Elastografía tipo ARFI: modificación tras tratamiento antiviral en el trasplante hepático con recidiva por VHC / ARFI elastography: changes after direct-acting antiviral treatment in transplanted livers with relapse of hepatitis C virus infection

Objetivo. Evaluar la modificación de los valores en la elastografía hepática tipo ARFI tras el tratamiento antiviral en pacientes con trasplante hepático e infección por el virus de la hepatitis C (VHC) con recidiva durante el postrasplante. Material y métodos. Se han estudiado 15 pacientes receptores de trasplante hepático con infección por el VHC y recidiva sobre el injerto durante el primer año tras el trasplante que fueron tratados con antivirales de acción directa. A todos ellos se les realizó ecografía basal, Doppler y elastografía hepática tipo ARFI en los 3 meses anteriores al inicio del tratamiento y durante los 3 meses posteriores a su finalización. En la misma semana de la elastografía se realizó analítica con perfil hepático y determinación de la carga viral (ARN-VHC) en sangre periférica mediante técnica de reacción en cadena de la polimerasa. Se ha estudiado el cambio en las velocidades de cizallamiento de la elastografía antes y después del tratamiento. El análisis estadístico se ha efectuado mediante el test de Wilcoxon para datos apareados. Resultados. Todos los pacientes alcanzaron una respuesta viral mantenida a los 3 meses de finalizar el tratamiento. Se han encontrado diferencias estadísticamente significativas en las velocidades de la elastografía, con disminución de estas tras finalizar el tratamiento (la mediana de los valores de la onda de cizallamiento previos al tratamiento fue de 1,97m/s, y tras finalizarlo fue de 1,58m/s; p=0,001). Conclusión. La velocidad de la onda de cizallamiento disminuye de manera significativa tras el tratamiento antiviral en los pacientes receptores de trasplante hepático con recidiva de la infección por VHC (AU)

Objective. To evaluate the changes in the values obtained in acoustic radiation force impulse (ARFI) elastography of the liver after antiviral treatment in patients with liver transplants and hepatitis C virus (HVC) infection recurring after transplantation. Material and methods. We studied 15 patients infected with HVC who had received liver transplants where an HVC infection recurring in the graft within one year after the transplant was treated with direct-acting antivirals. All patients underwent ultrasonography including Doppler and ARFI elastography in the three months before starting treatment with direct-acting antivirals (baseline study) and again in the three months after finishing the treatment. In the same week when the elastography study was done, liver function tests were done and the viral load (HCV RNA) was determined in peripheral blood with the polymerase chain reaction method. We used the Wilcoxon test for paired samples to compare the changes in the shear wave velocities before and after treatment. Results. All patients achieved a virologic response that was sustained at 3 months after the end of treatment. On elastography, median shear wave velocities decreased after treatment (1.97m/s before treatment vs. 1.58m/s after treatment; p=0.001). Conclusion. The shear wave velocity decreased significantly after antiviral treatment in patients who had relapsed HVC infection after liver transplantation (AU)

Metabolismo del hierro: conceptos actuales sobre un micronutriente esencial / Iron metabolism: current concepts of an essential micronutrient

Iron is an essential micronutrient involved in multiple biochemical and physiological process. In this review we discuss the most relevant aspect of its metabolism in order to reach a better comprehension of the relevant roll that this micronutrient plays in human health.

Evaluation of different formulations to label exogenous natural surfactant labeled with (99m-Tc-ENS): stability and toxicity studies

El surfactante natural exógeno (ENS) marcado con 99mTc (99mTc-ENS) es un nuevo agente ventilatorio para la centellografía aérea pulmonar. Con el fin de elegir una formulación estable de ENS para ser marcado rutinariamente con 99mTc en Centros de Medicina Nuclear, las propiedades de dos formulaciones (ENS + cloruro estannoso + ácido gentísico y ENS + cloruro estannoso + ácido ascórbico) y una formulación control liofiolizada del ENS fueron analizadas mensualmente por un período de 12 meses. Sus propiedades fisicoquímicas, sus porcentajes de marcación y sus distribuciones biológicas fueron adecuadas durante este período. La formulación ENS + cloruro estannoso + ácido gentísico presenta la menor dispersión en los resultados de biodistribución, por lo cual esta formulación fue elegida para la futura producción de 99mTc-ENS. El estudio de toxicidad aguda de esta última formulación demostró que la dosis tóxica es al menos 1000 veces mayor que la dosis diagnóstica

