PanGen-Fam: Spanish registry of hereditary pancreatic cancer.

PURPOSE: To describe the organisation of the registry and the preliminary results in terms of characteristics of high-risk pancreatic ductal adenocarcinoma (PDAC) families recruited to date and findings of the screening programme. To compare early onset sporadic cases (⩽50 years), sporadic cases (>50 years) and cases with family history of cancer, for PDAC possible risk factors. METHODS/PATIENTS: Families with hereditary cancer syndromes predisposing to PDAC were recruited from two main sources: Spanish hospitals participating in PanGenEU, a pan-European multicentre case-control study, and their genetic counseling unit. Individuals at high-risk of PDAC were enrolled into a screening programme, consisting of Endoscopic ultrasound, computerised tomography, magnetic resonance imaging. Genetic testing of candidate genes was offered according to each patient's risk. RESULTS: Among 577 consecutive PDAC cases, recruited via PanGenEU, 36 (6%) had ⩾2 first-degree relative with PDAC: Familial pancreatic cancer (FPC). So far PanGen-Fam has recruited 42 high-risk PDAC families; 25 (60%) had FPC. Five index cases with cancer were positive for BRCA2 and one for BRCA1 germline mutations. In the second year of prospective PDAC screening, one neuroendocrine tumour and a high-grade dysplasia lesion suspicious of carcinoma were diagnosed among 41 high-risk individuals. Furthermore EUS detected chronic-pancreatitis-like parenchymal changes in 15 patients. CONCLUDING STATEMENT: The identification and recruitment of PDAC high-risk families into the PanGen-Fam registry provides an opportunity to detect early onset cancer and precursor pancreatic cancer lesions at a potentially curative stage and to increase the knowledge of the natural history of the disease.

[Effect on ocular blood flow of Combigan® versus placebo in patients with ocular hypertension]. / Efecto de Combigan(®) versus placebo en el flujo sanguíneo ocular en pacientes hipertensos oculares.

PURPOSE: This study was undertaken to compare the ocular haemodynamic effects of Combigan(®) versus placebo in patients with ocular hypertension (OHT). METHODS: Thirty patients with OHT were included in a controlled, randomised, double blind study in two parallel groups; 15 were randomised to receive Combigan(®) and 15 to receive placebo for a period of 3 months. At baseline and at 3 months retrobulbar blood flowmeasurements of the ophthalmic artery (OA) and central retinal artery (CRA) were taken using colour Doppler imaging(CDI) ultrasound, concurrently with intraocular pressure (IOP). RESULTS: Combigan(®) significantly reduced IOP after 3 months of treatment (P = 0.001), whereas placebo showed no significant change in IOP. The baseline haemodynamic parameters were similar between treatment and placebo groups. Patients treated with Combigan® showed a statistically significant decrease in CRA resistive index (P = 0.007). CONCLUSIONS: Patients treated for 3 months with Combigan(®) showed a significant decrease of CRA resistive index that could be explained by the decrease in IOP.

Efecto de Combigan® versus placebo en el flujo sanguíneo ocular en pacientes hipertensos oculares / Effect on ocular blood flow of Combigan® versus placebo in patients with ocular hypertension

Propósito: Estudiar los cambios hemodinámicos retrobulbares mediante ecografía dopplercolor, en pacientes hipertensos oculares (HTO) en tratamiento con Combigan® versus placebo.Método: Treinta pacientes randomizados en 2 grupos paralelos fueron incluidos en un estudioprospectivo y a doble ciego; quince de ellos en tratamiento con Combigan® y quince entratamiento con placebo, durante un periodo de 3 meses. Se obtuvieron medidas de la presiónintraocular (PIO) y del flujo sanguíneo a nivel de la arteria central de la retina (ACR) y la arteriaoftámica en el momento basal y a los 3 meses.Resultados: Combigan® redujo significativamente la PIO tras tres meses de tratamiento(p = 0,001). Los parámetros hemodinámicos basales fueron similares entre los grupos placeboy tratamiento. Los pacientes tratados con Combigan® mostraron un descenso estadísticamentesignificativo del índice de resistencia de la ACR (p = 0,007).Conclusiones: Los pacientes tratados durante 3. meses con Combigan® mostraron un descensoestadísticamente significativo del índice de resistenciade la ACR que podría explicarsepor el descenso de PIO(AU)

