[Isolated peripheral facial paralysis in a patient with COVID-19]. / Parálisis facial periférica aislada en un paciente con COVID-19.

TITLE: Parálisis facial periférica aislada en un paciente con COVID-19.

Active study: undetected prevalence and clinical inertia in the treatment of breakthrough cancer pain (BTcP).

AIMS: To prove if there is clinical inertia in the identification and treatment of episodes of breakthrough cancer pain (BTcP), comparing actual results from clinical practice with clinical oncologists' prior perception. DESIGN: Observational and descriptive study, using information collected by practising medical oncologists, at three moments: (a) questionnaire regarding their professional judgement of the handling of patients with BTcP in their practice, (b) cross-sectional clinical screening, to detect possible existing cases of BTcP in a representative sample of their patients, (c) retrospective self-audit of clinical case histories of patients diagnosed with BTcP to find out about how it has been handled. PARTICIPANTS AND STUDY PERIOD: A random sample on a state level of 108 specialists in medical oncology. 540 patients who suffer some type of cancer pain on the designated study date for each specialist (July-December 2016). RESULTS: The global prevalence of BTcP in the study sample covered 91.3% of the patients who were suffering some type of cancer pain. Barely 2% of the doctors surveyed suspected figures around this mark. 40.9% of the cases had not been previously detected as BTcP by their doctors. Although 90% of the patients who had previously been diagnosed with BTcP received a specific analgesic treatment for the symptoms, 42% of those patients with known BTcP were not able to control their episodes of pain. CONCLUSIONS: Clinical inertia is a serious problem in the handling of BTcP in medical oncology services, where it is the subject of a significantly low level of detection and treatment, despite the contrasting perception of specialists.

Síndrome de encefalopatía posterior reversible: a propósito de dos casos / Posterior reversible encephalopathy syndrome: about two cases

El síndrome de encefalopatía posterior reversible es una entidad clinicorradiológica cada vez más conocida en la práctica diaria pediátrica, pero puede presentarse con una sintomatología neurológica muy diversa (cefalea, alteración del nivel de conciencia, pérdida de visión, crisis convulsivas, etc.), generalmente asociada a un cuadro de hipertensión arterial o insuficiencia renal. Para su diagnóstico se utilizan actualmente pruebas de imagen, como la resonancia magnética, con una elevada sensibilidad, la tomografía computarizada y el electroencefalograma. Su manejo radica en el tratamiento de las crisis y el control de la presión arterial, además de la eliminación de los factores predisponentes, y suele tener un buen pronóstico, con una resolución completa del cuadro en días o semanas

Posterior reversible encephalopathy syndrome is a clinical-radiological entity that is increasingly known in pediatric practice but it can be presented with a diverse neurological clinic (headache, altered consciousness level, loss of vision, seizures, etc.), usually associated to an episode of hypertension or renal failure. Imaging tests such as magnetic resonance, with greater sensitivity, and computed tomography or electroencephalogram are currently used for diagnosis. Its management is based in seizures treatment and control of blood pressure in addition to the elimination of predisposing factors and it usually has a good prognosis with a complete resolution of the episode in days or weeks

Documento de Consenso sobre el uso de factores estimuladores de colonias de granulocitos biosimilares para la corrección de la neutropenia asociada en pacientes con cáncer / No disponible

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Spanish Society of Medical Oncology consensus on the use of erythropoietic stimulating agents in anaemic cancer patients

Treatment of anaemia is a very important aspect in the management of cancer patients. In order to carry out a consensus process about the use of erythropoietic stimulating agents (ESAs) in cancer patients, the Spanish Society of Medical Oncology (SEOM) elaborated a working group which coordinated a panel of medical oncology specialists. This working group has reviewed the main issues about the use of ESAs. In addition a consensus meeting was held in Madrid on 25 April 2007. The following conclusions were made: Since ESA treatment increases the haemoglobin (Hb) level and decreases the red blood cell (RBC) transfusion requirements, ESAs should be used within the approved indications in patients undergoing chemotherapy treatment, beginning at a Hb level below 11 g/dl and maintaining it around 12 g/dl, with iron supplements if necessary. Neither increasing the ESA dose in nonresponders nor the use of ESAs in the treatment of chronic cancer-related anaemia is recommended (AU)

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Biomarkers and anti-EGFR therapies for KRAS wild-type metastatic colorectal cancer

