Evolución del estado nutricional y de la función pulmonar en una cohorte de pacientes con fibrosis quística seguidos en un centro de atención integral / Change over time of nutritional status and lung function in a cohort of patients with cystic fibrosis followed in a multidisciplinary care center

Cystic Fibrosis is a multisystemic inherited disease that requires ongoing care by multidisciplinary teams. The objective of this study is to describe changes on nutrition and lung function in a cohort of patients in a Cystic Fibrosis (CF) Care Center at the Hospital Infantil Universitario San José in Bogotá (HIUSJ), between 2010 and 2013.Is a descriptive study in a cohort of CF patients during four years of follow-up. The quantitative variables were described using medians and interquartile ranges, and the qualitative variables with absolute frequencies and percentages. Descriptive statistics was used to summarize the findings. Of the 63 patients in the initial group, 47 (74.6%) completed the follow-up time. The age range was between 3 to 30 years. The median BMI increased as follows: 17.9 (RIQ: 12.5-25.6) in 2010, 18.6 (RIQ: 12.9-24.8) in 2011, 18.9 RIQ (13.6-26.5) in 2012 and 19.0 (RIQ: 13.5-25.8) in 2013, with lower values in men. The forced expiratory volume in the first second (FEV1) at admission was classified as severe (FEV1 <40%) in 7.1%, moderate (FEV1 40-69%) in 35.7%, mild (FEV1 70-79%) in 7.1% and as normal (FEV1> 80%) in 50%. It is concluded that during the 4 years of follow-up at the HIUSJ CF Center there is an improvement in BMI and a deterioration in lung function in the whole group. The importance of establishing more reference centers to improve clinical outcomes and of implement a National registry to follow up over time are highlighted.

La fibrosis quística es una enfermedad hereditaria, multisistémica, cuyo manejo continuo requiere de equipos multidisciplinarios de salud. El objetivo de este trabajo es describir la evolución nutricional y de la función pulmonar en una cohorte de pacientes en el centro de atención integral de la fibrosis quística (FQ), del Hospital Infantil Universitario San José de Bogotá (HIUSJB), entre 2010 y 2013. Estudio descriptivo, en una cohorte de pacientes, en seguimiento durante cuatro años. Las variables cuantitativas fueron descritas mediante medianas y rangos intercuartílicos y las cualitativas con frecuencias absolutas y porcentajes. De los 63 pacientes del grupo inicial, 47 (74.6%), completaron el tiempo de seguimiento. El rango de edad fue de 3 a 30 años. La mediana del IMC (índice de masa corporal) se incrementó así: 17.9 (RIQ:12.5-25.6) en el 2010, 18.6 (RIQ:12.9-24.8) en el 2011, 18.9 ( RIQ(13.6-26.5) en el 2012 y 19.0 (RIQ:13.5-25.8) en el 2013, con menores valores en los hombres. El volumen espiratorio forzado en el primer segundo (VEF1) al ingreso fue clasificado como severo (VEF1<40%) en el 7.1%, moderado (VEF1 40-69%) en el 35.7%, leve (VEF1 70-79%) en el 7.1% y como normal (VEF1>80%) en el 50%. Se concluye que durante los 4 años de seguimiento en el programa de FQ del HIUSJ, ocurre una mejoría del IMC en todo el grupo y un deterioro de la función pulmonar. Se resalta la importancia de constituir más centros de referencia para mejorar los desenlaces clínicos e implementar un registro Nacional para hacer seguimiento a través del tiempo.

Responses of Crepis japonica induced by supplemental blue light and UV-A radiation.

