European academy of dermatology and venereology European prurigo project: expert consensus on the definition, classification and terminology of chronic prurigo.

BACKGROUND: The term prurigo has been used for many decades in dermatology without clear definition, and currently used terminology of prurigo is inconsistent and confusing. Especially, itch-related prurigo remains unexplored regarding the epidemiology, clinical profile, natural course, underlying causes, available treatments and economic burden, although burdensome and difficult to treat. OBJECTIVE: To address these issues, the multicentre European Prurigo Project (EPP) was designed to increase knowledge on chronic prurigo (CPG). In the first step, European experts of the EADV Task Force Pruritus (TFP) aimed to achieve a consensus on the definition, classification and terminology of CPG. Additionally, procedures of the cross-sectional EPP were discussed and agreed upon. METHODS: Discussions and surveys between members of the TFP served as basis for a consensus conference. Using the Delphi method, consensus was defined as an agreement ≥75% among the present members. RESULTS: Twenty-four members of the TFP participated in the consensus conference. Experts consented that CPG should be used as an umbrella term for the range of clinical manifestations (e.g. papular, nodular, plaque or umbilicated types). CPG is considered a distinct disease defined by the presence of chronic pruritus for ≥6 weeks, history and/or signs of repeated scratching and multiple localized/generalized pruriginous skin lesions (whitish or pink papules, nodules and/or plaques). CPG occurs due to a neuronal sensitization to itch and the development of an itch-scratch cycle. CONCLUSION: This new definition and terminology of CPG should be implemented in dermatology to harmonize communication in the clinical routine, clinical trials and scientific literature. Acute/subacute forms of prurigo are separated entities, which need to be differentiated from CPG and will be discussed in a next step. In the near future, the cross-sectional EPP will provide relevant clinical data on various aspects of CPG leading to new directions in the scientific investigation of CGP.

[Adaptive behaviour and learning in children with neurodevelopmental disorders (autism spectrum disorders and attention deficit hyperactivity disorder). Effects of executive functioning]. / Conducta adaptativa y aprendizaje en niños con trastornos del neurodesarrollo (trastornos del espectro autista y trastorno por deficit de atencion/hiperactividad). Efectos del funcionamiento ejecutivo.

INTRODUCTION: Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) present difficulties in adaptive functioning and learning, possibly associated with failures in executive functioning characteristic of both disorders. AIM: To analyze the impact of executive functioning in the adaptive behaviors of socialization and daily life and in learning behaviors in children with ASD and children with ADHD. SUBJECTS AND METHODS: The participants were 124 children matched in age and intellectual quotient: 37 children with typical development, 52 children with ASD and 35 children with ADHD. Parents reported on their children's adaptive behaviors, while teachers provided information on learning behaviors and executive functioning in daily life. RESULTS: There are significant differences between the groups with ASD and ADHD with the typical development group in all domains evaluated. In addition, the group with ASD had worse socialization skills while persistence in learning was more affected in children with ADHD. Finally, the metacognitive index of executive functioning predicted the socialization and persistence of children with ASD. On the other hand, the index of behavioral regulation and the educational level of the parents predicted the socialization skills in children with ADHD. CONCLUSIONS: The results highlight the need to include differentiated executive strategies in the intervention of children with ASD and children with ADHD.

TITLE: Conducta adaptativa y aprendizaje en niños con trastornos del neurodesarrollo (trastornos del espectro autista y trastorno por deficit de atencion/hiperactividad). Efectos del funcionamiento ejecutivo.Introduccion. El trastorno del espectro autista (TEA) y el trastorno por deficit de atencion/hiperactividad (TDAH) presentan dificultades en el funcionamiento adaptativo y en el aprendizaje, que posiblemente estan asociadas a fallos en el funcionamiento ejecutivo caracteristicos de ambos trastornos. Objetivo. Analizar el impacto del funcionamiento ejecutivo en las conductas adaptativas de socializacion y de la vida diaria y en conductas de aprendizaje en niños con TEA y niños con TDAH. Sujetos y metodos. Los participantes fueron 124 niños igualados en edad y cociente intelectual: 37 con desarrollo tipico, 52 con TEA y 35 niños con TDAH. Los padres informaron sobre las conductas adaptativas, y los profesores, sobre las conductas de aprendizaje y del funcionamiento ejecutivo en la vida diaria. Resultados. Existen diferencias significativas entre los grupos con TEA y con TDAH y el grupo con desarrollo tipico en los dominios evaluados. Ademas, el grupo con TEA tenia peores habilidades de socializacion, pero la persistencia en el aprendizaje estaba mas afectada en los niños con TDAH. Por ultimo, el indice metacognitivo de funcionamiento ejecutivo predijo la socializacion y la persistencia de los niños con TEA, mientras que el indice de regulacion comportamental y el nivel educativo de los padres predijo las habilidades de socializacion en los niños con TDAH. Conclusiones. Los resultados sugieren la necesidad de incluir estrategias ejecutivas en la intervencion de niños con TEA y niños con TDAH.

