Four years of clinical experience with Radium-223 for the treatment of castration-resistant prostate cancer. / Cuatro años de experiencia clínica con radio-223 para el tratamiento del cáncer de próstata resistente a la castración.

PURPOSE: Radium-223 is an alpha-emitting radiopharmaceutical that significantly prolongs overall survival in patients with castration-resistant prostate cancer and symptomatic bone metastases. We report a retrospective analysis of our clinical experience with Radium-223 in the first 68 patients treated. METHODS: The incidence of hematologic, gastrointestinal, and other adverse events was identified, including events that led to treatment discontinuation or delay. Alterations in bone pain and prostate-specific antigen and serum alkaline phosphatase levels were evaluated. Bone scan changes were identified and correlated with the clinical course. RESULTS: Sixty-eight patients were included in the study. The median number of radium-223 injections was 5 (range 1-6), with 69% of patients receiving 5 to 6 injections. The most common side effects were digestive alterations in 24 patients, anemia in 7 patients, and thrombocytopenia in 5 patients. Clear downward trends in serum alkaline phosphatase were seen, that were less clear in prostate-specific antigen. Mean serum alkaline phosphatase decreased from baseline in 77% of the patients, and prostate-specific antigen in less than 40%. The majority of patients (62) experienced an improvement in bone pain intensity or no increase in bone pain intensity. No prostate-specific antigen flare phenomenon was noted. CONCLUSIONS: Radium-223 was generally well tolerated and there were no safety concerns. The adverse events were mild and manageable. A decline in serum alkaline phosphatase was more common than a decline in prostate-specific antigen. Monitoring changes in serum alkaline phosphatase dynamics may be useful.

[Utility of myocardial perfusion scintigraphy in the emergency department for evaluation of patients with chest pain]. / Utilidad de la gammagrafía de perfusión miocárdica para la evaluación de pacientes con dolor torácico en el servicio de urgencias.

OBJECTIVE: To evaluate diagnostic efficacy of rest myocardial perfusion scintigraphy in the detection of acute coronary syndrome in patients with chest pain and non diagnostic electrocardiogram, comparing it with reference techniques, in Emergency Department. MATERIAL AND METHODS: Myocardial perfusion scintigraphy was carried out in 40 patients with those defined characteristics in the Emergency Department, administering the radiopharmaceutical in the next 6 hours after the pain was over. All subjects followed routine diagnostic and treatment management. Final diagnosis of coronary disease was established by coronariography and/or stress perfusion myocardial scintigraphy. Patients were followed up for 9-12 months. RESULTS: Myocardial perfusion scintigraphy showed a negative predictive value of 96,15 % (CI 95 %: 86.84-100.00). The main limitation of its application was breast and diaphragmatic attenuation phenomenon, given that correction algorithms were not available. Global kappa coefficient was 0.78 when to compared interobserver agreement. CONCLUSION: Rest myocardial perfusion scintigraphy is a safe and efficient test in the screening of patients with chest pain suggestive of angor with non-diagnostic ECG in Emergency Department, and also provides prognostic information and risk stratification.

[Utility of Tc-99m labeled heat-denatured red blood cell scintigraphy in a case of hepatic splenosis]. / Utilidad de la gammagrafía selectiva con hematíes desnaturalizados Tc-99m en un caso de esplenosis hepática.

The term splenosis, first used in the medical literature in 1939, refers to the autotransplantation of splenic tissue in a heterotopic location. We report the case of a known hepatitis C carrier in whom computed tomography scanning revealed a hepatic lesion suggestive of hepatocarcinoma. Magnetic Resonance imaging was performed for suspected hepatic splenosis, which was confirmed by Tc-99m labeled heat-denatured red blood cell scintigraphy. In addition to confirming the suspected diagnosis, this technique showed several pathological foci in distinct abdominal locations compatible with splenosis that had not previously been identified.

[Application of 123I-FP-CIT in the clinical practice in Parkinsonism patients]. / Aplicación del FP-CIT-I-123 en la práctica clínica de pacientes con Parkinsonismo.

