ABSTRACT
Antecedentes: El hiperparatiroidismo primario es causado por un adenoma único en alrededor del 90 por ciento de los casos; debido a la más precisa localización preoperatoria, se ha cuestionado la exploración cervical bilateral en todos los enfermos. Objetivos: Presentar la técnica y los resultados de la paratiroidectomia radioguiada mínimamente invasiva (PRM) en el tratamiento del hiperparatiroidismo primario. Lugar y aplicación: Servicio de cirugía oncológica. Diseño: Observacional retrospectivo. Población: 54 pacientes consecutivos operados por hiperparatiroidismo primario: 49 para tratamiento primario y 5 por recidiva. Método: Ecografía y centellograma con Sesta MIBI preoperatorios y paratiroidectomía radioguiada con cámara manual para detección de radiaciones gamma. Resultados: La cámara manual localizó al adenoma en el 88,8 por ciento de los casos, mientras que la ecografía y el centellograma lo hicieron en el 76 y 87 por ciento respectivamente. La combinación de los tres métodos permitió ubicar el adenoma en toda la serie; en 15 oportunidades fue necesario prolongar la cervicotomía por patología tiroidea sincrónica y en 2 por carcinoma de paratiroides. Conclusiones: La PRMI es una técnica complementaria de los estudios preoperatorios
Subject(s)
Adult , Male , Humans , Female , Middle Aged , Hyperparathyroidism , Parathyroidectomy/methods , Parathyroid Glands , Parathyroid Glands/surgery , Hyperparathyroidism , Minimally Invasive Surgical Procedures/methods , Retrospective Studies , Technetium Tc 99m SestamibiABSTRACT
Antecedentes: El hiperparatiroidismo primario es causado por un adenoma único en alrededor del 90 por ciento de los casos; debido a la más precisa localización preoperatoria, se ha cuestionado la exploración cervical bilateral en todos los enfermos. Objetivos: Presentar la técnica y los resultados de la paratiroidectomia radioguiada mínimamente invasiva (PRM) en el tratamiento del hiperparatiroidismo primario. Lugar y aplicación: Servicio de cirugía oncológica. Diseño: Observacional retrospectivo. Población: 54 pacientes consecutivos operados por hiperparatiroidismo primario: 49 para tratamiento primario y 5 por recidiva. Método: Ecografía y centellograma con Sesta MIBI preoperatorios y paratiroidectomía radioguiada con cámara manual para detección de radiaciones gamma. Resultados: La cámara manual localizó al adenoma en el 88,8 por ciento de los casos, mientras que la ecografía y el centellograma lo hicieron en el 76 y 87 por ciento respectivamente. La combinación de los tres métodos permitió ubicar el adenoma en toda la serie; en 15 oportunidades fue necesario prolongar la cervicotomía por patología tiroidea sincrónica y en 2 por carcinoma de paratiroides. Conclusiones: La PRMI es una técnica complementaria de los estudios preoperatorios (AU)
Subject(s)
Adult , Male , Humans , Female , Middle Aged , Aged , Hyperparathyroidism/surgery , Parathyroidectomy/methods , Hyperparathyroidism/diagnostic imaging , Minimally Invasive Surgical Procedures/methods , Technetium Tc 99m Sestamibi/diagnosis , Parathyroid Glands/surgery , Parathyroid Glands/diagnostic imaging , Retrospective StudiesABSTRACT
Hyperparathyroidism is a relatively frequent condition mostly due to a solitary parathyroid adenoma. Although it has been claimed that surgical exploration is the best way to visualize the abnormal parathyroid gland, several imaging techniques have been proposed to localize it in order to simplify and shorten the surgical procedure. Echography, thalium-technetium scintigraphy, computerized tomography and nuclear magnetic resonance have shown a mean sensitivity of 75% which can be increased to about 90% by combining 2 or more of these procedures. In this study, we evaluated the utility of Tc-99m-sestamibi scintigraphy in 13 patients with hyperparathyroidism (11 primary, 2 secondary). High resolution neck echography was carried out in all of the cases. Cervical scans were obtained 10-15 min and 3 hours after giving an i.v. injection of 25 mCi Tc-99m-sestamibi in all the patients; suppression studies with combined 131-I were also done. Positive scans were obtained in 11 out of the 13 patients. Abnormal parathyroid glands were found and surgically excised in all the cases (10 adenomas, 1 carcinoma, 2 hyperplasias). Echographic localization had a sensitivity of only 33.3%. On the contrary, Tc-99m-sestamibi showed a sensitivity of 56% for the whole group, increasing to 82% in the 11 patients with primary hyperparathyroidism whereas the positive predictive value was of 91% and 90%, respectively. We conclude that Tc-99m-sestamibi is a very useful tool in localizing abnormal parathyroid glands and should be the first choice before reoperation after surgical failure or before the first parathyroid surgery whenever it is desired to shorten the surgical and anesthetic duration.
