April 2006

CURRICULUM VITAE

SUMMARY

Doctor Cum Laude in Medicine and Surgery, Internal Medicine Molecular Medicine

Carlos Ramirez Martinez-Duncker

Mexican Academy of Surgery - Department of Medical Biology and Basic Sciences
Hospital Infantil de Mexico Federico Gómez - Molecular Nuclear Medicine Department official title

Radiation Facility Operator
Official Title Radiation Facility Supervisor - Medical and Research Area
Member: American College of Member
Nuclear Medicine, The Johns Hopkins Medical Institutions
Member: American College of Nuclear Physicians
Member: American Society of Nuclear Medicine
Founding Member: American Society of Nuclear Cardiology
Certificate: Consejo Mexicano de Medicina Molecular
President, National College of Paediatrics Nuclear
President, National College of Nuclear Cardiology
Honorary President: International College of Nuclear Physicians
President, Mexican Association of Thyroid AC
Chairman: Committee on Biosafety of the Hospital Infantil de Mexico Federico Gómez.
Researcher: National Institutes of Health Committee Member
Editorial: The Journal of Nuclear Medicine Editorial Board Member
: The European Journal of Nuclear Medicine & Molecular Imaging

CURRENT LOCATION OF WORK:
Head of Molecular Nuclear Medicine - Hospital Infantil de Mexico Federico Gómez

Keywords: Medicine Nuclear Molecular, Research, Radiation Safety, Biomedical Engineering

SURGEON CAREER: Universidad Autónoma de Ciudad Juárez. Chihuahua, Mexico. 1986.

INTERNSHIP: Teaching Unit, Hospital de la Santa Creu i Sant Pau. Faculty of Medicine. Autonomous University of Barcelona. SPAIN 1987.

BUSINESS REVIEW:
Approved unanimously. 1987.

SOCIAL SERVICE: Made conducting scientific research work at the Autonomous University of Barcelona, Spain. With authorization from the Ministry of Health of Mexico.

medical degree: Universidad Autonoma de Ciudad Juarez, Chihuahua, Mexico.

CERTIFICATION IN NUCLEAR AND RADIATION FACILITIES
RADIOACTIVE Operates: Department of Industry and Energy. Autonomous University of Barcelona. Certification Examination approved and endorsed by the National Safety Council of Spain on January 27, 1989.

· PLANT SUPERVISOR RADIOACTIVE: PRACTICE OF MEDICINE AND RESEARCH: Service Radiation Physics. Autonomous University of Barcelona. Certification Examination approved and endorsed by the National Safety Council of Spain on October 6, 1989.

· Responsible for radiation safety in various institutions and radioactive facilities at the NUCLEAR SAFETY COMMISSION AND SAFEGUARDS from 1991 to date.

SPECIALTY STUDIES IN NUCLEAR MEDICINE INTERNAL MEDICINE AND MOLECULAR
Hospital de la Santa Creu i Sant Pau. Teaching Unit, Faculty of Medicine.
Autonomous University of Barcelona. 1988-1990. RESEARCH FELLOW

Radiological AND SCIENCE IN RADIOLOGY - NUCLEAR MEDICINE
A) The Johns Hopkins Medical Institutions. Division of Nuclear Medicine. 1990-1991.
B) The Johns Hopkins Medical Institutions. Division of Internal Medicine, Department of Cardiology
. 1990-1991. DIPLOMA

· Diploma in Clinical Nutrition. Division Graduate School of Medicine. Universidad Autonoma del Estado de Morelos (2000).

· Diploma in Human Physiology. 150 hours. Graduate Division of the Faculty of Medicine. Universidad Autonoma del Estado de Morelos and College of Physicians and Surgeons of the State of Morelos (2001).

· Diploma in Clinical Pharmacology. 200 hours. University Autonoma del Estado de Morelos, General Medical Council of the State of Morelos and the College of Physicians and Surgeons of the State of Morelos (2001). TIPS

Consejo Mexicano de Medicina Molecular, AC 24-Nov-1995.
National Council for Nuclear Safety, Radiological and Pediatrics, Cardiology and Nuclear Medicine, AC 3-September-1997. DOCTORAL

School of Medicine. Autonomous University of Barcelona. Barcelona, Spain. 1987-1990.

DOCTORAL THESIS:
Radioinmunodiagnóstico of Inflammation, Infection and Invasion of Metastatic Tumor of Bone Marrow with Monoclonal Antibody antigranulocyte BW250/183
DATE READING OF THESIS: March 5, 1990

academic degree: CUM LAUDE DOCTOR IN MEDICINE AND SURGERY FOR AUTONOMOUS UNIVERSITY OF BARCELONA.

1. Co. Isotope Studies in Cardiology. In: Isotope Studies in Medicine. Ignasi Carrio. Ed Springer-Verlag Spain (Spain) 1992, page 55 through 81. ISBN 84-07-00113-9

2. Martínez-Duncker C. Imaging in Rheumatic Diseases: Modern Nuclear Medicine in Rheumatology. In: Pediatric Rheumatology. Romeo S Rodríguez. American Ed-McGraw-Hill (MEXICO) 1994, page 294 to 308. ISBN 968-25-2041-X

3. Martínez-Duncker C. Pharmacologic coronary vasodilation in Nuclear Cardiology. In: Cardiovascular Therapy: Experiences and Reflections Selection. Gustavo Sánchez Torres. Published by the Mexican Society of Cardiology. (Mexico) 1993 Page 55 to 64. ISBN 970-626-079-X

4. Martínez-Duncker C. Bone Marrow Imaging. In: Principles in Nuclear Medicine. Henry N. Wagner Jr., Z. Szabo and J. Buchanan. Second Edition. Ed Saunders (EEUUA) 1995, page 715 to 722. ISBN 0-7216-9091-2

5. Co. Mexican Consensus Study of the thyroid nodule. Continuing Medical Education Department of the Mexican Association of General Surgery. 2001.

