RESUMEN
Objetivo Identificar la frecuencia de errores en los documentos de consentimiento informado en cirugía radioguiada en un hospital de tercer nivel y detectar posibles causas o factores asociados a un mayor riesgo de error. Material y método Se analizaron los consentimientos informados de un total de 369 intervenciones de cirugía radioguiada, cumplimentados por los servicios de Medicina Nuclear y Cirugía General, y se analizó el grado de cumplimentación de los mismos y su correlación con facultativos responsables, tipo de enfermedad e intervención, tiempo de espera y cumplimentación del consentimiento de la otra especialidad. Resultados Se identificaron errores en 22 consentimientos de Medicina Nuclear y 71 consentimientos de Cirugía General. El error más común fue la ausencia de identificación del facultativo responsable (17 en Medicina Nuclear, 51 en Cirugía General), y el segundo más común la ausencia de documento (2 en Medicina Nuclear, 20 en Cirugía General). Existieron diferencias significativas en los errores cometidos en función del médico responsable, sin encontrarse correlación significativa con el resto de las variables. Conclusiones Los médicos responsables fueron el principal factor asociado a un mayor riesgo de error en la cumplimentación de consentimientos informados. Serían recomendables nuevos estudios para analizar factores casuales y posibles intervenciones para minimizar errores (AU)
Objective To identify the frequency of errors in the informed consent documents in radioguided surgery in a third level hospital and to detect possible causes or factors associated with a greater risk of error. Material and method The informed consents of a total of 369 radioguided surgery interventions, completed by the Nuclear Medicine and General Surgery services, were analyzed, as well as their degree of completion and its correlation with responsible physicians, type of pathology and intervention, waiting time and completion of the consent of the other specialty. Results Errors were identified in 22 consent forms for Nuclear Medicine and 71 consent forms for General Surgery. The most common error was the absence of identification of the responsible physician (17 in Nuclear Medicine, 51 in General Surgery), and the second most common was the absence of a document (2 in Nuclear Medicine, 20 in General Surgery). There were significant differences in the errors made depending on the doctor in charge, without finding a significant correlation with the other variables. Conclusions The responsible physicians were the main factor associated with a greater risk of error in the completion of informed consent. New studies would be recommended to analyze causal factors and possible interventions to minimize errors (AU)
Asunto(s)
Humanos , Consentimiento Informado , Medicina Nuclear , Cirugía Asistida por Computador , Procedimientos Quirúrgicos Operativos/métodos , Factores de RiesgoRESUMEN
OBJECTIVE: To identify the frequency of errors in informed consent documents in radioguided surgery in a third level hospital and to detect possible causes or factors associated with a greater risk of error. MATERIAL AND METHODS: Informed consent forms of a total of 369 radioguided surgery interventions, completed by the Nuclear Medicine and General Surgery services, were analyzed, and the degree of completion of the forms and its correlation with the physicians responsible, type of pathology, intervention, and waiting time were compared with the completion of consent by another specialty. RESULTS: Errors were identified in 22 consent forms from Nuclear Medicine and 71 from General Surgery. The most common error was the absence of identification of the physician responsible (17 in Nuclear Medicine, 51 in General Surgery), and the second most common was the absence of a document (2 in Nuclear Medicine, 20 in General Surgery). There were significant differences in the errors made depending on the doctor in charge, with no significant correlation with the other variables. CONCLUSIONS: The physicians responsible were the main factor associated with a greater risk of error in the completion of informed consent forms. Further studies are needed to analyze the causal factors and possible interventions to minimize errors.
Asunto(s)
Medicina Nuclear , Cirugía Asistida por Computador , Consentimiento Informado , HospitalesAsunto(s)
Neoplasias Óseas/diagnóstico por imagen , Neoplasias de la Mama/radioterapia , Clavícula/diagnóstico por imagen , Neoplasias Inducidas por Radiación/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Sarcoma/diagnóstico por imagen , Anciano , Neoplasias Óseas/etiología , Resultado Fatal , Femenino , Fluorodesoxiglucosa F18 , Humanos , Radiofármacos , Sarcoma/etiologíaRESUMEN
The aim of this review is to provide an updated perspective on different fields of radioguided surgery. With reference to the sentinel lymph node biopsy in oral squamous cell carcinoma, we present the results of the interactive debate held at the recent Congress of our specialty about the more relevant aspects of the London Consensus. Drainage peculiarities and indications according to the current guidelines on gynaecological tumours, endometrial and cervical cancer, are detailed and new scenarios for nuclear medicine physicians are presented; robotic surgery and hybrid tracers, for instance. Moreover, the notable growth in radioguided surgery indications for non-palpable lesions, widely used in mammary pathology, make it advisable to update two procedures which have shown satisfying results, such as the solitary pulmonary nodule and the osteoid osteoma.
