Terapia metabólica / Metabolic therapy

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Controversias en el seguimiento del carcinoma diferenciado de tiroides. Nuevas respuestas a viejas cuestiones / Controversies in the follow-up and management of well-differentiated thyroid cancer. New answers to old questions

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Calidad ¿únicamente una moda? / Quality only a fashion?

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[Gastric uptake of gallium67 in the human immunodeficiency virus infection]. / Captación gástrica de Galio67 en la infección por virus de la inmunodeficiencia humana.

Nowadays, the human immunodeficiency virus infection (HIV) is a chronic disease. In the frequent clinical situations with fever, lymph nodes and loss weight it is necessary to determine their etiology, for establishing a specific treatment. Gastrointestinal opportunistic infections or gastric lymphomatous or sarcomatous process, which can accumulate Ga67, may be present in the patient with acquired immunodeficiency syndrome. We report 2 cases with gastric uptake in which endoscopy and biopsy was obtained. In the first one, with previous treatment with omeprazol and almalgate for gastroesophagic reflux, endoscopy and biopsy were normal and in the second patient an Helicobacter pylori infection was diagnosed. We think that gastric uptake of Ga67 in HIV patients, must indicate to the clinician to rule out associated pathologies.

[Histological prediction of cerebral tumors using SPECT with 201T1]. / Predicción histológica de los tumores cerebrales mediante SPECT con 201T1.

INTRODUCTION AND OBJECTIVE: SPECT with 201Tl provides information regarding the degree of malignancy of cerebral tumours, their possible relapses, the differentiation of necrotic tissue in the tumours following chemotherapy or radiotherapy and permits differentiation into zones of various grades of histological malignancy. MATERIAL AND METHODS: We carried out a prospective analysis of the usefulness of SPECT with 201Tl for the histological prognosis of cerebral tumours. For one year 68 patients diagnosed (on CT and/or MR) as having an expansive cerebral lesion were studied. The early uptake (ICP) and retention (R) indices were calculated, and these results correlated with the morbid anatomy (AP) findings and the results obtained with surgery and stereotactic biopsy. Four patients were excluded due to lack of AP results. RESULTS: Significant differences were found between the ICP of grade I-II astrocytomas (1.34 +/- 0.52) and glioblastomas multiformes (2.56 +/- 0.57), between the ICP of meningiomas (4.53 +/- 1.68) and metastases (2.45 +/- 0.58) and between those of meningiomas and all glial tumours. With regard to IR, we saw significant differences between the figures for meningiomas (0.63 +/- 0.13) and meningiomas with malignant relapses (0.94 +/- 0.17) and between metastases (0.8 +/- 0.03) and all glial tumours. CONCLUSIONS: From our study, it may be concluded that rapid, high captation of 201Tl (high ICP) with a slow fall (high IR), is associated with a process showing malignancy on histological study (malignant relapse of meningioma, glioblastoma multiforme, metastasis), whilst high take-up (high ICP) with rapid elimination (low IR) corresponds to a benign hypervascularized tumour (meningioma).

Transthoracic aspiration biopsy of pulmonary and mediastinal lesions.

Thoracic aspiration biopsy (TAB) constitutes a useful technique in establishing a diagnosis in diseases of the lungs and mediastinum. Results obtained from 1046 fluoroscopically-guided TABs are presented with review of the most important aspects of the technique. Diagnostic accuracy in malignancy detection was 93.8% in lung lesions (n = 984) and 74.5% in mediastinal lesions (n = 62). Sensitivity was higher in peripheral than in central lesions (96% vs. 87%, respectively). Specificity was 100% in both groups. Sensitivity in lesions smaller than 2 cm was 70% and 94% in larger lesions. Aspiration biopsies performed with Chiba and Franseen needles showed a similar sensitivity (95%) higher than with other types of needles. A pneumothorax developed in 138 patients (13.2%). Only eight of these required the use of an endothoracic tube (0.8% of all biopsies).

