Influence of familial forms of inflammatory bowel disease on the use of immunosuppressants, biological agents, and surgery in the era of biological therapies. Results from the ENEIDA project.

BACKGROUND AND AIMS: Familial inflammatory bowel disease (IBD) history is a controversial prognostic factor in IBD. We aimed to evaluate the impact of a familial history of IBD on the use of medical and surgical treatments in the biological era. METHODS: Patients included in the prospectively maintained ENEIDA database and diagnosed with IBD after 2005 were included. Familial forms were defined as those cases with at least one first-degree relative diagnosed with IBD. Disease phenotype, the use of biological agents, or surgical treatments were the main outcomes. RESULTS: A total of 5263 patients [2627 Crohn's disease (CD); 2636 ulcerative colitis (UC)] were included, with a median follow-up of 31 months. Of these, 507 (10%) corresponded to familial forms. No clinical differences were observed between familial and sporadic IBD forms except a lower age at IBD diagnosis and a higher rate of males in familial forms of UC. In CD, the proportions of patients treated with thiopurines (54.4% vs 46.7%; P = .015) and survival time free of thiopurines (P = .009) were lower in familial forms. No differences were found regarding the use of biological agents. Concerning surgery, a higher rate of intestinal resections was observed in sporadic CD (14.8% vs 9.9%, P = .027). No differences were observed in UC. CONCLUSIONS: In the era of biological therapies, familial and sporadic forms of IBD show similar phenotypes and are managed medically in a similar way; whether these is due to lack of phenotypical differences or an effect of biological therapies is uncertain. What is already known on this topic: IBD's etiopathogenesis points to an interaction between environmental and genetic factors, being familial history a controversial prognostic factor. Biological agents use and need for surgery regarding familial or sporadic forms of IBDs present conflicting results. What this study adds: Familial and sporadic forms of IBD have similar phenotypes and are managed medically and surgically in a similar way. How this study might affect research, practice or policy: Familial aggregation should not be considered a factor associated with more aggressive disease.

Sodium Tungstate (NaW) Decreases Inflammation and Renal Fibrosis in Diabetic Nephropathy.

BACKGROUND: Diabetic Nephropathy is one of the most severe complications of Diabetes Mellitus and the main cause of end-stage kidney disease worldwide. Despite the therapies available to control blood glucose and blood pressure, many patients continue to suffer from progressive kidney damage. Chronic hyperglycemia is the main driver of changes observed in diabetes; however, it was recently discovered that inflammation and oxidative stress contribute to the development and progression of kidney damage. Therefore, it is important to search for new pharmacological therapies that stop the progression of DN. Sodium tungstate (NaW) is an effective short and long-term antidiabetic agent in both type 1 and type 2 diabetes models. METHODS: In this study, the effect of NaW on proinflammatory signalling pathways, proinflammatory proteins and fibrosis in the streptozotocin (STZ)-induced type 1 diabetic rat model was analysed using histological analysis, western blotting and immunohistochemistry. RESULTS: NaW treatment in diabetic rats normalize parameters such as glycemia, glucosuria, albuminuria/creatinuria, glomerular damage, and tubulointerstitial damage. NaW decreased the proinflammatory signaling pathway NF-κB, inflammatory markers (ICAM-1, MCP-1 and OPN), profibrotic pathways (TGFß1/Smad2/3), reduced epithelial-mesenchymal transition (α -SMA), and decreased renal fibrosis (type IV collagen). CONCLUSION: NaW could be an effective drug therapy for treating human diabetic nephropathy.

Persistence, effectiveness and safety of ustekinumab and vedolizumab therapy for complex perianal fistula in Crohn's disease: The HEAL study from GETECCU.

