Comparative study of 18F-FDG PET/CT and CT angiography in detection of large vessel vasculitis. / Estudio comparativo de la PET/TC con 18F-FDG y la angiografía por TC en la detección de la vasculitis de grandes vasos.

OBJECTIVE: Compare 18F-FDG PET/CT and CTangio in the diagnosis of extracraneal large vessel involvement in patients with suspicion of large vessel vasculitis (LVV). MATERIAL AND METHODS: A retrospective database reviewed 59 patients with clinical suspicion of LVV undergoing 18F-FDG PET/CT and CTangio. In 55 patients PET/TC and CTangio were done simultaneously in the same machine and in 4 patients with a scan interval of<1 month. PET/CT analyses included qualitatively and quantitative analysis (ratio SUVmax 18F-FDG vessel/SUVmax liver). CTangio was assessed for concentric mural thickening, contrast wall enhancement and structural vascular changes as potential complications of vasculitis. RESULTS: 18F-FDG PET/CT and CTangio show high specificity (97.2%) for LVV diagnosis, with an excellent sensitivity for 18F-FDG PET/CT (95.6%) and lower for CTangio (60.9%), which leads to a high negative predictive value for 18F-FDG PET/CT (97.2%) and a high false negative rate for CTangio (39.1%). A 70% concordance between 18F-FDG PET/CT and CTangio was obtained (Kappa index 0.70± 0.095 (P<.001). CONCLUSION: The results show the greater potential of 18F-FDG PET/CT for the detection and extension of LVV. Therefore, 18F-FDG PET/CT should be exploited to the maximum and consider as the first line imaging technique in the extracranial diagnosis of LVV and its possible association with polymyalgia rheumatica. The addition of CTangio could be more indicated in patients with Takayasu arteritis and in long-standing and/or severe vasculitis since it increases the accuracy in the detection of possible vascular complications.

Endoscopic resection as unique treatment for early colorectal cancer.

Colonoscopic screening in developed countries allows detection and resection of a great number of early colorectal cancers. There is a strong controversy to decide when endoscopic treatment is enough or when surgical resection is necessary. To this contributes the diverse names to define the lesions, the wide number of classifications and the different criteria of each author. We perform an extense literature review, aiming to clarify concepts and unify criteria that can be used as a guide for the treatment of early colorectal cancer. We conclude that in early colorectal cancer arising in pedunculated polyps (0-Ip), mucosal endoscopic resection would be indicated as only treatment in Haggitt levels 1, 2 and 3, tumors smaller than 2 cm, well- or moderately differentiated, without vascular or lymphatic affection, with submucosal infiltration lower than 1 microm from the muscularis mucosae and maximal submucosal width lower than 4 microm, and undergoing en bloc resection. In sessile polyps (0-Is) or non-polypoideal elevated (0-IIa) or plain (0-IIb) lesions, recommendations will be similar, without applicability of Haggitt levels.

Resección endoscópica de cáncer colorrectal temprano como único tratamiento / No disponible

El screening mediante colonoscopia que se realiza en paísesoccidentales ha permitido la detección y resección de un númeroelevado de tumores colorrectales en estadio temprano. Existe unagran controversia a la hora de decidir cuándo el tratamiento endoscópicoes suficiente y cuándo debe realizarse la resección quirúrgica.A ello contribuye la gran diversidad en la nomenclaturapara definir estas lesiones, la amplia variedad de clasificaciones delas mismas y los diferentes criterios que tiene cada autor. Medianteuna revisión extensa de la literatura, pretendemos aclarar conceptos,enlazar los datos de las diferentes clasificaciones y unificarunos criterios que sirvan de guía para el tratamiento del cáncercolorrectal temprano. Tras ello, llegamos a la conclusión de queen el cáncer colorrectal temprano que aparece en pólipos pedunculados(0-Ip), estaría indicada la resección endoscópica comoúnico tratamiento en los niveles 1, 2 y 3 de Haggitt, tumores menoresde 2 cm de diámetro, en tumores bien o moderadamentediferenciados, sin afectación vascular ni linfática, con infiltraciónde la submucosa menor de 1 mm desde la muscularis mucosae yanchura máxima en la submucosa menor de 4 mm y resecados enbloque. En las lesiones polipoideas sésiles (0-Is) y no polipoideaselevadas (0-IIa) o planas (0-IIb) las recomendaciones serían las mismasdescritas anteriormente, no siendo aplicables los niveles deHaggitt(AU)

