Tratamiento ambulatorio del adenoma único de paratiroides mediante abordaje unilateral / Ambulatory treatment of solitary parathyroid adenoma using the unilateral approach

Introducción. El desarrollo de técnicas de localización preoperatoria, como la gammagrafía con 99mTcsestamibi, ha permitido simplificar la técnica quirúrgica en pacientes con hiperparatiroidismo primario, permitiendo un abordaje unilateral en casos seleccionados. El objetivo de este trabajo es estudiar prospectivamente los pacientes con hiperparatiroidismo intervenidos con abordaje unilateral y de forma ambulatoria. Pacientes y método. Estudiamos a 50 pacientes (43 mujeres y 7 varones) con diagnóstico bioquímico de hiperparatiroidismo y captación gammagráfica única sugerente de adenoma solitario de localización cervical que fueron sometidos a exploración unilateral con extirpación del adenoma e identificación de una glándula homolateral normal. Excluimos a los pacientes con hiperparatiroidismo secundario o terciario, historia familiar de hiperparatiroidismo o neoplasia endocrina múltiple, enfermedad tiroidea asociada, cirugías previas sobre tiroides o paratiroides, fosfatasa alcalina mayor de 300 U/l y causas de exclusión clásicas en cirugía mayor ambulatoria. Se estudiaron el tiempo quirúrgico, el número de ingresos, las complicaciones, la histología de las piezas y los resultados de la cirugía, con determinación del calcio y la hormona paratiroidea a las 48 h, al mes y a los 3 meses. Resultados. La duración media de la cirugía fue de 34,7 ñ 17,53 min. Sólo existió un ingreso en la serie. La mortalidad fue nula. Respecto a las complicaciones, no existió ningún caso de sangrado-hematoma ni parálisis recurrencial. Ninguno de los pacientes presentó hipoparatiroidismo permanente y sólo en cinco se apreciaron parestesias ligeras, que cedieron sin necesidad de tratamiento. El diagnóstico anatomopatológico fue adenoma de paratiroides en los 50 casos. En el 100 por ciento de los casos se había normalizado la cifra de calcio y hormona paratiroidea al mes y 3 meses de la cirugía. Conclusiones. El abordaje cervical unilateral realizado de forma ambulatoria es seguro y efectivo en el tratamiento quirúrgico de pacientes con hiperparatiroidismo primario debido a adenoma solitario, con una baja morbilidad y excelentes resultados. No obstante, siempre se debe realizar una buena selección de los pacientes y poseer una gammagrafía de alta calidad como método de localización preoperatorio (AU)

[Pyogenic liver abscess as a complication of Crohn's disease]. / Absceso hepático piogénico como complicación de la enfermedad de Crohn.

Pyogenic liver abscess in patients with Crohn's disease is not common, but the mortality has been reported to be high if diagnosis and treatment is delayed. Intra-abdominal abscesses, fistulous disease, and steroid therapy have all been reported to be important predisposing factors in the pathogenesis of this entity. We present a patient with Crohn's disease in whom multiple abscesses were encountered in the right lobe of the liver. The diagnosis of liver abscess was established by abdominal computed tomography and the patient was treated by percutaneous catheter drainage. Awareness of this rare complication is important because diagnosis is difficult to make and a high index of suspicion is required. Once suspected, aggressive diagnostic workup and treatment is indicated. Most patients with liver abscess can be successfully managed by percutaneous catheter drainage combined with antibiotic therapy if it is diagnosed before extensive necrosis has occurred.

Protein kinase inhibitors disrupt memory formation in two chick brain regions.

The amnesic effects of protein kinase inhibitors (H-7, HA-156, TFP, W-9, and W-13) on memory formation for a one trial peck-avoidance task in chicks were investigated with bilateral and unilateral injections into either the left or the right intermediate medial hyperstriatum ventrale (IMHV) or the left or right lobus parolfactorius (LPO). All five inhibitors injected bilaterally 5 min pretraining into either the IMHV or LPO or unilaterally into the left IMHV produced amnesia. Unilateral injections into the right IMHV did not produce amnesia. Unilateral injections of W-9 or W-13 into the left but not the right LPO produced amnesia, H-7, HA-156, or TFP did not produce amnesia when injected unilaterally into either the left or right LPO. The time of onset of amnesia produced by injecting TFP and W-13 into the LPO occurred 45 min after training, whereas H-7 produced amnesia significantly later (90 min after training). Amnesia induced by TFP, W-13, and H-7 injected into the LPO occurred significantly later than amnesia produced when these agents were injected into the IMHV. Together these data suggest that the IMHV and LPO process memory sequentially using various protein kinase activities.

