Analytical performance validation of aPROMISE platform for prostate tumor burden, index and dominant tumor assessment with 18F-DCFPyL PET/CT. A pilot study.

To validate the performance of automated Prostate Cancer Molecular Imaging Standardized Evaluation (aPROMISE) in quantifying total prostate disease burden with 18F-DCFPyL PET/CT and to evaluate the interobserver and histopathologic concordance in the establishment of dominant and index tumor. Patients with a recent diagnosis of intermediate/high-risk prostate cancer underwent 18F-DCFPyL-PET/CT for staging purpose. In positive-18F-DCFPyL-PET/CT scans, automated prostate tumor segmentation was performed using aPROMISE software and compared to an in-house semiautomatic-manual guided segmentation procedure. SUV and volume related variables were obtained with two softwares. A blinded evaluation of dominant tumor (DT) and index tumor (IT) location was assessed by both groups of observers. In histopathological analysis, Gleason, International Society of Urological Pathology (ISUP) group, DT and IT location were obtained. We compared all the obtained variables by both software packages using intraclass correlation coefficient (ICC) and Cohen's kappa coefficient (k) for the concordance analysis. Fifty-four patients with a positive 18F-DCFPyL PET/CT were evaluated. The ICC for the SUVmax, SUVpeak, SUVmean, tumor volume (TV) and total lesion activity (TLA) was: 1, 0.833, 0.615, 0.494 and 0.950, respectively (p < 0.001 in all cases). For DT and IT detection, a high agreement was observed between both softwares (k = 0.733; p < 0.001 and k = 0.812; p < 0.001, respectively) although the concordances with histopathology were moderate (p < 0001). The analytical validation of aPROMISE showed a good performance for the SUVmax, TLA, DT and IT definition in comparison to our in-house method, although the concordance was moderate with histopathology for DT and IT.

Diagnostic and therapeutic impact of PET/CT with 18F-DCFPyL versus 18F-Fluorocholine in initial staging of intermediate-/high-risk prostate cancer: a pilot study.

AIM: To assess the diagnostic and therapeutic impact of PET/CT with 18F-DCFPyL with respect to 18F-Fluorocholine in initial staging of intermediate-/high-risk prostate cancer (PCa). MATERIAL AND METHODS: Patients with recent diagnosis of intermediate-/high-risk PCa without androgen deprivation therapy and previous 18F-Fluorocholine-PET/CT (negative for extraprostatic disease or with oligometastatic disease) were referred to 18F-DCFPyL-PET/CT. Patients' disease characteristic as grade group, D'Amico risk category (intermediate/high), prostate-specific antigen (PSA) closest to PET/CTs and its kinetics were obtained. The overall detection rate (DR) and molecular imaging TNM (miTNM) stage according to the prostate cancer molecular imaging standardized evaluation (PROMISE) criteria were assessed for both radiotracers, and their concordance (Kappa coefficient) was analyzed. The diagnostic and therapeutic impact of 18F-DCFPyL with respect to 18F-Fluorocholine was evaluated. RESULTS: Fifty-eight patients were analyzed (84.5% high-risk). 18F-Fluorocholine showed a higher DR than 18F-DCFPyL of prostate gland involvement (100% versus 93.1%) and pelvic node disease (37.9% versus 31%; k = 0.436, p = 0.001). On the other hand, 18F-DCFPyL-PET/CT showed a higher DR of metastatic disease than 18F-Fluorocholine-PET/CT, 9/58 patients (15.5%): 3 M1a, 5 M1b and 1 M1c) versus 5/58 (8.6%) patients: 1 M1a and 4 M1b), k = 0.426; p = 0.001. No significant association was found between clinical characteristics (grade group, risk category, PSA level and kinetic) and 18F-Fluorocholine or 18F-DCFPyL results. The results of 18F-DCFPyL-PET/CT modified the previously planned treatment compared to 18F-Fluorocholine-PET/CT in 13 patients (22.4%). CONCLUSIONS: 18F-Fluorocholine and 18F-DCFPyL PET/CT showed a similar DR of prostate gland and lymph node involvement, although with moderate concordance for the latter. 18F-DCFPyL was superior to 18F-Fluorocholine in detecting regional and distant metastasis with a therapeutic impact in one of every five patients.

