Papel de los nuevos agentes inmunosupresores en el cáncer cutáneo no melanoma en pacientes trasplantados renales / The Role of New Immunosuppressive Drugs in Nonmelanoma Skin Cancer in Renal Transplant Recipients

INTRODUCCIÓN: El cáncer de piel no melanoma (CCNM) es la neoplasia maligna que se presenta con más frecuencia después de un trasplante de órgano sólido. La etiología del CCNM tras el trasplante es multifactorial. OBJETIVOS: Analizar la relación entre los nuevos agentes inmunosupresores y la aparición de CCNM en pacientes trasplantados renales. MÉTODO: Estudio observacional. Se examinaron una combinación de datos retrospectivos y prospectivos. Incluimos en el estudio 289 pacientes que habían recibido trasplante renal desde enero de 1996 hasta diciembre de 2010 en el Hospital Universitario Doctor Peset de Valencia. RESULTADOS: Tras una mediana de seguimiento de 72 meses 73 pacientes (25,2%) desarrollaron 162 CCNM. No hubo diferencias estadísticamente significativas en la incidencia de CCNM al comparar las distintas estrategias de inducción con anticuerpos mono o policlonales. La incidencia de tumores en pacientes con inhibidores mTOR fue menor que con el resto de tratamientos, aunque sin mostrar diferencias estadísticamente significativas. De 5 pacientes con CCNM recurrente que pasaron a tratarse con inhibidores mTOR (tras ser tratados previamente con inhibidores de la calcineurina), 3 continuaron presentando CCNM a pesar del cambio de tratamiento. CONCLUSIONES: La utilización de anticuerpos mono o policlonales en la terapia de inducción en pacientes trasplantados renales no se asocia a un mayor riesgo de CCNM. Si bien los inhibidores mTOR muestran menor riesgo de aparición de CCNM postrasplante queda por determinar si el cambio de tratamiento a inhibidores mTOR es un buena opción en el manejo de pacientes con múltiples CCNM

INTRODUCTION: Nonmelanoma skin cancer (NMSC) is the most common malignancy in patients who have received a solid organ transplant. Multiple factors are involved in the onset of posttransplant NMSC. OBJECTIVES: To analyze the relationship between new immunosuppressive drugs and the onset of NMSC in renal transplant recipients. METHOD: This was a combined retrospective and prospective observational study in which we studied 289 patients who received a kidney transplant between January 1996 and December 2010 at Hospital Universitario Doctor Peset in Valencia, Spain. RESULTS: Seventy-three patients (25.2%) developed 162 NMSCs over a median follow-up of 72 months. There were no statistically significant differences in the onset of NMSC on comparing different induction therapy strategies involving monoclonal and polyclonal antibodies. NMSCs occurred less frequently in patients treated with mammalian target of rapamycin (mTOR) inhibitors than in those treated with other immunosuppressive regimens, although the differences were not statistically significant. Three of 5 patients with recurrent NMSC who were switched from calcineurin inhibitors to mTOR inhibitors developed additional NMSCs despite the change. CONCLUSIONS: Induction therapy with monoclonal and polyclonal antibodies in renal transplant recipients is not associated with an increased risk of NMSC. While mTOR inhibitors are associated with a lower risk of posttransplant NMSC, it remains to be determined whether a switch to these drugs is useful in the management of patients who develop multiple NMSCs

Lactante con tumoración subcutánea en el área genital / Infant with Subcutaneous Tumor in the Genital Area

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The role of new immunosuppressive drugs in nonmelanoma skin cancer in renal transplant recipients.

