The role of PET-PSMA in guiding prostate cancer radiation therapy: experience in a salvage and curative setting / Radioterapia guiada por PET-PSMA en cáncer de próstata: experiencia en el escenario curativo y en el salvamento

Introduction: The role of positron emission tomography (PET) prostate-specific membrane antigen (PSMA) in guiding radiation therapy treatment plans remains to be defined. Methods: We conducted a retrospective observational study of patients with prostate cancer referred for radiotherapy. Our objective was to establish the role of PET-PSMA in decision-making and changes in the radiotherapy treatment plan. Results: In the entire cohort, 26.8% had lymph node involvement outside the conventional field. The PET results upstaged and changed radiotherapy treatment plans for 75% in primary radiotherapy and 50% in salvage radiation. Conclusions: PET-PSMA changes decision-making and treatment planning for radiotherapy, including treatment volumes not traditionally delimited in contour atlases.

Introducción: El rol del PET-PSMA para guiar los planes de radioterapia aún debe definirse. Métodos: Realizamos un estudio observacional retrospectivo de pacientes con cáncer de próstata localizado remitidos para radioterapia. Nuestro objetivo fue establecer el rol del PET-PSMA en la toma de decisiones y cambios en el plan de tratamiento de radioterapia. Resultados: En toda la cohorte el 26,8% presentaba afectación ganglionar fuera del campo convencional. Los resultados del PET cambiaron los planes de tratamiento en el 75% para radioterapia primaria y en el 50% para salvamento. Conclusiones: El PET-PSMA cambia la toma de decisiones y planificación del tratamiento de radioterapia, incluyendo volúmenes de tratamiento no delimitados tradicionalmente en los atlas de contorneo.

Caso clínico 2. ¿Cuál sería su enfoque terapéutico? / Clinical Case 2. What would be your therapeutic approach?

Paciente de 46 años, sexo femenino, con dolor abdominal, se encuentra el siguiente hallazgo.

46 years old female patient with abdominal pain, present some findings

A prospective, multicenter, randomized, double-blind study comparing ertapenem and ceftriaxone followed by appropriate oral therapy for complicated urinary tract infections in adults.

OBJECTIVES: To compare the efficacy and safety of ertapenem, a new once-daily parenteral beta-lactam, with that of ceftriaxone for the initial empiric treatment of adults with complicated urinary tract infections (cUTIs). METHODS: In a multicenter, prospective, double-blind study, patients with cUTIs were stratified as to whether they had acute pyelonephritis or other cUTIs (without pyelonephritis) and randomized to receive ertapenem, 1 g once a day, or ceftriaxone, 1 g once a day. After 3 days, patients with a satisfactory clinical response could be switched to an oral antimicrobial agent. RESULTS: Of 258 randomized patients, 97 (55.4%) in the ertapenem group and 53 (63.9%) in the ceftriaxone group were evaluated microbiologically. Almost all patients in each treatment group were switched to oral therapy. The mean duration of therapy was similar in both treatment groups: parenteral, approximately 4 days; total, approximately 13 days. The most common pathogen was Escherichia coli. At the primary efficacy endpoint, 5 to 9 days after treatment, 85.6% of patients who received ertapenem and 84.9% who received ceftriaxone had a favorable microbiologic response, indicating that the two treatment groups were equivalent. The frequency and severity of drug-related adverse events were generally similar in both treatment groups. CONCLUSIONS: In this study, ertapenem was as effective as ceftriaxone for the initial treatment of cUTI in adults, was generally well tolerated, and had a similar safety profile.

Experiencia inicial con transplantes renales cadavericos en el Hospital Militar Central / Initial experience with cadaveric renal transplantation at Hospital Militar Central, CO

Se presentaron los primeros 7 pacientes que recibieron transplantes renales cadavericos en el Hospital Militar de Bogota. 4 pacientes tuvieron inicialmente una excelente funcion del injerto y pudieron ser rehabilitados satisfactoriamente. En el primer caso se presentaron varias complicaciones urologicas que finalmente fueron resueltas con intervenciones urologicas. 2 pacientes murieron poco despues del transplante, uno por hemorragia del pediculo y otro a causa de una infeccion pulmonar por criptococo. En un paciente la recuperacion funcional del injerto fue muy pobre; probablemente debido a la reproduccion de oxalosis en el rinon transplantado. En 3 casos hubo insuficiencia renal aguda despues de la operacion y en 5 se detectaron episodios de rechazo agudo del transplante. El tratamiento de estas entidades y la utilizacion de tecnica gammagraficas en su diagnostico diferencial se discuten en detalle