68Ga-PSMA-11 PET/CT in patients with occult biochemical recurrence of prostate carcinoma and negative 18F-Choline PET/CT. Preliminary assessment of its clinical use

OBJECTIVE

To assess the clinical usefulness of ⁶⁸Ga-PSMA PET/CT studies in patients with occult biochemical recurrence of prostate carcinoma, with negative or inconclusive radiologic and 18F-Choline PET/CT imaging studies.

MATERIAL AND METHODS

Retrospective observational and diagnostic accuracy. The first 14 patients with a history of prostate carcinoma, treated with curative intent and presenting suspicion of biochemical recurrence with low PSA values (< 3 ng/ml) were selected. Imaging studies, prostate ultrasound, pelvic CT and/or MRI were negative, and all of them had a negative or inconclusive 18F-Choline PET/CT. All patients were referred to ⁶⁸Ga-PSMA-11 PET/CT.

PROTOCOL

Dose 2.2 MBq/kg. 20 mg furosemide at start. PET/CT images from skull base to proximal third of thighs at 60 min, and late images at 3 hours if needed.

RESULTS

The ⁶⁸Ga-PSMA-11 PET/CT was able to localize the occult biochemical recurrence in 9 of the 14 patients (64.2%), and it affected the therapeutic attitude in all of them. Four patients (28.5%) obtained a negative or inconclusive ⁶⁸Ga-PSMA-11 PET/CT and continued under vigilant approach with PSA controls and imaging studies according to the clinical guidelines. These patients had the lowest PSA values (less than 1 ng/ml). One of the ⁶⁸Ga-PSMA-11 PET/CT studies was inconclusive, reporting the presence of a doubtful right iliac adenopathy. CONCLUSIóN: ⁶⁸Ga-PSMA-11 PET/CT allows an early diagnosis, with low PSA values, of occult biochemical recurrence of prostate carcinoma, even in patients with negative 18F-Choline PET/CT.

Role of boost radiotherapy for local control of pure ductal carcinoma in situ after breast-conserving surgery: a multicenter, retrospective study of 622 patients

PURPOSE

To evaluate the effect of boost radiotherapy on ipsilateral breast tumor recurrence (IBTR) for ductal carcinoma in situ (DCIS) after breast-conserving surgery and whole breast radiotherapy (WBRT) with or without boost.

METHODS AND MATERIALS

Retrospective, multicentre study of 622 patients (624 tumors) diagnosed with pure DCIS from 1993-2011.

RESULTS

Most tumors (377/624; 60.4%) received a boost. At a median follow-up of 8.8 years, IBTR occurred in 64 cases (10.3%). A higher percentage of patients with risk factors for IBTR received a boost (p < 0.05). Boost was not associated with lower rates of IBTR than WBRT alone (HR 0.75, 95% CI 0.42-1.35). On the univariate analyses, IBTR was significantly associated with tumor size (11-20 mm, HR 2.32, 95% CI 1.27-4.24; and > 20 mm, HR 2.10, 95% CI 1.14-3.88), re-excision (HR 1.76, 95% CI 1.04-2.96), and tamoxifen (HR 2.03, 95% CI 1.12-3.70). Boost dose > 16 Gy had a protective effect (HR 0.39, 95% CI 0.187-0.824). Multivariate analyses confirmed the independent associations between IBTR and 11-20 mm (p = 0.02) and > 20 mm (p = 0.009) tumours, and re-excision (p = 0.006). On the margin-stratified multivariate analysis, tamoxifen was a poor prognostic factor in the close/positive margin subgroup (HR 4.28 95% CI 1.23-14.88), while the highest boost dose ( > 16 Gy) had a significant positive effect (HR 0.34, 95% CI 0.13-0.86) in the negative margin subgroup.

CONCLUSIONS

Radiotherapy boost did not improve the risk of IBTR. Boost radiotherapy was more common in patients with high-risk disease. Tumor size and re-excision were significant independent prognostic factors.

