Hyperparathyroidism associated with thyroid disease. Retrospective study of 15 patients treated in 11 years

The association of hyperparathyroidism with thyroid pathology previous to surgery is not very frequent in our cases, almost a 15%, but it means another difficulty for the diagnostic and treatment. Between 1991 and 2001 we have studied and operated 15 patients with this clinic association. 14 were female and only 1 male with a range age of 59 years old. We studied the type of hyperparathyroidism, personal history, clinic, type of thyroid pathology associated, complementary explorations, type of surgery, anatomopathology evolution, and hospital stay. We have done 12 adenoma resections, 1 subtotal parathyroidectomy, 2 total thyroidectomies and 5 hemithyroidectomies. Only in one patient the anatomopathology was informed as a thyroid carcinoma associated to a parathyroid adenoma, being the other patients benign pathologies. We did literaturer revision on this association. We believe that in all patients with a thyroid pathology we should an associated hyperparathyroidism and vice versa.     

Nasopharyngeal angiofibroma. Our experience (1990-2001)

We present our experience in the treatment of nasopharyngeal angiofibromas, tumours not very common, with a benign histology but with the risk of severe epistaxis or possible involvement of vital structures. In a period of 12 years (1990-2001) we have treated 6 males with this pathology, operating 5 of them. We describe the clinical manifestations, the tumour stages following the Fisch classification, the diagnostic and surgical techniques used, the evolution of the patients and their postoperatory. We review also the literature about this subject.     

Sudden deafness. 12 year of experience

We report 48 cases of sudden deafness admitted in our Hospital between 1990 and 2001. A series of variables were analyzed like affected ear, evolution time, personal precedents, clinic, audiometry, complementary tests, treatments followed (according protocol), clinical evolve and average stay. Four cases annually, more or less, have been registered, with little predominance of men (28) than women (13), being the happy medium 48 years (between 22 and 74 years). 43 percent of cases came to Urgency ward before 24 hours since the beginning of symptoms and 31 percent came three or more days later. 45 patients (93.7%) with an audiometric loss of 500 Hz, 1,000 Hz and 2,000 Hz over 55 dB, with 11 cases of total deafness. In our Department two several treatment protocol have been employed, which results are considered in the paper. Generally 52 percent showed little improvement and only 7 cases gain more than 40 dB, with 2 complete recovery and 23 without improvement. We think that this pathology must be i.v. precociously treated with the selected protocols although without any warranty of hearing improvement, as reflected in our paper.     

Benign symmetric lipomatosis (Madelung's disease)

We report on a 50-year-old man who presented with benign, symmetric lipomatosis and chronic alcoholic liver disease. The characteristic clinical features and a brief review of the current literature are presented.     

Stoma complications

PURPOSE: A retrospective analysis of enteric stomas performed at Cook County Hospital was undertaken to evaluate stoma complications per stoma type and configuration and operating service. In addition, we attempted to identify factors predictive of increased enteric stoma complications. METHODS: From 1976 to 1995, data cards on 1,616 patients with stomas were compiled by Cook County Hospital enteric stomal therapists. Data card information included age, gender, weight, early and late stoma complications, emergency status, operating service, type and configuration of the stoma, and whether the patient was seen preoperatively by an enteric stomal therapist. Data were then analyzed using a logistic regression model to identify those variables that influenced the rate of complications. RESULTS: There were 553 (34 percent) patients with complications. Among the total complications, 448 (28 percent) occurred early (<1 month postoperative), and 105 (6 percent) occurred late (>1 month). The most common early complications were skin irritation (12 percent), pain associated with poor stoma location (7 percent), and partial necrosis (5 percent). The most common late complications were skin irritation (6 percent), prolapse (2 percent), and stenosis (2 percent). The enteric stoma with the most complications was the loop ileostomy (75 percent). The enteric stoma with the least complications was the end transverse colostomy (6 percent). The general surgery service had the most complications (47 percent), followed by gynecology (44 percent), surgical oncology (37 percent), colorectal (32 percent), pediatric surgery (29 percent), and trauma (25 percent). Age, operating service, enteric stoma type and configuration, and preoperative enteric stomal therapist marking were found to be variables that influenced stoma complications. CONCLUSIONS: Complications from enteric stoma construction are common. Preoperative enteric stoma site marking, especially in older patients, and avoiding the ileostomy, particularly in the loop configuration, can help minimize complications.     

