Registro de linfomas cutáneos primarios de la AEDV: primer año de funcionamiento / The First Year of the AEVD Primary Cutaneous Lymphoma Registry

ANTECEDENTES Y OBJETIVO: Los linfomas primarios cutáneos son enfermedades poco frecuentes. Este artículo describe el Registro de linfomas cutáneos primarios de la AEDV y sus primeros resultados. PACIENTES Y MÉTODOS: Registro de enfermedad de pacientes con linfomas cutáneos primarios. Los centros participantes recogieron datos prospectivamente de todos los pacientes, incluyendo datos del diagnóstico, de los tratamientos, de las pruebas realizadas y del estado actual del paciente. Se realizó un análisis descriptivo. RESULTADOS: En diciembre del 2017 el registro tenía datos de 639 pacientes pertenecientes a 16 hospitales universitarios. Un 60% eran hombres y los diagnósticos, por orden de frecuencia, fueron: micosis fungoide/síndrome de Sézary (MF/SS) (348 casos; 55%), linfoma cutáneo primario de células B (LCCB) (184; 29%), trastorno linfoproliferativo de células T CD30+ (LTCD30+) (70; 11%) y otro tipo de linfoma T (OLT) (37; 5%). El número de casos incidentes recogidos durante el primer año fue de 105 (16,5%). En los pacientes con MF/SS, el diagnóstico más frecuente fue MF clásica (77,3%). La mitad de estos casos se diagnosticaron en estadio IA. La mayoría de los pacientes estaban en remisión parcial (32,5%) o enfermedad estable (33,1%). Los tratamientos más usados fueron los corticoides tópicos (90,8%) seguidos de fototerapia. En los pacientes con LCCB el diagnóstico más frecuente fue el linfoma de la zona marginal (50%). Casi todos los pacientes tuvieron afectación exclusivamente cutánea y casi la mitad fue T1a. La mayoría (76,1%) estaba en remisión completa. Los tratamientos más utilizados fueron la cirugía (55,4%) y la radioterapia (41,9%). En los pacientes con LTCD30+, el diagnóstico más frecuente fue la papulosis linfomatoide (68,6%). La mayoría fueron clasificados T3b (31,4%). La mitad de los casos estaban en remisión completa. Los tratamientos más frecuentes fueron los esteroides tópicos (68,6%), seguidos de la quimioterapia sistémica (32,9%). CONCLUSIÓN: Las características del paciente con linfoma cutáneo primario en España no difieren de otras series descritas en la literatura. El registro facilitará al grupo de linfomas de la AEDV realizar investigación clínica

BACKGROUND AND OBJECTIVE: Primary cutaneous lymphomas are uncommon. This article describes the Primary Cutaneous Lymphoma Registry of the Spanish Academy of Dermatology and Venereology (AEDV) and reports on the results from the first year. PATIENTS AND METHODS: Disease registry for patients with primary cutaneous lymphoma. The participating hospitals prospectively recorded data on diagnosis, treatment, tests, and disease stage for all patients with primary cutaneous lymphoma. A descriptive analysis was performed. RESULTS: In December 2017, the registry contained data on 639 patients (60% male) from 16 university hospitals. The most common diagnoses, in order of frequency, were mycosis fungoides/Sézary syndrome (MF/SS) (348 cases, 55%), primary cutaneous B-cell lymphoma (CBCL) (184 cases, 29%), primary cutaneous CD30+ T-cell lymphoproliferative disorder (CD30+ CLPD) (70 cases, 11%), and other types of T-cell lymphoma (37 cases, 5%). In total, 105 (16.5%) of the cases recorded were incident cases. The most common diagnosis in the MF/SS group was classic MF (77.3%). Half of the patients with MF had stage IA disease when diagnosed, and the majority were either in partial remission (32.5%) or had stable disease (33.1%). The most widely used treatments were topical coricosteroids (90.8%) and phototherapy. The most common form of primary CBCL was marginal zone lymphoma (50%). Almost all of the patients had cutaneous involvement only and nearly half had stage T1a disease. Most (76.1%) were in complete remission. The main treatments were surgery (55.4%) and radiotherapy (41.9%). The most common diagnosis in patients with CD30+ CLPD was lymphomatoid papulosis (68.8%). Most of the patients (31.4%) had stage T3b disease and half were in complete remission. The most common treatments were topical corticosteroids (68.8%) and systemic chemotherapy (32.9%). CONCLUSION: The characteristics of patients with primary cutaneous lymphoma in Spain do not differ from those described in other series in the literature. The registry will facilitate clinical research by the AEDV's lymphoma group

The First Year of the AEVD Primary Cutaneous Lymphoma Registry. / Registro de linfomas cutáneos primarios de la AEDV: primer año de funcionamiento.

