Clinical characteristics of vulnerable populations hospitalized and diagnosed with COVID-19 in Buenos Aires, Argentina.

There is not in Argentina publications regarding the presentation of patients with COVID-19 requiring hospitalized and emergency care in vulnerable populations (lower incomes and less education tend at greater risk for poor health status and healthcare access), and it has few reports in developing countries. The objective is to determine whether in the care of vulnerable patients, to succeed against COVID-19, multiple public health tools and interventions will be needed to minimize morbidity and mortality. The study is a prospective cohort investigation of patients with lab-confirmed COVID-19, who required to any of the Health Centers response from April 8, 2020, to August 18, 2020. In Buenos Aires Metropolitan Area (AMBA), April 8, 2020 the virus was identified in patients hospitalized in the "Southeast Network" (SN), AMBA. SN covering an area of 661 square kilometers, with 1.8 million inhabitants residing in urban, and rural areas. A total of 14 health centers with different levels of care complexity provide care to patients in the region. The information of each patient with COVID-19 evaluated by SN, was incorporated in an Epidemiological Dashboard. The investigation was designed and reported with consideration of observational studies in epidemiology. We describe the hospitals presentation and care of persons who required SN response and were ultimately diagnosed with COVID-19. From April 8, 2020, to August 18, 2020, were included 1495 patients with lab-confirmed COVID-19 in SN. A total of 58% patients were men, and the mean age (SD) was 48.9 (15.59) years. Eighty one percent patients with pre-existing diseases, most frequent hypertension and diabetes, but hypertension, chronic lung disease, and cardiovascular disease presented higher risk. A total of 13% were hospitalized in Intensive Therapy Unit. The mortality of the cohort was 9.77%. Mortality was higher for patients aged 65 or more (OR 5.09), and for those had some pre-existing disease (OR 2.61). Our observations are consistent with reports demonstrating older persons, and those with comorbidities have the highest risk of mortality related to COVID-19. However, unlike other reports from developed or some developing countries, the mortality in our study is lower. This finding may be related to age of our cohort is younger than other published. Also, the health system was able to respond to the demand.

Acute pulmonary embolism detection with ventilation/perfusion SPECT combined with full dose CT: what is the best option? / SPECT/TC de ventilación-perfusión pulmonar en el diagnóstico del tromboembolismo pulmonar agudo

Aim. To compare diagnostic accuracy of Ventilation/Perfusion (V/P) single-photon emission computed tomography (SPECT) combined with simultaneous full-dose CT with a hybrid SPECT/CT scanner versus planar ventilation/perfusion (V/P) SPECT and CT angiography (CTA) in patients suspected with acute pulmonary embolism (PE). Methods. Between 2009 and 2011, consecutive patients suspected of acute PE were referred for V/P SPECT/CT (reviewed board approved study). A contrast agent was administered to patients who had no contraindications. Non-contrast V/P SPECT/CT was performed on the remaining patients. All patients were followed-up for at least 3 months. Results. A total of 314 patients were available during the study period, with the diagnosis of PE confirmed in 70 (22.29%) of them. The overall population sensitivity and specificity was 90.91% and 92.44%, respectively for V/P SPECT, 80% and 99.15%, respectively, for CTA, and 95.52% and 97.08% for V/P SPECT/CT. SPECT/CT performed better than V/P SPECT (AUC differences=0.0419, P=0.0043, 95% CI; 0.0131-0.0706) and CTA (AUC differences=0.0681, P=0.0208, 95% CI; 0.0103-0.1259)). Comparing imaging modalities when contrast agent could be administered, sensitivity and specificity increased and V/P SPECT/CT was significantly better than CTA (AUC differences=0.0681, P=0.0208, 95% CI; 0.0103-0.1259) and V/P SPECT (AUC differences=0.0659, P=0.0052, 95% CI; 0.0197-0.1121). In case of non-contrast enhancement, there was non-significant increase of specificity. Secondary findings on CT impacted patient management in 14.65% of cases. Conclusion. Our study shows that combined V/P SPECT/CT scanning has a higher diagnostic accuracy for detecting acute PE than V/P SPECT and CTA alone. When feasible, V/P SPECT/CT with contrast enhancement is the best option (AU)

