Decision-making process in long term acute cholecystitis

OBJECTIVE

To demonstrate that the categorization of different therapeutic options is essential for the decision-making applied to clinical management.

METHOD

This paper compares the usefulness of percutaneous echo-guided cholecystostomy as the first therapeutic option in acute long-term cholecystitis versus the exclusive surgical or clinical management.

RESULT

We have analyzed the usefulness of different therapeutic options in a case of long term acute cholecystitis and we have obtained the following results: isolated intravenous antibiotic therapy (0.76), surgery (0.73) and echo-guided cholecystostomy (0.93). This last option has provided good clinical-radiological results.

CONCLUSION

Decision trees are a good methodological option as support of surgical and non surgical therapeutic procedures.

[Reliability of the evaluation of regional cerebral blood flow using SPECT in chronic schizophrenia and bipolar disorder]

OBJECTS

Demonstrate the reliability of cerebral SPECT using 99 mTc-HMPAO.

METHODS & MATERIALS

Evaluation of cerebral blood flow using SPECT in 24 patients with schizophrenia, 24 patients with bipolar disorder and 20 controls. In the study we have reliability between observers and intraobserver. In both cases kappa statistic has been applied for measuring reliability.

RESULTS

reliability between observers represents a kappa coefficient of 0.71. Intraobserver reliability, with a medium grade concordance slightly superior, shows a medium kappa coefficient of 0.74.

CONCLUSIONS

Visual evaluation of SPECT images using 99mTc--HMPAO is a trustworthy technique to document the different patterns of regional cerebral blood flow. Reliability is determinate by the improvement, during visual analysis of reliability between observers (kappa: 0.71) and intraobservers (kappa: 0.74).

[Gerstmann-Straussler syndrome clinical and neuromorphofunctional diagnosis: a case report]

The Syndrome of Gerstmann-Straussler is a constellation of typical symptoms that affects the parietotemporal crossroad and also involves the contiguous parts of the occipital lobe of the dominant hemisphere. Is a family ailment that starts with an espinocerebellar ataxy followed by dementia. Diagnosis options such as EEG, TC, RM and brain SPECT-99mTc-HMPAO have been carried out in an adult with Gerstmann Syndrome.

RESULTS

The brain SPECT disclosed a disminution of the flow at the parietotemporooccipital areas of both hemispheres. The results revealed a clinical and a neuromorphofunctional correlation.

CONCLUSION

Brain SPECT is a complementary test to the structural neuroradiological examinations, such as TC and RM, that occasionally is useful not only to clarify but also to widen the information that these offer.