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Mora-Guzmán I, Del Pozo Jiménez JA, Martín-Pérez E. Abdominal compartment syndrome secondary to acute necrotizing pancreatitis. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 109:538. [PMID: 28593784 DOI: 10.17235/reed.2017.4810/2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Severe acute pancreatitis occurs in around 20% of patients and is associated with mortality rates between 8-40%. Abdominal compartment syndrome is a fatal complication that is associated with new organ failure or acute worsening of existing organ failure and has an associated mortality of around 60%. Intra-abdominal pressure measurements are recommended in patients with risk factors for intra-abdominal hypertension or abdominal compartment syndrome. Management should be based on a step-up method and surgical intervention may be indicated when conservative treatment fails.
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Mora-Guzmán I, Muñoz de Nova JL, Marín-Campos C, Jiménez-Heffernan JA, Cuesta Pérez JJ, Lahera Vargas M, Torres Mínguez E, Martín-Pérez E. Efficiency of the Bethesda System for Thyroid Cytopathology. Cir Esp 2018; 96:363-368. [PMID: 29605452 DOI: 10.1016/j.ciresp.2018.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 02/17/2018] [Accepted: 02/19/2018] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Fine-needle aspiration biopsies are a key tool for preoperative assessment of thyroid nodules, and the Bethesda system is the preferred method to report cytological analysis. The purpose of this study is to assess the efficiency of the Bethesda system to identify the malignancy risk of thyroid nodules. METHODS Patients who underwent thyroid surgery between June 2010 and June 2017 were included. Samples were classified into 6categories according to rates of malignancy associated with each diagnostic category. In order to investigate the correlation between categories, a statistical analysis compared the categories with pathology reports. Diagnostic indicators were calculated as a screening test (categories IV, V, VI as true-positive) and as a method to identify malignancy (V, VI as true-positive). RESULTS In a series of 522 patients, we found 184 (35.2%) malignant tumours, papillary carcinoma being the most prevalent with 155 cases (84.2%). Malignant rates for diagnostic categories were: I, 0%; II, 1.5%; III, 6.4%; IV, 31%; V, 86.5%; VI, 100%. A robust correlation was identified between categories on statistical analysis. For the «screening test» analysis, sensitivity was 98.9%, specificity 84.4%, positive predictive value 69.6%, negative predictive value 99.5%, and diagnostic accuracy 88.2%. Analysing the accuracy to detect malignancy, values were: sensitivity 98.6%, specificity 97.6%, positive predictive value 93.5%, negative predictive value 99.5%, diagnostic accuracy 97.9%. CONCLUSION The Bethesda system is a clear and reliable approach to report thyroid cytology and therefore is an effective tool to identify malignancy risk and guide clinical management.
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Mora-Guzmán I, Muñoz de Nova JL, Martín-Pérez E. Neuroendocrine tumours within a Meckel's diverticulum. Ann R Coll Surg Engl 2018; 100:e10-e11. [PMID: 29046099 PMCID: PMC5838679 DOI: 10.1308/rcsbull.2018.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2017] [Indexed: 06/07/2023] Open
Abstract
A Meckel's diverticulum is a common anomaly of the gastrointestinal tract. Although the majority of patients do not have any symptoms, malignancies can develop inside these diverticula, with neuroendocrine tumours being the most common. Diverticulectomy is the best option for complicated diverticula but prophylactic resection of asymptomatic diverticula in adults remains controversial. We present a case series of three patients with a neuroendocrine tumour found in a Meckel's diverticulum. Given the number of asymptomatic diverticula not resected, it seems likely that incidental neuroendocrine tumours are more prevalent than thought previously. With the minimally invasive techniques now available and the low complication rate for incidental diverticulectomy, we believe that the benefits of resection of this high risk area for cancer outweigh the risks of surgery.
