Localización atípica de metástasis de carcinoma de ovario detectada con 18F-FDG PET/TC / Atypical location of metastatic ovarian carcinoma detected by 18F-FDG PET/CT

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Servicio de sistemas personalizados de dosificación: coste del servicio frente al margen de los medicamentos / Unit dose drug distribution systems: direct service cost versus pharmaceutical fees

Introducción: La preparación de sistemas personalizados de dosifi cación (SPD) dentro del servicio de seguimiento farmacoterapéutico (SFT) ha demostrado ser un instrumento que mejora la adherencia terapéutica del paciente. Para la valoración de su remuneración se analiza el coste de este servicio y si el margen de los medicamentos dispensados e incluidos en el SPD cubre su prestación. Objetivos: Establecer un análisis de costes del servicio; averiguar si, en pacientes polimedicados tipo, el margen de los medicamentos incluidos en el SPD cubre los costes, y conocer el número de medicamentos que deberían incluirse cuyo margen cubra la prestación del servicio. Material y métodos: Para el análisis del coste del servicio, se ha considerado el coste de la preparación del SPD y de la intervención farmacéutica más el coste directo del material utilizado. En el análisis de pacientes reales, se ha calculado el margen de los medicamentos incluidos en el SPD y se ha comparado con el coste calculado de la prestación del servicio. Para el análisis del número de medicamentos, se ha tomado como referencia el precio medio de los medicamentos dispensados al CatSalut y el margen medio actual. Resultados: El coste del servicio por paciente y mes (4 semanas) se ha estimado en 19,85 €. Se necesitarían un mínimo de 8 medicamentos para cubrir este coste. Conclusiones: A partir de los casos analizados, se concluye que es muy difícil cubrir el coste del servicio con el margen de los medicamentos dispensados e incluidos en el SPD. La remuneración debe considerar otros aspectos tras evaluar la efi ciencia del servicio(AU)

Introduction: Pharmaceutical care service with unit dose drug distribution systems (UDDDS/PCS) is an instrument that has showed to improve the patient’s therapeutic adherence. To analyze the service’s remuneration is necessary to establish the direct service costs and to know if the pharmaceutical fees of the medicines included in the UDDDS/PCS is enough to covers it. Aims: To establish the direct service costs analysis; to know if, in polymedicated patient type, pharmaceutical fees of the medicines included in the UDDDS/PCS covers the service costs, and to know the number of medicines needed to include in the UDDDS/PCS whose pharmaceutical fees covers the service. Material and methods: It has been considered for the analysis of the service cost, the following aspects: cost of UDDDS/PCS preparation, cost of pharmaceutical intervention and the direct cost of the used material. In the analysis to real patients, it has been calculated the pharmaceutical fees of the medicines included in the UDDDS/PCS and has been compared with the estimated service cost. In order to analyze the number of medicines it has been taken the average price of the medicines dispensed for the CatSalut and the current average margin as a reference. Results: The cost of the service for patient and month (4 weeks) has been estimated in 19.85 €. It would be need a minimum of 8 medicines to cover this cost. Conclusions: It is very difficult to cover service costs through the pharmaceutical fees of the medicines dispensed and included in the PCS. Regarding to the remuneration of the service, it’s necessary to consider other aspects related to service efficiency evaluation(AU)

A propósito de un caso: falso positivo en pelvis en un estudio PET-TAC debido a una reimplantación ovárica / False positive in pelvis in a PET-CT scan due to ovarian reimplantation: a case report

Presentamos el caso de una mujer de 36 años con antecedente de una neoplasia de cérvix, tratada quirúrgicamente, a la que se le realiza un estudio PET-TAC para caracterizar unas adenopatías inguinales de nueva aparición. La PET mostró 2 nódulos hipermetabólicos pélvicos, sugestivos de corresponder a un implante y a una adenopatía tumoral, respectivamente. Tras una reevaluación clínica y con un nuevo estudio PET-TAC, se evidenció que dichos focos de captación correspondían a actividad fisiológica de fluordesoxiglucosa secundaria a la ovulación en una paciente con reimplantación ovárica. Este artículo muestra la importancia de disponer de una información clínica exhaustiva de los pacientes antes de valorar los estudios. Asimismo, realizamos una revisión bibliográfica sobre el carcinoma de cérvix y el comportamiento metabólico de los anejos en relación con el ciclo menstrual en mujeres premenopáusicas(AU)

