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J Gastrointest Surg ; 2020 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-33236322


BACKGROUND: Delayed gastric emptying (DGE) is a frequent complication after pancreaticoduodenectomy (PD) that impairs recovery and quality of life. The purpose of this study was to assess the impact risk-stratified pancreatectomy clinical pathways (RSPCPs) had on delayed gastric emptying (DGE) and identify factors associated with DGE in a contemporary period. METHODS: A single-institution, prospective database was queried for consecutive PDs during July 2011-November 2019. Using international definitions, DGE rates were compared between periods before and after RSPCPs were implemented in 2016, classifying patients according to their postoperative pancreatic fistula (POPF) risk. Risk factors were analyzed to identify modifiable targets. RESULTS: Among 724 elective PDs, 552 (76%) were for adenocarcinoma and 172 (24%) for other diagnoses. Of the 197 (27%) patients with DGE, 119 (16%) had type A, 41 (6%) type B, and 38 (5%) type C. In the overall cohort, DGE rates were higher with pylorus-preserving vs. classic hand-sewn reconstruction (odds ratio [OR] - 1.84; p < 0.001), postoperative abscess (OR - 2.54; p = 0.003), and non-white patients (p = 0.007), but lower after implementation of RSPCPs (OR - 0.34, p < 0.001). In the 374 patients treated with RSPCPs, only 17% (n = 65/374) developed DGE. Patients with protocol-compliant NGT removal ≤ 48 h were less likely to experience DGE (OR - 1.46, p = 0.042). CONCLUSION: Our data suggest that implementation of preoperatively assigned RSPCPs as a care bundle was the most important factor in decreasing DGE. These gains were accentuated in patients who underwent early nasogastric tube removal and had a classic hand-sewn gastro-jejunostomy reconstruction. Application of these modifiable factors is generalizable with low implementation barriers.

Rev. colomb. gastroenterol ; 35(3): 304-310, jul.-set. 2020. tab, graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1138787


Resumen Introducción: la patología biliar litiásica es una de las entidades más frecuentes en el área de cirugía general y en gastroenterología. El tratamiento varía según el lugar donde se alojen los cálculos. Para esto, se han definido diversas escalas de estratificación del riesgo de presentar coledocolitiasis, pero son los criterios planteados por la Sociedad Americana de Endoscopia Gastrointestinal (American Society for Gastrointestinal Endoscopy, ASGE) los más usados a nivel mundial, ya que tienen una precisión diagnóstica definida del 70 %. Los procedimientos o ayudas diagnósticas establecidas por estos criterios, en ocasiones, prolongan el tiempo de hospitalización, aumentan los costos y pueden tener complicaciones. Metodología: se realizó un estudio observacional analítico, de tipo transversal retrospectivo, con datos obtenidos a partir de las historias clínicas de pacientes sometidos a colecistectomía laparoscópica, en la Clínica CES de Medellín, entre julio y diciembre de 2017. Resultados y conclusiones: se analizaron 424 historias clínicas de pacientes sometidos a colecistectomia laparoscópica. De ellos, 254 (56,76 %) se categorizaron como de riesgo bajo, mientras que 94 (22,11 %) fueron de riesgo intermedio y 76 (17,88 %) de riesgo alto. Se encontró una frecuencia de coledocolitiasis del 90,8 % en aquellos categorizados como de riesgo alto y del 26,6 % en los pacientes de riesgo intermedio. En la categoría de riesgo intermedio se hallaron diferencias estadísticamente significativas entre ambos grupos para los valores de bilirrubina total, bilirrubina directa y aspartato aminotransferasa (AST) (p = 0,001; p = 0,014; p = 0,007, respectivamente). La baja frecuencia de coledocolitiasis en la categoría de riesgo intermedio puede ser explicada por cálculos menores a 5 mm no visibles en la colangiorresonancia. A partir de este estudio, se propone ajustar los rangos de valores de los criterios de la ASGE para la categoría de riesgo intermedio, permitiendo tener una mayor precisión a la hora de clasificar los pacientes con patología litiásica y disminuir costos y estancia hospitalaria.