Crepis japonica (L.) D.C. (Asteraceae), a weed with antioxidant, antiallergenic, antiviral and antitumor properties displays both medicinal properties and nutritional value. This study aims to assess the effects of a supplementation of blue light and UV-A radiation on the growth, leaf anatomical structure and phenolic profile of the aerial parts of Crepis japonica. Plants were grown under two light treatments: W (control - white light), W + B (white light supplemented with blue light) and W + UV-A (white light supplemented with UV-A radiation). We recorded the length, width, and weight of fresh and dry leaves, the thickness of the epidermis and mesophyll, and stomata density. The phenolic profiles of the aqueous extracts of the aerial parts were analyzed by HPLC-DAD. There was an increase in the leaf size, stomatal density, and phenolic production, and a thickening of the mesophyll and epidermis. UV-A radiation increased the phenolic production more than blue light. Blue light and UV-A radiation both improved the production of caffeic acid by about 6 and 3 times, respectively, in comparison to control. This compound was first reported as a constituent of the extract from the aerial parts together with caftaric acid. UV-A also promoted the production of chlorogenic acid (about 1.5 times in comparison to the control). We observed that the morphological and chemical parameters of C. japonica are modified in response to blue light and UV-A radiation, which can be used as tools in the cultivation of this species in order to improve its medicinal properties and nutritional value.

[To maintain or to withdraw life support? Variations on the methods of ending life in a pediatric intensive care unit over a period of 6 years]. / Continuer, limiter ou arrêter? Évolution des modalités de décès sur une période de 6ans en réanimation pédiatrique.

Since 2005, forgoing live-support (FLS) is allowed by the French law (known as the Leonetti law) for end-of-life patients only. This study aims at describing the variations over time in the use of the following methods to end life: FLS, brain death and cardiopulmonary resuscitation failure (CPR failure). It is a single retrospective study from 2007 to 2012. The Cochran-Armitage trend test is used in the statistical analysis. Over six years, 263 of the 5100 children who were hospitalized in our intensive care unit died, which represents a 5.2% mortality rate. FLS increased yearly from 31% of the deaths in 2007, to 71% in 2012 (P=0.0008). The rate of CPR failure decreased over the same period (P=0.0015). The rate of brain death remained constant. Following to the Leonetti law, FLS increase, and palliative cares develop without any increase of mortality.

Línea básica de susceptibilidad y efecto sinérgico a los insecticidas malation y pirmifos-metil en adultos de Culex spp. Say, 1823 (Díptera: Culicidae) del municipio Mario Briceño Iragorry del estado Aragua, Venezuela / Baseline susceptibility and synergistic effect to the insecticides malathion and pirmiphos-methyl in adults of Culex spp. Say, 1823 (Diptera: Culicidae) Mario Briceño Iragorry municipality, Aragua state, Venezuela

Se evaluó la respuesta a los insecticidas organofosforados malatión y pirimifos-metil en poblaciones de campo de adultos Culex spp. del Municipio Mario Briceño Iragorry del Estado Aragua. Se realizaron los bioensayos en botellas tratadas con insecticidas. La determinación del tiempo-mortalidad, permitió obtener la línea base de susceptibilidad de los insecticidas evaluados. Se definió la dosis diagnóstica como la menor dosis que mata el mayor porcentaje de los insectos expuestos. El número de sobrevivientes a los 60 minutos de exposición a dichas dosis fue considerado como criterio de resistencia definiéndose dicho tiempo, como el umbral de resistencia. Los mosquitos resultaron resistentes a malatión a las concentraciones 0,1; 1 y 5 μg/mL con valores de TL100= 90; 90 y 75 minutos respectivamente y susceptibles a pirimifos-metil a las concentraciones 1 y 5 μg/mL con valores TL100= 30 y 15 minutos respectivamente, a la concentración 0,1 μg/mL se obtuvo TL100= 75 lo cual no se estimó por ser una dosis baja. Las concentraciones 5 μg/mL de malatión, 0, μg/ml de pirimifos-metil se sugieren como dosis referenciales. Se identificaron mecanismos de resistencia con el sinergista butóxido de piperonilo (PB) a las concentraciones de malatión 1 y 5 μg/mL con FS = 2 y 2,5 respectivamente. Las enzimas de multifunción oxidasa (MFO) juegan un papel importante en la resistencia al insecticida malation. Los resultados obtenidos, aportan información básica para futuros programas de control de Culex spp., si fuese necesario, debido a su importancia como plaga de ambientes turísticos y como vector de Filariasis (bancroftiasis) y Fiebre del Nilo.

