Estudio prospectivo para determinar el valor real de la captación de 18F-FDG mesentérica en pacientes oncológicos: ¿paniculitis mesentérica inflamatoria o tumoral? / A prospective study to determine the real value of mesenteric 18F-FDG uptake in cancer patients. inflammatory or tumoral mesenteric paniculitis?

Objetivo. Determinar el comportamiento metabólico de la paniculitis mesentérica (PM), los posibles patrones de presentación en la imagen 18F-FDG-PET/TAC y conocer si es una técnica diagnóstica fiable para diferenciar enfermedad tumoral y patología inflamatoria en este contexto. Material y métodos. Dos mil seiscientas sesenta y seis exploraciones PET/TAC fueron evaluadas de forma prospectiva desde abril de 2012 hasta agosto de 2013. Se incluyeron en nuestro estudio a 30 pacientes (37 exploraciones) que presentaban signos radiológicos de PM, 8 mujeres y 22 hombres, con edades comprendidas entre 39 y 81 años. Según la captación de 18F-FDG en las lesiones mesentéricas, expresado como SUVmax, los pacientes fueron clasificados en dos grupos: Grupo A: conformado por 10 pacientes con captación aumentada, SUVmax ≥ 2 o superior a la actividad hallada en el tejido mesentérico sano circundante y Grupo B (conformado por 20 pacientes): SUVmax < 2 o indistinguible del tejido sano. Resultados. En el 80% de los pacientes del Grupo A (media de SUVmax 7,11) no se demostraron criterios de afectación tumoral mesentérica durante un seguimiento medio de 13 meses (falsos positivos), exceptuando a dos pacientes de este grupo que sí mostraron signos de afectación tumoral (SUVmax 7,57 y 9,46), obteniéndose un valor predictivo positivo de 49,79%. En el 100% de los pacientes del Grupo B se confirmó ausencia de afectación tumoral mesentérica. Conclusiones. Ante la presencia de signos radiológicos de PM, un aumento del metabolismo glucídico, incluso intenso y focal en estas lesiones, aunque no excluye la posibilidad de afectación tumoral, puede corresponder, con una alta probabilidad, a actividad inflamatoria (AU)

Aim. To assess the metabolic behavior of mesenteric panniculitis (MP), possible manifestation patterns in 18F-FDG PET/CT imaging and to discover if it is a reliable diagnostic method to differentiate tumor disease from inflammatory condition in this context. Material and methods. A total of 2,666 PET/CT scans were evaluated prospectively from April 2012 to August 2013. Thirty patients were included (37 scans) with radiological signs of MP. There were 8 women and 22 men, aged between 39 and 81 years, in the sample. According to the 18F-FDG uptake in the mesenteric lesions, expressed as SUVmax, patients were classified into two different groups: Group A consisted of 10 patients with increased uptake, SUVmax ≥ 2 or greater than the activity found in the surrounding healthy mesenteric tissue, and Group B (20 patients) SUVmax < 2 or indistinguishable from healthy tissue. Results. No signs of mesenteric tumour involvement were demonstrated during a mean follow up of 13 months (false positives) in 80% of the Group A patients (mean SUVmax 7.11). Signs of the presence of tumor were only demonstrated in two patients of Group A (SUVmax 7.57 and 9.46) with a positive predictive value of 49.79%. All Group B patients were confirmed to be free of mesenteric involvement. Conclusions. The presence of radiological signs of suggestive of MP, increase in glycidic metabolism, even intense and focal in these lesions, which may not exclude the possibility of an ongoing tumour process, would have a high likelihood of being indicative of intense inflammatory activity (AU)

[A prospective study to determine the real value of mesenteric ¹8F-FDG uptake in cancer patients. inflammatory or tumoral mesenteric paniculitis?]. / Estudio prospectivo para determinar el valor real de la captación de ¹8F-FDG mesentérica en pacientes oncológicos: ¿paniculitis mesentérica inflamatoria o tumoral?

