Is trimodal therapy the current standard for muscle-invasive bladder cancer?

OBJECTIVE: The aim of this review is to summarize the current evidence and future perspectives of bladder-sparing treatment for MIBC. METHODS: A non-systematic literature search in Medline/Pubmed was performed in October 2023 with the following keywords "bladder cancer", "bladder-sparing", "trimodal therapy", "chemoradiation", "biomarkers", "immunotherapy", "neoadjuvant chemotherapy", "radiotherapy". RESULTS: Urology guidelines recommend radical cystectomy as the standard curative treatment for muscle-invasive urothelial bladder cancer, reserving radiotherapy for patients who are unfit or who want to preserve their bladder. Given the morbidity and mortality of cystectomy and its impact on quality of life and bladder function, modern oncologic therapies are increasingly oriented toward organ preservation and maximizing functional outcomes while maintaining treatment efficacy. Trimodal therapy, which incorporates maximal transurethral resection followed by radiotherapy with concurrent radiosensitizing chemotherapy, is an effective regimen for bladder function preservation in well-selected patients. Despite the absence of comparative data from randomized trials, the two approaches seem to provide comparable oncologic outcomes. Studies are evaluating the expansion of eligibility criteria for trimodal therapy, the optimization of radiotherapy and immunotherapy delivery to further improve outcomes, and the validation of biomarkers to guide bladder preservation. CONCLUSIONS: Trimodal therapy has shown acceptable outcomes for bladder preservation; therefore, it provides a valid treatment option in well-selected patients.

[Long-term evolution of a patient diagnosed of small lung cancer with extension to the central nervous system]. / Larga evolución de un paciente diagnosticado de cáncer microcítico de pulmón con afectación del sistema nervioso central.

Cell lung cancer is the principal cause of cancer death in men and women. We report the case of a man diagnosed with small cell lung cancer, metastatic from the outset. The disease is stable at present, forty-seven months from dia-gnosis, after receiving different treatment modalities.

Larga evolución de un paciente diagnosticado de cáncer microcítico de pulmón con afectación del sistema nervioso central / Long-term evolution of a patient diagnosed of small lung cancer with extension to the central nervous system

El cáncer de pulmón es la principal causa de muerte por cáncer en hombres y mujeres. Presentamos el caso de un varón diagnosticado de un carcinoma microcítico de pulmón metastásico desde el inicio, con enfermedad estable en la actualidad, cuarenta y siete meses después del diagnóstico, tras recibir diferentes modalidades de tratamiento (AU)

Cell lung cancer is the principal cause of cancer death in men and women. We report the case of a man diagnosed with small cell lung cancer, metastatic from the outset. The disease is stable at present, fortyseven months from diagnosis, after receiving different treatment modalities (AU)

Cinética de la proteína C reactiva y procalcitonina en el postoperatorio de la escoliosis / Kinetics of C-reactive protein and procalcitonin after scoliosis surgery

Introducción. El síndrome de respuesta inflamatoria sistémica que se desencadena tras distintos tipos de cirugía condiciona una elevación en los niveles de proteína C reactiva (PCR) y procalcitonina (PCT) que puede limitar su valor para el diagnóstico de una infección postoperatoria. El objetivo del estudio es describir la cinética de ambas tras la cirugía de escoliosis. Métodos. Estudio prospectivo observacional desarrollado en una Unidad de Cuidados Intensivos Pediátricos de8 camas de un hospital universitario. Se incluyeron 29 niños. Se analizaron los niveles de PCR y PCT a las 0, 24, 48 y 72horas del postoperatorio de la escoliosis. Resultados. La PCT se elevó precozmente con un pico máximo a las 24 horas (media: 0,41 ng/ml; IC 95%: 0,11-0,71ng/ml) y se mantuvo por debajo de los puntos de corte para infección localizada y sepsis, establecidos en nuestra Unidad (0,79 y 1,80 ng/ml respectivamente). La proteína C reactiva se elevó más tardíamente, alcanzando su pico a las 48horas (media: 12,23 mg/dl; IC 95%: 5,61-18,86 mg/dl) y superando los puntos de corte para sepsis e infección localizada (5,7 y 6,45 mg/dl respectivamente) establecidos en nuestra unidad. Conclusiones. La PCT, debido a su elevación más precoz manteniéndose por debajo de 0,5 ng/ml, se perfila como una herramienta más fiable que la PCR para el diagnóstico de infección en el postoperatorio de la escoliosis (AU)

