Long-term survival in advanced non-squamous NSCLC patients treated with first-line bevacizumab-based therapy.

BACKGROUND/AIM: First-line bevacizumab-based therapies have been shown to improve clinical outcomes in patients with non-squamous non-small-cell lung cancer (NSCLC). We aimed to descriptively analyse patients with non-squamous NSCLC who received a long-term period of maintenance bevacizumab. PATIENTS AND METHODS: This retrospective study included 104 patients who had already reached a progression-free survival (PFS) of at least 9 months. RESULTS: Median overall survival and PFS were 30.7 and 15.1 months, respectively. The overall response rate was 83 %. Weight loss ≤5 %, ECOG PS = 0, or low number of metastatic sites seem to be predictive factors of good evolution. The incidence of bevacizumab-related adverse events appeared to be similar as the previous studies. CONCLUSION: Our findings show that there is a long-term survivor group whom the administration of bevacizumab resulted in a relevant prolongation of response without new safety signals. Due to the population heterogeneity, it was not possible to identify the standardised predictive factors.

Use of Paliperidone Palmitate Throughout a Schizoaffective Disorder Patient's Gestation Period.

Introduction: Paliperidone palmitate treatment of schizophrenia or schizoaffective disorder is effective and well tolerated, but there is almost no data on its safety during pregnancy. Case report: An analysis is made of the safety and tolerability of paliperidone palmitate treatment throughout the gestation period in a 34-year-old patient diagnosed with schizoaffective disorder. Discussion: Paliperidone palmitate treatment throughout the gestation period was safe and well tolerated by both mother and foetus, there being no malformations or other perinatal complications in the newborn to date.

Almost 2% of Spanish breast cancer families are associated to germline pathogenic mutations in the ATM gene.

PURPOSE: There is still a considerable percentage of hereditary breast and ovarian cancer (HBOC) cases not explained by BRCA1 and BRCA2 genes. In this report, next-generation sequencing (NGS) techniques were applied to identify novel variants and/or genes involved in HBOC susceptibility. METHODS: Using whole exome sequencing, we identified a novel germline mutation in the moderate-risk gene ATM (c.5441delT; p.Leu1814Trpfs*14) in a family negative for mutations in BRCA1/2 (BRCAX). A case-control association study was performed to establish its prevalence in Spanish population, in a series of 1477 BRCAX families and 589 controls further screened, and NGS panels were used for ATM mutational screening in a cohort of 392 HBOC Spanish BRCAX families and 350 patients affected with diseases not related to breast cancer. RESULTS: Although the interrogated mutation was not prevalent in case-control association study, a comprehensive mutational analysis of the ATM gene revealed 1.78% prevalence of mutations in the ATM gene in HBOC and 1.94% in breast cancer-only BRCAX families in Spanish population, where data about ATM mutations were very limited. CONCLUSION: ATM mutation prevalence in Spanish population highlights the importance of considering ATM pathogenic variants linked to breast cancer susceptibility.

Efficacy of bupropion in the treatment of pemoline dependence.

We present the case of a woman who requested psychiatric evaluation because she had been taking pemoline for six months at a dose between 100-150 mg/day, and was finding it difficult to discontinue taking this substance. Initiation of 300 mg/day of bupropion solved the patient's dependence problem. We propose using antidepressants such as bupropion for the treatment of addictive behaviors due to central nervous system stimulants.

[Psychological features and Doppler-Duplex in erectile disfunction]. / Aspectos psicológicos y Doppler-Duplex dinámico en disfunción eréctil.

