[Spirometric evaluation of respiratory involvement in asymptomatic multinodular goiter with an intrathoracic component]. / Valoración espirométrica de la afectación respiratoria en el bocio multinodular asintomático con componente intratorácico.

Respiratory tract obstruction is underestimated in asymptomatic intrathoracic goiter. Our aim was to evaluate the involvement of the upper airway of asymptomatic patients with intrathoracic multinodular goiter, assessing the effect on respiratory function by means of spirometry. We selected 21 patients with asymptomatic intrathoracic goiter on whom a thyroidectomy had been performed. Spirometry was done in supine decubitus and in standing position before and 3 months after surgery. The preoperative study in decubitus showed mild obstruction in 4 cases (20%). In 2 of these cases this condition was also present in standing position (10%). Spirometry became normal after surgery in the 4 patients with obstruction. To conclude, spirometry in asymptomatic intrathoracic goiter shows mild obstruction of respiratory function in 10% to 20% of cases, depending on position. Surgery was associated with normalization of the abnormal parameters and an improvement in the remaining parameters. These data support the need to schedule surgery as soon as possible.

Valoración espirométrica de la afectación respiratoria en el bocio multinodular asintomático con componente intratorácico / Spirometric evaluation of respiratory involvement in asymptomatic multinodular goiter with an intrathoracic component

La obstrucción de la vía aérea se infravalora en el bocio intratorácico asintomático. Nuestro objetivo ha sido valorar mediante espirometría la afectación de la vía aérea superior y la repercusión en la función respiratoria de pacientes asintomáticos con bocio multinodular intratorácico. Para ello se seleccionó prospectivamente a 21 pacientes con bocio intratorácico asintomático a quienes se había practicado una tiroidectomía. Se realizó la espirometría en decúbito supino y en bipedestación antes y a los 3 meses de la cirugía. El estudio preoperatorio mostró en decúbito una afectación obstructiva leve en 4 casos (20%), en 2 de los cuales persistía en bipedestación (10%). Tras la cirugía se normalizó la alteración en los 4 casos. En conclusión, la espirometría en el bocio intratorácico asintomático muestra una afectación obstructiva leve de la función respiratoria en el 10-20% de los casos, en función de la postura. La cirugía se acompaña de la normalización de los parámetros alterados y de la mejoría del resto. Estos datos apoyan la necesidad de indicar la cirugía lo antes posible (AU)

Respiratory tract obstruction is underestimated in asymptomatic intrathoracic goiter. Our aim was to evaluate the involvement of the upper airway of asymptomatic patients with intrathoracic multinodular goiter, assessing the effect on respiratory function by means of spirometry. We selected 21 patients with asymptomatic intrathoracic goiter on whom a thyroidectomy had been performed. Spirometry was done in supine decubitus and in standing position before and 3 months after surgery. The preoperative study in decubitus showed mild obstruction in 4 cases (20%). In 2 of these cases this condition was also present in standing position (10%). Spirometry became normal after surgery in the 4 patients with obstruction. To conclude, spirometry in asymptomatic intrathoracic goiter shows mild obstruction of respiratory function in 10% to 20% of cases, depending on position. Surgery was associated with normalization of the abnormal parameters and an improvement in the remaining parameters. These data support the need to schedule surgery as soon as possible (AU)

Actitud hacia el xenotrasplante en los servicios quirúrgicos en un hospital con un programa preclínico de xenotrasplante hepático / Attitude to xenotransplantation in surgical departments in a hospital with a preclinical liver xenotransplant program

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El personal médico ante la donación hepática de vivo. Estudio de opinión en un hospital español con programa de trasplante hepático de donante vivo / Physicians faced with living liver donation: an attitudinal study in a Spanish hospital with a living donor liver transplant program

