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BACKGROUND: Portal vein obstructive lesions associated with hypertrophy of the hepatic artery territory are observed in Schistosoma mansoni schistosomiasis. Liver perfusion scintigraphy is a method used for evaluation of hepatic perfusion changes in liver diseases. It has been suggested that, like in cirrhosis, where compensatory increase in perfusion through the hepatic artery is documented, perfusion changes occur in hepatosplenic schistosomiasis (HSS). AIMS: This study aims to determine changes in liver hemodynamics using hepatic perfusion scintigraphy and correlate them with clinical and laboratory variables and ultrasound findings in HSS. METHODS: Nineteen patients with schistosomiasis underwent ultrasound evaluation of degree of liver fibrosis, splenic length, and splenic and portal vein diameter, digestive endoscopy, and quantification of platelets. Subsequently, perfusion scintigraphy with measurement of hepatic perfusion index (HPI) was performed. RESULTS: It was observed that patients with hepatosplenic schistosomiasis had significantly higher HPI compared with normal individuals (p = 0.0029) and that this increase correlated with splenic length (p = 0.038) and diameter of esophageal varices (p = 0.0060). Angioscintigraphy showed high accuracy for predicting presence of large esophageal varices. CONCLUSIONS: Angioscintigraphy could show that patients with HSS had increased HPI, featuring greater liver "arterialization," as previously described for cirrhotic patients. Correlations were also observed between HPI and longitudinal splenic length, caliber of esophageal varices, caliber of portal vein, and blood platelet count. Angioscintigraphy is a promising technique for evaluation of hepatosplenic schistosomiasis.

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La medicina nuclear es la especialidad médica que se ocupa del diagnóstico, tratamiento e investigación médica mediante el uso de radioisótopos como fuentes abiertas. A menudo, las personas presentan diferentes condiciones patológicas óseas como la osteoporosis, el cáncer de hueso primario, las metástasis óseas, la artrosis y la artritis. Como objetivo de esta revisión se presentaron estadísticas internacionales y nacionales, y se evaluó la incidencia de esas afecciones. Además, se identificaron los radiofármacos más empleados en la actualidad para el diagnóstico y tratamiento de las enfermedades óseas, así como el uso combinado con las técnicas de imagen más utilizadas mediante la revisión de diferentes estudios clínicos. Se expuso la utilidad de la gammagrafía ósea para el diagnóstico y la confirmación de las afecciones estudiadas. Igualmente, se presentó el empleo de nuevas técnicas como las tomografías por emisión de fotón único o por emisión de positrones. Se observó que el radioisótopo más empleado para el diagnóstico de enfermedades del sistema óseo es el 99mTc por sus características físicas y químicas, mientras que para terapia se emplean 186Re, 188Re, 153Sm, 177Lu, 32P, 89Sr, 85Sr, 117mSn, según el tipo, ubicación y magnitud de las lesiones y la disponibilidad del radioisótopo. En la actualidad, el desarrollo de los radiofármacos se ha centrado en la combinación de estos radioisótopos con diferentes biomoléculas para mejorar sus propiedades y ampliar su campo de aplicaciones(AU)

Nuclear medicine is the medical specialty that deals with clinical diagnosis, treatment and research through the use of isotopes as open sources. Bone diseases such as osteoporosis, primary bone cancer, bone metastases, arthrosis and arthritis are common among the population. The objective of this review was to present international and national statistics, and evaluate the incidence of these disorders. Additionally, a review was conducted of various clinical studies to identify the radiopharmaceuticals most frequently used to diagnose and treat bone disease, and their combination with the most common imaging techniques. A presentation was made of the usefulness of bone gammagraphy and the confirmation of the disorders studied. Reference was also made to the use of new techniques such as single photon emission tomography or positron emission tomography. It was found that the radioisotope most commonly used to diagnose diseases of the bone system was 99mTc, due to its physical and chemical characteristics, whereas 186Re, 188Re, 153Sm, 177Lu, 32P, 89Sr, 85Sr, 117mSn are used for therapeutic purposes, depending on the type, location and magnitude of the lesions and the availability of the radioisotope. At present, radiopharmaceutical development centers on combining these radioisotopes with various biomolecules to improve their properties and broaden their field of application(A)

La médecine nucléaire est la spécialité médicale s'occupant du diagnostic, du traitement et de la recherche médicale au moyen de radioisotopes comme sources ouvertes. Les personnes sont souvent touchées par différentes conditions pathologiques osseuses telles que l'ostéoporose, le cancer d'os primaire, les métastases osseuses, l'arthrose, et l'arthrite. Le but de cette révision est de présenter des statistiques internationales et nationales, et d'évaluer l'incidence de ces affections. Grâce à la révision de différentes études cliniques, on a également identifié les traceurs isotopiques les plus souvent utilisés de nos jours pour le diagnostic et le traitement des maladies osseuses, ainsi que l'emploi combiné des techniques par image les plus fréquentes. L'utilité de la gammagraphie osseuse pour le diagnostic et la confirmation des affections étudiées a été mise en évidence. De nouvelles technologies telles que les tomographies par émission de photon unique ou par émission de positons a été également présentées. On a trouvé que le radioisotope le plus souvent utilisé pour le diagnostic des maladies du système osseux est le 99mTc, dû à ses caractéristiques physiques et chimiques, tandis que pour la thérapie, les 186Re, 188Re, 153Sm, 177Lu, 32P, 89Sr, 85Sr, et 117mSn sont utilisés selon le type, la localisation et la magnitude des lésions, et la disponibilité du radioisotope. Aujourd'hui, le développement des traceurs isotopiques est axé sur la combinaison de ces radioisotopes avec différentes biomolécules pour améliorer leurs propriétés et élargir leur champ d'applications(AU)