Introduction. Post-surgery systemic inflammatory response syndrome leads to an elevation in C reactive protein (CRP) and procalcitonin (PCT) levels which may impedet heir diagnostic value for postoperative infection. The aim of this study is to establish the kinetics of both markers after scoliosis surgery. Methods. Prospective observational study setting in an eight-bed pediatric intensive care unit of a university hospital. Twenty-nine children were included. CRP and PCT levels were determined at 0, 24, 48 y 72 h after scoliosis surgery. Results. PCT levels increased early after surgery with a maximum peak at 24 hours (mean: 0.41 ng/ml; IC 95% 0.11-0.71 ng/ml) that is below the cutoff values for local infection or sepsis diagnosis (0.79 and 1.8 ng/ml respectively)previously established in our pediatric intensive care unit. However, C reactive protein increased later, reached the higher peak at 48 hours (mean: 12.23 mg/dl IC 95% 5.61-18.86 mg/dl) that is above cutoff values for sepsis and local infection (5.7 and 6.45 mg/dl respectively) previously established in our pediatric intensive care unit Conclusion. Procalcitonin seems to be a more reliable diagnosis tool of postoperative scoliosis infection due to its earlier elevation and the maintenance of its levels below the cut-off value for infection (AU)

Helmet-delivered continuous positive airway pressure with heliox in respiratory syncytial virus bronchiolitis.

AIM: The objective of this study was to check the feasibility and efficacy of helmet-delivered heliox-continuous positive airway pressure (CPAP) in infants with bronchiolitis. METHODS: Children <3 months of age diagnosed with respiratory syncytial virus bronchiolitis and recurrent apnoeas or a venous PCO(2) >55 mmHg or a transcutaneous oxygen saturation <92% in room air were eligible for inclusion in the study. CPAP was delivered by a noninvasive ventilator connected to a heliox port. The interface was a helmet. RESULTS: Eight consecutive infants fulfilled the inclusion criteria. Apnoeas were present in six children before respiratory support was started; they disappeared in five of them. Two infants had to be changed to pressure support noninvasive ventilation, and one of them required intubation. No side effects were recorded. CONCLUSION: We propose a relatively new device to deliver heliox-CPAP in small infants with bronchiolitis. Although this is just a descriptive study with a short sample, this system seems to be feasible and effective.

[Success and failure predictors of non-invasive ventilation in acute bronchiolitis]. / Predictores de éxito y de fracaso en la ventilación no invasiva en la bronquiolitis aguda.

INTRODUCTION: The objective was to identify predictive factors for non-invasive ventilation (NIV) failure and to describe its use in bronchiolitis. PATIENTS AND METHODS: Prospective observational study that included patients diagnosed with bronchiolitis with a modified Wood's Clinical Asthma Score 5, or oxygen saturation <92%, or venous CO(2) partial pressure (PCO(2)) 60 mm Hg, with no response to medical treatment, who received NIV from December 2005 to May 2008. We collected clinical data before NIV began and at 1, 6, 12, 24 and 48 h. Need for intubation was considered as NIV failure. RESULTS: NIV was successful in 83% of 47 cases included. Patients in whom NIV failed had lower weight (5.2+/-2.2 vs. 3.5+/-0.8 kg, P=.011), lower age [1.8 (0.3-12.3) vs. 0.8 (0.4-4.3) months, P=.038)], lower heart rate (HR) before NIV began (176.3+/-19.1 vs. 160.4+/-9.7 beats/minute, P=.010), lower HR decrease at hours 1 (-16.0+/-17.3 vs.+1.1+/-11.6, P=.005) and 12 (-31.5+/-19.7 vs. -0.75+/-12.2, P=.002), presence of apnoeas (23.1% vs. 75%; P=.004) and of a predisposing condition (84.6% vs. 50%; P=.029). Multivariate analysis identified the absence of a predisposing condition, and a greater HR decrease during the first hour as success-associated independent factors (OR 0.004; 95% CI 0.000-0.664 and OR 0.896; 95% CI: 0.809-0.993, respectively). CONCLUSIONS: NIV has a high success rate in bronchiolitis. The main parameters which can predict NIV success are the absence of a predisposing condition and a higher HR decrease in the first hour.

