[Toxicity of radiation therapy and antiangiogenics combination: a case report]. / Toxicité de l'association radiothérapie et antiangiogéniques: à propos d'un cas.

The combined administration of antiangiogenic agents (AA) and radiation is being evaluated. No AA has yet received Marketing Authorization in this indication. However, they are widely used in medical oncology and criteria for stopping their administration in case of irradiation have not been defined. We report the case of a 63-year-old man experiencing grade 2 skin toxicity while on radiation treatment and sorafenib (400mg twice daily) for a metastatic lesion developing between the vastus medialis muscle and the cortical of the mid-diaphysis of the right femur. Toxicity occurred at 21Gy, for a total dose of 36Gy (12 fractions of 3Gy). Cutaneous symptoms rapidly disappeared after treatment discontinuation. Radiotherapy alone was resumed after a few days and the total dose could be delivered, with good tolerance. At 2-month follow-up, the intramuscular lesion had regressed. Several other cases of patients with poor tolerance to the association of AA and radiotherapy have been reported. Further studies of the effectiveness and tolerance of the combination treatment are needed before indications for AA can be extended to other diseases.

Tree-based modeling of complex interactions of phosphorus loadings and environmental factors.

Phosphorus (P) enrichment has been observed in the historic oligotrophic Greater Everglades in Florida mainly due to P influx from upstream, agriculturally dominated, low relief drainage basins of the Everglades Agricultural Area (EAA). Our specific objectives were to: (1) investigate relationships between various environmental factors and P loads in 10 farm basins within the EAA, (2) identify those environmental factors that impart major effects on P loads using three different tree-based modeling approaches, and (3) evaluate predictive models to assess P loads. We assembled thirteen environmental variable sets for all 10 sub-basins characterizing water level management, cropping practices, soils, hydrology, and farm-specific properties. Drainage flow and P concentrations were measured at each sub-basin outlet from 1992-2002 and aggregated to derive monthly P loads. We used three different tree-based models including single regression trees (ST), committee trees in Bagging (CTb) and ARCing (CTa) modes and ten-fold cross-validation to test prediction performances. The monthly P loads (MPL) during the monitoring period showed a maximum of 2528 kg (mean: 103 kg) and maximum monthly unit area P loads (UAL) of 4.88 kg P ha(-1) (mean: 0.16 kg P ha(-1)). Our results suggest that hydrologic/water management properties are the major controlling variables to predict MPL and UAL in the EAA. Tree-based modeling was successful in identifying relationships between P loads and environmental predictor variables on 10 farms in the EAA indicated by high R(2) (>0.80) and low prediction errors. Committee trees in ARCing mode generated the best performing models to predict P loads and P loads per unit area. Tree-based models had the ability to analyze complex, non-linear relationships between P loads and multiple variables describing hydrologic/water management, cropping practices, soil and farm-specific properties within the EAA.

Relevancia para el tratamiento de la sintomatología depresiva de los pacientes adictos / Importance for the treatment of depressive symptomatology in addited patients

Muchos de los pacientes que acuden a los tratamientos por consumo de drogas acusan una serie de problemas solapados, a veces, por la propia adicción y que llegan a condicionar el resultado final de la intervención terapéutica. Para precisar la incidencia de algunos de esos problemas estudiamos una muestra de 210 sujetos adictos sometidos a tratamiento (83 por ciento varones y 17 por ciento mujeres) tratando de interrelacionar diferentes tipos de problemas (legales, laborales, económicos, familiares, psicopatológicos, etc.) con su evolución terapéutica. Una de las variables que con más consistencia parece predecir los resultados del tratamiento es precisamente el nivel de sintomatología depresiva aducido por el propio paciente. Para valorar más la incidencia de esta variable fueron comparados los pacientes con sintomatología depresiva (75 sujetos) con los carentes de esos síntomas (135 sujetos). Los datos indican que los pacientes con sintomatología depresiva tienen un ambiente familiar más problemático y conflictivo, diferenciándose de manera significativa de aquellos otros carentes de dichos síntomas, lo que parece añadir más complicaciones a su recuperación. A juzgar por estos datos, sería conveniente diversificar los tratamientos con intervenciones expresamente dirigidas al abordaje de la sintomatología depresiva y problemática familiar de cara a optimizar los resultados de la intervención (AU)

