PHLPP-1 negatively regulates Akt activity and survival in the heart.

RATIONALE: The recently discovered PHLPP-1 (PH domain leucine-rich repeat protein phosphatase-1) selectively dephosphorylates Akt at Ser473 and terminates Akt signaling in cancer cells. The regulatory role of PHLPP-1 in the heart has not been considered. OBJECTIVE: To test the hypothesis that blockade/inhibition of PHLPP-1 could constitute a novel way to enhance Akt signals and provide cardioprotection. METHODS AND RESULTS: PHLPP-1 is expressed in neonatal rat ventricular myocytes (NRVMs) and in adult mouse ventricular myocytes (AMVMs). PHLPP-1 knockdown by small interfering RNA significantly enhances phosphorylation of Akt (p-Akt) at Ser473, but not at Thr308, in NRVMs stimulated with leukemia inhibitory factor (LIF). The increased phosphorylation is accompanied by greater Akt catalytic activity. PHLPP-1 knockdown enhances LIF-mediated cardioprotection against doxorubicin and also protects cardiomyocytes against H(2)O(2). Direct Akt effects at mitochondria have been implicated in cardioprotection and mitochondria/cytosol fractionation revealed a significant enrichment of PHLPP-1 at mitochondria. The ability of PHLPP-1 knockdown to potentiate LIF-mediated increases in p-Akt at mitochondria and an accompanying increase in mitochondrial hexokinase-II was demonstrated. We generated PHLPP-1 knockout (KO) mice and demonstrate that AMVMs isolated from KO mice show potentiated p-Akt at Ser473 in response to agonists. When isolated perfused hearts are subjected to ischemia/reperfusion, p-Akt in whole-heart homogenates and in the mitochondrial fraction is significantly increased. Additionally in PHLPP-1 KO hearts, the increase in p-Akt elicited by ischemia/reperfusion is potentiated and, concomitantly, infarct size is significantly reduced. CONCLUSIONS: These results implicate PHLPP-1 as an endogenous negative regulator of Akt activity and cell survival in the heart.

Dose received by the sentinel node volume during tangential radiation therapy to the breast.

The dose received by the sentinel node (SN) volume during tangential irradiation was studied on 31 patients. Of the 50Gy prescribed to the breast volume 95% of the SN volume received from 6.9 to 27.5Gy. In 19 patients the SN volume overlapped with the tangential field deep side.

Should elderly non-small-cell lung cancer patients be offered elderly-specific trials? Results of a pooled analysis from the North Central Cancer Treatment Group.

PURPOSE: To answer the question, "should elderly non-small-cell lung cancer patients be offered elderly-specific trials?" PATIENTS AND METHODS: The North Central Cancer Treatment Group (NCCTG) performed a pooled analysis of elderly patients who participated in elderly-specific trials (required age > or = 65 years) and age-unspecified trials (required age > or = 18 years). Between 1998 and 2000, all NCCTG non-small-cell lung cancer (NSCLC) patients with incurable cancer, age > or = 65 years, and receiving first-line chemotherapy were included. A total of 118 elderly patients participated in elderly-specific trials, and 108, in age-unspecified trials. Demographics and outcomes were compared based on trial type. RESULTS: The median age of elderly patients in elderly-specific trials was greater: median (range): 73 years (65 to 87) and 70 years (65 to 85), respectively (P < .001), as was the percentage older than 80 years: 17% and 3%, respectively (P = .0008). Median survival times were 232 and 302 days, respectively (P = .08). After adjustment for baseline age, Eastern Cooperative Oncology Group performance score, cancer stage, and body mass index, this survival difference was not statistically significant (hazard ratio = 1.25; P = .16). Grade 3 or worse nonhematologic adverse event rates were greater in age-unspecified trials (81% v 57%, respectively; P < .001), as were grade 3 or worse hematologic events (68% v 10%, respectively; P < .001). CONCLUSION: Elderly patients in NSCLC elderly-specific trials suffered lower rates of severe adverse events with no statistically significant differences in survival. It seems that elderly-specific trials are providing quality care and helping to define optimal cancer therapy in the elderly, particularly among the "oldest of the old."

Efficacy and safety analysis of epoetin alfa in patients with small-cell lung cancer: a randomized, double-blind, placebo-controlled trial.