Objetivo del estudio. Valorar la exactitud diagnóstica de la SPECT/TC de ventilación-perfusión (V/P) pulmonar de alta dosis mediante un equipo híbrido SPECT/TC frente a la SPECT de V/P pulmonar y a la angiografía por TC (CTA) en pacientes con sospecha de tromboembolismo pulmonar (TEP) agudo. Metodología. Entre 2009 y 2011, se estudiaron de forma consecutiva con SPECT/TC de V/P pulmonar los pacientes con sospecha de TEP agudo que acudieron a nuestro centro (estudio aprobado por el comité de ética hospitalaria). A los pacientes que no presentaban contraindicaciones se les administró contraste yodado (CI) por vía intravenosa. En el resto se realizó un estudio SPECT/TC de V/P pulmonar sin CI. Los pacientes fueron seguidos durante un período de 3 meses. Resultados. Se estudiaron un total de 314 pacientes. En 70 (22,29%) se confirmó el diagnóstico de TEP. La sensibilidad y especificidad para la población global fue: 90,91 y 92,44% respectivamente para la SPECT de V/P; 80 y 99.15% para la CTA; y 95.52 y 97.08% para la SPECT/TC de V/P pulmonar. La SPECT/TC presentaba una exactitud diagnóstica superior a la SPECT de V/P (diferencias AUC=0,0419; p=0,0043; IC95%: 0,0131-0,0706) y la CTA (diferencias AUC=0,0681, p=0,0208; IC95%: 0,0131-0,1259). Comparando las diferentes modalidades cuando se administró CI, observamos un aumento de la sensibilidad y la especificidad de la SPECT/TC de V/P superior a la CTA (diferencias AUC=0,0681; p=0,0208; IC95%: 0,0131-0,1259) y a la SPECT de V/P (diferencias AUC=0,0659; p=0,0052; IC95%: 0,0197-0,1121). En el caso de no administrar CI se observó un aumento no estadísticamente significativo de la especificidad. Los hallazgos secundarios de la TC provocaron un cambio en el manejo del paciente en un 14,65% de los casos. Conclusión. Nuestro estudio demuestra que el estudio combinado SPECT/TC de V/P pulmonar tiene una mayor exactitud diagnóstica para detectar el TEP agudo que la SPECT de V/P pulmonar o la CTA por sí solos. Cuando es factible, la SPECT/TC de V/P pulmonar con CI es la mejor opción diagnóstica (AU)

Acute pulmonary embolism detection with ventilation/perfusion SPECT combined with full dose CT: What is the best option?

AIM: To compare diagnostic accuracy of Ventilation/Perfusion (V/P) single-photon emission computed tomography (SPECT) combined with simultaneous full-dose CT with a hybrid SPECT/CT scanner versus planar ventilation/perfusion (V/P) SPECT and CT angiography (CTA) in patients suspected with acute pulmonary embolism (PE). METHODS: Between 2009 and 2011, consecutive patients suspected of acute PE were referred for V/P SPECT/CT (reviewed board approved study). A contrast agent was administered to patients who had no contraindications. Non-contrast V/P SPECT/CT was performed on the remaining patients. All patients were followed-up for at least 3 months. RESULTS: A total of 314 patients were available during the study period, with the diagnosis of PE confirmed in 70 (22.29%) of them. The overall population sensitivity and specificity was 90.91% and 92.44%, respectively for V/P SPECT, 80% and 99.15%, respectively, for CTA, and 95.52% and 97.08% for V/P SPECT/CT. SPECT/CT performed better than V/P SPECT (AUC differences=0.0419, P=0.0043, 95% CI; 0.0131-0.0706) and CTA (AUC differences=0.0681, P=0.0208, 95% CI; 0.0103-0.1259)). Comparing imaging modalities when contrast agent could be administered, sensitivity and specificity increased and V/P SPECT/CT was significantly better than CTA (AUC differences=0.0681, P=0.0208, 95% CI; 0.0103-0.1259) and V/P SPECT (AUC differences=0.0659, P=0.0052, 95% CI; 0.0197-0.1121). In case of non-contrast enhancement, there was non-significant increase of specificity. Secondary findings on CT impacted patient management in 14.65% of cases. CONCLUSION: Our study shows that combined V/P SPECT/CT scanning has a higher diagnostic accuracy for detecting acute PE than V/P SPECT and CTA alone. When feasible, V/P SPECT/CT with contrast enhancement is the best option.

Consumo de frutas y verduras por escolares adolescentes de la ciudad de Chillán. Chile / Fruit and vegetable intake by adolescents of Chillán City, Chile

The objective of this study was to estimate adolescent fruit and vegetable intake. An analytical cross-sectional study was conducted with a random sample of 100 adolescents between the ages of 14 and 17 from a private subsidized school in Chillán. Nutritional status was evaluated according to BMI, and a food survey was applied. The survey was specially designed to capture fruit and vegetable intake and was applied by personnel with standardized training. Results: Median fruit and vegetable intake was 217g (p25-p75: 139g-328g) and 183 g (p25-p75: 139g-299g) respectively; vegetable intake was higher for girls (217g v/s 165g, p=0.001). Highly inadequate fruit and vegetable intake was 12% for girls and 88% for boys. Conclusions: Adolescent fruit and vegetable intake was lower than the recommended intake.

