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During the TIMO meeting 2023, national and international scientists as well as clinicians gave novel insights as well as perspectives into basic and translational tumor immunology. https://dgfi.org/arbeitskreise/ak-tumorimmunologie/meeting/.
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Neoplasias , Humanos , Neoplasias/terapia , Imunoterapia , Oncologia , AlemanhaRESUMO
Objetivo: Describir la evolución clínica postquirúrgica de una serie de casos de pacientes con Miastenia Gravis juvenil (MGJ) tratados con timectomía por toraoscópica videoasistida (TVA) derecha. Materiales y Métodos: Estudio retrospectivo que incluyó 13 pacientes pediátricos con diagnóstico de MGJ sometidos a timectomía toracoscópica derecha en la Unidad Médica de Alta Especialidad Hospital de Pediatría, Centro Médico Nacional Siglo XXI de México, entre marzo de 2016 y abril de 2022. Los pacientes fueron caracterizados clínicamente y la enfermedad fue clasificada de acuerdo a los criterios de Osserman. La evolución postquirúrgica se evaluó con la clasificación de DeFilippi para determinar la proporción de pacientes con mejoría y la remisión completa. Resultados: Los pacientes incluidos fueron, en su mayoría, mujeres (84,6%) con edad promedio al diagnóstico fue de 11,1 ± 3,1 años. Las cuatro clasificaciones de MG fueron incluidas, con mayor proporción de MG generalizada leve (38,5%), seguida de ocular (23,1%) y generalizada moderada grave (23,1%). La evaluación de la progresión postquirúrgica demostró que a los tres meses de seguimiento 92,3% presentó mejorías, incluyendo la disminución del uso de medicamentos. La remisión total solo se registró en uno de los pacientes. Los pacientes que tuvieron cirugía antes de los 12 meses de evolución de la MGJ presentaron mejores resultados post timectomía por TVA. Conclusión: Se demostró la utilidad de timectomía por TVA en pacientes pediátricos mexicanos con MGJ. Nuestra experiencia agrega evidencia de que los pacientes pediátricos se benefician de la timectomía, mejorando su estado clínico y disminuyendo el uso de medicamentos y complicaciones e la enfermedad.
Objective: To describe the post-surgical clinical evolution of a case series of patients with juvenile myasthenia gravis (JMG) treated with right video-assisted thoracoscopic (TVA) thymectomy. Materials and Methods: Retrospective study that included 13 pediatric patients with JMG who underwent right TVA thymectomy at the Siglo XXI National Medical Center of Mexico between March 2016 and April 2022. Patients were clinically characterized, and the disease was classified according to Osserman's criteria. Post-surgical evolution was evaluated using the DeFilippi classification to determine the proportion of patients with improvement and complete remission. Results: The included patients were mostly women (84.6%) with a mean age at diagnosis of 11.1 ± 3.1 years. The four MG classifications were included, with the highest proportion of mild generalized MG (38.5%), followed by ocular (23.1%) and moderate-severe generalized (23.1%). The evaluation of post-surgical progression showed that after three months of follow-up, 92.3% presented improvements, including a decrease in the use of medications. Complete remission was only recorded in one of the patients. Patients who underwent surgery before 12 months of evolution of JMG had better results after TVA thymectomy. Conclusion: The usefulness of TVA thymectomy in Mexican pediatric patients with JMG was demonstrated. Our experience adds evidence that pediatric patients benefit from thymectomy by improving their clinical status and decreasing the use of medications and complications of the disease.
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Se describe el caso clínico de un paciente de 54 años de edad, quien fue ingresado en el Hospital Docente Clínico-Quirúrgico Hermanos Ameijeiras de La Habana por presentar fiebre, hipotensión y diarrea, a lo que se añadió dificultad respiratoria complicada durante su estancia en la institución y requirió apoyo ventilatorio mecánico en la Unidad de Terapia Intensiva. Como hallazgo radiográfico se observó una sombra en el pulmón izquierdo que resultó ser un timoma; mientras que en el examen sanguíneo se comprobó hipogammaglobulinemia. Se decidió realizar timectomía convencional mediante esternotomía media, luego de lo cual evolucionó satisfactoriamente y se le dio el alta hospitalaria 10 días después.
