Una evolución inusual en un paciente con amigdalitis aguda / An unusual outcome in a patient with acute tonsillitis

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Infecciones del tracto urinario bajo en adultos y embarazadas: consenso para el manejo empírico / Lower Urinary Tract Infections in Adults and Pregnant Women: A Consensus for Empirical Treatment

Introducción: La infección no complicada del tracto urinario bajo y la bacteriuria asintomática son causas frecuentes de consulta médica ambulatoria y en el servicio de urgencias en Colombia y el mundo. La falta de pautas y consenso para el manejo, así como la emergencia de resistencia a las múltiples opciones terapéuticas disponibles en los uropatógenos provenientes de la comunidad, hacen necesario elaborar unas recomendaciones que orienten al clínico sobre el abordaje óptimo de estas entidades. Objetivo: Definir un consenso sobre el manejo empírico de la bacteriuria asintomática y la infección del tracto urinario (ITU) bajo en adultos y mujeres embarazadas en Colombia. Metodología: Se lleva a cabo una metodología de consenso con expertos en urología, infectología, medicina interna, ginecología y microbiología basada en la revisión de las referencias bibliográficas disponibles en los términos de búsqueda relacionados, haciendo énfasis en estudios locales. Resultados: Se elaboró un algoritmo de manejo para el tratamiento empírico de la ITU baja no complicada en adultos con antisépticos urinarios como nitrofurantoína y fosfomicina trometamol como primera línea, con recomendaciones terapéuticas específicas para el tratamiento de la bacteriuria asintomática en mujeres embarazadas. Adicionalmente, se formuló un algoritmo de decisión para el procesamiento de cultivos de orina. La recurrencia o recaída frecuente justifica remisión a urología e infectología. Conclusiones: Se generan recomendaciones prácticas de fácil implementación en el diagnóstico y manejo de la ITU bajo en adultos y embarazadas, y de los casos donde es necesario tratar la bacteriuria asintomática, con opciones terapéuticas efectivas y de espectro reducido.

Background: Uncomplicated infection of the lower urinary tract and asymptomatic bacteriuria are frequent causes of visits to outpatient clinics and emergency departments in Colombia and worldwide. The lack of guidelines and a consensus for their management, and the emergence of resistance of community-based uropathogens to the available therapeutic options, make it necessary to develop recommendations to guide clinicians on the optimal approach to these entities. Objective: Define a consensus for the empiric management of asymptomatic bacteriuria and Urinary Tract Infection (UTI) in adults and pregnant women in Colombia. Methods: We carried out a consensus methodology with experts in urology, infectious diseases, internal medicine, gynecology and clinical microbiology; based on reviewing the available literature on the related terms, and emphasizing local studies. Results: We developed a management algorithm for the empirical treatment of uncomplicated lower UTI in adults with urinary antiseptics such as nitrofurantoin and fosfomycin trometamol as first line, with specific therapeutic recommendations for the treatment of asymptomatic bacteriuria in pregnant women. Additionally, we created a decision algorithm for processing urine cultures. Frequent recurrence or relapse justifies referral to urology and infectious disease professionals. Conclusions: We generated straightforward and easy-to-implement recommendations for the diagnosis and management of UTI in adults and pregnant women, and in cases where it is necessary to treat asymptomatic bacteriuria, with effective therapeutic and narrow spectrum options.

An update on molecularly targeted therapies in second and third-line treatment in non-small cell lung cancer: focus on EGFR inhibitors and anti-angiogenic agents

