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Background Although the incidence of papillary thyroid microcarcinoma (PTMC) has increased in recent decades, the role played by minimal extrathyroidal extension (mETE) in the prognosis of PTMC is still unclear. The aim of this study is to analyze the factors associated with PTMC with mETE and its long-term prognosis. Material and methods We conducted a retrospective study on patients with a histological diagnosis of PTMC. We excluded patients who had previously undergone thyroid surgery, those who had other synchronous malignancies, those with an ectopic location of the PTMC, and those lost to follow-up within two years. We compared group 1 (PTMC without extrathyroidal extension) to group 2 (PTMC with mETE) and performed a multivariate analysis. Results We observed PTMC with mETE in 11.2% (n = 18) of patients. On the multivariate analysis, mETE was associated with an age ≥45 years (OR: 4.383; 95% CI: 1.051−18.283, p = .043), tumor size ≥8 mm (OR: 5.913; 95% CI: 1.795−19.481; p= .003), bilaterality (OR: 4.430; 95% CI: 1.294−15.173; p = .018) and metastatic lymph nodes (OR: 12.588; 95% CI: 2.919−54.280; p = .001). Over the mean follow-up period of 119.8 ± 65 months, one case of recurrence was detected in group 2 (0% vs. 5.6%; p= .112). No patients died of the disease. Disease-free survival was lower in group 2 (124.9 ± 5.6 vs. 97.4 ± 10.3 months; p = .034). Conclusions The mETE of PTMC is a factor of worse prognosis associated with the presence of metastatic lymph nodes and a lower rate of disease-free survival.

Resumen Introduccion Aunque el microcarcinoma papilar de tiroides (MCPT) ha sufrido un incremento en la incidencia en las ultimas decadas, todavia no esta claro que papel desempena la extension extratiroidea minima (EETm) en su pronostico. El objetivo de este estudio es analizar los factores asociados al MCPT con EETm y su pronostico a largo plazo. Material y metodos Estudio retrospectivo cuya poblacion a estudio la constituyen los pacientes con diagnostico histologico de MCPT. Se excluye a los pacientes con: cirugia tiroidea previa, otras enfermedades malignas sincronicas, localizacion ectopica del MCPT o perdida durante el seguimiento antes de los 2 anos. Se comparan 2 grupos: grupo 1 (MCPT sin extension extratiroidea) y grupo 2 (MCPT con EETm). Se realiza un analisis multivariante. Resultados El 11,2% (n = 18) de los pacientes presentaron MCPT con EETm. En el analisis multivariante, la EETm se asocio con la edad ≥ 45 anos (OR: 4,383; IC del 95%: 1,051-18,283; p = 0,043), el tamano tumoral ≥ 8 mm (OR: 5,913; IC del 95%; 1,795-19,481; p = 0,003), la bilateralidad (OR: 4,430, IC del 95%; 1,294-15,173; p = 0,018) y las adenopatias metastasicas (OR: 12,588; IC del 95%; 2,919-54,280; p = 0,001). Durante un seguimiento medio de 119,8 ± 65 meses, una recurrencia fue detectada en el grupo 2 (0% vs. 5,6%; p = 0,112). Ningun paciente fallecio debido a la enfermedad. La supervivencia libre de enfermedad fue menor en el grupo 2 (124,9 ± 5,6 vs. 97,4 ± 10,3 meses; p = 0,034). Conclusion La EETm del MCPT es un factor de peor pronostico, asociada a la presencia de adenopatias metastasicas y a una menor supervivencia libre de enfermedad.

Introduction The indications for adrenalectomy could be changing by the availability of laparoscopy and the growing detection of incidentalomas. The Endocrine Surgery Section of the Spanish Association of Surgeons conducted a survey to analyse the current indications for adrenalectomy and their results in Spanish surgical departments. Material and methods Data were gathered as regards the type of hospital and department, volume of procedures, localisation studies and pre-surgical preparations, indications, surgical approach, and results in terms of morbidity and hospital stay. The results of the centres were compared as regards their volume of activity using the Mann–Whitney Test for the quantitative variables and chi squared for the qualitative ones. Results Thirty-six centres completed the questionnaire and 301 adrenalectomies were reported to be performed in 2008. Most frequent indications were pheochromocytoma (25.2%), non-functioning adenoma (16.2%), aldosteronoma (15.9%), Cushing adenoma (11.2%), metastasis (10.3%), myelolipoma (5.6%), and carcinoma (4.9%). Laparoscopic adrenalectomy was performed in 83.7% of cases (6.7% required conversion to laparotomy). The mean hospital stay was 3.9 days for laparoscopic adrenalectomy and 7.4 days for laparotomy. High-volume units (more than 10 per year) used more frequently the laparoscopic approach ( P =.019), and had a shorter overall hospital stay ( P P Conclusions Laparoscopy for adrenalectomy has become the standard practice in Spain, with good results in terms of morbidity and hospital stay. High volume centres have better results as regards the use of minimally invasive surgery and hospital stay.

