Antonio Ríos Zambudio

Prospective Study of Postoperative Complications After Total Thyroidectomy for Multinodular Goiters by Surgeons With Experience in Endocrine Surgery

Objetives:(1) To show that total thyroidectomy (TT) can be performed in multinodular goiter (MG) by surgeons with experience in endocrine surgery with a definitive complication rate of 1% or less; and (2) to analyze the risk factors for complications in these patients. Summary Background Data:There is current controversy over the role of TT in the treatment of MG; although there are potential benefits, high rates of complications are not acceptable in surgery for a benign pathology. Patients and Method:A prospective study was conducted on 301 MGs meeting the following criteria: (1) bilateral MG; (2) no prior cervical surgery; (3) operation by surgeons with experience in endocrine surgery; (4) no associated parathyroid pathology; (5) no initial thoracic approach; and (6) minimum follow-up of 1 year. Age, sex, time of evolution, symptoms, cervical goiter grade, intrathoracic component, thyroid weight, and presence of associated carcinoma were analyzed as risk factors for complications. The χ2 test and a logistic regression analysis were applied. Results:Complications were presented by 62 patients (21%), corresponding to 29 hypoparathyroidisms, 26 recurrent laryngeal nerve injuries, 4 lesions of the superior laryngeal nerve, 3 cervical hematomas, and 1 infection of the cervicotomy. The variables associated with the presence of these complications were hyperthyroidism (P = 0.0033), compressive symptoms (P = 0.0455), intrathoracic component (P = 0.0366), goiter grade (P = 0.0195), and weight of excised specimen (P = 0.0302); hyperthyroidism (relative risk [RR] 2.5) and intrathoracic component (RR 1.5) persisted as independent risk factors. Definitive complications appeared in 3 patients (1%), corresponding to 2 hypoparathyroidisms and 1 recurrent laryngeal nerve injury. Two cases corresponded to a toxic goiter, and the third to an intrathoracic goiter with compressive symptoms. Conclusion:In endocrine surgery units, TT can be performed for MG with a definitive complication rate of around 1%; the main independent risk factors for the development of complications are hyperthyroidism and goiter size.

Acoustic Radiation Force Impulse Imaging for Evaluation of the Thyroid Gland

To study acoustic radiation force impulse (ARFI) imaging as a new quantitative and noninvasive tool for evaluating thyroid nodules and to compare ARFI imaging with other tools for studying thyroid nodules: sonography, real‐time elastography, and fine‐needle aspiration biopsy.

Utility of Frozen-Section Examination for Diagnosis of Malignancy Associated with Multinodular Goiter

Background: Frozen-section examination (FSE) has traditionally been used for the intraoperative diagnosis of thyroid cancer. However, the utility of the technique is now controversial, especially in multinodular goiter (MNG), on which there are few studies. The aim of this study was to analyze the utility of FSE for ruling out malignancy in patients undergoing surgery for MNG. Patients and Methods: FSE was performed in 197 patients with MNGs undergoing surgery for suspected malignancy, either preoperatively (n = 145; 74%) or intraoperatively (n = 52; 26%), and where the preoperatively planned surgical technique was partial resectional surgery. The FSE diagnosis was classified as benign, suggestive of malignancy, or malignant. The following FSE parameters were calculated for diagnosing MNG-associated carcinoma: true- and false-positives and true- and false-negatives, sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy. The χ2 and Students t tests were applied. Result...

Massive hemoptysis caused by tracheal hemangioma treated with interventional radiology

Capillary hemangiomas of the tracheobronchial tree are extremely rare in adults, with hemoptysis being one of the most serious forms of presentation. An operation has been the treatment of choice, although it does involve high rates of morbidity and mortality, especially in emergency situations such as massive hemoptysis, which has led to the search for other therapeutic alternatives. There is no experience with embolization by interventional radiology when the hemoptysis is tracheal in origin, caused partly because the infrequency of this pathology; however, the foundations for it have been laid with the development of embolization for bronchopulmonary pathology. We report a case of a tracheal capillary hemangioma in a 66-year-old woman diagnosed with idiopathic thrombopenic purpura, which began as a massive hemoptysis and was treated successfully with embolization by interventional radiology. There has been no recurrence of the bleeding after 1 years follow-up, and the patients control fibrobronchoscopy is normal.

