Implantación de un programa de mininefrolitotomía percutánea ambulatoria: presentación del protocolo y resultados iniciales / Initial results of the implementation of an ambulatory mini percutaneous nephrolithotomy program

Objetivo Presentar nuestro protocolo de nefrolitotomía percutánea ambulatoria y evaluar los resultados iniciales del programa. Material y métodos Se analiza la implantación clínica del protocolo con los 30 primeros casos de mininefrolitotomía percutánea ambulatoria realizados en nuestro centro entre abril de 2021 y septiembre de 2022. Se recogen datos demográficos, variables perioperatorias, complicaciones y necesidad de atención médica no planificada, stone-free rate, tipología litiásica y parámetros de satisfacción con el proceso de cirugía mayor ambulatoria. Resultados Con una edad media de 60,2±11,6 años se intervinieron un total de 30 pacientes que cumplían los criterios de inclusión. El tamaño medio de la litiasis fue de 15mm [rango: 5-20]. No se registró ninguna complicación intraoperatoria. Todos los pacientes excepto uno fueron dados de alta el mismo día de la intervención, según lo planificado. El mes posterior al alta, la tasa de complicaciones, reconsulta a urgencias o reingreso hospitalario ha sido del 0%. La stone-free rate a los 3 meses ha sido del 83%. La satisfacción global de todo el proceso perioperatorio, valorada a través del cuestionario EVAN-G, fue de 124,3 puntos sobre un máximo de 150, equivalente a un 78,6% de grado de satisfacción. Conclusión La mininefrolitotomía percutánea en régimen ambulatorio puede instaurarse como una opción de asistencia en centros con experiencia en endourología, una unidad establecida de cirugía mayor ambulatoria y mediante una selección estricta de los pacientes. Nuestros resultados iniciales muestran un perfil de seguridad adecuado y un grado de satisfacción global elevado de los pacientes intervenidos en esta modalidad (AU)

Objective To present our program for ambulatory mini percutaneous nephrolithotomy and evaluate its initial results. Material and methods We analyzed the implementation of the protocol into the clinical practice with the first 30 outpatient mini percutaneous nephrolithotomy cases performed in our center between April 2021 and September 2022. Demographic characteristics, perioperative variables, complications and need for unplanned health care, stone-free rate, stone type and patient satisfaction with the major ambulatory surgery process were collected. Results A total of 30 patients with a mean age of 60.2±11.6 years who met the inclusion criteria underwent surgery. The mean stone size was 15mm [range: 5-20]. No intraoperative complications were recorded. All patients except one were discharged the same day of surgery as planned. In the month following discharge, the rate of complications, emergency department revisits or hospital readmissions rates were 0%. Stone-free-rate at 3 months was 83%. Overall satisfaction with the whole perioperative process was assessed with the EVAN-G questionnaire, obtaining 124.3 points out of a maximum of 150, which is equivalent to a 78.6% level of satisfaction. Conclusion Ambulatory mini percutaneous nephrolithotomy can be implemented as a treatment option in centers with experience in endourology, an established major ambulatory surgery unit, and strictly selected patients. Our initial results show an adequate safety profile and high overall satisfaction perceived by patients undergoing the ambulatory approach (AU)

Preliminary results of the implementation of robotic radical prostatectomy in a major ambulatory surgery regimen.

OBJECTIVE: To report our initial experience with robotic radical prostatectomy as an outpatient procedure. MATERIAL AND METHODS: Retrospective analysis of patients who underwent RRP as MAS (Major Ambulatory Surgery) at our center between March 2021 and May 2022. We collected baseline patient characteristics, intraoperative outcomes and postoperative data (need for unplanned medical care and complications at one month after surgery). Oncologic characteristics at disease diagnosis (PSA, staging, ISUP, MRI) and postoperative pathologic outcomes were collected. RESULTS: We identified a total of 35 patients with an average age of 60,8 ± 6,88 years and a BMI of 27 ± 2,9 Kg/m2. All patients had a low anesthetic risk and 25.71% had undergone previous abdominal surgery. The surgical time was 151,66 ± 42,15 min and the average blood loss was 301,2 ± 184,38 mL. Two patients (5.7%) were admitted for one night and 7 patients (20%) consulted the emergency department in the following month, of which 3 (8.57%) were readmitted. We recorded one intraoperative complication, seven mild postoperative complications (Clavien I-II) and one severe complication (Clavien IIIb). The severe complication occurred on the eighth postoperative day and was not related to the procedure being ambulatory. CONCLUSION: The absence of serious complications in the immediate postoperative period supports RRP in MAS as a safe technique for selected patients.

