Impact of erythropoietin treatment on the quality of life of oncologic patients.

Anaemia has a high incidence in cancer patients, especially when it is a consequence of myelosuppressive treatments. The incidence and prevalence of this condition is influenced by the type and extension of the tumour, type and intensity of the myelosuppressive treatment that patients receive, and previous surgery or intercurrent infections. Clinical manifestations of anaemia, overlapped by tumour symptomatology, depend on haemoglobin (Hb) levels; these manifestations cause impairment of the functional capacity, as well as a negative impact on the quality of life (QOL) of cancer patients as a consequence. Erythropoietin treatment for anaemia has been established as optimal for correcting Hb levels. Its impact on patients' QOL has been evaluated in numerous randomised prospective studies by the use of diverse types of erythropoietin and administration modes. The three types of erythropoietin, alpha, beta and darbepoetin alpha, have shown a clear efficacy in all haematological parameters. This positive effect is related with significant improvements in the QOL of patients, especially those patients undergoing myelosuppressive treatments, and with regard to specific scales of fatigue and anaemia.

Prognostic value of apoptosis in breast cancer (pT1-pT2). A TUNEL, p53, bcl-2, bag-1 and Bax immunohistochemical study.

Apoptosis or programmed cell death produces cells breaking into several fragments of nuclei, cytoplasm or both nuclei and cytoplasm, known as apoptotic bodies which can be visualized in haematoxylin-eosin staining. Some genes (promoters and suppressors) control this process and certain mutations may induce the expression of abnormal proteins, which can be detected by immunohistochemical staining. Apoptosis can be detected by the TUNEL method either identifying apoptotic bodies or cells at the initial stages of the fragmentation process. We have studied 186 cases of infiltrating ductal breast carcinoma, stages pT1-pT2, and analysed the prognostic significance of tumour recurrence and overall survival of apoptotic index (AI) through univariate and multivariate analysis. We have also studied the immunohistochemical protein expression of apoptosis promoter and suppressors gene (p53, nuclear expression; bcl-2 and Bax, cytoplasm expression; BAG-1, nuclear and cytoplasm expression). The results indicate prognostic significance of p53 and bcl-2 related to patient death and bcl-2 and tumour size to tumour recurrence, bcl-2 acting as a protector factor (apoptotic suppressor) in both situations. On the other hand, we have not found useful prognostic information of AI either to tumour recurrence or overall survival in univariate or multivariate studies. In this study, Bax expression does not provide a new prognostic role in breast carcinoma, although it contrasts to the bcl-2 action and accelerates death.

Non-resectable phaeochromocytoma: long term follow-up.

A forty-two year old woman presented with hypertension, trembling, sweating, visual impairment, headache and weight loss. A right adrenal phaeochromocytoma was diagnosed. The tumour could not be resected because it encircled the inferior vena cava. She was treated at first with phenoxybenzamine and propranolol and later with phenoxybenzamine and labetalol. She has remained normo-tensive and free of signs of adrenergic hyperactivity for 11 years. We suggest that pharmacological treatment alone is a valid alternative in cases of phaeochromocytoma who are at high surgical risk or where the tumour is not resectable.

[Pulmonary hemorrhage and glomerulonephritis associated with essential mixed cryoglobulinemia]. / Hemorragia pulmonar y glomerulonefritis asociados a crioglobulinemia mixta esencial.

A 49-year-old male with essential mixed cryoglobulinemia IgM kappa-IgG of 4-years duration was treated with corticosteroids and immunosuppressive drugs during the repeated episodes. Finally, he developed a new episode with severe renal involvement and pulmonary hemorrhage without other associated etiological factors. The optical and immunofluorescent histological findings in lung and kidney are described. This is the second case of pulmonary hemorrhage and cryoglobulinemia associated with essential mixed cryoglobulinemia reported in the literature. A relation between essential mixed cryoglobulinemia and glomerulonephritis and pulmonary hemorrhage is suggested.

[A study of anemia in 86 patients on hemodialysis (author's transl)]. / Estudio de la anemia en 86 pacientes en hemodiálisis.

Anemia is one of the complications of terminal chronic renal failure that may worsen with periodical hemodialysis because of residual blood losses in the dialyzers that may be significant if clotting occurs within the circulation system. The potential iron deficiency component of the anemia has been studied in 86 patients submitted to periodic hemodialysis by measurement of hemoglobin, serum iron, transferrin saturation, total iron binding capacity, and ferritin. The following correlations were investigated: degree of anemia and type of renal disease, months on hemodialysis and hemoglobin, months on hemodialysis and serum ferritin, and liters of blood transfused and serum ferritin. Statistically significant correlations were found between months on hemodialysis and hemoglobin, and between liters of blood transfused and serum ferritin. From the correlation between serum iron and ferritin the patients could be classified in three groups: 1, with either normal or low serum iron and ferritin, candidates to iron therapy; 2, with elevated serum iron and ferritin, needing no iron treatment; and 3, with unequal changes of serum iron and ferritin, in whom iron kinetic studies are indicated in order to discover the patents that may benefit from iron therapy.

[Orofaciodigital syndrome]. / Síndrome oro-facial-digital.

The OFDS and kidney polycystic disease is a rare association. Only 7 cases we have been able to find in several references. A new female case with hypertension is reported.

Caspase-3 and caspase-6 in ductal breast carcinoma: a descriptive study.

