El papel de la resonancia magnética multiparamétrica en el diagnóstico de la recidiva local tras la prostatectomía radical y antes de la radioterapia de rescate / The role of multiparametric magnetic resonance imaging in the diagnosis of local recurrence after radical prostatectomy and before salvage radiotherapy

Objetivo Evaluar la precisión diagnóstica de la resonancia magnética multiparamétrica (RMmp) en la detección de la recidiva local del cáncer de próstata (CaP) después de la prostatectomía radical (PR) y antes de la radioterapia (RT). Materiales y métodos Un total de 188 pacientes se sometieron a una RMmp de 1,5T después de la PR y antes de la RT. Los pacientes se dividieron en 2 grupos: con recidiva bioquímica (grupo A) y sin recidiva bioquímica, pero con alto riesgo de recidiva local (grupo B). Las variables continuas se compararon entre los 2 grupos mediante la prueba t de Student; las variables categóricas se analizaron mediante chi-cuadrado de Pearson. El análisis ROC se realizó considerando como variables de agrupación el PSA antes de la RT, el grado ISUP, el pT y el pN. Resultados La recidiva del CaP (reducción de los niveles de PSA después de la RT) fue del 89,8% en el grupo A y del 80,3% en el grupo B. Al comparar los pacientes con y sin recidiva del CaP, hubo una diferencia significativa en los valores de PSA antes de la RT para el grupo A, y en los valores de PSA antes y después de la RT para el grupo B. En el grupo A hubo una correlación significativa entre el PSA antes de la RT y el diámetro de la recidiva, y entre el PSA antes de la RT y el tiempo transcurrido hasta la recidiva. La precisión diagnóstica de la RMmp en la detección de la recidiva local del CaP tras la RT es del 62,2% en el grupo A y del 38% en el grupo B. La imagen potenciada en difusión es la secuencia de RM más específica y la perfusión dinámica con contraste la más sensible. Para el PSA=0,5ng/ml, el AUC disminuye, mientras que la sensibilidad y la precisión aumentan para cada secuencia de RM. Para el PSA=0,9ng/ml, el AUC de la perfusión dinámica con contraste aumenta significativamente (AU)

Purpose Assess multiparametric-MRI (mp-MRI) diagnostic accuracy in the detection of local recurrence of prostate cancer (PCa) after radical prostatectomy (PR) and before radiation therapy (RT). Materials and methods A total of 188 patients underwent 1.5-T mp-MRI after RP before RT. Patients were divided into 2 groups: with biochemical recurrence (group A) and without but with high risk of local recurrence (group B). Continuous variables were compared between 2 groups using Student-t test; categoric variables were analyzed using Pearson chi-square. ROC analysis was performed considering PSA before RT, ISUP, pT and pN as grouping variables. Results PCa recurrence (reduction of PSA levels after RT) was 89.8% in group A and 80.3% in group B. Comparing patients with and without PCa recurrence, there was a significant difference in PSA values before RT for group A and for PSA values before RT and after RT for group B. In group A, there was a significant correlation between PSA before RT and diameter of recurrence and between PSA before RT and time spent before recurrence. The mp-MRI diagnostic accuracy in detecting PCa local recurrence after RP is of 62.2% in group A and 38% in group B. Diffusion weighted imaging is the most specific MRI-sequence and dynamic contrast enhanced the most sensitive. For PSA=0.5ng/ml, the AUC decreases while sensitivity and accuracy increase for each MRI-sequence. For PSA=0.9ng/ml, dynamic contrast enhanced-AUC increases significantly. Conclusion mp-MRI should always be performed before RT when a recurrence is suspected. New scenarios can be opened considering the role of diffusion weighted imaging for PSA≤0.5ng/ml (AU)

The role of multiparametric mri in the diagnosis of local recurrence after radical prostatectomy and before salvage radiotherapy.

