Infección urinaria por enterococos: Factores de riesgo y mortalidad. Estudio observacional / Urinary tract infection caused by Enterococcus spp.: risk factors and mortality. An observational study

Antecedentes y objetivo Los enterococos son una causa frecuente de infecciones del tracto urinario (ITU). Este trabajo pretende definir los factores de riesgo asociados con las ITU causadas por enterococos y determinar su mortalidad global y los factores de riesgo predictivos. Materiales y métodos Se llevó a cabo un estudio retrospectivo sobre las ITU bacteriémicas por enterococos en pacientes hospitalizados. Se compararon 106 sujetos hospitalizados por ITU bacteriémicas por enterococos con una muestra aleatoria de 100 pacientes hospitalizados por ITU bacteriémicas por otras enterobacterias. Resultados Se analizó un total de 106 sujetos hospitalizados por ITU por enterococos, 51 de ellos con hemocultivos positivos concomitantes. La distribución por especies fue: 83% por Enterococcus faecalis (E. faecalis) y 17% por Enterococcus faecium (E. faecium). La puntuación media en el índice de comorbilidad de Charlson fue de 5,9 ± 2,9. Al comparar las ITU bacteriémicas por enterococos con las causadas por otras enterobacterias se identificaron los siguientes factores predictivos independientes de ITU bacteriémicas por enterococos: sexo masculino, uropatía obstructiva, infección nosocomial, cánceres de vías urinarias y tratamiento antibiótico previo. En conjunto, la mortalidad hospitalaria fue del 16,5% y se asoció con una mayor puntuación de la escala para la evaluación del daño orgánico secuencial (SOFA) (> 4), a enfermedades concomitantes graves, como inmunodepresión, hemopatía maligna y nefrostomía, y a la especie E. faecium y su patrón de resistencia a la ampicilina o la vancomicina (p < 0,05). Un tratamiento antibiótico empírico adecuado no se relacionó con un mejor pronóstico (p > 0,05). Conclusiones Los enterococos son una causa frecuente de ITU complicadas en pacientes con factores de riesgo. La elevada mortalidad vinculada con la severidad de la infección y el grado de comorbilidad podrían justificar un tratamiento empírico en pacientes de riesgo (AU)

Background and objective Urinary tract infections (UTIs) are frequently caused by Enterococcus spp. This work aims to define the risk factors associated with UTIs caused by Enterococci and to determine its overall mortality and predictive risk factors. Materials and methods A retrospective study was conducted on bacteremic UTIs caused by Enterococcus spp. among inpatients. We compared 106 inpatients with bacteremic UTIs caused by Enterococcus spp. vs. a random sample of 100 inpatients with bacteremic UTIs caused by other enterobacteria. Results A total of 106 inpatients with UTIs caused by Enterococcus spp. were analyzed, 51 of whom had concomitant positive blood cultures. Distribution by species was 83% E. faecalis and 17% E. faecium. The mean Charlson Comorbidity Index score was 5.9 ± 2.9. Upon comparing bacteremic UTIs caused by Enterococcus spp. vs. bacteremic UTIs caused by others enterobacteria, we found the following independent predictors of bacteremic UTI by Enterococcus: male sex, obstructive uropathy, nosocomial infection, cancers of the urinary system, and previous antimicrobial treatment. Overall, inpatient mortality was 16.5% and was associated with a higher Sequential Organ Failure Assessment (SOFA) score (>4); severe comorbidities such as immunosuppression, malignant hemopathy, and nephrostomy; and Enterococcus faecium species and its pattern of resistance to ampicillin or vancomycin (p< 0.05). Appropriate empiric antibiotic therapy was not associated with a better prognosis (p >0.05). Conclusions Enterococcus spp. is a frequent cause of complicated UTI in patients with risk factors. High mortality secondary to a severe clinical condition and high comorbidity may be sufficient for justifying the implementation of empiric treatment of at-risk patients (AU)

Urinary tract infection caused by Enterococcus spp.: Risk factors and mortality. An observational study.