Introducción: La mortalidad de los pacientes en lista de espera para el trasplante hepático es elevada, por lo que se buscan alternativas, como la donación de vivo. Por ello, uno de los aspectos que se debe mejorar es la actitud de los profesionales sanitarios hacia dicha donación para crear un clima favorable al respecto. El objetivo es analizar la actitud hacia la donación hepática de vivo entre los médicos de un hospital con programa de trasplante hepático de donante vivo, y analizar las variables que influyen en dicha opinión. Pacientes y método: Muestra aleatorizada y estratificada por tipo de servicio (n = 369) entre el personal médico del hos-pital. La actitud se valoró mediante una encuesta validada en nuestro medio. Para su distribución se contactó con cada jefe de servicio, o un médico adjunto en su defecto, al cual se le explicó el estudio y fue el responsable del reparto de la encuesta en los turnos seleccionados. La encuesta fue cumplimentada de forma anónima y autoadministrada. Para el análisis estadístico se emplearon las pruebas de la *2 y de la t de Student, así como un análisis de regresión logística. Resultados: El grado de cumplimentación del cuestionario fue del 93% (n = 345). Entre los encuestados, el 15% (n = 52) está a favor de la donación hepática de vivo tanto relacionada como no relacionada. Dicho porcentaje asciende hasta el 85% (n = 292) si la donación está relacionada. Del resto, el 8% (n = 27) no acepta la donación hepática de vivo y el 7% (n = 26) restante está indeciso. Dicha actitud se ha asociado sólo a 2 factores: a) considerar la posible necesidad de un futuro trasplante (p = 0,003), de tal manera que los individuos que creen que pueden necesitarlo están a favor en un 90%, y b) aceptar en el futuro, si fuera necesario, un hígado de donante vivo de un familiar o amigo (p = 0,000). Quien así lo acepta está a favor de esta donación de vivo en un 96%. En el análisis multivariante persisten ambas variables: que el encuestado considere la posibilidad de necesitar un trasplante en un futuro (odds ratio [OR] = 2,36) y, en dicho caso, la aceptación de un hígado de donante vivo (OR = 7,11). Conclusiones: La actitud hacia la donación hepática de vivo entre el personal médico de un hospital trasplantador es muy favorable, por lo que actualmente puede ser una pieza importante de promoción, cuando se está intentando potenciar dicha donación para evitar la mortalidad de pacientes en lista de espera

Introduction: Mortality on the waiting list for liver transplants is high. Consequently, alternatives such as living donation are being sought. Therefore, one of the aspects that should be improved is the attitude of healthcare professionals toward this type of donation in order to create a favorable climate. The objective of this study was to identify attitudes toward living liver donation among physicians in a hospital with a living donor liver transplant program and to analyze the variables that affect these attitudes. Patients and methods: A random sample stratified by type of service (n = 369) was performed among physicians in the hospital. Attitudes were evaluated using a survey validated in our geographical area. In each service, the head of service, or in their absence, an attending physician, was contacted. This person was given an explanation of the study and was made responsible for distributing the questionnaire in selected work shifts. The questionnaire was completed anonymously and was self-administered. Statistical analysis consisted of *2 test, Student's t-test, and a logistic regression analysis. Results: The survey completion rate was 93% (n = 345). Of those surveyed, 15% (n = 52) were in favor of living liver donation whether related or unrelated. This percentage increased to 85% (n = 292) if donation was related. Of the remainder, 8% (n = 27) did not accept living liver donation and the remaining 7% (n = 26) were undecided. This attitude was associated with only two factors: the respondent's belief that he or she might need a transplant in the future (p = 0.003) ­90% of those who believed that they might need a transplant at some point in the future were in favor­, and the respondent's acceptance (if transplantation were necessary at some point in the future) of a living donated liver from a family member or a friend (p = 0.000). Thus, 96% of those who would be prepared to accept a living organ were in favor. In the multivariate analysis, both variables remained significant: the respondent's belief that he or she might need a transplant in the future (odds ratio [OR] = 2.36) and, if this were the case, the respondent's acceptance of a living donated liver (OR = 7.11). Conclusions: Attitudes toward living liver donation among physicians in a hospital with a living donor transplant program were highly favorable. Consequently, these health professionals may be a key element for the promotion of living donation at the present time when this form of donation is being encouraged to avoid mortality on waiting lists

Diagnostic efficiency of sestamibi gammagraphy and Doppler sonography in the preoperative assessment of breast lesions.

