Neurotoxidad inducida por ifosfamida / Ifosfamide-induced neurotoxicity

Introducción: La ifosfamida es un agente alquilante utilizado para el tratamiento de enfermedades oncohematológicas. Entre sus eventos adversos agudos se encuentra la neurotoxicidad. Esta puede presentarse desde el inicio de la infusión hasta tres días después. El tratamiento consiste en suspender la administración y asegurar una adecuada hidratación. Objetivo: Describir eventos neurológicos asociados al uso de ifosfamida en pacientes pediátricos con enfermedades oncohematológicas. Materiales y métodos: Estudio observacional, descriptivo, retrospectivo y transversal. Los datos se obtuvieron de historias clínicas de pacientes internados en el Hospital Garrahan que infundieron ifosfamida y desarrollaron síntomas neurológicos. Se analizaron edad, diagnóstico de base, dosis de ifosfamida, síntomas neurológicos y su relación con la infusión, tratamiento instaurado, exámenes complementarios y posibles factores de riesgo asociados. Resultados: Se registraron un total de catorce eventos neurológicos en doce pacientes, sin diferencia de sexo, con una mediana de edad de 9,5 años. La enfermedad de base más prevalente fue osteosarcoma. Las convulsiones fueron el síntoma más frecuente (50%), seguido de somnolencia y paresias. La combinación de ifosfamida y etopósido con/sin carboplatino se asoció en un 36% cada uno. El 64% desarrolló neurotoxicidad dentro de las primeras cuatro horas. Ningún paciente presentó alteraciones en los exámenes complementarios. Todos presentaron recuperación ad integrum. Conclusión: Este estudio brinda información acerca del tiempo de aparición de esta complicación, lo cual facilitará su detección precoz y tratamiento oportuno (AU)

Introduction: Ifosfamide is an alkylating agent used for the treatment of cancer. Among its acute adverse events is neurotoxicity. This can occur from the beginning of the infusion up to three days afterwards. Treatment consists of discontinuing administration and ensuring adequate hydration. Objective: To describe neurological events associated with the use of ifosfamide in children with cancer. Materials and methods: Observational, descriptive, retrospective, and cross-sectional study. Data were obtained from clinical records of patients admitted to the Garrahan Hospital who received ifosfamide infusion and developed neurological symptoms. Age, baseline diagnosis, ifosfamide dose, neurological symptoms and their relationship with the infusion, treatment, complementary tests, and possible associated risk factors were analyzed. Results: A total of fourteen neurological events were recorded in twelve patients, without difference in sex and with a median age of 9.5 years. The most prevalent underlying disease was osteosarcoma. Seizures were the most frequent symptom (50%), followed by drowsiness and paresis. The combination of ifosfamide and etoposide with/without carboplatin was associated in 36% each. Sixty-four percent developed neurotoxicity within the first four hours. None of the patients presented with abnormalities in the complementary examinations. All recovered ad integrum. Conclusion: This study provides information about the time of onset of this complication, which will facilitate its early detection and timely treatment (AU)

Síndrome coronario agudo en mujer joven: en búsqueda de la afectación arterial sistémica / Acute coronary syndrome in a young woman: The search of systemic arterial involvement

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Embolismo de trombo ventricular izquierdo gigante hacia aorta abdominal / Giant left ventricular thrombus embolism into the abdominal aorta

No disponible

Dataset reporting BCKDK interference in a BCAA-catabolism restricted environment.

This data article contains complementary figures to the research article "Mitochondrial response to the BCKDK-deficiency: some clues to understand the positive dietary response in this form of autism" [1]. Herein we present data relative to the effect of knocking down BCKDK gene on the real time oxygen consumption rate of fibroblasts obtained from a Maple Syrup Urine Disease (MSUD) patient. Interference of BCKDK expression on such cells showing a reduced branched-chain α-ketoacid dehydrogenase (BCKDHc) activity; let us generate a scenario to study the direct effect of BCKDK absence in an environment of high branched-chain amino acids (BCAAs) concentrations. Data relative to the effectiveness of the knockdown together with the potentiality of the BCKDK-knockdown to increase the deficient branched-chain α-ketoacid dehydrogenase activity detected in MSUD patients are also shown.

Mitochondrial response to the BCKDK-deficiency: Some clues to understand the positive dietary response in this form of autism.

