[A description and consensus on the role of the professional in the integral management of the haematology patient: Results of a national multicentre Delphi study]. / Descripción y consenso del rol del profesional de enfermería en la gestión integral del paciente hematológico: resultados de un estudio Delphi multicéntrico nacional.

BACKGROUND AND OBJECTIVE: The Haematology Service has undergone significant advances in recent years. Given the vital part played by the nurse in the care of the haematology patient, ensuring optimal management by adapting their role to meet the current healthcare needs is a priority. The aim of this study was to evaluate the level of agreement among professionals of the Haematology Service regarding the role of the nursing professional and their importance in the comprehensive management of these patients in a multidisciplinary work setting. PATIENTS AND METHOD: A national multicentre Delphi study with haematology specialists and nursing professionals. A two-round questionnaire was used, and consensus was reached when > 75% of the panellists scored on the same tertile (1-3: disagreement, 7-9: agreement), and the interquartile range of the median of the responses was ≤4. RESULTS: A total of 33 professionals from the Haematology Department were invited to participate, of whom 19 were haematology specialists and 14 were nursing professionals. In the first round, 25 panellists responded (14 haematology specialists and 11 nursing professionals), and in the second round, 22 panellists responded (12 haematology specialists and 10 nursing professionals). The panel of experts agreed that haematology nurses should have specific training in haematology (96%) and on the definition of the role of nursing in the care process of the haematology patient, except in the possible participation in decision-making with regard to the most appropriate oncological treatment for a patient (58%). The role of the nursing professional as a reference for the patient throughout the healthcare process and their involvement in the process at the time of diagnosis were agreed upon in the second round (72.7% and 68.2%). Their role in the control of nutritional status (100%), visit compliance (96%), and health education for the patient and the family (96%) were included in the highly agreed upon aspects. The panel considered the improvement of adherence to treatment (96%), and the role as consultant for specific care of the haematology patient within the hospital (96%) as important aspects. Together with health education and patient follow-up, a total of 88% of the panellists considered that the haematology nurse reduces patient visits to the emergency department as well as physical visits to the outpatient clinics of the health centre. CONCLUSIONS: The current profile of the haematology nursing professional implies a high level of specialisation. The competencies of the haematology nursing professional are aimed at guaranteeing an integral management of these patients; with important healthcare functions, as well as a key element in the flow of information, and are framed within a multidisciplinary work setting.

Malformaciones congénitas en mujeres sometidas a técnicas de reproducción asistida / Birth defects in women undergoing assisted reproduction techniques

Objetivo: Conocer la tasa de aparición de malformaciones fetales, así como los resultados perinatales adversos en pacientes estériles sometidas a técnicas de reproducción asistida. Material y método: Estudio de casos y controles retrospectivo, en pacientes sometidas a técnica de reproducción asistida: FIV/ICSI, IAC, OVODON, en el año 2013, y un grupo control de pacientes sanas en las mismas fechas. Han sido extraídas de la base de datos de la Unidad de Reproducción Humana. Los datos de las ecografías morfológicas se obtuvieron del software Astraia. Las variables analizadas se recogieron del sistema operativo Drago. El análisis estadístico de las variables se llevó a cabo mediante SPSS 20.0. Resultados: Se obtuvieron 619 pacientes, de las cuales se eliminaron 38 por falta de datos. Se obtuvo un mayor porcentaje de pacientes con edades entre 35-40 años en el grupo de casos, estadísticamente significativo (p<0,05). La técnica más utilizada fue la FIV (55,3% de gestaciones únicas y 16,5% de gemelares). El factor masculino supone el 32,9%. Se objetivó un 1,2% de controles con PAPP-A menor de 0,3MoM; todos los casos presentaban PAPP-A mayor de 0,3MoM (p<0,05). De las variables estudiadas, en cuanto a la aparición de malformaciones detectadas en la ecografía morfológica, no se obtuvieron diferencias estadísticamente significativas entre los casos y los controles. Hubo mayor ingreso de casos en sala de Neonatología y UCIN, y de valores menores de pH, ambos estadísticamente significativos (p<0,05). Conclusión: Analizando técnicas de reproducción asistida y su relación con las malformaciones fetales no se objetiva un mayor riesgo de defectos de nacimiento entre los recién nacidos concebidos con técnicas en comparación con los de concepción espontánea

