Nevos epidérmicos tratados con láser de CO 2: respuesta y seguimiento a largo plazo / Carbon Dioxide Laser Treatment of Epidermal Nevi: Response and Long-Term Follow-Up

Introducción y objetivos: Los nevos epidérmicos son proliferaciones benignas de la epidermis para los que se han utilizado múltiples tratamientos con resultados variables. Las terapias tópicas resultan ineficaces y el tratamiento quirúrgico obtiene resultados más definitivos, pero conlleva la aparición de cicatrices. En las últimas décadas se han utilizado diversas modalidades de láser. El objetivo del trabajo es describir nuestra experiencia en el tratamiento de nevos epidérmicos y nevos epidérmicos verrugosos inflamatorios lineales (NEVIL) con láser de CO2. Pacientes y métodos: Veinte pacientes (15 con nevos epidérmicos y 5 con nevo epidérmico verrugoso inflamatorio lineal) fueron tratados con láser de CO2 entre 2002 y 2010 en nuestro centro. Resultados: Un 50% de los pacientes presentaron buena respuesta (reducción de la lesión mayor del 50%) y un 30% respuesta excelente (reducción mayor del 75%). Los pacientes con NEVIL mostraron mayor resistencia al tratamiento (40% buena respuesta). Se realizó seguimiento a largo plazo (mínimo de 18 meses) y se observaron recurrencias en el 30% de los pacientes. Los efectos secundarios detectados fueron: hipopigmentación en el 25% de los pacientes y cicatrices en el 20%. Conclusiones: Consideramos el láser de CO2 como el tratamiento de elección para estas lesiones, ya que es bien tolerado y se ha demostrado su eficacia y seguridad a largo plazo. Aunque la respuesta es limitada en los NEVIL, no existen en la actualidad otros tratamientos eficaces, por lo que podría ser una buena opción terapéutica en casos seleccionados o como tratamiento paliativo para la mejoría de los síntomas (AU)

Background and objectives: Epidermal nevi, which are benign skin growths, have been treated using a range of approaches, with varying results. Topical treatments are ineffective and, while surgical excision is a more definitive treatment, it causes scar formation. In recent decades, epidermal nevi have been treated with various types of laser therapy. We describe our experience with the use of carbon dioxide (CO2) laser therapy to treat epidermal nevi and inflammatory linear verrucous epidermal nevi (ILVEN). Patients and methods: Twenty patients (15 with epidermal nevi and 5 with ILVEN) underwent CO2 laser treatment at our hospital between 2002 and 2010. Results: Response was good (> 50% reduction in lesion size) in 50% of cases and excellent (> 75%reduction) in 30%. A greater resistance to treatment was observed in patients with ILVEN (only40% had a good response). Long-term follow-up (at least 18 months) showed a recurrence rate of 30%. The side effects were hypopigmentation (25% of patients) and scarring (20%). Conclusions: We consider CO2 laser therapy to be the treatment of choice for epidermal nevi as it is well tolerated and has proven to be safe and effective in the long term. While the response in patients with ILVEN was limited, CO2 laser therapy might be a good option for selected cases or for palliative treatment since no other treatments have yet proven effective in this setting (AU)

Carbon dioxide laser treatment of epidermal nevi: response and long-term follow-up.

BACKGROUND AND OBJECTIVES: Epidermal nevi, which are benign skin growths, have been treated using a range of approaches, with varying results. Topical treatments are ineffective and, while surgical excision is a more definitive treatment, it causes scar formation. In recent decades, epidermal nevi have been treated with various types of laser therapy. We describe our experience with the use of carbon dioxide (CO(2)) laser therapy to treat epidermal nevi and inflammatory linear verrucous epidermal nevi (ILVEN). PATIENTS AND METHODS: Twenty patients (15 with epidermal nevi and 5 with ILVEN) underwent CO(2) laser treatment at our hospital between 2002 and 2010. RESULTS: Response was good (>50% reduction in lesion size) in 50% of cases and excellent (>75% reduction) in 30%. A greater resistance to treatment was observed in patients with ILVEN (only 40% had a good response). Long-term follow-up (at least 18 months) showed a recurrence rate of 30%. The side effects were hypopigmentation (25% of patients) and scarring (20%). CONCLUSIONS: We consider CO(2) laser therapy to be the treatment of choice for epidermal nevi as it is well tolerated and has proven to be safe and effective in the long term. While the response in patients with ILVEN was limited, CO(2) laser therapy might be a good option for selected cases or for palliative treatment since no other treatments have yet proven effective in this setting.