A DOG TEST FOR MEASURING THE IMMUNIZING POTENCY OF ANTIRABIES VACCINES

1. A quantitative method is described for testing the immunizing potency of antirabies vaccines in dogs. 2. Phenolized, single-injection, canine vaccines from seven manufacturers, when administered to dogs according to directions, failed to protect them against the least measurable amount of test virus fatal to 50 per cent or more of controls. Chloroformized vaccines from two of three manufacturers, under the same conditions, gave equivocal or suggestive results. 3. Commercial chloroformized vaccines in 10 cc. doses, injected intraperitoneally rather than subcutaneously into dogs, conferred a significant degree of immunity but proved temporarily irritative to the peritoneum. 4. These results of canine vaccines in dogs parallel closely those already reported in mice.

INFLUENCE OF AGE FACTORS ON SUSCEPTIBILITY OF MICE TO RABIES VIRUS

1. 7 to 9 day old mice are more susceptible than older mice to injections of fixed or street virus by any route. 2. 20 day old mice are more susceptible than 60 day old mice to peripheral but not intracerebral injection of fixed virus. 3. 20 day and 60 day old mice are equally susceptible to street virus.

NEUTRALIZING AND COMPLEMENT-FIXING ANTIBODY PRODUCTION AND RESISTANCE FOLLOWING VACCINATION IN EXPERIMENTAL ENCEPHALITIS INFECTIONS

In mice vaccinated subcutaneously with different doses of virulent W.E.E. virus or with formolized vaccine, neutralizing and complement-fixing antibodies paralleled resistance to some extent yet appeared in groups in which resistance remained undetectable, persisted at a similar maximum level in spite of different titers of resistance, and after resistance had become negligible. In mice vaccinated subcutaneously with different doses of virulent St. Louis encephalitis virus or with formolized vaccine, neutralizing and complement-fixing antibodies bore little relation to resistance. Neutralizing antibodies appeared only in the group showing resistance but not until resistance was diminishing. Complement-fixing antibodies developed equally well in groups with or without resistance.

IMMUNOLOGICAL RELATIONSHIPS AMONG CENTRAL NERVOUS SYSTEM VIRUSES

From observations carried out with the viruses of Russian spring-summer encephalitis, louping ill, W.E.E., and the Japanese B, St. Louis, and West Nile types of encephalitis, the following facts and inferences have been derived. 1. Russian encephalitis and louping ill viruses showed a close relationship by complement fixation, neutralization, and intraperitoneal cross-resistance tests. Intracerebral cross-resistance tests, on the other hand, failed to reveal any connection between them. Neither Russian nor louping ill virus appeared to be related to the remaining viruses tested. 2. Japanese B, St. Louis, and West Nile types of encephalitis, as a group, showed a certain degree of group relationship, but it was not so close as that between the Russian and louping ill viruses. In complement fixation tests, besides homologous reactions, Japanese serum brought about reactions with both St. Louis and West Nile antigens; St. Louis serum reacted with Japanese antigen, and West Nile serum with Japanese antigen. In neutralization tests with mouse sera, no relationship was found amongst these three viruses, while in similar tests with either hamster or guinea pig serum,—which gave higher homologous titers,—it was found that Japanese serum protected against West Nile and St. Louis viruses, St. Louis serum protected against West Nile virus, and West Nile serum against Japanese virus. In intracerebral and intraperitoneal cross-resistance tests, no relationship was found to exist between these three viruses. Moreover, the Japanese B, St. Louis, and West Nile viruses appeared to be unrelated to any one of the three other viruses tested. 3. W.E.E. virus stood apart in all tests as unrelated to any of the other viruses studied. 4. The homologous titers of complement-fixing antibodies in mouse sera showed a gradual decline with the passing of time after vaccination, and this loss of homologous titer was paralleled by a similar drop in the titer of the heterologous reactions. In the case of the Japanese B, St. Louis, and West Nile viruses, with which at the start the amount of crossing was not high, a point was reached beyond which heterologous reactions could no longer be detected. 5. A comparison of the specific levels of complement-fixing and neutralizing antibodies for the viruses in mouse hyperimmune sera showed their rate of persistence to differ. Complement-fixing antibodies which had highest titers on the 10th day, diminished gradually until, when tested on the 50th day, all titers had reached levels from one-fourth to one-eighth of their values on the 10th day. On the other hand, the levels of neutralizing antibodies for the same samples of serum were, on the 50th day, as high as or higher than those found on either the 25th or 10th days, save in the case of the Japanese B virus. 6. The state of immunity of animals following vaccination with the viruses discussed was found to be different at a given time, depending on the method employed to determine it. Thus, mice vaccinated with St. Louis virus had positive complement-fixing antibodies on the 10th day and no neutralizing antibodies. The state of immunity changed in the course of time. For this reason it is felt that in order to detect whether two viruses are related or not, multiple observations are necessary, over a considerable time and employing all available methods of immune comparison.

