[Ablation of malignant liver tumors with radiofrequency. A series of cases in Mexico.]. / Ablación de neoplasias hepáticas malignas con radiofrecuencia. Una serie de casos en México.

BACKGROUND: Surgical resection is the treatment of choice for most of the primary and secondary liver tumors, unfortunately, many patients are not suitable for resection. Several ablative alternatives have been employed for treatment; the most commonly used has been radiofrequency ablation. OBJECTIVE: To establish the safety and results of treatment with radiofrequency ablation (RF) of malignant liver tumors. MATERIAL AND METHODS: A retrospective review of clinical files of patients with malignant hepatic tumors treated with RF was performed. Epidemiological variables, selection criteria pre- treatment and morbidity and mortality related to the procedure were analyzed. Descriptive statistics were used. RESULTS: From September 2002 to August 2006, 30 patients were treated: eighteen females and 12 males with a median age of 62 years (range 41-83 years). Histologic type was as follows: 18 hepatocellular carcinomas; 10 metastatic tumors (four breast, four colorectal and two neuro- endocrine); one gallbladder carcinoma and one peripheral cholangiocarcinoma. Indications for ablative procedure were the presence of cirrhosis, poor functional reserve, bilobar disease, proximity to major vascular structures and patients with increased operative risk. The size of the lesion range from 2 to 20 cm (mean 5.6 cm) and the median time of ablation was 30.2 min (range 5-50 min). Two minor complications (6.6%) and no operative mortality were recorded. At 18 months of follow-up, 23 patients (76.6%) are still alive and seven patients have died for tumor progression. CONCLUSION: Radiofrequency ablation is a safe procedure that allows local control of the disease with satisfactory results, when the surgical resection is not feasible.

[Paragangliomas: clinical and secretory profile. Result of 39 cases]. / Paragangliomes: profil clinique et sécrétoire. A propos de 39 cas.

THIS RETROSPECTIVE STUDY AIMS: To define a clinical and secretory profile of paragangliomas extra-adrenal chromaffin tumors. METHODS: From 1971 throughout 2002, 39 paragangliomas have been observed in 38 patients (22 male, 16 female, average age 41,2 years). RESULTS: Four were located above the diaphragm, 35 were sub-phrenic (6 of the organ of Zuckerkandl), 32 secreted catecholamines, 23 were hypertensive (with only one without hypersecretion of catecholamines). Among 29 (131)I-metaiodobenzylguanidine scans (MIBG) reviewed, 20 tumors took up the radiopharmaceutical. The treatment was surgical in 35 cases with addition of external radiotherapy and MIBG in one case each; two patients died before any treatment. Two patients with persistent disease after surgery were successfully treated by surgery or MIBG. Histologically, 20 were malignant and 17 were seemingly benign. All exclusive dopamine secreting paragangliomas were malignant. Six patients relapsed two of which for a tumor initially classified as benign. The treatment of recurrences was surgical, by MIBG or by external radiotherapy. Nine patients had a family history of chromaffin tumor(s). The genetic survey made in five of these nine patients was positive in all cases.

[Radioguided surgery for primary hyperparathyroidism: 100 cases]. / Chirurgie radioguidée de l'hyperparathyroïdisme primaire.

One hundred patients with primary hyperparathyroidism underwent radioguided surgery within 90 to 180 minutes following IV injection of a diagnostic dose of MIBI and after parathyroid scanning with planar and oblique views. Exclusion criteria were thyroid pathology requiring surgery and suspicion of multiple endocrine neoplasia. A>20% step-up between the background noise and tissue uptake was the diagnostic threshold for parathyroid hyperfunctionning tissue, and this was observed in only 15% of cases overall all cured, but two. This method of detection is technically demanding and various angles of application of the probe can result in significant discrepancies of recorded uptake for the same spot. Our results demonstrate a physiological step-up between the ipsilateral unaffected upper and lower quadrants of the neck (range: - 34% to - 5%), seemingly because of the proximity of supra-aortic vessels (upper neck-upper mediastinal gradient: - 57% to - 21%). Therefore, significant ratios are meaningful only between either the symmetrical left and right controlateral quadrants, 8% of pre-operative scannings were non-contributory, and probe detection was contributory in 3/8 cases only. Benefit of the technique is limited in routine, but it can be helpful in redo cases if the offending gland is not located in close surroundings of tissues physiologically taking up the radio pharmaceutical (salivary glands, great vessels and heart).

[Radioguided surgery for primary hyperparathyroidism. Experience in 75 cases]. / Chirurgie radioguidée de l'hyperparathyroïdie primaire. Expérience de 75 observations.

