¿Qué es la psicosomática? / What is psychosomatics?

La definición de Psicosomática recorre un camino triangular en el que la biología, la personalidad y los eventos ambientales cierran los ángulos; está matizado por los recursos de afrontamiento ante diversas situaciones. Una posible nosología transcurre transversalmente todo el abanico de la patología: trastornos somáticos con marcada incidencia psicológica; la deconstruida somatización; la alta morbilidad psicológica en enfermos médico quirúrgicos (30 a 50% de ingresados y 25-30% ambulatorios), con la Psiquiatría de Enlace siempre presente en su abordaje; la Ansiedad por la Enfermedad (primaria o secundaria). Se sintetizan algunos de los modelos más destacados desde el Córticovisceral a la Psiconeuroinmunoendocrinología, pasando por los procesos del estrés. La conclusión es que la psicosomática se integra en el conjunto de la Medicina y potencia los recursos diagnósticos, terapéuticos, de investigación y colaborativos entre los diversos profesionales implicados. (AU)

The expression level of BAALC-associated microRNA miR-3151 is an independent prognostic factor in younger patients with cytogenetic intermediate-risk acute myeloid leukemia.

Acute myeloid leukemia (AML) is a heterogeneous disease whose prognosis is mainly related to the biological risk conferred by cytogenetics and molecular profiling. In elderly patients (⩾60 years) with normal karyotype AML miR-3151 have been identified as a prognostic factor. However, miR-3151 prognostic value has not been examined in younger AML patients. In the present work, we have studied miR-3151 alone and in combination with BAALC, its host gene, in a cohort of 181 younger intermediate-risk AML (IR-AML) patients. Patients with higher expression of miR-3151 had shorter overall survival (P=0.0025), shorter leukemia-free survival (P=0.026) and higher cumulative incidence of relapse (P=0.082). Moreover, in the multivariate analysis miR-3151 emerged as independent prognostic marker in both the overall series and within the unfavorable molecular prognostic category. Interestingly, the combined determination of both miR-3151 and BAALC improved this prognostic stratification, with patients with low levels of both parameters showing a better outcome compared with those patients harboring increased levels of one or both markers (P=0.003). In addition, we studied the microRNA expression profile associated with miR-3151 identifying a six-microRNA signature. In conclusion, the analysis of miR-3151 and BAALC expression may well contribute to an improved prognostic stratification of younger patients with IR-AML.

Plerixafor in patients with lymphoma and multiple myeloma: effectiveness in cases with very low circulating CD34+ cell levels and preemptive intervention vs remobilization.

This retrospective study presents data from 105 consecutive multiple myeloma and lymphoma patients who had PB CD34+ cell counts <10/µL on day 4 of steady-state G-CSF mobilization for autologous hematopoietic cell transplantation. Our results confirm the capacity of plerixafor to improve mobilization outcomes in this clinical setting. In addition, they show that the effectiveness of plerixafor, compared with G-CSF only, translates to patients with very low (<3.5/µL) circulating CD34+ cell counts: overnight CD34+ cell count expansion (5.3- vs 1.7-fold), overall CD34+ cell yield (2.29 vs 0.15 × 10(6) CD34+ cells per kg) and patients yielding ⩾2 × 10(6) CD34+ cells per kg (63% vs 3%). Furthermore, our data also show that preemptive plerixafor is significantly more effective and more efficient than in remobilization: CD34+ cell yield in the first apheresis (3.28 vs 2.0 × 10(6) CD34+ cells per kg) and overall (3.73 vs 2.44 × 10(6) CD34+ cells per kg), patients yielding ⩾2 × 10(6) CD34+ cells per kg in the first apheresis (85% vs 44%) and overall (92% vs 64%), all this requiring less days and doses of plerixafor treatment (1.08 vs 1.48). These data would advocate using plerixafor as an early preemptive intervention based on day 4 circulating CD34+ counts, including very high-risk patients with very low circulating levels.

Low-dose beta-lactam plus amikacin in febrile neutropenia: cefepime vs. piperacillin/tazobactam, a randomized trial.

