Consensus of experts from the Spanish Pharmacogenetics and Pharmacogenomics Society and the Spanish Society of Medical Oncology for the genotyping of DPYD in cancer patients who are candidates for treatment with fluoropyrimidines

5-Fluorouracil (5-FU) and oral fluoropyrimidines, such as capecitabine, are widely used in the treatment of cancer, especially gastrointestinal tumors and breast cancer, but their administration can produce serious and even lethal toxicity. This toxicity is often related to the partial or complete deficiency of the dihydropyrimidine dehydrogenase (DPD) enzyme, which causes a reduction in clearance and a longer half-life of 5-FU. It is advisable to determine if a DPD deficiency exists before administering these drugs by genotyping DPYD gene polymorphisms. The objective of this consensus of experts, in which representatives from the Spanish Pharmacogenetics and Pharmacogenomics Society and the Spanish Society of Medical Oncology participated, is to establish clear recommendations for the implementation of genotype and/or phenotype testing for DPD deficiency in patients who are candidates to receive fluoropyrimidines. The genotyping of DPYD previous to treatment classifies individuals as normal, intermediate, or poor metabolizers. Normal metabolizers do not require changes in the initial dose, intermediate metabolizers should start treatment with fluoropyrimidines at doses reduced to 50%, and poor metabolizers are contraindicated for fluoropyrimidines.

Consensus of experts from the Spanish Pharmacogenetics and Pharmacogenomics Society and the Spanish Society of Medical Oncology for the genotyping of DPYD in cancer patients who are candidates for treatment with fluoropyrimidines.

5-Fluorouracil (5-FU) and oral fluoropyrimidines, such as capecitabine, are widely used in the treatment of cancer, especially gastrointestinal tumors and breast cancer, but their administration can produce serious and even lethal toxicity. This toxicity is often related to the partial or complete deficiency of the dihydropyrimidine dehydrogenase (DPD) enzyme, which causes a reduction in clearance and a longer half-life of 5-FU. It is advisable to determine if a DPD deficiency exists before administering these drugs by genotyping DPYD gene polymorphisms. The objective of this consensus of experts, in which representatives from the Spanish Pharmacogenetics and Pharmacogenomics Society and the Spanish Society of Medical Oncology participated, is to establish clear recommendations for the implementation of genotype and/or phenotype testing for DPD deficiency in patients who are candidates to receive fluoropyrimidines. The genotyping of DPYD previous to treatment classifies individuals as normal, intermediate, or poor metabolizers. Normal metabolizers do not require changes in the initial dose, intermediate metabolizers should start treatment with fluoropyrimidines at doses reduced to 50%, and poor metabolizers are contraindicated for fluoropyrimidines.

Interactive impacts of boron and organic amendments in plant-soil microbial relationships.

Water shortage and low organic carbon content in soil limit soil fertility and crop productivity. The use of desalinated seawater is increasing as an alternative source of irrigation water. However, it has a high boron (B) content that could cause toxicity in the plant-soil microbial system. Here, we evaluated the responses of the soil microbiota and lemon trees to 3 irrigation B doses (0.3, 1, and 15 mg L-1) under two types of soil management (conventional, CS; and organic, OS) in a 180-days pot experiment. High B doses promoted B accumulation in soil, reaching harmful concentrations that affected soil biodiversity. Our results suggest a close interaction between B and organic labile fractions that increased B availability in soil solution. Besides, B addition to soil impacted on microbial biomass. The bacterial community showed sensitivity to the B dose. Organic amendment did not increase B soil adsorption but it favored B plant uptake. The highest B dose had a detrimental impact on plant physiology, finally resulting lethal for the plants. Our study provides a comprehensive assessment of the microbes-plant interactions in soils irrigated with water with high B content. This will be fundamental in the design of future fertirrigation strategies.

Advanced-stage mycosis fungoides: role of the signal transducer and activator of transcription 3, nuclear factor-κB and nuclear factor of activated T cells pathways.

