Surgical technique for en bloc transurethral resection of bladder tumour with a Hybrid Knife(®). / Técnica quirúrgica de la resección transuretral de tumor vesical en bloque con Hybrid Knife(®).

BACKGROUND: Bladder cancer is the second most common malignancy of the urinary tract and the 9th worldwide. Latin American has an incidence of 5.6 per 100,000 inhabitants per year. Seventy-five percent of newly diagnosed cases are nonmuscle invasive bladder cancer, and 25% of cases present as muscle invasive. The mainstay of treatment for nonmuscle invasive bladder cancer is loop transurethral resection. In 2013, the group led by Dr Mundhenk of the University Hospital of Tübingen, Germany, was the first to describe the Hybrid Knife(®) equipment for performing en bloc bladder tumour resection, with favourable functional and oncological results. OBJECTIVE: To describe the surgical technique of en bloc bladder tumour resection with a Hybrid Knife(®) as an alternative treatment for nonmuscle invasive bladder tumours. MATERIAL AND METHODS: A male patient was diagnosed by urotomography and urethrocystoscopy with a bladder tumour measuring 2×1cm on the floor. En bloc transurethral resection of the bladder tumour was performed with a Hybrid Knife(®). RESULTS: Surgery was performed for 35min, with 70 watts for cutting and 50 watts for coagulation, resecting and evacuating en bloc the bladder tumour, which macroscopically included the muscle layer of the bladder. There were no complications. CONCLUSION: The technique of en bloc bladder tumour resection with Hybrid Knife(®) is an effective alternative to bipolar loop transurethral resection. Resection with a Hybrid Knife(®) is a procedure with little bleeding and good surgical vision and minimises the risk of bladder perforation and tumour implants. The procedure facilitates determining the positivity of the neoplastic process, vascular infiltration and bladder muscle invasion in the histopathology study.

[An analisys fo causes for the discontinuation of a simplified antiretroviral regimen with abacavir, lamivudine and zidovudine]. / Análisis de las causas de suspensión del régimen antirretroviral simplificado abacavir, lamivudina y zidovudina.

OBJECTIVE: To identify and analyze the most common causes for the discontinuation of antiretroviral therapy, including the co-formulation of abacavir, lamivudine and zidovudine (ABC-3TC-AZT). METHOD: An observational, retrospective study was carried out on patients receiving antiretroviral therapy with ABC-3TC-AZT seen in the Pharmacy Department s outpatient unit from February 2002 through June 2004. The causes for discontinuation among patients withdrawing from this therapy were analyzed. Adherence was assessed using computerized dispensation records. A Kaplan-Meier survival analysis was designed in order to identify factors predictive of discontinuation. RESULTS: In all, 114 patients (85 males, 74.6%) received this therapy - 25.4% of them were naïve patients - and 34.2% (39/114) withdrew from this regimen, amongst them 44.8% (13/29) of naïve subjects. In 92.3% of cases this happened before treatment week 48. Discontinuation causes included: adverse reactions (46.1%), voluntary discontinuation (33.3%), clinical decision (15.4%), and other reasons (5.1%). A possible hypersensitivity reaction to ABC was reported for 9 patients. A greater likelihood of discontinuation was associated with detectable viral load at therapy onset, ex-parenteral drug abuser status, and naïve status (p < 0.05). CONCLUSIONS: A high percentage of discontinuations due to adverse events and voluntary withdrawal was found, particularly early during treatment. Patients who may therapeutically benefit from this regimen, particularly naïve subjects, should be identified, and interventions to improve adherence and optimize recovery parameters should be implemented.

Análisis de las causas de suspensión del régimen antirretroviral simplificado abacavir, lamivudina y zidovudina / An analysis of causes for the discontinuation of a simplified antiretroviral regimen with abacavir, lamivudine and zidovudine

