Controlled Ovarian Stimulation Initiated at Different Phases of the Menstrual Cycle for Fertility Preservation in Oncological Patients: a Retrospective Study.

The purpose of this study is to compare conventional start in early follicular phase (EFP) with late follicular phase (LFP) and luteal phase (LP) in controlled ovarian stimulation (COS) for fertility preservation (FP) to assess differences in clinical outcomes. Retrospective study of the first cycles of COS for FP in oncological patients between 2012 and 2020 in a tertiary hospital. Two-hundred forty-eight cycles were classified into 3 groups: 176 cycles in EFP, 8 cycles in LFP, and 52 cycles in LP. Comparing LFP to EFP, there were no differences in number of oocytes (10.0 [6.3-16.0] vs 12.0 [8.0-18.0]; p = 0.253) or number of metaphase II (MII) obtained (7.0 [2.3-13.3] vs 9.0 [6.0-13.0]; p = 0.229). Total number of days needed was higher in LFP (14.5 [12.5-16.0] vs 3.0 vs 10.0 [8.3-11.0 p = 0.000) but without significant differences in number of days of usage of gonadotropins (11.5 [8.3-12.8] vs 10.0 [8.3-11.0] p = 0.308). No differences were found between LP and EFP in number of oocytes (14.5 [9.0-20.0] p = 0.151) or MII (11.5 [7.0-16.0] p = 0.084). Number of days of gonadotropins (11.0 [10.0-12.0] p = 0.00) and total dosing (3000.0 [2475.0-3600.0] p = 0.013) were significantly higher in LP. FORT and FOI were similar in all groups. COS with a random start in fertility preservation has similar outcomes to EFP start. Therefore, we can initiate COS at any phase of the menstrual cycle with optimal results. However, LP may need more days of stimulation.

Criopreservación ovárica en niñas con cáncer: nuevos retos / Ovarian cryopreservation in girls with cancer: new challenges

Objetivos. La criopreservación de la corteza ovárica (CCO) para futuro autotrasplante permitirá hacer frente al fallo ovárico precoz y a las alteraciones de la capacidad reproductiva que afectan a algunas delas supervivientes de cáncer pediátrico. Material y métodos. En el Programa de Preservación de Fertilidad en Oncología Pediátrica se incluyen pacientes con alto riesgogonadotóxico: las que vayan a recibir radioterapia pélvica, trasplante de precursores hematopoyéticos, altas dosis de radioterapia craneal o agentes alquilantes, o aquéllas con patología ovárica bilateral. Antes del tratamiento oncológico y coincidiendo con otros procedimientos invasivos, se recoge el tejido ovárico por vía laparoscópica. Una vez descartada la malignidad en la muestra y confirmada la presencia de folículos primordiales, el equipo multidisciplinar de oncólogo, cirujano y especialista en fertilidad coordina la manipulación y envío de la corteza ovárica al Banco de Tejidos de la Comunidad Valenciana. Resultados. De julio de 2008 hasta mayo de 2010 se incluyeron en el programa a 8 pacientes, entre 8 y 18 años, con diagnóstico de: linfoma de Hodgkin (n= 2), leucemia aguda linfoide y mieloide (n= 2),sarcoma de Ewing pélvico, teratoma ovárico bilateral y meduloblastoma. Cinco pacientes recibieron quimioterapia no gonadotóxica previa a la CCO. De forma adicional, se practicaron 6 procedimientos en el mismo acto anestésico. Se realizó o oforectomía parcial en la mitad delos casos y total en el resto, asociando pexia ovárica en 1 ocasión. Todas las muestras fueron válidas. Conclusiones. La CCO de los casos seleccionados se realizó de forma segura, sin complicaciones ni demora del tratamiento oncológico. Podemos afi rmar que la primera experiencia nacional en este tipo de abordaje ha sido satisfactoria (AU)

