[Mesenteric panniculitis with retroperitoneal involvement resolved after treatment with intravenous cyclophosphamide pulses]. / Paniculitis mesentérica con afectación retroperitoneal resuelta tras tratamiento con pulsos de ciclofosfamida endovenosa.

Mesenteric panniculitis is an inflammatory process of the adipose tissue of the mesentery. It produces a thickening of the mesentery of the small bowel or colon and can occasionally involve the retroperitoneum. It is characterized by an infiltration of lipid-laden macrophages and associated with variable degrees of inflammation and fibrosis. Several treatments have been used, including colchicine, dapsone, corticosteroids associated or not with immunosuppressants, but there are no prospective controlled studies to define appropriate treatment: moreover, there are cases of regression without specific therapy. We present the case of a patient with mesenteric panniculitis affecting the colon and retroperitoneal space including the right ureter and iliac vein. Immunosuppressive treatment with monthly intravenous pulse cyclophosphamide and oral corticosteroids, resulted in the disappearance of the abdominal mass without relapse during ten months of monitoring.

Paniculitis mesentérica con afectación retroperitoneal resuelta tras tratamiento con pulsos de ciclofosfamida endovenosa / Mesenteric panniculitis with retroperitoneal involve ment resolved after treatment with intravenous cyclophosphamide pulses

La paniculitis mesentérica es un proceso inflamatorio del tejido graso mesentérico. Cursa con un engrosamiento del mesenterio del intestino delgado o colon y puede afectar en ocasiones al retroperitoneo. Se caracteriza por una infiltración de macrófagos cargados de grasa y asociados a un grado variable de inflamación y fibrosis. En el tratamiento se ha empleado colchicina, dapsona, corticoides asociados o no a inmunosupresores, pero no hay estudios controlados prospectivos que definan el tratamiento adecuado. Además hay casos de regresión sin terapéutica específica. Presentamos el caso de una paciente con paniculitis mesentérica con afectación del colon y espacio retroperitoneal englobando el uréter y la vena ilíaca derechos. El tratamiento médico inmunosupresor con ciclofosfamida en pulsos mensuales endovenosos y corticoides orales, consiguió la desaparición de la masa abdominal sin recaída durante diez meses de seguimiento (AU)

Background: The most commonly used measures of association in cross-sectional studies are the odds ratio (OR) and the prevalence ratio (PR). Some cross-sectional epidemiologic studies describe their results as OR but use the definition of PR. The main aim of this study was to describe and compare different calculation methods for PR described in literature using two situations (prevalence < 20% and prevalence > 20%). Material and methods: A literature search was carried out to determine the most commonly used techniques for estimating the PR. The four most frequent methods were: 1) obtaining the OR using non-conditional logistic regression but using the correct definition; 2) using Breslow-Cox regression; 3) using a generalized linear model with logarithmic transformation and binomial family, and 4) using the conversion formula from OR into PR. The models found were replicated for both situations (prevalence less than 20% and greater than 20%) using real data from the 1994 Catalan Health Interview Survey. Results: When prevalence was low, no substantial differences were observed in either the estimators or standard errors obtained using the four procedures. When prevalence was high, differences were found between estimators and confidence intervals although all the measures maintained statistical significance. Conclusion: All the methods have advantages and disadvantages. Individual researchers should decide which technique is the most appropriate for their data and should be consistent when using an estimator and interpreting it (AU)

[Suicide attempts attended at a health centre]. / Intentos de suicidio atendidos en un centro de salud.

OBJECTIVE: To describe the characteristics of the suicide attempts attended in a health district over 10 years (June 1989 to December 1998). DESIGN: Cross-sectional, descriptive study. SETTING: Primary care, rural health district.Patients. Everyone attended after a suicide attempt (55 cases). MAIN MEASUREMENTS AND RESULTS: Data of the following variables were obtained from the legal reports: sex, age, place of residence, prognosis, means used and year of attempt. 51% were women and 49% men. Average age was 34.07, SD 3.82. 96% occurred in the health district. 38% had light prognosis, 49% serious, 7% very serious and 4% uncertain. The means used was ingestion of drugs in 44% of cases. 72% of the attempts occurred in the last 5 years. CONCLUSIONS: There were no differences between the sexes. Most of the patients were under 35. Drug overdose was the method of choice. Suicide attempts are on the up. Primary care authorities and doctors need to become more conscious of potentially suicidal conduct.

