Paniculitis mesentérica asociada al uso de bifosfonatos: ¿son estos más proinflamatorios de lo que sabemos? / Mesenteric panniculitis associated with the use of bisphosphonates: are these more proinflammatory than we know?

La paniculitis mesentérica se caracterizada por una inflamación crónica inespecífica del tejido adiposo del mesenterio intestinal, y su etiología es desconocida. Se ha relacionado con malignidad, vasculitis, enfermedades reumáticas y con determinados fármacos. Presentamos un caso de paniculitis mesentérica asociada a la toma de bifosfonatos, no descrita previamente en la literatura, apoyando así el concepto de sus potenciales efectos secundarios proinflamatorios (AU)

Mesenteric panniculitis is characterized by chronic inflammation of the adipose tissue of the intestinal mesentery, and its etiology is unknown. It has been associated with malignancy, vasculitis, rheumatic diseases and the use of certain drugs. We present a case of panniculitis associated with bisphosphonate use, not previously described in the literature, thus suggesting its potential secondary proinflammatory effects (AU)

Oral chemotherapy in elderly women with metastatic breast cancer.

Life expectancy has significantly increased over the past 30 years, with a greater prevalence of diverse disease states, especially cancer. As older persons are a very heterogeneous group with an increased prevalence of comorbidities and a relative inability to tolerate the adverse effects of chemotherapy, the treatment of cancer in the elderly is particularly demanding. The principles of its management are similar to those in younger patients but with special considerations linked to comorbidities and clinical status. The objective of chemotherapeutic treatment in metastatic breast cancer has historically been primarily palliative. The introduction of newer approaches with improved or at least equivalent efficacy and reduced toxicity is highly desirable. Such approaches may include the use of less toxic drugs, more convenient routes of administration (e.g., oral) and home-based (outpatient) rather than hospital-based therapies. The available oral cytostatic drugs include vinorelbine and capecitabine. In this review, we analyze oral cytostatic drugs in the elderly patient diagnosed with metastatic breast cancer.

Tools for decision-making in older cancer patients. Role of the comprehensive geriatric assessment.

Approximately 60% of cancer incidence and 70% of cancer mortality occurs in individuals older than 65 years. The optimal approach to cancer therapy in older adults is often unclear. Historically, advanced age has been an exclusion criterion in clinical cancer trials, and older adults have been consistently underrepresented. As a result, there is a lack of information about treatment efficacy and tolerability in this population. Comprehensive Geriatric Assessment (CGA) is one of the most useful tools for the oncologist to make decisions related to older patients diagnosed with cancer. This tool has proved to be very useful to detect many deficits, tolerance to chemotherapy and survival in such patients. In this review, we analyze the role of CGA in decision making in geriatric oncology.

Targeted anti-HER2 cancer therapy in elderly women diagnosed with breast cancer.

Trastuzumab or lapatinib treatment with chemotherapy or hormonotherapy are the gold standard treatments for human epidermal growth factor receptor 2 (HER2)-positive breast cancer (early breast cancer or metastatic breast cancer). Older patients have been largely underrepresented in clinical trials, and few data on trastuzumab or lapatinib efficacy and toxicity have been reported for this subgroup. This article has reviewed the main articles that have analyzed these items.

Recalibración del Palliative Prognostic Index en pacientes con enfermedades médicas avanzadas / Adaptation of the Palliative Prognostic Index in patients with advanced medical conditions

