[Thalamic metabolism and neurological outcome after traumatic brain injury. A voxel-based morphometric FDG-PET study]. / Metabolismo talámico y situación neurológica tras un traumatismo craneoencefálico. Estudio mediante PET-FDG y morfometría basada en vóxel.

OBJECTIVE: to study the relationship between thalamic metabolism and neurological outcome in patients who had sustained a traumatic brain injury (TBI). METHODS: nineteen patients who had sustained a severe TBI and ten control subjects were included in this study. Six of the 19 patients had a low level of consciousness (vegetative state or minimally conscious state), while thirteen showed normal consciousness. All patients underwent a PET with 18F-FDG, 459.4 +/- 470.9 days after the TBI. The FDG-PET images were normalized in intensity, with a metabolic template being created from data derived from all subjects. The thalamic trace was generated automatically with a mask of the region of interest in order to evaluate its metabolism. A comparison between the two groups was carried out by a two sample voxel-based T-test, under the General Linear Model (GLM) framework. RESULTS: patients with low consciousness had lower thalamic metabolism (MNI-Talairach coordinates: 12, -24, 18; T = 4.1) than patients with adequate awareness (14, -28, 6; T = 5.5). Control subjects showed the greatest thalamic metabolism compared to both patients groups. These differences in metabolism were more pronounced in the internal regions of the thalamus. CONCLUSIONS: the applied method may be a useful ancillary tool to assess neurological outcomes after a TBI, since it permits an objective quantitative assessment of metabolic function for groups of subjects. Our results confirm the vulnerability of the thalamus to suffering the effects of the acceleration-deceleration forces generated during a TBI. It is hypothesized that patients with low thalamic metabolism represent a subset of subjects highly vulnerable to neurological and functional disability after TBI.

Metabolismo talámico y situación neurológica tras un traumatismo craneoencefálico. Estudio mediante PET-FDG y morfometría basada en vóxel / Thalamic metabolism and neurological outcome after traumatic brain injury. A voxel-based morphometric FDG-PET study

Objetivos: Estudiar la relación entre el metabolismo talámico y la situación neurológica en pacientes que han sufrido un traumatismo craneoencefálico (TCE). Material y métodos: Se incluyó a 19 pacientes que habían sufrido un TCE grave y 10 sujetos control. De los 19 pacientes, 6 presentaban un grado de alerta bajo (estado vegetativo o estado de mínima conciencia), mientras que 13 mostraban un grado de alerta normal. A todos los pacientes se les realizó una tomografía con emisión de positrones (PET) con 18-fluorodesoxiglucosa (18F-FDG) 459,4 ± 470,9 días después del TCE. Las imágenes de PET-FDG se normalizaron en intensidad, creándose posteriormente una plantilla metabólica del grupo entre todos los sujetos. El trazado talámico se generó automáticamente con una máscara de la región de interés. Se comparó el metabolismo talámico de los dos grupos de pacientes respecto al grupo control, para ello se utilizó un método de análisis basado en vóxel, con significación estadística, p < 0,05 corregido para múltiples comparaciones. Resultados: Los pacientes con grado de alerta bajo mostraron menor metabolismo talámico (coordenadas MNI-Talairach, 12, -24, 18; T = 4,1), con respecto a los sujetos control, que los pacientes con grado de alerta adecuado (14, -28, 6; T = 5,5). Estas diferencias en el metabolismo fueron más acentuadas en las regiones internas del tálamo. Conclusiones: La PET-FDG puede ser una herramienta útil para valorar la situación neurológica después de un TCE. El método utilizado permite una evaluación objetiva y cuantitativa de imágenes de PET-FDG para grupos de sujetos. Nuestros resultados confirman la vulnerabilidad del tálamo a sufrir los efectos de las fuerzas de aceleración-desaceleración generadas durante un TCE (AU)