We evaluated the response to the organophosphorus insecticides malathion and pirimiphos-methyl in field populations of adult Culex spp. Mario Briceño Iragorry Municipality Aragua state. Bioassays were carried out using the bottles treated with insecticides. The time-mortality determination allowed us to obtain the baseline susceptibility of the insecticides evaluated. Diagnostic dose was defined as the lowest dose that kills the highest percentage of exposed insects. Survivors after 60 minutes of exposure to these doses was considered as resistance criterion defining this time, as the threshold of resistance. The mosquitoes were resistant to malathion at concentrations 0.1; 1 and 5 μg/mL with values of TL100= 90; 90 and 75 minutes respectively and susceptible to pirimiphos-methyl at concentrations 1 and 5 μg/mL with values of TL100= 30 and 15 minutes respectively, was obtained at the concentration 0.1 μg /mL TL100= 75 which was not considered to be a low dose. The concentrations 5 μg /mL of malathion, 0.1 μg / ml of pirimiphos-methyl are suggested as a reference dose. Resistance mechanisms were identified with the synergist piperonyl butoxide (PB) at concentrations of malathion 1 and 5 μg/mL with FS = 2 and 2.5 respectively. Multifunction oxidase enzymes (MFO) play an important role in resistance to the insecticide malathion. The obtained results provide basic information for future monitoring programs of Culex spp, if necessary, due to its importance as a pest of tourist environments and as a vector of Filariasis (bacroftiosis) and West Nile Fever.

Clinically important molecular features of Peruvian colorectal tumours: high prevalence of DNA mismatch repair deficiency and low incidence of KRAS mutations.

BACKGROUND: The incidence of colorectal cancer (CRC) in Peru has been increasing, and no data have been published on the molecular features. We explored the most relevant genetic events involved in colorectal carcinogenesis, with clinical implications. METHODS: Using immunohistochemistry for mismatch-repair (MMR) proteins (MLH1, MSH2, MSH6, and PMS2) and microsatellite instability analysis, we evaluated the status of 90 non-selected CRC Peruvian patients followed in a nationwide reference hospital for cancer (INEN, Lima). Tumours with loss of hMLH1 were evaluated further for hMLH1 promoter hypermethylation and all cases were evaluated for the presence of KRAS and BRAF-V600E mutations. RESULTS: MMR deficiency was found in 35 (38.8%) patients. We identified an unexpected association between MMR deficiency and older age. Among the 14 cases with loss of MLH1, 10 samples exhibited hypermethylation. Of the 90 cases evaluated, 15 (16.7%) carried KRAS mutations; we found one previously unreported mutation (G13R). CONCLUSIONS: Peruvian CRC tumours exhibited the highest prevalence of MMR deficiency reported to date. The expected hereditary component was also high. The age of onset of these MMR deficient tumours was greater than that observed for non-MMR deficient cases, suggesting the ineffectiveness of the Bethesda criteria for Lynch syndrome screening in Peru. Prospective studies are warranted to define the molecular characteristics of CRC in this population.

Clonación y transcripción del gen EBER-1 del virus Epstein-Barr: estudio de su expresión genética por hibridación in situ / Cloning and transcription of gene EBER-1 of Epstein-Barr virus: study of its genetic expression by hybridization in situ

La capacidad de virus de Eptein Barr (VEB) de inducir transformación e inmortalización de linfocitos y su alta prevalencia en algunas neoplásias linfoides ha motivado intensa investigación de su biología y comportamiento. Describimos la hibridación in situ (HIS), para la identidicación de transcriptos del virus de Epstein-Barr, desarrollado en la Unidad de Biología Molecular del Centro de Investigación en Cáncer Maes Heller, en biopsias de linfoma incluidas en parafina.El gen EBER-1 (Epstein Barr-encoded RNA) fue clonado y transcrito, el ARN transcrito fue evaluado con óptimos resultados en las líneas celulares Raji y Daudi que expresan EBER. Este transcrito marcado fue usado como sonda para determinar la expresión genética del virus en 159 especimenes biológicos en estudio y en controles positivos y negativos conocidos empleando la HIS.La actividad transcripcional del virus fue observada en 44 de los casos estudiados. Concluimos que la HIS en tejido incluido en parafina es una buena alternativa para detectar actividad del VEB y la presencia o ausencia de EBER puede ser considerada como marcador biológico en la etiopatología de estos linfomas

Elderly patients with aggressive non-Hodgkin's lymphoma treated with CHOP chemotherapy plus granulocyte-macrophage colony-stimulating factor: identification of two age subgroups with differing hematologic toxicity.

