Clinical features and survival of 338 multiple myeloma patients treated with hematopoietic stem cell transplantation or conventional chemotherapy.

Therapeutic approaches against multiple myeloma (MM) have largely changed during the past decade. Hematopoietic stem cell transplantation (HSCT) and licensing of immunomodulators and proteasome inhibitors have resulted in better response and increased overall survival rates compared to previous conventional therapies. To assess the impact that these new strategies have had on outcome of patients with symptomatic MM in Spain, we conducted an epidemiological retrospective analysis of 338 newly diagnosed patients with stage II-III MM who started first-line treatment over a 2-yr period (2003-2005) by collecting data from their medical records. Most patients had been diagnosed with secretory MM (94.4%), 41.7% stage II and 58.3% stage III. The presence of bone lesions (72.2%), as well as anemia (79.8%) and elevated beta2-microglobulin levels (62.3%), was a common finding; in contrast, hypercalcemia and elevated serum creatinine were less frequent (25% each). First-line treatment had consisted of either conventional chemotherapy (62%) or induction treatment plus autologous HSCT (38%), as per standard clinical practice. HSCT not only resulted in greater objective response rates (93% vs. 50%), but also contributed to a significant increase in 3-yr survival (85% vs. 49.7%; 95% CI, range 77-91 vs. 41-58; P < 0.001). Overall, 55% of patients presented treatment-related adverse events, mainly hematological. Toxicity rates were higher among patients treated with alkylating-based regimens and in those undergoing transplantation. In conclusion, data analysis shows an adequate balance between increased response rates and safety that supports the use of up-front high-dose HSCT therapy in younger patients. Most importantly, this study provides further confirmation that the introduction of HSCT has significantly prolonged survival of patients with MM.

Calidad de vida y afrontamiento: diferencias entre los pacientes de diálisis peritoneal continua ambulatoria y hemodiálisis hospitalaria / Quality of life and coping: differences between patients receiving continuous ambulatory peritoneal dialysis and those under hospital hemodialysis

Objetivo: Comparar la satisfacción con la vida y calidad de vida de pacientes en hemodiálisis hospitalaria(HDH) y diálisis peritoneal continua ambulatoria (DPCA), y analizar su asociación con las estrategias de afrontamiento. Método: Se estudiaron, mediante un estudio de corte transversal, 61 pacientes de HDH y 32 de DPCA, con edad 70 años. Se aplicaron los cuestionarios de índice de Charlson, Stai-R, estrés percibido-PSS, percepción de control, soporte social MOS, formas de de afrontamiento, calidad de vida (SF-36) y satisfacción con la vida. Los análisis estadísticos se ajustaron por edad y sexo. Resultados: La proporción de mujeres fue del 35,5%, la edad media de 54 años. El grupo DPCA era más joven con una proporción de mujeres superior. El índice Charlson (comorbilidad) fue similar en HDH y DPCA. El grupo de HDH utilizó psicofármacos en un porcentaje superior a DPCA (el 38 frente al 13%; p 0,01). El grupo DPCA puntuó significativamente más alto en las estrategias de búsqueda de apoyo, regulación emocional, resolución de problemas y distracción, sin diferencias en el soporte social. No se encontraron diferencias en los componentes físico y mental, ni en las 7 dimensiones del SF-36. La satisfacción con la vida fue superioren DPCA (7,12 frente a 6,21; p ¼ 0,07). Conclusiones: Entre las 2 modalidades no hay diferencias en la percepción de calidad de vida. Los pacientes de DPCA tienden a una mayor satisfacción con la vida y un afrontamiento más adaptativo (de regulación emocional y búsqueda de sentido), esto sugiere que podrían tener una mayor asimilación y control del proceso de enfermedad(AU)

