[What do MRI and CT scan provide us in patients with vertigo and dizziness? A cost-utility analysis]. / Que aporta la neuroimagen en pacientes con vertigo y mareo? Analisis coste-utilidad.

INTRODUCTION: Vertigo and dizziness are symptoms with a significant burden in the hospital and involve several specialties. There are few guidelines of radiological tests for these symptoms. AIMS: To know which profile of patients with vertigo and dizziness has neuroimaging tests, quantify and describe the radiological findings. To analyze the cost-utility of CT and MRI in the study of these patients. PATIENTS AND METHODS: Descriptive study, we selected patients referred to the hospital for vertigo and dizziness. We analyze demographic and clinical characteristics and quantify the neuroimaging tests requested. We describe the radiological findings, assess their relevance in the diagnosis and detail the cost-benefit. RESULTS: We identified 493 patients, those with neuroimaging test (60%) are older, depressed and frequented the emergency department because of vertigo. The most requested test was the cranial CT scan (5% identifies the cause of the symptom). MRI of the inner ear and cerebellopontine angle was the test that presented the most significant findings (17.7%). The 286 image tests requested for vertigo cost 56,741 euros. The cost for a positive test was 1,576 euros. CONCLUSIONS: A large number of head CT and MRI are made in patients with vertigo and dizziness. A clinical suspicion is recommended from the anamnesis and exploration to make a good selection of test to request. In more than 90% of cases, radiological findings are not shown in relation to vertigo.

TITLE: Que aporta la neuroimagen en pacientes con vertigo y mareo? Analisis coste-utilidad.Introduccion. Vertigo y mareo son sintomas que suponen una carga significativa en el hospital e involucran a varias especialidades. Existen pocas guias sobre la solicitud de pruebas radiologicas ante estos sintomas. Objetivos. Conocer que perfil de pacientes con vertigo y mareo tiene realizadas pruebas de neuroimagen, cuantificar y describir los hallazgos radiologicos, y analizar el coste-utilidad de la tomografia computarizada (TC) y la resonancia magnetica (RM) en pacientes con estos sintomas. Pacientes y metodos. Estudio descriptivo en el que se seleccionan pacientes remitidos al hospital por vertigo y mareo. Se analizan caracteristicas demograficas y clinicas y se cuantifican las pruebas de neuroimagen solicitadas. Se describen los hallazgos radiologicos, se valora su relevancia en el diagnostico y se detalla el coste. Resultados. Se identifica a 493 pacientes, el 60% tiene realizada una prueba de neuroimagen; son pacientes de mas edad, depresivos y que han acudido a urgencias por vertigo. La prueba mas realizada fue la TC de craneo sin contraste (el 5% identifica la causa del sintoma). La que presento mas hallazgos significativos fue la RM de la base del craneo (17,7%). Las 286 pruebas de imagen solicitadas por vertigo costaron 56.741 euros. El gasto para obtener un diagnostico radiologico fue de 1.576 euros. Conclusiones. Se realiza un gran numero de TC y RM de cabeza en pacientes con vertigo y mareo. Es recomendable tener un diagnostico de sospecha previo a partir de la anamnesis y la exploracion para hacer una buena seleccion de las pruebas que hay que solicitar. En mas del 90% de los casos no se muestran hallazgos radiologicos en relacion con el vertigo.

Transient rise in intact parathyroid hormone concentration after surgery for parathyroid adenoma.

OBJECTIVE: Our goal was to describe the course of parathyroid hormone (PTH) after surgery for primary hyperparathyroidism (PHPT). PTH levels drop to low values after parathyroidectomy for PHPT. However, in some patients, a rebound transient increase in PTH concentrations can occur. Study design and setting A prospective study included 72 patients who underwent surgical exploration for PHPT. A single adenoma was found in 57 patients (79.1%), 2 adenomas were found in 2 (2.7%), and parathyroid hyperplasia was found in 13 (18.05%). The postoperative PTH secretion was studied in those patients who had an adenoma excised. RESULTS: This phenomenon was noted in 18 (31.6%) patients between 4 and 12 weeks, although total calcium concentrations were normal (9.3 +/- 0.6 mg/dL). Before surgery these patients had a more remarkable hyperparathyroidism (clinical and biochemical) than the others, but differences were not significant. CONCLUSION: Postoperative increases in PTH concentration can occur after successful parathyroidectomy. These increases are transient and do not indicate persistent or recurrent disease.

