Investigation of screening questions to identify insomnia in cancer patients.

The high prevalence of insomnia in cancer patients leads to a significant reduction in the quality of life of those affected. A detailed record of symptoms therefore plays an essential role for further course of treatment. Which screening instruments enable identification of cancer patients with insomnia is the subject of this single-arm nonrandomized study. During the data collection period, cancer patients meeting the following criteria: self-reported tiredness and/or trouble falling or staying asleep or sleeping too much in an electronic patient-reported outcome measurement were enrolled. For further analysis, focus was placed on the Patient Health Questionnaire Depression Scale (PHQ-8), the Minimal Documentation System (MIDOS2) and the Insomnia Severity Index (ISI). Frequency, correlation, and variance analyses were conducted to identify likely predictors of insomnia. Our findings indicate a closer correlation between the screening question pertaining to sleep disorders and the ISI, compared to the question on tiredness and the ISI. The initial recording of sleep-related parameters plays an essential role for cancer patients in order to identify and treat modifiable factors as promptly as possible. For an initial assessment, we recommend asking about trouble falling or staying asleep or sleeping too much.

Carcinoma, tuberculosis and elastofibroma in one patient: is [18F]FDG-PET/CT helpful?

We present the case of a woman with persistent dorsal pain and two solid lung lesions documented on multidetector CT which showed concomitant [18F]FDG uptake. One of the lesions proved to be adenocarcinoma at biopsy and presented a lower [18F]FDG uptake when compared to the second lesion, which was smaller in size, and was postsurgically diagnosed as tuberculoma. This case portrays the paradoxical metabolic behaviour of two lesions, leading to misdiagnosis and erroneous disease staging in an oncology patient. Incidentally, the patient also had an elastofibroma dorsi, a rare benign tumour which can also be a possible source of false results in the PET exam. We provide explanations and possible solutions to these findings in order to familiarise the physician with them, and optimise patient management.

Radioembolization in liver tumours. / Radioembolización en tumores hepáticos.

The detection of malignant liver tumours is recently increasing. These lesions have frequently arterial vascularization which differs from healthy parenchyma with main portal flow making them especially susceptible to transarterial therapies. Transarterial Radioembolization (TARE) is an emerging treatment for the management of different liver tumours. Significant improvements in the procedure have been made so it is considered a safe and effective treatment. A multidisciplinary approach is necessary because of the complexity of the procedure. An optimal selection of the patients and good planning arteriography are essential to obtain benefit and reduce complication rate. Although TARE has been used mostly in hepatocellular carcinoma and liver metastases, indications are currently in expansion as the only treatment or in combination.

[Relevance of septal hypokinesia as a finding in myocardial perfusion gated-SPECT]. / Relevancia de la hipocinesia septal como hallazgo en la gated-SPECT de perfusión miocárdica.

OBJECTIVE: To identify septal hypokinesia (SH) with signs of right ventricular (RV) overload. MATERIALS AND METHODS: Prospective study of consecutive patients divided into cases with SH (n = 39) and controls without SH (n = 27). Subjects with septal perfusion defects and alterations in conduction were excluded. Images were obtained after injection of 20 mCi (740 MBq) of technetium tracer. The perfusion and septal mobility, RV and left ventricle values were quantified and other clinical parameters were obtained. Multivariate non-parametric tests and Pearson's correlation tests were applied. RESULTS: RV perfusion was higher in the case group (31.7 % vs 27.5 %, p = 0.012). 35.9 % of cases had undergone cardiac surgery (CS) in the past. A higher number of subjects with valve diseases (VD) was found in the case group (23.1 % vs 3.7 %, p = 0.031); the same occurred with smoking (46.2 % in cases vs. 11.1 % in controls, p = 0.05). Correlation was obtained between septal mobility and RV perfusion (-0.374, p = 0.015 bilateral), and between mobility of the septum and the RV (0.299, p = 0.015 unilateral). DISCUSSION: This test has been scarcely applied in RV pathology; this entity has great repercussion on the prognosis of patients with heart failure. These findings may clarify certain aspects of its physiopathology. CONCLUSIONS: According to our study, SH is associated with the degree of RV perfusion and mobility, as well as the presence of history of CS, VD and smoking.

[Meta-analysis of the diagnostic performance of 18F-FDG PET in renal cell carcinoma]. / Meta-análisis sobre el rendimiento diagnóstico de la tomografía por emisión de positrones con 18F-FDG en el carcinoma de células renales.

