Tomografía computada de doble energía para la detección de lesiones focales hepáticas / Dual-energy computed tomography for the detection of focal liver lesions

Objetivo. Explorar cualitativamente y cuantitativamente el estudio espectral de las lesiones focales hepáticas, comparándolo con la valoración policromática habitual de la tomografía de energía simple. Método. El presente estudio prospectivo incluyó 50 pacientes remitidos para la realización de tomografía computada multidetector abdominal con contraste intravenoso, que tuvieran al menos una lesión focal hepática. La fase portal fue adquirida con energía dual. Se realizaron mediciones densitométricas de las lesiones y del parénquima hepático circundante, tanto en la adquisición policromática basal como en las posteriores reconstrucciones monocromáticas a 40, 70 y 140 keV. Se trazaron las curvas espectrales y se calcularon los índices de doble energía y la relación contraste-ruido. Por último, se hizo una valoración subjetiva de la calidad de las imágenes y la detectabilidad lesional. Resultados. Las diferencias densitométricas entre los distintos tipos de lesiones (avasculares y vascularizadas) y el hígado fueron mayores a bajos niveles energéticos (a la izquierda de la curva espectral) que en la evaluación policromática. En la valoración subjetiva, el nivel energético de 40keV presentó una mayor detectabilidad lesional. Conclusiones. El estudio espectral monocromático mediante tomografía computada de energía dual provee una mayor detectabilidad lesional a 40keV en relación a la que se dispone con la valoración policromática habitual (AU)

Objective. To qualitatively and quantitatively explore the spectral study of focal liver lesions, comparing it with the usual polychromatic assessment with single-energy computed tomography. Material and methods. We prospectively studied 50 patients with at least one focal liver lesion who were referred for abdominal multidetector computed tomography with intravenous contrast material. The portal phase was acquired with dual energy sources. The density of the lesions and of the surrounding liver parenchyma was measured both in the baseline polychromatic acquisition and in the posterior monochromatic reconstructions at 40 keV, 70 keV, and 140 keV. Spectral curves were traced and the dual-energy indices and contrast-to-noise ratio were calculated. Lastly, the quality of the images and the detectability of the lesions were assessed qualitatively. Results. Densitometric differences between the different types of lesions (avascular and vascularized) and the liver were greater at low energy levels (left side of the spectral curve) than in the polychromatic evaluation. In the subjective assessment, the 40keV energy level had the greatest lesion detectability. Conclusions. Monochromatic spectral study with dual-energy computed tomography provides better lesion detectability at 40keV compared to that provided by the ordinary polychromatic evaluation (AU)

Dual-energy computed tomography for the detection of focal liver lesions. / Tomografía computada de doble energía para la detección de lesiones focales hepáticas.

OBJECTIVE: To qualitatively and quantitatively explore the spectral study of focal liver lesions, comparing it with the usual polychromatic assessment with single-energy computed tomography. MATERIAL AND METHODS: We prospectively studied 50 patients with at least one focal liver lesion who were referred for abdominal multidetector computed tomography with intravenous contrast material. The portal phase was acquired with dual energy sources. The density of the lesions and of the surrounding liver parenchyma was measured both in the baseline polychromatic acquisition and in the posterior monochromatic reconstructions at 40 keV, 70 keV, and 140 keV. Spectral curves were traced and the dual-energy indices and contrast-to-noise ratio were calculated. Lastly, the quality of the images and the detectability of the lesions were assessed qualitatively. RESULTS: Densitometric differences between the different types of lesions (avascular and vascularized) and the liver were greater at low energy levels (left side of the spectral curve) than in the polychromatic evaluation. In the subjective assessment, the 40keV energy level had the greatest lesion detectability. CONCLUSIONS: Monochromatic spectral study with dual-energy computed tomography provides better lesion detectability at 40keV compared to that provided by the ordinary polychromatic evaluation.

Design, construction, and performance of a device for directional recrystallization of metallic alloys.

A device was designed to apply the directional recrystallization method to Fe-based alloys in order to obtain bamboo-like microstructures. This microstructure is suitable for improving creep properties and resistance to fatigue in some alloys and for enhancing pseudoelastic properties in shape memory alloys. The design and construction of a flat coil are described in detail. In addition, we developed an electromechanical system to control the movement of a wire within the flat coil. The construction details and system performance are presented. Furthermore, metallographic studies taken from the directionally recrystallized low-carbon steel samples are shown. Nearly monocrystalline and bamboo-like microstructures were achieved in the steel wires.

Actualización de la estadificación del cáncer de próstata

En nuestro país el cáncer de próstata es la neoplasia más frecuente en hombres de edad avanzada. Por ello, resulta indispensable una adecuada estadificación al momento de establecer la estrategia terapéutica. En este artículo se presenta la 7.a edición del sistema TNM de estadifi cación para el cáncer de próstata, vigente desde el 1.º de enero de 2010. El mismo ha tenido modifi caciones mayores con respecto a la 6.a edición.

In our country prostate cancer is the most common malignancy in older men. An accurate staging is very important to establish treatment strategies.This article presents the 7th edition TNM staging system for prostate cancer, effective January 1, 2010. This has undergone major changes over the 6th edition.

