High-dose-rate plesiotherapy with customized molds in non-melanoma skin cancer: efficacy and safety at 10 years—single institution experience

PurposeOur center adopted high-dose-rate brachytherapy with surface applicators (plesiotherapy) in 2008, creating custom molds to treat irregular areas. This study describes the efficacy and safety outcomes after extensive follow-up in the patients.Methods/patientsWe planned the treatment using two computed tomography (CT) scans: the first to delineate the lesion and the second after placing the thermoplastic mold. Fusing the two CT images enables planning of the target volume and pinpointing, where the catheters are in the mold.ResultsSeventy patients received plesiotherapy, either exclusively or following excision in patients with risk factors for recurrence. Those receiving plesiotherapy alone showed a complete response rate of 95.8%, and recurrences occurred in 5.7% at a mean follow-up of 96.2 months. Chronic toxicity appeared in 26.6% of patients, but severity was limited to grade 1 or 2.ConclusionsHigh-dose-rate brachytherapy with customized molds yields a high rate of complete response, with long-term recurrence rates in line with similar studies and an acceptable toxicity rate.

Hernia enlargement and pancreatitis in a patient with short bowel syndrome treated with teduglutide / Crecimiento de hernias y pancreatitis en una paciente con síndrome de intestino corto tratada con teduglutida

Introduction: teduglutide (TED) is indicated for the treatment of patients with short-bowel syndrome (SBS) who are dependent on parenteral support. Case report: we report the case of a 60-year-old woman with SBS treated with TED. She had previously undergone multiple surgical resections due to Crohn's disease. Her remnant bowel included only the duodenum and 50-60 centimeters of jejunum. The patient was dependent on intravenous fluids (2,320 mL/48 h) and had a high stoma output (3,000 mL/day). After four months of TED the jejunostomy output had decreased to 2,200 mL/day with a thicker consistency, and intravenous fluid therapy was reduced to 2,010 mL/48 h. TED was withdrawn due to acute pancreatitis and enlargement of two supraumbilical hernias with high strangulation risk. Discussion: pancreatitis has been reported in clinical studies, and determination of amylase and lipase is recommended in all patients receiving TED. In contrast, there are no recommendations for the surveillance of hernia enlargement in patients on TED therapy, but we suggest the need for surveillance based on this case report (AU)

Introducción: la teduglutida (TED) está indicada para el tratamiento de pacientes con síndrome de intestino corto (SBS) que precisen soporte parenteral. Caso clínico: mujer de 60 años con SBS tratada con TED. Previamente se había sometido a múltiples resecciones quirúrgicas por su enfermedad de Crohn. Su intestino remanente incluía el duodeno y 50-60 centímetros de yeyuno. La paciente era dependiente de líquidos por vía intravenosa (2320 ml/48 h) y tenía una ostomía de alto débito (3000 ml/día). Después de cuatro meses de TED, el débito de la yeyunostomía disminuyó a 2200 ml/día, con una consistencia más espesa, y la fluidoterapia intravenosa se redujo a 2010 ml/48 h. Se retiró la TED por pancreatitis aguda y agrandamiento de dos hernias supraumbilicales con alto riesgo de estrangulamiento. Discusión: se han descrito casos de pancreatitis en estudios previos, por lo que se recomienda la determinación de la amilasa y la lipasa en los pacientes tratados con TED. Sin embargo, no hay recomendaciones específicas sobre la vigilancia del agrandamiento de hernias, pero sugerimos su idoneidad basada en este caso clínico (AU)

High-dose-rate plesiotherapy with customized molds in non-melanoma skin cancer: efficacy and safety at 10 years-single institution experience.

PURPOSE: Our center adopted high-dose-rate brachytherapy with surface applicators (plesiotherapy) in 2008, creating custom molds to treat irregular areas. This study describes the efficacy and safety outcomes after extensive follow-up in the patients. METHODS/PATIENTS: We planned the treatment using two computed tomography (CT) scans: the first to delineate the lesion and the second after placing the thermoplastic mold. Fusing the two CT images enables planning of the target volume and pinpointing, where the catheters are in the mold. RESULTS: Seventy patients received plesiotherapy, either exclusively or following excision in patients with risk factors for recurrence. Those receiving plesiotherapy alone showed a complete response rate of 95.8%, and recurrences occurred in 5.7% at a mean follow-up of 96.2 months. Chronic toxicity appeared in 26.6% of patients, but severity was limited to grade 1 or 2. CONCLUSIONS: High-dose-rate brachytherapy with customized molds yields a high rate of complete response, with long-term recurrence rates in line with similar studies and an acceptable toxicity rate.

