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The neuropsychological batteries traditionally used for the assessment of cognitive impairment (CI) in patients with multiple sclerosis are complex tests requiring a long time to administer. Simpler tests are needed to detect cognitive impairment in daily clinical practice.We aimed to evaluate the diagnostic validity and reliability of the Montreal Cognitive Assessment (MoCA) test as a screening tool for CI in patients with multiple sclerosis, as compared against the Brief Neuropsychological Battery.We recruited 52 patients with multiple sclerosis (61.5% women; mean age [standard deviation]: 41.7 [11.5] years). We analysed the reliability (internal consistency, interobserver reliability, and test-retest reliability), construct validity (factor analysis, Pearson correlation coefficient, and coefficient of determination), and criterion validity (ROC curve, sensitivity, specificity, total agreement, positive and negative predictive values, positive and negative likelihood ratios, and Fagan nomogram) of the MoCA test in this population.The prevalence of CI was 21.2% according to findings from the Brief Neuropsychological Battery, and 25% according to the MoCA test. The MoCA test showed good internal consistency (Cronbach alpha, 0.822) and interobserver and test-retest reliability (intraclass correlation coefficient 0.80 and 0.96, respectively). The correlation coefficient between total Brief Neuropsychological Battery and MoCA test scores was 0.82. The optimal cut-off point on the ROC curve was 25-26, yielding 91% sensitivity and 93% specificity.The MoCA test is a valid and reliable tool for screening for CI in patients with multiple sclerosis.

Although dual-energy CT was initially described by Hounsfield in 1973, it remains underused in clinical practice. It is therefore important to emphasize the clinical benefits and limitations of this technique. Iodine mapping makes it possible to quantify the uptake of iodine, which is very important in characterizing tumors, lung perfusion, pulmonary nodules, and the tumor response to new treatments. Dual-energy CT also makes it possible to obtain virtual single-energy images and virtual images without iodinated contrast or without calcium, as well as to separate materials such as uric acid or fat and to elaborate hepatic iron overload maps. In this article, we review some of the clinical benefits and technical limitations to improve understanding of dual-energy CT and expand its use in clinical practice.

The main objective was to study the perception of physical and emotional health of Spanish ophthalmologists and their health habits, as well as the possible influence of the COVID-19 pandemic.An observational, cross-sectional, non-randomized and uncontrolled study was carried out among at Spanish ophthalmologists through an online survey of 47 questions on eating habits, tobacco, alcohol, physical exercise, workload, and perception of physical and emotional state.Of a total of 2,179 ophthalmologists, 260 (11.9%) of whom 55% were men responded to the survey, with a mean age of 52.9±11.4 years. 5.8% were smokers. In total, 51.5% reported good physical health, with a mean Body Mass Index of 24.4kg/mSpanish ophthalmologists have a positive perception of their physical and emotional health, despite having life habits that are not always healthy and feeling mostly down. The COVID-19 pandemic has had a negative influence on the physical and emotional health of ophthalmologists.

COVID-19 is a disease with many clinical, biochemical, and radiological signs that has a predilection for the lungs, probably because of the high number of ACE-2 receptors in this organ. The infection of cells activates proinflammatory substances, causing diffuse alveolar damage, which is the histopathological basis of ARDS. The exudative phase would manifest as ground-glass opacities and consolidation, and the proliferative phase would manifest as a tendency toward a more linear morphology. Both CT and PET/CT findings support the inflammatory character of the lung lesions in the initial phase of the disease and in patients with mild-moderate disease. Severe cases have pulmonary hypoperfusion that is likely due to abnormal alveolar ventilation and perfusion. On the other hand, a prothrombotic state increases the risk of thromboembolic disease through the activation of coagulation and platelet pathways with the production of fibrin degradation products (D-dimer) and consumption of platelets.

OBJECTIVES The aims of the present study were to describe the prevalence of positive urinary bacterial culture in dogs, to identify the most commonly isolated microorganisms and to analyse changes in antimicrobial susceptibility patterns over time. MATERIAL AND METHODS A retrospective case series was performed using culture and susceptibility results from canine urine samples collected between January 2010 and December 2017. The presence or absence of infection, identity of the bacterium with heaviest growth, and susceptibility profile were recorded for each sample. Trends in the frequency of positive culture and antimicrobial resistance were assessed by Poisson regression modelling. Prevalence rate ratio and 95% confidence interval were reported for resistance to each antimicrobial. RESULTS A positive urine culture was documented in 771 (22.5%) of 3420 samples. Escherichia coli was the most commonly isolated microorganism. There was no significant increase in the frequency of positive bacterial culture over the study period (prevalence rate ratio 0.98; 95% confidence interval: 0.92 to 1.0). Overall, there was an increase in antimicrobial resistance within Enterobacteriaceae from 5.2 to 35.6%. The prevalence of multidrug-resistant bacteria varied from year to year throughout the study period. However, the Poisson regression model identified a significant increase in the frequency of multidrug-resistant Enterobacteriaceae over this period, averaging approximately 22% per year (prevalence rate ratio 1.22, 95% confidence interval: 1.06 to 1.42). CLINICAL SIGNIFICANCE The significant increase in antimicrobial resistance observed in this study is concerning and may have implications for veterinary and public health. Appropriate measures, such as antibiotic stewardship programmes, should be implemented to address increasing antimicrobial resistance.

Bone metastases are very common complications associated with certain types of cancers that frequently negatively impact the quality of life and functional status of patients; thus, early detection is necessary for the implementation of immediate therapeutic measures to reduce the risk of skeletal complications and improve survival and quality of life. There is no consensus or universal standard approach for the detection of bone metastases in cancer patients based on imaging. Endorsed by the Spanish Society of Medical Oncology (SEOM), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM) a group of experts met to discuss and provide an up-to-date review of our current understanding of the biological mechanisms through which tumors spread to the bone and describe the imaging methods available to diagnose bone metastasis and monitor their response to oncological treatment, focusing on patients with breast and prostate cancer. According to current available data, the use of next-generation imaging techniques, including whole-body diffusion-weighted MRI, PET/CT, and PET/MRI with novel radiopharmaceuticals, is recommended instead of the classical combination of CT and bone scan in detection, staging and response assessment of bone metastases from prostate and breast cancer.Clinical trial registration: Not applicable.