Objective: To determine the rate of occurrence of birth defects and adverse perinatal outcomes in infertile patients undergoing assisted reproduction techniques. Material and method: We conducted a retrospective case-control study that included patients undergoing assisted reproduction techniques (IVF, ICSI, CAI, OVODON) in 2013 and a control group of healthy patients who delivered in the same dates. Patients were drawn from the database of the Human Reproduction Unit. Morphological data were obtained from Astraia ultrasound software. The data analysed were collected from the Drago operating system. The statistical analysis was conducted with the SPSS 22.0 statistical package. Results: There were 619 patients, of which 38 were excluded due to lack of data. There was a significantly higher percentage of women aged 35-40 years (P<.05) in the cases group. The most frequently used technique was IVF (55.3% of single pregnancies and 16.5% of twin pregnancies). The male factor accounted for 32.9%. A total of 1.2% of controls had a PAPP-A MoM less than 0.3 and all cases showed a PAPP-A greater than 0.3 MoM (P<.05). There were no statistically significant differences between cases and controls in any of the variables studied in relation to defects identified in the morphological ultrasound. The cases group showed more frequent admission to the neonatology ward and neonatal intensive care unit and lower pH values; both these differences were statistically significant (P<.05). Conclusion: Analysis of the different assisted reproduction techniques and their relationship to foetal malformations did not show an increased risk of defects among infants conceived with assisted reproductive techniques compared with newborns resulting from spontaneous conception

Diagnóstico ecográfico y manejo de la infección fetal por parvovirus B19 / Prenatal diagnosis and management of fetal parvovirus B19 infection

Introducción: El parvovirus humano B19 (B19V) es una de las principales causas de anemia fetal que puede ocasionar hidropesía fetal grave, siendo el responsable de un 18-27% de las hidropesías fetales no inmunitarias. La infección por el B19V presenta brotes epidémicos cada 4-6 años, ocasionando un mayor número de casos de anemia fetal en los que es necesario realizar tratamiento. Objetivo: Conocer los resultados de los fetos con infección por B19V, su evolución, manejo y resultados perinatales. Material y métodos: Estudio descriptivo retrospectivo de los casos de infección congénita por B19V, diagnosticados en un periodo de 5 años. Resultados: Se analizaron 14 fetos con infección y afectación por el B19V. Un 71,4% de los fetos tuvieron hidropesía fetal. El hallazgo ecográfico más frecuente fue la cardiomegalia (78,6%). Se realizó transfusión intrauterina a 7 fetos. Fallecieron un 40% de los fetos. De los fetos a los que se les realizó TIU, un 42,85% falleció tras el procedimiento, todos ellos presentaron una pancitopenia grave arregenerativa. Conclusiones: Aunque es una patología de buen pronóstico, los resultados dependen en gran medida del estado hemodinámico del feto, así como el grado de afectación hematológica y los riesgos de las técnicas invasivas. Existen parámetros de anemia fetal como es la presencia de regurgitación de la válvula tricúspide que ayudan a predecir un grado de afectación fetal y, por lo tanto, debería tenerse en cuenta para valorar la realización de técnicas invasivas para estimación directa del grado de anemia fetal

