Utilidad de la gammagrafía con hematíes desnaturalizados por calor marcados con 99mTc en el diagnóstico de una esplenosis intramuscular / Usefulness of 99mTc labelled heat-denatured red blood cell scintigraphy in the diagnosis of intramuscular splenosi

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Protocolo de un día vs protocolo de dos días de adquisición mediante gammagrafía con leucocitos marcados in vitro para el diagnóstico de infección osteoarticular / One-day protocol versus two-day protocol in acquisition of scintigraphy with "in vitro" labelled white blood cells for diagnosis of osteoarticular infection

Introducción: Resulta difícil determinar la infección osteoarticular y diferenciar entre inflamación e infección mediante procedimientos de laboratorio e imagen (TC, RM, US). La gammagrafía con leucocitos marcados (GLM) constituye la prueba de medicina nuclear de elección, pero su duración es de dos días, y a veces es difícil diferenciar entre tejido blando e infección, por lo que se produce una variabilidad interobservador que hace disminuir su especificidad. Objetivo: Demostrar la utilidad del protocolo de un día de GLM con corrección por decaimiento del tiempo de adquisición para diagnosticar la infección osteoarticular y reducir la variabilidad interobservador. También se evaluó la función de SPECT/TC en GLM en la localización del foco de infección. Métodos: Se estudiaron prospectivamente 110 pacientes con sospecha de infección osteoarticular. Se obtuvieron imágenes planares con corrección por decaimiento del tiempo de adquisición a 30min, 4h, 8h y 24h. Las imágenes planares de GLM se agruparon en dos protocolos: Protocolo de un día: los expertos evaluaron imágenes de 30min, 4h y 8h. Protocolo de dos días: los expertos evaluaron imágenes de 30min, 4h y 24h. Ambos protocolos fueron clasificados como: Negativos: ausencia de migración leucocitaria. Positivos: persistencia o incremento de la captación con el tiempo. Inflamación aséptica: disminución de la captación con el tiempo. La SPECT/TC se realizó en 72 pacientes. Se calculó el índice kappa para evaluar la variabilidad interobservador. Resultados: Se confirmó infección en 34 casos. Los valores de sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y precisión diagnóstica fueron del 97,1, del 97,4, del 94,3, del 98,7 y del 97,3% para el protocolo de un día, y del 94,1, del 97,4, del 94,1, del 97,4 y del 96,4 para el protocolo de dos días, respectivamente. SPECT/TC contribuyó al diagnóstico en 45 de 50 pacientes con GLM planar positiva. Índice kappa: 0,8 para el protocolo de un día y 0,79 para el protocolo de dos días. Conclusión: El protocolo de un día de GLM con corrección por decaimiento del tiempo de adquisición y SPECT/TC permite el diagnóstico precoz y preciso de la infección osteoarticular

Introduction: It is difficult to determine osteoarticular infection and differentiate inflammation from infection with laboratory and imaging procedures (CT, MRI, US). Labelled white-blood-cell scintigraphy (WBCS) is the nuclear medicine test of choice but it takes two days, sometimes finds it difficult to differentiate soft tissue from bone infection and therefore causes interobserver variability, which decreases its specificity. Objective: To demonstrate the usefulness of the one-day protocol with time decay-corrected acquisition in WBCS to diagnose osteoarticular infection and to reduce interobserver variability. The role of SPECT/CT in WBCS in locating the infected focus was also evaluated. Methods: 110 patients with suspected osteoarticular infection were studied prospectively. Planar images were obtained with time decay-corrected acquisition at 30min, 4h, 8h and 24h. WBCS planar images were grouped in two protocols: One-day protocol: experts evaluated 30min, 4h and 8h images. Two-day protocol: experts evaluated 30min, 4h and 24h images. Both protocols were classified as: Negative: absence of leukocyte migration. Positive: uptake persisted or increased over time. Aseptic inflammation: uptake decreased over time. SPECT/CT was performed in 72 patients. Kappa index was calculated to evaluate interobserver variability. Results: Infection was confirmed in 34 cases. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 97.1%, 97.4%, 94.3%, 98.7%, and 97.3% for the one-day protocol and 94.1%, 97.4%, 94.1%, 97.4%, and 96.4% for two-days-protocol. SPECT/CT contributed to diagnosis in 45/50 patients with planar WBCS positive. Kappa index: 0.8 for one-day protocol and 0.79 for two-day protocol, respectively. Conclusion: One-day protocol with time decay-corrected acquisition WBCS and SPECT/CT enables early and accurate diagnosis of osteoarticular infection

One-day protocol versus two-day protocol in acquisition of scintigraphy with "in vitro" labelled white blood cells for diagnosis of osteoarticular infection. / Protocolo de un día vs protocolo de dos días de adquisición mediante gammagrafía con leucocitos marcados in vitro para el diagnóstico de infección osteoarticular.