PURPOSE: Standard cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy repeated at 3-week intervals is difficult to deliver in elderly patients with non-Hodgkin's lymphoma (NHL). The use of hemopoietic growth factors may decrease the hematologic toxicity of chemotherapy and allow the delivery of full-dose CHOP. PATIENTS AND METHODS: We conducted a phase II trial with the addition of granulocyte-macrophage colony-stimulating factor (GM-CSF) to CHOP chemotherapy in NHL patients older than 60 years of age. Twenty-six previously untreated patients were assessable; median age was 67 years (range, 61 to 84 years). CHOP included cyclophosphamide 750 mg/m2 intravenously day 1; doxorubicin 50 mg/m2 intravenously day 1; vincristine 1.4 mg/m2 (2 mg total dose) intravenously day 1; and prednisone 100 mg orally days 1 through 5. GM-CSF 5 microg/kg was administered subcutaneously on days 4 through 13. Cycles were repeated every 21 days for six cycles. Results were analyzed for the total group and for two age subgroups: 61 to 69 years (n = 15) and 70 years or older (n = 11). RESULTS: Sixteen patients (62%) achieved a complete response (CR), four patients (15%) achieved a partial response (PR), and six patients (23%) did not respond to therapy. After a median follow-up of 41 months, the median progression-free and overall survival were 19 and 30 months, respectively. Twenty patients completed six cycles. One hundred thirty-eight of the 156 planned cycles were delivered (88%). The relative dose-intensity was 95%. The chemotherapy-induced toxicity was important. Absolute neutrophil count was less than 500/mL in 43% of the cycles, platelet nadir was less than 20,000/mL in 19%, and febrile neutropenia occurred in 21%. There were no grades 3 to 4 mucositis. Treatment-related death occurred in two patients, and was associated with neutropenic septic shock. The toxicity related to GM-CSF was mild hypotension after the cytokine was administered in 7% of cycles. When the results of the study were analyzed by age subgroups, we observed that whereas response and median survival were similar in patients aged 61 to 69 years or 70 years or older, there were significant differences in dose delivery and toxicity. Chemotherapy was delivered in 86 of 90 planned cycles in patients aged 61 to 69 years, but in only 52 of 72 planned cycles in patients aged 70 to 84 years (P = .00008). Absolute neutrophil count was less than 500/mL in 24% of cycles in patients aged 61 to 69 years and 73% of cycles in patients aged 70 years or older (P = .00001). The platelet nadir of less than 20,000/mL occurred in 5% of patients aged 61 to 69 years and in 42% of patients aged 70 years or older (P < .0001). Fever and neutropenia occurred in 8% of patients aged 61 to 69 years and in 42% of patients aged 70 years or older (P < .0001). Mucositis (grades 1 to 2) occurred in 21% of patients aged 61 to 69 years and in 42% of patients aged 70 years or older (P = .006). CONCLUSION: CHOP chemotherapy plus GM-CSF is an active regimen in elderly patients with NHL. Despite cytokine support, the toxicity of the regimen is elevated. We have identified two age subgroups (61 to 69 and > or = 70 years) that do not differ in treatment efficacy but show large differences in treatment-related toxicity.

Risk factors for treatment-related death in elderly patients with aggressive non-Hodgkin's lymphoma: results of a multivariate analysis.

