[Epilepsy in cancer patients: primary prevention and the importance of high-risk patient screening]. / Epilepsia en el paciente oncológico: prevención primaria e importancia en la selección del paciente de alto riesgo.

INTRODUCTION: Epilepsy in cancer patients has a prevalence of 13%, and is especially high in patients with brain tumours, with a higher morbidity and mortality rate compared to non-tumour-related epilepsy. Its physiopathogenic mechanisms are distinct and include distortion of the cortical architecture and alteration of the glutamate-enhancing tumoural and peritumoural molecular microenvironment. Nevertheless, there is scarce and inconsistent scientific evidence on some fundamental aspects, such as primary post-operative prophylaxis, the ideal pharmacological profile or the withdrawal time of antiseizure drugs after their release. DEVELOPMENT: Characteristics such as low tumour grade, number/size of cortical lesions, location (frontal, cortical/subcortical or eloquent area), early seizures and molecular alterations, such as IDH1/2 mutation, are factors that favour the occurrence of seizures. Within the treatment, surgery will provide cytoreduction and seizure control by excision of the epileptogenic area, with 75-90% freedom from disabling seizures. Although still a controversial issue, the post-operative use of antiseizure drugs is contraindicated by the main scientific societies due to the scarce evidence and the wide spectrum of side effects. However, they are frequently used in daily clinical practice. CONCLUSIONS: All this forces us to establish a group of patients at 'high risk' of postoperative seizures, who will need to select the ideal antiseizure drug for primary prevention, with a route of administration that facilitates a rapid action effect and pharmacokinetics that prevents hepatic metabolism and CYP450 induction to achieve a lower number of interactions with chemotherapy, corticosteroids and radiotherapy. Despite this, drug resistance rates of 20-40% and relapse rates of 25-29% have been reported.

TITLE: Epilepsia en el paciente oncológico: prevención primaria e importancia en la selección del paciente de alto riesgo.Introducción. La epilepsia en el paciente oncológico presenta una prevalencia del 13%, especialmente elevada en pacientes con tumores cerebrales, así como una mayor morbimortalidad respecto de la epilepsia no tumoral. Sus mecanismos fisiopatógenos son diferenciadores, e incluyen la distorsión de la arquitectura cortical y la alteración del microambiente molecular tumoral y peritumoral favorecedor de glutamato. A pesar de ello, existe evidencia científica escasa e inconsistente acerca de aspectos fundamentales, como la profilaxis primaria postoperatoria, el perfil farmacológico idóneo o el tiempo de retirada de fármacos anticrisis tras la libertad de éstas. Desarrollo. Características como el bajo grado tumoral, el número/tamaño de las lesiones corticales, la localización (frontal, cortical/subcortical o área elocuente), las crisis tempranas y las alteraciones moleculares, como mutación IDH1/2, son factores favorecedores para la aparición de crisis. Dentro del tratamiento, la cirugía aportará citorreducción y control de crisis por escisión del área epileptógena, con libertad de crisis incapacitantes del 75-90%. Aunque sigue siendo un tema controvertido, el uso postoperatorio de fármacos anticrisis está contraindicado por las principales sociedades científicas por la escasa evidencia y el amplio espectro de efectos secundarios. Sin embargo, se emplean frecuentemente en la práctica clínica diaria. Conclusiones. Todo ello nos obliga a establecer un grupo de pacientes de 'alto riesgo' de crisis postoperatorias, que precisará seleccionar el fármaco anticrisis idóneo en prevención primaria, con una vía de administración que facilite un rápido efecto de acción y una farmacocinética que evite el metabolismo hepático y la inducción de CYP450 para conseguir un menor número de interacciones con quimioterápicos, corticoides y radioterapia. A pesar de ello, se describen tasas de farmacorresistencia del 20-40% y recidiva del 25-29%.

EMMPRIN is an emerging protein capable of regulating cancer hallmarks.

