Cuantificación de la atrofia cerebral en esclerosis múltiple mediante medidas bidimensionales / Quantification of brain atrophy in multiple sclerosis using two-dimensional measurements

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[Appraisal of cerebral atrophy in multiple sclerosis by means of the corpus callosum index. Reply]. / Valoracion de la atrofia cerebral en la esclerosis multiple mediante el indice de cuerpo calloso. Replica.

TITLE: Valoracion de la atrofia cerebral en la esclerosis multiple mediante el indice de cuerpo calloso. Replica.

[Appraisal of cerebral atrophy in multiple sclerosis by means of the corpus callosum index]. / Valoracion de la atrofia cerebral en la esclerosis multiple mediante el indice de cuerpo calloso.

INTRODUCTION: The course of multiple sclerosis is characterised by the development of cerebral atrophy. It is of interest to monitor it in order to evaluate the treatment response, and the preferred technique consists in performing brain volume analyses, which are currently restricted to the field of research. AIM: To analyse the corpus callosum index (CCI) as a possible alternative to the methods based on brain segmentation. SUBJECTS AND METHODS: Our sample was made up of 109 patients with recently diagnosed demyelinating diseases (90 relapsing-remitting multiple sclerosis, 7 primary progressive forms and 12 isolated demyelinating syndromes), and the CCI was calculated in their first magnetic resonance brain scan, together with 101 healthy controls. The sequences of the patients were submitted to a volumetric analysis using the software package MSmetrix. RESULTS: The mean value of the CCI was 0.377 in patients and 0.411 in the controls, and the difference was statistically significant (p < 0.001). The CCI also showed a statistically significant correlation with the brain volume (p < 0.001; r = 0.444) and with the lesional volume in the FLAIR sequence (p < 0.001; r = -0.521), while no association was observed with the volume of grey matter (p = 0.058). CONCLUSIONS: The CCI is related to the overall brain volume obtained by volumetric techniques and may reflect the presence of atrophy in the initial stages of demyelinating diseases, which makes it a fast and easy to calculate alternative.

TITLE: Valoracion de la atrofia cerebral en la esclerosis multiple mediante el indice de cuerpo calloso.Introduccion. La esclerosis multiple se caracteriza en su evolucion por el desarrollo de atrofia cerebral. Su monitorizacion resulta de interes para evaluar la respuesta al tratamiento, y son de eleccion los analisis volumetricos cerebrales, actualmente confinados al ambito de la investigacion. Objetivo. Analizar el indice de cuerpo calloso (ICC) como una posible alternativa a los metodos basados en la segmentacion cerebral. Sujetos y metodos. Se reune a 109 pacientes con enfermedades desmielinizantes de reciente diagnostico (90 con esclerosis multiple remitente recurrente, 7 con formas primarias progresivas y 12 con sindrome desmielinizante aislado) y se calcula el ICC en su primer estudio de resonancia magnetica cerebral, asi como en 101 controles sanos. Las secuencias de los pacientes se someten a analisis volumetrico mediante el programa MSmetrix. Resultados. El valor medio del ICC es de 0,377 en los pacientes y 0,411 en los controles, y la diferencia es estadisticamente significativa (p < 0,001). El ICC muestra una correlacion estadisticamente significativa con el volumen encefalico (p < 0,001; r = 0,444) y con el volumen lesional en secuencia FLAIR (p < 0,001; r = ­0,521), mientras que no se demuestra asociacion con el volumen de la sustancia gris (p = 0,058). Conclusiones. El ICC se relaciona con el volumen encefalico global obtenido mediante tecnicas volumetricas y puede reflejar la presencia de atrofia ya en los estadios iniciales de las enfermedades desmielinizantes, por lo que se presenta como una alternativa de rapido y sencillo calculo.

Subacute intoxication with sodium nitrate induces hematological and biochemical alterations and liver injury in male Wistar rats.