INTRODUCTION: Nonmelanoma skin cancer (NMSC) is the most common malignancy in patients who have received a solid organ transplant. Multiple factors are involved in the onset of posttransplant NMSC. OBJECTIVES: To analyze the relationship between new immunosuppressive drugs and the onset of NMSC in renal transplant recipients. METHOD: This was a combined retrospective and prospective observational study in which we studied 289 patients who received a kidney transplant between January 1996 and December 2010 at Hospital Universitario Doctor Peset in Valencia, Spain. RESULTS: Seventy-three patients (25.2%) developed 162 NMSCs over a median follow-up of 72 months. There were no statistically significant differences in the onset of NMSC on comparing different induction therapy strategies involving monoclonal and polyclonal antibodies. NMSCs occurred less frequently in patients treated with mammalian target of rapamycin (mTOR) inhibitors than in those treated with other immunosuppressive regimens, although the differences were not statistically significant. Three of 5 patients with recurrent NMSC who were switched from calcineurin inhibitors to mTOR inhibitors developed additional NMSCs despite the change. CONCLUSIONS: Induction therapy with monoclonal and polyclonal antibodies in renal transplant recipients is not associated with an increased risk of NMSC. While mTOR inhibitors are associated with a lower risk of posttransplant NMSC, it remains to be determined whether a switch to these drugs is useful in the management of patients who develop multiple NMSCs.

Detección del virus del papiloma humano en muestras de cáncer cutáneo no melanoma y piel sana perilesional en pacientes trasplantados renales y pacientes inmunocompetentes / Detection of Human Papillomavirus in Nonmelanoma Skin Cancer Lesions and Healthy Perilesional Skin in Kidney Transplant Recipients and Immunocompetent Patients

ANTECEDENTES: La influencia del virus del papiloma humano (VPH) en el desarrollo de carcinoma cutáneo no melanoma es un tema controvertido. VPH-beta es el género más frecuente relacionado con el desarrollo de cáncer de piel. OBJETIVOS: Analizar la prevalencia y espectro de los tipos de VPH presentes en piel tumoral y piel sana perilesional en pacientes inmunodeprimidos y pacientes inmunocompetentes, así como evaluar la influencia de diferentes factores clínicos en la prevalencia del VPH en cáncer de piel. MÉTODOS: Se determinó la presencia de VPH en 120 muestras mediante PCR nested y posterior secuenciación. Se tomó biopsia de piel de 30 pacientes trasplantados renales y de 30 pacientes inmunocompetentes con cáncer cutáneo tanto de zona tumoral como de piel sana perilesional. Se registraron las variables potenciales de confusión. Los datos fueron analizados utilizando análisis de regresión logística multivariado. RESULTADOS: ADN del VPH fue detectado en 44/60 (73,3%) de las muestras de pacientes inmunodeprimidos y en 32/60 (53,3%) de las muestras de pacientes inmunocompetentes (OR ajustada 3,4 [1,2-9,6]). Al comparar la presencia de VPH en los 2 grupos entre piel tumoral y piel sana perilesional la presencia de VPH en piel sana perilesional fue mayor que en piel tumoral. El género más frecuente aislado fue el VPH-beta. CONCLUSIÓN: Un amplio espectro de tipos de VPH, la mayoría del género beta, se encuentran en la piel de pacientes trasplantados e inmunocompetentes con cáncer cutáneo

BACKGROUND: The influence of human papillomavirus (HPV) on the development of nonmelanoma skin cancer (NMSC) is a topic of debate. HPV types from the beta genus (HPV-Beta) have been most frequently associated with the development of skin cancer. OBJECTIVES: To analyze the prevalence and range of HPV types in NMSC lesions and healthy perilesional skin in immunodepressed and immunocompetent patients and to evaluate the influence of various clinical factors on the prevalence of HPV in skin cancer. METHODS: Nested polymerase chain reaction and sequencing were used to detect HPV in 120 NMSC samples obtained by biopsy from 30 kidney transplant recipients and 30 immunocompetent patients. In all cases, a sample was taken from the tumor site and the surrounding healthy skin. Potential confounders were assessed and the data analyzed by multivariate logistic regression. RESULTS: HPV DNA was detected in 44 (73.3%) of the 60 samples from immunodepressed patients and in 32 (53.3%) of the 60 samples from immunocompetent patients (adjusted odds ratio, 3.4; 95% CI , 1.2-9.6). In both groups of patients, HPV was more common in healthy perilesional skin than in lesional skin. HPV-Beta was the most common type isolated. CONCLUSION: We found a wide range of HPV types (mostly HPV-Beta) in the skin of kidney transplant recipients and immunocompetent patients with skin cancer

Detection of human papillomavirus in nonmelanoma skin cancer lesions and healthy perilesional skin in kidney transplant recipients and immunocompetent patients.