Introduction: The human parvovirus B19 virus (B19V) is one of the most common infectious causes of foetal anaemia, which can lead to severe foetal hydrops. This infection causes 17-27% of non-immune foetal hydrops. Epidemic outbreaks of B19V infection occur at intervals of 4-6 years, increasing the number of cases of foetal anaemia requiring treatment. Objective: To determine the findings in foetuses with B19V infection, the clinical course of these pregnancies, their management and perinatal outcomes. Material and methods: A retrospective study of cases of congenital B19V infection diagnosed over a 5-year period. Results: We found 14 foetuses with B19V infection. Hydrops was present in 71.4% of the cases. The most frequent ultrasound finding was cardiomegaly (78.6%). Exchange transfusion was carried out in 7 foetuses. Overall mortality was 40%. Of the 7 treated foetuses, 42.85% died after the procedure. All of them had severe aregenerative pancytopenia. Conclusion: The results of B19V infections largely depend on the degree of the anaemia, the haemodynamic status of the foetus, and the risk of invasive procedures. Some parameters, such as the presence of tricuspid regurgitation, can be used to diagnose foetal anaemia and could therefore be useful as a tool to evaluate the use of invasive procedures to directly estimate the degree of foetal anaemiA

Inferior alveolar nerve trajectory, mental foramen location and incidence of mental nerve anterior loop.

OBJECTIVES: Injury of the inferior alveolar nerve (IAN) is a serious intraoperative complication that may occur during routine surgical procedures, such as dental implant placement or extraction of impacted teeth. Thus, the purpose of this study was to analyze the trajectory of the mandibular canal (MC), the location of the mental foramen (MF) and the presence and extension of an anterior loop of the mental nerve (AL). STUDY DESIGN: In this cross-sectional study, a total of 348 CBCTs were analyzed. Distances from MC to the surface of the basal, medial and lateral cortical of the mandible were measured at the level of the second molar, first molar and second premolar. Location of the MF relative to the apices of the premolars, as well as incidence and anterior extent of the AL were also determined. RESULTS: Significant and clinically relevant correlations were found between the position of the MC in women, which was located more caudal (r=-0.219, p=0.007; r=-0.276, p<0.001; right and left, respectively) and lateral (r=-0.274, p=0.001; r=-0.285, p<0.001; right and left, respectively), particularly at the level of the premolars. Additionally, the presence (r=-0.181, p=0.001; r=-0.163, p=0.002; right and left, respectively) and anterior extension (r=-0.180, p=0.009; r=-0.285, p=0.05; right and left, respectively) of the AL was found to be inversely correlated with the age of the patient. CONCLUSIONS: This analysis of a Caucasian population has found that the older the patient, the lower the incidence of the loop and the shorter its anterior extension.

Diagnóstico ecográfico de 2 casos de displasias esqueléticas con alteración en la mineralización. Papel de la ecografía 3D / Role of 3D ultrasound in the diagnosis of skeletal dysplasias with hypomineralisation. Report of two cases

Las displasias esqueléticas que cursan con alteraciones en la mineralización son difíciles de diferenciar desde el punto de vista ecográfico, debido a que comparten características comunes unas con otras. Es importante conocer el diagnóstico exacto de estas entidades para realizar un asesoramiento adecuado. El uso de la ecografía tridimensional (3D), la navegación multiplanar y las reconstrucciones nos permite visualizar mejor ciertas características ecográficas de este tipo de alteraciones, que nos puede ayudar en el diagnóstico diferencial. Se presentan 2 casos de fetos afectos de displasias esqueléticas letales con alteración en la mineralización ósea diagnosticados prenatalmente y su dificultad en el diagnóstico

Skeletal dysplasias with hypomineralisation are difficult to distinguish by ultrasound because they share common features. It is very important to determine the exact diagnosis and provide appropriate counselling to parents for future pregnancies. The use of 3D ultrasound, multiplanar navigation and reconstructions allows better visualization of certain ultrasonographic features of these types of alteration, which can help to establish the differential diagnosis. We report the cases of two foetuses with skeletal dysplasias and hypomineralisation and the difficulties of the differential diagnosis

Absorción sistémica de tacrolimus tópico en enfermedad de Crohn metastásica con úlceras cutáneas / Systemic absorption of topical tacrolimus in metastatic Crohn disease with skin ulcers