BACKGROUND AND OBJECTIVE: Primary cutaneous lymphomas are uncommon. This article describes the Primary Cutaneous Lymphoma Registry of the Spanish Academy of Dermatology and Venereology (AEDV) and reports on the results from the first year. PATIENTS AND METHODS: Disease registry for patients with primary cutaneous lymphoma. The participating hospitals prospectively recorded data on diagnosis, treatment, tests, and disease stage for all patients with primary cutaneous lymphoma. A descriptive analysis was performed. RESULTS: In December 2017, the registry contained data on 639 patients (60% male) from 16 university hospitals. The most common diagnoses, in order of frequency, were mycosis fungoides/Sézary syndrome (MF/SS) (348 cases, 55%), primary cutaneous B-cell lymphoma (CBCL) (184 cases, 29%), primary cutaneous CD30+ T-cell lymphoproliferative disorder (CD30+ CLPD) (70 cases, 11%), and other types of T-cell lymphoma (37 cases, 5%). In total, 105 (16.5%) of the cases recorded were incident cases. The most common diagnosis in the MF/SS group was classic MF (77.3%). Half of the patients with MF had stage IA disease when diagnosed, and the majority were either in partial remission (32.5%) or had stable disease (33.1%). The most widely used treatments were topical corticosteroids (90.8%) and phototherapy. The most common form of primary CBCL was marginal zone lymphoma (50%). Almost all of the patients had cutaneous involvement only and nearly half had stage T1a disease. Most (76.1%) were in complete remission. The main treatments were surgery (55.4%) and radiotherapy (41.9%). The most common diagnosis in patients with CD30+ CLPD was lymphomatoid papulosis (68.8%). Most of the patients (31.4%) had stage T3b disease and half were in complete remission. The most common treatments were topical corticosteroids (68.8%) and systemic chemotherapy (32.9%). CONCLUSION: The characteristics of patients with primary cutaneous lymphoma in Spain do not differ from those described in other series in the literature. The registry will facilitate clinical research by the AEDV's lymphoma group.

Views of parents in four European countries about the effect of food on the mental performance of primary school children.

BACKGROUND/OBJECTIVES: Several factors affect the mental performance of children. The importance that parents attribute to food-related determinants, compared with genetic, socio-economic and school environment, was investigated. SUBJECTS/METHODS: Parents of school children (aged 4-11) were recruited through state primary schools in four European countries. Interviews were conducted in which participants were asked to sort 18 cards representing possible determinants of four elements of mental performance (attention, learning, mood and behaviour) according to perceived strength of effect. Determinants were identified from the literature and grouped in six categories: food-related, school environment, physical, social, psychological and biological. Effects were scored: 0=none; 1=moderate; and 2=strong. Views were compared between and within countries. RESULTS: Two hundred parents took part (England: 53; Germany: 45; Hungary: 52; Spain: 50). Differences existed between countries in the proportions reporting university education and being in employment. Taking all countries together, parents consider the food category (mean 1.33) to have a lower impact on a child's mental performance than physical (activity and sleep, 1.77), psychological (mood and behaviour, 1.69) and school environment (1.57). Social (1.12) and biological (0.91) determinants were ranked lower than food. Of determinants in the food category, parents thought regularity of meals had more influence on mental performance (1.58) than what a child eats now (1.36), food at school (1.35), nutrition as a baby/infant (1.02). CONCLUSION: Scope exists to improve parental awareness of the repercussions of their dietary choices for the mental performance of their children.

First Report of Meloidogyne incognita Infecting Corn in Western Spain.

