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D Fuster

Publications and source records attributed to D Fuster.

46 records · Page 3Linked to original sources
PubMed1998

Single photon emission computed tomography (SPECT) in a patient with bilateral temporal seizures: correlation between ictal EEG and postictal/ictal SPECT.

We report a patient with bilateral independent temporal lobe seizures in whom two [99mTc]HMPAO single photon emission computed tomograph (SPECT) scans were performed during two different seizures. In the first periictal SPECT, [99mTc]HMPAO was injected in the interval between two closely spaced seizures (one localized in the left temporal lobe and the other in the right temporal lobe). SPECT images showed hypoperfusion in the left lateral temporal lobe, hyperperfusion of the left mesial temporal region, and pronounced hyperperfusion in the right anterior temporal lobe. These results suggest both a postictal left temporal SPECT pattern and an ictal right temporal pattern. In the second periictal SPECT, [99mTc]HMPAO was injected immediately after a right temporal lobe seizure and showed right lateral temporal lobe hypoperfusion and right mesial hyperperfusion, suggesting a postictal right temporal SPECT pattern. Interpretation of the periictal SPECT should take into account EEG changes at the time or in the minutes immediately after injection of [99mTc]HMPAO.

Adult↗
PubMed1998

Furosemide inhibits 11beta-hydroxysteroid dehydrogenase type 2.

11Beta-hydroxsteroid dehydrogenase 2 (11beta-OHSD2) protects the nonselective renal mineralocorticoid receptor from the endogenous glucocorticoid cortisol. Thus, drugs inhibiting 11beta-OHSD2 might enhance urinary loss of potassium. As diuretics influence the renal handling of potassium, we analyzed the impact of 13 commonly used diuretics on 11beta-OHSD2. Furosemide was the only inhibitor. Its inhibition constant (Ki) was 30 micromol when extracts from COS-1 cells transfected with human 11beta-OHSD2 were used as an enzyme source. The type of inhibition was competitive. To establish whether furosemide inhibits 11beta-OHSD2 and 11beta-OHSD1 in the renal target tissue, isolated tubular segments from rats were analyzed. Furosemide decreased the oxidative activity of 11beta-OHSD2 in intact distal tubules and 11beta-OHSD1 in proximal convoluted tubules. For the assessment of furosemide on the excretion of corticosterone metabolites in vivo, rats were given furosemide i.p., and the ratio of tetrahydrocorticosterone plus 5alpha-tetrahydrocorticosterone to 11-dehydrotetrahydrocorticosterone was determined in urine. This ratio increased after the administration of furosemide in all animals, indicating inhibition of the oxidative activity of 11beta-OHSD. Thus, furosemide inhibits the 11beta-OHSD2 enzyme in the target tissue and might by that mechanism enhance the mineralocorticoid effect of 11beta-hydroxyglucocorticoids.

11-beta-Hydroxysteroid Dehydrogenases↗
PubMed1998

[Cerebral SPECT in partial epilepsy].

UNLABELLED: Effective surgical treatment of patients with medically intractable complex partial seizures depends on accurate preoperative localization of the seizure focus. 99mTc-HMPAO brain SPECT could assist us in localizing the epileptic foci showing focal hypoperfusion on interictal SPECT and hyperperfusion on ictal SPECT. METHODS: Video-EEG monitoring, MRI, as well as interictal and peri-ictal brain SPECT were performed on 37 patients with refractory epilepsy. Ictal brain SPECT was performed on 14 patients and in the remaining 23 patients a postictal SPECT was obtained. Video-EEG was used as the gold standard procedure for localizing the seizure focus and was compared to the interictal and peri-ictal brain SPECT results. Twenty-four patients suffered from temporal lobe epilepsy and 13 had extratemporal seizures. RESULTS: Interictal brain SPECT correctly localized the seizure focus in 43% of the patients (58.3% of the patients with temporal lobe seizures and 15.4% of the patients with extratemporal seizures). Ictal SPECT correctly identified the seizure focus in the 93% of cases (100% of the patients with temporal lobe seizures and 75% of the patients with extratemporal seizures). Finally, 52% of the patients were correctly identified with postictal SPECT (71.4% of the patients with temporal lobe seizures and 22.2% of the patients with extratemporal seizures). CONCLUSION: Our findings suggest that interictal brain SPECT could assist in the localization of temporal lobe seizures. Tracer injection during seizure or immediately after it (peri-ictal SPECT) is the method of choice for SPECT imaging aimed at the non-invasive localization of seizure focus.