El objetivo de este estudio fue estimar el consumo de frutas y verduras en adolescentes que asisten a un colegio particular subvencionado de la comuna de Chillán. Se realizó un estudio transversal analítico, con una muestra aleatoria de 100 adolescentes con edades entre los 14 y 17 años. Se evaluó estado nutricional según el IMC, y se aplicó una encuesta alimentaria, especialmente diseñada para captar el consumo de frutas y verduras, la que fue aplicada por personal capacitado y estandarizado. Resultados: La mediana de consumo de frutas y verduras fue 217 g (p25-p75= 139,1-328,6) y 183 g (p25-p75=139,0-299,0) respectivamente, siendo mayor la ingesta de verduras en mujeres (217 v/s 165; p=0,001). Los consumos altamente inadecuados de frutas y verduras representan el 12% en mujeres y 88% en hombres. Conclusión: Los adolescentes presentan consumos de frutas y verduras bajo las recomendaciones.

Cáncer oculto de la mama. Caso clínico y revisión de la literatura / Occult breast cancer. Case report and literature review

Se presenta el caso clínico de una paciente con un cáncer oculto de la mama. La situación clínica en la que se detectan ganglios axilares afectos por metástasis de adenocarcinoma pero sin evidenciarse tumor en la mama no es frecuente: entre el 0,3 y 0,8% de todos los tumores de la mama. En esta revisión se subraya la importancia que está adquiriendo el PET como técnica de elección en la detección del tumor primario así como en la monitorización de la respuesta a la quimioterapia neoadyuvante. Asimismo, se repasan los diferentes y controvertidos tratamientos propuestos. La tendencia actual es de máxima conservación, preconizando la disección axilar con radioterapia y tratamiento sistémico posteriores. En este último adquiere especial importancia el análisis inmunohistoquímico de la metástasis ganglionar para un diseño adecuado de la quimioterapia y los agentes anti-diana (AU)

We report the case of a patient with occult cancer of the breast. A finding of metastatic adenocarcinoma to the axillary nodes with no apparent mass in the breast is rare, occurring in 0.3% to 0.8% of all breast tumors. This review of the literature highlights the importance of positron emission tomography, which is becoming the gold standard in the detection of primary tumors and in monitoring response to neoadjuvant chemotherapy. The various treatments proposed and their controversies are also discussed. The current trend is breast conservation. Axillary dissection, adjuvant radiotherapy and systemic treatment are recommended. In the latter, immunohistochemical analysis of lymph node metastases is particularly important for the appropriate design of chemotherapy and anti-target agents (AU)

Monitorización de la respuesta a la terapia neoadyuvante en el carcinoma de mama localmente avanzado mediante métodos de imagen / No disponible

Objetivo: Establecer la validez diagnóstica de la mamografía, de la resonancia magnética y de la gammagrafía 99mTc-sestamibi en la valoración de la respuesta terapéutica de pacientes diagnosticadas de carcinoma de mama localmente avanzado. Pacientes y métodos: Estudio prospectivo observacional aprobado por el Comité Ético de nuestra institución en el que se han incluido 75 pacientes diagnosticadas de carcinoma de mama localmente avanzado por core biopsia (edad media: 52 años, rango: 26-80 años). Las pacientes fueron valoradas clínicamente, por mamografía, resonancia magnética y gammagrafía 99mTc-sestamibi antes de iniciar la terapia neoadyuvante y una vez finalizada la misma. Se han administrado regímenes terapéuticos basados en antraciclinas excepto en siete pacientes que recibieron hormonoterapia con inhibidores de la aromatasa. Para la valoración de la respuesta clínica se utilizaron los criterios RECIST y los mismos criterios, adaptados y consensuados, se emplearon para la valoración de la respuesta mediante técnicas de imagen e histología. Resultados: Tras cirugía se constató respuesta histológica, bien sea parcial o completa, en 61 pacientes (81,3%). Se evidenció conformidad entre la respuesta clínica y los hallazgos histológicos en el 80% de los casos, entre mamografía e histología en el 79,7% de casos, y esta fue del 78,9 % para la resonancia magnética y del 86,4% para la gammagrafía. La sensibilidad y especificidad fueron del 64,3 y del 83,8% para la mamografía, del 61,5 y 82,8% para la resonancia magnética, y del 58,3 y 92,6%, para la gammagrafía. Se pudo observar una concordancia del 88,8% entre resonancia y gammagrafía, del 75,7% entre esta y la mamografía y del 77,3 % entre gammagrafía y mamografía. Conclusiones: La resonancia magnética y la gammagrafía 99mTc-sestamibi demuestran su utilidad en la valoración de la respuesta tras la terapia neoadyuvante, si bien persiste la dificultad en la valoración de focos microscópicos de tumor o del componente in situ, y por tanto, en la definición de respuesta completa(AU)

