One-day protocol versus two-day protocol in acquisition of scintigraphy with "in vitro" labelled white blood cells for diagnosis of osteoarticular infection

INTRODUCTION

It is difficult to determine osteoarticular infection and differentiate inflammation from infection with laboratory and imaging procedures (CT, MRI, US). Labelled white-blood-cell scintigraphy (WBCS) is the nuclear medicine test of choice but it takes two days, sometimes finds it difficult to differentiate soft tissue from bone infection and therefore causes interobserver variability, which decreases its specificity.

OBJECTIVE

To demonstrate the usefulness of the one-day protocol with time decay-corrected acquisition in WBCS to diagnose osteoarticular infection and to reduce interobserver variability. The role of SPECT/CT in WBCS in locating the infected focus was also evaluated.

METHODS

110 patients with suspected osteoarticular infection were studied prospectively. Planar images were obtained with time decay-corrected acquisition at 30min, 4h, 8h and 24h. WBCS planar images were grouped in two protocols: One-day protocol: experts evaluated 30min, 4h and 8h images. Two-day protocol: experts evaluated 30min, 4h and 24h images. Both protocols were classified as: SPECT/CT was performed in 72 patients. Kappa index was calculated to evaluate interobserver variability.

RESULTS

Infection was confirmed in 34 cases. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 97.1%, 97.4%, 94.3%, 98.7%, and 97.3% for the one-day protocol and 94.1%, 97.4%, 94.1%, 97.4%, and 96.4% for two-days-protocol. SPECT/CT contributed to diagnosis in 45/50 patients with planar WBCS positive. Kappa index: 0.8 for one-day protocol and 0.79 for two-day protocol, respectively.

CONCLUSION

One-day protocol with time decay-corrected acquisition WBCS and SPECT/CT enables early and accurate diagnosis of osteoarticular infection.

[Positive sentinel node risk in relation to oestrogen receptors in breast cancer in premenopausal and postmenopausal women]

OBJECTIVE

The influence of the relationship between pre- and post-menopausal stage of patients with breast cancer (BC) and the risk of sentinel lymph node (SLN) metastasis as well as the influence of oestrogen receptor (ER) status within each one of these groups were analyzed.

METHODS

A BC database with 1,388 patients was analysed. Three age groups were studied: A, elderly postmenopausal, 200 patients, ≥ 70 years old; B, younger postmenopausal, 89 patients, 55-69 years old; C, premenopausal, 85 patients, <55 years old. In each group 2 subgroups were analyzed: positive ER and negative ER tumours. Data analysed: SLN-positive patients, non-sentinel node (NSN)-positive patients, non-surgical detections (NSD) and non disease-free (NDF) patients after a follow-up of 52 months.

STATISTICAL ANALYSIS

chi-squared test, significance: P ≤ 0.05.

RESULTS

SLN metastasis was significantly (P<0.025) more common in premenopausal than in postmenopausal patients, and within those, mainly in negative ER tumours. Positive-NSN increases slightly in premenopausal patients (exclusively in negative ER tumours). NDF patients are similar in the 3 groups and in all of them it is much more frequent in negative ER tumours.

CONCLUSION

SLN metastasis varies significantly according to hormonal state and not according to age, being more frequent in premenopausal patients and mainly in ER negative tumours.

[Family planning: an evaluation of the program at a health center (1986-1990)]

OBJECTIVE

To gain dome idea of the characteristics of the population attended at a Family Planning Clinic (FPC) in a Health Centre, attempting to find the coverage and performance of the Clinic.

DESIGN

Retrospective descriptive study, which analysed 403 cases between July 1986 and December 1990. SITE. Family Planning Clinic in the "Huerta de la Reina" Health Centre.

PATIENTS AND OTHERS PARTICIPANTS

Women of child-bearing age who requested a consultation during the period of the study.

MAIN MEASUREMENTS AND RESULTS

A uni/bivariate analysis of the studies was carried out. Coverage of 16.3% of the population of child-bearing age, with 69.5% of the women being under 29, was attained. The most frequent motive for a consultation was advice on methods of contraception. Oral contraception (65.0%) was the most common form prescribed. 27.1% of those attending consultation were referred to the second level. Attendance at periodic check-ups was very low.