Desarrollo y manejo de indicadores para mejorar la gestión de la asistencia. Una herramienta que puede ser útil a pesar de sus limitaciones / Development and use of indicators to improve assistant management in a hospital. A useful tool in spite of its limitations

La política del Hospital Puerta de Hierro de fomentar el uso de indicadores para la gestión ha sido desarrollada en diferentes ámbitos a partir de una estrategia común que adopta formas diferentes según el lugar de implantación. La aplicación hospitalaria general se centró en el estudio, selección, recopilación y difusión de información; la información más importante en la aplicación a los cuidados enfermeros fue la de activar y automatizar fuentes de información específicas; en un servicio clínico con su propio sistema de información, toma la forma de un proceso informático de cálculo; y en el caso de consultas externas su función fue la de priorizar indicadores incluidos en el Sistema de Información

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[Study of pulmonary lesions with (99m)Tc-Tetrafosmin and chest spect. Determination of uptake related factors, diagnostic value and prognosis]. / Estudio de las lesiones pulmonares con(99M)Tc-Tetrofosmin y SPECT de tórax. Determinación de los factores que intervienen en la captación, valor diagnóstico y pronóstico.

One hundred fifteen patients with 119 pulmonary lesions in which malignancy was suspected underwent a SPECT study with 99mTc-Tetrofosmin (TTF) to assess the possible factors involved in the uptake of the radiopharmaceutical. The TTF uptake rate in the lung tumor with respect to that of healthy tissue (TTF index) was evaluated in terms of: benignity and malignancy, histological type, stage, cell differentiation, size, necrosis, survival and the influence of P-glycoprotein (Pgp), detected by immunohistochemistry, on the TTF uptake. The mean TTF index in the 18 benign lesions studied was 1.01 0.05, while that of the 101 malignant lesions was 1.59 0.45 (p < 0.001), with a positive predictive value of 97.7% and a negative predictive value of 50%. The comparison of the histological types, degree of cell differentiation, necrosis and stage revealed no statistically significant differences. With respect to size, those tumors measuring > 3 cm showed greater uptake than smaller lesions. In patients with non-small cell lung cancer, a positive relationship was observed between the TTF index and survival, a circumstance that did not occur in patients with small cell lung cancer. In the cases in which the presence of Pgp was assessed, there was an inverse relationship between the TTF ratio and Pgp expression. In conclusion, thoracic SPECT with 99mTc-TTF has a high positive predictive value for the presence of lung cancer, although a negative study does not rule out the existence of the disease. The reason for this is the inverse relationship between 99mTc-TTF uptake and the density of Pgp expression.

Estudio de las lesiones pulmonares con 99mTc-Tetrofosmin y SPECT de tórax. Determinación de los factores que intervienen en la captación, valor diagnóstico y pronóstico / Study of pulmonary lesions with 99mTc-Tetrofosmin and chest SPECT. Determination of uptake related factors, diagnostic value and prognosis

Se ha realizado el estudio mediante SPECT y 99mTc-Tetrofosmin (TTF) en 115 pacientes con 119 lesiones pulmonares sospechosas de malignidad para valorar los posibles factores que intervienen en la captación del radiofármaco. Los índices de captación del tumor respecto al tejido sano (índice TTF) se evaluaron respecto a: benignidad y malignidad, tipo histológico, estadio, diferenciación celular, tamaño, necrosis, supervivencia y la influencia de la P-glicoproteína (Pgp) en la captación de TTF, detectada mediante inmunohistoquímica. En las 18 lesiones benignas estudiadas la media del índice TTF fue 1,01 ñ 0,05 mientras que en las 101 malignas 1,59 ñ 0,45 (p 3cm presentaron mayor captación que los inferiores. En los pacientes con cáncer de pulmón de célula no pequeña se detectó una relación positiva entre el índice TTF y la supervivencia, no así en los pacientes con cáncer de pulmón de célula pequeña. En los tumores en los que se determinó la presencia de Pgp existía una relación inversa entre los índices de TTF y la expresión de Pgp. En suma, el estudio mediante SPECT torácico y 99mTc-TTF tiene un alto valor predictivo positivo para la presencia de cáncer de pulmón, aunque un estudio negativo no excluye su existencia. Esto es debido a que existe una relación inversa entre la captación de 99mTc-TTF y la densidad de expresión de la Pgp (AU)

[Angina pectoris in the heart transplant recipient: evidence of reinnervation]. / Angina de pecho en el paciente con trasplante cardíaco: una evidencia de reinervación.