Initial results of the implementation of an ambulatory mini percutaneous nephrolithotomy program.

OBJECTIVE: To present our program for ambulatory mini percutaneous nephrolithotomy (mini-PCNL) and evaluate its initial results. MATERIAL AND METHODS: We analyzed the implementation of the protocol into the clinical practice with the first 30 outpatient mini-PCNL cases performed in our center between April 2021 and September 2022. Demographic characteristics, perioperative variables, complications and need for unplanned health care, stone-free rate (SFR), stone type and patient satisfaction with the major ambulatory surgery (MAS) process were collected. RESULTS: A total of 30 patients with a mean age of 60.2 ±â€¯11.6 years who met the inclusion criteria underwent surgery. The mean stone size was 15 mm [range: 5-20]. No intraoperative complications were recorded. All patients except one were discharged the same day of surgery as planned. In the month following discharge, the rate of complications, emergency department (ED) revisits or hospital readmissions rates were 0%. Stone-free-rate (SFR) at 3 months was 83%. Overall satisfaction with the whole perioperative process was assessed with the EVAN-G questionnaire, obtaining 124.3 points out of a maximum of 150, which is equivalent to a 78.6% level of satisfaction. CONCLUSION: Ambulatory mini-PCNL can be implemented as a treatment option in centers with experience in endourology, an established MAS Unit, and strictly selected patients. Our initial results show an adequate safety profile and high overall satisfaction perceived by patients undergoing the ambulatory approach.

Resultados preliminares de la implementación de la prostatectomía radical robótica en régimen de cirugía mayor ambulatoria / Preliminary results of the implementation of robotic radical prostatectomy in a major ambulatory surgery regimen

Objetivo Reportar nuestra experiencia inicial de prostatectomía radical robótica (PRR) en régimen ambulatorio. Material y métodos Análisis retrospectivo de los pacientes intervenidos de PRR en cirugía mayor ambulatoria (CMA) en nuestro centro entre marzo de 2021 y mayo de 2022. Recopilamos las características basales de los pacientes, los resultados intraoperatorios y los datos del postoperatorio (necesidad de asistencia médica no planificada y complicaciones al mes de la cirugía). Se recogieron las características oncológicas al diagnóstico de la enfermedad (PSA, estadificación, ISUP, RMN) y el resultado anatomopatológico tras la intervención. Resultados Identificamos un total de 35 pacientes, con una edad promedio de 60,8 ±6,88 años y un IMC de 27 ±2,9kg/m2. Todos presentaban un riesgo anestésico bajo y un 25,71% tenían alguna cirugía abdominal previa. El tiempo quirúrgico fue de 151,66 ±42,15 minutos y el sangrado promedio fue de 301,2 ±184,38mililitros. Dos pacientes (5,7%) ingresaron la primera noche de la cirugía y 7 pacientes (20%) consultaron en urgencias en el mes siguiente, de los cuales 3 (8,57%) reingresaron. Registramos una complicación intraoperatoria, 7 complicaciones postoperatorias leves (ClavienI-II) y una complicación grave (ClavienIIIb). La complicación grave transcurrió al octavo día postoperatorio y no tuvo relación con la ambulatorización del procedimiento. Conclusión La ausencia de complicaciones graves en el postoperatorio inmediato avala la PRR en régimen de CMA como una técnica segura dirigida a pacientes seleccionados (AU)

