SEMNIM 2.0: una estrategia sólidamente líquida / SEMNIM 2.0: a solidly fluid policy

No disponible

Contribución de la detección radioguiada y biopsia selectiva del Ganglio centinela al estadiaje de 100 pacientes con melanoma cutáneo / Contribution of the radioguided detection and selective biopsy of the sentinel lymph node with staging in 100 patients with cutaneous melanoma

Objetivo: La biopsia selectiva del Ganglio Centinela (GC) se ofrece como una alternativa a la linfadenectomía regional convencional en el estadiaje de pacientes con melanoma cutáneo maligno. El objetivo de este trabajo es analizar nuestra experiencia en la localización del GC mediante linfogammagrafía y sonda detectora y su utilidad en el estadiaje del melanoma cutáneo maligno (MCM).Material y Métodos: Se estudiaron 100 pacientes, 56 mujeres y 44 hombres, con edad media de 51,5 ñ 31,5 años, diagnosticados de MCM. En todos los casos se realizó linfografía radioisotópica pre-operatoria para detectar el área ganglionar de drenaje tras administración intradérmica peritumoral de 600 microCi de 99mTc- sulfuro coloidal, adquiriendose imágenes planares cada 10 minutos hasta la localización de actividad en áreas ganglionares de drenaje. Posteriormente se efectuó localización intraoperatoria mediante sonda detectora y biopsia selectiva del GC, enviándose al Servicio de Anatomía Patológica para evaluar infiltración metastásica. Resultados: El estudio linfogammagráfico resultó positivo en 99 de los 100 casos, siendo identificados intraoperatoriamente 98 casos. El análisis anatomopatológico fue negativo en el 78,9 por ciento y positivo en el 21,1 por ciento de los ganglios extraídos. Conclusiones: La linfografía radioisotópica y la detección intraoperatoria son dos técnicas extraordinariamente útiles en la localización del GC y estadiaje del MCM. Son muchos los pacientes que se benefician de la biopsia selectiva radioguiada del GC en ésta patología tumoral, tanto en disminución de la morbilidad de la intervención como en un mejor estadiaje de la enfermedad. (AU)

[Contribution of radioguided detection and selective biopsy of the sentinel lymph node to staging in 100 patients with cutaneous melanoma]. / Contribución de la detección radioguiada y biopsia selectiva del Ganglio centinela al estadiaje de 100 pacientes con melanoma cutáneo.

OBJECTIVE: A selective sentinel node (SN) biopsy appears to be an alternative to conventional lymph node dissection for staging patients with cutaneous melanoma. This study has aimed to analyze our experience in the localization of the sentinel node with a probe detector and lymphoscintigraphy and its utility in the staging of this disease. MATERIAL AND METHODS: 100 patients, 56 female and 44 male, 51.5 31.5 mean age, diagnosed of cutaneous melanoma were studied. The lymphoscintigraphy was performed in all cases to detect the area of lymphatic drainage after peritumoral intradermal administration of 600 uCi of 99mTc-colloidal sulfur, and planar images were acquired every 10 minutes until activity was detected in these areas. Afterwards, the intraoperative localization of the sentinel node with a probe detector was performed and the selective biopsy of the node was sent to the Pathology Department for its histologic study. RESULTS: The lymphoscintigraphy study was positive in 99 of the 100 cases and it was identified intraoperatively in 98 cases. The histologic analysis was negative in 78.9% and positive in 21.1% of the nodes. CONCLUSIONS: Radioisotopic lymphography and intraoperative probe detection are two very useful techniques for locating the sentinel node and staging patients with cutaneous melanoma. Many patients are benefiting from the selective biopsy of the sentinel node because of the decreased post-surgical morbidity and better staging of the cutaneous melanoma.

[Evaluation of cardiac sympathetic innervation with 123I-metaiodobenzylguanidine in patients with diabetes mellitus]. / Valoración de la inervación simpática cardíaca con 123I-metayodobencilguanidina en pacientes con diabetes mellitus.

OBJECTIVES: To evaluate the usefulness of iodine-123 metaiodobencylguanidine (123I-MIBG) in the study of the cardiac autonomic neuropathy in insulin-dependent diabetic patients, by means of: a) analysis of heart to mediastinic ratio and tomographic images with 123I-MIBG; b) comparison with conventional non-invasive cardiac reflex test, and c) analysis of left ventricle ejection fraction. POPULATION AND METHODS: Ten patients submitted for cardiac evaluation with 123I-MIBG were compared with a control group of 11 patients. In both groups we excluded the presence of coronary pathology by means of an exercise test. We carried out planar and SPECT studies, using 123I-MIBG, and the calculation of the ejection fraction by equilibrium ventriculography. RESULTS: The uptake of 123I-MIBG in diabetic patients was significantly smaller than the control group in the calculated index (heart to mediastinic ratio: 1.64 +/- 0.20 vs 2.00 +/- 0.26; p < 0.001; SPECT index: 44.87 +/- 8.37 vs 55.54 +/- 3.96; p < 0.001). In polar images we noted a more reduced uptake in the diabetic group in the inferior wall (p = 0.020). Patients with cardiac sympa-thetic dysinnervation demonstrated less uptake in both indexes (p < 0.05 and 0.005, respectively), essentially in the inferior wall and in basal and medium territories (p < 0.05). No differences in respect to the ejection fraction parameter were found. CONCLUSIONS: Despite the small sample population, insuli-dependent diabetic patients in show a significant reduction of the uptake of 23I-MIBG, more accentuated in the base. Scintigraphy using 123I-MIBG can be an approach to investigate the pattern and the natural history of the sympathetic innervation in these patients.