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Calcio, Fósforo Y Vitamina D) Con Las Alteraciones Del Complejo Estilohioideo

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Calcio, Fósforo Y Vitamina D) Con Las Alteraciones Del Complejo Estilohioideo TESIS DOCTORAL ANÁLISIS DE LA RELACIÓN ENTRE LOS PARÁMETROS ANALÍTICOS SÉRICOS DEL METABOLISMO ÓSEO (CALCIO, FÓSFORO Y VITAMINA D) CON LAS ALTERACIONES DEL COMPLEJO ESTILOHIOIDEO CARLOS MIGUEL SALVADOR RAMÍREZ Directores: Ana Sánchez del Rey y Agustín Martínez Ibargüen Facultad de Medicina y Enfermería 2018 (c)2018 CARLOS MIGUEL SALVADOR RAMIREZ “No tienes que ser grande para comenzar, pero tienes que comenzar para ser grande”. Zig Ziglar AGRADECIMIENTOS La elaboración del presente trabajo ha significado el resultado de un gran esfuerzo personal; pero deseo señalar, ya con la satisfacción de haber alcanzado el objetivo, la valiosa implicación y colaboración de todos quienes me ayudaron y animaron en esta labor. El inicio de mi interés por el estudio del complejo estilohioideo se dio desde mi etapa como residente ORL y como docente de prácticas universitarias, por lo que destaco la colaboración de parte del servicio de Otorrinolaringología del Hospital Universitario Basurto-Bilbao y de la cátedra de Anatomía y Embriología Humana UPV/EHU (Dra. Concepción Reblet López). A cada uno de los pacientes, quienes prestaron su tiempo y buena disposición a participar en el presente estudio. A los compañeros del Hospital Medina del Campo, en especial al equipo del servicio de Otorrinolaríngología, servicio de Laboratorio Clínico, servicio de Medicina Preventiva (Dra. María del Carmen Viña Simón), servicio de Radiodiagnóstico, residente: Dra. Jenny Dávalos Marín. A María Fé Muñoz Moreno, responsable de Metodología y Bioestadística de la Unidad de apoyo a la investigación del Hospital Clínico Universitario de Valladolid, cuya colaboración ha sido fundamental para el análisis de los resultados encontrados. A Lourdes Sáenz de Castillo, de la Biblioteca del Campus de Álava UPV/EHU, por la colaboración en la obtención de material bibliográfico. A mis directores de tesis Dra. Ana Sánchez del Rey y Dr. Agustín Martínez Ibargüen, quienes en base a su experiencia, han sabido guiarme en cada paso de la investigación. A mi mujer, Ivonne, a mi hijo, Carlos, por su constante apoyo, paciencia y compresión y; porque son la fuerza y el motor de mi vida. A mis padres; a mi madre Numila, allá donde estés, porque fuiste quién me transmitió que la constancia nos hace alcanzar las metas. A todos, mi más profundo agradecimiento. LISTADO DE ABREVIATURAS AE : Apófisis Estiloides AMA : American Medical Association (Asociación Médica Americana) Atc. : Antecedentes BAPTA : Ácido aminopolicarboxílico específico de calcio BD : Becton Dickinson CA2 Gen2 : Calcio Segunda Generación CBCT : Cone Beam Computed Tomography (Tomografía Computada de haz cónico) CEH : Complejo Estilohioideo CFAS : Calibrator For Automated Systems (Calibrador para sistemas automatizados) Col. : Colaboradores CV : Coeficiente de variación DS : Desviación estándar EH : Estilohioideo Fig. : Figura IRC : Insuficiencia Renal Crónica Kv : Kilovoltaje LEH : Ligamento estilohioideo m. : Músculo mAs : miliamperes por segundo mg/dl : miligramos por decilitro mGy : miligray ml : mililitros mm : milímetros mmol/lt : milimol por litro ng/dl : nanogramos por decilitro ORL : Otorrinolaringología PAL : Phase Alternating Line (Línea de fase alternada) PHOS 2 : phosphorus second generation (segunda generación de Fósforo) PTH : Paratohormona, hormona paratiroidea RP : Radiografía Panorámica rpm : revoluciones por minuto SCEH : Síndrome Complejo Estilohioideo Sd. : Síndrome SE : Síndrome de Eagle SEH : Síndrome Estilohioideo SPEH : Síndrome Pseudo Estilohioideo SPSS : Statiscal Package for the Social Sciences (Paquete estadístico para ciencias sociales) TC : Tomografía computarizada UV : ultravioleta VDR : Vitamin D Receptor (Receptor de Vitamina D) 3 D : Tres dimensiones ÍNDICE ÍNDICE CAPÍTULO 1: INTRODUCCIÓN 1.1 EMBRIOLOGÍA ................................................................................................ 3 1.1.1 Embriología de los arcos faríngeos .............................................................. 3 1.1.2 Segundo arco faríngeo ................................................................................. 5 1.1.2.1 Postulado clásico ...................................................................................................... 5 1.1.2.1 Postulado actual ..................................................................................................................... 8 1.2 ANATOMÍA ...................................................................................................... 15 1.2.1 Aparato estilohioideo, complejo estilohioideo ........................................... 15 1.2.1.1 Apófisis estiloides .................................................................................................. 