[Interventions to promote social communication in children with autism spectrum disorders]. / Intervenciones para promover la comunicacion social en niños con trastornos del espectro autista.

INTRODUCTION: The difficulties encountered when it comes to social communication are one of the core disorders experienced by persons with autism spectrum disorders (ASD). This problem leads to feelings of loneliness and social exclusion, which negatively affect the quality of life. AIMS: To review the characteristics of the main interventions in this field in high-functioning ASD. DEVELOPMENT: Strategies employed include social stories, comic-strip conversations or videomodelling, and interventions mediated by peers and multicomponent treatments. CONCLUSIONS: The design of the programmes used today has evolved towards more ecological approaches that take the family, teachers and companions into account in the treatment. The most recent literature reviews have found evidence of significant improvements following their implementation, which has been reflected in better social competence and lesser feelings of loneliness. The social communication intervention must combine individualised instruction with consideration of the child's environment and the motivation towards communicative interaction.

TITLE: Intervenciones para promover la comunicacion social en niños con trastornos del espectro autista.Introduccion. Las dificultades en la comunicacion social constituyen una de las alteraciones nucleares que experimentan las personas con trastorno del espectro autista (TEA). Esta problematica provoca sentimientos de soledad y exclusion social, que repercuten negativamente en la calidad de vida. Objetivo. Revisar las caracteristicas de las principales intervenciones en este ambito en el TEA de alto funcionamiento. Desarrollo. Se sintetizan estrategias como las historias sociales, comic-strip conversations o videomodelaje, e intervenciones mediadas por pares y tratamientos multicomponente. Conclusiones. El diseño de los actuales programas ha evolucionado hacia enfoques mas ecologicos, considerandose a la familia, a los profesores y a los compañeros en el tratamiento. Las ultimas sintesis de la bibliografia han evidenciado mejoras significativas tras su implementacion, lo que se ha manifestado en una mejor competencia social y un menor sentimiento de soledad. La intervencion en comunicacion social debe combinar la instruccion individualizada con la consideracion del entorno del niño y de la motivacion hacia la interaccion comunicativa.

[Discriminatory power of executive functions and of theory of mind in attention deficit hyperactivity disorder. Rationale for intervention]. / Poder de discriminacion del funcionamiento ejecutivo y de la teoria de la mente en el trastorno por deficit de atencion/hiperactividad. Fundamentos para la intervencion.

INTRODUCTION: Executive functions and theory of mind (ToM) deficits are present in children with attention deficit hyperactivity disorder (ADHD). Identifying the magnitude of the association between executive functions and ToM is important for understanding the disorder. AIMS: This study adopts a naturalistic evaluation approach to analyze the executive functions versus ToM ability to discriminate between children with ADHD and typically developing children and to identify the degree of association between deficits in the components of executive functions (behavioral regulation and metacognitive) and ToM. SUBJECTS AND METHODS: Thirty-five children with ADHD and 37 typically developing children-7 to 11 years old, matched in age and intelligence quotient, participated in this study. Parents assessed ToM skills and teachers estimated the executive functions. RESULTS AND CONCLUSIONS: The percentage of children with ADHD classified correctly was higher in the discriminant analysis where the executive functions components were introduced as an independent variable than in the discriminant analysis performed with the ToM. However, a high percentage of children with executive functions deficits had also problems in ToM. Interventions focused on the development of a broad range of executive processes are reviewed.

