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Background: Ovarian cortex cryopreservation (OCC) for future autotransplant represents a treatment alternative for those paediatric cancer survivors affected of ovarian failure and fertility disorders., Methods: Patients with high gonadotoxic risk are included in the Oncology Paediatric Fertility Preservation Programme: those receiving pelvic radiotherapy, bone marrow transplantation, high doses of cranial radiotherapy or alquilating agents, or those with bilateral ovarian pathology. Prior to the oncological treatment, the ovarian tissue is harvested laparoscopically. At the same time, other invasive procedures are done. Once malignancy is ruled out of the specimen and the presence of primordial follicles is confirmed, the multidisciplinary team of oncologist, paediatric surgeon and fertility specialist coordinate the processing and delivery of the ovarian cortex to the Comunidad Valenciana Tissue Bank., Results: From July 2008 to May 2010 eight patients have been included in the programme, aged between 8-18 years old and with diagnosis of: Hodgkin's lymphoma (n= 2), Acute Myeloblastic and Lymphoblastic leukaemia (n= 2), pelvic Ewing's sarcoma, bilateral ovarian Teratoma and Meduloblastoma. Five patients underwent non gonadotoxic chemotherapy before OCC. Six additional procedures were done using the same anaesthetic event. Partial oophorectomy was performed in half the cases, total oophorectomy in the rest of them, and an ovarian pexia was once associated. All taken samples were found to be valid., Conclusions: OCC of selected patients was performed safely, with neither postoperative complications nor delay of the oncological treatment. Therefore, the first national experience in this procedure has been satisfactorily achieved.

Introduction: Temporomandibular joint dysfunction (TMD) is involved in important activities of the stomatognathic system for nutrition, such as chewing or swallowing. If the physiological tolerance of its components is exceeded, it can trigger symptoms of temporomandibular dysfunction (TMD)., Objectives: To assess and relate the symptoms of TMD, functional limitations and estimates of self-perceived oral health and general geriatric population in a communitydwelling elderly population., Methods: An observational study was performed. Ninetyfour persons belonging to units of Granada Geriatric Day were assessed symptoms of TMD (Helkimo Simplified Index), pain (VAS scale), functional limitation of stomatognathic system (research diagnostic criteria for temporomandibular disorders CDI/TTM), jaw opening index, general health index (1-5) and oral health (geriatric oral health assessment)., Results: In the total sample, 42.7% had at least one symptom of TMD. The most common symptoms were muscular fatigue (26.6%), noise (21.3%) and TMD pain (14.9%). The most common non-specific symptoms in the symptomatic group were neck pain and nervousness. A 48.9% of the sample had functional limitation in orofacial activities. Also, there was a statistically significant association (p<0.05) between the jaw opening index and symptomatic and asymptomatic groups with TMD., Conclusions: In the group with symptoms of TMD were more common temporomandibular joint departures and pain, and they presented lower values in oral and general health self-perception.

Introduction: Among the numerous pathophysiological theories that attempt to explain the development of Alzheimer's disease (AD) there are two facts that stand out above the rest: on the one hand, the formation of neurofibrillary tangles inside cells and, on the other, the extra-cellular deposition of beta-amyloid protein. These two mechanisms lead to neurodegeneration and the death of cells by means of a process called 'apoptosis' or 'programmed cell death'. In the early stages of this neurodegenerative process it is more pronounced in cholinergic-type brain centres. This led to the formulation of the so-called cholinergic theory of Alzheimer, which provides the rationale behind the use of the drugs that are currently available to treat this disease, namely, acetylcholine esterase (AChE) inhibitors (rivastigmine, donepezil and galanthamine)., Development and Conclusions: We review the possible pharmacological approaches that could help to prevent or delay cell death, and which act on the mechanisms involved in the production of neurofibrillary tangles or the deposition of beta-amyloid protein. We also review the main characteristics of cholinergic neurotransmission, which will help us to understand the therapeutic approaches that have been applied in an attempt to enhance deficient cholinergic neurotransmission. One of the most notable of these is the amount of attention recently being paid to the enzyme AChE, which increases the bioavailability of the neurotransmitter in the cholinergic synapses by preventing the hydrolysis of acetylcholine; these are the only drugs currently available for the symptomatic treatment of this disease.

