Intra-abdominal desmoplastic small round cell tumour in a 39-year-old man

Desmoplastic small round cell tumor is a very rare neoplasm, that usually appears in children and young adolescents. There is no standard therapy, and responses to chemotherapy are infrequent. Surgery is still the main treatment for this disease. We report the case of a 39 year-old man and briefly summarize the evidence about this tumor (AU)

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Cirrhosis-like radiological pattern in patients with breast cancer

INTRODUCTION: Hepatic toxicity of breast cancer therapy is well known, usually consisting of elevation in the serum levels of hepatic enzymes or fatty infiltration of the liver. The chemotherapeutic agents most commonly linked to hepatotoxic effects are methotrexate, anthracyclines, taxanes and cyclophosphamide. There are few reports of patients with liver metastasis having radiological findings mimicking cirrhosis, both in the presence or the absence of prior systemic chemotherapy. Hepatotoxicity of antineoplastic drugs and cellular necrosis induced by response of liver metastases to chemotherapy may play a critical role in its physiopathology. MATERIALS AND METHODS: This article reports a series of ten women with breast cancer (nine with liver metastasis) treated with chemotherapy or hormonotherapy. RESULTS: They had low risk factors for hepatic disease, but developed a cirrhosis-like appearance in the computed tomography scan. The patient without liver metastasis is the second of this kind described in the literature. Relatively few reports have documented clinical sequelae of portal hypertension. In our series, three patients had oesophageal bleeding varices needing be hospitalised. To our knowledge, these are the first cases reported in the literature. CONCLUSIONS: This suggests that some manifestations of portal hypertension may develop in association with the cirrhosis- like pattern induced by breast cancer therapy (AU)

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Oxycodone: a pharmacological and clinical review.

Oxycodone is a semi-synthetic opioid with an agonist activity on mu, kappa and delta receptors. Equivalence with regard to morphine is 1:2. Its effect commences one hour after administration and lasts for 12 h in the controlled-release formulation. Plasma halflife is 3-5 h (half that of morphine) and stable plasma levels are reached within 24 h (2-7 days for morphine). Oral bioavailability ranges from 60 to 87%, and plasma protein binding is 45%. Most of the drug is metabolised in the liver, while the rest is excreted by the kidney along with its metabolites. The two main metabolites are oxymorphone--which is also a very potent analgesic--and noroxycodone, a weak analgesic. Oxycodone metabolism is more predictable than that of morphine, and therefore titration is easier. Oxycodone has the same mechanism of action as other opioids: binding to a receptor, inhibition of adenylyl-cyclase and hyperpolarisation of neurons, and decreased excitability. These mechanisms also play a part in the onset of dependence and tolerance. The clinical efficacy of oxycodone is similar to that of morphine, with a ratio of 1/1.5-2 for the treatment of cancer pain. Long-term administration may be associated with less toxicity in comparison with morphine. In the future, both opioids could be used simultaneously at low doses to reduce toxicity. It does not appear that there are any differences between immediate and slow-release oxycodone, except their half-life is 3-4 h, and 12 h, respectively. In Spain, controlled-release oxycodone (OxyContin) is marketed as 10-, 20-, 40- or 80-mg tablets for b.i.d. administration. Tablets must be taken whole and must not be broken, chewed or crushed. There is no food interference. The initial dose is 10 mg b.i.d. for new treatments and no dose reduction is needed in the elderly or in cases of moderate hepatic or renal failure. Immediate-release oxycodone (OxyNorm) is also available in capsules and oral solution. Side effects are those common to opioids: mainly nausea, constipation and drowsiness. Vomiting, pruritus and dizziness are less common. The intensity of these side effects tends to decrease over the course of time. Oxycodone causes somewhat less nausea, hallucinations and pruritus than morphine.

