Embolia esplénica / Splenic embolism

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The pattern of the descent of PTH measured by intraoperative monitoring of intact-PTH in surgery for renal hyperparathyroidism.

BACKGROUND: In the setting of total parathyroidectomy and autotransplantation surgery (TPTxAS) treatment for secondary hyperparathyroidism (SHPT) we evaluated whether intraoperative parathyroid hormone (iPTH) monitoring is an useful tool as a reference for total parathyroid removal. DESIGN: Prospective open single value measurement efficacy study of one intraoperative (i.o.) diagnostic monitoring method (iPTH) on a cohort of surgical patients. PATIENTS: All patients (n = 35) undergoing TP and SCTx at the Department of Surgery, Donostia Hospital from January 2002 to December 2006. MAIN OUTCOME MEASURES: Serum levels of iPTH during surgery and prediction time of the of descent of PTH levels (measured in the clinic, at admission day and intra-operatively during induction of anesthesia, and every 5 and 10 minutes after removal of adenoma and 24 hours thereafter) were analyzed. RESULTS: iPTH levels dropped clearly at ten minutes in all 35 patients and were non-measurable at 24 hours. iPTH decreased from pathological (1302.24 + 424.9 pg/ml) to half (50%) the values at the third intra-operative determination - minute 10 - (614.8 ± 196.62) and was undetectable at 24 hours. CONCLUSIONS: Intra-operative measurement of iPTH is useful in the prediction of complete removal of all parathyroid tissue prior to autotransplantation thus avoiding persistence because of incomplete surgery.

[Evaluation of parathyroid function in presternal subcutaneous grafting after total parathyroidectomy for renal hyperparathyroidism]. / Evaluación de la función paratiroidea en el injerto subcutáneo preesternal tras paratiroidectomía total en el hiperparatiroidismo renal.

INTRODUCTION: In the setting of total parathyroidectomy (TPT) and parathyroid transplantation (PTx) for renal hyperparathyroidism (RHP), we evaluated long-term parathyroid graft function after subcutaneous presternal transplantation (SCPTx). HYPOTHESIS: Parathyroid glands are surrounded by fatty tissue. Therefore, we postulated that subcutaneous implantation of parathyroid tissue after TPT for RHP could be at least as effective as intramuscular grafting and would avoid the complications of the latter technique. MATERIAL AND METHOD: We performed a study in a university hospital and its dialysis unit. DESIGN: Prospective open efficacy study of a postoperative diagnostic monitoring method of intact parathyroid hormone (iPTH) in a cohort of surgical patients without loss to follow-up. PATIENTS AND INTERVENTIONS: Thirty-five patients (19 women and 16 men) underwent TPT and SCPTx for RHP at the Department of General Surgery and Department of Nephrology, Donostia Hospital, San Sebastián, Gipuzkoa, Spain, from January 2002 to December 2005. Follow-up ranged from 6 to 42 months (mean, 15.4 months). Graft function was evaluated by measurement of plasma iPTH levels before surgery and 24 hours and 1, 3, 5, 15, 30, 60, 100 and 150 weeks after surgery. Reference values for PTH in our laboratory were 20-65 pg/mL. RESULTS: The mean preoperative iPTH values were 1245 +/- 367.9 pg/mL (mean +/- SD) (range, 493-2160). After TPT and SCPTx, iPTH levels became undetectable in all patients at 24 hours. A value of 50 pg/mL was established as the criterion for adequate parathyroid graft function. The following values were obtained: 15.54 +/- 10.61 pg/mL (mean +/- SD) (range, 6-44) after 1 week, 57.2 +/- 1.9 pg/mL (mean +/- SD) (range, 43-74) after 5 weeks, 64.21 +/- 9.73 pg/mL (mean +/- SD) (range, 11.3-89) after 15 weeks, 75.12 +/- 9.05 pg/mL (mean +/- SD) (range, 24.6-104.2) after 30 weeks, 101.63 +/- 19.85 pg/mL (mean +/- SD) (range, 65-143) after 60 weeks, 121.63 +/- 27.85 pg/mL (mean +/- SD) (range, 62-179) after 100 weeks, 63 +/- 19.85 pg/mL (mean +/- SD) (range, 68-723) after 150 weeks and 102 +/- 18.65 pg/mL (mean +/- SD) (range, 68-113) after 200 weeks. The prevalence of hypoparathyroidism (serum iPTH level of < 20 pg/mL with a normal or low serum calcium concentration) was 2 out of 35 patients (5.71%) by week 60, with recovery of normal values by week 100. Graft-related recurrence occurred in one out of 35 patients (2.85%). CONCLUSIONS: SCPTx after TPT and PTx for secondary RHP is an adequate method to replace muscular forearm parathyroid transplantation and avoid its complications. The functional results of TPT and SCPTx compare favorably with published data on other surgical techniques proposed for the treatment of RHP. Long-term follow-up of this series is currently being performed.