Hipoparatiroidismo e hipocalcemia en el postoperatorio de la cirugía del bocio multinodular. Estudio multivariante de los factores de riesgo

BACKGROUND AND OBJECTIVE: The hypoparathyroidism is one of the most important complications in the patients submitted to thyroid surgery. The aim is to analyze across a multivariate statistical analysis the risks factors for the development of transient and permanent hypoparathyroidism following the multinodular goiter (MG) surgery. PATIENTS AND METHOD: Between 1970 and 1999, 672 thyroidectomies by MG were reviewed. It was considered transient hypoparathyroidism when the calcemia was minor of 7.5 mg/dl or when being minors of 8.5 mg/dl the patient was presenting symptomatology for the hipocalcemia. The hypoparathyroidsm was considered permanent when the calcemia was minor of 8.5 mg/dl to the year of the surgery. RESULTS: The hypoparathyroidism appeared in 75 patients (11.2%), 20 with symptomatology (3%), persisting like permanent 6 cases (0.9%). The risk factors for the development of this were the hyperthyroidism (p = 0.0370), and the surgical technique (p < 0.00001) (unilateral versus bilateral surgery), persisting in the multivariate analysis both variables. With respect to the permanent hypoparathyroidism, the risk factor was the toxic MG (p = 0.0109), persisting as independent risk factor in the multivariate analysis (RR = 2.3). CONCLUSIONS: The principal risk factor of permanent hypoparathyroidism in the MG surgery is the presence of hyperthyroidism.Fundamento y objetivo El hipoparatiroidismo es una de las complicaciones mas importantes en los pacientes a los que se practica cirugia tiroidea. Nuestro objetivo es analizar a traves de un estudio estadistico multivariante los factores de riesgo de desarrollo de hipoparatiroidismo transitorio y definitivo en el postoperatorio de la cirugia del bocio multinodular (BM). Pacientes y metodo Se han revisado de manera retrospectiva 672 casos de pacientes intervenidos de BM entre 1970 y 1999. Se considero hipoparatiroidismo durante el postoperatorio inmediato si las cifras de calcio eran menores de 7,5 mg/dl o cuando siendo menores de 8,5 mg/dl el paciente presentaba sintomas por la hipocalcemia, y definitivo cuando las cifras de calcemia eran menores de 8,5 mg/dl al ano de la cirugia. Resultados Se presentaron 75 casos de hipoparatiroidismo (11,2%), 20 de ellos sintomaticos (3%), y 6 persistieron como definitivos al ano (0,9%). Los factores de riesgo para el desarrollo de hipoparatiroidismo durante el postoperatorio fueron el hipertiroidismo (p = 0,0370) y la tecnica quirurgica (p Conclusiones El principal factor de riesgo de hipoparatiroidismo en la cirugia del BM es la presencia de hipertiroidismo asociado.

Tratamiento quirúrgico de los quistes mediastínicos no neoplásicos

Resumen Objetivo La importancia de los quistes mediastinicos no neoplasicos (QMNN) radica en su dificil diagnostico diferencial, y en la ausencia de un consenso sobre la mejor opcion terapeutica. El objetivo es analizar el abordaje diagnosticoterapeutico de estos quistes. Pacientes y metodos Desde 1980 hasta 2000 se han intervenido 18 QMNN. Se analiza la forma de presentacion, la clinica, las tecnicas de imagen, la intervencion quirurgica, la morbimortalidad y el seguimiento. Resultados Nueve (50%) corresponden a quistes broncogenicos, cuyo sintoma mas frecuente fue el dolor toracico. La radiografia de torax pone de manifiesto una masa en mediastino anterosuperior en 8 casos (88,9%), y la tomografia computarizada (TC), objetivo un tumor quistico en el mediastino anterior en 4 casos; todos fueron extirpados quirurgicamente, y 2 pacientes (22,2%) presentaron complicaciones leves. Seis (33,3%) correspondieron a quistes pleuropericardicos, tres de ellos (50%) asintomaticos. La radiografia de torax evidencio una tumoracion mediastinica paracardial derecha, que se confirmo con la TC (3 casos). Todos fueron extirpados quirurgicamente, con una morbilidad del 33,3% (2 casos). Tres (16,7%) correspondieron a quistes entericos. La radiografia de torax puso de manifiesto una tumoracion en el mediastino posterior, cuya naturaleza quistica fue confirmada por la TC (2 casos). Se realizo exeresis del quiste en todos los casos, de los que correspondieron a quistes de duplicacion dos esofagicos (66,7%) y uno gastrico. Todos permanecen asintomaticos y sin recidiva tras un seguimiento de 12 ± 10 anos. Conclusiones Los QMNN son lesiones benignas en las que, en la actualidad, la TC permite con frecuencia realizar un diagnostico prequirurgico, y en las que el tratamiento de eleccion es la cirugia, pues presenta baja morbimortalidad, permite descartar malignidad y lo cura definitivamente.