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Mora-Guzmán I, Muñoz de Nova JL, Martín-Pérez E. Neuroendocrine tumours within a Meckel's diverticulum. Ann R Coll Surg Engl 2017. [PMID: 29046099 DOI: 10.1308/rcsann.2017.0180] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A Meckel's diverticulum is a common anomaly of the gastrointestinal tract. Although the majority of patients do not have any symptoms, malignancies can develop inside these diverticula, with neuroendocrine tumours being the most common. Diverticulectomy is the best option for complicated diverticula but prophylactic resection of asymptomatic diverticula in adults remains controversial. We present a case series of three patients with a neuroendocrine tumour found in a Meckel's diverticulum. Given the number of asymptomatic diverticula not resected, it seems likely that incidental neuroendocrine tumours are more prevalent than thought previously. With the minimally invasive techniques now available and the low complication rate for incidental diverticulectomy, we believe that the benefits of resection of this high risk area for cancer outweigh the risks of surgery.
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Mora-Guzmán I, Martín-Pérez E. Primary Abdominal Wall Abscess by Actinomyces and Eikenella corrodens: A First Report. Surg Infect (Larchmt) 2017; 18:941-942. [PMID: 29040018 DOI: 10.1089/sur.2017.200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hernández-Bartolomé Á, López-Rodríguez R, García-Buey L, Martín-Vílchez S, Rodríguez-Muñoz Y, Borque MJ, González-Moreno L, Real-Martínez Y, Mendoza-Ridruejo J, Martín-Pérez E, Moreno-Otero R, Sanz-Cameno P. Intrahepatic angiopoietin-2 correlates with chronic hepatitis C progression and is induced in hepatitis C virus replicon systems. Liver Int 2017; 37:1148-1156. [PMID: 28027429 DOI: 10.1111/liv.13352] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 12/13/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Chronic hepatitis C (CHC) is a major cause of cirrhosis and hepatocellular carcinoma and angiogenesis is closely related to the pathogenesis and progression of different chronic liver diseases (CLD). Thus, the intrahepatic expression of angiopoietins 1 and 2 (Ang1 and Ang2), as relevant mediators of pathological angiogenesis in several CLD, was investigated. In addition, the differential influence of structural and non-structural genomic regions of HCV on the expression of angiopoietins and the possible signalling involved were studied. METHODS Ang1 and Ang2 expression was evaluated by western blotting and enzyme-linked immunosorbent assay (ELISA) in liver homogenates of CHC patients (n=47) and uninfected subjects (n=8). Their association with disease progression (according to METAVIR classification) was assessed by Spearman's correlation. Statistical differences among the expression of angiopoietins at different CHC stages were calculated by Mann-Whitney U-test. Finally, the in vitro expression of Angiopoietins in HCV replicons (complete or non-structural subgenomic) and the main signalling pathways involved were also examined. RESULTS Ang2 levels were significantly higher in the liver of CHC patients compared to controls and significantly correlated with inflammation and fibrosis. Accordingly, an increased expression of Ang2 was found in all HCV replicons tested. Interestingly, the inhibition of MEK and PI3K signalling pathways exerted differential effects on Ang2 expression concerning to the genomic region of HCV. CONCLUSIONS Hepatitis C virus induces Ang2 expression in hepatocytes through different signalling routes which may lead to the disregulation of vascular homeostasis in the liver. Thus, pharmacologic intervention on Ang2 signalling might constitute an important therapeutic tool.
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Mora-Guzmán I, Muñoz de Nova JL, Martín-Pérez E. Fe de errores de «Recurrencia de enfermedad biliar tras el tratamiento conservador de la colecistitis aguda en la población geriátrica» [MedClin(Barc) 148(12) (2017) 569–572]. Med Clin (Barc) 2017; 149:139. [DOI: 10.1016/j.medcli.2017.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 06/09/2017] [Indexed: 11/30/2022]
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Mora-Guzmán I, Del Pozo Jiménez JA, Martín-Pérez E. A giant hiatal hernia and intrathoracic pancreas. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 109:458-459. [PMID: 28597678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Transhiatal herniation of the pancreas is an extremely rare condition, with only a few more than ten cases reported. Most patients are symptomatic at initial presentation and multi-detector computed tomography allows a detailed visualization of the anatomy and size of the diaphragmatic defect. Surgical repair is recommended for symptomatic cases.
