Biopsia selectiva de ganglio centinela en el carcinoma escamoso de vulva. Análisis de seguimiento a 10 años / Sentinel lymph node biopsy procedure in squamous vulvar cancer. 10 years follow-up analysis

OBJETIVO: Aplicación de la biopsia selectiva de ganglio centinela (BSGC) en el carcinoma de vulva en estadios iniciales y análisis de los resultados, recurrencias y complicaciones. MATERIAL Y MÉTODOS: Se revisaron retrospectivamente 40 pacientes con cáncer de vulva y BSGC entre 2008 y 2018. El día de la intervención se rastrearon las cadenas ganglionares inguinales mediante sonda gammadetectora para identificar los ganglios centinela que se extirparon y remitieron para estudio anatomopatológico intraoperatorio. Posteriormente, se realizó seguimiento a largo plazo con análisis de complicaciones, recaída y mortalidad. RESULTADOS: De las 40 pacientes (edad media: 72 años [47-86]), la tasa de detección global por paciente fue del 95%, con un total de 129 ganglios centinela (GC) (3,22 GC/paciente). En tres de 25 pacientes con lesiones tumorales laterales el drenaje fue bilateral y en dos de 15 con lesiones de línea media fue unilateral. De las 40 linfogammagrafías 16 presentaban drenaje bilateral y 24 unilateral. Se obtuvieron un total de 119 GC- y 10 GC+, realizándose vaciamiento en ocho. En el grupo de GC- se incluyeron un caso de bloqueo linfático y un falso negativo. En 12 de 40 pacientes hubo complicaciones posquirúrgicas, cuatro de ellas linfedemas. Durante una mediana de seguimiento de 40 meses, recayeron seis de 10 con GC+ (40% mortalidad) y siete de 30 GC- (16% mortalidad). CONCLUSIONES: La BSGC en cáncer de vulva es la técnica de elección para una correcta estadificación y tratamiento locorregional. Es importante una adecuada estadificación ganglionar previa a la cirugía para evitar posibles bloqueos linfáticos que puedan inducir falsos negativos

AIM: Application of sentinel lymph node biopsy (SLNB) procedure in early-stage vulvar cancer and analysis of results, recurrences and complications. MATERIAL AND METHODS: 40 patients with vulvar cancer and SLNB between 2008 and 2018 were retrospectively reviewed. During the surgical procedure the inguinofemoral lymph nodes were checked with a gamma probe to identify the sentinel nodes that were removed and referred for intraoperative pathological assessment. Subsequently, long-term patient follow-up was performed with analysis of complications, relapse and mortality. RESULTS: 40 patients (mean age: 72 years [47-86], the overall detection rate per patient was 95% and a total of 129 Sentinel Lymph Nodes (SLNs) were removed (3.22 SLN/patient). In 3 out of 25 patients with lateral tumour lesions drainage was bilateral and in 2 out of 15 with midline lesions drainage was unilateral. On lymphoscintigraphy, 16 out of 40 had bilateral drainage and 24 unilateral. A total of 119 SLN- and 10 SLN+ were obtained, in 8 out of 10 an inguinofemoral lymphadenectomy was performed. In the SLN- group, one case of lymphatic blockage and one false negative were included. In 12 out of 40 patients there were post-surgical complications, 4 of them lymphoedemas. In the median follow-up (40 months), 6 out of 10 with SLN+ (40% mortality) and 7 out of 30 SLN- (16% mortality) had recurrences. CONCLUSIONS: SLNB in vulvar cancer is the technique of choice for correct staging and locoregional therapy. Correct clinical lymph node staging is important before surgery in order to avoid potential blockage drainages which could induce a false negative SLN

18F-FDG PET/CT y el síndrome de intolerancia inmunológica en el injerto renal no funcionante / 18F-FDG PET/CT and non-functioning renal graft intolerance syndrome

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Sentinel lymph node biopsy procedure in squamous vulvar cancer. 10 years follow-up analysis. / Biopsia selectiva de ganglio centinela en el carcinoma escamoso de vulva. Análisis de seguimiento a 10 años.