BACKGROUND AND OBJECTIVE: Urinary tract infections (UTIs) are frequently caused by Enterococcus spp. This work aims to define the risk factors associated with UTIs caused by Enterococci and to determine its overall mortality and predictive risk factors. MATERIALS AND METHODS: A retrospective study was conducted on bacteremic UTIs caused by Enterococcus spp. among inpatients. We compared 106 inpatients with bacteremic UTIs caused by Enterococcus spp. vs. a random sample of 100 inpatients with bacteremic UTIs caused by other enterobacteria. RESULTS: A total of 106 inpatients with UTIs caused by Enterococcus spp. were analyzed, 51 of whom had concomitant positive blood cultures. Distribution by species was 83% E. faecalis and 17% E. faecium. The mean Charlson Comorbidity Index score was 5.9±2.9. Upon comparing bacteremic UTIs caused by Enterococcus spp. vs. bacteremic UTIs caused by others enterobacteria, we found the following independent predictors of bacteremic UTI by Enterococcus: male sex, obstructive uropathy, nosocomial infection, cancers of the urinary system, and previous antimicrobial treatment. Overall, inpatient mortality was 16.5% and was associated with a higher Sequential Organ Failure Assessment (SOFA) score (>4); severe comorbidities such as immunosuppression, malignant hemopathy, and nephrostomy; and Enterococcus faecium species and its pattern of resistance to ampicillin or vancomycin (p<0.05). Appropriate empiric antibiotic therapy was not associated with a better prognosis (p>0.05). CONCLUSIONS: Enterococcus spp. is a frequent cause of complicated UTI in patients with risk factors. High mortality secondary to a severe clinical condition and high comorbidity may be sufficient for justifying the implementation of empiric treatment of at-risk patients.

Rethinking prognostic factors in locally advanced or metastatic urothelial carcinoma in the immune checkpoint blockade era: a multicenter retrospective study.

BACKGROUND: Few studies have investigated the safety and efficacy of anti-PD-(L)1 antibodies in metastatic urothelial carcinoma (mUC) in daily clinical practice. Knowledge about the influence of baseline clinical and analytical factors on therapy outcomes is scarce. PATIENTS AND METHODS: We conducted a multicenter retrospective study involving 119 previously treated or untreated mUC patients under anti-PD-(L)1 therapy in a real-world scenario. The objectives of this study were to confirm the safety and efficacy of anti-PD-(L)1 monotherapy and to identify pretreatment factors influencing therapy outcomes. In addition, an independent prognostic model for overall survival (OS) was developed and internally validated. RESULTS: Median OS was 7.8 months [95% confidence interval (CI), 5.4-10.4], median progression-free survival (PFS) was 2.80 months (95% CI, 2.4-3.4), disease control rate (DCR) was 40% (95% CI, 31-49), and overall response rate (ORR) was 24% (95% CI, 15-31). Presence of peritoneal metastases was associated with poor OS [hazard ratio (HR) = 2.40, 95% CI, 1.08-5.33; P = 0.03]. Use of proton-pump inhibitors (PPI) was associated with poor OS (HR = 1.83, 95% CI, 1.11-3.02; P = 0.02) and PFS (HR = 1.94, 95% CI, 1.22-3.09; P = 0.005), and lower DCR (OR = 0.38, 95% CI, 0.17-0.89; P = 0.03) and ORR (OR = 0.18, 95% CI, 0.02-1.60; P = 0.002). The three risk category prognostic model developed included Eastern Cooperative Oncology Group performance status, PPI use, albumin level, presence of liver metastases, and presence of peritoneal metastases variables and was associated with higher risk of death (HR = 3.00, 95% CI, 1.97-4.56; P = 0.0001). CONCLUSIONS: This study confirms anti-PD-(L)1 monotherapy as a safe and effective treatment option in daily clinical practice for mUC patients. It also describes the presence of peritoneal metastases as an independent prognostic factor for OS and underlines the association between PPI use and worse therapeutic outcomes. Finally, it proposes a new easy-to-use risk-assessment model for OS prediction.

Latest progress in molecular biology and treatment in genitourinary tumours.