Objective To report our initial experience with robotic radical prostatectomy (RRP) as an outpatient procedure. Material and methods Retrospective analysis of patients who underwent RRP as major ambulatory surgery (MAS) at our center between March 2021 and May 2022. We collected baseline patient characteristics, intraoperative outcomes and postoperative data (need for unplanned medical care and complications at one month after surgery). Oncologic characteristics at disease diagnosis (PSA, staging, ISUP, MRI) and postoperative pathologic outcomes were collected. Results We identified a total of 35 patients with an average age of 60,8 ±6,88years and a BMI of 27 ±2,9kg/m2. All patients had a low anesthetic risk and 25.71% had undergone previous abdominal surgery. The surgical time was 151,66 ±42,15minutes and the average blood loss was 301,2 ±184,38milliliters. Two patients (5.7%) were admitted for one night and 7 patients (20%) consulted the emergency department in the following month, of which 3 (8.57%) were readmitted. We recorded one intraoperative complication, 7 mild postoperative complications (ClavienI-II) and one severe complication (ClavienIIIb). The severe complication occurred on the eighth postoperative day and was not related to the procedure being ambulatory. Conclusion The absence of serious complications in the immediate postoperative period supports RRP in MAS as a safe technique for selected patients (AU)

Page kidney after pediatric kidney transplantation: a case report. / Riñón de Page tras trasplante renal pediátrico: informe de un caso.

INTRODUCTION: Page kidney (PK) is a rare condition caused by parenchymal compression due to a subcapsular hematoma. Irreversible damage of the graft may occur if this condition is not recognized and treated properly. CLINICAL CASE: We describe the case of a 16-year-old man with chronic renal failure secondary to corticosteroid-resistant nephrotic syndrome (CRNS) caused by NPHS2 mutations. The patient underwent a 5th fifth living-related KT. The graft was placed intraperitoneally and reperfused well without complications. On the 4th postoperative day his labs demonstrated raising creatinine associated with refractory hypertension, gross hematuria and anemia. Urgent ultrasound revealed a subcapsular hematoma with signs of parenchymal compression. PK phenomenon was suspected and urgent surgical intervention decided. COMMENTS: PK is a rare but an emergence potentially treatable and reversible complication after pediatric KT. Early diagnosis based on clinical suspicion and suggestive imaging are the key points for a favorable outcome.

INTRODUCCION: El riñón de Page (RP) es una enfermedad rara provocada por compresión parenquimatosa debido a un hematoma subcapsular. El injerto puede sufrir daños irreversibles si la enfermedad no se reconoce y se trata de forma adecuada. CASO CLINICO: Describimos el caso de un varón de 16 años con fallo renal crónico secundario a síndrome nefrótico corticorresistente (SNCR) provocado por mutaciones del gen NPHS2. El paciente se somete a un quinto TR de donante vivo. El injerto se coloca en posición intraperitoneal, con una adecuada reperfusión, sin complicaciones. Al cuarto día postoperatorio, sus análisis revelan una subida de la creatinina asociada a hipertensión refractaria, hematuria macroscópica y anemia. La ecografía de urgencia revela hematoma subcapsular con signos de compresión parenquimatosa. Se sospecha RP y se decide intervención quirúrgica de urgencia. COMENTARIOS: El RP es una complicación rara y urgente, aunque a su vez tratable y reversible, tras TR pediátrico. El diagnóstico precoz basado en la sospecha clínica y las imágenes son claves a la hora de conseguir un resultado favorable.

Riñón de Page tras trasplante renal pediátrico: informe de un caso / Page kidney after pediatric kidney transplantation: a case report

Introducción: El riñón de Page (RP) es una enfermedad rara provocada por compresión parenquimatosa debido a un hematoma subcapsular. El injerto puede sufrir daños irreversibles si la enfermedad no se reconoce y se trata de forma adecuada.Caso clínico: Describimos el caso de un varón de 16 años con fallo renal crónico secundario a síndrome nefrótico corticorresistente (SNCR) provocado por mutaciones del gen NPHS2. El paciente se somete a un quinto TR de donante vivo. El injerto se coloca en posición intraperitoneal, con una adecuada reperfusión, sin complicaciones. Alcuarto día postoperatorio, sus análisis revelan una subida de la creatininaasociada a hipertensión refractaria, hematuria macroscópica y anemia.La ecografía de urgencia revela hematoma subcapsular con signos de compresión parenquimatosa. Se sospecha RP y se decide intervenciónquirúrgica de urgencia. Comentarios: El RP es una complicación rara y urgente, aunque a su vez tratable y reversible, tras TR pediátrico. El diagnóstico precoz basado en la sospecha clínica y las imágenes son claves a la hora de conseguir un resultado favorable.

