Información incluida en las fichas técnicas de los primeros medicamentos homeopáticos "sin indicaciones" de uso humano autorizados y registrados en España / Information included in the summary of product characteristics of the first homeopathic medicinal products "without therapeutic indications" for human use registered in Spain

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Información incluida en las fichas técnicas de los primeros medicamentos homeopáticos «sin indicaciones» de uso humano autorizados y registrados en España / Information included in the summary of product characteristics of the first homeopathic medicinal products «without therapeutic indications» for human use registered in Spain

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[Authorized specifications for human use in clinical practice of radiopharmaceuticals composed of iobenguane (123I) marketed in Spain]. / Condiciones de uso humano autorizadas en la práctica clínica para los radiofármacos compuestos de iobenguano (123I) comercializados en España.

This article details the specifications authorised for human use in the clinical practice for the radiopharmaceutical products composed of iobenguane ((123)I) marketed in Spain.

Condiciones de uso humano autorizadas en la práctica clínica para los radiofármacos compuestos de iobenguano (123I) comercializados en España / Authorized specifications for human use in clinical practice of radiopharmaceuticals composed of iobenguane (123I) marketed in Spain

Este artículo detalla las condiciones de usohumano autorizadas en la práctica clínica para los radiofármacos compuestos de iobenguano (123I) legalmente comercializados en España

This article details the specifications authorisedfor human use in the clinical practice for the radiopharmaceutical products composed of iobenguane (123I) marketed in Spain (AU)

[Atypical findings of the combined scintigraphy of bone marrow and labeled leukocytes in osteonecrosis of the hip secondary to infection]. / Hallazgos atípicos de la gammagrafía combinada de médula ósea y leucocitos marcados en osteonecrosis de la cadera secundaria a infección.

Avascular osteonecrosis can be associated with septic arthritis and osteomyelitis. Combined labeled leukocyte-marrow imaging scintigraphy has demonstrated excellent accuracy for the detection of infection since both tracers accumulate in the bone marrow and only leukocytes accumulate in infection. We report an unusual total absence of 99mTc HMPAO leukocytes/9mTc-sulfur colloid tracer accumulation, not only in the femoral head but also in the acetabulum and hip in hip osteonecrosis secondary to septic arthritis and osteomyelitis.

Hallazgos atípicos de la gammagrafía combinada de médula ósea y leucocitos marcados en osteonecrosis de la cadera secundaria a infección / Atypical findings of the combined scintigraphy of bone marrow and labeled leukocytes in osteonecrosis of the hip secondary to infection

La osteonecrosis avascular puede asociarse con artritis séptica y osteomielitis. La gammagrafía combinada de médula ósea y leucocitos marcados ha demostrado una excelente fiabilidad para la detección de infección, ya que ambos marcadores se acumulan en la médula ósea y únicamente los leucocitos se concentran en los focos infecciosos. Presentamos un caso atípico de ausencia completa de acúmulo de sulfuro coloidal-99mTc y leucocitos-HMPAO-99mTc, no sólo en la cabeza femoral sino también en el acetábulo y pelvis, en osteonecrosis de la cadera secundaria a artritis séptica y osteomielitis (AU)

Inter-modality comparisons of seizure focus lateralization in complex partial seizures.

Anterior temporal lobectomy offers a high chance of seizure-free outcome in patients suffering from drug-refractory complex partial seizure (CPS) originating from the temporal lobe. Other than EEG, several functional and morphologic imaging methods are used to define the spatial seizure origin. The present study was undertaken to compare the merits of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET), magnetic resonance imaging (MRI) and single-voxel proton MR spectroscopy (MRS) for the lateralization of temporal lobe seizure foci. The clinical charts and imaging data of 43 consecutive CPS patients were reviewed. Based on surface EEG, 31 patients were classified with temporal lobe epilepsy (TLE; 25 lateralized, 6 not lateralized) and 12 with non-temporal lobe epilepsy. All were examined by FDG-PET, MRS and MRI within 6 weeks. FDG-PET and MRI were interpreted visually, while the N-acetyl-aspartate to creatine ratio was used for MRS interpretation. One FDG-PET scan was invalid due to seizure activity post injection. The MR spectra could not be evaluated in five cases bilaterally and three cases unilaterally for technical reasons. A total of 15 patients underwent anterior temporal lobectomy. All showed a beneficial postoperative outcome. When the proportions of agreement between FDG-PET (0.77), MRI (0.58) and MRS (0.56) and surface EEG in TLE cases were compared, there were no significant differences (P>0.10). However, FDG-PET showed a significantly higher agreement (0.93) than MRI (0.60; P=0.03) with the side of successful temporal lobectomy. The concordance of MRS with the side of successful temporal lobectomy was intermediate (0.75). When the results of functional and morphologic imaging were combined, no significant differences were found between the rates of agreement of FDG-PET/MRI and MRS/MRI with EEG (0.80 vs 0.68; P=0.50) and with the side of successful temporal lobectomy (0.87 vs 0.92; P=0.50) in TLE cases. However, MRS/MRI showed significantly more lateralized temporal lobe abnormalities in non-temporal lobe epilepsy cases than FDG-PET/MRI (0.90 vs. 0.17; P<0.01). Although FDG-PET seems to be the most reliable and stable method for this purpose, we conclude that in TLE cases it may be justified to perform MRS, which is less expensive, faster and has no radiation exposure, in combination with MRI before FDG-PET, since FDG-PET offers little additional diagnostic information if MRS and MRI indicate the same seizure focus lateralization.

Do high glucose levels have differential effect on FDG uptake in inflammatory and malignant disorders?