Background. Ovarian cortex cryopreservation (OCC) for future autotransplant represents a treatment alternative for those paediatriccancer survivors affected of ovarian failure and fertility disorders. Methods. Patients with high gonadotoxic risk are included in the Oncology Paediatric Fertility Preservation Programme: those receiving pelvic radiotherapy, bone marrow transplantation, high doses of cranial radiotherapy or alquilating agents, or those with bilateral ovarian pathology. Prior to the oncological treatment, the ovarian tissue is harvested laparoscopically. At the same time, other invasive procedures are done. Once malignancy is ruled out of the specimen and the presence of primordial follicles is confirmed, the multidisciplinary team of oncologist, paediatric surgeon and fertility specialist coordinate the processing and delivery of the ovarian cortex to the Comunidad ValencianaTissue Bank. Results. From July 2008 to May 2010 eight patients have been included in the programme, aged between 8-18 years old and with diagnosis of: Hodgkin’s lymphoma (n= 2), Acute Myeloblastic and Lymphoblasticleukaemia (n= 2), pelvic Ewing’s sarcoma, bilateral ovarian Teratoma and Meduloblastoma. Five patients underwent non gonadotoxicchemo therapy before OCC. Six additional procedures were doneusing the same anaesthetic event. Partial oophorectomy was performed in half the cases, total oophorectomy in the rest of them, and an ovarianpexia was once associated. All taken samples were found to be valid. Conclusions. OCC of selected patients was performed safely, with neither postoperative complications nor delay of the oncological treatment. Therefore, the fi rst national experience in this procedure has been satisfactorily achieved (AU)

[Ovarian cryopreservation in girls with cancer: new challenges]. / Criopreservación ovárica en niñas con cáncer: nuevos retos.

BACKGROUND: Ovarian cortex cryopreservation (OCC) for future autotransplant represents a treatment alternative for those paediatric cancer survivors affected of ovarian failure and fertility disorders. METHODS: Patients with high gonadotoxic risk are included in the Oncology Paediatric Fertility Preservation Programme: those receiving pelvic radiotherapy, bone marrow transplantation, high doses of cranial radiotherapy or alquilating agents, or those with bilateral ovarian pathology. Prior to the oncological treatment, the ovarian tissue is harvested laparoscopically. At the same time, other invasive procedures are done. Once malignancy is ruled out of the specimen and the presence of primordial follicles is confirmed, the multidisciplinary team of oncologist, paediatric surgeon and fertility specialist coordinate the processing and delivery of the ovarian cortex to the Comunidad Valenciana Tissue Bank. RESULTS: From July 2008 to May 2010 eight patients have been included in the programme, aged between 8-18 years old and with diagnosis of: Hodgkin's lymphoma (n= 2), Acute Myeloblastic and Lymphoblastic leukaemia (n= 2), pelvic Ewing's sarcoma, bilateral ovarian Teratoma and Meduloblastoma. Five patients underwent non gonadotoxic chemotherapy before OCC. Six additional procedures were done using the same anaesthetic event. Partial oophorectomy was performed in half the cases, total oophorectomy in the rest of them, and an ovarian pexia was once associated. All taken samples were found to be valid. CONCLUSIONS: OCC of selected patients was performed safely, with neither postoperative complications nor delay of the oncological treatment. Therefore, the first national experience in this procedure has been satisfactorily achieved.

[Cutaneous alternariosis and its diagnosis in an inmunocompromised patient]. / Alternariosis cutánea en paciente inmunocomprometido. Su diagnóstico.

In this paper, a cutaneous alternariosis is described. This is a strange opportunist infection with less than 100 cases. The patient was not VIH although inmunocompromised due to several factors: Malabsorption Syndrome, megaloblastic anemia secondary to gastrectomy and distal pancreatomy with gastrodigiunostomia due to gastric adenocarcinoma four years ago; splenectomied in the same operation, long treatment with hydantoin, and corticosteroids. The patient was managed in the internal medicine unit due to a problematic respiratory infection with cardiac rhythm disorder and progressive debility in lower limbs, together with cutaneous lesions in which "alternaria sp" was isolated by culture. After beginning treatment with oral itraconazole, his evolution was excellent. The main interest consists in the rareness and the original presentation of the cutaneous alternariosis in this case.

