{"id":95501,"date":"2018-03-11T10:15:28","date_gmt":"2018-03-11T10:15:28","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/contribucion-de-la-localizacion-radioguiada-con-99mtc-mibi-y-la-medida-intraoperatoria-de-pthi-a-la-ciruga%c2%ada-del-hiperparatiroidismo-primario\/"},"modified":"2018-03-11T10:15:28","modified_gmt":"2018-03-11T10:15:28","slug":"contribucion-de-la-localizacion-radioguiada-con-99mtc-mibi-y-la-medida-intraoperatoria-de-pthi-a-la-ciruga%c2%ada-del-hiperparatiroidismo-primario","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/oncologia-clinica\/contribucion-de-la-localizacion-radioguiada-con-99mtc-mibi-y-la-medida-intraoperatoria-de-pthi-a-la-ciruga%c2%ada-del-hiperparatiroidismo-primario\/","title":{"rendered":"Contribuci\u00f3n de la localizaci\u00f3n radioguiada con 99mtc-mibi y la medida intraoperatoria de pthi a la cirugia del hiperparatiroidismo primario"},"content":{"rendered":"<h2>Tesis doctoral de <strong> Paloma Garcia-talavera San Miguel <\/strong><\/h2>\n<p>La cirug\u00eda del hiperparatiroidismo primario (hptp) est\u00e1 haci\u00e9ndose menos invasiva, con ayuda de t\u00e9cnicas, como gammagraf\u00eda, sonda gammadetectora y determinaci\u00f3n de pthi intraoperatoria (iopthi). El papel de estas dos \u00faltimas sigue controvertido. Pretendemos comprobar que ambas contribuyen al \u00e9xito quir\u00fargico, resultando procedimientos complementarios.  material y m\u00e9todos. Incluimos 94 pacientes, intervenidos de hptp. Adquirimos im\u00e1genes gammagr\u00e1ficas, 15 y 120 minutos post-inyecci\u00f3n de 20mci de 99mtc-mibi. Con la sonda, medimos los espec\u00edmenes in vivo y ex vivo, el background (tiroides) y el lecho post-operatorio. Cuantificamos la iopthi, basal y 10 minutos post-extirpaci\u00f3n. Recogimos calcio plasm\u00e1tico y pthi, antes, a los 6 meses, al a\u00f1o y a m\u00e1s de un a\u00f1o de la intervenci\u00f3n.   resultados. La gammagraf\u00eda alcanz\u00f3 una sensibilidad del 85% y un vpp del 88%. En el 75% de los pacientes se observ\u00f3 un descenso de iopthi mayor al 57%, detect\u00e1ndose persistencia de enfermedad en 3 casos, enfermedad multiglandular en otros 3 y existiendo 3 fp. La sonda mejora el resultado gammagr\u00e1fico, localiza gl\u00e1ndulas ect\u00f3picas y diferencia entre paratiroides patol\u00f3gica y otros tejidos, generando 5 fp, por patolog\u00eda tiroidea. Tomando un punto de corte de 1,13 en el \u00edndice in vivo gl\u00e1ndula patol\u00f3gica\/bkg, resultaron una sensibilidad del 88,1% y especificidad del 91,7%. Se detectan 4 persistencias de enfermedad y ninguna recidiva durante el seguimiento. La sonda tiene mejores resultados que la iopthi, excepto cuando coexiste patolog\u00eda tiroidea. Conjuntamente, alcanzan un 99,7% de \u00e9xitos en la cirug\u00eda limitada.   conclusiones. La gammagraf\u00eda ha demostrado su utilidad para planificar la cirug\u00eda. La combinaci\u00f3n de sonda y iopthi es beneficiosa, confirmando la extirpaci\u00f3n completa del tejido paratiroideo patol\u00f3gico, detectando enfermedad multiglandular, ayudando a localizar casos ect\u00f3picos, y complementando los resultados de la gammagraf\u00eda, incluso en pacientes con enfermedad tiroidea. Con la conjunci\u00f3n de las tres, se obtuvo un \u00e9xito del 95% al a\u00f1o de seguimiento.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Contribuci\u00f3n de la localizaci\u00f3n radioguiada con 99mtc-mibi y la medida intraoperatoria de pthi a la cirugia del hiperparatiroidismo primario<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Contribuci\u00f3n de la localizaci\u00f3n radioguiada con 99mtc-mibi y la medida intraoperatoria de pthi a la cirugia del hiperparatiroidismo primario <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Paloma Garcia-talavera San Miguel <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Salamanca<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 21\/07\/2009<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Alberto Gomez Alonso<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: Jos\u00e9 Luis Carreras delgado <\/li>\n<li>francesca Pons pons (vocal)<\/li>\n<li>Juan  ignacio Landa garcia (vocal)<\/li>\n<li>Jorge Teijeiro vidal (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Paloma Garcia-talavera San Miguel La cirug\u00eda del hiperparatiroidismo primario (hptp) est\u00e1 haci\u00e9ndose menos invasiva, con ayuda de [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center 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