Cicatriz renal detectada mediante cintigrama renal DMSA en niños con primera pielonefritis aguda: estudio de factores de riesgo / Renal scars after one year of follow up in children with a first episode of acute pyelonephritis

Background: Acute pyelonephritis in children can leave a kidney scar that eventually can lead to hypertension or renal failure. 99mTc-dimercaptosuccinic acid renal scintigraphy (RC DMSA) is a widely accepted technique to assess children with acute pyelonephritis. Aim: To evaluate the presence of residual kidney scars detected through RC DMSA, in children with a first episode of acute pyelonephritis. Patients and methods: Clinical records of children with a first episode of acute pyelonephritis that were assessed within seven days of the episode with RC DMSA were reviewed. Children were considered eligible if they did not have a new episode of acute pyelonephritis and a second RC DMSA, one year after the first episode, was performed. The presence or absence of a renal scar after one year was associated to demographic, scintigraphy and laboratory variables. Results: Fifty nine children, aged 1 month to 10 years, 35 females, were studied. Thirty nine percent had a renal scar in the scintigraphy perfomed after one year of follow up. The presence of a scar was correlated with a C reactive protein over 130 mg/dl and an altered relative renal function (below 44%), during the acute phase. Conclusions: A high C reactive protein and alterations of relative renal function during the acute phase of acute pyelonephritis in children, may be risk factors for the development of renal scars in the long term follow up.

Cintigrafía pulmonar por perfusión en niños con daño pulmonar crónico: resultados preliminares de la aplicación de la técnica SPECT / Lung perfusion scintigraphy in children with chronic lung damage: preliminary results of the application of SPECT technique

El objetivo fue describir los hallazgos del SPECT de perfusión pulmonar (SPP) en niños con daño pulmonar crónico. Material y Método: Se revisaron 106 SPP de niños (edad promedio: 3,9± 3,3 años) con daño pulmonar crónico realizados con gammacámara doble cabezal. Los diagnósticos más frecuentes fueron secuela de BNM por adenovirus (ADV) (29 por ciento), daño pulmonar crónico de etiología desconocida (DPED) (21 por ciento), displasia broncopulmonar (DBP) (15 por ciento), y síndrome bronquial obstructivo (SBO) (14 por ciento). El grado de alteración se evaluó utilizando un Score, que consideró extensión y tipo de compromiso y perfusión pulmonar diferencial. El tipo de compromiso y Score fueron correlacionados con diagnóstico y sexo. Resultados: El 91 por ciento (96/106) de los estudios fueron anormales (62 por ciento varones), 52 (54 por ciento) con alteraciones bilaterales, más frecuentes en varones (p:0,019). El grupo ADV mostró principalmente (35 por ciento) un patrón mixto bilateral, el DPED uno unilateral focal (32 por ciento), el SBO uno unilateral difuso (33 por ciento), y la DBP uno normal (25 por ciento). Misceláneas y DPED presentaron los Score más altos (alteraciones severas), y DBP y SBO los más bajos. Conclusión: En esta población el SPP se altera en una alta proporción con algunas características diferenciales según sexo y etiología.

Rendimiento del SPECT talio 201: reposo redistribución para predecir viabilidad post infarto reciente del miocardio / Performance of thallium 201 rest redistribution SPECT to predict viability in recent myocardial infarction

Background: The detection of viability after acute myocardial infarction is primordial to select the most appropriate therapy, to decrease cardiac events and abnormal remodeling. Thallium201 SPECT is one of the radionuclide techniques used to detect viability. Aim: To evaluate the use of Thallium201 rest-redistribution SPECT to detect myocardial viability in reperfused patients after a recent myocardial infarction. Patients and methods: Forty one patients with up to of 24 days of evolution of a myocardial infarction were studied. All had angiographically demonstrated coronary artery disease and were subjected to a successful thrombolysis, angioplasty or bypass grafting. SPECT Thallium201 images were acquired at rest and after 4 h of redistribution. These results were compared with variations in wall motion score, studied at baseline and after 3 or 4 months with echocardiography. Results: The sensitivity of rest-redistribution Thallium201 SPECT, to predict recovery of wall motion was 91 percent when patient analysis was performed and 79 percent when segmental analysis was done in the culprit region. The figures for specificity were 56 and 73 percent respectively. Conclusions: Rest-distribution Thallium201 SPECT has an excellent sensitivity to predict myocardial viability in recent myocardial infarction. The data obtained in this study is similar to that reported for chronic coronary artery disease

Cintigrafía ósea trifásica con Tc-99mMDP en el diagnóstico y manejo de infecciones osteoarticulares agudas en niños / Three-phase bone cintigraphy with Tc-99mMDP in the diagnosis and management of acute osteoarticular infections in children

One of the most important causes of residual damage in skeleton is incompletely treated osteoarticular infections (OAI). Goal: to assess the value of emergency three-phase bone scan (3FBS) in the evaluation of OAI. Methods: Thirty-eight children were studied with 54 3FBS. Results: Global analysis: 76% of the cases were principally articular; staphylococcus germs and hip's affection were the common. Nine patients with preoperative scan were positive with 16 foci, 86% confirmed by surgery cultivate. Seven children had negative 3FBS without posterior clinical symptomatology; in 5 of them it was demonstrated soft tissue involvement with normal osteoblastic phase. In 14/17 cases evaluated after surgical intervention, there was a relation between the scan and the clinical course. In two of those cases, in the 3FBS a new location was found. Conclusion: 3FBS is a helpful tool in the diagnosis and assessment of acute OAI in pediatric population. A positive 3FBS is highly accurate for OAI and a negative one rules it out securely.