Intentos de suicidio atendidos en un centro de salud / Suicide attempts attended at a health centre

Objetivo. Describir las características de los intentos de suicidio producidos y atendidos en una zona básica de salud (ZBS) en 10 años (junio 1989-diciembre 1998).Diseño. Estudio descriptivo, transversal. Emplazamiento. Atención primaria, zona básica de salud de un área rural. Pacientes. Todos aquellos atendidos por intento de suicidio (55 casos).Mediciones y resultados principales. Los datos se obtuvieron de los partes judiciales recogiendo las siguientes variables: sexo, edad, localidad de residencia, pronóstico, medios utilizados y año del intento. Un 51 por ciento era mujer y el 49 por ciento varón. La edad media fue 34,07 (DE, 3,82). La localidad de origen en un 96 por ciento fue la ZBS. Por lo que atañe al pronóstico, leves, 38 por ciento; graves, 49 por ciento; muy graves, 7 por ciento, y reservado, 4 por ciento. El medio utilizado fue en un 44 por ciento la ingesta de medicamentos. En los 5 últimos años ocurrió el 72 por ciento de los intentos. Conclusiones. No hay diferencias en cuanto a sexos. La mayoría de los sujetos eran menores de 35 años. El medio preferido fue, sobre todo, la ingesta de fármacos. Los intentos de suicidio constituyen un fenómeno en aumento. Es necesario concienciar a las autoridades y a los médicos de atención primaria para poder detectar posibles conductas suicidas. (AU)

A randomized phase II trial of 5-fluorouracil, with or without human interferon-beta, for advanced colorectal cancer.

This study compared the efficacy and safety of 5-fluorouracil (5-FU) monotherapy to that of 5-FU combined with natural human interferon-beta (IFN-beta) in patients with unresectable, advanced colorectal carcinoma. Forty-nine chemotherapy-naive patients were randomized to 5-FU alone or to the combination. All patients received 750 mg m(-2) day(-1) 5-FU for 5 days by continuous intravenous (i.v.) infusion, followed after day 15 by a weekly i.v. bolus of 750 mg m(-2). IFN-beta was injected intramuscularly three times weekly at 9 M IU. Treatment continued for 52 weeks, or until disease progression or intolerable toxicity. Clinical endpoints were tumor response, time to progression, survival and toxicity. The addition of IFN-3 to 5-FU significantly improved response rate (33.3% vs 4.5% for evaluable patients; P = 0.021), time to progression (median 7.2 vs 4.2 months; P = 0.0435), and survival time (median 15.9 vs 7.2 months; P = 0.038) without significantly increasing toxicity compared to 5-FU alone. Cumulative 5-FU dose was higher with combined therapy (P < 0.001): more patients receiving monotherapy discontinued treatment because of disease progression. Fever was more frequent with combined therapy (P = 0.008); there were no other differences in toxicity. The only grade IV toxicity observed was neutropenia (two patients per group). A randomized phase III trial has been initiated to confirm the synergy between 5-FU and IFN-beta.

[Hospitalization demand for medical specialties in a health area with 200,000 inhabitants]. / Demanda de hospitalización de especialidades médicas en un área sanitaria de 200,000 habitantes.

To assess the hospitalisation requirements for medical specialties (MS), admissions to a district hospital were studied during two subsequent years. Of the 196,800 inhabitants, 3% (6,089) were admitted which resulted in 7,841 admissions during this period. Four hundred and forty two different main diagnosis were performed but only 14 led to 50% of admissions and these same entities were also involved in any of the diagnosis associated (comorbidity). Mean age of the total group was 61 +/- 18 years being women patients three years older than men. More men than women were admitted. Pathology complexity was usually due to comorbidity, rather than a specific entity. Therefore we consider that the relationship between primary, general medicine and specialty attention should be reviewed and the involvement of MS in district hospitals should be revised so that the service may be efficient as well as improving cost-effectiveness ratio and thus achieving a remarkable economical saving.

Adjuvant cyclophosphamide, methotrexate, and fluorouracil versus fluorouracil, epirubicin, and cyclophosphamide chemotherapy in premenopausal women with axillary node-positive operable breast cancer: results of a randomized trial. The International Collaborative Cancer Group.