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Neoplasias de los Genitales Femeninos/cirugía , Neoplasias de Cabeza y Cuello/cirugía , Cirugía Asistida por Computador , Conferencias de Consenso como Asunto , Femenino , Humanos , Biopsia del Ganglio Linfático CentinelaRESUMEN
INTRODUCTION AND OBJECTIVE: Febrile syndromes of unknown origin (FSUO) are complex processes in hospital practice. Their management includes an exhaustive medical history and examination, as well as an extensive number of biochemical tests. If these are inconclusive, diagnostic imaging techniques such as SPECT/CT with 67-Gallium Citrate (67Ga-SPECT/CT) could play an important role. We evaluated its role in the management of FSUO in our healthcare area. MATERIAL AND METHODS: We reviewed 57 patients who underwent a 67Ga-SPECT/CT due to a FSUO (32 women and 25 men, age range: 32-83 years old) obtaining scintigraphic findings, previous treatments and final diagnosis. Values of sensitivity, specificity, positive predictive values (VPP) and negative values (NPV) were obtained and compared with the results for PET/CT with 18Fluor-deoxy-glucose (18F-FDG PET/CT) found in the literature. RESULTS: The diagnoses found were: infection in 27/57 (47%), inflammatory disease in 15/57 (26%), neoplasm in 1/57 (1.75%) and patients without final diagnosis in 14/57 (24%). The statistical values of 67Ga-SPECT/CT were: sensitivity, specificity, PPV and NPV of 67%, 93%, 97% y 48%, respectively which were slightly lower than those found for the 18F-FDG PET/CT (86%, 52%, 70% and 92%, respectively). The diagnostic yield was 73% which increased to 80% in the patients who lacked empirical treatment. CONCLUSION: Despite the better results of 18F-FDG PET/CT, 67Ga-SPECT/CT behaved as a useful technique in the management of FSUO. It is advisable to use it if 18F-FDG PET/CT is not available.
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Fiebre de Origen Desconocido/diagnóstico por imagen , Radioisótopos de Galio , Tomografía Computarizada por Tomografía de Emisión de Positrones , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Fiebre de Origen Desconocido/etiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , SíndromeRESUMEN
The case is presented on a patient with abdominal pain and suspicion of neuroendocrine tumor in the tail of the pancreas shown in the abdominal CT and MRI. Whole-body scintigraphy and abdominal SPECT/CT with 99mTc-octreotide were performed that showed a nodular lesion partially on the posterior side of the pancreas tail. This nodule showed faint tracer uptake, and was reported as probable neuroendocrine tumor. Partial pancreatectomy and splenectomy were performed, and the histological study identified the lesion as an ectopic spleen. There are similar cases in the literature that match these findings, but this lesion is still frequently diagnosed after performing unnecessary surgery. When an asymptomatic intrapancreatic mass is detected, an accessory spleen should be considered and specific diagnostic techniques should be performed, such as labeled and denatured red blood cell SPECT/CT.
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Coristoma/diagnóstico por imagen , Errores Diagnósticos , Enfermedades Pancreáticas/diagnóstico por imagen , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único , Bazo/diagnóstico por imagen , Dolor Abdominal/etiología , Anciano , Coristoma/cirugía , Humanos , Imagen por Resonancia Magnética , Masculino , Tumores Neuroendocrinos/diagnóstico , Octreótido/análogos & derivados , Compuestos de Organotecnecio , Pancreatectomía , Enfermedades Pancreáticas/cirugía , Neoplasias Pancreáticas/diagnóstico , Radiofármacos , Bazo/cirugía , Esplenectomía , Tecnecio , Tomografía Computarizada por Rayos X , Procedimientos Innecesarios , Imagen de Cuerpo EnteroRESUMEN
Cerebral malaria is a serious complication of infection with Plasmodium falciparum. Its pathophysiological mechanisms and clinical manifestations are still currently being studied. Structural imaging techniques such as CT and MRI provide non-specific information during the diagnostic process. However, there are hardly any references on the use and potential benefits of radioisotope procedures for this pathology. In this article we present the case of a patient diagnosed with cerebral malaria treated in our centre, subjected to progressive monitoring using SPECT perfusion.
