Metodología de la gammagrafía con leucocitos marcados en el diagnóstico de infección osteoarticular protésica/no protésica: ¿análisis visual o semicuantitativo? ¿Protocolo de uno o 2 días? / Diagnostic methodology in labelled leukocyte scan for prosthetic / non-prosthetic osteoarticular infection: Visual or semi-quantitative analysis? One- or two-day protocol?

Objetivo: Como hay poca literatura sobre el tema, nos propusimos comparar la utilidad diagnóstica del análisis semicuantitativo versus el análisis visual en la escintigrafía de glóbulos blancos etiquetados (WBCS) para la infección osteoarticular. Se evaluaron protocolos de uno y dos días, en particular en los dispositivos ortopédicos.Material y métodos: Estudio prospectivo de 79 pacientes consecutivos con sospecha de infección osteoarticular. En todos los pacientes, la SCBM se realizó a los 30 min, 4 h, 8 h y 24 h. Las imágenes se analizaron agrupándolas en dos protocolos: protocolo de un día (los expertos evaluaron imágenes planas de 30 min, 4 h y 8 h) y protocolo de dos días (los expertos evaluaron imágenes planas de 30 min, 4 h y 24 h). Las imágenes planas se interpretaron cualitativa y semicuantitativamente y también se compararon agrupando a los pacientes con y sin dispositivos ortopédicos. Para determinar qué valor de corte de la variación porcentual podía predecir la infección osteoarticular, se calcularon múltiples valores de corte en ambos protocolos a partir del índice de Youden. Tres lectores ciegos analizaron las imágenes.Resultados: Comparando el diagnóstico final, el análisis visual del protocolo de un día proporcionó mejores resultados con una sensibilidad del 95,5%, una especificidad del 93% y una precisión diagnóstica del 93,7% (p < 0,01) que el protocolo de dos días con valores del 86,4%, 94,7% y 92,4%, respectivamente (p < 0,01). Para el análisis semicuantitativo, el protocolo de un día también obtuvo mejores resultados con una sensibilidad del 72,7%, una especificidad del 78,9% y una precisión del 77,2% (p < 0,01) que el protocolo de dos días (sin resultados significativos; p = 0,14), especialmente en el grupo de pacientes con aparatos ortopédicos (sensibilidad del 100%, especificidad del 79,5% y precisión del 82,7%; p < 0,01)

Objective: As scarce literature on the topic is available, we aimed to compare diagnostic utility of semi-quantitative versus visual analysis in labelled white blood cell scintigraphy (WBCS) for osteoarticular infection. One-day and two-day protocols were assessed, particularly in orthopaedic devices.Material and methods: Prospective study of 79 consecutive patients with suspected osteoarticular infection. In all patients, WBCS were performed at 30min, 4h, 8h and 24h. Images were analysed by grouping in two protocols: one-day-protocol (experts evaluated 30min, 4h and 8h planar images) and two-day-protocol (experts evaluated 30min, 4h and 24h planar images). Planar images were interpreted qualitative and semiquantitatively and also were compared grouping patients with and without orthopaedic devices. To find which cut-off value of the percentage variation could predict of osteoarticular infection, multiple cut-off values were calculated in both protocols from the Youden index. Three blinded readers analysed the images.Results: Comparing final diagnosis visual analysis of the one-day-protocol provided better results with sensitivity of 95.5%, specificity of 93% and diagnostic accuracy of 93.7% (P<.01) than the two-day-protocol with values of 86.4%, 94.7% and 92.4%, respectively (P<.01). For semi-quantitative analysis, the one-day-protocol also obtained better results with sensitivity of 72.7%, specificity of 78.9% and accuracy of 77.2% (P<.01) than two-day-protocol (no significant results; P=.14), especially in the group of patients with orthopaedic devices (sensitivity of 100%, specificity of 79.5% and accuracy of 82.7%; P<.01).Conclusions: Most accurate approach in the diagnosis of osteoarticular infection corresponded to visual analysis in one-day-protocol that showed greater sensitivity and specificity than semi-quantitative analysis. Semi-quantitative analysis only could be useful when visual analysis is doubtful

Risk factors for lymphedema after breast surgery: A prospective cohort study in the era of sentinel lymph node biopsy.