VENEZUELAN EQUINE ENCEPHALOMYELITIS IN MAN

A filterable agent was isolated from the blood and from washings of the upper respiratory passages of a young laboratory worker during a mild, acute, febrile illness. This agent was identified as a strain of Venezuelan equine encephalomyelitis virus. Circulating specific complement-fixing and neutralizing antibodies not present in sera withdrawn during the acute phase of illness were demonstrated in sera obtained during convalescence. A fellow laboratory worker who became similarly ill simultaneously also developed during convalescence specific circulating antibodies not present prior to illness.

THE COMPLEMENT FIXATION TEST IN THE DIAGNOSIS OF VIRUS INFECTIONS OF THE CENTRAL NERVOUS SYSTEM

A specific complement fixation test can be obtained in various central nervous system virus infections by using as antigens emulsions of infected brain tissue, freezing and thawing the brain emulsion, and then centrifuging it in an angle head centrifuge at 3500 R.P.M. for 1 hour. The method has proved reliable in the case of rabies, St. Louis encephalitis, Japanese B encephalitis, lymphocytic choriomeningitis, Eastern equine encephalomyelitis, Western equine encephalomyelitis, louping ill, and spontaneous encephalomyelitis of mice (Theiler's disease). The specificity of the reaction, regardless of the virus involved, requires different temperatures of inactivation of the sera according to animal species: 56°C. for guinea pig, 60°C. for mouse, and 65°C. for rabbit and dog sera, all heated for 20 minutes. For human sera a temperature of inactivation of 60°C. also for 20 minutes has been adopted; at this temperature the reaction is in general specific. Complement-fixing antibodies in high titre were found in the sera of rabbits, guinea pigs, mice, and dogs immunized with rabies virus. Complement-fixing antibodies were present in high titre in sera drawn from two persons 8 years after an attack of louping ill, from five persons 2½ years after an attack of Eastern equine encephalomyelitis, and from two persons 2½ years after Western equine encephalomyelitis. In cases of St. Louis encephalitis and lymphocytic choriomeningitis, complement-fixing antibodies have been found shortly following infection but not after long periods.

INFLUENCE OF AGE FACTORS ON IMMUNIZABILITY OF MICE TO RABIES VIRUS

1. W-Swiss mice 60 or more days old are more readily immunizable against rabies virus infection than 20 day old or younger mice; this difference in immunizability with increasing age is most conspicuous when vaccination with virulent virus is followed by intracerebral test infection and least apparent when vaccination with avirulent virus is followed by intramuscular test infection. 2. The titre of circulating neutralizing antibodies does not parallel the titre of immunity.

THE QUANTITY OF IRRADIATED NON-VIRULENT RABIES VIRUS REQUIRED TO IMMUNIZE MICE AND DOGS

In the experiments described above, we found with respect to tissue culture rabies virus that 1 cc., which contains approximately 50,000 mouse intracerebral lethal doses, properly irradiated, was required to immunize a mouse; 500 cc., which contain 25,000,000 doses, were required to immunize a 20 pound beagle dog. Tissue culture virus concentrated ten times proved capable of immunizing mice in a dose one-tenth as large as that required for unconcentrated culture virus. Brain virus suspensions were centrifuged so as to remove a large part of the tissue particles without striking loss in the virulence of the supernatant. The centrifuged supernatants of 1 to 5 per cent brain virus suspensions were irradiated so as to destroy virulence and yet retain immunizing potency. Irradiated supernatants of mouse brain virus proved capable of immunizing mice as well as or better than similar supernatants treated with chloroform. 0.1 cc. of a 1 per cent irradiated dog brain virus containing approximately 50,000 mouse intracerebral lethal doses immunized mice effectively.