The management of genitourinary cancer, including bladder, prostate, renal and testicular cancer, has evolved dramatically in recent years due to a better understanding of tumour genetic mutations, alterations in molecular pathways, and to the development of new kinds of drugs such as targeted therapies and immunotherapies. In the field of immunotherapy, new drugs focused on stimulating, enhancing and modulating the immune system to detect and destroy cancer, have been recently discovered. Research in oncology moves quickly and new data of great relevance for clinical practice are communicated every year. For this reason, a group of experts, focused exclusively on the treatment of genitourinary tumours and who get together every year in the BestGU conference to assess the latest progress in this field have summarized the most important advances in a single review, along with a critical assessment of whether these results should alter daily clinical practice.

Infección urinaria en el anciano / Urinary infection in the elderly

Introducción: Las infecciones del tracto urinario (ITU) constituyen una de las infecciones más frecuentes. En el anciano presentan diversas comorbilidades. El objetivo de este trabajo es conocer la epidemiologia clínica y microbiológica en el anciano ingresado por ITU y evaluar la idoneidad de los tratamientos empíricos y su implicación con la mortalidad. Material y métodos: Estudio observacional del 2013 al 2015 en 4 hospitales en pacientes mayores de 65 años ingresados en Medicina Interna con diagnóstico clínico y confirmación microbiológica. Se excluyeron los casos de bacteriuria asintomática. Se evaluó la mortalidad intrahospitalaria. Se realizó un análisis univariante y multivariante. Resultados: Se seleccionaron 349 episodios de pacientes con edad media 82 ±11 años, 51% mujeres. La mortalidad fue del 10,3%, asociada a la edad, demencia y presentación como sepsis grave/shock séptico (p < 0,05). Los aislamientos más frecuentes fueron Escherichia coli (E. coli) (53,6%), Klebsiella spp. (8,7%) y Enterococcus spp. (6,6%). Un 13% del total de los aislamientos correspondían a E. coli y Klebsiella spp. con betalactamasas de espectro extendido; el uso previo de antibióticos, cuidados socio-sanitarios y catéter urinario permanente fueron predictores independientes (p < 0,05). El tratamiento empírico resultó adecuado solo en el 73,6% de los casos. La falta de adecuación se asoció a una mayor mortalidad (p < 0,05). Conclusiones: La ITU del anciano que ingresa presenta una alta mortalidad. El tratamiento empírico es frecuentemente inadecuado y puede asociarse a una mayor mortalidad

Introduction: Urinary tract infections (UTIs) are one of the most frequent infections. In the elderly, they have multiple comorbidities. The objective of this work is to describe the clinical and microbiological epidemiology of elderly persons admitted for UTIs and to evaluate the suitability of empirical treatments and their implications regarding mortality. Material and methods: An observational study was conducted during 2013-2015 in 4public hospitals, with patients older than 65 years who were admitted to the Internal Medicine service with a microbiological diagnosis of UTI. Cases of asymptomatic bacteriuria were excluded. In-hospital mortality was analyzed. Univariate analysis and multivariate analysis was carried out. Results: A total of 349 episodes were selected, with a mean age of 82 ± 11 years, 51% female. Mortality was 10.3% and was associated with age, dementia and sepsis and septic shock (P<.05). The most frequent organisms were Escherichia coli(E. coli) (53.6%), Klebsiella spp. (8.7%) and Enterococcus spp. (6.6%). E. coli and Klebsiella spp. with extended-spectrum beta-lactamases (13% of the total isolated) were associated with the previous use of antibiotics, community care treatment and a permanent urinary catheter (P<.05). The empirical treatment was adequate only in 73.6% of cases. As these treatments were associated with higher mortality, they were not considered adequate. Conclusions: In the elderly, UTIs show a high mortality. Empirical treatment is often inadequate and may be associated with increased mortality

Urinary infection in the elderly. / Infección urinaria en el anciano.

