Shielding behavior of artisanal bricks against ionizing photons.

In the work reported in this article, were determined the shielding capabilities of three artisanal bricks used massively in the construction industry in Mexico. The linear attenuation coefficients for photons between 1 keV and 100 GeV are reported; and the half-value layers for energies used in the medical field, show that the three typical artisanal bricks have good shielding capabilities for photons below 50 keV. We compared the effective atomic numbers of one of our bricks against two widely used materials in the construction industry, and our results suggest that the greater the effective atomic number, the less material attenuation capacity. A comparison of the half-value layer of one of our bricks against the half-value layers of two clay bricks with different percentages of fly ash particles published in the literature, suggests that in the region between 0.001 and 2.8 MeV, all the three bricks have practically the same attenuation capacity and that from 2.8 MeV to 100 GeV the clay bricks with different percentages of fly ash particles, need less material to show the same attenuation capacity than our artisanal bricks. Energy Dispersed X-Ray Fluorescence suggests that regardless of the number of constituent elements in a sample, a critical mass per atom is required to have a positive impact on density; and as a consequence, in the capacity of attenuation of the materials. Normalized half-value layers suggest on the other hand, that the uncooked bricks have better shielding capabilities than cooked.

Acaricidal activity of Metarhizium anisopliae isolated from paddocks in the Mexican tropics against two populations of the cattle tick Rhipicephalus microplus.

The acaricidal effects of 55 strains of Metarhizium anisopliae (Metschnikoff) Sorokin, 1883 (Hypocreales: Clavicipitaceae) isolated from paddocks of cattle farms were evaluated in two Rhipicephalus microplus (Canestrini 1887) (Ixodida: Ixodidae) populations, of which one was multi-resistant and one was susceptible to chemical acaricides. Percentage mortality and reproductive efficiency indices in R. microplus were evaluated by adult immersion tests at a dose of 1 × 108 conidia/mL for each fungal strain. Some strains were selected to calculate lethal concentrations to kill 50% (LC50 ) and 99% (LC99 ) of engorged ticks. Strains MaV22, MaV26 and MaV55 induced 100% mortality in R. microplus on day 14. Strains MaV05, MaV09 and MaV22 caused mortality of >90% from day 12 onward in both tick populations. The most effective acaricidal fungal strain, MaV55, inhibited egg laying by 54.86 and 55.86% in acaricide-resistant and -susceptible R. microplus populations, respectively. None of the fungal strains had statistically significant effects on larval hatching. In conclusion, nine strains of M. anisopliae demonstrated high acaricidal effects against R. microplus and reduced its egg laying. No differences in acaricidal effects were observed between the two populations of ticks tested.

Medication adherence in patients who undergo cardiac transplantation.

BACKGROUND: Heart transplant patients are required to take medication for life, both immunosuppressants to prevent rejection and any required for other illnesses. Treatment compliance can be measured quantitatively or qualitatively. Compliance measurement is not easy owing to different factors. The aim of this study was to assess the prevalence of therapeutic compliance in heart transplant patients. METHODS: We undertook a cross-sectional observational descriptive study. The sample comprised patients who received a heart transplant from 2001 to 2011. Of the 203 patients in total, we studied 99. We used the Morisky-Green test as an indirect method and recorded the immunosuppressant blood levels as a direct method. RESULTS: The mean age of the patients was 50 ± 12 years, and 84% were male. According to the Morisky-Green test, 33% of the patients were noncompliant, of whom 30% said they rarely forgot to take their medication. Patients took an average of 8 ± 3 drugs per day, but only 85% knew what the drugs were for; 24% of the patients had grade 3A rejection, and 65% had graft vessel disease. CONCLUSIONS: Transplanted patients in this study showed a high level of therapeutic adherence that did not differ from other transplant series, either cardiac or other organs, nor from other chronic diseases. The results for defaulters were higher than that expected from these patients. The defaulter results were expected to be lower, given the information that the patients were supposed to have, both before and after the transplantation, and with the strict medical monitoring. Therefore, we have to stress therapeutic compliance, both medical and dietary-hygiene measures, and seek new strategies to improve the results.

Efectividad y seguridad del régimen FLAG-IDA en leucemias agudas resistentes o recidivantes / Effectiveness and safety of the FLAG-IDA regimen in acute refractory or recurrent leukaemia