The case report of a 54 years patient is described, who was admitted to Hermanos Ameijeiras Clinical-Surgical Teaching Hospital in Havana city due to fever, hypotension and diarrhea, to which complicated respiratory difficulty was added during his hospitalization and he required mechanical ventilator support in the Intensive Care Unit. As a radiographic finding, a shade in the left lung was observed that turned out to be a thymoma; while the blood test revealed hipogammaglobulinemia. It was decided to carry out conventional thymectomy by means of midline sternotomy, after which the patient had a favorable clinical course and was discharged from the hospital 10 days later.
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Resumen El síndrome de persona rígida es un cuadro neuro lógico infrecuente caracterizado por rigidez muscular de tronco y extremidades y espasmos musculares ga tillados por estímulos sensoriales o emocionales, que progresa hacia la postración. Cuenta con un mecanismo fisiopatogénico con base inmunológica, en el cual los autoanticuerpos, como el antiGAD65, cumplen un rol central. Asimismo, la detección de dichos anticuerpos corrobora el diagnóstico ante un paciente con cuadro clínico sugestivo. Un 4 a 6% de los casos tienen neoplasias subyacentes. El tratamiento se basa en el manejo sintomático, inmunomodulador y de la enfermedad de base en los casos paraneoplásicos. Reportamos un caso de síndrome de persona rígida clásico asociado a timoma y describimos las características principales de esta entidad.
Abstract Stiff-person syndrome is a rare neurological condi tion characterized by muscular rigidity of the trunk and extremities and muscle spasms triggered by sensory or emotional stimuli, which progresses towards prostra tion. It has a pathophysiogenic mechanism with an immunological basis, in which autoantibodies, such as antiGAD65, play a central role. Likewise, the detec tion of these antibodies corroborates the diagnosis in a patient with a suggestive clinical picture. Four to 6% of cases have underlying neoplasms. Treatment is based on symptomatic, immunomodulatory, and underlying disease management in paraneoplastic cases. We re port a case of classic stiff person syndrome associated with thymoma and review the main characteristics of this entity.
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Thermal expansion measurements were used to characterize phase transformations in metastable ß-Ti alloys (Ti15MoxSi) without and with various Si additions (where x = 0, 0.5, 1.0, 1.5, and 2 in wt.%) during linear heating at two heating rates of 5 and 10 °C/min up to 850 °C. For this study, five alloys were developed and examined in terms of their presence phases, microstructures, and starting and final transformation temperatures. According to the results, all of the as-cast samples primarily include an equiaxed ß-Ti phase. The influence of phase transformation on the material dimensions was discussed and compared with the variations in Si contents. The transformation was investigated using a dilatometric technique for the developed alloys during continuous heating and cooling. The dilatometric curve of heating revealed two distinct reflection points as the heating temperature increased. The starting transformation temperature (Ts) to obtain the ω-phase was reported at 359 °C without Si addition; whereas the final transformation temperature (Tf) of the dissolution of α-phase was obtained at 572 °C at a heating rate of 10 °C/min. At 2 wt.% Si, the first derivative curves reported Ts and Tf transforming temperatures of 314-565 °C (at a 5 °C/min heating rate) and 270-540 °C (at a 10 °C/min heating rate), respectively. The Ts and Tf transforming temperatures were significantly decreased with Si additions, which decreased the ß-transus temperature. Moreover, the thermal expansion coefficient curves of the investigated alloys without and with 2 wt.% Si were studied. The transformation heating curves have an S-shaped pattern, according to the results.
RESUMO
During the TIMO meeting 2022, national and international scientists as well as clinicians gave novel insights as well as perspectives into basic and translational tumor immunology.
Assuntos
Neoplasias , Humanos , Neoplasias/terapia , Imunoterapia , Oncologia , AlemanhaRESUMO
Myasthenia gravis is an autoimmune disease caused by the presence of specific antibodies targeting different postsynaptic components of the neuromuscular junction, and is clinically characterized by the presence of fatigueable muscle weakness. In the etiopathogenesis plays a central role the thymus and the most frequently detected pathogenic autoantibodies are targeted to the acetylcholine receptor. The increase in the knowledge of the immunological components of the neuromuscular junction in the last two decades has been fundamental to identify new pathogenic antibodies, reduce the percentage of patients with seronegative myasthenia, and propose a classification of patients into subgroups with clinical-therapeutic interest. In addition, in recent years, new drugs have been developed for the treatment of patients with myasthenia gravis that are refractory to conventional immunosuppressive treatment.
