ABSTRACT
OBJECTIVES: To evaluate the predictive factors for biochemical failure and distant metastases in a prospective cohort of patients with localized prostate cancer treated with the combination of HDR BT and EBRT. METHODS AND MATERIALS: Patients with intermediate (IR) or high-risk (HR) prostate adenocarcinoma received a single fraction of HDR of 15 Gy combined with RT of 37.5 Gy in 15 fractions. ADT duration was used depending on risk-group. Descriptive analyses were performed. Univariate and multivariate Hazard Ratios were obtained. Finally, the Kaplan-Meier model was used to describe the survival of the events of interest. RESULTS: 309 patients were treated prospectively (199 were IR and 110 HR). Median age was 72 years; 58.3 % were MRI stage ≤ T2c, 34.1 % T3a and 7.6 % T3b; ISUP-grade 1-3 in 78.9 % and ISUP 4-5 in 21.1 %. 71.8 % of patients had ≤ 50 % positive-cores in biopsy and 28.2 % had > 50 %. Median pre-treatment PSA was 9.9 ng/mL. After a median follow-up of 88 months, 41 patients presented biochemical failure and 18 developed distant metastases. Multivariate cox-regression analyses found that MR-T3b Stage (HR 3.88, p = 0.001) and ADT use (HR 3.99, p = 0.03) were the only predictive factors for biochemical failure and the number of positive cores (>50 %) the only independent predictive factor of distant metastases (HR 4.36, p = 0.002). CONCLUSIONS: Patients with mpMRI evidence of invasion of the SV and involvement of more than 50% of the cores in the prostate biopsy are patients with a higher risk of presenting a biochemical recurrence or developing metastasis due to their prostate cancer, respectively.
Subject(s)
Brachytherapy , Prostatic Neoplasms , Male , Humans , Aged , Brachytherapy/methods , Prospective Studies , Prostatic Neoplasms/diagnostic imaging , Prostatic Neoplasms/drug therapy , Prostatic Neoplasms/radiotherapy , Androgen Antagonists/therapeutic use , Androgens/therapeutic use , Prostate-Specific Antigen/analysis , Radiotherapy Dosage , Magnetic Resonance Imaging , Retrospective StudiesABSTRACT
MRI-detected T3a prostate cancer is a heterogeneous disease. This post-hoc analysis of a prospective trial found that patients with T3a disease presenting obliteration of the recto-prostatic angle, contact-asymmetry of neuro-vascular bundle and periprostatic fat invasion, may be at higher risk of biochemical failure and metastases.
ABSTRACT
PURPOSE: Multiparametric MRI (mpMRI) has a potential role for the identification of aggressive cancer that can be targeted for biopsy. We report the incidence and severity of discordant information between the pathology found on the transrectal ultrasound (TRUS)-guided biopsy and the mpMRI findings in patients with favorable or intermediate-risk prostate cancer referred for brachytherapy. METHODS AND MATERIALS: From March 2014 to September 2015, 10/44 consecutive patients with low- or intermediate-risk prostate cancer referred for brachytherapy presented an aggressive lesion on mpMRI and underwent an MRI-TRUS fusion-guided transperineal biopsy of the index lesion. RESULTS: A median of two intraprostatic lesions were detected by mpMRI for each patient. Three patients had bilateral disease, and seven had unilateral disease on mpMRI. The median number of cores obtained by MRI-TRUS-guided fusion of the index lesion was 3 (range 2-4). As a result of the re-evaluation consequent to additional information becoming available after the transperineal biopsy, upgrading of Gleason score occurred in 8 of the 10 patients, which changed the risk group in 9 patients. These changes resulted in modification of the proposed treatment in 8 patients. CONCLUSIONS: MpMRI-US fusion-targeted biopsy sampling allows detection and characterization of otherwise undetected aggressive disease, often placing men in higher risk groups and altering the treatment approach.
