Mesothelioma: Questions and Answers

Mesothelioma is a rare form of cancer in which malignant (cancerous) cells are found in the mesothelium, a protective sac that covers most of the body's internal organs. Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles.

1. What is the mesothelium?

The mesothelium is a membrane that covers and protects most of the internal organs of the body. It is composed of two layers of cells: One layer immediately surrounds the organ; the other forms a sac around it. The mesothelium produces a lubricating fluid that is released between these layers, allowing moving organs (such as the beating heart and the expanding and contracting lungs) to glide easily against adjacent structures.

The mesothelium has different names, depending on its location in the body. The peritoneum is the mesothelial tissue that covers most of the organs in the abdominal cavity. The pleura is the membrane that surrounds the lungs and lines the wall of the chest cavity. The pericardium covers and protects the heart. The mesothelial tissue surrounding the male internal reproductive organs is called the tunica vaginalis testis. The tunica serosa uteri covers the internal reproductive organs in women.

2. What is mesothelioma?

Mesothelioma (cancer of the mesothelium) is a disease in which cells of the mesothelium become abnormal and divide without control or order. They can invade and damage nearby tissues and organs. Cancer cells can also metastasize (spread) from their original site to other parts of the body. Most cases of mesothelioma begin in the pleura or peritoneum.

3. How common is mesothelioma?

Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. About 2,000 new cases of mesothelioma are diagnosed in the United States each year. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age.

4. What are the risk factors for mesothelioma?

Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure at work is reported in about 70 percent to 80 percent of all cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos.

Asbestos is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven. Asbestos has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.

Smoking does not appear to increase the risk of mesothelioma. However, the combination of smoking and asbestos exposure significantly increases a person's risk of developing cancer of the air passageways in the lung.

5. Who is at increased risk for developing mesothelioma?

Asbestos has been mined and used commercially since the late 1800s. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of asbestos exposure in the workplace. People who work with asbestos wear personal protective equipment to lower their risk of exposure.

The risk of asbestos-related disease increases with heavier exposure to asbestos and longer exposure time. However, some individuals with only brief exposures have developed mesothelioma. On the other hand, not all workers who are heavily exposed develop asbestos-related diseases.

There is some evidence that family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases. This risk may be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers. To reduce the chance of exposing family members to asbestos fibers, asbestos workers are usually required to shower and change their clothing before leaving the workplace.

6. What are the symptoms of mesothelioma?

Symptoms of mesothelioma may not appear until 30 to 50 years after exposure to asbestos. Shortness of breath and pain in the chest due to an accumulation of fluid in the pleura are often symptoms of pleural mesothelioma. Symptoms of peritoneal mesothelioma include weight loss and abdominal pain and swelling due to a buildup of fluid in the abdomen. Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.

These symptoms may be caused by mesothelioma or by other, less serious conditions. It is important to see a doctor about any of these symptoms. Only a doctor can make a diagnosis.

7. How is mesothelioma diagnosed?

Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history, including any history of asbestos exposure. A complete physical examination may be performed, including x-rays of the chest or abdomen and lung function tests. A CT (or CAT) scan or an MRI may also be useful. A CT scan is a series of detailed pictures of areas inside the body created by a computer linked to an x-ray machine. In an MRI, a powerful magnet linked to a computer is used to make detailed pictures of areas inside the body. These pictures are viewed on a monitor and can also be printed.

A biopsy is needed to confirm a diagnosis of mesothelioma. In a biopsy, a surgeon or a medical oncologist (a doctor who specializes in diagnosing and treating cancer) removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. If the cancer is in the abdomen, the doctor may perform a peritoneoscopy. To obtain tissue for examination, the doctor makes a small opening in the abdomen and inserts a special instrument called a peritoneoscope into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.

If the diagnosis is mesothelioma, the doctor will want to learn the stage (or extent) of the disease. Staging involves more tests in a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Knowing the stage of the disease helps the doctor plan treatment.

Mesothelioma is described as localized if the cancer is found only on the membrane surface where it originated. It is classified as advanced if it has spread beyond the original membrane surface to other parts of the body, such as the lymph nodes, lungs, chest wall, or abdominal organs.

8. How is mesothelioma treated?

Treatment for mesothelioma depends on the location of the cancer, the stage of the disease, and the patient's age and general health. Standard treatment options include surgery, radiation therapy, and chemotherapy. Sometimes, these treatments are combined.

• Surgery is a common treatment for mesothelioma. The doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. For cancer of the pleura (pleural mesothelioma), a lung may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.
• Radiation therapy, also called radiotherapy, involves the use of high-energy rays to kill cancer cells and shrink tumors. Radiation therapy affects the cancer cells only in the treated area. The radiation may come from a machine (external radiation) or from putting materials that produce radiation through thin plastic tubes into the area where the cancer cells are found (internal radiation therapy).
• Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Most drugs used to treat mesothelioma are given by injection into a vein (intravenous, or IV). Doctors are also studying the effectiveness of putting chemotherapy directly into the chest or abdomen (intracavitary chemotherapy).

To relieve symptoms and control pain, the doctor may use a needle or a thin tube to drain fluid that has built up in the chest or abdomen. The procedure for removing fluid from the chest is called thoracentesis. Removal of fluid from the abdomen is called paracentesis. Drugs may be given through a tube in the chest to prevent more fluid from accumulating. Radiation therapy and surgery may also be helpful in relieving symptoms.

9. Are new treatments for mesothelioma being studied?

Yes. Because mesothelioma is very hard to control, the National Cancer Institute (NCI) is sponsoring clinical trials (research studies with people) that are designed to find new treatments and better ways to use current treatments. Before any new treatment can be recommended for general use, doctors conduct clinical trials to find out whether the treatment is safe for patients and effective against the disease. Participation in clinical trials is an important treatment option for many patients with mesothelioma.

People interested in taking part in a clinical trial should talk with their doctor. Information about clinical trials is available from the Cancer Information Service (CIS) (see below) at 1–800–4–CANCER. Information specialists at the CIS use PDQ®, NCI's cancer information database, to identify and provide detailed information about specific ongoing clinical trials. Patients also have the option of searching for clinical trials on their own. The clinical trials page on the NCI's Cancer.gov Web site, located at http://www.cancer.gov/clinicaltrials on the Internet, provides general information about clinical trials and links to PDQ.

People considering clinical trials may be interested in the NCI booklet Taking Part in Cancer Treatment Research Studies. This booklet describes how research studies are carried out and explains their possible benefits and risks. The booklet is available by calling the CIS, or from the NCI Publications Locator Web site at http://www.cancer.gov/publications on the Internet.

# # #

Related NCI materials and Web pages:

• National Cancer Institute Fact Sheet 3.21, Asbestos Exposure: Questions and Answers
  (http://www.cancer.gov/cancertopics/factsheet/Risk/asbestos)
• Clinical Trials Home Page
  (http://www.cancer.gov/clinicaltrials)
• Malignant Mesothelioma Home Page (http://www.cancer.gov/cancertopics/types/malignantmesothelioma)
• Taking Part in Cancer Treatment Research Studies
  (http://www.cancer.gov/clinicaltrials/Taking-Part-in-Cancer-Treatment-Research-Studies)

For more help, contact:

NCI's Cancer Information Service
Telephone (toll-free): 1–800–4–CANCER (1–800–422–6237)
TTY (toll-free): 1–800–332–8615
LiveHelp^® online chat: https://cissecure.nci.nih.gov/livehelp/welcome.asp