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Miastenia Gravis , Humanos , Miastenia Gravis/diagnóstico , Miastenia Gravis/terapia , Junção Neuromuscular/patologia , Receptores Colinérgicos , Autoanticorpos , Imunossupressores/uso terapêutico , Debilidade MuscularRESUMO
Objetivos : Determinar las características clínicas y epidemiológicas de niños con hipoplasia del timo y enfermedad respiratoria en Cuba. Material y Métodos : Estudio descriptivo retrospectivo en niños con edades comprendidas entre 1 y 6 años, de ambos sexos, atendidos en la consulta de Inmunología Pediátrica del Programa de Proyección Comunitaria del Municipio Arroyo Naranjo de La Habana o en la consulta de Inmunología Pediátrica del Hospital Materno Infantil Ángel Arturo Aballí Arellano del Municipio Arroyo Naranjo La Habana, entre los meses de septiembre 2019 y agosto 2022. Se incluyeron los niños con hipoplasia tímica y con antecedentes personales de enfermedad respiratoria infecciosa o no infecciosa diagnosticadas durante el período de estudio. Resultados : No se encontró relación entre la hipoplasia tímica y la edad o el sexo; se encontró mayor frecuencia de la hipoplasia tímica leve y moderada en niños con desarrollo de enfermedad respiratoria grave. Los factores con mayor frecuencia descritos en la enfermedad respiratoria complicada fueron la lactancia materna inefectiva, los antecedentes patológicos personales de atopia, el embarazo de riesgo, la prematuridad, el humo de tabaco en el ambiente y la asistencia a círculo infantil o a casa de cuidado infantil. Conclusiones : El desarrollo de hipoplasia tímica no mostró relación con la edad y el sexo. Se describieron varias condiciones con mayor frecuencia en niños con hipoplasia tímica y con enfermedad respiratoria complicada. La frecuencia de la hipoplasia tímica leve y moderada fue mayor en los pacientes con enfermedad respiratoria grave.
SUMMARY Objective : To determine the clinical and epidemiologic features of children with thymic hypoplasia and respiratory illnesses in Cuba. Methods : A retrospective study was conducted among children of 1-6 years of age of both sexes attended at a Pediatric Immunology Program of Hospital Materno Infantil Ángel Arturo Aballí Arellano in Habana, Cuba from September 2019 to August 2022. Children with thymic hypoplasia with and without a history of a respiratory illness either infectious or non-infectious were included. Results : No association between age and sex with thymic hypoplasia but an association was found with children with a severe respiratory illness. Factors associated with a severe respiratory illness were ineffective breastfeeding, history of an atopic condition, pregnancy of high risk, prematurity and exposure to tobacco smoke. Conclusions : Thymic hypoplasia was not associated with age or sex. An association with mild-moderate thymic hypoplasia was found with a severe respiratory illness.
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Humanos , Masculino , Feminino , Pré-Escolar , Pediatria , Sistema Respiratório , Doenças Respiratórias , Timo , Ultrassonografia , Alergia e Imunologia , CubaRESUMO
This study evaluated the effect of luting system with acidic primers on the durability of bonds with Ti-15Mo-5Zr-3Al titanium alloy (Ti-15Mo-5Zr-3Al) and its component metals. Adherend metals were Ti-15Mo-5Zr-3Al, Ti, Mo, Zr, and Al. Four primers were evaluated as adhesion promoters: Alloy Primer (ALP), Estenia Opaque Primer (EOP), M. L. Primer (MLP), and Super Bond liquid (SBL). An acrylic resin was used as the luting material. Pre- and post-thermocycling shear bond strength was determined to evaluate the bonding durability, and the results were compared using non-parametric statistical analyses (n=11/group). The post-thermocycling bond strength in MPa (median) associated with ALP, EOP, MLP, and SBL were 18.8, 19.8, 4.1, and 0.8, respectively, for Ti-15Mo-5Zr-3Al. The results showed that two primers containing 10-methacryloyloxydecyl dihydrogen phosphate (MDP) were effective for the durability of bonding of Ti-15Mo-5Zr-3Al to the resin. MDP enhanced the bonding durability of the resin bonded to either Ti, Zr, or Al.
