Epidemiological and clinical description of patients with oropharyngeal cancer treated in a public oncology referral hospital in Chile.

Introduction: The incidence of squamous carcinoma of the oropharynx (OPSCC) has presented an increase worldwide, a fact that occurs along with a phenomenon of epidemiological transition, whose pathogenesis is linked to human papilloma virus (HPV) in a significant part of the cases. Published evidence at the Latin American level is scarce. The present study aims to evaluate the epidemiological and clinical characteristics of patients with oropharyngeal cancer treated in a public oncology reference centre in Chile. Methodology: A cross-sectional study was carried out. Patients with histological confirmation of OPSCC aged 18 years or older, referred to the National Cancer Institute of Chile between 2012 and 2023 were included. The association with HPV was determined by immunohistochemistry for p16. Results: 178 patients were analysed, most of them in locoregionally advanced stages involving the palatine tonsil. Seventy-seven percent were male, with a median age of 60 years. Sixty-seven percent of patients were positive for p16, with a progressive increase to 85% in the last 2 years of the study. The p16(+) patients were younger and had fewer classical risk factors. Primary treatment was radiotherapy in 94% of patients. Conclusion: The epidemiological profile of patients with OPSCC treated in a Chilean public oncology referral centre reflects the epidemiological transition observed in developed countries. This change justifies the need to adapt health policies and conduct research that considers the characteristics of this new epidemiological profile.

Gasserian ganglion stimulation for refractory trigeminal neuropathic pain.

BACKGROUND AND OBJECTIVE: Painful trigeminal neuropathy is a complex clinical entity due to its severity and refractoriness to pharmacological and interventional management. We describe our experience in treating refractory painful trigeminal neuropathy (RPTN) with gasserian ganglion stimulation (GGS). MATERIALS AND METHODS: Six patients with RPTN were treated with GGS in our Unit between 2019 and 2022. The following data were collected: socio-demographic characteristics, triggering event, duration of the disease and treatment received prior to surgery, pre- and post-intervention visual analogue scale (VAS) score, follow-up time, and pre- and post-intervention functionality and quality of life. RESULTS: All patients were women who had received aggressive first-, second-, and third-line pharmacological, non-pharmacological, and interventional management before being referred for GGS. Patients reported a 50%-72% decrease in pain on VAS and improved functionality during follow-up. CONCLUSIONS: GGS is a promising therapeutic alternative for patients with RPTN. Although the initial outcomes and experience are encouraging, RPTN is recommended on the basis of safety, reproducibility, and trends observed in clinical practice.

Consideraciones radiológicas del cáncer de pulmón y Covid-19: una mirada oncológica / Radiological considerations of lung cancer and Covid-19: a oncology look

Patients with SARS-Cov-2 infection and lung cancer have an unfavorable prognosis, characterized by higher rates of respiratory failure, use of invasive mechanical ventilation and higher mortality rates. Due to similarities in affected organs in Covid-19 and lung cancer, the radiological accurate diagnosis has become a challenge for physicians. Radiologic findings of lung cancer, such as parenchymal consolidation, spiculation and microlobulations are not specific. Imaging findings of Covid-19 in patients with lung cancer consist of multiple patchy multifocal bilateral ground-glass opacities and consolidations, being hardly distinguishable from an underlying lung malignancy. Differential radiological diagnosis in patients with lung cancer and Covid-19 must include pneumonitis and lung toxicity caused by chemotherapy, target therapies and radiotherapy. Follow-up and simulation tomography in radiotherapy have become an unexpected ally in the early detection of Covid-19 in asymptomatic stages in lung cancer patients. Patients with lung cancer should have particular considerations due to their high risk and the adverse effects of systemic therapies and radiotherapy. (AU)

Membrane translocation and activation of GnRH receptor sensitize prostate cancer cells to radiation.

