José Amat V

Síndrome de huesos hambrientos: experiencia clínica en su diagnóstico y tratamiento

Hungry bone syndrome is a unusual complication of the postoperative period of primary hyperparathyroidism. This syndrome is characterized by hypocalcemia, hypophosphatemia and hypomagnesemia, due to an excessive bone remineralization. We report the clinical features, laboratory and therapy in four females (aged 39 to 73 years old) with a long standing hyperparathyroidism, elevated alkaline phosphatases and decreased bone mineralization in two. The mean size of the adenoma was 2.9 +/- 1.1 cm. Hypocalcemia appeared between days 1 and 6 of the postoperative period. All were treated with calcium, calcitriol and magnesium at different timing and dosages. The mean hospitalization period was 19.8 +/- 2.1 days. As reported previously, low bone mineralization and a large adenoma are risk factors for the syndrome. Serial monitoring of serum calcium and magnesium and an early supplementation of these minerals could prevent hypocalcemia and decrease the hospitalization time.

Incidencia de hipocalcemia pos tiroidectomía total

Postoperative hypocalcemia is one of the mostcommon complications of thyroid surgery. It is related to the type of disease (malignant orbenign), the number of identified parathyroid glands during the surgical procedure, and thesurgeon’s experience. Total thyroidectomy is the procedure of choice in our hospital for benignand malignant thyroid disease, but it can increase the incidence of complications.

Sobrevida de pacientes con cáncer de esófago sometidos a esofagectomía total torácica

Background: Esophageal carcinoma has a dismal prognosis. Several authors have reported a very low survival in Chile. Aim: To report the survival of patients with esophageal carcinoma, subjected to esophageal resection. Material and methods: Analysis of 108 patients subjected to thoracic esophageal resection between 1985 and 1996. Patients were classified according to the location of the tumor and its staging. Results: Eleven patients died in the immediate postoperative period and 90 patients were followed. In 53 the exact cause of death was determined. Global five years survival was 29% and median survival was 18 months. Survival was 100% in stage I tumors. Adjuvant therapy resulted in a better survival of stage III tumors. Survival of stage IV tumors was worst than stage I to III tumors. There was no survival difference between squamous carcinoma or adenocarcinoma. Tumors located in the superior third of the esophagus had a worst prognosis. Causes of death were mediastinic metastases, local recidivism, pleural or pulmonary metastases and less frequently, brain, bronchial or bone metastases. Conclusions: The survival of these, patients with esophageal carcinoma did not differ from the figures reported abroad. (Rev Med Chile 2000; 128: 64-74)

Tiroidectomia sin ligaduras: evaluando Ligasure Precise®

Introduccion: En tiroidectomia total se estan evaluando metodos de hemostasia distintos a la ligadura habitual. Objetivo: Presentar nuestra experiencia inicial en la tiroidectomia total sin ligaduras, al utilizar el metodo de sellado de vasos a traves de Ligasure Precise®. Material y metodo: Se consignaron en forma prospectiva, los datos de 129 pacientes: Datos personales, fecha de operacion, antecedentes morbidos, sintomas, funcion tiroidea, examen fisico, ecografia, puncion con aguja fina, tipo de operacion, cirujano, tiempo operatorio, estadia postoperatoria, debito de drenajes, biopsia intraoperatoria y definitiva, complicaciones. Se utilizo un p 0.05). Biopsia definitiva informo carcinoma en 34 y 32 % respectivamente. Hospitalizacion promedio de 2,63 dias y 2,26 dias (p 0.02). El debito de drenajes fue 78 ce para el grupo Ligasure y 63,2 ce para el grupo tradicional. Tiempo operatorio promedio de 94 minutos (grupo tradicional) y 92 minutos (Ligasure) (p= 0.6). Las complicaciones fueron hematoma (1 caso por grupo), Lesion de recurrente laringeo (1 caso en el grupo de ligadura tradicional) e hipocalcemia transitoria (6 casos en el grupo Ligasure y 1 caso en el grupo control). Conclusion: La tiroidectomia con Ligasure Precise es un metodo comodo para el cirujano y tan seguro como la tiroidectomia con ligaduras. Su aplicacion, indicacion y reales beneficios deben ser evaluados en el futuro con mayor numero de casos

Carcinoma medular de tiroides: Experiencia de 20 años

Antecedentes: El carcinoma medular de tiroides (CMT) es un tumor maligno poco frecuente, originado a partir de las celulas C. Su tratamiento quirurgico y resultados son controvertidos, por lo que hemos decidido estudiarlo. Objetivo: Describir clinicamente el CMT, tratamiento y resultados a largo plazo. Material y metodo: Se revisaron retrospectivamente las fichas clinicas de pacientes con CMT operados en nuestro hospital entre 1987 y el 2007. Se analizaron las caracteristicas clinicas, tratamiento, morbilidad y seguimiento a largo plazo. Resultados: Se operaron 24 pacientes, cuya edad media fue 46,1 ± 16,6 anos. La principal forma de presentacion fue aumento de volumen cervical (56,2%). Un 15% formaba parte de una NEM 2b. A todos se les realizo una tiroidectomia total, ampliada en el 50% de los casos. El 35,2% eran multifocales, el 29,4% bilaterales y el 62,5% tenia metastasis ganglionar. Cinco pacientes mantuvieron niveles de calcitonina elevados en el postoperatorio y nueve pacientes recurrieron clinicamente, en promedio, a los 4,5 anos. La enfermedad persistente se asocio significativamente con CMT hereditario (p = 0,0088) y la recurrencia clinica a tiroidectomia total no ampliada (p = 0,0196). La probabilidad de sobrevivir mas de 19 anos fue 66,6% (IC 95% = 0,24 a 0,89). Conclusiones: EL CMT es un tumor raro cuyo tratamiento de eleccion es la cirugia. La persistencia de enfermedad se asocia con la forma hereditaria, y la recurrencia clinica con la tiroidectomia total no ampliada, lo que nos hace recomendar una tiroidectomia total asociada a vaciamiento central y diseccion yugular radical modificada.

