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Sarcoidosis is a systemic granulomatous disease of unknown etiology. It affects patients from all the latitudes and ages, being more frequent between the third and the fourth decades of life and with a second peak around the sixth decade of age in the Japanese and Scandinavian population. It’s more common in women, and it has a more severe course in Afro-descendant population. The antigens that start the granulomatous response are unknown, but presumed that be airborne antigens, because of the high frequency of pulmonary involvement. Its clinical presentation is variable, ranging from acute self-limited presentation to chronic disease with progressive organ damage and death. Its diagnosis relies upon the demonstration of noncaseating granulomas in the affected tissue and the exclusion of other conditions including mycobacteria infections.

Tras un periodo de despoblación coincidente con las campañas romanas de principios del siglo I a.C., las campiñas de la zona nordeste de la provincia de Segovia serán explotadas de forma poco intensa a partir de pequeños asentamientos rurales localizados en las proximidades de la calzada Termes-Duratón, en la parte sur de la zona de estudio: estos poblados estarían vinculados a la oligarquía urbana de Termes. Esta situación perdurará durante el bajo imperio, con una estabilidad en el número de asentamientos, hasta un momento muy tardío, probablemente en el siglo V, cuando se abandonan los poblados de las campiñas y la población se desplazada a las zonas montañosas anteriormente despobladas (Serrezuela de Pradales); posteriormente, el poblamiento visigodo volverá a reocupar estas campiñas.

En este trabajo se estudia el poblamiento en la zona nordeste de Segovia en el periodo Celtibérico Antiguo, posiblemente con una serie de rasgos individualizadores, por su situación fronteriza con el mundo de El Soto. También se establecen las diferentes variables de un poblamiento que sería continuador en parte del de la etapa protoceltibérica; en todo caso, se caracteriza por la existencia de una serie de poblados en alto y en llano, sin vestigios de fortificaciones, junto con otros dos grandes poblados, uno de ellos fuertemente amurallado, y con necrópolis de incineración desde sus primeras etapas. Igualmente hemos destacado la creciente jerarquización de los asentamientos, unido a la concentración de la población desde época muy temprana, posiblemente como única opción para someter a grupos de habitantes por parte de las elites detentadoras del poder en los grandes poblados; así, se observa la progresiva desaparición de los asentamientos menores en beneficio de los que se van a convertir en grandes castros, para posteriormente, desaparecer alguno de ellos en el momento de la configuración de los oppida ya en el Celtibérico Pleno.

Although they have proven effectiveness, radiofrequency and microwave ablation techniques have a high rate of partial responses. Diagnostic studies that anticipate the changes in morphology are essential for earlier detection of residual viable tumor tissue or local recurrences to identify patients who will benefit from a new treatment. Our study has determined the diagnostic yield of PET/CT studies at baseline and follow-up and adequate time between them and the ablation intervention. Seven patients with single tumor lesion with a total of 8 ablations were included. CT and PET/CT studies were performed at baseline and follow-up after ablation. Average times between PET studies at baseline and follow-up and the ablative therapy were 1.8 and 3.4 months, respectively. Mean scores in metabolic activities of the PET at baseline and follow-up were 7.6 and 4.3g/ml of SUVmax, respectively. The Dual Time Point technique helped to identify viable tissue after ablation in 3 cases. Follow-up PET/CT studies have conditioned the various treatment strategies adopted by clinical oncologists. The high yield of the PET/CT study including the Dual Time Point technique may be considered as a study replacement of initial and follow-up Contrast-Enhanced CT before and after treatment with RFA and AMO, this achieving considerable reduction in the exposure to high radiation levels. We propose conducting the first PET/CT follow-up study at 3 months of the RFA and AMO., (Copyright © 2011 Elsevier España, S.L. y SEMNIM. All rights reserved.)

Non-invasive ventilation (NIV) is nowadays increasingly used. The significant decrease in tracheal intubation related complications makes it particularly attractive in patients with moderately acute respiratory failure (ARF) who still have some degree of respiratory autonomy. It has also been used to support patients with chronic respiratory failure. However, final outcomes are variable according to the conditions which determined its application. This Consensus was performed in order to review the evidence supporting the use of positive pressure NIV. The patho-physiological background of NIV and the equipment required technology are described. Available evidence clearly suggests benefits of NIV in acute exacerbation of chronic obstructive pulmonary disease (COPD) and in cardiogenic pulmonary edema (Recommendation A). When considering ARF in the setting of acute respiratory distress syndrome results are uncertain, unless dealing with immunosupressed patients (Recommendation B). Positive results are also shown in weaning of mechanical ventilation (MV), particularly regarding acute exacerbation of COPD patients (Recommendation A). An improved quality of life in chronic respiratory failure and a longer survival in restrictive disorders has also been shown (Recommendation B) while its benefit in stable COPD patients is still controversial (Recommendation C). NIV should be performed according to pre-established standards. A revision of NIV related complications is performed and the cost-benefit comparison with invasive MV is also considered.

Objective: To describe a case of pyonephrosis in a child with special reference to the importance of scintigraphy in its evaluation., Methods: We studied the correlation of the findings of conventional radiology (abdominal x-ray), ultrasound, abdominal CT, scintigraphy and anatomopathology (left kidney) in a 5-year-old boy with a history of renal lithiasis that was seen at our pediatric emergency services. The patient's clinical course and the scinscan findings using two tracers (Tc-99m DMSA, Ga-67 citrate) showed a severely compromised left renal function. The foregoing finding and the risk of major life-threatening complications prompted surgical treatment. Pathological analysis showed pyonephrosis of left kidney., Results: X-ray, ultrasound and abdominal CT showed left renal lithiasis, an enlarged left kidney, poor cortico-medullary differentiation and parenchymal destructuring with areas suggestive of cortical abscesses. A Ga-67 citrate scintiscan showed a notable intensity that completely affected the left renal parenchyma with no other changes. On the other hand, Tc-99m DMSA showed no uptake in the left kidney and normal uptake in the right kidney. A left nephrectomy was performed. Histological analysis demonstrated pyonephrosis of left kidney., Conclusions: Tc-99m DMSA and Ga-67 citrate scintigraphy and the patient's poor clinical course showed the extent and severity of the underlying condition that was underestimated by the other imaging techniques.