Efectividad de un protocolo consensuado para la prevención de náuseas y vómitos inducidos por quimioterapia / Effectiveness of a consensus protocol for the prevention of chemotherapy-induced nausea and vomiting

Objetivo: Evaluar la efectividad de un protocolo consensuado para la prevención de NVIQ en nuestro centro y la adherencia de las prescripciones al mismo. Método: Estudio observacional prospectivo. Se incluyeron pacientes tratados con quimioterapia (QT) en los que fue posible un seguimiento de 120 horas tras el ciclo. Se evaluó la respuesta al tratamiento, medida como: respuesta completa (RC) (ausencia de náuseas y vómitos, sin necesidad de tratamiento adicional en las 120 posteriores al ciclo), respuesta aguda (RA) (en las primeras 24 horas) y tardía (RT) (entre las 24 y las 120 horas), según si se ajustaban o no al protocolo del hospital. Se realizó un análisis estadístico descriptivo, analizando los diferentes factores riesgo y la adherencia al protocolo del hospital. Resultados: Se incluyeron un total de 167 pacientes en los que se observó una RC en el 71,9% de los casos (88,9% RA y 73,7% RT), con ausencia de vómitos en el 89,8%. El 7,2% de los casos no se ajustaron al protocolo. No se encontraron diferencias en la respuesta al tratamiento entre los pacientes que se ajustaron o no al protocolo (RC, RA o RT) pero si en la aparición de vómitos (8,3% vs 36,4%, p = 0,014). Conclusión: La efectividad de nuestro protocolo es buena especialmente en el control de los vómitos aunque las náuseas en la fase retardada siguen siendo un problema sin resolver. El control de vómitos es peor en los pacientes que no se ajustan al protocolo (AU)

Objective: To assess the effectiveness of a consensus protocol for the prevention of CINV at our institution and level of adherence to it. Method: Prospective observational study. Patients treated with chemotherapy (CT) in whom a 120-hour follow-up was made after the cycle were included. We assessed the response to the therapy, categorized as: complete response (CR) (absence of nausea and vomiting, without the need of additional treatment within the 120 hours following the cycle), acute response (AR) (within the first 24 hours) and delayed response (DR) (within 24 and 120 hours), depending on whether or not these were adjusted to the hospital protocol. A descriptive statistical analysis was performed analyzing the different risk factors and level of adherence to the hospital protocol. Results: A total of 167 patients were included in whom CR was observed in 71.9% of the cases (88.9% AR and 73.7% DR), with absence of vomiting in 89.8%. Seven point two percent of the cases did not adhere to the protocol. There were no differences in treatment response between the patients adhering and adhering to the protocol (CR, AR o DR) but yes in vomiting occurrence (8.3% vs. 36.4%, p = 0.014). Conclusion: The effectiveness of our protocol is good specially for controlling the vomiting although nausea during the delayed phase still is a not resolved matter. Vomiting control is poorer in those patients not adjusting to the protocol (AU)

[Effectiveness of a consensus protocol for the prevention of chemotherapy-induced nausea and vomiting]. / Efectividad de un protocolo consensuado para la prevención de náuseas y vómitos inducidos por quimioterapia.

OBJECTIVE: To assess the effectiveness of a consensus protocol for the prevention of CINV at our institution and level of adherence to it. METHOD: Prospective observational study. Patients treated with chemotherapy (CT) in whom a 120-hour follow-up was made after the cycle were included. We assessed the response to the therapy, categorized as: complete response (CR) (absence of nausea and vomiting, without the need of additional treatment within the 120 hours following the cycle), acute response (AR) (within the first 24 hours) and delayed response (DR) (within 24 and 120 hours), depending on whether or not these were adjusted to the hospital protocol. A descriptive statistical analysis was performed analyzing the different risk factors and level of adherence to the hospital protocol. RESULTS: A total of 167 patients were included in whom CR was observed in 71.9% of the cases (88.9% AR and 73.7% DR), with absence of vomiting in 89.8%. Seven point two percent of the cases did not adhere to the protocol. There were no differences in treatment response between the patients adhering and adhering to the protocol (CR, AR o DR) but yes in vomiting occurrence (8.3% vs. 36.4%, p = 0.014). CONCLUSION: The effectiveness of our protocol is good specially for controlling the vomiting although nausea during the delayed phase still is a not resolved matter. Vomiting control is poorer in those patients not adjusting to the protocol.

