¿Es la música un complemento a la analgesia en la litotricia extracorpórea? / No disponible

No disponible

Combination of cardiorespiratory reflex parameters and heart rate variability power spectrum analysis for early diagnosis of diabetic cardiac autonomic neuropathy.

AIM: The study objective was to compare cardiorespiratory reflex (CR-R) parameters and heart rate variability power spectrum (HRV-PS) analysis in the diagnosis of cardiac autonomic neuropathy (CAN) in diabetic patients. METHODS: Four CR-R tests (Valsalva manoeuvre, deep breathing, and two successive 5-minute periods with the subject supine and standing, respectively) were performed in 399 diabetic patients (58.6% male, median age: 51 years) and 105 healthy controls (40% male, median age: 34 years). Patients with two or more abnormal CR-R parameters were classified as CAN+, while those with only one abnormal CR-R parameter were considered CAN 'borderline'. HRV-PS was performed in all study participants. RESULTS: The low-frequency (LF) area with the patient standing was reduced in CAN+ diabetics (median 35.6 normalized units [nu], n=31), in CAN 'borderline' diabetics (median 64.3nu, n=70) and even in diabetics without CAN (median 89.4nu, n=298) versus control subjects (median 93.7nu; P<0.001, P<0.001 and P<0.05, respectively). Adding the abnormal (<2.5 nu) LF area to the diagnostic criteria in CAN 'borderline' patients caused 11 (15.7%) patients to be considered CAN+. CONCLUSION: Combining abnormal CR-R parameters (I - E and I/E the most specific) with HRV-PS (particularly the LF area with the subject standing) allowed diagnosis of diabetic CAN at an earlier stage.

99mTc-cisteina-glucosamina (99mTc-CG) en la evaluación de pacientes con tumores malignos: correlación histopatológica / 99mTc-glucosamine-cysteine in the evaluation of patient with malignant tumors: histopathological correlates

Las imágenes de PET con 18Fluordeoxyglucosa (18FDG-PET) son utilizadas para estudiar tumores. Debido a su alto costo y baja disponibilidad, el PET es inaccesible para muchos pacientes. Algunas moléculas marcadas con 99mTc utilizadas para imágenes SPECT podrían ser una alternativa al 18FDG-PET. La Glucosamina(G) es un aminoazúcar de 6 carbonos que entra a la célula a través de un sistema transportador de glucosa, se fosforila y forma glucosamina-6-fosfato. Combinando G con cisteína(C) y marcándolas con 99mTc se obtiene un compuesto (99mTc-CG) que puede ser utilizado para demostrar lesiones hipermetabólicas en forma similar al 18FDG-PET. Objetivo: Evaluar la utilidad de las imágenes con 99mTc-CG en la detección de tumores y correlacionarlas con los resultados histopatológicos. Material y Métodos: La marcación de 99mTc-CG fue realizada agregando G, C, N-hydroxisuccinimida, carbodiimida y cloruro estanoso al 99mTc. 35 pacientes (23F, 12M, edad promedio 52 años, rango 7-79) con diagnóstico histopatológico fueron derivados para centellografía con 99mTc-CG. Los pacientes ayunaron por 12hs, 1-4 hs luego de la inyección EV de 920-1088MBq de 99mTc-CG se adquirierion 1) barrido corporal total y 2) imágenes SPECT(reconstruídas con algoritmo OSEM) en el área de interés de las lesiones. Para eliminar la actividad intravascular e intersticial de las imágenes con 99mTc-CG, se administraron 737MBq de 99mTc-albúmina sérica humana (99mTc-ASH) y se realizó otro SPECT. Se norquirierion 1) barrido corporal total y 2) imágenes SPECT(reconstruídas con algoritmo OSEM) en el área de interés de las lesiones. Para eliminar la actividad intravascular e intersticial de las imágenes con 99mTc-CG, se administraron 737MBq de 99mTc-albúmina sérica humana (99mTc-ASH) y se realizó otro SPECT. Se normalizaron ambos SPECT y posteriormente las imágenes con 99mTc-ASH fueron sustraídas de las de 99mTc-CG. Las imágenes fueron analizadas visualmente. Resultados: 32 lesiones fueron malignas (5 de mama)...