Heart transplantation involves the removal of a sick heart together with its innervation and replacement with a donor heart isolated from the control of the autonomous nervous system of the recipient, therefore being, functionally dennervated. Dennervation conditions several alterations in cardiac physiology, such as the inability to experience pain during myocardial ischemia, so that theoretically these patients cannot present angina pectoris. However, several reports have shown evidence of reinnervation with isolated cases of transplanted patients with angina pectoris having been reported. We describe the case of a transplanted patient who showed typical effort angina, vascular disease of the graft and data of sympathetic reinnervation demonstrated by cardiac gammagraphy with metayodo-benzilguanidina-I-123.

Effect of propranolol on the factors promoting bacterial translocation in cirrhotic rats with ascites.

Bacterial translocation appears to be an important mechanism in the pathogenesis of spontaneous infections in cirrhosis. Cirrhotic patients are commonly treated with beta-adrenoceptor blockers, but the impact of this treatment in the factors promoting bacterial translocation has not been investigated. This study was aimed at investigating in cirrhotic rats with ascites the effect of propranolol on intestinal bacterial load, transit, and permeability of the bowel and on the rate of bacterial translocation. Bacterial translocation to mesenteric lymph nodes and intestinal bacterial overgrowth, permeability (urinary excretion of (99m)Tc-diethylenetriaminepentaacetic acid [(99m)Tc-DTPA]), and transit (geometric center ratio of (51)Cr) were assessed in 29 rats with carbon tetrachloride (CCl(4)) cirrhosis and 20 controls. These variables were then measured in 12 placebo- and in 13 propranolol-treated ascitic cirrhotic rats. Bacterial translocation was present in 48% of the cirrhotic rats and in none of the controls. Cirrhotic rats with intestinal bacterial overgrowth had a significantly higher rate of translocation and slower intestinal transit than those without it. Among the 15 rats with overgrowth and a (99m)Tc-DTPA excretion greater than 10%, 15 had translocation and 2 had bacterial peritonitis. Only 1 of the 14 rats with either intestinal overgrowth or a (99m)Tc-DTPA excretion greater than 10% presented translocation. Compared with the placebo group, propranolol-treated animals had significantly lower portal pressure, faster intestinal transit, and lower rates of bacterial overgrowth and translocation. In ascitic cirrhotic rats, bacterial translocation results from intestinal overgrowth and severe damage to gut permeability. In this setting, intestinal overgrowth is associated with intestinal hypomotility. Propranolol accelerates the intestinal transit, decreasing the rates of bacterial overgrowth and translocation.

[Eight year history of neuroblastoma in an adult patient. Value of 123I-MIBG and 111In-DTPA-D-Phe-octreotide scintigraphy]. / Neuroblastoma de 8 años de evolución en paciente adulto: valor de la gammagrafía con 123I-MIBG y con 111In-DTPA-D-Phe-octreótido.

A case of a 30 year old male with an eight year history of neuroblastoma and whose general health was good is presented. After his last check-up, which included a CT scan and 99mTc-MDP bone scintigraphy, a 123I-MIBG and 111In-DTPA-D-Pheoctreotide scintigraphy was performed and provided us with complementary data that contributed to a more precise diagnosis of the location and extension of the neuroblastoma and to the biological features of the tumor. Thus, this report deals with an adult neuroblastoma patient whose general health is good in whom the exact extension of the lesion was determined by a combination of diagnostic imaging techniques.

[Evaluation of the hemodynamic effects of tumor necrosis factor alpha factor in rats with portal hypertension using the radioactive microsphere technique]. / Evaluación de los efectos hemodinámicos del factor de necrosis tumoral alfa en ratas con hipertensión portal mediante le técnica de las microesferas radiactivas.

UNLABELLED: This study was aimed at investigating the effects of blocking circulating TNF on the hyperdynamic circulatory state developed in rats with portal vein stenosis (PVS), and the factors mediating the hemodynamic action of this cytokine in this setting. MATERIALS AND METHODS: Murine antiTNF polyclonal antibodies (100 microgram) or placebo were intravenously injected into PVS rats (n = 24) before and 4 days after PVS. Hemodynamic studies were performed the day after the last antiTNF injection. RESULTS: Short-term TNF inhibition led to reductions in cardiac index (p < 0.05) and portal venous inflow (p < 0.01), and significant increases in splanchnic and systemic vascular resistances. Portal pressure was unchanged, but portal-systemic shunting was decreased (p < 0.05). CONCLUSION: TNF plays a key role in promoting the development of the hyperdynamic state of portal hypertension. The effect of TNF is mediated through an increased release of nitric oxide.

[Correlation between 99m Tc-tetrofosmin uptake and P-glycoprotein expression in non-small-cell lung cancer]. / Correlación entre la captación de 99m Tc-tetrofosmín y la expresión de P-glicoproteína en cáncer de pulmón no microcítico.