BACKGROUND: The efficacy of ustekinumab and vedolizumab for treating complex perianal fistula in Crohn's disease has been barely studied. We aimed to assess treatment persistence, clinical remission, and safety of these drugs in this context. METHODS: Crohn's disease patients who had received ustekinumab or vedolizumab for the indication of active complex perianal fistula, were included. Clinical remission was defined according to Fistula Drainage Assessment Index (no drainage through the fistula upon gentle pressure) based on physicians' assessment. RESULTS: Of 155 patients, 136 received ustekinumab, and 35 vedolizumab (16 received both). Median follow-up for ustekinumab was 27 months. Among those on ustekinumab, 54 % achieved remission, and within this group, 27 % relapsed during follow-up. The incidence rate of relapse was 11 % per patient-year. Multivariate analysis found no variables associated with treatment discontinuation or relapse. Median follow-up time for patients receiving vedolizumab was 19 months. Remission was achieved in 46 % of the patients receiving vedolizumab, and among them, 20 % relapsed during follow-up. The incidence rate of relapse was 7 % per patient-year. Adverse events were mild in 6 % on ustekinumab and 8 % on vedolizumab. CONCLUSION: Ustekinumab and vedolizumab appear effective, achieving remission in around half of complex perianal fistula patients, with favorable safety profiles.

Sex-Related Differences in the Phenotype and Course of Inflammatory Bowel Disease: SEXEII Study of ENEIDA.

BACKGROUND & AIMS: The impact of patient sex on the presentation of inflammatory bowel disease (IBD) has been poorly evaluated. Our aims were to assess potential disparities in IBD phenotype and progression between sexes. METHODS: We performed an observational multicenter study that included patients with Crohn's disease (CD) or ulcerative colitis from the Spanish ENEIDA registry. Data extraction was conducted in July 2021. RESULTS: A total of 51,595 patients with IBD were included, 52% were males and 25,947 had CD. The median follow-up period after diagnosis was 9 years in males and 10 years in females. In CD, female sex was an independent risk factor for medium disease onset (age, 17-40 y) (relative risk ratio, 1.45; 95% CI, 1.31-1.62), later disease onset (age, >40 y) (relative risk ratio, 1.55; 95% CI, 1.38-1.73), exclusive colonic involvement (odds ratio, 1.24; 95% CI, 1.14-1.34), inflammatory behavior (odds ratio, 1.14; 95% CI, 1.07-1.21), and extraintestinal manifestations (odds ratio, 1.48; 95% CI, 1.38-1.59). However, female sex was a protective factor for upper gastrointestinal involvement (odds ratio, 0.84; 95% CI, 0.79-0.90), penetrating behavior (odds ratio, 0.76; 95% CI, 0.70-0.82), perianal disease (odds ratio, 0.77; 95% CI, 0.71-0.82), and complications (odds ratio, 0.73; 95% CI, 0.66-0.80). In ulcerative colitis, female sex was an independent risk factor for extraintestinal manifestations (odds ratio, 1.48; 95% CI, 1.26-1.61). However, female sex was an independent protective factor for disease onset from age 40 onward (relative risk ratio, 0.76; 95% CI, 0.66-0.87), left-sided colonic involvement (relative risk ratio, 0.72; 95% CI, 0.67-0.78), extensive colonic involvement (relative risk ratio, 0.59; 95% CI, 0.55-0.64), and abdominal surgery (odds ratio, 0.78; 95% CI, 0.69-0.88). CONCLUSIONS: There is sexual dimorphism in IBD. The patient's sex should be taken into account in the clinical management of the disease.

Controversies in the management of anti-TNF therapy in patients with Crohn's disease: a Delphi consensus.