STUDY AIM: To report feasibility and efficacy of radioguided mini invasive hyperparathyroidism surgery. PATIENTS AND METHOD: From November 1998 to August 2000, 75 patients with primary hyperparathyroidism have been operated on by radioguided surgery within 90 to 180 minutes following i.v. injection of a diagnostic dose of MIBI and after parathyroid scanning with planar and oblique views. Exclusion criteria were thyroid pathology requiring surgery and suspicion of multiple endocrine neoplasia. A 20% step-up between the background noise and tissue uptake was the diagnostic threshold for parathyroid hyperfunctioning tissue. RESULTS: A 20% step-up was observed in only 17% of cases overall; all cured, but two. Various angles of application of the probe can result in significant discrepancies of recorded uptake for the same spot. These results demonstrate a physiological step-up between the ipsilateral unaffected upper and lower quadrants of the neck (range: -17 to -8%), because of the proximity of supraortic vessels (upper neck-upper mediastinal gradient: -44 to -30%). Therefore, significant ratios are meaningful only between either the symmetrical left and right controlateral quadrants respectively, and not between the upper and the lower ipsilateral quadrants. Eleven per cent (8/75) of preoperative scannings were non-contributory, and probe detection was contributory in 3/8 cases only. CONCLUSION: Benefit of the technique is limited in routine, but it can be helpful in redo cases if the offending gland is not located in close surroundings of tissues physiologically taking up the radiopharmaceutical (salivary glands, great vessels and heart).

[Laparoscopic partial hepatectomy. Report of the first case in Mexico]. / Hepatectomía parcial por laparoscopia. Informe del primer caso en México.

The authors report the case of a 47-year-old female patient referred to the Instituto Nacional de Cancerología with abdominal pain and a focal liver lesion in the left lateral segment. After a careful tumor work-up, a laparoscopic left lateral segmentectomy was performed. The postoperative course was uneventful and the patient was discharged at the 2nd postoperative day. Histologic examination revealed focal nodular hyperplasia. In a search of the literature we find this to be the first case treated by this approach in Mexico.

Intraoperative decay profile of intact (1-84) parathyroid hormone in surgery for renal hyperparathyroidism--a consecutive series of 80 patients.

BACKGROUND: The utility of intraoperative parathyroid hormone (PTH) monitoring is unclear in the surgical management of renal hyperparathyroidism. Our goal was to define the normal pattern of decay during operation for renal hyperparathyroidism by using the rapid intact (1-84) parathyroid hormone (PTH) assay. METHODS: Eighty consecutive patients underwent neck exploration for renal hyperparathyroidism. Intact PTH levels were monitored with a rapid immunochemiluminometric assay. Samples were assayed at the induction of anesthesia, after dissection before resection, and 20 and 40 minutes after resection. Follow-up ranged from 3 to 24 months. RESULTS: Twenty minutes after resection, PTH levels remained many-fold supranormal. Seventy-seven patients (96%) were cured. Of these, 75 patients (94%) had PTH decay of more than 50% from the preoperative level; 74 (99%) were cured. Only 1 of 3 patients (33%) in whom the PTH level decreased less than 40% from the preoperative level was cured. Two patients had intermediate values and both were cured. CONCLUSIONS: The intraoperative decay of PTH during operation for renal hyperparathyroidism is slower than for patients with normal renal function. However, 20 minutes after resection, a decline to less than 50% of the preoperative level predicts cure, while a level greater than 60% predicts failure.

Correlation of parathyroid scanning and anatomy in 261 unselected patients with sporadic primary hyperparathyroidism.

BACKGROUND: Despite abundant literature on parathyroid scanning with technetium 99m-labeled cationic complexes, comprehensive clinical reports that unequivocally correlate scanning findings with the anatomy of parathyroid glands in extensive and homogeneous cohorts of patients are lacking. METHODS: We analyzed the records of patients with sporadic primary hyperparathyroidism who had had a preoperative scan with either 99mTc-labeled sestamibi or 99mTc-labeled tetrofosmin at our institution and who were cured after a bilateral surgical neck exploration procedure. RESULTS: In 261 patients, 710 normal and 347 abnormal glands (1494 +/- 2626 mg), including 15 glands within the mediastinum, were identified. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of scanning were 82%, 98%, 91%, 94%, and 94%, respectively, in 197 patients with uniglandular disease and 53%, 98%, 98%, 60%, and 72%, respectively, in 64 patients with multiglandular disease. False-positive uptakes were encountered in 17 patients (7%), 3 false-positive uptakes being within the mediastinum. If the unilateral approach had been followed, guidance with preoperative scanning would have significantly increased the number of effective unilateral neck exploration procedures (164 patients (63%) vs 78 patients (30%); P < .001). One abnormal gland would also have been neglected in 28 patients (11%). CONCLUSIONS: Preoperative scanning would limit neck exploration procedures in two thirds of patients with sporadic primary hyperparathyroidism but may also increase the risk of failure in the most challenging cases.