Implication of Candida parapsilosis FKS1 and FKS2 mutations in reduced echinocandin susceptibility.

We evaluated FKS1 and FKS2 mutations in Candida parapsilosis bloodstream isolates and correlated them with the echinocandin MIC values determined by guidelines in CLSI document M27-A3 and the YeastOne panel. All mutations detected were outside hot spot (HS) regions. The F1386S mutation detected in an isolate that was resistant by the YeastOne panel but not by the M27-A3 guidelines might be implicated in echinocandin resistance. Further studies are needed to confirm the implication of the F1386S mutation and to elucidate the capability of the M27-A3 guidelines to detect echinocandin resistance.

Granulocytic sarcoma of the right humerus in a non-leukaemia patient

Granulocytic sarcoma (GS), an uncommon solid extramedullary tumour, should be considered even in the absence of leukaemia, as delay in diagnosis and treatment worsens the prognosis. We present a GS (single humeral bone lesion) in a non-leukaemia patient, treated with intensive AML (Acute Myeloid Leukaemia) chemotherapy and sequential radiotherapy, in complete response 26 months after diagnosis, confirmed by histopathology and without leukaemia progression (AU)

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Superoxidase dismutase (SOD) topical use in oncologic patients: treatment of acute cutaneous toxicity secondary to radiotherapy

OBJECTIVE: The objective of this study is to evaluate the efficiency of SOD applied topically in oncologic patients affected by acute radiodermatitis. MATERIALS AND METHOD: This study includes 57 patients who showed a dermatitis grade 2 or superior; they were administered SOD ointment b.i.d. (40 mg, weekly) and follow-up continued for 12 weeks. RESULTS: At the end of radiotherapy, 77.1% of the patients ameliorated completely or partially, and at the end of the 12-week period 100% of patients were free of toxicity. No acute toxicity relapses were reported. Response time reduced during radiotherapy, as well as the treatment time at the end of it. CONCLUSIONS: The employment of SOD topically is efficient in the treatment of radiodermatitis, which is an acute side effect of radiotherapy (AU)

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High dose rate brachytherapy (HDR-BT) in locally advanced oesophageal cancer. Clinic response and survival related to biological equivalent dose (BED)

INTRODUCTION: Ninety percent of oesophageal cancers are locally advanced at diagnosis, and treatment yields discouraging results. High dose rate brachytherapy (HDR-BT) permits an increment of local doses without a significant increment of toxicity. The goal of our study is to compare different HDR-BT fractions and assess global survival (GS) and cause-specific survival (CSS). MATERIAL AND METHODS: Twenty-six patients were treated for locally advanced oesophageal cancer with chemotherapy concomitant with conformal three-dimensional radiotherapy (C3DR) from January 1994 to December 2000. Of this group, 96.2% were males, mean age 63.08 years; the most frequent location was medium third, for 50% of cases. Eighty-four percent of cases were G2-3 epidermoid carcinomas. The administration consisted of 44.2 Gy with C3DR and 5 applications of HDR-BT of 500 cGy each. RESULTS: Actuarial GS and CSS at 5 years is 10.18% and 12.96%, a mean survival of 25.68 and 29.14 months respectively. The following factors (C3DR total dose, fraction dose and total dose of HDR-BT, number of applications, active length of application, total dose of C3DR plus HDR-BT, and BED of HDR-BT) are evaluated to find if they have an influence on treatment response, GS and actuarial CSS. The only result that yields statistical significance, in univariant analysis, is the active length in HDR-BT, thus for a greater active length of application, a minor response is obtained and GS diminishes (p=0.05). We grouped BT fractions on biological equivalent dose (BED) into: <28, 28-33 and >33 Gy; mean survival and GS at 5 years increases with BED>or=28 Gy (p=0.016). CONCLUSION: Tumour response increases (complete and partial) when BED on HDR-BT is increased, regardless of the fraction employed. A BED higher than 28 Gy yields a significant increase of mean survival and GS at 5 years (p=0.016) (AU)

Impact of neoadjuvant hormonal therapy on dose-volume histograms in patients with localized prostate cancer under radical radiation therapy.