BACKGROUND: Despite research, there are still controversial areas in the management of Crohn's disease (CD). OBJECTIVE: To establish practical recommendations on using anti-tumour necrosis factor (TNF) drugs in patients with moderate-to-severe CD. METHODS: Clinical controversies in the management of CD using anti-TNF therapies were identified. A comprehensive literature review was performed, and a national survey was launched to examine current clinical practices when using anti-TNF therapies. Their results were discussed by expert gastroenterologists within a nominal group meeting, and a set of statements was proposed and tested in a Delphi process. RESULTS: Qualitative study. The survey and Delphi process were sent to 244 CD-treating physicians (response rate: 58%). A total of 14 statements were generated. All but two achieved agreement. These statements cover: (1) use of first-line non-anti-TNF biological therapy; (2) role of HLA-DQA1*05 in daily practice; (3) attitudes in primary non-response and loss of response to anti-TNF therapy due to immunogenicity; (4) use of ustekinumab or vedolizumab if a change in action mechanism is warranted; (5) anti-TNF drug level monitoring; (6) combined therapy with an immunomodulator. CONCLUSION: This document sought to pull together the best evidence, experts' opinions, and treating physicians' attitudes when using anti-TNF therapies in patients with CD.

Importancia de la ruta de señalización JAK/STAT en la sepsis / Importance of the JAK/STAT signaling pathway in sepsis

RESUMEN El transductor de señal Janus-Kinasa y la vía de activación de la transcripción conocida como JAK/STAT es una ruta de señalización principal para la transducción de información en muchas citocinas inflamatorias implicadas durante la sepsis. Se ha demostrado que la vía JAK/STAT está fuertemente relacionada con el fallo multiorgánico, además que muchas citocinas pueden ejercer sus efectos biológicos a través de esta ruta. En los últimos años, se ha logrado un progreso significativo en la comprensión de las funciones de este complejo, sin embargo, su rol en la sepsis como objetivo terapéutico permanece en experimentación. En esta revisión se describen las funciones específicas de la vía JAK/STAT, su rol en la sepsis y presentamos un enfoque traslacional respecto a la perspectiva terapéutica para inhibir esta ruta de señalización durante la sepsis y su interacción con enfermedades inflamatorias como la COVID-19.

ABSTRACT The Janus-Kinase signal transducer and the transcription activation pathway known as JAK /STAT is a major signaling pathway for the transduction of information in many inflammatory cytokines involved during sepsis. The JAK /STAT pathway has been shown to be strongly related to multiorgan failure, and many cytokines can exert their biological effects through this pathway. In recent years, considerable progress has been made in understanding functions of this complex; however, its role in sepsis as a therapeutic target remains under experimentation. This review describes the specific functions of the JAK /STAT pathway, its role in sepsis, and presents a translational approach to the therapeutic perspective aiming to inhibit this signaling pathway during sepsis and its interaction with inflammatory diseases such as COVID-19.

Riesgo de infección asociado a los inhibidores de las quinasas Janus (JAK) y las terapias biológicas en enfermedad inflamatoria intestinal y artritis reumatoide. Estrategias de prevención / Risk of infection associated with Janus Kinase (JAK) inhibitors and biological therapies in inflammatory intestinal disease and rheumatoid arthritis. Prevention strategies

Los pacientes con ciertas enfermedades inflamatorias mediadas inmunológicamente, como la artritis reumatoide (AR) y la enfermedad inflamatoria intestinal (EII), presentan una mayor incidencia y gravedad de enfermedades infecciosas que la población general, asociadas especialmente a los tratamientos inmunosupresores que reciben.Dichos tratamientos actúan sobre el sistema inmunitario a través de diferentes mecanismos, causando diferentes grados de inmunosupresión y un riesgo variable dependiendo de si el patógeno es un virus, una bacteria o un hongo. Este artículo es una revisión de la bibliografía más relevante sobre el tema, seleccionada y debatida por un panel de expertos. El objetivo de este artículo es revisar el riesgo de infecciones en pacientes con EII y AR y las potenciales medidas preventivas.(AU)

