Diagnosis and treatment of primary thyroid lymphoma from a surgical perspective: a multi-institutional study.

PURPOSE: Surgery of primary thyroid lymphoma (PTL) has been mostly limited to diagnostic work-up. This study aimed to further study its potential role. METHODS: This was a retrospective study from a multi-institutional registry of PTL patients. Clinical, diagnostic work-up (fine needle aspiration, FNA; core needle biopsy, CoreNB), contribution of surgery (open surgical biopsy, OpenSB; thyroidectomy), histology subtype, and outcome data were evaluated. RESULTS: Some 54 patients were studied. Diagnostic work-up included FNA in 47 patients, CoreNB in 11, and OpenSB in 21. CoreNB yielded the best sensitivity (90.9%). Thyroidectomy was performed in 14 patients with other diagnosis (incidental PTL), in 4 for diagnosis and in 4 for elective treatment of PTL. Incidental PTL was associated with not performed FNA nor CoreNB (OR 52.5; P = 0.008), mucosa-associated lymphoid tissue (MALT) subtype (OR 24.3; P = 0.012), and Hashimoto's thyroiditis (OR 11.1; P = 0.032). Lymphoma-related death (10 cases) mostly occurred within the first year after diagnosis and was associated with diffuse large B-cell (DLBC) subtype (OR 10.3; P = 0.018) and older patients (OR 1.08 for every 1-year increase; P = 0.010). There was a trend towards lower mortality rate in patients receiving thyroidectomy (2/22 versus 8/32, P = 0.172). CONCLUSION: Incidental PTL accounts for most of thyroid surgery cases and are associated with incomplete diagnostic work-up, Hashimoto's thyroiditis and MALT subtype. CoreNB appears to be the best tool for diagnosis. Most of PTL deaths occurred during the first year after diagnosis and mostly related to systemic treatment. Age and DLBC subtype are poor prognostic factors.

PET-TC [18F]F-choline and intraoperative PTH in the surgical treatment of the primary hyperparathyroidism without preoperative location.

BACKGROUND AND OBJECTIVES: To assess the feasibility of performing selective parathyroidectomy without intraoperative parathyroid hormone (PTHio) determination when first-line preoperative localization tests (ultrasonography and [99mTc]Tc-MIBI) are negative and/or discordant, and second-line [18F]F-Colina PET-CT, is positive. MATERIALS AND METHODS: Retrospective cohort study, including patients with negative or discordant ultrasound and MIBI scans and positive [18F]F-Colina PET-CT, who underwent selective parathyroidectomy between 2019 and 2022. Groups were compared based on PTHio determination. Study variables were: gender, mean age, biochemical cure assessed by PTH value (pg/mL) and corrected calcium by albumin (mg/dL) at 6 months post-surgery follow-up, and histopathological analysis. RESULTS: The final sample included 42 patients. At 6 months post-surgery, in the PTHio group (20 patients), PTH values were 64.50 pg/mL and calcium 9.30 pg/mL, with 19 adenomas and 1 hyperplasia found. In the non-PTHio group (22 patients), PTH values were 61 pg/mL and calcium 9.37 pg/mL, with 22 adenomas found. No statistically significant differences were found between both groups. CONCLUSIONS: Based on the results obtained in our patient cohort, selective parathyroidectomy could be considered with negative or discordant first-line tests and positive [18F]F-Colina PET-CT, without intraoperative PTH determination.

Randomized clinical trial of pancreaticogastrostomy versus pancreaticojejunostomy on the rate and severity of pancreatic fistula after pancreaticoduodenectomy.

BACKGROUND: Anastomotic leakage of pancreaticojejunostomy (PJ) remains the single most important source of morbidity after pancreaticoduodenectomy (PD). The primary aim of this randomized clinical trial comparing PG with PJ after PD was to test the hypothesis that invaginated PG would result in a lower rate and severity of pancreatic fistula. METHODS: Patients undergoing PD were randomized to receive either a duct-to-duct PJ or a double-layer invaginated PG. The primary endpoint was the rate of pancreatic fistula, using the definition of the International Study Group on Pancreatic Fistula. Secondary endpoints were the evaluation of severe abdominal complications (Clavien-Dindo grade IIIa or above), endocrine and exocrine function. RESULTS: Of 123 patients randomized, 58 underwent PJ and 65 had PG. The incidence of pancreatic fistula was significantly higher following PJ than for PG (20 of 58 versus 10 of 65 respectively; P = 0.014), as was the severity of pancreatic fistula (grade A: 2 versus 5 per cent; grade B-C: 33 versus 11 per cent; P = 0.006). The hospital readmission rate for complications was significantly lower after PG (6 versus 24 per cent; P = 0.005), weight loss was lower (P = 0.025) and exocrine function better (P = 0.022). CONCLUSION: The rate and severity of pancreatic fistula was significantly lower with this PG technique compared with that following PJ. REGISTRATION NUMBER: ISRCTN58328599 (http://www.controlled-trials.com).

