Paciente con síndrome de platipnea ortodesoxia / Patients with platypnea-orthodeoxia syndrome

Resumen. El síndrome platipnea-ortodesoxia (SPO) se caracteriza por disnea e hipoxemia en ortostatismo que remite al adoptar el decúbito supino. Las causas pueden ser cardíacas o pulmonares. Las cardíacas se deben a un circuito derecha- izquierda que se hace más evidente al incorporarse, cuando aumenta la cantidad de sangre desoxigenada que confluye a la circulación sistémica. Las causas pulmonares se deben a un circuito vascular (fístulas arteriovenosas pulmonares o síndrome hepatopulmonar), cuando en ortostatismo la gravedad aumenta el flujo en las bases pulmonares, o a un circuito parenquimatoso (enfisema pulmonar, neumonectomias, embolismos pulmonares o síndrome de distrés respiratorio del adulto), si la afectación es predominante en bases, al incrementarse el espacio muerto por hematosis ineficaz. El SPO es un fenómeno más común de lo que parece, y su diagnóstico ha aumentado, no sólo por la mejoría de las técnicas diagnósticas, sino porque se piensa en él y se incluye en los diagnósticos diferenciales (AU)

Abstract: Platypnea-orthodeoxia Syndrome (POS) consists in the presence, of dyspnea and hypoxemia in orthostatism that submit in recumbence. Its causes can be either cardiac or pulmonary. In the first case it is due to a right to left shunt which increases in orthostatism, causing more deoxygenated blood to enter the systemic circulation. If the origin is pulmonar it can happen in vascular shunt (arterious venous pulmonary fistulas and hepatopulmonary syndrome) where gravity increases the blood flow to the bases; or it can happen in parenchimal shunts (pulmonary emphysema, pneumonectomy, pulmonary embolism or adult respiratory distress syndrome) if the pulmonar bases are particularly affected increasing the dead space because of inefficient hematosis. This syndrome is more diagnosed due not only to the improvement of the techniques but also to its inclusion within the different and possible diagnosis (AU)

Factors that motivate and hinder blood donation in Greece.

Donations in Greece are insufficient to cover the high transfusion needs arising from large numbers of thalassaemia and sickle cell anaemia patients and the implementation of new surgical techniques. Efforts to achieve self-sufficiency, and to render blood supplies safer and manageable must focus on recruiting and retaining more volunteer donors and on converting the large pool of replacement donors. The aim of the study was to gain insight into public perception regarding the risks of donation and transfusion and to identify the factors that would motivate more people in Greece to regularly donate blood. Questionnaires were distributed to 1,600 donors at the blood bank and visitors to hospitals at 11 locations across the country. Data on demographics, donation behaviour, incentives, risk perception and attitudes towards donation and transfusion were analysed separately for volunteer and replacement donors and non-donors. The results showed that women and young people donate the least in Greece. Also, many donors do not donate because they are not reminded to. A small percentage of donors confessed to having concealed part of the truth to background questions. Overall, incentives to donate were considered important and included future availability of blood for self or family, paid leave from work and free blood tests. Recruitment and retention efforts should include better communication with current donors, and raising awareness among eligible donors. Staff should be educated in soliciting information from potential donors, and incentives should be better aligned to avoid conflict with ethical values and ensure honesty in the prescreening process.

Long-term remission of recalcitrant tumour-stage mycosis fungoides following chemotherapy with pegylated liposomal doxorubicin.

Advanced stage mycosis fungoides (MF) generally has a poor prognosis, and currently there is no standard treatment available. Here we report the case of a young woman with recalcitrant tumour-stage MF (T3, stage IIb) whose disease was unresponsive to several therapeutic modalities, but who has showed sustained clinical response to pegylated liposomal doxorubucin. No severe infectious complications have been observed. The use of this drug in tumour-stage MF should be investigated further.

Development of CLL in individuals with mild lymphocytosis, without bone marrow infiltration, but with evidence of a monoclonally expanded population in peripheral blood.

Mild lymphocytosis (< 10 x 10(9)/L) is a common finding in routine blood tests. When it persists, it raises the question of whether this disorder is an early manifestation of chronic lymphocytic leukemia (CLL). If it is accompanied by bone marrow infiltration, it can be safely considered as a sign of CLL. The aim of this study was to analyze retrospectively the usefulness of immunophenotyping and immunogenotyping for early detection of lymphocyte clonality in ambiguous cases of lymphocytosis without bone marrow infiltration. Twenty-six healthy individuals, 47 to 77 years old, with an absolute lymphocyte count (ALC) at the "onset" of the disorder between 4 x 10(9)/L and 9 x 10(9)/L, without marrow infiltration, were studied and followed for a period of 31 to 51 months. CD19, CD20, CD5, CD2, CD4, CD8 surface markers and amplification of the Ig heavy chain CDR-3 locus were used for immunophenotypic and genotypic analysis, respectively. Our studies indicate that immunophenotyping alone is sufficient and superior to CDR-3 locus amplification for the early detection of lymphocyte clonality in peripheral blood. Furthermore, the high frequency of CLL development in individuals with established monoclonality strongly suggests that patients with mild borderline lymphocytosis, even without bone marrow infiltration, have to be followed for progression to CLL and its possible complications.

Efficacy of vancomycin plus tobramycin as antiperitonitis regimen for patients on CAPD.

From October 1985 to August 1989, 55 episodes of peritonitis were treated with intraperitoneal (i.p.) use of Vancomycin (V) and Tobramycin (T), in 35 patients (18 males, 17 females). After three rapid IL peritoneal exchanges, the pts received i.p. loading dose of V500 mg/L and an intramuscular dose of T 1.7 mg/Kg, followed by four IL exchanges, with addition of V15 mg/L and T8 mg/L. The length of treatment was 10 days for all pts. The continued administration of V or T as the simple antibiotic regimen was based on the antibiogram, while the combination of both antibiotics was used in negative cultures. Recurrence of peritonitis was seen in 3 episodes (5.4%). No side effects were seen during the therapy. These results indicate that the i.p. use of Vancomycin plus Tobramycin are an appropriate antiperitonitis regimen in the treatment of CAPD peritonitis.

In vivo recording of blood velocity profiles and studies in vitro of profile alterations induced by known stenoses.

Recordings of blood velocity profiles and their behavior in the time domain in some peripheral human vessels (carotid arteries and limb vessels) are reported. Measurements have been obtained with a pulsed ultrasonic instrument based on the analysis of the cross-correlation function of blood-diffused echoes. The alterations of blood velocity profiles and of the velocity in the time domain, induced by known stenosis, have been studied in vitro as a function of the distance between stenosis and measuring point, and the position of the sample volume along the diameter. These studies may be useful for a better comprehension of blood velocity measurements made with ultrasound equipment for clinical noninvasive diagnostic purposes.