Docetaxel, pemetrexed and epidermal growth factor receptor tyrosine kinase inhibitors (gefitinib and erlotinib) are recommended second-line therapy for advanced non-small cell lung cancer (NSCLC) patients with disease progression. Although erlotinib is the only recommended third-line therapy, several drugs are being used in the clinic. Recent studies have focused on combining targeted agents with approved therapies, including broad-spectrum multikinase inhibitors targeting multiple ErbB Family receptors and multitargeted anti-angiogenic agents targeting the vascular endothelial growth factor receptor, platelet-derived growth factor receptor and fibroblast growth factor receptor pathways. Here, we review targeted therapies that are being evaluated in second- and third-line settings in NSCLC, including the ErbB Family Blocker afatinib (BIBW 2992), multityrosine kinase inhibitors (pelitinib [EKB-56]), neratinib [HKI-272], canertinib [CI-1033], lapatinib [GW-572016], dacomitinib [PF-299804]) and multitargeted anti-angiogenic agents (vandetanib [ZD6474], sunitinib [SU11248], sorafenib [BAY43-9006], nintedanib [BIBF1120], axitinib [AG-013736], cediranib [AZD2171], motesanib [AMG 706], linifanib [ABT869] and pazopanib [GW786034]) (AU)

An update on molecularly targeted therapies in second- and third-line treatment in non-small cell lung cancer: focus on EGFR inhibitors and anti-angiogenic agents.

Docetaxel, pemetrexed and epidermal growth factor receptor tyrosine kinase inhibitors (gefitinib and erlotinib) are recommended second-line therapy for advanced non-small cell lung cancer (NSCLC) patients with disease progression. Although erlotinib is the only recommended third-line therapy, several drugs are being used in the clinic. Recent studies have focused on combining targeted agents with approved therapies, including broad-spectrum multikinase inhibitors targeting multiple ErbB Family receptors and multitargeted anti-angiogenic agents targeting the vascular endothelial growth factor receptor, platelet-derived growth factor receptor and fibroblast growth factor receptor pathways. Here, we review targeted therapies that are being evaluated in second- and third-line settings in NSCLC, including the ErbB Family Blocker afatinib (BIBW 2992), multityrosine kinase inhibitors (pelitinib [EKB-56]), neratinib [HKI-272], canertinib [CI-1033], lapatinib [GW-572016], dacomitinib [PF-299804]) and multitargeted anti-angiogenic agents (vandetanib [ZD6474], sunitinib [SU11248], sorafenib [BAY43-9006], nintedanib [BIBF1120], axitinib [AG-013736], cediranib [AZD2171], motesanib [AMG 706], linifanib [ABT869] and pazopanib [GW786034]).

Amniocentesis genéticas durante los últimos 6 años en nuestro hospital / Genetic amniocentesis in our hospital in the last six years

Introducción La identificación de posibles alteraciones cromosómicas fetales es sin duda uno de los principales retos a los que ha de enfrentarse cualquier obstetra involucrado en el diagnóstico prenatal de anomalías congénitas. Objetivos Evaluar el rendimiento diagnóstico del procedimiento en nuestro servicio, así como sus complicaciones asociadas. Pacientes y métodos En el presente artículo realizamos un análisis retrospectivo de las amniocentesis realizadas en nuestro centro durante un periodo de 6 años, prestando atención a la rentabilidad diagnóstica del procedimiento, las complicaciones asociadas más frecuentes y las indicaciones que llevaron a la realización de la técnica, revisando finalmente las estrategias de cribado poblacional actualmente aplicadas. Resultados El riesgo de cromosomopatía asociado a la edad materna fue el motivo principal por el cual la técnica fue realizada. El 2,16% de amniocentesis condujeron al diagnóstico de una cromosomopatía, con una tasa de complicaciones asociadas a la técnica del 1,02%.Conclusiones Aunque nuestros resultados son similares a los comunicados en otras series, debemos reconsiderar las estrategias de cribado que hasta ahora se han venido aplicando, particularmente para las gestantes de mayor edad (AU)

Introduction Identification of fetal congenital chromosomal abnormalities is undoubtedly one of the main challenges faced by obstetricians involved in the prenatal diagnosis of congenital anomalies. Objective To evaluate the diagnostic yield of genetic amniocentesis in our hospital and its associated complications. Patients And Methods We performed a retrospective analysis of all genetic amniocenteses performed in our hospital in the last 6 years, focusing on diagnostic yield, the most common associated complications, and the indications for this procedure. We also reviewed the various population-based screening programs currently applied. Results The main indication for amniocentesis was maternal age-associated risk. A total of 2.161% of procedures led to diagnosis of chromosomal abnormalities, with a complications rate of 1.028%. Conclusion Although our results are similar to those reported in other published series, current screening strategies should be revised, mainly in older pregnant women (AU)

Phase II study of continuous daily sunitinib dosing in patients with previously treated advanced non-small cell lung cancer.

