Inmunoterapia y toxicidades inmunorrelacionadas: Experiencia clínica unicéntrica / No disponible

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Utility and interobserver agreement of ultrasound elastography in the detection of malignant thyroid nodules in clinical care.

BACKGROUND AND PURPOSE: Malignancy correlates with hardness of tissues and US elastography can potentially analyze the stiffness of lesions. Our aim was to evaluate the utility of US elastography in the detection of malignant nodules and to investigate interobserver agreement with this technique. MATERIALS AND METHODS: One-hundred three consecutive patients with 106 thyroid nodules were examined prospectively with conventional B-mode sonography and real-time US elastography. All patients were referred for FNAB. Conventional B-mode sonography and US elastographic examinations were performed, and images were separated and independently interpreted by 2 radiologists blinded to pathologic results. US elastogram evaluation was based on a simplified classification of stiffness based on gray-scale patterns, tumor size compared with B-mode, and margins. Interobserver agreement was studied. FNAB was used as the reference standard for the diagnosis of benign nodules, but histopathologic evaluations were performed when results suspicious for malignancy or malignant results were obtained on FNAB as well as in indeterminate lesions. RESULTS: In our study, pattern of stiffness based on gray-scale and classification proposed were statistically significant and predicted malignancy with 100% sensitivity and 40.6% specificity. Tumor size when compared with B-mode images or margins was not statistically significant in our study. No false-negatives were found, and an NPV of 100% was seen. Interobserver agreement for US elastography was excellent in our study, with a κ index of 0.82 (95% CI). CONCLUSIONS: We believe that US elastography is a promising technique that can assist in the evaluation of thyroid nodules and can potentially diminish the number of FNAB procedures needed. We believe that it may be useful to introduce US elastography into routine clinical practice.

Estudio clínico y epidemiológico de la sepsis neonatal de transmisión vertical y nosocomial en nuestro medio / Clinical and epidemiological study of neonatal sepsis of vertical and nosocomial trasmission in our setting

Objetivo. Estudio clínico y epidemiológico de la sepsis neonatal en nuestro medio para conocer su situación actual. Material y métodos. Revisión retrospectiva de los casos de sepsis neonatal confirmada de transmisión vertical (STV) durante un periodo de cinco años (16 casos) y de transmisión nosocomial (STN) en los últimos dos años (85 casos). Se analiza su incidencia y epidemiología, así como los factores de riesgo, presentación clínica, datos de laboratorio, tratamientos empíricos, los gérmenes identificados y su sensibilidad a los antibióticos habituales. Se hizo también estudio comparativo con un grupo control representativo de cada tipo de infección. El estudio estadístico descriptivo y comparativo se ha llevado a cabo con el programa SPSS v15.0 para Windows (AU). Resultados: La incidencia actual de sepsis verticales en nuestro medio es de 1,25 pro 1.000 RN vivos y las nosocomiales representan 1 por cada 50 ingresos. En nuestro estudio todos los casos de STV fueron de etiología bacteriana con excepción de uno por Candida albicans y los gérmenes más frecuentes fueron Streptococcus agalactiae y Escherichia coli. Las STN fueron causadas por bacterias gran positivas, seguidas por las fúngicas y gran negativas. Los principales factores de riesgo obstétricos y perinatales relacionados con la sepsis de transmisión vertical fueron fiebre intraparto, hijo e madre portadora de Streptococcus, CVR desconocido y aguas teñidas, mientras que la STN se asoció principalmente con prematuridad, estancia en UCI y embarazo múltiple. La presentación clínica no mostró diferencias entre ambos tipos de sepsis, predominando la afectación hemodinámica. En cuanto a datos de laboratorio analizados, no se encontraron diferencias significativas respecto a los controles, siendo el hematocrito el único hallazgo positivo (p=0,02). En relación a la aparición de resistencias antimicrobianas, se identificó K. pneumoniae en el 12,8% % de los casos de STN con un 54,5% protadoras de Betalactamasas de spectro extendido (BLEEs). El germen aislado con más frecuencia en nuestro estudio fue el Estafilococo coagulasa negativo (COAS) en un 45,3% de los casos de sepsis nosocomiales seguido por Candida spp con un 26,7%. En nuestra serie, todas las cepas de COAs eran sensibles a la vancomicina excepto una, identificándose también en un caso un S. aureus resistente a la misma. Conclusiones. La incidencia de STV ha disminuido en nuestro medio, no así las nosocomiales que muestran aumento. La etiología de la STV no ha variado ni han aparecido resistencias que justifiquen un cambio de tratamiento. Las STN fueron causadas por bacterias gran positivas, seguidas por las fúngicas y gran negativas. Los principales factores de riesgo obstétricos y perinatales fueron los habituales y en cuanto a datos de laboratorio, sólo el descenso de hematocrito resulto significativo. Hemos constatado un 12,8% de Klebsiella pneumoniae, 54.4% de las cuales eran portadoras de BLEES (AU)

