[Authorized specifications for human use in clinical practice of radiopharmaceuticals composed of iobenguane (123I) marketed in Spain]. / Condiciones de uso humano autorizadas en la práctica clínica para los radiofármacos compuestos de iobenguano (123I) comercializados en España.

This article details the specifications authorised for human use in the clinical practice for the radiopharmaceutical products composed of iobenguane ((123)I) marketed in Spain.

Do high glucose levels have differential effect on FDG uptake in inflammatory and malignant disorders?

BACKGROUND: The association of hyperglycaemia with reduced fluorodeoxyglucose (FDG) uptake by tumour cells is well established. Therefore, it is standard practice that all patients must fast for at least several hours prior to FDG positron emission tomography (PET) imaging. However, the effect of hyperglycaemia on FDG uptake by inflammatory and infectious lesions is unknown. The aim of this study was to investigate this important issue. METHODS: For in vitro studies human mononuclear cells were isolated from 12 normal volunteers and FDG uptake was determined in medium containing differing concentrations of glucose. FDG uptake by human mesothelioma cells was also measured for comparison. For studies involving patients, 416 FDG PET scans of patients with confirmed malignancy (n=321) or benign lesions (n=95) were reviewed retrospectively. The relationship between serum glucose level and FDG uptake by the lesions was assessed utilizing the standardized uptake value (SUV) technique. RESULTS: In the in vitro studies, while FDG uptake by mesothelioma cells decreased as glucose concentration increased, there was no differential uptake of FDG uptake by mononuclear cells at glucose concentrations less than 250 mg x dl(-1). In clinical patients, FDG uptake by malignant lesions was slightly, but negatively affected by serum glucose level (r= -0.21, P<0.01) (glucose range 49-187 mg x dl(-1)). In contrast, FDG uptake by inflammatory lesions was positively associated with serum glucose level (r=0.43, P<0.01) (glucose range 54-215 mg x dl(-1)). DISCUSSION AND CONCLUSION: While the degree of FDG uptake is primarily influenced by the nature of the underlying lesion, serum glucose concentration appears to have a small effect on FDG uptake, which differs between malignant disorders and inflammatory processes. Our data suggest that below a certain level, elevated glucose concentration might not have a negative effect on FDG uptake in inflammatory cells, contrary to that observed in malignant disorders.

[Human immunodeficiency virus (HIV) infection. The effectiveness of different diagnostic sequences in suspected pulmonary infection]. / Infección por el virus de la inmunodeficiencia humana (VIH). Rentabilidad de diferentes secuencias diagnósticas ante sospecha de infección pulmonar.

BACKGROUND: Assessment of different diagnostic sequences, in patients VIH(+) with a suspected pulmonary infection. METHODS: A cross-sectional descriptive study of 76 HIV(+) patients with suspected respiratory infection. It has been determined the validity and the pretest and post-test probability of the radiology (Rx) of thorax, 67Ga pulmonary scintigraphy and seric LDH levels, in order to design four different diagnostic algorithms. RESULTS: The diagnostic sequence Rx-LDH-scintigraphy with normal results involved an infection probability of 58.0%. Pathological Rx with successively normal LDH and scintigraphy, implied a likelihood of 97.0%. The LDH elevation in sequence with scintigraphy and Rx rose to 96.1% if both were abnormal and diminished to 8.3% if normal. CONCLUSIONS: The LDH elevation associated with the sequence of normal Rx and scintigraphy suggests a low infection likelihood. On the contrary, associated with pathological Rx and scintigraphy in sequence, practically assures the pulmonary infection.

[Atypical findings of the combined scintigraphy of bone marrow and labeled leukocytes in osteonecrosis of the hip secondary to infection]. / Hallazgos atípicos de la gammagrafía combinada de médula ósea y leucocitos marcados en osteonecrosis de la cadera secundaria a infección.

Avascular osteonecrosis can be associated with septic arthritis and osteomyelitis. Combined labeled leukocyte-marrow imaging scintigraphy has demonstrated excellent accuracy for the detection of infection since both tracers accumulate in the bone marrow and only leukocytes accumulate in infection. We report an unusual total absence of 99mTc HMPAO leukocytes/9mTc-sulfur colloid tracer accumulation, not only in the femoral head but also in the acetabulum and hip in hip osteonecrosis secondary to septic arthritis and osteomyelitis.