Errores del desfibrilador semiautomático en el reconocimiento de la fibrilación ventricular / Semiautomated external defibrillator errors in recognizing ventricular fibrillation

Presentamos tres casos clínicos de errores del desfibrilador semiautomático (DESA) durante el análisis de la fibrilación ventricular (FV). El primer caso corresponde a un error operador dependiente, en el que las vibraciones de la ambulancia provocan una omisión en la orden de desfibrilar. Las otras dos situaciones, DESA dependientes, constatan que la actividad eléctrica del marcapasos influye en la decisión de no desfibrilar en el contexto de una FV (AU)

We report 3 cases of semi automated external defibrillator error during analysis of ventricular fibrillation. The first involved operator-dependent error, in which ambulance motion led to failure to order a shock. The other 2 cases involved defibrillator-dependent error, in which signals from a pacemaker apparently led to the automatic decision not to shock even when ventricular fibrillation was detected (AU)

Desgaste profesional en los técnicos de emergencias sanitarias del soporte vital básico del País Vasco / Professional burnout among basic life support caregivers in the Basque Country

Objetivos: Cuantificar los niveles de desgaste profesional entre los técnicos en emergencias sanitarias (TES) de los recursos de soporte vital básico (SVB) del País Vasco y estudiar su asociación a las variables sociolaborales más habituales. Métodos: Estudio exploratorio de corte transversal sobre una muestra representativa (intervalo de confianza del 95% y precisión del 9%) compuesta de 98 TES, obtenida mediante una técnica aleatoria estratificada por sector de trabajo, a los que se les administró una encuesta sobre las características sociolaborales y el Maslach Burnout Inventory (MBI) como test de evaluación psicométrica. Posteriormente se realizó la estadística descriptiva y el contraste de hipótesis para una significación del 95%. Resultados: Presentaron puntuaciones en la escala MBI compatibles con síndrome de desgaste profesional (SDP) 87 trabajadores (88,8%; IC95% 80,9-94,3%), los niveles globales de afectación fueron considerados como elevados o muy elevados en 61 sujetos(62,2%; IC95% 51,9-71,8%) y moderados en 26 (26,5%; IC95% 18,1-36,4). Presentaron mayores proporciones de afectación global en grado elevado los TES con mayor experiencia laboral (p < 0,05). Los TES con un nivel académico más bajo presentaron menores puntuaciones en la subescala cansancio emocional (p < 0,05) y una mayor antigüedad en el sector se correlacionó con un mayor sentimiento de falta de logro profesional (p < 0,05).Conclusiones: La prevalencia del SDP en los TES del SVB del País Vasco es muy elevada y es superior a la documentada en otros profesionales del ámbito sanitario. Una mayor antigüedad profesional se asocia a niveles elevados de SDP, sin embargo deben explorarse otras variables como posibles causas del síndrome en este colectivo (AU)

Objectives: To quantify the level of professional burnout among emergency medical responders who provide basic life support in the Basque Country of Spain and to explore the association between professional burnout and conventional social and occupational variables. Methods: Exploratory cross-sectional study of a representative sample (reporting 95% confidence intervals [CI];precision of 9%). The sample consisted of a stratified random selection of 98 emergency medical responders. The participants answered the Maslach Burnout Inventory (MBI), a psychometric questionnaire covering social and occupational characteristics. Descriptive statistics were compiled and comparisons between subgroups were considered significant at a level of P<.05.Results: Eighty-seven emergency responders (88.8%; 95% CI, 80.8%-94.3%) had MBI scores compatible with professional burnout syndrome. The global score indicated high or very high risk of burnout in 61 (62.2%; 95% CI,51.9%-71.8%) and moderate risk in 26 (26.5%; 95% CI, 18.1%-36.4%). Responders who had been working longer in the field were at higher risk of burnout (P=.031). A lower educational level correlated with lower scores on the subscale for feeling drained of emotional energy (P=.04). Longer experience in the profession correlated with a feeling of achieving less than one should (P=.031).Conclusions: The prevalence of risk of professional burnout syndrome is very high among emergency medical responders in the Basque Country and is higher than the prevalence identified among other groups of health care professionals. Spending a longer period in the profession is associated with high risk of burnout. However, additional variables should be explored to discover the possible reasons for burnout in these professionals (AU)

[Clinical cross-sectional and epidemiologic study of Chagas disease in a rural area of the Argentinian northeast]. / Estudio transversal clínico y epidemiológico de la enfermedad de Chagas en una área rural del Nordeste Argentino.

The main goal was to know the epidemiologic, clinical, electrocardiographic and radiologic characteristics among a population of seropositives and seronegatives to Trypanosoma cruzi in a rural area of the Department of San Miguel, province of Corrientes, Argentina. One hundred and thirty-two patients of different ages: 2-79 years old were researched (58 males, 74 females). In order to make a thorough assessment clinical evaluation and cardiologic testing were carried out. Signs and symptoms consistent with heart disease, blood pressure, 12-lead ECG registry and chest x-ray (PA view) were registered. In signs and symptoms, abnormal ECG patterns and radiologic abnormalities, non-significant statistic difference were observed. Although we were unable to find a significant relationship between chagasic infection and a higher prevalence for heart disease, it is important to stress the fact that 54.0% of the studied population was largely composed of very young patients whose ages were less than 20 years old, and 45.0% of those older than 41 years showed ECG abnormalities.