Evaluación de la función paratiroidea en el injerto subcutáneo preesternal tras paratiroidectomía total en el hiperparatiroidismo renal / Evaluation of parathyroid function in presternal subcutaneous grafting after total parathyroidectomy for renal hyperparathyroidism

Introducción. En el contexto de la paratiroidectomía total (TPT) y trasplante paratiroideo (PTx) para el hiperparatiroidismo renal (RHP) evaluamos la función a largo plazo de injerto paratiroideo después de trasplante subcutáneo preesternal (SCPTx). Hipótesis: las glándulas paratiroideas están rodeadas por tejido adiposo. Por lo tanto, postulamos que la implantación subcutánea después de paratiroidectomía en el hiperparatiroidismo renal puede ser al menos tan eficaz como el implante muscular y sin sus complicaciones evolutivas. Material y método. Estudio realizado en un hospital universitario y su unidad de diálisis. Diseño: estudio prospectivo sobre la eficacia del procedimiento mediante determinación de paratirina intacta (iPTH) en una cohorte de pacientes quirúrgicos sin pérdida en el seguimiento. Pacientes e intervenciones: 35 (19 mujeres y 16 varones) fueron sometidos a TPT y SCPTx por RHP en el Departamento de Cirugía y Servicio de Nefrología, Hospital de Donostia (San Sebastián, Gipuzkoa, España), entre enero de 2002 y diciembre de 2005. El seguimiento ha variado entre 6 y 42 (media, 15,4) meses. Se evaluó la función del injerto mediante la determinación de las concentraciones plasmáticas de iPTH antes de la operación y 24 horas y 1, 3, 5, 15, 30, 60, 100, 150 y 200 semanas después. Los valores de referencia para la PTH en nuestro laboratorio fueron de 20-65 pg/ml. Resultados. Los valores medios preoperatorios ± desviación estándar de iPTH fueron de 1.245 ± 367,9 (rango, 493-2.160) pg/ml. Después de la TPT y el SCPTx, las concentraciones de iPTH llegaron a ser indetectables en todos los casos a las 24 horas. Se estableció 50 pg/ml como criterio de función adecuada de injerto paratiroideo. Los valores obtenidos fueron: 15,54 ± 10,61 (rango, 6-44) pg/ml a la semana, 57,2 ± 1,9 (rango, 43-74) pg/ml a las 5 semanas, 64,21 ± 9,73 (rango, 11,3-89) pg/ml a las 15 semanas, 75,12 ± 9,05 (rango, 24,6-104,2) pg/ml a las 30 semanas, 101,63 ± 19,85 (rango, 65-143) pg/ml a las 60 semanas, 121,63 ± 27,85 (rango, 62-179) pg/ml a las 100 semanas, 63 ± 19,85 (rango, 68-723) pg/ml a las 150 semanas y 102 ± 18,65 (rango, 68-113) pg/ml a las 200 semanas. La frecuencia de hipoparatiroidismo (concentración de iPTH en suero < 20 pg/ml con una concentración normal o baja de calcio en suero) fue 2/35 (5,71%) a la semana 60, y se recuperó para la semana 100. La recidiva relacionada con el injerto fue del 2,85% (1/35). Conclusiones. El trasplante subcutáneo preesternal tras paratiroidectomía total y trasplante paratiroideo para el hiperparatiroidismo renal secundario parece un método adecuado como alternativa al trasplante muscular antebraquial y para evitar sus complicaciones. Los resultados funcionales del injerto se comparan favorablemente con los datos publicados sobre otras técnicas quirúrgicas utilizadas para el tratamiento del hiperparatiroidismo renal. El seguimiento a largo plazo de la serie está en curso (AU)