Objective: To study the relationship between thalamic metabolism and neurological outcome in patients who had sustained a traumatic brain injury (TBI). Methods: Nineteen patients who had sustained a severe TBI and ten control subjects were included in this study. Six of the 19 patients had a low level of consciousness (vegetative state or minimally conscious state), while thirteen showed normal consciousness. All patients underwent a PET with 18F-FDG, 459.4 ± 470.9 days after the TBI. The FDG-PET images were normalized in intensity, with a metabolic template being created from data derived from all subjects. The thalamic trace was generated automatically with a mask of the region of interest in order to evaluate its metabolism. A comparison between the two groups was carried out by a two sample voxel-based T-test, under the General Linear Model (GLM) framework. Results: Patients with low consciousness had lower thalamic metabolism (MNI-Talairach coordinates: 12, -24, 18; T = 4.1) than patients with adequate awareness (14, -28, 6; T = 5.5). Control subjects showed the greatest thalamic metabolism compared to both patients groups. These differences in metabolism were more pronounced in the internal regions of the thalamus. Conclusions: The applied method may be a useful ancillary tool to assess neurological outcomes after a TBI, since it permits an objective quantitative assessment of metabolic function for groups of subjects. Our results confirm the vulnerability of the thalamus to suffering the effects of the acceleration-deceleration forces generated during a TBI. It is hypothesized that patients with low thalamic metabolism represent a subset of subjects highly vulnerable to neurological and functional disability after TBI (AU)

Técnicas de imagen multimodalidad / Multimodal imaging techniques

En la década de los noventa comenzó aplantearse a necesidad de combinar la información obtenida por las diversas técnicas de diagnóstico por la imagen (morfólogícas y funcionales) de forma que puediera disponerse simultáneamente d ela información morfofuncional proorcionada por amabas. Aunque al principio se ultilizaba el sofware con este propóstio, pronto comenzaron a emplearse equipos híbridos que realizaban esta misma función. Actualmente el SEPECT-TAC y el PET- TAC son los más utilizados. En el futuro, las te´cnicas de imagen multimodalidad van a ocupar un lugar predominante en e campo del diagnóstico por la imagen, fundamentalmente en oncología, cardiología, neruopsiquiat´ria y en los estudios experimentales con pequeños animales (AU)

The 1990s saw the need to combine the information obtained by the different imaging diagnosis techiques (morphological and functional) in such a way that the morpho-funtional information provided by both could be accessed simultaneosly. Although specially-designed software was used at the beginning, soon hybrid systems began to beused to carry out this same fuction. Today the SPECT-TAC and the PET-TAC are the msot widely used systems. In the future, multimodal imaging techniques will occupy a predominat place in the field of imaging diagnosis, basically in oncology, cardiology, neuropsychiatry and in experimental studies with small animals (AU)

¿Cómo perciben los profesionales de paliativos las necesidades espirituales del paciente al final de la vida? / No disponible

Objetivo: obtener datos empíricos sobre la detección y atención de las necesidades espirituales en las unidades de cuidados paliativos españolas. Método: se ha diseñado un cuestionario anónimo ad hoc autoadministrado, del cual se han distribuido 1.200 ejemplares a través de la revista Medicina Paliativa a profesionales con experiencia paliativa de toda la geografía española. Los cuestionarios incluían cuestiones sobre la detección, valoración e intervención sobre necesidades espirituales de los pacientes al final de la vida. Se han recibido 202 cuestionarios cumplimentados correspondientes a una muestra de 72 médicos, 73 enfermeras y el resto psicólogos, trabajadores sociales, sacerdotes y voluntarios. Los datos han sido analizados cualitativamente mediante un análisis sistemático de contenido y cuantitativamente mediante análisis estadístico. Resultados: el ratio de retorno ha sido de un 17%. De los 202 cuestionarios analizados, un 31% de los participantes manifiesta tener bastante o mucha dificultad en la identificación de las expresiones de necesidades espirituales escuchadas a sus pacientes. El 28% expresa que todos o la mayoría de sus pacientes manifiestan preocupaciones espirituales, un 56% afirma que sólo una minoría de sus pacientes lo hace. Un 40% de los profesionales expresa que se siente con pocos o escasos recursos para responder a estas situaciones donde el enfermo expresa sufrimiento de origen espiritual. Un 23% manifiestan que los aspectos espirituales son tratados regularmente dentro de las sesiones de trabajo del equipo multidisciplinar, mientras que un 63% expone que los mismos no se abordan nunca o prácticamente nunca en las sesiones clínicas del equipo. El 39% de los participantes expresa que siempre o casi siempre habla de la muerte con sus pacientes, sin embargo un 43% indica que no lo hace nunca o prácticamente nunca. Del análisis cualitativo, se propone una taxonomía con 12 tipos de necesidades existenciales-espirituales, basadas en las 463 expresiones textuales de los propios pacientes tal y como son recogidas por sus cuidadores. Esta categorización empírica ofrece pistas para estructurar la atención a la dimensión espiritual en los pacientes al final de la vida. Conclusión: los datos encontrados sugieren que, en general, las necesidades existenciales-espirituales no están debidamente atendidas en las unidades de cuidados paliativos de nuestro país. Los profesionales sanitarios suelen mostrar un nivel de concienciación insuficiente respecto a la detección de las preocupaciones espirituales y, por tanto, se percibe una incapacidad de atención adecuada, y dificultad para abordar o discutir estas cuestiones en las sesiones clínicas de los equipos