No disponible

Diagnóstico prenatal de peritonitis meconial simple / Prenatal diagnosis of simple meconium peritonitis

Nos encontramos ante un feto que presenta una masa anecoica con una superficie calcificada desde el principio del segundo trimestre que posteriormente se resuelve con la aparición de calcificaciones distribuidas en la cápsula hepática. No presenta ninguna otra calcificación en el parénquima hepático ni patología a nivel intestinal o abdominal. Clínicamente se mantuvo estable. Estos hallazgos conducen al diagnóstico de peritonitis meconial simple. El diagnóstico ecográfico prenatal de la peritonitis meconial juega un papel muy importante y se ha demostrado para mejorar los resultados prenatales significativos. Los resultados son de todo tipo y también dependerán de la gravedad de la perforación y el momento en que se diagnostica

We report the case of a foetus with an anechoic mass with a calcified surface from the beginning of the second trimester, which subsequently resolved with the appearance of calcifications distributed in the liver capsule. No calcification of the liver parenchyma or intestinal or abdominal organ disease was identified and the condition was clinically stable. These findings led to the diagnosis of simple meconium peritonitis. The antenatal ultrasonographic diagnosis of meconium peritonitis plays a very important role and has been shown to significantly improve the antenatal results. The findings are varied and depend on the severity of the perforation and the timing of diagnosis

Prognostic significance of FLT3 mutational status and expression levels in MLL-AF4+ and MLL-germline acute lymphoblastic leukemia.

There is barely any information about the prognostic significance of FLT3 expression and mutational status in cytogenetically distinct subgroups of acute lymphoblastic leukemia (ALL). We analyzed the presence of FLT3-tyrosine kinase domain (TKD) and FLT3-internal tandem duplication (ITD) mutations as well as FLT3 expression levels in 54 newly diagnosed patients with B-ALL (n=49) or T-ALL (n=5). All B/T-ALL samples tested negative for the presence of FLT3-TKD or FLT3-ITD. None of the T-ALL and E2A-PBX1+ B-ALL overexpressed FLT3. In contrast, mainly MLL-AF4+ B-ALL but also ETV6-RUNX1+, BCR-ABL+ or B-ALL displaying normal cytogenetics exhibited significantly higher FLT3 expression levels than normal bone marrow, supporting that aberrantly increased transcription of FLT3, rather than activating FLT3 mutations, contributes to the pathogenesis of these B-ALL. Using the median FLT3 expression as cut-off value we found that high-level FLT3 expression is associated with an extremely poor 1-year overall survival (OS; 0 vs 71%; P=0.002) and disease-free survival (DFS; 0 vs 43%; P=0.03) in MLL-AF4+ B-ALL but not in MLL-germline B-ALL. Cox regression analysis with OS/DFS as end points showed that age>14 years and high-level FLT3 expression were independent prognostic factors when all ALL patients were analyzed together. Importantly, when the MLL-AF4+ B-ALL subgroup was analyzed separately, high-level FLT3 expression was the only independent prognostic factor for OS and treatment outcome. These findings indicate that high FLT3 expression identifies MLL-AF4+ ALL patients at very high risk of treatment failure and poor survival, emphasizing the value of ongoing/future clinical trials for FLT3 inhibitors.

Probable interaction between trazodone and carbamazepine.

The need to maintain long-term treatment of chronic pathologies makes the appearance of interactions possible when such therapies incorporate other drugs to deal with the aggravation of the same or other intercurrent pathologies. A case is presented in which the addition of trazodone to a chronic treatment with carbamazepine (CBZ) is associated with symptoms typical for intoxication by this antiepileptic, accompanied by a raised serum concentration. When the trazodone was suspended, these symptoms lessened and the concentration of CBZ decreased progressively, suggesting a probable interaction between the 2 drugs.

Assessment of cellular and plasma oxidative stress in SAHS patients before and after continuous positive airway pressure treatment.

