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Psoriasis and hidradenitis suppurativa are often associated with obesity. Because chronic low-grade inflammation underlies these 2 diseases, they can progress to more severe forms in patients with obesity if weight-reduction measures are not taken. This review covers pharmacologic alternatives for treating obesity, with emphasis on the benefits associated with the novel use of glucagon-like peptide-1 (GLP-1) agonists that act on satiety receptors. These drugs have led to greater weight loss in clinical trials and real-world settings than orlistat, which until recently was the only drug approved for treating obesity in the European Union. Although experience with GLP-1 agonists in patients with obesity and inflammatory skin diseases is currently scarce, the promising results reported suggest they may offer a useful tool for managing obesity., (Copyright © 2023 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

CD30 + primary cutaneous lymphomas comprise a large group of malignant lymphoproliferative disorders that present in the skin without extracutaneous involvement at the time of diagnosis. The incidence of these lymphomas is low, at 7 to 10 cases per 100 000 population. Two types, derived from T cells (70%-85%) or B cells (15%-30%), have been identified. Hematologists and oncologists have increasingly recognized the idiosyncrasy of primary cutaneous lymphomas, as reflected in the updated classification of the World Health Organization. However, there remain nuances or small differences to consider when managing these conditions, obliging dermatologists to continue to strive to fully reconcile the various clinical pictures in future reviews of the classification of lymphoid neoplasms. A diagnosis of a primary cutaneous lymphoma is based on clinical, histopathologic, immunophenotypic, and genotypic criteria, particularly evidence of T- or B-cell lymphoid monoclonality in lesions. Also relevant are complementary tests to rule out extracutaneous involvement., (Copyright © 2020 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Primary cutaneous T-cell lymphomas other than mycosis fungoides, Sézary syndrome, and lymphoproliferative CD30 + disorders are few, accounting for less than 5% of all cutaneous lymphomas. A cytotoxic phenotype is characteristic of these tumors, and their clinical behavior is usually aggressive. Patients often present with extracutaneous symptoms or develop them shortly after diagnosis. Management is usually multidisciplinary, and intensive systemic therapy and bone marrow transplantation should be considered. Cutaneous B-cell lymphomas account for approximately 30% of primary cutaneous lymphomas. They make up a heterogeneous group of tumors that have different clinical and pathological features. Clinical course also varies. Presenting as papules, nodules, or tumors of variable reddish-violaceous coloring, the lesions may be solitary or multiple and occasionally form clusters. There may also be generalized lesions, present at multiple sites on the trunk, head, or extremities. Three well-defined groups of primary cutaneous lymphoma have been reported: follicle center lymphoma; marginal zone lymphoma, which follows an indolent course; and a diffuse large B-cell lymphoma, leg type, which follows an aggressive course., (Copyright © 2020 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Tenofovir is a nucleotide analogue used for the treatment of chronic hepatitis B and HIV infection. The safety of tenofovir is high but it has been described that tenofovir produces tubular toxicity and Fanconi's syndrome in some HIV-infected patients. To our knowledge this is the first documented case of bone involvement in Fanconi's syndrome in a patient treated with tenofovir for chronic hepatitis B without HIV coinfection. Bone scintigraphy has proven to be very useful for the diagnosis of secondary osteomalacia. Normalization of the bone scan after the withdrawal of the drug and the decline in alkaline phosphatase and phosphate serum levels reinforce the cause-effect relationship., (Copyright © 2013 Elsevier España, S.L. and SEMNIM. All rights reserved.)

