The validity of salivary gland scintigraphy in Sjögren's syndrome diagnosis: comparison of visual and excretion fraction analyses.

OBJECTIVES: The diagnostic validity of salivary gland scintigraphy in Sjögren's syndrome (SS) has not been conclusively defined. Whether a quantitative (excretion fraction) interpretation of scintigraphy is superior to a qualitative one (visual analysis) remains a matter of debate. We sought to determine whether the diagnostic discrimination of excretion fraction is higher compared to that obtained by visual analysis. METHODS: Diagnostic test validity study that encompassed 137 suspected SS subjects who underwent scintigraphy for diagnostic purposes. Patients were diagnosed as SS and non-SS according to the rheumatologist's clinical judgment, and by using the American-European Consensus Group (AECG) and American College of Rheumatology (ACR) classification criteria. Visual analysis (normal vs. abnormal and Schall's classification grade) and excretion fraction scores were calculated. The diagnostic discrimination of these methods was compared through the area under the curve (AUC) analysis. Scintigraphy associations with SS clinical and laboratory features were assessed through multivariable regression analysis. RESULTS: Schall's classification AUC reached statistical significance in its diagnostic discrimination for SS clinical judgment (0.704 [95%CI 0.597-0.811]) and AECG criteria (0.764 [95%CI 0.641-0.886]). Similarly, submandibular excretion fraction was associated with SS diagnosis based on ACR (0.737 [95%CI 0.546-0.931]) and AECG criteria (0.715 [95%CI 0.597-0.833]). However, AUC comparisons between qualitative and quantitative methods did not yield statistically significant values. Both interpretation modalities were associated with SS serological features. Moreover, excretion fraction was also associated with salivary gland biopsy. CONCLUSIONS: SS diagnostic discrimination of excretion fraction is not superior to that obtained by qualitative visual analysis. Both qualitative and quantitative scintigraphy methods are associated with SS clinical and laboratory characteristics.

Value of the bone scintigraphy in multiple osteochrondromatosis with sarcomatous degeneration.

Multiple osteochondromatosis can become malignant in 20% of the cases, this being more common when the lesion is multiple than when it is solitary. A male patient with multiple osteochondromatosis who had several local recurrences of secondary chondrosarcoma and who is still under follow-up by the Nuclear Medicine Department is presented. The bone scintigraphy findings were compared with the histopathologic results, and the importance of the patient's symptoms was verified when a sarcomatous transformation is suspected. The bone scintigraphy has the potential to detect malignization of the benign bone lesions. It also makes it possible to obtain whole-body images in a single examination, this being very useful to detect the presence of new bone lesions.

Valor de la gammagrafía ósea en la osteocondromatosis múltiple con degeneración sarcomatosa / Value of the bone scintigraphy in multiple osteochrondromatosis with sarcomatous degeneration

La osteocondromatosis múltiple puede malignizar hasta en un 20% de los casos, siendo mucho más frecuente que cuando la lesión es solitaria. Presentamos el caso de un paciente con osteocondromatosis múltiple que ha presentado varias recidivas locales de un condrosarcoma secundario en años sucesivos y que sigue controles gammagráficos en nuestro servicio. Los hallazgos de la gammagrafía ósea se compararon con los resultados anatomopatológicos y se comprobó la importancia de la sintomatología del paciente ante la sospecha de transformación sarcomatosa. La gammagrafía ósea puede aportar datos sobre la posible malignización de las lesiones benignas y permite obtener imágenes de cuerpo completo en una sola exploración, siendo muy útil ante la aparición de nuevas lesiones(AU)

Multiple osteochondromatosis can become malignant in 20% of the cases, this being more common when the lesion is multiple than when it is solitary. A male patient with multiple osteochondromatosis who had several local recurrences of secondary chondrosarcoma and who is still under follow-up by the Nuclear Medicine Department is presented. The bone scintigraphy findings were compared with the histopathologic results, and the importance of the patient‘s symptoms was verified when a sarcomatous transformation is suspected. The bone scintigraphy has the potential to detect malignization of the benign bone lesions. It also makes it possible to obtain whole-body images in a single examination, this being very useful to detect the presence of new bone lesions(AU)

Effects of 5-azacytidine on lymphocyte-metaphases of Creole cows carrying the rob(1;29).