PURPOSE: It has been suggested that age is associated with chemotherapy-related death in patients with non-Hodgkin's lymphoma (NHL) treated with doxorubicin-containing chemotherapy. The purpose of this study was to evaluate the relative influence of increasing age and other clinical parameters on the occurrence of treatment-related death in elderly patients with intermediate- or high-grade NHL treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy. METHODS: A retrospective study of patients 60 years of age or older with intermediate- or high-grade NHL treated with CHOP chemotherapy in a single cancer center. The following variables were recorded: age (60 to 69, 70 to 79, and 80 to 94 years), histology (Working Formulation [WF] D, E, F, G, and H), Ann Arbor stage, B symptoms, extranodal involvement, bulky disease (> 7 cm), performance status (Eastern Cooperative Oncology Group [ECOG] scale), International Prognostic Index (IPI score), serum lactate dehydrogenase (LDH) level and doxorubicin relative dose-intensity (RDI). The relationship between these features and treatment-related death was assessed in univariate and multivariate logistic regression analysis. RESULTS: From 1982 to 1991, 267 consecutive patients were treated. Median age was 70 years (range, 60 to 94 years). There were 35 toxic deaths. Sixty-three percent of the deaths occurred after the first cycle. Infection accounted for 82% of the toxic deaths. In the univariate analysis, the features associated with an increased risk of toxic death were ECOG performance status 2 to 4 (relative risk [RR], 7.82), B symptoms (RR, 3.38), diffuse large-cell histology (RR, 3.06), bulky disease (RR, 2.58), serum levels of LDH (RR, 2.53), and IPI score (RR, 2.46). The age groups did not show significance. In the regression model, performance status 2 to 4 was the only independent predictor of treatment-related death (RR, 3.52; 95% confidence interval [CI], 2.98 to 4.06). CONCLUSION: Our results show that in elderly patients with NHL treated with doxorubicin-based chemotherapy the risk for treatment-related death is associated with poor performance status rather than with increasing chronologic age.

Ifosfamide plus cisplatin as primary chemotherapy of advanced ovarian cancer.

We have performed a phase II study to evaluate the activity and toxicity of ifosfamide and cisplatin as first-line treatment for advanced ovarian cancer. Patients were treated with cisplatin 100 mg/m2 on day 1 and ifosfamide 5 g/m2 in 18-hr continuous infusion on day 1 or 1.5 g/m2 bolus on days 1-5. Between August 1988 and March 1990, 30 women were entered in the trial, 26 of them with measurable disease. The overall clinical response rate was 69% (95% CI: 48-85%), including 34.6% complete responses (95% CI:17-55%). Reassessment laparotomy was performed in 12 cases, and 4 (33%) exhibited a pathologic complete response. For all patients, the median duration of progression-free survival was 14 months, and the median overall survival was 25 months. There were no major differences in the response rate or survival between the two ifosfamide administration modalities. Relevant toxicities were grade IV hematologic toxicity in 11/30 patients and grade IV renal toxicity in 2/30 patients. A patient with grade IV encephalopathy developed a trauma-related cerebral hemorrhage and died 2 months later. The combination of ifosfamide and cisplatin is active in first-line therapy in advanced ovarian cancer, although it does not seem to improve the efficacy or toxicity profile of conventional combinations.

Phase I trial of a 24-h continuous infusion of ifosfamide/mesna in acute lymphoblastic leukemia.

Based on previous reports suggesting that an intravenous (i.v.) continuous infusion of alkylating agents produced a significant response rate in acute lymphoblastic leukemia (ALL), a phase I trial of ifosfamide/mesna (IFO/MES) was conducted in 11 adult patients with relapsed ALL. IFO/MES were administered as a 24-h i.v. continuous infusion in doses ranging from 5 g/m2 to 9 g/m2; the courses of treatment were repeated every 3 weeks. Patients were examined for toxicity after every cycle and responses were carefully defined and evaluated. All 11 admitted patients were evaluable for toxicity and response. Myelosuppression was the dose limiting effect and it was dose-related. Microscopic and/of macroscopic hematuria was detected in four (11%) out of 36 cycles administered. Ifosfamide produced a positive biological response with a preliminary response rate of 45.4%. Ifosfamide/mesna in a 24-h i.v. continuous infusion appears to be tolerated and produces a biological response in ALL. We recommend that phase II studies of this drug schedule be conducted at the initial dose of 7 g/m2 repeated every 3 weeks and combined with other antileukemic agents.