Many of the patients who undertake treatment for drug consumption reveal a series of overlapping problems, sometimes due to their own addiction. These problems influence the final results of therapeutic supervision. In order to accurately determine the influence of some of these problems, we studied a sample of 210 addicts subjected to treatment (83% males and 17% females), trying to correlate the various types of problems (legal, vocational, economic, psychopathologic as well as family problems, etc.) with their therapeutic evolution. One of the variables which seems most consistently to predict treatment results is precisely the level of depressive symptomatology shown by the patient. To more accurately assess the influence of this variable, we compared 75 subjectpatients, all of them presenting depressive symptomatology, with 135 patients who did not. The data indicated that patients with certain levels of depressive symptomatology came from more problematic and conflictive family environments, a significant difference from those who did not present those symptoms. This seems to complicate their recovery. Judging by the data, it would be advisable to diversify treatment, with procedures that specifically address depressive symptomatology and family environment, with the aim of optimizing treatment results (AU)

[Selective training of respiratory muscles in patients with chronic heart failure]. / Entrenamiento selectivo de los músculos respiratorios en pacientes con insuficiencia cardíaca crónica.

BACKGROUND: Patients with chronic heart failure have a lower inspiratory muscle strength and fatigue endurance. AIM: To assess the effects of selective training of respiratory muscles in patients with heart failure. PATIENTS AND METHODS: Twenty patients with stable chronic heart failure, aged 58.3 +/- 3 years with an ejection fraction of 28 +/- 9%, were subjected to respiratory muscle training with threshold valves. The load was fixed in 30% of maximal inspiratory pressure (PImax) in 11 and in 10% of PImax in nine. Two sessions of 15 minutes, 6 days per week, during 6 weeks were done. Degree of dyspnea (Mahler score), maximal oxygen uptake, distance walked in 6 minutes, respiratory muscle function and left ventricular ejection fraction were measured before and after training. RESULTS: Both training loads were associated to an improvement in dyspnea (+2.7 +/- 1.8 and +2.8 +/- 1.8 score points with 30% PImax and 10% PImax respectively), maximal oxygen uptake (from 19 +/- 3 to 21.6 +/- 5 and from 16 +/- 5 to 18.6 +/- 7 ml/kg/min with 30% PImax and 10% PImax respectively, p < 0.05), PImax (from 78 +/- 22 to 99 +/- 22 and from 72 +/- 34 to 82.3 cm H20 with 30% PImax and 10% PImax respectively), sustained PImax (from 63 +/- 18 to 90 +/- 22 and from 58 +/- 3 to 69 +/- 3 cm H20 with 30% PImax and 10% PImax respectively), and maximal sustained load (from 120 +/- 67 to 195 +/- 47 and from 139 +/- 120 to 192 +/- 154 g with 30% PImax and 10% PImax respectively). The distance walked in 6 min only increased in subjects trained at 30% PImax (from 451 +/- 78 to 486 +/- 68 m). CONCLUSIONS: Selective training of respiratory muscles results in a functional improvement of patients with chronic heart failure.

Invaginación sigmoidoanal: caso clínico / Sigmoid-anal invagination. Case report

Presentamos, dada su rareza, un nuevo caso de invaginación sigmoidoanal. Se trata de una mujer de 61 años que acudió a urgencias presentando el sigma invaginado a través del ano por un adenocarcinoma de sigma. Una vez diagnosticada mediante los hallazgos clínicos, exploración física y realización de enema opaco, fue tratada quirúrgicamente realizándose una laparotomía con desinvaginación y resección del rectosigma con colostomía ilíaca proximal y fístula mucosa distal. Se analizan los aspectos etiopatogénicos, diagnósticos y terapéuticos de la invaginación intestinal en el adulto y, en particular, de la invaginación sigmoidoanal (AU)

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Cellular bioenergetics after erythropoietin therapy in chronic renal failure.

