Comparison of intraoperative imaging with a portable gamma camera with extemporaneous histology in minimally invasive surgery for primary hyperparathyroidism.

INTRODUCTION: The curative treatment of primary hyperparathyroidism (PPH) is surgical and today it can be performed by minimally invasive surgery (MIS) and also be radioguided (RG) if a radiopharmaceutical with affinity for the parathyroid tissue that can be detected with gamma-detector probes or with a portable gamma camera (PGC) is injected. AIM: The objective is to assess whether intraoperative scintigraphy (GGio) with PGC can replace intraoperative pathological anatomy (APio) to determine if the removed specimen is an abnormal parathyroid. MATERIAL AND METHOD: 92 patients underwent CMI RG--HPP with PGC after the administration of a dose of 99 mTc-MIBI. The information provided by the PGC in the analysis of the excised specimens is qualitatively compared (capture yes/no) with the result of the intraoperative pathological anatomy (APio). The Gold standard is the definitive histology. RESULTS: 120 excised pieces are evaluated with GGio and APio. There were 110 agreements (95TP and 15TN) and 10 disagreements (3FP and 7FN). Of the 120 lesions, 102 were parathyroid and 18 were non-parathyroid. There was good agreement between intraoperative scintigraphy imaging (GGio) and PA, 70.1% according to Cohen's Kappa index. The GGio presented the following values ​​of Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value, Positive Likelihood Ratio, Negative Likelihood Ratio and Overall Value of the Test (93.1%, 83.3%, 96.9%, 68.2%, 5.59, 0.08 and 0.92 respectively). CONCLUSION: GGio is a rapid and effective surgical aid technique to confirm/rule out the possible parathyroid nature of the lesions removed in PPH surgery, but it cannot replace histological study.

[Calcitonin in the treatment of osteoporosis: its use in a basic health area]. / Calcitonina para el tratamiento de la osteoporosis: su empleo en una zona básica de salud.

OBJECTIVES: To find the number of patients who receive calcitonin in a health district and to evaluate the quality of their treatments in terms of their completeness and of health promotion measures. DESIGN: A descriptive crossover study with a questionnaire. SETTING: A rural health district in Alicante province. PATIENTS OR OTHER PARTICIPANTS: 116 patients who attended the different clinics in the district and received calcitonin treatment. INTERVENTIONS: A questionnaire on treatment and health promotion advice was given to those patients located. We also checked through the existing clinical documentation. MEASUREMENTS AND MAIN RESULTS: The prevalence of treatment was 2.27 per 100 inhabitants over 45. The standardised ratio of consumption of calcitonin in the District was 0.663 of that in the Health Area and 0.631 of that in the Community of Valencia. Eighty-three of the treatments (78.3%) did not contain sufficient calcium salt and/or vitamin D, according to the criteria of the study. Thirty-one patients (29.2%) did not remember having received any recommendation on health promotion measures. There were no significant differences on account of the origin of, or responsibility for, the treatment. CONCLUSIONS: The prevalence of treatment in the district was less than in the Area and the Community of Valencia. Many of these treatments were incomplete in calcium and vitamin D. Recommendations about life-styles were remembered little. An effort is needed to make correct and integrated treatments.