Gammagrafía con 75SeHCAT en la diarrea crónica por malabsorción de ácidos biliares / 75SeHCAT scan in bile acid malabsorption in chronic diarrhoea

La diarrea crónica es una entidad común en la práctica clínica diaria y supone un deterioro en la calidad de vida de los pacientes. Puede ser el síntoma principal de múltiples etiologías, entre las que se encuentra la malabsorción de ácidos biliares (MAB), que en la población general presenta una prevalencia comparable a la enfermedad celíaca. La MAB ocurre por una alteración en la homeostasis de los ácidos biliares en la circulación enterohepática. Puede aparecer como consecuencia de una disfunción o enfermedad ileal (MAB tipo II), por causas idiopáticas (MAB tipo II) o asociada con otras entidades gastrointestinales (MAB tipo III). Entre los diferentes métodos diagnósticos disponibles destacamos la gammagrafía con 75SeHCAT como gold standard debido a sus valores de sensibilidad, especificidad, seguridad y bajo coste. La principal desventaja es que no se encuentra disponible en todos los países, por lo que se han desarrollado otros métodos como la medición sérica de FGF19 y C4 que, sin embargo, presentan una mayor complejidad y coste. El tratamiento de primera línea ante un diagnóstico de MAB es con quelantes de ácidos biliares como la colestiramina, pero presenta baja tolerabilidad y efectos secundarios, que son menores con los nuevos fármacos como el colesevelam. En resumen, la MAB es una entidad común que se encuentra infradiagnosticada e infratratada, por lo que es fundamental establecer un adecuado algoritmo diagnóstico de la diarrea crónica en el que el estudio con 75SeHCAT ocuparía la primera o segunda línea en el diagnóstico diferencial de estos pacientes (AU)

Chronic diarrhoea is a common entity in daily clinical practice and it leads to a loss in these patients quality of life. It may be the main symptom of multiple ethiologies including bile acid malabsorption (BAM) which has a comparable prevalence to celiac disease. The BAM results from imbalances in the homeostasis of bile acids in the enterohepatic circulation. It can be a consequence of ileal disease or ileal dysfunction (BAM type I), it can be considered idiopathic or primary (BAM type II) or associated with other gastrointestinal entities (BAM type III). Among the different diagnostic methods available, 75SeHCAT study is the primary current method due to its sensitivity, specificity, safety and low cost. The main disadvantage is that it's not available in all countries, so other diagnostic methods have appeared, such as serum measurement of FGF19 and C4, however they are significantly more complex and costly. The first-line treatment of bile acid diarrhoea is bile acid sequestrant, such as cholestyramine, which can be difficult to administer due to its poor tolerability and gastrointestinal side effects. These are less prominent with newer agents such as colesevelam. In summary, the BAM is a common entity underdiagnosed and undertreated, so it is essential to establish a diagnosis algorithm of chronic diarrhoea in which the 75SeHCAT study would be first or second line in the differential diagnosis of these patients (AU)

75SeHCAT scan in bile acid malabsorption in chronic diarrhoea. / Gammagrafía con 75SeHCAT en la diarrea crónica por malabsorción de ácidos biliares.

Chronic diarrhoea is a common entity in daily clinical practice and it leads to a loss in these patients quality of life. It may be the main symptom of multiple ethiologies including bile acid malabsorption (BAM) which has a comparable prevalence to celiac disease. The BAM results from imbalances in the homeostasis of bile acids in the enterohepatic circulation. It can be a consequence of ileal disease or ileal dysfunction (BAM type i), it can be considered idiopathic or primary (BAM type ii) or associated with other gastrointestinal entities (BAM type iii). Among the different diagnostic methods available, 75SeHCAT study is the primary current method due to its sensitivity, specificity, safety and low cost. The main disadvantage is that it's not available in all countries, so other diagnostic methods have appeared, such as serum measurement of FGF19 and C4, however they are significantly more complex and costly. The first-line treatment of bile acid diarrhoea is bile acid sequestrant, such as cholestyramine, which can be difficult to administer due to its poor tolerability and gastrointestinal side effects. These are less prominent with newer agents such as colesevelam. In summary, the BAM is a common entity underdiagnosed and undertreated, so it is essential to establish a diagnosis algorithm of chronic diarrhoea in which the 75SeHCAT study would be first or second line in the differential diagnosis of these patients.