BACKGROUND: The association of hyperglycaemia with reduced fluorodeoxyglucose (FDG) uptake by tumour cells is well established. Therefore, it is standard practice that all patients must fast for at least several hours prior to FDG positron emission tomography (PET) imaging. However, the effect of hyperglycaemia on FDG uptake by inflammatory and infectious lesions is unknown. The aim of this study was to investigate this important issue. METHODS: For in vitro studies human mononuclear cells were isolated from 12 normal volunteers and FDG uptake was determined in medium containing differing concentrations of glucose. FDG uptake by human mesothelioma cells was also measured for comparison. For studies involving patients, 416 FDG PET scans of patients with confirmed malignancy (n=321) or benign lesions (n=95) were reviewed retrospectively. The relationship between serum glucose level and FDG uptake by the lesions was assessed utilizing the standardized uptake value (SUV) technique. RESULTS: In the in vitro studies, while FDG uptake by mesothelioma cells decreased as glucose concentration increased, there was no differential uptake of FDG uptake by mononuclear cells at glucose concentrations less than 250 mg x dl(-1). In clinical patients, FDG uptake by malignant lesions was slightly, but negatively affected by serum glucose level (r= -0.21, P<0.01) (glucose range 49-187 mg x dl(-1)). In contrast, FDG uptake by inflammatory lesions was positively associated with serum glucose level (r=0.43, P<0.01) (glucose range 54-215 mg x dl(-1)). DISCUSSION AND CONCLUSION: While the degree of FDG uptake is primarily influenced by the nature of the underlying lesion, serum glucose concentration appears to have a small effect on FDG uptake, which differs between malignant disorders and inflammatory processes. Our data suggest that below a certain level, elevated glucose concentration might not have a negative effect on FDG uptake in inflammatory cells, contrary to that observed in malignant disorders.

Gammagrafía con hematíes marcados con 99mTecnecio: visualización precoz de la vesícula biliar / Technetium99m labeled red blood cells scintigraphy: early gallbladder visualization

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[Hormonal reference values for adrenocortical function in healthy children from Zaragoza]. / Valores de referencia hormonales de función corticosuprarrenal en niños sanos zaragozanos.

OBJECTIVE: Estimation of reference values for basal serum concentrations of adrenocorticotropic hormone (ACTH), cortisol, 11-deoxycortisol, 17-OH-progesterone (17-OHP), plasma renin activity (PRA), aldosterone, -4-androstendione ( 4A) and dehydroepiandrosterone sulphate (DHA-S) in healthy children from Zaragoza. METHODS: Reference population were healthy children aged 0 to 14, with normal weight and height, living in the metropolitan area of Zaragoza (Spain). It is a transversal study. Reference values and ranges for ACTH, cortisol, 11-deoxycortisol, 17-OHP, PRA, aldosterone, 4A and DHA-S were estimated, and changes in concentrations were analyzed in relation to age, sex and puberal stage. RESULTS: Reference values have been classified by puberal stage and age in eleven groups for every sex: Tanner I (umbilical cordon, 3 days, 4-30 days, 1-6 months, 6 months-4 years, 4-7 years, 7-10 years, 10-14 years), Tanner II, Tanner III and Tanner IV-V. Sex did not influence ACTH, cortisol, 17-OHP and PRA concentrations, and there are punctual differences in 11-deoxycortisol, aldosterone, 4A and DHA-S levels. 17-OHP, 11-deoxycortisol and aldosterone concentrations significantly decreased from birth to 6 months-4 years and subsequently kept steady. The maximal concentration of ACTH, and ARP in blood cord significantly decreased until the period 6 months-4 years, and subsequent differences among different age groups, and between prepuberal and puberal groups are scarce. The highest concentration of 4A and DHA-S were observed in blood cord and third day of life, decreased until the lowest level in 6 months-4 years and progressively increased with age in prepuberty, and between prepuberty and puberty. The lowest concentration of cortisol was detected in 4-30 days, increased until 6 months-4 years and kept steady along the prepuberty and puberty. CONCLUSION: It is necessary that every population establish own reference values for ACTH, cortisol, 11-deoxycortisol, 17-OHP, PRA, aldosterone, 4A and DHA-S during infancy, childhood and adolescence, according to age, sex and puberal stage.

[Reproducibility of the qualitative interpretation of dynamic salivary radionuclide scans with excretory stimulation]. / Reproducibilidad de la interpretación cualitativa de la gammagrafía salival dinámica con estímulo excretor.

OBJECTIVE: To evaluate intraobserver and interobserver agreement in the qualitative interpretation of dynamic salivary radionuclide scans to detect salivary disease, and the agreement between interpretation of dynamic and static image compositions. MATERIAL AND METHODS: Two observers (A, B) interpreted 110 dynamic salivary radionuclide scans with excretory stimulation based on dynamic image composition. Both again interpreted every studies: A based on dynamic image composition and B on static image composition. Kappa statistics were used to determine the degree of intraobserver and interobserver agreement. RESULTS: Considering all the studies, the dynamic composition showed an intraobserver agreement of 0.76 and interobserver agreements of 0.58 and 0.61. In patients with clinical sicca syndrome, agreements were 0.60, 0.52 and 0.62, respectively. For all the cases, the agreements between dynamic and static composition was 0.62 (intraobserver), and 0.42 and 0.43 (interobserver). For patients with clinical sicca syndrome these agreements were 0.63 (intraobserver), and 0.36 and 0.51 (interobserver). CONCLUSION: Intraobserver and interobserver agreement in the qualitative interpretation of dynamic salivary radionuclide scan with excretory stimulation are moderate and notable-moderate overall and in patients with clinical sicca syndrome. These agreements are greater than between dynamic and static image composition.