Role of 99mTc-HYNIC-Tyr3-octreotide scintigraphy in neuroendocrine tumors based on localization of the primary tumor.

BACKGROUND: The aim of our work was to determine the accuracy of 99mTc-HYNIC Tyr3 octreotide scintigraphy (TcOS) in detecting active disease in neuroendocrine tumors (NETs) based on embryological origin of the primary tumor (foregut, midgut or hindgut). METHODS: We analyzed retrospectively 45 studies (12 staging, 26 suspicion of recurrence, and 7 treatment response) belonging to 33 patients with histological confirmation of NETs. Whole body scan and a SPECT-CT were acquired 4 hours post-injection of 740 MBq of 99mTc-HYNIC Tyr3 octreotide. The studies were divided into 3 groups based on the embryological origin of primary tumor (foregut [group 1], midgut [group 2] and hindgut [group 3]). The accuracy of TcOS in each group was assessed, included chi-square analyses. The final diagnosis was established by histopathology or clinical/radiological follow-up greater than 6 months. RESULTS: The localization of the primary tumor per patient revealed that 58% were from the foregut, 30% from the midgut and 12% from the hindgut. In study-based analysis (45 studies), TcOS showed an overall sensitivity, specificity and accuracy of 95%, 92% and 93% respectively. The accuracy per studies for the groups 1, 2 and 3 were: 100%, 92% and 66% respectively, demonstrating a better detection of active disease in primary tumors from foregut and midgut compared to hindgut (P=0.02). CONCLUSIONS: The accuracy of TcOS in the assessment of NETs seems to be better in tumors with foregut and midgut origin, showing a possible relationship between the embryological origin of NETs and detection of active disease by TcOS.

(18)F-FDG-PET/CT in the assessment of pulmonary solitary nodules: comparison of different analysis methods and risk variables in the prediction of malignancy.

OBJECTIVE: To compare the diagnostic performance of different metabolical, morphological and clinical criteria for correct presurgical classification of the solitary pulmonary nodule (SPN). METHODS: Fifty-five patients, with SPN were retrospectively analyzed. All patients underwent preoperative (18)F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT). Maximum diameter in CT, maximum standard uptake value (SUVmax), histopathologic result, age, smoking history and gender were obtained. Different criteria were established to classify a SPN as malignant: (I) visually detectable metabolism, (II) SUVmax >2.5 regardless of SPN diameter, (III) SUVmax threshold depending of SPN diameter, and (IV) ratio SUVmax/diameter greater than 1. For each criterion, statistical diagnostic parameters were obtained. Receiver operating characteristic (ROC) analysis was performed to select the best diagnostic SUVmax and SUVmax/diameter cutoff. Additionally, a predictive model of malignancy of the SPN was derived by multivariate logistic regression. RESULTS: Fifteen SPN (27.3%) were benign and 40 (72.7%) malignant. The mean values ± standard deviation (SD) of SPN diameter and SUVmax were 1.93±0.57 cm and 3.93±2.67 respectively. Sensitivity (Se) and specificity (Sp) of the different diagnostic criteria were (I): 97.5% and 13.1%; (II) 67.5% and 53.3%; (III) 70% and 53.3%; and (IV) 85% and 33.3%, respectively. The SUVmax cut-off value with the best diagnostic performance was 1.95 (Se: 80%; Sp: 53.3%). The predictive model had a Se of 87.5% and Sp of 46.7%. The SUVmax was independent variables to predict malignancy. CONCLUSIONS: The assessment by semiquantitative methods did not improve the Se of visual analysis. The limited Sp was independent on the method used. However, the predictive model combining SUVmax and age was the best diagnostic approach.

Role of [¹8F]FDG PET in prediction of KRAS and EGFR mutation status in patients with advanced non-small-cell lung cancer.

