The role of 2-[18F]FDG PET/CT in Erdheim-Chester disease.

OBJECTIVE: To analyze the body distribution of Erdheim-Chester disease (ECD) and determine the utility of 2-[18 F]FDG PET/CT compared to other imaging techniques. Additionally, to assess the aggressiveness and extent of the disease based on the presence/absence of the BRAFV600E mutation. MATERIALS AND METHODS: The 2-[18F]FDG-PET/CT scans of all patients diagnosed with ECD between 2008 and 2021 were reviewed, including 19 patients. The affected territories were classified as detectable by PET/CT or detectable only by other imaging techniques (bone scintigraphy, contrast-enhanced CT, or MRI). Descriptive analysis and correlation of the BRAF mutation with the affected organs and maximum SUV were performed using the Student's t-test. RESULTS: Out of the 19 patients (14 males; mean age 60.3 years), 11 had the BRAFV600E mutation. A total of 127 territories (64 organ-systems) affected were identified using different imaging modalities, of which 112 were detected by PET/CT, and an additional 15 territories were solely identified by cerebral and cardiac MRI. The presence of BRAFV600E mutation was associated with greater organ involvement (p < 0.05) without differences in SUVmax (p > 0.05). CONCLUSION: 2-[18F]FDG PET/CT is a highly effective diagnostic tool in patients with ECD, detecting the majority of affected territories. MRI was the only imaging modality with additional findings in territories showing high physiological uptake of 2-[18F]FDG (cerebral and cardiac). The presence of the BRAFV600E mutation correlated with a higher extent of the disease.

Role of sCD40L in the prediction of super-response to cardiac resynchronization therapy.

BACKGROUND: The aim of this paper is to analyze the role of the biomarkers Interleukin 6, Tumoral Necrosis Factor a, sCD40L, high sensitive Troponin T, high sensitive C-Reactive Protein and Galectin-3 in predicting super response (SR) to Cardiac Resynchronization Therapy (CRT), as they have not been studied in this field before. METHODS: Clinical, electrocardiographic and echocardiographic data was obtained preimplant and after one year. SR was defined as reduction in LVESV = 30% at one year follow-up. Blood samples were extracted preimplant. Multivariate logistic regression and ROC curves were performed. RESULTS: 50 patients were included, 23 (46%) were SR. Characteristics related to SR were: female (35 vs. 11%, p?=?0.04), suffering from less ischemic cardiomyopathy (13 vs. 63%, p?

18F-FDG PET/CT in a patient with atypical presentation of cardiac angiosarcoma. / PET/TC con 18F-FDG en paciente con presentación atípica de angiosarcoma cardiaco.

Primary cardiac or pericardial tumors are infrequent, metastatic involvement being more common. Cardiac angiosarcoma is a rare primary malignant tumor of mesenchymal origin. It entails a poor prognosis mostly due to frequent metastases at the time of diagnosis, as well as low response to onco-specific treatments. We describe a case of a 74-year-old patient with a primary cardiac angiosarcoma with an infrequent location at pericardium level. We review the literature and the utility of 18F-FDG PET/CT in the initial staging.

[Operational units for health risk management (patient safety)]. / Las unidades funcionales para la gestión de riesgos sanitarios (seguridad del paciente).

In 1995 INSALUD began to develop performance measures in the field of risk management, and following transfer of powers to the regions, these led to the development of operational units in individual healthcare centres. These units, which consist of a group of health professionals, including managers, aim to identify, evaluate, analyse and deal with health risks, to enhance patient safety. Their organisational structure can vary in accordance with the needs, resources and philosophy of each individual organisation. This paper presents the experience of the risk management units developed in four Spanish regions: Madrid, the Basque Country, Galicia and INGESA (Ceuta and Melilla). It also includes reflections on assessment of their impact and on their future role in improving safety in healthcare services.

