Pruebas de diagnóstico por la imagen: ¿generan ansiedad? / Diagnostic imaging studies: do they create anxiety?

El cáncer constituye uno de los principales problemas de salud en los países occidentales. En el año 2008 fue la primera causa de muerte en varones y la segunda en mujeres. En el contexto de pacientes con sospecha o diagnóstico de cáncer, la realización de pruebas diagnósticas desempeña un papel central de la actividad clínica y puede tener un elevado impacto psicológico. Objetivo. Evaluar el grado de ansiedad que presentan los pacientes oncológicos que se realizan un estudio PET-TAC en un Servicio de Medicina Nuclear, mediante el cuestionario State Trait Anxiety Inventory (STAI). Material y método. Doscientos pacientes que se realizaron un estudio PET-TAC en un Servicio de Medicina Nuclear realizaron el cuestionario STAI para valorar el grado de ansiedad que genera la realización de esta prueba. El STAI es un cuestionario validado desarrollado como herramienta de investigación de la ansiedad en adultos sanos. Resultados. De los 200 pacientes, dos tercios (n=135; 67%) presentaban ansiedad. De los 133 que realizaron el estudio por primera vez, el 70% (n=93) estaba ansioso. De los 67 que ya se habían realizado el estudio con anterioridad un 62,7% (n=42) estaba ansioso. Los pacientes que presentaron mayor ansiedad son los que se realizaron el estudio para estadificar inicialmente la enfermedad. Conclusión. La realización de un estudio PET-TAC como método de estadificación inicial y/o para valorar una recurrencia tumoral es un importante generador de ansiedad, de forma estadísticamente significativa. Existe un elevado impacto emocional y cognitivo asociado a la participación de pruebas de diagnóstico(AU)

Cancer is one of the main health problems in western countries. In 2008, it represented the first cause of death in men and the second one in women. When there is a diagnosis or suspicion of cancer, performing diagnostic imaging studies has an important role in the clinical activity and may have an elevated psychological impact. Objective. The purpose of this study was to evaluate the level of anxiety in oncology patients during the performance of a nuclear medicine study (PET-CT) in a Nuclear Medicine Service, by means of the State Trait Anxiety Inventory (STAI). Material and methods. A total of 200 cancer patients who underwent a PET-CT study in a Nuclear Medicine Service were administered the STAI to evaluate the level of anxiety generated during this test. The STAI is a validated questionnaire developed as a research tool on anxiety in healthy adults. Results. Of the 200 patients, two thirds (n=135) (67%) of the patients evaluated had anxiety. Of the 133, 93 (70%) of the patients who underwent PET-CT study for the first time were anxious whereas 42 (62.7%) of the patients who had undergone the study on previous occasions were anxious. Those patients with the greatest anxiety were those in whom the study was performed to initially stage the disease. Conclusion. Performing the PET-CT study as an initial staging method and/or to evaluate tumor recurrence is an important and statistically significant generator of anxiety. There is a high emotional and cognitive impact associated to the participation of the diagnostic tests(AU)

[Diagnostic imaging studies: do they create anxiety?]. / Pruebas de diagnóstico por la imagen: ¿generan ansiedad?

UNLABELLED: Cancer is one of the main health problems in western countries. In 2008, it represented the first cause of death in men and the second one in women. When there is a diagnosis or suspicion of cancer, performing diagnostic imaging studies has an important role in the clinical activity and may have an elevated psychological impact. OBJECTIVE: The purpose of this study was to evaluate the level of anxiety in oncology patients during the performance of a nuclear medicine study (PET-CT) in a Nuclear Medicine Service, by means of the State Trait Anxiety Inventory (STAI). MATERIAL AND METHODS: A total of 200 cancer patients who underwent a PET-CT study in a Nuclear Medicine Service were administered the STAI to evaluate the level of anxiety generated during this test. The STAI is a validated questionnaire developed as a research tool on anxiety in healthy adults. RESULTS: Of the 200 patients, two thirds (n=135) (67%) of the patients evaluated had anxiety. Of the 133, 93 (70%) of the patients who underwent PET-CT study for the first time were anxious whereas 42 (62.7%) of the patients who had undergone the study on previous occasions were anxious. Those patients with the greatest anxiety were those in whom the study was performed to initially stage the disease. CONCLUSION: Performing the PET-CT study as an initial staging method and/or to evaluate tumor recurrence is an important and statistically significant generator of anxiety. There is a high emotional and cognitive impact associated to the participation of the diagnostic tests.