Protein kinase C inhibitor chelerythrine disrupts memory formation in chicks.

Chelerythrine (CHELE), a specific, potent protein kinase C (PKC) inhibitor, disrupts memory formation for a one-trial peck-avoidance task. Three predictions were made about how CHELE, injected into chick brain near the time of training, would affect memory formation, based on previous work with two classes of protein kinase inhibitors (M. R. Rosenzweig et al., 1992; P. A. Serrano et al., 1994) and the in vitro inhibition of PKC by CHELE: (a) CHELE, injected into the intermediate medial hyperstriatum ventrale, would significantly impair memory formation; (b) the amnestic dose would be approximately 10 nmol; (c) CHELE would not produce amnesia for about 45 min after training, but significantly impair memory by 60 min. Experimental tests confirmed each prediction. This study adds to evidence that PKC activity is part of a cascade of neurochemical events initiated by learning and that PKC activity shortly after training is necessary for long-term memory.

[Carcinoma of the esophagus: risk factors of morbimortality following esophagectomy]. / Carcinoma de esófago: factores de riesgo en la morbimortalidad tras esofaguectomía.

OBJECTIVE: To identify which perioperative risk factors are associated to postoperative morbidity and mortality in patients with carcinoma of the esophagus. DESIGN: We analyzed 8 perioperative risk factors: age, preoperative hospital stay, intraoperative blood transfusions, tumor stage, histology, grade of tumor differentiation, prior respiratory disease, surgical treatment. PATIENTS: Forty-six patients with esophageal carcinoma who underwent surgical resection. RESULTS: 1) Morbidity: There was statistical significance between the increase in postoperative morbidity and age > 75 years (p < 0.001), advanced stage of disease (p < 0.001), preoperative hospital stay higher than 20 days (p < 0.05) and severe respiratory disease (p < 0.05). 2) Mortality: There was a statistically significant increase in postoperative mortality in patients with preoperative hospital stay higher than 20 days and in patients > 75 years. CONCLUSIONS: The incidence of postoperative morbidity and mortality in esophageal cancer varies according to age, prior respiratory disease, tumor stage and preoperative hospital stay.

Differential effects of protein kinase inhibitors and activators on memory formation in the 2-day-old chick.

Thirteen protein kinase inhibitors (PKIs) were investigated in chicks for their in vitro effects on PKC activity and for their in vivo effects on memory formation for a peak-avoidance task. Amnesia occurred by 15-30 min post-training when agents that inhibit primarily Ca2+/calmodulin were injected into brain. Amnesia occurred by 60 min post-training when agents that inhibit PKC-, PKA-, and/or PKG-dependent protein kinases, but not Ca2+/calmodulin, were injected. Enhancement of memory formation was accomplished by injecting bradykinin, but not forskolin. Both of these agents, however, attenuated the amnesia produced by H-7. These results are discussed as relevant neural processes involved in memory and synaptic plasticity.

Short-term, intermediate-term, and long-term memories.

This paper focuses on the temporal dimension of memory formation and storage. Is the usual two-fold separation between short-term memory (STM) and long-term memory (LTM) sufficient to encompass all the phenomena of memory? The traditional view is that STM grades into LTM. Evidence for an intermediate-term memory (ITM) has been proposed by some investigators. We have used both rats and chicks to investigate the stages of memory formation. In this paper, the advantages of chicks for this type of research are briefly discussed. Using a paradigm that produces weak training, the retention function for control chicks appears to be made up of four successive components which we have interpreted as representing the memory buffer, STM, ITM, and LTM. In experiments using a variety of kinase inhibitors, we have obtained evidence that ITM and LTM depend on different classes of protein kinase activities. Agents that act on calcium/calmodulin kinase cause amnesia in the ITM range--15 to 30 min post-training. Another class of inhibitors act on one or more of the kinases PKA, PKC, or PKG and cause amnesia by 60 min post-training, so we interpret this group of inhibitors as inhibiting the formation of LTM. However, the three-stage model of memory may be over-simple. For example some agents including [Leu]enkephalin and MK801 cause amnesia 4 or more h after training.(ABSTRACT TRUNCATED AT 250 WORDS)

[Determination of the tumor marker CA 72-4 in gastric carcinoma]. / Determinación del marcador tumoral CA 72-4 en el carcinoma gástrico.