Nitrate pollution has emerged as a problem of great importance because in recent years, the levels of nitrate in soil and groundwater have increased, mainly through anthropogenic activities, such as the use of fertilizers in agriculture, domestic wastewater and septic tanks, industrial waste and deforestation. In animals, nitrate reduction to nitrite (NO2) and nitric oxide (NO) promote the formation of methemoglobin in the blood and the generation of highly reactive intermediates that induce oxidative stress in target organs. Exposition to nitrates has been associated with methemoglobinemia, reproductive toxicity, metabolic and endocrine alterations and cancer. This study analyzed acute intoxication with sodium nitrate (NaNO3) in male Wistar rats, aged 12-16 weeks. Four groups with n = 10 rats each were formed: group 1 was the control, and group 2, group 3 and group 4 were treated for 10 days with intragastric doses of 19, 66 and 150 mg/kg/d NaNO3, respectively. Hematological, metabolic and histological biomarkers in the liver were analyzed. The results showed high percentages of methemoglobin, an increase in NO2 in the plasma and an accumulation in the liver. Moreover, there were high counts of white blood cells and platelets in all treated groups. Additionally, there was an increase in the spleen weight in group 4. High levels of glucose, triglycerides, lactate dehydrogenase (LDH), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were observed and were significantly increased in groups 3 and 4. For oxidative stress biomarkers, there were increases in Thiobarbituric Acid Reactive Substances (TBARS), total GSH and SOD activity, mainly in group 4. Changes in mitochondrial activity were not significant. Histopathological analyses of the liver showed inflammation, infiltration of mononuclear cells, steatosis, ischemia and necrosis, and these findings were more evident at high doses of NaNO3 in which high of S-nitrosylation were found. In conclusion, NaNO3 was reduced to NO2, thereby inducing methemoglobinemia, whereas other reactive species generated oxidative stress, causing hematological and metabolic alterations and injury to the liver.

[Analysis of the direct costs associated with mechanical thrombectomy and intravenous fibrinolysis in the Hospital Universitario Central de Asturias]. / Analisis de los costes directos asociados a la trombectomia mecanica y a la fibrinolisis intravenosa en el Hospital Universitario Central de Asturias.

INTRODUCTION: The increase in the indications for mechanical thrombectomy and its implementation in Spanish hospitals makes it necessary to determine the costs related to this treatment so as to be able to streamline economic resources and allow them to be distributed in an appropriate manner. AIMS: To analyse the direct costs associated with patients with acute ischaemic stroke who are treated with intravenous fibrinolysis and with mechanical thrombectomy, and to assess the effectiveness and safety of both treatments during the first 90 days of progression in the Hospital Universitario Central de Asturias. PATIENTS AND METHODS: A retrospective analysis was performed that included 44 patients who received intravenous fibrinolysis and 61 patients treated with mechanical thrombectomy, in whom a series of clinical and economic variables were analysed. RESULTS: The mean final total cost per patient was 16,059 euros in treatments with thrombectomy and 8,169 euros in those in which intravenous fibrinolysis was administered. The percentage of patients with a good functional prognosis at 90 days was 63.93% in those treated by endovascular means and 56.82% in those who received intravenous fibrinolysis. Mortality rates were 18.03 and 11.36%, respectively. CONCLUSIONS: The mean cost of treatment with mechanical thrombectomy, as well as the total mean cost per patient during the acute phase of the disease associated with this technique, is higher than in the case of intravenous fibrinolysis. In our setting, both intravenous fibrinolysis and mechanical thrombectomy are considered to be effective and safe.

TITLE: Analisis de los costes directos asociados a la trombectomia mecanica y a la fibrinolisis intravenosa en el Hospital Universitario Central de Asturias.Introduccion. La ampliacion de las indicaciones de la trombectomia mecanica y su implementacion en los hospitales españoles hacen necesario conocer los costes relacionados con este tratamiento para racionalizar los recursos economicos y permitir una adecuada distribucion de estos. Objetivos. Analizar los costes directos asociados a los pacientes con ictus isquemico agudo tratados con fibrinolisis intravenosa y con trombectomia mecanica, y valorar la efectividad y seguridad de ambos tratamientos durante los primeros 90 dias de evolucion en el Hospital Universitario Central de Asturias. Pacientes y metodos. Se realizo un analisis retrospectivo en el que se incluyo a 44 pacientes que recibieron fibrinolisis intravenosa y a 61 pacientes tratados con trombectomia mecanica, en los que se analizaron una serie de variables clinicas y economicas. Resultados. El coste total final medio por paciente fue de 16.059 euros en los tratados con trombectomia y de 8.169 euros en los que se administro fibrinolisis intravenosa. El porcentaje de pacientes con buen pronostico funcional a los 90 dias fue del 63,93% en los tratados de forma endovascular y del 56,82% en los que recibieron fibrinolisis intravenosa. Las tasas de mortalidad fueron del 18,03% y 11,36%, respectivamente. Conclusiones. El coste medio del tratamiento con trombectomia mecanica, asi como el coste medio total por paciente durante la fase aguda de la enfermedad asociado a esta tecnica, es mayor que en el caso de la fibrinolisis intravenosa. Tanto la fibrinolisis intravenosa como la trombectomia mecanica se configuran en nuestro medio como tratamientos efectivos y seguros.