AIM: Application of sentinel lymph node biopsy (SLNB) procedure in early-stage vulvar cancer and analysis of results, recurrences and complications. MATERIAL AND METHODS: 40 patients with vulvar cancer and SLNB between 2008 and 2018 were retrospectively reviewed. During the surgical procedure the inguinofemoral lymph nodes were checked with a gamma probe to identify the sentinel nodes that were removed and referred for intraoperative pathological assessment. Subsequently, long-term patient follow-up was performed with analysis of complications, relapse and mortality. RESULTS: 40 patients (mean age: 72 years [47-86], the overall detection rate per patient was 95% and a total of 129 Sentinel Lymph Nodes (SLNs) were removed (3.22 SLN/patient). In 3 out of 25 patients with lateral tumour lesions drainage was bilateral and in 2 out of 15 with midline lesions drainage was unilateral. On lymphoscintigraphy, 16 out of 40 had bilateral drainage and 24 unilateral. A total of 119 SLN- and 10 SLN+ were obtained, in 8 out of 10 an inguinofemoral lymphadenectomy was performed. In the SLN- group, one case of lymphatic blockage and one false negative were included. In 12 out of 40 patients there were post-surgical complications, 4 of them lymphoedemas. In the median follow-up (40 months), 6 out of 10 with SLN+ (40% mortality) and 7 out of 30 SLN- (16% mortality) had recurrences. CONCLUSIONS: SLNB in vulvar cancer is the technique of choice for correct staging and locoregional therapy. Correct clinical lymph node staging is important before surgery in order to avoid potential blockage drainages which could induce a false negative SLN.

Captación de 131I en calcinosis tumoral en un paciente en hemodiálisis tratado de cáncer de tiroides / 131I uptake in tumoral calcinosis in a patient on hemodialysis treated for thyroid cancer

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Seudotumor fibroelástico elastofibroma dorsi detectado por 18F-FDG PET/TC y por 131I SPECT/TC posterapia / Fibroelastic pseudotumor elastofibroma dorsi detected by 18F-FDG PET/CT scan and by postherapy radioiodine SPECT/CT

La captación de yodo radioactivo en el tejido tiroideo y en las metástasis del cáncer diferenciado de tiroides (CDT) y otros tejidos depende de la expresión del transportador de sodio-yodo (NIS). La permeabilidad vascular, derrames serosos, procesos inflamatorios y otros mecanismos también pueden desempeñar un papel en la acumulación de yodo radioactivo. Una mujer de 63 años fue sometida a terapia con yodo radiactivo y a un estudio de cuerpo completo después de la terapia, debido a la sospecha de metástasis pulmonar de carcinoma diferenciado de tiroides. La exploración no solo mostró captación en la metástasis de pulmón, sino también una captación difusa leve en la región posterior del tórax en ambos lados; en la SPECT/TC esta captación se localiza en un elastofibroma dorsi (ED) ya conocido, previamente diagnosticado mediante TC con contraste y visto también en una PET/TC con 18F-FDG. La captación de radioyodo en el ED, sobre todo si es típico, no plantea un problema de diagnóstico en el estudio de SPECT/TC, pero puede inducir a error en un estudio limitado a unas pocas imágenes planares, especialmente si la captación se produce de forma asimétrica, o el ED se encuentra en una localización insospechada (AU)

Radioiodine uptake in the thyroid tissue, metastasis of differentiated thyroid cancer (DTC), and in other tissues, depends on the expression of sodium-iodide symporter (NIS). Vascular permeability, effusions, inflammation, and other mechanisms may also play a role in the accumulation of radioactive iodine. A 63-year-old woman underwent radioiodine therapy, as well as a post-therapy whole-body scan, as she was suspected of having lung metastasis from thyroid carcinoma. The scan not only showed uptake at the lung metastasis but also a faint diffuse bilateral uptake in the posterior thorax. On SPECT/CT this uptake was located in a known Elastofibroma Dorsi (ED) previously diagnosed by contrast CT and viewed in a FDG PET/CT. The radioiodine uptake in ED, especially if typical, is not a diagnostic problem in SPECT/CT study, but can be misleading in a study limited to a few planar images, particularly if the uptake occurs asymmetrically, or ED is located in a unsuspected área (AU)

Captación de yoduro sódico 131I en un teratoma ovárico / Radioactive iodine 131I uptake in an ovarian teratoma

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Fibroelastic pseudotumor elastofibroma dorsi detected by 18F-FDG PET/CT scan and by postherapy radioiodine SPECT/CT. / Seudotumor fibroelástico elastofibroma dorsi detectado por 18F-FDG PET/TC y por 131I SPECT/TC posterapia.

