Peter Josef Ell : discurs llegit a la cerimònia d'investidura celebrada a l'aula magna de Casa Convalescència el dia 5 d'abril de l'any 2005

Peter Josef Ell , nascut el 7 de maig de 1944, és professor de Medicina Nuclear a la Universitat de Londres des de 1987, director del Institute of Nuclear Medicine, UCL, des de 1986, Honorary Consultant Physician del Middlesex Hospital des de 1976, i Clinical Director del UCLH NHS Trust des de 2001. El professor Ell és una de les figures més rellevants del món en l'àrea de la medicina nuclear i del diagnòstic per la imatge. La seva formació, variada i europeista, inclou una llicenciatura en Medicina per la Universitat de Lisboa, un màster en Ciències per la Universitat de Londres i un doctorat per la Universitat de Berna. No solament parla diverses llengües, sinó que ha integrat les cultures portuguesa, alemanya i anglesa. És director del Institute of Nuclear Medicine del UCL, un dels serveis més grans d'Anglaterra en l'especialitat, i catedràtic de Medicina Nuclear en aquest mateix centre. És autor de més de cinc-centes publicacions científiques, moltes d'elles en les revistes de més factor d'impacte (Lancet, JCO, JACC, etc.), i és editor/autor de dotze llibres de text, i de múltiples comunicacions i presentacions a congressos. Ha estat convidat a pronunciar nombroses conferències arreu del món. La seva multiculturalitat li ha permès de tenir un paper central en la creació i formació de la Societat Europea de Medicina Nuclear (EANM), de la qual va ser autor de molts dels documents fundacionals, i de la qual ha estat president entre 1994 i 1996. Ha estat quinze anys redactor en cap del European Journal of Nuclear Medicine and Molecular Imaging, revista que, sota la seva direcció, s'ha consolidat com una de les més importants del món en aquesta àrea científica.Nomenament 10/11/2004. A proposta de Facultat de Medicina. Investidura 05/05/2005. Padrí: Ignasi Carri

Marked ventricular repolarization abnormalities in highly trained athletes’ electrocardiograms: clinical and prognostic implications

AbstractOBJECTIVEWe sought to study the functional, clinical and prognostic implications of marked repolarization abnormalities (MRA) sometimes seen in athletes’ electrocardiograms (ECGs).BACKGROUNDThe clinical meaning of ECG MRA in athletes is unknown. No relationship has been drawn between either training intensity or any particular type of sport and MRA. Athletes are usually symptom free and do not show any decrease in their physical performance. It is as yet unclear whether MRA may have a negative effect on the performance of such athletes in competitive sports.METHODSWe studied 26 athletes with MRA (negative T waves ≥2 mm in three or more ECG leads at rest). No athletes presented clinical symptoms of cardiac disease or decrease in their physical performance. Clinical and physical examinations, ECG at rest, exercise test and echocardiographic and antimyosin studies were performed in all athletes. Rest/exercise myocardial perfusion single-photon emission computed tomography studies were performed in 17 athletes. The follow-up ranged from 4 to 20 years (mean 6.7 years).RESULTSFour athletes were excluded due to hypertrophic cardiomyopathy. Echocardiographic studies showed right and left normal ventricular dimensions for highly conditioned athletes. In the exercise test, heart rate was 166 ± 12.4 beats/min, and exercise tolerance was 15.2 ± 2.7 metabolic equivalents of the task. All athletes had ECG at rest simulating myocardial ischemia or “pseudoischemia” with a tendency to normalize during exercise. Myocardial perfusion studies were normal in the studied athletes. Antimyosin studies showed mild and diffuse myocardial radiotracer uptake in 15 athletes (68%). No adverse clinical events were observed in the follow-up.CONCLUSIONSThese results suggest that MRA have no clinical or pathological implications in athletes and should, therefore, not preclude physical training or participation in sporting events

Response to 223 Ra-dichloride in castration-resistant prostate cancer with bone metastasis : A case report

Painful bone metastases are common in prostate cancer, with current treatments including non-steroidal analgesics and opiates, surgery, external beam radiotherapy and bone-targeting β-emitting radiopharmaceuticals. The α-emitting isotope 223 Ra-dichloride (Ra-223) has been associated with improved overall survival and increased time to first skeletal-related events in patients with castration-resistant prostate cancer (CRPC) presenting with symptomatic bone metastases. The current study reports the case of a 70-year-old male patient, who was diagnosed with prostate cancer in 1999 upon presentation with increased prostate-specific antigen (PSA) levels and painful bone metastases in the context of CRPC. In November 2010, subsequent to undergoing hormonal blockage, the patient was treated with ketoconazole (200 mg/8 h) followed by 10 cycles of docetaxel (75 mg/m 2 every 3 weeks). Following disease progression, the patient received 6 doses of Ra-223 (50 kBq/kg; 1 dose/4 weeks). During this treatment period, an improvement in the patient's symptoms, and levels of bone alkaline phosphatase (BAP) and PSA were noted. Furthermore, Ra-223 was well-tolerated without any relevant bone marrow toxicity. However, 2 months after the administration of the final dose of Ra-223, PSA and BAP levels increased again, and bone pain deteriorated. A bone scan showed stable disease in the previously observed metastatic lesions; however, new lesions simultaneously appeared in different locations, indicating progressive disease

Efficacy of augmented immunosuppressive therapy for early vasculopathy in heart transplantation

AbstractObjectives. The present study was undertaken to prospectively and comparatively evaluate the role of serial myocardial perfusion imaging and coronary angiography for the detection of early vasculopathy in a large patient population and also to determine the short- and long-term efficacy of augmented immunosuppressive therapy in the potential reversal of the early vasculopathy.Background. Allograft vasculopathy is the commonest cause of death after the first year of heart transplantation. Anecdotal studies have reported the efficacy of augmented immunosuppressive therapy after early detection of vascular involvement. However, no prospective study has evaluated the feasibility of early detection and treatment of allograft vasculopathy.Methods. In 76 cardiac allograft recipients, 230 coronary angiographic and 376 scintigraphic studies were performed in a follow-up period of 8 years. Angiography was performed at 1 month and every year after transplantation, and thallium-201 scintigraphy at 1, 3, 6 and 12 months after transplantation and twice a year thereafter. Prospective follow-up of 76 patients showed that 18 developed either angiographic or scintigraphic evidence of coronary vasculopathy. All episodes were treated with 3-day methylprednisolone pulse and antithymocyte globulin.Results. Twenty-two episodes of vasculopathy were diagnosed and treated in these 18 patients. Of these 22 episodes, two were detected only by angiography, seven by both angiography and scintigraphy, four by scintigraphy and histologic evidence of vasculitis and nine episodes only by thallium-201 scintigraphy studies. Angiographic and/or scintigraphic resolution was observed in 15 of the 22 episodes (68%) with augmented immunosuppression. The likelihood of regression was higher when treatment was instituted within the first year of transplantation (92%) than after the first year (40%) (p = 0.033). Eighty percent of patients who responded to follow-up.Conclusions. The present study suggests that early detection of allograft coronary vasculopathy is feasible with surveillance myocardial perfusion or coronary angiographic studies. When identified early after transplantation, immunosuppressive treatment may result in regression of coronary disease