RESUMEN

Calpains, also called calcium activated neutral proteases (CANP), are expressed ubiquitously. They are intracellular, non-lysosomal cytoplasmic cysteine endopeptidases. Calcium is required for their activation. Their endogenous specific inhibitor is calpastatin, which is expressed ubiquitously and coexists within cells besides calpain. When calcium is present, calpastatin and calpain attach to each other inhibiting the protease. The calpain system plays an important role in many processes including apoptosis, necrosis, ischemia formation and exocytosis. So far, many reports exist on studies about the influence of calpains in different tumors (skin, breast, renal cell and prostate cancers). The role of calpains in pathogenesis or further tumor progression has always been proved in related studies, but their exact function could not be demonstrated. So far, no studies on calpains being involved in the pathogenesis of ovarian cancer have been published. In our study we focused on the expression of the enzymes calpain 1, calpain 2 and their inhibitor calpastatin in normal and malign ovarian tissue. Therefore, we performed immunohistochemical stainings of paraffin slices and evaluated staining intensity (SI), percentage of positive cells (PP) and immunoreactive score (IRS). We evaluated the correlation between enzyme expression in malign and benign ovarian tissues. In malignant ovarian tissue, we found decreased expression, staining intensity and immunoreactive score of calpastatin. With higher grading of the ovarian carcinoma, staining intensity and immunoreactive score of calpain 1 decreased. Staining intensity of calpain 2 in ovarian carcinoma decreased with increasing lymph node status. We clearly demonstrated differences between enzyme expressions in malign and benign tissue. This study could not find any specific function of calpains. Only few studies in the literature have been found that deal with calpain evaluation of ovarian cancer. Additional studies including more patients are required to elucidate the functional role and impact of calpain in tumors in detail.

Asunto(s)

Proteínas de Unión al Calcio/análisis , Calpaína/análisis , Neoplasias Ováricas/química , Proteínas de Unión al Calcio/fisiología , Calpaína/fisiología , Femenino , Humanos , Inmunohistoquímica , Neoplasias Ováricas/patología

RESUMEN

Medicine and psychology are two different but, at the same time, complementary disciplines. Each addresses the same persons, even the same symptoms, but with very different approaches. Medicine uses a scientific processes which, when possible, is objective. Psychology relies on the subjective personal experience of the person. They rejoin in that each takes the person into consideration with his individual sensitivity. The non medical manner of approaching pregnancy consists of taking into consideration at the same time the psychological experiences stimulated by the desire to have a child, the pregnancy, the birth, the post-partum in conjunction with the psychological affective need of the trio: mother, father and baby. This article considers, in a succinct manner, the mother's psychological experience of pregnancy and the psychological life of the baby in uterus. Next the author discusses Loving Preparation for Birth in its three aspects: relational games with the baby in uterus, psychological-affective preparation for labor and delivery, and the loving accompaniment of the baby by games after birth.

Asunto(s)

Embarazo/fisiología , Embarazo/psicología , Afecto , Parto Obstétrico , Embrión de Mamíferos/fisiología , Femenino , Humanos , Recién Nacido , Trabajo de Parto/fisiología , Trabajo de Parto/psicología , Masculino , Relaciones Madre-Hijo

RESUMEN

PURPOSE: The aim of this study was to determine the predictive values of 2-[fluorine-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) in primary staging in patients with newly diagnosed non-seminomatous germ cell tumour (NSGCT) clinical stage I/II. PATIENTS AND METHODS: The hypothesis was that FDG-PET would improve the negative predictive value (NPV) from 70% to 90%, thus requiring a total of 169 patients. All scans underwent visual analysis by a reference team of nuclear medicine physicians. Results were validated by histology following retroperitoneal lymph node dissection. RESULTS: Only 72 of the planned 169 patients were included, due to poor accrual. The prevalence of nodal involvement was 26%. Correct nodal staging by FDG-PET was achieved in 83% compared with correct computed tomography (CT) staging in 71%. CT had a sensitivity and specificity of 41% and 95%, respectively. Positive predictive value (PPV) and NPV were 87% and 67%, respectively. FDG-PET had a sensitivity and specificity of 66% and 98%, respectively. PPV was 95%. The primary end point was not reached, with an NPV of 78%. CONCLUSION: FDG-PET as a primary staging tool for NSGCT yielded only slightly better results than CT. Both methods had a high specificity while false-negative findings were more frequent with CT. FDG-PET is mostly useful as a diagnostic tool in case of questionable CT scan.