6. Martínez-Duncker C., Martínez-Duncker I. Chapter 241. Emergencies in Paediatrics Hospital Infantil de Mexico Federico Gómez. 5ta.Edición. McGraw-Hill. 2002. P. 1388-1391. ISBN 970-10-3837-1.

7. Carlos Martínez-Duncker-R., Raúl Martínez-Lázaro, Anabel Cortés-Blanco, Ivan Martinez-Duncker-R. Chapter 17. Multisystem diseases: AIDS. Editorial Masson. 2003. Nuclear Medicine: Clinical Applications (2nd Edition). Pp 609-615. ISBN 84-458-1291-2.

8. Armando Vargas Domínguez and Carlos Martínez-Duncker R. Diagnostic studies and needle biopsy in thyroid disease. Treaty of General Surgery. Manual Moderno. 2003. Chapter 53. Pags 431-440. ISBN 968-426-990-0

9. Martínez-Duncker C, Martínez-Duncker I. Martinez-Duncker D. Radiopharmaceuticals. Clinical Pharmacology. Editorial Trillas. 2003. Chapter 90. Pags. 1091-1107. ISBN 968-24-6606-7.

published in medical journals

1. Gimeno J, Berna L, Proubasta J, Martínez-Duncker C. Isotope scans in patients with primary tumors of bone and infectious disease. Radiology (Spain) 1988, 9:563-567.

2. Carrio I, Berna L, M. Estorch, Martínez-Duncker C. Radioiodine Treatment of Hyperthyroidism Today. Rev Esp Med Nucl 1989; 8 (I) :3-5.

3. M. Estorch, I. Carrio, A. Artigas, J. Rodríguez-Arias, L. Berne, C. Martínez-Duncker, M. Ginjaume. Study of Right Ventricular Contractility by radionuclide ventriculography. Rev Lat Cardiol 1989:10 (3), 177-182.

4. Mora J, Martin-Comin J, Carrio I, Berna L, Estorch M, Martinez-Duncker C, Gomez D, Daumal J, Ramos M. Usefulness of myocardial scintigraphy with methoxy-isobutyl-isonitrile-Tc99m in the diagnosis of coronary artery disease. Rev Esp Cardiol 1990; 43 (1) :18-22. We Have Studio 24 Patients (21 ills and 3 female) with coronary artery disease. Stress and rest myocardial scintigraphy WAS Performed in all married with 15-20 mCi of Tc 99m methoxy-isobutyl-isonitrile. The examination was done in 2 sessions. Usually the stress scan was obtained and within 2-4 days the rest study was obtained. All patients underwent selective coronary arteriography within a week of the scintigraphy and, in 13 cases, rest radiologic ventriculography was also performed. In 5 patients coronary arteriography and myocardial scintigraphy were normal. In 19 cases the coronary arteriography showed lesions, the myocardial scintigraphy showed ischemia or necrosis in 17 of them and was normal in two. To localize the pathologic vessel the myocardium was divided into 3 segments and segmentary analysis localized the abnormal coronary artery in 51 out of 72 cases. The best availability of the new myocardial agent and the results obtained make it a good tracer for myocardial studies.

5. Germá JR. I. Alvarez Carrio I. Estorch M. Berná L. Martinez-Duncker C. Marcuello E. Nogueras FM .. Radioinmunolocalización clinical application in Colorectal Cancer. Med Clinic (Spain) 1990, 94 (9) :325-328. We present preliminary results of radioimmunolocalization (RIL) of colorectal cancer with 131I Labelled F (ab ') 2 fragments from monoclonal anti anti CEA and CA 19.9 Antibodies in 22 Patients with colorectal cancer and in one patient with metastases of unknown origin and high CEA value . Positive images Were Obtained in 7 of 11 primary tumors from 10 Patients Evaluated preoperatively, in 2 of 3 recurrences, in 9 of 12 metastatic localizations and in the unknown primary tumor localized, finally in the cecum. One local recurrence and Stock not was detected by diagnostic Methods, pero RIL. There Was Not false-positive images. Therefore, it RIL Appears Promising as a method for the diagnosis and follow-up of colorectal cancer.

6. Martínez-Duncker, C, M. Estorch, L. Berne et al. Circumferential profiles Versus Visual Analysis in the Study of Stress Myocardial Perfusion with Thallium-201. English Journal of Cardiology 1990, 43 (3) :171-176. Two Methods of analysis for myocardial perfusion studies with thallium Are compare: the visual Conventional analysis, and a quantitative method Which shows results as circumferential profiles. Three hundred and ninety myocardial Segments in 65 Patients Were Studied. Visual analysis showed abnormalities in 44/65 (68%) patients, the quantitative method did it in 53/65 (81%). When localization and/or extension discrepancy between the two methods was found, angiography was always concordant with circumferential profiles findings. Total agreement between the two methods was present in 20/65 (31%) patients. The quantitative method is more sensitive than the visual analysis. It is also more precise in defining localization and extension of thallium defects.