EMMPRIN, also known as Basigin or CD147, is a transmembrane glycoprotein member of the immunoglobulin superfamily. It is expressed basally in cells that regulate physiological processes of the cardiovascular, nervous, and immune systems. However, EMMPRIN is also capable of interacting with different proteins, like VEGFR, SMAD4, Integrin, MCT, CyPA, GLUT1, CAIV, Annexin II, Cav-1, CAML, etc., and regulating signaling pathways that stimulate the cell processes of proliferation, apoptosis, metabolism, adhesion, invasion, migration, metastasis, tumor immune response, and angiogenesis processes, which favors the development of different types of cancer. EMMPRIN is the first protein reported that favors cancer development due to its ability to interact with extracellular, intracellular, and membrane proteins. In conclusion, EMMPRIN regulates several proteins associated with the development of tumor processes. Therefore, blocking the expression of EMMPRIN can be a therapeutic target, and the analysis of its expression can be used as an important biomarker in cancer.

Use of coumarins as complementary medicine with an integrative approach against cervical cancer: background and mechanisms of action.

Cervical cancer is characterized by the cellular transformation caused by Human Papillomavirus (HPV), favoring cell proliferation, migration, invasion, and metastasis. Cervical cancer is conventionally treated with radiation therapy, and chemotherapy focused on the destruction of tumor cells. However, chemoresistance and low selectivity between tumor and non-tumor cells have been reported, causing side effects in patients. Metabolites of natural origin have shown selectivity against tumor cells, suggesting their use for reducing the side effects caused by drugs used in conventional therapy. Among these compounds, several natural coumarins stand out, such as auraptene, scopoletin, osthole, and praeruptorin, of which antiproliferative, anti-migratory, and anti-invasive activity have been reported. Auraptene, scopoletin, osthole, and praeruptorin show a cytotoxic or antiproliferative effect on cervical tumor cells, arresting the cell cycle by inducing the overexpression of negative regulators of the cell cycle, or inducing cell death by increasing the expression of pro-apoptotic proteins and decreasing that of anti-apoptotic proteins. On the other hand, auraptene, scopoletin, and praeruptorin inhibit the capacity for migration, invasion, and metastasis of cervical tumor cells, mainly by inhibiting the expression and activity of matrix metalloproteinase-2 and -9. The PI3K/Akt signal pathway appears to be central to the anti-tumor activity of the coumarins analyzed in this review. In addition, auraptene, osthole, and praeruptorin are useful in sensitizing tumor cells to radiotherapy or chemotherapeutic molecules, such as FOLFOX, cisplatin, or DOX. Coumarins offer an excellent possibility for developing new drugs as complementary medicine with an integrative approach against cervical cancer.

Manejo perioperatorio de feocromocitoma y paraganglioma / Perioperative management of paragangliomas and pheochromocytomas

Los feocromocitomas y paragangliomas son tumores neuroendocrinos raros, caracterizados por una alta tasa de morbilidad debida a un exceso de niveles de catecolaminas. Este exceso de catecolaminas es independiente de los estresores fisiológicos. Para el diagnóstico de un feocromocitoma-paraganglioma son fundamentales las pruebas bioquímicas. Las más utilizadas son las metanefrinas fraccionadas urinarias o metanefrinas libres plasmáticas. Seguido del diagnóstico bioquímico, debe realizarse un estudio imagenológico. La evaluación del paciente con diagnóstico de feocromocitoma-paraganglioma debe realizarse teniendo presente sus principales causas de morbimortalidad perioperatoria. Las dos grandes intervenciones que han disminuido la mortalidad perioperatoria son la introducción del α bloqueo y la restauración de la volemia. El otro gran avance ha sido la introducción de la cirugía laparoscópica como el estándar de oro para el abordaje quirúrgico. En relación con el manejo intraoperatorio, no se ha identificado que alguna técnica anestésica sea superior a otra. Sí se ha logrado establecer criterios de inestabilidad hemodinámica que se correlacionan con mayor morbilidad, por lo que los principales objetivos intraoperatorios son mantener estabilidad hemodinámica. El avance en el manejo preoperatorio e intraoperatorio con la consecuente disminución en la mortalidad relacionada a esta patología ha llevado el foco al manejo postoperatorio tanto agudo como a largo plazo. También se debe considerar el riesgo de recurrencia tumoral, por lo que estos pacientes deben tener un control anual de por vida.