Patients with fever and granulocytopenia are at risk of developing severe infection. We performed a prospective, randomized trial to evaluate the efficacy of low-dose cefepime plus amikacin (C-A) compared to low-dose piperacillin/tazobactam plus amikacin (PT-A). Patients received cefepime (2 g/12 h) plus amikacin (15 mg/kg/day) or piperacillin/tazobactam (4 g/500 mg/8 h) plus amikacin. A total of 317 episodes of febrile granulocytopenia in 190 patients were studied (152 in the C-A group, 165 in the PT-A group). A microbiologically documented infection was present in 53 (35%) episodes in the C-A group and 41 (25%) episodes in the PT-A group (p = ns); a clinically documented infection was observed in 39 (26%) and 47 (28%) episodes, respectively. Toxicity was observed in 6 (4%) episodes in the C-A group and in 5 (3%) episodes in the PT-A group. The antibiotic success rate (no change or addition of antibiotics) was recorded in 89 (59%) and 105 (64%) cases, respectively (p = ns). Mortality related to infection was similar in each arm (3.9% vs. 3.6%). Combination therapy of low-dose beta-lactam with an aminoglycoside achieves very good response rates and low rates of toxicity. It might be an attractive option in an environment of increasing resistance among gram-negative bacteria.

Prognostic value of minimal residual disease (MRD) in acute myeloid leukemia (AML) with favorable cytogenetics [t(8;21) and inv(16)].

Most patients with acute myeloid leukemia (AML) and t(8;21) or inv(16) have a good prognosis with current anthracycline- and cytarabine-based protocols. Tandem analysis with flow cytometry (FC) and real-time RT-PCR (RQ-PCR) was applied to 55 patients, 28 harboring a t(8;21) and 27 an inv(16), including one case with a novel CBFbeta/MYH11 transcript. A total of 31% (n=17) of CR patients relapsed: seven with t(8;21) and 10 with inv(16). The mean amount of minimal residual disease (MRD) detected by FC in relapsed and nonrelapsed patients was markedly different: 0.3 vs 0.08% (P=0.002) at the end of treatment. The mean number of fusion transcript copies/ ABL x 10(4) also differed between relapsed and non-relapsed patients: 2385 vs 122 (P=0.001) after induction, 56 vs 7.6 after intensification (P=0.0001) and 75 vs 3.3 (P=0.0001) at the end of chemotherapy. Relapses were more common in patients with FC MRD level >0.1% at the end of treatment than in patients with < or = 0.1%: cumulative incidence of relapse (CIR) was 67 and 21% (P=0.03), respectively. Likewise, using RQ-PCR, a cutoff level of >10 copies at the end of treatment correlated with a high risk of relapse: CIR was 75% for patients with RQ-PCR >10 compared to 21% for patients with RQ-PCR levels < or = 10 (P=0.04). Combined use of FC and RQ-PCR may improve MRD detection, and provide useful clinical information on relapse kinetics in AML patients.

Adverse prognostic impact of CD36 and CD2 expression in adult de novo acute myeloid leukemia patients.

BACKGROUND AND OBJECTIVES: A consecutive series of acute myeloid leukemias (AML) patients was analyzed in conditions which reduce the inter-assay variations (the same flow cytometer, the same observers and the same panel of monoclonal antibodies) in order to investigate the prognostic information provided by flow cytometry. DESIGN AND METHODS: Two hundred and sixty-six bone marrow (BM) samples from 326 patients enrolled in the LMA-99 protocol from the CETLAM group were studied by multiparametric flow cytometry. Immunophenotyping studies were performed on erythrocyte-lysed BM samples. Antigen expression of leukemic cells was analyzed using triple stainings with fluorochrome-conjugated combinations of monoclonal antibodies. RESULTS: CD2 was positive in 21 cases (8%); an associated inv(16) was detected in eight CD2+ cases (38%). Two-year overall survival (OS) rate for CD2+/inv(16)+ patients was 75%, whereas it was 0% for CD2+/inv(16)- patients and 47% for CD2- patients (p=0.0001). CD36 was expressed in 37% of patients (n=98). Two-year leukemia-free survival (LFS) rate was 34% for CD36+ patients and 55% for CD36- patients (p=0.001). In the multivariate analysis, CD2+ (RR=8.4; p=0.0001) and adverse karyotype (RR=10.2; p=0.0001) were associated with a lower CR rate, CD36+ (RR=1.5; p=0.03), CD2+ (RR=2; p=0.04) and adverse karyotype (RR=4; p=0.0001) were associated with a lower OS and CD36+ (RR=2; p=0.002) and adverse karyotype (RR=3.5; p=0.005) predicted a lower LFS. CONCLUSIONS: CD2+ patients had a very poor OS when CD2/inv(16)+ cases were excluded. CD36 and CD2 expression at diagnosis can provide prognostically important information in adult de novo AML.