INTRODUCTION: It is difficult to determine osteoarticular infection and differentiate inflammation from infection with laboratory and imaging procedures (CT, MRI, US). Labelled white-blood-cell scintigraphy (WBCS) is the nuclear medicine test of choice but it takes two days, sometimes finds it difficult to differentiate soft tissue from bone infection and therefore causes interobserver variability, which decreases its specificity. OBJECTIVE: To demonstrate the usefulness of the one-day protocol with time decay-corrected acquisition in WBCS to diagnose osteoarticular infection and to reduce interobserver variability. The role of SPECT/CT in WBCS in locating the infected focus was also evaluated. METHODS: 110 patients with suspected osteoarticular infection were studied prospectively. Planar images were obtained with time decay-corrected acquisition at 30min, 4h, 8h and 24h. WBCS planar images were grouped in two protocols: One-day protocol: experts evaluated 30min, 4h and 8h images. Two-day protocol: experts evaluated 30min, 4h and 24h images. Both protocols were classified as: SPECT/CT was performed in 72 patients. Kappa index was calculated to evaluate interobserver variability. RESULTS: Infection was confirmed in 34 cases. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 97.1%, 97.4%, 94.3%, 98.7%, and 97.3% for the one-day protocol and 94.1%, 97.4%, 94.1%, 97.4%, and 96.4% for two-days-protocol. SPECT/CT contributed to diagnosis in 45/50 patients with planar WBCS positive. Kappa index: 0.8 for one-day protocol and 0.79 for two-day protocol, respectively. CONCLUSION: One-day protocol with time decay-corrected acquisition WBCS and SPECT/CT enables early and accurate diagnosis of osteoarticular infection.

Hipoestesia mentoniana como manifestación de metástasis mandibular diagnosticada en la gammagrafía ósea / Numb chin syndrome as a manifestation of jaw metastasis diagnosed in a bone scan

El síndrome del mentón entumecido (numb chin syndrome [NCS]) en muchos casos puede representar una patología banal, pero al poder asociarse con procesos malignos, su presencia debe alertar al clínico como posible manifestación de una enfermedad maligna oculta. En pacientes previamente diagnosticados de una neoplasia, representa a menudo un signo ominoso que indica mal pronóstico por el rápido progreso de la enfermedad. Se presenta el caso de un paciente de 62 años diagnosticado de cáncer de pulmón y de vejiga que aqueja sensación de «acorchamiento» en zona mentoniana. La gammagrafía ósea confirma la sospecha de enfermedad metastásica ósea falleciendo a los 2 meses de manifestarse este signo (AU)

In many cases, numb chin syndrome (NCS) may represent a banal pathology. However, as it can be associated with malignant processes, its presence should alert the clinician of a possible occult disease. In patients already diagnosed with cancer, it often represents an ominous sign that indicates poor prognosis, due to the rapid progress of the disease. The case is presented of a 62-year-old man diagnosed with synchronous lung and bladder cancer, who suddenly complained of numbness in the chin. The bone scan confirmed the suspicion of metastastic bone disease, and the patient died two months after the appearance of this sign (AU)

Numb chin syndrome as a manifestation of jaw metastasis diagnosed in a bone scan.

In many cases, numb chin syndrome (NCS) may represent a banal pathology. However, as it can be associated with malignant processes, its presence should alert the clinician of a possible occult disease. In patients already diagnosed with cancer, it often represents an ominous sign that indicates poor prognosis, due to the rapid progress of the disease. The case is presented of a 62-year-old man diagnosed with synchronous lung and bladder cancer, who suddenly complained of numbness in the chin. The bone scan confirmed the suspicion of metastastic bone disease, and the patient died two months after the appearance of this sign.

[Preoperative workup to assess indication for laparoscopic treatment in gastroesophageal reflux disease].

INTRODUCTION AND OBJECTIVES: antireflux surgery performed by an experienced surgeon is a maintenance option for patients with well-documented gastroesophageal reflux disease (GERD). Well-documented GERD is difficult to find, as GERD is a multifactorial disease in which the gastroesophageal junction, with its special anatomical and functional components, is important. In order to examine patient preoperative workups, and their indication for surgical treatment in GERD, we retrospectively studied patients who underwent a laparoscopic antireflux procedure. METHODS: preoperative workups in patients from our health care area who underwent a laparoscopic antireflux procedure from December 1997 to February 2007 were retrospectively analyzed. Data related to epidemiological findings, symptoms, morphologic and functional evaluation, medical therapy, and indication for surgical treatment were recorded and statistically analyzed by means of a bivariate test. Differences were significant when the p value was equal to or less than 0.05. RESULTS: 100 patients (50 % female, 51.31 +/- 13.53 years of age) underwent a laparoscopic antireflux surgery after 56.47 +/- 61.33 months with symptoms. Ninety-five percent of patients had an anatomical abnormality. The pH monitoring test diagnosed three quarters of cases. The most frequent indication for GERD treatment was persistent or recurrent esophagitis despite adequate medical treatment (52 cases). CONCLUSIONS: based on our preoperative workup, as described, 100 percent of subjects were well documented and diagnosed with GERD (both non-erosive reflux disease and erosive reflux disease), and their indication for laparoscopic treatment was retrospectively assessed in 94% of cases.