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Di Martino M, Laganá C, Delgado Valdueza J, Martín-Pérez E. A bronchobiliary fistula due to giant hydatid cyst. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 109:462-463. [PMID: 28597682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Intrathoracic rupture of hydatid cyst of the liver is a rare but severe complication of echinococcal disease. It represent a serious condition responsible for lesions at 3 levels: hepatic, diaphragmatic, and pulmonary. Early diagnosis and management of septic associated complications are essential. We present the case of a 55 year old female patient with a giant hydatid cyst type CE 2 based on WHO Classification, communicating with the biliary tree and with a massive extension to the right hemithorax.
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Mora-Guzmán I, Muñoz de Nova JL, Martín-Pérez E. Meckel's diverticulitis in adults: study of 15 patients. Med Clin (Barc) 2017; 148:569-570. [PMID: 28283269 DOI: 10.1016/j.medcli.2017.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 01/24/2017] [Accepted: 01/26/2017] [Indexed: 11/25/2022]
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Sabater Ortí L, Martín-Pérez E, Artigas Raventós V. The origins of oncological pancreatic surgery in Spain. A tribute to pioneers. Cir Esp 2017; 95:190-198. [PMID: 28238362 DOI: 10.1016/j.ciresp.2017.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/22/2016] [Accepted: 01/07/2017] [Indexed: 11/28/2022]
Abstract
Pancreaticoduodenectomy (PD) is a very complex operation. Its development took place very slowly at the most prestigious centers in the world. The aim of this investigation is to know who were the first surgeons to perform a PD in Spain as well as its historical circumstances. Despite all kinds of difficulties and very few resources, the first PD in Spain were carried out in Barcelona at the Hospital de la Santa Creu i Sant Pau where from the mid-50s a school of gastrointestinal surgery emerged with surgeons soon to become the spearhead of the Spanish surgery and a reference for the whole country: Pi-Figueras, Vicente Artigas, Antonio Soler-Roig and Antonio Llauradó. Almost simultaneously, in Oviedo, Luis Estrada also introduced the PD and total pancreaticoduodenectomy after a period of training with the pioneers of pancreatic surgery in the United States.
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Sabater L, Ausania F, Bakker OJ, Boadas J, Domínguez-Muñoz JE, Falconi M, Fernández-Cruz L, Frulloni L, González-Sánchez V, Lariño-Noia J, Lindkvist B, Lluís F, Morera-Ocón F, Martín-Pérez E, Marra-López C, Moya-Herraiz Á, Neoptolemos JP, Pascual I, Pérez-Aisa Á, Pezzilli R, Ramia JM, Sánchez B, Molero X, Ruiz-Montesinos I, Vaquero EC, de-Madaria E. Evidence-based Guidelines for the Management of Exocrine Pancreatic Insufficiency After Pancreatic Surgery. Ann Surg 2016; 264:949-958. [PMID: 27045859 DOI: 10.1097/sla.0000000000001732] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To provide evidence-based recommendations for the management of exocrine pancreatic insufficiency (EPI) after pancreatic surgery. BACKGROUND EPI is a common complication after pancreatic surgery but there is certain confusion about its frequency, optimal methods of diagnosis, and when and how to treat these patients. METHODS Eighteen multidisciplinary reviewers performed a systematic review on 10 predefined questions following the GRADE methodology. Six external expert referees reviewed the retrieved information. Members from Spanish Association of Pancreatology were invited to suggest modifications and voted for the quantification of agreement. RESULTS These guidelines analyze the definition of EPI after pancreatic surgery, (one question), its frequency after specific techniques and underlying disease (four questions), its clinical consequences (one question), diagnosis (one question), when and how to treat postsurgical EPI (two questions) and its impact on the quality of life (one question). Eleven statements answering those 10 questions were provided: one (9.1%) was rated as a strong recommendation according to GRADE, three (27.3%) as moderate and seven (63.6%) as weak. All statements had strong agreement. CONCLUSIONS EPI is a frequent but under-recognized complication of pancreatic surgery. These guidelines provide evidence-based recommendations for the definition, diagnosis, and management of EPI after pancreatic surgery.