INTRODUCTION: The Objective was to investigate the incidence of lymphedema after breast cancer treatment and to analyze the risk factors involved in a tertiary level hospital. METHODS: Prospective longitudinal observational study over 3 years post-breast surgery. 232 patients undergoing surgery for breast cancer at our institution between September 2013 and February 2018. Sentinel lymph node biopsy (SLNB) or axillary lymphadenectomy (ALND) were mandatory in this cohort. In total, 201 patients met the inclusion criteria and had a median follow-up of 31 months (range, 1-54 months). Lymphedema was diagnosed by circumferential measurements and truncated cone calculations. Patients and tumor characteristics, shoulder range of motion limitation and local and systemic therapies were analyzed as possible risk factors for lymphedema. RESULTS: Most cases of lymphedema appeared in the first 2 years. 13.9% of patients developed lymphedema: 31% after ALND and 4.6% after SLNB (p < 0.01), and 46.7% after mastectomy and 11.3% after breast-conserving surgery (p < 0.01). The lymphedema rate increased when axillary radiotherapy (RT) was added to radical surgery: 4.3% for SLNB alone, 6.7% for SLNB + RT, 17.6% for ALND alone, and 35.2% for ALND + RT (p < 0.01). In the multivariate analysis, the only risk factors associated with the development of lymphedema were ALND and mastectomy, which had hazard ratios (95% confidence intervals) of 7.28 (2.92-18.16) and 3.9 (1.60-9.49) respectively. CONCLUSIONS: The main risk factors for lymphedema were the more radical surgeries (ALND and mastectomy). The risk associated with these procedures appeared to be worsened by the addition of axillary radiotherapy. A follow-up protocol in patients with ALND lasting at least two years, in which special attention is paid to these risk factors, is necessary to guarantee a comprehensive control of lymphedema that provides early detection and treatment.

Diagnostic methodology in labelled leukocyte scan for prosthetic / non-prosthetic osteoarticular infection: Visual or semi-quantitative analysis? One- or two-day protocol? / Metodología de la gammagrafía con leucocitos marcados en el diagnóstico de infección osteoarticular protésica/no protésica: ¿análisis visual o semicuantitativo? ¿Protocolo de uno o 2 días?

OBJECTIVE: As scarce literature on the topic is available, we aimed to compare diagnostic utility of semi-quantitative versus visual analysis in labelled white blood cell scintigraphy (WBCS) for osteoarticular infection. One-day and two-day protocols were assessed, particularly in orthopaedic devices. MATERIAL AND METHODS: Prospective study of 79 consecutive patients with suspected osteoarticular infection. In all patients, WBCS were performed at 30min, 4h, 8h and 24h. Images were analysed by grouping in two protocols: one-day-protocol (experts evaluated 30min, 4h and 8h planar images) and two-day-protocol (experts evaluated 30min, 4h and 24h planar images). Planar images were interpreted qualitative and semiquantitatively and also were compared grouping patients with and without orthopaedic devices. To find which cut-off value of the percentage variation could predict of osteoarticular infection, multiple cut-off values were calculated in both protocols from the Youden index. Three blinded readers analysed the images. RESULTS: Comparing final diagnosis visual analysis of the one-day-protocol provided better results with sensitivity of 95.5%, specificity of 93% and diagnostic accuracy of 93.7% (P<.01) than the two-day-protocol with values of 86.4%, 94.7% and 92.4%, respectively (P<.01). For semi-quantitative analysis, the one-day-protocol also obtained better results with sensitivity of 72.7%, specificity of 78.9% and accuracy of 77.2% (P<.01) than two-day-protocol (no significant results; P=.14), especially in the group of patients with orthopaedic devices (sensitivity of 100%, specificity of 79.5% and accuracy of 82.7%; P<.01). CONCLUSIONS: Most accurate approach in the diagnosis of osteoarticular infection corresponded to visual analysis in one-day-protocol that showed greater sensitivity and specificity than semi-quantitative analysis. Semi-quantitative analysis only could be useful when visual analysis is doubtful. In patients with joint prostheses, an increase in percentage variation above 9% obtained maximum sensitivity and negative predictive value.