Bone metastases are very common complications associated with certain types of cancers that frequently negatively impact the quality of life and functional status of patients; thus, early detection is necessary for the implementation of immediate therapeutic measures to reduce the risk of skeletal complications and improve survival and quality of life. There is no consensus or universal standard approach for the detection of bone metastases in cancer patients based on imaging. Endorsed by the Spanish Society of Medical Oncology (SEOM), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM) a group of experts met to discuss and provide an up-to-date review of our current understanding of the biological mechanisms through which tumors spread to the bone and describe the imaging methods available to diagnose bone metastasis and monitor their response to oncological treatment, focusing on patients with breast and prostate cancer. According to current available data, the use of next-generation imaging techniques, including whole-body diffusion-weighted MRI, PET/CT, and PET/MRI with novel radiopharmaceuticals, is recommended instead of the classical combination of CT and bone scan in detection, staging and response assessment of bone metastases from prostate and breast cancer.Clinical trial registration: Not applicable.

To compare the peripapillary and optic nerve head vessel density (PP-ONH VD) between glaucoma patients (all, early, moderated, and advanced) and healthy subjects of Afro-Caribbean descent (AD) and European descent (ED).This was a cross-sectional study. One eye was evaluated in 90 subjects, including 66 glaucoma patients and 24 healthy subjects, who underwent PP-ONH VD imaging using SPECTRALIS® Optical Coherence Tomography Angiography (OCT-A). We analysed the superficial vascular complex using the AngioTool version 0.6a software. The correlation between the PP-ONH VD and visual field mean deviation (MD) was evaluated using a scatter plot and Spearman's rho correlation coefficient.Among the healthy subjects, the AD group had a lower superficial PP-ONH VD [43.29±3.25% (mean±standard deviation)] than the ED group (46.06±1.75%) (P=0.016). Overall, superficial PP-ONH VD did not show any significant differences between the total AD and ED glaucoma patients or in the subgroup analyses (early/moderate/advanced) (AD: 32.73±6.70%, 37.11±5.72%, 32.48±5.73%, 27.76±4.74%, respectively; ED: 33.94±6.89%, 38.52±3.82%, 35.56±4.18%; 27.65±6.31%, respectively) (P0.05 for all). A strong, statistically significant correlation was established between vessel density and mean deviation among AD and ED glaucoma patients (r=0.709 and r=0.704, respectively) (P0.001 for both).This pilot study shows that healthy subjects of AD had lower peripapillary and optic nerve head superficial vessel density than healthy subjects of ED, but no significant differences were found between AD and ED glaucoma groups (all, early, moderate, or advanced).

Smoking is considered the chief leading cause of chronic obstructive pulmonary disease (COPD). Its impact on the progressive deterioration of the airways has been extensively studied. However, its direct effects on pulmonary vasculature have not been studied in deep, in part due to the classic conception that vascular damage is a consequence of alveolar hypoxia and loss of capillary bed. We have used different molecular and cell biology approaches, as well as tissue studies from in vivo models and human samples to analyse how cigarette smoke extract (CSE) regulated pulmonary arterial cells phenotypic modulation, particularly on human fibroblasts and smooth muscle cells. Our results demonstrate that CSE exposure has direct effects on hPAFib and hPASMC, promoting a senescent phenotype that in turn contributes to increase the proliferative potential of non-exposed cells. Using traction force microscopy, wire myography and patch-clamp techniques, we demonstrate that CSE affects cell contractility and dysregulates the expression and activity of the voltage-gated K+ channel Kv7.4. This ultimately contributes to limit vascular responses impairing vasoconstriction and endothelium-dependent and independent relaxation. Additionally, the levels of this channel are diminished in the lungs of smoke-exposed mice and COPD patients. These findings greatly enhance knowledge about pulmonary diseases, in particular COPD, and open a new line of study related to the exploitation of these mechanisms as therapeutic targets.

To determine the presence of a group of mutations, and establish the prognostic value for recurrence and progression.Prospective observational study. Intermediate-to-high-risk non-muscle invasive bladder cancer (NMIBC) was evaluated. Data from genetic analyses were included in a database along with clinicopathological variables of interest.Seventy-four patients. Twenty-five (33.8%) recurred and 3 (4.1%) progressed. Median time to recurrence: 8 months (5.7-12.7). Median time to progression: 14 months (P75: 12). Mutation distribution: KRAS codon 12: one patient (1.4%), BAT25: five patients (6.8%), BAT-26: four patients (5.4%), and D2S123: 6 patients (8.1%). Arg72Pro polymorphism: 50 patients (67.6%) exhibited homozygous mutations, 23 (31.1%) were heterozygous, and 1 patient (1.4%) did not present the mutation. We found an association between presence of MSI at BAT26 and female sex (p 0.05) and tumor stage and the TP53 Arg72Pro polymorphism. Recurrence-free survival (RFS) was significantly associated with presence of MSI at D2S123, with a HR of 5.44 for patients presenting the mutation (95% CI 1.83-16.16). On multivariate analysis, we found a statistically significant increase in risk of recurrence among patients with MSI at D2S123 (HR 5.15; p 0.05) and more than 2 previous transurethral bladder resections (TURBs) (HR 5.07; p 0.05) adjusted for tumor stage and grade. Harrell's concordance index revealed an accuracy of 0.74 (p 0.05).An association was found between presence BAT26 MSI and female sex, Arg72Pro polymorphism with tumor stage and D2S123 and more than 2 TUR procedures were associated with RFS adjusted to tumor stage and grade.

Resumen La COVID-19 es una enfermedad con una gran semiologia clinica, bioquimica y radiologica, que tiene una afectacion preferente por el pulmon, probablemente debido a un mayor numero de receptores ECA-2. La infeccion celular activa sustancias proinflamatorias y provoca un dano alveolar difuso, que es la base histopatologica del distres respiratorio del adulto. La fase exudativa explicaria las imagenes “en vidrio deslustrado” y consolidacion, mientras que la tendencia hacia una morfologia mas lineal representa la fase proliferativa. Tanto la tomografia computarizada (TC) como la tomografia por emision de positrones/ tomografia computarizada (PET/TC) apoyan el caracter inflamatorio de las lesiones pulmonares cuando la enfermedad esta en fase inicial o es leve-moderada. Los casos graves muestran una hipoperfusion pulmonar que se explicaria por una alteracion de la ventilacion-perfusion alveolar (V/Q). Por otro lado, un estado protrombotico conlleva mayor probabilidad de enfermedad tromboembolica por la activacion de la via de la coagulacion y plaquetaria, con la produccion de sustancia de degradacion de la fibrina (dimero D) asi como el consumo de plaquetas.

