SPECT-CT in the localization of an ectopic retropharyngeal parathyroid adenoma as a cause for persistent primary hyperparathyroidism.

A common cause for surgical failure of primary hyperparathyroidism (pHPT) is the non-detection of an ectopic adenoma during the intervention. We present a case of a patient with pHPT in whom an ectopic gland was found in the right retropharyngeal space by means of a double phase (99m)Tc-methoxy-isobutyl-isonitrile ((99m)Tc-MIBI) scintigraphy and early SPECT-CT after several surgeries and imaging tests. The addition of a tomography to the planar scintigraphy increases its sensitivity and improves pathological parathyroid glands localization. The hybrid imaging is sometimes essential to obtain surgical success, as in the case of ectopic adenomas.

Valor de la SPECT-TAC en la localización de un adenoma de paratiroides ectópico retrofaríngeo como causa de hiperparatiroidismo primario persistente / SPECT-CT in the localization of an ectopic retropharyngeal parathyroid adenoma as a cause for persistent primary hyperparathyroidism

Una causa frecuente de fracaso de la cirugía del hiperparatiroidismo primario (HPTp) es la existencia de un adenoma ectópico no detectado en la intervención. Presentamos a una paciente con HPTp en la que, tras sucesivas intervenciones y pruebas de imagen, se encuentra una glándula ectópica en el espacio retrofaríngeo derecho mediante gammagrafía de doble fase con 99mTc-metoxi-isobutil-isonitrilo (99mTc-MIBI) y SPECT-TAC precoz. La adición de una tomografía al estudio gammagráfico planar, aumenta su sensibilidad y mejora la localización de las paratiroides patológicas. En ciertas ocasiones, como es el caso de adenomas ectópicos, la imagen híbrida será esencial para conseguir el éxito quirúrgico(AU)

A common cause for surgical failure of primary hyperparathyroidism (pHPT) is the non-detection of an ectopic adenoma during the intervention. We present a case of a patient with pHPT in whom an ectopic gland was found in the right retropharyngeal space by means of a double phase 99mTc-methoxy-isobutyl-isonitrile (99mTc-MIBI) scintigraphy and early SPECT-CT after several surgeries and imaging tests. The addition of a tomography to the planar scintigraphy increases its sensitivity and improves pathological parathyroid glands localization. The hybrid imaging is sometimes essential to obtain surgical success, as in the case of ectopic adenomas(AU)

Quistes esplénicos: aspectos clínicos, diagnósticos y terapéuticos / Splenic cysts: clinical, diagnostic and therapeutical aspects

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Quistes esplénicos: aspectos clínicos, diagnósticos y terapéuticos / Splenic cysts: clinical, diagnostic and therapeutic aspects

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Trastornos cognoscitivos en el paciente quirúrgico anciano / Cognitive disorders in the elderly surgical patient

Introducción. Los trastornos cognoscitivos en los pacientes quirúrgicos ancianos son frecuentes y obstaculizan su recuperación funcional. El objetivo de este trabajo es analizar la frecuencia de los trastornos cognoscitivos, en particular del delirio, y valorar su repercusión sobre la morbimortalidad postoperatoria. Pacientes y método. Se estudiaron prospectivamente 183 pacientes ingresados en el servicio de cirugía entre noviembre de 1994 y septiembre de 1995, con una edad igual o superior a 80 años. Se valoraron las funciones cognoscitivas pre y postoperatorias mediante el test de Fosltein, tanto en los pacientes ingresados de forma electiva como de urgencias. Resultados. De 129 pacientes sometidos a alguna intervención quirúrgica, el 20 por ciento presentaban demencia. La disminución preoperatoria de la puntuación del test de Folstein se registró en el 43,4 por ciento, y en el postoperatorio en el 52,7 por ciento. La incidencia de delirio postoperatorio fue del 37,9 por ciento. Se produjeron complicaciones en el postoperatorio en 46 pacientes (35,6 por ciento), registrándose 16 fallecimientos. Entre los pacientes hospitalizados no intervenidos, 10 tenían demencia, disminución de la puntuación del Miniexamen del Estado Mental de Folstein el 57 por ciento y delirio el 24 por ciento. Conclusiones. El deterioro cognoscitivo en el paciente quirúrgico octogenario es elevado. Tanto en cirugía de urgencia como en cirugía programada, los pacientes que presentan trastornos cognoscitivos preoperatorios suelen tener también alteraciones cognoscitivas en el postoperatorio. El delirio ha resultado ser un problema postoperatorio frecuente, que aumenta la morbimortalidad y la estancia hospitalaria. Los pacientes ingresados de urgencias tienen más trastornos cognoscitivos y las complicaciones postquirúrgicas son más frecuentes (AU)

[Therapeutic use of albumin: a discussion on its efficacy]. / Uso terapéutico de la albúmina: una discusión sobre su eficacia.

