Cirugía radioguiada en el hiperparatiroidismo primario: resultados y correlación con el diagnóstico anatomopatológico intraoperatorio / Radioguided surgery in primary hyperparathyroidism: Results and correlation with intraoperative histopathologic diagnosis

Introducción y objetivos: La cirugía radioguiada es una técnica de tratamiento quirúrgico mínimamente invasivo del hiperparatiroidismo primario. Los objetivos de este estudio fueron estudiar el porcentaje de éxito de esta técnica y realizar una comparación de la misma con el estudio histológico intraoperatorio. Métodos: Estudiamos retrospectivamente a 84 pacientes con hiperparatirodismo primario con gammagrafía paratiroidea positiva. Se administró una dosis de Tc-99 m sestamibi previa a la cirugía y se utilizó una sonda gammadetectora intraoperatoria para detectar el tejido paratiroideo anómalo, siguiendo la «regla del 20%». En todos los casos se realizó estudio anatomopatológico intraoperatorio y seguimiento clínico y analítico durante al menos 6 meses. Asimismo, se comparó el valor predictivo positivo de la ecografía cervical respecto a la gammagrafía paratiroidea. Resultados: El porcentaje de éxito de la cirugía radioguiada fue 99%. La sonda gammadetectora intraoperatoria tuvo una sensibilidad, especificidad, valores predictivos positivo y negativo respecto al estudio histológico intraoperatorio de 99, 73, 97 y 89%, respectivamente. La calcemia se normalizó en 83 de 84 pacientes (99%) y la paratohormona se normalizó en 77 de los 84 pacientes (92%). La ecografía mostró un bajo valor predictivo positivo (41%) comparada con la gammagrafía. Conclusiones: La cirugía radioguiada es una técnica con excelentes resultados en el tratamiento quirúrgico mínimamente invasivo del hiperparatiroidismo primario y podría sustituir tanto al estudio anatomopatológico intraoperatorio como a la determinación intraoperatoria de paratohormona. Esta última posibilidad debe ser demostrada en futuros estudios (AU)

Introduction and objectives: Radioguided surgery is a minimally invasive surgical technique for the treatment of primary hyperparathyroidism. The goals of our study were to evaluate the rate of success and compare the results with intraoperative histological analysis. Methods: We retrospectively studied 84 patients with primary parathyroidism who had undergone radioguided surgery. All the patients had a positive parathyroid scintigraphy prior to surgery. An intravenous injection of Tc-99 m sestamibi was administered before surgery, and radioguided location of the pathologic parathyroid tissue was performed using an intraoperative gamma probe, applying the "20% rule". All resected specimens underwent intraoperative histologic analysis. All patients were followed up for at least 6 months. Positive predictive values of both parathyroid scintigraphy and cervical ultrasonography were also compared. Results: Radioguided surgery success rate was 99%. Sensitivity, specificity, positive and negative predictive values for gamma probe were 99, 73, 97 and 89%, respectively. After surgery, 83 of 84 patients were eucalcaemic (99%) and parathyroid hormone normalised in 77 of 84 patients (92%). Ultrasonography showed low positive predictive value (41%) when compared with scintigraphy. Conclusions: Radioguided surgery is a minimally invasive surgical technique with excellent results for the treatment of primary hyperparathyroidism and could replace both intraoperative histological analysis and intraoperative parathyroid hormone assay. Further studies are needed to confirm these findings (AU)

Radioguided surgery in primary hyperparathyroidism: Results and correlation with intraoperative histopathologic diagnosis. / Cirugía radioguiada en el hiperparatiroidismo primario: resultados y correlación con el diagnóstico anatomopatológico intraoperatorio.

INTRODUCTION AND OBJECTIVES: Radioguided surgery is a minimally invasive surgical technique for the treatment of primary hyperparathyroidism. The goals of our study were to evaluate the rate of success and compare the results with intraoperative histological analysis. METHODS: We retrospectively studied 84 patients with primary parathyroidism who had undergone radioguided surgery. All the patients had a positive parathyroid scintigraphy prior to surgery. An intravenous injection of Tc-99m sestamibi was administered before surgery, and radioguided location of the pathologic parathyroid tissue was performed using an intraoperative gamma probe, applying the "20% rule". All resected specimens underwent intraoperative histologic analysis. All patients were followed up for at least 6 months. Positive predictive values of both parathyroid scintigraphy and cervical ultrasonography were also compared. RESULTS: Radioguided surgery success rate was 99%. Sensitivity, specificity, positive and negative predictive values for gamma probe were 99, 73, 97 and 89%, respectively. After surgery, 83 of 84 patients were eucalcaemic (99%) and parathyroid hormone normalised in 77 of 84 patients (92%). Ultrasonography showed low positive predictive value (41%) when compared with scintigraphy. CONCLUSIONS: Radioguided surgery is a minimally invasive surgical technique with excellent results for the treatment of primary hyperparathyroidism and could replace both intraoperative histological analysis and intraoperative parathyroid hormone assay. Further studies are needed to confirm these findings.

PET/CT in a Patient Diagnosed With Dandy-Walker Syndrome.

