Experiencia y resultados en el tratamiento de la leucemia linfoblástica aguda en la edad pediátrica en el periodo comprendido entre 1989 y 2005 en la Comunidad de Navarra / Experience and results of acute lymphoblastic leukaemia treatment in children between 1989-2005 in Navarre

Fundamento. El conocimiento de factores que se comportan como pronósticos en la leucemia linfoblástica aguda (LLA) es cada vez más importante para establecer una estrategia de tratamiento correcta. Se analiza la supervivencia global (SG), supervivencia libre de eventos (SLE) y los factores pronósticos en 16 años de experiencia en nuestra comunidad. Material y métodos. Estudio descriptivo retrospectivo en el que se incluyen los pacientes diagnosticados de leucemia aguda (LA) en ese periodo de tiempo. Análisis uni y multivariante de aquellos factores que hemos considerado relevantes en nuestra serie aplicando el paquete estadístico SPSS para Windows versión 12. Resultados. En el periodo comprendido entre enero de 1989 y diciembre de 2005 se diagnosticaron 58 pacientes de LA, 50 de ellos tipo linfoblástica aguda (LLA). Se analiza un subgrupo de 41 pacientes de forma más exhaustiva por ser el tipo de leucemia más frecuente y por haber estado incluidos en protocolos bien establecidos. En este grupo la SLE fue del 78% y la SG del 87,8%. Las variables multivariante predictoras en nuestra serie fueron: el inmunofenotipo (B-Común/Otras) con un HR de 13,82 (IC95%: 1.019-166.008) p120meses/12-120meses) con un HR de 13,82 (IC95%: 0,58-329,48) p =0,1. Conclusiones. En nuestra serie la tasa de supervivencia es superponible a la de otros grupos colaborativos. El inmunofenotipo y el protocolo vigente se comportan como factores que influyen significativamente en la evolución de los pacientes

Background. The determination of prognostic factors in acute lymphoblastic leukaemia (ALL) is increasingly important in establishing a correct treatment. We analyse the overall survival (OS), event free survival (EFS) and prognostic factors in our 16 years experience of treating acute lymphoblastic leukaemia. Methods. We performed univariate and multivariate analyses of the prognostic factors we considered most significant in our serie of patients Results. From January 1989 to December 2005, 50 cases of ALL were reported in 58 patients with LA. We analysed a subgroup of 41 patients with LLA as they were included in standard protocols. In this group the EFS was 78% and OS 87.8%. Inmunophenotype is a predictor of prognosis when we compare Common with Others, with a HR of 13.82 (CI95%: 1.019-166.008) p120 months/12-120 months) with a HR of 13.82 (CI95%: 0.58-329.48) p=0.1 Conclusions. The OS in our series is similar to that reported in the literature. Inmunophenotype and protocols of treatment are the most significant prognostic factors

[Experience and results of acute lymphoblastic leukaemia treatment in children between 1989-2005 in Navarre]. / Experiencia y resultados en el tratamiento de la leucemia linfoblástica aguda en la edad pediátrica en el periodo comprendido entre 1989 y 2005 en la Comunidad de Navarra.

BACKGROUND: The determination of prognostic factors in acute lymphoblastic leukaemia (ALL) is increasingly important in establishing a correct treatment. We analyse the overall survival (OS), event free survival (EFS) and prognostic factors in our 16 years experience of treating acute lymphoblastic leukaemia. METHODS: We performed univariate and multivariate analyses of the prognostic factors we considered most significant in our serie of patients. RESULTS: From January 1989 to December 2005, 50 cases of ALL were reported in 58 patients with LA. We analysed a subgroup of 41 patients with LLA as they were included in standard protocols. In this group the EFS was 78% and OS 87.8%. Inmunophenotype is a predictor of prognosis when we compare Common with Others, with a HR of 13.82 (CI95%: 1.019-166.008) p<0.05; Protocol of Treatment of the Paediatric Haematology Oncology Society (SHOP) (94-99/89) with HR of 0.065 (CI95%: 0.005-0.008) p<0.02; and Age (>120 months/12-120 months) with a HR of 13.82 (CI95%: 0.58-329.48) p=0.1. CONCLUSIONS: The OS in our series is similar to that reported in the literature. Inmunophenotype and protocols of treatment are the most significant prognostic factors.

