Síndrome de lisis de glóbulos blancos después de un trasplante autólogo de células troncales hematopoyéticas en el tratamiento de la amiloidosis AL renal: Caso clínico / White blood cell lysis syndrome after autologous peripheral blood stem cell transplantation in the treatment of renal AL amyloidosis: Case report

The treatment of AL amyloidosis was not successful until the advent of myeloablative chemotherapy consisting of high-dose intravenous melphalan followed by autologous peripheral blood stem cell transplantation. This new treatment has achieved better survival rates and, remarkably, it has obtained complete remission. Among patients with renal involvement, achievement of a complete hematological response was associated with a 50% reduction in proteinuria and stable creatinine clearance in more than 2/3 of patients. Despite of these excellent results, this new therapy is associated with significant toxicity, including the development of acute renal failure due to white blood cell lysis syndrome. We report a 59 year-old female with a nephrotic syndrome due to primary amyloidosis successfully treated autologous stem cell transplantation who developed acute renal failure caused by white blood cell lysis syndrome. The patient required treatment with granulocytic colony stimulating factor and intermittent hemofiltration and was discharged 23 days after melphalan administration with a satisfactory renal function and white blood cell count. After one year of follow up, she maintains a good glomerular filtration rate, a proteinuria of less than, 1 g/day and normal hematological values.

Experiencia en cirugía resectiva del cáncer esofágico / Experience in surgical resection of esophageal cancer

El objeto del presente trabajo es analizar la experiencia en cirugía resectiva del cáncer del esófago comparándola con nuestra experiencia anterior y con la de otros centros nacionales y extranjeros. Entre 1986 y 1995 operamos 138 pacientes con cáncer esofágico; 48,5 porciento de ellos se resecaron, la mitad con intención curativa. El 94,1 porciento fueron epidermoides y sólo 1,5 porciento resultaron adenocarcinomas. El 32 porciento de los resecados recibió radioterapia coadyuvante. La mortalidad operatoria global fue de 19,3 porciento. La morbilidad postoperatoria fue de 46,6 porciento, siendo grave en la mitad de los casos. Hubo un 21,5 porciento de fístulas. La sobrevida promedio global, incluyendo mortalidad operatoria, fue de 18,2 meses con 24,2 meses para resecciones curativas y 10,2 meses para las paliativas. La sobrevida promedio también fue mejor en los que tenían linfonodos negativos, y en los que recibieron radioterapia. Los 7 pacientes con lesiones incipientes están vivos sin enfermedad entre 8 y 63 meses

Encefalopatía de Wernicke como complicación de hemodiálisis crónica: caso clínico / Wernicke's encephalopathy as an hemodialysis complication: clinical case

Wernicke encephalopathy, due to the depletion of thiamine, can be a complication of chronic hemodialysis. We report a 43 years old diabetic male in chronic hemodialysis, who two weeks after an infra-condyleal amputation of his left leg, was admited to the hospital due to an episode of vomiting and abdominal pain lasting 5 days, where confusion and ocular motor signs appeared. Parenteral thiamine administration was started and the confusional state abated. Dialysis can be a predisposing factor for Wernicke encaphalopathy and this diagnosis must be considered in confuse patients

Conversión de sandimmune a neoral en pacientes trasplantados renales que reciben ciclosporina-ketoconazol / Conversion of sandimmune to neoral in patients with renal transplantation treated with cyclosporine-ketoconazol

Patients and methods: Thirty four patients with more than one year after the transplantation, with stable renal function and receiving triple immunosuppression were studied. Conventional cyclosporine was changed to the microemulsion form maintaining the same daily dose. Drug serum levels, serum creatinine and blood pressure were measured within two to eight months after the conversion. Doses of microemulsion cyclosporine were adjusted to achieve serum levels of 150 ñ 40 ng/ml. Results: Microemulsion cyclosporine induced a slight initial increase in blood cyclosporine levels. Afterwards, levels were more stable than with conventional cyclosporine (165-185 and 145-210 ng/ml respectively) and the dispersion of values were lower (standard deviations of 70 and 100 ng/ml respectively). Twenty three patients did not require dose adjustments, in four it was reduced and in five it was increased. There were no changes in serum creatinine or blood pressure after the conversion. Conslusion: More stable serum levels without adverse reactions were obtained with microemulsion cyclosporine. Doses of cyclos porine need not to be changed during the conversion