Deferasirox reduces oxidative DNA damage in bone marrow cells from myelodysplastic patients and improves their differentiation capacity.

Patients with low-risk myelodysplastic syndromes (MDS) usually develop iron overload. This leads to a high level of oxidative stress in the bone marrow (BM) and increases haematopoietic cell dysfunction. Our objective was to analyse whether chelation with deferasirox (DFX) alleviates the consequences of oxidative stress and improves BM cell functionality. We analysed 13 iron-overloaded MDS patients' samples before and 4-10 months after treatment with DFX. Using multiparametric flow cytometry analysis, we measured intracellular reactive oxygen species (ROS), DNA oxidation and double strand breaks. Haematopoietic differentiation capacity was analysed by colony-forming unit (CFU) assays. Compared to healthy donors, MDS showed a higher level of intracellular ROS and DNA oxidative damage in BM cells. DNA oxidative damage decreased following DFX treatment. Furthermore, the clonogenic assays carried out before treatment suggest an impaired haematopoietic differentiation. DFX seems to improve this capacity, as illustrated by a decreased cluster/CFU ratio, which reached values similar to controls. We conclude that BM cells from MDS are subject to higher oxidative stress conditions and show an impaired haematopoietic differentiation. These adverse features seem to be partially rectified after DFX treatment.

Outpatient Microureteroscopy for Distal Ureteral Stone-A True Minimally Invasive Procedure.

INTRODUCTION: To describe microureteroscopy, a novel minimally invasive approach for treating distal ureteral lithiasis. TECHNICAL CONSIDERATIONS: Seven female patients with distal ureteral stones ≤ 10 mm were operated by microureteroscopy. The microureteroscope consist on a 4.85 Fr (16-gauge) sheath, a 0.9 mm diameter flexible optic system, and a 3-arm Luer-lock adapter to connect the sheath and insert the optics. Patients are placed in lithotomy position. Under sedative anesthesia and antimicrobial coverage, we performed microureteroscopy in patients with distal ureteral stones, describing key steps and perioperative and postoperative outcomes. Stone clearance was assessed using X-ray plain abdominal film of KUB at 15 days. Mean patients age was 54.5 years, and mean stone size was 7.98 mm. Stone-free rate was 100%. Patients were discharged 2-4 hours after the procedure without intraoperative or major perioperative complications. CONCLUSION: Microureteroscopy was developed to reduce dilation and ureteral wall damage and, thus, to decrease postoperative stenting and hospital stay.

Unclassifiable CD20-negative Testicular Diffuse Large B-cell Lymphoma.

CD20-negative diffuse large B-cell lymphoma (DLBCL) is a very uncommon neoplasm, and very rare unclassifiable cases that did not meet the criteria for well-established subtypes of CD20-negative DLBCLs have been reported. CD20-negative DLBCLs often present an aggressive clinical course with important chemoresistance and poor prognosis. Here, we report a case of CD20-negative DLBCL presented as a testicular mass. To the best of our knowledge, this is one of the first reported cases of testicular unclassifiable CD20-negative DLBCL.

Tratamiento del embarazo ectópico cervical con metotrexato y rescate con leucovorina / Treatment of cervical pregnancy with methotrexate and folnic acid

Objetivo. Presentar dos casos de gestación ectópica cervical tratados en forma exitosa con metotrexato sistémico. Sujetos y métodos. Dos pacientes (28 y 35 años de edad) portadoras de una gestación ectópica cervical. Intervenciones: Régimen a días alternos de metotrexato 1mg/kg (días 1, 3, 5 y 7) con rescate de leucovorina (días 2, 4, 6 y 8). Punto final (resultado que se midió): éxito del tratamiento conservador de una gestación ectópica cervical. Resultados. Los dos casos de gestación ectópica cervical fueron exitosamente tratados y la capacidad reproductiva preservada. Conclusiones. El tratamiento conservador de la gestación ectópica con metotrexato sistémico es seguro y coste-efectivo (AU)

Objective. To present two cases of cervical ectopic pregnancy successfully treated with systemic methotrexate. Subjects and methods. Two women with a cervical ectopic pregnancy. Interventions: alternative day regime of methotrexate 1mg/kg (days 1,3,5 and 7) with folinic acid rescue (days 2, 4, 6, and 8). End points: successful treatment. Results. Two cases of ectopic cervical pregnancy were successfully treated and preserved their reproductive capability. Conclusions. Conservative medical treatment of cervical ectopic pregnancy with systemic methotrexate is safe and effective (AU)

Pericarditis purulenta: diagnóstico ecográfico precoz en el servicio de urgencias / Purulent pericarditis: early ultrasound diagnosis in the emergency department

La pericarditis purulenta presenta, en la actualidad, diversos retos. Primero, en el aspecto epidemiológico, a su rareza lo que nos exige tenerla siempre in mente para evitar un retraso fatal en el diagnóstico. Segundo, en el aspecto etiológico debido a los cambios en el espectro bacteriológico responsable del cuadro (desde el descubrimiento y generalización de las drogas antimicrobianas han aumentado los casos asociados a gérmenes anaerobios, gram negativos y fúngicos frente a los clásicos aerobios gram positivos de otras etapas), así como por su cada vez mayor vinculación con enfermedades y condiciones predisponentes, no necesariamente infecciosas ni previamente conocidas. Tercero, en el aspecto terapéutico, alimentado por la aún viva polémica en torno a la técnica de drenaje más eficaz. Presentamos un caso de pericarditis purulenta en el que la práctica de la ecografía a la cabecera del enfermo acortó los tiempos de diagnóstico y tratamiento del proceso y permitió que el paciente no abandonase el medio y lugar más apropiado: el Servicio de Urgencias (AU)

The diagnosis of purulent pericarditis (PP) faces several challenges at the present time. The first of them is the epidemiology of the disease. PP is very uncommon and requires the physician best efforts to avoid a fatal diagnostic delay. The second challenge is the aetiology of the disease. On one hand deep changes in the bacteriological spectra has been reported since the antibiotic drug era began. An increasing trend of PP cases are now caused by anaerobic, gram– and fungus species in contrast with gram+ bacteria cultured before. There is also a predominant role of underlying conditions neither necessarily infectious nor previously diagnosed that increase the risk for PP. On the other hand a controversy related to the most efficient surgical drainage technique still remains. We report a case of a patient with PP who underwent bedside ultrasound at emergency department that reduced both diagnostic and treatment times and achieved an important aim: the patient remained in the most adequate setting for medical assistance, the Emergency Department (AU)