Spanish Society of Medical Oncology consensus on the use of erythropoietic stimulating agents in anaemic cancer patients

Treatment of anaemia is a very important aspect in the management of cancer patients. In order to carry out a consensus process about the use of erythropoietic stimulating agents (ESAs) in cancer patients, the Spanish Society of Medical Oncology (SEOM) elaborated a working group which coordinated a panel of medical oncology specialists. This working group has reviewed the main issues about the use of ESAs. In addition a consensus meeting was held in Madrid on 25 April 2007. The following conclusions were made: Since ESA treatment increases the haemoglobin (Hb) level and decreases the red blood cell (RBC) transfusion requirements, ESAs should be used within the approved indications in patients undergoing chemotherapy treatment, beginning at a Hb level below 11 g/dl and maintaining it around 12 g/dl, with iron supplements if necessary. Neither increasing the ESA dose in nonresponders nor the use of ESAs in the treatment of chronic cancer-related anaemia is recommended (AU)

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[The clinical and radiological characteristics and evolution of incidentally diagnosed pulmonary thromboembolism]. / Diagnóstico casual de tromboembolismo pulmonar: descripción de las características clínicas y radiológicas y su evolución.

OBJECTIVES: To evaluate the cases of pulmonary embolism (PE) detected incidentally in our hospital, the associated risk factors, clinical and radiological characteristics, and evolution. MATERIAL AND METHODS: We retrospectively reviewed the reports of routine contrast-enhanced chest CT examinations performed during a 19-month period to detect cases in which PE was diagnosed incidentally. We found 18 cases of incidentally diagnosed PE and we reviewed the clinical histories and CT images of these patients to analyze the risk factors, clinical presentation, radiological characteristics, treatment, and evolution of PE in these cases. RESULTS: We found 18 patients (9 men and 9 women; mean age: 61 years) with incidentally detected PE. The main risk factor for developing PE was the presence of a neoplasm (n = 16). No PE-related symptoms were present in 12 patients. A multidetector CT scanner was used for the examination in most cases (n = 16). PE was centrally located in 16 patients. Five patients were not treated with anticoagulation and no embolic events occurred in these patients. Two of the remaining patients died because of PE. CONCLUSIONS: The incidental finding of PE can be common in oncological patients. Multidetector CT probably has a greater capacity for the incidental detection of PE in these patients. The outcome of incidentally detected PE can vary from death to remaining stable to spontaneous resolution.

Diagnóstico casual de tromboembolismo pulmonar: descripción de las características clínicas y radiológicas y su evolución / The clinical and radiological characteristics and evolution of incidentally diagnosed pulmonary thromboembolism

Objetivos. Evaluar a los enfermos con tromboembolismo pulmonar (TEP) detectados de forma casual en nuestro hospital, los factores de riesgo asociados, sus características clínicas y radiológicas y su evolución. Material y métodos. Se revisaron de forma retrospectiva los informes de tomografías computarizadas (TC) torácicas de rutina con contraste intravenoso de un periodo de 19 meses, para detectar aquellos casos en los que se estableció un diagnóstico de TEP de forma casual. Se detectaron 18 pacientes con ese diagnóstico y se revisaron los estudios de TC y las historias clínicas de esos pacientes para analizar las características radiológicas del TEP, los factores de riesgo, la clínica que presentaban, si recibieron tratamiento y su evolución. Resultados. De los 18 pacientes 9 eran mujeres y 9 varones con una edad media de 61 años. El principal factor de riesgo de desarrollar TEP fue la existencia de una neoplasia, presente en 16 enfermos. El 66% de los pacientes no presentaban síntomas en relación con el TEP. En la mayoría de los pacientes (16) la TC fue realizada en un aparato multidetector (TCMD) y en el mismo número la extensión del TEP fue central. Cinco pacientes no fueron tratados con anticoagulación y en su evolución no se produjeron eventos embólicos. Del resto de pacientes dos fallecieron debido al TEP. Conclusiones. El hallazgo casual de un TEP puede ser frecuente en pacientes oncológicos. Probablemente la TCMD tiene una mayor capacidad de detección casual de estos TEP. Su evolución puede ser variable, desde causar la muerte hasta permanecer estables o resolverse sin tratamiento (AU)

