. DAD is divided into two phases, and depending on the length of the disease, the morphological features seen in the specimens vary. There is an acute/exudative phase, which occurs during the first week after the pulmonary injury, following by the organizing/proliferative phase. Additional features detailed include vascular thrombosis, endothelialitis and angiogenesis. Interestingly, there is an ongoing discussion about the specificity of these changes, as diffuse alveolar damage seen in other viral infections show similar features.

Extended Totally Extraperitoneal (eTEP) Approach for Ventral Hernia Repair: Initial Results. / Vía totalmente extraperitoneal extendida (eTEP) para la corrección de hernias ventrales: resultados preliminares.

INTRODUCTION: Since the first laparoscopic incisional hernia repair, several minimally invasive procedures have been developed in abdominal wall repair. In 2017, the extended totally extraperitoneal (eTEP) approach for abdominal wall repair was published. We present the results from eTEP implementation at two medical centers by one surgeon. METHODS: Prospective descriptive study of the implementation of the eTEP approach, with transversus abdominis release (TAR) when needed. The surgical technique was initiated by accessing the space between the rectus abdominis muscle and posterior rectus sheath, connecting this space with the fatty preperitoneal space at the midline and the contralateral retrorectal space. Identification and dissection of the hernia sac is performed in the created cavity. Additionally, posterior component release in a TAR fashion could be done. Finally, closure of posterior plane and linea alba is completed and mesh prosthesis is deployed along the whole dissected space. RESULTS: Forty patients underwent an eTEP procedure with 20 supraumbilical defects, 10 infraumbilical and 10 lateral hernias. Sixteen cases required a TAR technique. Mean operative time was 126minutes. Median pain reported the first postoperative day was 3 on the visual analogue scale. Median length of stay was 1 day and mean follow-up was 10 months. Only one patient developed recurrence, and two patients underwent reoperation. CONCLUSIONS: Implementation of eTEP in abdominal wall repair is safe. Preliminary outcomes of the eTEP approach in ventral hernia repair show good pain control with less hospital stay.

Metástasis esplénica secundaria a carcinoma mamario / Splenic metastasis secondary to breast cancer

INTRODUCCIÓN: Los tumores de bazo primarios o metastásicos suponen menos del 0,96% de todas las metástasis. CASO CLÍNICO: Mujer de 80 años de edad intervenida 3,5 años antes por carcinoma ductal infiltrante con tratamiento neoadyuvante. Durante el seguimiento se encontró en PET-TAC recidiva tumoral en hilio esplénico. Se realizó esplenectomía laparoscópica que fue informada como adenocarcinoma de origen mamario. DISCUSIÓN: Las metástasis esplénicas son infrecuentes, suelen manifestarse como esplenomegalia asociadas a molestias abdominales. Los tumores esplénicos malignos presentan fiebre, síndrome constitucional, derrame pleural y caquexia. El diagnóstico de metástasis esplénicas suele realizarse durante el seguimiento oncológico con tomografía computarizada (TC). El tratamiento es la resección quirúrgica, aunque no existen protocolos para el tratamiento de las metástasis esplénicas. La supervivencia tras la esplenectomía por metástasis aumenta. CONCLUSIONES: La esplenectomía ante metástasis esplénicas es el tratamiento realizado habitualmente ante estos casos

INTRODUCTION: Both primitive and metastatic splenic tumours represent less than 0.96% of all metastases. CLINICAL CASE: We report the case of an 80-year-old woman, who had undergone surgery for invasive ductal carcinoma 3.5 years previously with neoadjuvant treatment. During follow-up, PET-CT revealed tumour recurrence in the splenic hilum. Laparoscopic splenectomy was performed, which was reported as an adenocarcinoma of mammary origin. DISCUSSION: Splenic metastases are infrequent, and usually present as splenomegaly associated with abdominal discomfort. The symptoms of malignant splenic lesions are fever, constitutional syndrome, pleural effusion, and cachexia. Diagnosis of splenic metastases is usually carried out during oncological follow-up with computed tomography. Treatment is surgical resection, although there are no protocols for the treatment of splenic metastases. Survival increases after splenectomy due to metastasis. CONCLUSIONS: Splenectomy for splenic metastases is the most common treatment in these cases