BACKGROUND: The malignant mechanisms that control the development of cutaneous T-cell lymphoma (CTCL) are beginning to be identified. Recent evidence suggests that disturbances in specific intracellular signalling pathways, such as RAS-mitogen-activated protein kinase, T-cell receptor (TCR)-phospholipase C gamma 1 (PLCG1)-nuclear factor of activated T cells (NFAT) and Janus kinase (JAK)-signal transducer and activator of transcription (STAT), may play an essential role in the pathogenesis of CTCL. OBJECTIVES: To investigate the mechanisms controlling disease development and progression in mycosis fungoides (MF), the most common form of CTCL. METHODS: We collected 100 samples that were submitted for diagnosis of, or a second opinion regarding, MF between 2001 and 2018, 80% of which were in the early clinical stages of the disease. Formalin-fixed paraffin-embedded tissues were used for histological review and to measure the expression by immunohistochemistry of surrogate markers of activation of the TCR-PLCG1-NFAT, JAK-STAT and NF-κB pathways. Folliculotropism and large-cell transformation were also examined. RESULTS: NFAT and nuclear factor kappa B (NF-κB) markers showed a comparable activation status in early and advanced stages, while STAT3 activation was more frequent in advanced stages and was associated with large-cell transformation. Consistently with this observation, STAT3 activation occurred in parallel with MF progression in two initially MF-negative cases. A significant association of NFAT with NF-κB markers was also found, reflecting a common mechanism of activation in the two pathways. Genomic studies identified nine mutations in seven genes known to play a potential role in tumorigenesis in T-cell leukaemia/lymphoma, including PLCG1, JAK3 and STAT3, which underlies the activation of these key cell-survival pathways. A higher mutational allele frequency was detected in advanced stages. CONCLUSIONS: Our results show that STAT3 is activated in advanced cases and is associated with large-cell transformation, while the activation of NFAT and NF-κB is maintained throughout the disease. These findings could have important diagnostic and therapeutic implications. What's already known about this topic? Mycosis fungoides is characterized by a clonal expansion of T cells in the skin. The mechanisms controlling disease development and progression are not fully understood. What does this study add? An association of the nuclear factor of activated T cells and nuclear factor kappa B pathways was found, which could reflect a common mechanism of activation. These pathways were activated in early and advanced stages at the same level. Signal transducer and activator of transcription 3 activation was associated with large-cell transformation and was more frequent in advanced stages. A genomic analysis of cutaneous T-cell lymphoma-associated genes was performed. Nine mutations were detected. What is the translational message? These results could have important implications for the treatment of MF in the near future.

When drought meets forest management: Effects on the soil microbial community of a Holm oak forest ecosystem.

The growth and survival of plants in semiarid Mediterranean forests can be improved through the benefits conferred by thinning, a forest management practice that removes trees and reduces the competition between the remaining ones. Here, we evaluate the impacts of induced drought (the exclusion of 25% of the natural rainfall for 5 years) and thinning, and their interaction, with the objective of determining whether the thinning of Holm oak (Quercus ilex L.) modulates the resistance of the soil microbial community to drought. Sequencing of 16S rRNA and ITS amplicons revealed that drought, thinning, and their interaction influenced the composition of the bacterial community, while the fungal community was exclusively affected by thinning. Thinning consisted of the removal of the aboveground parts of the Holm oak trees, which were thereafter left in forest stand. Thinning contributed to the C and N contents, with parallel increases in microbial biomass, particularly in summer. Drought increased the amounts of total organic C and total N, likely due to the reduced enzyme activities. Indeed, the composition of the bacterial community was modulated primarily by the indirect and long-term effects of drought - the accumulation of soil organic matter - rather than by the direct effect of the lower water content imposed by the drought treatments. Thinning under drought conditions did not increase soil organic C (SOC) content. However, the resistance of the soil microbial community to drought was fostered by thinning, particularly at the functional level, as indicated by the enzyme activities related to C, N and P cycles. These responses were associated to variations in the composition of the microbial communities in thinned, drought-exposed plots, in comparison to unthinned, drought-exposed plots. In conclusion, the interaction between forest management and drought influenced the soil microbial community of a Holm oak-dominated Mediterranean ecosystem.

Immune-related adverse events predict the therapeutic efficacy of anti-PD-1 antibodies in cancer patients.