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Di Martino M, García Sanz I, Delgado Valdueza J, Martín-Pérez E. Giant Malignant Insulinoma. J Gastrointest Surg 2016; 20:1530-1. [PMID: 26969167 DOI: 10.1007/s11605-016-3118-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/22/2016] [Indexed: 01/31/2023]
Abstract
The role of debulking resections in giant malignant insulinoma is still controversial. Here, we report the case of a 49-year-old patient woman with a giant malignant symptomatic insulinoma, who underwent debulking surgery, realizing a total pancreatectomy, splenectomy, partial gastrectomy and cholecystectomy.
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Mora-Guzmán I, Muñoz de Nova JL, García-Sanz Í, Martín-Pérez E. Acute pancreatitis secondary to periampullary duodenal diverticulitis. Cir Esp 2016; 95:231. [PMID: 27234129 DOI: 10.1016/j.ciresp.2016.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 03/23/2016] [Indexed: 11/24/2022]
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Kennedy KV, Yela R, Achalandabaso MDM, Martín-Pérez E. Superior mesenteric artery syndrome: diagnostic and therapeutic considerations. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2016; 105:236-8. [PMID: 23859456 DOI: 10.4321/s1130-01082013000400012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Mora-Guzmán I, Muñoz de Nova JL, Vivancos Costaleite K, Martín-Pérez E. Colecistitis aguda en un paciente con situs inversus totalis. Cir Esp 2016; 94:181. [DOI: 10.1016/j.ciresp.2015.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 09/18/2015] [Indexed: 11/17/2022]
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Sampedro-Núñez M, Luque RM, Ramos-Levi AM, Gahete MD, Serrano-Somavilla A, Villa-Osaba A, Adrados M, Ibáñez-Costa A, Martín-Pérez E, Culler MD, Marazuela M, Castaño JP. Presence of sst5TMD4, a truncated splice variant of the somatostatin receptor subtype 5, is associated to features of increased aggressiveness in pancreatic neuroendocrine tumors. Oncotarget 2016; 7:6593-608. [PMID: 26673010 PMCID: PMC4872735 DOI: 10.18632/oncotarget.6565] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 11/21/2015] [Indexed: 12/13/2022] Open
Abstract
Purpose Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are rare and heterogeneous tumors, and their biological behavior is not well known. We studied the presence and potential functional roles of somatostatin receptors (sst1-5), focusing particularly on the truncated variants (sst5TMD4, sst5TMD5) and on their relationships with the angiogenic system (Ang/Tie-2 and VEGF) in human GEP-NETs. Experimental Design We evaluated 42 tumor tissue samples (26 primary/16 metastatic) from 26 patients with GEP-NETs, and 30 non-tumoral tissues (26 from adjacent non-tumor regions and 4 from normal controls) from a single center. Expression of sst1-5, sst5TMD4, sst5TMD5, Ang1-2, Tie-2 and VEGF was analyzed using real-time qPCR, immunofluorescence and immunohistochemistry. Expression levels were associated with tumor characteristics and clinical outcomes. Functional role of sst5TMD4 was analyzed in GEP-NET cell lines. Results sst1 exhibited the highest expression in GEP-NET, whilst sst2 was the most frequently observed sst-subtype (90.2%). Expression levels of sst1, sst2, sst3, sst5TMD4, and sst5TMD5 were significantly higher in tumor tissues compared to their adjacent non-tumoral tissue. Lymph-node metastases expressed higher levels of sst5TMD4 than in its corresponding primary tumor tissue. sst5TMD4 was also significantly higher in intestinal tumor tissues from patients with residual disease of intestinal origin compared to those with non-residual disease. Functional assays demonstrated that the presence of sst5TMD4 was associated to enhanced malignant features in GEP-NET cells. Angiogenic markers correlated positively with sst5TMD4, which was confirmed by immunohistochemical/fluorescence studies. Conclusions sst5TMD4 is overexpressed in GEP-NETs and is associated to enhanced aggressiveness, suggesting its potential value as biomarker and target in GEP-NETs.
