History of parathyroid surgery in Puerto Rico

Review article that includes the worldwide history, as a reference for the readers, and the local history of hyperparathyroidism in Puerto Rico.

Parathyroid surgery without instant PTH or radioguided Sestamibi scan

BACKGROUND: Radioguided Sestamibi scan and instant PTH (iPTH) are being used in minimally invasive parathyroid surgery (MIP). Experienced surgeons cure over 90-95% of the patients with primary hyperparathyroidism. PURPOSE/METHOD: To study the surgical results in treating hyperparathyroidism in a for profit community hospital lacking both iPTH and radioguided Sestamibi scan, we reviewed the patients operated from November 1, 2005 to October 31, 2006. RESULTS: The study comprised 56 patients: 52 with primary hyper-parathyroidism, three with secondary hyperparathyroidism and one with tertiary hyperparathyroidism. The only localizing test utilized pre-operatively was the Sestamibi Scan. PTH was measured immediately before and after surgery but the results was received seven to ten days later. The affected glands were removed in all patients. Fifty of 52 (96%) of the patients with primary hyperparathyroidism, the three patients with secondary hyper-parathyroidism and the patient with tertiary hyperparathyroidism are normocalcemic with normal PTH levels. Two patients have persistent mild hypercalcemia. Associated conditions were three papillary carcinoma of the thyroid, three multinodular goiter, four had a single thyroid nodule, one had an adrenal tumor and three were reoperations. CONCLUSION: Parathyroid surgery can be done safely and effectively in community hospitals without the utilization of radioguided Sestamibi scan and iPTH measurement.

Características sociales y clínicas del embarazo en adolescentes / Social and clinical features of pregnancy in adolescents

Pregnancy in adolescents is a public health problem that should be evaluated in the framework of a socio ecological model. Puerto Rico is among the countries with a higher pregnancy rate among adolescents, 42 per 1000 births for 2002. This is an observational cross-sectional study of deliveries of pregnant adolescents carried out at Hospital San Lucas II between the years 2000 to 2004. The total number of deliveries that fulfilled the selection criteria was 110. The data was obtained from the medical record of the mother and the newborn. The variables analyzed were: age, prenatal care, age of gestation, birthweight of the newborn, Apgar, maternal infections, infections in the newborn, education of the mother, work and marital state. The percentage of deliveries preterm was greater than the expected for adult women. The outcomes in the newborns preterm were worse than those born at term. The percentage of caesarean sections in the adolescents was smaller than in the population of women in general. Teenage mothers tend to drop out of school. The results of our study indicate the need of interventions following an ecological model in order to be more effective in the prevention of adolescent pregnancies and its consequences.

The surgical management of insulinoma

Insulinoma is the most common endocrine tumor of the pancreas. Over 90 of the insulinomas are benign and single, and can be cured by simple excision. Depending on the location, insulinomas can be enucleated, might require partial or distal pancreatectomy or pancreaticoduodenectomy. Five cases with insulinoma successfully treated by surgical intervention, two by enuclation, two by distal pancreatectomy and splenectomy, and preservation of the spleen have been summarized. The management of insulinoma involves the diagnosis, localization of the tumor and treatment. Insulinomas are rare tumors of the pancreas. Nevertheless, it is the most common endocrine tumor of the pancreas. Specifically arising from the beta cells, of the islets of Langerham, that produce insulin (fig.1). Its incidence is one in 250,000 inhabitants. It can be seen at any age, but is more frequent in females between 4 and 82 years of age, with a mean of 45.5 years. Insulinomas are evenly distributed between the head, body and tail of the pancreas. Over 90 are benign and single and can be cured by simple excision. Depending on the location insulinomas can be enucleated, might require partial or distal pancreatectomy or a pancreaticoduodenectomy. Ten percent could be malignant when metastasis to peripancreatic lymph nodes or to the liver is detected. The course of the patient with malignant insulinoma is an indolent one. The release of insulin leads to fasting hypoglycemia producing confusion, loss of consciousness, coma or convulsions. The hypoglycemia in turn can induce the release of cathecolamines producing tachycardia, tremulousness and diaphoresis. The Whipple's triad must be present for the diagnosis of insulinoma; symptoms of hypoglycemia, glucose level below 50 mgs/dl and relief of symptoms by the administration of glucose. In large series the interval between the onset of symptoms and a definitive diagnosis of insulinoma was 37 months, with a range of 0 to 14 years

Extra-adrenal pheochromocytoma

We have presented our experience in the diagnosis and management of three patients with extra-adrenal pheochromocytomas. Only two had hypertension, although all three had increased catecholamine production. The third patient was normotensive preoperatively and remained normotensive after the immediate postoperative period. Two patients are alive and without evidence of disease, the third patient died from what was considered to be a malignant pheochromocytoma. All three patients presented with palpable masses, confirmed by computerized tomography

Surgical management of hyperparathyroidism. A 24 years experience

Our 24 years experience in the surgical treatment of 130 patients with primary hyperparathyroidism was presented. A single adenoma of the parathyroid glands was the predominant lesion. The lower parathyroid glands were more frequently the site of the adenoma, with the right lower gland presenting the highest incidence. The incidence of hyperplasia and carcinoma is similar to the reported literature. The offending glands were identified in the vast majority of the patients. The number of complications is significantly low with a zero surgical mortality. The utilization of preoperative localizing test is not recommended for the initial neck exploration. Satisfactory results can be obtained with a minimal work up

Hypertension secondary to adrenal tumors ten years experience

We have presented our ten years experience in the surgical management of adrenal tumors. Patients presenting with hypertension (9) are normotensive following the removal of the offending adrenal tumor. One patient had an extra-adrenal pheochromocytoma, one had a huge organized adrenal hematoma and one patient has a non-functional tumor. The diagnosis and management of endocrine tumors is a challenge to the clinician

Modification of electrocyte membrane lipid composition induced by denervation

1. We determined the effect of denervation on the lipid composition of the main electric organ and electrocyte postsynaptic membrane vesicles of Electrophorus electricus. 2. Lipid extracts of whole electric organ contain mainly cholesterol, triglycerides, phosphatidylcholine and phosphatidlethanolamine. After 30 days of denervation, the lipid composition of whole electric organ did not change appreciably. 3. Lipid extracts of the membrane vesicles were similar, except that they contained mainly free fatty acids rather than triglycerides. After 30 days of denervation, cholesterol concentration was increased and phsopholipids were decreased in the membrane fraction, with higher relative concentrations of phosphatidylethanolamine and cerebrosides. 4. These results suggest that electrocyte membrane fluidity and permeability will change after 30 days of denervation