Avelumab to treat Merkel cell carcinoma: real-life experience in a dedicated oncology center. / Avelumab en el tratamiento del carcinoma de células de Merkel: experiencia en vida real en un centro monográfico oncológico.

The arrival of immunotherapy has revolutioned the management of patients with metastatic Merkel cell carcinoma (MCC). We conducted an observational, retrospective study of 14 cases treated with avelumab. The response rate was 57%: complete response was reached in 29% of patients, and partial responses in 29%. The drug proved effective in 83% (5/6) of the patients with a single metastatic site. However, the disease progressed in 75% (3/4) of the patients with bone metastases. PD1-L expression, MCC polyomavirus (MCPyV) positivity, and an impaired neutrophil-to-lypmhocyte ratio (NLR) could not be associated with responses to the therapy. Avelumab is an effective and safe drug for the management of advanced MCC, and its effectiveness appears to be impacted by the number and location of metastases.

Interleukin-2 enhances the growth of human melanoma cells derived form primary but not from metastatic tumours.

Previously, we demonstrated that in vitro treatment of B16F10 murine melanoma cells with interleukin-2 (IL-2) enhances proliferation and metastasis. To further investigate the role played by IL-2 in human melanomas, we studied the expression of IL-2/IL-2 receptor and the effect of IL-2 on the proliferation of melanoma cell lines derived from primary (A375 and RMS cell lines) and metastatic (Hs294T cell line) tumours. We found a constitutive expression of cytoplasmic IL-2 and alpha, beta and gamma-subunits of the IL-2R on the surface of the three melanoma cell lines. The presence of IL-2 in the culture increased the proliferation rate in A375 and RMS cell lines, but no effect was observed in Hs294T metastatic cells. Biologically active IL-2 could be found in the supernatant of the three melanoma cell lines, particularly in A375 and RMS cells, in which an inhibition of the proliferation rate was observed when IL-2 was blocked. Moreover, the combination of anti-IL-2R beta and anti-IL-2R gamma blocking antibodies induced a significant down-regulation of cell proliferation in the three melanoma cell lines, and the combination of anti-IL-2R alpha, anti-IL-2R beta and anti-IL-2R gamma blocking antibodies inhibited IL-2-mediated growth stimulation in A375 and Hs294T cell lines. In RMS cells, a more significant effect was observed when only IL-2R gamma was blocked. Finally, exogenous IL-2 modulated the IL-2 endogenously produced by melanoma cells. These data show that IL-2 may modulate the growth of melanoma cells through autocrine or/and paracrine mechanisms.

[Enteral nutrition and changes in taste in diabetic patients: a double-blind prospective study]. / Nutrición enteral y alteraciones del gusto en pacientes diabéticos: estudio prospectivo doble ciego.

The authors present a prospective double blind test aimed at objectively determining the acceptance of flavoured orally administered enteric diets specific to patients with glucose metabolism alterations (Glucerna and Precitene Diabet), in the light of the taste disorders described in such patients. Sixty-two patients were studied, 32 diabetics and 32 control patients, who were given a sample of each product; the level of acceptance was quantified on a modified wine-tasting scale. The average taste of the diabetics was 12.1 points (SD = 4.34) for Glucerna, and 10.1 (SD = 3.91) for the Precitene Diabet. In the control patients, the scores were 12.7 (SD = 3.78) and 13.2 (SD = 3.23) respectively. Multiple regression analysis did not reveal significant differences in taste according to age, sex or place of origin. Average taste among the diabetic patients as a whole with both products was 11.2 points and, for the nondiabetics, 12.92. The model detected significant differences (p = 0.01) between the two groups. The average taste of the diabetics was less than that of the non-diabetics, irrespective of all the remaining variables examined, including the type of preparation. These results confirm the lower oral acceptance in diabetic patients, possibly associated with disorders in the sense of taste, showing the utility of the modified wine-tasting scale as a test in evaluating the acceptance of enteric diets which must be administered orally.

[Surgical treatment of hypertrophic stenosis of the pylorus at a general surgery service]. / Tratamiento quirúrgico de la estenosis hipertrófica del píloro en un servicio de cirugía general.

The authors purpose was to demonstrate that pyloromyotomy can be successfully carried out by nonspecialist surgeons. Eighty three cases admitted over a twelve-year period to the Department of Pediatrics of Montecelo Hospital, a district general hospital, were reviewed. Extramucosal pyloromyotomy was performed by general surgeons under general anaesthesia in all cases. There were no deaths. Three infants had postoperative complications and required treatment. All cases underwent prophylactic antibiotics and no wound infections were recorded. When compared with other published series, our study shows that extramucosal pyloromyotomy can be carried out safely by general surgeons and that prophylactic antibiotic treatment can decrease morbidity. Postoperative complications are not related to damage of the duodenal mucosa or the type of skin incision.

