ABSTRACT
BACKGROUND: Serum bile acids (SBAs) are frequently measured in dogs. However, there is limited data comparing SBAs in different liver diseases diagnosed according to standardized histological criteria. OBJECTIVES: To compare resting and postprandial SBAs, and determine their sensitivity and specificity, for various liver diseases in dogs. ANIMALS: Three hundred and forty-one client-owned dogs with suspected liver disease that had a liver biopsy and SBAs measured. METHODS: Multicenter retrospective study. Cases were classified according to standardized histological criteria. The sensitivity and specificity of resting and postprandial SBAs for the diagnosis of each liver disease, and all liver diseases combined, were calculated. RESULTS: The median resting SBAs were highest in dogs with cirrhosis (98.8 µmol/L; range, 6-135) and congenital circulatory anomalies (CCa; 79.45 µmol/L; 0.3-705). The highest median postprandial concentrations were found in CCa (126 µmol/L; 0-726) and chronic hepatitis (CH; 54.3 µmol/L; 0-260). Using the cut-off value of 10 µmol/L, the highest sensitivities of resting SBAs were recorded in dogs with CCa (87.5%; 95% confidence interval, 76.8-94.4) and CH (81.1%; 71.5-88.6). The sensitivities of postprandial SBAs were the highest in cholangitis (100%; 47.8-100.0) and CCa (91.1%; 78.8-97.5). The specificities of resting and postprandial SBAs for all diseases were 49.3% (37.6-61.1) and 29.7% (15.9-47.0), respectively. CONCLUSIONS AND CLINICAL IMPORTANCE: Postprandial SBAs are more sensitive but less specific than resting SBAs for the diagnosis of liver disease. There were dogs in all categories of liver disease with resting SBAs <10 and >90 µmol/L. Therefore, careful interpretation of both normal and elevated values is required.
Subject(s)
Dog Diseases , Liver Diseases , Animals , Bile Acids and Salts , Dog Diseases/diagnosis , Dogs , Liver Cirrhosis/veterinary , Liver Diseases/veterinary , Retrospective StudiesABSTRACT
OBJETIVOS: Describir la las respuestas completas obtenidas en nuestros pacientes con cáncer renal metastásico tratados con inhibidores de la tirosin kinasa. MÉTODOS: Entre junio de 2007 y diciembre del 2014 hemos tratado en nuestro servicio a 43 pacientes de cáncer renal metastásico con tratamiento antiangiogénicos. RESULTADOS: Un 9,3% (4/43) de los pacientes tratados con antiangiogénicos obtuvieron respuesta completa según criterios RECIST 1.1. En 3 de los 4 pacientes, la respuesta completa se obtuvo durante el tratamiento de primera línea con sunitinib a dosis de 50 mgrs/dia en esquema 4/2 y en el paciente restante la obtuvo con axitinib en segunda línea a dosis de 10 mgrs/dia. CONCLUSIONES: Los inhibidores de la tirosin kinasa pueden inducir respuestas completas en los pacientes con cáncer renal metastásico. La discontinuación del tratamiento con los inhibidores de la tirosin kinasa después de una respuesta completa puede ser una opción
OBJECTIVE: To describe the complete responses in our patients with metastatic renal cancer treated with tyrosine kinase inhibitors. MATERIAL AND METHODS: Between June 2007 and December 2014 we treated in our department 43 patients with metastatic renal cancer with antiangiogenic drugs. RESULTS: 9.3% (4/43) of the patients treated with antiangiogenic drugs obtained complete response according to RECIST 1.1 criteria. In 3 of the 4 patients, complete response was obtained during the first-line treatment with sunitinib at doses of 50 mgr/day in a 4/2 scheme and the remaining patient obtained it with second line axitinib at doses of 10 mgr/day. CONCLUSIONS: Tyrosine kinase inhibitors can induce complete responses in patients with metastatic renal cancer. Discontinuation of treatment with tyrosine kinase inhibitors after a complete response may be an option
Subject(s)