Objetivo. Analizar el rendimiento del Palliative Prognostic Index (PPI) en los pacientes con enfermedades médicas en estadio avanzado, y recalibrarlo para adaptarlo al perfil de estos pacientes. Métodos. Estudio prospectivo observacional multicéntrico. Se incluyeron pacientes con una o más enfermedades médicas avanzadas. Se analizó la calibración (bondad de ajuste de Hosmer-Lemeshow) y el poder discriminativo (curva ROC y área bajo la curva [AUC]) del PPI en la predicción de la mortalidad a los 180 días. La recalibración se llevó a cabo analizando las puntuaciones en el PPI de cada cuartil ascendente de probabilidad de fallecer. Se comparó la precisión del PPI con la obtenida con el índice de Charlson. Resultados. La mortalidad global de los 1.788 pacientes fue del 37,5%. La calibración en la predicción de mortalidad fue buena (bondad de ajuste con p=0,21), oscilando la probabilidad pronosticada entre 0-0,25 en el primer cuartil de riesgo, y 0,48-0,8 en el último cuartil. El poder discriminativo fue aceptable (AUC=0,69; p<0,0001). En los grupos recalibrados, la mortalidad de los pacientes con 0/1-2/2,5-9,5 >=10 puntos fue del 13, 23, 39 y 68%, respectivamente. La sensibilidad y el valor predictivo negativo del punto de corte de la escala por encima de 0 fueron 96 y 87%, respectivamente; la especificidad y el valor predictivo positivo del punto de corte de la escala por encima de 9,5 fueron del 95 y 68%. La calibración del índice de Charslon fue buena (p=0,2), y el poder discriminativo subóptimo (AUC=0,52; p=0,06). Conclusiones. El PPI en los pacientes con enfermedades médicas en estadio avanzado puede ser de utilidad para el pronóstico de supervivencia a 6 meses (AU)

Objective. To analyze the accuracy of the Palliative Prognostic Index (PPI) in patients with advanced medical diseases and to recalibrate it in order to adapt it to the profile of these patients. Methods. Multicenter, prospective, observational study that included patients with one or more advanced medical diseases. Calibration (Hosmer-Lemeshow goodness of fit) and discriminative power (ROC and area under the curve [AUC]) of PPI were analyzed in the prediction of mortality at 180 days. Recalibration was carried out by analyzing the scores on the PPI of each quartile upward of dying probability. Accuracy of PPI was compared with that obtained for the Charlson index. Results. Overall mortality of the 1.788 patients was 37.5%. Calibration in the prediction of mortality was good (goodness of fit with P=.21), the prognostic probabilities ranging from 0-0,25 in the first quartile of risk and from 0,48-0,8 in the last quartile. Discriminative power was acceptable (AUC=69; P=.0001). In recalibrated groups, mortality of patients with 0/1-2/2.5-9.5/>=10 points was 13, 23, 39 and 68%, respectively. Sensitivity (S) and negative predicative value (NPF) of the cutoff point above 0 points were 96 and 87%, respectively; while specificity (sp) and positive predictive value (PPV) of the cutoff point above 9.5 points were 95 and 68%. Calibration of the Charlson index was good (P=.2), and its discriminative power (AUC=.52; P=.06) was suboptimal. Conclusions. PPI can be a useful tool in predicting 6-month survival of patients with advanced medical conditions (AU)

Adaptation of the Palliative Prognostic Index in patients with advanced medical conditions.

OBJECTIVE: To analyze the accuracy of the Palliative Prognostic Index (PPI) in patients with advanced medical diseases and to recalibrate it in order to adapt it to the profile of these patients. METHODS: Multicenter, prospective, observational study that included patients with one or more advanced medical diseases. Calibration (Hosmer-Lemeshow goodness of fit) and discriminative power (ROC and area under the curve [AUC]) of PPI were analyzed in the prediction of mortality at 180 days. Recalibration was carried out by analyzing the scores on the PPI of each quartile upward of dying probability. Accuracy of PPI was compared with that obtained for the Charlson index. RESULTS: Overall mortality of the 1.788 patients was 37.5%. Calibration in the prediction of mortality was good (goodness of fit with P=.21), the prognostic probabilities ranging from 0-0,25 in the first quartile of risk and from 0,48-0,8 in the last quartile. Discriminative power was acceptable (AUC=69; P=.0001). In recalibrated groups, mortality of patients with 0/1-2/2.5-9.5/≥10 points was 13, 23, 39 and 68%, respectively. Sensitivity (S) and negative predicative value (NPF) of the cutoff point above 0 points were 96 and 87%, respectively; while specificity (sp) and positive predictive value (PPV) of the cutoff point above 9.5 points were 95 and 68%. Calibration of the Charlson index was good (P=.2), and its discriminative power (AUC=.52; P=.06) was suboptimal. CONCLUSIONS: PPI can be a useful tool in predicting 6-month survival of patients with advanced medical conditions.

