Cystic parathyroid adenoma: Primary hyperparathyroidism without 99mTc-MIBI uptake. / Adenoma quístico paratiroideo: hiperparatiroidismo primario sin captación de 99mTc-MIBI.

Cystic parathyroid adenoma is a rare disease (<0.01% of all cervical masses) that associates primary hyperparathyroidism in 9% of cases. Parathyroid scintigraphy is essential for its diagnosis with uncommon false negative results. Hybrid SPECT/CT equipments allow a more accurate diagnosis. Functional cystic parathyroid adenomas are surgically treated. A case of a 64-year-old woman with diagnoses of hyperparathyroidism and a cystic parathyroid adenoma without uptake in scintigraphy is described.

Consideraciones en torno a la formación del residente en cirugía de pared abdominal en España / Training of residents in abdominal wall surgery in Spain

La formación del residente en cirugía de la pared abdominal constituye un aspecto fundamental en la formación quirúrgica, representando globalmente un 20% de su actividad. En el presente artículo, se analiza el estado actual de la formación del residente en este tipo de cirugía en España teniendo en cuenta el amplio espectro en el que se desarrolla: servicios generales, unidades funcionales específicas, programas de cirugía mayor ambulatoria. Para ello, partiendo de las especificaciones del programa de la especialidad, se han utilizado datos concretos obtenidos de diversas fuentes de información directas, así como una revisión de los resultados obtenidos por los residentes en cirugía herniaria. En general los residentes en nuestro país manifiestan su conformidad con la formación recibida, y los resultados objetivos registrados se adecuan a los planteados en el programa. Sin embargo, sería importante estructurar en sus itinerarios docentes, un periodo de rotación en alguna Unidad específica y su implicación en programas de cirugía mayor ambulatoria (AU)

The training of residents in abdominal wall surgery is a fundamental aspect of surgical training, representing globally 20% of its activity. In this paper, we analyze the current state of resident training in this kind of surgery in Spain, taking into account the broad spectrum it covers: general services, specific functional units, ambulatory surgery programs. To do this, based on the specifications of the specialty program, specific data were used from several different sources of direct information and a review of the results obtained by residents in hernia surgery. In general, our residents agree with their training and the recorded results are in line with objectives outlined in the program. However, it would be important to structure their teaching schedules, a rotation period in any specific unit and their involvement in outpatient surgery programs (AU)

[Training of residents in abdominal wall surgery in Spain]. / Consideraciones en torno a la formación del residente en cirugía de pared abdominal en España.

The training of residents in abdominal wall surgery is a fundamental aspect of surgical training, representing globally 20% of its activity. In this paper, we analyze the current state of resident training in this kind of surgery in Spain, taking into account the broad spectrum it covers: general services, specific functional units, ambulatory surgery programs. To do this, based on the specifications of the specialty program, specific data were used from several different sources of direct information and a review of the results obtained by residents in hernia surgery. In general, our residents agree with their training and the recorded results are in line with objectives outlined in the program. However, it would be important to structure their teaching schedules, a rotation period in any specific unit and their involvement in outpatient surgery programs.

[Timing of tourniquet release in total knee arthroplasty doesn't affect on transfusion needs]. / El momento de retirada del manguito de isquemia en las artroplastias totales de rodilla no influye en la necesidad de transfusión.

OBJECTIVE: To determine whether the removal of the ischaemia tourniquet to perform haemostasis during knee replacement surgery, reduces bleeding, the need for transfusions, the incidence of complications, the incidence of further surgery, and the hospital stay. PATIENTS AND METHOD: A non-randomised, prospective, descriptive and observational study was conducted on patients subjected to primary knee replacement with only one anaesthetist and 2 surgical teams. The same surgical technique and prosthesis model was used, with 2 schemes for ischaemia removal and drainage management. The patients were divided into 2 groups. In group i, the ischaemia tourniquet was released during the operation, before wound closure, and leaving the drainages without a vacuum. In group ii the tourniquet was released when the limb was bandaged and the drainages were connected to a vacuum. The parameters recorded were; bleeding during surgery, bleeding due to the drainages, monitoring the haemoglobin and haematocrit, incidence of complications and further surgery, transfusion needs, and hospital stay. RESULTS: The study included 100 patients. The mean bleeding during surgery was 230,0mL in group i and 2,0mL in group ii (P<.05). The bleeding due to the drainages in group i was 531,2mL and 601,6mL in Group ii (P>.05). The total bleeding was 754,3mL in group i and 621,6mL in group ii. There were statistically significant differences in both cases (P<.05). The transfusion incidence in both groups was 16,7%. There were no significant differences between either group as regards medical complications or further surgery. A longer hospital stay was observed in group ii. CONCLUSION: In this study, the need for transfusions in knee replacement surgery is not influenced by the time of releasing the ischaemia tourniquet. There is also no relationship between the incidence in postoperative complications and further surgery and the time of removing the tourniquet. The preoperative haemoglobin was the only predictive factor of transfusion in our study.