Objetivo: Evaluar la efectividad y seguridad del esquema FLAG-IDA en pacientes con leucemias agudas refractarias o recidivantes. Método Estudio observacional descriptivo retrospectivo en el que se revisaron las historias clínicas de pacientes con el esquema FLAG-IDA en el periodo 2005-2010. La efectividad se evaluó mediante la respuesta objetiva, el intervalo libre de progresión y la supervivencia global. La seguridad se midió según el sistema de clasificación NCI, Criterios comunes de Toxicidad para Acontecimientos Adversos. Resultados Fueron 12 pacientes (52,17 ± 8,26 años entre las mujeres y 54,83 ± 7,22 años en los hombres), 11casos fueron leucemias mieloides agudas (5 resistentes, 3 en recaída, una secundaria a leucemia mieloide crónica (LMC) resistente y 2 secundarias a síndrome mielodisplásico (SMD), de las que una fue resistente y la otra no había sido tratada previamente) y un caso de leucemia linfoide aguda (LLA) resistente. Seis pacientes (50%) alcanzaron una respuesta completa (RC). Un paciente consiguió una respuesta parcial (RP) tras la cual se administró otro protocolo indicado consiguiendo posteriormente una RC, 2 fallecieron por progresión de la enfermedad y 3 por complicaciones secundarias al tratamiento. El intervalo libre de progresión para los pacientes que alcanzaron la RC fue de 24,38 semanas (6 meses). La mediana de supervivencia global fue de 8,4 semanas. La media del tiempo necesario para la recuperación de la neutropenia fue de 23 y 37 días en el primer y segundo ciclo respectivamente. La media del tiempo necesario para la recuperación de la trombocitopenia fue de 24 y 35 días en cada ciclo. Conclusiones El esquema de inducción FLAG-IDA para el tratamiento de pacientes con leucemias de alto riesgo es un esquema establecido, bien tolerado y con una toxicidad aceptable que ofrece una oportunidad para optar al trasplante de progenitores hematopoyéticos (AU)

Objective: To evaluate the effectiveness and safety of the FLAG-IDA regimen in patients with acute refractory and/or recurrent leukaemia. Method: Descriptive, retrospective, observational study of the clinical histories of patients with the FLAG-IDA regimen during the period of 2005-2010. Effectiveness was measured using objective response, progression-free interval, and global survival. Safety was measured using the NCI classification system of common toxicity criteria for adverse events. Results: We registered 12 patients (52.17±8.26 years in women, and 54.83±7.22 years in men),11 cases were acute myeloid leukaemia (5 refractory, 3 in recurrence, 1 secondary to chronicre fractory myeloid leukaemia (CML) and 2 secondary to myelodysplastic syndrome (MDS), one of which was refractory and the other had not been previously treated) and one case was acuterefractory lymphoblastic leukaemia (ALL). Six patients (50%) reached a complete response (CR).One patient reached a partial response (PR), which was followed by another protocol that produced a CR, two died due to disease progression, and three due to secondary complications from treatment. The progression-free interval for patients that reached a CR was 24.38 weeks (6 months).Median global survival was 8.4 weeks. Mean time needed for the recovery of neutropenia was 23 and 37 days in the first and second cycle, respectively. The mean time required for recuperation of thrombocytopenia was 24 and35 days in each cycle. Conclusions: The FLAG-IDA induction regimen for the treatment of high-risk leukaemia patients is an established protocol, with good tolerance and acceptable toxicity levels that offers an opportunity for facilitating the transplantation of haematopoietic progenitors (AU)

[Effectiveness and safety of the FLAG-IDA regimen in acute refractory or recurrent leukaemia]. / Efectividad y seguridad del régimen FLAG-IDA en leucemias agudas resistentes o recidivantes.

OBJECTIVE: To evaluate the effectiveness and safety of the FLAG-IDA regimen in patients with acute refractory and/or recurrent leukaemia. METHOD: Descriptive, retrospective, observational study of the clinical histories of patients with the FLAG-IDA regimen during the period of 2005-2010. Effectiveness was measured using objective response, progression-free interval, and global survival. Safety was measured using the NCI classification system of common toxicity criteria for adverse events. RESULTS: We registered 12 patients (52.17±8.26 years in women, and 54.83±7.22 years in men), 11 cases were acute myeloid leukaemia (5 refractory, 3 in recurrence, 1 secondary to chronic refractory myeloid leukaemia (CML) and 2 secondary to myelodysplastic syndrome (MDS), one of which was refractory and the other had not been previously treated) and one case was acute refractory lymphoblastic leukaemia (ALL). Six patients (50%) reached a complete response (CR). One patient reached a partial response (PR), which was followed by another protocol that produced a CR, two died due to disease progression, and three due to secondary complications from treatment. The progression-free interval for patients that reached a CR was 24.38 weeks (6 months). Median global survival was 8.4 weeks. Mean time needed for the recovery of neutropenia was 23 and 37 days in the first and second cycle, respectively. The mean time required for recuperation of thrombocytopenia was 24 and 35 days in each cycle. CONCLUSIONS: The FLAG-IDA induction regimen for the treatment of high-risk leukaemia patients is an established protocol, with good tolerance and acceptable toxicity levels that offers an opportunity for facilitating the transplantation of haematopoietic progenitors.

Uso de la PET-18F-FDG en pacientes con sospecha de recurrencia de cáncer diferenciado de tiroides por anticuerpos anti-tiroglobulina elevados y rastreo 131I negativo / Use of 18FFDG-PET in patients with suspicion of recurrent differentiated thyroid cancer by elevated antithyroglobulin antibodies levels and negative 131I scan