Estatus epiléptico: seguimiento e individualización farmacoterapéutica / Status epilepticus: follow-up and pharmacotherapy individualization

El estatus epiléptico superrefractario es un cuadro muy grave que pone en riesgo la vida de los pacientes. En este sentido, la monitorización rigurosa de los antiepilépticos es clave para un desenlace favorable. La excepcionalidad del caso presentado radica en la superrefractariedad del cuadro, que dificultó su manejo terapéutico y requirió un elevado grado de implicación del farmacéutico hospitalario en el seno de un equipo multidisciplinar. (AU)

Super-refractory epileptic status is a really serious and life-threatening condition. In this sense, rigorous monitoring of antiepileptic drugs is key to a favourable outcome. The exceptionality of the case presented lies in the super-refractoriness of the clinical profile, which made its therapeutic management difficult and required a high degree of involvement of the pharmacist’s hospital within a multidisciplinary team. (AU)

Grado de acuerdo entre la acelerometría y el Cuestionario Internacional de Actividad Física en pacientes supervivientes de cáncer de mama / Level of agreement between accelerometry and the International Physical Activity Questionnaire in breast cancer survivors

Objetivo primario: Analizar el grado de acuerdo entre la medida autoinformada provista por el International Physical Activity Questionnaire (IPAQ) y la medida objetiva aportada por los acelerómetros (ActiGraph) en mujeres supervivientes a un cáncer de mama. Objetivo secundario: Evaluar la percepción de sensación de fatiga de estas pacientes, así como su estado de ánimo y la fuerza prensil. También quisimos comprobar la relación entre el soporte social y la práctica de actividad física. Material y método: Las 10 participantes llevaron un acelerómetro 9 días y a su retirada completaron los cuestionarios IPAQ, PIPER, POMS, uno de valoración de su soporte social y se tomaron medidas de la dinamometría de ambas manos. Se procedió al análisis inferencial usando el coeficiente de correlación de Spearman (rs) entre la AF total y las diferentes categorías por intensidad contabilizada por el ActiGraph, y la recogida por el IPAQ. Los datos fueron comparados en min/día realizando actividad sedentaria, ligera, moderada o intensa. Resultados: No se encontró concordancia entre los datos arrojados por ambos instrumentos, a excepción de la categoría sedentaria/sentado, con un rs=0,714 (p=0,02). Los minutos/día totales de AF del acelerómetro ha sido un 263% más elevados que del cuestionario, por lo que este último infravalora la AF. Respecto a las dimensiones emocionales evaluadas, la confusión/aturdimiento se relacionó significativamente con la sensación de fatiga (rs=0,85, p=0,002) y la fatiga total (rs=0,71, p=0,02). También apareció una relación inversa entre vigor/actividad y la dimensión cognitiva de la fatiga (rs=-0,63, p=0,04). La sensación de fatiga/inercia también se relacionó inversamente con la fuerza prensil de la mano del lado intervenido. También fue inversa la relación entre el soporte familiar y de amigos y el tiempo en posición tumbado o en decúbito (rs=-0,77, p=0,008 y rs=-0,84, p=0,002, respectivamente) y entre este apoyo de los amigos y la rabia/hostilidad (rs=-0,64, p=0,04) Conclusiones: Había un grado de acuerdo limitado en la medida de la AF y las conductas sedentarias del IPAQ y del Actigraph. El primero no parece ser muy adecuado para esta población, y para el acelerómetro necesitaríamos valores de referencia más en consonancia con estas mujeres

Primary objective: To analyse the level of agreement between that measured by the self-report provided by the IPAQ (International Physical Activity Questionnaire) and the objective measurement provided by accelerometers (ActiGraph) in breast cancer patients. Secondary objective: To evaluate the perception of their fatigue in these patients, as well as their state of mind and prehensile strength. An attempt was also made to determine the relationship between social support and the practice of physical activity. Material and method: The 10 patients carried an accelerometer for 9 days, and afterwards they completed the IPAQ, Piper Fatigue Scale (PFS), and Profile of Mood States (POMS) questionnaires. Their social support was also assessed, and dynamometry measurements were taken on both hands. An inferential analysis was performed using the Spearman correlation coefficient (rs) between the total physical activity (PA) and the different categories by the intensity measured by ActiGraph, and that recorded in the IPAQ. The data were compared in minutes/day of sedentary, light, moderate or intense activity. Results: No agreement was found between the data provided by both tools, with the exception of the sedentary/seated category with a Spearman coefficient (rs) of 0.714 (P=.02). The total minutes/day of the accelerometer was 263% higher than the questionnaire, thus this latter undervalued the PA. As regards the emotional dimensions evaluated, confusion/bewilderment was significantly associated with feeling of fatigue (rs=0.85, P=.002), and total fatigue (rs=0.71, P=.02). An inverse relationship was also observed between vigour/activity and cognitive dimension of fatigue (rs=-0.63, P=.04). The feeling of fatigue/inertia was also inversely associated with prehensile strength of the hand on the side of the intervention. There was also an inverse relationship between family and friends support and the time in the lying down or decubitus position (rs=-0.77, P=.008 and rs=-0.84, P=.002, respectively) and between this support by friends and anger/hostility (rs=-0.64, P=.04)Conclusions: There was a limited level of agreement in the measurement of PA and sedentary behaviours of the IPAQ and Actigraph. The first one does not seem to very suitable for this population, and reference values more in line with these women are needed for the accelerometer

What PEEP level should I use in my patient? / ¿Qué nivel de PEEP debería utilizar en mi paciente?