BACKGROUND: Sunitinib malate (SUTENT) has promising single-agent activity given on Schedule 4/2 (4 weeks on treatment followed by 2 weeks off treatment) in advanced non-small cell lung cancer (NSCLC). METHODS: We examined the activity of sunitinib on a continuous daily dosing (CDD) schedule in an open-label, multicentre phase II study in patients with previously treated, advanced NSCLC. Patients > or =18 years with stage IIIB/IV NSCLC after failure with platinum-based chemotherapy, received sunitinib 37.5 mg per day. The primary end point was objective response rate (ORR). Secondary end points included progression-free survival (PFS), overall survival (OS), 1-year survival rate, and safety. RESULTS: Of 47 patients receiving sunitinib, one patient achieved a confirmed partial response (ORR 2.1% (95% confidence interval (CI) 0.1, 11.3)) and 11 (23.4%) had stable disease (SD) > or =8 weeks. Five patients had SD>6 months. Median PFS was 11.9 weeks (95% CI 8.6, 14.1) and median OS was 37.1 weeks (95% CI 31.1, 69.7). The 1-year survival probability was 38.4% (95% CI 24.2, 52.5). Treatment was generally well tolerated. CONCLUSIONS: The safety profile and time-to-event analyses, albeit relatively low response rate of 2%, suggest single-agent sunitinib on a CDD schedule may be a potential therapeutic agent for patients with advanced, refractory NSCLC.

Utilidad clínica de la corrección de atenuación con rayos X en los estudios SPECT de perfusión miocárdica / Clinical utility of attenuation correction with X-RAYS in myocardial perfusion SPECT studies

Objetivos. Comparar la tomogammagrafía (SPECT) de perfusión miocárdica con corrección de atenuaciónmediante rayos X con la evaluación conjunta delas imágenes no corregidas y los datos del gated en el manejo de la enfermedad arterial coronaria.Método. A 60 pacientes (p) se les realizó una SPECT deperfusión miocárdica esfuerzo/reposo-gated con correcciónde atenuación mediante una tomografía computarizada (TC)de baja resolución con una gammacámara híbrida y una cateterización cardíaca. Se evaluaron cualitativamente tres tipos de imágenes: esfuerzo/reposo no corregidas (NC), esfuerzo/ reposo no corregidas valoradas juntamente con el gated (NCG) y esfuerzo/reposo corregidas por atenuación y con correción de scatter (CA). Con el test de McNemar se analizaron las diferencias estadísticas en la exactitud diagnósticaentre cada tipo de imágenes; p < 0,05 se consideró estadísticamente significativa. Resultados. Catorce p no tenían lesiones significativas en las arterias coronarias (LNS), en los 46 p restantes se detectaron:29 lesiones en la descendente anterior, 26 en la coronaria derecha y 18 en la circunfleja. En el territorio de la coronaria derecha la exactitud diagnóstica fue significativamente mayor en lasimágenes CA que en las NC (p < 0,001) y que en las NCG(p < 0,01). En el grupo de LNS hubo diferencias significativas entre NC y CA (p < 0,02) y entre NCG y CA (p < 0,05). Conclusiones. La corrección de atenuación con rayos X en los estudios SPECT-gated de perfusión miocárdica mejora significativamente tanto la capacidad de los mismos para descartar la existencia de enfermedad coronaria, como la exactitud diagnóstica en el territorio de la coronaria derecha

