The predictive role of interim PET after the first chemotherapy cycle and sequential evaluation of response to ABVD in Hodgkin's lymphoma patients-the Polish Lymphoma Research Group (PLRG) Observational Study.

BACKGROUND: Interim PET after two ABVD cycles (iPET2) predicts treatment outcome in classical Hodgkin's lymphoma. To test whether an earlier assessment of chemosensitivity would improve the prediction accuracy, we launched a prospective, multicenter observational study aimed at assessing the predictive value of iPET after one ABVD (iPET1) and the kinetics of response assessed by sequential PET scanning. PATIENTS AND METHODS: Consecutive patients with newly diagnosed classical Hodgkin's lymphoma underwent interim PET scan after one ABVD course (iPET1). PETs were interpreted according to the Deauville score (DS) as negative (-) (DS 1-3) and positive (+) (DS 4, 5). Patients with iPET1 DS 3-5 underwent iPET2. RESULTS: About 106 early (I-IIA) and 204 advanced (IIB-IV) patients were enrolled between January 2008 and October 2014. iPET1 was (-) in 87/106 (82%) or (+) in 19/106 (18%) of early, and (-) in 133/204 (65%) or (+) in 71/204 (35%) of advanced stage patients, respectively. Twenty-four patients were excluded from response analysis due to treatment escalation. After a median follow-up of 38.2 (3.2-90.2) months, 9/102 (9%) early and 43/184 (23%) advanced patients experienced a progression-free survival event. At 36 months, negative and positive predictive value for iPET1 were 94% and 41% (early) and 84% and 43% (advanced), respectively. The kinetics of PET response was assessed in 198 patients with both iPETs. All 116 patients with iPET1(-) remained iPET2(-) (fast responders), 41/82 with IPET1(+) became iPET2(-) (slow responders), and the remaining 41 stayed iPET2(+) (non-responders); progression-free survival at 36 months for fast, slow and non-responders was 0.88, 0.79 and 0.34, respectively. CONCLUSION: The optimal tool to predict ABVD outcome in HL remains iPET2 because it distinguishes responders, whatever their time to response, from non-responders. However, iPET1 identified fast responders with the best outcome and might guide early treatment de-escalation in both early and advanced-stage HL.

Oral alendronate induces progressive increases in bone mass of the spine, hip, and total body over 3 years in postmenopausal women with osteoporosis.

To determine the effects of long-term daily oral alendronate sodium (ALN) on bone mass in postmenopausal women with osteoporosis, 19 centers enrolled 516 postmenopausal women aged 45-80 years with spine bone mineral density (BMD) at least 2.5 SD below the mean for young premenopausal women in a 3-year, double-blind, placebo-controlled study. Subjects were randomly allocated to one of four treatment groups: placebo; alendronate, 5 or 10 mg/day for 3 years; or alendronate, 20 mg/day for 2 years followed by 5 mg/day for the 3rd year. All patients received 500 mg/day of supplemental calcium to ensure adequate calcium intake. BMD was measured by dual-energy X-ray absorptiometry at several skeletal sites. Nonsignificant mean decreases in BMD of the spine, femoral neck, and trochanter of 0.6, 0.7, and 0.4%, respectively, occurred in the placebo group at 3 years. Relative to placebo-treated patients, spine BMD increased by 5.4%, 7.4%, and 8.4% in the 5, 10, and 20/5 mg ALN groups, respectively. Increases at the femoral neck were 3.5%, 5.5%, and 4.3%, and those at the trochanter were 5.1%, 7.2%, and 7.2%, respectively. Thus, efficacy of 10 and 20/5 mg ALN was similar, whereas the 5 mg dose was less effective. BMD continued to increase over the entire 3-year study duration in the ALN-treated groups and, compared with the other dosage groups, 10 mg ALN produced the largest gains in BMD during the 3rd year. Changes in biochemical markers of bone turnover and mineral homeostasis confirmed the effect of ALN to decrease bone turnover to a new steady-state level. The safety and tolerability of ALN were comparable with those of placebo. In summary, 10 mg daily oral ALN given for 3 years significantly and progressively increases bone mass and is a generally well-tolerated treatment for osteoporosis in postmenopausal women.

Effectiveness of etodolac ('Lodine') compared with naproxen in patients with acute gout.

A double-blind, parallel group study was carried out in 61 patients suffering from acute gouty arthritis to compare the effectiveness of etodolac and naproxen in the relief of symptoms. Patients were allocated at random to receive either 300 mg etodolac twice daily (31 patients) or 500 mg naproxen twice daily (30 patients) for 7 days. Both groups were comparable for sex, age and weight of patients, but there was a tendency for patients in the etodolac group to have more severe gout as shown by baseline clinical assessment scores. The variables assessed on entry and on Days 2, 4 and 7 of treatment were pain intensity, swelling, tenderness, erythema, joint heat, range of motion, and physician's and patients' overall evaluation of the condition. The results showed that there was a significant improvement from baseline in all of the variables at each time point in both treatment groups. However, more etodolac-treated patients (81%) than naproxen-treated patients (53%) showed overall improvement at Day 2, and etodolac was significantly better than naproxen on the Day 2 evaluation of joint swelling and at the Day 4 evaluations of joint tenderness, range of motion and the physician's global assessment. At the final evaluation on Day 7, 97% of the etodolac group reported that their condition had improved as compared to 93% of the naproxen group. Both drugs were well tolerated and only a few mild side-effects were reported.