Alternariosis cutánea en paciente inmunocomprometido. Su diagnóstico / Cutaneous alternariosis and its diagnosis in an inmunocompromised patient

Describimos un caso de alternariosis cutánea, extraña infección oportunista de la que existen menos de cien casos descritos. Paciente no VIH aunque inmunocomprometido por múltiples factores: síndrome de malabsorción, y anemia megaloblástica secundarios a gastrectomía y pancreatectomía distal con gastroyeyunostomía por adenoma gástrico hacía 4 años; esplenectomizado en la misma intervención, en largo tratamiento con fenitoína, y corticosteroides. Ingresa por una infección respiratoria complicada con trastornos del ritmo cardíaco y debilidad progresiva de miembros inferiores junto con lesiones cutáneas en las que se aisló por cultivo Alternaria sp. Instaurado tratamiento con itraconazol oral, su evolución fue excelente. El interés del caso entendemos reside en la rareza y la original forma de presentación de esta alternariosis cutánea

In this paper, a cutaneous alternariosis is described. This is an estrange opportunist infection with less than 100 cases. The patient was not VIH although inmunocompromised due to several factors: Malabsorption Syndrome, megaloblastic anemia secondary to gastrectomy and distal pancreatomy with gastrodigiunostomia due to gastric adenocarcinoma four years ago; splenectomied in the same operation, long treatment with hydantoin, and corticosteroids. The patient was managed in the internal medicine unit due to a problematic respiratory infection with cardiac rhythm disorder and progressive debility in lower limbs, together with cutaneous lesions in which “alternaria sp” was isolated by culture. After beginning treatment with oral itraconazole, his evolution was excellent. The main interest consists in the rareness and the original presentation of the cutaneous alternariosis in this case

Utilidad de la transferrina deficiente en carbohidratos (CDT) para la valoración del abuso y la abstinencia en el alcoholismo crónico / Utility of carbohydrate deficient transferrin (CDT) in chronic alcohol abuse and abstinence

Objetivo: Valorar la utilidad de la transferrina deficiente en carbohidratos (CT) en el diagnóstico del alcoholismo crónico, la ingesta reciente y la abstinencia, comparándola con los marcadores biológicos más reconocidos, especialmente el VCM y la GT. Método: Estudio prospectivo en 87 sujetos: 22 controles, 42 pacientes alcohólicos crónicos en abstinencia y 23 alcohólicos activos, sometiendo un subgrupo de estos últimos a un periodo de abstinencia de 15 días. Valorando y comparando la CDT con otros parámetros biológicos reconocidos, en los diferentes grupos. Resultados: Para el alcoholismo crónico encontramos diferencia significativa en el VCM y la GGT. En el caso de la ingesta alcohólica reciente existió diferencia significativa en el VCM, la GGT y sobretodo en la CDT. En la abstinencia reciente el único que presentó diferencia significativa fue la CDT. Conclusiones: Según nuestros resultados la CDT tiene escasa utilidad erl el diagnóstico del alcoholismo crónico, siendo superada en esta propiedad por los marcadores clásicos (VCM y GGT). La CDT, sin embargo, es un marcador válido y efectivo para el diagnóstico de la ingesta alcohólica reciente, superando a la GGT y al VCM. Y es el único válido para el diagnóstico de la abstinencia reciente. Estimamos por tanto que, sería aconsejable el uso clínico de la CDT con criterios restringidos, para el diagnóstico de la ingesta alcohólica reciente y sobre todo para el diagnóstico de la abstinencia (AU)

[Usefulness of carbohydrate-deficient transferrin (CDT) in the assessment of abuse and abstinence in chronic alcoholism]. / Utilidad de la transferrina deficiente en carbohidratos (CDT) para la valoración del abuso y la abstinencia en el alcoholismo crónico.

OBJECTIVE: To evaluate the utility of carbohydrate deficient transferrin (CDT) for the chronic alcoholism diagnostic, the recent intake and the abstinence, comparing it with the most recognized biological markers, specially the MCV and the GGT. METHODS: We study 87 subjects: 22 controls, 42 subjects abstinent chronic alcoholics and 23 patient active alcoholics. From the last group we subject the middle to a 15 days abstinence period. We compare the CDT with the mos recognized markers in the difference groups. RESULTS: We found significant difference with MCV and GGT in the chronic alcoholism diagnostic. There were significant difference with MCV, GGT and specially CDT in the case of recent alcoholic intake. CDT was the only one that shows significant difference in recent abstinence. CONCLUSION: According to our results the CDT is a poor marker of chronic alcoholism. The classical markers (MCV nd GGT) are better on tha propriety. CDT, however, is a valid and effective marker for the recent alcohol intake, it is better than GGT and MCV. And it is the only valid marker for the recent abstinence. So, we estimate that, it would be advisable the CDT clinical use with restringed criterions for the recent alcoholic intake diagnostics and, specially for the abstinence one.