In this paper, a cutaneous alternariosis is described. This is a strange opportunist infection with less than 100 cases. The patient was not VIH although inmunocompromised due to several factors: Malabsorption Syndrome, megaloblastic anemia secondary to gastrectomy and distal pancreatomy with gastrodigiunostomia due to gastric adenocarcinoma four years ago; splenectomied in the same operation, long treatment with hydantoin, and corticosteroids. The patient was managed in the internal medicine unit due to a problematic respiratory infection with cardiac rhythm disorder and progressive debility in lower limbs, together with cutaneous lesions in which "alternaria sp" was isolated by culture. After beginning treatment with oral itraconazole, his evolution was excellent. The main interest consists in the rareness and the original presentation of the cutaneous alternariosis in this case.

Objective: To assess the effectiveness of erythropoietin (EPO) in a Clinical Oncohematology Unit within a general hospital, and to propose a therapeutic algorithm with EPO based on recommendations by ASCO., Material and Methods: A descriptive, retrospective study was carried out on patients who required support treatment with EPO while in the Oncohematology Unit during the year 2001. Data were collected by reviewing patient medical records. An effective treatment was defined as an increase in baseline hemoglobin (Hb) equal to or higher than 2 g/dL over 4-8 weeks, with no transfusion requirements or decreased transfusion needs. Baseline Hb values, their distribution per diagnosis, and the involvement of platinum-containing chemotherapy regimens were analyzed., Results: Of the 353 patients in chemotherapy, 87% corresponded to oncologic diagnoses while the rest had hematological neoplasms. A total of 54 patients were assessed, with 83% of these corresponding to the oncologic area. Oncologic diagnoses that most required the use of EPO included: head-neck 53%, genitourinary 39%, and lung 39%. Overall effectiveness was 57% (60% in oncology and 44% in hematology). The Hb value leading to initial prescription (baseline Hb) was always below 10 g/dL for the hematology area, whereas most oncology patients exhibited higher levels at therapy onset., Conclusions: 1. Its percentage of failure: 40% for oncology and 56% for hematology patients, together with its high cost, shows that a further search for predictive factors is warranted in order to more precisely select individuals who may benefit from this therapy. 2. The percentage of oncology patients with baseline Hb <10 is only 29%. Baseline Hb values for treatment onset and peak Hb values for therapy discontinuation should be agreed upon. Treatment initiation when Hb values fall below 10 g/dL would be a reasonable option, and a decision to use EPO above 10 g/dL should be made in patients with less severe anemia (10-12 g/dL) only if clinical circumstances render it advisable. 3. Use protocols must include clear concept definitions for treatment, and for primary and secondary prophylaxis, which will help in the establishment of therapeutic algorithms.

Objective: To discuss various aspects of drug prescription for first-year resident physicians (MIR-1) working in Emergency Departments in order to promote a rational use of drugs, and to assess the impact of such pharmaceutical intervention., Method: During personal interviews MIR-1s were briefed (both orally and in written form) on prescription characteristics of their department. Both qualitative (compliance with the Pharmaco-therapeutic Guide, prescription of drugs with low intrinsic value) and quantitative (prescription profile for medicines with the same active principle but different price) parameters were discussed. Then the impact of these interviews was analysed by comparing outpatient prescriptions by MIR-1s during August-November 2000 versus those filled by their colleagues during this same period in 1998 and 1999., Results: Outpatient prescriptions by the MIR-1 group conformed better to the qualitative and quantitative parameters studied. Despite such better results, greater savings may still be obtained by improving quinolone/macrolide, anti-ulcer drug, ACE inhibitor and NSAID prescriptions, since these amount to 93% of total potential savings., Discussion: By conducting personal interviews with a pharmacist new MIR-1s encounter an additional information source contributing to more sensible drug prescriptions.