The next phase

Objective To assess the importance of false-negative and false-positive findings in computed tomography (CT) and 18F-FDG positron emission tomography (PET) in mediastinal lymph node staging in patients undergoing surgery for non-small cell lung cancer (NSCLC). Material and methods This retrospective study included 113 consecutive patients and 120 resected NSCLCs; 22 patients received neoadjuvant treatment. We compared the findings on preoperative 18F-FDG PET-CT studies with the postoperative pathology findings. Lymph node size and primary tumor size were measured with CT, and lymph nodes and primary tumors were evaluated qualitatively and semiquantitatively (using standardized uptake values (SUVmax)) with PET. Results Metastatic lymph nodes were found in 26 (21.7%) of the 120 tumors and in 41 (7.7%) of the 528 lymph node stations analyzed. 18F-FDG PET-CT yielded 53.8% sensitivity, 76.6% specificity, 38.9% positive predictive value, 85.7% negative predictive value, and 71.7% diagnostic accuracy. The false-negative rate was 14.2%. Multivariable analysis found that the factors associated with false-negative findings were a moderate degree of differentiation in the primary tumor (p = 0.005) and an SUVmax of the primary tumor >4 (p = 0.027). The false-positive rate was 61.1%, and the multivariable analysis found that lymph node size >1 cm was associated with false-positive findings (p Conclusions In mediastinal lymph node staging in patients with NSCLC, 18F-FDG PET-CT improves the specificity and negative predictive value and helps clinicians to select the patients that will benefit from surgery. Given the high rate of false positives, histological confirmation of positive cases is recommendable.

Resumen Objetivo Valorar las implicaciones de los falsos negativos (FN) y de los falsos positivos (FP) de la tomografia computarizada (TC) y la tomografia por emision de positrones (PET) con fluorodesoxiglucosa ( 18 F-FDG) en nuestro medio en la estadificacion ganglionar mediastinica de pacientes operados de carcinoma de pulmon de celulas no pequenas (CPCNP). Material y metodos Estudio retrospectivo de 113 pacientes consecutivos con 120 CPCNP operados; 22 pacientes recibieron tratamiento neoadyuvante. Se compararon los resultados obtenidos en la 18 F-FDG PET-TC prequirurgica con los patologicos. Se analizaron el tamano ganglionar y del tumor primario en la TC, y su valoracion cualitativa y semicuantitativa (SUVmax) en la PET. Resultados Se encontraron ganglios metastasicos en el 21,7% de los 120 tumores y en el 7,7% de las 528 estaciones ganglionares analizadas. La 18 F-FDG PET-TC en el estudio por tumor mostro una sensibilidad del 53,8%, una especificidad del 76,6%, un valor predictivo positivo del 38,9%, un valor predictivo negativo del 85,7% y una precision diagnostica del 71,7%. La tasa de FN fue del 14,2%. El analisis multivariable mostro que un grado de diferenciacion moderado del tumor primario (p = 0,005) y una SUVmax del tumor primario >4 (p = 0,027) eran los factores asociados con los FN. La tasa de FP fue del 61,1% y el tamano ganglionar >1 cm era el factor asociado con los FP (p Conclusiones La 18 F-FDG PET-TC en la estadificacion ganglionar mediastinica de pacientes con CPCNP mejora la especificidad y el valor predictivo negativo, y ayuda al clinico a seleccionar los pacientes que se beneficiaran de la cirugia. Dada la elevada tasa de FP, es recomendable que, antes de excluir a pacientes de la cirugia, se confirmen histologicamente los casos positivos.

A case is described of a woman with history of right peribulbar nerve block prior to cataract surgery that, within a few days, presented with a trochlear intraorbital arteriovenous fistula. This was resolved without sequelae after three months by performing intermittent homolateral carotid massages. This is the first case of supratrochlear intraorbital arteriovenous fistula. There are only 8 cases reported of traumatic intraorbital arteriovenous fistula, and only one was with post-peribulbar anaesthesia.

Chronic obstructive pulmonary disease (COPD) is a widespread disease, with no curative therapies nowadays. Exposure to cigarette smoking is considered the chief leading cause of COPD. Current drugs therapies improve patient quality of life, however they do not revert the progression of the disease. Therefore, a deeper study of the cellular and molecular mechanisms that underlie this pathology is required to be able to carry out targeted and effective treatments. Although the effects of cigarette smoke in the progressive deterioration of the airway have been extensively studied in COPD patients, its effects on pulmonary vasculature have been unexplored, due to the classic conception that vascular damage is a consequence of alveolar hypoxia and loss of capillary bed. In this paper, we aimed to study the effects of cigarette smoke extract (CSE) in regulating pulmonary arterial cells phenotypic modulation, in particular the effects in fibroblasts (hPAFib) and smooth muscle cells (hPASMC), and in murine pulmonary arteries. Our results demonstrated that CSE exposure had direct effects on hPAFib and hPASMC, promoting a senescent phenotype that in turn contributed, through the secretion of inflammatory molecules, to increase the proliferative potential of non-exposed cells. CSE also increased total ROS levels in hPAFib and hPASMC, and upregulated NADPH oxidase subunits NOX1 and p22phox. Most importantly, CSE affected cell contractility and dysregulated the expression and activity of voltage-gated K+ channel Kv7.4. This contributed to limit vascular responses impairing vasoconstriction and endothelium-dependent and independent relaxation.

Patients with large incisional hernias have significant morbidity and their management is a challenge for the surgical team because of the large abdominal wall involvement. The choice of surgical technique is still controversial. The purpose of this study is to analyze the predictive factors for recurrence after intraperitoneal mesh repair in patients with large incisional hernias. A retrospective cohort observational study with a prospectively collected database was performed in the Hospital Clinico San Carlos (Madrid, Spain). All consecutive patients operated on from January 2009 to December 2014 with incisional hernia of 10 or more centimeters in its transverse diameter were included. An intraperitoneal repair with a composite mesh fixed with discontinuous absorbable suture and fibrin sealant was performed. Demographic data, comorbidities, and early and long term outcomes were analyzed. The primary outcome was the presence of recurrence. One hundred and twenty patients were included. Mean age was 63.3 years (SD 12.9) and sex ratio was 1.4:1. Seventy-two patients (60%) were ASA III–IV. Forty-five patients (37.5%) had recurrent ventral hernias. Mean defect size was 14.7 cm (SD 3.21) of width. Overall postoperative morbidity rate was 25%. Median hospital stay was 6 days (IQR 4–8). Recurrence rate was 8.3%, after a median follow-up of 16 months (IQR 10–25). Multivariate analysis showed significant association between ASA III–IV, use of Composix Kugel™ mesh, superficial surgical site infection, and the presence of recurrence. The recurrence rate after intraperitoneal mesh repair in patients with large incisional hernias might be associated with ASA III–IV, use of Composix Kugel™ mesh, and superficial surgical site infection.

