Cost of Treating Cutaneous T-Cell Lymphoma in Spain: Analysis of MICADOS Study Data by Disease Stage. / Evaluación de los costes asociados a la enfermedad de pacientes con linfoma cutáneo de células T en España: análisis en función del estadio clínico (estudio MICADOS).

BACKGROUND AND OBJECTIVE: The cost of treating cutaneous T-cell lymphoma (CTCL) in Spain is unknown. With the advent of new treatments, it is more important than ever to gain an accurate picture of the true costs involved. The MICADOS study had 2 primary objectives: 1)to evaluate the impact of CTCL on patient quality of life, and 2)to evaluate the costs associated with the disease. This article reports the results of the cost analysis. METHODS: We estimated the cost of treating CTCL over a period of 1year from the perspective of the Spanish National Health System. Twenty-three dermatologists and hematologists from 15 public hospitals analyzed data for adult patients with mycosis fungoides (MF) or Sézary syndrome (SS). RESULTS: A total of 141 patients (57.4% male) with a mean age of 63.6 years (95%CI: 61.4-65.7 years) were included. The mean direct annual cost of treating CTCL was €34,214 per patient. The corresponding costs by stage were €11,952.47 for stageI disease, €23,506.21 for stageII disease, €38,771.81 for stageIII disease, and €72,748.84 for stageIV disease. The total direct annual cost of treating MF/SS in public hospitals in Spain was estimated at €78,301,171; stageI disease accounted for 81% of all costs, stageII for 7%, and stagesIII andIV for 6% each. CONCLUSIONS: The MICADOS study offers an accurate picture of the direct cost of treating CTCL in patients with MF/SS in Spain and shows that costs vary significantly according to disease stage. Patient-borne and indirect costs should be analyzed in future studies.

[Translated article] Cost of Treating Cutaneous T-Cell Lymphoma in Spain: Analysis of MICADOS Study Data by Disease Stage.

BACKGROUND AND OBJECTIVE: The cost of treating cutaneous T-cell lymphoma (CTCL) in Spain is unknown. With the advent of new treatments, it is more important than ever to gain an accurate picture of the true costs involved. The MICADOS study had 2 primary objectives: 1)to evaluate the impact of CTCL on patient quality of life, and 2)to evaluate the costs associated with the disease. This article reports the results of the cost analysis. METHODS: We estimated the cost of treating CTCL over a period of 1year from the perspective of the Spanish National Health System. Twenty-three dermatologists and hematologists from 15 public hospitals analyzed data for adult patients with mycosis fungoides (MF) or Sézary syndrome (SS). RESULTS: A total of 141 patients (57.4% male) with a mean age of 63.6 years (95%CI: 61.4-65.7 years) were included. The mean direct annual cost of treating CTCL was €34,214 per patient. The corresponding costs by stage were €11,952.47 for stageI disease, €23,506.21 for stageII disease, €38,771.81 for stageIII disease, and €72,748.84 for stageIV disease. The total direct annual cost of treating MF/SS in public hospitals in Spain was estimated at €78,301,171; stageI disease accounted for 81% of all costs, stageII for 7%, and stagesIII andIV for 6% each. CONCLUSIONS: The MICADOS study offers an accurate picture of the direct cost of treating CTCL in patients with MF/SS in Spain and shows that costs vary significantly according to disease stage. Patient-borne and indirect costs should be analyzed in future studies.

European S1 guidelines on the management of lichen planus: a cooperation of the European Dermatology Forum with the European Academy of Dermatology and Venereology.

Lichen planus (LP) is a chronic inflammatory and immune-mediated disease that affects the skin, hair, nails and mucous membranes. Although there is a broad clinical spectrum of lichen planus manifestations, the skin and oral cavity remain the major sites of involvement. A group of European dermatologists with a long-standing interest and expertise in lichen planus has sought to define therapeutic guidelines for the management of patients with LP. The clinical features, diagnosis and possible medications that clinicians can use, in order to control the disease, will be reviewed in this manuscript. The revised final version of the lichen planus guideline was passed on to the European Dermatology Forum (EDF) for a final consensus with the European Academy of Dermatology and Venereology (EADV).

Evaluation of efficacy of a biofilm-embedded bacteria-based vaccine against staphylococcal mastitis in sheep-A randomized, placebo-controlled field study.

