Valor de la ecoendoscopia transesofágica en el diagnóstico de localización en el hiperparatiroidismo primario / Oesophageal endoscopic ultrasound in the accurate location of primary hyperparathyroidism (HPT)

Objetivos. Considerar la utilidad de la ecoendoscopia trasesofágica en la localización del hiperparatiroidismo primario recidivado o persistente. Material y método Durante 7 años consecutivos, hemos intervenido a 352 pacientes con hiperparatiroidismo primario (HPP). Sistemáticamente se realiza gammagrafía paratiroidea con 99Tc-sestamibi preoperatorio y determinación intraoperatoria de paratirina. Sólo 5 (1,4%) pacientes han presentado problemas de localización: 3 por persistencia tras cirugía paratiroidea, 1 por recidiva y 1 por HPP con antecedente de hemitiroidectomía derecha. Antes de indicar una cervicotomía exploradora, se decide la realización de una ecoendoscopia trasesofágica para intentar una localización definitiva. Resultados La ecoendoscopia detecta una imagen clara de adenoma con localización precisa en 4 pacientes. Sólo en 1 paciente no se visualiza tumoración. Los 5 pacientes fueron intervenidos. Se confirmó la exactitud del diagnóstico en los 4 pacientes con visualización positiva. La exploración quirúrgica del quinto paciente resultó ser una paratireosis. Los 5 pacientes tuvieron un postoperatorio favorable, sin lesiones recurrenciales ni morbilidad asociada a la ecoendoscopia. Conclusiones La ecoendoscopia trasesofágica resulta muy útil en los hiperparatiroidismo que presenta dificultades para localizar la glándula patológica, especialmente en casos con alteración anatómica por cirugía previa. Así, ayuda a que el cirujano pueda explorar la zona sospechosa de forma más selectiva y más eficiente (AU)

Aim. Our aim was to estimate the usefulness of oesophageal endoscopic ultrasound in the accurate location of recurrent or persistent primary hyperparathyroidism (HPT).Material and methodA total of 352 patients with primary hyperparathyroidism were operated on over the last seven years. A preoperative parathyroid 99Tc- sestamibi gammagraphy and an intraoperative PTH determination were performed routinely. Only 5 patients (1.4%) had localization problems: three with persistent HPT after parathyroid extirpation, one recurrent HPT and one HPT after a right hemithyroidectomy. An oesophageal endoscopic ultrasound was carried out before any new exploratory neck surgery in order to find the definitive location. Results The endoscopic ultrasound showed a clear image of adenoma with an accurate location in four patients. No tumour was present in one patient. All five patients were operated on. The exact location was confirmed in the four patients with positive endoscopic ultrasound images. The fifth surgical exploration revealed a parathyreosis. All five patients had a favourable post-operative period, with no nerve lesions or morbidity associated with the endoscopic ultrasound. Conclusions Oesophageal endoscopic ultrasound is a very useful diagnostic tool in HPT patients with location problems, particularly in cases having anatomical changes due to previous surgery. It is a procedure that helps the surgeon to make a more selective and efficient exploration of parathyroid glands (AU)

[Oesophageal endoscopic ultrasound in the accurate location of primary hyperparathyroidism (HPT)]. / Valor de la ecoendoscopia transesofágica en el diagnóstico de localización en el hiperparatiroidismo primario.

AIM: Our aim was to estimate the usefulness of oesophageal endoscopic ultrasound in the accurate location of recurrent or persistent primary hyperparathyroidism (HPT). MATERIAL AND METHOD: A total of 352 patients with primary hyperparathyroidism were operated on over the last seven years. A preoperative parathyroid 99Tc- sestamibi gammagraphy and an intraoperative PTH determination were performed routinely. Only 5 patients (1.4%) had localization problems: three with persistent HPT after parathyroid extirpation, one recurrent HPT and one HPT after a right hemithyroidectomy. An oesophageal endoscopic ultrasound was carried out before any new exploratory neck surgery in order to find the definitive location. RESULTS: The endoscopic ultrasound showed a clear image of adenoma with an accurate location in four patients. No tumour was present in one patient. All five patients were operated on. The exact location was confirmed in the four patients with positive endoscopic ultrasound images. The fifth surgical exploration revealed a parathyreosis. All five patients had a favourable post-operative period, with no nerve lesions or morbidity associated with the endoscopic ultrasound. CONCLUSIONS: Oesophageal endoscopic ultrasound is a very useful diagnostic tool in HPT patients with location problems, particularly in cases having anatomical changes due to previous surgery. It is a procedure that helps the surgeon to make a more selective and efficient exploration of parathyroid glands.