Carbon Dioxide Laser Treatment of Epidermal Nevi: Response and Long-Term Follow-Up. / Nevos epidérmicos tratados con láser de CO(2): respuesta y seguimiento a largo plazo.

BACKGROUND AND OBJECTIVES: Epidermal nevi, which are benign skin growths, have been treated using a range of approaches, with varying results. Topical treatments are ineffective and, while surgical excision is a more definitive treatment, it causes scar formation. In recent decades, epidermal nevi have been treated with various types of laser therapy. We describe our experience with the use of carbon dioxide (CO(2)) laser therapy to treat epidermal nevi and inflammatory linear verrucous epidermal nevi (ILVEN). PATIENTS AND METHODS: Twenty patients (15 with epidermal nevi and 5 with ILVEN) underwent CO(2) laser treatment at our hospital between 2002 and 2010. RESULTS: Response was good (>50% reduction in lesion size) in 50% of cases and excellent (>75% reduction) in 30%. A greater resistance to treatment was observed in patients with ILVEN (only 40% had a good response). Long-term follow-up (at least 18 months) showed a recurrence rate of 30%. The side effects were hypopigmentation (25% of patients) and scarring (20%). CONCLUSIONS: We consider CO(2) laser therapy to be the treatment of choice for epidermal nevi as it is well tolerated and has proven to be safe and effective in the long term. While the response in patients with ILVEN was limited, CO(2) laser therapy might be a good option for selected cases or for palliative treatment since no other treatments have yet proven effective in this setting.

Análisis coste-efectividad de la fototerapia domiciliaria con ultravioleta B de banda estrecha frente a fármacos biológicos en el tratamiento de la psoriasis moderada-grave / Analysis of the Cost Effectiveness of Home-Based Phototherapy With Narrow-Band UV-B Radiation Compared With Biological Drugs For the Treatment of Moderate to Severe Psoriasis

Introducción: La psoriasis ocasiona un elevado coste terapéutico debido a la creciente utilización de los fármacos biológicos. La fototerapia ha demostrado ser un tratamiento seguro y coste-efectivo para la psoriasis, aunque presenta la limitación del desplazamiento del paciente varios días en semana a un centro hospitalario. Objetivos: Evaluar la eficiencia de la fototerapia domiciliaria con ultravioleta B de banda estrecha frente a los fármacos biológicos en el tratamiento de la psoriasis moderada-grave en condiciones reales de nuestro entorno. Métodos: Estudio de evaluación económica de coste-efectividad, con carácter retrospectivo, sobre 12 pacientes con psoriasis moderada-grave. La mitad recibió tratamiento con fármacos biológicos -dos etanercept, dos adalimumab y dos infliximab- y la otra mitad recibió fototerapia en su domicilio con una lámpara Waldmann UV100L-T. La medida de efectividad clínica fue la obtención de un PASI-75 antes de la semana 16 de tratamiento. Resultados: En 5 de 6 pacientes (83%) con terapia biológica y en 4 de 6 pacientes (66%) con fototerapia domiciliaria el tratamiento fue efectivo. Los costes directos por PASI-75 alcanzado fueron de 8.256 euros para los biológicos y de 903 euros para la fototerapia domiciliaria. Con el coste requerido para que un fármaco biológico fuera efectivo en un único paciente podía obtenerse respuesta en 9,1 pacientes tratados con fototerapia domiciliaria. Limitaciones Número reducido de pacientes, horizonte temporal limitado a 16 semanas, grupo de comparación heterogéneo, con fármacos de perspectivas de respuesta diferente. Conclusiones: A pesar de que los fármacos biológicos presentaron una mayor efectividad, la fototerapia domiciliaria fue más eficiente para el tratamiento de la psoriasis moderada-grave. La fototerapia domiciliaria representa una alternativa terapéutica coste-efectiva para los pacientes con psoriasis con potencial aplicación en nuestro sistema sanitario (AU)

