Hyperparathyroidism due to chronic renal failure. Analysis of 32 operated patients

We report our study of 32 patients diagnosed as hyperparathyroidism due to chronic renal failure (27 secondary forms and 5 tertiary ones), between June 1990 and 2003, that were sent from Nefrology Department for to surgical intervention. The following parameters have been analysed: Age, sex, clinical symptoms, kind of surgery performed, postoperative complications and anatomopathologic result (AP). On 64 nerves exposed, there were no recurrent nerve palsies. 12 patients suffered a symptomatic hypocalcemia (37,5%) although only one was permanent. The control of calcium, phosporus and calcitriol is essential to try to avoid a hyperplasia of the parathyroid glands.     

Severe epistaxis secondary to ticlopidine. Report of 3 cases

Ticlopidine (Ticlid@) is a platelet aggregation inhibitor that can produce bleeding or severe hemorrhage as a side-effect. The cases of three patients on previous treatment with that drug that required admission in our hospital because of recurrent epistaxis are reported. We have analysed their personal antecedents, complementary explorations, type of nasal packing used, clinical evolution and stay.     

Sino-nasal undifferentiated carcinoma. Report of 1 case and literature review

Sinonasal undifferentiated carcinomas are rare neoplasms but highly malignant and aggressive. We are reporting the case of a 75 year-old female who had related recurrent epistaxis, facial pain and progressive nasal obstruction. The clinical data collected by the exploration joint to CT showed us the presence of a tumoral mass located in the right nasal fossa and homolateral maxillary sinus, eroding structures around. Its biopsy was informed as undifferentiated carcinoma and the patient was sent to Oncology Department, where she was treated by Radiotherapy (68 Gy) and weekly carboplatin during 2 months. After a short improvement of her symptoms and due to poor prognosis in this type of tumors, she died a few months later.     

Hemostatic effect of activated recombinant factor VII (rFVIIa) in liver disease: studies in an in vitro model

BACKGROUND/AIMS: There is clinical evidence for the efficacy of activated recombinant factor VII (rFVIIa) in patients with cirrhosis. The exact mechanism of action of rFVIIa in this clinical condition is unknown. We have explored effects of rFVIIa on hemostasis in cirrhotic patients using an in vitro perfusion technique. METHODS: Blood samples were drawn from control donors or from 11 patients previously diagnosed with cirrhosis (seven Child-Pugh B and four Child-Pugh C) and anticoagulated with low molecular weight heparin. rFVIIa was added to blood samples at therapeutic concentrations (0.5 or 1 microg/ml of plasma) and blood was recirculated through annular chambers containing damaged vascular segments. Presence of platelets and fibrin on the subendothelium were morphometrically quantified. RESULTS: Cirrhotic patients showed a diminished platelet interaction with the subendothelium compared to healthy donors (17.3% (9.28-28.88%) vs. 26.16% (19.96-54.5%), P<0.05). After addition of rFVIIa to cirrhotic samples, no differences in platelet covered surface were observed. However, fibrin formation was significantly improved after the addition of rFVIIa (from 51.81% (3.02-86.68%) to 86.94% (30.03-93.18%) and 89.05% (45.65-93.84%), respectively, P<0.05). CONCLUSIONS: Our data confirm a defective interaction of platelets with the subendothelium in cirrhotic patients. rFVIIa improved local fibrin formation at damaged sites and this mechanism could explain the beneficial action of rFVIIa in cirrhotic patients.     

Clinical course in patients treated for primary hyperparathyroidism. Our results and review of the literature

Our aim was to verify the clinical improvement following surgery in patients diagnosed of primary hyperparathyroidism. Between april 1990 and november 2002 we have operated 83 patients with this diagnosis (12 men and 71 women). Before surgery, calcium and paratohormone (PTH) levels were measured, Together with clinical symptoms. We analysed the kind of surgery, AP results, complications and clinical evolution. In over 97% of cases we obtained a biochemical normalization after surgery, 96% of the patients with nephrolithiasis improved notoriously, being this the only statistically significant symptom (p < 0.01). The rest of symptoms also decreased following parathyroidectomy (p > 0.05).     

Brown bone tumor as the first manifestation of primary hyperparathyroidism

We report a clinical case of a 26 years old female who had a 2 years evolution chin tumour with hypercalcemia (11.8 mg/dl) and PTH (paratohormone) of 761 pg/ml. She underwent a CT scan and MRI of the mandible, as well as a biopsy followed by excision of the tumour by the maxilofacial surgeons. Our ENT Department asked for a Scintigraphy (Tc99s-mibi) and thoracic-cervical CT, which showed a lesion that turned out to be an adenoma of the lower right parathyroid gland after surgery and pathological examination. The patient suffered a Primary hyperparathyroidism that was the main stimulus for the Brown Tumour made up by macrophagos and multinuclear giant cells, being this the first manifestation of the metabolic disorder. This form of hyperparathyroidism is very rare in the clinic. We do a literature review to establish the differential diagnosis for such pathology.     

Complications of thyroid and parathyroid surgery. Retrospective study and review of the literature

The number of ORL surgeons performing thyroid and parathyroid glands interventions is increasing more. Most of these surgeries are successful for us and our patients specially. However, this kind of operation can result in complications such as hypocalcemia and recurrential palsy, transitory or permanent, that it is necessary to know and avoid as far as possible. We are reporting a retrospective study of 12 years, based on our personal experience, where the real complications are analysed in 615 operated patients (500 with thyroid pathology and other 115 with parathyroid affectation) and after a comparation between both groups. The percentages of hypocalcemias were 25.6% and 24.3%, respectively. While in thyroid surgery (TS) the recurrential palsies showed a 6.6%, in parathyroid surgery (PS) were 0.8% only. The anatomical-embriologic knowledge, meticulousness and experience are three main qualities that are able to reduce the number of complications in the surgery of thyroid and parathyroid glands.     

Peritonsillar phlegmons and abscesses. Retrospective study of 100 cases

Our main goal was performing a retrospective study about peritonsillar cellulitis and abscess to prove the efficiency of treatment. So that we have collected 100 clinical histories of admitted patients in our ENT Service between 1990 and 2001 with such pathology and analysed a serie of variables and the treatment given in each case. It is one of the most common infectious diseases of the head and neck region. If aspiration positive, it require an incision and drainage to improve the symptoms (throat pain, fever, dysphagia and trismus). We have made no immediate tonsillectomies. All the patients were hospitalized and average stay was 3 days. 21 patients were re-admitted because of a recurrence pathology before the later programmed surgery.