Validación de fases estacionarias en la cromatografía planar de 111In-pentetreótida / Validation of stationary phases in 111In-pentetreotide planar chromatography

Introducción: Tras el cese en la fabricación de ITLC-SG por Pall-Gelman, es necesaria la validación de fases estacionarias alternativas. Objetivo: Validar diferentes fases estacionarias frente a ITLC-SG de Pall-Gelman en la determinación de la pureza radioquímica (PRQ) de 111In-pentetreótida (111In-Octreoscan) por cromatografía planar. Material y métodos: Realizamos un estudio caso-control en el que incluimos 66 preparaciones de 111In-pentetreótida. Determinamos la PRQ mediante cromatografía plana, empleando una solución recién preparada de citrato de sodio de 0,1 M (pH 5) y las siguientes fases estacionarias: ITLC-SG (Pall-Gelman) (método de referencia), iTLC-SG (Varian), Silicagel 60 HPTLC (Merck), Whatman 1, Whatman 3 MM y Whatman 17. Para cada uno de los métodos calculamos: PRQ, factores de retención (RF) del radiofármaco e 111In libre, tiempo de desarrollo cromatográfico y resolución entre picos. Comparamos los resultados obtenidos con los del método de referencia. Para el análisis estadístico de datos utilizamos el programa SPSS. Para el estudio de significación estadística calculamos el valor de p. Resultados: Con Silicagel 60 HPTLC (Merck) se obtiene la mayor resolución, aunque el tiempo de desarrollo cromatográfico es prolongado (media = 33,62 min). Con iTLC-SG (Varian) se obtiene una resolución mayor que con el método de referencia, siendo menor el tiempo de desarrollo cromatográfico (media = 3,61 min). Con papel Whatman se obtienen resoluciones muy bajas, fundamentalmente con Whatman 1 y 3 MM, por lo que no recomendamos su utilización. Conclusiones. Aunque iTLC-SG (Varian) y Silicagel 60 HPTLC (Merck) son alternativas adecuadas a ITLC-SG (Pall-Gelman) en la determinación de la PRQ de 111In-pentetreótida, iTLC-SG (Varian) es el método de elección por su menor tiempo de desarrollo cromatográfico(AU)

Introduction: Since Pall-German stopped manufacturing ITLC-SG, it has become necessary to validate alternative stationary phases. Objective: To validate different stationary phases versus ITLC-SG Pall-Gelman in the determination of the radiochemical purity (RCP) of 111In-pentetreotide (111In-Octreoscan) by planar chromatography. Material and methods: We conducted a case-control study, which included 66 111In-pentetreotide preparations. We determined the RCP by planar chromatography, using a freshly prepared solution of 0,1 M sodium citrate (pH 5) and the following stationary phases: ITLC-SG (Pall-Gelman) (reference method), iTLC-SG (Varian), HPTLC silica gel 60 (Merck), Whatman 1, Whatman 3 MM and Whatman 17. For each of the methods, we calculated: PRQ, relative front values (RF) of the radiopharmaceutical and free 111In, chromatographic development time, resolution between peaks. We compared the results obtained with the reference method. The statistical analysis was performed using the SPSS program. The p value was calculated for the study of statistical significance. Results: The highest resolution is obtained with HPTLC silica gel 60 (Merck). However, the chromatographic development time is too long (mean = 33.62 minutes). Greater resolution is obtained with iTLC-SG (Varian) than with the reference method, with lower chromatographic development time (mean = 3.61 minutes). Very low resolutions are obtained with Whatman paper, essentially with Whatman 1 and 3 MM. Therefore, we do not recommend their use. Conclusions: Although iTLC-SG (Varian) and HPTLC silica gel 60 (Merck) are suitable alternatives to ITLC-SG (Pall-Gelman) in determining the RCP of 111In-pentetreotide, iTLC-SG (Varian) is the method of choice due to its lower chromatographic development time(AU)

Validation of stationary phases in (111)In-pentetreotide planar chromatography.

INTRODUCTION: Since Pall-German stopped manufacturing ITLC-SG, it has become necessary to validate alternative stationary phases. OBJECTIVE: To validate different stationary phases versus ITLC-SG Pall-Gelman in the determination of the radiochemical purity (RCP) of (111)In-pentetreotide ((111)In-Octreoscan) by planar chromatography. MATERIAL AND METHODS: We conducted a case-control study, which included 66 (111)In-pentetreotide preparations. We determined the RCP by planar chromatography, using a freshly prepared solution of 0,1M sodium citrate (pH 5) and the following stationary phases: ITLC-SG (Pall-Gelman) (reference method), iTLC-SG (Varian), HPTLC silica gel 60 (Merck), Whatman 1, Whatman 3MM and Whatman 17. For each of the methods, we calculated: PRQ, relative front values (RF) of the radiopharmaceutical and free (111)In, chromatographic development time, resolution between peaks. We compared the results obtained with the reference method. The statistical analysis was performed using the SPSS program. The p value was calculated for the study of statistical significance. RESULTS: The highest resolution is obtained with HPTLC silica gel 60 (Merck). However, the chromatographic development time is too long (mean=33.62minutes). Greater resolution is obtained with iTLC-SG (Varian) than with the reference method, with lower chromatographic development time (mean=3.61minutes). Very low resolutions are obtained with Whatman paper, essentially with Whatman 1 and 3MM. Therefore, we do not recommend their use. CONCLUSIONS: Although iTLC-SG (Varian) and HPTLC silica gel 60 (Merck) are suitable alternatives to ITLC-SG (Pall-Gelman) in determining the RCP of (111)In-pentetreotide, iTLC-SG (Varian) is the method of choice due to its lower chromatographic development time.