Asunto(s)

Invasividad Neoplásica/patología , Neoplasias de Células Germinales y Embrionarias/diagnóstico por imagen , Neoplasias de Células Germinales y Embrionarias/patología , Tomografía de Emisión de Positrones , Neoplasias Testiculares/diagnóstico por imagen , Neoplasias Testiculares/patología , Adolescente , Adulto , Fluorodesoxiglucosa F18 , Alemania , Humanos , Escisión del Ganglio Linfático/métodos , Ganglios Linfáticos/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias de Células Germinales y Embrionarias/cirugía , Valor Predictivo de las Pruebas , Pronóstico , Medición de Riesgo , Sensibilidad y Especificidad , Neoplasias Testiculares/cirugía , Tomografía Computarizada por Rayos X/métodos

RESUMEN

PURPOSE: The primary aim of this work was to establish a radiolabeling procedure of vinblastine, a vinca alkaloid widely used in chemotherapy, with the positron-emitter carbon-11 for application in positron-emission-tomography (PET) studies in cancer patients. The optimized reaction conditions were transferred to an automated radiosynthesizer system for the preparation of [11C]vinblastine under GMP conditions for human use. We report about the whole body activity distribution after injection of [11C]vinblastine as well as the pharmacokinetic behavior in selected organs and the tumor in two patients that were investigated with [11C]vinblastine PET before chemotherapy. METHODS: For carbon-11 labeling of vinblastine the reaction conditions were determined with respect to the two possible labeling precursors (i.e. [11C]methyl iodide and [11C]diazomethane), solvent, reaction temperature and reaction time. Both, [11C]diazomethane and [11C]methyl iodide were tested as labeling precursors with the corresponding demethyl compound of vinblastine, i.e. the vinblastine acid and the potassium salt of vinblastine acid. Two patients with renal carcinoma underwent [11C]vinblastine PET before chemotherapy. One patient underwent a second scan during infusion of unlabeled vinblastine at a therapeutic dose. RESULTS: Best results for the labeling procedure were found when methylation was carried out at 100 degrees C within 20 min using 2 mg/mL of the potassium salt of vinblastine acid in DMSO and [11C]methyl iodide as labeling precursor. Based on [11C]methyl iodide starting activity a radiochemical yield of up 53 % [11C]vinblastine was achieved. In addition, the synthesis was transferred to a remotely controlled module for routine GMP conform production for human use. In large scale production runs up to 1 GBq of [11C]vinblastine was obtained ready for injection within 45 min after EOB. In one patient, whole body PET scans 40 min after injection of 112 MBq [11C]vinblastine showed a focally increased [11C]vinblastine uptake and [11C]vinblastine metabolite uptake, respectively in the known metastases, along with a slow but continuous washout during the measurement interval (0-60 min p.i.). Another patient showed no focally increased [11C]vinblastine uptake and [11C]vinblastine metabolite uptake in the tumor, where radioactivity concentration was comparable to that in the blood. In this patient, a second PET scan during infusion of unlabeled vinblastine revealed similar kinetics with a trend towards delayed hepatic metabolism and higher blood and tumor concentrations. Whereas this patient showed a partial response to chemotherapy, the first patient did not, hypothetically due to the observed vinblastine washout from the tumor. CONCLUSIONS: The carbon-11 labeling of vinblastine using [11C]methyl iodide is superior to the method using [11C]diazomethane. A well working automated radiosynthesis was established for the production of [11C]vinblastine for PET-investigations in cancer patients. The individual pharmacokinetic behavior of the chemo-therapeutic agent to the tumor can be assessed with PET, thus, can be considered to be a realistic approach for individualized chemotherapy.

Asunto(s)

Antineoplásicos Fitogénicos/farmacocinética , Radioisótopos de Carbono/química , Carcinoma de Células Renales/tratamiento farmacológico , Neoplasias Renales/tratamiento farmacológico , Vinblastina/farmacocinética , Antineoplásicos Fitogénicos/química , Carcinoma de Células Renales/diagnóstico por imagen , Química Farmacéutica , Diazometano/química , Humanos , Hidrocarburos Yodados/química , Marcaje Isotópico/métodos , Neoplasias Renales/diagnóstico por imagen , Estimulación Luminosa , Tomografía de Emisión de Positrones , Radiofármacos/síntesis química , Radiofármacos/química , Tiempo de Reacción , Solventes , Temperatura , Distribución Tisular , Vinblastina/química

Asunto(s)

Ácido Etidrónico/uso terapéutico , Melfalán/uso terapéutico , Mieloma Múltiple/terapia , Compuestos Organometálicos/uso terapéutico , Trasplante de Células Madre de Sangre Periférica/métodos , Huesos/metabolismo , Supervivencia sin Enfermedad , Ácido Etidrónico/farmacocinética , Humanos , Persona de Mediana Edad , Agonistas Mieloablativos/uso terapéutico , Compuestos Organometálicos/farmacocinética , Radioisótopos/uso terapéutico , Inducción de Remisión/métodos , Renio/uso terapéutico , Terapia Recuperativa/métodos , Trasplante Autólogo

RESUMEN

Venous thromboembolism is a common and frequent complication of hospitalized patients. Some venous thromboembolisms may be subclinical, while others present as symptomatic deep vein thrombosis and/or pulmonary embolism. Venous thromboembolism and pulmonary embolism contribute significantly to inhospital morbidity and mortality. The risk of venous thromboembolism is aggravated by dispositional and/or expositional risk factors. In patients at intermediate or high risk of venous thromboembolism, additional pharmacological thromboembolism prophylaxis becomes mandatory.

