What happens to the bone structure after normocalcemic primary hyperparathyroidism surgery?

BACKGROUND: Bone disease in primary hyperparathyroidism is a clear indication for surgical treatment. However, it is not known whether surgery benefits hypercalcemic primary hyperparathyroidism and normocalcemic primary hyperparathyroidism equally. The aim of our study was to evaluate the bone changes in patients undergoing parathyroidectomy based on the biochemical profile 1 and 2 years after surgery. METHODS: This prospective study included 87 consecutive patients diagnosed with primary hyperparathyroidism who underwent surgery between 2016 and 2018. Bone densitometry (1/3 distal radius, lumbar, and femur) and bone remodeling markers (osteocalcin, type 1 procollagen [P1NP], ß-cross-linked telopeptide of type I collagen [BCTX]) were performed preoperatively and postoperatively. Postoperative changes in bone mineral density and bone markers were compared and evaluated according to the clinical characteristics and the individual biochemical profile. RESULTS: One year after surgery, all patients showed an increase in bone mineral density at the lumbar site (mean, 0.029 g/cm2; range, 0.017-0.04; P < .001) and femur neck (mean, 0.025 g/cm2; range, 0.002-0.05; P < .001); however, there were no changes in the distal third of the radius (mean, -0.003 g/cm2; range, -0.008 to 0.002; P = NS). There were no significant differences when comparing normocalcemic primary hyperparathyroidism and hypercalcemic primary hyperparathyroidism. Serum osteocalcin (37 ± 17.41), P1NP (67.53 ± 31.81) and BCTX (0.64 ± 0.37) levels were elevated before surgery. One year after the surgery, we observed a significant decrease in P1NP (33.05 ± 13.16, P = .001), osteocalcin (15.80 ± 6.19, P = .001), and BCTX (0.26 ± 0.32, P < .001) levels. CONCLUSION: Our findings indicate that parathyroidectomy has similar benefits for normocalcemic primary hyperparathyroidism and hypercalcemic primary hyperparathyroidism in terms of bone improvement. Although the most substantial improvement occurred during the first postoperative year in both groups, we consider that studies with longer follow-up are warranted.

Vía totalmente extraperitoneal extendida (eTEP) para la corrección de hernias ventrales: resultados preliminares / Extended Totally Extraperitoneal (eTEP) Approach for Ventral Hernia Repair: Initial Results

INTRODUCCIÓN: Desde la primera eventroplastia laparoscópica se han desarrollado múltiples procedimientos en cirugía miniinvasiva de la pared abdominal. En 2017 se publica el acceso endoscópico totalmente extraperitoneal extendido (eTEP) para la reparación abdominal. Se presentan los resultados de la implementación de la técnica en 2 centros por un único cirujano. MÉTODOS: Estudio prospectivo descriptivo de la implementación de la vía eTEP con o sin liberación de transverso (TAR) para defectos de la pared abdominal. La técnica quirúrgica se inicia con el acceso al espacio entre el músculo recto y la vaina posterior, uniendo dicho espacio con el preperitoneo de la línea media y el espacio retrorrectal contralateral. En la cavidad creada se realiza la disección y reducción del saco herniario. Se puede realizar adicionalmente una liberación posterior de componentes tipo TAR. Se realiza el cierre del peritoneo y del defecto fascial y se extiende una prótesis en el espacio definitivo. RESULTADOS: Se intervinieron 40 casos, 20 casos con defectos supraumbilicales, 10 casos infraumbilicales y 10 en la línea semilunar. Dieciséis casos asociaron TAR. El tiempo quirúrgico medio fue de 126 minutos. El dolor mediano por la escala EVA al alta fue de 3. La estancia mediana fue de un día y el seguimiento medio de 10 meses. Un caso mostró recidiva y 2 pacientes requirieron reintervención. CONCLUSIONES: La reparación de hernias primarias e incisionales abdominales mediante eTEP es segura y reproducible. Los resultados preliminares muestran buen control del dolor postoperatorio y baja estancia

INTRODUCTION: Since the first laparoscopic incisional hernia repair, several minimally invasive procedures have been developed in abdominal wall repair. In 2017, the extended totally extraperitoneal (eTEP) approach for abdominal wall repair was published. We present the results from eTEP implementation at two medical centers by one surgeon. METHODS: Prospective descriptive study of the implementation of the eTEP approach, with transversus abdominis release (TAR) when needed. The surgical technique was initiated by accessing the space between the rectus abdominis muscle and posterior rectus sheath, connecting this space with the fatty preperitoneal space at the midline and the contralateral retrorectal space. Identification and dissection of the hernia sac is performed in the created cavity. Additionally, posterior component release in a TAR fashion could be done. Finally, closure of posterior plane and linea alba is completed and mesh prosthesis is deployed along the whole dissected space. RESULTS: Forty patients underwent an eTEP procedure with 20 supraumbilical defects, 10 infraumbilical and 10 lateral hernias. Sixteen cases required a TAR technique. Mean operative time was 126 minutes. Median pain reported the first postoperative day was 3 on the visual analogue scale. Median length of stay was 1 day and mean follow-up was 10 months. Only one patient developed recurrence, and two patients underwent reoperation. CONCLUSIONS: Implementation of eTEP in abdominal wall repair is safe. Preliminary outcomes of the eTEP approach in ventral hernia repair show good pain control with less hospital stay

