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.

Hipertensión arterial pulmonar secundaria a tromboembolismo crónico como causa de disnea: a propósito de un caso / Pulmonary arterial hypertension secondary to chronic thromboembolism as a cause of dyspnea: a case report

El tromboembolismo pulmonar es una patología relativamente frecuente y su diagnóstico sigue siendo hoy en día un grave problema en la práctica clínica diaria. Para realizarlo se combinan habitualmente la sospecha clínica con pruebas de imagen, como la gammagrafía de ventilación/perfusión, la tomografía computarizada y, en ocasiones, la angiografía. En el tromboembolismo agudo, la frecuencia de hipertensión pulmonar es elevada, mientras que un porcentaje mucho menor desarrolla hipertensión arterial pulmonar crónica. Presentamos el caso de una mujer de 81 años con antecedentes de hipertensión arterial y cardiopatía hipertensiva que tras un episodio de sensación de fatiga y disnea intensa y de la realización de las pruebas complementarias pertinentes fue diagnosticada de hipertensión arterial pulmonar crónica secundaria a tromboembolismo pulmonar. Estos enfermos habitualmente presentan un curso de deterioro progresivo y un pronóstico muy pobre a corto plazo (AU)

Pulmonary embolism is a relatively frequent disease and its diagnosis continues to be a serious problem in the daily clinical practice. For its diagnosis, clinical suspicion is usually combined with other imaging tests, such as ventilation/perfusion lung scan, computed tomography (CT) and sometimes angiography. In acute thromboembolism, frequency of pulmonary hypertension is elevated while a much lower percentage develops chronic pulmonary arterial hypertension. We present the case of an 81-year-old woman with a background of arterial hypertension and hypertensive heart disease, who, after an episode of intense fatigue and breathlessness, and carrying out the pertinent complementary tests, was diagnosed of pulmonary hypertension secondary to chronic pulmonary thromboembolism. These patients usually follow a course of progressive deterioration and have a poor short-term prognosis (AU)

Hipertensión arterial pulmonar secundaria a tromboembolismo crónico como causa de disnea: a propósito de un caso / Pulmonary arterial hypertension secondary to chronic thromboembolism as a cause of dyspnea: A case report

El tromboembolismo pulmonar es una patología relativamente frecuente y su diagnóstico sigue siendo hoy en día un grave problema en la práctica clínica diaria. Para realizarlo se combinan habitualmente la sospecha clínica con pruebas de imagen, como la gammagrafía de ventilación/perfusión, la tomografía computarizada y, en ocasiones, la angiografía. En el tromboembolismo agudo, la frecuencia de hipertensión pulmonar es elevada, mientras que un porcentaje mucho menor desarrolla hipertensión arterial pulmonar crónica. Presentamos el caso de una mujer de 81 años con antecedentes de hipertensión arterial y cardiopatía hipertensiva que tras un episodio de sensación de fatiga y disnea intensa y de la realización de las pruebas complementarias pertinentes fue diagnosticada de hipertensión arterial pulmonar crónica secundaria a tromboembolismo pulmonar. Estos enfermos habitualmente presentan un curso de deterioro progresivo y un pronóstico muy pobre a corto plazo (AU)

Pulmonary embolism is a relatively frequent disease and its diagnosis continues to be a serious problem in the daily clinical practice. For its diagnosis, clinical suspicion is usually combined with other imaging tests, such as ventilation/perfusion lung scan, computed tomography (CT) and sometimes angiography. In acute thromboembolism, frequency of pulmonary hypertension is elevated while a much lower percentage develops chronic pulmonary arterial hypertension. We present the case of an 81-year-old woman with a background of arterial hypertension and hypertensive heart disease, who, after an episode of intense fatigue and breathlessness, and carrying out the pertinent complementary tests, was diagnosed of pulmonary hypertension secondary to chronic pulmonary thromboembolism. These patients usually follow a course of progressive deterioration and have a poor short-term prognosis (AU)

[Preoperative serum CA15.3 and CEA levels and clinical-biological parameters in breast tumors]. / Concentraciones séricas preoperatorias de antígeno carbohidrato 15.3 y antígeno carcinoembrionario y características clínico-biológicas tisulares de los carcinomas mamarios.