Aim: To establish diagnostic validity of mammography, mammary magnetic resonance and 99mTc-sestamibi scintimammography to assess response to neoadjuvant therapy in patients with locally advanced breast cancer. Patients and methods: A prospective observational study was approved at our institution which included 75 women with core biopsy diagnostic of locally advanced breast cancer (mean age: 52 y, range 26-80 y). All patients had clinical, mammography, mammary magnetic resonance and 99mTc-sestamibi scintimammography assessment before and after receiving neoadjuvant therapy. Primary chemotherapy based on anthracyclines was administered except in seven patients who received endocrine therapy with aromatase inhibitors. RECIST criteria were considered for clinical response assessment, and the same criteria were adapted for imaging methods and pathologic response. Results: After surgery, 61 patients (81,3%) showed histologic response (complete or partial). Clinical assessment of tumour response was in concordance with histologic study in 80% of patients. Mammography, magnetic resonance and scintimammography agreed with pathology in 79,7, 78,9 and 86,4% of patients, respectively. Based on histologic response, sensitivity and specificity were 64,3 and 83,8% for mammography, 61,5 and 82,8% for magnetic resonance, and 58,3 and 92,6% for scintimammography, respectively. Agreement between magnetic resonance and scintimammography was 88,8%, between magnetic resonance and mammography 75,7%, and 77,3% between scintimammography and mammography. Conclusion: Magnetic resonance and scintimammography should be added to the diagnostic arsenal since they have shown more reliability than conventional methods for predicting histopathologic response to neoadjuvant therapy. Nevertheless, tumour size is critical for the detection of residual small lesions, usually microscopic and DCIS foci, or in others words, there is a limitation to define complete response(AU)

Estudio comparativo de la técnica del ganglio centinela entre los casos de carcinoma de mama multifocal y unifocal / Comparative study of sentinel node biopsy in patients with multifocal breast carcinoma versus in those with unifocal breast carcinoma

Objetivo valorar los resultados de la biopsia del ganglio centinela (BGC) en pacientes con cáncer de mama multifocal (CMMF) en comparación con el unifocal (CMUF). Pacientes y métodos se han realizado e incluido en una base de datos de manera prospectiva 1.535 BGC a pacientes de 9 centros hospitalarios. De ellos 174 presentaban CMMF. Para la BGC se utilizaron coloides de Tc-99m y la vía de administración fue mayoritariamente la profunda, repartiendo el trazador en los diferentes focos. Resultados el índice de detección global fue del 93,8%, sin encontrar diferencias entre ambos grupos (el 94,8% en CMMF frente al 93,4%). La media de GC detectados fue de 1,46, siendo mayor en el grupo CMMF (1,58 frente a 1,45; p=0,036). La localización fue extraaxilar en el 19,6%, más frecuente en el grupo CMMF (el 23,4 frente al 18,9%, no significativo) y más en el territorio de la cadena mamaria interna y en el nivel III axilar. La incidencia de metástasis en los GC biopsiados fue del 27,3%, mayor en el grupo CMMF (el 29,1 frente al 26,7%, no significativo), con una media de GC afectados mayor (0,42 frente a 0,32, no significativo). En la linfadenectomía axilar se identificó afectación de ganglios adicionales en una proporción igual en ambos grupos (29,7%). Conclusionesla BGC parece tener un rendimiento similar en tumores unifocales y multifocales. En tumores multifocales, parece haber un patrón de drenaje linfático específico, con mayor número de GC detectados y probablemente con mayor número de localizaciones de GC extraaxilares (AU)