PURPOSE: To determine whether a combination chemotherapy regimen that contains epirubicin (fluorouracil, epirubicin, and cyclophosphamide [FEC]) is superior to the standard cyclophosphamide, methotrexate, and fluorouracil (CMF) combination in premenopausal women with axillary node-positive operable breast cancer. PATIENTS AND METHODS: The International Collaborative Cancer Group (ICCG) conducted a large randomized trial in which two alternative schedules were used according to participating center: CMF1 versus FEC1 and CMF2 versus FEC2. RESULTS: Seven hundred fifty-nine patients were entered onto the trial. At a median follow-up time of 4.5 years, no significant benefit for the anthracycline-containing regimen was observed in terms of relapse-free (P = .61) or overall survival (P = .13). FEC1 and CMF1 appear to be of similar efficacy, but there is a suggestion that FEC2 may be superior to CMF2, since patients who received FEC2 had improved overall (P = .02) and relapse-free survival (P = .03) rates. Nausea and vomiting and alopecia were more common in the epirubicin-containing regimen (P = .001). CONCLUSION: We conclude that the FEC2 regimen, in which epirubicin replaced the methotrexate in CMF, is the preferable adjuvant chemotherapy regimen for premenopausal patients with operable axillary node-positive breast cancer.

Phase II study with iododoxorubicin in measurable advanced colorectal adenocarcinoma. Effective rescue using weekly high-dose 5-fluorouracil (WFU). Spanish Cooperative Group for Gastrointestinal Tumor Therapy (TTD), Work Group of SEOM (Spanish Medical Oncology Society).

AIMS AND BACKGROUND: To evaluate a new anthracycline 4'-iodo-4'-deoxydoxorubicin (I-DOX) in patients with measurable advanced colorectal adenocarcinoma in a phase II study. METHODS: We investigated therapeutic activity and toxicities associated with repeated courses of I-DOX 80 mg/m2 administered every 3 weeks. Eighteen patients entered the trial, all of them evaluable for response and toxicity. RESULTS: A total of 47 courses were administered. The median cumulative I-DOX dose was 238 mg/m2 (80-320). Myelosuppression, particularly leukopenia, was the most frequent and serious side effect associated with I-DOX treatment; World Health Organization (WHO) grade 3-4 leukopenia occurred in 4 patients (22%). No thrombocytopenia was observed except in 1 patient who presented WHO grade 4. Only 1 patient developed febrile neutropenia but recovered uneventfully. Overall, the I-DOX treatment was well tolerated. Grade 3-4 nausea/vomiting was observed in 2% of the cycles and no other severe toxicities were recorded. Echocardiography or multiple gated scan was performed before treatment and during follow-up in 14 patients to measure left ventricular ejection fraction (LVEF), and a decrease > 15% was detected in 3, including 1 whose LVEF fell below normal values (48%) (normal range > 49%). There were no cases of congestive heart failure or treatment-related deaths. No complete or partial response (PR) was observed. Twelve patients received weekly high-dose 5-fluorouracil (WFU) as rescue. Four patients had PR, 5 no change and 3 progressive disease (PD). The median time to PD of the whole group from study entry to failure after WFU was 30 weeks and the overall median survival was 11 months. CONCLUSIONS: As reported for other anthracyclines, I-DOX showed no activity in colorectal adenocarcinoma; however, the use of an investigational agent as front-line chemotherapy for colorectal adenocarcinoma does not compromise further response to 5-FU.

5-Fluorouracil, folinic acid, epidoxorubicin and cisplatin (FLEP) combination chemotherapy in advanced measurable gastric cancer. A phase II trial of the Spanish Cooperative Group for Gastrointestinal Tumor Therapy (TTD).

BACKGROUND: Metastatic disease is a common problem in gastric cancer and the development of better chemotherapeutic regimens is a clear priority in gastrointestinal oncology. PATIENTS AND METHODS: Ninety consecutive, previously untreated patients with unresectable or measurable metastatic gastric cancer were included in a multicenter phase II trial with a combination of folinic acid (200 mg/m2) and 5-fluorouracil (400 mg/m2) days 1-3, with epidoxorubicin (60 mg/m2) and cisplatin (100 mg/m2) on day 2. RESULTS: A total of 376 courses of FLEP were given, with a median of four courses per patient. Objective responses were observed in 32 (35%) patients (CI at 95%: 25.7%-46.3%). Eight (9%) patients experienced clinical complete remissions. Median time to progression was 25 weeks for the entire group of patients and 38 weeks for responders. Myelosuppression was the primary toxicity. WHO grade 3 leukopenia appeared in 26 patients (29%). Ten presented episodes of febrile neutropenia requiring hospitalization, but no toxic deaths were observed. Grades 3 and 4 thrombocytopenia were seen in 8 and 1 patients, respectively. Median survival time was 8 months for all treated patients and 11 months for responders. CONCLUSIONS: The FLEP regimen is an active combination in advanced gastric cancer with moderate toxicity that warrants further testing in a phase III trial.

