ABSTRACT
INTRODUCTION: New imaging studies have appeared in recent years for the diagnosis and follow-up of metastatic urological tumours. MATERIAL AND METHODS: A total of 41 patients were reviewed with suspected recurrence of a urothelial or kidney tumour, analysing the diagnostic performance of PET-CT scans undertaken between 2013 and 2016. RESULTS: We collected 17 urothelial tumours and 24 renal tumours, with a median follow-up of 30 months. A total of 39.3% of the urothelial tumours were high grade and 29.3% of the kidney tumours were clear cell Fuhrman II. As a whole, the imaging studies detected recurrences in 34 patients. CT was positive in 83% of the patients, while the PET scan was positive in 75.6%, CT/PET coincidence was 50%. The PET scan detected further disease in 41% of the cases compared to 5% by CT. This resulted in a change of therapeutic strategy in 40% of the patients. Sensitivity, specificity, positive predictive value and negative predictive value for the CT and the PET scans were 92% and 92%, 57% and 100%, 92% and 100%, and 57% and 70% respectively. CONCLUSION: The PET scan showed similar sensitivity for urological tumours to the standard imaging techniques but with higher specificity, positive predictive value and negative predictive value. This led to a change in treatment strategy for 40% of the patients in our series. The PET scan will probably become the standard test in the extension and follow-up studies of most urological tumours.
Subject(s)
Fluorine Radioisotopes , Fluorodeoxyglucose F18 , Positron Emission Tomography Computed Tomography/methods , Radiopharmaceuticals , Urologic Neoplasms/diagnostic imaging , Adult , Aged , Carcinoma, Papillary/diagnostic imaging , Carcinoma, Renal Cell/diagnostic imaging , Carcinoma, Renal Cell/secondary , Carcinoma, Transitional Cell/diagnostic imaging , Carcinoma, Transitional Cell/secondary , Cystadenoma, Mucinous/diagnostic imaging , Cystadenoma, Mucinous/secondary , Female , Follow-Up Studies , Humans , Kidney Neoplasms/diagnostic imaging , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/secondary , Male , Middle Aged , Neoplasm Recurrence, Local/diagnostic imaging , Positron-Emission Tomography , Predictive Value of Tests , Sensitivity and Specificity , Tomography, X-Ray Computed , Urinary Bladder Neoplasms/diagnostic imagingABSTRACT
The urinary incontinence is a highly prevalent symptom in the adult female population. It has important psychosocial and economic connotations, and affects the quality of life of these patients. As it is an under-diagnosed problem due to patients not always consulting for it, it is very important to keep this in mind and to provide an opportunistic screening from Primary Health Care. It is difficult to determine the costs of this, but it is estimated to be the 2% of the health budget. Because of all of this, it is very important to know how to make a correct diagnose of this condition, to determine the different types of incontinence, possible causes, and treatments available. The purpose of this review is to show the different diagnostic and therapeutic tools available, to show the Primary Health Care role in this condition, and when to refer to specialist care.
Subject(s)
Primary Health Care/methods , Quality of Life , Urinary Incontinence/therapy , Female , Humans , Mass Screening/methods , Prevalence , Referral and Consultation/organization & administration , Urinary Incontinence/diagnosis , Urinary Incontinence/epidemiologyABSTRACT
OBJECTIVE: To assess the efficacy of treatment with transcutaneous posterior tibial nerve stimulation (TPTNS) in patients with urge urinary incontinence, of neurogenic or nonneurogenic origin, refractory to first-line therapeutic options. MATERIAL AND METHODS: We included 65 patients with urge urinary incontinence refractory to medical treatment. A case history review, a urodynamic study and a somatosensory evoked potentials (SEP) study were conducted before the TPTNS, studying the functional urological condition by means of a voiding diary. The treatment consisted of 10 weekly sessions of TPTNS lasting 30minutes. RESULTS: Some 57.7% of the patients showed abnormal tibial SEPs, and 42% showed abnormal pudendal SEPs. A statistically significant symptomatic improvement was observed in all clinical parameters after treatment with TPTNS, and 66% of the patients showed an overall improvement, regardless of sex, the presence of underlying neurological disorders, detrusor hyperactivity in the urodynamic study or SEP disorders. There were no adverse effects during the treatment. CONCLUSIONS: TPTNS is an effective and well tolerated treatment in patients with urge incontinence refractory to first-line therapies and should be offered early in the treatment strategy. New studies are needed to identify the optimal parameters of stimulation, the most effective treatment protocols and long-term efficacy, as well as its applicability to patients with a neurogenic substrate.
Subject(s)
Transcutaneous Electric Nerve Stimulation , Urinary Incontinence, Urge/therapy , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Prospective Studies , Tibial Nerve , Urinary Incontinence, Urge/etiologyABSTRACT
OBJECTIVE: To analyze the expression of metalloprotein 11 (MMP11) in cultured fibroblasts obtained from human prostate tumors with different clinical and pathological characteristics. MATERIAL AND METHODS: For this study we analyzed samples of transrectal prostate biopsies from tumors with different characteristics, treated with or whithout androgen deprivation (AD). After optimization of the culture method, fibroblasts were isolated and cultured to perform the study (PCR) of MMP11 mRNA. RESULTS: Finally, 37 cases were studied: 5 samples of benign prostatic hyperplasia, 14 cases with localized neoplasms (7 high-risk according to the D'Amico classification), 5 with metastasic tumors (bone metastases), and 13 treated with AD therapy, of which 6 fulfilled the requirements to be defined as resistant to castration. In tumors without AD therapy, MMP11 expression was significantly higher (P=.001) in fibroblasts of higher grade tumors. A significant (P=.001) correlation was found between PSA and expression of MMP11 in fibroblast s and a significant increase of MMP11 expression in metastatic tumors. In tumors with AD therapy, a significantly greater expression of MMP11 was observed in resistant to castration patients than in those sensitive to castration (P=.003). CONCLUSION: In advanced prostate tumors or in stages of increased tumor aggressiveness, the production of MMP11 by fibroblasts is significantly greater than in non-metastatic tumors or in AD sensitive tumors.
Subject(s)
Cancer-Associated Fibroblasts/metabolism , Matrix Metalloproteinase 11/biosynthesis , Prostatic Neoplasms, Castration-Resistant/pathology , Prostatic Neoplasms/pathology , Aged , Biomarkers, Tumor/biosynthesis , Cells, Cultured , Humans , Male , Middle Aged , Molecular Targeted Therapy , Neoplasm Staging , Prostatic Neoplasms/therapy , Prostatic Neoplasms, Castration-Resistant/therapyABSTRACT
A restricted dynamics, previously introduced in a kinetic model for relaxation phenomena in linear polymer chains, is used to study the dynamic critical exponent of one-dimensional Ising models. Both an alternating isotopic chain and an alternating-bond chain are considered. In contrast with what occurs for Glauber dynamics, in these two models the dynamic critical exponent turns out to be the same. The alternating isotopic chain with the restricted dynamics is shown to lead to Nagel scaling for temperatures above some critical value. Further support is given relating the Nagel scaling to the existence of multiple (simultaneous) relaxation processes, the dynamics apparently not playing the most important role in determining such scaling.