Oxycodone: a pharmacological and clinical review

Oxycodone is a semi-synthetic opioid with an agonist activity on mu, kappa and delta receptors. Equivalence with regard to morphine is 1:2. Its effect commences one hour after administration and lasts for 12 h in the controlled-release formulation. Plasma halflife is 3-5 h (half that of morphine) and stable plasma levels are reached within 24 h (2-7 days for morphine). Oral bioavailability ranges from 60 to 87%, and plasma protein binding is 45%. Most of the drug is metabolised in the liver, while the rest is excreted by the kidney along with its metabolites. The two main metabolites are oxymorphone--which is also a very potent analgesic--and noroxycodone, a weak analgesic. Oxycodone metabolism is more predictable than that of morphine, and therefore titration is easier. Oxycodone has the same mechanism of action as other opioids: binding to a receptor, inhibition of adenylyl-cyclase and hyperpolarisation of neurons, and decreased excitability. These mechanisms also play a part in the onset of dependence and tolerance. The clinical efficacy of oxycodone is similar to that of morphine, with a ratio of 1/1.5-2 for the treatment of cancer pain. Long-term administration may be associated with less toxicity in comparison with morphine. In the future, both opioids could be used simultaneously at low doses to reduce toxicity. It does not appear that there are any differences between immediate and slow-release oxycodone, except their half-life is 3-4 h, and 12 h, respectively. In Spain, controlled-release oxycodone (OxyContin) is marketed as 10-, 20-, 40- or 80-mg tablets for b.i.d. administration. Tablets must be taken whole and must not be broken, chewed or crushed. There is no food interference. The initial dose is 10 mg b.i.d. for new treatments and no dose reduction is needed in the elderly or in cases of moderate hepatic or renal failure. Immediate-release oxycodone (OxyNorm) is also available in capsules and oral solution. Side effects are those common to opioids: mainly nausea, constipation and drowsiness. Vomiting, pruritus and dizziness are less common. The intensity of these side effects tends to decrease over the course of time. Oxycodone causes somewhat less nausea, hallucinations and pruritus than morphine (AU)

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Radioquimioterapia preoperatoria frente a postoperatoria en el carcinoma de recto estadios II-III: estudio comparativo no aleatorizado / Preoperative versus postoperative radiochemotherapy in stages II and III rectal carcinoma: a non-randomized comparative study

Propósito: comparar la eficacia, toxicidad y tasa de complicaciones quirúrgicas del tratamiento adyuvante frente al tratamiento neoadyuvante en el carcinoma de recto.• Material y métodos: 111 pacientes con carcinoma de recto estadios II-III recibieron tratamiento complementario con radioterapia (RT) y quimioterapia (QT). La QT consistió en leucovorin (500 mg/m2) intravenoso el primer día, seguido de lencovorin oral 15 mg/12 horas entre los días 2 y 14 del ciclo, y UFT 390 mg/m2/día entre los días 1 y 14 (350 mg/m2 durante la RT) . En 32 enfermos el tratamiento se realizó de forma neoadyuvante (grupo N), mientras que en los 79 restantes se administró tras la cirugía (grupo A).• Resultados: no hubo diferencias significativas en la supervivencia libre de enfermedad (72 por ciento en el grupo A y 69 por ciento en el grupo N) ni en la supervivencia global a los 3 años (91 por ciento en el grupo A y 95 por ciento en el grupo N). La tasa de complicaciones mayores tras la cirugía fue similar en ambos grupos. La tasa de diarrea grado 3-4 fue del 43 por ciento en los primeros 14 pacientes del grupo N (que recibieron UFT 350 mg/m2), mientras que en el grupo A fue del 18 por ciento (Fisher, p=0.07). En los restantes 18 pacientes del grupo N la dosis de UFT fue reducida a 300 mg/m2. La tasa de cirugía conservadora de esfínter en los tumores situados en los 10 cm últimos del recto fue superior en el grupo N (53 por ciento vs 38 por ciento, p=n.s.).• Conclusiones: el tratamiento neoadyuvante en el cáncer de recto no presenta diferencias significativas con el tratamiento adyuvante en cuanto a tasa de complicaciones quirúrgicas, tasa de recaídas y supervivencia, pero sí aumenta la toxicidad gastrointestinal. (AU)

Varón de 63 años con síndrome general y masa esplénica / 63-year old male patient with general syndrome and splenic mass

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Quimioterapia a altas dosis en el tratamiento de tumores no hematológicos / Hig-dose chemoterapy in non hematologic tumors

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Carboplatino -Tegafur- Leucovorin en el tratamiento del cáncer de mama avanzado / Carboplatin-Tegafur-Leucovorin in the treatment of advanced breast cancer