[Response of thyroglobulin, anti-thyroglobulin antibodies, TSH, FT4 and total T3 after rhTSH stimulation in differentiated thyroid carcinoma]. / Respuesta de tiroglobulina, anticuerpos antitiroglobulina, TSH, FT4 y T3 total tras estimulación con rhTSH en carcinoma diferenciado de tiroides.

OBJECTIVE: To analyse the behaviour of serum thyroglobulin (Tg), antithyroglobulin antibodies (TgAb), thyrotropin (TSH), free thyroxine (FT4) and total triiodothyronine (TT3) levels at each time during the rhTSH stimulation protocol in patients with differentiated thyroid carcinoma (DTC). MATERIALS AND METHODS: We carried out 117 rhTSH stimulations in DTC patients. We determined the serum levels of Tg, TgAb, TSH, FT4 and TT3 at baseline and 24, 48 and 96 hours after beginning stimulation, using RIA or IRMA. The software program SPSS 15.0 was used for statistical analysis of data. RESULTS: We found statistically significant differences between the mean Tg values at different times (2.08 ng/ml baseline; 2.64 ng/ml at 24 hours; 4.98 ng/ml at 48 hours; 6.59 ng/ml at 96 hours), reaching maximum values at 96 hours. During this time, we observed the highest percentage of pathological values. After administration of rhTSH, there was a significant increase in the mean TSH value (98.88 mIU/l at 24 hours; 111.10 mIU/l at 48 hours). The mean TSH value at 96 hours decreased approximately 5 times with respect to the mean 48 hour value. We did not observe changes in the TgAb, FT4 or TT3 levels. CONCLUSIONS: The assessment of Tg after rhTSH stimulation should be performed 96 hours after beginning stimulation. Administration of rhTSH causes a significant elevation in serum TSH levels, without modifying serum TgAb, FT4 or TT3 levels.

Respuesta de tiroglobulina, anticuerpos antitiroglobulina, TSH, FT4 y T3 total tras estimulación con rhTSH en carcinoma diferenciado de tiroides / Response of thyroglobulin, anti-thyroglobulin antibodies, TSH, FT4 and total T3 after rhTSHstimulation in differentiated thyroid carcinoma

Objetivo. Analizar el comportamiento de los niveles séricos de tiroglobulina (Tg), anticuerpos antitiroglobulina (AbTg), tirotropina (TSH), tiroxina libre (FT4) y triyodotironina total (T3T) en cada momento del protocolo de estimulación con TSH humana recombinante (rhTSH), en pacientes con carcinoma diferenciado de tiroides (CDT). Material y métodos. Realizamos 117 estimulaciones con rhTSH en pacientes con CDT. Determinamos, mediante radioinmunoanálisis o análisis radioinmunométrico, los niveles séricos de Tg, AbTg, TSH, FT4 y T3T basales y a las 24, 48 y 96 horas tras el inicio del estímulo. Para el análisis estadístico de los datos utilizamos el programa SPSS 15.0. Resultados. Encontramos diferencias estadísticamente significativas entre los valores medios de Tg en los distintos tiempos (2,08 ng/ml basal; 2,64 ng/ml a las 24 horas; 4,98 ng/ml a las 48 horas; 6,59 ng/ml a las 96 horas), alcanzándose valores máximos a las 96 horas. En este tiempo observamos el mayor porcentaje de valores patológicos. Tras la administración de rhTSH, se produce un aumento significativo en el valor medio de TSH (98,88 mUI/l a las 24 horas; 111,10 mUI/l a las 48 horas). El valor medio de TSH a las 96 horas disminuyó aproximadamente 5 veces con respecto al valor medio de las 48 horas. No observamos cambios en los niveles de AbTg, FT4 ni T3T. Conclusiones. La valoración de Tg tras estímulo con rhTSH debe realizarse a las 96 horas del inicio del estímulo. La administración de rhTSH produce una elevación significativa de los niveles séricos de TSH, sin modificar los niveles séricos de AbTg, FT4 ni T3T