A NON-VIRULENT, SINGLE-DOSE RABIES VACCINE FOR PROPHYLACTIC IMMUNIZATION OF DOGS

Our studies on rabies vaccines thus far have led us to the view that in order to develop and test vaccines, quantitative methods are necessary, and that such quantitative methods may be exploited to greatest advantage by using mice, preferably W-Swiss, as the test animal. Dogs, due to their variability and susceptibility to intercurrent infections when kept under experimental conditions, are useful chiefly to check whether or not a vaccine produces a high grade of immunity; they remain of limited value in testing the comparative potencies of weak vaccines. A second point is that the Pasteur strain of virus has proved as potent as any tested for the preparation of vaccines. Another point is that virus material for preparing vaccines must titre at least 330,000 mouse doses per cc. to be effective. This requirement has eliminated all culture vaccines thus far reported, with the possible exception of Plotz's (7) and leaves virus-containing brain tissue as the sole potent source of vaccine. In summary, we believe that a single injection of non-virulent irradiated vaccine, prepared as herein described, immunizes mice and dogs effectively against a subsequent test inoculation of virulent rabies virus and does so to a greater degree than do other vaccines now obtainable. It is easily and quickly prepared, keeps well, and has a low nitrogen content.

RELATIONSHIP OF THE VIRUS OF LOUPING ILL IN SHEEP AND THE VIRUS OF RUSSIAN SPRING-SUMMER ENCEPHALITIS IN MAN

An experimental study of three strains of Russian spring-summer encephalitis virus and one of louping ill virus has yielded the following results:— 1. The sera of mice hyperimmunized to the viruses of Russian encephalitis and louping ill respectively have produced complement fixation with both antigens in almost precisely the same titer. 2. In neutralization tests hyperimmune sera against the Russian virus strains protected against louping ill virus to the same extent as against the Russian virus strains. Conversely, hyperimmune sera against the louping ill virus protected against the Russian viruses, although to a less degree than against louping ill virus. 3. In cross-resistance tests in mice, a vaccine consisting of formolized Russian virus gave strong protection against this latter and moderate protection against louping ill virus. Formolized louping ill virus gave moderate protection against infection with louping ill and considerably less against the Russian virus. 4. Serum from an individual recovered from a laboratory infection with louping ill virus contracted in 1933 gave positive complement fixation and neutralization tests with the Russian spring-summer encephalitis, as well as with louping ill virus. 5. Serum from a patient who became infected with either Russian or louping ill virus or both while working with the viruses in the laboratory in the fall of 1942, gave positive reactions on complement fixation and neutralization tests against them both. 6. No such similarities have been found with other central nervous system viruses. Hence it would appear that they are specific.

Effect of the M(s) transformation temperature on the wear behaviour of NiTi shape memory alloys for articular prosthesis

The main objective of this work has been the characterisation and correlation of the wear behaviour of the NiTi shape memory alloys in their different phases. The weight losses for the different alloys in function of the present phase, and of the M(s) transformation temperature are studied. Adhesive wear tests, Pin-on-Disk, according to the ASTM-G99 standard have been carried out. The thermoelastic martensitic transformations that cause the super-elastic effect, the reorientation and coalescence of martensitic plates and the damping effect promotes a high ability to accommodate large deformations without generating permanent damages that causes the wear. The resulting plastic deformation may be accumulated during wear process without generating fracture. The results show that the wear resistance is mainly dependent of the M(s) transformation temperature for both alloys. For the NiTi alloys also the Ni atomic percentage and the hardness of the alloys are important parameters in the wear behavior.

In vitro Antifungal Activity of Sertaconazole Compared with Nine Other Drugs against 250 Clinical Isolates of Dermatophytes and Scopulariopsis brevicaulis

We have tested 250 strains belonging to 15 species of clinically important dermatophytes and Scopulariopsis against ten antifungal drugs using an agar diffusion method (NeoSensitabstrade mark, Rosco, Taastrup, Denmark). Some of the experimental factors were adapted to dermatophyte development, such as temperature (28 vs. 35 degrees C) and time of incubation (2-5 days vs. 21-74 h). The antifungals used are itraconazole, ketoconazole, miconazole, clotrimazole, sertaconazole, terbinafine, tioconazole, fluconazole, isoconazole and econazole. Except for fluconazole, all the drugs tested have shown to be highly effective, especially sertaconazole and terbinafine. Percentages of susceptibility ranged between 94% for terbinafine, 87.6% for sertaconazole and 86.4% clotrimazole; 81.6% econazole; 42.8% fluconazole; 57.2% isoconazole; 78.4% itraconazole; 74.4% ketoconazole; 73.3% miconazole, and 85.2% for tioconazole. Percentages of resistance were similar between sertaconazole and terbinafine (4%) but in contrast to the 48% obtained for fluconazole.

