Coronariografía no invasiva meidante tac multicorte de 64 detectores en medicina del trabajo / Non-invasive coronariography with 64 detector-row multislice ct scan in ocupational medicine

Las enfermedades cardiovasculares representan la primera causa de mortalidad en los países industrializados; entre ellas, en España, la primera causa de mortalidad (30% del total por enfermedad cardiovascualar) es la esquemia miocárdica secuendaria a ateroclerosis coronaria. La caridopatía coronaria puede manifestarse de múltiples maneras y es importante identificar y valorar los síntomas que un paciente presenta para poder prevenir la aparición de un síndrome coronario agudo. A las tablas de factores de riego cardiovascular se han unido, más recientemente, una serie de exploraciones de imagen no invasivas; una de las que hoy manifiestan un mayor potencial es la de la TAC multicorete. Se exponen en el presente artículo la técnica, los requisitos, los inconvenientes y las aplicaciones clínicas de la coronariografía no invesiva mediante TAC multicorte con 64 detectores en Medicina del Trabajo (AU)

Cardiovascular diseases constitute the first cause of mortality in the inddustrialised countires; among them, and in Spain, the first one (30% of the total caridovascular mortality) is myocardial Iscaemi secondary to coronary artery atherosclerosis. Coronary heart disease may manifest in a number of ways, and it is important to identify and assess the symptoms in any given patient so as to be able to prevent the development of an acute corronary syndrome. A recent addition to the many cardiovascular risk factosr tables in use have been the non-invasive imaging techniques; among these, one of the those evidencing the greast potential is that multislice CT scan. The present paper reviews the technique, the requirements, the disadvantages and the clinical applications of non-invasive coronariography with 64 detector row multislice CT scan in the field of Occupational Medicine (AU)

Sobreexposicón al cobre en el ámbito industrial y agrícola / Copper overexposure in the industrial and agricultural environments

Se presentan dos casos de exposicón laboral por cobre. El primer caso es el de un soldador expuesto a polvo de cobre; presenta una cupruria elevada que nos hace que realicemos un seguimiento durante varios días sobre las concentraciones de cobre urinario. Estas determinaciones nos permiten evaluar el cobre urinario como biomarcador de exposición laboral. El segundo es un caso de intoxicación laboral por cobre debido a la inadecuada utilización de pesticidas que contienen cobre y que se emplean en el ámbito agrícola. De nuestras observaciones concluimos que la medición del cobre en muestras biológicas (sangre y orina) tiene utilidad en caso de intoxicación por cobre y en exposiciones elevadas por dicho metal, y permite, también, conocer problemas debidos a malas prácticas higiénico-sanitarias de los trabajadores

We report two cases of occupational overexposure. Case 1 is a welder exposed to copper powder. High cupruria levels led to a follow-up of the urinary copper concentrations in this patient over several days. These determinations have allowed us to assess the urinary copper levels as a biological marker of occupationa exposure. Case 2 is one of occupational copper intoxication due to inadequate handling and use of copper-containing pesticides used in agriculture. Based on our observations we conclude on the interest of the determination of copper in biological samples (blood and urine) in cases of copper intoxication and over-exposure, and at the same tiem render possible the detection of inadequate hygienic and health practices among workers

Sinusitis fúngicas no invasivas: sinusitis fúngica alergica y micetomas sinusales / Non-invasive fungal sinusitis; allergic fungal sinusitis and sinusal mycetomas

Revisamos los casos de sinusitis fúngica (SF) no invasivas tratados en nuestra Unidad aplicando la reciente clasificación de las SF, basada en su fisiopatologÍa, tratamiento y pronóstico. Presentamos una serie de 7 casos de SF no invasivas tratados durante 2 años con un seguimiento mínimo de 24 meses. Se trata de dos SF alérgicas, una de ellas asociada a aspergilosis broncopulmonar alérgica, y de cinco micetomas, dos de ellos sin cuerpo extraño sinusal, de localización esfenoidal y maxilar respectivamente, y otros tres asociados a un cuerpo extraño maxilar. Todos ellosfueron tratados mediante cirugía endoscópica sinusal. En los casos de SF alérgica, fue preciso añadir tratamiento corticoides sistémicos en el postoperatorio. Se revisa la presentación de los distintos tipos de SF no invasivas, la importancia de la endoscopia y de las técnicas de imagen, la utilidad de la cirugía endoscópica sinusal para su tratamiento, la asociación frecuente de las SF con los cuerpos extraños sinusales, y su pronóstico (AU)