Abstract Introduction: Biliary lithiasis is one of the most frequent diseases in the area of general surgery and gastroenterology. Treatment varies depending on the location of the gallstones. Several stratification scales of the risk of choledocholithiasis have been defined, being the criteria proposed by the American Society of Gastrointestinal Endoscopy (ASGE) the most used worldwide, with a diagnostic accuracy of 70%. However, the procedures or diagnostic aids defined by these criteria, sometimes, increase hospital stay, costs, and may lead to the development of complications. Methodology: An observational, analytical, retrospective, cross-sectional study was conducted with data obtained from the clinical records of patients undergoing laparoscopic cholecystectomy at the CES Clinic in Medellín, Colombia, between July and December of 2017. Results and conclusions: 424 medical records were analyzed, of which 254 (56.76%) were classified as low-risk, 94 (22.11%) as intermediate-risk and 76 (17.88%) as high-risk. The frequency of choledocholithiasis was 90.8% in high-risk patients and 26.6% in intermediate-risk patients. For the intermediate-risk category, statistically significant differences were found between the two groups for the total bilirubin, direct bilirubin, and AST values (p: 0.001, p: 0.014, p:0.007, respectively). The low frequency of choledocholithiasis in the intermediate-risk category can be explained by less than 5mm gallstones not identified by the cholangioresonance. Based on this study, we propose to adjust the ranges of the ASGE criteria variables for the intermediate-risk category for better accuracy when classifying patients with biliary lithiasis and, thus, reduce costs and hospital stay.

Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Doença , Colecistectomia Laparoscópica , Coledocolitíase , Pacientes , Aspartato Aminotransferases , Bilirrubina , Risco , Estudos Transversais , Litíase
Parasitol Res ; 118(12): 3449-3457, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31659453


We assessed the risk for toxoplasmosis in 10 school restaurants in Armenia (Quindio, Colombia). We analyzed the presence of Toxoplasma gondii DNA in the food, water, and living and inert surfaces of school restaurants, and we correlated these findings with the results of food safety inspection scores and with the prevalence of specific anti-T. gondii antibodies in children who ate at these restaurants. Of the 213 samples, 6.1% were positive using PCR to test for T. gondii DNA. Positive samples were found in meat, water, cucumber, guava juice, inert surfaces, and living surfaces. In 60% (6/10) of the public school restaurants, there was at least one PCR T. gondii-positive sample. In 311 serum samples from children who attended the restaurants, 101 (33%) were positive for IgG and 12 (3.9%) for IgM anti-T. gondii. The median of the compound score for the fulfillment of inspection for food safety conditions was of 60.7% (range 50-72). Higher T. gondii PCR positivity in surfaces, food, or water at each restaurant was correlated with lower inspection scores for water supply and water storage conditions. Lower scores in physical infrastructure and disinfection procedures and higher scores in furniture were correlated with a higher prevalence of IgG anti-T. gondii in children who ate at those restaurants. Inspection scores can identify restaurants with a higher risk for the presence of T. gondii.

Contaminação de Alimentos/análise , Parasitologia de Alimentos , Toxoplasma/isolamento & purificação , Toxoplasmose/epidemiologia , Animais , Anticorpos Anti-Idiotípicos/sangue , Anticorpos Antiprotozoários/sangue , Armênia/epidemiologia , Criança , Colômbia/epidemiologia , Feminino , Inocuidade dos Alimentos , Humanos , Masculino , Carne/parasitologia , Prevalência , Restaurantes/estatística & dados numéricos , Fatores de Risco , Instituições Acadêmicas/estatística & dados numéricos , Toxoplasma/classificação , Toxoplasma/genética , Toxoplasmose/sangue , Toxoplasmose/diagnóstico , Toxoplasmose/parasitologia
Heliyon ; 5(8): e02377, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31517100


Methods to detect protozoa are needed for food safety monitoring. We evaluated protocols to recover Giardia spp. cysts in Brassica oleracea (cabbage) and Lactuca sativa (lettuce) and then detection was performed by concentrating with formalin/ether solutions and microscopy or immunofluorescence or DNA amplification via PCR. To evaluate this methodology, G. duodenalis cysts were inoculated in triplicate (10 cysts) in 35-g samples of lettuce and cabbage. The method obtaining the highest percentage of recovery in cabbage was sulfamic acid solution plus stirring with stomacher (47.7% ± 7.5). For lettuce, the best method was glycine solution plus stirring with stomacher (46.6% ± 5.3). Inter-observer agreement was of 0.99. Giardia was detected by amplifying specific sequences for the DNA coding SSU rRNA. In 27 lettuce samples and 27 cabbage samples, obtained from supermarkets and street vendors, two lettuce samples (7.4%) and one cabbage sample (3.7%) were positive for Giardia via PCR assay and were sequenced, determining that they were two of assemblage B and one of lettuce to assemblage E. This method is proposed to detect Giardia in vegetables by PCR detection, enabling public health authorities to identify genotypes circulating in food, which will help to establish measures that reduce outbreaks of parasitic diseases associated with contaminated food.