A 3D Hermite-based multiscale local active contour method with elliptical shape constraints for segmentation of cardiac MR and CT volumes.

Analysis of cardiac images is a fundamental task to diagnose heart problems. Left ventricle (LV) is one of the most important heart structures used for cardiac evaluation. In this work, we propose a novel 3D hierarchical multiscale segmentation method based on a local active contour (AC) model and the Hermite transform (HT) for LV analysis in cardiac magnetic resonance (MR) and computed tomography (CT) volumes in short axis view. Features such as directional edges, texture, and intensities are analyzed using the multiscale HT space. A local AC model is configured using the HT coefficients and geometrical constraints. The endocardial and epicardial boundaries are used for evaluation. Segmentation of the endocardium is controlled using elliptical shape constraints. The final endocardial shape is used to define the geometrical constraints for segmentation of the epicardium. We follow the assumption that epicardial and endocardial shapes are similar in volumes with short axis view. An initialization scheme based on a fuzzy C-means algorithm and mathematical morphology was designed. The algorithm performance was evaluated using cardiac MR and CT volumes in short axis view demonstrating the feasibility of the proposed method.

18F-FDG metabolism in a rat model of chronic infarction: a 17-sector semiquantitative analysis.

UNLABELLED: Strategies to establish the functional benefit of cell therapy in cardiac regeneration and the potential mechanism are needed. AIMS: Development of a semi-quantitative method for non invasive assessment of cardiac viability and function in a rat model of myocardial infarction (MI) based on the use of microPET. ANIMALS, METHODS: Ten rats were subjected to myocardial imaging 2, 7, 14, 30, 60 and 90 days after left coronary artery ligation. Intravenous 18F-fluoro-2-deoxy-2-D-glucose (18F-FDG) was administered and regional 18F activity concentrations per unit area were measured in 17 regions of interest (ROIs) drawn on cardiac polar maps. By comparing the differences in 18F uptake between baseline and each of the follow up time points, parametric polar maps of statistical significance (PPMSS) were calculated. Left ventricular ejection fraction (LVEF) was blindly assessed echocardiographically. All animals were sacrificed for histopathological analysis after 90 days. RESULTS: The diagnostic quality of 18F-FDG microPET images was excellent. PPMSS demonstrated a statistically significant decrease in 18F concentrations as early as 48 hours after MI in 4 of the 17 ROIs (segments 7, 13, 16 and 17; p < 0.05) that persisted throughout the study. Semiquantitative analysis of 18F-FDG uptake correlated with echocardiographic decrease in LVEF (p < 0.001). CONCLUSION: The use of PPMSS based on 18F-FDG-microPET provides valuable semi-quantitative information of heart glucose metabolism allowing for non-invasive follow up thus representing a useful strategy for assessment of novel therapies in cardiac regeneration.

[Study of vascular risk in Navarre: objectives and design. Prevalence of metabolic syndrome and of vascular risk factors]. / Estudio de riesgo vascular en Navarra: objetivos y diseño. Prevalencia del síndrome metabólico y de los factores mayores de riesgo vascular.

BACKGROUND: To determine in a representative sample of the population the prevalence of risk factors and metabolic syndrome; their association with sub-clinical atherosclerotic lesions and their impact on cardiocerebrovascular disease 10 years after. MATERIAL AND METHODS: (Phase 1) Cross sectional survey of a random sample stratified by age and sex of the population of Navarre aged between 35 and 84. Antecedents, risk factors, physical and analytical exploration. (Phase II) Ten year follow-up cohort study, in 500 exposed to MS and 500 not exposed persons, aged between 45 and 74 years; with an 82.25% power to detect a risk ratio of 2; with analytical and image markers of sub-clinical atherosclerosis. (Phase III) Follow up of vascular events at ten years. RESULTS: The subjects recruited were 6,553; excluded or not found 871; the final sample was 5,682 (2,644 men and 3,038 women); 4,168 (73,4%) took part in the study. The prevalence of MS was 22.1% (95%CI 20.5 - 23.7) for men and 17,2% (95%CI 15.8 - 18.5) for women. The main cardiovascular RF were high compared to other geographical areas except for HDL cholesterol. The rate was 8.5% (95%CI 7.4 - 9.6) for men and 1.7% (95%CI 1.3 - 2.2) CONCLUSIONS: There are important differences in risk between sex, being worst for men. The high figures for HDL cholesterol and the low prevalence of MS might mean a lower risk of vascular events in Navarra.

