Radiotherapy in rectal cancer: development, adequacy and radiotherapy utilisation rate. A comparative analysis with the most frequent tumour sites

INTRODUCTION: Radiotherapy is a basic weapon in the local treatment of multiple solid tumors. The radiotherapy activity has been evaluated in our centre during the past eleven years. The study focused on rectal cancer. MATERIALS AND METHODS: This is a descriptive study of all radiotherapy procedures performed between January 1998 and December 2008. It quantifies the workload of each pathology treated, the rate of irradiation and its adequacy with optimal rates of irradiation according to the best available scientific evidence. RESULTS: We quantified 9,622 external radiotherapy procedures of which 6,009 were associated with the five pathologies that involved the highest workloads. Of these, 905 were performed in rectal cancer. The workloads due to cancers of the breast, prostate, lung, gynaecological pathologies and rectal cancers were 23.2%, 11.8%, 11.6%, 6.3% and 9.3% respectively. The real "radiotherapy utilisation rates" of these pathologies were 62%, 20.2%, 34.3%, 21% and 64% respectively, while the "rates of adequacy" were 74.7%, 33.6%, 45.1%, 60% and 104.8%. CONCLUSIONS: The "radiotherapy utilisation rate" for rectal cancer was equivalent to the estimated optimum rate as defined on the basis of reference groups. The therapy utilised developed chronologically in parallel with the available scientific evidence. The radiotherapy utilisation rates for breast and prostate cancer gradually increased, with a tendency to reach optimal rates. Radiotherapy as a treatment for lung cancer was underutilised. In global terms, the rate of utilisation of radiation therapy was low, although it displayed a tendency to increase (AU)

Calidad de vida relacionada con la salud en receptores de un trasplante pulmonar. Su relación con variables clínicas / Health-related quality of life in lung transplantation recipients. Relationship with clinical variables

Objetivo Conocer la calidad de vida relacionada con la salud (CVRS) en trasplantados de pulmón y su relación con la disnea y la prueba de 6 min marcha. Material y método Estudio descriptivo. Participantes: pacientes trasplantados de pulmón. Mediciones: variables sociodemográficas, volumen espiratorio forzado en el primer segundo, parámetros funcionales (disnea y prueba de 6min marcha) y test genérico de calidad de vida SF-36. Prueba t de una muestra para comparar las puntuaciones medias en cada dimensión del SF-36 con los valores de referencias de la población española. Correlación de Pearson entre CVRS percibida y parámetros funcionales. Análisis multivariante para identificar variables predictivas de la CVRS. Resultados Participaron 59 personas, 36 hombres y 23 mujeres. La media de edad fue de 43,77 años (DE±15,27) y el tiempo medio postrasplante de 3,7 años (DE±2,18). Las puntuaciones obtenidas en el SF-36 para las dimensiones de función física, dolor, salud mental y vitalidad fueron superiores a las de la población de referencia (p<0,05), no encontrándose diferencias para el resto. Las dimensiones función física, rol físico y función social presentaron correlación con el grado de disnea (p=0,01), así como en el análisis multivariante (R2=0,60). Conclusiones La CVRS declarada por los pacientes trasplantados de pulmón es similar a la de la población de referencia española. El grado de disnea es el parámetro que mejor se relaciona con la calidad de vida (AU)

Objective To know the health-related quality of life (HRQL) to the in lung transplantation recipient and their relationship with the dyspnea and with the 6-min walk test. Material and method Descriptive study. Participants: Lung transplanted patients. Mensurations: socio-demografic data, FEV1, functional parameters (dyspnea and 6-min walk test), and generic test of HRQL SF-36 Health Index. A t-test to compare the mean punctuations in each dimesion the SF-36 with the reference values of the spanish population. Pearson correlation between perceived HRQL and functional parameters. Multivariate analysis to identify predicted variables of the HRQL. Results 59 people, 36 men and 23 women participated. The mean age was 43.77 years (SD±15.27) and the mean time postrasplante of 3.7 years (SD±2.18). The punctuations obtained in the lung transplanted patients for the dimensions physical function, pain, mental health and vitality they went upper to them the population reference values (p value<0.05), not being differences for the rest. The dimensions physical function, role physical and social function presented high correlations with the degree of dyspnea (p value=0.01) as well as in the multivariate analysis (R2=0.60). Conclusions The HRQL declared by the lung transplanted patients it is similar to the reference spanish population. The dyspnea it is the parameter that better is related with the quality of life (AU)