Clin Cancer Res ; 23(21): 6468-6477, 2017 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-29093017


Background: Breast cancer patients who do not respond to neoadjuvant therapy have a poor prognosis. There is a pressing need for novel targets and models for preclinical testing. Here we report characterization of breast cancer patient-derived xenografts (PDX) largely generated from residual tumors following neoadjuvant chemotherapy.Experimental Design: PDXs were derived from surgical samples of primary or locally recurrent tumors. Normal and tumor DNA sequencing, RNASeq, and reverse phase protein arrays (RPPA) were performed. Phenotypic profiling was performed by determining efficacy of a panel of standard and investigational agents.Results: Twenty-six PDXs were developed from 25 patients. Twenty-two were generated from residual disease following neoadjuvant chemotherapy, and 24 were from triple-negative breast cancer (TNBC). These PDXs harbored a heterogeneous set of genomic alterations and represented all TNBC molecular subtypes. On RPPA, PDXs varied in extent of PI3K and MAPK activation. PDXs also varied in their sensitivity to chemotherapeutic agents. PI3K, mTOR, and MEK inhibitors repressed growth but did not cause tumor regression. The PARP inhibitor talazoparib caused dramatic regression in five of 12 PDXs. Notably, four of five talazoparib-sensitive models did not harbor germline BRCA1/2 mutations, but several had somatic alterations in homologous repair pathways, including ATM deletion and BRCA2 alterations.Conclusions: PDXs capture the molecular and phenotypic heterogeneity of TNBC. Here we show that PARP inhibition can have activity beyond germline BRCA1/2 altered tumors, causing regression in a variety of molecular subtypes. These models represent an opportunity for the discovery of rational combinations with targeted therapies and predictive biomarkers. Clin Cancer Res; 23(21); 6468-77. ©2017 AACR.

Proteína BRCA1/genética , Proteína BRCA2/genética , Ftalazinas/administração & dosagem , Neoplasias de Mama Triplo Negativas/tratamento farmacológico , Acrilonitrila/administração & dosagem , Acrilonitrila/análogos & derivados , Compostos de Anilina/administração & dosagem , Animais , Linhagem Celular Tumoral , Modelos Animais de Doenças , Feminino , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Mutação em Linhagem Germinativa , Humanos , Camundongos , Inibidores de Fosfoinositídeo-3 Quinase , Ftalazinas/efeitos adversos , Inibidores de Poli(ADP-Ribose) Polimerases/administração & dosagem , Inibidores de Poli(ADP-Ribose) Polimerases/efeitos adversos , Serina-Treonina Quinases TOR/antagonistas & inibidores , Neoplasias de Mama Triplo Negativas/genética , Neoplasias de Mama Triplo Negativas/patologia , Ensaios Antitumorais Modelo de Xenoenxerto
Breast Cancer Res ; 19(1): 93, 2017 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-28810913


BACKGROUND: Selinexor (KPT-330) is an oral agent that has been shown to inhibit the nuclear exporter XPO1. Given the pressing need for novel therapies for triple-negative breast cancer (TNBC), we sought to determine the antitumor effects of selinexor in vitro and in vivo. METHODS: Twenty-six breast cancer cell lines of different breast cancer subtypes were treated with selinexor in vitro. Cell proliferation assays were used to measure the half-maximal inhibitory concentration (IC50) and to test the effects in combination with chemotherapy. In vivo efficacy was tested both as a single agent and in combination therapy in TNBC patient-derived xenografts (PDXs). RESULTS: Selinexor demonstrated growth inhibition in all 14 TNBC cell lines tested; TNBC cell lines were more sensitive to selinexor (median IC50 44 nM, range 11 to 550 nM) than were estrogen receptor (ER)-positive breast cancer cell lines (median IC50 > 1000 nM, range 40 to >1000 nM; P = 0.017). In multiple TNBC cell lines, selinexor was synergistic with paclitaxel, carboplatin, eribulin, and doxorubicin in vitro. Selinexor as a single agent reduced tumor growth in vivo in four of five different TNBC PDX models, with a median tumor growth inhibition ratio (T/C: treatment/control) of 42% (range 31 to 73%) and demonstrated greater antitumor efficacy in combination with paclitaxel or eribulin (average T/C ratios of 27% and 12%, respectively). CONCLUSIONS: Collectively, these findings strongly suggest that selinexor is a promising therapeutic agent for TNBC as a single agent and in combination with standard chemotherapy.

Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Proliferação de Células/efeitos dos fármacos , Hidrazinas/administração & dosagem , Triazóis/administração & dosagem , Neoplasias de Mama Triplo Negativas/tratamento farmacológico , Animais , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Apoptose/efeitos dos fármacos , Doxorrubicina/administração & dosagem , Feminino , Furanos/administração & dosagem , Furanos/efeitos adversos , Humanos , Hidrazinas/efeitos adversos , Cetonas/administração & dosagem , Cetonas/efeitos adversos , Células MCF-7 , Camundongos , Triazóis/efeitos adversos , Neoplasias de Mama Triplo Negativas/patologia , Ensaios Antitumorais Modelo de Xenoenxerto
Oncotarget ; 8(26): 41806-41814, 2017 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-28415679


PURPOSE: Molecular profiling performed in the research setting usually does not benefit the patients that donate their tissues. Through a prospective protocol, we sought to determine the feasibility and utility of performing broad genomic testing in the research laboratory for discovery, and the utility of giving treating physicians access to research data, with the option of validating actionable alterations in the CLIA environment. EXPERIMENTAL DESIGN: 1200 patients with advanced cancer underwent characterization of their tumors with high depth hybrid capture sequencing of 201 genes in the research setting. Tumors were also tested in the CLIA laboratory, with a standardized hotspot mutation analysis on an 11, 46 or 50 gene platform. RESULTS: 527 patients (44%) had at least one likely somatic mutation detected in an actionable gene using hotspot testing. With the 201 gene panel, 945 patients (79%) had at least one alteration in a potentially actionable gene that was undetected with the more limited CLIA panel testing. Sixty-four genomic alterations identified on the research panel were subsequently tested using an orthogonal CLIA assay. Of 16 mutations tested in the CLIA environment, 12 (75%) were confirmed. Twenty-five (52%) of 48 copy number alterations were confirmed. Nine (26.5%) of 34 patients with confirmed results received genotype-matched therapy. Seven of these patients were enrolled onto genotype-matched targeted therapy trials. CONCLUSION: Expanded cancer gene sequencing identifies more actionable genomic alterations. The option of CLIA validating research results can provide alternative targets for personalized cancer therapy.

Variação Genética , Genoma Humano , Genômica , Laboratórios , Pesquisa , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Criança , Pré-Escolar , Análise Mutacional de DNA , Estudos de Viabilidade , Feminino , Testes Genéticos/métodos , Testes Genéticos/normas , Genômica/métodos , Genômica/normas , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , Neoplasias/diagnóstico , Neoplasias/genética , Medicina de Precisão/métodos , Medicina de Precisão/normas , Reprodutibilidade dos Testes , Projetos de Pesquisa , Fluxo de Trabalho , Adulto Jovem
Contraception ; 93(2): 178-83, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26475368


OBJECTIVE: To compare discontinuation rates and incidence of repeat pregnancy within 1 year among young mothers choosing postplacental intrauterine devices (IUDs) versus postpartum contraceptive implants. STUDY DESIGN: We enrolled a prospective cohort of postpartum adolescents and young women who chose either postplacental IUDs or postpartum contraceptive implants prior to hospital discharge. We used chart review and phone interviews to assess device discontinuation (by request or expulsion) and pregnancy within 12 months. RESULTS: Of the 244 13-22 year-old participants, 82 chose IUDs (74 levonorgestrel IUDs and 8 copper IUDs), and 162 chose implants. Both groups had participant-requested discontinuation rates of 14% (9/67 IUD; 19/135 implant) within 1 year. Participants choosing IUDs had a 25% (17/67) expulsion rate. Median time to expulsion was 4.1 weeks (range: 0.4-29.3 weeks, 16/17 within 12 weeks), and participants recognized 15/17 expulsions. IUD initiators had significantly higher pregnancy rates by 12 months (7.6% vs. 1.5%, p=0.04). Most pregnancies occurred when women discontinued their initial device and did not start alternative contraception. DISCUSSION: Participant-requested discontinuation was similar in both groups. Differences in overall device discontinuation rates were due to IUD expulsions. Pregnancy rates by 12 months postpartum were lower than previously reported in this age group in both implant initiators and IUD initiators. IMPLICATIONS: Young mothers who choose postplacental IUDs or postpartum contraceptive implants are unlikely to request removal within the first year. Clinicians should counsel postplacental IUD users that early expulsion is common (25%) and may be unrecognized (11% of expulsions). Patients should have a plan for contraceptive management should expulsion occur.