Pheochromocytomas and paragangliomas are rare neuroendocrine tumors, characterized by a high morbidity rate due to catecholamine excess. These high levels are independent of physiologic stressors. For the diagnosis, a biochemical workup is paramount. The most widely used are plasma-free metanephrines and urinary fractionated metanephrines. Imaging studies should be initiated once the biochemical diagnosis is established. Evaluation of the patient with pheochromocytomas and paragangliomas must be done taking into account the leading causes of perioperative morbidity and mortality. The two primary interventions that have reduced perioperative mortality are alpha-adrenergic blockade and intravascular volume normalization. Another significant advance has been the establishment of laparoscopic surgery as the gold standard for the surgical approach. No anesthetic technique has been found to be superior to another. Intraoperative hemodynamic instability has been correlated with poorer outcomes; thus one of the main intraoperative goals is maintaining hemodynamic stability. Lower morbidity and almost zero mortality rates due to preoperative and intraoperative management improvements have led to a focus on the immediate and long-term postoperative care. Anual lifelong follow-up is recommended to detect recurrent disease.

Obstrucción intestinal por hernia obturatriz: serie de casos / Intestinal obstruction caused by obturator hernia: case series

OBJETIVO: Se presentan 3 casos de obstrucción intestinal por hernia obturatriz atascada, su manejo y una breve revisión de la literatura. MATERIALES Y MÉTODOSles y Métodos: Discusión del cuadro clínico, imágenes y manejo. Todos los casos fueron operados dentro del mismo día del diagnóstico y se confirmó la presencia de hernia obturatriz. El manejo de la hernia y su contenido fue ajustado a la situación de cada paciente. RESULTADOS: Los tres casos de hernia obturatriz aquí discutidos tienen la presentación clásica del cuadro, cuando se los revisa en forma retrospectiva y con imagenología compatible. Los tres pacientes evolucionaron en forma satisfactoria con alta precoz y control posoperatorio sin incidentes. Discusión: Nuestros 3 casos se condicen tanto en hallazgos clínicos, imagenológicos y en manejo con lo descrito en la literatura internacional. CONCLUSIÓN: La hernia del agujero obturatriz siendo infrecuente, se presenta en un tipo particular de pacientes y con sintomatología clásica. La tomografía axial computada es de gran ayuda y suele hacer el diagnóstico preciso en el preoperatorio. Es importante recordar este diagnóstico diferencial al momento de estudiar pacientes con obstrucción intestinal.

OBJECTIVE: 3 cases of intestinal obstruction that resulted in diagnosis of obturator hernia, their management and a brief international literature review are presented. MATERIAL AND METHODS: Discussion of the presentation, images, and management. In all cases surgery was performed the same day from the diagnosis of intestinal obstruction and confirmation of obturator hernia. The management of the hernia and it's content was adjusted to each patient's situation. RESULTS: Our 3 patients, when reviewed retrospectively, had the classic presentations and images of obturator hernia. All of them had a favourable evolution with an early discharge and no complications on follow up. DISCUSSION: Our 3 cases had clinical presentations and imaging studies that correlated well with international literature. CONCLUSION: Obturator hernia is an infrequent pathology, but appears in a particular type of patient and with classic presentation. Axial computed tomography is an important tool and usually makes the diagnosis previously to surgical exploration. It is important to consider this diagnosis when being faced with patients with intestinal obstruction.

