Increased prevalence of prior malignancies and autoimmune diseases in patients diagnosed with chronic myeloid leukemia.

We recently reported an increased incidence of second malignancies in chronic myeloid leukemia (CML) patients treated with tyrosine kinase inhibitors (TKI). To elucidate whether this increase may be linked, not to TKI but rather to a hereditary or acquired susceptibility to develop cancer, we estimated the prevalence of malignancies, autoimmune disease (AD) and chronic inflammatory disease (CID) in CML patients prior to their CML diagnosis. Nationwide population-based registers were used to identify patients diagnosed with CML in Sweden 2002-2012 and to estimate the prevalence of other malignancies, AD and CID prior to their CML diagnosis. For each patient with CML, five matched controls were selected from the general population. Conditional logistic regression was used to calculate odds ratios (OR). Nine hundred and eighty-four CML patients were assessed, representing more than 45 000 person-years of follow-up. Compared with matched controls, the prevalence of prior malignancies and AD was elevated in CML patients: OR 1.47 (95% confidence interval (CI) 1.20-1.82) and 1.55 (95% CI 1.21-1.98), respectively. No associations were detected between CML and previous CID. An increased prevalence of other malignancies and AD prior to the diagnosis of CML suggest that a hereditary or acquired predisposition to cancer and/or autoimmunity is involved in the pathogenesis of CML.

A comparison of prostate cancer survival in England, Norway and Sweden: a population-based study.

PURPOSE: The objective of the study was to compare patterns of survival 2001-2004 in prostate cancer patients from England, Norway and Sweden in relation to age and period of follow-up. SUBJECTS AND METHODS: Excess mortality in men with prostate cancer was estimated using nation-wide cancer register data using a period approach for relative survival. 179,112 men in England, 23,192 in Norway and 59,697 in Sweden were included. RESULTS: In all age groups, England had the lowest survival, particularly so among men aged 80+. Overall age-standardised five-year survival was 76.4%, 80.3% and 83.0% for England, Norway and Sweden, respectively. The majority of the excess deaths in England were confined to the first year of follow-up. CONCLUSION: The results indicate that a small but important group of older patients present at a late stage and succumb early to their cancers, possibly in combination with severe comorbidity, and this situation is more common in England than in Norway or Sweden.

Sedoanalgesia con propofol-ketamina a bajas dosis para la práctica del bloqueo retrobulbar / Sedation and analgesia with propofol plus low-dose ketamine for retrobulbar block

OBJETIVOS: Determinar si la adicción de ketamina apropofol mejora la sedación durante un bloqueo retrobulbarpara cirugía oftalmológica respecto a la administraciónde propofol solo.MATERIAL Y MÉTODOS: Estudio aleatorio a doble ciegoprospectivo sobre 50 pacientes intervenidos de cirugíaocular con anestesia retrobulbar. Asignación aleatoria endos grupos: Grupo propofol: Inducción de sedación conpropofol 0,45 mg Kg-1. Grupo propofol ketamina: Inducciónde sedación con propofol 0,45 mg Kg-1 + ketamina0,25 mg Kg-1. Se recogieron las siguientes variables:Demográficas (edad, peso, ASA, talla, sexo), hemodinámicas(TA, FC), dolor a la punción (EVA), condicionesde punción, sedación (OAA/S), ventilación (ETCO2,apneas, necesidad de maniobras de reanimación, pulsioximetría),el tiempo de inicio de acción, duración delefecto y amnesia.RESULTADOS: No hallamos diferencias significativas enel tiempo de inicio, duración del efecto, variables demográficas,hemodinámicas, respiratorias ni de amnesia.La sedación medida por la escala OAAS fue menor en elgrupo propofol y las condiciones de punción fueron significativamentemejores en el grupo propofol / ketamina.No observamos reacciones psicomiméticas adversas,excepto en 2 pacientes del grupo propofol que presentaronagitación transitoria.CONCLUSIONES: Bajas dosis de ketamina asociadas apropofol mejoran las condiciones de la punción del bloqueoretrobulbar sin aumentar los efectos indeseables