Anticoncepção/métodos , Anticoncepcionais Femininos/administração & dosagem , Implantes de Medicamento , Dispositivos Intrauterinos/estatística & dados numéricos , Período Pós-Parto , Adolescente , Feminino , Humanos , Expulsão de Dispositivo Intrauterino , Dispositivos Intrauterinos de Cobre , Dispositivos Intrauterinos Medicados , Levanogestrel , Paridade , Gravidez , Fatores de Tempo , Adulto Jovem
Rev. colomb. cancerol ; 18(2): 69-77, abr.-jun. 2014. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-726889


Objetivo: Describir las características clínicas y epidemiológicas de los pacientes con osteosarcoma de extremidad de alto grado tratados entre 2007 y 2010 con los protocolos Rizzoli 2 o Rizzoli 4 en el Instituto Nacional de Cancerología. Materiales y métodos: Se analizaron las historias clínicas de pacientes con osteosarcoma de extremidad que recibieron tratamiento con los regímenes Rizzoli 2 o Rizzoli 4. Se utilizaron técnicas de estadística descriptiva y se estimaron funciones de supervivencia para mortalidad y recaída. Resultados: Se encontraron un total de 18 pacientes que recibieron protocolo Rizzoli. Con edad promedio de 25 años (DE=10,2) y localización anatómica más frecuente en el fémur. 15 de los 18 pacientes que recibieron quimioterapia preoperatoria fueron llevados a cirugía, lográndose la preservación de la extremidad en 9 de ellos (60%); los demás requirieron amputación. Entre los 15 pacientes operados, se encontró buena respuesta patológica (viabilidad tumoral ≤ 10%) en 5 (33,33%). Luego de un seguimiento de 2 años, el 57% de los pacientes se encontraban vivos. El evento adverso no hematológico más frecuente fue la elevación de transaminasas grado 3. La toxicidad hematológica más frecuente fue la leucopenia grado 2 y neutropenia grado 3. De los 18 pacientes, 7 abandonaron el tratamiento (2 durante la neoadyuvancia y 5 en la adyuvancia). Conclusiones: El uso de los protocolos Rizzoli 2 y 4 en la población incluida dio como resultado tasas de respuesta, preservación de extremidad y supervivencia global menores que las reportadas en las publicaciones originales.

Objective: To describe the clinical and epidemiological characteristics of patients with osteosarcoma high grade limb osteosarcoma treated between 2007 and 2010 using Rizzoli 2 or Rizzoli 4 protocols in the National Cancer Institute, Colombia. Materials and methods: An analysis was made of the medical histories of patients with limb osteosarcoma who had received treatment with the Rizzoli 2 or Rizzoli 4 protocol. Descriptive statistics were used and survival and recurrence rates were estimated. Results: A total of 18 patients were found that had received treatment using the Rizzoli protocol. The mean age was 25 years (SD=10.2) and the most frequent anatomical location was in the femur. Surgery was performed on 15 of the 18 patients who received pre-operative chemotherapy, with limb salvage being achieved in 9 (60%) of them, and the remainder required amputation. A good pathological response was observed in the 15 patients who received surgery (tumor viability ≤ 10%) in 5 (33.33%). In the follow up at 2 years, 57% of the patients were still alive. The most frequent non-hematological adverse event was a grade 3 increase in transaminases. The most frequent hematology event was grade 2 leukopenia and grade 3 neutropenia of the 18 patients, 7 of them dropped out of the treatment (2 during neoadjuvant and 5 during adjuvant). Conclusions: The use of the Rizzoli 2 and 4 protocols in this population gave lower response, limb salvage, and overall survival rates than those reported in other publications.