Asunto(s)

Tromboembolia/prevención & control , Anestesia , Anticoagulantes/efectos adversos , Anticoagulantes/uso terapéutico , Heparina/efectos adversos , Heparina/uso terapéutico , Hospitalización , Humanos , Complicaciones Intraoperatorias/prevención & control , Complicaciones Posoperatorias/prevención & control , Embolia Pulmonar/epidemiología , Embolia Pulmonar/prevención & control , Factores de Riesgo , Trombocitopenia/inducido químicamente , Tromboembolia/epidemiología , Trombosis de la Vena/epidemiología , Trombosis de la Vena/prevención & control

Asunto(s)

Adenocarcinoma Mucinoso/diagnóstico por imagen , Neoplasias del Apéndice/diagnóstico por imagen , Neoplasias Ováricas/diagnóstico por imagen , Trastornos Puerperales/diagnóstico por imagen , Tomografía Computarizada de Emisión/métodos , Adenocarcinoma Mucinoso/secundario , Adenocarcinoma Mucinoso/terapia , Adulto , Neoplasias del Apéndice/patología , Neoplasias del Apéndice/terapia , Cesárea , Terapia Combinada , Femenino , Humanos , Estadificación de Neoplasias , Neoplasias Ováricas/secundario , Neoplasias Ováricas/terapia , Trastornos Puerperales/terapia

RESUMEN

PURPOSE: To assess the ability of [(18)F]FDG-PET, CT/MRI and serum tumor marker (TM) for the early prediction of response in patients with metastatic germ cell tumors (GCT) undergoing salvage high-dose chemotherapy (HD-CTX). MATERIALS AND METHODS: Before commencement of HD-CTX, 19 patients with metastases from GCT were evaluated with [(18)F]FDG-PET, CT or MRI and TM after 2-3 cycles of induction chemotherapy and the results compared with those of the baseline examinations. PET was analyzed visually and quantitatively by calculating the standard uptake value (SUV). CT or MRI was evaluated for changes in tumor size (progressive disease/stable disease PD/SD = viable lesion; partial remission/complete remission PR/CR = nonviable lesion), density or signal intensity, homogeneity and contrast enhancement. For the prognosis, the worse case, i.e., the most vital lesion detected in a patient, was considered. The reference standard was the result of the histology after resection of any residual masses (N = 10) and/or the clinical-radiological follow-up for at least 6 months after completion of the treatment (N = 9). RESULTS: Six of nineteen patients (32 %) remained progression-free for over 6 months following treatment, whereas 13 (68 %) progressed. The outcome of HD-CTX was correctly predicted by PET, CT and TM in 89 %, 67 % and 88 %, respectively. In 5 of 6 patients with successful HD-CTX, PET was negative (mean SUV = 1.8), with CT or MRI showing a partial regression of the tumor in 4 of 5 patients. Of the 13 patients not cured by HD-CTX, the PET data were positive in all (mean SUV = 2.7), and the CT/MRI results were true positive (PD or SD) in 8 and false negative (PR) in 5 patients. The combined assessment of CT and TM corrected 3 false negative prognoses and 1 false positive CT prognosis. Two patients with unfavorable outcome despite a favorable response by CT and TM criteria were exclusively identified by PET. The resultant sensitivities and specificities for the prediction of therapy response are as follows: PET 100% and 67%; CT/MRI 62% and 80%; TM 83% and 100%; CT+TM 85% and 83%. CONCLUSION: FDG-PET has a high prognostic value for predicting the response to chemotherapy in patients with metastatic GCT early in the course of treatment and may improve patient selection for subsequent HD-CTX protocols. Especially in patients with response to induction chemotherapy according to CT or TM evaluation, PET offers additional information to detect patients with an overall unfavorable outcome.

