Evanescent Prostate Carcinoma, Case Report

Objective: To report the treatment and clinical monitoring in patients with prostatic evanescent carcinoma at Hospital Carlos Andrade Marin. Methods: We reviewed the medical records of 148 patients undergoing by robot-assisted radical prostatectomy in Carlos Andrade Marin hospital. The cases reported between January 2016 to December 2018. The diagnosis was carried by taking a transrectal prostate biopsy with 12 cylinders. This samples are studied by the pathologist who reviews the radical prostatectomy surgery. Results: Three patients had prostatic evanescent carcinoma, which those cases showed Gleason 6 (3+3) prostate cancer. Two received neoadjuvant hormone therapy and the other patient presented minor tumor invasion in 1 out of 12 cylinders used during the biopsy. In the three cases, after the sample analysis, there was no residual tumor evidence. Therefore, they were classified as pT10. Conclusions: In this study, the results obtained from the patients studied presents the incidence of prostatic evanescent carcinoma is 2%. The combination of these different factors such as clinical status, preoperative PSA, number of positive cylinders and the invasion percentage, additionally to the usage of neoadjuvant hormone therapy prior the radical prostatectomy can help to predict evanescent carcinoma of the prostate (AU)

Objetivos: Reportar la experiencia del Hospital Carlos Andrade Marín en el tratamiento y seguimiento de pacientes con cáncer de próstata evanescente.Materiales y Métodos: Se ha estudiado las historiasclínicas de 148 pacientes que se realizaron prostatectomíaradical asistida por robot en el Hospital Carlos AndradeMarín en el periodo enero 2016 hasta diciembre 2018, eldiagnostico se realiza mediante toma de biopsia prostáticatransrectal con toma de 12 cilindros, los cuales son estudiados por el mismo medico patólogo que revisa la piezaquirúrgica de prostatectomía radical.Resultados: Se identifican tres casos de carcinomade próstata evanescente, los cuales presentan carcinoma depróstata Gleason 6 (3+3), dos reciben terapia neoadyuvantehormonal y uno presenta escasa invasión tumoral en 1/12cilindros de biopsia prostática (cáncer de próstata diminuto). En los tres casos después del análisis de las piezasquirúrgicas no se evidencia tumor residual por lo que se loscataloga como pT0.Conclusiones: En nuestra experiencia la incidenciade carcinoma de próstata evanescente es del 2% en elgrupo de pacientes estudiados. La combinación del estadio clínico, PSA preoperatorio, numero de cilindros positivos y el porcentaje de invasión de los mismos como el usode neoadyuvancia previo a la prostatectomía radical puedeayudar a predecir el fenómeno de carcinoma de próstata evanescente (AU)

Leiomiosarcoma de vena ovárica izquierda: a propósito de un caso / Leiomyosarcoma of the ovarian vein: Presentation of a case

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Changing the p53 master regulatory network: ELEMENTary, my dear Mr Watson.

The p53 master regulatory network provides for the stress-responsive direct control of a vast number of genes in humans that can be grouped into several biological categories including cell-cycle control, apoptosis and DNA repair. Similar to other sequence-specific master regulators, there is a matrix of key components, which provide for variation within the p53 master regulatory network that include p53 itself, target response element sequences (REs) that provide for p53 regulation of target genes, chromatin, accessory proteins and transcription machinery. Changes in any of these can impact the expression of individual genes, groups of genes and the eventual biological responses. The many REs represent the core of the master regulatory network. Since defects or altered expression of p53 are associated with over 50% of all cancers and greater than 90% of p53 mutations are in the sequence-specific DNA-binding domain, it is important to understand the relationship between wild-type or mutant p53 proteins and the target response elements. In the words of the legendary detective Sherlock Holmes, it is 'Elementary, my dear Mr. Watson'.

[Urachal sinus: an unusual cause of recurrent umbilical discharge in adults]. / Uracosinus: una causa poco frecuente de onfalitis recurrente en adultos.

Urachal sinus is a rare congenital anomaly due to incomplete closure the urachus in the umbilical region, it is very rare in adults. 47-year-old male who arrived at our Emergency Department with recurrent umbilical discharge. Not response medical treatment (oral antibiotic and drainage). Abdominal computerized tomography scan confirmed the urachal sinus with omphalitis. Surgical complete excision with omphalectomy was performed. Any complications in the postoperative was observed.