Objective: The purpose of this work has been to determine the prognostic value of normal thallium-201 myocardial perfusion scintigraphy (MPS) in patients who had suffered myocardial infarction in the three months prior to the examination., Material and Methods: A stress test followed by (201)Tl Gated SPECT was performed. A follow-up was made of 63 patients with normal perfusion scintigraphy. According to the MPS results, the patients were divided into 2 groups. Group I (n=63; 57% males, age 65±12), patients with normal MPS, and group II (n=60; 81% males, age 64±10), patients with abnormal MPS. The appearance of a new infarction or cardiac death occurring during this period (63±3 months) was analyzed. The appearance of events was related with the cardiovascular risk factors, perfusion study and ventricular function., Results: Five events occurred in group I in 4 patients: 3 new infarctions and 2 cardiac deaths. In group II, there were 18 events in 14 patients: 8 new infarctions and 10 cardiac deaths (p<0,0001). The events were related with age, time from MPS, diabetes, size of perfusion defect and post stress ventricular ejection fraction. Mean survival en group I was 108 months (103-112) and in group II 97 (88-107) (p=0,01)., Conclusion: Patients with normal MPS had fewer major events than patients with abnormal MPS. The size of MPS has been related with the appearance of events. A depressed post-stress left ventricular ejection fraction has a poor prognosis., (Copyright © 2010 Elsevier España, S.L. y SEMNIM. All rights reserved.)

The consensus statement on the management of primary cutaneous melanoma that we present here was based on selection, discussion, review, and comparison of recent literature (including national and international guidelines). The protocols for the diagnosis, treatment, and follow-up used in the hospital centers throughout Catalonia and the Balearic Isles belonging to the Network of Catalan and Balearic Melanoma Centers were also considered. The main objective of this statement was to present the overall management of melanoma patients typically used in our region at the present time. As such, the statement was not designed to be an obligatory protocol for health professionals caring for this group of patients, and neither can it nor should it be used for this purpose. Professionals reading the statement should not therefore consider it binding on their practice, and in no case can this text be used to guarantee or seek responsibility for a given medical opinion. The group of dermatologists who have signed this statement was created 3 years ago with the aim of making our authorities aware of the importance of this complex tumor, which, in comparison with other types of cancer, we believe does not receive sufficient attention in Spain. In addition, the regular meetings of the group have produced interesting proposals for collaboration in various epidemiological, clinical, and basic applied research projects on the subject of malignant melanoma in our society.

Introduction: This study has aimed to establish quantitative normality parameters in the thallium-201 GATED SPECT and to assess the changes related to age, gender, risk factors and stress testing., Methods: A total of 427 patients with low pre-test likelihood of coronary artery disease were selected (45.5% men). The examinations were performed, by obtaining 32 25-second images on a 180% arc. The isotope used was thallium-201 and the SU SEGAMI software was using for the examination procedure., Results: Myocardial tracer uptake in each one of the vascular territories was: left descending artery 77%+/-4; circumflex artery 76%+/-5 and right coronary artery 70%+/-4 (P=.000). Uptake in the right coronary artery territory was lower in men (68.7% vs 70.5% in women, P=.000) and in the left descending artery territory in the obese. There were no gender-related differences in the post-stress ejection fraction for both genders (65.7% in men vs 66.8% in women). However, ventricular volumes were higher in men (end-diastolic volume 80ml+/-27 vs 61ml+/-22; P=0.000 and end-systolic volume 27.2ml+/-25 vs 19ml+/-8; P=0.000). There is an inverse relationship between age and end-diastolic volume. Smokers have higher end-diastolic volumes than non-smokers., Conclusions: Quantification of T1201 uptake in patients having low pre-test probability of coronary artery disease and normal thallium GATED-SPECT in the RCA territory is lower in men. The ventricular function study shows that there are no differences in post-stress EF based on gender but that the end-diastolic and end-systolic volumes are higher in men.