TITLE: Poder de discriminacion del funcionamiento ejecutivo y de la teoria de la mente en el trastorno por deficit de atencion/hiperactividad. Fundamentos para la intervencion.Introduccion. Los deficits en funcionamiento ejecutivo y en teoria de la mente (ToM) estan presentes en los niños con trastorno por deficit de atencion/hiperactividad (TDAH). Identificar la magnitud de la asociacion entre funcionamiento ejecutivo y ToM resulta primordial para la comprension del trastorno. Objetivos. Adoptando un enfoque de evaluacion naturalista, se analiza la capacidad del funcionamiento ejecutivo frente a la ToM para discriminar entre niños con TDAH y con desarrollo tipico, y se identifica el grado de asociacion entre deficits en los componentes de funcionamiento ejecutivo (regulacion conductual y metacognitivos) y de la ToM. Sujetos y metodos. Participaron un grupo de 35 niños con TDAH y otro de 37 niños con desarrollo tipico entre 7 y 11 años, igualados en edad y capacidad intelectual. Los padres evaluaron las habilidades de ToM y los profesores estimaron las funciones ejecutivas. Resultados y conclusiones. El porcentaje de niños con TDAH clasificados correctamente fue superior en el analisis discriminante al introducir los componentes de funcionamiento ejecutivo como variable independiente, que en el analisis discriminante realizado con la ToM. No obstante, un elevado porcentaje de niños con deficits en funcionamiento ejecutivo tambien tenian problemas en ToM. Se revisan intervenciones enfocadas en el desarrollo de un rango amplio de procesos ejecutivos.

[Integrating model of the social adaptation of children with attention deficit hyperactivity disorder]. / Modelo integrador de la adaptacion social de niños con trastorno por deficit de atencion/hiperactividad.

INTRODUCTION: Children with attention deficit hyperactivity disorder (ADHD) experience social difficulties affecting their personal and academic functioning. AIM: To review the research addressing the influence of cognitive/affective abilities involved in their social adaptation, from the perspective of an integrative model that includes executive functioning, theory of mind and pragmatic language. DEVELOPMENT: Research shows an association between executive functioning (working memory, inhibition, planning), pragmatic abilities, performance in theory of mind tasks, and the social problems experienced by individuals with ADHD. CONCLUSIONS: Although literature supports a relationship between these constructs, deficits observed in theory of mind tasks or language use, seem rather to reflect a procedural deficit than a conceptual impairment.

TITLE: Modelo integrador de la adaptacion social de niños con trastorno por deficit de atencion/hiperactividad.Introduccion. Los niños con trastorno por deficit de atencion/hiperactividad (TDAH) experimentan dificultades sociales que afectan a su funcionamiento personal y academico. Objetivo. Revisar los estudios que han abordado la influencia de las habilidades cognitivas y afectivas implicadas en su adaptacion social, desde la perspectiva de un modelo integrador que incluye el funcionamiento ejecutivo, las habilidades mentalistas y el lenguaje pragmatico. Desarrollo. Las investigaciones revisadas constatan una asociacion entre funcionamiento ejecutivo (memoria de trabajo, inhibicion, planificacion), habilidad pragmatica y rendimiento en tareas mentalistas, con la problematica social que experimentan las personas con TDAH. Conclusiones. Aunque la bibliografia respalda una relacion entre estos constructos, los deficits observados en la ejecucion de tareas de teoria de la mente o en el uso del lenguaje parecen responder mas bien a un deficit de caracter procedimental y no tanto a dificultades de indole conceptual.

[Value of the detection of serum thyroglobin and I-131 scintigraphy in the follow-up of differentiated thyroid cancer]. / Valor de la determinación de la tiroglobulina sérica y de la gammagrafía mediante I-131 en el seguimiento del cáncer diferenciado de tiroides.

