Immunodeficiency associated with tumour pathology: Good's syndrome.

The Good's syndrome (GS) is a low prevalence entity where thymoma often is associated with immunodeficiency. Patients may start presenting recurrent rhinosinusal infections, bronchopulmonary infections, haematological alterations and diarrhoea, secondary to immunodeficiency. They can also present respiratory symptoms and parathymic syndromes derived from the existence of thymoma, a slow-growing neoplasm located in the anterior mediastinum. We present the case of a 76-year-old man diagnosed with thymoma by image analysis, which had presented multiple episodes of pneumonia and two admissions to the hospital for diarrhoea of weeks of evolution. After finishing the study, the patient is diagnosed of GS. In this case, thymectomy prevented the appearance of parathymic syndrome, but without any effect on immunodeficiency symptoms. To decrease repeat infections, substitution therapy with immunoglobulins was started. The prognosis will depend mainly on the recurrent infectious and to a lesser extent on the thymic neoplasm.

Outcome of 490 Desensitizations to Chemotherapy Drugs with a Rapid One-Solution Protocol.

BACKGROUND: Hypersensitivity reactions to chemotherapy drugs are quite frequent. Desensitization for chemotherapy drugs has become an option to maintain first-line therapy in patients who have suffered such reactions. OBJECTIVE: The objective of this study was to describe our experience in desensitization with antineoplastic agents using a rapid 1-solution protocol. METHODS: We performed a 3-year prospective observational study recording all patients who were desensitized with this protocol. All patients signed an informed consent. Skin test was performed at concentrations previously described as nonirritant. Desensitization was performed using only 1 solution of the drug prepared following the manufacturer instructions. Most drugs were diluted in a volume of 500 mL. We started infusion at 5 mL/h and increased doses at 15-minute intervals to 10, 25, 50, 75, and 100 mL/h. If no reaction occurred, and if the pharmacokinetics of the drug allowed it, we stepped up to 150, 200, and 250 mL/h. RESULTS: Ninety patients were desensitized to 93 drugs: oxaliplatin (30), carboplatin (16), paclitaxel (19), docetaxel (6), cetuximab (5), rituximab (6), and others (11). A total number of 490 procedures were performed. Sixteen patients (17.77%) presented 26 reactions (5.3%). Most reactions appeared in patients who were desensitized to platins and in patients with severe reactions. All but 3 cycles were completely administrated. No deaths or hospital admissions were recorded. CONCLUSIONS: This 1-solution protocol for desensitization has demonstrated to be safe and useful in our study population, especially for mild-to-moderate reactions and nonplatinum drugs. If our results were reproducible in other centers and larger populations, they could contribute to simplifying protocols and making desensitization available for more patients.

Diferentes tipos de respuesta inflamatoria en el asma / Different types of inflammatory response in asthma

El asma es una enfermedad compleja en la que participan numerosas células inflamatorias y más de 100 mediadores con múltiples efectos. El infiltrado inflamatorio en el asma es multicelular y está formado por eosinófilos, neutrófilos, linfocitos y células mononucleares en proporción variable. Estas células y los mediadores que se liberan son responsables de la respuesta inmediata y tardía del asma. Los mastocitos desempeñan un papel primordial en los síntomas inmediatos del asma mientras que los eosinófilos, los macrófagos, los neutrófilos y los linfocitos Th2 intervienen preferentemente en la inflamación crónica. Se han descrito distintos fenotipos inflamatorios en el asma, definidos de acuerdo con el tipo celular predominante. Por otro lado, se sabe que determinadas células estructurales de la vía aérea, tales como las células epiteliales y del músculo liso bronquial, participan en la producción de mediadores inflamatorios y en el desarrollo del remodelado de la vía aérea (AU)

Asthma is a complex disease in which numerous inflammatory cells and more than 100 mediators participate with multiple effects. The inflammatory infiltrate in asthma is multicellular and consists of eosinophils, neutrophils, lymphocytes and mononuclear cells in variable proportions. These cells and the mediators released are the cause of immediate and delayed response in asthma. Mastocytes play a major role in the immediate symptoms of asthma while eosinophils, macrophages, neutrophils and Th2 lymphocytes mainly intervene in chronic inflammation. Distinct inflammatory phenotypes have been described in asthma, defined on the basis of the predominating cell type. In addition, specific cellular structures in the airway, such as epithelial cells and bronchial smooth muscle, participate in the production of inflammatory mediators and in the development of airway remodeling (AU)