Prevalence of alcohol, tobacco, and illicit drugs consumption during teenage pregnancy: an observational, prospective, and cross-sectional study.

BACKGROUND: Teenage pregnancy is a significant public health issue in Mexico; its prevalence oscillates around 20% of all pregnancies. Concurrently, alcohol, tobacco, and illicit drug use have become more common in this age group. METHODS: To estimate the prevalence of substance exposure in a population of pregnant teenagers, we conducted a prospective, observational, and cross-sectional study. The protocol was approved by the institutional review board. On informed consent, we asked 420 consecutive pregnant youngsters cared for at the outpatient obstetric service of a tertiary public regional women's and children's hospital in Nuevo León, in northeast Mexico, to answer a previously validated questionnaire to estimate the prevalence of alcohol, tobacco, or illicit drugs use during pregnancy. RESULTS: Of the 420 participants, 317 (75.5%) consumed at least one substance during pregnancy. Alcohol, either alone or in combination, was consumed by 300 (71.7%) participants. Tobacco was used by 117 (27.8%) participants, almost always in combination with other substances, while marijuana and other illicit drugs were consumed by 92 (21.9%) participants. Approximately one-fourth of the participants, 102 (24.1%) reported no substance use during pregnancy. CONCLUSIONS: In this series, the reported prevalence of alcohol, tobacco, and illicit drugs consumption during pregnancy, explored with a validated instrument, is higher than that previously reported in our country. This fact offers a worrying picture of another set of factors adding to the burden of teenage pregnancy.

INTRODUCCIÓN: El embarazo en la adolescencia ha adquirido gran importancia en la salud pública en México; su prevalencia oscila alrededor del 20% de los embarazos. Paralelamente, el consumo de alcohol, tabaco y drogas ilícitas en este periodo es cada vez más común en estas jóvenes. MÉTODOS: Para estimar la prevalencia de exposición a estas substancias en adolescentes embarazadas, se llevó a cabo un estudio prospectivo, observacional y transversal. El protocolo fue aprobado por los Comités de Ética e Investigación. Previo consentimiento informado, se solicito a 420 jóvenes embarazadas atendidas en la clínica prenatal del hospital materno-infantil más grande en Nuevo León, que respondieran un cuestionario previamente validado para estimar la prevalencia del consumo de substancias. RESULTADOS: De 420 participantes, 317 (75.5%) consumieron al menos una de estas sustancias durante el embarazo. El alcohol, solo o en combinación, fue consumido por 300 (71.5%). El tabaco fue usado por 117 (27.8%), casi siempre en combinación con otras sustancias, mientras que la mariguana y otras drogas ilícitas fueron consumidas por 92 (21.9%) participantes. Alrededor de una cuarta parte del grupo estudiado (24.1%) reportó no haber consumido ninguna de estas substancias en su embarazo. CONCLUSIONES: En nuestra serie, la prevalencia de consumo de alcohol, tabaco y drogas ilícitas durante el embarazo, explorada con un instrumento validado, es mayor de la reportada en estimaciones previas en nuestro país. Estos datos ofrecen un panorama preocupante de una serie de factores que se agregan a la carga del embarazo en la adolescencia.

Prevalence of alcohol, tobacco, and illicit drugs consumption during teenage pregnancy: an observational, prospective, and cross-sectional study / Prevalencia del consumo de alcohol, tabaco y drogas ilícitas durante el embarazo en adolescentes: un estudio observacional, prospectivo y transversal

Abstract Background: Teenage pregnancy is a significant public health issue in Mexico; its prevalence oscillates around 20% of all pregnancies. Concurrently, alcohol, tobacco, and illicit drug use have become more common in this age group. Methods: To estimate the prevalence of substance exposure in a population of pregnant teenagers, we conducted a prospective, observational, and cross-sectional study. The protocol was approved by the institutional review board. On informed consent, we asked 420 consecutive pregnant youngsters cared for at the outpatient obstetric service of a tertiary public regional women´s and children´s hospital in Nuevo León, in northeast Mexico, to answer a previously validated questionnaire to estimate the prevalence of alcohol, tobacco, or illicit drugs use during pregnancy. Results: Of the 420 participants, 317 (75.5%) consumed at least one substance during pregnancy. Alcohol, either alone or in combination, was consumed by 300 (71.7%) participants. Tobacco was used by 117 (27.8%) participants, almost always in combination with other substances, while marijuana and other illicit drugs were consumed by 92 (21.9%) participants. Approximately one-fourth of the participants, 102 (24.1%) reported no substance use during pregnancy. Conclusions: In this series, the reported prevalence of alcohol, tobacco, and illicit drugs consumption during pregnancy, explored with a validated instrument, is higher than that previously reported in our country. This fact offers a worrying picture of another set of factors adding to the burden of teenage pregnancy.