After erythropoietin (rHuEPO) therapy, patients with chronic renal failure (CRF) do not improve peak O2 uptake (VO2 peak) as much as expected from the rise in hemoglobin concentration ([Hb]). In a companion study, we explain this phenomenon by the concurrent effects of fall in muscle blood flow after rHuEPO and abnormal capillary O2 conductance observed in CRF patients. The latter is likely associated with a poor muscle microcirculatory network and capillary-myofiber dissociation due to uremic myopathy. Herein, cellular bioenergetics and its relationships with muscle O2 transport, before and after rHuEPO therapy, were examined in eight CRF patients (27 +/- 7.3 [SD] yr) studied pre- and post-rHuEPO ([Hb] = 7.8 +/- 0.7 vs. 11.7 +/- 0.7 g x dl-1) during an incremental cycling exercise protocol. Eight healthy sedentary subjects (26 +/- 3.1 yr) served as controls. We hypothesize that uremic myopathy provokes a cytosolic dysfunction but mitochondrial oxidative capacity is not abnormal. 31P-nuclear magnetic resonance spectra (31P-MRS) from the vastus medialis were obtained throughout the exercise protocol consisting of periods of 2 min exercise (at 1.67 Hz) at increasing work-loads interspersed by resting periods of 2.5 min. On a different day, after an identical exercise protocol, arterial and femoral venous blood gas data were obtained together with simultaneous measurements of femoral venous blood flow (Qleg) to calculate O2 delivery (QO2leg) and O2 uptake (VO2leg). Baseline resting [phosphocreatine] to [inorganic phosphate] ratio ([PCr]/[Pi]) did not change after rHuEPO (8.9 +/- 1.2 vs. 8.8 +/- 1.2, respectively), but it was significantly lower than in controls (10.9 +/- 1.5) (P = 0.01 each). At a given submaximal or peak VO2leg, no effects of rHuEPO were seen on cellular bioenergetics ([PCr]/[Pi] ratio, %[PCr] consumption halftime of [PCr] recovery after exercise), nor in intracellular pH (pHi). The post-rHuEPO bioenergetic status and pHi, at a given VO2leg, were below those observed in the control group. However, at a given pHi, no differences in 31P-MRS data were detected between post-rHuEPO and controls. After rHuEPO, at peak VO2, Qleg fell 20% (P < 0.04), limiting the change in QO2leg to 17%, a value that did not reach statistical significance. The corresponding O2 extraction ratio decreased from 73 +/- 4% to 68 +/- 8.2% (P < 0.03). These changes indicate that maximal O2 flow from microcirculation to mitochondria did not increase despite the 50% increase in [Hb] and explain how peak VO2leg and cellular bioenergetics (31P-MRS) did not change after rHuEPO. Differences in pHi, possibly due to lactate differences, between post-rHeEPO and controls appear to be a key factor in the abnormal muscle cell bioenergetics during exercise observed in CRF patients.

[Sublingual captopril versus nifedipine in the treatment of hypertensive crisis]. / Captopril sublingual versus nifedipina para el tratamiento de la crisis hipertensiva.

The currently accepted drug of choice for treatment of hypertensive crisis is sublingual nifedipine. We compared the effects of sublingual captopril (25 mg) to those of nifedipine (10 mg) in 54 patients with this complication who came to the emergency room. Five min after administration of captopril, blood pressure decreased from 197.5 +/- 32.7/118.3 +/- 8.2 to 156 +/- 27.2/95.8 +/- 12.9 mmHg and heart rate decreased from 87.9 +/- 15.1 to 74.7 +/- 10.9 (p < 0.05). Blood pressure in the nifedipine group decreased from 198 +/- 27.3/120 +/- 9.8 to 147.7 +/- 17.8/86 +/- 17.9 (p < 0.05), while no change was observed in heart rate. Delayed measurements showed lower diastolic pressures at 60 and 75 min and lower systolic pressure at 120 min in the nifedipine group (p < 0.054). Few and not significantly different side effects were observed with both drugs. Thus, sublingual captopril is useful for treatment of hypertensive crisis.