Oncocytic Lipoadenoma: Report of 3 Rare Cases Involving the Parotid Gland, Including a Synchronous Presentation With Paraganglioma of the Right Carotid Bifurcation and Literature Review.

Oncocytic lipoadenoma (OL) is a rare salivary gland tumor characterized by the presence of oncocytic cells and mature adipose tissue. To date, only 30 cases of OL have been reported in the English-language literature. We present 3 additional OL cases involving the parotid, including a synchronous presentation with paraganglioma of the right carotid bifurcation. Microscopically, both the OLs were composed of a mixed population of oncocytes and adipocytes in varying proportions surrounded by a thin, connective tissue fibrous capsule. Oncocytes were positive for pan-cytokeratins (CKs) AE1/AE3, epithelial membrane antigen, CK5, CK7, CK14, CK18, and CK19. Calponin, p63, alpha-smooth muscle actin, and carcinoembryonic antigen were negative. Vimentin and S-100 protein were positive only in adipose cells. Despite distinctive morphologic features, OL is often misdiagnosed, given its rarity. We hope to contribute to surgeons' and pathologists' awareness and knowledge regarding the existence of this tumor and provide adequate management through conservative surgical excision.

Sagliker syndrome in patients with secondary hyperparathyroidism and chronic renal failure: Case report.

INTRODUCTION: Sagliker described craniofacial, skeletal, neurologic and soft tissue abnormalities in patients with secondary hyperparathyroidism with end-stage chronic renal disease. This unique entity has been attributed to delay in treatment of renal insufficiency. As of 2012 sixty cases have been reported. The aim of the study is to report this entity in five patients and to propose this condition as an indication for parathyroidectomy. METHODS: We report five patients. All patients had chronic renal failure (CRF) and secondary hyperparathyroidism that fulfilled the criteria for Sagliker syndrome and underwent parathyroid surgery. We collected detailed information, including clinical history, laboratory data, and old/current photographs for comparison. RESULTS: The five patients, four women and one man mean age 21 years, had severe secondary hyperparathyroidism (mean serum preoperative PTH=3779.6pg/ml, mean preoperative Ca(2+)=8.83mg/dl and P(3-)=5.66mg/dl); maxillary and mandibular bone changes; teeth/dental abnormalities; and soft and benign tumors in the mouth. Three had severe uglifying facial appearance. All patients underwent total parathyroidectomy without postoperative complications. After surgery mean serum PTH was 17.16pg/ml (p=0.006), P(3-)=3.38mg/dl (p=0.0068) and Ca(2+)=6.97mg/dl (p=0.345). At surgery, average height was 149.8cm, a mean of 6cm (p=0.003) less than at the beginning of CRF. Preoperative Beck Depression Inventory test mean score was 37 (severe depression); 6 months after surgery mean score was 15.8 (mild mood disturbance)(p=0.0001). Clinical follow-up was satisfactory with a mean follow up time of 14 months. CONCLUSION: We consider that Sagliker syndrome should be added to current surgical indications for parathyroidectomy.

Acceptance of the WHO Surgical Safety Checklist among surgical personnel in hospitals in Guatemala city.

BACKGROUND: Studies have highlighted the effects the use of the WHO Surgical Safety Checklist can have on lowering mortality and surgical complications. Implementation of the checklist is not easy and several barriers have been identified. Few studies have addressed personnel's acceptance and attitudes toward the WHO Surgical Safety Checklist. Determining personnel's acceptance might reflect their intention to use the checklist while their awareness and knowledge of the checklist might assess the effectiveness of the training process. METHODS: Through an anonymous self- responded questionnaire, general characteristics of the respondents (age, gender, profession and years spent studying or working at the hospital), knowledge of the WHO Surgical Safety Checklist (awareness of existence, knowledge of objectives, knowledge of correct use), acceptance of the checklist and its implementation (including personal belief of benefits of using the checklist), current use, teamwork and safety climate appreciation were determined. RESULTS: Of the 147 surgical personnel who answered the questionnaire, 93.8% were aware of the existence of the WHO Surgical Safety Checklist and 88.8% of them reported knowing its objectives. More nurses than other personnel knew the checklist had to be used before the induction of anesthesia, skin incision, and before the patient leaves the operating room. Most personnel thought using the WHO Surgical Safety Checklist is beneficial and that its implementation was a good decision. Between 73.7% and 100% of nurses in public and private hospitals, respectively, reported the checklist had been used either always or almost always in the general elective surgeries they had participated in during the current year. CONCLUSIONS: Despite high acceptance of the checklist among personnel, gaps in knowledge about when the checklist should be used still exist. This can jeopardize effective implementation and correct use of the checklist in hospitals in Guatemala City. Efforts should aim to universal awareness and complete knowledge on why and how the checklist should be used.

Occult papillary thyroid carcinoma in postmortem species: prevalence at autopsy.

OBJECTIVE: The purpose of this study was to determine the prevalence of occult papillary thyroid cancer (OPTC) in a sample of cadavers from Guatemala, a country in Central America. STUDY DESIGN AND SETTING: This was a cross-sectional study of cadaver samples. We analyzed 150 glands that were removed during autopsy from 150 cadavers (34 women and 116 men) who were admitted to the morgue of the Judicial Bureau between January and March 2000. RESULTS: A total of 17 glands showed macroscopic evidence of disease, but only 3 glands (1 female and 2 males) showed microscopic evidence of malignancy. This corresponded to a 2% prevalence rate (range, 0.4-5.7%). The sex prevalence of OPTC was 2.9% (range, 0.07-15%) for females and 1.7% (range, 0.2-6.1%) for males. No significant difference was noted ( P = .47, exact unconditional test). The male-to-female ratio was 1:1.7. CONCLUSION: We concluded that the prevalence of OPTC in Guatemala is low but comparable to literature reports. Occult papillary thyroid carcinoma appears to have no sex predilection as opposed to the clinically evident papillary thyroid carcinoma, which develops more commonly in females. SIGNIFICANCE: Occult papillary thyroid carcinoma is a much more common pathology than clinically evident thyroid cancer, and the clinical implications still need to be determined.