Objective To evaluate the results for sentinel node biopsy (SNB) in patients with multifocal breast cancer (MBC) in comparison to in those with unifocal breast cancer (UBC). Patients and methods A total of 1535 prospective SNB (174 on patients with MBC) were performed at 9 hospitals. In most patients, Tc-99m album in colloids were injected intraparenchymally into each tumoral focus for SNB. Results The overall identification rate was 93.8%; no differences between groups were observed (94.8% in MBC vs 93.4% in UBC). The mean number of sentinel nodes detected was 1.46, being higher in the MBC group than in the UBC group (1.58 vs 1.45; p=0.036). Extra-axillary sentinel nodes were found in 19.6%; extra-axillary sentinel nodes were more common in the MBC group (23.4% vs 18.9%, ns) and in the internal mammary chain and in level III axillary lymph nodes. The incidence of sentinel node metastasis was 27.3% (29.1% MBC vs 26.7% UBC, ns), and the mean number of positive sentinel nodes was 0.42 in the MBC group vs 0.32 in the UBC group (p=ns). Axillary dissection identified the same rate of positive additional nodes (29.7%) in both groups. Conclusions The diagnostic yield of SNB seems similar in MBC and UBC. In MBC, there appears to be a specific pattern of lymphatic drainage, with a higher number of sentinel nodes detected and probably a higher number of extra-axillary sentinel nodes (AU)

[Comparative study of sentinel node biopsy in patients with multifocal breast carcinoma versus in those with unifocal breast carcinoma.]. / Estudio comparativo de la técnica del ganglio centinela entre los casos de carcinoma de mama multifocal y unifocal.

OBJECTIVE: To evaluate the results for sentinel node biopsy (SNB) in patients with multifocal breast cancer (MBC) in comparison to in those with unifocal breast cancer (UBC). PATIENTS AND METHODS: A total of 1535 prospective SNB (174 on patients with MBC) were performed at 9 hospitals. In most patients, Tc-99m albumin colloids were injected intraparenchymally into each tumoral focus for SNB. RESULTS: The overall identification rate was 93.8%; no differences between groups were observed (94.8% in MBC vs 93.4% in UBC). The mean number of sentinel nodes detected was 1.46, being higher in the MBC group than in the UBC group (1.58 vs 1.45; p=0.036). Extra-axillary sentinel nodes were found in 19.6%; extra-axillary sentinel nodes were more common in the MBC group (23.4% vs 18.9%, ns) and in the internal mammary chain and in level III axillary lymph nodes. The incidence of sentinel node metastasis was 27.3% (29.1% MBC vs 26.7% UBC, ns), and the mean number of positive sentinel nodes was 0.42 in the MBC group vs 0.32 in the UBC group (p=ns). Axillary dissection identified the same rate of positive additional nodes (29.7%) in both groups. CONCLUSIONS: The diagnostic yield of SNB seems similar in MBC and UBC. In MBC, there appears to be a specific pattern of lymphatic drainage, with a higher number of sentinel nodes detected and probably a higher number of extra-axillary sentinel nodes.

Identificación de factores de riesgo y factores protectores del embarazo en adolescentes de la novena región / Identification of risk factors and protective factors of pregnancy in adolescents of the ninth region

Objetivo: Comprender los factores relacionados con el embarazo no planificado en las adolescentes, desde la perspectiva de las escolares nuligestas.Método: Estudio cualitativo de casos, en mujeres entre 15 y 19 años, pertenecientes a dos establecimientos educacionales, con altos índices de embarazo, en la ciudad de Temuco, Chile. Se realizaron cuatro grupos focales, constituidos por 14 adolescentes no embarazadas,identificándose factores en las dimensiones individuales, familiares y sociales. Para el análisis se utilizó el programa ATLAS-ti 4,1. Se trianguló por investigador en la ejecución del estudio y análisis de los datos. Resultados: En la dimensión individual aparecen como relevantes factores de riesgo que favorecen el embarazo (FFE): "amor romántico", no uso de métodos anticonceptivos, baja autoestima, irresponsabilidad masculina y falta de conocimiento en sexualidad. En la dimensión familiar destacan los factores: límite estrecho familiar y negligencia paterna. Surgen factores percibidos por las adolescentes como protectoras del embarazo no planificado (FPE), en la dimensión individual destacan: capacidad reflexiva y proyecto de vida; en la dimensión familiar: "familia cuidadora" y límites claros; y en la dimensión social la categoría o factor con mayor peso es "sanción social". Conclusiones: Entre los hallazgos destacan como FFE relevantes el "amor romántico" y los límites polares familiares. Como FPE, la capacidad de reflexión y "familia cuidadora". Estos elementos debieran ser considerados en la prevención del embarazo no planificado en población adolescente.