BACKGROUND: Several indirect techniques have been used for measuring oxidative stress in sleep apnoea-hypopnoea syndrome (SAHS) patients. The purpose of this study was to find out if both, cellular or plasma oxidative stress evaluations, are good estimators to assess oxidative stress in SAHS patients before and after one month's CPAP treatment. METHODS: The study included 28 SAHS patients requiring CPAP treatment and 15 healthy control subjects. Plasma and serum oxidative stress biomarkers (lipid peroxidation, total antioxidant capacity, and the activities of glutathione peroxidase, glutathione reductase, glutathione s-transferase, catalase and superoxide dismutase) were measured using commercial kits. Cellular oxidative stress biomarkers (mitochondrial membrane potential, intracellular glutathione, superoxide anion, and hydrogen peroxide) were analysed by flow cytometry. The Wilcoxon test for paired samples was used to compare oxidative stress and clinical parameters in patients before and after treatment with CPAP. Relationships in oxidative stress markers between controls and patients were analyzed using the Mann-Whitney U test. The Spearman correlation coefficient was calculated to estimate the linear correlations between variables. RESULTS: Oxidative stress was notably decreased after CPAP. Before CPAP, SAHS severity positively correlated with hydrogen peroxide levels, while negative correlations were observed between SAHS severity and plasma TAC in patients. Also, plasma glutathione peroxidase activity negatively correlated with cellular superoxide anion, while plasma superoxide dismutase activity positively correlated with intracellular glutathione. After CPAP, plasma TAC and glutathione peroxidase activity negatively correlated with cellular hydrogen peroxide and superoxide anion. CONCLUSIONS: In conclusion, this study seems to confirm that plasma and cellular assessment reflect, in the same way, the oxidative stress status of the studied patients. Furthermore, plasma total antioxidant capacity as well as cellular hydrogen peroxide levels can be good markers for assessing oxidative stress in SAHS patients.

Diagnóstico prenatal del síndrome de Meckel Gruber / Prenatal diagnosis of Meckel Gruber syndrome

El síndrome de Meckel Gruber viene definido por latriada malformativa: encefalocele, displasia renal quística ypolidactilia(AU)

Meckel Gruber syndrome is defined by encephalocele,cystic dysplasia of the kidneys and polydactyly(AU)

Quiste funicular gigante / Giant umbilical cord

Los quistes de cordón umbilical son una entidad relativamentefrecuente. Normalmente su evolución es favorable,presentan crecimiento importante en muy pocas ocasiones.Presentamos 3 casos de quistes que afectaron al cordónumbilical, con importante crecimiento y mal resultado perinata(AU)

Umbilical cord cysts are relatively frequent conditions.They Normally present favorable evolution, andimportant cyst-growth is an uncommon feature. We presentthree cases of cysts that affected the umbilical cord,with important growth and adverse perinatal outcome(AU)

Evolution of bone mineral density in AIDS patients on treatment with zidovudine/lamivudine plus abacavir or lopinavir/ritonavir.

OBJECTIVES: The aim of the study was to determine the factors that may contribute to decreases in bone mineral density (BMD) in patients with AIDS. METHODS: This was a prospective, non-randomized study. Dual X-ray absorptiometry (DXA) was used to determine the BMD of the lumbar spine, femoral neck and distal radius in treatment-naïve HIV-infected male patients with AIDS before and after 1 year of treatment with zidovudine (ZDV)/lamivudine (3TC) plus abacavir (ABC) or lopinavir/ritonavir (LPV/r). RESULTS: Basal DXA was performed in 50 patients with CD4 counts <200 cells/microL and/or any AIDS-defining condition. Thirty-two patients completed 1 year with full adherence (17 on ABC and 15 on LPV/r) and a second DXA was then performed. At baseline, 19% had osteopenia at the lumbar spine and 19% at the femoral neck. Low body weight was related to low BMD. After 48 weeks, BMD loss was significant at the three locations. The percentage of BMD loss at the femoral neck tended to be greater in the lopinavir group (5.3 vs. 3.2%, P=0.058). The differences became significant at the lumbar spine (5.7 vs. 2.7%, P=0.044). In the multivariate analysis, the treatment with LPV/r remained associated with bone loss at the lumbar spine. CONCLUSIONS: Osteopenia is frequent in treatment-naïve HIV-infected men with AIDS. Bone loss is higher with LPV/r-based regimens compared with triple nucleoside reverse transcriptase inhibitors.