Patients with certain immune-mediated inflammatory diseases, such as rheumatoid arthritis (RA) and inflammatory bowel disease (IBD), have an increased risk of severe infectious diseases than the general population, which are mainly associated with the immunosuppressive treatments that they receive.These treatments act on the immune system through different mechanisms, causing different degrees of immunosuppression and a variable risk depending on whether the pathogen is a virus, bacteria or fungus. This article reviews the most relevant literature on the subject, which was selected and discussed by a panel of experts. The aim of this article is to review the risk of infections in patients with IBD and RA, and the potential preventive measures.(AU)

Recomendaciones del Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa (GETECCU) sobre el cribado y tratamiento de la infección tuberculosa en pacientes con enfermedad inflamatoria intestinal / Recommendations of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) on screening and treatment of tuberculosis infection in patients with inflammatory bowel disease

La evidencia de que el seguimiento de las recomendaciones sobre el cribado y tratamiento de la infección tuberculosa no evita totalmente la aparición de tuberculosis en pacientes con enfermedad inflamatoria intestinal, y el uso reciente de nuevos fármacos biológicos y de nuevos inmunomoduladores, ha llevado al Grupo Español de Trabajo en Enfermedad de Crohn y en Colitis Ulcerosa a actualizar sus recomendaciones para la prevención de la tuberculosis en los pacientes con enfermedad inflamatoria intestinal. Se revisan los métodos de diagnóstico de la infección tuberculosa latente, los distintos escenarios en los que se va a realizar el cribado, las estrategias para disminuir el riesgo de tuberculosis una vez iniciado el tratamiento biológico, las pautas de quimioprofilaxis de la infección tuberculosa latente y el manejo de la tuberculosis activa durante el tratamiento biológico. Finalmente, se resumen las recomendaciones en el texto y en un algoritmo

There is evidence that following the recommendations on screening and treatment of tuberculosis infection does not completely prevent the onset of tuberculosis in patients with inflammatory bowel disease. This fact, and the increasing use of new biologics and immunomodulators, has led the Spanish Group Working on Crohn's Disease and Ulcerative Colitis to update their recommendations for the prevention of tuberculosis in patients with inflammatory bowel disease. Diagnostic methods for latent tuberculosis infection, different scenarios in which screening is to be performed, strategies to reduce the risk of tuberculosis once biological treatment is initiated and chemoprophylaxis guidelines for latent tuberculosis infection are reviewed, as well as the management of active tuberculosis during biological treatment. Finally, there is a summary of the current recommendations within the paper and in an algorithm

Daño hepatocelular, proteinuria y autoinmunidad: ¿enfermedad multisistémica o coincidencia de enfermedades? Caso clínico / Hepatocellular damage, proteinuria and autoimmunity: multisystemic disorder or coexistence of diseases?

We report a 19 years old male presenting with knee pain, elevated liver enzymes and proteinuria. Further investigation found positive antinuclear and anti-smooth muscle antibodies and a liver biopsy revealed the presence of an autoimmune hepatitis. Treatment with corticosteroids and azathioprine was started, resulting in normalization of liver enzymes but proteinuria persisted and a kidney biopsy disclosed a focal segmental glomerulosclerosis. The use of lisinopril resulted in a significative reduction of proteinuria and, after 30 months of follow up, he continues with azathioprine, lisinopril and a low prednisone dose without evidence of liver or kidney disease activity.

Conocimiento de la enfermedad y acceso al especialista descrito por pacientes españoles con colitis ulcerosa. Encuesta UC-LIFE / Knowledge of disease and access to a specialist reported by Spanish patients with ulcerative colitis. UC-LIFE survey

