Ética en investigación: desafíos durante la pandemia / Research ethics: challenges during the pandemic

Durante la pandemia de Covid-19 los hospitales pediatricos se vieron menos afectados, debido a la menor infección en niños, y sus recursos fueron reasignados en distintas tareas.. El Comité de Ética en Investigación del Hospital General de Niños Pedro de Elizalde presenta los distintos procedimientos implementados en esta emergencia, para sostener diferentes investigaciones, y que les permitió una rápida respuesta a esta situación.

Fibro - odontoma ameloblástico; reporte de caso clínico / Fibro - odontoma ameloblástico; relato de caso clínico / Ameloblastic fibro odontoma; clinical case report

El fibro - odontoma ameloblástico es un tumor odontogénico benigno con células epiteliales odontogénicas cúbicas, tejido conjuntivo fibroso embrionario y epitelio odontogénico primitivo. Se presenta con poca frecuencia y afecta principalmente a niños y adultos jóvenes entre la primera y segunda década de vida. Este trabajo es un reporte del caso clínico de un paciente de sexo masculino de 12 años de edad atendido en el Hospital de Odontología Infantil "Don Benito Quinquela Martín", al cual se le diagnostica un tumor odontogénico benigno asociado a un canino permanente inferior derecho impactado. Se realiza un plan de tratamiento integral, individualizado y con fuerte componente preventivo, trabajando siempre en constante interrelación con los servicios de Odontología Preventiva, Cirugía, Radiología y Ortodoncia del hospital. En una primera etapa se tratan las infecciones prevalentes y se realiza el refuerzo del huésped. Posteriormente se realiza la intervención quirúrgica para extirpar la lesión y las estructuras dentarias asociadas a esta. La evolución del paciente fue favorable permitiendo continuar su tratamiento en el servicio de Ortodoncia. Objetivo: Describir la situación clínica de un paciente masculino de 12 años de edad, con diagnóstico de fibro - odontoma ameloblástico con un enfoque interdisciplinario y dentro de un plan de tratamiento integral. Conclusión: El tratamiento realizado con un enfoque interdisciplinario y dentro de un plan integral, permitió lograr un resultado favorable en el abordaje del fibro - odontoma ameloblástico

O fibro - odontoma ameloblástico é um tumor odontogênico benigno com células epiteliais odontogênicas cuboides, tecido conjuntivo fibroso embrionário e epitélio odontogênico primitivo. Se apresenta com pouca frequência e afeta principalmente crianças e adultos jovens entre a primeira e segunda década de vida. Este trabalho é um relato de caso clínico de um paciente de sexo masculino de 12 anos de idade atendido no Hospital de Odontologia Infantil "Don Benito Quinquela Martín"; diagnosticado com um tumor odontogênico benigno associado a um canino permanente inferior direito impactado. É realizado um plano de tratamento integral, individualizado e com forte componente preventivo, trabalhando sempre em constante inter-relação entre os Serviços de Odontologia Preventiva, Cirurgia, Radiologia e Ortodontia do hospital. Numa primeira fase, são tratadas as infecções prevalentes e é realizado o reforço do hospedeiro. Posteriormente é realizada a intervenção cirúrgica para remover a lesão e as estruturas dentárias associadas a ela. A evolução do paciente foi favorável, permitindo que ele continue o tratamento no Serviço de Ortodontia. Objetivo: Descrever a situação clínica de um paciente masculino de 12 anos de idade, com diagnóstico de fibro - odontoma ameloblástico com uma abordagem interdisciplinar e dentro de um plano de tratamento integral. Conclusão: O tratamento realizado com uma abordagem interdisciplinar e dentro de um plano integral, permitiu alcançar um resultado favorável na abordagem do fibro - odontoma ameloblástico.

