Captación atípica de la vesícula biliar como causa de falso positivo en rastreo postablación de restos tiroideos con 131I / Atypical uptake of gallbladder as cause of False-positive iodine-131 in post-surgical removalscanning of thyroid remains

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[When should a brain scan with HMPAO be performed to diagnose brain death?]. / ¿Cuando realizar una gammagrafía cerebral con HMPAO en el diagnóstico de muerte encefálica?

INTRODUCTION: Current Spanish law defines the criteria to be met in the case of brain death (BD) and the complementary tests to confirm it, although they do not always need to be carried out. In Spain one of the most frequently used methods is the electroencephalogram (EEG), which has its shortcomings in patients who are under sedation with barbiturates. Transcranial Doppler (TCD) offers a number of advantages in the diagnosis of BD, but it also has certain limitations. In these cases, a cerebral perfusion scan (CPS) with HMPAO can be very useful. CASE REPORTS: We describe the case of two patients who were admitted to the Intensive Care Unit with serious traumatic brain injuries. Progress was unfavourable and the findings of the clinical exploration were compatible with BD. Since we were dealing with patients under barbiturate therapy, the EEGs were complex and difficult to interpret. TCD was difficult to perform in both cases because of loss of brain matter and displacement of intracranial structures, respectively. CPS, however, allowed us to confirm the diagnosis of BD. CONCLUSION: Although it has obvious advantages, TCD cannot always be performed to confirm BD diagnosis. In these cases, CPS can be an extremely valuable tool

¿Cuándo realizar una gammagrafía cerebral con HMPAO en el diagnóstico de muerte encefálica? / When should a brain scan with HMPAO be performed to diagnose brain death?

Introducción. La legislación española vigente establece los criterios de muerte encefálica (ME) y las pruebas complementarias de confirmación -que no siempre es necesario realizar-.Entre ellas, la más utilizada en nuestro país es el electroencefalograma (EEG), que tiene limitaciones en pacientes con sedación barbitúrica. El Doppler transcraneal (DTC) presenta numerosas ventajas para el diagnóstico de ME, pero también algunas limitaciones. En esos casos, la gammagrafía de perfusión cerebral (GPC) con HMPAO puede ser de gran utilidad. Casos clínicos. Se presentan dos pacientes jóvenes que ingresan en la Unidad de Cuidados Intensivos tras traumatismo craneoencefálico grave. Evolucionan desfavorablemente y presentan exploración clínica compatible con ME. Los EEG, al tratarse ambos pacientes con barbitúricos, son de interpretación compleja. El DTC es difícil de realizar en ambos casos, por presentar pérdida de masa encefálica y desplazamiento de estructuras intracraneales, respectivamente. La GPC, sin embargo, permitió confirmar el diagnóstico de ME. Conclusión. El DTC, aunque presenta evidentes ventajas, no siempre puede realizarse para confirmar el diagnóstico de ME. En esos casos, la GPC puede ser muy útil (AU)

Gastroesophageal scintigraphy: a useful screening test for GE reflux.

Ninety children with signs and symptoms of gastroesophageal (GE) reflux were studied. All of them had GE scintigraphy, barium, and endoscopy, and 50, in addition, ultrasound examination. The sensitivity of the GE scintigraphy, in comparison with the other methods, was 92.5%. It is a useful screening test for GE reflux.