Antecedentes y propósito: la educación de los pacientes con colitis ulcerosa (CU) sobre su enfermedad y el acceso al especialista es importante para mejorar los resultados en salud. Nuestro objetivo fue conocer, recogiendo información directamente de los pacientes, sus fuentes de información y su conocimiento de la enfermedad, y las posibilidades de acceso al especialista en gastroenterología. Métodos: la información fue recogida mediante encuesta impresa, entregada por 39 gastroenterólogos a 15 pacientes adultos consecutivos con CU. Los pacientes contestaron de forma anónima desde su domicilio. Las respuestas se estratificaron según el tamaño del hospital (> 900; 500-900; < 500 camas). Resultados: quinientos ochenta y cinco pacientes recibieron la encuesta y 436 contestaron (74,5%; edad media 46 años (13,5), 53% hombres). La principal fuente de información fue su médico especialista (89,2%). Entre un 32% y un 80% presentaron áreas de mejora en el conocimiento de su enfermedad. El conocimiento de la enfermedad fue mejor en pacientes de hospitales pequeños (< 500 camas). La frecuencia de revisiones rutinarias fue mayor también en hospitales pequeños. Ante empeoramiento, el 60% declaró poder contactar por teléfono con su médico y el 37%, conseguir cita el mismo día. El porcentaje que declaró tener que pedir cita y esperar disponibilidad fue menor en hospitales pequeños. Conclusiones: en pacientes con CU seguidos en consultas hospitalarias, existen áreas de mejora en el conocimiento de su enfermedad. Los pacientes seguidos en hospitales pequeños parecen conocer mejor su enfermedad, son seguidos con más frecuencia en la consulta y tienen mejor acceso en caso de empeoramiento (AU)

Background and aim: Education of patients with ulcerative colitis (UC) about their disease and access to a specialist are important to improve health outcomes. Our objective was to determine, by collecting information directly from the patients, their information sources and knowledge of the disease, and the options for access to the gastroenterologist. Methods: The information was collected using a printed survey handed out by 39 gastroenterologists to 15 consecutive adult patients with UC. Patients answered anonymously from their home. The responses were stratified by hospital size (> 900; 500-900; < 500 beds). Results: A total of 585 patients received the survey and 436 responded (74.5%; mean age of 46 years [13.5], 53% men). The main information source was the specialist physician (89.2%). Between 32% and 80% of patients had areas of improvement regarding knowledge of their disease. Knowledge of the disease was better in patients from small hospitals (< 500 beds). The frequency of routine visits was also higher in small hospitals. In case of a flare-up, 60% stated they were able to contact their doctor by phone and 37%, that they could get an appointment on the same day. The percentage stating that they had to ask for an appointment and wait until their physician was available was lower in small hospitals. Conclusions: There are areas of improvement with regard to knowledge of their disease in patients with UC followed in hospital clinics. Patients followed in small hospitals seem to know their disease better, are followed more frequently in the clinic, and have better access in case of a flare-up (AU)

Histoplasmosis diseminada con síndrome hemofagocítico asociado con infección por HTLV-1. reporte de caso / Disseminated histoplasmosis with hemophagocytic syndrome associated with HTLV-1 infection. case report

Síndrome hemofagocítico (SH) es un cuadro sistémico severo usualmente fatal, reportado como causa secundariaen adultos. Histoplasmosis ha sido descrita como una de las causas, siempre en pacientes con inmunosupresión. Sepresenta el caso de un paciente varón natural de Huánuco con historia de tos y expectoración de dos meses e infiltradopulmonar intersticial y parenquimal basal derecho con adenopatía mediastinal. Ingresó con fiebre, pancitopenia,alteración de pruebas hepáticas y pruebas de coagulación que cumplía criterios de SH. En el aspirado de médulaósea se observaron inclusiones intracitoplasmáticas en los macrófagos compatibles con Histoplasma capsulatum.La serología para HTLV-1 fue positiva por lo que se analiza el rol de este virus como agente inmunosupresor quecondiciona SH secundario a histoplasmosis diseminada.

