Tertiary hyperparathyroidism after renal transplantation.

Tertiary hyperparathyroidism is considered as an autonomous proliferation state of the parathyroid glands with biological hyperfunction resistant to calcium/vitamin suppressor therapy. This phenomenon is thought to be secondary to monoclonal inactivation of tumoral growth suppression factor located on chromosome 11. Three patients, 13, 15, and 22 years of age, with chronic renal insufficiency of long evolution who presented with tertiary hyperparathyroidism following renal transplantation are described. The three patients underwent subtotal parathyroidectomy with consequent normalization of biochemical parameters of phospho-calcium metabolism in the first few weeks post surgery. Pathologic study showed adenoma in the affected glands with hyperplasia of the rest. We believe that in patients with long-term renal insufficiency an aggressive treatment, either medical or surgical, of secondary hyperparathyroidism which is continued after renal transplantation may be useful in preventing the development of tertiary hyperparathyroidism.

US, CT, and MR imaging of neck lesions in children.

Neck lesions are common findings in pediatric patients and can be classified as congenital, vascular, inflammatory, or tumoral. They can be evaluated with ultrasonography (US), computed tomography (CT), and magnetic resonance (MR) imaging, either alone or in combination. US should be considered first for studying suspected congenital, vascular, and inflammatory lesions, although CT and MR imaging are best for demonstrating the extent of benign and malignant tumors and the presence or absence of bone erosion, vascular encasement, and airway compromise. MR imaging is also preferred for ruling out intracranial and intraspinal extension (eg, as occurs in rhabdomyosarcoma and neuroblastoma, respectively). In the authors' experience, thyroglossal duct cysts and lymphangioma are the most common congenital anomalies; jugular vein aneurysms are the most common vascular lesion; lymphadenitis is the most common inflammatory lesion; fibromatosis colli is the most common benign tumor or tumorlike condition; and lymphoma is the most common malignant neoplasm.

Maxillectomy in childhood.

A maxillectomy in the upper part of the maxilla is an uncommon operation in childhood. The authors comment on the clinical evolution, the related pathologies and the surgical techniques employed in the treatment of eight patients.

[Juvenile nasopharyngeal angiofibroma]. / Angiofibroma nasofaríngeo juvenil.

Juvenile Nasopharyngeal Angiofibroma is a rare benign neoplasm occurring almost exclusively in adolescent males. Surgery is the only curative treatment, but it is very difficult to be performed, because of the nasopharyngeal location of the tumour. We studied a case and its treatment with arterial embolization before the intervention. Surgery is started using the transfacial route, with total resection and avoiding irreparable mutilations.

[Our experience in the treatment of cervico-facial adenitis caused by non-tuberculous mycobacteria (atypical mycobacteria)]. / Nuestra experiencia en el tratamiento de las adenitis cervicofaciales por micobacterias no tuberculosas (micobacterias atípicas).

The authors believe that the greater part of chronic cervicofacial adenitis actually observed in our hospitals, are not caused by M. tuberculosis or M. bovis but by scrofulaceum mycobacterium, M. avium, M. fortuitum and M. Kansasii, and above all, by the first two of these. They present their experience with 16 cases of cervico-facial adenitis due to atypical mycobacterium (CAAM) treated in our centre during the last years, in which period no case of cervical tuberculosis (CT) was observed. It is important to establish an early differential diagnosis between both etiologies, seeing as treatment is different. Whilst tuberculostatics can solve the phymic infection, surgical extirpation is the only solution for CAAM. The diagnosis of these types of infection is achieved by means of a very characteristic clinical procedure and by cutaneous tests specific for each bacteria. Faced with the clinical suspicion, the total extirpation should be effected of the adenopathic block affected. The exact diagnosis can only be made by the culture of the operatory mass.

Congenital pyriform sinus fistula: a cause of acute left-sided suppurative thyroiditis and neck abscess in children.

Acute bacterial thyroiditis or neck abscesses in children can be caused by infection through pyriform sinus fistulae which usually originate from the tip of the left pyriform sinus. They are thought to be remnants of either the third or fourth pharyngeal pouches. CT, ultrasound and gastrointestinal contrast studies are all useful in clarifying the pathological process and showing the extent.

[Fistula of the pyriform sinus. Report of 2 cases]. / Fístula del sinus piriforme. A propósito de dos casos.

The authors present two patients of 8 and 11 years of age that presented a left sided piriform sinus fistula diagnosed by esophagram and surgically treated in our centre. One had been operated previously with a diagnosis of relapsing thyroglossal quist on five occasions. The piriform sinus fistula is a recently recognised entity as cause of thyroiditis and suppurative cervical infections in the pediatric age. Communicated for the first time in the literature in 1957 by Japanese authors, it was not until 1973 that Tucker published for the first time in English a case of recurrent cervical abscess caused by a fistula initiated in the piriform sinus. Until now very few cases have been published. The majority of authors consider it to be an embryological residue of the third or fourth pharyngeal pouch. The key to diagnosis is to bear it in mind whenever a patient presents suppurative thyroiditis or repetitive cervical infections, principally of the left side. An esophagram is necessary to demonstrate the course of the fistula. In cases of thyroiditis a thyroidal gammagraphy will allow vision of a cold zone in the upper third of the affected lobe. Treatment consists of total extirpation of the fistula and affected portion of the thyroidal lobe, once the infection has been solutioned. Before intervention it is important to collocate a tube in the fistula's course by means of a direct microlaryngoscopy which will serve as guide and allow the injection of methylene blue.