INTRODUCTION: It would be desirable to have preoperative methods that allow an adequate selection of patients with breast lesions to rule out breast cancer. The aim of the present study is to evaluate the efficiency of preoperative Sestamibi gammagraphy and Doppler sonography regarding the differential diagnosis of malignancy in breast lesions. MATERIAL AND METHODS: A prospective observational study was conducted on 88 consecutive patients with breast lesions. All the patients underwent preoperative Doppler sonography with an echo-enhancing agent and Sestamibi gammagraphy. All the patients had histopathological study of the surgical specimen to compare with the result of the preoperative techniques. These comparisons were done both for the overall series and separately for palpable and non-palpable lesions. RESULTS: In the overall series results, both tests separately and the two combined, are related significantly to the malignant histological diagnosis (p < 0.001). In palpable lesions, there is a considerable increase in sensitivity, and especially in specificity, attaining 100%, with the combination of both tests. In non-palpable lesions, a relationship was only found between the results of the Sestamibi gammagraphy and the malignant histological diagnosis (93.3%; p < 0.05). CONCLUSIONS: Sestamibi gammagraphy and Doppler sonography are two efficient exploratory techniques in the preoperative assessment of malignancy in breast lesions, especially for palpable lesions, and this efficiency is greater when they are combined.

Diagnostic efficiency of Sestamibi gammagraphy and Doppler sonography in the preoperative assessment of breast lesions

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Introduction. It would be desirable to have preoperativemethods that allow an adequate selection ofpatients with breast lesions to rule out breast cancer.The aim of the present study is to evaluate theefficiency of preoperative Sestamibi gammagraphyand Doppler sonography regarding the differentialdiagnosis of malignancy in breast lesions.Material and methods. A prospective observationalstudy was conducted on 88 consecutive patientswith breast lesions. All the patients underwent preoperativeDoppler sonography with an echo-enhancingagent and Sestamibi gammagraphy. All thepatients had histopathological study of the surgicalspecimen to compare with the result of the preoperativetechniques. These comparations were doneboth for the overall series and separately for palpableand non-palpable lesions.Results. In the overall series results, both tests separatelyand the two combined, are related significantlyto the malignant histological diagnosis (p <0.001). In palpable lesions, there is a considerableincrease in sensitivity, and especially in specificity,attaining 100%, with the combination of both tests.In non-palpable lesions, a relationship was onlyfound between the results of the Sestamibi gammagraphyand the malignant histological diagnosis(93.3%; p < 0.05).Conclusions. Sestamibi gammagraphy and Dopplersonography are two efficient exploratory techniquesin the preoperative assessment of malignancy inbreast lesions, especially for palpable lesions, andthis efficiency is greater when they are combined

[Physicians faced with living liver donation: an attitudinal study in a Spanish hospital with a living donor liver transplant program]. / El personal médico ante la donación hepática de vivo. Estudio de opinión en un hospital español con programa de trasplante hepático de donante vivo.

