Incidental Diagnosis of Metastatic Breast Cancer in a Man With 99m Tc-PSMA SPECT/CT.

ABSTRACT: Breast cancer in men is a rare and unsuspected malignancy. A 48-year-old man begins with disabling low back pain. The CT scan reported a compression fracture in L2 and diffuse skeletal lesions suggestive of metastatic disease. The serum prostate-specific antigen was 6.2 ng/mL. He was referred for SPECT/CT with 99m Tc-EDDA/HYNIC-inhibitor prostate-specific membrane antigen due to clinical suspicion of prostate cancer. SPECT/CT with 99m Tc-EDDA/HYNIC-inhibitor prostate-specific membrane antigen showed a primary lesion in the left breast and multiple bone lesions. Biopsy confirmed infiltrating ductal carcinoma with positive hormone receptors and indeterminate HER2 (human epidermal growth factor receptor 2).

Diagnosis of Traumatic Bronchobiliary Fistula With Late 99m Tc-Mebrofenin SPECT/CT.

ABSTRACT: Bronchobiliary fistula (BBF) represents a rare disorder; it consists of abnormal interconnection between the biliary tract and bronchial trees. A 22-year-old woman with persistent chest pain, jaundice, and biliptysis was referred for hepatobiliary scintigraphy under clinical suspicion of a BBF. Patient medical history was consistent with biliary tree reconstruction secondary to an iatrogenic injury during cholecystectomy 4 years ago. Previous complementary studies (CT and MR cholangiopancreatography) were equivocal for diagnosis. Planar dynamic images of hepatobiliary scintigraphy in the first hour were inconclusive. A 24-hour SPECT/CT was performed and confirmed the BBF in a minimally invasive way.

Burnout, depersonalization, and anxiety contribute to post-traumatic stress in frontline health workers at COVID-19 patient care, a follow-up study.

INTRODUCTION: We designed a follow-up study of frontline health workers at COVID-19 patient care, within the same working conditions, to assess the influence of their general characteristics and pre-existing anxiety/depression/dissociative symptoms and resilience on the development of symptoms of post-traumatic stress disorder (PTSD), while monitoring their quality of sleep, depersonalization/derealization symptoms, acute stress, state anxiety, and burnout. METHODS: In a Hospital reconfigured to address the surge of patients with COVID-19, 204 frontline health workers accepted to participate. They completed validated questionnaires to assess mental health: before, during, and after the peak of inpatient admissions. After each evaluation, a psychiatrist reviewed the questionnaires, using the accepted criteria for each instrument. Correlations were assessed using multivariable and multivariate analyses, with a significance level of .05. RESULTS: Compared to men, women reporting pre-existing anxiety were more prone to acute stress; and younger age was related to both pre-existent common psychological symptoms and less resilience. Overall the evaluations, sleep quality was bad on the majority of participants, with an increase during the epidemic crisis, while persistent burnout had influence on state anxiety, acute stress, and symptoms of depersonalization/derealization. PTSD symptoms were related to pre-existent anxiety/depression and dissociative symptoms, as well as to acute stress and acute anxiety, and negatively related to resilience. CONCLUSIONS: Pre-existent anxiety/depression, dissociative symptoms, and coexisting acute anxiety and acute stress contribute to PTSD symptoms. During an infectious outbreak, psychological screening could provide valuable information to prevent or mitigate against adverse psychological reactions by frontline healthcare workers caring for patients.

[Standardization of gastric emptying scintigraphy with egg white labeled with 99mTc-sulfur colloid]. / Estandarización de la gammagrafía de vaciamiento gástrico con albúmina de huevo marcada con 99mTc sulfuro coloidal.

BACKGROUND: Gastric emptying scintigraphy has become the gold standard, by excellence, in gastric emptying studies. This method must be standardized for the correct interpretation of results. The ideal protocol must be performed with an egg sandwich or egg white poder, both labeled with 99mTc sulphur colloid. The aim of this study was to standardize and determine the protocol with99m Tc sulphur colloid incorporated in egg white and compare it with a hamburger labeled with 99mTc sulphur colloid as well. METHODS: We studied 30 patients who underwent gastric emptying scintigraphy with the two aforementioned meals. RESULTS: Emptying percentages and retention with both meals were similar within an hour and two; however, statistical significance arose until the third hour with a p value of 0.26 by using Student's t for independent samples. CONCLUSIONS: Gastric emptying studies in both protocols where similar with normal ranges. The egg white ingested must be consistent for reproducible results in gastric motility disease, like organoleptic and volume characteristics.

Introducción: la gammagrafía de vaciamiento gástrico (VG) es el estándar de oro para determinar el porcentaje de VG. La estandarización del método permite la obtención de resultados reproducibles. La dieta estandarizada se compone de un sándwich de albúmina de huevo en polvo reconstituida y marcada con 99mTc sulfuro coloidal (SC). El objetivo fue estandarizar y determinar el porcentaje de vaciamiento gástrico tras la ingesta del sándwich de albúmina de huevo y compararlo con el porcentaje de ingesta de una hamburguesa, ambos marcados con 99mTc sulfuro coloidal. Método: se incluyeron 30 pacientes a los que se les realizó estudio de gammagrafía de vaciamiento gástrico con las dos dietas propuestas. Resultados: los porcentajes de vaciamiento y retención con ambos tipos de alimentos fueron similares a la hora y a las dos horas; sin embargo, hubo diferencias significativas a las tres horas con un valor de p = 0.26, calculado mediante t de Student para muestras independientes. Conclusiones: los tiempos de vaciamiento gástrico con ambas dietas estuvieron dentro de rangos normales. La dieta estandarizada con albúmina de huevo reconstituida aporta ventajas en cuanto al estudio de las posibles alteraciones de la motilidad gástrica, como sus características organolépticas y de volumen.

[Toxic epidermic necrolysis]. / Necrólisis epidérmica tóxica.

BACKGROUND: Toxic epidermal necrolysis is a dermatological disease that evolves with an elevated mortality. Our objective was to show the utility of a nonconventional treatment for toxic epidermal necrolysis in place of conventional treatment where the mortality is <50 %. With this suggested treatment, mortality is 0 %. METHODS: This is a prospective and descriptive study presenting the case of 12 patients with toxic epidermal necrolysis. Diagnosis was made by history of drug ingestion, clinical presentation and skin biopsy, which was corroborated by light microscopy. RESULTS: Twelve patients were treated with heparin, dypiridamol, potassium permanganate, methylcellulose, respiratory therapy treatments and early peritoneal dialysis for stabilization in one patient who development acute renal failure. All patients recovered between 20 and 25 days after the beginning of the disease with a mortality of 0%. CONCLUSIONS: The relationship between intravascular coagulation and TEN is corroborated by mediators of the inflammatory reaction that can trigger multiple organ dysfunction. By using anticoagulants and antiplatelet drugs at an early stage, the inflammatory response can be avoided as demonstrated in our group of patients.