Extended Totally Extraperitoneal (eTEP) Approach for Ventral Hernia Repair: Initial Results. / Vía totalmente extraperitoneal extendida (eTEP) para la corrección de hernias ventrales: resultados preliminares.

INTRODUCTION: Since the first laparoscopic incisional hernia repair, several minimally invasive procedures have been developed in abdominal wall repair. In 2017, the extended totally extraperitoneal (eTEP) approach for abdominal wall repair was published. We present the results from eTEP implementation at two medical centers by one surgeon. METHODS: Prospective descriptive study of the implementation of the eTEP approach, with transversus abdominis release (TAR) when needed. The surgical technique was initiated by accessing the space between the rectus abdominis muscle and posterior rectus sheath, connecting this space with the fatty preperitoneal space at the midline and the contralateral retrorectal space. Identification and dissection of the hernia sac is performed in the created cavity. Additionally, posterior component release in a TAR fashion could be done. Finally, closure of posterior plane and linea alba is completed and mesh prosthesis is deployed along the whole dissected space. RESULTS: Forty patients underwent an eTEP procedure with 20 supraumbilical defects, 10 infraumbilical and 10 lateral hernias. Sixteen cases required a TAR technique. Mean operative time was 126minutes. Median pain reported the first postoperative day was 3 on the visual analogue scale. Median length of stay was 1 day and mean follow-up was 10 months. Only one patient developed recurrence, and two patients underwent reoperation. CONCLUSIONS: Implementation of eTEP in abdominal wall repair is safe. Preliminary outcomes of the eTEP approach in ventral hernia repair show good pain control with less hospital stay.

Incidencia y seguimiento a 5 años de la recidiva locorregional durante 4 años consecutivos en una unidad multidisciplinar de patología mamaria / Incidence and 5-year follow-up of locoregional recurrence during 4 consecutive years in a multidisciplinary breast unit

Objetivos. Analizar la incidencia de recidiva locorregional y la evolución de las pacientes diagnosticadas de carcinoma infiltrante de mama con seguimiento de larga evolución. Métodos. Estudio retrospectivo de pacientes intervenidas por carcinoma infiltrante de mama entre enero de 2006 y diciembre de 2009. Criterios de inclusión: seguimiento mínimo de 24 meses, diagnóstico de recidiva locorregional de mama confirmado mediante biopsia. Se recogieron características diagnósticas y terapéuticas del tumor primario y la recidiva, la biología molecular, el tiempo libre de enfermedad y la supervivencia global a 5 años. Resultados. Cuatrocientas setenta y dos pacientes cumplieron los criterios de inclusión, con una mediana de seguimiento de 66 meses (47-85). Quince (3,2%) pacientes presentaron recaída locorregional. El diagnóstico fue carcinoma ductal infiltrante, la mediana del tamaño tumoral fue de 18 mm (12-30) y 16 mm en la recidiva (8-28). De las piezas analizadas, en 5 casos (2 luminal A, 2 luminal B y un HER2) la biopsia de la recidiva mostró un cambio histopatológico a triple negativo. Se observó un mayor índice de proliferación celular en la recidiva frente al tumor primario (45 vs. 30%; p = 0,068). La supervivencia libre de enfermedad en meses fue mayor en las pacientes con tumores que no eran triple negativo (33 vs. 28 meses; p = 0,199). Solo una paciente (6%) falleció a lo largo del periodo de seguimiento. Conclusiones. La incidencia de recidiva locorregional a 5 años permanece baja y dentro de los estándares actuales. La selección a triple negativo mostró peores tasas de supervivencia libre de enfermedad (AU)

Aims. To evaluate our results in locoregional recurrences in a cohort of patients with infiltrating breast cancer. Methods. A retrospective study was performed over patients with breast cancer who underwent surgery for breast cancer form January 2006 to December 2009 in Breast Surgery Unit of Fundación Jiménez Díaz University Hospital. Those with a minimum follow-up of 2 years and a locoregional recurrence confirmed by biopsy were selected. We analyzed patient and tumor's characteristics, time to recurrence confirmed by biopsy and long-term oncological outcomes. Results. 472 completed the inclusion criteria with a median follow-up of 66 months (47-85). Of them, 15 patients (3.2%) had a locoregional recurrence. A triple-negative breast cancer was found in 5 patients at the time of relapse (2 luminal A, 2 luminal B and one HER2), compared to one patient at the initial surgery. A higher cellular proliferation index was observed in recurrence tumors (45 vs. 30%; P = .068). Disease-free survival was higher in triple-negative non-selected patients (33 vs. 28 months; P = .199). During the follow-up period, one patient died (6%). Conclusions. In our experience, locoregional recurrence of breast cancer is low and similar to the existing standard guidelines. Patients with triple-negative selected tumors showed worst disease-free survival rates (AU)

[Implementation of an ERAS program in liver surgery]. / Implantación de un programa ERAS en cirugía hepática.