Objetivo: Identificar y analizar las causas más frecuentes de discontinuación de la terapia antirretroviral que incluye la co-formulación: abacavir, lamivudina y zidovudina (ABC-3TC-AZT). Método: Estudio retrospectivo observacional de los pacientesen tratamiento antirretroviral con ABC-3TC-AZT, atendidos en la unidad de pacientes externos del servicio de farmacia durante el periodo comprendido entre febrero de 2002 y junio de 2004. Se analizó la causa de discontinuación en aquellos pacientes que no siguieron con esta terapia. Se evaluó la adherencia mediante los registros informáticos de dispensación. Se diseñó un análisis de supervivencia de Kaplan-Meier para identificar factores predictivos de discontinuación. Resultados: Un total de 114 pacientes (85 hombres, 74,6%) fueron tratados con esta terapia. Un 25,4% era naïve. El 34,2% (39/114) de los pacientes discontinuó el tratamiento. Entre ellos, el 44,8% (13/29) de los sujetos naïve. En el 92,3% del total de casos esto ocurrió antes de alcanzar las 48 semanas en tratamiento. Las causas de discontinuación fueron: reacciones adversas (46,1%), abandono voluntario (33,3%), decisión clínica (15,4%) y otros motivos (5,1%). Posible reacción de hipersensibilidad a ABC fue descrita en 9 pacientes. Se relacionó tener carga viral detectable al inicio del tratamiento, ser ex-ADVP, y paciente naïve, con mayor probabilidad de discontinuación (p < 0,05). Conclusiones: Se encontró un alto porcentaje de discontinuación debido a efectos adversos y abandono voluntario, principalmente al inicio del tratamiento. Es necesario identificar a aquellos pacientes a los cuales este esquema les puede aportar un beneficio terapéutico, especialmente los sujetos naïve, y realizar intervenciones para mejorar la adherencia y optimizar así los parámetros de recuperación

Objective: To identify and analyze the most common causes for the discontinuation of antiretroviral therapy, including the coformulation of abacavir, lamivudine and zidovudine (ABC-3TCAZT). Method: An observational, retrospective study was carried out on patients receiving antiretroviral therapy with ABC-3TC-AZT seen in the Pharmacy Department’s outpatient unit from February 2002 through June 2004. The causes for discontinuation among patients with drawing from this therapy were analyzed. Adherence was assessed using computerized dispensation records. A Kaplan-Meier survival analysis was designed in order to identify factors predictive of discontinuation. Results: In all, 114 patients (85 males, 74.6%) received this therapy – 25.4% of them were naïve patients – and 34.2% (39/114) with drew from this regimen, amongst them 44.8%(13/29) of naïve subjects. In 92.3% of cases this happened before treatment week 48. Discontinuation causes included: adverse reactions (46.1%), voluntary discontinuation (33.3%), clinical decision (15.4%), and other reasons (5.1%). A possible hypersensitivity reaction to ABC was reported for 9 patients. A greater likelihood of discontinuation was associated with detectable viral load at therapy onset, ex-parenteral drug abuser status, and naïve status (p < 0.05). Conclusions: A high percentage of discontinuations due to adverse events and voluntary withdrawal was found, particularly early during treatment. Patients who may therapeutically benefit from this regimen, particularly naïve subjects, should be identified, and interventions to improve adherence and optimize recovery parameters should be implemented

Prescripción de medicamentos en receta y en informe de alta del servicio de medicina interna de un hospital general / Medicines given out on prescription and on discharge reports of the internal medicine service of a general hospital

No disponible

No disponible

Case reports. Transient colonization with Scedosporium prolificans. Report of four cases in Madrid.

Four cases of transient colonization of the respiratory tract by Scedosporium prolificans are presented, two in patients with cystic fibrosis, one in a liver transplant patient and one in a patient with AIDS. Colonization versus infection by S. prolificans is discussed.

A-549 is a suitable cell line for primary isolation of coxsackie B viruses.

A common receptor for coxsackie B virus and adenovirus has been described recently in cells of human and murine origin. Since the established cell line A-549 is suitable for adenoviruses, the potential use of A-549 cells for the isolation of coxsackie B viruses from clinical samples was investigated. All throat swabs sent to the laboratory between April 1998 and June 1999 were inoculated onto monolayers of MRC-5 and A-549 cells in tubes, and the enterovirus isolates obtained were typed. From April to June 1999, A-549 cells were compared prospectively to Buffalo green monkey (BGM) cells, considered as the most susceptible cell line for isolating coxsackie B viruses. Fifty-six out of 171 enterovirus isolates (33%) displayed a cytopathic effect (CPE) in the A-549 monolayer only, 48 isolates (28%) in the MRC-5 monolayer only, and 67 isolates (39%) in both cell lines. Most isolates that showed CPE in A-549 cells only (48 out of 56, 86%) were coxsackie B viruses, belonging to four different serotypes (B1, B2, B4, and B6). When BGM and A-549 cells were inoculated in parallel, both recovered the same number of coxsackie B isolates (n = 20), and the CPE was noted on approximately the same day. In conclusion, growth in A-549 but not MRC-5 cells identified coxsackie B viruses in most cases. A-549 was comparable to BGM for primary isolation of coxsackie B viruses.