Análisis del valor de la biopsia del gangliocentinela en el melanoma cutáneo / Analysis in the meaning of sentinel lymph node biopsy in cutaneous melanoma

El melanoma cutáneo es una neoplasia cuya incidencia va en aumento en nuestro medio. Presentamos un estudio sobre 1023 casos de esta patología recogidos a lo largo de 20 años, distribuidos en 2 grupos: grupo A tratados antes del 2000, y grupo B tratados después del2000. Comparamos la supervivencia de ambos grupos en base al cambio de tratamiento por la introducción del estudio del ganglio centinela a partir del año 2000.No observamos diferencias significativas entre los 2grupos en la supervivencia de los pacientes con melanoma a pesar de realizar tratamientos más conservadores. Por tanto, gracias a la biopsia de ganglio centinela, se pueden evitar un 75% de linfadenectomías electivas realizadas en este tipo de patología sin modificar los índices de supervivencia (AU)

The incidence of cutaneous melanoma has increased in our country recently. We report our experience during 20 years in 1023cases, comparing the survival between 2 groups of patients: group A treated before 2000, and group B treated after 2000, based on the different treatment after the introduction of sentinel lymph node biopsy in 2000.There are no differences in survival rates between both groups in spite of being more conservative. Moreover,75% of the lymphadenectomy could be evitated (AU)

Reply to the comments on 'Selective biopsy of the sentinel lymph node in patients with breast cancer and previous excisional biopsy: is there a change in the reliability of the technique according to time from surgery?' / Respuesta a los comentarios sobre 'Biopsia selectiva del ganglio centinela en pacientes con cáncer de mama y biopsia escisional previa: ¿cambia la fiabilidad de la técnica según el tiempo transcurrido desde la cirugía?'

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Biopsia selectiva del ganglio centinela en pacientes con cáncer de mama y biopsia escisional previa: ¿cambia la fiabilidad de la técnica según el tiempo transcurrido desde la cirugía? / Selective biopsy of the sentinel lymph node in patients with breast cancer and previous excisional biopsy: is there a change in the reliability of the technique according to time from surgery?

Objetivo. Analizar la influencia del tiempo sobre la fiabilidad de la biopsia selectiva del ganglio centinela (BSGC) en pacientes con cáncer de mama y biopsia escisional (BE) previa, estudiando la tasa de detección del ganglio centinela y de recidivas ganglionares. Material y métodos. Se incluyeron 36 pacientes con cáncer de mama cT1/T2 N0 y BE de la lesión, a los que se realizó la linfogammagrafía tras la administración periareolar subdérmica de radiocoloide, el día previo a la cirugía para BSGC. Los pacientes se clasificaron en dos grupos: uno incluyó 12 pacientes en los que la BSGC tuvo lugar durante los 29 días posteriores a la BE (grupo A) y otro 24 en que el tiempo transcurrido entre ambas cirugías fue igual o superior a 30 días (grupo B). Se analizaron la detección gammagráfica y quirúrgica del ganglio centinela, la histología del ganglio centinela y de la linfadenectomía axilar realizada, y las recidivas ganglionares durante el seguimiento. Resultados. La detección gammagráfica y quirúrgica del ganglio centinela fue del 100% en ambos grupos. Histológicamente, tres pacientes presentaron macrometástasis en el ganglio centinela, una del grupo A y dos del B. Ningún paciente, ni siquiera aquellos con afectación metastásica del ganglio centinela, recidivó después de un seguimiento medio de 49,5 meses (24 - 75). Conclusión. En la serie estudiada, el tiempo transcurrido entre la BE y la BSGC no ha influenciado la fiabilidad de esta última después de una inyección superficial del radiofármaco, demostrando una alta tasa de detección del ganglio centinela, sin evidencia de recidivas ganglionares durante el seguimiento (AU)