PURPOSE: This randomized, double-blind, placebo-controlled trial (N93-004) evaluated the effects of epoetin alfa on tumor response to chemotherapy and survival in patients with small-cell lung cancer (SCLC). PATIENTS AND METHODS: Adult patients with hemoglobin < or = 14.5 g/dL starting chemotherapy received epoetin alfa 150 U/kg or placebo subcutaneously 3 times weekly until 3 weeks after completion of chemotherapy. Survival was assessed for 3 years. The primary end point was the proportion of patients with complete or partial response after three chemotherapy cycles. RESULTS: The trial was terminated prematurely after 224 of a projected 400 patients were accrued. Baseline characteristics were similar between groups. Epoetin alfa and placebo patients (n = 109 and n = 115, respectively) had mean baseline hemoglobin of 12.8 g/dL and 13.0 g/dL, respectively. Overall tumor response was similar between the epoetin alfa and placebo groups after three chemotherapy cycles (72% and 67%, respectively; 95% CI of difference, -6% to 18%) and after completion of chemotherapy (60% and 56%, respectively; 95% CI of difference, -9% to 17%). Epoetin alfa and placebo groups had similar median overall survival (10.5 and 10.4 months, respectively) and overall mortality (91.7% and 87.8%, respectively; hazard ratio, 1.172; 95% CI, 0.887 to 1.549; P = .264). Hemoglobin was maintained in the prechemotherapy range in epoetin alfa patients, but decreased substantially in placebo patients. Fewer epoetin alfa patients than placebo patients required transfusion. CONCLUSION: These results suggest that in newly diagnosed patients with SCLC epoetin alfa does not affect tumor response to chemotherapy or survival. However, the early trial closure makes these conclusions preliminary.

Validation of neuroradiologic response assessment in gliomas: measurement by RECIST, two-dimensional, computer-assisted tumor area, and computer-assisted tumor volume methods.

Significant limitations are associated with the use of standard radiographic measurements as indicators of response in glioma therapy trials. The Response Evaluation Criteria in Solid Tumors (RECIST) were recently introduced in an attempt to standardize and simplify assessment of response to treatment in cancer clinical trials. However, their applicability in gliomas has been assessed in only a very small number of patients. Our aim was to validate radiographic response assessment in newly diagnosed glioma patients. Sixty-seven newly diagnosed glioma patients participating in nine North Central Cancer Treatment Group glioma trials were included; 565 MRI scans were analyzed. All scans were performed with the same technique. Kappa statistics were calculated to determine agreement between assessment methods. Cox proportional hazards analyses and time-dependent Cox models were used to assess the association between different measurement methods and overall survival. Results showed agreement between the one-dimensional (1D) and two-dimensional (2D) measurements both for T2 images and for gadolinium-enhanced images. Comparison of duration of response and time to progression as assessed by eight different methods showed similarity in response assessments by 1D, 2D, area, and volume gadolinium measurements. In contrast, time to progression was significantly shorter when assessed by 1D-T2 or 2D-T2 images as compared to area-T2 or volume-T2 images. This set of data indicates that RECIST could be used instead of 2D imaging for response assessment in newly diagnosed glioma trials. Overall, responses as determined by any tumor measurement method did not correlate with patient survival for either enhancing or nonenhancing tumors, although the small number of responders limits definitive conclusions. Time-dependent Cox models demonstrated that, in contrast to the case of nonenhancing tumors, progression as determined by 1D, 2D, area, and volume measurements in gadolinium-enhanced images was predictive of survival of patients with enhancing tumors.

Factores Predictivos de Compromiso Axilar en ocasión de Ganglio Centinela Positivo en Cáncer de Mama Temprano / Predictive Factors of Axillary Compromise on the Occasion of Positive Sentinel Lymph Node in Early Breast Cancer

Introducción: Se ha demostrado en diversos protocolos que, en gran proporción de casos con cáncer de mama en estadíos tempranos y ganglio centinela positivo, no se observa enfermedad metastásica en ganglios linfáticos no centinelas (GNC). A raíz de esto es que se han descripto diferentes factores predictores de metástasis axilar. Esto nos motivó a realizar el presente trabajo. Objetivo: Analizar diferentes factores anatomopatológicos y su influencia en el compromiso metastásico de los ganglios no centinela. Material y método: Se estudiaron casos de cáncer de mama estadíos tempranos (T1-T2) con ganglio centinela positivo y seguidas de vaciamiento axilar, operadas en IMGO entre febrero del año 2000 y diciembre de 2012. De la muestra total se identificaron dos grupos: GnC negativos y GnC positivos. Analizamos diferentes variables anatomopatológicas vinculadas a cada grupo y calculamos su grado de significancia. Finalmente, analizamos estas variables en una tabla de análisis multivariado. Resultados: De una muestra de 205 casos (20,8% del total de ganglios estudia- dos en ese período de tiempo), el 48.3% (n=99) presentaba metástasis solo en el GC. De todas las características anatomopatológicas de mal pronóstico analizadas encontramos que el tamaño tumoral 2, el subtipo lobulillar y la invasión linfovascular tuvieron correlación significativa con la cantidad de GnC comprometidos. En el análisis multivariado encontramos tres factores predictivos, la invasión linfovascular, el tamaño de la metástasis en el ganglio centinela y el número de ganglios centinelas comprometidos. Conclusiones: Los factores independientes de compromiso de ganglios no centinela (GNC) en nuestra serie fueron: la invasión linfovascular, el tamaño de la metástasis en el ganglio centinela y el número de ganglios centinelas comprometidos

