[Incidence of febrile episodes in patients with multiple myeloma undergoing autologous peripheral blood stem cell transplantation]. / Incidencia de episodios febriles en pacientes con mieloma múltiple sometidos a trasplante autólogo de progenitores hematopoyéticos de sangre periférica (TASPE).

BACKGROUND: Autologous peripheral blood stem cell transplantation (PBSCT) is a procedure frequently used as therapy for hematological malignancies, in which infectious complications are a major cause of morbimortality. The duration and intensity of neutropenia, indwelling central venous catheters, and mucosa chemotherapy-induced damage, contribute to increase infection rates. We have retrospectively review the incidence of febrile episodes and microbiological documented infections (MDI) in patients with multiple myeloma (MM) undergoing PBSCT. PATIENTS AND METHODS: We have retrospectively analyzed 56 PBSCT in patients diagnosed of MM between 1995 and 2002 in our hospital. RESULTS: 34 patients showed fever: 19 fever of unknown origin; 5 clinically documented infections and 10 patients MDI. We isolated 5 pathogens gram negative and 4 gram positive. We observed 2 infections associated to indwelling central venous catheters and 1 MDI due to simplex Herpes Virus. Two patients died due to infectious complications. CONCLUSIONS: The incidence of febrile episodes in our patients is similar to those previously reported as well, duration of neutropenia associated to PBSCT. We have observed a slightly higher incidence of gram negative pathogens.

[Aging of the population and incidence of primary acquired hemopathies in the Autonomous Community of Aragón]. / Envejecimiento poblacional e incidencia de hemopatías primarias adquiridas en un área de la Comunidad Autónoma de Aragón.

BACKGROUND: Aging probably comprises one of the major factors contributing to the onset of acquired primary blood diseases (APBD's) most of which are of a chronic type. The purpose of this study is to analyze the rate of occurrence (RO) of HPA in a population of 522,621 inhabitants (Males: 252,721; Females: 269,900) showing a negative vegetative growth (-1.4/10(5) inhabitants/year), said occurrence being dealt with separately for the population under age 60 and the population over age 60. METHODS: In January-December, 1994, a estimate was made of the HPA rate of occurrence and rate of analyses among the patients from the area in question, dealing separately with those under age 60 and over age 60. The diagnostic criteria applied were Monoclonal Gammopathies of Undetermined Significance (MGUS's) in keeping with Kyle's criteria. Multiple Myeloma (MM) and Chronic Lymphatic Leukemia (CLL) in keeping with the Myeloma Task Force criteria. Non-Hodgkin's Lymphoma (NHL) and Hodgkin's Disease (HD) in keeping with the REAL classification, Myelodisplasic Syndromes (MS's) and Acute Leukemia (AL) in keeping with the FAB classification, Chronic Myeloproliferative Syndromes (CMS's) in keeping with the PVSG. For calculating the rates of occurrence, descriptive epidemiological methods were used. RESULTS: The highest rates of blood analyses as the result of suspected APH's fell within the over 60 age group (p < 0.0001). During the length of time analyzed, a total of 302 APH's (< 60/> or = years: 100/202, p < 0.0001) were diagnosis, being worthy of special mention: 84 MGUS's; 21 MM's; 57 NHL's; 26 CLL's; 33 CMS's; 11 AL's and 14 HD's. The spread by gender was: Males: 177; Females 125. Average age: 63.54 years (age range 19-92). The rates of occurrence (cases/10(5) inhabitants/year) were (< age 60/> or = age 60): overall: 31.31/178.86; MGUS: 7.37/52.87; MM: 1.84/13.21; NHL: 5.53/34.36; CLL: 1.53/18.50; MS: 0.62/27.31; CMS: 5.52/16.74; AL: 1.53/5.29; HD: 3.68/1.76. CONCLUSIONS: The highest rate of analyses as the result of suspected APH was found among those over 60 years of age. The overall occurrence of APH is significantly higher in those over age 60, as well as for each type of APH taken into account, except for AL and HD. The highest rate of occurrence is that of MGUS, NHL and MS's, especially in males.

[Primary extramedullary plasmacytomas of the upper respiratory tract. A study of four cases with infrequent localization]. / Plasmocitomas primarios de vías aerodigestivas altas. A propósito de cuatro casos.

OBJECTIVE: Assessment of the incidence, diagnosis and treatment of three patients afflicted of extramedullary plasmacytoma located in the Waldeyer's ring, and one case afflicted of maxillary sinus disease. PATIENTS: The localization of the masses was the palatine amygdala in two cases, and the rhinopharynx and maxillary sinus in the remaining two patients. Major symptoms were dysphagia respiratory failure with closed rhinolalia, and headache. Diagnosis was made by histological study of biopsied tissue. In every case, general illness or other site of localization were ruled out. RESULTS: In our casuistic, the incidence of primary extramedullary plasmacytoma in Waldeyer's ring is 1.2%. The patient's age were 45, 50, 62, and 73 years respectively, and the male/female ratio was 1. In those cases located in the tonsils, a bilateral tonsillectomy was performed. In the case located at the maxillary sinus, a sinus trepanation was performed according the Caldwell-Luc's technique, followed by local radiotherapy at doses of 40 Gy. In the case located at the rhinopharynx, radiotherapy was the only choice. These three different therapeutical procedures led to the disappearance of the disease, and, after a 12 to 53 month-period, patients remain asymptomatic. A patient died due to other causes not related to the illness.