Head-to-Head Comparison of [18F]F-choline and Imaging of Prostate-Specific Membrane Antigen, Using [18F]DCFPyL PET/CT, in Patients with Biochemical Recurrence of Prostate Cancer.

PURPOSE: To analyse diagnostic and therapeutic impact of molecular imaging TNM (miTNM) stage obtained with [18F]DCFPyL versus [18F]F-choline in head-to-head comparison in biochemical recurrence (BCR) of prostate cancer (PCa). MATERIAL AND METHODS: Patients with BCR of PCa after radical treatment with previous [18F]F-choline-PET/CT (negative or oligometastatic disease) were recruited to [18F]DCFPyL-PET/CT. Patients were classified according to: grade group, European Association of Urology classification, PSA, PSA doubling time (PSAdt) and PSA velocity (PSAvel). The overall detection rate (DR) and miTNM stage according to PROMISE criteria were assessed for both radiotracers and also correlated (Kappa). The influence of PSA and kinetics on both PET/CT (DR and miTNM) and predictive value of unfavourable kinetics on miTNM were determined. Cut-off PSA, PSAdt and PSAvel values able to predict PET/CT results were determined. Change in miTNM and treatment derived from [18F]DCFPyL information compared with [18F]F-choline were also evaluated. RESULTS: We studied 138 patients. [18F]DCFPyL showed a higher DR than [18F]F-choline (64.5% versus 33.3%) with a fair agreement. [18F]DCFPyL and [18F]F-choline detected T in 33.3% versus 19.6%, N in 27.5% versus 13.8%, and M in 30.4% versus 8.7%. Both tracers' DR showed significant associations with PSA and PSAvel. Significant association was only found between miTNM and PSA on [18F]F-choline-PET/CT (p = 0.033). For [18F]F-choline and [18F]DCFPyL-PET/CT, a PSAdt cut-off of 4.09 and 5.59 months, respectively, were able to predict M stage. [18F]DCFPyL changed therapeutic management in 40/138 patients. CONCLUSIONS: [18F]DCFPyL provides a higher DR and superior miTNM staging than [18F]F-choline in restaging BCR, especially with high PSA and unfavourable PSA kinetics, showing a fair agreement to [18F]F-choline.

Longitudinal study of the sympathovagal balance in women submitted to bariatric surgery.

Studies have shown improvement of the cardiac autonomic balance in post-bariatric patients. Most of these studies included patients using drugs interfering in the autonomic nervous system. This study assessed the time course of changes in the sympathovagal balance after bariatric surgery (Roux-en-Y gastric bypass) in 26 women free from drugs. A 10-min electrocardiographic recording was obtained at baseline and at 3 and 6 months after surgery. Temporal and spectral domains of heart rate variability were analysed. The time domain components of cardiac vagal modulation increased progressively after surgery. In the frequency domain, high frequency power increased from 24.9 at baseline (18.0 to 46.3) to 44.5 at 3 months (23.4 to 65.6), and 54.1 at 6 months after surgery (37.6 to 64.0) (median and IQR in normalized units). Low frequency spectral power decreased from 56.2 at baseline (39.6 to 74.4) to 36.8 at 6 months after surgery (24.9 to 53.9) (P= 0.036). Low frequency/high frequency ratio decreased from 2.3 at baseline (1.0 to 4.2) to 0.8 at 6 months after surgery (0.4 to 1.3) (P= 0.038). Progressive shift towards predominance of vagal tonus was detected in the follow-up. Most of the patients recovered low frequency/high frequency at 6 months after surgery.

Reflexión sobre el screening de neoplasias en glomerulonefritis / Review on the screnning of cancer in glomerulonephritis

No disponible

Diagnóstico de obstrucción de catéter peritoneal mediante peritoneografía fluoroscópica / Diagnosis of obstruction peritoneal catheter by fluoroscopic peritoneography

No disponible

Peritonitis causada por Pantoea agglomerans en diálisis peritoneal / Peritonitis caused by Pantoea agglomerans in peritoneal dialysis

No disponible

Factores de riesgo asociados a hernias en diálisis peritoneal / Risk factors associated with hernias on peritoneal dialysis

No disponible

Peritonitis causada por Paracoccus yeei en diálisis peritoneal / Paracoccus yeei peritonitis in peritoneal dialysis

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Decisiones médicas al final de la vida de los niños / Medical decisions at the end of a child's life

Se presentan los conceptos generales sobre la fase terminal de las enfermedades en los niños, el abordaje terapéutico que se realiza en una institución de tercer nivel de atención, la forma en que se proporcionan las malas noticias a los padres y niños, los aspectos bioéticos y el apoyo médico, emocional y espiritual que se requiere en esta compleja situación.

