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Introduction: The early diagnosis of infective endocarditis (IE) is a medical challenge and a multidisciplinary approach is essential to improve its frequently fatal prognosis. Our goal was to evaluate the usefulness of [18F]2-fluoro-2-deoxy-d-glucose positron emission tomography (18F-FDG PET) in the diagnosis of this disease. Materials and Methods: We prospectively assessed 43 patients (five female and 38 male) with clinical suspicion of IE between 2014 and 2017. All patients underwent transesophageal echocardiography (TEE) and an 18F-FDG PET scan, and the results were compared. A positive PET finding was defined as increased FDG uptake on cardiac valves or intracardiac devices. Results: Out of 43 patients with suspected IE, the diagnosis was confirmed in 30 cases (79.7%). 18F-FDG PET was positive in 24 patients, with 19 showing FDG uptake on cardiac valves (two native and 17 prosthetic) and five on cardiac devices, being concordant with echocardiographic findings in 11 cases. 18F-FDG PET sensitivity was 80%, specificity 92%, positive predictive value (PPV) 96% and negative predictive value (NPV) 66%. Echocardiography presented sensitivity, specificity, PPV and NPV of 36%, 84%, 84% and 36%, respectively. Conclusions: 18F-FDG PET proved to be a sensitive technique with a high diagnostic value in patients with prosthetic valves and intracardiac devices and suspected IE. Its utility decreased dramatically in patients with suspected IE on native valves, in which TEE presented higher sensitivity and thus better diagnostic value. Resumo: Introdução: O diagnóstico precoce de endocardite infecciosa (EI) é um desafio médico. Portanto, uma abordagem multidisciplinar é essencial para melhorar o prognóstico desta patologia, muitas vezes fatal. O nosso objetivo foi avaliar a utilidade da tomografia por emissão de pósitrons [18F] 2-fluoro-2-desoxi-D-glicose (18F-FDG-PET) no diagnóstico desta doença. Materiais e métodos: De forma prospetiva, avaliámos 43 doentes (5 do sexo feminino e 38 do masculino) clinicamente suspeitos de EI entre 2014-2017. Todos os doentes foram submetidos a um ecocardiograma transesofágico (ETE) e uma PET 18F-FDG, os resultados foram posteriormente comparados. Um critério PET positivo foi definido como um aumento na captação de FDG nas válvulas cardíacas ou nos dispositivos intracardíacos. Resultados: Dos 43 doentes com suspeita de EI, o diagnóstico foi confirmado em 30 casos (79,7%). O 18F-FDG-PET foi positivo em 24 doentes, dos quais 19 demonstraram captação de FDG nas válvulas cardíacas (2 nativas e 17 protésicas) e cinco nos dispositivos cardíacos, concordando com os achados ecocardiográficos em 11 casos. A sensibilidade de 18F-FDG-PET (S) foi de 80%, especificidade (P) de 92%, valor preditivo positivo (VPP) de 96% e valor preditivo negativo (VPN) de 66%. A ecocardiografia apresentou valores de S, P, PPV e VPN de 36%, 84%, 84% e 36%, respetivamente. Conclusões: O 18F-FDG-PET demonstrou ser uma técnica sensível com alto valor diagnóstico em doentes com suspeita de EI com próteses valvulares e dispositivos intracardíacos. A utilidade desta técnica diminui drasticamente em doentes com suspeita de EI nas válvulas nativas, nas quais a ETE apresentou maior sensibilidade e, portanto, melhor valor diagnóstico. Keywords: Infective endocarditis, Positron emission tomography, 18-Fluoro-2-deoxy-d-glucose, Transesophageal echocardiography, Palavras-chave: Endocardite infecciosa (EI), Tomografia por emissão de pósitrões (18F-FDG-PET), Ecocardiograma transesofágico (ETE)

