Patient profiles as an aim to optimize selection in the second line setting: the role of aflibercept.

Colorectal cancer is the second leading cause of cancer-related death worldwide. For metastatic colorectal cancer (mCRC) patients, it is recommended, as first-line treatment, chemotherapy (CT) based on doublet cytotoxic combinations of fluorouracil, leucovorin, and irinotecan (FOLFIRI) and fluorouracil, leucovorin, and oxaliplatin (FOLFOX). In addition to CT, biological (targeted agents) are indicated in the first-line treatment, unless contraindicated. In this context, most of mCRC patients are likely to progress and to change from first line to second line treatment when they develop resistance to first-line treatment options. It is in this second line setting where Aflibercept offers an alternative and effective therapeutic option, thought its specific mechanism of action for different patient's profile: RAS mutant, RAS wild-type (wt), BRAF mutant, potentially resectable and elderly patients. In this paper, a panel of experienced oncologists specialized in the management of mCRC experts have reviewed and selected scientific evidence focused on Aflibercept as an alternative treatment.

First-line mFOLFOX plus cetuximab followed by mFOLFOX plus cetuximab or single-agent cetuximab as maintenance therapy in patients with metastatic colorectal cancer: Phase II randomised MACRO2 TTD study.

BACKGROUND: This multicentre, randomised, and phase II study evaluated mFOLFOX+cetuximab followed by maintenance mFOLFOX+cetuximab or single-agent cetuximab in metastatic colorectal cancer (mCRC) patients (NCT01161316). PATIENTS AND METHODS: Previously, untreated mCRC patients (wild-type KRAS) were randomised to receive cetuximab+mFOLFOX-6 (8 cycles for 2 weeks) followed by maintenance therapy: single-agent cetuximab (Arm-A) or mFOLFOX-6 + cetuximab (Arm-B) until progression. Primary endpoint was progression-free survival (PFS) at 9 months. RESULTS: One hundred ninety-three patients (median [range] age 60 [33-74] years) were randomised (2:1): 129 Arm-A versus 64 Arm-B. PFS at 9 months (95% confidence interval) showed non-inferiority between arms (Arm-A/Arm-B: 60 [52, 69]%/72 [61, 83]%, p [non-inferiority]<0.1). There were no statistically significant differences in the PFS (Arm-A/Arm-B: 9 [95% CI 7, 10] months/10 [7,13] months, hazard ratio [HR] = 1.19 [0.80, 1.79]) or overall survival (23 [19, 28] months/27 [18, 36] months, HR = 1.24 [0.85, 1.79]) between arms. The objective response rate was also similar (48 [39, 57]%/39 [27, 52]%). The safety profile was similar between arms, and all patients experienced at least one adverse event (AE) (Arm-A/Arm-B grade ≥III AEs: 70%/68%). The most common grade ≥III AEs were as follows: neutropenia (Arm-A/Arm-B: 28%/26%), rash acneiform (15%/24%) and sensory neuropathy (2%/15%) in any group. Arm-A was associated with less grade ≥III rash and sensory neuropathy and a lower rate of serious AEs (20%/27%). CONCLUSION(S): This phase II exploratory trial with a non-inferiority design suggests that maintenance therapy with single-agent cetuximab following mFOLFOX+cetuximab induction could be a valuable option compared with mFOLFOX+cetuximab treatment continuation. We await phase III trials to confirm single-agent cetuximab as maintenance therapy in mCRC patients.

Guías de ayuno preoperatorio: actualización / Preoperative fasting guidelines: An update

Desde 1990 las sociedades de Anestesiología han realizado distintas guías de ayuno preoperatorio ya no solo para disminuir la incidencia de aspiración pulmonar y morbilidad anestésica, sino para aumentar el bienestar del paciente previo a la anestesia. Algunas de estas sociedades han ido actualizando sus guías, de manera que desde 2010 ya disponemos de 2 dedicadas al ayuno preoperatorio basadas en la evidencia. Con este trabajo se ha pretendido revisar las actualizaciones de las guías, así como las pautas actuales para pacientes más controvertidos, como lactantes, obesos y programados para cierto tipo de cirugía oftálmica (AU)

Anesthesiology societies have issued various guidelines on preoperative fasting since 1990, not only to decrease the incidence of lung aspiration and anesthetic morbidity, but also to increase patient comfort prior to anesthesia. Some of these societies have been updating their guidelines, as such that, since 2010, we now have 2 evidence based preoperative fasting guidelines available. In this article, an attempt is made to review these updated guidelines, as well as the current instructions for more controversial patients such as infants, the obese, and a particular type of ophthalmic surgery (AU)

[Preoperative fasting guidelines: an update]. / Guías de ayuno preoperatorio: actualización.