PURPOSE: The tumour molecular profile predicts the activity of epidermal growth factor receptor (EGFR) inhibitors in non-small-cell lung cancer (NSCLC). However, tissue availability and tumour heterogeneity limit its assessment. We evaluated whether [(18)F]FDG PET might help predict KRAS and EFGR mutation status in NSCLC. METHODS: Between January 2005 and October 2011, 340 NSCLC patients were tested for KRAS and EGFR mutation status. We identified patients with stage III and IV disease who had undergone [(18)F]FDG PET/CT scanning for initial staging. SUVpeak, SUVmax and SUVmean of the single hottest tumour lesions were calculated, and their association with KRAS and EGFR mutation status was assessed. A receiver operator characteristic (ROC) curve analysis and a multivariate analysis (including SUVmean, gender, age and AJCC stage) were performed to identify the potential value of [(18)F]FDG PET/CT for predicting KRAS mutation. RESULTS: From 102 patients staged using [(18)F]FDG PET/CT, 28 (27%) had KRAS mutation (KRAS+), 22 (22%) had EGFR mutation (EGFR+) and 52 (51%) had wild-type KRAS and EGFR profiles (WT). KRAS+ patients showed significantly higher [(18)F]FDG uptake than EGFR+ and WT patients (SUVmean 9.5, 5.7 and 6.6, respectively; p < 0.001). No significant differences were observed in [(18)F]FDG uptake between EGFR+ patients and WT patients. ROC curve analysis for KRAS mutation status discrimination yielded an area under the curve of 0.740 for SUVmean (p < 0.001). The multivariate analysis showed a sensitivity and specificity of 78.6% and 62.2%, respectively, and the AUC was 0.773. CONCLUSION: NSCLC patients with tumours harbouring KRAS mutations showed significantly higher [(18)F]FDG uptake than WT patients, as assessed in terms of SUVpeak, SUVmax and SUVmean. A multivariate model based on age, gender, AJCC stage and SUVmean might be used as a predictive marker of KRAS mutation status in patients with stage III or IV NSCLC.

PET Tracers for Clinical Imaging of Breast Cancer.

Molecular imaging of breast cancer has undoubtedly permitted a substantial development of the overall diagnostic accuracy of this malignancy in the last years. Accurate tumour staging, design of individually suited therapies, response evaluation, early detection of recurrence and distant lesions have also evolved in parallel with the development of novel molecular imaging approaches. In this context, positron emission tomography (PET) can be probably seen as the most interesting molecular imaging technology with straightforward clinical application for such purposes. Dozens of radiotracers for PET imaging of breast cancer have been tested in laboratory animals. However, in this review we shall focus mainly in the smaller group of PET radiopharmaceuticals that have lead through into the clinical setting. PET imaging can be used to target general metabolic phenomena related to tumoural transformation, including glucose metabolism and cell proliferation, but can also be directed to specific hormone receptors that are characteristic of the breast cancer cell. Many other receptors and transport molecules present in the tumour cells could also be of interest for imaging. Furthermore, molecules related with the tumour microenvironment, tumour induced angiogenesis or even hypoxia could also be used as molecular biomarkers for breast cancer imaging.

Prevalencia de defectos congénitos en un hospital de tercer nivel en Cali (Colombia) 2004-2008. Asociación con edad materna / Prevalence of congenital defects in a third level hospital of Cali, Colombia 2004-2008. Association with maternal age

Objetivo: evaluar la prevalencia de defectos congénitos (DC) en un hospital de alta complejidad en Cali (Colombia). Hacer una aproximación a su asociación con la edad materna. Materiales y métodos: se desarrolló un estudio transversal con base en la información recolectada por el sistema de registros de DC del Hospital Universitario del Valle (HUV), Cali (Colombia), entre los años 2004 y 2008. Se incluyó el total de nacimientos del período y se determinó el tipo de DC y las variables sociodemográficas de las madres. La prevalencia fue establecida de acuerdo a la edad materna y se analizó la asociación entre ésta y los DC. Resultados: durante el período del estudio se registraron en el HUV 32 995 nacimientos y una prevalencia general de DC del 2,22%. Se encontró una prevalencia de defectos por disrupción vascular (DDV) de 4,5/1000 en madres <15 años y una prevalencia de alteraciones cromosómicas de 13,1/1000 en madres >45 años. Conclusiones: la edad materna <20 años se relaciona con una mayor ocurrencia de DDV (3 a 4 veces más alta) y la edad materna >35 años se relaciona con alteraciones cromosómicas (13 veces más) comparado con la prevalencia general de estos DC...