BACKGROUND: Cancer immune therapy has shown remarkable benefit in the treatment of a range of cancer types, although it may initiate autoimmune-related disorders in some patients. We have attempted to establish whether the incidence of irAEs after the use of anti-PD-1 antibodies nivolumab or pembrolizumab in advanced malignancies is associated with anti-PD-1 treatment efficacy. PATIENTS AND METHODS: We studied patients treated with single-agent nivolumab or pembrolizumab for advanced cancer. irAEs (immune-related adverse events) were identified clinically and graded as per the Common Terminology Criteria for Adverse Events version 4.0. Efficacy was evaluated with objective response rate (ORR, immune-Response Evaluation Criteria in Solid Tumours [RECIST] criteria) progression-free survival (PFS) and overall survival (OS). Tests were performed to determine the association between irAEs and ORR, PFS or OS. RESULTS: We identified 106 patients. Primary diagnoses were lung cancer (n = 77), melanoma (n = 8), head and neck carcinoma (n = 7), renal carcinoma (n = 5), Hodgkin's lymphoma (n = 3), urothelial carcinoma (n = 3) and gallbladder adenocarcinoma, hepatocellular carcinoma and Merkel cell carcinoma (n = 1 each). IrAEs were observed in 40 patients (37.7%). The most frequent irAEs were hypothyroidism (n = 15), nephritis (n = 5) and hyperthyroidism (n = 4). Objective response was observed in 44 patients (41.5%), and median PFS was 5.5 months (0.5-31 months). Thirty-three of the 40 patients with irAEs had objective response (82.5%) in contrast with 11 of the 66 cases without irAEs (16.6%) (OR 23.5, P < 0.000001). PFS in patients with irAEs was 10 months and 3 months in those without irAEs (HR 2.2, P = 0.016). OS in patients with irAEs was 32 months and 22 in those without irAEs, without statistically significant differences. CONCLUSION: In advanced cancer treated with single-agent anti-PD-1 antibodies, patients with irAEs showed a markedly improved efficacy over patients without irAEs (ORR of 82.5% and PFS of 10 months vs ORR of 16.6% and PFS of 3 months). Future studies of anti-PD-1 immune-therapy should address this association to explore the underlying biological mechanisms of efficacy.

Diagnóstico molecular de cavernomatosis cerebral / Molecular diagnosis in cerebral cavernous malformations

Introducción: Las malformaciones cavernosas cerebrales (CCM; OMIM 116860) son engrosamientos cavernosos vasculares sin intervención del parénquima cerebral con una prevalencia estimada en la población general del 0,1-0,5%. La cavernomatosis cerebral presenta un patrón de herencia autosómico dominante con penetrancia clínica y radiológica incompleta. Tres genes se han asociado al desarrollo de lesiones: CCM1/KRIT1, CCM2/MGC4607 y CCM3/PDCD10. Desarrollo: La mutación responsable no es detectada en un alto porcentaje de casos, por lo que nuevos enfoques son necesarios para su detección. En esta revisión se analizan las técnicas actualmente utilizadas y las posibles mutaciones o variantes que pueden ser detectadas en un laboratorio de genética molecular o biología molecular. Asimismo, se analizan alternativas que pueden ser abarcadas para la detección de mutaciones en aquellos pacientes en los que los estudios hayan resultado negativos. Conclusiones: El diagnóstico molecular de la cavernomatosis cerebral debe incluir al menos la detección del número de copias y la secuenciación de los genes CCM. Finalmente, ofrecer un adecuado consejo genético es crucial para proporcionar información y apoyo a los pacientes y familias que padecen la enfermedad (AU)

Introduction: Cerebral cavernous malformations (CCMs; OMIM 116860) are enlarged vascular cavities without intervening brain parenchyma whose estimated prevalence in the general population is between 0.1% and 0.5%. Familial CCM is an autosomal dominant disease with incomplete clinical and radiological penetrance. Three genes have been linked to development of the lesions: CCM1/KRIT1, CCM2/MGC4607, and CCM3/PDCD10. Development: : The aetiological mutation is not detected in a large percentage of cases and new approaches are therefore needed. The aim of this review is to analyse current molecular techniques and the possible mutations or variations which can be detected in a molecular genetics or molecular biology laboratory. Likewise, we will analyse other alternatives that may help detect mutations in those patients showing negative results. Conclusions: A molecular diagnosis of cerebral cavernous malformations should provide at least the copy number variation and sequencing of CCM genes. In addition, appropriate genetic counselling is a crucial source of information and support for patients and their relatives (AU)