We present the case of a 36-year-old premenopausal woman with a background of surgically-treated cervical neoplasm. She underwent a positron emission tomography-computed tomography (PET-CT) for evaluation of the new appearance of abnormal inguinal lymph nodes. The study showed two hypermetabolic nodules in the pelvic region suggestive of corresponding to an implant and to tumor involvement of the lymph node, respectively. After a clinical evaluation and a new PET-CT scan, it was considered that these uptake foci corresponded to physiological activity of the FDG secondary to ovarian activity in a patient with ovariopexy. This article shows the importance of having complete clinical information about the patients before evaluating the studies. We also present a review of the medical literature on the cervical neoplasm and metabolic behavior of the adnexa in relationship with the menstrual cycle of pre-menopausal women(AU)

[False positive in pelvis in a PET-CT scan due to ovarian reimplantation: a case report]. / A propósito de un caso: falso positivo en pelvis en un estudio PET-TAC debido a una reimplantación ovárica.

We present the case of a 36-year-old premenopausal woman with a background of surgically-treated cervical neoplasm. She underwent a positron emission tomography-computed tomography (PET-CT) for evaluation of the new appearance of abnormal inguinal lymph nodes. The study showed two hypermetabolic nodules in the pelvic region suggestive of corresponding to an implant and to tumor involvement of the lymph node, respectively. After a clinical evaluation and a new PET-CT scan, it was considered that these uptake foci corresponded to physiological activity of the FDG secondary to ovarian activity in a patient with ovariopexy. This article shows the importance of having complete clinical information about the patients before evaluating the studies. We also present a review of the medical literature on the cervical neoplasm and metabolic behavior of the adnexa in relationship with the menstrual cycle of pre-menopausal women.

Effectiveness of a Surgery Admission Unit for patients undergoing major elective surgery in a tertiary university hospital.

BACKGROUND: The increasing demand on hospitalisation, either due to elective activity from the waiting lists or due to emergency admissions coming from the Emergency Department (ED), requires looking for strategies that lead to effective bed management. The aim of this study was to evaluate the effectiveness of a surgery admission unit for major elective surgery patients who were admitted for same-day surgery. METHODS: We included all patients admitted for elective surgery in a university tertiary hospital between the 1st of September and the 31st of December 2006, as well as those admitted during the same period of 2008, after the introduction of the Surgery Admission Unit. The main outcome parameters were global length of stay, pre-surgery length of stay, proportion of patients admitted the same day of the surgery and number of cancellations. Differences between the two periods were evaluated by the T-test and Chi-square test. Significance at P < 0.05 was assumed throughout. RESULTS: We included 6,053 patients, 3,003 during 2006 and 3,050 patients during 2008. Global length of stay was 6.2 days (IC 95%:6.4-6) in 2006 and 5.5 days (IC 95%:5.8-5.2) in 2008 (p < 0.005). Pre-surgery length of stay was reduced from 0.46 days (IC 95%:0.44-0.48) in 2006 to 0.29 days (IC 95%:0.27-0.31) in 2008 (p < 0.005). The proportion of patients admitted for same-day surgery was 67% (IC 95%:69%-65%) in 2006 and 76% (IC 95%:78%-74%) in 2008 (p < 0.005). The number of cancelled interventions due to insufficient preparation was 31 patients in 2006 and 7 patients in 2008. CONCLUSIONS: The implementation of a Surgery Admission Unit for patients undergoing major elective surgery has proved to be an effective strategy for improving bed management. It has enabled an improvement in the proportion of patients admitted on the same day as surgery and a shorter length of stay.

WITHDRAWN: A MVSA approach to mine information from APT data.

This article has been withdrawn at the request of the author. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

COPD case finding by spirometry in high-risk customers of urban community pharmacies: a pilot study.