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Malaria Cerebral/diagnóstico por imagen , Imagen de Perfusión , Tomografía Computarizada de Emisión de Fotón Único , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada de Emisión de Fotón Único/métodosRESUMEN
INTRODUCTION: SPECT-CT in the detection of the sentinel lymph node (SLN) of breast cancer offers known advantages over conventional planar lymphoscintigraphy. Sometimes, it shows atypical findings like mediastinal lymphatic drainage. We have evaluated these atypical findings showed by SPECT-CT performed in patients with migration to the internal mammary chain (IMC) and their roles in the management of the patients. MATERIALS AND METHODS: We reviewed the 56 lymphoscintigraphies (planar and SPECT-CT) of 56 women (average age: 55 years) diagnosed with breast cancer with IMC migration observed in the planar images. We compared the two techniques, obtaining the number of depicted nodes, atypical locations, their exact anatomical location and their role in the management of the patient. RESULTS: Planar images showed a total number of 81 IMC nodes. SPECT-CT showed 74 nodes in the IMC territory and 14 mediastinal lymphatic nodes in 6 patients. Out of the 81 IMC nodes reported by planar images, seven corresponded to mediastinal nodes. Planar and hybrid images showed 110 and 130 axillary nodes, respectively. SPECT-CT showed additional findings in five patients: three infraclavicular and two supraclavicular nodes that were exactly located. One intramammary node was discarded by the SPECT-CT as a focal skin contamination. CONCLUSION: Mediastinal nodes are unexpected, but not uncommon findings that are important in the planning of SLN biopsy. SPECT-CT found more nodes than planar images, being able to separate mediastinal and IMC nodes, helping to exactly depict the SLN and its relations with anatomical structures.
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Neoplasias de la Mama/diagnóstico por imagen , Drenaje/métodos , Ganglios Linfáticos/diagnóstico por imagen , Linfocintigrafia/métodos , Biopsia del Ganglio Linfático Centinela/métodos , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único/métodos , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Femenino , Estudios de Seguimiento , Humanos , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Persona de Mediana Edad , Estadificación de Neoplasias , PronósticoAsunto(s)
Carcinoma Papilar/diagnóstico por imagen , Coristoma/diagnóstico por imagen , Radioisótopos de Flúor , Fluorodesoxiglucosa F18 , Hallazgos Incidentales , Imagen Multimodal , Neoplasias Primarias Desconocidas/diagnóstico por imagen , Tomografía de Emisión de Positrones , Radiofármacos , Quiste Tirogloso/diagnóstico por imagen , Neoplasias de la Tiroides/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Carcinoma Papilar/complicaciones , Carcinoma Papilar/radioterapia , Carcinoma Papilar/cirugía , Terapia Combinada , Humanos , Radioisótopos de Yodo/uso terapéutico , Masculino , Disección del Cuello , Neoplasias Primarias Desconocidas/complicaciones , Radiofármacos/uso terapéutico , Proteínas Recombinantes , Quiste Tirogloso/complicaciones , Neoplasias de la Tiroides/complicaciones , Neoplasias de la Tiroides/radioterapia , Neoplasias de la Tiroides/cirugía , Tiroidectomía , Tirotropina , Adulto JovenRESUMEN
Sjögren syndrome is a chronic systemic autoimmune disease in which there is an increased risk of developing non-Hodgkin's lymphoma. Neoplastic lung involvement and the coexistence of different histological types of lymphoma are uncommon in these patients. These patients frequently have associated infectious processes, most of them due to oral candidiasis. When there is immunodeficiency, the hematogenous spread of the fungus may affect the lungs. We present the case of a female patient diagnosed with follicular non- Hodgkin lymphoma within the context of long-term Sjögren syndrome. In addition to the neoplastic nodal and splenic disease, the PET-CT study showed extensive lung involvement. Due to suspicion of a false positive result for pulmonary Candida infection, antifungal treatment was initiated, with no response. A further histological study showed the presence of a second and different type of lymphoma.
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Linfoma Folicular/diagnóstico por imagen , Linfoma de Células B Grandes Difuso/diagnóstico por imagen , Imagen Multimodal , Neoplasias Primarias Múltiples/diagnóstico por imagen , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Femenino , Humanos , Linfoma Folicular/complicaciones , Linfoma de Células B Grandes Difuso/complicaciones , Persona de Mediana Edad , Neoplasias Primarias Múltiples/complicaciones , Síndrome de Sjögren/complicacionesAsunto(s)
Encéfalo/diagnóstico por imagen , Circulación Cerebrovascular , Cisteína/análogos & derivados , Despersonalización/diagnóstico por imagen , Compuestos de Organotecnecio , Radiofármacos , Tomografía Computarizada de Emisión de Fotón Único , Enfermedad Aguda , Síntomas Afectivos/complicaciones , Síntomas Afectivos/diagnóstico por imagen , Síntomas Afectivos/fisiopatología , Ansiedad , Apatía , Encéfalo/irrigación sanguínea , Despersonalización/etiología , Despersonalización/fisiopatología , Femenino , Alucinaciones/diagnóstico por imagen , Alucinaciones/etiología , Alucinaciones/fisiopatología , Humanos , SíndromeRESUMEN
We present a patient with clinical suspicion of intestinal carcinoid relapse confirmed by a somatostatin receptor scintigraphy. A very intense somatostatin avid abdominal lesion was located and radioguided surgery was proposed. Prior to the procedure, we performed a SPECT-CT that made it possible to detect and localize the lesion anatomically, thus facilitating the performance of the radioguided procedure. Furthermore, it modified the planning of the intervention with the adequate physical and human resources to prevent the possible surgical complications.