BACKGROUND: The influence of human papillomavirus (HPV) on the development of nonmelanoma skin cancer (NMSC) is a topic of debate. HPV types from the beta genus (HPV-ß) have been most frequently associated with the development of skin cancer. OBJECTIVES: To analyze the prevalence and range of HPV types in NMSC lesions and healthy perilesional skin in immunodepressed and immunocompetent patients and to evaluate the influence of various clinical factors on the prevalence of HPV in skin cancer. METHODS: Nested polymerase chain reaction and sequencing were used to detect HPV in 120 NMSC samples obtained by biopsy from 30 kidney transplant recipients and 30 immunocompetent patients. In all cases, a sample was taken from the tumor site and the surrounding healthy skin. Potential confounders were assessed and the data analyzed by multivariate logistic regression. RESULTS: HPV DNA was detected in 44 (73.3%) of the 60 samples from immunodepressed patients and in 32 (53.3%) of the 60 samples from immunocompetent patients (adjusted odds ratio, 3.4; 95% CI, 1.2-9.6). In both groups of patients, HPV was more common in healthy perilesional skin than in lesional skin. HPV-ß was the most common type isolated. CONCLUSION: We found a wide range of HPV types (mostly HPV-ß) in the skin of kidney transplant recipients and immunocompetent patients with skin cancer.

Plasmocitosis cutánea / Cutaneous plasmacytosis

La plasmocitosis cutánea es un raro trastorno caracterizado por una proliferación benigna de células plasmáticas maduras que se presenta como múltiples lesiones rojizo-marronáceas, normalmente asociadas a hipergammaglobulinemia policlonal. Presentamos el caso de una mujer blanca de 33 años con clínica de placas marronáceas en tronco y cuero cabelludo. Histológicamente las lesiones mostraban un denso infiltrado en dermis superficial y profundo de distribución perivascular y perianexial compuesto principalmente de células plasmáticas maduras sin atipia (AU)

Cutaneous plasmacytosis is a rare disorder characterized by a benign proliferation of mature plasma cells that appears as multiple red to dark brown skin lesions, often associated with polyclonal hypergammaglobulinaemia. We report the case of a 33-year-old white woman who presented with reddish brown plaques restricted to trunk and scalp. Histologically, the lesions showed a moderately dense superficial and deep perivascular and periadnexal infiltrate composed predominantly of mature plasma cells without atypia (AU)

[Hyperbaric bupivacaine: a randomized double-blind trial of different doses with or without fentanyl for cesarean section under spinal anesthesia]. / Estudio aleatorio, doble ciego sobre la utilización de diferentes dosis de bupivacaína hiperbara con o sin fentanilo, en cesáreas con anestesia subaracnoidea.

OBJECTIVES: To compare the effects of spinal anesthesia with different doses of hyperbaric bupivacaine with or without fentanyl in patients undergoing cesarean section. MATERIAL AND METHODS: Prospective study enrolling 50 ASA 1-2 patients undergoing cesarean section, randomized to 5 treatment groups. Groups A, B, C, and D received 15 microg of fentanyl and group X received no fentanyl. The doses of hyperbaric bupivacaine given in each group were as follows: 10 mg in Group A, 11 mg in group B, 12 mg in group C, 13 mg in group D, and 14 mg in group X. RESULTS: Patients in groups A and B had greater hemodynamic stability than patients in groups C, D, or X (P < 0.05). The incidence of hypotension was 70% in group C and 80% in groups D and X. The sensory block reached level T4 in groups D and X and the motor block was complete in all cases. Postoperative analgesia lasted longer in group D with a mean (SD) duration of 202 (25) minutes than in group X with a mean duration of 194 (19) minutes. Assessment on a visual analog scale was under 3 in all groups except group A, where 2 patients required administration of propofol. CONCLUSIONS: Acceptable operative conditions with a low incidence of hypotension are provided with an 11 mg dose of hyperbaric bupivacaine.

