Valor pronóstico de los criterios PERCIST y los parámetros metabólicos de la PET/TC en pacientes con cáncer de esófago tras tratamiento neoadyuvante / Prognostic value of PERCIST and PET/CT metabolic parameters in patients with esophageal cancer after neoadjuvant treatment

Objetivo Valorar la utilidad clínica de los criterios PERCIST y de los cambios en los parámetros cuantitativos de la PET/TC con [18F]FDG como factores pronósticos para la supervivencia libre de progresión y la supervivencia cáncer-específica en pacientes con cáncer de esófago tratados mediante quimiorradioterapia. Material y métodos Se valoraron retrospectivamente 50 pacientes (48 hombres) diagnosticados de cáncer de esófago durante un intervalo de 7,5 años. Se utilizaron los criterios PERCIST para valorar la respuesta a la neoadyuvancia. Asimismo, se determinaron las variaciones del SUV máximo, volumen metabólico tumoral y glucólisis tumoral total entre los estudios PET/TC pre- y postratamiento. Las curvas ROC, el método de Kaplan-Meier y el modelo de regresión de Cox se aplicaron para el análisis de factores pronósticos y curvas de supervivencia. Resultados El seguimiento medio fue de 26,8 meses, produciéndose 40 recurrencias-progresiones y 41 muertes. El análisis de supervivencia mostró curvas de supervivencia cáncer-específica con diferencias estadísticamente significativas en relación con los criterios PERCIST y la variación del volumen metabólico tumoral y la glucólisis tumoral total. Los criterios PERCIST fueron el único factor predictivo independiente en el análisis multivariante. Ni el SUV máximo ni el tamaño tumoral fueron predictores para ninguno de los criterios de evaluación. Conclusión La aplicación de los criterios PERCIST, así como el cambio de volumen metabólico tumoral y glucólisis tumoral total de los estudios PET/TC demostraron ser factores pronósticos para la supervivencia cáncer-específica en pacientes de nuestro entorno tratados por cáncer de esófago. Los resultados podrían ayudar a personalizar el tratamiento (AU)

Aim To assess the clinical utility of PERCIST criteria and changes in [18F]FDG PET/CT quantitative parameters as prognostic factors for progression-free survival and cancer-specific survival in patients with esophageal cancer treated by chemoradiotherapy. Material and methods Fifty patients (48 men) diagnosed with esophageal cancer were retrospectively evaluated over a 7.5-year interval. PERCIST criteria were used to assess response to neoadjuvant therapy. Variations in the metabolic parameters maximum SUV, metabolic tumor volume and total lesion glycolysis between pre- and post-treatment PET/CT studies were also determined. ROC curves, Kaplan-Meier method and Cox regression model were used for the analysis of prognostic factors and survival curves. Results The average follow-up was 26.8 months, with 40 recurrences-progressions and 41 deaths. Survival analysis showed statistically significant differences in cancer-specific survival curves for PERCIST criteria and variation of metabolic tumor volume and total lesion glycolysis. PERCIST criteria were the only independent predictor in the multivariate analysis. Neither maximum SUV nor tumor size were predictors for any of the assessment criteria Conclusion Application of PERCIST criteria as well as change in metabolic tumor volume and total lesion glycolysis from PET/CT studies proved to be prognostic factors for cancer-specific survival in patients in our setting treated for esophageal cancer. The results could help to personalize treatment (AU)

Prognostic value of PERCIST and PET/CT metabolic parameters after neoadjuvant treatment in patients with esophageal cancer.

AIM: To assess the clinical utility of PERCIST criteria and changes in [18F]FDG PET/CT quantitative parameters as prognostic factors for progression-free survival and cancer-specific survival (CSS) in patients with esophageal cancer treated by chemoradiotherapy. MATERIAL AND METHODS: Fifty patients (48 men) diagnosed with esophageal cancer were retrospectively evaluated over a 7.5-year interval. PERCIST criteria were used to assess response to neoadjuvant therapy. Variations in the metabolic parameters maximum SUV (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) between pre- and post-treatment PET/CT studies were also determined. ROC curves, Kaplan-Meier method and Cox regression model were used for the analysis of prognostic factors and survival curves. RESULTS: The average follow-up was 26.8 months, with 40 recurrences-progressions and 41 deaths. Survival analysis showed statistically significant differences in CSS curves for PERCIST criteria and variation of MTV and TLG. PERCIST criteria were the only independent predictor in the multivariate analysis. Neither SUVmax nor tumor size were predictors for any of the assessment criteria. CONCLUSION: Application of PERCIST criteria as well as change in MTV and TLG from PET/CT studies proved to be prognostic factors for CSS in patients in our setting treated for esophageal cancer. The results could help to personalize treatment.