Asunto(s)

Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Germinoma/diagnóstico , Germinoma/tratamiento farmacológico , Germinoma/secundario , Imagen por Resonancia Magnética , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/tratamiento farmacológico , Tomografía Computarizada de Emisión , Tomografía Computarizada por Rayos X , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biomarcadores de Tumor/sangre , Gonadotropina Coriónica Humana de Subunidad beta/sangre , Fluorodesoxiglucosa F18 , Estudios de Seguimiento , Alemania , Germinoma/diagnóstico por imagen , Humanos , Estado de Ejecución de Karnofsky , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estudios Multicéntricos como Asunto , Recurrencia Local de Neoplasia , Selección de Paciente , Valor Predictivo de las Pruebas , Pronóstico , Radiofármacos , Seminoma/diagnóstico , Seminoma/diagnóstico por imagen , Seminoma/tratamiento farmacológico , Seminoma/secundario , Sensibilidad y Especificidad , Neoplasias Testiculares/diagnóstico por imagen , Factores de Tiempo , alfa-Fetoproteínas/análisis

RESUMEN

Due to the stochastic nature of radioactive decay, any measurement of radioactivity concentration requires spatial averaging. In pharmacokinetic analysis of time-activity curves (TAC), such averaging over heterogeneous tissues may introduce a systematic error (heterogeneity error) but may also improve the accuracy and precision of parameter estimation. In addition to spatial averaging (inevitable due to limited scanner resolution and intended in ROI analysis), interindividual averaging may theoretically be beneficial, too. The aim of this study was to investigate the effect of such averaging on the binding potential ( BP) calculated with Logan's non-invasive graphical analysis and the "simplified reference tissue method" (SRTM) proposed by Lammertsma and Hume, on the basis of simulated and measured positron emission tomography data [[(11)C] d- threo-methylphenidate (dMP) and [(11)C]raclopride (RAC) PET]. dMP was not quantified with SRTM since the low k(2) (washout rate constant from the first tissue compartment) introduced a high noise sensitivity. Even for considerably different shapes of TAC (dMP PET in parkinsonian patients and healthy controls, [(11)C]raclopride in patients with and without haloperidol medication) and a high variance in the rate constants (e.g. simulated standard deviation of K(1)=25%), the BP obtained from average TAC was close to the mean BP (error <5%). However, unfavourably distributed parameters, especially a correlated large variance in two or more parameters, may lead to larger errors. In Monte Carlo simulations, interindividual averaging before quantification reduced the variance from the SRTM (beyond a critical signal to noise ratio) and the bias in Logan's method. Interindividual averaging may further increase accuracy when there is an error term in the reference tissue assumption E= DV(2)- DV' ( DV(2) = distribution volume of the first tissue compartment, DV' = distribution volume of the reference tissue). This can be explained by the fact that the distribution volume ratio ( DVR= DV/DV') obtained from averaged TAC is an approximation for Sigma DV/Sigma DV' rather than for Sigma DVR/ n. We conclude that Logan's non-invasive method and SRTM are suitable for heterogeneous tissues and that discussion of group differences in PET studies generally should include qualitative and quantitative assessment of interindividually averaged TAC.

Asunto(s)

Cuerpo Estriado/diagnóstico por imagen , Cuerpo Estriado/metabolismo , Interpretación de Imagen Asistida por Computador/métodos , Enfermedad de Parkinson/diagnóstico por imagen , Enfermedad de Parkinson/metabolismo , Racloprida/farmacocinética , Simulación por Computador , Técnicas de Diagnóstico por Radioisótopo , Humanos , Aumento de la Imagen , Cinética , Tasa de Depuración Metabólica , Modelos Biológicos , Modelos Estadísticos , Unión Proteica , Cintigrafía , Radiofármacos/farmacocinética , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Distribución Tisular

RESUMEN

In Europe, capillary membrane filters are the favored method for plasmapheresis and detoxification systems including a plasma separation unit. Using capillary membrane filters clearance depends on the filtration rate and the sieving coefficient (Qs) for the plasma substrates. We investigated whether the increase of the effective membrane surface of plasmafilters enables higher clearance rates than a small plasmafilter. Heparinized porcine blood (5 I.U./l) of healthy pigs was used for an in vitro circuit. Filter types used were from GAMBRO: n = 5 PF1000N (effective membrane surface: 0.15 m(2)), n = 4 PF2000N (0.35) and from ASAHI: n = 4 PLASMAFLO OP-05W (L) (0.5). Spontaneous hemolysis was chosen to indicate the individual threshold limit for maximal flow rates. Sieving coefficient was determined for ten parameters at lowest and highest blood flow (Qb) and filtration rates (Qf). PF1000N enabled maximal flow rates as high as PF2000N and PLASMAFLO (Qb/Qf in ml/min: 200/40). Qs for most substrates were similar between the filter types and the flow rates. Compared to PLASMAFLO, the filter type with the largest membrane surface, the PF1000N provided significantly better Qs for triglycerides and albumin and a trend for a better elimination of cholesterol, GGT, and LDH. The sieving properties of the PF2000N ranged between PF1000N and PLASMAFLO. Under standardized in vitro conditions, the larger plasmafilters tested did not improve the overall performance of the plasmapheresis procedure. Thus, enlargement of the membrane surface such as provided by two commercially available and clinically well-established plasmafilters could not be proven to enable higher clearance rates.