Objectives To analyse the activity of interconsultations conducted by the departments of internal medicine, communicating their importance to managers and offering information to these departments to improve their organisation. Methods A cross-sectional study was conducted using an interconsultation activity survey (on-demand consulting activity for other departments) and shared care (consulting activity provided in a regulated manner to other departments). Results We received 120 surveys that corresponded to 108 public and 12 private hospitals. Forty-five percent of the surveyed hospitals had a specialised interconsultation unit, and 31% had shared care. The department most frequently helped by the presence of a stable consultation unit (65% of the cases) was orthopaedic and trauma surgery. Fifty-five percent of the departments of internal medicine surveyed had an interconsultation activity record since the start of their activity. Ninety-two percent of the departments lacked a protocol that regulated interconsultations, and in 74% of the cases, the interconsultation was on demand. Conclusions The interconsultation activity is generalised in the departments of internal medicine, but only 45% of these departments have interconsultation units, and only 33% provide the shared care modality. The survey reflects the shortcomings of training and some confusion in the concept of interconsultations. The considerable majority of departments lack organisational interconsultation protocols.

Resumen Objetivos Analizar la actividad de interconsulta (IC), realizada por los Servicios de Medicina Interna (SMI), transmitir su importancia a los gestores y ofrecer informacion a los SMI para mejorar la organizacion de la misma. Metodos Estudio transversal mediante una encuesta de actividad en IC (actividad de consultoria a demanda para otros servicios) y asistencia compartida (actividad de consultoria que se presta de modo reglado en otros servicios). Resultados Se recibieron 120 encuestas que correspondian a 108 hospitales publicos y 12 privados. El 45% de los hospitales encuestados disponen de unidad de IC monografica y en el 31% existe asistencia compartida. El servicio mas frecuentemente asistido por una consultoria estable (65% de los casos) fue cirugia ortopedica y traumatologia. El 55% de los SMI encuestados lleva un registro de la actividad de IC desde el inicio de su actividad. El 92% de los servicios carece de un protocolo que regule la IC y en el 74% de los casos la IC se responde a demanda. Conclusiones La actividad de IC esta generalizada en los SMI, pero solo el 45% de ellos disponen de unidades de IC y el 33% prestan la modalidad de asistencia compartida. La encuesta refleja carencias de formacion y cierta confusion en el concepto de IC. La gran mayoria de los servicios carecen de protocolos organizativos de IC.

Fundamento: Investigar el comportamiento de varios indicadores de producción y repercusión científicos en un grupo de investigadores clínicos españoles y valorar su utilidad para interpretar trayectorias individuales o colectivas. Material y método: Estudio piloto ecológico unicéntrico en un grupo de médicos con trayectoria investigadora consolidada. A través de Science Citation Index Expanded se obtuvo el número de trabajos publicados por cada autor (indicador de producción) y el número de citas, el factor de impacto y el índice h (indicadores de repercusión). Los indicadores se calcularon para cada año de la trayectoria investigadora. Se relacionó la experiencia del investigador y el valor del indicador alcanzado, la relación entre indicadores y la evolución temporal, tanto individual como colectivamente. Resultados: Se analizaron 35 investigadores, con experiencia de 28,4 (9,6) años. El índice h fue el indicador con coeficiente de variación más bajo. La relación entre indicadores y experiencia investigadora es significativa pero discreta (R² entre 0,15-0,22). Los cuatro indicadores mostraron buenas correlaciones entre ellos. La evolución temporal de los indicadores, tanto individual como colectiva, se ajustó mejor a una función polinómica de segundo grado que a una lineal: individualmente, todos los autores obtuvieron R²>0,90 en todos los indicadores; el mejor ajuste se produjo con el índice h (R²=0,61). En función del indicador utilizado, pueden producirse variaciones sustanciales en la ordenación de los investigadores. Conclusiones: Es posible describir, en una muestra relativamente homogénea de investigadores, un modelo de evolución temporal de los indicadores de producción y repercusión, y el índice h parece mostrar ciertas ventajas respecto al resto. Este análisis podría convertirse en una herramienta predictiva del rendimiento a alcanzar por investigadores individuales y para grupos homogéneos de investigadores correspondientes a un mismo nicho científico. Background: To study the behaviour of several indicators of scientific production and repercussion in a group of Spanish clinical researchers and to evaluate their possible utility for interpreting individual or collective scientific pathways. Method: We performed a unicentric, ecological pilot study involving a group of physicians with consolidated research experience. From the Science Citation Index Expanded (SCI-Expanded) database, we obtained the number of publications of each author (indicator of production) and the number of citations, impact factor and h index (indicators of repercussion). These indicators were calculated individually for each of the years of research experience and we assessed the relationship between the experience of the researcher and the value of the indicator achieved, the relationship between these indicators themselves, and their temporal evolution, both individually and for the entire group. Results: We analysed 35 researchers with a research experience of 28.4 (9.6) years. The h index showed the lowest coefficient of variance. The relationship between the indicators and research experience was significant, albeit modest (R² between 0.15-0.22). The 4 indicators showed good correlations. The temporal evolution of the indicators, both individual and collective, adjusted better to a second grade polynomial than a linear function: individually, all the authors obtained R²>0.90 in all the indicators; together the best adjustment was produced with the h index (R²=0.61). Based on the indicator used, substantial variations may be produced in the researchers' ranking. Conclusions: A model of the temporal evolution of the indicators of production and repercussion can be described in a relatively homogeneous sample of researchers and the h index seems to demonstrate certain advantages compared to the remaining indicators. This type of analysis could become a predictive tool of performance to be achieved not only for a particular researcher, but also for a homogeneous group of researchers corresponding to a specific scientific niche.

Resumen Introduccion Los errores en la identificacion del paciente representan uno de los problemas con mayor indice de factor de riesgo en provocar un evento adverso en el paciente. Objetivo Detectar y analizar las causas de los errores de identificacion de paciente y sus muestras biologicas en las solicitudes analiticas (EIPMB) procedentes de Urgencias e implantar estrategias de mejora. Material y metodos Diseno del proceso y protocolo a seguir por todos los profesionales implicados en el proceso de peticion y realizacion de pruebas analiticas. Evaluacion y seguimiento de indicadores de EIPMB antes y despues de la implantacion de dichas medidas de mejora (anos 2010 a 2014). Resultados Durante el periodo del estudio se detectan un total de 316 EIPMB en un total de 483.254 solicitudes del Servicio de Urgencias que representan una media de 6,80/10.000. El error de identificacion de paciente fue el mas frecuente en todos los semestres, con una diferencia significativa con p Conclusiones Las estrategias de mejora aplicadas demostraron ser eficaces en la deteccion de los EIPMB, asi como en su prevencion. No obstante, se debe seguir trabajando en esta estrategia, fomentando la cultura de seguridad de todos los profesionales implicados e intentando alcanzar el objetivo de que el 100% de las solicitudes analiticas, asi como las muestras, esten identificadas correctamente.