AIM: Renal cell carcinoma is the most frequent solid kidney tumor. At present, PET is not the imaging test of choice, the helical CT being the best method to assess these patients. The aim of the study was to perform a meta-analysis of the literature to evaluate the performance and accuracy of 18F-FDG PET in the detection of primary disease, recurrence and metastasis of renal cell carcinoma. MATERIALS AND METHODS: A systematic search was done of the available literature in primary and secondary databases published until October 2004 indexed in MEDLINE and CANCERLIT. Exclusion/inclusion criteria were applied. Their quality was evaluated using the Flynn criteria and joint estimators of sensitivity (S), specificity (Sp), likelihood ratios (LR), diagnostic odds ratio (DOR) and summary ROC (SROC) curve were obtained. The presence of the threshold effect was evaluated and the summary ROC (SROC) curve was calculated. RESULTS: Seven out of 46 studies fulfilled the inclusion criteria and were analyzed. Three studies evaluated the use of 18F-FDG PET in the differential diagnosis of renal masses. Two studies analyzed restaging and two analyzed the role of 18F-FDG PET in the detection of metastatic disease. All the selected studies were classified according to Flynn's criteria. We found the highest S in restaging with S 0.87 (95 % CI, 0.75-0.95) and in metastases detection with S 0.72 (95 % CI, 0.56-0.85) as well as the high Sp in differential diagnosis of renal masses. CONCLUSIONS: The results of this meta-analysis suggest that 18F-FDG PET can be useful in restaging and detection of metastatic disease, based on its acceptable S and Sp. However, the performance of 18F-FDG PET in the detection of primary disease is limited, but this may improve with the new PET/CT systems.

Epidemiology of cancer among Hispanics in the United States.

BACKGROUND: There are very limited data on cancer among U.S. Hispanics. The data that are available seldom appear outside individual registry reports. Without coalescing and assessing such information, the epidemiology of cancer among Hispanics cannot be understood. PURPOSE: This article presents an overall view of the epidemiology of cancer among Hispanic populations in the United States. METHODS: Major types of cancer were reviewed from geographic areas with 1) large Hispanic/Latino populations and 2) population-based cancer registries that cover 68% of the U.S. Hispanic population. Age-standardized rates, standardized rate ratios, and ranks of the top cancers are presented for Hispanics and non-Hispanics by sex. RESULTS: Hispanic men had consistently lower rates of cancers of the lung, prostate, colon, rectum, and oral cavity as well as of melanoma and non-Hodgkin's lymphoma than non-Hispanic men. Among Hispanic men, higher rates were observed for cancers of the stomach, liver, and gallbladder. Compared with the rates in non-Hispanic women, Hispanic women had consistently lower rates of cancers of the breast, colon, rectum, endometrium, lung, ovary, and oral cavity, non-Hodgkin's lymphoma, and melanoma and higher rates of cancers of the uterine cervix, stomach, liver, and gallbladder. Perhaps more importantly, however, was that, within U.S. Hispanic populations, the top five sites of cancer for women were breast, colon, lung, cervix, and uterine corpus. For men, the top sites were usually prostate, lung, colon, stomach, and rectum. Furthermore, some geographic areas showed differences in the order of importance within these five sites, while in other areas, the top five cancers for Hispanic men included kidney and bladder cancers, liver cancer, and non-Hodgkin's lymphomas. For women, other leading cancers mentioned were ovarian cancer, non-Hodgkin's lymphoma, and gallbladder cancer. CONCLUSIONS: Hispanics had consistently lower rates of breast, lung, prostate, and colon cancers than non-Hispanics. In some geographic regions, however, differences in cancer incidence rates with respect to specific sites existed between the heterogenous Hispanic populations. Furthermore, the rankings demonstrated that, even if Hispanics have lower rates of the most common cancers than non-Hispanics, such sites are still the most important cancers among Hispanic populations. IMPLICATIONS: Cancer is a major problem among U.S. Hispanic populations. The information given in this article can be used to develop etiologic studies and cancer control interventions. Data limitations and recommendations for improving data quality are presented.

Translational research studies of erbB oncogenes: selection strategies for breast cancer treatment.