Comorbilidad, discapacidad y mortalidad en pacientes pluripatológicos con enfermedad pulmonar obstructiva crónica / Comorbidity, discapacity and mortality in patients with multiple conditions and chronic obstructive pulmonary disease

Objetivo. Estudiar la asociación entre diferentes comorbilidades y condiciones clínicas con la mortalidad en pacientes pluripatológicos (PPP) con enfermedad pulmonar obstructiva crónica (EPOC). Pacientes y métodos Estudio observacional, prospectivo y multicéntrico. Se han incluido pacientes consecutivos con EPOC y criterios de PPP. Se han recogido las variables: edad, sexo, índice de Charlson, comorbilidades, índice de Barthel, índice de Lawton-Brody, test de Pfeiffer, escala de Gijón, nivel de educación, hospitalizaciones en los últimos 3 y 12 meses y supervivencia al cabo de un año. Mediante un análisis univariante y una regresión logística se ha establecido la relación de las variables con la mortalidad. Resultados. Se han incluido 688 PPP con EPOC con edad media 77,9 años. La puntuación media (DE) en el índice de Charlson fue 3,99 (2,07). Las comorbilidades más frecuentes son insuficiencia cardiaca (59%), diabetes (48%), infarto de miocardio (29,4%), insuficiencia renal moderada (22%), enfermedad cerebrovascular (19%), hipertensión arterial (71%), anemia (62%), fibrilación auricular (34%), dislipemia (28%) y obesidad (21%). El 26% tenía dependencia para las actividades básicas de la vida diaria, el 47% precisaba de un cuidador y el 54% tenía riesgo de problema social. Al cabo de un año fallecieron 258 pacientes (37%). El índice de Charlson, la dependencia para las actividades de la vida diaria y la anemia se asocian con una mayor mortalidad y la hipertensión arterial y saber leer y escribir con menor mortalidad. Conclusiones. La comorbilidad y la discapacidad son dos factores pronósticos en los pacientes con EPOC(AU)

Aims. To determine the association between different comorbidities and other clinical conditions with mortality in patients with multiple diseases (PMD) suffering from chronic obstructive pulmonary disease (COPD). Subjects and methods. Patients with COPD and PMD criteria were included in an observational, prospective and multicentrer study. Data on age, gender, Charlson index, Barthel index, Lawton-Brody index, Pfeiffer test, sociofamilial Gijon scale, education level, hospitalizations during the previous 3 and 12 months and survival at one year were collected. The relationship between the variables and mortality were established by means of a univariate analysis and logistic regression model. Results. A total of 688 PMD with COPD and mean age of 77.9 years were included. The mean score one the Charlson index was 3.99 (2.07). The most frequent comorbidities were heart failure (59%), diabetes (48%), myocardial infarction (29%), moderate kidney failure (22%), cerebrovascular disease (19%), hypertension (71%), anemia (62%), atrial fibrillation (34%), dyslipidemia (28%) and obesity (21%). A total of 26% of patients were dependent for activities of daily living, 47% needed a caregiver and 54% were at risk of having social problems. At one year, 258 patients (37%) had died. The Charlson index, dependency for activities of daily living and anemia were associated with mortality and hypertension and capacity for reading and writing were associated with survival(AU)

[Comorbidity, discapacity and mortality in patients with multiple conditions and chronic obstructive pulmonary disease]. / Comorbilidad, discapacidad y mortalidad en pacientes pluripatológicos con enfermedad pulmonar obstructiva crónica.