[Superior vena cava syndrome and insular thyroid carcinoma: the stent as a palliative therapeutic alternative]. / Síndrome de vena cava superior y carcinoma insular de tiroides: el stent como alternativa terapéutica paliativa.

The superior vena cava syndrome (SVCS) is a uncommon complication of thyroid cancers. It is produced as consequence of the mediastinal spread of the tumor or by intravascular invasion with thrombosis. We describe a case of insular thyroid carcinoma with an SVCS solved by putting an intravenous stent. The patient was a 73 year old male that consulted for aphonia and presence of a tumor in the right side of the neck of two months of evolution. The PAAF of thyroid suggested the diagnosis of "follicular tumor". A total thyroidectomy was performed on the patient and the sample histological study revealed the existence of a insular carcinoma. An ablative dosis of 131I was administered to him. One year after the patient developed the SVCS. A TAC detected a tumoral relapse consistent with clinical syntoms, and was confirmed by a high level of Tg (with TgAntibodies -). As the patient showed a slight response to radiotherapy (52Gy), a thoracic phlebography was realized demostrating an extense upper vena cava obstruction. After having accomplished an angioplasty, a long stent (20 mm wide) was put into the upper vena cava that was followed by a fast clinical and radiological improvement. A new phlebography practiced three month later showed a rapid venous flux through the stent, and near total disapperance of collateral circulation on thorax wall and mediastinum.

Manifestaciones conjuntivales biomicroscópicas en paciente con retinopatía proliferativa drepanocítica / Conjunctival biomicroscopical findings in the conjunctiva of a patient with drepanocytic proliferative retinopathy

No disponible

Postpartum contraceptive acceptance in León, Mexico: a multivariate analysis.

OBJECTIVES: The aim of the present study was to identify the reasons for the acceptance or rejection of contraceptive methods among postpartum women at the Hospital of Obstetrics and Gynecology in León, Mexico. METHODS: A prospective cross-sectional study of 1025 postpartum women was undertaken. Reasons for acceptance or refusal of contraceptives were registered in a written survey. Twelve sociodemographic variables were included as predictors in a logistic regression analysis; the acceptance or refusal was the dependent variable, and statistical significance was set at 0.05. RESULTS: There were 513 patients who accepted contraceptives (50.0%) and 512 (50.0%) who refused them. The main reasons for accepting contraceptives were definitive desire for no more children (17.0%) and satisfaction with previous contraceptive methods (21.5%). The main contraceptive methods chosen were intrauterine device (67.7%) and tubal sterilization (28.5%). Reasons for contraceptive refusal were husband's rejection (33.2%) and delaying contraceptive use until after finishing the postpartum period (31.8%). In the logistic regression model, the variables previous deliveries (p < 0.001), number of Cesarean sections (p < 0.001) and women's level of education (p < 0.02) were included as predictors of acceptance. CONCLUSIONS: Previous deliveries, previous Cesarean sections and women's level of education were significant in contraception acceptance. The rejection of contraceptives was mainly attributed to husbands.

Cyclosporin A upmodulates the alpha-subunit of the interleukin-2 receptor and the metastatic ability of murine B16F10 melanoma cells.

In the present study, the effect of in vitro cyclosporin A (CsA) treatment on IL-2R expression and the metastatic behavior of B16F10 melanoma cells has been reported. CsA treatment was found to increase the percentage of B16F10 cells expressing the alpha-subunit of IL-2R on the cell surface and also at the mRNA level. Moreover, CsA treated B16F10 cells also express the beta-subunit of IL-2. In vivo experiments showed that CsA increases the affinity of B16F10 metastazing cells for the liver and decreases that for the lung. CsA modulated the expression of MHC class I and class II antigens, but no significant differences in the resistance of CsA-treated B16F10 cells to NK lysis were observed. Finally, proliferation of B16F10 cells in the presence of several doses of CsA did not vary and CsA increased the amount of IL-1beta mRNA expression. These results suggest that CsA, through the modulation of cytokines and MHC antigen expression on B16F10 cells, could have an effect upon the metastatic progression of the B16F10 melanoma.

Effect of IL-2 and IL-6 on parameters related to metastatic activity in a murine melanoma.

