Recomendaciones de la analgesia perioperatoria del donador de trasplante renal / Recommendations for perioperative renal transplant donor analgesia

Resumen: Actualmente a nivel global se recomienda que la realización del tratamiento médico de los donadores en el trasplante renal sea estandarizado, ya que estas acciones incrementan la seguridad y disminuyen la morbimortalidad del donador y receptor renal. La evaluación preoperatoria incluye la elaboración de una historia clínica con exploración física, laboratorio, estudios de imagen, pruebas especiales y pruebas para enfermedades infecciosas. El manejo analgésico debe ser cuidadoso y debe orientarse a fármacos y maniobras que no modifiquen la fisiología del paciente (visita http://www.painoutmexico.com para obtener la versión completa del artículo y el diagrama de recomendaciones).

Abstract: Nowadays, it is globally recommended that the realization of medical treatment for renal transplant donor patients be standardized as it increases safety and decreases donor and renal recipient mortality and morbidity factors. The preoperative evaluation includes a clinical history elaborated with a physical examination, laboratory tests, imaging studies, specialized tests and infectious disease tests. The analgesic management must be carefully considered and must be focussed on drugs and manoeuvring them so that it doesn't modify the physiology of the patient (visit http://www.painoutmexico.com to see the full article and recommendations).

Recomendaciones en la analgesia del receptor de trasplante renal / Recommendations for kidney transplant recipient analgesia

Resumen: En el año 2012 se realizaron alrededor de 77,818 trasplantes según estimaciones de la Organización Mundial de la Salud. El trasplante renal es la mejor terapia de reemplazo en pacientes con enfermedad renal crónica, ya que mejora la calidad de vida y la posibilidad de supervivencia. El dolor postoperatorio en el trasplante renal es generalmente de leve a moderado y es de especial consideración debido a la existencia de diversas comorbilidades y la variabilidad en las respuestas que puede presentar el injerto. El manejo efectivo del dolor postoperatorio contribuye a un resultado exitoso después del trasplante renal (visita http://www.painoutmexico.com para obtener la versión completa del artículo y el diagrama de recomendaciones).

Abstract: In 2012, 77,818 kidney transplants were performed in the world according to the World Health Organization. Kidney transplantation is the best replacement therapy in patients with advanced chronic kidney disease as it improves the quality of life and survival possibilities. Postoperative pain is usually from mild to moderate after a kidney transplantation and it's of special consideration because of underlying comorbidities and variable graft responses. Effective postoperative pain management contributes to a successful outcome after kidney transplantation (visit http://www.painoutmexico.com to see the full article and recommendations).

Mucocutaneous leishmaniasis caused by Leishmania infantum var Lombardi in an immunocompetent patient, Spain / Leishmaniasis mucocutánea causada por Leishmania infantum var Lombardi en un paciente inmunocompetente, España

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Acute myeloid leukemia with inv(3)(q21q26.2) or t(3;3)(q21;q26.2): Clinical and biological features and comparison with other acute myeloid leukemias with cytogenetic aberrations involving long arm of chromosome 3.

OBJECTIVES: To compare, from a biological and clinical perspective, a significant group of patients with AML with inv(3)(q21q26.2) or t(3;3)(q21;q26.2) with another group of AML carrying different abnormalities of 3q at q21 or q26, the latter named as the AML abn(3q) group. METHODS: We developed a national survey with the participation of 13 Spanish hospitals, and retrospectively reviewed (from 1990 to 2010) these subtypes of AML. Fifty-five patients were collected: 35 with AML inv(3)/t(3;3) and 20 with AML abn(3q). A data collecting page that included main features at diagnosis, therapeutic approach and response, and survival variables, was distributed and completed. RESULTS: We did not find significant differences in sex, age, history of myelodysplastic syndrome or chemo-/radiotherapy, clinical presentation, WBC and platelet counts, hemoglobin level, blasts immunophenotype, serum lactatedehydrogenase, peripheral blood and bone marrow cellular dysplasia, and bone marrow biopsy findings. Although the association with monosomy 7 was significantly more frequent in AML inv(3)/t(3;3), this did not seem to influence outcome. The lack of response to the different modalities of treatment and the aggressive course of the disease were the standard in both cohorts of patients. DISCUSSION: Although not yet recognized by the World Health Organization classification, our results are in agreement with the findings of other authors, who include both subsets of AML together in the same group of adverse prognosis. CONCLUSION: In an attempt to simplify and bound entities with similar genetic background and clinical behavior, it would be desirable to bring together both subgroups of AML in a single section.

Interobserver variance in myelodysplastic syndromes with less than 5 % bone marrow blasts: unilineage vs. multilineage dysplasia and reproducibility of the threshold of 2 % blasts.

Previous studies have shown the reproducibility of the 2008 World Health Organization (WHO) classification in myelodysplastic syndromes (MDS), especially when multilineage dysplasia or excess of blasts are present. However, there are few data regarding the reproducibility of MDS with unilineage dysplasia. The revised International Prognostic Scoring System R-IPSS described two new morphological categories, distinguishing bone marrow (BM) blast cell count between 0-2 % and >2- < 5 %. This distinction is critical for establishing prognosis, but the reproducibility of this threshold is still not demonstrated. The objectives of our study were to explore the reliability of the 2008 WHO classification, regarding unilineage vs. multilineage dysplasia, by reviewing 110 cases previously diagnosed with MDS, and to study whether the threshold of ≤2 % BM blasts is reproducible among different observers. We used the same methodology as in our previous paper [Font et al. (2013) Ann Hematol 92:19-24], by encouraging investigators to include patients with <5 % BM blasts. Samples were collected from 11 hospitals and were evaluated by 11 morphologists. Each observer evaluated 20 samples, and each sample was analyzed independently by two morphologists. Discordance was observed in 36/108 suitable cases (33 %, kappa test 0.503). Diagnosis of MDS with unilineage dysplasia (refractory cytopenia with unilineage dysplasia (RCUD), refractory anemia with ring sideroblasts (RARS) or unclassifiable MDS) was assessed in 33 patients, by either of the two observers. We combined this series with the cases with RCUD or RARS included in our 2013 paper, thus obtaining 50 cases with unilineage dysplasia by at least one of the observers. The whole series showed very low agreement regarding RCUD (5/23, 21 %) and RARS (5/28, 18 %). Regarding BM blast count, the threshold of ≤2 % was not reproducible (discordance rate 32/108 cases, kappa test 0.277). Our study shows that among MDS WHO 2008 categories, interobserver discordance seems to be high in cases with unilineage dysplasia. We also illustrate that the threshold of ≤2 % BM blasts as settled by the R-IPSS may be not easy to reproduce by morphologists in real practice.

Inhibidor adquirido del factor V: una causa infrecuente de alargamiento de los tiempos de coagulación / Acquired inhibitor of factor V: an uncommon cause of prolonged coagulation tests

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