Specific gene families, e.g. encoding members of signal transduction pathways, show a gene dosage sensitivity. We report on the determination of the gene dosages of egfr and c-erbB-2 in relation to the intratumoral concentration of the tyrosine kinase receptor protein EGFR and p185c-erbB-2 and the clinical outcome of breast cancer patients in a retrospective study. Prognostic unfavorable subgroups were determined in a life-table analysis by (a) an average gene copy number of egfr of less than 0.4 and greater than 1.6 and an intratumoral EGFR concentration of more than 56 fmol/mg, (b) an intratumoral p185c-erbB-2 concentration above 26 HNU/mg and (c) a quotient of egfr and c-erbB-2 average gene copy numbers of less than 0.15 and greater than 4.35.

[Osteoarthropathy in three siblings with Wilson's disease]. / Manifestaciones osteoarticulares en tres hermanos con enfermedad de Wilson.

Osteoarthropathies are one of the less usual manifestations of Wilson's disease. They appear in different forms such as osteoporosis (the most frequent), inflammatory changes in small joints, osteomalacia, osteoarthritis in younger ages, spine osteochondritis, fractures and heterotopic ossification. This article describes the different osteoarthropathies in three children: two brothers and one sister with Wilson's disease that first manifested in early childhood with severe neurological signs. After drug treatment and an intense rehabilitation program, the clinical signs stabilized. During the course of the disease, all three children presented fractures of the ulna and radius after low energy trauma, several heterotopic ossifications, some of which were asymptomatic, and inflammatory processes such as hip synovitis and reduction in mineral bone density. The etiology of this kind of manifestation is not yet clear, although the most widely accepted explanation is alteration in calcium and phosphate metabolism.

[Multiple sclerosis and fatigue]. / Esclerosis múltiple y fatiga.

Fatigue is a frequent symptom in multiple sclerosis, known since the first descriptions of the disease, and it has been the object of special interest in recent years due to the great influence it has on the quality of life of those suffering from the disease. The fatigue of multiple sclerosis has clinical characteristics that differentiate it from the fatigue of other systemic diseases. At the same time, it is highly variable between patients and a clear distinction can be made between three types: astenia, fatigability and the worsening of symptoms with exercise. The physiopathological bases are not fully established, but there is data indicating that astenia is related to immunoactivation and evidence of the relation of fatigability to alterations of the pyramidal tract. Another point of interest in the study of fatigue is how to objectivise and quantify it, as well as the neurophysiological techniques for its evaluation and the measurement scales most frequently employed. The paper also sets out the principal therapeutic tests and considers the relative efficacy of aminopyridine and amantadine in alleviating it.

Radioembolización en tumores hepáticos / Radioembolization in liver tumours

La enfermedad hepática tumoral es cada vez más frecuente. Su peculiar forma de irrigación, predominantemente arterial, a diferencia del resto del hígado con flujo fundamentalmente por vía portal, hace a los tumores susceptibles de terapias intraarteriales. La TARE o «transarterial radioembolization» ha irrumpido con fuerza como tratamiento de tumores hepáticos de diferentes tipos. Significativas mejoras en el procedimiento a lo largo del tiempo han hecho de la TARE un procedimiento cada vez más seguro y eficaz. Además, su naturaleza multidisciplinar y la complejidad en su ejecución hacen de esta técnica un reto para todos los especialistas implicados. Una adecuada selección de los pacientes y una correcta planificación del tratamiento son necesarios para conseguir un beneficio óptimo, reduciendo además las complicaciones. Utilizada hasta ahora en el carcinoma hepatocelular y en las metástasis hepáticas del cáncer colorrectal, sus indicaciones están actualmente en proceso de expansión como tratamiento único o combinado con otros tratamientos

The detection of malignant liver tumours is recently increasing. These lesions have frequently arterial vascularization which differs from healthy parenchyma with main portal flow making them especially susceptible to transarterial therapies. Transarterial Radioembolization (TARE) is an emerging treatment for the management of different liver tumours. Significant improvements in the procedure have been made so it is considered a safe and effective treatment. A multidisciplinary approach is necessary because of the complexity of the procedure. An optimal selection of the patients and good planning arteriography are essential to obtain benefit and reduce complication rate. Although TARE has been used mostly in hepatocellular carcinoma and liver metastases, indications are currently in expansion as the only treatment or in combination

Effects of nonstructural carbohydrates and protein sources on intake, apparent total tract digestibility, and ruminal metabolism in vivo and in vitro with high-concentrate beef cattle diets.