Humans , Protein-Tyrosine Kinases/antagonists & inhibitors , Kidney Neoplasms/drug therapy , Neoplasm Metastasis/drug therapy , Kidney Neoplasms/secondary , Angiogenesis Inhibitors/therapeutic use , Treatment OutcomeABSTRACT
OBJECTIVE: Calciphylaxis is a potentially lethal syndrome reported mainly in patients with ESRD on hemodialysis. Etiopathogenesis remains unclear and there is much controversy regarding optimal diagnostic and therapeutic approach. Penile necrosis as a disease presentation is extremely rare. We report two clinical cases treated in our center and perform an evidence review. METHODS: Clinical data was obtained from both patients and an evidence review was performed on PubMed under the criteria "penile necrosis" and "Calciphylaxis". RESULTS: Both patients underwent partial penectomy due to severe penile necrosis. After surgery both patients received treatment with sodium thiosulfate (STS) 20mg in every hemodialysis session. Both patients showed stabilization of necrotic lesions. DISCUSSION: The same way that biopsying the ischemic lesions produced by Calciphylaxis is discussed and even misadvised, the role of aggressive surgery as first line therapy might be uncertain specially with the raising of new specific drugs such as sodium thiosulfate (STS) that have shown efficacy stopping disease progression.
Subject(s)
Calciphylaxis/complications , Penis/pathology , Calciphylaxis/diagnosis , Humans , Male , Necrosis/etiologyABSTRACT
OBJETIVOS: La calcifilaxia es un síndrome potencialmente letal descrito primordialmente en pacientes con insuficiencia renal crónica en diálisis. La etiopatogenia es incierta y existe controversia en cuanto al manejo diagnóstico y terapéutico. La necrosis peneana como manifestación de esta enfermedad es extremadamente infrecuente. Analizamos dos casos clínicos tratados en nuestro centro y realizamos una revisión de la literatura. MÉTODOS: Se recogió la información clínica de ambos pacientes y se realizó una búsqueda bibliográfica en Pubmed bajo los criterios de búsqueda "penile necrosis", "penile calciphylaxis", "sodium thiosulfate" y "systemic calciphylaxis". RESULTADOS: Ambos pacientes fueron sometidos a penectomía parcial debido a extensa necrosis peneana. Tras la misma, iniciaron un régimen de Tiosulfato de Sodio 20 mg i.v. durante sus sesiones de hemodiálisis. En ambos pacientes se apreció estabilización del proceso isquémico. CONCLUSIÓN: La biopsia de las lesiones en la necrosis isquémica de pene, por sospecha de calcifilaxis sistémica, es controvertido. Igualmente, el papel de la cirugía agresiva de entrada puede ser discutible; más aún con la aparición de nuevos fármacos específicos, como el Tiosulfato de sodio, que parecen ser eficaces en la estabilización de las lesiones
OBJECTIVE: Calciphylaxis is a potentially lethal syndrome reported mainly in patients with ESRD on hemodialysis. Etiopathogenesis remains unclear and there is much controversy regarding optimal diagnostic and therapeutic approach. Penile necrosis as a disease presentation is extremely rare. We report two clinical cases treated in our center and perform an evidence review. METHODS: Clinical data was obtained from both patients and an evidence review was performed on PubMed under the criteria "penile necrosis" and "Calciphylaxis". RESULTS: Both patients underwent partial penectomy due to severe penile necrosis. After surgery both patients received treatment with sodium thiosulfate (STS) 20mg in every hemodialysis session. Both patients showed stabilization of necrotic lesions. DISCUSSION: The same way that biopsying the ischemic lesions produced by Calciphylaxis is discussed and even misadvised, the role of aggressive surgery as first line therapy might be uncertain specially with the raising of new specific drugs such as sodium thiosulfate (STS) that have shown efficacy stopping disease progression
