Hiponatremia secundaria a oxcarbazepina / Oxcarbazepine-induced hyponatremia

La utilización de la oxcarbazepina como tratamiento anticomicial se ha relacionado con numerosos casos de hiponatremia (sodio [Na] sérico <135mmol/l), tanto en monoterapia como en combinación con diuréticos u otros fármacos. Los mecanismos etiopatogénicos son variados y las causas más promulgadas son la liberación inadecuada y/o una mayor sensibilidad de la vasopresina tubular, así como el incremento de agua y la pérdida secundaria de Na. Presentamos un caso de una mujer de 67 años con una hiponatremia secundaria (Na sérico <120mmol/l) a oxcarbazepina con un cuadro clínico sintomático de hiponatremia que mejoró notablemente ante su retirada y sustitución por levetiracetam. Hacemos una revisión de los casos publicados al respecto, valorando el fármaco, las interacciones y los tratamientos concomitantes. Concluimos haciendo notar la importancia de diferenciar estos cuadros de los etiquetados como «asténicos o depresivos propios de la edad» cuando evaluemos a pacientes geriátricos en atención primaria (AU)

The use of oxcarbazepine as anti-seizure treatments has been related with many cases of hyponatremia (serum sodium <135mmol/l) both in single drug therapy as well as in combination with diuretics or other drugs. The etiopathogenic mechanisms are varied, inadequate release and/or greater sensitivity of tubular vasopressin as well as increased water and secondary loss of sodium being the most expressed one. We present a case of a 67-year old woman with hyponatremia secondary (serum sodium < 120mmol/l) to oxcarbazepine with a symptomatic clinical picture of hyponatremia that significantly improved when it was discontinued and replaced by levetiracetam. We have made a review of the cases published on this, evaluating the drug, interactions and concomitant treatments. We conclude by making note of the importance of differentiating these pictures from those labeled as "asthenic or depressive subjects characteristic of the age" when we evaluate geriatric patients in Primary Health Care (AU)

Grading and prognosis of infiltrating ductal breast carcinoma by mean nuclear volume estimates.

OBJECTIVE: Quantitative evaluation of nuclear size in breast cancer is performed with the aim of investigating whether the data obtained are related to subjective grading and prognosis. STUDY DESIGN: Unbiased stereologic estimates of the volume-weighted mean nuclear volume (nuclear vv) in paraffin-embedded tissue from 44 specimens of infiltrating ductal breast carcinoma were obtained by the point-sampled intercepts method. RESULTS: Histologically graded cases showed an overlap in nuclear vv estimates, but significant differences were demonstrated in which averaged values increased from grade 1 to 3 breast carcinomas. Nuclear vv estimates in grade 3 breast carcinoma (mean, 495.4 microns 3; SD, 101.7 microns 3) were significantly larger than those in grades 1 (mean, 327.8 microns 3; SD, 90.9 microns 3) and 2 (mean, 409.9 microns 3; SD, 72.6 microns 3) (P < .01). Minor statistically significant differences (P < .05) were found between grades 1 and 2. Estimates of nuclear vv based on systematic sampling within the specimen showed high efficiency, with > 80% of the total observed variance contributing to biologic differences between individual specimens. Univariate prognostic study showed that clinical stage, and not histologic grade, was of prognostic value in the cases studied. Similarly, nuclear vv estimates were associated with disease recurrence and survival, with a cutoff point of 425 microns 3. CONCLUSION: Based on the cases investigated, shape-independent nuclear vv estimates may be an adjuvant tool in the grading and prognostic evaluation of infiltrating ductal breast carcinoma.