Introduction: It has been shown in various protocols that pathologically negative nonsentinel lymph node (NSN) disease, is observed in the rest of the armpit in a large proportion of cases with early stage breast carcinoma and positive sentinel node. As a result of this, different pathological predictors of axillary metastasis have been described. This motivated us to carry out the present work. Objetive: To analyze different pathological factors and their influence on the metastatic involvement of nonsentinel nodes. Material and method: Early stage breast cancer cases (T1-T2) with positive sentinel node and axillary emptying, operated on in IMGO between February 2000 and December 2012, were studied. Two groups were identified from the total sample: negative GnC and positive GnC, and analyzed diffe- rent pathological variables associated with metastatic nonsentinel nodes, calculating their significance. Finally, we analyze these variables in a multivariate analysis table. Results: From a sample of 205 cases (20.8% of the total lymph nodes studied), 48.3% (n = 99) had metastasis only in the SN. Of all the anatomo-pathological characteristics analyzed, we found that tumor size two, lobular subtype, and lymphovascular invasion had a significant correlation with the amount of compromised non-sentinel node (NSN). In the multivariate analysis, we found three predictive factors: lymphovascular invasion, the size of the metastasis in the sentinel node and the number of positive sentinel nodes. Conclusions: The independent factors of nonsentinel node involvement (NSN) in our series are: lymphovascular invasion, the size of the sentinel node metastasis, and the number of sentinel nodes involved

[Breast cancer. current use of the extra-pleural exploration of the internal mammary chain]. / Cáncer de mama: alcances actuales y vigencia de la exploración estadificatoria extra-pleural de la cadena mamaria interna.

The interest to know the Internal Mammary Chain (IMC) Involvement , is that it is a lymphatic filter as primary as the axilla. Anatomic-surgical fundaments, were presented for their exploration. Fifty (50) pectus-sternal, analizing the number of nodes (average 9,7 per specimen), located preferably in the three first intercostal spaces, were studied. In the second phase IMC with a staging criterion and extrapleural way, resecting 1 or 2 costal cartilages, were explored. In 78 patients, pathological-anatomy correlation between IMC and the axilla, we observed 6% positive IMC with negative axilla. More recently in the era of the setinel node, we have explored IMC in 44 patients through intercostal spaces and without cartilages resection. In 28 patients we performed through radioisotopic way and gamma probe and in the remaining 16, through anatomic search if the tumor was either upper mid or lower. The most frequent spaces explored were in the 2nd and 3rd; 2,27 nodes average per patient. The pathological-anatomy between IMC and the axilla revealed the following results: axilla (-) IM (-): 59%; axilla (+) MI (-): 25%; axilla (+) IM (+): 11% and axilla (-)IM (+): 5%. We concluded that this is a non-aggressive method, with an excellent tolerance that allows the evaluation of another filter as primary as the axilla and that together they represent the best systemic disease prognostics. We believe that its exploration is justified in those cases in which the histological result , correlated with the axilla, allows a therapeutic approach change.

Oral vinorelbine for the treatment of metastatic non-small cell lung cancer in elderly patients: a phase II trial of efficacy and toxicity.

PURPOSE: Before now oral vinorelbine has not yet been tested in a cohort of elderly, advanced non-small cell lung cancer patients, even though the intravenous form of this drug provides a reasonable therapeutic option for this group. This trial was conducted to determine the tumor response rate and toxicity profile of oral vinorelbine in advanced non-small cell lung cancer patients > or = 65 years of age. PATIENT AND METHODS: Fifty-eight evaluable patients > or = 65 years of age with advanced non-small cell lung cancer were enrolled. Median age was 73 years (range: 65-87). The Eastern Cooperative Oncology Group (ECOG) performance score was 0, 1, or 2 in 29, 59, and 12% of patients, respectively. All patients had adequate organ function. Oral vinorelbine 60 mg/m2 per week was prescribed weekly as first-line therapy. RESULTS: Two patients manifested a confirmed tumor response, yielding a response rate of 3.4% (95% confidence interval (CI): 0.4, 11.9%). There were no complete responses. Median progression-free survival was 3.5 months (95% CI: 2.2, 5.4 months), and median overall survival was 7.5 months (95% CI: 5.0, 12 months). There were five deaths, one of which might have been treatment-related, and there were 10 grade 4 events. CONCLUSIONS: Oral vinorelbine, as prescribed in this trial, provides minimal activity in the treatment of advanced non-small cell lung cancer in patients > or = 65 years of age.