This paper presents the general concepts regarding the terminal phase of a child's illness and the therapeutic approach undertaken at a third-level care institution. We discuss how this information is transmitted to parents and children along with the bioethical aspects and the medical, emotional and spiritual support required during this complex situation.

Ensayo clínico, aleatorizado, abierto y prospectivo, de 3 años de seguimiento, que compara la eficacia del TVT y la colposuspensión de Burch como tratamiento de la incontinencia urinaria de esfuerzo femenina / A three year follow-up of a prospective open randomized trial to compare tension-free vaginal tape with Burch colposuspension for treatment of female stress urinary incontinence

Antecedentes: Las evidencias que comparan la eficacia a largo plazo de TVT (tensión freevaginal tape) y la de colposuspensión (CS) de Burch son escasas. Objetivos: Comparar la eficacia de TVT con CS como tratamiento de la incontinencia urinaria de esfuerzo femenina (IUE).Diseño: Estudio clínico, aleatorizado, abierto, de 3 años de seguimiento. Participantes: Se incluyó a 49 mujeres consecutivas de 35 a 70 años con IUE demostrada en estudio urodinámico. Ámbito de estudio: Servicio de Urología del Hospital Severo Ochoa de Leganés (Madrid), España. Intervención: Se aleatorizó a 24 pacientes a tratamiento con TVT y 25 con CS. Mediciones: Variable principal: evaluación antes del tratamiento y a los 6 meses, 1 año y 3 años postoperatorios con un cuestionario de severidad de síntomas de incontinencia (SSI) y de impacto de síntomas de incontinencia (SII). Variable secundaria: 3 grupos para evaluar las proporciones de curación, mejoría y fallo. Resultados: El tiempo quirúrgico, el consumo de analgésicos postoperatorios y la estancia postoperatoria fueron inferiores en el grupo TVT (41,1 ± 10,9 min, 6 [2,8-10,5] dosis y 1 [1-2] días frente a 57,1 ± 18,3 min, 23,5 [18-31,5] dosis y 3 [3-3] días [p < 0,0001]). Las puntuaciones SSI y SII se redujeron significativamente en ambos grupos después del tratamiento y no hubo diferencias significativas en las complicaciones operatorias, urgencia, obstrucción, test de la compresa de 1 h, urocultivo, flujometría, costes totales y proporciones de curación en ningún momento del seguimiento (curación/mejoría del 76,2, el 78,3 y el 77,3% a los 6 meses, 1 y 3 años con TVT, y del 87,5, el 87,5 y el 91,3% con CS; p = 0,32, p = 0,4 y p = 0,19). Limitaciones: El estudio es abierto, lo que puede generar sesgos. Un número mayor de pacientes o un mayor tiempo de seguimiento podrían demostrar diferencias entre los procedimientos que no se han observado en el estudio, pero las limitaciones presupuestarias y en el tiempo no lo han permitido. Discusión: Tanto a corto como a largo plazo, la técnica TVT es tan eficaz como la CS para el tratamiento de la IUE femenina, con una proporción similar de curaciones subjetivas y de complicaciones. El tiempo quirúrgico, consumo de analgésicos y la estancia postoperatoria son inferiores con TVT. En nuestro medio, con 1 día de estancia postoperatoria con TVT, los dos procedimientos tienen costes totales similares (AU)