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del Pozo-Ruiz J, Martín-Pérez E, Malafarina V. Pharmacoeconomic and clinical aspect of a sequential intravenous to oral therapy plan in an acute geriatric ward. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2015.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Di Martino M, García Sanz Í, Muñoz de Nova JL, Marín Campos C, Martín-Pérez E. Comb sign in intestinal obstruction secondary to desmoplastic reaction due to an ileal neuroendocrine tumor. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2015; 107:697-698. [PMID: 26561912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This article report the case of an intestinal obstruction secondary to desmoplastic reaction of an ileum neuroendocrine tumor (NET), that was radiologically diagnosed by the comb sign. This is an infrequent clinical manifestation of NETs, often underdiagnosed, related to local overproduction of serotonin.
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Muñoz de Nova JL, García-Sanz I, del Campo Val L, Martín-Pérez E. Giant hepatic hydatidosis. Cir Esp 2014; 93:e11. [PMID: 25282361 DOI: 10.1016/j.ciresp.2014.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 08/01/2014] [Indexed: 10/24/2022]
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Salido S, Gómez-Ramírez J, Bravo JM, Martín-Pérez E, Fernández-Díaz G, Múñoz de Nova JL, Auza J, Larrañaga E. Parathyroid adenoma in third pharyngeal pouch cyst as a rare case of primary hyperparathyroidism. Ann R Coll Surg Engl 2014; 96:e8-10. [PMID: 25245714 DOI: 10.1308/003588414x13946184900804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The primitive thymus and inferior parathyroid derive from the third branchial cleft. During embryonic development, these structures descend, reaching their final localisation. Third branchial cleft anomalies present usually as a fistula, abscess or cyst. However, there are no reports on parathyroid adenomas in the literature other than as a morphological possibility. We describe the case of a 47-year-old man, who had been diagnosed with arterial hypertension and who presented with a cervical mass at the edge of the lower third of the sternocleidomastoid muscle. On ultrasonography, the mass had a cystic walled appearance. Laboratory analysis only revealed an intact parathyroid hormone level of 140.5 pg/ml. Sestamibi imaging showed a probable parathyroid adenoma in the anterior mediastinum. During surgery, a tract running from beyond the superior thyroid pedicle to the superior mediastinum was dissected and removed. In the inferior end of the tract, a brown mass was visible. Pathological examination revealed a thymus cyst surrounding a parathyroid adenoma. The primal alteration was the lack of division between the thymus and inferior parathyroid gland, and the prompt prevention of their development. In the case of our patient, a parathyroid adenoma had grown by chance.