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Tumor Carcinoide/diagnóstico , Tumor Carcinoide/cirugía , Neoplasias Intestinales/diagnóstico , Neoplasias Intestinales/cirugía , Recurrencia Local de Neoplasia/diagnóstico , Recurrencia Local de Neoplasia/cirugía , Cirugía Asistida por Computador , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Rayos X , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Divertículo/complicaciones , Hernia Inguinal/diagnóstico por imagen , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Enfermedades de la Vejiga Urinaria/complicaciones , Anciano , Diagnóstico Diferencial , Divertículo/diagnóstico por imagen , Hernia Inguinal/etiología , Humanos , Ganglios Linfáticos/diagnóstico por imagen , Linfoma no Hodgkin/diagnóstico por imagen , Masculino , Enfermedades de la Vejiga Urinaria/diagnóstico por imagenRESUMEN
INTRODUCTION: Sentinel node biopsy (SNB) by radioisotopes is a widely accepted and reliable surgical method for staging breast cancer in patients with unknown positive axillary lymph nodes involvement. The main limitation of this method is due to the appearance of false negatives that may be caused by tumor lymph node blockage of the sentinel lymph node and uptake in the neighboring lymph nodes. Infiltered sentinel nodes are generally increased in size and firm. Thus, they can be detected by intraoperative palpation, even when there is no uptake by the radiotracer. AIM: To reduce the false negative rates by applying intraoperative axillary palpation after SNB. METHOD: Over a two-year period, we complemented the SNB in 168 patients with careful intraoperative axillary palpation, detecting and removing all the palpable suspicious lymph nodes (SLN) that were analyzed as sentinel nodes RESULTS: In 32 out of 168 patients, 50 palpable SLN were found. In 3 out of 32 patients, 4 infiltrated SLNs were demonstrated with negative SNB and positive axillary lymphadenectomy. Thus, intraoperative palpation avoided false negative results. In one patient, one palpable SLN with tumor involvement was observed and SNB was also positive. In the remaining 28 patients, the histological analysis of 45 SLN was negative for tumor but SNB was positive in 3 patients. CONCLUSION: Intraoperative axillary palpation, once the SNB was done, reduced the false negative rate. Thus, we consider that it should be included as one more part of this procedure.
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Adenocarcinoma/secundario , Neoplasias de la Mama/cirugía , Escisión del Ganglio Linfático , Metástasis Linfática/diagnóstico , Palpación/métodos , Biopsia del Ganglio Linfático Centinela/métodos , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Axila , Reacciones Falso Negativas , Femenino , Humanos , Metástasis Linfática/diagnóstico por imagen , Metástasis Linfática/patología , Mastectomía , Cintigrafía , Radiofármacos/farmacocinética , Estudios RetrospectivosRESUMEN
OBJECTIVE: A non-degenerative etiology is supported by a normal SPI [normal SPECT with 123I-Ioflupane (SPI)] in a patient with movement disorders (MD). METHOD: A total of 196 SPIs were conducted during the period of 2004/05. Of these, 44 were selected in order to rule out degenerative MD (DMD), the results being normal in these patients. The clinical background of these patients were reviewed in a minimum period of 24 months (range 24-40), collecting the diagnoses reached by the neurology specialists. The SPI were evaluated using a consensus, according to subjective criteria and quantification. RESULTS: Thirty-six of the 44 patients (81%) were identified at 2 years of having nondegenerative movement disorders: 18 as essential tremor, 5 as drug-induced disorder, 4 as vascular disease, 3 as peripheral polyneuropathy, 2 postural tremors, 1 writer's cramp, 1 psychogenic tremor, 1 intercranial hypertension and 1 fibromyalgia. The remaining 8 patients were diagnosed with Parkinson's disease in 5 cases, 1 corticobasal degeneration, 1 multisystemic atrophy and another degenerative Parkinsonism with unclear etiology. CONCLUSION: The SPI in our hospital has a lower negative predictive value than the data reported in the literature. The false negatives could be explained because most of our patients come from neurologist physicians who are not movement disorder experts. In addition, a small proportion of degenerative Parkinsonism could evolve with normal SPI.