Estudio transversal clínico y epidemiológico de la enfermedad de Chagas en una área rural del Nordeste Argentino / Clinical cross-sectional and epidemiologic study of Chagas disease in a rural area of the Argentinian northeast

Esta investigación tiene por objeto analizar las características epidemiológicas, clínicas, electrocardiográficas y radiológicas de una población de seropositivos y seronegativos al Trypanosoma cruzi en una área rural del Departamento San Miguel, provincia de Corrientes, Argentina. Se seleccionaron 132 pobladores (58 hombres y 74 mujeres) de todos los grupos etareos para la realización de un examen clínico y cardiovascular. Se registraron síntomas y signos compatibles con afección cardíaca, tensión arterial, electrocardiograma de 12 derivaciones y radiografía anteroposterior de tórax. En la signo-sintomatología, anomalías electrocardiográficas y en las alteraciones radiográficas detectadas, no se observaron diferencias estadísticamente significativas entre seropositivos y seronegativos. Se concluye que si bien en la población objeto de estudio la infección chagásica no se asoció a mayor prevalencia de cardiopatía, cabe destacar que los pacientes chagásicos pertenecían a un grupo etareo muy joven con un 54,0% de ellos menores de 20 años y que el 45,0% de los pacientes mayores de 41 años tenían alteraciones electrocardiográficas.

The main goal was to know the epidemiologic, clinical, electrocardiographic and radiologic characteristics among a population of seropositives and seronegatives to Trypanosoma cruzi in a rural area of the Department of San Miguel, province of Corrientes, Argentina. One hundred and thirty-two patients of different ages: 2-79 years old were researched (58 males, 74 females). In order to make a thorough assessment clinical evaluation and cardiologic testing were carried out. Signs and symptoms consistent with heart disease, blood pressure, 12-lead ECG registry and chest x-ray (PA view) were registered. In signs and symptoms, abnormal ECG patterns and radiologic abnormalities, non-significant statistic difference were observed. Although we were unable to find a significant relationship between chagasic infection and a higher prevalence for heart disease, it is important to stress the fact that 54.0% of the studied population was largely composed of very young patients whose ages were less than 20 years old, and 45.0% of those older than 41 years showed ECG abnormalities.

CONAREC III: predicción del riesgo de mortalidad intrahospitalaria en pacientes sometidos a cirugía coronaria / CONAREC III: prediction of in hospital mortality in patients undergoing isolated coronary artery bypass graft surgery

Se analizaron los datos de 1293 pacientes sometidos a cirugía coronaria con circulación extracorpórea entre octubre de 1992 y setiembre de 1993 en 41 centros asistenciales de nuestro país. A través de un análisis multivariado, se identificaron los predictores independientes de muerte hospitalaria y se elaboraron dos métodos capaces de estimar la mortalidad intrahospitalaria: un modelo matemático y un score de riesgo. Ambos son sencillos de aplicar y útiles a la hora de evaluar la calidad de la cirugía coronaria y los cuidados en recuperación cardiovascular

CONAREC III: predicción del riesgo de mortalidad intrahospitalaria en pacientes sometidos a cirugía coronaria / CONAREC III: prediction of in hospital mortality in patients undergoing isolated coronary artery bypass graft surgery

Se analizaron los datos de 1293 pacientes sometidos a cirugía coronaria con circulación extracorpórea entre octubre de 1992 y setiembre de 1993 en 41 centros asistenciales de nuestro país. A través de un análisis multivariado, se identificaron los predictores independientes de muerte hospitalaria y se elaboraron dos métodos capaces de estimar la mortalidad intrahospitalaria: un modelo matemático y un score de riesgo. Ambos son sencillos de aplicar y útiles a la hora de evaluar la calidad de la cirugía coronaria y los cuidados en recuperación cardiovascular (AU)

Serum unconjugated estriol concentrations before and after the oxytocin challenge test: an index of fetal well-being.

Serum unconjugated estriol concentrations before and after the oxytocin challenge test (stress test) were measured in 54 high-risk, obstetric patients. Six of the stress test results were positive, and eight were equivocal. Eleven patients demonstrated decrements in estriol of greater than or equal to 25% after stress tests, and the infants of six of these patients demonstrated perinatal morbidity. Three patients exhibited positive stress test results but had estriol concentrations which were unaltered by the stress test; all were delivered vaginally of healthy infants shortly after the stress test. The coefficient of correlation between the stress test and perinatal outcome was 0.58 (P less than 0.001). When the estriol and stress test results were combined to predict outcome, a multiple correlation coefficient of 0.71 was obtained (P less than 0.001). This increment represents a significant (P less than 0.001) and substantial (18%) improvement in the prediction of perinatal outcome. These findings indicate that the measurement of changes in estriol with the stress test significantly improves one's ability to define the fetus at risk.