The European Biomedicine and Health (BIOMED-2) Concerted Action Project BMH4-CT98-3936 has defined standardized protocols for polymerase chain reaction (PCR) amplification of different loci of the T-cell receptor (TCR) and immunoglobulin (Ig) genes with a view to achieving greater sensitivity and specificity in the assessment of clonality of lymphoid neoplasms. To assess T-cell clonality, analysis of TCRbeta gene and TCRdelta rearrangements (useful in cases of Tgammadelta + cell neoplasms) is proposed alongside that of TCRgamma. For analysis of B-cell clonality, along with the framework (FR) III segment of the IgH gene, other segments are studied (FRI, FRII) in addition to Igl and Igk genes or incomplete DJ rearrangements of the IgH gene and the k deleting element. The results of the amplification are read using automatic reading systems (GeneScan) or using a heteroduplex system.

Unlabelled: The aim of the study was to evaluate the sensitivity and specificity of TI-201 myocardial perfusion SPECT for the diagnosis of ischaemic cardiopathy in a group of patients with chronotropic insufficiency., Materials and Methods: The examinations of 750 patients who had attended for the diagnosis of ischaemic cardiopathy during 2005-2006 were selected. 28 % (n = 209) did not reach submaximal frequency. Data on the diagnosis was collected in 112 by telephone interview. Ergometry and SPECT were carried out following the usual techniques., Results: Patients who reached submaximal frequency and patients with chronotropic insufficiency did not show differences in age and exercise time. The proportion of patients on beta-blocker treatment, with clinically positive ergometries and pathological SPECT was higher in the patient group which had not reached 85 % of their maximum frequency. The data obtained in the patient group which did not reach submaximal frequency and followed-up by telephone interview showed a SPECT sensitivity of 84 % and specificity of 96 %. The sensitivity of the ergometry was 25 % and its specificity was 96 %., Conclusions: Ergometry with myocardial perfusion SPECT has adequate sensitivity and specificity for the diagnosis of ischaemic cardiopathy, even in patients with chronotropic incompetence. The proportion of pathological examinations is higher in those patients in whom tachycardia could not be sufficiently induced, which seems to indicate that the inability to reach submaximal frequency is related with a higher probability of having ischaemic cardiopathy.

Objective: The aim of this study was to compare a recently described method to evaluate endothelial function; the hyperemic reactivity scintigraphy (HRS) with the ultrasonographic flow-mediated dilatation (FMD) in brachial artery and its relationship with myocardial SPECT., Methods: 42 consecutive patients that underwent myocardial scintigraphy were included. Thirty-six patients had simultaneous measurement of FMD. Both studies were obtained after 5 minutes occlusion of the upper arm with a blood pressure cuff inflated at 250 mmHg. HRS was performed dynamically at rate 1 frame/sec during 3 minutes after intravenous injection of 740 MBq of Tc-99 sestamibi. Time-activity curves allowed obtaining the following indexes: medium hyperemic activity/medium contrallateral activity (MHA/MCA) and maximum hyperemic activity/maximum contrallateral activity (MxHA/CxHA)., Results: In 13 patients SPECT was normal. Twenty-nine patients had perfusion defects in scintigraphy. There was relationship between the FMD and the MHA/MCA (r = 0.23; p = 0.018) and the FMD and the MxHA/CxHA (r = 0.18; p = 0.05). Patients with alterations in the SPECT had an index MxHA/CxHA lower than patients with normal SPECT (1.8 +/- 0.2 vs 1.5 +/- 0.4; p = 0.04). We did not find relationship between FMD and alterations in SPECT., Conclusions: There is relationship between FMD and HRS. HRS is lower in patients with perfusion defects in the SPECT. HRS could provide additional value to myocardial scintigraphy.

It is reported a HIV infected patient under antiretroviral therapy including tenofovir therapy who was referred to the Nuclear Medicine Department to complete bone pain study. A bone scan was performed at 3 hours after the injection of 740 MBq of 99mTc-MDP, revealing an abnormal distribution with characteristic changes compatible with osteomalacia. In further analysis, a secondary hyperparathyroidism and osteomalacia were diagnosed in the context of Fanconi syndrome, an infrequent complication described in patients under treatment with tenofovir.