Influence of the participation of women in the labour market on attitude towards donation

The decision to donate is the process that occurs before transplantation, and in the last resort it is a personal or family option which is strongly affected by different factors in the psychosocial field of research [1,2]. In recent decades there has been an important social change, with an increase in the protagonism of women in the world of work as well as in education. This fact has placed women in a position in which their opinions and attitudes are becoming more and more important in the professional world as well as in the family, in a traditionally patriarchal society. Therefore, in a field such as organ donation, in which family authorization is fundamental, the opinion of women is becoming increasingly important for making the final decision. For this reason, the objective of this study is to analyse whether the attitude of the female population towards organ donation is influenced by the participation of women in the world of work. A random sample was obtained and stratified according to age and geographical location with 1022 women aged 15 ‡ years in our Autonomous Community. The sample was computationally designed using the stratification procedure by conglomerates and it included as sample points the 45 municipalities of our Community. The sample error (level of confidence 95.5%) was estimated to be e ±2.2. The attitude towards organ donation and transplantation was evaluated using a questionnaire on the psychosocial aspects of donation [3], which was carried out using a personal interview (December 1998–April 1999). The Students t-test and the chi-square test were applied, considering values of P < 0.05 to be significant. Of the 1022 women surveyed, 62% (n 1⁄4 635) were prepared to donate their organs, mainly because of reasons of solidarity and reciprocity. The remaining 38% (n 1⁄4 387) expressed their opinion against. The main reasons given for not donating were rejection of body mutilation and fear of apparent death. Of those surveyed, 66% (n 1⁄4 679) had been incorporated into the world of work. Of these women, 3% (n 1⁄4 20) were businesswomen, 1% (n 1⁄4 7) were on work experience and the remaining 96% were contracted by an employer [10% (n 1⁄4 68) liberal professions; 46% (n 1⁄4 313) administrative and service sector; 21% (n 1⁄4 142) employed in the home; and 19% (n 1⁄4 129) workers in agriculture]. A comparison of the two groups of women (Table 1) shows that the group participating in the labour market, with a clear percentage

Neoplasias primarias del timo de estirpe no linfoide. Estudio de 58 casos

Fundamento y objetivo: Los tumores primarios del timo de estirpe no linfoide son infrecuentes, aunque presentan una gran variedad. El objetivo de este trabajo es identificar las variables clinicas, terapeuticas e histologicas que tienen valor pronostico. Pacientes y metodo: Se estudiaron 58 tumores primarios del timo de estirpe no linfoide que correspondieron a 52 neoplasias epiteliales (NEPT) (90%), 4 timolipomas (7%) y 2 tumores neuroendocrinos (3%). La clinica mas frecuente fue la miastenia grave (41%) y la disnea (21%). Cabe destacar la presencia de 13 pacientes asintomaticos (24%). Para el analisis estadistico se utilizaron las curvas de supervivencia de Kaplan-Meier y el modelo de regresion de Cox. Resultados: Se intervino a todos los pacientes con timectomia, excepto en 4 casos en que se efectuo una biopsia. La mortalidad perioperatoria fue del 3% (n = 2) y la morbilidad, del 31% (n = 18), principalmente por afecciones respiratorias y de la herida. Se administro tratamiento adyuvante con quimioterapia y/o radioterapia en las 24 NEPT grados de Masaoka III y IV, y en el carcinoma linfoepitelial. Con un seguimiento medio (DE) de 13 (5) anos, fallecieron 12 pacientes con NEPT y 1 con un tumor neuroendocrino, debido a evolucion de la enfermedad. La supervivencia acumulada fue del 80% a los 5 anos, del 71% a los 7 anos y del 63% a los 10 anos. Actualmente existen 2 recidivas locales en 2 NEPT, tras 9 y 8 anos de seguimiento, respectivamente. Los principales factores pronosticos son el tipo y subtipo histologicos, asi como el estadio clinico (p < 0,001). Conclusiones: El diagnostico precoz en los tumores primarios del timo de estirpe no linfoide es fundamental para instaurar un tratamiento correcto antes de que presenten un estadio clinico mas avanzado. Los principales factores pronosticos son el tipo y subtipo histologicos, asi como el estadio clinico.

