Intususcepción ileocólica en el adulto como presentación de un linfoma no Hodgkin de intestino delgado / Ileocolic Intussusception in Adults due to Small-Bowel Non-Hodgkin's Lymphoma

La intususcepción intestinal, definida como la penetración de un segmento intestinal en otro adyacente, es una causa infrecuente de obstrucción intestinal en el adulto. El objetivo de este trabajo es presentar el caso de un paciente adulto con intususcepción ileocólica como presentación de un linfoma no Hodgkin de intestino delgado. Este paciente presenta una causa poco frecuente de intususcepción intestinal. Dada lo inespecífico de la clínica, el diagnóstico etiológico suele ser intraoperatorio, precisando resección de la lesión causante y, en el caso de nuestro paciente, quimioterapia adyuvante(AU)

Intestinal intussusception, defined as penetration of an intestinal segment into an adjacent, is a rare cause of intestinal obstruction in adults. The aim of this paper is to present the case of an adult patient with ileocolic intussusception as presenting a non-Hodgkin lymphoma of the small intestine. This patient has a rare cause of intestinal intussusception. Because of its non-specific clinical, etiologic diagnosis is usually intraoperative, requiring resection of the culprit lesion and, in the case of our patient, adjuvant chemotherapy(AU)

[Modifications in intact parathyroid hormone, total serum calcium, and ionized calcium levels in the surgery of primary hyperparathyroidism for single adenoma]. / Modificaciones de paratirina intacta, calcio sérico total y calcio ionizado en la cirugía por hiperparatiroidismo primario por adenoma único.

INTRODUCTION: We evaluated total serum calcium (TSC) and ionized calcium (IC) and their correlation with intraoperative intact parathyroid hormone (iPTH) in the surgery of primary hyperparathyroidism in patients with a single adenoma. MATERIAL AND METHOD: We performed a prospective, blind trial with determination of iPHT, TSC and IC in a cohort of surgical patients (n = 279; 244 were valid for the study) who underwent surgery in the Department of Surgery, Hospital de Cruces, between October 1999 and April 2006. Total calcium, ionic calcium and iPTH were measured in the outpatient department, on admission and intraoperatively (at anesthesia induction and every 5 minutes after surgical excision). RESULTS: Levels of calcium and iPTH were corrected in 234 (95.9%) patients. iPTH decreased from abnormal preoperative values of 294.43 +/- 286.38 pg/ml to 97.89 +/- 121.01 mg/dl (minute 5), 58.58 +/- 58.37 pg/ml (minute 10), 44.62 +/- 54.77 pg/ml (minute 15), and 38.42 +/- 51.72 pg/ml (minute 20). TSC decreased from preoperative values of 10.93 +/- 1.04 mg/dl to 10.2 +/- 0.97 mg/dl (minute 5), 10.17 +/- 1.00 mg/dl (minute 10), 10.12 +/- 0.98 mg/ml (minute 15), and 10.09 +/- 1.03 mg/ml (minute 20). The results for ionized calcium were as follows: 4.90 +/- 0.63 mg/dl at induction, 4.84 +/- 0.61 mg/dl (minute 5), 4.84 +/- 0.66 mg/dl (minute 10), 4.82 +/- 0.63 mg/dl (minute 15), and 4.82 +/- 0.63 mg/dl (minute 20). Frozen samples were conclusive for parathyroid tissue (19.56 +/- 15.3 after excision). CONCLUSIONS: Intraoperative total calcium levels may help to predict adequate elimination of parathyroid tissue in primary hyperparathyroidism when intraoperative iPTH is not available. Ionized calcium levels did not show the same decrease.

