Intérêt du bleu de méthylène dans la chirurgie de l'hyperparathyroïdism primaire [Methylene blue in surgery of primary hyperparathyroidism]

Is surgery for primary hyperparathyroidism easier when methylene blue (MB) is given preoperatively? This retrospective study compares the durations of interventions for primary hyperparathyroidism carried out after i.v. MB administration to those when no MB was given. Over a period of 20 years (June 1976 to December 1996), 175 consecutive patients (56 men and 119 women, with ages ranging from 16 to 92, mean 59.6) were operated upon for primary hyperparathyrodism; 55 were operated before February 1986--the period when BM was introduced routinely, and 120 after. Thirty-two other patients were excluded from the study: 14 had had a previous cervicotomy and 18 another procedure in addition to the parathyroidectomy (usually on the thyroid gland), two conditions which prolonged the time devoted to parathyroid identification and excision. Preoperative calcemia averaged 2.97 mmol/L (2.34 to 4.59) and mean preoperative PTH was equal to 2.6 times the upper normal limit (0.5 to 24.1). Both groups were similar for as age, sex, preoperative calcium and PTH, and histologies. Methylene blue was administered intravenously (5 mg/kg diluted in 500 cc of 5% glucose) over a period of time of one hour starting two hours prior to surgery. All 175 procedures were performed by two surgeons and duration of surgery was recorded from the anesthesiologist's notes. There were 149 adenomas (85%), 24 hyperplasias (14%), a combination of both in two, and unspecified in two others. Except for a case of acute lower back pain synchronous to the injection of the dye (which was immediately stopped), MB was well tolerated. Mean duration for the 55 interventions performed without MB was 68 minutes (35 to 140, median 60), compared to 49 minutes for the 120 procedures carried out after MB had been given (20 to 155, median 45). Differences in operative, times were highly significant (p < 10(-6) and represented a gain of time of 27%. Surgery for primary hyperparathyroidism was significantly shorter when it was preceded by the administration of MB, a dye which facilitates the identification of pathologic parathyroid gland(s).

Footnotes, March 2009, Vol.34, no.1-3

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Footnotes, April-May-June 2009, Vol.34, no.4-6

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Footnotes, July, August, September 2009, Vol.34, no.7-9

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Footnotes, October, November, December 2009, Vol.34, no.10-12

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Estoques de carbono orgânico e de nitrogênio, pH e densidade de um Latossolo após três aplicações de lodos de esgoto

O elevado conteúdo de matéria orgânica de lodo de esgoto é uma das motivações para sua disposição no ambiente como condicionador do solo. O objetivo deste trabalho foi avaliar o efeito de aplicações consecutivas de lodo de esgoto sobre o acúmulo de C e de N (total e mineral), sobre o pH e sobre a densidade de um Latossolo. As avaliações foram feitas em duas profundidades do solo (0-0,1 e 0,2-0,4 m) após três cultivos de milho, em experimento realizado entre os anos de 1999 e 2001, em Jaguariúna-SP. Os tratamentos consistiram de cinco doses crescentes de dois tipos de lodo de esgoto, aplicadas a cada cultivo. O aumento das doses aplicadas (totalizando 0, 10.284, 20.568, 41.136 e 82.272 kg ha-1) do lodo da Estação de Tratamento de Esgotos de Franca-SP, de origem urbana, causou crescimento significativo dos estoques de C orgânico e de N na camada superficial. Nos tratamentos com o lodo da Estação de Tratamento de Esgotos de Barueri-SP (totalizando 0, 17.405, 34.810, 69.620 e 139.240 kg ha-1), produzido a partir de esgotos urbanos e industriais, apesar da incorporação de 14 % a mais de C ao solo, os estoques de C não foram influenciados pelas doses aplicadas e houve crescimento significativo dos estoques de N. A densidade na camada superficial diminuiu significativamente com o aumento das doses dos dois tipos de lodo de esgoto. Houve acidificação do solo nas duas camadas estudadas, com necessidade de duas calagens, após o segundo e terceiro cultivos. Observou-se lixiviação de N-mineral para maiores profundidades do solo.

Safe and effective variability-a criterion for dose individualization.

BACKGROUND: : A primary goal of clinical pharmacology is to understand the factors that determine the dose-effect relationship and to use this knowledge to individualize drug dose. METHODS: : A principle-based criterion is proposed for deciding among alternative individualization methods. RESULTS: : Safe and effective variability defines the maximum acceptable population variability in drug concentration around the population average. CONCLUSIONS: : A decision on whether patient covariates alone are sufficient, or whether therapeutic drug monitoring in combination with target concentration intervention is needed, can be made by comparing the remaining population variability after a particular dosing method with the safe and effective variability.

Friday Facts, August 28, 2009, vol. 34

Bureau of Nutrition and Health Promotion part of the Iowa Department of Public Health produces of weekly newsletter about the Iowa WIC Program for the State of Iowa citizen.

The prognostic value of semi-quantitative i-123 mibg scintigraphy at diagnosis in high risk neuroblastoma: validation of the siopen score method

Purpose: SIOPEN scoring of 123I mIBG imaging has been shown to predict response to induction chemotherapy and outcome at diagnosis in children with HRN.Method: Patterns of skeletal 123I mIBG uptake were assigned numerical scores (Mscore) ranging from 0 (no metastasis) to 72 (diffuse metastases) within 12 body areas as described previously. 271 anonymised, paired image data sets acquired at diagnosis and on completion of Rapid COJEC induction chemotherapy were reviewed, constituting a representative sample of 1602 children treated prospectively within the HR-NBL1/SIOPEN trial. Pre-and post-treatment Mscores were compared with bone marrow cytology (BM) and 3 year event free survival (EFS).Results: Results 224/271 patients showed skeletal MIBG-uptake at diagnosis and were evaluable forMIBG-response. Complete response (CR) on MIBG to Rapid COJEC induction was achieved by 66%, 34% and 15% of patients who had pre-treatment Mscores of <18 (n¼65, 29%), 18-44 (n¼95,42%) and Y ´ 45 (n¼64, 28.5%) respectively (chi squared test p<.0001). Mscore at diagnosis and on completion of Rapid COJEC correlated strongly with BM involvement (p<0.0001). The correlation of pre score with post scores and response was highly significant (p<0.001). Most importantly, the 3 year EFS in 47 children with Mscore 0 at diagnosis was 0.68 (A ` 0.07), by comparison with 0.42 (A` 0.06), 0.35 (A` 0.05) and 0.25 (A` 0.06) for patients in pre-treatment score groups <18, 18-44 and Y ´ 45, respectively (p<0.001). AnMscore threshold ofY ´ 45 at diagnosis was associated with significantly worse outcome by comparison with all other Mscore groups (p¼0.029). The 3 year EFS of 0.53 (A` 0.07) of patients in metastatic CR (mIBG and BM) after Rapid Cojec (33%) is clearly superior to patients not achieving metastatic CR (0.24 (A ` 0.04), p¼0.005).Conclusion: SIOPEN scoring of 123I mIBG imaging has been shown to predict response to induction chemotherapy and outcome at diagnosis in children with HRN.