Postmarketing study for assessment of tolerability of a grass allergen immunotherapy tablet (GRAZAX) in patients with rhinitis or rhinoconjunctivitis.

BACKGROUND AND OBJECTIVE: Many patients with grass pollen allergy in Spain have concomitant sensitization to other allergens such as profilin. Since this type of sensitization is more common in Mediterranean countries than in countries where most patients were enrolled in clinical trials on GRAZAX (Phleum pratense 75,000 SQ-T/2, 800 BAU, ALK), the aim of this study was to analyze tolerability to GRAZAX under clinical practice conditions in patients with grass pollen allergy. METHODS: A total of 155 patients were enrolled consecutively in a prospective, open-label, observational study. Adverse reactions were recorded during the first month of treatment at 3 different timepoints: after the first dose, when patients were kept under observation for 30 minutes, and on days 15 and 30 after starting treatment RESULTS: With the first dose, 117 adverse reactions were recorded in 63 patients (40.7%). The commonest reactions (>10% patients) were oral pruritus (25.2%) and throat irritation (24.5%). Ear pruritus was recorded in 7.7%. All reactions but 1 occurred within 30 minutes of administration and all were mild-to-moderate. At the end of treatment, the percentage of patients with adverse reactions had decreased significantly (21.3%). Most adverse reactions (95.2%) were mild-to-moderate and only 3 (1.4%) were severe. No serious adverse reactions were recorded. CONCLUSION: GRAZAX seems to be well tolerated, and most reactions were mild-to-moderate. Many of these reactions occur with the first dose. Therefore, according to the Summary of Product Characteristics, the first dose has to be administered under medical supervision.

Efectos electrofisiológicos del sevoflurano versus propofol en niños con síndrome de Wolff-Parkinson-White / Electrophysiological effects of sevoflurane in comparison with propofol in children with Wolff-Parkinson-White syndrome

OBJETIVOS: Evaluar los efectos electrofisiológicos delsevoflurano en niños con síndrome de Wolff-Parkinson-White (WPW) sometidos a ablación por radiofrecuencia(RF).MÉTODOs: Se estudiaron de forma prospectiva 15pacientes con síndrome de WPW, programados paraestudio electrofiosológico (EEF) y ablación por RF.La inducción anestésica se realizó con fentanilo (2 μkg–1), propofol (3 mg kg–1) y vecuronio (0,1 mg kg–1) y el mantenimiento con propofol (100 μ kg–1 min–1), bolus de fentanilo y vecuronio según necesidades. El EEF(EEFpropofol) se practicó mediante la introducción de cuatro electrocatéteres intracardiacos. Se determinaron la función del nodo sinusal, la conducción sinoatrial, períodos refractarios (auricular, nodo AV, anterógrado y retrógrado de la vía accesoria, ventricular)y características de la taquicardia ortodrómicainducida. Posteriormente, se intercambió propofol por sevoflurano (1 MAC según edad) repitiendo las mediciones(EEFsevoflurano). Los parámetros EEFpropofol y EEFsevoflurano se compararon mediante el test de Wilcoxon. RESULTADOS: La edad media fue de 9,3 ± 6 años. Trasla administración de sevoflurano se produjo un alargamiento del período refractario efectivo anterógrado de la vía accesoria (EEFpropofol 283 ± 22 ms; EEFsevoflurano 298 ± 25 ms; p = 0,004), y del ciclo mínimo de estimulación con conducción ventrículo-atrial 1:1 (EEFpropofol 244 ± 41 ms; EEFsevoflurano 273 ± 28 ms; p = 0,028). No hubo cambios significativosen el resto de los parámetros. En todos lospacientes se consiguió la ablación de la vía accesoria.CONCLUSIONES: El sevoflurano modificó parcialmentelas propiedades de la vía accesoria, aunque esto no impidióla ablación de la misma

OBJECTIVE: To evaluate the electrophysiologicaleffects of sevoflurane in children with Wolff-Parkinson-White (WPW) syndrome undergoing radiofrequencyablation.METHODS: We performed a prospective study of 15patients with WPW syndrome who were scheduled foran electrophysiological study (EPS) and radiofrequencyablation.Anesthesia was induced with fentanyl (2 μg/kg),propofol (3 mg/kg), and vecuronium (0.1 mg/kg), andinitially maintained using propofol (100 μg/kg), withbolus administration of fentanyl and vecuronium asrequired. Four intracardiac catheters were introducedfor the EPSpropofol, which included measurements ofsinus-node function, sinoatrial-node conduction,refractory periods (atrial, AV-node, accessory pathwayanterograde and retrograde, and ventricular), and thecharacteristics of induced orthodromic tachycardia.The propofol was then replaced with sevoflurane (1MAC adjusted for age) and the measurements wererepeated (EPSsevoflurane). The EPSpropofol and EPSsevoflurane data were compared using the Wilcoxon signed-rank test.RESULTS: The mean (SD) age was 9.3 (6 ) years. Afteradministration of sevoflurane, the duration of the antegrade effective refractory period of the accessory pathway increased (EPSpropofol, 283 (22) ms; EPSsevoflurane, 298 (25) ms; P = .004), as did the duration of the minimum pacing cycle with 1:1 atrioventricular conduction (EPSpropofol, 244 (41) ms; EPSsevoflurane, 273 (28) ms; P = .028). No significant changes were observed in the other parameters. Ablation of the accessory pathway was achieved in all patients.CONCLUSIONS: Sevoflurane partially modified the properties of the accessory pathway but did not prevent ablation

[Treatment of tumor osteopathy in cancer of the prostate]. / Tratamiento de la osteopatía tumoral en el cáncer de próstata.

Some 40% of patients with prostate cancer present with disseminated disease at the time of diagnosis and up to 80% of the total will develop bone dissemination during the disease. The aging of the population and the elevated incidence of prostate cancer (13% of malignancies in males) bring the figure of prostate cancer diagnosed in Europe to 85,000 new cases every year. To begin with, a comment on the overall aspects of bone metastasis from prostate cancer such as incidence, development mechanisms, distribution, prognosis and clinical outcome is made placing special emphasis on the grading and the evaluation of major therapeutical regimes for this kind of patients. Bone metastasis are the most frequent cause of pain due to cancer and are also the cause of immobilization, pathological fractures, bone marrow affectation, medullary compression and sometimes hypercalcemia. It is obvious that any comprehensible therapeutical approach must be multidisciplinary.