We review non-invasive fungal sinusitis (FS) cases treated at our Unit following the recent SF classification, based on physiopathology, treatment and prognosis. We report 7 FS cases treated during 2 years and followed a minimum of 24 months. They are two allergic FS, one of them related to an allergic bronchopulmonary aspergillosis, and five mycetomas, two of them without a sinusal foreign body, sphenoidal and maxillary respectively, and three caused by a maxillary foreign body. All were treated by endoscopic sinus surgery (ESS). The two allergic cases were also treated with systemic corticoids in the postoperative period. We review the clinical presentation of the different types of non-invasive FS, the importance of endoscopy and imaging techniques in their management, the usefulness of ESS, the common association of FS to foreign bodies, and their prognosis (AU)

[Non-invasive fungal sinusitis: allergic fungal sinusitis and sinusal mycetomas]. / Sinusitis fúngicas no invasivas: sinusitis fúngica alérgica y micetomas sinusales.

We review non-invasive fungal sinusitis (FS) cases treated at our Unit following the recent SF classification, based on physiopathology, treatment and prognosis. We report 7 FS cases treated during 2 years and followed a minimum of 24 months. They are two allergic FS, one of them related to an allergic bronchopulmonary aspergillosis, and five mycetomas, two of them without a sinusal foreign body, sphenoidal and maxillary respectively, and three caused by a maxillary foreign body. All were treated by endoscopic sinus surgery (ESS). The two allergic cases were also treated with systemic corticoids in the postoperative period. We review the clinical presentation of the different types of non-invasive FS, the importance of endoscopy and imaging techniques in their management, the usefulness of ESS, the common association of FS to foreign bodies, and their prognosis.

Report of an image quality and dose audit according to directive 97/43/Euratom at Spanish private radiodiagnostics facilities.

An audit of Spanish private medicine radiodiagnostics facilities has been carried out, based partly on Spanish legislation relating to European Directives on health protection against ionizing radiation risks in medical exposure. The study included an appraisal of infrastructure and equipment, and aspects of quality assurance and radiation protection, by means of data collected through surveys. Of the 51 centres audited, a sample of 24 X-ray rooms was chosen, then an external evaluation with regard to image quality and patient dose was performed, by an advisory board of radiologists and medical physicists. The methodology used was similar to that of the group of European Union experts in European dose evaluation and image quality trials. Chest, abdomen, lumbar spine and breast examinations were monitored. Doses were measured with thermoluminescent dosimeters. A third of the X-ray rooms evaluated reached or exceeded dose reference values, and in a third of the cases the image quality left considerable room for improvement. Breast and chest examinations showed themselves to be the hardest to perform, not only as a result of exceeding the reference doses, but also due to failure to meet good image quality standards.

Image quality and dose in lumbar spine examinations: results of a 5 year quality control programme following the European quality criteria trial.

The large dose values found for lumbar spine examinations in a centre participating in the European quality criteria trial have been investigated within a 5 year quality control programme. Actions focused mainly on optimizing the focus-to-film distance, tube potential (kV), film optical density and X-ray beam filtration. These actions lead to overall dose reductions of up to 75% in lumbo-sacral joint examinations and prove the need for a regular survey of patient skin doses.

Radiographic findings for the adult respiratory distress syndrome in patients with peritonitis.

Ninety-seven consecutive patients admitted to the ICU with peritonitis were studied. Of these, 66 (68%) died and autopsies were performed on 38 (58%). Twelve of the 38 autopsied patients showed pathologic criteria of adult respiratory distress syndrome (ARDS); 26 did not. Chest x-rays of the 38 autopsied patients were examined and 9 (75%) of the 12 patients with histologic criteria of ARDS, specifically, moderate or severe fibrosis, had decreased pulmonary longitudinal diameter on serial chest x-rays. The remaining 3 (25%) patients did not have this specific finding. Of the 26 patients without pathologic criteria of ARDS, only 2 (8%) had reduction in pulmonary longitudinal diameter. We conclude that a marked reduction in the pulmonary longitudinal diameter is highly suggestive of ARDS and especially useful in differentiating ARDS from bilateral pneumonia.