Objectives. To evaluate the cases of pulmonary embolism (PE) detected incidentally in our hospital, the associated risk factors, clinical and radiological characteristics, and evolution. Material and methods. We retrospectively reviewed the reports of routine contrast-enhanced chest CT examinations performed during a 19-month period to detect cases in which PE was diagnosed incidentally. We found 18 cases of incidentally diagnosed PE and we reviewed the clinical histories and CT images of these patients to analyze the risk factors, clinical presentation, radiological characteristics, treatment, and evolution of PE in these cases. Results. We found 18 patients (9 men and 9 women; mean age: 61 years) with incidentally detected PE. The main risk factor for developing PE was the presence of a neoplasm (n = 16). No PE-related symptoms were present in 12 patients. A multidetector CT scanner was used for the examination in most cases (n = 16). PE was centrally located in 16 patients. Five patients were not treated with anticoagulation and no embolic events occurred in these patients. Two of the remaining patients died because of PE. Conclusions. The incidental finding of PE can be common in oncological patients. Multidetector CT probably has a greater capacity for the incidental detection of PE in these patients. The outcome of incidentally detected PE can vary from death to remaining stable to spontaneous resolution (AU)

Alexithymia: a relevant psychological variable in near-fatal asthma.

Alexithymia is a psychological trait characterised by difficulty in perceiving and expressing emotions and body sensations. Failure to perceive dyspnoea could lead alexithymic asthmatics to underestimate the severity of an asthma exacerbation, and thereby increase the risk of developing a fatal or near-fatal asthma (NFA) attack. The objective of the present study was to determine the prevalence of alexithymia in NFA patients and to analyse their clinical characteristics. Alexithymia was assessed using the Toronto Alexithymia Scale in this multicentric prospective observational study. From 33 Spanish hospitals, 179 NFA patients and 40 non-NFA patients, as a control group, were enrolled. There was a higher proportion of alexithymia in the NFA group than in the non-NFA group (36 versus 13%). Patients with NFA and alexithymia were older than the rest of the NFA group, and had a lower level of education, a higher level of psychiatric morbidity, a higher proportion of severe persistent asthma and a greater number of prior very severe asthma exacerbations (49 versus 27%). Alexithymia, severe persistent asthma and a low level of education were identified as independent variables related to repeated very severe asthma exacerbations. The results show that alexithymia is more frequent in near-fatal asthma patients compared to the rest of asthmatics and is associated with recurrent very severe asthma exacerbations.

Corticosteroids, ibuprofen, and acetaminophen for IFNbeta-1a flu symptoms in MS: a randomized trial.

OBJECTIVE: To compare the efficacy of acetaminophen, ibuprofen, and prednisone in the treatment of interferon beta-1a (IFNbeta-1a) flu-like syndrome (FLS). METHODS: Patients with relapsing-remitting multiple sclerosis initiating treatment with IM IFNbeta-1a were randomized in a multicenter, randomized, double-blind, controlled trial to receive acetaminophen 500 mg before and 6 and 12 hours after each injection, ibuprofen 400 mg before and 6 and 12 hours after each injection, or prednisone 60 mg daily for 1 week, plus tapering. Patients were instructed to keep a daily diary of fever severity, myalgia, chills, headache, and asthenia for 27 days. The sum of the scores of individual symptoms was used to obtain a daily FLS index. The primary outcome was the FLS index area under the curve (AUC) corrected by the number of measurement days. RESULTS: Eighty-four patients were randomized at 11 hospitals: acetaminophen (n = 28), ibuprofen (n = 28), and corticosteroids (n = 28). No differences were detected between treatments in the mean AUC of the FLS index. With limitation of the analysis to the days of IM IFNbeta-1a injection, differences favoring ibuprofen were observed in the mean FLS index (p = 0.0007). CONCLUSIONS: No prophylactic treatment for flu-like syndrome seems to be superior to another in terms of overall well-being during the first month of IM IFNbeta-1a therapy. However, ibuprofen confers better control of symptoms immediately following IM IFNbeta-1a injection.

[Alexithymia and verbal intelligence: a psychometric study]. / Alexitimia e inteligencia verbal: un estudio psicométrico.