Objetivo. Valorar la utilidad de los estudios PET-18F-FDG en el seguimiento de los pacientes diagnosticados de carcinoma diferenciado de tiroides que presentan riesgo de enfermedad y niveles de tiroglobulina (Tg) no interpretables por la presencia de anticuerpos antitiroglobulina (AbTg). Material y métodos. Estudio retrospectivo de 7 mujeres con edad media de 40 años y diagnóstico histológico de cáncer diferenciado de tiroides (7 carcinomas papilares) que fueron remitidos a nuestro servicio para la realización de estudio PET-18F-FDG por sospecha de enfermedad, debido a rastreo 131I negativo y niveles de AbTg elevados, entre los años 2002 y 2007. Se les realizaron 11 exploraciones PET tras la inyección de 370-434 MBq de 18F-FDG en condiciones de normoglucemia y previa administración de relajante muscular, hidratación y furosemida. Los resultados de la PET se confirmaron por histología y/o por evolución clínico radiológica, con un período de seguimiento mínimo de 24 meses. Resultados. La prevalencia de la recurrencia de la enfermedad en la población estudiada fue del 57,14%. Todas las pacientes presentaban niveles de Tg inferiores a 3 ng/dl y AbTg superiores a 200 UI/ml. Tres pacientes presentaban antecedentes de tiroiditis. De los 11 estudios realizados la PET fue negativa en tres y positiva en 8. Se descartó la existencia de enfermedad en 3 pacientes mientras que en 4 pacientes la PET permitió localizar con éxito la existencia de recidiva. Conclusión. La PET-18F-FDG es una técnica útil para localizar enfermedad, así como para descartar la existencia de recurrencia con una elevada seguridad diagnóstica, en pacientes con antecedentes de carcinoma diferenciado de tiroides con rastreo 131I negativo, pero con elevación patológica de anticuerpos AbTg(AU)

Aim. To evaluate the utility of 18FFDG-PET for patients diagnosed of differentiated thyroid carcinoma who present risk of disease and invaluable levels of thyroglobulin (Tg) by the presence of antibodies antithyroglobulin (AbTg). Material and methods. Retrospective study of 7 women of 40 years old and histological diagnosis of differentiated thyroid cancer (7 papillary tumours) that were sent to our department for the accomplishment of18FFDG-PET study because of suspicion of disease, due to 131I negative and high levels of AbTg, between the year 2002 and 2007. 11 PET scans were obtained after the intravenous injection of 370-434 MBq of 18FFDG in normoglycemia conditions and previous administration of muscle relaxant, hydration and diuretic. The results of 18FFDG-PET scans were confirmed by pathologic examination or clinical outcome and radiographic examination for more than 24 months. Results. The prevalence of recurrence in our population was 57.14%. All patients presented levels of Tg lower than 3 ng/dl and AbTg superior to 200 UI/ml. Three patients had precedent thyroiditis. Out of 11 scans performed 3 of them were negative and 8 cases were found positive. It ruled out the existence of disease in three patients and localized the presence of recurrence in 4 patients. Conclusion. 18FFDG-PET Conclusion. CONCLUSION: 18F-FDG-PET is a useful diagnostic tool for the detection of recurrence as well as to rule out the existence of disease with a high accuracy, in patients with differentiated thyroid carcinoma with 131I whole body scan negative but with pathological elevation of antithyroglobulin antibodies(AU)

[Use of 18F FDG-PET in patients with suspicion of recurrent differentiated thyroid cancer by elevated antithyroglobulin antibodies levels and negative ¹³¹I scan]. / Uso de la PET-18F-FDG en pacientes con sospecha de recurrencia de cáncer diferenciado de tiroides por anticuerpos anti-tiroglobulina elevados y rastreo ¹³¹I negativo.

AIM: To evaluate the utility of (18F)FDG-PET for patients diagnosed of differentiated thyroid carcinoma who present risk of disease and invaluable levels of thyroglobulin (Tg) by the presence of antibodies antithyroglobulin (AbTg). MATERIAL AND METHODS: Retrospective study of 7 women of 40 years old and histological diagnosis of differentiated thyroid cancer (7 papillary tumours) that were sent to our department for the accomplishment of(18F)FDG-PET study because of suspicion of disease, due to ¹³¹I negative and high levels of AbTg, between the year 2002 and 2007. 11 PET scans were obtained after the intravenous injection of 370-434 MBq of (18F)FDG in normoglycemia conditions and previous administration of muscle relaxant, hydration and diuretic. The results of (18F)FDG-PET scans were confirmed by pathologic examination or clinical outcome and radiographic examination for more than 24 months. RESULTS: The prevalence of recurrence in our population was 57.14%. All patients presented levels of Tg lower than 3 ng/dl and AbTg superior to 200 UI/ml. Three patients had precedent thyroiditis. Out of 11 scans performed 3 of them were negative and 8 cases were found positive. It ruled out the existence of disease in three patients and localized the presence of recurrence in 4 patients. CONCLUSION: (18F)FDG-PET CONCLUSION: 18F-FDG-PET is a useful diagnostic tool for the detection of recurrence as well as to rule out the existence of disease with a high accuracy, in patients with differentiated thyroid carcinoma with ¹³¹I whole body scan negative but with pathological elevation of antithyroglobulin antibodies.