Humanos , Osteossarcoma , Extremidades , Recidiva , Técnicas , Sobrevivência , Amputação , Métodos
Rev. colomb. cancerol ; 16(2): 119-129, jun. 2012. tab
Artigo em Espanhol | LILACS | ID: lil-662991


El carcinoma córtico-adrenal es una entidad que se presenta raras veces; su evolución es agresiva, con una alta probabilidad de recaída y una supervivencia a 5 años que no supera el 60%. El único tratamiento curativo es la cirugía, siempre y cuando esta sea completa y a los pacientes se los diagnostique en estadios tempranos. Otras intervenciones que se pueden brindar son la radioterapia, la quimioterapia y el control de secreción hormonal en el contexto adyuvante o paliativo. En algunos casos (síndrome de Cushing) el bloqueo hormonal previo a la cirugía es imperativo. En esta revisión se describen la patogénesis, el diagnóstico, los factores pronósticos y el tratamiento del carcinoma córtico-adrenal, con el propósito de guiar el enfoque diagnóstico y el tratamiento.

Adrenal-cortical carcinoma is a rarely occurring entity; it evolves aggressively, has a high probability of relapse and survival at 5 years does not surpass 60%. Surgery provides the only curative treatment, but only when it is complete and carried out on patients with early-stage diagnosis. Additional treatments that may be used include radiotherapy, chemotherapy and control of hormonal secretion in an adjuvant or palliative context. In some cases (Cushing´s syndrome), it is imperative to provide hormonal block before surgery. The pathogenesis, diagnosis, prognostic factors and treatment of adrenal-cortical carcinoma are described in this review in order to sharpen the focus on diagnosis and treatment.

Humanos , Carcinoma Adrenocortical , Síndrome de Cushing , Metástase Neoplásica , Cirurgia Geral/métodos
Lung Cancer ; 77(2): 469-72, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22534670


The use of erlotinib throughout pregnancy has not been previously reported. We present the case of a 40 year-old female patient with stage IV lung adenocarcinoma, mediastinal, bone and cerebral metastasis, a EGFR mutation and no smoking history, who had begun first line treatment with erlotinib 150 mg once daily. After two and a half months of treatment a fourteen-week pregnancy was documented, and after informing on fetal risks secondary to erlotinib use and maternal risks secondary to treatment withholding, she decided to continue with treatment under clinical surveillance by both the oncology and obstetrics clinics. At thirty-three weeks gestation a live born 1600 g female was born by caesarean section without evidence of congenital malformations. Imaging assessment after eight months of treatment showed complete bone and central nervous system response and partial lung and mediastinal response. The patient is currently undergoing the 11th month of treatment and is asymptomatic, the baby is 4 months old and is in good health.

Adenocarcinoma/tratamento farmacológico , Antineoplásicos/uso terapêutico , Neoplasias Pulmonares/tratamento farmacológico , Complicações Neoplásicas na Gravidez/tratamento farmacológico , Inibidores de Proteínas Quinases/uso terapêutico , Quinazolinas/uso terapêutico , Adenocarcinoma/diagnóstico , Adenocarcinoma/genética , Adulto , Sequência de Bases , Receptores ErbB/antagonistas & inibidores , Receptores ErbB/genética , Cloridrato de Erlotinib , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/genética , Mutação , Metástase Neoplásica , Gravidez , Complicações Neoplásicas na Gravidez/diagnóstico , Resultado da Gravidez , Resultado do Tratamento
Rev. colomb. cancerol ; 16(1): 49-58, mar. 2012. graf
Artigo em Espanhol | LILACS | ID: lil-662982


El hemangiosarcoma cutáneo es una enfermedad maligna rara de origen vascular, y corresponde a menos del 1% de todas las malignidades y al 2% de todos los sarcomas de tejidos blandos. Su presentación usual es en el rostro y en la región del cuero cabelludo; al momento de diagnosticarse ya es una enfermedad avanzada. Afecta a menudo al anciano del género masculino y de raza blanca. El tratamiento oncológico se basa en la resección quirúrgica, la radioterapia y la quimioterapia, dado el alto riesgo tanto de recaída local como de diseminación hematológica con intención paliativa. Las tasas de control locorregional a 5 años son, aproximadamente, del 40% al 50%, las tasas de supervivencia libre de metástasis a distancia a 5 años están en el rango del 20% al 40%, y las tasas de supervivencia a 5 años se encuentran entre el 10% y el 30%.