Modificaciones de paratirina intacta, calcio sérico total y calcio ionizado en la cirugía por hiperparatiroidismo primario por adenoma único / Modifications in intact parathyroid hormone, total serum calcium, and ionized calcium levels in the surgery of primary hyperparathyroidism for single adenoma

Introducción. Evaluamos el calcio total en suero (CTS) y el calcio ionizado (CI) y su correlación con la paratirina intacta (iPTH) intraoperatoria en la cirugía del hiperparatiroidismo primario seleccionando los casos que correspondieron a adenoma único. Material y método. Ensayo prospectivo, determinando (iPTH, CTS y CI) y con enmascaramiento en una cohorte de pacientes quirúrgicos (n = 279; 244 válidos para el estudio) que fueron intervenidos en el Departamento de Cirugía del Hospital de Cruces (octubre de 1999 a abril de 2006). Se valoró: CTS, CI e iPTH medida en consulta, en admisión e intraoperatoriamente: inducción anestésica, y cada 5 min tras la exéresis quirúrgica. Resultados. Se logró corregir las concentraciones de calcio e iPTH en 234 (95,9%) pacientes. La iPTH descendió de valores patológicos preoperatorios 294,43 ± 286,38 pg/ml a 97,89 ± 121,01 mg/dl (minuto 5), 58,58 ± 58,37 pg/ml (minuto 10), 44,62 ± 54,77 pg/ml (minuto 15) y 38,42 ± 51,72 pg/ml (minuto 20). El CTS descendió de valores preoperatorios: 10,93 ± 1,04 mg/dl a 10,2 ± 0,97 mg/dl (minuto 5), 10,17 ± 1,00 mg/dl (minuto 10), 10,12 ± 0,98 mg/ml (minuto 15) y 10,09 ± 1,03 mg/ml (minuto 20). El CI ofreció los siguientes resultados: de 4,90 ± 0,63 mg/dl en tiempo de inducción a 4,84 ± 0,61 mg/dl (minuto 5), 4,84 ± 0,66 mg/dl (minuto 10), 4,82 ± 0,63 mg/dl (minuto 15) y 4,82 ± 0,63 mg/dl (minuto 20). Las muestras congeladas fueron concluyentes para tejido paratiroideo (19,56 ± 15,3 tras la exéresis). Conclusiones. La determinación intraoperatoria de CT puede ser de ayuda para predecir la eliminación adecuada de tejido paratiroideo en el hiperparatiroidismo primario cuando no sea posible la determinación intraoperatoria de iPTH. El CI no muestra la misma pauta de descenso (AU)

Introduction. We evaluated total serum calcium (TSC) and ionized calcium (IC) and their correlation with intraoperative intact parathyroid hormone (iPTH) in the surgery of primary hyperparathyroidism in patients with a single adenoma. Material and method. We performed a prospective, blind trial with determination of iPHT, TSC and IC in a cohort of surgical patients (n = 279; 244 were valid for the study) who underwent surgery in the Department of Surgery, Hospital de Cruces, between October 1999 and April 2006. Total calcium, ionic calcium and iPTH were measured in the outpatient department, on admission and intraoperatively (at anesthesia induction and every 5 minutes after surgical excision). Results. Levels of calcium and iPTH were corrected in 234 (95.9%) patients. iPTH decreased from abnormal preoperative values of 294.43 ± 286.38 pg/ml to 97.89 ± 121.01 mg/dl (minute 5), 58.58 ± 58.37 pg/ml (minute 10), 44.62 ± 54.77 pg/ml (minute 15), and 38.42 ± 51.72 pg/ml (minute 20). TSC decreased from preoperative values of 10.93 ± 1.04 mg/dl to 10.2 ± 0.97 mg/dl (minute 5), 10.17 ± 1.00 mg/dl (minute 10), 10.12 ± 0.98 mg/ml (minute 15), and 10.09 ± 1.03 mg/ml (minute 20).The results for ionized calcium were as follows: 4.90 ± 0.63 mg/dl at induction, 4.84 ± 0.61 mg/dl (minute 5), 4.84 ± 0.66 mg/dl (minute 10), 4.82 ± 0.63 mg/dl (minute 15), and 4.82 ± 0.63 mg/dl (minute 20). Frozen samples were conclusive for parathyroid tissue (19.56 ± 15.3 after excision). Conclusions. Intraoperative total calcium levels may help to predict adequate elimination of parathyroid tissue in primary hyperparathyroidism when intraoperative iPTH is not available. Ionized calcium levels did not show the same decrease (AU)