BACKGROUND: GnRH analogs are widely used as neoadjuvant agents for radiotherapy in prostate cancer (PCa) patients, with well-documented effects in reducing tumor bulk and increasing progression-free survival. GnRH analogs act locally in the prostate by triggering apoptosis of PCa cells via activation of the GnRH receptor (GnRHR). During PCa progression, the distribution of GnRHR within the cell is altered, with reduced expression in the cell membrane and remaining sequestered in the endoplasmic reticulum. Pharmacoperone IN3 is able to relocalize GnRHR to the cell membrane. The aim of this study was to evaluate the effect of radiation on PCa cells pretreated with leuprolide, alone or in combination with IN3, as radiosensitizers. MATERIAL AND METHODS: PC3 and human PCa primary cell cultures were treated with IN3 for 24 h, followed by different doses of leuprolide for 48 h and, finally, single doses of radiation (3, 6, and 9 Gy). After radiation, cell survival, apoptosis, cell cycle distribution, and colony growth were evaluated. RESULTS: Radiation reduced cell survival and increased apoptosis in a dose-dependent manner. This effect was also directly related to leuprolide concentration. Pretreatment with IN3 enhanced apoptosis and decreased cell survival, also observing a higher proportion of cells arrested in G2. CONCLUSION: Neoadjuvant leuprolide increases radiation-mediated apoptosis of PCa cells. This effect was enhanced by pretreatment with pharmacoperone IN3. Clinical use of IN3 as a radiosensitizer combined with androgen deprivation therapy to improve survival of patients with PCa remains to be evaluated.

Resección endometrial histeroscópica más inserción de DIU-LNG en el sangrado uterino anormal refractario a tratamiento médico / Hysteroscopic endometrial resection plus LNG-IUD insertion in abnormal uterine bleeding refractory to medical treatment

OBJETIVO: Evaluar los resultados del tratamiento del sangrado uterino anormal (SUA) refractario a tratamiento médico, con resección endometrial histeroscópica asociado a la inserción de un sistema intrauterino de liberación de levonorgestrel. MÉTODO: Estudio prospectivo de 24 pacientes con SUA tratadas con resección endometrial histeroscópica seguida de inserción de un dispositivo intrauterino que libera 20 microgramos diarios de levonorgestrel. RESULTADOS: En 23 de las 24 pacientes tratadas se obtuvo un resultado favorable en término de control del SUA, con un período de seguimiento promedio de 18,3 meses. Una paciente requirió histerectomía por persistencia de dolor pélvico. CONCLUSIÓN: Asociar a la resección endometrial histeroscópica la inserción de un sistema intrauterino de liberación de levonorgestrel mejora los resultados de la cirugía conservadora pudiendo evitar la histerectomía en el 95,9% de las mujeres con SUA de causa benigna.

OBJECTIVE: To evaluate hysteroscopic endometrial resection associated to levonorgestrel intrauterine device insertion as a treatment of abnormal uterine bleeding of benign cause. METHOD: 24 patients with abnormal uterine bleeding, were treated with hysteroscopic endometrial resection followed by the insertion of a intrauterine levonorgestrel device. RESULTS: 23 of 24 patients no report symptoms after 18.3 months follow up. One hysterectomy was performed for persistent chronic pelvic pain. CONCLUSIONS: Endometrial ablations with diathermic loop followed by the insertion of intrauterine levonorgestrel device improve the results of the conservative surgeries, avoiding 95.9% of hysterectomies in patients with abnormal uterine bleeding.

Epidemiología del cáncer diferenciado de tiroides / Epidemiology of differentiated thyroid carcinoma