Vía totalmente extraperitoneal extendida (eTEP) para la corrección de hernias ventrales: resultados preliminares / Extended Totally Extraperitoneal (eTEP) Approach for Ventral Hernia Repair: Initial Results

INTRODUCCIÓN: Desde la primera eventroplastia laparoscópica se han desarrollado múltiples procedimientos en cirugía miniinvasiva de la pared abdominal. En 2017 se publica el acceso endoscópico totalmente extraperitoneal extendido (eTEP) para la reparación abdominal. Se presentan los resultados de la implementación de la técnica en 2 centros por un único cirujano. MÉTODOS: Estudio prospectivo descriptivo de la implementación de la vía eTEP con o sin liberación de transverso (TAR) para defectos de la pared abdominal. La técnica quirúrgica se inicia con el acceso al espacio entre el músculo recto y la vaina posterior, uniendo dicho espacio con el preperitoneo de la línea media y el espacio retrorrectal contralateral. En la cavidad creada se realiza la disección y reducción del saco herniario. Se puede realizar adicionalmente una liberación posterior de componentes tipo TAR. Se realiza el cierre del peritoneo y del defecto fascial y se extiende una prótesis en el espacio definitivo. RESULTADOS: Se intervinieron 40 casos, 20 casos con defectos supraumbilicales, 10 casos infraumbilicales y 10 en la línea semilunar. Dieciséis casos asociaron TAR. El tiempo quirúrgico medio fue de 126 minutos. El dolor mediano por la escala EVA al alta fue de 3. La estancia mediana fue de un día y el seguimiento medio de 10 meses. Un caso mostró recidiva y 2 pacientes requirieron reintervención. CONCLUSIONES: La reparación de hernias primarias e incisionales abdominales mediante eTEP es segura y reproducible. Los resultados preliminares muestran buen control del dolor postoperatorio y baja estancia

INTRODUCTION: Since the first laparoscopic incisional hernia repair, several minimally invasive procedures have been developed in abdominal wall repair. In 2017, the extended totally extraperitoneal (eTEP) approach for abdominal wall repair was published. We present the results from eTEP implementation at two medical centers by one surgeon. METHODS: Prospective descriptive study of the implementation of the eTEP approach, with transversus abdominis release (TAR) when needed. The surgical technique was initiated by accessing the space between the rectus abdominis muscle and posterior rectus sheath, connecting this space with the fatty preperitoneal space at the midline and the contralateral retrorectal space. Identification and dissection of the hernia sac is performed in the created cavity. Additionally, posterior component release in a TAR fashion could be done. Finally, closure of posterior plane and linea alba is completed and mesh prosthesis is deployed along the whole dissected space. RESULTS: Forty patients underwent an eTEP procedure with 20 supraumbilical defects, 10 infraumbilical and 10 lateral hernias. Sixteen cases required a TAR technique. Mean operative time was 126 minutes. Median pain reported the first postoperative day was 3 on the visual analogue scale. Median length of stay was 1 day and mean follow-up was 10 months. Only one patient developed recurrence, and two patients underwent reoperation. CONCLUSIONS: Implementation of eTEP in abdominal wall repair is safe. Preliminary outcomes of the eTEP approach in ventral hernia repair show good pain control with less hospital stay

Comparison of different predictive tools of axillary status in breast cancer with micrometastatic sentinel node.