[Angioimmunoblastic lymphadenopathy. Apropos a case with unusual clinical manifestations and evolution to T-cell lymphoma]. / Linfadenopatía angioinmunoblástica. A propósito de un caso con manifestaciones clínicas inusuales y evolución a linfoma T.

We present the case of a 67-years-old patient which, after treatment with ciprofloxacin, developed fever, exanthema, arthralgias, polyadenopathies, hepatosplenomegaly, autoimmune hemolytic anemia, hypergammaglobulinemia and severe inversion of the CD4/CD8 ratio. Latter, he developed ischemic signs in several locations (splenic and cerebral infarcts), as well as polyneuropathy and inflammatory myopathy. The diagnosis of angioimmunoblastic lymphadenopathy was established through ganglionary biopsy. The patient improved initially with the administration of corticoids, but in a few months, he developed pleomorphic T lymphoma with quick fatal evolution. We discuss the rarity of some of the clinical and laboratory manifestations in this patient and we comment on the association of ciprofloxacin and the angioimmunoblastic lymphadenopathy, which has never been previously described in the international literature.

[Iatrogenic gastrointestinal hemorrhages. A review of 108 cases (author's transl)]. / Hemorragias digestivas yatrógenas. Consideraciones en torno a 108 casos.

Macroscopic gastrointestinal hemorrhages caused by the consumption of oral drugs are relatively scarce among patients receiving antirheumatic treatment. On the other hand, in a high percentage of all cases of digestive bleeding, antirheumatic drugs were administered shortly beforehand. A review of 216 cases with hematemesis and/or melena are presented. In 50 percent of the patients there was evidence of previous administration of potentially ulcerogenic drugs capable of causing hemorrhages in the digestive tract. Salicylates predominated among the compounds that were considered to be responsible for hemorrhages (salicylates, corticosteroids, reserpine, and other antirheumatic products). The mechanisms involved in producing iatrogenic hemorrhages were examined and the drugs were classified as precipitating and directly ulcerogenic compounds. Precipitating drugs were those which were able to reactivate a preexisting lesion (reserpine, glucocorticoids, phenylbutazone, etc.). The ulcerogenic drugs included those products that could provoke a lesion of previously unimpaired digestive mucosa (salicylates).

[Investigation of the hypoosmolal syndrome in carcinomas of the lung (author's transl)]. / Investigación del síndrome hipoosmolal en el carcinoma de pulmón.

A study was performed on 30 patients diagnosed antomopathologically for malignant neoplasia of the lung (epidermoid carcinomas, adenocarcinomas, oat-cell carcinomas, and neoplasias which could not be definitely classified). The following parameters for blood and urine were determined: osmolality, sodium, potassium, urea, and creatinine. Osmotic free water, creatinine, sodium, and potassium clearances were also calculated, as well as the plasma osmolality/urinary osmolality ratio. The basic aim of our study was to investigate for the presence of disturbances in the metabolism of water and alterations in plasmatic and urinary osmolality in this type of tumor. These could appear as complete inadequate ADH secretion syndromes as discovered by Bartter and Schwartz or as incomplete syndromes (hypoosmolality and/or hyponatremia). Among the more significant results was the tendency toward oliguira seen in 44% of the patients and the high incidence of plasmatic hypoosmolality (31%). In three patients plasmatic hypoosmolality and hyponatremia were concommitant in repeated observations. A complete inadequate ADH secretion syndrome was discovered in another patient with an oat-cell carcinoma. He presented plasmatic hypoosmolality, hyponatremia, relative urinary hypertonia, and oliguria but not renal, suprarenal, or hepatic pathology.