Ameloblastic fibro-odontoma is an infrequent benign odontogenic tumor with cubic odontogenic epithelia cells, embryonic fibrous connective tissue, and primitive odontogenic epithelium. It mainly affects children and young adults between the first and second decade of life. This article is a clinical case report of a 12 - year - old male patient seen at Hospital of Pediatric Dentistry "Don Benito Quinquela Martín," where he was diagnosed with a benign odontogenic tumor associated with an impacted permanent lower right canine tooth. The treatment plan included a multidisciplinary collaboration among the Departments of Preventive Dentistry, Surgery, Radiology, and Orthodontics. In the first stage, prevalent infections were treated and the host was strengthened. The second stage was the surgica removal of the lesion and associated dental structures. The patient's course was favorable and continued his treatment at the Department of Orthodontics. Objective: To describe the clinical course of a 12-year-old male patient diagnosed with ameloblastic fibro-odontoma managed with an interdisciplinary approach in the setting of a comprehensive treatment plan. Conclusion: An interdisciplinary management in the setting of a comprehensive plan resulted in a favorable approach to ameloblastic fibro-odontoma.

Lived experiences relating to pediatric surgery: the case of Mexican American mothers in a southern US border city.

PURPOSE: This study examined the lived experiences of Mexican American mothers residing near a US/Mexico border town whose children underwent a surgical procedure requiring general anesthesia. DESIGN: Phenomenology was used to examine the lived experiences of the participants. METHOD: Twelve Mexican American mothers were interviewed in the preoperative phase; 9 from the 12 participants were interviewed in the post-surgery phase. Giorgi's method of phenomenological analysis was used to identify the common themes. FINDINGS: Thematic differences and commonalities were found in the lived experiences between bilingual and monolingual Spanish-speaking Mexican American mothers in the preoperative and post-surgery phase. CONCLUSION: The lived experiences of Mexican American mothers regarding their children's surgery are shaped by language barriers and sociocultural factors. The findings of this study could inform health care providers on how to prepare Mexican American mothers about their children's surgery requiring general anesthesia.

Quistes inflamatorios. Abordaje preventivo con técnica descompresiva: presentación de situación clínica / Inflammatory cysts. A preventive approach with decompression technique: report of a clinical case

Se realiza una revisión bibliográfica sobre quistes inflamatorios de los maxilares y se presenta una situación clínica de udna paciente niña de 9 años de edad que concurre a la guardia del Hospital de Odontología Infantil Don Benito Quinquela Martín, con quistes inflamatorios bilaterales (cuyas biopsias confirmaron el diagnóstico inicial) y desplazamiento de los gérmenes de segundos premolares inferiores derecho e izquierdo (3.5 y 4.5) hacia la basal. Considerando la edad de la paciente y el pronóstico favorable de las piezas dentarias en desarrollo, se decidió utilizar como tratamiento la técnica de Waldron-Axhausen o técnica descompresiva. La evolución de la paciente fue favorable, ya que se logró la remisión del proceso patológico y la normal erupción de dichas piezas dentarias...

Simulación educativa: Herramienta didáctica para educación Ciencia Tecnología y Sociedad en la disciplina Filosofía y Sociedad / Educational simulation: teaching tool for Science, Technology and Society Education in the discipline of Philosophy and Society

El perfeccionamiento de la disciplina Filosofía y Sociedad en la Educación Superior es una de la exigencias en los Lineamientos al VI Congreso del Partido Comunista de Cuba lo cual contribuye a la preparación de un profesional a la altura de los cambios científico tecnológicos que actualmente despliega la Educación Médica Superior cubana. Para el logro de este propósito se aplicó la simulación educativa como herramienta didáctica avanzada en temas de Ciencia Tecnología y Sociedad en la disciplina Filosofía y Sociedad, la que permitió a los educandos desarrollar habilidades investigativas, un pensamiento científico, político, económico y social así como elevar su nivel creativo y productivo (AU)

Development of the discipline of Philosophy and Society in Higher Education is one of the requirements in the guidelines to the 6th Congress of the Communist Party of Cuba which contributes to the preparation of a professional at the height of the scientific-technological changes that Cuban Higher Medical Education currently deploys. For the achievement of this purpose the educational simulation was applied as a teaching tool advanced in terms of science, technology and society in the discipline of Philosophy and Society, which helped the students to develop research skills, scientific, political, economic and social thinking as well as raise their creative and productive level (AU)

Simulación educativa: Herramienta didáctica para educación Ciencia Tecnología y Sociedad en la disciplina Filosofía y Sociedad / Educational simulation: teaching tool for Science, Technology and Society Education in the discipline of Philosophy and Society