Therapy for metastatic colorectal cancer has been improved in terms of response rate, time to progression and overall survival by the emergence of anti-EGFR monoclonal antibodies (cetuximab and panitumumab) in combination with standard cytotoxic chemotherapy (oxaliplatin or CPT-11-based combinations). However, the benefits of cetuximab and panitumumab are confined to KRAS wild-type (KRAS-wt) colorectal tumours; KRAS-mutated tumours rarely respond to these drugs. Of all colorectal tumours, 65% are KRAS-wt tumours, but anti-EGFR therapies are effective for only 60-70% of these. Therefore, other biomarkers and molecular pathways must be involved in the response to anti-EGFR therapies in KRASwt colorectal tumours. Factors that may explain the lack of response include EGFR ligands, EGFR phosphorylation levels, the number of EGFR copies, the status of the KRAS effector B-RAF and the alternative intracellular PIK3CA/ PTEN/AKT and JAK/STAT signalling pathways. A battery of biomarkers is needed to select the patients that will be most sensitive to anti-EGFR therapies. Such patterns may be a novel and cost-effective tool to develop tailored treatments. This manuscript will review biomarkers and molecular pathways that are involved in the tumour response to anti-EGFR therapies (AU)

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Spanish Society of Medical Oncology consensus for the use of haematopoietic colony-stimulating factors in cancer patients

Neutropenia is a common complication of cancer chemotherapy. Colony-stimulating factors (CSF) may be used to avoid neutropenia-associated complications. The Spanish Society of Medical Oncology (SEOM) recently constituted a working group to review the main issues concerning the use of CSF and carried out a consensus process about the use of CSF in cancer patients, held in Madrid on 26 May 2006. The group concluded the following recommendations: prophylactic use of CSF is recommended when a rate of febrile neutropenia (FN) higher than 20% is expected without the use of CSF or when additional risk factors for neutropenia exist; therapeutic use of CSF is recommended in order to treat FN episodes but not to treat afebrile neutropenic episodes. In addition, the use of CSF is considered effective when used to mobilise stem cells before high-dose chemotherapy and when used for chemotherapy schedule optimisation in dose-dense and in dose-intense regimens (AU)

Adjuvant chemotherapy for early-stage non-small-cell lung cancer. Single-centre experience and literature review

BACKGROUND: In recent years platinum-based chemotherapy has become the standard of care for patients with good performance status after complete resection in stages IB-IIIA non-small-cell lung cancer (NSCLC), although the benefit is mainly in stages II and IIIA. PATIENTS AND METHODS: In a retrospective trial we evaluate the clinical efficacy and toxicity profile of a platinum- and taxanes-based adjuvant chemotherapy in completely resected IB-IIIA NSCLC. The primary end point was relapse- free survival (RFS); principal secondary end points were overall survival (OS) and safety of the regimen. Potential predictive factors of efficacy and clinical patterns of relapse were also analysed. RESULTS: From January 2003 to December 2006, 41 patients met the inclusion criteria and were evaluable. Median age at diagnosis was 68.1 years (CI 95% 54-72; range 45-78). Most patients were males (87.7%) and had an Eastern Cooperative Oncology Group performance status score (PS) of 0-1 (87.8%), and 53.6% had adenocarcinomas. Pathological stages were as follow: 48.7% stage IB, 24.3% stage II and 26.8% stage IIIA. 75.6% of patients underwent a lobectomy and mediastinal lymphadenectomy and were treated with a combination of carboplatin AUC6 and paclitaxel 200 mg/m2 (85.36%) for 3 or 4 cycles. With a median follow-up of 18.2 months (range 5.1-46.5), 26 patients (63%) were free of disease and 32 of them were alive (78%). Median RFS was 12.1 months (CI 95% 9.8-14.9) and median OS had not been reached at the time of analysis. Patients with PS< or =1 at diagnosis had a higher RFS [p=0.051 (CI 95% 0.90-0.96)]. Toxicity was generally mild and haematologic events were the most frequent. Non-haematologic toxic effects of chemotherapy were asthenia/ anorexia (12.2%), nausea/vomiting (12.2%) and peripheral neuropathy (17%), but severe toxic effects (grade 3 or greater) were uncommon (<10%). We did not observe treatment-related deaths. CONCLUSIONS: Platinum-taxane-based adjuvant chemotherapy in IB-IIIA NSCLC following complete resection is feasible, well tolerated and can be delivered in most patients in the adjuvant setting. Ongoing molecular studies may have value in determining which patients will benefit from adjuvant chemotherapy (AU)

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Cardiac metastasis from uterine leiomyosarcoma.