Previous results have shown that the metastatic colonization with B16F10 melanoma in vivo increased after in vitro treatment of the cells with IL-2 or IL-6. To further investigate the mechanisms underlying this effect, we have studied adhesion, invasion, and proliferation properties of B16 melanoma, using two sublines with different metastatic ability. Adhesion of tumor cells to Matrigel coats increased using IL-6, which also induced upregulation of VLA-4 expression in both sublines. Unexpectedly, invasion through Matrigel filters was almost completely inhibited by IL-6 and decreased in the presence of IL-2. Cell growth was not affected by these interleukins; however, IL-6 could partially overcome the proliferation blockade induced by stress conditions. Taken together, these results suggest that upregulation of adhesion properties and/or the protective effect induced by IL-6 could account for the enhancement of metastasis exerted by this interleukin.

Serum-soluble IL-2 receptor and IL-6 levels in patients with melanoma.

Elevated soluble IL-2 receptor (sIL-2R) and IL-6 serum concentrations have been reported as adverse prognostic factors in several types of cancer. In order to determine whether these factors are predictive of metastatic progression in melanoma, sIL-2R and IL-6 levels were measured in sera from 172 patients with melanoma and 60 in healthy controls. Mean sIL-2R values were significantly higher in the patients than in normal controls and the highest values were observed in those that developed metastasis during follow-up. However, no correlation was found with the stage of the disease. Serum IL-6 levels were found to be correlated with age and sex, but not correlated with sIL-2R levels. Statistical analysis was based on logistic and Cox regression models. The factors considered were age, sex, stage, disease-free interval and serum sIL-2R and IL-6 levels. The analysis showed that only the sIL-2R value is significantly linked to metastatic progression. This finding suggests that high serum levels of sIL-2R could be a predictive factor of metastatic progression in malignant melanoma.

Soluble interleukin-2 receptor, intercellular adhesion molecule-1 and interleukin-10 serum levels in patients with melanoma.

Serum soluble interleukin-2 receptor (sIL-2R), intercellular adhesion molecule-1 (sICAM-1) and interleukin-10 (IL-10) have each been reported as useful markers for melanoma progression. To evaluate the clinical relevance of these three markers, we simultaneously analysed their serum levels in patients with melanoma. A longitudinal study with a 3-year follow-up was performed and different stages of the disease were considered. Mean values of sIL-2R were significantly higher than in normal controls in all stages and correlated with the disease progression. The prognosis of patients with levels > 529 U/ml of sIL-2R was significantly poorer than in patients with sIL-2R levels < 529 U/ml. Levels of sICAM-1 were also elevated in melanoma patients, specially at the time of the metastatic disease. Serum IL-10 levels were more frequently detectable in the patients that developed metastasis during follow-up, and the prognosis of patients with detectable IL-10 levels was significantly poorer than in those patients with IL-10 undetected levels. Statistical analysis based on Logistic and Cox regression models showed that only sex, stage and sIL-2R value are factors significantly associated with metastatic progression. Moreover, high levels of sIL-2R could be a risk factor for malignant progression in melanoma.

Síndrome del Hamulus Pterigoideo / Pterygoid Hamulus Syndrome

El síndrome del Hamulus Pterigoideo se produce por una bursitis en el tendón del músculo tensor del velo del paladar. Presenta una patología dolorosa y muy variada dada la complejidad de la región y muchas veces este dolor puede enmascarar diferentes patologías que hay que diagnosticar y diferenciar. El tratamiento es multidisciplinario en muchos de los casos (AU)

The Pterygoid Hamulus Syndrome is produced by bursitis in the tendon of the tensormuscle of the soft palate. It presents a painful and varied pathology given the complexity of the region and many times this pain can mask different pathologies that must be diagnosed and differentiated. The treatment is multidisciplinary in many of the cases (AU)

Puesta al día en adhesivos para prótesis removibles / No disponible

Los adhesivos para prótesis removibles son un método alternativo para pacientes que presentan condiciones particulares por lo tanto es nuestra obligación como profesionales estar debidamente informados para poder prescribirlos adecuadamente, conociendo sus presentaciones, formulaciones, indicaciones y contraindicaciones para cada tipo de paciente y sus circunstancias particulares (AU)

The adhesives for removable prostheses are an alternative method for patients that present particular conditions on which it is our obligation as professionals to be duly informed in order to be able to prescribe them appropriately, knowing their presentations, formulas, indications and contraindications for each type of patient and their particular circumstances (AU)

Piedras de afilado para instrumental odontológico / Sharpening Stones for Dental Instruments

Los instrumentos dentales con el uso se van deteriorando y perdiendo el filo o corte, por lo que se debe realizar un afilado con las piedras adecuadas y la técnica correcta para mantenerlos en buen estado y fieles a su diseño original. En este trabajo haremos una puesta al día de este tema (AU)

With use, dental instruments deteriorate and lose their edge or cut, for which reason they must be sharpened with the proper stones and the correct technique to keep them in good condition and according to their original design. In this paper, we will update this subject (AU)