Sunitinib-induced hypertension in CYP3A4 rs4646437 A-allele carriers with metastatic renal cell carcinoma.

The single nucleotide polymorphism (SNP) rs4646437G>A in CYP3A4 was suggested to be related to sunitinib toxicity. Our objective was to perform an in-depth investigation of the association between this SNP and sunitinib toxicity and efficacy using a large cohort of metastatic renal cell carcinoma (mRCC) patients. We collected DNA and clinical information of mRCC patients treated with sunitinib. SNP rs4646437 in CYP3A4 was tested for associations with toxicity using logistic regression. Cox regression modeling was used for association analysis of rs4646437 with progression-free survival (PFS) and overall survival (OS). In a total of 287 patients, the A-allele of CYP3A4 rs4646437 was associated with an increased risk for hypertension (odds ratio=2.4, 95% confidence interval: 1.1-5.2, P=0.021) and showed no significant association with PFS or OS. In conclusion, hypertension is more likely to occur in A-allele carriers of the CYP3A4 rs4646437 variant in our cohort of mRCC patients treated with sunitinib.

[Non-invasive ventilation in kyphoscoliosis. A comparison of a volumetric ventilator and a BIPAP support pressure device]. / Ventilación no invasiva en cifoescoliosis. Estudio comparativo entre respirador volumétrico y soporte de presión (BIPAP).

Non-invasive intermittent positive pressure ventilation (NIPPV) at home is the treatment of choice for patients with chronic respiratory insufficiency secondary to severe kyphoscoliosis. Our aim was to compare clinical course, blood gases and lung function after one month of domiciliary NIPPV with two types of ventilator and to assess sleep pattern changes in patients enrolled in a prospective, randomized crossover study. Ten patients with chronic respiratory insufficiency due to kyphoscoliosis were enrolled and randomly assigned to the first device. After one month of use, the patients underwent clinical and functional examinations and polysomnographic studies while using the ventilator. The same protocol was applied with the second device after a ten-day washout period. Baseline polysomnographs showed fragmented sleep with low percentages of deep non-REM sleep and of REM sleep, as well as respiratory patterns characterized by very high frequencies coinciding with significant desaturations. In all cases symptoms and arterial blood gas improvements were significant, with no differences between the two treatment periods. The percentages of time spent with SaO2 below 90% of reference in sleep studies were significantly lower than baseline with both ventilators. All but one patient had better tolerance of the bilevel positive airway pressure (BIPAP) support mode than of the volumetric ventilator. Our study shows that NIPPV is equally effective for patients with kyphoscoliosis whether administered with a volumetric ventilator or a BIPAP device. Subjective response and tolerance seem to be slightly better with BIPAP.

Ventilación no invasiva en cifoescoliosis. Estudio comparativo entre respirador volumétrico y soporte de presión (BIPAP) / Non-invasive ventilation in kyphoscoliosis. A comparison of a volumetric ventilator and a BIPAP support pressure device

El tratamiento de elección de los pacientes con insuficiencia respiratoria crónica secundaria a cifoescoliosis grave es la administración de ventilación no invasiva domiciliaria. El propósito de nuestro estudio ha sido comparar, en un estudio prospectivo, cruzado y aleatorizado, la evolución clínica, gasométrica y funcional tras un mes de tratamiento domiciliario con los dos tipos de respirador, así como evaluar las alteraciones que presentan durante el sueño estos enfermos. Para ello hemos incluido en el estudio a 10 pacientes con insuficiencia respiratoria crónica secundaria a afección restrictiva por cifoescoliosis. Se asignó a cada paciente el primer dispositivo de manera aleatoria y tras un mes de tratamiento en su domicilio se realizó una nueva evaluación clínica, funcional y polisomnográfica con el respirador. El mismo protocolo se aplicó con el segundo dispositivo, dejando entre uno y otro 10 días de descanso. En la polisomnografía basal observamos un sueño fragmentado, con disminución de las fases profundas de sueño NREM y de sueño REM, así como un patrón respiratorio con frecuencias muy elevadas que coincidían con importantes desaturaciones. En todos los enfermos se objetivó una mejoría clínica y gasométrica con ambos dispositivos, sin diferencias estadísticas entre ellos. En los registros polisomnográficos se observó una disminución significativa en el porcentaje de tiempo transcurrido con saturación de oxígeno por debajo del 90 per cent con ambos respiradores respecto al registro basal. En nueve de los 10 pacientes se observó una mejor adaptación y tolerancia a la presión de soporte respecto al respirador volumétrico. En conclusión, en nuestra experiencia la ventilación no invasiva en los pacientes con insuficiencia respiratoria crónica secundaria a cifoescoliosis es igualmente efectiva administrada con respirador volumétrico o con soporte de presión (BIPAP). La respuesta subjetiva y la adaptación al dispositivo parece ligeramente superior para el BIPAP (AU)

[High-frequency oscillatory ventilation as salvage strategy in the newborn infant. Spanish multicenter study. I]. / Ventilación de alta frecuencia oscilatoria como estrategia de rescate en el recién nacido. Estudio multicéntrico Español. I.