El cáncer diferenciado de tiroides, procedente de células foliculares, es la forma más frecuente de tumor tiroideo maligno. Incluye los subtipos papilar, variedad más común, folicular y carcinoma de células de Hürthle. La edad media al diagnóstico se sitúa entre los 40 y 45 años para el papilar, y entre los 48 y 53 años para el folicular; es mucho más frecuente en mujeres y en población blanca. Posee una baja aunque creciente incidencia, así como una baja letalidad. España ocupa una posición intermedia entre los países europeos, con una tasa de incidencia ajustada por la población europea en 1998 de 2,12 y 5,42 por 100.000 habitantes en varones y mujeres, respectivamente, y una tasa de mortalidad en 2001 de 0,41 y 0,58 por 100.000 habitantes. El único factor de riesgo fehacientemente conocido es la exposición a radiación ionizante, bien por irradiación terapéutica, bien por contaminación ambiental generalmente asociada a accidentes nucleares. Estas radiaciones afectan en mayor grado a niños e inducen cánceres principalmente de tipo papilar. Existen también estudios epidemiológicos que asocian el cáncer diferenciado de tiroides con factores dietéticos (deficiencia de yodo o alto consumo de alimentos bociógenos); ocupacionales (presentan un exceso de riesgo los técnicos sanitarios, los dentistas, los profesores y los trabajadores de la industria eléctrica y del petróleo); hormonales y reproductivos, así como con la historia previa de enfermedades tiroideas benignas, como bocio o adenomas. Finalmente, una pequeña proporción de casos tiene carácter familiar, asociados a determinados síndromes (enfermedad de Cowen y síndrome de Gardner) o como única manifestación en el llamado síndrome familiar de cáncer no medular de tiroides (AU)

Differentiated thyroid carcinomas (DTC), which arising from follicular cells, are the most frequent types of malignant thyroid cancer. They include papillary, follicular and Hurtle carcinoma, of which papillary carcinoma is the most common. The mean age at diagnosis is around 40-45 years for papillary tumors and around 48-53 years for follicular carcinomas. DTC are more frequent in women and among whites. The incidence is low but has been growing, while the lethality of these tumors is very low. Spain occupies an intermediate position among European countries, with a standardized incidence rate ­taking the standard European population as reference­ of 2.12 and 5.42 cases per 100,000 inhabitants/year among men and women respectively in 1998. Regarding mortality, the most recent information corresponds to 2001, showing a standardized rate of 0.41 per 100,000 inhabitants/year in men and 0.58 per 100,000 inhabitants/year in women. The only well established risk factor is ionizing radiation, whether from radiotherapy or environmental contamination generally associated with nuclear accidents. Children are particularly susceptible to ionizing radiation and papillary tumors represent the main histological type associated with this exposure. Other suggested risk factors comprise diet (including iodine deficiency and high consumption of goitrogens), occupational factors (with an increased risk observed among medical technicians, dentists, teachers and workers in the electric and petroleum industries), hormonal and reproductive factors, and a history of benign thyroid diseases such as goitre and adenomas. Finally, a small proportion of cases is inherited, associated with certain syndromes (Cowen disease, Gardner's syndrome) or are the only manifestation of familial nonmedullary thyroid carcinoma syndrome (AU)

Growth suppression and branchitis in trout exposed to hydrogen peroxide.

This study was designed to investigate the effect of single short-duration bath-treatment with hydrogen peroxide (1000, 1250 or 1500 mg/l for 20 min), as currently used in treatment for sea lice, on the growth rate and gill morphology of rainbow trout. All three dose levels significantly reduced the specific growth rate of fish (22-36% reduction) during the first 3 weeks after treatment. A significant effect on growth rate (10-11% reduction) persisted over an additional 3 weeks for the two highest doses. Gill lesions occurred at all three dose levels and also at an additional peroxide concentration of 750 mg/l; these lesions were characterized by large foci of epithelial hyperplasia in which lamellar fusion, pillar cell necrosis, and pillar channel aneurysms had developed. The proportion of damaged filaments showed a significant positive linear relationship with dose during the first 2 weeks after treatment. A significant decline in number of lesions occurred at 1000-1500 mg/l over the 3-week sampling period. During healing, necrotic lamellae were replaced by means of a pillar channel regenerative process.

Uso precoz de penicilina cristalina en pacientes quemados en el Hospital Eugenio Espejo / Uso precóz of crystalline penicillin in patients burned in the Hospital Eugene Mirror