Introduccion En el bocio multinodular no existe consenso sobre cual es la tecnica quirurgica mas adecuada, pues, aunque las tecnicas resectivas parciales presentan menor riesgo de complicaciones, conllevan un alto riesgo de recidivas. El objetivo es determinar los factores de riesgo de recidiva del bocio multinodular tras la cirugia en una serie con un seguimiento medio postquirurgico superior a los 12 anos. Pacientes y metodo Se analizan 231 bocios multinodulares con cirugia tiroidea parcial. La recidiva se valora mediante exploracion clinica y se confirma mediante ecografia. Las variables analizadas son edad, sexo, antecedentes familiars de patologia tiroidea, residir en areas bociogenas, asintomatico, hipertiroidismo, syndromes compresivos, prolongacion intratoracica del bocio, experiencia en cirugia endocrina del cirujano, peso del tiroides y tecnica quirurgica. Se aplica la prueba de χ2, la de la «t» de Student y una prueba de regresion logistica. Resultados Con un seguimiento medio de 152 ± 71 meses recidivaron 67 bocios (29%) con un tiempo medio de recidiva de 85 ± 67 meses. Los factores de riesgo detectados en el estudio multivariante fueron la edad mas joven, la no experiencia en cirugia endocrina del cirujano y la tecnica quirurgica. Cuarenta y seis pacientes (69%) fueron intervenidos de la recidiva, la mayoria por cirujanos con experiencia en cirugia endocrina. En todos los casos se complete la tiroidectomia y se presentaron dos complicaciones postoperatorias definitivas. Conclusiones El indice de recidivas clinicas es alto y aumenta con la evolucion, siendo los principales factores de riesgo la juventud, la experiencia del cirujano y la tecnica quirurgica. Por lo que que estas tecnicas resectivas parciales deben realizarse por cirujanos con experiencia y evitarse en pacientes jovenes.

Introduccion El tratamiento medico del fracaso hepatico fulminante busca la recuperacion espontanea de la funcion hepatica, pero sus resultados son muy desalentadores (mortalidad del 50-80%). El trasplante hepatico es una opcion en los pacientes con mala evolucion a pesar del tratamiento medico, con una supervivencia superior al 50%. El momento idoneo para efectuar el trasplante es discutido, pues no debe hacerse ni demasiado pronto, cuando la enfermedad hepatica aun es reversible, ni demasiado tarde, cuando el paciente se encuentra en una situacion clinica irreversible. Pacientes y Metodo Se revisaron de forma retrospectiva las historias clinicas de 34 pacientes ingresados en nuestro hospital con el diagnostico de fracaso hepatico fulminante, de los que 26 fueron sometidos a trasplante. La causa mas frecuente fue la viral con 10 casos (38%), sin que se pudiera establecer etiologia alguna en 11 casos (42%). Trece pacientes presentaron complicaciones preoperatorias, la mas frecuente de las cuales fue la insuficiencia renal. Segun el grado de compatibilidad ABO/DR, fueron identicos en 13 casos (40%), compatibles en 17 (51%) e incompatibles en los 3 casos restantes (9%). Resultados Se efectuaron 33 trasplantes en 26 pacientes: 4 fueron retrasplantados por rechazo cronico, dos por fallo primario del injerto y un caso por rechazo hiperagudo. La mortalidad global fue del 46% (12 pacientes), y la causa mas frecuente de fallecimiento fue la infecciosa (50%). La supervivencia actuarial global fue del 68% al ano, del 63% a los 3 anos y del 59% a los 5 anos. Los factores de mal pronostico fueron la insuficiencia renal y respiratoria, el electroencefalograma grado D y los grados de encefalopatia III y IV; este ultimo fue el unico factor pronostico segun el analisis multivariante. Los factores pronosticos de mortalidad fueron los hallazgos de un electroencefalograma grado D, los grados de encefalopatia III y IV y la insuficiencia respiratoria; este ultimo fue el unico factor pronostico segun el analisis multivariante. Conclusiones La obtencion de buenos resultados con el empleo del trasplante en el abordaje del fracaso hepatico fulminante depende de una optima seleccion de los candidatos a trasplante, lo que implica la identificacion temprana de los mismos, esto es, precocidad en la indicacion del trasplante, reduccion del tiempo medio de espera y exclusion de aquellos con factores de mal pronostico.

Currently, the vena cava superior syndrome (VCSS) is mainly of oncologic origin. We report here four cases of this syndrome caused by intrathoracic multinodular goiter. All patients had compressive symptoms, particularly of the oesophagus and trachea. Axial CT was the imaging technique that delineated the intrathoracic multinodular goiter compressing brachiocephalic vessels. Surgery (total thyroidectomy) was used and all compressive symptoms resolved.