Impacto en la República Mexicana del Programa Extramuros de Prótesis Maxilofacial de la Facultad de Odontología UNAM de 1994 al 2018 (reseña histórica) / Impact of the UNAM Faculty of Dentistry Extramural Maxillofacial Prosthesis Program in Mexico from 1994 to 2018 (historical overview)

RESUMEN El propósito del presente escrito es hacer una reseña histórica del impacto e importancia que tienen los Programas Extramuros de la Especialidad de Prótesis Maxilofacial y para que exista un precedente narrativo documentado; así como resaltar la importancia de la atención médica que está encaminada a la rehabilitación física e incremento de la calidad de vida de los pacientes, lo cual figura en las declaraciones universales de salud pero que, debido a su alto costo, no hay una cobertura adecuada para los sistemas de salud gubernamentales; sin embargo, cuando se conjugan esfuerzos, voluntades y capacidades de diversas instituciones participantes, se puede lograr trascender y acercarse a una medicina de alto nivel.

ABSTRACT The goal of this document is to give an historical account of the importance and impact of the extramural program carried out by the UNAM Faculty of Dentistry Specialty of Maxillofacial Prosthetics to set a narrative precedent. The right of healthcare directed toward the physical rehabilitation and hence increased quality of life of patients is contained in the Article 25 of the Universal Declaration of Human Rights. However, the high cost of this type of care complicates its coverage on the part of Government health systems. But when the effort, the determination, and the capacity of various participating institutions blend, high-level medicine can reach to the most disadvantaged populations.

Segunda cirugía conservadora ante una recidiva local del cáncer de mama / Second breast conservative surgery for ipsilateral breast tumor recurrence

Introducción La mastectomía es el tratamiento estándar de la recidiva local (rl) luego de un tratamiento conservador por cáncer de mama. Para algunos centros, una segunda cirugía conservadora es una opción para un subgrupo de pacientes. Objetivos Identificar alguna variable que nos permita realizar una segunda cirugía conservadora ante una recidiva local en paciente con cáncer de mama. Material y método Estudio retrospectivo de 1.661 pacientes con cáncer de mama estadio temprano sometidas a un tratamiento conservador. Se diagnosticaron 75 recurrencias locales. En 33 casos se les realizó una segunda cirugía conservadora. Se evaluaron características clínicas, histológicas y moleculares de la recurrencia local. Resultados La edad promedio al momento de la recaída fue de 55,4 años. El tamaño tumoral promedio de la rl fue de 12 mm. Los receptores hormonales fueron positivos en el 69,8%. Durante un seguimiento promedio de 7,6 años, 9 (27,1%) pacientes presentaron una segunda recurrencia local y 5 (15,1%) murieron por enfermedad metastásica. La sobrevida global fue del 84,8%. El tiempo de intervalo promedio en el grupo libre de enfermedad fue de 103,3 meses, y el 70% de las pacientes recurrieron después de los 60 meses. En el grupo de pacientes con progresión, el 38,4% presentó la recurrencia después de los 60 meses con un intervalo promedio de 57,2 meses. Conclusiones Según nuestros resultados, el tiempo que transcurre hasta la recurrencia local es una variable a tener en cuenta para seleccionar pacientes para una segunda cirugía conservadora. Las pacientes con recurrencias posteriores a 60 meses presentaron mejor evolución.

Introduction The standard surgical treatment after breast conservative treatment (bct) for an ipsilateral breast tumor recurrence (ibtr) is salvage mastectomy. For some centers, second conservative surgery is an option for a subset of patients. Objectives Identify some variable that allows us to perform a second conservative surgery before a local recurrence in a patient with breast cancer. Materials and method Retrospective study of 1,661 patients with early stage breast cancer undergoing conservative treatment. 75 ibrt were diagnosed. In 33 cases, a second conservative surgery was performed. Clinical, histological and molecular characteristics of the ibrt were evaluated. Results Average age of 55.4 years at the time of relapse. The mean tumor size of the rl was 12 mm. The hormone receptors were positive in 69.8%. During an average follow-up of 7.6 years, 9 (27.1%) patients had a second ibrt and 5 (15.1%) died of metastatic disease. Overall survival was 84.8%. The mean interval time in the disease free group was 103.3 months, and 70% of the patients recurred after 60 months. In the group of patients with progression, 38.4% presented recurrence after 60 months with an average interval of 57, 2 months. Conclusions According to our results, the time to local recurrence is a variable to be taken into account in selecting patients for conservative management. Patients with recurrences after 60 months presented better evolution.

