Cáncer sincrónico y metacrónico detectado con PET/CT en población oncológica / Multiple primary malignant neoplasms detected by PET/CT in cancer patients

Background Imaging with F18-fluorodeoxyglucose PET/CT is used to determine sites of abnormal glucose metabolism and can be used to characterize and localize many types of tumors. Aim To assess the prevalence of multiple primary malignant neoplasms (MPMN) detected by PET/CT in cancer patients. Material and Methods F18-fluorodeoxyglucose PET/CT scans performed to 800 patients with a newly diagnosed cancer or with already treated tumors were retrospectively reviewed. In patients whose examination described incidental findings not related to the primary tumor, a research was done about further laboratory, imaging or pathological studies. Results In 188 PET/CT scans (23%) an incidental finding was found. Of these, 66 (35%) were considered as MPMN, 12 as atypical metastases of a known primary tumor, 14 as false positive images (inflammatory or physiologic uptake) and 29 as benign or low grade tumors. In 67 cases (36% of all incidental tumors), the finding was not confirmed. Seven percent of patients with a newly diagnosed tumor had a synchronic MPMN detected by PET/CT. Nine percent of patients with treated tumors developed a metachronous MPMN during their follow up. The most common incidental tumors were thyroid cancer in 15 cases, kidney cancer in 13, lung cancer in 10, colorectal carcinoma in 9, breast cancer in 6, prostate cancer in 4, non-Hodgkin lymphoma in 3 and pancreatic cancer in 2. Conclusions A MPMN is detected by PET/CT in a significant number of cancer patients.

Validación del puntaje de riesgo TIMI como predictor de mortalidad en pacientes chilenos con infarto agudo al miocardio con supradesnivel de ST / Prediction of hospital mortality of ST elevation myocardial infarction using TIMI score

Background: Thrombolysis in myocardial infarction risk score (TIMI-RS) was designed to predict early mortality in patients with a ST elevation acute myocardial infarction (STEAMI). Aim: To evaluate the predictive capacity for hospital mortality of TIMI-RS. Material and Methods: Patients with ≤ 12-hour evolution STEAMI were selected from a prospective registry of all patients hospitalized in our coronary unity within January 1988 and December 2005. Observed mortality was analyzed according to TIMI-RS and its predictive capacity was estimated. Results: We analyzed 1125 consecutive patients aged 61 ± 13 years (76% men). Fifty one percent were smokers, 47% hypertensive and 40% had a history of angina. Fifty eight percent of patients underwent reperfusion therapy. Most patients had TIMI-RS scores ≤ 5 points and only 3.6% had scores ≥ 10 points. Overall mortality was 14.8% and there was an 80% concordance between observed mortality and that predicted with the TIMI-RS score. The area under the curve for the receiver operating characteristic (ROC) curve was 0.7. Conclusions: TIMI-RS was acceptably useful to predict in-hospital mortality in this group of patients with STEAMI. Differences between the observed and originally predicted mortality are explained by the clinical profile and therapeutic protocols applied to patients in different studies. Thus, caution needs to be taken when interpreting the risk associated to a specific score, particularly within non-reperfused patients whose risk might be underestimated.

Disección coronaria espontánea posterior a ejercicio: presentación de un caso y revisión bibliográfica / Spontaneous Coronary Artery Dissection after to exercise: a case report and literature review

Spontaneous coronary dissection (SCD) is a rare cause of acute coronary syndrome (ACS) in patients with no risk factors, usually described in young women within delivery period. The test of choice to approach diagnosis is coronary angiography, which could result therapeutic as it achieves myocardial revascularization though angioplasty. Occasionally, complementary radiologic techniques are required for diagnosis, as well as other treatments such as coronary bypass surgery (CBS). The prognosis of successfully revascularized patients is favorable, generally with no recurrence. We report the case of a 25 year-old woman, with no medical records, who experienced two episodes of ACS; first after exercise and two days later while she was at rest,revascularized in our hospital due to a double SCD that required CBS with a propitious evolution and remaining asymptomatic trough a six-year follow up...

Disección coronaria espontánea posterior a ejercicio: presentación de un caso y revisión bibliográfica / Spontaneous coronary artery dissection posterior to exercise: presentation of a case and bibliographic review

Spontaneous coronary dissection (SCD) is a rare cause of acute coronary syndrome (ACS) in patients with no risk factors, usually described in young women within delivery period. The test of choice to approach diagnosis is coronary angiography, which could result therapeutic as it achieves myocardial revascularization though angioplasty. Occasionally, complementary radiologic techniques are required for diagnosis, as well as other treatments such as coronary bypass surgery (CBS). The prognosis of successfully revascularized patients is favorable, generally with no recurrence. We report the case of a 25 year-old woman, with no medical records, who experienced two episodes of ACS; first after exercise and two days later while she was at rest,revascularized in our hospital due to a double SCD that required CBS with a propitious evolution and remaining asymptomatic trough a six-year follow up. (AU)