Objective: to collect empirical evidence about the identification and care of spiritual needs for patients in palliative care units. Method: an anonymous questionnaire was designed and 1200 copies were distributed through the Medicina Paliativa journal to palliative care professionals all over Spain. Questionnaires included items on the detection, assessment, and care of spiritual needs in end-of-life patients. We received 202 completed questionnaires from 72 physicians, 73 nurses, and 57 psychologists, social workers, priests, and volunteers. Data were analyzed using a qualitative systematic content analysis and standard statistical quantitative procedures. Results: the return ratio was 17%. Among all 202 questionnaires analyzed, 31% of participants reported many difficulties in identifying spiritual concerns from sentences collected from their patients. Twenty-eight percent stated that nearly all of their patients expressed spiritual concerns, and 56% affirmed that only a minority of their patients did. Forty percent of all professionals interviewed expressed that they had little or very few abilities to respond to situations where patients showed spiritual suffering. Only 23% of professionals agreed that the spiritual needs of patients in their unit were taken into account regularly in the multidisciplinary team sessions, whereas 63% reported that such issues were never dealt with in clinical team sessions. Thirty-nine percent of professionals shared that they always or nearly always talked about death with their patients, whereas 43% said that they never or very rarely did so. From the content analysis of 463 literal expressions from patients, as collected by their carers, a taxonomy of 12 different types of existential-spiritual needs is proposed. This empirical categorization offers interesting clues about the rationale on which a model of spiritual care at the end of life should be based. Conclusion: data collected suggest that existential-spiritual needs are not properly cared for in most palliative care units in our country. Health professionals show an insufficient level of awareness in identifying spiritual distress in their patients. Additionally, our survey detected an inability to deliver appropriate care, and difficulties to discuss such issues in clinical team sessions

Tiempo y duelo / No disponible

No disponible

Percepción subjetiva del paso del tiempo en el enfermo y el cuidador primario en Cuidados Paliativos hospitalarios / No disponible