Introduction: The aim of this work was to describe the variables associated to silent ischemia in patients with reversible perfusion defects in poststress myocardial perfusion scintigraphy., Methods: Tl-201 myocardial perfusion SPECT of 522 patients showing total or partially reversible perfusion defects after exercise testing were quantitatively analyzed retrospectively. Relationship between silent ischemia, size of perfusion defect and presence of risk factors was performed., Results: Ischemia was silent in 412 (73 %) patients. In 176 (33 %) patients exercise test was electrically positive. There were no differences in perfusion defect size between patients with and without angina in exercise test (27 +/- 12 vs 27 +/- 14), but patients with angina had a greater degree of reversibility, in left descending artery (LDA) territory (56 +/- 40 vs 45 +/- 40 p < 0.01). Silent ischemia was more frequently observed in patients with previous acute myocardial infarction (46 % vs 35 %). There was no relationship between the production of exertional angina and the presence of risk factors., Conclusions: A high number of patients with reversible perfusion defects on SPECT had silent ischemia. Patients with angina during exercise test had more defect reversibility in LDA territory. Silent ischemia is more frequent in patients with previous acute myocardial infarction.

Background: The aim of this study is to report two patients with osteitis in secondary syphilis. The increase in the number of cases of syphilis, linked to the changes in sexual behavior and to the increase of immigrants from areas of high prevalence of STD, as well as its relationship with HIV infection, makes important to clinicians become aware of unusual presentation of secondary syphilis., Patients: We report two patients diagnosed of secondary syphilis, one of them with HIV infection. Both showed dermatological lesions in palms and soles, malaise and fever. Bone scintigraphy showed significant uptake in parietal and frontal bones in both patients. Clinical response was quickly achieved after penicillin treatment., Conclusions: In patients with secondary syphilis and osteoarticular symptoms luetic osteitis must be included in differential diagnosis. Bone scintigraphy should be the first diagnostic tool because it possibilities to perform a total body scan which allows localizing asymptomatic lesions. Moreover bone scan shows a high sensitivity.

Introduction: Benign recurrent intrahepatic cholestasis (BRIC) is a rare autosomal-crecessive or sporadic disorder, characterized by repeated episodes of unexplained cholestasis followed by prolonged asymptomatic periods., Case Report: We present two male patients aged 12 and 15 years old who initially presented cholestasis and who had no family history of liver or biliary disease. Typically, alkaline phosphatase and bilirubin levels were elevated, with a slight increase in transaminases and gamma-glutamyltransferase. In both patients biliary tract disease was ruled out by endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiography while no significant abnormalities of the liver parenchyma were found on liver biopsy. Early treatment with ursodeoxycholic acid (UDCA) reduced the duration of the cholestasis episode compared with that of other episodes in which the patient had received other treatment or the treatment was late (1 or 2 months vs 4 months in patient 1 and 1-3 months vs 5 months in patient 2, respectively)., Discussion: Consensus is lacking on the treatment of BRIC although several treatment have been used. UDCA could be effective in increasing bile acid secretion and in reducing serum bilirubin levels. In the two patients described, the initial dosage was 15 mg/kg/day, which was subsequently maintained at 6 mg/kg/day, which was subsequently maintained 6 mg/kg/day until biochemical parameters returned to normal. Nevertheless, larger studies are required to confirm that UDA shortens episodes of cholestasis in BRIC.

Unlabelled: Brain lymphoma is a late complication in AIDS. Lymphoma incidence is increasing in AIDS patients due to the introduction of HAART and prolongation of these patients' life expectancy. This work aims to evaluate the usefulness of brain SPECT with 201Tl in patients with AIDS who present focal brain lesions in computed tomography (CT)., Methods: Seventeen patients with neurologic symptoms and focal neurologic lesions in the CNS (central nervous system) were studied. The images were interpreted as positive when the intensity of the focal deposit of the tracer was greater than that of the adjacent tissue. The SPECT results were compared with serologic data, clinical evolution and/or radiologic follow-up and cerebral biopsy., Results: SPECT images showed focal uptake of radiotracer in 3 patients. All three died shortly after the SPECT was performed. All of them had negative serology for toxoplasmosis. Four patients were diagnosed of progressive multifocal leukoencephalopathy and the ten remaining cases had a good clinical and/or radiologic response., Conclusions: Brain SPECT with 201Tl is a very useful non-invasive technique for the differential diagnosis of cerebral focal lesions in AIDS patients.