Tratamiento endovascular de la estenosis carotídea: experiencia en el Hospital Universitario Central de Asturias / Endovascular treatment of carotid stenosis: an experience in the Hospital Universitario Central de Asturias

Introducción. La estenosis carotídea es responsable de aproximadamente el 25% de los eventos cerebrovasculares isquémicos. La angioplastia-stent carotídeo (ASC) constituye un procedimiento mínimamente invasivo utilizado como alternativa a la endarterectomía carotídea, especialmente en pacientes de alto riesgo quirúrgico. Objetivo. Analizar la eficacia y seguridad del tratamiento endovascular de la estenosis carotídea en el Hospital Universitario Central de Asturias. Pacientes y métodos. Análisis retrospectivo de las estenosis carotídeas tratadas mediante ASC entre febrero de 2005 y abril de 2010, con registro de datos demográficos, diagnóstico clínico, indicación de tratamiento, tiempo entre el inicio de los síntomas y la realización del tratamiento, resultados angiográficos, complicaciones y seguimiento a largo plazo (incluyendo la tasa de reestenosis). Resultados. Se trataron 121 pacientes (77,8% varones y 22,2% mujeres), con una edad media de 70,8 ± 10,7 años. Los principales factores de riesgo vascular fueron hipertensión arterial (65,3%), tabaquismo (61,2%) y dislipidemia (42,1%). En el 86% de los casos se trataba de estenosis sintomáticas y en el 14% de asintomáticas. En un 60,3% de los casos se trataba de estenosis > 70%; en un 30,6%, de estenosis preoclusivas, y en un 9,1%, de recanalizaciones de oclusiones carotídeas inestables. El tiempo medio de tratamiento fue de 17,0 ± 8,3 días tras el evento isquémico. La estenosis residual fue inferior al 30% en todos los casos. La tasa de morbimortalidad a 30 días fue del 4,1% y la tasa de reestenosis a lo largo de un seguimiento medio de 31,2 ± 10,8 meses fue del 2,4%. Conclusiones. La ASC en nuestro hospital se configura como una técnica eficaz y segura, con una tasa de complicaciones dentro de los parámetros que justifican su indicación (AU)

Introduction. Carotid stenosis accounts for about 25% of all ischaemic cerebrovascular events. Carotid angioplasty and stenting (CAS) is a minimally invasive procedure used as an alternative to carotid endarterectomy, especially in high surgical risk patients. Aim. To analyse the effectiveness and safety of the endovascular treatment of carotid stenosis in the Hospital Universitario Central de Asturias. Patients and methods. The study consisted in a retrospective analysis of the carotid stenoses treated by means of CAS between February 2005 and April 2010, and the following information was recorded: demographic data, clinical diagnosis, indication of treatment, time between the onset of symptoms and beginning of treatment, angiographic findings, complications and long-term follow-up (including the rate of restenosis). Results. Altogether 121 patients were treated (77.8% males and 22.2% females), with a mean age of 70.8 ± 10.7 years. The main vascular risk factors were arterial hypertension (65.3%), smoking (61.2%) and dyslipidaemia (42.1%). In 86% of cases the stenoses were symptomatic and in the remaining 14% they were asymptomatic. In 60.3% of cases they were stenoses > 70%, in 30.6% they were preocclusive stenoses and in 9.1% they were recanalisations of unstable carotid occlusions. The mean treatment time was 17.0 ± 8.3 days after the ischaemic event. The residual stenosis was less than 30% in all cases. The morbidity and mortality rate at 30 days was 4.1% and the rate of restenosis throughout a mean follow-up of 31.2 ± 10.8 months was 2.4%. Conclusions. In our hospital CAS is considered an effective and safe technique, with a rate of complications that is within the parameters that justify its indication (AU)

Tratamiento quirúrgico del ictus de la arteria cerebral media / Surgical treatment of the stroke in the middle cerebral artery

