[Enteropathic acrodermatitis in a patient with high-out-put ileostomy]. / Acrodermatitis enteropática en paciente con ileostomía de alto débito.

Zinc deficiency is relatively common in certain pathologies, although its clinical manifestation is uncommon. We present the case of a patient who was admitted presenting hyponatremic dehydration and pre-renal failure secondary to high-output ileostomy and oral intolerance. Although the ileostomy output was normalized within 3 days of admission and initial zinc plasma levels were normal, after being fed with TPN supplemented with 13 mg/day of zinc, he suffered a severe zinc deficit with enteropathic acrodermatitis that was completely resolved after one week with 26.5 mg/day. However, plasma levels did not return to normal until one month on therapy with high doses of zinc. Zinc plasma levels are not a good indicator of zinc stores in the body and many times their changes are a late indicator of zinc deficit. There is not a correlation between the clinical improvement and normalization of zinc levels, being common the clinical resolution within few days of the supplementation without observing an increase of zinc plasma levels.

La deficiencia de zinc es relativamente frecuente en ciertas patologías, pero su manifestación clínica es rara. Se expone el caso de un paciente que ingresó con cuadro de deshidratación hiponatrémica e insuficiencia prerrenal secundaria por ileostomía de alto débito e intolerancia oral. Aunque se normalizó el débito de la ilesotomía al tercer día del ingreso y los niveles plasmáticos de zinc iniciales fueron normales, el paciente después de estar con NPT suplementada con 13 mg/día de zinc, sufrió una deficiencia severa de zinc con acrodermatitis enteropática que se resolvió completamente después de una semana con 26,5 mg/día. Sin embargo, los niveles plasmáticos no se normalizaron hasta pasado un mes de estar en tratamiento con estas macrodosis de zinc. El zinc plasmático no es un buen indicador de los depósitos de zinc en el organismo, y muchas veces, su alteración es un indicador tardío de deficiencia. Tampoco se observa una correlación entre la mejoría clínica y la normalización de sus niveles, siendo frecuente la resolución clínica a los pocos días de la suplementación sin detectarse aumento de zinc en plasma.

Acrodermatitis enteropática en paciente con ileostomía de alto débito / Enteropathic acrodermatitis in a patient with high-out-put ileostomy

La deficiencia de zinc es relativamente frecuente en ciertas patologías, pero su manifestación clínica es rara. Se expone el caso de un paciente que ingresó con cuadro de deshidratación hiponatrémica e insuficiencia prerrenal secundaria por ileostomía de alto débito e intolerancia oral. Aunque se normalizó el débito de la ilesotomía al tercer día del ingreso y los niveles plasmáticos de zinc iniciales fueron normales, el paciente después de estar con NPT suplementada con 13 mg/día de zinc, sufrió una deficiencia severa de zinc con acrodermatitis enteropática que se resolvió completamente después de una semana con 26,5mg/día. Sin embargo, los niveles plasmáticos no se normalizaron hasta pasado un mes de estar en tratamiento con estas macrodosis de zinc. El zinc plasmático no es un buen indicador de los depósitos de zinc en el organismo, y muchas veces, su alteración es un indicador tardío de deficiencia. Tampoco se observa una correlación entre la mejoría clínica y la normalización de sus niveles, siendo frecuente la resolución clínica a los pocos días de la suplementación sin detectarse aumento de zinc en plasma (AU)

Zinc deficiency is relatively common in certain pathologies, although its clinical manifestation is uncommon. We present the case of a patient who was admitted pre -senting hyponatremic dehydration and pre-renal failure secondary to high-output ileostomy and oral intolerance. Although the ileostomy output was normalized within 3days of admission and initial zinc plasma levels were normal, after being fed with TPN supplemented with 13mg/day of zinc, he suffered a severe zinc deficit with enteropathicacrodermatitis that was completely resolved after one week with 26.5 mg/day. However, plasma levels did not return to normal until one month on therapy with high doses of zinc. Zinc plasma levels are not a good indicator of zinc stores in the body and many times their changes are a late indicator of zinc deficit. There is not a correlation between the clinical improvement and normalization of zinc levels, being common the clinical resolution within few days of the supplementation without observing an increase of zinc plasma levels (AU)

Soporte con nutrición enteral en tumores de cabeza y cuello / No disponible

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Concomitant boost radiation and concurrent cisplatin for advanced head and neck carcinomas. Preliminary results of a phase II, single-institutional trial.

INTRODUCTION: This study aims to asses the effectiveness and toxicity of boost radiotherapy concomitant and concurrent cisplatin for patients with locally advanced head and neck cancer (LAHNC). MATERIAL AND METHODS: There were 30 patients included in a prospective, phase II single-institution trial and of whom, 29 were at AJCC stage IV and 1 at stage III. Treatment consisted of radiotherapy acceleration fractionation with concomitant boost, 72 Gy, and 2 cycles of concomitant cisplatin (20 mg/m2/day continuous infusion; days 1-5 and 29-33). Amifostine, (i.v. 200 mg/m2) was administered to 26 prior to the first fraction of radiotherapy. Endpoints of the study were quality-of-life (QL), overall survival, and local control of disease. RESULTS: Complete response (CR) was achieved in 23 patients (77%), 2 patients had partial response (PR) (7%), 4 had no response (13%), and 1 was not evaluated for response. The 2-year overall survival and loco-regional control were 60% and 56%, respectively. Main toxicity was grade 3 or 4 mucositis in 93% of the patients. QL scores (questionnaire QLQC30; version 3.0) and the HN cancer module QLQ-HN35) showed a worsening in areas related to the treatment e.g. dry mouth, problems stretching the mouth, and sticky saliva. CONCLUSIONS: this combination modality is active, but toxic, in the treatment for LAHNC. Concomitant boost radiotherapy is probably, not the best radiotherapy schema for combining with chemotherapy in LAHNC.

Concomitant boost radiation and concurrent cisplatin for advanced head and neck carcinomas. Preliminary results of a phase II, single-institutional trial

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Introduction. This study aims to asses the effectiveness and toxicity of boost radiotherapy concomitant and concurrent cisplatin for patients with locallyadvanced head and neck cancer (LAHNC). Material and methods. There were 30 patients included in a prospective, phase II single-institution trial and of whom, 29 were at AJCC stage IV and 1 at stage III. Treatment consisted of radiotherapyacceleration fractionation with concomitant boost, 72 Gy, and 2 cycles of concomitant cisplatin (20 mg/m2/day continuous infusion; days 1-5 and 29-33). Amifostine, (i.v. 200 mg/m2) was administered to 26 prior to the first fraction of radiotherapy. Endpoints of the study were quality-of-life (QL), overall survival, and local control of disease. Results. Complete response (CR) was achievedin 23 patients (77%), 2 patients had partial response (PR) (7%), 4 had no response (13%), and 1 was not evaluated for response. The 2-year overall survival and loco-regional control were 60% and 56%, respectively. Main toxicity was grade 3 or 4 mucositis in 93% of the patients. QL scores (questionnaire QLQC30; version 3.0) and the HN cancer module QLQ-HN35) showed a worsening in areas related to thetreatment e.g. dry mouth, problems stretching the mouth, and sticky saliva. Conclusions. this combination modality is active, but toxic, in the treatment for LAHNC. Concomitant boost radiotherapy is probably, not the best radiotherapy schema for combining with chemotherapy in LAHNC