Concentration of adipogenic and proinflammatory cytokines in the bone marrow supernatant fluid of osteoporotic women

Osteoporosis is characterized by low bone mass, microarchitectural deterioration of bone tissue leading to increased bone fragility, and a resulting susceptibility to fractures. Distinctive environmental bone marrow conditions appear to support the development and maintenance of the unbalance between bone resorption and bone formation; these complex bone marrow circumstances would be reflected in the fluid surrounding bone marrow cells. The content of regulatory molecules in the extracellular fluid from the human bone marrow is practically unknown. Since the content of cytokines such as adiponectin, leptin, osteoprogeterin (OPG), soluble receptor activator of nuclear factor κB ligand (s‐RANKL), tumor necrosis factor α, and interleukin 6 (IL‐6) may elicit conditions promoting or sustaining osteoporosis, in this work we compared the concentrations of the above‐mentioned cytokines and also the level of the soluble receptors for both IL‐6 and leptin in the extracellular fluid from the bone marrow of nonosteoporotic and osteoporotic human donors. A supernatant fluid (bone marrow supernatant fluid [BMSF]) was obtained after spinning the aspirated bone marrow samples; donors were classified as nonosteoporotic or osteoporotic after dual‐energy X‐ray absorptiometry (DXA) measuring. Specific commercially available kits were used for all measurements. The cytokines' concentration in BMSF showed differently among nonosteoporotic and osteoporotic women; this last group was characterized by higher content of proinflammatory and adipogenic cytokines. Also, osteoporotic BMSF differentiated by decreased leptin bioavailability, suggesting that insufficient leptin action may distinguish the osteoporotic bone marrow. © 2010 American Society for Bone and Mineral Research     

Quantitative correlation among DNA damaging potency of six N-nitroso compounds and their potency in inducing tumor growth and bacterial mutations

Six N-nitroso compounds (N-nitrosodimethylamine, N-nitrosodiethylamine,N-nitrosodi-n-propylamine, N-nitroso-N-methylurea, N-nitrosopyrrolidine,and N-nitrosodi-n-butylamine) were tested in rats for liverDNA damaging activity by the alkaline elution technique. Onmolar basis their DNA damaging potency was found to decreasein the above order, and to vary over a 28-fold range. The elaborationof homogenous data available from literature showed that thecarcinogenic potency of the 6 N-nitroso compounds varied overan 18-fold range, and that their mutagenic potency varied overa 490-fold range. Regression analysis indicated that correlationbetween carcinogenic and DNA damaging potencies was positivebut at a low significance level, while the correlation betweencarcinogenic and mutagenic potencies was negative.     

Perturbation of the blood-retinal barrier after enzyme perfusion. A cytochemical study

The retina is protected from circulating molecules by a blood-retinal barrier. This is comprised of the impermeable apical-lateral junctions of the retinal pigment epithelium and intraretinal blood vessels lined by endothelia that have impermeable junctions and vesicles that do not transport material from the luminal to abluminal front. This study examined the effect of enzyme digestion upon the restrictive properties of the retinal capillary endothelium. Rats were perfused first with enzymes and then by hemoglobin that was visualized by ultrastructural cytochemical methods. After perfusion of buffer alone or buffers containing neuraminidase or heparinase, the cytochemical reaction product was confined to the capillary lumina and to endothelial cell vesicles facing the luminal front. In contrast, after heparitinase or pronase perfusion, reaction product filled the extravascular spaces. Chains of endothelial cell vesicles and patent transendothelial channels were often encountered. Endothelial cell junctions did not appear to be affected by enzyme treatment. These findings indicate that a cell-surface heparan sulfate proteoglycan (or a nonidentified protein removed by proteolysis) is a key molecule required for the maintenance of the blood-retinal barrier.