Irradiación parcial acelerada de mama (apbi) después de cuadrantectomía más biopsia del ganglio centinela axilar: características clínico-patológicas e inmunohistoquímicas / Accelerated partial breast irradiation (apbi) after breast conservative surgery plus sentinel node biopsy: clinical-pathological and immunohistochemical characteristics

Introducción El tratamiento estándar en estadios tempranos del cáncer de mama es la cirugía conservadora (cc) más radioterapia del volumen total mamario (wbi). Dado que la mayoría de las recidivas locales ocurren cercanas al sitio del tumor (85%) y existiendo la posibilidad de acortar tiempos de irradiación ­debido a que esta insume varias semanas­, podría no ser necesario irradiar toda la mama, sino el área donde estaba situado el tumor más margen de seguridad, lo que insume un menor tiempo. Este el fundamento de la Irradiación Parcial Acelerada Mama (apbi). Consensos internacionales proporcionan guías para administrar apbi fuera de ensayos clínicos. Objetivos El objetivo principal de este trabajo es determinar y analizar las características clinico-anatomopatológicas e inmunohistoquímicas de las pacientes que fueron operadas y luego seleccionadas para ser irradiadas con técnica de apbi con radioterapia externa con intensidad modulada guiada por imágenes (imrt). Material y método Se trata de un trabajo prospectivo, no randomizado. La muestra está constituida por las primeras 20 pacientes ingresadas al protocolo apbi. El reclutamiento se realizó entre marzo de 2012 y julio de 2014. Se analizaron las características clínico-patológicas e inmunohistoquímicas de esas pacientes luego de cc más biopsia del ganglio centinela (bgc). Resultados Media de seguimiento en meses: 37,7 (r: 22-51); edad media: 65,7 años. Tamaño tumoral medio por anatomía patológica: 12,03 mm. Media de número de ganglios centinelas extirpados: 1,7. Todos los tumores fueron unifocales. Los márgenes quirúrgicos resultaron negativos en todos los casos. Tumores Luminal A: 19 pacientes; tumores Luminal B: 1 paciente. Hormonoterapia adyuvante en todas las pacientes. Control locorregional: 100%. Conclusiones A pesar del corto tiempo de seguimiento y del escaso número de pacientes, este análisis sugiere que la apbi en el lecho del tumor marcado intraoperatoriamente con fiduciales de titanio es factible para pacientes que reúnen los criterios estrictos clínico-patológicos e inmunohistoquímicos acordes con las guías internacionales.

Introduction The standard conservative treatment for early stage breast carcinomas is the breast conservative surgery plus whole breast irradiation. Because most local recurrences occur close to the site of the primary tumor (80- 90%) and the possibility of shortening the irradiation times ­because it takes several weeks­, it may not be necessary to irradiate the entire breast, but the area where the tumor was located plus a margin of safety in less time. This is the basis of Accelerated Partial Irradiation of the Breast Objectives Determination and analysis of clinical-pathological and immunohistochemical characteristics in patients selected for Accelerated Partial Breast Irradiation (apbi) performed by imrt + igrt technique after breast conservative surgery plus sentinel node biopsy. Materials and method A prospective, non-randomized study of the first 20 patients performed apbi strictly following the recommendations of international consensus. It was initiated in March 2012 until July 2014. Clinical-pathological and immunohistochemical characteristics of these patients were analyzed to be selected for apbi, after breast conservative surgery plus sentinel node biopsy. Results Median follow up: 37.7 months (r: 22-51); average age: 65.7 years. Mean tumor size by pathological analysis: 12.03 mm. Mean number of sentinel nodes removed: 1.7. All tumors were unifocal. Negative surgical margins in all cases. Luminal A tumors: 19 patients; Luminal B tumors: 1 patient. Adjuvant hormone therapy in all patients. Loco-regional control: 100%. Conclusions Despite the short time of follow up and the small numbers of patients, this analysis suggests that apbi performed by imrt + igrt technique added to the placement of fiduciary marks at the time of surgery is feasible for highly selected patients who meet the clinical-pathological and immunohistochemical selection criteria according to international guidelines

Rehabilitación protésica integral en ausencia de maxilar. Reporte de un caso / Comprehensive prosthetic rehabilitation in absence of the maxilla. Clinical case report

La prótesis maxilofacial estudia dos importantes ramas; la bucal y la facial. En relación a la bucal, algunos defectos originados por maxilectomías unilaterales o bilaterales ya sean parciales o totales en el tratamiento del cáncer de cabeza y cuello; dejan secuelas estructurales, funcionales y psicológicas; estableciendo así la necesidad de una rehabilitación protésica integral; para lo cual son utilizadas las prótesis obturadoras de paladar, que ofrecen así al paciente su reintegración a la sociedad con una mejor calidad de vida. En el presente caso clínico, el obturador es colocado en ausencia completa de maxilar, obteniendo como resultados el restablecimiento de las funciones y estética aceptables.