Use of reverse-transcriptase polymerase chain reaction (RT-PCR) for carcinoembryonic antigen, cytokeratin 19, and maspin in the detection of tumor cells in leukapheresis products from patients with breast cancer: comparison with immunocytochemistry.

This study evaluates the role of reverse-transcriptase polymerase chain reaction (RT-PCR) assay for carcinoembryonic antigen (CEA), cytokeratin 19 (CK19), and maspin transcripts to identify breast cancer cells (BCC) in leukapheresis products (LP) collected from breast cancer (BC) patients and compares these results with those obtained using immunocytochemistry (IC). Eighty-four LP obtained from 33 patients with stage II-III BC and control subjects without BC were screened for the presence of BCC by IC and CK19, CEA, and maspin expression using RT-PCR. CEA RT-PCR and IC were the only specific markers, as no false positives were detected in any patients without BC. CK19 RT-PCR gave 11% false positives, whereas maspin RT-PCR with 25% was the most unspecific marker. In LP from BC patients, positive results were observed in 70% and 63% for CK19 and CEA RT-PCR, respectively. For maspin RT-PCR, this percentage was 22%, and for IC it was 17%. There was a good correlation between the CEA and CK19 RT-PCR (p = 0.018). No correlation between CEA and CK19 RT-PCR and IC was found, and although 5 of the 6 IC+ samples were CEA+/CK19+, great discrepancies in the group of IC- samples were observed. Our data suggest that RT-PCR assays for CEA and, to a lesser extent, for CK19 have more sensitivity and specificity than IC to detect BCC in LP.

Ochrobactrum intermedium infection after liver transplantation.

A case of bacteremia due to Ochrobactrum intermedium, with concomitant liver abscesses, in an orthotopic liver transplant recipient is presented. Identical microorganisms were isolated from fecal specimens and from an aspirate of a liver abscess that was indicative of invasion of the graft by gastrointestinal spread. 16S DNA sequence analysis of the blood isolate revealed the recovery of the recently proposed new species O. intermedium, closely related to Ochrobactrum anthropi and Brucella spp.

[Renal angiomyolipoma. Ultrasonography and computerized tomography findings]. / Angiomiolipomas renales. Reflexión sobre los hallazgos por ultrasonido y tomografía computerizada.

OBJECTIVE: To analyze the US and CT findings and their value in the diagnosis and follow-up of renal angiomyolipoma. METHODS/RESULTS: The clinical features, US and CT findings in 17 cases of renal angiomyolipoma were reviewed. Patient mean age was 49.1 years, 15 were asymptomatic and two presented with spontaneous bleeding. Two patients with Bourneville's disease presented bilateral lesions. The presumptive diagnosis was based on the US findings in 15 patients and on the CT findings in 16 patients. The remaining patient was evaluated by MRI. Three patients underwent partial nephrectomy and three other patients required total nephrectomy. CONCLUSIONS: Ultrasound is useful in the diagnosis of renal angiomyolipoma and it is probably the method of choice for follow-up. Two thirds were echogenic, although an echogenic lesion is not necessarily fat or viceversa. It is therefore necessary to perform a CT evaluation to make the diagnosis, especially if the tumor produces symptoms. In this series, detection of fat on CT evaluation was diagnostic of renal angiomyolipoma, although fatty tissue can also be found in other tumors or inflammatory lesions. Occasionally, the densitometric findings may not be conclusive due to the artefact of partial volume. The use of 5 mm slices without contrast and volumetric acquisitions for reconstruction can enhance the spatial resolution. It must also be taken into account that the fat content of a lesion can be scanty and may be undetected or not distinguished from other tumors.