INTRODUCTION: Prostate volume involves a defined toxicity predictor in the radiation therapy of localized prostate cancer. Neoadjuvant hormone therapy (nHT) can reduce prostate volume and, therefore, the planned volume. The objective of this study was to establish if the value of nHT reduces the planned volume and if this reduction correlates with a reduction of the dose received in the target organs. MATERIAL AND METHODS: 28 patients diagnosed of localized prostate cancer and referred to our departments for radiation therapy with radical intention, in the period ranging between April 2002 and October 2003, were included prospectively. The patients received nHT (triptorelin + flutamide) for 2 months and adjuvant HT until completing 2 years in the high-risk cases. A transrectal ultrasound study was performed in all patients, simulation CT and planning before the start of HT and after 2 months of treatment. The radiation therapy was carried out with 6 or 18 MV LINAC photons, with a dose fractioning scheme of 5 x 180-200 cGy, a total dosage of 66-72 Gy to prostate, 56 Gy to seminal vesicles and, in the high-risk cases, 46 Gy to pelvic lymph nodes. RESULTS: The distribution according to risk group was: low risk 3.6%, intermediate risk 28.6% and high risk 67.9%. By transrectal ultrasound, prostate volume on diagnosis was 50.65 cc pre HT and 38.97 cc post HT (p < 0.001), which means a volume reduction of 24%. The comparative analysis of the dose-volume histograms of the first versus the second CT shows a reduction in the planned volume GTV1 (prostate) (81.33 cc vs 63.96 cc, p < 0.05), PTV1 (prostate and margin) (197.51 cc vs 168.38 cc, p < 0.001) and PTV2 (prostate, vesicles and margin) (340.5 cc vs 307.26 cc, p < 0.05), a reduction of the maximum dose in the seminal vesicles (70.2 versus 68.75 Gy, p < 0.05), a reduction of the mean dose in the seminal vesicles (65.07 Gy versus 63.07 Gy, p < 0.05), PTV2 (67.72 Gy versus 66.9 Gy, p < 0.01) and PTV3 (prostate, vesicles, pelvic lymph nodes and margin) (58.86 Gy versus 57.21 Gy, p < 0.01), a reduction of the D90 in the seminal vesicles (61.83 Gy versus 60.06 Gy, p < 0.05) and PTV2 (61.04 Gy versus 59.45 Gy, p < 0.05) and a reduction of V60 of the rectum (32.45% versus 28.22%, p < 0.05) and V60 of the bladder (41.78% versus 31.67%, p < 0.005). CONCLUSIONS: Neoadjuvant hormone therapy reduces significantly prostate volume and as a result the planned volume and consequently the rectal and bladder V60 can be significantly reduced.

Impact of neoadjuvant hormonal therapy on dose-volume histograms in patients with localized prostate cancer under radical radiation therapy

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Introduction. Prostate volume involves a definedtoxicity predictor in the radiation therapy of localizedprostate cancer. Neoadjuvant hormone therapy(nHT) can reduce prostate volume and, therefore,the planned volume. The objective of thisstudy was to establish if the value of nHT reducesthe planned volume and if this reduction correlateswith a reduction of the dose received in thetarget organs.Material and methods. 28 patients diagnosed of localizedprostate cancer and referred to our departmentsfor radiation therapy with radical intention,in the period ranging between April 2002 andOctober 2003, were included prospectively. The patientsreceived nHT (triptorelin + flutamide) for 2months and adjuvant HT until completing 2 yearsin the high-risk cases. A transrectal ultrasoundstudy was performed in all patients, simulation CTand planning before the start of HT and after 2months of treatment. The radiation therapy wascarried out with 6 or 18 MV LINAC photons, with adose fractioning scheme of 5 x 180-200 cGy, a totaldosage of 66-72 Gy to prostate, 56 Gy to seminalvesicles and, in the high-risk cases, 46 Gy to pelviclymph nodes.Results. The distribution according to risk groupwas: low risk 3.6%, intermediate risk 28.6% and highrisk 67.9%. By transrectal ultrasound, prostate volumeon diagnosis was 50.65 cc pre HT and 38.97 ccpost HT (p < 0.001), which means a volume reductionof 24%. The comparative analysis of the dosevolumehistograms of the first versus the second CTshows a reduction in the planned volume GTV1(prostate) (81.33 cc vs 63.96 cc, p < 0.05), PTV1(prostate and margin) (197.51 cc vs 168.38 cc, p <0.001) and PTV2 (prostate, vesicles and margin)(340.5 cc vs 307.26 cc, p < 0.05), a reduction of themaximum dose in the seminal vesicles (70.2 versus68.75 Gy, p < 0.05), a reduction of the mean dose inthe seminal vesicles (65.07 Gy versus 63.07 Gy, p <0.05), PTV2 (67.72 Gy versus 66.9 Gy, p < 0.01) andPTV3 (prostate, vesicles, pelvic lymph nodes andmargin) (58.86 Gy versus 57.21 Gy, p < 0.01), a reductionof the D90 in the seminal vesicles (61.83 Gyversus 60.06 Gy, p < 0.05) and PTV2 (61.04 Gy versus59.45 Gy, p < 0.05) and a reduction of V60 of the rectum(32.45% versus 28.22%, p < 0.05) and V60 of thebladder (41.78% versus 31.67%, p < 0.005).Conclusions. Neoadjuvant hormone therapy reducessignificantly prostate volume and as a resultthe planned volume and consequently the rectaland bladder V60 can be significantly reduced