7. Duncker CM, Carrió I, Berná LL, Estorch M, y cols. Radioimmune Imaging of Bone Marrow in Patients with Suspected Bone Metastases from Primary Breast Cancer. Journal of Nuclear Medicine 1990;31(9):1450-1455. Radioimmune imaging of bone marrow was performed by technetium-99m- (99mTc) labeled antigranulocyte monoclonal antibody BW 250/183 (AGMoAb) scans in 32 patients with suspected bone metastases from primary breast cancer. AGMoAb scans showed bone marrow defects in 25/32 (78%) patients; bone invasion was subsequently confirmed in 23 (72%) patients. Conventional bone scans performed within the same week detected bone metastases in 17/32 (53%) patients (p less than 0.001). AGMoAb scans detected more sites indicating metastatic disease than bone scans in 12 of these 17 patients (71%). All patients with bone metastases in the axial skeleton had bone marrow defects at least at the sites of bone metastases. Of 15 patients with normal, or indicative of, benign disease bone scans, 8 Patients (53%) present with Defects in the bone marrow AGMoAb scans. Bone invasion WAS confirmed in six of them to be. Bone marrow scans AGMoAb Provide a method for the early detection of bone invasion in Patients with metastatic breast cancer and bone metastases Suspected.

8. Rhodes BA, Martínez-Duncker C. Direct Labeling of Antibodies with Tc-99m. American Biotechnology Laboratory. 1990, 8 (4) :50-53.

9. L. Berne, C. Martínez-Duncker, M. Estorch, A. Segarra, C. Alonso, B. Ojeda, JR Herman, R. White, I. Carrio. Scintigraphic study of bone marrow with a monoclonal antibody-Tc-99m antigranulocyte: Value complementary to bone scintigraphy. Rev Esp Med Nucl 1990;9:35-37.

10. Carrió, R. Serra, Ll. Berná, M. Estorch, C. Martínez, J. Ordoñez. Transient Alterations in Cardiac Performance After a 6 Hour Race. American Journal of Cardiology 1990;65(22):1471-1474. Ten long distance runners were enrolled in a 6-hour competitive race. Immediately after the race technetium-99m-albumin gated blood pool scans were performed and indium-111 antimyosin was injected. Forty-eight hours later antimyosin scans were obtained and control gated blood pool scans were performed. Left ventricular ejection fraction was higher after the race (65 +/- 5 vs 60 +/- 7%, p less than 0.01) due to a decrease in end-systolic counts. Right ventricular ejection fraction was lower after the race (42 +/- 7 vs 54 +/- 12%, p = 0.03) due to an increase in both end-diastolic and end-systolic counts. A longer systolic period was observed after the race (53 +/- 5% of the RR interval vs 39 +/- 3%, p = 0.005). No significant differences were observed in peak filling or peak emptying rates after the race. An increase in pulmonary blood volume (116% of control) was observed after the race. Antimyosin scans were normal in 7 athletes and minimal antimyosin myocardial uptake was seen in 3. Transient alterations in biventricular performance present after the race correspond to function adaptation to strenuous exercise and are not due to irreversible myocyte damage.

11. M. Estorch, I. Carrió, L. Berná, C. Martínez-Duncker, C. Alonso, JR Germá, B. Ojeda. 111-In-Antimyosin Scintigraphy After Doxorubicin Therapy in Patients with Advanced Breast Cancer. Journal of Nuclear Medicine 1990;31(12):1965-1969.

12. Carrio I., Estorch M., Berna L,. Germa JR., Alonso C., Ojeda B., de Andres L., Lopez-Pousa A., Martinez-Duncker C., Torres G. Assessment of anthracycline-induced myocardial damage by quantitative indium 111 myosin-specific monoclonal antibody studies. European Journal of Nuclear Medicine 1991;18(10):806-12. To assess chemotherapeutically induced myocardial damage, myosin-specific antibody scans and ejection fraction measurements were performed in 32 patients with breast cancer and in 9 patients with other tumours. All patients had received chemotherapy including anthracyclines. The ejection fraction decreased by less than or equal to 10% in 14 of 41 (34%) patients after chemotherapy. Antimyosin uptake in the myocardium was observed in 38 of 41 (92%) patients after chemotherapy. Antimyosin uptake was quantified by means of a heart-to-lung ratio, revealing a correlation between the degree of antimyosin uptake in the myocardium and the cumulative dose of anthracycline. Patients with a decreased ejection fraction showed more intense antimyosin uptake, indicating more severe myocardial damage. A higher degree of antimyosin uptake was found in 17 breast cancer patients treated with doxorubicin compared with 15 patients treated with mitoxantrone. We conclude that antimyosin studies provide a sensitive, non-invasive method to monitor myocardial damage in patients treated with anthracyclines. Antimyosin uptake in the myocardium precedes ejection fraction deterioration. This technique may be helpful in the early identification of patients at risk of congestive heart failure during chemotherapy including anthracyclines.

13. Martínez-Duncker C. Nuevas técnicas en Cardiología Nuclear. SPECT, PET y Antimiosina. [New techniques in nuclear cardiology: SPECT, PET and antimyosin]. Arch Inst Cardiol Mex. 1991 Nov-Dec;61(6):597-601. Nuclear Cardiology offers non-invasive techniques of high reproducibility for cardiovascular assessment. These techniques have advanced enormously in the latest years. The advances in areas such as general technology and computer systems, medicine, immunology and research, allow us to obtain and interpret cardiac information with immediate or potential clinical applications unavailable few years ago. This paper describes 3 of these new techniques in nuclear cardiology: Single Photon Computed Tomography (SPECT); Positron Emission Tomography (PET) and; the use of an Antimyosin monoclonal antibody.