OBJECTIVE: The aim of this study was to evaluate the results of high frequency ventilation (HFV) used as a rescue strategy in newborn infants with severe lung disease who either failed conventional mechanical ventilation (CMV) or had an air block. PATIENTS AND METHODS: From April 1995 to June 1998, 241 infants with severe lung disease and managed according to a common protocol of HFV used as a rescue strategy were prospectively evaluated in the nine participating level III Spanish Neonatal Intensive Care Units. The most frequent diagnoses were respiratory distress syndrome (119), meconium aspiration (24), pneumonia (19) and congenital diaphragm hernia (18). RESULTS: Mean +/- SD gestational age and birth weight were 32.0 +/- 5.5 weeks and 1,187 +/- 1,071 g, respectively. All babies were previously manages with CMV for a mean of 59 hours. HFV was started at a mean postnatal age of 82 hrs, with a mean oxygenation index (OI) of 28.3 +/- 15.3 and an a/A DO2 of 0.10 +/- 0.08. Initial mean HFV settings were: mean airway pressure 12.8 +/- 3.4 mbar, frequency 8.3 +/- 1.4 Hz, amplitude 53 +/- 20 percent, tidal volume 2.2 +/- 0.7 ml/kg and FiO2 0.88 +/- 0.2. At two hours of HFV there was a significant increase in the mean PaO2 (from 48 to 80 mmHg), with a concomitant decrease in FiO2 (from 0.88 to 0.79), PaCO2 (from 60 to 46 mmHg) and OI (from 28 to 18). Mean a/A DO2 increased from 0.10 to 0.19; these changes remained similar thereafter. HFV was suspended after a mean of 95 hrs because of improvement in 70%, death in 19% and failure to improve the clinical condition in the remaining 19%. Intrahospital death rate was 32%. The following complications were observed: pneumothorax (10%), interstitial emphysema (4%), intraventricular hemorrhage grades III and IV (14.5%) and bronchopulmonary dysplasia (35%). CONCLUSIONS: HFV is an effective rescue strategy that improves pulmonary gas exchange within two hours of its initiation.

Randomized comparative clinical trial of itraconazole and selenium sulfide shampoo for the treatment of pityriasis versicolor.

Forty patients with pityriasis versicolor, fluorescence of involved areas under Wood's light, and positive microscopic identification of Malassezia furfur were randomly assigned to treatment with either oral itraconazole (200 mg once daily for five consecutive days) or 2.5% selenium sulfide shampoo (once daily application for seven days). Each treatment group consisted of 20 patients. On assessment three weeks after the end of treatment, all patients given itraconazole showed a response: 17 were healed, and three had mild residual lesions. Likewise, all patients in the selenium sulfide group responded to therapy: 16 were healed, and four had mild residual lesions. Tolerability, acceptability, and compliance were excellent with itraconazole. All 20 patients given the drug stated a preference for oral treatment. In the selenium sulfide group, five patients (25%) had adverse reactions attributable to the medication; one of these patients experienced an irritation severe enough to warrant the discontinuation of treatment on the third day. Ten patients in this group stated a preference for oral treatment.

[Neonatal transitional care unit (author's transl)]. / Valoración de una unidad neonatal de reanimación-transición.

Statistical analysis between a two year period with a five year interval (1972-1975) in a neonatal transitional care unit is evaluated. Number of resucitations doubled and neonatal mortality in the first seven days of life as well as in the first twenty four hours decreased significantly, being newborns under 1,000 gr. of weight and malformations the first two causes of death in both periods. Factors related to hypoxia which accounted for other 25% of deaths should be prevented. Importance of this type of units in huge maternities is emphasized considering their role in immediate neonatal care.

[Newborn of diabetic mother. Glucose in amniotic fluid and clinical conditions (author's transl)]. / Fetopatía diabética. Glucosa en líquido amniótico y su relación en algunos parámetros perinatales.

Clinical and analytical data of sixteen newborns of insulin dependant mothers are studied. Relation between these data and newborn conditions as Apgar score and hypoglicemia are considered.