Cardiac metastases are more frequent than primary heart neoplasias. Nearly any malignant tumour may metastasize to the heart, but the most common are carcinomas rather than sarcomas. We report the case of a patient who presented with heart metastasis 6 years after resection of an uterine leiomyosarcoma. The patient died thirty months after surgical resection without evidence of cardiac recurrence. Although cardiac metastases from uterine leiomyosarcoma are exceptional, they should be suspected in the presence of suggestive symptoms, since they can be associated with long survival after surgical treatment.

Predictive value of brain-stem auditory evoked potentials in children with post-traumatic coma produced by diffuse brain injury.

In the present study, brain-stem auditory evoked potentials (BAEPs) in 31 children in post-traumatic coma with diffuse brain injury were examined. The BAEPs were recorded in the first 72 h after hospital admission and the findings of 29 patients related to the level of neurological recovery at 6 months after head injury. On the basis of the results, children were divided into three groups: the first consisted of children with bilateral and normal BAEPs (n = 19); the second of those with asymmetrical BAEPs (n = 6); and the third of those in whom BAEPs has disappeared or in whom only responses of the seventh cranial nerve and cochlear nucleus were recorded (n = 4). All the patients in the first group presented a good clinical outcome, with excellent recovery in 80%. In the second group three children (42.8%) had a good recovery, two (28.6%) were moderately disabled and one (14.3%) died of extraneurological causes. All the patients in the third group died. Abnormal BAEPs showed a significant correlation with absence of pupillary and/or corneal reflex, but not with the Glasgow Coma Score and anisocoria. Good statistical correlation was observed between normal BAEPs and visualization of basal cisterns on computed tomographic scan. The incidence of increased intracranial pressure was higher in patients with abnormal BAEPs, but the differences were not significant (P = 0.06). Our study confirms the predictive value of BAEPs in children's post-traumatic coma due to diffuse brain injury.

[Intracranial arteriovenous malformations in children and adolescents]. / Malformaciones arteriovenosas intracraneales en niños y adolescentes.

Six children, ranging in age from 5 years to 13 years, with a history of intracranial arteriovenous malformation were studied from 1980 to 1989. The more frequent clinical presentation was the intracranial bleeding. The brain angiography was performed on five patients who were all diagnosed with cavernous hemangioma the diagnosis was anatomopathologic. Three patients were treated with neurosurgery and two patients were treated with radiosurgery. Only one patient died after the operation and the other five had a satisfactory recovery.

[Cardiotoxicity induced by 5-fluorouracil. Review of the literature]. / Cardiotoxicidad inducida por 5-fluorouracilo. Revisión de la literatura.

5-fluorouracil is potentially cardiotoxic to man. To date, 47 patients have been reported with undesired heart disorders after the administration of this cytotoxic drug. The incidence of cardiotoxicity due to 5-FU is 1.6%. Angina-type precordial pain with electrocardiographic changes suggesting myocardial ischemia is the common clinical feature. Generally it disappears spontaneously or after the use of coronary vasodilators. Acute left ventricular failure, pericarditis and rythm disorders are not often found. The pathogenesis is unknown however, cardiac spasm as well as the direct or indirect effect of the drug on myocardium, are possible responsible mechanisms.

Acute subdural hematoma and diffuse axonal injury after severe head trauma.

The association of acute subdural hematoma (SDH) and diffuse axonal injury has received little attention in the literature. The authors report the clinicopathological findings in six patients who died of severe head injury in whom computerized tomography revealed acute SDH as the predominant lesion. All patients were injured in road traffic accidents and lost consciousness on impact. The mean total contusion index was 17.4 and sever contusions were seen in only two cases. All patients presented histological criteria of intracranial hypertension (pressure necrosis focus in one or both parahippocampal gyri). Hypoxic brain damage was evident in the postmortem examination of three patients. In three cases, macroscopic hematic lesions were observed in the corpus callosum. All patients had widespread axonal retraction balls disseminated in the white brain matter. Three patients who survived for more than 11 days had microglial clusters. In some patients with a head injury, acute SDH may be only an epiphenomenon of a primary impact lesion of variable severity: that is, a diffuse axonal injury. In these cases, the final outcome is fundamentally dependent on the severity of the subjacent diffuse axonal injury.