Resumen Introducción: El embarazo en la adolescencia ha adquirido gran importancia en la salud pública en México; su prevalencia oscila alrededor del 20% de los embarazos. Paralelamente, el consumo de alcohol, tabaco y drogas ilícitas en este periodo es cada vez más común en estas jóvenes. Métodos: Para estimar la prevalencia de exposición a estas substancias en adolescentes embarazadas, se llevó a cabo un estudio prospectivo, observacional y transversal. El protocolo fue aprobado por los Comités de Ética e Investigación. Previo consentimiento informado, se solicito a 420 jóvenes embarazadas atendidas en la clínica prenatal del hospital materno-infantil más grande en Nuevo León, que respondieran un cuestionario previamente validado para estimar la prevalencia del consumo de substancias. Resultados: De 420 participantes, 317 (75.5%) consumieron al menos una de estas sustancias durante el embarazo. El alcohol, solo o en combinación, fue consumido por 300 (71.5%). El tabaco fue usado por 117 (27.8%), casi siempre en combinación con otras sustancias, mientras que la mariguana y otras drogas ilícitas fueron consumidas por 92 (21.9%) participantes. Alrededor de una cuarta parte del grupo estudiado (24.1%) reportó no haber consumido ninguna de estas substancias en su embarazo. Conclusiones: En nuestra serie, la prevalencia de consumo de alcohol, tabaco y drogas ilícitas durante el embarazo, explorada con un instrumento validado, es mayor de la reportada en estimaciones previas en nuestro país. Estos datos ofrecen un panorama preocupante de una serie de factores que se agregan a la carga del embarazo en la adolescencia.

Additive manufacturing of LiNi1/3Mn1/3Co1/3O2 battery electrode material via vat photopolymerization precursor approach.

Additive manufacturing, also called 3D printing, has the potential to enable the development of flexible, wearable and customizable batteries of any shape, maximizing energy storage while also reducing dead-weight and volume. In this work, for the first time, three-dimensional complex electrode structures of high-energy density LiNi1/3Mn1/3Co1/3O2 (NMC 111) material are developed by means of a vat photopolymerization (VPP) process combined with an innovative precursor approach. This innovative approach involves the solubilization of metal precursor salts into a UV-photopolymerizable resin, so that detrimental light scattering and increased viscosity are minimized, followed by the in-situ synthesis of NMC 111 during thermal post-processing of the printed item. The absence of solid particles within the initial resin allows the production of smaller printed features that are crucial for 3D battery design. The formulation of the UV-photopolymerizable composite resin and 3D printing of complex structures, followed by an optimization of the thermal post-processing yielding NMC 111 is thoroughly described in this study. Based on these results, this work addresses one of the key aspects for 3D printed batteries via a precursor approach: the need for a compromise between electrochemical and mechanical performance in order to obtain fully functional 3D printed electrodes. In addition, it discusses the gaps that limit the multi-material 3D printing of batteries via the VPP process.

Impact of secondary salts, temperature, and pH on the colloidal stability of graphene oxide in water.