Objetivos: estudiar la percepción subjetiva del paso del tiempo en enfermos hospitalizados en una Unidad de Cuidados Paliativos (UCP) y sus cuidadores primarios. Averiguar el grado de concordancia entre la percepción temporal de ambos. Explorar factores personales, clínicos y psicosociales que pueden estar relacionados con dicha percepción. Método: estudio descriptivo llevado a cabo en la Unidad de Cuidados Paliativos del Hospital Santa Caterina de Girona desde el 1 de mayo de 2005 al 31 de mayo de 2006. Participan 96 pacientes ingresados con enfermedad terminal y sus cuidadores primarios. Resultados: el 41,7% de los enfermos refiere una percepción subjetiva del paso del tiempo «largo» o «muy largo» mientras que un 28,1% lo considera «corto» o «muy corto». La percepción temporal en los enfermos está relacionada con la edad y la valoración de la calidad de la relación con el cuidador primario, siendo las personas mayores y las que refieren una buena relación con el cuidador las que perciben un paso del tiempo más rápido. Por el contrario, la percepción subjetiva del paso del tiempo en enfermos es independiente del sexo, de los días de ingreso en la UCP, del grado de dependencia funcional para las actividades básicas de la vida diaria (ABVD), de la gravedad de la enfermedad y la proximidad a la muerte, y de comunicar experiencias subjetivas positivas y/o negativas durante la jornada. En referencia a los cuidadores primarios, la mayoría encuentran el tiempo «ni corto ni largo» (39,6%). No se observa relación entre la percepción del paso del tiempo del cuidador primario y las horas de estancia en el hospital, los días de ingreso, el grado de dependencia funcional del enfermo para las ABVD, el informar de experiencias subjetivas positivas y/o negativas y la calidad de la relación enfermo-cuidador primario. Contrariamente, la percepción subjetiva del paso del tiempo del cuidador estuvo relacionada con la gravedad de la enfermedad y la proximidad a la muerte, percibiéndose el tiempo más largo a medida que se agrava la situación del enfermo. Las percepciones subjetivas del paso del tiempo del enfermo y del cuidador primario no están relacionadas. Enfermos y cuidadores primarios perciben el paso del tiempo de forma distinta, pasando algo más largo para los enfermos que para sus cuidadores primarios. Conclusiones: en general, los enfermos ingresados en una UCP perciben el paso del tiempo ligeramente más lento que sus cuidadores primarios, quedando pendiente para posteriores análisis valorar aquellos factores que modulan dicha percepción. Las percepciones del paso del tiempo de enfermos y cuidadores primarios no están relacionadas, percibiendo ambos el paso del tiempo en el hospital de forma diferente. A pesar de estas divergencias, otros aspectos psicosociales como una buena relación entre ambos, pueden influir en su percepción de la situación, convirtiendo así los hechos en más agradables y positivos. Es posible que se considere un hecho positivo simplemente la presencia y asistencia de un cuidador primario con el que se tenga una buena relación. En este sentido, integrando en nuestra atención sanitaria, recursos ambientales y técnicas terapéuticas destinadas a mejorar la relación enfermo-cuidador, podríamos facilitar en un futuro un mayor bienestar para el enfermo y para su cuidador primario en esta etapa difícil que es el final de la vida (AU)

Objectives: to study the subjective perception of the passing of time among patients hospitalized in a Palliative Care Unit (PCU) and their primary caregivers. To find out agreement extent between perceived time in both. To explore personal, clinical, and psychosocial factors that may be related to this perception. Method: a descriptive study carried out in the Palliative Care Unit at Hospital Santa Caterina in Girona from May 1st 2005 to May 31st 2006. Ninety-six terminally ill patients and their primary caregivers took part in the survey. Results: in 41.7% of patients the subjective perception of the passage of time was described as «long» or «very long», while 28.1% considered it «short» or «very short». Time perception in patients was related to age and quality of the relationship with primary caregivers, with older people and those having a good relationship with their caregiver experiencing a faster passage of time. In contrast, the subjective perception of the passage of time in patients is unrelated to sex, days in a PCU, functional dependence for basic activities of daily living (BADL), seriousness of illness, and proximity of death, as well as the communication of positive and/or negative events during the day. Regarding primary caregivers, most of them find that time is «neither short nor long» (39.6%). No connection was observed between perceived passage of time in primary caregivers and hours in the hospital, days in the PCU, extent of functional dependence for BADL, communication of positive and/or negative events, and quality of patient-caregiver relationship. On the contrary, the subjective perception of the passage of time in caregivers was related to seriousness of illness and proximity of death, with time being perceived as longer with patient worsening. The subjective perceptions of the passage of time in patients and primary caregivers are unrelated. Patients and primary caregivers perceive the passage of time in a different way - time is longer for patients versus primary caregivers. Conclusions: in general, patients in a PCU perceive the passage of time as slightly slower when compared to their primary caregivers, leaving for a later analysis an evaluation of factors modulating this perception. The perceptions of the passage of time in patients and primary caregivers are unrelated, and both perceive the passage of time in hospital in a different way. In spite of these divergences other psychosocial aspects, such as a good relationship between both, may influence their perception. Thus, everything may become more pleasant and positive. It is possible that the simple fact of having a good relationship with the caregiver can be positively considered. In this sense, integrating in our healthcare system environmental resources and therapeutical techniques aimed at improving the relationship between patients and caregivers may improve wellbeing for both patients and primary caregivers at the end of life (AU)

[Receptors and markers: toward a science of imaging through hybridization]. / Los receptores y los marcadores: hacia la Ciencia de la Imagen a través de las hibridaciones.

