[Thyroid orbitopathy, an overview with special attention to the role of radiotherapy]. / Orbitopatía tiroidea, una visión global con atención especial al papel de la radioterapia.

Thyroid orbitopathy is the most prevalent non-thyroid symptom in Graves' syndrome. It has a high incidence and particularly affects young women. Smoking is clearly involved in its development and progress, and in its response to different treatments. This autoimmune condition usually has a benign course, independent from hyperthyroidism, but its severe, progressive forms represent a major therapeutic challenge. Clinical evaluation poses great difficulties, as there is no truly objective rating scale representing disease activity. New molecular or inflammation markers may prove to be useful in this regard. This review reports new findings about its pathophysiology and the different techniques used for treatment over time. Discussion particularly focuses on the immunomodulatory role of radiotherapy, as well as on its role together with corticosteroids.

[Spinal cord compression: a multidisciplinary approach to a real neuro-oncological emergency. Reply]. / Compresion medular: aproximacion multidisciplinar a una autentica urgencia neurooncologica. Replica.

TITLE: Compresion medular: aproximacion multidisciplinar a una autentica urgencia neurooncologica. Replica.

[Spinal cord compression: a multidisciplinary approach to a real neuro-oncological emergency]. / Compresion medular: aproximacion multidisciplinar a una autentica urgencia neurooncologica.

Spinal cord compression must be considered a top-priority neuro-oncological emergency. Hence, a multi-disciplinary approach and swiftness in establishing appropriate therapeutic measures are crucial to optimise the functional (and perhaps vital) prognosis of these patients. The nihilistic attitudes that have prevailed up until now in some professional sectors, possibly stemming from the perception of a poor short-term prognosis, must be completely eradicated. The overall improvement in survival rates among cancer patients in general, the availability of new neurosurgical techniques in the vast majority of our hospitals and the obvious improvements in radiotherapy equipment and techniques all this pathology to be addressed with greater chances of success. This greater likelihood of accomplishing a better outcome refers not only to the control of the development of the tumour itself, but also to pain control, maintenance of the functioning of the spinal cord and the overall survival of the patient. In this context, we consider it essential for all hospitals to have specific protocols on how to proceed in cases of acute spinal cord compression. The fact that this kind of protocol has been introduced in the Centro Medico de Asturias has prompted us to conduct a review of the current state-of-the-art in this field, with special emphasis on the evidence available for each of the modes of therapy that are discussed.

Mechanism of hot flashes.

Hot flashes are a common and disturbing adverse effect of hormonal therapy for cancer. Their pathophysiology is poorly understood. At present, the leading mechanistic hypothesis rests on the assumption that abrupt hormone deprivation will result in loss of negative feedback over hypothalamic noradrenaline synthesis. In this article we critically review the different theories used to explain this phenomenon. A better understanding of the pathophysiology of hot flashes may facilitate the development of new therapeutic approaches.

[Review of current treatment for hot flushes induced by androgen deprivation in prostate carcinoma]. / Revisión del tratamiento actual de los sofocos inducidos por deprivación androgénica en el carcinoma prostático.

Considering the currently increased incidence, prevalence and survival of prostate cancer, the management of hot flushes associated with LH-RH analog treatment must be taken into account. The most widely used and effective treatment is hormone replacement, though the latter is not without risks. It is presently possible to address hot flushes in these patients based on a broad range of treatment options in which hormone therapy may constitute a last option, due to the risk of tumor relapse or progression -- since prostate cancer is hormone sensitive. The present study reviews the currently used treatments and hygiene-dietary measures that may help reduce the symptoms. A review is made of both hormone and non-hormone therapies, based on the existing scientific evidence. Drugs such as the new antidepressants, gabapentin and clonidine may play an important role in the management of hot flushes. While the underlying mechanisms of action are varied, they are related to the complex feedback exerted by the sexual hormones upon the hypothalamic secretion of noradrenalin -- this being the principal etiological factor of hot flushes.

[Physiopathological mechanism of hot flushes-perspiration induced by androgen deprivation in prostate carcinoma]. / Mecanismo fisiopatológico de los sofocos-sudores inducidos por deprivación androgénica en el carcinoma prostático.

Hot flushes and perspiration are common problems during androgen deprivation therapy for prostate carcinoma, and largely contribute to worsen patient quality of life. Different hypotheses have been proposed to explain the underlying physiopathological mechanisms, though all are very complex, basically because of the multiple causal factors involved. The present review offers a pondered and updated perspective of the origin of hot flushes-perspiration in such patients. Negative feedback of the plasma sexual hormones upon the hypothalamic secretion of noradrenalin and serotonin appears to be the main cause. Likewise, the direct action of such mechanisms upon the LH-RH producing hypothalamic center located close to the thermoregulatory center, together with shortening of the thermoneutral interval, would also play a role. Improved understanding of the causal mechanism may help improve the treatment of such symptoms.