Benign cystic mesothelioma

Benign cystic mesotheliomalar (BCM) nadir
It is a common lesion. Patients in the history of
patogenez and prognosis differ mostly in
thesis is defended. BCM first time in 1979
And is defined by Smith Mennemeyer.
Multikistik peritoneal mesothelioma, peritoneum of the cystic
mesothelioması, multiokuler cysts of the peritoneum,
multikistik mesothelioma and peritoneal multiokuler
inklüzyon kisti
Other names used are
forms olmuştur. Multible, thin-walled, frajil a
structure of the large mass of the abdomen
oluşturabilmektedir.
Preoperative diagnosis is often difficult. Separator
In recognition sarcomas, lymphoma and Non Hodgkin's lymphoma
Just as surgery düşünülmelidir.Tedavi method
at a rate of recurrence has been reported, but there is 50%.
Sıklıklayerleştiğiyerler; over, falloptüpleri, column,
cul de sac and pelvis is the base. Dimensions 0.3 cm and 15
cmarasındadeğişebilmektedir.
Both are very rare in men with
can be seen in the breed. Usually fertile
are seen in women and 1998 since
Total 130 cases have been reported in English literature.
These are only 19 male patients. Literature
reviewed by the rare, mature men
Besides that, the placement of peritoneal malignant and selim tümöral audience to distinguish the importance
nedeniylesunulmuştur
15-year-old male patient with abdominal pain and right lower
was admitted to our clinic because of the sensitivity dial.
Stories, the two-day loss of appetite and nausea vomiting
was available. Physical examination in the right lower quadrant
sensitivity of patients with bowel sounds present
routine, had no defense and rebound. Acute appendicitis front
the patients were diagnosed pancakes. Configuration of examinations
The white sphere is 76% 8800/mm ³ and granulocyte
other routine examinations were normal except for. Configuration
ultrasonography (USG) 'de; ilia vascular structures
The reshuffle of the medial area of the iliopsoas muscle
In the neighborhood of about 57x22x16 mm
In the septasyonları and thin ekojeniteleri
complicated in view of the fluid collection was identified.
And bladder in the neighborhood also trasede ilia
multible lenfadenopatiler (lap) seen. "Perforated
appendicitis? "has been reported as (Figure 1.2). A
In the next report "hydatid cyst?" de
were normal, but multiple appendiks lap.
Observation of the patient, except in the right lower quadrant pain
USG findings and reports be determined because of different patient diagnostic information
has been scheduled for laparaskopi. General anesthesia
six 1 cm below the belly of the camera insizyondan
was entered. Looked at in the right neighborhood pelviste bladder
The cystic structures were observed on multible peritoneum. And other Western bodies Appendiks salim
as was observed. Then right-va left 5mm'lik trokar
After entering the cystic lesions of the lower quadrant
to complete by being perforated with peritoneal
been removed (Picture3). Be done to identify pathological
reported as a result of benign cystic mesothelioma
edildi. Smooth as the first postoperative day the patient
taburcuedildi.3aysonrakontroleçağrıldı.
BCM mezotelyumdan from peritoneal
tumoral is a rare occurrence. Etiology of
There is no definite information. Often, early or
the age of fertility is higher for women
seen in male patients but also has been reported.
Connected with malignant Asbestozise a clear mesothelioma
relationship-although, even if it has been reported 2 patients
has not been shown. In the stories of patients often
not the surgical operations, or endometriozis
is an inflammatory event. BCM a reactive
is considered as events and malignant transformation
expected. Metastasis is reported so far
is not.
Abdominal distension and masses in the form of
Discharge is the most common findings. Rare as
karınağrısıilekarşımızaçıkar. Bizimolgumuzdasağ
lower quadrant pain with the present findings, such as a rare
olmuştur. However Tangjitgamol et al. 'T say
not a specific finding as preoperative diagnosis
nedeniylemümkünolmamaktadır.
Anekoik with imaging techniques, low
reported as mass density or cystic hipointense
are. We also as a result USG cystic
characters are defined by the audience. The specific
view of the findings; invasion without mass
Depending on the size of the distortion around the structure
is doing. Abdominal into us, the grapes
as a bunch of thin-walled, fluid-filled interior of the serous
out as the formation of various sizes. Our
Although it is small, white grape olgumuzda
salkımıgörüntüsümevcuttu.
Diagnostic imaging techniques, except in the thin
needle aspiration biopsy has been applied, but non
Except mezotelyal cells specific findings
as a useful means to identify preoperative
It is not.
In the differential diagnosis of cystic Hygroma, endometriozis,
retroperitonu tutan müllerian cyst, cystic adenomatoid
tumors, cystic mezonefrik duktus residues and
formation of benign cystic form endosalpingiozisin
should be considered as pathological in bakılan. As malignant
ise; mesothelioma and peritoneal malignant serous and kicking
tümörlerdüşünülmelidir.
Surgical resection is the most effective treatment methods.
Not be removed if the recurrence is often OK.
For this aggressive surgical approach kistoredüktif
with peritonektomi is recommended. We
Because of the small mass limit clean surgery to remove the entire laparaskopik way we did it.
If a second surgical attempt to detect the recurrence
yerineantiöstrojenlerveyagonadotropinanaloglarıile
hormonal therapy, intraperitoneal hipertermik
chemotherapy and tetrasiklinle sikleroterapi
is recommended. However, success is variable. Benign
after surgery due to be in natur Adjuvan
olarakkemoterapiveradyoterapiönerilmemektedir.
As a result, good-natured with a tümöral structure
BCM, preoperative diagnosis is difficult, despite
treatment is possible with resection method.
Cystic appearance must occur in the presence
mutlakatümüyleçıkarılmalıdır.

Bibliography

1. Mennemeyer R, Smith M. Multicystic peritoneal

mesothelioma: A report with electron microscopy of a

case mimicking intraabdominal cystic hygroma

(lymphangioma).Cancer1979;44:692.

2. Akata D, Arat A, Ozdogan M. Benign cystic

mesothelioma of the peritoneum. Abdom Imaging

1999;24:188.

3. Tangjitgamol S, Erlichman J, Northrup H, Malpica A,

Wang X, Lee E, et al. Benign multicystic peritoneal

mesothelioma: cases reports in the family with

diverticulosis and literature review. Int J Gynecol

Cancer2005;15:1101-7.

4. O'Neil JD, Ros PR, Storm BL, Buck JL, Wilkinson EJ.

Cystic mesothelioma of the peritoneum. Radiology

1989;170:333-7.

5. Samson P, Cacala S. Rare case of benign multicystic

peritoneal mesothelioma. A letter. ANZ J Surg 2005;

75(7):619-20.

6. Safioleas MC, Kontzoglou C, Stamakos M,

Glaslakiotis K, Safioleas C, Kostakis A. Benign

multicystic peritoneal mesothelioma:Acase report and

review of the literature.World J Gastroenterol 2006;

12(35):5739-42

What is mesothelioma?

Is a natural silicate mineral asbestos with people because of the combination does not transmit heat started in the old ages. On the ninth hundred years in the second half of the next industrial revolution, heat, electricity, friction, and is resistant to acid because many businesses are using the "magic mineral" as is the twentieth in the face of the second half after being karsinojenik emerged, the name "deadly dust" has been.

Asbestos as a solid physical structure (amphibol) and curve-fiber (chrysotile) has two types. Amphibol of asbestos, according to chemical structure, crocidolite (blue asbestos), amosite (brown asbestos), tremolit to anthophollite and actinolite varieties are available. Industries most frequently used in chrysotile, crocidolite and amosite were denominated. These are the most dangerous for health and crocidolite were banned in many countries using amosite'nin. 90% of the asbestos industry in many countries, including chrysotile, but is prohibited in some countries is less controversial karsinojenisitesi are used under strict control.

Asbestos disease can only enters the body through breathing. Caused diseases, may be benign or malignant. In the first group, plevrada fibrosis, calcification, effüzyon; parankima in lung fibrosis (asbestosis) is located. In the second group, the malignant mezotelyomaları pleura and peritoneum, lung cancer and even if less is available larenks and cancer of the digestive organs. No non-smoker and non-industrial relations risk of lung cancer in people 1 is approved, this rate 45'e who smokes 20 a day, and smoking, but also the 92 times out who is breathing asbestos dust. With smoking and asbestos are carcinogenic for human health when minerals can be very dangerous. In Turkey, smoking rates of men in rural areas and find the% 70'lerin however breathing asbestos fibers that have the higher our people would say the chances of cancer, you'll catch.