Estudio aleatorio, doble ciego sobre la utilización de diferentes dosis de bupivacaína hiperbara con o sin fentanilo, en cesáreas con anestesia subaracnoidea / Hyperbaric bupivacaine: a randomized double-blind trial of different doses with or without fentanyl for cesarean section under spinal anesthesia

OBJETIVOS: Comparar los efectos de la anestesia subaracnoidea, en pacientes sometidas a cesárea, empleando distintas dosis de bupivacaína hiperbara con o sin fentanilo. MATERIAL Y MÉTODOS: Estudio prospectivo con 50 pacientes ASA I-II sometidas a cesárea y distribuidas aleatoriamente en cinco grupos. Los grupos A, B, C y D con 15 μg de fentanilo y el grupo X sin fentanilo. Grupo A: 10 mg de bupivacaína hiperbara y fentanilo; grupo B: 11 mg de bupivacaína hiperbara y fentanilo; grupo C: 12 mg de bupivacaína y fentanilo; gupo D:13 mg de bupivacaína y fentanilo y grupo X: 14 mg de bupivacaína hiperbara sin fentanilo. RESULTADOS: Las pacientes de los grupos A y B presentaron mayor estabilidad hemodinámica frente a los pacientes de los grupos C, D y X (p < 0,05). La incidencia de hipotensión en estos grupos fue del 70% (grupo C) y del 80% (grupos D y X). En los grupos D y X se alcanzó un nivel de bloqueo sensitivo T4 y un bloqueo motor completo en todos los casos. La duración de la analgesia postoperatoria fue mayor en el grupo D que en el X (202 ± 25 min frente 194 ± 19 min). La EVA intraoperatoria se mantuvo por debajo de 3 en todos los grupos excepto en el grupo A, donde en 2 pacientes fue necesaria la administración de propofol. CONCLUSIONES: Con dosis de 11 mg de bupivacaína hiperbara (grupo B) obtenemos unas aceptables condiciones intraoperatorias, con una baja incidencia de hipotensión

OBJECTIVES: To compare the effects of spinal anesthesia with different doses of hyperbaric bupivacaine with or without fentanyl in patients undergoing cesarean section. MATERIAL AND METHODS: Prospective study enrolling 50 ASA1-2 patients undergoing cesarean section, randomized to 5 treatment groups. Groups A, B, C, and D received 15 μg of fentanyl and group X received no fentanyl. The doses of hyperbaric bupivacaine given in each group were as follows: 10 mg in Group A, 11 mg in group B, 12 mg in group C, 13 mg in group D, and 14 mg in group X. RESULTS: Patients in groups A and B had greater hemodynamic stability than patients in groups C, D, or X (p<0.05). The incidence of hypotension was 70% in group C and 80% in groups D and X. The sensory block reached level T4 in groups D and X and the motor block was complete in all cases. Postoperative analgesia lasted longer in group D with a mean (SD) duration of 202 (25) minutes than in group X with a mean duration of 194 (19) minutes. Assessment on a visual analog scale was under 3 in all groups except group A, where 2 patients required administration of propofol. CONCLUSIONS: Acceptable operative conditions with a low incidence of hypotension are provided with an 11 mg dose of hyperbaric bupivacaine

Extracción de un alfiler en la vía aérea de un paciente pediátrico: técnica anestésica / Removal of a pin from an infant's airway: anesthetic technique

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