14. J. Monés, I. Carrió, M. Roca,. M. Estorch, R. Calabuig, S. Sainz, C. Martínez-Duncker, F. Vilardell. Gastric Emptying of Two Radiolabelled Antacids. Gut 1991:32(2):147-150. The rate of gastric emptying of two antacids, magaldrate and Maalox, was investigated using scintigraphy. Successful labelling of the antacids was carried out with 99mTc. The stability of the 99mTc- labelled antacids was satisfactory and there was no difference in antacid capacity between the labelled and unlabelled antacids. The studies were carried out on 15 healthy male volunteers. After an eight hour fast each subject ingested a standardised meal of 95.7 MJ (400 kcal). One hour later 10 ml of one of the two antacids previously labelled with 99mTc was administered. Serial detection by anterior and posterior projection of the amount of antacid retained in the stomach was performed to determine gastric emptying of antacid. One week later the study was repeated under the same conditions with the other antacid also labelled with 99mTc. The mean (SD) percentages of antacid retained in the stomach fit a linear model with a t1/2 of 86.6 (15.3) minutes for magaldrate and 52.3 (5.2) minutes for Maalox (p less than 0.01). When the mean percentages of retention at six time intervals were compared for both antacids, it was found that Maalox emptied much faster (p less than 0.01 at 15 and 30 minutes, p less than 0.02 at 45, 60, 75, and 90 minutes).

15. Serra-Grima R, Carrió I, Estorch M, Trilla E, Berná L, Martínez-Duncker C, Rodas G. The effect of prolonged physical exercise on ventricular function. Int J Sports Cardiol 1992;2:79-82.

16. Martínez-Duncker C. Cardiología Nuclear: Isquemia Miocárdica y Viabilidad Celular. Principia Cardiológica. EPOCA 2, 1992;6(2):2-7.

17. Carrió, M. Estorch, Ll. Berná, C. Martínez-Duncker, J. Germá, C. Alonso, L. Andrés, A. López-Pousa, G. Torres. Assessment of Anthracycline cardiotoxicity by Quantitative In-111-Monoclonal Antibody Antimyosin Studies. Eur J Nucl Med 1992.

18. Torres G, Martinez-Duncker C, Pujol J, Estorch M, Berna L, Marti-Vilalta JL, Carrio I. CT brain single photon emission. Semiquantitative analysis of vascular territories in patients with cerebral vascular disease. [Cerebral single-photon emission-computed tomography. A semiquantitative analysis of vascular areas in Patients with cerebrovascular pathology]. Med Clin (Barc). 1992, 22, 98 (7) :241-4. BACKGROUND: Brain perfusion SPECT studies in Patients with Cerebral Stroke May Be Useful to evaluate distant perfusion abnormalities. METHODS: 99mTc-HMPAO brain SPECT studies were performed in 17 patients with ischemic lesions in the basal ganglia and/or internal capsule demonstrated by NMR. Regions of interest were adjusted in representative transverse slices to the vascular territories of the anterior, middle, posterior and communicating cerebral arteries. RESULTS: Patients with ischemic lesions in the right basal ganglia showed increased cerebral perfusion in the left middle artery territory (0.95 +/- 0.13 versus 0.80 +/- 0.06; p = 0.0365). Patients with ischemic lesions in the left basal ganglia showed increased perfusion in the right anterior artery territory (0.93 +/- 0.09 versus 0.82 +/- 0.09; p = 0.0464), in the left anterior artery territory (0.93 +/- 0.09 versus 0.83 +/- 0.14; p = 0.0464), in the left middle artery territory (0.92 +/- 0.09 versus 0.78 +/- 0.05; p = 0.0079) and in the left posterior artery territory (1.05 +/- 0.14 versus 0.90 +/- 0.09; p = 0.036). Patients with ischemic lesions in the right internal capsule showed increased perfusion in the right posterior artery territory (0.95 +/- 0.11 versus 1.10 +/- 0.18; p = 0.0431). CONCLUSIONS: These results show the presence of delayed luxury perfusion phenomena in regions distant from the ischemic site.

19. Férez S, Martínez-Duncker C, Vargas J, Vázquez G, Verdejo J, Sghaib S. Isquemia Miocárdica Asintomática. Nueva Cardiología 1993;3:6-13.

20. Martínez-Duncker C, Carrio I. Utility of a Monoclonal Antibody antigranulocyte Marked Technetium-99m in the Identification of Infectious Disease Bone and extraosseous location. Military Medical Journal, MEXICO 1993, 47 (2) :44-48.

21. Civelek C, Martínez-Duncker C, Becker LC Temporarily Altered Thallium-201 Redistribution Following Acute Myocardial Infarction: An Unreported Manifestation of Stunned Myocardium. Am J Cardiac Imaging 1993, 7 (1) :63-67.

22. Martínez-Duncker C, Martínez-Duncker D, Takatsu H, Civelek C, Becker LC. The size of area at risk of stroke determines the residual left ventricular function in patients with a first acute myocardial infarction. Medical Journal of Hospital General de Mexico 1994:57 (3), 110-118.

