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Jimenez Londono G.A.,Hospital Universitario Of Ciudad Real | Garcia Vicente A.M.,Hospital Universitario Of Ciudad Real | Amo-Salas M.,University of Castilla - La Mancha | Funez Mayorga F.,Hospital Virgen Of Altagracia | And 6 more authors.
Revista Espanola de Medicina Nuclear e Imagen Molecular | Year: 2017

Objectives: To study 18F-Choline PET/CT in the diagnosis and biopsy guide of prostate cancer (pCa) in patients with persistently high prostate-specific antigen (PSA) and previous negative prostate biopsy. To compare the clinical risk factors and metabolic variables as predictors of malignancy. Methods: Patients with persistently elevated PSA in serum (total PSA >4ng/mL) and at least a previous negative or inconclusive biopsy were consecutively referred for a whole body 18F-Choline PET/CT.Patient age, PSA level, PSA doubling time (PSAdt) and PSA velocity (PSAvel) were obtained.PET images were visually (positive or negative) and semiquantitatively (SUVmax) reviewed. 18F-Choline uptake prostate patterns were defined as focal, multifocal, homogeneous or heterogeneous. Histology on biopsy using transrectal ultrasound-guided approach was the gold standard.Sensitivity (Se), specificity (Sp) and accuracy (Ac) of PET/CT for diagnosis of pCa were evaluated using per-patient and per-prostate lobe analysis. Receiver-operating-characteristic (ROC) curve analysis was used to assess the value of SUVmax to diagnose pCa.Correlation between PET/CT and biopsy results per-prostate lobe was assessed using the Chi-square test. Univariate and multivariate logistic regression analysis were applied to compare clinical risk factors and metabolic variables as predictors of malignancy. Results: Thirty-six out of 43 patients with histologic confirmation were included. In 11 (30.5%) patients, pCa was diagnosed (Gleason score from 4 to 9). The mean values of patient age, PSA level, PSAdt and PSAvel were: 65.5 years, 15.6. ng/ml, 28.1 months and 8.5. ng/mL per year, respectively.Thirty-three patients had a positive PET/CT; 18 had a focal pattern, 7 multifocal, 4 homogeneous and 4 heterogeneous. Se, Sp and Ac of PET/CT were of 100%, 12% and 38% in the patient based analysis, and 87%, 29% and 14% in the prostate lobe based analysis, respectively. The ROC curve analysis of SUVmax showed an AUC of 0.568 (p = 0.52).On a lobe analysis, poor agreement was observed between PET/CT findings and biopsy results (p = 0.097). In the univariate/multivariate analysis, none of clinical and metabolic variables were statistically significant as predictor of pCa. Conclusion: Choline PET/CT is a suitable procedure for the detection of pCa in highly selected patients, however, a high rate of false positive should be expected. © 2017 Elsevier España, S.L.U. y SEMNIM.


Molina-Infante J.,Hospital San Pedro Of Alcantara | Rodriguez-Sanchez J.,Hospital Universitario Of Ciudad Real | Martinek J.,Institute for Clinical and Experimental Medicine | Krajciova J.,Institute for Clinical and Experimental Medicine | And 6 more authors.
American Journal of Gastroenterology | Year: 2015

OBJECTIVES:Proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE) is diagnosed in at least one-third of patients with suspected eosinophilic esophagitis (EoE). We aimed to evaluate the durability and factors influencing long-term efficacy of PPI therapy.METHODS:Retrospective multicenter cohort study of patients with PPI-REE who had at least 12 months of follow-up. PPI therapy was tapered to the lowest dose, which maintained clinical remission. Primary outcomes were the proportion of patients with loss of histological response (<15 eos/HPF) and predictors of loss of response. CYP2C19 polymorphisms were determined from blood samples in a subset of patients.RESULTS:Seventy-five PPI-REE patients were included (mean follow-up 26 months (12-85)), of whom fifty-five (73%) had sustained histological remission on low-dose PPI therapy. Loss of response was significantly higher in those patients with a CYP2C19 rapid metabolizer genotype (36% vs. 6%, P = 0.01) and with rhinoconjunctivitis (40% vs. 13%, P = 0.007). On the multivariate analysis, a CYP2C19 rapid metabolizer genotype (odds ratio (OR) 12.5; 95% confidence interval (CI): 1.3-115.9) and rhinoconjunctivitis (OR 8.6; 95% CI: 1.5-48.7) were independent predictors of loss of response. Among relapsing patients, eosinophilia was limited to the distal esophagus in 14/20 (70%). Nine of ten relapsers, with distal eosinophilia, all showing a CYP2C19 rapid metabolizer genotype, regained histological remission after PPI dose intensification.CONCLUSIONS:Most PPI-REE patients remain in long-term remission on low-dose PPI therapy. CYP2C19 rapid metabolizer genotypes and rhinoconjunctivitis were independent predictors of loss of response to PPI, but patients frequently responded to PPI dose escalation. © 2015 by the American College of Gastroenterology.