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Colagem Dentária , Titânio , Titânio/química , Colagem Dentária/métodos , Teste de Materiais , Metacrilatos/química , Resistência ao Cisalhamento , Cimentos de Resina/químicaRESUMO
Palpable tumors in children are a common reason for consulting a radiologist. The origin of these lesions varies widely, and although they are common, classic radiology books do not cover some of them. This series of two articles aims to review the clinical and radiological characteristics of a selection of palpable tumors in children that radiologists need to be familiar with.
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Fibroma , Neoplasias de Tecidos Moles , Humanos , Criança , Diagnóstico por ImagemRESUMO
Metal ion release studies were carried out on three of the most commonly used orthodontic wires in the clinic: austenitic stainless steel, Ti-Mo, and superelastic NiTi, using three mouthwashes with different fluoride concentrations: 130, 200, and 380 ppm. Immersions were carried out in these mouthwashes at 37 °C for 1, 4, 7, and 14 days, and the ions released were determined by inductively coupled plasma-mass spectrometry (ICP-MS). All wires were observed by scanning electron microscopy (SEM). The results showed a moderate ion release in the stainless steel wires, with nickel and chromium values of 500 and 1000 ppb in the worst conditions for the wires: concentrations of 380 ppm fluoride and 14 days of immersion. However, in the Ti-Mo and NiTi alloys, an abrupt change in release was observed when the samples were immersed in 380 ppm fluoride concentrations. Titanium releases in Ti-Mo wires reached 200,000 ppb, creating numerous pits on the surface. Under the same conditions, the release of Ni and Ti ions from the superelastic wires also exceeded 220,000 ppb and 180,000 ppb, respectively. This release of ions causes variations in the chemical composition of the wires, causing the appearance of martensite plates in the austenitic matrix after 4 days of immersion. This fact causes it to lose its superelastic properties at a temperature of 37 °C. In the case of immersion in 380 ppm mouthwashes for more than 7 days, rich-nickel precipitates can be seen. These embrittle the wire and lose all tooth-correcting properties. It should be noted that the release of Ni ions can cause hypersensitivity in patients, particularly women. The results indicate that the use of mouthwashes with a high content of fluoride should not be recommended with orthodontic archwires.
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Fluoretos , Antissépticos Bucais , Feminino , Humanos , Antissépticos Bucais/química , Níquel , Fios Ortodônticos , Aço Inoxidável , Propriedades de Superfície , Titânio/química , MasculinoRESUMO
Abstract Several species of thymus have therapeutic properties, so they are used in traditional medicine. In this work was carried out to synthesize Thymus vulgalis silver nanoparticles (TSNPS) and evaluate antioxidant and antimicrobial activities of TSNPS and T. vulgalis essential oil extract (TEOE). The essential oils analyzed by GC-MS and were characterized. Major compounds of phenol, 2 methyl 5 (1 methylethyle) (CAS), thymol and 1,2 Benzene dicarboxylic acid, 3 nitro (CAS) (48.75%, 32.42% and 8.12%, respectively) were detected. Results demonstrated that the TSNPS gave a highest DPPH radical scavenging activity, it was obtained 97.2 at 1000 ug/ml. TSNPS, Thymus + Hexane (T+H), Thymus + Ethanol (T+E) gave the greatest antimicrobial activity than amoxicillin (AM) and ciprofloxacin (CIP). In conclusion: The essential oil of thymus (Vulgaris) and thymus (Vulgaris) silver nanoparticles can be a good source of natural preservatives as an antioxidant and antimicrobial agents for increasing the shelf life of foodstuffs.