Tumor cervical por enfermedad de Kikuchi: Una entidad clínica a la que no estamos habituados. Caso clínico

Histiocytic necrotizing lymphadenitis (HNL), also known as Kikuchi 5 disease is a rare condition of unknown etiology. Patients present with cervical lymph node enlargement, fever and malaise. The diagnosis is made by excision biopsy. However, this entity must be distinguished from both reactive processes and malignant tumors such as lymphoma. The clinical course is self limited with spontaneous resolution within a few months. We report three patients with the disease. A 37 year-old woman with a 4 months history of a painless submaxillary mass of 2.5 cm diameter, attached to the deep tissues of the neck. The mass was excised and the biopsy report was HNL. After 26 months of follow up, the patient is asymptomatic. A 30 year-old woman with a history of 2 months of a painless lateral cervical mass and aspiration biopsy was reported as suspicious for lymphoma. An excision biopsy was performed, that was reported as HNL. In both patients, lymphoma was ruled out by immunohistochemistry. A 33 year-old woman with a 3 weeks history of an asymptomatic lateral cervical mass. Biopsy was reported as HNL. This condition must be included in the differential diagnosis of cervical asymptomatic masses. The clinician must be aware of it to avoid long-term, costly treatments

CARCINOMA PAPILAR DE TIROIDES EN QUISTE DEL CONDUCTO TIROGLOSO

thyroglossal duct cyst with papillary carcinoma introduction: In about 1-2% of cases of thyroglossal cyst may be neoplastic changes, mostly corres - pond to papillary thyroid carcinoma (75-85%). The aim of this paper is to present 9 cases of papillary thyroid carcinoma in thyroglossal duct cyst. Materials and Methods: Data were recorded retrospectively from patients diagnosed with papillary thyroid carcinoma in thyroglossal duct cyst treated at Hospital Clinico Universidad de Chile between 1999-2014. results: From 142 cases operated for thyroglossal duct cyst, 9 cases of papillary cancer (6.34%) were recorded. The average age was 32 years. The average diameter of the lesion was 4.4 cm (SD 2.2 cm). 8 patients underwent total thyroidectomy; a simultaneous thyroid cancer was diagnosed in 3 of them. In 6 cases was added iodine therapy. In only one patient a lymph nodal dissection was performed. We do not observe any surgical complication. A solid component in preoperative ultrasonogra- phic study is suspicious of malignancy. The average follow-up time was 85 months. There is no recurrence or mortality in this group of patients. conclusions: Although the safest long-term management is Sistrunk surgery associated with thyroidectomy and radioiodine in selected cases, these patients must be evaluated by a multidisciplinary group and thyroidectomy should be considered in high surgical volume center, in order to minimize complications.

Detección inmunohistoquímica de parafibromina en patología de paratiroides

Immunohistochemical detection of parafibromin in parathyroid pathology Introduction: The definitive diagnosis of parathyroid cancer is extremely difficult, from the clinical approach to the molecular diagnosis. A gene mutation was detected recently in patients with parathyroid cancer. It is a suppressor tumor gene called HRPT2, which codifies for a protein that participates in PAF1 complex, the parafibromin. It has been observed that the expression of this protein its altered in parathyroid cancer, what would serve like method of diagnosis by immunohystochemistry, with a sensitivity and speci- ficity of 73-96% and 99-100%, respectively. Material and Method: The anti-parafibromin immunohysto - chemistry staining was made in 23 parathyroids tissue samples (5 adenomas, 6 hyperplasia, 7 normal and 5 carcinomas). Results: A positive pattern is observed in almost 100% of benign pathology and 100% in normal tissue. In the cases of carcinoma only 2 of 5 had a strong positivity. Conclusions: The pathological clinical correlation does not allow the association of the loss of parafibromin immunoreactivity in some unequivocal cases of parathyroid cancer. The parafibromin immunostaining does not allow to discriminate between benign or malign pathologies.

Linfoma primario de tiroides: Reporte de cuatro casos

Primary thyroid lymphoma is uncommon and usually of non-Hodgkin type. We report four female patients with thyroid lymphoma. An 81 year-old patient that was operated and received three cycles of chemotherapy and was lost from follow up. A 16 year-old patient that is operated and received full chemotherapy and was discharged free of disease. A 80 year-old patient that was operated and died due to a multiple organ failure, 50 days after hospital admission and a 54 year-old female that was operated but rejected chemotherapy and was lost from follow up.

Sarcoma sinovial intraoral primario monofásico

El sarcoma sinovial es un tumor maligno de partes blandas, bien diferenciado y que representa entre 5.6% a 10% de todos los sarcomas. Su localizacion en cabeza y cuello no es comun, y representa cerca de un 9%, con menos de 100 casos reportados en la literatura. La localizacion intraoral es muy peculiar, existiendo 32 casos previamente descritos en el mundo, de los cuales 3 corresponden al tipo monofasico. Se presenta un caso de un paciente varon de 16 anos con un caso de sarcoma sinovial intraoral monofasico y una revision de la literatura disponible