Tumor adrenal productor de corticotropina determinante de síndrome de Cushing / Cushing’s syndrome due to an ACTH-producing adrenal tumor

No disponible

Embolia esplénica / Splenic embolism

No disponible

Quiste paratiroideo e hiperparatiroidismo / Parathhyroid cyst and hyperparathyroidism

No disponible

Papilomatosis biliar difusa / Diffuse biliary papillomatosis

No disponible

The pattern of the descent of PTH measured by intraoperative monitoring of intact-PTH in surgery for renal hyperparathyroidism.

BACKGROUND: In the setting of total parathyroidectomy and autotransplantation surgery (TPTxAS) treatment for secondary hyperparathyroidism (SHPT) we evaluated whether intraoperative parathyroid hormone (iPTH) monitoring is an useful tool as a reference for total parathyroid removal. DESIGN: Prospective open single value measurement efficacy study of one intraoperative (i.o.) diagnostic monitoring method (iPTH) on a cohort of surgical patients. PATIENTS: All patients (n = 35) undergoing TP and SCTx at the Department of Surgery, Donostia Hospital from January 2002 to December 2006. MAIN OUTCOME MEASURES: Serum levels of iPTH during surgery and prediction time of the of descent of PTH levels (measured in the clinic, at admission day and intra-operatively during induction of anesthesia, and every 5 and 10 minutes after removal of adenoma and 24 hours thereafter) were analyzed. RESULTS: iPTH levels dropped clearly at ten minutes in all 35 patients and were non-measurable at 24 hours. iPTH decreased from pathological (1302.24 + 424.9 pg/ml) to half (50%) the values at the third intra-operative determination - minute 10 - (614.8 ± 196.62) and was undetectable at 24 hours. CONCLUSIONS: Intra-operative measurement of iPTH is useful in the prediction of complete removal of all parathyroid tissue prior to autotransplantation thus avoiding persistence because of incomplete surgery.

Effect of liver resection on the progression and growth of rhabdomyosarcoma metastases in a rat model.

BACKGROUND/AIMS: To analyze the effect of liver resection on the progression of liver metastases in a rhabdomyosarcoma rat model. METHODS: Liver metastases were induced by intrasplenic injection of S4MH rhabdomyosarcoma cells in WAG/RijCrl rats. In a first experiment, rats were sequentially sacrificed until day 30 following tumor cell inoculation to establish the optimal day to evaluate liver and lung metastases. A second group of rats were hepatectomized or laparotomized 10 d after tumor inoculation, and on day 21 they were sacrificed to determine the size and number of liver and lung metastases. Also, in vitro proliferation rates of tumor cells in the presence of fetal calf serum or hepatectomized or laparotomized rat serum were assessed. RESULTS: Individual metastases could be optimally determined on day 21. In hepatectomized animals liver metastases reached greater size and their number was significantly increased (28.7 versus 9.3, P < 0.05). Moreover, the number of lung tumor foci in this group nearly doubled that in the control group (99.2 versus 28.5, P < 0.05). In vitro studies showed that hepatectomized rat serum increased cell proliferation when compared with laparotomized rat serum (2.0-fold) or fetal calf serum (1.4-fold). CONCLUSIONS: This tumor model shows the tumor-enhancing effect derived from hepatic resection, and may be useful to assess preventive therapeutic strategies.

[Mucocele of the appendix]. / Mucoceles apendiculares.

INTRODUCTION: Mucoceles of the appendix are infrequent entities and are found in only 0.25% of all appendectomies and 8% of all appendicular tumors. MATERIAL AND METHODS: We describe 27 cases of mucocele of the appendix treated at Donostia Hospital between January 1978 and December 2006. RESULTS: The mean age of the patients was 54.4 +/- 21.7 years (range: 17-88). Of the 27 patients, 15 (55.5%) were males and 12 (44.5%) were females. Emergency surgery was performed in 17 patients (62.9%). Mucoceles were identified as operative findings during surgery for other reasons in seven patients (25.9%). Three patients (11.1%) underwent surgery because of a diagnosis of abdominal tumor. The main reason for emergency surgery was lower right abdominal pain in 14 patients (82.2%), intestinal obstruction in one (5.8%), a diagnosis of endometriosis in one (5.8%) and a diagnosis of pyosalpinx in one (5.8%). Three patients underwent surgery due to pseudomyxoma peritonei after 24, 36 and 41 months' follow-up. The third patient is asymptomatic after peritonectomy and a follow-up of 78 months. We found an overall incidence of 11 cases (40.7%) presenting with synchronous or metachronous neoplasms from other locations. CONCLUSIONS: We recommend monitoring of all patients with mucocele of the appendix, because these masses can sometimes be associated with neoplasms in other locations and there is a risk of pseudomyxoma peritonei even after a long follow-up.

