Jose J. Mateos

Normalization of frontal cerebral perfusion in remitted elderly major depression: a 12-month follow-up SPECT study.

We examined global and regional cerebral blood flow abnormalities in a group of unmedicated nondemented elderly late-onset unipolar major depressed patients in acute depression and in remission (after a 12-month follow-up period). 35 somatic treatment remitter patients over the age of 60 years and 20 sex-, age-, and vascular risk factor-matched healthy controls were imaged with single photon emission computed tomography, using technetium-99m hexamethylpropylene amine oxime as a tracer. In depression, the depressed group had significantly lower uptake in the left anterior frontal region than the control group. In remission, the left frontal cerebral perfusion abnormalities disappeared, and there were no significant differences in uptake between controls and patients. No significant correlations were found between baseline clinical characteristics of patients and their regional cerebral perfusion at baseline or after a 12-month follow-up. These findings are consistent with the hypothesis that certain neuroanatomic regions of the central nervous system may be functionally and reversibly involved in unipolar major depression, particularly in the late-onset subgroup.

Dopamine transporter (DAT) genotype (VNTR) and phenotype in extrapyramidal symptoms induced by antipsychotics

INTRODUCTION Impaired dopamine transporter (DAT) function may be involved in antipsychotic (AP)-induced extrapyramidal symptoms (EPS). A polymorphism involving a variable number of tandem repeats (VNTR) has been described in the DAT gene (SLC6A3). OBJECTIVE We studied whether the SLC6A3 VNTR polymorphism is a risk or protection factor for AP-induced EPS. We also investigated the relationship between the polymorphism and DAT availability in the schizophrenic patients brain. METHODS Sixty-one patients receiving AP therapy participated in the EPS study. Of these, thirty-two cases presented EPS (Simpson-Angus >3) and twenty-nine without EPS (Simpson-Angus < or =3). The DAT expression was studied in fifteen AP-naive patients by [(123)I] FP-CIT SPECT. RESULTS No significant differences were observed for the more common alleles ((*)9R and (*)10R) or for genotype frequencies between patients with EPS and those without EPS. The frequency of the (*)9R and (*)10R alleles was similar to that described in other European populations. There were no significant differences in striatal DAT binding among the three major VNTR genotype groups. CONCLUSIONS Our results suggest that the VNTR polymorphism did not influence AP-induced EPS and did not affect DAT gene expression or protein function.

Frontal Cerebral Perfusion Dysfunction in Elderly Late-Onset Major Depression Assessed by 99MTC-HMPAO Spect

Baseline regional cerebral blood flow of thirty unmedicated late-onset unipolar major depressed patients over the age of 60 years and 20 sex-, age-, and vascular risk factor-matched healthy controls was imaged with single photon emission computed tomography, using technetium-99m hexamethylpropylene amine oxime as a tracer. To avoid errors of diagnosis--in particular, confusion between major depression and organic cognitive impairment--only treatment responders were included in the final sample. Statistically significant differences were observed in both left and right anterior frontal regions, with reduced uptake in depressed patients; these differences were more pronounced in the left hemisphere. Among patients, there was no correlation between regional cerebral blood flow and the severity of baseline symptoms. Our results support the hypothesis that certain neuroanatomic regions of the central nervous system may be functionally involved in elderly unipolar major depression, particularly in the late-onset subgroup.

Brain perfusion and neuropsychological changes in schizophrenic patients after cognitive rehabilitation

The role of cognitive variables was compared in two single cases of schizophrenia hypofrontality. SPECT procedures and neuropsychological tests were used to study frontal brain function. After cognitive rehabilitation, neuropsychological performance were enhanced in both patients, but only one of them showed enhanced the frontal blood flow. The brain perfusion changes after cognitive rehabilitation could be associated with the cognitive-dependent hypofrontality.

Tratamiento del dolor óseo metastásico con dosis repetidas de Estroncio-89 en pacientes con neoplasia de próstata

Resumen El objetivo de este estudio ha sido valorar la utilidad del tratamiento repetido con 89Sr en pacientes con neoplasia de prostata y dolor oseo metastasico. Diecisiete pacientes con respuesta parcial o completa tras una 1.a dosis de 89Sr se trataron con dos o mas dosis (total de 39 dosis). En la valoracion de los pacientes se tuvo en cuenta la capacidad funcional (Karnofsky), el dolor y el grado de analgesia. Tras la 1.a dosis, la respuesta fue buena en un 68% de los pacientes y parcial en un 32%. Tras la 2.a dosis, la respuesta fue buena en un 62%, parcial en un 15% y no hubo respuesta en un 23% de los casos. El Karnofsky pretratamiento y la duracion del efecto del 89Sr fue menor tras la 2.a dosis (p = 0,03, p = 0,02), aunque no hubo diferencias significativas en el tipo de respuesta. En conclusion, el tratamiento repetido con 89Sr puede realizarse sin mayor riesgo y con un tipo de respuesta similar a la obtenida tras la 1.a dosis.

No brain perfusion impairment at long-term follow-up in elderly patients treated with electroconvulsive therapy for major depression.