The Robertsonian translocation rob(1;29) is the most important chromosomal abnormality in cattle. It has been demonstrated that carriers of this chromosomal alteration exhibit reduced fertility due to an early embryonic loss. In the present study we analyzed the effects of DNA methylation inhibitor 5-azacytidine (5-aza-C) on metaphase lymphocytes from Uruguayan Creole cows carrying the rob(1;29). The analysis was focused on the chromatin structure of rob(1;29) comparing it to active and inactive BTAX chromosomes. Lymphocyte cultures were treated with 5-aza-C (1 x 10(-3)M) for 2 h to analyze regions of chromatin decondensation. A comparative analysis of chromatin decondensation among rob(1;29), active BTAX and inactive BTAX showed significant differences (p=1.07 x 10(-7)). Post-hoc pair-wise comparisons using the Mann-Whitney U-test showed significant differences between rob(1;29) and active BTAX (p=1.97 x 10(-5)) and between the active BTAX and inactive BTAX (p=2.55 x 10(-7)). Nevertheless, rob(1;29) did not show significant differences when compared to inactive BTAX (p=0.078). Robertsonian translocation rob(1;29) showed a despiralization pattern similar to the inactive X chromosome. Pericentromeric despiralization in rob(1;29) and the inactive X chromosome was similar, with an average value and standard error of 0.75+/-0.11 and 0.75+/-0.083, respectively. A single condensed region was observed in the inactive X chromosome, whereas in rob(1;29) two regions of condensation, one proximal to the centromere and another proximal to the telomere were detected. Our results show that rob(1;29) and the inactive X chromosome present instability regions susceptible to 5-aza-C. Further studies will be needed to understand the nature and expression pattern of genes located in chromatin condensed regions of rob(1;29).

Recambio plasmático terapéutico en enfermedades neurológicas pediátricas / Therapeutic plasma exchange in pediatric neurological diseases

El recambio plasmático terapéutico (RPT) es un procedimiento utilizado en el tratamiento de distintas patologías, especialmente las de etiología autoinmune. La base fisiopatológica del RPT consiste en la eliminación de mediadores inflamatorios a través de la extracción de un volumen variable de plasma del paciente y su sustitución por una solución de reposición, usualmente albúmina al 5%; utilizando separadores celulares. Objetivo: analizar la experiencia de nuestra institución en el tratamiento con RPT de pacientes con enfermedades neurológicas. Material y métodos: estudio retrospectivo, descriptivo sobre una población de 43 pacientes con enfermedad neurológica (Miastenia Gravis, Guillain Barré, Enfermedad de Devic, Encefalomielitis diseminada aguda, Polineuropatía desmielinizante inflamatoria crónica y Encefalitis de Rasmussen), tratados con una serie de RPT entre junio 1994 y junio 2009. Resultados: se pudieron evaluar 38 pacientes, por falta de información sobre los 5 restantes, observándose alguna mejoría del cuadro clínico en el 79% de los mismos. En 68% de los RPT se observó una o más complicaciones (hipocalcemia, hipotensión, parestesias). Conclusiones: en nuestra experiencia el recambio plasmático terapéutico constituye un tratamiento efectivo para las enfermedades neurológicas en las que fenómenos autoinmunes juegan un rol importante en la patogénesis, incluso en aquellas con un bajo nivel de evidencia clínica según la categorización de indicaciones de la ASFA.