Validación del renograma con estímulo diurético inmediato / Validation of the renogram with immediate diuretic stimulus

Objetivo El objetivo de este estudio es determinar la fiabilidad diagnóstica del renograma con estímulo diurético a la vez que la administración de la dosis comparando dos grupos de 59 pacientes cada uno (F0 y F+10) para identificar a aquellos pacientes susceptibles de ser tratados con cirugía. Material y métodos Estudio retrospectivo de dos grupos de 59 pacientes cada uno a los que se les efectuó renograma con estímulo diurético (furosemida) por sospecha de obstrucción ureteropiélica o ureterovesical, utilizando 99mTc-mercaptoacetylglicina. En el primero se aplicó el estímulo diurético a los 600 s de la administración de la dosis del radiotrazador (F+10). En el segundo se efectuó simultáneamente a la administración de la dosis (F0). Para la interpretación se valoró el análisis visual de las imágenes, los parámetros de las curvas y el porcentaje de eliminación tras modificación con la gravedad y micción. Se realizó análisis estadístico de los datos. Resultados El renograma F+10 muestra una sensibilidad del 96,7%, especificidad del 96,1%, valor predictivo positivo del 90,6% y valor predictivo negativo del 98,6%. El renograma F0 muestra una sensibilidad del 95,2%, especificidad del 98,9%, valor predictivo positivo del 95,2% y valor predictivo negativo del 98,9%. Conclusión La realización de renograma mediante la administración de estímulo diurético al mismo tiempo que la administración del radiofármaco es un método útil y cómodo en pacientes de edad pediátrica, y no supone una merma significativa en los parámetros de eficacia de la prueba en la selección de pacientes para intervención quirúrgica(AU)

Objective The aim of this study is to determine the diagnostic reliability of the renogram with diuretic stimulus simultaneously at the administration of the dose, comparing two groups of 59 patients each one (F0 and F+10), to select patients for surgery. Material and Methods This is an retrospective study about two groups of 59 patients to whom the diuretic renogram was carried out by stimulus (furosemide), by suspicion of ureteropelvic or vesicoureteral obstruction, using 99mTc-Mercaptoacetylglicine. In the first one, the study was conducted applying the diuretic stimulus 600 seconds after the administration of the dose of the radiotracer (F+10). In the second one it was carried out simultaneously to the administration (F0). For the interpretation there was used the visual analysis, the parameters of the curves and the percentage of elimination after modification by the severity and micturition. Statistical analysis of the information was made. Results The F+10 renogram shows a sensitivity of 96,7%, specificity of 96,1%, positive predictive value of 90,6%, and a negative predictive value of 98,6%. The F0 renogram shows a sensitivity of 95,2%, specificity of 98,9%, positive predictive value of 95,2%, and a negative predictive value of 98,9%. Conclusion The performance of renogram by means of the administration of diuretic stimulus at the same time as the administration of the radiotracer is a useful and comfortable method in paediatric patients, not supposing a significant wastage in the parameters of efficiency of the test in the patients selection for surgery(AU)

Adenoma tóxico como causa de hipertiroidismo en la infancia. Diagnóstico y tratamiento / Toxic adenoma as cause of hyperthyroidism in childhood. Diagnosis and treatment

El adenoma tóxico es una causa frecuente de hipertiroidismo en la edad adulta. No obstante, su baja prevalencia en la infancia hace de ésta una patología de especial interés, siendo motivo de discusión en la actitud terapéutica dado su mayor riesgo de malignidad. Describimos el caso de una paciente de 9 años de edad con una tumoración cervical anterior. En el estudio se detecta nódulo tiroideo hiperfuncionante con elevación de T3L, con diagnóstico definitivo de adenoma tóxico tiroideo en la anatomía patológica (AU)

The toxic adenoma is a common cause of hyperthyroidism in adulthood. However, its low prevalence in childhood makes it a condition of particular interest to be a matter of discussion in the therapeutic attitude due to its increased risk of malignancy. We describe the case of a 9 year-old patient with an anterior cervical tumour. The study detected thyroid nodule hiperfuncionante with elevated T3L, with a definitive diagnosis of toxic thyroid adenoma in the pathology (AU)

[Bone metastases from unknown primary. FDG-PET detection of two synchronous tumors]. / Metástasis óseas de tumor primario desconocido. Detección mediante PET-FDG de dos tumores sincrónicos.

A 60-year-old woman presented with noncardiac chest pain over months and negative laboratory findings. Conventional imaging methods and bone scintigraphy detected bone lesions suggesting metastatic disease from an unknown primary tumor. An 18FDG-PET scan performed to orient the search for the primary tumor found focal lesions suggesting lymphoma and identified a focal thyroid lesion and a cervical lymph node accessible for biopsy. The biopsy of this lymph node incidentally detected a papillary differentiated thyroid cancer (DTC), since the existence of a non-Hodgkin's lymphoma was confirmed after a new biopsy. After confirming the presence of a lymphoma, 18FDG-PET enabled the initial staging of the tumor, the evaluation of the response to treatment, and follow-up for detection of recurrence. On the other hand, 18FDG-PET incidentally detected a DTC.

