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Resumen Introduccion La principal causa de hiperparatiroidismo primario en nuestro medio es el adenoma paratiroideo unico. La paratiroidectomia se considera el unico tratamiento potencialmente curativo y requiere de estudios de imagen de localizacion preoperatorios para un abordaje quirurgico dirigido. En pacientes con negatividad en pruebas convencionales, la PET-TC colina ha demostrado tasas de sensibilidad superiores respecto al gold-standard. Metodos Se diseno un estudio de cohortes prospectivo que incluyo a 34 pacientes con diagnostico de hiperparatiroidismo primario entre 2017 y 2019, candidatos a cirugia con pruebas de imagen con gammagrafia y SPECT-TC MIBI negativas. A todos se les realizo una PET-TC con 18F-fluorocolina. Los resultados se compararon con un grupo control de 30 pacientes con pruebas convencionales positivas intervenidos en el mismo periodo. Resultados La PET-TC colina detecto tejido paratiroideo hiperfuncionante en el 85% de los pacientes con gammagrafia previa negativa. Se realizo reseccion selectiva del adenoma identificado en estos pacientes, con criterio de curacion en el 87% de los casos, sin precisar de exploracion cervical bilateral. Los niveles de PTH, calcemia y el peso glandular fueron significativamente menores en este grupo con respecto al control. No se identificaron diferencias respecto al criterio de curacion ni a la via de abordaje en ambos grupos. Conclusion En nuestro estudio, la PET-TC colina demostro tasas superiores de deteccion que permitieron aumentar el numero de pacientes candidatos a cirugia dirigida con disminucion de la morbilidad quirurgica, especialmente en grupos con adenomas de menor tamano asociados a niveles mas bajos de calcemia y PTH preoperatorias y en pacientes con cirugias cervicales previas.

Anal intraepithelial neoplasia (AIN) is a premalignant lesion of anal squamous cell carcinoma. HIV-positive males who have sex with males, are the most affected at-risk population. Cytology and anuscopy are the best accepted methods for its diagnosis, although it is controversial which patients should complete it with a biopsy. Neither which patients should undergo treatment nor which is the best treatment is not well established. With this study, we would like to present our experience in the diagnostic-therapeutic management of AIN in the short term.Retrospective observational study of patients at risk of AIN with altered anal cytology who underwent high-resolution anuscopy with biopsy. After histological confirmation of dysplasia, they started treatment with trichloroacetic acid. Its effectiveness was verified by subsequent cytology. The demographic variables of the sample and the results of both diagnostic and treatment tests were analyzed.The majority were HIV-positive males (104/115) and 50% had sexual relations with other men. We included 115 patients with altered anal cytology, of whom 92% had dysplasia on biopsy. 97% with atypia of uncertain significance on cytology had histological dysplasia. Cytology normalized after treatment in 60% of patients.Early detection of AIN should be routinely considered in known at-risk populations. Any cytological abnormality should be biopsied. Tricholoroacetic acid can be an effective treatment achieving a high percentage of regression, although currently, the information we have is of low level of evidence.

Introduction Single parathyroid adenomas are the most common cause of primary hyperparathyroidism (PHP) in our population. Parathyroidectomy is still the only potentially curative treatment and requires preoperative localization imaging studies to perform selective surgery. In patients with negative results on conventional tests, PET/CT has demonstrated higher sensitivity rates. Methods A prospective cohort study was designed, including 34 patients diagnosed with PHP between 2017 and 2019, candidates for surgery with negative preoperative localization tests with scintigraphy and MIBI SPECT/CT. All patients underwent PET/CT with 18F-Fluorocholine. The clinical, biochemical, and postoperative outcome results were compared with a control group of 30 patients with positive standard tests. Results Hyperfunctional parathyroid tissue was detected in 85% of the patients that had undergone choline PET/CT. The selective resection of the adenoma identified in these patients achieved curative criteria in 87% of the cases without undergoing bilateral cervical surgical exploration. The preoperative levels of PTH, calcemia, and gland weight were significantly lower in this group compared to the control group. No differences were identified in cure criteria or approach between the 2 groups. Conclusion In our study, choline PET/CT showed higher detection rates compared to the gold standard. The increase provides the opportunity to perform unilateral selected adenoma resection, especially in patients with smaller adenomas associated with lower calcemia and PTH levels and patients with previous cervical surgery.