Introducción. La craniectomía descompresiva aumenta la supervivencia en los infartos malignos de la arteria cerebral media (ACM). Se analizan los signos radiológicos y clínicos que predicen la evolución maligna del infarto de la ACM,y factores asociados a un peor pronóstico. Pacientes y métodos. Se estudian 30 pacientes divididos en tres grupos: pacientes operados, y pacientes no operados con ingreso en cuidados intensivos o en planta de neurología. La técnica quirúrgica consistióen la creación de una ventana ósea de al menos 10 cm de diámetro y apertura dural. Para la valoración inicial del paciente se utilizó la escala de Glasgow y la escala de ictus del National Institute of Health, y para el seguimiento, la escala modificadade Rankin, el índice de Barthel y la Glasgow Outcome Scale a los seis meses. Resultados. Los pacientes más jóvenes tienen un mejor pronóstico funcional que los mayores de 60 años. La desviación de la línea media mayor de 10 mm se asocia con un peor pronóstico, al igual que volúmenes de tejido infartado mayores de 350 cm3. Menor puntuación en la escala de Glasgow al ingreso se asocia a peor pronóstico vital y a mayor número de secuelas, así como su disminución durante el ingreso. Conclusiones. La edad condiciona la presencia de secuelas en estos pacientes. La presencia de signos clínicos de herniación (anisocoria, menor puntuación inicial o descenso importante en la escala de Glasgow) y radiológicos (desplazamiento de la línea media, volumen infartado) implica un peor pronóstico. La cirugía precoz en aquellos pacientes en que estuviera indicada reduce el número de secuelas y aumenta la supervivencia (AU)

Introduction. Decompressive craniectomy increases the survival rate in cases of malignant middle cerebral artery (MCA) stroke. The imaging and clinical signs that predict a malignant progression of stroke of the MCA are analysed, together with factors associated with a poorer prognosis. Patients and methods. The study involved 30 patients, who were divided into three groups: patients who had undergone surgery, and patients who had not undergone surgery but were admitted to intensive care or to neurology wards. The surgical procedure consisted in creating a bone window with a diameter of at least 10 cm and a dural opening. The initial evaluation of the patient was performed using the Glasgow scale and the National Institute of Health stroke scale; follow-up was carried out using the modified Rankin scale, the Barthel index and the Glasgow Outcome Scale at six months. Results. Younger patients have a better functional prognosis than those over 60 years of age. A deviation of more than 10 mm from the mean line is associated with a poorer prognosis, as are volumes of infarcted tissue above 350 cm3. Lower scores on the Glasgow scale on admission are associated with a poorer prognosis for survival and a higher number of sequelae, as well as their reduction during hospitalisation. Conclusions. Age conditions the presence of sequelae in these patients. The presence of clinical signs of herniation (anisocoria, lower initial score or important drop on the Glasgow scale) and imaging signs (displacement of the mean line, volume of infarcted tissue) imply a poorer prognosis. Early surgery in those patients in whom it is indicated reduces the number of sequelae and increases the rate of survival (AU)

[Surgical treatment of the stroke in the middle cerebral artery]. / Tratamiento quirúrgico del ictus de la arteria cerebral media.

INTRODUCTION: Decompressive craniectomy increases the survival rate in cases of malignant middle cerebral artery (MCA) stroke. The imaging and clinical signs that predict a malignant progression of stroke of the MCA are analysed, together with factors associated with a poorer prognosis. PATIENTS AND METHODS: The study involved 30 patients, who were divided into three groups: patients who had undergone surgery, and patients who had not undergone surgery but were admitted to intensive care or to neurology wards. The surgical procedure consisted in creating a bone window with a diameter of at least 10 cm and a dural opening. The initial evaluation of the patient was performed using the Glasgow scale and the National Institute of Health stroke scale; follow-up was carried out using the modified Rankin scale, the Barthel index and the Glasgow Outcome Scale at six months. RESULTS: Younger patients have a better functional prognosis than those over 60 years of age. A deviation of more than 10 mm from the mean line is associated with a poorer prognosis, as are volumes of infarcted tissue above 350 cm3. Lower scores on the Glasgow scale on admission are associated with a poorer prognosis for survival and a higher number of sequelae, as well as their reduction during hospitalisation. CONCLUSIONS: Age conditions the presence of sequelae in these patients. The presence of clinical signs of herniation (anisocoria, lower initial score or important drop on the Glasgow scale) and imaging signs (displacement of the mean line, volume of infarcted tissue) imply a poorer prognosis. Early surgery in those patients in whom it is indicated reduces the number of sequelae and increases the rate of survival.

[Assessment of quality as perceived by users of an outpatient pharmaceutical care unit]. / Evaluación de la calidad percibida por los usuarios de una unidad de atención farmacéutica a pacientes externos.

