Preoperative matching studies in the diagnosis of parathyroid adenoma for primary hyperparathyroidism: Can we avoid intraoperative PTH monitoring?

INTRODUCTION: We aim to determine the utility of intraoperative parathyroid hormone (IOPTH) monitoring in patients with matching preoperative ultrasound and mibi SPECT for primary hyperparathyroidism for a single adenoma. METHODS: All patients who underwent minimally invasive parathyroidectomy (MIP) for pseudohypoparathyroidism (PHP) for a single parathyroid adenoma, were included. An Ultrasound and mibi SPECT were performed in all patients. We defined matching studies when both coincided in the localization of the adenoma. IOPTH was performed in all patients and analyzed in three occasions: a baseline measurement at the anesthetic induction, immediately before, and 15 min after gland excision. Success was defined during the third measurement as a drop of IOPTH of at least 50% compared to the previous maximum value after gland excision. Demographics, intraoperative, postoperative variables and the utility of IOPTH monitoring were analyzed. RESULTS: A total of 218 MIP were performed. The average age was 60.1 years and 85% were female. Preoperative ultrasound and mibi SPECT coincided 100%. When the adenoma was localized, 15 min after its excision, IOPTH did not decrease in 9 patients (4.2%. OR 1.9%-7.69%); all of them underwent a bilateral neck exploration. The added-value of IOPTH accuracy for disease cure was 3.6%. There was a 99% of cure rate. The mean surgical time was 66.4 min and the waiting time for the third IOPTH result was 31 min. Performing IOPTH monitoring made the surgery about twice more expensive. CONCLUSIONS: Preoperative matching ultrasound and mibi SPECT for parathyroid adenoma localization in PHP, could avoid IOPTH monitoring in minimally invasive parathyroidectomies.

Preoperative matching studies in the diagnosis of parathyroid adenoma for primary hyperparathyroidism: Can we avoid intraoperative PTH monitoring? / Estudios preoperatorios coincidentes para el diagnóstico de hiperparatiroidismo primario por adenoma simple: ¿podemos evitar la PTH intraoperatoria?

INTRODUCTION: We aim to determine the utility of intraoperative parathyroid hormone (IOPTH) monitoring in patients with matching preoperative ultrasound and mibi SPECT for primary hyperparathyroidism for a single adenoma. METHODS: All patients who underwent minimally invasive parathyroidectomy (MIP) for pseudohypoparathyroidism (PHP) for a single parathyroid adenoma, were included. An Ultrasound and mibi SPECT were performed in all patients. We defined matching studies when both coincided in the localization of the adenoma. IOPTH was performed in all patients and analyzed in three occasions: a baseline measurement at the anesthetic induction, immediately before, and 15 minutes after gland excision. Success was defined during the third measurement as a drop of IOPTH of at least 50%compared to the previous maximum value after gland excision. Demographics, intraoperative, postoperative variables and the utility of IOPTH monitoring were analyzed. RESULTS: A total of 218 MIP were performed. The average age was 60.1 years and 85% were female. Preoperative ultrasound and mibi SPECT coincided 100%. When the adenoma was localized, 15 minutes after its excision, IOPTH did not decrease in 9 patients (4.2% OR 1.9% - 7.69%); all of them underwent a bilateral neck exploration. The added-value of IOPTH accuracy for disease cure was 3.6%. There was a 99% of cure rate. The mean surgical time was 66.4 minutes and the waiting time for the third IOPTH result was 31minutes. Performing IOPTH monitoring made the surgery about twice more expensive. CONCLUSIONS: Preoperative matching ultrasound and mibi SPECT for parathyroid adenoma localization in PHP, could avoid IOPTH monitoring in minimally invasive parathyroidectomies.

Abordaje laparoscópico en el tratamiento de las tumoraciones adrenales malignas / Laparoscopic approach in the treatment of malignant adrenal tumours

Introducción Los tumores suprarrenales malignos son infrecuentes. La cirugía es el tratamiento que ofrece mejores resultados. Aunque existe controversia al respecto, la creciente experiencia en cirugía laparoscópica permitió la indicación de suprarrenalectomías laparoscópicas en tumores primarios potencialmente malignos y metastásicos. Nuestro objetivo es evaluar la factibilidad técnica de la suprarrenalectomía laparoscópica en neoplasias malignas y describir los resultados de nuestra serie consecutiva de pacientes. Material y métodos Se analizaron retrospectivamente 13 pacientes (10 varones y 3 mujeres) operados por neoplasias suprarrenales primarias y secundarias por vía laparoscópica entre marzo de 1999 y junio de 2009 en el Hospital de Clínicas de la Universidad de Buenos Aires y en el Hospital Alemán de Buenos Aires. El abordaje transperitoneal se utilizó en todos los casos. El seguimiento promedio fue de 37,9 meses (2–84).Resultados Se operaron 13 pacientes que tenían neoplasias malignas suprarrenales por vía laparoscópica. La edad promedio fue de 55,2+12 años, con una relación hombre/mujer de 10/3. Cinco pacientes presentaron carcinomas corticosuprarrenales, uno presentó feocromocitoma maligno y 7 presentaron tumores metastásicos. Tres pacientes requirieron conversión a cirugía abierta. El tiempo operatorio promedio fue de 146,4min. Se presentaron 2 complicaciones postoperatorias. No hubo mortalidad perioperatoria en la serie. La estadía hospitalaria promedio fue de 4,6 días (1–35). La sobrevida actuarial a 3 años fue del 46%. La causa de muerte en todos los casos fue la enfermedad de base. Conclusiones El abordaje laparoscópico es razonable para los tumores suprarrenales malignos cuando se puede reproducir la técnica oncológica realizada por vía abierta (AU)

