Rodrigo Jaimovich

Nuclear medicine in the management of patients with heart failure: guidance from an expert panel of the International Atomic Energy Agency (IAEA)

Heart failure is increasing worldwide at epidemic proportions, resulting in considerable disability, mortality, and increase in healthcare costs. Gated myocardial perfusion single photon emission computed tomography or PET imaging is the most prominent imaging modality capable of providing information on global and regional ventricular function, the presence of intraventricular synchronism, myocardial perfusion, and viability on the same test. In addition, 123I-mIBG scintigraphy is the only imaging technique approved by various regulatory agencies able to provide information regarding the adrenergic function of the heart. Therefore, both myocardial perfusion and adrenergic imaging are useful tools in the workup and management of heart failure patients. This guide is intended to reinforce the information on the use of nuclear cardiology techniques for the assessment of heart failure and associated myocardial disease.

Changes in Regional Cerebral Blood Flow Are Associated With Endothelial Dysfunction Markers in Cocaine-dependent Patients Under Recent Abstinence

Objectives:Cocaine is a known risk factor for several vascular ischemic events. The underlying mechanisms leading to the complications are not fully understood, although thrombus formation and accelerated atherosclerosis are prominent findings. Evidence of endothelial dysfunction (ED), a key phenomenon in the pathogenesis of atherogenesis, has been demonstrated in cocaine-dependent individuals. Abnormal regional cerebral blood flow (rCBF) is a common finding among chronic cocaine users. The aim of this study was to evaluate whether brain perfusion changes were associated with ED markers in cocaine-dependent individuals. Methods:Circulating endothelial cells (CECs), soluble intercellular cell adhesion molecule, and the chemokine regulated on activation normal T cells expressed and secreted were measured in 27 DSM-IV (Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition) cocaine-dependents patients. Regional cerebral blood flow was assessed using single-photon emission computed tomography at baseline (after recent cocaine consumption) and after 4 weeks of strict abstinence under standard benzodiazepine or antipsychotic therapy. We used statistical parametric mapping analysis to evaluate the covariates. Results:Endothelial cell damage/activation markers were significantly higher in cocaine-dependent individuals after recent consumption and were reduced after 1-month abstinence (P < 0.05). Global rCBF exhibited no significant difference between baseline and after abstinence. When regional perfusion was analyzed in association with ED covariates, significant differences were observed in bilateral cortical areas, including the limbic lobes. Conclusions:We demonstrated an association between systemic ED markers and rCBF in cocaine-dependent patients. These findings suggest that vascular injury may play a role in the pathogenesis of abnormal rCBF.

Descripción de los hallazgos en el perfil lipídico y proteico de pacientes dependientes a cocaína, en abstinencia reciente

BACKGROUND Chronic cocaine users develop multiple potentially lethal ischemic vascular complications associated with accelerated atherosclerosis. AIM To assess biochemical and lipid profiles among cocaine dependent subjects in recent abstinence. MATERIAL AND METHODS A blood sample to measure blood count, biochemical and lipid profiles was obtained from 78 patients aged 19 to 53 years (78% males) who complied with DSM-IV criteria for cocaine dependency. Laboratory results were compared with a group of normal subjects. RESULTS All cases had positive urinary cocaine, with a mean consumption lapse of 7.6 years. The frequency of smoking was higher in cases. Dependent males had higher body mass index than controls. Compared to controls, dependent females had significantly higher triglyceride (TG) levels and lower HDL cholesterol. Therefore the relation total/HDL cholesterol was higher (p = 0.0365). Dependent males had higher TG levels than their normal counterparts. Dependent subjects consuming cocaine base-paste had higher TG levels. Total proteins, albumin, urea and blood urea nitrogen were lower in dependent subjects. Among males, serum creatinine was lower and blood urea was positively correlated with the daily amount of cocaine use (p = 0.03). After a month of strict abstinence, lipid profile was repeated in 27 patients and remained unchanged. CONCLUSIONS Chronic cocaine use was associated with higher TG in both genders and lower HDL cholesterol in women when compared with a group of healthy counterparts.Background: Chronic cocaine users develop multiple potentially lethal ischemic vascular complications associated with accelerated atherosclerosis. Aim: To assess biochemical and lipid profiles among cocaine dependent subjects in recent abstinence. Material and methods: A blood sample to measure blood count, biochemical and lipid profiles was obtained from 78 patients aged 19 to 53 years (78% males) who complied with DSM –IV criteria for cocaine dependency. Laboratory results were compared with a group of normal subjects. Results: All cases had positive urinary cocaine, with a mean consumption lapse of 7.6 years. The frequency of smoking was higher in cases. Dependent males had higher body mass index than controls. Compared to controls, dependent females had significantly higher triglyceride (TG) levels and lower HDL cholesterol. Therefore the relation total/HDL cholesterol was higher (p=0.0365). Dependent males had higher TG levels than their normal counterparts. Dependent subjects consuming cocaine base-paste had higher TG levels. Total proteins, albumin, urea and blood urea nitrogen were lower in dependent subjects. Among males, serum creatinine was lower and blood urea was positively correlated with the daily amount of cocaine use (p=0.03). After a month of strict abstinence, lipid profile was repeated in 27 patients and remained unchanged. Conclusions: Chronic cocaine use was associated with higher TG in both genders and lower HDL cholesterol in women when compared which a group of healthy counterparts.