Assessment of resolution and intercenter reproducibility of results of genotyping Staphylococcus aureus by pulsed-field gel electrophoresis of SmaI macrorestriction fragments: a multicenter study.

Twenty well-characterized isolates of methicillin-resistant Staphylococcus aureus were used to study the optimal resolution and interlaboratory reproducibility of pulsed-field gel electrophoresis (PFGE) of DNA macrorestriction fragments. Five identical isolates (one PFGE type), 5 isolates that produced related PFGE subtypes, and 10 isolates with unique PFGE patterns were analyzed blindly in 12 different laboratories by in-house protocols. In several laboratories a standardized PFGE protocol with a commercial kit was applied successfully as well. Eight of the centers correctly identified the genetic homogeneity of the identical isolates by both the in-house and standard protocols. Four of 12 laboratories failed to produce interpretable data by the standardized protocol, due to technical problems (primarily plug preparation). With the five related isolates, five of eight participants identified the same subtype interrelationships with both in-house and standard protocols. However, two participants identified multiple strain types in this group or classified some of the isolates as unrelated isolates rather than as subtypes. The remaining laboratory failed to distinguish differences between some of the related isolates by utilizing both the in-house and standardized protocols. There were large differences in the relative genome lengths of the isolates as calculated on the basis of the gel pictures. By visual inspection, the numbers of restriction fragments and overall banding pattern similarity in the three groups of isolates showed interlaboratory concordance, but centralized computer analysis of data from four laboratories yielded percent similarity values of only 85% for the group of identical isolates. The differences between the data sets obtained with in-house and standardized protocols could be the experimental parameters which differed with respect to the brand of equipment used, imaging software, running time (20 to 48 h), and pulsing conditions. In conclusion, it appears that the standardization of PFGE depends on controlling a variety of experimental intricacies, as is the case with other bacterial typing procedures.

Minimal illegitimate levels of cytokeratin K19 expression in mononucleated blood cells detected by a reverse transcription PCR method (RT-PCR).

Cytokeratin K19 (CK19) expression was evaluated by a reverse transcription PCR method (RT-PCR) in the RNA obtained from peripheral blood stem cell collections (PBSC) from four patients with breast cancers (BC) and 34 mononucleated blood cell (MBC) negative controls (17 PBMC from normal subjects 12 PBSC from different types of leukaemias--M3, M4Eo, M2, etc.--and two from patients with Hodgkin's lymphoma; and three bone marrow (BM) collections). Two BC tissues were taken as positive controls. The method studied (Datta YH, Paul T, Adams PT, Drobyski WR. Sensitive detection of occult breast cancer by reverse transcription polymerase chain reaction. J Oncol 1994;12:475-8) is sensitive enough to allow the detection of CK19 transcripts in a 10(-6) dilution of cDNA reverse transcribed from 1 microgram of BC RNA, but CK19 transcripts were also detected in 64% of the RNA obtained from the MBC controls. However, the amplified product detected in the control samples represents the transcript of the CK19 gene as confirmed by the results of Mae III digestion. It should be pointed out that although the CK19 expression was detected, the levels of expression in PBMC were almost negligible for they disappeared at 1:5 cDNA dilution. Moreover, a direct relationship between the number of BC cells added to PBMC and the increasing dilution levels of the cDNA necessary to prevent CK19 expression was observed. This allows us to conclude that the cDNA dilutions make it possible to distinguish the false from the true positive samples and that, in addition, the cDNA dilutions inform about the degree of BC cell contamination.

[Study of DNA content and its association with staging, tumor size, architecture, cell type, and nuclear grade in renal adenocarcinoma]. / Estudio del contenido en ADN y de su asociación con el estadio, tamaño tumoral, arquitectura, tipo celular y grado nuclear en el adenocarcinoma renal.