Caspases are the main point in the apoptotic process. We have collected some information from 210 cases of Ductal breast cancer (pT1 - pT2) such as tumour size, histological differentiation degree, lymph node status and tumor necrosis in the infiltrating component and we have evaluated the number of apoptotic cells or bodies by TUNEL technique as well as immunohistochemical studies to evaluate the expression of caspase 3 and caspase 6, and proliferation index. Our results show that lymph node status and cell atypism are independent prognostic factors for recurrence and mortality and only tumour size is an independent prognostic factor for recurrence. However, the apoptotic index and the immunohistochemical expression of caspases and cell proliferation index have not turned out to be independent prognostic factors neither for recurrence nor mortality. These results show that classic prognostic factors known until now are the most important factors to predict the evolution of the illness.

Effect of bezafibrate on lipoprotein (a) and triglyceride-rich lipoproteins, including intermediate-density lipoproteins, in patients with chronic renal failure receiving haemodialysis.

The effect of bezafibrate, at doses of 200 mg three times weekly throughout a period of 10 weeks, on lipoprotein (a) and triglyceride-rich lipoproteins including intermediate-density lipoproteins (IDL) has been studied in 12 patients with chronic renal failure receiving haemodialysis. No side-effects were observed, and serum creatine phosphate kinase values remained within normal limits throughout the duration of the study. Serum cholesterol, triglycerides and apoprotein (apo) B significantly decreased after bezafibrate, whereas apo A-I increased significantly. Serum lipoprotein (a) decreased after bezafibrate, although differences reached no statistical significance. The very-low-density lipoproteins (VLDL) cholesterol and the VLDL triglycerides decreased from 0.93 +/- 0.45 mmol/l (Mean +/- SD) to 0.54 +/- 0.27 mmol/l (P less than 0.05) and from 1.50 +/- 0.58 mmol/l to 0.91 +/- 0.35 mmol/l (P less than 0.01) respectively. The IDL cholesterol and IDL triglycerides decreased from 0.44 +/- 0.35 mmol/l to 0.20 +/- 0.18 mmol/l (P = NS) and from 0.46 +/- 0.35 mmol/l to 0.17 +/- 0.12 mmol/l (P less than 0.05) respectively. These data, with a substantial improvement of the lipoprotein profile in patients with chronic renal failure on haemodialysis after treatment with bezafibrate, suggest a decrease in the coronary heart disease risk.

Lipoprotein abnormalities in hyperlipidemic and normolipidemic men on hemodialysis with chronic renal failure.

Lipids, lipoproteins, apolipoproteins (apo) and apo E polymorphism were determined in 101 men with chronic renal failure (CRF) were were on hemodialysis and 101 healthy controls matched for age and sex. Patients with CRF on hemodialysis had significantly higher levels of serum triglycerides, very-low-density lipoprotein (VLDL) cholesterol, intermediate-density lipoproteins (IDL), and lower levels of low- and high-density lipoproteins (LDL and HDL, respectively) than controls. Regarding apolipoproteins, serum apo B concentrations were decreased. Apo C-III concentrations in sera and in VLDL and HDL fractions were significantly increased in 35 hemodialysis patients compared with 32 controls. Seventy-eight of the 101 CRF patients had normal serum cholesterol and triglycerides (less than 5.2 mmol/liter and less than 2.3 mmol/liter, respectively). However, this subgroup also showed a significant increase in VLDL-triglycerides and serum apo E concentration in addition to changes observed in the group as a whole. Apo E polymorphism in our study population did not differ from that reported for other European populations. According to the different apo E phenotypes, lipids and lipoprotein composition showed no significant differences in controls or patients. We conclude that accumulation of triglyceride-rich lipoproteins in patients with CRF on hemodialysis may thus be at least in part related to the enrichment of apo C-III in VLDL and HDL fractions. Lipoprotein profile in hemodialysis patients, including those with normal serum cholesterol and triglyceride levels, is consistent with high cardiovascular risk.

When to treat dyslipidaemia of patients with chronic renal failure on haemodialysis? A need to define specific guidelines.

BACKGROUND: There are no specific recommendations for management of dyslipidaemia in patients with chronic renal failure (CRF) on haemodialysis, in which atherosclerosis is a common cause of morbidity and mortality. The aim of the present study was to analyse different approaches based on low-density lipoprotein (LDL) cholesterol (measured and calculated with a formula), non-high-density lipoprotein (HDL) cholesterol, and HDL cholesterol levels in the clinical management of dyslipidaemia in haemodialysis patients. METHODS: Calculated LDL cholesterol by the Friedewald formula was compared with measured LDL cholesterol after separation by ultracentrifugation in 101 male patients with CRF on haemodialysis and in 101 healthy control subjects. RESULTS: Calculated LDL cholesterol coincided with measured LDL cholesterol, with less than 10% error, in 54 patients (53.4%) and in 75 controls (74.2%). Calculated LDL cholesterol was overestimated, with an error of 10% or more with respect to measured LDL cholesterol, in 37.6% of patients and in 23.7% of controls, and underestimated in 8.9% and 1. 9% respectively. Despite a good correlation between calculated and measured LDL cholesterol, the intraclass correlation coefficients demonstrate a poor concordance between calculated and measured LDL cholesterol, both in patients and controls. Only 17 patients were at non-HDL cholesterol level risk defined as higher than 4.28 mmol/l. HDL cholesterol levels lower than 0.9 mmol/l were found in 70% of patients and in 23% of controls. CONCLUSIONS: LDL or non-HDL cholesterol levels may not be appropriate for management of lipoprotein abnormalities in CRF patients. Further studies must clarify whether HDL cholesterol may be the best lipoprotein parameter for evaluating cardiovascular risk in these patients.