Anesthesiology societies have issued various guidelines on preoperative fasting since 1990, not only to decrease the incidence of lung aspiration and anesthetic morbidity, but also to increase patient comfort prior to anesthesia. Some of these societies have been updating their guidelines, as such that, since 2010, we now have 2 evidence-based preoperative fasting guidelines available. In this article, an attempt is made to review these updated guidelines, as well as the current instructions for more controversial patients such as infants, the obese, and a particular type of ophthalmic surgery.

Fluidoterapia perioperatoria en el paciente pediátrico. Recomendaciones / Perioperative fluid therapy in the pediatric patient. Recommendations

No disponible

Anticoncepción en la mujer inmigrante: influencia de los aspectos socioculturales en la elección del método anticonceptivo / Contraception in immigrant women: influence of sociocultural aspects on the choice of contraceptive method

Actualmente residen en nuestro país 6 millones de inmigrantes. La mitad son mujeres, la mayoría en edad fértil. Son un grupo de especial problemática, con altas tasas de interrupción voluntaria de embarazo (IVE) en el que es fundamental abordar su salud reproductiva. Hemos dilucidado cómo es el uso de métodos anticonceptivos por esta población. Para ello revisamos 1.100 historias de nuestra consulta de salud sexual y reproducción. El colectivo más prevalente que acude a nosotros en busca de información son las latinoamericanas, seguidas por europeas del Este y marroquíes, y en menor proporción asiáticas y subsaharianas. Los anticonceptivos más utilizados son el DIU, sobre todo latinoamericanas y europeas del Este, y los anticonceptivos orales combinados, más utilizados entre las marroquíes. Es importante informar a las mujeres inmigrantes sobre anticoncepción, teniendo en cuenta sus preferencias, para aumentar la adherencia al tratamiento y disminuir las altas tasas de IVE (AU)

There are currently 6 million immigrants living in Spain. Half of them are women, the majority of whom are of childbearing age. These women, who suffer high rates of induced abortion, form a special group who require a special approach to their reproductive health. In order to study the use of contraceptive methods in this population, a review was made of 1100 clinical histories from our Sexual Health and Reproduction Clinic. Latin American women were the most prevalent group who came to seek information about contraception, followed by Eastern Europeans and Moroccans. Fewer Asian and Sub-Saharan women sought these services. The contraceptives most frequently used were the intrauterine device (used mostly by Latin American and Eastern European women), and combined oral contraception, most used by Moroccan women. It is important to advise the immigrant women about contraceptive methods, taking into account their preferences, in order to improve adherence to the method (AU)

[Contraception in immigrant women: influence of sociocultural aspects on the choice of contraceptive method]. / Anticoncepción en la mujer inmigrante: influencia de los aspectos socioculturales en la elección del método anticonceptivo.

There are currently 6 million immigrants living in Spain. Half of them are women, the majority of whom are of childbearing age. These women, who suffer high rates of induced abortion, form a special group who require a special approach to their reproductive health. In order to study the use of contraceptive methods in this population, a review was made of 1100 clinical histories from our Sexual Health and Reproduction Clinic. Latin American women were the most prevalent group who came to seek information about contraception, followed by Eastern Europeans and Moroccans. Fewer Asian and Sub-Saharan women sought these services. The contraceptives most frequently used were the intrauterine device (used mostly by Latin American and Eastern European women), and combined oral contraception, most used by Moroccan women. It is important to advise the immigrant women about contraceptive methods, taking into account their preferences, in order to improve adherence to the method.

[Preoperative fasting regimens and premedication to reduce the risk of pulmonary aspiration]. / Pautas de ayuno preoperatorio y premedicación para reducir el riesgo de aspiración pulmonar.

Our greater understanding of gastric physiology and the epidemiology of Mendelson's syndrome has allowed the traditional guidelines for preoperative fasting (nothing by mouth after midnight or 6 hours before surgery) to be changed, based on the results of many scientific studies. The stomach is not emptied of liquids and solids in the same way, and therefore preoperative fasting should not be the same for both. Human milk leaves the stomach more rapidly than infant formulas, and the emptying of non-human milk is similar to that of solids. Fasting does not guarantee that the stomach will be empty or that the pH of gastric juices will be high; moreover, shortening the preoperative fasting period may bring several advantages for the patient. Factors such as premedication, anxiety, age, certain associated diseases or injuries may or may not influence gastric emptying and/or acidity at the time of anesthesia. We review the literature, including the guidelines on fasting of the American Society of Anesthesiologists for application with healthy patients of all ages in elective procedures, excluding, among others, women in childbirth and patients undergoing emergency surgery.