Objective. We have compared the uncorrected images of SPECT myocardial perfusion plus gated data with corrected images with X-rays in the management of coronary artery disease. Methods. In 60 patients (p) a stress/rest-gated myocardial perfusion SPECT was performed with attenuation correction with a hybrid gammacamera. All patients underwent cardiac catheterization. 3 types of images were qualitatively evaluated: uncorrected stress/rest (NC), uncorrected stress/rest plus gated (NCG) and stress/rest corrected for attenuation with scatter correction (AC). McNemar’s test was used to analyze the statistical differences in assessing the diagnostic accuracy of each type of images; p < 0.05 was considered statistically significant. Results. Fourteen p did not have significant lesions in the coronary arteries (NSL), 46 p showed lesions in coronary arteries: 29 in anterior descending, 26 in right coronary and 18 in circumflex. In right coronary territory, diagnostic accuracy was significantly higher on AC than on NC images (p < 0.001) and on AC than on NCG images (p < 0.01). In NSL group there are significant differences between NC and AC (p < 0.02) and between NCG and AC (p < 0.05). Conclusions. Attenuation correction with X-rays significantly improves diagnostic accuracy of uncorrected images and uncorrected images plus gated

[Clinical utility of attenuation correction with X-rays in myocardial perfusion SPECT studies]. / Utilidad clínica de la corrección de atenuación con rayos X en los estudios SPECT de perfusión miocárdica.

OBJECTIVE: We have compared the uncorrected images of SPECT myocardial perfusion plus gated data with corrected images with X-rays in the management of coronary artery disease. METHODS: In 60 patients (p) a stress/rest-gated myocardial perfusion SPECT was performed with attenuation correction with a hybrid gammacamera. All patients underwent cardiac catheterization. 3 types of images were qualitatively evaluated: uncorrected stress/rest (NC), uncorrected stress/rest plus gated (NCG) and stress/rest corrected for attenuation with scatter correction (AC). McNemar's test was used to analyze the statistical differences in assessing the diagnostic accuracy of each type of images; p < 0.05 was considered statistically significant. RESULTS: Fourteen p did not have significant lesions in the coronary arteries (NSL), 46 p showed lesions in coronary arteries: 29 in anterior descending, 26 in right coronary and 18 in circumflex. In right coronary territory, diagnostic accuracy was significantly higher on AC than on NC images (p < 0.001) and on AC than on NCG images (p < 0.01). In NSL group there are significant differences between NC and AC (p < 0.02) and between NCG and AC (p < 0.05). CONCLUSIONS: Attenuation correction with X-rays significantly improves diagnostic accuracy of uncorrected images and uncorrected images plus gated.

Himen imperforado neonatal / Neonatal imperforate hymen

La imperforación de himen es la anomalía obstructiva más frecuente del tracto genital femenino. Aunque en el neonato su presencia a menudo pasa inadvertida, su diagnóstico es relativamente simple y está basado en una adecuada anamnesis y una cuidadosa exploración física, y las pruebas de imagen quedan como medio de apoyo. Entre ellas, la ecografía es de primera elección. La detección temprana previene la morbilidad consiguiente al diagnóstico tardío, motivo por el cual resulta recomendable una exploración cuidadosa y sistemática del área genital, que debería formar parte de todo examen pediátrico. Ante la existencia de una obstrucción al drenaje vaginal se debe investigar el tracto urinario. El tratamiento de elección es la himeneotomía, si bien no hay consenso en cuanto al momento idóneo para su realización (AU)

Imperforate hymen is the most common obstructive anomaly of the female genital tract. Although this abnormality often goes unnoticed in neonates, it is relatively simple to diagnose. Diagnosis is based on history taking and thorough physical examination. Imaging studies can also be used, if required, and the procedure of choice is ultrasonography. Early diagnosis prevents the morbidity associated with late diagnosis. Consequently, thorough and systematic examination of the genital area is advisable and should form part of all pediatric examinations. When vaginal outflow obstruction is found, the urinary tract should be examined. The treatment of choice is hymenotomy. However, consensus is lacking on the optimal timing of this procedure (AU)

Induction chemotherapy with paclitaxel plus carboplatin followed by paclitaxel with concurrent radiotherapy in stage IIIB non-small-cell lung cancer (NSCLC) patients: a phase II trial.