To make a benign or beneficial owner of the asbestos diseases, has been left to take a period of 20-40. People asbestos, work environment (vocational or occupational) or environmental (environmental or Domestic) way to breathe. Az da olsa, asbestos workers who have stuck to the powder of the clothes at home that relatives can breathe it in as indirek directly or to the left is called asbestos paraoccupational way.

In Central Anatolia in Turkey approximately 16 million people living in the rural areas are considered to have. These are approximately 25% of asbestos depends on over the age of twenty Plevral disease are benign. This ratio as a linear increase as the years progress, and can reach the 80's%. Asbestos is also mezotelyoma it is aklamMaliğn. In the Western world mezotelyoma incidence of malignant 1-2.2 / 1,000,000 / year in Turkey, while at least 500 persons per year are seen in this disease. Western countries have retired asbestos worker malignant disease mezotelyoma, our country is in middle age disease. We the people of our rural areas, environmental asbestos-Domestic way to breathe. Reported above, the most number of years it could happen by the left vocational asbestos. That is, vocational disease of the western world, our environment is our disease. Central Anatolian origin is actually working in Europe to receive compensation for their workers per mezotelyomaya shot was caught when the asbestos that accept and lungs were found in the Anatolian territories show that the request can not be accepted as tremolit. Asbestos-related diseases in workers in Europe, "Imported asbestos" and running a shameful situation, it is funny.

Turkey is working in the same confusion that is. Asbestos is processed in a factory work related illness occurs employer-worker is the problem. Asbestos workers to patients has come from his village, or did you work?

In Turkey to the left of asbestos fibers, asbestos in the white ground, "Ak soil," the heavens earth "," Ceren earth "" Çelpek "with various names, lime, plaster, roof and ground floor is used as is. Used for this purpose in the villages of Anatolia, most of the land in the industrial value of any non-asbestos tremolit have to. This type of asbestos fiber, just like blue and brown asbestos thin or thick can be long.

Asbestos, environmental way our country is connected to the left peak of disease in the region: Mihallıççik districts and villages of Eskişehir and Konya Ereğli'sinin Ayrancı Halkapınar and villages, of Çankırı Ilgaz and Şabanözü Sorgun village and district of Yozgat and villages, and Yıldızeli of Sivas Şarkışla villages, west of Diyarbakir in South Eastern Anatolia region Ergani and villages, Polu Mine and villages of Elazığ, Malatya, Adiyaman and Urfa district includes the Siverek. Coast of the Black Sea and Eastern Anatolia regions in residential areas do not have asbestos-related diseases. Connected to the asbestos left several villages in Thrace Plevral benign changes are found. Only in the villages in the Aegean region Denizli'in Tavas County, Burdur's Yeşilova region, and the Gediz Aslanapa district of Kütahya, Afyon district's Elmadag about asbestos disease was found sporadically in the villages. Mediterranean region, the slope of the Taurus Mountains in the villages and some villages of Hatay Kirikhan and Reyhanlı soil drink the above mentioned tremolit way asbestos is used by the left end of the air within the environment to develop diseases related asbesle.

The 30 species of natural zeolit'lerin a aluminosilikat crystallize only in erionite and mordenite lifsel structure. The crystal structure alone is erionite'in epidemiological lifsel, in vivo and in vitro has been shown to be as karsinojenik and fibrojenik. So far, the most potent carcinogen known Erionite'nin a mineral that is connected to the World Health Organization, the International Cancer Research Agency (International Agency for Research on Cancer) has been adopted by.

Thousands of years ago, Erciyes, Hasandağı and the volcanic lava of nearby mountains covered Melendiz that foreigners Cappadocia, Goreme said we are in the unique natural wonders of the geological structure has emerged. The region's only three-place, water and salt into the reaction of volcanic lava chabazite, clinopitololite create and crystallize as lifsel structure where erionite'nin Karain, Sarıhıdır villages and is located Tuzköy. To all of the diseases of asbestos Erionite'nin caused Göreme region has to face the day with work. This area is separate from the three villages in the other villages is infrequent, and peritoneal malignant Plevral has been shown by us to be mezotelyoma endemisi. The average age of patients from the region mezotelyomalı most people 50 and 26, were the oldest is 75. In both men and women and Disease was seen. Interesting side of the business, the disease was seen in a way more intense in some families. A family with the lymphoma mezotelyoma Plevral and peritoneal, liver cancer, bone sarcoma, tumors such as non-mezotelyoma were seen. On these observations formed the basis of cancer, although genetic predisposition factors erionite also suggests additional factors may be as effective.

Göremenin Karain, Tuzköy and the proportional mortality studies Sarıhıdır villages, the first of two who died in a village in the fact that 70% died from malignant disease has been revealed. However Kızırmağın the oldest settlements in the south of the river flooding and falling rocks in the back of people and animals by causing loss of time due to the government in 1958 villages of the north side of the river in the brick, briquette made with materials such as new home has to be moved. Be below 50% of Sarıhıdır'daki mortality rate is probably related. All patients except one in this village was born in the old villages were individuals. This event Göreme'deki the problem of cancer, but show the villages can be solved through a change of location.

Cancer Göreme'deki people in villages, houses and garden walls of the building blocks that slide into the water to breathe in erionit'ten. Bronchi of the patient and provide sekresyonunda, breathing the air in the house and in the lungs is similar to the erionite fibers and asbestos cisimcik shows zeolite cisimcik. Today only 35 digits of a village that has become a large part Karainliler'ın, for various reasons, domestic and foreign locations to maintain life. After finishing elementary school, even separated from the village who goes to the world, wherever you are mezotelyoma risk.


Mesothelioma Treatment Methods
1. İmmünoterapi and / or combination chemotherapy
Ex: + IFN-a combination of cisplatin,
cisplatin + mitomisin - C + IFN-a combination,
IL-2 or IFN-g intrakaviter,
intralezyoner GM-CSF infusion,

2. Photodynamic therapy

3. Gene therapy

4. Selective receptors for growth or antagonistic treatment faktöıü

5. Plörektomi / intrakaviter chemotherapy / postoperative chemotherapy / radiotherapy preventif

Median 4-12 months after diagnosis MPM'de between sağkalım are reported.

At the moment not possible to talk about curing the disease is below 5% in five years of life.

Treatment cases are reported with long-lived.

Prognostic factors in the life time is effective.

Can not be used in response to PA lung graph treatment.

For phase MPM'de "International mesothelioma Interest Group" (IMIG) prepared by the phase recommended for use (Table 4).

For less than the number of Olgu treatment is difficult to comment about. Studies suggest that at least 15 patients are. This case centered on the work should come into question.

The multidisciplinary treatment of liver diseases can change the natural history of disease.

I Multidisciplinar Open Classroom in Viral and Bacterial Infections of the Liver.

• Sponsored by Gilead Sciences Laboratory, the reunion is accredited by the Menendez Pelayo International University and sponsored by the Spanish Association for the Study of the Liver.

• One hundred hepatologists Spaniards have gathered in this first Open Classroom Cross is drawn into a discussion forum on infectious diseases of the liver.

• The ideal drug is one that achieves a potent viral suppression (effectiveness) as long as possible (no resistance).

• Around 400 million people worldwide are infected with Hepatitis B, and 200 million for hepatitis C. Most do not know.

• In Spain there are between 300,000 and 400,000 people with hepatitis B, and between 800,000 and one million with hepatitis C.

El Palacio de la Magdalena Santander I just host the Open Classroom in Cross Viral and Bacterial Infections of the liver that has brought over one hundred nationally hepatologists.