Colonoscopic screening in developed countries allows detectionand resection of a great number of early colorectal cancers.There is a strong controversy to decide when endoscopic treatmentis enough or when surgical resection is necessary. To thiscontributes the diverse names to define the lesions, the wide numberof classifications and the different criteria of each author. Weperform an extense literature review, aiming to clarify conceptsand unify criteria that can be used as a guide for the treatment ofearly colorectal cancer. We conclude that in early colorectal cancerarising in pedunculated polyps (0-Ip), mucosal endoscopic resectionwould be indicated as only treatment in Haggitt levels 1, 2and 3, tumors smaller than 2 cm, well- or moderately differentiated,without vascular or lymphatic affection, with submucosal infiltrationlower than 1 mm from the muscularis mucosae and maximalsubmucosal width lower than 4 mm, and undergoing en blocresection. In sessile polyps (0-Is) or non-polypoideal elevated (0-IIa) or plain (0-IIb) lesions, recommendations will be similar, withoutapplicability of Haggitt levels(AU)

[Giant cell tumor of the tendon sheath: characteristic findings of the bone scintigraphy and correlation with MRI]. / Tumor de células gigantes de la vaina tendinosa: hallazgos característicos de la gammagrafía ósea y correlación con la RMN.

We report 3 cases of an unusual tumor, that is, the giant cell tumor of the tendon sheath. The patients consulted due to the appearance of a well-defined, painless, soft tissue mass with mild-to-moderate inflammation located in the thumbs or toes. These clinical data, together with the bone scan findings, oriented the diagnostic suspicion that was confirmed by a pathology study of the tumor after resection. This work has aimed to review the characteristics of the bone scan (BS) image of this tumor and its correlation with the conventional X-ray imaging and magnetic resonance imaging (MRI).

Patients' perception of cancer-related fatigue: results of a survey to assess the impact on their everyday life

PURPOSE: Fatigue is a cancer-related symptom with great impact on patients' daily lives, but often not discussed with their oncologists. This survey explored functional and psychological fatigue impact among different cancer symptoms according to patient's perception (pp). METHODS: A cross-sectional, self-administered survey was conducted in 10 oncologist services throughout Spain. Demographical data and tumour diagnoses were collected. Fatigue impact on functional and social activities (Likert scale) and on emotional well-being (visual analogue scale) was measured. The pp of oncologist's response to fatigue report was recorded. RESULTS: 505 surveyed cancer patients were analysed (55.2% women, aged 58.8 years +/-11.7), 97.8% remembered experiencing fatigue during treatment. 27.1% did not discuss their fatigue with their oncologist. Fatigue affected patient's daily routine (> or = 50% of times) included self-care (58.26%), entertainment activities (69.8%), and relationships (71.4%). Fatigue was the most bothersome symptom of cancer. CONCLUSIONS: Cancer patients perceive fatigue as the symptom with highest impact on their daily living and that substantially affects their emotional and social areas (AU)

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[Evaluation of renal lesions using 99mTc-DMSA in children with urinary tract infection and the relation with vesicoureteral reflux]. / Evaluación de lesiones renales mediante 99mTc-DMSA en niños con antecedentes de infección del tracto urinario y su relación con el reflujo vesicoureteral.

OBJECTIVE: Paediatric patients with urinary tract infection (UTI) have risk of developing renal scarrings. Although it is known that vesicoureteral reflux (VUR) predisposes to UTIs and it seems to have an important role in the development of renal lesions, some recent published studies question that relation. The aim of the study was to evaluate renal scarring by using renal scintigraphy 99mTc-DMSA and see the relation with or without the presence of VUR. MATERIAL AND METHODS: We evaluated retrospectively a total of 230 patients (460 renal units), mean age: 11 months (range: 12d-5y), with UTI probed by urinoculture. All were studied with voiding cistourethrography (MCU) to evaluate the presence or absence of VUR. Patients were evaluated with 99mTc-DMSA scan 6 months after UTI to determine if UTI caused renal scarring. RESULTS: Renal scans with 99mTc-DMSA 6 months post-infection were abnormal in 62 renal units, affecting 54 patients (23 %). From all patients studied, 110 were diagnosis of VUR being affected 161 renal units, 43 of them (27 %) presented renal scarrings. From the remaining 120 patients without VUR that is 240 renal units, 19 of them (8 %) presented parenchymatous damage. CONCLUSION: Renal scarring resulting from UTI are in some cases related to VUR, but sometimes are caused by the infection itself. Not all patients with VUR develop renal lesions, and neither the presence of VUR always predispose children to renal lesions. MCU and direct isotopic cystography are useful for diagnosis of VUR but we shouldn't avoid 99mTc-DMSA scan in the management of children with UTI.

