Clinical risk management in High-Security Forensic Psychiatry Residences. Protecting patients and health professionals: perspectives and critical issues of the Law 81/2014.

The Italian Law n. 9/2012 provided the Italian Regions with a new decisional role by demanding the management/rehabilitation of prisoners judged as partially/fully mentally ill to care and protection delivered by the psychiatric services of the Regional Health Service. Healthcare has to be guaranteed by the so-called High-Security Forensic Psychiatry Residences (Italian: Residenze per l'Esecuzione delle Misure di Sicurezza: REMS) and by community mental health centres. Ensuring patients' and professionals' health and safety is a complex issue which requires effective strategies to cope with several structural, technological, and organisational problems. The present paper summarises the historical evolution of the Italian laws towards the development of the High-Security Forensic Psychiatry Residences in Italy, focusing specifically on the Tuscany Region situation. The paper also presents the key issues emerging after the implementation of the Law 81/2014 which complemented the Law 9/2012. Since these reforms included the need for assessing to what extent the patient may be considered as a danger to society and for ensuring the safety of National Health Service (NHS) professionals, they underscored the importance of a preventive use of specific clinical governance tools aimed to reduce risk of adverse events. The present work has the strength of proposing a new, evidence-based scientific approach to the implementation of assessment and care pathways in High-Security Forensic Psychiatry Residences.

The Hannes hand prosthesis replicates the key biological properties of the human hand.

Replacing the human hand with artificial devices of equal capability and effectiveness is a long-standing challenge. Even the most advanced hand prostheses, which have several active degrees of freedom controlled by the electrical signals of the stump's residual muscles, do not achieve the complexity, dexterity, and adaptability of the human hand. Thus, prosthesis abandonment rate remains high due to poor embodiment. Here, we report a prosthetic hand called Hannes that incorporates key biomimetic properties that make this prosthesis uniquely similar to a human hand. By means of an holistic design approach and through extensive codevelopment work involving researchers, patients, orthopaedists, and industrial designers, our proposed device simultaneously achieves accurate anthropomorphism, biomimetic performance, and human-like grasping behavior that outperform what is required in the execution of activities of daily living (ADLs). To evaluate the effectiveness and usability of Hannes, pilot trials on amputees were performed. Tests and questionnaires were used before and after a period of about 2 weeks, in which amputees could autonomously use Hannes domestically to perform ADLs. Last, experiments were conducted to validate Hannes's high performance and the human likeness of its grasping behavior. Although Hannes's speed is still lower than that achieved by the human hand, our experiments showed improved performance compared with existing research or commercial devices.

Feline Leukaemia Virus Associated with Leukaemia in Cats in Santa Catarina, Brazil.

Leukaemia is a haemopoietic neoplasm originating from myeloid or lymphoid precursors in the bone marrow and may be either acute or chronic. These tumours are rare, but occur more frequently in cats because of an association with the feline leukaemia virus (FeLV) and feline immunodeficiency virus (FIV). To the best of our knowledge, no studies conducted in Brazil to date have analysed the association between leukaemia and FeLV and FIV infection in cats. The aim of this study was to perform a histopathological analysis of feline leukaemia and evaluate the association between leukaemia and FeLV and FIV infection in cats. The study evaluated 37 cats with leukaemia diagnosed between 2009 and 2017. The animals underwent necropsy examination, histopathology and immunohistochemistry with anti-FeLV gp70 and anti-FIV p24 gag antibodies. Of the evaluated animals, 54% (20/37) were males and 43.2% (16/37) were females. With respect to the life stage of the animals, 24.3% (9/37) were junior, 32.4% (12/37) were prime, 18.9% (7/37) were mature and 10.8% (4/37) were senior, and five animals were of unknown age. Myeloid leukaemia occurred in 56.8% (21/37) of the cases and lymphocytic leukaemia occurred in 43.2% (16/37) of the cases. Acute leukaemia (73%, 27/37) was more common than chronic leukaemia (27%, 10/37). The positivity for FeLV (78.4%, 29/37) and FIV (16.2%, 6/37) indicated a high association between FeLV infection and tumour development in the study region.

