Clinical and pathological factors related to 18F-FDG-PET positivity in the diagnosis of recurrence and/or metastasis in patients with differentiated thyroid cancer.

BACKGROUND: Objectives were to analyze the relationship between a positive (18)F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) result and clinical and tumor factors in patients treated for differentiated thyroid cancer (DTC) and under suspicion of recurrence or metastasis, and to determine the diagnostic validity of PET in DTC patients with elevated serum thyroglobulin (Tg) and negative (131)I whole-body scan ((131)I-WBS). METHODS: We studied 50 DTC patients with elevated serum Tg and negative WBS treated with total thyroidectomy and (131)I ablation. Thyroxin treatment was withdrawn and patients were on iodine-free diet before WBS. Tg, anti-Tg antibodies, and thyroid-stimulating hormone (TSH) were determined. Patients with negative WBS and elevated Tg underwent PET study 1 week later. PET findings were verified by pathology findings or other imaging techniques [computed tomography (CT), magnetic resonance imaging (MRI), ultrasound (US)] and/or 12-month follow-up. The relationship between PET findings and tumor (histological type, size, multifocality, thyroid capsular invasion, lymph-node and/or metastatic involvement) and clinical (age at diagnosis, sex, Tg, accumulated iodine dose, and recurrence time) variables was analyzed. RESULTS: PET was positive in 32/39 patients with confirmed disease (82% sensitivity) and negative in 7/11 of disease-free cases (64% specificity), a positive predictive value (PPV) of 89%. Tumor size (P < 0.05) and thyroid capsular invasion (P < 0.05) were significantly associated with positive PET study. The relationship of PET findings with Tg levels and age at diagnosis was close to significance. CONCLUSION: (18)F-FDG-PET study offers a high sensitivity and positive predictive value (PPV) in patients with negative WBS and Tg positive. The use of FDG-PET is strongly recommended in DTC patients with large tumors, thyroid capsule invasion or poor-prognosis variants.

In-vitro radiosensitivity in patients with systemic lupus erythematosus.

To determine the "in-vitro" intrinsic cell radiosensitivity (RS) as a risk indicator of radiation-related side-effects in patients with systemic lupus erythematosus (SLE) compared with healthy subjects (control group). Moreover, we elucidated if clinical, therapeutic and biological parameters could affect the "in-vitro" intrinsic RS in patients with SLE. Intrinsic RS was determined by the quantification of the initial radiation-induced DNA double-strand breaks in peripheral lymphocytes, measured by pulsed-field gel electrophoresis from 52 patients with SLE and a control group consisting of 48 sex- and age-matched healthy subjects. No difference in intrinsic RS was found among both groups. However, SLE patients with anaemia, increased erythrocyte sedimentation rate and those with positive result for anti-La/SSB and anti-RNP antibodies showed significantly higher DNA double-strand breaks than those without them. In our study, patients with SLE did not have a higher intrinsic RS than healthy subjects. According to these results, and with the caution of being a limited laboratory study, the use of radiotherapy should not be avoided in patients with SLE when it is clinically needed.

[Morbimortality of acute endocarditis caused by Streptococcus agalactiae]. / Morbimortalidad de la endocarditis aguda por Streptococcus agalactiae.

INTRODUCTION: Streptococcus agalactiae is an uncommon cause of acute endocarditis. It is more likely to occur in people with underlying diseases and usually evolves poorly. MATERIALS AND METHODS: We have conducted a retrospective study comparing the clinical features of Streptococcus agalactiae acute endocarditis attended in our Hospital during the last twelve years with the ones caused by other microorganisms; we have analized as dependent variables the vegetation size, surgery needing, complications, time of hospitalisation and global mortality. RESULTS: All the cases by SGB had a great vegetation size, all needed surgery in its management with long hospitalisation periods, and the mortility was of 40%; everything was higher than other microorganism's endocarditis. CONCLUSION. Streptococcus agalactiae acute endocarditis is a serious disease which requires early surgery in its management. Its mortality rate, complications and hospitalisation time are high.

Magic syndrome and true aortic aneurysm.

Magic syndrome is a very uncommon disease, and vascular involvement is exceptional; only one case has been reported in the literature associated to a true aortic aneurysm. The treatment of aneurysms recommended in these patients is based on isolated cases and includes corticosteroids, other immunosuppressant drugs, and surgery. We report a case of a patient with Magic syndrome who developed aneurysm at the end of the aorta during treatment with infliximab, corticosteroids, and cyclosporine and who needed endovascular prosthesis implantation. After 12 months, she suffered an aneurysm of the ascending aorta, dilatation of the sinotubular junction, and severe aortic insufficiency, which forced surgery. During this time, the patient finally died.

Study of a functional polymorphism in the p53 gene in systemic lupus erythematosus: lack of replication in a Spanish population.

