Metformin and blood cancers

Type 2 diabetes mellitus and cancer are correlated with changes in insulin signaling, a pathway that is frequently upregulated in neoplastic tissue but impaired in tissues that are classically targeted by insulin in type 2 diabetes mellitus. Many antidiabetes treatments, particularly metformin, enhance insulin signaling, but this pathway can be inhibited by specific cancer treatments. The modulation of cancer growth by metformin and of insulin sensitivity by anticancer drugs is so common that this phenomenon is being studied in hundreds of clinical trials on cancer. Many meta-analyses have consistently shown a moderate but direct effect of body mass index on the incidence of multiple myeloma and lymphoma and the elevated risk of leukemia in adults. Moreover, new epidemiological and preclinical studies indicate metformin as a therapeutic agent in patients with leukemia, lymphomas, and multiple myeloma. In this article, we review current findings on the anticancer activities of metformin and the underlying mechanisms from preclinical and ongoing studies in hematologic malignancies.

Miastenia gravis y su asociación con trastornos linfoproliferativos: casos clínicos / Myasthenia gravis and its association with lymphoproliferative disorders: a case series

Myasthenia gravis (MG) is a rare autoimmune disease of the neuromuscular junction. It is characterized by variable weakness and excessive fatigability of skeletal muscles. In the last few years, numerous reports have been published showing the association between autoimmune diseases, such as systemic erythematous lupus or rheumatoid arthritis, with lymphoid neoplasias. The association between MG and lymphoid neoplasia seems to be less frequent. To analyze this association we reviewed the MG patients in the Department of Neurology, Hospital Salvador of Santiago, Chile. During a three-year period we identified four patients who developed different lymphoproliferative disorders: two with B-cell lymphoma, one with chronic lymphocytic leukaemia and one plasmacytoma with an associated amyloidosis. The MG was generalized but mild, all cases classified as type IIa according to the definition proposed by the MG Foundation of America. The neoplasia appeared two to 36 years after the onset of MG. These cases provide additional evidence of the association between MG and lymphoproliferative disorders.

Plasmocitoma solitário do osso: relato e discussão de um caso de acometimento incomum / Solitary plasmacytoma of the bone: report and discussion of a case of involvement unusual

Plasmocitoma é uma proliferação clonal e neoplásica de células plasmáticas. Paciente, sexo feminino, 51 anos, sem história de tabagismo e consumo de álcool mostrou leve inflamação e inchaço na gengiva vestibular do dente 48 com mobilidade grau I. Radiograficamente verificou--se a presença de imagem radiolúcida multilocular na região do ângulo mandibular. Durante a cirurgia confirmou-se a presença de uma lesão destacável, friável, contendo líquido acastanhado e purulento em seu interior. A lesão foi totalmente removida em conjunto com o dente 48. Ao exame histopatológico (HE), foi identificada uma neoplasia maligna caracterizada pela proliferação de células plasmocitoides pleomórficas com núcleos intensamente hipercromáticos. Estas células exibiam núcleo basofílico com notável distribuição irregular da cromatina. Para confirmar o diagnóstico procedeu a avaliação imuno-histoquímica, que mostrou positividade para Plasm cell e Lambda e negatividade para Kappa. Com base nestes resultados concluiu-se o diagnóstico de plasmocitoma solitário do osso.

Plasmacytoma is a clonal proliferation and neoplastic of plasma cells. Patient, female, 51 years old, no history of smoking and alcohol consumption showed mild inflammation and swelling in the oral gingiva of the tooth 48 with mobility grade I. Radiographically verified the presence of radiolucent and multilocular image in the region of the mandibular angle. During surgery confirmed the presence of a lesion detachable, friable, browned and containing purulent fluid inside. This lesion was removed fully together with the tooth 48. Histopathology (HE) was identified a malignant neoplasm characterized by proliferation of plasmacytoid cells intensely hyperchromatic and pleomorphic. These cells exhibited large basophilic nucleus with remarkable irregular chromatin distribution. To confirm the diagnosis proceeded immunohistochemistry evaluation which showed positivity for Plasma Cell and Lambda and negativity of Kappa. Based on these findings concluded the diagnosis of plasmacytoma.

Discomfort and unease of the subject in the interpretation movement of a Tuberculosis questionnaire / O desconforto e inquietação do sujeito em seu movimento de interpretação de um questionário sobre a tuberculose / Malestar e inquietud del sujeto en su movimiento de interpretación de un cuestionario sobre la Tuberculosis

OBJECTIVE: to propose a discussion about traces of the derivation of meanings, the subjects' discomfort and resistance when they are called upon to signify a questionnaire on the transfer of the Directly Observed Treatment of Tuberculosis policy, in order to reveal the limitations of closed questionnaires in the subject's interpretation process. METHOD: health professionals from a Primary Health Care Unit in Porto Alegre/RS were interviewed and some excerpts from the interviews were investigated in the light of French Discourse Analysis. RESULTS: resistance, discomfort, slips, silencing and the derivation of meanings were observed in the subjects' interpretation. CONCLUSION: the interpretation process has multiple meanings and varies from subject to subject. The questionnaire, as a prototype of the logically stabilized universe, fails when the purpose is to control the interpretation. Its isolated use in health research can entail inexactness or incompleteness of the collected data. Therefore, its use associated with qualitative research techniques is ideal. .