Feline Lymphoma and a High Correlation with Feline Leukaemia Virus Infection in Brazil.

Lymphoma is the most important haemopoietic tumour in cats and has been associated with feline leukaemia virus (FeLV) infection. In Brazil, no studies have established a correlation between FeLV infection and lymphoma. The aim of this study was to characterize lymphomas arising in cats in Brazil anatomically and microscopically, and to correlate these data with FeLV infection as determined by immunohistochemistry for the FeLV gp70 antigen. Fifty-three cats with lymphoma were evaluated. The mean age of junior, prime, mature, senior and geriatric cats was 1.65 years, 4.34 years, 8 years, 12.14 years and 15.5 years, respectively. The anatomical types of lymphoma were multicentric (43.4%, 23/53), mediastinal (33.96%, 18/53), renal (11.32%, 6/53), hepatic (5.66%, 3/53), nodal (3.77%, 2/53) and alimentary (1.89 %, 1/53). The histological types were small noncleaved-cell (33.96%, 18/53), mixed diffuse (22.64%, 12/53), immunoblastic (15.11%, 8/53), lymphoblastic (11, 32%, 6/53), small lymphocytic (9.43%, 5/53), small cleaved-cell (3.77%, 2/53) and large cell lymphomas (3.77%, 2/3). Immunopositivity for FeLV was observed in 56.6% (30/53) of the samples. FeLV positivity was equally distributed between the genders, but predominated in junior and prime cats. The degree of association between lymphoma and FeLV infection in Brazil was higher than that found in other countries, demonstrating the need to prevent and control the factors associated with infection.

Idiopathic seasonal alopecia in horse: case report / Alopecia sazonal idiopática em equino: relato de caso

This report describes the first case of idiopathic seasonal alopecia in a horse in Brazil. The disease is of unknown etiology, characterized by alopecic processes in the thoracic and lateral abdominal regions, in a bilaterally symmetrical way. An eight-year-old male grade horse was treated presenting hair loss in a bilaterally symmetrical manner in the arm and abdomen areas, without any other associated clinical signs. The areas with alopecia showed no pruritus, inflammation or scaling. On the epidermis, the histological evaluation presented irregular hyperplasia, hyperpigmentation, compact orthokeratosis, edema and an inflammatory infiltrate. The hair follicles were active and containing hair shaft. The case was monitored with photographic records for two consecutive years (2012 to 2014), in which the hair fall occurred at the end of autumn with spontaneous hair growth in the middle of the summer. The diagnosis was based on the history, histopathology and photographic follow-up performed. Although mentioned in the literature, this is the first clinical and pathological description of such disorder affecting an equine in Brazil.(AU)

Relata-se o primeiro caso de alopecia sazonal idiopática em um equino no Brasil, doença de etiologia desconhecida, caracterizada por processos alopécicos, nas regiões torácicas e abdominais laterais, de forma simétrica bilateralmente. Um equino mestiço, macho, de oito anos de idade, foi atendido sob queixa de perda dos pelos em regiões do tórax e do abdômen, simétrica bilateralmente, sem qualquer outro sinal clínico associado. As regiões alopécicas não apresentavam prurido, inflamação nem descamação. A avaliação histológica revelou, na epiderme, hiperplasia irregular, hiperpigmentação e ortoqueratose compacta, edema e infiltrado inflamatório. Os folículos pilosos estavam ativos e contendo hastes de pelos. O caso foi acompanhado com registros fotográficos durante dois anos consecutivos (2012 a 2014), com a queda do pelo acontecendo no final do outono e com retorno espontâneo em meados do verão. O diagnóstico baseou-se no histórico, na histopatologia e no acompanhamento fotográfico. Mesmo sendo mencionada na literatura, esta é a primeira descrição clínico-patológica de tal distúrbio acometendo um equino no Brasil.(AU)

Neuronal growth and the Steiner problem.