Maxillofacial prosthesis studies comprehend two main branches: oral and facial. In the mouth, some defects caused by unilateral or bilateral maxillectomies performed as part of head and neck cancer treatment, leave structural, functional and psychological sequels. This gives rise to the need of a comprehensive prosthetic rehabilitation. To this end, palate prostheses are used, which offer patients' reinsertion into society as well as better quality of life. In the present clinical case, the shutter was placed in a situation of complete absence of the maxilla, achieving thus function reestablishment and acceptable aesthetics.

Manejo protésico-quirúrgico del paciente hemimandibulectomizado / Prosthetic and surgical treatment of patient previously subjected to hemi-mandibulectomy

Por lo general las mejores opciones de rehabilitación para el paciente hemimandibulectomizado quedan fuera del alcance del poder adquisitivo de la mayoría de ellos, esto hace que el abordaje reconstructivo protésico- quirúrgico para éstos se tenga que restringir al uso de materiales más accesibles tales como el clavo de Kirschner y las prótesis inmediatas de metilmetacrilato, siendo estas últimas las más recomendables por su bajo costo, fácil manejo, por evitar la rotación mandibular y por prevenir la atrofia de los tejidos blandos. Se reporta el caso clínico de un paciente masculino de 25 años de edad el cual ingreso al Servicio de Oncología del Hospital General de México debido a la presencia de un aumento de volumen en el área correspondiente al ángulo mandibular izquierdo, diagnosticándose microscópicamente como un tumor mixto maligno (diagnóstico histopatológico final). Se decidió hacer la hemimandibulectomía de la zona involucrada, con reconstrucción del segmento óseo perdido mediante la colocación de una prótesis inmediata implantada confeccionada con metilmetacrilato de metilo termocurable, la cual fue fijada con alambre para osteosínteis aproximadamente a 3 y 6 milímetros por arriba de la cortical inferior mandibular en ambos bordes de sección.

In general terms, the best rehabilitation options for patients previously subjected to hemi-mandibulectomy are far beyond their financial possibilities. For this reason surgical-prosthetic reconstructive approach is mainly restricted to the use of more affordable materials such as Kirschner wire and methyl-methacrylate immediate prostheses. The latter are widely recommended due to their low cost, ease of handling, and because they prevent soft tissue atrophy. A clinical case is reported in this article: 25 year old male patient seeking treatment at the Oncology Service of the Hospital General de Mexico (Mexico's General Hospital) due to the presence of a volume increase in the area of the left mandibular angle. Microscopic analysis revealed presence of mixed malign tumor ( final histopathological diagnosis). It was decided to perform hemi-mandibulectomy of involved area, with reconstruction of lost bone segment by means of positioning an immediate methyl methacrylate prosthesis (thermosetting methyl). The prosthesis was fixated with osteosynthesis wire at both resection margins, at 3 mm above the cortex.

Elaboración de una sobredentadura modificada para paciente con secuelas quirúrgicas de labio y paladar hendidos: reporte de un caso / Construction of a modified overdenture for patient with cleft lip and palate surgery sequels: case report

La rehabilitación de pacientes con secuelas de labio y paladar hendidos todavía sigue siendo un reto para los profesionales de la salud, tanto desde el punto de vista quirúrgico como del protésico. Estos pacientes necesitan de un tratamiento multidisciplinario que ofrezca la mejor alternativa de rehabilitación para el paciente. En este artículo presentamos la rehabilitación integral de un paciente con secuelas de labio y paladar hendidos (pérdida de la dimensión vertical, colapso nasal, defecto del labio superior, discrepancia del maxilar y la mandíbula, fístulas oro-antrales y ausencia de incisivos anteriores superiores) por medio de una sobredentadura modificada (sin hacer tratamiento endodóntico). El resultado estético y funcional con este tipo de tratamiento fue satisfactorio y se realizó en un periodo corto de tiempo.

Rehabilitation of patients suffering from cleft lip and palate surgery sequels is still a challenge for health professionals related to both surgical and prosthetic fields. These patients require a multi-disciplinary treatment able to offer the best possible rehabilitation alternative. The present article presents a case of total rehabilitation of a patient with sequels to cleft lip and palate surgery (loss of vertical dimension, nasal collapse, upper lip defect, upper and lower jaw discrepancies, oro-antral fistulae, absence of upper incisors) by means of a modified over-denture (with absence of endodontic treatment). Esthetic and functional results achieved with this treatment were satisfactory as well as achieved in a short period of time.