Objective. To analyse the behaviour of serum thyroglobulin (Tg), antithyroglobulin antibodies (TgAb), thyrotropin (TSH), free thyroxine (FT4) and total triiodothyronine (TT3) levels at each time during the rhTSH stimulation protocol in patients with differentiated thyroid carcinoma (DTC). Materials and methods. We carried out 117 rhTSH stimulations in DTC patients. We determined the serum levels of Tg, TgAb, TSH, FT4 and TT3 at baseline and 24, 48 and 96 hours after beginning stimulation, using RIA or IRMA. The software program SPSS 15.0 was used for statistical analysis of data. Results. We found statistically significant differences between the mean Tg values at different times (2.08 ng/ml baseline; 2.64 ng/ml at 24 hours; 4.98 ng/ml at 48 hours; 6.59 ng/ml at 96 hours), reaching maximum values at 96 hours. During this time, we observed the highest percentage of pathological values. After administration of rhTSH, there was a significant increase in the mean TSH value (98.88 mIU/l at 24 hours; 111.10 mIU/l at 48 hours). The mean TSH value at 96 hours decreased approximately 5 times with respect to the mean 48 hour value. We did not observe changes in the TgAb, FT4 or TT3 levels. Conclusions. The assessment of Tg after rhTSH stimulation should be performed 96 hours after beginning stimulation. Administration of rhTSH causes a significant elevation in serum TSH levels, without modifying serum TgAb, FT4 or TT3 levels

[Quality assurance of the renal applications software]. / Control de calidad de las aplicaciones de procesado renal.

INTRODUCTION: The need for quality assurance of all technical aspects of nuclear medicine studies is widely recognised. However, little attention has been paid to the quality assurance of the applications software. Our work reported here aims at verifying the analysis software for processing of renal nuclear medicine studies (renograms). MATERIAL AND METHODS: The software tools were used to build a synthetic dynamic model of renal system. The model consists of two phases: perfusion and function. The organs of interest (kidneys, bladder and aortic artery) were simple geometric forms. The uptake of the renal structures was described by mathematic functions. Curves corresponding to normal or pathological conditions were simulated for kidneys, bladder and aortic artery by appropriate selection of parameters. RESULTS: There was no difference between the parameters of the mathematic curves and the quantitative data produced by the renal analysis program. CONCLUSION: Our test procedure is simple to apply, reliable, reproducible and rapid to verify the renal applications software.

Control de calidad de las aplicaciones de procesado renal / Quality assurance of the renal applications software

Objetivo. Todos los aspectos técnicos de los estudios de Medicina Nuclear deben ajustarse a un programa de garantía de calidad. Sin embargo, se ha prestado poca atención al control de calidad de las aplicaciones de procesado. Nuestro trabajo pretende verificar los programas de análisis empleados en el procesado de los estudios renales (renogramas). Material y métodos. Mediante software hemos construido un modelo dinámico sintético del sistema renal. El modelo consta de dos fases: perfusión y función. Los órganos de interés (riñones, vejiga y arteria aorta) fueron simulados mediante formas geométricas simples. Las captaciones de las estructuras renales vienen descritas por funciones matemáticas. Se simularon distintas curvas de actividad-tiempo de riñón, vejiga y arteria aorta correspondientes a situaciones normales y patológicas mediante la selección adecuada de parámetros. Resultados. No se ha observado ninguna diferencia entre los parámetros de las curvas matemáticas y los datos cuantitativos producidos por el programa de análisis renal. Conclusión. Nuestro procedimiento nos permite verificar los programas de procesado de los estudios renales de forma simple, fiable, reproducible y rápida

Introduction. The need for quality assurance of all technical aspects of nuclear medicine studies is widely recognised. However, little attention has been paid to the quality assurance of the applications software. Our work reported here aims at verifying the analysis software for processing of renal nuclear medicine studies (renograms). Material and methods. The software tools were used to build a synthetic dynamic model of renal system. The model consists of two phases: perfusion and function. The organs of interest (kidneys, bladder and aortic artery) were simple geometric forms. The uptake of the renal structures was described by mathematic functions. Curves corresponding to normal or pathological conditions were simulated for kidneys, bladder and aortic artery by appropriate selection of parameters. Results. There was no difference between the parameters of the mathematic curves and the quantitative data produced by the renal analysis program. Conclusion. Our test procedure is simple to apply, reliable, reproducible and rapid to verify the renal applications software

99mTc-HMPAO leucocitos: imagen ''donuts'' por adenocarcinoma metastásico / 99mTc-HMPAO leukocytes: doughnut image due to adenocarcinoma of colon

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