Usefulness of proprostate-specific antigen in the diagnosis of prostate cancer.

BACKGROUND: Free prostate-specific antigen (fPSA), the minor form of total PSA, contains different molecular subforms, including BPSA and proPSA. Whereas BPSA is associated with benign prostate hyperplasia, proPSA is associated with prostate tumor. PATIENTS AND METHODS: The serum levels of PSA, fPSA and proPSA were measured using automated electrochemiluminescent immunoassays (Elecsys 2010, Roche Diagnostics) in 87 patients with prostate cancer and 138 patients with benign prostate hyperplasia. Also, we calculated the derived tests of these assays through the subtraction or the ratio between the measured tests. RESULTS: Receiver operating characteristics curves were used for comparison of the diagnostic utility of tests assessed. The biggest areas were obtained for the free/total PSA ratio (0.705), the calculated Bfree PSA/total PSA ratio (0.719) and the calculated Bfree PSA/bound PSA ratio (0. 726). CONCLUSION: Applying a multivariate logistic regression analysis, it was determined that the combination of the proPSA concentration, the proPSA/total PSA ratio and the calculated Bfreeltotal PSA ratio improves the area under the curve obtained for individual tests (0.753). ProPSA may be useful in the diagnosis of prostate cancer.

Pressure-mediated versus pharmacologic treatment of radial artery spasm during cardiac catheterisation: a randomised pilot study.

AIMS: The aim of the study was to determine the effectiveness of a novel strategy to treat radial artery spasm (RAS). METHODS AND RESULTS: We conducted a prospective, randomised, single-centre, open-label trial comparing a novel strategy of pressure-mediated dilatation versus intra-arterial administration of a combination of nitroglycerine plus verapamil for the treatment of RAS. The primary endpoint was radial artery intraluminal diameter acute gain assessed by quantitative radial angiography. After screening two hundred and twenty consecutive cases, twenty patients presented with RAS and were randomised 1:1 to either strategy. Overall the mean age was 60.8±11.5 years and 53% were females. Pre-treatment angiographic characteristics were similar between the groups. The primary endpoint of radial artery acute gain was significantly greater in the pressure-mediated dilatation group (0.85±0.46 mm vs. 0.03±0.24 mm, p<0.001). Blood pressure drop was significantly lower in the pressure-mediated dilatation group (ΔBP -3.8±24 vs. -31.6±19 mmHg, p<0.001). There was one case of radial artery occlusion in the pressure-mediated dilatation group at follow-up. Short-duration pain was observed during the application of pressure. CONCLUSIONS: Pressure-mediated dilatation for the treatment of RAS was feasible, with superior angiographic results compared to a pharmacologic vasodilator strategy, with no impact on blood pressure. This novel approach proved to be safe and effective and should be tested in a large randomised trial.

Fluorescence in situ hybridization analysis of matched primary tumour and lymph-node metastasis of D1 (pT2-3pN1M0) prostate cancer.

OBJECTIVE: To describe the chromosomal numerical changes present in primary prostate tumours and their matched lymph-node metastases, to identify a clonal cell migration process which could account for the metastatic behaviour. MATERIALS AND METHODS: Twenty-eight cases of unsuspected stage D1 (pT2-3pN1M0) prostate cancer were detected among patients who had a radical prostatectomy for clinically localized prostate cancer. Fluorescence in situ hybridization (FISH), using centromeric probes to enumerate chromosomes 7, 8, 10 and 12, was used to assess numerical chromosomal changes. FISH analysis was used on isolated nuclei obtained from matched primary tumours and their lymph node metastases. RESULTS: Of the 28 suitable cases it was possible to complete the study in 18 pairs of matched tissues; the remainder were excluded because of insufficient tissue or poor preservation of at least one of the tissues. There was cytogenetic change (aneuploidy) in 16 of the 18 primary tumours, the most common being monosomy 8, detected in 14, followed by trisomy 7, in 13 aneuploid tumours. All lymph node metastases were aneuploid by FISH. As in the primary tumours, monosomy 8 and trisomy 7 were the most common cytogenetic alterations, in 13 and 15 of the lymph node tissues. FISH analysis showed a high correlation (83%) in the cytogenetic pattern of changes between the primary tumours and their lymph node metastases. Moreover, a similar number of cells had the most common aneusomies when comparing prostate and the lymph node tissues. CONCLUSIONS: These results show a similar pattern of cytogenetic alteration in the primary tumour and its lymph node metastasis, characterized by the frequent presence of trisomy 7 and monosomy 8, suggesting that clonal cell selection is not involved in the metastatic process.

Evaluación de cuatro protocolos de anticoagulación durante los procedimientos de cardiología intervencionista

Sesenta pacientes (42) hombres y 18 mujeres) a quienes se les realizó algún procedimiento de cardiología intervencionista desde enero a noviembre de 1998, ingresaron de manera aleatoria en uno de cuatro grupos de tratamiento con heparina: 10.000 U.I. por vía endovenosa o intra-arterial o 100 U.I. por Kg de peso corporal por vía endovenosa o intra-arterial. El objetivo del estudio era determinar cual de estos protocolos permitía obtener el mejor nivel de anticoagulación, definido por un tiempo de coagulación activado de 300ñ10 seg. Resultados: Las características demográficas fueron homogéneas entre los cuatro grupos. El tratamiento con 100 U.I. de heparina por Kg. de peso por vía endovenosa produjo niveles de anticoagulación esperados con valores estadísticamente significativos en comparación con los otros tres grupos. Del total de pacientes 10 por ciento presentó complicaciones leves (quimosis y hematoma local en región inguinal) relacionados con el uso de la heparina, sin embargo ninguna de éstas en el grupo de 100 U.I. por kg. de peso por vía venosa. En el 80 por ciento de los procedimientos se utilizaron stents con un éxito en el 100 por ciento de los casos. No se presentaron oclusiones agudas ni subagudas. Conclusión: El tratamiento con 100 U.I. de heparina por kg. de peso por vía endovenosa durante los procedimientos de cardiología intervencionista produce mejores niveles de anticoagulación que la terapia con 10.000 U.I. por kg. de peso por vía intra-arterial, optimizando la seguridad y los resultados del procedimiento con menos complicaciones debidas a trombosis aguda y subaguda y a hemorragia