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ResumenObjetivo Determinar el impacto de una TAC en inspiracion adicional al protocolo convencional de la PET-TAC con 18F-FDG en la deteccion de nodulos pulmonares de pequeno tamano. Metodo Hemos estudiado consecutivamente 100 pacientes que presentaban uno o varios nodulos pulmonares radiologicos. A todos los pacientes se les practico un PET/TAC (Gemini, Philips). Los parametros de adquisicion fueron los mismos para la TAC no inspiratoria/fusion y la TAC en inspiracion: 120 kV, 25 mAs. Resultados Un total de 188 nodulos fueron detectados en la TAC inspiratoria, con tamano entre 0,3 y 3 cm. La TAC no inspiratoria no evidencio 20/188 nodulos (10,6%) con tamano entre 0,3 y 1 cm: correspondiendo a 17 pacientes. La localizacion mas frecuente en la que no se evidenciaron nodulos en la TAC fue en lobulos inferiores. La PET visualizo hipercaptacion de 18F-FDG en el 83,9% y el 72% de los nodulos >1 cm y entre 0,7 y 1 cm, respectivamente. Sin embargo, unicamente el 10,5% de los nodulos

Aim To determine the impact of an additional inspiration CT scan on the conventional 18 F-FDG PET-CT protocol in the detection of small pulmonary nodules. Method One hundred consecutive patients who presented with one or various nodules were studied. Whole-body PET-CT was performed using Gemini (Philips). CT acquisition parameters were 120 Kv/25 mAs, the same as those for the transmission/fusion CT (mild expiration) and inspiratory CT. Results A total of 188 nodules were detected in the inspiratory CT with sizes between 0.3–3 cm. Non-inspiratory CT did not show 20/188 nodules (10.6%) with sizes between 0.3–1 cm, this corresponding to 17 patients. The most frequent localization of non-detectable nodules in non-inspiratory CT was the lower lobes. 18 F-FDG uptake was detected by the PET in 83.9% and 72% of nodules with >1 cm and between 0.7 and 1 cm, respectively. However, only 10.5% of nodules Conclusions In selected patients, inspiratory CT added to conventional PET-CT significantly improves the detection of small nodules (10.6%), especially in those lesions located in the lower lobes, due to respiratory movements, and may have an impact on patient management.

Introduccion: En el tratamiento de las lesiones subepiteliales podria plantearse la reseccion endoscopica en casos seleccionados. Una de las tecnicas endoscopicas que ha demostrado ser util y evitar la perforacion de la pared gastrica consiste en la inyeccion intramural de suero fisiologico y posterior reseccion con asa de polipectomia. Sin embargo, si la inyeccion es superficial y no se realiza en la base del tumor la reseccion puede ser tecnicamente muy compleja y finalmente incompleta. Nuestro objetivo ha sido evaluar la utilidad de la ecoendoscopia en la inyeccion submucosa previa a la reseccion endoscopica de lesiones subepiteliales. Material y metodo: Se incluyeron pacientes remitidos a la Unidad de Endoscopias de nuestros hospitales (junio de 2008– diciembre de 2011) para valorar la reseccion de lesiones submucosas y en los que decidio realizar reseccion asistida por ecoendoscopia. Se procedio a la puncion con aguja de 22G colocando la punta entre el borde inferior de la lesion y la muscular propia. Se inyecto suero fisiologico y se comprobo ecograficamente como la muscular propia se separaba de las capas superficiales. Posteriormente con vision endoscopica se procedio a reseccion con asa de polipectomia. Resultados. Se trataba de seis pacientes que presentaban tres lesiones gastricas (dos tumores carcinoides y un polipo inflamatorio fibroide), dos rectales (dos tumores carcinoides) y una duodenal (pancreas heterotopico). El tamano medio de las lesiones fue de 9,8mm (rango 7–13mm), localizadas en cuatro casos en la submucosa y en dos en la mucosa profunda. Se consiguio reseccion completa en una sola sesion endoscopica en cinco de ellas y en un caso fue preciso un segundo procedimiento para conseguir una reseccion completa. No existieron recidivas en un periodo medio de seguimiento de 24 meses (rango: 8–36 meses). En dos casos se produjo sangrado tras la reseccion que se controlo con tratamiento endoscopico. No existieron perforaciones ni otras complicaciones. Conclusion. La ecoendoscopia aumenta la seguridad de la reseccion de lesiones subepiteliales al permitir la inyeccion de suero fisiologico bajo la lesion y comprobar en tiempo real una adecuada separacion entre lesion y muscular propia.