OBJECTIVE: To assess quality of care by an Outpatient Pharmaceutical Care Unit (OPCU) from patient satisfaction regarding the unit s premises and activities. METHOD: A transversal study performed at the OPCU using a patient survey. Patient opinions were obtained regarding structural aspects, pharmaceutical care, patient information, overall satisfaction, and preference for care in the OPCU or pharmacy office. The response variable was the presumed choice for the OPCU or traditional pharmacy office. A multivariate analysis using logistic regression was used to evaluate the independent effect of variables. RESULTS: In all, 256 surveys were administered, of which 195 were assessable. Response rate was 76%. Responses with highest scores included communication and interaction with professionals (4.8 points on average) and care received (4.5 points). Worst assessments included OPCU s timetable (3.8 points) and location (3.9 points); 98.4% of patients were satisfied or very satisfied with care received, and only 18.4% would switch to the pharmacy office if allowed to. The multivariate analysis suggested that variables associated with the pharmacy office choice included a negative rating of OPCU s location (OR 9.8, CI 1.3-76.8) and a negative rating of information delivered (OR 4.1, CI 1.7-9.8); p < 0.05. CONCLUSIONS: Information received and OPCU s location had the greatest impact on patient satisfaction. Patient remarks and suggestions were very useful to identify areas of improvement, and to introduce modification suiting their views.

Evaluación de la calidad percibida por los usuarios de una unidad de atención farmacéutica a pacientes externos / Assessment of quality as perceived by users of an outpatient pharmaceutical care unit

Objetivo: Evaluar la calidad de la asistencia prestada en una Unidad de Atención Farmaceútica a Pacientes Externos (UFPE) a partir de la satisfacción de los pacientes con las instalaciones y las actividades desarrolladas en la misma. Método: Estudio transversal realizado en la UFPE, mediante una encuesta. Se recogió la opinión sobre aspectos estructurales, atención farmacéutica, información al paciente, satisfacción general y preferencias a ser atendidos en la UFPE o en la oficina de farmacia. La variable de respuesta fue la elección hipotética de laUFPE o la farmacia tradicional. Se recurrió a un análisis multivariante por medio de la regresión logística para evaluar el efecto independiente de las variables. Resultados: Se entregaron 256 encuestas, de las cuales fueron evaluables 195. El porcentaje de respuesta fue del 76%. Las respuestas con mayor puntuación fueron la comunicación y trato con los profesionales (4,8 puntos sobre 5) y la información recibida (4,5 puntos). Los peores valorados fueron el horario (3,8 puntos) y la ubicación de la UFPE (3,9 puntos). El 98,4% de los pacientes estuvieron satisfechos o muy satisfechos con la atención recibida y sólo el 18,4% cambiarían, si pudieran, a la oficina de farmacia. Del análisis multivariante se dedujo que las variables asociadas a la elección de oficina de farmacia fueron la valoración negativa de la ubicación de la UFPE (OR 9,8, IC 1,3-76,8) y la valoración negativa sobre la información facilitada (OR 4,1, IC1,7-9,8), p < de 0,05. Conclusiones: La información recibida y la ubicación de la UFPE fueron los factores que más peso tuvieron en la satisfacción de los pacientes. Las observaciones y sugerencias aportadas, fueron muy útiles para detectar puntos de mejora e introducir modificaciones según sus opiniones

Objective: To assess quality of care by an Outpatient Pharmaceutical Care Unit (OPCU) from patient satisfaction regarding the unit's premises and activities. Method: A transversal study performed at the OPCU using apatient survey. Patient opinions were obtained regarding structural aspects, pharmaceutical care, patient information, overall satisfaction, and preference for care in the OPCU or pharmacy office.The response variable was the presumed choice for the OPCU ortradicional pharmacy office. A multivariate analysis using logistic regression was used to evaluate the independent effect of variables. Results: In all, 256 surveys were administered, of which 195 were assessable. Response rate was 76%. Responses with highest scores included communication and interaction with professionals (4.8 points on average) and care received (4.5 points). Worst assessments included OPCU's timetable (3.8 points) and location (3.9 points); 98.4% of patients were satisfied or very satisfied with care received, and only 18.4% would switch to the pharmacy office if allowed to. The multivariate analysis suggested that variables associated with the pharmacy office choice included a negative rating of OPCU's location (OR 9.8, CI 1.3-76.8) and a negative rating of information delivered (OR 4.1, CI 1.7-9.8); p <0.05. Conclusions: Information received and OPCU's location had the greatest impact on patient satisfaction. Patient remarks and suggestions were very useful to identify areas of improvement, and to introduce modification suiting their views

[Drug therapy for corneo-conjunctival neoplasm]. / Tratamiento farmacológico de la neoplasia corneal y conjuntival.