The hemophagocytic syndrome (HS) is a severe systemic illness ultimately fatal associated with underlying conditions. Histoplasmosis has been associated with HS in immunosuppressed patients. We present the case of a male patient from Huanuco with a 2-month history of productive cough and presence of interstitial pulmonary infiltrates, and consolidation in the right lower lobe associated with mediastinal lymphadenopathies on the chest x-ray. The patient presented with fever, pancytopenia and abnormalities in the liver and coagulation tests fulfilling criteria for HS. A bone marrow aspiration showed intracytoplasmic structures within the macrophages compatible with Histoplasma capsulatum. Serology for HTLV-1 was positive. We analyzed the role of HTLV-1 inducing immunosuppression leading to the development of disseminated histoplasmosis and HS.

Malabsorción de levotiroxina / Levothyroxine malabsortion

No disponible

Estudio traslacional de la vía Notch en nefropatía hipertensiva / Translational study of the Notch pathway in hypertensive nephropathy

Introducción: La ruta de señalización de Notch está activada en una gran variedad de patologías renales humanas. Recientemente hemos demostrado que la activación de esta ruta no estaría implicada en la fibrosis renal experimental inducida por angiotensina II o hipertensión. Objetivos: Evaluar si la vía Notch está activada en la fibrosis renal asociada a nefroesclerosis hipertensiva. Para validar la hipótesis se estudiaron varias patologías glomerulares caracterizadas por fibrosis túbulo-intersticial. Métodos: Se utilizaron biopsias renales de pacientes con nefroesclerosis hipertensiva, en comparación con nefropatía diabética y nefropatía membranosa en diferentes etapas de progresión. La expresión génica y proteica se evaluó por hibridación in situ e inmunohistoquímica, respectivamente. Resultados: En nefroesclerosis hipertensiva se observó baja expresión renal de proteínas de la vía Notch, no existiendo asociación entre la fibrosis túbulo-intersticial y los niveles de estas proteínas. Por el contrario, en las patologías glomerulares estudiadas se observó una elevada expresión de los transcritos Jagged-1, HES-1 y TGF-β, y de las proteínas Jagged-1 y Notch-1, localizados principalmente en células túbulo-epiteliales. Los niveles de expresión de los componentes de la vía Notch se relacionaron con el grado de fibrosis túbulo-intersticial, lo que confirma la activación de esta vía en nefropatías progresivas. Conclusiones: Nuestros datos muestran que la vía Notch no está activada en el riñón de pacientes con nefropatía hipertensiva, ampliando los resultados de los modelos experimentales de daño renal asociado a hipertensión a la patología humana. Nuestros estudios aportan nueva información sobre la compleja regulación del sistema Notch en el riñón (AU)

Introduction: The Notch signalling pathway is activated in a wide variety of human renal diseases. We have recently demonstrated that the activation of this pathway is not involved in experimental renal fibrosis induced by angiotensin II or hypertension. Objectives: To assess whether the Notch pathway is activated in renal fibrosis related to hypertensive nephrosclerosis. To test the hypothesis, various glomerular diseases characterised by tubulointerstitial fibrosis were analysed. Method: Renal biopsies were performed on patients with hypertensive nephrosclerosis, in comparison with diabetic nephropathy and membranous nephropathy at various stages. Gene and protein expression were evaluated by in-situ hybridisation and immunohistochemistry respectively. Results: In hypertensive nephrosclerosis low renal expression of notch-related proteins was observed. There was no link between tubulointerstitial fibrosis and the levels of these proteins. By contrast, in the glomerular diseases studied we observed high expression of the transcripts Jagged-1, HES-1 and TGF-β and the proteins Jagged-1 y Notch-1, localised primarily in tubuloepithelial cells. The levels of expression of the components of the Notch pathway correlate to the degree of tubulointerstitial fibrosis, which confirms the activation of this pathway in progressive nephropathies. Conclusions: Our data demonstrate that the Notch pathway is not activated in the kidneys of patients with hypertensive nephropathy, which extends the results of experimental models of kidney damage related to hypertension to the realm of human pathology. Our studies provide new information on the complex regulation of the Notch pathway in the kidney (AU)

Efecto de un anticuerpo monoclonal anti CD20 (Rituximab) en trombocitopenia inmune / Effect of an anti CD20 monoclonal antibody (Rituximab) in immune thrombocytopenia

