Manejo exitoso de infección de injerto vascular: rol del 18 fluorodeoxyglucose positron emission tomography/computed tomography / Successful management of vascular graft infection: The role of 18fluorodeoxyglucose positron emission tomography/computed tomography

La opción de un injerto vascular es una medida correctiva para pacientes con enfermedad arterial periférica o aneurismas y para acceso arteriovenoso en pacientes con hemodiálisis crónica. A partir de la colocación de una prótesis de injerto vascular se puede desarrollar infección asociada en el 1-6% de los pacientes, con una alta incidencia de mortalidad del 13 al 58%. El diagnóstico de una infección asociada a injerto vascular se realiza a partir de hallazgos clínicos, microbiológicos e imagenológicos, para así definir, además de su presencia, su compromiso y extensión. El manejo ideal requiere de tratamiento quirúrgico y antibioticoterapia; sin embargo, el tratamiento quirúrgico no siempre es posible. Reportamos este caso de manejo médico exitoso de una infección de injerto vascular de aorta en la cual el 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) presentó utilidad como método diagnóstico y de seguimiento.

The option of a vascular graft is a corrective intervention for patients with peripheral artery disease, aneurisms, and to achieve arterio-venous access in patients on chronic hemodialysis. Infections from a prosthetic vascular graft occurs in 1 to 6% of patients, and this development is related to the incidence of mortality of 13 to 58%. The diagnosis of a vascular graft infection is made via the combination of clinical, microbiologic and imaging findings that allow a definition of not only the presence of infection but also its severity and spread. The ideal approach requires both surgical and antimicrobial therapy; however, the former is not always possible. We report a case of successful medical management of an aortic vascular graft infection and the usefulness of a 18F-fluorodeoxyglucose positron emission tomography/computedtomography (18F-FDG-PET/CT) scan as a tool for diagnosis and follow-up.

Regorafenib: A novel tyrosine kinase inhibitor: A brief review of its therapeutic potential in the treatment of metastatic colorectal carcinoma and advanced gastrointestinal stromal tumors.

Regorafenib is a novel oral multitargeted tyrosine kinase inhibitor having both antitumor and anti‑angiogenic activities. Regorafenib was recently approved by US Food and Drug Administration in February 25, 2013 in the treatment for patients with advanced gastrointestinal stromal tumor and for the treatment of patients with metastatic colorectal carcinoma after disease progression or intolerance to imatinib mesylate and sunitinib therapy. Oral regorafenib demonstrates a high level of efficacy with acceptable tolerability with the 160 mg daily for 3 weeks followed by 1 week off schedule; a continuous schedule could be of interest. Hypertension, mucositis, hand foot skin reaction, diarrhea and asthenia are the most common side‑effects. Regardless of these encouraging results, studies investigating, adjuvant and neoadjuvant settings are awaited, as well as trials using regorafenib in combination with chemotherapy or other targeted therapies. Clinical trials investigating regorafenib in other tumor types are ongoing.