BACKGROUND: The goal of therapy for corneo-conjunctival neoplasm is lesion removal, with the most widespread procedure being complete tumor resection with or without associated chemotherapy lines. As this sort of procedure entails a high relapse rate (9-52%) the use of adjuvant therapies to reduce the occurence of relapse becomes a need. The administration of a number of topically administered drugs has been used for adjuvant therapy, including mitomycin C, 5-fluorouracil and interferon a 2b. OBJECTIVE: To determine the clinical experience published regarding the effectiveness of the various drug therapies for cor-neo-conjunctival neoplasm. SEARCH STRATEGY: Information reported on this topic in the Medline database (1966-2004) was searched using corneo-conjunctival neoplasm, 5-fluorouracil, mitomycin C, and interferon ca2b as key words. SELECTION CRITERIA: All papers quoting dosage for drugs used,treatment length, adverse effect development, and clinical response obtained were included. PRIMARY RESULTS: Papers reporting the use of 5-fluorouracil re few when compared to those quoting other drugs, with a response rate of 88% and a relapse rate of 20%. The use of mitomycin C is widely described in the medical literature with a response rate of 90% and a relapse rate of 13%, but in association with the development of adverse effects in a high percentage of patients. Interferon ca 2b is the last drug to be incorporated in the treatment of these ocular lesions, with a response rate of 100% and a low incidence of adverse effects, with a relapse rate of 4%. CONCLUSIONS: Mitomycin C is an effective drug, but its use is associated with a high number of adverse events, some of which may lead to therapy discontinuation. Interferon ct 2b has efficacy outcomes comparable to mitomycin C and a lower incidence of adverse effects, which are mostly mild in nature. The use of 5-fluorouracil is relegated to a second-tier status.

Tratamiento farmacológico de la neoplasia corneal conjuntival / Drug therapy for corneo-conjunctival neoplasm

Antecedentes: El objetivo del tratamiento de la neoplasia córneo- conjuntival es la eliminación de la lesión, siendo el más extendido la resección quirúrgica completa del tumor asociado o no a varias hileras de crioterapia. Debido a la elevada tasa de recidivas de este tipo de intervención (9-52%), se hace necesaria la utilización de tratamientos adyuvantes que la reduzcan. Para el tratamiento adyuvante se ha empleado la administración de varios fármacos por vía tópica tales como: la mitomicina-C, el 5-fluorouracilo y el interferón alfa 2b. Objetivo: Conocer la experiencia clínica publicada sobre la efectividad de los diferentes tratamientos farmacológicos de la neoplasia córneo-conjuntival. Estrategia de la búsqueda: Se revisó la información publicada sobre este tema en la base de datos Medline (1966-2004), utilizando como palabras clave neoplasia córneo conjuntival, 5- fluorouracilo, mitomicina C e interferón alfa 2b. Criterios de selección: Se incluyeron todos los trabajos en los que se expresaba la dosis de fármaco utilizado, la duración del tratamiento, la aparición de efectos adversos y la respuesta clínica obtenida. Resultados principales: Los artículos publicados en los que se ha utilizado el 5-fluorouracilo son escasos en comparación con los publicados con los otros dos fármacos, presentando una tasa de respuesta del 88% y una tasa de recidivas del 20%. La utilización de mitomicina-C está ampliamente descrita en la literatura médica con una tasa de respuesta del 90% y tasa de recidivas del 13%, pero está asociada a la aparición de efectos adversos en un porcentaje elevado de pacientes. El interferón alfa 2b, ha sido el último fármaco incorporado para el tratamiento de estas lesiones oculares obteniendo unos resultados en cuanto a respuesta del 100% y un bajo número de efectos adversos, con un tasa de recidivas del 4%. Conclusiones: La mitomicina C es un fármaco eficaz, pero que se asocia a la aparición de un gran número de efectos adversos, que en algunos casos obligan a suspender el tratamiento. El interferón alfa 2b presenta unos resultados de eficacia comparables a la mitomicina-C y con un menor número de reacciones adversas, siendo en su mayoría de carácter leve. Queda en un segundo plano la utilización del 5-fluorouracilo