23. Martínez-Duncker C. Nuclear Medicine in Pediatrics: Basic Income liver scans, bone, kidney and brain. Journal of Child Care and Pediatrics, 1994, 1 (3), 73-88.

24. Martínez-Duncker C, Fosado-Márquez MG. Utility of Molecular Nuclear Medicine in the study of most common bone disease in children. Medical Journal of Hospital Infantil de Mexico 1995:52, 543-548.

25. Martínez-Duncker C. Definition and clinical applications of modern Molecular Nuclear Medicine: Diagnosis and treatment with emphasis on pediatrics. Medical Journal of Hospital Infantil de Mexico 1995:52, 731-746.

26. Martínez-Duncker C, Alcántara-Ramírez R, Fosado-Márquez MG, Mayer-Perez GF, Campos L. Lagarde Nuclear Medicine: Study of renal function in children. Medical Journal of Hospital Infantil de Mexico 1995:52, 606-613.

27. Martínez-Duncker C, Fosado-Márquez MG. Biological and Medical Basic ionizing radiation. Medical Journal of Hospital Infantil de Mexico 1995:52, 669-678.

28. Takatsu H, Duncker CM, Arai M, Becker LC. Assessed Cardiac Sympathetic nerve function by I-131-MIBG after ischemia in anesthetized dogs. Journal of Nuclear Cardiology, 1997;4:35-41. Background. Accumulation of 131I-labeled metaiodobenzylguanidine ([131I]MIBG), a radiolabeled norepinephrine analog, is reduced in infarcted myocardium, suggesting loss of cardiac sympathetic nerve viability. Histopathologic studies, however, indicate that the nerve endings are morphologically intact. Experiments were therefore designed to determine the mechanism of reduced MIBG accumulation. Methods and Results. Desipramine, a specific blocker of neuronal norepinephrine reuptake, was used to separate the portions of total myocardial [131I]MIBG accumulation attributable to neuronal and nonneuronal uptake mechanisms. Sixteen dogs underwent circumflex coronary artery occlusion for 60 minutes followed by a 5-hour reperfusion. [131I]MIBG was injected intravenously 1 hour after reperfusion. The left ventricle was removed and incubated in triphenyltetrazolium chloride to identify infarcted and viable myocardium within the zone at risk. Preliminary studies in sham-operated dogs showed that pretreatment with desipramine (5 mg/kg) reduced [131I]MIBG accumulation 4 hours after injection to 38.9% of untreated controls. Chemical sympathectomy by topical phenol resulted in a similar decrease in [131I]MIBG accumulation (to 45.7% of normal), and desipramine did not produce further inhibition of [131I]MIBG accumulation over that produced by phenol alone, indicating that the inhibitory effect of desipramine on neuronal accumulation of [131I]MIBG was essentially complete. In dogs undergoing ischemia-reperfusion, myocardial samples from infarcted and viable postischemic areas showed 64.5% ± 11.8% and 84.7% ± 9.1% of normal [131I]MIBG activity, respectively (both, p < 0.01 vs normal area, n = 9). With desipramine pretreatment (n = 7), accumulation of [131I]MIBG decreased in all areas. Neuronal accumulation was reduced uniformly in infarcted, viable postischemic, and normal areas by 30% to 35% compared with sham-operated controls. In contrast, nonneuronal accumulation was only 39.3% in infarcted areas and 84.6% in viable postischemic areas compared with normal areas, and these decreases accounted entirely for the reduced total [131I]MIBG accumulation. Conclusions. Reduced [131I] MIBG Accumulation in infarct myocardium after 60 minutes of ischemia and 5 hours of reperfusion is attribute to a deficit in nonneuronal Not to Decreased Accumulation and Accumulation by Sympathetic Nerve.

29. Martínez-Duncker C. Three-dimensional representation of left ventricular perfusion and rest and pharmacological stress in patients with myocardial ischemia [Tridimensional representation of left ventricular perfusion DURING Pharmacological stress and rest in Patients with myocardial ischemia]. Gac Med Mex 1998; 134 (1) :103-5

30. Takatsu H, Duncker CM, Arai M, Becker LC. Granulocyte Accumulation in ischemic / reperfused myocardium: Assessment with a technetium-99m labeled antigranulocyte monoclonal antibody in the dog. J Nucl Cardiol, 1999;6(5):641-650. This study tested the usefulness of technetium-99m—labeled antigranulocyte monoclonal antibody BW250/183 (AGMAb) for identifying granulocyte accumulation in ischemic/reperfused canine myocardium. In dogs with 90 minutes coronary artery occlusion and 180 minutes reperfusion (n = 8), ischemic/reperfused myocardial samples demonstrated 8.5 ± 2.4 times more Tc-99m—AGMAb accumulation than nonischemic samples. Dogs given Tc-99m—labeled nonspecific human immunoglobulin instead of Tc-99m—AGMAb (n = 3) had about half as much accumulation (4.5 ± 1.6, P < .05). Ex vivo myocardial imaging of Tc-99m—AGMAb demonstrated marked uptake in infarcted regions identified by absent triphenyl tetrazolium chloride staining. The amount of uptake was inversely related to the severity of ischemia (determined by radioactive microspheres) and directly correlated with tissue myeloperoxidase activity, a specific marker of granulocyte accumulation. No increase in Tc-99m—AGMAb uptake occurred in dogs with 90 minutes ischemia and no reperfusion (n = 3) or 15 minutes ischemia and 180 minutes reperfusion (n = 2). In conclusion, Tc-99m—AGMAb is taken up in reperfused infarcted myocardium by both nonspecific and specific mechanisms. Because the amount of uptake reflects myocardial granulocyte accumulation, Tc-99m—AGMAb combined with nuclear imaging techniques may be useful for studying inflammatory Processes in the heart in experimental animal models and human beings.