OBJETIVO: propor uma discussão a respeito de vestígios da derivação de sentidos, do desconforto e resistência dos sujeitos, quando convocados a significar um questionário referente à transferência da política do tratamento diretamente observado da tuberculose, de modo a revelar as limitações de questionários fechados, quando se trata do processo interpretativo do sujeito. MÉTODO: profissionais de saúde de uma Unidade de Atenção Primária de Saúde de Porto Alegre, RS, foram entrevistados e alguns recortes das entrevistas examinados à luz da Análise de Discurso de linha francesa. RESULTADOS: observou-se a resistência, o incômodo, o deslizamento, o silenciamento e a derivação dos sentidos no ato de interpretação dos sujeitos. CONCLUSÃO: o processo de interpretação é polissêmico e varia de sujeito para sujeito. O questionário, enquanto um protótipo do universo logicamente estabilizado, falha quando o propósito é o de controlar a interpretação. O seu uso de forma isolada, em pesquisas em saúde, pode incorrer em inexatidão ou incompletude dos dados obtidos, sendo ideal a sua utilização associada a técnicas qualitativas de pesquisa. .

OBJETIVO: proponer una discusión respecto a vestigios de la derivación de sentidos, del malestar y resistencia de los sujetos cuando convocados a significar un cuestionario respecto a la trasferencia de la política del Tratamiento Directamente Observado de la Tuberculosis, de manera a revelar las limitaciones de cuestionarios cerrados cuando se trata del proceso interpretativo del sujeto. MÉTODO: profesionales de salud de una Unidad de Atención Primaria de Salud de Porto Alegre/RS fueron entrevistados y algunos recortes de las entrevistas examinados a la luz del Análisis de Discurso de línea Francesa. RESULTADOS: fueron observados la resistencia, la molestia, el deslizamiento, el silenciamiento y la derivación de los sentidos en el acto de interpretación de los sujetos. CONCLUSIÓN: el proceso de interpretación es polisémico y varia de sujeto a sujeto. El cuestionario como un prototipo del universo lógicamente estabilizado falla cuando el objetivo es el de controlar la interpretación. Su uso de forma aislada en investigaciones en salud puede llevar a datos inexactos o incompletos, siendo ideal su utilización asociada a técnicas cualitativas de investigación. .

Resección quirúrgica de plasmocitoma solitario del esternón asociado a cirugía de revascularización miocárdica: seguimiento a largo plazo / Surgical resection of solitary plasmacytoma of the sternum associated with coronary artery bypass grafting surgery: long-term follow up

The plasmacytomas tumors are caused by a malignant proliferation of plasma cells. Primary tumors of the sternum are uncommon, being this kind of tumors exceptional. We present the case of a 72 years old man with a sternal plasmacytoma, that after 2 years of receiving radiotherapy treatment, had tumor growth, associated with coronary artery disease. In this case, surgical resection of solitary sternal plasmacytoma was performed associated with coronary artery bypass grafting surgery. The chest wall reconstruction was done with a polypropylene mesh. More than 5 years long-term follow up was completed and the patient is asymptomatic and free of malignant proliferation of plasma cells.

Los plasmocitomas son tumores originados por una proliferación neoplásica de células plasmáticas. Los tumores primarios de esternón son infrecuentes, siendo los plasmocitomas solitarios de esternón excepcionales. Presentamos el caso de un hombre de 72 años con un plasmocitoma esternal que después de 2 años post tratamiento con radioterapia presentó aumento de tamaño tumoral asociado a enfermedad coronaria. Se realizó resección quirúrgica del plasmocitoma solitario del esternón asociada a cirugía de revascularización miocárdica con 4 bypass coronarios. La pared torácica fue reconstituida con una malla de polipropileno. A más de 5 años de seguimiento el paciente se encuentra asintomático cardiovascular y libre proliferación maligna de células plasmáticas.

Diagnostic dilemma in a case of early spinal tumour fracture (Plasmacytoma): a case report.

MRI findings of D12 fracture were suspicious of a pathological fracture. However, biopsy did not show any evidence of tumour. This resulted in the patient following up after one and half years with an epidural mass lesion and neurological deterioration. This paper highlights some of the MRI features of fractures associated with underlying pathology over traumatic or osteoporotic fracture.

Plasmocitoma solitario gástrico asociado a infección por Helicobacter pylori / Gastric solitary plasmacytoma associated to Helicobacter pylori infection

Los plasmocitomas solitarios gástricos son tumores infrecuentes y representan el 5 por ciento de los plasmocitomas extramoleculares. Estos presentan algunas características que los diferencian de los plasmocitomas óseos, independientemente de su localización, como son: una mayor sobrevida con terapia conservadora local, infrecuentes metástasis óseas y prolongadas remisiones. Estas condiciones de su evolución y algunas características histológicas han llevado a algunos autores a considerar un origen común con linfomas MALT de bajo grado. Al momento del diagnóstico la mayoría de los casos presenta invasión total o de la mayor parte de la pared gástrica. Los plasmocitomas pueden producir o no inmunoglobulinas y su tratamiento de elección es el quirúrgico. Presentamos un caso inusual de plasmocitoma extramedular, en un varón de 14 años, que solamente invadaría la mucosa gástrica, estaba a sociado a la presencia de Helicobacter Pilori y curó con el tratamiento indicado para su erradicación.

The POEMS syndrome

The POEMS syndrome is an unusual disorder manifesting primary as peripheral sensorimotor neuropathy in association with a monoclonal gammopathy. The importance of its recognition is that significant clinical improvement may result from localization and treatment of the underlying plasma cell tumour.

Extrusäo de prótese de acrílico em artrodese cervical anterior / Extrusion of acrylic prosthesis in anterior cervical arthrodesis

Relato de caso de extrusäo pela boca de acrílico usado em artrodese cervical anterior no tratamento cirúrgico de fratura-esmagamento de vértebra cervical secundária a plasmocitoma