Objetivo: Describir la respuesta terapéutica con un anticuerpo monoclonal anti CD20 (Rituximab), en pacientes con Trombocitopenia Inmune (PTI). Material y métodos: Estudio retrospectivo, descriptivo y observacional tipo serie de casos. Se revisaron las historias clínicas de pacientes adultos con PTI que recibieron el anticuerpo monoclonal anti CD20 (Rituximab), desde diciembre 2005 hasta diciembre 2010. Se definió respuesta: conteo plaquetario >30 mil, por lo menos duplicar el conteo plaquetario inicial y no signos de sangrado, y respuesta completa: conteo plaquetario >100 mil y no signos de sangrado. Resultados: Se evaluaron 24 cursos de tratamiento. Hubo respuesta en 18 (75%), en una media de 11,9 semanas (rango 0,7 û 37,4), la duración media de respuesta fue 16 meses (rango 3,3 û 55,3). Se mantuvo la respuesta obtenida en 12 pacientes, seguimiento promedio de 22 meses (rango 4 - 62). Se logró respuesta completa en 13/23 (60%) casos, en una media de 17 semanas (rango 0,7 û 62,3), con una duración media de respuesta completa de 10,1 meses (rango 2,3 û 25,2), 5 casos mantuvieron respuesta completa con una media de seguimiento de 20 meses (rango 8 û 29). Conclusiones: Se obtuvo una alta tasa de respuesta al tratamiento con Rituximab (hasta 75%) en casos de PTI que fallaron al menos a una línea de tratamiento.

Objective: To describe the therapeutic response of an anti CD20 monoclonal antibody (Rituximab) in patients with immune thrombocytopenia (ITT). Methods: Retrospective, descriptive and observational case series. The clinical charts of ambulatory patients with ITT who received Rituximab from December 2005 to December 2010 were reviewed. Response was defined as platelet count > 30 thousand, at least duplicate the initial platelet count and no evidence of bleeding, and complete response was defined as platelet count > 100 thousand and no evidence of bleeding. Results: 24 courses of treatment were evaluated. Response was obtained in 18 patients (75%); mean time to response was 11.9 weeks (range: 0,7 to 37.4); mean duration of response was 16 months (range: 3.3 to 55.3); 12 patients remained with the achieved response during a mean follow up of 22 months (range: 2.3 to 25.2). Complete response was obtained in 13/23 cases (60%); mean time to response was 17 weeks (range: 0.7 to 62,3); mean duration of response was 10,1 months (range: 2.3 to 25.2); 5 patients remained with complete response after a follow up of 20 months (range: 8-29). Conclusions: A high response rate was achieved with Rituximab (75%) in patients with ITT who had failed at least to one treatment.

Cáncer evanescente de la próstata. Presentación clínica y revisión histológica / Vanishing prostate cancer. Clinical presentation and histological review

Se ha descrito en pacientes portadores de cáncer prostático, sometidos a prostatectomía radical, la imposibilidad de identificar cáncer en la pieza quirúrgica definitiva. Este fenómeno se ha atribuido a un error en el diagnóstico o de la técnica anatomopatológica o a la curación del tumor, espontánea o inducida por la biopsia. En este estudio se evalúa la incidencia de cáncer evanescente en nuestro servicio durante 12 años, las características clínicas de los pacientes y su seguimiento. Adicionalmente, se revalúan las biopsias por punción iniciales con uso de tinciones inmunohistoquímicas. De un total de 346 pacientes operados y en ausencia de terapia neoadyuvante, en 6 (1,73%) no se pudo confirmar un cáncer prostático en la pieza quirúrgica. Al someter las placas iniciales a revisión, sólo se confirmó cáncer en 3 casos. La incidencia de cáncer evanescente en nuestro servicio para los 12 años evaluados es de un 0,86% (3/346). Durante 4,5 años de seguimiento ningún caso presentó recidiva tumoral (AU)