OBJECTIVES: The objective of this work has been to know the sensitivity of serum thyroglobulin and I-131 scintigraphy in the detection of thyroid remnants or metastases, and to evaluate the predictive value of serum thyroglobulin in the follow-up of differentiated thyroid cancer patients. METHODS: We have carried out a retrospective study of 218 patients with differentiated thyroid cancer, with detection of serum thyroglobulin levels and I-131 scintigraphy in clinical status of hypothyroidism, after to perform thyroidectomy and between six and nine months later. We have rejected 16 and 14 patients who have had presented high serum levels of thyroglobulin, or an incomplete follow-up. RESULTS: Our results showed a good correlation of both parameters (92%). The sensitivity of TG and I-131 scan was 85% and 90% respectively, and superior to 90% for both procedures in the diagnosis of the osseous and lung metastases. The sensitivity of I-131 scan and TG was 100% and less to 70% in the detection of thyroid remnants and regional lymphatic nodes. The positive and negative value of TG was 99% and 91%, respectively, with a total of 24 false negative results. CONCLUSIONS: Considering this study, we believe that both techniques are complementary, with a lower sensitivity of serum TG in the detection of thyroid remnants and regional lymphatic involvement, and a negative predictive value that does not permit to accomplish the follow-up of differentiated thyroid cancer patients, considering exclusively the results of this tumoral marker.

[Scientigraphic hot lesions secondary to osseous metastases in a patient with multiple myeloma]. / Lesiones gammagráficas hipercaptadoras secundarias a metástasis óseas en paciente con mieloma múltiple.

The myeloma bone deposits may be normal or may also appear as areas of a low uptake on the bone scintigraphy; the presence of multiple hot lesions with negative X-ray and minimal CT findings in patients with multiple myeloma being very uncommon. We reported the case of a 68 year old woman suffering from a multiple myeloma with multiple and hot metastatic lesions in bone scintigraphy. The X-ray was negative and the CT-findings only demonstrated a lytic femoral lesion, the spinal osseous dissemination being confirmed by MRI. We believe that this is an interesting work due to the rarity of the scintigraphic pattern as well as the discussion carried out on the radionuclide imaging methods in the diagnosis of myeloma-related bone lesions.

[Role of 99mTC-Sestamibi in the diagnosis of breast cancer. Report on 100 cases]. / Papel del 99mTc-Sestamibi en el diagnóstico del cáncer de mama. A propósito de 100 casos.

OBJECTIVE: To evaluate the usefulness of the isotopic mammography with 99mTc-MIBI in the diagnosis of tumoral pathology of the mammary gland. METHODS: One hundred women with clinical/radiological suspicion of malignant pathology in the breast and/or lymph nodes were studied. The isotopic technique consisted of administration 740MBq 99mTc-MIBI, i.v., obtaining AP and prone lateral views. RESULTS: The overall sensitivity and specificity for the scintimammography in tumoral detection was 90% and 86% respectively. The sensitivity was 60% in nonpalpable lesions. The scintimammography had a 40% sensitivity and 98% specificity in lymph node detection. CONCLUSION: The complementary use of scintimammography can improve the sensitivity for the detection of breast carcinoma. The diagnostic accuracy of 99mTc-MIBI depends on the tumor size and histopathological characteristics. The 99mTc-MIBI can potentially determine the presence of recurrent breast cancer and multicentric disease.

[Locating the sentinel node in breast cancer by gamma probe and staining agent. Preliminary study]. / Localización del ganglio centinela en el cáncer de mama mediante sonda gammadetectora y colorante. Estudio preliminar.

OBJECTIVE: The sentinel node biopsy appears to offer an alternative to routine axillary lymph node dissection for staging patients with breast cancer. Various techniques have been studied for identifying the sentinel node, using vital blue or radioactive colloid. This study aimed to evaluate our preliminary results with these techniques. MATERIAL AND METHODS: In this work carried out in the Valencian Institute of Oncology, 21 women with T1- T2 breast cancer with an average age of 52 years (range: 42-73) underwent the sentinel node biopsy, which was immediately followed by standard axillary dissection. Both blue dye and radioisotope were used to identify the sentinel node. The radioactive axillary of sentinel node was localized by the gamma probe. RESULTS: The sentinel node was successfully identified by lymph node scintigraphy in 100%. It was localized by blue dye in 33% and by combination of blue dye and isotope in 95%. Of the 21 patients in this study in whom sentinel nodes were identified, 7 (35%) were histologically positive; in 6 cases, the sentinel was the only site of the metastases (86%). The histology of the sentinel node accurately predicted axillary node status in 95% of cases. CONCLUSIONS: The sentinel node biopsy technique is a promising and feasible procedure in patients with clinically T1-T2 N0M0 breast cancer, providing valuable axillary staging information.