Asunto(s)

Membranas Artificiales , Plasmaféresis/instrumentación , Animales , Materiales Biocompatibles , Pruebas de Coagulación Sanguínea , Filtración , Hemólisis , Cinética , Modelos Animales , Plasmaféresis/efectos adversos , Plasmaféresis/normas , Propiedades de Superficie , Porcinos

RESUMEN

Plasmaseparation is a treatment under discussion for critically ill patients, especially in sepsis and multiorgan failure. These patients receive a variety of different fluid substitutes, including hydroxyethylstarch (HES). HES is known to influence rheological properties, but nothing is known about the possible interactions between HES and the plamaseparation procedure. We used an in vitro plasmaseparation circuit with heparinized porcine blood. Before priming the system, 2 liters of blood were supplemented by adding 100 ml of either NaCl 0.9% or HES (n=6 in each group). We monitored the transmembrane (TMP) and the filtration pressure (PF) and measured free plasma hemoglobin (free Hb) and platelet counts before and after the two hours plasmaseparation procedure. The final transmembrane pressure was significantly higher with HES substitution. In the HES group we found negative filtration pressures from the very beginning with a significant further decrease toward the end of the experiments. A significant increase in free Hb and decrease in platelet counts were noted only in the HES group. Volume substitution with HES leads to impaired filtration properties and deteriorated hemocompatibility in in vitro plasmaseparation. Further studies have yet to evaluate whether or not the effects described also occur under clinical conditions.

Asunto(s)

Hemofiltración/instrumentación , Derivados de Hidroxietil Almidón/farmacología , Sustitutos del Plasma/farmacología , Porcinos/sangre , Animales , Capilares/efectos de los fármacos , Circulación Extracorporea , Recuento de Plaquetas , Reología

RESUMEN

The aim of this study was to evaluate positron emission tomography (PET) with fluorine-18 fluorodeoxyglucose (FDG) for the staging of non-small cell lung cancer (NSCLC) before combined neoadjuvant, i.e. preoperative, radio-chemotherapy (RCT). From November 1998 until September 2001, 101 patients with NSCLC were investigated prospectively. The inclusion criterion was a histologically proven NSCLC of stage IIIA or B according to conventional staging including biopsy. The results of PET were compared with those obtained by mediastinoscopy, computed tomography (CT), bone scan and abdominal ultrasonography. Validation of discrepant findings was achieved by biopsy or repeated CT. PET proved to be highly accurate for the detection of lymph node metastases (sensitivity 96%, specificity 73%, positive predictive value 88%, negative predictive value 89%, accuracy 88%) as well as distant metastases (in 25/101 patients, all previously unknown). PET findings changed further treatment in 29/101 patients (29%). Twenty-five were excluded from RCT due to the presence of previously unknown distant metastases. One patient was free of metastases and therefore was operated on without pre-treatment. Two patients did not receive any further treatment because a malignant tumour could be excluded after PET. In the final patient PET demonstrated a tumour pattern not typical for NSCLC which could be attributed to a seminoma after repeated biopsy. FDG PET is the most accurate non-invasive diagnostic procedure for the staging of advanced NSCLC. Therefore use of FDG PET is highly recommended in order to select patients for neoadjuvant or other stage-dependent treatment modalities.

Asunto(s)

Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Carcinoma de Pulmón de Células no Pequeñas/terapia , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/terapia , Estadificación de Neoplasias/métodos , Adulto , Anciano , Carcinoma de Pulmón de Células no Pequeñas/metabolismo , Carcinoma de Pulmón de Células no Pequeñas/secundario , Femenino , Fluorodesoxiglucosa F18/farmacocinética , Humanos , Neoplasias Pulmonares/metabolismo , Metástasis Linfática , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante , Cintigrafía , Radiofármacos/farmacocinética