INTRODUCTION: 123I-FP-CIT scan has been supported in the last years by numerous studies as a technique of undeniable value to assess presynaptic integrity of the nigrostriatal pathway. The objective of this study is to perform a descriptive analysis of the main diagnostic aspects obtained from the first 110 studies made with FP-CIT in our center. MATERIAL AND METHODS: The study population consisted of 110 consecutive patients distributed into 5 groups according to the clinical diagnosis, after a follow-up period of at least one year. Qualitative and quantitative scintigraphy was done. RESULTS: A total of 61.8 % (68/110) of the studies were considered abnormal and 38.2 % (42/110) as normal. Among the abnormal examinations there was 88.3 % (60/68) agreement with the clinical diagnosis and agreement was 83.4 % (35/42) in the normal examinations. Inverse significant correlation was assessed between striatal binding and severity according to the H and Y scale (r = -0.4) and between qualitative and quantitative assessment (r = -0.86). There was no significant correlation between the degeneration of dopaminergic function according to age and degree of asymmetry on striatal binding in the different groups. CONCLUSIONS: Generally an adequate agreement between clinical diagnosis and SPECT-FP-CIT was observed. Inverse correlation between striatal binding and H and Y scale and greater asymmetry at striatal binding was obtained among Parkinson patients than in the rest of groups.

[Application of recombinant human TSH in the diagnostic protocol of differentiated thyroid carcinoma]. / Aplicación de la TSH humana recombinante en el protocolo diagnóstico del cáncer diferenciado de tiroides.

OBJECTIVES: To describe the preliminary results of the application of this new technique in the diagnostic protocol in the management of differentiated thyroid cancer (DTC). MATERIAL AND METHODS: 131I Whole body scan (WBS) was made under rhTSH stimulation in a group of 102 patients with DTC in follow-up, all treated by means of total thyroidectomy. The administration guideline was a dose of 0.9 mg of rhTSH (intramuscular) for two consecutive days, followed by oral activity of 185 MBq of 131I 24 hours after the last rhTSH injection, and later scintigraphic scan after 48 hours of the administration of 131I. Serum samples for TSH, thyroglobulin and antithyroglobulin antibodies determination were collected at 24 and 72 hours of the last administration of the rhTSH. Measures were made by means of immunometric assays. RESULTS: TSH values at 24 hours after exogenous stimulation were 147.54 +/- 46.46 mIU/l. In 62 patients values of negative Tg were obtained (< 1 ng/ml), 50 of which presented negative WBS and 12 positive. 37 patients had positive Tg, 17 of whom presented negative WBS (confirming presence of disease in 7 patient by means of other imaging techniques) and 20 positive. CONCLUSIONS: In every case, administration of rhTSH produced a significant increase of the TSH, making it possible to perform the usual controls of patient management (determination of serum Tg and WBS), similarly to the hormone withdrawal situation. There is no evidence of significant side effects, and its use makes it possible to avoid disadvantages derived from the hormonal withdrawal, maintaining a good quality of life in patients.

Dissolution of the capitellum after nondisplaced supracondylar fracture of the humerus in a child: a case report of transient osteochondrosis.

Supracondylar fractures of the humerus are the most common type of elbow fractures in children. Nonunion of the lateral condyle, cubitus varus, cubitus valgus, fishtail deformity, or growth disorders, including premature physeal arrest or even avascular necrosis, are uncommon but important complications. However, transient osteochondrosis of the capitellum after a supracondylar fracture has been reported in only two cases in the literature. We report our experience of transient osteochondrosis of the capitellum in a 5-year-old boy after conservative treatment with cast immobilization for a nondisplaced supracondylar fracture of the distal humerus with 8 years of follow-up. Serial radiography of both the injured and the contralateral elbows were performed, which enabled monitoring of the evolution of the transient osteochondrosis. No specific treatment was provided because there was no evidence of acute complication or of a progressing deformity. The patient had gained full range of motion of the elbow without pain by 6 weeks of follow-up. At 5 years after the fracture, the ossification center of the capitellum was restored to its normal size and shape. There was no evidence of growth disturbances in this case. This case report is an uncommon case of transient osteochondrosis of the capitellum in the distal humerus after conservative treatment for nondisplaced supracondylar fractures in children. The evolution of this entity is good and it is managed by conservative treatment.

[Epidemiologic surveillance of hospital infection. Preliminary analysis of a 5-year series]. / Vigilancia epidemiológica de la infección hospitalaria. Análisis preliminar de una serie de cinco años.