INTRODUCTION: Mortality on the waiting list for liver transplants is high. Consequently, alternatives such as living donation are being sought. Therefore, one of the aspects that should be improved is the attitude of healthcare professionals toward this type of donation in order to create a favorable climate. The objective of this study was to identify attitudes toward living liver donation among physicians in a hospital with a living donor liver transplant program and to analyze the variables that affect these attitudes. PATIENTS AND METHODS: A random sample stratified by type of service (n = 369) was performed among physicians in the hospital. Attitudes were evaluated using a survey validated in our geographical area. In each service, the head of service, or in their absence, an attending physician, was contacted. This person was given an explanation of the study and was made responsible for distributing the questionnaire in selected work shifts. The questionnaire was completed anonymously and was self-administered. Statistical analysis consisted of chi2 test, Student's t-test, and a logistic regression analysis. RESULTS: The survey completion rate was 93% (n = 345). Of those surveyed, 15% (n = 52) were in favor of living liver donation whether related or unrelated. This percentage increased to 85% (n = 292) if donation was related. Of the remainder, 8% (n = 27) did not accept living liver donation and the remaining 7% (n = 26) were undecided. This attitude was associated with only two factors: the respondent's belief that he or she might need a transplant in the future (p = 0.003) -90% of those who believed that they might need a transplant at some point in the future were in favor-, and the respondent's acceptance (if transplantation were necessary at some point in the future) of a living donated liver from a family member or a friend (p = 0.000). Thus, 96% of those who would be prepared to accept a living organ were in favor. In the multivariate analysis, both variables remained significant: the respondent's belief that he or she might need a transplant in the future (odds ratio [OR] = 2.36) and, if this were the case, the respondent's acceptance of a living donated liver (OR = 7.11). CONCLUSIONS: Attitudes toward living liver donation among physicians in a hospital with a living donor transplant program were highly favorable. Consequently, these health professionals may be a key element for the promotion of living donation at the present time when this form of donation is being encouraged to avoid mortality on waiting lists.

Surgical management of multinodular goiter with compression symptoms.

HYPOTHESIS: Multinodular goiter (MG) with compression symptoms has a clinical profile different from that of goiter without these symptoms. The surgical treatment of MG with compression symptoms has a high rate of sternotomy and morbidity. DESIGN: Retrospective study conducted between 1970 and 1999. SETTING: Tertiary referral center. PATIENTS: One hundred fifty-seven patients with MG with compression symptoms were reviewed from 672 patients with MG undergoing surgery in our department. We used 515 patients with MG without compression symptoms as a control group. INTERVENTION: All 157 patients underwent programmed surgery for thyroidectomy. MAIN OUTCOME MEASURES: General patient data, history and symptoms, exploration (both physical and with complementary techniques), data on the surgery and surgeon, and postsurgery morbidity and evolution. The chi2 test, the t test, and a logistic regression test were applied. RESULTS: Multinodular goiter with compression symptoms is characterized by its appearance in persons older than 55 years, a preoperative evolution of more than 10 years, and an intrathoracic component in more than 75% (P<.001). All the patients underwent surgery, with 6 (4%) requiring a sternotomy. Twenty-four percent had complications (n = 37), 3% of which corresponded to 4 cases of permanent recurrent laryngeal nerve injury. Eleven patients (7%) had an associated thyroid carcinoma, 9 of them corresponding to microcarcinomas. However, 5 were multifocal, and there was 1 anaplastic carcinoma, from which the patient died. All the papillary carcinomas are currently asymptomatic. The symptoms were remitted after surgery in all the cases except 1 dysphonia. Of the 32 patients receiving partial surgery, 9 (28%) had recurrence, of whom 6 underwent reoperation to complete the thyroidectomy. CONCLUSIONS: Multinodular goiter with compression symptoms occurs in long-evolving goiters with an intrathoracic component. Surgery is the definitive treatment, as it excludes malignancy, involves low rates of permanent morbidity and mortality, and, if the technique is total thyroidectomy, avoids recurrences.

Surgical treatment for multinodular goitres in geriatric patients.

