Correlation Between Tacrolimus Levels in Blood Samples Obtained from Central Catheter and Peripheral Venipuncture in Lung Transplant Patients (Ven-Cat Study).

BACKGROUND: Following lung transplantation (LT), receiving immunosuppressive therapy is crucial. Tacrolimus is considered a drug with a narrow therapeutic range and its use requires constant monitoring. This study aimed to evaluate the correlation between tacrolimus levels obtained from central venous catheter and direct venipuncture in adult patients undergoing LT. METHODS: This prospective study included LT patients hospitalized in conventional ward carrying a central catheter through which no intravenous tacrolimus was administered. Trough samples were obtained through direct puncture and from the central catheter. Pearson correlation coefficient was calculated to quantify the mean difference between the 2 measures. RESULTS: A total of 54 sample pairs from 16 LT patients were obtained, mostly male (81.3%) and bilateral transplant recipients (93.8%); the transplant procedure was the primary reason for admission (81.3%). The difference in tacrolimus levels between both samples was 0.3 (0.1-0.6) mcg/L, with the measurement for the samples obtained through venipuncture being mostly higher than that for those obtained from the catheter. A strong correlation was observed between the tacrolimus levels in the samples obtained from the catheter and through venipuncture (Pearson correlation coefficient, 0.991; P < 0.001; R2 = 0.982). CONCLUSIONS: There is an excellent correlation between tacrolimus levels obtained from venipuncture and those obtained from central venous catheter in LT patients undergoing oral tacrolimus therapy.

[Peritoneal recurrence prediction for colon cancer based on immunoexpression]. / Predicción de recurrencia peritoneal mediante inmunoexpresión en cáncer de colon.

INTRODUCTION AND OBJECTIVES: Peritoneal relapse as an isolated form of recurrence in colon cancer occurs in 25% of cases during the first two years subsequent to a curative colectomy. Currently, the diagnostic limitations of imaging studies and the absence of predictive scales for peritoneal recurrence warrant "second look" surgery in high-risk patients. The aim of this study is to assess features of some epithelial-mesenchymal transition biomarkers (c-Met, IGF-1R and plexin ß1) in order to predict post-surgical peritoneal colonization and develop a mathematical model to predict carcinomatous relapse. METHODS: A retrospective study of the histopathological samples of 87 patients diagnosed with colon cancer who underwent radical resection was carried out, using immunohistochemical techniques for c-Met, IGF-1R and plexin ß1. The patients were divided into two groups; those who had presented peritoneal recurrence and those who only had risk factors for this kind of relapse. Every stained sample was assessed by the rate of stained cells and immunostaining intensity. A possible association between immunohistochemical findings and peritoneal relapse was evaluated. Statistical analysis of the biomarkers with higher prognostic value allowed a risk mathematical formula to be developed based on coefficients, providing a specific value to each biomarker and patient. RESULTS: c-Met expression in the primary tumour showed a high statistical trend (p: .074) while IGF-1 (p: .022) and plexin ß1 (p: .021) revealed a significative association with peritoneal relapse. However, the multivariate analysis selected c-Met y plexin ß1 as useful factors for a predictive mathematical model on peritoneal recurrence with a 75.8% sensitivity and 80.5% specificity in patients with a staining more than 50% for both biomarkers. CONCLUSION: c-Met and plexin B1 overexpression is related to an increased risk of peritoneal relapse in cases of colon cancer where a radical resection is feasible. The encouraging outcomes of the proposed mathematical model may prove useful clinically in the identification of candidates for carcinoprophylaxis.

Lymph risk factors and prognostic impact of lateral-aortic lymphadenectomy in ovarian peritoneal carcinomatosis / Factores de riesgo ganglionar e impacto pronóstico de la linfadenectomia lumboaortica en carcinomatosis peritoneal ovárica

Background: Ovarian carcinoma is going with peritoneal dissemination in more than a half of the cases at diagnosis. Lymph node involvement is a poor prognostic factor limiting survival. Lumboaortic lymphadenectomy is a part of the therapeutic armamentarium, although there are discrepancies in the selection of patients and prognostic impact. We evaluate some nodal infiltration risk factors for this disease and lymphadenectomy prognostic influence. Material and methods: A retrospective study of 93 patients diagnosed with stage III ovarian cancer between 2006 and 2012. A total of 52 (55.9%) patients were selected to undergo a complete or optimal cytoreduction. Two groups were established according to absence or presence of retroperitoneal lymph nodes during preoperative diagnosis, to assess the objectives of this study. Results: Statistical analysis for clinical and histopathological variables determined prealbumin (p = 0'027) and Ca 125 (p = 0'048) were associated with the risk of nodal infiltration. No significant value was seen in the parameters related to the peritoneal spread of the cancer. Lumboaortic lymphadenectomy improved disease-free survival (25'7 ± 21'4 vs 35'6 ± 22 months) with statistical significance (p = 0'033) but did not appear to achieve outstanding changes in overall survival (39'7 ± 20'1 vs 41'9 ± 20'8 months). Conclusions: A poor nutritional status and high Ca 125 could be predictive factors of lymph node involvement. The performance of a systematic lumboaortic lymphadenectomy seems to increase disease-free survival in association with a properly debulking and absence of severe postoperative complications. A broader recruitment of patients will be needed to know a more accurate pattern of lymph node disease in order to carry out a selective indication for lymphadenectomy

Introducción: el cáncer de ovario se acompaña de diseminación peritoneal en más de la mitad de los casos al diagnóstico. La afectación ganglionar es un factor de mal pronóstico que limita su supervivencia. La linfadenectomía lumboaórtica forma parte del arsenal terapéutico aunque existen discrepancias en la selección de pacientes y su impacto pronóstico. Se pretende evaluar algunos factores de riesgo de infiltración nodal para esta enfermedad y la influencia pronóstica de dicha linfadenectomía. Material y métodos: estudio retrospectivo de 93 pacientes diagnosticados de cáncer ovárico en estadio III entre 2006 y 2012. Fueron seleccionadas 52 (55'9%) enfermas que se beneficiaron de una citorreducción completa u óptima, estableciéndose dos grupos ante la ausencia o presencia de adenopatías retroperitoneales durante el diagnóstico preoperatorio, para contrastar los objetivos del estudio. Resultados: el análisis estadístico de variables clínicas e histopatológicas determinó relación de la prealbúmina (p = 0'027) y Ca 125 (p = 0'048) con el riesgo de infiltración nodal. No se apreció valor significativo en los parámetros relativos a la extensión peritoneal del cáncer. La linfadenectomía lumboaórtica mejoró la supervivencia libre de enfermedad (25'7 ± 21.4 vs 35'6 ± 22 meses) con relevancia estadística (p = 0'033) pero no presentó grandes variaciones en la supervivencia global (39'7 ± 20'1 vs 41'9 ± 20'8 meses). Conclusiones: un estado nutricional deteriorado y un Ca 125 elevado podrían ser factores predictivos de afectación ganglionar. La realización de una linfadenectomía lumboaórtica sistemática parece incrementar la supervivencia libre de enfermedad ante una citorreducción adecuada y ausencia de complicaciones postquirúrgicas graves. Se necesitará un mayor reclutamiento de pacientes para conocer con más exactitud el patrón de enfermedad ganglionar a efectos de una indicación de linfadenectomía más selectiva