The epidemiological surveillance provides opportunities to know the magnitude and determinants of nosocomial infection and permits, at the same time, the planning, implementation and evaluation of prevention and treatment activities in order to approach the rates of infection in the hospital, as near as possible, to the irreducible minimum. We show data collected by surveillance system Guadalajara General Hospital from 1982 to 1987. In order to analyze general trends, seasonality, accidental variations and endemic levels, we have used statistical methods as linear regression, chi 2, equality proportions and built of an endemic channel with confidence intervals of 95%. We have observed a decreasing trend, locating endemic levels around to 4% of monthly accumulated incidence. There is a possible seasonal influence concurring with holidays periods and someone accidental variation over that we expected, it was related with a deteriorated situation about medical care.

[Relationship between nosocomial infection and hospital mortality. Multicenter study]. / Relación de la infección nosocomial con la mortalidad hospitalaria. Estudio multicéntrico.

BACKGROUND: Hospital mortality related to infections acquired in the hospital setting has not been well studied in Spain. We carried out a study of seven hospitals in order to assess and quantify the problem. METHODS: The study period included three months of observations (between November 1, 1989 and January 31, 1990), and data pertaining to all deaths of patients hospitalized for a minimum of 24 hours were collected. The number of people admitted within the study period was 16,025, and the number of deaths registered and included in our study was 488 (3%). The data were obtained from the patient's medical history one week after death as well as from the hospital physicians on the case. In order to quantify the interobserver variability derived from the classification criteria, the simple kappa index was calculated and averaged to form an ordinal scale. RESULTS: 216 (44.3%) of 488 deaths included in our study had no infection, 138 (28%) had an infection no-hospital-associated, and 134 (27%) had nosocomial infection (50-10%--"causally related to death", 59-12%--"contributing to death", and 25-5%--"not related to death"). The lower respiratory tract infections, bacteremias and surgical wound infections were the most related to cause of death. Staphylococcus aureus was the pathogen most frequently associated with the infections found at the time of death. CONCLUSIONS: Those patients admitted with non-fatal diseases made up the greatest percentage (39.9%) of deaths from nosocomial infections. The infection was considered the direct cause of death in 18.8% of these cases, although the differences found had no statistical significance.

[Beta-cell, thyroid and celiac autoimmunity in children with type 1 diabetes]. / Autoinmunidad pancreática, tiroidea y relacionada con la celiaquía en niños con diabetes mellitus tipo 1.

OBJECTIVE: The aim of this study was to evaluate the presence of beta-cell, thyroid and coeliac autoimmunity in children with recent-onset type 1 diabetes. METHODS: We studied all children with newly diagnosed type 1 diabetes. Data were analyzed from 63 children aged 2-14 years who were treated in the Department of Pediatrics of the Virgen de las Nieves University Hospital in Granada (Spain) from 1998-2002. Antibodies to glutamic acid decarboxylase-65 (GADA), anti-insulin (AIA), thyroperoxidase (anti-TPO), thyroglobulin (anti-TG), thyroid-stimulating immunoglobulins (TSI) and endomysial antibodies (EmA-IgA) were measured and documented. A total of 55.5 % of these patients were girls and the mean age was 7.9 +/- 3.2 years. RESULTS: The prevalence rates were: GADA 65.1 %; AIA 68.3 %; anti-TPO 11.1 %; anti-TG 9.5 %; TSI 4.8 % and EmA-Ig A 3.1 %. Children with thyroid antibodies (anti-TPO1) were significantly older and developed diabetes later in life (P < 0.05) than those without antibodies. Thyroid-stimulating hormone levels, goiter and thyroid dysfunction were higher in children who were anti-TPO1 than in diabetic children without thyroid autoimmunity. CONCLUSIONS: Children with newly diagnosed type 1 diabetes show a high prevalence of thyroid and coeliac autoimmunity. In cases of positivity, additional work-up and intervention are advocated. These measures can prevent the well-known complications of diabetes and improve its clinical course.

[Quality control dose calibrators]. / Control de calidad de activímetros.

