[Diagnostic limitations of positron emission tomography. What are we seeking?]. / Limitaciones diagnósticas de la tomografía por emisión de positrones. ?Qué buscamos?

Positron emission tomography is an imaging technique based on the use of radiopharmaceuticals. The most extended one is the glucose analogue 18F fluorodeoxyglucose (FDG) that is deposited where there is an increase of glycolytic metabolism, whether this is caused by neoplastic, inflammatory or infectious diseases. It is used in oncology for the initial staging, to assess response to treatment, residual disease, recurrent diagnosis and restaging, but specifically among the different types of tumor. It also has a field in the study of large vessel vasculitis, in granulomatous diseases and in dementias.

Limitaciones diagnósticas de la tomografía por emisión de positrones. ¿Qué buscamos? / Diagnostic limitations of positron emission tomography. What are we seeking?

La tomografía por emisión de positrones es una técnica de imagen basada en la utilización de radiofármacos. El más extendido es la 18F fluorodeoxiglucosa (FDG) análogo de la glucosa que es captado allá donde hay un aumento del metabolismo glucolítico, ya sea originado por enfermedades neoplásicas, inflamatorias o infecciosas. Esto hace que sea una técnica muy sensible. En oncología es utilizada para la estadificación inicial, para valorar la respuesta al tratamiento, la enfermedad residual, el diagnóstico de recidiva y la reestadificación, pero con particularidades entre los distintos tipos de tumor. También tiene campo en el estudio de las vasculitis de grandes vasos, en las enfermedades granulomatosas y en las demencias

Positron emission tomography is an imaging technique based on the use of radiopharmaceuticals. The most extended one is the glucose analogue 18F fluorodeoxyglucose (FDG) that is deposited where there is an increase of glycolytic metabolism, whether this is caused by neoplastic, inflammatory or infectious diseases. It is used in oncology for the initial staging, to assess response to treatment, residual disease, recurrent diagnosis and restaging, but specifically among the different types of tumor. It also has a field in the study of large vessel vasculitis, in granulomatous diseases and in dementias (AU)

Ascitis tabicada por tuberculosis peritoneal / Ascities by peritoneal tuberculosis

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Ascitis tabicada por tuberculosis peritoneal / Loculated ascitis by peritoneal tuberculosis

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[Value of C-reactive protein for detecting bacteremia in febrile patients]. / Utilité de la protéine C réactive dans la détection de bactériémie chez les patients fébriles.

OBJECTIVES: Mortality among bacteremic adults ranges between 14 and 35%, and there is no biological clue to identify such patients a priori. As C-reactive protein (CRP) blood level rises in children during bacteremia, we investigated its accuracy to identify bacteremic patients among febrile adults who were admitted to our hospital either for study or treatment. METHODS: Patients older than 14 entering the emergency room with objective axilar temperature above 37.5 degrees C and admitted either for study or treatment were elligible for enrollment. After initial examination, samples were obtained for blood cultures and CRP measurement. Follow-up during hospitalization was assessed. All variables were related with one another by bivariant statistical methods performed with Sigma Horus hardware. After bivariant study we used the program BMDP Statistical Software (1991) to perform the multivariate study in its discriminant analysis. RESULTS: One hundred seventy-four patients entered the study with an average age of 58.9 years; 47.7% were over 65 years of age; 88% of febrile syndromes were of infectious origin and among them, bacteremia ranged up to 17.2%. Values of CRP were significantly related with the following variables: "age": patients younger than 45 had average CRP concentrations of 9.5 mg%, age over 45 had 17.4 mg% (Mann Whitney U (MW) p < 0.001); "clinical situation on admission": for poor, intermediate and stabilized situations average CRP levels were 14.7, 18.5 and 12.4 mg% respectively (MW p < 0.05); "time from fever onset"; "clinical outcome": for death average CRP was 23.01 mg% and for cure 14.6 mg% (MW, p < 0.05), in that way probability of death was 21%, 9% and 3% for CRP concentrations higher than 20, between 10 and 20 and under 10 mg% respectively. There was no link between CRP serum levels and sex, severity of chronic illness, cause of fever, localization of infection and existence of bacteremia. The multivariate study in its discriminate mode was of no use to identify bacteremic patients. CONCLUSION: According to our findings CRP determination can not be used alone or associated to identify patients with positive blood cultures among the febrile ones. CRP blood determination should not be considered before 24 hours from disease onset as this time is required for CRP to stabilize. Patients with CRP levels higher than 20 mg% on admission have a higher risk of dying during hospitalization.

[The length of stay in hospital emergency medical care]. / Tiempo de estancia asistencial en la atención urgente médica hospitalaria.

The length of stay in emergency services has been considered as a quality control and evaluation index of emergency care. The impact of several factors on its magnitude is analyzed. The age of the patient, the time of admission, the performance of complementary explorations (simple radiology, analytic tests, abdominal echography), as well as the disease group including the diagnosis of the emergency service, significantly modify the length of stay. The age and performance of such tests seem to be the most relevant factors, although they may not be independent. The length of stay of the patients in the emergency service may be shortened by reducing the complementary explorations just to the ones mentioned above. The adequacy of the functional organization, the material and human resources, as well as the adequate staff skills and attitudes, may also reduce the length of stay of these patients in the hospital emergency care.

[Febrile syndrome in hospitalized patients]. / Síndrome febril en pacientes hospitalizados.

This study was designed to ascertain if certain characteristics of febrile patients could help to identify infectious or bacteremic conditions. Patients with axillary temperature higher than 37,4 degrees C visiting the emergency room and requiring hospitalization were included in the study. The sample included 345 patients. Infections made up 89% of the causes of fever. The most frequent site of infection was the respiratory system (39%). 13% of hemocultures were positive. Gram negative germs were the most frequent agents. Infectious FS was related with the presence of predisposing factors, duration of fever, erythrocyte sedimentation rate and hemoglobin. Bacteremia was associated to treatment prior hospitalization, average temperature, hemoglobin, AST and urinary sediment. We may conclude that infections are the most frequent cause of FS. We could not found any clinical or analytical parameters that, used together, could help us to identify infectious or bacteremic FS.