Pioderma gangrenoso post-quirúrgico: reporte de un caso en paciente con fibrosis retroperitoneal / Postoperative pyoderma gangrenosum: a case report of a patient with retroperitoneal fibrosis

El pioderma gangrenoso (PG), es una patología ulcerativa infrecuente de etiología desconocida, asociado ocasionalmente a enfermedades autoinmunes. Es una condición crónica, de curso clínico impredecible y puede ser invalidante. Al ser complejo su diagnóstico, el retraso del mismo puede ocasionar al paciente morbilidades añadidas, como: tratamientos incorrectos y períodos de hospitalizaciones prolongados. Se presenta el caso de un paciente de 52 años, sin antecedentes mórbidos, que ingresa a Urgencias en el Hospital el Pino, por dolor abdominal recurrente. Durante el estudio de imágenes se evidencia una masa retroperitoneal, asociada a hidro-uretero-nefrosis izquierda. Ingresa al Servicio de Cirugía para estudio, realizándose una laparotomía media exploratoria y toma de muestras para biopsia. Procedimiento realizado sin incidentes. El paciente pese a múltiples tratamientos otorgados en esa unidad, evoluciona con dehiscencia de suturas recurrentes por tres meses. Evaluado por Dermatología se inicia estudio y se diagnostica PG, teniendo una excelente respuesta al tratamiento indicado.

Gangrenous pioderma (PG) is an uncommon ulcerative pathology of unknown etiology associated with autoimmune diseases. It is a non-predictable chronic condition, that can be incapacitating and patients that suffer this disease can also present systemic compromise. As it is a diagnosed by exclusion it may lead to long periods of failed treatments. The present work deals with a case of a 52-year-old male patient with no prior record of disease, who was admitted to the ER of El Pino Hospital suffering from recurrent abdominal pain. During the imaging study a retroperitoneal mass was found, associated with a left hydro-uretero-nephrosis. He was admitted and a exploratory mid-laparotomy was performed and samples were taken for biopsy. The procedure was successful and the established protocol was followed. However, during the recovery period the patient developed repeated surgical wound dehiscences of the surgical wounds. An internal consultation with the Dermatology Service took place, and the diagnosis of PG was made; proper pharmaceutical treatment was provided attaining excellent results.

Dermatosis intertriginosa crónica de aparición tardía: pénfigo de Hailey-Hailey / Chronic late-onset intertriginous dermatitis: Hailey-Hailey's pemphigus

El pénfigo familiar benigno o enfermedad de Hailey Hailey, es una genodermatosis vesico-ampollar autosómica dominante, con penetrancia incompleta y expresividad variable de presentación infrecuente. Se presenta el caso de un paciente con un cuadro de cinco años de evolución, caracterizado por lesiones vesiculares intertriginosas, de olor desagradable, con mala respuesta al tratamiento tópico con antifúngicos y corticoides. Se realiza biopsia de piel compatible con pénfigo de Hailey Hailey, el que fue manejado con antibióticoterapia y corticoides sistémicos, evolucionando favorablemente.

The benign familial pemphigus or Hailey Hailey´s disease is a rare autosomal dominant disorder. We present the clinical case of a patient with a five years history, characterized by vesicular intertriginous malodorous lesions with poor response to topical antifungal therapy. Skin biopsy it was compatible with Hailey Hailey´s disease which was managed with antibiotic therapy and systemic corticosteroids. The patient evolved favorably.

Molecular characterization of infectious bursal disease virus (IBDV) isolated in Argentina indicates a regional lineage.