Introduction: Page kidney (PK) is a rare condition caused by parenchymal compression due to a subcapsular hematoma. Irreversible damage of the graft may occur if this condition is not recognized and treated properly.Clinical case: We describe the case of a 16-year-old man withchronic renal failure secondary to corticosteroid-resistant nephroticsyndrome (CRNS) caused by NPHS2 mutations. The patient underwent a 5th fifth living-related KT. The graft was placed intraperitoneallyand reperfused well without complications. On the 4 th postoperativeday his labs demonstrated raising creatinine associated with refractoryhypertension, gross hematuria and anemia. Urgent ultrasound revealeda subcapsular hematoma with signs of parenchymal compression. PKphenomenon was suspected and urgent surgical intervention decided.Comments: PK is a rare but an emergence potentially treatableand reversible complication after pediatric KT. Early diagnosis basedon clinical suspicion and suggestive imaging are the key points for afavorable outcome.

Study of antidepressant use in 5 European settings. Could economic, sociodemographic and cultural determinants be related to their use?

BACKGROUND: We aimed at describing the trends in antidepressants use (AD) by age and sex, during 2007-2011, in 5 European settings (Sweden, Norway, Denmark, Catalonia and Veneto), and to assess whether the differences found across settings could be related to economic, social and cultural determinants. METHODS: We collected data of AD use expressed in defined daily doses (DDD). Data were retrieved from population-based databases. We calculated DDD/1000 inhabitants/day. We analysed which economic, social, and cultural covariates determined between-settings differences in AD consumption. RESULTS: The use of AD showed an increasing trend during the study period, being Selective Serotonin Reuptake Inhibitors the most consumed, followed "others AD". Women and the elderly showed the highest AD consumption. Between-settings variability in AD consumption showed a positive correlation with pharmaceutical expenditure and a negative one with general practitioner's rate. After adjusting by pharmaceutical expenditure and general practitioners rate Masculinity, Long-Term Orientation and Individualism cultural dimensions were associated with AD use by using the Hofstede´s cultural dimensions model. LIMITATIONS: This study has been conducted in administrative databases, with no information on AD use by indication; differences among AD use could be related to their prescription for other disorders. Analyses were based on a small dataset and none of the results reached statistical significance. CONCLUSIONS: AD use increased through 2007-2011. Pharmaceutical expenditure and General Practitioners rate, Masculinity, Long-Term Orientation and Individualism explained the differences in AD use between countries. People's attitude should be considered when designing national campaigns to improve antidepressant use.

[Education and occupational social class: their relationship as indicators of socio-economic position to study social inequalities in health using health interview surveys]. / Educación y clase social basada en la ocupación: su interrelación como indicadores de posición socioeconómica en el estudio de las desigualdades sociales mediante encuestas de salud.

AIM: To analyse the relationship between social class based on occupation and level of education in the study of social inequalities in health and use of health services. DESSIGN: Cross-sectional study (health interview survey). SETTING: General population of the city of Cornellà de Llobregat (Spain). PARTICIPANTS: Representative sample of subjects aged 14 years old or over (1043 men and 1101 women) who personally answered the questionnaire. MEASUREMENTS: We analyse the association between social class and level of studies and different independent variables (self-perceived health, smoking, medical visits) by means of logistic regression. RESULTS: The proportion of men who declare their self-perceived health as poor is higher among those who have low education (45.4%) than among those who have primary education level or higher (25.9%). The prevalence of smoking shows a similar pattern (54.2% versus 41.5%), with a gradient effect, which is statistically non-significant. However, these differences are no longer evident if social class is used to group the individuals. No clear association is observed between the use of health services and socio economic level. CONCLUSIONS: We need to use several indicators of socioeconomic position to evaluate social inequalities In this disadvantaged population, level of education seems to be a good indicator to study social inequalities in health.

[Cost effectiveness analysis of highly active antiretroviral therapy in HIV asymptomatic patients]. / Análisis coste-efectividad del tratamiento antirretroviral de gran actividad en pacientes infectados por el VIH asintomáticos.

