Ultrasound-guided interventional radiology procedures in the chest.

Ultrasonography is a very good tool for guiding different interventional procedures in the chest. It is the ideal technique for managing conditions involving the pleural space, and it makes it possible to carry out procedures such as thoracocentesis, biopsies, or drainage. In the lungs, only lesions in contact with the costal pleura are accessible to ultrasound-guided interventions. In this type of lung lesions, ultrasound is as effective as computed tomography to guide interventional procedures, but the rate of complications and time required for the intervention are lower for ultrasound-guided procedures.

Cell-free DNA concentration and fragment size fraction correlate with FDG PET/CT-derived parameters in NSCLC patients.

PURPOSE: The aim of our study was to investigate the correlation between cfDNA concentration and fragment size fraction with FDG PET/CT- and CT-derived parameters in untreated NSCLC patient. METHODS: Fifty-three patients diagnosed of locally advanced or metastatic NSCLC who had undergone FDG PET/CT, CT and cfDNA analysis prior to any treatment were included in this retrospective study. CfDNA concentration was measured by fluorometry and fragment size fractions were determined by microchip electrophoresis. [18F]F-FDG PET/CT was performed and standardised uptake values (SUV), metabolic tumour volume (MTV) and total lesion glycolysis (TLG) were calculated for primary, extrapulmonary and total disease. CT scans were evaluated according to RECIST 1.1 criteria. RESULTS: CfDNA concentration showed a positive correlation with extrapulmonary MTV (r2 = 0.36, P = 0.009), and extrapulmonary TLG (r2 = 0.35, P = 0.009) and their whole-body (wb) ratios. Higher concentrations of total cfDNA were found in patients with liver lesions. Short fragments of cfDNA (100-250 bp) showed a positive correlation with extrapulmonary MTV (r2 = 0.49, P = 0.0005) and extrapulmonary TLG (r2 = 0.39, P = 0.006) and their respective wb ratios, and a negative correlation with SUVmean (r2 = -0.31, P = 0.03) and SUVmean/SUVmax ratio (r2 = -0.34, P = 0.02). A higher fraction of short cfDNA fragments was found in patients with liver and pleural lesions. CONCLUSIONS: This study supports the hypothesis that cfDNA concentration and short cfDNA fragment size fraction reflect the tumour burden as well as metabolic activity in advanced NSCLC patients. This suggests their suitability as complementary tests for a more accurate diagnosis of tumour metabolic behaviour and to allow personalised therapies.

Thoracic ultrasound in viral infections. / Ecografía torácica de las infecciones víricas.

Ultrasonography has proven useful in the study of many pulmonary diseases that affect the subpleural regions. This article reviews the current evidence regarding the role of ultrasonography in the diagnosis and management of viral lung infections. It describes the examination technique and the main ultrasonographic findings for different viruses that can affect the lungs.

Multidisciplinary consensus statement on the clinical management of patients with stage III non-small cell lung cancer.

Stage III non-small cell lung cancer (NSCLC) is a very heterogeneous disease that encompasses patients with resected, potentially resectable and unresectable tumours. To improve the prognostic capacity of the TNM classification, it has been agreed to divide stage III into sub-stages IIIA, IIIB and IIIC that have very different 5-year survival rates (36, 26 and 13%, respectively). Currently, it is considered that both staging and optimal treatment of stage III NSCLC requires the joint work of a multidisciplinary team of expert physicians within the tumour committee. To improve the care of patients with stage III NSCLC, different scientific societies involved in the diagnosis and treatment of this disease have agreed to issue a series of recommendations that can contribute to homogenise the management of this disease, and ultimately to improve patient care.

Dual time-point 18F-FDG PET/CT to assess response to radiofrequency ablation of lung metastases / Imágenes en 2 tiempos con 18F-FDG PET/TC para evaluar la ablación por radiofrecuencia de las metástasis pulmonares

Aim. To establish the usefulness of dual time-point PET/CT imaging in determining the response to radiofrequency ablation (RFA) of solitary lung metastases from gastrointestinal cancer. Materials and methods. This prospective study included 18 cases (3 female, 15 male, mean age 71 ± 15 yrs) with solitary lung metastases from malignant digestive tract tumors candidates for RFA. PET/CT images 1 h after injection of 4.07 MBq/kg of 18F-FDG (standard images) were performed at baseline, 1 month, and 3 months after RFA. PET/CT images 2 h after injection centered in the thorax at 1 month after RFA were also performed (delayed images). A retention index (RI) of dual time-point images was calculated as follows: RI = (SUVmax delayed image − SUVmax standard image/SUVmax standard image) * 100. Pathological confirmation of residual tumor by histology of the treated lesion was considered as local recurrence. A negative imaging follow-up was considered as complete response. Results. Local recurrence was found in 6/18 lesions, and complete response in the remaining 12. The mean percentage change in SUVmax at 1 month and at 3 months showed a sensitivity and specificity for PET/CT of 50% and 33%, and 67% and 92%, respectively. The RI at 1 month after RFA showed a sensitivity and specificity of 83% and 92%, respectively. Conclusions. Dual time point PET/CT can predict the outcome at one month after RFA in lung metastases from digestive tract cancers. The RI can be used to indicate the need for further procedures to rule out persistent tumor due to incomplete RFA (AU)