AIM: To compare the performance of six different nomograms and one score in the prediction of non-sentinel lymph node status in a subset of women with breast cancer and micrometastatic sentinel nodes (SN). MATERIAL AND METHODS: Twenty-five patients were included in the study. Five different nomograms not specifically designed for micrometastatic SN, one recently published nomogram specially developed for this type of patients and one score were analyzed, and the corresponding receiver operating characteristic curves were obtained. The area under the curve (AUC) was calculated, as well as the false negative and false positive results and their corresponding rates (FNR and FPR) for a cutoff of ≤10% or ≤4 points. RESULTS: The Memorial Sloan Kettering Cancer Center (MSKCC) nomogram showed the best performance in this low-risk group of patients (AUC 0.900, FPR 64%, FNR 0%), followed by the French nomogram. CONCLUSIONS: The MSKCC nomogram seems to have the highest accuracy in the identification of patients with low risk of further axillary disease in the subgroup of women with micrometastatic SN.

Los sellantes en cirugia mamaria. El sueño que no acaba de hacerse realidad / Sealants in breast cancer surgery. The dream that hasn't quite become reality

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[Fibromatosis breast in the male. Case study]. / Fibromatosis mamaria en el varón. A propósito de un caso.

BACKGROUND: mammary fibromatosis is a rare pathology. It constitutes 0.2% of breast cancers, and case in men are exceptional. The definitive diagnosis is histological. CLINICAL CASE: we report the case of a male of 52 years, diagnosed with breast fibromatosis after pathologic study of tumor in the right breast. Programmed surgery for excision with wide margins was done. We performed a mastectomy of the subcutaneous fibromatosis with a pathologic study with clear margins. The postoperative course was uncomplicated and did not require adjuvant therapy. At 6 months follow-up he remains free of disease. The treatment of choice is surgical excision with wide margins. Adjuvant treatment is controversial. CONCLUSIONS: the fibromatosis in the breast is very rare and an exceptional occurrence in men. Surgery is the definitive treatment; few results exist for adjuvant therapy.

Antecedentes: la fibromatosis mamaria es una enfermedad rara; sus casos son 0.2% de las neoplasias de mama, y en los varones es aún más rara. El diagnóstico definitivo es anatomopatológico. Caso clínico: se comunica el caso de un varón de 52 años, con diagnóstico anatomopatológico de fibromatosis mamaria posterior al estudio de un tumor en la mama derecha. Se le practicó exéresis con amplios márgenes, luego mastectomía subcutánea, con estudio histológico de fibromatosis con márgenes libres. El postoperatorio transcurrió sin complicaciones y no requirió tratamiento coadyuvante. En el seguimiento a seis meses continuaba libre de enfermedad. El tratamiento de elección es la escisión con amplios márgenes y el oncológico coadyuvante es motivo de controversia. Conclusiones: la fibromatosis en la mama es poco frecuente y su aparición en el varón excepcional. El tratamiento quirúrgico es el definitivo, no así la terapia oncológica neoadyuvante que sigue suscitando controversia.

Enfermedad de Zuska: fístula crónica mamaria infrecuente / Zuska disease: An uncommon chronic fístula of the breast

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Impact of radioguided occult lesion localization on the correct excision of malignant breast lesions: effect of histology and tumor size.

AIM: To evaluate the impact of radioguided occult lesion localization (ROLL) in the correct location and excision of malignant breast lesions, and analyze if these results are affected by the histology and tumor size. MATERIALS AND METHODS: A total of 105 patients with occult breast lesions were studied. The mean age was 55 years. An intralesional dose of 18.5 MBq of 99mTc-labeled macroaggregated human albumin (AMA) was administered using stereotaxic mammography or ultrasound. Surgical resection was carried out with the help of a gammadetector probe. In the histological study, disease-free margin was defined by a distance between the tumor lesion and the surgical margin of more than 1 mm. The possible influence of tumor histology and lesion diameter with respect to free/affected margins was analyzed. RESULTS: Correct radiotracer placement was achieved in 100/105 of the cases (95.2%). In the remaining 5 cases (4.8%), radiotracer placement was incorrect, with 2 of them being malignant lesions that were found by macroscopic inspection, and the other 3 having benign pathology. Among the malignant lesions (44 cases), correct placement of the radiotracer was achieved in 42 cases (95.5%). Of these 42 malignant lesions, in which the ROLL was correctly performed, free surgical margins were obtained in 24 cases (57.1%), while the other 18 (42.9%) had infiltrated surgical margins. The most common histological type among the malignant lesions was invasive ductal carcinoma (71.4%). The histological types with an increased frequency of infiltration of surgical margins were invasive and microinvasive cancer (94.4%). All the affected margins were in lesions greater than 10 mm, and the highest incidence was in those between 20 and 30 mm (55.5%). CONCLUSION: In our experience, the advantages of the ROLL technique are a precise localization of malignant breast lesions (95.5%) and an increased probability of a complete excision with free margins in more than one half of them. Nevertheless, special consideration should be taken when dealing with invasive and microinvasive cancers and in those exceeding 10 mm because of their higher incidence of infiltrated margins.