Objective: To evaluate the utility of carbohydrate deficient transferrin (CDT) for the chronic alcoholism diagnostic, the recent intake and the abstinence, comparing it with the most recognized biological markers, specially the MCV and the GGT., Methods: We study 87 subjects: 22 controls, 42 subjects abstinent chronic alcoholics and 23 patient active alcoholics. From the last group we subject the middle to a 15 days abstinence period. We compare the CDT with the mos recognized markers in the difference groups., Results: We found significant difference with MCV and GGT in the chronic alcoholism diagnostic. There were significant difference with MCV, GGT and specially CDT in the case of recent alcoholic intake. CDT was the only one that shows significant difference in recent abstinence., Conclusion: According to our results the CDT is a poor marker of chronic alcoholism. The classical markers (MCV nd GGT) are better on tha propriety. CDT, however, is a valid and effective marker for the recent alcohol intake, it is better than GGT and MCV. And it is the only valid marker for the recent abstinence. So, we estimate that, it would be advisable the CDT clinical use with restringed criterions for the recent alcoholic intake diagnostics and, specially for the abstinence one.

We present the case of a 67-years-old patient which, after treatment with ciprofloxacin, developed fever, exanthema, arthralgias, polyadenopathies, hepatosplenomegaly, autoimmune hemolytic anemia, hypergammaglobulinemia and severe inversion of the CD4/CD8 ratio. Latter, he developed ischemic signs in several locations (splenic and cerebral infarcts), as well as polyneuropathy and inflammatory myopathy. The diagnosis of angioimmunoblastic lymphadenopathy was established through ganglionary biopsy. The patient improved initially with the administration of corticoids, but in a few months, he developed pleomorphic T lymphoma with quick fatal evolution. We discuss the rarity of some of the clinical and laboratory manifestations in this patient and we comment on the association of ciprofloxacin and the angioimmunoblastic lymphadenopathy, which has never been previously described in the international literature.

A clinical lacteal, neonatal, following up, was done in 25 puerperal women, post-cesarean section, who had selected breast feeding for their child since their prenatal control. It was concluded that adequate assessorship about lactation during prenatal consultation, positively modifies maternal attitudes towards natural feeding; and that it is also possible and convenient to introduce in the perinatology team's practice the support to lactation with special emphasis in hospital stay after cesarean section and subsequent consultation, for adequate surveillance of post-operative evolution, and control of the healthy child. In this manner, it is possible to orientate and encourage recent puerperae and to verify newborn's optimal growth when fed with this natural method.

Macroscopic gastrointestinal hemorrhages caused by the consumption of oral drugs are relatively scarce among patients receiving antirheumatic treatment. On the other hand, in a high percentage of all cases of digestive bleeding, antirheumatic drugs were administered shortly beforehand. A review of 216 cases with hematemesis and/or melena are presented. In 50 percent of the patients there was evidence of previous administration of potentially ulcerogenic drugs capable of causing hemorrhages in the digestive tract. Salicylates predominated among the compounds that were considered to be responsible for hemorrhages (salicylates, corticosteroids, reserpine, and other antirheumatic products). The mechanisms involved in producing iatrogenic hemorrhages were examined and the drugs were classified as precipitating and directly ulcerogenic compounds. Precipitating drugs were those which were able to reactivate a preexisting lesion (reserpine, glucocorticoids, phenylbutazone, etc.). The ulcerogenic drugs included those products that could provoke a lesion of previously unimpaired digestive mucosa (salicylates).

A study was performed on 30 patients diagnosed antomopathologically for malignant neoplasia of the lung (epidermoid carcinomas, adenocarcinomas, oat-cell carcinomas, and neoplasias which could not be definitely classified). The following parameters for blood and urine were determined: osmolality, sodium, potassium, urea, and creatinine. Osmotic free water, creatinine, sodium, and potassium clearances were also calculated, as well as the plasma osmolality/urinary osmolality ratio. The basic aim of our study was to investigate for the presence of disturbances in the metabolism of water and alterations in plasmatic and urinary osmolality in this type of tumor. These could appear as complete inadequate ADH secretion syndromes as discovered by Bartter and Schwartz or as incomplete syndromes (hypoosmolality and/or hyponatremia). Among the more significant results was the tendency toward oliguira seen in 44% of the patients and the high incidence of plasmatic hypoosmolality (31%). In three patients plasmatic hypoosmolality and hyponatremia were concommitant in repeated observations. A complete inadequate ADH secretion syndrome was discovered in another patient with an oat-cell carcinoma. He presented plasmatic hypoosmolality, hyponatremia, relative urinary hypertonia, and oliguria but not renal, suprarenal, or hepatic pathology.