Metástasis óseas de tumor primario desconocido. Detección mediante PET-FDG de dos tumores sincrónicos / Bone metastases from unknown primary. Fdg-pet detection of two sincronic tumors

Paciente mujer de 60 años con dolor torácico características mecánicas de meses de evolución y determinaciones analíticas dentro de la normalidad. Los estudios morfológicos y la gammagrafía ósea detectaron lesiones óseas sugestivas de afectación metastásica de un tumor de origen desconocido, por lo que se solicitó una exploración con tomografía por emisión de positrones con 2-18F-fluoruro-2-deoxi- D-glucosa (PET-FDG) con el objetivo de orientar la búsqueda del tumor primario. El estudio se informó como lesiones hipermetabólicas sugestivas de linfoma, mencionando la presencia de una lesión tiroidea hipermetabólica y de una adenopatía cervical accesible para la toma de biopsia. Dicha adenopatía detectó de forma incidental un cáncer diferenciado de tiroides (CDT) papilar, ya que posteriormente se confirmó la existencia de un linfoma no-Hodgkin tras la toma de una nueva biopsia. La PET-FDG, tras confirmar la existencia de un linfoma, permitió su estadificación inicial, así como valorar la respuesta al tratamiento y realizar su seguimiento. Por otro lado, detectó de forma incidental la existencia de un CDT

A 60-year-old woman presented with noncardiac chest pain over months and negative laboratory findings. Conventional imaging methods and bone scintigraphy detected bone lesions suggesting metastatic disease from an unknown primary tumor. An 18FDG-PET scan performed to orient the search for the primary tumor found focal lesions suggesting lymphoma and identified a focal thyroid lesion and a cervical lymph node accessible for biopsy. The biopsy of this lymph node incidentally detected a papillary differentiated thyroid cancer (DTC), since the existence of a non-Hodgkin’s lymphoma was confirmed after a new biopsy. After confirming the presence of a lymphoma, 18FDG-PET enabled the initial staging of the tumor, the evaluation of the response to treatment, and follow-up for detection of recurrence. On the other hand, 18FDG-PET incidentally detected a DTC

Pacientes tratados por carcinoma diferenciado de tiroides con rastreos de 131I negativos y niveles de tiroglobulina elevada. Una evolución posible / Patients treated for differentiated thyroid cancer with negative 131i whole-body scanning and elevated thyroglobulin levels. A possible course

Objetivo. Constatar la existencia de pacientes con carcinoma diferenciado de tiroides (CDT) tratados que en el seguimiento presentan rastreos negativos con tiroglobulina (Tg) elevada y evolucionan hacia la normalización sin otras actuaciones terapéuticas.Material y métodos. Revisión retrospectiva de los exámenes periódicos de 725 pacientes con CDT, analizando los niveles de Tg sérica determinados con IRMA anualmente en tratamiento hormonal y cada 1-5 años en ausencia de tratamiento hormonal, previo a rastreos con 131I. Seguimiento mínimo de 2 años. Se seleccionaron y se analizaron las características de aquellos que presentaron en su evolución niveles elevadosde Tg (>3 ng/ml), rastreos negativos y otras pruebas de imagen negativas en los que se normalizó la cifra de Tg sin tratamiento médico-quirúrgico específico (grupo I), y de aquellos en los que no se normalizó la cifra de Tg (grupo II). Resultados. Se encontraron 130 pacientes (17,93 %) con niveles elevados de Tg y rastreos negativos. Grupo I: 31 pacientes (4,28 %), 11 hombres y 20 mujeres; edad media en el momento del diagnóstico de 33,4 años (rango: 5-60 años); seguimiento medio: 12,4 años (+/-7,4). Histología: 27 tumores papilares, 4 foliculares. Dosis media de ablación 3,260 GBq (88,1 mCi); dosis total media de 131I 6,850 GBq (185,13 mCi). Normalización de la Tg en una media de 8,2 años. Grupo II: 99 pacientes (13,65 %), 27 hombres y 72 mujeres; edad media de 40,4 años (rango 7-76); seguimiento medio: 9,8 años (rango 2-28 años). Histología: 86 tumores papilares y 13 tumores foliculares. Dosis media de ablación de 3,266 GBq (88,28 mCi) y dosis total media de 9,363 GBq (253,06 mCi). Dos de los pacientes del grupo I presentaron fluordesoxiglucosa-F18 (PETFDG) negativo. Se detectaron 13 pacientes en los que se constató un descenso progresivo de los niveles de Tg sin llegar a la normalización con PET-FDG negativo. Conclusiones. En pacientes con CDT irradiado, es posible la normalización diferida de los niveles de la Tg. Los tratamientos empíricos no pueden ser considerados como único factor que contribuye a este resultado

Objective. To verify the existence of patients with treated differentiated thyroid cancer (DTC) with negative 131I whole-body scanning (WBS) and high serum thyroglobulin (Tg) in the follow-up who evolve towards normalization without other therapy interventions. Material and methods. Retrospective revision of the periodic examinations established in the protocol for patients with DTC, analyzing the levels of Tg found with IRMA annually in those with hormonal treatment and every 1-5 years in absence of previous hormonal treatment to WBS. Minimum surveillance of 2 years. Those who had elevated levels of Tg and WBS and other negative imaging tests in their course were selected. The characteristics of the patients selected were analysed in those whose Tg levels evolved to normalization without specific medical or surgical treatment (Group I) and those who did not reach normalization of Tg (Group II). Results. A total of 130 patients (17.93 %) with high levels of Tg and negative WBS were detected. Group I: 31 patients (4.28 %), 11 men and 20 women; average age at the moment of the diagnosis of 33.4 years (rank: 5-60); average surveillance: 12.4 years (+/-7.4). Histology: 27 papillary and 4 follicular carcinoma. Average ablation dose: 3.260 GBq (88,1 mCi); average total I131 dose: 6.850 GBq (185.13 mCi). Tg normalization average time: 8.2 years. Group II: 99 patients (13.65 %), 27 men and 72 women. Average age of 40.4 years (rank: 7-76). Average surveillance: 9.8 years. Histology: 86 papillary and 13 follicular carcinoma. Average ablation dose: 3.266 GBq (88.28 mCi); average total 131I dose: 9.363 GBq (253,06 mCi). Two of the patients in group I had negative PET-FDG. There were 13 patients in whom progressive reduction of the levels of thyroglobulin without reaching normalization with negative PET-FDG was detected. Conclusions. In patients with radiated DTC, deferred normalization of the levels of the serum thyroglobulin is possible. Empirical treatments cannot be considered the only factor that contributes to this result, which can occur without the administration of high-doses of 131I