Tratamiento quirúrgico ambulatorio del cáncer de mama. Experiencia en el Hospital General de Ciudad Real / Breast cancer ambulatory surgery. Experience at General Hospital in Ciudad Real

Objetivo. Describir la casuística de pacientes con diagnóstico de cáncer de mama intervenidas en el Hospital General Universitario de Ciudad Real mediante un programa de cirugía mayor ambulatoria (CMA). Pacientes y método. Estudio descriptivo retrospectivo donde se presenta la serie de pacientes del Hospital General de Ciudad Real con diagnóstico de cáncer de mama e intervenidas quirúrgicamente en el periodo comprendido entre el 1 de enero de 2010 y el 1 de febrero de 2011. Resultados. Se intervinieron un total de 130 pacientes; de ellas, un 20% se consideraron larga estancia, un 32,3% corta estancia y un 47,7%, CMA. En el 69,4% de los casos, las técnicas quirúrgicas más asociadas a CMA fueron cirugías conservadoras. Conclusiones. La cirugía del cáncer de mama es factible en programas de cirugía mayor ambulatoria, con criterios establecidos de selección de pacientes. Las técnicas conservadoras fueron las más empleadas en nuestro programa (AU)

Objective. To describe the series of patients diagnosed with breast cancer that went to the operation room in the Ambulatory Surgery Program in the University General Hospital of Ciudad Real. Patients and methods. Retrospective descriptive study of patients diagnosed of breast cancer in University General Hospital of Ciudad Real and had been operated between 01-01-2010 to 01-02-2011. Results. 130 patients were analyzed. 20% were considered long stay more than 72 hours, 32,3% were short stay and 47,7% were ambulatory surgery. Conservative surgery were performed in 69,4% of all the cases included. Conclusion. Breast cancer surgery is feasible in ambulatory surgery programs with patients selection criteria. Conservative techniques were the most common surgery in our program (AU)

Necrosis mamaria bilateral por acenocumarol / Acenocoumarol-induced bilateral breast necrosis

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Uso del lipofilling en la mejora de los resultados de la cirugía de la mama. Nuestra experiencia / Use of lipofilling to improve the results of breast surgery: our experience

Objetivos. Presentar nuestra serie de pacientes en los que se ha llevado a cabo la técnica de lipofilling en el Hospital General Universitario de Ciudad Real. Material y métodos. Estudio descriptivo, retrospectivo de una serie de pacientes intervenidas quirúrgicamente por cáncer de mama y candidatas a reconstrucción mamaria mediante injerto autógeno de grasa, en el período de tiempo comprendido entre 2010 y 2012. Las variables analizadas fueron: edad, primera intervención quirúrgica realizada, tratamiento adyuvante, peso medio de grasa injertada, tiempo medio operatorio, tiempo de hospitalización, así como complicaciones a corto (en los primeros 7 días) y largo plazo (pasados los primeros 7 días). Resultados. Nuestra serie consta de un total de 40 pacientes mujeres, con una edad media de 44,9 años (40-54). El tiempo medio de hospitalización fue de 23 h, sin complicaciones a corto ni a largo plazo. Quince (37,5%) pacientes han referido pérdida de volumen con hundimiento del lecho quirúrgico durante el seguimiento. Seis casos se han sometido de nuevo al procedimiento. Conclusión. En nuestra experiencia durante 2 años, el autotrasplante de grasa puede ser una técnica conveniente que permita la regeneración de áreas afectadas, proporcionando elasticidad a los tejidos en pacientes con defectos estéticos tras cáncer de mama. En una tercera parte de las pacientes hubo pérdida de volumen durante el seguimiento (AU)