Predictores de éxito y de fracaso en la ventilación no invasiva en la bronquiolitis aguda / Success and failure predictors of non-invasive ventilation in acute bronchiolitis

Introducción: el objetivo de este trabajo ha sido identificar los marcadores de fracaso de la ventilación no invasiva (VNI) y describir su uso en la bronquiolitis. Sujetos y métodos: en el estudio prospectivo observacional se incluyeron sujetos con bronquiolitis y puntuación clínica de asma modificada de Wood≥5, o saturación de oxígeno (SO2)<92% o con presión parcial venosa de dióxido de carbono (PCO2)≥60mmHg, sin respuesta al tratamiento médico y que recibieron VNI entre diciembre de 2005 y mayo de 2008. Se recogieron los datos clínicos previos al inicio de la VNI y a las 1; 6; 12; 24, y 48h. El fracaso de la VNI se definió como necesidad de intubación endotraqueal. Resultados: la VNI tuvo éxito en el 83% de los 47 casos incluidos. Los sujetos en los que que fracasó presentaron menor peso (5,2±2,2 frente a 3,5±0,8kg; p=0,011), menor edad (1,8 [0,3 12,3] frente a 0,8 [0,4 4,3] meses; p=0,038), menor frecuencia cardíaca (FC) pre-VNI (176,3±19,1 frente a 160,4±9,7 latidos por minuto; p=0,010), menor disminución de la FC a la hora (−16,0±17,3 frente a +1,1±11,6; p=0,005) y a las 12h (−31,5±19,7 frente a −0,75±12,2; p=0,002). También presentaron apneas (23,1 frente a 75%; p=0,004) y algún cuadro clínico predisponente (84,6 frente a 50%; p=0,029) con mayor frecuencia. El análisis multivariante identificó la ausencia de un cuadro clínico predisponente y una mayor disminución de la FC en la primera hora como factores relacionados con el éxito de forma independiente (odds ratio [OR]=0,004; intervalo de confianza [IC] del 95%, 0,000 0,664 y OR=0,896; IC del 95%, 0,809 0,993, respectivamente). Conclusiones: la VNI tiene un alto porcentaje de éxito en la bronquiolitis. Los principales parámetros que pueden predecir su éxito son la ausencia de un cuadro clínico predisponente y una mayor disminución de la FC en la primera hora (AU)

Introduction: The objective was to identify predictive factors for non-invasive ventilation (NIV) failure and to describe its use in bronchiolitis. Patients and methods: Prospective observational study that included patients diagnosed with bronchiolitis with a modified Wood's Clinical Asthma Score ≥5, or oxygen saturation <92%, or venous CO2 partial pressure (PCO2) ≥60mmHg, with no response to medical treatment, who received NIV from December 2005 to May 2008. We collected clinical data before NIV began and at 1, 6, 12, 24 and 48h. Need for intubation was considered as NIV failure. Results: NIV was successful in 83% of 47 cases included. Patients in whom NIV failed had lower weight (5.2±2.2 vs. 3.5±0.8kg, P=0.011), lower age [1.8 (0.3 12.3) vs. 0.8 (0.4 4.3) months, P=0.038)], lower heart rate (HR) before NIV began (176.3±19.1 vs. 160.4±9.7 beats/minute, P=0.010), lower HR decrease at hours 1 (−16.0±17.3 vs.+1.1±11.6, P=0.005) and 12 (−31.5±19.7 vs. −0.75±12.2, P=.002), presence of apnoeas (23.1% vs. 75%; P=.004) and of a predisposing condition (84.6% vs. 50%; P=0.029). Multivariate analysis identified the absence of a predisposing condition, and a greater HR decrease during the first hour as success-associated independent factors (OR 0.004; 95% CI 0.000 0.664 and OR 0.896; 95% CI: 0.809 0.993, respectively). Conclusions: NIV has a high success rate in bronchiolitis. The main parameters which can predict NIV success are the absence of a predisposing condition and a higher HR decrease in the first hour (AU)