The impossibility to identify cancer in the final surgical specimen has been reported in some patients with prostate cancer undergoing radical prostatectomy. This has been attributed to either a wrong diagnosis or pathological technique, or to spontaneous or biopsy-induced cure of the tumor. This study assessed the incidence of vanishing prostate cancer in our department for 12 years, the clinical characteristics of patients, and their follow-up. The initial puncture biopsies were also re-evaluated using inmunohistochemical stains. Prostate cancer could not be confirmed in the surgical specimen in six out of 346 operated patients (1.73%) receiving no neoadjuvant therapy. When the initial biopsies were reviewed, cancer was only confirmed in three patients. Incidence of vanishing cancerat our department in the 12-year period considered was 0.86% (3/346). No tumor relapse occurred during 4.5 years of follow-up (AU)

Invasión perineural en la biopsia prostática transrectal: ¿Aumenta la probabilidad de cáncer extraprostático? / Perineural invasion in transrectal prostatic biopsy: is there an increase of extracapsular disease?

Introducción: La invasión perineural en biopsia transrectal se ha relacionado con un cáncer prostático de mayor estadío patológico. Materiales y métodos: Para determinar si la invasión perineural es un factor de riesgo de enfermedad extraprostática analizamos las biopsias transrectales y de prostatectomías radicales durante 11 años. Se agruparon según grupos de riesgo y se estimó Likelihood ratio (LR) de la invasión perineural como predictor de etapa pT3. Resultados: De 269 pacientes, 5,97 por ciento (16) presentaba invasión perineural en la biopsia transrectal. De estos 87,5 por ciento presentaba un estadio pT3, comparado a 41 por ciento del total. La invasión perineural tiene un LR (+) de 10,05 para enfermedad extraprostática. Cuando está presente la probabilidad de enfermedad pT3 aumenta de 20,1 por ciento a 71,6 por ciento en el grupo de riesgo bajo, de 54 por ciento a 92,1 por ciento en el riesgo medio y de 59,7 por ciento a 93,1 por ciento en el riesgo alto. Conclusiones: La invasión perineural en la biopsia prostática transrectal es un factor de riesgo de cáncer extraprostático.

Introduction: Perineural invasion in transrectal biopsy specimens correlates with higher pathological stages in prostate cancer. Material and methods: To determinate if perineural invasion is a risk factor for non organo-confined disease we analyzed 269 consecutive transrectal biopsy and radical prostatectomy specimens over the period of eleven years. They were categorized in risk groups and the Likelihood ratio (LR) of the perineural invasion as a predictor of phase pT3 was calculated. Results: Of 269 patients, 5.97 percent (16) had a perineural invasion in a transrectal biopsy. Of those patients, 87.5 percent had phase pT3, compared to 41 percent of the total. The perineural invasion has an LR (+) 10,05 for non organo-confined disease, when it’s present the LR of pT3 disease increases from 20.1percent to 71.6 percent in the low-risk group, from 54 percent to 92.1 percent in the medium risk and 59.7 percent to 93.1 percent in the high risk group. Conclusions: The perineural invasion in transrectal prostate biopsy is a risk factor for non organo-confined disease.

Síndrome de hiperinfección por strogyloides stercoralis en una paciente con infeccvión por el virus de la inmunodeficiencia humana (VIH): reporte de un caso y revisión de la literatura / Strongyloides stercoralis hyperinfection syndrome in a patient with human inmunodeficience virus infection (HIV): report of one case and review of the medical literature

Reportamos el caso de una paciente de 21 años, con la asociación síndrome de interinfección por Strongyloides stercoralis e infección por el virus de la inmunodeficiencia humana (VIH) que constituye el décimo quinto publicado en la literatura. Se revisan las hipótesis por las cuales esta asociación es infrecuente, así como las alternativas terapéuticas