Aim. To assess the influence of time on the reliability of sentinel lymph node biopsy (SLNB) in breast cancer patients with previous excisional biopsy (EB), analyzing both the sentinel lymph node detection and the lymph node recurrence rate. Material and methods. Thirty-six patients with cT1/T2 N0 breast cancer and previous EB of the lesion underwent a lymphoscintigraphy after subdermal periareolar administration of radiocolloid, the day before SLNB. Patients were classified into two groups, one including 12 patients with up to 29 days elapsed between EB and SLNB (group A), and another with the remaining 24 in which time between both procedures was of 30 days or more (group B). Scintigraphic and surgical detection of the sentinel lymph node, histological status of the sentinel lymph node and of the axillary lymph node dissection, if performed, and lymphatic recurrences during follow-up, were analyzed. Results. Sentinel lymph node visualization at the lymphoscintigraphy and surgical detection were 100% in both groups. Histologically, three patients showed macrometastasis in the sentinel lymph node, one from group A and two from group B. None of the patients, not even those with malignancy of the sentinel lymph node, relapsed after a medium follow-up of 49.5 months (24 - 75). Conclusion. Time elapsed between EB and SLNB does not influence the reliability of this latter technique as long as a superficial injection of the radiopharmaceutical is performed, proving a very high detection rate of the sentinel lymph node without evidence of lymphatic relapse during follow-up (AU)

[Selective biopsy of the sentinel lymph node in patients with breast cancer and previous excisional biopsy: is there a change in the reliability of the technique according to time from surgery?]. / Biopsia selectiva del ganglio centinela en pacientes con cáncer de mama y biopsia escisional previa: ¿cambia la fiabilidad de la técnica según el tiempo transcurrido desde la cirugía?

AIM: To assess the influence of time on the reliability of sentinel lymph node biopsy (SLNB) in breast cancer patients with previous excisional biopsy (EB), analyzing both the sentinel lymph node detection and the lymph node recurrence rate. MATERIAL AND METHODS: Thirty-six patients with cT1/T2 N0 breast cancer and previous EB of the lesion underwent a lymphoscintigraphy after subdermal periareolar administration of radiocolloid, the day before SLNB. Patients were classified into two groups, one including 12 patients with up to 29 days elapsed between EB and SLNB (group A), and another with the remaining 24 in which time between both procedures was of 30 days or more (group B). Scintigraphic and surgical detection of the sentinel lymph node, histological status of the sentinel lymph node and of the axillary lymph node dissection, if performed, and lymphatic recurrences during follow-up, were analyzed. RESULTS: Sentinel lymph node visualization at the lymphoscintigraphy and surgical detection were 100% in both groups. Histologically, three patients showed macrometastasis in the sentinel lymph node, one from group A and two from group B. None of the patients, not even those with malignancy of the sentinel lymph node, relapsed after a medium follow-up of 49.5 months (24-75). CONCLUSION: Time elapsed between EB and SLNB does not influence the reliability of this latter technique as long as a superficial injection of the radiopharmaceutical is performed, proving a very high detection rate of the sentinel lymph node without evidence of lymphatic relapse during follow-up.

[Lymphoscintigraphy and sentinel node biopsy in non-palpable breast cancer]. / Linfogammagrafía y biopsia del ganglio centinela en el carcinoma no palpable de mama.