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OBJECTIVE: To identify and evaluate latent variables (variables that are not directly observed) for adopting and using nuclear technologies in diagnosis and treatment of chronic diseases. The measurement and management of these latent factors are important for healthcare due to complexities of the sector. METHODS: An exploratory factor analysis study was conducted among 52 physicians practicing in the areas of Cardiology, Neurology and Oncology in the State of Sao Paulo who agreed to participate in the study between 2009 and 2010. Data were collected using an attitude measurement questionnaire, and analyzed according to the principal component method with Varimax rotation. RESULTS: The component matrix after factor rotation showed three elucidative groups arranged according to demand for nuclear technology: clinical factors, structural factors, and technological factors. Clinical factors included questionnaire answers referring to medical history, previous interventions, complexity and chronicity of the disease. Structural factors included patient age, physician's practice area, and payment ability. Technological factors included prospective growth in the use of nuclear technology and availability of services. CONCLUSIONS: The clinical factors group dimension identified in the study included patient history, prior interventions, and complexity and chronicity of the disease. This dimension is the main motivator for adopting nuclear technology in diagnosis and treatment of chronic diseases.

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Micelles composed of amphiphilic copolymers linked to a radioactive element are used in nuclear medicine predominantly as a diagnostic application. A relevant advantage of polymeric micelles in aqueous solution is their resulting particle size, which can vary from 10 to 100 nm in diameter. In this review, polymeric micelles labeled with radioisotopes including technetium (99mTc) and indium (111In), and their clinical applications for several diagnostic techniques, such as single photon emission computed tomography (SPECT), gamma-scintigraphy, and nuclear magnetic resonance (NMR), were discussed. Also, micelle use primarily for the diagnosis of lymphatic ducts and sentinel lymph nodes received special attention. Notably, the employment of these diagnostic techniques can be considered a significant tool for functionally exploring body systems as well as investigating molecular pathways involved in the disease process. The use of molecular modeling methodologies and computer-aided drug design strategies can also yield valuable information for the rational design and development of novel radiopharmaceuticals.

Micelas poliméricas compostas de copolímeros ligadas a um elemento radioativo são utilizadas em Medicina Nuclear com aplicação predominantemente diagnóstica. A vantagem relevante da utilização de micelas poliméricas em solução aquosa é o tamanho de suas partículas, as quais podem variar de 10 a 100 nm de diâmetro. Neste trabalho de revisão são apresentadas micelas poliméricas marcadas com radioisotopos, como tecnécio-99m (99mTc) e índio-111 (111In), assim como suas aplicações clínicas em técnicas de diagnóstico como Tomografia por emissão de Fóton Único (Single photon Emission Computed Tomography - SPECT), cintilografia, e Ressonância Magnética Nuclear (RMN). Neste contexto, sua aplicação em diagnóstico de sistema linfático e linfonodo sentinela recebe atenção especial. O emprego de técnicas de diagnóstico pode ser considerado uma ferramenta importante para a exploração de sistemas no organismo humano assim como para a investigação de caminhos moleculares envolvidos nos processos de diversas doenças. O uso de metodologias de modelagem molecular e estratégias de desenvolvimento de fármacos assistidas computacionalmente também pode fornecer informações valiosas para o planejamento e o desenvolvimento racional de novos radiofármacos.

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Objective: To identify and evaluate latent variables (variables that are not directly observed) for adopting and using nuclear technologies in diagnosis and treatment of chronic diseases. The measurement and management of these latent factors are important for healthcare due to complexities of the sector. Methods: An exploratory factor analysis study was conducted among 52 physicians practicing in the areas of Cardiology, Neurology and Oncology in the State of Sao Paulo who agreed to participate in the study between 2009 and 2010. Data were collected using an attitude measurement questionnaire, and analyzed according to the principal component method with Varimax rotation. Results: The component matrix after factor rotation showed three elucidative groups arranged according to demand for nuclear technology: clinical factors, structural factors, and technological factors. Clinical factors included questionnaire answers referring to medical history, previous interventions, complexity and chronicity of the disease. Structural factors included patient age, physician's practice area, and payment ability. Technological factors included prospective growth in the use of nuclear technology and availability of services. Conclusions: The clinical factors group dimension identified in the study included patient history, prior interventions, and complexity and chronicity of the disease. This dimension is the main motivator for adopting nuclear technology in diagnosis and treatment of chronic diseases.