Objetivo. Establecer la utilidad de las imágenes PET/TC en 2 tiempos en la determinación de la respuesta a la ablación por radiofrecuencia (RFA) de las metástasis pulmonares de tumores digestivos. Material y métodos. Estudio prospectivo con 18 casos (3 mujeres, 15 varones) y edad media de 71 ± 15 años con metástasis pulmonar única de cáncer digestivo candidato a tratamiento mediante RFA. Se realizaron imágenes PET/CT 1 h tras inyección de 4,07 MBq/Kg de 18F-FDG (imagen estándar) basal, un mes y 3 meses después de la RFA y una imagen tardía 2 h tras la inyección centrada en tórax un mes después de la RFA. Se calculó el índice de retención (RI): RI = (SUVmáx imagen tardía − SUVmáx imagen estándar/SUVmáx imagen estándar) * 100. La recurrencia local se confirmó con estudio histológico de la lesión tratada con RFA. Un resultado negativo en las pruebas de imagen durante el seguimiento se consideró como respuesta completa. Resultados. Se diagnosticó recidiva local en 6/18 lesiones y respuesta completa en 12/18. El cambio porcentual medio de SUVmáx al mes y a los 3 meses mostró una sensibilidad y especificidad para evaluar la respuesta a la RFA de 50% y 33% y 67% y 92%, respectivamente. El RI un mes posradiofrecuencia mostró una sensibilidad y especificidad del 83% y 92%. Conclusiones. Las imágenes en 2 tiempos con PET/TC un mes posradiofrecuencia pueden predecir el resultado de la RFA de las metástasis pulmonares de origen digestivo. El RI se puede utilizar para indicar la necesidad de otros procedimientos para descartar recurrencia tumoral debido a una RFA incompleta (AU)

Dual time-point (18)F-FDG PET/CT to assess response to radiofrequency ablation of lung metastases.

AIM: To establish the usefulness of dual time-point PET/CT imaging in determining the response to radiofrequency ablation (RFA) of solitary lung metastases from gastrointestinal cancer. MATERIALS AND METHODS: This prospective study included 18 cases (3 female, 15 male, mean age 71±15 yrs) with solitary lung metastases from malignant digestive tract tumors candidates for RFA. PET/CT images 1h after injection of 4.07MBq/kg of (18)F-FDG (standard images) were performed at baseline, 1 month, and 3 months after RFA. PET/CT images 2h after injection centered in the thorax at 1 month after RFA were also performed (delayed images). A retention index (RI) of dual time-point images was calculated as follows: RI=(SUVmax delayed image-SUVmax standard image/SUVmax standard image)*100. Pathological confirmation of residual tumor by histology of the treated lesion was considered as local recurrence. A negative imaging follow-up was considered as complete response. RESULTS: Local recurrence was found in 6/18 lesions, and complete response in the remaining 12. The mean percentage change in SUVmax at 1 month and at 3 months showed a sensitivity and specificity for PET/CT of 50% and 33%, and 67% and 92%, respectively. The RI at 1 month after RFA showed a sensitivity and specificity of 83% and 92%, respectively. CONCLUSIONS: Dual time point PET/CT can predict the outcome at one month after RFA in lung metastases from digestive tract cancers. The RI can be used to indicate the need for further procedures to rule out persistent tumor due to incomplete RFA.

[False images of endobronchial tumor in CT-scan]. / Falsas imágenes de tumoración endobronquial por tomografía computarizada.

Bronchoscopic identification of an endobronchial foreign body is an unexpected finding in adults. Modern imaging techniques such as computerised tomography (CT) may identify bronchial obstruction but not the cause. Moreover, images may be suggestive of other pathologies, especially when the previous aspiration cases are unknown. The most common CT findings in this setting are atelectasis, lung hyperlucency, localised bronchiectases and lobar consolidation. CT diagnosis of false endobronchial tumors in patients who have swallowed a foreign body is rarely described in the bibliography. In view of the potential adverse outcome in the case of wrong diagnosis we consider it is of interest to report two cases of endobronchial tumors diagnosed by CT in which flexible bronchoscopy allowed identification and extraction of an endobronchial foreign body.