Severe allergic ocular diseases as atopic keratoconjunctivitis can induce corneal damage due to inflammatory substances released from giant papillae. Tacrolimus eye drops are one of the current therapeutic alternatives for its treatment. This work is aimed at developing and characterizing a 0.03% tacrolimus ophthalmic formulation, which was introduced in three types of vehicles (BBS, PVA and Hyaluronic Acid). For this, we have performed in vitro (stability studies) and in vivo assays (corneal permanence time measured directly by Positron Emission Tomography) of three potential formulations. Next, the best formulation was selected, and its toxicological profile and clinical effectiveness have been evaluated. The biopermanence studies (direct measurements and PET/CT) showed that the formulations with PVA and Hyaluronic Acid present more retention time on the ocular surface of rats than PBS. From the stability study, we have determined that tacrolimus with PVA in cold storage is the best option. Tacrolimus with PVA has shown lower cytotoxicity than cyclosporine at early times. On the other hand, the pilot study performed has shown significant improvements in patients, with no noticeable adverse reactions. Based on stability, biopermanence, safety and clinical effectiveness studies, we concluded that tacrolimus-PVA eye drops are a suitable candidate for its clinical application in inflammatory ophthalmology diseases.

A 65-year-old male presented with unexplained hypoxia that became exacerbated by an upright posture (platypnea-orthodeoxia syndrome) secondary to hepatopulmonary syndrome (HPS). A (99m)Tc-macroaggregated albumin pulmonary perfusion scan revealed a right to left shunt of 29% in the sitting position, which had not been previously detected when the radiotracer injection was performed with the patient in supine position, nor was it diagnosed using another non-invasive imaging method (transthoracic contrast echocardiography and angio-CT). A transesophageal echocardiography was contraindicated due to the presence of esophageal varices. The administration of the radiopharmaceutical in sitting position for the study of the pulmonary perfusion allowed us to confirm the presence of the shunt and consider the patient a candidate for liver transplantation.

Objectives: The aim of the present study was to determine the long-term prognostic value provided by the exercise electrocardiographic (ECG) response to nuclear myocardial perfusion imaging (MPI) in the evaluation of patients with chest pain, focusing on patients with a discrepancy between the two tests. Methods: A total of 1460 consecutive patients (777 female; 62.6±11.4 years) undergoing exercise myocardial single-photon emission computed tomography (SPECT) were included. The endpoint was the occurrence of acute coronary syndrome, heart failure or cardiac death during follow-up. Results: Ischemic ECG changes were observed during stress testing in 271 patients (18.5%) and 362 patients (24.7%) had positive (abnormal) exercise MPI results. There was a discrepancy between ECG and SPECT findings in 471 patients (32.2%). During the follow-up period (14.0-39.6 months), 224 patients (15.3%) presented cardiac events. The hazard ratios (HR) of ECG and MPI results to predict events were 1.506 (95% CI: 1.113-2.039) and 10.481 (95% CI: 7.799-14.080), respectively. In patients with negative MPI, the ECG response did not predict events (HR 1.214 [95% CI: 0.646-2.282]), the same as in patients with positive MPI (HR 1.203 [95% CI: 0.848-1.705]). Only in hypertensive patients with positive SPECT did the ECG show significant prognostic value (HR 1.937 [95% CI: 1.030-3.642]). In multivariate analysis, positive MPI proved an independent long-term prognostic factor (HR 10.536 [95% CI: 7.759-14.308]), but not ECG (HR 1.356 [95% CI: 0.994-1.850]). Conclusion: MPI results (normal vs. abnormal) had strong predictive value and discrepant ECG results had no significant additive prognostic value. Resumo: Objetivos: O objetivo do presente estudo foi determinar o valor prognóstico a longo prazo, fornecido pelo eletrocardiograma (ECG) em resposta ao esforço na cintigrafia de perfusão miocárdica (CPM) na avaliação de doentes com dor torácica, com ênfase para os grupos de doentes com discrepância entre os dois testes. Método: Foram incluídos 1460 doentes consecutivos (777 do sexo feminino; 62,6 ± 11,4 anos), submetidos a exercício na cintigrafia de perfusão miocárdica com SPECT. O endpoint foi a presença de síndrome coronária aguda, insuficiência cardíaca ou morte cardíaca durante o seguimento. Resultados: Duzentos e setenta e um doentes (18,5%) apresentaram alterações eletrocardiográficas de isquemia durante o teste de esforço e 362 doentes (24,7%) tinham resultados positivos (anormais) na CPM. A discrepância entre os resultados do ECG e CPM apareceu em 471 doentes (32,2%). Durante o período de seguimento (14,0-39,6 meses), 224 (15,3%) apresentaram eventos cardíacos. O hazard ratio (HR) para predizer eventos dos resultados do ECG e CPM foi de 1,506 (1,113-2,039) e 10,481 (7,799-14,080), respetivamente. No grupo de doentes com CPM negativo, o ECG não prediz eventos [HR 1,214 (0,646-2,282)],e o mesmo acontece no grupo de doentes com CPM positivo [HR 1,203 (0,848-1,705)]. Apenas em doentes hipertensos com CPM positivo, o ECG mostrou valor prognóstico significativo [HR 1,937 (1,030-3,642)]. Na análise multivariada, a CPM positiva foi um fator independente de prognóstico a longo prazo [HR 10,536 (7,759-14,308)], mas não o ECG [HR 1,356 (0,994-1,850)]. Conclusão: O resultado da CPM (normal versus anormal) teve um forte valor preditivo e o resultado discrepante no ECG não teve um valor prognóstico adicional significativo. Keywords: Electrocardiogram, Myocardial perfusion imaging, Stress test, Prognosis, Palavras-chave: Eletrocardiograma, Imagens de perfusão miocárdica, Prova de esforço, Prognóstico