INTRODUCTION: Urinary tract infections (UTIs) are one of the most frequent infections. In the elderly, they have multiple comorbidities. The objective of this work is to describe the clinical and microbiological epidemiology of elderly persons admitted for UTIs and to evaluate the suitability of empirical treatments and their implications regarding mortality. MATERIAL AND METHODS: An observational study was conducted during 2013-2015 in 4public hospitals, with patients older than 65 years who were admitted to the Internal Medicine service with a microbiological diagnosis of UTI. Cases of asymptomatic bacteriuria were excluded. In-hospital mortality was analyzed. Univariate analysis and multivariate analysis was carried out. RESULTS: A total of 349 episodes were selected, with a mean age of 82 ± 11 years, 51% female. Mortality was 10.3% and was associated with age, dementia and sepsis and septic shock (P<.05). The most frequent organisms were Escherichia coli(E. coli) (53.6%), Klebsiella spp. (8.7%) and Enterococcus spp. (6.6%). E. coli and Klebsiella spp. with extended-spectrum beta-lactamases (13% of the total isolated) were associated with the previous use of antibiotics, community care treatment and a permanent urinary catheter (P<.05). The empirical treatment was adequate only in 73.6% of cases. As these treatments were associated with higher mortality, they were not considered adequate. CONCLUSIONS: In the elderly, UTIs show a high mortality. Empirical treatment is often inadequate and may be associated with increased mortality.

Chemotherapy management for unfit patients with metastatic castration-resistant prostate cancer.

Administration of chemotherapy in prostate cancer depends on patient fitness. In unfit patients, physiological impairment determines the optimum treatment. Although no consensus on assessing patient fitness currently exists, this article proposes an algorithm combining the available information for administering chemotherapy, and in particular docetaxel, in unfit patients. It was constructed by reviewing factors that can influence treatment, such as performance status, taxane-related comorbidities and nutritional status. Geriatric scales for prostate cancer patients and alternative treatment regimens for this population are also reviewed. In summary, patients require overall assessment to optimise treatment. Use of docetaxel should be restricted in unfit patients, and other options must be evaluated, because of high toxicity and low efficacy.

Abordaje del paciente con cáncer renal: ¿existe la colaboración entre urología y oncología? / Approach of the patient with renal cancer: Is there a collaboration between urology and oncology?

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Update on the distribution of the co-invasive Schyzocotyle acheilognathi (= Bothriocephalus acheilognathi), the Asian fish tapeworm, in freshwater fishes of Mexico.

The Asian fish tapeworm, Schyzocotyle acheilognathi (syn. Bothriocephalus acheilognathi) represents a threat to freshwater fish, mainly cyprinids, across the globe. This tapeworm possesses an extraordinary ability to adapt to different environmental conditions and, because of that, from its natural geographical origin in mainland Asia, it has colonized every continent except Antarctica. It is thought that this pathogenic tapeworm was first co-introduced into Mexico in 1965 from China, with the grass carp Ctenopharyngodon idella, although the first formal record of its presence was published in 1981. Over the past 35 years, the Asian fish tapeworm has invaded about 22% of the freshwater fish in Mexico. Because fish communities in Mexico are characterized by high species richness and levels of endemism, S. acheilognathi is considered as a co-introduced and co-invasive species. In this review, we update the geographic distribution and host spectrum of the Asian fish tapeworm in Mexico. Up until December 2016, the tapeworm had been recorded in 110 freshwater fish species (96 native and 14 introduced), included in 51 genera, 11 families and 4 orders; it was also widely distributed in all types of aquatic environments, and has been found in 214 localities. We present novel data from a survey aimed at establishing the distribution pattern of the tapeworm in native freshwater fishes of two rivers in north-central Mexico, and the genetic variation among individuals of this co-invasive species collected from different host species and localities. We discuss briefly the factors that have determined the remarkable invasive success of this parasite in freshwater systems in Mexico.

Androgen receptor gene status in plasma DNA associates with worse outcome on enzalutamide or abiraterone for castration-resistant prostate cancer: a multi-institution correlative biomarker study.