Endogenous thyroid-stimulating hormone and radioactive iodine uptake in normal subjects.

In 105 normal volunteers, 52 male and 53 female, mean age 45 (range, 20-68), serum thyroid-stimulating hormone (TSH) (1.46 ± 0.7; range, 0.43-3.87 microUI/mL) and 24-hour thyroid radioactive iodine uptake (RAIU) (16.15% ± 4.78% range, 6.45%-30.08%) were measured. Additionally, TSH was 1.18 ± 0.5 microUI/mL for 20 to 29 year-olds and 1.59 ± 0.9 microUI/mL for 60 to 68 year old (P = 0.037). RAIU was 18.30 ± 4.5 for 20 to 29-year-olds and 14.92 ± 3.1 for 60 to 68 year-olds (P = 0.009). TSH trends positively and RAIU at 24 hours correlates negatively with aging of the pituitary axis.

Estudio y manejo de nódulos tiroideos por médicos no especialistas. Consenso SOCHED

The thyroid nodule is a frequent cause of primary care consultation. The prevalence of a palpable thyroid nodule is approximately 4-7%, increasing up to 67% by the incidental detection of nodules on ultrasound. The vast majority are benign and asymptomatic, staying stable over time. The clinical importance of studying a thyroid nodule is to exclude thyroid cancer, which occurs in 5 to 10% of the nodules. The Board of SOCHED (Chilean Society of Endocrinology and Diabetes) asked the Thyroid Study Group to develop a consensus regarding the diagnostic management of the thyroid nodule in Chile, aimed at non-specialist physicians and adapted to the national reality. To this end, a multidisciplinary group of 31 experts was established among university academics, active researchers with publications on the subject and prominent members of scientific societies of endocrinology, head and neck surgery, pathology and radiology. A total of 14 questions were developed with key aspects for the diagnosis and subsequent referral of patients with thyroid nodules, which were addressed by the participants. In those areas where the evidence was insufficient or the national reality had to be considered, the consensus opinion of the experts was used through the Delphi methodology. The consensus was approved by the SOCHED board for publication.

SEGUIMIENTO A CINCO AÑOS EN PACIENTES DIABÉTICOS SIN SÍNTOMAS CARDÍACOS ESTUDIADOS CON PERFUSIÓN MIOCÁRDICA

Se estudiaron 40 pacientes asintomati-cos coronarios, con DM conocida por ≥5 anos, >45 anos de edad, con ≥2 factores de riesgo cardiovascular (FRCV) y electrocardiograma basal normal o con al-teraciones inespecificas. Todos efectuaron una prueba de esfuerzo (PE) adecuada y se estudiaron con Sesta-mibi-Tc99m repetido en 32 casos al 3o ano. Ademas, se evaluo a 36 controles no diabeticos con >2 FRCV. El seguimiento fue de 64±11 meses.

Actualización de protocolos de cardiología nuclear para evaluación y manejo de enfermedad coronaria: Sociedad Chilena de Cardiología y Cirugía Cardiovascular

Resumen: Se revisan los protocolos de cardiologia nuclear actuales, con enfasis en los estudios tomograficos de foton unico (“SPECT”) de perfusion miocardica principalmente en evaluacion de enfermedad corona-ria (EC). Las indicaciones y protocolos mas utilizados son detallados, asi como la actualizacion bibliografica pertinente, tanto al uso clinico como al control de ca-lidad e interpretacion de los estudios. Palabras clave: SPECT, perfusion miocardica, enfermedad coronaria. Articulo de revision Departamento de Imagenes Cardiovasculares No Invasivas.Sociedad Chilena de Cardiologia y Cirugia Cardiovascular. *Becario Programa de Medicina Nuclear, Hospital Clinico Universidad de Chile Correspondencia: Teresa Massardo M.D.Seccion Medicina Nuclear, Hospital Clinico Universidad de ChileSantos Dumont 999-1E, Independencia, Santiago, Chile.Zip Code: 6531063Fono Fax (562) 7770569 E-mail: tmassardo@redclinicauchile.cl Introduccion : Se revisan los protocolos de cardiologia nuclear, que han sido ya publicados en esta revista en los anos 1996 y 2004, con enfasis en los estudios tomograficos de fo-ton unico SPECT de perfusion miocardica en evaluacion de enfermedad coronaria (EC)