COMPARISON OF THREE STRATEGIES OF GVHD PROPHYLAXIS AFTER T-CELL REPLETE HAPLOIDENTICAL HEMATOPOIETIC TRANSPLANTATION: TACROLIMUS vs. CALCINEURIN INHIBITORS-MMF vs. SIROLIMUS-MMF.

Since the introduction of post-transplant cyclophosphamide (PTCy), haploidentical HSCT (HaploSCT) has become a real alternative for patients who lack other eligible donors. The standard GvHD prophylaxis after PTCy has been a calcineurin inhibitor plus MMF (up to day+35), but promising results with sirolimus (+/- MMF) and single-agent tacrolimus have been recently published. The current multicenter retrospective study compared the outcomes of 372 adult HaploSCT recipients who received TBF conditioning; PTCY and additional GVHD prophylaxis with one of three strategies, cohort-A: single-agent tacrolimus (N 222), cohort-B: CNI-MMF (N 49) and cohort-C: sirolimus-MMF (N 101). No differences in terms of grade II-IV (20%, 25%, and 30%) and III-IV (9%, 6%, and 15%) aGvHD at 100 days were found. However, cohort A had the lowest incidence of overall cGvHD [24%, 47%, and 52%, respectively (p 0.001)] and moderate-severe cGvHD [13%, 35%, and 33%, respectively (p 0.001)]. There were no differences in the 3-year overall survival, progression-free survival, NRM nor relapse among the cohorts. In conclusion, our study suggests that single-agent tacrolimus, CNI+MMF and sirolimus+MMF GvHD prophylaxis lead to similar outcomes following HaploSCT with TBF and PTCy, with low incidence of grade III-IV aGvHD, albeit possible differences in cGVHD require further investigation.

Protocol description and initial experience in kidney graft perfusion using infrared thermography.

PURPOSE: Protocol description for renal perfusion study using thermographic technology and description of the thermographic and clinical behavior of the transplanted kidneys before and after unclamping. METHODS: Infrared thermographic images of renal grafts are obtained before kidney reperfusion, 10 min after and just before closing the surgical wound. Thermographic data is evaluated together with the type of graft and donor, cold ischemia time, hypovascularized areas determined by the surgeon during surgical intervention, alterations in vascular flow in postoperative echo-Doppler, time at the beginning of graft function and serum creatinine monitoring during postoperative follow-up. RESULTS: 17 grafts were studied. The mean temperature of the grafts before reperfusion, 10 min after and at the end of the surgery were 18.7 °C (SD 6.27), 32.36 °C (SD1.47) and 32.07 °C (SD1.78) respectively. 4 grafts presented hypoperfused areas after reperfusion. These areas presented a lower temperature compared to the well perfused parenchyma surface using thermographic images. CONCLUSION: The study of the usefulness and applicability of thermography can allow the development of tools that provide additional objective information on organ perfusion in real time and non-invasive manner. Our protocol and initial results can contribute to provide new evidence. Further analyses should be developed to shed light on the role of this technology.

Premix versus On-Demand Workflow Models in a Veterans Affairs Hematology/Oncology Pharmacy: Impact on Estimated Waste Costs and Patient Wait Time.

Background: The balance between reducing patient wait time and mitigating waste of parenteral products has not been well described in literature. Objective: Evaluate the patient wait times and cost-effectiveness of employing a premix versus an on-demand workflow model for compounding parenteral admixtures in a hematology/oncology infusion setting. Methods: This single center, retrospective cost analysis compiled manually documented monthly waste reports and estimated drug pricing for the institution to calculate the cost of waste during both premix and on-demand compounding workflows. Time to administration was audited for one week with both models. Results: Over a period of 28.5 months following the premix model, 564 products were documented as wasted ($1,196,014.01 in estimated drug purchasing cost). Over a period of 3 months following the on-demand model, 12 products were wasted ($34,823.98 in estimated drug purchasing cost). Switching models reduced the monthly average number of wasted products from 20 to 4 per month; the average cost of waste was reduced from $41,965.40 to $11,607.99 per month (P < .0001). Overall patient wait time from clearance until administration, excluding any recommended wait times after premedication administration (if applicable), was similar in both models: an average of 38.26 minutes in the premix model and 40.97 minutes in the on-demand model. Conclusion: Premixing parenteral admixtures was not cost effective at our institution. After resuming an on-demand compounding model, the monthly cost of waste (based on drug pricing alone) was reduced by over 70%. The wait time from clearance to treatment administration was similar in both models.

Biomarkers of bleeding and venous thromboembolism in patients with acute leukemia.