Resumo Diversas espécies de timo possuem propriedades terapêuticas, por isso são utilizadas na medicina tradicional. Neste trabalho foi realizado para sintetizar nanopartículas de prata Thymus vulgalis (TSNPS) e avaliar as atividades antioxidante e antimicrobiana de TSNPS e extrato de óleo essencial de T. vulgalis (TEOE). Os óleos essenciais analisados por GC-MS e foram caracterizados. Os principais compostos de fenol, 2 metil 5 (1 metiletilo) (CAS), timol e ácido 1,2 Benzenodicarboxílico, 3 nitro (CAS) (48,75%, 32,42% e 8,12%, respectivamente) foram detectados. Os resultados demonstraram que o TSNPS deu uma maior atividade de eliminação do radical DPPH , foi obtido 97,2 a 1000 ug / ml. TSNPS, Timo + Hexano (T + H), Timo + Etanol (T + E) deu a maior atividade antimicrobiana do que amoxicilina (AM) e ciprofloxacina (CIP). Em conclusão: O óleo essencial de nanopartículas de prata do timo (Vulgaris) e do timo (Vulgaris) pode ser uma boa fonte de conservantes naturais como agentes antioxidantes e antimicrobianos para aumentar a vida útil de alimentos.
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Óleos Voláteis/farmacologia , Thymus (Planta) , Nanopartículas Metálicas , Anti-Infecciosos/farmacologia , Prata , Antioxidantes/farmacologiaRESUMO
Several species of thymus have therapeutic properties, so they are used in traditional medicine. In this work was carried out to synthesize Thymus vulgalis silver nanoparticles (TSNPS) and evaluate antioxidant and antimicrobial activities of TSNPS and T. vulgalis essential oil extract (TEOE). The essential oils analyzed by GC-MS and were characterized. Major compounds of phenol, 2 methyl 5 (1 methylethyle) (CAS), thymol and 1,2 Benzene dicarboxylic acid, 3 nitro (CAS) (48.75%, 32.42% and 8.12%, respectively) were detected. Results demonstrated that the TSNPS gave a highest DPPH radical scavenging activity, it was obtained 97.2 at 1000 ug/ml. TSNPS, Thymus + Hexane (T+H), Thymus + Ethanol (T+E) gave the greatest antimicrobial activity than amoxicillin (AM) and ciprofloxacin (CIP). In conclusion: The essential oil of thymus (Vulgaris) and thymus (Vulgaris) silver nanoparticles can be a good source of natural preservatives as an antioxidant and antimicrobial agents for increasing the shelf life of foodstuffs.
Diversas espécies de timo possuem propriedades terapêuticas, por isso são utilizadas na medicina tradicional. Neste trabalho foi realizado para sintetizar nanopartículas de prata Thymus vulgalis (TSNPS) e avaliar as atividades antioxidante e antimicrobiana de TSNPS e extrato de óleo essencial de T. vulgalis (TEOE). Os óleos essenciais analisados por GC-MS e foram caracterizados. Os principais compostos de fenol, 2 metil 5 (1 metiletilo) (CAS), timol e ácido 1,2 Benzenodicarboxílico, 3 nitro (CAS) (48,75%, 32,42% e 8,12%, respectivamente) foram detectados. Os resultados demonstraram que o TSNPS deu uma maior atividade de eliminação do radical DPPH , foi obtido 97,2 a 1000 ug / ml. TSNPS, Timo + Hexano (T + H), Timo + Etanol (T + E) deu a maior atividade antimicrobiana do que amoxicilina (AM) e ciprofloxacina (CIP). Em conclusão: O óleo essencial de nanopartículas de prata do timo (Vulgaris) e do timo (Vulgaris) pode ser uma boa fonte de conservantes naturais como agentes antioxidantes e antimicrobianos para aumentar a vida útil de alimentos.
Assuntos
Anti-Infecciosos/análise , Antioxidantes/análise , Extratos do Timo/química , Nanopartículas , Prata , Óleos Voláteis/análise , Conservação de AlimentosRESUMO
Abstract Several species of thymus have therapeutic properties, so they are used in traditional medicine. In this work was carried out to synthesize Thymus vulgalis silver nanoparticles (TSNPS) and evaluate antioxidant and antimicrobial activities of TSNPS and T. vulgalis essential oil extract (TEOE). The essential oils analyzed by GC-MS and were characterized. Major compounds of phenol, 2 methyl 5 (1 methylethyle) (CAS), thymol and 1,2 Benzene dicarboxylic acid, 3 nitro (CAS) (48.75%, 32.42% and 8.12%, respectively) were detected. Results demonstrated that the TSNPS gave a highest DPPH radical scavenging activity, it was obtained 97.2 at 1000 ug/ml. TSNPS, Thymus + Hexane (T+H), Thymus + Ethanol (T+E) gave the greatest antimicrobial activity than amoxicillin (AM) and ciprofloxacin (CIP). In conclusion: The essential oil of thymus (Vulgaris) and thymus (Vulgaris) silver nanoparticles can be a good source of natural preservatives as an antioxidant and antimicrobial agents for increasing the shelf life of foodstuffs.