99mTc-mazindol: a potential radiopharmaceutical agent for dopamine transporter imaging with SPET: preparation and preliminary clinical observations

Objetivo: Marcar el anorexigeno Mazindol, inhibidor del transportador de dopamina(DA), norepinefrina (NE) y serotonina, con Tc99m por método indirecto, con la finalidad de visualizar con SPECT los receptores dopaminergicos localizados en el cuerpo estriado. Material y métodos: se estudiaron con Tc99m-Mazindol, 5 sujetos; 2 voluntarios sanos (1 mujer y 1 hombre, 35-60 años) y 3 pacientes ( 2 mujeres, 1 hombres) entre 35-80 años, 2 con trastornos cognitivos y 1 paciente con enfermedad de Parkinson, referidos para estudio de perfusión cerebral con Tc99m ECD. Mazindol se hizo reaccionar en frió con disulfito de carbono seguido por hidróxido de sodio, agregándose posteriormente ditiocarbamato y luego de 1 hora de incubación a temperatura ambiente, se lo marcó con Tc99m por método indirecto empleando ácido gluconico, calculándose posteriormente el coeficiente de determinación lipofilico del Tc99-Mazindol. Se realizo SPECT cerebral 30-60 minutos después de administrar 925 MBq (25 mCi) de Tc-99m-Mazindol, utilizando una cámara gamma con dos cabezas, opuestas 102 grados. Los parámetros de adquisición fueron: matriz de 128x128,120 imágenes, cada una de 25 seg., orbita circular con movimiento continuo y 258 grados de rotación. En todos los sujetos sé en las imágenes SPECT con Tc99-Mazindol, se visualizó captación cortical y subcortical, las que fueron interpretadas la primera como reflejo de perfusión cerebral y la segunda al cuerpo estriado estructura que reciben inervación DA. La comparación de imágenes en 3 pacientes en quienes se realizó SPECT con Tc99m Mazindol y con Tc99m ECD, muestra , menor intensidad y resolución en la captación cortical con Tc99m-Mazindol que con Tc99m ECD, visualizándose en éstas captación en el cerebelo , no así en las imágenes con Tc99m Mazindol. La diferencia más significativa entre ambos estudios fue visualizar con Tc99m Mazindol captación subcortical, no presentes en el SPECT con Tc99m-ECD...

Comparación entre la ventriculografía radioisotópica en equilibrio con Tc99-albúmina-DTPA y SPECT gatillado cuantitativo (QGS) con Tc-99m-MIBI, para determinar la fracción de eyección del ventrículo izquierdo / Comparisson between radioisotopic ventriculography in balance with Tc99-albumine-DTPA and quantitative gated SPECT with Tc-99m-MIBI for determining the eject fraction of left ventricle