To investigate the effects of synchronizing nonstructural carbohydrate (NSC) and protein degradation on intake and rumen microbial fermentation, four ruminally fistulated Holstein heifers (BW = 132.3 +/- 1.61 kg) fed high-concentrate diets were assigned to a 4 x 4 Latin square design with a 2 x 2 factorial arrangement of treatments studied in vivo and in vitro with a dual-flow continuous culture system. Two NSC sources (barley and corn) and 2 protein sources [soybean meal (SBM) and sunflower meal (SFM)] differing in their rate and extent of ruminal degradation were combined resulting in a synchronized rapid fermentation diet (barley-SFM), a synchronized slow fermentation diet (corn-SBM), and 2 unsynchronized diets with a rapidly and a slowly fermenting component (barley-SBM, and corn-SFM). In vitro, the fermentation profile was studied at a constant pH of 6.2, and at a variable pH with 12 h at pH 6.4 and 12 h at pH 5.8. Synchronization tended to result in greater true OM digestion (P = 0.072), VFA concentration (P = 0.067), and microbial N flow (P = 0.092) in vitro, but had no effects on in vivo fermentation pattern or on apparent total tract digestibility. The NSC source affected the efficiency of microbial protein synthesis in vitro, tending to be greater (P = 0.07) for barley-based diets, and in vivo, the NSC source tended to affect intake. Dry matter and OM intake tended to be greater (P > or = 0.06) for corn- than barley-based diets. Ammonia N concentration was lower in vitro (P = 0.006) and tended to be lower in vivo (P = 0.07) for corn- than barley-based diets. In vitro, pH could be reduced from 6.4 to 5.8 for 12 h/d without any effect on ruminal fermentation or microbial protein synthesis. In summary, ruminal synchronization seemed to have positive effects on in vitro fermentation, but in vivo recycling of endogenous N or intake differences could compensate for these effects.

Effects of dietary nonstructural carbohydrates and protein sources on feeding behavior of tethered heifers fed high-concentrate diets.

To describe the feeding behavior of growing heifers fed high-concentrate diets with different sources of protein and nonstructural carbohydrates, and to explain the ruminal fermentation pattern, 4 ruminally fistulated Holstein heifers (BW = 132.3 +/- 1.61 kg) were assigned to a 4 x 4 Latin square design with a 2 x 2 factorial arrangement of treatments. Two non-structural carbohydrate sources (barley and corn) and 2 protein sources [soybean meal (SBM) and sunflower meal (SFM)] that differ in their rate and extent of ruminal degradation were combined, resulting in a synchronized, rapid fermentation diet (barley-SFM), a synchronized, slow fermentation diet (corn-SBM), and 2 unsynchronized diets consisting of a rapidly and a slowly fermenting component (barley-SBM and corn-SFM). The corn-SFM diet resulted in a lower frequency of feeding (P < or = 0.05), longer meal length (P < or = 0.043), and larger meal size (P < or = 0.037) than the other 3 diets. Dietary treatment had no effect (P > or = 0.09) on the daily percentages of posture and behaviors. In general, heifers spent 9.97 +/- 0.83% of the day eating, 2.11 +/- 0.42% drinking, 25.13 +/- 1.36% ruminating, 16.97 +/- 1.42% in other activities such as social behavior and self-grooming, and the rest of the day (45.82 +/- 2.55%) resting or doing no chewing activities. Eating, drinking, and social behaviors were performed while standing (P < or = 0.01), whereas resting and ruminating occurred mainly while lying (P = 0.001). Eating took place mainly in the first 4 h after feeding (P = 0.001), whereas ruminating occurred mainly at night (P = 0.001). When chewing activities (eating and ruminating) were expressed per kilogram of DM or NDF from roughage intake, more time (P = 0.004) was spent chewing per kilogram of DMI for barley-based diets, and per kilogram of NDF from roughage intake for barley- (P = 0.01) and SFM- (P = 0.002) based diets. Tethered heifers fed the more fermentable and rapidly synchronized diet (barley-SFM) reduced intake and increased chewing time. With these high-concentrate diets, time spent chewing was inversely related to roughage intake.

Changes in ruminal fermentation and protein degradation in growing Holstein heifers from 80 to 250 kg fed high-concentrate diets with different forage-to-concentrate ratios.