Pautas de ayuno preoperatorio y premedicación para reducir el riesgo de aspiración pulmonar / Guidelines for preoperative fasting and premedication to reduce the risk of pulmonary aspiration

Gracias a un mejor conocimiento de la fisiología gástrica y de la epidemiología del síndrome de Mendelson y a la experiencia de múltiples trabajos científicos, ha sido posible modificar las pautas tradicionales de ayuno preoperatorio de nada por boca a partir de medianoche o de 6 horas antes de la intervención. Los líquidos y los sólidos no son vaciados igualmente del estómago, luego el ayuno preoperatorio no debería ser el mismo para ambos. La leche materna abandona el estómago más rápidamente que las fórmulas para lactantes, y la leche no humana es similar a los sólidos en cuanto al tiempo de vaciamiento gástrico. Ayunar no garantiza que el estómago estará vacío o que el pH del líquido gástrico será alto, y acortar el tiempo de ayuno preoperatorio puede aportar múltiples ventajas al paciente. Factores como la premedicación, la ansiedad, la edad, algunas patologías asociadas o los traumatismos, pueden o no influir sobre el vaciamiento y/o acidez gástrica en el momento de la anestesia. Presentamos una revisión de la literatura sobre el tema, que incluye la guía de la ASA de ayuno preoperatorio y uso de agentes farmacológicos para reducir el riesgo de aspiración pulmonar, para aplicar a pacientes sanos de todas la edades y procedimientos electivos, excluyendo, entre otros, mujeres de parto y cirugía de urgencia (AU)

Influencia de los neuropéptidos,bombesina y calcitonina, sobre el crecimiento de las líneas celulares prostáticas, PC-3, DU 145 y LNCaP / Influence of neuropetides, bombesin and calcitonin, on prostatic cell lines PC-3, DU-145 and LNCaP growth

Las células neuroendocrinas están presentes en el tejido prostático normal y tumoral. Los neuropéptidos secretados por estas células tienen funciones biológicas que todavía no han sido totalmente esclarecidas. La presencia de células neuroendocrinas en el carcinoma prostático se relaciona con la progresión del tumor y un peor pronóstico. Estudiamos la influencia de bombesina y calcitonina sobre la proliferación de líneas tumorales prostáticas humanas andrógeno-insensibles, PC-3 y DU-145, y andrógeno-sensible, LNCaP , para ello utilizamos el análisis colorimétrico XTT y recuentos celulares con un hematocitómetro. El crecimiento de la línea celular PC-3 y DU-145 es estimulado por la bombesina y calcitonina pero estos peptidos no ejercen efecto estimulador sobre la línea celular LNCaP. Esto indica que la bombesina y calcitonina pueden modular la proliferación sobre las líneas andrógeno-insensibles "in vitro" y podrían actuar, por tanto, como factores paracrinos estimuladores del crecimiento sobre las células cancerosas prostáticas que se vuelven resistentes al tratamiento hormonal (AU)

[Effect of the neuropeptides bombesin and calcitonin on the growth of prostate cell lines, PC-3, DU 145, and LNCaP]. / Influencia de los neuropéptidos, bombesina y calcitonina, sobre el crecimiento de las líneas celulares prostáticas, PC-3, DU 145 y LNCaP.

Neuroendocrine cells are present in normal and tumoral prostate tissue, the neuropeptides secreted by this cells have a biological functions that have not been fully elucidated. The presence of neuroendocrine cells in prostatic carcinoma have been shown to increase tumor progression. We characterized the in vitro proliferative influence of bombesin and calcitonin in androgen-insensitive, PC-3 and DU-145, and androgen-sensitive, LNCaP, cell lines of human prostate cancers. The influence of these neuropeptides on proliferation were assessed using the colorimetric XTT assay and by cells counts with a hemocytometer. The growth of PC-3 and DU-145 cell lines is stimulated by bombesin and calcitonin but exerted any stimulatory effect on the proliferation of the LNCaP cell line. This indicate that bombesin and calcitonin can modulate proliferation of androgen-insensitive human prostate cell lines "in vitro" and may be potential paracrine growth promoters in stablished androgen irresponsive human prostatic carcinoma cells.

[Histomorphometry study of the effect of an inhibitor of 5-alpha reductase on the coating of human prostate explants in tissue culture]. / Estudio histomorfométrico del efecto de un inhibidor de la 5-alfa-reductasa sobre el recubrimiento de explantes de próstata humana en cultivo de tejido.