INTRODUCTION: Alexithymia is a concept that describes the unability to put emotions into words ant that has been associated with somatization and psychosomatic disorders. METHODS: A sample of 124 outpatients attending the Psychosomatic Unit of a General Hospital was studied in order to test the hypothesis that alexithymic patients have a significantly lower verbal intelligence than nonalexithymics. Alexithymia was assessed by the Toronto Alexithymia Scale (TAS), and verbal, nonverbal and general intelligence were measured by the WAIS. RESULTS: TAS scores were not related to medical and psychiatric diagnoses, and alexithymic patients (n: 53) showed not only significantly lower scores in verbal intelligence than undifferentiated subjects (n: 37) and nonalexithymics (n: 34) but also significantly lower scores in nonverbal and general intelligence. CONCLUSION: The results do not confirm our hypothesis and are discussed in relation to theories that consider alexithymia as a consequence of cerebral asymmetry and interhemispheric dysfunctions.

Alexitimia e inteligencia verbal: un estudio psicométrico / Alexithymia and verbal intelligence: a psychometric study

Introducción: La alexitimia es un concepto que describe la dificultad para verbalizar las emociones, y que se ha asociado a un mayor riesgo de somatizaciones y trastornos psicosomáticos. Material y métodos: Se estudió una muestra de 124 pacientes ambulatorios atendidos en el área de medicina psicosomática de un hospital general, con la finalidad de comprobar si los pacientes alexitímicos presentan menor inteligencia verbal que los no alexitímicos. La alexitimia se evaluó con la Toronto Alexithymia Scale (TAS), y la inteligencia verbal y no verbal se evaluó con el test de WAIS. Resultados: Los puntajes en alexitimia no se relacionaron con el diagnóstico médico y psiquiátrico, y los pacientes alexitímicos (n: 53) no sólo presentaron menores puntajes en inteligencia verbal que los sujetos indiferenciados (n: 37) y no alexitímicos (n: 34), sino que también presentaron menores puntajes en inteligencia no verbal y en inteligencia general. Conclusiones: Los resultados no confirmaron la alexitimia como una consecuencia de asimetría cerebral y de disfunciones interhemisféricas (AU)

[Nocturnal eating syndrome]. / El síndrome de la cena durante el sueño.

AIM: A clinical and polysomnographic study of two patients with nocturnal eating syndrome (recurrent awakenings associated with the need to eat and difficulty in returning to sleep it the patient does not eat). PATIENTS AND METHODS: Two patients, one 36-year-old male and one 41-year-old woman underwent clinical tests (including a psychopathological study based on a structured interview and a series of psychometric tests) and polysomnographical tests with audiovisual recording. RESULTS: The two patients presented a history since adolescence and insidious, progressive course of multiple nocturnal episodes associated with the need to eat and difficulty in returning to sleep if they did not do so. The polysomnographic study with video demonstrated awakenings in all the phases of sleep which were rapidly followed by food intake discarding other diseases. The biochemical, hormonal and neuroimaging studies were normal. The two patients showed alterations in alimentary habits characterized by gorging and a psychiatric profile of obsessive and compulsive traits. Bulimia and anorexia nervosa were excluded. CONCLUSIONS: The association of nocturnal eating syndrome with a compulsive alimentary pattern and the presence of obsessive-compulsive features in exception and suggests a common mechanism characterized by compulsive acts. Polysomnographic recording allows confirmation of the clinical diagnosis of nocturnal eating syndrome and discards other diseases.