Objective. Clinical and epidemiological study of the nenatal sepsis in our center to know its current situation. Patients and methods. Retrospective review of cases of confirmed sepsis of vertical transmission (STV) for a period of five years (16 cases) nosocomial transmission (STN) in the last two years (85 cases). We have analyzed the incidence, epidemiology and risk factors, clinical presentation, laboratory data, empirical treatments, the sources identified and their sensitivity to common antibiotics. There was also a comparative study with a control group representative of each type of infection. The statistical descriptive and comparative study has been carried our using the program SPSS v15.0 for windows. Results.. the actual incidence of sepsis of vertical transmission in our center is 1.,25 per 1000 RM alive and nosocomial represent 1 per 50 revenue. In our study all the STV´s cases were of bacterial etiology except one for more Candida albicans, the most common germs were Streptococcus agalactiae and Escherichia coli. The STN were caused by gram-positive bacteria, followed by fungal and gram-negative. The main risk factors related to obstetric and perinatal sepsis of vertical transmission were intrapartum fever, carrying of Streptococcus, VR unknown and dyed waters, whereas the STN was associated principally with prematurity, stay in UCI and multiple pregnancy. The clinical presentation did not show differences between both types of sepsis predominant hemodynamic compromise. Regarding laboratory data analyzed they did not show significant differences relative to controls, hematocrit being the only positive finding (p=0.02). In relation to the emergence of microbial resistance, was identified K. pneumoniae in 12,8% Beta-lactamases (ESBLs). The germ most frequently isolated in our study was coagulase negative staphylococcus (COAS) by 45.3% of cases of nosocomial sepsis by Candida spp followed with 26.7%. In our series all strains of COAS were sensitive to vancomycin except one, also identified in one case a S. aureus resistant to it. Conclusions. STV´s incidence has decreased in our center, except for nosocomial sepsis that show increase. The etiology of STV has not changed nor has appeared resistances that justify a change of treatment. STN were caused by gram-positive bacteria, followed by fungal and Gram-negative. The main risk factors were obstetric and perinatal usual and as for the laboratory data alne was significant decreases in hematocrit. We found 12,8% of Klebsiella pneumonia, 54,4€ of whom were carriers of ESBLs (AU)

Microftalmía por deficiencia materna de vitamina A como complicación de derivación biliopancreática: comunicación de un caos / Microphthalmia for maternal vitamina A deficiency: complications of biliopancreatic diversión: report of a case

Los procedimientos quirúrgicos bariáticos pueden ocasionar graves alteraciones nutricionales que pueden afectar a la embriogénesis con riegos potenciales para el feto, pudiendo asociarse con una amplio espectro malformativo principalmente a nivel ocular. Se presenta el caso de una mujer que, tres años después de someterse a una derivación biliopancreática por obesidad mórbida, tuvo un recién nacido a término con una microfatmía bilateral severa. En la madre se confirmó una deficiencia de vitamina A con unos niveles séricos de 0,05 mg/dl (rango normal de 0,3-0,8 mg/dl) y en el recién nacido se realizaron las exploraciones complementarias para descartar otras causas etiológicas asociadas con microftalmía y se evaluó el estado vitamínico A, D, E y K que mostró una concentración también baja de vitamina A (< 0,10 mcg/ml. Rango normal 0,25-0,45 mcg/ml). Se hace una revisión de los principales aspectos relacionados con la deficiencia materna de vitamina A y la anoftamía/microftalmía (AU)