The aim of our study is to discuss the current recommendations for the use of intravenous albumin in hypoalbuminemic patients obtained from a literature review. Some data available lead us to the belief that its use does not influence the clinical outcome of the patients, in most of the cases in which it is employed. Therefore its use should be limited to a certain number of clinical situations, in which its efficiency has been clearly shown, as in new-born in whom plasma expansion with small volume is necessary, in cases in which synthetic colloids cannot be employed, in massive paracentesis in cirrhotic patients, in selected cases of edema unresponsive to diuretics or other colloids in plasmapheresis, in kidney and liver transplant surgery.

Evaluation of ultrasonography and clinical diagnostic scoring in suspected appendicitis.

BACKGROUND: Several diagnostic aids have been developed to improve diagnosis in suspected appendicitis including ultrasonography and clinical diagnostic scoring. The aim of this study was to elaborate a new scoring system and to measure its accuracy in the preoperative diagnosis of appendicitis, comparing it with the available scoring systems. METHODS: The clinical, radiological and ultrasonographic data of 192 patients with suspected appendicitis were collected prospectively. RESULTS: Only six of the 12 variables analysed were shown to have prognostic significance. Using Bayesian methodology, a weight was given to each criterion and two overall scores were calculated (ultrasonographic and classical scores). A cut-off point was identified to separate patients who needed surgery and those for observation. The ultrasonographic score showed an 81 per cent sensitivity and a 96 per cent specificity, compared with 60 and 73 per cent respectively for the classical score. CONCLUSION: Ultrasonography increases the diagnostic accuracy in patients with suspected acute appendicitis.

Factors associated with hyperdynamic or hypodynamic circulation and role of platelet-activating factor in hemodynamic alterations in bacterial peritonitis in conscious rats.

Male Wistar rats injected intraperitoneally (i.p.) with 10(9) U Escherichia coli ATCC 25922 developed acute bacterial peritonitis. Hemodynamic studies, with microspheres labeled with 103Ru 57Co, and 113Sn, were performed before, 30 min after bacterial injection, and 30 min after administration of either the platelet-activating factor (PAF) antagonist BN-52021 (5 mg/kg body weight) or isotonic saline. A blood sample of 0.3 ml was obtained for bacterial culture and endotoxemia measurements. Plasma PAF levels were measured in a different group of 10 control rats and 20 animals with experimental peritonitis. One group of rats injected with E. coli (n = 13) displayed hyperdynamic circulation, with an increase in cardiac output (CO) from 15.1 +/- 1.2 to 19.4 +/- 1.1 ml/min/100 g body weight and a decrease in total peripheral resistance (TPR) from 19.5 +/- 2.4 to 14.9 +/- 1.1 dynes.s.cm-5 10(-4). Furthermore, these rats showed high endotoxin blood concentrations and low hemoculture levels. The remaining 7 peritonitic rats showed a significant decrease in CO from 16.3 +/- 1.6 to 12.7 +/- 1.2 ml/min/100 g body weight and an increase in TPR from 17.3 +/- 1.8 to 22.6 +/- 2.8 dynes.s.cm-5 10(-4). In addition, these rats showed low endotoxin blood concentrations and high hemoculture levels. Endotoxin blood concentrations were positively correlated with the change in CO (r = 0.87, p < 0.05), and cell hemocultures were positively correlated with CO (r = 0.89, p < 0.05). Rats with high endotoxin blood levels showed higher PAF plasma levels than control rats or peritonitic rats with low endotoxin blood levels. When peritonitic rats were injected with the specific PAF-receptor blocker BN-52021 (5 mg/kg body weight) as a bolus, CO and TPR returned to baseline values in both groups of animals. These data suggest that the hemodynamic changes induced by bacterial peritonitis depend on endotoxemia and bacteremia in opposite ways. In addition, PAF appears to be involved in both the hyperdynamic and hypodynamic hemodynamic changes shown by peritonitic rats.