Six Holstein heifers (initial BW = 65.2 +/- 1.8 kg) fitted with ruminal cannulas were used in a repeated measures trial to assess the effect of age and forage-to-concentrate ratio on ruminal fermentation end products and in situ degradation kinetics of four plant protein supplements (soybean meal, sunflower meal, peas, and lupin seeds). Alfalfa hay also was incubated in situ to estimate NDF degradation. Three experimental periods were conducted at 13, 27, and 41 wk of age. Heifers were fed one of two diets, 12:88 vs. 30:70 forage-to-concentrate ratio (DM basis), offered as total mixed ration on an ad libitum basis. Intakes of DM, OM, CP, NDF, and ADG were not affected (P > or = 0.105) by diet. The 30:70 diet resulted in faster (P = 0.045) fluid passage rate and decreased (P = 0.015) ammonia N concentration compared with the 12:88 diet, but no differences (P > or = 0.244) were detected in ruminal pH and total VFA concentration between diets. The rate of degradation and the effective degradability of N in protein supplements was greater with the 30:70 diet for peas (P < or = 0.008) and lupin seeds (P < or = 0.02), and in the 12:88 diet for sunflower meal (P < or = 0.06). Degradation of NDF of alfalfa hay was low with both diets (18.5 and 23.7 % for 12:88 and 30:70, respectively); however, the rate and extent of DM and NDF degradation were greater (P < or = 0.016) with the 30:70 diet, suggesting a higher cellulolytic activity. Total VFA concentration and the proportion of propionate increased (P < or = 0.035), and the acetate proportion decreased (P = 0.021) with age. Average pH, ammonia N concentration, and passage rates were not affected (P > or = 0.168) by age. Degradation rate and effective degradability of N of sunflower meal, peas, lupin seeds, and of DM of alfalfa hay increased (P < or = 0.08) with age, but degradation kinetics of NDF of alfalfa hay was not affected (P > or = 0.249). The increase in the rate and extent of N degradation with age would suggest an increase in proteolytic activity, and the changes in the fermentation pattern may reflect an increase in amylolytic activity caused mainly by an increase in the gross intake of nonstructural carbohydrates and by adaptation of ruminal microflora after long exposure to these nutrients.

Carta réplica a la carta al director: «Ciencia y gestión: difícil punto de encuentro» / Letter of response to the letter to the editor: «Science and management: a difficult meeting point»

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Carcinoma, tuberculosis and elastofibroma in one patient: is [18F]FDG-PET/CT helpful?

We present the case of a woman with persistent dorsal pain and two solid lung lesions documented on multidetector CT which showed concomitant [18F]FDG uptake. One of the lesions proved to be adenocarcinoma at biopsy and presented a lower [18F]FDG uptake when compared to the second lesion, which was smaller in size, and was postsurgically diagnosed as tuberculoma. This case portrays the paradoxical metabolic behaviour of two lesions, leading to misdiagnosis and erroneous disease staging in an oncology patient. Incidentally, the patient also had an elastofibroma dorsi, a rare benign tumour which can also be a possible source of false results in the PET exam. We provide explanations and possible solutions to these findings in order to familiarise the physician with them, and optimise patient management (AU)

Se presenta el caso de una mujer con dorsalgia persistente y 2 lesiones pulmonares de carácter sólido visualizadas en tomografía computarizada multidetector. Dichas lesiones mostraban concomitantemente captación de [18F]FDG. Una de las lesiones se diagnosticó de adenocarcinoma tras la biopsia, y presentaba una captación de [18F]FDG de menor intensidad que la mostrada por la segunda lesión, de menor tamaño, y que tras la cirugía se diagnosticó como tuberculoma. Este caso demuestra cómo el comportamiento metabólico paradójico de 2 lesiones puede suponer un diagnóstico y estadificación oncológico erróneo. Incidentalmente, la paciente también se vio afectada de un elastofibroma dorsi, un tumor benigno poco frecuente, que puede ser, a su vez, causa de falsos positivos en el examen PET (tomografía por emisión de positrones). Con este caso se pretende ofrecer razonamientos y posibles soluciones a estos hallazgos, así como familiarizar al médico con estas entidades para optimizar el tratamiento del paciente oncológico (AU)

Influencia de la recuperación de la marcha sobre el tiempo de ingreso hospitalario en el niño y adolescente con traumatismo craneoencefálico / Influence of the recovery of walking on the hospital impatient time in children and adolescents with traumatica brain injury

