RESUMEN
BACKGROUND: The primary benefit of preoperative scintigraphy in patients with primary hyperparathyroidism not previously surgically explored seems to be the possibility of unilateral or limited access surgery in selected patients. MATERIAL AND METHODS: We studied the accuracy of scintigraphy using 99mTc sestamibi and dual phase imaging protocol combined with thyroid scintigraphy using 99mTc pertechnetate before conventional neck exploration and histologic verification in 78 consecutive patients. RESULTS: In 65 patients with solitary, focal uptake on scintigraphy, we found a solitary adenoma in 61 patients (94%), a solitary adenoma on the contralateral side in one patient, two adenomas on the indicated side in one patient, bilateral adenomas in one and hyperplasia in one patient. In 13 patients with a negative or equivocal scintigraphic result, eight had a solitary adenoma and five hyperplasia. INTERPRETATION: These result may support a limited unilateral surgical approach when scintigraphy shows a localized focal uptake and this is confirmed perioperatively. In experienced hands the risk of overlooking an adenoma will be small. However, it is mandatory to have an experienced parathyroid surgeon prepared to proceed with full neck exploration when this is necessary.
Asunto(s)
Hiperparatiroidismo/diagnóstico por imagen , Glándulas Paratiroides/diagnóstico por imagen , Cuidados Preoperatorios/métodos , Adulto , Anciano , Femenino , Humanos , Hiperparatiroidismo/cirugía , Masculino , Persona de Mediana Edad , Paratiroidectomía , Cintigrafía , Pertecnetato de Sodio Tc 99m , Tecnecio Tc 99m SestamibiRESUMEN
Since 1991 laparoscopic cholecystectomy has been performed on 323 patients; 47 patients underwent conversion to open surgery. In the same period, 46 patients were primarily selected for open cholecystectomy. Half the patients were operated on because of gallbladder colic (the sole symptom). Conversion to open operation (14%) occurred not so much because of peroperative complications, but rather because of anatomical problems. On the fourth postoperative day, one patient died of septicaemia caused by iatrogenic diathermy damage to the duodenum. One patient developed a stricture of the choledochus as a result of ischemia. This was caused by dissecting the choledochus, having mistaken it for the ductus cysticus which was missing in this anatomic variant.
Asunto(s)
Colecistectomía Laparoscópica , Colecistectomía , Adolescente , Adulto , Anciano , Colecistectomía/economía , Colecistectomía/estadística & datos numéricos , Colecistectomía Laparoscópica/efectos adversos , Colecistectomía Laparoscópica/economía , Colecistectomía Laparoscópica/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , ReoperaciónRESUMEN
According to preset criteria, 1,194 women at risk for inherited breast carcinoma were selected and subjected to examination. Six hundred and three women were examined once, 591 were followed for a mean of 1.8 years. Twenty infiltrating cancers (median age 49 years) and 16 precancers (median age 44 years) were found, demonstrating that breast carcinoma continued to occur in the selected families as expected under the hypothesis of dominant inheritance. At first round, 14 (1.2%) infiltrating carcinomas and a total of 22 (1.8%) cancers or precancers were found. Incidence rates of 0.58% pr. year for infiltrating cancers, and 1.04% pr. year for cancer or precancer were calculated. This confirms the tentative conclusions that were drawn in our previous report. These are the first prospective reports documenting how to delineate a high risk group for premenopausal breast cancer, and how to diagnose cancer at an early stage. All but two affected women had cancer without lymph node metastasis. Although a longer observation time is needed, we cautiously conclude that the results are in keeping with our aim of providing safety for those at risk. Clinical use of predictive genetic testing may be implemented within these families.
Asunto(s)
Neoplasias de la Mama/genética , Adulto , Anciano , Familia , Femenino , Genes Dominantes , Humanos , Persona de Mediana Edad , Estudios Prospectivos , RiesgoRESUMEN
The clinical effect of cis(Z)-clopenthixol has been compared with that of clopenthixol, which is a mixture of the pharmacologically active cis(Z)-isomer and the inactive trans(E)-isomer. In the 2-month double-blind trial were included 57 psychotic patients, mainly schizophrenics. Ratings evaluating severity of illness, therapeutic effect, possible interference of side effects with the patient's functioning, as well as any individual side effects were done at months 0, 1, and 2. The antipsychotic effect of cis(Z)-clopenthixol was found equal to that of clopenthixol whereas the cis(Z)-isomer on a mg/mg basis was twice as active as clopenthixol. Apart from the finding that the unspecific sedative effect appeared to be less marked with cis(Z)-clopenthixol, the type, degree, and frequency of side effects were the same in the two groups of patients. More than half of the patients experienced no side effects.