PURPOSE: We conducted a prospective phase II trial to evaluate the efficacy and toxicity of induction chemotherapy with paclitaxel plus carboplatin followed by concurrent radiotherapy with weekly paclitaxel in stage IIIB non-small-cell lung cancer (NSCLC) patients. PATIENTS AND METHODS: Patients with stage IIIB NSCLC received two 3-week cycles of paclitaxel 200mg/m(2) combined with carboplatin (target area under the plasma concentration curve (AUC) of 6 mg/ml) followed by weekly paclitaxel 50mg/m(2) concurrently with radiotherapy consisted of 2 Gy daily, 5 days per week (60 Gy total dose in 6 weeks). The median follow-up period was 5 years. RESULTS: Between March 1999 and January 2002, 21 patients were enrolled and analyzed. Ninety percent of patients completed the planned treatment schedule. The overall response rate was 76% (24% complete response and 52% partial response). The median overall survival time was 15 months and the 1-year, 2-year and 5-year overall survival rates were 57, 33 and 24%, respectively. The disease progression rate at 1 year was 43% and the median progression-free survival was 8 months. During the chemoradiation period, grade 3-4 oesophagitis and pneumonitis were observed in 24 and 14% of patients, respectively. CONCLUSIONS: Induction chemotherapy with carboplatin and paclitaxel followed by weekly paclitaxel with concurrent radiotherapy was found to be active and tolerable in selected stage IIIB NSCLC patients. Further studies are needed to improve the safety profile and outcome in this setting.

Medical speciality and pattern of medicines prescription.

OBJECTIVE: To describe the prescribing patterns and their quality in relation to the prescriber's medical specialty in a defined population. METHODS: The study was done on a random sample of all primary care medical prescriptions made through the social security system during 1 year in Andorra, a small European country. Number and type of prescribed medicines, prescribers' medical speciality and patients' age and gender were recorded. Medical specialties considered were General Practice, Paediatrics, Cardiology, Pneumology, Gynaecology, Ophthalmology and Other. A set of various quality indicators [World Health Organisation (WHO)/International Network for Rational Use of Drugs (INRUD) indicators and others] was used. RESULTS: The number of medicines prescribed per encounter varied depending on the prescriber's medical specialty and patient's age. Cardiologists and pneumologists tended to prescribe more medicines than other medical specialties. Patients older than 65 years received more prescriptions than younger adults, mostly at the expense of cardiovascular drugs. The contribution of the various groups and subgroups of medicines and the scores of various prescribing indicators showed wide variability across the medical specialties. CONCLUSION: Prescribing patterns and indicators of prescription quality show wide variability depending on the prescriber's medical specialty. This has important implications for priority setting in information, continuous education and research.

[Impact of thrombolytic therapy on short and long-term survival of a cohort of patients with acute myocardial infarction consecutively admitted to all the hospitals of a health care area. GESIR-5 study]. / Impacto de la trombólisis sobre la supervivencia a corto y largo plazo de una cohorte de pacientes con infarto agudo de miocardio atendidos de forma consecutiva en todos los hospitales de una región sanitaria. Estudio GESIR-5.

AIM: This study aims to assess the application of thrombolysis in patients with acute myocardial infarction admitted to all the hospitals of a health care area in Catalonia (Spain), and to estimate the effect of thrombolysis on short and long-term survival. METHODS: From May 1992 to May 1993, all the patients with myocardial infarction admitted to the hospitals of the Costa de Ponent area in the first 72 hours after the initial symptoms were consecutively included in this prospective study. Information on pre-hospital phase, emergency room management and hospitalization was collected. All the patients discharged alive from hospital were followed up by telephone one and four years after hospital admission. RESULTS: 521 patients aged 74 years or less were included. Thrombolytic therapy was applied in 35.3%. There were no statistically significant differences in the proportion of thrombolysis between hospitals with or without intensive care or coronary units. Ten patients died in the emergency room; in the remaining cases, the 28-day case fatality was 10.0%. The effect of thrombolytic treatment on 28-day case fatality was estimated in a logistic regression model, after controlling for age, gender, Killip, ventricular arrhythmia and location of infarction (OR: 0.36; CI 95%: 0.15-0.88). In 28-day survivors, the 4-year cumulated probability of survival was 88.4%, being significantly higher in the group who had received thrombolytic therapy. CONCLUSIONS: In the population studied, 28-day case mortality of acute myocardial infarction is similar to that reported in other Mediterranean regions. The benefits of thrombolysis in the acute phase are found to persist after 4 years.