RESUMEN

OBJECTIVE: The therapeutic strategy in non-small-cell lung cancer (NSCLC) requires exact staging of tumour invasion (T) as well as differentiation between ipsi- and contralateral lymph node invasion (N1/2 vs N3). [18F]FDG-positron emission tomography (FDG-PET) has been shown to detect invaded N with high accuracy while correct determination of T appears to be unclear. The purpose of this prospective study was to evaluate benefit and necessity of 18FDG-PET as an additive to conventional staging modalities. METHODS: Forty patients with suspected non-small-cell lung cancer (NSCLC) were staged by means of computed tomography (CT), bronchoscopy, mediastinoscopy and bone scintigraphy. Additionally, attenuation corrected FDG-PET of the thorax was performed pre-operatively for analysis of T and N topography. After surgical resection with radical lymphadenectomy T and N staging results of CT and PET were compared with the pathological diagnoses. Specificity, sensitivity, positive predictive value and accuracy of CT and PET were calculated. RESULTS: Twenty three squamous cell carcinomas, 14 adenocarcinomas, and three non-malignant tumours were found. Accuracy of CT-T was 0.75 and of PET-T 0.78; accuracy of CT-N was 0.78 and of PET-N 0.80. By combination of CT-T and PET-T accuracy was 0.88. Combination of CT-N and PET-N yielded an accuracy of 0.90. In two out of three cases, PET correctly determined T0. In two cases non-malignant inflammatory lymph nodes were falsely staged as malignant by PET. CONCLUSIONS: Adequate pre-operative T- and N-staging is possible with both CT and FDG-PET. Accuracy can be improved by combination of CT and FDG-PET. FDG-PET is superior to CT in order to differentiate between malignant and benign tumours. However, acute inflammation can mimic malignant lymph node invasion. FDG-PET is justified as a supporting staging measure in cases presenting unclear differentiation between N2 and N3 after conventional staging and is helpful in cases with unclear cell type of the primary tumour.

Asunto(s)

Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico por imagen , Tomografía Computarizada de Emisión , Carcinoma de Pulmón de Células no Pequeñas/patología , Fluorodesoxiglucosa F18 , Humanos , Neoplasias Pulmonares/patología , Estadificación de Neoplasias , Valor Predictivo de las Pruebas , Estudios Prospectivos , Radiofármacos , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X

RESUMEN

To assess the ability of [(18)F]fluorodeoxyglucose positron emission tomography for the early prediction of response in patients with relapsed metastatic germ cell tumours undergoing salvage high-dose chemotherapy. The role of positron emission tomography was compared with established means of tumour response assessment such as CT scans/MRI and serum tumour marker changes. In addition, positron emission tomography was compared with a current prognostic score which differentiates three prognostic groups with failure-free survival rates ranging from 5-50%. [(18)F]fluorodeoxyglucose uptake of metastases from germ cell tumours as well as CT scans and serum tumour marker were acquired after 2-3 cycles of induction chemotherapy but before the start of high-dose chemotherapy and CT scans/serum tumour marker were compared with the baseline examinations in 23 patients with relapsed germ cell tumours. To evaluate the validity of early response prediction by positron emission tomography, radiological monitoring and serum tumour marker decline, histopathologic response after resection of residual masses and/or the clinical course over 6 months after the end of treatment (relapse vs freedom of progression) were used. Overall, 10 patients (43%) achieved a marker-negative partial remission, three (13%) a marker-positive partial remission, five (22%) a disease stabilization and five (22%) progressed during treatment. Nine patients (39%) remained progression-free over 6 months following treatment, whereas 14 (61%) progressed. The outcome of high-dose chemotherapy was correctly predicted by positron emission tomography/CT scan/serum tumour marker in 91/59/48%. Eight patients with a favourably predicted outcome by CT scans plus serum tumour marker but a positive positron emission tomography prior to high-dose chemotherapy, failed treatment. This results in the following sensitivities/specificities for the prediction of failure of high-dose chemotherapy: positron emission tomography 100/78%; radiological monitoring 43/78%; serum tumour marker 15/100%. The positive and negative predictive values of positron emission tomography were 88 and 100%, respectively. As compared with the prognostic score, positron emission tomography was correctly positive in all patients of the three risk groups who failed treatment. In addition, a negative positron emission tomography correctly predicted a favourable outcome in the good and intermediate group. [(18)F]fluorodeoxyglucose positron emission tomography imaging can be used to assess response to chemotherapy in patients with relapsed germ cell tumours early in the course of treatment and may help to identify patients most likely to achieve a favourable response to subsequent high-dose chemotherapy. In patients with response to induction chemotherapy according to CT scans or serum tumour marker evaluation, positron emission tomography seems to add information to detect patients with an overall unfavourable outcome. It may also be a valuable addition to the prognostic model particularly in the good and intermediate group for further selection of patients who will profit from high-dose chemotherapy.

Asunto(s)

Fluorodesoxiglucosa F18 , Recurrencia Local de Neoplasia/diagnóstico por imagen , Radiofármacos , Terapia Recuperativa , Seminoma/diagnóstico por imagen , Neoplasias Testiculares/diagnóstico por imagen , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Biomarcadores de Tumor/análisis , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/tratamiento farmacológico , Recurrencia Local de Neoplasia/patología , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Seminoma/tratamiento farmacológico , Sensibilidad y Especificidad , Neoplasias Testiculares/tratamiento farmacológico , Tomografía Computarizada de Emisión , Resultado del Tratamiento