New oncologic procedures are currently more focused on the biological features of tumors. The ideal objective is the administration of personalized effective treatments for each patient that affects not just the location and spread of disease but also special metabolic characteristics of tumoral cells. Radiologic diagnostic methods are extremely important in the management of the patient for staging, restaging, and evaluation of treatment response, and clinicians are avid for some additional functional and metabolic information. Further, they need more dynamic methods for follow-up. Nuclear Medicine and positron emission tomography (PET) in many cases can meet this requirement, although it is not perfect, at least at the present time. Currently 2-((18)F)fluoro-2-desoxi-D: -glucose positron emission tomography is being widely used for oncologic purposes. Its information can be very useful in abdominal diseases and must be taken into account with the results of radiologic imaging. Thus, many changes in the choice of treatment are seen. However, it is very important to know that sometimes there is a lack of specificity that has to be considered.

Cancer stem cells play an important role in carcinogenesis and resistance to treatment and may lead to metastasis. The isolation of circulating stem cells involves cell sorting based on the presence of cell surface markers. Many surface markers such as CD133, c-Kit, SOX, OCT4 and TWIST have been reported. In the present study, we determined the expression of different stem cell markers and their variation in expression at different stages of the treatment process. Samples of EDTA blood were collected from metastatic colorectal cancer patients, and circulating cancer stem cells were isolated for the analysis of the expression of stem cell markers using RT-PCR. These findings were correlated with the response to therapy. All statistical analyses were performed using the GraphPad Prism 5.03 software. Significant differences were found in the expression levels of the markers CD133, SOX2, OCT4 and TWIST1. No differences were found in c-Kit expression. Correlation in the expression levels of most of the markers was observed. Expression of CD133, OCT4, SOX2 and TWIST1 had a predictive value for colon cancer behavior. Evaluation of this stem cell gene expression panel may be useful for predicting the response during the process of treatment, and the relative easy access to samples facilitates this method. Moreover the correlation between CD133 and TWIST1 expression may be associated with tumor regrowth and metastatic relapse.