Bariatric surgery can carry important nutritional deficiencies that might impair embryogenesis with potential risks to the fetus. It could be associated with a wide spectrum of fetal malformations, mainly congenital eye malformations. We report the case of a woman who had undergone biliopancreatic diversion 3 years before and gave birth to a child with severe bilateral microphtalmia. The mother had a documented vitamin A deficiency with serum levels of 0,05 mg/dl (normal reference range 0,3-0,8 mg/dl). In the newborn baby other causes of microphthalmia were evaluated, showing low vitamin A levels (<0,10 mcgr/ml, normal range 0,25-0,45 mcgr/ml). The most important aspects related to maternal hypovitaminosis A and microphthalmia/anophtalmia have been checked (AU)

An interview with Purificación García de Miguel, chief of Haematology-Oncology and the Paediatric Bone Marrow Transplantation Unit of the Hospital La Paz, Madrid, and President of the Spanish Society of Paediatric Oncology (SEOP). Interview

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[Respiratory function in pediatric survivors of malignant neoplasms]. / Función respiratoria en niños supervivientes de neoplasia maligna.

AIM: To evaluate post-treatment pulmonary function in patients with malignant extrapulmonary neoplasia and its relationship with age, type of neoplasty and treatment received. METHODS: Cohort study of 95 pediatric patients after chemotherapy with or without surgery or extrapulmonary thoracic radiotherapy. The patients were in remission without treatment and able to undergo pulmonary function testing. Personal history and exposure to risk factors or toxic habits were evaluated. Clinical examination, chest radiographs, pulmonary gammography, basal and stress pulmometry, forced spirometry, whole body phletismography and carbonmonoxide transfer test were performed. RESULTS: Mean age at diagnosis was 5 +/- 3.3 years. Treatment duration was 2.4 +/- 1.3 years and time without treatment 4.3 +/- 3. 3 years. Thirty-six patients were reviewed two and a half years after the first control. Thirty-nine patients had acute lymphoblastic leukemia and 57 had solid tumors. Sixty percent showed functional restriction due to chest deformity after undergoing chest surgery. The association between functional restriction and radiotherapy (6 patients) did not produce poorer functional results. Forty-three percent showed initial change in TLCO. Nineteen percent showed basal hemoglobin saturation under 93% which in 16% fell after physical exercise. These alterations improved with time. However, restrictive change initially present in 11.5% persisted at the second evaluation. Thoracic surgery was the main cause of thoracic deformity and therefore of restrictive change. The children under 8 years old and those who received longer treatments tended to show the worst TLCO values. The patients with neuroblastoma showed greater restrictive change while the change in TLCO was more frequent in patients with Burkitt s lymphoma and in those treated with cyclophosphamide. CONCLUSIONS: Neither personal or family history of respiratory disease nor the presence of symptoms such as cough served to identify risk of functional change. Restrictive change in pulmonary function was greater in patients who had undergone thoracic surgery. Functional values were worse in patients with neuroblastoma. Pulmonary function should be followed up in pediatric survivors of malignant neoplasia in order to prevent restrictive alterations.

Función respiratoria en niños supervivientes de neoplasia maligna / Pulmonary function in pediatric survivors of malignant neoplasty