Histomorphometric study of hyperplastic human prostate explants coating grown "in vitro" to evaluate the response to a 5-alpha-reductase inhibitor (finasteride). Explants were grown for four weeks in three groups, one in growth medium alone (RPM1-1640), one supplemented with testosterone and one supplemented with testosterone plus finasteride. Explants underwent histological studies, quantifying the surface and thickness of the coating epithelium. Study of the values obtained from the different samples show significant differences (p < 0.001) for the coated surface and its thickness between groups supplemented with testosterone and testosterone + finasteride, and so it can be inferred that this compound (finasteride) would blockade basal cells proliferation and their migration on the explant surface.

[Effect of bombesin on cultured prostatic cells]. / Evaluación de la acción de la bombesina sobre células prostáticas en cultivo.

The detection of immunoreactivity to bombesin-like peptides in endocrine-paracrine cells from normal and pathological prostates suggest they have a regulatory role over this structure. With the purpose of explaining the action of these peptides on the prostate tissue an analysis is made of the bombesin effect on single-layer cultures of normal (rat ventral prostate) and tumoral (PC-3 cell line) prostate tissue. After performing morphological studies through phase contrast microscopy, as well as using cell counts and immunohistochemical techniques (Ki-67) to study the influence of bombesin on cell proliferation, this has been shown to stimulate prostate cells proliferation "in vitro". This response was revealed with greater intensity at bombesin concentrations of 0.5 nM/ml on the rat ventral prostate and bombesin 1 nM/ml on the PC-3 cell line. No morphological differences were observed between the controls and the bombesin-containing microwells in the rat ventral prostate, but some greater size cell elements with irregular shape were seen in the PC-3 cultures, as well as an increased number of mitotic division shapes in the wells filled up with bombesin.

[Common health disorders: self-care and self-medication]. / Trastornos comunes de salud: autocuidado y automedicación.

SETTING: Community level. "Santa María de Benquerencia" Health District, Toledo. PARTICIPANTS: People over 15, chosen by random sampling from the municipal census, who stated that they had suffered some health disorder over the previous fortnight. MEASUREMENTS AND MAIN RESULTS: 212 surveys were accepted as valid (average age 42.75, 51.89% male and 48.11% female). 73% had suffered one of the disorders included in the survey during the previous fortnight. The commonest response was self-medication (39.84%), especially when dealing with pain and Pyrosis. Pyrazolones and Salicylates were the most commonly used drugs. The instructions were only read in 48.64% of cases. No measure was adopted in 34.56% of the disorders. The doctor was only consulted in 6.86% of cases. Both these responses were more common in men and young people. Non-pharmacological self-care was adopted in 30.07% of cases. This was generally of a dietetic or physical nature and was commoner in women and elderly people. CONCLUSIONS: Self-care, whether pharmacological or not, is the most common response to the perception of some symptom. These practices (especially self-medication because of its possible attendant problems) should be directed and used as one tool more in health care.

[Epithelial polyp of the posterior urethra]. / Pólipo epitelial de uretra posterior.

A case of posterior urethra polyp located at the veru montanum is reported in an adult with azoospermia. Deferentvesiculography, testes biopsy, transrectal echography and urethroscopy were carried out. Following diagnosis, a tumour endoscopic resection was performed. After reviewing the literature, no other cases of posterior urethra polyp presenting the reported clinical picture was found. Also, aspects related to clinic, diagnostic procedures and therapeutical approach are reported.

[Abscess of the prostate: intracavitary echography and echo-guided drainage]. / Absceso de próstata: ecografía endocavitaria y drenaje ecodirigído.

We submit the present paper three cases of prostate abscess. The various aspects related to ethiopathogeny, clinic, and current diagnostic procedures are analyzed emphasixing the use of endocavitary echography, as well as the different therapeutic approaches that can be used, with particular attention to ecomonitored aspirative drainage.

[Verrucous carcinoma of the penis]. / Carcinoma verrucoso de pene.

The present work reports one case of penis verruciform carcinoma. Such neoplastic process is considered to be a variation of the scaly carcinoma with specific histopathological features. Clinical and histopathological as well as therapeutic aspects (conservative or radical surgical therapy, depending on the evolutive stage and laser electrocoagulation) were analyzed.

[Adrenal gland myelolipoma: diagnostic and therapeutic aspects]. / Mielolipoma suprarrenal: aspectos diagnósticos y terapéuticos.

Presentation of a case of suprarenal myelolipoma, pre-operatively diagnosed through sonography and CAT due to endocrine inactivity, as shown by the laboratory tests carried out. There is also a literature review and the analysis of the clinical, diagnostic and therapeutic aspects regarding this disorder.