Uracosinus: una causa poco frecuente de onfalitis recurrente en adultos / Urachal sinus: an unusual cause of recurrent umbilical discharge in adults

El uracosinus es una anomalía congénita poco frecuente secundaria a la obliteración incompleta del uraco en su porción infraumbilical, que puede aparecer a cualquier edad. Presentamos un paciente de 47 años que acudió al servicio de urgencias por supuración umbilical persistente que no había respondido al tratamiento médico (antibioterapia y curas). El TAC confirmó la existencia de un sinus del uraco con cambios de onfalitis. La cirugía consistió en la resección en bloque del mismo con onfalectomía. El postoperatorio transcurrió sin incidencias

Urachal sinus is a rare congenital anomaly due to incomplete closure the urachus in the umbilical region, it is very rare in adults. 47-year-old male who arrived at our Emergency Department with recurrent umbilical discharge. Not response medical treatment (oral antibiotic and drainage). Abdominal computerized tomography scan confirmed the urachal sinus with omphalitis. Surgical complete excision with omphalectomy was performed. Any complications in the postoperative was observed

Effects of capsule endoscopy on cardiac pacemakers.

BACKGROUND AND STUDY AIMS: Capsule endoscopy is a new, noninvasive diagnostic technique which enables visualization of the mucosa of the small intestine in physiological conditions and without the need to subject the patient to external radiation. Wireless capsule video endoscopy is contraindicated in patients with a cardiac pacemaker. However, on the basis of the characteristics of the radiofrequency band used by the endoscopic capsule, together with a series of other factors, it is possible that the patient's use of a pacemaker should not be a contraindication to capsule endoscopy. PATIENTS AND METHODS: This work had two phases: an in vitro study, using an interference detector, and an in vivo study involving 20 patients with cardiac pacemakers who showed symptoms or signs that justified a capsule endoscopy investigation. RESULTS: No interference was observed during the first, in vitro, phase of the study. In the second phase, patients wore a Holter recorder for a mean time of 10 hours, during which the average number of recorded QRS complexes exceeded 30,000. All the pacemakers functioned normally. Interference due only to myopotentials was detected in a single patient in whom modification of the pacemaker programming was necessary. In the other 19 patients, neither sensing nor stimulation failures were observed. CONCLUSIONS: No interference between the pacemaker and the endoscopic capsule was observed. All the pacemakers functioned normally, and no increased incidence of adverse effects was observed. Neither was any pacemaker-induced interference observed on the capsule endoscopy images.

Phase II Clinical Trial With Pegylated Liposomal Doxorubicin (CAELYX(R)/Doxil(R)) and Quality of Life Evaluation (EORTC QLQ-C30) in Adult Patients With Advanced Soft Tissue Sarcomas: A study of the Spanish Group for Research in Sarcomas (GEIS).

BACKGROUND: Pegylated liposomal doxorubicin (PLD), a formulation with pharmacokinetic differences with respect to doxorubicin (DXR), might benefit patients with advanced soft tissue sarcoma (STS) pretreated with DXR. PATIENTS AND METHODS: Patients with measurable and progressive STS received PLD at 35 mg/(2) every 3 weeks. Quality of life before and during treatment was assessed with EORTC QLQ-C30. RESULTS: Twenty-eight patients, 22 DXR-pretreated, were given 140 cycles (median 3, range 1-18). Activity in 27 patients (5 GIST): one complete and one partial remission (both non-GIST and without prior DXR), 12 stabilizations and 13 progressions (response rate 7.4%, 95% CI: 0-17%). Grade 3 toxicity: palmar-plantar erythrodysesthesia (19% of patients), stomatitis (4%) or cutaneous (4%). Neutropenia grade>/=3 was detected in 16% of patients. Median relative dose intensity was 95%. Progression-free rate at 3 and 6 months was, respectively, 48 and 22%, median progression-free survival 5.8 months and median overall survival 8.7 months. QLQ-C30 at baseline and at weeks 6-11 in 23 and 13 patients, respectively, showed good reliability and validity. Quality of life did not seem to worsen during therapy. CONCLUSIONS: PLD did not induce objective remissions in 22 STS patients pretreated with DXR, but progression-free rate figures support the use of this agent in patients who have not progressed under a DXR-containing regimen. The toxicity observed was comparable to that of other PLD schedules.

Raltitrexed in the treatment of elderly patients with advanced colorectal cancer: an active and low toxicity regimen.

