[Renal hyperparathyroidism's control after subtotal parathyroidectomy]. / Control del hiperparatiroidismo renal tras paratiroidectomía subtotal.

UNLABELLED: Parathyroidectomy, in any of its forms, is considered an effective short-term treatment of renal hyperparathyroidism in patients who are not being controlled with drugs. Nevertheless, the outcome in the medium and long term of the various surgical procedures is still unclear and seems a controversial issue. We conducted a prospective study of 15 patients undergoing subtotal parathyroidectomy who were followed up for a period of 48 months after surgery. All patients were included in hemodialysis programmes. Elevated levels of parathyroid hormone which did not decrease with drug therapy recommended parathyroidectomy. The aim of our study is to determine whether subtotal parathyroidectomy is an effective technique in the medium and long term. As regards the results obtained, the levels of parathyroid hormone and calcemia remarkably decreased during the follow-up period, if compared to pre-surgery levels. The level of alkaline phosphatase also showed a reduction and the "hungry bone effect" was observed. The phosphorus and Ca-P product levels only showed a significant reduction immediately after surgery but showed an increment from the first year after surgery onwards. Hemoglobin levels did not show any alteration after parathyroidectomy. In two patients we observed a relapse of hyperparathyroidism. The anatomopathological examination revealed nodular hyperplasia in most of the cases, including the two relapses. CONCLUSION: Subtotal parathyroidectomy is an effective surgical procedure in the medium-term treatment of renal hyperparathyroidism.

Experiencia en la asignación de la productividad de forma variable en el Hospital Clínico Universitario de Zaragoza / Experience in the alocation of variable productivity in the University Hospital Clinic of Zaragoza

Desde el año 2000 el Hospital Clínico Universitario de Zaragoza (HCU) viene utilizado un modelo de evaluación de la gestión clínica, diseñado por el propio centro, para el reparto de la productividad anual de forma variable en función de los resultados alcanzados por cada servicio a fin de año. Este método de evaluación e incentivación ha representado importantes cambios en la cultura de gestión de los profesionales, incrementando el interés por el seguimiento de los indicadores y por los resultados obtenidos así como un mayor compromiso con los acuerdos de gestión. A pesar de haber existido diferencias importantes entre la cuantías percibidas entre Servicios, el modelo ha sido bien aceptado y no ha generado ningún tipo de conflicto ya que se ha basado en a transparencia y el consenso de la metodología utilizada (AU)

This article presents a clinical management assessment model, designed by the University Hospital Clinic of Zaragoza, to obtain a distribution of the annual variable productivity according to the results achieved by each service at the end of the year (AU)

[Oncologic treatment of oto-neuro-ophthalmological metastases and their complications]. / Tratamiento oncológico de las metástasis otoneuroftalmológicas y sus complicaciones.

INTRODUCTION: Cerebral metastases and the sequelae of their treatment are the major cause of neurological symptoms in patients with cancer. OBJECTIVE: In this article we review the oto-neuro-ophthalmological complications of the treatment of metastases with radiotherapy and/or chemotherapy. DEVELOPMENT: When speaking of the iatrogenic diseases caused by radiotherapy treatment of metastases, it is important to emphasize that the major complications of this form of treatment are seen in the long term, in general, months or years later. When dealing with incurable diseases, such as most metastatic cancers, the benefit/risk balance of each therapeutic option has to be taken into account. Thus we have a population of patients with symptoms secondary to metastatic involvement, and with an overall life expectancy which may be measured in months. The oto-neuro-ophthalmological toxicity of the chemotherapy may present as an infrequent and unexpected complication or as a usual, expected secondary effect of the drug used. A large variety of drugs are used for the systemic control of cancer (cystostatic drugs, hormones and modifiers of the biological response) which, in one way or another, may cause neurological signs. CONCLUSION: The increasingly frequent use of high dose chemotherapy and of the combined use of chemotherapy and radiotherapy mean that these types of toxicity have become common clinical syndromes in current oncological practices.

[Severe liver failure in erythropoietic protoporphyria. A report of a case treated by liver transplantation]. / Fallo hepático grave en la protoporfiria eritropoyética. Comunicación de un caso tratado con trasplante hepático.

Severe liver failure is a rare complication of erythropoietic protoporphyria (PEP), which is associated with a high rate mortality. Until now, 31 patients with this hepatic complication had underwent a liver transplantation, with a high rate of survival, but their long-term outcome is not well established. We report the first case in Spain of PEP in 59-year-old, whose acute liver failure was treated with liver transplantation, without postoperative complications. The patient is in good clinical condition 30 months later. Nevertheless during the first eleven months of follow-up the plasma levels of protoporphyrin remained elevated, which was accompanied of biochemical and histological evidence of relapse of the metabolic disease in the graft. Cases such as this stress the usefulness of liver transplantation, but also the need of more efficient measures to decrease the protoporphyrin levels before and after the transplant, in order to prevent hepatic and extrahepatic complications in these patients.

Granulomatous slack skin in childhood.

Granulomatous slack skin is an uncommon cutaneous T-helper cell lymphoma closely related to mycosis fungoides. To the best of our knowledge this disease has not been previously described in children. We report on an 11-year-old boy who presented with painless slack skin masses in the neck, right axilla and arm, anterior wall of the abdomen, both inguinal regions, and the malleolar and dorsal aspects of the feet. The disease started 3 years earlier with erythematous lesions on the neck and wrists. Histologic examination of a specimen from the abdominal mass revealed an extensive lymphoid infiltrate with scattered multinucleated giant cells extending from the papillary dermis to the subcutis. The lymphoid cells showed the following immunophenotype: CD43+ (MT1), CD45+, CD45RO+, CD20-. The phenotype of the giant cells was lysozyme positive, CD68+ and Mac387-. The tumoral lymphoid cells had clonal rearrangement for the gene of the beta chain of the T-cell receptor (C beta TCR). The disease could be controlled with systemic glucocorticoids. Due to the presence of many histiocytes arranged in aggregates in the papillary and mid-dermis, this case was initially considered to be a cutaneous form of histiocytosis. We recommend deep and extensive biopsies in patients with slack skin disease.

Cutaneous ganglion cell choristoma. Report of a case.

We describe the histological, immunohistochemical, and ultrastructural findings of a cutaneous tumour composed of ganglion cells, without any other proliferating component. As ganglion cells are not normal components of the skin, we propose the term "ganglion cell choristoma" for this lesion. The differential diagnosis of related lesions such as cutaneous ganglioneuroma, well-differentiated metastases from neuroblastoma, autonomic ganglia entrapped by neurofibroma, and reactive processes, and the possible histogenesis of ganglion cell choristoma are discussed.

[Oncocytic cell tumor. Problems, diagnosis, therapy]. / Tumor de células oncocíticas. Problemática, diagnóstico-terapéutica.

Renal oncocytoma is an uncommon tumor. At least 203 such cases have been reported. This urologic condition represents a diagnostic difficulty and because its natural history has not been elucidated, its treatment remains a controversy. Two recent cases of renal oncocytoma seen at our Urology Service prompted us to review the literature and analyze the diagnostic methods, therapeutic approach and its prognosis.