Seguimiento mediante angio-resonancia magnética de aneurismas cerebrales embolizados: concordancia entre lectores / MR angiography follow-up of embolized cerebral aneurysms: interobserver agreement

Objetivo: valorar el grado de concordancia entre lectores en los estudios de angio-resonancia magnética (angio-RM) realizados como seguimiento de aneurismas intracraneales embolizados. Asimismo, comprobar si el uso de contraste paramagnético mejora el grado de concordancia. Material y métodos: se recogen los estudios de angio-RM realizados desde julio de 2004 a diciembre de 2006 como seguimiento de aneurismas cerebrales embolizados. Estas exploraciones se analizaron de forma independiente por 2 neurorradiólogos con experiencia en RM. Se obtuvieron 2 secuencias para cada paciente, una sin contraste, mediante parámetros 3D time-of-flight, y otra con contraste paramagnético. Los hallazgos se dividieron en: a) invalorable; b) oclusión completa, y c) resto aneurismático. El grado de concordancia entre lectores para las angio-RM sin y con contraste se midió mediante el cálculo del coeficiente kappa y se clasificó en: k<0,2 insignificante; k=0,21–0,4 bajo; k=0,41–0,6 moderado; k=0,61–0.8 bueno, y k>0,81 excelente. Resultados: se obtuvieron 200 angio-RM, 100 realizadas sin contraste y 100 con contraste, en un total de 48 pacientes a los 6, 12 y/o 24 meses tras la embolización. El grado de concordancia entre lectores fue bueno, tanto para las angio-RM sin contraste como para las con contraste, si bien fue superior para los estudios con contraste (k=0,660, p<0,001 y k=0,779, p<0,001, respectivamente). Conclusiones: la angio-RM presenta una buena concordancia entre lectores en el seguimiento de aneurismas intracraneales embolizados. El uso de contraste paramagnético ha supuesto un mayor grado de concordancia observado (AU)

Objective: To determine the interobserver agreement in the interpretation of MR angiography (MRA) studies for surveillance of embolized intracranial aneurysms. To determine whether contrast administration improves interobserver agreement. Material and methods: Two experienced neuroradiologists independently reviewed all follow-up MRA studies performed between July 2004 and December 2006 of cerebral aneurysms embolized with coils. All MRA studies included both unenhanced 3D time-of-flight (3D TOF) and contrast-enhanced MRA (CE-MRA) images. Studies were classified as: a) not assessable; b) complete occlusion; c) residual aneurysm. Interobserver agreement for unenhanced and enhanced MRA studies was determined using the kappa statistic. Kappa values were considered insignificant when<0.2, low when between 0.21 and 0.4, and moderate when between 0.41–0.6; values >0.6 were considered good agreement and >0.8 excellent agreement. Significance was set at p<0.005. Results: We reviewed a total of 200 MRA studies (100 3D TOF studies and 100 CE-MRA studies) performed in 48 patients (25 women, 23 men) at 6, 12, and/or 24 months after embolization. Interobserver agreement was good in both 3D TOF and CE-MRA studies, although it was better in CE-MRA studies (k=0.660, p<0.001 and k=0.779, p<0.001, respectively). Conclusions: Interobserver agreement is good for follow-up MRA studies of embolized intracranial aneurysms. Gadolinium administration improves interobserver agreement (AU)

[MR angiography follow-up of embolized cerebral aneurysms: interobserver agreement]. / Seguimiento mediante angio-resonancia magnética de aneurismas cerebrales embolizados: concordancia entre lectores.