The stability of graphene oxide (GO) in water is extremely relevant because of its application as an adsorbent material, as well as for its fate and behavior in the environment. Zeta potential was used to study the effect of secondary salts (carbonate, sulfate, and phosphate), temperature (20 to 60 °C), and pH (5 to 9) on the stability of six different GOs produced from natural, synthetic, and amorphous graphite-with and without the use of attrition milling. Generally, GOs produced with attrition-milled graphites had lower ζ-potentials than their unmilled counterparts because of their smaller particle sizes and higher concentration of oxygen-containing functional groups. It was observed that GO produced from graphite and synthetic graphite had ζ-potential values lower than -30 mV, even at 30 °C. However, it was observed that all the GOs studied were unstable in the presence of carbonate and sulfate salts at concentrations between 170 and 1695 mg L-1, as they reached a ζ-potential of -4.1 mV. Density-functional theory electronic structure calculations suggested that the instability of GO in the presence of carbonate and sulfate was caused by the abstraction of a proton resulting in interaction energies E int of 28.3 and 168.9 kJ mol-1, respectively. Our results suggest that temperatures above 30 °C, as well as carbonate and sulfate salts at concentrations relevant to arid and semi-arid regions, could promote the formation of agglomerates of GO, thus limiting its use and mobility in water.

[Neumatosis quística intestinal: reporte de un caso]. / Pneumatosis cystoides intestinalis: a case report.

ANTECEDENTES: La neumatosis quística intestinal es una condición infrecuente, caracterizada por la formación de quistes de contenido gaseoso debajo de la mucosa y la serosa intestinales. CASO CLÍNICO: Mujer de 84 años, con antecedente de artritis reumatoide en tratamiento inmunosupresor, intervenida hace 2 años por neumoperitoneo, con diagnóstico de diverticulosis yeyunal y enfisema mesentérico, acude con cuadro de dolor abdominal difuso de 2 días de evolución, sin otra sintomatología. En la radiografía de abdomen se observa neumoperitoneo con elevación del hemidiafragma derecho y distensión de asas del intestino delgado. Ante la sospecha de perforación de víscera hueca se decide intervención quirúrgica, en la cual se diagnostica a la paciente de neumatosis quística intestinal. CONCLUSIÓN: La neumatosis quística intestinal es de causa desconocida, aunque en un elevado porcentaje de pacientes se ha visto asociada a enfermedades pulmonares obstructivas, enfermedades del tejido conectivo, inmunosupresión o enfermedades gastrointestinales. Se localiza más frecuentemente en el colon y el intestino delgado. Se diagnostica principalmente mediante pruebas de imagen (radiografía o tomografía computarizada). El tratamiento es conservador, realizándose intervención quirúrgica si existe sospecha de necrosis intestinal. Es difícil el diagnóstico diferencial con un neumoperitoneo por perforación de víscera hueca. BACKGROUND: Pneumatosis cystoides intestinalis is an infrequent condition, characterized by the formation of gaseous content cysts under the mucosa and intestinal serous. CLINICAL CASE: 84-year-old woman, with a history of rheumatoid arthritis under immunosuppressive treatment, operated 2 years ago by pneumoperitoneum, where she was diagnosed of jejunal diverticulosis and mesenteric emphysema, with diffuse abdominal pain of 2 days of evolution, without other symptoms. In abdominal radiography: pneumoperitoneum with elevation of right hemidiaphragm and distention of small intestine. Given the suspicion of perforation of the intestinal wall, surgical intervention was decided, in which the patient was diagnosed with pneumatosis cystoides intestinalis. CONCLUSION: Pneumatosis cystoides intestinalis has an unknown etiology, although in a high percentage of patients it has been associated with obstructive pulmonary pathologies, connective tissue diseases, immunosuppression or gastrointestinal diseases. It is located more frequently in the colon and small intestine. It is diagnosed mainly through imaging tests (radiography or computed tomography). The treatment is conservative, performing surgical intervention if there is suspicion of intestinal necrosis; being difficult the differential diagnosis with a pneumoperitoneum by perforation of hollow viscera..

TLR2 activation induced by H. pylori LPS promotes the differential expression of claudin-4, -6, -7 and -9 via either STAT3 and ERK1/2 in AGS cells.

