Solitary adrenal gland metastasis of a follicular thyroid carcinoma presenting with hyperthyroidism.

Follicular thyroid carcinoma typically manifests under euthyroid conditions, and diagnostic scintigraphy usually identifies a cold nodule. Sometimes, such tumors can appear in the context of hyperthyroidism, which can be caused by a toxic multinodular goitre, a toxic adenoma, or even carcinoma. We report a case of follicular thyroid carcinoma discovered after surgical treatment of a toxic multinodular goiter, in which solitary adrenal gland metastasis was detected five years later. A (131)I whole body scan is the diagnostic method of choice for functioning thyroid metastasis.

Complicaciones de la cirugía tiroidea / Complications of thyroid surgery

En este trabajo se estudian las complicaciones de la cirugía tiroidea, aportando tanto la experiencia personal de nuestro servicio como la de la bibliografía general. Estudiando todas estas complicaciones se observa que la experiencia del cirujano y una técnica cuidadosa son los factores más determinantes de la morbilidad de esta cirugía. La iatrogenia recurrencial, hemorrágica y la hipocalcemia aumentan con la cirugía oncológica y de repetición. Se insiste en la necesidad de la disección de los nervios recurrentes hasta su entrada en la laringe, y en la búsqueda sistemática de las cuatro paratiroides. Existe una relación directa entre el número de paratiroides encontradas y el grado de hipocalcemia. La necesidad de drenajes es controvertida, pero éstos son preferibles ante la agresividad de la cirugía tiroidea actual (AU)

Manometric comprobation of esophagogastric junction competence after Nissen fundoplication and its relation to the length of fundic wrap.

We present 98 patients operated on by two techniques of 360-degree fundoplication due to gastroesopagheal reflux disease and divided in two groups: Group I comprised those who were given a conventional valve 5 cm in length, and group II underwent a short fundoplication that did not surpass 1.5 cm. All were subjected to preoperative esophageal manometry, with determination of the pressure and length of the lower esophageal sphincter (LES) and the motor behavior of the esophageal body. The postoperative manometric results are analyzed, checking that after fundoplication there was a significant increase in tone and length of the LES (p < 0.00005); there were no differences between the two groups (p = 0.9920 and p = 0.2160, respectively). The motor function of the esophageal body did not change after surgery. We conclude that even the smallest length of the fundic wrap does not cause a reduction in the pressure and length of the manometric LES; that is, the antireflux effectiveness, measured by manometry, did not depend on the anterior length of the valvuloplasty.

The importance of a tumor capsule in columnar cell thyroid carcinoma: a report of two cases and review of the literature.

Two cases of papillary columnar cell thyroid carcinoma are presented. A 49-year-old man presented with lymph node and pulmonary metastases at diagnosis; a 51-year-old woman developed local recurrence and lung and bone metastases 3 years postsurgery. Death occurred after 52 and 57 months, respectively. The first case lacked a tumor capsule, although the second exhibited capsule remains with extensive tumor cell infiltration. A review is made of all similar cases reported to date in the literature, placing emphasis on the epidemiological and prognostic differences observed in terms of circumscribed or noncircumscribed tumor. The presence of a capsule was associated with a higher frequency of female patients and a favorable prognosis. In contrast, tumors profusely infiltrating the thyroid parenchyma or extrathyroid tissues in the absence of a capsule, found in similar proportion of men and women had a fatal prognosis.

[Multiple endocrine neoplasia type 1: genetic study of a large family]. / Síndrome de la neoplasia endocrina múltiple tipo 1: estudio genético de una extensa familia.

Multiple endocrine neoplasia syndrome type 1 (MEN-1) is an inherited disorder characterised by the predisposition of the cells from parathyroid glands, endocrine pancreas and adenohypophysis to develop neoplasms. We report the genetic study of an extended family with at least 8 affected patients and 10 putative carriers of a mutation in MEN-1 gene. One intragenic (Asp418 GAC-->GAT), and five flanking markers were characterised in the family by PCR amplification and polyachrylamide gel electrophoresis. Association of the disease to MEN-1 gene was confirmed for this family: all the affected members show a haplotype in common. Three patients at risk were diagnosed as non-carriers, since they have not inherited that haplotype. The remaining seven members, presymptomatic carriers, are included in a follow-up protocol. The genetic study of families segregating MEN-1 syndrome are useful in avoiding indiscriminate follow-up determinations to those members who have not received the genetic predisposition to develop any of the manifestations of the syndrome. Segregation analysis with linked markers is useful, under certain circumstances, to perform such type of studies.

