Biodistribution and radiation dosimetry of [64Cu]copper dichloride: first-in-human study in healthy volunteers.

BACKGROUND: In recent years, Copper-64 (T1/2 = 12.7 h) in the chemical form of copper dichloride ([64Cu]CuCl2) has been identified as a potential agent for PET imaging and radionuclide therapy targeting the human copper transporter 1, which is overexpressed in a variety of cancer cells. Limited human biodistribution and radiation dosimetry data is available for this tracer. The aim of this research was to determine the biodistribution and estimate the radiation dosimetry of [64Cu]CuCl2, using whole-body (WB) PET scans in healthy volunteers. Six healthy volunteers were included in this study (3 women and 3 men, mean age ± SD, 54.3 ± 8.6 years; mean weight ± SD, 77.2 ± 12.4 kg). After intravenous injection of the tracer (4.0 MBq/kg), three consecutive WB emission scans were acquired at 5, 30, and 60 min after injection. Additional scans were acquired at 5, 9, and 24 h post-injection. Low-dose CT scan without contrast was used for anatomic localization and attenuation correction. OLINDA/EXM software was used to calculate human radiation doses using the reference adult model. RESULTS: The highest uptake was in the liver, followed by lower and upper large intestine walls, and pancreas, in descending order. Urinary excretion was negligible. The critical organ was liver with a mean absorbed dose of 310 ± 67 µGy/MBq for men and 421 ± 56 µGy/MBq for women, while the mean WB effective doses were 51.2 ± 3.0 and 61.8 ± 5.2 µSv/MBq for men and women, respectively. CONCLUSIONS: To the best of our knowledge, this is the first report on biodistribution and radiation dosimetry of [64Cu]CuCl2 in healthy volunteers. Measured absorbed doses and effective doses are higher than previously reported doses estimated with biodistribution data from patients with prostate cancer, a difference that could be explained not just due to altered biodistribution in cancer patients compared to healthy volunteers but most likely due to the differences in the analysis technique and assumptions in the dose calculation.

Estrategias de intervención en promoción de la salud / Intervention strategies in health promotion

La promoción de la salud es un proceso esencial, no exclusivo de las intituciones sanitarias. La promoción de la salud incluye también estrategias políticas, económicas, educativas y sociales. El principal objetivo de este trabajo es resaltar la relevancia de la promoción de la salud, atendiendo a su conceptualización y algunas de las estrategias principales que se pueden desarrollar. Respecto a ello, tienen una relevancia especial las estrategias que no están centradas exclusivamente en el individuo, sino que también toman en consideración el contexto comunitario. Pueden implementarse diferentes estrategias y su nivel de éxito dependerá, en muchos casos, de la interrelación con otras estrategias, la adaptación al contexto, la participación comunitaria y la utilización de recursos de la comunidad(AU)

Health promotion is an essential process not only exclusive of health care institutions.Health promotion includes political, economical, educational and social strategies as well.The main aim of this essay is to point out the relevance of health promotion taking intoaccount the concepts involved and the main strategies that can be developed. In thiscontext, estrategies that are not only focused on the individual but more in thecommunity, have a special importance. A variety of strategies can be implemented, andtheir success will depend in many cases on the level of correlation with other strategies,adaptation to the context, community participation and use of communitary resources(AU)

Pileflebitis tras apendicitis aguda / Pylephlebitis due to acute appendicitis

No disponible

Disfunción sexual asociada al uso de gabapentina en el tratamiento del dolor central / Associated sexual dysfunction to the use of gabapentin in the treatment of the central pain

El dolor neuropático de origen central es uno de los síndromes dolorosos más complejos, su tratamiento es difícil y, en general, poco satisfactorio. Gabapentina (GBP) es un anticonvulsivante usado en el tratamiento de la epilepsia, dolor neuropático, desórdenes bipolares, y es generalmente bien tolerado. Los anticonvulsivantes de segunda generación cuentan entre sus ventajas con una menor incidencia de efectos secundarios. No obstante, estamos hablando de fármacos relativamente nuevos, sobre todo para su utilización al margen de los trastornos no epilépticos, como es el caso del dolor neuropático, por lo que es necesario un estudio y seguimiento más completo de sus posibles efectos secundarios. Presentamos 2 casos de disfunción sexual en hombre y mujer en relación con la administración de gabapentina para control del dolor de origen central. El aumento de la concentración de serotonina podría ser la causa de las alteraciones sexuales relacionadas con el tratamiento con GBP a las dosis utilizadas en nuestros pacientes, superiores a 1.800 mg/día. Este efecto es dosis-dependiente y el tratamiento consiste en disminuir o ajustar la dosis para maximizar el intervalo de tiempo entre la toma previa y el acto sexual (AU)