BACKGROUND: Coagulopathy and associated bleeding and deep vein thrombosis (DVT) are major causes of morbidity and mortality in patients with acute leukemia. The underlying mechanisms of these complications have not been fully elucidated. OBJECTIVES: To evaluate the associations between biomarker levels and bleeding and DVT in acute leukemia patients. METHODS: We examined plasma levels of activators, inhibitors, and biomarkers of the coagulation and fibrinolytic pathways in patients aged ≥18 years with newly diagnosed acute leukemia compared with those of normal controls. Multivariable regression models were used to examine the association of biomarkers with bleeding and DVT in acute leukemia patients. The study included 358 patients with acute leukemia (29 with acute promyelocytic leukemia [APL], 253 with non-APL acute myeloid leukemia, and 76 with acute lymphoblastic leukemia) and 30 normal controls. RESULTS: Patients with acute leukemia had higher levels of extracellular vesicle tissue factor (EVTF) activity, phosphatidylserine-positive extracellular vesicles, plasminogen activator inhibitor-1, plasmin-antiplasmin complexes, and cell-free DNA and lower levels of citrullinated histone H3-DNA complexes compared with normal controls. APL patients had the highest levels of EVTF activity and the lowest levels of tissue plasminogen activator among acute leukemia patients. There were 41 bleeding and 23 DVT events in acute leukemia patients. High EVTF activity was associated with increased risk of bleeding (subdistribution hazard ratio, 2.30; 95% CI, 0.99-5.31), whereas high levels of plasminogen activator inhibitor-1 were associated with increased risk of DVT (subdistribution hazard ratio, 3.00; 95% CI, 0.95-9.47) in these patients. CONCLUSION: Our study shows alterations in several biomarkers in acute leukemia and identifies biomarkers associated with risk of bleeding and DVT.

The complex heterogeneity of immune cell signatures across wasting tissues with C26 and 5-fluorouracil-induced cachexia.

Immune cell-driven pathways are linked to cancer cachexia. Tumor presence is associated with immune cell infiltration whereas cytotoxic chemotherapies reduce immune cell counts. Despite these paradoxical effects, both cancer and chemotherapy can cause cachexia; however, our understanding of immune responses in the cachexia condition with cancer and chemotherapy is largely unknown. We sought to advance our understanding of the immunology underlying cancer and cancer with chemotherapy-induced cachexia. CD2F1 mice were given 106 C26 cells, followed by five doses of 5-fluorouracil (5FU; 30 mg/kg LM, ip) or PBS. Indices of cachexia and tumor (TUM), skeletal muscle (SKM), and adipose tissue (AT) immune cell populations were examined using high-parameter flow cytometry. Although 5FU was able to stunt tumor growth, % body weight loss and muscle mass were not different between C26 and C26 + 5FU. C26 increased CD11b+Ly6g+ and CD11b+Ly6cInt inflammatory myeloid cells in SKM and AT; however, both populations were reduced with C26 + 5FU. tSNE analysis revealed 24 SKM macrophage subsets wherein 8 were changed with C26 or C26 + 5FU. C26 + 5FU increased SKM CD11b-CD11c+ dendritic cells, CD11b-NK1.1+ NK-cells, and CD11b-B220+ B-cells, and reduced Ly6cHiCX3CR1+CD206+CD163IntCD11c-MHCII- infiltrated macrophages and other CD11b+Ly6cHi myeloid cells compared with C26. Both C26 and C26 + 5FU had elevated CD11b+F480+CD206+MHCII- or more specifically Ly6cLoCX3CR1+CD206+CD163IntCD11c-MHCII- profibrotic macrophages. 5FU suppressed tumor growth and decreased SKM and AT inflammatory immune cells without protecting against cachexia suggesting that these cells are not required for wasting. However, profibrotic cells and muscle inflammatory/atrophic signaling appear consistent with cancer- and cancer with chemotherapy-induced wasting and remain potential therapeutic targets.NEW & NOTEWORTHY Despite being an immune-driven condition, our understanding of skeletal muscle and adipose tissue immune cells with cachexia is limited. Here, we identified immune cell populations in tumors, skeletal muscle, and adipose tissue in C26 tumor-bearing mice with/without 5-fluorouracil (5FU). C26 and C26 + 5FU had increased skeletal muscle profibrotic macrophages, but 5FU reduced inflammatory myeloid cells without sparing mass. Tumor presence and chemotherapy have contrasting effects on certain immune cells, which appeared not necessary for wasting.