Se estudiaron 18 pacientes consecutivos (14 hombres y 4 mujeres, edad media 65 años) referidos para estudio GSPECT con Tc-99m MIBI después de esfuerzo ergométrico / reposo siguiendo protocolo de 1 dia. Las imágenes fueron sumadas y procesadas para la evaluación SPECT de perfusión miocardio (PM). GSPECT fue además procesado para calcular la FEVI(por ciento) usando el programa sincronizado cuantitativo (QGS). La VGRI en reposo se realizo 48-72 hrs. después de administrar con 925 MBq (25 mCi) de Tc-99m-ASH usando DTPA como agente quelante bifuncional. La ASH-DTPA fue preparada a temperatura ambiente, agregando a 2 ml de ASH al 2por ciento, 20 mg de DTPA y 1 mg de una solución estándar de cloruro estanoso y después el Tc-99m recién eluido del generador. La VGRI fue adquirida en posición anterior y en la mejor vista septal oblicua izquierda (OAI) durante 10 min. La FEVI (por ciento) en OAI fue computada manualmente dibujando regiones de interes (ROI) en la imagen de fin de diástole y sístole. En la VGRI también evaluamos visualmente la calidad de las imágenes cardiovasculares, y en la imagen de fin de diástole del ventriculograma en posición anterior, mediante ROI colocadas en el Ventrículo izquierdo (VI), hígado, pulmón y en el tercio superior del abdomen ( irradiación de fondo), se calculó la relación de actividad entre ellos. Resultados: A todos los pacientes se les realizó GSPECT después del ejercicio ergométrico máximo. Se utilizó QGS para calcular la FEVI(por ciento) tanto posejercicio en los pacientes con estudio SPECT de PM normal (n = 10) como en los con PM. anormal (n = 8) en quienes la FEVI(por ciento) fue estimada en reposo. No hubo diferencias significativas entre la FEVI (por ciento) con QGS y VGRI ( 55.5 ñ 13.4 vs 56.5 ñ 14.2 respectivamente). Ambos métodos se correlacionaron significativamente ( r = 0.78, p = 0.0001) y concordaron para identificar los pacientes con FEVI (por ciento) superior o inferior al 50 por ciento (índice kappa = 0.76). No se observaron diferencias estadísticamente significativas entre la FEVI(por ciento) calculada en la VGRI en reposo y QGS post ejercicio (n = 10) (62,5 ñ 8.3 vs 63 ñ 11.3), o la estimada reposo con ambos métodos. (n = 8) (VGRI 48.6 ñ 16.7, QGS 46.2 ñ 9.7 ), observándose correlación significativa entre la VGRI y QGS independientemente de que la FEVI(por ciento) fuera estimada después del ejercicio(r = 0.74, p =0.013) o en reposo(r = 0.75, p = 0.03)...

Estudio epidemiológico de la lactancia materna en Soria / An epidemiological study of breast-feeding in Soria

Los objetivos fueron estudiar la prevalencia de la lactancia materna (LM) en Soria, investigar la influencia de los factores maternos y perinatales en la elección y duración de ésta y, finalmente, comparar los resultados con aquellos que habían sido estudiados, en las mismas condiciones, tres años antes. Se registraron un total de 60 niños nacidos en él Hospital General de Soria durante el mes de noviembre de 1999. Se llevó a cabo una entrevista con cada una de las madres durante su ingreso en la maternidad, previa al alta. A continuación, se estableció un seguimiento telefónico mensual para tratar de conocer la duración de la LM y, cuando finalizó; se analizaron los factores que influyeron en este cambio. Se realizó un análisis simple de los datos. Se produjo un progresivo descenso de la LM, más acusado a partir de que el lactante cumplía los 3 meses de edad. En este estudio únicamente un lactante permanecía con lactancia materna exclusiva a los 6 meses de edad. Los factores que influyeron en la duración y dificultad de la LM fueron: excesiva preocupación materna, esquemas rígidos de alimentación, tiempo de la primera puesta al pecho y estudios maternos. Entre las mujeres con trabajo por cuenta ajena, el principal factor que limitaba la duración de la lactancia materna. era la vuelta al trabajo tras el nacimiento (AU)

Pain as a mutual experience for patients, nurses and families: a perspective from Valencia, Spain.

The Spanish data collection was consistent with the overall study design and drew from three groups: laboring women, children and elderly patients. The Valencia data was amongst the most detailed, specific and complete in this international study. This is most likely due to the experienced nature of the Spanish research team. The study results revealed more commonalities than differences in all age groups with regard to pain identification and pain alleviation. Across age groups, pain was identified by study participants through observation and listening.

[Glomerular filtration rate with Tc99m DTPA. Comparison of methods]. / Medición del filtrado glomerular con Tc99m DTPA. Comparación de métodos.

UNLABELLED: Glomerular filtration rate (GFR) is an important index of renal function. The aim of this study was to compare the GFR with 99m Tc. DTPA without urine collection estimated with three, two and single-sample methods. We studied 148 patients (54 women and 94 men, 3-84 years old) with diverse renal diseases. After intravenous administration of Tc99m DTPA three (90-120-180 min. Method 1; n = 44) or two (120 and 180 min or 180 and 240 min Method 2, n = 104) blood samples were taken. The GFR (ml/min) were calculated using monoexponential analysis, or with only the sample of the 180 or 240 min with the methods of Jacobsson, Russel, Groth-Aasted, Dakubu and Constable. RESULTS: 1) In 37/148 (25%) the GFR by Method 1-2 was less than 30 ml/min. All the single-sample methods did not perform well. 2) in 107/148 (75%) the GFR using method 1 and 2 was superior to 30 ml/min. The single sample methods showed clinically acceptable absolute error differences with method 1 and 2. However, we cannot suggest a preferable one single sample method that covers all the range of GFR that we analyzed. In conclusion, the 2 sample technique provides an estimate of GFR and we also suggest ultrafiltering the plasma before measuring radioactivity to give better accuracy in calculating GFR.

