TC-4D como prueba de localización preoperatoria de segunda línea en la evaluación del hiperparatiroidismo primario / 4D-CT as a second line preoperative localization test for the evaluation of primary hyperparathyroidism

Introducción: La tomografía computarizada en cuatro dimensiones (TC-4D) ofrece buena sensibilidad para localizar la glándula patológica responsable del hiperparatiroidismo primario. El objetivo fue evaluar su rendimiento como estudio de segunda línea tras ausencia de localización o resultado no concordante de los estudios habituales. Material y métodos: Estudio observacional retrospectivo que incluyó todos los pacientes intervenidos por hiperparatiroidismo primario con TC-4D como estudio preoperatorio, del 1 de octubre de 2016 al 1 de octubre de 2021, en un centro hospitalario de tercer nivel. Se compararon los resultados de la TC-4D, la ecografía y las exploraciones de medicina nuclear (gammagrafía, SPECT y SPECT-TC) con el gold standard de la exploración quirúrgica y el resultado anatomopatológico, analizando los porcentajes de lateralización correcta y localización aproximada de la glándula patológica. Resultados: El análisis incluyó 64 pacientes, con una curación del 93,8% (60/64). La TC-4D mostró una lateralización correcta del 57,8% (37/64) y reveló la localización aproximada de la glándula en el 48,4% (31/64). La ecografía tuvo unos porcentajes del 31,1% (19/61) y del 18% (11/61) para la lateralización correcta y la localización aproximada, respectivamente, vs. un 34,9% (22/63) y un 28,6% (18/63) de los estudios de medicina nuclear y un 32,7% (16/49) y un 24,5% (12/49) de la SPECT-TC. Estas diferencias fueron estadísticamente significativas. Conclusiones: La TC-4D ofrece un rendimiento aceptable para localizar las lesiones responsables del hiperparatiroidismo primario, por lo que debería considerarse su uso ante la ausencia de localización en los estudios habituales. (AU)

Introduction: Four-dimensional computerized tomography (4D-CT) offers a good sensitivity for the localization of the pathological gland responsible of primary hyperparathyroidism. The aim was to evaluate its results as a second line preoperative localization test after inconclusive or discordant results of usual preoperative studies. Material and methods: Observational retrospective study that included all patients intervened for primary hyperparathyroidism with 4D-CT scan as preoperative study, from 1st October 2016 to 1st October 2021, in a tertiary referral centre. The results of 4D-CT, cervical ultrasound, and nuclear medicine explorations (scintigraphy, SPECT and SPECT-CT) were compared with the gold standard of the surgical exploration and the pathological result. The correct lateralization and the approximate localization rates of the pathological gland were evaluated. Results: A total of 64 patients were analysed, with a 93,8% (60/64) remission rate. 4D-CT showed a correct lateralization in 57,8% (37/64) of the cases and revealed the approximate localization of the gland in 48,4% (31/64) of the cases. The cervical ultrasound had a rate of 31,1% (19/61) and 18% (11/61) for the correct lateralization and approximate localization, respectively, compared to 34,9% (22/63) and 28,6% (18/63) in nuclear medicine explorations, and 32,7% (16/49) and 24,5% (12/49) in SPECT-CT. These differences were statistically significant. Conclusion: 4D-CT demonstrated acceptable results for the localization of the lesions responsible of primary hyperparathyroidism, thus its use should be considered with the absence of localization in routinely studies. (AU)

4D-CT as a second line preoperative localization test for the evaluation of primary hyperparathyroidism.

INTRODUCTION: Four-dimensional computerized tomography (4D-CT) offers a good sensitivity for the localization of the pathological gland responsible of primary hyperparathyroidism. The aim was to evaluate its results as a second line preoperative localization test after inconclusive or discordant results of usual preoperative studies. MATERIAL AND METHODS: Observational retrospective study that included all patients intervened for primary hyperparathyroidism with 4D-CT scan as preoperative study, from 1st October 2016 to 1st October 2021, in a tertiary referral centre. The results of 4D-CT, cervical ultrasound, and Nuclear Medicine explorations (scintigraphy, SPECT and SPECT-CT) were compared with the gold standard of the surgical exploration and the pathological result. The correct lateralization and the approximate localization rates of the pathological gland were evaluated. RESULTS: A total of 64 patients were analysed, with a 93,8% (60/64) remission rate. 4DCT showed a correct lateralization in 57,8% (37/64) of the cases and revealed the approximate localization of the gland in 48,4% (31/64) of the cases. The cervical ultrasound had a rate of 31,1% (19/61) and 18% (11/61) for the correct lateralization and approximate localization, respectively, compared to 34,9% (22/63) and 28,6% (18/63) in Nuclear Medicine explorations, and 32,7% (16/49) and 24,5% (12/49) in SPECT-CT. These differences were statistically significant. CONCLUSION: 4D-CT demonstrated acceptable results for the localization of the lesions responsible of primary hyperparathyroidism, thus its use should be considered with the absence of localization in routinely studies.