OBJETIVO: Valorar la función pulmonar postratamiento, en pacientes que padecen neoplasias malignas extrapulmonares y su relación con la edad, tipo de tumor y tratamiento recibido. MÉTODOS: Estudio de una cohorte de 95 pacientes pediátricos tras recibir tratamiento quimioterápico con o sin cirugía o radioterapia torácica extrapulmonar, en fase de remisión sin tratamiento, y capaces de colaborar en la realización de las pruebas de función respiratoria.Se valoraron antecedentes personales y de exposición a factores o hábitos nocivos. Se realizaron controles clínicos, radiografía de tórax, gammagrafía pulmonar, pulxiosimetría basal y de esfuerzo, espirometría forza-da, plestimografía corporal total y transferencia de CO (TLCo). RESULTADOS: Los pacientes presentaron una edad media al diagnóstico de 5 ñ 3,3 años, duración del tratamiento de 2,4 ñ 1,3 años y un tiempo sin tratamiento de 4,3 ñ 3,3 años; 36 de ellos fueron revisados dos años y medio después del primer control; 39 correspondieron a leucemia linfoblástica aguda y 57 a tumores sólidos. El 60 por ciento de los que fueron sometidos a cirugía torácica presentaron deformidad responsable de restricción funcional. La asociación de ésta con radioterapia (6 pacientes) no condicionó peores resultados funcionales. El 43 por ciento presentaron inicialmente alteración de la TLCO, el 19 por ciento SatO2 basal inferior al 93 por ciento y el 16 por ciento un descenso de ésta con el ejercicio. Estas alteraciones mejoraron con el tiempo. Por el contrario, la alteración restrictiva que estuvo presente inicialmente en el 11,5 por ciento persistió en el segundo control. Los pacientes exclusivamente irradiados no presentaron alteración restrictiva con más frecuencia. Los menores de 8 años y los que sufrieron tratamientos más prolongados tendieron a presentar peores valores de TLCO. Los neuroblastomas presentaron mayor alteración restrictiva, mientras que la alteración de la TLCO fue más frecuente en los linfomas tipo Burkitt y en otros pacientes tratados con ciclofosfamida. CONCLUSIÓN: Ni los antecedentes personales, los antecedentes familiares de enfermedad respiratoria ni la presencia de síntomas como la tos sirvieron para identificar el riesgo de alteración funcional. Los pacientes sometidos a cirugía torácica presentaron patología restrictiva; su asociación con tratamiento radioterápico no pareció influir negativamente. Los neuroblastomas presentaron los peores resultados respecto a otro tipo de tumores. Es necesario hacer un seguimiento respiratorio funcional en estos niños a fin de prever posibles secuelas restrictivas (AU)

Immunohistochemical comparative analysis of transforming growth factor alpha, epidermal growth factor, and epidermal growth factor receptor in normal, hyperplastic and neoplastic human prostates.

Immunoreaction to TGF-alpha was limited to the basal epithelial cells of focal areas in the normal prostates. In benign prostatic hyperplasia (BPH) the immunostained areas were more widespread and immunolabelling was observed in both basal and columnar (secretory) cells of the epithelium. Some cells in the connective tissue stroma were also stained. In prostatic adenocarcinoma, epithelial immunostaining was even more extensive and intense than in BPH, and some stromal cells were also stained. Epidermal growth factor (EGF) immunostaining was only present in some basal cells in normal prostates. In BPH, this immunoreaction was strong in the basal cells and even stronger in the secretory cells. In prostatic cancer, the intensity of epithelial cell immunoreactivity was intermediate between that of normal prostates and that of BPH specimens. EGF-receptor immunostaining was focal and located in the basal cells in normal prostates. In BPH, labelling was also localized in basal cells but extended to wider areas. Some stromal cells appeared weakly labelled. In the prostatic carcinoma, both basal and columnar cells appeared stained and the number of immunolabelled stromal cells was higher than in BPH. The results presented suggest that, in normal conditions, EGF and TGF-alpha act as autocrine growth factors for the basal cells of the prostatic epithelium. In BPH this action is maintained and, in addition, the columnar cells start to secrete both factors which are bound by the basal cell receptors, giving rise to a paracrine regulation which probably overstimulates basal cell proliferation. In prostatic carcinoma, besides these regulatory mechanisms, the acquisition of EGF-receptors by the secretory cells develops an autocrine regulation which might induce their proliferation.

Single-centre experience of peripheral blood stem cell transplantation using cryopreservation by immersion in a methanol bath.