Despite progress made in the treatment of tobacco dependence, currently available treatments are effective for only a fraction of smokers. The aim of this study was to evaluate the association between the effectiveness of treatment with nicotine or bupropion in heavy smokers (n=70), and 6 candidate polymorphisms in CYP2A6, 5-HTT and HTR2A genes. Analysis revealed a significant association between "favourable" genotype combination carriers (CYP2A6 "slow metabolizer" or 5HTT L-allele or HTR2A-1438GG) and nicotine treatment outcome (OR=2.69, 95% CI=1.28-5.64). Genetic variations in CYP2A6 gene or genotypes associated with reduced synaptic serotonin activity may influence the success of smoking cessation treatment. 1.851 JCR (2014) Q3, 158/254 Pharmacology and pharmacy, 83/140 Psychiatry UEM

Twenty-four-hour gastric pH measurement was used to study duodenogastric reflux. To differentiate between gastric hyposecretion and duodenogastric reflux, we also measured bile acid concentrations in the gastric juice, and regarded pH increases to above 4 as possible episodes of reflux. The procedure was used in 60 patients, divided into the following groups: (1) control group (ten patients); (2) duodenal ulcer (ten patients); (3) type 1 gastric ulcer (five patients); (4) type 3 gastric ulcer (five patients); (5) bilateral truncal vagotomy plus pyloroplasty (ten patients); (6) truncal vagotomy plus Billroth I partial gastrectomy (ten patients); and (7) truncal vagotomy plus Billroth II partial gastrectomy (ten patients). The amount of reflux (areas of pH > 4) in the type I gastric ulcer and Billroth 1 and Billroth II groups was significantly greater than that found in the control, duodenal ulcer, type 3 gastric ulcer and truncal vagotomy plus pyloroplasty groups. The mean concentration of total bile acids was also greater in the gastrectomized patients than in the rest of the groups studied. In the type 1 gastric ulcer group the mean bile acid concentration was similar to that of the control group.

Background Numerous prognostic factors have been studied for survival in patients with papillary thyroid carcinoma (PTC), although there are few multivariate studies that include the histological variety of PTC. Hypothesis There are prognostic factors that influence survival in a series of patients with PTC, including the histological variety, and a new prognostic index (PI) for survival can be formulated by accounting for these factors. Design A retrospective study. Setting A university hospital department of surgery. Patients Between January 1970 and December 1995, 200 patients undergoing surgery for PTC were observed (mean follow-up, 8 years). Main Outcome Measures A univariate analysis was done for survival rates using the Kaplan-Meier estimation method. The possible prognostic factors were evaluated using a multivariate analysis according to the Cox model. We formulated a PI and defined 3 risk groups (low, medium, and high) for mortality. Results Of the 200 patients, 175 (87.5%) are still alive. Of the 25 deaths, 19 (9.5%) were due to the tumor. The survival was 97.5% at 1 year, 92.8% at 5, 89.5% at 10, and 83.9% at 15 and 20 years. The prognostic factors obtained after the multivariate analysis were age, tumor size, extrathyroid spread, and histological variant of the PTC. The PI is calculated as follows: PI = (2 × size) +(6 × spread) + (2 × variant) + (3 × age). As for the risk groups, the low-risk group showed a mortality of 0%; the medium-risk group, 17.1%; and the high-risk group, 76.5%. Conclusions The histological variety of PTC has prognostic value for survival in patients with PTC. As risk factors for PTC mortality, we consider an age of 50 years or older, a tumor larger than 4 cm, the existence of extrathyroid spread, and a certain histological subtype of PTC. With these risk factors, it is possible to formulate a PI and classify patients into low-, medium-, and high-risk groups for mortality.

Three new cases of diffuse pulmonary lymphangioleiomyomatosis are presented. Case number 1 is a female patient who presented repeated pneumotorax and dyspnea without evidence by CT scan and gynecological ultrasound of extrathoracic lesions. This patient did not respond to medroxiprogesterone and died 5 years after the initial diagnosis having suffered chronic, severe, global respiratory failure for 4 years. Case number 2 is a female patient who presented dyspnea, chyloptysis and chylothorax, with iliac, paraaortic and mediastinic lymphangioleiomyomas. The last time she was seen, she was still alive after 6 years without treatment. Case number 3 presented lymphangioleiomyomatosis associated to undifferentiated breast carcinoma. The evolution was apparently slow probably because it was diagnosed 14 years after menopause, and died due to a relapse of the neoplasia. All three patients had radiographic images and respiratory functional studies characteristic of this disease and diagnosis was confirmed by biopsy. The literature is reviewed.

Conventional polysomnography (CPS) is a complex, costly procedure that is not widely available, meaning that it is difficult to apply it in patients suspected of having obstructive sleep apnea syndrome (OSAS). Various procedures have therefore been proposed for screening candidates for CPS. We studied the usefulness of visual analysis of nocturnal oximetry in 96 patients suspected of having OSAS. The OSAS diagnosis was confirmed by CPS in 67 (69.8%). Oximetry was positive in 70 cases. Sixty-one patients were positive by both oximetry and CPS, while 9 and positive oximetry results and a negative CPS. We conclude that nocturnal oximetry has a 91% sensitivity and 69% specificity for OSAS, with a positive predictive value of 87% and a negative predictive value of 77%. We believe that nocturnal oximetry may be a useful way of screening for OSAS, in order to decrease the number of CPS performed on patients without the disease.