BACKGROUND: Although age is not a contraindication for thyroid surgery, few elderly patients undergo surgery due to the greater risk of morbidity. The aims of this study are to determine in patients aged >65 years: (1) whether the indications for surgery on multinodular goitre (MG) differ with respect to younger patients; (2) the surgical results; and (3) whether the postsurgery morbidity and mortality rates are higher. PATIENTS AND METHOD: Eighty-one patients aged over 65 years who were receiving surgery for MG were analysed; 40 49%) presented with associated co-morbidities. Sixty percent had thyroid symptoms, either compressive and/or toxic. All underwent programmed surgery following stabilisation and strict control of their co-morbidities. As a control group we used 510 MG patients receiving surgery and aged between 30 and 65 years. RESULTS: Compared with the control group the geriatric patients had a longer time of goitre evolution (P=0.032), greater presence of symptoms (P=0.001) and a higher percentage of intrathoracic component (P=0.001). Compressive symptoms were the major indication for surgery (P=0.001). Postoperative complications occurred in 40% of the patients, a higher rate than in the control group (28%; P=0.011), although a large percentage of those complications were transitory. Definitive complications included two recurrent laryngeal nerve injuries (2.5%). The preoperative symptoms remitted in all the patients, and only three were associated with a thyroid carcinoma, one of which was anaplastic. CONCLUSIONS: MG operated on in elderly patients has a longer evolution and an intrathoracic component, and surgery is indicated restrictively. With close monitoring of the co-morbidities and a programmed operation the results with regard to morbidity and mortality are similar to those obtained at younger ages.

Utility of fine-needle aspiration for diagnosis of carcinoma associated with multinodular goitre.

BACKGROUND: Fine-needle aspiration (FNA) is a useful method for evaluating a solitary thyroid nodule; however, this is not an agreed method for a multinodular goitre (MNG). The aim of this study was to assess the utility of preoperative FNA for detecting malignancy in MNG. PATIENTS AND METHOD: We analysed operated MNGs in which FNA had been performed. Puncture was carried out on the dominant nodule and any other nodules with features suggesting malignancy. The diagnosis was classed as colloid, follicular or Hurthle proliferation, suggestive of malignancy, haematic and inadequate. The thyroid FNA results, grouped into suggestive of malignancy (positive result) and other diagnoses (negative result), were compared to those of the final histological study in order to calculate the value of the test in diagnosing malignancy. RESULTS: FNA was performed in 432 MNGs, of which 42 (9.7%) were associated with carcinoma. Overall, the results of the test were poor, revealing a sensitivity of 17%, specificity of 96% and diagnostic accuracy of 88%, with a positive predictive value of 32% and negative predictive value of 88%. When the values were recalculated with the exclusion of microcarcinomas--considering their minor clinical importance--there was a slight improvement in the results: the sensitivity increased to 26%, diagnostic accuracy to 93% and negative predictive value to 96%. However, the specificity remained at 96%, and the positive predictive value fell from 32% to 25%. The results of the test improved in multifocal carcinomas. CONCLUSIONS: Thyroid fine needle aspiration is not useful for differentiating MNG with malignant degeneration from benign MNG, as more than 80% of carcinomas go unnoticed; it provides a sensitivity of 17% for detecting carcinomas, rising to 26% if microcarcinomas are excluded. We therefore suggest that clinical criteria should prevail over FNA.

Factores de recidiva precoz tras la resección de las metástasis pulmonares / Factors related to early recurrence after resection of pulmonary metastases