The objective of this class has been updated knowledge related to bacterial and viral infectious diseases of the liver, especially hepatitis B and C, so that specialists may be transferred to everyday clinical practice, it has been established what should be the action protocols in many cases. It also has a special focus on the most controversial points of the treatment of these diseases. This classroom has led Dr. Fernando Pons Romero, Professor of Medicine and Chief of Digestive Medicine of the Hospital Universitario Marqués de Valdecilla, Dr. José Luis Calleja, Deputy Medical Service of Gastroenterology Hospital Universitario Puerta de Hierro, and Dr. Javier Garcia Crespo, Physician Assistant Digestive Medicine Department of Hospital Universitario Marqués de Valdecilla. Sponsored by Gilead Sciences Laboratory, the reunion had the accreditation of the Menéndez Pelayo International University and sponsored by the Spanish Association for the Study of the Liver.

This meeting, held for the first time in Spain, intends to become a forum for discussion of liver disease in the coming years. It has highlighted the importance of multidisciplinary treatment of viral and bacterial diseases of the liver, focusing on the need to work together in addressing them to ensure that treatment is successful.

Thus, Dr. Fernando Pons explains that for this first class multidisciplinary "have been selected infectious diseases for several reasons, firstly by its frequency, because of its high morbidity and have at present a very effective therapeutic arsenal can control. " We therefore have analyzed the liver related to hepatitis B and C which are responsible for a significant number of hepatitis, which if not treated properly can lead to the development of liver cirrhosis and even liver cancer.
Similarly, we have studied the bacterial diseases that can present and cirrhotic patients whose diagnosis and treatment is essential because they are a very important cause of mortality.

Here I Cross Open Classroom in viral and bacterial diseases of the liver has been spoken of spontaneous bacterial peritonitis, bacterial infections in cirrhotic patients in hepatic disease or infectious diseases. About C virus has affected the clinical extrahepatic manifestations of this virus in the predictors of non-modifiable and modifiable treatment response and treatment of hepatitis C after liver transplantation. As for the B virus, in this meeting have been presented the epidemiological changes of infection by this virus in Spain, explaining the diagnosis of infection and evolving forms of B virus infection highlighting the therapeutic options currently available.

Specialist Hospital Universitario Marqués de Valdecilla stresses the importance of these meetings as a forum for exchange of knowledge between hepatologists and other specialists who treat diseases that are related to these infections and to alter its natural history, hence the importance the multidisciplinary approach. "

Hepatitis B and C. Treatment

Among other points, in this classroom were addressed novel aspects in epidemiology, natural history, diagnosis and treatment of chronic infection by hepatitis B. Dr. José Luis Calleja, Deputy Medical Service of Gastroenterology Hospital Universitario Puerta de Hierro, emphasizes that the majority of treatments are prescribed for long term is essential to choose appropriate candidates for the treatment. At present, most of the international consensus to recommend treating only those patients who present with histologic and analytical data relevant to active disease. " In this sense, it emphasized the importance of team-resistant effectiveness when planning appropriate treatment. The ideal drug is one that achieves a potent viral suppression (effectiveness) as long as possible (no resistance). In this sense, the new generation of antiviral drugs such as tenofovir, a major breakthrough for the treatment of these patients and are regarded as drugs of choice, "clarifies Dr. Calleja.

Regarding hepatitis C, this reunion was discussed the possibility of improving the antiviral response by modifying factors: treatment of docility, the host and virus. It also emphasized the individualization of treatment, ie the adaptation of treatment to each patient and each type of virus to achieve optimal viral response in the shortest possible time and with fewer side effects. Thus, Dr. Javier Crespo, Associate Medical Digestive Medicine Department of Hospital Universitario Marqués de Valdecilla, explains that "it is important impact on reducing the treatment time in patients infected with genotype I with low viral load and that they possible treatment of 6 months instead of 12 without loss of efficiency. " On the other hand, in the Open Classroom I Cross in viral and bacterial diseases of the liver, is said to increase the treatment in some cases of infection with genotype 3 and high viral loads do not exhibit an early virological response.

Hepatitis B and C. Prevalence

One in 12 people worldwide are living with hepatitis B or C, and most have known the disease. According to estimates by the World Health Organization estimated that there are approximately 400 million people globally affected by hepatitis B and between 170 and 200 million cases of hepatitis C. One in three people worldwide have ever been exposed to hepatitis B or C.

The prevalence of these diseases is highest in China, Southeast Asia and tropical Africa, and in turn the lowest in North America, Western Europe and Australia.

5% of the world population are carriers of hepatitis B virus and produces two million deaths annually caused by this virus. In Southeast Asia and in sub-Saharan Africa 10% of the population are chronic carriers. The level of prevalence of hepatitis B is such that the number of infected is 10 times higher than those infected with the AIDS virus and its transmission is 100 times easier than that of HIV.

In Spain, there are 12,000 cases of hepatitis B each year. Between 5 and 10% become chronic hepatitis B and approximately 250 cases developed hepatocarcinoma (liver cancer). In total, there are between 300,000 and 400,000 Spaniards infected by this virus, approximately 1% of the population. For its part, the prevalence of hepatitis C infection is relatively high, with between 800,000 and one million infected people in our country. It is estimated that nearly a million Spaniards are unaware that they carry some hepatitis viruses.

Complications commonly associated with hepatitis B and C are cirrhosis, liver failure and liver cancer, disorders that may affect 20 percent of these patients. The existence of such factors as alcohol consumption, being male, having been infected in late age and being infected by human immunodeficiency virus negative impact on prognosis and disease progression.

About Gilead Sciences

Gilead Sciences, sponsor of the Open Classroom I Cross in viral and bacterial infections of the liver, is a biopharmaceutical company that discovers, develops and markets innovative treatments in areas with unresolved medical needs. The company's mission is to advance the care of patients suffering from life-threatening diseases worldwide. Gilead Sciences now sells Viread ® (tenofovir), a single administration of antiviral daily for the treatment of chronic hepatitis B and Hepsera ®, widely used in Europe. In addition, the company is developing small molecule compounds for the treatment of hepatitis C and a hepatoprotective liver fibrosis due to hepatitis.

Pill and wife celebrate 30 years to grow together.

• Yesterday was inaugurated in Madrid the exhibition "Pill and women 30 years of evolution" that will tour major cities in Spain.

• According to experts, the pill has undergone in recent years a radical transformation and now have fewer side effects and many health benefits.

Yesterday, October 7, 2008 was held in Spain on 30th anniversary of the decriminalization of the contraceptive pill. A date which marked a milestone in the history of women and society of our country, and that somehow symbolized the arrival of a new era of openness and freedom.

Since then, many things have changed for women and society itself, but so has the pill. Now, three decades later, the pill is no longer used only as a contraceptive method, but developments in recent years have focused on meeting additional health needs and welfare of women.

This has been reflected in the "Pill and women: 30 years of evolution" which was presented yesterday at the hands of the Spanish Society of Gynecology and Obstetrics, the Spanish Society of Contraception and in collaboration with Bayer Schering Pharma. The sample includes the testimonies of 30 women on the pill and its evolution over these 30 years.

According to sociologist Jose M Bleda, "it is striking to see how women have changed in so little time. Its more professional, its growing integration into working life and other facets of development has marked his career in 30 years and has led him to be more demanding and have greater concern for their health, wellbeing and physical appearance .

In these years there has been a substantial change in relation to the pill. Once the efficacy and safety of contraceptives, recent developments have been designed to meet the changing needs of health and welfare of women. In this sense, as the widow of Dr. Esther, Chairman of the SEC and Gynecologist Hospital of Guadalajara, "Reducing the dose of hormone and the incorporation of new progestins increasingly similar to natural progesterone in women has been key to achieving other benefits to health and welfare of women. " Now, the contraceptive pill also has a therapeutic use to reduce symptoms associated with menstruation such as menorrhagia (abundant bleeding) or dysmenorrhea (menstrual pain), treatment of acne and seborrhea, or alleviation of symptoms associated andalusia Premenstrual syndrome. Sometimes, these signs have become characteristic of oral contraception or treatment specialists recommend that outside purely contraceptive. This means that over 1,700,000 women choose this method in Spain.