Incorporación de la metodología geoestadística a la vigilancia de la gripe en una red centinela / Incorporation of geostatistical methodology for influenza surveillance in a sentinel network

Objetivo: Valorar la descripción geoestadística realizada de los datos de gripe recogidos a través de la Red Centinela Sanitaria de la Comunidad Valenciana (RCSCV) mediante la utilización del método kriging con la finalidad de evaluar la posibilidad de su incorporación a la vigilancia rutinaria Método: Se han utilizado los datos de vigilancia de gripe de la RCSCV en tres temporadas gripales (1997-1998, 1998-1999 y 1999-2000), construyéndose una matriz de datos de incidencia de gripe geocodificada. La distribución geográfica fue estudiada mediante la técnica geoestadística kriging, que permite estimar la incidencia de la enfermedad en cualquier punto del territorio, a partir de la incidencia observada en unos pocos puntos estratégicamente distribuidos. Se elaboraron mapas de curvas de isoincidencia de gripe para cada semana. La valoración de la técnica se realizó mediante validación cruzada. Resultados: En la mayoría de las semanas, los valores tanto de la desviación estándar (DE) reducida, como de la media reducida estuvieron cercanos a los valores considerados óptimos (0 o 1, respectivamente), y sólo en la última temporada se obtuvieron valores de la DE reducida alejados de los considerados como de buen ajuste en 12 de las 20 semanas. La estimación de tasas en todas las temporadas demostró una coherencia en su distribución espacial. También se observó coherencia en la evolución temporal. Conclusiones: En la mayoría de las situaciones los resultados pueden considerarse aceptables, no requiere recursos informáticos extraordinarios ni un empleo de tiempo excesivo, y necesita tan sólo una adaptación anual. Su facilidad de uso lo hace apto para su utilización como una técnica de rutina, pese a que puede mejorarse la precisión de las estimaciones, incrementando la complejidad del modelo (AU)

Objectives: To evaluate geostatistical description of influenza data from the Valencian Sentinel Network (VSN) in Spain using the kriging method and to assess the possibility of incorporating this method into routine surveillance. Methods: We use influenza surveillance data on three influenza seasons (1997-1998, 1998-1999 and 1999-2000) from the VSN to construct a geocodified data matrix of the incidence of this disease. The geographic distribution was studied using the kriging method, which enables estimation of the incidence in a few strategically distributed points. Influenza isoincidence maps for each week were plotted. Cross validation was used to evaluate the method. Results: In most of the weeks, the values of reduced standard deviation and reduced mean were close to the optimal values (0 and 1, respectively). Out of range reduced standard deviation values were found in 12 of 20 weeks in the last season only. The estimation of rates in all three seasons showed coherence in spatial distribution and temporal evolution. Conclusions: In most situations the results were acceptable. The method does not requiere extra computer resources or an excessive amount of time and requires only annual adaptation. Becauseit is easy to use, the technique is appropriate for routine use but the accuracy of estimations could be improved by increasing the complexity of the model (AU)

[Incorporation of geostatistical methodology for influenza surveillance in a sentinel network]. / Incorporación de la metodología geoestadística a la vigilancia de la gripe en una red centinela.

OBJECTIVES: To evaluate geostatistical description of influenza data from the Valencian Sentinel Network (VSN) in Spain using the kringing method and to assess the possibility of incorporating this method into routine surveillance. METHODS: We use influenza surveillance data on three influenza seasons (1997-1998, 1998-1999 and 1999-2000) from the VSN to construct a geocodified data matrix of the incidence of this disease. The geographic distribution was studied using the kringing method, which enables estimation of the incidence in a few strategically distributed points. Influenza isoincidence maps for each week were plotted. Cross validation was used to evaluate the method. RESULTS: In most of the weeks, the values of reduced standard deviation and reduced mean were close to the optimal values (0 and 1, respectively). Out of range reduced standard deviation values were found in 12 of 20 weeks in the last season only. The estimation of rates in all three seasons showed coherence in spatial distribution and temporal evolution. CONCLUSIONS: In most situations the results were acceptable. The method does not require extra computer resources or an excessive amount of time and requires only annual adaptation. Because it is easy to use, the technique is appropriate for routine use but the accuracy of estimations could be improved by increasing the complexity of the model.

[Cerebrovascular accident as the form of presentation of a pancreatic cystadenocarcinoma: an unusual form of presentation in a rare tumor]. / Accidente cerebrovascular como forma de presentación de un cistoadenocarcinoma de páncreas: una forma de presentación inusual en un tumor infrecuente.

Pancreatic cystadenocarcinoma is an uncommon neoplasm of the pancreas. Mucinous cystadenocarcinoma is the most frequent pancreatic cystadenocarcinoma. Symptoms are often non-specific but abdominal pain and jaundice are common in tumors localized in the head of the pancreas. Thromboembolic manifestations of pancreatic neoplasm have been described but are infrequent. The commonest manifestations are migratory thrombophlebitis, mesenteric venous thrombosis and pulmonary embolism. Cerebral stroke as the first manifestation of pancreatic carcinoma is exceptional. The mechanism by which pancreatic carcinoma induces stroke is unclear, although Trousseau's syndrome, complications of mucinous cancer or blood disorders could play a role. We report the case of a young woman with transient stroke and paraneoplastic thrombocytosis in whom pancreatic cystadenocarcinoma was diagnosed.