[99mTc-MAA peritoneal scintigraphy in pleuroperitoneal comunication in peritoneal dialysis patients]. / Gammagrafía peritoneal con 99mTc-MAA en las comunicaciones pleuroperitoneales en pacientes en diálisis peritoneal.

Peritoneal dialysis is a fully-contrasted alternative for the treatment of end-stage renal disease although it is not exempt of complications. Peritonitis and exit-site infections are among the most frequent complications found. Pleural effusion secondary to pleuroperitoneal communication (PPC) is a serious and uncommon complication in these patients. We present the case of a 50-year old man diagnosed of end-stage renal disease undergoing treatment with peritoneal dialysis who presented progressive dyspnea and right pleural effusion. The peritoneal scintigraphy with (99m)Tc-MAA makes it possible to confirm communication of intraperitoneal dialysis fluid to the pleural cavity.

[Utility of myocardial perfusion SPECT for evaluation of patients from Chest Pain Unit]. / Análisis y utilidad de la tomografía de emisión de fotón único de perfusión miocárdica en la evaluación de pacientes de la Unidad de dolor torácico.

UNLABELLED: The Chest Pain Units (CPU) are currently the best solution to improve management of patients with acute chest pain in the Emergency Room thanks to the use of reliable ischemia diagnostic detection tests and early treatment. OBJECTIVE: To assess the value of myocardial perfusion SPECT (MPS) in the CPU in order to treat acute coronary syndromes (ACS) early and discharge patients with low risk of coronary artery disease (CAD) who can be treated as outpatients. MATERIAL AND METHODS: We studied 629 patients from January 2003 to September 2005 with acute chest pain suggestive of angina, normal cardiac enzymes and normal or non-diagnostic ECG who had been referred to Nuclear Medicine for evaluation with a stress test for ischemia: 32 p treadmill stress testing and 597 p MPS (525 p exercise-rest and 72 p pharmacologic stress test). We compared the results with catheterization and clinical follow up for a 6-months period, evaluating new coronary events. RESULTS: 76 % of MPS were normal and 24 % pathological. Only 1.5 % of the patients with normal MPS had CAD or coronary events in the follow-up, increasing to 35.2 % in patients with ischemia. A total of 45 catheterizations were performed, showing CAD 27 (24 with pathological MPS). A total of 2.6 % of the patients had coronary events during follow-up, 75 % of whom had pathological MPS. CONCLUSION: The MPS improves diagnosis of ACS in the CPU, with a very low number of new coronary events at 6 months of the follow-up and permits safe discharge of these patients.

[Iatrogenic lung microembolism detected by 18FDG PET/CT]. / Microembolia pulmonar iatrogénica detectada mediante 18F-FDG PET/TC.

We present the cases of two oncology patients: a male with Hodgkin's disease after completion of chemotherapy, and a woman recently diagnosed of melanoma, who underwent positron emission tomography/computed tomography (PET/CT) with 18F-FDG for therapeutic monitoring and initial staging, respectively. In both cases, hypermetabolic foci of 18F-FDG in lung parenchyma were found, without morphologic abnormalities in CT. These findings would have been consistent with lung pathology in the absence of any anatomic correlation. Combined PET/CT interpretation was of lung microembolisms probably originated at the injection site.

[Follow-up of children and young adults with differentiated thyroid cancer treated with radioiodine]. / Seguimiento de niños y jóvenes adultos con cáncer diferenciado de tiroides (CDT) tratados con radioyodo.

This is a retrospective study carried out in a group of 30 patients with differentiated thyroid cancer (age at diagnosis equal to or less than twenty years old). The aim of the study is to evaluate outcome after 131I therapy. Patients were classified into three groups on the basis of initial surgery, pathology and scintigraphic results: group I (thyroid extent), group II (locoregional extent), and group III (distant metastatic disease). Clinical parameters, 131I scans, serum thyroglobulin determinations and 131I therapeutic administered doses were evaluated in the follow-up. Some other complementary techniques such as chest X-ray and pulmonary function tests are also described. Scintigraphic absence of thyroid tissue has been observed in 83% of the cases; high thyroglobulin level is still detectable in 34% of the patients as a single evidence of disease, and 21% remain without any abnormal clinical, scintigraphic or analytical findings. Total doses administered have increased in groups I, II and III respectively, and have also been inversely proportional to the extension of lymph node surgery. At present, all the patients are alive and in good general condition. According to the results obtained, we conclude that children and young adults with DTC should undergo periodical 131I therapeutic doses in case of positive scans (once total thyroidectomy has been realized, with or without lymph node resection depending on the extension of disease). In our experience, the use of radioiodine is effective and safe in the follow-up of children and youngs with DTC.