Gastric carcinogenesis has been associated to H. pylori virulence factors that induce a chronic inflammation process. Lipopolysaccharides play a role in chronic inflammatory responses via TLR2- and TLR4-dependent signaling pathways. Similarly, cellular invasiveness, metastatic potential and prognosis are usually associated to claudin-4, -6, -7 and -9 expression in gastric carcinogenesis. Therefore, the aim of this study was to determine if H. pylori LPS exerts an influence on carcinogenesis-related claudin expression and if it was directly regulated through the TLR2 pathway. Human antrum gastric adenocarcinoma AGS cells exposed or not to H. pylori LPS were used. Polyclonal anti-claudin-4, -6, -7 and -9, anti-TLR2, anti-pERK1/2 as well as rabbit monoclonal anti-pNFκB p65 and mouse monoclonal anti-CdX2 were used. ERK1/2 inhibitor UO126 and STAT3 inhibitor Stattic were also used. Western blot, immunofluorescence and confocal experiments were performed in whole cells as well as total protein, nuclear and cell membrane fractions. The results showed that H. pylori LPS increased the expression of TLR2 in a time dependent bi-phasic manner (<12 and >12h exposure). Immunofluorescence using AGS monolayers corroborated the double phase TLR2 expression mainly on the cell membrane but a detectable signal was also determined in the cytoplasm of the cells. Activation of NFkB was downstream and depended on TLR2 expression as a statistically significant increase in pNFkB, that followed a pattern highly similar to the TLR2 expression was observed on the cell membrane fraction. The increase in TLR2 expression was accompanied by dramatically increased claudin-4 expression in cultures exposed from 30m to 8h to LPS. Increased expression of claudin-6, -7 and -9 also increases in >12h LPS exposure times. The increase in claudins expression was also dependent on NFkB activation. The results also showed an increase in pSTAT3 that followed a bi-phasic pattern that began 30min after stimulation and was compatible with the increase in TLR2 expression. The expression of the claudin-4 related CDX2 transcription factor did not followed the biphasic pattern. The results also showed that claudin-4 expression was STAT3 dependent whereas claudin-6, 7 and 9 expressions was ERK1/2 dependent. Our results suggest that H. pylori LPS induces TLR2 expression in the AGS cells, and that the longer the exposure to LPS, the greater the expression of TLR2 in the cell membrane. Consequently the expression of claudin-4, -6, -7 and -9 also increases.

Meningitis por Haemophilus influenzae b: ¿estamos ante una reemergencia? 24 años de experiencia en un hospital pediátrico / Haemophilus influenzae type B meningitis: Is there a re-emergence? 24 years of experience in a children's hospital

Introducción. Haemophilus influenzae b era la principal causa de meningitis bacteriana en menores de 5 años. Después de la introducción de la vacuna al calendario (1998), se observó un descenso significativo de la incidencia, pero, en los últimos años, hubo un aumento. Los objetivos de este estudio fueron describir las características y analizar la curva epidémica de los casos de meningitis por Haemophilus influenzae b (MHib) comparando los períodos pre- y posvacunación. Material y métodos. Estudio de series temporales. Se incluyeron todos los pacientes internados por MHib en el Hospital de Niños "R. Gutiérrez" (enero de 1992-mayo de 2016). Se compararon las tasas de hospitalización antes (prevacunación) y después (posvacunación) de la introducción de la vacuna. Se dividió la etapa posvacunación en tres períodos similares. Resultados. Fueron admitidos 85 pacientes con MHib (73,3% prevacunación). Las características clínicas y sociodemográficas de los casos en ambos períodos no mostraron diferencias. Prevacunación: 10,5 casos/año; y posvacunación: 0,7 casos/año. A partir de 2014, se observó un aumento. Tasa de letalidad: 4,8% (todos prevacunación). Datos posvacunación (n= 15): 40% del esquema primario completo, 40% del esquema atrasado para la edad. Reducción global de la tasa hospitalaria de MHib de 89,8% (IC 95%: -82,79-93,96%; p < 0,001) en el período posvacunación. Al analizar los diferentes períodos posvacunación, se observa una caída en la reducción a lo largo del tiempo. Conclusiones. Se observó una disminución muy importante de las hospitalizaciones por MHib pos introducción de la vacuna, pero, en los últimos años, se evidenció un aumento de estos casos sin modificaciones en las características de los pacientes.