Objective: To identify and understand factors associated to pregnancy in adolescents under the perspective of the never pregnant adolescent. Methods: Qualitative study undergone on women 15 to 19 years of age. School based sample of women were drawn from 2 schools chosen due to their high pregnancy rate. Four focus groups were created and each one was composed by 14 eligible women. Factors associated to individuals, to family, and to social environment were studied. Triangulation was performed during the study conduction and data analysis. Analysis was done by using ATLAS-ti 4.1. Results: Factors which appear to be favouring pregnancy at the individuals were: "romantic love", no use of contraceptives, low self esteem, male irresponsibility, lack of knowledge in sexuality. At the family level, the factors are: the permit's restriction and paternal negligence. Factors which help in avoiding pregnancy in adolescents at the individual level are: subject's reflexive capacity and project of life. At the family level, protective family and clearly defined limits are the ones which help preventing pregnancy. Social punishment is the main social factor associated. Conclusions: The view of the never pregnant adolescent and the multilevel model used in the focus group will allow decision makers to design strategies at the subject, family and social levels to help in reducing the unwanted pregnancy in adolescents. Main factors here identified are: "romantic love", permit`s restriction, paternal negligence as favouring pregnancy; reflexive capacity and protective family are the ones shown as preventives.

Docencia e investigación en Medicina Legal: Situación actual y desafíos para las Facultades de Medicina de Chile / Training and research in Forensic Medicine: Present situation and future challenges

Background:Lawyers need some medical knowledge and physicians must know about forensics. Aim: To explore training and research programs in forensic medicine in Chilean universities. Material and methods: Deans of all Medicine Faculties in Chile were contacted by e-mail and invited to answer a questionnaire containing 21 questions. A survey of Chilean publications on forensic medicine was performed in Medline, Lilacs and SciELO databases. Results: Fourteen deans answered the questionnaire. In all the responding faculties, forensic medicine is an obligatory course, generally during the fifth year and mostly combining theory with practice. In seven faculties, forensic medicine concepts are included in other courses. Forensics is taught in only two of 10 dental schools, two of 17 nursing schools, one of nine midwives schools and one of nine medical technology schools. It is not taught in phonoaudiology, kinesiology and nutrition schools. There are 74 physicians that teach the specialty but only 10 are certified by the National Board of Medical Specialty Certification (CONACEM). Treatment of most topics on forensics is insufficient. Thanatology is the strongest topic and forensic dentistry is the weakest. There are 52 publications in the area, mostly on "medical law". Conclusions: Forensic medicine is taught in medical schools mostly as thanatology. The knowledge of forensics among medical students is limited and must be improved.

Use of 201Tl SPECT imaging to assess the response to therapy in patients with high grade gliomas.

PURPOSE: To assess the potential role of 201Tl single photon emission tomography (201-Thallium SPECT) when compared to other imaging modalities in the evaluation of the response to therapy in high grade gliomas. MATERIALS AND METHODS: Twenty patients with histologically proved high grade glioma have been included: 15 with glioblastoma (GBM), 3 with anaplastic astrocytoma (AA) and 2 with anaplastic oligoastrocytoma (AOA). Patients were assessed by 201Tl SPECT, computed tomography (CT) and magnetic resonance imaging (MRI) at (a) either at the moment of maximum response to first line chemotherapy, or after the completion of radiotherapy and chemotherapy if post-surgical residual disease was present, and (b) after the completion of second line chemotherapy if disease persisted, or either a relapse or disease progression was confirmed. Final response was evaluated according to the McDonald criteria, and by comparing SPECT, CT and MRI results. RESULTS: According to the McDonald criteria, clinical response after first line chemotherapy was 5 partial response, 7 stable disease and 8 progressive disease. Evaluation by 201Tl SPECT was in agreement with such criteria in nearly all patients (90%). MRI findings closely agreed with the clinical follow-up. CT findings clearly differed from those observed by SPECT and MRI. After second line therapy, 10 patients progressed, 3 had stable disease and 7 had partial response. 201Tl SPECT agreed with the clinical status in 89% cases, whereas MRI and, specially CT, fared significantly lower. CONCLUSION: Compared to conventional neuroimaging, 201Tl SPECT added valuable information in the assessment of the response to therapy in our patient population; whenever findings were not conclusive and in the case of disagreement between CT and MRI findings.

Indirect immunofluorescence using monoclonal antibodies for the detection of leukocytospermia: comparison with peroxidase staining.

The presence of increased number of leukocytes in semen is indicative of inflammation in the male genital tract. Inflammatory processes at this level may lead to marked impairment of sperm function, and finally to a reduction in their fertilizing capability. An immunocytological technique for the detection of seminal leukocytes was evaluated in this study. As part of the standardization technique, different fixation methods were tested to ascertain whether samples could be stored and examined later. It was found that fixation with cold acetone at freezing temperatures retained immunoreactivity until day 11 of storage. All other methods showed a significant loss of immunoreactivity, from as little as day 2 of storage. In 46 specimens with elevated numbers of round cells, number of peroxidase-positive cells and number and type of leukocytes were evaluated by means of indirect immunofluorescence. Determination of peroxidase-positive cells to detect leukocytospermia, the standard procedure recommended by the WHO, was compared with the indirect immunofluorescence technique using monoclonal antibodies. While 19 of 46 patients showed high numbers of leukocytes in the ejaculate, as determined by the immunocytological method, only 9 of these were identified to be leukocytospermic, according to the WHO (standard) procedure. This difference was statistically significant (P < 0.01) and indicates that the standard method of detection of seminal leukocytes may be inaccurate.