Introducción. Clásicamente, las metástasis pulmonares se consideraban una diseminación sistémica del tumor que no precisaban cirugía. Sin embargo, hay estudios que muestran los beneficios de la metastasectomía en casos seleccionados. El objetivo es analizar la morbimortalidad de la metastasectomía pulmonar y determinar los factores de recidiva precoz. Pacientes y método. De los 42 pacientes intervenidos por metástasis pulmonares se excluyó a 4 por considerarlas irresecables intraoperatoriamente; se analizó a los 38 restantes. Las variables analizadas fueron la edad, el sexo, el tumor primario, el tiempo libre de enfermedad, las metástasis extrapulmonares resecadas, el número de metástasis, la bilateralidad, la morbimortalidad, las recidivas, las reintervenciones, el tiempo libre de enfermedad y la supervivencia. Resultados. El abordaje quirúrgico fue una toracotomía posterolateral extraserrática, y no se presentó mortalidad perioperatoria. La morbilidad fue del 11 por ciento (n = 4), y fue precisa una reintervención por un hemotórax posquirúrgico. La supervivencia a 1, 2 y 3 años fue del 87, el 61 y el 25 por ciento, respectivamente, y el índice de pacientes libres de enfermedad, del 71, el 56 y el 17 por ciento, respectivamente. Los principales factores de recidiva precoz fueron el tipo histológico del tumor (más recidivas en los sarcomas y menos en los adenocarcinomas), el tiempo libre de enfermedad entre el tumor primario y la metástasis pulmonar, y el número de metástasis. Cinco de las recidivas pulmonares fueron resecadas una segunda vez, y se pudo extirpar sólo 4 de ellos, 3 de los cuales están libres de enfermedad a los 6, 12 y 24 meses, y el cuarto presenta recidiva pulmonar a los 18 meses. Conclusiones. Las metástasis pulmonares pueden resecarse con baja morbimortalidad, y los principales factores pronósticos de supervivencia son la cirugía completa, el tipo histológico, el tiempo libre de enfermedad entre el tumor primario y la metástasis, y el número de metástasis pulmonares (AU)

Manejo de la vía aérea en la cirugía del bocio multinodular con afección traqueal / Airway management in the surgery of multinodular goiter with tracheal involvement

Objetivos. Determinar el mejor manejo de la vía área para la intervención del bocio multinodular con síndrome compresivo traqueal y/o compresióndesviación traqueal, y valorar las complicaciones en la vía aérea derivadas de dicha compresión. Pacientes y método. Se revisaron 672 bocios multinodulares intervenidos, de los que 238 cumplían alguno de los siguientes criterios: a) sintomatología derivada de la compresión de la vía aérea (n = 87), o b) bocios asintomáticos con compresión-desplazamiento traqueal en la radiografía simple cervicotorácica (n = 151). El tiempo medio de evolución del bocio superaba los 10 años y el 76 por ciento presentaba un componente intratorácico. Se valora la intubación/ orotraqueal (IOT), que se agrupa en normal, dificultosa, por fibrobroncoscopia o traqueotomía, así como la presencia de traqueomalacia y su manejo postoperatorio. Resultados. En 3 pacientes (1,3 por ciento) se indicó directamente una intubación bajo control de fibrobroncoscopio, dadas las características del bocio y de los pacientes. Del resto, en 25 (11 por ciento) hubo algún tipo de dificultad y 7 (3 por ciento) precisaron la utilización de un fibrobroncoscopio. No fue preciso realizar ninguna traqueotomía. No se presentaron diferencias en la IOT entre los pacientes con sintomatología y los asintomáticos. En 3 (1,3 por ciento) casos, las características de la tráquea hicieron sospechar una traqueomalacia, aunque sólo se confirmó 1 caso, que se resolvió mediante IOT prolongada (36 h).Conclusiones. En los bocios multinodulares con compresión-desviación traqueal la IOT presenta dificultades en más del 10 por ciento, por lo que el quirófano debe estar preparado para una intubación de emergencia e incluso una traqueotomía. Sin embargo, no es necesaria una fibrobroncoscopia o traqueotomía sistemáticas, pues en la mayoría de los casos la IOT se realizará simplemente disminuyendo el calibre del tubo de intubación (AU)

Tratamiento quirúrgico del bocio multinodular en pacientes geriátricos / Surgical treatment of multinodular goiter in the elderly