Mucoceles apendiculares / Mucocele of the appendix

Introducción. Los mucoceles apendiculares son una entidad infrecuente; representan sólo el 0,25% de todas las apendicectomías y un 8% de todos los tumores apendiculares. Material y métodos. Describimos 27 casos de mucoceles apendiculares tratados entre enero de 1978 y diciembre de 2006 en el Hospital Donostia. Resultados. La edad media ± desviación estándar de los pacientes fue de 54,4 ± 21,7 años (rango, 17-88). De los 27 pacientes, 15 (55,5%) eran varones y 12 (44,5%) mujeres. Fueron intervenidos de urgencia 17 pacientes (62,9%). Resultaron hallazgos operatorios en el curso de intervenciones por otra razón en 7 (25,9%) ocasiones; 3 pacientes fueron operados con diagnóstico de tumoración abdominal no filiada (11,1%). La causa principal de intervención de urgencia fue el dolor en la fosa ilíaca derecha, 14 (82,2%); obstrucción intestinal, 1 (5,8%); diagnóstico de endometriosis, 1 (5,8%), y diagnóstico de piosalpinx, 1 (5,8%). Se intervino a 3 pacientes por presentar seudomixoma peritoneal pasados 24, 36 y 41 meses. El último caso se encuentra bien tras peritonectomía y pasados 78 meses. Hemos encontrado una incidencia global de 11 casos (40,7%) de neoplasias isocronas o metacronas de otra localización en estos pacientes. Conclusiones. Recomendamos el seguimiento de todos los pacientes con mucocele apendicular porque a veces se asocian a neoplasias de otra localización y riesgo de seudomixoma peritoneal, incluso en fases más avanzadas del seguimiento (AU)

Introduction. Mucoceles of the appendix are infrequent entities and are found in only 0.25% of all appendectomies and 8% of all appendicular tumors. Material and methods. We describe 27 cases of mucocele of the appendix treated at Donostia Hospital between January 1978 and December 2006. Results. The mean age of the patients was 54.4 ± 21.7 years (range: 17­88). Of the 27 patients, 15 (55.5%) were males and 12 (44.5%) were females. Emergency surgery was performed in 17 patients (62.9%). Mucoceles were identified as operative findings during surgery for other reasons in seven patients (25.9%). Three patients (11.1%) underwent surgery because of a diagnosis of abdominal tumor. The main reason for emergency surgery was lower right abdominal pain in 14 patients (82.2%), intestinal obstruction in one (5.8%), a diagnosis of endometriosis in one (5.8%) and a diagnosis of pyosalpinx in one (5.8%). Three patients underwent surgery due to pseudomyxoma peritonei after 24, 36 and 41 months' follow-up. The third patient is asymptomatic after peritonectomy and a follow-up of 78 months. We found an overall incidence of 11 cases (40.7%) presenting with synchronous or metachronous neoplasms from other locations. Conclusions. We recommend monitoring of all patients with mucocele of the appendix, because these masses can sometimes be associated with neoplasms in other locations and there is a risk of pseudomyxoma peritonei even after a long follow-up (AU)

[Expression of proteins associated with multidrug resistance and resistance to chemotherapy in lung cancer]. / Expresión de proteínas relacionadas con resistencia a múltiples fármacos y resistencia a la quimioterapia en el cáncer de pulmón.

OBJECTIVE: Membrane transporters are proteins that play a crucial role in resistance to chemotherapy. The aim of this study was to assess the influence of membrane transporter protein expression on chemotherapeutic response. MATERIAL AND METHODS: One hundred and forty seven samples of tumor tissue were collected from 143 patients; 35 samples were obtained by bronchoscopy and 112 were surgical specimens. A total of 101 samples from 99 patients were adequate for study. Cryopreserved samples were subjected to immunohistochemical analysis to detect 3 proteins associated with multidrug resistance: P-glycoprotein (Pgp), multidrug-resistance-associated protein 1 (MRP1), and lung resistance protein (LRP). RESULTS: In 16 cases none of the proteins were expressed. A single protein was expressed in 32 (3 Pgp, 11 MRP1, and 18 LRP); 2 in 34 cases (24 Pgp and LRP; 5 MRP1 and Pgp; 5 MRP1 and LRP); and all 3 in 17 cases. No significant relationship was found between age and the expression of Pgp (P=.74), MRP1 (P=.95), or LRP (P=.26). Nor were there significant differences in number (P=.72) or type of coexpressed proteins (P=.39) by sex, by tumor stage (number, P=.55; type, P=.21), or by tumor grade (number, P=.59; type, P=.51). There was a highly significant trend toward coexpression of Pgp and LRP (P< .01) but not of Pgp and MRP1 (P=.18) or MRP1 and LRP (P=.26). MRP1 was expressed less often in adenocarcinoma. LRP was expressed less often in squamous cell carcinoma than in adenocarcinoma and undifferentiated large cell carcinoma. Coexpression of Pgp, MRP1, and LRP was observed most often in squamous cell carcinoma. CONCLUSIONS: Proteins associated with multidrug resistance are commonly expressed in lung cancer. Of the 3 proteins studied, LRP was the one most often found. Coexpression of more than 1 of the proteins was found in a considerable percentage of patients. Pgp was mainly found to be coexpressed with LRP. Pgp expression and the number of coexpressed proteins seemed to have a negative impact on response to chemotherapy.