Transaxillary breast augmentation: two breast cancer patients with successful sentinel lymph node diagnosis.

In recent years, some surgeons have been warned of possible problems with sentinel lymph node diagnosis (SLND) for patients who have undergone transaxillary breast augmentation (TBA), although no scientific studies support this warning. The authors report two additional cases of breast cancer in which the SLND was successfully performed for patients with previous TBA. The surgical anatomy of the axilla, the groups of lymph nodes, and a personal way of performing TBA are described. Five other reports concerning the same issue are thoroughly discussed. Four of these are clinical in vivo reports, and one is a cadaver study. The four in vivo studies and what we are reporting now clearly demonstrate that what was said regarding possible problems in the SLND after TBA was not founded on clinical research and contradicts these five clinical findings.

Carcinoma hepatocelular en el Hospital Nacional Rosales entre los años 2009 y 2014 / Hepatocellular carcinoma at the Rosales National Hospital between 2009 and 2014

El carcinoma hepatocelular (CHC), es el cáncer primario de hígado más frecuente. Entre los factores de riesgo están la infección viral por hepatitis B y C, la cirrosis alcohólica, y la ocasionada por infiltración grasa (Diabetes mellitus). La modalidad de tratamiento depende del tamaño del tumor, el estado basal del hígado y la funcionalidad del paciente. En el Hospital Nacional Rosales recibe a estos pacientes y se desconoce su comportamiento. Se desarrolló un estudio descriptivo, longitudinal de seguimiento de una cohorte basado en datos retrospectivos de los expedientes de pacientes con CHC que consultaron en el Hospital Nacional Rosales con en los años del 2009 al 2014. Se encontró un total de 62 pacientes: 38 mujeres (61.3%) y 24 hombres (38.7%). Edad media de 62.48 años. Entre sus antecedentes: hepatitis 0, alcoholismo 12.90% (8 pacientes), 6 ya con cirrosis, y 1 agregado con diabetes mellitus; Diabetes mellitus en el 19.35%. Tiempo de presentar los síntomas entre 7 y 5 meses. Motivo de consulta: dolor abdominal en un 61.3% de casos, ictericia en un 14.5%. Método diagnóstico: La Tomografía Axial computarizada en 26 pacientes (41.94%), ultrasonografía en 21 pacientes (32.25%). Hubo 21 muertes (33.87%), documentadas y 39 perdidos de vista y 2 vivos y en consulta en el año 2015. Sobre vida global de 8.47 meses desde el diagnóstico. Conclusión: En nuestro hospital, el CHC se presenta más frecuentemente en mujeres, asociado a diabetes mellitus, con síntomas y signos de enfermedad avanzada que no les permite recibir ningún tratamiento y tienen 8.47 meses de sobrevida desde el diagnóstico

Cáncer de mama: alcances actuales y vigencia de la exploración estadificatoria extrapleural de la cadena mamaria interna / Breast cancer. current use of the extra-pleural exploration of the internal mammary chain

El interés por conocer el compromiso de la Cadena Mamaria Interna (CMI), radica en el hecho de tratarse de un filtro linfático tan primario como la axila. Se presentan los fundamentos anátomo-quirúrgicos para su exploración. Fueron estudiados 50 pectoesternales, analizando el número de ganglios (promedio 9,7 por espécimen) ,ubicados de preferencia en los 3 primeros espacios intercostales. En una segunda etapa se exploró la CMI con criterio estadificatorio y por vía extrapleural , resecando 1 o 2 cartílagos costales. En la correlación anatomopatológica entre CMI y axila en 78 pacientes, observamos un 6% de CMI positiva con axila negativa. Más recientemente, en al era del ganglio centinela, hemos explorado la CMI en 44 pacientes, a través de los espacios intercostales y sin resecar cartílagos. En 28 pacientes lo realizamos con guía radio isotópica y gamma probe y en las 16 restantes mediante búsqueda anatómica, según el tumor fuese medial superior o inferior. Los espacios más frecuentemente explorados fueron el 20 y 3D, con un promedio de 2,27 ganglios por paciente. La correlación anatomopatológica entre CMI y axila reveló los siguientes resultados: axila (-) MI (-): 59%; axila (+) MI (-): 25%; axila (+) MI (+): 11 % Y axila (-) MI (+): 5%. Concluimos que es un método no agresivo, de excelente tolerancia, que permite la evaluación de otro filtro tan primario como el axilar y que junto con éste constituyen los mejores pronosticadores de la enfermedad sistémica. Creemos que su exploración está justificada en aquellos casos en que su resultado histológico, al ser correlacionados con la axila permita un cambio de actitud terapéutica.