El sistema surfactante pulmonar: fisiología, patologías asociadas a su alteración y administración exógena como agente terapéutico y de diagnóstico / The pulmonary surfactant system: physiology, associated pathologies the its alteration and exogenous administration as therapeutic and diagnostic agent

El surfactante pulmonar es una mezcla lipoproteica sintetizada y secretada por las células alveolares pulmonares tipo II. Su principal función es la disminución de la tensión superficial formando una monocapa en la superficie alveolar. Su deficiencia es el principal factor asociado al síndrome de dificultad respiratoria del recién nacido (RDS) y al síndrome de dificultad respiratoria del adulto (ARDS). Desde 1980 se está estudiando la administración exógena del surfactante pulmonar para el tratamiento de estos dos síndromes. En este trabajo se describen los surfactantes exógenos disponibles para uso clínico, las técnicas de administración y el esquema de dosificación. La utilización del surfactante natural exógeno (ENS) marcado con (99m)Tc((99m)Tc-ENS) para su utilización como radiofármaco en centellografía aérea pulmonar también es descripta en este trabajo.

Great particles (32P) chromic phosphate for treatment of solid tumors

With the purpose studying the effectivity of an intratumoral single dose of chromic [(32)P] phosphate with great particles for the treatment of solid tumors, studies of biolimination, biodistribution and therapeutic action were carried out. Only for comparative purpose, similar studies were undertaken using a solution of sodium [(32)P] orthophosphategelatine. The results show that when sodium [(32)P] orthophosphategelatine is used, the percentage of total elimination is (85.90+8,70) per cent with a higler percentage in urine (64.50+13.70) per cent than in faeces (21.40+4.50) per cent. In biodistribution studies, the greater percentage is found in bone (15.54+2.21) per cent while only a (2.51+0.39) per cent remains in the tumor. When great particles chromic [(32)P] phosphate was intratumorally injected, we determined that the total elimination is equal (36.28+6.27) per cent, finding a higler amount in faeces (29.44+5.26) per cent than in urine (6.84+2.21) per cent. Biodistribution studies demonstrated that (49.82+5.41) per cent remains in the tumor and (9.63+4.89) per cent of the injected activity is found in the liver. On the other hand, when therapeutic action was evoluted, we observed that the percentage of tumor regression (P.T.R) is 52.0 per cent for the tumors injected with chromic [(32)P] phosphate and 0.0 per cent for those injected with sodium [(32)P] orthophosphate-gelatine. These results show that the great particles colloid of chromic [(32)P] phosphate is not safe enough for the tratment of solid tumors, since it is mobilezed from the injection point, delivering a high dose to the whole organism. (AU)

El sistema surfactante pulmonar: fisiología, patologías asociadas a su alteración y administración exógena como agente terapéutico y de diagnóstico / The pulmonary surfactant system: physiology, associated pathologies the its alteration and exogenous administration as therapeutic and diagnostic agent

El surfactante pulmonar es una mezcla lipoproteica sintetizada y secretada por las células alveolares pulmonares tipo II. Su principal función es la disminución de la tensión superficial formando una monocapa en la superficie alveolar. Su deficiencia es el principal factor asociado al síndrome de dificultad respiratoria del recién nacido (RDS) y al síndrome de dificultad respiratoria del adulto (ARDS). Desde 1980 se está estudiando la administración exógena del surfactante pulmonar para el tratamiento de estos dos síndromes. En este trabajo se describen los surfactantes exógenos disponibles para uso clínico, las técnicas de administración y el esquema de dosificación. La utilización del surfactante natural exógeno (ENS) marcado con (99m)Tc((99m)Tc-ENS) para su utilización como radiofármaco en centellografía aérea pulmonar también es descripta en este trabajo. (AU)

