Inducción con timoglobulina: ¿incrementa el riesgo hemorrágico en receptores renales sensibilizados? / Could thymoglobulin increase hemorrhagic risk in the perioperative transplantation period of sensitized kidney recipients?

Objetivo: Se ha descrito que la timoglobulina podría aumentar el riesgo de infecciones y neoplasias, en comparación con basiliximab. La leucocitopenia y la trombocitopenia también son más frecuentes en los primeros días tras el trasplante en los pacientes tratados con timoglobulina.Nuestro objetivo fue analizar las complicaciones hemorrágicas en este subconjunto de pacientes.Material y métodos: Se evaluaron las complicaciones hemorrágicas en 515 trasplantes renales realizados en nuestra institución entre 2012 y 2018. Se comparó a los pacientes tratados con timoglobulina (grupo 1, N=91) con los tratados con basiliximab (grupo 2, N=424).Resultados: Encontramos diferencias en cuanto al descenso plaquetario: 95.142,2 (55.339,6) en el grupo 1 y 52.364,3 (69.116,6) en el grupo 2 (p=0,001), número de pacientes con trombocitopenia grave (< 7.5000/mm3) (20,8% vs. 3,7%, p=0,001), número de concentrados de hematíes transfundidos (3,25 [0,572] vs. 2,2 [0,191], p=0,028) y porcentaje de pacientes que requirieron reintervención por sangrado (18,2% vs. 7,7%, p=0,046). En un análisis multivariable de regresión lineal múltiple (la variable dependiente fue el número de concentrado de hematíes transfundidos), solo la edad (OR 0,037, IC del 95%, 0,003-0,070) y el tipo de inmunosupresión (OR 1,592, IC del 95%, 1,38-2,84) tuvieron significación estadística.Conclusiones: El uso de timoglobulina en el período perioperatorio del trasplante podría aumentar las complicaciones hemorrágicas. En nuestra serie, la trombocitopenia grave y el sangrado activo que requirió reintervención, fueron 6 y 2,5 veces más frecuente, respectivamente, en el grupo de pacientes con timoglobulina. En lugar de suspender el uso de este agente inmunosupresor, se podría ajustar la dosis para continuar con el tratamiento.Se debe evaluar el uso de timoglobulina en el postoperatorio de estos pacientes (AU)

Objective: It has been described that thymoglobulin could increase the risk of infections and malignancies, in comparison to basiliximab. Leukopenia and thrombocytopenia are also more common within the first days after transplantation among thymoglobulin patients. Our objective was to analyze bleeding complications in this subset of patients.Material and methods: Bleeding complications were evaluated among 515 renal transplants carried out at our institution between 2012 and 2018. We compared patients treated with thymoglobulin (Group 1, N=91) with those treated with basiliximab (Group 2, N=424).Results: We found differences in platelet decrease:95142.2 (55,339.6) in Group 1 and 52,364.3 (69,116.6) in Group 2 (P=.001), number of patients with severe thrombocytopenia (<75,000/mm3) (20.8% vs. 3.7%, P=.001), number of blood units transfused (3.25 (0.572) vs. 2.2 (0.191, P=.028) and percentage of patients that required surgery due to bleeding (18.2% vs. 7.7%, P=.046). In a multiple lineal regression multivariable analysis (dependent variable was number of blood units transfused), only age [OR 0.037, 95% CI (0.003-0.070)] and type of immunosuppression [OR 1.592, 95% CI (1.38-2.84)] showed statistical significance.Conclusions: The use of thymoglobulin in the perioperative transplantation period could increase bleeding complications. In our series, in the group of patients with thymoglobulin, severe thrombocytopenia was 6 times more frequent, and active bleeding that required surgery was also 2.5 times more frequent. One way to continue with the use of this immunosuppression agent, might be to adjust the dose instead of discontinuing it. The use of thymoglobulin should be a factor to consider in the postoperative period of these patients (AU)

Carcinoma intraductal de próstata concomitante y respuesta al tratamiento hormonal en el carcinoma de próstata metastásico / Concomitant intraductal carcinoma of the prostate and response to hormonal therapy in metastatic prostate carcinoma

Introducción y objetivo: La mayoría de los cánceres de próstata (CP) se clasifican como adenocarcinoma acinar. El carcinoma intraductal de la próstata (CIDP) es una entidad histológica distinta que se cree que representa la propagación retrógrada del adenocarcinoma acinar invasivo en los conductos prostáticos y acinos.Hemos analizado el impacto del CIDP en pacientes con cáncer de próstata resistente a la castración metastásico (CPRCm) y sin tratamiento hormonal previo (hormone-naïve).Pacientes y métodosEvaluamos retrospectivamente a 118 pacientes con CPRCm con diagnóstico inicial de cáncer de prostata metastásico (CPM) desde mayo del 2010 hasta septiembre del 2018. El grupo uno incluyó 81 personas con CPM con adenocarcinoma acinar y el grupo dos estuvo compuesto por 37 pacientes con CPM con CIDP.ResultadosLa edad media de presentación fue de 76 años (IQR 73,4 a 78,7) en el grupo uno y de 74 años (68,5 a 80,6) en el grupo dos. El valor medio del PSA en el momento del diagnóstico fue de 619 ng/mL (IQR 85 a 1.113) y 868 ng/mL (IQR 186 a 1.922), respectivamente. El tiempo hasta la resistencia a la castración fue de 24,7 meses (IQR 16,7 a 32,7) en el grupo uno y 10,2 meses (IQR 4,2 a 16,2) en el grupo dos (p = 0,007). El tiempo hasta la progresión en los pacientes con cáncer de próstata resistente a la castración (CPRC) fue: 10,6 meses (IQR 5,6 a 15,6) y 6,2 meses (3,2 a 9,2), respectivamente (p = 0,05). La supervivencia global fue de 57,9 meses en el grupo uno (IC 95% 56,4 a 59,5) y de 38 meses (IC 95% 19,9 a 48,06) en el grupo dos (p = 0,001). En el análisis multivariante, el subtipo de adenocarcinoma fue estadísticamente significativo p 0,014, IC 95% (Hazard Ratio [HR] 0,058, 0,006 a 0,56).ConclusionesEl CIDP parece ser un subtipo de CP que se asocia con una respuesta más corta al tratamiento hormonal cuando se compara con el adenocarcinoma acinar en pacientes con cáncer metastásico. (AU)

