Osteomalacia hipofosfatémica sintomática secundaria a tratamiento con hierro carboximaltosa objetivada con gammagrafía ósea / Symptomatic hypophosphataemic osteomalacia secondary to the treatment with iron carboxymaltose detected in bone scintigraphy

El desarrollo de osteomalacia hipofosfatémica se ha relacionado con diversos tratamientos, fundamentalmente antirretrovirales y administración de hierro por vía intravenosa. La frecuencia de la hipofosfatemia hace necesario vigilar el fosfato tras la administración de hierro carboximaltosa. Presentamos el caso de una mujer sin antecedentes de alteración del metabolismo fosfo-cálcico a la que se pautó este tratamiento por anemia debida a hipermenorrea e intolerancia al hierro por vía oral. Comenzó con dolor oligoarticular que se generalizó más tarde, con importante impotencia funcional y cuya relación con la administración por vía intravenosa de hierro fue descubierta cuando los hallazgos gammagráficos junto con la analítica orientaron hacia una osteomalacia hipofosfatémica. Respondió de forma satisfactoria al tratamiento con fosfato como se objetivó clínicamente y en la gammagrafía ósea de control (AU)

The development of hypophosphataemic osteomalacia has been linked with several treatments, mainly antiretroviral and intravenous iron administration. The frequency of the hypophosphataemia requires monitoring the phosphate after the administration of iron carboxymaltose. We describe a case of a woman with no calcium-phosphorous metabolism disorder, to whom this treatment was prescribed for anaemia due to menorrhagia and intolerance to oral iron. She started with oligoarticular pain, which was spreading with a significant functional loss. The relationship with the administration of intravenous iron was discovered when scintigraphic findings together with laboratory results led to a diagnosis of hypophosphataemic osteomalacia. The patient responded satisfactorily to treatment with phosphate both clinically and in the follow-up bone scintigraphy (AU)

Symptomatic hypophosphataemic osteomalacia secondary to the treatment with iron carboxymaltose detected in bone scintigraphy. / Osteomalacia hipofosfatémica sintomática secundaria a tratamiento con hierro carboximaltosa objetivada con gammagrafía ósea.

The development of hypophosphataemic osteomalacia has been linked with several treatments, mainly antiretroviral and intravenous iron administration. The frequency of the hypophosphataemia requires monitoring the phosphate after the administration of iron carboxymaltose. We describe a case of a woman with no calcium-phosphorous metabolism disorder, to whom this treatment was prescribed for anaemia due to menorrhagia and intolerance to oral iron. She started with oligoarticular pain, which was spreading with a significant functional loss. The relationship with the administration of intravenous iron was discovered when scintigraphic findings together with laboratory results led to a diagnosis of hypophosphataemic osteomalacia. The patient responded satisfactorily to treatment with phosphate both clinically and in the follow-up bone scintigraphy.

Evaluación de la eficacia en la detección del ganglio centinela en el cáncer de mama: evolución cronológica e influencia de la incorporación de una gammacámara portátil intraoperatoria / Evaluation of the efficacy of sentinel node detection in breast cancer: chronological course and influence of the incorporation of an intra-operative portable gamma camera

Objetivo. Determinar el porcentaje de identificación global del ganglio centinela (GC) en el cáncer de mama, la evolución cronológica de este parámetro y la influencia de la introducción de una gammacámara portátil. Material y métodos. Estudio retrospectivo a partir de una base de datos prospectiva de 754 pacientes a las que se realizó biopsia selectiva del GC de forma consecutiva entre enero de 2003 y diciembre de 2011. La técnica fue mixta en periodo inicial y posteriormente con radiotrazador administrado intra-peritumoralmente. Hasta octubre de 2009 la exéresis del GC fue guiada por sonda y a partir de esta fecha se introdujo una gammacámara portátil para la detección intraoperatoria. Resultados. Se ha biopsiado el GC en 725 de 754 pacientes, siendo por tanto la eficacia global del 96,2%. Según el año de intervención quirúrgica los porcentajes de identificación han sido del 93,5% en 2003, del 88,7% en 2004, del 94,3% en 2005, del 95,7% en 2006, del 93,3% en 2007, del 98,8% en 2008, del 97,1% en 2009 y del 99,1% en 2010 y 2011. Existe una diferencia de proporciones entre el porcentaje de identificación antes y después de la incorporación de la gammacámara portátil del 4,6% que es estadísticamente significativa (IC 95% de la diferencia 2-7,2% con una p asociada de 0,0037). Conclusiones. El porcentaje de identificación global se halla por encima del nivel recomendado por las directrices actuales. Cronológicamente se constata elevación de este parámetro a lo largo del periodo estudiado. Los datos apuntan a que la incorporación de una gammacámara portátil ha tenido un papel en ello (AU)