Resumen Objetivo Estudiar la evolucion temporal de los indices bibliometricos de internistas con una trayectoria investigadora consolidada, con el fin de predecir el comportamiento futuro de un investigador y evaluar si la produccion centrada en un area concreta de la medicina interna permite obtener mayor visibilidad que en medicina interna general. Material y metodo Se analizo un grupo representativo de miembros de la Sociedad Espanola de Medicina Interna a partir de los datos obtenidos de la Web of Science. Como indicador de productividad se analizo el numero de articulos publicados y como indicadores de repercusion el factor de impacto, el numero de citas y el indice h. Resultados Se analizo a 42 internistas, con una media de 30 anos de experiencia y un total de 6.655 publicaciones. La media (DE) del numero de trabajos fue de 158 (96), el numero de citas 2.850 (2.865), el factor de impacto 711 (549) y el indice h 25 (11), siendo superiores estos datos en los internistas especializados respecto a los generalistas. Hubo buena relacion entre indicadores de repercusion y de productividad (R 2 = 0,61-0,89) y poca entre estos y los anos de experiencia (R 2 = 0,13-0,19). La evolucion temporal de estos indicadores para cada investigador individual, y para todos ellos en conjunto, se ajusto a un modelo polinomial de segundo grado, teniendo el indice h las R 2 mas altas. Conclusiones El indice h es el que mejor se ajusta y menos variabilidad presenta, lo cual podria permitir predecir la produccion e impacto cientifico futuro de los internistas. Los investigadores especializados obtienen mas visibilidad que los generalistas.

Objective To study the temporal evolution of the bibliometric indices of internists with established research experience in order to predict the future behavior of researchers and to assess whether output focused on a specific area of internal medicine helps obtain greater visibility than in general internal medicine. Materials and methods We analyzed a representative group of members of the Spanish Society of Internal Medicine (SEMI) based on data obtained from the Web of Science. As an indicator of productivity, we analyzed the number of articles published. As impact indicators, we studied the impact factor (IF), the number of citations and the h -index. Results We analyzed 42 internists, with a mean experience of 30 years and a total of 6655 publications. The mean (SD) number of studies was 158 (96), the number of citations was 2850 (2865), the IF was 711 (549) and the h -index was 25 (11). These figures were higher for the specialist internists than for the general internists. There was a good relationship between the impact and productivity indicators ( R 2 = 0.61–0.89) and a poor relationship between these indicators and the years of experience ( R 2 = 0.13–0.19). The temporal evolution of these indicators for each individual researcher and for all researchers as a whole was adjusted to a second-degree polynomial model, with the h -index having the highest R 2 values. Conclusions The h -index is the factor that had the best adjustment and least variability and could therefore help predict the future scientific output and impact of internists. The specialist researchers achieved greater visibility than the general internists.

To analyse the evolution of care provided by the internal medicine units (IMU) of the Spanish National Health System from 2007 to 2014.We analysed all discharges from the IMU of the Spanish National Health System in 2007 and 2014, using the Minimum Basic Data Set. We compared the risk factors by episode, mortality and readmissions between the two periods. We prepared specific fits for the risk for mortality and readmissions in heart failure, pneumonia and chronic obstructive pulmonary disease, as well as the Charlson index for all activity.Discharges from the IMU between the two periods increased 14%. The average patient age increased by 2.8 years (71.2±17.1 vs. 74±16.2; p.001), with a marked increase in comorbidity (Charlson index, 4±3.7 vs. 4.7±3.9; p.001; 24% increase in risk factors per episode). The adjusted mortality rates decreased slight but significantly, with a slight increase in readmissions.During the analysed period, there was an increase of almost 3 years in the mean age of patients treated in the IMU of the Spanish National Health System, with a marked increase in comorbidity. These results should lead to a more appropriate assignment of nurse workloads and an increased implementation of good practices in clinical management.

Left ventricular systolic function: How to understand it and analyze it Abstract In cardiac magnetic resonance imaging studies, left ventricular systolic function is usually calculated automatically. To understand and interpret parameters of left ventricular systolic function correctly, it is fundamental to understand how each parameter is obtained and why values obtained with different techniques, for example, ultrasonography and magnetic resonance imaging, can differ. This article provides details about the usual analysis of systolic function from the quantitative and qualitative points of view; it also explains other methods that do not require specific software. Moreover, we provide a file that we designed for use with Microsoft Excel ® to enable simple, intuitive analysis of systolic function. Readers can use this file freely.

Background and objectives We do not know what factors influence residents’ perceived satisfaction during their training. The aim of this study was to analyze the satisfaction of specialists with their training and its associated factors. Material and methods This was a cross-sectional study using self-completion surveys of residents in training at the Clinic Hospital San Carlos for the courses conducted in 2006, 2009, 2010 and 2012. The study's dependent variable was overall satisfaction with the training; the independent factors were demographic and occupational characteristics, variables related to healthcare, teaching and research activity. Results The total participation percentage was 83.7% (1424/1701), and the mean age was 28.4 years (SD, 3.2 years). The overall satisfaction percentage was 75.2%. The factors statistically associated with overall satisfaction in the multivariate analysis were the involvement of the teaching staff (tutors and assistants) in the training, greater satisfaction in medical versus surgical specialties, the year of residence, the facilities for completing the thesis, working less than 40 h a week, adequate time to perform daily tasks, appropriate number of department meetings and not having a previous specialty. Conclusions The activities related to research and teaching are associated with the overall satisfaction of residents. The routine activity factors most closely associated with satisfaction were the time available and the work hours. More studies are necessary to understand the impact of resident satisfaction on care quality and in their activity as future specialists.