No disponible

Prevention of acute radiation enteritis: efficacy and tolerance of glutamine.

PURPOSE Our primary endpoint is to determine the effect of L-glutamine Resource (Nestlé Healthcare Nutrition) in the prevention of induced enteritis after pelvic radiotherapy (RT). METHODS We observed the incidence of diarrhoea during and after pelvic radiation therapy in patients receiving L-glutamine Resource (Nestlé Healthcare Nutrition) supplementation. To assess results, patients were stratified according to prior treatment (prior surgery and/or concomitant chemotherapy, or no prior or concomitant treatment). RESULTS Incidence of diarrhoea observed is similar to published series in which glutamine is not administered. Grade 1 intestinal toxicity was observed in 4 patients (15.4%), grade 2 in 10 patients (38.4%) and grade 3 in 5 patients (19.2%). Mean dose of RT at the start of enteritis was 23.55 Gy (12-40). No grade 4 toxicity occurred and in 7 patients (27%) no toxicity was reported. No differences in toxicity incidence were observed between RT dose levels. CONCLUSIONS Administration of glutamine to patients during pelvic RT does not appear to prevent the incidence of enteritis (diarrhoea). No differences were observed between patients who underwent concomitant chemotherapy (where you would expect an increase in toxicity) and those who did not.

Prevention of acute radiation enteritis: efficacy and tolerance of glutamine

PURPOSE Our primary endpoint is to determine the effect of L-glutamine Resource (Nestlé Healthcare Nutrition) in the prevention of induced enteritis after pelvic radiotherapy (RT). METHODS We observed the incidence of diarrhoea during and after pelvic radiation therapy in patients receiving L-glutamine Resource (Nestlé Healthcare Nutrition) supplementation. To assess results, patients were stratified according to prior treatment (prior surgery and/or concomitant chemotherapy, or no prior or concomitant treatment). RESULTS Incidence of diarrhoea observed is similar to published series in which glutamine is not administered. Grade 1 intestinal toxicity was observed in 4 patients (15.4%), grade 2 in 10 patients (38.4%) and grade 3 in 5 patients (19.2%). Mean dose of RT at the start of enteritis was 23.55 Gy (12-40). No grade 4 toxicity occurred and in 7 patients (27%) no toxicity was reported. No differences in toxicity incidence were observed between RT dose levels. CONCLUSIONS Administration of glutamine to patients during pelvic RT does not appear to prevent the incidence of enteritis (diarrhoea). No differences were observed between patients who underwent concomitant chemotherapy (where you would expect an increase in toxicity) and those who did not (AU)

Neuroendocrine small cell carcinoma of the uterine cervix

Neuroendocrine small cell carcinoma of the uterine cervix (SCC) is a rare disease that mixes clinical and biological characteristics of both cervical neoplasms and neuroendocrine small cell cancer. The prognosis is poor and the optimal treatment has not yet been clarified. Multimodality treatment, with surgery and concurrent chemoradiation has recently been shown to improve local control and survival rates (AU)

Use of radiation treatment units in breast cancer. Changes in the last 15 years.

INTRODUCTION: Advances in diagnosis and treatment in oncology combined with technical advances in radiotherapy have resulted in qualitative and quantitative changes in the use of radiation to treat breast cancer. OBJECTIVE: The objective was to analyse changes in radiation indications from 1990 to the present time and their consequences in the use of treatments units. METHODS AND MATERIAL: From January 1990 to December 2005, 4545 radiation treatments for breast cancer were performed, classified as radical after conservative surgery, radical after mastectomy or palliative. Data are presented as relative frequencies and as 3-year period groups. RESULTS: An increase in the proportion of treatments for breast cancer and in treatment unit use distribution is observed. Radical treatments have increased over time, ranging from 55% in the first 3-year period group to 82% in the last one. Unit treatment distribution analysis is similar, but with a less important increase, rising from 85% to 95%. A rise in conservative treatment is also observed, from 43% to 75%. CONCLUSIONS: An increase in breast cancer incidence is observed and there was also an increase in irradiation after conservative treatment. On the contrary, probably due to the rise in the use of systemic treatments, a decrease in postmastectomy irradiation and palliative treatments is shown.