A propósito de un caso: falso positivo en pelvis en un estudio PET-TAC debido a una reimplantación ovárica / False positive in pelvis in a PET-CT scan due to ovarian reimplantation: a case report

Presentamos el caso de una mujer de 36 años con antecedente de una neoplasia de cérvix, tratada quirúrgicamente, a la que se le realiza un estudio PET-TAC para caracterizar unas adenopatías inguinales de nueva aparición. La PET mostró 2 nódulos hipermetabólicos pélvicos, sugestivos de corresponder a un implante y a una adenopatía tumoral, respectivamente. Tras una reevaluación clínica y con un nuevo estudio PET-TAC, se evidenció que dichos focos de captación correspondían a actividad fisiológica de fluordesoxiglucosa secundaria a la ovulación en una paciente con reimplantación ovárica. Este artículo muestra la importancia de disponer de una información clínica exhaustiva de los pacientes antes de valorar los estudios. Asimismo, realizamos una revisión bibliográfica sobre el carcinoma de cérvix y el comportamiento metabólico de los anejos en relación con el ciclo menstrual en mujeres premenopáusicas(AU)

We present the case of a 36-year-old premenopausal woman with a background of surgically-treated cervical neoplasm. She underwent a positron emission tomography-computed tomography (PET-CT) for evaluation of the new appearance of abnormal inguinal lymph nodes. The study showed two hypermetabolic nodules in the pelvic region suggestive of corresponding to an implant and to tumor involvement of the lymph node, respectively. After a clinical evaluation and a new PET-CT scan, it was considered that these uptake foci corresponded to physiological activity of the FDG secondary to ovarian activity in a patient with ovariopexy. This article shows the importance of having complete clinical information about the patients before evaluating the studies. We also present a review of the medical literature on the cervical neoplasm and metabolic behavior of the adnexa in relationship with the menstrual cycle of pre-menopausal women(AU)

[False positive in pelvis in a PET-CT scan due to ovarian reimplantation: a case report]. / A propósito de un caso: falso positivo en pelvis en un estudio PET-TAC debido a una reimplantación ovárica.

We present the case of a 36-year-old premenopausal woman with a background of surgically-treated cervical neoplasm. She underwent a positron emission tomography-computed tomography (PET-CT) for evaluation of the new appearance of abnormal inguinal lymph nodes. The study showed two hypermetabolic nodules in the pelvic region suggestive of corresponding to an implant and to tumor involvement of the lymph node, respectively. After a clinical evaluation and a new PET-CT scan, it was considered that these uptake foci corresponded to physiological activity of the FDG secondary to ovarian activity in a patient with ovariopexy. This article shows the importance of having complete clinical information about the patients before evaluating the studies. We also present a review of the medical literature on the cervical neoplasm and metabolic behavior of the adnexa in relationship with the menstrual cycle of pre-menopausal women.

[PET/CT with (18F)FDG in the initial staging of a pelvic kidney neoplasm. A case report]. / PET-TAC con (18)F-FDG en la estadificación inicial de una neoplasia de pelvis renal. A propósito de un caso.

We report a case of 58-year-old woman referred to our service for an (18)FFDG PET/CT study of initial staging after being diagnosed of a pelvic kidney mass consistent with malignancy. The FDG-PET showed an abnormal mass in the right kidney, a suspicious metastasis versus a second primary tumor in the cortex of the kidney and lymph node infiltration in the paracaval nodes. The histological analysis verification after exeresis of the lesions confirmed the diagnosis of renal metastases. In this article, we present a brief review of the literature published on the role of PET in the characterization and initial staging of kidney and urinary tract tumors. We also stress the clinical importance of carefully evaluating any low attenuation lesion or focal glucose uptake detected in these structures in a PET/CT study with (18)FFDG.