Background: The goal of therapy for corneo-conjunctival neoplasm is lesion removal, with the most widespread procedure being complete tumor resection with or without associated chemotherapy lines. As this sort of procedure entails a high relapse rate (9-52%) the use of adjuvant therapies to reduce the occurence of relapse becomes a need. The administration of a number of topically administered drugs has been used for adjuvant therapy, including mitomycin C, 5-fluorouracil and interferon alpha 2b. Objective: To determine the clinical experience published regarding the effectiveness of the various drug therapies for corneo- conjunctival neoplasm. Search strategy: Information reported on this topic in the Medline database (1966-2004) was searched using corneo-conjunctival neoplasm, 5-fluorouracil, mitomycin C, and interferon alpha 2b as key words. Selection criteria: All papers quoting dosage for drugs used, treatment length, adverse effect development, and clinical response obtained were included. Primary results: Papers reporting the use of 5-fluorouracil are few when compared to those quoting other drugs, with a response rate of 88% and a relapse rate of 20%. The use of mitomycin C is widely described in the medical literature with a response rate of 90% and a relapse rate of 13%, but in association with the development of adverse effects in a high percentage of patients. Interferon alpha 2b is the last drug to be incorporated in the treatment of these ocular lesions, with a response rate of 100% and a low incidence of adverse effects, with a relapse rate of 4%. Conclusions: Mitomycin C is an effective drug, but its use is associated with a high number of adverse events, some of which may lead to therapy discontinuation. Interferon alpha 2b has efficacy outcomes comparable to mitomycin C and a lower incidence of adverse effects, which are mostly mild in nature. The use of 5-fluorouracil is relegated to a second-tier status

[Intravenous immunoglobulin therapy in Vogt-Koyanagi-Harada syndrome]. / Inmunoglobulinas en el síndrome de Vogt-Koyanagi-Harada.

Vogt-Koyanagi-Harada (VKH) syndrome or uveomeningitic syndrome is a disease affecting several organs: eye (bilateral uveitis, exudative retinal detachments), ear (tinnitus, dysacousia), skin and hair (vitiligo, alopecia, poliosis) and the nervous system (meningism, headache, pleocytosis in cerebrospinal fluid). The etiology remains unknown but it is probably a cell-mediated autoimmune disorder in individuals genetically susceptible to antigenic components of melanocytes. We report a 25 year old patient with VKH syndrome treated with intravenous steroid therapy and cycles of intravenous immunoglobulin with good clinical response. We concluded that treatment of the VKH syndrome should be early but definitely aggressive with high doses of systemic corticosteroids and intravenous immunoglobulin, assessing the maintenance of the latter by cycles.

[Ring chromosome 20: a distinctive syndrome identifiable by electroclinical diagnosis]. / Cromosoma 20 en anillo: un síndrome identificable por las características electroclínicas.

The ring chromosome 20 syndrome is characterized by treatment resistant non-convulsive status epilepticus, and slow waves intercalated by spikes/spike waves predominantly in the front-temporal regions. Here, we describe the case of an 18 year old patient, whose seizures began at the age of 10, these being resistant to treatment. Neurologic examination and cranial MRI were normal. Interictal EEG showed normal background activity with burst of 2-20 seconds with bilateral spike wave. Ictal EEG showed continuous paroxysmal activity with generalized spike waves discharges and slow delta waves, coinciding with nonconvulsive status epilepticus. After 1 mg of intravenous clonazepam, both clinical semiology and EEG abnormalities disappeared. A cytogenetic study showed ring chromosome 20 in 35 % of metaphases. The epilepsy associated with ring chromosome 20 constitutes a syndrome with its distinctive electroclinical characteristics.

[Charles Bonnet's syndrome]. / Síndrome de Charles Bonnet.

Charles Bonnet's syndrome is characterized by the existence of visual hallucinations without psychiatric manifestations or cognitive disorder. Most patients are elderly people with severe visual problems. The objective of this paper is to describe the cases of three patients with this syndrome. The first is an 87 year old woman with bilateral cataract who had visual hallucinations seeing women and faces. The second is another 87 year old woman with advanced myopia and visions of people, animals and objects. The third is a 52 year old woman with atypical pigmentary retinopathy who suffered visual hallucinations of objects and animals in color. The neuroimaging and neurophysiological studies were not contributory. Treatment with neuroleptics or antiepileptics was effective only in one case. We conclude that it is important to know the syndrome and to differentiate it from psychiatric semiology. Deafferentation of the visual cortex could be the decisive factor in the occurrence of visual hallucinations.

Evaluation of once daily tobramycin dosing in critically ill patients through Bayesian simulation.