A 34-year-old woman withDown’ssyndromeandadequatemotor,cognitive,andadaptivedevelopmentpresentedtoourhospital’semer-gencyroombecauseofpoorly-defined,continuousse -vereepigastralgiafor24hours,withnoreductionsorexacerbations, radiating to the back, and associatedwithnausea,bilevomiting,andasthenia.Herpersonalhistoryincludednoallergiesortoxichabits,andthepa -tienthadundergonelaparotomyfortheexcisionofaleft ovarian “chocolate cyst” three years before. Thequestioning on organ systems revealed intermittentdyspepticsymptomssinceyoungagewithnomentiontospecifictriggeringfactors,whichconsistedofpost-prandial fullness, heartburn, non-specific epigastricdiscomfort,andflatulence.Shealsoreportedintermit-tent,self-limitedfluiddiarrheaepisodeswithnopatho -logical products, alternating with normal intestinalrhythm.Physicalexplorationrevealedthephenotypicalman -ifestations of trisomy 21; heart and lung auscultationwasnormal;theabdomenwassoftandtendertodeeppalpationintheepigastrium,withnodefensereactionorotherperitonealirritationsigns;palpationrevealednomassesororganomegalies;bowelsoundswerenor-mal.Theremainingexplorationwasuneventful.The CBC and coagulation tests performed in theemergency room were normal, but biochemistry re -vealedelevatedamylaselevels(660IU/l).Thepatientwasadmittedwithadiagnosisofacutepancreatitis.The patient had a favorable clinical course. At 48hoursafteradmissionshewasasymptomatic,toleratedfluidingestion,andlackedRanson’scriteriaforseveri-ty.Duringadmissionthefollowinglabtestswereper-formed: CBC, coagulation, renal and liver function,andlipids,whichwereallnormal.Serumamylasewas624IU/landlipasewas8,859IU/l.Serumironwas43µg/dl,butferritinandtransferrinlevelswerenormal.C-reactiveprotein(CRP)was0.50mg/dl.Twocopro -culturesshowedthestandardsaprophyticbacterialflo -ra,andno

Study Objective To evaluate the efficacy of enteral acetazolamide treatment for hypochloraemic metabolic alkalosis in critically ill children. Methods We designed an observational retrospective study that included critically ill children admitted to the PICU from January 2010 to December 2013 and treated with acetazolamide for at least 48 h for metabolic alkalosis. We recorded demographic data, dose and type of diuretic treatment, use of mechanical ventilation and acid-base and biochemical data. Acetazolamide was administered enterally and both dose and adverse effects were collected. Results A total of 120 episodes of treatment (86 post-cardiac surgery, 17 cardiac decompensations and 17 patients with respiratory disease) in 93 patients (median age 6 months) were analysed. 85% received a continuous IV furosemide infusion and 14.2% intermittent bolus administration of furosemide. Furosemide doses of patients with respiratory disease were lower (p After 48 h of treatment a significant decline in bicarbonate levels (from 35,3 ± 4,7 to 31,1 ± 3,9 mmol/L, p Average Acetazolamide dose was 8,46 mg/Kg/day. None of the patients suffered from serious side-effects attributable to Acetazolamide. Conclusions Acetazolamide treatment improved metabolic alkalosis secondary to diuretic treatment in critically ill children, contributing to a decrease in PaCO2. Enteral administration was effective and well tolerated without serious adverse effects.