BACKGROUND: Assessment of cost and effectiveness in highly active antiretroviral therapy (HAART) in HIV asymptomatic patients. PATIENTS AND METHODS: A cohort of several asymptomatic HIV-infected patients were observed under real practice and treated with two nucleosid analogues (AN) of which therapy was modified. A protease inhibitor (PI) was added and at least one AN was changed (or not), following the current clinical recommendations (1997). Data on direct cost (drug cost, visits and clinical procedures) were then recorded both three and six months after the beginning of the study. Data on effectiveness (percentage of patients with undetectable levels of viral load) and quality of life were next measured according to the EuroQol, and recorded at the same time. All patients used a monthly diary to keep record of resource consumption and quality of life progress. RESULTS: All treatment regimens were effective in lowering the viral load and improve quality of life. The less expensive HAART was AZT + 3TC + IND (1,037,757 pesetas) and AZT + ddl + IND (1,045,339 pesetas), but both were the least effective to reduce patient's viral load to undetectable levels (52.7 and 57.7% respectively); meanwhile d4T + 3TC + IND (1,188,177 pesetas) and d4T + ddl + IND (1,212,285 pesetas) were more expensive but more effective (67.9 and 66% respectively). Cost-effectiveness ratios ranged between 9,896 and 13,122 pesetas. There was no statistically significant differences in quality of life among the different HAART regimens. CONCLUSIONS: HAART implementation is effective in reducing patients' viral load to undetectable levels and to slightly improve their quality of life after six months. Costs and effectiveness vary according to the type of HAART treatment used.

[Epidemiological data on chronic myeloid leukemia in Asturias, 1972-1986]. / Datos epidemiológicos de la leucemia mieloide crónica en Asturias durante el periodo 1972-1986.

PURPOSE: To evaluate the incidence of CML in Asturias during the period 1972-1986, studying the variations in relation to age, sex and geographical zone. MATERIAL AND METHODS: Information relating to the date of diagnosis, name, age, sex and home address of the 108 cases (65 men and 43 women) diagnosed CML during the period 1972-1986 according to conventional criteria was collected from the hospital records of the region. For the calculations, SADEI demographic data were taken as a reference, comparing the incidence between sexes and geographical zones by means of the CHI2. RESULTS: A rate of incidence of 0.64/100,000 inhabitants/year was obtained, this being 0.8 in men and 0.5 in women (p < 0.05). The rate of incidence increased progressively with age until the 45-59 age group when it was maximum. There were no differences between the three main centres of population Gijón (0.53), Oviedo (0.55) and Avilés (0.69) nor the latter with the rest of the zones in Asturias; nor was three either any difference between coastal towns (0.56) and those of the interior (0.71) (p = NS). CONCLUSIONS: Limited incidence of CML in Asturias without significant differences in its geographical distribution within the region. The incidence, which was higher among males, increased progressively with age until reaching maximum importance in the 45-59 age group.

[Features of chronic myeloid leukemia at diagnosis. Study of a series of 134 cases]. / Características de la leucemia mieloide crónica al diagnóstico. Estudio de una serie de 134 casos.

PURPOSE: To analyse the clinico-biological features of 134 patients with chronic myelogenous leukaemia (CML) at presentation. MATERIAL AND METHODS: The series is comprised of 134 patients from the Asturias Central Hospital and other hospital of the region, diagnosed of CML with conventional criteria between 1970 and 1989. A retrospective study was carried out revising the clinical records and the clinico-biological data at diagnosis. Cytogenetic studies were available in 62 cases. The statistical analysis was based upon descriptive statistics and comparison of means and proportions by the chi square and Student's tests. Univariate study was also performed for several variables. RESULTS: The mean age of the group was 50 years, ranging between 2 and 81. The M/F ratio was 76/58. The commonest symptoms at onset were those secondary to hypermetabolism and splenomegaly, 8% of the patients being asymptomatic. Splenomegaly was present in 73.8% of the patients and hepatomegaly in 37.6%. The median white cell count was 132 x 10(9)/L. Absolute basophilia and eosinophilia were seen in 83% and 78% of the cases, respectively. Anaemia was found in 47.4% of the patients, usually mild, and 39% of them had nucleated red cells in peripheral blood. The median platelet count was 400 x 10(9)/L. Thrombocytosis was found in 48% of the cases, while 11% had thrombocytopenia. The mean number of blast cells in the bone marrow was 1.72%. The histopathologic study of the bone marrow revealed decreased red cells in 94.5% of the patients and decreased megakaryocytes in 29.5%; these last were increased in 50% of the patients. Increased reticulin fibres were found in 38.5% of the bone marrow samples. In addition to the Ph' chromosome, which was present in 51 patients, chromosomal abnormalities were seen in 15.6% of the cases in the chronic phase and in 69.2% in the terminal stages of the disease. Positive correlation could be established between the white cell count and the size of spleen (p < 0.001) and liver (p < 0.05), and there was a negative correlation between white blood cell count and haemoglobin rate and platelet count (p < 0.05 for both). CONCLUSIONS: (1) The analysis of this series shows that the CML cases in this region have similar characteristics to those in other western world communities (2). The mean age of this group is somewhat higher than in other series, which should be re-evaluated after discarding the Ph'-negative cases. (3) There seems to be positive correlation between leucocyte count and spleen and liver enlargement, and negative correlation between leucocyte count and haemoglobin and platelet count.