[Patients with vulnerable coronary plaques have higher serum metalloproteinase-1 levels]. / Los pacientes con placas coronarias vulnerables presentan mayores niveles séricos de metaloproteinasa-1.

BACKGROUND: Most acute coronary syndromes are caused by the fracture of a vulnerable atherosclerotic plaque. These plaques are thin cap fibroatheromas, which can only be detected with invasive coronary imaging techniques. It is necessary to find a non-invasive biomarker of these vulnerable plaques in order to identify patients at risk without a coronary angiography. Metalloproteinase-1 is an enzyme involved in extracellular matrix metabolism which has been correlated with the rupture of atherosclerotic plaques. Its serum levels in patients with vulnerable plaques remain unknown. METHODS: Patients with suspected stable coronary artery disease undergoing coronary angiography in our hospital were in-cluded. The coronary arteries were studied with optical coherence tomography to detect vulnerable plaques. Blood samples were taken from a peripheral vein and from the coronary sinus, to assess metalloproteinase-1 levels. RESULTS: Fifty-one patients were included, 13 of whom had at least one vulnerable plaque. There were not significant dif-ferences in clinical characteristics, lipid profile or C reactive protein levels, between patients with or without vulnerable plaques. Patients with vulnerable plaques had significant higher metalloproteinase-1 levels both in peripheral (7330±5541 vs 2894±1783 pg/ml, p=0.025) and coronary sinus serum (6012±3854 vs 2707±1252 pg/ml, p=0.047). CONCLUSIONS: Patients with vulnerable plaques had significantly higher metalloproteinase-1 serum levels. Further studies with clinical follow up are needed to assess the prognostic value of serum metalloproteinase-1.

The effects of the anthropic actions on the sandy beaches of Guardamar del Segura, Spain.

There are many activities and uses in the coastal environment, which has historically attracted the humans. This attraction has led to many anthropic actions that have generated imbalances, more important as the human pressure increases. This research focuses on the effects of these pressures along of 11km of the coastline of Guardamar del Segura, a high-value environmental area where is the Segura River mouth and one of the last dune systems of the southeast of Spain. The historic evolution of the shoreline position has been analysed using 60years of aerial images from 1950s to 2014, the seabed depth changes, the maritime climate, the distribution of the sediment grain size and the anthropic actions such as urban development or the channelling of the river. All data were integrated and processed using a Geographic Information System (GIS). The results show that the lack of sediment supply by Segura River and the cut-off in the longshore transport due to the breakwaters and others anthropic actions has led into an increase in the beaches erosion rates, with a loss of >3.2millionm3 of sand in the last 58years (≈55,200m3/year). The conclusions of this research could be useful to the coastal managers at the moment of making the decisions of action and/or conservation on a coastal system to achieve positive results in the medium and long term.

New data on epizootiology and genetics of piroplasms based on sequences of small ribosomal subunit and cytochrome b genes.