Leprosy: dental and periodontal status of the anterior maxilla in 76 patients.

OBJECTIVE: To evaluate the presence of oral disease, as assessed by dental and periodontal indices, in the anterior maxilla of a group of 76 patients with leprosy, compared with a group of matched control subjects. MATERIALS AND METHODS: The study included 76 patients with leprosy (age range 40-82 years; 39 males), resident in the sanatorium of San Francisco de Borja de Fontilles (Alicante, Spain). Clinical examination was carried out to evaluate the decayed missing and filled index, and the periodontal status in the anterior maxilla, using the Löe-Silness dental plaque index, mean periodontal probing depth and the average periodontal attachment loss. RESULTS: In the leprosy patients, a large proportion of maxillary incisors and canines were missing. The mean plaque index in leprosy was 2.35 +/- 0.7, with a probing depth of 2.96 +/- 0.8, and an average attachment loss of 4.18 +/- 1.3, indices all statistically greater than in controls. There were no differences detected in the oral indices measured according to the presence or absence of facial destruction or the type of leprosy. CONCLUSIONS: Patients with leprosy show a tendency to poor dental and periodontal health, unrelated to the presence of facial destruction or the type of leprosy.

Comportamiento materno durante el parto según parámetros clínicos y sociológicos de la gestación / Maternal behavior in labor according to clinical and sociological childbirth variables

Objetivo: Analizar diversos factores que pueden influir en el comportamiento de la mujer durante el parto. Pacientes y método: Se estudiaron 100 embarazadas elegidas al azar. Las variables analizadas fueron: nivel de estudios, dismenorrea, antecedentes obstétricos desfavorables, psicoprofilaxis obstétrica, gestación deseada, miedo previo al parto, tratamiento intraparto, tipo de parto, tipo de registro cardiotocográfico y peso fetal. La variable resultado valorada fue el comportamiento intraparto (colabora/no colabora); se analizó su relación con las 10 variables elegidas tanto durante el período de dilatación como durante el período expulsivo. Resultados: Tan sólo la variable miedo previo al parto presentó una asociación estadísticamente significativa con el comportamiento de la mujer, tanto en el período de dilatación (p = 0,011) como en el período expulsivo (p = 0,002). Conclusiones: Cuando la mujer reconoce tener miedo al parto puede presentar una actitud totalmente negativa que le impida llevar a cabo de manera adecuada las instrucciones de los profesionales. (AU)

Valor clínico de la tomografía de emisión de positrones con f-18-fdg en el seguimiento de pacientes con cáncer de ovario / Clinical value of positron emission tomography with f-18-fdg in the follow up of patients with cancer of the ovary