Various authors have proposed the use of hyaluronic acid (HA) as a tumor marker. In order to analyze its usefulness as a marker in bronchogenic carcinoma, the most common carcinoma in men, we determined the HA values in serum and bronchoalveolar lavage fluid (BAL). We performed prospective studies on two groups of patients: 81 diagnosed as having bronchial carcinoma and 34 with benign respiratory diseases. HA values were higher in patients with cancer than in those with benign diseases (serum: 79.8 ng/ml vs 63.7 ng/ml; BAL: 927 ng/mg vs 522 ng/mg). Also, the percentage of patients with levels exceeding the established cutoff was greater in the group with cancer than in the group with benign diseases (serum: 24.6 vs 17.6; BAL: 25.3 vs 3). Statistically significant differences in these percentages were found in BAL (p We conclude that the HA levels in serum and BAL could be of interest as a tumor marker, especially in patients with small cell carcinoma.

Gastric carcinoma can be divided into two main histological and clinical types: diffuse and intestinal. The aim of this study was to investigate the expression of neu/c-erbB-2 oncoprotein, epidermal growth factor receptor (EGFR), cathepsin D (catD), progesterone receptor (PR) and tumor-associated glycoprotein-72 (TAG-72) in gastric carcinoma of these histological types.In this randomized, prospective study we analyzed 85 biopsy samples from patients with gastric adenocarcinoma. The control group consisted of 40 specimens from normal gastric mucosa. Neu oncoprotein and PR were determined by ELISA. CatD and TAG-72 were quantified with immunoradiometric (IRMA) methods, and EGFR were studied by radioimmunoassay (RIA).Neu, EGFR, catD and TAG-72 concentrations were higher in the tumoral group (p = 0.02, p = 0.00001, p = 0.002 and p = 0.007, respectively). In diffuse adenocarcinomas, catD and PR expression was increased (p = 0.01 and p = 0.04 respectively), whereas TAG-72 concentration, which correlated with neu (r = 0.57), was higher in the intestinal type (p = 0.04). No significant differences in EGFR and neu concentrations were seen between the two histological types.The higher PR and catD concentrations in diffuse adenocarcinomas, and the overexpression of TAG-72 in the intestinal type, support the existence of two modes of gastric carcinogenesis.

We assayed prostatic specific antigen (PSA) and prostatic acid phosphatase (PAP) serum levels in 1383 patients using a double antibody radioimmunoassay (RIA) I125. Establishing the upper normal limit in 10 ng/ml PSA and 2.5 ng/ml for PAP, the false positive results were only 1.9 and 5.1 percent in men with non-prostatic benign or malignant pathology and respectively 0 and 2.2 percent in women. We detected false positive levels for these two tumoral markers in 3.5 and 4.7 percent of patients with non-complicated benign prostatic hypertrophy, 64.8 and 19.2 percent in complicated benign prostatic hypertrophy, 24 and 16 percent in acute prostatitis and 3.3 percent in chronic prostatitis. The sensitivity in patients with prostate cancer was 87.2 percent for PSA and 64.1 percent for PAP, and there was a better correlation with PSA than PAP for tumoral spread and histological grading. Finally, clinical efficacy was higher with PSA and was no better when both markers were assayed.

We assayed prostatic specific antigen and prostatic acid phosphatase serum levels in 1,383 patients using a double antibody radioimmunoassay (RIA) 125I. Establishing the upper normal limit in 10 ng/ml for prostatic specific antigen and 2.5 ng/ml for prostatic acid phosphatase, the false positive results were only 1.9 and 5.1% in men with nonprostatic benign or malignant pathology and 0 and 2.2% in women, respectively. We detected false positive levels in 3.5 and 4.7% of the patients with noncomplicated benign prostatic hypertrophy, 64.8 and 19.2% in complicated benign prostatic hypertrophy, 24 and 16% in acute prostatitis and 3.3% in chronic prostatitis for both tumoral markers. The sensibility in patients with prostate cancer was 87.2 and 64.1%, respectively, and there was better correlation with prostatic specific antigen than prostatic acid phosphatase levels on tumoral spread and histologic grading. Finally, the clinical efficacy was higher with prostatic specific antigen and it did not increase with the quantification of both tumoral markers.