In Argentina, classical vaccines are used to control infectious bursal disease virus (IBDV); however, outbreaks of IBDV are frequently observed. This could be due to failures in the vaccination programs or to the emergence of new strains, which would be able to break through the protection given by vaccines. Hence, genetic characterization of the viruses responsible for the outbreaks that occurred in recent years is crucial for the evaluation of the control programs and the understanding of the epidemiology and evolution of IBDV. In this study, we characterized 51 field samples collected in Argentina (previously identified as IBDV positive) through the analysis of previously identified apomorphic sequences. Phylogenetic analysis of regVP2 showed that 42 samples formed a unique cluster (Argentinean lineage), seven samples were typical classical strains (one of them was a vaccine strain), and two belonged to the very virulent lineage (vvIBDV). Interestingly, when the analysis was performed on the regVP1 sequences, the field samples segregated similarly to regVP2; thus, we observed no evidence of a reassortment event in the Argentinean samples. Amino acid sequence analysis of regVP2 showed a particular pattern of residues in the Argentinean lineage, particularly the presence of T272, P289 and F296, which had not been reported before as signature sequences for any IBDV phenotype. Notably, the residue S254, characteristic of the antigenic variant, was not present in any of the Argentinean samples.

Prevalencia de metástasis ósea, detección por gammagrafía y frecuencia de cáncer de origen primario / Prevalence of bone metastases detected by scintigraphy and frequency of cancer of primary origin

Objetivos: determinar la prevalencia de metástasis óseas, evaluando la predominancia respecto al género, grupo etáreo, e identificar la frecuencia de los tipos de cáncer primario. Métodos: la presente investigación es de tipo, descriptiva, retrospectiva, transversal que considero una muestra de 1593 estudios de gammagrafías óseas realizados con MDP 99mTc en el Centro de Medicina Nuclear Cochabamba durante el periodo 2009 al 2013. Resultados: la prevalencia de metástasis ósea obtenida fue de 24,7%, siendo el género masculino (65%) el grupo más afectado respecto al femenino (35%). El grupo etáreo con mayor número de casos fue el de 61-70 años. Con relación al cáncer de origen primario se obtuvieron los siguientes datos: próstata (59,3%); mama (26,2%), pulmón (4,6%), cáncer cérvicouterino (1,7%), mieloma múltiple (1,7%); sarcoma (1,4%); riñón (1,1%), colon (0,9%) y otros (3,1%). Conclusiones: se obtuvo una prevalencia de metástasis óseas en la cuarta parte de la población, donde el género masculino fue más afectado. El grupo etáreo con mayor cantidad de neoplasias estuvo en la población adulta a partir de los 61 años. Finalmente en nuestro estudio el cáncer de origen primario con mayor frecuencia fue el de próstata, seguido de mama y pulmón respecto a otros.

Objectives: to determine the prevalence of bone metastases, assessing the predominance respect to gender, age group, and to identify the frequency of primary cancers. Methods: this research type is descriptive, retrospective; I consider a cross-sample of 1593 studies performed bone scans with 99mTc MDP in the Nuclear Medicine Center Cochabamba during the period 2009 to 2013. Results: the prevalence of bone metastases obtained was 24.7%, male gender (65%) being the most affected compared to women (35%) group. The age group with the highest number of cases was 61-70 years. Relative to the source primary cancer the following data were obtained: prostate (59.3%); breast (26.2%), lung (4.6%), cervical cancer (1.7%), myeloma multiple (1.7%); sarcoma (1.4%); kidney (1.1%), colon (0.9%) and others (3.1%). Conclusions: the prevalence of bone metastases in a quarter of the population, where the male was most affected was obtained. The age group with the highest number of tumors were in the adult population aged 61 years. Finally, in our study the primary origin of cancer was most frequent prostate, breast and lung followed over others.

HLA antigenic and haplotype frequencies estimated in hematopoietic progenitor cell donors from Argentina.