Resumo Diversas espécies de timo possuem propriedades terapêuticas, por isso são utilizadas na medicina tradicional. Neste trabalho foi realizado para sintetizar nanopartículas de prata Thymus vulgalis (TSNPS) e avaliar as atividades antioxidante e antimicrobiana de TSNPS e extrato de óleo essencial de T. vulgalis (TEOE). Os óleos essenciais analisados por GC-MS e foram caracterizados. Os principais compostos de fenol, 2 metil 5 (1 metiletilo) (CAS), timol e ácido 1,2 Benzenodicarboxílico, 3 nitro (CAS) (48,75%, 32,42% e 8,12%, respectivamente) foram detectados. Os resultados demonstraram que o TSNPS deu uma maior atividade de eliminação do radical DPPH , foi obtido 97,2 a 1000 ug / ml. TSNPS, Timo + Hexano (T + H), Timo + Etanol (T + E) deu a maior atividade antimicrobiana do que amoxicilina (AM) e ciprofloxacina (CIP). Em conclusão: O óleo essencial de nanopartículas de prata do timo (Vulgaris) e do timo (Vulgaris) pode ser uma boa fonte de conservantes naturais como agentes antioxidantes e antimicrobianos para aumentar a vida útil de alimentos.
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Intrathyroidal thymus tissue (ITTT) is a rare, benign condition; its diagnosis can prove challenging due to unfamiliarity with this entity. However, it has ultrasonographical and cytological characteristics which can suggest its presence and thus should be considered in the differential diagnosis of thyroid nodules. Presently, immunohistochemistry can be used with fine needle aspiration (FNA) cytology, thus decreasing the need for unnecessary surgery. We discuss the usefulness of immunohistochemistry in thyroid cytology, with reference to a case of a 10-year-old patient, who underwent partial thyroidectomy for a suspicious thyroid nodule which was eventually diagnosed as ITTT by the histopathology of the surgical specimen.
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Nódulo da Glândula Tireoide , Biópsia por Agulha Fina , Criança , Citodiagnóstico , Humanos , Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/cirurgia , TireoidectomiaRESUMO
Resumen Las neoplasias epiteliales del timo (NET) son tumores infrecuentes. El manejo inicial de las mismas se basa en el análisis de la resecabilidad del tumor en los estudios por imágenes, siendo la resección completa el tratamiento estándar para cualquier estadio. El objetivo principal fue evaluar la supervivencia global y la supervivencia libre de enfermedad de los pacientes con diagnóstico de NET sometidos a tratamiento quirúrgico. El objetivo secundario fue comparar la supervivencia global de acuerdo al tipo de resección quirúrgica, el estadio de Masaoka-Koga y subtipo histológico. Estudio observacional descriptivo realizado en el Hospital Británico de Buenos Aires desde 2004 a 2020. Se incluyeron 42 pacientes operados de tumores en mediastino anterior con diagnóstico histopatológico definitivo de NET. Treinta y nueve eran timomas y 3 carcinomas tímicos. La cirugía realizada en todos los pacientes fue una timectomia total. La mediana de seguimiento fue de 63.5 meses (RIQ 32-97.5). La supervivencia global estimada a los cinco y diez años fue del 87% (95% IC, 0.69-0.95) y 78% (95% IC, 0.5-0.92), respectivamente. La supervivencia libre de enfermedad estimada a cinco y diez años fue del 90% (95% IC, 0.74-0.96). Los pacientes a los que se le realizó una resección completa y que tenían estadios tem pranos de Masaoka-Koga presentaron una supervivencia global superior en comparación con las resecciones incompletas y estadios avanzados (p = 0.0097 y p = 0.0028, respectivamente). Al contar con un bajo número de pacientes en el grupo de carcinomas tímicos, no pudimos sacar conclusiones en cuanto a supervivencia entre éstos y los timomas.