The aim of this study was to assess the possible association between the p53 suppressor gene codon 72 polymorphism and systemic lupus erythematosus (SLE). Our study population consisted of 513 SLE patients and 567 healthy controls. All the individuals were of Spanish Caucasian origin. Genotyping of the p53 codon 72 polymorphism was performed by allele-specific PCR. No statistically significant differences were observed between SLE patients and healthy controls when p53 codon 72 genotype and allele frequencies were compared. In addition, no evidence for association with clinical subfeatures of SLE was found. In conclusion, the p53 codon 72 polymorphism associated with SLE in a Korean population does not appear to play a major role in the susceptibility or severity of SLE in the Spanish population.

Study of the role of functional variants of SLC22A4, RUNX1 and SUMO4 in systemic lupus erythematosus.

BACKGROUND: Functional polymorphisms of the solute carrier family 22, member 4 (SLC22A4), runt related transcription factor 1 (RUNX1) and small ubiquitin-like modifier 4 (SUMO4) genes have been shown to be associated with several autoimmune diseases. OBJECTIVE: To test the possible role of these variants in susceptibility to or severity of systemic lupus erythematosus (SLE), on the basis that common genetic bases are shared by autoimmune disorders. METHODS: 597 SLE patients and 987 healthy controls of white Spanish origin were studied. Two additional cohorts of 228 SLE patients from Sweden and 122 SLE patients from Colombia were included. A case-control association study was carried out with six single nucleotide polymorphisms (SNP) spanning the SLC22A4 gene, one SNP in RUNX1 gene, and one additional SNP in SUM04 gene. RESULTS: No significant differences were observed between SLE patients and healthy controls when comparing the distribution of the genotypes or alleles of any of the SLC22A4, RUNX1, or SUMO4 polymorphisms tested. Significant differences were found in the distribution of the SUMO4 genotypes and alleles among SLE patients with and without nephritis, but after multiple testing correction, the significance of the association was lost. The association of SUMO4 with nephritis could not be verified in two independent SLE cohorts from Sweden and Colombia. CONCLUSIONS: These results suggest that the SLC22A4, RUNX1, and SUMO4 polymorphisms analysed do not play a role in the susceptibility to or severity of SLE.

Two cases of catastrophic antiphospholipid syndrome.

Catastrophic antiphospholipid syndrome (CAPS) is a rare complication of antiphospholipid syndrome. It is a disseminated severe vascular pathology which presents with multi-organic dysfunction that progresses rapidly. Prognosis ends up being fatal in half of the cases. It may appear during pregnancy, surgery, infection, or after suspension of anticoagulation therapy. We studied two female patients with CAPS who survived after treatment with anticoagulation therapy and intravenous corticosteroids. The evolution of our two patients, after 17 months of follow-up under oral anticoagulant treatment was favourable and they are currently asymptomatic. In these patients the early diagnosis and treatment were essential to enhance their possibilities of survival.

[Usefulness of the clonidine test for the diagnosis of pheochromocytoma]. / Utilidad de la prueba de clonidina en el diagnóstico de feocromocitoma.

BACKGROUND: The clonidine test has been proposed as diagnostic biochemical test for patients with clinical suspicion of pheochromocytoma. METHODS: The clonidine test was used in 80 patients with suspicion of pheochromocytoma (on account of suggestive clinical findings, increased levels of metanephrines, increased plasma or urinary levels of catecholamines, or suggestive images by ultrasonography or CT). RESULTS: Surgery confirmed the diagnosis of pheochromocytoma in 16 patients. The highest sensitivity (62%) and specificity (46%) of the clonidine test corresponded to a brake degree of 5%, with a predictive negative value of 83%. The test was most useful in patients with increased basal plasma values of catecholamines (sensitivity, 62%; specificity, 66%). CONCLUSIONS: The clonidine test can be useful for the diagnosis of pheochromocytoma in patients with increased basal plasma levels of catecholamines and a brake degree lower than 5% at 180 minutes.

[Clinical characteristics of patients with essential hypertension regarding salt intake]. / Características clínicas de los pacientes hipertensos esenciales respecto al consumo de sal.

A number of epidemiologic and experimental studies have revealed the close relationship between salt intake and blood pressure. The objective of this study was to know the salt intake among 293 not previously treated hypertensive patients and to identify their clinical characteristics that would allow us to define the profile of patients with high sodium intake. Hypertensive patients who first attended a specialized high blood pressure (HBP) clinic not previously treated with drugs, at least for the last month were selected. Sodium 24 h urinary excretion was determined on two occasions, as sodium intake index. Thirteen percent of patients had a salt intake lower than 100 mEq/24 h and 35% of patients higher than 200 mEq/24 h. Sodium intake was higher among men, younger patients, those with a higher Quetelet index, smokers, higher socioeconomic status, and less years with IBP. No differences were observed between salt intake among hypertensive patients with associated diabetes or hyperlipidemia. The Quetelet index, sex, age and smoking were identified as independent variables for salt intake by the multiple linear regression analysis. No correlation was found between salt intake and blood pressure. In conclusion, a high sodium intake was observed in our setting among hypertensive patients who had previously been advised to moderate salt intake. The highest salt intake was observed among men, youths, obese and smokers.