During the 2009 to 2010 corn-growing (Zea mays L. cv. Alexandria) seasons, severely stunted and yellowing corn plants in several commercial fields at Aldearrubia (Salamanca Province) were observed in western Spain. The disease incidence ranged from 80 to 100%. Early symptoms consisted of severely reduced growth of the plants coupled with extensive leaf yellowing. Occurrence of the disease was estimated to cause near complete loss of the crop yields since the corn produced in affected fields was unmarketable. Disease surveys revealed high parasitism in the main and feeder roots and a large soil population of the root-knot nematode Meloidogyne spp. The nematode population was extracted and quantified from soil and root samples according to Barker (1). It was identified as the southern root-knot nematode M. incognita race 1, by female perineal pattern, host-differential test, and multiplex PCR using forward primers H-18S, CF-ITS, I-ITS, and reverse primer HCFI-28S (3,4). ITS products cloned and assayed using the ABI PRISM 3100 Genetic Analyzer (Applied Biosystems, Salamanca, Spain) were subjected to a database search using BLAST (National Centre for Biotechnology Information) to confirm the identification. These sequences exhibited 99.0% similarity with that of an M. incognita isolate from France (GenBank Accession No. AF402309.1). M. incognita was found in 80% of soil samples collected from the areas where the disease was observed and 83.5% of root samples with nematode population densities ranging from 26 to 269 eggs and second-stage juveniles (J2s) per 100 cm3 of soil and 234 to 1,634 eggs and J2s per 5 g of fresh roots. In glasshouse proofs of pathogenicity, a mix of 1,500 eggs and J2s of these populations of M. incognita were inoculated in 20-cm-diameter pots with 10 replicates with a single pregerminated seed of corn cv. Alexandria as host plant; another 10 replicates without inoculation were established as control plants. After 6 weeks, all plants inoculated were severely stunted and yellowing; infected roots showed galls on root tips and secondary feeder roots. Galling of root tips that cause stubby root symptoms prevented further root growth into deeper soil layers and induced proliferation of secondary roots, which confirmed the nematodes' pathogenicity. The severe infections in roots of corn plants suggest that parasitism of corn roots by the root-knot nematode must contribute to stunting, yellowing, and decline of corn, reducing yield by restricting access to water and nutrients that are needed for plant growth and development, and can result in the death of younger plants as previously reported (2). To our knowledge, this is the first report of M. incognita infecting corn in Spain. References: (1) K. R. Barker. Nematode extraction and bioassays. Page 19 in: An Advanced Treatise on Meloidogyne. Vol. II, Methodology. K. R. Barker et al., eds. North Carolina State University Graphics, Raleigh, 1985. (2) T. P. Heffes et al. Nematropica 22:139, 1992. (3) L. Robertson et al. Crop Prot. 25:440, 2006. (4) C. Zijlstra. Fund. Appl. Nematol. 20:505, 1997.

First Report of Heterodera ripae on Common Nettle in Spain.