Fundamento. La tomografía por emisión de positrones con flúor-18-desoxiglucosa (PET-FDG) es una técnica eficaz en la detección de tejido tumoral. El objetivo del trabajo fue evaluar la PET-FDG en el diagnóstico de enfermedad residual o recidiva en pacientes con cáncer de ovario. Material y métodos. Se incluyeron un total de 24 pacientes diagnosticadas y tratadas por cáncer de ovario con cirugía y posterior quimioterapia. En 12 pacientes el estudio se realizó previo a la cirugía de second-look y en las otras 12 tras objetivarse en el seguimiento un aumento del marcador tumoral. En todas las pacientes se realizó TAC abdomino-pélvico, determinación de los niveles séricos de CA-125 y PET-FDG de tórax, abdomen y pelvis. La PET-FDG se valoró de forma cualitativa, mediante el estudio visual de las imágenes, y cuantitativa mediante el SUV o valor estándar de captación. El diagnóstico definitivo se confirmó mediante el estudio anatomopatológico en 13 casos y en el resto por seguimiento clínico con una media de 11,2ñ5,4 meses (rango 6-24).Resultados. Se consideró positivo un valor de CA-125 superior a 35 UI/ml, obteniendo una sensibilidad del 77 por ciento y una especificidad del 100 por ciento. La sensibilidad del TAC fue del 23 por ciento y la especificidad 91 por ciento. Con la PET-FDG la sensibilidad fue del 92 por ciento y la especificidad del 90 por ciento. Se consideró patológico un valor SUV 3, obteniéndose los mismos resultados que con la valoración visual. La PET-FDG fue positiva en 5 pacientes con TAC no concluyente, 4 con TAC negativo y 2 con CA-125 negativo. Conclusión. Estos resultados preliminares sugieren que la PET-FDG puede ser útil en el seguimiento de pacientes tratadas por cáncer de ovario. La PET-FDG puede ser especialmente eficaz en la diferenciación entre enfermedad residual o recurrencia frente a secuelas del tratamiento cuando la TAC no es concluyente debido a la distorsión anatómica. La PETFDG puede ser más sensible que la elevación del marcador y ante una elevación de éste permite la localización no invasiva de la enfermedad (AU)

[Clinical value of positron emission tomography with F-18-FDG in the follow up of patients with cancer of the ovary]. / Valor clínico de la tomografía de emisión de positrones con F-18-FDG en el seguimiento de pacientes con cáncer de ovario.

BACKGROUND: Positron emission tomography with fluor-18-deoxyglucose (PET-FDG) is an efficient technique for the detection of tumoural tissue. The aim of the paper is to evaluate the PET-FDG in the diagnosis of residual disease or relapse in patients with cancer of the ovary. METHODS: A total of 24 patients, diagnosed and treated for cancer of the ovary with surgery and subsequent chemotherapy, were included. With 12 patients the study was carried out prior to second-look surgery, and with the other 12 after objectivising an increase of the tumoural marker in the follow up. Abdominal-pelvic CAT, determination of the seric levels of CA-125 and PET-FDG of thorax, abdomen and pelvis were carried out on all patients. The PET-FDG was evaluated in a qualitative way through the visual study of the images, and quantitatively through the SUV or standard uptake value. The definitive diagnosis was confirmed through an anatomopathological study in 13 cases and through clinical follow up in the rest with an average of 11.2+/-5.4 months (range 6-24). RESULTS: A CA-125 value higher than 35 UI/ml was considered positive, obtaining a sensitivity of 77% and a specificity of 100%. The sensitivity of the CAT was 23% and the specificity 91%. With the FDG-PET sensitivity was 92% and the specificity 90%. A SUV value >or= 3 was considered pathological, obtaining the same results as with the visual evaluation. The FDG-PET was positive in 5 patients with non-conclusive CAT, 4 with negative CAT and 2 with negative CA-125. CONCLUSION: These preliminary results suggest that the FDG-PET could be useful in the detection of disease in the follow up of patients treated for cancer of the ovary. The FDG-PET could be efficient in the differentiation between residual disease or recurrence, as opposed to sequels to the treatment, when the CAT is not conclusive due to anatomical distortion, since it permits the detection of tumoural lesions undetected by the radiological image techniques but metabolically active. The FDG-PET could be more sensitive than an increased marker value, and facing an increase of the latter it permits a non-invasive localisation of the disease.

Synthesis and reactivity of bridging and terminal hydrosulfido palladium and platinum complexes. Crystal structures of [NBu4]2[(Pt(c6F5)2(mu-SH)]2], [Pt(C6F5)2(PPh3)[S(H)AgPPh3]], and [Pt(C6F5)2(PPh3)[S(AuPPh3)2]].