In this paper we conjecture that neuronal networks develop following an optimality principle. We point out that a neuronal outgrowth in culture may be seen as the solution of a classical optimization problem: the "Steiner Problem". A neuron might grow minimizing a "cost", which may be determined by the viscoelastic properties of the neuron cytoplasm. We then discuss the role of chemiotactic factors such as the Nerve Growth Factor (NGF) in an optimized neuronal development in vivo. Finally we suggest, with some mathematical arguments, that the optimization of the elastic forces in the growing neuron may give rise to a "fractal" structure.

Proteins, nucleic acids and genetic codes.

On the basis of the previous article (Morchio and Traverso [1999]), we discuss the possible interactions between the first proteic fragments developed in the hydrophobic layer made of hydrocarbons, which would have covered the surface of the primitive seas, and the nitrogenous bases, particularly the pyrimidinic ones, which would have found in such hydrophobic layer favourable conditions to their prebiotic synthesis. These interactions would have presumably brought, on the basis of the physicochemical laws, at the moment the only ones at work, to the linkage of various bases and so to the construction of the first nucleic acid chains (most likely RNA). Interestingly enough this result would have been obtained by inserting two more bases between those hydrogen bound to the amino acids and this might have been the ground for the future "triplets". These interactions might have been particularly significant because of two important consequences: the birth of a rough genetic code and the starting of interactions of the co-operative type between bases and amino acids that would have made the growth of both proteic and nucleic acid fragments easier and faster. We conclude that the development of the genetic code was neither a "frozen accident" nor an occurrence directed by any information flow.

Performance reprodutiva de leitoas submetidas à inseminação artificial pós-cervical / Reproductive performance of gilts submitted to post-cervical artificial insemination

O objetivo deste trabalho foi avaliar o desempenho reprodutivo de nulíparas submetidas à inseminação artificial pós-cervical (IAPC) comparada à inseminação artificial tradicional (IAT). Foram avaliados ocorrência de sangramento, ocorrência de refluxo, dificuldade no transpasse da cérvix e total de células refluídas até 30 minutos após inseminação. Fêmeas submetidas à IAPC (n=279) foram inseminadas com doses de 1,5 x 109 diluídas em 45mL, e fêmeas submetidas à IAT (n=273) inseminadas com doses de 2,5 x 109 em 80mL. O transpasse da cérvix foi possível em 91,04% (254/279) das leitoas. A dificuldade no transpasse foi de 41,58% (116/279), não comprometendo o desempenho reprodutivo (P>0,05). Presença de sangramento não afetou a taxa de parto nem o número de leitões nascidos para ambos os tratamentos (P>0,05). O percentual de espermatozoides presentes no refluxo foi maior na IAT, não sendo observada diferença no tamanho de leitegada de acordo com o percentual de espermatozoides no refluxo (P>0,05) e no número de leitões nascidos totais (11,63 e 11,81) entre os tratamentos IAT e IAPC, respectivamente. Pode-se realizar IAPC em leitoas sem causar redução no desempenho, utilizando-se doses com 1,5 x 109 células espermáticas.(AU)

The objective of this study was to evaluate the reproductive performance of gilts subjected to post-cervical artificial insemination (PCAI) compared to traditional artificial insemination (TAI). We also evaluated the degree of difficulty in bypassing the cervix, time required to perform the insemination, presence of bleeding after insemination, semen backflow, as well as the volume and the total reflow cells 30 minutes after insemination. Gilts submitted to PCAI (n = 279) were inseminated with 45 mL doses of 1.5 x 109 sperm cells and the ones submitted to TAI (n = 273) were inseminated with 80 mL doses with 2.5 x 109 cells. The bypassing of the cervix was possible in 91.04% (254/279) of gilts. The difficulty bypassing the cervix in at least one of the gilt's PCAI procedures happened with 41.58% (116/279) of the females, but it did not affect reproductive performance (P>0.05). The presence of bleeding after insemination did not affect the farrowing rate and total number of piglets born for both treatments (P>0.05). The average time needed to carry out the PCAI was 1.47 minutes and the TAI was 4.04 minutes. The percentage of sperm present in the reflux was higher in TAI than the PCAI, but no correlation was found between litter size and the percentage of sperm in reflux (P>0.05) and the total number of piglets born (11.63 and 11.81) between TAI and PCAI treatments, respectively. Thus, it is possible to perform the post-cervical artificial insemination in gilts without causing a reduction in reproductive performance, using doses with a concentration of 1.5 x 109 sperm cells.(AU)