Genomic- and proteomic-based imaging will enable the selection of populations and individuals "at risk"of suffering a certain disease before the clinical symptoms appear, identifying the existence, location, and extension of the bases of the disease, stratifying the risk, and making it possible to carry out and control treatments designed for each patient. In order to be efficacious, these molecular imaging techniques must generate both functional and structural information. The use of imaging probes together with advanced equipment allows numerous molecular complexes and cellular structures to be seen. Molecular imaging makes it possible to acquire, whether directly or indirectly, information about the spatial and temporal distribution of molecular or cellular processes that have not only clinical (diagnostic and therapeutic) applications but also basic (biochemical and physiological) applications. In the clinical area, nuclear medicine and radiology must work together to lead the development, implementation, and technological evaluation of molecular imaging. From this perspective, molecular hybridization techniques must progress toward the coordination of efforts, in training and in application as well as in research, to enable us to develop fully as imaging professionals in the service of healthcare. Molecular imaging provides imaging physicians with the possibility to advance substantially in early diagnosis, in the stratification of risk and prognosis, as well as in treatment monitoring in numerous biological and cellular processes related to the disease.

Los receptores y los marcadores: hacia la Ciencia de la Imagen a través de las hibridaciones / Receptors and markers: toward a science of imaging through hybridization

La imagen basada en la genómica y la proteómica va a permitir seleccionar a poblaciones e individuos «con riesgo» de padecer una determinada enfermedad antes de que aparezcan los síntomas clínicos, identificando la existencia, localización y extensión de las bases de la enfermedad, estratificando el riesgo y posibilitando la realización y el control de tratamientos diseñados para cada paciente.Estas técnicas de imagen molecular deben generar, para ser eficaces, información tanto funcional como estructural. La utilización de sondas de imagen junto a equipamientos avanzados permite ver numerosos complejos moleculares y estructuras celulares. La imagen molecular permite, directa o indirectamente, recoger y seguir la distribución espacio-temporal de los procesos moleculares o celulares con aplicaciones no sólo clínicas (diagnósticas y terapéuticas), sino también básicas (bioquímicas y fisiológicas). En la parte clínica, la Medicina Nuclear y la Radiología están necesariamente obligadas a trabajar conjuntamente para liderar el desarrollo, la implantación y la evaluación tecnológica de la imagen molecular. Desde esta perspectiva, las técnicas de hibridación molecular deben progresar hacia la coordinación de esfuerzos, tanto de formación y utilización, como de investigación, que permitan desarrollarnos plenamente como profesionales de la imagen médica al servicio de la sanidad.La imagen molecular dota a los médicos relacionados con la imagen médica de la posibilidad de avanzar sustancialmente en el diagnóstico precoz, la estratificación del riesgo y el pronóstico, y la monitorización del tratamiento de numerosos procesos biológicos y celulares relacionados con la enfermedad

Genomic- and proteomic-based imaging will enable the selection of populations and individuals «at risk» of suffering a certain disease before the clinical symptoms appear, identifying the existence, location, and extension of the bases of the disease, stratifying the risk, and making it possible to carry out and control treatments designed for each patient.In order to be efficacious, these molecular imaging techniques must generate both functional and structural information. The use of imaging probes together with advanced equipment allows numerous molecular complexes and cellular structures to be seen. Molecular imaging makes it possible to acquire, whether directly or indirectly, information about the spatial and temporal distribution of molecular or cellular processes that have not only clinical (diagnostic and therapeutic) applications but also basic (biochemical and physiological) applications. In the clinical area, nuclear medicine and radiology must work together to lead the development, implementation, and technological evaluation of molecular imaging. From this perspective, molecular hybridization techniques must progress toward the coordination of efforts, in training and in application as well as in research, to enable us to develop fully as imaging professionals in the service of healthcare.Molecular imaging provides imaging physicians with the possibility to advance substantially in early diagnosis, in the stratification of risk and prognosis, as well as in treatment monitoring in numerous biological and cellular processes related to the disease