4ª Reunión de expertos Internacional en SIDA. Sydney, 22-25 de Julio de 2007 / 4th International Aids Conference on Hiv pathogenesis treatment and prevention. Sydney, 22-25 July 2007

El objetivo de este trabajo es resumir parte de las aportacionesde la cuarta reunión de expertos internacional en SIDA (1)celebrada en Sydney (Australia) en el mes de Julio, que, desdeel punto de vista del inmunólogo, son importantes en el estudiode la patogénesis por el VIH

The aim of this report is to summarize some of the presentationsfrom the 4th international meeting of the experts in AIDS,held in Sydney (Australia) in the last July, that, from an immunologicalpoint of view, are important in the study of HIV pathogenesis

[Can treatment associated with ticlopidine and nifedipine increase serum levels of phenobarbital?]. / ¿Puede el tratamiento asociado con ticlopidina y nifedipina aumentar los niveles séricos de fenobarbital?

INTRODUCTION: We report a case in which the association between ticlopidine, nifedipine and phenobarbital was linked with a higher than expected phenobarbital concentration in serum, which suggested a possible interaction between these drugs. CASE REPORT: A 67 year old male who received treatment with phenobarbital, digoxin, nifedipine, ticlopidine, paroxetine and clorazepate dipotassium. The first control of the level of phenobarbital in serum was performed without any symptoms or signs of toxicity or ineffectiveness. A phenobarbital concentration in serum of 21.4 mg/L was obtained, with a serum level/dosage ratio of 16.7. DISCUSSION: The serum level/dosage ratio of phenobarbital that was found in this case is almost twice as high as expected. In the absence of other factors that can explain this finding, we believe that two drugs (ticlopidine and nifedipine) may be involved in an interaction with phenobarbital. CONCLUSIONS: The high value of the serum level/dosage ratio that was found makes it advisable to monitor the concentrations of phenobarbital in serum in treatment associated with ticlopidine or nifedipine, especially when adjusting the dosage, beginning or ending treatment with these drugs.

¿Puede el tratamiento asociado con ticlopidina y nifedipina aumentar los niveles séricos de fenobarbital? / Can treatment associated with ticlopidine and nifedipine increase serum levels of phenobarbital?

Introducción. Describimos un caso en que la asociación de ticlopidina, nifedipina y fenobarbital se asoció con una concentración sérica de fenobarbital mayor que la previsible, que sugirió una posible interacción entre estos fármacos. Caso clínico. Varón de 67 años en tratamiento con fenobarbital, digoxina, nifedipina, ticlopidina, paroxetina y cloracepato dipotásico. Se realizó el primer control del nivel sérico de fenobarbital, sin ningún síntoma o signo de toxicidad o ineficacia. Se obtuvo una concentración sérica de fenobarbital de 21,4 mg/L, con un índice nivel sérico/dosis de 16,7. Discusión. El índice nivel sérico/dosis de fenobarbital que se encontró en este caso es casi el doble que el previsible. En ausencia de otros factores que puedan explicar este resultado, creemos que dos fármacos (ticlopidina y nifedipina) pueden estar implicados en una interacción con fenobarbital. Conclusiones. El alto valor del índice nivel sérico/dosis que se encontró hace aconsejable monitorizar las concentraciones séricas de fenobarbital en el tratamiento asociado con ticlopidina o nifedipina, especialmente al ajustar las dosis, iniciar o suspender el tratamiento con estos fármacos (AU)