Radioiodine uptake in the thyroid tissue, metastasis of differentiated thyroid cancer (DTC), and in other tissues, depends on the expression of sodium-iodide symporter (NIS). Vascular permeability, effusions, inflammation, and other mechanisms may also play a role in the accumulation of radioactive iodine. A 63-year-old woman underwent radioiodine therapy, as well as a post-therapy whole-body scan, as she was suspected of having lung metastasis from thyroid carcinoma. The scan not only showed uptake at the lung metastasis but also a faint diffuse bilateral uptake in the posterior thorax. On SPECT/CT this uptake was located in a known Elastofibroma Dorsi (ED) previously diagnosed by contrast CT and viewed in a FDG PET/CT. The radioiodine uptake in ED, especially if typical, is not a diagnostic problem in SPECT/CT study, but can be misleading in a study limited to a few planar images, particularly if the uptake occurs asymmetrically, or ED is located in a unsuspected area.

[Significance of pyrimidine nucleoside phosphorylase (PyNPase) and dihydropyrimidine dehydrogenase (DPD) in advanced gastric cancers].

We measured pyrimidine nucleoside phosphorylase (PyNPase), a known angiogenetic factor, and dihydropyrimidine dehydrogenase (DPD) in advanced gastric cancers. PyNPase was expressed in cytoplasm of the cancer cells and surrounding interstitial cells. The levels of PyNPase and DPD were significantly higher in cancer tissue. With respect to tumor factors, the level of PyNPase was significantly higher in cases positive for venous invasion. We divided patients into two groups, with high and low activities of IAP and MMP-9. The level of PyNPase was significantly higher in the high IAP activity group. A correlation was suggested between the level of PyNPase and the activity of IAP. 5'-Deoxy-5-fluorouridine (5'-DFUR) is transformed into 5-FU by PyNPase and manifests antitumor effects. DPD is a rate-limiting enzyme in the process of degradation of 5-FU. In the present study, the level of PyNPase/DPD was significantly higher in cancer tissue. PyNPase/DPD suggests not only the malignant potential of the tumor but also the efficiency of chemotherapy using 5-FU, especially 5'-DFUR.

Antibody to streptococcal zymogen in the serum of patients with acute glomerulonephritis: a multicentric study.

BACKGROUND: Cationic streptococcal proteinase (erythrotoxin B) and its precursor, zymogen, are putative nephritogenic antigens. The present study was designed to test whether serum titers to these antigens were good markers of streptococcal infection associated with glomerulonephritis. METHODS: We studied 153 patients (male/female = 104/49, age range, 2 to 23 years old) with acute poststreptococcal glomerulonephritis (APSGN) from three countries (Venezuela, Chile and Argentina). The site of the initial infection was the skin in 84 patients, the throat in 55 patients and was unknown in 14 patients. In addition, we studied 23 patients (1 to 24 years old) with streptococcal infection not associated with glomerulonephritis (14 patients with impetigo and 9 patients with pharyngitis). As control group, 93 healthy individuals (54 males, 2 to 19 years old) were studied. Anti-zymogen and anti-proteinase titers were determined in a single laboratory by ELISA, and the intra- and interassay coefficients of variation were 5.3% and 8.5%, respectively. ASO titers and anti-DNAse B titers were also done. RESULTS: Anti-zymogen titers of 1:800 to 1:3200 had likelihood ratios (sensitivity/1-specificity) for detection of streptococcal infection in APSGN patients ranging from 2.00 to 44.2 in Argentina, Chile and Venezuela. Anti-zymogen titers decreased one to two months after APSGN and they were 1 to 3 log2 dilutions higher that anti-proteinase titers. Receiver operating characteristic (ROC) curves showed that anti-zymogen titers were consistently superior to anti-streptolysin O and anti-DNAse B titers as markers for streptococcal infection in APSGN. CONCLUSIONS: These results suggest that increased anti-zymogen antibody titers are the best available marker for streptococcal infection associated with acute glomerulonephritis.