Evaluación de lesiones renales mediante 99mTc-DMSA en niños con antecedentes de infección del tracto urinario y su relación con el reflujo vesicoureteral / Evaluation of renal lesions using 99mTc-DMSA in children with urinary tract infection and the relation with vesicoureteral reflux

Objetivo. Los pacientes pediátricos con infección del tracto urinario (ITU) tienen riesgo de desarrollar lesiones renales. Aunque el reflujo vesicoureteral (RVU) predispone a ITU y parece tener un papel importante en el desarrollo de estas lesiones, estudios recientes cuestionan dicha relación. El objetivo del estudio fue evaluar mediante gammagrafía renal con 99mTc-DMSA la existencia de lesiones renales y su relación con la presencia o no de RVU. Material y métodos. Se evaluaron retrospectivamente 230 pacientes (460 unidades renales), edad media 11 meses (intervalo: 12 días-5 años), con ITU probada mediante urinocultivo. A todos ellos se les realizó cistografía miccional seriada (CUMS) para valorar la existencia o no de RVU. Para determinar si la ITU originó cicatrices se practicó 99mTc-DMSA a partir de los 6 meses postinfección. Resultados. El estudio con 99mTc-DMSA de control postinfección fue patológico en 62 unidades renales, afectando a 54 pacientes (23 %). De los pacientes estudiados, 110 fueron diagnosticados de RVU, afectando a 161 unidades renales, de las cuales 43 unidades (27 %) presentaron cicatrices. De los restantes 120 pacientes sin RVU, 240 unidades renales, 19 de ellas (8 %) presentaron afectación renal. Conclusión. Las cicatrices renales post-ITU están en algunos casos relacionadas con RVU, pero en ocasiones se asocian a la propia infección. No todos los pacientes con RVU desarrollan lesiones y su presencia no siempre predispone a mayor susceptibilidad a lesiones renales. La CUMS o cistografía isotópica directa son útiles para diagnosticar RVU, pero no deberíamos obviar el estudio con 99mTc-DMSA en el manejo del paciente con ITU

Objective. Paediatric patients with urinary tract infection (UTI) have risk of developing renal scarrings. Although it is known that vesicoureteral reflux (VUR) predisposes to UTIs and it seems to have an important role in the development of renal lesions, some recent published studies question that relation. The aim of the study was to evaluate renal scarring by using renal scintigraphy 99mTc-DMSA and see the relation with or without the presence of VUR. Material and methods. We evaluated retrospectively a total of 230 patients (460 renal units), mean age: 11 months (range: 12d-5y), with UTI probed by urinoculture. All were studied with voiding cistourethrography (MCU) to evaluate the presence or absence of VUR. Patients were evaluated with 99mTc-DMSA scan 6 months after UTI to determine if UTI caused renal scarring. Results. Renal scans with 99mTc-DMSA 6 months post-infection were abnormal in 62 renal units, affecting 54 patients (23 %). From all patients studied, 110 were diagnosis of VUR being affected 161 renal units, 43 of them (27 %) presented renal scarrings. From the remaining 120 patients without VUR that is 240 renal units, 19 of them (8 %) presented parenchymatous damage. Conclusion. Renal scarring resulting from UTI are in some cases related to VUR, but sometimes are caused by the infection itself. Not all patients with VUR develop renal lesions, and neither the presence of VUR always predispose children to renal lesions. MCU and direct isotopic cystography are useful for diagnosis of VUR but we shouldn't avoid 99mTc-DMSA scan in the management of children with UTI

Calcifilaxis: una causa poco común de acumulación de fosfonatos en partes blandas / Calciphylaxis: a rare cause of accumulation of phosphonates in soft tissues

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Treatment of stage I and II Hodgkin's lymphoma with ABVD chemotherapy: results after 7 years of a prospective study.

BACKGROUND: Chemotherapy with ABVD (doxorubicin, bleomycin, vinblastine and darcarbacine) schedule is the standard treatment for advanced Hodgkin's lymphoma. Certain facts, including a low toxicity compared with MOPP/ABV (mechlorethamine, vincristine, procarbazine, prednisone, doxorubicin, bleomycin and vinblastine) and minimal potential for inducing second neoplasias or patient sterility, support the use of ABVD to treat early disease stages. In the present study, we prospectively evaluated the long-term efficacy and toxicity of six cycles of ABVD as treatment for early-stage Hodgkin's lymphoma. PATIENTS AND METHODS: From January 1990 to June 2002, 95 patients with stage I and II Hodgkin's lymphoma were treated with six ABVD cycles. Fifteen patients who met the criteria for mediastinal bulky disease also received further radiotherapy on the mediastinum. RESULTS: After six cycles, 89 patients (94%) showed a complete response (CR) and six patients (6%) showed a partial response (PR). These PRs became CRs after radiotherapy. After a median follow-up of 78 months, 14 patients had relapsed and three had died. Overall survival and progression-free survival rates at 7 years were 96% and 84%, respectively. For patients with stage IA and IIA without mediastinal bulky disease, the survival rates were 97% and 88%, respectively. CONCLUSIONS: The administration of six ABVD cycles is an effective and safe treatment in patients with stage I and II Hodgkin's lymphoma.