El perfeccionamiento de la disciplina Filosofía y Sociedad en la Educación Superior es una de la exigencias en los Lineamientos al VI Congreso del Partido Comunista de Cuba lo cual contribuye a la preparación de un profesional a la altura de los cambios científico tecnológicos que actualmente despliega la Educación Médica Superior cubana. Para el logro de este propósito se aplicó la simulación educativa como herramienta didáctica avanzada en temas de Ciencia Tecnología y Sociedad en la disciplina Filosofía y Sociedad, la que permitió a los educandos desarrollar habilidades investigativas, un pensamiento científico, político, económico y social así como elevar su nivel creativo y productivo.

Development of the discipline of Philosophy and Society in Higher Education is one of the requirements in the guidelines to the 6th Congress of the Communist Party of Cuba which contributes to the preparation of a professional at the height of the scientific-technological changes that Cuban Higher Medical Education currently deploys. For the achievement of this purpose the educational simulation was applied as a teaching tool advanced in terms of science, technology and society in the discipline of Philosophy and Society, which helped the students to develop research skills, scientific, political, economic and social thinking as well as raise their creative and productive level.

Expression pattern of Tau in the rat brain during pregnancy and the beginning of lactation.

Pregnancy involves changes in brain function that implicate a re-organization in neuronal cytoskeleton. We analyzed the content of the microtubule associated protein Tau (65kDa isoform) and its phosphorylated form (PhosphoTau) in several rat brain regions throughout pregnancy and on day 2 of lactation by Western blot. In hypothalamus the content of Tau increased on days 2 and 18 of gestation compared with days 14, 21 and in lactation. PhosphoTau content increased throughout pregnancy. In preoptic area Tau content did not show significant changes throughout pregnancy or lactation, however, the content of PhosphoTau presented a decrease on day 21 of gestation. In hippocampus Tau content decreased on day 14 until day 21 compared with day 2 of gestation, however, in lactation day 2 the content of Tau increased meanwhile PhosphoTau content progressively increased throughout pregnancy. In frontal cortex Tau content decreased on day 21 of gestation compared with days 2, 14 and 18, with an increase in lactation, whereas PhosphoTau did not show significant changes. In cerebellum Tau protein decreased on days 14, 18 and 21 of pregnancy with an increase in lactation. PhosphoTau content increased throughout pregnancy and on day 2 of lactation. PhosphoTau/Tau ratio changes in each brain area along pregnancy and in lactation. Our data suggest that Tau expression and its phosphorylation pattern change in a tissue-dependent manner throughout pregnancy and the beginning of lactation in the rat brain.

Acromegalia: casuística y alternativas de tratamiento / Acromegaly casuistics and alternative treatments

Introducción: La acromegalia se caracteriza por elevación de los niveles de hormona de crecimiento (GH) y factor de crecimiento tipo 1 similar a la insulina (IGF-1). Su tratamiento puede ser quirúrgico, médico o por radiación hipofisaria para el control de los síntomas. Objetivo: Dar a conocer la importancia de la enfermedad, hacer diagnóstico oportuno, evitar complicaciones y exhortar al envío al especialista. Material y métodos: Expedientes de pacientes con acromegalia no tratados, operados, irradiados o en tratamiento médico con octreotida de acción prolongada (OCT LAR) entre 1990 y 2010. Categorías: curación: supresión de GH > 1.0 ng/ml a los 3-12 meses luego de la cirugía; controlados: mínimo 6 meses de tratamiento, niveles seguros de GH (media) < 2.5 ng/ml; en ambos niveles de IGF-1 normales para edad y sexo; activos, quienes no cumplan estos criterios o estén recién diagnosticados. Resultados: Se analizaron 109 expedientes (se descartaron tres por defunción); 7.2 pacientes por año; 80 fueron tratados quirúrgicamente (73%); 60 activos (75%); edad promedio: 47.5 años (rango 18-76); se detectaron 37 microadenomas y 69 macroadenomas; 65 mujeres, 41 varones, relación de 1.5:1; comorbilidades: prediabetes, diabetes tipo 2 e hipertensión arterial; tasa de cura bioquímica: 25%; tasa de control con OCT LAR: 27%. Conclusiones: El tratamiento de elección continúa siendo quirúrgico; los componentes del síndrome metabólico aumentan el riesgo cardiovascular. La curación se incrementó del 7% al 20% y el control un 27%