We have reviewed the legislation about the quality control of dose calibrator. The importance of verifying the correct work of these instruments, is fundamental in daily practice of radiopharmacy and nuclear medicine. The Spanish legislation establishes to include these controls as part of the quality control of radiopharmaceuticals, and the program of quality assurance in nuclear medicine. We have reviewed guides and protocols from international eminent organizations, summarizing the recommended tests and periodicity of them.

Cuatro años de experiencia clínica con radio-223 para el tratamiento del cáncer de próstata resistente a la castración / Four years of clinical experience with Radium-223 for the treatment of castration-resistant prostate cancer

El dicloruro de radio-223 es un radiofármaco emisor alfa que prolonga la supervivencia global en pacientes con cáncer de próstata resistente a la castración y metástasis óseas sintomáticas. Presentamos un análisis retrospectivo de 68 pacientes tratados. MÉTODO: Se evaluó la incidencia de eventos adversos hematológicos, gastrointestinales y otros, incluidos aquellos que llevaron a la interrupción o el retraso del tratamiento. Se determinó la mejoría o empeoramiento del dolor óseo, los niveles de antígeno prostático específico y de fosfatasa alcalina sérica. Se valoró la gammagrafía ósea pre- y postratamiento y se correlacionó con la evolución clínica. RESULTADOS: Fueron incluidos 68 pacientes. La media del número de inyecciones de radio-223 fue de 5 (rango 1-6), el 69% de los pacientes recibieron 5 o 6 inyecciones. Los efectos secundarios más comunes fueron alteraciones digestivas en 24 pacientes, anemia en 7 y trombocitopenia en 5. Se observaron claras tendencias a la baja en la fosfatasa alcalina sérica. La fosfatasa alcalina sérica media disminuyó desde el inicio en el 77% de los pacientes y el antígeno prostático específico en menos del 40%. La mayoría de los pacientes (62) experimentaron una mejoría en la intensidad o estabilidad del dolor. No se observó ningún fenómeno de llamarada de antígeno prostático específico. CONCLUSIONES: El radio-223 fue generalmente bien tolerado y no hubo problemas de seguridad. Los eventos adversos fueron leves y manejables. Fue más común una disminución en la fosfatasa alcalina sérica que del antígeno prostático específico. La monitorización de la dinámica de la fosfatasa alcalina sérica puede ser útil

PURPUSE: Radium-223 is an alpha-emitting radiopharmaceutical that significantly prolongs overall survival in patients with castration-resistant prostate cancer and symptomatic bone metastases. We report a retrospective analysis of our clinical experience with Radium-223 in the first 68 patients treated. METHODS: The incidence of hematologic, gastrointestinal, and other adverse events was identified, including events that led to treatment discontinuation or delay. Alterations in bone pain and prostate-specific antigen and serum alkaline phosphatase levels were evaluated. Bone scan changes were identified and correlated with the clinical course. RESULTS: Sixty-eight patients were included in the study. The median number of radium-223 injections was 5 (range 1-6), with 69% of patients receiving 5 to 6 injections. The most common side effects were digestive alterations in 24 patients, anemia in 7 patients, and thrombocytopenia in 5 patients. Clear downward trends in serum alkaline phosphatase were seen, that were less clear in prostate-specific antigen. Mean serum alkaline phosphatase decreased from baseline in 77% of the patients, and prostate-specific antigen in less than 40%. The majority of patients (62) experienced an improvement in bone pain intensity or no increase in bone pain intensity. No prostate-specific antigen flare phenomenon was noted. CONCLUSIONS: Radium-223 was generally well tolerated and there were no safety concerns. The adverse events were mild and manageable. A decline in serum alkaline phosphatase was more common than a decline in prostate-specific antigen. Monitoring changes in serum alkaline phosphatase dynamics may be useful

Un caso infrecuente de doble adenoma paratiroideo evidenciado con 99mTc-sestaMIBI SPECT/TC / A rare case of double parathyroid adenoma evidenced by 99mTc-sestaMIBI SPECT/CT

No disponible

[Diagnostic accuracy of FP-CIT SPECT in the evaluation of patients with clinically uncertain parkinsonian syndrome]. / Validez diagnóstica de la SPECT con FP-CIT en la evaluación de pacientes con síndrome parkinsoniano clínicamente incierto.