Prospective study on the usefulness of lung scan in patients with deep vein thrombosis of the lower limbs.

BACKGROUND: Asymptomatic pulmonary embolism (PE) is a common finding in patients with deep venous thrombosis (DVT) of the lower limbs, but the usefulness of seeking for silent PE in patients with acute DVT has not been evaluated. PATIENTS AND METHODS: This was a prospective study involving consecutive patients with acute symptomatic proximal DVT (confirmed by objective methods) and no clinical suspicion of PE. All patients underwent chest X-ray, ventilation-perfusion lung scan and arterial blood gases on admission, and received anticoagulant therapy. Those with scintigraphic evidence of PE underwent repeated lung scan and blood gases 7 days later. The aim of the study was to assess how many patients with silent PE develop symptoms while on heparin therapy, and in how many of them such symptoms are due to recurrent PE. RESULTS: 946 consecutive patients with acute, proximal DVT had no contraindications to full-dose anticoagulant therapy. Baseline lung scan revealed high-probability defects (silent PE) in 200 (21%). Seven of these 200 patients had symptomatic recurrences during the 7-day study period, and an inferior vena cava filter was inserted. Besides, 6 patients developed PE symptoms, but no new perfusion defects were found on repeated scan. They switched to coumarin therapy, and they did not develop any further complications. CONCLUSIONS: Lung scan in patients with symptomatic DVT and no clinical suspicion of PE may be useful, since some patients with silent PE may develop symptoms while on heparin therapy. Without a baseline scintigraphy all these patients would have been considered to have recurrent PE, and vena cava interruption could have been performed.

[Subperiosteal abscess as a complication of osteomyelitis: usefulness of bone scintigraphy]. / Absceso subperióstico como complicación de la osteomielitis: utilidad de la gammagrafía ósea.

We present the case of an unweaned baby girl with acute femoral osteomyelitis. The bone scintigraphy showed diffuse photopenia of the femoral diaphysis. The final diagnosis revealed diaphyseal osteomyelitis complicated by the presence of a subperiostic abscess.

Sentinel node biopsy as a practical alternative to axillary lymph node dissection in breast cancer patients: an approach to its validity.

BACKGROUND: Sentinel node biopsy (SNB) has been proposed as an alternative to axillary lymph-node dissection (ALND) in breast cancer. Before implementing SNB in our practice, we wished to test its validity by comparing it to the standard ALND, both in our hands and with other reported series. PATIENTS AND METHODS: One hundred thirty-two patients were included prospectively. SNB and immediate ALND were performed. For SNB, a technetium-colloid was used to produce preoperative lymphoscintigraphy and intraoperative gamma-probe search for the SN. Serial sectioning and immunostains were used on the SN. A comprehensive review of the literature was done in order to run a meta-analysis of diagnostic tests using a summary receiver operating characteristic curve (SROC) to calculate the pooled parameters of sensitivity and associated 95% confidence interval (95% CI), including our own data. RESULTS: Our technical success rate was 96%. Local sensitivity was 96%, with a 95% CI from 85%-99%. Seven patients were upstaged by the SNB. A literature search identified 18 studies published from 1996-1999. Estimates of sensitivity ranged from 83%-100%. The pooled data meta-analysis gave a global sensitivity of 91%, with a 95% CI from 89%-93%. The area under the global SROC curve was 0.9967. CONCLUSIONS: The minimally invasive SNB was shown to be a practical alternative to ALND. We propose to use local as well as global sensitivity and associated 95% CI to test the validity of SNB in the clinical setting. Due to limitations of ALND as the golden standard, SNB can in fact be considered a more accurate method for nodal staging.