Mutations on the mitochondrial-expressed Branched Chain α-Keto acid Dehydrogenase Kinase (BCKDK) gene have been recently associated with a novel dietary-treatable form of autism. But, being a mitochondrial metabolism disease, little is known about the impact on mitochondrial performance. Here, we analyze the mitochondrial response to the BCKDK-deficiency in patient's primary fibroblasts by measuring bioenergetics, ultra-structural and dynamic parameters. A two-fold increase in superoxide anion production, together with a reduction in ATP-linked respiration and intracellular ATP levels (down to 60%) detected in mutants fibroblasts point to a general bioenergetics depletion that could affect the mitochondrial dynamics and cell fate. Ultrastructure analysis of BCKDK-deficient fibroblasts shows an increased number of elongated mitochondria, apparently associated with changes in the mediator of inner mitochondria membrane fusion, GTPase OPA1 forms, and in the outer mitochondrial membrane, mitofusin 2/MFN2. Our data support a possible hyperfusion response of BCKDK-deficient mitochondria to stress. Cellular fate also seems to be affected as these fibroblasts show an altered proportion of the cells on G0/G1 and G2/M phases. Knockdown of BCKDK gene in control fibroblasts recapitulates most of these features. Same BCKDK-knockdown in a MSUD patient fibroblasts unmasks the direct involvement of the accelerated BCAAs catabolism in the mitochondrial dysfunction. All these data give us a clue to understand the positive dietary response to an overload of branched-chain amino acids. We hypothesize that a combination of the current therapeutic option with a protocol that considers the oxidative damage and energy expenditure, addressing the patients' individuality, might be useful for the physicians.

Therapeutic Effects of Policosanol and Atorvastatin against Global Brain Ischaemia-Reperfusion Injury in Gerbils.

Stroke is the third cause of death and the first of permanent adult disability. Pretreatment with policosanol and atorvastatin has been effective in experimental models of cerebral ischaemia in rodents. The objective was to compare the therapeutic effects of policosanol and atorvastatin in a model of global cerebral ischaemia in gerbils. Gerbils were distributed into seven groups, a negative control and six with ischaemia-reperfusion-induced global cerebral ischemia (one vehicle positive control, two policosanol (100 and 200 mg/kg), two atorvastatin (10 and 20 mg/kg) and one aspirin (60 mg/kg) group). Treatments were given 4 h after ischaemia induction. Effects on ischemia-reperfusion-induced symptoms, hyperlocomotion, damage of pyramidal hipoccampal neurons and increased plasma oxidative markers were investigated. Positive, not negative controls, exhibited clinical symptoms, hyperlocomotion, neuronal damage and increased plasma oxidative markers. Policosanol (100 and 200 mg/kg) reduced significantly ischemia-reperfusion-induced symptoms, the frequency of symptomatic animals, histological scores of neuronal damage and plasma oxidative markers as compared with the positive control group. Atorvastatin (10 and 20 mg/kg) decreased significantly the symptoms and histological scores, but unchanged the frequency of symptomatic gerbils and oxidative variables. Only the highest dose of policosanol (200 mg/kg) and atorvastatin (20 mg/kg) reduced significantly ischemia reperfusion-induced hyperlocomotion, policosanol being the most effective. Aspirin 60 mg/kg lowered significantly symptom score, the rate of symptomatic gerbils and hyperlocomotion versus the positive controls, but failed to modify oxidative parameters. In conclusion, postreperfusion treatment with policosanol and atorvastatin was effective for ameliorating symptoms, hyperlocomotion and neurological damage of hippocampal CA1 neurons in gerbils with ischemia-reperfusion-induced global cerebral ischemia, but only policosanol reduced increased plasma oxidative variables.

One year oral Toxicity of D-004, a lipid extract from Roystonea regia fruits, in Sprague Dawley rats.

D-004, a lipid extract of royal palm (Roystonea regia) fruits that contains a reproducible mixture of fatty acids, has been shown to prevent testosterone and phenylephrine-induced prostate hyperplasia in rodents. This study investigated the long-term oral toxicity of D-004 in rats. Rats from both sexes were randomized into four groups (20 rats sex/group): a control and three treated with D-004 (800, 1500 or 2000 mg/kg/day, respectively). At study completion, rats were sacrificed under anaesthesia. Determinations of blood biochemical and haematological parameters and organ weight were done. Also, necropsy and histopathological studies were performed. Four of 160 rats died before study completion. No clinical signs of toxicity were observed throughout the study. Food and water consumption, bodyweight, blood biochemical and haematological parameters, organ weight ratios and histopathological findings were similar in control and treated groups. The histological lesions found in treated animals are commonly present in this specie and strain according to literature and our historical data. In conclusion, long-term (12 months) oral treatment of rats with D-004 (800-2000 mg/kg/day) did not show evidences of D-004-related toxicity under our conditions. The highest dose tested (2000 mg/kg) was a no-observed adverse effect level in this study.