BACKGROUND: COPD case finding is currently recommended at primary and tertiary care levels only. AIM: To evaluate the feasibility of a community pharmacy program for COPD case finding in high-risk customers by means of spirometry. METHODS: Pilot cross-sectional descriptive study in 13 urban community pharmacies in Barcelona, Spain, from April to May 2007. Customers >40 years old with respiratory symptoms and/or a history of smoking were invited to participate in the study during pharmacists' routine work shifts. High-risk customers were identified by means of a 5-item COPD screening questionnaire based on criteria of the Global Initiative for Chronic Obstructive Lung Disease, and were invited to perform spirometry accordingly. Those with an FEV(1)/FVC ratio less than 0.70 were referred to the hospital for a repeat spirometry. RESULTS: Of the 161 pharmacy customers studied, 100 (62%) scored 3 or more items in the COPD screening questionnaire, and after spirometry, 21 (24%) had an FEV(1)/FVC ratio<0.7. When these subjects with airflow limitation were offered referral to a hospital respiratory function laboratory for further assessments, 11 (52%) attended the appointment. Over 70% of spirometries were rated as being of acceptable quality. No significant differences were observed in lung function parameters between the pharmacy and hospital measurements. CONCLUSIONS: COPD case finding by spirometry in high-risk customers of urban community pharmacies is feasible. Similarly to primary care practitioners, pharmacists have access to high-risk, middle-aged subjects who have never been tested for COPD. Pharmacists can help with early detection of COPD if they are correctly trained.

Comparación entre la actuación hospitalaria y la de Atención Primaria ante las crisis hipertensivas / Comparison between hospital action and that of primary health care for hypertensive episodes

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Ética del tratamiento hormonal sustitutivo de la menopausia con estrógenos y gestágenos / Ethics of hormone replacement therapy with estrogens and gestagens in menopause

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[Troponine T as possible myocardial injury marker. Its application in myocardial stunning and silent ischemia]. / La troponina T como posible marcador del daño miocárdico menor. Su aplicación en el miocardio aturdido y en la isquemia silente.

INTRODUCTION AND OBJECTIVES: The need for more specific, more sensitive and earlier biochemical markers of acute myocardial infarction, has led to the development of alternative methods to CK-MB). The aim of this work is to assess the usefulness of TnT measurement, in comparison with other markers for detecting transitory ischemic processes without necrosis in some experimental models. METHODS: The plasma levels of Troponine T, CK, CK-MB and adenosine were assessed as markers of ischemic myocardial injury. Two protocols were used: in Series I and II very brief (2 min ischemia with 3-min reperfusion) repeated (20 episodes) ischemias were induced, while Series III involved a single 15-min ischemia with a 60-min reperfusion. In Series I the coronary occlusor was placed close to the anterior descending coronary artery (AD); in Series II and III it was placed distally in the AD. Blood samples were taken from the peripheral vein (PVB) and corresponding coronary segment vein; in a basal situation, during ischemia, upon reperfusion, after 24 hours, and after 5 and 10 days. The plasma levels of adenosine, troponine T, CK and CK-MB as well as general and regional function parameters were measured. RESULTS: In Series I we observed hypokinesis that lasted 10 days, reaching its maximum on days 4-5. In Series II and III regional function was restored by 24 hours. CK and CK-MB showed similar behaviour; they rose significantly when the chest was opened (p < 0.05) reaching the highest value at 24 hours in all the series. Adenosine rose significantly only during reperfusion (p < 0.05). Troponine T increased after ischemia but not before, remained high for 5 days in all series (PVB). CONCLUSIONS: Troponine T rises in absence of necrosis, preferably when the ischemia is longer.

Analysis of genes involved in 6-deoxyhexose biosynthesis and transfer in Saccharopolyspora erythraea.

Glycosylation represents an attractive target for protein engineering of novel antibiotics, because specific attachment of one or more deoxysugars is required for the bioactivity of many antibiotic and antitumour polyketides. However, proper assessment of the potential of these enzymes for such combinatorial biosynthesis requires both more precise information on the enzymology of the pathways and also improved Escherichia coli-actinomycete shuttle vectors. New replicative vectors have been constructed and used to express independently the dnmU gene of Streptomyces peucetius and the eryBVII gene of Saccharopolyspora erythraea in an eryBVII deletion mutant of Sac. erythraea. Production of erythromycin A was obtained in both cases, showing that both proteins serve analogous functions in the biosynthetic pathways to dTDP-L-daunosamine and dTDP-L-mycarose, respectively. Over-expression of both proteins was also obtained in S. lividans, paving the way for protein purification and in vitro monitoring of enzyme activity. In a further set of experiments, the putative desosaminyltransferase of Sac. erythraea, EryCIII, was expressed in the picromycin producer Streptomyces sp. 20032, which also synthesises dTDP-D-desosamine. The substrate 3-alpha-mycarosylerythronolide B used for hybrid biosynthesis was found to be glycosylated to produce erythromycin D only when recombinant EryCIII was present, directly confirming the enzymatic role of EryCIII. This convenient plasmid expression system can be readily adapted to study the directed evolution of recombinant glycosyltransferases.