Abstract Thymic epithelial tumors are a group of rare neoplasms of the mediastinum. When resectable, complete resection is considered the gold standard for any stage. The primary endpoint was to evaluate overall survival and disease-free survival of patients with thymus epithelial tumors who underwent surgical treatment. The secondary endpoint was to evaluate and compare the overall survival according to: resection type (complete vs. incomplete), Masaoka-Koga stage and tumor histology according to WHO classification. This is a descriptive observational study from January 2004 to December 2020, in which 42 patients with a postoperative histopathological diagnosis of thymic epithelial tumours were included. Thirty-nine were thymomas (92.9%) and 3 were thymic carcinomas (7.1%). In all patients a total thymectomy was performed. The median follow-up was 63.5 months (IQR 32-97.5). The estimated overall survival at five and ten years was 87% (95% CI, 0.69-0.95) and 78% (95% CI, 0.5-0.92), respectively. Estimated disease-free survival at five and ten years was 90% (95% CI, 0.74-0.96). Patients who underwent complete resection and with early Masaoka-Koga stages had superior overall survival compared to incomplete resections and advanced Masaoka-Koga stages (p = 0.0097 and p = 0.0028, respectively). We found no differences in terms of survival between histological subtypes due to a low number of patients in the thymic carcinoma group.
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Hace aproximadamente 20 años un grupo de médicos investigadores de Cuba reportaron el empleo de las mediciones del timo por ultrasonografía, como un arma valedera en la evaluación inmunológica de los niños menores de 7 años con cuadros de infecciones frecuentes, fundamentalmente respiratorias. El rango de normalidad propuesto del área de la silueta tímica, es entre 1010,6 - 1425,4 mm2, o sea, 1 218 ± 207,4 mm2. Por debajo y por encima de estos valores se hablaría de hipoplasia e hiperplasia, respectivamente. Se considera hipoplasia grave cuando el área tímica es menor de 500 mm2; moderada cuando se encuentra entre 500 y 799 mm2 y leve cuando se halla entre 800 y 999 mm2. Se propone un algoritmo de diagnóstico y tratamiento que engloba la experiencia clínica de 12 años de trabajo en inmunología clínica pediátrica en el Instituto de Hematología e Inmunología. Este puede constituir una herramienta útil en las manos de los inmunólogos clínicos pediátricos que adecuarían el tratamiento idóneo para llevar el órgano a su tamaño estándar con la consecuente disminución de los procesos infecciosos y la elevación de los niveles de inmunoglobulina A en los pacientes(AU)
About 20 years ago, a group of Cuban medical researchers reported to the literature the use of measurements of the thymus by ultrasonography, as a valid weapon in the immunological evaluation of children under 7 years of age with frequent infections, mainly respiratory. The range of normality proposed for the area of the thymic silhouette is between 1010.6 - 1425.4 mm2, that is, 1 218 ± 207.4 mm2. Below and above these values, we would speak of hypoplasia and hyperplasia, respectively. Severe hypoplasia is considered when the thymic area is less than 500 mm2; moderate when it is between 500 and 799 mm2 and mild when it is between 800 and 999 mm2. A diagnosis and treatment algorithm is proposed that encompasses the clinical experience of 12 years of work in pediatric clinical immunology at the Institute of Hematology and Immunology. It can be a useful tool in the hands of pediatric clinical immunologists who would adapt the ideal treatment to bring the organ to its standard size with the consequent decrease in infectious processes and the elevation of immunoglobulin A levels in patients(AU)
Assuntos
Humanos , Masculino , Feminino , Algoritmos , Imunoglobulina A , Ultrassonografia , Alergia e Imunologia , HematologiaRESUMO
Se presenta conceptos de la inmunocompetencia y su relación con la nutrición en niños, que describen aspectos fisiológicos integrales. También se describen los aspectos inmunológicos, que permiten interpretar los mecanismos de la respuesta inmune, destacándose conceptos y criterios fisiológicos. Un niño malnutrido presenta alteraciones inmunológicas, y las mismas se las puede identificar como deficiencias a predominio celular, y a predominio humoral. Se destaca la importancia del eje Neuroinmunoendocrinológico como integrador de respuestas fisiológicas. El propósito del presente trabajo, esta dirigido a identificar las herramientas que permiten el estudio del sistema inmune en nuestro contexto, haciendo especial hincapié en la ecografía del timo, por ser una herramienta útil para evaluar al sistema inmune en niños con estado nutricional alterado en forma leve o moderada.