AIMS: To determine the association between different comorbidities and other clinical conditions with mortality in patients with multiple diseases (PMD) suffering from chronic obstructive pulmonary disease (COPD). SUBJECTS AND METHODS: Patients with COPD and PMD criteria were included in an observational, prospective and multicentrer study. Data on age, gender, Charlson index, Barthel index, Lawton-Brody index, Pfeiffer test, sociofamilial Gijon scale, education level, hospitalizations during the previous 3 and 12 months and survival at one year were collected. The relationship between the variables and mortality were established by means of a univariate analysis and logistic regression model. RESULTS: A total of 688 PMD with COPD and mean age of 77.9 years were included. The mean score one the Charlson index was 3.99 (2.07). The most frequent comorbidities were heart failure (59%), diabetes (48%), myocardial infarction (29%), moderate kidney failure (22%), cerebrovascular disease (19%), hypertension (71%), anemia (62%), atrial fibrillation (34%), dyslipidemia (28%) and obesity (21%). A total of 26% of patients were dependent for activities of daily living, 47% needed a caregiver and 54% were at risk of having social problems. At one year, 258 patients (37%) had died. The Charlson index, dependency for activities of daily living and anemia were associated with mortality and hypertension and capacity for reading and writing were associated with survival. CONCLUSIONS: Comorbidity and discapacity are two prognostic factors in COPD patients.

Malignant uveitis masking a lymphocytic lymphoma

A multitude of diseases can present as posterior bilateral uveitis. In most cases, the cause of pericardial effusion can be determined, but in some instances, the cause is not apparent even after making a systematic and complete diagnostic evaluation. We report here an unusual case of a patient who had a B-cell lymphochytic lymphoma, which presented as bilateral posterior uveitis. The diagnosis by biopsy is described, as is the role of multiple test in the diagnosis of bilateral uveitis (AU)

[Fever of unknown origin as first manifestation of two cases of cervix carcinoma]. / Fiebre de origen desconocido como presentación inicial de dos casos de carcinoma epidermoide de cérvix.

We present the case of two women with FUO as first manifestation of a cervical carcinoma. In both cases, wide spectrum antibiotic treatment (and tuberculostatic medication in the first woman) were not useful to stop fever. Autoimmune diseases tests were normal. Just image techniques let us detect a suspicious lesion (specially, abdomino-pelvic magnetic resonance) and biopsy gave the definitive diagnosis. A radical surgery caused the fever resolution. These are two cases of cervical cancer as cause of fever of unknown origin and, at the moment, we have not found another cases in the literature. We should consider this kind of tumor as a possible origin of fever.

Recurrent pericardial effusion as initial manifestation of primary diffuse pericardial malignant mesothelioma

The case of a 61-year-old woman who presented a recurrent symptomatic pericardial effusion and a malignant cardiac tamponade six months prior to the detection of a mediastinal anterior mass is described. Diffuse malignant pericardial mesothelioma was diagnosed after mediastinal mass biopsy. The patient underwent further oncological evaluation followed by chemotherapy (AU)

Fiebre de origen desconocido como presentación inicial de dos casos de carcinoma epidermoide de cérvix / Fever of unknown origin as first manifestation of two cases of cervix carcinoma

Presentamos dos casos de mujeres con FOD como primera manifestación de un cáncer de cérvix. En ambos casos, se hizo un despistaje exhaustivo de causas de fiebre. Los tratamientos antibióticos de amplio espectro (junto con tuberculostáticos, en la primera de las pacientes), no consiguieron erradicar la fiebre; los distintos tests de enfermedad autoinmune fueron negativos . Sólo las pruebas de imagen, en especial, la resonancia magnética nuclear, desvelaron que existía una lesión sospechosa, y fue la anatomía patológica la que corroboró la etiología de ambos procesos. El tratamiento del tumor (en ambos casos consistió en una cirugía radical) permitió la resolución de la fiebre. Se trata de dos casos representativos de fiebre etiquetados inicialmente como de origen desconocido, en los que un estudio exhaustivo reveló que esta era secundaria a cáncer epidermoide de cérvix, de los que no se dispone de literatura previa

We present the case of two women with FUO as first manifestation of a cervical carcinoma. In both cases, wide spectrum antibiotic treatment (and tuberculostatic medication in the first woman) were not useful to stop fever. Autoimmune diseases tests were normal. Just image thecniques let us detect a suspicious lesion (specially, abdomino-pelvic magnetic resonance) and biopsy gave the definitive diagnosis. A radical surgery caused the fever resolution. These are two cases of cervical cancer as cause of fever of unknown origin and, at the moment, we have not found another cases in the literature. We should consider this kind of tumor as a possible origin of fever

Crioglobulinemia mixta asociada a infección de catéter ventrículoatrial / Mixed crioglobulinemia related to ventriculoatrial infection

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[Leydig cell tumor, gynecomastia, and inferior vena cava thrombosis]. / Tumor de células de Leydig, ginecomastia y trombosis de vena cava inferior.

