Tratamiento de la necrobiosis lipoídica con terapia fotodinámica convencional: serie de 4 casos tratados con éxito / Conventional Photodynamic Therapy for Necrobiosis Lipoidica: Successful Treatment in a Series of 4 Cases

La necrobiosis lipoídica (NL) es una enfermedad granulomatosa crónica poco frecuente para la que existen multitud de tratamientos disponibles. No obstante, estos ofrecen habitualmente mínimos e inconsistentes resultados. En algunas publicaciones se describe el tratamiento con terapia fotodinámica (TFD) como tratamiento de segunda línea en casos refractarios, con resultados variables. Comunicamos 4 casos de NL tratados satisfactoriamente con TFD convencional con MAL y BF-200 ALA. Las 4 pacientes eran mujeres afectas de diabetes mellitus y todas habían recibido al menos 2 tratamientos previos con escaso resultado. Tras una media de 3,2 sesiones de TFD por lesión, las 4 pacientes presentaron una resolución completa de las lesiones, persistiendo únicamente atrofia residual

Necrobiosis lipoidica is a rare chronic granulomatous disease. Multiple treatment approaches are available, but results are generally minimal and inconsistent. Some publications report variable results with photodynamic therapy (PDT) as a second line of treatment for refractory cases. We report 4 cases of necrobiosis lipoidica treated satisfactorily with conventional PDT using methyl aminolevulinate or 5-aminolevulinic acid BF-200 as the photosensitizing agent. All 4 patients were women with diabetes mellitus who had undergone treatment at least twice in the past, with little improvement. The lesions resolved completely with PDT, leaving only residual atrophy after a mean of 3.2 sessions per lesión

Conventional Photodynamic Therapy for Necrobiosis Lipoidica: Successful Treatment in a Series of 4 Cases. / Tratamiento de la necrobiosis lipoídica con terapia fotodinámica convencional: serie de 4 casos tratados con éxito.

Necrobiosis lipoidica is a rare chronic granulomatous disease. Multiple treatment approaches are available, but results are generally minimal and inconsistent. Some publications report variable results with photodynamic therapy (PDT) as a second line of treatment for refractory cases. We report 4 cases of necrobiosis lipoidica treated satisfactorily with conventional PDT using methyl aminolevulinate or 5-aminolevulinic acid BF-200 as the photosensitizing agent. All 4 patients were women with diabetes mellitus who had undergone treatment at least twice in the past, with little improvement. The lesions resolved completely with PDT, leaving only residual atrophy after a mean of 3.2 sessions per lesion.

Fístula parotídea tras biopsia cutánea: tratamiento con toxina botulínica / Parotid Fistula After Skin Biopsy: Treatment With Botulinum Toxin

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Histologic Changes During Treatment With Vismodegib in Locally Advanced Basal Cell Carcinoma: A Series of 19 Cases.

BACKGROUND: There are no large series describing cutaneous histologic changes during treatment with vismodegib in locally advanced basal cell carcinoma (BCC). OBJECTIVE: To analyze histologic changes in skin biopsy specimens from patients with locally advanced BCC treated with vismodegib. METHODS: A descriptive, retrospective study of patients with locally advanced BCC treated with vismodegib between June 2012 and December 2017 at the Instituto Valenciano de Oncología, Spain. Nineteen patients were biopsied before and during the treatment with vismodegib, and we compared histologic changes observed. RESULTS: Seven patients (37%) achieved complete response, which was characterized by replacement of tumor stroma with a hyaline scar, lymphocytic inflammatory infiltrate, keratin formation, and infundibular cysts. Twelve patients (63%) achieved partial response; 5 showed no phenotypic changes, whereas 7 showed histologic changes; 5 cases showed metatypical differentiation; and 2 cases presented squamous differentiation. We observed no cases of squamous cell carcinoma arising at vismodegib treatment sites and no association between initial histologic subtype and clinical response. LIMITATIONS: Many biopsy specimens were obtained by punch biopsy and may not be representative of the full tumors. We studied histologic changes only in complete and partial responses. CONCLUSION: Vismodegib can induce histologic changes toward metatypical or squamous differentiation of BCC in patients with partial response. Keratinizing phenomena were frequent, both in partial and complete response groups.