Artritis reumatoidea y aterosclerosis / Atherosclerosis and rheumatoid arthritis

Objetivo: Evaluar la influencia de los factores de riesgo cardiovascular tradicionales para el desarrollo de aterosclerosis subclinica en pacientes con artritis reumatoidea y la correlacion de los mismos con la ingesta de corticoides, actividad de la enfermedad y daño radiologico. Material y metodos: se evaluaron 137 pacientes con artritis reumatoidea clasica, segun criterios de ACR 1987. Los pacientes tenian edad media 52 años, 11 varones, 126 mujeres. Fueron divididos en 2 grupos segun fueran tratados o no con meprednisona (2 a 8 mg/dia). No se observaron diferencias en cuanto a los factores de riesgo en pacientes con AR activa e inactiva, independientemente del tratamiento con corticoides. Se encontraron niveles de colesterol LDL aumentados en 50 por ciento de los pacientes y HDL bajo en menos del 10 por ciento. Conclusion: Deben encontrarse otros factores que causen aterosclerosis subclinica, reconocer el rol de la inflamacion sistemica y buscar el mejor camino terapeutico para proteger la vasculatura

Hemorragia alveolar difusa en lupus eritematoso sistématico.Una entidad poco frecuente. Reporte de un caso y revisión de la literatura / Diffuse alveolar hemorrhage in systemic lupus erithematosus. An infrequent disorder

Diffuse alveolar hemorrhage (DAH) is a catastrophic and usually fatal complication in Systemic Lupus Erythematosus (SLE), it is not so frecuent,<2 por ciento. It was first described by Osler in 1904. The reported mortallity is 70-90 por ciento, though recent works indicate an improvement in survival. 57 well documented DAH cases complicating SLE were reported in the English literature up to now

Paquidermoperiostosis o Osteoastropatia hipertrofica primaria / Pachydermoperiostosis or osteoarthropathy hypertrophic primary

Se presenta el caso de un paciente con Paquidermoperiostosis y Osteoartropatia hipertrofica primaria, de 65 años, sexo masculino. Clubbing digital desde la pubertad, grasitud facial, no fumador y sin compromiso sistemico, con franca disociacion clinico radiologica. Radiologia: periostitis generalizada (falanges, radio, cubito, tibia, peron), engrosamiento de hueso cortical e irregularidades endusticas

Artritis psoriasica. Correlacion clinica inmunologica e inmunogenetica. / Psoriatis arthritis. Clinic immunologic and immunogenetic correlation

Fueron estudiados veinte pacientes portadores de A.P. en su correlacion clinica, inmunologica e inmunogenetica. En el primer aspecto nuestros resultados pusieron evidencia que la manifestacion cutanea se antecipo a la articular en todos los casos excepto en uno. En pacientes con gran compromiso reumatologico, como en las espondilitis, existia afectacion cutanea de mas del 50%. En el aspecto inmunologico las gammaglobulinas estuvieron elevadas o dentro de valores que en ningun caso descendieron del termino medio normal. Hubo aumento de las IgA y en menor grado de las IgG. Existio correlacion significativa entre aumento de IgA y superficie cutanea afectada.En lo inmunogenetico nuestros resultados coincidieran solo parcialmente con los hallazgos de autores extranjeros. Encontramos altas frecuencias relativas de los antigenos A2, A10, Bw35 y B27. En las espondilitis los resultados concuerdan con los datos de la bibliografia en la presencia del HLA B27

Tomografía computada de alta resolución de pulmón y test funcionales pulmonares en pacientes con artritis reumatoidea con y sin metotrexato / High resolution computed tomography of lung pulmonary function tests in patients with Rheumatoid Arthritis with and without methotrexate

En la Artritis Reumatoidea (AR) el pulmón es un órgano blanco que puede estar comprendido por la enfermedad per se o por la acción de drogas. Objetivo:Valorar la radiografía planimétrica de tórax. Tests Funcionales Pulmonares (TFP), y Tomografía Computada de Alta Resolución (TCAR) en pacientes con AR con y sin MTX.Material y método:21 pacientes AR, (ACR 1987), no fumadores,12 recibían MTX (Grupo A), 9 sin MTX (Grupo B). Se efectuó:semiología articular y pulmonar,Rx planimétrica de tórax, TFP incluyendo DLCO, y TCAR.Resultados:Radiología:patológicas:A: 2/12 ( 17 por ciento ) patrón intersticial 1, Hiperaereación 1. Grupo B: 1/9 (11 por ciento) ,patrón intersticial.TFP: 2/12 (17 por ciento),patrón obstructivo.DLCO fue normal en todos los pacientes.TCAR:Engrosamiento septales interlobulares: A:5/12 (42 por ciento P<0,005). B:0/9, Bandas parenquimatosas: A:2/12 (17 por ciento, B:0/9;Bullas A:2/12( 17 por ciento),B: 1/9 (11 por ciento);Enfisema centrolobular A: 2/12 (17 por ciento),B: 1/9 (11 por ciento);Vidrio esmerilado A: 3/12 (25 por ciento), B:1/9 (11 por ciento);Engrosamiento peribroncovascular A: 5/12 (42 por ciento), B:1/9 (11 por ciento);Bronquiectasias A:A: 1/12 (8 por ciento), B:2/9 (22 por ciento)Engrosamientos subpleurales A:1/12(8 por ciento),B: 1/9 (11 por ciento).Hubo mayor frecuencia de alteraciones en el grupo que recibía MTX.Conclusión: En nuestra experiencia los TFP