The neuropathic central pain, is one of the more complex painful syndromes, its treatment is difficult and, in general, little satisfactory. Gabapentin (GBP), it is a anticon-vulsant used in the treatment of the epilepsy, neuropathic pain, disorder bipolar, and it is generally well tolerated The anticonvulsants of second generation count between their advantages with a smaller incidence of secondary effects. However, we are considering of relatively new drugs, mainly for its use to the margin of epilepsy, as it is the case of the neuropathic pain. For this reason it is necessary a study and more complete pursuit of its possible secondary effects. We presented 2 cases of sexual dysfunction in a man and a woman in relation to the administration of gabapentin for control of the pain of central origin. The increase of the serotonin concentration could be the cause of the sexual alterations related to the treatment with GBP to the doses used in our patients, superior to 1,800 mg/day. This effect is doses dependent, and the treatment consists of diminishing or fitting the dose to maximize the time interval between the previous taking and to the sexual act (AU)

Fármacos hemostáticos en paciente con síndrome antifosfolípido y hemorragia perioperatoria importante / Hemostatic drugs in a patients with antiphospholipid syndrome and clinically significant perioperative bleeding

No disponible

Colangitis esclerosante primaria como causa de un pseudotumor de la confluencia de la vía biliar / Primary sclerosing cholangitis as a cause of bile duct confluence pseudotumor

No disponible

Manejo actual del quilotórax iatrogénico / Current management of iatrogenic chylothorax

La actitud quirúrgica agresiva en el tratamiento de procesos neoproliferativos ha condicionado un aumento en la frecuencia de un padecimiento iatrogénico poco frecuente fuera del ámbito quirúgico, en gran medida motivado por la diversidad de variantes anatómicas de drenaje linfático. La base de una terapéutica efectiva radica en la necesidad de un diagnóstico precoz, debatiéndose, en la actualidad, una actitud conservadora frente a una reintervención quirúrgica temprana. Exponemos el resultado de nuestra experiencia en 3 casos de pacientes operados, en nuestro servicio, de tumores de esófago y cardias al aplicar las actitudes diagnóstico-terapéuticas propuestas con mayor aceptación en la bibliografía. El quilotórax, aunque infrecuente, presenta una elevada morbimortalidad. A pesar de continuar en controversia, se apuesta por un tratamiento inicial conservador. Un fracaso precoz de éste establece, casi con seguridad, la indicación quirúrgica (AU)

Hernioplastia umbilical laparoscópica en paciente cirrótico / Laparoscopic repair of umbilical hernia in a cirrhotic patient

Los defectos de la pared abdominal, en especial las hernias umbilicales en pacientes cirróticos sin cirugía abdominal previa, son frecuentes en la cirrosis descompensada con ascitis de larga evolución. El enigma de este tipo de hernias radica no sólo en el dolor y riesgo de incarceración con estrangulación intestinal sino también en la posibilidad de ulceración y necrosis cutánea que desemboca en un drenaje ascítico al exterior de la cavidad abdominal con el consiguiente riesgo de infección bacteriana. La alta mortalidad por incarceración (3-14 por ciento) y rotura espontánea (30 por ciento), en el contexto de un proceso benigno, debe plantear la necesidad de buscar soluciones poco agresivas, hacia un paciente con deterioro hepático, que ofrezcan buenos resultados a largo plazo. Hoy día, el factor quizá más relacionado con el éxito quirúrgico es la estabilización de la cirrosis de base. Partiendo de esta premisa, proponemos un nuevo abordaje terapéutico con el objetivo de conseguir, en un futuro no lejano, resultados mejores o cuanto menos iguales a los presentados por la cirugía convencional. El buen resultado de esta modalidad terapéutica podría plantearla como elección en pacientes con ascitis y hernias irreducibles que precisan una cirugía de urgencia. Exponemos el caso de una paciente cirrótica, con una hernia umbilical incarcerada, operada en nuestro servicio por vía laparoscópica mediante hernioplastia con malla de politetrafluoretileno (Gore-Tex Dual Mesh Plus®) (AU)

Gallstone disease in patients over the age of 80. Surgery or long-term medical treatment?