Our objective was to evaluate the efficacy of a vaccine against staphylococcal mastitis in 5 dairy sheep farms, with 316 ewes in the vaccinated (V) group and 307 in the control (C) group studied throughout a lactation period. Two administrations of the vaccine were performed during the last stage of gestation of ewes. Starting 15 d after lambing and at monthly intervals thereafter, up to 9 milk samplings were performed for bacteriological and cytological examinations. Staphylococcal isolates recovered were examined for biofilm formation. Blood samples were collected for measurement of IgG poly-N-acetylglucosamine-specific antibodies. The most frequently isolated bacteria were staphylococci: 56.4 and 76.1%, respectively, of total isolates recovered from ewes of group V and C, respectively; staphylococci as causal agents of mastitis were isolated less frequently from V (5.3%) than in ewes in C (10.3%). Among mastitis-associated staphylococcal isolates recovered from V ewes, a smaller proportion was biofilm-forming than among ones from C: 53.2% versus 74.9% of isolates; biofilm-forming staphylococci as causal agents of mastitis were isolated less frequently from ewes in group V (2.3%) than in ewes in group C (6.0%). Anti-poly-N-acetylglucosamine-specific antibody values increased in V ewes and were higher than in C; a greater proportion of ewes with low antibody titers developed staphylococcal mastitis (41.4%) than of V ewes with high antibody titers (17.0%). Incidence risk of mastitis, staphylococcal mastitis, and biofilm-associated staphylococcal mastitis was smaller in V than in C: 36.7, 17.1, and 8.0% versus 44.3, 30.9, and 18.9%, respectively. The first case of staphylococcal mastitis occurred later in V than in C: third versus second sampling point. Overall, efficacy of the vaccine was 44.6% for staphylococcal mastitis, 57.7% for biofilm-associated staphylococcal mastitis, 33.1% for staphylococcal intramammary infection, and 51.5% for biofilm-associated staphylococcal intramammary infection. Nevertheless, vaccination should not be the only means for controlling mastitis; other udder health management measures should be included therein to improve control of the infection.

Un caso de galactorrea psicógena sin hiperprolactinemia o síndrome de Nunes / Psychogenic galactorrhea without hyperprolactinemia or Nune's syndrome

Diversos estudios han evidenciado la existencia de factores psicológicos que juegan un papel clave en muchos casos de mujeres que padecen hiperprolactinemia, galactorrea o incluso prolactinoma (fenómeno conocido como síndrome de Nunes). Se han descrito vivencias infantiles que generan tales desórdenes somáticos: separación o ausencia del padre, o padre alcohólico y/o violento que favorecen una regresión infantil donde madre e hija recuperan una relación simbiótica maligna, simbolizada en la lactancia. La paciente aquí descrita presenta una galactorrea euprolactinémica, coincidente con el parto y lactancia de una amiga (AU)

[Early onset of neonatal sepsis due to Streptococcus agalactiae: study of ten years (1985-1994) and the utility of intrapartum prophylaxis]. / Sepsis neonatal precoz por Streptococcus agalactiae: estudio de diez años (1985-1994) y eficacia de la profilaxis intraparto.

OBJECTIVES: The objectives of this study were to determine the characteristics of early onset neonatal sepsis (EONS) due to group B streptococci (GBS) in our population and to evaluate the efficacy of a prevention program in our hospital during a 4 year period. MATERIAL AND METHODS: We revised all cases of EONS due to GBS between 1985 and 1994 and studied pregnant women colonized by GBS and their infants between 1991 and 1994. RESULTS: In ten years, we diagnosed 45 cases of EONS due to GBS, 30 born in our hospital and 15 born in other hospitals. Sixty-two percent of the patients presented some risk factor (gestation < 37 weeks, rupture of membranes > 18 hours or intrapartum fever > or = 37.8 degrees C. Between 1991 and 1994, 93% of pregnant women colonized by GBS received antibiotic prophylaxis, 14.7% of these women had some risk factor for infection. Two infants from mothers colonized had EONS due to GBS. One mother did not receive antibiotic prophylaxis and the other presented intrapartum fever. In another 5 cases observed during this period, the vaginal culture of the mother was negative for GBS. The incidence of EONS due to GBS during these 4 years was 0.82 cases per 1,000 live births. CONCLUSION: We consider it necessary to use antibiotic prophylaxis in all pregnant carriers of GBS, as well as the administration of antibiotics to pregnant women with a rupture of membranes < 34 weeks of gestation and the practice of an intrapartum culture for the detection of GBS in pregnant women without previous cultures and premature rupture of the membranes.

[Relaxation therapy in patients with anxiety and somatoform disorders in primary care]. / Tratamiento de relajación en pacientes con trastornos de ansiedad y somatoformes en atención primaria.