Adolescent↗
PubMed1998

[Use of bone SPECT of the dorsolumbar spine in oncological patients with suspected bone metastases].

UNLABELLED: A retrospective study was made to evaluate the usefulness of bone SPECT of the dorsolumbar spine in identifying benign and malignant lesions. A study was made of oncological patients who presented active images in the spinal column visible on planar radionuclide scans who also underwent SPECT. The average follow-up period was 25+/-13 months. MATERIAL AND METHOD: In 43 neoplastic patients 55 visible lesions on SPECT were evaluated, of which 29 were benign and 26 metastatic. The criteria for benign lesions were the absence of change or involution without treatment in the follow-up period. The criteria for classifying metastases were: 1. Positive biopsy. 2. Neurological complications derived from the lesion. 3. Increased extension and tracer uptake by the lesion, and the appearance of other bone metastases. RESULTS: Twelve of 15 lesions located in the vertebral body or pedicle and 11/16 located in the body with extension toward the pedicles were metastases. Twenty-one of 24 lesions located on the anterior face of the vertebral body, articular processes, lamina, or intervertebral disk were benign. CONCLUSION: Bone SPECT was useful for locating the vertebral lesion, which in many cases allows differentiation of benign and metastatic lesions.

Adult↗
PubMed1997

Strontium-89 for palliation of pain from bone metastases in patients with prostate and breast cancer.

We have used strontium-89 chloride (89Sr) for the palliative treatment of metastatic bone pain. Seventy-six patients (50 males with prostate carcinoma and 26 females with breast cancer) were treated with 148 MBq of 89Sr. Sixteen patients were retreated, receiving two or three doses; the total number of injected doses was consequently 95. The Karnofsky performance status was assessed and pain and analgesia were scored on scales of 9 and 5 points, respectively. The efficacy of 89Sr was evaluated at 3 months of treatment. Three levels of response were considered: good - when there was an increase in the Karnofsky status and a decrease in the pain score (equal to or higher than 4) or analgesic score (equal to or higher than 1); partial - when there was an increase in the Karnofsky status and a decrease in the pain score (2 or 3 points) without significant changes in the analgesic score; no response - if no variation or deterioration in these parameters was observed. In prostate cancer patients, the response was good in 64% of cases and partial in 25%, and there was no response in the remaining 11%. In breast cancer patients, the response was good in 62% of cases and partial in 31%, and there was no response in the remaining 8%. Duration of the response ranged from 3 to 12 months (mean 6 months). In the patients who were retreated the effectiveness was as good as after the first dose of 89Sr. A decrease in the initial leucocyte and platelet counts was observed after the 1st month of treatment, with a gradual partial to complete recovery within 6 months. It is concluded that 89Sr is an effective agent in palliative therapy for metastatic bone pain in patients with prostate or breast carcinoma. If required, retreatment can be administered safely and with the same efficacy as is achieved by the first dose.

Aged↗
PubMed1997

Preoperative parathyroid gland localization with technetium-99m sestamibi in secondary hyperparathyroidism.