OBJECTIVES: To establish a relationship between Doppler-Duplex colour ultrasound after prostaglandin intracorporeal injec tion and psychological features in patients suffering from erectile dysfunction. METHODS: Forty two patients with erectile dysfunction were prospectively evaluated with Doppler-Duplex colour ultra sonography after intracavernosal injection of 20 micrograms of E1 prostaglandin. Dynamic vascular pattern were analyzed an penile tumescence were graded in poor, moderate or good (I, II, III). All of them completed the International Index of Erectile Dysfunction, International Exam of Personality Traits (IPDE) and the Symptom Checklist (SCL-90). RESULTS: 29 patients (69.05%) showed a normal ultrasonography response (Peak Systolic Velocity >30 cm/s; Telediastolic velocity negative or less than 5 cm/s and penile tumescence grade III) and were classified as good responders with probably psy chogenic erectile dysfunction. Patients who did not show these values were classified in the group of erectile dysfunction of vas cular origin. We found significative differences between the two groups in sex desire, tumescence and paranoid personality. Th more frequent personality features were paranoid and squizoid (excentric) and ananchastic and anxious (fearful ones). Somatization and obsessive-compulsive symptoms have been outlined over the rest. We have found that paranoid personality is sixteen times more frequent in patients with normal ultrasonography. CONCLUSIONS: Psychological features and dysfunctional personality traits accompany psychogenic and organic erectile dys function, thus it is thought that mixed aetiology coexist in this patients. Doppler-Dupplex Colour ultrasound is an usefu method to exclude organic vascular factors. On de basis of our article, is more common to find psychological discomfort an dysfunctional personality traits in patients with normal ultrasound, which may help in their diagnosis and treatment.

[History of sexual abuse in patients with bulimia nervosa: its influence on clinical status]. / Antecedentes de abusos sexuales en pacientes con bulimia nerviosa: su influencia en el estado clínico.

INTRODUCTION: Studies analyzing the relationship between sexual abuse and bulimia nervosa (BN) have reported discrepant results. This study aimed to assess the role of a history of sexual abuse in the clinical status of a group of patients diagnosed of BN using DSM-IV diagnostic criteria. METHODS: Seventy patients with BN were assessed using specific clinical tools: Eating Attitudes Test-40 items (EAT-40), Bulimia Investigation Test Edinburgh (BITE), Symptom Checklist (SCL-90), Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II), Sixteen Personality Factors Test (16-PF) and a clinical interview for the assessment of past and current substance abuse. The data from the 15 patients with a history of sexual abuse (21.4 % of the sample) were compared with those from the 55 patients without such a history. RESULTS: Both groups were very similar regarding symptom severity. Only the tendency to somatization and higher scores in the factor E of the 16-PF (dominance) were associated with antecedents of sexual abuse in the sample. CONCLUSIONS: The results support the idea that sexual abuse may be related to higher non-specific vulnerability to psychopathology, but do not increase symptom severity in BN patients.

Obesity surgery: evidence-based guidelines of the European Association for Endoscopic Surgery (EAES).

BACKGROUND: The increasing prevalence of morbid obesity together with the development of laparoscopic approaches has led to a steep rise in the number of bariatric operations. These guidelines intend to define the comparative effectiveness and surrounding circumstances of the various types of obesity surgery. METHODS: A consensus panel representing the fields of general/endoscopic surgery, nutrition and epidemiology convened to agree on specific questions in obesity surgery. Databases were systematically searched for clinical trial results in order to produce evidence-based recommendations. Following two days of discussion by the experts and a plenary discussion, the final statements were issued. RECOMMENDATIONS: After the patient's multidisciplinary evaluation, obesity surgery should be considered in adults with a documented BMI greater than or equal to 35 and related comorbidity, or a BMI of at least 40. In addition to standard laboratory testing, chest radiography, electrocardiography, spirometry, and abdominal ultrasonography, the preoperative evaluation of obesity surgery patients also includes upper gastrointestinal endoscopy or radiologic evaluation with a barium meal. Psychiatric consultation and polysomnography can safely be restricted to patients with clinical symptoms on preoperative screening. Adjustable gastric banding (GB), vertical banded gastroplasty (VBG), Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) are all effective in the treatment of morbid obesity, but differ in degree of weight loss and range of complications. The choice of procedure therefore should be tailored to the individual situation. There is evidence that a laparoscopic approach is advantageous for LAGB, VBG, and GB (and probably also for BPD). Antibiotic and antithromboembolic prophylaxis should be used routinely. Patients should be seen 3 to 8 times during the first postoperative year, 1 to 4 times during the second year and once or twice a year thereafter. Outcome assessment after surgery should include weight loss and maintainance, nutritional status, comorbidities and quality-of-life.