Adverse reactions during transfusion of thawed haematopoietic progenitor cells from apheresis are closely related to the number of granulocyte cells in the leukapheresis product.

BACKGROUND AND OBJECTIVES: The infusion of thawed haematopoietic progenitor cells from apheresis (HPC-A) is associated with minor but frequent adverse reactions (ARs), which has been mainly attributed to dimethyl sulphoxide (DMSO). Nevertheless, other factors may play a role in the pathogenesis of such toxicity. MATERIALS AND METHODS: The ARs on a cohort of 423 cryopreserved HPC-A infusions for 398 patients in HPC transplantation program were analysed. RESULTS: ARs were reported in 105 graft infusions (24·8%) and most of them were graded as mild to moderate. The most frequently reported ARs were gastrointestinal and respiratory, and three patients presented epileptic seizure. The volume of DMSO/kg (P < 0·001), volume of red-blood-cells/kg (P = 0·02), number of nuclear cells (NCs)/kg (P <0·001) and number of granulocytes/kg (P<0·001) in the infused graft were significant in the univariate analysis for the occurrence of ARs. The amount of granulocytes/kg remained significant in the multivariate analysis (P<0·001). The grade of ARs also correlated with the amount of cryopreserved granulocytes. CONCLUSION: The incidence and grade of ARs during infusion of cryopreserved HPC-A are related to the amount of granulocytes in the graft.

Muerte fetal anteparto y síndrome de Sjögren oculto / Antepartum fetal death and occult Sjögren's syndrome

El síndrome (Sd) de Sjögren es un trastorno inmunológico caracterizado por una destrucción linfocitaria progresiva de las glándulas exocrinas y a menudo está asociado con trastornos autoinmunitarios. Los anticuerpos anti-Ro/SSA y anti-La/SSB tienen una alta prevalencia en pacientes con Sd de Sjögren y están íntimamente relacionados con el aumento del riesgo de muerte fetal, abortos de repetición, lupus neonatal, bloqueo cardíaco congénito completo y, menos frecuentemente, con valvulopatías fetales. Presentamos un caso de muerte fetal anteparto en una paciente con Sd de Sjögren oculto. Incluso sin clínica sugestiva, es necesario incluir esta patología en el diagnóstico diferencial de muerte fetal anteparto (AU)

Sjögren's syndrome is an immunological disorder characterized by progressive lymphocyte destruction of exocrine glands and is often associated with autoimmune diseases. Anti-Ro/SSA and anti-La SSB antibodies have a high prevalence in Sjögren's syndrome and are closely associated with fetal loss, recurrent abortions, neonatal lupus, and congenital complete atrioventricular block and less frequently with fetal valvulopathy. We report a case of antepartum fetal death in a patient with occult (..) (AU)

Factores de riesgo de la muerte fetal anteparto / Risk factors for antepartum fetal death

La muerte fetal supone más de la mitad de las muertes perinatales. El grupo con mayor morbimortalidad corresponde a los recién nacidos que asocian prematuridad y bajo peso. Hay una marcada tendencia a repetir el mal resultado de la gestación anterior. Se presentan 2 casos de muerte fetal, y se realiza una revisión de las causas más frecuentes y de su influencia. El estudio de las alteraciones maternas, fetales y placentarias puede, en algunos casos, establecer la etiología de la muerte fetal (AU)

Fetal death represents more than half of perinatal deaths. Morbidity is highest in newborns who associate prematurity and low birth weight. Adverse pregnancy outcomes show a marked tendency to be repeated. We present two cases of fetal death and review the most frequent causes of this adverse outcome and their influence. Study of maternal, fetal and placental alterations can sometimes establish the etiology of fetal death (AU)

Satisfacción de los pacientes con cervicalgia y lumbalgia en un servicio de rehabilitación / Satisfaction of patients with cervical pain and low back pain in a rehabilitation service

