Detection rate, pattern of relapse and influence on therapeutic decision of PSMA PET/CT in patients affected by biochemical recurrence after radical prostatectomy, a retrospective case series.

AIMS: 68Ga-Prostate-specific membrane antigen (PSMA) PET/CT is widely used in patients with biochemical recurrence (BCR) after radical prostatectomy. We collected data about patients staged with PSMA PET/CT after BCR (PSA < 1 ng/ml) in four different institutes. Impact of baseline features (Gleason score, risk classification, PSA at recurrence, PSA doubling time and time to recurrence) was explored to understand predictive factors of (PSMA) PET/CT positivity. Impact of restaging on following treatment approaches was reported. RESULTS: 92 patients were included. PSMA PET/CT detection rate was 56.5% and low-volume disease (≤ 3 non-visceral lesions) was detected in 52.2% of patients. After positive scan, 13.5% of patients still lies on observation, ADT alone was administered in 30.8% of cases, Stereotactic body RT (SBRT) alone was delivered to 44.2% of patients and 11.5% of patients underwent concomitant SBRT and ADT. Seven patients underwent conventional salvage prostate bed RT. Chi-squared test showed a higher rate of positive PSMA PET/CT for patients with Gleason score > 7 (p = 0.004) and TTR < 29.5 months (p = 0.003). CONCLUSIONS: PSMA PET/CT showed a high detection rate. This influenced clinical management in a significant percentage of patients, allowing treatment tailoring on the basis of imaging.

Revision of Cirratulus (Cirratulidae: Polychaeta) from Argentina, with the description of three new species and a key to identify all species of the area

Introduction: The taxonomy of Cirratulidae is not easy due to the diagnostic characters currently accepted change through ontogeny, in some cases, there are even difficulties to separate juveniles from adults. Among the Cirratulus species cited, described and considered as valid for Argentina are Cirratulus jucundus (Kinberg, 1866), Cirratulus patagonicus (Kinberg, 1866) and Cirratulus mianzanii Saracho Bottero, Elías & Magalhães, 2017. Objetive: This study made a revision of Cirratulus includes material deposited in the Museo de Ciencias Naturales de La Plata (MLP) and specimens collected privately by J.M. Orensanz that was donated to the laboratory of Bioindicadores Bentónicos of the National University of Mar del Plata. Methods: The specimens were examined with optical equipment (microscope and stereomicroscope) and also by a scanning electron microscope (SEM). Results: A complete examination of the material, revealed a higher number of species than those already mentioned. In the present work, three new species are described from the intertidal and subtidal areas of the Argentine continental shelf: Cirratulus orensanzii n. sp.; Cirratulus knipovichana n. sp. and Cirratulus alfonsinae n. sp. Conclusions: The knowledge about the taxonomy of the family as well as the updating of the geographic registries contributes to the biodiversity of the region, which is of great importance to carry out both ecological studies and conservation plans.

Introducción: La taxonomía de Cirratulidae no es fácil debido a que los caracteres diagnósticos actualmente aceptados cambian a través de la ontogenia; en algunos casos, incluso existen dificultades para separar a los juveniles de los adultos. Entre las especies de Cirratulus citadas, descritas y consideradas como válidas para Argentina se encuentran Cirratulus jucundus (Kinberg, 1866), Cirratulus patagonicus (Kinberg, 1866) y Cirratulus mianzanii Saracho Bottero, Elias & Magalhães, 2017. Objetivo: El presente estudio hace una revisión de Cirratulus que incluye material depositado en el Museo de Ciencias Naturales de La Plata (MLP) y especímenes recolectados en privado por JM Orensanz que fue donado al laboratorio de Bioindicadores Bentónicos de la Universidad Nacional de Mar del Plata. Métodos: Las muestras se examinaron con equipo óptico (microscopio y estereomicroscopio) y también con microscopio electrónico de barrido (SEM). Resultados: Un examen completo del material, reveló un mayor número de especies que las ya mencionadas. En el presente trabajo, se describen tres nuevas especies de las áreas intermareales y submareales de la plataforma continental argentina: Cirratulus orensanzii n. sp.; Cirratulus knipovichana n. sp. y Cirratulus alfonsinae n. sp. Conclusiones: El conocimiento sobre la taxonomía de la familia, así como la actualización de los registros geográficos, contribuye a la biodiversidad de la región, lo cual es de gran importancia para llevar a cabo estudios ecológicos y planes de conservación.