Leydig cell tumor is a testicular tumor with a low incidence characterized by a high estrogens secretion from the tumoral cells. Its more frequent clinical presentation is a testicular nodule with or without other endocrine manifestations due to estrogenic hypersecretion. We're reporting a case of a Leydig cell tumor with high plasmatic levels of estradiol, gynecomastia and inferior cava vein thrombosis, which hasn't been described among its clinical features up to now. Vascular thrombotic phenomenons have already been reported in other clinical situations with hiperestrogesism and they could also be associated with these tumors. Patients with Leydig cell tumors could be at a higher risk of developing thromboembolic phenomenons because of tumoral hyperestrogenism and could present thrombotic complications among the clinical findings.

Tumor de células de ley dig, ginecomastia y trombosis de vena cava inferior / Leydig cell tumor, gynecomastia and inferior cava vein thrombosis

El tumor de células de Leydig es un tumor testicular de baja incidencia caracterizado por la secreción de estrógenos por las células tumorales. Sus manifestaciones clínicas más frecuentes son la presencia de un nódulo testicular acompañado o no de manifestaciones endocrinas secundarias a la hipersecreción estrogénica. Comunicamos un caso de tumor de células de Leydig con elevadas concentraciones plasmáticas de estradiol, ginecomastia y trombosis de la vena cava inferior, que no ha sido descrita como manifestación de estos tumores hasta la actualidad. Los fenómenos trombóticos vasculares se han descrito en otras situaciones clínicas de hiperestrogenismo y también podrían presentarse asociados a estos tumores. Los pacientes con tumores de células de Leydig podrían tener un mayor riesgo de desarrollar fenómenos tromboembólicos secundarios al hiperestrogenismo de origen tumoral y podrían presentar complicaciones trombóticas como manifestación clínica (AU)

Adhesión al tratamiento antirretrovírico en pacientes VIH+ / Adherence to antiretroviral treatment in HIV-positive patients

La adhesión al tratamiento antirretrovírico es difícil de conseguir al 100 por ciento debido a la complejidad del mismo.Objetivo. Conocer la adhesión terapéutica de los pacientes VIH+ a los tratamientos antirretrovíricos en nuestra área sanitaria y relacionarlo con la efectividad virológica de los mismos.Método. Estudio observacional prospectivo de los pacientes adultos con tratamiento antirretrovírico que acudieron a retirar la medicación desde marzo a junio de 1998 al servicio de farmacia del Hospital d'Elx. Se hizo un seguimiento de las dispensaciones mensuales de todos los pacientes seleccionados durante seis meses.Resultados. El número total de pacientes analizados fue de 188. Un 59,5 por ciento (112 pacientes) son cumplidores, mientras que el 40,5 por ciento (76 pacientes) son no cumplidores. Al relacionar la adhesión terapéutica con la carga viral obtenemos que de los 112 pacientes cumplidores, 80 (71,4 por ciento) tienen éxito virológico y 32 (28,6 por ciento) fracaso. De los 46 pacientes no cumplidores, nueve (19,6 por ciento) tienen éxito virológico y 37 (80,4 por ciento) fracaso.Discusión. La utilización de los registros de las dispensaciones del servicio de farmacia y el seguimiento individualizado de las mismas por paciente, si se hace de forma informatizada, es un método sencillo que nos permite conocer las fechas y las cantidades de medicamentos dispensados. Los fallos en la recogida de medicación nos pueden informar de incumplimiento, siempre que se tengan controladas otras variables como son los cambios de domicilio, los ingresos hospitalarios o carcelarios, etc (AU)

Absceso prostático como complicación tardía de una bacteriemia estafilocócica: resolución con tratamiento antibiótico / Prostatic abscess as a late complication of staphylococcal bacteremia: resolution with antibiotic therapy

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