Pulmonary manifestations in systemic lupus erythematosus (SLE) with special reference to HR CT.

AIMS AND OBJECTIVES: 1. To evaluate whether CT helps in the early diagnosis of pulmonary manifestations in SLE. 2. To study the pulmonary involvement and determine the incidence and type of pulmonary involvement. MATERIALS AND METHODS: Thirty eight patients fulfilling ACR classification criteria for SLE were studied. Chest X-ray, pulmonary function tests (PFT), HRCT scan thorax were done. Investigations were done to detect other organ involvement. Patients with known interstitial lung disease (occupational hazard) or pregnant females were excluded. RESULTS: Clinical signs and symptoms referable to pulmonary involvement were present in 9 patients (23.68%). HRCT thorax detected abnormalities in 21 patients (55.26%); pulmonary function abnormalities were present in 11 patients (28.95%) and plain X-ray chest abnormalities were present in 7 patients (18.42%). Out of 38 patients pulmonary involvement was present in 22 (57.89%) cases and HRCT thorax findings were present in 21 (95.45%) of them. CONCLUSION: Pulmonary involvement is present in a significant number of SLE patients, who are often asymptomatic, with normal chest X-ray or normal PFT. HRCT scan thorax could diagnose the pulmonary involvement in asymptomatic patients with normal chest X-ray and uncertain PFT.

PET/CT: state of the art and future prospects

Many papers have demonstrated both the relevant impact of positron emission tomography (PET) on staging of many cancers, and the superior accuracy of the technique compared with conventional diagnostic methods for pre-treatment evaluation, therapy response evaluation, and relapse identification. But, PET/CT is a new imaging modality that integrates functional (PET) and structural (CT) information into a single scanning session, thus improving lesion localization and interpretation accuracy. PET/CT fusion images result in higher diagnostic accuracy with fewer equivocal findings. With attenuation correction performed by the CT component, PET/CT can provide higher quality images over shorter examination times than conventional PET. PET/CT is currently the most advanced technique of metabolic imaging and the most accurate tool for tumor staging in the pretreatment, post-treatment and follow-up phases. Although PET/CT offers many advantages, this dual-modality imaging also poses some challenges such as misregistration due to respiration, overattenuation correction due to metals, etc.

Tratamiento neuroquirúrgico del hematoma extradural en el Hospital Clínico Regional de Antofagasta / Neurosurgical treatment of extradural hematoma in the Regional Hospital Clinic of Antofagasta, Chile

An analysis was made on processes of emergency attention, diagnosis, and neurosurgical treatment of patients with encephalocranial trauma complicated by extradural hematoma of patients entering the Neurosurgical and Neurological Service of the Regional Hospital Clinic of Antofagasta between 1999 and 2002. The causes of this injury included falls (four cases), traffic accidents (four cases) and head impacts (four cases). Of 12 patients submitted to surgery, all were male with ages between 15 and 47 years of age. Most of the injuries were frontal or temporal. Among the signs and symptoms the most frequent was impaired consciousness. A total of 83 percent of the patients required attention outside of normal working hours, and thus the wait between emergency treatment and neurosurgery was 7.34 hours. Computed axial tomography (CAT) was indicated as the diagnostic method of choice for this injury. There were no sequelae in 75 percent of the cases, while anosmia (17 percent) was the most relevant sequela. Mortality occurred in only case, and evolutional complications presented in three cases of the group studied. Recommendations are made for the optimization of the process of attention to these patients in a regional assistence network.

Se analizan los procesos de atención de urgencia, diagnóstico y tratamiento neuroquirúrgico de pacientes portadores de un traumatismo encefalocraneano complicado por un hematoma extradural que ingresaron al Servicio de Neurocirugía y Neurología del Hospital Clínico Regional de Antofagasta entre 1999 y 2002. Las causas del TEC fueron caídas (4 casos), accidente del tránsito (4 casos) e impacto craneano (4 casos). De 12 pacientes sometidos a cirugía, todos eran del sexo masculino, con edades entre 15 y 47 años. La mayoría de los HED fueron de localización frontal o temporal. Entre los signos y síntomas, el de mayor frecuencia fue el compromiso de conciencia. En el 83 por ciento de los pacientes la atención se realizó en horario no hábil, en tanto que el tiempo promedio de espera entre la hora de atención de urgencia y la intervención neuroquirúrgica fue de 7,34 horas. Se señala la tomografía axial computarizada (TAC) como el procedimiento diagnóstico de elección en el HED. El 75 por ciento de los casos no presentó secuelas, mientras que la anosmia (17 por ciento) fue la secuela más relevante. La mortalidad fue de un sólo caso y complicaciones evolutivas se observaron en 3 de los casos de esta serie. Se hacen recomendaciones a fin de optimizar el proceso de atención de este tipo de pacientes a nivel de la red asistencial regional.