Acromegalia: casuística y alternativas de tratamiento / Acromegaly casuistics and alternative treatments

Introducción: La acromegalia se caracteriza por elevación de los niveles de hormona de crecimiento (GH) y factor de crecimiento tipo 1 similar a la insulina (IGF-1). Su tratamiento puede ser quirúrgico, médico o por radiación hipofisaria para el control de los síntomas. Objetivo: Dar a conocer la importancia de la enfermedad, hacer diagnóstico oportuno, evitar complicaciones y exhortar al envío al especialista. Material y métodos: Expedientes de pacientes con acromegalia no tratados, operados, irradiados o en tratamiento médico con octreotida de acción prolongada (OCT LAR) entre 1990 y 2010. Categorías: curación: supresión de GH > 1.0 ng/ml a los 3-12 meses luego de la cirugía; controlados: mínimo 6 meses de tratamiento, niveles seguros de GH (media) < 2.5 ng/ml; en ambos niveles de IGF-1 normales para edad y sexo; activos, quienes no cumplan estos criterios o estén recién diagnosticados. Resultados: Se analizaron 109 expedientes (se descartaron tres por defunción); 7.2 pacientes por año; 80 fueron tratados quirúrgicamente (73%); 60 activos (75%); edad promedio: 47.5 años (rango 18-76); se detectaron 37 microadenomas y 69 macroadenomas; 65 mujeres, 41 varones, relación de 1.5:1; comorbilidades: prediabetes, diabetes tipo 2 e hipertensión arterial; tasa de cura bioquímica: 25%; tasa de control con OCT LAR: 27%. Conclusiones: El tratamiento de elección continúa siendo quirúrgico; los componentes del síndrome metabólico aumentan el riesgo cardiovascular. La curación se incrementó del 7% al 20% y el control un 27%(AU)

Homeopatia: Medicina à sua Medida

Dra.Graciela Alicia Martínez, Médica formada em Medicina na Faculdade de Ciências Médicas da Universidade Estadual de Campinas - UNICAMP, especialista em Homeopatia pela Associação Médica Brasileira e Associação Médica Homeopática Brasileira-AMHB.

Effects of RU486 in the expression of progesterone receptor isoforms in the hypothalamus and the preoptic area of the rat during postpartum estrus.

In several mammalian species females undergo postpartum estrus, a brief period of ovulation and sexual receptivity that in rats usually occurs during the first 24h following parturition. The maximal lordotic expression occurs at 12h after the initiation of parturition and depends on intracellular progesterone receptor (PR). We studied the regulation of PR expression by its antagonist, RU486 in the hypothalamus and the preoptic area of the rat during postpartum estrus by Western blot. Adult female rats were treated with RU486 (1.25 and 5mg) 3h after parturition, and Western blot was performed to assess the expression of PR-A and PR-B at 12h postpartum. RU486 (1.25 and 5mg) reduced the expression of PR-A (63% and 95%) and that of PR-B (75% and 99%), respectively in the preoptic area whereas it had no effects in the hypothalamus. These results suggest a differential regulation of PR expression in the rat brain during postpartum estrus.