Fundamento. Son objetivos del presente trabajo: reducir el tiempo de espera para iniciar tratamiento de pacientes con lumbalgia/cervicalgia; conocer el grado de satisfacción de los pacientes al ser tratados mediante terapia en grupo; y determinar si existe correlación entre la satisfacción global, mejora del dolor e impacto sobre las actividades de la vida diaria.Material y métodos. Estudio prospectivo observacional. Población a estudio: usuarios de las consultas de un hospital terciario y del centro de especialidades adscrito al mismo, que acudieron por dolor cervical/lumbar y que modificaron una serie de ejercicios en grupo. Período de estudio: del 1 de octubre de 2001 al 1 de abril de 2002. El instrumento de medida para valorar el dolor y discapacidad fue el cuestionario Von Korff del dolor lumbar, realizándose una adaptación del mismo para el dolor cervical. Análisis estadístico: test no paramétrico de Wilcoxon.Resultados. Total de pacientes 273 (176 cervicalgias y 97 lumbalgias): 198 mujeres y 75 hombres. Edad media: 48,5 (20-81). La valoración subjetiva de los pacientes tratados en grupo mejoró en 72 sujetos (p<0,0001) con cervicalgia y en 33 (p<0,001) con lumbalgia. El dolor post-tratamiento fue significativamente mejor (p<0,001) que el pre-tratamiento en ambos grupos. Su influencia en las actividades de la vida diaria no alcanzó significación estadística. La percepción de la información recibida fue positiva en el grupo cervical (p<0,05).Conclusiones. Tras la aplicación de diversas técnicas: disminuye el volumen y el tiempo de espera –determinantes de la satisfacción de estos pacientes–; se logra una buena aceptación del tratamiento grupal, mejorando el dolor. El grado de conocimiento sobre su patología sólo mejoró en el grupo cervical

Background. The aims of the present paper are: to reduce waiting time for treatment of patients with low back pain/cervical pain; to determine the degree of satisfaction of patients being treated by groups; and to determine whether there is correlation amongst satisfaction, improvement of pain and impact on the activities of everyday life.Methods. Prospective observational study. Study population: users of the surgeries of a tertiary hospital and the specialties center attached to it, who attended surgery because of cervical/low back pain, and practiced a serie of exercises. Period of study: 1 october 2001 to 1 April 2002. The instrument of measurement used for evaluating pain and disability was the Von Korff questionnaire for low back pain, with an adaptation of this questionnaire for cervical pain. Statistical analysis: Wilcoxon’s non-parametric test.Results. Total number of patients 273 (176 with cervical pain and 97 with low back pain): 198 women and 75 men. Average age: 48.5 (20-81). The self perceived evaluation of the patients treated in a group improved in 72 subjects (p<0.0001) with cervical pain and in 33 (p<0.001) with low back pain. Post-treatment pain was significantly better (p<0.001) than pre-treatment pain in both groups. Its influence on the activities of everyday life did not achieve statistical significance. Perception of the information received was positive in the cervical group (p<0.05).Conclusions. Following the application of different techniques: reduction in number of patients and waiting time – decisive factors in the satisfaction of these patients; a good acceptance of group treatment was obtained, ameliorating pain. The degree of knowledge of their pathology only improved in the cervical group

Anestesia intracervical en la histeroscopia / Intracervical anesthesia in hysteroscopy

Objetivo: Valorar los resultados obtenidos con la utilización de anestesia intracervical con jeringa y aguja de dentista en la histeroscopia. Material y métodos: Desde el 1 de enero hasta el 30 de junio se han realizado 622 histeroscopias en nuestra consulta. A las mujeres a quienes no se puede practicar la histeroscopia porque sienten dolor, se les inyecta anestesia intracervical con jeringa y aguja de dentista. Resultados: De las 622 histeroscopias realizadas en el primer semestre de 2004, han precisado anestesia local 90 mujeres (14,5%). El porcentaje de histeroscopias que no se han podido realizar en consulta ha sido del 1,7%, bastante menor que el observado en años anteriores: en el primer semestre de 2000 fue del 4,9%, en 2001 y 2002 del 8,3%, y en 2003 del 6,1%. Conclusiones: Al revisar la bibliografía, todos los estudios han encontrado beneficioso el uso de anestesia intracervical en la histeroscopia, y hacen hincapié en la importancia de la selección de las pacientes. Nuestro estudio llega a las mismas conclusiones, y aporta la ventaja que supone la utilización de la jeringa y aguja de dentista, con lo cual se consigue una correcta analgesia y una mejor tolerancia de la mujer, sin olvidarnos del ahorro económico que supone la anestesia local respecto a la general