BACKGROUND: Hematopoietic progenitor cell transplantation is considered a standard-of-care treatment for defined hematological and non-hematological conditions affecting bone marrow-derived cells. METHODS: Patients and potential donors are HLA typed for their HLA-A, -B, -C, -DRB1, and -DQB1 alleles. The best allogeneic donor is one for which each allele matches the patient at HLA-A, -B, -C, and -DRB1 (8/8). For patients with no related donor, the transplant physician will start a search for unrelated donors. The search is performed through a local registry and often includes the search for donors worldwide. The Argentinean HPC Donors Registry was established in 2003. Our National HPC Donor Registry has already typed more than 31,000 donors for HLA-A, -B, and -DR. RESULTS: We present the analysis of HLA frequencies and haplotypes estimates for the subset of our donor database that is additionally typed for HLA-C. We analyzed HLA data from 2657 donors. Antigen and haplotype frequencies were estimated through the use of expectation maximization. CONCLUSIONS: Our analysis showed for the first time the antigenic HLA frequency distribution from HPC donors in Argentina. Knowing haplotype frequencies in our population will help us to select potential donors for high-resolution typing for the patients.

Aplicación de grupos clínicos ajustados como herramienta de ajuste de riesgo: evaluación en la distribución de recursos en programa de enfermedades crónicas / Adjusted Clinical Groups as a risk assessment model for healthcare resource allocation

Background: There is increasing interest in the study and improvement of health system resource allocation. The Adjusted Clinical Groups (ACG) System measures the morbidity burden of patient populations based on disease patterns, age and gender. This system can be used in primary health care settings. Aim: To report the use of the ACG system as a risk based patient classification system and its potential as a resource allocation mechanism in primary health care. Material and Methods: Patient diagnoses from a sample of primary care establishments were processed using the Johns Hopkins ACG System. Linear regressions were used to measure the ACG System's ability to explain resource use and ambulatory visit rates. Results: The ACG System had a statistically significant capacity to explain primary health care costs with an adjusted R² of 0.26. These results are significantly better, compared with risk assessment models based on patients' age and sex, whose adjusted R² is 0.05. Conclusions: The use of risk adjustment mechanisms will contribute to improve health care resource allocation as well to know the disease profile of the population.

Evaluación de bioaerosoles en ambientes de centros de salud de la ciudad de Valencia, Venezuela / Evaluation of bioaerosoles in health center environments in the city of Valencia, Venezuela

Los establecimientos de atención en salud son entornos donde se congregan pacientes que en menor o mayor grado presentan compromisos inmunológicos. En este contexto, el ambiente hospitalario resulta un espacio donde podrían adquirir infecciones nosocomiales con el consiguiente deterioro del cuadro clínico preexistente. En el presente estudio se realizaron evaluaciones en ambientes hospitalarios de centros de salud ubicados en la ciudad de Valencia, Venezuela, tomando en cuenta áreas críticas como quirófanos. Para la captación de las muestras se tomó en cuenta las metodologías establecidas en las Normas Técnicas Españolas. La captación del aire sobre los medios de cultivo Nutritivoy Sabouraud se incubaron a 37°C de 24-72 horas, para determinar UFC/m3 de aire. Conjuntamente se midió la temperatura y humedad relativa. La identificación microbiológica se realizó utilizando galerias bioquímicas automatizadas (API). De los 6 centros hospitalarios evaluados, 5 quirófanos presentaron más de 10 UFC/m3 de aerobios mesófilos y más de 20 UFC/m3 de población fúngica, cuyo rango debería ser menor a 10UFC/m3. Los microorganismos identificados con mayor frecuencia fueron: Staphylococcus spp, Pseudomonas aeruginosa, Bacillus spp., Acinetobacter lowfii, Aspergillus nidulans, A. terreus y Geotrichum candidum. Las medidas de temperatura fueron mayores a 20°C y la humedad relativa mayor a 45%, siendo el rango establecido por la NTP 409 para la temperatura entre 15-18°C, y 50-70% en cuanto a la humedad relativa. Se infiere que existe poco compromiso en aplicar las medidas correctas para cumplir a cabalidad con las normas de manipulación de pacientes en áreas críticas, lo que propicia un entorno favorable para el desarrollo microbiano, además de factores como temperatura, humedad relativa, sistemas de climatización, que no cumplen con lo indicado según las normas técnicas Internacionales