BACKGROUND: There is an urgent need to identify biomarkers to guide personalized therapy in castration-resistant prostate cancer (CRPC). We aimed to clinically qualify androgen receptor (AR) gene status measurement in plasma DNA using multiplex droplet digital PCR (ddPCR) in pre- and post-chemotherapy CRPC. METHODS: We optimized ddPCR assays for AR copy number and mutations and retrospectively analyzed plasma DNA from patients recruited to one of the three biomarker protocols with prospectively collected clinical data. We evaluated associations between plasma AR and overall survival (OS) and progression-free survival (PFS) in 73 chemotherapy-naïve and 98 post-docetaxel CRPC patients treated with enzalutamide or abiraterone (Primary cohort) and 94 chemotherapy-naïve patients treated with enzalutamide (Secondary cohort; PREMIERE trial). RESULTS: In the primary cohort, AR gain was observed in 10 (14%) chemotherapy-naïve and 33 (34%) post-docetaxel patients and associated with worse OS [hazard ratio (HR), 3.98; 95% CI 1.74-9.10; P < 0.001 and HR 3.81; 95% CI 2.28-6.37; P < 0.001, respectively], PFS (HR 2.18; 95% CI 1.08-4.39; P = 0.03, and HR 1.95; 95% CI 1.23-3.11; P = 0.01, respectively) and rate of PSA decline ≥50% [odds ratio (OR), 4.7; 95% CI 1.17-19.17; P = 0.035 and OR, 5.0; 95% CI 1.70-14.91; P = 0.003, respectively]. AR mutations [2105T>A (p.L702H) and 2632A>G (p.T878A)] were observed in eight (11%) post-docetaxel but no chemotherapy-naïve abiraterone-treated patients and were also associated with worse OS (HR 3.26; 95% CI 1.47-not reached; P = 0.004). There was no interaction between AR and docetaxel status (P = 0.83 for OS, P = 0.99 for PFS). In the PREMIERE trial, 11 patients (12%) with AR gain had worse PSA-PFS (sPFS) (HR 4.33; 95% CI 1.94-9.68; P < 0.001), radiographic-PFS (rPFS) (HR 8.06; 95% CI 3.26-19.93; P < 0.001) and OS (HR 11.08; 95% CI 2.16-56.95; P = 0.004). Plasma AR was an independent predictor of outcome on multivariable analyses in both cohorts. CONCLUSION: Plasma AR status assessment using ddPCR identifies CRPC with worse outcome to enzalutamide or abiraterone. Prospective evaluation of treatment decisions based on plasma AR is now required. CLINICAL TRIAL NUMBER: NCT02288936 (PREMIERE trial).

A randomized phase II/III study of cabazitaxel versus vinflunine in metastatic or locally advanced transitional cell carcinoma of the urothelium (SECAVIN).

BACKGROUND: Despite the advent of immunotherapy in urothelial cancer, there is still a need to find effective cytotoxic agents beyond first and second lines. Vinflunine is the only treatment approved in this setting by the European Medicines Agency and taxanes are also widely used in second line. Cabazitaxel is a taxane with activity in docetaxel-refractory cancers. A randomized study was conducted to compare its efficacy versus vinflunine. PATIENTS AND METHODS: This is a multicenter, randomized, open-label, phase II/III study, following a Simon's optimal method with stopping rules based on an interim futility analysis and a formal efficacy analysis at the end of the phase II. ECOG Performance Status, anaemia and liver metastases were stratification factors. Primary objectives were overall response rate for the phase II and overall survival for the phase III. RESULTS: Seventy patients were included in the phase II across 19 institutions in Europe. Baseline characteristics were well balanced between the two arms. Three patients (13%) obtained a partial response on cabazitaxel (95% CI 2.7-32.4) and six patients (30%) in the vinflunine arm (95% CI 11.9-54.3). Median progression-free survival for cabazitaxel was 1.9 versus 2.9 months for vinflunine (P = 0.039). The study did not proceed to phase III since the futility analysis showed a lack of efficacy of cabazitaxel. A trend for overall survival benefit was found favouring vinflunine (median 7.6 versus 5.5 months). Grade 3- to 4-related adverse events were seen in 41% patients with no difference between the two arms. CONCLUSION: This phase II/III second line bladder study comparing cabazitaxel with vinflunine was closed when the phase II showed a lack of efficacy of the cabazitaxel arm. Vinflunine results were consistent with those known previously. TRIAL NUMBER: NCT01830231.