Lipoidoproteinosis o enfermedad de Urbach-Wiethe: a propósito de un nuevo caso con afectación cerebral / Lipoid proteinosis or Urbach-Wiethe disease: description of a new case with cerebral involvement

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Performance of the clinical index of stable febrile neutropenia (CISNE) in different types of infections and tumors

Purpose. The clinical index of stable febrile neutropenia (CISNE) can contribute to patient safety without increasing the complexity of decision-making. However, febrile neutropenia (FN) is a diverse syndrome. The aim of this analysis is to assess the performance of CISNE according to the type of tumor and infection and to characterize these patients. Methods. We prospectively recruited 1383 FN episodes in situations of apparent clinical stability. Bonferroni-adjusted z tests of proportions were used to assess the association between the infections suspected at the time of onset and the type of tumor with the risk of serious complications and mortality. The performance of CISNE was appraised in each category using the Breslow-Day test for homogeneity of odds ratios and Forest Plots. Results. 171 patients had a serious complication (12.3 %, 95 % confidence interval 10.7-14.2 %). The most common initial assumptive diagnoses were: fever without focus (34.5 %), upper respiratory infection (14.9 %), enteritis (12.7 %), stomatitis (11.8 %), and acute bronchitis (10.7 %). Lung and breast were the most common tumors, accounting for approximately 56 % of the series. The distribution of complications, mortality, and bacteremia varies for each of these categories. However, Breslow-Day tests indicate homogeneity of the odds ratio of the dichotomized CISNE score to predict complications in all infection and tumor subtypes. Conclusion. Despite FN’s clinical and microbiological heterogeneity, the CISNE score was seen to be consistent and robust in spite of these variations. Hence, it appears to be a safe tool in seemingly stable FN (AU)

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Molecular diagnosis in cerebral cavernous malformations. / Diagnóstico molecular de cavernomatosis cerebral.

INTRODUCTION: Cerebral cavernous malformations (CCMs; OMIM 116860) are enlarged vascular cavities without intervening brain parenchyma whose estimated prevalence in the general population is between 0.1% and 0.5%. Familial CCM is an autosomal dominant disease with incomplete clinical and radiological penetrance. Three genes have been linked to development of the lesions: CCM1/KRIT1, CCM2/MGC4607, and CCM3/PDCD10. DEVELOPMENT: The aetiological mutation is not detected in a large percentage of cases and new approaches are therefore needed. The aim of this review is to analyse current molecular techniques and the possible mutations or variations which can be detected in a molecular genetics or molecular biology laboratory. Likewise, we will analyse other alternatives that may help detect mutations in those patients showing negative results. CONCLUSIONS: A molecular diagnosis of cerebral cavernous malformations should provide at least the copy number variation and sequencing of CCM genes. In addition, appropriate genetic counselling is a crucial source of information and support for patients and their relatives.

Performance of the clinical index of stable febrile neutropenia (CISNE) in different types of infections and tumors.

PURPOSE: The clinical index of stable febrile neutropenia (CISNE) can contribute to patient safety without increasing the complexity of decision-making. However, febrile neutropenia (FN) is a diverse syndrome. The aim of this analysis is to assess the performance of CISNE according to the type of tumor and infection and to characterize these patients. METHODS: We prospectively recruited 1383 FN episodes in situations of apparent clinical stability. Bonferroni-adjusted z tests of proportions were used to assess the association between the infections suspected at the time of onset and the type of tumor with the risk of serious complications and mortality. The performance of CISNE was appraised in each category using the Breslow-Day test for homogeneity of odds ratios and Forest Plots. RESULTS: 171 patients had a serious complication (12.3 %, 95 % confidence interval 10.7-14.2 %). The most common initial assumptive diagnoses were: fever without focus (34.5 %), upper respiratory infection (14.9 %), enteritis (12.7 %), stomatitis (11.8 %), and acute bronchitis (10.7 %). Lung and breast were the most common tumors, accounting for approximately 56 % of the series. The distribution of complications, mortality, and bacteremia varies for each of these categories. However, Breslow-Day tests indicate homogeneity of the odds ratio of the dichotomized CISNE score to predict complications in all infection and tumor subtypes. CONCLUSION: Despite FN's clinical and microbiological heterogeneity, the CISNE score was seen to be consistent and robust in spite of these variations. Hence, it appears to be a safe tool in seemingly stable FN.

