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A 54-year-old man with progressive prostate cancer underwent a 68 Ga-PSMA PET/CT, which showed lymph node and bone metastases. After 2-cycles of 177 Lu-PSMA therapy, the repeated 68 Ga-PSMA PET/CT showed decreased radiotracer uptake in lymph node and bones metastases, but there were new lesions which may be compatible with progression or tumour sink-effect. A review of 177 Lu-PSMA-therapy images revealed that new lesions in the second PET/CT were the metastatic lesions that progressed after the first PET/CT, and subsequently showed a good response. The patient received additional cycles of 177 Lu-PSMA therapy, and the disease regressed further, with a PSA of 0.06ng/ml. Response evaluation of new therapeutic diagnostics (theranostic) agents needs a review of not only diagnostic PET/CT images, but also post-therapy images and laboratory results., (Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.)

For years the mainstay of antiphospholipid syndrome treatment has been anticoagulation and antiplatelet therapy, but the autoimmune nature of the disease, and complications of these therapies, created the need to develop new therapeutic strategies. New therapeutic alternatives inhibit at different levels, the cascade of events leading to the pro-thrombotic state characteristic of the antiphospholipid syndrome. We conducted a literature review of these new treatments, focusing on the pathophysiological bases that support them and their possible clinical applications.

Introduction: Autologous bone marrow transplant (ABMT) represents a high metabolic stress. Glutamine has proven to be effective in severe catabolic states, although there are controversial studies., Objectives: To assess the effect of parenteral nutrition (PN) therapy supplemented with glutamine on the occurrence of mucositis and mean hospital stay in patients submitted to ABMT., Methods: Retrospective study of patients submitted to ABMT between 2006 and 2009. In 2008, one vial of L-alanyl-L-glutamine (20 g) was added by protocol to the PN formulations of these patients. Thirteen clinical charts since that date (glutamine group) and 13 previous charts (control group) were randomly selected (n = 26). We compared the degree of mucositis and hospital stay in both groups. In the subgroup of glutamine-treated patients, we compare the glutamine dose in the patients developing some degree of mucositis with that of those not having this complication., Results: Mean hospital stay: 27.8 ± 7.4 days (control group) vs. 20.3 ± 5.3 days (glutamine group) (p = 0.01). The severity of mucositis was lower in the glutaminetreated group (p = 0.02). The weight-adjusted dose of L-alanyl-L-glutamine in the patients not developing mucositis was higher than in the other ones (0.32 vs. 0.24 g/kg/day; p = 0.02)., Conclusions: Glutamine supplementation reduces the degree of mucositis and hospital stay in patients submitted to autologous bone marrow transplantation. The degree of mucositis is lower in the subgroup of patients receiving higher doses of glutamine.

Hypothesis: the endovenous administration of glutamine, independently of the type of nurtrition received, can reduce the ICU length of stay, the incidence of infections and the mortality in the traumatic patients admitted to the ICU., Objectives: The main objective is to assess the efficacy of glutamine suplementation, given intravenously, to reduce the incidence of infectious complications, mortality and ICU length of stay in the traumatic patients admitted to the ICU. Other objectives are: 1) to assess the efficacy of glutamine in different groups of patients according to the severity and the plasma levels of glutamine. 2) Record all the adverse events due to the intravenous administration of glutamine., Methods: prospective, randomized, doble-blind and multicenter study with two parallel groups: placebo and treatment group. The patients who fulfill the inclusion criteria will receive either glutamine or placebo, independently of the type on nutrition. Glutamine will be administered as a pharmaconutrient at 0.5 g/kg/day during 5 days as a continous perfusion.

Background: Hepatic encephalopathy (HE) is a common cause of hospital admission in patients with cirrhosis involving high costs of care., Aim: To evaluate the use of L-ornithine L-aspartate (LOLA) vs. lactulose is able to reduce the length of hospital stay and the timing of improvement of hepatic encephalopathy., Methods: Retrospective and comparative study of patients with HE admitted to the Medical Gastroenterology Unit of a tertiary referral center in Mexico City (Hospital General de México) in a period of three years. Patients were divided in two treatment groups: LOLA vs. oral lactulose. We compared time to remission of encephalopathy, days of hospital stay and costs of hospital care., Results: We included 80 patients: 40 patients who received treatment with latulose had acumulative hospital stay of 443 days vs. 264 days for those who received LOLA (40% reduction in hospital stay). In the group treated with lactulose, mean hospital stay was 11.07 days vs. 6.47 days in the group treated with LOLA. Thus, a significantly greater number of patients treated with LOLA remained hospitalized less than a week compared with those treated with lactulose (65% vs. 20% respectively. OR 4.33, 95% CI 1.67- 11.23, p = 0.004). The mean recovery time of encephalopathy was less with LOLA treatment (4.32 vs. 10.15 days)., Conclusion: Treatment with LOLA was more effective in improving HE and reducing the duration of hospital stay.

Hepatic encephalopathy (HE) is a neuropsychiatric syndrome in patients with liver failure and/or a portal-systemic bypass. Since 2002 a new nomenclature of HE exists, that classifies HE in encephalopathy type A (associated with acute liver failure), type B (associated with portal-systemic bypass), and type C (associated with liver cirrhosis). HE type A is characterized by a rapid development to coma, cerebral edema, and a poor short-term prognosis. Therefore, these patients should be referred to a liver transplantation center. Standard treatment of HE consists of non absorbable disaccharides, non absorbable antibiotics, and a diet with an appropriate amount of proteins. In addition, the possibility of performing a liver transplantation should be evaluated. In patients with intractable HE other alternative treatments adjunct to standard treatment, like zinc, sodium benzoate, ornithine aspartate, branched chain amino acids, flumazenil, and bromocriptine should be considered.