Stereotactic body radiation therapy (SBRT) on renal cell carcinoma, an overview of technical aspects, biological rationale and current literature.

BACKGROUND: Stereotactic body radiotherapy (SBRT) is characterized by the delivery of high doses of ionizing radiation in few fractions. It is highly effective in achieving local control, and, due to the high biological effective dose administered, it seems to overcome the radioresistance of renal cell carcinoma (RCC). Thus, SBRT could constitute a treatment option for the management of localized RCC in patients who are not surgical candidates. In this paper, we report an overview about data from the current evidence about SBRT in patients affected by localized RCC. MATERIALS AND METHODS: A non-systematic review was performed, including data from both retrospective and prospective studies focusing on the use of SBRT for localized RCC and its biological rationale. Furthermore, ongoing trials on this issue are reported. CONCLUSION: Currently, SBRT might be considered a treatment alternative in inoperable patients affected by primary RCC. Currently, dose-escalation to 48 Gy in 3-4 fractions are effective and well tolerated. Emerging role of immune therapies in RCC patients warrant further studies to explore interactions between SBRT and immune response.

Abciximab in rescue coronary angioplasty after full-dose tissue-type plasminogen activator.

BACKGROUND: Rescue angioplasty is a complex procedure because of frequent reocclusions secondary to a paradoxical pro-thrombotic effect brought about by thrombolytic therapy. Administration of abciximab may improve procedural results but its utilization in this setting is limited by the potential hemorrhagic risk. Very few data on this approach are currently available in the medical literature. METHODS: After failed full-dose tissue-type plasminogen activator (tPA), 30 patients (23 males, 7 females, mean age 64 +/- 13 years) referred for rescue angioplasty received abciximab (0.25 mg/kg bolus + 0.125 mcg/kg/min x 12 hour infusion) (Abc+ group). The procedural results, hemorrhagic complications and in-hospital outcome observed in these patients were compared to those of 35 patients submitted to rescue angioplasty in the same time period (1997-1999) who did not receive abciximab (Abc- group). RESULTS: In the Abc+ group, 11 patients (37%) were in Killip class 3-4, 14 (47%) had multivessel disease, and 4 (13%) had previous bypass surgery. In all Abc+ patients, factors suggestive of procedural failure were present (i.e. saphenous vein graft occlusion, intraluminal thrombus, dissection, reocclusion, slow flow). The periprocedural heparin dose was 5,000 IU in Abc+ and 100 IU/kg in Abc-patients (range 5,000-10,000 IU). The procedure was successful in 29 Abc+ (97%) and in 34 Abc- patients (97%). A hemoglobin drop > 5 g occurred in 3 Abc+ (10%) and in 4 Abc- patients (11%) with a similar incidence of blood transfusion in the two groups. In all these cases, significant bleeding occurred at the vascular access site. There were 2 in-hospital deaths in Abc+ and 1 in Abc- patients. CONCLUSIONS. Selected patients undergoing rescue angioplasty may be treated with abciximab without an undue increase in hemorrhagic complications. Larger studies are needed to confirm the feasibility of this approach and to assess its potential benefits.

[Acute changes in the hemodynamic profile and circulating levels of atrial natriuretic peptide induced by dobutamine in severe heart failure]. / Modificazioni acute del profilo emodinamico e dei livelli circolanti di peptide natriuretico atriale indotte dalla dobutamina nello scompenso cardiaco grave.