Ascitis secundaria a chlamydia trachomatis tras procedimiento de reproducción asistida / Ascites secondary to chlamydia trachomatis after assisted reproduction procedure

El desarrollo de ascitis moderada o severa es infrecuente tras una enfermedad inflamatoria pélvica por Chlamydia trachomatis, una de las principales causas de infección de transmisión sexual a nivel mundial. Caso clínico: Paciente de 29 años que tras aborto diferido (gestación tras inseminación artificial) que inicia a las seis semanas con cuadro de dolor abdominal inespecífico y ascitis de predominio linfocitario. El diagnostico se realizo mediante PCR (Werfen®) tanto el liquido ascítico como en exudado endocervical. La paciente recibió tratamiento antibiótico con doxiciclina. Conclusión: Las enfermedades de transmisión sexual deben ser consideradas cuando se realiza un diagnóstico diferencial de una mujer sexualmente activa con dolor abdominal y ascitis, instaurar tratamiento antibiótico y evitar pruebas e intervenciones quirúrgicas innecesarias.

The development of moderate or severe ascites is infrequent after a pelvic inflammatory disease from Chlamydia trachomatis, one of the main causes of sexually transmitted infection worldwide. Clinical case: A 29-year-old patient who, after a delayed abortion (gestation after artificial insemination), started at six weeks with symptoms of non-specific abdominal pain and predominantly lymphocytic ascites. The diagnosis is made by PCR (Werfen®) both the ascitic fluid and the endocervical exudate. The patient received antibiotic treatment with doxycycline. Conclusion: Sexually transmitted diseases should be considered when making a differential diagnosis of a sexually activated woman with abdominal pain and ascites. Establishing antibiotic treatment, and avoiding unnecessary tests and surgical treatments.

Efectividad del calzado ortopédico pronador en el tratamiento postoperatorio de niños con pie equino varo congénito idiopático rígido / Effectiveness of the corrective shoes in the posoperative treatment of equinovarus deformities in children

El uso de calzado ortopedico en el tratamiento postoperatorio del pie equino varo congenito idiopatico (PEVCI) es motivo de controversia. Con el fin de conocer la efectividad del uso del calzado con modificaciones especiales (botas pronadoras) en el manejo postoperatorio del paciente con PEVCI, a quienes se les efectuó una liberación posterointerna ampliada (LIPA), se realizó un estudio experimental clinico controlado ciego, que comparó dos intervenciones: al primer grupo se le formuló zapato ortopedico (botas pronadoras), al segundo se le asigno zapato normal. Para la evaluación se utilizaron los enterizos de Turco modificados. Los resultados se clasificaron como buenos regulares y malos. Se presenta un analisis interno con el objeto de detectar diferencias entre los grupos. Hasta el momento no se han encontrado diferencias por lo que se autoriza la continuación del estudio para definir con mayor precisión la efectividad de la intervención

Estenosis carotídea exocreaneal: estudio comparativo por angiotomografía helicoidal 3-D, angio resonancia y ecodoppler color / Exocranial carotid stenosis: a comparative study between 3D-Angio CT, MR-angiography and color Doppler US

Nuestro objetivo fue valorar la utilidad de la angiotomografía computada 3D helicoidal (ATC) en relación con los métodos habituales de diagnóstico (angiorresonancia y eco Doppler), en la estenosis cartídea exocraneal. Para ello, fueron estudiadas con las tres modalidades, 32 arterias carótidas internas en 16 pacientes sintomáticos. Se realizaron las mediciones correspondientes, según el método N.A.S.C.E.T., obteniendo porcentajes de sensibilidad y especificidad de la ATC respecto a la angiorresonancia (ARM). Nuestros hallazgos permitirían incluir la ATC como segundo método prequirúrgico, en pacientes claustrofóbicos o que presenten contraindicaciones para la ARM

Neoadjuvant chemotherapy interferon for epidermoid penile cancer: a case report

Antecedentes. El carcinoma avanzado de pene es un tumor con un pronóstico malo con el tratamiento estándar por lo que la quimioterapia neoadyuvante se ha estado evaluando para mejorar la preservación del órgano y la supervivencia. Caso clínico. Paciente de 56 años visto en el Instituto Nacional de Cancerología en noviembre de 1993 siendo diagnosticado de cáncer de pene T3 N3 MO. El tratamiento consistió en cisplatino 100 mg/m2 cada 21 días por cinco ciclos alternados con metotrexato intravenoso a dosis de 250 mg/m2 más rescate con leucovorín oral a dosis de 10 mg/m2 cada ocho horas por seis dosis. El metotrexato y leucovorín se administraron cada 15 días en siete ocasiones. Además recibió interferón-alfa 4.5 x 10 6 U por vía subcutánea cada tercer día durante las 12 semanas del tratamiento. Resultados. El tratamiento fue bien tolerado alcanzando una respuesta clínica del 70 por ciento en el tumor primario y completa en los ganglios inguinales. Fue sometido a penectomía radical en abril de 1994 y actualmente está libre de enfermedad a los 61 meses de seguimiento. Conclusiones. Esta modalidad de quimioinmunoterapia parece ser muy activa en el cáncer de pene y debería evaluarse en un número mayor de pacientes con el fin de preservar el órgano e incrementar la supervivencia