Experiencia con vismodegib en carcinoma basocelular avanzado en un centro oncológico / Experience With Vismodegib in the Treatment of Advanced Basal Cell Carcinoma at a Cancer Center

INTRODUCCIÓN Y OBJETIVOS: Vismodegib es el primer inhibidor selectivo de la vía de la señalización Hedgehog aprobado para el tratamiento del carcinoma basocelular (CBC) localmente avanzado y metastásico. Describimos nuestra experiencia en un centro oncológico con el vismodegib en el tratamiento de pacientes con CBC avanzados y/o múltiples durante un periodo de 5 años. MATERIAL Y MÉTODOS: Analizamos variables como la edad y el sexo del paciente, la localización, el tamaño, el tipo y las características del tumor, el tiempo de evolución, si son tumores primarios o recidivas, la duración del tratamiento, la respuesta a este (completa, parcial, estabilización o ausencia de respuesta), los efectos secundarios observados y las recidivas. RESULTADOS: Un total de 22 pacientes fueron tratados, 20 con CBC localmente avanzados y 2 con CBC metastásicos con afectación ganglionar. El tratamiento fue administrado durante 11,8 meses de media. El 41% (9) de los pacientes obtuvieron una respuesta completa al tratamiento, un 45% (10) respuesta parcial y en el 14% (3) de los pacientes el tratamiento consiguió estabilizar la enfermedad. Tras una mediana de 21 meses, 2 casos recidivaron. Los principales efectos secundarios observados fueron disgeusia, alopecia y calambres musculares, todos ellos de carácter leve. Ningún paciente desarrolló un carcinoma epidermoide sobre el área tratada con vismodegib, aunque sí cambios metatípicos tras el tratamiento. CONCLUSIONES: El vismodegib es un fármaco seguro y eficaz para el tratamiento del CBC localmente avanzado, con un porcentaje de respuesta del 86%. Los efectos adversos deben tenerse en cuenta por su alta frecuencia, aunque estos suelen ser de carácter leve

INTRODUCTION AND OBJECTIVES: Vismodegib is the first selective Hedgehog inhibitor approved for the treatment of locally advanced and metastatic basal cell carcinoma (BCC). In this article, we describe our experience with the use of this drug to treat advanced and/or multiple BCCs at a cancer center over 5 years. MATERIAL AND METHODS: We analyzed the following variables: patient age and sex; tumor location, size, type, and characteristics; time since onset; primary or recurrent status; duration of treatment; response to treatment (complete, partial, stabilization, or absence of response); adverse effects; and recurrences. RESULTS: We treated 22 patients, of whom 20 had locally advanced BCCs and 2 had metastatic BCCs with lymph node involvement. The treatment was administered over a mean of 11.8 months. Nine patients (41%) achieved complete response and 10 (45%) partial response. The disease was stabilized in 3 (14%). Two patients relapsed after a median of 21 months. The main adverse effects were dysgeusia, alopecia, and muscle cramps, all of which were mild. None of the patients developed squamous cell carcinoma in an area treated with vismodegib, although metatypical changes were observed after treatment. CONCLUSIONS: With a response rate of 96%, vismodegib is a safe and effective treatment for locally advanced BCC. Adverse effects are generally mild but they need to be taken into account owing to their high frequency

Experience With Vismodegib in the Treatment of Advanced Basal Cell Carcinoma at a Cancer Center. / Experiencia con vismodegib en carcinoma basocelular avanzado en un centro oncológico.