Cutaneous hemangiosarcoma is a rare malignant disease of vascular origin which accounts for less than 1% of all malignancies and 2% of all soft tissue sarcomas. It most frequently affects elderly white males, and is usually found on the face and scalp; at diagnosis it tends to be advanced. Oncologic treatment is based upon surgical resection, radiotherapy and chemotherapy due to the high risk of local relapse as well as to hematologic dissemination with palliative intention. Loco-regional control rates at 5 years range from 40% to 50%, metastasis-free survival rates at 5 years are from 20% to 40%, and survival rates at 5 years from 10% to 30%.

Humanos , Masculino , Feminino , Idoso , Biologia Molecular/classificação , Biologia Molecular/métodos , Hemangiossarcoma , Neoplasias Cutâneas , Tratamento Farmacológico/métodos , Radioterapia/métodos
Med. UIS ; 23(2): 103-127, mayo-ago. 2010. tab, ilus
Artigo em Espanhol | LILACS | ID: lil-604102


Los avances recientes en el tratamiento de las enfermedades neoplásicas han mejorado las tasas de supervivencia. Las intervenciones médicas generan diversos efectos adversos agudos que comprometen el tracto gastrointestinal y la medula ósea, mientras la neurotoxicidad tiende a ser tardía y evoluciona en el tiempo. En el sistema nervioso periférico es frecuente documentar la neuropatía inducida por el tratamiento médico del cáncer, hallazgo relacionado con la administración de agentes quimioterapéuticos utilizados para controlar los tumores hematológicos y sólidos. El tratamiento oncológico genera una gran variedad de cambios estructurales y funcionales en los nervios periféricos, incluyendo la afectación de los cuerpos neuronales del sistema de transporte axonal, del recubrimiento mielínico y de las estructuras de soporte glial. Cada agente presenta un espectro de toxicidad único que se relaciona con su mecanismo de acción, eventos que pueden mitigarse gracias a los resultados de múltiples estudios. Gracias al reconocimiento de los efectos devastadores de la neuropatía inducida por el tratamiento médico del cáncer en la calidad de vida, la investigación básica y clínica ha empezado a evaluar el papel de múltiples terapias para prevenir y tratar el daño neurológico. Esta revisión integra información seleccionada a partir de búsquedas estructuras realizadas en las bases de datos biomédicas más relevantes, haciendo énfasis en el diagnóstico y en las intervenciones farmacológicas y no farmacológicas descritas como parte del manejo de la neuropatía inducida por el tratamiento médico del cáncer, que con frecuencia es subvalorada. En conclusión, la información disponible hasta el momento permite establecer los mecanismos de la enfermedad y sugiere el desarrollo de un número mayor de estudios que permitan validar las estrategias descritas hasta el momento.

Recent advances in the development and administration of therapy for malignant diseases have been rewarded with prolonged survival rates. Unlike more immediate toxicities that affect the gastrointestinal tract and bone marrow, chemotherapy-induced neurotoxicity is frequently delayed in onset and may progress over time. In the peripheral nervous system, the major brunt of the toxicity is directed against the peripheral nerve, resulting in cancer therapy-induced peripheral neuropathy. Chemotherapeutic agents used to treat hematologic and solid tumors target a variety of structures and functions in the peripheral nervous system, including the neuronal cell body, the axonal transport system, the myelin sheath, and glial support structures. Each agent exhibits a spectrum of effects unique to its mechanism of action, and recent studies in this fi eld have yielded clearer ideas on how to mitigate injury. Combined with the call for a greater recognition of the devastating effects of cancer therapy-induced peripheral neuropathy on quality of life, basic and clinical researchers have begun to investigate therapy to prevent and treat neurologic damage. This review was made based on relevant information avaliable on international databases concerning cancer therapyinduced peripheral neuropathy and summarizes the evidence for diagnosis, pharmacologic and nonpharmacologic approaches to the management of this commonly unrecognized condition. In conclusion, the information avaliable in this moment establish the mechanisms of the disease and exposes the importance of the development of statistically stronger clinical trials that complement current data available in this moment.

Antineoplásicos , Tratamento Farmacológico , Doenças do Sistema Nervoso Periférico , Tratamento Farmacológico/efeitos adversos , Cisplatino , Vincristina