[Pneumococcal arthritis in paediatric population]. / Artritis neumocócica en población pediátrica.

OBJECTIVE: Cases of septic arthritis in paediatric population by Streptococcus pneumoniae in the Health Area of Santiago de Compostela (Spain) were reviewed. METHODS: A retrospective study from January 2005 to March 2014 was conducted for all S. pneumoniae isolates obtained from joint fluids in children. RESULTS: From the 7,416 joint fluids received in the Microbiology Department, 77 belonged to paediatric patients, and of these, only 8 had positive culture. In total, there were three positive cases for S. pneumoniae, two with positive culture and a third with positive antigen detection. In the three patients (two of them under 15 months) the affected joint was hip, antibiotic treatment was combined with surgical drainage and evolution was favourable. CONCLUSIONS: We conclude that pneumococcal arthritis is an entity that must be taken into account since most cases of arthritis in paediatric population appear as a complication of bacteraemia after a common cold or an ear infection. The greatest risk of sequel is associated with delays in diagnosis, so it is essential clinical and microbiological early diagnosis.

[Changes in the epidemiology of Clostridium difficile infection during 2005-2014 in Salamanca, Spain]. / Cambios en la epidemiología de la infección por Clostridium difficile durante 2005-2014 en Salamanca, España.

OBJECTIVE: To know the most relevant epidemiological features of Clostridium difficile infection (CDI) between 2005- 2014 in the province of Salamanca (Spain). METHODS: Descriptive cross-sectional study carried out through review of the clinical microbiologic records at Complejo Asistencial Universitario de Salamanca. Detection was performed according to standard methodology. RESULTS: 2.6% of stool samples analyzed for detection of C. difficile toxins (9,103) were positive. The average prevalence was 6.8 cases per 100,000 people per year. The mean age was 65 ± 21.4 years and the median 70 years. 59% of cases occurred in patients over 64 years, with an average prevalence of 16.5 (4 times higher than the 15-64 group). Most cases (86.4%) occurred in hospitalized patients, and the group of over 64 had the highest percentage of hospital CDI, with 55%. CONCLUSIONS: A significant increase in the number of requests and in the prevalence of CDI over the decade studied is observed, and prevalence rates were significantly lower than those of other studies. The percentage of CDI increased significantly in both inpatient and community. Age and hospitaliza-tion were risk factors for developing CDI. After the introduc-ion of a molecular detection technique in 2014, the prevalence increased, being 2.5 times higher than 2013.

Scintigraphic depiction of non-ossifying fibromas and the role of SPECT/CT / Representación gammagráfica de fibromas no osificantes y el rol de SPECT/TAC

Non-ossifying fibromas (NOF) are a benign entity of the developing bone, relatively common in children and young adults. Their location is most frequently metaphyseal. They are usually asymptomatic (unless associated to a fracture) and have a self-limited behavior, with spontaneous regression through a sclerotic consolidation. Plain X-ray is the main imaging tool for its diagnosis. However, an unclear X-ray may lead to further imaging studies. We present the case of a 17-year-old male with back pain and lower limb dysmetria referred for a bone scintigraphy to complete the diagnostic and assess disease extension and the subsequent MRI evaluation

Los fibromas no osificantes (NOF) son entidades benignas del hueso en desarrollo, relativamente frecuentes en niños y adultos jóvenes. Su localización más habitual es la metáfisis de los huesos largos, suelen ser asintomáticos (excepto si se asocian a una fractura) y normalmente se autolimitan, regresando espontáneamente mediante una consolidación esclerosante. La radiografía simple es la principal herramienta para su diagnóstico. Sin embargo, una radiografía dudosa puede llevar a la realización de otras pruebas de imagen. Presentamos el caso de un chico de 17 años con dolor de espalda y dismetría de miembros inferiores, remitido para la realización de una gammagrafía ósea con la finalidad de completar el diagnóstico y evaluar la extensión de la afectación, y la posterior valoración mediante RM

Potential toxic effects of aircraft de-icers and wastewater samples containing these compounds.

