David Cano

La radiología y la detección precoz del cáncer de pulmón: evolución histórica

Lung cancer is the neoplasia with the highest worldwide mortality rate. During recent decades, several programs for early detection of lung cancer have been initiated with none having demonstrated a significant reduction in mortality. Recent technological advances (spiral CT) have rekindled an interest in screening programs and results have been encouraging. Nevertheless, the initial question remains: would programs for the early detection of lung cancer be able to significantly decrease mortality rates?

Drenaje permanente tunelizado de la ascitis maligna: experiencia inicial con el catéter PleurX ®

OBJECTIVE The most common treatment in recurrent malignant ascites is generally temporary peritoneal drainage. We present our experience in placing permanent tunneled catheters in a series of patients and analyze the safety and efficacy of the treatment. MATERIAL AND METHODS We used total aseptic measures in the interventional ultrasonography suite to place permanent tunneled catheters in 10 patients under ultrasonographic guidance and local anesthesia. RESULTS The catheters remained patent for a median of 52 days in the nine patients who died. In one of these, the catheter was withdrawn while still patent due to generalized sepsis. At the end of the study, one patient still had a permeable catheter 124 days after placement. CONCLUSION Although the low number of patients in our series precludes generalizations, tunneled peritoneal catheters seem to be a safe and effective minimally invasive treatment for malignant ascites in terminal oncologic patients. This approach facilitates the draining of the ascites at home, obviating the need for repeated hospital visits and punctures and the risks involved therein. Nevertheless, further experience and prospective randomized trials are necessary.

[Permanent tunneled drainage for malignant ascites: initial experience with the PleurX® catheter].

Abstract Objective The most common treatment in recurrent malignant ascites is generally temporary peritoneal drainage. We present our experience in placing permanent tunneled catheters in a series of patients and analyze the safety and efficacy of the treatment. Material and methods We used total aseptic measures in the interventional ultrasonography suite to place permanent tunneled catheters in 10 patients under ultrasonographic guidance and local anesthesia. Results The catheters remained patent for a median of 52 days in the nine patients who died. In one of these, the catheter was withdrawn while still patent due to generalized sepsis. At the end of the study, one patient still had a permeable catheter 124 days after placement. Conclusion Although the low number of patients in our series precludes generalizations, tunneled peritoneal catheters seem to be a safe and effective minimally invasive treatment for malignant ascites in terminal oncologic patients. This approach facilitates the draining of the ascites at home, obviating the need for repeated hospital visits and punctures and the risks involved therein. Nevertheless, further experience and prospective randomized trials are necessary.

Detección y caracterización del nódulo pulmonar por tomografía computarizada multicorte

El nodulo pulmonar es un hallazgo frecuente en los estudios toracicos realizados durante la practica clinica diaria. Aunque no existen datos clinicos o radiologicos patognomonicos que indiquen su naturaleza exacta, el contexto clinico y la caracterizacion adecuada del nodulo pulmonar permiten realizar el diagnostico correcto en la mayoria de los casos. En este articulo se exponen los aspectos mas relevantes de la utilidad de la tomografia computarizada multicorte (TCMC) para detectar y caracterizar los nodulos pulmonares de forma no invasiva.

Gastric Diverticulum Mimicking Cystic Lesion in Left Adrenal Gland

Adrenal pseudotumors can have many origins. We report the case of a gastric subcardial diverticulum misdiagnosed as a left adrenal cystic lesion on magnetic resonance imaging. A retrospective study of a previous computed tomography scan detected a previously unnoticed gastric diverticulum. The embryology, clinical aspects, and explanation of the misdiagnosis are exposed.