In spite of the high prevalence of advanced colorectal cancer in the elderly, we have little data on the efficacy and toxicity of chemotherapy in this age group. Raltitrexed is a thymidylate synthetase inhibitor with known activity in the treatment of advanced colorectal cancer. The objective of this study was to analyse the efficacy and tolerance of raltitrexed in elderly patients with advanced colorectal cancer. 92 patients diagnosed with advanced colorectal cancer aged >or=70 years were entered into the study. Raltitrexed was given at a dose of 3 mg/m(2) once every 3 weeks for a minimum of three cycles. A total of 511 cycles were given with a median of five cycles per patient. 20 out of the 90 patients evaluable for response achieved a partial response (PR) (22%, 95% Confidence Interval (CI): 17-36%), 43 (48%) remained stable and 27 showed progression (30%). The mean duration of response was 24 weeks and the progression-free interval was 15 weeks. The overall median survival was 41 weeks. 31 patients (39%, 95% CI: 28-50%) experienced a clinical benefit (improvement of the performance status without a worsening of symptoms or relief of symptoms without a worsening of the performance status). The main toxicities were gastrointestinal and haematological. 12 patients (13%) developed grade 3-4 side-effects: 7 had nausea/vomiting (8%), 6 a transaminase increase (7%), 4 asthenia (4%), 3 diarrhoea (3%), 2 neutropenia (2%), 2 anaemia (2%) and 1 thrombocytopenia (1%). Three toxic deaths occurred (3%). The group of patients with a creatinine clearance

Role of P53 functionality in the genotoxicity of metronidazole and its hydroxy metabolite.

P53 mediates several biological processes for preservation of genetic stability such as the induction of cell cycle arrest, DNA repair or apoptosis in response to DNA damage. The antiparasitic drug, 1-(2-hydroxyethyl)-2-methyl-5-nitroimidazole (metronidazole, MTZ) is able to increase lymphocyte proliferation inducing at the same time chromosomal aberrations. Trying to understand this unexpected event we used cell lines with different P53 functionality, determining the proliferation capacity and the induction of micronuclei (MN) after the treatment with MTZ or its hydroxy metabolite. Our results show that MTZ increased proliferation in a dose response manner in all P53 functional cell lines without inducing changes on the levels of P53 nor MN. However, MTZ hydroxy metabolite induced a dose response increase of P53 and MN, while cell proliferation was not increased. Several studies have shown that the hydroxy metabolite is more potent than MTZ itself. Only in cell lines that do not have a functional P53, MTZ and its metabolite increased both cell proliferation and MN. MTZ use is increasing and its carcinogenicity has not been discarded. Our data indicate that MTZ hydroxy metabolite is potentially a carcinogen and needs to be further studied.

ATM status confers sensitivity to arsenic cytotoxic effects.

Arsenic (As), a human carcinogen, represents a worldwide health problem due to the high number of people exposed to this element in their drinking water. Previously our group has demonstrated that As can impair lymphocyte cell proliferation in vitro and in vivo and can increase the level of P53 protein, with different responses to these effects between individuals. Recently it has been shown that ATM protein, responsible for the autosomal recessive disorder ataxia telangiectasia (AT), regulates P53. In this study the induced response of P53 was evaluated following exposure to As in human lymphoblastoid cell lines normal (+/+), heterozygous (+/-) or homozygous (-/-) for the mutant ATM gene. After 24 h As treatment we found a dose-dependent induction of P53 in normal and heterozygous cell lines, although differences between cell lines were observed. An increase in P21(WAF) protein, a main effector of P53 activation, was also observed in the same cell lines. In contrast, neither P53 nor P21 induction was detected in homozygous cells. The ATM (+/-) and (-/-) genotypes confer more sensitivity to As cytotoxic effects than the normal allelic condition. Paradoxically, ATM heterozygous cells were more sensitive to As, leading us to propose that this might be related to activation of apoptosis and removal of non-repairable cells. In contrast, in AT cells in which ATM is absent or mutated activation of P53 and its target genes is abrogated, allowing cells to replicate with damage in the presence of As, with cell death ensuing by a pathway different from P53.

DNA breakage due to metronidazole treatment.

The mutagenicity of metronidazole [1-(hidroxyethyl)-2-methyl-5-nitroimidazole] (MTZ) has been shown in different prokaryotic systems. However, data on human cells are still contradictory. In this study DNA damage was determined by the single cell gel electrophoresis (SCGE) assay, in lymphocytes from 10 healthy subjects treated with therapeutic doses of this drug. Samples were obtained before treatment, as well as 1 and 15 days after ending treatment. Results showed a significant increase of DNA strand breaks 1 day after ending treatment, although, an inverse correlation between the amount of DNA damage and plasma concentrations of MTZ was obtained. Thus, the observed damage may be induced by some MTZ metabolite rather than by the parent drug. Interestingly, the amount of DNA damage returned to basal levels 15 days after ending treatment, except in two individuals. This persistent damage should be further investigated.