OBJECTIVE: To determine diagnostic accuracy of FP-CIT SPECT in a subgroup of patients who clinically present nonconclusive or atypical characteristics of parkinsonism (Clinically Uncertain Parkinsonian Syndromes, CUPS), and assess the contribution of the quantitative analysis in this group of patients. PATIENTS AND METHODS: We included 54 patients who make up the CUPS group. After a variable follow-up period, we evaluated the existence of a degenerative parkinsonism and compared it with the result of the FP-CIT SPECT, establishing the diagnostic accuracy of this procedure in the CUPS patient group. RESULTS: We obtained a high diagnostic accuracy of neurodegenerative Parkinsonism in the CUPS patient group (sensitivity: 85%; specificity: 93%). False positive results were obtained in patients with vascular parkinsonism and most of the false negative results in patients with Parkinson's disease. The quantitative evaluation did not contribute data of relevance to the qualitative evaluation. CONCLUSIONS: FP-CIT SPECT makes it possible to show the involvement of nigrostriatal dopaminergic pathway, also contributing with information of relevance to the clinician about the etiology of the extrapyramidal symptomatology in patients with nonconclusive signs and symptoms of the existence of a Parkinsonism.

Validez diagnóstica de la SPECT con FP-CIT en la evaluación de pacientes con síndrome parkinsoniano clínicamente incierto / Diagnostic accuracy of FP-CIT SPECT in the evaluation of patients with clinically uncertain parkinsonian syndrome

Objetivo. Establecer la validez diagnóstica de la SPECT con FP-CIT en un subgrupo de pacientes que presentan clínicamente rasgos no concluyentes o atípicos de parkinsonismo (síndrome parkinsoniano clínicamente incierto [SPCI]), valorando la aportación del análisis cuantitativo en este grupo de pacientes. Pacientes y métodos. Se incluye a 54 pacientes que conforman el grupo con SPCI. Tras un período de seguimiento se establece desde el punto de vista clínico la existencia o no de parkinsonismo degenerativo y se confronta con el resultado de la SPECT con FP-CIT, estableciendo la validez diagnóstica de dicho procedimiento en el grupo de pacientes con SPCI. Resultados. Se obtuvo una elevada validez diagnóstica en el diagnóstico de un parkinsonismo de origen neurodegenerativo en pacientes con SPCI (sensibilidad: 85 %, y especificidad, 93 %). Los resultados falsos positivos se obtuvieron a partir de pacientes con Parkinson vascular (PV) y la mayoría de falsos negativos a partir de sujetos con enfermedad de Parkinson (EP). La valoración cuantitativa no aportó datos de relevancia a la valoración visual. Conclusiones. El estudio tomográfico con FP-CIT permite poner de manifiesto con elevada seguridad diagnóstica la afectación de la vía dopaminérgica nigroestriada, aportando, asimismo, información de relevancia al clínico acerca de la etiología de la sintomatología extrapiramidal en pacientes con síntomas y signos no concluyentes de la existencia de un parkinsonismo

Objective. To determine diagnostic accuracy of FP-CIT SPECT in a subgroup of patients who clinically present nonconclusive or atypical characteristics of parkinsonism (Clinically Uncertain Parkinsonian Syndromes, CUPS), and assess the contribution of the quantitative analysis in this group of patients. Patients and methods. We included 54 patients who make up the CUPS group. After a variable follow-up period, we evaluated the existence of a degenerative parkinsonism and compared it with the result of the FP-CIT SPECT, establishing the diagnostic accuracy of this procedure in the CUPS patient group. Results. We obtained a high diagnostic accuracy of neurodegenerative Parkinsonism in the CUPS patient group (sensitivity: 85 %; specificity: 93 %). False positive results were obtained in patients with vascular parkinsonism and most of the false negative results in patients with Parkinson's disease. The quantitative evaluation did not contribute data of relevance to the qualitative evaluation. Conclusions. FP-CIT SPECT makes it possible to show the involvement of nigrostriatal dopaminergic pathway, also contributing with information of relevance to the clinician about the etiology of the extrapyramidal symptomatology in patients with nonconclusive signs and symptoms of the existence of a Parkinsonism

Utilidad de la gammagrafía de perfusión miocárdica para la evaluación de pacientes con dolor torácico en el servicio de urgencias / Utility of myocardial perfusion scintigraphy in emergency department for evaluation of patients with chest pain