PURPOSE: Assess multiparametric-MRI (mp-MRI) diagnostic accuracy in the detection of local recurrence of Prostate Cancer (PCa) after Radical Prostatectomy (PR) and before Radiation Therapy (RT). MATERIALS AND METHODS: A total of 188 patients underwent 1.5-T mp-MRI after RP before RT. Patients were divided into two groups: with biochemical recurrence (group A) and without but with high risk of local recurrence (group B). Continuous variables were compared between two groups using T-Student; categoric variables were analyzed using Pearson chi-square. ROC analysis was performed considering PSA before RT, ISUP, pT and pN as grouping variables. RESULTS: PCa recurrence (reduction of PSA levels after RT) was 89.8% in the group A and 80.3% in the group B. Comparing patients with and without PCa recurrence, there was a significant difference in PSA values before RT for group A and for PSA values before RT and after RT for group B. In group A, there was a significant correlation between PSA before RT and diameter of recurrence and between PSA before RT and time spent before recurrence. The mp-MRI diagnostic accuracy in detecting PCa local recurrence after RP is of 62.2% in group A and 38% in group B. DWI is the most specific MRI-sequence and DCE the most sensitive. For PSA = 0.5 ng/ml, the AUC decreases while sensitivity and accuracy increase for each MRI-sequence. For PSA = 0.9 ng/ml, DCE-AUC increases significantly. CONCLUSION: mp-MRI should always be performed before RT when a recurrence is suspected. New scenarios can be opened considering the role of DWI for PSA ≤ 0.5 ng/ml.

Clinical and Spectrophotometric Evaluation of LED and Laser Activated Teeth Bleaching.

BACKGROUND: Auxiliary power sources (LED and laser) are used in in-office teeth bleaching techniques to accelerate the redox reaction of the whitening gel to increase ease of use, to improve comfort and safety, and to decrease the procedure time. OBJECTIVE: The aim this study is to evaluate the efficiency of the teeth whitening procedures performed with hydrogen peroxide and carbamide peroxide, LED or Laser activated. METHOD: 18 patients, affected by exogenous dyschromia, were treated with a bleaching agent composed by 35% hydrogen peroxide and 10% carbamide peroxide. They were divided into two groups: in the first group the bleaching agent was activated by a LED lamp; in the second group it was activated by a Laser diode lamp. Both groups were subjected to 3 bleaching cycle of 15' each. The chromatic evaluations were performed before and after one week from the treatment, using a chromatic scale and a spectrophotometer. The mean value of pre, post bleaching and follow-up were analyzed using a T-test, with results statistically significant for P<0,05. RESULTS: Results showed that the variations in brightness, chroma and hue are significantly influenced by the interaction between the whitening agent and the original colour of the teeth. Laser-activation has marginally improved the bleaching effectiveness. All patients treated with laser activation complained an increase in dental sensitivity. CONCLUSION: The use of laser-activating systems did not improve the efficacy of bleaching.

[Proposal of a new transurethral method for repeated prostatic biopsy]. / Proposta di una nuova metodica transuretrale nell'esecuzione di biopsie prostatiche iterative.

In many clinical situations a patient affected by pre-cancerous prostatic lesions, suspected cancer or true cancer (assessed through biopsies or incidentally) must undergo iterative bioptic examinations. Three groups can be sub-divided: A) Patients with no previous endoscopic resection. B) Patients with previous endoscopic resection for BPH. C) Patients with previous RP for cancer. A persistent clinical suspicion for high PSA, a bioptic assessment for Ca T1c or PIN belong to the first group. A suspected cancer in a patient who had already undergone TUR, or a T1a neoplasia assessed incidentally, or PIN found in the resected fragments constitute the second group. A suspected local relapse after a RP characterizes the third group. In 28 cases of these clinical diagnoses, we have applied a new method of bioptic trans-urethral sampling. We used an eco-reflectant, flexible needle and applied it under endoscopic vision to the transitional zone or to tissues of the already resected prostatic fossa. In the first case these biopsies were integrative of the usual randomized biopsies. If transrectal ultrasound had given evidence of altered structures, biopsy was carried out with selective ultrasound guided technique. This procedure has proved to be minimally invasive, easy to carry out and particularly adapted to bioptise zones that are easier to reach transurethrally or tissues with low thickness.

Comparative non-blind trial of ceftriaxone and gentamicin in the treatment of complicated urinary tract infections.

Forty hospitalized patients with complicated urinary tract infections were treated with gentamicin 240 mg die i.m. or ceftriaxone, a new parenteral cephalosporin, 2 g die i.v. for 7 days. Ceftriaxone gave good clinical and bacteriological results which were better than those obtained with gentamicin, showing also an appreciable activity in cases of infection due to problematic organisms.

[A bladder calculus of unusual dimensions]. / Calcolosi vescicale di non frequente dimensione.

A case of giant vesical calculosis is presented on account of its statistical and radiographical unusualness. Its aetiopathogenesis is briefly discussed.