As a continuation of our studies on molecular epizootiology of piroplasmosis in Spain and other countries, we present in this contribution the finding of new hosts for some piroplasms, as well as information on their 18S rRNA gene sequences. Genetic data were complemented with sequences of apocytochrome b gene (whenever possible). The following conclusions were drawn from these molecular studies: Theileria annulata is capable of infecting dogs, since it was diagnosed in a symptomatic animal. According to cytochrome b sequences, isolates from cows and dog present slight differences. The same isolates showed, however, identical sequence in the 18S rRNA gene. This exemplifies well the usefulness of the mitochondrial gene for examining infra-specific variation. Babesia bovis is an occasional parasite of equines, since it was detected in two symptomatic horses. We found evidence of genetic polymorphism occurring in the 18S rRNA gene of Spanish T. equi-like and B. ovis isolates. B. bennetti from Spanish seagull is loosely related to B. ovis, and might represent a genetically distinct branch of babesids. A partial sequence of a cytochrome b pseudogene was obtained for the first time in Babesia canis rossi from South Africa. The pseudogene is distantly related to B. bigemina cytochrome b gene. These new findings confirm the ability of some piroplasms to infect multiple hosts, as well as the existence of a relatively wide genetic polymorphisms with respect to the cytochrome b gene. On the other hand, the existence of mtDNA-like pseudogenes of possible nuclear location in piroplasms is interesting due to their possible impact on molecular phylogeny studies.

The multifunctional artificial reef and its role in the defence of the Mediterranean coast.

Multifunctional artificial reefs (MFAR) are being implemented around the world, due to their ability to provide an environment where a sports-economic-recreational use and environmental improvement is implemented, and are also elements of coastal defence. However, a lot of failures have been recorded, possibly due to disregarded local factors in the formulations used, and there is no method that has encompassed all these factors, in order to take them into account in its design. The aim of this paper was to provide the coastal engineer with a method that would be used for the design of such reefs. To do this, the Babilonia beach of Guardamar del Segura, Alicante (Spain), was chosen because it is a fully anthropised area (with houses in the Maritime-Terrestrial Public Domain, marina, channelling and river mouth) with continuous regression, in which all the elements considered in this study, were treated. Based on the performance obtained in studies and projects worldwide, the climatic characteristics, biocenosis, sediment transport, settlements and liquefaction and the evolution of the coastline, were analysed. The multidisciplinary study carried out showed that with the implementation of a MFAR, the problem was reversed. Furthermore, the area was provided with a playful-economic use, and could be used 60% of the time, by surfers whose skill level were low to intermediate, without forgetting that the diversity of the marine ecosystem in the area was increased.

The impacts of Segura River (Spain) channelization on the coastal seabed.

Human actions over rivers and coasts have generated great changes along seaboard. In order to know future development of those changes, it is necessary to understand the development of the coast during the past. When there is a complex morphologic system as a result of the combination of natural elements with human construction elements, the study of the abovementioned changes requires a wider perspective than the one provided by traditional two-dimensional methods. Thus, the Geographic Information Systems (GIS) become a suitable tool for that kind of studies. In this work, GIS are used to understand changes in bathymetry, sediments properties and transport, as well as surface variations of plant species occurred in the Segura River mouth (Spain) within a period of 17 years due to the channelization of the river low course. The methodology followed here implies the integration of data coming from different sources and with different formats in a GIS, what allows for a spatial analysis. Results obtained show the grain-size spatial distribution for every period of time studied, as well as bathymetry changes and seabed morphology. It can be concluded that the construction works carried out in the riverbed have affected sediment grain-size in the area. Clays have nearly disappeared and consequently there is a descent of seabed level that affects plant species, such as Posidonia oceanica.

Role of sCD40L in the prediction of super response to cardiac resynchronization therapy / Rol de sCD40L en la predicción de súper respuesta a la terapia de resincronización cardiaca