Objetivo. Evaluar la validez diagnóstica de la gammagrafía de perfusión miocárdica precoz en reposo para la detección de síndrome coronario agudo en pacientes con dolor torácico y electrocardiograma no diagnóstico, comparándola con las técnicas de referencia. Material y métodos. Se realizó una gammagrafía de perfusión miocárdica en 40 de estos pacientes atendidos en el servicio de urgencias, inyectando el radiofármaco en las primeras seis horas tras la finalización del dolor. Todos los sujetos siguieron su curso diagnóstico y terapéutico de rutina. El diagnóstico final de enfermedad coronaria se estableció mediante coronariografía y/o gammagrafía de esfuerzo. Se realizó un tiempo de seguimiento clínico de todos los pacientes entre 9-12 meses. Resultados. El valor predictivo negativo de la gammagrafía de perfusión miocárdica fue del 96,15 % (IC 95 %: 86,84-100,00 %). La principal limitación de su aplicación fue el fenómeno de atenuación mamaria y diafragmática, al no disponer de algoritmos de corrección de atenuación. El índice global de kappa obtenido para valorar la concordancia interobservadores fue del 0,78. Conclusiones. La gammagrafía de perfusión miocárdica en reposo es una técnica eficiente y segura para el screening en urgencias de pacientes con dolor torácico sugestivo de ángor con electrocardiograma normal o no diagnóstico, y proporciona además información pronóstica y estratificación del riesgo

Objective. To evaluate diagnostic efficacy of rest myocardial perfusion scintigraphy in the detection of acute coronary syndrome in patients with chest pain and non diagnostic electrocardiogram, comparing it with reference techniques, in Emergency Department. Material and methods. Myocardial perfusion scintigraphy was carried out in 40 patients with those defined characteristics in the Emergency Department, administering the radiopharmaceutical in the next 6 hours after the pain was over. All subjects followed routine diagnostic and treatment management. Final diagnosis of coronary disease was established by coronariography and/or stress perfusion myocardial scintigraphy. Patients were followed up for 9-12 months. Results. Myocardial perfusion scintigraphy showed a negative predictive value of 96,15 % (CI 95 %: 86.84-100.00). The main limitation of its application was breast and diaphragmatic attenuation phenomenon, given that correction algorithms were not available. Global kappa coefficient was 0.78 when to compared interobserver agreement. Conclusion. Rest myocardial perfusion scintigraphy is a safe and efficient test in the screening of patients with chest pain suggestive of angor with non-diagnostic ECG in Emergency Department, and also provides prognostic information and risk stratification

Utilidad de la gammagrafía selectiva con hematíes desnaturalizados Tc-99m en un caso de esplenosis hepática / Utility of Tc-99m labeled heat-denatured red blood cell scintigraphy in a case of hepatic splenosis

El término esplenosis se introdujo en la bibliografía médica en 1939 para designar el autoimplante de tejido esplénico en una localización heterotópica. Presentamos el caso de un paciente afectado de infección crónica por el virus de la hepatitis C al que, tras un control mediante tomografía computarizada, se le detectó una lesión hepática indicativa de hepatocarcinoma, tras lo cual se le realizó una resonancia magnética y se estableció la sospecha de esplenosis hepática, que se confirmó mediante gammagrafía selectiva con hematíes desnaturalizados marcados con Tc-99m. Esta técnica, además de confirmar la sospecha diagnóstica comentada, mostró múltiples depósitos patológicos en distintas localizaciones abdominales compatibles con focos de esplenosis cuya presencia no se conocía hasta ese momento

The term splenosis, first used in the medical literature in 1939, refers to the autotransplantation of splenic tissue in a heterotopic location. We report the case of a known hepatitis C carrier in whom computed tomography scanning revealed a hepatic lesion suggestive of hepatocarcinoma. Magnetic Resonance imaging was performed for suspected hepatic splenosis, which was confirmed by Tc-99m labeled heat-denatured red blood cell scintigraphy. In addition to confirming the suspected diagnosis, this technique showed several pathological foci in distinct abdominal locations compatible with splenosis that had not previously been identified

Aplicación del FP-CIT-I-123 en la práctica clínica de pacientes con parkinsonismo / Application of 123I-FE-CIT in the clinical practice in Parkinsonism patients