En el país, actualmente existe discrepancia de criterios sobre el beneficio de emplear terapia antibiótica profiláctica en pacientes con porcentajes y grados de quemadura importantes, como medida de prevención de complicaciones infecciosas "a posteriori". Mediante un ensayo clínico concurrente aleatorio, controlado, empleando técnica de simple ciego, se estudiaron 50 pacientes que ingresaron al Servicio de Emergencia y Unidad de Quemados del Hospital Eugenio Espejo, durante 1998, los cuales fueron asignados aleatoriamente como casos y controles, para recibir terapia con penicilina cristalina (100.000 UI/Kg), siendo sometidos ambos grupos a hemocultivos al ingreso, a las 72 horas y a la semana, además de signos clínicos locales y sistémicos como indicadores de infección. Los resultados encontrados, muestran que el tipo más frecuente de lesión es la causada por quemadura eléctrica para los dos grupos; con un tiempo de llegada al hospital de 16.5 horas para los casos y de 13.1 horas para los controles. Dentro de las lesiones asociadas al trauma cráneo encefálico leve fue el más común para ambos. Con un tiempo promedio entre llegada y realización de limpieza quirúrgica de 16,5 horas para los casos y de 13.1 horas para los controles. En relación con los resultados de los hemocultivos, estos fueron en mayor porcentaje positivos a las 72 horas para quienes recibieron terapia antibiótica (p 0.05), diferencia que desaparece en el cultivo a los 7 días. (p 0.05). En definitiva, se establece que la utilización de Penicilina Cristalina no modifica la frecuencia de infección sistémica, ni el pronóstico durante la primera semana posterior a la quemadura, excepto en aquellos pacientes sometidos tardíamente a limpieza quirúrgica, donde el pronóstico mejora, razón por la cual se recomienda este esquema profiláctico solamente en este tipo de pacientes.

Histerectomía total por videolaparoscopia: experiencia en Antofagasta / Total hysterectomy by videolaparoscopy: experience at Antofagasta

Se informa sobre 96 casos de histerectomía total por vía laparoscópica, efectuadas con electrocoagulación bipolar, y corte con tijera y electrobisturí monopolar. La media de edad fue de 45 años, de paridad 2,87 y de aborto 0,78. Setenta y seis pacientes tenían antecedente de cirugía abdominal previa. El tiempo quirúrgico medio fue de 134,48 minutos (rango de 70 minutos a 4 horas). Hubo lesión de uréter en 2 pacientes y en 4 casos se necesitó de transfusión por sangrado intraoperatorio. Se convirtieron a laparotomía 7 casos. En 59 pacientes se practicaron otros procedimientos. El tiempo promedio de hospitalización fue de 51,9 horas. El peso promedio del útero fue de 300 g con mínimo de 105 y máximo de 620 g

Ablación endometrial histeroscópica: experiencia en Antofagasta / Hysteroscopic endometrial ablation: experience at Antofagasta

Se analizan 52 casos de ablación endometrial histeroscópica, realizadas entre marzo de 1992 a diciembre de 1995, procedimientos que se efectuaron con resectoscopio y asa diatérmica. El signo común de estas pacientes era genitorragia refractaria a tratamientos médicos. El seguimiento postcirugía es de 20,3 meses promedio, el 76,9 por ciento de ella están sin problemas, el 19,2 por ciento (10 casos), requirieron otra cirugía por recurrencia de sus síntomas, 8 histeroctomías

Histerectomía por videolaparoscopía usando técnica C.I.S.H / Hysterectomy by videolaparoscopy using C.I.S.H technic

Se informa sobre 110 casos de histerectomías translaparoscópicas sin colpotomía, utilizando la técnica C.I.S.H. del Dr. Kurt Semm, con morcelación de útero y su extracción a través de un macromorcelador abdominal de punta aserrada de 1,5 cm de diámetro. las medias de edad, paridad y abortos fueron 41,8; 2,93 y 0,52 respectivamente. Ochenta y dos pacientes tenían antecedentes de cirugía abdominal previa. El tiempo quirúrgico medio fue de 116 minutos y no hubo complicaciones importantes en el tiempo operatorio. La media de estadía en clínica fue de 46,18 horas

Histerectomía por videolaparoscopía: uso de técnica Cash / Hysterectomy by videolaparascopy: use of Cash technic

Se informa sobre 9 casos de histerectomías translaparoscópicas utilizando la técnica CASH del Dr. Kurt Semm (Kiel, Alemania), con morcelación de útero y su extracción a través de un macromorcelador abdominal de punta aserrada de 1,5 cm de diámetro