Subject(s)
Hyperparathyroidism/diagnostic imaging , Radiopharmaceuticals , Technetium Tc 99m Sestamibi , Adenoma/diagnostic imaging , Female , Humans , Hyperparathyroidism/surgery , Male , Middle Aged , Parathyroid Glands/diagnostic imaging , Parathyroid Neoplasms/diagnostic imaging , Preoperative Care , Radionuclide ImagingABSTRACT
We have studied by immunohistochemistry the nuclear expression of p53 and the finding of oncoprotein c-erbB-2 in a series of 85 breast carcinomas. The tissue was fixed in buffered formalin and embedded in paraffin. The primary antisera were obtained from Biogenex (USA), Bp53-12, monoclonal, used in a dilution of 1:100 for p53 and from Triton Diagnostics (USA), pAB-1, polyclonal, used in a dilution of 1:200 for c-erbB2. The detection system was the Vectastain Elite kit obtained from Vector Laboratories (USA). The results were compared with several morphological features of the tumors such as size and type of the tumor, extension of the intraductal component, nuclear grade, axillary lymph node metastasis and estrogen receptor data as well as with total and disease free survival. The oncoprotein p53 was detected in the nuclei in 25 (29.4%) of our cases (Fig 1). Its presence was correlated with tumor size (p < 0.01), high nuclear grade (p < 0.0001) and estrogen receptor negative tumors (p < 0.0001). There was an inverse relationship between p53 expression and 5 year disease free survival (p < 0.005). In 21 (24.7%) of the cases we found amplification of c-erbB-2. The staining pattern was membranous (Fig. 2). It was correlated significantly with the ductal type of invasive carcinoma (p < 0.05), an associated extensive intraductal component (p < 0.001), estrogen receptor negative tumors (p < 0.0001) and shortening of disease free survival in the patients with positive axillary lymph nodes (p < 0.005). In 9 cases we found staining for both markers without statistically significant relationship with the other features studied. We conclude that the presence of these genetic alterations demonstrated by immunohistochemistry were, in our series, unfavourable prognostic factors in invasive breast cancer.
Subject(s)
Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/pathology , Adult , Aged , Aged, 80 and over , Breast Neoplasms/diagnosis , Breast Neoplasms/genetics , Carcinoma, Ductal, Breast/diagnosis , Carcinoma, Ductal, Breast/genetics , Disease-Free Survival , Female , Follow-Up Studies , Gene Expression Regulation, Neoplastic , Humans , Immunohistochemistry , Middle Aged , Prognosis , Risk Factors , Staining and Labeling , Tumor Suppressor Protein p53/physiologyABSTRACT
We have studied by immunohistochemistry the nuclear expression of p53 and the finding of oncoprotein c-erbB-2 in a series of 85 breast carcinomas. The tissue was fixed in buffered formalin and embedded in paraffin. The primary antisera were obtained from Biogenex (USA), Bp53-12, monoclonal, used in a dilution of 1:100 for p53 and from Triton Diagnostics (USA), pAB-1, polyclonal, used in a dilution of 1:200 for c-erbB2. The detection system was the Vectastain Elite kit obtained from Vector Laboratories (USA). The results were compared with several morphological features of the tumors such as size and type of the tumor, extension of the intraductal component, nuclear grade, axillary lymph node metastasis and estrogen receptor data as well as with total and disease free survival. The oncoprotein p53 was detected in the nuclei in 25 (29.4
) of our cases (Fig 1). Its presence was correlated with tumor size (p < 0.01), high nuclear grade (p < 0.0001) and estrogen receptor negative tumors (p < 0.0001). There was an inverse relationship between p53 expression and 5 year disease free survival (p < 0.005). In 21 (24.7
) of the cases we found amplification of c-erbB-2. The staining pattern was membranous (Fig. 2). It was correlated significantly with the ductal type of invasive carcinoma (p < 0.05), an associated extensive intraductal component (p < 0.001), estrogen receptor negative tumors (p < 0.0001) and shortening of disease free survival in the patients with positive axillary lymph nodes (p < 0.005). In 9 cases we found staining for both markers without statistically significant relationship with the other features studied. We conclude that the presence of these genetic alterations demonstrated by immunohistochemistry were, in our series, unfavourable prognostic factors in invasive breast cancer.
