FDG PET/CT in colorectal cancer. / FDG PET/TC en el cáncer colorrectal.

Colorectal cancer is the third most frequent cancer worldwide. Although its incidence is increasing, mainly in those aged under50, mortality has decreased by 50% in the more developed countries, principally due to the adoption of new practices in prevention, diagnosis and treatment. In particular, the various diagnostic imaging modalities allow improved therapeutic decision-making, evaluation of the response and early detection of recurrence. The aim of this paper is to review the available scientific evidence on the value of positron emission tomography with 18F-FDG (18F-FDG PET/CT) in the colorectal cancer, with special emphasis on the indications of the guidelines and recommendations of the main international scientific associations regarding this imaging technique.

Incidence of new-onset benign anal disorders after bariatric surgery.

New-onset benign anal disorders (NBADs) represent a potential complication following bariatric surgery, although their incidence in this population is not well studied. The preoperative characteristics, weight loss, bowel habits and NBADs data of 196 patients with bariatric surgery were collected by telephone interviews and medical records review and evaluated retrospectively. Ninety-nine patients had undergone gastric bypass (GBP) and 97 had a modified biliopancreatic diversion (MBPD). Fifty-nine patients were excluded. The mean follow-up of the remaining 137 patients was 87.8 months, and 51 of them (37.2%) developed NBADs. Haemorrhoids were the most common diagnosis and 27.5% of the patients that developed NBADs were treated surgically. Patients who developed NBADs had a longer follow-up time (92.5 vs. 85.1 months, P = 0.003), and those with an abnormal bowel habit (diarrhoea or constipation) had a higher percentage of NBADs (54.5 vs. 28.3%, P = 0.003). NBADs were more frequent after MBPD (52.9%) than after GBP (21.7%) (P < 0.001). Multivariate analysis found that only an abnormal bowel habit was associated with NBADs, with an odds ratio of 3.2 (95% CI: 1.5-6.9, P = 0.003). As NBADs are a common complication after bariatric surgery, further studies should be performed to find the reasons for these complications.

18F-FDG PET/CT in the clinical management of patients with lymphoma. / 18F-FDG PET/TC en el manejo clínico de los linfomas.

The aim of this work was to review the current recommendations for staging and response assessment of patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) in routine clinical practice after chemotherapy and/or stem cell transplantation. A five-point scale (5-PS) from the First International Workshop on PET in Lymphoma in Deauville, France, in 2009, was recommended as the standard tool to score imaging to assess treatment response in patients with lymphoma using 18F-Fluorodeoxyglucose (FDG) PET/CT. Following the recommendations of the 11th and 12th International Conferences on Malignant Lymphoma held in Lugano (Switzerland), in 2011 and 2013, respectively, a consensus (the so-called Lugano Classification) was reached regarding the use of PET/CT for staging and response assessment in FDG-avid lymphomas. As a result, 18F-FDG PET/CT was formally incorporated into standard staging for FDG-avid lymphomas. A bone marrow biopsy is no longer indicated for the routine staging of HL and most diffuse large B-cell lymphomas. PET/CT will be used to assess response in FDG-avid histologies using the 5-point scale. The recent introduction of biological agents with immune mechanisms requires flexibility in interpretations of the Lugano criteria due to tumour flare or a pseudo-progression effect produced by these agents. Provisional criteria have been proposed (Lymphoma Response to Immunomodulatory Therapy Criteria) with the introduction of the term 'Indeterminate Response' in order to identify this phenomenon until confirmed as flare/pseudoprogression or true progression. All these recommendations will improve evaluations of patients with lymphoma, and allow comparison of results from clinical practice and trials.

Contribution of early SPECT/CT to 99mTc-MIBI double phase scintigraphy in primary hyperparathyroidism: Diagnostic value and correlation between uptake and biological parameters.