Medición del filtrado glomerular con Tc99m DTPA. Comparación de métodos. / [Glomerular filtration rate with Tc99m DTPA. Comparison of methods]

Glomerular filtration rate (GFR) is an important index of renal function. The aim of this study was to compare the GFR with 99m Tc. DTPA without urine collection estimated with three, two and single-sample methods. We studied 148 patients (54 women and 94 men, 3-84 years old) with diverse renal diseases. After intravenous administration of Tc99m DTPA three (90-120-180 min. Method 1; n = 44) or two (120 and 180 min or 180 and 240 min Method 2, n = 104) blood samples were taken. The GFR (ml/min) were calculated using monoexponential analysis, or with only the sample of the 180 or 240 min with the methods of Jacobsson, Russel, Groth-Aasted, Dakubu and Constable. RESULTS: 1) In 37/148 (25

) the GFR by Method 1-2 was less than 30 ml/min. All the single-sample methods did not perform well. 2) in 107/148 (75

) the GFR using method 1 and 2 was superior to 30 ml/min. The single sample methods showed clinically acceptable absolute error differences with method 1 and 2. However, we cannot suggest a preferable one single sample method that covers all the range of GFR that we analyzed. In conclusion, the 2 sample technique provides an estimate of GFR and we also suggest ultrafiltering the plasma before measuring radioactivity to give better accuracy in calculating GFR.

[Helicobacter pylori: 14C urea breath test in clinical practice at a general hospital]. / Helicobacter pylori: prueba de la respiración con 14C urea en la práctica clinica de un hospital general.

Using isotope methods we studied in 125 patients the absence or presence of gastric urease. Carbon 14 urea was given orally, breath samples were collected over a 30 min period, and the amount of 14CO2 excreted every 10 min was determined. The patients were divided in two groups: 1) uninfected with Helicobacter pylori (HP) (n = 64), 2) infected (n = 41), depending on whether the excretion of the 14CO2 in the breath was greater o lower that 1% of the administered dose. Compared with the infected patients the uninfected patients have shown a mean values of 14CO2 in the breath significantly lower at 10-20-30 min. Among 38 patients who underwent both the 14C urea breath test and endoscopy biopsy of the antral mucosa for histological examination, 22 (58%) and 16 (42%) showed positive or negative HP on biopsy respectively. Among these HP-positive patients, 16 (73%) had chronic gastritis, 3 (14%) gastritis acute and 3 (14%) had duodenal ulcer. Excretion of 14CO2 in breath, lower than 1% and higher than 1% has a specificity of 81% and sensitivity accuracy, positive predictive power of 86%, 84% and 86% respectively. In conclusion 14C urea breath test is a simple noninvasive and easy way to detect with high degree of confidence the presence or absence of gastric urease.

Anticonvulsant effects of intra-hippocampal injection of TRH in amygdala kindled rats.

The anticonvulsant effects of intra-hippocampal thyrotropin-release hormone (TRH) were examined in amygdala kindled rats. Subjects were implanted unilaterally with an electrode in the amygdala and bilaterally with guide cannulae in the hippocampus, aimed at the dorsal and ventral dentate gyri. Rats were kindled daily with suprathreshold electrical stimulation (800 microA, 1 ms pulse width, 100 Hz, duration 0.5 s) until seizures were reliably elicited. The afterdischarge (AD) duration, seizure duration, and seizure stage were recorded daily, and AD thresholds were determined after kindling was completed. TRH was infused into each of the four cannulae of freely moving rats at doses of 0 (vehicle), 1.25, 2.5 and 5 microg/site. Five minutes after the last infusion, the rats received electrical stimulation at their AD threshold (mean = 135 microA) + 50 microA. TRH reduced the AD and seizure duration in a dose-dependent manner. At the dose of 2.5 microg/site, TRH also reduced AD and seizure duration in rats stimulated with suprathreshold current (800 microA). However, TRH had minimal effects on seizure stage irrespective of the stimulation intensity. These results suggest that the seizure-induced elevations of TRH in the hippocampus, as demonstrated in previous studies, may be part of an endogenous anticonvulsant compensatory mechanism and that further elevations of TRH in the hippocampus can produce anticonvulsant effects mainly by reducing the AD and seizure duration.