[Nodular lymphoid hyperplasia of the liver. Pseudolymphoma]. / Hiperplasia nodular reactiva linfoidea hepática. Seudolinfoma.

UNLABELLED: We present a rare pathological entity of the liver and review the literature. CASE REPORT: a 33-year-old asymptomatic woman showed a space-occupying lesion on liver segment VI, which was detected incidentally on ultrasound examination performed for a gynecological disorder. Computed tomography and magnetic resonance imaging of the liver confirmed a 3-cm lesion in segment VI. Segmentectomy of segment VI was performed. Pathological diagnosis was nodular lymphoid hyperplasia of the liver. Nodular lymphoid hyperplasia or pseudo-lymphoma is a highly uncommon disease that usually develops in cirrhotic liver. Our patient was free of liver disease.

[Evaluation of parathyroid function in presternal subcutaneous grafting after total parathyroidectomy for renal hyperparathyroidism]. / Evaluación de la función paratiroidea en el injerto subcutáneo preesternal tras paratiroidectomía total en el hiperparatiroidismo renal.

INTRODUCTION: In the setting of total parathyroidectomy (TPT) and parathyroid transplantation (PTx) for renal hyperparathyroidism (RHP), we evaluated long-term parathyroid graft function after subcutaneous presternal transplantation (SCPTx). HYPOTHESIS: Parathyroid glands are surrounded by fatty tissue. Therefore, we postulated that subcutaneous implantation of parathyroid tissue after TPT for RHP could be at least as effective as intramuscular grafting and would avoid the complications of the latter technique. MATERIAL AND METHOD: We performed a study in a university hospital and its dialysis unit. DESIGN: Prospective open efficacy study of a postoperative diagnostic monitoring method of intact parathyroid hormone (iPTH) in a cohort of surgical patients without loss to follow-up. PATIENTS AND INTERVENTIONS: Thirty-five patients (19 women and 16 men) underwent TPT and SCPTx for RHP at the Department of General Surgery and Department of Nephrology, Donostia Hospital, San Sebastián, Gipuzkoa, Spain, from January 2002 to December 2005. Follow-up ranged from 6 to 42 months (mean, 15.4 months). Graft function was evaluated by measurement of plasma iPTH levels before surgery and 24 hours and 1, 3, 5, 15, 30, 60, 100 and 150 weeks after surgery. Reference values for PTH in our laboratory were 20-65 pg/mL. RESULTS: The mean preoperative iPTH values were 1245 +/- 367.9 pg/mL (mean +/- SD) (range, 493-2160). After TPT and SCPTx, iPTH levels became undetectable in all patients at 24 hours. A value of 50 pg/mL was established as the criterion for adequate parathyroid graft function. The following values were obtained: 15.54 +/- 10.61 pg/mL (mean +/- SD) (range, 6-44) after 1 week, 57.2 +/- 1.9 pg/mL (mean +/- SD) (range, 43-74) after 5 weeks, 64.21 +/- 9.73 pg/mL (mean +/- SD) (range, 11.3-89) after 15 weeks, 75.12 +/- 9.05 pg/mL (mean +/- SD) (range, 24.6-104.2) after 30 weeks, 101.63 +/- 19.85 pg/mL (mean +/- SD) (range, 65-143) after 60 weeks, 121.63 +/- 27.85 pg/mL (mean +/- SD) (range, 62-179) after 100 weeks, 63 +/- 19.85 pg/mL (mean +/- SD) (range, 68-723) after 150 weeks and 102 +/- 18.65 pg/mL (mean +/- SD) (range, 68-113) after 200 weeks. The prevalence of hypoparathyroidism (serum iPTH level of < 20 pg/mL with a normal or low serum calcium concentration) was 2 out of 35 patients (5.71%) by week 60, with recovery of normal values by week 100. Graft-related recurrence occurred in one out of 35 patients (2.85%). CONCLUSIONS: SCPTx after TPT and PTx for secondary RHP is an adequate method to replace muscular forearm parathyroid transplantation and avoid its complications. The functional results of TPT and SCPTx compare favorably with published data on other surgical techniques proposed for the treatment of RHP. Long-term follow-up of this series is currently being performed.