Endogenous glutathione-binding proteins of insect cell lines: characterization and removal from glutathione S-transferase (GST) fusion proteins.

After affinity purification on immobilized glutathione, insect-cell-derived glutathione S-transferase (GST) fusion proteins contain variable amounts of protein contaminants of about 23-24 kDa. We have isolated these glutathione-binding proteins from the widely used Sf9 and Hi5 insect cell lines and characterized them by LC-MS and N-terminal sequencing. Based on the observation that these proteins have higher affinity for glutathione than GST fusions, we have found that by using differential elution conditions the amount of such contaminants in GST fusion preparations can be strongly reduced directly during the affinity purification step. The main interest of these results is that they are not restricted to a specific construct, but rather they seem to apply to various insect-cell-derived GST fusions.

Enzymatic activity of two caspases related to interleukin-1beta-converting enzyme.

Interleukin-1beta-converting enzyme is a member of a family of human cysteine proteases with specificity for aspartic acid, which have been named caspases. Within this family of enzymes, transcript X (TX) and transcript Y (TY) (caspases 4 and 5, respectively) are very similar to ICE (caspase 1) and form the ICE subfamily. Given the high degree of conservation in the sequences of these proteases (more than 50% amino acid identity in the mature enzymes), it was of interest to examine whether they shared similar substrate specificities. The three enzymes, ICE, TX and TY, were therefore expressed in baculovirus-infected insect cells, as 30-kDa proteins lacking the propeptide. Automaturation into p20 and p10 subunits occurred within the cells. Active ICE, TX and TY were collected in the cell culture supernatants. In addition, their production induced the activation of an endogenous 32-kDa putative cysteine protease (CPP32) like caspase. T7-tagged ICE, TX and TY were purified by immunoaffinity and tested for their catalytic efficiency on YVAD-containing synthetic substrates and on the ICE natural substrate, pro-interleukin-1beta. TX cleaved the same synthetic substrates as ICE (Km of 90 microM and k(cat) of 0.4 s(-1) for Suc-YVAD-NH-Mec, where Suc represents succinyl and NH-Mec represents amino-4-methylcoumarin) and could cleave pro-interleukin-1beta into the same peptides as ICE but less efficiently. On the other hand, TY showed very little efficacy on the different ICE substrates (Km of 860 microM for Suc-YVAD-NH-Mec). These results show that the ICE/TX/TY subfamily has functional heterogeneity and that ICE remains the preferred enzyme for pro-interleukin-1beta cleavage.

Partial purification and characterization of a tumor necrosis factor-alpha converting activity.

Tumor necrosis factor (TNF)-alpha is initially synthesized as an extracellular membrane-associated 26-kDa protein that is further cleaved at Ala76-Val77 to yield the soluble 17-kDa form. Recently, peptide-hydroxamate metalloproteinase inhibitors have been reported to block the proteolytic processing of TNF-alpha, thus suggesting that the putative TNF-alpha converting enzyme (TACE) is a zinc-dependent metalloendopeptidase. In this report, we characterize a TNF-alpha converting activity (TACA) that cleaves in vitro the human 26-kDa TNF-alpha at the physiological processing site. The chromatography steps followed for purification and the use of a panel of proteinase inhibitors indicate that the enzyme responsible for TACA is a membrane glycosylated metalloendopeptidase which is most likely different from the matrix-degrading metalloproteinases. The failure of TACA to process a Val77-->Gly77 precursor mutant emphasizes the importance of hydrophobic residue at P1' position. In addition, TACA is not able to cleave the mouse pro-TNF-alpha and does not catalyze in vitro the processing of other transmembrane proteins susceptible to metalloproteinase-mediated shedding, such as interleukin-6 or TNF receptors. These studies suggest the existence of an enzyme specific for TNF-alpha within the metalloproteinases involved in the processing/shedding of a number of cytokines and cytokine receptors.

Dysfunctional uterine bleeding and dysmenorrhea.