[Diuresis renography in the postoperative course of pyeloureteral stenosis]. / El renograma diurético en la evolución postoperatoria de la estenosis pieloureteral.

Ureteropelvic junction (UPJ) obstruction constitutes the most common form of upper urinary tract obstruction in children. We study the role of diuretic renography and its correlation with other diagnostic methods for postoperative evaluation of this malformation. We reviewed 13 patients, 10 males and 3 females aged 1 months to 15 years, and with right UPJ obstruction in six and left obstruction in seven. In all of them pre and postoperative IVP, abdominal ultrasound, diuretic renography, and pressure flow studies. Were performed our results demonstrated a non-correlation between the findings of excretory urogram, abdominal ultrasound and diuretic renography and a close relation between pressure flow studies and diuretic nephrography. This two last methods are good tools for assessment of UPJ obstruction.

Microembolia pulmonar iatrogénica detectada mediante 18F-FDG PET/TC / Iatrogenic lung microembolism detected by 18FDG PET/CT

Presentamos los casos de dos pacientes oncológicos: varón con enfermedad de Hodgkin tras finalizar tratamiento quimioterápico y mujer recién diagnosticada de melanoma coroideo, a los que se realiza tomografía por emisión de positrones/tomografía computarizada (PET/TC) con 18F-fluorodesoxiglucosa ( 18F-FDG) para monitorización terapéutica y estudio de extensión inicial, respectivamente. En ambos casos se encuentran focos hipermetabólicos de 18F-FDG en parénquima pulmonar, sin concordancia morfológica en la TC. Estos hallazgos hubieran sugerido patología pulmonar en caso de no disponer de estudio anatómico conjunto. La interpretación de la PET/TC fue de microembolismos pulmonares probablemente originados en el punto de inyección

We present the cases of two oncology patients: a male with Hodgkin's disease after completion of chemotherapy, and a woman recently diagnosed of melanoma, who underwent positron emission tomography/computed tomography (PET/CT) with 18F-FDG for therapeutic monitoring and initial staging, respectively. In both cases, hypermetabolic foci of 18F-FDG in lung parenchyma were found, without morphologic abnormalities in CT. These findings would have been consistent with lung pathology in the absence of any anatomic correlation. Combined PET/CT interpretation was of lung microembolisms probably originated at the injection site

Seguimiento de niños y jóvenes adultos con cáncer diferenciadode tiroides (CDT) tratados con radioyodo / Follow-up of children and young adults with differentiated thyroid cancer treated with radioiodine

Este es un estudio retrospectivo realizado en un grupo de treinta pacientes con carcinoma diferenciado de tiroides (edad al dignóstico igual o menor a veinte años), que tiene como objetivo valorar la respuesta al tratamiento con radioyodo. Los pacientes fueron clasificados en tres grupos según los resultados quirúrgicos, anatomopatológicos y gammagráficos iniciales: grupo I (enfermedad limitada al tiroides), grupo II (enfermedad locorregional), grupo III (afectación metastásica a distancia). En el seguimiento se evaluaron parámetros clínicos, resultados de rastreos gammagráficos con Iodo-131, determinaciones de tiroglobulina sérica y dosis terapeúticas de radioyodo administradas. También se describen otras técnicas complementarias como la radiología de tórax y las pruebas de función respiratoria. Hemos observado una negativización gammagráfica en el 83 por ciento de los casos; un 34 por ciento presenta niveles de tiroglobulina elevados como único hallazgo sugestivo de existencia de enfermedad y un 21 por ciento no presenta hallazgos clínicos, analíticos o gammagráficos patológicos. Las dosis totales de radioyodo administradas han sido crecientes en los grupos I, II y III respectivamente, e inversamente proporcionales a la extensión de la limpieza ganglionar efectuada. En la actualidad todos los pacientes están vivos y presentan un buen estado general.De acuerdo con los resultados obtenidos, concluímos que el manejo adecuado del CDT en este grupo de edad debe incluir rastreos gammagráficos periódicos con 131I y dosis terapeúticas de 131I en caso de rastreos positivos (una vez realizada la tiroidectomía total, con o sin limpieza ganglionar dependiendo de la extensión de la enfermedad). Según nuestra experiencia, el empleo de radioiodo es eficaz y seguro en el seguimiento de niños y jóvenes con CDT. (AU)