16 1.2.1.2 Ligamento estilohioideo ..................................................................................................... 21 1.2.1.3 Cuerno menor del hioides ................................................................................................. 22 1.3 SÍNDROMES RELACIONADOS CON EL COMPLEJO ESTILOHIOIDEO ............................................................................................... 24 1.3.1 Síndrome de Eagle: historia ....................................................................... 25 1.3.1.1 Síndrome Clásico ................................................................................................... 26 1.3.1.2 Síndrome Carotídeo ............................................................................................................ 27 1.3.2 Síndrome Estilohioideo ............................................................................. 27 1.3.3 Síndrome Pseudoestilohioideo .................................................................. 28 1.4 ETIOLOGÍA Y PATOGÉNESIS .................................................................... 29 1.4.1 Fisiopatología del dolor ............................................................................. 29 1.4.2 Teorías Etiológicas .................................................................................... 29 1.4.3 Metabolismo del Calcio, Fósforo y Vitamina D ........................................ 38 1.4.3.1 Calcio ....................................................................................................................... 38 1.4.3.2 Fósforo ................................................................................................................................. 40 1.4.3.3 Vitamina D ........................................................................................................................... 41 1.5 FRECUENCIA ................................................................................................ 43 1.6 CLÍNICA .......................................................................................................... 45 1.7 DIAGNÓSTICO .............................................................................................. 48 1.7.1 Anamnesis y Examen Clínico .................................................................... 48 1.7.2 Exámenes Auxiliares: Radiología ............................................................. 50 1.7.3 Diagnóstico diferencial .............................................................................. 55 1.8 TRATAMIENTO ............................................................................................ 56 1.8.1 Tratamiento Médico-Conservador ........................................................... 56 1.8.2 Tratamiento Quirúrgico ........................................................................... 57 CAPÍTULO 2: HIPÓTESIS DE TRABAJO, OBJETIVOS Y JUSTIFICACIÓN 2.1 HIPÓTESIS DE TRABAJO ........................................................................ 63 2.2 OBJETIVOS ................................................................................................ 64 2.2.1 Objetivo general ..................................................................................... 64 2.2.2 Objetivos específicos ............................................................................. 64 2.3 JUSTIFICACIÓN ........................................................................................ 66 CAPÍTULO 3: MATERIAL Y MÉTODOS 3. MATERIAL Y MÉTODOS ............................................................................... 73 3.1 MATERIAL .................................................................................................. 73 3.1.1 Población de estudio .............................................................................. 73 3.1.1.1 Características de los pacientes .................................................................................... 75 3.1.1.2 Clasificación de los pacientes ...................................................................................... 76 3.1.2 Soporte técnico ....................................................................................... 78 3.1.2.1 Material de consulta ...................................................................................................... 78 3.1.2.2 Material de laboratorio ................................................................................................. 79 3.1.2.3 Material de radiodiagnóstico ....................................................................................... 80 3.1.2.4 Soporte informático ...................................................................................................... 80 3.2. MÉTODOS .................................................................................................. 81 3.2.1 Diseño
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