INTRODUCTION AND OBJECTIVES: Vismodegib is the first selective Hedgehog inhibitor approved for the treatment of locally advanced and metastatic basal cell carcinoma (BCC). In this article, we describe our experience with the use of this drug to treat advanced and/or multiple BCCs at a cancer center over 5 years. MATERIAL AND METHODS: We analyzed the following variables: patient age and sex; tumor location, size, type, and characteristics; time since onset; primary or recurrent status; duration of treatment; response to treatment (complete, partial, stabilization, or absence of response); adverse effects; and recurrences. RESULTS: We treated 22 patients, of whom 20 had locally advanced BCCs and 2 had metastatic BCCs with lymph node involvement. The treatment was administered over a mean of 11.8 months. Nine patients (41%) achieved complete response and 10 (45%) partial response. The disease was stabilized in 3 (14%). Two patients relapsed after a median of 21 months. The main adverse effects were dysgeusia, alopecia, and muscle cramps, all of which were mild. None of the patients developed squamous cell carcinoma in an area treated with vismodegib, although metatypical changes were observed after treatment. CONCLUSIONS: With a response rate of 96%, vismodegib is a safe and effective treatment for locally advanced BCC. Adverse effects are generally mild but they need to be taken into account owing to their high frequency.

Análisis de centros de investigación clínica: calidad en la conducción de ensayos clínicos / Analysis of investigational centres: quality in the conduct of clinical trials

En el presente estudio se buscó describir las prácticas de control de calidad interno usadas por los centros de investigación cínica en el Perú para la conducción de ensayos cínicos; así como, describir el rol del Químico Farmacéutico dentro del equipo de investigación. Para este propósito, se envió una encuesta a investigadores que realizaron ensayos clínicos en el periodo enero 2011 a agosto 2013 y que estén registrados en la base de datos del Instituto Nacional de Salud. De 134 investigadores contactados, 75 respondieron a la encuesta. Los resultados de las encuestas indican que los centros tienen implementados procedimientos o actividades de control de calidad en la conducción de los ensayos clínicos. Entre los métodos más comunes para supervisar las actividades realizadas en un centro de investigación, el 86,1 % tiene procedimientos estandarizados, paralelamente el investigador realiza reuniones periódicas con el personal del centro. Además, se observe que el Químico Farmacéutico actúa como parte del personal del centro de Investigación asumiendo las responsabilidades de coordinador, dispensación y almacenamiento de la medicación de estudio.

The purpose of this study is to describe the internal quality control practices implemented by Research centers in Peru in order to conduct clinical trials. It also describes the role of the pharmacist as part of the research team. An electronic survey was distributed to investigators that conducted clinical trials in the period between January 2011 and August 2013 and that were registered in the Instituto Nacional de Salud database. Seventy five surveys were answered from 134 investigators contacted. Data from the surveys indicate that investigational centers have implemented standard operative procedures (SOPs) or quality control activities in their clinical trials processes. Among the most common processes for clinical trials oversight in investigational centers 86,1 % of them have SOPs, also, the investigators have routine meetings with staff to review trial progress. Besides, it was observed that the pharmacist acts as part of the research team assuming the responsibilities of study coordinator, dispense and storage of investigational product.

Ocurrencia de leucemia mieloide crónica y linfoma no Hodgkin en un mismo paciente: caso clínico / Simultaneous occurrence of chronic myeloid leukemia and non Hodgkin lymphoma: clinical case

Chronic myeloid leukemia is a myeloproliferative disorder caused by a clonal disturbance of the trunk cell and the accumulation of granulocytic series in the marrow, blood and other organs. We report a 63 years old male, carrier of a chronic myeloid leukemia whose clinical condition was complicated by the appearance of a T cell lymphoma. He was subjected to chemotherapy, that reduced the size of adenopathies and improved his general condition. Further studies are required to determine if there is a relationship between these two clinical entities

Experiencia con clozapina en esquizofrenia resistente / Experience with clozapine in ressistant schizophrenia

Se presenta una experiencia de tratamiento con clozapina en 11 pacientes esquizofrénicos resistentes. Se discute la eficacia del tratamiento y sus efectos adversos, así como la metodología empleada

Enfermedad de Hodgkin: recaída tras 16 años de remisión continuada / Hodgkin's disease: relapse after 16 years of continous remission

We report a boy in whom an advanced Hodgkin's disease, nodular sclerosis variety was diagnosed at 5 yeras of age and treated with exclusive chemotherapy. After 16 years of remission, he presented with a relapsed of the disease with a different histological pattern and was subjected to chemotherapy (C-MOPP/AVB) and unilateral axillary irradiation, obtaining a complete remission of the disease. Four months later, the patients is asymptomatic and without evidences of relapse