[Hereditary hemorrhagic telangiectasia at an internal medicine service: study of 12 patients]. / La telangiectasia hemorrágica hereditaria en un servicio de medicina interna: estudio de doce enfermos.

Hereditary hemorrhagic telangiectasia (HHT) is a hereditary dominant autosoma clinical entity characterized by repeated hemorrhages (being epistaxis the more frequent) and telangiectasia in skin, mucosa and internal organs. Incidence in Europe is 1,2 per 100,000 pop. We discuss the experience of an Internal Medicine Department (Arnau de Vilanova Hospital), during 10 years, in which 12 patients were diagnosed. With the aim to provide more information about this rare disease. There was no predominant sex and the age of onset was very variable. All patients referred at admission past history of hemorrhages (either the patient him/herself or some relative), or were suffering it at admission. Except one patient, all of them showed telangiectasias in skin and mucosa. In five of them telangiectaias were found in upper gastrointestinal tract, in two there were localized on the tracheobronchial tree and one patient had teleangiectasia in liver. Three patients were diagnosed of pulmonary arteriovenous fistula (PAVF). The clinical, diagnostic and therapeutic aspects of this disease are reviewed.

120-hour 5-fluorouracil (5-FU) continuous infusion (CI) plus BCNU in advanced colorectal cancer.

Seventy-five previously untreated patients with measurable advanced colorectal cancer were treated with 5 fluorouracil 1,000 mg/m2 as a 24-hour intravenous (i.v.) continuous infusion during days 1-5 and 28-32 every cycle, plus 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU), 200 mg/m2 i.v. bolus on day 1, all given every 8 weeks up to 6 cycles. Median Karnofsky performance status (KPS) was 100. Sites of disease at entry were mainly the abdomen (45%) and liver (33%). All patients were evaluable for response and survival. There were two complete responses and seven partial responses (PR) for an overall response rate of 12% (95% confidence limits: 5-20%). Four out of 25 patients with liver metastases alone had PR. Stabilization was seen in 40 patients (53%). Median time to progression was 9.3 months and overall median survival was 12.5 months, whereas median survival for patients with liver metastases alone was 16 months. Toxicity was mild except for 8% with WHO grade 4 mucositis. Only KPS had statistical significance in the multivariate analysis of prognostic factors. It is concluded that this regimen is relatively active and well tolerated in patients with advanced colorectal cancer.

A randomized trial comparing adjuvant fluorouracil, doxorubicin, and mitomycin with no treatment in operable gastric cancer. International Collaborative Cancer Group.

Three hundred fifteen patients with operable gastric cancer were randomized to receive fluorouracil, Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH), and mitomycin (FAM) or no adjuvant treatment between September 1981 and July 1984. After excluding ineligible patients, 281 patients are included in this analysis. Treatment was moderately well tolerated by the majority of patients, the common side effects being nausea and vomiting (58%) and alopecia (57%). Three possible treatment-related deaths were seen, all due to cardiac failure. At median follow-up of 68 months, 164 patients have died, 73 in the treated arm and 91 in the control arm. There was no significant difference in disease-free or overall survival between the two arms of the study (P = 0.21). There is some evidence that patients with more advanced carcinoma (T3-T4) derived some benefit from treatment (P = 0.04). The interpretation of this finding must take into account that all subgroups were defined retrospectively, and this could, therefore, be a chance finding. We conclude that adjuvant chemotherapy as given in this trial is not indicated as routine treatment in operable gastric cancer, but that further evaluation in stage T3-T4 patients is warranted.

[Tuberculosis at an internal medicine service of a regional hospital]. / La tuberculosis en un servicio de medicina interna de un hospital de área.

The causes of the maintained endemia of tuberculosis in the area of the "Hospital Arnau de Vilanova", Valencia, were studied in 162 cases treated over a 6 year period. The social conditions of the area, predisposition factors and the rare clinical and radiological first manifestations are factors influencing the maintained endemia. The introduction of invasive diagnosis techniques to confirm the disease, brought about the diagnoses of cases that with the standard techniques would have been impossible, giving the false impression of a higher incidence. We concluded that it is necessary to keep the disease in mind in the differential diagnosis of risk groups, maintaining the required epidemiological measures.