Soil and root samples were collected from May to October 2010 from cultivated and wild plants during a survey for hop cyst nematodes. Cyst nematodes were detected in roots of common nettle (Urtica dioica L.) with severe plant yellowing in four natural areas of León and Burgos provinces, Spain, where common nettle is grown in organic farming systems as a substrate for pharmaceutical products. Cysts were isolated by flotation and sieving methods. Cysts and juveniles were analyzed by morphological and molecular methods. The cyst nematodes obtained from soil and plant samples from all four locations had uniform morphological and molecular characteristics that differed from those of Heterodera humuli. Cysts (n = 25) had the following characteristics: lemon shaped, yellow to pale brown; cyst wall with ridges forming an irregular zigzag pattern; young cysts covered by subcrystalline layer; vulval cone bifenestrate with circular or subcircular fenestrae; bullae absent; underbridge weak; body length (not including the neck) ranging from 295 to 489 µm (mean of 418 µm); body width ranging from 208 to 375 µm (mean of 310 µm); fenestrate length of 39 to 58 µm (mean of 46.5 µm) and width of 25.2 to 30.9 µm (mean of 25.1 µm); underbridge length from 51 to 90 µm (mean of 69.2 µm); and vulval slit length from 26 to 40 µm (mean of 33 µm). J2 (n = 20) had the following characteristics: body length ranging from 338 to 380 µm (mean of 359.3 µm); stylet length from 21 to 24 µm (mean of 22.1 µm) with knobs rather wide and slightly projecting anteriorly; tail conical with a length of 41 to 52.5 µm (mean of 45.6 µm) and hyaline part of tail ranging from 18 to 25 µm (mean of 23.3 µm); lateral field with four lines. All morphological data and characters were consistent with those of H. ripae (1). DNA from single cysts was extracted to amplify the internal transcribed spacer (ITS) region of rDNA by PCR with forward primer TW81 (5'-GTTTCCGTAGGTGAACCTGC-3') and reverse primer AB28 (5'-ATATGCTTAAGTTCAGCGGGT-3') (2). The PCR product was digested by restriction enzymes (AluI, CfoI, HaeI, HinfI, PstI, RsaI, TaqI, and Tru9I) to obtain restriction fragment length polymorphism profiles (2). ITS products cloned and assayed using the ABI PRISM 3100 Genetic Analyzer (Applied Biosystems, Salamanca, Spain) were subjected to a database search using BLAST (National Centre for Biotechnology Information) to confirm the identification. These sequences exhibited 99.0% similarity with that of a H. ripae isolate from Germany (GenBank Accession No. AF274407.1). In glasshouse proofs of pathogenicity with these populations of H. ripae, 25 full cysts placed in nylon net bags were inoculated in 9-cm-diameter pots with 10 replicates per plant. After 12 weeks, soil from each pot was dried and cysts extracted. Cysts did not develop on roots of common hop (Humulus lupulus L.) and hemp (Cannabis sativa L.), but in common nettle there was an increase in nematode populations, with all plants severely stunted and yellowing, which confirmed the nematodes' pathogenicity. H. ripae has been previously reported in Russia, Estonia, Latvia, Armenia, Moldova, Ukraine, Bulgaria, Slovakia, Germany, and Belgium (1). To our knowledge, this is the first report of H. ripae in Spain. The identification of H. ripae in nettle fields is important in this region where it could cause large yield reductions if not properly managed. References: (1) S. A. Subbotin et al. Russ. J. Nematol. 5:143, 1997. (2) S. A. Subbotin et al. Nematology 5:515, 2003.

Bloqueo neuroaxial y fármacos que alteran la coagulación. Hábitos de los anestesiólogos. Resultados de una encuesta realizada en 2003 en murcia, alicante y albacete / Neuroaxial blockade and anticoagulant drugs: habitual practice of anesthesiologists. Results of a 2003 survey in Murcia, Alicante and Albacete, Spain

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Hemisíndrome de cauda equina tras anestesia intradural con bupivacaína para cirugía de la cadera / Hemi-cauda equina syndrome after intradural anesthesia with bupivacaine for hip surgery

Un paciente de 68 años fue sometido a recambio acetabular de cadera bajo anestesia subaracnoidea con bupivacaína y fentanilo. A los dos días de la intervención el paciente presentó un cuadro de afectación unilateral de la cola de caballo que afectaba a cinco raíces nerviosas (L4 a S3), sin afectación esfinteriana. Dos años y medio después, la lesión es permanente. Se discute la posible etiología del cuadro clínico, planteándose el diagnóstico diferencial entre causas mecánicas (posición-movilización) y toxicidad del anestésico (AU)

[Hyperbaric subarachnoid ropivacaine in ambulatory surgery: comparative study with hyperbaric bupivacaine]. / Ropivacaína hiperbárica subaracnoidea en cirugía ambulatoria: estudio comparativo con bupivacaína hiperbárica.

OBJECTIVES: To compare the clinical efficacy of hyperbaric 0.5% ropivacaine and 0.5% bupivacaine in subarachnoid blockade for ambulatory surgery. MATERIAL AND METHOD: Randomized double-blind study of 90 patients undergoing lower abdominal surgery. Subarachnoid blockade was achieved with 0.5% ropivacaine (12.5 mg) or 0.5% bupivacaine (12.5 mg) in 10% glucose. We recorded age, sex, weight, latency, extension of motor and sensory blocks, duration of surgery, side effects and quality as perceived by the surgeon and the patient. RESULTS: The two groups were similar with respect to latency time and extension of sensory block. Durations of motor (68.9 +/- 22.9 min) and sensory (127.0 +/- 24.3 min) blocks were significantly shorter with ropivacaine than with bupivacaine (133.3 +/- 29.4 and 174.9 +/- 25.5 min, respectively). Patients in the ropivacaine group also experienced a less intense motor block (Bromage 1, 11.1% vs. 93.3%) and fewer episodes of hypotension 0% vs. 17.7%) or bradycardia (4.4% vs. 8.8%) than those in the bupivacaine group. No neurotoxic effects or instances of postdural puncture headache were recorded. CONCLUSIONS: Hyperbaric 0.5% ropivacaine offers certain advantages over hyperbaric 0.5% bupivacaine for subarachnoid block in outpatient surgery. Duration and intensity of the sensory-motor blockade is less with ropivacaine and fewer cardiovascular side effects develop.