[Low-grade non-Hodgkin's lymphomas. Study of 73 cases]. / Linfomas no Hodgkin de bajo grado. Revisión de 73 casos.

PURPOSE: To analyse the clinico-biologic features at diagnosis and the response to therapy and survival of a group of patients with low-grade non-Hodgkin's lymphoma (NHL). MATERIAL AND METHODS: The study comprises 73 NHL patients diagnosed between 1974 and 1989 in the Covadonga Hospital and classified as low-grade in accordance with the international Working Formulation. The first-line treatment regimens used were cyclophosphamide-vincristine-prednisone (CVP), chlorambucil-prednisone (CBL-PRED), radiotherapy, and other combinations. The statistical study was performed by comparative statistics (Student's tests, chi-square), univariate analysis (Cox Mantel method) and multivariate analysis (Cox proportional risks); the BMDP pack was used for the study. RESULTS: The median age of the group was 63 years. Stages III and IV were seen at first in 75% of the patients, and 22% of the series had extranodal involvement. CVP was used in 69% of the cases, 7.6 received CBL-PRED, 11% were given radiotherapy, and other combinations were given to 11% of the patients. As a whole, responses were seen in 46 cases (73%), of whom complete remission (CR) was achieved in 49% and partial remission (PR) or minor responses (MR) were attained in 24% of instances. The factors influencing upon CR were: stage (p less than 0.0005), B-symptoms (p 0.004), splenomegaly (p less than 0.801), platelet count and haemoglobin rate (p less than 0.01). The total survival at 10 years was 53%, and the disease-free survival for those attaining CR was 48%, with disease-free median of 81 months. The univariate analysis was influenced in a negative fashion by the following: peripheral blood lymphocyte count below 2 x 10(9)/L, B-symptoms (p less than 0.002), bulky tumoural mass (p less than 0.007), advanced stage (p less than 0.003) and, chiefly, response to treatment (p less than 0.0001). The 10-year survival of the patients achieving CR was 86%, that of both types of response (PR and MR) was 20%, and it was 0% for the failures. CONCLUSIONS: 1) Patients in low stages have high possibilities of curation with radiotherapy. 2) CVP for advanced stages provides moderate percentage of response, with CR rate lower than 50%. It is necessary to select those patients with unfavourable prognostic factors in order to use aggressive treatment to achieve CR. 3) Patients attaining CR have better prognosis in spite of the frequent relapses (63% at 10 years).

Pregnancy outcome in hematologic malignancies.

By means of a mail questionnaire, information on a series of 56 pregnancies i in 48 women diagnosed with leukemia or lymphoma was collected from ten hospitals. Seven patients conceived while receiving treatment for their neoplasms; in 22 patients, the hematologic disease was diagnosed during pregnancy, and the remaining 27 patients became pregnant after completion of the antineoplastic treatment. When a comparison was made of the evolution of these pregnancies to that of pregnancies in a healthy population, no increase in the incidence of complications was observed: 64% of the pregnancies went to term, 9% resulted in spontaneous abortion, and 5% resulted in premature births. The observed incidence of one major malformation in 56 pregnancies did not differ from the frequency of malformations in the offspring of healthy individuals. There were no fetal losses in six pregnancies in which conception occurred during the first year after chemotherapy. In spite of the inherent limitations derived from the design of this type of study and the type of subject analyzed, the data here support the hypothesis that the cytostatic treatment of hematologic malignancies, if deemed necessary, should not be postponed because of pregnancy. Moreover, the authors agree with advice recommending that no antifolic or alkylating agents be used for prolonged periods and that radiotherapy be avoided, especially to those fields involving the pelvic area.