[Preliminary evaluation of the effect of an attenuation correction method in myocardial perfusion SPECT]. / Evaluación preliminar del efecto de un método de corrección de la atenuación en SPECT miocárdica de perfusión.

We propose a method to assess an attenuation correction method in myocardial perfusion SPECT. Three types of images are obtained: one resulting from a classic acquisition and filtered back-projection (classic), and those resulting from acquisition with a transmission source and an iterative reconstruction, with (music) or without (hybrid) the attenuation correction factored in to compare the three types of images and classify them as normal or abnormal, a three dimensional inter-patient quantitative comparison method was used. Differences were computed as fractions of the myocardial volume in which density differences are significant by population standards. In 7 cases the cumulative difference between prone and supine in hybrid images was 124 and 45 in music images. In 10 cases the cumulative difference between classic vs music images was 279, and between classic and hybrid 86. The AC changed 4/12 cases from abnormal to normal. The attenuation correction effect was concentrated on the septal and inferior walls, but neither exclusively nor evenly among patients. The attenuation correction effectively minimizes attenuation effects by a factor of 2.7, due to a correction of at least 69%. The correction has a small but substantial effect on the results.

[Reproducibility of the qualitative interpretation of dynamic salivary radionuclide scans with excretory stimulation]. / Reproducibilidad de la interpretación cualitativa de la gammagrafía salival dinámica con estímulo excretor.

OBJECTIVE: To evaluate intraobserver and interobserver agreement in the qualitative interpretation of dynamic salivary radionuclide scans to detect salivary disease, and the agreement between interpretation of dynamic and static image compositions. MATERIAL AND METHODS: Two observers (A, B) interpreted 110 dynamic salivary radionuclide scans with excretory stimulation based on dynamic image composition. Both again interpreted every studies: A based on dynamic image composition and B on static image composition. Kappa statistics were used to determine the degree of intraobserver and interobserver agreement. RESULTS: Considering all the studies, the dynamic composition showed an intraobserver agreement of 0.76 and interobserver agreements of 0.58 and 0.61. In patients with clinical sicca syndrome, agreements were 0.60, 0.52 and 0.62, respectively. For all the cases, the agreements between dynamic and static composition was 0.62 (intraobserver), and 0.42 and 0.43 (interobserver). For patients with clinical sicca syndrome these agreements were 0.63 (intraobserver), and 0.36 and 0.51 (interobserver). CONCLUSION: Intraobserver and interobserver agreement in the qualitative interpretation of dynamic salivary radionuclide scan with excretory stimulation are moderate and notable-moderate overall and in patients with clinical sicca syndrome. These agreements are greater than between dynamic and static image composition.

Información incluida en las fichas técnicas de los primeros medicamentos homeopáticos "sin indicaciones" de uso humano autorizados y registrados en España / Information included in the summary of product characteristics of the first homeopathic medicinal products "without therapeutic indications" for human use registered in Spain

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[Reference values for IGF-I, IGFBP-1, IGFBP-3 and osteocalcin in healthy children in Zaragoza]. / Valores de referencia de IGF-I, IGFBP-1, IGFBP-3 y osteocalcina en niños sanos zaragozanos.

OBJECTIVE: Our aim was to estimate reference values for basal serum concentrations of insulin-like growth factor (IGF)-I, IGF binding protein (IGFBP)-1, IGFBP-3 and osteocalcin in healthy children of Zaragoza. PATIENTS AND METHODS: The reference population consisted of healthy children between 0 and 14 years of age with normal weight and height and living in the metropolitan area of Zaragoza (Spain). It was a transversal study. Immunoradiometric assays were used to determine basal serum IGF-I, IGFBP-1, IGFBP-3 and osteocalcin concentrations. Reference values and ranges were estimated according to the recommendations of the International Federation of Clinical Chemistry. RESULTS: Reference values have been classified according to age, sex and pubertal stage. IGF-I, IGFBP-1, IGFBP-3 and osteocalcin concentrations differ during the pubertal period according to age. There are differences in IGF-I, IGFBP-3 and osteocalcin levels between prepuberty and puberty and differences in IGF-I and osteocalcin levels among the pubertal stages. Sex did not influence IGF-I or IGFBP-1 concentrations and there were punctual differences in IGFBP-3 and osteocalcin levels between girls and boys. CONCLUSIONS: Sincere there are differences in IGF-I, IGFBP-1, IGFBP-3 and osteocalcin reference values according to age, sex, pubertal stage and immunoassays, it is necessary to establish the reference values for each population and laboratory in accordance with these parameters.