Use of radiation treatment units in breast cancer. Changes in the last 15 years

INTRODUCTION: Advances in diagnosis and treatment in oncology combined with technical advances in radiotherapy have resulted in qualitative and quantitative changes in the use of radiation to treat breast cancer. OBJECTIVE: The objective was to analyse changes in radiation indications from 1990 to the present time and their consequences in the use of treatments units.METHODS AND MATERIAL: From January 1990 to December 2005, 4545 radiation treatments for breast cancer were performed, classified as radical after conservative surgery, radical after mastectomy or palliative. Data are presented as relative frequencies and as 3-year period groups. RESULTS: An increase in the proportion of treatments for breast cancer and in treatment unit use distribution is observed. Radical treatments have increased over time, ranging from 55% in the first 3-year period group to 82% in the last one. Unit treatment distribution analysis is similar, but with a less important increase, rising from 85% to 95%. A rise in conservative treatment is also observed, from 43% to 75%. CONCLUSIONS: An increase in breast cancer incidence is observed and there was also an increase in irradiation after conservative treatment. On the contrary, probably due to the rise in the use of systemic treatments, a decrease in postmastectomy irradiation and palliative treatments is shown (AU)

Risk factors of local relapse in breast cancer: the importance of age.

PURPOSE: The objective of the present analysis is to know what risk factors affect local relapse in breast cancer. METHODS AND MATERIALS: A total of 1165 patients diagnosed with early breast cancer were included. Boost dose was modulated in the presence of risk factors. Patients with one risk factor received a boost of 10 Gy, while 20 Gy was administered in those with two risk factors. RESULTS: Median follow-up was of 60 months. Mean age of patients was 56.7+/-10.8 years. Local risk factors were present in 82.8% of patients. The probability of remaining free of local recurrence at 5 and 10 years is 97.7% (CI 95%: 96.7-98.7) and 94.5% (CI 95%: 92.1-96.9). Only age showed an impact in local relapse on multivariate analysis. Patients 40 years or younger had a relative risk of local relapse of 5.27 and patients 41-50 of 3.7 with respect to patients older than 50 years. CONCLUSION: Patients 40 years or younger have a higher risk of local failure than older patients. Other risk factors such as tumour size, intraductal carcinoma or margin status could be masked by an increase of radiation dose.

Risk factors of local relapse in breast cancer: the importance of age

PURPOSE: The objective of the present analysis is to know what risk factors affect local relapse in breast cancer. METHODS AND MATERIALS: A total of 1165 patients diagnosed with early breast cancer were included. Boost dose was modulated in the presence of risk factors. Patients with one risk factor received a boost of 10 Gy, while 20 Gy was administered in those with two risk factors. RESULTS: Median follow-up was of 60 months. Mean age of patients was 56.7+/-10.8 years. Local risk factors were present in 82.8% of patients. The probability of remaining free of local recurrence at 5 and 10 years is 97.7% (CI 95%: 96.7-98.7) and 94.5% (CI 95%: 92.1-96.9). Only age showed an impact in local relapse on multivariate analysis. Patients 40 years or younger had a relative risk of local relapse of 5.27 and patients 41-50 of 3.7 with respect to patients older than 50 years. CONCLUSION: Patients 40 years or younger have a higher risk of local failure than older patients. Other risk factors such as tumour size, intraductal carcinoma or margin status could be masked by an increase of radiation dose (AU)

Prevención de riesgos laborales por tuberculosis / Prevention of occupational risks by tuberculosis

El impacto de la tuberculosis en España es importante. La TB es un riesgo laboral significativo en los trabajadores sanitarios y en aquellos que trabajan en instituciones cerradas y prestan atención a colectivos con alto riesgo de tuberculosis. Los aspectos claves de la prevención son la identificación precoz de los casos, las medidas de protección ambiental y un programa efectivo de control del personal sanitario. A los médicos les corresponde el diagnostico precoz y la instauración del tratamiento correcto y a la empresa el prestar los recursos diagnósticos necesarios y la infraestructura oportuna para el aislamiento respiratorio y las medidas de protección ambiental (AU)

The impact of the tuberculosis in Spain is important. The tuberculosis is a significant occupational risks in the healthcare workers and in those that work in institutions closed and lend attention to collective with high risks of tuberculosis. The key points of the prevention are the premature identification of the cases, the measures of environmental protection and an effective program of control of the healthcare workers. To the doctors corresponds the I diagnose premature and the establishment of the correct processing and to the business the to lend the necessary diagnostic resources and the opportune infrastructure for the respiratory isolation and the measures of environmental protection (AU)