Cardiac Function and Serum Biomarkers throughout Staged Fontan Palliation: A Prospective Observational Study.

Fontan patients undergo multiple cardiothoracic surgeries in childhood. Following these procedures, ventricular function is temporarily decreased, and recovers over months. This is presumably related to cardiopulmonary bypass, but this is incompletely understood. Throughout the Fontan palliation, cardiac function is also affected by volume unloading. We aimed to gain insight into the biological processes related to impaired ventricular function and recovery following Fontan palliations using a panel of biomarkers. Furthermore, we described changes in ventricular function across the Fontan palliation due to volume unloading. We performed a prospective multicenter observational study in patients undergoing partial (PCPC) or total cavo-pulmonary connection (TCPC). Patients underwent assessment-including echocardiography and blood sampling-before surgery (T1), at first follow-up (T2), and 1 year after their procedures (T3). Blood samples were analyzed using a biomarker panel (OLINK CVD-III). Ninety-two biomarkers were expressed as principal components (PC) to limit multiple statistical testing. We included 32 PCPC patients aged 7.2 [5.3-10.3] months, and 28 TCPC patients aged 2.7 [2.2-3.8] years. The single ventricular longitudinal strain (SV GLS) temporarily decreased for PCPC patients at T2 (-15.1 ± 5.6 (T1) to -13.5 ± 5.2 (T2) to -17.3 ± 4.5 (T3), p < 0.047 for all differences), but not following TCPC. The serum biomarkers were expressed as 4 PCs. PC1, including biomarkers of cell-cell adhesion, was not related to any patient characteristic. PC2, including biomarkers of superoxide anion regulation, increased at T2. PC3, including biomarkers of cardiovascular development, related to the stage of Fontan palliation. PC4 was of uncertain biological or clinical significance. No PC was found that related to ventricular performance. The SV GLS was temporarily diminished following PCPC, but not following TCPC. Several biomarkers were related to post-operative stress and adaptation to the PCPC or TCPC circulation, but none were related to the outcome.

[Diagnostic value of parathyroid localization techniques in surgery for primary hyperparathyroidism]. / Valor diagnóstico de las técnicas de localización paratiroidea en la cirugía del hiperparatiroidismo primario.

OBJECTIVES: To determine the accuracy of imaging techniques for localization of nodular lesions of parathyroid glands. MATERIAL AND METHODS: Seventy one patients were prospectively enrolled and underwent surgical examination for primary hyperparathyroidism. Ultrasonography (US), 201Tl/99mTc parathyroid subtraction scintigraphy and 99mTc MIBI scintigraphy were evaluated. RESULTS: The sensitivity and specificity for combined 201Tl/99mTc parathyroid subtraction scintigraphy and US for parathyroid adenomas were 72.27% and 89.22% respectively. The combination of 99mTc MIBI scintigraphy and US resulted in improved specificity (93.67%) and positive predictive value (80.39%). The accuracy of the localizing studies was lower for patients with hyperplasia. CONCLUSIONS: The combination of scintigraphy and US is the best approach for localization of nodules. In most cases, the two techniques are complementary.

Valor diagnóstico de las técnicas de localización paratiroidea en la cirugía del hiperparatiroidismo primario / Diagnostic value of parathyroid localization techniques in surgery for primary hyperparathyroidism

Objetivo: Determinar la rentabilidad diagnóstica de las diferentes técnicas de localización de las glándulas paratiroides. Material y Métodos: Se realiza un estudio prospectivo sobre 71 pacientes diagnosticados de hiperparatiroidismo primario e intervenidos quirúrgicamente. Evaluamos la validez diagnóstica de la ecografía de alta resolución, gammagrafía de sustracción Talio/Tecnecio y gammagrafía sestamibi en doble fase. Resultados: La sensibilidad (S) y especificidad (E) de la utilización conjunta de la gammagrafía de sustracción Talio/Tecnecio y la ecografía en los adenomas fue de 72,27 por ciento y 89,22 por ciento, respectivamente. La combinación de la gammagrafía sestamibi seguida de la ecografía mejoró discretamente los parámetros evaluados, en particular la especificidad (93,67 por ciento) y el valor predictivo positivo (80,39 por ciento). En nuestra serie la rentabilidad diagnóstica ha sido inferior en las hiperplasias. Conclusión: La utilización conjunta de la gammagrafía seguida de la ecografía de alta resolución, realizadas por un operador experimentado, son la mejor estrategia diagnóstica a seguir para la localización preoperatoria de las glándulas paratiroides patológicas (AU)

OBJECTIVES: To determine the accuracy of imaging techniques for localization of nodular lesions of parathyroid glands. MATERIAL AND METHODS: Seventy one patients were prospectively enrolled and underwent surgical examination for primary hyperparathyroidism. Ultrasonography (US), 201Tl/99mTc parathyroid subtraction scintigraphy and 99mTc MIBI scintigraphy were evaluated. RESULTS: The sensitivity and specificity for combined 201Tl/99mTc parathyroid subtraction scintigraphy and US for parathyroid adenomas were 72.27% and 89.22% respectively. The combination of 99mTc MIBI scintigraphy and US resulted in improved specificity (93.67%) and positive predictive value (80.39%). The accuracy of the localizing studies was lower for patients with hyperplasia. CONCLUSIONS: The combination of scintigraphy and US is the best approach for localization of nodules. In most cases, the two techniques are complementary (AU)

Contabilidad de costes por actividades aplicada a los procesos hospitalarios / Cost accounting for activities applied to hospital processes

En la necesidad de disponer de un Instrumento de Gestión eficaz, relacionamos intrínsecamente la información económica con la actividad hospitalaria, con el objetivo de CONTROLAR LOS COSTES Y NO LIMITARNOS A SU DISTRIBUCIÓN. Iniciando el análisis por los Productos Intermedios elaborados en los Servicios Centrales de: Radiología; Anatomía Patológica; Laboratorio Clínico; Neurofisiología. Hemos continuado por las áreas de actividad de uso compartido: Consultas Externas; Quirófanos; Unidades de Hospitalización. Siendo nuestro objetivo último determinar Coste Proceso por adición del coste de cada una de las actividades necesarias para su desarrollo. Conocido el Coste Real por Proceso y contrastado con las decisiones clínicas protocolizadas, podemos optimizar la utilización de los recursos, planificar presupuestos en base a la actividad prevista, conocer nuestro nivel de competitividad y desarrollar políticas de estímulo y motivación, base de la Dirección Participativa por Objetivos. Deducimos Índices de Rendimiento, por el detalle con que se define la dedicación a cada actividad; y de Rentabilidad, por contraste con las tarifas de facturación de cada proceso (AU)

Value of radionuclide oesophageal transit in studies of functional dysphagia.

Radionuclide oesophageal transit time was evaluated in 70 individuals, divided into three groups: normal individuals, patients with non-organic dysphagia and patients with primary oesophageal motility disorders treated with per-endoscopic forced pneumatic dilatation. In all of them the oesophageal transit time of a bolus of water with 18.5 MBq (500 microCi) of 99Tmc sulphur colloid was assessed, as was the percentage of residual activity of the bolus in the oesophagus. There was a significant difference in these parameters between the control group and the group with non-organic dysphagia, the diagnostic capacity of this test being 93% sensitivity, 100% specificity, 100% positive predictive value and 90% negative predictive value, which suggests its inclusion in diagnostic protocols of dysphagias. In patients with primary oesophageal motility disorders, a significant decrease in values of residual activity has been observed after treatment with per-endoscopic forced pneumatic dilatation.