Introducción. El traumatismo craneoencefálico (TCE) es la primera causa de discapacidad adquirida entrela población infantil y juvenil, y la recuperación de la marchauno de los principales objetivos de los programas de rehabilitación. La finalidad de este trabajo es estudiar la influencia de la capacidad de la marcha en el momento del alta hospitalaria,y su repercusión sobre el tiempo de estancia hospitalaria en un grupo de niños y adolescentes con TCE ingresadosen el Servicio de Rehabilitación de un hospital infantil. Pacientes y métodos. Evaluamos 40 niños con TCE y conuna edad media de 13,5 años ingresados en la planta de Rehabilitaciónde un hospital infantil desde el año 2001 hasta el 2006. En el momento del alta hospitalaria la marcha se clasificó de forma cuantitativa por su presencia o ausencia, y de forma cualitativa por ser autónoma o asistida. Las variablesanalizadas fueron: tipo de lesión según la neuroimagen, lesiones asociadas en extremidades inferiores y/o pelvis, días de estancia en la Unidad de Cuidados Intensivos (UCI), en la planta de Rehabilitación y días de estancia total, presencia del síndrome de disfunción autonómica (SDA) y pronóstico funcionalal alta según la escala de resultados de Glasgow (GOS). Resultados. En el momento del alta hospitalaria 35 niños(87,5 %) realizaban marcha; 29 de ellos (72,5 %) lo hacían de forma autónoma y 6 (15,0 %) de forma asistida. Los 5 restantes (12,5 %) no deambulaban. Tres pacientes presentaron el síndrome de disfunción autonómica, ninguno de los cualescaminaba. La estancia media hospitalaria fue de 32,15 días enlos ambulantes y de 46,35 en los no ambulantes. Se encontró correlación entre la capacidad de marcha, el tiempo medio de coma y los días de estancia en la UCI. Otras variables correlacionadas,aunque estadísticamente menos significativas, fueron los días de estancia en la planta de Rehabilitación y el tiempo total de ingreso (AU)

Introduction. Traumatic brain injury (TBI) is the most important cause of acquired disability in children and young people. Restoring walking ability is one of the primary purposes of our rehabilitation program. This work has aimed to study the incidence of the walking ability on hospital discharge time and its effects on the average hospital stay in children and young people with TBI admitted to a Children¿s Hospital Rehabilitation Service. Patients and methods. Forty children with TBI and an average age of 13.5 were admitted to the rehabilitation service between 2001 and 2006. Walking was evaluated at the time of discharge quantitatively (presence or absence of walking ability) and qualitatively (independent or device assisted walking). The variables analyzed were: lesion type through neuroimaging, associated lower limb injuries, average stay in ICU (Intensive care Unit) and Rehabilitation Service, presence of Autonomic Dysfunction Syndrome (SDA) and functional outcome on discharge by Glasgow Outcome Scale (GOS). Results. Thirty-five (87.5 %) of the 40 children and adolescents were walkers on discharge, 29(72.5 %) as independent walkers, 6(15.0 %) walked with device assistance and 5 (12.5 %) were non-walkers. Average Hospital stay was 32.15 days for walking children and 46.35 for non-walking ones. A correlation was found between walking ability, length of coma and length of the impatient stay in the ICU. Other correlated variables but with less statistical significance were average Rehabilitation service stay and total length of impatient stay. We did not find any correlation with initial TBI severity or with lower limb or pelvis injuries. Conclusions. Most of the children were walkers at discharge. The average Rehabilitation impatient stay and total average inpatient stay were lower in non-walking patients. We conclude that walking ability has an influence over total average Hospital inpatient stay (AU)

Escoliosis en enfermedades neuromusculares infantiles / Scoliosis in chilhood neuromuscular diseases

Objetivo. La escoliosis es una complicaciónfrecuente y grave en la mayoría de las enfermedades neuromuscularesde la infancia. Nuestro objetivo es realizar unaactualización del tema, describiendo su historia natural y elmanejo global de la misma.Estrategia de búsqueda. Se ha revisado la base de datosMedline, completada con una búsqueda en la Biblioteca Cochrane,en lo que se refiere al tratamiento ortésico y quirúrgico,sus complicaciones y manejo multidisciplinar. Serevisan también las citas bibliográficas de los artículos seleccionados.Selección de estudios. Se han seleccionado los artículosrelativos al manejo de la escoliosis en estas enfermedades.Entre ellos destacamos dos revisiones Cochrane, una específicasobre cirugía de la escoliosis en la distrofia muscularde Duchenne (DMD), publicada en 2007 y actualizadaen 2009, y otra relativa al tratamiento con corticoidespara la misma enfermedad, publicada en 2008, un documentode consenso para pacientes con atrofia muscularespinal y una guía de práctica clínica para enfermedadesneuromusculares.Síntesis de resultados. Ante la ausencia de artículos que demuestrenla evidencia científica del manejo actual de la escoliosisse da especial importancia a los artículos de consenso.Conclusiones. Las ortesis no impiden la evolución de laescoliosis, aunque pueden mejorar la sedestación. Actualmentela cirugía es considerada como la única intervencióncapaz de frenar la evolución de la curva y debe realizarse encentros especializados, siendo necesario un abordaje multidisciplinaren el pre y postoperatorio(AU)