Concepts of immunocompetence and its relationship with nutrition in children are presented, describing comprehensive physiological aspects. Immunological aspects are also described, which allow to interpret the mechanisms of the immune response, highlighting physiological concepts and criteria. A malnourished child presents immunological alterations, and these can be identified as deficiencies with a cellular predominance, and with a humoral predominance. The importance of the Neuro-immunoendocrinological axis as an integrator of physiological responses is highlighted. The purpose of this work is aimed at identifying the tools that allow the study of the immune system in our context, with special emphasis on ultrasound of the thymus, as it is a useful tool to evaluate the immune system in children with altered nutritional status, mild or moderate.
Assuntos
Humanos , Masculino , Feminino , Timo , Estado Nutricional , Crescimento e Desenvolvimento , Ciências da Nutrição , Fenômenos Fisiológicos , Sistema Imunitário , ImunocompetênciaRESUMO
Intrathyroidal ectopic thymic tissue (IETT) is an indulgent, unusual entity and is part of the differential diagnosis of thyroid nodules in the pediatric population. Because of the low prevalence of IETT, the diagnosis may be difficult. Awareness of this diagnosis is definitive to avoid surgical interventions. The aim of this study was to review the literature on the echographic characteristics of IETT. We conducted a search of Ovid, PubMed and the virtual health library. A total of 619 patients with a mean age of 6.2 years old were included. IETT was located in the lower portion of both of the thyroidal lobes in 556 children, the echographic shape was reported for 173 patients, with the fusiform shape as the most representative, the appearance of the IETTs was reported for 121 patients, the most common was the hypoechogenic pattern with multiple internal echogenic foci. The average lesion diameter was 5.53â¯mm, and Doppler findings reported a hipovascular pattern in 56% of the lesions. In conclusion, IETT is an infrequent entity; nonetheless, it must be considered in the differential diagnosis of neck nodules in children and should be study and follow with echography to avoid unnecessary surgery.
Assuntos
Nódulo da Glândula Tireoide , Criança , Diagnóstico Diferencial , Humanos , Prevalência , Nódulo da Glândula Tireoide/diagnóstico por imagem , UltrassonografiaRESUMO
RESUMEN El carcinoide atípico (CA) de timo es la neoplasia más agresiva y rara que surge en el mediastino anterior y que pertenece a los tumores primarios neuroendocrinos de timo. La mayoría de los pacientes son asintomáticos y según la extensión de la enfermedad pueden presentar desde tos, disnea, dolor torácico hasta síndrome de vena cava superior. Esta presentación clínica inespecífica disminuye la probabilidad del diagnóstico temprano que, sumado con el estadio avanzado al debut y la imposibilidad de resección quirúrgica reduce la tasa de supervivencia. El objetivo es dar a conocer la presentación clínica, imagenológica y patológica en un varón de 39 años con CA de timo cuyo diagnóstico definitivo se basó en el estudio histopatológico (morfología carcinoide, mitosis 0-1/2 mm2, necrosis, Ki 67 = 12%) y marcadores inmunofenotípicos del tumor (CD 56 (+), Panqueratina (+), Sinaptofisina (+), TTF -1 (-)).
ABSTRACT The atypical carcinoid (AC) of thymus is the most aggressive and uncommon neoplasm in the anterior mediastinum, that belongs to the neuroendocrine primary tumors of thymus. Most patients are asymptomatic and according to the disease extension they may present with cough, dyspnea, chest pain, and superior cava vein syndrome. This non-specific clinical presentation reduces the likelihood for making an early diagnosis; and this, together with disease stage and lack of surgical resection reduces the survival rate. The aim of this paper is to describe the clinical presentation in a 39-year old male with thymus carcinoid whose diagnosis was based on histopathological studies (carcinoid morphology, 0-1/2 mitoses/mm2), necrosis, Ki67, 12%), and immunophenotypic tumor markers (CD56(+), Pankeratin (+), Synaptophysin (+), and TTF-1 (-)).