ABSTRACT
The present studies were performed in order to analyze the incorporation of 3H-uridine into RNA and its hormonal regulation as well as the content of total iodine, T3, T4, RNA, DNA and protein in normal and abnormal human thyroid obtained at surgery. The content of protein, RNA and DNA is not significantly changed in follicular adenoma and in adenomatous goiter, RNA labeling from 3H-uridine showed similar values in slices from normal and abnormal glands. TSH and cyclic AMP increased the labeling of RNA in normal tissue but had no effect in the follicular adenoma and adenomatous goiter. A significant decrease in total iodine, T3 and T4 concentration was found in the pathological samples when compared to normals. The present results would suggest that in these patients the biochemical abnormalities lie at a step distal to the TSH receptor and the adenylate cyclase.
Subject(s)
Goiter/metabolism , RNA/biosynthesis , Thyroid Gland/metabolism , Thyroid Neoplasms/metabolism , Uridine/metabolism , Adenoma/metabolism , Adolescent , Adult , Aged , DNA/analysis , Female , Homeostasis , Humans , Male , Middle Aged , RNA/analysis , Thyrotropin/physiology , Triiodothyronine/physiology , TritiumABSTRACT
Los estudios realizados tuvieron como objetivo analizar la incorporacion de 3H-uridina al ARN y su regulacion hormonal, asi como el contenido total de yodo, T3,T4 ARN, ADN y proteina en tiroides humanas normales y anormales, obtenidas por cirurgia. El contenido de proteina, ARN y ADN no se encontro significativamente alterado en el adenoma folicular y en el bocio adenomatoso. La incorporacion de 3H-uridina al ARN de cortes tiroideos fue similar en glandulas normales y anormales. TSH y AMP ciclico estimularon la marcacion del ARN en tejido normal, pero no ejercieron efectos en adenoma folicular y bocio adenomatoso. Una disminucion significativa en la concentracion total de yodo, T3 y T4 fue observada en las muestras patologicas comparadas con las normales. Los resultados obtenidos sugeririan que las alteraciones bioquimicas de los pacientes estudiados estarian localizadas en un paso distal al receptor de la TSH y la adenilciclasa
Subject(s)
Adolescent , Adult , Middle Aged , Humans , Male , Female , RNA , Thyroid Gland , Tritium , UridineABSTRACT
The present studies were performed in order to analyze the incorporation of 3H-uridine into RNA and its hormonal regulation as well as the content of total iodine, T3, T4, RNA, DNA and protein in normal and abnormal human thyroid obtained at surgery. The content of protein, RNA and DNA is not significantly changed in follicular adenoma and in adenomatous goiter, RNA labeling from 3H-uridine showed similar values in slices from normal and abnormal glands. TSH and cyclic AMP increased the labeling of RNA in normal tissue but had no effect in the follicular adenoma and adenomatous goiter. A significant decrease in total iodine, T3 and T4 concentration was found in the pathological samples when compared to normals. The present results would suggest that in these patients the biochemical abnormalities lie at a step distal to the TSH receptor and the adenylate cyclase.