OBJECTIVE: The aim of the study was to evaluate the efficacy of lymphatic mapping and sentinel node biopsy in non-palpable breast cancer (NPBC) patients in comparison with palpable breast cancer (PBC) patients. MATERIAL AND METHODS: 199 breast cancer patients were studied. Patients were classified into two groups: NPBC and PBC. Following sentinel node biopsy all patients underwent axillary lymphadenectomy. Surgery was performed at 4-24 h after peritumoral injection of 111MBq 99mTc-nanocolloid. Histological sentinel node analysis was performed by cytological imprinting and delayed study. The following parameters were analyzed in both groups: scintigraphic and surgical detection rates, true positives (TP), true negatives (TN), sensitivity (S), predictive negative value (PNV), false negative rate (FNR) and global precision (GP) of the technique. RESULTS: No significant differences were observed (p > 0.05) in either the lymphoscintigraphy or surgical sentinel node detection, or drainage to internal mammary chain (p = 0.211) in both groups. Metastatic axillary prevalence was lower in NPBC group (p = 0.019). Similar S, NPV and GP values (>90 %) and FNR (< or = 6 %) were found in both groups. CONCLUSIONS: The reliability of the technique is similar in both groups. Drainage is predominantly axilar. Drainage to internal mammary chain was more frequently seen in medial tumours and in NPBC. Metastatic axillary prevalence was lower in the NPBC group.

Linfogammagrafía y biopsia del ganglio centinela en el carcinoma no palpable de mama / Lymphoscintigraphy and sentinel node biopsy in non-palpable breast cancer

Objetivo. Analizar las detecciones radioisotópica y quirúrgica del ganglio centinela (GC) en el carcinoma no palpable de mama (CNPM) y comparar los resultados en este grupo con los del grupo de tumores palpables de mama (CPM). Material y métodos. Se estudian 199 pacientes. Se les realizó biopsia del GC y linfadenectomía axilar (LDNA). Se establecen dos grupos: CNPM y CPM. La cirugía tuvo lugar entre las 4-24 horas de la administración peritumoral de 111MBq de 99mTc-nanocoloide. La histopatología del GC fue mediante impronta peroperatoria y estudio diferido. Se analiza el porcentaje de detección gammagráfica y quirúrgica y la vía de drenaje del GC según la palpación del tumor y su localización en la mama; los verdaderos positivos (VP), verdaderos negativos (VN), falsos negativos (FN), la sensibilidad (S), el valor predictivo negativo (VPN), la tasa de falsos negativos (TFN) y la precisión global (PG) de la técnica. Resultados. No se observaron diferencias estadísticamente significativas (p > 0,05) ni en la detección gammagráfica y quirúrgica del GC, ni en la existencia de drenaje a mamaria interna (p = 0,211) entre ambos grupos. La prevalencia de metástasis axilar fue menor en el grupo CNPM (p = 0,019). La S, el VPN y la PG de la técnica fue similar en los dos grupos (> 90 %), así como la TFN (<= 6 %). Conclusiones. La fiabilidad de la técnica es similar en los dos grupos. El drenaje predominante es axilar. El drenaje a mamaria interna predominó en los tumores mediales y en CNPM. La prevalencia metastásica axilar es menor en el CNPM

Objective. The aim of the study was to evaluate the efficacy of lymphatic mapping and sentinel node biopsy in non-palpable breast cancer (NPBC) patients in comparison with palpable breast cancer (PBC) patients. Material and methods. 199 breast cancer patients were studied. Patients were classified into two groups: NPBC and PBC. Following sentinel node biopsy all patients underwent axillary lymphadenectomy. Surgery was performed at 4-24h after peritumoral injection of 111MBq 99mTc-nanocolloid. Histological sentinel node analysis was performed by cytological imprinting and delayed study. The following parameters were analyzed in both groups: scintigraphic and surgical detection rates, true positives (TP), true negatives (TN), sensitivity (S), predictive negative value (PNV), false negative rate (FNR) and global precision (GP) of the technique. Results. No significant differences were observed (p > 0.05) in either the lymphoscintigraphy or surgical sentinel node detection, or drainage to internal mammary chain (p = 0.211) in both groups. Metastatic axillary prevalence was lower in NPBC group (p = 0.019). Similar S, NPV and GP values (> 90 %) and FNR (<= 6 %) were found in both groups. Conclusions. The reliability of the technique is similar in both groups. Drainage is predominantly axilar. Drainage to internal mammary chain was more frequently seen in medial tumours and in NPBC. Metastatic axillary prevalence was lower in the NPBC group