Análisis descriptivo y resultados quirúrgicos del hiperparatiroidismo primario / Descriptive analysis and surgical outcome of primary hyperparathyroidism

El hiperparatiroidismo primario (HPP) ha pasado de ser una enfermedad rara caracterizada por presentar una sintomatología florida renal y esquelética, a ser una enfermedad más común con mínima sintomatología. El empleo difundido de los autoanalizadores ha conducido a un aumento en su incidencia y a que el diagnóstico se realice precozmente. El objetivo de este estudio es analizar la forma de presentación y alteraciones bioquímicas, así como los hallazgos quirúrgicos y resultados postoperatorios de un grupo de pacientes diagnosticados de HPP e intervenidos quirúrgicamente. De los 71 pacientes estudiados, la mayoría presentaban sintomatología en el momento del diagnóstico, 6 eran asintomáticos y 11 normocalcémicos. En 5 pacientes fue necesaria una reintervención por HPP persistente. El 95,77 per cent de los pacientes normalizaron los niveles de hormona paratiroidea tras la cirugía. La paratiroidectomía es una técnica segura y efectiva que debe ser indicada precozmente, incluso en los casos asintomáticos (AU)

Primary hyperparathyroidism (PHPT) was a rare but serious disease with massive biochemical, renal and skeletal signs at the time of diagnosis. In the last decades it has become a more common disorder often diagnosed by chance. The disease usually shows minimal symptoms. These clinical changes are due to advances in biochemical screening procedures, which have led to a remarkable increase in the incidence of PHPT. The aim of this study is to describe the clinical profiles, biochemical data, operative findings and postoperative results. Seventy one consecutive patients were prospectively enrolled and underwent surgical examination. Most of them showed symptoms: 6 patients were asymptomatic and 11 had a normocalcemic hyperparathyroidism. After surgery 5 patients showed persistent primary hyperparathyroidism. Parathyroid hormone concentration returned to normal levels in 95.77% of the patients studied. Parathyroidectomy is a safe and effective approach to the treatment of primary hyperparathyroidism (AU)

[Unilateral polyposis: evaluation of preoperative tests]. / Poliposis unilaterales: evaluación de las pruebas preoperatorias.

UNLABELLED: The aim of this paper is to study a group of patients with occupancy of a nasal fossal, apparently by polyps, and being the other side of the nose normal. Evaluating on the one hand the true incidence of unspecific polyposis and, of other diagnosis, and on the other hand to compare the preoperative radiological findings with those seen during surgery. MATERIAL AND METHODS: A prospective study of 23 consecutive patients was carried out over a period of 30 months at the ENT Department of the Dr. Peset Hospital, in Valencia. A CT scan and preoperative biopsy was performed in all cases, the results of these being later compared with the surgical findings and the final histopathologic diagnosis. RESULTS AND CONCLUSIONS: A discrepancy between the preoperative biopsy and final diagnosis was found in 26% of the patients. The incidence of polyposis was 52%, inverted papilloma 26%, malignant tumours 13% and other diagnosis 8.6%. There is a good correlation between preoperative CT scans and surgical findings in those cases of polyposis and inverted papilloma, but not in those of malignant tumours as CT scans often underestimated these lesions.

Poliposis unilaterales: evaluación de las pruebas preoperatorias / Unilateral polyposis: evaluation of preoperative tests

El objetivo del trabajo es estudiar a aquellos pacientes que presentan una ocupación unilateral de fosa nasal, en apariencia polipoidea, y la fosa contralateral normal.Valorando, por un lado, la incidencia real de poliposis inespecíficas y de otros diagnósticos. Y, por otro lado, comparamos los datos que nos ofrece la radiología preoperatoria con los hallazgos quirúrgicos encontrados. Material y métodos: Hacemos un estudio prospectivo de 23 pacientes recogidos en un periodo de 30 meses en el servicio de ORL del Hospital Dr. Peset de Valencia. Se realiza en todos los pacientes TAC y biopsia preoperatoria, comparándolos posteriormente con los hallazgos quirúrgicos y el diagnóstico anatomopatológico definitivo. Resultados y conclusiones: Hubo discordancia entre la biopsia preoperatoria y el diagnóstico definitivo en el 26 por ciento de los pacientes, siendo la incidencia de poliposis del 52 por ciento, papilomas invertidos del 26 por ciento, tumores malignos el 13 por ciento y otros diagnósticos 8,6 por ciento. Hay una buena correlación entre La TAC preoperatoria y los hallazgos quirúrgicos en las poliposis y los papilomas invertidos, pero no en los tumores malignos donde la TAC suele infravalorar las lesiones. (AU)