Monocular visual loss in a patient undergoing cisplatin chemotherapy.

Chemotherapeutic agents used against tumours have a variety of toxic effects. We describe a case of acute blindness in the left eye of a patient after treatment with cisplatin for lung cancer. Both the clinical findings and the absence of either ocular or retrobulbar metastasis suggested that the condition was related to chemotoxicity.

[Proximal vein by-pass in the treatment of venous stenosis in expanded polytetrafluoroethylene prosthesis for hemodialysis]. / By-pass a vena proximal para el tratamiento de estenosis venosas en prótesis de politetrafluoroetileno expandido para hemodiálisis.

OBJECTIVE: To show the long-term results of 97 politetraflouroethylene dialysis grafts submitted to a graft by-pass to treat graft-vein stenosis. MATERIALS AND METHODS: Venous stenoses were studied and diagnosed by means of fistulography in cases with fistula dysfunction or during surgery for graft thrombectomy. Both early and late complication rates were studied, as well as primary and secondary patency rates. RESULTS: Number of cases, 97. Mean age, 58 years (7-79). Diabetic nephropathy: 19.5%. Types of grafts in which stenoses developed: straight forearms 13; loop forearm 9; 6 mm upper arm 36; 6-8 mm upper arm 34; brachio-jugular 4; femoro-femoral 1. Overall follow-up time: 2,427 graft-months. Mean follow-up time: 21 +/- 5 months. Late complication rate: 0.30 episodes per graft-year of follow-up. Re-stenosis rate: 0.12 graft-year of follow-up. Primary cumulative patency rate: 70%, 62%, 51%, 45% at one, two, three and four years, respectively. Secondary cumulative patency rate: 87%, 79%, 74% and 71% at one, two, three and four years, respectively (p < 0.0016). No differences were observed between secondary patency observed after by-pass to treat dysfunction or thrombosis (p = 0.09259). DISCUSSION: In our experience, by-pass to proximal vein is associated with good results both at short and long term, probably because the intimal hyperplasia area is excluded and because by-pass is performed on an already dilated vein. The procedure can be performed under local anesthesia and in an outpatient basis between dialysis, with little discomfort for the patient.

By-pass a vena proximal para el tratamiento de estenosis venosas en prótesis de politetrafluoroetileno expandido para hemodiálisis / By-pass to proximal vein for treatment of venous stenoses in politetrafluorethylene grafts for haemodialysis

Objetivo. Mostrar los resultados a largo plazo de 97 by-pass a vena proximal para tratar estenosis protésis-vena periféricas de prótesis de politetrafluoroetileno (PTFE) para hemodiálisis.Material y métodos. Las estenosis venosas fueron estudiadas y diagnosticadas con fistulografía en casos de disfunción de la fístula o durante el procedimiento de trombectomía de las prótesis. Se estudiaron la tasa de complicaciones precoces y tardías, así como las curvas de permeabilidad primaria y secundaria.Resultados. Número de casos: 97. Edad media: 58 (7-79). Nefropatía diabética: 19,5 por ciento. Tipos de prótesis en las que se desarrollaron las estenosis: 13 rectas de antebrazo, 9 antebrazo curvas, 36 brazo 6 mm, 34 brazo 6-8 mm, 4 humeroyugulares y 1 femorofemoral. Tiempo global de seguimiento: 2.427 meses. Tiempo medio de seguimiento: 21ñ 5 meses. Tasa de complicaciones totales: 0,30 episodios prótesis/año de seguimiento. Tasa de reestenosis: 0,12 prótesis/año de seguimiento. Curva actuarial de permeabilidad primaria: 70 por ciento, 62 por ciento, 51 por ciento, 45 por ciento al primer, segundo, tercer y cuarto año, respectivamente. Curva actuarial de permeabilidad secundaria: 87 por ciento, 79 por ciento, 74 por ciento y 71 por ciento al primer, segundo, tercer y cuarto año, respectivamente (p < 0,0016). No hubo diferencia en la curva de función secundaria si el by-pass fue realizado por malfunción o trombosis. Conclusiones. En nuestra experiencia el by-pass a vena proximal tiene buenos resultados a corto y largo plazo probablemente por excluir la zona de hiperplasia intimal y por realizar el by-pass sobre vena dilatada. El tratamiento puede ser realizado bajo anestesia local, en régimen ambulatorio y en período interdiálisis con mínimas molestias para los pacientes (AU)