OBJECTIVE: To study the possible associations between preoperative serum CEA and CA15.3 levels and different clinical-biological parameters of infiltrating ductal carcinomas of the breast (IDC). PATIENTS AND METHOD: Preoperative serum CA15.3 and CEA levels were determined in 255 and 224 females, respectively, having IDC. We assayed the cytosolic levels of estrogen receptor, pS2, cathepsin D and hyaluronic acid, as well as the levels of epidermal growth factor receptor in cell surfaces. Tumor size, axillary involvement (N), distant metastasis (M), histological grade (HG) and cellular S-phase (SP) were taken into account. RESULTS: 22 IDC were positive for CA15.3 (> 40 U/ml) and they had greater global tumor size (p < 0.001), > 2 cm (p: 0.005) and distant metastasis (p < 0.001). 19 IDC were positive for CEA (> 4 ng/ml) and they had greater global tumor size (p < 0.001), > 2 cm (p < 0.001), > 5 cm (p: 0.052) and global S-phase values (p: 0.062), and were more frequently N + (p: 0.045), > 3N + (p: 0.001) and > 10N + (p < 0.001), M + (p: 0.004), HG3 (p: 0.091) and SP > 7 % (p: 0.006). CONCLUSIONS: Our results led us to the following: In patients having IDC of the breast, preoperative serum CA15.3 levels are associated with greater tumor size and distant metastasis, while pre-treatment CEA serum levels are associated moreover with axillary involvement; we have not observed any correlation between serum levels of both antigens and the hormonal status of the tumor; these results had physiopathological interest but reduced clinical value in pretreatment breast carcinomas due to their low sensitivity of both markers. However, they are useful in the follow-up of the patients when assessing serum concentrations of both markers, since they contribute to knowing the patients' clinical status better.

Concentraciones séricas preoperatorias de antígeno carbohidrato 15.3 y antígeno carcinoembrionario y características clínico-biológicas tisulares de los carcinomas mamarios / Preoperative serum CA15.3 and CEA levels and clinical-biological parameters in breast tumors

Objetivo. Estudiar las posibles correlaciones entre las concentraciones séricas pretratamiento del antígeno carcinoembrionario (CEA) y antígeno carbohidrato (CA) 15.3 y diferentes parámetros clínico-biológicos no titulares de carcinomas ductales infiltrantes de mama (CDI).Pacientes y método. El grupo de estudio incluyó 255 y 224 mujeres afectas de CDI pretratamiento en las que determinamos, mediante sendos IRMAS, las concentraciones séricas de CA 15.3 y CEA respectivamente. A nivel tisular dosificamos las concentraciones citosólicas de receptor de estrógenos, pS2, catepsina D y ácido hialurónico, así como las del receptor del factor de crecimiento epidérmico (EGFR) en las membranas celulares. Tuvimos también presente el tamaño, afectación ganglionar axilar (N), metástasis a distancia (M), grado histológico (GH) y fase de síntesis celular (FS).Resultados. Los 22 CDI con concentraciones de CA15.3 > 40 U/ml mostraron mayor tamaño global (p 2 cm (p: 0,005), así como metástasis a distancia (p 4 ng/ml) cursaron con mayor tamaño global (p 3 N + (p: 0,001) y > 10N + (p 2 cm (p 5 cm (p: 0,052), GH3 (p: 0,091) y FS > 7 % (p: 0,006).Conclusiones. Nuestros resultados inducen a las siguientes consideraciones: las concentraciones séricas pretratamiento del CA15.3 en mujeres afectas de CDI de mama se asocian con un mayor tamaño y metástasis a distancia, mientras que las de CEA lo hacen, además, con la afectación ganglionar; no hemos constatado una relación con el estatus hormonal del tumor y las concentraciones séricas de ambos marcadores tumorales; estos resultados son de interés fisiopatológico, de reducido valor clínico en los carcinomas mamarios pretratamiento, dada la baja sensibilidad de ambos marcadores, pero de utilidad en el seguimiento de los pacientes a la hora de valorar las concentraciones séricas de ambos marcadores, pues pueden contribuir a conocer de un modo más exacto su situación

Objective. To study the possible associations between preoperative serum CEA and CA15.3 levels and different clinical-biological parameters of infiltrating ductal carcinomas of the breast (IDC).Patients and method. Preoperative serum CA15.3 and CEA levels were determined in 255 and 224 females, respectively, having IDC. We assayed the cytosolic levels of estrogen receptor, pS2, cathepsin D and hyaluronic acid, as well as the levels of epidermal growth factor receptor in cell surfaces. Tumor size, axillary involvement (N), distant metastasis (M), histological grade (HG) and cellular S-phase (SP) were taken into account.Results. 22 IDC were positive for CA15.3 (> 40 U/ml) and they had greater global tumor size (p 2 cm (p: 0.005) and distant metastasis (p 4 ng/ml) and they had greater global tumor size (p 2 cm (p 5 cm (p: 0.052) and global S-phase values (p: 0.062), and were more frequently N + (p: 0.045), > 3N + (p: 0.001) and > 10 N + (p 7 % (p: 0.006).Conclusions. Our results led us to the following: In patients having IDC of the breast, preoperative serum CA15.3 levels are associated with greater tumor size and distant metastasis, while pre-treatment CEA serum levels are associated moreover with axillary involvement; we have not observed any correlation between serum levels of both antigens and the hormonal status of the tumor; these results had physiopathological interest but reduced clinical value in pretreatment breast carcinomas due to their low sensitivity of both markers. However, they are useful in the follow-up of the patients when assesing serum concentrations of both markers, since they contribute to knowing the patients'clinical satus better

[Expression of epidermal growth factor receptor (EGFR) in hormone-independent breast cancers]. / La expresión del receptor del factor de crecimiento epidérmico (EGFR) en carcinomas mamarios hormonoindependientes.