[Minimally invasive surgical gastrostomy]. / Gastrostomía quirúrgica mínimamente invasiva.

GOAL: Description of a simple surgical gastrostomy technique fulfilling minimally-invasive surgery criteria and presentation of the results obtained with the same, compared with those of other surgical gastrostomies and percutaneous techniques. SCOPE: Patients from various wards in the Miguel Servet Teaching Hospital in Zaragoza, whether admitted or out-patients, all seen by the Hospital Nutrition Unit and where food-restricting gastrostomy is indicated. PATIENTS AND METHODS: Prospective study including the first fifteen successive patients in whom a minimally-invasive surgical gastrostomy technique has been applied between January 1st, 2001, and June 30th, 2002, and in whom it was not possible, for a variety of reasons, to perform any kind of percutaneous gastrostomy. The technique was applied in the operating theatre, under local anaesthetic, using a Flexiflo 20 F gastrostomy probe and with antibiotic prophylaxis (Amoxicillin-Clavulanic Acid: 2 g i.v. pre-operatively). Patients were assessed as out-patients by the Nutrition and Surgery Unit after 10, 30 and 60 days. RESULTS: The procedure could be successfully completed in all cases. The mean time of the procedures duration was 45 minutes. In 5 patients, the procedure was performed without admission to hospital. The functionality of the device was 100% and it was effective from 10 days after the operation. Morbidity: 6.6%. Mortality after 60 days: 0%. CONCLUSIONS: This is a procedure which is safe, simple, economic and capable of being performed as an out-patient procedure, thus complying with the criteria for minimally-invasive techniques. It is complementary or an alternative to percutaneous techniques in selected cases or where these are impossible, have failed or are contraindicated.

Linfoma secundario de mama: ¿expresión de un linfoma extranodal tipo Malt? / Secondary lymphoma of the breast: expression of extranodal MALT-type hymphoma?

La afectación de la mama por un linfoma tanto primaria como secundariamente, resulta muy poco frecuente debido a la escasez de población linfocitaria normal en dicho órgano, aunque la introducción del concepto MALT (mucosa associated lymphoid tissue), justificaría la aparición de linfomas en determinados tejidos y órganos extraganglionares como la mama. La mayoría de la bibliografía consultada hace referencia a linfomas primarios de mama siendo pocos los trabajos que hacenreferencia a la afectación secundaria de la mama por un linfoma de otra localización primaria. Se presenta un caso de linfoma secundario de mama diagnosticado preoperatoriamente mediante PAAF. Dado el tamaño y características de la tumoración, así como los antecedentes, se realizó mastectomía radical modificada tipo Madden. Diagnóstico: Linfoma no Hodgkin, inmunoblástico, de alto grado (W.F.), Estadio I, compatible con criterios de linfoma secundario de mama tipo MALT (AU)

Vólvulo gástrico / Gastric volvulus

El vólvulo gástrico organoaxial o mesentericoaxial es una entidad rara de la que se describen en la literatura casos aislados. Se presentan 5 casos en todos ellos acompañados de una alteración diafragmática. El diagnóstico se hace fundamentalmente por la radiografía con contraste. El tratamiento médico hace que se resuelba el problema en la mayoría de los casos. La indicación operatoria se establece cuando el proceso no responde al tratamiento médico, por las recidivas, gravedad de la sintomatología y valorando el riesgo quirúrgico. La operación consiste en corección de la hernia diafragmática y gastropexia entre la pared abdominal y el estómago a nivel de la curvadura menor, a lo que nosotros hemos añadido una segunda pexia entre la pared y la cara anteior del estómago próxima a la curvadura mayor (AU)

[Completely implantable venous access systems. A study of the morbidity and benefits of a model third-generation device, the PAS Port with Cath-Finder]. / Sistemas de acceso venoso totalmente implantables. Estudio de la morbilidad y rentabilidad de un modelo de dispositivo de tercera generación, PAS Port con Cath-Finder.

Venous access for chemotherapy in oncological patients, has experienced continuous modifications in recent years, both with regard to the types of devices used as with regard to the venous access itself. We present a prospective study of two groups of 25 patients, in which the patients in the first group were given a Port-A-Cath PAS Port venous access system with a Cath-Finder catheter locating system, and those in the second group were given a conventional Implantofix and Hickman venous access system. The device placed in the first group belongs to a third generation venous access system, involving a simple and safe placing technique which neither requires an operating room nor radiology. The incidence of complications in the first group was similar to that seen in conventional systems. To prevent early or late phlebitis in the cephalic or basilar vein, we recommended the prophylactic use of low molecular weight heparin during the procedure and maintaining this during the next three to five days, as well as during each new chemotherapy session and at any time this complication may arise. The economic benefits of this device are much greater than those of conventional systems.