Background: Psoriasis is associated with high treatment costs due to the increasing use of biologic drugs. Phototherapy has been demonstrated to be safe and cost effective for the treatment of psoriasis, although it is limited by the requirement for patients to visit a hospital various times week. Objectives: To evaluate the efficieny of home-based phototherapy with narrow-band UV-B radiation compared with biologic drugs for the treatment of moderate to severe psoriasis under normal practice conditions in our setting. Methods: A retrospective cost-effectiveness study was undertaken in 12 patients with moderate to severe psoriasis. Half of the patients were treated with biologic drugs (2 with etanercept, 2 with adalimumab, and 2 with infliximab) and the other half with home-based phototherapy using a Waldmann UV100L-TL01 lamp. Clinical effectiveness was determined on the basis of achieving a 75% improvement in Psoriasis Area and Severity Index (PASI 75) within 16 weeks of treatment. Results: Treatment was considered to be effective in 5 out of 6 patients (83%) treated with biologics and 4 out of 6 patients (66%) treated with home-based phototherapy. The direct costs required to achieve PASI 75 were 8256€ per patient for biologics and 903€ per patient for home-based phototherapy. The costs associated with effective treatment using biologic drugs in a single patient would provide effective home-based phototherapy for 9.1 patients. Limitations: The study included a limited number of patients analyzed over a short time period (16 weeks) and the comparison group included multiple treatments with different predicted responses. Conclusion: Although biologic drugs exhibited greater efficacy, home-based phototherapy was more efficient for the treatment of moderate to severe psoriasis. Home-based phototherapy represents a cost-effective treatment option for patients with psoriasis and may be appropriate for use in the Spanish health care system (AU)

[Analysis of the cost effectiveness of home-based phototherapy with narrow-band UV-B radiation compared with biological drugs for the treatment of moderate to severe psoriasis]. / Análisis coste-efectividad de la fototerapia domiciliaria con ultravioleta B de banda estrecha frente a fármacos biológicos en el tratamiento de la psoriasis moderada-grave.

BACKGROUND: Psoriasis is associated with high treatment costs due to the increasing use of biologic drugs. Phototherapy has been demonstrated to be safe and cost effective for the treatment of psoriasis, although it is limited by the requirement for patients to visit a hospital various times a week. OBJECTIVES: To evaluate the efficiency of home-based phototherapy with narrow-band UV-B radiation compared with biologic drugs for the treatment of moderate to severe psoriasis under normal practice conditions in our setting. METHODS: A retrospective cost-effectiveness study was undertaken in 12 patients with moderate to severe psoriasis. Half of the patients were treated with biologic drugs (2 with etanercept, 2 with adalimumab, and 2 with infliximab) and the other half with home-based phototherapy using a Waldmann UV100L-TL01 lamp. Clinical effectiveness was determined on the basis of achieving a 75% improvement in Psoriasis Area and Severity Index (PASI 75) within 16 weeks of treatment. RESULTS: Treatment was considered to be effective in 5 out of 6 patients (83%) treated with biologics and 4 out of 6 patients (66%) treated with home-based phototherapy. The direct costs required to achieve PASI 75 were 8256€ per patient for biologics and 903€ per patient for home-based phototherapy. The costs associated with effective treatment using biologic drugs in a single patient would provide effective home-based phototherapy for 9.1 patients. LIMITATIONS: The study included a limited number of patients analyzed over a short time period (16 weeks) and the comparison group included multiple treatments with different predicted responses. CONCLUSIONS: Although biologic drugs exhibited greater efficacy, home-based phototherapy was more efficient for the treatment of moderate to severe psoriasis. Home-based phototherapy represents a cost-effective treatment option for patients with psoriasis and may be appropriate for use in the Spanish health care system.

Keratosis pilaris rubra and keratosis pilaris atrophicans faciei treated with pulsed dye laser: report of 10 cases.

BACKGROUND: Keratosis pilaris rubra (KPR) and keratosis pilaris atrophicans faciei (KPAF) are both keratinization disorders characterized by erythema and keratotic follicular papules usually located on cheeks, forehead, chin and eyebrows. Topical keratolytics, vitamin D3 analogues, antibiotics, topical and oral retinoids have been used with limited results. As this condition can be socially very limiting, the need for an effective treatment has led to the use of other technologies such as pulsed dye laser (PDL) or intense pulsed light. OBJECTIVE: The aim of this study was to assess the efficacy and safety of PDL in patients with KPR or KPAF. METHODS: Ten patients with KPR or KPAF were treated with two to seven sessions of PDL at 595-nm wavelength. Laser therapy was performed using a spot size of 7 or 10mm, a pulse duration of 0.5 or 1.5ms and a fluence from 5 to 9J/cm(2) . Two dermatologists evaluated treatment effectiveness by means of photographs of the patients before starting and after finishing the therapy. RESULTS: Complete resolution of erythema was achieved in three patients; clearance of erythema was >75% in the other seven patients. Transient purpura was present in all patients for about 2weeks and one patient presented postinflammatory hyperpigmentation for 7months. CONCLUSION: We consider that PDL is a good option for the treatment of KPR and KPAF. A marked reduction in erythema is achieved in all patients with a low incidence of side effects.