OBJECTIVES: To determine if adding ketamine topropofol provides better sedation than propofol alonefor patients receiving a retrobulbar block for eye surgery.MATERIAL AND METHODS: Randomized double-blindtrial enrolling 50 patients receiving a retrobulbar nerveblock for eye surgery. Patients were randomly assignedto 2 groups. In the propofol group sedation was inducedwith 0.45 mg·kg-1 of propofol. In the ketamine plus propofolgroup sedation was induced with 0.45 mg·kg-1 ofpropofol plus 0.25 mg·kg-1 of ketamine. We recordedpatient characteristics (age, weight, ASA class, height,sex), hemodynamic variables (blood pressure, heartrate), puncture conditions, sedation (score on theObserver's Assessment of Alertness/Sedation [OAA/S]scale), ventilation (end-tidal carbon dioxide pressure,apneas, need for reanimation maneuvers, pulse oximetry),time until onset of effect, duration of effect, andamnesia.RESULTS: No significant differences were observed intime to onset, duration of effect, patient characteristics,hemodynamic or respiratory variables, or amnesia.Sedation assessed on the OAA/S scale was lower inthe propofol group and the puncture conditions weresignificantly better in the ketamine plus propofolgroup. The only adverse psychomimetic reaction wastransient agitation, observed in 2 propofol grouppatients.CONCLUSIONS: Low doses of ketamine associated withpropofol improve puncture conditions for performing aretrobulbar block without increasing unwanted sideeffects

[Sedation and analgesia with propofol plus low-dose ketamine for retrobulbar block]. / Sedoanalgesia con propofol-ketamina a bajas dosis para la práctica del bloqueo retrobulbar.

OBJECTIVES: To determine if adding ketamine to propofol provides better sedation than propofol alone for patients receiving a retrobulbar block for eye surgery. MATERIAL AND METHODS: Randomized double-blind trial enrolling 50 patients receiving a retrobulbar nerve block for eye surgery. Patients were randomly assigned to 2 groups. In the propofol group sedation was induced with 0.45 mg x kg(-1) of propofol. In the ketamine plus propofol group sedation was induced with 0.45 mg x kg(-1) of propofol plus 0.25 mg x kg(-1) of ketamine. We recorded patient characteristics (age, weight, ASA class, height, sex), hemodynamic variables (blood pressure, heart rate), puncture conditions, sedation (score on the Observer's Assessment of Alertness/Sedation [OAA/S] scale), ventilation (end-tidal carbon dioxide pressure, apneas, need for reanimation maneuvers, pulse oximetry), time until onset of effect, duration of effect, and amnesia. RESULTS: No significant differences were observed in time to onset, duration of effect, patient characteristics, hemodynamic or respiratory variables, or amnesia. Sedation assessed on the OAA/S-scale was lower in the propofol group and the puncture conditions were significantly better in the ketamine plus propofol group. The only adverse psychomimetic reaction was transient agitation, observed in 2 propofol group patients. CONCLUSIONS: Low doses of ketamine associated with propofol improve puncture conditions for performing a retrobulbar block without increasing unwanted side effects.

Estudio comparativo de dosis bajas de bupivacaína hiperbárica versus convencionales para cesárea programada: reflexiones / On the randomized trial comparing low dose and conventional hyperbaric bupivacaine for cesarean section

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INTRODUCTION:Spinal anesthesia is the technique most often applied in cases of scheduled cesarean section.Many authors have tried decreasing the local anesthetic dose by adding opioids to achieve adequate analgesia with greater hemodynamic stability,although the ideal dose remains to be established.Our aim was to analyze hemodynamic stability and quality of analgesia with 2 different regimens for administering spinal hyperbaric bupivacaine. METHODS:We designed a controlled,double-blind trial comparing 2 doses of spinal hyperbaric bupivacaine with fentanyl in 42 patients undergoing elective cesarean sec- tion randomized to 2 groups to receive either the low dose or the conventional one.One group received an 11 mg dose of bupivacaine and the other group received a 6.5 mg dose,combined with 20 g of fentanyl in both cases. RESULTS:The hemodynamic profile and the level of maximum sensory block obtained were similar in the two groups.The motor block was less intense in patients receiving the lower dose and it was necessary to convert 2 patients (10%)to general anesthesia in that group. CONCLUSIONS:Spinal anesthesia with low doses of bupivacaine and fentanyl provides acceptable intraopera- tive conditions for a high percentage of patients under- going cesarean section,with a similar incidence of hypo- tension.The low dose generates a less intense intraoperative motor blockade with similar spread of the sensory block.The low dose was not efficacious for 10% of the patients who received it