Along with all of them in this presentation has been Mr. Theo van der Loo, Managing Director of Bayer Healthcare in Spain, which now incorporates the company that once was responsible for the introduction of the pill in our country, and which now represents 30 years after the breakthrough and development in this method since, and wanted to support with their presence Sponsored by: In collaboration with: the initiative and show the company's commitment to continue working on improving the health and quality of life of women.

On exposure

The exhibition is based on the personal testimony of 30 Spanish women, of varying age and condition, we have personal experience with the contraceptive pill. Among them we find housewives, students, journalists or gynecologists.

Some of the familiar faces that have given their testimony are actresses Monica Estarreado, or Powdery Ana Carla Hidalgo. The show also has collected the testimony of political or professional recognition by the President of the Spanish Federation of Women Entrepreneurs, Business & Professional (FEMENP), Carmen Sanz Chacon or writer Mariana Jara.

Also the exhibition runs through the development of oral contraception in the last 30 years, so informative and entertaining.

Pill and Women: 30 years of evolution starts today in Madrid, but your first stop for the general public will be in Santiago de Compostela from October 28 to November 1. Other cities that will traverse Bilbao, Sevilla, Valencia and Barcelona. In February revert back to Madrid where he will be a week before its closure. During his trip, the exhibition provides informative host various activities around the oral contraceptive. For the itinerary or further information: http://www.pildoraymujer.com.

30 years of decriminalization

On October 7, 1978 the courts gave the green light by the Law 45/1978 which approved the decriminalization of the use of the contraceptive pill. Today, 30 years later, the Spanish Association of Gynecology and Obstetrics (SEGO) and the Society of Contraception Esañola (SEC), supported by Bayer Shering Pharma, the company which marketed the first pill in our country, and we have held in Madrid with the opening of an exhibition that will tour the Spanish in the coming months.

Although oral contraceptives were being recent past as menstrual regulation, legalization of contraceptive use as the beginning of a new era for millions of Spanish, since that time, had the opportunity to choose when and how to conceive.

The stigma of mental illness results in a lack of resources.

• On Friday, October 10 is World Day of Mental Health.

• The prevalence of psychiatric disorders in Spain is high at around 20-25% of the population.

• The health care effort, both as a means of adequately trained personnel, which is below it as a "pro" to load.

• For every 100,000 inhabitants, in Spain there are 5.5 psychiatrists, while in another EU country there are 15 professionals.

• The rate of suicide mortality adjusted for age and sex of persons suffering from a schizophrenic disorder, is 9 times that of the general population.

• An important factor that affects the use of mental health services is the stigma and discrimination associated.

In Spain, about half a million people suffer from some form of serious mental disorder, however, mental illness is still not well known socially. The prevalence of psychiatric disorders in Spain is high at around 20-25% of the population.

At present there is widespread concern among patients, families and professionals regarding the need to ensure access to quality care to reduce the heavy burden of suffering and disability associated with mental disorders, therefore, the Spanish Foundation Psychiatric and Mental Health (FEPSM) joins the voices on the occasion of World Day of Mental Health, calling for a sustained and coherent effort to achieve that goal.

Mental disorders as a whole, in Europe are responsible for the greatest burden of disease pathology groups, ahead of cardiovascular disease or cancer. However, the effort of care, both as a means of adequately trained personnel, which is below it as a "pro" to load.

The reasons for this situation which is repeated in many countries, are manifold, ranging from stigma / discrimination associated with this group of disorders until the late introduction of psychiatric care to National Health System as has happened in our country, through suffering cuts on social protection in times of economic crisis.

There is a big difference between the number of professionals for the Mental Health in Spain and one of the most advanced countries of the European Union. Per 100,000 inhabitants, in Spain there are 5.5 psychiatrists, while in another EU country there are 15 professionals. If we attend to the number of nurses, found that in our country there are about 6 compared to 50 other European countries. On the other hand, if we refer to the number of occupational therapists, we find that in Spain with 0.5 per 100,000 population compared to 20 other countries. And finally, if we stop at the number of social workers, we see that while the figures in any of European countries is around 10 in our country we are close to 1.3. (Fuente. - Studio 2001 J. Luis Váquez, a professor at the University of Cantabria)

Interesting Facts

According to the Mental Health Strategy, Ministry of Health and Consumption, 2006, produced in collaboration with andalusia FEPSM, the prevalence of psychiatric disorders is high, 20-25% of the general population as the most rigorously designed epidemiological studies . In Spain it is estimated that half a million people suffer from some form of serious mental disorder. The distribution of prevalence by regional governments is relatively uniform, varying according to the present data between Andalusia and Catalonia 15.71 with 23.68.

Mental disorders are the cause of 10.5% of days lost for temporary disability and about 6.8% of the years of life lost due to permanent disability. The suicide mortality rate adjusted for age and sex of persons suffering from a schizophrenic disorder, is 9 times that of the general population. In major depression, the suicide risk is multiplied by 21, on eating disorders by 33 and 86 for drug addiction.

Spanish Foundation of Psychiatry and Mental Health (FEPSM)

One of the most important in recent years in the health world, has been the growth of mental illness. So all national health systems considered as a mental health emergency needs. In the immediate future, these problems will require greater attention in the planning and provision of social services and health.

In Spain, about half a million people suffer from some form of serious mental disorder, however, mental illness is still not well known socially. In this sense, the Spanish Foundation of Psychiatry and Mental Health (FEPSM) aims to contribute to knowledge development and refinement of Psychiatry and Mental Health, as well as their related disciplines, through meetings, publications, scientific events, developing research and other scientific and cultural activity.

This Foundation was created as an initiative of the Spanish Society of Psychiatry (SEP) and Spanish Society of Biological Psychiatry (SEPB) to give the general public of an instrument of service to the scientific advancement of Psychiatry and Mental Health in Spain.

Conclusions of the XXIII Annual Meeting of the Spanish Group of Photobiology.

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Are we protected from the sun an umbrella? What is therapeutic light?
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More than 40 experts in dermatology, physics, chemistry, meteorology, biology and pharmacy, have presented this weekend in Barcelona the latest research that reveals the keys to these questions.

More than 40 recognized experts in the fields of dermatology, physics, chemistry, meteorology, biology and pharmacy, have participated in the XXIII Annual Meeting of the Spanish Group of Photobiology (GEF) held this weekend in Barcelona. During the meeting, there have been recent developments and research on the effects of sunlight and other sources of artificial light on health in general and in particular the skin, and its possible practical application in the prevention damage.

"Mindful of the effects of solar radiation on the immune system of humans, a large group of professionals decided to create this group and pool our efforts to prevent its negative consequences and exploit the positive towards the health of humans , "said Dr. José Manuel Carrascosa, coordinator of the GEF and dermatologist Service of Dermatology Hospital Universitari Germans Trias i Pujol" Can Ruti.

This year, in terms of diagnosis and treatment of diseases, mainly skin, experts presented the latest developments related to the treatment of skin cancer, psoriasis and vitiligo with phototherapy, fotoquimioterapia (PUVA) and photodynamic therapy.

This block has been reinforced by the launch of the first theoretical-practical course of phototherapy to dermatologists and dermatology residents, organized by the GEF and held at the Hospital de Sant Pau and Santa Creu of Barcelona, whose aim was to updating and deepening of the methodological aspects of some of the variants of phototherapy and studying the most common photosensitivity. The increasing number of patients with these diseases and the limited number of Photobiology and phototherapy limit access of many users of public health to these treatments. Both the course and in the reunion of the GEF, have prestigious dermatologists like Dr. José Manuel Carrascosa, coordinator of the GEF and dermatologist Service of Dermatology Hospital Universitari Germans Trias i Pujol "Can Ruti" Dr. Agustín Alomar, Chief of Dermatology of the Hospital de la Santa Creu i Sant Pau and Dr. Mario Lecha, dermatologist Dermatology Service, Hospital Clínic i Provincial and founding member of the GEF.