Sufrimiento al final de la vida / No disponible

Durante el 6º Congreso Nacional de la Sociedad Española de Cuidados Paliativos, celebrado en San Sebastián del 7 al 10 de Junio de 2006, tuvo lugar una mesa interactiva sobre el tema «Sufrimiento al final de la vida». Objetivo: el objetivo del presente artículo es exponer las respuestas de 175 profesionales sanitarios presentes en la sala a las preguntas formuladas desde la mesa. Método: cuestionario anónimo de tipo categórico presentado a la audiencia a través de un sistema interactivo. Resultado y conclusiones: se exponen los datos facilitados por los 175 profesionales así como los comentarios que los mismos suscitaron en los componentes de la mesa, sobre diversos temas de actualidad en el campo de los cuidados paliativos, desde los miedos y sentimientos de culpa de los enfermos hasta la espiritualidad, la sedación y la eutanasia (AU)

During the 6th National Congress of the Spanish Society of Palliative Care, that took place in San Sebastian from the 7th to the 10th of June of 2006, a symposium on «Suffering at the end of life» was held. Objective: the objetive of the present paper is to show the answers of 175 sanitary professionals who answered relevant questions coming from the table experts invited. Method: an anonymous categoric questionnaire present through an interactive system. Results and conclusions: answers from the audience and commentaries made by the table membres about different themes suchs as fears and guilt thoughts of patients, spirituality, sedation and euthanasia are shown (AU)

[Usefulness of FDG-PET in the diagnosis of patients with chronic severe brain injury]. / Utilidad de la PET con FDG en la valoración del paciente con traumatismo craneoencefálico severo crónico.

INTRODUCTION: To describe the changes in cerebral glucose metabolism after a severe traumatic brain injury (TBI), at the beginning of the rehabilitation, to analyze its diagnostic agreement with morphologic neuroimaging technologies (MR/CT) and to correlate the neuroimaging findings with the intensity of the TBI and the functional ability for daily activities. MATERIAL AND METHODS: Prospective study of 55 patients who had sustained a severe TBI (GCS < or = 8) by means of 18F-FDG PET and MR/CT. The agreement between anatomical and functional neuroimagen studies was measured. Correlation between cerebral injury severity in neuroimaging, clinical functional evaluation assessed with Barthel-M Index and GCS were tested. RESULTS: 100 % of patients showed changes in cerebral metabolism, being the thalamus the area more frequently affected. 60 % of patients showed injuries in MR/CT, more frequently in frontal areas. The agreement for the diagnosis of pathology between morphologic and functional neuroimagen was very low. The TBI severity showed significant statistical correlation with the degree of cerebral metabolism and the level of disability. CONCLUSIONS: 18F-FDG PET allows to know the cerebral glucose metabolism at the beginning of the rehabilitation, being correlated with the TBI severity and the level of patient's disability for daily activities. 18F-FDG PET diagnoses major number of injuries that traditional neuroimaging and demonstrates a high thalamic vulnerability, with injuries in up to 76 % of patients with severe TBI.

Utilidad de la PET con FDG en la valoración del paciente con traumatismo craneoencefálico severo crónico / Usefulness of FDG-PET in the diagnosis of patients with chronic severe brain injury