Cefotaxima vs. cefalotina-gentamicina en el primer episodio febril de pacientes con tumores sólidos y neutropenia de corta duración / Cefotaxime vs Cephalotin-Gentamicin in the first febrile episode of patients having solid tumors and short-term neutropenia

Las infecciones no tratadas en un paciente neutropénico son rápidamente fatales y está plenamente justificado el uso de antibióticos en forma empírica. En el Instituto Nacional de Enfermedades Neoplásicas (INEN) el régimen de elección habitual para pacientes con el primer episodio febril con tumores sólidos y neutropenia de corta duración, es la asociación de gentamicina más cefalotina. Con el efecto de comparar la eficacia y toxicidad de un régimen de monoterapia con cefotaxima con este régimen combinado, llevamos a cabo un estudio prospectivo y randomizado comparando cefotaxima (1 g/8 h) versus la combinación de cefalotina (1 g/6 h) y gentamicina (4 mg/kg/día-dosis única-). Seleccionamos pacientes con tumores sólidos en el primer episodio febril que recibieron quimioterapia y desarrollaron neutropenia menor de 1000 neutrófilos/mm3. Con una duración esperada menor de 10 días. Se incluyeron 64 pacientes en el brazo de cefotaxima y 72 en el de cefalotina-gentamicina. El estudio se llevó a cabo entre mayo de 1993 hasta junio de 1994. La tasa de respuestas para el grupo de pacientes tratados con cefotaxima fue 75 por ciento y para el grupo tratado con cefalotina-gentamicina 69 por ciento. Las tasas de respuestas completas en los pacientes con infecciones microbiológicamente documentadas fueron 65.5 por ciento para el brazo de cefotaxima y 63.4 por ciento para el brazo de cefalotina-gentamicina. Los índices de falla fueron 23 por ciento para los pacientes incluidos en el brazo de cefotaxima y 30 por ciento para los pacientes tratados con cefalotina-gentamicina. No se demostró diferencias significativas en los índices de respuesta entre los dos brazos de tratamiento. No observamos efectos tóxicos secundarios que obligaran a suspender el tratamiento en ninguno de los dos esquemas. En conclusión: los índices de respueta obtenidos con los dos esquemas de tratamiento son adecuados en nuestro medio para la población de pacientes portadores de tumores sólidos que reciben quimioterapia y presenten un efecto infeccioso durante un período de neutropenia menor de 10 días. La combinación cefalotina-gentamicina requiere no sólo de un esquema posológico de mayor complejidad sino que también tiene una toxicidad potencialmente mayor y requiere de monitorización estrecha. La eficacia terapéutica fue mayor en el grupo que recibió cefotaxima, diferencia que no alcanzó significación estadística

Metopimazina en la prevención de la náusea y el vómito, inducido por quimioteapia a base de cisplatino en múltiples dosis / Metopimazine in prevention of nausea and vomiting chemoterapy induced (cisplatin)