The role of anxiety and adaptation to illness in the intensity of postchemotherapy nausea in cancer patients.

The aim of this work was to assess whether cancer patients presenting high anxiety levels or poor adaptation to cancer experience higher levels of postchemotherapy nausea, regardless of the emetogenicity of the chemotherapy schedule. Sixty-three patients were interviewed before receiving their chemotherapy schedule and some psychological variables were assessed. Nausea intensity was also assessed after treatment. The results showed that patients with relatively higher levels of nausea reported higher levels of anxiety prior to chemotherapy and lower levels of adaptation to cancer. Thus, evidence for a modulating effect of psychological factors in postchemotherapy emesis is suggested.

Synthesis of aryl 3-O-beta-cellobiosyl-beta-D-glucopyranosides for reactivity studies of 1,3-1,4-beta-glucanases.

A series of substituted aryl beta-glycosides derived from 3-O-beta-cellobiosyl-D-glucopyranose with different phenol-leaving group abilities as measured by the pKa of the free phenol group upon enzymatic hydrolysis has been synthesised. Aryl beta-glycosides with a pKa of the free phenol leaving group > 5 were prepared by phase-transfer glycosidation of the per-O-acetylated alpha-glycosyl bromide with the corresponding phenol, whereas the 2,4-dinitrophenyl beta-glycoside was obtained by condensation of 1-fluoro-2,4-dinitrobenzene with the partially acetylated trisaccharide followed by acid de-O-acetylation. The aryl beta-glycosides have been used for reactivity studies of the wild-type Bacillus licheniformis 1,3-1,4-beta-D-glucan 4-glucanohydrolase. The Hammett plot log kcat versus pKa is biphasic with an upward curvature at low pKa values suggesting a change in transition-state structure depending on the aglycon.

Cardiovascular risk factors associated with clinically isolated and diffuse atherosclerosis in Spanish patients with coronary artery disease.

BACKGROUND: Patients with coronary artery disease (CAD) associated with peripheral (PAD) or cerebrovascular disease (CVD), a condition called diffuse atherosclerosis, have a higher risk of death than patients with isolated CAD. The prevalence of diffuse atherosclerosis and the atherogenic risk factors associated with this condition in our geographic area have not been described previously. METHODS: A cohort of 2597 patients (62 +/- 10.8 years, 665 women) consecutively admitted at Bellvitge Hospital because of acute coronary syndromes were studied. CAD patients were divided in two groups with diffuse and located atherosclerosis according to whether they had or they had not an associated PAD or CVD. Baseline history, physical data and lipid profile were recorded in each patient according to a standardized questionnaire. RESULTS: A total of 370 patients (14.2%) had diffuse atherosclerosis. Among them, there were more men and women older than 55 years than among those with isolated CAD. Patients with diffuse atherosclerosis were more frequently hypertensive, diabetic and former smokers than those with isolated CAD (60.5% vs. 49.4%, P < 0.01; 37.4% vs. 24.5%, P < 0.01; and 47% vs. 35.7%, P < 0.01, respectively). There were no significant differences in the mean values of total cholesterol (TC), low-density cholesterol (LDL-C), high-density cholesterol (HDL-C) and triglycerides between both groups of patients, but patients with diffuse atherosclerosis had a lower HDL-C/TC ratio, with borderline statistical significance (0.18 +/- 0.06 vs. 0.19 +/- 0.06, P = 0.06). Using multiple logistic regression analysis, the variables associated with diffuse atherosclerosis in men were age greater than 55 years (OR 1.97, CI 1.33-2.93), hypertension (OR 1.50, CI 1.14-2.20), diabetes (OR 1.78, CI 1.20-2.70), smoking (former smokers) (OR 2.09, CI 1.36-3.24) and HDL-C/TC < 0.20 (OR 1.60, CI 1.18-2.17); and in women hypertension (OR 3.43, CI 1.48-7.94) and diabetes (OR 2.58, CI 1.55-4.80). CONCLUSIONS: Clinically overt diffuse atherosclerosis is a relatively common disease. Older patients and those with hypertension, diabetes or low HDL-C/TC ratio are more likely to have diffuse atherosclerosis than those without these conditions.