Objective. Scoliosis is a frequent, seriouscomplication in the majority of childhood neuromusculardiseases. Our objective was to carry out an updating surveyon the topic, describing its natural history and its globalmanagement.Search strategy. We reviewed the Medline database,complemented by a search in the Cochrane Library, withreference to orthopedic devices and surgical treatment,com plications, and multidisciplinary management. Wealso reviewed the bibliographic citations of the selectedarticles.Study selection. Selected were those articles related tothe management of scoliosis in these diseases. Of note weretwo Cochrane reviews, one specifically on surgery for scoliosisin Duchenne’s muscular dystrophy, published in 2007and updated in 2009, and another relating to treatment ofthe same disease with corticoids, published in 2008, as wellas a consensus document for patients with spinal muscularatrophy and a practical clinical guide for neuromuscular disorders.Synthesis of results. Given the lack of articles with scientificevidence on the current management of scoliosis, theconsensus articles are of particular importance.Conclusions. Orthopedic devices do not limit the evolutionof scoliosis although they may improve sedestation.Currently surgery is considered to be the only interventioncapable of stopping the evolution of the curvature. It mustbe carried out in specialized centers and it requires a multidisciplinaryapproach both pre- and post-operative(AU)

Relevancia de la hipocinesia septal como hallazgo en la gated-SPECT de perfusión miocárdica / Relevance of septal hypokinesia as a finding in myocardial perfusion gated-SPECT

Objetivo. Identificar la hipocinesia septal (HS) con signos de sobrecarga del ventrículo derecho (VD). Material y métodos. Estudio prospectivo de pacientes consecutivos divididos en casos (n = 39), con HS y controles (n = 27) sin HS. Se excluyeron sujetos con defectos septales de perfusión, así como alteraciones de la conducción. Las imágenes se obtuvieron tras la inyección de 20 mCi (740 MBq) de trazador tecneciado. Se cuantificaron los valores de perfusión y movilidad septal del VD y del ventrículo izquierdo, y se obtuvieron otros parámetros clínicos. Se aplicaron pruebas no paramétricas multivariantes y prueba de correlación de Pearson. Resultados. La perfusión del VD fue mayor en el grupo de casos (31,7 % frente a 27,5 %, p = 0,012). El 35,9 % de los casos había sido sometido a cirugía cardíaca (CC) en el pasado. Se halló un mayor número de sujetos con valvulopatías (VP) en el grupo de casos (23,1 % frente a 3,7 %, p = 0,031), lo mismo ocurrió con el hábito tabáquico (46,2 % en casos frente a 11,1 % en controles, p = 0,05). Se obtuvo una correlación entre la movilidad septal y la perfusión del VD (-0,374, p = 0,015 bilateral), y entre la movilidad del septo y del VD (0,299, p = 0,015 unilateral). Discusión. La aplicación de esta prueba en patología del VD es escasa, dicha entidad entraña gran repercusión sobre el pronóstico de pacientes con insuficiencia cardíaca. Estos hallazgos pueden esclarecer ciertos aspectos de su fisiopatología. Conclusiones. Según nuestro estudio, la HS se asocia al grado de perfusión y movilidad del VD, así como a la presencia de antecedentes de CC, VP y de hábito tabáquico

Objective. To identify septal hypokinesia (SH) with signs of right ventricular (RV) overload. Materials and methods. Prospective study of consecutive patients divided into cases with SH (n = 39) and controls without SH (n = 27). Subjects with septal perfusion defects and alterations in conduction were excluded. Images were obtained after injection of 20 mCi (740 MBq) of technetium tracer. The perfusion and septal mobility, RV and left ventricle values were quantified and other clinical parameters were obtained. Multivariate non-parametric tests and Pearson's correlation tests were applied. Results. RV perfusion was higher in the case group (31.7 % vs 27.5 %, p = 0.012). 35.9 % of cases had undergone cardiac surgery (CS) in the past. A higher number of subjects with valve diseases (VD) was found in the case group (23.1 % vs 3.7 %, p = 0.031); the same occurred with smoking (46.2 % in cases vs. 11.1 % in controls, p = 0.05). Correlation was obtained between septal mobility and RV perfusion (-0.374, p = 0.015 bilateral), and between mobility of the septum and the RV (0.299, p = 0.015 unilateral). Discussion. This test has been scarcely applied in RV pathology; this entity has great repercussion on the prognosis of patients with heart failure. These findings may clarify certain aspects of its physiopathology