OBJECTIVE: Growth in the geriatric population is increasing the biliary pathology of the elderly, thus becoming more frequent in the medical environment. The different therapeutic methods that are at present in use, should be applied to this group, employing open cholecystectomy as a reference. MATERIAL AND METHODS: During a period of 5 years we have attended 209 patients over the age of 80 (13.8 of the total of gallstones), 76 patients (36.4%) underwent surgery and in 133 cases (63.6%) another therapeutic method was decided upon. The progression, complications and mortality rate are studied closely herein. RESULTS: The majority, 156 (74.6%) were not previous admissions and in 108 (51.7%) the symptoms had been present for less than one month. Eighty four (40.2%) were suffering from jaundice on admission (on average 4 days) and 89 (42.6%) showed signs of inflammation. 23 patients (11%) were submitted only to an endoscopic sphincterotomy. Of those patients who underwent surgery, 52 (67.5%) had a range of inflammatory phenomena. Open cholecystectomy was carried out on 65 patients (85.5%). Sixty one patients (29.2%) presented complications, 38 (50%) in the group underwent surgery. Twenty eight patients (13.4%) died-9 (11.8%) of the 76 patients were operated upon. CONCLUSIONS: Elderly patients can undergo surgery in selected cases with an acceptable mortality rate and high morbidity. Surgery is recommended in those of a lesser age, not always possible as many of them lacked prior symptoms.

Hepatic metastases of granulosa cells tumour of the ovary.

A case of metastatic granulosa cell tumour of the ovary is reported. Investigations revealed a secondary tumour in segment VI and VII of the liver. Right hepatic resection was performed. Microscopic findings revealed a tumour with histological features identical to that removed eleven years before.

[Digestive hemorrhage caused by jejunoileal tumors]. / Hemorragia digestiva por tumoraciones yeyunoileales.

Between January-73 and February-92 twelve patients with digestive hemorrhage due to primary jejunoileal tumors were treated. Eight cases had rectal bleeding and four chronic gastrointestinal hemorrhage as first clinical manifestation. Patients underwent upper endoscopy, colonoscopy and barium enema. Three out of nine barium meals (33%), two out of four ultrasonographies (50%) and eight out of nine arteriographies (89%) were abnormal. The barium meals showed submucosal lesions on two occasions and a jejunal luminal mass. The ultrasonography detected two intrabdominal masses. All arteriographies, except one with extravased intestinal contrast and other which showed a hypovascular zone, depicted homogeneous hypervascular images. All patients were operated on. Seven segmental enterectomies, four limited resections and a polipectomy were performed. Seven tumours were found in the jejunum, three in the jejunoleum and two in the ileum. There were four leiomyosarcomas, three leiomyomas, two polyps, one leiomyoblastoma, one adenocarcinoma and one lymphoma. Rebleeding and mortality were absent.

[Effect of catalase on acute experimental pancreatitis in rats]. / Efecto de la catalasa en la pancreatitis aguda experimental de la rata.

Oxygen free radicals are highly toxic end products of the cellular oxidative metabolism that are scavenged by antioxidative systems such as superoxide dismutase and catalase. Previous studies have suggested that oxygen free radicals may play a role in the pathophysiology of acute pancreatitis. The present study was designed to determine the effect of catalase on experimental acute pancreatitis in the rat. Rats were given either saline or enterokinase by the intraductal pancreatic route. Catalase was given intraperitoneally at doses of 80, 160 and 320 mg/kg. Administration of saline resulted in mild acute pancreatitis. In contrast, administration of enterokinase resulted in oedema, haemorrhage and necrosis of the pancreas. Catalase had no effect when given at 80 mg/kg; at 160 mg/kg, an improvement at the ultrastructural level was noted, whereas at 320 mg/kg, a change in serum calcium level was found. Our studies suggest that intraperitoneal administration of catalase slightly improves the outcome of experimental acute pancreatitis in the rat.

[Spontaneous hematoma of the transverse mesocolon]. / Hematoma espontáneo de mesocolon transverso.

A case of spontaneous rupture of an aneurysm of a colic artery is presented. A large hematoma in the transverse mesocolon was found. The case is interesting because of its rarity and its preoperative angiographic diagnosis.

[The effects of allopurinol on experimental mesenteric ischemia in the rat]. / Efectos del alopurinol sobre la isquemia mesentérica experimental en la rata.

The effect of allopurinol at doses of 25, 50 and 100 mu p/Kg on the release of free toxic radicals in acute mesenteric ischemia (AMI) produced experimentally has been studied in rats after clamping the superior mesenteric artery. Mortality and variations in haematological, biochemical and morphological parameters (both microscopic and ultrastructural) were recorded. A dose-dependent effect of a bolus of intraperitoneal alopurinol on the severity of mucosal lesions has been noted. A protection against mucosal damage was observed which may be due to the block by alopurinol of the xantine-oxidase system in the ischaemic reperfused intestine. This should be confirmed by larger studies. Alopurinol might be useful prophylactically to prevent damage of the intestine after ischaemia-revascularization events.