Introducción: La SPECT con FP-CIT-I-123 ha sido avalada en los últimos años por numerosos estudios como una técnica muy valiosa para evaluar la integridad presináptica de la vía estriato nígrica. El presente estudio tiene como objetivo realizar un análisis descriptivo de los principales aspectos diagnósticos extraídos de los 110 primeros estudios realizados con FP-CIT en nuestro centro. Material y métodos: Se incluyeron a 110 pacientes reclutados de forma consecutiva, distribuidos en 5 grupos según el diagnóstico clínico de presunción, con un período de seguimiento de al menos un año. La exploración gammagráfica se valoró tanto cualitativa como cuantitativamente. Resultados: El 61,8 % (68/110) de los estudios fueron considerados como patológicos y el 38,2 % (42/110) no presentaron alteraciones. Entre lo estudios patológicos hubo una concordancia con el diagnóstico clínico del 88,3 % (60/68). En el grupo de exploraciones consideradas normales, la concordancia fue del 83,4 % (35/42). En los pacientes con Enfermedad de Parkinson (EP), se apreció correlación inversa estadísticamente significativa entre captación estriatal y severidad según grado H&Y (r = ­0,4) y entre valoración cualitativa y cuantitativa (r = ­0,86). No se obtuvo significación entre pérdida fisiológica de función dopaminérgica y edad, ni entre grado de asimetría a nivel estriatal en los distintos grupos. Conclusiones: Se observó en general una adecuada concordancia entre diagnóstico clínico y resultado de la SPECT con FP-CIT. En los pacientes con EP se obtuvo correlación inversa entre captación estriatal y grado de H&Y y mayor grado de asimetría a nivel estriatal que en el resto de grupos

Introduction: 123I-FP-CIT scan has been supported in the last years by numerous studies as a technique of undeniable value to assess presynaptic integrity of the nigrostriatal pathway. The objective of this study is to perform a descriptive analysis of the main diagnostic aspects obtained from the first 110 studies made with FP-CIT in our center. Material and methods: The study population consisted of 110 consecutive patients distributed into 5 groups according to the clinical diagnosis, after a follow-up period of at least one year. Qualitative and quantitative scintigraphy was done. Results: A total of 61.8 % (68/110) of the studies were considered abnormal and 38.2 % (42/110) as normal. Among the abnormal examinations there was 88.3 % (60/68) agreement with the clinical diagnosis and agreement was 83.4 % (35/42) in the normal examinations. Inverse significant correlation was assessed between striatal binding and severity according to the H&Y scale (r = ­0.4) and between qualitative and quantitative assessment (r = ­0.86). There was no significant correlation between the degeneration of dopaminergic function according to age and degree of asymmetry on striatal binding in the different groups. Conclusions: Generally an adequate agreement between clinical diagnosis and SPECT-FP-CIT was observed. Inverse correlation between striatal binding and H&Y scale and greater asymmetry at striatal binding was obtained among Parkinson patients than in the rest of groups

Aplicación de la TSH humana recombinante en el protocolo diagnóstico del cáncer diferenciado de tiroides / Application of recombinant human TSH in the diagnostic protocol of differentiated thyroidcarcinoma

Objetivos: Describir los resultados preliminares de la aplicación de esta nueva técnica en la práctica diagnóstica habitual en el manejo del cáncer diferenciado de tiroides (CDT). Material y métodos: Se realizó rastreo corporal total (RCT) con 131I tras estimulación con TSH recombinante humana (rhTSH) en un grupo de 102 pacientes con CDT en seguimiento, todos tratados mediante tiroidectomía total. La pauta de administración fue de 0,9 mg rhTSH los días primeros y segundo del procedimiento, seguidos de 185 MBq de 131I administrados vía oral el día siguiente y posterior rastreo gammagráfico a las 48 horas. Se determinaron TSH, tiroglobulina (Tg) y anticuerpos antitiroglobulina en suero, mediante técnicas inmunométricas, a las 24 y 72 horas de la última administración de la rhTSH. Resultados. Los valores de TSH a las 24 horas tras estimulación con rhTSH fueron de 147,54 ± 46,46 mUI/l. En 62 pacientes se obtuvieron valores de Tg negativa (< 1 ng/ml), de los que 50 presentaron rastreo negativo y doce positivo. Entre los que tuvieron Tg positiva (37), 17 presentaron rastreo negativo (confirmándose presencia de enfermedad en 7 pacientes mediante otras técnicas de imagen) y 20 positivo. Conclusiones: La administración de rhTSH produjo en todos los casos un significativo aumento de la TSH, permitiendo la realización de los controles habituales de seguimiento de los pacientes de forma similar a la supresión hormonal. No han existido evidencias de efectos secundarios significativos, y su utilización permite obviar los inconvenientes derivados de la supresión, manteniendo una buena calidad de vida en los pacientes