Nefrectomía laparoscópica por hidronefrosis: presentación de 1 caso y revisión del tema / Laparoscopic nephrectomy for the treatment of hydronephrosis: case presentation and subject review

Se presenta 1 caso de reseccion completa de un riñon hidronefrotico gigante mediante acceso laparoscopico en una mujer de 28 años con una estenosis pieloureteral izquierda y atrofia renal severa. La evolucion posquirurgica fue excelente.

Nefrectomia laparoscopica por hidronefrosis / Laparoscopic nephrectomy for hydrophrenosis

Se presenta un caso de resección completa de un riñon hídronefrótico gigante usando abordaje laparoscópico en una mujer de 28 años con una estenosis pieloureteral izquierda y atrofia renal severa. La evolución post-quirúrgica fue excelente

Adenocarcinoma del colon en ninos.Estudio de dos casos. / Adenocarcinoma of the colon in children. Study of 2 cases

El adenocarcinoma del colon es excepcionalmente raro en los ninos. Se presentan dos casos estudiados en un periodo de dos anos en el Hospital de Pediatria del Centro Medico de Occidente del IMSS. Se analiza su presentacion clinica, manejo quirurgico y control postoperatorio. Se efectuo una revision de la literatura mundial concluyendo en la necesidad de dedicar mas tiempo al estudio de este tipo de tumores en los ninos para conocer su frecuencia real y elaborar un protocolo de manejo, pues existe un punto importante:el comportamiento biologico del adenocarcinoma colonico es muy diferente al del adult

Schistosomiasis vesical. Lesiones endoscopicas. / Vesical schistosomiasis.Endoscopic lesions

Se realizaron 1.127 endoscopias en el periodo comprendido desde marzo de 1977 hasta octubre de 1979 en el Hospital Universitario "Americo Boavida" de Luanda.Se selecciona para el estudio 690 (61.1%) endoscopias con diagnostico de schistosomiasis vesical. Se encuentran como lesiones mas frecuentes los huevos calcificados del parasito y la mucosa vesical deslustrada, signos de cronicidad que alertan sobre lo tardiamente que acuden a las consultas de urologia los pacientes portadores de esta enfermedad en el medio estudiado

Hipernefroma en una escolar. / Hypernephroma in a schoolgirl

El adenocarcinoma renal, conocido como el tumor renal maligno mas frecuente en el adulto, es una neoplasia poco frecuente en pacientes pediatricos. Se describe en este trabajo bajo el caso de una nina de 8 anos de edad en quien la exploracion fisica rutinaria descubrio una masa en hemiabdomen izquierdo correspondiente a un adenocarcinoma del polo inferior del rinon izquierdo, sin invasion a la capsula ni ganglios periaorticos, que curso con estado de salud satisfactorio y sin evidencia de la actividad tumoral a los 18 meses del postoperatorio. La revision de la literatura evidencia la dificultad en su diagnostico con el tumor de Wilms, lo cual solo es posible mediante los hallazgos del estudio histopatologico. En nuestro pais, el primer caso descrito correponde al Dr. Maximiliano Salas del Hospital Infantil dei Mexico y el caso presente parece ser el segundo caso publicado

Concentracion de cinc y cobre en plasma y eritrocitos en pacientes con insuficiencia renal cronica. / Zinc and copper concentration in plasma and erythrocytes of patients with chronic renal failure

Se estudiaron la concentracion de cinc (Zn) y de cobre (Cu) en el plasma y los eritrocitos de pacientes con insuficiencia renal cronica (IRC) que recebian tratamiento con hemodialisis o dialisis peritoneal, y el efecto que tiene la terapeutica dialitica sobre la concentracion de esos elementos. El Zn plasmatico se encontro significativamente disminuido en los dos grupos de pacientes.En contraste, el Zn del eritrocito estuvo elevado. Esto se interpreta como una adaptacion metabolica mas que como un hecho patologico. Se encontro aumento del Cu plasmatico en los pacientes en hemodialisis; en cambio, en el grupo de dialisis peritoneal fue normal. La dialisis no altero significativamente los niveles plasmaticos de ninguno de los dos elementos; por lo contrario, en el eritrocito se observo una disminucion tanto del Zn como del Cu. La ceruloplasmina se incremento con la hemodialisis y disminuyo con la dialisis peritoneal, posiblemente por la perdida de proteinas que se produce cuando se realiza este procedimiento