Subject(s)
Adenocarcinoma/pathology , Prostatic Neoplasms/pathology , Adenocarcinoma/diagnostic imaging , Adenocarcinoma/radiotherapy , Aged , Biopsy, Large-Core Needle , Brachytherapy , Endosonography , Humans , Image-Guided Biopsy , Magnetic Resonance Imaging , Male , Neoplasm Grading , Prostatic Neoplasms/diagnostic imaging , Prostatic Neoplasms/radiotherapyABSTRACT
Q fever, caused by Coxiella burnetii, may cause vascular complications, but the role that this infection may play in the development of atherosclerotic cardiovascular disease remains unknown. This study examined the association between Q fever serology and cardiovascular disease in a region where Q fever is endemic. A case-control study was conducted in the Hospital Universitario de Burgos (Spain) between February 2011 and June 2012. A total of 513 samples were tested, from 454 hospitalized patients ≥65 years old, of whom 164 were cases (patients with prevalent or incident coronary heart, cerebrovascular or peripheral artery, disease) and 290 controls (patients without cardiovascular disease). Serum IgG antibody phase II titres against Q fever were determined by immunofluorescence assay. Seropositivity (titres ≥1:256) was detected in 84/164 (51.2%) cases and in 109/290 (37.6%) controls (p = 0.005; OR, 1.7; 95% CI, 1.1-2.5). This ratio increases when adjusted for sex, hypertension, dyslipidaemia, smoking, diabetes and atrial fibrillation (OR, 2.6; 95% CI, 1.5-4.7). The geometric mean titre (GMT) for C. burnetii phase II assay was higher in cases than in controls (p = 0.004). We found no significant relationship between cardiovascular disease and C. pneumoniae, and Cytomegalovirus seropositivity (both determined by the IgG ELISA method). In conclusion, serological evidence of past Q fever is associated with atherosclerotic cardiovascular disease in elderly patients in an endemic region.
Subject(s)
Antibodies, Bacterial/blood , Atherosclerosis/epidemiology , Cardiovascular Diseases/epidemiology , Coxiella burnetii/immunology , Q Fever/complications , Aged , Aged, 80 and over , Case-Control Studies , Female , Fluorescent Antibody Technique , Humans , Immunoglobulin G/blood , Male , Serologic Tests , Spain/epidemiologySubject(s)
Abdominal Pain/etiology , Entamoeba histolytica/isolation & purification , Liver Abscess, Amebic/complications , Amebicides/therapeutic use , Animals , Drainage/methods , Humans , Laparotomy , Liver Abscess, Amebic/pathology , Liver Abscess, Amebic/therapy , Male , Middle Aged , Rupture, Spontaneous , Rural Population , Treatment OutcomeABSTRACT
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Subject(s)
Middle Aged , Animals , Male , Humans , Rural Population , Rupture, Spontaneous , Abdominal Pain , Treatment Outcome , Drainage , Amebicides , Laparotomy , Liver Abscess, Amebic , Entamoeba histolytica , Liver Abscess, AmebicABSTRACT
Presentamos un caso de síndrome de Turner detectado en la semana 13, con flujo reverso del ductus venoso y translucencia nucal aumentada que nos puso en alerta de una afectación cardíaca precoz. El estudio citogenético realizado por amniocentesis en la semana 16 detectó que se trataba de un cariotipo 45 X0. (AU)
Subject(s)
Adult , Pregnancy , Female , Humans , Turner Syndrome , Ultrasonography, Prenatal/methods , Amniocentesis , Karyotyping , Fetal Heart/physiopathology , Abortion, TherapeuticSubject(s)
HIV Infections/complications , Leiomyosarcoma/complications , Leiomyosarcoma/diagnosis , Lung Neoplasms/complications , Lung Neoplasms/diagnosis , Adult , Humans , Mouth Neoplasms/complications , Mouth Neoplasms/diagnosis , Pancreatic Neoplasms/complications , Pancreatic Neoplasms/diagnosisABSTRACT
No disponible
Subject(s)
Adult , Humans , HIV Infections , Leiomyosarcoma , Mouth Neoplasms , Pancreatic Neoplasms , Lung NeoplasmsABSTRACT
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Subject(s)
Animals , Adult , Female , Humans , Strongyloidiasis , Tomography, X-Ray Computed , Tuberous Sclerosis , Thiabendazole , Antinematodal Agents , Eosinophilia , Lung DiseasesABSTRACT