OBJECTIVE: To evaluate if once-daily dose (ODD) regimens of tobramycin attain pharmacodynamic goals using individualized pharmacokinetic monitoring of critically ill patients with creatinine clearance (Clcr) over 60 mL/min. METHODS: Fifty-one adult critically ill patients treated with intravenous tobramycin with ODD were included in the study. The effect of dosing using the proposed method was compared with a weight-based (7 mg/kg) dosing method. Pharmacokinetics parameters, peak concentration (Cpeak), minimum concentration (Cmin) and the time below the minimum inhibitory concentration (MIC) were estimated using Bayesian analysis. Pharmacodynamic parameters used to evaluate both dosing regimens were Cpeak/MIC ratio and, secondly, time below MIC (T< MIC). RESULTS: The median dose of tobramycin administrated in our hospital was too low for achieving pharmacodynamic goals. In contrast, the weight-based (7 mg/kg) method produced an adequate Cpeak/MIC ratio but an increase of the dose would not reduce the secondary pharmacodynamic index T60 mL/min achieved the Cpeak/MIC target values of 10. However in critically ill patients with Clcr>80 mL/min, T

[Headache associated with cyclosporin ina patient with membranous glomerulonephritis]. / Cefalea asociada a ciclosporina en una paciente con glomerulonefritis membranosa.

OBJECTIVE: To report the case of a patient diagnosed with membranous glomerulonephritis and autoimmune non-central neutropenia under treatment with cyclosporin who developed severe, disabling headache. CASE REPORT: A 66-year-old female patient with no history of headache or adverse drug reactions was diagnosed with membranous glomerulonephritis and autoimmune non-central neutropenia. Neoral (cyclosporin A) was initiated at a dose of 2.5 mg/kg/24 h (100 mg/12 h), with whole blood cyclosporin levels within the therapeutic range. After 5 days the patient reported holocranial severe, disabling headache. A cranial CT scan was normal and other headache causes were also ruled out; her headache subsided only upon cyclosporin discontinuation. COMMENT: Severe headache is an uncommon adverse effect of cyclosporin whose recognition is relevant, since it may compromise therapy compliance and require the drug to be discontinued. The attribution of cyclosporin with this neurotoxic effect was analyzed using Naranjo's probability estimation method for adverse drug reactions, which resulted in causality being considered probable.

Medicamentos que contienen látex: una información necesaria en la guía farmacoterapéutica / Latex-containing drugs: a piece of information to be necessarity included in the Pharmaco-Therapeutic Guide

Introducción: El aumento de la incidencia de alergia al látex, la gravedad de las manifestaciones clínicas y la ausencia de una legislación que regule la advertencia del contenido en látex en medicamentos y productos sanitarios, motivó en nuestro Servicio la consideración de información imprescindible a incluir en la nueva edición de la Guía Farmacoterapéutica del hospital. Método: Elaboración de un listado de medicamentos y soluciones intravenosas susceptibles de contener látex en su material de acondicionamiento. Se agruparon por laboratorio fabricante y se solicitó a cada uno de ellos a través de conversación telefónica, información escrita (fax o carta) acerca del contenido en látex de sus productos. La información se completó con la búsqueda de trabajos publicados en nuestro entorno profesional sobre listados de contenido en látex de especialidades farmacéuticas. Resultados: Se evaluaron: a) un total de 188 especialidades farmacéuticas. Se obtuvo información escrita para 129 de ellas (68,6 por ciento), de las cuales se identificaron como seguras 100 (53,2 por ciento), recogidas en la tabla III, mientras que 29 (15,4 por ciento) se catalogaron como especialidades farmacéuticas con potencial riesgo en pacientes sensibilizados al látex (Tabla IV). No se pudieron clasificar por falta de información 59 (31,4 por ciento). De ellas, se obtuvo información indirecta para 23 (12,2 por ciento) a partir de los listados de fármacos elaborados por distintos Servicios de Farmacia (Tabla V). Mientras que las 36 (19,2 por ciento) restantes quedaron sin catalogar (Tabla VI). b) la información sobre el contenido en látex de las soluciones para infusión intravenosa y para irrigación está documentada por cada laboratorio fabricante y se recoge globalmente en la tabla VII. Conclusiones: Consideramos necesario conocer en un determinado entorno sanitario los medicamentos seguros para pacientes alérgicos al látex, teniendo en cuenta que los únicos elastómeros realmente exentos de látex son los fabricados con gomas sintéticas, siendo la GFT el mejor instrumento de transmisión de dicha información (AU)