AIM: To evaluate the value of 99mTc-MIBI double-phase scintigraphy (DPS) and early SPECT/CT in the pre-surgical assessment of patients with primary hyperparathyroidism (PHPT). Also, to calculate the correlation between uptake and some biological parameters. MATERIAL AND METHODS: Forty patients with PHPT were included: 37 solitary adenomas, 1 hyperplasia, and 2 double adenomas. Fifteen patients had ectopic glands. DPS and early SPECT/CT were acquired in all patients. Ultrasound was performed in 31/40. All patients underwent surgery, intra-operative iPTH measurements, and histopathological examinations. Qualitative DPS uptake was assessed and correlated to pre-surgical calcium, iPTH levels, gland weight, and maximum diameter. RESULTS: In the planar study, there were 23 positive cases, 8 doubtful, and 9 negatives. With the SPECT/CT, 8/9 negatives cases were located. All doubtful cases were confirmed as positives. Gland location improved in 16 cases (12 ectopic). DPS+SPECT/CT failed to detect a solitary adenoma and at least one gland in three cases of multiglandular disease (MGD). The sensitivity by patient was: DPS 72.5%, DPS+SPECT/CT 90%, and ultrasound 42%. Ultrasound and scintigraphy (DPS+SPECT/CT) were concordant in 16/31 patients. For the rest of them, scintigraphy proved correct in 14/15, and both techniques failed in one case. There was a significant correlation between level of uptake and iPTH level, gland weight, and maximum diameter. CONCLUSION: Early SPECT/CT improves sensitivity and the locating of parathyroid pathological glands and increases diagnostic confidence. iPTH level, glandular size, and weight are related to the qualitative assessment of 99mTc-MIBI uptake in early DPS.

HaNDL syndrome: Correlation between focal deficits topography and EEG or SPECT abnormalities in a series of 5 new cases. / Síndrome HaNDL: correlación entre la topografía del déficit neurológico y las alteraciones en electroencefalograma y SPECT en una serie de 5 nuevos casos.

INTRODUCTION: Transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) is characterised by migraine-like headache episodes accompanied by neurological deficits consisting of motor, sensory, or aphasic symptoms. Electroencephalogram (EEG) and single photon emission computed tomography (SPECT) may show focal abnormalities that correspond to the neurological deficits. We aim to evaluate the correlation between focal deficit topography and EEG or SPECT abnormalities in 5 new cases. PATIENTS: We retrospectively reviewed patients attended in a tertiary hospital (January 2010-May 2014) and identified 5 patients (3 men, 2 women) with a mean age of 30.6 ± 7.7 (21-39) years. They presented 3.4 ± 2.6 episodes of headache (range, 2-8) of moderate to severe intensity and transient neurological deficits over a maximum of 5 weeks. Pleocytosis was detected in CSF in all cases (70 to 312 cells/mm3, 96.5-100% lymphocytes) with negative results from aetiological studies. RESULTS: At least one EEG was performed in 4 patients and SPECT in 3 patients. Patient 1: 8 episodes; 4 left hemisphere, 3 right hemisphere, and 1 brainstem; 2 EEGs showing left temporal and bilateral temporal slowing; normal SPECT. Patient 2: 2 episodes, left hemisphere and right hemisphere; SPECT showed decreased left temporal blood flow. Patient 3: 3 left hemisphere deficits; EEG with bilateral frontal and temporal slowing. Patient 4: 2 episodes with right parieto-occipital topography and right frontal slowing in EEG. Patient 5: 2 episodes, right hemisphere and left hemisphere, EEG with right temporal slowing; normal SPECT. CONCLUSION: The neurological deficits accompanying headache in HaNDL demonstrate marked clinical heterogeneity. SPECT abnormalities and most of all EEG abnormalities were not uncommon in our series and they did not always correlate to the topography of focal déficits.

[Radioguided surgery in neuroendocrine tumors. A review of the literature]. / Cirugía radioguiada de tumores neuroendocrinos. Revisión de la literatura.

Radioguided surgery can be a useful technique in the localization of neuroendocrine tumors. It detects more and smaller lesions compared to pre-surgical imaging and intraoperative digital palpation by the surgeon. It detects residual lesions and also indicates the shortest access route to the lesion. Nevertheless, its use has not become widespread because of technical difficulties. There is a limited number of published series, a lack of standardized protocol because of the great variability regarding type of radiopharmaceutical, dose of radiotracer, timing between injection and surgery. In this paper, we review these issues, describing the experience of different authors in diverse tumors.

Evaluation by SPECT-CT of an incidental finding of a thymoma and breast cancer in a myocardial perfusion SPECT with 99mTc-MIBI.