[Initial experience in intraoperative radiolocalization of the parathyroid adenoma with freehand SPECT and comparative assessment with portable gamma-camera]. / Experiencia inicial en la radiolocalización intraoperatoria del adenoma paratiroideo con freehand SPECT y valoración comparativa con gammacámara portátil.

Initial experience is presented by using freehand SPECT in the intraoperative radiolocalization of a parathyroid adenoma in 2 patients, one which was mediastinal. There is only one previous publication including 3 patients with parathyroid adenomas in usual parathyroid localizations. We also report for the first time a comparative assessment of results with portable gammacamera during the same surgery. In the operating room, we obtained images with portable gamma-camera and 3 D reconstruction with freehand SPECT from 15 min after iv injection of 5 mCi of (99m)Tc-MIBI. Both devices enabled the 2 adenomas to be detected intraoperatively, as well as checking activity of the excised gland and absence of significant uptake in surgical bed, with confirmation by intraoperative pre-postsurgical PTH levels, pathology and clinical follow-up for 10 months. Both devices accurately located the parathyroid adenomas intraoperatively, as well as confirmation of their extirpation, but freehand SPECT provided additional information of adenoma depth (mm) from the skin border, very useful for minimally invasive radio-guided surgery.

[Arterial embolisms in the upper and lower limbs: a clinical review]. / Embolias arteriales en miembros superiores e inferiores: revisión clínica.

A clinical review about the subjects is made. Percentages and comparisons between lower and upper limbs were established. Correlation with statistics from other authors are presented.

[Contribution of intraoperative scintigraphy to the detection of intrathyroidal parathyroid adenoma]. / Aportación de la gammagrafía intraoperatoria en la detección del adenoma paratiroideo intratiroideo.

The intrathyroidal parathyroid adenomas (IPA) represent a rare cause of primary hyperparathyroidism whose location difficults appropriate surgical removal. We present the case of a patient diagnosed of parathyroid adenoma by presurgical scintigraphy in which finally during the parathyroidectomy, the lesion location was intrathyroidal. We consider that the intrasurgical parathyroid scintigraphy with (99m)Tc-MIBI by portable gammacamera is useful in the parathyroid adenomas removal and essential in the case of IPA.

Preoperative weight loss in patients with indication of bariatric surgery: which is the best method?

BACKGROUND: Surgery is the only effective treatment for people with a body mass index (BMI) greater than 40 Kg/m² or even greater than 35 Kg/m² when some diseases like diabetes or hypertension appear. In order to minimize surgical risk and improve postoperative results, preoperative preparation it's very important. "Acute" preoperative weight loss just before surgery plays a crucial role in that preparation and can be achieved through different ways like a low calorie diet, a very low calorie diet or with the use of an intragastric balloon. The advantages or particularities of every one of them will be summarized in this article. MATERIAL AND METHODS: Literature review of the benefits, risks and complications of preoperative weight loss through a low calorie diet, a very low calorie diet or intragastric balloon placement. RESULTS: Seven of thirteen initially selected reports from Medline search were considered relevant, including a total 371 patients (240 patients treated with low calorie diet, 90 with very low calorie diet and 41 cases of intragastric balloon placement). We found that weight loss was greater in patients with very low calorie diets and intragastric balloon groups but with a slightly increase in morbidity and cost. CONCLUSION: Although there are no comparative studies, data from the literature results show that diets very low in calories are more effective and require less time than low-calorie diets and cheaper with fewer side effects than the intragastric balloon.

Myocardial protection by retrograde cardioplegic perfusion in the presence of acute coronary artery obstruction. An experimental study.

To investigate retrograde delivery of cardioplegic solutions as a means of enhancing myocardial protection in the presence of coronary artery occlusion, a two-part experimental model was devised. In part 1 (in vitro) the possibility of retroperfusing the entire myocardium during acute occlusion of the left anterior descending artery (LAD) was assessed. In part 2 (in vivo) acute LAD occlusion was performed in dogs, and during 2 hours of aortic cross-clamping crystalline cardioplegic solution was infused at 20-minute intervals. In group I the infusion was antegrade, via the aortic root, and in group II it was retrograde, via the coronary sinus. Thereafter the LAD snare was released and the dogs were weaned from bypass. Delivery of cardioplegia through the aortic root was associated with depression of ventricular function, poor myocardial cooling and severe cellular damage. With the retrograde procedure there was significantly improved recovery of left ventricular function, uniform myocardial cooling and better preservation of cellular morphology.

[The influence of attending theory classes and other factors on the academic performance of undergraduate surgery students]. / Influencia de la asistencia a las clases teóricas y otros factores en el rendimiento académico de alumnos pregraduados en Cirugía.

The authors have studied the influence of the academic history, class attendance, and use of commission notes on the student's academic performance, evaluated by the final marks, on a population of 335 sixth year students taking a surgical pathology course at the School of Medicine. The results show that previous marks correlate with the final surgery mark, that class attendance does not determine significant differences in the student's performance, and that the use of commission notes is widely spread conditioning a mediocre undergraduate [correction of pregraduate] theoretical education [correction of formation].