Introduction and objective: Most prostate cancers are classified as acinar adenocarcinoma. Intraductal carcinoma of the prostate (IDC-P) is a distinct histologic entity that is believed to represent retrograde spread of invasive acinar adenocarcinoma into prostatic ducts and acini.We have analyzed the impact of IDC-P in hormonal naïve and castration resistant metastatic prostate cancer patients.Patients and methodsWe retrospectively evaluated 118 metastatic castration resistant prostate cancer (mCRPC) patients who were initially diagnosed with distant metastases from May 2010 to September 2018. Group 1 patients included 81 metastatic PCa patients with acinar adenocarcinoma and Group 2 included 37 metastatic PCa patients with IDC-P.ResultsMean age at presentation was 76 years (IQR 73.4-78.7) in group 1 and 74 years (68.5-80.6) in group 2. Mean PSA at diagnosis was 619 ng/mL (IQR 85-1113) and 868 ng/mL (IQR 186-1922), respectively. Time to castration resistance was 24.7 months (IQR 16.7-32.7) in group 1 and 10.2 months (IQR 4.2-16.2) in group 2 (p = 0.007). Time to progression in CPRC patients was: 10.6 months (IQR 5.6-15.6) and at 6.2 months (3.2-9.2), respectively (p = 0.05). Overall survival was 57.9 months in group 1(CI 95% 56.4-59.5) and 38 months (CI 95% 19.9-48.06) in group 2 (p = 0.001). In the multivariate analysis, adenocarcinoma subtype was statistically significant p 0.014, CI 95% (HR 0.058, 0.006-0.56).ConclusionsIDC-P seems to be a subtype of prostate cancer that is associated with a shorter response to hormonal treatment when compared to acinar adenocarcinoma in metastatic patients. New drugs in CRPC scenario as abiraterone and enzalutamide also obtained less response in IDC-P patients. In daily clinical practice it might be interesting to take into account that patients with IDC-P may present shorter responses to first and second line hormonal treatments. (AU)

Concomitant intraductal carcinoma of the prostate and response to hormonal therapy in metastatic prostate carcinoma.

INTRODUCTION AND OBJECTIVE: Most prostate cancers are classified as acinar adenocarcinoma. Intraductal carcinoma of the prostate (IDC-P) is a distinct histologic entity that is believed to represent retrograde spread of invasive acinar adenocarcinoma into prostatic ducts and acini. We have analyzed the impact of IDC-P in hormonal naïve and castration resistant metastatic prostate cancer patients. PATIENTS AND METHODS: We retrospectively evaluated 118 metastatic castration resistant prostate cancer (mCRPC) patients who were initially diagnosed with distant metastases from May 2010 to September 2018. Group 1 patients included 81 metastatic PCa patients with acinar adenocarcinoma and Group 2 included 37 metastatic PCa patients with IDC-P. RESULTS: Mean age at presentation was 76 years (IQR 73.4-78.7) in group 1 and 74 years (68.5-80.6) in group 2. Mean PSA at diagnosis was 619 ng/mL (IQR 85-1113) and 868 ng/mL (IQR 186-1922), respectively. Time to castration resistance was 24.7 months (IQR 16.7-32.7) in group 1 and 10.2 months (IQR 4.2-16.2) in group 2 (P = .007). Time to progression in CPRC patients was: 10.6 months (IQR 5.6-15.6) and at 6.2 months (3.2-9.2), respectively (P = .05). Overall survival was 57.9 months in group 1(CI 95% 56.4-59.5) and 38 months (CI 95% 19.9-48.06) in group 2 (P = .001). In the multivariate analysis, adenocarcinoma subtype was statistically significant P .014, CI 95% (HR 0.058, 0.006-0.56) CONCLUSIONS: IDC-P seems to be a subtype of prostate cancer that is associated with a shorter response to hormonal treatment when compared to acinar adenocarcinoma in metastatic patients. New drugs in CRPC scenario as abiraterone and enzalutamide also obtained less response in IDC-P patients. Once IDC-P is identified, clinicians could extrapolate the relative poor response to hormonal therapy. Consequently, follow-up of these patients in this scenario should be more strict.

[Renal pseudotumor secondary to acute pancreatitis. Report of one case]. / Pseudotumor renal secundario a pancreatitis aguda. A propósito de un caso.

We present the case of a renal pseudotumor corresponding to a esteatonecrotic granuloma, secondary to an enolic acute pancreatitis a few months ago. The main caractheristics, diagnosis and terapeuthics of the renal pseudotumors are discussed with the case report of a 60 year old man who presents a renal mass founded incidentally at a control computed tomography.