Normal menstruation involves the breakdown, remodelling and repair of the functional endometrial layers. Endometrial destruction and regeneration are largely controlled local factors, that are dependent on the levels of estradiol and progesterone. Prostaglandins and endothelins appear to be powerful vasoactive substances in the control of menstrual blood loss. The tissue endothelin concentration may interact with relaxing factors, such as nitric oxide, prolonging or increasing menstrual blood loss. Disturbances of menstrual bleeding and dysmenorrhea are a major medical problem not only for women but also for their families and health services. Management of dysfunctional uterine bleeding is determined by the needs of the patient: oral contraceptives are used for women of reproductive age with ovulatory uterine bleeding episodes who also require contraception; they have a strong progestogenic effect that is evident as early as the first week of pill intake. In the perimenopausal patient, dysfunctional uterine bleeding may be treated by cyclic progestins with or without conjugated equine estrogens; oral contraceptives can also be used in non-smokers who have no evidence of vascular disease. Dysmenorrhea is defined as a complaint of pain experienced during or immediately before menstruation. In the pathogenesis of dysmenorrhea, prostaglandins and arachinodonic acid metabolites play an important role, being elevated in women with dysmenorrhea. Oral contraceptives are very effective in the treatment of dysmenorrhea; they act mainly by reducing the levels of the prostaglandins and arachinodonic acid metabolites. For women reluctant to take oral contraceptives, non-steroidal anti-inflammatory drugs may be a better option.

Endothelial toxicity of ceftazidime in anterior chamber irrigation solution.

Due to the high toxicity of aminoglycoside antibiotics, many authors prefer to use third generation cephalosporines in the prophylaxis and treatment of intraocular infections. The aim of the present study was to determine safe ceftazidime levels in anterior chamber irrigation solution. Twenty-two eyes of 12 white New Zealand rabbits were divided into six groups of two animals each. Double paracentesis was performed in both eyes, irrigating the right eye with 250 ml of BSS-Plus (BSS+) solution, and the left eye with 250 ml of BSS+ solution with increasing concentrations of ceftazidime (2, 3, 4, 6 and 8 mg ml-1). Each rabbit was killed at the end of surgery, except the last group, which received BSS+ and BSS+ with 8 mg ml-1 of ceftazidime, respectively, in one eye, and were then killed 24 hr later. Endothelial lesions were assessed by silver nitrate staining. We considered lesions endothelial silver affinity ranging from minimal (1-2+) to intense (3-4+). 1-2+ silver affinity was found in 4 +/- 1.35% of endothelial cells in the controls; this percentage in turn increased with antibiotic concentration (6.1 +/- 1.13%, 6.7 +/- 0.4%, 7.2 +/- 1.36%, 7.3 +/- 1.93% and 7.5 +/- 1.83%, respectively). The percentage of 3-4+ silver affinity was 0.18 +/- 0.17% in the controls, and likewise increased with antibiotic concentration (0.22 +/- 0.11%, 0.37 +/- 0.09%, 2.8 +/- 0.63% and 3.1 +/- 0.46%, respectively). The increase in affinity was greatest up to the 4 mg ml-1 concentration. In the last group there were zones of endothelial alterations in morphology and size, with signs of attempted repair in the eye treated with antibiotic, but none in the case treated only with BSS+. Ceftazidime concentrations above 3 mg ml-1 in intraocular infusions induce endothelial cell toxicity.

Effect of hyperlipidemic diets, proinflammatory agents and plasma expanders on leukocyte adhesion to the endothelium of aorta and carotid artery of rats.

A comparative study of leukocyte adhesion to the endothelium of the thoracic aorta and left carotid artery in rats has been performed after administration of two hyperlipidemic diets for 15 days, proinflammatory agents (thrombin, lipopolysaccharide and zymosan activated serum) and plasma expanders [dextran, polyvinylpyrrolidone (PVP), rat albumin and several bovine albumins from different sources]. Leukocytes adhered to the endothelium were demonstrated in surface preparations by esterase activity. Activation of circulating leukocytes was measured by nitroblue tetrazolium reduction and luminol enhanced chemiluminescence. Both hyperlipidemic diets produced, in all rats, more leukocyte adhesion in the aorta than in the carotid artery. All proinflammatory agents produced at 1 h, increases in leukocyte adhesion--which in all rats were greater in the carotid artery than in the aorta--and leukocyte activation, which was higher at 3 h than at 1 h. Dextran, PVP, bovine albumins 103700 and A-4503 at 18 h produced slight increases in leukocyte adhesion in the aorta but not in the carotid artery. Rat albumin and bovine albumin A-7906 determined an intense leukocyte adhesion at 18 h which was not preferential to either vessel. Adhesion produced by A-7906 was maximal at 12 h and partially inhibited by dexamethasone. This last albumin produced leukocyte activation at 3 h and was sequestered 5 min after administration, reaching normal values at 1 h. Albumins 103700 and A-4503 neither activated leukocytes nor were sequestered after administration.