We present a case of a 78-year-old female with effort angina. A myocardial perfusion SPECT (MPS) showed increased tracer uptake in two synchronic tumor lesions, a thymoma and a breast cancer. This case highlights the contribution of SPECT-CT in the characterization of these findings and its essential role in rapid decision-making. The patient underwent surgery of both lesions that had gone undetected prior to the conduction of the MPS.

SPECT-CT in the localization of an ectopic retropharyngeal parathyroid adenoma as a cause for persistent primary hyperparathyroidism.

A common cause for surgical failure of primary hyperparathyroidism (pHPT) is the non-detection of an ectopic adenoma during the intervention. We present a case of a patient with pHPT in whom an ectopic gland was found in the right retropharyngeal space by means of a double phase (99m)Tc-methoxy-isobutyl-isonitrile ((99m)Tc-MIBI) scintigraphy and early SPECT-CT after several surgeries and imaging tests. The addition of a tomography to the planar scintigraphy increases its sensitivity and improves pathological parathyroid glands localization. The hybrid imaging is sometimes essential to obtain surgical success, as in the case of ectopic adenomas.

Real-time RT-PCR analysis for evaluating the Her2/neu status in breast cancer.

OBJECTIVE: The Her2/neu status is of great clinical value in breast tumor patients. Fluorescence in situ hybridization (FISH) and immunohistochemistry (IHC) techniques are the test of choice for many practicing pathologies. The main objective of this retrospective study was to investigate the relationship between Her2/neu breast cancer amplification and overexpression (DNA, mRNA and protein). METHODS: To accomplish this goal, we evaluated Her2/neu mRNA expression by real-time quantitative RT-PCR, gene amplification by FISH and protein expression by IHC. RESULTS: An excellent correlation between FISH and IHC Her2/neu results was observed, confirming that protein levels were directly related to DNA amplification. Polysomy 17 was frequently found in tumors showing Her2/neu overexpression. However, we did not find any statistically significant correlation among DNA, mRNA and protein levels, suggesting that Her2/neu could be post-transcriptionally regulated. CONCLUSIONS: There was a highagreement between Her2/neu gene amplification and protein overexpression but not mRNA expression levels. Nevertheless, IHC3+ and FISH-positive tumors indicated higher expression levels of Her2/neu mRNA by RT-PCR than those observed in IHC and FISH-negative tumors. These findings question the relevance of quantitative RT-PCR in routine assessment of Her2/neu overexpression in human breast cancer in the clinical laboratory setting.

[Conscientous health objection in the prison environment]. / La objeción de conciencia sanitaria en el ámbito penitenciario.

To be fully in accordance with constitutional doctrines the notion of conscientious objection must be understood as a manifestation of the fundamental right to ideological freedom as contained in art. 16.1 CE (assuming of course that all objecting conduct is legitimate), but it must also be understood as a principle. That is to say, any conflict between the subject's fundamental right and legal duty that he rejects must be resolved by the judge who must make a careful judgement of values and property. This fundamental right still exists and may invoked and exercised by inmates and health personnel in the prison context in the face of predictions of the forcible imposition of medical treatment as stated in the LOGP and RP, with no more limit than public order itself.

The histological spectrum of non-granulomatous localized mucosal leishmaniasis caused by Leishmania infantum.

Although human mucosal leishmaniasis is much more common in Latin America, a few cases that are the result of local transmission occur in Europe. A suspected case of leishmaniasis is usually confirmed by the demonstration of amastigotes in smears, the culture of promastigotes from blood or tissue samples, or the PCR-based demonstration of leishmanial DNA. Biopsies may contain too few parasites to be found positive by microscopy or culture, however, and then a diagnosis may be difficult, especially in regions where human leishmaniasis in general or particular forms of the disease are rarely seen. The aim of the present study was to investigate the histopathological characteristics of three Spanish cases of non-granulomatous mucosal leishmaniasis caused by Leishmania infantum. The hope was that the information collected will help European clinicians diagnose such cases, even when amastigotes cannot be readily demonstrated.

Cytochrome P450 3A5 is highly expressed in normal prostate cells but absent in prostate cancer.