Introduction. Haemophilus influenzae type B (Hib) used to be the main cause of bacterial meningitis in children younger than 5 years old. Following the introduction of the Hib vaccine in the immunization schedule (1998), its incidence reduced significantly but it has increased over the last years. The objectives of this study included describing the characteristics and analyzing the epidemic curve of Haemophilus influenzae type B (Hib) meningitis by comparing the pre- and postimmunization periods. Material and methods. Time-series study. All patients hospitalized with Hib meningitis at Hospital de Niños "R. Gutiérrez" (January 1992-May 2016). Hospitalization rates were compared before (pre-immunization) and after (post-immunization) the introduction of the Hib vaccine. The post-immunization period was divided into three similar periods. Results. Eighty-five patients with Hib meningitis were admitted (73.3% in the pre-immunization period). No differences were observed in relation to the clinical and sociodemographic characteristics of cases in both periods. Pre-immunization: 10.5 cases/year; postimmunization: 0.7 cases/year. As of 2014, the rate has increased. Lethality rate: 4.8% (all preimmunization). Post-immunization data (n= 15): 40% had completed their primary immunization schedule, 40% were delayed on the immunization schedule for their age. Overall reduction in the hospital rate of Hib meningitis by 89.8% (95% confidence interval: -82.79-93.96%, p < 0.001) in the post-immunization period. The analysis of the different post-immunization periods shows a decline in reduction over time. Conclusions. A very significant reduction in hospitalizations due to Hib meningitis was observed after the Hib vaccine was introduced; however, over the past years, the number of cases has increased although no changes have been observed in patient characteristics.

Haemophilus influenzae type B meningitis: Is there a re-emergence? 24 years of experience in a children's hospital. / Meningitis por Haemophilus influenzae b: ¿estamos ante una reemergencia? 24 años de experiencia en un hospital pediátrico.

INTRODUCTION: Haemophilus influenzae type B (Hib) used to be the main cause of bacterial meningitis in children younger than 5 years old. Following the introduction of the Hib vaccine in the immunization schedule (1998), its incidence reduced significantly but it has increased over the last years. The objectives of this study included describing the characteristics and analyzing the epidemic curve of Haemophilus influenzae type B (Hib) meningitis by comparing the pre- and postimmunization periods. MATERIALS AND METHODS: Time-series study. All patients hospitalized with Hib meningitis at Hospital de Niños "R. Gutiérrez" (January 1992-May 2016). Hospitalization rates were compared before (pre-immunization) and after (post-immunization) the introduction of the Hib vaccine. The post-immunization period was divided into three similar periods. RESULTS: Eighty-five patients with Hib meningitis were admitted (73.3% in the pre-immunization period). No differences were observed in relation to the clinical and sociodemographic characteristics of cases in both periods. Pre-immunization: 10.5 cases/year; postimmunization: 0.7 cases/year. As of 2014, the rate has increased. Lethality rate: 4.8% (all preimmunization). Post-immunization data (n= 15): 40% had completed their primary immunization schedule, 40% were delayed on the immunization schedule for their age. Overall reduction in the hospital rate of Hib meningitis by 89.8% (95% confidence interval: -82.79-93.96%, p < 0.001) in the post-immunization period. The analysis of the different post-immunization periods shows a decline in reduction over time. CONCLUSIONS: A very significant reduction in hospitalizations due to Hib meningitis was observed after the Hib vaccine was introduced; however, over the past years, the number of cases has increased although no changes have been observed in patient characteristics.

INTRODUCCIÓN: Haemophilus influenzae b era la principal causa de meningitis bacteriana en menores de 5 años. Después de la introducción de la vacuna al calendario (1998), se observó un descenso significativo de la incidencia, pero, en los últimos años, hubo un aumento. Los objetivos de este estudio fueron describir las características y analizar la curva epidémica de los casos de meningitis por Haemophilus influenzae b (MHib) comparando los períodos pre- y posvacunación. MATERIAL Y MÉTODOS: Estudio de series temporales. Se incluyeron todos los pacientes internados por MHib en el Hospital de Niños "R. Gutiérrez" (enero de 1992-mayo de 2016). Se compararon las tasas de hospitalización antes (prevacunación) y después (posvacunación) de la introducción de la vacuna. Se dividió la etapa posvacunación en tres períodos similares. RESULTADOS: Fueron admitidos 85 pacientes con MHib (73,3% prevacunación). Las características clínicas y sociodemográficas de los casos en ambos períodos no mostraron diferencias. Prevacunación: 10,5 casos/año; y posvacunación: 0,7 casos/año. A partir de 2014, se observó un aumento. Tasa de letalidad: 4,8% (todos prevacunación). Datos posvacunación (n= 15): 40% del esquema primario completo, 40% del esquema atrasado para la edad. Reducción global de la tasa hospitalaria de MHib de 89,8% (IC 95%: -82,79-93,96%; p < 0,001) en el período posvacunación. Al analizar los diferentes períodos posvacunación, se observa una caída en la reducción a lo largo del tiempo. CONCLUSIONES: Se observó una disminución muy importante de las hospitalizaciones por MHib pos introducción de la vacuna, pero, en los últimos años, se evidenció un aumento de estos casos sin modificaciones en las características de los pacientes.