Background: Evidence comparing the effectiveness of tension-free vaginal tape (TVT) with Burch colposuspension (CS) over a long-term follow-up is scarce. Purpose: To compare TVT with CS as primary treatment for female stress urinary incontinence (SUI). Design: Open randomised clinical trial with a three-year follow-up period. Participants: 49 consecutive women aged 35 to 70 with SUI demonstrated by a urodynamic study. Setting: Urology department of Severo Ochoa general hospital in Leganés, Madrid, Spain. Intervention: 24 random patients treated with TVT and 25 with CS. Measurements: Main variable: assessment before treatment and at six months, one year and three years after the operation using the incontinence severity symptoms index (SSI) and the incontinence impact symptoms index (SII). Secondary variable: three groups for assessing cure, improvement and failure rates. Results: Time in surgery, consumption of postoperative analgesics and length of the postoperative hospital stay were lower in the TVT group (41.1 ± 10.9 minutes; 6 [2.8-10.5]capsules and 1 [1-2] days vs. 57.1 ± 18.3 minutes, 23.5 [18.0-31.5] capsules and 3 [3-3] days[p < 0.0001]). There was a significant reduction in SSI and SII scores in both groups and no differences in surgical complications, urgency, obstruction, one-hour pad test, urineculture, flowmetry, costs and cure rates at any moment during follow-up (cured/improved76.2%, 78.3% and 77.3% at six months, one year and three years for TVT vs. 87.5%, 87.5%and 91.3% for CS; p = 0.32, p = 0.4 and p = 0.19). Limitations: The trial is open, which can create observer bias. A study with a higher number of patients or a longer follow-up time could show differences between the procedures that we were unable to observe in this study, due to our budget and time limits. Discussion: Based on both short-term and long-term results, TVT is as effective as CS for the treatment of SUI, and has similar subjective cure and surgical complication rates. Time in surgery, consumption of analgesics and length of postoperative hospital stay are all lower in the TVT group. In our clinical setting, with a one-day postoperative stay for TVT, the two procedures have similar costs (AU)

A three year follow-up of a prospective open randomized trial to compare tension-free vaginal tape with Burch colposuspension for treatment of female stress urinary incontinence.

BACKGROUND: Evidence comparing the effectiveness of tension-free vaginal tape (TVT) with Burch colposuspension (CS) over a long-term follow-up is scarce. PURPOSE: To compare TVT with CS as primary treatment for female stress urinary incontinence (SUI). DESIGN: Open randomised clinical trial with a three-year follow-up period. PARTICIPANTS: 49 consecutive women aged 35 to 70 with SUI demonstrated by a urodynamic study. SETTING: Urology department of Severo Ochoa general hospital in Leganes, Madrid, Spain. INTERVENTION: 24 random patients treated with TVT and 25 with CS. MEASUREMENTS: Main variable: assessment before treatment and at six months, one year and three years after the operation using the incontinence severity index (ISI) and the incontinence impact questionnaire (IIQ). Secondary variable: three groups for assessing cure, improvement and failure rates. RESULTS: Time in surgery, consumption of postoperative analgesics and length of the postoperative hospital stay were lower in the TVT group (41.1 +/- 10.9 minutes; 6 [2.8-10.5] capsules and 1 [1-2] days vs. 57.1 +/- 18.3 minutes, 23.5 [18.0-31.5] capsules and 3 [3-3] days [p < 0.0001]). There was a significant reduction in ISI and IIQ scores in both groups and no differences in surgical complications, urgency, obstruction, one-hour pad test, urine culture, flowmetry, costs and cure rates at any moment during follow-up (cured/improved 76.2%, 78.3% and 77.3% at six months, one year and three years for TVT vs. 87.5%, 87.5% and 91.3% for CS; p = 0.32, p = 0.4 and p = 0.19). LIMITATIONS: The trial is open, which can create observer bias. A study with a higher number of patients or a longer follow-up time could show differences between the procedures that we were unable to observe in this study, due to our budget and time limits. DISCUSSION: Based on both short-term and long-term results, TVT is as effective as CS for the treatment of SUI, and has similar subjective cure and surgical complication rates. Time in surgery, consumption of analgesics and length of postoperative hospital stay are all lower in the TVT group. In our clinical setting, with a one-day postoperative stay for TVT, the two procedures have similar costs.

[Urodynamic assessment of the voiding phase in childhood]. / Valoración urodinámica de la fase miccional en la infancia.