Impact of peritoneal cytology on survival of endometrial cancer patients treated with surgery and radiotherapy

Stage IIIA endometrial cancer includes patients with serosal or adnexal invasion and patients with positive peritoneal cytology only. In this study, we assessed the impact of peritoneal cytology on endometrial cancer survival. All endometrial cancer patients receiving surgery and radiotherapy at the Geneva University Hospitals between 1980 and 1993 were included. Stage lllA cancers were categorised into ‘cytological’ stage lllA (only positive peritoneal cytology) and ‘histological’ stage lllA (serosal or adnexal infiltration). Survival rates were analysed by Kaplan–Meier method and compared using log-rank test. The prognostic importance of peritoneal cytology was analysed by multivariate regression analysis. This study included 170 endometrial cancers (112 stage I, 17 cytological stage IIIA, 18 histological stage IIIA, 9 stage lllB+). Disease-specific survival of cytological stage IIIA was not different from stage I (94 vs 88% respectively, P=0.5) but better than histological stage IIIA (94 vs 51% respectively, P<0.01). Histological stage IIIA patients were at increased risk to die from cancer compared to stage I patients (HR 2.7, 95% CI 1.0–7.7), while cytological stage IIIA patients were not (HR 0.3, 95% CI 0.3–2.0). Cytological stage lllA endometrial cancer has similar prognosis as stage l and better prognosis than histological stage IIIA. Additional research, definitively separating stage and cytology is warranted.

Postencephalitic parkinsonism--a review

The pandemic of von Economo's disease which began in January 1917 preceded that of influenza of 1918-1919 by more than a year. Though it has been customary to link the two it seems unlikely that the latter was responsible for the former as has been proposed. It has been assumed that von Economo's disease (ED) was caused by a virus; but in fact the etiology is in question as no virus has yet been transmitted to experimental animals or cells in culture. However, the presence of oligoclonal IgG bands in the CSF of suspected cases and the finding of chronic active lesions in the brain tissue at autopsy suggests a viral etiology. Occasional, sporadic presumed cases of the disease have been reported within the last 25 years. Encephalitides due to established neurotropic viruses or to other viruses that may on occasion invade the CNS only rarely produce parkinsonism, and when they do it differs from that seen in ED. The present report reviews the overall concept of a viral etiology of Parkinson's disease with particular reference to von Economo's disease.

[Prognostic factors in uterine sarcomas: a 21-year retrospective study at the Clinic and Provincial Hospital of Barcelona]

BACKGROUND

Uterine sarcomas show low incidence and poor outcome despite the treatment. The prognostic factors for the survival were determined in this study.

PATIENTS AND METHODS

Thirty-nine females with sarcoma of the uterus have been studied retrospectively from January 1975 to December 1996. They were treated in the Gynecology and Radiation Oncology Departments at Hospital Clínic i Provincial of Barcelona. Thirty-seven patients had surgery, 22 radiotherapy and 4 chemotherapy. The influence on the disease-specific survival, disease-free survival, local relapse disease-free survival and metastasis disease-free survival from the following pronostic factors was studied: age, pathologic subtype, miometrial invasion, mitosis, vascular and lymphatic invasion, tumor size, stage, radiotherapy and local relapse.

RESULTS

1) The disease-specific survival at 2 and 5 years was 51.5% and 42.5% respectively, and the disease-free survival at 2 and 5 years was 39%; the incidence of local and distant relapses--was 28 and 33%. 2) The multivariate analysis showed that the overall survival and the disease free survival were affected by the vascular invasion (odds ratio [OR] 12 and 32.6, respectively) and the local failure (OR = 3 and 25.5, respectively); the only factor that affected the local relapse-free survival and metastasis free survival was the III and IV stages (OR = 5.6 in both cases).