[Factors associated with poor response after surgery in morbid obesity]. / Factores asociados a mala respuesta tras cirugía en obesidad mórbida.

The eating behavior, the psychopathological status, and the personality were analyzed in a group of patients with morbid obesity, 18 months after surgery, isolating psychopathological factors associated with a poor response.

Psychopathological differences between morbidly obese binge eaters and non-binge eaters after bariatric surgery.

AIMS: To determine the psychological characteristics of a group of morbidly obese patients with binge eating disorders and to investigate whether the psychopathological status of binge eaters is different from that of other morbidly obese patients. METHODS: We used the Binge Eating Scale, the Three-Factor Eating Questionnaire and the Millon Clinical Multiaxial Inventory-II (MCMI-II) to interview 140 morbidly obese patients 18 months after bariatric surgery (vertical banded gastroplasty), and compared the results obtained in binge eaters (n = 25) and non-binge eaters (n = 115). RESULTS: The binge eaters had more eating disturbances (more binge eating, less restriction, more disinhibition, more hunger) and psychopathological characteristics (passive-aggressive traits, aggressive-sadistic traits, manic disorders, alcohol dependence and major depression) than the non-binge eaters. They were also younger and achieved a lower percentage of weight loss. CONCLUSIONS: After bariatric surgery, our obese binge eaters reported significantly more psychiatric symptoms, especially those relating to eating disorders, depression, alcohol dependence and personality disturbances. Their weight loss was less satisfactory, and they sought bariatric surgery at a younger age.

Immediate vs. delayed imipenem treatment in cancer patients with profound neutropenia induced by high-dose chemotherapy: results of a randomized study.

A study was carried out to compare the use of prophylactic imipenem administered at the onset of profound neutropenia (immediate) with therapeutic imipenem administered at the onset of neutropenic fever (delayed) in cancer patients treated with high-dose chemotherapy. A total of 65 patients who were scheduled to receive two cycles of high-dose cyclophosphamide, etoposide, cisplatin (CEP) chemotherapy were randomized to receive imipenem either at presentation of neutropenia (immediate imipenem arm, prophylactic arm) or at commencement of neutropenic fever (delayed imipenem arm, therapeutic arm). Treatment was crossed over when the second CEP chemotherapy cycle was received. Of the 65 patients, 41 received the two planned cycles and 24 received only the first. Compared with the delayed imipenem arm, the immediate imipenem arm was associated with lower fever incidence (86.3% vs. 100%, p=0.0142) and Gram-negative bacteria infection [4/51 (7.8%) vs. 14/55 (25.5%), OR=0.24, p =0.031]. There were fewer episodes of pneumonia (2% vs. 12.7%), septic shock (0% vs. 3.6%) and deaths from infection (0% vs. 3.6%), but these differences did not reach statistical significance. With regard to delayed imipenem, for every seven patients with immediate imipenem, one episode of febrile neutropenia was avoided; for every six patients administered immediate imipenem, one case of Gram-negative infection was avoided; and for every nine patients administered immediate imipenem, one episode of pneumonia was avoided. There were no differences in the incidence of Gram-positive infections nor in the length of hospitalization between the two treatment arms. In conclusion, compared to its conventional delayed use, immediate imipenem significantly reduces the frequency of febrile neutropenia and Gram-negative infections in patients with high-dose chemotherapy.

[Psychopathology of bulimia nervosa: a multidimensional model]. / Psicopatología de la bulimia nerviosa: un modelo multidimensional1

INTRODUCTION: In recent years, a number of studies have been carried out with the intention of isolating clinical dimensions in the psychopathology of bulimia nervosa. Although borderline personality has been considered a core element of the bulimic psychopathology by most of the authors, it has not been incorporated into any of these models. In this context, the present study was aimed at testing the consistence of the more complex model proposed until now, including in the analysis borderline personality as a clinical variable. SAMPLE AND METHODS: A group of 66 female patients fulfilling DSM-IV criteria for bulimia nervosa were assessed using a set of clinical instruments. The isolated items were processed using factor analysis techniques. RESULTS: Five basic dimensions of bulimia nervosa were obtained: 1. body disatisfaction; 2. restrictive eating behaviors; 3. purging behaviors; 4. emotional instability; and 5. disocial behavior. CONCLUSIONS: Our results support the idea that bulimia nervosa is a multidimensional condition. In our model, the dimension emotional instability incorporated borderline features, which tended to be strongly associated to self-defeating behaviors and depressive symptoms.