The perioperative management of patients undergoing abdominal surgery has been based on traditional concepts and often not supported by scientific evidence. Recently there have been several scientific studies showing that some traditional procedures for the perioperative management of patients as preoperative fasting, bowel preparation, use of naso-gastric tubes, placement of intra-abdominal drainage, postoperative fasting etc. They are unnecessary and sometimes counterproductive. Perioperative management protocols ERAS or Fast-Track (Enhanced Recovery After Surgery) are based on the use in the perioperative period of measures that are supported by current scientific evidence. Since 2000 appear in the scientific literature several works that reflect the application of protocols ERAS or Fast- Track in surgery of the digestive system where it's shown uniformly, not only the security of your application but also, decreased complications and hospital stay. Although initially these protocols were described in colorectal surgery, due to the good results obtained, the application of these protocols has rapidly expanded to other surgical specialties such as thoracic surgery, Urology, Gynaecology, etc. In all these specialties has unanimously showing improved postoperative recovery with ERAS application protocols. The purpose of this paper is twofold. On the one hand examine the scientific evidence that exists today on the most important elements of an ERAS program and present preliminary results of the implementation of a program ERAS in our hospital.

Implantación de un programa ERAS en cirugía hepática / Implementation of an ERAS program in liver surgery

El manejo perioperatorio de los pacientes sometidos a cirugía abdominal se ha basado en conceptos tradicionales y frecuentemente no avalados por la evidencia científica. Recientemente han aparecido varios estudios científicos que demuestran que algunos procedimientos tradicionales para el manejo perioperatororio de los pacientes como, el ayuno preoperatorio, la preparación intestinal, el uso de sondas naso-gástricas, la colocación de drenajes intraabdominales, el ayuno en el postoperatorio etc., son innecesarios e incluso a veces contraproducentes. Los protocolos de manejo perioperatorio de ERAS o Fast-Track (Enhanced Recovery After Surgery) se basan en la utilización de medidas en el periodo perioperatorio que están avaladas por la evidencia científica actual. A partir del año 2000 empiezan a aparecer en la bibliografía científica varios trabajos que recogen la aplicación de protocolos ERAS o Fast- Track en la cirugía del aparato digestivo en los que se nuestra de manera uniforme, no solo la seguridad de su aplicación sino también, la disminución de las complicaciones y de la estancia postoperatoria. Aunque inicialmente estos protocolos fueron descritos en la cirugía colo-rectal, debido a los buenos resultados obtenidos, la aplicación de estos protocolos se ha expandido rápidamente a otras especialidades quirúrgicas como la cirugía torácica, la Urología, la Ginecología, etc. En todos estas especialidades se ha mostrando de forma unánime la mejoría de la recuperación postoperatoria con la aplicación de protocolos ERAS. El motivo de este artículo es doble. Por un lado examinar la evidencia científica que existe en la actualidad sobre los elementos mas importantes de un programa ERAS y presentar los resultados preliminares de la implantación (AU)

The perioperative management of patients undergoing abdominal surgery has been based on traditional concepts and often not supported by scientific evidence. Recently there have been several scientific studies showing that some traditional procedures for the perioperative management of patients as preoperative fasting, bowel preparation, use of naso-gastric tubes, placement of intra-abdominal drainage, postoperative fasting etc. They are unnecessary and sometimes counterproductive. Perioperative management protocols ERAS or FastTrack (Enhanced Recovery After Surgery) are based on the use in the perioperative period of measures that are supported by current scientific evidence. Since 2000 appear in the scientific literature several works that reflect the application of protocols ERAS or Fast- Track in surgery of the digestive system where it´s shown uniformly, not only the security of your application but also, decreased complications and hospital stay. Although initially these protocols were described in colorectal surgery, due to the good results obtained, the application of these protocols has rapidly expanded to other surgical specialties such as thoracic surgery, Urology, Gynaecology, etc. In all these specialties has unanimously showing improved postoperative recovery with ERAS application protocols. The purpose of this paper is twofold. On the one hand examine the scientific evidence that exists today on the most important elements of an ERAS program and present preliminary results of the implementation of a program ERAS in our hospital (AU)