Objective To compare satisfaction with life and quality of life in patients receiving continuous ambulatory peritoneal dialysis (CAPD) and hospital hemodialysis (HHD) and to analyze their relationship with coping strategies. Methods. We performed a cross-sectional study in 61 patients aged<70 years old under HHD and 32 patients receiving CAPD. We applied the Charlson Index, the State-Trait Anxiety Inventory (Stai-R), the Perceived Stress Scale (PSS), the MOS Social Support Survey, and the Short-Form 36 questionnaire for quality of life. Coping strategies, perceived control and satisfaction with life were also analyzed. Statistical analyses were adjusted by differences in age and sex. Results. Women accounted for 35.5% of the patients. The mean age was 54 years. The CAPD group was younger and had a higher proportion of women. Charlson Comorbidity Index scores were similar in patients receiving HHD and in those receiving CAPD. The use of psychoactive drugs was higher in the CAPD group than in the HHD group (38% vs. 13%; p<0.01). The CAPD group scored significantly higher in strategies of seeking help, emotional regulation skills, problem resolving and distraction. No differences were found in social support between the two groups. No significant differences were found in the physical or mental components or in the seven dimensions of the SF-36. Satisfaction with life was higher in the CAPD group (7.12 versus 6.21; p=0.07). Conclusions. No differences in the perception of quality of life were found between patients receiving the two modalities. The CAPD group tended to show greater satisfaction with life and more adaptive coping strategies (emotional regulation and search for meaning), suggesting that these patients may have greater acceptance and control over the disease process(AU)

Elastofibroma dorsi: estudio retrospectivo de seis casos / Retrospective analysis of 6 cases of elastofibroma dorsi

El elastofibroma dorsi es una lesión benigna de tejido fibroelástico, a menudo bilateral, localizada frecuentemente en la región subescapular, más común en mujeres de edad media y ancianas. La patogénesis es desconocida, y se ha sugerido que se trate de un proceso reactivo, degenerativo o neoplásico. Presentamos un estudio retrospectivo de los hallazgos observados en seis pacientes con elastofibroma dorsi. El elastofibroma debe plantearse en el diagnóstico diferencial de tumoraciones subcutáneas de localización escapular, ya que es una lesión benigna que sólo requiere tratamiento quirúrgico cuando es sintomático o muy grande. Técnicas no invasivas, como la ecografía, tomografía computarizada y especialmente la resonancia magnética pueden ser suficientes para orientar el diagnóstico, con estrecha correlación entre el cuadro histológico y las imágenes radiológicas específicas evitando biopsias y cirugías innecesarias (AU)

Elastofibroma dorsi is a benign lesion of fibroelastic tissue. It often presents bilaterally, is frequently localized to the subscapular region, and is more common in middle-aged and elderly women. The pathogenesis is still unclear but it has been suggested to involve reactive, degenerative, or neoplastic processes. We present a retrospective study of the findings from 6 patients with elastofibroma dorsi. Elastofibroma should be included in the differential diagnosis of subcutaneous scapular tumors, as it is a benign lesion that only requires surgery when associated with symptoms or the lesion is extensive. Noninvasive techniques such as ultrasonography, computed tomography, and, above all, magnetic resonance imaging, may be sufficient to guide diagnosis. The results of histology and imaging are closely correlated, so the need for unnecessary biopsy and surgery may beavoided (AU)

Radiological aid to clinical diagnosis of Schnitzler's syndrome: multimodality imaging approach.

Schnitzler's syndrome is a rare combination of chronic urticaria, fever of unknown origin, disabling bone pain, and monoclonal gammopathy. We report a case with an unusual radiological manifestation as a solitary sclerotic lesion of the right iliac bone. Its main features on conventional radiography, computed tomography, and magnetic resonance imaging are described, and the main radiological differential diagnoses are discussed to help with the characterization of this syndrome, which requires a combination of clinical, laboratory, and radiological data. On the other hand, although our patient had an excellent clinical response to anakinra, the sclerotic lesion remained unchanged on follow-up X-ray examinations.