Falsas imágenes de tumoración endobronquial por tomografía computarizada / False images of endobronchial tumor in CT-scan

La identificación mediante broncoscopia de uncuerpo extraño endobronquial es a menudo unhallazgo no esperado entre los adultos. Enocasiones, las más modernas técnicas de imagen,como la tomografía computarizada (TC), aunquepueden identificar la ocupación bronquial, nopermiten reconocer su naturaleza e incluso puedensimular otro tipo de patologías, sobre todo cuandose desconoce el antecedente de aspiración. Loshallazgos más habituales en la TC suelen ser lasatelectasias, la hiperclaridad pulmonar, lasbronquiectasias localizadas y la consolidación lobar.El falso diagnóstico de tumoración endobronquialpor TC, en sujetos que han sufrido la aspiración deun cuerpo extraño, se halla muy poco referido en laliteratura. Dadas las repercusiones pronósticas quepuede acarrear un diagnóstico incorrecto nos parecede interés reportar dos casos diagnosticados porTC de tumoración endobronquial y en los que lafibrobroncoscopia permitió la identificación y laextracción del cuerpo extraño endobronquial

Bronchoscopic identification of an endobronchialforeign body is an unexpected finding in adults.Modern imaging techniques such as computerisedtomography (CT) may identify bronchial obstructionbut not the cause. Moreover, images may besuggestive of other pathologies, especially when theprevious aspiration cases are unknown. The mostcommon CT findings in this setting are atelectasis,lung hyperlucency, localised bronchiectases andlobar consolidation. CT diagnosis of falseendobronchial tumors in patients who haveswallowed a foreign body is rarely described in thebibliography. In view of the potential adverseoutcome in the case of wrong diagnosis we considerit is of interest to report two cases of endobronchialtumors diagnosed by CT in which flexiblebronchoscopy allowed identification and extractionof an endobronchial foreign body

Marcada e inusual dilatación unihemisférica de los espacios de Virchow-Robin / Marked and unusual dilatation of one hemisphere of Virchow-Robin spaces

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Antidepressants do not modulate estrogen receptor alpha-mediated gene expression.

The estrogen receptor alpha has been shown to be activated both in a ligand-dependent and in a ligand independent fashion. We investigated whether antidepressants may directly activate the estrogen receptor alpha or enhance ligand-dependent or ligand-independent activation of the estrogen receptor alpha. Whereas both ligand-dependent and ligand-independent activation of the estrogen receptor alpha could be demonstrated in transient transfection studies, antidepressants neither directly activated the estrogen receptor alpha nor did they enhance ligand-dependent or ligand-independent activation. Thus, there are differences between the glucocorticoid receptor and the estrogen receptor alpha with regard to ligand-independent activation and action of antidepressants.

Comparative methodological analysis of erbB-2/HER-2 gene dosage, chromosomal copy number and protein overexpression in breast carcinoma tissues for diagnostic use.

AIMS: This study was performed to test the validity of different methods for determining the status of the erbB-2/HER-2 oncogene in breast cancer tissues for diagnostic use. METHODS AND RESULTS: Forty formalin-fixed, paraffin-embedded breast carcinomas were investigated by fluorescence in situ and comparative genomic hybridization (FISH, CGH) as well as by immunohistochemistry (IHC) using Dako-HercepTest and CB11 antibody (Ventana). Additionally, competitive-differential polymerase chain reaction (cdPCR) was performed on frozen samples to estimate gene dosage alterations of erbB-2/HER-2. Amplification was detected in 12-23% and protein overexpression in 16-68% of the cases, depending on the methodology and/or the reagent used. Perfect concordance (100%) was found between the results of cdPCR and CB11-IHC, and a 97% concordance between FISH and CB11-IHC. The concordance between Dako-HercepTest and CB11-IHC was 78%: seven of eight 2+ carcinomas with the Dako-HercepTest were classified as nonamplified using FISH. CONCLUSIONS: Our results indicate that high-level expression as well as normal erbB-2/HER-2 status of breast carcinomas can be detected reliably both by IHC and gene dosage assessment in paraffin material for diagnostic use. However, borderline results, especially those with 2 + immunopositivity, should be interpreted with caution and increased emphasis should be given to other clinical and prognostic information available.

Tacrolimus reversibly reduces insulin secretion in paediatric renal transplant recipients.