As for the latest research on the adverse effects of sunlight on human health include the presentation of the study by Joseph A. Martínez and M. Lozano Utrillas Pilar, professors in the Department of Thermodynamics, Faculty of Physics, University of Valencia, which shows that, far from much of the population believes the umbrella is not enough to protect us from the negative effects of the sun . The study concludes that the diffuse radiation under the umbrella is 35% which equates to an ICU for 3 or 4, so we can burn it too low. In case you are putting the risk is lower, but if you are sitting or standing under it must also add radiation by reflection from the sand (25%) or grass (33%).
Josep Montero, pharmaceutical ISDIN and founding member of the GEF, said that "these findings is essential to remind people that, despite that we will be under the umbrella on the beach, pool or field, it is very important to apply photoprotective one suited to the needs of each type of skin that protect us and help prevent skin cancer. "

About the GEF
The GEF is a multidisciplinary group, attached to the Spanish Academy of Dermatology and Venerology, born in 1988 to promote the exchange of scientific knowledge about the effects of radiation of light in the earth and man, studying the effects of artificial light sources and assess the risks from exposure to light sources.

Throughout his more than 20 years of work, the GEF has undertaken projects relating to the fields of Photobiology (science that studies the interaction between electromagnetic radiation and life), fotodiagnóstico, phototherapy and photoprotection, activity sun and the ozone layer. Moreover, it has worked on many skin diseases and drug reactions, batteries fotoparches, skin diseases and cancer, regulation of the tanning booth ....

Since its inception, ISDIN, leading dermatology pharmaceutical company in the Spanish market, has supported and publicized the work of the GEF, as well as holding its annual reunion in several Spanish cities.


http://www.aedv.es/grupos_trabajo/fotobiologia/

The Hepatitis B vaccination of health professionals is required to perform their work.

• About 95 percent of the health care of our environment is vaccinated against Hepatitis B.

• Failure of the immunization schedule for this group of legal and industrial implications

• Working in a sensitive habitat, the risk of occupational health is above average and the consequences of transmission of Hepatitis A and B are most relevant.

• The philosophy behind this concept is to protect oneself and others by vaccination.

• Ignorance of the working calendar of the immigrant population increases the risks of contagion and sobrevacunación.

• The scientific community is working on a protocol for action in the event of an influenza pandemic.

• The policy approach of Public Health means that, thanks to the immunization schedule for children, young people entering the labor market are better protected than the older population.


Health professionals should be vaccinated for the performance of their work. The rotundity of the sentence, the core of the conference organized by the Center for Immunization in the workplace (OVAL) today, Thursday, February 5, 2009, from 11:00 in the Company Bilbaina is based on a goals: minimizing the risk to others. As John says Goiri, president of the Academy of Medical Sciences of Bilbao and coordinator of the observatory, "Vaccination is a medical fitness test, especially as a means of preventing infection, both to themselves and colleagues to patients.

OVAL coordinator understands that "health professionals, and other labor groups at risk, must exercise extreme vigilance when it comes to health care. Not surprisingly, working in an environment where the risk is above average and the consequences of transmission of hepatitis B are more relevant. Andalusia handled in many cases, people with immune deficiencies are more serious sequelae.

The conference organized by the vaccinations OVAL seen as a test of capacity to work, both from a legal perspective and from the standpoint of occupational medicine. The judge of the administrative division of the Tribunal Superior de Justicia del País Vasco, Luis Garrido, explain what are the legal requirements for the performance of the health profession, with special emphasis on the criterion of medical and fitness of the worker to his job, along with preventive measures that work proceed in its case. " He recalled what the legal consequences are brought about by a breach of infection immunization schedule.

The president of the National Commission of Occupational Medicine, Mary Castilian, also recommended "an appropriate vaccination reduces rates of infection and the risk to others. Health professionals face a greater responsibility than other professionals and have to monitor this issue as a clear measure of job protection. " Both voices have been moderated by Dr. Juan José Díaz Franco.

It is, however, has already warned that a deep draft. Juan Goiri that "about 95 percent of the health care of our environment is vaccinated against Hepatitis B. The philosophy behind this concept is to protect oneself and others by vaccination. "To this we must add another fact that underscores the president of the Academy of Medical Sciences of Bilbao. "The policy approach of Public Health means that, thanks to the immunization schedule for children, young people entering the labor market are better protected than the older population."

Also, the time of updating the knowledge organized by the OVAL has reviewed the three most common types of vaccines in adults: influenza vaccine, tetanus vaccine and vaccines against hepatitis B. The head of vaccines and monitoring of management of Public Health of the Basque government, José María Arteagoitia has reviewed the current status of vaccine, and future prospects. This field is particularly important with the analysis of a virtual scene: how to act in the event of an influenza pandemic? The expert says that "has established a protocol on who to vaccinate first vaccination and what criteria should be followed."

In the field of tetanus vaccine, José Antonio Navarro-Alonso, a member of the European Commission on Prevention, revised criteria such as the risk of hipervacunación-economic carries a surcharge, the more discomfort and possible side-effects and lack of timing vaccine followed by the immigrant population. Following these reflections, Juan Goiri advocates the creation of a universal vaccination record, which reduces the margin of error. "

In any of the aforementioned types of vaccines, their administration is voluntary within the healthcare workplace. Unlike in the case of the vaccine for Hepatitis B. Luis Urbiztondo, section chief of infectious disease prevention for the general direction of Public Health of Catalonia, increased the possibility of reducing the number of doses required for a proper prophylaxis. Scientific research towards a vaccine for life ", a concept that, in the words of John Goiri," would significantly advance the health workforce of health professionals.

Some innovative practices workshops instruct medical residents about the physical examination of the locomotor system.

● Residents of Orthopedic Surgery and Traumatology have had the opportunity to train in the physical form of current, complete and practical.
● The conference took place within the Congress of the Spanish Society of osteoporotic fractures


Under the Second Congress of the Spanish Society of osteoporotic fracture (SEFRAOS), which is taking place these days in Madrid, there have been some innovative practices Exploration Workshop Physics Locomotive. The purpose of these meetings has been to offer a comprehensive and detailed knowledge of the specific exercises necessary to address the problems of locomotion. As commented by Dr. Antonio Rios, Orthopedic Surgery Service, Hospital Virgen del Mar de Almería, who has been a teacher "It is essential for proper diagnosis of any problem locomotor conducting a thorough physical examination it. This is a test of a very high reliability and great tradition, to which is added a series of radiological tests in order to obtain an accurate diagnosis. "

At the conference, sponsored by Bayer Schering Pharma, residents have orthopedic surgery and traumatology in Spain. Professor Francisco Gomar has been in charge of coordinating the practices taught by specialists who have carried out spot tests for structured exploration location: shoulder, knee, spine, hip, hand, ankle-foot.

According to Dr. Rios' One day as we have given are of great importance for the learning of medical residents as it is rare to receive such training. " It added that "practices, in the framework of a national congress, are quite novel in Spain. But in the American Congress is very common and make small workshops, several hours' duration, which focus on a specific part of the locomotor system, and study from beginning to end everything associated with it. I trust that these meetings will be repeated next year in the Congress of the SEFRAOS to become a tradition. "


Roundtable on thromboembolic disease

Bayer Schering Pharma also sponsors of this Congress in a Roundtable on thromboembolic disease tomorrow.

During the meeting, national experts will address various aspects of thromboprophylaxis: the role of primary care, the use of catheters, new drugs, etc..

Referring to the issue of new drugs for the treatment of thromboembolic disease, the European Commission in September 2008 authorized the sale of Xarelto ® (rivaroxaban), a new anticoagulant, and fixed-dose oral administration once daily for preventing the formation of venous blood clots in patients undergoing elective surgery for total hip replacement and knee. Bayer Schering Pharma will market Xarelto ® in Spain shortly, a drug that has been launched in over 15 countries worldwide.