Great particles (32P) chromic phosphate for treatment of solid tumors

With the purpose studying the effectivity of an intratumoral single dose of chromic [(32)P] phosphate with great particles for the treatment of solid tumors, studies of biolimination, biodistribution and therapeutic action were carried out. Only for comparative purpose, similar studies were undertaken using a solution of sodium [(32)P] orthophosphategelatine. The results show that when sodium [(32)P] orthophosphategelatine is used, the percentage of total elimination is (85.90+8,70) per cent with a higler percentage in urine (64.50+13.70) per cent than in faeces (21.40+4.50) per cent. In biodistribution studies, the greater percentage is found in bone (15.54+2.21) per cent while only a (2.51+0.39) per cent remains in the tumor. When great particles chromic [(32)P] phosphate was intratumorally injected, we determined that the total elimination is equal (36.28+6.27) per cent, finding a higler amount in faeces (29.44+5.26) per cent than in urine (6.84+2.21) per cent. Biodistribution studies demonstrated that (49.82+5.41) per cent remains in the tumor and (9.63+4.89) per cent of the injected activity is found in the liver. On the other hand, when therapeutic action was evoluted, we observed that the percentage of tumor regression (P.T.R) is 52.0 per cent for the tumors injected with chromic [(32)P] phosphate and 0.0 per cent for those injected with sodium [(32)P] orthophosphate-gelatine. These results show that the great particles colloid of chromic [(32)P] phosphate is not safe enough for the tratment of solid tumors, since it is mobilezed from the injection point, delivering a high dose to the whole organism.

Stable isotope techniques for the detection of Helicobacter pylori infection in clinical practice. 13C-urea breath test in different experimental conditions

The (13)C-UBT has been demonstrated to be a reliable method for the evaluation of Helicobacter pylori infection. The aim of our work is to determine the cut-off point of the (13)C-UBT for samples collected as gas or collected in a solution of triethanolamine. For this purpose, patients fasted for at least 6 hours were able to collect basal samples before the administration of 65 mg of (13)C-urea solution. Breath samples were taken 10,30 and 60 minutes after the administration of the labeled solution. All the samples were collected in gas collectors and in glass vials containing 1 ml of a 7 per cent triethanolamine solution. The cut-off points for gas collected samples were established in 4.0 per cent and for 10, 30 and 60 minutes samples, respectively, while for the samples, collected in triethanolamine solution, cut-off points were established in 5.0 per cent, for the 10 minutes samples, in 3.5 per cent for the 30 minutes samples and 4.7 per cent for the 60 minutes samples. We found that this test has a sensitivity of 100 per cent and a specificity of 100 per cent for H. pylori detection in both experimental conditions, when multiple breath samples are taken. If we considered only the 30 minutes time, sensitivity and specificity diminish for the gas collected samples. We conclude that the collection of breath samples in triethanolamine solution allows a better differentiation between H. pylori infected and non infected patients than gas collected samples.

Cinc: conceptos actuales sobre un micronutriente esencial / Cinc: conceptos on an essential micronutrient

Se ha postulado que el aporte de hierro a las células usuarias se halla bajo un control dependiente del tamaño de la fracción intracelular libre del metal, cuyos cambios se reflejarían en mensajes a la expresión de los receptores séricos o de membrana para ajustar la oferta a la demanda. La posibilidad de que los receptores de membrana pudieran estar afectados por la malnutrición calórico-proteica se exploró en estudios a través de los cambios de la capacidad de los reticulocitos circulantes de ratón normal para incorporar hierro in vitor, observando el diferente comportamiento ocasionado por la incubación de las células con suero humano de dadores normales y de pacientes de anemia nutricional. Los resultados muestran una significativa caída de dicha capacidad cuando se utilizó suero de pacientes afectados de anemia nutricional. Se discute el probable mecanismo responsable de dicha diferencia.

Intervención de ayuda en pacientes en duelo / Intervention to assist grieving patients