Purpose: This study was undertaken to compare the ocular haemodynamic effects ofCombigan® versus placebo in patients with ocular hypertension (OHT).Methods: Thirty patients with OHT were included in a controlled, randomised, double blindstudy in two parallel groups; 15 were randomised to receive Combigan® and 15 to receiveplacebo for a period of 3 months. At baseline and at 3 months retrobulbar blood flowmeasurementsof the ophthalmic artery (OA) and central retinal artery (CRA) were taken usingcolour Doppler imaging(CDI) ultrasound, concurrently with intraocular pressure (IOP). Results: Combigan® significantly reduced IOP after 3 months of treatment (P = 0.001), whereasplacebo showed no significant change in IOP. The baseline haemodynamic parameters weresimilar between treatment and placebo groups. Patients treated with Combigan® showed astatistically significant decrease in CRA resistive index (P = 0.007).Conclusions: Patients treated for 3 months with Combigan® showed a significant decrease ofCRA resistive index that could be explained by the decrease in IOP(AU)

[Evaluation of the effect of bimatoprost/timolol fixed combination on ocular blood flow in patients with ocular hypertension using colour Doppler imaging. Preliminary study]. / Evaluación mediante ecografía doppler color del efecto de la combinación fija bimatoprost/timolol sobre el flujo sanguíneo ocular en pacientes con hipertensión ocular. Estudio preliminar.

PURPOSE: To investigate the effects of topical bimatoprost (0.3 mg/ml)/timolol maleate (5 mg/ ml) fixed combination on retrobulbar blood flow in patients with ocular hypertension (OHT). PATIENTS AND METHODS: Twenty consecutive patients with OHT were prospectively randomised to either bimatoprost/timolol or placebo during a 12 weeks double masked treatment trial. Examinations were performed at baseline and after 12 weeks of treatment. Visual acuity, intraocular pressure (IOP), slit-lamp examination, automated static perimetry, systemic blood pressure and heart rate were all recorded. Retrobulbar blood flow measurements of the ophthalmic artery (AO) and central retinal artery (CRA) were measured by colour Doppler imaging. RESULTS: IOP was significantly decreased by bimatoprost/timolol fixed combination (p < 0.0001). Bimatoprost/timolol fixed combination therapy resulted in a significant increase in end diastolic velocity (EDV) of the CRA (p = 0.03). In patients treated with bimatoprost/timolol a statistically significant correlation between IOP and EDV was observed after 12 weeks of treatment (r = -0.511, p = 0.045). The systolic (p = 0.54) and diastolic (p = 0.67) blood pressures and heart rate (p = 0.10) did not show statistically significant differences during the study period. CONCLUSIONS: Topical bimatoprost/timolol fixed combination significantly reduced IOP in patients with OHT. However, the only significant change observed in retrobulbar haemodynamics was an increase in EDV of the CRA, probably associated with a reduction in IOP.

Evaluación mediante ecografía doppler color del efecto de la combinación fija bimatoprost/timolol sobre el flujo sanguíneo ocular en pacientes con hipertensión ocular. Estudio preliminar / Evaluation of the effect of bimatoprost/timolol fixed combination on ocular blood flow in patients with ocular hypertension using colour Doppler imaging. Preliminary study

Objetivo: Evaluar el efecto de la administración tópica de la combinación fija bimatoprost(0,3 mg/ml)/maleato de timolol (5 mg/ml) sobre el flujo sanguíneo retrobulbar en pacientescon hipertensión ocular (HTO).Pacientes y métodos: Veinte pacientes con HTO fueron incluidos en este estudio prospectivo,doble ciego y aleatorizados a recibir tratamiento con bimatoprost/timolol o placebo durante12 semanas. Las pruebas se llevaron a cabo en la primera visita y a las 12 semanas. Seregistraron la agudeza visual, presión intraocular (PIO), examen en lámpara de hendidura,perimetría estática automática, presión arterial sistémica y frecuencia cardíaca. Medianteecografía doppler color (EDC) se midieron los parámetros del flujo sanguíneo retrobulbarde la arteria oftálmica (AO) y arteria central de la retina (ACR).Resultados: La combinación fija bimatoprost/timolol redujo significativamente la PIO(p < 0,0001), además de conseguir un incremento significativo de la velocidad diastólicafinal (VDF) en la ACR (p = 0,03). En el grupo de pacientes tratados con bimatoprost/timololse observó una correlación estadísticamente significativa entre la PIO y la VDF a las 12semanas de tratamiento (r = –0,511, p = 0,045). No hubo cambios significativos en las presionesarteriales sistólica (p = 0,54) y diastólica (p = 0,67) ni en la frecuencia cardíaca(p = 0,10) durante el período de tratamiento.Conclusiones: La combinación fija bimatoprost/timolol redujo significativamente la PIO enpacientes con HTO. El único cambio observado en la hemodinámica retrobulbar fue unincremento de la VDF en la ACR, probablemente relacionado con la reducción de la PIO(AU)