Health center facilities are areas where patients who have a greater or lesser degree of immunological compromise congregate. In this context, the hospital environment is a space where nosocomial diseases could be acquired causing deterioration of the preexistent clinical condition. This study carried out evaluations in hospital environments at health centers in the city of Valencia, Venezuela, taking into account critical areas such as operating theatres. For sample collection, methodologies established by the Spanish Technical Standards were taken into account. The air samples taken over Nutritivo and Sabouraud cultivation media were incubated at 37°C for 24-72 hours, to determine the UFC/m3 for the air. Following a 24-hour incubation at 37°C, the bacterial charges (UFC/m3) were determined. Additionally, temperature and relative humidity were measured. Taxonomical identification was achieved through a computerized biochemical test (API galleries). Five out of the six health centers evidenced more than 10UFC/m3 and 20 UFC/m3 for the bacterial and fungal charges, respectively. These values are higher than those allowed by official legislation. The most frequently detected microorganisms were Staphylococcus spp, Pseudomonas aeruginosa, Bacillus spp., Acinetobacter lowfii, Aspergillus nidulans, A. terreus and Geotrichum candidum. The temperature and relative humidity were always higher than 20°C and 45%, whereas ranges established by the NTP 409 norm are 15-18ºC and 50-70%, respectively. It seems there is little commitment to applying correct measures to comply fully with standards for patient handling in critical areas, favoring an environment conducive to microbial development, as well as factors such as temperature, relative humidity and air conditioning systems, which do not comply with what is indicated in international technical standards

[Calcific uremic arteriolopathy. a case report and review of the literature]. / Arteriolopatía cálcica urémica: comunicación de un caso y revisión de la literatura.

BACKGROUND: Calcific uremic arteriolopathy is defined as a syndrome consisting of ischemic skin ulceration due to calcification of the wall of the arterioles of the subcutaneous tissue as a result of hyperparathyroidism in uremic patients. CASE REPORT: A 55-year old female patient, hypertense, with heart failure and kidney failure treated with hemodialysis, who presented lower limb pain and hypercalcemia. On physical examination, skin lesions with symmetrical peripheral pulses present in the limbs. Laboratory tests revealed hypercalcemia, hyperphosphatemia, and very high parathyroid hormone levels. Parathyroidectomy was performed and biopsy of skin lesions, the patient having a torpid course causing exitus. Autopsy was performed, with histologic features characteristic of calcific uremic arteriolopathy. CONCLUSIONS: Calcific calcium uremic arteriolopathy or calciphylaxis is a complex and variable disease that is difficult to diagnose and whose treatment is complicated. Despite the efforts of the investigators, there are still many questions regarding its pathogenesis. This acts as an incentive for further research to establish the most appropriate actions to take to maintain an adequate quality of life for the patients and avoid complications that trigger death in some cases.

Analytical methodologies for the determination of cisplatin.

cis-Diamminedichloroplatinum(II) (cisplatin) is a important chemotherapeutic drug for cancer treatment since 1978. Unfortunately, because of the severe side-effects like nephrotoxicity, ototoxicity, etc., they are administered in small doses at low concentration establishing the maximum limit dosage to 100 mg/m(2) (21 days). A variety of analytical methods have been proposed for the determination of cisplatin in biological fluids and tissues that permit the accurate determination at or below the part per billion level in the native sample. The purpose of the current review is to provide a systematic survey of the latest analytical techniques for the determination of cisplatin in biological samples.

Recent advances in analytical determination of thalidomide and its metabolites.

Thalidomide, a racemate, is coming into clinical use as immuno-modulating and anti-inflammatory drug. Thalidomide was approved by the FDA in July 1998 for the treatment of erythema nodusum leprosum associated with leprosy. Recently, thalidomide is proving to be a promising drug in the treatment of a number of cancers and inflammatory diseases, such as multiple myeloma, inflammatory bowel disease (Crohn's disease), HIV and cancer associated cachexia. These effects may chiefly be exerted by S-thalidomide, but the enantiomers are inter-converted in vivo. Thalidomide is given orally, although parenteral administration would be desirable in some clinical situations. Thalidomide has been determined in formulations and, principally in biological fluids by a variety of methods such as high-performance liquid chromatography with ultraviolet detection and liquid chromatography coupled with tandem mass spectrometry. The overview includes the most relevant analytical methodologies used in its determination.