Objetivo. Describir los cambios del metabolismo glucolítico cerebral tras un traumatismo craneoencefálico (TCE) severo en el momento de iniciar la rehabilitación, medir su nivel de acuerdo diagnóstico con las técnicas de neuroimagen morfológica (RM/TC) y correlacionar los hallazgos en neuroimagen con la intensidad del TCE sufrido y con la discapacidad funcional para las actividades de la vida diaria. Material y métodos. Estudio prospectivo de 55 pacientes con antecedente de TCE severo (GCS <= 8) mediante 18F-FDG PET y RM/TC. Medida del acuerdo entre los estudios de neuroimagen anatómica y funcional. Valoración funcional mediante el test de Barthel-M y cálculo de correlación entre la afectación cerebral en neuroimagen y el test de Barthel y la GCS. Resultados. El 100 % de los pacientes presentó alteración en el metabolismo cerebral, siendo los tálamos las áreas más frecuentemente afectadas. El 60 % de los pacientes mostró lesiones en RM/TC, más frecuentemente frontales. El grado de acuerdo para el diagnóstico de patología entre la neuroimagen morfológica y funcional fue muy bajo. La intensidad del traumatismo sufrido y el nivel de discapacidad se correlacionaron de forma estadísticamente significativa con el grado de afectación del metabolismo cerebral. Conclusiones. La PET con 18F-FDG permite conocer el estado del metabolismo glucolítico cerebral en el momento de iniciar la rehabilitación, correlacionándose con la severidad del traumatismo sufrido y con la discapacidad para las actividades de la vida diaria. La PET diagnostica mayor número de lesiones que la neuroimagen anatómica y demuestra una elevada vulnerabilidad talámica, con lesiones hasta en el 76 % de pacientes con antecedente de TCE severo

Introduction. To describe the changes in cerebral glucose metabolism after a severe traumatic brain injury (TBI), at the beginning of the rehabilitation, to analyze its diagnostic agreement with morphologic neuroimaging technologies (MR/CT) and to correlate the neuroimaging findings with the intensity of the TBI and the functional ability for daily activities. Material and methods. Prospective study of 55 patients who had sustained a severe TBI (GCS <= 8) by means of 18F-FDG PET and MR/CT. The agreement between anatomical and functional neuroimagen studies was measured. Correlation between cerebral injury severity in neuroimaging, clinical functional evaluation assessed with Barthel-M Index and GCS were tested. Results. 100 % of patients showed changes in cerebral metabolism, being the thalamus the area more frequently affected. 60 % of patients showed injuries in MR/CT, more frequently in frontal areas. The agreement for the diagnosis of pathology between morphologic and functional neuroimagen was very low. The TBI severity showed significant statistical correlation with the degree of cerebral metabolism and the level of disability. Conclusions. 18F-FDG PET allows to know the cerebral glucose metabolism at the beginning of the rehabilitation, being correlated with the TBI severity and the level of patient's disability for daily activities. 18F-FDG PET diagnoses major number of injuries that traditional neuroimaging and demonstrates a high thalamic vulnerability, with injuries in up to 76 % of patients with severe TBI

Focal nodular hyperplasia (FNH): a potential cause of false-positive positron emission tomography.

Positron emission tomography (PET) using F-18 fluorodeoxyglucose (FDG) has been proven to be a useful tool in the differential diagnosis of liver tumors. Focal nodular hyperplasia (FNH) is an uncommon benign liver lesion, which can be difficult to differentiate from other benign and malignant liver pathologies. FDG PET imaging usually shows uptake similar or even decreased compared to that of the normal liver. We describe a hypermetabolic FNH lesion in a patient with a history of breast cancer. Computed tomography scan, ultrasonography (US), and magnetic resonance imaging were negative. The lesion was resected, and histologic findings were consistent with FNH.

¿Qué son las necesidades espirituales? / What are spiritual needs?

Uno de los objetivos de los Cuidados Paliativos es atender las necesidades espirituales de los enfermos, conjuntamente con sus necesidades somáticas, emocionales y sociales. Para lograr este objetivo, es necesario que dispongamos de: a) una definición de «necesidades espirituales»; b) un modelo que integre las necesidades espirituales en la atención global que se dispensa al enfermo y permita a los profesionales sanitarios hacerles frente con independencia de sus propios valores y creencias; c) instrumentos para su detección y evaluación, los cuales deberán ser sensibles tanto alas diferencias individuales, como a las variaciones temporales que se dan en una misma persona; y d) estrategias que permitan al profesional sanitario que deba afrontar esta responsabilidad intervenir con eficacia cuando sea necesario. Se propone un enfoque pragmático de la espiritualidad y delas necesidades espirituales, en el marco de los Cuidados Paliativos, centrado en las respuestas observables -verbales y no verbales- del enfermo yen cómo su manejo adecuado puede contribuir a atenuar su sufrimiento (AU)