OBJECTIVE: To determine the expression of epidermal growth factor receptor (EGFR) in ER-negative and Pg-R negative infiltrating ductal carcinomas of the breast (IDC) and to analyze the possible relationship between the EGFR positivity and some clinico-biological parameters of tumors. MATERIAL AND METHODS: EGFR was measured by a single point radioligand assay in the cell surfaces of 115 ER-negative and Pg-R-negative (< 10 fmol/mg prot.) IDC. We measured also the cytosolic concentrations of pS2, cathepsin D, tissue-type plasminogen activator (t-PA) and hyaluronic acid (AH), as well as the levels of AH in cell surfaces. Tumor size, axillary involvement, distant metastasis, histological grading, ploidy and S-phase (SP) were taken account. RESULTS: Using as cut-off for EGFR a value of 5 fmol/mg prot., we can observed that IDCs -EGFR + had greater global values of S-phase (p: 0.005) and were more frequently metastastatic (p: 0.004), SP > 7 % (p < 0.001) and SP > 14 % (p: 0.077); likewise, they were lower frequently pS2-positive (p < 0.01) and t-PA-positive (p < 0.01). During the follow up time (median 85 months), the number of recurrences was higher in EGFR-positive than in EGFR- negative tumors (14/41 frente a 1/29; p: 0.002), but there was not differences in the number of deaths by the tumor. CONCLUSIONS: 1) The EGFR-positivity in ER-negative and PgR-negative IDCs is associated with distant metastasis, greater cellular proliferation (SP), lower positivity for pS2 and t-PA and greater number of recurrences. 2) Using 10 fmol/mg prot. as cut-off, we observed the same findings, except the change in cellular proliferation. 3) Our findings support the possible use of EGFR as a prognostic parameter in those breast carcinomas.

La expresión del receptor del factor de crecimiento epidérmico (EGFR) en carcinomas mamarios hormonoindependientes / Expression of epidermal growth factor receptor (EGFR) in hormone dependent breast cancers

Objetivo. Estudiar la expresión del receptor del factor de crecimiento epidérmico (EGFR) en carcinomas ductal infiltrantes (CDI) hormonoindependientes así como sus posibles relaciones con otros parámetros clínico-biológicos. Material y método. El EGFR fue determinado, mediante un método de radioligando, en las membranas celulares de 115 CDI RE y RP negativos ( 7 % (p < 0,001); asimismo, fueron menos frecuentemente pS2 + (p < 0,001) y t-AP + (p: < 0,001). Pudimos seguir 70 pacientes (i: 54-168; mediana 85 meses) y observamos que los carcinomas EFGR + presentaron mayor número de recidivas (14/41 frente a 1/29; p: 0,002), pero no de muertes por el tumor. Conclusiones. 1) La positividad para el EGFR en los CDI RE y RP negativos se asoció con metástasis a distancia, mayor proliferación celular, menor positividad para pS2 y t-AP y con superior número de recidivas; 2) los mismos hallazgos, excepto el cambio en la proliferación celular, fueron constatados cuando el dintel de positividad fue establecido en 10 fmol/mg prot, y 3) El EGFR podría ser utilizado como factor pronóstico en este tipo de carcinomas mamarios

Objective. To determine the expression of epidermal growth factor receptor (EGFR) in ER-negative and Pg-R negative infiltrating ductal carcinomas of the breast (IDC) and to analyze the possible relationship between the EGFR positivity and some clinico-biological parameters of tumors. Material and methods. EGFR was measured by a single point radioligand assay in the cell surfaces of 115 ER-negative and Pg-R-negative ( 7 % (p 14 % (p: 0.077); likewise, they were lower frequently pS2-positive (p < 0.01) and t-PA-positive (p < 0.01). During the follow up time (median 85 months), the number of recurrences was higher in EGFR-positive than in EGFR- negative tumors (14/41 frente a 1/29; p: 0.002), but there was not differences in the number of deaths by the tumor. Conclusions. 1) The EGFR-positivity in ER-negative and PgR-negative IDCs is associated with distant metastasis, greater cellular proliferation (SP), lower positivity for pS2 and t-PA and greater number of recurrences. 2) Using 10 fmol/mg prot. as cut-off, we observed the same findings, except the change in cellular proliferation. 3) Our findings support the possible use of EGFR as a prognostic parameter in those breast carcinomas