Ropivacaína hiperbárica subaracnoidea en cirugía ambulatoria: estudio comparativo con bupivacaína hiperbárica / Subarachnoid hyperbaric ropivacaine for outpatient surgery: comparison with hyperbaric bupivacaine

OBJETIVOS: Objetivo: Comparar la eficacia clínica de ropivacaína al 0,5 por ciento frente a bupivacaína al 0,5 por ciento, ambas hiperbaras, en el bloqueo subaracnoideo para cirugía ambulatoria. MATERIAL Y MÉTODO: Estudio doble ciego aleatorio sobre 90 pacientes de cirugía infraumbilical. Bloqueo subaracnoideo con ropivacaína al 0,5 por ciento (12,5 mg) o bupivacaína al 0,5 por ciento (12,5 mg) en glucosa al 10 por ciento. Se registraron: edad, sexo, peso, latencia, grados de bloqueo motor y sensitivo, duración de la cirugía, efectos adversos, y calidad percibida por el cirujano y por el paciente. RESULTADOS: Ambos grupos fueron comparables en tiempo de latencia y nivel de bloqueo sensorial. La ropivacaína demostró tener significativamente menor duración de bloqueo motor (68,9 ñ 22,9 min.) y sensitivo (127,0 ñ 24,3 min.) que la bupivacaína (133,3 ñ 29,4 y 174,9 ñ 25,5 min. respectivamente). Igualmente, los pacientes del grupo de la ropivacaína, presentaron menor intensidad de bloqueo motor (11,1 por ciento Bromage 1, frente a 93,3 por ciento), y menores episodios de hipotensión (0 por ciento, frente a 17,7 por ciento) y bradicardia (4,4 por ciento, frente a 8,8 por ciento) que la bupivacaína. No se apreciaron efectos neurotóxicos ni cefaleas postpunción dural. CONCLUSIONES: La ropivacaína al 0,5 por ciento hiperbara ofrece ciertas ventajas sobre bupivacaína al 0,5 por ciento hiperbara en bloqueo subaracnoideo para cirugía ambulatoria. La ropivacaína tiene menor duración e intensidad de bloqueo sensitivo-motor, y provoca menos efectos adversos cardiovasculares (AU)

[Cauda equina hemisyndrome after intradural anesthesia with bupivacaine for hip surgery]. / Hemisíndrome de cauda equina tras anestesia intradural con bupivacaína para cirugía de la cadera.

A 68-year-old man underwent hip surgery under subarachnoid anesthesia with bupivacaine and fentanyl to replace an acetabular component. Two days after surgery the patient developed unilateral cauda equina syndrome, affecting five nerve roots (L4 to S3), with no sphincter involvement. Two and a half years later, the lesion had become permanent. We discuss the possible origin of the condition, suggesting differential diagnoses such as mechanical problems (position-mobilization) and anesthetic toxicity.

Grado de implantación de las recomendaciones para la comprobación del funcionamiento del sistema de anestesia / Extent of application of guidelines for checking anesthetic systems

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[Cardiovascular response to orotracheal intubation using midazolam or etomidate in anesthesia induction]. / Respuesta cardiovascular a la intubación orotraqueal utilizando midazolam o etomidato en la inducción anestésica.

By means of the present study, we compare the variations in the cardiovascular response to the orotracheal intubation while using midazolam or etomidate during the anesthetic induction. For this purpose, we studied 2 groups of 10 patients each one which were premedicated with fentanyl and atropine, and succinylcholine as muscle relaxant. We took the data at a basal state, 10 minutes after premedication and 0, 1, 2, 3, 4, 5 and 10 minutes after the intubation handling. As hemodynamic data we registered heart rate, systolic and diastolic blood pressure and the rate product (PRP). In both groups, the peak response occurred two minutes after intubation in all the studied parameters. Systolic and diastolic blood pressure as well as PRP were significantly lower with midazolam. We conclude that midazolam and etomidate do not prevent the cardiovascular response to the intubation handling, although midazolam smooths pressure response.