RESUMEN
OBJECTIVES: The aim of the present study was to determine the long-term prognostic value provided by the exercise electrocardiographic (ECG) response to nuclear myocardial perfusion imaging (MPI) in the evaluation of patients with chest pain, focusing on patients with a discrepancy between the two tests. METHODS: A total of 1460 consecutive patients (777 female; 62.6 ± 11.4 years) undergoing exercise myocardial single-photon emission computed tomography (SPECT) were included. The endpoint was the occurrence of acute coronary syndrome, heart failure or cardiac death during follow-up. RESULTS: Ischemic ECG changes were observed during stress testing in 271 patients (18.5%) and 362 patients (24.7%) had positive (abnormal) exercise MPI results. There was a discrepancy between ECG and SPECT findings in 471 patients (32.2%). During the follow-up period (14.0-39.6 months), 224 patients (15.3%) presented cardiac events. The hazard ratios (HR) of ECG and MPI results to predict events were 1.506 (95% CI: 1.113-2.039) and 10.481 (95% CI: 7.799-14.080), respectively. In patients with negative MPI, the ECG response did not predict events (HR 1.214 [95% CI: 0.646-2.282]), the same as in patients with positive MPI (HR 1.203 [95% CI: 0.848-1.705]). Only in hypertensive patients with positive SPECT did the ECG show significant prognostic value (HR 1.937 [95% CI: 1.030-3.642]). In multivariate analysis, positive MPI proved an independent long-term prognostic factor (HR 10.536 [95% CI: 7.759-14.308]), but not ECG (HR 1.356 [95% CI: 0.994-1.850]). CONCLUSION: MPI results (normal vs. abnormal) had strong predictive value and discrepant ECG results had no significant additive prognostic value.
Asunto(s)
Dolor en el Pecho/diagnóstico por imagen , Dolor en el Pecho/etiología , Electrocardiografía , Prueba de Esfuerzo , Imagen de Perfusión Miocárdica , Tomografía Computarizada de Emisión de Fotón Único , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Factores de TiempoRESUMEN
Poorly differentiated follicular thyroid carcinoma (PDFC) is a tumor of follicular cell origin with intermediate attributes between well-differentiated carcinomas and anaplastic carcinomas. The majority of patients presenting with distant metastases have locally advanced tumors, being lungs and bones the most common sites affected. We present a case of a patient with a painful bulky mass at the left thorax-abdominal wall as an uncommon distant metastasis of a PDFC. After thyroidectomy, a pre-ablative 131I whole-body scan showed distant metastases on the neck, both lungs, and lateral chest-abdominal wall, so the administration of I for thyroid remnant ablation stimulated with RH-TSH was decided.
Asunto(s)
Adenocarcinoma Folicular/patología , Diferenciación Celular , Adenocarcinoma Folicular/cirugía , Anciano de 80 o más Años , Biopsia con Aguja Fina , Femenino , Humanos , Metástasis de la Neoplasia , Glándula Tiroides/patología , Tiroidectomía , Imagen de Cuerpo EnteroAsunto(s)
Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico por imagen , Tumores Neuroendocrinos/diagnóstico por imagen , Radiografía Abdominal , Radiografía Torácica , Tomografía Computarizada por Rayos X , Anciano , Anciano de 80 o más Años , Biopsia con Aguja , Hepatomegalia/diagnóstico , Humanos , Inmunohistoquímica , Hígado/patología , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/secundario , Neoplasias Pulmonares/diagnóstico , Masculino , Síndrome Carcinoide Maligno/diagnóstico , Tumores Neuroendocrinos/diagnóstico , Tumores Neuroendocrinos/patología , Tumores Neuroendocrinos/secundario , Palpación , Cintigrafía , Somatostatina/análogos & derivadosRESUMEN
No disponible
Asunto(s)
Adulto , Anciano , Persona de Mediana Edad , Humanos , Embolia Pulmonar/diagnóstico , Relación Ventilacion-Perfusión/fisiología , Tomografía Computarizada por Rayos X , Espectrometría gammaRESUMEN
Tumours that produce metastases in the paranasal sinuses or sphenoidal sinus are rare; the carcinomas of kidney and lung being the most frequent with this type of metastasis. Distant metastases from differentiated thyroid carcinoma are rare and, moreover, when they metastasize, they do so into lung and bone. We report a patient who had a papillary thyroid carcinoma with metastases into the sphenoidal sinus.
Asunto(s)
Carcinoma Papilar/secundario , Neoplasias de los Senos Paranasales/secundario , Seno Esfenoidal/patología , Neoplasias de la Tiroides/patología , Carcinoma Papilar/diagnóstico por imagen , Carcinoma Papilar/radioterapia , Carcinoma Papilar/cirugía , Terapia Combinada , Irradiación Craneana , Diplopía/etiología , Femenino , Cefalea/etiología , Humanos , Histerectomía , Radioisótopos de Yodo/uso terapéutico , Leiomioma/cirugía , Imagen por Resonancia Magnética , Persona de Mediana Edad , Neoplasias Primarias Secundarias , Neoplasias de los Senos Paranasales/diagnóstico por imagen , Neoplasias de los Senos Paranasales/radioterapia , Neoplasias de los Senos Paranasales/cirugía , Cintigrafía , Radiofármacos/uso terapéutico , Radioterapia Adyuvante , Neoplasias de la Tiroides/cirugía , Tiroidectomía , Neoplasias Uterinas/cirugíaRESUMEN
Tumours that produce metastases in the paranasal sinuses or sphenoidal sinus are rare; the carcinomas of kidney and lung being the most frequent with this type of metastasis. Distant metastases from differentiated thyroid carcinoma are rare and, moreover, when they metastasize, they do so into lung and bone. We report a patient who had a papillary thyroid carcinoma with metastases into the sphenoidal sinus