Resumen Antecedentes y objetivos No se conoce que factores influyen en la percepcion de la satisfaccion de los residentes durante su formacion. El objetivo del estudio fue analizar la satisfaccion del especialista en formacion y sus factores asociados. Material y metodos Estudio transversal mediante encuestas autocumplimentadas a los residentes en formacion del Hospital Clinico San Carlos en los cortes realizados en los anos 2006, 2009, 2010 y 2012. La variable dependiente del estudio fue la satisfaccion global con la formacion, y como factores independientes se estudiaron caracteristicas sociodemograficas y laborales, variables relacionadas con la actividad asistencial, docente e investigadora. Resultados Porcentaje de participacion total de un 83,7% (1.424/1.701). La edad media fue 28,4 (DE 3,2) anos. El porcentaje de satisfaccion global fue de un 75,2%. En el analisis multivariado, los factores asociados de manera estadisticamente significativa a la satisfaccion global fueron: la implicacion del personal docente (tutores y adjuntos) en la formacion, mayor satisfaccion en especialidades medicas frente a las quirurgicas, el ano de residencia, las facilidades para realizar la tesis, trabajar menos de 40 h a la semana, el tiempo adecuado para la realizacion de las tareas diarias, la adecuacion en el numero de sesiones en el servicio y el no disponer de otra especialidad previa. Conclusiones Las actividades relacionadas con la investigacion y docencia estan asociadas con la satisfaccion global del residente. Los factores de la actividad rutinaria que mas se asocian con la satisfaccion fueron el tiempo disponible y las horas de trabajo. Son necesarios mas estudios para conocer el impacto de la satisfaccion del residente en la calidad asistencial y en su actividad como futuro especialista.

Background The aim of this study was to evaluate postoperative complications in patients having major elective surgery using oesophageal Doppler monitor-guided goal-directed haemodynamic therapy (GDHT), in which administration of fluids, inotropes, and vasopressors was guided by stroke volume, mean arterial pressure, and cardiac index. Methods The FEDORA trial was a prospective, multicentre, randomised, parallel-group, controlled patient- and observer-blind trial conducted in adults scheduled for major elective surgery. Randomization and allocation were carried out by a central computer system. In the control group, intraoperative fluids were given based on traditional principles. In the GDHT group, the intraoperative goals were to maintain a maximal stroke volume, with mean arterial pressure >70 mm Hg, and cardiac index ≥2.5 litres min−1 m−2. The primary outcome was percentage of patients with moderate or severe postoperative complications during the first 180 days after surgery. Results In total, 450 patients were randomized to the GDHT group (n=224) or control group (n=226). Data from 420 subjects were analysed. There were significantly fewer with complications in the GDHT group (8.6% vs 16.6%, P=0.018). There were also fewer complications (acute kidney disease, pulmonary oedema, respiratory distress syndrome, wound infections, etc.), and length of hospital stay was shorter in the GDHT group. There was no significant difference in mortality between groups. Conclusions Oesophageal Doppler monitor-guided GDHT reduced postoperative complications and hospital length of stay in low–moderate risk patients undergoing intermediate risk surgery, with no difference in mortality at 180 days. Clinical trial registration ISRCTN93543537.

Papillary carcinoma is the second most common renal cell carcinoma. It has a better prognosis than the more frequent clear cell carcinoma, although this does not hold true for advanced cases, because no specific treatment exists. It presents as a circumscribed peripheral tumor (small and homogeneously solid or larger and cystic/hemorrhagic) or as an infiltrating lesion that invades the veins, which has a worse prognosis. Due to their low vascular density, papillary renal cell carcinomas enhance less than other renal tumors, and this facilitates their characterization. On computed tomography, they might not enhance conclusively, and in these cases they are impossible to distinguish from hyperattenuating cysts. Contrast-enhanced ultrasonography and magnetic resonance imaging are more sensitive for detecting vascularization. Other characteristics include a specific vascular pattern, hypointensity on T2-weighted images, restricted water diffusion, and increased signal intensity in opposed phase images. We discuss the genetic, histologic, clinical, and radiological aspects of these tumors in which radiologists play a fundamental role in management.

To assess the importance of false-negative and false-positive findings in computed tomography (CT) andThis retrospective study included 113 consecutive patients and 120 resected NSCLCs; 22 patients received neoadjuvant treatment. We compared the findings on preoperativeMetastatic lymph nodes were found in 26 (21.7%) of the 120 tumors and in 41 (7.7%) of the 528 lymph node stations analyzed.In mediastinal lymph node staging in patients with NSCLC

Cancer of the esophagus is a tumor with aggressive behavior that is usually diagnosed in advanced stages. The absence of serosa allows it to spread quickly to neighboring mediastinal structures, and an extensive lymphatic drainage network facilitates tumor spread even in early stages. The current TNM classification, harmonized with the classification for gastric cancer, provides new definitions for the anatomic classification, adds non-anatomic characteristics of the tumor, and includes tumors of the gastroesophageal junction. Combining endoscopic ultrasound, computed tomography, positron emission tomography, and magnetic resonance imaging provides greater accuracy in determining the initial clinical stage, and these imaging techniques play an essential role in the selection, planning, and evaluation of treatment. In this article, we review some particularities that explain the behavior of this tumor and we describe the current TNM staging system; furthermore, we discuss the different imaging tests available for its evaluation and include a diagnostic algorithm.

Heart failure is not always due to an alteration in systolic function, and a diastolic dysfunction could explain many cases of heart failure with a normal systolic function. Diastolic function depends on the left ventricular filling capacity to ensure a normal stroke volume. It is routinely measured with transthoracic echocardiography, as it is an easily accessible non-invasive test. The MRI, using flow sequences, shows good agreement with the echocardiography, analysing the diastolic function in a practical way, by the flow into the mitral valve and pulmonary veins. In this sense, the analysis of diastolic function should be added as part of a routine cardiac MR examination.

Heart failure is not always due to an alteration in systolic function, and a diastolic dysfunction could explain many cases of heart failure with a normal systolic function. Diastolic function depends on the left ventricular filling capacity to ensure a normal stroke volume. It is routinely measured with transthoracic echocardiography, as it is an easily accessible non-invasive test. The MRI, using flow sequences, shows good agreement with the echocardiography, analysing the diastolic function in a practical way, by the flow into the mitral valve and pulmonary veins. In this sense, the analysis of diastolic function should be added as part of a routine cardiac MR examination.

OBJECTIVE. The objective of this article is to show how MRI findings can be used to differentiate Takotsubo cardiomyopathy from acute coronary syndrome.CONCLUSION. Takotsubo cardiomyopathy is a disorder that mimics acute coronary syndrome. MRI can show not only edema in the ventricular wall, which is diffuse and without arterial territory distribution, but also motion abnormalities with typical akinesis in the apical and mid planes. Moreover, MRI can detect potential complications such as obstruction of the left ventricular outflow tract or thrombus in the left ventricular cavity.