The marketing authorization by the European Union (EU), was received after the evaluation of data from the RECORD clinical program that included three Phase III studies conducted with rivaroxaban, involving nearly 10,000 patients undergoing elective surgery of replacing hip or knee (RECORD1, RECORD2 and RECORD3). The results of this program demonstrate the superior efficacy of rivaroxaban compared with enoxaparin in both tests (RECORD1 and RECORD3) as compared to the long pattern of rivaroxaban (5 weeks) compared to the standard short (2 weeks) enoxaparin (RECORD2). In all three studies, rivaroxaban showed a comparable safety profile, including a low incidence of bleeding similar.

Xarelto ® provides the comfort of administration in the hospital and home, as it does not require monitoring or dose adjustment. As an oral treatment, unlike conventional heparins are administered by injection, and low risk of interactions with other drugs, it makes has all the characteristics the ideal anticoagulant. Rivaroxaban offers superior performance, without an increased risk of bleeding.
The extensive program of clinical trials of the drug make it an oral anticoagulant, direct Factor Xa inhibitor, the world's most studied so far. It is expected that over 60,000 patients are included in the clinical development program for rivaroxaban, which will investigate the product for the prevention and treatment of a wide range of diseases, both acute and chronic, related to blood clotting. For example the treatment of venous thromboembolism (VTE), prevention of stroke in patients with atrial fibrillation, the prevention of VTE in medical patients in hospitals and secondary prevention of acute coronary syndrome.

The number of men affected by eating disorders.

Currently 8-10% of patients are men, especially youth sports

The Eating Disorders (ED) are increasingly affecting a wide profile of patients. Currently ranging from 10 years young, older people who have symptoms of the disease swept over much of his life and is at maturity when manifested more clearly.

Anorexia, bulimia and other eating disorders are not exclusive to women. Although the ratio is still there and 9 out of 10 affected women, plus the ever increasing number of men. According to the experience of the Eating Disorders Institute (ITA) the number of men affected by these diseases has increased in recent years, reaching around 8-10% of the total. These figures may vary depending on the clinical picture and age, but in the case of the men remained in anorexia and bulimia this data is even more frequent.

In regard to age, number of patients is higher with fewer years. Thus, between groups of prepubertal between 11-13 years reach a 25-30% incidence of the disease, and 15-20% decrease in 13-14 years.

Eating disorders are also more frequently in certain groups who practice sports of effort such as gymnasts, jockeys, dancers, or skaters.

Changing profile of patients with TCA

In the 10 years history of ITA, 101 boys have passed constituting 5% of the total admitted to the hospital. Has been basically since 2005 that has begun to raise the incidence of these disorders in males and in the last year has led to double the number of patients treated at the Institute.


Eating Disorders in the male

In practice, the symptoms of eating disorders in males is very similar to that of women, but you can highlight the following aspects:
• Men with anorexia are more obsessed than women, with a tendency to intellectualise, perfectionism and rigidity.
• In men allegedly stealing more and more compulsive emotional stress.
• It is more often a history of overweight, both in patient and family, more somatic complaints, more and more psychiatric comorbidity disorders among family members of men
• An important aspect is related to hyperactivity. Has established the presence of hyper-inflated until exhaustion as a mechanism of weight control much more common in men.
• The environment of the ED is related to the cultures, the unbridled passion for fitness, concern for the body to develop muscles and shape the figure.
• love cooking for others, love to make huge and unnecessary purchases of food, collecting cookbooks, the composition of food, calories, forcing others to eat even without wishing to do so, because many hours in the kitchen, etc.
• It has linked the ED in men with sexual identity. Greater proportion of homosexuals. They were more dissatisfied with their shape and weight than heterosexuals and more concerned with the physical layout and appearance.
• "sexual alexithymia: difficulty to feel and express emotions or communicate their feelings on everything that relates to the sexual area.
• Regarding the precipitating stress is at a higher intensity and more.

About ITA

The Eating Disorders Institute (ITA) is a health care network founded in 1998 for treatment, training and investigation of disturbances in eating behavior. This is the main institution at the state level in private care for Eating Disorders (ED). The institution understands that the care of such disorders must encompass not only preventing disease and restoring health, but also the rehabilitation and reintegration into their environment.

ITA offers a variety of healthcare resources to achieve its objectives: inpatient facilities, day hospitals, outpatient and medical floors. This is the first center in Spain in terms of number of beds and patients.

In phase III studies have shown that raltegravir in combination achieved significant reductions in viral load during 96 weeks ..

In phase III studies have shown that raltegravir in combination achieved significant reductions in viral load during 96 weeks in previously treated patients whose HIV was resistant to three classes of drugs.

In the phase III studies, BENCHMRK-1 and 2, the integrase inhibitor from Merck Sharp & Dohme (MSD) raltegravir in combination with an optimized base treatment (TBO) produced greater reductions in viral load compared to placebo for 96 more TBO weeks in previously treated patients whose HIV was resistant to three classes of drugs that were not responding to antiretroviral treatment. (Poster 571b).
These results together with data from other studies were presented Monday at the XVI Conference on Retroviruses and Opportunistic Infections (CROI) held in Montreal, Canada.
"As doctors continue using raltegravir in patients treated previously, data from longer term studies BENCHMRK-1 and 2 continues to inspire confidence among physicians when treating patients whose treatment cycle is more advanced," said Dr. Daniel S. Berger, assistant clinical professor, College of Medicine, University of Illinois at Chicago and medical director of Northstar Medical Center.
Raltegravir is indicated in combination with other antiretroviral agents for the treatment of infection with human immunodeficiency virus (HIV-1) in adult patients previously treated and who show signs of HIV-1 replication despite receiving antiretroviral therapy.
This indication is based on data on safety and efficacy trials of two double-blind, placebo-controlled 48 weeks' duration in patients treated previously.

Important safety information about raltegravir.
We need to warn patients that antiretroviral treatment can not cure HIV infection and that has not been shown to prevent HIV transmission to others through blood or sexual contact. Should continue to take appropriate precautions.

In HIV-infected patients with severe immunodeficiency at the time of the introduction of antiretroviral combination therapy (TARC) may be an inflammatory reaction to asymptomatic or residual opportunistic pathogens, which can cause severe clinical disorders or exacerbate symptoms. Usually, such reactions are observed in the first weeks or months after the start of the TARC. Some relevant examples are cytomegalovirus retinitis, mycobacterial infections, and generalized or focal pneumonia caused by Pneumocystis jiroveci (formerly known as Pneumocystis carinii). All symptoms should be evaluated inflammatory treatment should be initiated when necessary.

Demonstrated the persistence length and tolerability of raltegravir to week 96 in previously treated patients (BENCHMRK-1 and-2)
The results of the studies BENCHMRK 1 and 2 after 96 weeks showed that in 96 weeks, 57% of patients (262 of 460) treated with raltegravir achieved a more TBO undetectable viral load (less than 50 copies / ml ), compared with 26% of patients (62 of 237) treated with placebo plus TBO, p <0001. In addition, patients treated with the pattern with raltegravir experienced significantly higher increases of CD4 counts (123 células/mm3) than those treated with placebo and TBO (49 células/mm3) at week 96, p <0001.
In BENCHMRK studies, patients received 400 mg of raltegravir orally twice daily in combination with TBO (n = 462) of placebo or 400 mg orally in combination with TBO (n = 237). The data demonstrate that raltegravir plus TBO has an antiretroviral and immunological efficacy powerful and superior to that obtained with placebo over TBO. The reductions in viral load and immunological efficacy was maintained through week 96: 57% of patients treated with raltegravir more TBO had viral load below 50 copies / ml, up to 79% of patients treated with enfuvirtide darunavir and raltegravir with TBO in the viral load remained below 50 copies / ml. There were few withdrawals for adverse events: 4% of patients receiving raltegravir and TBO and 5% of those treated with placebo and TBO. The risk of malignancy was equivalent in the raltegravir groups and control.
Rates adjusted for exposure (per 100) of clinical adverse events related to the medication most common (frequency ≥ 2.0%, of any intensity) observed in patients treated with raltegravir and TBO and in patients treated with placebo and TBO were: headache (2.7 per 100 and 4.5 per 100), nausea (2.3 per 100 and 4.1 per 100), diarrhea (1.8 per 100 and 4.5 per 100) fatigue (1.8 per 100 and 0.7 per 100), abdominal distension (1.5 and 1.2 per 100 for 100), vomiting (0.8 per 100 and 1.9 per 100) and fever (0, 5 per 100 and 2.2 per 100), respectively.
The cancer rate in patients treated with raltegravir and TBO in studies BENCHMRK 1 and 2 was 3.0 per 100 and 2.6 per 100 in those treated with placebo and TBO, which represents a relative risk of 1 , 1 (0.5, 3.1). The rate of new AIDS-defining illnesses or recurring was 2.2 per 100 in the raltegravir group and 4.1 per 100 in the placebo group, representing a relative risk of 0.5 (0.2, 1 , 3).
Raltegravir is indicated in combination with other antiretroviral agents for the treatment of infection with human immunodeficiency virus (HIV 1) in adult patients previously treated and who show signs of HIV-1 replication despite receiving antiretroviral therapy.
This indication is based on data on safety and efficacy trials of two double-blind, placebo-controlled 48 weeks' duration in patients previously treated
The marketing of raltegravir was approved in Spain by the Spanish Ministry of Health in February 2008.