Púrpura trombocitopénica asociada a infección por Mycoplasma pneumoniae en un paciente adulto / Thrombocytopenic purpura associated to Mycoplasma pneumoniae infection in an adult patient

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Adjuvant anthracycline therapy as a prognostic factor in metastatic breast cancer.

BACKGROUND: Prognostic factors in metastatic breast cancer continue to be identified. Previous adjuvant chemotherapy appeared to have poor prognosis in some studies but, despite this, the prior use of anthracyclines in the adjuvant setting has not been clearly established as an adverse prognostic factor once metastatic disease develops. PATIENTS AND METHODS: Patients (n = 1,436) with stages I-IIIa breast cancer were surgically treated with/without radiotherapy and/or systemic adjuvant treatment. Of these, 297 patients who relapsed with metastatic disease constitute the sample population of this retrospective study. Survival, as a function of time since diagnosis of metastatic disease, was assessed in relation to the following factors: age, size of the primary tumor, grade, number of positive axillary nodes, type of surgery, type of adjuvant treatment administered, time to relapse, number of metastatic sites, presence of visceral metastases and type of treatment employed at the time of relapse. RESULTS: In multivariable analysis three factors remained significant predictors of short survival time: more than 1 site of metastases (p = 0.00003), shorter time to relapse (p = 0.003) and the previous administration of anthracyclines as adjuvant therapy (p = 0.005). CONCLUSIONS: The prior use of adjuvant anthracyclines, with other known clinical prognostic factors, confers a poorer outcome in metastatic disease, perhaps as a result of resistant clones selection or by induction of de novo resistance.

Secondary prophylactic G-CSF (filgrastim) administration in chemotherapy of stage I and II Hodgkin's lymphoma with ABVD.

UNLABELLED: The purpose of this study was to determine the effect of granulocyte colony-stimulating factor (filgrastim, G-CSF) for maintenance of chemotherapy dose-intensity in patients with stage I or II Hodgkin's lymphoma treated with six cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). Fifty-six patients with stage I or II Hodgkin's lymphoma treated with ABVD were eligible for secondary prophylactic G-CSF administration because of neutropenia (absolute neutrophil count < 1 x 10(9) /L) causing treatment delay or febrile neutropenia. Patients received 300 microg (total dose) of G-CSF (filgrastim) subcutaneously on days 3 to 7 and 17 to 21 of each cycle in order to prevent dose reduction or delay in subsequent cycles of treatment continuing the G-CSF until completion of chemotherapy. Results showed that 30 (54%) of the patients required the use of G-CSF, 26 (47%) during the first or second cycle. After G-CSF administration delay in chemotherapy did not occur in 25 patients, whereas delays in the fifth or sixth cycle occurred in four patients. Despite treatment with G-CSF, one patient had febrile neutropenia. Dose intensity greater than 90% of that planned was delivered to more the 85% of patients. IN CONCLUSION: Secondary prophylactic G-CSF administration was necessary in more than half of patients with stage I or II Hodgkin's lymphoma during chemotherapy with ABVD. The use of G-CSF allowed maintenance of chemotherapy schedule and dose intensity in the majority of patients.

Six cycles of ABVD in the treatment of stage I and II Hodgkin's lymphoma: a pilot study.

PURPOSE: Chemotherapy is the standard treatment in advanced Hodgkin's lymphoma and a therapeutic alternative for early stages. Although polychemotherapy with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) is equivalent or superior to mechloretamine, vincristine, procarbazine, and prednisone (MOPP) in advanced disease, no series have been published using ABVD without associated radiotherapy in early stages. We report the results obtained with the administration of six cycles of ABVD alone in clinical stage I and II disease. PATIENTS AND METHODS: From January 1990 to October 1994, 23 patients with stage I or II Hodgkin's lymphoma were treated with six cycles of ABVD; six patients who met the criteria for mediastinal bulky disease also received radiotherapy to the mediastinum. RESULTS: After six cycles, 20 complete responses (CRs) and three partial responses (PRs), which became CRs after radiotherapy, were obtained. Toxicity was moderate and manageable. With a median follow-up duration of 37 months (range, 12 to 75), three patients have relapsed and one has died. Overall and progression-free survival rates at 42 months are 95% and 84%, respectively. CONCLUSION: Six cycles of ABVD are effective and safe in the treatment of stage I and II Hodgkin's lymphoma, at least in the short term, but long-term observation data are not yet available.