Diagnosis and treatment of primary thyroid lymphoma from a surgical perspective: a multi-institutional study.

PURPOSE: Surgery of primary thyroid lymphoma (PTL) has been mostly limited to diagnostic work-up. This study aimed to further study its potential role. METHODS: This was a retrospective study from a multi-institutional registry of PTL patients. Clinical, diagnostic work-up (fine needle aspiration, FNA; core needle biopsy, CoreNB), contribution of surgery (open surgical biopsy, OpenSB; thyroidectomy), histology subtype, and outcome data were evaluated. RESULTS: Some 54 patients were studied. Diagnostic work-up included FNA in 47 patients, CoreNB in 11, and OpenSB in 21. CoreNB yielded the best sensitivity (90.9%). Thyroidectomy was performed in 14 patients with other diagnosis (incidental PTL), in 4 for diagnosis and in 4 for elective treatment of PTL. Incidental PTL was associated with not performed FNA nor CoreNB (OR 52.5; P = 0.008), mucosa-associated lymphoid tissue (MALT) subtype (OR 24.3; P = 0.012), and Hashimoto's thyroiditis (OR 11.1; P = 0.032). Lymphoma-related death (10 cases) mostly occurred within the first year after diagnosis and was associated with diffuse large B-cell (DLBC) subtype (OR 10.3; P = 0.018) and older patients (OR 1.08 for every 1-year increase; P = 0.010). There was a trend towards lower mortality rate in patients receiving thyroidectomy (2/22 versus 8/32, P = 0.172). CONCLUSION: Incidental PTL accounts for most of thyroid surgery cases and are associated with incomplete diagnostic work-up, Hashimoto's thyroiditis and MALT subtype. CoreNB appears to be the best tool for diagnosis. Most of PTL deaths occurred during the first year after diagnosis and mostly related to systemic treatment. Age and DLBC subtype are poor prognostic factors.

Morbid obesity: postsurgical predictive factors and prioritization of the waiting list.

AIM: To study a sample of patients with morbid obesity who are on the waiting list for a surgical intervention, to establish various scores of surgical risk (Possum and severity score), and to assess potential criteria for list prioritization. DESIGN: We calculated physiological and surgical Possum scores for every patient, and analysed comorbidities and other associated factors to calculate the severity score. Likewise, we calculated the predictive rates of morbimortality. Differences between associated comorbidities in body mass index (BMI) were also analyzed. The correlation between Possum score, prediction rates, and severity score were analyzed. PATIENTS: Fifty-two patients on the surgical waiting list in our institution (San Juan University Hospital, Reus) from 26/4/02 to 5/03/04. RESULTS: The mean qualitative score is significantly higher in the female sex. Invalidating arthropathy and socio-occupational and/or psychiatric criteria are significantly higher in women. There is a significant correlation between the severity score and Possum score. Age does not correlate with any of the variables studied. CONCLUSIONS: Possum scores are significantly related to BMI, particularly in terms of morbidity rates. The degree of correlation between the Possum score and the qualitative score tells how useful the latter is to cover other determinant factors in the severity of this condition. Socio-occupational and psychiatric criteria, and invalidating arthropathy are the main variables to be taken into account for postsurgical prediction, and are directly related to BMI degree.

Obesidad mórbida: factores predictivos postquirúrgicos y priorización de la lista de espera / Morbid obesity: postsurgical predictive factors and priorization of the waiting list

Objetivo: estudio de una muestra de pacientes afectos deobesidad mórbida y en lista de espera para intervención quirúrgica,determinar el riesgo quirúrgico según diferentes scores (Possumy score de gravedad) y valorar los posibles criterios en la priorizaciónde dicha lista. Diseño: cálculo del Possum fisiológico y quirúrgico para cadapaciente y análisis de las comorbilidades y otros factores asociadospara el cálculo del score de gravedad. Cálculo de los ratiospredictivos de morbi-mortalidad. Análisis de las diferencias observadas,según el índice de masa corporal (IMC), de las comorbilidadesasociadas. Análisis del grado de correlación entre el Possum,los ratios de predicción y el score de gravedad. Pacientes: Cincuenta y dos pacientes incluidos en la lista deespera quirúrgica de nuestro centro (Hospital Universitario SanJoan de Reus) durante el periodo del 26/4/02 al 5/03/04.Resultados: el score cualitativo tiene una media superior significativaen el sexo masculino. La artropatía invalidante y los criteriossocio-laborales y/o psiquiátricos son significativamente superioresen el sexo femenino. Existe una correlación significativaentre el score de gravedad y el Possum. La edad no se correlacionaen nuestra serie con ninguna de las variables estudiadas.Conclusiones: los valores del Possum están relacionados significativamentecon el IMC, en especial en base al ratio de morbilidad.El grado de correlación entre el Possum y el score cualitativonos indica la utilidad de este para cubrir otros factoresdeterminantes en la gravedad de esta patología. Los criterios socio-laborales y psiquiátricos y la artropatía invalidante, son lasprincipales variables a tener en cuenta en la predicción postquirúrgica,estando directamente relacionados con el grado de IMC

Aim: to study a sample of patients with morbid obesity whoare on the waiting list for a surgical intervention, to establish variousscores of surgical risk (Possum and severity score), and to assesspotential criteria for list prioritization.Design: we calculated physiological and surgical Possumscores for every patient, and analysed comorbidities and other associatedfactors to calculate the severity score. Likewise, we calculatedthe predictive rates of morbimortality. Differences betweenassociated comorbidities in body mass index (BMI) were also analyzed.The correlation between Possum score, prediction rates,and severity score were analyzed.Patients: fifty-two patients on the surgical waiting list in ourinstitution (San Juan University Hospital, Reus) from 26/4/02 to5/03/04.Results: the mean qualitative score is significantly higher inthe female sex. Invalidating arthropathy and socio-occupationaland/or psychiatric criteria are significantly higher in women.There is a significant correlation between the severity score andPossum score. Age does not correlate with any of the variablesstudied.Conclusions: possum scores are significantly related to BMI,particularly in terms of morbidity rates. The degree of correlationbetween the Possum score and the qualitative score tells how usefulthe latter is to cover other determinant factors in the severity ofthis condition. Socio-occupational and psychiatric criteria, and invalidatingarthropathy are the main variables to be taken into accountfor postsurgical prediction, and are directly related to BMIdegree

Paresia del VI par tras raquianestesia

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[Macroamylasemia in the differential diagnosis of acute pancreatitis]. / La macroamilasemia en el diagnóstico diferencial de la pancreatitis aguda.

The presence of macroamylasemia should be considered in the differential diagnosis of hyperamylasemia associated with acute abdominal pain, with suspect of pancreatitis. This uncommon and poorly known abnormality is defined as a blinding of serum amylase to certain proteins forming a circulating macrocomplex which prevents renal clearance of serum amylase. Two clinical cases as well as a review of this rare entity are here reported.