[Lympho-gammagraphy and study of sentinel node in cutaneous melanoma]. / Linfogammagrafía y estudio del ganglio centinela en el melanoma cutáneo.

OBJECTIVE: To evaluate the role of selective sentinel lymph node dissection to reduce the number of unnecessary lymphadenectomies in patients with intermediate risk of melanoma and without clinical evidence of regional node and distant metastases. MATERIAL AND METHOD: We studied 65 patients with stage I and II melanoma. Only vital blue dye mapping was carried out in nine patients and combined lymphatic mapping with both blue dye and lymphoscintigraphy was used in the remaining 56 patients. RESULTS: The sentinel node was identified in 63 of 65 patients (97%). Only eighth patients (12%) were found to have metastatic melanoma cells in their sentinel node. CONCLUSIONS: Our findings confirm that the intraoperative lymphatic mapping of the sentinel node using both blue dye and radiodetection is an appropriate and simple technique for selecting patients who are more likely to benefit from lymph node dissection.

[The content of DNA, RNA and wet weight and the RNA:DNA and wet weight:DNA ratio in different tissues during the growth of chickens. 1. Analysis of the brain, the myocardium, the lungs and the liver]. / Der Gehalt an DNA, an RNA und an Frischmasse sowie der RNA:DNA- und der Frischmasse: DNA-Quotient in verschiedenen Geweben während des Wachstums beim Huhn. 1. Mitteilung: Analyse des Gehirns, des Herzmuskels, der Lunge und der Leber.

At each 8 chickens of the race "white leghorn" analyses of the body weight as well of the wet weight and the concentration of DNA and of RNA in different tissues from the 2nd to the 203rd day after hatching were performed. On the 2nd day after hatching the DNA-concentration in the brain amounted to 1.50 +/- 0.12, in the heart-muscle to 2.86 +/- 0.19, in the lung to 7.23 +/- 0.19 and in the liver to 2.86 +/- 0.20 mg/g wet weight. The highest content of nuclei in the brain of 1.38 x 10(9) was estimated on the 56th, in the heart-muscle of 1.94 x 10(9) on the 168th day, in the lung of 16.86 x 10(9) on the 112th day and in the liver of 69.81 x 10(9) on the 203rd day. Further the RNA:DNA- and the wet weight:DNA-ratio of the different tissues was calculated.

[The content of the DNA, the RNA and the wet weight and the RNA:DNA and the wet weight:DNA ratio in different tissues during the growth of chickens. 2. Analysis of the kidney, the spleen, the gizzard and the M. pectoralis superficialis]. / Der Gehalt an DNA, an RNA und an Frischmasse sowie der RNA:DNA-und der Frischmasse:DNA-Quotient in verschiedenen Geweben während des Wachstums beim Huhn. 2. Mitteilung: Analyse der Nieren, der Milz, des Muskelmagens und des M. pectoralis superficialis.

At chicken of the race "White Leghorn" the content of nuclei in the kidney was highest (14.60 x 10(9)) on the 203rd, in the spleen on the 112th (14.85 x 10(9)), in the gizzard on the 112th (18,24 x 10(9)) and in the M. pectoralis superficialis on the 168th day (36.42 x 10(9)) after hatching. The biggest fresh weight:DNA-ratio was determined in the kidney on the 203rd (285), in the spleen on the 28th (92) and in the gizzard (694) and in the M. pectoralis superficialis (1984) on the 203rd day. The DNA-concentration on the 2nd day after hatching in the kidney was 4,56 +/- 0,36, in the spleen 11.49 +/- 0.84, in the gizzard 1.85 +/- 0.13 and in the M. pectoralis superficialis 2.96 +/- 0.18 mg/g wet weight respectively the RNA:DNA-ratio in these tissues 1.00, 0.88, 1.70 and 0.85. The growth of tissues by the increase of the number of cells (hyperplasia) and of the volume of cells (hypertrophy) is described.

