ABSTRACT
OBJETIVOS. Presentar las peculiaridades clínico-quirúrgicas de los adenomas ectópicos de paratiroides relacionándolas con las de los adenomas normotópicos. Determinar el valor de las pruebas diagnósticas para asegurar el éxito terapéutico. MATERIAL Y MÉTODOS. Estudio prospectivo de 158 pacientes intervenidos por hiperparatiroidismo primario (1998-2010). 83% mujeres. Edad media 62,8 años±13,7. Para el diagnóstico topográfico se usaron la gammagrafía con Tecnecio-sestaMIBI, ECO y TAC (ocasional) y para asegurar la exéresis quirúrgica, la monitorización intraoperatoria de PTH y, eventualmente en los ectópicos, la cirugía radioguiada. Se seleccionaron 15 pacientes (80% mujeres) con adenomas ectópicos y se compararon con 143 adenomas ortotópicos. Se evaluaron: sexo, edad, localización, clínica, diagnóstico bioquímico y topográfico, peso glandular, vías de abordaje quirúrgico, gradientes de descenso de PTH en la monitorización y resultados postoperatorios. Para la comparación de medias se utilizó la U de Mann-Whitney y para las variables cualitativas el test de Fisher aceptando valores de p≤0,05. RESULTADOS. Fueron ectópicos el 9,5% de los adenomas. 86,7% en paratiroides inferiores (4 mediastínicas) y 13,3% en superiores. La ectopia no modificó el comportamiento clínico de los adenomas (ambas series fueron similares). La sensibilidad diagnóstica de la gammagrafía, en los ectópicos, fue 100% y para los normotópicos 80,5%. La TAC alcanzó el 66,7%, en los ectópicos, y 48,6% en los normotópicos y la Ecografía el 36,4% y 54%, respectivamente. En el grupo de adenomas ectópicos se utilizó la cervicotomía bilateral en 12 pacientes (80%), el abordaje selectivo en 3 y la sonda radioisotópica en 4. Las glándulas ectópicas extirpadas fueron adenomas. En el grupo normotópico se eligió el abordaje selectivo en el 55%. La comparación de grupos no mostró diferencias de los parámetros evaluados, salvo en la localización de los adenomas, mayor en las paratiroides inferiores (86,7% vs 68%) (p<0,05), en la sensibilidad de la gammagrafía con MIBI, también mayor (100% vs 80,5%) (p<0,001) en el grupo de los ectópicos, y en el tipo de abordaje quirúrgico CONCLUSIONES: 1. Los adenomas ectópicos constituyeron el 9,5% y fueron más frecuentes en las glándulas inferiores (86,4%). 2. No hubo diferencias clínicas entre los ectópicos y normotópicos. 3. La gammagrafía fue la prueba más sensible (100%) para detectarlos (AU)
OBJECTIVES. To present the clinical-surgical peculiarities of ectopic parathyroid adenomas, comparing them to those of the normotopic adenomas. To determine the value of the diagnostic tests in ensuring therapeutic success. MATERIAL AND METHODS. Prospective study of 158 patients operated on for primary hyperparathyroidism (1998-2010), in which 83% were women, average age 62.8 years±13.7. For the topographic diagnostic, the gammagraph was used with Tecnecio-sestamibi, ultrasound and CAT (occasional) and to ensure the surgical exeresis, the intraoperative monitoring of PTH and, possible radio-guided surgery in the ectopic adenomas. Fifteen patients were selected (80% women) with ectopic adenomas and they were compared with 143 orthotopic adenomas. The following were evaluated: Gender, age, location, clinical symptoms, biochemical diagnosis, and topography, glandular weight, channels for surgical approach, degrees of decrease of PTH in the monitoring and postoperative results. For the comparison of means, the U of Mann-Whitney was used and the Fisher test was used for the qualitative variable, accepting values of p≤0.05. RESULT. Of the adenomas, 9.5% were found to be ectopic; 86.7% in inferior parathyroids (4 mediastinal) and 13.3% in superior parathyroids. The ectopia did not change the clinical behaviour of the adenomas (both series were similar). The diagnostic sensitivity of the gammagraphy, in the ectopic adenomas, was 100% and for the normotopic 80.5%. The CAT achieved 66.7% in the ectopic and 48.6% in the normotopic; and the ultrasound achieved 36.4% and 54%, respectively. In the group of ectopic adenomas, the bilateral cervicotomy was used on 12 patients (80%), the selective approach on 3 and the radioisotopic probe on 4. The removed ectopic glands were adenomas. In the normotopic group, the selective approach was chosen in 55%. The comparison of the groups did not show differences of the evaluated parameters, except in the location of the adenomas, greater in the inferior parathyroids (86.7% vs. 68%) (p<0.05), in the sensitivity of the gammagraph with MIBI also greater (100% vs. 80.5%) (p<0.001) in the group of ectopic adenomas, and in the type of surgical approach. CONCLUSIONS: 1. The ectopic adenomas constituted 9.5%. More frequent in the inferior glands (86.4%). 2. There were no clinical differences between the ectopic and normotopic adenomas. 3. The gammagraph was the most sensitive test (100%) for detecting them (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Hyperparathyroidism/diagnosis , Adenoma/diagnosis , Sensitivity and Specificity , Technetium Tc 99m Sestamibi , /methods , Tomography, X-Ray Computed/methods , Ultrasonography/methodsABSTRACT
OBJECTIVE: The aim of this study was to look for correlations between nuclear DNA content of colo-rectal tumors, and such clinical parameters as age, sex, location, CEA, histological grade and Duke's stages. EXPERIMENTAL DESIGN: A prospective study is carried out on surgical patients, subjected to standard criteria of radicality. Nuclear DNA content was quantified in tumoral cells by microcytophotometric techniques. PATIENTS: 106 patients with colo-rectal cancer. Patients with colonic perforation, other concomitant neoplasia, non-curative surgery or receiving adjuvant therapies were excluded from the study. Five patients died during the postoperative period and one was lost. RESULTS: Histological grade: 28% G1, 35% G2 and 37% G3. Dukes': 8% A, 40% B, 32% C and 20% D. DNA quantification has rendered 45% as euploid and 55% as aneuploid. There was no statistical correlation between ploidy and location, age, sex or CEA. However, there is a clear preponderance of euploid tumors in G1 (23 vs. 5), while the aneuploid tumors double the euploid ones (24 and 25 vs. 12 and 12) in G2 and G3. A similar result was found comparing ploidy and Dukes: euploid tumors reach 77% both in stages A and B, while they drop to 24% and 14% in stages C and D. It has also been found that euploid tumors show a longer period of survival free of recurrence. CONCLUSIONS: Evidence has been found supporting a prognostic value for tumoral DNA quantification in colo-rectal cancer. A longer follow-up is required to study absolute survival of the patients.
Subject(s)
Colonic Neoplasms/chemistry , DNA, Neoplasm/analysis , Rectal Neoplasms/chemistry , Adult , Aged , Aged, 80 and over , Colonic Neoplasms/genetics , Colonic Neoplasms/pathology , Cytophotometry , Female , Humans , Male , Microspectrophotometry , Middle Aged , Ploidies , Prognosis , Prospective Studies , Rectal Neoplasms/genetics , Rectal Neoplasms/pathologyABSTRACT
A case is presented of abdominal actinomycosis restricted to the cecum, with the appendix and terminal ileum spared. We analyze the clinical and diagnostic aspects, with their differential diagnoses, as well as medico-surgical therapeutic options.
