La tomografía por emisión de positrones-tomografía computarizada con 18F-fluordesoxiglucosa en los pacientes con cáncer diferenciado de tiroides en recurrencia y rastreo con radioyodo negativo. Rendimiento diagnóstico y relación con los niveles de tiroglobulina / Positron emission tomography-computed tomography with 18F-fluorodeoxyglucose in patients with recurrent differentiated thyroid carcinoma and negative radioiodine scan. Diagnostic performance and relation with tyroglobulin levels

Objetivo. Evaluar el rendimiento diagnóstico de la PET-TC con 18F-FDG y su relación con los niveles séricos de tiroglobulina (Tg) en los pacientes con cáncer diferenciado de tiroides con sospecha de persistencia o recurrencia de enfermedad y rastreo con radioyodo negativo. Material y métodos. Análisis retrospectivo de 35 estudios PET-TC en 25 pacientes (17 mujeres, edad media 48,8±15,2 años). Los resultados se comprobaron histológicamente, o mediante ecografía y seguimiento clínico. Se analizó la relación entre el rendimiento diagnóstico de la PET-TC y 3 niveles de Tg: ≤2ng/ml; entre 2 y 10 ng/ml, y >10ng/ml. Resultados. Se obtuvieron 26 verdaderos positivos, un falso positivo, 3 verdaderos negativos y 5 falsos negativos. De los 18 pacientes con una PET-TC clasificada como verdadero positivo, 3 mostraron lesiones en el lecho postiroidectomía, 15 mostraron afectación ganglionar y 5 presentaron metástasis a distancia. La sensibilidad fue del 83,9% (IC95%: 69,3-98,4%) y la especificidad del 75% (IC95%: 20-100%). Para 3 intervalos de Tg, la PET-TC mostró una tasa de verdaderos positivos del 37,5, del 83 y del 100% en los pacientes con niveles de Tg <2, entre 2 y 10, y >10 ng/ml, respectivamente. Conclusiones. La PET-TC con 18F-FDG muestra un alto rendimiento diagnóstico de la enfermedad locorregional y a distancia en la población de pacientes con cáncer diferenciado de tiroides en situación de persistencia de enfermedad y rastreo con yodo negativo con niveles de Tg >2ng/ml(AU)

Objective. To assess the diagnostic performance of 18F-FDG PET-CT scan and its relation to serum thyroglobulin (Tg) levels in patients with differentiated thyroid carcinoma with suspicion of persistence or recurrence of the disease and negative radioiodine scans. Materials and methods. This is a retrospective analysis of 35 PET-CT studies in 25 patients (17 women, average age 48.8±15.2 years). The results were confirmed by histology or by ultrasonography and clinical follow-up. We analyzed the relationship between the diagnostic performance of the PET-CT scans and three levels of Tg: ≤2ng/ml; between 2 and 10 ng/ml, and >10ng/ml. Results. We obtained 26 true-positives (TP), one false-positive (FP), 3 true-negatives (TN) and 5 false-negatives (FN). Of the 18 patients with PET-CTs classified as TP, 3 showed lesions at the post-thyroidectomy bed, 15 showed lymph node metastases and 5 were distant metastases. Sensitivity was 83.9% (95%CI: 69.3%-98.4%) and specificity was 75% (95%CI: 20%-100%). Regarding the three intervals of Tg, PET-CT scan showed TP rates of 37.5%, 83% and 100% in patients with Tg levels <2ng/ml, between 2 and 10ng/ml, and >10ng/ml, respectively. Conclusions. 18F-FDG PET-CT demonstrates high diagnostic yield in local disease and distant lesions for the population of patients with differentiated thyroid carcinoma and persistence of the disease with negative radioiodine scans at Tg levels above 2ng/ml(AU)

[Positron emission tomography-computed tomography with (18)F-fluorodeoxyglucose in patients with recurrent differentiated thyroid carcinoma and negative radioiodine scan. Diagnostic performance and relation with tyroglobulin levels]. / La tomografía por emisión de positrones-tomografía computarizada con (18)F-fluordesoxiglucosa en los pacientes con cáncer diferenciado de tiroides en recurrencia y rastreo con radioyodo negativo. Rendimiento diagnóstico y relación con los niveles de tiroglobulina.