Background Malignant primary or secondary adrenal tumours are uncommon. For most of them early surgery with adrenalectomy is the only means of cure. Although controversy exists on this issue, the increasing experience in laparoscopic surgery extends the indication for laparoscopic adrenalectomy to potentially malignant and to metastatic adrenal tumours. Our aim was to evaluate the technical feasibility of laparoscopic adrenalectomy for malignant neoplasias, describing the results of our consecutive series of patients. Material and methods We retrospectively analysed 13 patients who underwent laparoscopic adrenalectomy for malignant neoplasia between March 1999 and June 2009, at the Hospital de Clínicas of the Universidad of Buenos Aires and at the Hospital Alemán of Buenos Aires. A transperitoneal laparoscopic approach was used in all patients. The mean follow up was 37.9 months (2–84).Results Thirteen laparoscopic adrenalectomies were performed due to malignant neoplasia. Mean age was 55.2+12 years. The relationship between male and female was 10/3. Five patients had an adrenal carcinoma, 1 patient a malignant phaeochromocytoma, and 7 patients had metastatic tumours. Three patients required conversion to laparotomy. Average operation time was 146.4 min. There were two perioperative complications and no mortality. Average length of hospital stay was 4.6 days (1–35). The survival at 3 years was 46%. The cause of death was the underlying disease in all cases. Conclusion Laparoscopic adrenalectomy is a reasonable technique for malignant adrenal tumours, when the open oncological resection can be reproduced by the laparoscopic approach (AU)

[Laparoscopic approach in the treatment of malignant adrenal tumours]. / Abordaje laparoscópico en el tratamiento de las tumoraciones adrenales malignas.

BACKGROUND: Malignant primary or secondary adrenal tumours are uncommon. For most of them early surgery with adrenalectomy is the only means of cure. Although controversy exists on this issue, the increasing experience in laparoscopic surgery extends the indication for laparoscopic adrenalectomy to potentially malignant and to metastatic adrenal tumours. Our aim was to evaluate the technical feasibility of laparoscopic adrenalectomy for malignant neoplasias, describing the results of our consecutive series of patients. MATERIAL AND METHODS: We retrospectively analysed 13 patients who underwent laparoscopic adrenalectomy for malignant neoplasia between March 1999 and June 2009, at the Hospital de Clínicas of the Universidad of Buenos Aires and at the Hospital Alemán of Buenos Aires. A transperitoneal laparoscopic approach was used in all patients. The mean follow up was 37.9 months (2-84). RESULTS: Thirteen laparoscopic adrenalectomies were performed due to malignant neoplasia. Mean age was 55.2+12 years. The relationship between male and female was 10/3. Five patients had an adrenal carcinoma, 1 patient a malignant phaeochromocytoma, and 7 patients had metastatic tumours. Three patients required conversion to laparotomy. Average operation time was 146.4 min. There were two perioperative complications and no mortality. Average length of hospital stay was 4.6 days (1-35). The survival at 3 years was 46%. The cause of death was the underlying disease in all cases. CONCLUSION: Laparoscopic adrenalectomy is a reasonable technique for malignant adrenal tumours, when the open oncological resection can be reproduced by the laparoscopic approach.

Acalculous cholecystitis in a patient with metastatic renal cell carcinoma treated with sunitinib.

A 62-year-old woman was treated with sunitinib as a second-line therapy for metastatic clear-cell renal carcinoma. She was given oral sunitinib 50 mg once daily, 4 weeks on followed by 2 week off. During the fourth week of her first cycle, the patient was admitted to our hospital because of an acute-onset, right upper quadrant pain associated with nausea and vomiting. She was diagnosed with acute acalculous cholecystitis, which was treated with broad-spectrum antibiotics, and sunitinib therapy was discontinued. A follow-up computed tomography scan of the abdomen revealed a complete resolution of gallbladder changes. Our patient did not have major risk factors for developing an acalculous cholecystitis except for a relative immunosuppressed state secondary to her advanced renal cancer. The Naranjo Adverse Drug Reaction Probability Scale score for this event was 5, indicating a probable association of the event with sunitinib. Because the use of sunitinib is expanding in clinical practice, we want to alert the oncology community about this uncommon and life-threatening complication in patients receiving sunitinib or another agent with antiangiogenic activity.

Carcinoma apócrino de axila: reporte de una caso y revisión de la bibliografía / Apócrino carcinoma of armpit: report of a case and revision of the bibliography

En el siguiente trabajo se presenta el caso clínico de un paciente (pte.) de 57 años con carcinoma apócrino axilar, al cual se le realiza resección de tumor primario y vaciamiento axilar homolateral. En la revisión de bibliografía observamos que es una patología infrecuente y detallamos algunas características epidemiológicas y clínico-patológicas de entidad. Objetivos: descripción de un caso de patología infrecuente y revisión de bibliografía. Materiales y métodos: caso clínico. Revisión bibliográfica.