In this study, the authors determined the sensitivity and specificity of the new tumor marker CA 72-4 in detecting adenocarcinoma of the stomach. CA 72-4 serum levels were investigated in 279 patients consisting of: 100 control subjects, 88 patients with benign gastrointestinal disease and 91 patients with gastrointestinal cancer (31 with gastric cancer). We used a cut-off of 5 U/ml. The specificity of CA 72-4 was 91% and the sensitivity was 68%. Highest levels of CA 72-4 were found in patients with more advanced tumor (stages III-IV) and four of 5 patients with stage I had elevated levels of this tumor marker. These findings suggest that the use of serum CA 72-4 measurements may be more useful than other tumor markers in the diagnosis, prognosis and detection of recurrence in patients with gastric cancer. Although CA 72-4 can be elevated in other gastrointestinal adenocarcinomas, it can be useful in alerting the clinician to the possible presence of an intraabdominal neoplasm.

Comparative study of roles of the lobus parolfactorius and intermediate medial hyperstriatum ventrale in memory formation in the chick brain.

Two discrete areas of the chick brain, the intermediate medial hyperstriatum ventrale (IMHV) and lobus parolfactorius (LPO), were found to have different functions during the formation of memory for a 1-trial peck-avoidance paradigm. Glutamate, ouabain, and emetine, known to disrupt short-, intermediate-, and long-term memory when injected into the IMHV, were injected into the cerebellum and LPO. All amnestic agents investigated produced amnesia when injected into the IMHV; only one of these agents produced amnesia when injected into the LPO, and none of the agents produced amnesia when injected into the cerebellum. The chick brain was also found to exhibit hemispheric asymmetries: The left IMHV and LPO were more sensitive to the amnestic agents than their corresponding right structure. From these data, hypotheses for the roles of these structures during memory are proposed.

[Stimulation of the central dopaminergic receptor in essential hypertensive patients using amantadine]. / La estimulación del receptor dopaminérgico central en el hipertenso esencial mediante el uso de amantadina.

At present, evidence has been accumulating that point out that some central nervous structures, of oblongata to the limbic system, are primarily involved in the control of systemic arterial pressure (AP). In agreement with several experimental and clinical works, a hypothesis has been suggested that a functional defect of the central dopaminergic system could be involved in the etiopathogenesis of essential hypertension (EH). With the objective of analyzing this hypothesis, the effect of dopamine (DA) agonist, amantadine (Am) on heart rate (HR), AP, plasma catecholamines (CA, PCA), urinary DA, noradrenaline (NA), adrenaline (A), vanilmandelic acid (VMA) and homovanillic acid (HVA), was studied in 19 females with established EH. The study included 2 periods: "placebo" and "drug", each one lasting 22 days, with a register of HR and AP in clino and orthostatism, taken every 3-4 days; at the end of each period, CA and their metabolites were measured. During the drug period, oral Am clorhidrate (300 mg/day, t.i.d.) was administered. With the drug, HR was not change with respect to the placebo period; but the AP in both positions, just as PCA, DA, NA and HVA, showed a highly significant decrease; A and VMA displayed a less significant decrease from the statistical point of view. The obtained results and literature data support the hypothesis that in EH there probably exists a genetic disfunction of the inhibitory central dopaminergic receptor of peripheral sympathetic activity, which is susceptible to compensation by use of several dopaminergic agonists, such as Am.

[Pheochromocytoma and catecholamines. Experience in 63 cases studied for 25 years]. / Feocromocitoma y catecolaminas. Experiencia en 63 casos estudiados durante 25 años.