Therapuetica plasma exchange (TPE) is a procedure used for the treatment of different diseases, especially those of autoimmune etiology. The pathophysiological basis of the TPE is the removal of inflammatory mediators through the extraction of a variable volume of patient plasma and its replacement by a solution, usually albumin 5%, using cell separators. objective: to analyze our institution's experience in the TPE treatment of patients with neurological diseases. Material and methods: a retrospective, descriptive study of a population of 43 patients with neurological disease ( Myasthenia Gravis, Guillain Barre syndrome, Devic's disease, Acute demyelinating polyneuropathy, Rasmussen's encephalitis) treated with a series of TPE between june 1994 and june 2009. Results: 38 patients were able to assess, for lack of information on the remaining 5. We observed some clinical improvement in 79% of them. In 68% of the TPE one or more complications (hypocalcemia, hypotension, paresthesias) were observed. Conclusions: in our experience the therapeutic plasma exchange is an effective treatment for neurological diseases in which autoimmune phenomena play an important role in pathogenesis, even in those with low levels of clinical evidence according to the categorization of indications of the ASFA.

[SAPHO syndrome. Scintigraphic and radiologic findings]. / Síndrome de SAPHO. Hallazgos gammagráficos y radiológicos.

We present the case of a 39 year old woman with a several year long history of palmoplantar pustulosis and occasional pain in the anterior wall of the thorax, lumbar spine and both sacroiliac joints. As a consequence of low grade fever, severe sternoclavicular pain and discomfort and swelling in the first left rib arches, the patient was admitted to hospital. Based on the clinical, radiologic, scintigraphic and cutaneous findings, the SAPHO syndrome was diagnosed. Bone scintigraphy is an accurate and early diagnostic test for this syndrome which also provides the advantage of being able to obtain a whole body scan.

[Complete section of the choledochus caused by non-penetrating trauma of the abdomen. Use of minimal catheter jejunostomy]. / Sección completa del colédoco por traumatismo no penetrante de abdomen. Utilización de la yeyunostomía mínima a catéter (YMC).

A case is presented of complete section of the choledochus as the sole lesion in closed abdominal trauma. A study is made of the difficulties of an early diagnosis of this pathology, as well as techniques for intraoperative localization and repair. Emphasis is placed on the use of peritoneal lavage as a preoperative diagnostic method and Tc99m HIDA scintigraphy of the biliary tract. The surgical technique is reviewed, assuming that the most physiological and anatomic procedure is end-to-end choledochoduodenostomy using reabsorbable sutures. We recommend the use of minimal transcatheter jejunostomy (YMC) as a method for immediate replacement of bile juice and inhibition of secretion, as well as the possibility of postoperative physiological nutrition using this approach.

[Colonic lesion caused by acute pancreatitis. Use of minimal catheter jejunostomy. Apropos of 6 cases]. / Afectación colónica por pancreatitis aguda. Utilización de la yeyunostomía mínima a catéter. A propósito de seis casos.

Colonic affectation in the context of acute pancreatitis is undoubtedly a rare complication to judge from the number of cases reported in the literature, but its appearance is increasing, perhaps because it is receiving more attention. The "infrequent" complications of so-called acute pancreatitis range from massive necrosis of the colon to fistula of the transverse colon, colonic stricture as a chronic manifestation and finally, colonic varices as a sign of segmental portal hypertension due to involvement of the mesenteric portal axis. A retrospective study was made of 6 cases treated in our General and Digestive Surgery Department and the literature on this etiopathogenic situation was reviewed to study the clinical manifestations, diagnosis and treatment of these uncommon complications. We propose minimal catheter jejunostomy as a technique for the prevention and treatment of possible complications, with epidural analgesia of these patients.

[Physicochemical properties of an extracellular polysaccharide isolated from culture media of Bacillus amyloliquefaciens]. / Propriétés physicochimiques d'un polysaccharide extra-cellulaire isolé des moûts de fermentation de Bacillus amyloliquefaciens.

A new extracellular polysaccharide has been isolated by chromatography on anion exchanger of a fraction obtained from highly viscous culture media of Bacillus amyloliquefaciens. This polysaccharide is characterised by high molecular weight (1,000,000 dalton) and intrinsic viscosity (323 ml/g). It contains 24% neutral sugar (galactose and mannose 5:1), 35% glucuronic acid and 51.5% N-acetylhexosamines (N-actylglucosamine, N-acetylgalactosamine and N-acetylbacillosamine 6:9:1).