Análise produtiva e econômica de suínos criados nos sistemas wean-to-finish e convencional de produção / Productive and economic analysis of pigs raised in wean-to-finish and conventional production systems

O modelo de produção de suínos denominado Wean-to-Finish (WF) é considerado uma alternativa que busca alcançar melhor desempenho produtivo, redução de estresse aos animais e melhorias na logística. Nesse sistema, os leitões são desmamados e transferidos diretamente a um galpão WF (creche-crescimento-terminação), onde permanecem até o abate. Com o objetivo de avaliar os comportamentos produtivo e econômico de suínos alojados no sistema WF em comparação ao sistema convencional de produção (CC), foram avaliados dois grupos de suínos provenientes das mesmas unidades produtoras de leitões, nascidos e desmamados na mesma semana. Um grupo foi alojado em uma creche do sistema convencional de produção (grupo CC), e o outro em um galpão WF adaptado (grupo WF), ambos em baias coletivas. Para análise de produção, foram calculados o consumo médio diário de ração (CMDR), o ganho de peso médio diário (GPMD) e a conversão alimentar (CA). Para análise econômica, foi determinado o custo por quilograma de ganho de peso vivo. Os dados foram submetidos à análise de variância utilizando-se o pacote estatístico SAS, previamente testados para normalidade dos resíduos pelo teste de Shapiro-Wilk, e as médias dos grupos comparadas pelo teste de Tukey (5%). Na fase de creche, o GPMD foi de 0,468 e 0,449, e a CA de 1,48 e 1,42 para os Grupos WF e CC, respectivamente. Nas fases de crescimento e terminação, o GPMD foi de 0,924kg no grupo WF e de 0,909kg no grupo CC. A conversão alimentar foi de 2,41 para ambos os grupos, não sendo diferentes estatisticamente entre si (P>0,05) nas diferentes fases de produção nos parâmetros analisados. No aspecto econômico, o grupo WF apresentou os menores custos, com diferença de R$ 0,08 por quilograma de ganho de peso vivo em comparação ao grupo CC. Os resultados do desempenho produtivo associado ao aspecto econômico indicam que o sistema WF pode ser uma alternativa viável dentro da cadeia produtiva de suínos.

The pig production model called "Wean-to-Finish" (WF) is considered an alternative to better productive performance, reducing stress to the animals and improvements in logistics. In this system, the piglets are weaned and transferred directly to a WF shed (nursery-grower-finisher), where they remain until slaughter. Aiming to evaluate the productive and economic behavior of pigs housed in the WF system compared to conventional production system (CC), two groups of pigs from the same sow farm, born and weaned in the same week were evaluated. One group was housed in a conventional nursery production system (CC group) and the other in a WF shed adapted (WF group), both in collective pens. For analysis of the average production, average daily feed intake (ADFI), average daily weight gain (ADWG) and feed conversion ratio (FCR) were calculated. For economic analysis the cost per kilogram of live weight gain was determined. Data were subjected to analysis of variance using the SAS statistical package, previously tested for normality of the residuals using the Shapiro-Wilk test, and the means of groups were compared by the Tukey test (5 %). In the nursery phase ADWG was 0.468 and 0.449, and the FCR was 1.48 and 1.42 for the WF and CC groups respectively. During the growing and finishing ADWG was 0.924kg in the WF group and 0.909 in the CC group. The FCR was 2.41 for both groups, not being statistically different from each other (P>0.05) at different stages of production in the analyzed parameters. In the economic aspect, the WF group had the lowest costs, with a difference of R$ 0.08 per kilogram of live weight gain compared to the CC group. The results of productive performance associated with the economic aspect indicate that the WF system can be a viable alternative in the pig production chain.