[Circadian rhythms of cortisol and insulin in nutritional obesity in children]. / Estudio de ritmos circadianos de cortisol e insulina en la obesidad nutricional infantil.

It have been studied 90 children (obese 73, non obese or control 17), trying to analyze the following parameters: mean and standard deviation values, its circadian rhythms and relation between cortisol and insulin, correlation between both hormones and anthropometric parameters of obesity and sexual influence with all the studied parameters. The plasmatic cortisol values were higher in male, obese (180.4 +/- 11.2 ng/ml) and control (377.5 +/- 49.2 ng/ml) children. The plasmatic insulin values higher in obese children (55.3 +/- 9.5 microU/ml) verifying the hyperinsulinemia observed in obesity. There was not correlation between cortisol and insulin values with body fat. All the children showed cortisol and insulin circadian rythm. In the groups of obese children the cortisol circadian rythm was similar to the control one. However, the insulin circadian rythm was disturb. So, the acrophase was delayed two hours when male and female were analyzed all together and only one hour in the obese female group. The acrophase of cortisol and insulin rhythms in obese group is delayed in relation with the degree of obesity. The circadian rhythms of cortisol and insulin, in both obese and control groups, are not dependent. The duration of obesity do not have any relation with the mentioned alterations.

[Intravenous brain angioscintigraphy and brain death (author's transl)]. / Muerte cerebral en niños. Valor diagnóstico de la angiogammagrafía cerebral intravenosa y de las imágenes precoces.

Intravenous brain angioscintigraphy in combination with immediate static scan are very useful as a complement to the clinical and electroencephalographic data in diagnosis of brain death. Confusion in the differentiation of extracerebral from intracerebral flow on the dynamic radionuclide angiogram can be accomplished by identifying presence or absence of uptake in cerebral sinuses. Authors consider that the radionuclide study should be carried out in posterior view. Exploration is safe, quick to perform and easy to interpret and it enables to distinguish brain death from comas due to drug intoxication.

Renal uptake of 67Ga-citrate in renal amyloidosis due to familiar Mediterranean fever.

Renal uptake of 67Ga-citrate is described in a patient with biopsy-proven amyloidosis of the kidneys, due to Familiar Mediterranean Fever. After administration 150 MBq (4 mCi) 67Ga-citrate, scans were done at 48, 72, and 120 h. Intense uptake was noted in both kidneys. A renal biopsy done 5 days after the 67Ga-citrate scan revealed a pattern typical of amyloidosis. Gallium scanning can be useful in patients with fever of unknown origin. Renal amyloidosis can be considered when renal uptake of 67Ga-citrate associated with nephrotic syndrome is observed.

[DTPA-99mTc in pediatric renal disease (author's transl)]. / Utilidad del DTPA-Sn 99mTc en patología renal pediátrica.

99MTc is an ideal nuclide for Pediatric use. Combined with DTPA is an adequate agent for renal studies. 15 patients with ages ranging from eight days to eleven years were studied (10 patients with congenital malformation and five with renal tumour). The dosimetric advantages, the obtention with a single nuclide dose of multiple images and the diagnostic usefulness in congenital malformation and renal tumour suggest their use.

Value of the brain angioscintigraphy in posterior view.

The results obtained with intravenous brain angioscintigraphy (IBAS) with 99 mTc-DTPA(Sn) are evaluated in 61 patients with clinical suspicion of cerebellar, cerebral or cranial lesions of posterior location or without focal signs or with a previous IBAS in anterior view being normal or of low significance. One hundred patients without demonstrable cerebral or cranial pathology were explored to define the normal characteristics and variation of the IBAS in posteior view. Of the 61 patients with pathology, 45 showed angioscintigraphic alterations. The following angioscintigraphic patterns were found: 1. Perfusion increased, 2. Perfusion diminished, 3. Flip-flop, 4. Mixed pattern, 5. Circulatory arrest, 6. Jugular venous reflux, 7. Normal IBAS associated with an abnormal morphologicall study, 8. Normal IBAS associated with a normal morphological study.