Experiencia en el tratamiento quirúrgico del hiperparatiroidismo primario

RESUMEN Introducción Revisamos la experiencia en el tratamiento quirúrgico del hiperparatiroidismo primario en el Hospital Universitario Santa Cristina de Madrid. Material y métodos Realizamos un estudio retrospectivo en el que evaluamos a 60 pacientes intervenidos de hiperparatiroidismo primario desde enero de 2005 a enero de 2017. Se recogen las características clínicas, datos bioquímicos preoperatorios y postoperatorios, así como las características de la cirugía con la medición de la PTH intraoperatoria (PTHIOP) Resultados 60 pacientes fueron intervenidos por un hiperparatiroidismo primario (edad media de 55,5 ± 15,3 años, 85 % mujeres). El principal criterio quirúrgico fue la hipercalcemia. El diagnóstico más frecuente fue de adenoma de paratiroides. En el 98,3% de los pacientes se localizó lesión en alguna de las pruebas de imagen realizada. En los casos en los que se realizó más de una prueba existió una concordancia en la localización de la lesión del 66%. En el 85,7 % de los casos la PTHIOP descendió más del 50%. Con un descenso medio en los pacientes con criterios de curación del 67,6 % y del 27,8 % en los que no se curaron. La mediana de PTHIOP final en los pacientes curados fue 48,1 pg/ml (13,776,3) frente a 114 pg/ml (15-226) en los que no se curaron Los pacientes que se curaron con la cirugía tenían de forma significativa menor edad, menor valor de PTHIOP a los 10 minutos, menor calcio postoperatorio y diagnóstico más frecuente de adenoma. Discusión El hiperparatiroidismo primario se presenta en la práctica con un espectro clínico cada vez más amplio. La selección de pacientes candidatos a cirugía de realizarse de forma precisa, de cara a obtener el mayor beneficio clínico posible. La medición de PTHIOP es una herramienta útil en el tratamiento quirúrgico del HPP y aporta un valor pronóstico en el seguimiento de estos pacientes.

ABSTRACT Introduction A retrospective study was conducted on 60 patients operated of primary hyperparathyroidism from January 2005 to January 2017. We collected clinical data, biochemical parameters and the surgery characteristics included the measurement of intraoperative parathormone (IOPPTH). Results Sixty operated patients aged 55, 5 ± 15, 3 years (85 % female) were studied. The main surgical criteria was the hypercalcemia, but 15% of the patients had normocalcemic hyperparathyroidism. Adenoma was the most frequent diagnosis. Most patients had preoperative imaging studies with parathyroid disease. In patients with more than one imaging studies the agreement in the localization of abnormal parathyroid gland was 66%. IOPPTH dropped >50% in the 85,7% of the patients. The IOPPTH mean decrease was 67,6% and 27,8% in the patients who achieved healing or not and the median last IOPPTH in surgery was 48,1 pg/ml (13,7-76,3) vs 114 pg/ml (15-226). Patients who achieved healing after surgery were significantly younger. They had ten minutes IOPPTH and postoperative calcium lower and adenoma was the most common diagnosis. Conclusions Primary hyperparathyroidism occurs in clinical practice with an increasingly broad spectrum. The selection of patients candidates for surgery must be carried out accurately, in order to obtain the greatest possible clinical benefit. The measurement of IOPPTH is a useful tool in the surgical treatment and it provides a prognostic value in the follow-up of these patients.

Association between maltreatment and polydrug use among adolescents.

Different studies have related sexual and physical abuse during childhood and adolescence to the development of substance abuse disorders. Nevertheless, we are not aware of the role that other more common maltreatment types, such as neglect, will play among the most risky pattern of consumption: the polydrug use. A clinical sample of 655 adolescents, divided into two groups: polydrug users and non-polydrug users, were assessed on their pattern of drug consumption, history of childhood maltreatment, current psychopathology and their family history of alcoholism. Polydrug users had a greater prevalence of all types of maltreatment, although the most associated to this group were sexual abuse and emotional neglect. Other relevant variables to adolescent consumption were: the diagnosis of depressive disorder, the presence of anxiety traits and the family history of alcohol dependence. Polydrug users have higher risks of having had problems during infancy and adolescence, such as maltreatment and other psychopathological conditions, with the addition of family history of alcoholism. Accordingly, practitioners should take into account that those variables may influence polydrug abuse because it is the most risky pattern for subsequent dependence of substances, and they should always be considered during treatment.

Assessment of virulence factors characteristic of human Escherichia coli pathotypes and antimicrobial resistance in O157:H7 and non-O157:H7 isolates from livestock in Spain.

The distribution of virulence factors (VFs) typical of diarrheagenic Escherichia coli and the antimicrobial resistance (AMR) profiles were assessed in 780 isolates from healthy pigs, broilers, and cattle from Spain. VF distribution was broader than expected, although at low prevalence for most genes, with AMR being linked mainly to host species.

Prevalence of Shiga toxin-producing Escherichia coli, Salmonella spp. and Campylobacter spp. in large game animals intended for consumption: relationship with management practices and livestock influence.

Although wild ruminants have been identified as reservoirs of Shiga-toxin producing Escherichia coli (STEC), little information is available concerning the role of Salmonella spp. and Campylobacter spp. in large game species. We evaluated the presence of these pathogens in faeces (N=574) and carcasses (N=585) sampled from red deer (N=295), wild boar (N=333) and other ungulates (fallow deer, mouflon) (N=9). Animal sampling was done in situ from 33 hunting estates during two hunting seasons. Salmonella spp. and Campylobacter spp. strains associated with human campylobacteriosis were infrequently detected indicating that both pathogens had a limited zoonotic risk in our study area. The overall STEC prevalence in animals was 21% (134/637), being significantly higher in faeces from red deer (90 out of 264). A total of 58 isolates were serotyped. Serotypes O146:H- and O27:H30 were the most frequent in red deer and the majority of isolates from red deer and wild boar were from serotypes previously found in STEC strains associated with human infection, including the serotype O157:H7. The STEC prevalence in red deer faeces was significantly higher with the presence of livestock (p<0, 01) where high densities of red deer (p<0.001) were present. To the best of our knowledge, this is the first study reporting the occurrence of Salmonella spp. and STEC in carcasses of large game animals. Furthermore, this study confirmed by pulsed-field gel electrophoresis (PFGE) that cross contamination of STEC during carcass dressing occurred, implying the likelihood of these pathogens entering into the food chain.