AIM: To assess the metabolic behavior of mesenteric panniculitis (MP), possible manifestation patterns in ¹8F-FDG PET/CT imaging and to discover if it is a reliable diagnostic method to differentiate tumor disease from inflammatory condition in this context. MATERIAL AND METHODS: A total of 2,666 PET/CT scans were evaluated prospectively from April 2012 to August 2013. Thirty patients were included (37 scans) with radiological signs of MP. There were 8 women and 22 men, aged between 39 and 81 years, in the sample. According to the ¹8F-FDG uptake in the mesenteric lesions, expressed as SUVmax, patients were classified into two different groups: Group A consisted of 10 patients with increased uptake, SUVmax ≥ 2 or greater than the activity found in the surrounding healthy mesenteric tissue, and Group B (20 patients) SUVmax <2 or indistinguishable from healthy tissue. RESULTS: No signs of mesenteric tumour involvement were demonstrated during a mean follow up of 13 months (false positives) in 80% of the Group A patients (mean SUVmax 7.11). Signs of the presence of tumor were only demonstrated in two patients of Group A (SUVmax 7.57 and 9.46) with a positive predictive value of 49.79%. All Group B patients were confirmed to be free of mesenteric involvement. CONCLUSIONS: The presence of radiological signs of suggestive of MP, increase in glycidic metabolism, even intense and focal in these lesions, which may not exclude the possibility of an ongoing tumour process, would have a high likelihood of being indicative of intense inflammatory activity.

Hipertensión arterial vasculorrenal en varón joven / Vasculo-renal arterial hypertension in a young male patient

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[The reliability of computed tomography (CT) in the local (T) and lymph node (N) staging of kidney adenocarcinoma]. / Fiabilidad de la tomografía computarizada (TC) en el estadiaje local (T) y ganglionar (G) del adenocarcinoma de riñón.

OBJECTIVES: We investigated the reliability of local (T) and lymph node (N) category staging of renal adenocarcinoma by CT in patients submitted to radical nephrectomy. MATERIAL AND METHODS: The study comprised 109 patients with renal adenocarcinoma who had undergone radical nephrectomy from 1986-1994. The preoperative staging was done using dynamic CT. Clinical staging was based on the CT data and pathological staging was determined by the pathological findings. All patients had a transperitoneal radical nephrectomy. The sensitivity, specificity, positive (PPV) and negative predictive values (NPV) for tumors localized to the kidney, perirenal fat invasion, central venous and lymphatic invasion were analyzed. RESULTS: The overall sensitivity rate was 67%; the sensitivity and specificity rates were 77% and the PPV and NPV were 89.5% and 67%, respectively, for tumors localized to the kidney. The sensitivity rate was 66%, specificity was 76% and the PPV and NPV were 48.5% and 87.5%, respectively, for those with perirenal fat invasion. Tumors with venous spread showed a sensitivity of 90%, specificity of 92%, PPV 53% and NPV 99%. Concerning lymph node invasion, the sensitivity was 50%, specificity 96%, PPV 50%, NPV 96%. CONCLUSIONS: CT has a very low sensitivity and specificity in detecting fat invasion, a very high sensitivity and specificity for venous invasion and a low sensitivity, but high specificity in detecting lymphatic spread.

[A study of the locus of control in patients with renal transplants]. / Estudio del locus de control en pacientes trasplantados de riñón.

The locus of control (using I-E Rotter' Scale) maximum psychosocial adjustment level (according to Axis V of DSM-III) and other sociodemographic data were assessed in 31 patients with renal transplantation. 51.5% of the patient were not psychosocially adapted, and externality was the predominant locus of control. As far as psychosocial adjustment is concerned, no variation in the absolute as found in terms of Internality-Externality. Finally, there was a statistically significant correlation between some items of the Rotter' scale and psychosocial adjustment.

[The development of the index of probability of psychosocial adaptation of chronic kidney patients]. / Desarrollo de un indice de probabilidad de adaptación psicosocial de los enfermos renales crónicos (I.P.A.P.E.R.C).

Variables obtained from statistical techniques of multivarying analysis, related to psychosocial adaptation of chronic renal patients on treatment were applies in order to construct an index for the probability of the psychosocial adaptation of chronic renal patients (I.P.P.A.C.R.P.). The probability of 1% adaptation determines correctly to 97% of the cases with high sensibility and specificness thus is convenient to wait for the crossed validation of other investigators.

[Variables associated with psychosocial adaptation of chronic renal patients undergoing treatment]. / Variables asociadas a la adaptación psicosocial de los enfermos renales crónicos en tratamiento.

101 patients being treated for end-stage renal failure were studied in order to get the variables that are involved with psychosocial adaptation. Stepwise logistic regression analysis was made using the psychosocial adaptation as a dependent variable, determined by the Axis V of the D.S.M-III. 40 patients were found socially-adapted and 61 were not. Nine variables were related with the psychosocial adaptation: marital status, religious belief, education level, occupation, means of transportation to get to the treatment center, self-image before the sickness, C factor of 16 PF, the age and the evaluation of treatment by the patient. From the statistical analysis and from the interpretation of sings and values of the related variables, the influence of them on the psychosocial adaptation was demonstrated.