Introduction. In the setting total of parathyroidectomy (TPT) and parathyroid transplantation (PTx) for renal hyperparathyroidism (RHP), we evaluated long-term parathyroid graft function after subcutaneous presternal transplantation (SCPTx). Hypothesis: Parathyroid glands are surrounded by fatty tissue. Therefore, we postulated that subcutaneous implantation of parathyroid tissue after TPT for RHP could be at least as effective as intramuscular grafting and would avoid the complications of the latter technique. Material and method. We performed a study in a university hospital and its dialysis unit. Design: Prospective open efficacy study of a postoperative diagnostic monitoring method of intact parathyroid hormone (iPTH) in a cohort of surgical patients without loss to follow-up. Patients and interventions: Thirty-five patients (19 women and 16 men) underwent TPT and SCPTx for RHP at the Department of General Surgery and Department of Nephrology, Donostia Hospital, San Sebastián, Gipuzkoa, Spain, from January 2002 to December 2005. Follow-up ranged from 6 to 42 months (mean, 15.4 months). Graft function was evaluated by measurement of plasma iPTH levels before surgery and 24 hours and 1, 3, 5, 15, 30, 60, 100 and 150 weeks after surgery. Reference values for PTH in our laboratory were 20-65 pg/mL. Results. The mean preoperative iPTH values were 1245 ± 367.9 pg/mL (mean ± SD) (range, 493-2160). After TPT and SCPTx, iPTH levels became undetectable in all patients at 24 hours. A value of 50 pg/mL was established as the criterion for adequate parathyroid graft function. The following values were obtained: 15.54 ± 10.61 pg/mL (mean ± SD) (range, 6-44) after 1 week, 57.2 ± 1.9 pg/mL (mean ± SD) (range, 43-74) after 5 weeks, 64.21 ± 9.73 pg/mL (mean ± SD) (range, 11.3-89) after 15 weeks, 75.12 ± 9.05 pg/mL (mean ± SD) (range, 24.6-104.2) after 30 weeks, 101.63 ± 19.85 pg/mL (mean ± SD) (range, 65-143) after 60 weeks, 121.63 ± 27.85 pg/mL (mean ± SD) (range, 62-179) after 100 weeks, 63 ± 19.85 pg/mL (mean ± SD) (range, 68-723) after 150 weeks and 102 ± 18.65 pg/mL (mean ± SD) (range, 68-113) after 200 weeks. The prevalence of hypoparathyroidism (serum iPTH level of < 20 pg/mL with a normal or low serum calcium concentration) was 2 out of 35 patients (5.71%) by week 60, with recovery of normal values by week 100. Graft-related recurrence occurred in one out of 35 patients (2.85%). Conclusions. SCPTx after TPT and PTx for secondary RHP is an adequate method to replace muscular forearm parathyroid transplantation and avoid its complications. The functional results of TPT and SCPTx compare favorably with published data on other surgical techniques proposed for the treatment of RHP. Long-term follow-up of this series is currently being performed (AU)

Parathyroid subcutaneous pre-sternal transplantation after parathyroidectomy for renal hyperparathyroidism. Long-term graft function.