The reactions of the hydroxo complexes [M(2)R(4)(mu-OH)(2)](2)(-) (M = Pd, R = C(6)F(5), C(6)Cl(5); M = Pt, R = C(6)F(5)), [[PdR(PPh(3))(mu-OH)](2)] (R = C(6)F(5), C(6)Cl(5)), and [[Pt(C(6)F(5))(2)](2)(mu-OH)(mu-pz)](2-) (pz = pyrazolate) with H(2)S yield the corresponding hydrosulfido complexes [M(2)(C(6)F(5))(4)(mu-SH)(2)](2-), [[PdR(PPh(3))(mu-SH)](2)], and [[Pt(C(6)F(5))(2)](2)(mu-SH)(mu-pz)](2-), respectively. The monomeric hydrosulfido complexes [M(C(6)F(5))(2)(SH)(PPh(3))](-) (M = Pd, Pt) have been prepared by reactions of the corresponding binuclear hydrosulfido complexes [M(2)(C(6)F(5))(4)(mu-SH)(2)](2-) with PPh(3) in the molar ratio 1:2, and they can be used as metalloligands toward Ag(PPh(3))(+) to form the heterodinuclear complex [(C(6)F(5))(2)(PPh(3))[S(H)AgPPh(3)]], and toward Au(PPh(3))(+) yielding the heterotrinuclear complexes [M(C(6)F(5))(2)(PPh(3))[S(AuPPh(3))(2)]]. The crystal structures of [NBu(4)](2)[[Pt(C(6)F(5))(2)(mu-SH)](2)], [Pt(C(6)F(5))(2)(PPh(3))[S(H)AgPPh(3)]], and [Pt(C(6)F(5))(2)(PPh(3))[S(AuPPh(3))(2)]] have been established by X-ray diffraction and show no short metal-metal interactions between the metallic centers.

[Clinical characteristics of 104 patients with obsessive compulsive disorder]. / Características clínicas de 104 pacientes con diagnóstico de trastorno obsesivo compulsivo.

INTRODUCTION: Obsessive compulsive disorder is a common disorder, but research on its clinical features is scarce. The goal of this study is to describe the clinical characteristics and demographic features of a large sample of patients with Obsessive compulsive disorder. METHOD: The characteristics of 104 patients who sought psychiatric treatment and who were diagnosed as having Obsessive compulsive disorder were assessed by means of a structured questionnaire. RESULTS: The mean age of onset was 20 years and the mean time before soliciting treatment was 4 years. Most of the patients reported an insidious onset and related the onset to an stressful event. The most frequent obsessions were doubt, aggressiveness and contamination. Checking, need to ask and mental rituals were the most frequent compulsions. Cleaning and repetition compulsions were most frequent in women. DISCUSSION: Our results regarding age at onset of illness, way of onset or prevalence of certain obsessions and compulsions are similar to previous research. No agreement was obtained with previous research regarding the link between stress and illness onset, the course of the disorder or the time before treatment was sought. The differences with respect to previous studies could be accounted for the use of different instruments or criteria. The need for the development of instruments allowing to shed light on these discrepancies is stressed.

Características clínicas de 104 pacientes con diagnóstico de trastorno obsesivo compulsivo / Clinical characteristics of 104 patients with obsessive compulsive disorder

Introducción: El trastorno obsesivo compulsivo es un trastorno frecuente, pero los estudios sobre características clínicas son escasos. El objetivo del presente estudio es describir las características demográficas y clínicas de un grupo amplio de pacientes con trastorno obsesivo compulsivo. Material y métodos: Se evaluaron mediante un cuestionario estructurado las características de 104 pacientes que solicitaron tratamiento psiquiátrico y que recibieron el diagnóstico de trastorno obsesivo compulsivo. Resultados: La edad media de inicio del trastorno era de 20 años y el tiempo medio hasta solicitar tratamiento cuatro años. La mayoría de pacientes referían un inicio insidioso del trastorno y asociaban su comienzo con una experiencia estresante. Las obsesiones más frecuentes eran las de duda, agresividad y contaminación. Las compulsiones más habituales eran de comprobación, necesidad de preguntar y rituales mentales. Las compulsiones de limpieza y repetición eran más frecuentes en mujeres. Discusión: Los resultados obtenidos en la edad o forma de inicio del trastorno y la prevalencia de determinadas obsesiones y compulsiones son similares a investigaciones previas. No existe acuerdo con trabajos anteriores en otras variables como la asociación del inicio de la enfermedad con el estrés, el curso del trastorno o el tiempo transcurrido hasta solicitar tratamiento. Estas diferencias respecto a trabajos anteriores podrían deberse a la utilización de criterios o instrumentos de evaluación diferentes. Parece necesaria la elaboración de instrumentos que permitan aclarar estas discrepancias (AU)