Martí y los conocimientos médicos / Martí and the medical knowledges

Este trabajo es una revisión de fuentes bibliográficas donde aparecen elementos de una de las disciplinas científicas a las que prestó Martí gran atención: las ciencias médicas. Se realizó en el Instituto Superior de Ciencias Médicas de Camagüey en los meses comprendidos entre octubre y diciembre del curso 2004- 2005 y su contenido se ha empleado para su análisis en los turnos de reflexión y debate en algunos grupos del primer año de la carrera de Medicina. La escasa divulgación de esta esfera del conocimiento y la necesidad de popularizarla fue lo que motivó la realización del trabajo .Su objetivo es analizar las valoraciones martianas sobre los conocimientos médicos para incidir en la integridad cultural del profesional de la salud. .En el material se brinda una breve caracterización del desarrollo de la medicina en Cuba en el siglo XIX, se recogen las valoraciones realizadas por Martí sobre el desarrollo de los conocimientos médicos en esta etapa y que fueron tratados a través de comentarios en artículos de periódicos, revistas, en sus cuadernos de apuntes y en su Diario de Cabo Haitiano a Dos Ríos. Entre los resultados más importantes se destacan: la información que se brinda sobre el empleo de la medicina verde, el análisis de diversas enfermedades, técnicas terapéuticas, quirúrgicas y su valoración de la salud pública como problemática social ,sirviendo como una vía para formar profesionales creativos y de amplio perfil (AU)

This work is a revision of bibliographical sources where we expose some elements about one of those scientific disciplines that Marti paid more attention to: the medical sciences. It was carried out in the Medical Sciences Institute of Camaguey during the 2004-2205 and its contents have been used in reflection and discussion classes in some groups of the first year of the medicine carer. The poor popularisation of this knowledge sphere and the necessity to popularise it, motivated the development of this work, where the main objective is to analyse Marti's appraises on the medical knowledge's, to impact in the cultural integrity of the professionals of medicine. In this material, a brief characterization of the development of medicine in Cuba in the XIX century is offered, also it characterizes Marti's valuations about the development of medical knowledge in this stage, that were treated through comments he made in articles of newspapers and magazines, and in his Diary From Cabo Haitiano to Dos Rios. Among the most important results stand out: the information about the use of green medicine, the analysis of diverse illnesses, therapeutic and surgical techniques, and his valuation about the public medical care as a social problem, what is a way to form creative professionals with a wide profile (AU)

Una puerta abierta a la profesionalidad pedagógica / A door opened to pedagogical proficiency

Este trabajo es una experiencia pedagógica que se desarrolla en el Instituto Superior de Ciencias Médicas de Camagüey, se aplica desde el año 2003 y se extiende hasta este curso 2005-2006. Se tiene como base el trabajo desarrollado como profesor guía con el grupo D-11, F-16 y el testigo de primer año de Medicina, en los cuales se ha aplicado una estrategia pedagógica y a la misma se le adicionaron métodos educativos y un sistema de técnicas participativas, lo que ha dado resultados satisfactorios. El trabajo tiene como objetivo proponer una alternativa metodológica para el trabajo educativo del profesor guía en el proceso de fortalecimiento de los valores. El mismo brinda elementos teóricos relacionados con el trabajo educativo, diversos métodos y técnicas para realizar el mismo de manera más eficiente y se da a conocer la importancia del profesor guía en este proceso. Entre los resultados se destacan la formulación de pasos metodológicos para poder realizar una estrategia pedagógica, el diseño de una herramienta de trabajo para el profesor guía, indicaciones para efectuar el turno de reflexión y debate, la aplicación del material elaborado en la superación de los profesores guías que pertenecen al comité horizontal del primer año de medicina (AU)

This work is a pedagogic experience developed in the High Medical School of Camaguey, it is applied since 2003 and it extends to the school year 2005-2006. It is based on the work developed by the adviser teachers of two groups and witness classes from first year, in which pedagogic strategies have been applied adding educational methods and a participative techniques system, with satisfactory results. This work has as objective to propose a methodological alternative for the advicer teachers´ educational work in the process of strengthen values. It offers theoretical elements related to the educational work, diverse methods and techniques to carry out it in a more efficient way, and it is showed the importance of the adviser teacher in the process. Among the results stand out the formulation of methodological steps to be able to carry out a pedagogic strategy, the design of a tool for the adviser teacher, indications to develop the debate and reflection shifts, the application of the material elaborated in the adviser teachers´ preparation in the first year horizontal committee (AU)

La Universidad de Ciencias Médicas de Camagüey en el proceso de fortalecimiento de valores desde el proyecto educativo estudiantil / La Universidad de Ciencias Médicas de Camagüey en el proceso de fortalecimiento de valores desde el proyecto educativo estudiantil

Dentro del proceso de Universalización de la Educación Superior cubana, el fortalecimiento de valores constituye un desafío para las universidades. En este trabajo se aborda la necesidad de perfeccionar el proyecto de trabajo educativo de la brigada estudiantil, mediante el protagonismo de los educandos, en la Facultad de Medicina de la Universidad de Ciencias Médicas de Camagüey (AU)

Within the Universalization process of the Cuban Higher Education, the strengthening of values represents a challenge for universities. This paper deals with the necessary improvement of the educational work project of the group, in which students play a leading role, at the Faculty of Medicine of the Medical University of Camagüey (AU)

Role of progesterone receptors during postpartum estrus in rats.