[Reoperation after failure of gastroesophageal reflux surgery]. / Reintervenciones tras fracaso de la cirugía del reflujo gastroesofágico.

We present 28 patients who underwent surgery after failed procedures due to gastroesophageal reflux with an asymptomatic period over 2.6 years. The most frequent complications resulted in recurrent reflux (86%) and peptic strictures (36%). An abdominal approach was used on all the patients. Reoperation, using the Collis-Nissen gastroplasty (19 cases), Nissen 360 degrees (3 cases), duodenal diversion with Roux-en-Y (3 cases) and Angelchick prothesis (3 cases) gave excellent or good results in 84% of the patients and poor in 4 cases. There was one operative death. All patients were referred for 24 hour pH-monitoring. Sphincter pressure and length of the distal esophageal sphincter were significantly increased over the preoperative values. Our results suggest that the Collis Nissen procedure is a suitable form of treatment for complicated forms of peptic esophagitis after the failed antireflux operations.

[Perforation of hollow viscera in abdominal injuries]. / Perforación de víscera hueca en traumatismos abdominales.

OBJECTIVE: This is a retrospective study to evaluate our results in the treatment of abdominal trauma. DESIGN: We have analysed the incidence, the clinical characteristics, the diagnosis, the indications for laparotomy, the therapeutic methods and the morbidity-mortality. During the last 14 years we have operated on 29 hollow viscus injuries. They were divided into two groups: Eleven with penetrating or open trauma and 18 with blunt or closed traumatism. RESULTS: In the cases of blunt trauma 36.8% of injuries were located in the proximal jejunum, 21% in the terminal ileum, 15% in the colon. In the cases of penetrating trauma, small intestinal perforation predominated (46.9%). In 23.5% of the cases the colon was affected. Morbidity in blunt trauma was 38.8% and 0% in penetrating trauma. The mortality in the two groups has been zero. CONCLUSIONS: The most common surgical procedure practised for injuries to the small intestine was simple suture, and for injuries to the colon, colostomy. The most usual surgical procedures in penetrating trauma were simple suture in all small intestine injuries and for colonic lesions half had primary closure and half suture plus colostomy.

[Idiopathic sclerosing peritonitis (ISP). A report of a new case and a review of the literature]. / Peritonitis esclerosante idiopática (P.E.I.). Presentación de un nuevo caso y revisión de la literatura.

Idiopathic sclerosing peritonitis (I.S.P.) is a rare disease, in which the small bowel is encased in a fibrous capsule, with symptoms and signs of intestinal obstruction. A new case of I.S.P. in a 42-year-old man who underwent laparotomy and was reoperated for intestinal obstruction is presented. A jejunal fistula with a favorable outcome occurred in this case. The literature about this entity is reviewed, and 16 cases are collected. This condition is being reported more and more commonly and requires further research to elucidate its unknown mechanism.

[Splenic hydatidosis: presentation of 8 cases and review of the literature]. / Hidatidosis esplénica: presentación de 8 casos y revisión de la literatura.

A retrospective revision of 8 splenic hydatid cyst cases which underwent surgery in our Department over a period of 19 years is presented. Its rareness, clinical and diagnostic aspects, as well as the association to hydatidosis in other organs are pointed out presenting the results of surgical treatment and patients' evolution.

[Nonchromaffin neurogenic tumors of the intestinal tract. A report of 2 cases and their relation to von Recklinghausen's neurofibromatosis]. / Tumores neurogénicos no cromafines del tracto intestinal. Aportación de dos casos y estudio de su relación con la neurofibromatosis de von Recklinghausen.

Two patients with neurogenic gastrointestinal tumors are reported. One of them was a gangliocytic paraganglioma of the duodenum. The second one, a jejunal tumors in a patient with Von Recklinghausen's disease (ganglioneuroma). The neural crest origin of these tumours is discussed.

[Immune thrombocytopenia and HIV-1 infection. Response to splenectomy]. / Trombocitopenia inmune e infección por HIV 1. Respuesta a esplenectomía.

We present a case of thrombocytopenic purpura associated to acquired immunodeficiency; this disease is very infrequently associated to AIDS; the clinical characteristics are similar to the classical Idiopathic Thrombocytopenic Purpura, including the response to splenectomy. We discuss the therapeutic approach of this condition and review the literature, adding this new case of a patient with AIDS, Walter and Reed's stage II, who responded to splenectomy.