Objectives: To describe the preliminary results of the application of this new technique in the diagnostic protocol in the management of differentiated thyroid cancer (DTC).Material and methods: 131I Whole body scan (WBS) was made under rhTSH stimulation in a group of 102 patients with DTC in follow-up, all treated by means of total thyroidectomy. The administration guideline was a dose of 0.9 mg of rhTSH (intramuscular) for two consecutive days, followed by oral activity of 185 MBq of 131I 24 hours after the last rhTSH injection, and later scintigraphic scan after 48 hours of the administration of 131I. Serum samples for TSH, thyroglobulin and antithyroglobulin antibodies determination were collected at 24 and 72 hours of the last administration of the rhTSH. Measures were made by means of immunometric assays. Results: TSH values at 24 hours after exogenous stimulation were 147.54 ± 46.46 mIU/l. In 62 patients values of negative Tg were obtained (< 1 ng/ml), 50 of which presented negative WBS and 12 positive. 37 patients had positive Tg, 17 of whom presented negative WBS (confirming presence of disease in 7 patient by means of other imaging techniques) and 20 positive. Conclusions: In every case, administration of rhTSH produced a significant increase of the TSH, making it possible to perform the usual controls of patient management (determination of serum Tg and WBS), similarly to the hormone withdrawal situation. There is no evidence of significant side effects, and its use makes it possible to avoid disadvantages derived from the hormonal withdrawal, maintaining a good quality of life in patients

Autoinmunidad pancreática, tiroidea y relacionada con la celiaquía en niños con diabetes mellitus tipo 1 / Beta-cell, thyroid and coeliac autoimmunity in children with type 1 diabetes

Objetivo: El objetivo de este estudio ha sido investigar en niños que presentan diabetes mellitus tipo 1 (DM1) la presencia de autoinmunidad pancreática, tiroidea y relacionada con la celiaquía. Métodos: Se incluyeron todos los niños que presentaron DM1. Se analizaron datos de 63 niños con un rango de edad de 2 a 14 años, que fueron tratados en el centro maternoinfantil del hospital universitario Virgen de las Nieves de Granada durante el período 1998-2002. Se midieron y registraron los anticuerpos antiglutamato descarboxilasa (GADA), antiinsulina (AAI), antiperoxidasa tiroidea (anti-TPO), antitiroglobulina (anti-TG), inmunoglobulinas estimulantes del tiroides (TSI) y anticuerpos antiendomisio (AAE-IgA) relacionados con la enfermedad celíaca. El 55,5 por ciento de los pacientes eran de sexo femenino, la edad media fue de 7,9 +/- 3,2 años. Resultados: El porcentaje de positividad para los distintos anticuerpos fue: GADA, 65,1 por ciento; AAI, 68,3 por ciento; anti-TPO, 11,1 por ciento; anti-TG, 9,5 por ciento; TSI, 4,8 por ciento y AAE-IgA, 3,1 por ciento. Los niños con autoinmunidad tiroidea presente eran en el momento del diagnóstico de su diabetes de mayor edad y desarrollaban su enfermedad más tarde que los niños sin autoinmunidad tiroidea. Los pacientes anti-TPO positivos presentaban niveles más elevados de hormona tirostimulante, mayor prevalencia de bocio y disfunción tiroidea que los niños sin anti-TPO. Conclusiones: Los niños que presentan DM1 presentan una alta prevalencia de autoinmunidad tiroidea y relacionada con la enfermedad celíaca. En caso de presentar estos marcadores positivos es preciso prestar especial atención a la posible asociación de otras enfermedades, completando los estudios que se precisen. Estas medidas pueden prevenir complicaciones y mejorar la evolución de la enfermedad diabética (AU)