OBJECTIVE: To determine the interobserver agreement in the interpretation of MR angiography (MRA) studies for surveillance of embolized intracranial aneurysms. To determine whether contrast administration improves interobserver agreement. MATERIAL AND METHODS: Two experienced neuroradiologists independently reviewed all follow-up MRA studies performed between July 2004 and December 2006 of cerebral aneurysms embolized with coils. All MRA studies included both unenhanced 3D time-of-flight (3D TOF) and contrast-enhanced MRA (CE-MRA) images. Studies were classified as: a) not assessable; b) complete occlusion; c) residual aneurysm. Interobserver agreement for unenhanced and enhanced MRA studies was determined using the kappa statistic. Kappa values were considered insignificant when<0.2, low when between 0.21 and 0.4, and moderate when between 0.41-0.6; values >0.6 were considered good agreement and >0.8 excellent agreement. Significance was set at p<0.005. RESULTS: We reviewed a total of 200 MRA studies (100 3D TOF studies and 100 CE-MRA studies) performed in 48 patients (25 women, 23 men) at 6, 12, and/or 24 months after embolization. Interobserver agreement was good in both 3D TOF and CE-MRA studies, although it was better in CE-MRA studies (kappa=0.660, p<0.001 and kappa=0.779, p<0.001, respectively). CONCLUSIONS: Interobserver agreement is good for follow-up MRA studies of embolized intracranial aneurysms. Gadolinium administration improves interobserver agreement.

Estadificación axilar mediante ecografía. Manejo pretratamiento de la axila / No disponible

La extensión de los programas poblacionales para la detecciónprecoz del cáncer de mama y la mejora en los métodosde imagen, han permitido el diagnóstico de tumores de mamaen estadios iniciales, con menor probabilidad de afectaciónaxilar.A su vez, esto ha impulsado el desarrollo de métodos terapéuticosmenos agresivos para el cáncer de mama, como la cirugíaconservadora o la biopsia selectiva del ganglio centinela.Dado el abanico de posibilidades terapéuticas para el cáncerde mama y las tendencias a un tratamiento individualizadobasado en las características propias de cada paciente, se hacenecesaria una correcta estadificación con el fin de elegir la mejoropción terapéutica en cada caso.En este sentido, la valoración ecográfica ganglionar axilarha cobrado gran importancia en los últimos años en el cáncerde mama. Esta técnica ha demostrado que es capaz no sólo devalorar las características morfológicas de los ganglios axilaresy del resto de cadenas ganglionares, sino también de orientary dirigir la biopsia percutánea de los ganglios sospechosos, yde este modo seleccionar de forma precisa las pacientes candidatasde biopsia selectiva del ganglio centinela.En el presente trabajo se valora la aportación de la ecografíay biopsia percutánea ganglionar axilar en pacientes concáncer de mama(AU)

Breast cancer screening programs and improved imagingtechniques have made it possible to detect breast cancer in theearly stages when axillary involvement is less likely. Early detectionhas led to less aggressive treatments for breast cancerlike conservative surgery and sentinel lymph node biopsy.Given the wide variety of therapeutic alternatives for breastcancer and the trend toward tailoring treatment to each patient’scharacteristics, correct staging is crucial to ensure thebest treatment option is chosen in each case.In this sense, ultrasonographic evaluation of lymph nodesin patients with breast cancer has become increasingly importantin recent years. Ultrasonography has proven to be effectivenot only in the evaluation of the morphological characteristicsof the axillary lymph nodes and other lymph node chainsbut also in guiding percutaneous biopsy of suspicious lymphnodes to accurately select candidates for sentinel lymph nodebiopsy.This study evaluates the contribution of ultrasonographyand percutaneous biopsy of axillary lymph nodes in patientswith breast cancer(AU)

[Magnetic resonance diagnosis of ankylosing spondylitis and evaluation of the response to treatment]. / Diagnóstico y valoración de la respuesta al tratamiento mediante resonancia magnética en la espondilitis anquilosante.

OBJECTIVE: To show the role of magnetic resonance imaging in the early diagnosis of ankylosing spondylitis and discuss its possible usefulness in evaluating the response to treatment. MATERIAL AND METHODS: We describe the findings on magnetic resonance images using STIR and contrast-enhanced T1-weighted sequences in 13 patients diagnosed with ankylosing spondylitis receiving adalimumab treatment. Magnetic resonance images were acquired at baseline and after six months. We describe the findings obtained and the results of the quantitative analysis of vertebral affection (using the ASspiMRI-a score), and sacroiliac and hip joint affection. RESULTS: Inflammatory effects were demonstrated in 12 patients as signal hyperintensity in STIR sequences and as contrast enhancement in T1-weighted sequences. After treatment, 12 patients showed decreased ASspiMRI-a score and less affection in the sacroiliac and hip joints. No changes were observed in the remaining patient. Two patients showed posterior vertebral element involvement and disc involvement was seen in three. CONCLUSIONS: MRI opens up new possibilities for the management of patients with ankylosing spondylitis. On the one hand, it enables early diagnosis, saving the patient years of trial treatments and saving the healthcare system the cost of multiple diagnostic tests to try to explain the symptoms these patients present. On the other hand, it enables the rapid, objective evaluation of the response to therapy, thus making it possible to step up to a new, more aggressive therapy quickly and avoid treatments that are not very effective.