Utilidad de la gammagrafía de tránsito gastrointestinal en la valoración del estreñimiento crónico / Utility of gastrointestinal transit scintigraphy in chronic constipation evaluation

Objetivo El estreñimiento crónico es una patología frecuente en la práctica clínica. Ante la falta de respuesta al tratamiento se recomienda evaluar la función gastrointestinal. Para ello puede ser útil la gammagrafía, aunque su uso no es generalizado. El objetivo del estudio fue valorar la utilidad de la gammagrafía de tránsito gastrointestinal en pacientes con estreñimiento crónico. Material y métodos Se valoraron 20 pacientes (13 niños) remitidos para estudio gammagráfico por estreñimiento crónico refractario al tratamiento, siringomielia, rectocele o migraña abdominal. Todos fueron sometidos a valoración clínica, determinación analítica, estudio de imagen radiológica y/o biopsia rectal. Se realizó un protocolo de estudio completo, incluyendo gammagrafía de vaciamiento gástrico, tránsito de intestino delgado y colónico. Para ello, se administró una dosis de [111In]In-DTPA diluida en agua (37MBq) junto con comida estandarizada. Siguiendo las guías internacionales, se definieron áreas de interés en el estómago, en el íleon terminal y en diferentes regiones del intestino grueso para calcular el centro geométrico como medida de progresión. Resultados De los 13 pacientes en edad pediátrica, 10 presentaron patrones gammagráficos anormales, modificando el tratamiento en 8 de ellos. La mayoría de los niños no mostraron alteraciones en las exploraciones radiológicas. En pacientes adultos, el resultado de la prueba conllevó el cambio del manejo terapéutico en todos ellos, Conclusiones El estudio gammagráfico proporcionó información útil en el estudio del estreñimiento crónico, influyendo en el diagnóstico y en el manejo terapéutico del paciente. La información fisiológica y cuantitativa que proporciona permite la determinación global y regional del tránsito gastrointestinal (AU)

Aim Chronic constipation is a common pathology in clinical practice. In the absence of response to treatment, assessment of gastrointestinal function is recommended. This can be performed by scintigraphy, although its use is not widespread. The aim of this paper was to assess the utility of gastrointestinal transits scintigraphy in patients with chronic constipation. Material and methods Twenty patients (13 children) sent for scintigraphy for chronic constipation refractory to treatment, syringomyelia, rectocele or abdominal migraine were evaluated. All underwent clinical assessment, analytical determination, radiological imaging and/or rectal biopsy. A complete study protocol was performed, including gastric emptying, small bowel and colonic transits scintigraphy. For this, a dose of [111In]In-DTPA diluted in water (37MBq) was administered together with standardized food. Following international guidelines, regions of interest were defined in the stomach, terminal ileum and different regions of the large intestine to calculate the geometric center as a measure of progression. Results Of the 13 pediatric patients, 10 had abnormal gammagraphic patterns, with treatment being modified in 8 of them. Most of the children showed no alterations on radiological explorations. In adult patients, the results of the test changed the therapeutic management in all of them. Conclusions Scintigraphic study provided useful information in the study of chronic constipation, influencing the diagnosis and therapeutic management of the patient. The physiological and quantitative information it provides allows both global and regional of gastrointestinal transit time determination (AU)

Utility of gastrointestinal transit scintigraphy in the evaluation of chronic constipation.

