Infarto de miocardio silente diagnosticado por SPECT de perfusión miocárdica en mujer joven con lupus eritematoso sistémico / Silent myocardial infarction diagnosed by myocardial perfusion SPECT in a young woman with systemic lupus erythematosus

La ateroesclerosis prematura y su consecuente enfermedad coronaria tienen un papel fundamental en los pacientes con lupus eritematoso sistémico, incluso en las mujeres premenopáusicas, siendo unas de las principales causas de mortalidad en el lupus de larga evolución. Presentamos el caso de una mujer premenopáusica de 42 años, fumadora, con antecedentes de hipertensión arterial, colecistectomía y lupus de 23 años de evolución, en tratamiento con AINE, esteroides y antipalúdicos. La paciente acude por dolor opresivo precordial con moderados esfuerzos. Ante la sospecha de cardiopatía isquémica se inicia estudio cardiológico y se realiza una SPECT de perfusión miocárdica que objetivó un defecto de perfusión intenso y extenso anteroapical, con muy ligera reperfusión en las imágenes de reposo, compatible con el diagnóstico de infarto agudo en la región apical e isquemia en el territorio de la arteria descendente anterior, confirmada por el cateterismo cardíaco(AU)

Premature atherosclerosis and its consequent heart disease play a crucial role in patients with systemic lupus erythematosus, even in premenopausal women. It is one of the leading causes of death in long evolution lupus. We present the case of a 42-year-old premenopausal woman, smoker, with a history of hypertension, cholecystectomy and lupus for 23 years, treated with NSAID, steroids and antimalarial drugs. The patient consulted due to chest pain on moderate efforts. Due to the suspicion of ischemic heart disease, a cardiology study was initiated, performing a myocardial perfusion SPECT. This revealed an intense and extensive anterolateral perfusion defect, with very light reperfusion in rest images, consistent with the diagnosis of acute infarction in the apical region and ischemia in the territory of the left anterior descending artery, which was confirmed later by cardiac catheterization(AU)

[Silent myocardial infarction diagnosed by myocardial perfusion SPECT in a young woman with systemic lupus erythematosus]. / Infarto de miocardio silente diagnosticado por SPECT de perfusión miocárdica en mujer joven con lupus eritematoso sistémico.

Premature atherosclerosis and its consequent heart disease play a crucial role in patients with systemic lupus erythematosus, even in premenopausal women. It is one of the leading causes of death in long evolution lupus. We present the case of a 42-year-old premenopausal woman, smoker, with a history of hypertension, cholecystectomy and lupus for 23 years, treated with NSAID, steroids and antimalarial drugs. The patient consulted due to chest pain on moderate efforts. Due to the suspicion of ischemic heart disease, a cardiology study was initiated, performing a myocardial perfusion SPECT. This revealed an intense and extensive anterolateral perfusion defect, with very light reperfusion in rest images, consistent with the diagnosis of acute infarction in the apical region and ischemia in the territory of the left anterior descending artery, which was confirmed later by cardiac catheterization.

CA15.3 sérico y proliferación celular en carcinomas ductales infiltrantes de mama / Preoperative CA15.3 serum levels and cellular proliferation in patients having infiltrating ductal carcinomas of the breast