Methotrexate, uracil and tegafur, and leucovorin chemotherapy for patients with breast cancer in progression after high-dose chemotherapy with peripheral blood progenitor cell transplant: a phase II study.

Thirty-four patients with metastatic breast cancer (MBC) who had progression of disease after high-dose chemotherapy (HDCT) with peripheral blood progenitor cell support (PBPC) had methotrexate, uracil and tegafur (UFT), and leucovorin (MUL) therapy administered: methotrexate administered intramuscularly in combination with UFT given orally and leucovorin given orally. All patients had received extensive prior chemotherapy including a high-dose regimen with PBPC support. Two complete responses (CR) and 11 partial responses (PR) were observed (objective response rate: 13/34 or 38%, 95% confidence interval 22-56%). Seven additional patients had stable disease (SD), 4 of whom (12% of the total population) of 6 months or longer duration, with the clinical benefit rate (CR + PR + SD of at least 6-month duration) reaching 50%. Median follow-up was 38 months, and the median time to progression and the median overall survival time from the start of MUL were 5.5 and 11 months, respectively. Toxicity was mainly gastrointestinal. Eight patients (24%) had World Health Organization grade II or greater diarrhea and/or enteritis and, consequently, the UFT dose was reduced. Emesis was mild and easily manageable with thiethylperazine given orally. The regimen did not produce significant myelosuppression or alopecia. In conclusion, patients with MBC retain chemosensitivity even when they progress after HDCT/PBPC and can be treated again with chemotherapy. MUL is active and well tolerated in patients with MBC progressing after HDCT. Further studies with this regimen, as salvage chemotherapy or as maintenance chemotherapy after HDCT/PBPC, would appear to be warranted.

SSRI-induced sexual dysfunction: fluoxetine, paroxetine, sertraline, and fluvoxamine in a prospective, multicenter, and descriptive clinical study of 344 patients.

The authors analyzed the incidence of sexual dysfunction (SD) with different selective serotonin reuptake inhibitors (SSRIs; fluoxetine, fluvoxamine, paroxetine, and sertraline) and hence the qualitative and quantitative changes in SD throughout time in a prospective and multicenter study. Outpatients (192 women and 152 men; age = 39.6 +/- 11.4 years) under treatment with SSRIs were interviewed with an SD questionnaire designed for this purpose by the authors and that included questions about the following: decreased libido, delayed orgasm or anorgasmia, delayed ejaculation, inability to ejaculate, impotence, and general sexual satisfaction. Patients with the following criteria were included: normal sexual function before SSRI intake, exclusive treatment with SSRIs or treatment associated with benzodiazepines, previous heterosexual or self-erotic current sexual practices. Excluded were patients with previous sexual dysfunction, association of SSRIs with neuroleptics, recent hormone intake, and significant medical illnesses. There was a significant increase in the incidence of SD when physicians asked the patients direct questions (58%) versus when SD was spontaneously reported (14%). There were some significant differences among different SSRIs: paroxetine provoked more delay of orgasm or ejaculation and more impotence than fluvoxamine, fluoxetine and sertraline (chi 2, p < .05). Only 24.5% of the patients had a good tolerance of their sexual dysfunction. Twelve male patients who suffered from premature ejaculation before the treatment preferred to maintain delayed ejaculation, and their sexual satisfaction, and that of their partners, clearly improved. Sexual dysfunction was positively correlated with dose. Patients experienced substantial improvement in sexual function when the dose was diminished or the drug was withdrawn. Men showed more incidence of sexual dysfunction than women, but women's sexual dysfunction was more intense than men's. In only 5.8% of patients, the dysfunction disappeared completely within 6 months, but 81.4% showed no improvement at all by the end of this period. Twelve of 15 patients experienced total improvement when the treatment was changed to moclobemide (450-600 mg/day), and 3 of 5 patients improved when treatment was changed to amineptine (200 mg/day).