[The effect of a different level of crude protein in the feed of chickens from 1 to 14 days after hatching on the development of body weight, the biochemical parameters of the liver and breast muscle and the serum level of total protein and albumin]. / Der Einfluss eines unterschiedlichen Gehalts an Rohprotein im Futter von Küken vom 1. bis zum 14. Tag nach dem Schlüpfen auf die Entwicklung der Körpermasse, auf biochemische Kennwerte der Leber und des Brustmuskels sowie auf den Gehalt des Serums an Gesamtprotein und an Albumin.

The effect of a concentration of crude protein of 170 or of 227 g/kg in the ration of chicken from the 1st to the 14th day after hatching on biochemical values of the liver, the M. pectoralis superficialis and the serum was analysed. The significance of developmental investigations in domestic animals under normal and pathological conditions is discussed.

[Joint utilization of glucose and n-alkanes in citric acid synthesis by Saccharomycopsis lipolytica]. / Gemeinsame Verwertung von Glucose und n-Alkanen bei der Citronensäuresynthese durch Saccharomycopsis lipolytica.

Fermentations for the overproduction of citrate and isocitrate with S. lipolytica in media containing both glucose and n-alkanes as mixed C-source have been performed. Biomass and product yields strongly depend on the C-source of the inoculation culture. If the inoculation culture had been taken from media containing glucose as sole C-source both glucose and n-alkanes were utilized for cell growth in the main culture whereas only glucose was utilized if the inoculation medium contained only n-alkanes. For idiophasic citrate and isocitrate production both glucose and n-alkanes were consumed independently of the C-source of the inoculum but that C-source was preferentially utilized which has been the C-source of the inoculation culture. These findings are reflected by the activities of the isocitrate lyase and the pyruvate carboxylase, respectively. In S. lipolytica both anaplerotic pathways are coexisting but the C-source of the inoculation culture determines the level of the specific activities even if the ratio of the cell-mass of the inoculum to the cell mass of the main culture at the end of the growth phase is about 1:35.

The step response: a method to characterize mechanisms of renal blood flow autoregulation.

Response of renal vasculature to changes in renal perfusion pressure (RPP) involves mechanisms with different frequency characteristics. Autoregulation of renal blood flow (RBF) is mediated by the rapid myogenic response, by the slower tubuloglomerular feedback (TGF) mechanism, and, possibly, by an even slower third mechanism. To evaluate the individual contribution of these mechanisms to RBF autoregulation, we analyzed the response of RBF to a step increase in RPP. In anesthetized rats, the suprarenal aorta was occluded for 30 s, and then the occlusion was released to induce a step increase in RPP. Three dampened oscillations were observed; their oscillation periods ranged from 9.5 to 13 s, from 34.2 to 38.6 s, and from 100.5 to 132.2 s, respectively. The two faster oscillations correspond with previously reported data on the myogenic mechanism and the TGF. In accordance, after furosemide, the amplitude of the intermediate oscillation was significantly reduced. Inhibition of nitric oxide synthesis by Nomega-nitro-l-arginine methyl ester significantly increased the amplitude of the 10-s oscillation. It is concluded that the parameters of the dampened oscillations induced by the step increase in RPP reflect properties of autoregulatory mechanisms. The oscillation period characterizes the individual mechanism, the dampening is a measure for the stability of the regulation, and the square of the amplitudes characterizes the power of the respective mechanism. In addition to the myogenic response and the TGF, a third rather slow mechanism of RBF autoregulation exists.

Valor de la determinación de la tiroglobulina sérica y de la gammagrafía mediante I-131 en el seguimiento del cáncer diferenciado de tiroides / Value of the detection of serum thyroglobulin and I-131 scintigraphy in the follow-up of differentiated thyroid cancer