We studied the role of progesterone receptor (PR) in the display of female sexual behavior during postpartum estrus in rats. Adult female rats were treated with the PR antagonist, RU486 (1.25 and 5 mg), 3 h after parturition and sexual behavior was evaluated throughout the first postpartum day. Estradiol and progesterone serum levels changed during the first 24 h postpartum. The highest estradiol and progesterone levels were found at 9 and 12 h postpartum, respectively. The predominant PR isoform in the hypothalamus and the preoptic area was PR-A during postpartum day. The content of PR-A increased at 6 h postpartum in the hypothalamus and the preoptic area, and decreased in both regions at 9 h. PR-B content only increased in the preoptic area at 12 h postpartum. The highest display of lordotic and proceptive behaviors were found at 12 h postpartum. The treatment with 1.25 and 5 mg of RU486 respectively reduced lordosis by 61% and 92% at 12 h postpartum. These results suggest that PR is essential in the display of postpartum estrus in rats.

La Universidad de Ciencias Médicas de Camagüey en el proceso de fortalecimiento de valores desde el proyecto educativo estudiantil / La Universidad de Ciencias Médicas de Camagüey en el proceso de fortalecimiento de valores desde el proyecto educativo estudiantil

Dentro del proceso de Universalización de la Educación Superior cubana, el fortalecimiento de valores constituye un desafío para las universidades. En este trabajo se aborda la necesidad de perfeccionar el proyecto de trabajo educativo de la brigada estudiantil, mediante el protagonismo de los educandos, en la Facultad de Medicina de la Universidad de Ciencias Médicas de Camagüey.

Within the Universalization process of the Cuban Higher Education, the strengthening of values represents a challenge for universities. This paper deals with the necessary improvement of the educational work project of the group, in which students play a leading role, at the Faculty of Medicine of the Medical University of Camagüey.

[Acromegaly treatment with octreotide LAR in 42 cases]. / Tratamiento de acromegalia con octreotida LAR en 42 casos.

OBJECTIVE: To evaluate the efficacy of octreotide (OCT) LAR in patients with acromegaly. METHODS: Observational, retrospective, transversal and descriptive study was done. Forty two patients with acromegaly (recently diagnosed and who have undergone surgery but not cured) followed up for 24 weeks were studied. There were 14 males (30 %) and 28 females (70 %) with an average age of 44 (range: 18-67 years). Dose adjustments of 10, 20 and 30 mg were made. RESULTS: OCT LAR was administered in 24 patients who had been operated without cure and in 18 newly diagnosed patients. At 24 weeks of treatment in those patients not operated, GHm decreased 56 % and IGF-1 decreased 30 %. In patients who were operated but not cured, GHm decreased 49 % and IGF-1 decreased 53 %. For microadenomas, GHm decreased 57.6 % and IGF-1 60 %. For macroadenomas, decrease was 50 % and 37 %, respectively. The efficacy of OCT LAR on microadenomas, success was achieved (total and partial) in 65 % of patients and in 28 % of patients with macroadenomas. CONCLUSIONS: Patients with microadenomas and with lesser hypersomatotropinemia have a better response to treatment.

[Acromegaly. Report of 84 cases]. / Acromegalia. Informe de 84 casos.