One of the aims of Palliative Care is to attend to spiritual needs of the patient, along with his/her physical, emotional, and social needs. To achieve this aim, it is necessary to get: a) a definiton of what «spiritual needs» are; b) a comprehensive model that integrates spiritual needs as part of the global attention dispensed to the patient, and allows health professionals to cope with his/her spiritual needs without compromising their own values and beliefs; c) screening and assessing instruments, sensitive both to individual differences and temporal changes; and d) intervention strategies to cope with spiritual needs when necessary. Within the frame of Palliative Care, a pragmatic approach of spirituality and spiritual needs is proposed, centered on patient’s verbal and non verbal behaviour, and on how an appropiate management of them can effectively contribute to less enpatient's suffering (AU)

[Dynamic ultrasonography in the diagnosis of gallbladder dysfunction: reliability of a simple method with easy clinical application]. / Ultrasonografía dinámica en el diagnóstico de la disfunción vesicular: fiabilidad de un método sencillo de fácil aplicación clínica.

AIMS: Although the results of dynamic ultrasonography (DUS) are similar to those of dynamic cholescintigraphy (DCS) in the study of gallbladder function, the methodology required for this technique is laborious and sometimes complex. The aim of this study was to investigate the reliability of a simple method of DUS to evaluate gallbladder function using DCS as a reference. PATIENTS AND METHODS: Gallbladder function was studied using DUS and DCS in 80 consecutive patients with clinical findings compatible with gallbladder dysfunction. For DUS the ellipsoid method was used with measurement of three gallbladder diameters (transversal, longitudinal and anteroposterior) in basal conditions and after applying a cholecystokinetic stimulus (meal test); gallbladder emptying of less than 50% was considered abnormal. In DCS intravenous cholecystokinin (CCK) (0.40 IDU/kg in 20 minutes) was used as stimulus and an ejection fraction < or = 40% was considered abnormal. RESULTS: In 15 patients (19%; 95% CI, 11-29%) abnormal gallbladder response was found using DUS. The ejection fraction in the entire group of patients studied was 48 26.2%. Ejection fraction was abnormal in 41 patients (51%; 95% IC, 40-63%) with a value of 25 8.5% and was normal in 39 patients (49%; 95% IC, 40-63%) with a value of 71.5 14.5%. The correlation coefficient between the values of gallbladder emptying calculated with DUS and the ejection fraction obtained with DCS was 0.199 (p = 0.079). When patients were divided according to gallbladder emptying measured by DUS and the ejection fraction obtained with DCS the concordance was very low (k = 0.065; EE = 0.085). CONCLUSIONS: DUS performed using a simple technique lacks diagnostic value in gallbladder dysfunction when DCS is taken as a reference test

Practice of nuclear medicine in Spain.

This survey presents the results of a poll sent to all Spanish nuclear medicine departments between July 1999 and March 2000, with the aim of clarifying the current situation of nuclear medicine in Spain. This survey is believed to be the first of its kind, and it is anticipated that the data will be of assistance to health authorities in ensuring that the needs of the population with regard to nuclear medicine facilities are met.

[Study of gastric emptying by dual isotopes. Corrections due to contamination]. / Estudio del vaciamiento gástrico mediante técnica con doble isótopo. Consideraciones con respecto a la corrección de la contaminación.

The evaluation of gastric emptying by the double isotope technique involves some methodologic conditioning. Among them contamination correction or interference in the energy windows of the activity of the two isotopes used in the marking of the solids and fluids of the test food are important. The results of an experiment in which a phantom was used to evaluate the contamination between indio 111 (DTPA-Ca111In) and technecium 99m (colloid99mTc). Three test studies were posteriorly performed in healthy volunteers and 27 studies in a control group (13 males, mean age of 33 years, mean body mass index 39.02 kg/m). In these studies the contamination was corrected with the acquisition, following an initial swallow of juice marked with 111In, of activity in the windows of both isotopes. The contamination of 111In (isotope of greatest radiation energy) in the window of 99mTc was 24% in the phantom and 20%, 23% and 26% in the three initial study tests. The mean contamination in the control group was of 22% with limits of 19% to 29% and a standard deviation of 3%. Despite the comparable results, the usefulness of the individualized contamination calculation in the studies of gastric emptying with dual isotope to minimize the methodologic errors of this technique is discussed.