Cintigrafía tiroídea (CT) con Tc99m-pertecnectato en recién nacidos (RN) con hipotiroidismo congénito (HC) / Tc99m-pertechnetate thyroid scintigraphy in newborns with congenital hypothyroidism

Background: Congenital hypothyroidism is one of the most frequent endocrine diseases of the newborn and requires an early diagnosis to avoid its deleterious effects on neurological and intellectual functions. Aim: To evaluate thyroid scintigraphy (TS) findings in newborns with congenital hypothyroidism (CH), detected in the national program of newborn screening, which is working in Chile since 1992. Material and methods : TS findings of 189 newborns with CH (68 percent female) were analyzed. Tc99m pertechnetate TS was performed at 19 ñ 11 days of life. The gland was classified as eutopic, ectopic or absence of contrast (AC). Eutopic glands were classified by visual and quantitative criteria as: normal, goiter and decreased contrast (DC). TS results were compared by gender and hormonal levels. Results: Forty seven percent of newborns had ectopy, 29.1 percent eutopy and 24.3 percent AC. Eutopic gland predominated in males (44.2 percent vs 22.7 percent) and ectopy was more frequent in girls (53.1 percent vs 32.8 percent, p <0.05). Newborns with AC had the most severe hormonal alterations, without gender differences. Newborns with normal TS had less hormonal alterations than those with goiter. Conclusions: TS allows an etiological classification of CH. Thyroid dysgenesis is the most frequent cause, most of which correspond to ectopy, especially in girls. Eutopic glands are present in one third of newborns with CH. Goiter predominates, especially in males

Hipertensión renovascular: caso clínico / Renal vascular hypertension: clinical case

Se presenta un caso de hipertensión secundaria de causa renovascular, detectado en una mujer diabética de 74 años con historia de hipertensión severa de 28 años de evolución conocida, acentuada en los últimos 3 meses. En el caso analizado, la arteriografía renal fue normal pero el cintigrama demostró la existencia de isquemia renal bilateral frente al uso de captopril. Debe recordarse que a pesar de que la arteriografía es el "gold standar"para el diagnóstico de la hipertensión renovascular, su sensibilidad no es 100 por ciento, especialmente en los casos en que existe enfermedad de pequeños vasos. Dentro del estudio de esta paciente hubiese sido ideal realizar un exámen con ecografía Doppler, el que, asociado al cintigrama, aumenta el rendimiento diagnóstico en los casos de hipertensión por estenosis de los vasos intrarrenales. Se aprovecha el caso para analizar brevemente el diagnóstico de la hipertensión renovascular: sospecha clínica; exámenes de laboratorio; imágenes y estudio funcionales. Desde el punto de vista terapéutico, el tratamiento quirúrgico es el más indicado en las estenosis ateroescleróticas de la arteria renal y la angioplastía en las de naturaleza fibromuscular

Utilidad de la cintigrafía de glándulas salivales en el síndrome de Sjogren y su relación con el resultado de la biopsia de labio: estudio comparativo con una población control / Salivary gland scintigraphy and lip biopsy in patients with Sjogren syndrome and normal controls

Background: Salivary gland scintigraphy allows a non invasive, morphological and functional assessment of parotid and submaxillary salivary glands. Aim: To describe the main features of salivary gland scintigraphy in patients with Sjögren syndrome, rheumatic fibromyalgia and normal controls and compare the results with lip biopsy. Patients and methods: Sixty one normal controls, 66 patients with Sjögren syndrome and 18 patients with rheumatic fibromyalgia were studied. For the diagnosis of Sjögren syndrome and fibromyalgia rheumatica, the Modified European and American College of Rheumatology criteria were used, respectively. Lip biopsies were obtained in 52 patients with Sjögren syndrome. Scintigraphy was done with a gamma camera and computer after the administration of 99mTc-pertechnetate, obtaining images during 30 min and creating time/activity curves. Scintigraphy was classified as normal, with mild or severe alterations. Results: Scintigraphy was normal in 74 percent of control subjects and in 26 percent, it had mild alterations. In 72 percent of patients with rheumatic fibromyalgia, scintigraphy was normal whereas in 28 percent, it had mild alterations. In 27 percent of patients with Sjögren syndrome, scintigraphy was normal, in 27 percent it had mild alterations and in 46 percent, severe alterations. There was a positive and significant correlation between pathological alterations of salivary glands and scintigraphic alterations (r=0.642, p < 0.001). Conclusions: Severe scintigraphic alterations of salivary glands strongly support the diagnosis of Sjögren syndrome. Mild alterations are non specific and anormal scintigraphy does not exclude the diagnosis

Resultados del cintigrama óseo en 37 pacientes pediátricos con síndrome febril prolongado: evaluación retrospectiva / Bone scintigraphy in pediatric patients with prolonged febrile syndrome: a retrospective evaluation

El objetivo del trabajo es describir los resultados del cintigrama óseo en niños con síndrome febril prolongado y correlacionarlos con aspectos clínicos y con otros estudios de imagen. Para ello, se revisan los cintigramas óseos de 37 niños con síndrome febril prolongado correlacionando sus resultados con la ocurrencia de dolor óseo y las informaciones proporcionadas por otros exámenes de imagen. Los pacientes fueron separados en grupos según la etiología del cuadro febril. El cintigrama óseo resultó positivo en 21,6 por ciento de los pacientes, de los cuales 75 por ciento eran de causa infecciosa. La mitad de las lesiones cintigráficas detectadas fueron indoloras y en el 80 por ciento de ellas el estudio radiográfico contemporáneo fue negativo. En 56,8 por ciento de los pacientes la etiología de la fiebre fue infecciosa, y en 24,3 por ciento de ellos la causa no fue aclarada. Se concluye que el cintigrama óseo es una valiosa herramienta en el estudio de niños con síndrome febril prolongado siendo, en el grupo estudiado, la manera más sensible de detección de focos óseos en forma precoz

Cintigrafía ósea en pacientes con cáncer de próstata: correlación con aspectos clínicos, de laboratorio y sobrevida / Bone scintigraphy in prostate cancer: correlation with clinical and laboratory features and with survival

Background: The yield of bone scintigraphy is specially good in some types of neoplasia such as mammary and prostate carcinoma, whose metastases cause a marked osteoblastic reaction in bone. Aim: To assess the usefulness of bone scintigraphy in patients with prostate carcinoma. Patients and methods: A retrospective analysis of bone scintigrams performed to 79 patients with prostate carcinoma aged 56 to 83 years old, describing their relationship with prostate specific antigen and bone pain. The predictive value of bone scan, prostate specific antigen and clinical variables was analyzed using Kaplan Meier survival tables. Results: Scintigraphy disclosed bone metastases in 22 patients (28 percent). The most frequently involved zones were pelvis (86 percent), rib cage (67 percent) and spine (57 percent). The association with pain was low specially for limbs, rib cage and skull. The better efficacy of prostate specific antigen for the prediction of bone metastases was obtained with a cutoff value of 50 ng/ml (sensitivity 72 percent, specificity 86 percent). With a cutoff value of 10 ng/ml, the negative predictive value was 100 percent. The only significant predictor of a lower patient survival was the presence of bone metastases on bone scintigraphy. Conclusions: In this series of patients, bone scintigraphy was an excellent diagnostic tool for bone metastases and had a survival prognostic value