El síndrome de la cena durante el sueño / Nocturnal eating syndrome

Objetivo: Estudio clínico y polisomnográfico de 2 pacientes afectados del síndrome de la cena durante el sueño (despertares recurrentes asociados a la necesidad de comer y a la dificultad de volver a conciliar el sueño si no se consigue comer). Pacientes y métodos: Dos pacientes, un varón de 36 años y una mujer de 41 años, fueron estudiados clínicamente (se incluye una exploración psicopatológica basada en una entrevista estructurada y una batería de tests psicométricos) y polisomnográficamente con registro audiovisual. Resultados: Los 2 pacientes presentaban una historia desde la adolescencia de curso insidioso y progresivo, de múltiples episodios nocturnos asociados a la necesidad de comer y a la dificultad de volver a conciliar el sueño si no conseguían comer. El estudio polisomnográfico con vídeo demostró despertares desde todas las fases del sueño que se seguían rápidamente de ingesta de alimentos, descartándose otras enfermedades. Los estudios bioquímicos, hormonales y de neuroimagen fueron normales. En los 2 pacientes coexistía durante el día una alteración de la conducta alimentaria caracterizada por atracones, y un perfil psiquiátrico con rasgos obsesivos y compulsivos. Se excluyeron la bulimia y la anorexia nerviosa. Conclusiones: La asociación del síndrome de la cena durante el sueño con un patrón alimentario compulsivo y la presencia de rasgos obsesivos-compulsivos es excepcional y sugiere un mecanismo común caracterizado por actos compulsivos. El registro polisomnográfico permite confirmar el diagnóstico clínico del síndrome de la cena durante el sueño y descartar otras enfermedades. (AU)

Granisetron plus methylprednisolone for the control of high-dose cisplatin-induced emesis.

This double-blind, double-dummy, randomized study compared the 24 h efficacy and safety of granisetron alone (3 mg i.v. over 30 s) or in combination with methylprednisolone (250 mg i.v. twice daily) in preventing nausea and vomiting in 308 patients (254 males) receiving high-dose cisplatin (100 mg/m2 or above) for mainly lung, and head and neck cancers. All patients received oral follow-on therapy comprising oral granisetron and methylprednisolone during the following 6 days. Primary efficacy variables were the proportions of complete responses (CR; no vomiting, no worse than mild nausea, no rescue and no withdrawal), no vomiting and no nausea over the first 24 h following initiation of the cisplatin infusion. The two treatment groups were well matched for demographics, cancer site, cisplatin dose and duration of infusion. Granisetron plus methylprednisolone was significantly more effective than granisetron alone for all primary efficacy variables: CR 78 versus 59% (p<0.001), no vomiting 80 versus 61% (p<0.001) and no nausea 74 versus 57% (p<0.002). Significantly more patients receiving the combination were free of any emetic symptoms (74 versus 54%, p<0.001). Significantly fewer patients receiving combination therapy also required rescue therapy with i.v. granisetron (12.2 versus 21.7%, p=0.026). During the follow-on period, complete response rates varied day by day from 50 to 71%. Both treatments were well tolerated, with constipation, abdominal pain and headache as the most frequent adverse events.

[Hemangiopericytoma of the soft palate and mediastinum: a case report]. / Hemangiopericitoma de paladar blando y mediastino. A propósito de un caso.

We report a case of hemangiopericytoma with simultaneous affectation of soft palate and mediastinum in a 46-year-old male. We describe the outstanding histologic features of this uncommon tumor, as well as its treatment and evolution. This case had a 5-year survival in spite of pulmonary metastases. We also reviewed the literature and discussed this rare clinical presentation of hemangiopericytoma.

[Recurrence of benign intracranial hypertension]. / Recidivas en la hipertensión intracraneal benigna.

The recurrence of benign intracranial hypertension (BIH) in 100 patients was analysed after a long-term follow-up. A recurrence appeared in 20% of the cases in this series. This being more frequent, with statistical significance, in females aged between 20-40 years. Obesity was the more frequent etiopathogenic factor involved in the onset of relapses. Other factors were pregnancy, steroid therapy, levothyroxine and obstruction of the cerebrospinal fluid derivation system. Relapses did not produce loss of sight. We insist on the elimination of developing factors in order to prevent the recurrence.

[Visual evoked potentials in benign intracranial hypertension]. / Potenciales evocados visuales en la hipertensión intracraneal benigna.

In 20 patients with benign intracranial hypertension (BIH) a study of the P100 latency of visual evoked potentials (VEP) was carried out. At admission only 5 patients showed abnormal latencies. The mean of the P100 latencies in patients was significantly increased as compared with controls. Latencies persisted relatively prolonged once the funduscopy had become normal. In the last investigation, one year after BIH had disappeared, the latencies in patients were already similar to those in the control group. On the other hand, no patient with normal latencies had visual sequelae. Sequelae also did not develop in patients in whom initially prolonged latencies progressively returned to normal during the evolution. Sequelae developed in one patient in whom latencies became progressively prolonged. In that case the increased latencies preceded the fall in visual acuity. These data may be useful to evaluate visual function in patients with BIH.