Estudio multivariante de los factores de riesgo de lesión del nervio laríngeo recurrente en la cirugía del bocio multinodular

Resumen Objetivo La lesion recurrencial es la complicacion mas grave en la cirugia tiroidea. Sin embargo, existen pocos analisis multivariantes que valoren el impacto de sus factores de riesgo. El objetivo es analizar, mediante un estudio estadistico multivariante, los factores de riesgo para el desarrollo de lesion recurrencial en la cirugia del bocio multinodular (BM). Pacientes y metodo Se han revisado de manera retrospectiva 672 BM intervenidos. Se considero disfonia a la alteracion en el tono, timbre o intensidad de la voz a raiz de la intervencion quirurgica y confirmada la paralisis de la cuerda vocal mediante laringoscopia. Si dicha alteracion persistia mas de 12 meses se consideraba definitiva. Se aplica el test de γ 2 , el de la t de Student, y un analisis de regresion logistica, para determinar las variables de riesgo de lesion recurrencial. Resultados Se confirmaron 76 disfonias (11%), lo cual supone un riesgo del 6,3% por nervio recurrente expuesto. La duracion media de la disfonia, en los 66 casos (87%), en los cuales esta fue transitoria, fue de 2,7 ± 2,9 meses (1-12 meses). Los factores de riesgo fueron la presencia de sintomatologia derivada del bocio (p = 0,0471), el hipertiroidismo (p = 0,0376), la gradacion del bocio (p = 0,0425) y la tecnica quirurgica utilizada (p = 0,0195), persistiendo como factores independientes la tecnica quirurgica y el hipertiroidismo. En 10 pacientes (1,5%) la disfonia persistio como definitiva (0,8% por recurrente expuesto). Las dos variables que se asociaban a su desarrollo fueron la gradacion del bocio (p = 0,0481) y el hipertiroidismo (p = 0,0227), persistiendo como factor de riesgo independiente el hipertiroidismo. Conclusiones El principal factor de riesgo de lesion recurrencial, tanto transitoria como definitiva, en la cirugia del BM, es que se trate de un bocio toxico.

Infección letal por Streptococcus del grupo A en cirugía tiroidea: la importancia de un diagnóstico precoz

Surgical wound infections after thyroid surgery have a low associated mortality rate. Among the microorganisms involved, group A Streptococcus is potentially lethal as it can be accompanied by descending necrotizing mediastinitis and streptococcal toxic shock syndrome (STSS). We present the case of a woman with no risk factors who had undergone thyroidectomy due to benign pathology and developed a lethal infection of the surgical wound due to group A Streptococcus. A 37-year-old woman with no relevant medical history consulted for asymptomatic multinodular goiter. Ultrasound revealed a multinodular goiter with a 3-cm right thyroid nodule in the lower pole. The FNA cytology was classified as Bethesda IV. Due to the tumor size and the aspiration sample, total thyroidectomy was performed. After 24 h, the patient began with cervical pain and restlessness, later associating drowsiness and respiratory distress. Lab work was normal except for leukopenia 3.6 10/mm and O2 saturation of 76%. Given this situation, she was transferred to the intensive care unit. A CT scan (Fig. 1A) demonstrated severe right pleural effusion, bibasilar atelectasis and soft tissue edema in the superior mediastinum; a chest tube was inserted and purulent fluid was drained. With these findings, a revision procedure was performed in the operating room, which revealed tissue hypoperfusion, edema and tracheal perforation (Fig. 1B). Extensive cervical and thoracic surgical debridement was conducted with complete excision of tissue necrosis, decortication and pleural drainage. A tracheostomy was also performed due to the tracheal perforation and a culture was