Background: The aim of this paper is to analyze the roleof the biomarkers Interleukin 6, Tumoral Necrosis Factor α,sCD40L, high sensitive Troponin T, high sensitive C-ReactiveProtein and Galectin-3 in predicting super response (SR) toCardiac Resynchronization Therapy (CRT), as they have notbeen studied in this field before. Methods: Clinical, electrocardiographic and echocardiographic data was obtained preimplant and after one year.SR was defined as reduction in LVESV ≥ 30% at one yearfollow-up. Blood samples were extracted preimplant. Multivariate logistic regression and ROC curves were performed. Results: 50 patients were included, 23 (46%) were SR. Characteristics related to SR were: female (35 vs. 11%, p = 0.04),suffering from less ischemic cardiomyopathy (13 vs. 63%,p < 0.0001) and lateral (0 vs. 18%, p = 0.03), inferior (4 vs.33%, p = 0.01) and posterior infarction (0 vs. 22%, p = 0.01);absence of mitral regurgitation (47% vs. 22%, p = 0.04), wider QRS width (157.7 ± 22.9 vs. 140.8 ± 19.2ms, p = 0.01), higher concentrations of sCD40L (6.9 ± 5.1 vs. 4.4 ± 3.3 ng/mL,p = 0.02), and left ventricular lead more frequent in lateralmedial position (69 vs. 26%, p = 0.002). QRS width, lateralmedial position of the lead and absence of mitral regurgitation were independent predictors of SR. sCD40L showeda moderate direct correlation with SR (r = 0.39, p = 0.02) andwith the reduction of LVESV (r = 0.44, p = 0.02). Conclusion: sCD40L correlates significantly with SR to CRT.QRS width, absence of mitral regurgitation and lateral medial position of the lead are independent predictors of SRin this cohort.(AU)

Fundamento: Analizar los biomarcadores Interleuquina 6,factor de necrosis tumoral α, sCD40L, troponina T hipersensible, proteína Creactiva hipersensible y galectina-3 en lapredicción de súper-respuesta (SR) a la terapia de resincronización cardiaca (TRC), ya que no han sido valorados conanterioridad. Material y métodos: Se recopilaron datos clínicos, electrocardiográficos y ecocardiográficos preimplante y al año.Se definió SR como disminución del VTSVI ≥ 30% al añode seguimiento. Las muestras sanguíneas fueron extraídaspreimplante. Se realizó regresión logística multivariante ycurvas ROC. Resultados: Se incluyeron 50 pacientes, 23 (46%) fueronSR.Las características relacionadas con la SR fueron: ser mujer (35 vs. 11%, p = 0,04), sufrir menos cardiopatía isquémica(13 vs. 63%, p < 0,0001) e infarto lateral (0 vs. 18%, p = 0,03),inferior (4 vs. 33%, p = 0,01) y posterior (0 vs. 22%, p = 0,01); ausencia de insuficiencia mitral (47% vs. 22%, p = 0,04), mayor anchura del QRS (157,7 ± 22,9 vs. 140,8 ± 19,2 ms, p = 0,01), mayorconcentración de sCD40L (6,9 ± 5,1 vs. 4,4 ± 3,3 ng/mL, p = 0,02),y electrodo ventricular izquierdo más frecuentemente en posición lateral media (69 vs. 26%, p = 0,002). El QRS, la posiciónlateral media del electrodo y la ausencia de insuficiencia mitral fueron predictores independientes de SR. sCD40L mostróuna correlación moderada directa con SR (r = 0,39, p = 0,02) ycon la disminución del VTSVI (r = 0,44, p = 0,02). Conclusiones: sCD40L se correlaciona significativamentecon SR a la TRC. El QRS, la ausencia de insuficiencia mitraly la posición lateral media del electrodo son predictores independientes de SR en esta cohorte.(AU)

Segmentation and optical flow estimation in cardiac CT sequences based on a spatiotemporal PDM with a correction scheme and the Hermite transform.