Objetivo. Principal: realizar una descripción de las características de los dolientes en una zona urbana. Secundarios: describir los factores de riesgo de duelo patológico y la distribución de duelos resueltos y tendentes a cronificarse. Diseño. Estudio descriptivo. Emplazamiento. Centro de Salud Txantrea (Pamplona).Pacientes. Muestreo consecutivo de todos los familiares de personas fallecidas entre enero y julio de 1999. En 4 unidades básicas de atención (UBA), se realiza un seguimiento protocolizado del duelo con 62 dolientes durante 8 meses. En las otras 8 UBA, los 21 dolientes captados han formado el grupo control. Intervención. Entrevista inicial con factores de riesgo de duelo patológico descritos en el PAPPS. Consultas periódicas basadas en la relación de ayuda. Entrevista final con test de ITRD (Texas Revised Inventory of Grief Manual) para determinar la evolución del duelo. Medición y resultados principales. Más de un 90 por ciento tenía algún factor de riesgo. Proporciones importantes con autopercepción de dificultad de superación de duelos anteriores. Más de un 50 por ciento no ha acudido ni siquiera a la mitad de las visitas, habiéndose relacionado con bajo nivel de ingresos (p < 0,005) y con antecedentes de depresión (p < 0,04). El bajo nivel de ingresos se relaciona con una peor evolución del duelo (p < 0,01). Altos porcentajes de duelos prolongados y retrasados, sin que se hayan observado diferencias entre el grupo de intervención y el grupo control. Conclusiones. Proporciones elevadas de dolientes con factores de riesgo. Altos porcentajes de falta de adhesión al programa propuesto. Elevado número de duelos prolongados y retrasados (AU)

Cinc: conceptos actuales sobre un micronutriente esencial. / [Zinc: concepts on an essential micronutrient]

It is now well known that zinc is an essential micronutrient. Even though much information is available, there are many points that remain to be studied. zinc is absorbed by the intestine and transported in the plasma by albumin, forming a small exchangeable pool, which is rapidly exhausted even in cases of mild deficiency. zinc is essential for the activity of about 70 enzymes among other functions. Therefore, zinc deficiency produces a great number of clinical disorders, the symptoms of which may range between mild up to serious dysfunctions. These problems are corrected by a dietary supplementation with zinc. The lack of a reliable method to determine the zinc nutritional status reflects the problem to estimate the metal recommended dietary allowances, which are difficulty met specially by children, old persons and pregnant women which constitute the main risk groups. Although our knowledge concerning zinc toxicity is scarce, it is well known that the amounts of zinc that produces toxic effects are much higher than those that are contained in regular diets as well as in diets supplemented with this metal. Therefore, the need of the development of effective strategies, like food fortification with proper zinc compounds, appears as an attractive alternative in order to prevent and/or correct the deficiency of this vital element and to improve the health and the life quality of the whole population.

Stable isotope techniques for the detection of Helicobacter pylori infection in clinical practice. 13C-Urea Breath Test in different experimental conditions.

The 13C-UBT has been demonstrated to be a reliable method for the evaluation of Helicobacter pylori infection. The aim of our work is to determine the cut-off point of the 13C-UBT for samples collected as gas or collected in a solution of triethanolamine. For this purpose, patients fasted for at least 6 hours were able to collect basal samples before the administration of 65 mg of 13C-urea solution. Breath samples were taken 10, 30 and 60 minutes after the administration of the labeled solution. All the samples were collected in gas collectors and in glass vials containing 1 ml of a 7

triethanolamine solution. The cut-off points for gas collected samples were established in 4.0/1000, 4.6/1000 and 4.4/1000 for 10, 30 and 60 minutes samples, respectively, while for the samples collected in triethanolamine solution, cut-off points were established in 5.0/1000, for the 10 minutes samples, in 3.5/1000 for the 30 minutes samples and 4.7/1000 for the 60 minutes samples. We found that this test has a sensitivity of 100

and a specificity of 100

for H. pylori detection in both experimental conditions, when multiple breath samples are taken. If we considered only the 30 minutes time, sensitivity and specificity diminish for the gas collected samples. We conclude that the collection of breath samples in triethanolamine solution allows a better differentiation between H. pylori infected and non infected patients than gas collected samples.

New methodology for pancreatic scintiscanning imaging using 125I-L-3 iodo-alpha-methyl tyrosine

