First study demonstrating speckle tracking echocardiography has prognostic value in patients with idiopathic inflammatory myopathies.

To measure left ventricular (LV) global longitudinal strain (GLS) using speckle tracking echocardiography in idiopathic inflammatory myopathy (IIM) patients and to determine whether the LV GLS predicts outcomes in those patients. Prospective study consisted of a cross-sectional phase with 61 IIM patients and 32 individuals without IIM and longitudinal phase, in which patients were divided into two subgroups: 26 with reduced LV GLS and 35 with normal LV GLS; patients were followed for a mean of 25 months, and the occurrence of cardiovascular events and criteria for IIM activity were compared. The mean LV GLS (18.5 ± 2.9% vs. 21.6 ± 2.5%; p < 0.001) and right ventricle free wall strain (21.9 ± 6.1% vs. 27.5 ± 4.7%; p < 0.001) were lower in patients than in controls. The mean N-terminal pro B-type natriuretic peptide level was higher in patients than in controls. There were no differences regarding other cardiac involvement. Anti-Jo1 antibody was associated with general electrocardiographic abnormality and LV diastolic dysfunction. The subgroup with reduced GLS progressed with higher mean creatine phosphokinase, myositis disease activity assessment visual analogue scales, the physician's and patient's visual analogue scales, the health assessment questionnaire, and a higher proportion of relapses than the subgroup with normal GLS. There was no difference between the subgroups regarding cardiovascular events. The LV GLS appears to be useful for evaluating patients with IIM. Abnormal values are associated with more frequent relapses and increased disease activity during follow-up.

Fluorine-18-fluorodeoxyglucose PET/CT in hematopoietic stem cell transplant patients with fusariosis: initial findings of a case series review.

BACKGROUND: Fusariosis is an opportunistic fungal infection that affects mostly leukemic and hematopoietic stem cell transplant patients. Locally invasive and disseminated infection may occur. Treatment is challenging, and besides evaluation of immune status, one also needs to take into account organ involvement to predict the duration and prognosis. OBJECTIVE: The aim of this study was to present the findings and clinical follow-up from a series of cases of Fusarium spp. infections in patients subjected to hematopoietic stem cell transplant evaluated with one or more fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT scans, according to the source of clinical culture sample (blood or wound secretion). RESULTS: Ten patients were included. In this series, 18F-FDG PET/CT was able to detect osteomyelitis in three patients. CONCLUSION: Although having a small number of patients and lack of standard approach, 18F-FDG PET/CT seemed useful to discriminate uncomplicated cases of primary bloodstream infections and detect occult foci of metastatic infection in patients with positive cutaneous lesions cultures.

A new myocardial perfusion scintigraphy stress protocol combining dipyridamole-dobutamine-atropine.

BACKGROUND: Pharmacological stress is often used, and the drugs most frequently utilized are dipyridamole (Dip) and dobutamine (Dob). We aimed to evaluate the safety and the results obtained with a new protocol associating Dip, Dob, and atropine, compared with the Dip protocol. METHODS: Thirty-two patients underwent rest Tl/Dip stress Tc-sestamibi myocardial perfusion tomography on the same day. Dip was administered intravenously (0.56 mg/kg) for 4 min, and Tc-sestamibi was injected 3 min after the end of the Dip injection. On another day, patients received the same Dip dose, immediately followed by the infusion of Dob [20 µg/kg/min for the first 2 min and 40 µg/kg/min in the next 2 min, with atropine (1 mg) given in the interval between the two Dob doses]. Images were acquired with a two-detector camera. In a 17-segment model of the left ventricle, each segment was automatically scored 0-4 (normal to absent radiotracer activity), and perfusion scores were obtained as the sum of stress score and sum of rest segmental score (SSS and SRS, respectively) and the difference between them [summed difference score (SDS)]. All scans were interpreted by two experienced physicians as either definitely normal, probably normal, probably abnormal, or definitely abnormal. RESULTS: No serious complication was found independently of the protocol used. Heart rate and systolic and diastolic blood pressure were similar in both protocols at the basal level. Maximum heart rate (126 ± 21 vs. 82.7 ± 13.6, P<0.001) and the double product (18816 ± 4194 vs. 11449 ± 2438, P<0.001) showed a significant increase in the tests that used Dob and atropine compared with the Dip protocol. Stress studies with Dip-Dob had higher SSS compared with the Dip protocol (9.4 ± 10.1 vs. 7.7 ± 8.8, P<0.001). SDS was also higher in the Dip-Dob protocol than in the Dip protocol (6.1 ± 6.8 and 4.8 ± 5.8, respectively, P< 0.001). CONCLUSION: This work shows that a new protocol of pharmacological stress with a combination of Dip, Dob, and atropine is safe, easy to administer, and results in larger stress-induced defect size and reversibility of myocardial perfusion.

Tecnécio-99M-MIBI no acompanhamento de carcinoma diferenciado de tireóide / Technetium-99m-MIBI in the follow-up of differentiated thyroid carcinoma

Tecnécio-99m-metoxiisobutil isonitrila (99mTc-MIBI) foi, recentemente, introduzido como fármaco marcador-tumoral.Este estudo avalia o papel da cintilografia com 99mTc-MIBI na localização de lesões metastáticas através daanálise de sua sensibilidade e especificidade, em comparação com rastreamento com 131I e níveis séricos detireoglobulina. Foram estudados oitenta e nove pacientes tireoidectomizados por câncer diferenciado de tireóide.Foram adquiridas imagens de corpo inteiro precoces (20 minutos) e tardias (6 e 24 horas) após injeção de 99mTc-MIBI. Foram determinados os níveis séricos de tireoglobulina durante tratamento com hormônio tireoideano e 4semanas após sua suspensão; rastreamento com 131I foi realizado após dose diagnóstica ou terapêutica/ablativa. Ospacientes que apresentaram resultados discordantes, foram submetidos a confirmação diagnóstica por tomografiacomputadorizada ou ressonância magnética. No grupo com rastreamento com 131I negativo (34/89), 23 pacientesapresentaram cintilografia com 99mTc-MIBI negativa e 11 pacientes tiveram resultado discordante (especificidade:67,6 por cento); 22 pacientes apresentaram cintilografia com 99mTc-MIBI e rastreamento com 131I positivas; enquanto ototal de rastreamento com 131I positivos foi 55(sensibilidade: 40,0 por cento). Onze pacientes apresentaram rastreamentocom 131I e cintilografia com 99mTc-MIBI positiva; 7 destes pacientes foram comprovados como verdadeiros positivos;e quando associados os valores de tireoglobulina e os resultados encontrados pela cintilografia com 99mTc-MIBI, asensibilidade passa a ser de 66,7 por cento e a especificidade de 86,7 por cento. Embora o 99mTc-MIBI apresente baixa sensibilidadena detecção de doença em atividade, o 99mTc-MIBI pode desempenhar papel importante como um métodocomplementar aos valores de tireoglobulina e rastreamento com 131I.