[Interferon alpha and systemic mastocytosis. Analysis of therapeutic efficacy in 6 cases]. / Interferón-alpha y mastocitosis sistémica. Análisis de la eficacia terapéutica en seis casos.

OBJECTIVE: To report the results obtained with the application of alpha-IFN for the treatment of a small group of patients diagnosed of systemic mastocytosis (SM) in the setting of a general hospital. PATIENTS AND METHODS: Six patients out of a group of 14 with the diagnosis of MS were prospectively selected from January 1991 to December 1996. Two patients had aggressive variant with lymph node involvement and eosinophilia and the other four had severe and repeated crises through release of mediators not controlled under symptomatic therapy. All patients received alpha-2b-IFN with gradual doses until a mean dose of 9 MU/week was obtained, associated with anti-H1 and anti-H2 antithistaminic agents and ketotiphen. Monthly clinical and analytical studies were performed until stabilization of the clinical picture and histamine metabolite measurements in urine every 6 months and histologic evolution of bone marrow every 12 months. RESULTS: Mean age at diagnosis was 41 years (range: 26-28), M/F ratio 3/3, mean evolution time 50.5 months and mean time under therapy with alpha-IFN 15.6 months (range: 3-26). Six months after therapy was initiated a decrease in the frequency and severity of crises through release of mediators and a slight improvement in cutaneous lesions, resolution of liver enlargement and ascites were observed. Treatment tolerance was quite acceptable and dose reduction was required in only two cases. Bone marrow assessment at one year showed a similar involvement, with decrease in the number of paratrabecullar nodules. CONCLUSIONS: The efficacy of alpha-2b-IFN therapy in SM is not clearly established, although the results obtained in this study seem encouraging. To obtain valid conclusions, a larger number of patients with similar characteristics and a longer follow-up with uniform assessment criteria are required.

Incidencia de episodios febriles en pacientes con mieloma múltiple sometidos a trasplante autólogo de progenitores hematopoyéticos de sangre periférica (TASPE) / Incidence of febrile episodes in patients with multiple myeloma undergoing autologous peripheral blood stemm cell transplantation

Introducción: El trasplante autólogo de progenitores hematopoyéticos de sangre periférica (TASPE), es un procedimiento frecuentemente empleado en el tratamiento de las hemopatías malignas, siendo la morbimortalidad atribuible a las infecciones un factor determinante en el resultado final del mismo. La duración e intensidad de la neutropenia, la presencia de catéteres venosos centrales y la alteración de las mucosas contribuyen a una mayor incidencia de infecciones. Revisamos de manera retrospectiva la incidencia de episodios febriles y en especial de infecciones microbiológicamente documentadas (IMD) en pacientes afectos de mieloma múltiple (MM) sometidos a TASPE. Pacientes y métodos: Análisis retrospectivo de una serie de 56 pacientes con MM sometidos a TASPE en nuestro hospital entre 1995 y 2002. Resultados: Treinta y cuatro pacientes presentaron fiebre: 19 episodios febriles sin foco; 5 episodios febriles clínicamente documentados y 10 pacientes IMD. Se aislaron 5 microorganismos gram negativos frente a 4 gram positivos. Se evidenció infección de catéter en 2 casos. Sólo observamos una IMD de etiología vírica por virus Herpes simple (VHS). Dos pacientes fallecieron como consecuencia del proceso infeccioso. Conclusiones: El porcentaje de procesos febriles en nuestra serie es similar al descrito en la literatura, así como la duración de la neutropenia asociada al TASPE. Observamos un discreto predominio de la infecciones por gram negativos

Background: Autologous peripheral blood stem cell transplantation (PBSCT) is a procedure frequently used as therapy for hematological malignancies, in wich infectious complications are a major cause of morbimortality. The duration and intensity of neutropenia, indwelling central venous catheters, and mucosa chemotherapy-induced damage, contribute to increase infection rates. We have retrospectively review the incidence of febrile episodes and microbiological documented infections (MDI) in patients with multiple myeloma (MM) undergoing PBSCT. Patients and methods: We have retrospectively analized 56 PBSCT in patients diagnosed of MM between 1995 and 2002 in our hospital. Results: 34 patients showed fever: 19 fever of unknown origin; 5 clinically documented infections and 10 patients MDI. We isolated 5 pathogens gram negative and 4 gram positive. We observed 2 infections associated to indwelling central venous catheters and 1 MDI due to simplex Herpes Virus. Two patiens died due to infectious complications. Conclusions: The incidence of febrile episodes in our patients is similar to those previously reported as well, duration of neutropenia associated to PBSCT. We have observed a slightly higher incidence of gram negative pathogens

Hiperhomocisteinemia y mutación C677T de la metilentetrahidrofolato reductasa / Hyperhomocysteinemia and C677T methylentetrahydrofolate reductase mutation

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Mutación C677TT de la metilentetrahidrofolato reductasa, homocisteína y trombofilia / C677TT mutation in methylentetrahydrofolate reductasa, homocystein and thrombofilia

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