[Influence of radioactive concentration and storage time on radiochemical purity of 18F-FDG]. / Influencia de la concentración radiactiva y el tiempo de almacenamiento sobre la pureza radioquímica de la 2-[18F]-fluoro-2-desoxi-D-glucosa.

OBJECTIVE: To study the influence of the 18F-FDG radioactive concentration and the usual greatest storage time of the radiopharmaceutical at the Radiopharmacy Unit (RU) over its radiochemical purity. MATERIAL AND METHODS: Thirty 18F-FDG preparations coming from different batches were studied. The radiochemical purity was determined at the RU by means of TLC to saline-diluted (1:10) and undiluted samples of each preparation, in the early 30 minutes since its arrival and 5 hours later. The radiochemical purity of the original 18F-FDG was determined at the PET radiopharmaceutical producer Laboratory (PETL) by means of HPLC in the early hour since the 18F-FDG dispensing. RESULTS: The increase of 18F-Fluoride found in the (5 h-30 min) period was significantly greater in the samples without diluting than in the diluted ones (p < 0.0001). We found a significant correlation between the percent of this increase of 18F-Fluoride (y) and the radioactive concentration of the 18F-FDG (x): y = 0.00061x + 0.1759 (R2 = 0.198; p < 0.0005). The percent of 18F-Fluoride determined at the RU was significantly higher than the percent of 18F-Fluoride determined at the PETL (p < 0.0001). A significant correlation between the differences of the percent of 18F-Fluoride determined by TLC and HPLC (y) and the radioactive concentration (x) was found: y = 0.0139x + 0.3146 (R2 = 0.196; p = 0.016). A significant correlation among the differences of percent 18F-Fluoride determined by TLC and HPLC ([%F] RU - [%F] PETL), the radioactive concentration (RC) and the time since the radiopharmaceutical dispensing (t) was found: [%F] RU - [%F] PETL = 0.01159*RC (mCi/mL) + 0.250*t (h) - 0.01903 (R2 = 0.226; p < 0.014). CONCLUSIONS: The stability of the 18F-FDG preparations with time increases when diminishing its concentration. We recommended the dilution of these preparations with physiological saline solution.

Influencia de la concentración radiactiva y el tiempo de almacenamiento sobre la pureza radioquímica de la 2- (18F) -fluoro-2-desoxi-D-glucosa / Influence of radioactive concentration and storage time on radiochemical purity of 18F-FDG