RESUMEN

The reliable assessment of residual masses after treatment as well as of new lesions suspected for relapse remains a diagnostic problem in patients with Hodgkin's disease (HD). The current study compares the results obtained by CT scan to FDG-PET imaging in a blind analysis with respect to the viability of residual masses and in case of suspected relapse. Between 1/94 and 10/99, 47 comparisons of PET and corresponding CT scans - 26 comparisons in 24 patients with residual tumors and 21 comparisons in 20 patients with suspected relapse of HD - were evaluated by independent reviewers blinded to he results of each other. Patients with primary diagnosis had been treated within trials of the German HD Trial study group. Relapsed patients received intensified salvage chemotherapy regimens. PET was assessed visually and by quantifying glucose uptake (SUV). Changes in size of tumor lesions as well as contrast medium enhancement served as criteria for assessment by CT scans. Results were validated either by histologic examination of a resected mass or biopsy (n=17) or by a clinical follow-up over 6 months following treatment (n=30). In 26 cases with residual lesions FDG-PET showed an increased tracer uptake in 8, 7 of which were true positive (TP) and 1 false positive (FP). Eighteen cases were classified as being negative (no viable HD), 17 true negative (TN) and 1 FN. In the blinded reading of the corresponding CT scans, 10 cases with residual lesions were considered to contain vital lymphoma (2 TP, 8 FP). Sixteen CT scans were classified as negative (10 TP, 6 FN). The resulting sensitivity and specificity of PET were 87.5% and 94.4% in contrast to only 25% and 56% for CT scans. The positive and negative predictive values of PET and CT scans were 87.5% and 94.4% and 20% and 62.5%, respectively. In patients with suspected relapse, sensitivity and positive predictive value for the diagnosis of the relapse were 100% and 86%, respectively, yielding the same results for both methods. FDG-PET performed in HD patients with residual masses appears to offer important additional information regarding the presence of viable HD in these residual lesions. In patients with suspected relapse of HD, FDG-PET seems not to offer any information over CT scans. Using SUVs is not superior to visual assessment of PET alone.

Asunto(s)

Enfermedad de Hodgkin/diagnóstico por imagen , Recurrencia Local de Neoplasia/diagnóstico por imagen , Neoplasia Residual/diagnóstico por imagen , Tomografía Computarizada de Emisión , Tomografía Computarizada por Rayos X , Adulto , Femenino , Fluorodesoxiglucosa F18 , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Radiofármacos

RESUMEN

PURPOSE: To establish the predictive potential of 2-18fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) for detecting viable tumor tissue in residual postchemotherapy masses of seminoma patients. PATIENTS AND METHODS: In this prospective multicenter trial, results of FDG PET studies in seminoma patients with postchemotherapy masses > or = 1 cm were correlated with either the histology of the resected lesion or the clinical outcome on follow-up without resection. Negative PET scans of residual lesions that were devoid of viable tumor tissue on resection or disappeared, shrunk, or remained stable in size for at least 2 years were rated as true-negative (TN). Positive scans without histologic or clinical evidence of tumor tissue were classified as false-positive. In patients with histologically positive or progressive lesions, positive PET scans were defined as true-positive (TP) and negative scans, false-negative (FN). RESULTS: Thirty-seven PET scans of 33 patients were assessable at a median follow-up time of 23 months (range, 2 to 46 months). Histologic data were available from nine patients who had undergone resection. Twenty-eight patients were followed-up clinically and radiologically. Twenty-eight scans were TN, eight were TP, and one was FN. All 14 residual lesions more than 3 cm and 22 (96%) of the 23 < or = 3 cm were correctly predicted by FDG PET. The specificity (100%; 95% confidence interval [CI], 87.7% to 100%), sensitivity (89%; 95% CI, 51.7% to 99.7%), positive predictive value (100%), and the negative predictive value (97%) of FDG PET were superior to data obtained by assessing residual tumor size (< or = or > 3 cm). CONCLUSION: FDG PET is a clinically useful predictor of viable tumor in postchemotherapy residuals of pure seminoma, especially those greater than 3 cm.

Asunto(s)

Fluorodesoxiglucosa F18 , Radiofármacos , Seminoma/diagnóstico por imagen , Neoplasias Testiculares/diagnóstico por imagen , Tomografía Computarizada de Emisión , Adulto , Humanos , Masculino , Persona de Mediana Edad , Neoplasia Residual/diagnóstico por imagen , Valor Predictivo de las Pruebas , Estudios Prospectivos , Seminoma/tratamiento farmacológico , Sensibilidad y Especificidad , Neoplasias Testiculares/tratamiento farmacológico

RESUMEN

A 33-year-old woman with type 1 Gaucher's disease developed painful swelling of her right tibia. Initial diagnostics suggested a typical bone crisis. However, clinical course and subsequent imaging pointed to malignant disease, which was specified as high-grade lymphoma. Chemotherapy was applied together with enzyme replacement and resulted in complete remission of the lymphoma. We conclude that osseous lesions, although suggestive of common manifestations of Gaucher's disease, should be discriminated very carefully from neoplastic infiltration to maintain curative treatment options.