Spontaneous lysosomal storage disease caused by Sida carpinifolia (Malvaceae) poisoning in cattle.

Clinical and pathologic findings for the spontaneous poisoning by Sida carpinifolia in cattle are described in this study. A survey on field cases of S. carpinifolia in cattle was carried out on farms of Alto Vale do Itajaí, State of Santa Catarina, southern Brazil. Sixteen affected animals were clinically evaluated and 9 were subjected to postmortem examination. The main clinical signs consisted of marching gait, alert gaze, head tremors, and poor growth. Histologic and ultrastructural lesions consisted of vacuolization and distension of neuronal perikarya, mainly from Purkinje cells, and of the cytoplasm of acinar pancreatic and thyroid follicular cells. Clinical signs and lesions varied from mild to severe. Improvement of the clinical signs was observed in cattle after a period of up to 90 days without consuming the plant; however, residual lesions, mainly characterized by axonal spheroids and absence of Purkinje neurons in some areas of the cerebellum, were observed in these cases. It is concluded that the natural chronic consumption of S. carpinifolia was the etiologic cause of storage disease in cattle in this study.

Ablación con 131I en pacientes con carcinoma papilífero de bajo riesgo: comparación de tres métodos de preparación del paciente a través de control evolutivo / Radioiodine Ablation in Patients with Low Risk Papillary Thyroid Carcinoma. Comparison of Three Methods to Prepare the Patient. Evolution of Illness in Follow-Up

Antecedentes: El tratamiento habitual del carcinoma diferenciado de tiroides es tiroidectomía seguida de ablación con radioiodo(1-16). En los últimos años el empleo de ablación en casos de carcinoma papilar de tiroides considerados de bajo riesgo (CPT-BR) está en controversia(17,18). Objetivo: a) determinar que el método de estímulo de TSH con TRH (TRH-ST) es adecuado para obtener ablación. Material y métodos: Se efectuó ablación en 117 pacientes considerados CPT-BR empleando 3 métodos. G-I: en 34 pacientes se empleó el método TRH-St comenzando el día 8 después de cirugía y administrado el 131I el día 13. G-II en 54 pacientes se utilizó el método “gold standard”, retrasando el inicio del tratamiento con hormona tiroidea por 4-5 semanas y llevando al paciente al hipotiroidismo. G-III, En 29 pacientes se utilizó rhTSH. Los pacientes fueron seguidos durante 1,5 a 6,2 años (promedio 3,6 años) considerándolos de acuerdo a resultados como libres de enfermedad (LE) o con recidiva o metástasis (RoM). Resultados: G-I: TSH 109 ± 106 mU/L , rango 35-360, Tg 7,9 ± 6,1;, RoM 3,23% . G-II: TSH 82 ± 87 mU/L. rango 31-220, Tg 5,8 ± 6,9 ng/mL; RoM 4 %; G.III: TSH 138 ± 32 mU/L, rango 82-280; Tg 3,9 ± 2,2 ng/mL RoM 4 %. No se apreciaron diferencias en los resultados del seguimiento de los pacientes, con controles de centellografía corporal total y Tg bajo TSH estimulada a los 6 meses, 1 y 2 años y posteriormente ante hallazgos LE con ecografía de cuello, RMN de cuello y mediastino y TC de tórax sin contraste periódicamente. Los valores de TSH del G-III fueron estadísticamente superiores a los de los otros dos grupos (p< 0,05) y los del G-I superiores a los del G-II. Discusión: No existieron diferencias significativas en el seguimiento de los pacientes con los 3 métodos empleados, por lo cual el método TRH-ST es apto para estimular TSH preablación, retardando en caso de ablación, el inicio del tratamiento hormonal solo 2 semanas. La observación del hallazgo total de 3,74 % de pacientes incorrectamente considerados como de bajo riesgo es similar a la referida por Tuttle y col.(19) y lleva a considerar que los requisitos para incluir a un paciente como de BR son incompletos. La no ablación incrementa la posibilidad de recidivas y metástasis a lo largo de la evolución de la afección. Este hecho modifica la calidad de vida física y sicológica de los pacientes, así como la relación costo-beneficio del cuidado de su salud. Por estas razones consideramos que mientras no se modifiquen las pautas para considerar a un paciente como de bajo riesgo, la ablación debe realizarse modificando las actividad de radioiodo utilizada a ese efecto. Conclusión: hemos alcanzado nuestro objetivo.