[Sexual dysfunction secondary to SSRIs. A comparative analysis in 308 patients]. / Disfunción sexual secundaria a ISRS. Análisis comparativo en 308 pacientes.

UNLABELLED: The authors analyze the incidence of sexual dysfunction (SD) with different SSRIs (Fluoxetine, Fluvoxamine, Paroxetine and Sertraline) and hence the qualitative and quantitative changes in SD throughout time 308 outpatients (169 women, 139 men; mean +/- SD age = 41 +/- 7) under treatment with SSRIs were interviewed with an SD questionnaire designed for this purpose by the authors including questions about the following items decreased libido, delayed orgasm or anorgasmia, delayed ejaculation inability to ejaculation, impotence and general sexual satisfaction. Patients with the following criteria were included: normal sexual function before SSRIs intake, exclusive treatment with SSRIs or associated with benzodiazepines, previous heterosexual or self-orone current sexual practices. We excluded patients with previous sexual dysfunction, association of SSRIs with neuroleptics, recently hormone intake and significant medical illnesses. RESULTS: There is a significant increase in the incidence of SD when the physicians ask the patients direct questions (55.29%) versus spontaneous SD reported (14.2%). There are some significant differences among different SSRIs paroxetine provoked more delay of orgasm/ejaculation and more impotence than fluvoxamine, fluoxetine and sertraline (Chi square p < 0.05). Only 22.6% of the patients had a good tolerance about their sexual dysfunction. SD has positive correlation with the dose. The patients experienced substantial improvement in sexual function when the dose was diminished or the drug was withdrawn. Men showed more incidence of sexual dysfunction than women but women's sexual dysfunction was more intense than men. Seven of nine patients (77.7%) experienced total improvement when the treatment was changed to Moclobemide (450 mg/day) and two of four patients (50%) improved when treatment was changed to Amineptine.

[Our clinical experience with choanal atresia]. / Nuestra experiencia clínica en la atresia de coanas.

We present a retrospective work of 6 cases with choanal atresia studies between the years 1985-1990 in the ORL service of the Basurto Hospital (Bilbao). It is interesting to remember that this anomaly can be associated with other malformations included in the so called CHARGE Association. Half of our patients present associated anomalies.

Early aspects of human cochlea development and tectorial membrane histogenesis.

Several human embryos and foetuses cochlea from the first half of pregnancy were studied by light, transmission and scanning electron microscopy. Cochlea development in man is the result of three coexisting processes: First, coiling and maturation of the cartilaginous otic capsule. Second, resorption of the periodic mesenchymal reticulum with the appearance of the labyrinthine fluids. Third, differentiation of the sensory epithelium. Tectorial membrane morphogenesis is closely related to the apocrine secretory activity of the greater and lesser epithelial ridges in the 50 mm c.r.l. specimen. In the 70, 110 and 120 mm c.r.l. specimens the secretory activity rests on the interdental cells of the spiral limbus, the undifferentiated cells of Corti's primordium and in the most external cells of the lesser epithelial ridge.

Studies on the Criollo goat of Northern Mexico: Part 1 - The effects of body weight on body components and carcass development.

Male Criollo castrate goats were reared on natural rangeland and also given some concentrate supplementation. They were slaughtered in groups of ten at 8, 12, 16 and 24 kg live weight. At slaughter the weights of body components were recorded and also carcass measurements and joint weights on the chilled left half of each carcass, which was then completely dissected into lean, fat and bone tissues. With increasing slaughter weight the proportion of internal body components minus gut contents, increased relative to the external components. In some of the goats from the higher slaughter weight groups the gut contents formed up to 26% of the total live weight. The dressing percentage based on empty body weight did not show an appreciable increase with increasing slaughter weight. The lean proportion in the carcass rose from 56% of the carcass weight in the 8 kg group to about 68% in the 24 kg group. The proportion of fat in the carcasses did not show any increase with increasing slaughter weight. The results indicate that, in terms of yield of lean meat and also edible offal, it is better not to slaughter castrate male Criollo goats before 24 kg live weight.