[Patients treated for differentiated thyroid cancer with negative 131I whole-body scans and elevated thyroglobulin levels: a possible course]. / Pacientes tratados por carcinoma diferenciado de tiroides con rastreos de 131I negativos y niveles de tiroglobulina elevada. Una evolución posible.

OBJECTIVE: To verify the existence of patients with treated differentiated thyroid cancer (DTC) with negative 131I whole-body scanning (WBS) and high serum thyroglobulin (Tg) in the follow-up who evolve towards normalization without other therapy interventions. MATERIAL AND METHODS: Retrospective revision of the periodic examinations established in the protocol for patients with DTC, analyzing the levels of Tg found with IRMA annually in those with hormonal treatment and every 1-5 years in absence of previous hormonal treatment to WBS. Minimum surveillance of 2 years. Those who had elevated levels of Tg and WBS and other negative imaging tests in their course were selected. The characteristics of the patients selected were analysed in those whose Tg levels evolved to normalization without specific medical or surgical treatment (Group I) and those who did not reach normalization of Tg (Group II). RESULTS: A total of 130 patients (17.93 %) with high levels of Tg and negative WBS were detected. Group I: 31 patients (4.28 %), 11 men and 20 women; average age at the moment of the diagnosis of 33.4 years (rank: 5-60); average surveillance: 12.4 years (+/- 7.4). HISTOLOGY: 27 papillary and 4 follicular carcinoma. Average ablation dose: 3.260 GBq (88,1 mCi); average total I131 dose: 6.850 GBq (185.13 mCi). Tg normalization average time: 8.2 years. Group II: 99 patients (13.65 %), 27 men and 72 women. Average age of 40.4 years (rank: 7-76). Average surveillance: 9.8 years. HISTOLOGY: 86 papillary and 13 follicular carcinoma. Average ablation dose: 3.266 GBq (88.28 mCi); average total 131I dose: 9.363 GBq (253,06 mCi). Two of the patients in group I had negative PET-FDG. There were 13 patients in whom progressive reduction of the levels of thyroglobulin without reaching normalization with negative PET-FDG was detected. CONCLUSIONS: In patients with radiated DTC, deferred normalization of the levels of the serum thyroglobulin is possible. Empirical treatments cannot be considered the only factor that contributes to this result, which can occur without the administration of high-doses of 131I.

Evidencia científica del tratamiento hormonal sustitutivo en la actualidad / Scientific evidence of the hormonal substitute treatment at present

Hasta épocas recientes, en España la sintomatología que acontecía durante el periodo de la menopausia (sofocos, sudores, cambios en el carácter, etc) se consideraban como achaques propios de la edad y por tanto sin necesidad de tratamiento, sin tener en cuenta que la menopausia por el contrario es una larga etapa de la mujer que en muchas ocasiones precisa de tratamiento. Se ha insistido reiteradamente que la Terapia Hormonal Sustitutiva (THS) es enormemente eficaz en la osteoporosis y en la cardiopatía isquémica. España es uno de los países de la Unión Europea con menor porcentaje de uso de THS, aproximadamente un 5% de la población susceptible de tratamiento, a diferencia de la media Europea establecida en un 20%. Se analiza en este estudio la evidencia científica publicada sobre el uso de THS

Until recent times, in Spain the symptoms that happened during the periodo f the menopause (hot flashes, sweating, change in the character, etc) they were considered like ailments characteristics of the age and therefore without treatment necessity, without keeping in mind that the menopause on the contrary is the woman’s long stage that she specifies treatment in many occasions. Repeatedly has been insisted that the Hormone Replacement Therapy. It is vastly effective in the Osteoporosis and in the coronary heart disease. Spain is one of the countries of the European Union with smaller percentage of user of THS, approximately the susceptible population’s of treatment 5%, contrary to the European stocking settled down in 20%. There is analyzed in this study the scientific evidence published on THS’s use

Autonomía y estado de salud percibidos en ancianos institucionalizados / Autonomy and health status perceived by elderly institutionalised people

