Survival outcomes in patients aged 75 years and over with peritoneal colorectal carcinomatosis after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC): multicenter study of the Spanish Group of Peritoneal Cancer Surgery (GECOP).

BACKGROUND: The attitude toward cytoreductive surgery with HIPEC in peritoneal carcinomatosis from colorectal cancer is unclear. The aim of this study is to report the perioperative outcomes after cytoreductive surgery with HIPEC in patients ≥ 75 years. METHODS: This retrospective multicenter study collected the data the Spanish Group of Peritoneal Cancer Surgery. Thirty-six patients with peritoneal carcinomatosis from colorectal cancer met the selection criteria for the study. Morbidity, mortality, disease-free and overall survival were analyzed. RESULTS: Morbidity (grade III-IV) was 17% and 2 patients died of complications related to the procedure (5.4%). Median disease-free survival (DFS) was 16 months. DFS at 1 and 3 years was 81% and 42%, respectively. Overall survival at 1 and 3 years was 96% and 75%. In the univariate analysis, preoperative comorbidities (p = 0.01), liver metastases (p = 0.02), blood transfusion (p = 0.001) and postoperative complications (p = 0.001); and in the multivariate analysis, perioperative blood transfusion (OR 2.56, 95% CI 1.95-6.24, p = 0.03) and postoperative complications (OR 3.25, 95% CI 2.35-7.56, p = 0.02) were associated with a lower overall survival. CONCLUSIONS: Age is not an absolute contraindication to perform cytoreduction surgery with HIPEC in highly selected elderly patients with colorectal peritoneal carcinomatosis.

How molecular diagnosis may modify immunotherapy prescription in multi-sensitized pollen-allergic children.

INTRODUCTION: Specific immunotherapy (SIT) is used to treat asthma and allergic rhinitis, and a dose-response relationship has been found for SIT efficacy, creating a need to accurately select the allergen used in therapy. This need is especially pronounced in poly-sensitized children living in areas where different pollen allergen sources coexist in the same season, as this circumstance complicates diagnostic efforts. In such cases, component-resolved diagnosis (CRD) can increase diagnostic accuracy and aid in SIT prescription. MATERIALS AND METHODS: We hypothesized that CRD results would lead to modifications in classical immunotherapy prescription based on sources such as medical history, season of symptom presentation, and skin testing. We studied a sample of children indicated for immunotherapy in whom classical methods had not pointed out the most relevant allergen due to sensitization to more than two pollens. We used a small panel of recombinant allergens, analyzing the percentage of changes to prescription considering the findings of molecular studies. RESULTS: Of the 70 children included, CRD led to modified immunotherapy prescription in 54.3%. Indications of single-allergen therapy increased from 18% to 51% when CRD was included. The decision to prescribe immunotherapy was reversed following CRD in 9.3% of cases. DISCUSSION: CRD use alters the choice of specific immunotherapy in poly-sensitized children. A wide panel of recombinant allergens may not be necessary to improve immunotherapy indication using molecular techniques; rather, a smaller panel adapted to include those allergens prevalent in the geographical area in question appears to be sufficient for more effective immunotherapy, also leading to an improved cost-benefit ratio.

Fully automated determination of vitamins A and E in milk-based products using a robotic station-HPLC arrangement.

An automated method, which includes an extraction procedure based on the AOAC official method of analysis for vitamins A and E in milk-based infant formula, was developed. The whole procedure is carried out automatically in a robotic station coupled to a liquid chromatograph with a UV detector for individual separation and quantification of the vitamins. Different commercial products (milk, infant formula and nutritional supplements) were analysed, and the data were compared with those obtained using the manual AOAC extraction method. Relative standard deviations using the automated method were 5.92 and 2.57% for vitamin A and E, respectively.

[Cerebrovascular stroke, the cause of the death of the caliph al-Hakam II]. / Un accidente cerebrovascular, causa de la muerte del califa al-Hakam II.

al-Hakam II was the ninth sovereign in the Hispano-Omeyan dynasty and the second caliph of Spain under the Moors. In the night of the 1st of October 976 he died as the result of a disease that had afflicted him for two years old. Cerebrovascular stroke first manifested as hemiplegia. The disease that afflicted the caliph was called al-'illat alfalichiya, or alfeliche in Castilian Spanish, which means the disease of hemiplegia. The caliph was 61 years old and led a sedentary life and was therefore predisposed to suffer ischemic cerebrovascular events. Climate may have played a role in triggering the stroke. Several authors have found that the incidences of ischemic infarcts and intracranial hemorrhages increase during the winter months and on cold days, particularly in patients under 65. The chronicler of the al-Razi period tells us that heavy snow fell in and around Córdoba in 974 and that the following months saw rain and strong winds. We can deduce that caliph al-Hakam II died of a cerebrovascular event and that, based on the few data available, it is likely that the infarction was ischemic and of atherothrombotic origin. Caliph al-Hakam II moved his household from Madinat al-Zahra' to Alcázar de Córdoba as a result of the "recommendation of his doctors because the cold of the Sierra stirred up his humors". This interpretation is correct according to Arab medicine, which is following the line of the ancient Greeks regarding natural faculties, the elements and their corresponding humors.