BACKGROUND: In the setting of total parathyroidectomy (TPT) and parathyroid transplantation (PTx) for renal hyperparathyroidism (RHP), we evaluated long-term parathyroid graft function after subcutaneous pre-sternal transplantation (SCPTx). Because parathyroid glands are surrounded by fatty tissue, we postulated that results of subcutaneous implantation of parathyroid tissue after total parathyroidectomy for renal hyperparathyroidism could be at least as successful as intramuscular grafting, but without its complications. PATIENTS AND METHODS: The study, a prospective open efficacy study of postoperative (po) diagnostic monitoring of intact parathyroid hormone (iPTH) on a cohort of surgical patients, was conducted within a university hospital with a dialysis unit. Thirty five patients (19 women and 16 men) operated on for renal hyperparathyroidism underwent TPT and SCPTx for RHP at the Department of General Surgery and the Department of Nephrology. Donostia Hospital. San Sebastián. Gipuzkoa. Spain, from January 2002 to December 2005. Follow-up ranges from 6 months to 42 months (median: 15.4 months). The main outcome measure was evaluation of graft function by measurement of iPTH plasma level, based on serum levels of iPTH before operation and 24 h and 1, 3, 5, 15, 30, 60, 100, and 150 weeks after surgery. RESULTS: Average preoperative iPTH values were 1,341.52 + 367.78 pg/ml (mean +/- SD) (range: 493-2,180). After TPT and PSCTx, iPTH levels became undetectable in all patients at 24 h. A level of 50 pg/ml was established as the criterion of adequate parathyroid graft function. Values obtained at the various time intervals were as follows: 14.14 + 7.73 1 pg/ml (mean +/- SD) (range: 6-36) after 1 week, 53 + 77.33 pg/ml (mean +/- SD) (range: 35-74) after 5 weeks, 62.95 + 20.93 pg/ml (mean +/- SD) (range: 11-89) after 15 weeks, 77.54 + 18.84 pg/ml (mean +/- SD) (range: 24.6-104.2) after 30 weeks, 109.29 + 50.22 pg/ml (mean +/- SD) (range: 54-327) after 60 weeks, 134.21 + 128.64 pg/ml (mean +/- SD) (range: 43-712) after 100 weeks, and 122.84 + 117.54 pg/ml (mean +/- SD) (range: 68-723) after 150 weeks. Prevalence of hypoparathyroidism (intact parathyroid hormone serum level < 20 pg/ml with a normal or low serum calcium concentration) was 2/35 (5.71%) by week 60 and recovered by week 100. Graft-related recurrence was 2.85% (1/35). CONCLUSIONS: Subcutaneous pre-sternal transplantation (SCPTx) after TPT and PTx for secondary (RHP) is an adequate method to replace muscular forearm parathyroid transplantation and avoid its complications. Functioning results of total parathyroidectomy and presternal subcutaneous grafting compare favorably with the published data on other surgical techniques proposed for the treatment of renal hyperparathyroidism. Results of long-term follow-up exceed previously reported results.

Carcinoma epidermoide sobre seno pilonidal / Epidermoid carcinoma arising in a pilonidal sinus

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Parathyroid graft function after presternal subcutaneous autotransplantation for renal hyperparathyroidism.

HYPOTHESIS: Presternal subcutaneous autotransplantation of parathyroid tissue after total parathyroidectomy for renal hyperparathyroidism could be at least as effective as intramuscular grafting, without its complications. DESIGN: Prospective study of a postoperative diagnostic method of monitoring intact parathyroid hormone (iPTH) levels among a cohort of surgical patients, without loss to follow-up. SETTING: Hemodialysis unit in a university hospital. PATIENTS: Twenty-five patients (17 women and 8 men) underwent total parathyroidectomy and presternal subcutaneous autotransplantation for renal hyperparathyroidism at Donostia Hospital, San Sebastián, Spain, between January 1, 2002, and June 30, 2004. MAIN OUTCOME MEASURES: Evaluation of parathyroid graft function by measurement of serum iPTH levels at admission and 24 hours and 1, 3, 5, 15, 30, and 60 weeks after surgery. RESULTS: The mean +/- SD preoperative serum iPTH level was 1302 +/- 425 pg/mL; the iPTH level was undetectable in all patients 24 hours after surgery. Subsequent mean +/- SD iPTH levels obtained were 14 +/- 10 pg/mL after 1 week, 54 +/- 1 pg/mL after 5 weeks, 64 +/- 9 pg/mL after 15 weeks, 77 +/- 8 pg/mL after 30 weeks, and 106 +/- 21 pg/mL after 60 weeks. Autotransplanted parathyroid tissue appears to be adequately functional at week 5 (criterion level of adequate functioning, 50 pg/mL). CONCLUSIONS: Presternal subcutaneous autotransplantation after total parathyroidectomy for renal hyperparathyroidism may be an alternative to avoid musculus brachialis grafting and its complications. Our functional results compare favorably with the published data on other surgical techniques for the treatment of renal hyperparathyroidism. Long-term follow-up of this series is planned.

Intraoperative monitoring of intact PTH in surgery for renal hyperparathyroidism as an indicator of complete parathyroid removal.