El ingreso en residencias ha sido denominado con el concepto de institucionalización, para diferenciarlo de la atención comunitaria y denotar su carácter de especialización. Los ancianos válidos al ingreso en un centro dejan de realizar tareas por un mecanismo de ajuste de su conducta a la vez que pueden adoptar una actitud pasiva; efecto generador de dependencia. Todos los ancianos al ingresar por primera vez en un centro geriátrico se someterán a un período de adaptación y observación establecido en 20 días tras el cual será valorado por una comisión técnica. En un estudio anteriormente realizado en la misma población se pudo constatar, refiriéndonos a la capacidad funcional traducida en AVD e AIVD y a la percepción de la salud de los residentes, durante los primeros 20 días de ingreso (período de adaptación), que los resultados muestran la existencia de una relación significativa entre la autonomía e independencia de un anciano y su deterioro debido a la institucionalización, a la vez se deduce que los mayores durante dicho período de adaptación no sufren cambios significativos en su percepción de salud por el hecho de la institucionalización, si bien es cierto que dicho período es sólo de 20 días según la Legislación sobre Servicios Sociales en Andalucía y no hay tiempo suficiente para evidenciar los cambios. Al creer necesario un seguimiento más a largo plazo, se pretende hacer una segunda valoración de los aspectos anteriormente mencionados y medidos tras pasar un período lo suficientemente amplio (año y medio) como para poder constatar si persiste o no el deterioro en la autonomía e independencia de los mayores para la realización de actividades de la vida diaria e instrumentales, así como si se mantiene su percepción de salud. Objetivo: Evaluar la influencia que ejerce la institucionalización en la autonomía de un anciano en el momento de su ingreso en una residencia geriátrica de válidos y compararlo con el obtenido tras año y medio de institucionalización. Método: Diseño pre-experimental con estudio pretest-postest de un solo grupo en dos momentos diferentes, es decir, medición previa y posterior a una intervención, que en este caso sería el tiempo. Variables dependientes: Grado de Autonomía: Medir la capacidad del anciano/a referente a actividades cotidianas mediante el Índice de Barthel, Actividades Básicas dela Vida Diaria (ABVD) y el de Lawton, Actividades Instrumentales de la Vida Diaria (AIVD). Variable Independiente: Ingreso del anciano/a en la Institución. Es la variable que pueda modificar o no su grado de autonomía. Variables sociodemográficas: Edad, sexo, procedencia, estado civil, capacidad adquisitiva, motivo de ingreso. Conclusiones: Dentro de una institución el programa de adaptación del anciano debería tener como prioridad la adaptación organizativa del centro a las verdaderas necesidades de los usuarios, no al revés, implicando en este proceso siempre a la familia… todo en pro de fomentar en todo momento la autonomía tanto física como psicológica del anciano

The admission to a residence has been termed “institutionalization ”in order to differentiate it from community care and to emphasize its nature as a specialisation. On admission to a centre, old people who are not invalid cease to perform certain tasks due to an adjustment process, which can result in passive behaviour; this in turn creates dependency. All old people, when enter a geriatric centre for the first time, undergo a period of adaptation and observation that lasts 20 days, after which they are evaluated by a technical committee. In a study previously made in the same population it was possible to be stated, referring us to the translated functional capacity in AVD and AIVD and to the perception of the health of the residents, during the first 20days of entrance (period of adaptation) that the results show the existence of a significant relation between the autonomy and independence of an old person and a its deterioration due to the institutionalization, simultaneously it is deduced that the elder during this period of adaptation do not undergo significant changes in their perception of health by the fact of the institutionalization, although is certain that this period is only of 20 days according to the Legislation of the Social Services in Andalusia and that is not enough time to demonstrate the changes. Believing necessary a pursuit but in the long term, we tried to make a second valuation of the aspects previously mentioned and measured after passing a sufficiently ample period (year and a half) like being able to state if the deterioration persists or not in the autonomy and independence of the elderly people to perform daily life and instrumental activities, as well as if their perception of health stays. Objective: To evaluate the influence of institutionalization on an old person’s autonomy on admittance to a geriatric residence for non-invalids, and the comparison with their behaviour after the period of a year and a half of institutionalization. Methods: A pre-experimental design with a pre- and posttest study of a single group during two different periods, that is to say, a measurement before and after of an intervention which in this case is defined as time. Dependent variables: Level of Autonomy. To measure the capacity of an old person in relation to everyday activities using the Barthel Scale (ABVD) Basic Activities of Daily Life; and the Lawton Scale (AIVD) Instrumental Activities of Daily Life. Independent variable: Admission of the old person into the Institution. This is the variable that could modify, or otherwise, the level of autonomy. Socio-demographic variables: Age; sex; background; civil status; acquisitive capability; reason for admission. Conclusions: Within the programme of adaptation in an institution, priority must be given to the organizational adaptation of the centre to the needs of the users and not the contrary. The user’s family should be involved as much as possible in order to preserve the physical and psychological autonomy of the old person at all times

Axisymmetric bubble pinch-off at high Reynolds numbers.

Analytical considerations and potential-flow numerical simulations of the pinch-off of bubbles at high Reynolds numbers reveal that the bubble minimum radius, rn, decreases as tau proportional to r2n sqrt[1lnr2n], where tau is the time to break up, when the local shape of the bubble near the singularity is symmetric. However, if the gas convective terms in the momentum equation become of the order of those of the liquid, the bubble shape is no longer symmetric and the evolution of the neck changes to a rn proportional to tau1/3 power law. These findings are verified experimentally.

