Ventilation/perfusion (V/Q) scanning in contemporary patients with pulmonary embolism: utilization rates and predictors of use in a multinational study

Journal of Thrombosis and Thrombolysis - Ventilation/perfusion (V/Q) imaging and computed tomography pulmonary angiography (CTPA) are common tools for acute pulmonary embolism (PE) diagnosis....     

High Bilirubin Levels Interfere with Serum Tartrate-Resistant Acid Phosphatase Determination: Relevance as a Marker of Bone Resorption in Jaundiced Patients

Serum tartrate-resistant acid phosphatase (TRAcP) activity is considered to be a biochemical marker of bone resorption. Recently, a lack of specificity of collagen-related markers for assessing bone turnover has been observed in patients with chronic liver disease. Thus, it could be of great interest to determine serum TRAcP activity in such patients. However, nonspecificity of the analytical reaction could occur when hemolyzed, lipemic, or icteric specimens are analyzed. Therefore, we have studied the interference caused by bilirubin in the measurement of serum TRAcP activity using the Hillmann method. The interference was assessed in two pools of serum containing different bilirubin concentrations but with similar total AcP levels. Mixing proportional parts of the two pools, 10 samples were also obtained. Serum activities of total AcP and TRAcP, and the concentration of bilirubin were measured in the 10 samples. Both the actual and the expected values obtained by theoretical calculations were compared. Serum bilirubin values of 2.4 mg/dl showed a negative interference of 15% in the determination of serum TRAcP activity, whereas values of bilirubin higher than 10 mg/dl interfered totally with the measurement of serum TRAcP. Bilirubin did not interfere with the total AcP determination. This study clearly shows the interference of bilirubin in the determination of serum TRAcP. This finding should be considered when bone metabolism disorders are evaluated in jaundiced patients. Received: 6 April 1998 / Accepted: 1 October 1998     

First-trimester biochemical markers for Down syndrome

The value of maternal serum pregnancy-associated protein A (PAPP-A), free and total beta human chorionic gonadotrophin (fbetahCG, betahCG) and alpha-fetoprotein (AFP) in screening for Down syndrome (DS) in early pregnancy has been assessed. To evaluate the different biochemical markers, 32 DS pregnancies and 267 controls were used for AFP, betahCG and PAPP-A. A subgroup of those (17 DS and 136 controls) were used to evaluate fbetahCG. All analytes were determined in fresh serum samples. Our results give support to the feasibility of maternal serum levels of PAPP-A as the best biochemical marker for DS in the first trimester, and either betahCG or fbetahCG as the second marker. No differences were found between betahCG and fbetahCG distribution levels as expressed as MoMs in normal and DS pregnancies in this study.     

Hemorragia subaracnoidea y embarazo

The incidence of subarachnoid hemorrhage increases during pregnancy and involves a wide range of activities and issues such as the performance of imaging tests with radiological protection, assessment of fetal viability, termination of pregnancy, the patient's anesthetic management, the drugs to be used, and neurosurgical intervention.Early diagnosis and treatment of this event are essential to obtain favorable outcomes for the mother and fetus and to avoid complications.We describe three cases of intracranial hemorrhage with spontaneous onset during pregnancy registered at the Virgen de las Nieves’ Hospital between 2008 and 2010 and provide a review of the topic.     

Mastopatía fibroquística. Aspectos controvertidos

ObjectivesTo elucidate the most controversial features of fibrocystic breast disease, which is highly prevalent.MethodsWe reviewed the literature on the topic.ResultsIn fibrocystic breast disease, the diagnostic method of choice is ultrasound, which shows similar characteristics to those in cystic tumors but with differences in number and maximum diameter. With dominant, or separate, nodules, ultrasound can be used to determine whether the lesion is cystic or solid. In cystic lesions, fine-needle aspiration can be used; in solid lesions, core needle biopsy can be employed. No active treatment is required if there is mastalgia and nodularity without a dominant nodule, or if diffusely nodular breasts are painless.Conclusions1. There is no risk of malignancy in simple fibrocystic breast disease but proliferative mastopathy with atypical cells has a relative risk of 4-5. 2. The diagnostic technique of choice for differentiating simple from complex cysts is ultrasound, which can also be used for monitoring and as a guide when aspirating the cyst. 3. When there are clinical and radiologic signs suspicious for malignancy (BI-RADS 3) or suggestive of malignancy (BI-RADS 4 and 5), the first step is fine-needle aspiration or core needle biopsy, or both. 4. Asymptomatic fibrocystic breast disease does not require follow-up, while symptomatic disease can be monitored with ultrasound and/or mammography.