La principal causa de daño esquelético residual son las infecciones osteoarticulares (IOA) con un tratamiento inadecuado. Objetivo: Determinar el valor del cintigrama óseo trifásico (CO3F) de urgencia en la evaluación de IOA. Material y método: Se estudiaron 38 niños en quienes se efectuaron 54 CO3F. Resultados: Análisis Global: 76% de los casos fueron principalmente articulares; el germen más frecuente fue Staphylococcus y la articulación más afectada la cadera. Nueve pacientes con CO3F preoperatorio fueron positivos con 16 focos, 86% confirmados con cultivo quirúrgico. Siete niños tuvieron CO3F negativo sin sintomatología clínica posterior. En cinco casos el estudio fue negativo para compromiso osteoarticular, pero se demostró compromiso de partes blandas con fase osteoblástica normal. En 14 de 17 casos evaluados post-cirugía, hubo relación entre el CO3F y la evolución clínica, en dos de esos casos en el CO3F se encontró una nueva localización. Conclusión: El CO3F es una herramienta útil en el diagnóstico y evaluación de las IOA agudas en población pediátrica. Un CO3F positivo es altamente seguro de IOA y uno negativo lo descarta con certeza.

Tomografía SPECT con F18 fluorodeoxiglucosa en infarto reciente del miocardio: caso clínico / Fluorodexyglucose SPECT in recent myocardial infarction: clinical case

We report a 50-year-old woman with a recent myocardial infarction in whom a myocardial perfusion single photon emission computed tomography (SPECT) with Thallium201 was done simultaneously with a F18-fluordeoxyglucose (FDG) SPECT to study glucose metabolism. Myocardial infarction was located in the anteroseptal and apical regions and an echocardiography, done at the second day of evolution, showed a septo-apical hypokinesia. On the tenth day, a coronary angiography showed a critical lesion of the anterior descending coronary artery and an angioplasty with stent placement was performed on the next day. On the twelfth day, a resting, redistribution 201Tl SPECT to study viability and a FDG-SPECT with a dual head high-energy collimator camera were done. Images, acquired 45 min after injection, were analyzed visually. In anterior and medial apical sectors, discordance between flux and metabolism, considered a classical mismatch, was observed. Echocardiographic hypokinesia disappeared three month after revascularization

Inmunosenescencia: pruebas cutáneas de hipersensibilidad retardada en adultos mayores chilenos autovalentes / Immunosenescence: delayed cutaneous hypersensitivity test in free living chilean elderly individuals

Background: Delayed cutaneous hypersensitivity tests are a globally accepted test to assess cellular immunity in vivo. The quality and quantity of the response to these type of tests, varies in different populations. Aim: To study delayed cutaneous hypersensitivity in a group of healthy Chilean elders. Material and methods: Forty two elders (32 male), aged 60 to 76 years old were studied. Multitest-CMI(r) was applied in the left forearm. This test allows the subcutaneous administration of seven antigens and a glycerin control. Results were compared with those of a group of young adults studied by the authors. Results: Among males there was a mean of 2.7 ñ 1.4 positive responses compared with women, that had 1.7 ñ 1 positive responses (p= 0.016). The sum of response diameters was 4.2 ñ 1.5 and 3.6 ñ 1.9 mm in men and women respectively (p = NS). Compared to young adults, elderly women had a lower response to tetanus and diphtheria toxoids and men had a lower response to diphtheria and Proteus mirabilis. Conclusions: Elderly people have a less intense response to delayed cutaneous hypersensitivity tests than young adults. This response must be assessed in each population to account for regional variability

Caso de interés: resultado preliminar de proyecto Fondecyt F 18 flúordeoxiglucosa SPECT para evaluación de miocardio atontado y viabilidad en el infarto reciente / Preliminary results of FONDECYT project F18 fludeoxyglucose SPECT for stunnig myocardial evaluation and infarction viability

Es sabido que la primera causa de muerte en nuestro país es de origen cardiovascular, siendo el infarto agudo una de sus manifestaciones. Se ha demostrado que la presencia de viabilidad miocárdica en la zona infartada, se asocia a un mayor número de eventos coronarios, que disminuyen si se revasculariza, por otro lado la revascularización disminuye la remodelación y la dilatación ventricular izquierda. Entre las técnicas que más han evaluado la viabilidad miocárdica están: el PET F18 FDG. SPECT TI 201 reposo-redistribución y ecocardiografía con dobutamina. Son escasos los estudio que han evaluado viabilidad en el infarto reciente y en consideración a que en Chile no se ha desarrollado el estudio con positrones (PET o SPECT), se presentó un proyecto Fondecyt multiinstitucional, con el fin de implementar esta técnica. Se estudiaron un grupo de 60 pacientes con infarto agudo (con o sin revascularización precoz), con anatomía conocida (coronariografía), correlacionándola con el estudio clásico de Talio reposo-redistribución, evaluando cual de las dos técnicas puede predecir mejor la viabilidad, se considero como gold standar de tejido viable, la recuperación de la motilidad por ecocardiografía al 3er mes post infarto. En la siguiente presentación se muestran los resultados preliminares y un ejemplo de viabilidad en un infarto de un paciente de 23 años