The aim of this paper is to study a group of patients with occupancy of a nasal fossal, apparently by polyps, and being the other side of the nose normal. Evaluating on the one hand the true incidence of unspecific polyposis and, of other diagnosis, and on the other hand to compare the preoperative radiological findings with those seen during surgery. MATERIAL AND METHODS: A prospective study of 23 consecutive patients was carried out over a period of 30 months at the ENT Department of the Dr. Peset Hospital, in Valencia. A CT scan and preoperative biopsy was performed in all cases, the results of these being later compared with the surgical findings and the final histopathologic diagnosis. RESULTS AND CONCLUSIONS: A discrepancy between the preoperative biopsy and final diagnosis was found in 26% of the patients. The incidence of polyposis was 52%, inverted papilloma 26%, malignant tumours 13% and other diagnosis 8.6%. There is a good correlation between preoperative CT scans and surgical findings in those cases of polyposis and inverted papilloma, but not in those of malignant tumours as CT scans often underestimated these lesions (AU)

[Descriptive analysis and surgical outcome of primary hyperparathyroidism]. / Análisis descriptivo y resultados quirúrgicos del hiperparatiroidismo primario.

Primary hyperparathyroidism (PHPT) was a rare but serious disease with massive biochemical, renal and skeletal signs at the time of diagnosis. In the last decades it has become a more common disorder often diagnosed by chance. The disease usually shows minimal symptoms. These clinical changes are due to advances in biochemical screening procedures, which have led to a remarkable increase in the incidence of PHPT. The aim of this study is to describe the clinical profiles, biochemical data, operative findings and postoperative results. Seventy one consecutive patients were prospectively enrolled and underwent surgical examination. Most of them showed symptoms: 6 patients were asymptomatic and 11 had a normocalcemic hyperparathyroidism. After surgery 5 patients showed persistent primary hyperparathyroidism. Parathyroid hormone concentration returned to normal levels in 95.77% of the patients studied. Parathyroidectomy is a safe and effective approach to the treatment of primary hyperparathyroidism.

[Complications of thyroid surgery. Report of 683 thyroidectomies]. / Complicaciones de la cirugía tiroidea. A propósito de 683 tiroidectomías.

Most important complications of thyroid gland surgery are recurrent paralysis (which usually results from section, stretching or devascularization of this neural branch) and parathyroid lesions resulting from unnoticed removal of more than two of these glands or through necrosis because deficient blood supply. We present a study about the complications of thyroid surgery based on the thyroid surgery done in our ENT Service during 1979-1998 term. An amount of 683 cases make the series. The 86% were female and 14% male, with a mean age of 40-50. Surgical techniques realized were: hemithyroidectomy (15.3%) and isthmectomy (2.9%). About 7.4% of patients were reoperated. Stated complications were: local (serohematoma 4.1%, infection 1.2%, postoperative hemorrhage 1.2%) and recurrent paralysis (unilateral transitory 2.6% and unilateral definitive 1.6%; there wasn't any case of bilateral palsy) and superior laryngeal nerve paralysis (1.4% as well as hypoparathyroidism (transitory 22.7% and definitive 5.3%). These complications were most frequent in reoperated cases and in total and subtotal thyroidectomies. In most of these series the incidence of recurrent palsy range between 1.5% and increases more than 9.5% in surgical check and the hypoparathyroidism incidence ranges over 25%.

[The value of the clinical picture and vestibular exploration in the vertiginous patient]. / Valor de la clínica y de la exploración vestibular en el paciente vertiginoso.

The aim of this work is to highlight the significance on features more frequent of the troubles of the balance and vestibular system in our environment. Also we present a statistic about the symptomatology, on the results of vestibular examination and the diagnoses of a series of patients, of all ages, suffering vertigo, and studied in our department.