Introducción. Aunque la edad no es contraindicación para la cirugía tiroidea, pocos pacientes añosos son intervenidos, dado su mayor riesgo de morbilidad. Los objetivos del estudio son determinar en los pacientes de más de 65 años: a) si las indicaciones de cirugía en el bocio multinodular difieren respecto a los más jóvenes; b) los resultados de la cirugía, y c) si la morbimortalidad posquirúrgica es mayor. Pacientes y método. Se analizan 81 bocios multinodulares intervenidos con más de 65 años, 40 de los cuales (49 por ciento) presentaban comorbilidades asociadas (hipertensión, diabetes, etc.). El 60 por ciento tenía clínica tiroidea, compresiva (n = 36; 44 por ciento) y/o tóxica (n = 18; 22 por ciento). Todos fueron intervenidos de forma programada, previa estabilización y control estricto de las comorbilidades. Como grupo control se utilizaron 510 bocios multinodulares intervenidos, con edades comprendidas entre 30 y 65 años. Se aplicaron los tests de la 2 y de la t de Student. Resultados. Los pacientes geriátricos presentan, respecto al grupo control, mayor tiempo de evolución del bocio (160 frente a 87 meses; p = 0,0321), mayor presencia de sintomatología (el 60 frente al 41 por ciento; p = 0,0001) y mayor porcentaje de componente intratorácico (el 63 frente al 37 por ciento; p = 0,0001). Respecto a las indicaciones de la cirugía destaca una mayor indicación por clínica compresiva (el 43 frente al 21 por ciento; p = 0,0012). Se presentaron complicaciones postoperatorias en el 40 por ciento de los pacientes (n = 32), índice superior al del grupo control (el 28 por ciento; p = 0,0113), aunque en un alto porcentaje fueron complicaciones transitorias. Como complicaciones definitivas se presentaron 2 lesiones recurrenciales (2,5 por ciento). En todos los casos la sintomatología preoperatoria remitió, y sólo se asoció un carcinoma tiroideo en 3 pacientes (3,7 por ciento), uno de ellos anaplásico. Conclusiones. El bocio multinodular intervenido en pacientes añosos presenta una mayor evolución y un mayor componente intratorácico, por lo que la indicación de cirugía se produce de forma restrictiva. Con un buen control de las comorbilidades y una intervención programada los resultados en cuanto a la morbimortalidad son semejantes a los obtenidos en edades más tempranas (AU)

Estudio comparativo entre el azul de isosulfán y el azul de metileno para la identificación del ganglio centinela en el cáncer de mama / Isosulfan blue compared with methylene blue in localizing sentinel lymph nodes in breast cancer

Introducción. Aunque el azul de isosulfán es el colorante más utilizado en la realización de la biopsia selectiva del ganglio centinela en el cáncer de mama, su limitación comercial en nuestro medio ha llevado a un uso creciente de otros colorantes, especialmente el azul de metileno. En este trabajo comparamos la utilidad del azul de metileno y el azul de isosulfán en la localización del ganglio centinela en pacientes con cáncer de mama. Método. Se ha estudiado de forma prospectiva y aleatorizada a 89 pacientes en las que se realizaron 91 marcajes con 94 biopsias del ganglio centinela. En todos se usó un marcador isotópico peritumoral y colorante periareolar: en 45 azul de metileno y en 46 azul de isosulfán. Se registraron la detección o no de ganglio centinela, la concordancia del resultado con el isótopo, la producción de efectos adversos, el número de ganglios detectados y su localización (axilar o mamaria interna), y se compararon los 2 grupos. Resultados. Sólo en un caso no se encontró el ganglio centinela (1,06 por ciento). No hemos encontrado diferencias significativas en el número medio de ganglios por drenaje ni en la proporción de drenajes extraaxilares. La tasa de concordancia con el isótopo fue del 100 por ciento en ambos grupos. En ninguna de las pacientes intervenidas se detectaron reacciones adversas atribuibles al uso del colorante. Conclusiones. El azul de metileno es una alternativa al azul de isosulfán en la técnica de la biopsia selectiva del ganglio centinela en pacientes con cáncer de mama (AU)

Frequency of HLA-C alleles in differentiated thyroid carcinoma in southeastern Spain.