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Abascal Amo A, Martín-Pérez E, Bravo Lifante JM, Larrañaga Barrera E. [Locoregional recurrence of Hurthle cell carcinoma]. Cir Esp 2013; 91:e57. [PMID: 23876374 DOI: 10.1016/j.ciresp.2013.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 03/30/2013] [Accepted: 04/02/2013] [Indexed: 10/26/2022]
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Gómez-Ramírez J, Tagarro D, Bravo JM, Martín-Pérez E, Larrañaga E. Preoperative parathyroid harpoon localisation: a new technique helpful in reoperative patients with persistent hyperparathyroidism. Ann R Coll Surg Engl 2013; 95:e25-6. [PMID: 23484975 PMCID: PMC4098598 DOI: 10.1308/003588413x13511609955896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Surgery for persistent primary hyperparathyroidism remains a major challenge for surgeons and these reoperative procedures require an experienced parathyroid surgeon. The goal of reoperative surgery is to excise the abnormal parathyroid gland(s) and limit exploration to help minimise the potential complications. At least two positive and concordant localising studies should be available before reoperation because the technical difficulties in these cases make an exact localisation necessary before surgery. We describe the placement of a metallic harpoon under ultrasonography guidance as a safe, simple and inexpensive technique for localisation of the enlarged gland prior to conservative surgery.
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Ruiz-Tovar J, Martín-Pérez E, Fernández-Contreras ME, Reguero-Callejas ME, Gamallo-Amat C. Identification of prognostic factors in pancreatic cancer. CIR CIR 2011; 79:313-322. [PMID: 21951885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Surgical resection is the only potentially curative treatment for pancreatic cancer, but it is associated with high complication rates. Outcome is poor, even in those resected cases. Identification of prognostic factors preoperatively may help to improve treatment of these patients, based on the expected response. METHODS A retrospective study of clinical variables of 59 patients with histological diagnosis of pancreatic carcinoma at University Hospitals Ramon y Cajal and La Princesa (Madrid, Spain) between 1999 and 2003 was performed. RESULTS We analyzed 59 patients (32 males and 27 females) with a mean age of 63.76 years. All patients were operated on, performing palliative surgery in 32% and tumor resection in 68%, including pancreaticoduodenectomy in 51% and distal pancreatectomy in 17%. Median overall survival was 14 months (range: 1-110 months). We observed that the presence of abdominal pain (p = 0.042) and back pain (p = 0.004) at diagnosis, palpation of abdominal mass at physical examination (p = 0.012), preoperative levels of hemoglobin <12 g/dl (p = 0.0006) and serum albumin <2.8 g/dl (p = 0.021), perineural infiltration (p = 0.025), lymph node affection (p = 0.004), stages II, III, and IV (p = 0.001), and presence of residual tumor (R+) (p = 0.008) are all associated with poor survival. CONCLUSIONS Abdominal and back pain, palpation of abdominal mass at physical examination, preoperative levels of hemoglobin <12 g/dl and serum albumin <2.8 g/dl, perineural infiltration, lymph node affection, stages II, III, and IV, and the presence of residual tumor are associated with poor outcome.
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Ruiz-Tovar J, Martín-Pérez E, Fernández-Contreras ME, Reguero-Callejas ME, Gamallo-Amat C. Impact of preoperative levels of hemoglobin and albumin on the survival of pancreatic carcinoma. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2011; 102:631-6. [PMID: 21142383 DOI: 10.4321/s1130-01082010001100003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Pancreatic cancer presents the worst survival rates of all neoplasms. Surgical resection is the only potentially curative treatment, but is associated with high complication rates and outcome is bad even in those resected cases. Therefore, candidates amenable for resection must be carefully selected. Identification of prognostic factors preoperatively may help to improve the treatment of these patients, focusing on individually management based on the expected response. PATIENTS AND METHODS We perform a retrospective study of 59 patients with histological diagnosis of pancreatic carcinoma between 1999 and 2003, looking for possible prognostic factors. RESULTS We analyze 59 patients, 32 males and 27 females with a mean age of 63.8 years. All the patients were operated, performing palliative surgery in 32% and tumoral resection in 68%, including pancreaticoduodenectomies in 51% and distal pancreatectomy in 17%. Median global survival was 14 months (Range 1-110).We observed that preoperative levels of hemoglobin under 12 g/dl (p = 0.0006) and serum albumina under 2.8 g/dl (p = 0.021) are associated with worse survival. CONCLUSION Preoperative levels of hemoglobin and serum albumina may be prognostic indicators in pancreatic cancer.
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