Background: Almost total thyroidectomy and ablation (A) are the primary treatment of differentiated thyroid carcinoma(1-16). In recent years the use of ablation in low risk papillary thyroid carcinoma (LR-PTC) has become controversial(17,18). Objectives: a) to confirm that the method of TRH-TSH stimulation -TRH-ST(15,16) is adequate to increase serum TSH in a short time. Material and Methods: Ablation was carried out in 117 patients with LR-PTC. In 34 patients (G-I) TRH-St method was utilized starting on day 8 after surgery with TRH stimulation on days 8, 10, 12 and 13 and applying ablation on day 13. In 54 patients (G-II) ablation was performed by delaying the onset of thyroid hormone treatment for 4-5 weeks, leading the patient to hypothyroidism. In the remaining 29 patients (G-III) rhTSH was utilized to increase TSH. Patients were followed up for 1.5 to 6.2 years (mean 3.6 years) and were classified according to the results observed during follow-up as free of disease (Fof D) or with relapse or metastasis (RorM). Results: G-I: TSH 109±106 mU/L (range 35-360); Tg 7.9 ± 6.1 ng/mL; RorM 3.23 %. G-II: TSH 82 ± 76 mU/L, range 31-220; Tg 5.8 ± 6.9 ng/mL; RorM 4 % .G-III: TSH 138 ± 32 mU/L. range 82-240, Tg 3.9 ± 2.2 ng/mL, RorM 4 %. The Tg values were those found under stimulated TSH previous ablation. No statistically significant differences were found in follow-up, TSH values were higher in G-III, p<005. Discussion: similar results were observed with the 3 methods used. TRH-ST is adequate to obtain ablation with a very short time of thyroid hormone withdrawal after surgery. At follow-up, 3.74 % of patients were erroneously incorporated to the group of LR, in agreement with the results presented by Tutttle et al(19). In patients with no radioiodine ablation the cases with relapses or metastasis increased with time and the incidence was estimated at more than 15 % according to Mazzaferri et al(5, 6) and our own experience. We considered that in patients with LR-PTC ablation is very important not only according to physical and psychological reasons but also for the cost-benefit ratio in the patient’s health care. For these reasons, we believe that as long as the criteria to consider a patient as low risk are not changed, thyroid ablation should be performed by modifying the radioiodine activity used for that purpose. Conclusion: Our objective has been accomplished.

Experimental Trema micrantha (Ulmaceae) poisoning in rabbits.

Nine rabbits presented signs of neurological disturbance and died after experimentally fed fresh leaves of Trema micrantha. At a rate of 35 g/kg bw, the plant proved toxic to rabbits. Clinical features and macroscopic lesions were similar to those described in Trema tomentosa poisoning. Main histological findings were degenerative and necrotic lesions affecting liver and the central nervous system.

Multiple pathways of Pb(2+) permeation in rat cerebellar granule neurones.