Testosterone is essential for the growth and function of the luminal prostate cells, but it is also critical for the development of prostate cancer, which in the majority of the cases derives from luminal cells. Cytochrome P450 3A (CYP3A) enzymes hydroxylate testosterone and dehydroepiandrosterone to less active metabolites, which might be the basis for the association between CYP3A polymorphisms and prostate cancer. However, it is unknown whether the CYP3A enzymes are expressed at relevant levels in the prostate and which polymorphisms could affect this tissue-specific CYP3A activity. Thus, we measured CYP3A4, CYP3A5, CYP3A7, and CYP3A43 mRNA in 14 benign prostatic hyperplasias and ten matched non-tumoral/tumoral prostate samples. We found that CYP3A5 mRNA in non-tumoral prostate tissue was 10% of the average amount of liver samples, whereas the expression of the other CYP3A genes was much lower. Similarly to liver, CYP3A5*3 polymorphism decreased CYP3A5 mRNA content 13-fold. CYP3A5 protein was detected in non-tumoral prostate microsomes by western blot, and immunohistochemistry (IHC) localized CYP3A5 exclusively in the basolateral prostate cells. In contrast to the normal tissue, IHC and RT-PCR showed that tumoral tissue lacked CYP3A5 expression. In conclusion, prostate basolateral cells express high levels of CYP3A5 which dramatically decrease in tumoral tissue. This finding supports an endogenous function of CYP3A5 related to the metabolism of intra-prostatic androgens and cell growth, and that polymorphisms affecting CYP3A5 activity may result in altered prostate cancer risk and aggressiveness.

Human papillomavirus associated with papillary squamous cell carcinoma of the oropharynx in a renal transplant recipient.

The papillary squamous cell carcinoma (PSCC) is a rare variant of the head and neck squamous cell carcinoma. Established etiological factors can include tobacco smoking and heavy alcohol abuse. Moreover, human papillomavirus infection can be involved in the pathogenesis of PSCC. This tumor is more frequent in patients with immunosuppression including those who have received a transplant. Most of the cases are produced by genotype HPV-6 and HPV-16, although there is a possibility of infection by other HPV subtypes. We present a case report of a PSCC and papilloma with oropharyngeal location in which high-risk HPV type 16 and low-risk HPV type 6, respectively, were identified by PCR in a renal transplant patient.

Forward-backward asymmetries of lepton pairs in events with a large-transverse-momentum jet at hadron colliders.

We discuss forward-backward charge asymmetries for lepton-pair production in association with a large-transverse-momentum jet at hadron colliders. The lepton charge asymmetry relative to the jet direction A(j)(FB) gives a new determination of the effective weak mixing angle sin((2)theta(lept)(eff)(M(2)(Z)) with a statistical precision after cuts of approximately 10(-3) (8x10(-3)) at LHC (Tevatron). This is to be compared with the current uncertainty at LEP and SLD from the asymmetries alone, 2x10(-4). The identification of b jets also allows for the measurement of the bottom-quark-Z asymmetry A(b)(FB) at hadron colliders, the resulting statistical precision for sin((2)theta(lept)(eff)(M(2)(Z)) being approximately 9x10(-4) (2x10(-2) at Tevatron), also lower than the reported precision at e(+)e(-) colliders, 3x10(-4).

Eta(') mass and chiral symmetry breaking at large N(c) and N(f).

We propose a method for implementing the large- N(c), large-N(f) limit of QCD at the effective Lagrangian level. Depending on the value of the ratio N(f)/N(c), different patterns of chiral symmetry breaking can arise, leading in particular to different behaviors of the eta(') mass in the combined large-N limit.

Enantioselective addition of a chiral thiazolidinethione-derived titanium enolate to acetals.

[reaction: see text] High stereoselectivities (up to 98% de) have been achieved for the Lewis acid-mediated cross-coupling reaction of dimethyl acetals to a chiral 1,3-thiazolidine-2-thione-derived titanium enolate. The reaction affords enantiopure anti alpha-methyl-beta-alkoxy carbonyl compounds in a wide range of acetals.

Hydatid liver cyst perforation into the digestive tract.

Complications of liver hydatid disease include those related to the compression of adjacent viscus, to the infection of the cyst's contents or to the perforation of the cyst. Perforations into hollow abdominal organs are rare, and can occur secondary to the infection of the cyst or to a primary pathology of the perforated organ. We report on 2 cases of perforation of a liver cyst into the duodenum, 1 due to the presence of a duodenal ulcer, and 1 secondary to a hydatid abscess. The surgical treatment of the lesions and their complications was, in both cases, successful.