Objetivos Los objetivos de este estudio son analizar las caracteristicas epidemiologicas de las fracturas vertebrales osteoporoticas no quirurgicas en mujeres, asi como la posible relacion que se da entre refractura y la existencia o no de tratamiento preventivo secundario contra la misma tras la primera fractura vertebral en un periodo de seguimiento de diez anos. Metodos Se realiza un estudio de cohortes clinicas retrospectivas de un total de 77 mujeres con fractura vertebral osteoporotica no quirurgica con un tiempo de seguimiento de diez anos. Como variable dependiente se considera el riesgo de refractura y como variables independientes la edad al ingreso, el numero de fracturas vertebrales osteoporoticas, los cambios en la actividad de la vida, el dolor de espalda, el tratamiento, el tratamiento previo con corticoides, las benzodiacepinas o psicotropicos, el tabaco, el consumo de alcohol, el deficit estrogenico, el peso, la vida sedentaria, el deficit visual, la patologia tiroidea y la dificultad para levantarse de la silla. Resultados El riesgo de nueva fractura vertebral o no vertebral a los 10 anos tras la primera fractura es del 26%. Al comparar los riesgos de refractura atendiendo las caracteristicas epidemiologicas, observamos que el porcentaje de refracturas aumenta con respecto al numero de fracturas vertebrales en el primer episodio, siendo del 21,4% en el caso de una fractura vertebral, del 25,4% en el caso de dos fracturas vertebrales y del 50% cuando se trata de tres. La mayoria de las fracturas ocurren tras accidentes dentro de la rutina de la vida diaria. Sin embargo, no todos los pacientes experimentan un restablecimiento completo tras la fractura, ya que alrededor del 35% de estos enfermos sufren sintomas persistentes. Conclusiones Los factores relacionados estadisticamente con la refractura son la edad mayor de 70 anos, la deprivacion de estrogenos y la dificultad para levantarse de la silla. Las pacientes que han recibido tratamiento frente a la osteoporosis tras la primera fractura vertebral tienen menos riesgo de refractura ( odds ratio [OR]: 0,32) con respecto al grupo que no ha recibido tratamiento alguno frente a la osteoporosis.

Resumen Objetivos Evaluar la validez y fiabilidad de la ecografia vesical en la estimacion no invasiva del volumen de orina y del volumen residual postmiccional, antes de la induccion anestesica, tras la intervencion y al sentir necesidad de orinar. Pacientes y metodos Serie prospectiva de 47 pacientes ASA I-III, de 18 a 79 anos de edad, intervenidos en regimen de cirugia mayor ambulatoria y sometidos a anestesia general (24) o a anestesia regional y sedacion (23). Se midio el volumen de orina mediante ecografia y en matraz en los tiempos basal y postquirugico, mediante ecografia en el postquirurgico inmediato. Se estimaron la fiabilidad y la validez de las mediciones. Resultados La concordancia entre las cuatro tomas basales realizadas con el ecografo en el primer tiempo y entre cada una de ellas, con las determinaciones del matraz oscila entre 0,70 y 0,86 (coeficiente de correlacion intraclase). La fiabilidad inter e intramedida es elevada, con coeficientes de correlacion intraclase superiores a 0,80. Las medianas de error entre el volumen medido con el ecografo y con el matraz, en el momento basal y en la readaptacion, fueron del 23 y el 29% a favor del volumen medido con el matraz. Conclusiones La monitorizacion por ultrasonidos del contenido vesical es un metodo fiable y valido, especialmente para volumenes pequenos, y aceptado por los pacientes.

Objetivo: Analizar la restricción posnatal del crecimiento en una cohorte de recién nacidos de muy bajo peso (RNMBP) y de no más de 32 semanas de gestación de 55 unidades de neonatología españolas (SEN 1500). Métodos: Se estudiaron peso, longitud y perímetro craneal al nacer y en el momento del alta. El peso se registró también a los 28 días de vida y 36 semanas de edad posmenstrual. Se analizó la relación entre restricción de crecimiento y datos perinatales y neonatales. Resultados: Se incluyeron 2.317 niños. La puntuación Z de peso al nacer, a los 28 días, a las 36 semanas de edad posmenstrual y al alta fue, respectivamente, −0,66 ± 1,3, −2,54 ± 1,35, −3,12 ± 1,7, −1,56 ± 1,1. La puntuación Z de longitud al nacer y al alta fue −0,88 ± 1,8 y −1,97 ± 1,56, respectivamente; la puntuación Z del perímetro craneal al nacer fue −0,83 ± 1,87 y en el momento del alta −0,60 ± 1,96. Los factores relacionados con el grado de restricción de peso a los 28 días fueron: corticoides prenatales, edad gestacional, lugar de nacimiento, tipo de hospital, puntuación CRIB, ductus arterioso persistente sintomático y sepsis tardía. Estos factores sólo explicaron el 14 % de la variabilidad del grado de restricción. El peso y la longitud al alta fueron inferiores a P10 en el 77 % y el 80 % de los RNMBP, respectivamente. Conclusiones: Los RNMBP de no más de 32 semanas de gestación durante su estancia en las unidades de neonatología sufren una “restricción de crecimiento” respecto al patrón intrauterino. Esta restricción ocurre sobre todo en los primeros 28 días de vida y es diferente en distintas unidades españolas. Las variables estudiadas explican en escasa medida este fenómeno. : Aim: To analyze postnatal growth restriction in a cohort of very low birth weight (VLBW) infants with gestational age ≤ 32 weeks in 55 Spanish neonatal units (SEN 1500 Network) during 2002 and 2003. Methods: Weight, length and head circumference were recorded at birth, and at discharge. Weight was also recorded at 28 days postnatal, and 36 weeks of postmenstrual age. Growth restriction was measured as the shift in weight z score from birth to 28th day. Results: The study included 2317 VLBW infants. Weight z score at birth, 28 days, 36 weeks of postmenstrual age and discharge were: −0.66 ± 1.3, −2.54 ± 1.35, −3.12 ± 1.7, −1.56 ± 1.1, respectively. Length z score at birth and at discharge were: −0.88 ± 1.8, and −1.97 ± 1.56. Head circumference z score at birth and at discharge: −0.83 ± .87, and −0.60 ± 1.96. Prenatal steroids, gestational age, place of birth, type of hospital, CRIB score, symptomatic patent ductus arteriosus and late-onset bacterial sepsis were related with the shift in weight z score at 28 days (multiple linear regression), but explained very little (14 %) of his change. Weight and length at discharge were under the 10th percentile in 77 % and 80 % of the infants, respectively. Conclusions: VLBW infants ≤ 32 GA suffer postnatal growth restriction with respect to intrauterine growth pattern, which is more relevant in the first 28 days of life, in patients with more severe illnesses, and differs among neonatal units. Perinatal and neonatal items evaluated are poorly related with restriction.