ABSTRACT
Los estudios realizados tuvieron como objetivo analizar la incorporacion de 3H-uridina al ARN y su regulacion hormonal, asi como el contenido total de yodo, T3,T4 ARN, ADN y proteina en tiroides humanas normales y anormales, obtenidas por cirurgia. El contenido de proteina, ARN y ADN no se encontro significativamente alterado en el adenoma folicular y en el bocio adenomatoso. La incorporacion de 3H-uridina al ARN de cortes tiroideos fue similar en glandulas normales y anormales. TSH y AMP ciclico estimularon la marcacion del ARN en tejido normal, pero no ejercieron efectos en adenoma folicular y bocio adenomatoso. Una disminucion significativa en la concentracion total de yodo, T3 y T4 fue observada en las muestras patologicas comparadas con las normales. Los resultados obtenidos sugeririan que las alteraciones bioquimicas de los pacientes estudiados estarian localizadas en un paso distal al receptor de la TSH y la adenilciclasa
Subject(s)
Adolescent , Adult , Middle Aged , Aged , Humans , Male , Female , Comparative Study , Thyroid Gland , RNA , Tritium , UridineSubject(s)
Calcitonin/analysis , Carcinoembryonic Antigen/analysis , Carcinoma/pathology , Thyroid Neoplasms/pathology , Adolescent , Adult , Aged , Carcinoma/analysis , Carcinoma/surgery , Female , Humans , Immunoenzyme Techniques , Male , Middle Aged , Thyroid Neoplasms/analysis , Thyroid Neoplasms/surgerySubject(s)
Adolescent , Adult , Middle Aged , Humans , Male , Female , Calcitonin , Carcinoembryonic Antigen , Thyroid NeoplasmsSubject(s)
Adolescent , Adult , Middle Aged , Aged , Humans , Male , Female , Carcinoembryonic Antigen , Calcitonin , Thyroid NeoplasmsABSTRACT
Se efectuo la determinacion histoquimica de receptores estrogenicos en 48 carcinomas mamarios usando un conjugado de 17Bestradiol con isotiocianato de fluoresceina que producia una fluorescencia citoplasmatica en las celulas positivas. Se demostro que todos los carcinomas mamarios estan compuestos por una mezcla en proporciones variables de celulas positivas y negativas para receptores estrogenicos. Utilizando criterios semicuantitativos, se consideraron a 23 de los 48 casos, como positivos. En el grupo positivo pero no en el negativo, la correlacion con los receptores estrogenicos dosados por la tecnica bioquimica fue excelente. El metodo histoquimico fue tambien aplicado a material citologico y al dosaje de receptores de progesterona con exito
Subject(s)
Humans , Female , Breast Neoplasms , Receptors, Estrogen , HistocytochemistryABSTRACT
Se efectuo la determinacion histoquimica de receptores estrogenicos en 48 carcinomas mamarios usando un conjugado de 17Bestradiol con isotiocianato de fluoresceina que producia una fluorescencia citoplasmatica en las celulas positivas. Se demostro que todos los carcinomas mamarios estan compuestos por una mezcla en proporciones variables de celulas positivas y negativas para receptores estrogenicos. Utilizando criterios semicuantitativos, se consideraron a 23 de los 48 casos, como positivos. En el grupo positivo pero no en el negativo, la correlacion con los receptores estrogenicos dosados por la tecnica bioquimica fue excelente. El metodo histoquimico fue tambien aplicado a material citologico y al dosaje de receptores de progesterona con exito
Subject(s)
Humans , Female , Breast Neoplasms , Receptors, Estrogen , HistocytochemistryABSTRACT
Se operaron 8 perros reemplazandose 4 sectores de pared abdominal con sendas protesis de Marlex, Dacron, tul de nylon y fascia de bovino. La fascia se comporto como el elemento protesico mejor incorporado y con menor reaccion inflamatoria. El tul de nylon presentaba una reaccion tisular mayor, mas prolongada y con tendencia al rechazo tardio, el Marlex y el Dacron una reaccion intermedia. Este ultimo no se incorporaba al tejido cicatrizal
Subject(s)
Abdominal Muscles , Surgical MeshABSTRACT
Se operaron 8 perros reemplazandose 4 sectores de pared abdominal con sendas protesis de Marlex, Dacron, tul de nylon y fascia de bovino. La fascia se comporto como el elemento protesico mejor incorporado y con menor reaccion inflamatoria. El tul de nylon presentaba una reaccion tisular mayor, mas prolongada y con tendencia al rechazo tardio, el Marlex y el Dacron una reaccion intermedia. Este ultimo no se incorporaba al tejido cicatrizal