[Effect of somatostatin on the hemodynamic changes induced by acute experimental pancreatitis in the conscious rat]. / Efecto de la somatostatina sobre los cambios hemodinámicos inducidos por la pancreatitis aguda experimental en la rata despierta.

The aim of this study was to determine the hemodynamic effect of somatostatin, either prophylactically or therapeutically, in shock caused by acute necrohemorragic pancreatitis in conscious rats. For this purpose, radioactive microspheres were used in 3 groups (control pancreatitis, therapeutic somatostatin and prophylactic somatostatin), performing a basal and final hemodynamic study. In the control group, acute necrohemorragic pancreatitis resulted in overwhelming shock with decrease of 55% in cardiac output, 58% in renal blood flow, increase in total peripheral resistances of 342%, and death after 70 min. Therapeutic somatostatin decreased cardiac output by 42%, renal blood flow by 47%, and increased total peripheral resistances by 153%. Prophylactic somatostatin decreased cardiac output by 24%, and renal blooded flow by 28%; it increased peripheral resistances by 146%, and improved survival up to 97 min. In conclusion, therapeutic somatostatin, and particularly prophylactic somatostatin, improved hemodynamic shock after acute necrohemorragic pancreatitis in conscious rats.

[Hypersplenism secondary to splenic tuberculosis]. / Hiperesplenismo secundario a tuberculosis esplénica.

We report a case of abdominal tuberculosis with predominant splenic involvement and hypersplenism in a patient without any risk factor for tuberculosis. We review the literature and emphasize the unusual splenic involvement, the difficulties in the specific diagnosis and the therapeutic strategy. We conclude that this disease should be included in the differential diagnosis of hypersplenism.

[Cystic neoplasm of the pancreas as a cause of intestinal obstruction]. / Neoplasia quística del páncreas como causa de obstrucción intestinal.

Cystic neoplasms of the pancreas are unusual varieties of pancreatic tumors. We herein report a new case presenting with atypical features, such as mental and electrolytic disturbances secondary to upper intestinal obstruction. We reviewed the literature, and discuss the differential diagnosis, the histopathological characteristics of prognostic value, and the therapeutic strategy. We conclude that these tumors should be included in the differential diagnosis of the upper intestinal obstructions, and emphasize the need to remove the lesion in all cases because of the difficulties of predicting the benign or malignant behaviour of these tumors before and during the surgical procedure.

Role of platelet-activating factor in hemodynamic derangements in an acute rodent pancreatic model.

Systemic hemodynamics were assessed in a model of experimental pancreatitis induced in rats by the retrograde injection of sodium deoxycholate, 40%, 1 mL/kg, in the pancreatic duct, using the radioactive microsphere technique before and 25 minutes after pancreatitis induction while blood pressure was stable (n = 10). A 55% decrease in cardiac out-put, a 14% decrease in heart rate, and a 3.3-fold increase in total peripheral resistances, without significant changes in blood pressure, were observed. Renal blood flow decreased by 68%. When rats were given BN-52021, a blocker of platelet-activating factor receptors (5 mg/h, IV; n = 13) coinciding with pancreatitis induction, no significant hemodynamic changes were observed. Animals treated with BN-52021 survived 89 +/- 10 minutes, whereas death occurred 67 +/- 5 minutes after pancreatitis induction in untreated rats (P less than 0.001). A different group of rats with pancreatitis showed higher blood levels of platelet-activating factor (0.28 +/- 0.06 ng/mL; n = 11) than control rats (0.16 +/- 0.03; n = 15; P less than 0.05). Very high levels of platelet-activating factor were found in peritoneal exudate from rats with pancreatitis. These data show an effective protective effect of BN-52021 on the hemodynamic impairment that follows pancreatitis induction, as well as a role of platelet-activating factor in these alterations.

Effect of endothelin on systemic and regional hemodynamics in rats.

In this study we analyzed the changes in systemic haemodynamics induced by endothelin, 1 nmol/kg, given as an i.v. bolus to anaesthetized rats. Endothelin induced a dramatic decrease in cardiac output whereas the total peripheral resistance increased more than two times. In addition, renal blood flow decreased while renal vascular resistance increased to a similar extent. A marked decrease in blood flow to the splanchnic organs was also observed. In conclusion, endothelin seems to modulate peripheral vasomotor tone, at least under certain conditions.