OBJECTIVE: To study the effect of relaxation therapy on the symptomology of patients with anxiety and somatoform disorders. DESIGN: An experimental prospective study, controlled through random assignation, using evaluation scales. SETTING: Mn. Jaume Soler Health Centre, Cornellà (Barcelona). PATIENTS: 31 patients (8 men and 23 women), diagnosed with anxiety or previously untreated somatoform disorders, for whom combined anti-depressive and relaxation therapy over a 5-month period was established. The results were compared with those of a control group (n = 17) with identical diagnoses, which only received antidepressive medication. MEASUREMENTS AND MAIN RESULTS: The STAI tests and two pain scales were administered at 0, 15, 30, 45, 60 and 150 days and the HRS and SCL-90-R at 0 and 150 days. The possible impact of the psychiatric diagnosis, age, gender, married status, existence of concomitant physical illness, SRE, present employment status and the presence of children or not were all considered. The results pointed to a significant improvement over the period in the analogue-visual scale of pain (p = .009) and in the HRS (p = .046) for the group comprised of those complying with the relaxation therapy independently of the psychiatric diagnosis. CONCLUSIONS: The benefit of relaxation in anxious and somatoform patients, when pain--and not anxiety--is the principal symptom, was confirmed. Depression improved when antidepressants were administered simultaneously, whereas anxiety varied little, at least during the time the trial lasted.

The Catalonia survey: Personality and intelligence structure in a sample of compulsive gamblers.

A sample of fifty-seven pathological gamblers and one hundred and fifteen controls (two per pathological gambler, matched as regards age and sex) was investigated. This sample received a complex battery of psychometric tests designed to evaluate two different axes: psychopathology and intelligence. The results obtained show that pathological gamblers have an unstable family and work background, that pathological gambling correlates with other addictions (alcohol, illness prone behavior, absenteeism, risk working, living alone and bereavement), that all the general and specific psychopathology vectors were significant in the addicts, and that the pathological gamblers' intelligence has characteristic factors.

Assessment of immunological responsiveness in members of International Biomedical Expedition to the Antarctic 1980/81.

Analysis of immune responsiveness was performed in members of the IBEA during a controlled trial of acclimatization with cold baths and during the subsequent 71 day period of Antarctic isolation. Several parameters of humoral and cellular immunity were assessed. No differences were found for those individuals who underwent cold-acclimatization in the first phase of the expedition. On the ice-cap all members showed slight elevation of their immunoglobulins, the increase in IgA reaching significance (p less than 0.05). Values returned to normal on returning to Sydney. Enhanced reactivity to the mycobacterium antigen purified protein derivative (PPD) was found on the ice-cap with 4 individuals becoming positive and remaining so on returning to Sydney. There was no obvious exposure to mycobacterium during the expedition but it is recommended that in future expeditions all PPD negative individuals be vaccinated with BCG.

Effects of 18-hydroxycorticosterone and of aldosterone on acid-base parameters in the arterial blood of adrenalectomized rats.

Adrenalectomized rats were injected twice with either 2 micrograms aldosterone or 6 micrograms 18-hydroxycorticosterone (18-OH-B) and were then kept either under normal, or high-CO2 respiratory conditions. Arterial blood samples were withdrawn sequentially from T1 (i.e., 70 minutes after the first injection) on, and were then submitted to determinations of pH and PCO2. Bicarbonate levels were calculated from these data. 18-OH-B: 1) increased pH under both conditions; 2) had a tendency to decrease PCO2 in both conditions; the decrease was significant at 130 minutes after injection, under normal conditions; 3) increased CO3H levels at T1 under high-CO2 atmospheres. Aldosterone did not produce changes in pH values, even if injected in doses equimolar to those of 18-OH-B, but showed a tendency--at these higher doses--to decrease PCO2 values.

Effects of 18-hydroxycorticosterone and of aldosterone on acid-base parameters in the arterial blood of adrenalectomized rats.

Adrenalectomized rats were injected twice with either 2 micrograms aldosterone or 6 micrograms 18-hydroxycorticosterone (18-OH-B) and were then kept either under normal, or high-CO2 respiratory conditions. Arterial blood samples were withdrawn sequentially from T1 (i.e., 70 minutes after the first injection) on, and were then submitted to determinations of pH and PCO2. Bicarbonate levels were calculated from these data. 18-OH-B: 1) increased pH under both conditions; 2) had a tendency to decrease PCO2 in both conditions; the decrease was significant at 130 minutes after injection, under normal conditions; 3) increased CO3H levels at T1 under high-CO2 atmospheres. Aldosterone did not produce changes in pH values, even if injected in doses equimolar to those of 18-OH-B, but showed a tendency--at these higher doses--to decrease PCO2 values.