Absceso subperióstico como complicación de la osteomielitis: utilidad de la gammagrafía ósea / Subperiostic abscess with complication of osteomyelitis: usefulness of the bone scintigraphy

Presentamos el caso de una lactante afecta de una osteomielitis femoral aguda. La gammagrafía ósea demostró un defecto de captación en la diáfisis femoral. El diagnóstico definitivo reveló la presencia de un absceso subperióstico como complicación asociada. (AU)

Resultados de la biopsia del ganglio centinela en 100 pacientes con cáncer de mama / Results of sentinel node biopsy in 100 patients with breast cancer

Comunicamos los resultados obtenidos con la biopsia del ganglio linfático (BGC) en 100 pacientes consecutivas con cáncer de mama en las que además se realizó vaciado axilar. Se utilizaron exclusivamente trazadores isotópicos y sonda gamma para la linfogammagrafía y el rastreo intraoperatorio. El análisis histopatológico incluyó cortes seriados e inmunohistoquímica para citoqueratinas en los GC. Los resultados mostraron una eficacia técnica del 97 por ciento. El número de GC por paciente fue de 2,0 ñ 1,2. En el 23 por ciento de las pacientes se encontraron GC fuera de la localización habitual (mamaria interna, intramamarios, etc.). En total, 37 pacientes mostraron metástasis ganglionares. La sensibilidad de la BGC fue del 94,6 por ciento, el valor predictivo del 96,8 por ciento y la tasa de falsos negativos del 5,4 por ciento. Se reestadiaron al alza seis pacientes (9,1 por ciento de las consideradas N0 por el vaciado axilar). Nuestros resultados confirman el valor de la BGC, que en el futuro tenderá a sustituir a la linfadenectomía axilar convencional. (AU)

The usefulness of Tc-99m tetrofosmin scintigraphy in the diagnosis and localization of hyperfunctioning parathyroid glands.

PURPOSE: The aim of the work was to study the diagnostic value of Tc-99m tetrofosmin to localize anomalous parathyroid glands in patients with hyperparathyroid disease. METHODS: We studied 31 patients, 19 with primary and 12 with secondary hyperparathyroid disease. Five of these patients were renal graft recipients. All patients underwent surgery. Each patient was injected with 555 to 740 MBq (15 to 20 mCi) Tc-99m tetrofosmin. Subsequently, radionuclide images were acquired 15 and 120 minutes after injection using a low-energy, all-purpose, parallel-hole collimator. Pertechnetate thyroid scintigraphy was obtained in nine cases (24 to 48 h later) when the thyroid activity made it difficult to identify the parathyroid glands. RESULTS: All cases showed tracer uptake as early as 15 minutes after injection. In the group of patients with primary hyperparathyroid disease, 15 showed focal uptake in a parathyroid gland, and surgery revealed an adenoma in the same location. In one patient with hyperplasia, scintigraphy identified only two of four diseased glands. In the three remaining cases, scintigraphy showed focal uptake in the lower parathyroid gland, whereas at surgery the abnormal gland was located in the upper pole. In the secondary hyperparathyroidism group, seven patients showed diffuse tracer uptake in two or more glands, and histologic analysis confirmed hyperplasia in all of them. Five cases showed focal uptake, with three evaluated after surgery (uptake in the only remaining gland); one of them was a renal graft recipient, and the remaining patient had chronic renal failure and was receiving hemodialysis. CONCLUSIONS: Our results suggest that Tc-99m tetrofosmin may be a suitable tracer for preoperative detection and screening of anomalous parathyroid glands. The earlier images at 15 minutes were better than those at 120 minutes. Tc-99m tetrofosmin is cleared more slowly from the normal thyroid than is Tc-99m sestamibi, and both of these tracers may give better results than the old pertechnetate TI-201 subtraction technique.

[Quantification of liver volume by SPECT]. / Cuantificación del volumen hepático por SPECT.

This study aimed to optimize a method to estimate liver volume by SPECT. Several phantoms were used to simulate the liver shape with a volume between 400 and 2,500 cc. The SPECT studies were acquired using 360 degrees and 180 degrees circular orbits, 64 projections, 64 x 64 word matrix, all purpose parallel-hole collimator and were reconstructed with a HANN filter with frequency cutoff = 0.5 cycles/ pixel. The reconstructed studies were processed with a program that estimates the organ volume for different threshold cutoff levels for counting. The optimum cutoff threshold level to quantify the liver volume was 50% and 48% for 360 degrees orbits and 180 degrees orbits, respectively. A linear relationship was observed between the real and calculated volumes with r = 0.994 for the 360% orbits and r = 0.976 for the 180 degrees orbits, The average error between corrected and real volumes was 4.2% and 10.87% for both orbits, respectively. The method was applied to 14 patients with different degrees of hepatomegaly who had undergone a liver 99mTc-sulfur colloid scintigraphy. The intra and interobserver variability as well as the influence of the degree of contour adjustment of the phantom mask were studied. No significant differences were observed in the results, so that it can be considered that neither the mask trace nor the operator influence the results.