Pathologic intrathyroidal parathyroid glands.

BACKGROUND: Parathyroid glands originate from the third and fourth branchial pouches and migrate caudally to their final positions. Aberrations during migration result in anomalous locations. Intrathyroidal location is not common. METHODS: We reviewed cervical explorations performed from 1974 to 1993 in hyperparathyroidism patients. RESULTS: We found pathological intrathyroidal glands in six patients. Three patients had adenomas (left superior, left inferior and right inferior glands). The hyperplastic glands were left inferior in one patient and right inferior in the remaining two. Intraoperative diagnosis was made in three cases in which palpation of the thyroid gland showed a nodule that was suspected to be the parathyroid missing gland. In three patients it was a finding in thyroidectomy or hemithyroidectomy specimens, two of them with associated thyroid nodular disease. CONCLUSIONS: Ipsilateral thyroidotomy on the side of a palpable thyroid mass or blind hemithyroidectomy are justified if a presumably pathological intrathyroidal gland is suspected, when all other sites in the neck have been excluded.

[Cancer of the gallbladder: survival and life quality depending on the type of surgical treatment]. / Cáncer de vesícula: supervivencia y calidad de vida según el tipo de tratamiento quirúrgico.

An analysis is made of the survival and life quality of 47 patients diagnosed by histopathology as gallbladder cancer, in relation to surgical treatment. The 47 patients, with a mean age of 70 years and a male female ratio of 1:3.7, were classified according to the Nevin stages: there were no stage I patients, 1 stage II, 8 III-IV and 38 V. The operations performed were 20 simple cholecystectomies with excision of a portion of adjacent hepatic tissue; 11 radical cholecystectomies; 10 surgical intubations; 3 percutaneous endoprosthesis; 2 gastroenteroanastomoses and 1 exploratory laparotomy. The results showed: 1) Radical cholecystectomy was the best therapeutic method, providing the longest survival (433 days) with the smallest proportion of days of poor life quality (10%). 2) In patients in stages II, III, IV, simple cholecystectomy with excision of the adjacent liver tissue yielded a survival of more than a year, even in patients of advanced age (greater than 80 years). 3) Although percutaneous and surgical intubation achieved a similar survival, the first technique produced a better quality of life. 4) In view of the diversity of the surgical techniques practiced in patients in stage V, a revaluation of this stage is necessary to individualize treatment.