UNLABELLED: We used thoracic SPECT to study the 99mTc-tetrofosmin (TF) uptake in patients with non-small-cell-lung-carcinoma (NSCLC). The results were compared with the percentage of P-glycoprotein (Pgp) found in flow cytometric analysis (FC) of samples of surgically-resected tumor tissue. MATERIAL AND METHODS: A total of 21 patients with NSCLC were studied by means 99mTC-TF and thoracic SPECT. Image analysis included the determination of the TF uptake rate in the lung mass with respect to that of healthy tissue of the contralateral lung. These rates were compared with the percentage of Pgp expression according to FC. FC analysis was also carried out in 16 samples of healthy lung tissue obtained from the patients. RESULTS: In healthy lung tissue, the mean Pgp expression according to FC was 4.58 +/- 1.87%. The cutoff value used to differentiate between Pgp positive and Pgp negative tumors was considered to be the mean plus two standard deviations (8.32). The Pgp-positive tumors (> 8.32%) presented significantly lower uptake levels (1.28 +/- 0.39) than the Pgp-negative lesions (1.66 +/- 0.33) (p = 0.029). CONCLUSIONS: There is a inverse correlation between the Pgp expression as determined by FC analysis and 99mTc-TF in NSCLC. Thus, this radiopharmaceutical provides rapid and non-invasive information on Pgp expression in these lesions.

Changes in gastrin and serum pepsinogens in monitoring of Helicobacter pylori response to therapy.

The aims of this study in 50 patients with H. pylori infection and duodenal ulcer were to examine the effect of eradication therapy on the serum levels of gastrin, pepsinogen I, and pepsinogen II and to investigate whether monitoring of the serum changes in these peptides after treatment could predict patient outcome. H. pylori status was assessed at entry and one and six months after therapy by culturing and microscopic analysis of the gastric mucosa and by [14C]urea breath test. Significant decreases were observed in the serum levels of gastrin (-11.4 +/- 3%), pepsinogen I (-28.9 +/- 4%), and pepsinogen II (-40.4 +/- 3%) in the 45 patients whose infection was eradicated, but not in the patients without eradication. Serum values of these peptides were unchanged in an additional group of 10 patients that only received omeprazol, none of whom had H. pylori eradicated. The best cutoff point of the percentage of each peptide to predict patient outcome was 10% for gastrin and pepsinogen I, and 15% for pepsinogen II. A pepsinogen II decrease > 15% resulted in the best marker of H. pylori clearance, accurately identifying patient outcome 86.6% of the time, whereas the diagnostic accuracy of gastrin and pepsinogen I was 61.7% and 76.6%, respectively. Significant correlations were found between the bacterial load assessed by histology with the serum concentrations of pepsinogen I and II and with the urease activity as measured by the amount of 14CO2 excreted. In conclusion, eradication of H. pylori infection is followed by a significant drop in serum levels of gastrin, pepsinogen I, and pepsinogen II. Changes in the latter are the most uniform and may be used as an indirect tool to predict treatment outcome.

Improved distribution of pulmonary flush solution to the tracheobronchial wall in pulmonary transplantation.

This report describes the experimental results obtained with conventional (pulmonary artery, PA) flushing versus retrograde perfusion (via left atrium, LA) using 99mTc-labeled macroaggregated albumin (MAA-99mTc) to ascertain the distribution throughout the tracheobronchial (TB) tree in 10 Large-White pigs. Lung preservation was achieved with 4 degrees C Euro-Collins solution (60 ml/kg) instilled via PA (n = 5) or LA (n = 5). Simultaneously, MAA-99mTc was given using the same respective route and the isotope uptake quantified at different TB levels after heart-lung block harvest and dissection of all tissue adjacent to TB: proximal and distal trachea and right and left main bronchi. Retrograde distribution resulted in a significantly higher 99mTc count compared to the PA route (p < 0.01).

[The usefulness of 99mTc-tetrofosmin in the diagnosis of pulmonary tumors. A preliminary assessment]. / Utilidad del 99mTc-tetrofosmin en el diagnóstico de tumoraciones pulmonares. Valoración preliminar.

We conducted a preliminary study of captation of the new radiopharmaceutical 99mTc-tetrofosmin in cases of primary carcinoma of the lung, analyzing the results of 5 cases studied before surgery with single photon emission tomography (SPECT) of the lung. The results obtained by imaging were compared with those from surgery. Tumor size ranged between 3.5 and 9 cm. In all cases the images showed that captation of the radiotracer by the neoplasm was satisfactory, leaving the area of the tumor clearly distinguishable from normal adjacent lung tissue and giving no signs of interference caused by absorption of 99mTc-tetrofosmin by contiguous structures (heart or liver). Based on these preliminary results we assert that SPECT of the lung using 99mTc-tetrofosmin may be useful in the clinical diagnosis of malignant lung tumors, although further research must determine to what extent the technique can be relied upon.