[Goldenhar syndrome]. / El sindrome de Goldenhar.

We present a report on 9 patients with Goldenhar's Syndrome, and the criteria used for the diagnosis. Familiar data and clinical characteristics. Are described and discussed with that of other authors. The medical literature about this syndrome shows a lack of uniformity on the criteria necessary to diagnose the syndrome, as well as the role of the pathogenic factors. The authors propose the adoption of uniform criteria on the basis of their own experience and the report of Feingold and Baum. They can help to better delineate the differences between Hemifacial Microsomia and Goldenhar's Syndrome.

[Primary cervical tumors of the sympathetic nervous system. Report of 8 cases]. / Tumores cervicales primitivos del sistema nervioso simpático. A propósito de 8 casos.

The authors present his experience in the treatment of 8 patients with primary tumors of cervical sympathetic ganglions. The presence of a hard, painless, adherent and slow evolution latero-cervical mass is the first sign in 7 cases. The other one, a neuroblastoma, had a Horner's syndrome. The authors expose the methods of diagnostic and staging, some characteristics of surgical technique, chemotherapy treatment and follow-up methods (TAC, Gammagraphy with i-MIBG and Tumoral Markers). This imply a survival in the 100% of cases.

Physiological mechanisms associated with ovulation prediction using the CUE Ovulation Predictor.

It has been shown that monitoring of salivary electrical resistance (SR) enables prediction of ovulation several days in advance, since a peak in SR is seen 5-6 days before the LH peak. This paper explores physiological mechanisms that may account for this change. The pathway whereby oestrogen stimulates aldosterone (ALDO) secretion acting through the renin-angiotensin system was considered. It is shown that this mechanism would only result in increasing SR as oestrogen values rise during the follicular phase and therefore is not an explanation of the SR peak and declining SR 5-6 days before the LH peak. The reported trend of sodium in milk of ovulating women parallels that of SR. It is shown that these changes are most likely to be due to a similar change in aldosterone levels. A possible role for adrenocorticotrophic hormone (ACTH) in causing the changes in aldosterone is discussed and supported with data from other independent studies as well as with preliminary data obtained from two normally ovulating subjects. Peaks in ACTH, ALDO and SR were coincidental and occurred 6 days before the LH peak. The temporal relationship observed among these variables suggest that ACTH, by affecting ALDO, modifies salivary electrolytes and hence SR.

Ovulation prediction and detection with the CUE Ovulation Predictor.

Predicting ovulation is useful for managing the infertile patient and when done sufficiently in advance for fertility regulation by periodic abstinence. It has been reported that ovulation could be predicted by measurement of salivary and vaginal electrical resistance (SR and VR). These data from 32 menstrual cycles of 23 women were obtained to evaluate this technique. Data of 14 cycles were from subjects receiving clomiphene citrate (CC), while the others were from spontaneously ovulating subjects. A peak in SR was seen 5-7 days before the day of the LH peak in both natural and CC cycles. A correlation coefficient (r) of 0.94 was seen for the day of the SR peak and that of the LH peak. The SR trend was similar in both natural and CC cycles. VR in spontaneous cycles declined to a periovulatory nadir and then increased. The patterns of VR in CC cycles were similar except that values were initially depressed during and shortly after the end of CC therapy. Over 90% of VR increases were on the day of the LH peak and the day following. Results indicate that the method is useful for predicting ovulation in natural and CC cycles. Since the number of days by which ovulation is predicted exceeds the expected lifespan of spermatozoa in the female reproductive tract, the method also shows potential for use in natural family planning.

Prediction of ovulation with the use of oral and vaginal electrical measurements during treatment with clomiphene citrate.

This study was undertaken to evaluate the usefulness of measuring salivary and vaginal electrical resistance in monitoring ovulation induced by clomiphene citrate (CC). Data from 28 cycles of 12 women treated with CC were compared with those of 18 cycles of 13 women who were ovulating spontaneously. Patterns of salivary readings in CC and spontaneous cycles were similar and showed a preovulatory peak 6.2 (mean) days before the luteinizing hormone peak. The trend in vaginal readings for CC cycles differed from that of spontaneous ovulations in that the values were depressed during and shortly after CC therapy. Occurrence of the periovulatory nadir and subsequent rise was common to both groups. The rise in vaginal readings CC cycles occurred within 24 hours of the luteinizing hormone peak in 88% of cases. Retrospective analysis showed that, based on this method, artificial insemination would have been timed appropriately in 25 of 27 cycles or in every cycle, depending on the protocol used. The results indicate that the method is equally useful for predicting and confirming ovulation in cycles in which CC was used to induce ovulation as it is in spontaneous cycles.

A new method for predicting and confirming ovulation.

Evaluation of a method for predicting and confirming ovulation by measurement of vaginal and salivary electrical resistance (VER and SER) was the purpose of this study. Eighteen menstrual cycles from 13 subjects were analyzed. A clearly defined nadir in VER at day 0, the day of the luteinizing hormone (LH) peak, followed by a pronounced increase the following day was observed. A peak in SER was consistently observed 5 to 6 days before day 0. The correlation coefficient (r) between the cycle day of the SER peak and cycle day of the LH peak was 0.94. After the peak in SER, values were low for several days but increased 1 to 2 days before the LH peak. Results indicate that monitoring of SER and VER may provide the basis for a simple method for predicting and confirming ovulation.