Imiquimod en crema al 5% en el tratamiento de verrugas anogenitales asociadas a VPH: experiencia preliminar / Imiquimod 5% cream in the treatment of anogenital warts HPV associated

Antecedentes: La infección persistente por VPH de alto riesgo se asocia con cáncer cervicouterino, encontrándosepositividad en el 99,7% de los casos. Las verrugas anogenitales son una forma de presentación de la infección persistente. Objetivo: Investigar la eficacia y seguridad de imiquimod en crema al 5%, en el tratamiento de las verrugas anogenitales en mujeres. Método: Estudio prospectivo no randomizado, en mujeres portadoras de verrugas anogenitales asociadas a VPH. El tratamiento consiste en la autoaplicación de imiquiomod en crema al 5% tres veces a la semana por hasta un período de 16 semanas. Se define como respuesta completa al tratamiento aquella en que desaparece completamente la lesión; por respuesta parcial la disminución de al menos un 50% del volumen inicial de la lesión. Resultados: Durante un período de 8 meses fueron ingresadas y tratadas 38 pacientes La duración del tratamiento varió entre 1 y 4 meses. El número promedio de aplicaciones fue de 28,7. El 66% (25 casos) de las pacientes presentaron una respuesta completa, en tres casos no hubo respuesta, uno de ellos en una paciente inmunodeprimida, en 10 casos hubo respuestas parciales. En las pacientes con respuestas completas se necesitó un promedio de 28,7 aplicaciones hasta obtener el resultado. Conclusiones: Imiquimod es un fármaco con buena efectividad y seguridad en el tratamiento de las verrugas anogenitales asociadas a VPH, en tratamiento de tres veces por semana durante mínimo de 10 semanas.

Background: The chronic infection by high-risk HPV serotypes is strongly associated with cervical cancer, detection of HPV on tissue sample has been reported 99.7% of cases. The anal-genital warts represent the clinical manifestation of the persistent infection by this virus. Objectives: To investigate the efficacy and safety of Imiquimod cream 5% concentration, in the treatment of anal-genital warts in women. Methods: A non-randomized prospective study in women diagnosed with anal-genital warts HPV associated. The treatment consists in self-application of imiquimod cream 5%, three times a week for a period of 16 weeks or more. We define complete response to treatment in those patients where the lesion disappeared completely, and partial response to those where the lesion declined at least 50% of its initial volume. Results: Over a period of 8 months were admitted to the study and treated a total of 38 patients. Treatment duration varied between 1 and 4 months. The average number of applications was 28.7 times. 66% (25 cases) of the patients had a complete response, in three cases there was no response, one of them was an immunodepressed patients, in 10 cases there was partial response. The patients with complete response needed an average of 28.7 applications to get that result. Conclusions: Imiquimod is a drug with high effectiveness and safety in the treatment of anal-genital warts HPV associated, in a three times per week and at least 10 weeks total duration treatment.

Lesiones preinvasoras de cuello uterino: una visión actual / Preinvasive injuries of uterine cervix: a current view

En Chile se producen anualmente alrededor de 1200 nuevos casos de cáncer cérvico-uterino y 677 muertes por año (tasa de mortalidad: 8,4/100.000 mujeres). La relación entre el virus papiloma humano de alto riesgo y este cáncer, es la más fuerte e importante de la epidemiología mundial. Se analiza en detalle el rol del virus papiloma en la carcinogénesis cervical y el rol de la tipificación viral en el estudio y manejo de la citología alterada, tanto en la literatura internacional como su aplicación en el modelo chileno.