CONCLUSIONS

In uterine sarcomas, the vascular invasion and the local relapse were prognostic factors for overall survival and for disease-free survival. In stages III and IV there was a decrease in the local relapse-free survival and metastasis-free survival. A correlation between vascular invasion and advanced stages was found. The outcome of the uterine sarcomas is poor, local and distant failure being responsible for this bad prognosis.

Primary small cell carcinoma of the esophagus: a review of the literature with emphasis on therapy and prognosis

BACKGROUND

Few studies of patients with esophageal small cell carcinoma (SCC) have been conducted. Choice of treatment remains controversial.

METHODS

The authors analyzed data on 199 evaluable esophageal SCC patients, selected from among 230 patients found in the literature, and a data extraction form that recorded 11 features was completed. To allow for the evaluation of prognostic factors that influenced survival, the patients were grouped according to limited stage (LS), which was defined as disease confined to the esophagus, or extensive stage (ES), which was defined as disease that had spread beyond locoregional boundaries. Univariate and multivariate analyses were performed. Treatment was categorized as either local or local with systemic; for the ES cases, the categories were defined as treatment versus no treatment.

RESULTS

The tumor site was described in 178 cases (89%). Mean tumor size was 6.1. Pure SCC was found in 137 cases (68.8%), whereas 62 cases (31.2%) showed mixed SCC; 93 (46.7%) were LS, whereas 95 (47.7%) were ES. In 11 cases (5.5%), the stage was not determined. There was a significant difference in survival between patients with LS and those with ES (P < 0.0001). The median survival was 8 months for patients with LS and 3 months for those with ES. Univariate analysis of LS showed 3 significant prognostic factors: age (for patients age < or =60 years, the median survival was 11 months, whereas for those age >60 years, the median survival was 6 months), tumor size (for those with tumors < or =5 cm, the median survival was 12 months, whereas for those with tumors >5 cm, the median survival was 4 months), and type of treatment (with local plus systemic treatment, the median survival was 20 months, whereas with local it was 5 months). In multivariate analysis, tumor size (P = 0.007) and type of treatment (P < 0.001) were shown to be independent predictive variables.

CONCLUSIONS

Esophageal SCC is an aggressive type of tumor. This study shows that there are significant differences between LS and ES and that in LS, both tumor size and type of treatment are possible prognostic factors.

Primary small cell carcinoma of the esophagus: a review of the literature with emphasis on therapy and prognosis

BACKGROUND

Few studies of patients with esophageal small cell carcinoma (SCC) have been conducted. Choice of treatment remains controversial.

METHODS

The authors analyzed data on 199 evaluable esophageal SCC patients, selected from among 230 patients found in the literature, and a data extraction form that recorded 11 features was completed. To allow for the evaluation of prognostic factors that influenced survival, the patients were grouped according to limited stage (LS), which was defined as disease confined to the esophagus, or extensive stage (ES), which was defined as disease that had spread beyond locoregional boundaries. Univariate and multivariate analyses were performed. Treatment was categorized as either local or local with systemic; for the ES cases, the categories were defined as treatment versus no treatment.

RESULTS

The tumor site was described in 178 cases (89%). Mean tumor size was 6.1. Pure SCC was found in 137 cases (68.8%), whereas 62 cases (31.2%) showed mixed SCC; 93 (46.7%) were LS, whereas 95 (47.7%) were ES. In 11 cases (5.5%), the stage was not determined. There was a significant difference in survival between patients with LS and those with ES (P < 0.0001). The median survival was 8 months for patients with LS and 3 months for those with ES. Univariate analysis of LS showed 3 significant prognostic factors: age (for patients age < or =60 years, the median survival was 11 months, whereas for those age >60 years, the median survival was 6 months), tumor size (for those with tumors < or =5 cm, the median survival was 12 months, whereas for those with tumors >5 cm, the median survival was 4 months), and type of treatment (with local plus systemic treatment, the median survival was 20 months, whereas with local it was 5 months). In multivariate analysis, tumor size (P = 0.007) and type of treatment (P < 0.001) were shown to be independent predictive variables.

CONCLUSIONS

Esophageal SCC is an aggressive type of tumor. This study shows that there are significant differences between LS and ES and that in LS, both tumor size and type of treatment are possible prognostic factors.