Objetivo: Identificar e avaliar as variáveis latentes (que não podem ser observadas diretamente) no processo de adoção e uso de tecnologias nucleares no diagnóstico e tratamento de doenças crônicas. A mensuração e a gestão dos fatores latentes são importantes dentro da área da Saúde devido às complexidades inerentes do setor. Métodos: Foi realizado um estudo do tipo fatorial exploratório com 52 médicos das especialidades de Cardiologia, Neurologia e Oncologia no Estado de São Paulo que participaram do estudo entre 2009 e 2010. Os dados foram coletados por meio de questionário de mensuração de atitudes e analisados pelo método dos componentes principais, com rotacionamento do tipo Varimax. Resultados: A matriz de componentes após a rotação dos fatores apresentou três agrupamentos explicativos ordenados para a demanda de uso das tecnologias nucleares: fatores clínicos, fatores estruturais e fatores tecnológicos. O fator clínico é formado por respostas referentes a histórico clínico, intervenção anterior, complexidade e cronicidade. O fator estrutural é composto por idade do paciente, área de atuação do médico e capacidade de pagamento; o fator tecnológico diz respeito às perspectivas de aumento do uso da tecnologia nuclear - quantidade de serviços. Conclusões: A dimensão de fatores clínicos é composta por histórico clínico, intervenção anterior, complexidade e cronicidade da doença. Essa dimensão é o principal motivador para adoção da tecnologia nuclear no diagnóstico e tratamento das doenças crônicas.

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La presencia de tiroides lingual es una entidad clínica poco común, que corresponde a una alteración embriológica incluida dentro del grupo de variantes de localización de tejido tiroideo ectópico. En el diagnóstico de esta entidad, la clínica se apoya fuertemente en los estudios de imaginología como metodología confirmatoria. Ante la infrecuencia de esta alteración, a continuación presentamos un caso sin sintomatología alguna y cuyo diagnóstico confirmatorio se realizó por medio de la gammagrafía de tiroides.

Lingual thyroid is an unusual entity corresponding to an embryological disorder included in the group of variants of ectopic thyroid tissue. Diagnosis is based strongly on imaging as confirmatory methodology. Given the infrequent occurrence of lingual thyroid, we report an asymptomatic case in which confirmatory diagnosis was made by radionucleotide thyroid scan.

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Se aborda el diagnóstico y seguimiento de la Enfermedad de McCune-Albright en un paciente masculino de 8 años de edad, afectado de esta rara entidad

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Introducción: Carvedilol es un bloqueador adrenérgico que mejora el remodelamiento ventricular izquierdo y reduce la morbi-mortalidad de los pacientes con insuficiencia cardíaca congestiva (ICC). Esto podría estar relacionado con una corrección de la sincronía ventricular. Objetivo: Evaluar el efecto de Carvedilol sobre la sincronía en la contracción ventricular en pacientes con ICC. Métodos: Se estudiaron 30 pacientes con ICC estable, capacidad funcional NYHA (CF) II-III, fracción de eyección (FE) < 40 por ciento, los cuales estaban tratados en forma habitual. Se excluyeron pacientes usuarios de betabloqueadores o de marcapaso. Se realizó ventriculografía radioisotópica de equilibrio, al inicio y posterior a la terapia con Carvedilol por 6 meses, para evaluar la función sistólica y la sincronía ventricular. La sincronía interventricular fue calculada mediante la diferencia de promedio de fase de ambos ventrículos y la intraventricular usando la desviación estándar del análisis de fase. Resultados: La edad fue 55 ± 13 años, 71 por ciento hombres, 35 por ciento de etiología isquémica y 29 por ciento con bloqueo completo de rama izquierda (BCRI). Posterior a la terapia con Carvedilol (dosis promedio de 22 mg, rango de 6.25 – 50 mg/día) hubo una mejoría en la CF y en la distancia recorrida en 6 min (499 ± 18 m a 534 ± 17 m ). La FE mejoró de 24 ± 8.3 por ciento a 31 ± 11. 3 por ciento (p<0.001). En los pacientes con peor sincronía, bajo el percentil 50, mejoró la sincronía intraventricular (113 ± ms vs. 94 ± 38 ms, p=0.02) e interventricular (62.8 ± 7 ms vs. 39.4 ± 9 ms, p=0.02). Los pacientes con etiología no isquémica tuvieron una mejoría en la sincronía intraventricular (103.8 ± 7 ms vs 78.3 ± 12 ms, p=0.04) e interventricular (68.1 ± 9 ms vs. 35.3 ± 12 ms, p=0.02). En aquellos sin BCRI mejoró la sincronía intraventricular (112.1 ± 8 ms vs. 88.5 ± 11.2 ms, p=0.01). No hubo cambios significativos en pacientes con causa isquémica o con BCRI. Conclusiones: En pacientes con IC y disfunción ventricular izquierda, Carvedilol mejora la sincronía intra e interventricular. Estos efectos podrían estar relacionados a una acción favorable sobre el remodelamiento cardíaco.

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