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BACKGROUND: Cervical thoracic duct cysts are a rare anomaly. OBJECTIVE: To report a case of cervical thoracic duct cyst, and perform a literature review. CLINICAL CASE: A 78-year-old female, with a one-year history of a left-sided asymptomatic supraclavicular cystic mass. Computerized tomography revealed a cystic mass 42mm in diameter. We performed a fine needle aspiration puncture, obtaining a thick, milky, whitish liquid. The patient underwent surgery; finding a left-sided supraclavicular cystic mass, with some lymph vessels heading towards the jugulo subclavian venous junction. We performed a ligation of these lymph vessels and resection of the mass. The histopathologic study confirmed the diagnosis of thoracic duct cyst. CONCLUSION: Diagnosis of cervical thoracic duct cyst should be suspected with a cystic lesion in the left supraclavicular region, which when perforated exudes a very distinctive thick milky, whitish liquid with a high content of lymphocytes and triglycerides. Treatment should be complete removal with ligation of the lymphatic afferent vessels.

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OBJECTIVE: To evaluate whether a quick parathyroid hormone assay that measures intact parathyroid hormone (iPTH) level intraoperatively has modified the surgical strategy for primary hyperparathyroidism in the Meixoeiro Hospital in Vigo (Pontevedra, Spain). DESIGN: An observational, analytic, historic cohort study was performed. Two study groups were established. In group 1 (n = 28) iPTH levels were not measured intraoperatively. In group 2 (n = 39) iPTH was measured intraoperatively. iPTH was monitored using blood samples from cannulated peripheral veins. A positive test was defined as a decrease in iPTH level of >or= 50% of the baseline preincision level at 10 minutes postexcision, even when the baseline value was outside the normal range. The dependent variables evaluated were operating time, the number of parathyroid glands visualized, the number of parathyroid glands biopsied, length of postoperative hospital stay, unilateral exploration, and the percentages of cure, persistence, and recurrence in each group. RESULTS: Group 2 showed a statistically significant decrease in operating time (144.7 +/- 62.1 versus 178.8 +/- 57.5 minutes; p = 0.025), the number of parathyroid glands visualized (1.9 +/- 0.9 versus 2.8 +/- 1.3; p = 0.002), the number of parathyroid glands biopsied (1.5 +/- 0.9 versus 2.2 +/- 1.4; p = 0.025), and the need for bilateral exploration (30.77% versus 85.72%) in comparison with group 1. No significant differences were observed in length of postoperative hospital stay or in the percentages of cure (94.8% versus 92.85%), persistence (5.12% versus 7.14%), and recurrence (2.56% versus 3.57%). CONCLUSIONS: In our hospital, intraoperative measurement of iPTH improved the surgical strategy of primary hyperparathyroidism and has therefore been included in our routine treatment protocol.

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Objetivo. Evaluar si la determinación rápida intraoperatoria de la paratirina intacta (PTHRIO) ha modificado la estrategia quirúrgica del hiperparatiroidismo primario (HPTP) en el Hospital do Meixoeiro de Vigo (Pontevedra, España). Diseño. Estudio observacional, analítico, tipo cohorte retrospectiva. Se establecieron 2 grupos de estudio, según no se hubiese practicado la PTHRIO a los pacientes ­grupo NOPTHRIO (n = 28)­ o sí se les hubiese determinado ­grupo SIPTHRIO (n = 39)­. Se determinó la PTHRIO mediante extracción de sangre por canalización venosa periférica. Se aplicó como criterio de positividad del test un descenso de la cifra de PTHRIO a los 10 min de la escisión ≥ 50% de la cifra basal, estuviera ésta en rango de normalidad o no. Se evaluó como variables dependientes: la duración de la intervención quirúrgica, el número de glándulas paratiroides visualizadas y el de biopsiadas, la estancia postoperatoria, la unilateralidad exploratoria y los porcentajes de curación, persistencia y recurrencia en cada grupo. Resultados. En el grupo SIPTHRIO hubo disminución estadísticamente significativa respecto al grupo NOPTHRIO de la duración de la intervención quirúrgica, 144,7 ± 62,1 frente a 178,8 ± 57,5 min (p = 0,025); del número de glándulas paratiroides visualizadas, 1,9 ± 0,9 frente a 2,8 ± 1,3 (p = 0,002), y biopsiadas, 1,5 ± 0,9 frente a 2,2 ± 1,4 (p = 0,025), y de la necesidad de exploración bilateral, el 30,77 frente al 85,72%. Las diferencias en el tiempo de estancia postoperatoria y en los porcentajes de curación (el 94,8 y el 92,85%), persistencia (el 5,12 y el 7,14%) y recurrencia (el 2,56 y el 3,57%) no han tenido significación estadística. Conclusiones. En nuestro hospital, la determinación de PTHRIO ha modificado favorablemente la estrategia quirúrgica del HPTP, por lo que se ha incluido en el protocolo habitual de su tratamiento (AU)

Objective. To evaluate whether a quick parathyroid hormone assay that measures intact parathyroid hormone (iPTH) level intraoperatively has modified the surgical strategy for primary hyperparathyroidism in the Meixoeiro Hospital in Vigo (Pontevedra, Spain). Design. An observational, analytic, historic cohort study was performed. Two study groups were established. In group 1 (n = 28) iPTH levels were not measured intraoperatively. In group 2 (n = 39) iPTH was measured intraoperatively. iPTH was monitored using blood samples from cannulated peripheral veins. A positive test was defined as a decrease in iPTH level of ≥ 50% of the baseline preincision level at 10 minutes postexcision, even when the baseline value was outside the normal range. The dependent variables evaluated were operating time, the number of parathyroid glands visualized, the number of parathyroid glands biopsied, length of postoperative hospital stay, unilateral exploration, and the percentages of cure, persistence, and recurrence in each group. Results. Group 2 showed a statistically significant decrease in operating time (144.7 ± 62.1 versus 178.8 ± 57.5 minutes; p = 0.025), the number of parathyroid glands visualized (1.9 ± 0.9 versus 2.8 ± 1.3; p = 0.002), the number of parathyroid glands biopsied (1.5 ± 0.9 versus 2.2 ± 1.4; p = 0.025), and the need for bilateral exploration (30.77% versus 85.72%) in comparison with group 1. No significant differences were observed in length of postoperative hospital stay or in the percentages of cure (94.8% versus 92.85%), persistence (5.12% versus 7.14%), and recurrence (2.56% versus 3.57%). Conclusions. In our hospital, intraoperative measurement of iPTH improved the surgical strategy of primary hyperparathyroidism and has therefore been included in our routine treatment protocol (AU)

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