Objetivo. Determinar la influencia de la concentración radiactiva de la 2-[ 18F]-fluoro-2-desoxi-D-glucosa ( 18F-FDG) y el tiempo de almacenamiento máximo habitual del radiofármaco en la Unidad de Radiofarmacia (UR) sobre su pureza radioquímica. Material y métodos. Se estudiaron 30 preparaciones de 18F-FDG procedentes de lotes diferentes. Se determinó la pureza radioquímica en la UR dentro de los 30 minutos siguientes a su recepción y a las 5 horas mediante cromatografía en capa fina (TLC) a las muestras diluidas con suero salino fisiológico (1:10) y sin diluir. La pureza radioquímica también se determinó en el Laboratorio de radiofármacos PET (LPET) dentro de la primera hora posterior a su dispensación por cromatografía líquida a alta presión (HPLC). Resultados. El aumento de porcentaje de 18F-Fluoruro a las 5 horas fue significativamente mayor en las muestras sin diluir que en las diluidas (p < 0,0001), encontrándose una correlación significativa entre el aumento de porcentaje de 18F-Fluoruro con el tiempo (y) respecto a la concentración radiactiva (x): y = 0,0061x + 0,1759 (R 2 = 0,1977; p < 0,0005). El porcentaje de 18F-Fluoruro determinado en la UR fue significativamente mayor que el determinado en el LPET (p < 0,0001), obteniéndose una correlación significativa entre el aumento de porcentaje de 18F-Fluoruro (y) y la concentración radiactiva (x): y = 0,0139x + 0,3146 (R 2 = 0,196; p = 0,016). Se obtuvo una correlación significativa entre este aumento ([ %F] UR ­ [ %F] LPET), la concentración radiactiva (CR) y el tiempo desde la dispensación (t): [ %F] UR ­ [ %F] LPET = 0,01159*CR (mCi/ml) + 0,250*t (h) ­ 0,01903 (R 2 = 0,226; p = 0,014). Conclusiones. La estabilidad de las preparaciones de 18F-FDG aumenta al disminuir su concentración. Aconsejamos la dilución de estas preparaciones con solución salina fisiológica

Objective. To study the influence of the 18F-FDG radioactive concentration and the usual greatest storage time of the radiopharmaceutical at the Radiopharmacy Unit (RU) over its radiochemical purity. Material and methods. Thirty 18F-FDG preparations coming from different batches were studied. The radiochemical purity was determined at the RU by means of TLC to saline-diluted (1:10) and undiluted samples of each preparation, in the early 30 minutes since its arrival and 5 hours later. The radiochemical purity of the original 18F-FDG was determined at the PET radiopharmaceutical producer Laboratory (PETL) by means of HPLC in the early hour since the 18F-FDG dispensing. Results. The increase of 18F-Fluoride found in the (5 h-30 min) period was significantly greater in the samples without diluting than in the diluted ones (p < 0,0001). We found a significant correlation between the percent of this increase of 18F-Fluoride (y) and the radioactive concentration of the 18F-FDG (x): y = 0,00061x + 0,1759 (R 2 = 0,198; p < 0,0005). The percent of 18F-Fluoride determined at the RU was significantly higher than the percent of 18F-Fluoride determined at the PETL (p < 0,0001). A significant correlation between the differences of the percent of 18F-Fluoride determined by TLC and HPLC (y) and the radioactive concentration (x) was found: y = 0,0139x + 0,3146 (R 2 = 0,196; p = 0,016). A significant correlation among the differences of percent 18F-Fluoride determined by TLC and HPLC ([ %F] RU ­ [ %F] PETL), the radioactive concentration (RC) and the time since the radiopharmaceutical dispensing (t) was found: [ %F] RU ­ [ %F] PETL = 0,01159*RC (mCi/mL) + 0,250*t (h) ­ 0,01903 (R 2 = 0,226; p < 0,014). Conclusions. The stability of the 18F-FDG preparations with time increases when diminishing its concentration. We recommended the dilution of these preparations with physiological saline solution

[Isotopic renal study in diabetic nephropathy]. / Estudio isotópico renal en la nefropatía diabética.