OBJECTIVE: To determine the more useful parameters of urethral resistance and bladder contractile power to explain the values of maximum flow and postvoid residual urine observed in free uroflowmetry and appropriately assess the voiding dynamics in childhood. METHODS: A cross-sectional study was carried out in 68 children (46 girls and 22 boys) with a mean age of 8.9 years. These children were subjected to free uroflowmetry in order to determine the maximum flow rate and the postvoid residual urine, and to a complete urodynamic study with perineal surface electromyography in order to determine the parameters of urethral resistance and bladder contractile power. A univariate linear regression model was built from these parameters for explanatory purposes. The independent variables were the parameters of the urodynamic study and the outcome variables were the value of the maximum flow in the free uroflowmetry and the proportion of postvoid residual urine in relation to the voiding volume of the free uroflowmetry. The resulting models were validated in order to determine its loss of predicting power (shrinkage). For this purpose, we used two other independent series: one comprised 50 patients (34 girls and 16 boys) extracted from the same sample as the derived model, and the other comprised 85 patients (53 girls and 32 boys) from another population. RESULTS: The multivariate model demonstrated that the maximum flow of the free uroflowmetry has a direct relationship with the square root of the voiding volume and the bladder contractile power [measured by Schafer's projected isometric pressure (PIP)] and an inverse relationship with the urethral resistance measured by means of a parameter (URA) and with the presence of electromyographic perineal activity (EMG) during voiding. Similarly, the proportion of postvoid residual urine has a direct relationship with the urethral resistance (measured by means of the parameter URA) and with the inverse function of the projected isometric pressure (I/PIP). The shrinkage of the multivariate models, when compared with other series, ranged from 26.9% and 1.3%. CONCLUSIONS: The urodynamic evaluation of the lower urinary tract in childhood can be carried out appropriately by means of the determination of the urethral resistance by the parameter URA and of the bladder contractile power by the projected isometric pressure (PIP), obtaining as a limit of normal values a URA of 16 cm H2O and a PIP of 105 cm H2O.

Valoración urodinámica de la fase miccional en la infancia / Voiding urodynamic assessment in childhood

OBJETIVOS: Determinar que parámetros de resistencia uretral y potencia contráctil vesical son más útiles para explicar los valores de flujo máximo y residuo postmiccional observados en la flujometría libre, y valorar adecuadamente la dinámica miccional en la infancia. MÉTODOS: Se realizó un estudio de corte en una serie de 68 niños (46 niñas y 22 niños varones) de edad media 8,9 años. Los niños fueron sometidos a una flujometría libre para determinar el flujo miccional máximo y el residuo postmiccional, y un estudio urodinámico completo, con electromiografía perineal, para determinar los parámetros de resistencia uretral y potencia contráctil vesical. A partir de estos parámetros se elaboró un modelo de regresión lineal multivariante con fines explicativos, utilizando como variables independientes los parámetros del estudio urodinámico, y como variables resultados el valor del flujo máximo en la flujometría libre y la proporción de residuo postmiccional respecto al volumen miccional de la flujometría libre. El modelo resultante fue validado, en orden de determinar su pérdida de poder predictivo ("shrinkage"), con otras dos series independientes: una serie formada por 50 pacientes (34 niñas y 16 niños) extraídos de la misma población del modelo derivado, y otra serie de 85 pacientes (53 niñas y 32 niños) extraída de otra población diferente. RESULTADOS: El modelo multivariante determinó que el flujo máximo de la flujometría libre depende directamente de: la raíz cuadrada del volumen miccional y la potencia contráctil vesical medida mediante la presión isométrica proyectada (PIP) de Schäfer, e inversamente de: la resistencia uretral medida mediante el parámetro URA y de la presencia de actividad EMG perineal durante la micción. Análogamente la proporción del residuo postmiccional fue directamente proporcional a la resistencia uretral medida mediante el parámetro URA y a la función inversa de la presión isométrica proyectada (1/PIP). La pérdida del poder predictivo ("shrinkage") del modelo al compararlo con otras series, osciló entre el 26,9 por ciento y el 1,3 por ciento. CONCLUSIONES:. La valoración urodinámica del tracto urinario inferior en la infancia se puede realizar adecuadamente mediante la determinación de la resistencia uretral por el parámetro URA y de la potencia contráctil vesical por la presión isométrica proyectada (PIP), obteniéndose como límite de la normalidad en nuestra serie una URA de 16 cm H2O, y una PIP de 105 cm H2O (AU)