Aim. To define the sentinel node identification rate in breast cancer, the chronological evolution of this parameter and the influence of the introduction of a portable gamma camera. Material and methods. A retrospective study was conducted using a prospective database of 754 patients who had undergone a sentinel lymph node biopsy between January 2003 and December 2011. The technique was mixed in the starting period and subsequently was performed with radiotracer intra-peritumorally administered the day before of the surgery. Until October 2009, excision of the sentinel node was guided by a probe. After that date, a portable gamma camera was introduced for intrasurgical detection. Results. The SN was biopsied in 725 out of the 754 patients studied. The resulting technique global effectiveness was 96.2%. In accordance with the year of the surgical intervention, the identification percentage was 93.5% in 2003, 88.7% in 2004, 94.3% in 2005, 95.7% in 2006, 93.3% in 2007, 98.8% in 2008, 97.1% in 2009 and 99.1% in 2010 and 2011. There was a significant difference in the proportion of identification before and after the incorporation of the portable gamma camera of 4.6% (95% CI of the difference 2–7.2%, P = 0.0037). Conclusions. The percentage of global identification exceeds the recommended level following the current guidelines. Chronologically, the improvement for this parameter during the study period has been observed. These data suggest that the incorporation of a portable gamma camera had an important role (AU)

[Evaluation of the efficacy of sentinel node detection in breast cancer: chronological course and influence of the incorporation of an intra-operative portable gamma camera]. / Evaluación de la eficacia en la detección del ganglio centinela en el cáncer de mama: evolución cronológica e influencia de la incorporación de una gammacámara portátil intraoperatoria.

AIM: To define the sentinel node identification rate in breast cancer, the chronological evolution of this parameter and the influence of the introduction of a portable gamma camera. MATERIAL AND METHODS: A retrospective study was conducted using a prospective database of 754 patients who had undergone a sentinel lymph node biopsy between January 2003 and December 2011. The technique was mixed in the starting period and subsequently was performed with radiotracer intra-peritumorally administered the day before of the surgery. Until October 2009, excision of the sentinel node was guided by a probe. After that date, a portable gamma camera was introduced for intrasurgical detection. RESULTS: The SN was biopsied in 725 out of the 754 patients studied. The resulting technique global effectiveness was 96.2%. In accordance with the year of the surgical intervention, the identification percentage was 93.5% in 2003, 88.7% in 2004, 94.3% in 2005, 95.7% in 2006, 93.3% in 2007, 98.8% in 2008, 97.1% in 2009 and 99.1% in 2010 and 2011. There was a significant difference in the proportion of identification before and after the incorporation of the portable gamma camera of 4.6% (95% CI of the difference 2-7.2%, P = 0.0037). CONCLUSIONS: The percentage of global identification exceeds the recommended level following the current guidelines. Chronologically, the improvement for this parameter during the study period has been observed. These data suggest that the incorporation of a portable gamma camera had an important role.

[Assessment of the patient satisfaction with a Nuclear Medicine Service]. / Evaluación del grado de satisfacción de los pacientes atendidos en un servicio de Medicina Nuclear.