Objective: To evaluate the results obtained with the use of intracervical anesthesia injected with a dental syringe in outpatient hysteroscopy. Material and methods: From January 1st to June 30th 2004, we performed 622 outpatient hysteroscopies. Intracervical anesthesia was injected with a dental syringe in women who did not tolerate the pain during hysteroscopy. Results: Of 622 outpatient hysteroscopies performed in the first semester of 2004, 90 women required local anesthesia (14.5%). The percentage of hysteroscopies that could not be performed in the office was 1.7%, less than that observed in previous years (4.9% in the first semester of 2000, 8.3% in 2001 and 2002 and 6.1% in 2003). Conclusions: A review of the literature reveals that all studies have found intracervical anesthesia to be beneficial in outpatient hysteroscopy, emphasizing the importance of patient selection. Our study supports these conclusions and additionally reports the advantage of the use of a dental syringe, which allows adequate analgesia and better patient tolerance, as well as economic savings in comparison with general anesthesia

[Satisfaction of patients with cervical pain and low back pain in a rehabilitation service]. / Satisfacción de los pacientes con cervicalgia y lumbalgia en un servicio de rehabilitación.

BACKGROUND: The aims of the present paper are: to reduce waiting time for treatment of patients with low back pain/cervical pain; to determine the degree of satisfaction of patients being treated by groups; and to determine whether there is correlation amongst satisfaction, improvement of pain and impact on the activities of everyday life. METHODS: Prospective observational study. STUDY POPULATION: users of the surgeries of a tertiary hospital and the specialties center attached to it, who attended surgery because of cervical/low back pain, and practiced a serie of exercises. PERIOD OF STUDY: 1 october 2001 to 1 April 2002. The instrument of measurement used for evaluating pain and disability was the Von Korff questionnaire for low back pain, with an adaptation of this questionnaire for cervical pain. STATISTICAL ANALYSIS: Wilcoxon's non-parametric test. RESULTS: Total number of patients 273 (176 with cervical pain and 97 with low back pain): 198 women and 75 men. Average age: 48.5 (20-81). The self perceived evaluation of the patients treated in a group improved in 72 subjects (p<0.0001) with cervical pain and in 33 (p<0.001) with low back pain. Post-treatment pain was significantly better (p<0.001) than pre-treatment pain in both groups. Its influence on the activities of everyday life did not achieve statistical significance. Perception of the information received was positive in the cervical group (p<0.05). CONCLUSIONS: Following the application of different techniques: reduction in number of patients and waiting time - decisive factors in the satisfaction of these patients; a good acceptance of group treatment was obtained, ameliorating pain. The degree of knowledge of their pathology only improved in the cervical group.

Edema agudo de pulmón en el embarazo / Acute pulmonary edema in pregnancy

El edema agudo de pulmón es una complicación poco frecuente durante el embarazo. Presenta una incidencia del 0,08 por ciento. Presentamos 2 casos clínicos de edema agudo de pulmón en el embarazo y hacemos una revisión de la bibliografía con el análisis de las etiologías más frecuentes y las medidas preventivas que se deben tomar para evitar su aparición (AU)

[Tumoral markers and acute-phase reactants in the diagnosis of pancreatic cancer]. / Marcadores tumorales y reactantes de fase aguda en el diagnóstico del cáncer de páncreas.

OBJECTIVE: To analyze the diagnostic accuracy of the following parameters in the diagnosis of pancreatic cancer: carcinoembryonic antigen (CEA), tissue plasminogen activator (TPA), carbohydrate antigen 19-9 (CA 19-9), carbohydrate antigen 50 (CA 50), alpha-1-antitrypsin (AAT), alpha-2 macroglobulin (AMG), and ceruloplasmin (CP). PATIENTS AND MENTOD: We prospectively studied 58 patients with pancreatic cancer, 40 with alcoholic pancreatitis and 40 healthy controls, in whom the above-mentioned parameters were analyzed. Receiver operating characteristic curves (ROC curves) were analyzed. RESULTS: The specificity of TPA, CA 19-9 and CA 50 in the differential diagnosis between pancreatic cancer and chronic pancreatitis was 87.5%, 90% and 95% respectively, with a sensitivity of nearly 90%. Although levels of AAT, AMG and CP were higher in patients with cancer than in those with pancreatitis, their specificity was lower, approximately 65%. CEA and TPA showed a positive association with the presence of metastases. CONCLUSION: TPA, CA 19-9 and CA 50 were useful in the differential diagnosis between pancreatic cancer and chronic pancreatitis.