OBJECTIVE: To present the results of the analysis of DNA content in renal adenocarcinoma and its correlation with histopathological findings as a first step to conduct predictive studies. MATERIAL AND METHOD: DNA analysis was carried out by flow cytometry in deparaffined and fresh samples (1-4 per tumour) from 192 tumours. Correlation to stage, size, growth pattern and grade was studied using the squared chi test. RESULTS: The percentage of non-diploid tumours increased with the number of samples analyzed. Use of multiple sampling allowed to classify as non-diploid an additional 19% tumours. 57% tumours were homogeneously diploid, while the rest were non-diploid showing a wide variety of patterns: homogeneous, heterogeneous, and even tumours with more than one different non-diploid population. A positive correlation was seen between DNA content pattern, pathological stage and grade. CONCLUSIONS: Multiple sampling is essential to obtain representative information on DNA content. Prior to conduct predictive studies, the correlation between DNA content, stage and grade should be studied to preclude addition of non-independent information.

Translational activities of EF-Tu [G222D] which cannot be reconciled with the classical scheme of the polypeptide chain elongation cycle.

We have developed a cell-free system of E. coli that enables us to study the in vitro translation of natural mRNA mediated by wild-type or mutant EF-Tu. Various mutant EF-Tu species have been analyzed, one of which, EF-Tu [G222D], appeared to be virtually unable to mediate the translation of natural mRNA. Since this mutant factor is able to participate in translation in vivo by suppressing nonsense and frameshift mutations in cooperation with EF-Tu [A375T], a revision of the generally accepted scheme of the elongation cycle has been proposed (Bosch, L., Vijgenboom, E., & Zeef, L.A.H., 1996, Biochemistry 36).

[Acute pancreatitis and acquired immunodeficiency syndrome]. / Pancreatitis aguda y síndrome de inmunodeficiencia adquirida.

Viral acute pancreatitis in Human Immunodeficiency Virus (HIV) infected patients has been occasionally described. We studied nine patients with HIV antibodies and acute pancreatitis attributed to Cytomegalovirus and/or Cryptosporidium infection. In four patients the clinical picture was consistent with acute pancreatitis while in five clinical manifestations were unspecific, and diagnosis was based on ultrasonography and/or computed tomography findings. In the HIV infected patient pancreatic evaluation by imaging techniques may disclose acute pancreatitis even in the absence of abdominal pain.

Anti-inflammatory activity of flavonol glycosides from Erythrospermum monticolum depending on single or repeated local TPA administration.

Two anti-inflammatory principles were isolated from the methanol extract of the leaves of Erythrospermum monticolum (Flacourtiaceae). The isolation was based on a guided bioassay of the inhibitory activity on TPA-induced ear edema in mice. These compounds were identified as quercetin 3-O-xylosyl(1-->2) rhamnoside and quercetin 3-O-rhamnoside. In addition, their effects on a chronic topic inflammation model were evaluated.

Healthcare Information Framework.

CEN committee TC 251 Medical Informatics, has set up a project team charged with producing a European pre-standard ENV on Healthcare Information Framework (HIF). The HIF is based on abstraction from a specific information system architecture to a reference architecture and further to a conceptual architectural framework based on serving open, distributed and heterogeneous healthcare enterprises. To specify the suitable healthcare information system architecture modelling of the healthcare enterprise is required. As there is no one method serving all needs, the HIF gives guidance on what aspects to look at in selecting a suitable modelling method. It is expected that the work will be completed by early 1995.

Chronic hepatitis and cirrhosis: evaluation by means of MR imaging with histologic correlation.

To characterize the relationship between findings on magnetic resonance (MR) images and histologic changes in chronic liver disease, a prospective study was performed in 100 patients with chronic hepatitis and cirrhosis and 28 healthy subjects. Biopsy specimens, obtained in all patients before MR imaging, were evaluated with the histologic activity (HA) index; MR images were obtained with short inversion time inversion-recovery (STIR) and spin-echo sequences. On STIR images, normal livers were iso-intense to fat. Significant differences (P < .001) existed between signal intensity of normal livers and that of diseased livers, which were brighter than normal livers on STIR images. The ratio of signal intensity of liver to that of fat on STIR images was associated with an HA index grouped by severity (P < .05): Patients with higher HA scores had a brighter liver. Signal intensity ratios on MR images were statistically significantly associated with periportal and lobular necrosis and portal inflammation. The signal intensity of liver on STIR images is associated with the degree of histologic severity in patients with chronic liver disease.