Role of antiphospholipid score and anti-ß2-glycoprotein I Domain I autoantibodies in the diagnosis of antiphospholipid syndrome.

BACKGROUND: Antiphospholipid syndrome (APS) is characterized by the presence circulating antiphospholipid (aPL) antibodies in patients with thrombosis or pregnancy morbidity. Recently it has been shown that multiple positive results define a higher risk of clinical manifestation in APS patients. However, utilizing combined results generates challenges for a physician. Therefore, the antiphospholipid score. (aPL-S), a new variable that encompasses all aPL assays, has been described. We analyze clinical performance of different aPL-Ss based on ELISA or chemiluminescent immunoassays (CIAs). METHODS: A total of 39 patients and 77 controls were included in this study. All patients were tested for lupus anticoagulant (LAC). In addition, IgM/IgG anticardiolipin (aCL) and anti-ß2 glycoprotein 1 (aß2GP1) autoantibodies were tested by ELISA and CIA. Anti-ß2GP1 Domain 1 IgG (D1) autoantibodies were tested by CIA. Three aPL-Ss were calculated (ELISA, CIA and CIA with D1 instead of ß2GP1 IgG) using the Otomo equation: aPL-S=5×exp([OR]-5)/4. RESULTS: IgG assays showed a good correlation while IgM assays showed moderate correlation. The relative risk of having clinical manifestation of APS was calculated for each aPL test. All three aPL-Ss were higher in individuals with thrombosis or pregnancy morbidity than in those without APS manifestations (p<0.001) and the prevalence of APS manifestations increased with increasing aPL-Ss. CONCLUSION: The CIAs are comparable with the ELISAs for the detection of aPL antibodies. aß2GPI-D1 antibodies seem to represent a strong indicator for clinical manifestations of APS. Any of the aPL-Ss studied represents a useful quantitative index for APS diagnosis and could be helpful to physicians in managing APS.

Suprarrenalectomía laparoscópica transperitoneal / Transperitoneal Laparoscopic Adrenalectomy

Objetivos: Presentar nuestros resultados en suprarrenalectomía laparoscópica transperitoneal tras haber realizado 70 procedimientos. Material y métodos: Entre julio de 2002 y diciembre de 2010, 70 pacientes fueron sometidos a suprarrenalectomía laparoscópica transperitoneal con los siguientes diagnósticos: 22 de síndrome de Conn, 18 adenomas no funcionantes, 10 casos de síndrome de Cushing, 7 feocromocitomas, 4 mielolipomas, 6 casos de metástasis tras tratamiento de neoplasia primaria no adrenal, un ganglioneuroma, un hematoma de glándula suprarrenal y un carcinoma suprarrenal. Describimos el tamaño, el tiempo quirúrgico y de hospitalización, la pérdida sanguínea y la necesidad de transfusión, las complicaciones quirúrgicas y la tasa de conversión a cirugía abierta. Resultados: De los 70 pacientes 35 fueron hombres y otras 35 mujeres (1:1) con una edad media de 58,2 años (82,2 - 29,1). La localización predominante fue la izquierda (58%) frente a la derecha (42%). Con un tamaño medio de la pieza quirúrgica de 5,11cm, el tiempo quirúrgico promedio fue de 119,2 minutos (50 - 240) y el sangrado operatorio medio de 140,6 cc (30 - 800), precisando tan sólo en tres pacientes transfusión sanguínea. El período promedio para alimentación oral fue de 17 horas y la estancia media hospitalaria fue de 4,3 días (15 - 2). Como complicaciones observamos dos casos de infecciones quirúrgicas, un íleo paralítico prolongado, un caso de laceración esplénica y otro de perforación intestinal; ambos precisaron reconversión a cirugía abierta (4,28%). Conclusiones: La suprarrenalectomía por vía laparoscópica es una técnica quirúrgica segura, con un bajo porcentaje de complicaciones y que precisa breve estancia hospitalaria. La elección de esta vía de acceso dependerá de la experiencia individual del cirujano, teniendo en cuenta tanto la etiología como el tamaño de la lesión en cada caso (AU)