Factores personales en la relación terapéutica / Personal factors in therapeutic relationship

El principal instrumento de trabajo en Salud Mental es la relación con otro, pero ésta está mediatizada por la posición tanto del observador como del observado. Toda ciencia en situación de observación se compone al menos de cuatro elementos: el observador, los fenómenos observados, la información buscada y el papel del observador. Los principales factores personales del profesional son: la orientación teórica, el uso del lenguaje, variables sociológicas e individuales. El artículo trata de reflejar todas estas variables y sus relaciones, para recordar a los profesionales la necesidad de controlarlas con el fin de paliar sus efectos, evitando el sesgo en la información recogida (AU)

Relationship with the other is the main instrument working in Mental Health Services, but it depends of the position of both observer and observed person. Every science that use observation consider four elements: the observer, the observed facts, the searched information and observer rol. Main personal factors of the professional are: theorical formation, language use and sociological and individual variables. This article describe these variables and their relations, to remember professionals that they must control them to palliate the effects, avoiding the bias when obtaining information (AU)

[F-18-fluordeoxyglucose positron emission tomography on patients with differentiated thyroid cancer who present elevated human serum thyroglobulin levels and negative I-131 whole body scan]. / PET con 18FDG en pacientes con cáncer diferenciado de tiroides que presentan niveles elevados de tiroglobulina sérica y rastreos con 131I negativos.

UNLABELLED: This study aimed to evaluate the role of Fluorine-18-fluorodeoxyglucose positron emission tomography (PET-FDG) in patients with elevated serum thyroglobulin (hTg) levels where thyroid cancer tissue does not concentrate radioiodine, rendering false-negative results on I-131 scanning. MATERIAL AND METHODS: Whole-body PET imaging using FDG was performed in 54 patients (37 female, 17 male) aged 17-88 years: 45 with papillary tumors and 9 with follicular tumors who were suspected of having recurrent thyroid carcinoma due to elevated thyroglobulin levels (hTg > 2 ng/ml) under thyroid-stimulating hormone (TSH > or = 30 microIU/ml) in whom the iodine scan was negative. All whole body scans were obtained with diagnostic doses (185 MBq). Whole body PET imaging was performed in fasting patients following i.v. administration of 370 MBq FDG while the patients were receiving full thyroid hormone replacement. Before PET, 99mTc methoxyisobutylisonitrile scintigraphy (99mTc-MIBI) was done in 14 patients and morphologic imaging in 26 by CT scan. RESULTS: Positive PET results confirmed the presence of hypermetabolic foci in 25/54 patients (46.29 %). Positive findings were found for PET-FDG in patients with hTg levels higher than 10 ng/ml receiving full thyroid hormone replacement. 99mTc-MIBI demonstrated lesions in 7/14 patients (50 %). PET-FDG and 99mTc-MIBI had congruent positive results in 4/7 patients. All the lesions found by CT were detected by PET-FDG, while recurrent disease was found in 12/21 patients with previous negative CT. CONCLUSIONS: These results suggest that PET-FDG seems to be a promising tool in the follow-up of thyroid cancer and should be considered in patients suffering from differentiated thyroid cancer with suspected recurrence and/or metastases by elevated thyroglobulin levels, and negative I-131 whole body scans. PET-FDG might be more useful at hTg levels > 10 ng/ml.

Pubertad precoz / Precocious puberty

A lo largo de los últimos años la Ginecología ha ido tomando un interés creciente por los problemas de los primeros años de la vida de la mujer. Si bien es cierto que la mayor parte de la patología femenina de esos años pertenece al campo de las malformaciones congénitas –muchas de las cuales sólo se diagnostican con motivo de la llegada de la pubertad o cuando consultan por esterilidad– es evidente que las niñas pueden consultar básicamente por los mismos problemas que las mujeres adultas (infecciones, tumores o sangrado genital anormal). El dolor es un síntoma subjetivo de difícil evaluación. Constituye uno de los motivos más frecuentes de consulta ginecológica junto con la hemorragia y la leucorrea. Es difícil marcar la diferencia entre dolor agudo y crónico, ya que según diversos criterios un dolor agudo puede ser aquel que dura desde unas horas a semanas. Nos parece más fácil diferenciar como dolor agudo aquel que motiva una consulta de urgencia, frente al crónico que puede ser visto de forma diferida en la consulta común (12, 33). El objeto del presente trabajo es el estudio de su etiología, diagnóstico y tratamiento

In last few years the study of adolescence gynaecology is increasing, and although the most frequent pathology is congenital, we can find the same pathology in adolescent as in the adult women, infections, tumours, menstrual problems. Pelvic acute and chronic pain in adolescence, is the most frequent consult next with bleeding and vaginal discharge. We can define pelvic acute pain as the pain that cause urgent consult, and the pelvic chronic pain, as the one that cause not urgent consult. The aim of this article is the study of aetiology, diagnosis and treatment of pelvic acute and chronic pain in adolescence

Tratamiento del hirsutismo en mujeres con síndrome de ovario poliquístico / Treatment of hirsutism in women with polycystic ovary syndrome

El hirsutismo es un grave problema estético de origen endocrino que precisa un enfoque cuidadoso y comprensivo hacia las mujeres que lo padecen. El objeto de este trabajo es presentar las perspectivas de tratamiento del hirsutismo

The hirsutism is a serious cosmetic problem, with endocrine aetiology, to need a careful and compressive approach to the women with him. The aims of this work is to present the new therapeutic perspectives of treatment of hirsutism