In the setting of total parathyroidectomy and autotransplantation surgery (TPT x AS) as treatment for secondary hyperparathyroidism (SHPT), we evaluated whether intraoperative parathyroid hormone (iPTH) monitoring is useful as a reference for total parathyroid removal. We conducted a prospective, open, single value measurement efficacy study of the intraoperative (i.o.) diagnostic monitoring of iPTH in a cohort of surgical patients. All patients (n = 25) underwent TPT x AS at the Department of Surgery, Donostia Hospital from January 2002 to October 2004. The primary outcome measures were kinetics of serum levels of iPTH during surgery and prediction time of the of descent of PTH levels (measured in the clinic on the day of admission and intraoperatively during induction of anesthesia, every 5 and 10 minutes after removal of the adenoma, and again 24 hours thereafter). iPTH levels returned to normal in all 25 patients, decreasing from pathological levels at the beginning of the operation (1302.24 + 424.9 pg/ml) to half (50%) values at the third intraoperative determination, minute 10 (614.8 +/- 196.62), becoming undetectable at 24 hours. Frozen sections were conclusive for parathyroid tissue (20.56 + 10.3 minutes after removal). Intraoperative measurement of iPTH is useful in the prediction complete removal of all parathyroid tissue prior to autotransplantation, thus avoiding persistence of disease because of incomplete surgery.

Fascioliasis: an exceptional cause of acute pancreatitis.

CONTEXT: Fasciola hepatica is known to cause bile duct inflammation and biliary obstruction but is rarely reported as responsible for producing acute pancreatitis. CASE REPORT: We report on a patient complaining of acute pancreatitis. Endoscopic retrograde cholangio-pancreatography showed distinct features and sphincterotomy allowed extraction of multiple parasites. CONCLUSIONS: Pancreatitis may occur in some patients with fascioliasis, but the condition may be overlooked in chronic cases. Endoscopic retrograde cholangio-pancreatography rule out other possible causes of irregularity and thickening of the common bile duct wall. Parasite removal during endoscopic retrograde cholangio-pancreatography is one therapeutic option. Hepatic involvement must be ruled out and complete pharmacological treatment is advised in this patient.

Función paratiroidea en el autotrasplante paratiroideo subcutáneo preesternal en el hiperparatiroidismo secundario / Parathyroid function in presternal subcutaneous parathyroid autotransplantation in secondary hyperparathyroidism

Introducción. Se ha estudiado la función del tejido paratiroideo trasplantado subcutáneamente. Pacientes y método. Se ha estudiado a 13 pacientes sobre una población en diálisis total de 187 (6,95 por ciento) pacientes. Se realizó paratiroidectomía total y autotrasplante subcutáneo preesternal. Resultados. Descendió el valor de hormona paratiroidea a las 24 h en todos los casos. Se observan concentraciones valorables de hormona paratiroidea a partir de la quinta semana postransplante en todos los casos. Conclusiones. El trasplante paratiroideo subcutáneo preesternal es una alternativa válida y funcional en el tratamiento del hiperparatiroidismo secundario (AU)

Hernias de Morgagni. presentación de una serie de casos tratados en la era prelaparoscópica / Morgagni's hernias. Presentation of a series of cases treated in the prelaparoscopic era

Material y método. Revisión de hernias de Morgagni intervenidas en tres hospitales entre los años 1980 y 2000.Resultados. Se recogieron 28 casos, y la proporción varones/mujeres era de 12/16. La edad media fue para los varones de 45 ñ 13,2 (rango: 7-83) y para las mujeres de 51 ñ 16,4 (rango: 18-85) años. Los hallazgos fueron casuales en 13 casos y sintomáticos en 15 ocasiones: cuadros digestivos inespecíficos (n = 8), respiratorios (n = 5) y cardíacos (n = 2). Siete casos fueron intervenidos por vía torácica. En 19 ocasiones el abordaje fue abdominal y en dos, mediante laparoscopia. Se han observado 6 recidivas (21,4 por ciento).Conclusiones. Las hernias de Morgagni son poco frecuentes. Existe riesgo elevado de recidiva tras el tratamiento tradicional. La mayoría se trataron de forma electiva y por abordaje abdominal. (AU)