Technetium-99m sestamibi scintigraphy has become a valuable tool in locating parathyroid glands in patients with primary hyperparathyroidism. The aim of this study was to evaluate its usefulness in secondary hyperparathyroidism. Twenty patients were injected intravenously with 740 MBq of 99mTc-sestamibi and images were obtained at 15 min and 2 h post injection. All patients underwent parathyroid ultrasonography (US) as well as bilateral surgical neck exploration and 64 parathyroid glands were removed. US revealed at least one enlarged gland in 15/20 patients (75%), while 99mTc-sestamibi scintigraphy showed focal areas of increased uptake in at least one gland in 17/20 patients (85%). When imaging results for all glands were evaluated according to surgical results, sensitivity was 54% for parathyroid scintigraphy and 41% for US, and specificity was 89% for both imaging techniques. There was a discrepancy between the two imaging modalities in 28 glands (35%). The mean surgical weight of US-positive glands (1492+/-1436 mg) was significantly higher than that of US-negative glands (775+/-703 mg) (P<0.05). However, there were no significant differences in weight between sestamibi-positive and sestamibi-negative glands. When only sestamibi-positive glands were considered, a positive correlation between uptake and weight was found (r=0.4, P<0.05). In conclusion, parathyroid US and 99mTc-sestamibi scintigraphy are complementary imaging techniques in the preoperative localization of abnormal parathyroid glands in patients with secondary hyperparathyroidism. The limited sensitivity of the techniques means that patients will still require bilateral neck exploration; therefore routine preoperative parathyroid scanning in renal patients is not justified.

Female↗
PubMed1997

Estimation of 99Tcm-MAG3 clearance using a single blood sample obtained over a continuous time interval.

Simplified methods based on a single blood sample have been proposed to estimate the clearance of 131I-hippuran (HIP) and 99Tcm-mercaptoacetyltriglycine (MAG). The blood sample is usually drawn at that time which yields a minimum error between the estimated clearance and that obtained by the standard nine-sample method. In this paper, we establish the regression equations to obtain the HIP and MAG clearances using one sample withdrawn during a fixed time interval. As HIP has long been the agent of choice, we have also established regression equations to estimate the clearance of HIP using one sample after MAG administration. Our results suggest that it is possible to obtain plasma samples 30-50 min post-injection which result in an error of the estimate only slightly higher than the minimum.

Adult↗
PubMedDate not supplied

[Psoas abscess as cause of lumbar spine pain detected by scintigraphy with gallium in a patient with suspicion of spondylodiscitis].

A 56 year old man with fever and lumbar pain who underwent an abdominal CT scan that showed lumbar arthrosic changes, although it was not possible to rule out infectious disease in L5/S1. Bone scintigraphy was requested. It showed heterogeneous hyperuptake that did not make it possible to exclude a spondylodiscitis in this site. Scintigraphy with 67Ga-citrate excluded infectious diseases in the lumbar spine column. However, a pathological uptake was observed in the left iliac fossa suggestive of psoas abscess, which was confirmed by ultrasonography, isolating streptococcus viridans.

Citrates↗
PubMedDate not supplied

[Ovarian and para-aortic recurrence from cervix cancer detected by PET/CT].

We present the case of a 34-year-old woman diagnosed of an adenosquamous carcinoma of the uterine cervix, stage IIB of the FIGO classification (International Federation of Gynecology and Obstetrics), treated with quimiotherapy, radiotheraphy and brachytheraphy with posterior hysterectomy. A recurrence of the disease was suspected due to the progressive rise of CEA levels. A PET/CT revealed abnormal foci in both ovaries, that had been transposed to avoid lesions due to radiation, and in a left para-aortic adenopathy. The diagnosis of recurrence in these sites was confirmed by biopsy. PET with FDG (F18-fluorodeoxyglucose) is useful in the staging of primary tumour and in the detection of recurrence in uterine cervical carcinoma, with better sensitivity and specificity than CT and MRI. PET/CT improves anatomic resolution and helps to resolve the origin of unclear foci like in the case presented in which ovaries were not in their normal situation due to transposition.

Adult↗