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Phase II trial of first-line high-dose ifosfamide in advanced soft tissue sarcomas of the adult: a study of the Spanish Group for Research on Sarcomas (GEIS)

BACKGROUND: The agent Ifosfamide (IFOS) is active against soft tissue sarcomas (STS), and patients who progress to IFOS at doses < or = 10 g/m2 show remissions when exposed to high-dose ifosfamide (HDI) (i.e., doses > 10 g/m2), which supports a dose-response relationship for this drug. Because of a lack of first-line studies in adult STS patients, we decided to test the activity and toxicity of HDI in a phase II trial. PATIENTS AND METHODS: Forty-eight patients were enrolled in the study. IFOS was administered at a dose of 14 g/m2 by continuous infusion over six days every four weeks. Granulocyte-macrophage colony-stimulating factor (GM-CSF) at 5 micrograms/kg/day for 10 consecutive days was systematically administered after an episode of neutropenic fever or a delay in hematologic recovery. Patients were treated until progression or the occurrence of severe toxicity, and surgical rescue was attempted when possible. RESULTS: Six pathology-established complete remissions and 11 partial remissions were observed in 45 assessable patients with a response rate of 37.7% (95% CI: 25.5%-50%). Grade 3-4 toxicity (% of cycles) was noted by hemoglobin (17%), leukocyte (75%), granulocyte (75%) and platelet (13%) counts in 158 evaluable cycles. GM-CSF was administered to 28 patients, and 25 suffered one or more episodes of neutropenic fever. Renal toxicity was mild and reversible with some degree of tubular and glomerular dysfunction detected in up to 60% of patients. Grade 3 CNS toxicity was observed in 32% of patients but only one required interruption of therapy. Sixty-four per cent of the patients had asthenia grade 2-3 and 20% were excluded from the study due to excessive toxicity. There was one treatment-related death. CONCLUSIONS: HDI is an active drug in first-line therapy against adult STS. Different administration schedules should be evaluated in an attempt to improve its therapeutic index.

Induction of p53 protein expression by sodium arsenite.

Arsenic is carcinogen for humans and has been shown to act as an enhancer in initiated animal models. In a previous work we found impairment of lymphocyte proliferation in arsenic-exposed individuals and in vitro we obtained dose-related inhibition of mitotic response and lymphocyte proliferation. Intrigued by these effects and based on the role of p53 on cell proliferation, we tested different concentrations of sodium arsenite for their ability to induce the expression of tumor suppressor gene p53 in different cell lines (HeLa, C-33A. Jurkat) and a lymphoblast cell line transformed with Epstein-Barr virus (LCL-EBV). We also evaluated changes in their viability after 24 h arsenic treatment; C-33A cells showed the higher sensitivity to arsenic treatment while HeLa, Jurkat and LCL-EBV cells showed similar cytotoxicity curves. Immunoblots showed an increased expression of p53 gene with 1 microM sodium arsenite in Jurkat cells and 10 microM sodium arsenite in HeLa and LCL-EBV cells. In addition, we transfected Jurkat cells and human lymphocytes with wild-type and mutated p53 genes; lymphocytes and Jurkat cells that received the mutated p53 showed increased sensitivity to arsenic cytotoxicity. Data obtained indicate that arsenic induces p53 expression and that cells with a functional p53 contend better with damage induced by this metalloid.

[An analysis of the evolution of consultation pressure in general medicine (1989-1993)]. / Análisis de la evolución de la presión asistencial en medicina general (1989-1993).

OBJECTIVE: To improve the understanding of attendance pressure, its evolution over time and its relationship with the indicators of demand, use and age of the resources. DESIGN: Descriptive and retrospective. SETTING: Primary care centres with an appointment system in the Community of Valencia. There were 6,756 valid registers of the monthly attendance pressure (1989-1993) available. MEASUREMENTS AND MAIN RESULTS: Attendance pressure has an extremely dispersed distribution. Behaviour which is constant in its evolution over time does exist, which allows a characteristic curve, repeated every year, to be defined: descent in August, two peaks in October and January and a third "mobile" peak around March and April. Mathematical equality between attendance pressure and the product of three factors has been obtained: duration of use per procedure x intensity of repeated use per procedure x ratio equivalent day. The analysis of the monthly evolution of each one of these three "components" helps understand changes in pressure. These "components" are also modified by the type and age of centre. CONCLUSIONS: The wide dispersion of the results of technical productivity (attendance pressure), and the evidence of its change in composition over time and according to the care model offer important scope for management. It also creates the need for an explanatory model which includes the variables which determine both the attendance pressure and a method for altering it.