[Pituitary study in benign intracranial hypertension]. / Estudio hipofisario en la hipertensión intracraneal benigna.

Pituitary function studies were performed on 20 patients with benign intracranial hypertension. Abnormal results were only obtained in six cases and all of these findings could be attributed to sources other than the increased intracranial pressure. Once the disease as well as its cause had disappeared, a second study was carried out and the results for all the patients were then normal. Computerized tomographic scanning of the sella turcica detected an empty sella in one patient and a possible hypophyseal microadenoma without functional repercussions in another. No evidence was found that benign intracranial hypertension is provoked by an impairment in pituitary function, nor that it could be a secondary complication thereof.

[Episodic ++paroxysmal hemicrania or chronic paroxysmal hemicrania in pre-chronic state?]. / Hemicrania paroxística episódica o hemicrania crónica paroxística en estadio precrónico?

Two women suffered from strictly unilateral, periocular headaches for many years. The clinical characteristics of headaches were those described in chronic paroxysmal hemicrania. However, both patients showed an episodic evolution of pain. In one case, this stage could be considered pre-chronic because it was later followed by the classic and apparently definitive chronic period of the disorder. In the second case the episodic stage persisted all along the evolution of the disease and the headache did not reach the chronic period. The patient has been free of pain without treatment for the last three years. This second observation can be considered as an example of episodic paroxysmal hemicrania. In the episodic cases the response of pain to indomethacin can be difficult to be ascertained.

[Pregnancy and benign intracranial hypertension]. / Embarazo e hipertensión intracraneal benigna.

Several papers have suggested that pregnancy is one of the etiopathogenic factors of benign intracranial hypertension (BIH). The therapeutic attitude to be taken as regards new pregnancies in women previously afflicted with BIH during pregnancy is still on discussion. This paper is based on a study of 100 BIH cases. The results support the idea that cases, but the obesity involved. The coexistence of BIH and pregnancy does not increase the risk of relapse, does not mean a worse prognosis of BIH nor does it appear to have a negative effect on the child. Any woman who has previously developed BIH during pregnancy should not be advised against future pregnancies. In the case of a new pregnancy, a very close control should be carried out in order to avoid an excessive increase in weight.

[Benign intracranial hypertension and obesity]. / Hipertensión intracraneal benigna y obesidad.

The incidence of obesity and excess weight were analyzed in a series of 100 cases of benign intracranial hypertension (BIH) and compared with a control group. The results of hypocaloric diet and lumbar puncture were compared to those obtained with other treatments. Relapses of the disease were analyzed in obese patients who maintained a normal weight after clinical recovery and compared with those who get fat again. A similar analysis was carried out in pregnant women. The frequency of sequelae in obese patients was also determined. A high incidence of obesity was observed only in women aged 20 to 40 years who presented BIH. Hypocaloric diet and lumbar puncture constituted the treatment which exerted a more marked shortening of the clinical course. Relapses of BIH were more frequent in obese patients who did not normalize the body weight and in new pregnant women. Data indicate the relevance of obesity as etiopathogenetic factor in a group of patients with BIH.

[Prophylactic treatment of episodic cluster headaches with methysergide and prednisone]. / Tratamiento profiláctico con metisergida y prednisona de la cefalea en racimos episódica.

In two consecutive series of 25 cases each suffering from episodic cluster headache, one of the clusters was treated prophylactically in the first series with methysergide and in the other with prednisone. The duration of the clusters under treatment was similar in both series. The results of our study suggest that neither the methysergide nor the prednisone were able to shorten the duration of clusters.

Cyst of the septum pellucidum and Korsakoff's psychosis.

Noncommunicating cysts of the septum pelludicum are rare and diagnostic experience with CT scan is scanty. They may cause hydrocephalus because of obstruction of Monro's foramina. In this report we describe a young patient with acute Korsakoff's syndrome. The CT scan revealed a cyst of the septum pellucidum without hydrocephalus. Surgery disclosed a noncommunicating cyst compressing structures of the limbic system. After surgery symptoms disappeared.