PET-TAC con 18F-FDG en la estadificación inicial de una neoplasia de pelvis renal. A propósito de un caso / PET/CT with 18FFDG in the initial staging of a pelvic kidney neoplasm. A case report

Presentamos el caso de una mujer de 58 años remitida a nuestro servicio para la realización de un estudio PET-TAC con 18F-FDG de estadificación inicial tras ser diagnosticada de una masa en la pelvis de riñón derecho compatible con un proceso neoproliferativo. La PET-FDG mostró una masa en riñón derecho, una lesión sospechosa de metástasis versus un segundo tumor primario en la cortical del propio riñón y signos de infiltración adenopática tumoral en situación paracaval. El estudio histológico tras la exéresis de las lesiones confirmó dichos hallazgos como metastásicos. En este artículo realizamos un breve repaso de la bibliografía publicada al respecto, valorando la utilidad de la PET en la caracterización y estadificación inicial de las neoplasias de riñón y vías urinarias. Asimismo enfatizamos la importancia de valorar cuidadosamente cualquier imagen hipodensa o depósito de glucosa en riñones y vías urinarias visualizado en un estudio PET-TAC con 18F-FDG(AU)

We report a case of 58-year-old woman referred to our service for an 18FFDG PET/CT study of initial staging after being diagnosed of a pelvic kidney mass consistent with malignancy. The FDG-PET showed an abnormal mass in the right kidney, a suspicious metastasis versus a second primary tumor in the cortex of the kidney and lymph node infiltration in the paracaval nodes. The histological analysis verification after exeresis of the lesions confirmed the diagnosis of renal metastases. In this article, we present a brief review of the literature published on the role of PET in the characterization and initial staging of kidney and urinary tract tumors. We also stress the clinical importance of carefully evaluating any low attenuation lesion or focal glucose uptake detected in these structures in a PET/CT study with 18FFDG(AU)

Gastro-oesophageal reflux in mechanically ventilated patients: effects of an oesophageal balloon.

Gastro-oesophageal reflux (GOR) and bronchoaspiration of gastric content are risk factors linked with ventilator-associated pneumonia. This study was aimed at evaluating the effect of a nasogastric tube (NGT) incorporating a low-pressure oesophageal balloon on GOR and bronchoaspiration in patients receiving mechanical ventilation. Fourteen patients were studied in a semi-recumbent position for 2 consecutive days. Inflation or deflation of the oesophageal balloon was randomised. Samples of blood, gastric content, and oropharyngeal and bronchial secretions were taken every 2 h over a period of 8 h. A radioactively labelled nutritional solution was continuously administered through the NGT. The magnitude of both the GOR and bronchoaspiration was measured by radioactivity counting of oropharyngeal and bronchial secretion samples, respectively. Inflation of the oesophageal balloon resulted in a significant decrease of both GOR and bronchoaspiration of gastric content. This protective effect was statistically significant from 4 h following inflation throughout the duration of the study. This study demonstrates that an inflated oesophageal balloon delays and decreases gastro-oesophageal and bronchial aspiration of gastric content in patients carrying a nasogastric tube and receiving enteral nutrition during mechanical ventilation. Although the method was found to be safe when applied for 8 h, longer times should be considered with caution.

Reflex sympathetic dystrophy syndrome of the lower limbs in a renal transplant patient treated with tacrolimus.

BACKGROUND: Recently, a previously unrecognized posttransplant syndrome known as reflex sympathetic dystrophy syndrome of the lower limbs has emerged in patients receiving cyclosporine as immunosuppression. We describe herein this complication observed in a patient treated with tacrolimus after kidney transplantation. METHODS: A 49-year-old man received a kidney transplant from a cadaver donor and was treated with tacrolimus. Three months later, the patient complained of severe pain in the lower limbs that affected both knees and ankles. Bone scintigraphy and magnetic resonance were consistent with reflex sympathetic dystrophy syndrome. RESULTS: Laboratory tests that included creatinine, glomerular filtration rate, calcium, phosphate, urate, alkaline phosphatase, and parathormone were normal or near normal. Tacrolimus levels were around 13 microg/ml. Clinical improvement appeared slowly and spontaneously during the following 3 months, without appreciable changes in the tacrolimus level. CONCLUSIONS: In kidney transplant patients, tacrolimus could be a risk factor for the development of a reflex sympathetic dystrophy syndrome.

Captopril test and renal duplex scanning for the primary screening of renovascular disease.