BACKGROUND: acromegaly is a rare disease, it is characterized by elevation of the levels of growth hormone and Insulin-like growth factor 1 (IGF-1). The definitive treatment of this disease is surgical. OBJECTIVE: to know the importance of this clinical disease and to exhort to the medical community for opportune delivery to specialist, to prove diagnosis and to treat with opportunity in order to avoid complications. METHODS: the clinical files of the patients received at Endocrinology Service from 1995 to 2005 were reviewed. The data of serum growth hormone levels after a 75 g oral glucose tolerance test, tumor size, criteria for cure, co-morbidities, affectation of hormonal axes and visual field defects of operated patients and not operated patients, were collected. RESULTS: 84 patients were studied, 35 men and 49 women, with an average of 42 years of aged agreement to the Classification of Hardy Vezina, was greater number of cases in degree 2 (macro adenoma with local expansion of the chair). 35 patients with microadenomas: and 25 with macroadenomas were operated. The most frequent co-morbidities were the alteration in the metabolism of carbohydrates and hypertension, and a frequent hormonal affectation was hypothyroidism; the rate of biochemical cure was 7 %. Discordant results with levels of growth hormone high and normal levels of IGF-1 were in 10 %. CONCLUSIONS: the present study confirms that the acromegaly is diagnosed late and it had been associated with co-morbidities and bigger tumor size, that they have influence on the surgical treatment results, since the rate of success were low (7 %).

[Usefulness of GH and IGF-1 to establish the dose and frequency of application of octreotide to treat acromegaly]. / IGF-1 y hormona de crecimiento. Marcadores para la aplicación de octreótida en acromegalia.

OBJECTIVE: to determine the dose and frequency of application of octreotide LAR to treat acromegaly by monitoring the levels of circulating growth hormone (GH) and insulin-like growth factor (IGF-1). MATERIAL AND METHODS: twelve patients (five men and seven women) with acromegaly, whose age was on average 48.9 years (range 35-67) participated. Eight had been surgically treated, yet non cured and 4 patients were treated de novo. The study lasted between 12-18 months. The initial octreotide dose was 20 mg/4 weeks intramuscular. Before administering the fourth dose, the levels of IGF-1 and GH were measured; then, the dose was adjusted and three more injections were applied. If the levels of GH and IGF-1 continued safe, the dose and frequency of application of octreotide LAR were individualized thus applying the minimum number of injections. RESULTS: the interval of octreotide LAR application to maintain the levels of GH and IGF-1 within safe range was prolonged to more than four weeks in nine patients (75%); in six patients (50%), the interval changed to eight weeks and to twelve weeks in three patients (25%). Three patients (25%) continued receiving injections in four-week intervals. The levels of GH and IGF-1 were lower during the treatment period when compared with the baseline measurements (p < 0.01). CONCLUSION: the adjustment of the dose of octreotide LAR keeps the levels of GH within safe range and reduces in 75% the frequency of injections to treat acromegaly.

[Follicular carcinoma of the thyroid and diffuse toxic goiter. Case report]. / Cancer folicular de tiroides y bocio tóxico difuso. Reporte de un caso.

BACKGROUND: Follicular thyroid cancer rarely manifests itself as a distant metastatic lesion. We report a case of a male with follicular thyroid cancer that presented as a distant metastatic lesion and diffuse toxic goiter. CASE REPORT: A 50-year-old man was evaluated because of a soft, painless, pulsating sternal mass of 6 x 6 cm. An incisional biopsy of the soft tissue showed metastatic thyroid follicular neoplasm. History and general examination revealed a weight loss of 10 kg, palpebral retraction and thyrotoxicosis, serum concentration of free thyroxine was elevated and TSH undetectable. A thyroid scan revealed uptake of (131)I in all thyroid areas of 36%. Clinical improvement was observed after methimazole (30 mg/day). Total thyroidectomy was performed: right lobe (5 x 4 x 2 cm), left lobe (4 x 3 x 1 cm), without nodules or lymphadenopathy. During the postoperative period, serum thyroglobulin level was 350 ng/ml, radioiodine treatment (100 mCi) was given, and there was a 75% reduction in the sternal mass. CT of the thorax showed bone destruction in the sternum and soft tissue. Clinical and radiological examination revealed no other metastases. Three months later, thyroid scan was negative and thyroglobulin was 17 ng/ml. CONCLUSIONS: We report this case of follicular thyroid cancer because of its uncommon initial sternal presentation and soft tissue metastasis with diffuse toxic goiter.