31. Martínez-Duncker C, Soto-Gutierrez S. Scintigraphy in the evaluation of pediatric patients with fever of unknown origin. Medical Journal of Hospital Infantil de Mexico 1999:56, 504-510.

32. Martínez-Duncker C, Soto-Gutierrez S, Pérez, R. Diuretic radionuclide renography in the evaluation process of the upper urinary tract obstruction in pediatric patients. Medical Journal of Hospital Infantil de Mexico 1999:56 (12) :667-672.

33. Martínez-Duncker C. Gastroesophageal reflux. Letter to the Editor. Bulletin Medical Hospital Infantil de Mexico 1999:56 (12) :686-687.

34. Duncker, CM. Nuclear Medicine in Latinamerica. Letter to the Editor. Journal of Nuclear Medicine 2000, 41 (2): 36N.

35. Martínez-Duncker C, Soto-Gutierrez S, Pérez, R. Hepatobiliary scintigraphy in the differential diagnosis of biliary atresia Children's Hospital Medical Bulletin of Mexico 2000, 57 (9) :517-521.

36. Cortés-Blanco A, Martinez-Lazaro R, Martinez-Duncker C. Images in Nephrology. Unusual diffuse I-131 MIBG Accumulation in a kidney with renal artery stenosis. Nephrol Dial Transplant 2000, 15:1885-1886.

37. Rivero-Escalante H, Dorantes-Alvarez LM, Garcia-Morales L, Coyote-Estrada N, Martínez-Duncker C, H Palafox-Vázquez and Peña-Alonso R. Frequency of autoimmune thyroid disease in children with type 1 diabetes mellitus. Bol Med Hosp Infant Mex 2001, 58:627-634. Introduction. Reports in the literature report a high prevalence of thyroid disease in patients with insulin-dependent diabetes mellitus of 7.3 to 23.4% and has been identified as a risk factor for thyroid disease microsomal antibodies (ACM). The objectives of this study were to determine the frequency of thyroid disease in the population of type 1 diabetic patients and the prevalence of ACM in such patients. Material and methods. Observational study transversal and descriptive. We studied patients with type 1 diabetes mellitus who attended the Department of Endocrinology, Hospital Infantil de Mexico from February to September 1998. All patients underwent neck palpation in deliberate search of goiter, thyroid profile and microsomal antibodies. The results were evaluated by Student t test, chi square and predictive values with Bayesian analysis. Results. Of the 108 patients, 41 were in the male and 67 female. We found 13.9% of patients with goiter, thyroid dysfunction, 18.3% and 6.4% with positive ACM. Euthyroid goiter was predominant with 53.3%, followed by hypothyroid goitre in 33.3%. Hypothyroidism was found after the onset of type 1 diabetes mellitus (2.76 ± 0.9 years) and was virtually concomitant hyperthyroidism (0.42 ± 0.5). We found a positive predictive value of 71% and negative predictive value of 86% for thyroid dysfunction ACM, considering them as a risk factor and not a factor. Conclusions. We found a high incidence of type 1 diabetic patients with goiter and thyroid dysfunction. It is recommended to perform annual thyroid profiles in these patients.

38. Martínez-Duncker C, Hurtado-Lopez LM, Martinez-Duncker I, Arellano-Montaño S, Torres-Acosta EM, Zaldivar-Ramirez FR, Guerrero-Aguirre A, Duarte-Torres R, Camarillo, Basurto C, Leon-Garcia S. The absence of uptake of Tc-99m-MIBI rule out the presence of neoplastic tissue in patients with single thyroid nodule nonfunctional. Surgeon General 2002, 24 (3) :179-183. Objective: To study the ability of the thyroid scan with Tc-99m-MIBI (MIBI) in the differential diagnosis of benign vs. malignant lesions in patients with palpable thyroid nodules resected surgically. Methods: Between January 2000 and April 2001 MIBI thyroid scintigraphy consecutive patients with palpable thyroid nodules that were later operated by thyroidectomy. Patients were divided into 2 groups depending on whether the thyroid nodule showed uptake of MIBI (MIBI positive) or did not (negative MIBI). The scintigraphic findings were compared with histopathology results (RHPD) of surgical specimens. Statistical analysis: Contingency tables and chi square. Results: This analysis includes the results obtained in 64 consecutive patients. The RHPD showed that 47/64 patients had benign lesions and 17 patients had malignant lesions. Of the 47 patients with benign RHPD, 18 patients were classified as MIBI MIBI positive and 29 as negative. Of the 17 patients with malignant RHPD, the 17 (100%) were classified as positive MIBI. Sensitivity and predictive value of a negative MIBI were 100%. Conclusion: Our results are consistent with the findings already reported in the literature, MIBI uptake in the thyroid nodule is not able to differentiate between malignant tissue and benign tissue. However, no patients with neoplastic thyroid lesions had negative MIBI, as in patients with nonfunctional thyroid nodule and a negative MIBI conservative clinical monitoring is warranted.