Caraterísticas del manejo hospitalario y oportunidad de la consulta en pacientes con meningitis por Neisseria meningitidis y Haemophilus influenzae tipo b. Medellin, Colombia / Characteristics of hospitable management and oportunity of consultation of meningitis patients

Objetivo: Evaluar las caracteristicas del manejo hospitalario y la oportunidad de la consulta de pacientes con meningitis por Neisseria meningitis y Haemophilus influenzae tipo B y su relación con la letalidad y las secuelas. Conclusión: Se encontró un deficiente cumplimiento en el suministro adecuado de antibióticos, de esteroides y de quimioprofilaxis. Se requieren estudios adicionales para evaluar el uso de esteroides en relacion con las seculas, por ser los resultados contradictorios a los informados en la literatura...

Inorganic and organic clays as carriers for controlled release of the herbicide hexazinone.

The risk of ground water contamination resulting from rapid leaching of highly soluble pesticides can be minimized through the application of the pesticide adsorbed on a matrix or carrier, which limits the amount of pesticide immediately available for undesirable losses. The use of natural materials for this purpose is of special interest in terms of economy and sustainability. In this work the adsorption of the herbicide hexazinone by two montmorillonites saturated with various inorganic and organic cations was determined and the ability of the two clays displaying the highest adsorption capacities [Fe(3+)-saturated Wyoming montmorillonite, (Fe-SW) and hexadecyltrimethylammonium-saturated Arizona montmorillonite (HDTMA-SA)] to act as carriers for slow release of hexazinone and to reduce herbicide leaching losses was evaluated. Hexazinone formulations based on Fe-SW and HDTMA-SA displayed slow release properties in water and soil/water suspensions, reduced herbicide leaching in soil columns, and maintained herbicidal activity, as compared with the currently available commercial hexazinone formulation (wettable powder). Loosely bound hexazinone-HDTMASA formulations, which led to the slowest breakthrough of hexazinone in soil columns along with the greatest amounts of herbicide released from the clay particles, displayed the most interesting characteristics for their use as slow release formulations and to prevent ground water contamination.

Prueba de evaluación psico-económico-social en niños con epilepsia / Psycho-economical-social evaluation test for epileptic children

Se presenta una "Prueba de evaluación psicoeconómica-social" para niños con epilepsias que permite un diagnóstico de esas condiciones. La prueba se puede realizar en pocos minutos durante la consulta médica o de enfermería. La aplicación de la Prueba a un grupo de 36 niños del Programa de Epilepsia del Hospital Luis Calvo Mackenna reveló que la mayoría de ellos presentaban dos o más problemas de los 10 que contiene la prueba

Epilepsia refractaria médica en niños: visión retrospectiva sobre su diagnóstico y manejo / Refractary medical epilepsy in children: a retrospective view of its diagnosis and treatment

La persistencia de crisis epilépticas adecuadamente tratadas se denomina epilepsia refractaria. La escala de Schmidt analiza el tratamiento farmacológico de los epilépticos con crisis, diferenciando la epilepsia refractaria de la insuficientemente tratada. Se describen características clínicas y electroencefalográficas y además se aplica la escala de Schmidt a 31 pacientes epilépticos con crisis, extraídos de los pacientes que entre julio y agosto de 1993 recibieron su receta de antiepilécticos. Dieciocho pacientes tenían crisis mixtas, en tanto que 19 tenían epilepsias sintomáticas. Se encontró EEG específico en 29 pacientes y retardo mental en 23. En 15 niños la enfermedad inició antes del primer año de vida, con una duración promedio de 8.6 años, una recaída con tratamiento antes de los 6 meses en 23 pacientes y la presentación de estado convulsivo en 10. La escala de Schmidt identificó 10 pacientes con tratamiento insuficiente y 21 refractarios. Se discuten los resultados y se recomienda la adopción de escalas de evaluación farmacológica en centros dedicados al manejo de epilepsia refractaria