[Improvement in diastolic function in hypertensive patients with left ventricular hypertrophy with inhibitors of the angiotensin converting enzyme]. / Mejoría de la función diastólica en pacientes hipertensos con hipertrofia ventricular izquierda mediante inhibidores de la enzima de conversión de la angiotensina.

An open and multicentric study was conducted with 66 patients with mild to severe diastolic arterial hypertension and echocardiographic left ventricular hypertrophy, the evolution of diastolic function, by means of doppler transmitral flow echocardiography, under treatment with ramipril, an angiotensin converting enzyme inhibitor, at a dose of 2.5 and 5 mg/day, or combined with a diuretic, after three and six months of treatment. Despite not obtaining the tensional control in all patients, a decrease in the mass, both in absolute values and mass index, was obtained. This decrease was observed both in male and female patients from the first three months, which went on until the sixth month, thus suggesting an independent action of the hemodynamic load decrease for the obtention of this effect. There was also a change in the ventricular geometry with a displacement of patients from concentric enlargement to normal, remodelling and eccentric enlargement. The diastolic function improved both for the early and for the late maximal filling velocity, relationship between both, and deceleration time, although the time during which this improvement occurred was different for each parameter, thus indicating the different influence of the dynamic and structural factors on these parameters. No correlation was found between the improvement in diastolic function and hypertrophy regression. We can conclude that ramipril is useful for the control of the left ventricular hypertrophy and diastolic function, irrespective of arterial tension values.

Vegetable and fruit intake and the risk of lung cancer in women in Barcelona, Spain.

A case-control study on women was carried out in Barcelona, Spain, to investigate the relationship of lung cancer with the intake of vegetables, fruits and some foods of animal origin. The study included 103 cases and 206 controls matched by age and residence. Diet intake was assessed by means of a food frequency questionnaire. A reduction in risk, adjusted for smoking habit, was found for the intake of yellow/orange vegetables (mainly carrots) and tomatoes. The odds ratio (OR) and 95% confidence interval (CI) for the highest versus lowest tertile of intake were 0.37 (0.19-0.74) for yellow/orange vegetables and 0.45 (0.22-0.91) for tomatoes; both had a significant inverse trend. A tendency to a reduction in risk of lung cancer with increased intake was observed for all vegetables, leafy green vegetables, dark green vegetables and cruciferous, but these associations did not reach statistical significance. No association with lung cancer was found for the intake of fruits or foods of animal origin rich in retinol. Similar patterns were observed for women who never smoked and when the analysis was restricted to adenocarcinoma.

[Malignant pleural mesothelioma: clinical characteristics, prognostic factors and treatment]. / Mesotelioma maligno pleural. Características clínicas, factores pronósticos y tratamiento.

Malignant pleural mesothelioma soon leads to death no matter what type of treatment is provided. We discuss the clinical signs, prognostic factors and treatment given in 41 cases managed over the past 13 years in our oncology department. 32% had been exposed to asbestos, 61% were 60 years old or younger, 71% had a Karnofsky's index > or = 80% and 63% were stage I (Butchart). The first symptom leading to diagnosis was pain in 66% and mean time between first symptom and diagnosis was 3 months. Thirty patients never experienced full remission of disease: 15 were treated with palliative chemotherapy (CHT), 1 with palliative radiotherapy (RT), 5 with partial pleurectomy (PP) plus RT and/or CHT. Nine were given symptomatic treatment only. Only 11 (27%) patients experienced full remission after treatment: 7 had had extrapleural pneumonectomy, 2 had been given CHT and RT series and 4 had undergone PP with or without RT and/or CHT follow-up. Only 3 of these patients were still alive with no relapse more than 1 year later. Mean survival was 8 months. Univariate analysis revealed that the prognostic factors influencing survival were age and Karnofsky's index. Patients initially treated with surgery had a higher rate of survival. In conclusion, only Karnofsky's index and age were prognostic factors in our series. The better survival of patients initially treated surgically is probably related to prior screening.