Meta-análisis sobre el rendimiento diagnóstico de la tomografía por emisión de positrones con 18F-FDG en el carcinoma de células renales / Meta-analysis of the diagnostic performance of 18F-FDG PET in renal cell carcinoma

Objetivos. El adenocarcinoma de células renales es el tumor sólido renal más frecuente. La tomografía por emisión de positrones (PET) no constituye en el momento actual la prueba de imagen de elección, siendo la tomografía axial computarizada (TAC) el método más adecuado para la valoración de estos pacientes. El objetivo de este estudio es realizar una revisión sistemática, con la que resumir toda la evidencia existente hasta el momento sobre la eficacia y rendimiento diagnóstico de la PET con 18F-fluoro-deoxi-glucosa (FDG) en el diagnóstico de enfermedad primaria, recurrencia y metástasis del adenocarcinoma de células renales. Material y métodos. Para ello se realizó una búsqueda sistemática de la literatura disponible en bases de datos primarias y secundarias (MEDLINE y CANCERLIT), hasta octubre de 2004. Se aplicaron criterios de inclusión y exclusión. Se evaluó su calidad según criterios de Flynn y se obtuvieron los estimadores conjuntos de sensibilidad (S), especificidad (E), cocientes de probabilidad (CP), y odds ratio diagnóstica (ORD) con sus intervalos de confianza del 95 %. Se evaluó la presencia de efecto umbral y se calculó la curva ROC resumen (SROC). Resultados. De los 46 estudios encontrados se seleccionaron 7 según criterios de inclusión/exclusión. De ellos, tres hacían referencia a la PET en el diagnóstico de lesiones primarias, dos a la reestadificación y otros dos a la detección de metástasis. Los 7 estudios cumplían criterios de calidad de Flynn. El valor más alto de S lo encontramos en la reestadificación con S = 0,87 (IC 95 %, 0,75-0,95) y en la detección de metástasis con S = 0,72 (IC 95 %, 0,56-0,85), siendo la E más alta en el diagnóstico inicial E = 0,93 (IC 95 %, 0,86-0,97). Conclusiones. Los resultados de este meta-análisis sugieren que la PET-FDG es capaz de reestadificar y detectar lesiones metastásicas con una S y E aceptables, presentando limitaciones en el diagnóstico de tumores renales primarios. Este rendimiento diagnóstico quizá sea mejorable con la introducción de los nuevos equipos híbridos PET-TAC

Aim. Renal cell carcinoma is the most frequent solid kidney tumor. At present, PET is not the imaging test of choice, the helical CT being the best method to assess these patients. The aim of the study was to perform a meta-analysis of the literature to evaluate the performance and accuracy of 18F-FDG PET in the detection of primary disease, recurrence and metastasis of renal cell carcinoma. Materials and methods. A systematic search was done of the available literature in primary and secondary databases published until October 2004 indexed in MEDLINE and CANCERLIT. Exclusion/inclusion criteria were applied. Their quality was evaluated using the Flynn criteria and joint estimators of sensitivity (S), specificity (Sp), likelihood ratios (LR), diagnostic odds ratio (DOR) and summary ROC (SROC) curve were obtained. The presence of the threshold effect was evaluated and the summary ROC (SROC) curve was calculated. Results. Seven out of 46 studies fulfilled the inclusion criteria and were analyzed. Three studies evaluated the use of 18F-FDG PET in the differential diagnosis of renal masses. Two studies analyzed restaging and two analyzed the role of 18F-FDG PET in the detection of metastatic disease. All the selected studies were classified according to Flynn's criteria. We found the highest S in restaging with S 0.87 (95 % CI, 0.75-0.95) and in metastases detection with S 0.72 (95 % CI, 0.56-0.85) as well as the high Sp in differential diagnosis of renal masses. Conclusions. The results of this meta-analysis suggest that 18F-FDG PET can be useful in restaging and detection of metastatic disease, based on its acceptable S and Sp. However, the performance of 18F-FDG PET in the detection of primary disease is limited, but this may improve with the new PET/CT systems