[Reference values of FSH, LH, total testosterone, free testosterone, 17-beta-estradiol and SHBG in healthy children in Zaragoza]. / Valores de referencia de FSH, LH, testosterona total, testosterona libre, 17-beta-estradiol y SHBG en niños sanos zaragozanos.

OBJECTIVE: Our purpose was to estimate reference values for basal serum concentrations of follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone, free testosterone, 17-beta-estradiol (E2) and sex steroid binding globulin (SHBG) in healthy children of Zaragoza. PATIENTS AND METHODS: The reference population consisted of healthy children between 0 and 14 years of age with normal weight and height and living in the metropolitan area of Zaragoza (Spain). It was a transversal study. Basal serum concentrations of FSH, LH and SHBG were measured by immunoradiometric assay. Basal serum concentrations of total testosterone, free testosterone and E2 were analyzed by radioimmunoassay. Reference values and ranges were estimated according to the recommendations of the International Federation of Clinical Chemistry. RESULTS: Reference values have been classified by age, sex and pubertal stage. Serum concentrations of FSH, LH, total testosterone, free testosterone and E2 increase during the first six months, remain low in infancy and rise during puberty. All of these concentrations showed marked differences according to sex. Serum SHBG levels are influenced by age and during puberty by sex. CONCLUSIONS: Differences in reference values for gonadotrophins, sex steroids and SHBG during infancy, childhood and adolescence makes it necessary for every population to establish their own reference values according to age, sex and pubertal stage.

Inter-modality comparisons of seizure focus lateralization in complex partial seizures.

Anterior temporal lobectomy offers a high chance of seizure-free outcome in patients suffering from drug-refractory complex partial seizure (CPS) originating from the temporal lobe. Other than EEG, several functional and morphologic imaging methods are used to define the spatial seizure origin. The present study was undertaken to compare the merits of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET), magnetic resonance imaging (MRI) and single-voxel proton MR spectroscopy (MRS) for the lateralization of temporal lobe seizure foci. The clinical charts and imaging data of 43 consecutive CPS patients were reviewed. Based on surface EEG, 31 patients were classified with temporal lobe epilepsy (TLE; 25 lateralized, 6 not lateralized) and 12 with non-temporal lobe epilepsy. All were examined by FDG-PET, MRS and MRI within 6 weeks. FDG-PET and MRI were interpreted visually, while the N-acetyl-aspartate to creatine ratio was used for MRS interpretation. One FDG-PET scan was invalid due to seizure activity post injection. The MR spectra could not be evaluated in five cases bilaterally and three cases unilaterally for technical reasons. A total of 15 patients underwent anterior temporal lobectomy. All showed a beneficial postoperative outcome. When the proportions of agreement between FDG-PET (0.77), MRI (0.58) and MRS (0.56) and surface EEG in TLE cases were compared, there were no significant differences (P>0.10). However, FDG-PET showed a significantly higher agreement (0.93) than MRI (0.60; P=0.03) with the side of successful temporal lobectomy. The concordance of MRS with the side of successful temporal lobectomy was intermediate (0.75). When the results of functional and morphologic imaging were combined, no significant differences were found between the rates of agreement of FDG-PET/MRI and MRS/MRI with EEG (0.80 vs 0.68; P=0.50) and with the side of successful temporal lobectomy (0.87 vs 0.92; P=0.50) in TLE cases. However, MRS/MRI showed significantly more lateralized temporal lobe abnormalities in non-temporal lobe epilepsy cases than FDG-PET/MRI (0.90 vs. 0.17; P<0.01). Although FDG-PET seems to be the most reliable and stable method for this purpose, we conclude that in TLE cases it may be justified to perform MRS, which is less expensive, faster and has no radiation exposure, in combination with MRI before FDG-PET, since FDG-PET offers little additional diagnostic information if MRS and MRI indicate the same seizure focus lateralization.