BACKGROUND: Conflicting reports exist about the mechanism of tacrolimus-induced post-transplant diabetes mellitus. METHODS: We analysed intravenous glucose tolerance tests (IVGTT) of 14 paediatric renal transplant recipients on cyclosporin (CsA) microemulsion and 15 patients on tacrolimus (FK506). The groups were similar in age (13.2+/-4.2 vs 13.0+/-3.7 years), body mass index, serum creatinine concentrations (96+/-60 vs 97+/-44 micromol/l), time after renal transplantation, and cumulative steroid dose over 12 weeks prior to the test (3.4 vs 3.5 mg/m(2)/day, NS, Mann-Whitney). Parameters of glucose tolerance included glucose, insulin, C-peptide concentrations, and HbA1c. The mean concentrations of the primary immunosuppressant were similar to treatments employed in other centres (CsA 165+/-59 ng ml and FK506 7. 5+/-2.2 ng ml). RESULTS: Baseline glucose concentrations were significantly higher on FK506 therapy compared with CsA microemulsion therapy. Baseline insulin concentrations and C-peptide concentrations were identical in both treatment groups. FK506 trough levels correlated negatively with k values (glucose constant decay) in the FK506 group. There was a significant reduction of the insulin first-phase concentrations, both after 1 min and after 3 min in the FK506 group compared with the CsA group (112+/-17 vs 237+/-57 microU/ml, P=0.034). In patients with repetitive IVGTTs, glucose constant decay and insulin production improved after lowering FK506 whole-blood trough levels. CONCLUSIONS: We conclude that post-transplant glucose intolerance could be due to a dose-dependent, direct effect of FK506 on the pancreatic beta cell function, which can be controlled by dose reduction.

Long-term prognosis of hemolytic uremic syndrome and effective renal plasma flow.

The long-term prognosis of diarrhea-associated hemolytic uremic syndrome (D+ HUS) was evaluated in a cohort of 127 of 149 children who had survived the acute phase. Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were estimated by serial (51)Cr-EDTA and (123)iodine-hippurate clearances. All children had acute renal failure during the initial phase and 74% of patients were dialyzed. During the 1st year, mean GFR and ERPF increased continuously until a plateau was reached. In the 2nd year after the diagnosis of HUS, GFR was below 80 and ERPF below 515 ml/min per 1. 73 m(2) in 16% and 47% of patients, respectively. At the end of a median follow-up of 5.0 (range 2.0-13.2) years, the proportion of children with renal sequelae such as proteinuria >/=300 mg/l, hypertension, or a GFR <80 ml/min per 1.73 m(2) was 23%. Anuria of more than 7 days' duration and hypertension during the acute phase were statistically significant risk factors for an unfavorable outcome. A reduced ERPF in the 2nd year was found in 93% of patients with sequelae. Mean filtration fraction (SD) in these patients was 0. 26 (+/-0.07) versus 0.19 (+/-0.05) in patients without sequelae (P<0. 0001). These data suggest that loss of nephrons during the acute phase may implicate hyperfiltration in the residual functioning kidney mass leading to progressive renal disease. ERPF in the 2nd year after D+ HUS may serve as an excellent parameter to detect patients with a high risk of an unfavorable long-term outcome.

Diagnostic sensitivity of serum cystatin for impaired glomerular filtration rate.

Recently, the reciprocal of cystatin C (Cys-C), a non-glycosylated 13-kilodalton protein that is produced by all investigated nucleated cells, was found to correlate closely with glomerular filtration rate (GFR). In order to determine the diagnostic validity in children for the detection of impaired GFR, venous blood samples from 381 children (aged 1.7-18 years) with various renal pathology referred for 51Cr-EDTA clearance investigations were obtained for measurement of Cys-C as well as beta2-microglobulin (beta2-MG) and serum creatinine. Two hundred and sixteen children with clearance values >90 ml/min per 1.73 m2 constituted a control group, with a normal GFR. In the control group, Cys-C values were normally distributed with a mean of 0.94+/-0.27 mg/l and an upper reference limit (97.5th percentile) of 1.47 mg/l. In all children, there was a positive correlation between 51Cr-EDTA clearance and the reciprocal of Cys-C (r=0.64, P<0.0001), beta2-MG (r=0.59, P<0.0001), creatinine (r=0.55, P<0.0001), and the height/creatinine ratio (r=0.73, P<0.0001). Receiver-operating characteristics analysis showed that there were no significant differences between these three parameters for discriminating between patients with normal and reduced GFR, although there was a tendency towards the best diagnostic sensitivity of the GFR estimate according to the Schwartz formula. We conclude that for the detection of mildly impaired GFR, a full clearance study cannot be replaced by measurement of serum Cys-C or beta2-MG concentrations.