Predictors of diagnosis and survival in idiopathic pulmonary fibrosis and connective tissue disease-related usual interstitial pneumonia.

BACKGROUND: Although usual interstitial pneumonia (UIP) appears to portend better survival when associated with connective tissue disease (CTD-UIP), little is known about the presenting clinical, radiologic, and pathologic features that differentiate pathologically confirmed UIP with CTD from idiopathic pulmonary fibrosis (IPF). In patients with atypical radiologic and clinical features, what specific findings predict underlying IPF vs. CTD-UIP diagnosis and their respective long term survival? METHODS: A large retrospective cohort analysis was done of consecutive patients seen from 1995 through 2010 with biopsy confirmed UIP completed or reviewed at our institution. CTD-UIP was defined by independent rheumatology consultation with exclusion of all other secondary causes of lung fibrosis. Primary clinical data was collected and compared for IPF and CTD-UIP along with logistic regression performed for predictors of disease likelihood and Cox proportional hazards analysis for predictors of survival. RESULTS: Six hundred and twenty five patients were included in the study of which 89 had diagnosed CTD-UIP representing 7 disease entities. Survival was better among those with CTD-UIP except in UIP associated with rheumatoid arthritis, which had similar presenting features and survival to IPF. Predictors of underlying CTD included female gender, younger age, positive autoimmune serology, and inconsistent presenting radiologic findings. Only age and forced vital capacity corrected for a priori covariates were predictive of survival in CTD-UIP. CONCLUSIONS: UIP pathology occurs frequently among patients with atypically presenting clinical and radiologic features, and may represent IPF or CTD-UIP with improved prognosis if underlying CTD is diagnosed. Presenting radiologic and pathologic features alone are not predictive of underlying secondary cause or survival between the two groups.

Neuroprotective effect of the aminoestrogen prolame against impairment of learning and memory skills in rats injected with amyloid-ß-25-35 into the hippocampus.

Alzheimer's disease (AD) is a neurodegenerative disorder caused by the deposition of the amyloid-beta peptide (Aß) in senile plaques and cerebral vasculature. Its neurotoxic mechanisms are associated with the generation of oxidative stress and reactive astrogliosis that cause neuronal death and memory impairment. Estrogens reduce the rate of Azheimer's disease because of their antioxidant activity. Prolame (N-(3-hydroxy-1,3,5(10)-estratrien-17ß-yl)-3-hydroxypropylamine) is an aminoestrogen with estrogenic and antithrombotic effects. In our study we evaluated the role of prolame on Aß(25-35)-caused oxidative stress, reactive astrogliosis, and impairment of spatial memory(.) The Aß(25-35) (100 µM/µl) or vehicle was injected into the CA1 subfield of the hippocampus of the rat. The subcutaneous injection of prolame (400 µl, 50 nM) or sesame oil (400 µl) started 1 day before the Aß(25-35) injection and was continued for another 29 days. The results showed a significant impairment of spatial memory evident 30 days after the Aß(25-35) injection. The prolame treatment significantly reduced spatial-memory impairment and decreased lipid peroxidation, reactive oxygen species, and reactive gliosis. It also restored the eNOS and nNOS expression to normal levels. In conclusion the aminoestrogen prolame should be considered as an alternative in the treatment of Alzheimer's disease.