BACKGROUND: Usually, there is a physiological fall in nocturnal blood pressure among all individuals, both hypertensive and normotensive individuals. The lack of nocturnal blood pressure (BP) fall may be associated with the risk of developing cardiovascular complications in hypertensive patients. Cardiovascular and hormonal factors associated with the lack of nocturnal blood pressure fall was studied in individuals aged over 55, those most exposed to this kind of complications. METHODS: A total of 108 individuals aged over 55 and with a wide range of BP (59 normotensive and 49 light-moderate hypertensive with no previous treatment) were studied. Two groups were established: dipper and non-dipper, with a fall over 10% in nocturnal SBP and DBP or not, respectively. Patients included in the study underwent serum hormonal measurements (renin, aldosterone, endoteline-1, atrial natriuretic peptide, free epinephrine and norepinephrine), continuous blood pressure monitoring for 24 hours (CBPM) and echocardiography with measurement of left ventricular mass (LVM), cardiac output, and peripheral vascular resistances (PVR) (determined in function of mean blood pressure and cardiac output). RESULTS: Fifty-one individuals were dipper and 57 were non-dipper. Significantly higher cholesterol (p < 0.05) and free norepinephrine (p < 0.001) levels among dipper compared with non-dipper individuals were observed. Non-dipper individuals had PVR significantly higher than dipper individuals (p < 0.05). Values of diurnal BP, other hormonal measurements, and CBPM did not differ significantly between the two groups. CONCLUSIONS: Non-dipper individuals aged over 55 have lower circulating free norepinephrine values and higher peripheral vascular resistances than dipper individuals, irrespective of diurnal blood pressure values. The left ventricular mass does not differ significantly between the two groups.
Subject(s)
Blood Pressure/physiology , Circadian Rhythm/physiology , Hypertension/physiopathology , Aged , Cardiovascular Diseases/physiopathology , Female , Hormones/blood , Humans , Hypertrophy, Left Ventricular/physiopathology , Male , Middle Aged , Norepinephrine/blood , Risk FactorsABSTRACT
Fundamento. Normalmente la presión arterial (PA) desciende durante la noche de forma fisiológica en todos los sujetos, tanto hipertensos como normotensos. La ausencia de descenso nocturno (condición no dipper) puede asociarse con el riesgo de desarrollar complicaciones cardiovasculares en pacientes hipertensos. Estudiamos en sujetos mayores de 55 años, los más expuestos a estas complicaciones, los factores cardiovasculares y hormonales asociados a la falta de descenso de la presión arterial nocturna. Métodos. Se seleccionaron 108 sujetos mayores de 55 años y con amplio rango de PA (59 normotensos y 49 hipertensos ligeros-moderados sin tratamiento previo). Se establecieron dos grupos: dipper y no dipper, según hubiera descenso superior al 10 por ciento de PA sistólica y PA diastólica nocturna o no. A los pacientes incluidos en el estudio se les realizó determinaciones hormonales en sangre (renina, aldosterona, endotelina-1, péptido natriurético atrial, adrenalina y noradrenalina libres), monitorización continua de la presión arterial durante 24 horas (MAPA) y ecografía cardíaca con determinación del índice de la masa ventricular izquierda (IMVI), gasto cardíaco y resistencias vasculares periféricas (RVP) (determinadas en función de la presión arterial media y el gasto cardíaco). Resultados. En la muestra a estudio 51 sujetos fueron dipper y 57 no dipper. Se apreciaron unos niveles de colesterol (p < 0,05) y de noradrenalina libre (p < 0,001) significativamente superiores en sujetos dipper en comparación con los no dipper. Los no dipper tuvieron unas RVP significativamente más elevadas que los dipper (p < 0,05). Los valores de PA diurna, resto de valores hormonales y el IMVI no variaron significativamente entre los dos grupos. Conclusiones. Los sujetos mayores de 55 años no dipper presentan menores valores de noradrenalina libre circulante y mayores resistencias vasculares periféricas que los dipper, independientemente de los valores diurnos de presión arterial. La masa ventricular izquierda no varía significativamente entre los dos grupos. (AU)