Propósito: Valorar la eficacia y seguridad del esquema Carboplatino -Tegafur- Leucovorín como tratamiento quimioterápico en el cáncer de mama avanzado. Material y métodos: Entre 1992-97 fueron tratadas con este régimen 19 pacientes (entre 34 y 76 años) con metástasis en distintas localizaciones y que habían recibido ya una o más líneas previas de quimioterapia. Resultados: Se administraron entre 1 y 12 ciclos por paciente. Las principal toxicidad fue: neutropenio, anemia y trombopenia y naúseas y vómitos. No ocurrieron muertes tóxicas. Hubo 1 remisión completa y 4 remisiones parciales. ConcIusiones: El régimen Carboplatino -Tegafur- Leucovorín es moderadamente eficaz como tratamiento de segunda o tercera línea en el cáncer de mama avanzado. La toxicidad, fundamentalmente hematológica, no es demasiado elevada por lo que puede ser una opción más de tratamiento en esos casos (AU)

Cutaneous malignant melanoma and sun exposure in Spain.

Cutaneous malignant melanoma has an increasing importance all over the world. However very few epidemiological studies have been published from Spain, and Spanish people have not become aware of the problem. This study was designed to examine sun exposure patterns and other related items among 116 consecutive patients with melanoma and 235 controls. Each subject answered a questionnaire covering the place of residence, sun exposure details and other risk factors, and underwent a skin examination. Continuous sun exposure due to residence or occupation was associated with an odds ratio (OR) of 2.0 (95% confidence interval [CI] = 1.2-3.3). People who lived in the city but spent 50% of their time in rural areas for holidays had an OR of 2.2 (95% CI = 1.3-3.8) when compared with those living in urban and rural areas. The OR for people who sunbathed more than 30 times a year was 1.8 (95% CI = 1.2-2.8), and outdoor leisure time was also associated with melanoma appearance when exposure was greater than 60 units in the last 2 years, with an OR of 3.0 (95% CI = 1.6-5.5); 1 unit is equivalent to total body sun exposure for at least 2 h. These OR estimates were adjusted for age, skin type and the number of naevi. Construction workers (OR = 1.6; 95% CI = 0.5-5.6) had increased risk after adjustment for skin type, age and freckle count (OR = 4.3; 95% CI = 1.8 9.9) or mole count (OR = 2.8; 95% CI = 1.4-5.8). Working as a farmer was a protective factor after adjustment (OR = 0.5; 95% CI = 0.3-0.8). The use of sunscreens was a protective factor against melanoma (OR = 2.6; 95% CI = 1.6-3.6 for non-users). Campaigns should focus on advising people to avoid sun exposure in sunny places and to use sunscreens every time they are exposed to the sun.

[Sneddon syndrome: diagnostic value of antiphospholipid antibodies]. / Síndrome de Sneddon: valor diagnóstico de los anticuerpos antifosfolípido.

The association of livedo reticularis and cerebrovascular lesions is known as Sneddon's syndrome. It affects young adults and is more common in females. Repeated strokes lead these patients to residual deficits. Recently, Sneddon's syndrome has been described in a subset of patients with systemic lupus erythematous and primary antiphospholipid syndrome. We report two cases, one of them with antiphospholipid antibodies. Antiphospholipid antibodies do not seem to explain the events of Sneddon's Syndrome. Perhaps, different pathogenic mechanisms play role in the clinical expression of this syndrome.

[Sclerosing cholangitis, papillary stenosis and B-cell lymphoma in a patient with acquired immunodeficiency syndrome]. / Colangitis esclerosante, estenosis de papila y linfoma-B en un paciente con síndrome de inmunodeficiencia adquirida.

The case of a 31 year old man who had been intravenous drug abuser for years is reported. He was studied because of abdominal pain, jaundice, a weight loss of 10 kg, and the presence of a subclavicular mass. Biopsy of the mass demonstrated a high-grade B-cell non-Hodgkin's lymphoma, and the patient was classified in group IV-D of the human immunodeficiency virus infection because he had HIV serum antibodies and a reduced CD4/CD8 lymphocyte ratio. Although lymphoma had a good response to chemotherapy, persistent cholestasis led to liver and biliary evaluation. Sclerosing cholangitis and papillary stenosis were found. He has been followed for two years, without evidence of any secondary infectious disease associated to the acquired immunodeficiency syndrome.