The usefulness of fluorimetric techniques in the diagnosis of pheochromocytoma was investigated. In the 63 cases studied during 25 years by measuring simultaneously various aminergic parameters, including plasma catecholamines and urinary adrenaline (A), noradrenaline (N) and vanilmandelic acid (VMA), we were able to establish the diagnosis of pheochromocytoma in all cases. Adrenaline excretion was found to be higher in patients with tumors located on the adrenal region, whereas N excretion was predominantly increased in patients with extra-adrenal tumors. In patients having tumors smaller than 50 g, A + N excretion was higher and VMA was lower than in those whose tumors were heavier; therefore in cases with small tumors the ratio VMA/A + N was lower than in those with larger tumors. It is concluded that simultaneous measurements of PC, A, N and VMA allow the diagnosis to be made in the most patients with this tumor. On the other hand, the predominant increase in A excretion is suggestive of adrenal pheochromocytoma.

[Effect of inhibition of converting enzyme by captopril on arterial pressure, renin and aldosterone in essential hypertension]. / El efecto de la inhibición de la enzima convertidora con captopril sobre la presión arterial, renina y aldosterona en el hipertenso esencial.

The response of arterial blood pressure, plasma renin activity (PRA) and plasma (PA) or urinary aldosterone (UA) concentrations to the administration of captopril, was studied in patients with established essential hypertension. Captopril was effective in lowering significantly the blood pressure (189.4/111.2 +/- 23.9/9.7 to 163.4/98.1 +/- 20.7/8.6 mmHg. mean +/- SD, p less than 0.01/0.001). Normal arterial blood pressure values (140.4/86.5 +/- 20.7/10.8 mmHg, were achieved by the addition of hydrochlorothiazide. Captopril administration was followed by a decrease in PA and in UA and an increase in PRA, suggesting the inhibition of angiotensin II formation. Captopril attenuated hypokalemia and hyperaldosteronism produced by the simultaneous administration of hydrochlorothiazide.

[Primary aldosteronism. Diagnostic aspects and treatment]. / Aldosteronismo primario. Aspectos diagnósticos y de tratamiento.

Despite the relatively low frequency of primary aldosteronism, its diagnosis is of great importance because surgical treatment results, in the majority of cases, in the disappearance of arterial hypertension. We present in this paper six cases with this type of secondary hypertension. The disease was suspected by the coexistence of hypertension and hypokalemia. The decrease in serum potassium after an oral load of salt proved to be of great value for the diagnoses. In the five patients treated surgically, the removal of the tumor produced the normalization of the arterial pressure and corrected the biochemical alterations. In four of the patients the tumor was located in the left adrenal gland and in one in the right adrenal gland. The patient not treated surgically has remained normotensive with spironolactone. This data confirm what has been described in the medical literature and emphasizes the importance of a correct diagnosis and treatment in patients with this form of hypertension.

[Effect of sub-pressor doses of dopamine on renin secretion in the anesthetized dog]. / Effecto de dosis sub-presoras de dopamina sobre la secreción de renina en el perro anestesiado.

The effects of dopamine, its precursor L-dopa, and the dopaminergic agonist bromocriptine (BEC), on plasma renin activity (PRA), in pentobarbital anesthetized male dogs were investigated. Infusion of dopamine at a dose which did not change blood pressure ( 4 ug/kg/min) had no effect on the secretion of renin, nor did it produce modifications in the PRA response to furosemide (10 mg i.v.). L-dopa, in single dose of 500 mg (p.o), significantly augmented PRA two hours after administration, and the renin values remained elevated throughout the observation period of 120 minutes. However, BEC (2.5 mg p.o.) produced no changes in PRA during this time period. We conclude that at the dose utilized, dopamine apparently has no influence on the secretion of renin, and does not modify the increase in PRA provoked by diuretic. It is possible that the L-dopa induced augmentation in PRA is due to stimulation of the juxtaglomerular cells, by the noradrenaline formed in peripheral tissues from administered L-dopa.

Dopamine excretion in benign pheochromocytoma.

Dopamine excretion is reported in 27 patients with benign pheochromocytoma. In 21 patients the tumours were in the adrenal (one patient, bilateral), four were extra-adrenal, and two were assumed to be so since they were not found at laparotomy. Dopamine excretion was found to be higher in the patients with extra-adrenal tumours and in one patient--with bilateral pheochromocytoma. Slight increase of dopamine excretion was found in two of the remaining patients. These observations--indicate that while increased dopamine excretion may be present in patients with malignant pheochromocytoma it can be also increased in some patients with benign tumours.