Asunto(s)

Enfermedad de Gaucher/complicaciones , Linfoma no Hodgkin/complicaciones , Linfoma no Hodgkin/diagnóstico , Tibia/patología , Adulto , Neoplasias Óseas/diagnóstico , Neoplasias Óseas/secundario , Diagnóstico Diferencial , Femenino , Humanos , Metástasis Linfática , Imagen por Resonancia Magnética , Tibia/diagnóstico por imagen , Tomografía Computarizada de Emisión

RESUMEN

PURPOSE: To evaluate dose-dependent growth-modulating effects of the beta-gamma emitter Rhenium-188 on cultured human aortic smooth muscle cells (haSMC). METHODS AND MATERIALS: HaSMC were plated in 25 cm(2) flasks. Two days after plating, cells were incubated with the Re-188 (beta E(max) 2.12 MeV, tissue range(max) < 10 mm, T(1/2) 17 h) for five days. The doses administered were 0.2 Gy, 1, 4, 6, 8, 16, and 32 Gy. After five days, the radionuclide was removed. Cell growth, cell cycle distribution, and clonogenic activity were analyzed for the following 25 days. RESULTS: The 0.2 and 1 Gy groups did not show relevant growth-inhibiting effects compared to the control groups. The 4 to 32 Gy groups presented dose-dependent growth inhibition, with a complete growth arrest of the 16 and 32 Gy groups. Clonogenic activity of the smooth muscle cell was strongly inhibited from doses > or =8 Gy. Flow cytometry showed a lasting dose-dependent G2/M phase block. CONCLUSION: Smooth muscle cell (SMC) growth can be controlled effectively with Re-188 for at least 25 days after radiation in vitro. As the first four weeks after arterial angioplasty are crucial concerning neointimal formation, Re-188 may be a valuable radionuclide to inhibit restenosis after arterial angioplasty.

Asunto(s)

Aorta/efectos de la radiación , División Celular/efectos de la radiación , Músculo Liso Vascular/efectos de la radiación , Radioisótopos/farmacología , Renio/farmacología , Aorta/citología , Relación Dosis-Respuesta a Droga , Humanos , Interfase/efectos de la radiación , Músculo Liso Vascular/citología , Radiobiología

RESUMEN

PURPOSE: The aim of this study was to evaluate the capability of human aortic smooth musc e cells (HaSMC) and endothelial cells (EC) to recover after incubation with the combined beta/gamma emitter 186rhenium. MATERIALS AND METHODS: Two days after plating, HaSMC and EC were incubated for five days with 186Re (total doses applied 4 Gy-32 Gy). Cell counts were performed for a period of 30 days (haSMC) and 22 days (EC). To detect possible growth recovery, colony formation assays were plated for both cell types on day 5, 10, and 20 (and lay 30 for haSMC). RESULTS: Both cell types presented a dose-dependent growth inhibition which was maximum at a dose of 32 Gy. Human endothelial cells presented with total growth recovery at 4 and 8 Gy, and a partial growth recovery at 16 Gy. Smooth muscle cells only presented partial growth recovery at 4 and 8 Gy. At 16 Gy and more no recovery was detected. CONCLUSION: HaSMC as well as EC growth can be modulated effectively with 186Re over a period of 30 days in vitro. Compared to smooth muscle cells human endothelial cellls seem to possess a higher potential to recover at doses of 8 to 16 Gy. 186Re may be a valuable radionuclide to prevent restenosis.

Asunto(s)

Endotelio Vascular/citología , Endotelio Vascular/efectos de la radiación , Músculo Liso Vascular/citología , Músculo Liso Vascular/efectos de la radiación , Radioisótopos/farmacología , Renio/farmacología , Angioplastia de Balón , Angioplastia Coronaria con Balón , Aorta/citología , Recuento de Células , División Celular , Células Cultivadas , Humanos , Dosis de Radiación , Recurrencia , Factores de Tiempo

RESUMEN

We report the case of a 65-year-old male who developed an oropharyngeal carcinoma, an oesophageal carcinoma and two primary bronchial carcinomas in combination with a renal cell carcinoma as an additional primary entity. By means of an aggressive diagnostic regimen including radiological and nuclear imaging techniques all carcinomas were detected early and could be treated with curative intention.

Asunto(s)

Neoplasias de los Bronquios/diagnóstico , Neoplasias Esofágicas/diagnóstico , Neoplasias Renales/diagnóstico , Neoplasias Primarias Múltiples/diagnóstico , Neoplasias Orofaríngeas/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada de Emisión , Tomografía Computarizada por Rayos X