[Hormonal reference values for adrenocortical function in healthy children from Zaragoza]. / Valores de referencia hormonales de función corticosuprarrenal en niños sanos zaragozanos.

OBJECTIVE: Estimation of reference values for basal serum concentrations of adrenocorticotropic hormone (ACTH), cortisol, 11-deoxycortisol, 17-OH-progesterone (17-OHP), plasma renin activity (PRA), aldosterone, -4-androstendione ( 4A) and dehydroepiandrosterone sulphate (DHA-S) in healthy children from Zaragoza. METHODS: Reference population were healthy children aged 0 to 14, with normal weight and height, living in the metropolitan area of Zaragoza (Spain). It is a transversal study. Reference values and ranges for ACTH, cortisol, 11-deoxycortisol, 17-OHP, PRA, aldosterone, 4A and DHA-S were estimated, and changes in concentrations were analyzed in relation to age, sex and puberal stage. RESULTS: Reference values have been classified by puberal stage and age in eleven groups for every sex: Tanner I (umbilical cordon, 3 days, 4-30 days, 1-6 months, 6 months-4 years, 4-7 years, 7-10 years, 10-14 years), Tanner II, Tanner III and Tanner IV-V. Sex did not influence ACTH, cortisol, 17-OHP and PRA concentrations, and there are punctual differences in 11-deoxycortisol, aldosterone, 4A and DHA-S levels. 17-OHP, 11-deoxycortisol and aldosterone concentrations significantly decreased from birth to 6 months-4 years and subsequently kept steady. The maximal concentration of ACTH, and ARP in blood cord significantly decreased until the period 6 months-4 years, and subsequent differences among different age groups, and between prepuberal and puberal groups are scarce. The highest concentration of 4A and DHA-S were observed in blood cord and third day of life, decreased until the lowest level in 6 months-4 years and progressively increased with age in prepuberty, and between prepuberty and puberty. The lowest concentration of cortisol was detected in 4-30 days, increased until 6 months-4 years and kept steady along the prepuberty and puberty. CONCLUSION: It is necessary that every population establish own reference values for ACTH, cortisol, 11-deoxycortisol, 17-OHP, PRA, aldosterone, 4A and DHA-S during infancy, childhood and adolescence, according to age, sex and puberal stage.

[Reference values for thyroid hormones, thyrotropin and thyroglobulin in healthy children of Zaragoza]. / Valores de referencia de hormonas tiroideas, tirotropina y tiroglobulina en niños sanos zaragozanos.

OBJECTIVE: The purpose of this study was to estimate the basal serum concentration reference values for total T3 (T3), total T4 (T4), free T4 (FT4), thyrotropin (TSH) and thyroglobulin (Tg) in healthy children of Zaragoza. PATIENTS AND METHODS: Healthy children aged 0 to 14, with normal weight and height, living in the metropolitan area of Zaragoza (Spain) were the reference population of this transversal study. Basal serum concentrations of T3, T4 and FT4 were measured by radioimmunoassay and of TSH and Tg by immunoradiometric assay. Reference values and ranges were estimated according to the recommendations of the International Federation of Clinical Chemistry. RESULTS: Reference values have been classified according to age, sex and pubertal stage. There are differences in T3, T4, FT4 TSH and Tg concentrations during the prepubertal period according to age, but not to sex, and between the prepubertal period and puberty. Sex and Tanner stage influence T3 and T4 concentrations during puberty. CONCLUSIONS: Since there are differences in T3, T4, FT4, TSH and Tg reference values according to age, sex, pubertal stage and immunoassays, it is necessary to establish reference values for every population and laboratory in accordance with these parameters.

Información incluida en las fichas técnicas de los primeros medicamentos homeopáticos «sin indicaciones» de uso humano autorizados y registrados en España / Information included in the summary of product characteristics of the first homeopathic medicinal products «without therapeutic indications» for human use registered in Spain

No disponible