[Multidisciplinary approach in the lymphedema patient: From rehabilitation to microsurgery]. / Abordaje multidisciplinar en el paciente con linfedema: de la rehabilitación a la microcirugía.

Lymphedema is a chronic disease with a high incidence in our society. In this paper, we present a review with the latest advances in imaging techniques and surgical reconstructive treatment of lymphedema (lymphovenous anastomosis, vascularized lymph node transfer, and prophylactic lymphedema surgery). In addition, a protocol is established based on a multidisciplinary team (composed of physiatrists, plastic surgeons, radiologists and nuclear medicine radiologists) to optimize the treatment of these patients.

99mTC-white blood cell scintigraphy with SPECT/CT in the diagnosis of vascular graft infection. / Gammagrafía con leucocitos marcados y SPECT/TC en el diagnóstico de infección de prótesis vasculares.

AIM: Vascular graft infection is a rare complication with a high morbidity and mortality. Early diagnosis is essential to establish an adequate treatment. We assess the accuracy of 99mTc-WBC scintigraphy with SPECT/CT in the diagnosis of vascular graft infection. MATERIALS AND METHODS: We retrospectively analyzed thirty 99mTc-WBC scintigraphies with SPECT/CT performed in thirty patients with suspicion of vascular prosthesis infection. Studies were considered positive for graft infection if the intensity of activity involving the graft was greater than the liver or bone marrow activity (spine and pelvis). RESULTS: Final diagnosis of infection was established in 10 patients, based on Fitzgerald criteria. Scintigraphy was positive in 11 patients. No false negatives were obtained. The values of sensitivity and specificity were 100% and 95%, respectively, with a PPV of 91% and a NPV of 100%. Twenty five patients had a CT performed prior to scintigraphy, in 9 cases the result was positive and in the remaining 16 was negative. CT sensitivity and specificity obtained in our study were 62.5% and 76% respectively, with a PPV of 55.6% and a NPV of 81.3%. Diagnosis of infection led to prosthesis exeresis in 8 cases (all of them had a positive microbiological study of the extracted material), while the remaining 2 patients were treated with antibiotic therapy alone due to high surgical risk. CONCLUSION: Our results suggest a high accuracy for 99mTc-WBC scintigraphy with SPECT/CT in the assessment of clinically suspected arterial graft infection.

Mouse models for the study of postnatal cardiac hypertrophy.

The main objective of this study was to create a postnatal model for cardiac hypertrophy (CH), in order to explain the mechanisms that are present in childhood cardiac hypertrophy. Five days after implantation, intraperitoneal (IP) isoproterenol (ISO) was injected for 7 days to pregnant female mice. The fetuses were obtained at 15, 17 and 19 dpc from both groups, also newborns (NB), neonates (7-15 days) and young adults (6 weeks of age). Histopathological exams were done on the hearts. Immunohistochemistry and western blot demonstrated GATA4 and PCNA protein expression, qPCR real time the mRNA of adrenergic receptors (α-AR and ß-AR), alpha and beta myosins (α-MHC, ß-MHC) and GATA4. After the administration of ISO, there was no change in the number of offsprings. We observed significant structural changes in the size of the offspring hearts. Morphometric analysis revealed an increase in the size of the left ventricular wall and interventricular septum (IVS). Histopathological analysis demonstrated loss of cellular compaction and presence of left ventricular small fibrous foci after birth. Adrenergic receptors might be responsible for changing a physiological into a pathological hypertrophy. However GATA4 seemed to be the determining factor in the pathology. A new animal model was established for the study of pathologic CH in early postnatal stages.

Pancreatic and thyroid metastases detected with 18F-FDG PET/CT in patient with colorectal cancer.

A 53-year-old woman with diagnosis of colorectal cancer, who received surgical treatment and chemotherapy. After 5-years of complete remission, she showed an atypical oncological evolution. The utility of (18)F-FDG PET/CT scan has been fundamental to detect suspected and unsuspected recurrence and to monitor response to treatment.

[Experience with 123I-Iodobenzamide in the differential diagnosis of Parkinson's disease and Parkinson-plus disease]. / Experiencia con 123I-Iodobenzamida en el diagnóstico diferencial de enfermedad de Parkinson frente a Parkinson plus.

OBJECTIVE: To perform a descriptive analysis of the clinical and diagnostic implications of (123)I-IBZM SPECT in the patients studied in our center for movement disorders suggestive of Parkinson-Plus Disease (PP). SUBJECTS AND METHODS: (123)I-IBZM SPECT was performed in 46 patients referred from the movement disorders consultation due to suspicion of PP. According to their symptoms, they were distributed into 3 groups: 35 patients had atypical symptoms (AS) for Parkinson's Disease, 2 showed no response to standard therapy (NR) and 9 presented both factors (AS, NR). The results of SPECT were only assessed qualitatively. RESULTS: The (123)I-IBZM supported the diagnosis of PP in 15(42.9%) out of the 35 patients with AS. The (123)I-IBZM was pathological in one of the two NR patients. Regarding the third group of patients (AS+NR), the (123)I-IBZM was pathological in 6 cases (66.7%). In 95.7% of our sample (44 patients), AS with or without NR was the main factor leading to suspicion of PP and the (123)I-IBZM was altered in only 47.7% (22 patients). Of these 22 cases, the final diagnosis was PP (with high positive predictive value) in 20(91%). CONCLUSION: The study with (123)I-IBZM is useful in the clinical practice because it provides objective diagnostic information with implications for the treatment and prognosis of patients with suspicion of PP.