Objetive: to evaluate the association between maternal age and prevalence of congenital defects (CD) in a third level hospital in Cali, Colombia. Materials and methods: cross-sectional study was developed based on data collected by the CD system records the Hospital Universitario del Valle (HUV), Cali, Colombia, between 2004 and 2008. It included all births in the period and determined the type of CD, socio-demographic variables of mothers. Prevalence according to maternal age and analyzed the association between maternal age and CD. Results: during the study period 32 995 newborns were registered with an overall CD prevalence of 2.22%. We found a 4.5/1000 prevalence of vascular disruption defects (VDD) in mothers <15 years, and a 13.1/1000 prevalence of chromosomal defects in mothers >45 years. Conclusions: as compared with the overall prevalence of CD, maternal age <20 is associated with a higher occurrence of VDD (3 to 4 times higher) while age >35 is related to chromosomal defects (13 times higher occurrence)...

Experiencias en homeopatía / Homeopathic experiences

Se presenta el relato de un médico anastesiólogo quien decide por azar y necesidad, adentrarse de lleno en el campo de la Homeopatía para adquirir sus beneficios y un nuevo enfoque que le ampliaron la posibilidad terapéutica de ayudar a sus pacientes.

Diseño e implementación del sistema de garantía de calidad en el hospital Occidente de Kennedy / Design and implementation of the quality assurance system at Hospital Occidente de Kennedy

El objetivo general de este trabajo es caracterizar e implementar un esquema de coordinación del sistema de garantía de la calidad en el hospital Occidente de Kennedy que integre las acciones y recursos destinados al control interno, al control de la calidad asistencial, la atención al usuario y la recepción y trámite de quejas. Los objetivos específicos consistieron en: caracterizar los mecanismos y procedimientos de garantía de la calidad en el hospital Occidente de Kennedy considerando el control interno, la garantía de la calidad y la atención a los usuarios; investigación aplicada para el diseño del sistema de garantía de la calidad que integre control interno, auditoría médica, quejas y reclamos, y atención al usuario; definir la oficina de garantía de la calidad y los ajustes a la estructura organizacional vigente; definir por consenso las funciones y procesos del sistema de garantía de la calidad (subsistema de control interno, subsistema de auditoría médica y subsistema de interacción con los usuarios); capacitar a los funcionarios para la puesta en operación; acompañar para la implementación del sistema de garantía de la calidad.

The general objective of this work is to characterize and implement a coordination scheme for the quality assurance system at the Hospital Occidente de Kennedy that integrates the actions and resources destined to internal control, quality control of care, user care and the reception and processing of complaints. The specific objectives consisted of: characterize the mechanisms and procedures for quality assurance in the hospital Occidente de Kennedy considering internal control, quality assurance and attention to users; applied research for the design of the quality assurance system that integrates internal control, medical audit, complaints and claims, and attention to the user; define the quality assurance office and adjustments to the current organizational structure; define by consensus the functions and processes of the quality assurance system (internal control subsystem, medical audit subsystem and subsystem of interaction with users); train staff to put it into operation; accompany the implementation of the quality assurance system.

Hemoglobinopatias en un grupo etnico negro colombiano / Hemoglobinopathies in a colombian black ethnic group

Se estudiaron 104 personas, 48 hombres y 56 mujeres, del corregimiento de Sabaletas, Buenaventura, cuyo grupo etnico es basicamente negro, raza en la cual se presentan diversas hemoglobinas anormales que han tenido un estudio muy limitado en Colombia. Se encontraron 8 casos, 5 mujeres y 3 hombres con hemoglobinopatia AS; 3 pertenecian a una misma familia, otros 2 eran madre e hija de otra familia y 3 casos sin ningun parentesco entre si. Se encontraron 2 casos de hemoglobina AC, sin parentesco. No se hallaron hemoglobinas F ni A2 aumentadas