To evaluate the utility of renal duplex scanning and the captopril test in the detection and functional assessment of renovascular disease, by comparing their results with those of angiography and captopril isotopic renography (CIR). Sixty hypertensive patients with aortoiliac disease and 16 with clinically suspected renovascular hypertension (RVH) were included. All the patients underwent renal duplex scanning prior to angiography. In addition, isotopic renograms and a determination of peripheral plasma renin activity (PRA) at baseline and 60 min after oral intake of 50 mg of captopril were both performed. A postcaptopril PRA > 5.7 ng/mL/h was considered as diagnostic of a positive captopril test. On the basis of the results of the angiography and isotopic renograms, all the patients were classified into three groups: group I (n = 33), essential hypertension (EHT); group II (n = 20), hypertension and angiographic RAS > 60% but negative CIR; and group III (n = 24), RAS > 60% and positive CIR. This last condition was considered as highly suspicious for RVH. Renal duplex scanning showed greater accuracy than captopril PRA or CIR for detecting RAS > 60% (groups II and III) with 87.3% versus 52.4% and 45.3% sensitivity (S), and 91.5% versus 84.4% and 92.8% specificity (Sp), respectively. The captopril test correctly identified 44 of 51 EHT patients (groups I and II) and 20 of 23 highly suspected of RVH (group III) with 87% S, 86.5% Sp, 74.1% PPV, and 93.6% NPV. Accuracy was further increased when a combined approach (renal duplex scanning and captopril test) was followed (82.6% S, 93.7% Sp, 86.4 PPV, and 91.8 NPV). In our study, renal duplex scanning was a useful screening method for detecting anatomical RAS. A combination of both renal duplex scanning and captopril test may be an appropriate approach to the primary screening for RVH, thereby permitting the selection of those patients indicated for angiography.

Radiolocalization of squamous lung carcinoma with 131I-labeled epidermal growth factor.

Overexpression of epidermal growth factor receptor (EGFr) in squamous carcinomas has been demonstrated extensively. Preliminary clinical studies have shown that radiolabeled anti-EGFr monoclonal antibodies can localize to these tumors. The aims of this study were to determine the tolerance, pharmacokinetics, and radiolocalization properties of 131I-labeled EGF in patients (n = 9) with advanced squamous lung cancer. Patients' vital signs and symptoms were monitored regularly for 3 days. Daily scintigrams and biological samples for pharmacokinetic analysis were obtained for 3-4 days. 99mTc-labeled human serum albumin was administered to patients with positive tumor scans. Six patients had positive tumor scans, and five of them had received >/=1.0 mg EGF. In all of these cases, tumors were visualized the same day of the infusion, although best tumor-background contrast was obtained at 50-74 h. There were no false-positive images. Whole-body radioactivity retention rose significantly with increasing EGF doses; most labeled EGF was eliminated by urinary excretion. Tumor:normal tissue uptake ratios increased during the course of the study. All patients presented self-limited, dose-related gastrointestinal adverse effects. In conclusion, recombinant 131I-labeled EGF administered i.v. can localize to squamous lung cancer efficiently, can be administered safely to patients, and has more advantageous pharmacokinetic properties than monoclonal antibodies. Further studies are warranted to determine more accurately the potential of EGF and EGF-related peptides in the imaging and/or therapy of EGFr-overexpressing human cancers.

Abnormal bone scintigraphy and silent radiography in localized reflex sympathetic dystrophy syndrome.

Typical, definite forms of the reflex sympathetic dystrophy syndrome present no diagnostic problems, but the diagnosis of localized or very localized forms is very difficult. In the absence of characteristic roentgenographic evidence of acute, patchy, bony demineralization in the affected extremity, scintigraphy has proven to be a valuable examination. A retrospective analysis of 6 patients with a partial form of reflex sympathetic dystrophy with negative roentgenogram results who were evaluated by bone scintigraphy is presented. In the initial clinical stages, the predominant scintigraphic pattern was a very localized and intense hyperactivity in the internal femoral condyle and/or tibial plate of the affected joint on both blood pool and static images. The increased periarticular activity showed a marked decrease in association with remission of the clinical symptoms. In conclusion, bone scintigraphy was found to be a useful tool in the diagnosis and assessment of the therapeutic response genograms and increased periarticular radionuclide activity on scintigrams in the affected extremity are characteristic findings (Intenzo et al. 1989). Cases of reflex sympathetic dystrophy syndrome involving the hip (Lequesne and Mauger 1982) and the knee (Doury et al. 1987) have been reported, although the diagnosis at these sites is more difficult due to the absence of characteristic external signs. Localized or very localized forms of reflex sympathetic dystrophy (mainly involving the knee) with no radiological abnormalities throughout the course of the disease have been documented (Doury et al. 1979; Doury 1982). In these cases, bone scintigraphs proved to be a valuable examination to confirm the diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)