Entre abril de 1993 y marzo 1994 llevamos a cabo el presente estudio con el fin de evaluar la eficacia de la metopimazina en la prevención de la emesis inducida por regímenes de platino administrados en cinco días. La metopimazina es un derivado fenotiacínico con moderada actividad antiemética. Este fue un estudio abierto, prospectivo y randomizado. Comparamos dos forma de administración de metopimazina: Régimen A: 25 mgr., 6 hr/días 1-5 EV, Régimen B: 50 mgr. antes y 4 horas después de la dosis de cisPlatino días 1-5 EV. Se utilizó además como parte de la antiemesis en ambos brazos de tratamiento: dexametasona 12 mgrs., clorfeniramina 8 mgr. y diazepán 10 mgrs. Todos los pacientes estuvieron hospitalizados. Ingresaron 70 pacientes de los cuales fueron evaluables 69. El promedio de edad fue 34.3 años (R: 16-63). La relación M/F 37/32. La distribución de neoplasias fue: testículo (40), cáncer de cérvix (21), tumores germinales del ovario (6), tumores germinales extragonadales (2). Ninguno tuvo metástasis hepática, ni al SNC; al ingreso 27 pacientes recibieron quimioterapia (Qt) por primera vez y el resto entre 2 a 5 cursos de Qt. Los esquema utilizados fueron: BEP (37 cursos), BIP (21 cursos), PEI (10 cursos). No encontramos diferencias en la distribución por edad, sexo, neoplasia, esquema de quimioterapia y número de cursos de quimioterapia recibidas entre los brazos de tratamiento. El 29 por ciento (95 por ciento CI 18.3-39.7) de los pacientes tuvieron control absoluto de las náuseas y el 24.6 por ciento tuvieron control absoluto de los vómitos durante los 5 días de tratamiento. Uno de nuestros pacientes incluido en el brazo B, fue retirado del estudio por haber presentado un evento de hipotensión y alteración de conciencia al iniciarse la administración de metopimazina. No se demostraron otros efectos adversos. Conclusión: metopimazina en la forma intravenosa puede ser una alternativa en la prevención de la náusea y el vómito inducidos por quimioterapia a base de cisPlatino. Se propone un estudio comparativo con otros regímenes considerados de uso estándar para comparar sus resultados

[Lymphomas of the gastrointestinal tract: a neoplastic disease of underdevelopment]. / Linfomas del tracto gastrointestinal: una enfermedad neoplásica del subdesarrollo.

458/3,495 malignant lymphomas seen at the Instituto de Enfermedades Neoplásicas between 1965-1992, had primary extranodal disease in the GI tract. This is one of the largest institutional series reported, which would suggest that this is a relatively frequent malignancy in Peruvian population. Fifty per cent of cases had a primary in the small bowel and 38.9 per cent in the stomach. The age at presentation, the clinical picture and the location at the intestine show similarities with the so called Mediterranean lymphoma. Cases were classified according to the TNM system, and patients in stages I-II were surgically resected; 80 per cent of them were alive and free of disease at 5 years. Gastric lymphomas with inoperable disease were treated with chemotherapy with a 5-year survival of 50 per cent.

An elevated maternal serum alpha-fetoprotein leading to the diagnosis of an immature teratoma.

A case report is presented of a woman with a maternal serum alpha-fetoprotein 17.46 multiples of the median (MOM), who was found to have an ovarian immature teratoma. It is suggested that patients who present with a maternal serum alpha-fetoprotein value greater than 9 multiples of the median receive a more comprehensive evaluation remembering that the alpha-fetoprotein in the adult can be a tumor marker.

Infecção perinatal pelo citomegalovirus em hospital publico do municipio de Sao Paulo: estudo prospectivo / Perinatal infection due to cytomegaloviruses in a public hospital of the municipality of Säo Paulo: a prospective study

Com o objetivo de se avaliar a magnitude da infeccao perinatal pelo citomegalovirus em hospital publico do municipio de Sao Paulo, os autores acompanharam prospectivamente 98 recem-nascidos ete o quarto mes de vida. Amostras de urina foram coletadas ao nascimento e posteriormente a cada mes, para inoculacao em tubos contendo fibroblastos humanos. Amostras de sangue foram coletadas ao nascimento, no segundo e quarto mes de vida para pesquisa de anticorpos IgM especificos para o CMV, pelo metodo de imunofluorescencia indireta. Dos 37 recem-nascidos que foram acompanhados ate o quarto mes de vida, 9 se infectaram neste periodo, com diagnostico feito pelo isolamento do CMV. O risco de aquisicao da infeccao pelo citomegalovirus no periodo perinatal estimado pela tabua de sobrevivencia foi de 30,9 por cento. A pesquisa de anticorpos IgM por imunofluorescencia so permitiu tal diagnostico em 2 casos (8,1 por cento). A diferenca observada entre os dois metodos foi estatisticamente significante (p = 0,015). O estudo da prevalencia de anticorpos IgG pelo ensaio imunoenzimatico nas maes das criancas mostrou taxas de 92,7 por cento. Nao se isolou CMV nas amostras de leite materno, coletadas mensalmente ate o terceiro mes de lactacao...