39. Hurtado-Lopez LM, Martinez-Duncker C, Arellano-Montaño SA, Torres-Acosta EM, Zaldivar-Ramirez FR, Pulido-Cejudo A, Basurto-Kuba E, Duarte-Torres R. Metabolic evaluation of functional thyroid nodules: Comparison pyrophosphates and methoxy isobutyl isonitrile. Rev Med Hosp Gen Mex 2003, 66 (3): 131-135. Objective: To evaluate the diagnostic value of metabolic evaluation of thyroid nodules with technetium-99 functional meta-stable pyrophosphate (Tc-99m-PYP) and meta-stable technetium-99-methoxy isobutyl isonitrile (MIBI). Material and methods: Prospective, longitudinal, blind, analytical, diagnostic reference standard in 40 patients. The variables age, sex, ability to diagnose cancer by perfusion scintigraphy with Tc-99m-PYP and metabolic MIBI. We determined sensitivity, specificity, positive and negative predictive values, diagnostic accuracy, prevalence and likelihood ratios (PR) positive and negative. Results: We studied 38 women and two men, average age 38 years, with a final diagnosis of colloid goiter 20, thyroiditis, four, four adenomas, two adenomatous goiters, papillary and follicular cancer nine one. The Tc-99m-PYP had sensitivity 20% and specificity 56.6% with a diagnostic ability to impact decision making very low (negative 0.45 and positive LR 1.43). The diagnostic value of MIBI had a sensitivity of 100% and specificity of 63%, negative predictive value was 100%, therefore, the impact of important diagnostic decision making (positive LR of 2.7 and negative 0). Conclusion: The metabolic evaluation nonfunctional thyroid nodule should be performed only with scintigraphy Tc-99m-MIBI, because when the tracer is not captured by the nodule means 100% of kindness.

40. Martínez-Duncker C, Hurtado-López LM. Regulations for the administration of I-131 for diagnostic and / or treatment in Mexico. Edocrinol Rev Nutr 2003, 11 (4) :179-181. In Mexico, nuclear medicine services to patients administered radioactive materials for diagnostic and therapeutic must observe radiation safety requirements described in NOM-013-NUCL-1995. In order to divulge the contents of this Statement did this brief review on radiation safety requirements that must be observed to graduate to patients who have been administered radioactive material for diagnostic purposes and / or treatment in Mexico. The requirements currently in force in Mexico were modified in the U.S. in 1997 due to an economic study that estimated the changes saved $ 9 million a year in hospital and non-work time lost. In a socioeconomic environment like ours, where lack of resources and desire to save is imperative, no decrease in the efficiency of services would be of great value to start the review by the respective authorities of the NOM-013-NUCL -1995, to be updated and provide the benefit of therapy with iodine-131 at doses far higher than those allowed, as this could affect significant savings and lower cost of such treatments for the country. Meanwhile, the NOM-013-NUCL-1995 is mandatory throughout Mexican territory.

41. Hurtado-Lopez LM, Martínez-Duncker C, Sara Arellano-Montaño, Torres Acosta EM, Duarte-Torres RM. Metabolic evaluation of cystic thyroid nodule. Edocrinol Rev Nutr 2003, 11 (4) :162-165. Introduction: The difficulty facing to a cystic thyroid tumor, is whether this is a benign or malignant. Therefore the objective of this study was to determine if the metabolic evaluation of cystic lesions of the thyroid provide information to make a safe conduct and whether it is complementary to the biopsy needle aspiration (FNA). Material and methods: Prospective, longitudinal, analytical, blinded in 140 by removing nonfunctional thyroid nodules FNAB of solid nodules, including nodules and cystic content. We determined the diagnostic value of metabolic evaluation by means of scintigraphy with Tc-99-MIBI. Statistical analysis was performed using central tendency measures and the determination of sensitivity, specificity, accuracy, predictive value positive, negative predictive value (PV), prevalence and positive likelihood ratio and negative for each alternative diagnostic method. Results: Of 140 patients with thyroid nodule, 26 (18.6%) had cystic lesions. Twenty-four women and 2 men with mean age of 43.1 years (mode 55, ranging from 17 to 63 years). For FNAB diagnosis was only made in 5 (19.23%), in exchange for MIBI (negative) were 17 (65.38%) benign nodules and MIBI (positive) 6 (23.08%) malignant, 3 (11.54%) were diagnosed by either of the two methods. The diagnostic value of MIBI was sensitivity 100%, specificity 85%, 66.6% VP + VP-100% accuracy 88.4%, LR + 6.6 and RP-0. Conclusions: All cystic nodules were not diagnosed by FNA should be evaluated metabolically using MIBI, MIBI captures otherwise be treated as benign nodules up 100%, if captured MIBI should undergo surgery with a high probability of cancer.