No functional neuroimaging study has previously assessed the long-term effects of electroconvulsive therapy (ECT) on brain perfusion. In this study, long-term follow-up brain perfusion in elderly patients treated with ECT for severe unipolar major depression was assessed. In 14 elderly major depressed patients who were ECT remitters, 22 elderly major depressed patients who were pharmacological treatment remitters and 25 age- and sex-matched healthy controls, a medication-free brain 9mTc-HMPAO-SPECT was performed after a minimum period of 12 months of euthymia and, in the case of the ECT remitters, at least 12 months after the last ECT session. Brain perfusion ratios in major depressed patients administered ECT were similar to those in major depressed patients receiving pharmacological treatment and in control subjects. This result suggests that elderly patients given ECT for severe unipolar major depression do not suffer brain perfusion abnormalities at long-term follow-up. Our study adds new evidence in favor of the safety of the ECT, particularly in elderly subjects.

Noninvasive assessment of cardiac risk in type I diabetic patients being evaluated for combined pancreas‐kidney transplantation using dipyridamole‐MIBI perfusion

Abstract This study was performed to determine the value of dipyridamole‐99 mTc‐methoxy‐isobutyl isonitrile perfusion (99mTC‐MIBI) tomographic scintigraphy in the assessment of cardiac risk in patients being evaluated prior to combined pancreas‐kidney transplantation (PKT). We performed perfusion tomographic scintigraphy using single photon emission computed tomography (SPECT) on 77 patients. The tomographic images did not show clinically relevant findings in 65 patients. In the remaining 12 patients, coronary arteriography was performed: 2 showed normal results, 4 showed no stenosis, and 6 showed significant stenosis (≥ 70%). Seventy‐two patients underwent PKT. During the follow‐up (6–48 months), there were seven cardiac events, 4 patients with significant stenosis, and 3 with nonsignificant stenosis upon coronary arteriography, and all had pathological tomographic images. 99mTc‐MIBI tomographic scintigraphy may be useful in identifying patients at low risk of incurring cardiac events after PKT and may, in a large group of patients, obviate the need for routine coronary angiography.

In-111 octreotide scan in a case of a neuroendocrine tumor of unknown origin.

Major neuroendocrine tumors contain many somatostatin receptors. This feature allows for the localization of primary tumors and tumor metastases by scintigraphy with the radiolabeled somatostatin analog octreotide. We describe a patient with nonspecific clinical data and ultrasonography and CT that showed an isolated focal lesion in the liver. In-111 octreotide scintigraphy was essential in establishing the diagnosis of liver metastasis from a neuroendocrine tumor confirmed by pathologic findings. Because clinical symptoms recurred, ultrasonography and CT were performed a few months after surgery. Both were negative. However, In-111 octreotide scintigraphy suggested multiple bone metastases and established the diagnosis of bone metastases from a neuroendocrine tumor, which was confirmed by Tc-99m MDP bone scans and MRI.

Disminución del transportador de dopamina estriatal en primeros episodios psicóticos de pacientes esquizofrénicos tratados con risperidona

Resumen El parkinsonismo (PS) es uno de los efectos secundarios mas comunes de los farmacos antipsicoticos. Un 24 % de pacientes esquizofrenicos nunca tratados tienen PS, lo cual contrasta con el 1% observado en la poblacion normal. El 123I-FP-CIT podria determinar el estado funcional dopaminergico presinaptico de estos pacientes, ya que permite diferenciar PS degenerativo de no degenerativo. Objetivo Evaluar la concentracion del transportador de la dopamina (DAT) en un grupo homogeneo de pacientes jovenes diagnosticados de esquizofrenia durante su primer episodio. Material y metodo Estudio abierto, transversal. Se incluyeron 30 pacientes y 15 controles sanos. Los pacientes se trataron con dosis similares de risperidona y a todos los sujetos del estudio se les realizo una tomogammagrafia (SPECT) con 123I-FP-CIT. Se valoraron sintomas extrapiramidales y psicopatologicos mediante escalas Simpson-Angus, CGI y PANSS. El analisis de las imagenes de SPECT se realizo utilizando regions de interes (ROI) en nucleos caudados, putamen anterior, medio, posterior y cortex occipital. Resultados Los indices de captacion global de 123I-FP-CIT fueron significativamente menores en pacientes esquizofrenicos que en sujetos sanos (t = 2,56; p Conclusion En nuestra serie los pacientes esquizofrenicos con primer episodio psicotico tuvieron una disminucion significativa de la captacion estriatal del 123I-FP-CIT. Esta alteracion podria ser debida a la propia enfermedad o ser secundaria al tratamiento antipsicotico.

Diagnosis and follow-up of acute bacterial prostatitis and orchiepididymitis detected by In-111-labeled leukocyte imaging

Urinary tract infections are some of the most prevalent disorders. Approximately one half of the male population will have symptoms consistent with some kind of prostatitis at some time in their lives. Although this is a very common problem, controversy over diagnosis remains despite a wide variety of diagnostic tools. The authors describe a 57-year-old man with prostatic hyperplasia and urinary tract syndrome in whom prostatitis and orchiepididymitis were detected by indium-111-labeled leukocyte scintigraphy. After completion of antibiotic treatment, a second scintigraph confirmed the clinical cure.