Poly(ethylene glycol)- block-poly(2-aminoethyl methacrylate hydrochloride)-Based Polyplexes as Serum-Tolerant Nanosystems for Enhanced Gene Delivery.

Incorporation of poly(ethylene glycol) (PEG) into polyplexes has been used as a promising approach to enhance their stability and reduce unwanted interactions with biomolecules. However, this strategy generally has a negative influence on cellular uptake and, consequently, on transfection of target cells. In this work, we explore the effect of PEGylation on biological and physicochemical properties of poly(2-aminoethyl methacrylate) (PAMA)-based polyplexes. For this purpose, different tailor-made PEG- b-PAMA block copolymers, and the respective homopolymers, were synthesized using the controlled/"living" radical polymerization method based on activators regenerated by electron transfer atom transfer radical polymerization. The obtained data show that PEG- b-PAMA-based polyplexes exhibited a much better transfection activity/cytotoxicity relationship than the corresponding non-PEGylated nanocarriers. The best formulation, prepared with the largest block copolymer (PEG45- b-PAMA168) at a 25:1 N/P ratio, presented a 350-fold higher transfection activity in the presence of serum than that obtained with polyplexes generated with the gold standard bPEI. This higher transfection activity was associated to an improved capability to overcome the intracellular barriers, namely the release from the endolysosomal pathway and the vector unpacking and consequent DNA release from the nanosystem inside cells. Moreover, these nanocarriers exhibit suitable physicochemical properties for gene delivery, namely reduced sizes, high DNA protection, and colloidal stability. Overall, these findings demonstrate the high potential of the PEG45- b-PAMA168 block copolymer as a gene delivery system.

Melanoma: diagnosis, staging, and treatment. Consensus group recommendations.

The incidence of malignant melanoma is increasing worldwide. In Spain, its incidence is increasing faster than any other cancer type, with a 5-year survival rate of about 85%. The impact and characteristics of malignant melanoma in the Spanish population can be ascertained from the national melanoma registry of the Academia Española de Dermatología y Venereología. This review presents consensus group recommendations for the diagnosis, staging and treatment of malignant melanoma in Spain. Incidence and mortality are discussed, as well as evaluation of various prevention and treatment strategies. Prognostic factors, such as BRAF and C-KIT mutations, which are expected to become routine staging procedures over the next few years, are outlined, especially in relation to treatment options. The use of recently approved targeted agents such as ipilimumab, a cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) inhibitor, and vemurafenib, a BRAF inhibitor, in metastatic disease are also discussed.

Cirugía radiodirigida del adenoma de paratiroides / Radioguided surgery for parathyroid adenoma

Introducción. En la última década, coincidiendo con la introducción de la gammagrafía marcada con sestamibi se han descrito distintos protocolos de cirugía con abordaje unilateral. Entre ellos surge la posibilidad de utilizar sondas manuales de detección de radiación gamma para identificar las glándulas marcadas con sestamibi. En el trabajo se evalúa la posibilidad de un abordaje unilateral en el hiperparatiroidismo primario facilitado por la sonda manual. Pacientes y método. Se incluye a 20 pacientes diagnosticados de hiperparatiroidismo primario en los que la gammagrafía preoperatoria con sestamibi muestra la sospecha de un adenoma, y se comparan con un grupo control de cirugía convencional recogido del archivo histórico del hospital. Resultados. Hubo un cado de conversión a cervicotomía bilateral (5 por ciento). En el resto se completó la intervención con abordaje unilateral sin que se produjeran recidivas del hiperparatiroidismo ni complicaciones importantes. La duración mediana de la cirugía fue de 40 min en el grupo radiodirigido (30 por ciento menor que con el abordaje convencional), con una estancia postoperatoria de un día (incluyendo a 4 pacientes que fueron intervenidos en régimen ambulatorio). El tamaño de las incisiones realizadas en los pacientes tratados con cirugía unilateral fue de 2,8 cm. Conclusion. Un abordaje unilateral mínimamente invasivo es posible y seguro cuando la gammagrafía preoperatoria muestra la sospecha de un adenoma de paratiroides. Con ello se consigue evitar una disección cervical innecesaria y una reducción de la duración de la cirugía, la estancia postoperatoria y el tamaño de la cicatriz, con la consiguiente satisfacción por parte de los pacientes y los cirujanos (AU)