The pathways of lead (Pb(2+)) uptake were studied in fura-2-loaded cerebellar granule cells from 8-day-old rats. In a nominal Ca-free external bath, Pb(2+) (5-50 microM) determined an increase of the fluorescence emission ratio (R = E(340)/E(380)) even in the absence of any specific stimulus. This rise was dose-dependent, was not significantly affected by mM Mg(2+) or Ca(2+), but it was readily reversed by the membrane-permeant heavy metal chelator tetrakis(2-pyridylmethyl) ethylene-diamine (TPEN, 100 microM), indicating that it was due to Pb(2+) influx. The rate of rise, dR/dt, was increased up to a factor of 5 by depolarizing high-KCl solution, indicating a sizeable permeation through voltage-dependent channels. This effect was neither antagonized by nimodipine, nor enhanced by BayK8644, but it was slackened by omega-agatoxin IVA (200 nM), suggesting an involvement of non-L-type calcium channels. Pb(2+) influx was also stimulated by glutamic acid or NMDA in the presence of 10-30 microM glycine, but only in Mg-free solution, suggesting that glutamate channels of the NMDA type are an additional pathway of Pb(2+) uptake. Pb(2+) caused a time-, dose- and stimulus-dependent saturation of the dye, whose intracellular concentration is approximately 10 microM, indicating that intracellular Pb(2+) can readily reach a concentration in the micromolar range. These results indicate that the particular vulnerability of neurones to Pb(2+) poisoning is linked to the presence of specific transport systems, which mediate the rapid uptake of Pb(2+) into the neurone.

Lead poisoning in cattle in southern Brazil

Em setembro de 2000, três novilhas, provenientes de um pequeno rebanho de bovinos de corte, apresentaram severa depressão, tremores musculares, ato de pressionar a cabeça contra objetos e de ranger de dentes, intensa salivação, cegueira e morte. Envenenamento por chumbo foi diagnosticado com base nos sinais clínicos e em função da presença de grandes concentrações de chumbo nos rins e no fígado de um dos animais afetados. Latas de tinta velhas, presentes no potreiro onde estavam os animais e cujo conteúdo extravasava através de fendas provocadas pela ferrugem, foram identificadas como a fonte de chumbo que causou a toxicose nos animais.

Valoración indirecta de la integridad de la membrana celular mediante la redistribución de veinticuatro horas y reinyección de talio 201 para el diagnóstico de viabilidad miocárdica: análisis de costo beneficio y correlación con el vaso afectado / Indirect assessment of membrane integrity with thallium 201 24 hs redistribution and reinjection for diagnosis of myocardial viability: cost-benefit analysis and correlation with the damaged vessel

La perfusión miocárdica con talio 201 ha demostrado ser de gran utilidad en la evaluación de pacientes con enfermedad coronaria. Se ha desarrollado un nuevo campo para tratar de establecer la existencia de territorios con alteraciones de la función contráctil secundarias a coronariopatía, con capacidad de recuperarse cuando son revascularizados ("viabilidad miocárdica"). El objetivo de este estudio es evaluar la información que aporta la reinyección de 1mCi de talio 201 sobre la redistribución de 24 horas para el diagnóstico de segmentos miocárdicos viables. Se incluyeron 25 pacientes con antecedentes de infarto. A todos se les realizó perfusión miocárdica con talio 201, adquiriéndose imágenes planares en el posesfuerzo, a las 4 y 24 horas y a los 15 minutos de la reinyección. La coronariografía mostró: 15 obstrucciones significativas de la arteria descendente anterior, 14 de la coronaria derecha y 7 de la circunfleja. Para el puntaje de extensión hubo diferencias significativas para la redistribución de 24 horas (p<0,002) y la reinyección (p<0,0001) con respecto a la redistribución a las 4 horas. De los 82 segmentos con hipoperfusión en las imágenes de esfuerzo, 25 (30,49 po ciento) mejoraron en la redistribución a las 4 horas, 30 (36,58 por ciento) en la redistribución a las 24 horas y 47 (57,32 por ciento) en la reinyección