Objectives: To present our results with transperitoneal laparoscopic adrenalectomy after completion of 70 procedures. Material and Methods: Between July 2002 and December 2010, transperitoneal laparoscopic adrenalectomy was performed in 70 patients with the following diagnoses: Conn syndrome (22 cases), nonfunctioning adenomas (18), Cushing syndrome (10), pheochromocytomas (7), myelolipomas (4), metastasis after treatment of primary nonadrenal tumors (6), ganglioneuroma (1), adrenal gland hematoma (1) and adrenal carcinoma (1). We describe the size, surgical and hospitalization times, blood loss, need for transfusion, surgical complications and rate of conversion to open surgery. Results: Of 70 patients, 35 were men and 35 women (1:1) with a mean age of 58.2 years (range, 82.2- 29.1). The most common site was left (58%) compared to right (42%). The mean size of the surgical specimen was 5.11cm, mean surgical time was 119.2minutes (50-240) and mean operative bleeding was 140.6 (30-800) cc. Only 3 patients required blood transfusion. The mean time until oral feeding was 17hours, and the mean hospital stay was 4.3 (2-15) days. Complications included 2 cases of surgical infections, 1 of prolonged paralytic ileus, and 1 of splenic laceration and 1 of intestinal perforation which both which required reconversion to open surgery (4.28%). Conclusions: Laparoscopic adrenalectomy is a safe procedure, with a low percentage of complications and a short hospital stay. The choice of this approach will depend on the surgeon's experience with the lesion etiology and size in each case (AU)

[Transperitoneal laparoscopic adrenalectomy]. / Suprarrenalectomía laparoscópica transperitoneal.

OBJECTIVES: To present our results with transperitoneal laparoscopic adrenalectomy after completion of 70 procedures. MATERIAL AND METHODS: Between July 2002 and December 2010, transperitoneal laparoscopic adrenalectomy was performed in 70 patients with the following diagnoses: Conn syndrome (22 cases), nonfunctioning adenomas (18), Cushing syndrome (10), pheochromocytomas (7), myelolipomas (4), metastasis after treatment of primary nonadrenal tumors (6), ganglioneuroma (1), adrenal gland hematoma (1) and adrenal carcinoma (1). We describe the size, surgical and hospitalization times, blood loss, need for transfusion, surgical complications and rate of conversion to open surgery. RESULTS: Of 70 patients, 35 were men and 35 women (1:1) with a mean age of 58.2 years (range, 82.2- 29.1). The most common site was left (58%) compared to right (42%). The mean size of the surgical specimen was 5.11 cm, mean surgical time was 119.2 minutes (50-240) and mean operative bleeding was 140.6 (30-800) cc. Only 3 patients required blood transfusion. The mean time until oral feeding was 17 hours, and the mean hospital stay was 4.3 (2-15) days. Complications included 2 cases of surgical infections, 1 of prolonged paralytic ileus, and 1 of splenic laceration and 1 of intestinal perforation which both which required reconversion to open surgery (4.28%). CONCLUSIONS: Laparoscopic adrenalectomy is a safe procedure, with a low percentage of complications and a short hospital stay. The choice of this approach will depend on the surgeon's experience with the lesion etiology and size in each case.

Utilisation of citrus compost-based growing media amended with Trichodermaharzianum T-78 in Cucumismelo L. seedling production.

Two citrus composts (C1: composed of 40% citrus wastes, 20% sludge obtained from a citrus industry waste-water treatment facility and 40% green residues; C2: composed of 60% citrus wastes and 40% green residues, and no sludge) and their water extracts amended with Trichodermaharzianum T-78 (T. harzianum T-78) were assayed in order to verify if these composts could act as a partial substitute for peat-based growing media as well as enhance suppressiveness against Fusarium wilt in the production of melon (Cucumismelo L.) seedlings at greenhouse nurseries. Over a 43-day growth cycle of melon seedlings, measurements were taken of the nutriactive effect (the capability of a substrate to express additional and/or synergistic nutritional and biostimulating effects), the pathogen incidence (percentage of fresh weight loss of melon plants grown on treatments infected with Fusariumoxysporum with respect to the same treatment without inoculation of the phytopathogen) and the trend of the T.harzianum T-78 population. A nutriactive effect was observed in the tested citrus compost-based growing media (96% and 112% plant weight increase with respect to peat for C1Th and C2Th, respectively). Pathogen incidence was significantly lower in C2Th than peat (12% compared to 33%), while no difference was observed in C1Th. The T.harzianum T-78 population showed a significant decrease at the first sampling time compared to the initial quantity (from 10(6) to 10(5)CFUg(-1)), but later recovered over time. These results demonstrate that the combination of citrus compost and T.harzianum T-78 can be a viable alternative to peat and can minimise the application of chemicals necessary to control Fusarium wilt in greenhouse nurseries for melon seedling production.