Preoperative workup to assess indication for laparoscopic treatment in gastroesophageal reflux disease

Introducción y objetivos: la cirugía antirreflujo realizadapor un cirujano experto es una opción para el tratamiento demantenimiento para el paciente con enfermedad por reflujo gastroesofágico(ERGE) bien documentada. La “buena documentación”de la ERGE es difícil de llevar a cabo, dado que se trata deuna entidad multifactorial, en la que la unión gastroesofágica, consus condiciones tan especiales tanto anatómicas como funcionales,es determinante. Para evaluar preoperatoriamente tanto eldiagnóstico como la indicación quirúrgica de los pacientes quehan sido intervenidos mediante un procedimiento laparoscópicoantirreflujo en nuestro centro, hemos estudiado retrospectivamentesus historiales clínicos.Métodos: se analizaron retrospectivamente los historiales clínicosde los pacientes de nuestra Área Sanitaria sometidos a unprocedimiento laparoscópico antirreflujo desde diciembre de1997 hasta febrero de 2007. Para evaluar el aseguramiento preoperatorioen el diagnóstico y la indicación quirúrgica, se tomaronlos datos epidemiológicos, la sintomatología, las pruebas diagnósticasrealizadas, tanto morfológicas como funcionales, la terapéuticamédica pautada y la indicación quirúrgica recogida en la historiaclínica de cada uno de los pacientes. La información obtenidafue analizada estadísticamente mediante los test bivariantes. Lasdiferencias obtenidas fueron significativas cuando el valor de p resultóigual o menor a 0,05.Resultados: se estudiaron 100 pacientes (50% mujeres, conuna edad media de 51,31 ± 13,53 años) intervenidos mediantecirugía antirreflujo por vía laparoscópica. Su sintomatología previaduró 56,47 ± 61,33 meses. El 95% de los pacientes presentóuna anormalidad anatómica. La monitorización del pH diagnosticóa 3 cuartas partes de ellos. Y la indicación quirúrgica más frecuenteresultó la recurrencia o persistencia de la esofagitis a pesarde un adecuado tratamiento médico (52 casos).Conclusiones: según los datos recogidos retrospectivamenteen sus historiales clínicos, nuestros pacientes tuvieron un diagnósticopreoperatorio bien documentado (incluyendo tanto el reflujono erosivo como el erosivo) en el 100% de los casos y una indicaciónquirúrgica sólidamente fundamentada en el 94% de ellos

Introduction and objectives: antireflux surgery performedby an experienced surgeon is a maintenance option for patientswith well-documented gastroesophageal reflux disease (GERD).Well-documented GERD is difficult to find, as GERD is a multifactorialdisease in which the gastroesophageal junction, with its specialanatomical and functional components, is important. In orderto examine patient preoperative workups, and their indication forsurgical treatment in GERD, we retrospectively studied patientswho underwent a laparoscopic antireflux procedure.Methods: preoperative workups in patients from our healthcare area who underwent a laparoscopic antireflux procedurefrom December 1997 to February 2007 were retrospectivelyanalyzed. Data related to epidemiological findings, symptoms,morphologic and functional evaluation, medical therapy, and indicationfor surgical treatment were recorded and statistically analyzedby means of a bivariate test. Differences were significantwhen the p value was equal to or less than 0.05.Results: 100 patients (50 % female, 51.31 ± 13.53 years ofage) underwent a laparoscopic antireflux surgery after 56.47 ±61.33 months with symptoms. Ninety-five percent of patientshad an anatomical abnormality. The pH monitoring test diagnosedthree quarters of cases. The most frequent indication forGERD treatment was persistent or recurrent esophagitis despiteadequate medical treatment (52 cases).Conclusions: based on our preoperative workup, as described,100 percent of subjects were well documented and diagnosedwith GERD (both non-erosive reflux disease and erosive refluxdisease), and their indication for laparoscopic treatment was retrospectivelyassessed in 94% of cases

Réplica a “Prolapso anal de un lipoma de colon sigmoide” / Reply to “Anal prolapse of a sigmoid lipoma”

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[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.