Principios y aplicaciones de la tomografía por emisión de positrones (PET) en la cardiologÝa. PET en MÚxico: una realidad / Principles and applications of positron emission tomography (PET) in cardiology. PET in Mexico: a reality

Positron emission tomography (PET) offers the unique capability of measuring non-invasive by the regional myocardial substrate flow and the biochemical reaction index in millimol per minute per gram of myocardial tissue. PET also allows for the assessment or quantification of regional myocardial blood flow, cardiac metabolism, ventricular function, myocardial viability, as well as autonomous nervous system, research and evaluating of dilated myocardiopathy and of ventricular hypertrophy. PET's success is based on the radioisotopes properties, their very short half-life allows for the administration of large doses.

Inovações e trajetórias tecnológicas no território das imagens médicas / Technological inovations in the medical imaging area

O campo das imagens médicas é uma das áreas da medicina onde o desenvolvimento e a incorporação de novas tecnologias à prática clínica e aos sistemas de saúde têm sido particularmente significativo. Essa tese tem por objeto o estudo do progresso técnico relacionado a três tecnologias de imagem introduzidas no cuidado à saúde nos últimos trinta anos: a tomografia computadorizada, a imagem por ressonância magnética e a tomografia por emissão de pósitrons. Sua proposta foi caracterizar a trajetória de desenvolvimento destas tecnologias de imagem, buscando reconhecer os diferentes fatores e mecanismos envolvidos na dinâmica deste processo. Para tal, utilizou-se de um conjunto de ferramentas oriundas do campo da economia da inovação - os conceitos de paradigma e trajetória tecnológica, de design dominante e de sistemas tecnológicos - que trabalham com a visão de multideterminação do desenvolvimento tecnológico, reconhecendo as inter-relações entre vários condicionantes como o progresso científico, as necessidades clínicas, o mercado e as políticas públicas. O conhecimento dos fatores e mecanismos intervenientes no desenvolvimento dessas tecnologias traz elementos que permitem uma melhor compreensão do processo de inovação tecnológica no setor de imagens. Elas podem auxiliar na avaliação de propostas de intervenção e na formulação de políticas referentes a estes equipamentos, seja no que diz respeito a políticas industriais, seja no que se refere a decisões internas ao sistema de saúde relacionadas com o acesso, uso e financiamento destas tecnologias e procedimentos.

Xerostomia: gama-câmara computadorizada no diagnóstico e avaliaçäo do tratamento: relato de caso / Xerostomia: computerized gamma-camera in the diagnosis and evaluation of treatment: case report

Uma mulher, com 36 anos, branca, casada, é portadora de xerostomia há 4 anos. Relatou que há 7 anos teve episódio de parotidite epidêmica e recentemente lhe surgiu um nódulo de cerca de 4 cm no pólo inferior da parótida esquerda. Realizou-se exame de fluxo sangüíneo regional, com obtençäo de imagens dinâmicas e estáticas em gama-câmara computadorizada ("GCC") após administraçäo intravenosa de pertecnetato radiativo de sódio (Na99mTC) como traçador. A perfusäo das glândulas salivares foi normal, sendo um pouco aumentada na regiäo do nódulo; as imagens estáticas mostraram ausência de capacidade de concentraçäo do traçador. A doente foi tratada com sucos cítricos, massagens locais, manuais e com auxílio de vibrador, e betametasona em formulaçäo de liberaçäo lenta ( 5 mg/ampola, 1 ampola cada 3 dias durante 21 dias). Após esse tempo, notou-se, em novo exame, que o nódulo havia desaparecido e já havia razoável concentraçäo do traçador nas glândulas salivares. O diagnóstico clínico foi de processo inflamatório crônico das glândulas salivares. O resultado do tratamento instituído nessa 3 semanas foi considerado excelente