[Hemolytic anemia induced by Chelidonium majus. Clinical case]. / Anemia hemolítica inducida por Chelidonium majus. Observación clínica.

A case of haemolytic anaemia secondary to oral ingestion of a Chelidonium majus extract is presented. It coursed with intravascular haemolysis, renal failure, liver cytolysis and thrombocytopenia. The direct Antiglobulin test was positive (4+), IgG+C'. The patient was treated with steroids, red cell and platelet transfusion and also twice with an haemodialytic treatment, with complete resolution of the clinical features about the 12th day. A complete bibliographic revision from 1966-1989 was performed and no cases like this one were found during that period, so this could the first one reported.

[Blood transfusion and survival of patients with neoplasms of the colon and rectum]. / Transfusión sanguínea y supervivencia de los pacientes con neoplasias de colon y recto.

The fate of 248 patients diagnosed of colorectal malignancies between 1973 and 1982 and subjected to radical surgery with curative purposes was analysed. The effect of peroperative whole blood and packed red cells transfusions, along with other co-variants, on the survival of the patients was studied. It was found, by means of the Cox analysis, that whole blood and the Duke's staging system had the most important correlation (p = 0.003 and p = 0.02, respectively) on the patients' prognosis and survival, no such relationship being found with packed red cells transfusion (p = 0.25). Dose-related association between the relapse index and the number of whole blood units transfused was shown by the Mantel's global trend test (p = 0.015). The different effect of the transfusion products would confirm the hypothesis that the relationship between transfusion and poorer prognosis, thought to be due to patient's immunosuppression and hence higher relapse index, could be determined by any ill-defined plasmatic factor.

Allogeneic bone marrow transplantation versus intensification chemotherapy for acute myelogenous leukaemia in first remission: a prospective controlled trial.

In 1982 we began a prospective controlled trial to assess the effectiveness of allogeneic bone marrow transplantation and intensive post-remission chemotherapy for patients with acute myelogenous leukaemia in first complete remission. Fourteen patients, 3-45 years of age, who had an HLA-identical sibling donor, received bone marrow transplantation. Twenty-five patients who either lacked an HLA-identical sibling or were over 45 years of age received intensive consolidation chemotherapy including high-dose cytosine arabinoside with or without adriamycin. The actuarial rate of continued complete remission (CCR) at 3 years was significantly higher in the transplantation group than in the chemotherapy group: 70% (95% confidence interval 35-91%) compared with 10% (95% confidence interval 2-30%); P = 0.01. However, the actuarial rate of CCR was not significantly different between the transplantation group and patients under 45 years in the chemotherapy group: 70% (95% confidence interval 35-91%) compared with 17% (95% confidence interval 4-45%), 0.1 greater than P greater than 0.05. The actuarial probability of leukaemia relapse was significantly lower in the transplantation group than in the chemotherapy group: 10% (95% confidence interval 4-21%) compared with 88% (95% confidence interval 70-96%), 0.005 greater than P greater than 0.001. There was no significant difference between both groups if we compare only the patients who died of non-leukaemic causes: 22% (95% confidence interval 9-42%) versus 25% (95% confidence interval 7-59%), P = NS. In summary, this study shows that allogeneic bone marrow transplantation is a better anti-leukaemic treatment than is intensive consolidation chemotherapy in patients with AML in first complete remission.

Double blind study of ketoconazole and griseofulvin in dermatophytoses.

Ketoconazole and griseofulvin were compared in a double blind fashion in 47 children with dermatophytosis and positive fungal culture. After 6 weeks of therapy there was clinical and mycologic cure or improvement of the lesions in 92% of patients treated with ketoconazole (Group A) and in 76% of those given griseofulvin (Group B). A patient in Group A showed clinical deterioration of the lesions after 4 weeks of treatment, although modification of antifungal therapy was not necessary to achieve final healing. One ketoconazole-treated patient relapsed within 7 days after cessation of therapy. In Group B the antifungal agent was changed in five cases due to worsening or slow resolution of the lesions and persistence of positive cultures after 6 weeks of treatment. Both ketoconazole and griseofulvin were useful drugs for treatment of dermatophytoses in children.