Carcinomatosis leptomeníngea secundaria a cáncer vesical indiferenciado de célula pequeña / Leptomeningeal carcinomatosis secondary to small cell undifferentiated bladder cancer

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Error fatal en prescripción medicamentosa / No disponible

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Una causa inusual de nódulos pulmonares múltiples / An unusual cause of multiple pulmonary nodules

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Linfoma de Burkitt abdominal en un adolescente / Abdominal burkitt lymphoma in an adolescent

Se describe el caso clínico de un adolescente con un linfoma de Burkitt que debutó con dolor abdominal agudo. El tumor aumentó de tamaño rápidamente, se localizó mediante tomografía computarizada y se confirmó mediante estudio de la médula ósea. Se aplicaron dos protocolos quimioterápicos distintos, debido a la mala evolución, pero sin resultado satisfactorio. Se hacen unas consideraciones sobre el diagnóstico diferencial, especialmente con otros tumores primarios infantiles y procesos no neoplásicos

We report the case of a male adolescent affected by Burkitt Lymphoma which presented as acute abdominal pain and rapid growth mass. It was characterized by computed tomography and diagnose was confirmed by bone marrow study. Two different chemotherapic regimens were used because of unfavourable evolution, but they were not successful. We consider some other causes of abdominal bulky in childhood, especially primary tumours and non tumoural diseases

[Chimerism: origin and medical implications]. / Quimerismo: origen e implicaciones médicas.

The organism whose cells come from different individuals is called chimera. It is frequently observed in nature: pregnancy, organ transplantation or transfusion are considered chimeric cell sources. It has been involved in autoimmune diseases development such as scleroderma, because of similarities between it and graft versus host disease, long term persistence of fetal cells in women and the finding of greater number of chimeric cells in affected women than healthy ones. It is not strictly a disease but might be considered helpful in non-invasive prenatal diagnosis and damaged organs regeneration.

Quimerismo: origen e implicaciones médicas / Chimerism: origin and medical implications

Se denomina «quimera» al organismo formado por células procedentes de distintos individuos. Se trata de un fenómeno frecuente en la naturaleza que puede aparecer tras la gestación, un trasplante de órganos o una transfusión. Se ha relacionado con el desarrollo de enfermedades autoinmunes (EAI), concretamente la esclerodermia. La hipótesis que relaciona el quimerismo con las EAI surge de distintas observaciones, como la similitud de la esclerodermia con la enfermedad injerto contra huésped, la persistencia de células quiméricas en el tiempo y el hallazgo de mayor número de células quiméricas en mujeres afectas que en sanas. Este fenómeno no se asocia necesariamente a enfermedad, y podría ser de utilidad en diagnóstico prenatal e incluso estar implicado en la regeneración de órganos dañados

The organism whose cells come from different individuals is called chimera. It is frequently observed in nature: pregnancy, organ transplantation or transfusion are considered chimeric cell sources. It has been involved in autoimmune diseases development such as scleroderma, because of similarities between it and graft versus host disease, long term persistence of fetal cells in women and the finding of greater number of chimeric cells in affected women than healthy ones. It is not strictly a disease but might be considered helpful in non-invasive prenatal diagnosis and damaged organs regeneration

[Abdominal Burkitt lymphoma in an adolescent]. / Linfoma de Burkitt abdominal en un adolescente.

We report the case of a male adolescent affected by Burkitt Lymphoma which presented as acute abdominal pain and rapid growth mass. It was characterized by computed tomography and diagnose was confirmed by bone marrow study. Two different chemotherapic regimens were used because of unfavourable evolution, but they were not successful. We consider some other causes of abdominal bulky in childhood, especially primary tumours and non tumoural diseases.

Aspectos agronómicos y propiedades fisiológicas del aceite de oliva / Agronomic aspects and physiological properties of olive oil

El aceite de oliva es un componente fundamental de la dieta mediterránea y su consumo está relacionado con una mayor esperanza de vida. Nuestro país es el mayor productor mundial aunque su consumo representa solo una mínima parte de las grasas consumidas por persona. El aceite de oliva virgen tiene propiedades beneficiosas en el organismo humano, debido, tanto a su fracciónoleosa (ácido oleico, fundamentalmente), como a los componentes de su fracción no oleosa, comportándose como un agente cardioprotector. También tiene efectos beneficiosos sobre el metabolismo lipídico, oxidación celular, coagulación, diabetes y algunos tipos de cáncer

Olive oil is a basic component of the Mediterranean diet and its consumption is related to a better life expectancy. Although Spain is the main producting country, olive oil is only a little portion of individual fat intake. Virgin olive oil has beneficial properties for human organism due to the cardioprotective effects of both oily fraction components (oleic acid essentially) and non-oily fraction components. Virgin olive has also beneficial on lipid metabolism, cellular oxidation, coagulation, diabetes and different types of cancer