The difficulty of a reliable diagnosis of pancreatic diseases by scintiscanning, is mainly derived from the lack of adequate radiopharmaceuticals. With this purpose (125) I-L(-3) Iodo-a-Methyl Tyrosine ((125) I-IMT) has been studied, which has also been used for the diagnosis of different kind of brain tumors. The purpose of this work is the development of a quick and easy method for the synthesis and purification of the (125) I-IMT in order to be used in a Nuclear Medicine Service. The L-(-Methly Tyrosine was labeled with (125) I using I-/I03 and afterwards purified by an aniomic exchange resin. The labeling yield obtained was (96.0+0.5) per cent when the incubation time was 15 minutes. No significant statistical differences were observed when the incubation time was extended to 1 hour. Biodistribution studies in mice show that the percentage of activity concentration in pancreas is (34.24+14.03) per cent at 15 minutes post injection, remaining constant for 30 minutes. The pancreas/liver ratio 15 minutes after the injection of the labeled product was (12.22+3.59) and it remained constant for 45 minutes more. These results show that (125) I-IMT cab be used as a diagnostic agent for pancreatic diseases. Since (123) I was not avilable at the moment, this new methodology was developed with (125) I. (AU)

Stable isotope techniques for the detection of Helicobacter pylori infection in clinical practice. 13C-urea breath test in different experimental conditions

The (13)C-UBT has been demonstrated to be a reliable method for the evaluation of Helicobacter pylori infection. The aim of our work is to determine the cut-off point of the (13)C-UBT for samples collected as gas or collected in a solution of triethanolamine. For this purpose, patients fasted for at least 6 hours were able to collect basal samples before the administration of 65 mg of (13)C-urea solution. Breath samples were taken 10,30 and 60 minutes after the administration of the labeled solution. All the samples were collected in gas collectors and in glass vials containing 1 ml of a 7 per cent triethanolamine solution. The cut-off points for gas collected samples were established in 4.0 per cent and for 10, 30 and 60 minutes samples, respectively, while for the samples, collected in triethanolamine solution, cut-off points were established in 5.0 per cent, for the 10 minutes samples, in 3.5 per cent for the 30 minutes samples and 4.7 per cent for the 60 minutes samples. We found that this test has a sensitivity of 100 per cent and a specificity of 100 per cent for H. pylori detection in both experimental conditions, when multiple breath samples are taken. If we considered only the 30 minutes time, sensitivity and specificity diminish for the gas collected samples. We conclude that the collection of breath samples in triethanolamine solution allows a better differentiation between H. pylori infected and non infected patients than gas collected samples. (AU)

Cinc: conceptos actuales sobre un micronutriente esencial / Cinc: conceptos on an essential micronutrient

Se ha postulado que el aporte de hierro a las células usuarias se halla bajo un control dependiente del tamaño de la fracción intracelular libre del metal, cuyos cambios se reflejarían en mensajes a la expresión de los receptores séricos o de membrana para ajustar la oferta a la demanda. La posibilidad de que los receptores de membrana pudieran estar afectados por la malnutrición calórico-proteica se exploró en estudios a través de los cambios de la capacidad de los reticulocitos circulantes de ratón normal para incorporar hierro in vitor, observando el diferente comportamiento ocasionado por la incubación de las células con suero humano de dadores normales y de pacientes de anemia nutricional. Los resultados muestran una significativa caída de dicha capacidad cuando se utilizó suero de pacientes afectados de anemia nutricional. Se discute el probable mecanismo responsable de dicha diferencia. (AU)

New methodology for pancreatic scintiscanning imaging using 125I-L-3 iodo-alpha-methyl tyrosine

The difficulty of a reliable diagnosis of pancreatic diseases by scintiscanning, is mainly derived from the lack of adequate radiopharmaceuticals. With this purpose (125) I-L(-3) Iodo-a-Methyl Tyrosine ((125) I-IMT) has been studied, which has also been used for the diagnosis of different kind of brain tumors. The purpose of this work is the development of a quick and easy method for the synthesis and purification of the (125) I-IMT in order to be used in a Nuclear Medicine Service. The L-(-Methly Tyrosine was labeled with (125) I using I-/I03 and afterwards purified by an aniomic exchange resin. The labeling yield obtained was (96.0+0.5) per cent when the incubation time was 15 minutes. No significant statistical differences were observed when the incubation time was extended to 1 hour. Biodistribution studies in mice show that the percentage of activity concentration in pancreas is (34.24+14.03) per cent at 15 minutes post injection, remaining constant for 30 minutes. The pancreas/liver ratio 15 minutes after the injection of the labeled product was (12.22+3.59) and it remained constant for 45 minutes more. These results show that (125) I-IMT cab be used as a diagnostic agent for pancreatic diseases. Since (123) I was not avilable at the moment, this new methodology was developed with (125) I.