The interest to know the Internal Mammary Chain (IMC) Involvement, is that it is a lymphatic filter as primary as the axilla. Anatomic-surgical fundaments, were presented for their exploration .Fifty (50) pectus-sternal, analyzing the number of nodes (average 9,7 per specimen), located preferably in the three first intercostals spaces, were studied. In the second phase IMC with a staging criterion and extrapleural ways, resecting 1 or 2 costal cartilages, were explored. In 78 patients, pathological-anatomy correlation between IMC and the axilla, we observed 6% positive IMC with negative axilla. More recently in the era of the sentinel node, we have explored IMC in 44 patients through intercostals spaces and without cartilages resection. In 28 patients we performed through radioisotopic way and gamma probe and in the remaining 16, through anatomic search if the tumour was either upper mid or lower. The most frequent spaces explored were in the 2.., and 3.,; 2,27 nodes average per patient. The pathological-anatomy between IMC and the axilla revealed the following results: axilla (-) 1M (-): 59%; axilla ( +) MI (-): 25%; axilla (+) 1M (+): 11% and axilla (-)IM (+): 5%. We concluded that this is a non aggressive method, with an excellent tolerance that allows the evaluation of another filter as primary as the axilla and that together they represent the best systemic disease prognostics. We believe that its exploration is justified in those cases in which the histological result, correlated with the axilla, allows a therapeutic approach change.

Centellografia osea corporal total en el diagnóstico de metastasis oseas de cancer de mama / Whole body bone scintigraphy for the diagnosis of bone metastasis of breast neoplasms

A un grupo de 263 pacientes portadoras de Cáncer de Mama, estadificadas según clínica, se le realizaron 436 centellogramas óseos con cámara gamma. Se comprueba metástasis óseas en un 15,9% de las pacientes con Cáncer de mama. La localización más frecuente de patología benigna ósea y metástasis es la columna lumbosacra. Observamos cambios de estadificación del carcinoma después de realizado el centellograma. Se demuestra la utilidad de la centellografía para valorar respuestas a quimioterapia, cobaltoterapia y hormonoterapia y se concluye que la centellografía es el método de elección en el diagnóstico de las metástasis óseas (au)

Indicaciones y limitaciones del estudio histopatologico oseo en las pacientes con carcinoma mamario y su correlacion con los demas metodos de diagnostico. / Indications and limitations of a bone histopathological study in patients with breast carcinoma and its correlation with other diagnostic methods

Sobre un total de 263 pacientes con diagnostico de cancer de mama, estudiados con la finalidad de diagnosticar una diseminacion osea, por medio de la centellografia, radiologia, y examen clinico del dolor; se efectua estudio histopatologico de imagenes de mayor captacion centellografica en 7 pacientes. Se valora las indicaciones, limitaciones de la anatomia patologica osea y su correlacion con los demas metodos de diagnostico para las metastasis oseas, analizando cada caso en particular

Conceptualización y clasificación del abdomen agudo ginecologico (A.A.G.): nuestra experiencia / Conceptualization and classification of the gynecologic acute abdomen (G.A.A): our experience

El objetivo de la presente comunicación es analizar los 1230 pacientes internados en el Hospital de Urgencias de Córdoba, entre 1967 y 1984, que configuraron emergencias ginecológicas médico-quirúrgicas, de las cuales 973 (79,11%) correspondieron a genuinos abdómenes agudos ginecológicos (A.A.G.). Para un diagnóstico certero de A.A.G. (cuyo sindrome clínico mínimo se caracteriza, por la rápida aparición del dolor, las modificaciones del abdomen y la afectación del estado general) enfatizamos la conveniencia de una completa semiología y la laparoscopía como maniobra instrumental de gran valor. La etiología dominante en el A.A.G. infeccioso fue la enfermedad pelviana inflamatoria aguda (EPIA), en su gran mayoría pelviperitonitis. El embarazo ectópico representó el 94% del A.A.G. hemorrágico. La torsión de tumor de ovario, el 50% del A.A.G. mecánico. La perforación uterina, el 83% del A.A.G. traumático. La rotura del cuerpo amarillo y folículo, el 81% del A.A.G. funcional y hormonal. Clasificamos, a los fines didácticos, los A.A.G. según: a) Criterio clínico etiopatogénico; b) Enfoque terapéutico; c) Incidencia etaria; d) Estrato sociocultural. El tratamiento de todo A.A.G. debe ser lo suficientemente conservador para mantener el órgano o la función, cuando el cuadro clínico lo permita, y lo bastante agresivo como para erradicar la enfermedad. Es de trascendencia vital determinar si el A.A.G. es quirúrgico o no, pues es preferible una laparotomía diagnóstica a la certidumbre de una autopsia