PURPOSE: The left ventricle and the myocardium are two of the most important parts of the heart used for cardiac evaluation. In this work a novel framework that combines two methods to isolate and display functional characteristics of the heart using sequences of cardiac computed tomography (CT) is proposed. A shape extraction method, which includes a new segmentation correction scheme, is performed jointly with a motion estimation approach. METHODS: For the segmentation task we built a Spatiotemporal Point Distribution Model (STPDM) that encodes spatial and temporal variability of the heart structures. Intensity and gradient information guide the STPDM. We present a novel method to correct segmentation errors obtained with the STPDM. It consists of a deformable scheme that combines three types of image features: local histograms, gradients and binary patterns. A bio-inspired image representation model based on the Hermite transform is used for motion estimation. The segmentation allows isolating the structure of interest while the motion estimation can be used to characterize the movement of the complete heart muscle. RESULTS: The work is evaluated with several sequences of cardiac CT. The left ventricle was used for evaluation. Several metrics were used to validate the proposed framework. The efficiency of our method is also demonstrated by comparing with other techniques. CONCLUSION: The implemented tool can enable physicians to better identify mechanical problems. The new correction scheme substantially improves the segmentation performance. Reported results demonstrate that this work is a promising technique for heart mechanical assessment.

The erosion of the beaches on the coast of Alicante: Study of the mechanisms of weathering by accelerated laboratory tests.

One of the main problems that coasts around the world present, is the regression and erosion of beaches. However, the factors involved in these processes are unclear. In this study, the influence of sediment erosion on beach regression has been analysed. In order to do that, a three-step investigation has been carried out. Firstly, coastline variations of four Spanish beaches have been analysed. Secondly, a study on sediment position along the beach profile has been developed. Finally, the process that beach sediments undergo along the surf zone when they are hit by the incident waves has been simulated by an accelerated particle weathering test. Samples of sand and shells were subjected to this accelerated particle weathering test. Results were supplemented with those from carbonate content test, XRD, SEM and granulometric analysis. Results shows a cross-shore classification of sediments along the beach profile in which finer particles move beyond offshore limit. Besides, it was observed that sediment erosion process is divided into three sages: i) particles wear due to crashes ii) dissolution of the carbonate fraction, and iii) breakage and separation of mineral and carbonate parts of particles. All these processes lead to a reduction of particle size. The mechanism responsible of beach erosion would consist of multiples and continuous particle location exchanges along the beach profile as a consequence of grain-size decrease due to erosion.

[Cardiac magnetic resonance: clinical applications]. / Resonancia magnética cardíaca: aplicaciones clínicas.

Cardiovascular disease is the most frequent cause of mortality in the developed countries and represents a serious social, economic and health problem. Although very diverse, useful techniques exist for diagnosing cardiac diseases, it is frequently necessary to ask for more than one test to reach a specific diagnosis. Magnetic resonance is a harmless, well tolerated and safe technique, which is currently available in the majority of hospitals. This technique makes it possible in a single exploration to study the anatomy of the heart and to make a qualitative, semi-quantitative and quantitative assessment of the parameters of cardiac function. It provides information of cardiac and vascular anatomy and function in complex congenital cardiopathies. Besides, with the administration of intravenous contrast, it enables knowledge to be gained of myocardial viability in ischaemic cardiopathy. Hence, cardiac magnetic resonance is emerging as one of the most promising techniques for the study of congenital and acquired cardiac pathology.

[Imaging modalities in cardiology: the present answers to permanent questions]. / Las técnicas de imagen en cardiología: la respuesta actual a los interrogantes de siempre.

Tremendous advances have been made in non-invasive cardiology, such as improved visualization of the anatomy and function of the heart and better understanding of heart disease. Echocardiography has improved in both simplicity and complexity, offering a range of modalities from small, hand-held devices that provide basic information simply and inexpensively to complex, dynamic three-dimensional imaging of regional myocardial function. Cardiovascular magnetic resonance imaging is the newest technique for non-invasive cardiology. It assesses cardiac function, mass and volume and can detect myocardial infarction, fibrosis, valvular and congenital heart disease. Computed tomography is used to detect and quantify coronary heart disease and coronary calcium, high scores being related to increased risk, but its use remains controversial. Myocardial perfusion scintigraphy single photon emission computed tomography (SPECT) is cost effective in investigating patients with suspected coronary disease and acute coronary syndrome. Also positron emission tomography (PET) is useful in the study of perfusion, metabolism, patients selection for revascularization, and in translational research in transgenic animal models.