Crossbreeding dual-purpose cattle for beef production in tropical regions.

Six breed types groups of six steer calves each were used to observe differences in growth and carcass traits: F1 Brown Swiss (F1BS), F1 Holstein (F1HO), F2 Brahman (F2BR), F2 Criollo Rio Limon (F2CRL), purebred Criollo Rio Limon (CRL), and Perija Mosaic (PMO). After 404 days of grazing, the heaviest F1BS and F2BR steers were different from F1HO and CRL counterparts (p < 0.05) in slaughter weight. F2BR dressed higher and had better muscle conformation scores than F1BS, F1HO, F2CRL and CRL (p < 0.05). F1BS had the thickest backfat (0.5 cm) but only differed (p < 0.05) from F1HO (0.3 cm). Rib eye area, marbling score, carcass maturity, quality or yield grade, boneless cut percentages, bone percentage or percent trimmable fat did not vary among breed types. All steers were within the A maturity level and graded Standard. Results indicate the importance of feeding dual-purpose steers to heavier weights to please industry preferences.

[Quantitative Tc 99m - DISIDA hepatobiliary scintigraphy in normal and cirrhotic alcoholic subjects]. / Centellografía hepatobiliar cuantitativa con 99m Tc DISIDA en sujetos normales y en cirróticos alcohólicos.

UNLABELLED: Quantitative hepatobiliary scintigraphy (Q.H.S.), with 99m Tc-DISIDA was performed on 15 control subjects and 32 alcoholic cirrhotic patients (A.C.). We used a dynamic planar scintigraphy (30 seg/frame, up to 45 min) technique following injection intravenously of 99m Tc-DISIDA. Time/activity curves were obtained from the right upper lobe of the liver and the: 1) slope uptake, 2) half-time (T 1/2 min) uptake, 3) excretion half-time (T1/2 min), were measured from the curve. The A.C. were divided in two groups, IIA (n = 32) and IIB (n = 6) if the excretory curve show negative slope or not respectively. RESULTS: The mean value (+/- 1 D.S. 95% coinfidence interval) of the slope uptake of the A.C. IIB (1.2 +/- 0.40) was significantly slower than a.C. IIA (2.8 +/- 0.39) and control (4.5 +/- 1.17, p = 0.0001 respectively). The difference also was significantly when the mean of A.C. IIA was compared to control (p = 0.007). The mean of T1/2 uptake of A.C.IIB (62.2 +/- 22.2) was significantly longer than A.C. IIA (28.4 +/- 4.4 p = 0.011) and control (17.9 +/- 3.87, p = 0.003). The mean T1/2 excretory of the A.C. IIA (90.0 +/- 17.8) was also significant delayed compared to the mean of normal control (35.6 +/- 7.6 p = 0.001). In the A.C. IIB the excretion plateau curve was associated with visualization of the gallbladder and bowel activity suggesting that the excretion of the IDA preferentially came from the left hepatic lobe. We conclude that alcoholic cirrhotic patients have impaired the mechanism related with the uptake/excretion transport of organic anion, and suggest that noninvasive Q.H.S. with 99m Tc-DISIDA, can be a useful clinical technique to be used for the quantification of hepatic function in cirrhotic alcoholic patients.