Isolation and functional analysis of histidine-tagged elongation factor Tu.

The study of the structure/function relationships of the Escherichia coli elongation factor Tu (EF-Tu) via mutagenesis has been hampered by difficulties encountered in separating the mutated factor from other proteins, in particular native EF-Tu. Here we describe a novel system for the purification of EF-Tu mutant species, based on metal-ion affinity chromatography. To facilitate rapid and efficient purification we designed a recombinant EF-Tu with an additional C-terminal sequence of one serine and six histidine residues. A cell extract containing the His-tagged EF-Tu (EF-TuHis) is applied to a Ni(2+)-nitrilotriacetic acid column. EF-TuHis can be selectively eluted with an imidazole containing buffer, yielding a preparation of more than 95% purity, free of wild-type EF-Tu. In-vitro and in-vivo functional analyses show that EF-TuHis resembles the wild-type EF-Tu, which makes this one-step isolation procedure a promising tool for the study of the interactions of mutant EF-Tu with the various components of the elongation cycle. The new isolation procedure was successfully applied for the purification of a mutant EF-TuHis with a Glu substitution for Lys237, a residue possibly involved in the binding of aminoacyl-tRNA.

[Calcification of the portal vein associated with hepatocarcinoma]. / Calcificación de la vena porta asociada a hepatocarcinoma.

We report a patient with alcoholic cirrhosis presenting with ascites, jaundice and malaise. Linear calcifications on the portal area were seen in the plain film of the abdomen. Computed tomography confirmed the presence of calcification of the portal vein wall and discovered lesions highly suggestive of diffuse multinodular hepatocarcinoma. We emphasize the rarity of portal vein calcification in patients with portal hypertension secondary to hepatic cirrhosis and hepatocarcinoma.

Lesion/fat intensity ratio in MR characterization of hepatic masses.

On T2-weighted spin echo images, lesion/liver intensity ratios can be used to accurately distinguish hepatic cavernous hemangioma from malignant lesions. However, since patients with focal liver lesions may present diffuse liver disease, this relationship can be inaccurate. We studied 91 hepatic lesions to compare the value of lesion/liver and lesion/fat ratios in the differential diagnosis of liver lesions. In doubtful cases the use of lesion/fat intensity ratio can be used to improve accuracy in the diagnosis of liver lesions. The combination of both ratios into a single diagnostic index gave a correct classification of malignant versus hemangioma in 92.3% of the cases.

[A favorable response to the somatostatin analog SMS 201-995 in a patient with the carcinoid syndrome]. / Respuesta favorable al análogo de la somatostatina SMS 201-995 en un paciente con síndrome carcinoide.

A patient with carcinoid syndrome was treated with the somatostatin analogue (SMS 201-995). The drug significantly improved the symptoms of the patient, flushing and diarrhea, and reduced urinary excretion of 5-hydroxyindole acetic acid. However, hepatic metastases remained unchanged. Clinical or biochemical adverse effects were not present during the treatment period.

High density barium sulphate as an MRI oral contrast.

High density barium sulphate suspension was investigated as an oral contrast on MRI. On 30 consecutive subjects, the stomach (in all cases) and the two first portions of the duodenum (in 21 cases) were filled with the suspension. This oral contrast behaved as a negative contrast, being hypointense on all pulse sequences (spin-echo T1-weighted, spin-echo T2-weighted and STIR). This characteristic is probably due to the low proton density of the suspension (260 +/- 40). Since barium sulphate is inexpensive, harmless and available on all radiologic departments, it is recommendable in MRI studies of the liver and head of the pancreas.