Objetivo: Diseño y desarrollo de un registro de niños de menos de 1.500 g al nacer en España. Material y métodos: Estudio de cohortes prospectivo multicéntrico. Se incluyen todos los recién nacidos vivos de peso inferior a 1.500 g al nacer en las unidades neonatales (UN) que voluntariamente se integren en el proyecto. Resultados: En los primeros 4 años de funcionamiento del registro han participado en el estudio 65 UN diferentes. El total de niños seleccionados entre 2002 y 2005 es de 9.637. Conclusiones: La misión de las bases de datos de los niños de muy bajo peso al nacer es intentar mejorar la calidad y la seguridad de los cuidados médicos que se proporcionan a los recién nacidos y a su familia. Su desarrollo posibilita la coordinación de programas de educación sanitaria y formación de profesionales médicos y de enfermería, de líneas de investigación y de proyectos de mejora. : Objective: To design and implement a registry of infants weighing less than 1,500 g at birth in Spain. Material and methods: Prospective, cohort, multicenter study. All live born infants weighing less than 1,500 g in several voluntarily participating neonatal units in public and private hospitals were included. Results: In the first 4 years of the registry (2002 to 2005), 9,638 very-low-birth-weight infants were born in the 65 neonatal units that have so far joined the program. Conclusions: The goal of very-low-birth-weight infant databases is to try to improve the quality and safety of the medical care given to these newborns and their families. This type of program helps to coordinate and promote several areas, including those of health education, training of medical staff, research and development, surveillance and quality improvement.

Introducción: Dada la elevada morbimortalidad asociada con la sepsis neonatal, es necesario un marcador diagnóstico que prediga la enfermedad antes de obtener el resultado del cultivo de sangre y/o líquido cefalorraquídeo.Se evaluaron los cambios en el inmunofenotipaje de los linfocitos T CD4+ en neonatos con sepsis de comienzo tardío con el fin de mejorar los resultados obtenidos con los test diagnósticos empleados actualmente (proteína C reactiva, índice neutrófilos inmaduros/neutrófilos totales, leucocitosis). Pacientes y métodos: Un estudio de cohortes prospectivo se llevó a cabo en 24 neonatos con sepsis de comienzo tardío y 48 recién nacidos controles no infectados, de edad gestacional igual o inferior a 37 semanas. Se identificaron las subpoblaciones de linfocitos T CD4+ en sangre periférica mediante tinción con anticuerpos monoclonales y cuantificación por citometría de flujo. Se construyeron curvas de rendimiento diagnóstico mediante regresión logística. Resultados: Como marcador de sepsis neonatal de comienzo tardío, un porcentaje de linfocitos T CD4+/CD45RO+/CD45RA– > 3,5 % muestra una sensibilidad del 94,1 %, una especificidad del 69,2 %, un valor predictivo positivo del 80,0 %, valor predictivo negativo del 90,0 %, y una odds ratio de 36,0 (p 10,0 mg/l, la especificidad de esta combinación de marcadores aumenta al 94,7 % y el valor predictivo positivo, al 85,7%. Conclusiones: Un porcentaje de linfocitos T CD4+/CD45RO+/CD45RA– > 3,5 % es un buen indicador de sepsis neonatal de comienzo tardío en neonatos pretérmino. Y si se combina con una proteína C reactiva > 10,0 mg/l el rendimiento diagnóstico mejora. : Background: Given the high risks associated with neonatal sepsis, there is a need for a diagnostic marker that would predict the disease before the results of blood or cerebrospinal fluid cultures are available. We evaluated changes in the CD4+ T lymphocyte immunophenotype in neonates with late-onset sepsis to try to improve the test combinations currently used (C reactive protein, immature:total neutrophil ratio, leukocytosis). Patients and methods: We performed a prospective cohort study in 24 neonates with late-onset sepsis and 48 non-infected controls with a gestational age of 37 weeks or less. CD4+ T lymphocyte subpopulations in peripheral blood samples were identified by labeling with monoclonal antibodies and quantified by flow cytometry. Diagnostic performance curves were constructed by logistic regression. Results: As a marker of late-onset neonatal sepsis, a percentage of CD4+/CD45RO+/CD45RA– T lymphocytes of > 3.5% showed a sensitivity of 94.1 %, specificity of 69.2 %, positive predictive value of 80.0 %, negative predictive value of 90.0 %, and odds ratio of 36.0 (p 10.0 mg/L, the specificity of this combination of tests increased to 94.7 % and the positive predictive value to 85.7%. Conclusions: A percentage of CD4+/CD45RO+/CD45RA– T lymphocytes of > 3.5 % is an effective indicator of late-onset neonatal sepsis in preterm infants. If this marker is combined with a C-reactive protein level of > 10.0 mg/l, its diagnostic performance is improved.

Resumen Introduccion La tomografia por emision de positrones (PET) 18 F-FDG ha mostrado su utilidad en el cancer diferenciado de tiroides (CDT) cuando se eleva la tiroglobulina (Tg), pero el rastreo corporal total (RCT) con 131 I es negativo, aunque el numero de pacientes analizados en la literatura es escaso y los resultados de eficacia diagnostica son heterogeneos. Objetivo Establecer la eficacia diagnostica de la PET 18 F-FDG en este subgrupo de pacientes. Material y metodos Se hizo estudio retrospectivo de 58 pacientes (64 estudios PET 18 F-FDG) tratados de CDT mediante tiroidectomia total y al menos una dosis terapeutica de 131 I para la ablacion de restos tiroideos y que presentaban Tg elevada y RCT con 131 I negativo. La confirmacion del resultado fue por anatomia patologica, seguimiento clinico, respuesta al tratamiento con 131 I o comparacion con otros metodos diagnosticos. Se calcularon sensibilidad (Se), especificidad (Sp), cocientes de probabilidad (CP), exactitud diagnostica (ED) y valores predictivos (VP) positivo (VPP) y negativo (VPN), y niveles de Tg medios en pacientes con PET 18 F-FDG positiva y negativa. Resultados Veintisiete estudios fueron verdaderos positivos, uno falso positivo, 25 verdaderos negativos y 11 falsos negativos. La Se fue del 71 %, la Sp del 96 %, VPP 96,4%; VPN 69,4 %, ED 81,3 %, CPP 17,75 y CPN 0,3. La Tg media en pacientes con PET 18 F-FDG positiva fue 202,34 ng/ml, y en pacientes con PET 18 F-FDG negativa 40,94 ng/ml. La diferencia de medias fue 161,4 ng/ml; p Conclusiones La PET 18 F-FDG resulta util para detectar enfermedad recurrente de CDT en pacientes con Tg elevada y RCT negativo.