BACKGROUND: The development of thyroid carcinoma may be influenced genetically and has been associated with certain HLA alleles. HLA-C alleles have not been studied in depth, because available serology techniques have not been very reliable in detecting them. However, the development of molecular biology provided an efficient and reliable technique for allele detection. The aims of the current study were to determine whether there is a significant association between any HLA-C allele and differentiated thyroid carcinoma and to establish the possible susceptibility or protection alleles related to these tumors. METHODS: HLA-C genotyping was performed in 63 patients undergoing surgery for differentiated thyroid carcinoma (57 patients with the papillary subtype and 6 patients with the follicular subtype). A representative sample of 100 nonrelated healthy Caucasians was used as a control group from the same geographic area. The polymerase chain reaction-sequence-specific primer technique was used for HLA-C genotyping. The clinical variables analyzed were age, gender, family history of thyroid pathology, residence in areas of endemic goiter, asymptomatic status, presence of hyperthyroidism, compressive symptoms, presence of an intrathoracic thyroid component, histologic variables of the tumor, and evolution. The chi-square test, the Mantel-Haenszel test, and the Bonferroni correction were used for the statistical analysis. RESULTS: In the control group, a significant correlation was observed between the lower frequency of the HLA-Cw7 allele and the development of differentiated thyroid carcinoma (P < 0.05). Analysis of the different clinical variables revealed a relation between HLA-C alleles and three clinical situations: cervical lymph node involvement with HLA-Cw7 and HLA-Cw2, vascular involvement with HLA-Cw7 and HLA-Cw1, and cervical carcinoma recurrence with HLA-Cw1. However, after application of the Bonferroni correction, only the association between HLA-Cw7 and lymphatic (P(c) = 0.0483) or vascular involvement (P(c) = 0.0324) persisted. CONCLUSIONS: The results revealed a relation between HLA-Cw7 and differentiated thyroid carcinoma. In future investigations, HLA-C typing may help to identify patients with a poor prognosis.

Estudio de los alelos HLA-C en el bociomultinodular / Study of HLA-C alleles in multinodular goiter

Introducción. Clásicamente, el bocio multinodular ha sido considerado una enfermedad tiroidea no autoinmune. Sin embargo, en la actualidad su origen sigue siendo incierto y existen varias alteraciones inmunológicas que no permiten descartarlo. El objetivo es determinar si existe alguna asociación entre el bocio multinodular y los alelos HLA-C. Pacientes y método. Se realiza la tipificación de los genes HLA-C mediante la técnica de biología molecular PCR-SSP en 90 bocios multinodulares intervenidos quirúrgicamente. Como grupo control se utilizó una muestra de 100 controles caucasianos sanos no relacionados representativos de la población. Las variables analizadas son la edad, el sexo, los antecedentes familiares de enfermedad tiroidea, la clínica del paciente, la gradación clínica del bocio, el componente intratorácico tiroideo, el peso del tiroides y el carcinoma asociado. Para el análisis estadístico se han utilizado el test de la 2 y la corrección de Bonferroni. Resultados. Se observa una menor frecuencia del alelo HLA-Cw4 en el bocio multinodular (15,5 frente a 8,3 por ciento; p = 0,0012), con un riesgo relativo de 0,49 (0,90,26). Al analizar las distintas variables clínicas, la asociación más importante es la ausencia del alelo Cw4 con la presencia de bocios con componente intratorácico (p = 0,0012) y con la presencia de bocios de más de 200 g (p = 0,0233). También se observa una asociación entre la presencia del alelo Cw7 y los antecedentes familiares de enfermedad tiroidea, y entre la presencia de un carcinoma asociado y el alelo Cw1.Conclusiones. El HLA-Cw4 se comporta como un alelo protector contra el desarrollo del bocio multinodular, pues no sólo aparece con menor frecuencia en la población con esta enfermedad sino que las personas que presentan este alelo desarrollan bocios más pequeños y sin componente intratorácico (AU)