UNLABELLED: This study aimed to evaluate the prognostic value of the kidney split function (KSF), the effective renal plasma flow (ERPF) and glomerular filtration rate (GF) in the evolution of diabetic nephropathy. MATERIAL AND METHODS: 125 patients (IDDM:10, NIDDM:115), including 62 men, ages 18-84 years, were studied. In all cases GF (Cr 51 EDTA), ERPF (131I-hippuran), kidney split function (obtained from the 99mTc-MAG3 renogram) and basal serum creatinine (SC) were evaluated at the beginning of the study and patients were clinically followed up for 5 years by SC. Ultrasound and/or intravenous digital angiography were performed in 120 patients. RESULTS: In patients with decreased ERPF (76 patients) the SC increased progresively during the 5 years, in both those with elevated PC (N = 54) as well as in those with normal baseline SC (n = 22). In patients with normal ERPF the SC did not change significantly during the study. An asymethric split function (KSF < 40% in one kidney) was found in the renogram of 42 patients; in 32 of them the ERPF was decreased. Of these, ulttrasonography was normal in 9, and vascular and/or obstructive pathology was demonstrated by ultrasonography or digital angiography in only 6 patients. CONCLUSION: The ERPF becomes altered earlier than serum creatinine in patients with diabetic nephropaty. ERPF and split function calculation, and FG seems to have higher prognostic value than ultrasounds in the management of diabetic nephropathy. Radionuclides seems to be an accurate test than the ultrasonography to detect renal function abnormalities in patients with diabetic and thus can be an examination of choice in these patients.

Estudio isotópico renal en la nefropatía diabética / Effective renal plasma flow measurement and 99mtc-mag3 renography in the study of diabetic nephropathy

El objetivo de este trabajo ha sido el de analizar el valor pronóstico de la función renal unilateral (ERR), del flujo plasmático renal efectivo (FPRE) y del filtrado glomerular (FG) en la evolución de la nefropatía diabética. Material y método: Se ha revisado un total de 125 pacientes (DMID:10, DMNID:115), 62 hombres, edad: 18-84 años. En todos se ha valorado al principio del estudio el FG (Cr 51 EDTA), el FPRE (HIPPURAN-131I), la ERR de cada riñón (obtenida del renograma con MAG 3) y, la creatinina plasmática (CP), y se les ha hecho un seguimiento de hasta 5 años mediante la CP. Se ha practicado ecografía y/o angiografía digital en 120 pacientes. Resultados: En todos los pacientes con FPRE disminuido (76 p) se observó un incremento de la CP a los 5 años tanto si la CP basal estaba elevada (n = 54) como normal (n = 22). En los pacientes con FPRE normal la CP no mostró variaciones significativas a lo largo del estudio. Se observó una asimetría de función (ERR < 40 por ciento) en 42 p y en 32 de ellos el FPRE total estaba disminuido. De estos, la ecografía fue normal en 9, demostrándose patología vascular y/u obstructiva por ecografía o angiografía digital solo en 6.Conclusiones: El FPRE se altera de forma más precoz que la creatinina plasmática en el paciente diabético. Los valores del FPRE y FG tienen un valor pronóstico en la evolución de la nefropatía diabética. El estudio isotópico se muestra más preciso que la ecografía en detectar anomalías de función y puede ser por tanto una exploración de elección en estos pacientes (AU)

[Validation of the preparation of individual doses of 51Cr-EDTA in syringes]. / Validación de la preparación de dosis individuales de 51Cr-EDTA en jeringas.

The 51Cr-EDTA is one of the radiopharmaceuticals more used in the glomerular filtration rate determination. The necessity to prepare a daily reference dose every time that are prepared the patient's doses can go to a poor exploitation of the multidose vial. One way of improving its use consists on the preparation of individual doses in ready syringes to inject, for several days, employing only one of them as a standard. The aim of this study was to evaluate the storing of 51Cr-EDTA individual doses at room temperature and at 4 degrees C during 4 weeks, analyzing the radiochemical purity, the sterility and the radiopharmaceutical retention into the syringe. The results obtained showed that the radiochemical purity remains stable, always been greater than the value recommended for its use (> 95%). Likewise, there were not microorganism contamination nor 51Cr-EDTA appreciable retention into the syringes. We concluded that the preparation of individual doses of 51Cr-EDTA in syringes and their conservation at room temperature, or at 4 degrees C, during a period of 4 weeks, neither influence in the radiopharmaceutical quality nor increase its retention into the syringe.