Diagnóstico y valoración de la respuesta al tratamiento mediante resonancia magnética en la espondilitis anquilosante / Magnetic resonance diagnosis of ankylosing spondylitis and evaluation of the response to treatment

Objetivo. Mostrar el papel de la resonancia magnética en el diagnóstico precoz de la espondilitis anquilosante y su posible utilidad en la valoración de la respuesta al tratamiento.Material y métodos. Se describen los hallazgos en resonancia magnética (secuencias STIR y T1 con contraste paramagnético) en 13 pacientes diagnosticados de espondilitis anquilosante que reciben tratamiento con adalimumab. Se realiza una resonancia magnética basal al comienzo del estudio y otra a los seis meses, describiendo los hallazgos obtenidos y valorando cuantitativamente la afectación vertebral (con el sistema de puntuación ASspiMRI-a), la afectación sacroilíaca y de la articulación coxofemoral.Resultados. La afectación inflamatoria se demostró en 12 pacientes en forma de hiperintensidad de señal en STIR y captación de contraste en secuencias T1. Tras la administración del tratamiento 12 pacientes mostraron una disminución de la puntuación ASspiMRIa, y una menor afectación en ASI y coxofemorales. En el paciente restante la puntuación no se modificó. Dos pacientes presentaban afectación de elementos posteriores vertebrales y en tres pacientes se apreció afectación discal.Conclusiones. La resonancia magnética abre nuevas posibilidades para el manejo de los pacientes con espondilitis anquilosante. Por un lado, permite el diagnóstico precoz, ahorrando al paciente años de tratamientos de prueba y ahorrando al sistema sanitario el coste de múltiples pruebas diagnósticas para intentar explicar los síntomas que presentan dichos enfermos. Por otro lado, permite una valoración rápida y objetiva de la respuesta al tratamiento, por lo que el paso a un nuevo escalón terapéutico más agresivo se podrá realizar con mayor celeridad, evitando tratamientos poco efectivos

Objective. To show the role of magnetic resonance imaging in the early diagnosis of ankylosing spondylitis and discuss its possible usefulness in evaluating the response to treatment.Material and methods. We describe the findings on magnetic resonance images using STIR and contrast-enhanced T1-weighted sequences in 13 patients diagnosed with ankylosing spondylitis receiving adalimumabtreatment. Magnetic resonance images were acquired at baseline and after six months. We describe the findings obtained and the results of the quantitative analysis of vertebral affection (using the ASspiMRI-a score), and sacroiliac and hip joint affection.Results. Inflammatory effects were demonstrated in 12 patients as signal hyperintensity in STIR sequences and as contrast enhancement in T1-weighted sequences. After treatment, 12 patients showed decreasedASspiMRI-a score and less affection in the sacroiliac and hip joints. No changes were observed in the remaining patient. Two patients showed posterior vertebral element involvement and disc involvementwas seen in three.Conclusions. MRI opens up new possibilities for the management of patients with ankylosing spondylitis. On the one hand, it enables early diagnosis, saving the patient years of trial treatments and saving the healthcare system the cost of multiple diagnostic tests to try to explain the symptoms these patients present. On the other hand, it enables the rapid, objective evaluation of the response to therapy, thus making it possible to step up to a new, more aggressive therapy quickly and avoid treatments that are not very effective

[Pituitary magnetic resonance in women with a clinical suspicion of microprolactinoma]. / Resonancia magnética hipofisaria en mujeres con sospecha clínica de microprolactinoma.