Prognostic factors in gestational trophoblastic tumors: a proposed new scoring system based on multivariate analysis.

All 1391 patients treated for gestational trophoblastic tumors (invasive mole and choriocarcinoma) at the John I. Brewer Trophoblastic Disease Center of Northwestern University between 1969 (when use of combination chemotherapy for initial treatment of high-risk disease came into general use) and 1988 were evaluated. Univariate and multivariate analyses were used to determine the relative importance of prognostic factors with respect to survival. The overall cure rate was 93% (363/391): 100% for 223 patients with nonmetastatic disease and 83% for 168 patients with metastatic disease. The only patients who died had a clinicopathologic diagnosis of metastatic choriocarcinoma. In addition to presence of metastasis (83% vs 100%, p less than 0.0001) and diagnosis of choriocarcinoma (67% vs 100%, p less than 0.0001), number of metastases (47% if greater than 8 vs 92% if less than or equal to 8, p less than 0.0001), metastases to sites other than the lung or vagina (52% vs 91%, p = 0.0002), and previous failed chemotherapy (46% vs 84%, p = 0.0014) demonstrated independent significant effects on survival in patients with metastatic disease. A Brewer score, based on our multivariate analysis of survival in patients with metastatic disease, provided predictability of outcome (likelihood ratio chi 2 statistic, chi 2 = 49.8) comparable to that with the World Health Organization score (chi 2 = 45.3), both of which, in turn, were better predictors than either the traditional Hammond clinical classification system (chi 2 = 34.4) or the International Federation of Gynecology and Obstetrics stage (chi 2 = 22.9).

Chromosome abnormalities in selected newborn infants with malformations in Brazil.

Between 1982 and 1985, 109 infants were referred for cytogenetic examination out of a population of 73,192 liveborn infants from eight maternity hospitals surveyed by the ECLAMC/MONITOR program. Thirty-one of the children had a chromosome abnormality different from trisomy 21. Considering the total population surveyed, trisomy 18 was detected in 1:6,099; trisomy 13 was seen in 1:24,397 and unbalanced rearrangements were found in 1:7,319 infants. Those rates were not significantly different from the expected ones, as compared to previous cytogenetic surveys of consecutive births. We concluded that most chromosome abnormalities associated with congenital malformations can be detected at low cost, provided there is a high accuracy of clinical examination and referral criteria, as well as close cooperation between pediatricians and geneticists.

[Combined chemotherapy with the FEM protocol in advanced gastric cancer]. / Quimioterapia combinada con el esquema FEM en cáncer gástrico avanzado.

Thirty one patients with diagnosis of Gastric Cancer were admitted in this study. Median age was 71 years (range 24-82). Twenty two were male. No one had previous chemotherapy. Functional capacity was 0-1 in 26/31 (60.6%). More common symptoms were: loss of weight 21/31 (75.1%) and abdominal pain in 13/31 (40.3%). Ten patients were Borrmann III and nine Borrmann IV. Twenty one had surgery: 12 palliative gastrectomy and 9 exploratory laparatomy. Twenty three cases were adenocarcinoma and 8 undifferentiated carcinoma. FEM regimen was administered (5 Fluoruracil 600 mg/m2/day 1 and 8, Epidoxorubicin 30 mg/m2/day 1 and Mitomycin 10 mg/m2/day 1). Ten of 24 patients (41.7%) achieved partial remission with a median survival of 10.5 months. Three patients achieved subjective response with a median survival of 6 months. Median survival for the non response was 3 months (range 2-7 months). Survival difference between responders and no responders was statistically significant. Survival among the adjuvent group was 5.7 months (range 2-16 months). One out of three patients survived without evidence of disease at the end of this study. Twenty three patients died and 5 were lost to follow up. Alopecia was the most common secondary effect in 74%, nausea and vomiting in 60% and leukopenia below 3000 x mm3 in 54%. Cardiotoxicity was not documented in any case.