Myelolipomatous adrenal masses causing Cushing's syndrome.

Adrenal myelolipomas are uncommon benign tumors, composed of mature adipose tissue and haematopoietic elements in varying proportions. They are usually asymptomatic, non-functioning adrenal incidentalomas, but there have been a few reports of myelolipomatous masses associated with adrenocortical hypersecretion. We report two cases of large mixed adrenal tumors, with heterogeneous appearance and areas of fat density in imaging techniques, and with autonomous cortisol production leading to Cushing's syndrome. Both underwent adrenalectomy and the histological study showed an adrenocortical adenoma with widespread myelolipomatous metaplasia. Hypercortisolism resolved in the one patient that could be evaluated after surgery. We review all the previous reported cases of hypercortisolism associated with adrenal myelolipomas. We also discuss the recommended diagnostic approach and therapeutic management of adrenal masses of lipomatous appearance.

Cirugía ambulatoria en un Servicio de Urología. Análisis del período 2003-2006 / Ambulatory surgery in a urology department. Analysis of the period 2003-2006

Objetivo: En la cirugía sin ingreso deberemos distinguir entre el concepto de cirugía menor ambulatoria y cirugía mayor ambulatoria. La cirugía ambulatoria, permite que el paciente no esté en el hospital más allá de unas horas, mostrando una seguridad y efectividad similar a la cirugía convencional. Evaluar los resultados de un programa de cirugía ambulatoria. Métodos: Estudio descriptivo retrospectivo de los resultados de funcionamiento de la Cirugía Ambulatoria (C.A) en un Servicio de Urología, incluyendo 4185 pacientes en un periodo de estudio de cuatro años, que comprende desde el 1 de enero del 2003 hasta el 31 de diciembre del 2006. Resultados: En el periodo de estudio el índice de sustitución global fue del 83,6%. El índice de ingresos fue del 2,5%, de los cuales la mayoría fueron ingresos precoces. Las complicaciones mayores se presentaron en 26 pacientes (0,6%), siendo la hemorragia mayor la predominante. La mayoría de las complicaciones son menores o leves, y el dolor en la zona de la herida quirúrgica es el problema encontrado con mayor frecuencia. Conclusiones: El auge y la promoción continua de la cirugía ambulatoria están más que justificadas. La alta satisfacción de los pacientes sometidos a este tipo de cirugía, con el escaso número de complicaciones registradas, nos proporcionan una valiosa herramienta de control del gasto sanitario (AU)

Objectives: When talking about day surgery we have to differentiate between minor and major ambulatory surgery. Ambulatory surgery enables the patient to stay in the hospital not more than a few hours, showing similar safety and efficacy than conventional surgery. The objective of this paper is to evaluate the results of an ambulatory surgery program. Methods: Descriptive retrospective study of the results of the Ambulatory Surgery in a Urology Department, including 4185 patients in a four-year period, from January 1st 2003 to December 31st 2006. Results: In the study period the global substitution rate was 83.6%. The hospital admission rate was 2.5%, most of which were early admissions. Major complications appeared in 26 patients (0.6%), being major bleeding the predominant one. Most complications were minor or mild, and pain at the site of the surgical wound was the most frequent problem found. Conclusions: The increase and continuous promotion of ambulatory surgery are more than justified. The high satisfaction among patients undergoing this type of surgery, with a very low number of complications registered, provides us with a valuable tool for health-care expenditure control (AU)

Hemoperitoneo y muerte por rotura de metástasis hepatoesplénicas de tumor testicular / Hemoperitoneum and death due to hepatoesplenic methastasis rupture in a testicular tumor

Presentamos un caso de tumor germinal mixto de testículo, en estadio III-C (AJCC-UICC), con evolución letal, por hemoperitoneo masivo por rotura de metástasis hepáticas y esplénicas

We present a case of a mix germinal testicular tumor,in III-C (AJCC-UICC) stage, at a terminal phase due to massive methastasis rupture at hepatic and splenic methastasis locations