Objetivo: El objetivo de nuestro estudio ha sido conocer la sensibilidad de la determinación de la tiroglobulina sérica y de la gammagrafía corporal mediante I-131 en la detección de tejido tiroideo residual y de la enfermedad loco-regional y a distancia; así como el valor predictivo de la tiroglobulina en el seguimiento de pacientes con cáncer diferenciado de tiroides. Método: Para ello hemos realizado un estudio retrospectivo de 218 enfermos con cáncer diferenciado de tiroides, diagnosticados y tratados de forma homogénea, en los que se había solicitado la determinación de tiroglobulina (TG) y la gammagrafía con I-131 tras efectuar la intervención quirúrgica y entre los 6 y los nueve meses posteriores a la misma, valorando ambas pruebas de "screening" en situación hormonal de hipotiroidismo. Se han excluido del estudio 16 pacientes con anticuerpos antitiroglobulina y 14 enfermos por carecer de un seguimiento completo. Resultados: Se ha obtenido una correlación entre ambas técnicas del 92 porciento, con una sensibilidad TG/scan para la detección de recidiva local de 85 y 90 porciento respectivamente y superior al 90 porciento para ambas pruebas en el diagnóstico de metástasis óseas y pulmonares. En el estudio de la afectación ganglionar regional y del tejido tiroideo residual, la sensibilidad del scan fue del 100 porciento para la gammagrafía con I-131 e inferior al 70 porciento para la tiroglobulina sérica. La determinación de la TG demostró un valor predictivo positivo del 99 porciento, con un valor predictivo negativo del 91 porciento y un total de 24 resultados falsos negativos. Conclusiones: Considerando nuestro trabajo, creemos que ambas exploraciones son complementarias, con una sensibilidad subóptima de la tiroglobulina en la detección de la afectación ganglionar loco-regional y del tejido tiroideo residual y un valor predictivo negativo que no permite realizar el seguimiento de pacientes con carcinoma diferenciado de tiroides, basándose únicamente en los resultados de este marcador tumoral (AU)

Lesiones gammagráficas hipercaptadoras secundarias a metástasis óseas en paciente con mieloma múltiple / Scintigraphic hot lesions secondary to osseous metastases in a patient with multiple myeloma

Las metástasis óseas en pacientes con mieloma múltiple pueden aparecer como áreas de baja o normal captación del radiofármaco; siendo muy infrecuente la presencia de lesiones hipercaptadoras múltiples con radiografía ósea negativa y cambios mínimos en la tomografía axial computarizada (TAC).Presentamos el caso clínico de una mujer de 68 años con metástasis óseas hipercaptadoras diagnosticadas por gammagrafía ósea secundarias a mieloma múltiple. La serie ósea fue negativa y la TAC únicamente demostró una lesión lítica femoral izquierda, confirmándose la diseminación ósea vertebral por resonancia magnética nuclear (RMN). Creemos interesante su aportación, por la rareza del patrón gammagráfico así como la discusión desarrollada sobre las técnicas de medicina nuclear en el diagnóstico de las metástasis óseas secundarias a mieloma múltiple. (AU)

Localización del ganglio centinela en el cáncer de mama mediante sonda gammadetectora y colorante. Estudio preliminar / Locating of the sentinel node in breast cancer by gamma probe and coloration agent. Preliminary study

Objetivo: La biopsia del ganglio centinela parece ofrecer una alternativa a la linfadenectomía convencional en el estadiaje de pacientes con cáncer de mama. Se han estudiado varias técnicas para identificar el ganglio centinela, usando azul vital o radiocoloide. El objetivo de este estudio fue evaluar nuestros resultados preliminares en estas técnicas. Material y métodos: En este trabajo, realizado en el Instituto Valenciano de Oncología, 21 mujeres con cáncer de mama T1-T2, con una edad media de 52 años (rango: 42-73) fueron sometidas a biopsia del ganglio centinela y posterior linfadenectomía axilar. Se usaron el colorante azul y el radioisótopo para identificar el ganglio centinela, usando una sonda detectora de radiación gamma. Resultados: El ganglio centinela fue identificado por linfogammagrafía en el 100 por ciento de los casos. Se localizó por colorante azul en el 33 por ciento y por la combinación de azul y radioisótopo en 95 por ciento. De los 21 pacientes de este estudio, en 7 (35 por ciento) el ganglio centinela fue histológicamente positivo; en 6 casos el ganglio centinela fue el único afecto (86 por ciento). Hubo correlación histológica entre el estado del ganglio centinela y de los ganglios axilares en el 95 por ciento de los casos. Conclusiones: La técnica del ganglio centinela es un método prometedor y de fácil realización en pacientes con cáncer de mama, clínicamente T1-T2N0M0, aportando información sobre el estadiaje axila (AU)