GOAL: To know the perceived quality and the levels of patient satisfaction with the Nuclear Medicine Service (MN). METHODS: A cross-sectional descriptive study was performed. The authors designed a self-applied questionnaire based on a questionnaire from a survey created by the National Health Service of the UK. The answers of 32 items were analyzed, including 4 social-demographic questions and one open question. The authors recoded the variables related to service quality and recorded them as "in accordance" and "not in accordance." The validity of the questionnaire was measured using Cronbach's alpha and determination (R(2)) indexes. The authors used the χ(2), Student's T, ANOVA and linear regression analysis statistical tests. RESULTS: A total of 179 questionnaires were analyzed (response rate: 36.6%, sampling error: 5.8%). Evaluation of general satisfaction and the recommendation of the NM Service obtained a mean score of 8.96 and 9.20 (1-10 scale) points, respectively. The most influential variable regarding general satisfaction was the general impression of the organization of the service. The strong points of the service were courtesy, general organizational image and cleanliness. The main areas for improvement were appointment change process and waiting list. There were no significant differences regarding satisfaction due to the social-demographic variables except for age. CONCLUSION: This satisfaction survey has shown that patients are satisfied with the Nuclear Medicine Service and that it is a useful tool to detect the strong points and areas for improvement of the Service from the user's perspective.

Evaluación del grado de satisfacción de los pacientes atendidos en un servicio de Medicina Nuclear / Assessment of the Patient Satisfaction with a Nuclear Medicine Service

Objetivo. Conocer la calidad percibida y el grado de satisfacción de los pacientes con el servicio de Medicina Nuclear (MN). Metodología. Estudio descriptivo transversal. Se diseñó un cuestionario, adaptando un cuestionario elaborado por el National Health Service. Se analizaron las respuestas de 32 ítems, incluyendo 4 preguntas socio-demográficas y una abierta. Las variables relacionadas con la calidad de servicio se recodificaron en conformidad y no conformidad. Se midió la validez del cuestionario a través de los coeficientes alfa de Cronbach y de determinación (R2). Se utilizaron los test estadísticos χ2, t de Student, ANOVA y análisis de regresión lineal. Resultados. Fueron analizados 179 cuestionarios (tasa de respuesta: 36,6%, error muestral: 5,8%). La valoración de la satisfacción general y la recomendación del servicio de MN obtuvieron una puntuación media de 8,96 y 9,20 puntos respectivamente (escala 1-10). La variable que más influyó en la satisfacción general fue la impresión de la organización del servicio. Los principales puntos fuertes del servicio fueron la cortesía, la impresión de la organización del servicio y la limpieza; y las principales áreas de mejora, el cambio de cita y la lista de espera. No hubo diferencias significativas en la satisfacción en función de las variables sociodemográficas excepto para la edad. Conclusiones. La encuesta de satisfacción realizada nos ha permitido conocer que los pacientes están satisfechos con el Servicio de MN y, al mismo tiempo, constituye un instrumento útil para poder detectar los puntos fuertes y áreas de mejora del servicio desde la óptica del usuario(AU)

Goal. To know the perceived quality and the levels of patient satisfaction with the Nuclear Medicine Service (MN). Methods. A cross-sectional descriptive study was performed. The authors designed a self-applied questionnaire based on a questionnaire from a survey created by the National Health Service of the UK. The answers of 32 items were analyzed, including 4 social-demographic questions and one open question. The authors recoded the variables related to service quality and recorded them as "in accordance" and "not in accordance". The validity of the questionnaire was measured using Cronbach's alpha and determination (R2) indexes. The authors used the χ2, Student's T, ANOVA and linear regression analysis statistical tests. Results. A total of 179 questionnaires were analyzed (response rate: 36.6%, sampling error: 5.8%). Evaluation of general satisfaction and the recommendation of the NM Service obtained a mean score of 8.96 and 9.20 (1-10 scale) points, respectively. The most influential variable regarding general satisfaction was the general impression of the organization of the service. The strong points of the service were courtesy, general organizational image and cleanliness. The main areas for improvement were appointment change process and waiting list. There were no significant differences regarding satisfaction due to the social-demographic variables except for age. Conclusion. This satisfaction survey has shown that patients are satisfied with the Nuclear Medicine Service and that it is a useful tool to detect the strong points and areas for improvement of the Service from the user‘s perspective(AU)