A simplified method to remove and cryopreserve peripheral blood stem cells (PBSC) was utilised to restore the bone marrow in 31 patients with haematological or solid neoplasms after ablative chemotherapy. Mobilization was performed with subcutaneous G-CSF, starting 4 days before the first PBSC harvest and continuing to the last day of harvest. Cryopreservation was carried out by freezing cells to -80 degrees C after addition of autologous fresh plasma with DMSO, in a methanol bath and non-programmed freezer. The PBSC were reinfused in all cases. The mean quantity of CD34 cell (x 10(6)/kg) infused was 6.5 +/- 6.7. The mean number of procedures needed to harvest an appropriate number of PBSC was 3.6 +/- 1.3. The mean times necessary to recover more than 0.5 x 10(9)/l granulocytes were 11 +/- 4 (8-30) days and 23 +/- 13 (8-55) days to obtain more than 20 x 10(9)/l platelets. These results confirm our method as very effective in achieving a high-quality harvest, and it was used in paediatric and adult patients without problems. This procedure, using a non-programmed freezer, simplifies and reduces enormously the cost of the technical measures currently used, enabling their adoption in almost any clinical oncological institution.

[Primary pulmonary hypertension. Clinico-pathologic analysis]. / Hipertensión pulmonar primaria. Análisis clínico-patológico.

We present a case of primary pulmonary hypertension, confirmed by open lung biopsy. The interest of the case resides in the microscopic study of the specimen, and the patient's prognosis is discussed. The physiopathology of the disease is reviewed and the palliative therapeutic measures that can be adopted.

Balanced reciprocal translocation (X;20) limited to Wilms' tumor in a Wiedemann-Beckwith syndrome.

A girl aged 4 years 3 months with sporadic unilateral Wilms' tumor associated with Wiedemann-Beckwith syndrome, but without aniridia, was found to have a t(X;20) in the tumor cells. Karyotypes of peripheral blood of the patient and her parents were normal. This translocation was confined to the tumor and not been previously reported either in nephroblastoma or any other neoplastic processes. Although there is no microscopic deletion on chromosome 11 and catalase activity was not decreased, we cannot rule out the possibility of a point mutation or a submicroscopic deletion.

[Sacrococcygeal tumors. Experience of 42 cases]. / Tumores sacrocoxígeos. Experiencia en 42 pacientes.

From 1966 to 1981, at "La Paz" Children's Hospital, Madrid, 42 patients with ST were studied. We exclude 4 stillborn, the remaining 38 underwent 40 surgical operations, 69% in the first week of life. The aim of the study is to classify and organize from the clinical and pathological points of view the usual equivocal terminology. From a clinical point of view, sex, localization and age at diagnosis were the usually described for these tumors. The relationship of age with malignancy is pointed out. Special emphasis is made on the pathological information about undifferentiated blastodermic tissues, like neuroblasts pointing out their low influence in prognosis. 79% were mature teratomas and 21% malignant tumors (Yolk sac and embrional carcinoma).

[Rhabdomyosarcoma in childhood. Report of 27 cases (author's transl)]. / Rabdomiosarcoma en la edad infantil. A propósito de 27 casos.

Twenty-seven cases of rhabdomyosarcoma in children between one month and 14 years of age are reported. The most frequent histologic type was the embryonal sarcoma and almost half of the cases were diagnosed in advanced clinical stages. Treatment consisted on the combination of surgery, radiotherapy and chemotherapy (vincristine, cyclophosphamide and actinomicin-D in non metastatic cases, plus adriamycin when metastases were present). The survival rate is 57.7% and the survival with no evidence of disease 53.8%, with observation periods from eight months to four years.

[Hodgkin's disease in small children (author's transl)]. / La enfermedad de Hodgkin en el niño en edad preescolar

17 cases of Hodgkin's disease are reported, seen in a ten year period. Age of patients oscillated between three and seven years. There was a predominance of mixed cellularity type in histologic pattern. Most of patients were diagnosed in advanced clinical stages. Primary sign of disease was presence of cervical adenopathies and there were few cases of thoracic disease. Treatment consisted in radiotherapy and chemotherapy, according to histological type and clinical stage. Survival in our serie is of 53.3% with periods of observation from six months to seven years.