[Myocardial regeneration: future at reach]. / Regeneración miocárdica: el futuro al alcance de la mano.

The last few years have witnessed a growing interest in regenerative therapy of the failing heart by cell transplantation. Initial studies with skeletal myoblasts were conducted more than 10 years ago. However, the potential of bone marrow derived cells has more recently led to a flurry of experimental studies generating overall positive but occasionally conflicting results. The ethics of initiating clinical trials with stem cells in patients with heart failure has been questioned. Although laboratory research attempts to overcome a number of questions surrounding the usefulness and safety of cell therapy, the accumulated body of evidence warrants implementation of clinical trials. The earliest of these have now documented the feasibility of cell therapy. It is now appropriate to conduct safety and efficacy studies which, if carefully done, should allow assessment of the extent to which this concept of regenerative therapy can be made a clinical reality.

Prognostic value of seminal vesicle involvement due to prostate cancer in radical prostatectomy specimens.

OBJECTIVE: To study the influence, in terms of prognosis, of the finding of seminal vesicle involvement in patients with prostate adenocarcinoma treated with radical prostatectomy. MATERIAL AND METHOD: We reviewed a series of patients with seminal vesicle involvement with clinically localized prostate adenocarcinoma who underwent radical prostatectomy between 1989 and 2009, focusing on their clinical-pathological characteristics, biochemical progression-free survival (BPFS) and specific survival (SS). We assessed the variables that influenced BPFS and designed a risk model. RESULTS: A total of 127 out of 1,132 patients who underwent surgery (11%) presented seminal vesicle invasion (i.e., pT3b). In the multivariate study of the entire series (Cox model), pT3b affects the BPFS (HR: 2; 95% CI: 1.4-3.3; P=.001). Other influential factors were the affected borders, initial prostate-specific antigen levels, pathological Gleason score and the presence of palpated tumor. The pT3b tumors have poorer clinical-pathological variables when compared with pT2 and pT3a tumors. Sixty-five percent of the patients evidenced biochemical progression. The BPFS was significantly poorer for pT3b (40 ± 4% and 28 ± 4% at 5 and 10 years, respectively) than for pT2 and pT3a (P<.0001). The SS was also poorer in patients with pT3b tumors (91 ± 2% and 76 ± 4% at 5 and 10 years, respectively) (P<.0001). The predictors within the pT3b patient group were: PSA levels >10 ng/mL (HR: 1.9; 95% CI: 1.04-3.6; P=.04) and pathological Gleason score 8-10 (HR: 2.1; 95% CI: 1.2-3.5; P=.03). We designed a risk model that accounts for the variables involved, which entails 2 groups with different BPFS (P=.004): Group 1 (0-1 variable), with a BPFS of 46 ± 7% and 27 ± 8% at 5 and 10 years, respectively; and Group 2 (2 variables), with a BPFS of 14 ± 7% and 5 ± 5% at 5 and 10 years, respectively. CONCLUSION: Seminal vesicle involvement severely and negatively affects the BPFS and SS. We designed a risk model with the independent influential variables in BPFS (pathological Gleason score 8-10 and PSA levels >10 ng/mL). This model confirms that pT3b tumors are a heterogeneous group, which includes an important group with better prognosis when surgical treatment is performed.

Methylergonovine-induced spasm of saphenous vein coronary bypass graft.

A case of repeated methylergonovine-induced spasm of a saphenous vein bypass graft in a 56-year-old man is presented. Prior to the operation, spasm was induced by methylergonovine in the stenosed right coronary artery. Six months after the operation, coronary angiographic studies showed induced spasm of the right coronary graft but no spasm in native vessels nor in the other graft to the left anterior descending coronary artery.