OBJECTIVE: To assess the diagnostic performance of (18)F-FDG PET-CT scan and its relation to serum thyroglobulin (Tg) levels in patients with differentiated thyroid carcinoma with suspicion of persistence or recurrence of the disease and negative radioiodine scans. MATERIALS AND METHODS: This is a retrospective analysis of 35 PET-CT studies in 25 patients (17 women, average age 48.8±15.2 years). The results were confirmed by histology or by ultrasonography and clinical follow-up. We analyzed the relationship between the diagnostic performance of the PET-CT scans and three levels of Tg: ≤2ng/ml; between 2 and 10 ng/ml, and >10ng/ml. RESULTS: We obtained 26 true-positives (TP), one false-positive (FP), 3 true-negatives (TN) and 5 false-negatives (FN). Of the 18 patients with PET-CTs classified as TP, 3 showed lesions at the post-thyroidectomy bed, 15 showed lymph node metastases and 5 were distant metastases. Sensitivity was 83.9% (95%CI: 69.3%-98.4%) and specificity was 75% (95%CI: 20%-100%). Regarding the three intervals of Tg, PET-CT scan showed TP rates of 37.5%, 83% and 100% in patients with Tg levels <2ng/ml, between 2 and 10ng/ml, and >10ng/ml, respectively. CONCLUSIONS: (18)F-FDG PET-CT demonstrates high diagnostic yield in local disease and distant lesions for the population of patients with differentiated thyroid carcinoma and persistence of the disease with negative radioiodine scans at Tg levels above 2ng/ml.

Tuberculosis de colon: dificultades diagnósticas actuales / Tuberculosis of the conjunctiva

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La disfunción familiar como predisponente de la enfermedad mental. ¿Existe tal asociación? / Family disfunction as a predisposing of mental disorders. is there any association between them?

Objetivos. El objetivo principal es conocer la relación entre la disfunción familiar y la presencia de trastorno mental. El objetivo secundario es conocer la prevalencia y la distribución de los principales tipos de patología mental en la población atendida en atención primaria. Diseño y emplazamiento. Estudio descriptivo y transversal realizado en 6 consultas de medicina de familia de un área básica de salud semiurbana. Método. Se seleccionaron 280 sujetos mediante muestreo aleatorio sistemático de los que acudieron espontáneamente a la consulta. Mediante entrevista se recogieron las variables de estudio: dinámica familiar (medida mediante el test de APGAR familiar), estructura familiar, variables sociodemográficas y presencia de trastorno mental detectado mediante la Mini International Neuropsyquiatric Interview (MINI-DSM IV). Resultados. Aceptaron participar 264 sujetos. Un 64,4 por ciento era mujer y la media de edad fue de 45,6 años (DE, 16,7). Se detectó patología mental en 87 participantes (33 por ciento), siendo la patología más frecuente trastorno de ansiedad generalizada, distimia y depresión mayor. Se encontró alteración de la dinámica familiar en 32 personas (12,3 por ciento). No se observaron diferencias significativas en la frecuencia de presentación de patología mental entre el grupo con disfunción familiar y el resto. Conclusiones. Los trastornos de salud mental son frecuentes entre los pacientes que acuden a las consultas de atención primaria. No encontramos asociación entre las alteraciones de la dinámica familiar y los trastornos de salud mental, lo que podría deberse a la dificultad para detectar disfunción familiar con el test de APGAR (AU)

[Social inequities in the use of primary care services: a long way to go]. / Desigualdades sociales en la utilización de servicios de atención primaria: un largo camino por recorrer.

OBJECTIVE: To describe the relation between the main variables related with social inequality and the utilization of primary care services. METHODS: Socio-demographic variables and the number of consultations were collected in a cross-sectional study. RESULTS: 264 subjects were interviewed. 66% of the population belonged to social classes IV and V. There was statistical signification between age and number of visits (p = 0.0014) and between number of visits and monoparental families (p = 0.01). CONCLUSIONS: Most of the attended population belonged to the low and middle socio-economic levels. The relationship between non-structured families and hyper-utilization and the relationship between age and hyper-utilization is confirmed.

[Family dysfunction as predisposing factor of mental disease. Does that relationship exist?]. / La disfunción familiar como predisponente de la enfermedad mental. Existe tal asociación?

OBJECTIVES: The purpose is to describe the relationship between family disfunction and mental disorder. The secondary objective is to know the prevalence and distribution of mental disorders in primary care attended population. DESIGN: A cross-sectional study was conducted in a primary care setting. PATIENTS AND METHODS: Random sample was selected over 280 subjects from consultant population. The variables (family function, family structure, social and economic conditions and mental disorders) were collected through interview. APGAR test and Mini International Neuropsychiatric Interview test were performed. RESULTS: 264 patients were finally included (64% women). Mean age was 45.6 years (SD 16.7). Mental disorders were detected in 87 patients (33%). The most prevalent disorders were generalized anxiety disorder, dysthymia and major depression, family disfunction was found in 32 patients (12.3%). Prevalence of mental disorders wasn't statistically different in the group with family disfunction. CONCLUSION: Mental disorders are a common problem between primary care attended population. There wasn't any association between family disfunction and mental disorders, because of the limitations in the APGAR test in detecting family disfunction.