Changes in bone mineral density, growth velocity and renal function of prepubertal uremic children during growth hormone treatment.

Thirteen prepubertal children with a mean chronological age of 6.7 +/- 3.4 years and severe chronic renal failure (mean glomerular filtration rate of 20.8 +/- 17.7 ml/min/1.73 m2) were studied. Patients received recombinant human growth hormone (rhGH) at a dose of 1 IU/kg/week given subcutaneously on a daily basis for 12 months. Mean growth rates of our patients increased significantly from a baseline level of 4.3 +/- 2.1 to 9.1 +/- 2.0 cm/year at 12 months of rhGH therapy. Mean height SDS improved from -3.5 +/- 1.0 at initiation of therapy to -2.6 +/- 1.3 at 12 months. Mean serum creatinine and blood urea nitrogen levels remained stable during the study, while mean glomerular filtration rates decreased initially and then stabilized; however, 2 subjects had a significant deterioration of their renal function at 6 and 9 months of rhGH, requiring discontinuing treatment. Before rhGH treatment, total bone mineral content as well as bone mineral density in cortical and trabecular bone were significantly reduced in our patients when compared to healthy controls paired for chronological age and similar to those of a healthy control group paired for bone age and height. Both these parameters increased significantly during rhGH treatment so that at 12 months our patients had values similar to those seen in a healthy control population paired to our patients for chronological age. While trabecular bone mineral density did not change in a group of untreated uremic controls during 12 months of follow-up, the percent of bone mineral density change in trabecular bone in our uremic patients during 12 months of rhGH treatment was very significant (p < 0.001) and larger than that noted in a group of healthy controls paired for bone age and height during 12 months of follow-up. This study demonstrates how rhGH treatment in prepubertal uremic children increases their growth velocity and their bone mineral density significantly, with an improvement in height for age. Careful followup of the renal function of patients in needed as they improve their height and bone mineral status.

Tratamiento moderno de la urolitiasis en el niño con ondas de choque extracorporea / Modern treatment of the urolithiasis in the child with extracorporal shock wave

En los últimos años del tratamiento de la urolitiasis ha tenido importantes avances con la implantación de nuevas técnicas para la eliminación de cálculos de las vias urinarias, partiendo de la cirujía convencional, la litotomía endoscópica y la nefrolitotomía percutánea; se ha usado recientemente las ondas de choque extracorpóreas, con o sin inmersión para la desintegración de cálculos. La Litotricia Extracorpórea (ESWL) aplica actualmente en diversos centros del mundo para el tratamiento de la utolitiasis del adulto, ha demostrado su eficacia en el manejo de esta patología, sin embargo no existen suficientes reportes sobre la aplicación de esta modalidad terepautica en pediatría. Nosotros hemos venido utilizando esta técnica durante los últimos dos años para el tratamiento de niños con litiasis urinaria, 52 pacientes han sido sometidos a ESWL con equipo Litrotitor Electromagnético (LITHOSTAR) el cual posee una fuente de ondas de impulsos ultracortos de baja potencia que aseguran fragmentación de cálculo en finas partículas, las cuales son expulsadas expontáneamente por el niño y permiten su aplicación sin anestésia general y ambulatoriamente los niños pequeños ameritaron analgesia con Diazepam ó anestesia disociativa con ketamina y por otra parte se empleó almohadilla de glicina sobre el abdómen, a fin de aumentar la distancia entre el cañón emisor de ondas y el objetivo (cálculo). La radiología de control practicada post ESWL mostró ausencia de cálculo en 50 casos tratados (997%). Las complicaciones durante las sesiones consistieron en arritmia supravetricular transitoria en 1 caso, la cual cedió rápida y espontaneamente, cólico nefrítico post ESWL, un caso y hematuria macroscópica. Cosideramos que nuestro trabajo constituye un importante aporte al manejo terepuético de la urolitiasis en el niño y es el primer reporte nacional y latinoamericano sobre el particular, y la vez contribuye a aumentar la escasa información disponible a nivel internacional. Por otra parte, el presente reporte demuestra la eficacia e inocuidad de las ondas extracorpóreas en el tratamiento de la litiasis urinaria en pediatria