Objetivo. Estudiar la posible correlación entre las concentraciones séricas preoperatorios de CA15.3 y laproliferación celular medida por la fase de síntesis (FS) en carcinomas ductales infiltrantes de mama (CDI).Material y métodos. El grupo estudio incluyó 79 pacientesde edades comprendidas entre los 39 y 86 años (64,8 ± 11,8). La ploidía y FS fueron determinadas por citometría de flujo en muestras en fresco (Fascam. Beckton Dikinson. EE.UU.). Resultados. Tomando como dintel de positividad para la FS el valor de 7 %, que representa la mediana obtenida previamente en un grupo de 321 CDI (i: 0,8-51,2; 9,3 ± 7,9; percentiles 25 y 75; 4,3 y 11,8 %), observamos que las concentraciones del marcador fueron mayores (p: 0,015) en los casos con menor proliferación celular. Esto mismo se constató al valorar cualitativamente (> 30 U/ml) el marcador. Asimismo, las concentraciones de CA15.3 aumentaron significativamente (p = 0,007) al pasar la FS de < 4,3 % a FS comprendida entre 4,3 y 7,1 %, para luego descender (p = 0,010) en los casos con FS entre 7,11 y 11,8% y no modificarse cuando aquella fue > 11,8 %. Este mismo comportamiento lo observamos en los tumores sin afectación axilar. Conclusiones. a) La liberación del CA15.3 ocurre cuando la FS se incrementa hasta alcanzar el valor del 7,1 %, para luego ir disminuyendo aunque aquella aumente, y b) este mismo comportamiento del marcador con la fase S se constató cuantitativamente en los tumores aneuploides y sin afectación axilar

Objective. To study the possible correlations betweenthe preoperative CA15.3 serum levels and the cellularproliferation, measured by S-phase (SP), in patients having infiltrating ductal carcinomas (IDC) of the breastMaterial and methods. The study group included 79 patients with an age ranged between 39 and 86 yrs (64,8 ± 11,8). Ploidy and S-phase were measured by cytometry (Fascam. Beckton Dikinson. USA) in fresh samplesResults: Using as cut-off for SP the value of 7 %, which represents the median obtained previously in 321 patients with IDC (r: 0,8-51,2; 9,3 ± 7,9; percentiles 25 y 75; 4,3 y 11,8 %), we can observed that the antigenic levels were higher (p:0,015) in the tumors with low SP. These same behavior was noted when 30U/ml was used as cut-off for CA15.3. Likewise, the levels of the tumor marker increased significantly (p:0,007)when the SP moved from < 4,3 % to 7,1 %, to decrease later (p:0,010) when the SP value was comprised between 7,11% and 11,8 %. The same behavior of this tumor marker in relation to the SP was noted in tumors without axillary involvement tumors, as well as in aneuploid carcinomas. Conclusion: a) Release of CA15.3 happens when SP increases to rise the 7,1 % value, to decrease later although that goes on increasing, and b) The same behaviour of this marker with the S-phase was observed in tumors without axillary involvement, as well as in aneuploid carcinomas

[Preoperative CA15.3 serum levels and cellular proliferation in patients having infiltrating ductal carcinomas of the breast]. / CA15.3 sérico y proliferación celular en carcinomas ductales infiltrantes de mama.

OBJECTIVE: To study the possible correlations between the preoperative CA15.3 serum levels and the cellular proliferation, measured by S-phase (SP), in patients having infiltrating ductal carcinomas (IDC) of the breast MATERIAL AND METHODS: The study group included 79 patients with an age ranged between 39 and 86 yrs (64,8 +/- 11,8). Ploidy and S-phase were measured by cytometry (Fascam. Beckton Dikinson. USA) in fresh samples RESULTS: Using as cut-off for SP the value of 7 %, which represents the median obtained previously in 321 patients with IDC (r: 0,8-51,2; 9,3 +/- 7,9; percentiles 25 y 75; 4,3 y 11,8 %), we can observed that the antigenic levels were higher (p:0,015) in the tumors with low SP. These same behavior was noted when 30U/ml was used as cut-off for CA15.3. Likewise, the levels of the tumor marker increased significantly (p:0,007) when the SP moved from < 4,3 % to 7,1 %, to decrease later (p:0,010) when the SP value was comprised between 7,11 % and 11,8 %. The same behavior of this tumor marker in relation to the SP was noted in tumors without axillary involvement tumors, as well as in aneuploid carcinomas. CONCLUSION: a) Release of CA15.3 happens when SP increases to rise the 7,1 % value, to decrease later although that goes on increasing, and b) The same behaviour of this marker with the S-phase was observed in tumors without axillary involvement, as well as in aneuploid carcinomas.