Introduction. We report a case in which the association between ticlopidine, nifedipine and phenobarbital was linked with a higher than expected phenobarbital concentration in serum, which suggested a possible interaction between these drugs. Case report. A 67-year-old male who received treatment with phenobarbital, digoxin, nifedipine, ticlopidine, paroxetine and clorazepate dipotassium. The first control of the level of phenobarbital in serum was performed without any symptoms or signs of toxicity or ineffectiveness. A phenobarbital concentration in serum of 21.4 mg/L was obtained, with a serum level/dosage ratio of 16.7. Discussion. The serum level/dosage ratio of phenobarbital that was found in this case is almost twice as high as expected. In the absence of other factors that can explain this finding, we believe that two drugs (ticlopidine and nifedipine) may be involved in an interaction with phenobarbital. Conclusions. The high value of the serum level/dosage ratio that was found makes it advisable to monitor the concentrations of phenobarbital in serum in treatment associated with ticlopidine or nifedipine, especially when adjusting the dosage, beginning or ending treatment with these drugs (AU)

[Possible gabapentin phenytoin interaction]. / Posible interacción gabapentina fenitoína.

INTRODUCTION: We report a possible case of gabapentin induced phenytoin toxicity. CASE REPORT: White man, 26 years old, chronically treated with phenytoin (for the past 4 years) and gabapentin (for the past 17 months). He was seen after complaining of dysarthria, ataxia and vertigo for the past 3 months, although having noted slight dizziness and a general, though undefined, indisposition from the start of taking gabapentin. The total and free serum levels of phenytoin found were clearly toxic. Gabapentin was discontinued definitively, and phenytoin for the next 7 days. The clinical symptoms had disappeared completely and phenytoin returned to within therapeutic levels. According to the criteria of causation it can be considered a possible adverse reaction caused by phenytoin related to incorporation of gabapentin. The mechanisms of this possible drug interaction are discussed, with emphasis on cytochrome P450 metabolism. CONCLUSION: The present case is a warning of the possible interaction of a drug (gabapentin) not contemplated when starting or when monitoring an antiepileptic treatment.

Posible interacción gabapentina-fenitoína / Possible gabapentin-phenytoin interaction

Introducción. Se presenta un caso de toxicidad por fenitoína posiblemente inducida por gabapentina. Caso clínico. Varón de raza blanca, 26 años, en tratamiento crónico con fenitoína (desde cuatro años antes) y gabapentina (desde hace 17 meses), que acude a la consulta por un cuadro de disartria, ataxia y vértigo desde hacía tres meses, aunque notaba mareos ligeros y malestar general impreciso desde que comenzó a tomar gabapentina. Los niveles séricos de fenitoína total y libre fueron claramente tóxicos. Se suspendió definitivamente la gabapentina y, durante siete días, la fenitoína. Los síntomas clínicos que motivaron la consulta desaparecieron completamente y los niveles de fenitoína disminuyeron hasta valores incluidos dentro del intervalo terapéutico. En relación a la causalidad de esta intoxicación, se puede considerar una posible reacción adversa causada por fenitoína relacionada con la asociación de gabapentina al tratamiento. Se discuten los mecanismos implicados en esta posible interacción, con énfasis en el metabolismo por el citocromo P450. Conclusiones. El presente caso alerta sobre la posible interacción de un fármaco, la gabapentina, en la cual no se piensa cuando se instaura o se hace el seguimiento de un tratamiento antiepiléptico (AU)

A column study of soil contamination by lead: influence of pH and carbonate content. II. Mathematical model.

A mathematical model is used for the interpretation of the results from earlier experimental studies in lab-scale columns on the contamination of a carbonatic soil with lead. Local equilibrium conditions suffice to reproduce the experimental curves for every pH value of the influent contaminant solution and carbonate content of the soils essayed, but heterogeneous contact between the aqueous and solid phase should be included. This heterogeneous contact is responsible for the important tailing effects observed, and is difficult to estimate even for the lab conditions. Then, important uncertainties should be accepted both for risk assessment and in situ remediation feasibility studies.