Unlabelled: This work aimed to assess the significance of abnormal gastroduodenal uptake in the 67Ga scintigraphy of HIV patients who have been studied for fever of unknown origin. The examinations of 12 patients who had had a normal panedoscopy when the 67Ga scan was done, were selected. One out of 7 patients without gastroduodenal 67Ga uptake was diagnosed of non-specific gastritis. Five patients had abnormal gastroduodenal involvement in the 67Ga scan. One of them was diagnosed of high grade lymphoma. The other 4 patients were diagnosed of mycobacteriosis., Conclusions: Although controversy exists in the literature, the current study shows a high correlation between abnormal gastroduodenal uptake in the 67GA scan of HIV (+) patients and the presence of gastroduodenal disease.

Background: Diagnosis of mycobacterioses in HIV infected patients is sometimes difficult because of atypical findings. The aim of this study was to assess the utility of gallium scintigraphy in diagnosis of AIDS related mycobacterioses in patients with fever of unknown origin., Patients and Methods: We retrospectively reviewed the scans of 220 HIV(+) patients with fever (176 males [80%] and 44 females) who were evaluated with conventional diagnostic procedures at least of a week before., Results: Gallium scintigraphy was positive in 114 patients (51%) and negative in 106 (49%). Mycobacteria were isolated in 83 patients (38%), 75 of these patients (90%) had a positive scintigraphy (sensitivity 90%; specificity 71%). Positive predictive value was 66% and negative predictive value was 92%. Mycobacterium avium-M. intracellulare (MAI) and M. tuberculosis were diagnosed in 22 (29%) and 53 (71%) HIV(+) patients, respectively. Seventy one (94%) of 75 patients with mycobacterioses had gallium uptake in at least two localizations., Conclusions: 67Ga scintigraphy is very useful in HIV(+) patients with fever of unknown origin. A negative gallium scintigraphy makes unlikely the diagnosis of mycobacterioses.

Objectives: To evaluate if cholesterol lowering therapy with simvastatin increases myocardial perfusion, assessed by Thallium-201 single photon emission computed tomography (SPECT) after dipyridamole, in patients with coronary artery disease., Patients and Methods: Ten hypercholesterolemic subjects with coronary artery disease were selected for a pilot study. Lipid and lipoprotein analysis and Thallium-201 SPECT were performed before and after 16 weeks of treatment with 40 mg of simvastatin QD. SPECT images were qualitatively analyzed in 8 myocardial segments using a 4 point scoring system. Quantitative evaluation was performed in 13 segments. The myocardial region with the maximal mean counts per pixel on the stress study was considered the reference region. TI201 activity in all other myocardial regions was expressed as a percentage of the activity in the reference region., Results: Total cholesterol and LDL cholesterol were reduced by 28.4% and 37.1% with treatment. Global myocardial perfusion was increased in all patients. Qualitative analysis demonstrated that cholesterol lowering improved myocardial perfusion during dipyridamole stress. Quantitative analysis showed an increased global perfusion during stress (41.8% vs 54.6%; p < 0.0001), due to increased perfusion of previous ischemic segments (32.4% vs 49.4%; p < 0.0001) but without changes in previous normally perfused segments (71.5% vs 71.3%)., Conclusion: Reduction of cholesterol levels in hypercholesterolemic subjects with coronary artery disease increases myocardial perfusion in ischemic segments during dipyridamole stress test as assessed by single photon emission computed tomography (SPECT).