Seventy-seven women with clinical suspect of microprolactinoma were studied by means of magnetic resonance of the pituitary gland. The homogeneity and signal intensity of the pituitary gland, presence of intraglandular nodule, height and gland morphology were evaluated. Radiological findings were correlated to prolactinemia values and the definite clinical diagnosis. The pituitary gland was normal in eleven out of the thirteen patients in whom the presence of hypophyseal endocrine pathology was not confirmed. In the remaining 64 women with hyperprolactinemia, 26 hypophyseal nodules were detected (40.6%), 3 questionable nodules (4.7%), 8 homogeneous glands (12.5%), 6 of empty sella turcica (9.4%) and 21 normal pituitary glands (32.8%). A correlation between radiological diagnosis, prolactinemia levels and definite clinical diagnosis was verified. The convexity degree of the pituitary gland was not useful for the diagnosis of microprolactinoma. In contrast, the height of the pituitary gland was indeed useful.

Myocardial damage following coronary bypass surgery: assessment with antimyosin antibody uptake.

To assess the role of 111In antimyosin antibody (AbAm) in the delineation of myocardial damage following coronary bypass surgery, we studied 51 consecutive patients who underwent coronary surgery, 27 of whom had a history of prior myocardial infarction. All patients underwent a diagnostic protocol comprising: (1) 99Tcm pyrophosphate (PYP) and AbAm injection 48 h after surgery (AbAm imaging 24 and 48 h post-injection) (myocardial/background and myocardial/lung ratios were obtained respectively from the computer image); (2) Radioimmunoassay (RIA) serum CK-B levels from samples obtained immediately before surgery, and 24 and 48 h later; (3) clinical and ECG follow-up. Twenty-five patients showed positive AbAm studies, 10 had positive PYP images, and 21 had CK-B levels above normal limits at 24 h. One patient with abnormal AbAm, PYP and CK-B studies had new Q waves on the ECG after surgery. This patient was considered to have sustained a peri-operative myocardial infarction. The large number of positive AbAm studies probably reflects myocardial damage frequently associated with coronary bypass surgery.

Muscarinic control of gallbladder dynamics. A study using 99Tcm-HIDA and cholinergic agonists and antagonists.

We studied 12 normal subjects who underwent four 99Tcm-HIDA examinations. Imaging was performed with 111 MBq at 1 image/min for 60 min, and was registered on a computer on a 64 x 64 word matrix. Normalized and background corrected time-activity curves on the gallbladder were obtained from which total and cumulative 10 min interval emptying was calculated. During the first examination (control), 10 min after the beginning of acquisition, 1 ml saline solution was injected subcutaneously. The second examination was performed injecting 5 mg bethanechol subcutaneously instead of saline solution. During the third and fourth examinations 10 mg pirenzepine and 0.15 mg/10 kg atropine were injected i.v. respectively, 5 min before bethanechol injection. Wilcoxon's test was used to compare the first and second studies and the latter with the third and fourth studies. The median value of gallbladder emptying at 60 min was 2% with saline solution injection and 27.5% with bethanechol. This difference was significant from minute 30 onwards. Atropine administration inhibited gallbladder emptying completely in all cases, with significant differences (P less than 0.01) in relation to bethanechol values following the first 30 min of the examination. Gallbladder emptying was observed in the study with pirenzepine, but was significantly inferior to the bethanechol values after the first 30 min.

99Tcm-MAG3 for quantitation of differential renal function.

We studied two different methods for the evaluation of differential renal function in a group of 100 patients with various kidney disorders whose effective renal plasma flow (ERPF) had been calculated previously by single 125I-orthoiodohippurate (OIH) injection and multiple blood sampling. Patients were divided into three groups according to their ERPF:ERPF is greater than or equal to 250 ml min-1; ERPF less than or equal to 100 ml min-1; and ERPF greater than 100 ml min-1 and less than 250 ml min-1. The two methods used to assess differential renal function were: first, relative 99Tcm-dimercaptosuccinic acid (DMSA) uptake calculated by normalized background and attenuation corrected cumulative counts in each kidney 24 h p.i.; and second, relative 99Tcm-mercaptoacetyl-triglycine (MAG3) uptake within 1 and 2 min p.i. calculated by normalized background and attenuation corrected counts on each renal area. The results obtained with each method correlated strongly with high significance (p less than 0.0001). In the right kidney, mean values obtained with 99Tcm-MAG3 tend to be higher than mean values obtained with 99Tcm-DMSA.