1,721,329 research outputs found
Hand-held gamma probe or hand-held miniature gamma camera for minimally invasive parathyroidectomy: competition, evolution or synergy?
No full textIs there an ideal diagnostic algorithm in solitary pulmonary nodules?
No full textdiscussion on the diagnostic algorythm in np
How accurate intraoperative quick parathyroid hormone measurement in establishing complete surgical removal of hyperfunctioning parathyroid issue?
No full textOPTIMIZATION OF PEROPERATIVE PROCEDURES
No full textAbstract: Minimally invasive radio-guided surgery (MIRS) of parathyroid adenomas has been favoured by three main factors. One is the significant improvements achieved in preoperative localizing imaging, particularly with sestamibi scintigraphy. Another is the availability of intra-operative quick parathyroid hormone measurement, and finally the increase in availability of the intra-operative gamma probes in many surgical centres especially those performing sentinel node biopsy. In contrast with the traditional wide bilateral neck exploration (BNE), MIRS requires strict inclusion criteria: 1) high probability of a solitary parathyroid adenoma, 2) a significant sestamibi uptake in the parathyroid adenoma, 3) absence of a concomitant thyroid nodular disease, 4) no family history of familial hyperparathyroidism (HPT) of multiple endocrine neoplasia, 5) no previous neck irradiation. Following these criteria about 60-70% of all primary HPT patients are suitable for a MIRS. Two main protocols for MIRS have been proposed. The single day, imaging and surgery, protocol is based on the injection of a 740 MBq dose of Tc-99m sestamibi with the purpose of obtaining scintigraphic imaging and then MIRS within 3 hours from radio-tracer injection. An alternative is for imaging to be performed a few days before surgery, with a further small administered activity of 37MBq of Tc-99m sestamibi injected intravenously in the operating theatre a few minutes before commencing the intervention for the purpose of MIRS only. The latter protocol allows both better planning of operating theatre scheduling and reduction of the radiation exposure to the surgical staff. The main advantages of MIRS in respect to the traditional BNE include less surgical trauma, a shorter duration of anaesthesia and surgery, a shorter hospital stay with the possibility of same-day discharge, less post-surgical pain with improved cosmetic results and lower costs. Moreover, MIRS has proven to be a safe technique with a low morbidity rate and a cure rate higher than 95% in patients with primary HPT. ((C) 2003 Lippincott Williams Wilkins)
Minimally invasive radio-guided parathyroidectomy on a group of 452 primary hyperparathyroid patients - Refinement of preoperative imaging and intraoperative procedure
No full textTHE AIM: of this study was to investigate the efficacy of minimally invasive radio-guided parathyroidectomy (MIRP) in primary hyperparathyroid (PHPT) patients.
PATIENTS, METHODS: 452 consecutive PHPT patients were evaluated. Inclusion criteria for MIRP were (a) evidence at scintigraphy of a solitary parathyroid adenoma (PA); (b) a clear sestamibi uptake in the PA; (c) the absence of concomitant thyroid nodules; (d) no history of familial HPT or MEN; (e) no history of previous neck irradiation. Intra-operative protocol consisted of the injection of a low 37 MBq sestamibi dose in the operating suite 10 min before surgery. A hand held 11-mm collimated gamma probe was used. Quick PTH (QPTH) was routinely measured.
RESULTS: 344 out of the 452 patients met the inclusion criteria, and MIRP was successfully performed in 321 of them (93.3%). No major intra-operative complication was recorded. MIRP required a mean operative time of 32 min, and a mean hospital stay of 1.2 d. The parathyroid to background ratio (P/B) calculated by the probe was well correlated with the P/B calculated by sestamibi SPECT (r = 0.91; p < 0.01), while no significant correlation was found between the probe-calculated P/B and the P/B calculated at planar sestamibi scan.
CONCLUSIONS: In our experience: a) an accurate preoperative localising imaging protocol based on planar and SPECT sestamibi scan, and neck US is effective in selecting PHPT patients for MIRP, b) the P/B calculated by sestamibi SPECT seems able to predict the probe-calculated P/B more accurately than the P/B calculated at planar scan, c) the low 37 MBq sestamibi dose protocol proved to be a safe and effective approach to perform MIRP
Is thyroid suppression an effective procedure in improving preoperative sestamibi parathyroid scintigraphy?
No full text
The optimal timing to perform 18F/11C-choline PET/CT in patients with suspicion of relapse of prostate cancer: Trigger PSA versus PSA velocity and PSA doubling time
No full textIn the present short communication we considered the main publications focused on trigger prostate-specific antigen (PSA) and PSA kinetics that systematically compared 18F to 11C-choline PET/CT in order to establish the optimal time to perform choline PET/CT in relation to the trigger values and velocity, as well as doubling time of PSA serum levels
NUCLEAR MEDICINE AND MINIMALLY INVASIVE SURGERY OF PARATHYROID ADENOMAS: A FAIR MARRIAGE
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