AIM: Chronic constipation is a common pathology in clinical practice. In the absence of response to treatment, assessment of gastrointestinal function is recommended. This can be performed by scintigraphy, although its use is not widespread. The aim of this paper was to assess the utility of gastrointestinal transits scintigraphy in patients with chronic constipation. MATERIAL AND METHODS: Twenty patients (13 children) sent for scintigraphy for chronic constipation refractory to treatment, syringomyelia, rectocele or abdominal migraine were evaluated. All underwent clinical assessment, analytical determination, radiological imaging and/or rectal biopsy. A complete study protocol was performed, including gastric emptying, small bowel and colonic transits scintigraphy. For this, a dose of [111In]In-DTPA diluted in water (37MBq) was administered together with standardized food. Following international guidelines, regions of interest were defined in the stomach, terminal ileum and different regions of the large intestine to calculate the geometric center as a measure of progression. RESULTS: Of the 13 pediatric patients, 10 had abnormal gammagraphic patterns, with treatment being modified in 8 of them. Most of the children showed no alterations on radiological explorations. In adult patients, the results of the test changed the therapeutic management in all of them. CONCLUSIONS: Scintigraphic study provided useful information in the study of chronic constipation, influencing the diagnosis and therapeutic management of the patient. The physiological and quantitative information it provides allows both global and regional of gastrointestinal transit time determination.

[Estimation of the percentage of body fat based on the body mass index and the abdominal circumference: Palafolls Formula]. / Estimación del porcentaje de grasa corporal en función del índice de masa corporal y perímetro abdominal: fórmula Palafolls.

INTRODUCTION: Overweight and obesity have the features of a worldwide epidemic, making it a public health problem. The traditional classification with the body mass index is a good start, but after the evidence of the biochemical activities of adipose tissue, its measurement is a necessity. There are multiple formulas for this purpose, but with little possibility of applying it in Primary Care. The following formulas are proposed for its use in this setting; Men=(body mass index [BMI/Abdominal Circumference [AC]*10)+BMI. Women=([BMI/AC]*10)+BMI+10. MATERIAL AND METHODS: A descriptive, prospective study was conducted, including 505 women and 489 men aged between 30 and 90 years. Weight, height, and abdominal circumference were measured, and the body mass index, percentage of fat using the CUN BAE (Clínica Universidad de Navarra - Body Adiposity Estimator) and proposed formulas were calculated. RESULTS: Comparative calculations were made between CUN BAE and formulas. No significant differences were observed in the descriptive values (Women χ2=1.1; P=.89. Men χ2=0.8; P=.93. The confidence interval and standard error p=1. The numerical correlation shows r=0.94; p=0.0001; R2=0.89. The relative error of the mean in men was 5.48% and -0.43% in women. The comparison of medians demonstrated Wilcoxon=0.8333. The study of sensitivity and specificity for cut-off points shows a ROC curve AUC=0.986; P=<.0001. CONCLUSIONS: The lack of significant differences between the results of both formulas, makes it possible to be proposed for the calculation of the fat percentage in body weight in Primary Care Clinics.

[Estimation of body mass index based on brachial circumference in patients with permanent or temporary incapacity]. / Estimación del índice de masa corporal con base en la circunferencia braquial, para pacientes con discapacidad permanente o transitoria.

INTRODUCTION: Many patients are affected by various conditions, which make it impossible to calculate body mass index (BMI) by measuring weight and height. For this reason, the purpose of this study was to develop a mathematical tool that allows the approximate calculation of the brachial circumference for diagnosis and follow-up. The formula proposed for both sexes is: brachial circumference (cm)×30/32. Results≥28 must be added 2 points. MATERIAL AND METHODS: Prospective, descriptive, observational study performed in a primary care clinic, including 224 men and 248 women. Weight, height, brachial circumference, and BMI were calculated using Quetelet's formula and the proposed formula. RESULTS: In men, BMI (CI 95%)=0.63, while BCF (CI 95%)=0.49 (P=.95), while in women BMI (CI 95%)=0.73 and BCF (CI 95%)=0.56 (P=.95). The numerical ratio showed r=0.82, R2=0.67, P<.005. In percentages, 80.3% of the men (P=.01) had their results between 90 and 110%, in women it was 85.8% (P=.0001). The median comparison, obtained a Wilcoxon P=.83. According to diagnostic criteria of the World Health Organization (obesity, overweight, normal and malnutrition) a P=.95 was obtained in both sexes. CONCLUSIONS: The proposed formula has values with no significant difference in its results, with respect to Quetelet, being applicable in patients in special condition due to physical limitations for the measurement of weight and height for the calculation of BMI.