Objectives. To present our series of patients who underwent the lipofilling technique in the University General Hospital of Ciudad Real (Spain). Material and methods. A descriptive, retrospective study was carried out in series of patients who underwent surgery for breast cancer and who were candidates for breast reconstruction using autologous fat graft between 2010 and 2012. The variables analyzed were age, first surgery performed, adjuvant treatment, mean weight of grafted fat, mean operating time, length of hospital stay, and complications in the short-term (within 7 days) and long-term (past 7 days). Results. Our series consisted of 40 women with a mean age of 44.9 years (40-54). The mean length of hospital stay was 23 h without complications in the short- or long-term. Fifteen (37.5%) patients reported sinking volume loss. In 6 patients, the procedure was repeated. Conclusion. In our 2-year experience, autologous fat can be a useful technique to allow regeneration of affected areas, providing elasticity to tissues in patients with cosmetic defects after breast cancer. One-third of the patients experienced a loss of volume during follow-up (AU)

Histiocitoma fibroso maligno. Un sarcoma excepcional en la glándula mamaria / Malignant fibrous histiocytoma. An exceptional sarcoma in the mammary gland

Introducción. El histiocitoma fibroso maligno constituye la neoplasia sarcomatosa más frecuente en los adultos, pero la mama es una localización excepcional. Presentamos el caso de una mujer que comenzó con una tumoración de crecimiento progresivo en la mama derecha. Caso clínico. Mujer de 68 años que consulta por autopalpación de un nódulo en la mama derecha que ha crecido de forma progresiva en los últimos meses. La mamografía y la ecografía muestran una imagen nodular con bordes bien definidos, situada en intercuadrantes superiores de mama derecha, sin adenopatías axilares. Se decidió intervención quirúrgica y el estudio histológico definitivo fue informado como neoformación mesenquimal fusocelular con patrón estoriforme. El estudio inmunohistoquímico fue compatible con un histiocitoma fibroso maligno. Conclusión. Es primordial el diagnóstico diferencial de esta entidad clínica debido a la variabilidad histológica de los tumores sarcomatosos. Sus características clínicas y radiológicas pueden hacerlo pasar desapercibido, pero su comportamiento agresivo hace necesario un diagnóstico precoz, lo cual permitirá un tratamiento adecuado para lograr el aumento en la supervivencia(AU)

Introduction. Malignant fibrous histiocytoma is the most common sarcomatous neoplasm in adults. Localization in the breast, however, is exceptional. We report the case of a woman who presented with progressive tumoral growth in the right breast. Case report. A 68-year-old woman consulted for a self-palpated nodule in the right breast that had grown steadily in the last few months. Mammography and ultrasound showed a nodule with well-defined borders, located in the upper inner quadrant of the right breast. There was no axillary lymphadenopathy. Surgery was performed and the histological examination gave a definitive diagnosis of mesenchymal spindle cell neoplasm with storiform pattern. Immunohistochemical analysis was compatible with a diagnosis of malignant fibrous histiocytoma. Conclusion. Due to the histological variability of sarcomatous tumors, differential diagnosis is paramount in malignant fibrous histiocytoma. Because of their clinical and radiological features, malignant fibrous histiocytoma can be overlooked. Because these tumors are aggressive, an early diagnosis is essential to allow appropriate treatment and to increase survival(AU)

Neumoperitoneo, neumomediastino y enfisema cervical subcutáneo tras colonoscopia / Pneumoperitoneum, pneumomediastinum and subcutaneous cervical emphysema after colonoscopy

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