42. Meléndez-Alafort L, Rodríguez Cortés J, Ferro-Flores G, Arteaga de Murphy C, Herrera Rodríguez R, Mitsoura E, Martínez-Duncker C. Biokinetics of (99m) Tc-UBI 29-41 in humans. Nucl Med Biol 2004, 31 (3) :373-9. Antimicrobial peptides as Have Been Proposed new agents to Distinguish Between Bacterial Infections and sterile inflammatory processes. (99m) Tc-labeled UBI by a direct method has shown high in vitro and in vivo stability, specific uptake at the site of infection, rapid background clearance, minimal accumulation in non-target tissues and rapid detection of infection sites in mice. The aim of this study was to establish a (99m)Tc-UBI biokinetic model and evaluate its feasibility as an infection imaging agent in humans. Whole-body images from 6 children with suspected bone infection were acquired at 1, 30, 120, 240 min and 24 h after (99m)Tc-UBI administration. Regions of interest (ROIs) were drawn around source organs (heart, liver, kidneys and bladder) on each time frame. The same set of ROIs was used for all 6 scans and the cpm of each ROI were converted to activity using the conjugate view counting method. Counts were corrected by physical decay and by the background correction factor derived from preclinical phantom studies. The image sequence was used to extrapolate (99m)Tc-UBI time-activity curves in each organ and calculate the cumulated activity (A). Urine samples were used to obtain the cumulative percent of injected activity (% I.A.) versus time renal elimination. The absorbed dose in organs was evaluated according to the general equation described in the MIRD formalism. In addition, (67)Ga-citrate images were obtained from all the patients and used as a control. Biokinetic data showed a fast blood clearance with a mean residence time of 0.52 h. Approximately 85% of the injected activity was eliminated by renal clearance 24 h after (99m)Tc-UBI administration. Images showed minimal accumulation in non-target tissues with an average target/non-target ratio of 2.18 +/- 0.74 in positive lesions at 2 h. All infection positive(99m)Tc-UBI images were in agreement with those obtained with (67)Ga-citrate. The mean radiation absorbed dose calculated was 0.13 mGy/MBq for kidneys and the effective dose was 4.34 x 10(-3)mSv/MBq.

43. Hurtado-López LM, Arellano-Montaño S, Torres-Acosta EM, Zaldivar-Ramirez FR, Duarte-Torres RM, Alonso-de-Ruiz P, Martínez-Duncker I, Martínez-Duncker C. Combined use of Fine Needle Aspiration Biopsy, MIBI Scans and Frozen Section Biopsy Offers the Best Diagnostic Accuracy in the Assessment of the Hypofunctioning Solitary Thyroid Nodule. Eur J Nucl Med Mol Imaging 2004;31:1273-1279 [Epub ahead of print May 6 ]. PURPOSE. The probability of malignancy is increased in hypofunctioning solitary thyroid nodules (HFNs). Fine-needle aspiration biopsy (FNA), (99m)Tc-methoxyisobutylisonitrile (MIBI) and frozen section biopsy (FS) have limited independent diagnostic accuracy for the differential diagnosis of HFNs. The goal of this study was to assess the accuracy of the three independent diagnostic methods in distinguishing between benign and malignant disease. METHODS. A total of 130 patients with an HFN on the (99m)Tc-pertechnetate scan were included in this study. FNA, MIBI scans, FS, thyroidectomy and histological analysis of surgical specimens for final diagnosis were performed in all patients. RESULTS. Of the 130 patients, 80 (61.54%) had benign lesions and 50 (38.46%), malignant lesions. FNA was diagnostic in 78/130 (60%) patients and non-diagnostic in 52/130 (40%) patients. None of the patients with a negative MIBI scan had a final histological diagnosis of malignancy, and MIBI scans were negative in 38.46% of patients with non-diagnostic FNA results. FS was diagnostic in 104/130 (80%) patients and non-diagnostic in 26/130 (20%) patients. Sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios were 81.3%, 97.8%, 96%, 88%, 36.95 and 0.19 respectively for FNA; 100%, 61.3%, 61.7%, 100%, 2.58 and 0 respectively for MIBI; and 80.5%, 100%, 100%, 89%, 0 and 0.2 respectively for FS. Use of Both MIBI scans and FS in Patients with non-diagnostic FNA rendered a specificity and sensitivity of 100%. CONCLUSION. MIBI scans exclude malignancy in a Significant proportion of Patients with non-diagnostic FNAS (38% in this study). Cystic nodules with a positive MIBI scan Should Be Further Investigate Even When the FNA result Indicates a benign lesion. Combined use of FNA, MIBI and FS Offers the best diagnostic accuracy.

44. Martínez-Duncker RC. Scintigraphic assessments practices in the diagnosis and treatment of diseases of head and neck. Surgeon General 2004, 26 (3): 192-202. Objective: Analysis of the main techniques of scintigraphy in diseases of head and neck. Venue: Hospital tertiary care. Study selection: We reviewed 31 studies from biomedical literature related to the subject and date were chosen in relation to the diagnosis and treatment of major diseases of head and neck. Results: Among the diseases most common head and neck, which scintigraphic assessments provide important clinical information for diagnosis and / or treatment and to discuss in this review are those of the thyroid gland (hyperthyroidism, thyroid nodules functional nonfunctioning thyroid nodules), malignant lesions such as melanoma, which is important to know the location of (Of) node (s) sentinel (s) for proper treatment, the salivary gland and parathyroid glands. Useful guides are attached to the differential diagnosis of various thyroid diseases, taking into account the results obtained by scintigraphy and additional laboratory tests (thyroid profile). It also discusses the treatment of overactive thyroid, the incidence of hypothyroidism after treatment with I-131, the rational calculation of the dose (activity) of I-131, of thyrotoxicosis and thyroid nodule, the calculation of functional thyroid mass and thyroid uptake and retention of I-131. Conclusion: The scintigraphic evaluation the sufferings of head and neck are important aids to the surgeon's work.

45. Martínez-Duncker C. On the use, disuse, misuse and abuse of medical technology. Bulletin of the Mexican Academy of Surgery 2005, 8 (3) :12-15.

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