Centellografía hepatobiliar cuantitativa con 99m Tc DISIDA en sujetos normales y en cirróticos alcohólicos. / [Quantitative Tc 99m - DISIDA hepatobiliary scintigraphy in normal and cirrhotic alcoholic subjects]

Quantitative hepatobiliary scintigraphy (Q.H.S.), with 99m Tc-DISIDA was performed on 15 control subjects and 32 alcoholic cirrhotic patients (A.C.). We used a dynamic planar scintigraphy (30 seg/frame, up to 45 min) technique following injection intravenously of 99m Tc-DISIDA. Time/activity curves were obtained from the right upper lobe of the liver and the: 1) slope uptake, 2) half-time (T 1/2 min) uptake, 3) excretion half-time (T1/2 min), were measured from the curve. The A.C. were divided in two groups, IIA (n = 32) and IIB (n = 6) if the excretory curve show negative slope or not respectively. RESULTS: The mean value (+/- 1 D.S. 95

coinfidence interval) of the slope uptake of the A.C. IIB (1.2 +/- 0.40) was significantly slower than a.C. IIA (2.8 +/- 0.39) and control (4.5 +/- 1.17, p = 0.0001 respectively). The difference also was significantly when the mean of A.C. IIA was compared to control (p = 0.007). The mean of T1/2 uptake of A.C.IIB (62.2 +/- 22.2) was significantly longer than A.C. IIA (28.4 +/- 4.4 p = 0.011) and control (17.9 +/- 3.87, p = 0.003). The mean T1/2 excretory of the A.C. IIA (90.0 +/- 17.8) was also significant delayed compared to the mean of normal control (35.6 +/- 7.6 p = 0.001). In the A.C. IIB the excretion plateau curve was associated with visualization of the gallbladder and bowel activity suggesting that the excretion of the IDA preferentially came from the left hepatic lobe. We conclude that alcoholic cirrhotic patients have impaired the mechanism related with the uptake/excretion transport of organic anion, and suggest that noninvasive Q.H.S. with 99m Tc-DISIDA, can be a useful clinical technique to be used for the quantification of hepatic function in cirrhotic alcoholic patients.

[Visceral leishmaniasis and AIDS. Apropos of 2 cases with different clinical course patterns]. / Leishmaniasis visceral y SIDA. A propósito de dos casos con patrón clínico-evolutivo distinto.

We present two cases of visceral leishmaniasis in patients with AIDS which represent two different clinical patterns of the disease. Special emphasis is made on the need to lavish bone marrow studies in those patients with AIDS who present fever of unknown origin since immunodepression can modify the classical clinical picture of the disease. According to our experience, visceral leishmaniasis should be included amongst the infections indicative of AIDS in patients with HIV infection.

[The prevalence of anti-hepatitis virus C antibodies in chronic hemodialysis patients]. / Prevalencia de anticuerpos anti-hepatitis por virus C en hemodializados crónicos.

Liver involvement with a variety of viral diseases is a frequent finding in chronic renal failure patients on regular hemodialysis treatment. We evaluated the prevalence of IgG anti-hepatitis C virus antibodies (HVC) in our dialysis unit, looking for risk factors associated with seropositivity and we assessed the type and degree of liver involvement by means of a liver biopsy in those patients with biochemical abnormalities of liver function test. We studied 50 patients aged 13 to 77 years, and performed serial determinations of serum ALT (UI/L). IgG anti HVC was determined by a second generation ELISA Kit (Abbot). We retrieved information from chart review and patient interview, regarding: time on hemodialysis, number of blood transfusions and intravenous IV drug use off dialysis. Liver biopsy specimens were stained with H.E. and Masson and findings were classified as chronic persistent, chronic active hepatitis or cirrhosis, according to Schewer. We compared the findings with those of other patients with liver dysfunction and positive IgG anti HVC who did not have renal failure. Anti-HVC prevalence in our hemodialysis patients was 44%. Anti-HVC seropositive hemodialysed (HD) patients were not different from seronegative HD patients, with regard to age, sex, i.v. drugs usage and peak ALT values. Twelve of 22 HVC positive patients had peak ALT values higher than 40 UI/L (Table 2). Time in HD (75.5 +/- 42.8 m) and number of blood transfusions received (35.3 +/- 28) were clearly different in HVC positive patients, compared to HVC negatives. Histologically, 11 seropositive patients showed chronic persistent hepatitis as the most frequent finding.(ABSTRACT TRUNCATED AT 250 WORDS)