Enfermedad de Hodgkin extranodal primaria gástrica: presentación de un caso clínico / Primary extranodal gastric tumor: case presentation

La enfermedad de Hodgkin extranodal primaria es una entidad poco frecuente, siendo el compromiso más frecuente el tracto digestivo y en especial el estómago, seguido del intestino delgado, intestino grueso y esófago (2). Se presenta un caso de Enfermedad de Hodgkin extranodal primaria gástrica en una mujer de 74 años de edad, no inmunodeprimida.

Trasplante de médula ósea en el tratamiento de enfermedades hematológicas malignas / Allogenic bone marrow transplantation in patients with malignant hematological diseases

We have treated 28 patients (pts) with malignant hematological diseases with allogenic bone marrow transplantation (BMT). 18 pts had acute lymphoblastic (ALL) and non lymphoblastic leukemia (ANLL), 5 chronic myeloid leukemia (CML), 2 severe aplastic anemia (SAA), 1 myelodisplasia, 1 Fanconi's anemia and 1 advanced Non Hodgkin's lymphoma. All but three received the graft from HLA identical sibling donors. We used conditioning with total body irradiation and chemotherapy (cyclophosphamide, cytarabine and etoposide) in 17 pts and chemotherapy alone in 11.24 pts had a full hematological recovery 18 to 25 days post BMT. 15 pts died after BMT as a consequence of toxicity or early infection (4), graft failure (2), graft vesus host disease (4) or relapse (5). Actuarial event free survival for the group with favorable prognosis (SAA, ALL and ANLL in first or second remission and CML in chronic phase) is 57 percent at 36 months. Allogeneic BMT is an effective and feasing therapeutic procedure for selected patients with hematological malignancies

Imipenem - cilastatina versus ceftazidima - amikacina para el tratamiento de pacientes neutropénicos febriles / Imipenem - cilastatine versus ceftazidime - amikacin in the treatment of febril neutropenic patients

Aim: To compare the efficacy of imipenem - cilastatine and ceftazidime - amikacin in the treatment of febril neutropenic patients. Design: Open prospective and randomized clinical study. Patients: 52 patients (26 females) aged 16 to 80 years old with 60 episodes of neutropenia were studied. They were randomly assigned to receive Imipenem - cilastatine in doses of 500 mg iv qid or the combination of ceftazidime 1 to 1.5 g iv tid and amikacin 7.5 mg/kg iv bid. Results: Global response to initial therapy was 53 percent in patients receiving imipenem - cilastatine and 37 percent in those receiving ceftazidime - amikacin (p=ns). When other antimicrobial were added, a 90 and 85 percent infection eradication success was achieved respectively. Six febrile episodes in the group receiving imipenem - cilastatine and 12 episodes in tha group receiving ceftazidime - amikacin had Gram positive cocci as the sole treatment outcome. Three patients receiving imipenem - cilastatine (10 percent) and 4 receiving ceftazidime - amikacin (13 percent) died. Superinfections and toxicity related to antibiotics were minimal in both groups. Conclusions: imipenem - cilastatine and the combination of ceftazidime with amikacin were equally effective in the treatment of febril episodes in neutropenic patients

Hiponatremia severa en porfiria aguda: mielinolisis pontina central como complicación de su tratamiento / Acute porphyria: central pontine myelinolysis developing during correction of severe hyponatremia

Two patients developed severe hyponatremia attributed to inappropriate antidiuretic hormone secretion during a crisis of acute porphyria, and were treated with intravenous hypertonic sodium solution. One of them developed clinical and radiological findings of pontine and extrapontine myelinolysis, which may constitute a risk in the treatment of this complication