Peripheral artery occlusive disease in chronic phase chronic myeloid leukemia patients treated with nilotinib or imatinib.

Several retrospective studies have described the clinical manifestation of peripheral artery occlusive disease (PAOD) in patients receiving nilotinib. We thus prospectively screened for PAOD in patients with chronic phase chronic myeloid leukemia (CP CML) being treated with tyrosine kinase inhibitors (TKI), including imatinib and nilotinib. One hundred and fifty-nine consecutive patients were evaluated for clinical and biochemical risk factors for cardiovascular disease. Non-invasive assessment for PAOD included determination of the ankle-brachial index (ABI) and duplex ultrasonography. A second cohort consisted of patients with clinically manifest PAOD recruited from additional collaborating centers. Pathological ABI were significantly more frequent in patients on first-line nilotinib (7 of 27; 26%) and in patients on second-line nilotinib (10 of 28; 35.7%) as compared with patients on first-line imatinib (3 of 48; 6.3%). Clinically manifest PAOD was identified in five patients, all with current or previous nilotinib exposure only. Relative risk for PAOD determined by a pathological ABI in first-line nilotinib-treated patients as compared with first-line imatinib-treated patients was 10.3. PAOD is more frequently observed in patients receiving nilotinib as compared with imatinib. Owing to the severe nature of clinically manifest PAOD, longitudinal non-invasive monitoring and careful assessment of risk factors is warranted.

[Effects of dexmedetomidine on intracranial hemodynamics in severe head injured patients]. / Efectos de la dexmedetomidina sobre la hemodinámica intracraneal en pacientes con lesión encefálica traumatica grave.

Dexmedetomidine, an alpha 2 adrenergic agonist, with distinctive characteristics when compared to traditional plans, namely: conscious sedation, sympatholysis and lack of respiratory depression, represents an attempt to improve the sedoanalgesia of critically ill patients. OBJECTIVE. To study dexmedetomidine's effect on intracranial hemodynamic and hemometabolic parameters in severe head injured patients. MATERIAL AND METHODS. Prospective study on the effect of Dexmedetomidine on twelve severe head injured patients (Glasgow Coma Scale score

Efectos de la dexmedetomidina sobre la hemodinámica intracraneal en pacientes con lesión encefálica traumatica grave / Effects of dexmedetomidine on intracranial hemodynamics in severe head injured patients

La dexmedetomidina, un agonista adrenérgico selectivoalfa2, constituye un intento de mejorar la sedoanalgesia de los pacientes críticos, por sus efectos distintivos en comparación a los planes tradicionales como son: sedación consciente, simpaticolisis y ausencia de depresión respiratoria. Objetivo. Estudiar el efecto de la dexmedetomidina, un nuevo agonista alfa28, sobre la hemodinámica intracraneal y sobre los parámetros hemometabólicos cerebrales en un grupo de pacientes con trauma craneoencefálico grave. Material y métodos. Estudio prospectivo de los pacientes con lesión encefálica traumática grave (Glasgow Coma Scale <= 8) ingresados en un Centro de Tratamiento Intensivo (CTI) que recibieron monitorización de la presión intracraneal (PIC) y monitorización de saturación de O2 del bulbo yugular (SjO2). Se realizó una perfusión intravenosa de la droga durante 3 horas, en dosis progresivas (0.2, 0.4 y 0.7 ug/kg/h), previa suspensión de otros sedantes y analgésicos. Resultados. Se estudiaron 12 pacientes sin hipertensión intracraneal. No se encontraron diferencias significativas entre los valores de PIC y presión arterial media (PAM) tras la infusión de la droga en relación con los valores basales. La presión de perfusión cerebral (PPC) mostró una tendencia a disminuir durante el estudio (efecto marginal, p=0.058). Se encontró un descenso significativo de la frecuencia cardíaca (FC) (p<0.0001) en relación a los valores basales. No se hallaron diferencias significativas en los parámetros hemometabólicos cerebrales (SjO2 y CEO2).Conclusión. A las dosis utilizadas, la dexmede-tomidina fue segura, no asociándose a alteraciones significativas de la hemodinámica intracraneal ni del metabolismo sanguíneo cerebral en pacientes en la etapa aguda del trauma craneoencefálico grave (TECG)

Dexmedetomidine, an alpha2 adrenergic agonist, with distinctive characteristics when compared to traditional plans, namely: conscious sedation, sympatholysis and lack of respiratory depression, represents an attempt to improve the sedoanalgesia of critically ill patients.Objective. To study dexmedetomidine´s effect on intracranial hemodynamic and hemometabolic parameters in severe head injured patients. Material and methods. Prospective study on the effect of Dexmedetomidine on twelve severe head injured patients (Glasgow Coma Scale score <= 8) admitted to an intensive care unit, with intracranial pressure < 20 mmHg and O2 saturation monitoring of blood from jugular bulb. The drug was perfused intravenously during 3 hours, in progressive doses (0.2, 0.4 y 0.7 ug/kg/h). All other sedo-analgesia medication had been previously withdrawn. Results. No significant differences were found in intracranial pressure, mean arterial pressure and cerebral hemometabolic parameters after infusion of dexmedetomidine in relation to basal values. Cerebral perfusion pressure showed a trend to decrease during the drug infusion (marginal effect, p =.058). Cardiac frequency decreased significantly after the drug administration. Conclusions. At the doses utilized, dexmedetomidine was safe, and it was not associated with significant changes in intracranial hemodynamics, nor in cerebral hemometabolic parameters, in a group of severe head injured patients

[Spinomedullary compression caused by neurinomas and meningiomas]. / Compresión radiculomedular por neurinomas y meningiomas.

A series of 30 spinal neurinomas and meningiomas studied in the Instituto de Neurología of Montevideo from 1958 to 1973 is analyzed. Seventeen neurinomas and 13 meningiomas are included. The following conclusions, in accordance with previous studies, were obtained from the clinical study and operative observations. Meningiomas were more commonly observed in females, in the sixth decade of life and were localized most frequently in the dorsal region. Neurinomas showed no preference for sex or site of the spine, and although they were more common in the sixth decade, they showed a greater dispersion in age. Clinical manifestations were similar in both groups but parasthesias were a more common initial symptom in meningiomas. Protein content of CSF was clearly greater in neurinomas. Radiological alterations of vertebrae were more frequently seen in neurinomas, but inespecific nature. Positive contrast mielography was in all cases useful for precise topographic diagnosis. Surgical results were satisfactory even in cases with severe preoperatory motor deficit.