METHODS: Sixteen patients (15 males, 1 female; mean age 63 years, range 45-78) with severe heart failure (NYHA class III = 5; class IV = 11) secondary to ischemic heart disease (8), dilated cardiomyopathy (5) and valvular heart disease (3), were evaluated for eligibility to intermittent Dobutamine (D) treatment. As a part of this evaluation, they were submitted to an acute dose-ranging test with D, up to 10 micrograms/Kg/min under hemodynamic and electrocardiographic monitoring. By inclusion criteria, all patients had:-cardiac index (CI) < 2.2 L/min/m2;-pulmonary wedge pressure (WP) > 18 mmHg;-left ventricular ejection fraction (EF) < 30%. At each step of the procedure, hemodynamic measurements and blood sampling for atrial natriuretic peptide (ANP) concentration were performed. RESULTS: Peak effect, defined as the dose corresponding to the maximum increase in CI, was reached at a mean of 7.8 +/- 0.5 micrograms/Kg/min. CI increased from 1.7 +/- 0.3 to 2.53 +/- 0.7 L/min/m2 (p < 0.001) and ANP decreased from 234 +/- 112 to 173 +/- 118 pg/ml (p < 0.001). Correspondingly, heart rate, stroke volume index and stroke work index increased, while right atrial pressure (RAP), mean pulmonary artery pressure (PAP), WP, systemic and pulmonary vascular resistance all significantly decreased. Mean arterial pressure was not affected. Changes in ANP concentration correlate significantly with changes in WP and in PAP (r = 0.65, p < 0.05 and r = 0.89, p < 0.001, respectively), but not with changes in RAP (r = 0.26, p = 0.34). Patients showing an increase > 40% in CI or a CI > or = 2.5 L/min/m2 at peak effect (responders) had significantly lower baseline PAP with respect to non-responders. Besides PAP, baseline ANP levels, end-systolic pressure/volume ratio and ejection fraction were also independent predictors of response. The test did not induce complex arrhythmias and was well tolerated in all patients. CONCLUSIONS: Patients with severe heart failure retain the ability to respond to acute administration of D. with a significant improvement in their hemodynamic profile. Response to D. administration is predicted by lower baseline pulmonary pressure and ANP levels and a lesser degree of left ventricular dysfunction. Despite high baseline ANP concentration, a significant decrease is obtained which parallels the decrease in pulmonary artery and pulmonary wedge pressure, but is not related to changes in right atrial pressure. These findings suggest that changes in left ventricular performance induced by D. are the major determinants of the decrease in ANP concentration in this clinical setting.

La desviación axial superior en el joven sano: un estudio electro-vectocardiográfico / The superior axial deviation in young healthy subjects: an electrovectocardiographic study

A través del vectocardiograma hemos estudiado 100 jóvenes no cardiópatas que presentaban en el ECG una desviación axial superior (DAS), con el eje del QRS a menos 30-, y ausencia de un tercer vector (rSr) en V1. Nuestros resultados demuestran que en este tipo de pacientes la DAS se debe a un bloqueo de rama derecha de "asa dorsalizada" en el 78% de los casos, mientras que seguramente se debe a un bloqueo de la subdivisión anterior izquierda en el 12% y probablemente asociada a subdivisión anterior de la rama derecha del haz de His en el 10%. El diagnóstico diferencial vectorcardiográfico es fácil en estos casos, mientras que por el ECG es muy difícil. Los criterios electrocardiográficos más confiables para distinguir este tipo de bloqueo de rama derecha de un hemibloqueo anterior izquierdo son: la deflexión intrinsecoide en VL y V6 > 0.015 (sensibilidad 100% y especificidad 57%); la relación entre RV6/Ra VL > 1 (sensibilidad 100% y especificidad 50%), y la presencia de una incisura de la R en D2, D3 y AVF (sensibilidad 90% y especificidad 100%

Comportamiento electro-vectocardiográfico del bloqueo de rama derecha del haz de His en el defecto de los cojines endocárdicos: su probable relación con el llamado hemilbloqueo fascicular anterior izquierdo / Electro-vectocardiographic behavior of the right bundle-branch block and His in endocardial cushion defects: its probable relationship with the so called left anterior semiblock

Hemos estudiado la existencia de eventuales criterios electrocardiográficos en las formas incompletas de hemibloqueo fascicular anterior (HFA), utilizando como modelo experimental el defecto de los cojines endocárdicos, que, por motivos anatómicos, tiene una activación ventricular comparable a grados diversos de hemibloqueo fascicular anterior. Hemos subdividido con el VCG los pacientes estudiados en 5 grupos sobre la base de la posible desviación izquierda y a lo alto del vector máximo izquierdo. La comparación de los datos electrocardiográficos medios de cada grupo demuestran que: a) los grados mínimos de HFA se manifestan con simple rotación antihoraria del eje frontal sin apreciable desviación axial izquierda; b) no existe una relación lineal entre el patrón de la desviación axial izquierda y el patrón de los signos electrocardiográficos de asincronismo de activación ventricular izquierda. De esta manera, se concluye que, aparte de esta particular cardiopatía congénita, los grados mínimos de HFA pueden ser sólo sospechados sobre la base del aspecto del asa vectorcardiográfico frontal, debido a que el diagnóstico electrocardiográfico es posible sólo cuando la desviación axial izquierda se vuelve importante