Purpose: To investigate the effects of topical bimatoprost (0.3 mg/ml)/timolol maleate (5 mg/ml) fixed combination on retrobulbar blood flow in patients with ocular hypertension(OHT).Patients and methods: Twenty consecutive patients with OHT were prospectively randomisedto either bimatoprost/timolol or placebo during a 12 weeks double masked treatment trial.Examinations were performed at baseline and after 12 weeks of treatment. Visual acuity,intraocular pressure (IOP), slit-lamp examination, automated static perimetry, systemicblood pressure and heart rate were all recorded. Retrobulbar blood flow measurements ofthe ophthalmic artery (AO) and central retinal artery (CRA) were measured by colourDoppler imaging.Results: IOP was significantly decreased by bimatoprost/timolol fixed combination(p < 0.0001). Bimatoprost/timolol fixed combination therapy resulted in a significantincrease in end diastolic velocity (EDV) of the CRA (p = 0.03). In patients treated withbimatoprost/timolol a statistically significant correlation between IOP and EDV wasobserved after 12 weeks of treatment (r = –0.511, p = 0.045). The systolic (p = 0.54) anddiastolic (p = 0.67) blood pressures and heart rate (p = 0.10) did not show statisticallysignificant differences during the study period.Conclusions: Topical bimatoprost/timolol fixed combination significantly reduced IOP inpatients with OHT. However, the only significant change observed in retrobulbarhaemodynamics was an increase in EDV of the CRA, probably associated with a reductionin IOP(AU)

[PET/CT: protocol aspects and legal controversies]. / PET/TC: aspectos de protocolo y controversias legales.

The combination of positron emission tomography (PET) and computed tomography (CT) in a single scanner (PET/CT) allows anatomic and metabolic images to be fused and correlated with a high degree of accuracy; this represents a very important landmark in the history of medicine and especially in the area of diagnostic imaging. Nevertheless, the implementation, startup, and operation of a PET/CT scanner presents particularly interesting challenges, because it involves the integration of two well-established and consolidated techniques (CT and PET, which provide complementary information) that have traditionally been carried out in the context of two different specialties (radiology and nuclear medicine). The rapid diffusion of this new integrated technology raises a series of questions related to the optimal protocols for image acquisition, the supervision of the examinations, image interpretation, and reporting, as well as questions related to the legal competence and responsibility of the specialists involved in a PET/CT study. The objective of this article is to approach these aspects from a constructive perspective and to stimulate the dialog between the specialties of radiology and nuclear medicine, with the aim of maximizing the diagnostic potential of PET/CT and thus of providing better care for patients.

PET/TC: aspectos de protocolo y controversias legales / PET/CT: protocol aspects and legal controversies

La combinación de una tomografía por emisión de positrones (PET) y de una tomografía computarizada (TC) en un único equipo (PET/TC) permite fusionar y correlacionar con un elevado grado de precisión imágenes anatómicas y metabólicas, y ha supuesto un hito reciente muy importante en la historia de la Medicina, y especialmente en el área del diagnóstico por la imagen. No obstante, la implementación, puesta en marcha y desarrollo de un equipo de PET/TC presenta desafíos particularmente interesantes, ya que supone la integración de dos técnicas diagnósticas reconocidas y consolidadas (la TC y la PET, que proporcionan información complementaria), pero que se han desarrollado tradicionalmente al amparo de dos especialidades diferentes (Radiología y Medicina Nuclear). La rápida difusión de esta nueva tecnología integrada plantea una serie de cuestiones relacionadas con los protocolos óptimos de adquisición de las imágenes, supervisión de los estudios, interpretación de las mismas, elaboración de informes y, especialmente, con la competencia y responsabilidad de los especialistas responsables de un estudio de PET/TC. El objetivo de este artículo es abordar estos aspectos desde una perspectiva constructiva, y estimular el diálogo entre las especialidades de Radiología y Medicina Nuclear, en un intento de maximizar el potencial diagnóstico de la PET/TC y así ofrecer una mejor atención a los pacientes (AU)

The combination of positron emission tomography (PET) and computed tomography (CT) in a single scanner (PET/CT) allows anatomic and metabolic images to be fused and correlated with a high degree of accuracy; this represents a very important landmark in the history of medicine and especially in the area of diagnostic imaging. Nevertheless, the implementation, startup, and operation of a PET/CT scanner presents particularly interesting challenges, because it involves the integration of two well-established and consolidated techniques (CT and PET, which provide complementary information) that have traditionally been carried out in the context of two different specialties (radiology and nuclear medicine). The rapid diffusion of this new integrated technology raises a series of questions related to the optimal protocols for image acquisition, the supervision of the examinations, image interpretation, and reporting, as well as questions related to the legal competence and responsibility of the specialists involved in a PET/CT study. The objective of this article is to approach these aspects from a constructive perspective and to stimulate the dialog between the specialties of radiology and nuclear medicine, with the aim of maximizing the diagnostic potential of PET/CT and thus of providing better care for patients (AU)