One of the major problems of airport operation is the impact of pollution caused by runoff waters. Runoff waters at an airport may contain high concentrations of different contaminants resulting from various activities of its operation. High quantities of aircraft de-icing/anti-icing fluids are used annually at airports worldwide. Aircraft de-icers and anti-icers may have negative environmental impacts, but their effects on aquatic organisms are virtually unknown. In order to address this issue, aircraft de-icers, pavement de-icers and wastewater samples were obtained from a regional airport. To evaluate the toxicity of wastewater samples and aircraft de-icing/anti-icing fluids (ADAFs), two bio-tests were performed: the Lemna growth inhibition test according to OECD guideline 221 and the luminescent bacteria test according to ISO guideline 11348-2. In the Lemna growth inhibition test, phytotoxicity was assessed using the endpoints frond number and frond area. The luminescent bacteria test involved the marine bacterium Vibrio fischeri. The estimates of effective concentrations (EC50) values were determined using the free software R and the "drc" library. Aquatic plants and marine bacteria showed a higher sensitivity towards ADAFs than to wastewater samples. Experiments showed that aircraft de-icing/anti-icing fluids and wastewater samples were relatively more toxic towards Lemna gibba L. in comparison to V. fischeri.

Scintigraphic depiction of non-ossifying fibromas and the role of SPECT/CT.

Non-ossifying fibromas (NOF) are a benign entity of the developing bone, relatively common in children and young adults. Their location is most frequently metaphyseal. They are usually asymptomatic (unless associated to a fracture) and have a self-limited behavior, with spontaneous regression through a sclerotic consolidation. Plain X-ray is the main imaging tool for its diagnosis. However, an unclear X-ray may lead to further imaging studies. We present the case of a 17-year-old male with back pain and lower limb dysmetria referred for a bone scintigraphy to complete the diagnostic and assess disease extension and the subsequent MRI evaluation.

Comprehensive overview of the efficacy and safety of sorafenib in advanced or metastatic renal cell carcinoma after a first tyrosine kinase inhibitor

We performed a literature search that shed light on the signaling pathways involved in the sorafenib activity as first- or subsequent-line treatment, taking into account its toxicity profile. Sorafenib appears to have better tolerability when compared with other agents in the same indication. Cross-resistance between tyrosine kinase inhibitors (TKIs) may be limited, even after failure with a previous VEGFR inhibitor, but the optimal sequence with TKIs remains to be determined. Randomized trials of second-line treatment options have showed either modest or no differences in terms of progression-free and overall survival (OS). Direct comparison between sorafenib and axitinib demonstrated differences in terms of PFS in favor of axitinib, but not in terms of OS as second-line treatment. In contrast, a phase III study showed a benefit in OS, favoring sorafenib when compared with temsirolimus. In conclusion, after using other VEGF inhibitor such as sunitinib, sorafenib is active and safe for the treatment of patients with advanced or metastatic RCC (AU)

Comprehensive overview of the efficacy and safety of sorafenib in advanced or metastatic renal cell carcinoma after a first tyrosine kinase inhibitor.

We performed a literature search that shed light on the signaling pathways involved in the sorafenib activity as first- or subsequent-line treatment, taking into account its toxicity profile. Sorafenib appears to have better tolerability when compared with other agents in the same indication. Cross-resistance between tyrosine kinase inhibitors (TKIs) may be limited, even after failure with a previous VEGFR inhibitor, but the optimal sequence with TKIs remains to be determined. Randomized trials of second-line treatment options have showed either modest or no differences in terms of progression-free and overall survival (OS). Direct comparison between sorafenib and axitinib demonstrated differences in terms of PFS in favor of axitinib, but not in terms of OS as second-line treatment. In contrast, a phase III study showed a benefit in OS, favoring sorafenib when compared with temsirolimus. In conclusion, after using other VEGF inhibitor such as sunitinib, sorafenib is active and safe for the treatment of patients with advanced or metastatic RCC.