The Dandy-Walker syndrome (DWS) is a rare congenital posterior fossa malformation characterized by aplasia or hypoplasia of the cerebellar vermis, cystic dilatation of the fourth ventricle, and enlargement of the posterior fossa. We present a 52-year-old Caucasian man diagnosed with gastrointestinal stromal tumor and submitted to 18F-FDG PET/CT as a staging procedure. The patient was previously diagnosed with DWS in brain CT scan. PET/CT images revealed an ametabolic large cyst in the posterior fossa and hypoplasia of cerebellar vermis. The case is presented with the aim to show the appearance of this syndrome on PET/CT study.

Functional fecal retention visualized by (111)In-DTPA colon transit scintigraphy.

Constipation is an extremely common problem in children, varying from mild and short-lived to severe and chronic. Chronic constipation is a serious childhood condition and requires further investigation, including blood test, colonoscopy, radio-opaque marker study, and/or scintigraphy. We present small bowel and colon transit scintigraphy of a 14-year-old girl with history of chronic constipation, abdominal pain, weight loss, and poor response to medical treatment. After oral administration of In-DTPA in water, planar and SPECT/CT images showed normal small bowel transit time and functional fecal retention in colon transit study.

High liver FDG uptake on PET/CT in patient with lymphoma diagnosed with hereditary hemochromatosis.

Hereditary hemochromatosis is an autosomal recessive disorder of iron metabolism resulting in toxic accumulation of iron in vital organs. We present a 64-year-old white man with non-Hodgkin lymphoma treated with high-dose chemotherapy and stem cell transplant that was subsequently diagnosed with hereditary hemochromatosis. F-FDG PET/CT was performed as routine follow-up and showed a pathological finding of homogeneous increased liver glucose metabolism. Increased FDG avidity in the liver suggested the presence of damage caused by hemochromatosis.

Q192R polymorphism of paraoxonase 1 gene associated with insulin resistance in Mexican children.

BACKGROUND AND AIMS: The SNP rs662 in the paraoxonase 1 gene (PON1 Q192R) has been associated with obesity, dyslipidemia and cardiovascular risk. In this study, DNA samples of 117 children aged 6 to 12 years from San Luis Potosí, México were genotyped for Q192R polymorphism of the PON1 gene. METHODS: Genotypic frequencies were determined by allelic discrimination assay by real-time PCR using TaqMan fluorogenic probes. Anthropometry, lipid profile, glucose and insulin were analyzed by genotype. RESULTS: The distribution of allele frequency in the population was Q = 65 and R = 35 following the Hardy Weinberg equilibrium (χ(2) = 3.15, p = 0.076). The Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) index showed statistically significant differences among QQ/QR/RR genotypes (p = 0.032). The odds ratio for the carriers of the RR genotype was associated with HOMA-IR corresponding to the 95(th) percentile or higher for Mexican children based on sex and age (OR = 4.68; 95% confidence intervals, 1.23-17.8; p = 0.016). When the absolute mean of HOMAR-IR was set as the cutoff, an increased odds was observed (OR = 6.52; 95% confidence intervals, 1.68-25.3; p = 0.008). CONCLUSIONS: According to our results, PON1 Q192R polymorphism is a risk marker for insulin resistance, a pathological factor involved in the development of metabolic syndrome.

Levels of immune cells in transcendental meditation practitioners.

CONTEXT: Relationships between mind and body have gradually become accepted. Yogic practices cause modulation of the immune system. Transcendental meditation (TM) is a specific form of mantra meditation. We reported previously different plasma levels of catecholamines and pituitary hormones in TM practitioners comparing with a control group, and patterns of the daytime secretion of these hormones different from those normally described. AIMS: The aim of the following study is to evaluate the immune system in these meditation practitioners, by determining leukocytes and lymphocytes subsets. METHODS: TM group consisted of 19 subjects who regularly practice either TM or the more advanced Sidhi-TM technique. A control group consisted of 16 healthy subjects who had not previously used any relaxation technique. Total leukocytes, granulocytes, lymphocytes and monocytes were counted by an automated quantitative hematology analyzer, whereas lymphocytes subsets were determined by flow cytometry. Samples were taken from each subject at 0900 h after an overnight fast. RESULTS: The results indicated that the TM group had higher values than the control group in CD3+CD4-CD8+ lymphocytes (P < 0.05), B lymphocytes (P < 0.01) and natural killer cells (P < 0.01), whereas CD3+CD4+CD8- lymphocytes showed low levels in meditation practitioners (P < 0.001). No significant differences were observed in total leukocytes, granulocytes, monocytes, total lymphocytes or CD3+ lymphocytes comparing both groups. CONCLUSIONS: The technique of meditation studied seems to have a significant effect on immune cells, manifesting in the different circulating levels of lymphocyte subsets analyzed. The significant effect of TM on the neuroendocrine axis and its relationship with the immune system may partly explain our results.

Scintigraphy in Ochoa syndrome.

The Ochoa or urofacial syndrome is a disease characterized by non-neurogenic bladder dysfunction and unusual facial expressions when smiling or crying. It is an extremely rare disorder with over 150 cases reported in the medical literature. This condition has been determined to be inherited by an autosomal recessive pattern. We present radionuclide renogram and renal scan of a boy with a history of incontinence, frequent infections of the urinary tract, and gene mutations consistent with this syndrome. Nuclear medicine images showed extensive bilateral renal scarring and obstructive pattern in diuretic renogram.