Salinas J.,Hospital Clinico | Casado J.S.,Hospital Clinico San Carlos | Beltran B.B.,Hospital Clinico Of Zaragoza | Rios J.S.,Hospital Clinico Of Zaragoza | And 21 more authors.
Archivos Espanoles de Urologia | Year: 2015

OBJECTIVES: To analyse the improvement in both symptoms (IPSS questionnaire) and uroflowmetry parameters (Qmax) after treatment with different alpha-blockers in patients with LUTS and BPH. The efficacy of alpha-blocker treatment on urodynamic parameters was also analysed in some patients. METHODS: An epidemiological, retrospective, multi-centre, and observational study. Twenty-five (24) Spanish healthcare centres recruited 443 patients with LUTS and BPH, and no other concurrent urological disease, they were on treatment with alpha-blockers. The study variables (demographic, physical examination, IPSS, and urodynamic) were collected retrospectively at start of the study (at least 12 weeks after the start of treatment). Two-tailed statistical tests were performed with a 5% significance level using a SAS statistical software package version 9.0. RESULTS: The IPSS score improved after 12 weeks of treatment (p<0.0001). The quality of life perception significantly improved (p<0.0001). The voiding volume and Qmax increased (p<0.0001) and the post-void residual urine decreased (p<0.0001) after treatment both in patients with moderate and severe symptoms. Other than filling pressure and involuntary contraction amplitude (p>0.05), all cystomanometry parameters improved(p<0.05). There were statistically significant differences (p<0.05) in the pressure flow study values, except for the detrusor contractility rate. CONCLUSION: Alpha-blocker drug treatment of LUTS in patients with BPH leads to a significant improvement in symptoms and bladder voiding urodynamic parameters.


PubMed | Hospital Rio Hortega, Hospital San Pedro Of Alcantara, University of North Carolina at Chapel Hill, Institute for Clinical and Experimental Medicine and 2 more.
Type: Journal Article | Journal: The American journal of gastroenterology | Year: 2015

Proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE) is diagnosed in at least one-third of patients with suspected eosinophilic esophagitis (EoE). We aimed to evaluate the durability and factors influencing long-term efficacy of PPI therapy.Retrospective multicenter cohort study of patients with PPI-REE who had at least 12 months of follow-up. PPI therapy was tapered to the lowest dose, which maintained clinical remission. Primary outcomes were the proportion of patients with loss of histological response (<15 eos/HPF) and predictors of loss of response. CYP2C19 polymorphisms were determined from blood samples in a subset of patients.Seventy-five PPI-REE patients were included (mean follow-up 26 months (12-85)), of whom fifty-five (73%) had sustained histological remission on low-dose PPI therapy. Loss of response was significantly higher in those patients with a CYP2C19 rapid metabolizer genotype (36% vs. 6%, P = 0.01) and with rhinoconjunctivitis (40% vs. 13%, P = 0.007). On the multivariate analysis, a CYP2C19 rapid metabolizer genotype (odds ratio (OR) 12.5; 95% confidence interval (CI): 1.3-115.9) and rhinoconjunctivitis (OR 8.6; 95% CI: 1.5-48.7) were independent predictors of loss of response. Among relapsing patients, eosinophilia was limited to the distal esophagus in 14/20 (70%). Nine of ten relapsers, with distal eosinophilia, all showing a CYP2C19 rapid metabolizer genotype, regained histological remission after PPI dose intensification.Most PPI-REE patients remain in long-term remission on low-dose PPI therapy. CYP2C19 rapid metabolizer genotypes and rhinoconjunctivitis were independent predictors of loss of response to PPI, but patients frequently responded to PPI dose escalation.


Villarejo-Campos P.,Hospital Universitario Of Ciudad Real | Padilla-Valverde D.,Hospital Universitario Of Ciudad Real | Martin R.M.,University of Castilla - La Mancha | Menendez-Sanchez P.,Hospital Universitario Of Ciudad Real | And 3 more authors.
Clinical and Translational Oncology | Year: 2013

Introduction: Angiogenesis and lymphangiogenesis are essential processes for the formation of blood and lymphatic vessels that allow tumour growth and spread. The binding of VEGF and VEGF-C factors with their receptors (VEGFR2, VEGFR3) in endothelial cells triggers signals that regulate these processes. We compared preoperative serum VEGF and VEGF-C levels with samples obtained after completion of surgery and adjuvant treatment in patients with gastric cancer. In addition, we determined the prognostic value and relationship to survival of serum VEGF and VEGF-C levels. Methods: We used a prospective cohort study of 59 gastric cancer patients who underwent surgery. Serum VEGF and VEGF-C were measured by enzyme-linked immunosorbent assay (ELISA) the day before surgery and 6 months later, after completion of adjuvant treatment. Results: Serum VEGF values decreased after treatment in patients with resectable tumours (mean ± SD) (405.42 ± 298.38 vs. 306.38 ± 212.47 pg/ml; p < 0.01), poorly differentiated and undifferentiated tumours (G3, G4) (438 ± 339.71 vs. 322.47 ± 210.71 pg/ml; p = 0.01), locally advanced gastric tumours (T4 stage) (424.27 ± 323.08 vs. 333.62 ± 221.72 pg/ml; p = 0.03) and tumours with a greater number of involved regional lymph nodes (N3) (442.38 ± 311.52 vs. 337.4 ± 203.64 pg/ml; p = 0.04). Serum preoperative VEGF values over 761 pg/ml were associated with shorter patient survival. The mean overall survival time for patients with serum VEGF levels higher than 761 pg/ml was 7 ± 2.99 months (95 % CI 1.14-12.86) while for patients with serum VEGF levels of less than 761 pg/ml was 21.18 ± 2.88 (95 % CI 15.54-26.83) The mean disease-specific survival time for patients with serum VEGF levels higher than 761 pg/ml was 6.25 ± 2.53 months (95 % CI 1.29-11.21) while for patients with serum VEGF levels of less than 761 pg/ml was 27.57 ± 3.45 (95 % CI 20.80-34.35). Multivariate analysis identified preoperative serum VEGF levels as an independent prognostic factor (HR = 0.144; p = 0.03). Conclusions: Serum VEGF levels decreased after the completion of treatment in patients with resected tumours, suggesting VEGF tracking may be useful in monitoring progression. Preoperative measurement of serum VEGF may help us identify patients with a poor prognosis. © 2012 Federación de Sociedades Españolas de Oncología (FESEO).

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