TC multicorte (TCMC) cardiaca: aplicaciones clínicas

Since the introduction of last generation multislice MSCT systems and the development of simultaneous electrocardiographic-tracing image acquisition and retrospective reconstruction techniques into clinical routine, cardiac MSCT has been considered a very useful non-invasive technique for the study of cardiac pathology in the daily clinical practice. One of the main clinical applications of this diagnostic technique is the evaluation of the coronary arteries including detection and quantification of coronary calcium, multislice CT coronary angiography (anatomy, anatomical variants and anomalies of the origin and course), the angiographic evaluation of the patency of aortocoronary by-pass grafts and coronary stents, and plaque characterization. The new reconstruction and postprocessing programs allow to obtain, in addition, parameters of myocardial morphology and contraction and cardiac function. Other clinical applications include the characterization of cardiac masses and the evaluation of the pericardium.

1078TiPPHASE II STUDY WITH IMMUNOTHERAPY WITH DENDRITIC CELLS (DC) COMBINED WITH INTRATUMORAL HILTONOL IN PATIENTS WITH ADVANCED CANCER

ABSTRACT Background: DC vaccines are active treatments for cancer and combination strategies are expected to increase anti-tumor activity. We explored the efficacy of intratumoral Hiltonol, a potent TLR3 agonist, combined with an autologous vaccine of DC loaded with self-tumor lysates that we developed in a previous study (Alfaro C, J Immunology 2011). Hiltonol is an stabilized form of polyI:C, a nucleic acid that mimics viral RNA. It induces local release of cytokines which promote inflammation, increase type I interferon secretion and stimulate leukocyte migration to infiltrate tissues. Preclinical data indicates that intratumoral Hiltonol activates pro-inflammatory changes that increase the efficacy of DC vaccination. Trial design: In this ongoing phase II study, 25 patients with advanced solid tumors non-amenable for conventional treatment are being treated with Hiltonol and DC vaccinations. Our vaccination protocol includes the following strategies: a) pretreatment with cyclophosphamide to decrease regulatory T cells; b) maturation and activation of DC with TNF-alpha, interferon-alpha and poly I:C, to induce type I interferon; c) use of autologous tumor as antigenic source to expose DC to antigens that are exclusive of tumor cells; and d) daily intradermal doses during four consecutive days in 2 cycles every 4 weeks. Two intratumoral ultrasound-guided injections of Hiltonol 0.25 mg are being administered on alternate days one week following each DC cycle. Sample size has been calculated using a two-stage Simons Minimax design, with alpha error a= 0.05 and beta-error = 0.10 for P0 = 0.05 and P1 = 0.25. The main objective is response rate. Secondary objectives include assessment of toxicity, overall survival and immunologic response (in vitro lymphocyte responses against tumor antigens; delayed hypersensitivity reactions; and assessment of DC maturation by expression of pro-inflammatory cytokines) (ClinicalTrials.gov Identifier: NCT01734564). This abstract was accepted and previously presented at the 2014 ASCO Annual Meeting Chicago, June 2014 (TPS3113). Disclosure: All authors have declared no conflicts of interest.

Detección y cuantificación de la calcificación de las arterias coronarias: perspectiva radiológica

La propia historia natural de la arteriosclerosis posibilita el desarrollo de estudios y proyectos dirigidos a identificar y clasificar los sujetos con alto riesgo de presentar enfermedad coronaria. Han sido diversas las tecnicas radiologicas que han tratado de determinar la severidad de la afectacion de las arterias coronarias, con un exito relativo. En esta ultima decada, los continuos avances en tomografia computarizada (TC) han posibilitado la deteccion y cuantificacion de los depositos de calcio en las arterias coronarias, con una sensibilidad y especificidad practicamente superponibles a los datos obtenidos tras coronariografia. La cuantificacion total del calcio coronario, indicador inequivoco de arteriosclerosis, permite estratificar el riesgo cardiovascular de los pacientes de manera no invasiva y con mayor fiabilidad que con los metodos habituales. Hoy dia, las principales aplicaciones clinicas de la deteccion y cuantificacion de la ateromatosis coronaria incluyen: dolor toracico de caracteristicas atipicas; cribado del riesgo coronario en pacientes asintomaticos, y seguimiento de la progresion de la arteriosclerosis coronaria en los pacientes tratados.