Cáncer de pulmón no a pequeñas células. Análisis de la sobrevida de acuerdo al tratamiento. Hospital de Clínicas 1990-1996 / Non small cell lung cancer. Analysis of survival according to treatment. Hospital de Clinicas 1990-1996

Objetivo: Evaluar la sobrevida de los pacientes con cáncer de pulmón no a pequeñas células según la terapéutica y el tipo histológico. Material y método: Fueron evaluados todos los pacientes registrados en el Departamento de Oncología del Hospital de Clínicas portadores de cáncer de pulmón no a pequeñas células en el período 1990-1996. La estadificación fue clínica y paraclínica de acuerdo al TNM. La evaluación inicial incluyó examen físico, Rx de tórax, tomografía computada de tórax y abdomen superior, hemograma y enzimograma hepático. Se incluyeron en el grupo de tratamiento oncoespecífico aquellos pacientes que recibieron tratamiento del tumor primario con cirugía, radioterapia a dosis igual o mayor de 4000 cGy, una o más series de quimioterapia y cirugía ó radioterapia de las metástasis encefálicas. El análisis de sobrevida se llevó a cabo estudiando diferentes variables. Para comparaciones univariadas se utilizó el test Logrank mientras que se usó el modelo de Cox para estudiar el rol de múltiples variables. Resultados: Fueron evaluados 199 pacientes y estadificados como estadío I=1, estadío II= 15, estadío III= 99, estadío IV= 84. La edad promedio fue de 62 años. El promedio de años de fumador fue de 46 años. La histología de 91 pacientes fue carcinoma epidermoide, 47 adenocarcinoma, 8 carcinoma a células grandes, 16 indiferenciado y en 28 pacientes no se llegó al diagnóstico histológico. La sobrevida global fue de 6 meses. La sobrevida mediana para los pacientes con tratamiento oncoespecífico fue de 8 y 6 meses para el estadío III y IV respectivamente; sin tratamiento oncoespecífico de 4 meses en ambos estadíos. Conclusiones: El diagnóstico de CBP continúa siendo tardío. La mayoría de los tumores no a células pequeñas son epidermoides. La sobrevida promedio en estadíos avanzados continúa siendo reducida. Existe una diferencia significativa en el tiempo de sobrevida con y sin tratamiento oncoespecífico

Análisis del tratamiento y sobrevida del cáncer de pulmón a células pequeñas. Hospital de Clínicas 1990-1996 / Analysis of treatment and survival for small cell lung cancer. Hospital de Clinicas 1990-1996

Objetivo: Evaluar en forma retrospectiva el tratamiento y la sobrevida de los pacientes con cáncer de pulmón a células pequeñas. Material y método: Fueron incluidos todos los pacientes registrados en el Departamento de Oncología del Hospital de Clínicas portadores de cáncer de pulmón a células pequeñas en el período 1990-1996. La estadificación fue clínica y paraclínica, usando el sistema de 2 etapas, dearrollado por el Grupo de Estudio del Cáncer de Pulmón de la Administración de Veteranos(1). Los pacientes con derrame pleural masivo y ganglios supraclaviculares contralaterales han sido incluidos en la etapa limitada. La evaluación inicial incluyó exámen físico, Rx de tórax, tomografía computada de tórax y abdomen superior, hemograma y enzimograma hepático. Se incluyeron en el grupo de tratamiento oncoespecífico aquellos pacientes que recibieron tratamiento de radioterapia sobre el tumor primario a dosis igual o mayor de 4000 cGy y una o más series de quimioterapia. Para el análisis de sobrevida se utilizó el test Logrank. Resultados: Fueron evaluados 50 pacientes y estadificados como estadío localizado 17 pacientes y como estadío extendido 33 pacientes. La edad promedio fue de 61 años. La sobrevida global fue de 8 meses. La sobrevida mediana para los pacientes con tratamiento oncoespecífico fue de 9 meses; sin tratamiento oncoespecífico de 2,5 meses. Conclusiones: Los 2/3 de los tumores en células pequeñas se presentan con enfermedad diseminada en el momento del diagnóstico. El tratamiento oncoespecífico aumenta la sobrevida casi 4 veces comparada con los pacientes que no reciben tratamiento oncoespecífico. La sobrevida continúa siendo reducida llegando al 0 por ciento a los 3 años y medio