More important safety information about raltegravir.
Raltegravir should be used with caution when given concurrently with potent inducers of uridine diphosphate glucuronosiltransferasa (UGT) 1A1 (eg., Rifampin). Rifampicin reduces plasma concentrations of raltegravir; unknown impact on the efficacy of raltegravir. However, if coadministration with rifampin is inevitable, we can consider doubling the dose of raltegravir.
The safety assessment of raltegravir in patients previously treated is based on the pooled safety data from three randomized clinical trials. These studies used the recommended dose of 400 mg twice daily in combination with an optimized base treatment (TBO) in 507 patients, compared with those obtained in 282 patients who received placebo in combination with TBO. During the double blind treatment, the total period of follow-up was 504.1 patient-years in the group of raltegravir 400 mg twice a day and 202.5 patient-years in the placebo group.
In group 400 mg of raltegravir twice daily + TBO and the comparison group of TBO + placebo, adverse reactions reported most frequently (> 10% of patients in each group) of any degree of intensity and independently of causality were: diarrhea in 17.6% and 20.6%, nausea in 11.2% and 15.2% and headache in 10.1% and 12.4%, pyrexia in 6.3% and 11.0% of patients, respectively. In this pooled analysis, the rates of discontinuation for adverse events were 2.4% in patients receiving raltegravir TBO + and 2.8% in patients receiving placebo + TBO.
There have been reports of myopathy and rhabdomyolysis, but it ignores the relationship of raltegravir to these events. Use with caution in patients who have had in the past myopathy or rhabdomyolysis, or having any factor, including other pharmaceutical products associated with these diseases.

Other posters on raltegravir presented at the CROI
In addition to studies BENCHMRK 1 and 2 previously treated patients, were presented at CROI two other posters in that also evaluates the safety and efficacy of raltegravir. They are:
• A review of cancer incidence in clinical trials of raltegravir in patients previously treated and untreated, which until now have not observed differences in risk among HIV-infected patients treated with raltegravir and treaties with other antiretroviral (Poster 859) and
• A review of preliminary data from a prospective, open, non-randomized and dose determination currently on raltegravir TBO more in children and adolescents aged 6 to 18 years previously treated (IMPAACT P1066). These results will be presented by the National Institutes of Health.

Review of cancer incidence in clinical trials of raltegravir.
We reviewed the incidence of cancer, a well known complication of HIV infection, in five randomized clinical trials and double blind study of raltegravir in patients previously treated and untreated, and in an expanded access program in the open. In an analysis of pooled data from two Phase II studies (protocols 004 and 005) and three phase III studies (BENCHMRK-1, BENCHMRK-2 and STARTMRK) to monitor at least 48 weeks and 120 at most ( exposure to raltegravir than 1700) showed that during double-blind cancer rates were slightly lower in patients treated with raltegravir (rate 1.7 per 100, is a broad definition of cancer, including recurrences, cancers other than melanoma and carcinoma in situ) without reaching statistical significance compared to patients receiving antiretroviral comparison (rate 2.2 per 100, definition of cancer). This was a relative risk of 0.75 with a confidence interval of 0.40 to 1.46.
With an additional exposure to raltegravir approximately 600 double-blind phases, cancer rates remained similar (rate 2.1 per 100) to those observed in the double blind phase. In a context of expanded access, after a median follow up of 24 weeks in more than 5,400 patients (raltegravir exposure to more than 2,200), cancer rates were similar to those observed in clinical trials with raltegravir.
In protocol 004, raltegravir was administered at doses of 100 to 600 mg twice daily for 48 weeks and a maximum of 400 mg thereafter. In protocol 005, raltegravir was administered at doses of 200 to 600 mg twice daily for 24 weeks at least in part double-blind study, all patients received a dose of 400 mg in the open part of the test. In the analysis of the combination of studies in phases II and III involved 1039 patients who received raltegravir, was assigned a treatment compared to 605 patients, 173 of whom went on to receive raltegravir at the open stage. In all cases, raltegravir is used in combination with other antiretrovirals. Made public the details of at least 48 weeks in the phase III trial STARTMRK of 96 weeks in trials BENCHMRK 1 and BENCHMRK 2 and at least 120 weeks in Phase II (protocols 004 and 005). We included double-blind and open data.

About raltegravir
Raltegravir is the first drug approved for a new class of antiretrovirals called integrase inhibitors,. Raltegravir works by inhibiting the insertion of HIV-1 DNA into human DNA by the integrase enzyme. By preventing the integrase to perform its function, limiting the ability of the virus to multiply and infect other cells. It is currently used drugs that inhibit two other enzymes critical to the replication process of HIV protease and reverse transcriptase, but raltegravir is the only drug approved that inhibits integrase.
Raltegravir is in a single tablet of 400 mg administered twice daily, regardless of meals. Raltegravir does not require reinforcement with ritonavir.

Global approval of raltegravir
Since 2007, raltegravir was approved in over 50 countries worldwide for use in combination with other antiretroviral agents for the treatment of adult patients infected by HIV-1 and previously treated who show signs of HIV-1 replication despite receiving antiretroviral treatment. MSD continues to submit applications for approval in other countries.

Merck's research on HIV
MSD is committed to developing innovative treatments that involve advances in the treatment of infectious diseases, including HIV infection. MSD's efforts to develop experimental treatments for HIV and AIDS reach over 20 years and continues today.
Merck began its research on the integrase inhibitor for HIV in 1993 and was the first to demonstrate inhibition of HIV integrase in vitro and in vivo.
Raltegravir is part of MSD in the history of research on HIV, including the development of indinavir sulfate, a protease inhibitor and efavirenz, a reverse transcriptase inhibitor non-nucleoside, and ongoing research into other options treatment.

Worldwide prevalence of HIV infection and AIDS
It is estimated that in the world 33 million people infected with HIV and AIDS, 1 and that in 2007 there were approximately 2.7 million cases of AIDS contagio.1 is a major cause of mortality from infectious diseases All mundo1 in 2007 and was responsible for approximately two million deaths.

About MSD
Merck & Co. Inc., Whitehouse Station, NJ, USA, which operates in many countries as MSD (Merck Sharp & Dohme) is an international pharmaceutical company based on research whose primary concern are the patients. Founded in 1891, Merck currently discovers, develops, manufactures and markets vaccines and medicines to meet unmet medical needs. The company also devotes great efforts to improve access to medicines through far-reaching programs that not only donate Merck medicines but help to distribute them to people who need them. Furthermore, MSD publishes objective information on health nonprofit. For more information, visit www.merck.com. / Www.msd.es


Bibliography:
1. UNAIDS. 2008 Report on the global AIDS epidemic. Available at: http://www.unaids.org/en/KnowledgeCentre/HIVData/ GlobalReport/2008/2008_Global_report.asp. Accessed on January 30, 2009.